The parietal cortex has a causal role in ambiguity computations in humans.

Humans often face the challenge of making decisions between ambiguous options. The level of ambiguity in decision-making has been linked to activity in the parietal cortex, but its exact computational role remains elusive. To test the hypothesis that the parietal cortex plays a causal role in computing ambiguous probabilities, we conducted consecutive fMRI and TMS-EEG studies. We found that participants assigned unknown probabilities to objective probabilities, elevating the uncertainty of their decisions. Parietal cortex activity correlated with the objective degree of ambiguity and with a process that underestimates the uncertainty during decision-making. Conversely, the midcingulate cortex (MCC) encodes prediction errors and increases its connectivity with the parietal cortex during outcome processing. Disruption of the parietal activity increased the uncertainty evaluation of the options, decreasing cingulate cortex oscillations during outcome evaluation and lateral frontal oscillations related to value ambiguous probability. These results provide evidence for a causal role of the parietal cortex in computing uncertainty during ambiguous decisions made by humans.

Global Prevalence of Pancreatic Cystic Lesions in the General Population on Magnetic Resonance Imaging: A Systematic Review and Meta-analysis.

BACKGROUND & AIMS: Understanding the burden of pancreatic cystic lesions (PCLs) in the general population is important for clinicians and policymakers. In this systematic review, we sought to estimate the global prevalence of PCLs using magnetic resonance imaging (MRI) and to investigate factors that contribute to its variation. METHODS: We searched MEDLINE, EMBASE, and Cochrane Central, from database inception through February 2023. We included full-text articles that reported the prevalence of PCLs using MRI in the general population. A proportional meta-analysis was performed, and the prevalence of PCLs was pooled using a random-effects model. RESULTS: Fifteen studies with 65,607 subjects were identified. The pooled prevalence of PCLs was 16% (95% confidence interval [CI], 13%-18%; I2 = 99%), most of which were under 10 mm. Age-specific prevalence of PCLs increased from 9% (95% CI, 7%-12%) at 50 to 59 years, to 18% (95% CI, 14%-22%) at 60 to 69 years, 26% (95% CI, 20%-33%) at 70 to 79 years, and 38% at 80 years and above (95% CI, 25%-52%). There was no difference in prevalence between sexes. Subgroup analysis showed higher PCL prevalence when imaging findings were confirmed by independent radiologist(s) (25%; 95% CI, 16%-33%) than when chart review alone was used (5%; 95% CI, 4%-7%; P < .01). There was no independent association of PCL prevalence with geographic location (Europe, North America, or Asia), MRI indication (screening vs evaluation of non-pancreatic pathology), enrollment period, sample size, magnet strength (1.5 vs 3 tesla), and MRI sequence (magnetic resonance cholangiopancreatography vs no magnetic resonance cholangiopancreatography). CONCLUSION: In this systematic review, the global prevalence of PCLs using a highly sensitive noninvasive imaging modality ranged between 13% and 18%.

Early Diagnostic Paracentesis Improves Outcomes of Hospitalized Patients With Cirrhosis and Ascites: A Systematic Review and Meta-Analysis.

INTRODUCTION: Diagnostic paracentesis is recommended for patients with cirrhosis admitted to the hospital, but adherence is suboptimal with unclear impact on clinical outcomes. The aim of this meta-analysis was to assess the outcomes of early vs delayed diagnostic paracentesis among hospitalized patients with cirrhosis and ascites. METHODS: We searched multiple databases for studies comparing early vs delayed diagnostic paracentesis among hospitalized patients with cirrhosis and ascites. The pooled odds ratio (OR) and mean difference with confidence intervals (CIs) for proportional and continuous variables were calculated using the random-effects model. Early diagnostic paracentesis was defined as receiving diagnostic paracentesis within 12-24 hours of admission. The primary outcome was in-hospital mortality. Secondary outcomes were length of hospital stay, acute kidney injury, and 30-day readmission. RESULTS: Seven studies (n = 78,744) (n = 45,533 early vs n = 33,211 delayed diagnostic paracentesis) were included. Early diagnostic paracentesis was associated with lower in-hospital mortality (OR 0.61, 95% CI 0.46-0.82, P = 0.001), length of hospital stay (mean difference -4.85 days; 95% CI -6.45 to -3.20; P < 0.001), and acute kidney injury (OR 0.62, 95% CI 0.42-0.92, P = 0.02) compared with delayed diagnostic paracentesis, with similar 30-day readmission (OR 1.11, 95% CI 0.52-2.39, P = 0.79). Subgroup analysis revealed consistent results for in-hospital mortality whether early diagnostic paracentesis performed within 12 hours (OR 0.51, 95% CI 0.32-0.79, P = 0.003, I2 = 0%) or within 24 hours of admission (OR 0.67, 95% CI 0.45-0.98, P = 0.04, I2 = 82%). Notably, the mortality OR was numerically lower when diagnostic paracentesis was performed within 12 hours, and the results were precise and homogenous ( I2 = 0%). DISCUSSION: Findings from this meta-analysis suggest that early diagnostic paracentesis is associated with better patient outcomes. Early diagnostic paracentesis within 12 hours of admission may be associated with the greatest mortality benefit. Data from large-scale randomized trials are needed to validate our findings, especially if there is a greater mortality benefit for early diagnostic paracentesis within 12 hours.

