Prevalencia de punto de úlceras por presión y nivel de riesgo en el Hospital Universitario Fundación Santa Fe de Bogotá

Las úlceras por presión causadas por una presión sostenida sobre la piel y sus tejidos adyacentes es una problemática considerada de salud pública, dada su alta prevalencia, se presentan mayormente en personas que tienen restricción en su movilidad, en el 3 a 10 % de los pacientes hospitalizados; con una tasa de incidencia que oscila entre 7,7 y 26,9 %, con consecuencias para la institución por altos costos, la comunidad, el paciente y su familia. En Colombia solo se cuenta con algunos estudios en instituciones en Bogotá, Cartagena, Bucaramanga y Medellín. Los estudios de prevalencia son importantes porque permiten visualizar la situación de la problemática, incentiva la implementación de medidas preventivas y la formulación de políticas institucionales que promuevan la seguridad del paciente y la calidad de la atención. En el Hospital Universitario Fundación Santa Fe de Bogotá no se conoce con exactitud la prevalencia pero se sabe que está presente por las complicaciones y consecuencias ya mencionadas, por ende el objetivo de este estudio fue determinar la prevalencia de punto de úlceras por presión en los pacientes hospitalizados, y al finalizar ser insumo para un estudio posterior que genere un Programa de Piel Sana institucional. El estudio se realizó mediante la medición en 1 día donde se valoró todos los pacientes hospitalizados, se realizó un análisis descriptivo de cada variable, y con un análisis bivariado se obtuvo medidas de asociación para identificar la relación entre los factores de riesgo y el desarrollo de ulceras por presión.

Caracterización sociodemográfica de las enfermedades huérfanas en Colombia

Las enfermedades huérfanas en Colombia, se definen como aquellas crónicamente debilitantes, que amenazan la vida, de baja prevalencia (menor 1/5000) y alta complejidad. Se estima que a nivel mundial existen entre 6000 a 8000 enfermedades raras diferentes(1). Varios países a nivel mundial individual o colectivamente, en los últimos años han creado políticas e incentivos para la investigación y protección de los pacientes con enfermedades raras. Sin embargo, a pesar del creciente número de publicaciones; la información sobre su etiología, fisiología, historia natural y datos epidemiológicos persiste escasa o ausente. Los registros de pacientes, son una valiosa herramienta para la caracterización de las enfermedades, su manejo y desenlaces con o sin tratamiento. Permiten mejorar políticas de salud pública y cuidado del paciente, contribuyendo a mejorar desenlaces sociales, económicos y de calidad de vida. En Colombia, bajo el decreto 1954 de 2012 y las resoluciones 3681 de 2013 y 0430 de 2013 se creó el fundamento legal para la creación de un registro nacional de enfermedades huérfanas. El presente estudio busca determinar la caracterización socio-demográfica y la prevalencia de las enfermedades huérfanas en Colombia en el periodo 2013. Métodos: Se realizó un estudio observacional de corte transversal de fuente secundaria sobre pacientes con enfermedades huérfanas en el territorio nacional; basándose en el registro nacional de enfermedades huérfanas obtenido por el Ministerio de Salud y Protección Social en el periodo 2013 bajo la normativa del decreto 1954 de 2012 y las resoluciones 3681 de 2013 y 0430 de 2013. Las bases de datos obtenidas fueron re-categorizadas en Excel versión 15.17 para la extracción de datos y su análisis estadístico posterior, fue realizado en el paquete estadístico para las ciencias sociales (SPSS v.20, Chicago, IL). Resultados: Se encontraron un total de 13173 pacientes con enfermedades huérfanas para el 2013. De estos, el 53.96% (7132) eran de género femenino y el 46.03% (6083) masculino; la mediana de la edad fue de 28 años con un rango inter-cuartil de 39 años, el 9% de los pacientes presentaron discapacidad. El registro contenía un total de 653 enfermedades huérfanas; el 34% del total de las enfermedades listadas en nuestro país (2). Las patologías más frecuentes fueron el Déficit Congénito del Factor VIII, Miastenia Grave, Enfermedad de Von Willebrand, Estatura Baja por Anomalía de Hormona de Crecimiento y Displasia Broncopulmonar. Discusión: Se estimó que aproximadamente 3.3 millones de colombianos debían tener una enfermedad huérfana para el 2013. El registro nacional logró recolectar datos de 13173 (0.4%). Este bajo número de pacientes, marca un importante sub-registro que se debe al uso de los códigos CIE-10, desconocimiento del personal de salud frente a las enfermedades huérfanas y clasificación errónea de los pacientes. Se encontraron un total de 653 enfermedades, un 34% de las enfermedades reportadas en el listado nacional de enfermedades huérfanas (2) y un 7% del total de enfermedades reportadas en ORPHANET para el periodo 2013 (3). Conclusiones: La recolección de datos y la sensibilización sobre las enfermedades huérfanas al personal de salud, es una estrategia de vital importancia para el diagnóstico temprano, medidas específicas de control e intervenciones de los pacientes. El identificar apropiadamente a los pacientes con este tipo de patologías, permite su ingreso en el registro y por ende mejora el sub-registro de datos. Sin embargo, cabe aclarar que el panorama ideal sería, el uso de un sistema de recolección diferente al CIE-10 y que abarque en mayor medida la totalidad de las enfermedades huérfanas.

