Genome Sequencing is Critical for Forecasting Outcomes following Congenital Cardiac Surgery.

While genome sequencing has transformed medicine by elucidating the genetic underpinnings of both rare and common complex disorders, its utility to predict clinical outcomes remains understudied. Here, we used artificial intelligence (AI) technologies to explore the predictive value of genome sequencing in forecasting clinical outcomes following surgery for congenital heart defects (CHD). We report results for a cohort of 2,253 CHD patients from the Pediatric Cardiac Genomics Consortium with a broad range of complex heart defects, pre- and post-operative clinical variables and exome sequencing. Damaging genotypes in chromatin-modifying and cilia-related genes were associated with an elevated risk of adverse post-operative outcomes, including mortality, cardiac arrest and prolonged mechanical ventilation. The impact of damaging genotypes was further amplified in the context of specific CHD phenotypes, surgical complexity and extra-cardiac anomalies. The absence of a damaging genotype in chromatin-modifying and cilia-related genes was also informative, reducing the risk for adverse postoperative outcomes. Thus, genome sequencing enriches the ability to forecast outcomes following congenital cardiac surgery.

Robotic sacrocolpopexy for the treatment of pelvic organ prolapse in elderly women: comparative analysis of safety and efficacy versus younger women.

INTRODUCTION: Pelvic organ prolapse is a condition with high prevalence in elderly women. With increasing life expectancy and a desire for improved quality of life, a rise in the frequency of surgical treatments for these women is anticipated. The aim is to compare complication, success, and satisfaction rates among elderly patients (aged >70 years) in comparison to younger women undergoing robotic sacrocolpopexy, thereby assessing the safety and efficacy of this surgery in this group of patients. METHOD: A prospective observational comparative study of 123 robotic sacrocolpopexies conducted between December 2016 and June 2022. Patients were stratified by age (cutoff point: 70 years). Baseline characteristics, type, and grade of prolapse, intra and postoperative data, complications, functional and anatomical outcomes, and satisfaction levels were collected. RESULTS: Among the 123 patients, 62.6% were under 70 years old, while 37.4% were 70 years or older, exhibiting similar baseline characteristics, prolapse grade, and type. The percentages of intraoperative (6.5%) and postoperative complications (4.4-9%) were comparable in both age groups. Furthermore, success and satisfaction rates exceeded 90%, with no significant differences between women under and over 70 years during a two-year follow-up. CONCLUSION: Robotic sacrocolpopexy is at least as effective and safe in women aged 70 years or older as in younger individuals, with no higher rates of intra and postoperative complications and similar rates of anatomical and subjective success.

Identification of novel candidate genes associated with meiotic aneuploidy in human embryos by whole-exome sequencing.

PURPOSE: To identify novel genetic variants responsible for meiotic embryonic aneuploidy. METHODS: A prospective observational cohort study that included 29 couples who underwent trophectoderm biopsies from 127 embryos and performed whole-exome sequencing (WES) between November 2019 and March 2022. Patients were divided into two groups according to the expected embryo aneuploidy rate based on maternal age. RESULTS: After variant filtering in the WES analysis of 58 patients/donors, five heterozygous variants were identified in female partners from the study group that had an impact on embryo aneuploidy. Additionally, a slowdown in embryo development and a decrease in the number of blastocysts available for biopsy were observed in the study group embryos. CONCLUSION: This study has identified new candidate genes and variants not previously associated with meiotic embryo aneuploidy, but which are involved in important biological processes related to cell division and chromosome segregation. WES may be an efficient tool to identify patients with a higher-than-expected risk of embryo aneuploidy based on maternal age and allow for individualized genetic counselling prior to treatment.

Correlation between contrast sensitivity and morphological features obtained by OCT in patients with age-related macular degeneration treated with a loading dose of vascular endothelial growth factor inhibitors.

