High-risk pregnancy and its relationship with the neurodevelopment and behavior of 2-year-old children.

High-risk pregnancies elevate maternal stress, impacting offspring neurodevelopment and behavior. This study, involving 112 participants, aimed to compare perceived stress, neurodevelopment, and behavior in high-risk and low-risk pregnancies. Two groups, high-risk and low-risk, were assessed during pregnancy for stress using hair cortisol and psychological analysis. At 24 months post-birth, their children's neurodevelopment and behavior were evaluated. Results revealed higher perceived stress and pregnancy-related concerns in high-risk pregnancies, contrasting with low-risk pregnancies. Offspring from high-risk pregnancies displayed elevated internalizing behavior scores, while low-risk pregnancies showed higher externalizing behavior scores. Additionally, women in low-risk pregnancies exhibited increased cortisol concentrations 24 months post-delivery. These findings underscore the necessity for early stress detection and prevention programs during pregnancy, particularly in high-risk cases, to enhance maternal and infant health.

The Structure-Antiproliferative Activity Relationship of Pyridine Derivatives.

Pyridine, a compound with a heterocyclic structure, is a key player in medicinal chemistry and drug design. It is widely used as a framework for the design of biologically active molecules and is the second most common heterocycle in FDA-approved drugs. Pyridine is known for its diverse biological activity, including antituberculosis, antitumor, anticoagulant, antiviral, antimalarial, antileishmania, anti-inflammatory, anti-Alzheimer's, antitrypanosomal, antimalarial, vasodilatory, antioxidant, antimicrobial, and antiproliferative effects. This review, spanning from 2022 to 2012, involved the meticulous identification of pyridine derivatives with antiproliferative activity, as indicated by their minimum inhibitory concentration values (IC50) against various cancerous cell lines. The aim was to determine the most favorable structural characteristics for their antiproliferative activity. Using computer programs, we constructed and calculated the molecular descriptors and analyzed the electrostatic potential maps of the selected pyridine derivatives. The study found that the presence and positions of the -OMe, -OH, -C=O, and NH2 groups in the pyridine derivatives enhanced their antiproliferative activity over the cancerous cellular lines studied. Conversely, pyridine derivatives with halogen atoms or bulky groups in their structures exhibited lower antiproliferative activity.

Efficient and Sustainable Bidentate Amines-Functionalized Resins for Removing Ag+, Cu2+, Pb2+, and Fe3+ from Water.

We evaluate the effectiveness of chelating resins (CR) derived from Merrifield resin (MR) and 1,2-phenylenediamine (PDA), 2,2'-dipyridylamine (DPA), and 2-(aminomethyl)pyridine (AMP) as adsorbent dosimeters for Ag+, Cu2+, Fe3+, and Pb2+ cations from water under competitive and noncompetitive conditions. MR-PDA, MR-DPA, and MR-AMP were obtained in a 95-97% yield and characterized by IR, fluorescence, and SEM. The ability of CRs as adsorbents was determined by batch and flow procedures. MR-PDA showed a batch adsorption capacity order of Fe3+ (29.8 mg/g) > Ag+ (2.7 mg/g) > Pb2+ (2.6 mg/g) at pH 3.4. The flow adsorption showed affinity towards the Ag+ cation at pH 7 (18.4 mg/g) and a reusability of 10 cycles. In MR-DPA, the batch adsorption capacity order was Ag+ (9.1 mg/g) > Pb2+ (8.2 mg/g) > Cu2+ (3.5 mg/g) at pH 5. The flow adsorption showed affinity to the Cu2+ cation at pH 5 (2.2 mg/g) and a reuse of five cycles. In MR-AMP, the batch adsorption capacity was Ag+ (17.1 mg/g) at pH 3.4. The flow adsorption showed affinity to the Fe3+ cation at pH 2 (4.3 mg/g) and a reuse of three cycles. The three synthesized and reusable CRs have potential as adsorbents for Ag+, Cu2+, Fe3+, and Pb2+ cations and showed versatility in metal removal for water treatment.

Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group.

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

When Is Sentinel Node Biopsy Indicated in High-Risk Ductal Carcinoma in situ? Four Hundred Sixty-Eight Cases from Three Institutions.

INTRODUCTION: Sentinel lymph node biopsy (SLNB) in ductal carcinoma in situ (DCIS) is not indicated. However, in certain cases (size >3 cm, high grade, mass effect on mammography, or palpable mass), it may be possible to find incidental invasive carcinoma (IC) that requires an SLNB. We studied the correlation of the aforesaid factors with the probability of finding IC in the surgical specimen. METHODS: Data was collected from 3 different institutions between 2010 and 2016, recording characteristics such as, but not limited to: high grade, size >3 cm, mass effect on mammography, and palpable mass. RESULTS: On the whole, 468 "high-risk" DCIS cases were identified, 139 (29%) of which had IC. When the DCIS was high grade or the size was >3 cm, there was no significant difference in the probability of finding IC in the surgical specimen (OR = 1.13; 95% CI 0.84-1.51; OR = 1.2; 95% CI 0.85-1.40). Nevertheless, when a high grade and size (>3 cm) were combined, IC was more likely to exist (72.7 vs. 27.3%; p = 0.001). In addition, mass effect and palpation were independently associated with a significantly greater degree of IC (OR = 12.76; 95% CI 6.93-23.52). CONCLUSIONS: The results suggest that high-grade DCIS or DCIS with a size >3 cm, independently, does not require SLNB. Nonetheless, in the event that both factors are found in the same case, SLNB may be indicated. Additionally, SLNB is advisable for DCIS cases that are palpable or show a mass effect on mammography.

