Long-term outcomes of extended DAPT in a real-life cohort of consecutive STEMI patients.

INTRODUCTION AND OBJECTIVES: Dual antiplatelet therapy (DAPT) duration after ST-segment elevation myocardial infarction (STEMI) remains a matter of debate. METHODS: We analyzed the effect of DAPT on 5-year all-cause mortality, cardiovascular mortality, and cardiovascular readmission or mortality in a cohort of 1-year survivor STEMI patients. RESULTS: A total of 3107 patients with the diagnosis of STEMI were included: 93% of them were discharged on DAPT, a therapy that persisted in 275 high-risk patients at 5 years. Cardiovascular mortality in patients on single antiplatelet therapy vs DAPT at 5 years was 1.4% vs 3.6% (P <.01), respectively, whereas noncardiovascular mortality was 3.3% vs 5.8% (P=.049) at 5 years. Cardiovascular readmission or mortality in patients with single antiplatelet therapy vs DAPT was 11.4% vs 46.5% (P <.001). Extended DAPT was independently associated with worse 5-year all-cause mortality (HR, 2.16; 95%CI, 1.40-3.33), cardiovascular mortality (HR, 2.83; 95%CI, 1.37-5.84), and cardiovascular readmission or mortality (HR, 5.20; 95%CI, 3.96-6.82). These findings were confirmed in propensity score matching and inverse probability weighting analyses. CONCLUSIONS: Our results suggest the hypothesis that, in 1-year STEMI survivors, extending DAPT up to 5 years in high-risk patients does not improve their long-term prognosis.

Incidência de doença inflamatória intestinal: estudo retrospectivo de um único centro / Incidence of inflammatory bowel disease: a single centre retrospective study

ABSTRACT Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder affecting the gastrointestinal tract. The etiology of this alarming condition is multifactorial. A Recently increasing trend in IBD is noted in our country. Objective: The present study was designed with the main objective to assess the incidence and to identify the associated risk factors including demographic, geographical areas, and dietary patterns of IBD population of Northern of Karnataka viz. Hubli-Dharwad city. Methods: A retrospective investigation was conducted on a cohort of 226 patients with a working diagnosis of IBD and those who were admitted between 2015 to 2019 the department of gastroenterology, SDMCMS&H. The diagnosis of IBD was made based on clinical, radiological, endoscopic, and histopathologic findings. The patients were categorized into IBD and those who have symptoms suggestive of IBD but did not fit into the diagnostic criteria into, non-IBD groups. The data about of on demography, diet patterns, and laboratory parameters were recorded. Results: Among 226 patients enrolled in this study 2015-2019, IBD was confirmed in 54 Ulcerative colitis - 44 (19.46%), Crohn's disease - 10 (4.42%) patients with varying distribution of disease among different age groups and both genders, Ulcerative colitis (UC) [M: F: 28 (63.6%): 16 (36.4%)] and Crohn's disease (CD) [M: F: 07 (70.0%):03 (30.0%)]. Dietary pattern and other habitats had no significant contribution to illness and its symptoms. Urban (U) and Rural (R) divide was UC [U: R: 32 (72.7%): 12 (27.3%)], CD [U:R:07(70.0%):03(30.0%)] maintained. Conclusion Incidence of IBD was high with UC as compared to CD. The incidence of IBD among patients presenting with symptoms suggestive of IBD is 19.46% with UC being major as compared to CD (4.42%). Male predominant patterns of IBD incidences were noted. Year by year increasing trend in disease burden was observed. The Dietary pattern has no direct correlation with IBD disease prevalence and incidences.

Resumo Contexto: A Doença inflamatória intestinal (DII) é uma doença inflamatória crônica que afeta o trato gastrointestinal. A etiologia desta condição alarmante é multifatorial. Uma tendência recentemente crescente na DII é notada em nosso país. Objetivo: O presente estudo foi desenhado com o objetivo principal de avaliar a incidência e identificar os fatores de risco associados, incluindo demográficos, áreas geográficas e padrões alimentares da população com DII do Norte de Karnataka viz. Cidade de Hubli-Dharwad. Metodos: Uma investigação retrospectiva foi realizada em uma coorte de 226 pacientes com diagnóstico de DII e que foram admitidos entre 2015 e 2019 no departamento de gastroenterologia, SDMCMS&H. O diagnóstico de DII foi feito com base em achados clínicos, radiológicos, endoscópicos e histopatológicos. Os pacientes foram categorizados em DII e aqueles que apresentam sintomas sugestivos de DII, mas não se enquadraram nos critérios diagnósticos em grupos sem DII. Os dados sobre a demografia, padrões de dieta e parâmetros laboratoriais foram registrados. Resultados: Entre os 226 pacientes inscritos neste estudo entre 2015-2019, DII foi confirmada em 54 [RCUI - 44 (19,46%), DC - 10 (4,42%)] com distribuição variada da doença entre diferentes faixas etárias e ambos os sexos, colite ulcerativa (RCUI) [M: F: 28 (63,6%):16 (36,4%)] e doença de Crohn (DC) [M: F: 07 (70,0%): 03 (30,0%)]. O padrão alimentar e outros hábitos não tiveram contribuição significativa para a doença e seus sintomas. Urbanos (U) e rurais (R) dividiram-se em RCUI [U: R: 32 (72,7%):12 (27,3%)], DC [07 (70,0%): 03 (30,0%)]. Conclusão A incidência de DII foi elevada para RCUI em relação a DC. A incidência de DII entre os pacientes com sintomas sugestivos de DIB é de 19,46% com a RCUI sendo maior em relação a DC (4,42%). Foram observados padrões predominantes masculinos de incidência de DII. Ano a ano foi observada tendência crescente de carga da doença. O padrão dietético não tem correlação direta com a prevalência e incidências da DII.