Clearance of p-cresol sulfate and β-2-microglobulin from dialysate by commercially available sorbent technology

Dialysate regeneration by sorbents is an alternative to conventional single-pass dialysis. Little is known about the capacity of sorbents to clear dialysate of “middle molecules” and protein-bound uremic toxins. We studied p-cresol sulfate (PCS) and β-2-microglobulin (β2M) removal from dialysate by a sorbent: 1. PCS (40 mg PCS dissolved in 4 L of fresh dialysate) was recirculated through a sorbent cartridge (SORB Technology, Inc.) for analysis of PCS removal. 2. Spent peritoneal dialysate was recirculated on the “blood” side of a high-flux dialyzer. On the “dialysate” side of the membrane, bicarbonate dialysate was recirculated through a sorbent cartridge. β2M was measured in both streams. Two results are of particular importance for the use of regenerated fluid in chronic dialysis: 1. PCS was virtually completely removed from the dialysate. On average, PCS concentration was reduced to 1.4% of the starting concentration after 60 minutes. PCS extraction across the sorbent was nearly complete at any time. 2. β2M was on average reduced to 14.3% of the starting concentration after 60 minutes. Postsorbent concentrations were consistently below the validated range of the test method. We conclude that PCS and β2M are efficiently removed from the dialysate by commercially available sorbent technology. Spent peritoneal dialysis fluid can be cleared of β2M when circulated against sorbent-regenerated dialysate using a high-flux membrane.

Estudo das lesões agudas da ginastica artistica feminina na infancia, a partir da população em treinamento em Campinas, S.P

Universidade Estadual de Campinas. Faculdade de Educação Física

Mass loss of four commercially available heat-polymerized acrylic resins after toothbrushing with three different dentifrices

The association between a toothbrush and a dentifrice is the most used denture cleaning method. The purpose of this study was to evaluate the abrasiveness of specific and non-specific denture cleaning dentifrices on different heat-polymerized acrylic resins. Sixteen specimens (90x30x3mm) of each acrylic resin (QC-20, Lucitone 550, Clássico, Vipi-Cril) were prepared and randomly assigned to 4 groups: 1: control (distilled water), 2: Colgate, 3: Bonyplus and 4: Dentu-Creme. The specimens were subjected to simulated toothbrushing in an automatic brushing machine using 35,600 brush strokes for each specimen. Brushing abrasion run at a 200-g load with the specimens immersed in 2:1 dentifrice/water slurry. Specimens were reconditioned to constant mass and the mass loss (mg) was evaluated. Data were analyzed by 2-way ANOVA and Tukey's test (a=0.05). Analysis of dentifrices' abrasive particles was made by scanning electron microscopy. Colgate produced the greatest mass reduction (42.44 mg, p<0.05), followed by Dentu-Creme (33.60 mg). Bonyplus was the less abrasive (19.91 mg), similar to the control group (19.69 mg) (p>0.05). The mass loss values indicated that QC-20 (33.13 mg) and Lucitone 550 (33.05 mg) resins were less (p<0.05) resistant to abrasion than Clássico (26.04 mg) and Vipi-Cril (23.43 mg). In conclusion, Colgate produced the greatest abrasion. Specific dentifrices for dentures tend to cause less damage to acrylic resins.

