Helicobacter pylori infection is associated with decreased odds for eosinophilic esophagitis in Mexican patients. / La infección por Helicobacter pylori se asocia con disminución del riesgo de esofagitis eosinofílica en pacientes mexicanos.

BACKGROUND: The incidence of eosinophilic esophagitis (EoE) is increasing in some regions of the world. Retrospective studies have found an inverse association with Helicobacter pylori infection (H. pylori). A recent prospective study has questioned this relationship. We aimed to evaluate this relationship in Mexican patients. PATIENTS AND METHODS: We evaluated adult patients without prior eradication of H. pylori. Cases were defined by the presence of esophageal symptoms and >15 eosinophils/high power field (HPF) in the esophageal biopsy. Controls were defined by the presence of <15 eosinophils/HPF in esophageal biopsy. H. pylori infection was defined by histology. Patients were matched by age and gender assigning four controls per case. RESULTS: We included 190 patients: 38 cases and 152 controls. Cases had higher frequency of atopy, dysphagia, food impaction, peripheral eosinophilia, and endoscopic EoE abnormalities. The overall prevalence of H. pylori was 63.6%. Cases had significantly lower prevalence of H. pylori than controls (36.8% vs. 70.4%, OR 0.21 95% CI 0.08-0.69, p = 0.001). Atopic patients had lower prevalence of H. pylori than non-atopic: 13.1% vs. 50.5% (OR 0.20, 95% CI 0.06-0.69, p < 0.001), particularly allergic rhinitis and food allergy. CONCLUSIONS: We observed an inverse relationship between H. pylori and EoE as well as atopy. Studies in experimental models of EoE that clarify the role of H. pylori in this interaction are required, as well as robust studies that include other factors (socioeconomic, cultural, microbiota, etc.) in order to clarify this relationship.

Differential diagnosis of human Entamoeba infections: Morphological and molecular characterization of new isolates in Argentina.

Entamoeba infections occur worldwide, with higher frequency in countries of low socioeconomic status and poor public health. Since Entamoeba histolytica has long been recognized as the only pathogenic species, making a differential diagnosis of other morphologically identical Entamoeba is important. This study aimed to determine the prevalence of Entamoeba species in two populations from Argentina, make a differential diagnosis by PCR and characterize Entamoeba isolates at the SSU rRNA gene. A total of 493 serial fecal samples were obtained from individuals in the provinces of Buenos Aires (n=210) and Misiones (n=283). Samples were examined by conventional methods (formalin-ethyl acetate and Willis flotation) and specific PCRs to differentiate Entamoeba species. Entamoeba isolates were characterized by sequencing a fragment of the SSU rRNA gene. The overall prevalence of Entamoeba infection was 12.4%, being more prevalent in Buenos Aires than in Misiones (14.8% vs. 10.6%). A case of E. histolytica confirmed by PCR and sequence analysis was reported for the first time in Buenos Aires. Moreover, new genetic data on Entamoeba coli and Entamoeba dispar were recorded. The phylogenetic analysis revealed a congruence between morphological characteristics and SSU rRNA gene sequences. This study increases the amount of information on the distribution of these species in Argentina and the region of the Americas.

Prevalence of diagnosed and undiagnosed osteoarthrosis and associated factors in the adult general Spanish population.

OBJECTIVE: To determine the prevalence and related factors of diagnosed osteoarthrosis (DO) and undiagnosed osteoarthrosis (UO) in the general Spanish adult population. SETTING: Cross-sectional study with data from the Spanish National Health Survey 2017. PARTICIPANTS: N=23,089 adults. Three groups of people were defined: DO, UO, and no osteoarthrosis (NO). MAIN MEASUREMENTS: Sociodemographic information, lifestyle (tobacco, alcohol, physical activity, body mass index) and health factors (intensity of pain, pain drug consumption, mental health, self-perceived health status, pain involvement in daily living) were collected. Descriptive and bivariate analyses were performed, and a multinomial logistic regression model for the factors associated with each group. RESULTS: The prevalence of DO was 22.4% (95%CI=21.8;22.9) and 0.9% (95%CI=0.8;1) of UO. With respect to NO, risk factors for DO and UO included higher pain levels and pain drug consumption. Better self-perceived health status was inversely related with both. More pain involvement in daily living was associated with increased risk of DO, but reduced risk of UO. CONCLUSIONS: The prevalence of DO and UO was similar to that reported in Europe, but slightly higher than in low/middle-income countries. It was more prevalent in females, older people, people with worse perceived health status and worse mental health. Higher pain levels and pain drug consumption were risk factors for DO and UO. Better self-perceived health status was protective. Pain involvement in daily living was a risk factor for DO, but protective for UO. Different public health strategies should be considered in view of this.

[Breastfeeding in Spain and the factors related to its establishment and maintenance: LAyDI Study (PAPenRed)]. / Lactancia materna en España y factores relacionados con su instauración y mantenimiento: estudio LAyDI (PAPenRed).