Development of a Greenhouse Assay to Screen Soybean Varieties for Resistance to Aerial Blight Caused by Rhizoctonia solani Anastomosis Group 1-IA.

Aerial blight, caused by the fungus Rhizoctonia solani anastomosis group (AG) 1-IA, is an economically important soybean disease in the mid-Southern United States. Management has relied on fungicide applications during the season, but there is an increasing prevalence of resistance to commonly used strobilurin fungicides and an urgent need to identify soybean varieties resistant to aerial blight. Because the patchy distribution of the pathogen complicates field variety screening, the present study aimed to develop a greenhouse screening protocol to identify soybean varieties resistant to aerial blight. For this, 88 pathogen isolates were collected from commercial fields and research farms across five Louisiana parishes, and 77% were confirmed to be R. solani AG1-IA. Three polymorphic codominant microsatellite markers were used to explore the genetic diversity of 43 R. solani AG1-IA isolates, which showed high genetic diversity, with 35 haplotypes in total and only two haplotypes common to two other locations. Six genetically diverse isolates were chosen and characterized for their virulence and fungicide sensitivity. The isolate AC2 was identified as the most virulent and was resistant to both active ingredients, azoxystrobin and pyraclostrobin, tested. The six isolates were used in greenhouse variety screening trials using a millet inoculation protocol. Of the 31 varieties screened, only Armor 48-D25 was classified as moderately resistant, and plant height to the first node influenced final disease severity. The study provides short-term solutions for growers to choose less susceptible varieties for planting and lays the foundation to characterize host resistance against this important soybean pathogen.

Less-lethal weapons: ocular trauma in Chile as psychosocial trauma. Challenges from a human rights and comprehensive perspective.

INTRODUCTION: In October 2019 in Chile, massive protests broke out in the so-called social uprising. The repressive response of the armed forces and Carabineros (Police) resulted in serious and mas-sive violations of human rights, with between 400 and 500 victims of ocular trauma caused mainly by shots from anti-riot shotguns, constituting the largest number of cases in the world linked to a single event. It is proposed to evaluate the different dimensions of the impact of ocular trauma due to state violence, using the concept of psychosocial trauma and a support model that integrates the medical-psychological and social dimensions. METHODS: Human rights violations of the period are described, focusing on cases of ocular trauma, and state and civil society responses. The requests of a survivors' organisations regarding truth, justice and reparation is presented. A clinical case of ocular trauma treated in our centre is analyzed. RESULTS: Survivors of ocular trauma manifest post-traumatic reactions regardless of the severity of their ocular injuries. The impact on the mental health of survi-vors of ocular trauma due to state violence is a phenomenon where the psychic and psychosocial im-pact of trauma due to socio-political violence intersects with the short- and long-term mental health effects. DISCUSSION: The impact of sociopolitical trauma must be understood considering both the in-dividual and social subject, considering their cultural, socioeconomic and political reality. Recovery from traumatic psychological injury must be addressed in its medical, sensory rehabilitation, psycho-logical and psychosocial dimensions, including processes of social recognition, search for justice and comprehensive reparation of damage. In contexts of impunity, a model is proposed that integrates rehabilitation with psycho-legal support, promotion of agency and organisation, within the frame-work of commitment to the movement and principles of human rights.

Endoscopic Ultrasound-Guided Ablation of Premalignant Pancreatic Cysts and Pancreatic Cancer.

Pancreatic cancer is on the rise and expected to become the second leading cause of cancer-related death by 2030. Up to a one-fifth of pancreatic cancers may arise from mucinous pancreatic cysts, which are frequently present in the general population. Currently, surgical resection is the only curative approach for pancreatic cancer and its cystic precursors. However, only a dismal proportion of patients are eligible for surgery. Therefore, novel treatment approaches to treat pancreatic cancer and precancerous pancreatic cysts are needed. Endoscopic ultrasound (EUS)-guided ablation is an emerging minimally invasive method to treat pancreatic cancer and premalignant pancreatic cysts. Different ablative modalities have been used including alcohol, chemotherapy agents, and radiofrequency ablation. Cumulative data over the past two decades have shown that endoscopic ablation of mucinous pancreatic cysts can lead to cyst resolution in a significant proportion of the treated cysts. Furthermore, novel data are emerging about the ability to endoscopically ablate early and locally advanced pancreatic cancer. In this review, we aim to summarize the available data on the efficacy and safety of the different EUS-ablation modalities for the management of premalignant pancreatic cysts and pancreatic cancer.

The effect of a cognitive training therapy based on stimulation of brain oscillations in patients with mild cognitive impairment in a Chilean sample: study protocol for a phase IIb, 2 × 3 mixed factorial, double-blind randomised controlled trial.

