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A systematic review of observational studies on oxidative/nitrosative stress involvement in dengue pathogenesis. 氧化/亚硝化应激参与登革热发病机制的观察性研究的系统综述。
IF 0.7 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2015-09-30
Raimundo Castro, Hernando Samuel Pinzón, Nelson Alvis-Guzman

Objective: Our objective was to systematically review the published observational research related to the role of oxidative-nitrosative stress in pathogenesis of dengue.

Methods: We searched electronic databases (PubMed, EMBASE, The COCHRANE library, ScienceDirect, Scopus, SciELO, LILACS via Virtual Health Library, Google Scholar) using the term: dengue, dengue virus, severe dengue, oxidative stress, nitrosative stress, antioxidants, oxidants, free radicals, oxidized lipid products, lipid peroxides, nitric oxide, and nitric oxide synthase. Articles were selected for review by title and abstract excluding letter, review, in vivo and in vitro studies, and duplicates studies. Selected articles were reviewed for study design, original purposes, sample size, main outcomes, methods, and oxidative-nitrosative stress markers values.

Results: In total, 4,331 non-duplicates articles were identified from electronic databases searches, of which 16 were eligible for full text searching. Data from the observational studies originate from Asian countries (50%; 8/16), South American countries (31.2%; 5/16), and Central America and the Caribbean countries (18.8%; 3/16). Case-control study was the type of design most common in researches reviewed. The 1997 World Health Organization (WHO) dengue case classification criteria were used in all studies included in this review.

Conclusions: Based on published data found in peer-reviewed literature, oxidative and nitrosative stress are demonstrated by changes in plasma levels of nitric oxide, antioxidants, lipid peroxidation and protein oxidation markers in patients with dengue infection. Additionally, elevated serum protein carbonyls and malondialdehyde levels appear to be associated with dengue disease severity.

目的:我们的目的是系统地回顾已发表的关于氧化-亚硝化应激在登革热发病机制中的作用的观察性研究。方法:检索电子数据库(PubMed、EMBASE、COCHRANE图书馆、ScienceDirect、Scopus、SciELO、LILACS via Virtual Health library、谷歌Scholar),检索词为:登革热、登革热病毒、重症登革热、氧化应激、亚氧化应激、抗氧化剂、氧化剂、自由基、氧化脂质产物、脂质过氧化物、一氧化氮和一氧化氮合酶。文章按标题和摘要进行筛选,不包括信件、综述、体内和体外研究以及重复研究。对选定的文章进行研究设计、原始目的、样本量、主要结果、方法和氧化-亚硝化应激标志物值的回顾。结果:电子数据库共检索到非重复文献4,331篇,其中16篇符合全文检索条件。观察性研究的数据来自亚洲国家(50%;8/16),南美国家(31.2%;5/16),中美洲和加勒比国家(18.8%;3/16)。病例对照研究是研究中最常见的设计类型。本综述纳入的所有研究均采用1997年世界卫生组织(WHO)登革热病例分类标准。结论:根据同行评议文献中已发表的数据,登革热感染患者血浆中一氧化氮、抗氧化剂、脂质过氧化和蛋白质氧化标志物水平的变化证明了氧化应激和亚硝化应激。此外,血清蛋白羰基和丙二醛水平升高似乎与登革热的严重程度有关。
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引用次数: 0
Atención primaria: una inversión necesaria, vigente y rentable 初级保健:一项必要的、当前的和有利可图的投资
IF 1.1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2015-09-30 DOI: 10.25100/CM.V46I3.2135
Sandra Lorena Girón
Por tradicion la atencion primaria en salud se ha enfocado en educacion y en campanas de salud, como una parte de la estrategia para abordar las enfermedades de interes en salud publica1.  Como muchos de estos problemas aun permanecen en la agenda de salud publica, es apremiante revisar el concepto de la atencion primaria en salud. En el pasado el control de las enfermedades inmunoprevenibles fue su mayor exito2, 3. Para el futuro es necesario considerar la atencion primaria en salud como una estrategia de alto impacto y dejarla de ver como una serie de actividades de bajo costo, circunscrita a los servicios brindados por promotores y voluntarios, con tecnologias de baja complejidad para atender a la poblacion pobre.  El Sistema de Salud requiere una atencion primaria en salud lider, digna de verse como una inversion con rentabilidad social, entendida como la superacion de los beneficios en relacion con los costos generados4-6. De esta manera, la atencion primaria en salud podria ser la estrategia que logre integrar los intereses privados y sociales, al lograr que  las ganancias de la prevencion contribuyan a la sostenibilidad economica y al mejoramiento de las condiciones de salud de la poblacion en general. Estos deben ser intereses comunes a las instituciones prestadoras de servicios y al sistema de salud.
在过去的几十年里,卫生保健的重点一直是教育和保健运动,作为解决公共卫生问题战略的一部分1。由于这些问题中的许多仍在公共卫生议程上,迫切需要审查初级卫生保健的概念。在过去,控制免疫可预防疾病是他们最大的成就。在未来,有必要将初级卫生保健视为一项具有高影响的战略,而不再将其视为一系列低成本活动,仅限于推广人员和志愿者提供的服务,使用低复杂性的技术来帮助穷人。卫生系统需要初级卫生保健,这应该被视为一种具有社会回报的投资,被理解为超过了产生的成本所带来的利益4-6。因此,初级保健可以成为一项战略,将私人利益和社会利益结合起来,确保预防的收益有助于经济可持续性和改善一般人口的健康状况。这些应该是提供服务的机构和卫生系统的共同利益。
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引用次数: 0
The incorporation of system health care in the Western 西方医疗保健制度的整合
IF 1.1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2015-09-30 DOI: 10.25100/CM.V46I3.1769
F. Pineda
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引用次数: 2
Sodium bicarbonate versus isotonic saline solution to prevent contrast-induced nephropathy : a systematic review and meta-analysis. 碳酸氢钠与等渗盐水预防造影剂肾病:一项系统综述和荟萃分析。
IF 0.7 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2015-09-30
Carlos Andres Zapata-Chica, Diana Bello Marquez, Lina Maria Serna-Higuita, John Fredy Nieto-Ríos, Fabian David Casas-Arroyave, Jorge Hernando Donado-Gómez

