Nivel de ansiedad según el trimestre del embarazo en un establecimiento de salud de atención primaria / Level of anxiety according to gestational trimester in a primary care health establishment

Resumen OBJETIVO: Determinar el nivel de ansiedad de las embarazadas conforme al trimestre de la gestación. MATERIALES Y MÉTODOS: Estudio observacional, correlacional y transversal efectuado en mujeres en curso del primer, segundo y tercer trimestre del embarazo atendidas en el Centro de Salud Base San Martín de Porres, Lima, Perú, entre diciembre de 2021 y febrero de 2022, a quienes se les aplicó el instrumento de tamizaje de ansiedad prenatal (Perinatal Anxiety Screening Scale [PASS]) y su variación según el trimestre del embarazo con las pruebas de χ2, Kruskall-Wallis y ANOVA. RESULTADOS: Se estudiaron 153 pacientes en los tres trimestres del embarazo en quienes se encontró: ansiedad prenatal en el 69.9% (n = 107); ansiedad leve en 45.8% (n = 70) y ansiedad moderada-severa en 24.2% (n = 37). El porcentaje es mayor de 100% porque no en todos los trimestres se encontraron síntomas depresivos. Solo 30.1% (n = 46) de las embarazadas no tuvieron síntomas de ansiedad prenatal. La puntuación de ansiedad global mostró un comportamiento diferente según el trimestre de gestación (ANOVA: p = 0,006), con predominio de mayor ansiedad en el primer trimestre seguido del tercero. La comparación por parejas solo mostró diferencias significativas en la puntuación de ansiedad entre el primer y el tercer trimestre (test de Tukey: p > 0.05). CONCLUSIONES: Más de la mitad de las embarazadas cursó con ansiedad, sobre todo en el primer y tercer trimestre y menor en el segundo.

Abstract OBJECTIVE: To determine the anxiety level of pregnant women according to the trimester of gestation. MATERIALS AND METHODS: Observational, analytical and prospective study of a random sample of pregnant women attended in a first level facility of the Ministry of Health (MINSA). Anxiety was assessed with the Perinatal Anxiety Screening Scale (PASS) and its variation according to the trimester of pregnancy with the χ2, Kruskall-Wallis and ANOVA tests. RESULTS: The prevalence of anxiety during pregnancy was 69.9% (n = 107) in a sample of 153 patients. Except for the social anxiety dimension (p > 0.05), significant differences were found in the scores of the anxiety dimensions by trimester. They were highest in the first, followed by the third trimester (p < 0.05). The global anxiety score showed different behavior by trimester of pregnancy (ANOVA: p = 0.006), with predominance of higher anxiety in the first trimester followed by the third trimester. Comparison by couples only showed significant differences in anxiety score between the first and third trimester (Tukey test: p > 0.05). CONCLUSIONS: More than half of the pregnant women had anxiety, especially in the first and third trimester and less in the second trimester.

Perinatal and long-term outcome of endoscopic laser surgery for twin-twin transfusion syndrome with and without selective fetal growth restriction: A retrospective cohort study.

OBJECTIVE: Report survival rates, neonatal mortality and morbidity and long-term outcomes of monochorionic (MC) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) or TTTS plus selective fetal growth restriction (sFGR) treated by endoscopic laser surgery. METHODS: Retrospective cohort study including 149 MC twin pregnancies complicated by TTTS or TTTS plus sFGR.Medical records were reviewed for survival rates, neonatal mortality, neonatal morbidity and long-term outcomes at 2 and 6 years of age. RESULTS: Survival of both babies was higher in the TTTS group than in the TTTS plus sFGR group (72.9%vs.54.8%); survival of at least one baby was similar in the two groups (90.7% and 88.1%). The incidence of severe neurological disability was not significantly different between TTTS and TTTS plus fetal growth restriction group at both stages, 1.9% versus 2.3% (p-value = 1) and 3.4%vs6.1% (p-value = 0.31). Multivariable analysis demonstrated that intact neurological outcome at 2 years of age was related with gestational age (GA) at birth and z score birthweight (Z BW), and at 6 years of age with GA at birth, Z BW and TTTS stage4. sFGR or abnormal brain findings at neonatal ultrasound were not related with impaired neurological outcome at two or 6 years of age. CONCLUSIONS: In pregnancies with TTTS and TTTS plus sFGR survival of at least one baby and long-term neurological outcome are comparable between both groups.

Potential colchicine binding site inhibitors unraveled by virtual screening, molecular dynamics and MM/PBSA.