BACKGROUND: The ageing population has increased the prevalence of disabling and high-cost diseases, such as dementia and mild cognitive impairment (MCI). The latter can be considered a prodromal phase of some dementias and a critical stage for interventions to postpone the impairment of functionality. Working memory (WM) is a pivotal cognitive function, representing the fundamental element of executive functions. This project proposes an intervention protocol to enhance WM in these users, combining cognitive training with transcranial electrical stimulation of alternating current (tACS). This technique has been suggested to enhance the neuronal plasticity needed for cognitive processes involving oscillatory patterns. WM stands to benefit significantly from this approach, given its well-defined electrophysiological oscillations. Therefore, tACS could potentially boost WM in patients with neurodegenerative diseases. METHODS: This study is a phase IIb randomised, double-blind clinical trial with a 3-month follow-up period. The study participants will be 62 participants diagnosed with MCI, aged over 60, from Valparaíso, Chile. Participants will receive an intervention combining twelve cognitive training sessions with tACS. Participants will receive either tACS or placebo stimulation in eight out of twelve training sessions. Sessions will occur twice weekly over 6 weeks. The primary outcomes will be electroencephalographic measurements through the prefrontal theta oscillatory activity, while the secondary effects will be cognitive assessments of WM. The participants will be evaluated before, immediately after, and 3 months after the end of the intervention. DISCUSSION: The outcomes of this trial will add empirical evidence about the benefits and feasibility of an intervention that combines cognitive training with non-invasive brain stimulation. The objective is to contribute tools for optimal cognitive treatment in patients with MCI. To enhance WM capacity, postpone the impairment of functionality, and obtain a better quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT05291208. Registered on 28 February 2022. ISRCTN87597719 retrospectively registered on 15 September 2023.

Oscillatory activity underlying cognitive performance in children and adolescents with autism: a systematic review.

Autism spectrum disorder (ASD) is a neurodevelopmental condition that exhibits a widely heterogeneous range of social and cognitive symptoms. This feature has challenged a broad comprehension of this neurodevelopmental disorder and therapeutic efforts to address its difficulties. Current therapeutic strategies have focused primarily on treating behavioral symptoms rather than on brain psychophysiology. During the past years, the emergence of non-invasive brain stimulation techniques (NIBS) has opened alternatives to the design of potential combined treatments focused on the neurophysiopathology of neuropsychiatric disorders like ASD. Such interventions require identifying the key brain mechanisms underlying the symptomatology and cognitive features. Evidence has shown alterations in oscillatory features of the neural ensembles associated with cognitive functions in ASD. In this line, we elaborated a systematic revision of the evidence of alterations in brain oscillations that underlie key cognitive processes that have been shown to be affected in ASD during childhood and adolescence, namely, social cognition, attention, working memory, inhibitory control, and cognitive flexibility. This knowledge could contribute to developing therapies based on NIBS to improve these processes in populations with ASD.

Patients recovering from COVID-19 who presented with anosmia during their acute episode have behavioral, functional, and structural brain alterations.

Patients recovering from COVID-19 commonly exhibit cognitive and brain alterations, yet the specific neuropathological mechanisms and risk factors underlying these alterations remain elusive. Given the significant global incidence of COVID-19, identifying factors that can distinguish individuals at risk of developing brain alterations is crucial for prioritizing follow-up care. Here, we report findings from a sample of patients consisting of 73 adults with a mild to moderate SARS-CoV-2 infection without signs of respiratory failure and 27 with infections attributed to other agents and no history of COVID-19. The participants underwent cognitive screening, a decision-making task, and MRI evaluations. We assessed for the presence of anosmia and the requirement for hospitalization. Groups did not differ in age or cognitive performance. Patients who presented with anosmia exhibited more impulsive alternative changes after a shift in probabilities (r = - 0.26, p = 0.001), while patients who required hospitalization showed more perseverative choices (r = 0.25, p = 0.003). Anosmia correlated with brain measures, including decreased functional activity during the decision-making task, thinning of cortical thickness in parietal regions, and loss of white matter integrity. Hence, anosmia could be a factor to be considered when identifying at-risk populations for follow-up.

Análisis Rasch de la escala APGAR-familiar en adultos mayores de Colombia / Rasch analysis of the APGAR-family scale in older adults in Colombia / Analise Rasch da escada APGAR-familiar em adultos maiores da Colômbia

Resumen El objetivo de este estudio fue analizar mediante el modelo Rasch las evidencias de validez de la medida de funcionalidad familiar obtenida a partir del APGAR-familiar en adultos mayores de Colombia. Se encuestaron 1.514 participantes residentes en Medellín, Barranquilla y Pasto. Se realizaron análisis Rasch de ajuste de categorías de respuesta, ajuste de los ítems y de las personas, funcionamiento diferencial de los ítems, dimensionalidad e independencia local de los ítems y confiabilidad. Los principales resultados indicaron que el formato de respuesta se ajusta a los requerimientos de optimización de función de Linacre, todos los ítems muestran medias cuadráticas Infit y Outfit en el rango esperado, la escala es unidimensional y la confiabilidad de Wright se estimó en 0,962. Se concluye que, en adultos mayores colombianos, el APGAR-familiar proporciona una medida de funcionalidad familiar unidimensional, a nivel de intervalo, confiable e insesgada por edad y sexo, que permite clasificar cinco niveles de funcionalidad familiar con fines de tamizaje.