OBJECTIVE: To determine the correlation between contrast sensitivity and morphological characteristics obtained by Optical Coherence Tomography (OCT) in patients with Age-Related Macular Degeneration treated with a loading dose of vascular endothelial growth factor inhibitors (anti-VEGF). DESIGN: This is an ambispective (prospective + retrospective) observational, cross-sectional, and analytical study. PARTICIPANTS: All patients over 55 years of age with Age-Related Macular Degeneration who attended the Retina service of the Ophthalmology department and met the inclusion criteria between March-May 2022. METHODS: Data collection was carried out by reviewing the records of patients diagnosed with Age-Related Macular Degeneration of the neovascular variety treated with the loading dose of anti-VEGF. OCT studies obtained by Optovue® iVue80 prior to the application of intravitreal injections of patients who met the inclusion criteria and were currently in the first month after the last dose of anti-VEGF were analyzed. A total of 33 subjects were included, of which 30 continued follow-ups. The subjects underwent a new ophthalmological evaluation and new retinal measurements of the affected eye. Normality tests (Shapiro‒Wilk) were performed where a nonparametric data distribution was demonstrated. RESULTS: A linear regression analysis was performed comparing the logarithmic values of both visual acuity and contrast sensitivity, obtaining a significant relationship between both values after the application of treatment (P = <.0001***). Likewise, correlation was demonstrated between the decrease in contrast sensitivity values and all the characteristics evaluated in the patients' OCT. CONCLUSIONS: Antiangiogenesis strategies can lead to better results in global visual function, positively impacting contrast sensitivity.

Violencia contra el personal de salud en tiempo de pandemia por SARS-COV-2 en México / Violence against health workers in time of SARS-COV-2 Pandemic in México

Introducción: se analiza la violencia contra el personal de salud en tiempos de pandemia por SARS-Cov-2 bajo la perspectiva fenomenológica y simbólica de la realidad social. Objetivo: analizar la violencia contra el personal de salud en tiempos de COVID-19 a partir de la fenomenología y semiótica de las emociones. Material y métodos: se realizó una metodología hibrida para la descripción e interpretación de los datos cualitativos y cuantitativos. Se realizó un estudio transversal sobre violencia contra el personal de salud durante los primeros meses de la pandemia. Muestreo no probabilístico; se les aplicó un cuestionario en línea. Asimismo, se realizaron entrevistas semiestructuradas mediante las TIC utilizando técnicas etnográficas para la obtención de relatos sobre experiencias de violencia contra el personal de salud relacionadas con la pandemia. Resultados: se presentan gráficas de los resultados arrojados en la encuesta, así como la interpretación y cruce de los datos cuantitativos y cualitativos obtenidos. Conclusiones: la violencia es un fenómeno complejo, por ahora, nuestros acercamientos nos permiten identificar el detonante social y su reproducción.

Introduction: violence against health personnel in times of the SARS-Cov-2 pandemic is analyzed from the phenomenological and symbolic perspective of social reality. Objective: to analyze violence against health personnel in times of COVID-19 from the phenomenology and semiotics of emotions. Material and methods: a hybrid methodology was carried out for the description and interpretation of qualitative and quantitative data. A cross-sectional study was conducted on violence against health personnel during the first months of the pandemic. The sampling was non-probabilistic, an online questionnaire was administered to them. Likewise, semi-structured interviews were applied through ICT using ethnographic techniques to obtain reports on experiences of violence against health personnel related to the pandemic. Results: graphs and data from the survey are presented, as well as the interpretation and crossing of the results obtained. Conclusions: violence is a complex phenomenon, for now, our approaches allow us to identify the social trigger and its reproduction.

Nivel de dependencia funcional de los adultos mayores de la comunidad de Tula de Allende / Level of functional dependence of older adults in the community of Tula de Allende

Introducción: El estado funcional se mide mediante la autonomía que tienen las personas para desarrollar las actividades de la vida diaria, cuando no se pueden realizar de manera autónoma es necesario un cuidador. Esta medida se sustenta en el modelo de adaptación de Sor Callista Roy, ya que se identifica el proceso de envejecimiento como el estímulo focal que produce una respuesta inmediata en el adulto mayor de acuerdo con el modo de interdependencia. Objetivo: Conocer el nivel de dependencia funcional de los adultos mayores de la comunidad de Tula de Allende, Hidalgo. Material y métodos: Estudio de aplicabilidad básica, cuantitativo, descriptivo y trasversal. Participaron 366 adultos mayores de Tula de Allende, y se les dio a conocer los términos de confidencialidad conforme a lo establecido en la Ley General de Salud y Declaración de Helsinki mediante el consentimiento informado. Se aplicó el cuestionario de Índice de Barthel (IB), para medir la dependencia funcional en las actividades instrumentales de la vida diaria. Resultados: Predomina el género femenino con el 52.7% representado por 193 participantes, la mayoría son casadas y amas de casa. De acuerdo con el IB la mayoría de los participantes tiene una dependencia leve, con una frecuencia de 206 y un porcentaje de 56.3%, y el cruce de variables arroja como resultado una relación significativa. Conclusión: Los adultos mayores de la comunidad de Tula de Allende presentan un nivel de dependencia funcional leve.