Microtubules have been widely studied in recent decades as an important pharmacological target for the treatment of cancer especially due to its key role in the mitosis process. Among the constituents of the microtubules, αß-tubulin dimers stand out in view of their four distinct interaction sites, including the so-called colchicine binding site (CBS) - a promising target for the development of new tubulin modulators. When compared to other tubulin sites, targeting the CBS is advantageous because this site is able to host ligands with lower molecular volume and lipophilicity, thus reducing the chances of entailing the phenomenon of multiple drug resistance (MDR) - one of the main reasons of failure in chemotherapy. However, colchicine, the first ligand ever discovered with affinity towards the CBS, despite modulating the action of microtubules, has shown toxicity in clinical studies. Therefore, in order to expand the known chemical space of scaffolds capable of interacting with CBS and to design non-toxic colchicine binding site inhibitors, we conducted a robust virtual screening pipeline. This has been rigorously validated and consisted of ligand- and structure-based methodologies, which allowed us to select four promising CBS inhibitors called tubLCQF1-4. These four compounds were also evaluated with long trajectories molecular dynamics simulations and respective results were used for the theoretical determination of the free energy released in the formation of the complexes, using the Molecular Mechanics Poisson-Boltzmann Surface Area (MM/PBSA) methodology.

Morbilidad materna extrema en mujeres peruanas atendidas en una institución especializada. 2012- 2016 / Extreme maternal morbidity in peruvian women attended at a specialized institution. 2012-2016

Introducción: La morbilidad materna extrema genera indicadores para evaluar y controlar el riesgo de muerte materna. Objetivo: Describir la morbilidad materna extrema en mujeres peruanas atendidas en una institución especializa de Perú, 2012-2016. Material y Método: Estudio observacional, descriptivo y transversal. Se incluyeron las pacientes atendidas en el Instituto Nacional Materno Perinatal de Perú, entre el 2012 y 2016. Los casos de morbilidad materna extrema fueron incluidos según criterios de la Federación Latinoamericana de Sociedades de Obstetricia y Ginecología. Se describieron características maternas y se evaluaron indicadores de resultado. Se aplicó estadística descriptiva e inferencial bajo intervalos de confianza al 95%, utilizando el programa Stata versión 14. Resultados: La población de estudio fue 1245 casos. La multiparidad estuvo presente en el 63,7% de casos, presentaron en promedio 4 controles prenatales y el 60% de los casos tuvo por lo menos una cesárea previa. La razón de morbilidad materna extrema varío entre 10,7 y 17,6 por cada 1,000 recién nacidos vivos, el Índice de Mortalidad fue 3%, la relación morbilidad materna extrema / muerte materna fue de 32,8 casos. Conclusiones: La prevalencia promedio de morbilidad materna extrema fue de 13 casos por cada mil nacidos vivos con tendencia al incrementó en los últimos tres años de estudio, siendo principalmente causado por trastornos hipertensivos, sepsis y hemorragias. Los índices de resultado de morbilidad materna extrema demuestran una mejora progresiva en la calidad de atención de las pacientes con una tendencia a la disminución de muerte materna.

Introduction: Extreme maternal morbidity generates indicators to assess and monitor the risk of maternal death. Objective: To describe the extreme maternal morbidity in Peruvian women attended in a specialized institution in Peru, 2012-2016. Material and Method: Observational, descriptive and transversal study. Patients attended at the National Maternal and Perinatal Institute, between 2012 and 2016 were included. Cases of extreme maternal morbidity were included according to criteria of the Latin American Federation of Obstetrics and Gynecology Societies. The study shows maternal characteristics and outcome indicators. Descriptive and inferential statistics were applied under 95% confidence intervals, using the Stata version 14. Results: The study population was 1245 cases. Multiparity was present in 63.7% of cases, presented on average 4 prenatal controls and 60% of cases had at least one previous cesarean section. The extreme maternal morbidity ratio varied between 10.7 and 17.6 per 1,000 live births, the mortality index was 3%, the extreme maternal morbidity / maternal mortality ratio was 32.8 cases. Conclusions: The average prevalence of extreme maternal morbidity was 13 cases per thousand live births with a tendency to increase in the last three years of the study, mainly due to hypertensive disorders, sepsis and hemorrhages. The outcome indexes of extreme maternal morbidity demonstrate a progressive improvement in the quality of care of patients with a tendency to decrease maternal death.

Unraveling the Influence of Common von Willebrand factor variants on von Willebrand Disease Phenotype: An Exploratory Study on the Molecular and Clinical Profile of von Willebrand Disease in Spain Cohort.