[Cognitive-behavioral therapy as a damper of the negative psychological effects of confinement by COVID-19 on pregnant women.] / La terapia cognitiva-conductual como amortiguadora de los efectos psicológicos negativos del confinamiento por la COVID-19 en mujeres embarazadas.

OBJECTIVE: The pandemic caused by COVID-19, at a psychological level, can cause an increase in levels of stress and anxiety due to the fear of contagion and its consequences. Pregnant women are especially vulnerable to these psychological consequences. Thus, the objective of this study was to verify the efficacy of a cognitive-behavioral stress control program in reducing psychological stress and increasing resilience in pregnant women, which ended at the begining of the confinement due to COVID-19 in Spain. METHODS: The study included 22 pregnant women who were randomly divided into two groups: the experimental group (GT) consisted of 11 participants and the control group (GC) also consisted of 11 participants. Participants were recruited from the Hospital Universitario Clínico San Cecilio in the province of Granada (Spain), where the weekly cognitive behavioral intervention was also carried out, which was implemented between January 22 and March 11, 2020. They used the assessment instruments: Pregnancy Distress Questionnaire (PDQ), Perceived Stress Scale (EEP-14), Inventory of Vulnerability to Stress (IVE) and Connor Davidson Resilience Scale (CD-RISC). A mixed ANOVA of repeated measures 2*2 was performed, with the variable between groups having two levels (CG and GT), and the within-subject having two time periods (pre and post). RESULTS: The repeated measures ANOVA analysis showed group*time interaction effects between the therapy group and the control group and the CD-RISC scores (F1,20=10.658; p<0.02). Intrasubject differences in CD-RISC scores were found in the (GT) (t=-2.529; p<0.05), with a moderate effect size. CONCLUSIONS: It can be affirmed that cognitive behavioral intervention in pregnant women, administrated prior to confinement in Spain and during the COVID-19 pandemic, has resulted in increased levels of resilience in this population.

OBJETIVO: La pandemia provocada por la COVID-19, a nivel psicológico, puede producir un aumento en los niveles de estrés y ansiedad por el miedo al contagio y sus consecuencias. Un grupo especialmente vulnerable a dichas consecuencias psicológicas es el de mujeres embarazadas. Así, el objetivo de este estudio fue comprobar la eficacia de un programa de control del estrés, de carácter cognitivo-conductual, en la reducción de estrés psicológico y el aumento de la resiliencia en mujeres embarazadas, que finalizó en el momento de la instauración del confinamiento por la COVID-19 en España. METODOS: El estudio quedó constituido por veintidós mujeres embarazadas que fueron divididas en dos grupos de forma aleatoria: once constituyeron el grupo experimental (GT) y once el grupo control (GC). Las participantes fueron reclutadas del Hospital Universitario Clínico San Cecilio de la provincia de Granada (España), donde también se llevó a cabo la intervención cognitivo-conductual de carácter semanal, que se implementó entre el 22 de enero y el 11 de marzo de 2020. Se emplearon los siguientes instrumentos de evaluación: Cuestionario de Preocupaciones Prenatales (PDQ), Escala de Estrés Percibido (EEP-14), Inventario de Vulnerabilidad al Estrés (IVE) y Escala de Resiliencia de Connor y Davidson (CD-RISC). Se realizó un ANOVA mixto de medidas repetidas 2*2, teniendo la variable entre grupos dos niveles (GC y GT), y la variable intrasujeto dos momentos temporales (pre y post). RESULTADOS: El análisis ANOVA de medidas repetidas mostró efectos de interacción grupo*tiempo entre los grupos de terapia y control y las puntuaciones del CD-RISC (F1,20=10,658; p<0,02). Se encontraron en el grupo de terapia diferencias intrasujeto en las puntuaciones del CD-RISC (t=-2,529; p<0,05), con un tamaño del efecto medio. CONCLUSIONES: Se puede afirmar que la intervención cognitivo-conductual en mujeres embarazadas, impartida de manera previa al confinamiento en España y durante la pandemia provocada por la COVID-19, ha provocado un incremento de los niveles de resiliencia en dicha población.

Wall-corner classification using sonar: a new approach based on geometric features.