Introduction: Functional status assesses people's ability to carry out daily activities; when these cannot be performed autonomously, a caregiver is necessary. This measure is based on the Roy Adaptation Model, which identifies the aging process as the focal stimulus that generates an effect according to the interdependence mode. Objective: To evaluate the level of functional dependence of the elderly in the community of Tula de Allende, Hidalgo. Material and methods: Quantitative, descriptive, and cross-sectional study of basic applicability. 366 older adults from Tula de Allende participated and were informed about confidentiality terms in accordance with the General Health Law and the Declaration of Helsinki through informed consent. The Barthel Index (BI) questionnaire was applied to measure functional dependence on daily instrumental activities. Results: The female gender predominates with 52.7% represented by 193 participants, the majority are married housewives. According to the BI, most of the participants have a slight dependency, with a frequency of 206 and a percentage of 56.3%; the correlation of variables showed statistical significance. Conclusion: Older adults in the community of Tula de Allende present a mild functional dependence level.

Isolated multiple neuropathy as clinical manifestation of leukemia relapse. / Neuropatía múltiple como manifestación clínica de una recidiva de leucemia.

INTRODUCTION: Neuroleukemia is a rare disorder of the peripheral nervous system due to leukemic cell infiltration. CASE REPORT: We present the case of a 34-year-old patient with history of acute myelomonoblastic leukemia in remission that presented progressive paresis of the right median, bilateral facial, and left peroneal nerves. The electromyogram confirmed the diagnosis of multineuropathy. A PET-CT showed hypermetabolism of both sciatic, facial, and right median nerves. A bone marrow aspirate confirmed the leukemia relapse so a new round of chemotherapy was performed with improvement of the neurological deficit. CONCLUSION: Peripheral nervous system infiltration by leukemic cells can mimic multiple syndromes depending on the structures involved. The nerve-blood barrier acts as a defense of leukemic cells against chemotherapy and the immune system. Thus, the peripheral nervous system constitutes a reservoir of leukemic cells. Neuroleukemia should be considered in patients with history of acute leukemia who have isolated symptoms of the peripheral nerve.

TITLE: Neuropatía múltiple como manifestación clínica de una recidiva de leucemia.Introducción. La neuroleucemiosis es una rara enfermedad del sistema nervioso periférico producida por la infiltración por células leucémicas. Caso clínico. Presentamos el caso de una paciente de 34 años con antecedente de una leucemia mielomonoblástica aguda en remisión, que presentaba una parálisis progresiva del nervio mediano derecho, del facial bilateral y del peroneal izquierdo. El electromiograma confirmó el diagnóstico de una neuropatía múltiple. La tomografía por emisión de positrones-tomografía computarizada mostró un hipermetabolismo de ambos nervios ciáticos, facial bilateral y mediano derecho. La biopsia de médula ósea confirmó la recidiva de la leucemia, por lo que se inició un nuevo ciclo de quimioterapia con mejoría de los déficits neurológicos. Conclusión. La infiltración del sistema nervioso periférico por células leucémicas puede simular múltiples síndromes neurológicos dependiendo de las estructuras afectadas. La barrera hematonerviosa actúa como defensa de las células leucémicas contra la quimioterapia y el sistema inmunitario, por lo que el sistema nervioso periférico constituye un reservorio de las células leucémicas. Por ello, la neuroleucemia debe considerarse en pacientes con antecedentes de leucemia que presenten síntomas aislados de afectación del sistema nervioso periférico.

Prevention of incisional hernia with a reinforced tension line (RTL) versus primary suture only in midline laparotomies: 3-year follow-up in a randomized clinical trial.