The clinical diagnosis of von Willebrand disease (VWD), particularly type 1, can be complex because several genetic and environmental factors affect von Willebrand factor (VWF) plasma levels. An estimated 60% of the phenotypic variation is attributable to hereditary factors, with the ABO blood group locus being the most influential. However, recent studies provide strong evidence that nonsynonymous single nucleotide variants (SNVs) contribute to VWF and factor VIII phenotypic variability in healthy individuals. This study aims to investigate the role of common VWF SNVs on VWD phenotype by analyzing data from 219 unrelated patients included in the "Molecular and Clinical Profile of von Willebrand Disease in Spain project." To that end, generalized linear mixed-effects regression models were fitted, and additive and epistatic analyses, and haplotype studies were performed, considering five VWD-related measures (bleeding score, VWF:Ag, VWF:RCo, factor VIII:C, and VWF:CB). According to these analyses, homozygotes: for p.Thr789Ala(C) would be expected to show 39% higher VWF:Ag levels; p.Thr1381Ala(C), 27% lower VWF:Ag levels; and p.Gln852Arg(C), 52% lower VWF:RCo levels. Homozygotes for both p.Thr789Ala(C) and p.Gln852Arg(T) were predicted to show 185% higher VWF:CB activity, and carriers of two copies of the p.Thr1381Ala(T)/p.Gln852Arg(T) haplotype would present a 100% increase in VWF:RCo activity. These results indicate a substantial effect of common VWF variation on VWD phenotype. Although additional studies are needed to determine the true magnitude of the effects of SNVs on VWF, these findings provide new evidence regarding the contribution of common variants to VWD, which should be taken into account to enhance the accuracy of the diagnosis and classification of this condition. ClinicalTrials.gov identifier: NCT02869074.

Graves' disease complicated by fetal goitrous hypothyroidism treated with intra-amniotic administration of levothyroxine.

Fetal goitrous hypothyroidism is a rare entity and is caused mainly by maternal treatment of Graves' disease (GD). We report a case of a 22-year-old woman referred at 12 weeks of gestation due to hyperthyroidism subsequent to recently diagnosed GD. She started treatment with propylthiouracil and, at 21 weeks of gestation, fetal goitre was detected. A cordocentesis confirmed the diagnosis of fetal goitrous hypothyroidism, and intra-amniotic administration of levothyroxine (LT4) was performed and repeated through the pregnancy due to maintenance of fetal goitre. The pregnancy proceeded without further complications and a healthy female infant was born at 37 weeks of gestation, with visible goitre and thyroid function within the normal range at birth. Although there is no consensus on the optimal dose, the number of injections and the interval between them, intra-amniotic LT4 administration is recommended once fetal goitrous hypothyroidism is suspected, in order to prevent long-term complications of fetal hypothyroidism.

Incorporation of ZnCl2 into an etch-and-rinse adhesive system on flexural strength, degree of conversion and bond durability to caries-affected dentin.

PURPOSE: To evaluate the effect of a zinc chloride (ZnCl2) solution (2% wt), incorporated into a two-step etch-and-rinse adhesive system (AS), on microtensile bond strength (µTBS) to caries-affected dentin (CAD). METHODS: First, the degree of conversion (DC) of the AS with and without the ZnCl2 solution was evaluated by Fourier transform infrared spectroscopy (FTIR). Second, beam-shaped samples (7 mm × 2 mm × 1 mm) were prepared with the AS containing the ZnCl2 solution to perform flexural strength (FS) tests. For µTBS testing purposes, CAD surfaces were etched with phosphoric acid and randomly divided into three groups (n=10) : ZnCl2- AS with ZnCl2; NT (no treatment)- AS without ZnCl2; and CHX - pretreatment with 2% chlorhexidine solution. AS (Adper Single Bond 2) was applied according to the manufacturer's instructions, and resin composite restorations were built up. After 24 hours, the resin-dentin blocks were sectioned into specimens (0.8 mm2), and then subjected to micro;TBS testing immediately following, or after 6 or 12 months of water storage (WS). The adhesive interface was evaluated by scanning electron microscope. Both µTBS and FS tests were performed using a universal testing machine ( 0.5 mm/minute). FS and DC data were submitted to the Student t-test, and µTBS data were subjected to two-way ANOVA and Tukey's test (α= 0.05). RESULTS: DC was not affected by ZnCl2 incorporation into AS (P= 0.2527). Higher FS values were obtained in the group with ZnCl2 added to AS. Regarding µTBS, the mean of the NT group was statistically higher than that of the ZnCl2 or the CHX groups (P< 0.001(, regardless of WS, but the latter groups did not differ from each other. µTBS at 24 hours was statistically superior to that of 6 and 12 months of WS (P< 0.001).