Abstract The objective of this study was to analyze, using the Rasch model, the evidence of validity of the measure of family functionality obtained from the APGAR-family assessment in older adults in Colombia. A total of 1,514 participants residing in Medellín, Barranquilla and Pasto were surveyed. Rasch analysis of adjustment of response categories, adjustment of items and people, differential functioning of the items, dimensionality and local independence of the items and reliability were carried out. The main results indicated that the response format conforms to the Linacre function optimization requirements. All the items show Infit and Outfit means square in the expected range. The scale is one-dimensional and Wright's reliability was estimated at 0.962. It is concluded that the APGAR-family assessment in Colombian older adults provides a one-dimensional measure of family functionality at the interval level, reliable and unbiased by age and gender, which allows classifying five levels of family functionality for screening purposes.

Resumo O objetivo deste estudo foi analisar através do modelo Rasch as evidencias de validez da medida de funcionalidade familiar obtida a partir do APGAR-familiar em adultos maiores da Colômbia. Entrevistaram-se 1.514 participantes residentes em Medellín, Barranquilla e Pasto. Fizeram-se análises Rasch de ajuste de categorias de resposta, ajuste dos itens e das pessoas, funcionamento diferencial dos itens, dimensionalidade e independência local dos itens e confiabilidade. Os principais resultados indicaram que o formato de resposta se ajusta aos requerimentos de optimização de função de Linacre, todos os itens amostram medias quadráticas Infit e Outfit no rango esperado, a escada é unidimensional e a confiabilidade de Wright se estimou em 0,962. Conclui que, em adultos maiores colombianos, o APGAR-familiar proporciona uma medida de funcionalidade familiar unidimensional, a nível de intervalo, confiável e imparcial por idade e sexo, que permite classificar cinco níveis de funcionalidade familiar com fins de triagem.

Trauma por caída de altura en niños que requirieron hospitalización / Trauma for fall of height in children who required hospitalization

Introducción. En Argentina, el trauma es la causa más frecuente de muerte en niños mayores de 1 año, con una elevada morbilidad y un alto costo para el sistema de salud. La caída de altura es la principal causa de lesiones traumáticas luego de los eventos por vehículo a motor. Objetivos. Explorar factores relacionados con traumatismos por caída de altura en pacientes hospitalizados, clasificar sus causas, describir la topografía lesional y analizar factores de riesgo y el evento traumático a través del Índice de Trauma Pediátrico (ITP). Material y métodos. Estudio de sección transversal con posterior tratamiento analítico mediante regresión logística. Se incluyeron 113 niños en forma consecutiva, de 0 a 18 años que requirieron hospitalización por trauma por caída de altura entre el 15 de noviembre de 2014 al 14 de noviembre de 2015, con seguimiento longitudinal hasta el alta. Dentro del universo de niños con trauma, se eligió el subconjunto de pacientes arriba mencionado. Se realizó una entrevista a los padres y se diseñó una ficha médica con datos obtenidos de las historias clínicas. Los pacientes enrolados se dividieron en dos grupos según el Índice de Trauma Pediátrico (ITP) para identificar potenciales factores de riesgo mediante un modelo de regresión logística. Se estratificaron en tres grupos etarios para el análisis de la topografía lesional. Resultados. De los 113 pacientes incluidos en el estudio, el 55,9% las caídas fueron por negligencia, siendo las lesiones más frecuentes el traumatismo encéfalo craneano (TEC) en menores de 3 años y de los miembros en niños mayores; los factores de riesgo identificados fueron el juego durante el evento y la presencia de gas natural, ambos predictores de trauma de menor gravedad. Conclusiones. Se pudo solo determinar la asociación de dos de los factores de riesgo explorados, probablemente relacionados a la n de pacientes en relación a las múltiples variables incluidas. La causa más frecuente de trauma fue por negligencia; el TEC fue la lesión más frecuente en niños pequeños y en los mayores fue el compromiso de miembros en la población estudiada

Introduction. Trauma injuries are the main cause of mortality in children older than 1 year, producing high morbidity and high costs in health system. After motor vehicle-related injuries, falls are the leading cause of unintentional injuries in children. Objectives. To explore factors related to trauma due to height fall in hospitalized patients, to classify the causes of trauma due to height fall, to identify the injuries topography and to analyze the association between risk factors and trauma events using the Pediatric Trauma Index. Methods. In this cross-section study, with posterior logistic regression analysis, one hundred and thirteen children consecutively admitted for trauma due to fall height, from 0 to 18 years old, from November 15th, 2014 to November 14th, 2015 were prospectively evaluated. Parental interviews were conducted, and medical file, based on clinical records was designed. The sample was divided in two groups according to the Pediatric Trauma Index in order to identify risk factors through a logistic regression model. Patients were stratified in 3 age groups for the analysis of lesion topography. Results. Of the 113 patients included, 55.9% of the falls were due to negligence, cranioencephalic trauma (TEC) was the main trauma in children less than 3 years old, and limb fractures predominated in older population. In the multiple regression analysis, the risk factors identified were game activity and gas for home use, both predictors of less severity trauma. Conclusions. We could only determine the association of two of the risk factors explored, probably related to the number of patients in relation to the multiple variables included. We can demonstrate only the association of two of all risk factors explored, probably related with n of patients and the multiple variables included. The most frequent cause of trauma was due to negligence. In the studied population, TEC was the most frequent injury in small children and in the older children the commitment of members