OBJECTIVE: To find out actual statistics on breastfeeding in Spain, as well as sociocultural and perinatal factors that affect its initiation and maintenance. DESIGN: Prospective, multicentre, longitudinal, nationwide study (XXX study). SITE: Primary care paediatricians' office. PARTICIPANTS: Cohort of newborns born between April 2017 and March 2018 in Spain who were followed up to two years of age in 8 visits. MAIN MEASURES: Rates of different types of breastfeeding were analysed at each visit and variables related to gestation, delivery, neonatal period, social, economic and biological variables were also analysed. RESULTS: Initial sample of 1946 (50.1% male). 90.7% decided to initiate breastfeeding at birth. Exclusive breastfeeding (EBF) was 66.4% at 15days and 35.2% at 6months. Any type of breastfeeding (total breastfeeding [TBF]) at 6months was 61.7%. Median survival from TBF was 6.0months (95%CI: 6.0-6.1). Variables related to EBF at 15days: previous children, mother's level of education, absence of illness during pregnancy, no separation of mother and child at birth, no dummy use, no nipple problems, and time of decision to breastfeed. Variables related to longer duration of TBF: relationship of parents older than 5years, no dummy use, co-sleeping at one month of life, deciding to breastfeed before pregnancy, receiving information on breastfeeding during pregnancy and using support from associations. CONCLUSIONS: Early abandonment of breastfeeding is a major problem in Western societies. There are factors that can be worked on to improve outcomes.

Incidence and prevalence of inflammatory bowel diseases in a population from Buenos Aires, Argentina.

BACKGROUND: Inflammatory bowel diseases (IBD) incidence and prevalence in Latin America have experienced a significant shift in the last decades. There is paucity of IBD epidemiologic data in Argentina. AIM: To determine the incidence and prevalence of IBD between 2018 and 2022 of a population from the city of Buenos Aires. MATERIALS AND METHODS: From January 1st, 2018 to December 31st, 2022, the total population of two healthcare insurances were studied. 'Possible' IBD cases were identified using the following information sources: IBD-unit patient databases; electronic medical record; central laboratory electronic database; histopathology electronic database; pharmacy electronic database. Age-adjusted incidence and prevalence rates for Crohn's disease (CD), ulcerative colitis (UC) and IBD were estimated based on the number of patients compared with the at-risk population and expressed per 100,000 subjects. Trends in IBD incidence and prevalence were estimated as annual percentage changes; we used Poisson regression modeling to calculate significance in these trends over time. RESULTS: Information source analysis rendered 172 possible cases, of which 82 cases of IBD were finally confirmed: 27.16% were CD and 72.84% were UC. Mean age-standardized incidence across the study period for IBD, CD and UC was 11.93 (11.28-12.55), 2.88 (2.65-3.07) and 9.05 (8.83-9.2) respectively. Point prevalence on December 31st, 2022 for IBD, UC and CD was 134 (95%CI 132.3-135.6), 98 (96.95-99.52) and 36 (35.69-36.4) respectively. CONCLUSIONS: We found an incidence and prevalence of IBD in a population from Buenos Aires higher than those previously published in epidemiological studies in Argentina.

[Risk factors for disability in patients with stroke in northeastern Mexico: A retrospective cross-sectional study]. / Factores de riesgo para discapacidad en pacientes con accidente cerebrovascular en el noreste de México: estudio retrospectivo transversal.

OBJECTIVE: To determine the risk factors associated with disability in patients who had a stroke in northeastern Mexico. DESIGN: This was an observational, retrospective, cross-sectional study. SITE: Conducted at the Family Medicine Unit No. 33 of the Mexican Institute of Social Security in Reynosa, Tamaulipas, Mexico. PARTICIPANTS: One hundred and ninety-eight males and 146 females, above 18 years old, beneficiaries of the Mexican Institute of Social Security with a diagnosis of stroke between 2018 and 2021. INTERVENTIONS: The Barthel index that assesses the degree of dependence to perform basic activities of daily living was applied to the participants and sociodemographic, biological and anthropometric variables were collected from the digital medical record. MAIN MEASURES: A univariate, correlational and ordinal logistic regression statistical analysis was performed between independent and dependent variables to obtain measures of frequency, percentages, and associated risks. RESULTS: The risk factors associated with disability were age (OR 1.03, CI 1.01-1.05), overweight (OR 1.81, CI 1.03-3.1), obesity grade I (OR 2.74, CI 1.46-5.1), obesity grade II (OR 4.38, CI 1.44-13), obesity grade III (OR 9.99, CI 2.12-47); type of stroke: ischemic (OR 4.60, CI 2.6-8) or thrombotic (OR 4.95, CI 1.57-15). The number of comorbidities was associated with disability when having one comorbidity (OR 2.80, CI 1.22-6.4), two comorbidities (OR 3.43, CI 1.37-8.5), three comorbidities (OR 2.71, CI 1.01-7.3), and with five comorbidities (OR 3.17, CI 1.01-9.9). CONCLUSIONS: The risk factors found for disability were age, overweight, obesity, and type of ischemic and thrombotic stroke. Being cared for by a relative and/or spouse reduces the probability of disability.

