Artículos FCS INSIS
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- ItemValoración de la escala News (National Early Warning Score) como predictor de sepsis en pacientes con síndrome febril. Servicio medicina interna, Hospital Salvador Bienvenido Gautier. Agosto – diciembre 2019(2022-02-27)Introducción: la utilización de la escala NEWS podría construir una herramienta en el diagnóstico, pronóstico y estratificación precoz ante la sospecha de sepsis. El propósito de esta investigación fue determinar la eficacia de la escala NEWS como predictor de sepsis en pacientes ingresados por síndrome febril en el Hospital Salvador Bienvenido Gautier, en el período de octubre-diciembre 2019. Material y método: se realizó un estudio descriptivo, prospectivo y de corte transversal donde la técnica utilizada para la recolección de la información fue la evaluación directa de los 43 pacientes admitidos aplicando la escala NEWS y revisión de expedientes clínicos. Resultados: se determinó que el punto de corte ≥6 en la escala NEWS obtuvo valores de sensibilidad (91 %), especificidad (70 %), índice de Youden de 0.61, valor predictivo positivo de 78 %, valor predictivo negativo de 88 %, razón de verosimilitud positiva de 3 y negativa de 0.1. La aplicación de la escala NEWS en el sexo masculino presentó una sensibilidad de 92.9 % y especificidad de 87.5 %. En los grupos de 18-30 y 71-80 años, esta escala presentó una sensibilidad y especificidad de 100 %. Los pacientes clasificados como riesgo bajo, moderado y alto fueron diagnosticados con sepsis el 16.67 %, 63.64 % y un 70 %, respectivamente. Conclusiones: una puntuación mayor o igual a 6 en la escala NEWS se presenta como un predictor estadísticamente significativo que ayudaría en el diagnóstico temprano de sepsis, siendo más sensible que especifica. Fue mejor predictor en el sexo masculino y en los grupos etarios de 18-30 y 71-80 años.
- ItemValidation of a new method for dose determination in radiosurgery: “The Sosa Model”(2024-04-04)Goals: to demonstrate the validity of the XYZ Geo Method of rapid indirect volumetry 37, 38, 39 using the simplified geometric formula of the XYZ/1910 ellipsoid, to obtain a volume of the anterior part of the hippocampus (Ammon’s Horn + Body = AA) or the complete Hippocampus, including the tail (AA + Tail = Complete Hippocampus = HarP = Harmonized Protocol 24), very close to the real volume determined by the voxel method (planimetry). Material and Method: prospective study, which took place between January 2020 and July 2022, of 100 Dominican adults, divided into a control group of 60 patients with normal cognition divided into 3 age groups (20-40, 41 to 60 and 61 to 80 years). and a case group of 40 patients complaining of cognitive problems (aged 41 to 60 and 61 to 80). The Folstein Mini Mental State Examination (MMSE) adapted to Latino patients was administered.15. All benefited from a 1.5 Tesla MRI with 1-1.5 mm slices for three- dimensional reconstruction including non-contrast T1, FLAIR, T2 and TOF sequences. The Principal Investigator (PI) performs real volumetry of the Anterior and Complete Hippocampus using voxels (planimetry), processing these Magnetic Resonance images on the Elekta Workstation Gamma Plan 10 platform of the Dominican Gamma Knife Center of CEDIMAT in the Plaza de la Salud de Santo Sunday, Dominican Republic. Next, the PI performs the indirect volumetry of these structures by applying the simplified formula of the Ellipsoid, following the guidelines of the XYZ Geo Method for rapid indirect volumetry of intracranial structures39, determining their largest diameters Axial (X), Sagittal (Y) and Vertical (Z) on the aforementioned Platform. For each of these patients, blindly with respect to the PI results, the Research Assistants (RA), using the Magnetic Resonance CD in which the RadiAnt DICOM Viewer software with capacity for millimeter measurement is encrypted, determine rapid indirect volumetry of the Anterior Hippocampus (AA) and complete Hippocampus (HarP) applying the aforementioned methodology. The data collected was processed using measures of central tendency and dispersion in the Microsoft Excel 2016 platform. Results: The indirect volumetry of the hippocampi studied carried out by the PI using the simplified geometric formula of the ellipsoid had an average approximation of 101.7% with respect to the real volume determined by voxels. The measurement carried out by the RAs approached 99.6% of the real volume of the hippocampi studied. The average time to perform the actual volumetry of the Anterior Hippocampus (AA) by the PI was more than 11 minutes, while using the formula for rapid indirect volumetry the hippocampal volume could be calculated in less than a minute. Conclusion: indirect volumetry of the hippocampus applying the guidelines of the XYZ Geo Method 39 and using the simplified geometric formula of the ellipsoid, it is a reliable and rapid alternative to determine the health and integrity of this important anatomical marker of cognitive and seizure health, even if it is used by non-neurospecialist doctors.