Ultrasonic signals coming from rotary sonar sensors in a robot gives us several features about the environment. This enables us to locate and classify the objects in the scenario of the robot. Each object and reflector produces a series of peaks in the amplitude of the signal. The radial and angular position of the sonar sensor gives information about location and their amplitudes offer information about the nature of the surface. Early works showed that the amplitude can be modeled and used to classify objects with very good results at short distances-80% average success in classifying both walls and corners at distances less than 1.5 m. In this paper, a new set of geometric features derived from the amplitude analysis of the echo is presented. These features constitute a set of characteristics that can be used to improve the results of classification at distances from 1.5 m to 4 m. Also, a comparative study on classification algorithms widely used in pattern recognition techniques has been carried out for sensor distances ranging between 0.5 to 4 m, and with incidence angles ranging between 20° to 70°. Experimental results show an enhancement on the success in classification rates when these geometric features are considered.

Neurodevelopment of high and low-risk pregnancy babies at 6 months of age.

OBJECTIVE: to compare neurodevelopment differences between babies born from low-risk pregnancies and babies born from high-risk pregnancies. STUDY DESIGN: Longitudinal design SETTING: Spain PARTICIPANTS: A total of 91 women participated in the study, divided into two groups: 49 women in the low-risk pregnancy group and 42 women in the high-risk group. MEASUREMENT AND FINDINGS: The average amount of cortisol in pregnant mothers' hair was determined in both groups. Following their birth, the babies' neurodevelopment was evaluated using the Bayley-III instrument at 6 months of age and a new sample of cortisol was obtained from both the baby and the mother. The results showed that pregnancy risk group could predict cognitive, fine motor, gross motor and general motor neurodevelopment. KEY CONCLUSIONS: These results seem to show that an appropriate treatment tailored to the needs of individualised pregnancies may favor babies' neurodevelopment, including that of babies born from high-risk pregnancies. IMPLICATIONS FOR RESEARCH: It is essential to take special care of pregnant women no matter their medical condition and offer them the best medical care available.

Surgical nursing care in the operating room: an integrative review / Cuidado cirúrgigo de enfermagem em salas de cirurgia: uma revisão integrativa / Cuidado quirúrgico de enfermería de sala de operaciones: una revisión integrativa

ABSTRACT Objective: to identify the state-of-the-art developed about surgical Nursing care in the operating room. Method: an integrative review with search and selection of primary studies conducted in April and May 2022 in four major data sources in the health field, namely: LILACS, SciELO, BDENF and PubMed, from 2018 to 2022. The sample consisted of 13 studies, 8 selected from a universe of 293 articles and 5 obtained through the manual search. Results: three categories were generated: Associating surgical care with care, people and material resources management for patient safety; Surgical care and ethical sensitivity in the search for patients' well-being; and Operating room nurses' manifestation and omission experiences and surgical care. Conclusions: surgical Nursing care in the operating room is varied and is manifested through meeting the administrative demands, ethical sensitivity, body temperature maintenance, preservation of individuality and meeting all the needs in the intraoperative period when patients are more vulnerable, including being duly informed as a way to provide safe surgical care. On the other hand, nurses acknowledge the need to change their world view and direct surgical care towards a more human, social and cultural perspective.

RESUMO Objetivo: identificar o estado da arte que foi desenvolvido sobre os cuidados cirúrgicos do enfermeiro da sala de cirurgia. Método: revisão integrativa com pesquisa e seleção de estudos primários realizada entre abril e maio de 2022 em quatro fontes de dados destacadas no campo da saúde: LILACS, SciELO, BDENF e PubMed de 2018 a 2022. A amostra consistiu-se de 13 estudos, 8 selecionados de um total de 293 artigos e 5 pesquisados manualmente. Resultados: foram geradas três categorias: associação do cuidado cirúrgico com a gestão dos cuidados, pessoas e recursos materiais para a segurança do paciente; cuidado cirúrgico e sensibilidade ética na busca do bem-estar do paciente e as experiências de manifestação e omissão do enfermeiro da sala de cirurgia e o cuidado cirúrgico. Conclusões: o cuidado cirúrgico na sala de cirurgia é variado e se manifesta através da atenção às exigências administrativas, sensibilidade ética, manutenção da temperatura corporal, preservação da individualidade e atenção a todas as necessidades no ambiente intra-operatório onde o paciente é mais vulnerável, incluindo o dever de estar informado como um meio de proporcionar um cuidado cirúrgico seguro. Por outro lado, reconhece a necessidade de mudar sua cosmovisão e direcionar os cuidados cirúrgicos para uma perspectiva mais humana, social e cultural.