Relevance and needs of irritable bowel syndrome (IBS): Comparison with inflammatory bowel disease (IBD). (Please, if you are not interested in IBS, read it.). / Relevancia y necesidades del síndrome del intestino irritable (SII): comparación con la enfermedad inflamatoria intestinal (EII). (Por favor, si no te interesa el SII, léelo.).

INTRODUCTION: In our opinion there is an imbalance between the relevance of irritable bowel syndrome (IBS), and the resources that are provided. OBJECTIVE: To review the different factors that determine (or should determine) the interest of gastroenterologists in IBS, comparing it with inflammatory bowel disease (IBD). For this, 7 different areas have been analyzed: (1)Medical impact; (2)Social impact; (3)Academic importance; (4)Clinical relevance; (5)Scientific relevance; (6)Public relevance, and (7)Personal aspects of the doctor. RESULTS: The prevalence is 10 times higher in IBS, which represents up to 25% of gastroenterologist visits. Both pathologies alter the quality of life, in many cases in a similar way. The social cost is very important in both cases (e.g.: absenteeism of 21% and 18%) as well as the economic cost, although much higher in medication for IBD. Academic dedication is more than double for IBD, both in university and in MIR training. Scientific relevance is greater in IBD, with a number of publications four times higher. Public relevance is not very different between the two entities, although IBD patients are more associative. Doctors prefer IBD and tend to stigmatize IBS. CONCLUSION: In our opinion, to reduce this imbalance between needs and resources, human and material, in IBS it is essential to make drastic changes both in educational aspects, communication skills, prioritization according to the demands of patients, and reward (personal and social) of physicians.

[Prevalence of Depressive Symptoms, Predictive Factors, and Diagnosis of Suspicion of Depression in Patients with COPD]. / Prevalencia de síntomas depresivos y diagnóstico de sospecha de depresión en pacientes con EPOC.

OBJECTIVE: to determine the prevalence of and predictive factors for depression in patients diagnosed with COPD and referred from primary care to pneumology departments, departments that share care for COPD patients. DESIGN: observational, multicentric, prospective with non-probabilistic sample, transversal study. SETTING: two pneumology visit offices at two hospitals offering different levels of care. PARTICIPANTS: 293 patients diagnosed with COPD in a stable phase of the disease. INTERVENTIONS: Carryng out common clinical questionnaires in COPD & HADS. MAIN MEASUREMENTS: Demographic, clinical, and functional variables of COPD, and HADS depression scale. RESULTS: Included were 229 men (78.16%) and 64 women (21.8%), with an average age of 68.2 ± 10.3 years of whom 93 (31.7%) were active smokers and 200 (68.3%) ex-smokers. 19.45% of patients had a previous diagnosis of clinical depression but the HADS test established a diagnosis of suspicion of depression in 32.6%. Predictive factors included: being female, living alone, and variables related to the severity of the disease (FEV1 postbronchodilator, being a high-risk patient, exacerbating phenotype criteria, and C and D GOLD criteria levels). CONCLUSIONS: The prevalence of depression in patients with COPD is high and is infra-diagnosed. The HADS diagnostic test is useful for establishing a diagnosis of suspicion of depression at primary care and pneumology visit offices. There are personal and clinical factors that may be considered predictive and aid healthcare professionals in determining which patients should take the HADS test and, based on results, referring patients to the mental health department to confirm or reject the diagnosis.

[Evolution of the prevalence of peripheral artery disease in clinical practice: A descriptive population study with real databases (SIDIAP-CMBD)]. / Evolución de la prevalencia de arteriopatía periférica en la práctica clínica: Estudio descriptivo poblacional con bases de datos reales (SIDIAP-CMBD).

OBJECTIVE: To evaluate, with real world data (SIDIAP and CMBD), the evolution of the prevalence of peripheral arterial disease (PAD) in the Catalan population and the cardiovascular risk factors present in people with this pathology. DESIGN: Longitudinal descriptive population study. SITE: Primary health care. PARTICIPANTS: Patients listed in SIDIAP and CMBD with a diagnosis of peripheral artery disease between 2008 and 2018 ≥ 35 years, as well as those without a diagnosis, but with an ABI < 0.9 in SIDIAP. INTERVENTIONS AND MAIN MEASUREMENTS: Main variable AP (ICD-9, ICD-10). Sociodemographic data, risk factors and cardiovascular disease, drug use and prevalent cardiovascular events at the time of diagnosis. RESULTS: 141,520 patients were studied. 75% had hypertension, 58% were smokers or former smokers, and 23% had a myocardial infarction. The global prevalence increased from 1.15% in 2008 to 3.10% in 2018. The prevalence of PAD increased with age, with a moderate increase at younger ages, and more pronounced in > 55 years, exceeding 10% in > 85 years. CONCLUSION: This is a population study where it is observed that the evolution of the prevalence of peripheral artery disease has presented a constant increase during the years 2008-2018, being higher in men, especially from 55 years of age. Studies with large databases can facilitate the design and implementation of new policies in national health systems.