Lesiones no intencionales por vehículos a motor en pediatría. Estudio epidemiológico en pacientes internados en el Hospital de Niños "Ricardo Gutiérrez" / Unintentional injuries by motor vehicles in pediatrics. Epidemiological study of admitted patients to the "Ricardo Gutierrez" Children's Hospital

Introducción: El trauma es la causa más frecuente de muerte en niños mayores de 1 año en Argentina y presenta elevada morbilidad y alto costo para el sistema de salud. Los traumatismos por vehículo a motor (VAM) son una de las causas más frecuentes de lesiones graves. Objetivo: Identificar las causas, cinemática, topografía lesional y analizar el impacto de los factores epidemiológicos relacionados con traumatismos por VAM en pacientes internados en el Hospital de Niños "Ricardo Gutiérrez" (HNRG). Analizar factores de riesgo pasibles de intervención. Métodos: Estudio observacional, prospectivo, analítico y de predictores. Se incluyeron 47 niños de 0 a 18 años, internados por lesiones por VAM entre el 1 de abril de 2015 al 31 de marzo de 2017. Se confeccionó una ficha médica con datos obtenidos de las historias clínicas y entrevista a los padres. Los pacientes se dividieron en tres grupos: pasajeros, peatones y biciclistas. La severidad se valoró según el Índice de Trauma Pediátrico (ITP) en dos grupos para identificar factores de riesgo para trauma grave (ITP≤8) mediante un modelo de regresión logística. Variables predictivas: características demográficas del paciente y sus padres, nivel y factores de riesgo socio-económicos, datos del incidente, asistencia inicial, evolución y su causa. Para analizar la injuria topográfica, se estratificaron tres grupos etarios. Resultados: En el 36.2% la causa del evento fue negligencia. En el 68.1% de los eventos el mecanismo lesional fue atropello. La topografía más frecuente fue Sistema Nervioso Central (SNC) 42.6% aislado y 57.5% asociado a otras lesiones. Se estimó un aumento de la probabilidad de riesgo de ingresar a cuidados intensivos de 15,27 veces, cada vez que ITP pasa de >8 a grave. Conclusiones: En más del 66% de los eventos las causas fueron: negligencia e imprudencia. El mecanismo lesional más frecuente fue el atropello. Los menores de 3 años presentaron trauma aislado de SNC (66%). Los pacientes con ITP bajo presentaron elevada probabilidad de requerir cuidados intensivos. Se recomienda enfatizar en educación, prevención e investigación para generar propuestas multisectoriales, fijar prioridades y monitorizar las intervenciones

Introduction: In our country trauma is the most frequent cause of death in children more than one year old, representing a high morbidity and an economic burden for the health system. Motor vehicle trauma (MVT) is one of the most frequent causes of severe injuries. Objective: To identify the causes, the kinematics and the injury topography and to analyze the impact of the epidemiological factors related to MVT of admitted patients to the "Ricardo Gutierrez" Children's Hospital. Modifiable risk factors were also analyzed. Methodology: Observational, prospective, analytical and predictive study. Forty seven (47) children between the ages of 0 and 18 years were included, all of them admitted with MVT injuries between April 1st 2015 and March 31st 2017, with follow up until discharge. A medical record was created with data from clinical history and interviews with parents. The enrolled inpatients were subdivided into three (3) groups: passengers, pedestrians and cyclists. Injury severity was assessed by the "Pediatric Trauma Index" (PTI) in two groups to identify risk factors for severe trauma (PTI ≤8) through a logistic regression model. Predictive variables: demographic characteristics in hospitalized children and their parents, socio-economic level and risk factors, event information, initial assistance and evolution of the clinical case. Injury topography was stratified in three (3) age groups. Results: Car hit was responsible for 68.1% of the events. Negligence was found in 36.2% of the causes. Central nervous system (CNS) was the most frequent topography: isolated in 42.6% and associated with other lesions in 57.5%. Identified risk factors: when PTI was >8 or critical, the risk probability to be admitted into intensive care units increased by 15.27 times. Conclusion: Car crash was the most frequent injury mechanism. Negligence and imprudence were 2/3 of the events causes. Children under three (3) years presented isolated CNS trauma (66%). PTI ≤8 was associated with high probability of intensive care requirement. Education, prevention programs and research are necessary in order to generate multisectoral proposals, to fix priorities, including monitoring and surveillance interventions

Caracterización de los egresos hospitalarios con tumores malignos, según la información de los Grupos Relacionados con el Diagnóstico / Characterization of hospital discharges with malignant tumors based on information from diagnosis related groups / Caracterização das saídas de pacientes de hospitais com tumores malignos segundo a informação dos Grupos de Diagnósticos Homogêneos