Revista Cubana de Informática Médica. Índice referativo 2019-2021 / Cuban Journal of Medical Informatics. Referative index 2019-2021

Se presenta el índice referativo de la Revista Cubana de Informática Médica correspondiente a los años 2019-2021. Se incluyen índices auxiliares de autor, instituciones, materias y direcciones electrónicas para facilitar el contacto con los autores y la consulta de la producción científica publicada por la revista. Se utilizó CDS/ISIS para Windows (versión 1.5.3) de la UNESCO, a partir de la cual se generaron los índices auxiliares de autor, instituciones y materias. Con ello se pretende que los profesionales, técnicos, directivos y estudiantes vinculados a esta importante disciplina en el país y el mundo, dispongan de una fuente de información para realizar investigaciones bibliográficas en este campo tan importante para la salud pública cubana(AU)

The reference index of the Cuban Journal of Medical Informatics corresponding to the years 2019-2021 is presented. Auxiliary indexes of authors, institutions, subjects and electronic addresses are included to facilitate contact with the authors and the consultation of the scientific production published by the journal. UNESCO's CDS/ISIS for Windows (version 1.5.3) was used, from which auxiliary author, institution and subject indexes were generated. With this, it is intended that professionals, technicians, managers and students linked to this important discipline in the country and the world, have a source of information to carry out bibliographic research in this field so important for Cuban public health(AU)

Clinical variants of mycosis fungoides in a cohort.

INTRODUCTION: Mycosis fungoides (MF) is the most common primary skin T-cell lymphoma, which is characterized for a heterogeneous clinical expressivity. OBJECTIVE: To report clinical variants and sociodemographic characteristics in patients with MF under the care of a dermatological hospital. METHODS: 290 patients with MF clinical and histopathological diagnosis attended to over the course of 11 years were included. Sociodemographic description of patients was made, who were classified according to clinical and histopathological variants. RESULTS: MF was recorded in 57.9 % of women and 42 % of men. The most common clinical variant was the classic type in 46.2 %; dyschromic variants accounted for 35.2 %, out of which hypopigmented MF was the most representative (17.6 %); poikilodermatous MF accounted for 4.1 %, and folliculotropic, for 3.1%. The papular variant occurred in six patients (2.1 %), the single-plaque variety in three (1%), and the ichthyosiform, syringotropic and granulomatous slack skin varieties occurred in one patient each. The granulomatous variant was found in 0.7 %, and 1.4 % had erythroderma. CONCLUSIONS: The most common MF clinical variant was classic plaque stage, followed by dyschromic variants. Other clinical variants accounted for 18.6 %.

INTRODUCCIÓN: La micosis fungoide es el linfoma primario de células T en piel más frecuente, con expresividad clínica heterogénea. OBJETIVO: Reportar las variedades clínicas y las características sociodemográficas en pacientes con micosis fungoide tratados en un hospital dermatológico. MÉTODOS: Se incluyeron 290 pacientes con diagnóstico clínico e histopatológico de micosis fungoide atendidos en el transcurso de 11 años. Se realizó descripción sociodemográfica de los pacientes, quienes se clasificaron conforme las variantes clínicas e histopatológicas. RESULTADOS: La micosis fungoide se presentó en 57.9 % mujeres y 42 % hombres. La variedad clínica más común fue la clásica en 46.2 %; la discrómica representó 35.2 %, del cual la hipopigmentada fue la más representativa (7.6 %); la poiquilodérmica constituyó 4.1 % y la foliculotrópica, 3.1 %. La variedad papular se presentó en seis pacientes (2.1 %), la de placa única en tres (1 %) y la ictiosiforme, siringotrópica y la piel laxa granulomatosa, en un paciente cada una. La variedad granulomatosa se encontró en 0.7 % y 1.4 % presentó eritrodermia. CONCLUSIONES: La variedad clínica más frecuente de micosis fungoide fue la clásica en fase de placa, seguida de las variedades discrómicas. Otras variedades clínicas representaron 18.6 %.

Desarrollo y validación interna de un modelo de predicción clínica del riesgo de infección bacteriana nosocomial en pacientes con lupus eritematoso sistémico / Development and internal validation of a clinical prediction model of the risk of nosocomial bacterial infection in patients with systemic lupus erythematosus

RESUMEN Introducción: Los pacientes con lupus eritematoso sistémico (LES) tienen un riesgo aumen tado de padecer infecciones tanto adquiridas en la comunidad como asociadas con el cuidado de la salud. Las infecciones bacterianas son las más frecuentes y graves durante la hospitalización de estos pacientes. Objetivo: Desarrollar y validar internamente un modelo de predicción clínica de pronóstico del riesgo de infección bacteriana adquirida en el hospital en pacientes con LES, usando datos clínicos y de laboratorio obtenidos durante las primeras horas de hospitalización. Métodos: Se analizó una cohorte retrospectiva de pacientes con LES mayores de 16 arios, hos pitalizados por motivos diferentes a infección bacteriana en 2 hospitales de alta complejidad de Medellín entre 2011 y 2016. Se compararon las características de los pacientes que des arrollaron el desenlace de infección bacteriana entre el día 3 y el día 15 de hospitalización con aquellos que no lo presentaron. Las variables significativas en el análisis bivariado fueron consideradas para la construcción del modelo por medio de regresión logística multivariada. Resultados: Se incluyeron 765 episodios, de los cuales 98 (12,8%) presentaron el desenlace de interés. Se consideraron 35 predictores candidatos. Las variables incorporadas en el modelo final fueron: edad, recuento de neutrófilos, puntaje de actividad lúpica SLEDAI, uso de sonda vesical, uso de catéter venoso central en las primeras 72 h, dosis de glucocorticoides en el mes previo y el uso de un antimalárico en los 3 meses previos. La capacidad de discrimi nación del modelo fue aceptable a buena (AUC-ROC 0,74; IC 95% 0,69-0,80). La prueba de bondad de ajuste de Hosmer-Lemeshow (p = 0,637) evidenció una adecuada calibración. Conclusión: Desarrollamos un modelo de predicción clínica de pronóstico del riesgo de infec ción bacteriana nosocomial en pacientes con LES. El modelo desarrollado está compuesto por variables clínicas y de laboratorio simples disponibles en el momento del ingreso al hospital. Se requieren estudios de validación externa y de impacto clínico antes de su implementación rutinaria.