The Effects of Commercially Available Preservative-Free FDA-Approved Triamcinolone (Triesence (R)) on Retinal Cells in Culture

Purpose: To evaluate the effects of Triesence (R) (TRI), a new preservative-free triamcinolone approved by the U. S. Food and Drug Administration (FDA) for intraocular use, on human retina pigment epithelial (ARPE-19) and rat neurosensory (R28) cells in culture. Methods: ARPE-19 and R28 cell cultures were treated 24 h with 1,000, 500, 200, or 100 mu g/mL of crystalline (cTRI) or 1,000, 500, or 200 mu g/mL of solubilized (sTRI). TRI was solubilized by centrifuging the drug, discarding the supernatant containing the vehicle and then resuspending the drug pellet in an equivalent amount of Dimethyl sulfoxide to achieve the same concentration as the commercial preparation. Percentage of cell viability (CV) was evaluated by a trypan blue dye-exclusion assay. The mitochondrial membrane potential (Delta Psi m) was analyzed with the JC-1 assay. The caspase-3/7 activity was measured by a fluorochrome assay. Results: In the ARPE-19 cultures, the cTRI caused a decrease in CV at 1,000 mg/mL (13.03 +/- 6.51; P < 0.001), 500 mu g/mL (28.87 +/- 9.3; P < 0.001), 200 mu g/mL (54.93 +/- 5.61; P < 0.001), and 100 mu g/mL (82.53 +/- 0.65; P < 0.005) compared with the untreated controls (96.98 +/- 0.16). In R28 cultures, the cTRI treatment also reduced CV values significantly (P < 0.001) for the 1,000 mu g/mL (22.73 +/- 2.44), 500 mu g/mL (34.63 +/- 1.91), 200 mu g/mL (58.70 +/- 1.39), and 100 mu g/m (75.33 +/- 2.47) compared with the untreated controls (86.08 +/- 3.54). Once the TRI was solubilized (sTRI), the CV and Delta Psi m remained similar to the untreated controls for both ARPE-19 and R28 cells. The sTRI treatment with 1,000, 500, and 200 mu g/mL increased in caspase-3/7 activity in ARPE-19 cells (P < 0.01) and in R28 cells (P < 0.05) compared with dimethyl sulfoxide equivalent controls. Conclusion: The crystalline form of TRI (cTRI) can cause a significant decrease in CV to cultured retinal cells. Once the TRI is solubilized (sTRI), at the same concentrations, the cells remain viable with no decrease in CV or Delta Psi m. The sTRI can, however, increase caspase-3/7 activity, thus suggesting some degree of apoptosis.

Spectra of identified high-p(T) pi(+/-) and p((p)over-bar ) in Cu + Cu collisions at root s(NN)=200 GeV

We report new results on identified (anti) proton and charged pion spectra at large transverse momenta (3 < p(T) < 10 GeV/c) from Cu + Cu collisions at root s(NN) = 200 GeV using the STAR detector at the Relativistic Heavy Ion Collider (RHIC). This study explores the system size dependence of two novel features observed at RHIC with heavy ions: the hadron suppression at high-p(T) and the anomalous baryon to meson enhancement at intermediate transverse momenta. Both phenomena could be attributed to the creation of a new form of QCD matter. The results presented here bridge the system size gap between the available pp and Au + Au data, and allow for a detailed exploration of the onset of the novel features. Comparative analysis of all available 200 GeV data indicates that the system size is a major factor determining both the magnitude of the hadron spectra suppression at large transverse momenta and the relative baryon to meson enhancement.