HPV infection profile in cervical lesions.

INTRODUCTION: The prevalence of the different genotypes of human papillomavirus (HPV) varies depending on lesion severity and geographic region. OBJECTIVE: To identify multiple HPV infections in low- and high-grade cervical lesions in a group of women from the Mexican Bajío region referred with inconclusive cytology. METHODS: Pilot study of women referred from primary care units of Guanajuato, Mexico, with cytology suggestive of cervical lesion. Cervical smears were subjected to DNA extraction and HPV genotyping using microarrays. RESULTS: 100 consecutive cases were collected and 90 were analyzed; HPV positivity was observed in 26% of healthy women, and 62% had some degree of cervical lesion. The most common HPV genotypes were 59, 31, 16 and 51. Multiple infections were found in most samples. CONCLUSIONS: HPV heterogeneity was identified in the samples of the study population in contrast to worldwide reports; furthermore, multiple infections are common in precursor lesions and decrease in high-grade lesions. These data could have an impact on current HPV vaccination programs.

INTRODUCCIÓN: La prevalencia de los diferentes genotipos de virus del papiloma humano (VPH) varía dependiendo de la severidad de la lesión y región geográfica. OBJETIVO: Identificar infecciones múltiples de VPH en lesiones cervicales de bajo y alto grado en un grupo de mujeres del Bajío mexicano referidas con citología no concluyente. MÉTODOS: Estudio piloto de mujeres referidas de unidades del primer nivel de atención de Guanajuato, México, por citología sugerente de lesión cervical. Los raspados cervicales fueron sujetos a extracción de ADN y genotipificación del VPH mediante microarreglos. RESULTADOS: Se colectaron 100 casos consecutivos y fueron analizados 90; se observó 26 % de positividad a VPH en mujeres sanas y 62 % presentó algún grado de lesión. Los genotipos de VPH más frecuentes fueron 59, 31, 16 y 51. En la mayoría de las muestras se encontró infección múltiple. CONCLUSIONES: Se identificó heterogeneidad de VPH en las muestras de la población estudiada en contraste con los reportes internacionales; además, son comunes las infecciones múltiples en lesiones precursoras y disminuyen en las lesiones de alto grado. Estos datos podrían influir en los actuales programas de vacunación anti-VPH.

[Prevalence of fear of falling and related factors in community-dwelling older people]. / Prevalencia del miedo a caer y factores asociados en personas mayores que viven en la comunidad.

AIM: To know, in the population over 70, independent for walking, the prevalence of the concern to fall according to the short version of the Short Falls Efficacy Scale-International (FES-I) questionnaire, in old people living in the community and their associated factors. DESIGN: Cross-sectional study. LOCATION: Centro de Salud El Greco, Getafe, Madrid, Spain. PARTICIPANTS: 189 patients ≥70years with a Barthel ≥60, independent for walking (walk 45minutes without help or with a cane). The study was offered to a total of 328 people, of these accepted 217 and rejected 111. MAIN MEASUREMENTS: The dependent variable, fear of falling (FOF), was evaluated by means of the short FES-I questionnaire, considering as a cut-off point for the positive screening of the MC a score ≥11. As independent variables we considered: Barthel index, Downton scale, the Short Physical Performance Battery (SPPB) fragility test, falls in the last year, injuries associated with falls, time since the last fall, sensory deficit, use of gait devices, comorbidity and pharmacological treatment. RESULTS: The prevalence of FOF was 42.9% (95%CI: 35.5-50.2). The factors associated with FOF in the final multivariate analysis were: female sex, living alone, high risk of falls, presence of frailty (SPPB≤9), use of hypotensive drugs, and injuries associated with previous falls. CONCLUSIONS: The prevalence of FOF in older people is high. Primary Care professionals should systematize the screening of this health problem, prioritizing especially in people who present the following risk factors: being a woman, living alone, having a low score on the SPPB (as an indicator of frailty) or presenting a high risk of falls.

[Prevalence and associated factors of frailty in adults over 70 years in the community]. / Prevalencia y factores asociados de fragilidad en adultos mayores de 70 años en la comunidad.