RESUMEN Objetivo: identificar el estado de arte que se ha desarrollado sobre el cuidado quirúrgico de la enfermera de sala de operaciones. Método: revisión integrativa con indagación y selección de estudios primarios efectuada en abril y mayo de 2022 en cuatro fuentes de datos destacadas en el campo de la salud: Lilacs, SciELO, BDENF y PubMed de 2018 a 2022. La muestra se conformó por 13 estudios, 8 seleccionados de un universo de 293 artículos y 5 de búsqueda manual. Resultados: se generaron tres categorías: asociando cuidado quirúrgico con gestión de cuidado, de personas y de recursos materiales para la seguridad del paciente; el cuidado quirúrgico y la sensibilidad ética en la búsqueda de bienestar para el paciente y las experiencias de manifestación y omisión del enfermero de quirófano y el cuidado quirúrgico. Conclusiones: el cuidado quirúrgico en la enfermera de sala de operaciones es variado y se manifiesta a través de la atención a las demandas administrativas, la sensibilidad ética, el mantenimiento de la temperatura corporal, conservación de la individualidad y atención a todas las necesidades en el intraoperatorio donde el paciente es más vulnerable, incluyendo el estar informada como una forma de brindar un cuidado quirúrgico seguro. Por otro lado, reconoce la necesidad de cambiar su visión de mundo y dirigir el cuidado quirúrgico hacia una mirada más humana, social y cultural.

Osteomielitis crónica agudizada del maxilar. Presentación de un caso pediátrico / Acute chronic osteomyelitis of the maxilla. Presentation of pediatric case / Osteomielite crônica aguda da maxila. Apresentação de um caso pediátrico

RESUMEN Se presentó el caso de una paciente femenina de 9 años con historia de traumatismo a nivel de incisivos centrales superiores, por lo cual recibió tratamiento para apicoformación con hidróxido de calcio durante un periodo prolongado, que luego de realizarle la obturación de los conductos radiculares presentó un cuadro de inflamación aguda en labio superior y vestíbulo bucal. El tratamiento incluyó terapia antimicrobiana, desbridamiento quirúrgico amplio bajo anestesia general, apicectomía de ambos incisivos, obturación a visión directa de los conductos y sellado apical de los dientes con gutapercha. El diagnóstico anatomopatológico fue el de osteomielitis crónica agudizada del maxilar. Año y medio después se observó ausencia clínica de signos inflamatorios y adecuada cicatrización del tejido óseo. Se concluyó que, aunque los reportes de osteomielitis crónica del hueso maxilar son escasos, debe estar presente dentro del diagnóstico diferencial cuando se evalúan pacientes en edad pediátrica con historia de traumatismo dentoalveolar y procesos inflamatorios en la región maxilofacial.

ABSTRACT A nine-year old female patient presented with a history of trauma to the upper central incisors. She received treatment for apicoforming with calcium hydroxide for a prolonged period, who after root canal obturation presented acute inflammation of the upper lip and buccal vestibule. Treatment included antimicrobial therapy, extensive surgical debridement under general anesthesia, apicoectomy of both incisors, and direct visual obturation of the canals and apical sealing of the teeth with gutta-percha. The anatomopathologic diagnosis was acute chronic osteomyelitis of the maxilla. One and a half years later, clinical absence of inflammatory signs and adequate healing of the bone tissue were observed. It was concluded that, although reports concerning chronic osteomyelitis of the maxillary bone are rare events, this type of infection should be always present at the time of the differential diagnosis for evaluating pediatric patients with a history of dentoalveolar trauma and inflammatory processes in the maxillofacial region.

RESUMO Apresentamos o caso de uma paciente feminina de 9 anos de idade com histórico de trauma nos incisivos centrais superiores, para a qual ela recebeu tratamento para apicoformação com hidróxido de cálcio por um período prolongado, que após a obturação do canal radicular apresentou inflamação aguda do lábio superior e vestíbulo vestibular. O tratamento incluiu terapia antimicrobiana, desbridamento cirúrgico extensivo sob anestesia geral, apicoectomia de ambos os incisivos, obturação visual direta dos canais e vedação apical dos dentes com guta-percha. O diagnóstico patológico foi uma osteomielite crônica aguda da maxila. Um ano e meio depois, houve uma ausência clínica de sinais inflamatórios e uma cicatrização adequada do tecido ósseo. Concluiu-se que, embora os relatos de osteomielite crônica do osso maxilar sejam escassos, ela deveria estar presente no diagnóstico diferencial ao avaliar pacientes pediátricos com histórico de trauma dentoalveolar e processos inflamatórios na região maxilofacial.