Introduction: Contrast-induced nephropathy is one of the main causes of acute kidney injury and increased hospital-acquired morbidity and mortality. The use of sodium bicarbonate for nephroprotection has emerged as a preventative strategy; however, its efficacy is controversial compared to other strategies, such as hydration using 0.9% saline solution.

Objective: To compare the effectiveness of sodium bicarbonate vs. hydration using 0.9% saline solution to prevent contrast-induced acute kidney injury.

Methods: A systematic review of studies registered in the COCHRANE, PUBMED, MEDLINE, LILACS, SCIELO and EMBASE databases was conducted. Randomized controlled studies that evaluated the use of 0.9% saline solution vs. sodium bicarbonate to prevent contrast-induced nephropathy were included.

Results: A total of 22 studies (5,686 patients) were included. Sodium bicarbonate did not decrease the risk of contrast-induced nephropathy (RD= 0.00; 95% CI= -0.02 to 0.03; p= 0.83; I(2)= 0%). No significant differences were found in the demand for renal replacement therapy (RD= 0.00; 95% CI= -0.01 to 0-01; I(2)= 0%; p= 0.99) or in mortality (RD= -0.00; 95% CI= -0.001 to 0.001; I(2)= 0%; p= 0.51).

Conclusions: Sodium bicarbonate administration is not superior to the use of 0.9% saline solution for preventing contrast-induced nephropathy in patients with risk factors, nor is it better at reducing mortality or the need for renal replacement therapy.