Multirefractory primary immune thrombocytopenia; targeting the decreased sialic acid content.

Patients with multirefractory immune thrombocytopenia (ITP) have limited treatment options. Recent data suggest that specific anti-platelet antibodies may cause destruction of platelets by favoring platelet loss of sialic acid. In this multicenter study 35 patients with ITP, including 16 with multirefractory disease, were analyzed for antiplatelet-antibodies, thrombopoietin (TPO) levels, and platelet desialylation. In selected cases, responses to a novel treatment strategy using oseltamivir were tested. We found that antibodies against GPIbα were overrepresented in multirefractory patients compared to responders (n = 19). In contrast to conventional ITP patients, multirefractory patients exhibited a significant increased platelet activation state (granule secretion) and desialylation (RCA-1 binding) (p < 0.05), and a trend toward higher plasma TPO concentrations. The decreased sialic acid content seemed to be restricted to platelet glycoproteins, since other plasma proteins were not hypoglycosylated. A total of 10 patients with multirefractory ITP having remarkable loss of platelet terminal sialic acids were given oseltamivir phosphate. When the antiviral drug was combined with TPO receptor agonists (TPO-RAs) or with immunosuppressant drugs, platelet responses were observed in 66.7% of patients. All responding patients presented with antibodies reactive only against GPIbα. These findings suggest that desialylation may play a key pathogenic role in some multirefractory ITP patients, and provide diagnostic tools for the identification of such patients. Furthermore, we show that sialidase inhibitor treatment in combination with therapies that help to increase platelet production can induce sustained platelet responses in some patients with anti-GPIbα -mediated thrombocytopenia that have failed previous therapies.

Unraveling the effect of silent, intronic and missense mutations on VWF splicing: contribution of next generation sequencing in the study of mRNA.

Large studies in von Willebrand disease patients, including Spanish and Portuguese registries, led to the identification of >250 different mutations. It is a challenge to determine the pathogenic effect of potential splice site mutations on VWF mRNA. This study aimed to elucidate the true effects of 18 mutations on VWF mRNA processing, investigate the contribution of next-generation sequencing to in vivo mRNA study in von Willebrand disease, and compare the findings with in silico prediction. RNA extracted from patient platelets and leukocytes was amplified by RT-PCR and sequenced using Sanger and next generation sequencing techniques. Eight mutations affected VWF splicing: c.1533+1G>A, c.5664+2T>C and c.546G>A (p.=) prompted exon skipping; c.3223-7_3236dup and c.7082-2A>G resulted in activation of cryptic sites; c.3379+1G>A and c.7437G>A) demonstrated both molecular pathogenic mechanisms simultaneously; and the p.Cys370Tyr missense mutation generated two aberrant transcripts. Of note, the complete effect of three mutations was provided by next generation sequencing alone because of low expression of the aberrant transcripts. In the remaining 10 mutations, no effect was elucidated in the experiments. However, the differential findings obtained in platelets and leukocytes provided substantial evidence that four of these would have an effect on VWF levels. In this first report using next generation sequencing technology to unravel the effects of VWF mutations on splicing, the technique yielded valuable information. Our data bring to light the importance of studying the effect of synonymous and missense mutations on VWF splicing to improve the current knowledge of the molecular mechanisms behind von Willebrand disease. clinicaltrials.gov identifier:02869074.

An Antioxidant Potential, Quantum-Chemical and Molecular Docking Study of the Major Chemical Constituents Present in the Leaves of Curatella americana Linn.

Reactive oxygen species (ROS) are continuously generated in the normal biological systems, primarily by enzymes as xanthine oxidase (XO). The inappropriate scavenging or inhibition of ROS has been considered to be linked with aging, inflammatory disorders, and chronic diseases. Therefore, many plants and their products have been investigated as natural antioxidants for their potential use in preventive medicine. The leaves and bark extracts of Curatella americana Linn. were described in scientific research as anti-inflammatory, vasodilator, anti-ulcerogenic, and hypolipidemic effects. So, the aim of this study was to evaluate the antioxidant potentials of leaf hydroalcoholic extract from C. americana (HECA) through the scavenging DPPH assay and their main chemical constituents, evaluated by the following quantum chemical approaches (DFT B3LYP/6-31G**): Maps of Molecular Electrostatic Potential (MEP), Frontier Orbital's (HOMO and LUMO) followed by multivariate analysis and molecular docking simulations with the xanthine oxidase enzyme. The hydroalcoholic extract showed significant antioxidant activity by free radical scavenging probably due to the great presence of flavonoids, which were grouped in the PCA and HCA analysis with the standard gallic acid. In the molecular docking study, the compounds studied presented the binding free energy (ΔG) values close each other, due to the similar interactions with amino acids residues at the activity site. The descriptors Gap and softness were important to characterize the molecules with antioxidant potential by capturing oxygen radicals.