PURPOSE: Incisional hernia (IH) has an incidence of 10-23%, which can increase to 38% in specific risk groups. The objective of this study is to report the results at 3 years of follow-up of the use of the reinforced tension line (RTL) technique compared with primary suture only (PSO) closure in the prevention of IH in high-risk patients undergoing laparotomy. METHODS: Open randomized controlled clinical trial. Included were patients older than 18 years who underwent midline laparotomy, emergency or scheduled, who were considered high risk, and who completed 3-year follow-up. The patients were randomized 1:1 to the RTL technique or to PSO. The objective was to report the incidence of IH and the complications associated with the closure method. Intention-to-treat analysis and Cox regression were performed. RESULTS: A total of 124 patients were randomized; 51 patients from the RTL group and 53 patients from the PSO group finished the 3-year follow-up. The incidence of IH was higher in the PSO group (15/53, 28.3%) than the RTL group (5/51, 9.8%) (p = 0.016, OR 0.35, 95% CI 0.14-0.88, number needed to treat 5.4, log-rank test p = 0.017). The groups were similar in the rates of surgical site infection, hematoma, seroma, and postoperative pain during follow-up. CONCLUSIONS: The RTL technique is useful in the prevention of IH when compared with PSO in high-risk midline laparotomy patients, and it is not associated with a higher percentage of complications. TRIAL REGISTRATION: Local Committee CI-HRAEB-2013-020. March 13, 2013. CLINICAL TRIALS: NCT02136628, retrospectively registered.

Efficacy and Safety of Tranexamic Acid for the Control of Surgical Bleeding in Patients Under Liposuction.

Liposuction remains one of the most frequently performed cosmetic surgical procedures and its popularity is increasing every year. However, since its inception, justified concerns regarding patient safety have placed limits on the volume of fat that can be aspirated, influenced by hemodynamic fluctuations and blood loss during liposuction. Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the conversion of plasminogen to plasmin, thus preventing the binding and degradation of fibrin. Despite the existence of evidence of the effectiveness of TXA in orthopedic and cardiac surgeries, there is little evidence of its use in liposuction. The objective of this study was to evaluate the efficacy and safety of tranexamic acid in the control of surgical bleeding in patients undergoing liposuction, through a prospective, open, randomized and controlled clinical trial. Two groups of 25 participants each were formed to whom the application of TXA in a tumescent solution prior to liposuction or liposuction with the traditional technique was randomly assigned. The results showed a decrease in blood loss reflected by the differences in the final hematocrit values, as well as decrease in the same per aspirated volume (p = 0.003). No adverse events were found related with the TXA application and no blood transfusions were required in this group, in contrast to the control group where the need for blood transfusion was present in 20% of the intervened participants. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Phosphorene and phosphorene oxides as a toxic gas sensor materials: a theoretical study.

A systematic study of the adsorption of several harmful gases (CO2, NO, SO2, NH3y H2S) onto black phosphorene and three different black phosphorene oxides (BPO) is carried out through density functional theory calculations. In general, it is shown that BPOs are more suitable adsorbents than pure black phosphorene. Smaller values of adsorption energy correspond to CO2molecules, whilst those exhibiting larger ones are NH3, H2S, NO y SO2. It is found that SO2shows the greater difference in electronic charge transfer as well as the longer time of recovery among all species, being an electron acceptor molecule. Besides, it is revealed that physisorption induces changes of different order in the electronic, magnetic and optical responses of phosphorene systems involved. Greater changes in the electronic structure are produced in the case of NO adsorption. In that case, semiconductor nature and magnetization features of black phosphorene band structure become significantly modified. Moreover, a notorious effect of an externally applied electric field on the molecule adsorption onto BPOs has been detected. In accordance, adsorption energy changes with the applied electric field direction, in such a way that the higher value is favored through an upwards-directed orientation of NO y SO2adsorbates. Results presented could help to enhancing the understanding of BPOs as possible candidates for applications in gas sensing.

Human prostate epithelial cells and prostate-derived stem cells malignantly transformed in vitro with sodium arsenite show impaired Toll like receptor -3 (TLR3)-associated anti-tumor pathway.