造影剂肾病是急性肾损伤的主要原因之一,并增加了医院获得性发病率和死亡率。使用碳酸氢钠进行肾保护已成为一种预防策略;然而,与其他策略(如使用0.9%盐水溶液补水)相比,其疗效存在争议。目的:比较碳酸氢钠与0.9%生理盐水水化对造影剂所致急性肾损伤的预防效果。方法:系统回顾在COCHRANE、PUBMED、MEDLINE、LILACS、SCIELO和EMBASE数据库中注册的研究。纳入了评估使用0.9%生理盐水溶液与碳酸氢钠预防造影剂肾病的随机对照研究。结果:共纳入22项研究(5686例患者)。碳酸氢钠不能降低造影剂肾病的风险(RD= 0.00;95% CI= -0.02 ~ 0.03;p = 0.83;(2) = 0%)。两组患者对肾脏替代治疗的需求差异无统计学意义(RD= 0.00;95% CI= -0.01 ~ 0-01;(2) = 0%;p= 0.99)或死亡率(RD= -0.00;95% CI= -0.001 ~ 0.001;(2) = 0%;p = 0.51)。结论:在有危险因素的患者中,碳酸氢钠在预防造影剂肾病方面并不优于0.9%生理盐水,在降低死亡率或肾脏替代治疗方面也不优于0.9%生理盐水。
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引用次数: 0
Bicarbonato de sodio versus solución salina isotónica para la prevención de la nefropatía inducida por medio de contraste: Revisión sistemática y meta-análisis 碳酸氢钠与等渗生理盐水预防造影剂诱发肾病:系统综述和荟萃分析
IF 1.1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2015-09-30 DOI: 10.25100/CM.V46I3.1925
Carlos Andrés Zapata-Chica, L. Serna-Higuita, J. F. Nieto-Ríos, F. D. Casas-Arroyave, J. donado-góMez
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引用次数: 11
In vitro-in vivo Pharmacokinetic correlation model for quality assurance of antiretroviral drugs. 用于抗逆转录病毒药物质量保证的体外-体内药代动力学相关模型。
IF 1.1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2015-09-30
Ricardo Rojas Gómez, Piedad Restrepo Valencia

Introduction: The in vitro-in vivo pharmacokinetic correlation models (IVIVC) are a fundamental part of the drug discovery and development process. The ability to accurately predict the in vivo pharmacokinetic profile of a drug based on in vitro observations can have several applications during a successful development process.

Objective: To develop a comprehensive model to predict the in vivo absorption of antiretroviral drugs based on permeability studies, in vitro and in vivo solubility and demonstrate its correlation with the pharmacokinetic profile in humans.

Methods: Analytical tools to test the biopharmaceutical properties of stavudine, lamivudine y zidovudine were developed. The kinetics of dissolution, permeability in caco-2 cells and pharmacokinetics of absorption in rabbits and healthy volunteers were evaluated.

Results: The cumulative areas under the curve (AUC) obtained in the permeability study with Caco-2 cells, the dissolution study and the pharmacokinetics in rabbits correlated with the cumulative AUC values in humans. These results demonstrated a direct relation between in vitro data and absorption, both in humans and in the in vivo model.

Conclusions: The analytical methods and procedures applied to the development of an IVIVC model showed a strong correlation among themselves. These IVIVC models are proposed as alternative and cost/effective methods to evaluate the biopharmaceutical properties that determine the bioavailability of a drug and their application includes the development process, quality assurance, bioequivalence studies and pharmacosurveillance.

