Mental health impact of the COVID-19 pandemic in perinatal women living in Puerto Rico.

BACKGROUND: Studies have reported an increase in mental health disorders during the perinatal period as a result of the COVID-19 pandemic and the quarantine restrictions imposed. The effects of untreated maternal mental health have an adverse impact on the mother, the development of the baby, and the family system. Determinants of health, recent natural disasters, and disparities in perinatal care that impact perinatal women in Puerto Rico place them at a higher risk of mental health difficulties. AIM: It is therefore, of extreme importance, to evaluate the effect that the COVID-19 pandemic has had on this vulnerable population. DESIGN: This is a cross-sectional observational study that interviewed 100 women in the perinatal period during the COVID-19 lockdown measures in Puerto Rico. Participants completed the Spanish version of the COVID-19 Perinatal Experiences (COPE-IS) questionnaire and assessments of clinical depression (PHQ-9) and anxiety (GAD-7). RESULTS: The prevalence of moderate to severe risk of depression in this sample is 14%, while 17% showed clinical signs of anxiety. Concerns about social impact and the quarantine mandate were the most common stressors reported. Additionally, our sample reported concerns about the impact the pandemic would have on future employment and finances. CONCLUSION: Perinatal women showed significantly higher prevalence of depression and anxiety during the COVID -19 pandemic when compared to the mental health prevalence of the general population pre-pandemic in Puerto Rico. The concerns identified during the pandemic provide information on the importance of a biopsychosocial approach to perinatal mental health care.

Prevalence of communicable and non-communicable diseases among adult immigrants from Venezuela at a university hospital in Colombia from 2017 to 2018.

Since 2015 immigration has increased significantly into Colombia. As immigrants who are not insured to the national health system present to public hospitals for medical care. However, there is little knowledge about the prevalence of communicable and non-communicable diseases amongst them. Ours was a cross-sectional study at a university hospital reviewing 154 medical records of Venezuelan immigrants treated by the Internal Medicine Specialty between 2017 & 2018. Non-communicable diseases representing 66.3% are the main cause of hospitalization, possibly owing to poor primary care.

A randomized clinical study comparing reduced-volume oral sulfate solution with standard 4-liter sulfate-free electrolyte lavage solution as preparation for colonoscopy.

BACKGROUND: Low-volume bowel preparations for colonoscopy improve tolerability. OBJECTIVE: We compared the efficacy, tolerability, and safety of a new low-volume sulfate solution with a standard 4-L polyethylene glycol electrolyte lavage solution as bowel preparation for colonoscopy. DESIGN: Multicenter, single-blind, randomized, noninferiority study. SETTING: Five academic and community endoscopy centers in the United States. PATIENTS: One hundred thirty-six outpatients undergoing colonoscopy. INTERVENTIONS: Patients were randomized to receive 4 L sulfate-free electrolyte lavage solution (SF-ELS) given the night before colonoscopy versus 12 oz oral sulfate solution (OSS) given in equally divided doses the evening before and the morning of colonoscopy. MAIN OUTCOME MEASUREMENTS: Successful (ie, good or excellent) bowel preparation. RESULTS: Successful bowel preparation was more frequent with OSS than with SF-ELS (98.4% vs 89.6%; P = .04). Excellent preparation also was achieved more frequently with OSS (71.4% vs 34.3%; P < .001). Patients receiving OSS had less residual stool in the cecum and ascending colon and less residual fluid in the cecum and ascending, transverse, and descending colon compared with SF-ELS. The percentage of patients with GI side effects and adverse events was not significantly different between the 2 groups. LIMITATIONS: The OSS was administered in split doses, whereas the SF-ELS was administered the evening before (which is its FDA-approved regimen). CONCLUSIONS: Oral sulfate solution is promising as a safe low-volume preparation for colonoscopy. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT00856843.).

A randomized clinical study evaluating the safety and efficacy of a new, reduced-volume, oral sulfate colon-cleansing preparation for colonoscopy.