Una mirada fenomenológica social al cotidiano de la gestión de la enfermera jefa de servicio / A Phenomenological Approach to the Daily Management Practice in the Head Nurse of the Service

Introducción: La inquietud surge como enfermera asistencial, percibiendo el trabajo diario de la enfermera jefa de servicio como sobrecargado y estresante. Está relacionado al quehacer cotidiano de la enfermera jefa, un área poco investigada. Objetivo: Comprender el cotidiano de la gestión de la enfermera jefa de servicio. Métodos: El abordaje teórico metodológico fue la fenomenología social de Alfred Schütz. El escenario, el Hospital Central de la Fuerza Aérea del Perú en el año 2018 a 2019. La muestra, conformada por diez enfermeras jefes de servicio, seleccionadas mediante saturación de discursos, utilizándose como técnica de recolección de datos la entrevista fenomenológica, como instrumento una guía de entrevista y para el análisis de los datos se utilizó el análisis temático. Resultados: Se generaron 2 categorías: "Asumiendo la responsabilidad y el liderazgo en la gestión del cotidiano de un servicio de Enfermería" y "Compartiendo intersubjetividades al interactuar con otros semejantes en el mundo de vida cotidiano". Conclusiones: La enfermera jefa de servicio en la gestión de su cotidiano tiene muy arraigado el sentido de responsabilidad atribuido al cargo, interactúa no solo con el equipo de enfermería, sino también con médicos y autoridades militares, encuentra muchas veces dificultades en hacerles entender las necesidades del servicio, sin embargo, en el cotidiano maneja estas intersubjetividades mediante su acervo de conocimientos(AU)

Introduction: The concern arises in the practice as a nurse, perceiving the daily work of the head nurse of the service as overloaded and stressful. It is associated with the daily work of the head nurse, an area little investigated. Objective: To understand the daily practice of the head nurse of the service. Methods: The theoretical-methodological approach was Alfred Schütz's social phenomenology. The setting was the Central Hospital of the Peruvian Air Force in the year 2018 to 2019. The sample was made up of ten service chief nurses, selected through saturation of speeches, using the phenomenological interview as a data collection technique; as an instrument, an interview guide was used and thematic analysis was used for data analysis. Results: Two categories were generated: "Assuming responsibility and leadership in the daily practice of a nursing service" and "Sharing intersubjectivities when interacting with other peers in the world of daily practice". Conclusions: The head nurse of the service, in the management of her daily practice, has a deep-rooted sense of responsibility attributed to the position. She interacts not only with the nursing team, but also with doctors and military authorities, often coming across difficulties in making them understand their needs. However, in everyday practice, the head nurse handles these intersubjectivities through her or his wealth of knowledge(AU)

Analysis of response patterns on the MMPI-2 in psychiatric prison inmates.

In order to assess mental health status, and the classification of both the overreporting and underreporting scales and indexes, 102 psychiatric prison inmates deemed mentally incompetent to stand trial completed the Spanish adaptation of the MMPI-2 under standard instructions (honest responding). The results showed patterns of consistent, non-random, nor extremely acquiescent responses. Moreover, no-outlier responses were detected. In line with the psychiatric diagnosis, all the psychiatric prison inmates were classified by the basic clinical scales as clinical cases of the psychotic dyad i.e., schizophrenia and paranoid ideation. The overreporting scales and indexes (i.e., F, K, Fb, F-K, Fp, Ds and FBS) classified the participants as malingerers, whereas the L, Wsd, and Od underreporting scales as good feigners. These scales assessing impression management i.e., consciously faking good biased responses, did not classify overreporters. Thus, they are robust indicators of honest responding among psychiatric prison inmates. The implications of these results for the practice of forensic psychology are discussed.

Se ha realizado un estudio ex post facto en una población de 102 penados psiquiátricos que respondieron bajo instrucciones estándar a la adaptación española del MMPI-2, con el objetivo de conocer el estado mental informado en el MMPI-2, así como el comportamiento de los indicadores de simulación y de disimulación. En los protocolos de respuesta no se observaron casos de outliers, patrones de respuestas totalmente azarosos o extremadamente aquiescentes, al tiempo que eran consistentes. Todos los penados psiquiátricos fueron clasificados, en consonancia con el diagnóstico psiquiátrico, en las escalas clínicas básicas como casos clínicos en la díada psicótica (i.e., esquizofrenia e ideación paranoide). Las escalas e índices de simulación utilizados (i.e., F, K, Fb, F-K, Fp, Ds y FBS) los clasificaron como simuladores, en tanto las escalas de medida de la disimulación L, Wsd y Od los clasificaron como disimuladores. Estas escalas, que forman parte del manejo de la impresión, esto es, de la manipulación favorable y consciente de la imagen, no informan de casos en poblaciones de simuladores. Así, éstas escalas serían indicadores robustos de no simulación. Finalmente, se discuten las implicaciones de estos resultados para la práctica forense.

[Incidence of hip fracture in Spain (1997-2010)]. / Incidencia de la fractura de fémur en España (1997-2010).

