Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist. / Consenso AITP español: Una lista de verificación AITP.

INTRODUCTION: The course in Primary Care in Pediatric Trauma (ATIP in Spanish) has been taught in Spain since 1997, and there are currently 9 accredited training centers. Care of polytraumatized pediatric patients often takes place in an environment conducive to errors resulting from forgetfulness, which is why checklists - mnemonic tools widely used in industry and medicine - are particularly useful to avoid such errors. Although several checklists exist for pediatric trauma care, none have been developed within the setting of our course. MATERIALS AND METHODS: The criteria for being selected as an expert in Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society. The items that make up the checklist were obtained from a review of the literature and consultation with selected experts, using the Delphi Technique. RESULTS: 10 experts representing the 9 groups or training centers in Primary Care in Pediatric Trauma were selected, and a 28-item checklist was drawn up in accordance with their design recommendations. CONCLUSIONS: With the consensus of all the groups, a checklist for the treatment of polytraumatized pediatric patients was drawn up using the Delphi Technique, an essential requirement for the dissemination of this checklist, which should be adapted and validated for use in each healthcare center.

INTRODUCCION: El curso de Asistencia Inicial al Trauma Pediátrico se imparte en España desde 1997, existiendo en la actualidad 9 centros formadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al error por olvido, por lo que las listas de verificación, como herramientas mnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas de verificación para la asistencia al traumatismo pediátrico, ninguna se ha desarrollado en el entorno de nuestro curso. MATERIAL Y METODOS: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con la comisión científica de politrauma de la Sociedad Española de Cirugía Pediátrica. Los ítems para formar la lista de verificación se obtuvieron a partir de una revisión bibliográfica y de la consulta a los expertos seleccionados, empleando un método Delphi. RESULTADOS: Se seleccionaron 10 expertos que representan los 9 grupos o centros formadores en Asistencia Inicial al Trauma Pediátrico y se elaboró una lista de verificación con 28 ítems, siguiendo sus recomendaciones de diseño. CONCLUSIONES: Se diseñó una lista de verificación para el manejo del paciente pediátrico politraumatizado, con el consenso de todos los grupos empleando un método Delphi, requisito fundamental para facilitar la difusión de esta lista. Sería preciso adaptar y validar dicha lista para su uso en cada centro asistencial.

Comparative study of intact specimen extraction in laparoscopic nephrectomy by Pfannenstiel incision.

OBJECTIVES: The aim of our study is to demonstrate that the Pfannenstiel incision is a reliable option in terms of postoperative complications compared to other types of incisions usually performed for kidney extraction after laparoscopic nephrectomy. MATERIALS AND METHODS: Retrospective and comparative study of 256 patients who underwent laparoscopic nephrectomy or nephroureterectomy. Patients were divided into two groups: specimen extraction by Pfannenstiel incision (group 1) and specimen extraction by way of other incisions (group 2). Incisional hernia, surgical site infection, pain score, seroma, haematoma/bleeding, wound dehiscence and muscle paralysis were analyzed in each patient. RESULTS: Patients in Pfannenstiel group presented a rate of wound complications of 11.72% vs. 27.34% with other incisions, p=0.002, it was significantly inferior the rate of wound dehiscence (5.5% vs. 12.5%, p=0.047) and seroma (3.1% vs. 7.8%, p=0.022). Using multivariate logistic regression, Pfannenstiel incision was a significant protective predictor factor for wound complications (OR=0.34, p=0.005). CONCLUSIONS: The Pfannenstiel incision allowed the extraction of bigger kidney masses with less incidence of dehiscence, seroma and in general wound complications. The hospital stay was lower in Pfannenstiel extraction group. These results present this incision as a reliable and safe option in the decision of which incision to select.

Plant-based drinks for vegetarian or vegan toddlers: Nutritional evaluation of commercial products, and review of health benefits and potential concerns.