Role of multimeric analysis of von Willebrand factor (VWF) in von Willebrand disease (VWD) diagnosis: Lessons from the PCM-EVW-ES Spanish project.

The multimeric analysis (MA) of plasma von Willebrand factor (VWF) evaluates structural integrity and helps in the diagnosis of von Willebrand disease (VWD). This assay is a matter of controversy, being considered by some investigators cumbersome and only slightly informative. The centralised study 'Molecular and Clinical Profile of von Willebrand Disease in Spain (PCM-EVW-ES)' has been carried out by including the phenotypic assessment and the genetic analysis by next generation sequencing (NGS) of the VWF gene (VWF). The aim of the present study was to evaluate the role of MA to the diagnosis of these patients and their potential discrepancies. Two hundred and seventy out of 480 patients centrally diagnosed with VWD had normal multimers, 168 had abnormal multimers and 42 a total absence of multimers. VWF MA was of great significance in the diagnosis of 83 patients (17.3%), it was also of help in the diagnosis achieved in 365 additional patients (76%) and was not informative in 32 cases (6.7%). With regard to discrepancies, 110 out of 480 (23%) patients centrally diagnosed with VWD presented some kind of discordance between VWF:RCo/VWF:Ag and/or VWF:CB/VWF:Ag ratios, multimeric study and/or genetic results. The VWF MA was key in the presence of novel mutations as well as in cases with phenotypic discrepancies. A comparison between the contribution of MA and VWF:CB showed a clearly higher contribution of the former in the diagnostic process. These data seem to reinforce the relevance of the VWF MA in VWD diagnosis, despite all its limitations.

Tasa relativa de crecimiento en plántulas de dos poblaciones de Magnolia pugana (Magnoliaceae) en distintos niveles de luz y fertilidad del suelo / Relative growth rate in Magnolia pugana (Magnoliaceae) seedlings from two populations at different light levels and soil fertility

Resumen El estudio de la ecofisiología de las especies en peligro de extinción es clave para el éxito de programas de conservación y restauración ecológica. El objetivo de este trabajo fue conocer el efecto de los factores luz, fertilidad de suelo y procedencia de las plántulas en el crecimiento de plántulas de Magnolia pugana. Se estimó la tasa relativa de crecimiento (TRC) y sus componentes (Tasa de Asimilación Neta: TAN y Cociente del Área Foliar: CAF), así como la relación raíz/vástago (C: R/V). Las plántulas fueron obtenidas de semillas recolectadas de dos localidades en Zapopan, Jalisco, México, la primera es una población silvestre en San Nicolás (SN) y la segunda es una plantación ubicada en los jardines del Centro Universitario de Ciencias Biológicas y Agropecuarias (CUCBA). El experimento se llevó a cabo en condiciones de invernadero. En septiembre 2015, 96 plántulas de tres meses de edad fueron sometidas a los siguientes tratamientos con un experimento factorial (2 × 2 × 2): nivel de luz (alta = 1 120 μmol m-2 s-1 y baja = 136.3 μmol m-2 s-1), procedencia de las plántulas (San Nicolás y CUCBA) y fertilidad del suelo (alta = suelo San Nicolás, baja = suelo del CUCBA) con 12 repeticiones por cada combinación de factores y niveles. El crecimiento se estimó con dos cosechas: la primera a los 30 días de establecido el experimento y la segunda a los 60 días. Los niveles de luz, fertilidad del suelo y la procedencia de las plántulas influyeron en el crecimiento a través de ajustes fisiológicos y morfológicos. En general Magnolia pugana mostró mayor TRC y TAN en la luz alta, mientras que el CAF disminuyó. La fertilidad del suelo y la procedencia de las plántulas no afectaron la TRC ni sus componentes. Sin embargo, si fueron afectados por los niveles de luz, las plántulas de SN crecieron más en luz alta. La altura del tallo varió debido a la fertilidad del suelo y a la procedencia de las plántulas, en el suelo con fertilidad baja, en el suelo del CUCBA las plántulas de SN fueron 35 % más altas que las del CUCBA. El suelo de baja fertilidad en la luz alta ocasionó que las plántulas asignaran mayor biomasa a la raíz. El componente fisiológico (TAN) fue el mayor determinante en la variación intraespecífica de la TRC. Las plántulas de SN mostraron mayor plasticidad fenotípica debido a que es una población silvestre, por lo que posiblemente tiene variación genética más alta que la población cultivada del CUCBA. Los resultados sugieren que Magnolia pugana es una especie con capacidad de adaptarse a diversos ambientes debido a su plasticidad fenotípica frente a los distintos niveles de luz y fertilidad del suelo.