BACKGROUND AND OBJECTIVE: To analyse differences in the incidence of hip fracture in people older than 65 years in the 17 autonomous communities (AA. CC.) (regions) of the Spanish state in the 1997-2010 period. MATERIAL AND METHODS: Ecological, observational and retrospective study that includes people≥65 year old who have suffered a hip fracture in Spain over 14 years. These records are taken from the minimum basic data set of patients treated in all hospitals of Spain. RESULTS: The analysis include 534,043 hip fractures in≥65 year olds (414,518 women and 119,525 men). A percentage of 85.4 of hip fractures occurred in people≥75 years (86.7% women; 80.7% men). The adjusted hip fracture rate/100,000/year was 722.6 in women and 284.8 in men. AA. CC. with women above the average of the country were 7, including Catalonia, Comunidad Valenciana and Castilla-La Mancha. Six AA. CC. had patients below the average, including Canary Islands and Galicia. In AA. CC. with highest and lowest adjusted hip fracture rate/100,000/year, the difference was 44% lower in women (Canary vs. Castilla-La Mancha) and 50% lower in men (Galicia vs. Catalonia). CONCLUSIONS: The analysis of the incidence of hip fracture in Spain in people≥65 year old shows a significant variability between AA. CC. Except in Canary Islands, this variability is difficult to explain only by factors such as population age, sun exposure or north-south gradient. Additional studies are needed to analyse the causes of these important differences between Spanish AA. CC.

Caracterización clínica-epidemiológica de la hipertensión arterial / Clinical-epidemiological characterization of arterial hypertension

Introducción: La hipertensión arterial constituye uno de los problemas médicos más importantes de la medicina contemporánea en los países desarrollados y se le ha denominado la plaga silenciosa del Siglo XXI. Objetivo: Caracterizar clínica y epidemiológicamente la hipertensión arterial en pacientes hipertensos. Métodos: Se realizó un estudio observacional, descriptivo, de corte longitudinal prospectivo. El universo estuvo constituido por 193 pacientes hipertensos de la población del consultorio 7 del Policlínico: Aleida Fernández Chardiet, en el período comprendido entre enero y diciembre del año 2017. Se utilizaron distribuciones de frecuencias, cálculos porcentuales y medidas de tendencia central. Resultados: Del total de pacientes, 48,7 por ciento pertenecía al grupo de edad 40 y 59 años. Predominaron las féminas (112/58,03 por ciento) y los pacientes de piel negra (36,8 por ciento). El factor de riesgo modificable que predominó fue el tabaquismo, presente en 62,7 por ciento 55,4 por ciento presentó cifras de tensión arterial controladas. La mayoría usaba 2 fármacos antihipertensivos (44,6 por ciento). Conclusiones: La hipertensión arterial en el adulto es mejor controlada a menor edad y cuando se utilizan dos fármacos. El principal factor de riesgo de los hipertensos fue el tabaquismo(AU)

Introduction: Hypertension is one of the most important medical problems of contemporary medicine in developed countries and it has been named the silent plague of the twenty-first century. Objective: To describe clinical and epidemiologically arterial hypertension in hypertensive patients. Methods: An observational, descriptive and prospective longitudinal study was carried out. The sample was of 193 hypertensive patients of the population belonging to the Family Doctor's office num. 7, Aleyda Fernández Chardiet Teaching Polyclinic, in the period between January and December, 2017. Frequency distributions, percentage calculations and measures of central tendency were used. Results: Of the total number of patients, 48.7 percent belonged to the age group from 40 to 59 years. There was a predominance of females (112; 58.03 percent) and patients with black skin (36.8 percent). The predominant modifiable risk factor was smoking habit that was present in the 62.7 percent; while the 55.4 percent presented controlled blood pressure´s numbers. Most of the patients used two antihypertensive drugs (44.6 percent). Conclusions: Hypertension in adults is better controlled at a lower age and when using two drugs. The main risk factor of hypertensive patients was smoking habit(AU)

Analysis of perinatal mortality in newborn infants with a birth weight of less than 1000 grams in Hospital San Cecilio in Granada (Spain) over the 1991-2010 period.

INTRODUCTION: Perinatal mortality has significantly decreased over the last decades. Low birth weight and prematurity are amongst the strongest predictors of neonatal death. The main objective is to analyze the evolution of perinatal mortality and its causes in newborn infants with a birth weight of less than 1000 grams over the last 20 years (1991-2010). POPULATION AND METHODS: Observational, descriptive, longitudinal and ecological study. A total of 264 infants weighing less than 1000 g out of a total of 56 024 births during the study period. Different specific perinatal mortality rates by weight were calculated. The Spearman's Rho correlation coefficient was applied to assess the relationship between mortality rates and years of study, and ANOVA and Mann-Whitney test were used to compare five-year periods and ten-year periods, respectively. RESULTS: There were 131 perinatal deaths, 82 stillbirths and 49 early neonatal deaths; 64.1% of them occurred before 27 weeks of gestation. Only the fetal mortality rate was statistically significant, although perinatal mortality showed a downward trend, without reaching significance. The main immediate causes of death were extreme prematurity, intrauterine hypoxia and infection. The underlying causes related to death in this group of newborn infants were infection caused by premature rupture of membranes, maternal hypertension, uncontrollable preterm labor and twin pregnancy. CONCLUSIONS: The reduction in mortality rates in this group of newborn infants is undergoing a slowdown.