OBJECTIVES: We sought to evaluate a new, low-volume, oral sulfate solution as a bowel preparation for colonoscopy in adult patients. METHODS: The investigations were designed as two multicenter, single-blind, randomized, non-inferiority studies to show that the sulfate regimen would effect cleansing that is acceptable and equivalent to polyethylene glycol electrolyte solution with ascorbic acid (PEG-EA), and would be suitable for colonoscopy. One study evaluated same-day administration; the other compared the two study preparations given by split-dose administration in which the first portion was taken the evening before colonoscopy and the second portion on the morning of the procedure. The primary efficacy variable was based on bowel cleansing graded by an investigator who was unaware of the preparation method received. RESULTS: Study 1 randomized 408 outpatients scheduled for colonoscopy for routine indications, with 387 subjects taking the preparation. In all, 364 subjects were randomized and took the preparation in study 2. The demographics of the enrolled subjects were similar across both treatment groups in the two studies, including gender, race, and ethnic characteristics. The primary efficacy analysis supports the conclusion that the oral sulfate solution produces the same degree of cleansing as PEG-EA. Successful preparations were seen in 82.4% and 80.3% in study 1 and 97.2% and 95.6% in study 2 for the oral sulfate solution and the PEG-EA regimen, respectively. Although no difference in excellent preparations was seen in the 1-day preparation, split-dose administration resulted in more excellent preparations in the sulfate group than in the PEG-EA group (63.3 vs. 52.5%, P=0.043). Preparation-related symptoms of cramping, bloating, nausea, and vomiting were generally mild and infrequent. Sulfate subjects reported slightly increased gastrointestinal events and higher vomiting scores (P=0.009) in the 1-day preparation but not in the split-dose regimen. There were no other differences for adverse events or clinically significant laboratory findings, including no increased creatinine. CONCLUSIONS: The new 960 -ml oral sulfate solution is effective for colonoscopy cleansing and has an acceptable safety profile.

Evaluating the Performance of Cardiac Pulse Duplicators Through the Concept of Fidelity.

INTRODUCTION: The advanced design techniques used in modern prosthetic heart valve (PHV) development require accurate replication of the entire cardiac cycle. While cardiac pulse duplicator (CPD) design has a direct impact on the PHV test data generated, no clear guidelines exist to evaluate the CPD's performance. In response to this, we present a method to quantitatively assess CPD performance. MATERIALS AND METHODS: A method to establish the fidelity of CPDs was formulated based on the pressure/time relationship and the error related to this relationship's target. This method was applied to assess the performance of a custom-made CPD. The performance evaluation included the assessment of the motion control system and overall repeatability of pressure measurements using a St Jude Epic 21 mm aortic valve. RESULTS: The CPD's motion control system had an average root mean square error (RMSE) beat-to-beat tracking accuracy of 0.046 ± 0.008 mm. Assessment of the pressure measurements yielded a repeatability of < 2.4 ± 0.9 mmHg RMSE beat-to-beat differential pressure. The combination of pressure and its location within a heartbeat (fidelity) was within 5.0% of the individual targets for at least 95% of heartbeats. CONCLUSION: Fidelity can be used to objectively quantify the performance of various aspects of CPDs and to identify the cause of unexpected PHV or CPD behaviour. It also enables comparisons to be made among various CPDs in terms of overall performance. This approach may enable standardization of the assessment of CPD performance in the future.

Presentación de bacterias resistentes en hemocultivos en pacientes con patología médica en un hospital de tercer nivel

Introducción. Las bacteriemias afectan a pacientes dentro del ámbito hospitalario y se reportan tasas de mortalidad del 35%. Los microorganismos productores de beta-lactamasas de espectro extendido son cada vez más resistentes a los antibióticos. Materiales y métodos. Estudio observacional descriptivo de corte transversal en pacientes mayores de 14 años con hemocultivos positivos en el Hospital Universitario de Santander, entre 2014 y 2016. Resultados. Se analizaron 148 historia clínicas, la edad promedio fue de 55,5 años, el 51,4% eran mujeres. La proporción de gérmenes resistentes fue del 23,6%, la producción de beta-lactamasas de espectro extendido en E. coli y K. pneumoniae fue del 40%. El 100% de los pacientes con gérmenes resistentes tenía un índice de PITT severo. El S. aureus mostró un 50% de resistencia a la oxacilina. Conclusión. El 23,6% de los pacientes tenía una infección por gérmenes resistentes, los más comunes fueron E. coli y K. pneumoniae, la mortalidad general fue del 30%.

