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Prevalence and Factors Associated with Vitamin D Deficiency and Hyperparathyroidism in HIV-Infected Patients Treated in Barcelona
Elisabet Lerma,M. Ema Molas,M. Milagro Montero,Ana Guelar
ISRN AIDS , 2012, DOI: 10.5402/2012/485307
Prevalence and Factors Associated with Vitamin D Deficiency and Hyperparathyroidism in HIV-Infected Patients Treated in Barcelona
Elisabet Lerma,M. Ema Molas,M. Milagro Montero,Ana Guelar,Alicia González,Judith Villar,Adolf Diez,Hernando Knobel
ISRN AIDS , 2012, DOI: 10.5402/2012/485307
Abstract: Vitamin D deficiency is an important problem in patients with chronic conditions including those with human immunodeficiency virus (HIV) infection. The aim of this cross-sectional study was to identify the prevalence and factors associated with vitamin D deficiency and hyperparathyroidism in HIV patients attended in Barcelona. Cholecalciferol (25OH vitamin D3) and PTH levels were measured. Vitamin D insufficiency was defined as 25(OH) D < 20?ng/mL and deficiency as <12?ng/mL. Hyperparathyroidism was defined as PTH levels >65?pg/mL. Cases with chronic kidney failure, liver disease, treatments or conditions potentially affecting bone metabolism were excluded. Among the 566 patients included, 56.4% were exposed to tenofovir. Vitamin D insufficiency was found in 71.2% and 39.6% of those had deficiency. PTH was measured in 228 subjects, and 86 of them (37.7%) showed high levels. Adjusted predictors of vitamin D deficiency were nonwhite race and psychiatric comorbidity, while lipoatrophy was a protective factor. Independent risk factors of hyperparathyroidism were vitamin D < 12?ng/mL (OR: 2.14, CI 95%: 1.19–3.82, P: 0.01) and tenofovir exposure (OR: 3.55, CI 95%: 1.62–7.7, P: 0.002). High prevalence of vitamin deficiency and hyperparathyroidism was found in an area with high annual solar exposure. 1. Introduction Vitamin D is a steroid liposoluble hormone and can be made available to the individuals in two forms. First, vitamin D3 or cholecalciferol is synthesized in the skin in response to ultraviolet B radiation and is present in oil-rich fish (salmon, mackerel, and herring), egg yolks, and liver [1]. Second, vitamin D2 or ergocalciferol is obtained from the UV irradiation of the yeast sterol ergosterol and is found in sun-exposed mushrooms [2]. Both vitamins undergo identical metabolism, and as they are biologically inert, they require two hydroxylations, in the liver and in the kidney, to become 1,25dihydroxyvitamin D [1,25(OH)2D] which is the biologically active form of the hormone [3, 4]. In the intestine this stimulates the absorption of calcium and phosphorus, and it helps to regulate the metabolism of both minerals within bone and kidney interaction [5]. Assessment of vitamin D is based on measurement of serum 25(OH)D [6, 7] that is the most stable and plentiful metabolite of vitamin D in serum and has a half-life about 21 days [8]. The main source of vitamin D is exposure to sunlight [9, 10]. Therefore, an insufficient exposure to sunlight is a major cause of vitamin D deficiency. Other causes of vitamin deficiency are sunscreen sun protection [2],
Empiric broad-spectrum antibiotic therapy of nosocomial pneumonia in the intensive care unit: a prospective observational study
Francisco álvarez-Lerma, Bernabe Alvarez, Pilar Luque, Francisco Ruiz, Jose-Maria Dominguez-Roldan, Elisabet Quintana, Cesar Sanz-Rodriguez, the ADANN Study Group
Critical Care , 2006, DOI: 10.1186/cc4919
Abstract: To assess a carbapenem-based de-escalating strategy in nosocomial pneumonia (NP), a prospective observational study was conducted in critically ill patients with NP treated empirically with imipenem ± aminoglycoside/glycopeptide in 24 intensive care units of Spanish general hospitals. Overall, 244 patients were assessable (91% with late-onset NP). The primary outcome was therapeutic success 7–9 days post therapy.Microbial identification – based on cultures of tracheal aspirates in 82% of patients, cultures of protected specimen brush in 33%, and cultures of bronchoalveolar lavage in 4% – was only available for 131 (54%) patients. Initial antibiotics were inadequate for 23 (9%) patients. Of the remaining patients, antibiotics were streamlined in 56 (23%) patients and remained unchanged in 14 (6%) patients based on microbiology data, in 38 (16%) patients despite microbiology data favouring de-escalation, and in 113 (46%) patients due to unknown aetiology. Overall, de-escalation was implemented in only 23% of patients with potentially multiresistant pathogens, compared with 68% of patients with the remaining pathogens (P < 0.001). Response rates were 53% for patients continuously treated with imipenem-based regimens and 50% for the de-escalated patients. Higher Acute Physiology, Age, and Chronic Health Evaluation II scores were associated with greater mortality, whereas adequate empiric antibiotic therapy protected against fatal outcomes. No increase of superinfection rates caused by emerging pathogens was observed. The costs associated with de-escalation were mainly dependent on the duration of hospitalization.This study mainly highlights the current practice of a specific algorithm of de-escalation solely based on the available microbiological data, and highlights the barriers to using it more widely. In this setting, de-escalation was less likely to occur in the presence of potentially multiresistant pathogens. Prior antibiotic administration and the low use of bron