Surgical procedures before and after starting chronic hemodialysis in a predominantly male population with high prevalence of diabetes.

PURPOSE: The purposes of this study were to analyze changes in the frequency of different categories of surgical procedures after initiation of chronic hemodialysis (HD) and to identify the types of procedures associated with in-hospital postoperative mortality. METHODS: This was a retrospective analysis of surgical procedures performed in an incident HD population of 392 patients followed in the dialysis unit of one hospital over 15 years. Among these patients, 384 were men and 258 had diabetes mellitus. At the start of HD, age of the patients was 66.3 ± 11.2 years and Charlson index 5.35 ± 2.41. Rates of procedures per patient year (n/[pt-yr]), reported as mean (95% Confidence Interval [CI]), were compared by nonparametric methods. RESULTS: In the whole HD population, the overall rate of procedures increased in the HD period (pre-HD 0.125 [95% CI 0.101-0.149] n/[pt-yr]; HD 0.928 [95% CI 0.795-1.061] n/[pt-yr]; p<0.001). The increase, noted in patients with and without diabetes, reflected increases in the rates for both vascular access and non-vascular access procedures from the pre-HD to the HD period. Amputations and surgery for hip fractures accounted for the increase in the rates of procedures related to non-vascular access. Procedures associated with mortality in the HD period included amputations, hip repair and abdominal surgery for septic conditions. CONCLUSIONS: Rates of surgical procedures for vascular access, amputations, and hip fractures ?increased after the start of HD. Amputations and hip fractures, both potentially preventable, are associated with mortality in HD patients.

Factores determinantes de la lactancia materna exclusiva: Policlínico "Aleida Fernández". 2015 / Determinant factors of exclusive breastfeeding. "Aleida Fernández" Polyclinic. 2015

Introducción: La historia de la lactancia materna es tan antigua como la historia de la humanidad. La leche materna ha sido durante toda la existencia del ser humano el único alimento que el recién nacido y el lactante pequeño podían recibir para sobrevivir. En Cuba en 2014 se pudo apreciar que 33,2 por ciento de los infantes menores de 6 meses eran amamantados con lactancia materna exclusiva. Objetivo: Caracterizar el comportamiento de la lactancia materna exclusiva, según factores biosociales en el Policlínico Docente Aleida Fernández Chardiet del municipio La Lisa, en 2015. Material y Métodos: Se realizó un estudio observacional descriptivo, de corte transversal. El universo de estudio lo constituyeron 182 madres de niños nacidos durante esa etapa en el área de salud. Se realizaron distribuciones de frecuencia y cálculos porcentuales. Resultados: El 49,5 por ciento de madres mantuvo lactancia materna exclusiva por 6 meses. Solo 34,2 por ciento de madres con nivel de escolaridad de secundaria, mantuvo la lactancia materna exclusiva por 6 meses. Conclusiones: Casi la mitad de las madres mantuvieron la lactancia materna exclusiva por 6 meses. En las madres en que la lactancia materna exclusiva duró menos de 6 meses, predominaron los siguientes factores biosociales: edad menor de 20 años, nivel de escolaridad de secundaria, estudiantes, primíparas, solteras y las de familia severamente disfuncionales. La insuficiente disponibilidad de leche en las mamas fue la la causa más frecuente de supresión de la lactancia materna exclusiva(AU)

Introduction: The history of breastfeeding is as old as the history of mankind. Breast milk has been the only food that the newborn and the small infant could receive to survive during all the existence of the human being. It was observed that 33,2 percent of the infants younger than 6 months received exclusive breastfeeding in Cuba, in 2014. Objective: To characterize exclusive breastfeeding behavior according to biosocial factors in Aleida Fernández Chardiet Teaching Polyclinic, La Lisa Municipality, in the year 2015. Material and Methods: A cross-sectional descriptive observational study was conducted. The universe of study was composed of 182 mothers of children who were born in the health area during the study period. Distribution of frequencies, and percentage calculations were carried out. Results: 49,5 percent of mothers maintained exclusive breastfeeding for 6 months. Only 34,2 percent of mothers with secondary school education maintained exclusive breastfeeding for 6 months. Conclusions:Almost half the mothers maintained exclusive breastfeeding for 6 months. The following biosocial factors predominate in those mothers in whom exclusive breastfeeding lasted less than 6 months: younger than 20 years of age, secondary school education, students, primiparas, single, and mothers from severe dysfunctional families. Insufficient milk availability in the breasts was the most frequent cause of breastfeeding suppression(AU)

Hospitalizations before and after initiation of chronic hemodialysis.