There is an increasing trend today towards plant-based diets in western society, often resulting in milk restriction. In the case of very young children, the direct substitution of milk by other foods, without proper nutritional advice, may lead to a lack of nutrients and hence to growth and development alterations. This study focuses on the nutritional assessment of various commercially available plant-based drinks, to determine their adequacy as alternatives to ruminant milk, in relation to the nutritional requirements of toddlers (1-3 years old), and to establish whether other sources of nutrient supplementation may be needed, as well as any other possible positive and /or negative health effects associated to their consumption. A sample of 179 commercial plant-based drinks (almond, coconut, hemp, oat, rice, soy, tigernut) were chosen and their nutrient contents were compared to the EFSA nutrient reference values for toddlers. The scientific literature on the presence of bioactive and/or undesirable compounds was reviewed. None of the plant-based drinks studied should be considered as a milk substitute, since they are different food products with a different composition. However, from the results obtained, the best choice for toddlers who do not consume milk would be to consume at least 250 mL/day of fortified soy drink (for its higher amount and quality of protein, polyunsaturated fatty acids and phytosterols), and always in the context of a carefully-balanced diet. Almond, hemp or oat drinks are other alternatives that can be used in combination or for soy-allergic toddlers. The key nutrients that should be fortified in plant-based drinks are: vitamins A and B12, calcium, zinc and iodine, as they represent the most significant nutritional differences with milk; vitamin D would also be desirable. Of these, vitamins A, B12, D and calcium, are easily found in many commercial plant-based drinks on the Spanish market (most frequently in soy drinks), unlike iodine and zinc, which were not added to any. Given the fish restriction in vegetarians/vegans and the fact that plant-based drinks provide high amounts of phytates and tannins, which act as antinutrients, a good strategy for the industry would be to fortify plant-based drinks with iodine and zinc to improve the nutritional value of products aimed to vegetarians/vegans.

[Faecal occult blood test in symptomatic patients in primary care: A retrospective study in a healthcare area of Toledo]. / Sangre oculta en heces en pacientes sintomáticos en Atención Primaria: Un estudio retrospectivo en el área sanitaria de Toledo.

AIM: To review referral protocol in symptomatic patients from primary care of using 15µgHb/g faeces threshold with three consecutive samples in faecal occult blood (FOB) test. To compare test utility using current recommendations of 10µgHb/g faeces threshold and one sample. MATERIAL AND METHODS: A retrospective observational study was designed, including FOB samples of symptomatic patients from primary care. Samples were analyzed at the biochemistry laboratory in 2017. Seven hundred and fifteen patients tested positive and 925 patients negative. Exclusion criteria were secondary care request and patients under the age of 18. Descriptive analysis was performed of FOB results and clinical data about request and colonoscopy. FOB test's diagnostic utility was studied for different threshold (10 and 15µgHb/g faeces) in the same population. RESULTS: FOB positivity rate was 22.8% and cancer detection rate was 11%. However, the number of samples does not modify diagnostic precision. Negative predictive value is higher with 10µgHb/g faeces threshold. CONCLUSIONS: Correct patient selection and optimal threshold increase cancer detection rate. The protocol with 10µgHb/g faeces threshold and one sample collection for symptomatic patients from primary care improves the FOB test's purpose.

Variant rs4149584 (R92Q) of the TNFRSF1A gene in patients with familial multiple sclerosis.

INTRODUCTION: Genomic studies have identified numerous genetic variants associated with susceptibility to multiple sclerosis (MS); however, each one explains only a small percentage of the risk of developing the disease. These variants are located in genes involved in specific pathways, which supports the hypothesis that the risk of developing MS may be linked to alterations in these pathways, rather than in specific genes. We analyzed the role of the TNFRSF1A gene, which encodes one of the TNF-α receptors involved in a signaling pathway previously linked to autoimmune disease. METHODS: We included 138 individuals from 23 families including at least 2 members with MS, and analyzed the presence of exonic variants of TNFRSF1A through whole-exome sequencing. We also conducted a functional study to analyze the pathogenic mechanism of variant rs4149584 (-g.6442643C > G, NM_001065.4:c.362 G > A, R92Q) by plasmid transfection into human oligodendroglioma (HOG) cells, which behave like oligodendrocyte lineage cells; protein labeling was used to locate the protein within cells. We also analyzed the ability of transfected HOG cells to proliferate and differentiate into oligodendrocytes. RESULTS: Variant rs4149584 was found in 2 patients with MS (3.85%), one patient with another autoimmune disease (7.6%), and in 5 unaffected individuals (7.46%). The 2 patients with MS and variant rs4149584 were homozygous carriers and belonged to the same family, whereas the remaining individuals presented the variant in heterozygosis. The study of HOG cells transfected with the mutation showed that the protein does not reach the cell membrane, but rather accumulates in the cytoplasm, particularly in the endoplasmic reticulum and near the nucleus; this suggests that, in the cells presenting the mutation, TNFRSF1 does not act as a transmembrane protein, which may alter its signaling pathway. The study of cell proliferation and differentiation found that transfected cells continue to be able to differentiate into oligodendrocytes and are probably still capable of producing myelin, although they present a lower rate of proliferation than wild-type cells. CONCLUSIONS: Variant rs4149584 is associated with risk of developing MS. We analyzed its functional role in oligodendrocyte lineage cells and found an association with MS in homozygous carriers. However, the associated molecular alterations do not influence the differentiation into oligodendrocytes; we were therefore unable to confirm whether this variant alone is pathogenic in MS, at least in heterozygosis.