OBJECTIVE: To estimate the prevalence and analyze the factors associated with frailty syndrome, in adults ≥70 years old, belonging to a health center in Asturias. DESIGN: Observational cross-sectional study. PARTICIPANTS: Adults ≥70 years of age. SITE: Health Centre of Llano (Asturias). MAIN MEASUREMENTS: Frailty was defined by the presence of ≥3 criteria of Fried's frailty phenotype. Secondary variables: sociodemographic characteristics, health status, functional status, cognitive-affective status and social risk. A bivariate analysis and logistic regression were performed. RESULTS: Four hundred eight participants were included, with a mean age of 79.8 (SD 6.6), 59.1% female. The prevalence of frailty was 27.7% and 44.9% for pre-frailty. The sociodemographic profile is that of a woman (77%), of high age (>84 years) (50.4%), without studies (65.5%), widow (48.7%) with low economic status (47.8%) and at social risk (OR: 3.3; 95% CI: 2.5-4). Factors that were statistically associated with frailty syndrome were: high comorbidity (OR: 2.7; 95% CI: 1.5-5), polypharmacy (OR: 1.9; 95% CI: 1.3-3), perception of quality of life with health (OR: 0.95; 95% CI: 0.93-0.97), impaired ambulation (OR: 17.9; 95% CI: 7.1-45.3), support for walking (OR: 10.5; 95% CI: 4.7-23.4), high risk of falls (OR: 6.4; 95% CI: 3.8-10.8), ABVD (OR: 4; 95% CI: 2.4-6.6), AIVD (OR: 9.7; 95% CI: 4.7-20), disability (OR: 37.7; 95% CI: 52.2-274.5), cognitive impairment (OR: 4.1; 95% CI: 1.8-9.3) and depression (OR: 4.8; 95% CI: 2.7-8.7). CONCLUSIONS: Frailty is a multifactorial syndrome, with a high prevalence in those over 70 years of age, in which, in addition to Fried's criteria of frailty, aspects of health, functional, cognitive-affective and social status must be analyzed.

Cardiovascular risk factors associated with coronary ectasia and acute myocardial infarction.

INTRODUCTION: Coronary ectasia has a low prevalence in the general population. Its risk factors may differ from those of coronary artery disease. OBJECTIVE: To identify the prevalence of coronary ectasia in patients with acute myocardial infarction (AMI) and cardiovascular risk factors (CVRFs). METHODS: Retrospective, cross-sectional study. Out of 3,254 cardiac catheterizations for AMI during one year, 2,975 had no coronary ectasia. We included 558 patients with coronary ectasia on coronary angiography and, as controls, subjects with similar characteristics except for coronary ectasia, and CVRFs were recorded. Descriptive statistics, bivariate and multivariate analysis were used; odds ratio (OR) was calculated. RESULTS: 279 patients with and without coronary ectasia were studied. The prevalence of coronary ectasia was 8.5 %. The platelet/lymphocyte ratio (PLR) was higher in patients with ectasia than in those without ectasia (p = 0.003). In the bivariate analysis, associated CVRFs were overweight, obesity and diabetes, and in the multivariate analysis, hypercholesterolemia (OR: 3.90; p = 0.0001) and exposure to herbicides (OR: 6.82; p = 0.020). CONCLUSIONS: A high prevalence of coronary ectasia was found, with the main risk factors being a history of herbicide use and hypercholesterolemia. PLR was found to be elevated in these patients. Early detection is important due to its association with acute coronary events.

INTRODUCCIÓN: La ectasia coronaria tiene baja prevalencia en población general, los factores de riesgo pueden diferir de la enfermedad arterial coronaria. OBJETIVO: Identificar la prevalencia de ectasia coronaria en pacientes con infarto agudo de miocardio (IAM) y factores de riesgo cardiovascular (FRCV). MÉTODOS: Estudio retrospectivo, transversal. De 3,254 cateterismos cardiacos por IAM durante un año, 2,975 no presentaron ectasia coronaria. Se incluyeron 558 pacientes clasificados como portadores de ectasia coronaria en coronariografía y controles aquellos con características similares exceptuando la ectasia coronaria y se registraron los FRCV. Empleamos estadística descriptiva, análisis bivariante, multivariante y calculamos el odds ratio (OR). RESULTADOS: Se estudiaron 279 pacientes con y sin ectasia coronaria. La prevalencia de ectasia coronaria fue del 8.5%. El índice plaqueta/linfocito (IPL) se encontró más elevado en pacientes con ectasia que en aquellos sin ectasia (p = 0.003). En el análisis bivariante los FRCV asociados fueron sobrepeso, obesidad y diabetes, y en el multivariante la hipercolesterolemia (OR: 3.90; p = 0.0001) y exposición a herbicidas (OR: 6.82; p = 0.020). CONCLUSIONES: Encontramos alta prevalencia de ectasia coronaria, los principales factores de riesgo fueron el antecedente de uso de herbicidas e hipercolesterolemia. Identificamos el IPL elevado en estos pacientes. Es importante la detección oportuna debido a su asociación con eventos coronarios agudos.