ABSTRACT Introduction: Patients with systemic lupus erythematosus (SLE) have an increased risk of developing community-acquired infections, as well as those associated with health care. Bacterial infections are the most common and serious while these patients are in hospital. Objective: To develop, and internally validate, a clinical prediction model for the prognosis of the risk of hospital-acquired bacterial infection in SLE patients using clinical and laboratory data obtained during the first hours of hospital admission. Methods: An analysis was performed on retrospective cohort of patients with SLE older than 16 years and admitted for reasons other than bacterial infection in 2 highly complex hospitals in Medellín between 2011 and 2016. The characteristics of the patients who developed a bacterial infection were compared between day 3 and day 15 of hospital admission with those who did not develop one. The significant variables in the bivariate analysis were used for the construction of the model using multivariate logistic regression. Results: A total of 765 episodes were included, of which 98 (12.8%) presented the outcome of interest. Thirty-five candidate predictors were considered. The variables incorporated in the final model were: age, neutrophil count, SLEDAI lupus activity score, use of a bladder catheter, use of a central venous catheter in the first 72 h, glucocorticoid doses in the previous month, and use of an antimalarial drug in the 3 previous months. The discrimination capacity of the model was acceptable to good (AUC-ROC 0.74; 95% CI 0.69-0.80). The Hosmer-Lemeshow goodness of fit test (P = .637) suggested adequate calibration. Conclusion: A clinical prediction model of prognostic risk of nosocomial bacterial infection in patients with SLE has been developed. This model is made up of simple clinical and laboratory variables available at the time of hospital admission. External validation and clinical impact studies are required before routine implementation.

Variedades clínicas de micosis fungoide en una cohorte / Clinical variants of mycosis fungoides in a cohort

Resumen Introducción: La micosis fungoide es el linfoma primario de células T en piel más frecuente, con expresividad clínica heterogénea. Objetivo: Reportar las variedades clínicas y las características sociodemográficas de pacientes con micosis fungoide tratados en un hospital dermatológico. Métodos: Se incluyeron 290 pacientes con diagnóstico clínico e histopatológico de micosis fungoide atendidos en el transcurso de 11 años. Se realizó descripción sociodemográfica de los pacientes, quienes se clasificaron conforme las variantes clínicas e histopatológicas. Resultados: 58 % de los casos de micosis fungoide se presentó en mujeres y 42 % en hombres. La variedad clínica más común fue la clásica en 46.2 %; la discrómica representó 35.2 %, del cual la hipopigmentada fue la más representativa (7.6 %); la poiquilodérmica constituyó 4.1 % y la foliculotrópica, 3.1 %. La variedad papular se presentó en seis pacientes (2.1 %), la de placa única en tres (1 %) y la ictiosiforme, siringotrópica y la piel laxa granulomatosa, en un paciente cada una. La variedad granulomatosa se encontró en 0.7 % y 1.4 % presentó eritrodermia. Conclusiones: La variedad clínica más frecuente de micosis fungoide fue la clásica en fase de placa, seguida de las variedades discrómicas. Otras variedades clínicas representaron 18.6 %.

Abstract Introduction: Mycosis fungoides (MF) is the most common primary skin T-cell lymphoma, which is characterized for a heterogeneous clinical expressivity. Objective: To report clinical variants and sociodemographic characteristics in patients with MF under the care of a dermatological hospital. Methods: 290 patients with MF clinical and histopathological diagnosis attended to over the course of 11 years were included. Sociodemographic description of patients was made, who were classified according to clinical and histopathological variants. Results: MF was recorded in 57.9 % of women and 42 % of men. The most common clinical variant was the classic type in 46.2 %; dyschromic variants accounted for 35.2 %, out of which hypopigmented MF was the most representative (17.6 %); poikilodermatous MF accounted for 4.1 %, and folliculotropic, for 3.1%. The papular variant occurred in six patients (2.1 %), the single-plaque variety in three (1%), and the ichthyosiform, syringotropic and granulomatous slack skin varieties occurred in one patient each. The granulomatous variant was found in 0.7 %, and 1.4 % had erythroderma. Conclusions: The most common MF clinical variant was classic plaque stage, followed by dyschromic variants. Other clinical variants accounted for 18.6 %.

Análisis psicométrico del cuestionario de memoria prospectiva y retrospectiva / Psychometric Analysis of the Prospective and Retrospective Memory Questionnaire

Resumen Para poder cuantificar e investigar científicamente las quejas mnésicas de los pacientes, se hace necesario contar con un instrumento adaptado y que presente análisis psicométricos adecuados. El objetivo del presente trabajo fue estudiar propiedades psicométricas de una versión argentina del Cuestionario de Memoria Prospectiva y Retrospectiva. Para ello se administró el Cuestionario de Memoria Prospectiva y Retrospectiva de forma individual a 192 participantes sanos con más de 27 puntos en el Mini Mental State Examination. La media de edad fue de 39.67 años (DE = 12.3). La media de escolaridad fue de 14.5 años (DE = 2.72). A un subgrupo de participantes (n = 45) denominado Subgrupo A, también se les administraron pruebas de memoria prospectiva y retrospectiva. El Índice Global del Cuestionario presentó una distribución normal. Según el análisis factorial exploratorio se estableció la extracción de un factor que explicó el 35.19 % de la varianza. El coeficiente α de Cronbach fue de .87. La confiabilidad estimada por el método de la división por mitades fue de .73 y de .84 luego de la corrección con la fórmula de Spearman-Brown. No hubo correlación significativa entre las respuestas del cuestionario y los test de memoria retro y prospectiva en el subgrupo A. Estos resultados permiten concluir que el Cuestionario de Memoria Prospectiva y Retrospectiva presenta adecuados índices de confiabilidad y una estructura de un solo factor. Si bien no se asocia con el rendimiento objetivo en pruebas de memoria, muestra ser apropiado para el registro de las quejas subjetivas de los pacientes en la región de estudio.