Tratamiento de heridas complejas mediante fibrina rica en plaquetas y leucocitos (L-PRF), experiencia inicial de un centro / Treatment of complex wounds using platelet rich fibrin and leukocytes (L-PRF), initial experience of a center

Resumen Introducción El uso de concentrados plaquetarios para el tratamiento de heridas complejas y regeneración tisular está siendo ampliamente utilizado a nivel mundial. Durante el último tiempo, la segunda generación de concentrados plaquetarios, particularmente el L-PRF, ha permitido tratar de manera efectiva a pacientes con esta patología. Debido a su bajo costo y versatilidad, ha sido posible aplicar esta técnica en variadas situaciones clínicas con buenos resultados. El objetivo de este trabajo es presentar nuestra experiencia utilizando L-PRF para la curación de heridas complejas (CHC) como una alternativa al uso de injertos de distinto grado de complejidad. Materiales y Método: Se realizó un análisis prospectivo de una serie de casos de pacientes que fueron sometidos a tratamiento quirúrgico de heridas complejas mediante el uso de L-PRF en el Hospital Santiago Oriente - Luis Tisné Brousse, entre los meses de enero de 2017 y diciembre de 2018. Mediante examen clínico y parámetros de inclusión, de éxito y de fracaso definidos previamente, se evaluó un total de 11 pacientes con heridas complejas a los cuales se les realizó un tratamiento local con injerto de L-PRF. Resultados: _La etiología de las heridas fue variada. 8 (72%) de los casos lograron una epitelización del 100% y 3 (28%) fracasaron. Se identificaron factores predisponentes para el fracaso de la técnica, y también fue posible establecer una relación de predicción de éxito en donde se relaciona una probabilidad alta de epitelización cuando la granulación de la herida ocurre durante los primeros 10 días sobre el injerto de L-PRF. Conclusión: El tratamiento de heridas complejas mediante L-PRF es una alternativa factible, de bajo costo y requerimientos (comparada con el uso de injertos, colgajos y sustitutos dérmicos), es segura en la resolución de heridas complejas, permitiendo disminuir la morbilidad, los costos asociados al tratamiento y estadía hospitalaria.

Introduction: The use of platelet concentrates for the treatment of complex wounds and tissue regenera-tion is being widely used worldwide. During the last time, the second generation of platelet concentrates, particularly L-PRF, has made it possible to effectively treat patients with this pathology. Due to its low cost and versatility, it has been possible to apply this technique in various clinical situations with good results. The objective of this work is to present our experience using L-PRF for the healing of complex wounds (HCC) as an alternative to the use of grafts of different degrees of complexity. Materials and Method: A prospective analysis was carried out with a series of cases who underwent surgical treatment of complex wounds using L-PRF at Santiago Oriente - Luis Tisné Brousse Hospital, between the months of January 2017 and December 2018. Through clinical examination and previously defined inclusion, success, and failure parameters, a total of 11 patients with complex wounds were evaluated who underwent local treatment with an L-PRF graft. Results: The etiology of the wounds was varied. 8 (72%) of the cases achieved 100% epithelialization and 3 (28%) failed. Predisposing factors for the failure of the technique were identified, and it was also possible to establish a predictive relationship of success where a high probability of epithelialization is related when the granulation of the wound occurs during the first 10 days on the L-PRF graft. Conclusion: The treatment of complex wounds using L-PRF is a feasible alternative, with low cost and requirements (compared to the use of grafts, flaps and dermal substitutes) and safe in the resolution of complex wounds, allowing to reduce morbidity, the costs associated with treatment and hospital stay.