Introduction: Bacteremia affects patients in the hospital, with mortality rates reported in 35%. Microorganisms that produce beta- lactamases of extended spectrum are each time more resistant to antibiotics. Method: Observational and descriptive study in patients older tan 14 years old with positive blood cultures in Hospital Universitario de Santander, between 2014 and 2016. Results: 148 clinic records were analyzed, the mean age was 55.5 years. 51.4% were women. The proportion of resistant germs was of 23.6%, the production of beta-lactamases of extended spectrum in E. coli and K. pneumoniae was 40%. 100% of patients with resistant germs had a rate of severe PITT. S. aureus showed a 50% of resistance to oxacillin. Conclusion: 23.6% of patients had an infection for resistant germs, the most common were E. coli and K. pneumoniae. General mortality was of 30%.

Introdução: as bactérias afetam pacientes do contexto hospitalar e relatam taxas de mortalidade de 35%. Os micro-organismos produtores de beta-lactamasas de espectro estendido são cada vez mais resistentes aos antibióticos. Materiais e métodos: estudo observacional descritivo de corte transversal com pacientes maiores de 14 anos com hemoculturas positivas, no Hospital Universitario de Santander, Colômbia, entre 2014 e 2016. Resultados: foram analisados 148 prontuários; a idade média foi de 55,5 anos; 51,4 % eram mulheres. A proporção de germens resistentes foi de 23,6 %; a produção de beta-lactamasas de espectro estendido em E. coli e K. pneumoniae foi de 40%. 100% dos pacientes com germens resistentes tinham um índice de PITT severo. O S. aureus mostrou 50% de resistência à oxacilina. Conclusão: 23,6% dos pacientes tinham uma infecção por germens resistentes, os mais comuns foram E. coli e K. pneumoniae; a mortalidade geral foi de 30%.

Presentación de bacterias resistentes en hemocultivos en pacientes con patología médica en un hospital de tercer nivel / Presentation of resistant bacteria in blood cultures in patients with medical pathology in a tertiary hospital / Apresentação de bactérias resistentes em hemoculturas em doentes com patologia médica num hospital terciário

Introducción. Las bacteriemias afectan a pacientes dentro del ámbito hospitalario y se reportan tasas de mortalidad del 35 %. Los microorganismos productores de beta-lactamasas de espectro extendido son cada vez más resistentes a los antibióticos. Materiales y métodos . Estudio observacional descriptivo de corte transversal en pacientes mayores de 14 años con hemocultivos positivos en el Hospital Universitario de Santander, entre 2014 y 2016. Resultados. Se analizaron 148 historia clínicas, la edad promedio fue de 55,5 años, el 51,4 % eran mujeres. La proporción de gérmenes resistentes fue del 23,6 %, la producción de beta-lactamasas de espectro extendido en E. coli y K. pneumoniae fue del 40 %. El 100 % de los pacientes con gérmenes resistentes tenía un índice de PITT severo. El S. aureus mostró un 50 % de resistencia a la oxacilina. Conclusión. El 23,6 % de los pacientes tenía una infección por gérmenes resistentes, los más comunes fueron E. coli y K. pneumoniae, la mortalidad general fue del 30 %.

Introduction. Bacteremias affect patients in the hospital setting and mortality rates of 35% are reported. Microorganisms producing extended-spectrum beta-lactamases are increasingly resistant to antibiotics. Materials and methods . Cross-sectional descriptive observational cross-sectional study in patients older than 14 years with positive blood cultures at the Hospital Universitario de Santander, between 2014 and 2016. Results. We analyzed 148 clinical histories, the average age was 55.5 years, 51.4 % were women. The proportion of resistant germs was 23.6 %, the production of extended-spectrum beta-lactamases in E. coli and K. pneumoniae was 40 %. One hundred percent of patients with resistant germs had a severe PITT index. S. aureus showed 50 % resistance to oxacillin. Conclusion. 23.6 % of patients had infection by resistant germs, the most common were E. coli and K. pneumoniae, overall mortality was 30 %.