Abstract Memory complaints are the reason for consultation in many cases of neurological injuries and in the majority of aged people who attend the neurological clinic. The presence of memory complaints is a diagnostic criterion for mild cognitive impairment, for which it is necessary to have an appropriate and specific instrument, which would allow us to quantify and scientifically investigate it. The aim of the present study is to analyze the psychometric properties of an Argentine version of the Prospective and Retrospective Memory Questionnaire: the factorial structure of the test; its internal consistency; correlations of the questionnaire with an objective measurement of retro and prospective memory; and correlations of the questionnaire with affective-emotional variables. The Mexican version of the Prospective and Retrospective Memory Questionnaire was administered individually to 192 healthy participants who achieved more than 27 point in the Mini Mental State Examination. A modification was made to the syntax of two sentences in order to increase the comprehensibility. A Global, Prospective and a Retrospective Index of the questionnaire was calculated for each participant. Anxiety (the State-Trait Anxiety Inventory: STAI) and depression (the Beck's Depression Inventory-II) scales were also administered. The mean age was 39.67 years (SD = 12.3). The average of schooling was 14.5 years (SD = 2.72). We also selected a subgroup of participants (n = 45) with a mean age of 37.58 years (SD = 11.4), and an average schooling in years of 14.36 (SD = 3). In addition to the memory questionnaire, this subgroup, called the A Subgroup, was administered prospective (El Cóndor test) and retrospective (The Selective Memory Test) objective memory tests. The mean in the Global Index was 32.25 (SD = 8.49), in the Prospective Index it was 17.3 (SD = 5.01) and in the Retrospective Index it was 14.95 (SD = 4.07). The test for normality of the distribution of the Global Index Kolmogorov-Smirnov (K-S) was Z = 1.031, p = .238. In the same way, the other two scores of the questionnaire show a normal curve, K-S of the Prospective Index Z = 1.109, p = .171; K-S of the Retrospective Index Z = 1.264, p = .082. According to the exploratory factor analysis through the Maximum Likelihood extraction method, a single factor explained 35.19 % of the variance. The Cronbach's α coefficient was .87. The reliability estimated by the split-half method was .73 and .84 after correction with the Spearman-Brown formula. There was a significant positive correlation of mild degree between the Global Questionnaire Index and the STAI Trait, r = .33, p = .013, and with the IDB-II, e = .23, p = .127. There was no significant correlation between the questionnaire responses and the retro and prospective memory objective tests in the A Subgroup. The Prospective and Retrospective Memory Questionnaire presents adequate reliability indexes and a single factor structure. The results indicate that the questionnaire associates with anxiety and depression in a positive way, but not with the objective measures of retro and prospective memory, in coincidence with the literature about the relationship between cognitive complaints and cognitive tests performance. In sum, this study shows that the questionnaire is an appropriate instrument to quantify patient's memory complaints and particularly for its use in the study region. This study is the first in the country to investigate the psychometric properties of the Prospective and Retrospective Memory Questionnaire, widely used in neuropsychological clinic and research around the world. Efforts should be made to obtain normative data and validation in the pathological population of interest.

Revista Cubana de Informática Médica: índice referativo 2016-2018

Se presenta el índice referativo de la Revista Cubana de Informática Médica correspondiente a los años 2016-2018. A través de los índices auxiliares de Autores, Instituciones, Materias y Direcciones, los lectores tendrán la oportunidad de revisar la producción científica publicada en la revista en ese periodo. Con ello se pretende que los profesionales, técnicos, directivos y estudiantes vinculados a esta importante disciplina, dispongan de una vía más para realizar investigaciones bibliográficas en este campo tan importante para la salud pública cubana.

The referative index of the Cuban Journal of Medical Informatics for the years 2016-2018 is presented. Through the auxiliary indexes of Authors, Institutions, Subjects and Directions, readers will have the opportunity to review the scientific production published in the journal in that period. This is intended to professionals, technicians, managers and students linked to this important discipline, have one more way to do bibliographic research in this field so important for Cuban public health.

Anestesia general con máscara laríngea para radioterapia infantil: técnica y complicaciones / General anesthesia with laryngeal mask airway management for radiotherapy in children: anesthetic technique and complications

Objetivo: El objetivo de este estudio es describir la técnica de anestesia general con máscara laríngea y la presencia de complicaciones anestésica en niños sometidos a radioterapia entre el 2014 y el 2016 en el Instituto Nacional del Cáncer. Secundariamente, se describirán las características demográficas y clínicas de la población estudiada. Material y Método: Estudio descriptivo, retrospectivo. Se extrajeron datos clínicos y demográficos de radioterapia bajo anestesia general realizados entre 2014 y el 2016 en niños menores de 15 años. Los datos recopilados fueron: edad, sexo, número de radioterapias con anestesia general, diagnóstico, tipo de anestesia, dispositivo de la vía aérea utilizado, complicaciones (náuseas, vómitos, laringoespasmo, aspiración broncopulmonar). El análisis estadístico fue descriptivo. Resultados: Se registraron 1.285 radioterapias en 65 niños. Todas con anestesia general. Del total de sesiones, en 85 (7%) fue necesario instalar una vía venosa periférica o el paciente contaba con una. Con respecto a los dispositivos de vía aérea, en 1.139 (94%) se utilizó máscara laríngea, en 64 (5%) presentaba traqueostomía y en 8 (0,66%) fue necesario la intubación orotraqueal. Dentro de las complicaciones encontramos náuseas y/o vómitos en 71 sesiones, correspondientes al 5,53%. Espasmo laríngeo ocurrió en 9 (0,7%) de las sesiones. Conclusiones: La anestesia general con máscara laríngea es una técnica útil y con pocas complicaciones para el manejo de niños que requieren radioterapia, donde parece no ser indispensable contar con una vía venosa periférica o central de rutina.