Diseño y validación de una rúbrica para evaluar las habilidades socioemocionales en estudiantes de enfermería / Design and validation of an instrument to assess the social and emotional skills of nursing students / Desenho e validação de uma rubrica para avaliar habilidades socioemocionais em estudantes de enfermagem

RESUMEN Introducción Las habilidades socioemocionales (HSE) hacen referencia a las actuaciones integrales representadas mediante la conducta para un adecuado manejo de emociones, realización personal y desarrollo social. Existen diversos instrumentos de evaluación para medir las HSE en universitarios, pero son inexistentes los dirigidos a estudiantes de enfermería. Objetivo Diseñar y determinar la validez de contenido de un instrumento para evaluar HSE en estudiantes de enfermería. Metodología Se realizó un estudio instrumental que incluyó las fases de revisión de instrumentos para evaluar las HSE; construcción del instrumento; revisión y mejora del instrumento por expertos; validación de contenido mediante el juicio de 16 expertos empleando un índice de relevancia (V de Aiken); pilotaje del instrumento con 50 estudiantes para el análisis de confiabilidad (Alpha de Cronbach) y comprensión del instrumento. Resultados El instrumento integró 12 indicadores (tolerancia, trabajo colaborativo, adaptación al entorno, comunicación eficaz, empatía, toma de decisiones, creatividad, relaciones interpersonales, asertividad, autoeficacia, resiliencia, y manejo del estrés). El juicio de expertos reveló la validez de contenido (V de Aiken > 0.90). Se obtuvo un valor aceptable de confiabilidad (α= 0.786) y una adecuada opinión sobre la comprensión del instrumento en el pilotaje. Discusión y Conclusión La evaluación de HSE en estudiantes de enfermería es fundamental tanto para mejorar y mantener su salud mental como para favorecer el desarrollo profesional, personal y social. La rúbrica es un instrumento confiable, primero en su tipo y con validez de contenido. Para que obtenga una calidad óptima se requiere continuar con el análisis de sus propiedades psicométricas.

ABSTRACT Introduction Social-emotional Skills (SES) refer to integral behaviors representing ade- quate management of emotions while achieving personal and social development. There are diverse instruments to assess SES on university students in general, but not on nursing students in particular. Objective To design an instrument to assess SES among nursing students and test its content validity. Methodology An instrumental study was carried out that included the revision phases of instruments to evaluate the SES: construction of the instrument; review and improvement of the instrument by experts; content validation by 16 experts using Aiken's V relevance index; and pilot test of the instrument on 50 students and assess its reliability (Cronbach´s Alpha) and ease of comprehension. Results The instrument integrated 12 indicators (tolerance, collaborative work, adaptation to the environment, efficacious communication, empathy, decision making, creativity, interpersonal relationships, assertiveness, self-efficacy, resilience, and stress management). Expert judgment revealed a content validity of Aiken's V > 0.90. An acceptable value of reliability (α= 0.786) and favorable opinion was obtained regarding the ease of comprehension of the instrument. Discussion and Conclusion The assessment of SES on nursing students is fundamental to improve and preserve their mental health, and foster their professional, personal, and social development. This is a reliable, first-of-its-kind, and content-validated instrument. Nevertheless, the analysis of its psychometric properties should be continued to keep improving its quality.