简介:体外-体内药代动力学相关模型(IVIVC体外-体内药代动力学相关模型(IVIVC)是药物发现和开发过程的基础部分。根据体外观察结果准确预测药物体内药代动力学特征的能力可在成功的研发过程中发挥多种作用:根据渗透性研究、体外和体内溶解度建立一个预测抗逆转录病毒药物体内吸收的综合模型,并证明其与人体药代动力学特征的相关性:方法:开发了测试司他夫定、拉米夫定和齐多夫定生物制药特性的分析工具。方法:开发了测试司他夫定、拉米夫定和齐多夫定生物药学特性的分析工具,评估了它们在兔子和健康志愿者体内的溶解动力学、在 caco-2 细胞中的渗透性和吸收药代动力学:结果:在 Caco-2 细胞渗透性研究、溶解研究和兔子药代动力学研究中获得的累积曲线下面积(AUC)与人体的累积 AUC 值相关。这些结果表明了体外数据与人体和体内模型吸收之间的直接关系:结论:用于开发 IVIVC 模型的分析方法和程序之间存在很强的相关性。建议将这些 IVIVC 模型作为评估决定药物生物利用度的生物制药特性的成本/效益型替代方法,其应用范围包括开发过程、质量保证、生物等效性研究和药物监测。
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引用次数: 0
Second toe-to-hand transfer. A surgical option for amputations in the hand 第二次手到脚的转移。手部截肢的手术选择
IF 1.1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2015-07-01 DOI: 10.25100/CM.V46I2.1551
E. Amador
Background: The toe to hand transplantation is a method of reconstruction on the unique or multiple amputations of the fingers. It can be used the whole toe or with certain modifications as a wrap-around flap from the big toe or fingertip. It is a widely accepted option for the thumb. Methods: It is  a series of patients with amputation of one or more fingers of the hand were operated with second toe to hand transplantation. The survival was evaluated and the sensory recovery by 2-point discrimination. Results: We practiced 12 transplants, 8 thumb, and 4 in other fingers. Ten were adults and 2 children. All transplants survived. Two patients required tenolysis flexor. The sensibility was recovered with good 2-point discrimination of 8 mm. Discussion: In the more proximal finger amputations, a second toe is the most appropriate, with lower morbidity of the donor site. The rates of success are  between 95 to 100%. We had a success rate of 100%. The resulting defect is in the foot is minimum when the second toe was used. The decision to use one of these techniques depends on the decision and transplant surgeon training. We always used the second toe for transfers to the hand, considering that it will be thinner than the original thumb; our patients had no complaint about the appearance. Conclusion: Toe-to-hand transplantation is a good technique, providing a very good aesthetic appearance and allowing the recovery of sensitivity. The defect that is created in the foot does not produce significant aesthetic and functional alterations
背景:趾手移植是手指单侧或多侧截肢的一种重建方法。它可以用于整个脚趾,也可以作为大脚趾或指尖的环绕皮瓣进行某些修改。这是拇指被广泛接受的选择。方法:对一系列手部单指或多指截肢患者行第二趾手移植。采用2点判别法评价患者的生存和感觉恢复情况。结果:12例移植,8例为拇指移植,4例为其他手指移植。其中10人是成年人,2人是儿童。所有移植都存活了下来。2例患者需要屈肌腱松解。灵敏度恢复良好,两点分辨力为8 mm。讨论:在更近端的手指截肢中,第二趾是最合适的,供体部位的发病率较低。成功率在95%到100%之间。我们的成功率是100%。当使用第二个脚趾时,所产生的缺陷在脚上是最小的。使用这些技术之一的决定取决于移植外科医生的决定和培训。我们总是用第二个脚趾来转移到手上,考虑到它会比原来的拇指薄;我们的病人对外观没有抱怨。结论:趾手移植是一种良好的技术,具有良好的美观性和恢复敏感性。在足部产生的缺陷不会产生显著的美学和功能改变
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引用次数: 2
Increasing collaboration between health professionals: Clues and challenges 加强卫生专业人员之间的合作:线索和挑战
IF 1.1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2015-04-01 DOI: 10.25100/CM.V46I2.1526
N. Aguirre-Duarte
Background:Scholars have recently started to pay more attention in the potential of the inter-professional relationship between general practitioners and specialists to improve outcomes, through consideration given to the effect on prescribing practices. However, more empirical research is needed.Objective:To explore inter-professional network factors that may explain effects on General Practitioners prescription behaviours.Methods:A qualitative study was conducted in an integrated diabetes care program. Data was collected through semi-structured interviews from 16 health practices and a hospital diabetes clinic, using a convenience sample of general practitioners, practices nurses, diabetes nurse specialists and endocrinologists. A conceptual mapping was performed to identify factors underlying networks and effects on patient outcomes.Results:Four themes with their concepts emerged from the conceptual map. These demonstrated the need for building effective channels of communication to share experience and knowledge timely in diabetes care. Communication, collaboration and coordination are critical factors to influence prescription behaviours within primary and secondary care.Conclusions:conceptual mapping allowed understanding factors that might explain how links between health professionals can improve patient outcomes at the primary and secondary care interface.