Abstract The study of ecophysiology of endangered species is key to the success of conservation and ecological restoration programs. The objective of this work was to know the effect of light, soil fertility and seed origin on the growth of Magnolia pugana seedlings. The relative growth rate (RGR) and its components (Net Assimilation Rate: NAR and Leaf Area Ratio: LAR), as well as the root-shoot ratio (R/S) were estimated. Seedlings were obtained from seeds collected in two localities in Zapopan, Jalisco, Mexico, the first is a wild population in San Nicolás (SN) and the second is a plantation located in the gardens of the Centro Universitario de Ciencias Biológicas y Agropecuarias (CUCBA). The experiment was conducted under greenhouse conditions. In September 2015, 96 seedlings of approximately three months old were subjected to the following treatments in a factorial experiment (2x2x2): light level (high = 1 120 μmol m-2 s-1 and low = 136.3 μmol m-2 s-1), seedling origin (SN and CUCBA) and soil fertility (high fertility = SN soil, low fertility = CUCBA soil) with 12 replicates for each combination of factors and levels. Growth was estimated in two harvests: the first harvest after 30 days of starting the experiment and the second at 60 days. Light and soil fertility levels, as well as seedling origin influenced growth through physiological and morphological adjustments. In general, Magnolia pugana showed higher RGR and NAR in high light, while LAR decreased. Soil fertility and seedling origin did not affect RGR or its components. However, these were affected by the light level, seedlings from SN grew more in high light. Stem height varied due to soil fertility and seedling origin, in low fertility soil (CUCBA) the seedlings of SN were 35 % higher than those of CUCBA. Low fertility soil under high light caused greater investment in seedling root biomass. The physiological component (NAR) was the major determinant of intraspecific variation in RGR. SN seedlings showed greater phenotypic plasticity due to coming from a wild population, which possibly has higher genetic variation than the cultivated population from CUCBA. The results suggest that Magnolia pugana is a species capable of adapting to diverse environments due to its phenotypic plasticity in response to different light and soil fertility levels. Rev. Biol. Trop. 66(2): 622-633. Epub 2018 June 01.

[Prevalence in the performance of mammographies in Spain: Analysis by Communities 2006-2014 and influencing factors]. / Prevalencia en la realización de mamografías en España: análisis por comunidades 2006-2014 y factores que influyen.

OBJECTIVE: To determine the frequency of the performance of mammography with preventive purpose of the screening of breast cancer in Spanish women, the evolution between the years 2006-2014, the sociodemographic profile of the women who undergo the mammography and to analyze the factors that influence in their adhesion. DESIGN: Transversal study. SITES: Spain. PARTICIPANTS: A total of 53.628 women over 15 years old that are surveyed in the National Health Survey in Spain 2006 and 2011/12 and the European Health Survey in Spain 2009 and 2014. MEASUREMENTS: The following variables were used: mammography, frequency of mammography performance and the reason for the realization, as well as sociodemographic variables. Social class was obtained from the last occupation of the main family supporter. A logistic regression analysis was performed with sociodemographic variables. RESULTS: The prevalence of mammography has been increasing from 2006 to 2014, and also for the reason that the participants had received a letter, they were telephoned or offered in their Health Center to undergo this test. There are significant differences in the performance of mammography in the different autonomous communities. CONCLUSIONS: Performing mammography has increased significantly from 2006 to 2014, although there are still differences between autonomous communities, with Ceuta and Melilla being the least percentage of performed mammography. The factors that are related to greater performed mammography are: higher educational level, higher social class, married civil status, Spanish nationality and age.

Molecular and clinical profile of von Willebrand disease in Spain (PCM-EVW-ES): comprehensive genetic analysis by next-generation sequencing of 480 patients.