RESUMO Introdução As habilidades socioemocionais (HSE) referem-se a ações integrais representadas por meio do comportamento para o manejo adequado de emoções, realização pessoal e desenvolvimento social. Existem diversos instrumentos de avaliação para mensurar a HSE em estudantes universitários, mas os voltados para estudantes de enfermagem são inexistentes. Objetivo Desenhar e determinar a validade de conteúdo de um instrumento para avaliar HSE em estudantes de enfermagem. Metodologia Foi realizado um estudo instrumental que incluiu as fases de revisão dos instrumentos de avaliação da HSE; construção de instrumentos; revisão e aperfeiçoamento do instrumento pelos especialistas; validação de conteúdo por meio dos pareceres de 16 especialistas utilizando um índice de relevância (V de Aiken); pilotagem do instrumento com 50 alunos para análise da confiabilidade (Alpha de Cronbach) e compreensão do instrumento. Resultados O instrumento integrou 12 indicadores (tolerância, trabalho colaborativo, adaptação ao entorno, comunicação efetiva, empatia, tomada de decisão, criatividade, relacionamento interpessoal, assertividade, autoeficácia, resiliência e gerenciamento de estresse). O parecer de especialistas revelou validade de conteúdo (V de Aiken > 0.90). Obteve-se um valor aceitável de confiabilidade (α= 0.786) e uma opinião adequada sobre o entendimento do instrumento na pilotagem. Discussão e Conclusão A avaliação da HSE em estudantes de enfermagem é essencial tanto para melhorar e manter sua saúde mental quanto para promover o desenvolvimento profissional, pessoal e social. A rubrica é um instrumento confiável, primeiro do gênero e com validade de conteúdo. Para obter a qualidade ideal, é necessário continuar com a análise de suas propriedades psicométricas.

Segundas resecciones anatómicas en pacientes con resección anatómica previa / Second pulmonary anatomical lung resections in patients with previous anatomical resections

Resumen Introducción: Las segundas resecciones anatómicas son cada vez más frecuentes en el tratamiento de carcinomas pulmonares sincrónicos, metacrónicos y de metástasis pulmonares de origen extrapulmonar. Objetivo: Determinar si las segundas resecciones anatómicas pulmonares se asocian con un mayor riesgo de complicaciones posoperatorias comparadas con la primera intervención. Materiales y Método: Hemos analizado todos los pacientes sometidos a una segunda resección anatómica en nuestro centro entre octubre de 2000 y febrero de 2019. Las complicaciones fueron clasificadas en mayores y menores según la clasificación estandarizada de morbilidad posoperatoria de Clavien-Dindo. Se compararon las características clínicas y demográficas de los pacientes y la ocurrencia de complicaciones mayores tras la primera y la segunda intervención quirúrgica mediante la prueba T para muestras relacionadas y la prueba exacta de McNemar para las variables cuantitativas y categóricas, respectivamente. Resultados: Setenta y cinco pacientes fueron sometidos a una segunda resección anatómica. La prevalencia de complicaciones globales y mayores tras la primera intervención fue del 26,7% y el 4% frente al 34,7% y al 6,7% tras la segunda intervención (p = 0,362 y p = 0,727, respectivamente). Las segundas resecciones pulmonares ipsilaterales se asociaron con un 16,7% de complicaciones mayores y los procedimientos consistentes en completar la neumonectomía con un 25%. Conclusión: Las segundas resecciones anatómicas pulmonares no se asocian con un mayor riesgo de complicaciones posoperatorias comparadas con la primera intervención. Sin embargo, las segundas resecciones ipsilaterales y las resecciones que impliquen completar la neumonectomía se asocian con riesgo significativamente superior de complicaciones mayores posoperatorias.

Introduction: Second anatomical resections are becoming more frequent in the treatment of synchronous, metachronous and pulmonary metastases of extrapulmonary origin. Aim: The objective of this study is to determine whether second pulmonary anatomical resections are associated with an increased risk of postoperative complications compared to the first intervention. Materials and Method: We have analyzed all patients undergoing a second anatomical resection in our center between October 2000 and February 2019. Complications were classified in major and minor according to the standardized Clavien-Dindo postoperative morbidity classification. The clinical and demographic characteristics of the patients and the occurrence of major complications after the first and second surgical intervention were compared using the T test for related samples and the McNemar exact test for quantitative and categorical variables, respectively. Results: Seventy-five patients underwent a second anatomic resection. The prevalence of global and major complications after the first intervention was 26.7% and 4% compared to 34.7% and 6.7% after the second intervention (p = 0.362 and p = 0.727, respectively). Second ipsilateral lung resections were associated with 16.7% of major complications and procedures consisting of completing pneumonectomy with 25%. Conclusion: Second lung anatomical resections are not associated with an increased risk of postoperative complications compared to the first intervention. However, second ipsilateral resections and resections that involve completing pneumonectomy are associated with a significantly higher risk of major postoperative complications.