Baixo peso ao nascer, prematuridade e restrição de crescimento intra-uterino: resultados dos dados de base da primeira coorte de nascimentos indígenas no Brasil (coorte de nascimentos Guarani).

ABSTRATO: FUNDO: O baixo peso ao nascer (BPN) continua sendo um importante problema de saúde global, associado a uma série de resultados adversos de saúde ao longo da vida. As evidências sugerem que o BPN é um determinante relevante de morbidade e mortalidade em grupos indígenas, que geralmente têm acesso limitado às políticas públicas de saúde e nutrição. O conhecimento da prevalência de BPN e de suas causas subjacentes pode contribuir com etapas essenciais para a prevenção de seus efeitos sobre a saúde. O estudo teve como objetivo estimar as prevalências de BPN, prematuridade e restrição de crescimento intra-uterino (RCIU) e investigar seus determinantes na primeira coorte de nascimentos indígenas no Brasil. MéTODOS: Este estudo transversal utilizou dados de linha de base coletados da primeira coorte de nascimentos indígenas no Brasil, a Coorte de Nascimentos Guarani. O Brasil é um dos países com maior diversidade étnica do mundo, com 305 povos indígenas e 274 línguas nativas. Os Guarani são uma das cinco maiores etnias, com aldeias localizadas principalmente na região sul. Todos os nascimentos únicos de 1º de junho de 2014 a 31 de maio de 2016 foram selecionados em 63 aldeias indígenas Guarani nas regiões Sul e Sudeste. Foi realizada regressão logística múltipla hierárquica. RESULTADOS: As taxas de prevalência de BPN, prematuridade e RCIU foram 15,5, 15,6 e 5,7%, respectivamente. As chances de BPN foram menores em recém-nascidos de mães que vivem em casas de tijolo e argamassa (OR: 0,25; IC 95%: 0,07-0,84) e foram maiores em filhos de mães ≤20 anos de idade (OR: 2,4; IC 95%: 1,29-4,44) e com anemia crônica antes da gravidez (OR: 6,41; IC 95%: 1,70-24,16). A prematuridade foi estatisticamente associada ao tipo de fonte de energia para cozinhar (fogão a lenha - OR: 3,87; IC 95%: 1,71-8,78 e fogueiras - OR: 2,57; IC 95%: 1,31-5,01). RCIU foi associado à primiparidade (OR: 4,66; IC 95%: 1,68-12,95) e anemia materna crônica antes da gravidez (OR: 7,21; IC 95%: 1,29-40,38). CONCLUSõES: Idade materna, estado nutricional e paridade, condições de moradia e exposição à poluição interna foram associados com resultados perinatais na população indígena Guarani. Esses resultados indicam a necessidade de investir no acesso e melhoria da assistência pré-natal; também no fortalecimento do Subsistema de Saúde Indígena, e em ações intersetoriais para o desenvolvimento de políticas habitacionais e de saneamento e melhorias ambientais ajustadas às necessidades e conhecimentos dos povos indígenas.

[Prevalence and risk factors associated with diabetic retinopathy in Santander. Northern Spain]. / Prevalencia y factores de riesgo asociados a la retinopatía diabética en Santander. Norte de España.

OBJETIVE: To assess the prevalence and risk factors associated with diabetic retinopathy (DR) in Cantabria. DESIGN: ross-sectional population based study. LOCATION: Health center of Cantabria. PARTICIANTS: A random sample of 442 patients with type 2 diabetes. MAIN MEASUREMENTS: Non-mydiatric retinography, classifying them according to the International Clinical Diabetic Retinopathy Disease Severity Scale. The analyzed risk factors were: age, gender, age at diabetes onset, duration of diabetes, glycated haemoglobin levels (A1C), treatment of diabetes, blood pressure (systolic and diastolic), serum lipids concentration, body mass index, smoking status, hematocrit, pregnancy, serum vitamin D (25 OH D) levels, nephropathy and cardiovascular events. RESULTS: The prevalence of DR was 8.56% (CI: 5.81-11.32): Mild non-proliferative DR: 5.07% (CI: 2.89-7.25); Moderate non-proliferative DR: 1.38% (CI: 0.17-2.60); Severe non-proliferative DR: 0.27% (CI: 0.006-1.28); proliferative DR: 1.84% (CI: 0.46-3.22). Diabetic macular oedema: 2.30% (CI: 0.77-3.83). Mean age: 70 years, mean diagnostic age: 58.97 years, mean body mass index 29.86, 78.40% patients with hypertension, 67.30% dyslipidemia and median A1C: 6.7%. A deficit of 25 (OH) D was identified in 77% of patients. In the multivariate analysis, treatment of type 2 diabetes, body mass index, duration of diabetes and metabolic control of glycaemia were identified as independent risk factors. CONCLUSIONS: The prevalence of DR, compared with former studies, has decreased to 8.56%; this decrease is associated with the improvement in the control of modifiable risk factors. The associated independent risk factors were: treatment, body mass index, duration and control of diabetes. The variables antihypertensive treatment, cardiovascular events and nephropathy showed predictive value for DR.