A therapeutic strategy for prostate cancer (PCa) involves the use of 9-cis-retinoic acid (9cRA) to induce cancer stem cells (CSCs) differentiation and apoptosis. Polyinosinic:polycytidylic acid (PIC) is a Toll-like receptor 3 (TLR3) agonist that induces tumor cells apoptosis after activation. PIC+9cRA combination activates retinoic acid receptor ß (RARß) re-expression, leading to CSC differentiation and growth arrest. Since inorganic arsenic (iAs) targets prostatic stem cells (SCs), we hypothesized that arsenic-transformed SCs (As-CSCs) show an impaired TLR3-associated anti-tumor pathway and, therefore, are unresponsive to PIC activation. We evaluated TLR3-mediated activation of anti-tumor pathway based in RARß expression, on As-CSC and iAs-transformed epithelial cells (CAsE-PE). As-CSCs and CAsE-PE showed lower TLR3 and RARß basal expression compared to their respective isogenic controls WPE-Stem and RWPE-1. Also, iAs transformants showed reduced expression of mediators in TLR3 pathway. Importantly, As-CSCs were irresponsive to PIC+9cRA in terms of increased RARß and decreased SC-markers expression, while CAsE-PE, a heterogeneous cell line having a small SC population, were partially responsive. These observations indicate that iAs can impair TLR3 expression and anti-tumor pathway activated by PIC+9cRA in SCs and prostatic epithelial cells. These findings suggest that TLR3-activation based therapy may be an ineffective therapeutic alternative for iAs-associated PCa.

Calidad de vida del adulto mayor del Valle del Mezquital post apoyo educativo mediante las Tic´s / Quality of life od the elderly in the Valley of the Mezquital post educational support by Ict´s

Introducción: según estudios previos en México señalan que la esperanza de vida era de 75.5 años y de acuerdo con nuevos datos, se estima que esta aumentara a 77.8 años para 2030¹, por lo cual es necesario fortalecer y fomentar el autocuidado en el adulto mayor, mediante el apoyo educativo, debido a la pandemia a través del uso de las tecnologías de la información y la comunicación (TICs) con la finalidad de aumentar su nivel de calidad de vida. Objetivo: evaluar el nivel de calidad de vida de los adultos mayores del Valle del Mezquital antes y después del apoyo educativo para fomentar el autocuidado mediante el uso de las TICs. Material y métodos: investigación cuantitativa, nivel de alcance exploratorio, con un diseño metodológico experimental, prolectivo longitudinal prospectivo. Se ocupó la prueba estadística paramétrica t de student. Resultados: de acuerdo al instrumento WHOQOL-BREF preintervención se obtuvo que el 80% de la población reflejo una calidad de vida media, posterior a un mes de intervención 67 % de la población reflejo calidad de vida alta, de acuerdo con la prueba estadística t se obtuvo una significan la bilateral de .041 posterior a la intervención. Conclusiones: la calidad de vida de los adultos mayores mejoró gracias a las intervenciones educativas ofrecidas médiate las TICs logrando así una nueva estrategia de acercamiento en tiempos de pandemia demostrando que estas herramientas ayudan a mejorar el autocuidado.

Introduction: according to previous studies in Mexico indicate that life expectancy was 75.5 years and according to new data, it is estimated that this will increase to 77.8 years by 2030, so it is necessary to strengthen and encourage self-care in the elderly, through educational support, due to the pandemic through the use of Information and communication technologies (ICTs) to increase their quality of life. Objective: to assess the quality of life of older adults in the Mezquital Valley before and after educational support to promote self-care through the use of ICTs. Material and methods: basic research with a quantitative approach, exploratory scope level, with an experimental methodological design, prospective longitudinal prolective. The parametric statistical test of the student was taken. Results: according to the instrument WHOQOL-BREF pre intervention was obtained that 80 % of the population reflected an average quality of life, and after a month of intervention was obtained 67 % of the population reflected high quality of life, according to the statistical test was obtained a bilateral mean of .041 after the intervention. Conclusions: the quality of life of older adults improved thanks to the educational interventions offered by ICTs, thus achieving a new approach strategy in times of pandemic, demonstrating that these tools help to improve self-care

The utility HBA1c test as a screening biomarker for detecting gestational diabetes mellitus.