Percutaneous tibial nerve stimulation in patients with severe low anterior resection syndrome: randomized clinical trial.

BACKGROUND: Treatment of low anterior resection syndrome (LARS) is challenging. Percutaneous tibial nerve stimulation (PTNS) can improve select bowel disorders. An RCT was conducted to assess the efficacy of PTNS compared with sham stimulation in patients with severe LARS. METHOD: This was a multicentre, double-blind RCT. Patients with major LARS score were allocated to receive PTNS or sham therapy (needle placement simulation without nerve stimulation). The study included 16 sessions of 30 min once a week for 12 consecutive weeks, followed by four additional sessions once a fortnight for the following 4 weeks. The primary endpoint was efficacy of PTNS defined by the LARS score 12 months after treatment. Secondary endpoints included faecal incontinence, quality of life (QoL), and sexual function. RESULTS: Between September 2016 and July 2018, 46 eligible patients were assigned randomly in a 1 : 1 ratio to PTNS or sham therapy. Baseline characteristics were similar. LARS scores were reduced in both groups, but only patients who received PTNS maintained the effect in the long term (mean(s.d.) score 36.4(3.9) at baseline versus 30.7(11.5) at 12 months; P = 0.018; effect size -5.4, 95 per cent c.i. -9.8 to -1.0), with a mean reduction of 15.7 per cent at 12-month follow-up. The faecal incontinence score was improved after 12 months in the PTNS group (mean(s.d.) score 15.4(5.2) at baseline versus 12.5(6.4) at 12 months; P = 0.018). No major changes in QoL and sexual function were observed in either group. There was no therapy-associated morbidity. Three patients discontinued the study, but none owing to study-related issues. CONCLUSION: PTNS has positive effects in some patients with major LARS, especially in those with faecal incontinence. Registration number: NCT02517853 (http://www.clinicaltrials.gov).

Estrés percibido en madres mexicanas de niños con necesidades especiales: un estudio etnográfico / Perceived stress among mexican mothers of children with special needs: an ethnographic study / Estresse percebido em mães mexicanas de crianças com necessidades especiais: um estudo etnográfico

RESUMEN Objetivo: Examinar las percepciones sobre los factores exploratorios, las manifestaciones y consecuencias del estrés en madres cuidadoras de niños con necesidades especiales en Veracruz, México. Métodos: Estudio cualitativo con diseño etnográfico focalizado. La muestra (n=20) se obtuvo de un grupo de madres cuidadoras del estado de Veracruz, México. El criterio de participación fue ser el tutor principal del niño dependiente. Los datos se recolectaron a través de cuatro grupos de discusión conformado cada uno por cinco cuidadoras. Las discusiones fueron audio-grabadas y los datos transcritos textualmente previo análisis. La información fue tratada mediante análisis temático, con el apoyo del programa QUIRKOS. Resultados: Las madres de los niños fueron el cien por ciento de las cuidadoras. La edad promedio de ellas fue de 36.95 años (DE= ±7.66). Las temáticas que surgieron del análisis inductivo fueron las siguientes: a) la situación económica familiar, b) el comportamiento de los niños, c) la falta de información sobre el diagnóstico del niño y, d) los problemas conyugales. Estas se identificaron como categorías que juegan un rol importante en el estrés percibido por las cuidadoras. Discusión y Conclusiones: Es claro que el rol y la responsabilidad de las madres cuidadoras es muy demandante, provocando manifestaciones físicas, mentales y emocionales. El profesional de enfermería juega un papel importante en el diseño de intervenciones de salud que favorezcan la reducción de los factores causales del estrés percibido, además de implementar estrategias que restrinjan sus manifestaciones.