Objective: Describe the use of general anesthesia with laryngeal mask airway management, and the presence of complications in children who require anesthesia for radiotherapy. The demographic and clinical characteristics of the children studied will also be described. Material and Methods: This is a descriptive, retrospective study. Clinical and demographic data were obtained from radiotherapy procedures with general anesthesia in children under 15 years of age completed between 2014 and 2016. The data collected included: sex, age, number of radiotherapies with general anesthesia, diagnosis, type of anesthesia, airway management device, complications (nausea and vomiting, laryngospasm and bronchopulmonary aspiration). The data were analyzed through descriptive statistics. Results: 1,285 radiotherapies where analyzed in 65 children. All patients received general anesthesia. Of the total sessions, only in 85 (7%). Was required to install a peripheral intravenous line or the patient had one. In 1,139 (94%) of the cases, the preferred airway management device was laryngeal mask, 64 (5%) presented with tracheostomy, and in 8 (0.66%) patients it was necessary to use an orotracheal tube. Nausea and vomiting occurred in 71 cases (5.53%), and laryngospasm in only 9 (0.7%) patients. Conclusion: General anesthesia with laryngeal mask airway management is a useful technique associated with low complications when caring for children requiring anesthesia for radiotherapy. Also, in this context, it seems unnecessary to routine install a peripheral intravenous line.

Use of long-term data to evaluate loss and endangerment status of Natura 2000 habitats and effects of protected areas.

Habitat loss is a key driver of biodiversity loss. However, hardly any long-term time series analyses of habitat loss are available above the local scale for finer-level habitat categories. We analysed, from a long-term perspective, the habitat specificity of habitat-area loss, the change in trends in habitat loss since 1989 (dissolution of the communist state), and the impact of protected areas on habitat loss in Hungary. We studied 20 seminatural habitat types in 5000 randomly selected localities over 7 periods from 1783 to 2013 based on historical maps, archival and recent aerial photos and satellite imagery, botanical descriptions, and field data. We developed a method for estimating habitat types based on information transfer between historical sources (i.e., information from a source was used to interpret or enrich information from another source). Trends in habitat loss over time were habitat specific. We identified 7 types of habitat loss over time regarding functional form: linear, exponential, linear and exponential, delayed, minimum, maximum, and disappearance. Most habitats had continuous loss from period to period. After 1986 the average annual rates of habitat loss increased, but the trend reversed after 2002. Nature conservation measures significantly affected habitat loss; net loss was halted, albeit only inside protected areas. When calculating the degree of endangerment based on short-term data (52 years), we classified only 1 habitat as critically endangered, but based on long-term data (230 years), this increased to 7 (including habitat that no longer existed). Hungary will probably reach the global Convention on Biological Diversity Target 5 but will probably not achieve the EU Biodiversity Strategy target of halting habitat loss by 2020. Long-term trend data were highly useful when we examined recent habitat-loss data in a wider context. Our method could be applied effectively in other countries to augment shorter-term data sets on trends in habitat area.

Características clínicas, histopatológicas y factores pronósticos del microcarcinoma tiroideo: estudio retrospectivo multicéntrico / Clinical, Hystopathologic Caractheristics and Prognostic Factors of Thyroid Microcarcinoma: A Retrospective Multicenter Study

Introducción: El microcarcinoma diferenciado de tiroides (MCDT) es definido por la OMS, como un tumor <10 mm en su diámetro mayor. Estos tumores son casi exclusivamente de estirpe papilar, representando el 30 % de todos los carcinomas papilares. La historia natural del MCDT es poco conocida y existe una controversia sobre cuál es la óptima forma de abordaje. Objetivos: 1) Analizar retrospectivamente las características del MCDT; 2) Evaluar factores de riesgo de persistencia/recurrencia en una cohorte retrospectiva seguida en la C.A.B.A. Materiales y Métodos: Se recolectaron los datos de 187 pacientes en un estudio retrospectivo multicéntrico y se analizaron las características clínicas, histopatológicas, bioquímicas y distintos factores pronósticos del MCDT. Resultados: El 82,8 % eran mujeres, con una X ± DS de edad de 48 ± 13 años. La mediana de tiempo de seguimiento fue de 38 meses (r: 1-120). El 97 % de los tumores eran de estirpe papilar. En el 29,4 % de los pacientes el hallazgo fue incidental, de los cuales el 57 % se operó por el tamaño del bocio. El 81 % de los pacientes fue sometido a una tiroidectomía total, mientras que el 91,4 % recibió ablación posquirúrgica con radioiodo. Los 174 pacientes que fueron seguidos por más de 12 meses, con una X ± DS de 49 ± 36,9 meses, fueron incluidos en el análisis de sobrevida. El 84 % estaban libres de enfermedad (LE) al final del seguimiento. De los factores de persistencia/recurrencia analizados, la Tg preablativa > 20 ng/ml resultó un predictor independiente. Al realizar el análisis de regresión de Cox para el evento LE, se demostró que tanto la edad

Introduction: Differentiated thyroid microcarcinoma (MCDT) has been defined as a differentiated thyroid cancer measuring 10 mm or less. The majority of these tumors are papillary thyroid carcinomas and comprise 30 % of all papillary thyroid carcinomas. Little is known of its natural history and there is an ongoing controversy in the field regarding its optimum management. Objectives: 1) To describe the characteristics of MCDT 2) To assess risk factors for persistence and/ or recurrence of disease in a retrospective cohort of patients followed up at several health centers of the City of Buenos Aires (CABA). Patients and Methods: The medical records of 187 patients with MCDT operated on between January 1st, 2000 and December 31st, 2009 at several centers of CABA were retrospectively reviewed, and clinical, histopathological, biochemical characteristics and risk factors were assessed. Results: Most of the patients were female (82.8 %) and their mean age was 48 ± 13 (X ± SD) years. Median follow up was 38 months (range: 1 to 120 months), and 97 % of tumors were papillary thyroid cancers. Incidentalomas accounted for 29.4 % of tumors, mostly found during a surgical procedure undergone for the size of the goitre. Over 81 % of patients underwent a total thyroidectomy, while 91.4 % received radioactive iodine ablation. Patients with a follow-up longer than 12 months after surgery were analyzed longitudinally to assess prognostic factors of disease outcome (174 patients). After a mean follow-up of 49 ± 36.9 months, 146 (84 %) patients had no evidence of disease. Only postoperative, preablation Tg levels > 20 ng/ml were identified as an independent adverse prognostic factor in the multivariate analyses. In addition, age < 45 ys. (p< 0.01), tumor size > 0.5cm (p<0.017), and preablation Tg levels >20 ng/ml (p<0.011) were independent prognostic factors of a longer time to disease remission in the longitudinal analyses. Conclusion: Differentiated thyroid microcarcinoma has an excellent prognosis in our local practice, with 84 % disease remission at long-term follow-up. Age at diagnosis, tumor size and preablation Tg levels were independent prognostic factors of time to disease remission.