[Detection of serovars of Salmonella in artificially reared calves in Mar y Sierras Dairy Basin, Argentina]. / Detección de serovares de Salmonella en terneros de crianza artificial de la región lechera Mar y Sierras, Argentina.

Salmonellosis in calves is a bacterial disease that affects their digestive tract causing diarrhea. A cross-sectional epidemiological study was carried out with the aim of studying the prevalence of various serovars of Salmonella in calves and their relationship with diarrhea signs. The study was conducted in Mar and Sierras Dairy Basin located in Buenos Aires province, Argentina. Seven hundred and twenty six calves both with diarrhea signs or not were sampled by rectal mucosa swab in 50 dairy farms during the rearing period. Isolates identified as Salmonella spp. were classified using polyvalent and monovalent antisera against somatic, flagellar and capsule antigens (Vi). Salmonella spp. was found in 36% of the farms and serotypes were: S. Mbandaka, S. Anatum, S. Typhimurium, S. Dublin, S. Montevideo, S. Meleagridis, S. Newport, S. Seftemberg, S. subesp. 16,7:z1, S. Infantis, S. Give. A percentage of 5.5% calves was positive and calves showing diarrheal signs were 5.9 times more likely to be infected with Salmonella spp. than those having no signs. The age of positive calves ranged from the first day of life to 53; the second day being the most frequent time. In conclusion, 11 Salmonella serovars were detected in one out of 3dairy farms in Mar and Sierras Dairy Basin, and not only were these serovars associated with diarrhea signs including the presence of mucus in feces, but they were also more prevalent among calves aged up to 21 days.

[Prevalence of insomnia and characteristic of patients with insomnia in a health area of Majorca (Spain)]. / Prevalencia de insomnio y características de la población insomne de una zona básica de salud de Mallorca (España).

OBJECTIVES: To estimate insomnia prevalence as well as habits comorbidity, sleep quality of insomnia patients. DESIGN: Cross sectional descriptive study. SETTING: Calvia health center (Majorca, Spain). PARTICIPANTS: We included subjects registered in a Health Center (> 2 years) of 18-80 years old. METHODS: Firstly, they were interviewed by telephone in order to identify persons with insomnia using the Insomnia Severity Index. Afterward, subjects with insomnia were interviewed in the health center in order to collect the data. RESULTS: From a simple of 1,563 persons, we contacted 591 and 467 participated. Insomnia prevalence was 21.1% (IC 95% 17.38-25.01) and 6.9% (IC 95% 4.45-9.25) clinical insomnia. It was significantly more frequent in women, widow, divorced, retired and unemployed. Two in three presented obesity or overweight, 37% chronic pain, 21.1% depression and 37.9% anxiety. Half of the patients with insomnia referred a negative impact on daily activities and difficulties to maintain enthusiasm. Moreover, 41.1% declared to take pharmacological treatment for sleep usually. The more common therapeutic measures for insomnia were sleep hygiene and benzodiazepines; while cognitive-behavioral therapies were rarely used. CONCLUSIONS: The prevalence of insomnia in our health area is similar to those described in population based studies. The presence of some prejudicial habits for sleep quality as well as comorbidities could facilitate insomnia to become a chronic illness. Then, management of insomnia should be considered in a patient more general context. Pharmacological treatment is still in the first line and effective non pharmacological treatment is still a rare option.

[Find your 1%: prevalence and mortality of a community cohort of people with advanced chronic disease and palliative needs]. / Busca tu 1%: prevalencia y mortalidad de una cohorte comunitaria de personas con enfermedad crónica avanzada y necesidades paliativas.

OBJECTIVE: To determine the prevalence and profiles of people with advanced chronic diseases in Primary Care and to analyse the elements related to their mortality in order to orient strategies for improvement in this level of care. DESIGN: An observational, analytical and prospective study during 3 years conducted on a cohort of patients with palliative needs. LOCATION: Three Primary Care teams of Osona (Catalonia). PARTICIPANTS: A total of 251 people identified as advanced patients using a systematic population-based strategy that included the NECPAL tool. MAIN MEASUREMENTS: Basic demographic and clinical profile (age, gender, type of residence, health stratification level and main disease); date, place, and cause of eventual deaths. RESULTS: 1% of the adult Primary Care population suffer from advanced diseases, of which 56.6% are women, and with a median age of 85 years. Dementia or advanced frailty is observed in 49.3%, and only 13.7% have cancer. Just under one-quarter (24.3%) live in nursing homes. The accumulated mortality at 3 years is 62.1%, with a median survival of 23 months. Factors significantly associated with the likelihood of dying are cancer, female gender, and over-aging. Patients died at their home (47.3%), in an intermediate care hospital (37.2%), or in an acute care hospital (15.5%), depending on certain explanatory factors. CONCLUSIONS: The prevalence and characteristics of advanced community-based disease coincide with that reported in the literature. Potentially, Primary Care is the reference level of care for these patients, especially if it incorporates nursing homes as a usual field of practice.