Available Phosphorus Evaluated by Three Soil Tests in a Brazilian Tropical Oxisol Treated With Gypsum

Mehlich-1, resin-HCO(3), and Pi tests were used to assess available P in an acid tropical Oxisol in Brazil treated with gypsum, which has been preferred over lime to ameliorate the Al toxicity in the subsoil. The soil was incubated in the laboratory at rates up to 75 g kg(-1) of phosphogypsum (PG) containing 0.3% total P, natural gypsum, or reagent-grade gypsum, and up to 100 mg P kg(-1) as triple superphosphate (TSP) or phosphate rock (PR). In the greenhouse, two consecutive maize crops were grown on the soil treated with 50 mg P kg(-1) of TSP and PG rates up to 75 g kg(-1). The results of the incubation study showed that Mehlich-P and Pi-P increased with increasing PG rate for the treatments of TSP, PR, and control. Resin-HCO(3) underestimated available P from TSP and PR because of the reaction between resin-HCO(3) and gypsum. Mehlich-1 overestimated available P from PR compared with TSP because of an excessive dissolution of PR by the strongly acidic Mehlich-1. Pi underestimated available P from PR in the treatments of natural and reagent-grade gypsum because of Ca common-ion effect from gypsum on depressing PR dissolution. The results in terms of the effect of PG on available P are similar in both incubation and greenhouse studies. Both Mehlich-P and Pi-P correlated well with P uptake by maize, whereas resin-P did not.

Comparative effects of pimecrolimus cream vehicle and three commercially available moisturizers on skin hydration and transepidermal water loss

Background: Hydration and integrity of the horny layer is essential to normal skin function. Objective: Comparison of the hydrating properties of three moisturizers with pimecrolimus cream vehicle. Methods: Four test preparations (high-quality skin cream, cold cream emulsion, emollient oil, pimecrolimus cream vehicle) were applied to four different regions of the forearms and legs. Transepidermal water loss (TEWL) was assessed by evaporimetry at baseline, and 3 and 6 hours after arm application, and electrical capacitance was assessed by corneometry at baseline, and 1, 2, 3 and 6 hours after leg application. Results: Corneometry assessment - in terms of efficacy in moisturizing the skin, test preparations were ranked (best to worst): high-quality skin cream (45.9 arbitrary units versus 75.3; p < 0.001) > pimecrolimus vehicle cream (46.6 versus 61.5; p < 0.001) > emollient oil (43.5 versus 54.8; p = 0.006) > cold cream emulsion (44.8 versus 49.9; p = 0.738). Untreated skin (control) had a mean capacitance of 44.8 units at baseline and 48.5 units at endpoint. Evaporimetry (assessment of TEWL) revealed no significant differences between control and any test preparation at any timepoint. Conclusions: Pimecrolimus cream vehicle has skin hydration properties comparable with highly effective commercially available products. No test preparation had a significant effect on TEWL.

Comparison of the efficacy of two commercially available media for culturing one-cell embryos in the in vitro fertilization mouse model

Objective: To examine the effects of two commercial media on the development of mouse ova fertilized in vitro to the blastocyst stage. Design: Animal model. Setting: Academic institution. Animal(s): Eight-week old, superovulated mice. Intervention(s): One-cell embryos cultured in vitro up to the blastocyst stage in potassium-enriched simplex optimized medium (KSOM) or G1/G2 medium. Main Outcome Measure(s): Blastocyst and hatching rates, total cell number count, and proportion of allocation of cells to the inner cell mass (ICM) and trophectoderm (TE). Result(s): The percentage of zygotes that developed to the blastocyst stage 96 and 120 hours after insemination was statistically significantly higher in the KSOM group. The percentage of blastocysts that partially or completely hatched by day 5 of culture was 84% and 71% for the KSOM and G1/G2 groups, respectively, showing a statistically significant difference between the groups. The mean number of ICM cells was 11.7 +/- 4.0 and 9.2 +/- 5.2 for the zygotes cultured in KSOM and G1/G2 media, respectively, revealing a statistically significantly higher cell number in the ICM of blastocysts derived from culture in KSOM medium. The ICM/TE ratio in the blastocysts cultured in KSOM or G1/G2 media was similar in both groups. Conclusion(s): Commercially available KSOM medium is superior to sequential G1/G2 media for culturing one-cell embryos up to the blastocyst stage in the mouse IVF model.