Diagnóstico prénatal: retrospectiva / Diagnóstico prénatal: retrospectiva / Prenatal diagnosis: retrospective

O Diagnóstico Pré-Natal (DPN) é um conjunto de técnicas destinado a investigar a saúde fetal ainda no período de vida intrauterina. é dirigido principalmente a casais com risco aumentado de gerar uma criança com uma anomalia genética ou congenita. Seu objetivo fundamental pressupõe a identificação de anomalias cromossômicas, malformações, doenças metabólicas mendelianas e outras alterações circunstancialmente adquiridas durante a gestação e com repercussões sobre o feto (1-4). O DPN tem sido usado como um método formal de diagnóstico por mais de 45 anos, passando por diferentes fases no seu desenvolvimento. A história do DPN está relacionada com a introdução e o aprimoramento de novas técnicas laboratoriais e diagnósticas. O primeiro passo para o conhecimento do compartimento feto-placentário foi dado por Bevis, em 1952, quando realizou uma amniocentese com fins propedeuticos: o estudo da doença hemolítica fetal. Nos seguintes anos, vários pesquisadores demostraram que é possível determinar o sexo fetal mediante o estudo da cromatina sexual em células de líquido amniótico (5- 8). O desenvolvimento das técnicas cito-genéticas (9) levou a Fuchs e Philips (10) a demonstrar a viabilidade de se cultivar células obtidas no Líquido Amniótico (LA) para posterior análise do cariótipo fetal. Desse modo, obtiveramse os primeiros cariótipos fetais a partir de células de LA entre 1965 e 1967 (11-13). Valenti (14) e Nadler (15) descreveram o primeiro DPN de uma anomalia cromossômica: a trissomia do cromossomo 21. No mesmo ano, diagnosticouse uma anomalia por erro inato do metabolismo (galactosemia) mediante a análise do LA (15). Quatro anos depois, altas dosagens de alfafetoproteína (AFP) no soro materno foram correlacionadas com o aumento da probabilidade de ocorrencia de erros no fechamento do tubo neural (16).

El Diagnóstico Prenatal (DPN) es un conjunto de técnicas destinadas a establecer un diagnóstico fetal aún en el periodo de vida intra-uterina. Está dirigido principalmente a parejas con mayor riesgo de presentar un embarazo de un hijo con una anomalía genética o congénita. Su objetivo fundamental es lograr la identificación de anomalías cromosómicas, malformaciones, enfermedades metabólicas, mendelianas y otras alteraciones eventualmente adquiridas durante la gestación y con repercusiones sobre el feto. El DPN ha sido usado como un método formal de diagnóstico desde hace más de 45 años, pasando por las diferentes fases de su evolución. Esta revisión describe estas fases abordando las realizaciones científicas que permitieron su implementación y mejoramiento continuo.

Prenatal diagnosis is a set of techniques intended to establish a fetal diagnosis even in the period of intrauterine life. It is aimed primarily at couples with higher risk of having a genetic or congenital abnormal pregnancy. Its basic aim is to ensure the identification of chromosomal anomalies, malformations, metabolic and Mendelian diseases, and other alterations eventually acquired during pregnancy which have an impact on the fetus.Prenatal diagnosis has been used as a formal diagnosis method for more than 45 years, going through the various stages of its evolution. This text revises these phases by addressing the scientific and technological developments that have led to its implementation and continuous improvement.

Radial vs femoral access after percutaneous coronary intervention for ST-segment elevation myocardial infarction. Thirty-day and one-year mortality results.

INTRODUCTION AND OBJECTIVES: Little attention has been given to the effect of vascular access site on mortality, while an increasing body of evidence is showing that radial access has much more benefit than femoral access for ST-segment elevation myocardial infarction patients. We aimed to assess the influence of vascular access site on mortality at 30 days and at 1 year in ST-segment elevation myocardial infarction patients. METHODS: We included all patients with ST-segment elevation myocardial infarction who had undergone primary angioplasty at 2 Galician hospitals between 2008 and 2010. We performed 2 multivariate regression models for each endpoint (30-day and 1-year mortality). The only difference between these models was the inclusion or not of the vascular access site (femoral vs radial). For each of the 4 models we calculated the Hosmer-Lemeshow test and the C-index. We also tested the interaction between hemodynamic instability and vascular access. RESULTS: We included 1461 patients with a mean age of 64. Of these patients, 86% had radial access and 7.4% had hemodynamic instability. All-cause mortality was 6.8% (100/1461) at 30 days and 9.3% (136/1461) at 1 year. Vascular access site follows hemodynamic instability and age in terms of effect on mortality risk, with an odds ratio of 5.20 (95% confidence interval, 2.80-9.66) for 30-day mortality. A similar effect occurs for 1-year mortality. The C-index slightly improves (without achieving statistical significance) with the inclusion of the vascular access site. CONCLUSIONS: Vascular access site should be taken into account when predicting mortality after a primary percutaneous coronary intervention.