BACKGROUND: Glycated Hb (HbA1c) has not been used for the diagnosis of gestational diabetes mellitus (GDM). Measurement of HbA1c levels is less complicated and more comfortable than glucose challenge test (GCT) for pregnant women. We studied HbA1c as a biomarker of GDM and as a screening test to avoid the use of GCT. METHODS: A prospective case-control study involves 745 pregnant women between 24th and 28th gestation week. HbA1c levels were measured and GDM was diagnosed according to Carpenter-Coustan criteria. Mean and SD were calculated for GCT value, HbA1c, age, and body mass index (BMI). A receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of HbA1c test in diagnosing GDM. Cut-off points were calculated to rule out GDM and sensitivity (Se) and specificity (Sp) were also determined. A study of the implementation of HbA1c cut-offs was performed to avoid the GCT or to perform the confirmatory oral glucose tolerance test (OGTT). RESULTS: The area under the curve (AUC) was 0.67 (0.58-0.76). Using 4.6% HbA1c as a cut-off prevented false negatives but only decreased the number of GCTs performed by 7.2%. However, using 4.7% HbA1c resulted in one false negative (reduction of 15.0%). Finally, by selecting 4.8% HbA1c, we found two false negatives, but there were 25.9% who do not require a GCT. CONCLUSIONS: Adoption of HbA1c as a screening test for GDM may eliminate the need of GCT. Although the HbA1c test does not have sufficient Se and Sp to be used as the only diagnostic test, the use of a rule-out strategy in combination with the OGTT could be useful.

Dermoscopy comparative approach for early diagnosis in familial melanoma: influence of MC1R genotype.

BACKGROUND: MC1R polymorphisms interact with CDKN2A mutations modulating melanoma risk and contribute to a less suspicious clinical and dermoscopic appearance of melanomas. Different strategies, including dermoscopic comparative approach and digital monitoring, are used for the melanoma diagnosis in this context. OBJECTIVE: To analyse the diagnostic accuracy of the morphologic approach and comparative approach in dermoscopy, and to detect melanoma in familial melanoma (FamMM) patients according to different genetic backgrounds. METHODS: Two independent readers evaluated 415 lesions belonging to 25 FamMM: 26 melanomas (62% in situ, 36% early invasive) and 389 naevi, blinded for dermoscopic and histopathologic diagnosis, following two different steps. First step-Randomized: all lesions were randomly located in one single folder. Second step-Comparative approach: the lesions were clustered by patient. Sensitivity, specificity and number needed to excise (NNE) for melanoma diagnosis were calculated for both diagnostic strategies. Sensitivity and specificity were also assessed regarding the genetic background. RESULTS: The comparative approach showed lower sensitivity compared to the morphologic approach (69.2 and 73.1 vs. 76.9 both readers) but better specificity (95.9 and 95.1 vs. 84.3 and 90.2, respectively). NNE was better in the comparative approach. The readers had more difficulties diagnosing lesions from CDKN2A mutation carriers with red hair colour (RHC) MC1R variants. CONCLUSION: The comparative approach can be useful in high-risk patients to decrease the NNE. Early melanomas in CDKN2A carriers with RHC polymorphisms are more difficult to diagnose even with the comparative approach and benefit from the detection of changes during digital dermoscopy monitoring for early diagnosis.

Caracterización clínico-epidemiológica de las enterocolitis necrosantes neonatales de siete hospitales públicos

Resumen Introducción: Enterocolitis necrosante (ECN) representa una elevada mortalidad y morbilidad post-quirúrgica, gastrointestinal y del neuro-desarrollo. Existe limitada información en Chile. Objetivo: Describir el comportamiento clínico/epidemiológico de recién nacidos que cursaron con ECN. Pacientes y Métodos: Estudio multicéntrico descriptivo de pacientes con ECN de siete hospitales de Santiago, Chile, durante el 2016. Se realizó estadística descriptiva y análisis univariable/multivariable (software SPSS v22). Resultados: Se recolectaron 75 casos. Mediana de edad al diagnóstico fue 11 días, el promedio de edad gestacional 29 semanas y peso de nacimiento 1.285 g. La incidencia fue 2,6 por 1.000/recién nacidos vivos y letalidad de 18,6%, mayor en ≤ 750 g, ≤ 25 semanas y ECN quirúrgica. Hubo aislamiento microbiológico en 45,3% y se utilizaron 19 distintos esquemas antimicrobianos empíricos para el tratamiento de ECN. El análisis multivariable mostró tendencia a que la ECN fuese quirúrgica en usuarios de catéter umbilical arterial, PCR > 10 mg/L y aislamiento microbiológico, y hubo tendencia a fallecer en usuarios de catéter umbilical arterial. Discusión: Es el primer estudio multicéntrico que recopila información de datos locales. La incidencia fue similar a la descrita en la literatura médica, en cambio la letalidad fue algo menor. No existen consensos del tratamiento antimicrobiano a utilizar. Con estos resultados esperamos avanzar en mejorar el diagnóstico y unificar tratamientos antimicrobianos, para reducir cifras de morbimortalidad.