Prevalencia de derrame pericárdico en enfermedades sistémicas.

INTRODUCTION: The presence of 50 mL of fluid or more in the pericardial sac is known as pericardial effusion. OBJECTIVE: To determine the prevalence of pericardial effusion in patients with systemic diseases. METHOD: Echocardiographic studies performed at the National Medical Center Siglo XXI Specialty Hospital Cardiology Department between 2006 and 2016 were reviewed. According to Weitzman's criteria, pericardial effusion was classified as mild, < 10 mm, moderate, 10 to 20 mm and severe, > 20 mm. RESULTS: In total, 10,653 studies were reviewed; the prevalence of pericardial effusion was 3.5 % (380), in 209 women (55 %, 45.9 ± 19.0 years) and 171 men (45 %, 41.9 ± 18.5 years). Etiology was uremic in 227 (59.7 %), lymphatic drainage reduction in 73 (15.8 %), autoimmune diseases in 30 (7.9 %), neoplastic in 26 (6.8 %), infectious in 19 (5 %), idiopathic in 14 (3.7 %), hypothyroidism in two (0.5 %), iatrogenic in one (0.3 %) and post-infarction in one (0.3 %). Severity was mild in 87 (22.9 %), moderate in 147 (38.7 %) and severe in 146 (38.4 %). CONCLUSIONS: The prevalence of pericardial effusion was 3.5% in patients with systemic diseases.

INTRODUCCIÓN: La presencia de 50 mL o más de líquido dentro del saco pericárdico se denomina derrame pericárdico. OBJETIVO: Determinar la prevalencia de derrame pericárdico en pacientes con enfermedades sistémicas. MÉTODO: Se revisaron los estudios ecocardiográficos efectuados en el Servicio de Cardiología del Hospital de Especialidades del Centro Médico Nacional Siglo XXI, entre 2006 y 2016. Conforme los criterios de Weitzman, el derrame pericárdico se clasificó en ligero, < 10 mm, moderado de 10 a 20 mm y severo, > 20 mm. RESULTADOS: Se revisaron 10 653 estudios; la prevalencia del derrame pericárdico fue de 3.5 % (380), 209 mujeres (55 %, 45.9 ± 19.0 años) y 171 hombres (45 %, 41.9 ± 18.5 años). La etiología fue urémica en 227 (59.7 %), reducción del drenaje linfático en 73 (15.8 %), enfermedades autoinmunes en 30 (7.9 %), neoplásicas en 26 (6.8 %), infecciosas en 19 (5 %), idiopáticas en 14 (3.7 %), hipotiroidismo en dos (0.5 %), iatrogénica en uno (0.3 %) y posinfarto en uno (0.3 %). La severidad fue ligera en 87 (22.9 %), moderada en 147 (38.7 %) y severa en 146 (38.4 %). CONCLUSIONES: La prevalencia de derrame pericárdico fue de 3.5 % en pacientes con enfermedades sistémicas.

Prevalence of incidental clinically relevant pancreatic cysts at diagnosis based on current guidelines.

BACKGROUND: Most pancreatic cysts (PCs) found incidentally by CT and MRI scans might not be clinically important according to the Fukuoka guidelines, the American Gastroenterological Association (AGA) guidelines and European guidelines. AIMS: To determine and compare the prevalence of incidental clinically important PCs (CIPCs). METHODS: Abdominal contrast-enhanced CT or MRI scans performed during a one-year period were retrospectively reviewed to identify incidental PCs. CIPCs were defined as those cysts that would be capable of triggering further evaluation with endoscopic ultrasound, immediate surveillance (within 3-6 months) and/or surgery. Prevalence was calculated as the number of patients with CIPCs per 100 subjects imaged (%). RESULTS: Sixty patients (mean age 70±14 years) out of 565 were found to have incidental PCs, representing a prevalence of 8.7% (95% CI 6.3-11.5) in CT scans and 27.5% (95% CI 16-41) in MRI scans. Seven patients (11.6%, 95% CI 5-22) had CIPCs based on size ≥ 30mm (n=5), size ≥ 30mm and pancreatic duct (PD) dilation (n=1) and PD dilation and presence of solid component (n=1). Based on the Fukuoka guidelines, the prevalence of CIPCs was 1.2% (95% CI 0.4-2.5) in CT scans (6/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Based on the AGA and European guidelines, the prevalence of CIPCs was 0.2% (95% CI 0.1-1) in CT scans (1/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Patients with PCs initially classified as "AGA- or European-positive" had a higher surgical probability and this decision was taken earlier in the follow-up. CONCLUSIONS: In our cohort, the prevalence of important incidental pancreatic cysts was not negligible at around 1% according to current guidelines.