La ciencia médica en la Cuba colonial a través de la bibliografía de sus protagonistas / The medical science in colonial Cuba through bibliography of their protagonist

Se pondera la ciencia desde la perspectiva dialéctica materialista y se pone de relieve su relación directa con la evolución en el tiempo de la especie humana. Se enuncian los antecedentes del movimiento científico en Cuba y se indican las circunstancias que propiciaron el despegue de la ciencia genuinamente cubana, con mención de varios de sus máximos exponentes a tenor de la bibliografía por ellos producida. Se destaca la significación del Papel Periódico de La Habana en su condición de soporte, donde han quedado registradas las primeras noticias y artículos de carácter científico producidos por cubanos, entre ellos 1594 trabajos sobre aspectos médicos, desde su aparición en 1790 hasta 1840, año en que surgió la primera revista científico-médica editada en el país. Se subraya la significación del año 1797 como momento histórico que marcó el inicio de la bibliografía científica moderna en el territorio nacional, particularmente en la ciencia médica, donde salieron a relucir nuevas concepciones que se constituyeron en expresión concreta de un criterio científico independiente y propio, y además contribuyeron de modo sustancial, al progreso de la nación cubana, como fundamento evidente de una etapa precisa de su evolución histórica con la aparición de una nueva formación social.

In this article, the science is pondered from the dialectical materialistic perspective and it is relieved its direct relationship with the evolution of the human species through the time. The antecedents of the Cuban scientific movement are enunciated and the circumstances that propitiated the take off of the genuinely Cuban science, pointing out several of their maximum exponents in the context of the bibliography produced by them. It is stood out the significance of the Papel Periódico de La Habana in Havana city as a supporting condition, where were been registered the first news and articles of scientist character taken place for Cuban scientists, among them 1594 works have more than enough medical aspects, from their appearance in 1790 up to 1840, year of the first journal scientific-doctor published in the country arose. The significance of the year 1797 is underlined, particularly as historical moment that marked the beginning of the scientific modern bibliography in the national territory, in the medical science, where were left to glitter new conceptions that constituted the concrete of a scientific independent expression and own approach that contributed from a substantial way to the progress of the Cuban nation, like evident foundation of a precise stage of its historical evolution with the appearance of a social new formation.

Biografía de la Revista de la Sociedad Cubana de Historia de la Medicina / Biography of the Revista de la Sociedad Cubana de Historia de la Medicina

En el primer trimestre de 1958 se puso en circulación la Revista de la Sociedad Cubana de Historia de la Medicina, como órgano de divulgación de la corporación del mismo nombre y vehículo para contribuir al cultivo de la historiografía nacional e internacional de la Medicina y otras disciplinas afines como la Farmacia, la Odontología y la Medicina Veterinaria. En este trabajo se da cuenta de lo que fue la vida de esta publicación, sobre la base de un índice analítico, donde se han registrado las referencias de todos los artículos atesorados en sus páginas, así como los nombres de los autores y la identificación de los asuntos por ellos estudiados. Se trata pues de un inventario, con el cual se hace constar buena parte de la labor realizada por quienes fueron los fundadores y precursores de la prestigiosa organización, que plasmaron los resultados de sus investigaciones en esta revista. Con el índice analítico que aquí se presenta, disponen asimismo las actuales y las futuras generaciones de profesionales de la salud y demás interesados de una fuente de información y referencia acerca del quehacer en general de la Sociedad Cubana de Historia de la Medicina entre 1958 y 1963.

The Revista de la Sociedad Cubana de Historia de la Medicina was put into circulation during the first trimester of 1958, as an spreading organ of the corporation with the same name, to contribute to the growing of the national and international history of Medicine and other similar subjects as Pharmacy, Odontology and Veterinary Medicine. In this paper the life of this publication is stated, based on an analytical index where the references of all the articles from the journal are stated, as well as the names of all the authors and the identification of the subjects they worked with. It is an inventory that serves as prove of the job done by the authors that were the founders of that important organization, they confirmed the results of their investigations in this journal. With the analytical index presented here, the present and future generations of health professionals have a source of reference and information about the general activity of the Sociedad Cubana de Historia de la Medicina in the years between 1958 and 1963.

Dermatofitias en niños: revisión retrospectiva de 487 casos en Tucumán-Argentina / Dermatophytoses in children: retrospective revision of 487 cases in Tucumán-Argentina

Los hongos dermatofitos son los agentes causales más frecuentes de micosis . No obstante, la prevalencia de los agentes causales varía en las regiones geográficas, las características demográficas de la población estudiada y la metodología de laboratorio. A fin de determinar la frecuencia de dermatofitos en niños de Tucumán (R. Argentina), se presentan los resultados de una revisión retrospectiva de 9 años (2000-2008) de los protocolos médicos de 712 niños de 0 a 14 años de edad, (413 varones y 299 mujeres), con diagnóstico clínico de micosis en piel, uñas, pelos y cuero cabelludo evaluados en el Hospital del Niño Jesús. Las tineas fueron diagnosticadas en 487 pacientes (68,4 por ciento), predominando en el género masculino. La distribución de los hongos aislados fue: M. canis (78,4 por ciento), T. mentagrophytes (6,4 por ciento), T. rubrum (6,2 por ciento),T. tonsurans (4,5 por ciento), M. gypseum (3,9 por ciento), T. mentagrophytes var. interdigitale (0,4 por ciento) y E. floccosum (0,2 por ciento). Coincidentemente con trabajos previos realizados en nuestra provincia, la tinea capitis es la afección predominante y M. canis sigue siendo su principal agente patógeno más frecuente (93,8 por ciento). La alta proporción de aislamientos de M. canis, indica claramente que las especies zoofílicas son las más prevalentes en nuestra área. El grupo etario de mayor incidencia fue el de 0 a 3 años seguido del grupo de 4 a 6 años de edad.