Resumen Objetivo: caracterizar los egresos hospitalarios del año 2014 con diagnóstico de cáncer, de acuerdo a la información de los Grupos Relacionados con el Diagnóstico (GRD). Metodología: estudio analítico con análisis descriptivo e inferencial, compuesto por información secundaria. La descripción estadística se hizo según la naturaleza y nivel de medición de las variables, y se realizó un análisis bivariado para estimar la diferencia de medias utilizando la t-Student (t) y la anova paramétrica (F de Snedecor). Resultados: se atendieron 3.030 egresos, con un peso medio relativo de 1,62, una estancia media inliers de 10,69 días y un IEMA de 0,97. El 56,01% de los egresos presentó un nivel de severidad mayor, con un peso relativo de 2,09 y una estancia media de 13,53 días. De los pacientes que presentaron una probabilidad mayor de morir, el 32,64% egresaron vivos y el 19,62% fallecieron. Se encontraron diferencias estadísticamente significativas en la estancia media con el estado al alta, el nivel de severidad y el nivel de mortalidad. Conclusiones: los resultados de este estudio indican el manejo eficaz que la institución le da a la estancia hospitalaria, evidenciado en la atención de 76 pacientes más por el ahorro de los días de estancia y en los indicadores funcionales, los cuales fueron acordes con la complejidad de los pacientes.

Abstract Objective: to describe the characteristics of hospital discharges with a diagnosis of cancer during 2014 based on DRG information. Methodology: an analytical study with a descriptive and inferential analysis using secondary information. The statistical description was carried out based on the variables' nature and level of measurement. Moreover, a bivariate analysis was performed to estimate the differences in the means using Student's t-test (t) and a parametric ANOVA (Snedecor's F). Results: a total of 3.030 hospital discharges were attended. The relative mean weight was 1.62, the mean inlier stay was 10.69 days and the mean adjusted length of stay was 0.97 days. Additionally, 56.01% of hospital discharges showed a higher level of severity, with a relative mean weight of 2.09, and a mean length of stay of 13.53 days. Of the patients who were more likely to die, 32.64% were discharged alive and 19.62% died. Furthermore, statistically significant differences were found between mean stay and patient status upon discharge, severity level and mortality level. Conclusions: the results of this study indicate that the institution is managing hospital stay effectively. Evidence of this lies in the possibility of providing care to 76 additional patients as a result of saving on stay days. Another proof of this effectiveness can be observed in the functional indicators, which were in line with patient complexity.

Resumo Objetivo: Caracterizar as saídas de pacientes do hospital no ano 2014 com diagnóstico de câncer, de acordo com a informação dos GDH. Metodologia: Estudo analítico com análise descritiva e inferencial, composto por informação secundária. A descrição estatística foi feita segundo a natureza e nível de medição das variáveis e realizou-se uma análise bivariada para estimar a diferença de médias utilizando a t-Student(t), e a anova paramétrica (F de Snedecor). Resultados: Foram atendidas 3.030 saídas, com um peso médio relativo de 1,62, uma internação média inliers de 10,69 dias e um IEMA de 0,97. 56,01% das saídas apresentou um nível de severidade maior, com um peso relativo de 2,09 e uma internação média de 13,53 dias. Dos pacientes que apresentaram uma probabilidade maior de morrer, 32,64% saíram vivos e 19,62% faleceram. Encontraram-se diferenças estatisticamente significativas na internação média com estado na alta, o nível de severidade e o nível de mortalidade. Conclusões: Os resultados deste estudo indicam o controle eficaz que a instituição exerce na internação hospitalar, evidenciado no atendimento de mais 76 pacientes, na diminuição dos dias de internação e nos indicadores funcionais, os quais foram correspondentes com a complexidade dos pacientes.

Gestación cuádruple: reporte de caso y revisión de la literatura / Quadruplet pregnancy: case report and review of the literature

RESUMEN Objetivo: Reportar un caso de embarazo cuádruple y revisar la literatura disponible con respecto a la edad gestacional en la que se identifica el tipo de placenta (mono o policoriónica) en la que finaliza el embarazo, el peso del recién nacido y la frecuencia del cuidado prenatal de este tipo de gestaciones. Materiales y métodos: Se presenta del caso de una mujer con embarazo cuádruple secundario a técnica de reproducción asistida, atendida en una institución de cuarto nivel de complejidad, ubicada en la ciudad de Bucaramanga, Colombia. Se realizó una revisión de la literatura publicada en las bases de datos Medline vía PubMed, Embase, SciELO y UptoDate® con los términos de búsqueda: "embarazo múltiple", "cuádruples", "atención prenatal" y "resultado perinatal". La búsqueda se limitó por idioma (artículos en inglés y español). Resultados: Se recuperaron 19 referencias que cumplían con los criterios de inclusión y de exclusión. No hay información sobre la frecuencia con la que se debe hacer el control prenatal. El tipo de placenta se pudo establecer entre las semanas 9 y 25; la edad gestacional varió entre 26 y 34 semanas. El peso varió entre 1.076 y 1.770 g. Los embarazos multigestación se acompañan frecuentemente de complicaciones maternas y perinatales. Conclusiones: El diagnóstico del embarazo cuádruple puede hacerse temprano en la gestación. Frecuentemente se acompaña de prematuridad y bajo peso al nacer. Se requieren estudios que evalúen el manejo más seguro y efectivo de esta condición.