Evas??o em cursos de educa????o continuada a dist??ncia: um estudo na Escola Nacional de Administra????o P??blica

A an??lise da literatura brasileira sobre educa????o a dist??ncia ?? ainda limitada no que diz respeito a estudos que investiguem o fen??meno da evas??o, em especial, em contextos de escolas de governo. Este artigo procura identificar e analisar os fatores que contribuem para a evas??o de participantes nos cursos de educa????o continuada a dist??ncia em uma organiza????o governamental respons??vel pela capacita????o dos servidores da administra????o p??blica federal. A ??nfase das investiga????es encontra-se nas vari??veis referentes ??s dificuldades pessoais, profissionais e tecnol??gicas, ??s peculiaridades do curso e caracter??sticas da clientela, contrastadas com as vari??veis demogr??ficas referentes ?? evas??o em cursos a dist??ncia mediados por tecnologias da informa????o e da comunica????o. O trabalho ?? embasado em metodologia quantitativa, por meio de pesquisa descritiva de campo junto aos participantes, valendo-se do uso de question??rio eletr??nico. Procura contribuir para investiga????es sobre o tema, em especial no que se refere aos servidores p??blicos.

Intraempreendedorismo e a inova????o na gest??o p??blica federal

O objetivo deste artigo ?? apresentar tr??s a????es empreendedoras em organiza????es p??blicas premiadas pela ENAP no concurso Inova????o na Gest??o P??blica Federal. A partir da revis??o de literatura e estudo de caso, ser??o confrontados os diversos tipos e modelos de processos de inova????o, para identificar as dificuldades apontadas e as solu????es adotadas nas a????es premiadas. Foram selecionados tr??s casos de iniciativas inovadoras no INSS, apontando a origem, caracter??sticas, amplitude e o modelo do processo. Nosso quadro te??rico de refer??ncia est?? estruturado no sentido de aprofundar a percep????o, bem como nos dar condi????es de comparar alguns estudos e apontar lacunas, se existentes. A pesquisa foi realizada por meio de metodologia qualitativa, explorat??ria e adotando a estrat??gia de investiga????o do estudo de caso. A revis??o de literatura teve como objetivo identificar o que se encontra dispon??vel em livros, artigos, teses e, inclusive, experi??ncias. A conclus??o alcan??ada no artigo ?? a de que, apesar dos alegados entraves e limita????es, o intraempreendedorismo se faz presente nas organiza????es p??blicas e vem crescentemente sendo adotado pelas chefias ou mesmo por funcion??rios sem nenhum tipo de fun????o comissionada, como relatado em um dos casos. A inova????o nas organiza????es p??blicas, representada pelo intraempreendedorismo das experi??ncias premiadas pelo concurso, confirma nosso quadro te??rico na medida em que a????es empreendedoras geradoras de inova????o se fazem presentes nas organiza????es p??blicas, em todos os seus processos e meios.

Mapeamento da oferta de capacita????o nas escolas de governo no Brasil: gest??o da informa????o para fortalecimento da gest??o p??blica

Esse texto tem por objetivo apresentar os resultados parciais do projeto ???Mapeamento da Oferta de Capacita????o nas Escolas de Governo??? e debater as possibilidades que se abrem para a gest??o do conhecimento e para o gerenciamento das informa????es estrat??gicas visando ?? tomada de decis??es e a otimiza????o dos recursos dispon??veis para a capacita????o. O projeto mapeamento tem por objetivo coletar dados da oferta existente de capacita????o em escolas de governo brasileiras, em n??vel municipal, estadual e federal. Foi concebido em tr??s fases: coleta das informa????es cadastrais e sobre a disponibilidade de cursos; constru????o do vocabul??rio controlado e classifica????o dos cursos; e transposi????o dessas informa????es para um sistema de informa????es com interface web: o Sistema Mapa. O Sistema Mapa, se efetivamente incorporado e utilizado, poder?? constituir um sistema de informa????o que auxilie os gestores e dirigentes a planejar e realizar planos de capacita????o, utilizando de forma eficiente a oferta existente nas escolas de governo. Al??m disso, poder?? contribuir para melhor coordena????o das atividades de capacita????o, incentivo ?? complementaridade, redu????o de duplicidades e incentivo ?? amplia????o da comunica????o entre as institui????es da Rede.