Introdução. As bacteriémias afectam os doentes em meio hospitalar, tendo sido registadas taxas de mortalidade de 35%. Os microrganismos que produzem beta-lactamases de espetro alargado são cada vez mais resistentes aos antibióticos. Materiais e métodos . Estudo observacional descritivo transversal em pacientes maiores de 14 anos com hemoculturas positivas no Hospital Universitário de Santander, entre 2014 e 2016. Resultados. Foram analisadas 148 histórias clínicas, a idade média foi de 55,5 anos, 51,4 % eram mulheres. A proporção de germes resistentes foi de 23,6 %, a produção de beta-lactamases de espetro alargado em E. coli e K. pneumoniae foi de 40 %. 100 % dos doentes com germes resistentes apresentavam um índice PITT grave. S. aureus apresentou 50 % de resistência à oxacilina. Conclusão. 23,6 % dos pacientes tiveram uma infeção com germes resistentes, os mais comuns foram E. coli e K. pneumoniae, a mortalidade geral foi de 30 %.

Bacteriemias en pacientes con VIH en un hospital de tercer nivel en Colombia, 2014-2016 / Bacteremias en HIV-patients in a third level hospital in Colombia, 2014-2016

Resumen: ANTECEDENTES Las infecciones del torrente sanguíneo son un problema creciente y actualmente una amenaza para la salud pública. Las bacteriemias representan 15% de todas las infecciones nosocomiales. En los pacientes con VIH el grado de inmunosupresión continúa siendo el factor de riesgo más importante. OBJETIVO Describir las características clínicas, microbiológicas y epidemiológicas de los pacientes con infección por VIH y bacteriemias. MATERIAL Y MÉTODO Estudio observacional, descriptivo, de pacientes mayores de 14 años con hemocultivos positivos del servicio de Medicina Interna del Hospital Universitario de Santander, Colombia, durante los años 2014 a 2016, con infección por VIH y que cumplieran los criterios del CDC para infección del torrente sanguíneo. RESULTADOS Se revisaron 450 expedientes, con 44 pacientes con el diagnóstico confirmado. El 59% eran hombres, el promedio de edad fue de 42 años. La mediana de linfocitos T CD4+ fue de 29 cél/mm3 y 55.8% no tenía tratamiento antirretroviral al ser diagnósticos nuevos. La mortalidad fue de 31.8%. El índice de severidad de PITT se clasificó como leve en 68.1%. El grupo de bacterias más frecuente fueron las enterobacterias, entre ellas destacó K. pneumoniae con 25%. El porcentaje de gérmenes resistentes (E. coli y K. pneumoniae BLEE, P. aeuruginosa MDR, A. baumanii MDR y S. aureus MR) fue de 26.9%. CONCLUSIONES El grupo de pacientes con VIH en la institución es superior al de otras series. Uno de cada cuatro pacientes con infección por VIH y bacteriemias tiene microorganismos resistentes.

Abstract: BACKGROUND Bloodstream infections are a growing problem and currently a threat to public health. Bacteremia accounts for 15% of all nosocomial infections. In patients with HIV, the degree of immunosuppression continues to be the most important risk factor. OBJECTIVE To describe the clinical microbiological and epidemiological characteristics of patients with HIV infection and bacteremia. MATERIAL AND METHOD A descriptive observational study with patients over 14 years of age with positive blood cultures from the internal medicine service of the Hospital Universitario de Santander, Colombia, between 2014 and 2016, with HIV infection and who met the CDC criteria for torrent infection. RESULTS We reviewed 450 records, 44 patients with confirmed diagnosis. 59% were men; the mean age was 42 years. The median of CD4+T lymphocytes count was 29 cells/mm3, 55.8% had no antiretroviral treatment because they were new diagnoses. The mortality rate was 31.8%. The PITT severity index was classified as mild at 68.1%. The most frequent group of bacteria was the Enterobacteriaceae including K. pneumoniae with 25%. The percentage of resistant germs (E. coli and K. pneumoniae BLEE, P. aeuruginosa MDR, A. baumanii MDR and S. aureus MR) was 26.9%. CONCLUSIONS The group of patients with HIV in our institution is superior to other series. One in four patients with HIV infection and bacteremia have resistant microorganism.