ABSTRACT Objective: To report the case of a quadruplet pregnancy and conduct the review of the available literature regarding gestational age at which the type of placenta (monochorionic or polychorionic) is identified, the gestational age at which the pregnancy comes to an end, the weight of the neonate, and the frequency of prenatal care in this type of gestation. Materials and methods: Case report of a woman with a quadruplet pregnancy secondary to assisted reproduction technique, seen at a Level IV complexity centre in the city of Bucaramanga, Colombia. A review of the literature was conducted in Medline vía PubMed, Embase, SciELO and UptoDate® databases using the search terms "multiple pregnancy," "quadruplets," "prenatal care," and "perinatal outcome". The search was limited by language to articles in English and Spanish. Results: Overall, 19 references that met the inclusion and exclusion criteria were retrieved. There is no information on the required frequency of prenatal visits. It was possible to identify the type of placenta between 9 and 25 weeks; gestational age varied between 26 and 34 weeks. Weight varied between 1,076 and 1,770 g. Multigestation pregnancies are frequently associated with maternal and perinatal complications. Conclusions: Quadruplet pregnancies may be diagnosed early in the gestation. They are frequently associated with prematurity and low birth weight. Further studies are required in order to assess the safest and most effective way of managing this condition.

Factores asociados con la supervivencia al año de pacientes operados con cáncer ampular o de páncreas / Factors associated with survival a one year of operated patients with cancer ampullary or pancreas

RESUMEN Objetivo Establecer los factores asociados a la supervivencia a un año de los pacientes operados con tumores de páncreas y ampulares. Materiales y Métodos Estudio descriptivo retrospectivo de una cohorte de pacientes con aplicación de análisis de supervivencia, basado en información secundaria. Se estimaron frecuencias absolutas y relativas para las variables cualitativas; y medidas de tendencia central y dispersión para las variables cuantitativas. La supervivencia global se estableció por medio del método Kaplan-Meier, en el análisis bivariado se utilizó la prueba Log-Rank y para establecer los factores asociados a la supervivencia, se efectuó un modelo de riesgos proporcionales de Cox. Resultados La supervivencia a un año de los 70 pacientes operados fue del 62,5 %. Los factores asociados a la supervivencia ajustada fueron la sepsis, sangrado posoperatorio, antígeno carcinoembrionario, trasfusión de glóbulos rojos, sangrado intraoperatorio, cirugías previas de abdomen y edad. Conclusiones El conocimiento que se obtuvo de la supervivencia a un año de los pacientes operados con cáncer de páncreas y ampular, permitirá crear estrategias encaminadas a la intervención de los factores asociados, y generar información que pueda conllevar a mejorar el pronóstico de los pacientes.(AU)

ABSTRACT Objective Determine the factors associated with survival a one year of patients operated with ampullary and pancreatic tumors. Materials and Methods A retrospective descriptive study of a cohort of patients with application of survival analysis based on secondary data. Absolute and relative frequencies for qualitative variables were estimated; and measures of central tendency and dispersion for quantitative variables. Overall survival was estimate by the Kaplan-Meier method, in the bivariate analysis was used the Log-Rank test and to establish the factors associated with survival was made a model Proportional Hazards of Cox. Results The survival a one year of 70 operated patients was 62,5 %. Factors associated with survival were adjusted sepsis, postoperative bleeding, carcinoembryonic antigen, red cell transfusion, intraoperative bleeding, previous abdominal surgeries and age. Conclusions The knowledge obtained from the survival a one year of patients operated with pancreatic and ampullary cancer, will create intervention strategies associated factors, generate more information that may lead to improve prognosis and reduce mortality.(AU)

Establecimiento in vitro de dos especies nativas de Costa Rica: Terminalia amazonia (Amarillón) y Vochysia allenii (Botarrama Blanco) / In vitro establishment of two species native to Costa Rica: Terminalia amazonia (Amarillón) and Vochysia allenii (Botarrama Blanco)

El objetivo de esta investigación fue lograr el establecimiento in vitro de la especie Terminalia amazonia y Vochysia allenii debido a la dificultad de propagarlas sexual y asexualmente con técnicas convencionales. Se logró establecer segmentos nodales de ambas especies en condiciones in vitro empleando el HgCl2 0,1 % con un tiempo de exposición de 5 minutos. El mejor medio de cultivo para nudos fue el WPM 100 % de sales para T.amazonia y para V. allenii fue el WPM 50 % de sales. Después de 28 días de cultivo se obtuvo un 42 % de nudos establecidos para T. amazonia y 10% para V. allenii. En ambas especies se evaluó el efecto sobre la brotación de cinco concentraciones de 6-bencilaminopurina (6-BAP) (0,0; 2.22, 4.44, 6.66, 8.88 μM L-1) y cinco de tidiazuron (TDZ) (0,0; 0.22, 0.45, 0.68, 0.90 μM L-1). Se obtuvó en promedio un brote por explante en los cinco tratamientos de BAP y TDZ utilizados.