Abstract Background: Necrotizing enterocolitis (NEC) presents high mortality and postoperative, gastrointestinal and neurodevelopmental morbidity. There is limited information about NEC in Chile. Aim: To describe the clinical/epidemiological behavior of newborns who underwent NEC. Methods: Multicenter descriptive study of patients with NEC from seven hospitals of Santiago, Chile, during 2016. Descriptive statistics and univariate/multivariate analysis were performed (SPSS v22 software). Results: 75 cases were collected. Median days of life at diagnosis was 11, gestational age was 29 weeks, birth weight 1,114 g. The incidence was 2.6 per 1,000 live newborns and mortality was 18.6%, higher in ≤ 750 g, ≤ 25 weeks and surgical NEC. There was 45.3% microbiological isolation and 19 different empirical antibiotic schemes were used for the treatment of NEC. The multivariate analysis showed a higher risk of surgery in umbilical arterial catheter users, CRP > 10 mg/L and positive microbiological isolation. The highest risk of death was in umbilical arterial catheter users. Discussion: This ie the first multicenter study that collects local data information. The incidence was similar to that found in medical reports but with a lower mortality. There is no consensus of antibiotic treatment to use. With these results we hope to advance in improving the diagnosis and unify antimicrobial treatments, to reduce morbidity and mortality figures.

Antimicrobianos en neonatología. Parte I: Recomendaciones de dosificaciones basadas, en la más reciente evidencia en recién nacidos Comité Consultivo de Infecciones Neonatales, Sociedad Chilena de Infectología / Antibiotics in neonatology. Part I: Dosage recommendations based on the most recent evidence in newborns Advisory Committee on Neonatal Infections, Chilean Society of Infectious Diseases

Resumen Los antimicrobianos son los medicamentos más utilizados en los neonatos durante su primer mes de vida cuando se encuentran en unidades neonatales, principalmente por el alto riesgo que presentan de adquirir infecciones graves como la sepsis. La mayoría de estos antimicrobianos se utilizan con dosis extrapoladas en base a las recomendaciones en población adulta y niños mayores, a pesar de que la fisiopatología en los recién nacidos es absolutamente diferente. Lo anterior lleva a un mayor riesgo a que ocurran más efectos adversos los que pueden conducir a una mayor toxicidad y a fallas terapéuticas, entre otros. En la última década se han realizado mayores estudios farmacocinéticos de antimicrobianos en neonatos; esta reciente evidencia ha permitido nuevas recomendaciones de dosificación considerando el peso y la edad gestacional del recién nacido, entre otras variables, de acuerdo al antimicrobiano estudiado. En base a una mayor evidencia sobre el comportamiento farmacocinético de los antimicrobianos en neonatos, se ha elaborado este documento para así facilitar y promover su correcto uso en las unidades neonatales.

Abstract Antibiotics are the most widely used medications in neonates during their first month of life in neonatal units, mainly due to the high risk they present of acquiring serious infections such as sepsis. Most of these antibiotics are used with extrapolated doses based on the suggestions in the adult population and older children, despite the fact that the pathophysiology in newborns is absolutely different. This leads to a higher risk of more adverse effects occurring, which can lead to greater toxicity and therapeutic failures, among others. In the last decade more and more pharmacokinetic studies of antibiotics have been carried out in neonates, this recent evidence has led to new dosage recommendations taking into account the weight and gestational age of the newborn, among other variables, in agreement to the antibiotic studied. Therefore, based on the need to order and summarize the most up-to-date and most evidence-based information on antibiotics in neonates, this document was prepared to facilitate and promote its correct use in neonatal units.

Persistent Barriers to Smoking Cessation Among Urban, Underserved Women: A Feasibility Study of Tailored Barriers Text Messages.