In vitro characterization of an aortic bioprosthetic valve using Doppler echocardiography and qualitative flow visualization.

A 19 mm diameter prototype bioprosthetic valve mounted in a cardiac pulse duplicator was characterized using Doppler echocardiography and qualitative flow visualization at a heart rate of 72 bpm. Analysis of the flow visualization images revealed that the prototype and control valve leaflets open symmetrically but close asymmetrically. The asymmetry in the closing of the valves is likely due to the large pressure gradients across the valves and may have implications for the long term mechanical failure of the valves. The relatively high peak systolic velocity of 309.9 cm/s, which was measured in the prototype 19 mm valve, can be attributed to the small valve diameter and the high cardiac output used in the current study.

Riesgo ergonómico en empresas artesanales del sector de la manufactura, Santander. Colombia / Ergonomic risk craft enterprises manufacturing sector, Santander. Colombia

Introducción: Es importante reconocer que algunas profesiones del ramo de la manufactura no tienen de manera estandarizada programas en ergonomía, por lo tanto se requiere reconocer dichas limitaciones, las cuales podrían desencadenar en patologías musculares, altos índices de ausentismo y disminución en la productividad. Objetivos: Determinar el perfil de riesgo ergonómico de las empresas artesanales de tabaco y joyería de la región de Santander, Colombia en el año 2010.Materiales y métodos: Se trató de un estudio descriptivo de corte transversal donde la población encuestada fueron empresas del sector de la manufactura de los sub-sectores artesanales tabacalero y joyero. La unidad de análisis principal fue la empresa. Se diligenció un instrumento que identificaba rasgos de la cultura ergonómica de las empresas. Resultados: Se encuestaron 15 empresas tabacaleras y 10 joyeras. Las empresas no cuentan con políticas en salud ocupacional en 73% para el sector tabaco y en 80% para el sector joyero. En ambos sectores la repetitividad fue el factor ergonómico más prevalente con 80% y 36,4% respectivamente. A su vez, 60% de las empresas del tabaco tienen establecido la elaboración de rediseño de puesto de trabajo, en relación al 10% presentado por las empresas joyeras, finalmente en ambos sectores se encontró un porcentaje no superior al 13% sobre realización de capacitaciones sobre control de riesgos ergonómicos a sus trabajadores. Conclusiones: El perfil de riesgo ergonómico en el sector tabacalero y joyero artesanal se muestra incipiente, considerando estar influenciado por factores como desconocimiento del tema y falta de compromiso gerencial en la implementación de programas que ayuden a minimizar las enfermedades derivadas de las actividades que se desarrollan en cada uno de los sectores (AU)

Introduction: It is important to recognize that some professions the manufacturing industry have no standardized way in ergonomics programs therefore requires recognizing these limitations, which could lead to muscle diseases, high rates of absenteeism and decreased productivity. Objectives: Determine the ergonomic risk profile of the craft and jewelry snuff in the region of Santander, Colombia in 2010.Methods: This survey was a descriptive cross-sectional study where people were surveyed companies manufacturing sub-sectors of the tobacco and handmade jewelry. The main unit of analysis was the company. He filled out an instrument that identified ergonomic features of the culture of the companies. Results: We interviewed 15 tobacco companies and 10 jewelers. Companies do not have policies on occupational health in 73% to snuff sector and 80% for the jewelery sector. In both sectors the ergonomic factor repeatability was the most prevalent with 80% and 36.4% respectively. In turn, 60% of companies have established snuff redesign making job, compared to 10% presented by jewelery companies, in both sectors finally found a rate not exceeding 13% on completion of training on ergonomic risk control their workers. Conclusions: Ergonomic risk profile ergonomic in the tobacco industry and craft jeweler shows incipient considering be influenced by factors such as ignorance of the subject and lack of management commitment to implement programs to help minimize disease arising from activities taking place in each of the sectors (AU)

Medical Care of the Patient With Compensated Cirrhosis.