Dermatophyte fungi are the most frequent agents causing mycosis. However prevalence of the causing agents varies with the geographic regions, demographic characteristics of the studied population and with the laboratory methodology. In order to determine the incidence of Dermatophytes in chidren of Tucumán (R. Argentina), results of a 9-year retrospective revision (2000-2008) of the medical protocols of 712 children of 0 to 14 years of age (413 men and 299 women) diagnosed with mycosis in hair, scalp, skin and nails are reported and who had been evaluated in the Hospital del Niño Jesús. Tinea were diagnosed in 487 patients (68.4 percent), prevailing in the masculine genus. The distribution of isolated fungi was: M.canis, (78.4 percent), T.mentagrophytes (6.4 percent), T.rubrum (6.2 percent), T tonsurans (4.5 percent), M.gypseum (3.9 percent), T.mentagrophytes var. interdigitale (0.4 percent) and E.floccosum (0.2 percent). Coincidently with previous studies accomplished in our province, tinea capitis is the prevailing affection while M.canis continues being its main and most frequent pathogenic agent (93.8 percent). The high number of M.canis isolations show clearly that zoophilic species are the most prevalent in our area. Children aged 0 to 3 year exhibited the highest prevalence followed by those of 4 to 6 year.

Contribución a la historia de la bibliografía pediátrica cubana / Contribution to history of Cuban paediatric bibliography

Se exponen los antecedentes y la evolución de la producción de literatura relacionada con las enfermedades de la infancia a escala internacional. Se identifican los primeros artículos sobre el tema editados en Cuba, aparecidos a finales del siglo XVIII en el Papel Periódico de la Havana, pionero de las publicaciones periódicas nacionales. Se realiza un breve análisis del contenido del primer libro cubano dedicado por entero al asunto y se divulgan otros materiales con similar característica aparecidos con posterioridad en el período colonial. Se refieren otras modalidades documentarias, integrantes también del conjunto que conforma la literatura precursora de la Pediatría en la isla, entre ellas las primeras tesis defendidas por estudiantes cubanos en opción al título de Doctor en Medicina en la Universidad de París, los primeros artículos de revista y las primeras ponencias vistas en un evento científico celebrado en el país. Por último, se puntualizan algunas particularidades respecto a la historia de la Revista Cubana de Pediatría, decana de las revistas científicas nacionales en ciencias de la salud.

Antecedents and evolution of the literature production related to children diseases at international scale are exposed. The first articles edited in Cuba on this theme are identified appeared at the end of the XVIII century in the Papel Periódico de la Habana, pioneer in these periodic national publications. A brief analysis of the first Cuban book content, completely dedicated to this matter is done, and other materials with similar characteristics that appeared after the colony period are disclosed. Other documentary modalities part of the group conforming the precursor literature of Paediatrics in the island are presented, among them the first thesis defended by Cuban students opting by the Doctor in Medicine Degree in the University of Paris, the first journals articles and the first papers seen in a scientific event in the country. Finally, some distinctive features regarding to the Revista Cubana de Pediatría history, dean of the national scientific publications in the health sciences, are specified.

Inventario bibliográfico de la revista Finlay (1963-1967) / Bibliographical inventory of Finlay journal (1963-1967)

Entre las primicias más importantes del Museo Histórico de las Ciencias Médicas Carlos J Finlay desde su creación en 1962, figura la puesta en circulación, al año siguiente, de su órgano oficial, la revista Finlay, en cuyas páginas se dieron a conocer durante cerca de un lustro interesantes trabajos relativos a la historia de la ciencia en general y de la Medicina cubana en particular. En esta contribución se ofrecen detalles sobre los rasgos formales más significativos de la mencionada publicación y se analiza su contenido desde su surgimiento hasta su desaparición. Se presenta un índice analítico con las citas de todos los trabajos allí publicados, los nombres de los autores y las materias tratadas, con referencias cruzadas entre sí. El presente trabajo, concebido para que pueda ser útil como obra de referencia, trata de ser también un modesto homenaje de recordación a su fundador, el doctor José López Sánchez (1911-2004), ante la proximidad del quinto aniversario de su desaparición física.

Among the more significant early results of the Carlos J Finlay Historical Museum of Medical Sciences from its creation in 1962, are the starting, at the next year, of its official organ: the Finlay journal, whose pages show during near a five-year period very interesting papers relative to history of science in general, and of Cuban Medicine, in particular. In this contribution we offer the more significant details on formal features of such publication, and we analyze its content from its appearance to its disappearance. An analytical index is showed including quotations of all papers there published; names of authors, and matter discussed each other. The present paper, conceived as a useful tool as a reference masterpiece, try to be also a modest tribute of remembering for its founder, Dr. José López Sánchez (1911-2004) near of the fifth anniversary of its physical disappearing.

Ecos de la Gaceta Médica de La Habana en el aniversario 130 de su aparición / Echoes of the Gaceta Médica de la Habana on the 130th anniversary of its foundation

Como resultado del estudio del contenido de una revista que circuló entre noviembre de 1878 y julio de 1881 con el título de Gaceta Médica de La Habana, se presenta una obra de referencia de lo acontecido en ella, destinada a los profesionales de la salud y de la información como beneficiarios principales. De esta publicación, cuyas páginas atesoran relevantes trabajos relacionados con los antecedentes de varias situaciones de salud que hoy día han adquirido nueva vigencia, se brindan las citas bibliográficas de todos los materiales que en ella se divulgaron. A continuación de esa descripción cronológica, se dan en orden alfabético los nombres de los autores, con vínculos a sus respectivos artículos mediante códigos numéricos que los identifican. Luego aparece, también en orden alfabético y con vínculos a las citas, todos los asuntos tratados en la revista. Con este inventario se pretende contribuir a poner de relieve y generalizar los ecos de la Gaceta Médica de La Habana en el aniversario 130 de su aparición.

As a result of the study of the content of a journal called Gaceta Médica de la Habana that circulated from November 1878 to July 1881, it is presented a reference work about what happened in this publication that is devoted mainly to health and information professionals. The bibliographic citations all the materials published in this journal, which treasures important papers related to the history of diverse health situations that have acquired new validity today, are provided. Following this chronological description, the names of the authors are arranged in alphabetical order, with links to their respective articles through numerical codes identifying them. Then, all the topics dealt with in the journal appear in alphabetical order and with links to the citations. This inventory is intended to highlight and generalize the echoes of the Gaceta Médica de la Habana on the occasion of its 130th anniversary.