Internet-Based Support and Coaching for Adolescents and Young Adults with Neuropsychiatric Disorders—The Implementation of an Intervention from an Organizational Perspective  [PDF]
Nanna Gillberg, Elisabet Wentz
Health (Health) , 2017, DOI: 10.4236/health.2017.91006
Abstract: There is a documented and often unmet need for interventions aimed at supporting young people with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) in their transition between adolescence and adulthood. Difficulties with social interaction, initiation difficulties, and impairments in executive function can complicate visits at a clinic, i.e. traditional treatment, for individuals with neuropsychiatric disorders (NPD). A model for internet-based support and coaching aimed at young people with ASD and/or ADHD was developed and tested at three treatment sites in western Sweden. The implementation was analyzed against an inventory according to which implementations are more likely to be successful if an intervention: 1) has advantages compared to other existing methods, 2) matches the individual and organizational values, norms and work practices of its recipients, 3) is perceived as easy to use, and 4) is adaptable to local conditions and the recipients’ needs. Data were collected through group interviews with professionals involved in the implementation of the intervention. The implementation of the intervention showed promising results on measures such as access, delivery/quality of healthcare services, and equality of distribution of healthcare services. The identified impediments to successful implementation related to a wide range of factors and levels, including the design of the intervention, technical issues, attitudes of staff, organizational culture, and organizational structure at the implementation sites in terms of patient stock, work division, and resource allocation. The results are consistent with previous studies that stress the need for multi-component implementation strategies.
Aspectos quirúrgicos del síndrome de inmunodeficiencia adquirida: revisión del tema y presentación de 5 casos Surgical aspects of AIDS: review of the subjetc and presentation of 5 cases
Carlos Lerma
Iatreia , 1989,
Abstract: Se presenta una revisión de la literatura sobre los aspectos quirúrgicos del síndrome de inmunodeficiencia adquirida (SIDA), con base en los artículos publicados en los a os 1980-1988, haciendo especial énfasis en las características clínicas de la entidad que la hacen susceptible de tratamiento quirúrgico. Como la incidencia del SIDA continúa en aumento la evaluación y la intervención quirúrgica oportunas se requerirán con mayor frecuencia. Se llama especialmente la atención sobre la etiología del abdomen agudo bien sea por Infecciones oportunistas o por neoplasias. Se Insiste en el diagnóstico diferencial y se analizan las pautas para el manejo adecuado. Finalmente, se presenta la estadística de los 5 casos de SIDA que requirieron intervención quirúrgica, entre los 34 de este síndrome diagnosticados en el Hospital Universitario San Vicente de Paúl, de Medellín, Colombia, desde el a o 1.984. A review of the literature on surgical complications of AIDS Is presented. It is based on articles published between 1980 and 1988, with special emphasis on the clinical characteristics that make these complications surgically treatable. As the frequency of AIDS Increases timely surgical evaluation and intervention will become more necessary. Attention is called to acute abdomen induced by opportunistic infections or neoplasias. Differential diagnosis and management are discussed. Finally, the 5 cases of AIDS that required surgical interventions among the 34 patients with this syndrome observed since 1984 at Hospital Universitario San Vicente de Paúl, Medellín, Colombia, are analyzed.
Bases moleculares del shock séptico Molecular bases of septic shock
Carlos Lerma
Iatreia , 1993,
Abstract: En la presente revisión se hace un análisisde las diferentes moléculas, recientemente descritas, mediadoras en la patogénesisdel shock séptico y se explican las distintas acciones de los mediadoresendógenos que se generan a partir de un evento infeccioso. También se consideracómo las actividades funcionales, bioquímicas y metabólicas de los factores examinadosproducen la lesión panendotelial estimada como el fenómeno central de la falla orgánicamultisistémica. Con estos conocimientos comienza a entenderse la secuencia delespectro clínico del shock séptico de modo que fenómenos antes dispersos empiezana verse como parte de un desarrollo lógico e interrelacionado. An analysis of recently described molecules acting as mediators in the pathogenesis of septic shock is made. The different actions these endogenous mediators generate in response to infectious processes are explained as well as the mechanisms through which their functional, biochemical and metabolic properties produce the panendothelial lesion. The latter appears to be central to the multisystemic organic failure.