The prevalence of liver disease and its complications is rapidly increasing in the United States. Gastroenterologists and hepatologists provide most of the medical care for patients with chronic liver disease and cirrhosis. While most gastroenterologists and hepatologists are comfortable managing the serious complications related to cirrhosis, many fail to provide the necessary education, prevention, and treatment for non-life-threatening problems associated with cirrhosis. Health-related quality of life has been found to strongly correlate with how well cirrhosis-related problems are addressed in the outpatient setting. This paper will review the outpatient management of patients with stable cirrhosis, including the surveillance and health maintenance recommendations necessary to monitor, prevent, or delay the onset of serious complications.

Estado de la ventilación pulmonar en fumadores activos y pasivos / State of pulmonary ventilation in active and passive smokers

Se realiza un estudio de cohorte histórico que analiza la repercusión del hábito de fumar en la ventilación pulmonar. Como universo se toma la población de 15 y más años del municipio Camagüey y como unidad de análisis, cada individuo procedente de 3 cohortes retrospectivos (fumador activo, pasivo y no fumador). Se valoran los resultados espirométricos de ventilación pulmonar disminuida y se realiza una encuesta que incluyó examen clínico y microespirometría a las 120 personas (40 procedentes de cada cohorte). Se señala que el 60 porciento de los fumadores presentó alteración en la ventilación pulmonar con primacía de los fumadores activos (80 porciento), la combinación cigarrillos-puros ofrece mayor repercusión en la ventilación pulmonar. El tiempo diario de exposición al humo del cigarro afecta de manera estable al fumador activo, mientras que el riesgo aumenta en el fumador pasivo a medida que es mayor el tiempo de exposición al día. El examen físico es un patrón relevante para el diagnóstico precoz de daño ventilatorio, sin necesidad de prueba especializada

Estudio de las características psicométricas del inventario de ansiedad Beck (en castellano) en una muestra de envejecidos puertorriqueños / Psychometric features of the Beck Anxiety Inventory (Spanish version) with a Puerto Rican elderly sample

OBJETIVO: El presente estudio fue diseñado para evaluar las características psicométricas del Inventario de Ansiedad Beck (BAI) en una muestra de envejecidos puertorriqueños. Para esto se establecieron los siguientes objetivos: 1) evaluar la prevalencia de ansiedad en dicha muestra, 2) evaluar la consistencia interna del inventario y 3) realizar un análisis de estructura factorial del BAI. MATERIAL Y MÉTODO: El BAI y la planilla demográfica se administraron a una muestra de 150 personas entre las edades de 60 a 99 años. De éstos, 100 participantes residen en égidas del área metropolitana de Puerto Rico y 50 en la comunidad de la misma región. El concepto de égidas ha sido definido por la Oficina de Asuntos de la Vejez del Gobierno de Puerto Rico como lugar de residencia multi-pisos de ancianos funcionales. RESULTADOS: Los resultados indicaron: 1) que un 28,9 por ciento de la muestra mostró síntomas de ansiedad entre moderados y severos según medido por el BAI, 2) que el BAI mostró tener una alta consistencia interna según el coeficiente alfa de Cronbach (0,94) y 3) que la composición factorial del BAI se modifica a tres factores en una muestra de envejecidos puertorriqueños. CONCLUSIONES: Los resultados obtenidos sugieren que el BAI, en castellano, es un instrumento adecuado para medir ansiedad en ancianos puertorriqueños. Además, presentan la necesidad de investigar más a fondo la prevalencia y sintomatología de la ansiedad en dicha población (AU)