Molecular diagnosis of patients with von Willebrand disease is pending in most populations due to the complexity and high cost of conventional molecular analyses. The need for molecular and clinical characterization of von Willebrand disease in Spain prompted the creation of a multicenter project (PCM-EVW-ES) that resulted in the largest prospective cohort study of patients with all types of von Willebrand disease. Molecular analysis of relevant regions of the VWF, including intronic and promoter regions, was achieved in the 556 individuals recruited via the development of a simple, innovative, relatively low-cost protocol based on microfluidic technology and next-generation sequencing. A total of 704 variants (237 different) were identified along VWF, 155 of which had not been previously recorded in the international mutation database. The potential pathogenic effect of these variants was assessed by in silico analysis. Furthermore, four short tandem repeats were analyzed in order to evaluate the ancestral origin of recurrent mutations. The outcome of genetic analysis allowed for the reclassification of 110 patients, identification of 37 asymptomatic carriers (important for genetic counseling) and re-inclusion of 43 patients previously excluded by phenotyping results. In total, 480 patients were definitively diagnosed. Candidate mutations were identified in all patients except 13 type 1 von Willebrand disease, yielding a high genotype-phenotype correlation. Our data reinforce the capital importance and usefulness of genetics in von Willebrand disease diagnostics. The progressive implementation of molecular study as the first-line test for routine diagnosis of this condition will lead to increasingly more personalized and effective care for this patient population.

Afianzamiento del conocimiento y manejo del paro cardiorrespiratorio usando simuladores clínicos en estudiantes de Medicina

Introducción: El paro cardiorrespiratorio es la documentación de la pérdida del pulso y respiración. La resucitación cardiopulmonar (RCP) está compuesta por compresiones torácicas interpuestas por ventilaciones, las cuales pueden producir el retorno de circulación espontánea, un ritmo y pulso viable. Los parámetros de cómo realizar RCP están definidas por guías consensuadas, pero estos no son rutinariamente medidos, por lo que la calidad es desconocida. Objetivos: Determinar el grado de conocimiento teórico y práctico del manejo del paro cardiorrespiratorio en estudiantes de 6to. año de la Facultad de Medicina de la Universidad Francisco Marroquín utilizando simuladores clínicos. Metodología: Estudio descriptivo y abierto, donde se incluyeron 26 estudiantes usando simuladores de alta fidelidad de RCP, las cuales proveen respuestas fisiológicas realísticas, por medio de algoritmos matemáticos generados por programas en computadoras. Resultados: De los 26 estudiantes 0% aprobó el examen teórico con un promedio de 77.4 puntos; en la evaluación práctica ninguna pareja logró una efectividad mayor al 80%. El promedio de la profundidad de las compresiones fue de 3.38 cm, el promedio de liberación post-compresión fue de 51% y el promedio de tiempo de interrupción total fue 79 segundos. El análisis estadístico demostró que no hay relación entre los resultados del test teórico y la efectividad en las compresiones y ventilaciones en el manejo del paro cardiorrespiratorio. Conclusiones: Se pudo evidenciar que los estudiantes no tienen la competencia apropiada en Soporte Vital Básico y Avanzado, por lo que se recomienda enfocar los cursos de Advance Cardiac Life Support (ACLS) a un mayor abordaje práctico con simuladores fisiológicos y que los estudiantes realicen el curso en periodos de tiempo más seguidos. Palabras clave: Paro Cardiorrespiratorio, Simulaciones fisiológicas, compresiones efectivas, ventilaciones efectivas, ACLS, RCP

A cardiorespiratory arrest is the documentation of absence of pulse and respiration. The cardiopulmonary resuscitation (CPR) is composed of chest compressions interposed by ventilations that will increase the probability of spontaneous circulation return and a viable pulse and rhythm. The parameters of how of perform CPR are defined by consensus guides but these aren't routinely measured in the practice setting, so the quality thereof is unknown. Objective: Determine the degree of theoretical and practical knowledge of the management of cardiorespiratory arrest in students coursing 6th year of Medical School at the University Francisco Marroquín using clinical simulators. Methodology: Descriptive, open study with 26 students using RCP high fidelity simulators providing real physiologic responses throw the use of mathematic algorithms generated by computerized programs. Results: Of the 26 students, 0% approved the theoretical test, with an average grade of 77.4 points. In the practical evaluation, none of the couples achieved greater effectiveness than 80% when doing compressions or ventilations. The average of compression depth was 3.38cm, the post-compression release average was 51%; and the total interruption time average was 79 seconds. The statistical analysis showed there wasn't a relationship between the grades of the theoretical test and the effectiveness of compressions and ventilations in the management of a cardiorespiratory arrest. Conclusions: It is evident that the students don't have proper competition in the management of the Basic and Advance Life Support. It's recommended to focus ACLS courses to a more practical approach with physiological simulators and encourage students to take the course at least once a year while in their hospital rotations. Keywords: Cardiorespiratory arrest, effective compressions, effective ventilations, clinical simulators, ACLS, CPR

GRIND2-based 3D-QSAR and prediction of activity spectra for symmetrical bis-pyridinium salts with promastigote antileishmanial activity.