OBJECTIVES: Despite health risks for themselves and their children, urban underserved women smoke at high rates postpartum. The postpartum period is a stressful transition time that presents unique barriers to sustained cessation. There is limited extant evidence of efficacious psychosocial programs to maintain postpartum smoking cessation. METHODS: Guided by the Cognitive-Social Health Information Processing model, we explored the feasibility of TxT2Commit, a text-messaging intervention designed to prevent postpartum smoking relapse. Participants (n = 43) received supportive cessation-focused text messages for one month postpartum. Using a convergent mixed method design, surveys and interviews assessed changes in psychosocial factors and smoking status through a three month follow-up. RESULTS: Participants reported satisfaction with TxT2Commit, rating text messages as helpful, understandable, supportive, and not bothersome. However, a majority of women (n = 28, 65.1%) relapsed by three months. Participants who stayed smoke free (i.e., non-relapsers) reported significantly less temptation to smoke at one and three months postpartum compared to relapsers (ps < .01). While relapsers had significantly less temptation at one month compared to baseline, temptation increased by three months (p < .01). Consistent with the quantitative results, qualitative interviews identified informational and coping needs, with continued temptation throughout the three months. Non-relapsers were able to manage temptation and reported greater support. CONCLUSIONS FOR PRACTICE: TxT2Commit demonstrates preliminary feasibility and acceptability among urban, underserved postpartum women. However, most participants relapsed by three months postpartum. Additional research is needed to identify targeted messaging to best help women avoid temptation and bolster support to stay smoke free in this uniquely stressful period.

Los determinantes sociales de la desnutrición infantil en Colombia vistos desde la medicina familiar / The social determinants of child malnutrition in Colombia from a family medicine perspective

CONTEXTO: La desnutrición infantil es un problema de salud pública no solo en Colombia, sino en todo el mundo, ya que aumenta la mortalidad asociada a causas que son prevenibles. En Colombia, la pobreza es una de esas causas, la cual se presenta principalmente en las zonas rurales, en donde uno de cada 10 niños presenta desnutrición. METODOLOGÍA: Se realizó una revisión a partir de la búsqueda de artículos en bases de datos electrónicas (ScienceDirect, PubMed, ClinicalKey y SciELO) y en referentes normativos sobre la desnutrición infantil, sus determinantes sociales y elementos para su intervención en Colombia. RESULTADOS: La revisión permitió identificar que son muchos los factores que influyen en esta condición que está determinada no solo por la falta de alimentos sino también por causas como la pobreza, la falta de recursos, una atención insuficiente, el alza en el precio de los alimentos básicos, los conflictos que originan desplazamientos masivos de la población, la sequía, la ausencia de un enfoque de equidad y el mal saneamiento ambiental, entre otros. CONCLUSIONES: Es importante dejar de concebir la desnutrición infantil como un problema exclusivamente alimentario. También es necesario tener en cuenta que en ella influyen otros factores que se deben trabajar para evitar esta enfermedad, los cuales deben ser intervenidos por personal capacitado para generar impacto en los determinantes sociales causantes de esta problemática. De ese modo en Colombia, el médico familiar se constituye como un eslabón fundamental del sistema de salud, el cual tiene como función de proveer atención médica integral y de liderar el nuevo modelo de salud basado en la atención primaria en salud.

CONTEXT: Child malnutrition is a public health problem not only in Colombia but throughout the world, as it increases mortality associated with preventable causes. In Colombia, poverty is one of those causes present mainly in rural areas where one in 10 children suffers from malnutrition. METHODOLOGY: We searched ScienceDirect, PubMed, ClinicalKey, and SciELO for references on child malnutrition, its social determinants, and elements for its intervention in Colombia. RESULTS: The review allowed us to identify that many factors influence this problem determined not only by the lack of food but also by other factors such as poverty, lack of resources, restricted access to health care, rising prices of essential foods, political conflicts leading forced displacement, drought, the absence of an equity-based policy approach, poor environmental sanitation, among others. CONCLUSIONS: Child malnutrition should not be conceived as mainly a food-related problem. Other factors that influence this problem should also be taken into account in order to prevent it. Trained personnel should be deployed to intervene in the social determinants that underpin child malnutrition. Thus, in Colombia, the family physician is a fundamental link in the health system, responsible for providing comprehensive medical care and for the leadership of the newly introduced health model based on primary health care.