背景:学者们最近开始更多地关注全科医生和专科医生之间的跨专业关系的潜力,通过考虑对处方实践的影响来改善结果。然而,还需要更多的实证研究。目的:探讨跨专业网络因素对全科医生处方行为的影响。方法:对糖尿病综合护理项目进行定性研究。数据是通过半结构化访谈从16个医疗机构和一家医院糖尿病诊所收集的,使用了方便的全科医生、执业护士、糖尿病护士专家和内分泌学家的样本。进行概念映射以确定潜在网络的因素和对患者结果的影响。结果:从概念图中出现了四个主题及其概念。这表明需要建立有效的沟通渠道,以便及时分享糖尿病护理方面的经验和知识。沟通、协作和协调是影响初级和二级保健处方行为的关键因素。结论:概念映射允许理解可能解释卫生专业人员之间的联系如何在初级和二级保健界面上改善患者预后的因素。
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引用次数: 8
Diagnóstico temprano de retinopatía diabética en el primer nivel de atención 糖尿病视网膜病变的早期诊断在一级护理
IF 1.1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2015-03-30 DOI: 10.25100/CM.V46I1.1681
María Valeria Jiménez-Báez, H. Márquez-González, Rodolfo Bárcenas-Contreras, Carlos Morales-Montoya, Laura Fátima Espinosa-García
Objective: To evaluate the impact of a strategy for early detection of diabetic retinopathy in patients with type 2 diabetes mellitus (DMT2) in Quintana Roo, Mexico.
目的:评估墨西哥金塔纳罗奥州2型糖尿病(DMT2)患者糖尿病视网膜病变早期检测策略的影响。
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引用次数: 4
Práctica basada en la evidencia: creencias, actitudes, conocimientos y habilidades entre fisioterapeutas colombianos 循证实践:哥伦比亚物理治疗师的信念、态度、知识和技能
IF 1.1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2015-03-30 DOI: 10.25100/CM.V46I1.1654
R. Ramírez-Vélez, Jorge Enrique Correa-Bautista, Diana Isabel Muñoz-Rodríguez, Lorena Ramírez, Katherine González-Ruíz, Maria Andrea Dominguez-Sánchez, Diana Durán-Palomino, M. Girabent-Farrés, M. E. Flórez-López, M. C. Bagur-Calafat
Objective: The main purpose of this study was to describe a group of Colombian physical therapists’ beliefs and attitudes towards Evidence-Based Practice (EBP), their education, knowledge and skills for implementing EBP, the use of relevant literature in clinical practice, access to and availability of scientific information and perceived barriers to including EBP in practice. Methods: This was a cross-sectional study which involved 1,064 Colombian physical therapists. The study used a 50-item screening questionnaire EBP developed to estimate attitudes, beliefs, knowledge and skills regarding. This instrument has been adapted and was validated previously in Colombia by Florez-Lopez et al. Results: The population mostly consisted of young females (77.2%) aged 22 to 29 years old (79.4%). Most respondents had an undergraduate degree (87.7%). The physical therapists stated that they had positive attitudes and beliefs regarding EBP, most of them answering that they agreed or strongly agreed that EBP is necessary (71.6%), the relevant literature is useful for practice (61.3%), EBP improves the quality of patient care (64.1%) and evidence helps in decision-making (44.5%). Forty-one percent of the respondents indicated that a lack of research skills was the most important barrier to the use of evidence in practice. Conclusion: The physical therapists reported that they had a positive attitude to EBP and were interested in learning about or improving the skills necessary to adopt EBP in their clinical practice. Article history:
目的:本研究的主要目的是描述一组哥伦比亚物理治疗师对循证实践(EBP)的信念和态度,他们的教育程度,实施EBP的知识和技能,临床实践中相关文献的使用,科学信息的获取和可用性以及将EBP纳入实践的感知障碍。方法:这是一项横断面研究,涉及1,064名哥伦比亚物理治疗师。该研究使用了EBP开发的50项筛选问卷来评估态度、信念、知识和技能。该仪器先前在哥伦比亚由Florez-Lopez等人进行了改进和验证。结果:人群以年轻女性为主(77.2%),年龄在22 ~ 29岁(79.4%)。大多数受访者拥有本科学历(87.7%)。物理治疗师对EBP持积极的态度和信念,大多数回答同意或强烈同意EBP是必要的(71.6%),相关文献对实践有用(61.3%),EBP提高了患者护理质量(64.1%),证据有助于决策(44.5%)。41%的答复者表示,缺乏研究技能是在实践中使用证据的最重要障碍。结论:物理治疗师报告他们对EBP持积极态度,并有兴趣学习或提高在临床实践中采用EBP所需的技能。文章历史:
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引用次数: 17
期刊
Colombia Medica
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