- ItemThe co-management of HIV and chronic non-communicable diseases in the Dominican Republic: A qualitative study.(2023-07-13)HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men’s experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women’s experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to “move on” and “look ahead.” Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.
- ItemThe ability of the yeast Wickerhamomyces anomalus to hydrolyze immunogenic wheat gliadin proteins(2022-12-19)Gliadins proteins make up around 30% of total wheat flour proteins. They are involved in many immune disorders affecting an increasing number of people who eat foods made with wheat flour. The triggering factor is the accumulation in the gut of immunogenic peptides derived from incomplete degradation of gliadins by gastric proteases. Previous research has revealed the effectiveness of sourdough-fermentation technology or related lactic acid bacteria in reducing wheat flour allergenic proteins. However, there are no single yeast cultures for producing reduced allergenicity wheat products. This study evaluated sourdough-related yeast Wickerhamomycesanomalus strains for their ability to hydrolyze gliadin proteins. All yeast strains were able to degrade gliadins and use them as carbon and nitrogen sources. The proliferation of the yeast strains depended on the gliadin addition; complete hydrolysis was observed after 24 h. The strain showing higher proteolytic activity fermented, acceptably wheat flour dough. The gliadin content of the leavened dough was reduced by 50%. Bread made from the W. anomalus-fermented dough showed a 78% reduction in immunogenic α-gliadins. 50% of the decrease was attributed to the proteolytic activity of the yeast cells, and the other 35% to the baking process. These results show the potential of the yeast W. anomalus as a starter for reducing immunogenicity wheat products.
- ItemReal World KINDLE-Latin America Subset data on treatment patterns and clinical outcomes in patients with stage III Non-Small-Cell Lung Cancer(2022-07-04)Introduction: Stage III non- small- cell lung cancer (NSCLC) management is challenging given the heterogeneous nature of the disease. The LATAM subset of the real- world, global KINDLE study reported the treatment patterns and clinical outcomes for LATAM from the pre- immuno- oncology era.Methods: The study was conducted in seven countries (Argentina, Chile, Colombia, Dominican Republic, Mexico, Peru and Uruguay) in stage III NSCLC (American Joint Committee on Cancer, 7th edition) diagnosed between January 2013 and December 2017. Retrospective data from patients’ medical records (index date to the end of follow- up) were collected. Summary statistics, Kaplan– Meier sur-vival estimates and a two- sided 95% confidence interval (CI) were provided. Cox proportional hazard model was used for univariate and multi- variateanalyses.Results: A total of 231 patients was enrolled, the median age was 65.0 years (range 21.0– 89.0), 60.6% were males, 76.6% had smoking history, 64.0% had ad-enocarcinoma and 28.7% underwent curative resection. Multiple treatment regi-mens (>25) were used; chemotherapy alone was the most common (24.8%). The overall median progression- free survival (mPFS) and median overall survival (mOS) were 14.8 months (95% CI, 12.1– 18.6) and 48.6 months (95% CI, 34.7 to not calculable). Significantly better mPFS and mOS were observed for stage IIIA with curative surgery and resectabletumours and stage IIIB with an Eastern Cooperative Oncology Group score of 0/1, female gender, resectabletumours, ad-enocarcinoma and curative surgery (p < 0.05).Conclusion: Results show diversity in treatment practices and the correspond-ing clinical outcomes in stage III NSCLC. There is a need to streamline treatment selection and sequencing to decrease relapse rates after initial therapy.