Liderazgo y futuro de enfermería
Lerma Julia
Avances en Enfermería , 1992,
Abstract: Mi presencia en este primer Congreso Nacional de Colombia, organizado por la asociación de exalumnos, de debe a la invitación realizada por un grupo de amigos, colegas y compa eras, con quienes me liga un sentimiento de hermandad. Esta invitación, me movilizó afectivamente, ya que me permitió recordar cuál ha sido mi proceso de vida y compromiso con la profesión a través de mi propia historia; al mismo tiempo que me motivó a leer mi vida, explicar algunos pensares, sentires y acciones, como también a analizar mis proyecciones en los a os que me quedan por vivir.
Life cycle of Misumenops pallida (Araneae, Thomisidae)
Minervino, Elisabet;
Memórias do Instituto Oswaldo Cruz , 1993, DOI: 10.1590/S0074-02761993000100009
Abstract: postembryonic development of misumenops pallida (keyserling) (araneae, thomisidae), one of the most abundant predator species in soybean fields in buenos aires province (argentina) was studied. the life cycle was observed in the laboratory from egg sacs collected in the field, and from egg sacs spined in the laboratory by gravid females collected in the field. results indicated that instar length and feeding rate increased throughout the life cycle being higher in females than in males. greater mortality was observed to third and fourth instars decreasing thereafter. these results may contribute to deternmine the efficiency of this species as a natural enemy of insect pests of soybean.
Climate and Tickborne Encephalitis
Elisabet Lindgren
Ecology and Society , 1998,
Abstract: Climatic changes are projected to alter the abundance, dynamics, and geographical distribution of many vector-borne diseases in human populations. Tick-borne diseases such as Lyme disease and tick-borne encephalitis (TBE) are a growing concern in northern Europe and the United States. The impact of a future climate change on the transmission of tick-borne diseases is not known. To make such assumptions, more empirical data are needed on the relations between short-term fluctuations in contemporary weather and disease incidence. This paper analyzes relations between daily minimum and maximum temperatures, monthly precipitation, and TBE incidence during a 36-yr period in Stockholm County, a high-endemic region for TBE in Sweden. Multiple regression analyses were performed, with temperature variables expressed as number of days per winter or spring - summer - fall season with temperatures above, below, or in the interval between different temperature limits. The limits used for daily minimum temperatures represent bioclimatic thresholds of importance for pathogen transmission. To adjust for the length of the tick's life cycle, each TBE incidence rate was related to meteorological data over two consecutive years. Results reveal that increased incidence of tick-borne encephalitis is related to a combination of two successive years of more days with temperatures permitting prolonged seasonal tick activity and, hence, pathogen transmission (i.e., daily minimum temperatures above 5oC-10oC), and a mild winter preceding the year before the incidence year (i.e., fewer winter days with minimum temperatures below -7oC). Alternative explanations of the results are discussed. Findings of this study suggest that a climate change may extend the seasonal range and intensify the endemicity of tick-borne diseases, in particular, at northern latitudes.
V lkomna (n stan) allihopa! Mellan kategoriserade olikheter och radikal skillnad
Elisabet Langmann
Utbildning & Demokrati : Tidsskrift f?r Didaktik och Utbildningspolitik , 2010,
Abstract: Welcome (almost) everyone! Between social categories and radicaldifference. This article explores the dilemmas involved in welcoming differences in education without simultaneously fostering structural conditions that reproduce discrimination and intolerance. Taking an excerpt from Fanny Abj rnsson’s doctoral thesis I en klass f r sig (2004) and Jacques Derrida’s deconstructions of the concept of hospitality as points of departure, the article unfolds in three parts. First, I make a distinction between two ways of responding to the otherness of the other: a conditional welcoming of social categories, and an unconditional welcoming of radical difference. These are further explored in part two. In part three I turn to he “double responsiveness” Derrida highlights as inherent in the paradoxes of hospitality, and ask how it is possible to act within this tension in relation to education. I argue that the welcoming of differences in education demands sensitivity to ambiguity and uncertainty, as well as tact and improvisation in concrete pedagogical situations.
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