The objective of this research was to achieve the in vitro establishment of the species Terminalia amazonia and Vochysia allenii due to the difficulty propagate sexually and asexually with conventional techniques. It was possible to establish the nodal segments of both species in in vitro conditions using 0.1 % HgCl2 with an exposure time of 5 minutes. The best nodal culture medium was 100 % WPM salts in T. amazonia and V. allenii was WPM 50% salts. After 28 days of culture 42 % of nodal segments to T. amazonia and V. allenii 10% was obtained. In both species, the effect on sprouting of five concentrations of 6-benzylaminopurine (6-BAP) (0.0, 2.22, 4.44, 6.66, 8.88 μM L-1) and five thidiazuron (TDZ) (0.0, 0.22, 0.45, 0.68, 0.90 μM L-1) was evaluated. Outbreak was scored on average per explant in the five treatments of BAP and TDZ used.

Experiencias de vida y de trabajo de un grupo de epidemiólogos en formación acerca del abordaje local y departamental de problemas y situaciones de salud mental. Medellín, 2013 / Experiences of Life and Work of a Group of Epidemiologists in Training in Order to Address Mental Health Problems and Issues at Local and Departmental Level. Medellin, 2013

Objetivo: Explorar desde la mirada de un grupo de epidemiólogos en formación sus experiencias de vida y de trabajo relacionadas con el abordaje de problemas y situaciones de salud mental. Métodos: Estudio exploratorio, cualitativo-descriptivo. Se utilizaron herramientas etnográficas: observación, diario de campo y entrevistas grupales (GF). Resultados: Refirieren los participantes que salud mental y problemas de salud mental son temas manejados indistintamente y poco diferenciados por ellos y por la comunidad en general. También manifestaron no estar preparados para el manejo de problemas mentales ni contar con el apoyo de servicios para la atención de pacientes; los temas de salud mental aún no han sido claramente dimensionados por la sociedad. La epidemiología tiene sus limitaciones, se centra más en el conocimiento de lo físico-biológico y la utilización del enfoque cuantitativo, con escasa integración del enfoque cualitativo, lo que dificulta comprender un fenómeno que supera los límites del enfoque de investigación. Conclusiones: El abordaje de problemas de salud y enfermedad mental supera ampliamente la mirada desde un solo enfoque del conocimiento. Se debe incluir la comprensión de lo cualitativo como opción para avanzar en el conocimiento y el reconocimiento de un problema de salud pública opacado por el estigma y la desidia de la sociedad.

Objective: To examine, from the point of view of a group of epidemiologists in training, their life experiences and work related to addressing mental health problems and mental health issues. Methods: An exploratory qualitative-descriptive study was conducted using ethnographic tools, non-participant observation, note-taking, and group interviews (FG). Results: The participants mentioned that mental health and mental health issues are managed and poorly differentiated either by them and the community in general. They also said they were not ready to handle mental problems, or have the support of services for patient care, as mental health issues have not yet been clearly dimensioned by society. Epidemiology has its limitations, it focuses on knowledge of the physical-biological aspects and the use of quantitative approach with poor integration of the qualitative approach, thus hindering the understanding of a phenomenon that exceeds the limits of a research approach. Conclusions: This approach to issues of health and mental illness widens the view of knowledge from only a single focus. It includes an understanding of the qualitative approach as an option to advance the knowledge and recognition of a public health problem overshadowed by stigma and apathy of society.

Perfil del paciente pediátrico mayor de un mes que fallece en el Hospital Félix Bulnes, 1999-2000 / Profile of infant patients that death at the Hospital Félix Bulnes 1999-2000

La mortalidad infntil en Chile ha disminuído en las ultimas décadas y el tipo de paciente que se hospitaliza ha variado con respecto a sus antecedentes clínicos y patología, por tal motivo se nos propuso tipificar al paciente pediátrico mayor de 28 días que fallece durante su hospitalización, pesquisando factores de riesgo que aumentan la probabilidad de fallecer y obtener la tasa de letalidad infantil intrahospitalaria. Se realizó un estudio de caso-controles (199-2000), con 56 pacientes fallecidos (casos) y 112 controles pareados por edad, sexo y período estacional de su hospitalización, la fuente de información fue la ficha clínica y el informe anatomopatológico. Los resultados muestran una tasa de letalidad infantil de 1.5x 100 egresados, siendo ésta mayor en el grupo etario menor de 3 meses (1.9), en el sexo masculino (1.64) y en el período oto¤o-invierno (1.56). Antecedentes estadísticamente significativos como factores de riesgo: parto quirurgico (OR: 2.7), prematurez (OR: 4.1), bajo peso al nacer (OR: 6.9), patología neonatal (OR:4.6), genopatía (OR: 8.9), malformación congénita (OR: 8.4), ausencia de lactancia materna exclusiva (OR: 6.25), infección intrahospitalaria (OR:2.4). La patología respiratoria constituyó la causa más frecuente de muerte (61 por ciento) y morbilidad (85 por ciento) intrahospitalaria

Causas de diarrea crónica infantil / Causes of chronic diarrhea in children

Se estudiaron los hechos clínicos de 100 pacientes consecutivos referidos a un consultorio de gastroenterología por diarrea crónica, dos causas fueron las responsables de los 3/4 de los casos: giardiasis (42 pacientes) y enfermedad celíaca (32 pacientes); esto último documentado histológicamente de acuerdo con los criterios actualmente aceptados