Hospitalization rate is high in patients on chronic hemodialysis (HD). We investigated whether initiation of HD changes the rate and length of hospitalization. We analyzed hospitalizations in HD patients in one hospital over 15 years. We compared annual rate and length of hospitalizations, both presented as mean (95% confidence interval [CI]) between the pre-HD and HD period. Three hundred ninety-two patients, 98% men, 59% diabetic, and 66.3 ± 11.2 years old at the onset of HD, had 1016 hospitalizations in the pre-HD period (60.0 ± 42.9 months) and 1627 hospitalizations in the HD period (32.5 ± 25.9 months). Higher values were found in the HD than the pre-HD period for rate, (pre-HD 0.557 [95% CI 0.473-0.611], HD 2.198 [95% CI 1.997-2.399] admissions/[patient-year], P<0.001) and length (pre-HD 4.63 [95% CI 3.71-5.55], HD 28.07 [95% CI 23.55-32.59] days/patient-year], P<0.001) of hospitalizations for all causes, cardiac disease, infections, vascular access, peripheral vascular disease, metabolic disturbances, gastrointestinal diseases, and miscellaneous conditions, mainly respiratory illness and malignancy. Similar differences were found when we compared the year before and the year after the start of HD. Diabetics had higher all cause rate and length of hospitalizations than non-diabetics in the pre-HD and HD periods. The rate and length of hospitalizations was higher in the HD than the pre-HD period for both HD-specific conditions and conditions encountered in both HD and general populations. Study of factors specific to HD that may affect these conditions should constitute the first step toward improving the morbidity of patients on HD.

Hospital admissions in elderly patients on chronic hemodialysis.

BACKGROUND: The purpose of this study was to determine whether number of hospital admissions per patient per year (n/[pt-yr]) and hospital days per patient per year (d/[pt-yr]) differ between elderly and younger patients on chronic hemodialysis (HD). PATIENTS AND METHODS: In a retrospective cohort analysis of incident HD patients in one dialysis unit over 15 years, we compared 166 HD patients older than 70 years (77.1 ± 4.7 yrs) at the onset of HD (group A) and 216 patients younger than 70 years both at onset (57.1 ± 7.6 yrs) and at the end of the HD period (group B). Eighty (48.2%) of group A and 141 (65.3%) patients of group B had diabetes mellitus. RESULTS: No differences were noted in the overall hospitalization rate, presented as mean, {95% Confidence interval} (group A 2.40 {2.04-2.75}, group B 2.03 {1.89-2.16} n[pt-yr]) and days/[pt-year] (group A 33.6 {25.3-41.8}, group B 24.1 {18.9-29.23}). Group A had higher number of hospitalization days (P = 0.012) for surgery or trauma and higher rate (P = 0.045) and days (P = 0.041) of hospitalization for miscellaneous causes, primarily pulmonary disease, or malignancy. Among diabetic patients, group A had only a greater number of hospital days for cardiac disease (P = 0.050). Among patients without diabetes, group A had a higher number for hospital days for surgery or trauma (P = 0.027). All other univariate comparisons were not significant. Multiple linear regression identified comorbidity, quantified by the Charlson index, Caucasian race and poor compliance with the HD schedule as predictors of admission rate and days per year for vascular access issues and comorbidity, poor compliance, and advanced age at onset of HD as predictors of admission for causes other than vascular access related. CONCLUSION: Hospitalizations, which affect quality of life, differ little between elderly and younger patients on HD. Therefore, hospitalizations do not constitute an argument for restricting access to HD to elderly patients.

Hypothyroidism and renal function in patients with systolic heart failure.

The extent to which hypothyroidism affects renal function in patients with heart failure remains incompletely explored, despite the known adverse prognostic implications of renal dysfunction in these patients.In a pilot retrospective study, we evaluated 75 patients (age, >or=18 yr) with left ventricular ejection fractions <0.40. Forty-five patients had normal thyroid function (thyroid-stimulating hormone [TSH], 0.35-5.5 micro IU/mL) and 30 had hypothyroidism. The group with hypothyroidism was subdivided into 17 patients who had controlled hypothyroidism (TSH, 0.35-5.5 micro IU/mL) and 13 who had uncontrolled hypothyroidism (TSH, >5.5 micro IU/mL). Renal function, measured in terms of glomerular filtration rate, was analyzed once in each patient, and the populations were statistically compared, with P <0.05 conferring statistical significance.Baseline characteristics in all groups were similar. Mean glomerular filtration rate was better in patients with normal thyroid function than those with hypothyroidism (75.45 +/- 31.48 vs 63.95 +/- 21.43 mL/min/1.73 m2; P=0.032). There was no significant difference between patients with controlled hypothyroidism (66.89 +/- 24.18 mL/min/1.73 m2) and those with normal thyroid function (P=0.131). In patients with uncontrolled hypothyroidism, mean glomerular filtration rate (60.2 +/- 17.4 mL/min/1.73 m2) was significantly worse than in patients with normal thyroid function (P=0.015).We found that heart-failure patients with insufficiently treated hypothyroidism have worse renal function than do patients whose thyroid function is normal or whose hypothyroidism is effectively treated. Larger studies will be needed in order to evaluate this conclusion further. We recommend that hypothyroidism in heart-failure patients be strictly controlled, lest it affect prognosis adversely.