Leishmaniasis is a major group of neglected tropical diseases caused by the protozoan parasite Leishmania. About 12 million people are affected in 98 countries and 350 million people worldwide are at risk of infection. Current leishmaniasis treatments rely on a relatively small arsenal of drugs, including amphotericin B, pentamidine and others, which in general have some type of inconvenience. Recently, we have synthesized antileishmanial bis-pyridinium derivatives and symmetrical bis-pyridinium cyclophanes. These compounds are considered structural analogues of pentamidine, where the amidino moiety, protonated at physiological pH, is replaced by a positively charged nitrogen atom as a pyridinium ring. In this work, a statistically significant GRIND2-based 3D-QSAR model was built and biological activity predictions were in silico carried out allowing rationalization of the different activities recently obtained against Leishmania donovani (in L. donovani promastigotes) for a data set of 19 bis-pyridinium compounds. We will emphasize the most important structural requirements to improve the biological activity and probable interactions with the biological receptor as a guide for lead and prototype optimization. In addition, since no information about the actual biological target for this series of active compounds is provided, we have used Prediction of Activity Spectra for Biologically Active Substances to propose our compounds as potential nicotinic α6ß3ß4α5 receptor antagonists. This proposal is reinforced by the high structural similarity observed between our compounds and several anthelmintic drugs in current clinical use, which have the same drug action mechanism here predicted. Such new findings would be confirmed with further and additional experimental assays.

[SAFETY IN THE ELDERLY: HOME ACCIDENTS]. / Seguridad en personas mayores: accidentes en el hogar.

Home accidents are more common in the elderly and they can have serious consequences to the injured person's health. At home, chances to suffer accidents of any type are higher, because it's the place where old people spend most of their daily time. It is important to point out that a high percentage of domestic accidents could be easily avoided by taking some simple cautions. The main aim of this paper is to know how we can prevent most common domestic accidents in the aged population: falls, burnings, poisonings and fire prevention.

[USE OF NNN LANGUAGE IN LOCAL CARE OF BURN INJURIES]. / Lenguaje NNN en los cuidados locales de las quemaduras.

Burn injuries are tissue injuries originated as a result of a physical or chemical trauma. They can cause from a mild skin affectation to the total destruction of the affected tissues, depending on various levels of severity. Moreover, if the affected body surface is very large, patient life can seriously be compromised. In this chapter, the intention is to clarify the nursing care for the affected area, once patient's life risk is stabilized and controlled. This care should be based on an adequate approach to local handling of burn injuries, after their severity and prognosis have been stated. To do this, it will be used the standardized nursing language NNN, referring to Nursing Diagnosis NANDA (North American Nursing Diagnosis Association), Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC). This taxonomy is very useful to describe the Nursing clinical practice of burns care because it can easily be used by nurses participating in the care of this type of patients. Nursing plans using the NNN taxonomy can be designed using existing software applications.

Effectiveness of three interventions to improve participation in colorectal cancer screening.

BACKGROUND AND OBJECTIVE: Participation in colorectal cancer (CRC) screening varies widely among different countries and different socio-demographic groups. Our objective was to assess the effectiveness of three primary-care interventions to increase CRC screening participation among persons over the age of 50 years and to identify the health and socio-demographic-related factors that determine greater participation. METHODS: We conducted a randomized experimental study with only one post-test control group. A total of 1,690 subjects were randomly distributed into four groups: written briefing; telephone briefing; an invitation to attend a group meeting; and no briefing. Subjects were evaluated 2 years post-intervention, with the outcome variable being participation in CRC screening. RESULTS: A total of 1,129 subjects were interviewed. Within the groups, homogeneity was tested in terms of socio-demographic characteristics and health-related variables. The proportion of subjects who participated in screening was: 15.4% in the written information group (95% confidence interval [CI]: 11.2-19.7); 28.8% in the telephone information group (95% CI: 23.6-33.9); 8.1% in the face-to-face information group (95% CI: 4.5-11.7); and 5.9% in the control group (95% CI: 2.9-9.0), with this difference proving statistically significant (p < 0.001). Logistic regression showed that only interventions based on written or telephone briefing were effective. Apart from type of intervention, number of reported health problems and place of residence remained in the regression model. CONCLUSIONS: Both written and telephone information can serve to improve participation in CRC screening. This preventive activity could be optimized by means of simple interventions coming within the scope of primary health-care professionals.