ABSTRACT Objective: To explore factors, manifestations, and consequences related to the stress perceived by Mexican mothers of children with special needs in Veracruz, Mexico. Methods: This is a qualitative study with a focalized ethnographic design. The sample (n=20) was constituted by healthcare providing mothers of the state of Veracruz, Mexico. The participation requirement was being the main tutor of a dependent child. Data were collected in four discussion groups of 5 healthcare providing mothers each. The discussions were recorded and the data were transcribed. The information was produced through a thematic analysis using the QUIRKOS program. Results: The average age of these mothers was 36.95 years old (SD= ±7.66). The topics arising from the analysis were: a) the economical situation of the family; b) the behavior of the children; c) the lack of information regarding the child's diagnosis; and d) the marital problems. All these categories were important sources of the stress perceived by these healthcare providers. Discussion and Conclusions: It is clear that the role and the responsibility of healthcare mothers is very demanding, provoking diverse physical, mental, and emotional responses. The nursing professionals play an important role in the design of health interventions which can favor the reduction of the perceived stress causing factors and thus the reduction of their associated impacts.

RESUMO Objetivo: Examinar as percepções sobre os fatores exploratórios, as manifestações e consequências do estresse em mães cuidadoras de crianças com necessidades especiais em Veracruz, México. Métodos: Estudo qualitativo com desenho etnográfico focalizado. A amostra (n=20) foi obtida de um grupo de mães cuidadoras do estado de Veracruz, México. O critério de participação era ser o cuidador principal da criança dependente. Os dados foram coletados através de quatro grupos de discussão, cada um conformado por cinco cuidadoras. As discussões foram áudio-gravadas e os dados transcritos textualmente antes da análise. A informação foi tratada por meio de análise temática, com apoio do programa QUIRKOS. Resultados: As mães das crianças eram cem por cento das cuidadoras. A idade média delas era de 36.95 anos (DE= ±7.66). As temáticas que emergiram da análise indutiva foram as seguintes: a) a situação económica familiar, b) o comportamento das crianças, c) a falta de informação sobre o diagnóstico da criança, e d) os problemas conjugais. Estas foram identificadas como categorias que desempenham um papel importante no estresse percebido pelas cuidadoras. Discussão e Conclusões: Fica claro que o papel e a responsabilidade das mães cuidadoras é muito exigente, provocando manifestações físicas, mentais e emocionais. O profissional de enfermagem desempenha um papel importante no desenho de intervenções de saúde que favorecem a redução dos fatores causais do estresse percebido, além de implementar estratégias que restrinjam suas manifestações.

Errores de administración de medicamentos en enfermería / Medication administration errors in nursing

Introducción: los errores en el proceso de administración de medicamentos (EPAM) corresponden a múltiples factores, como: la condición de vulnerabilidad del usuario, dinámica que se vive dentro de las propias unidades y confusión en la terapia farmacológica, entre otros. El mayor porcentaje de los EPAM se produce en la etapa de administración, por lo que el rol de enfermería es fundamental. Existen diversas estrategias destinadas a la prevención, con distintos niveles de complejidad, en términos de implementación. Objetivo: conocer las múltiples causas que llevan al personal de enfermería a realizar una mala praxis en el proceso de administración de medicamentos. Material y métodos: se realizó una revisión de literatura mediante la búsqueda de artículos científicos en las siguientes bases de datos: Cochrane, Embase, Medline y SciELO. Conclusión: es indispensable hacer conciencia de la responsabilidad en los profesionales de enfermería para cumplir con las normas en la administración de medicamentos, con los "10 correctos" y evitar riesgos innecesarios a los pacientes que pueden en algunos casos ocasionar consecuencias graves.

Management of early gestations with low beta-human chorionic gonadotropin conceived by assisted reproductive technologies: performance of M4 predictive model.

OBJECTIVES: To assess the safety and performance of the M4 model for classifying as high risk or low risk for ectopic pregnancy (EP) pregnancies conceived by assisted reproductive technologies (ART) that present with low beta-human chorionic gonadotropin (ß-hCG) concentration in early gestation. METHODS: This was a prospective cohort study of 243 pregnancies conceived by ART with low ß-hCG levels (5-50 IU/L) at 4 + 0 to 4 + 2 weeks' gestation. After subsequent ß-hCG testing at 48 h, pregnancies were classified according to the M4 model into the following categories: (i) high risk, probable EP/persistent pregnancy of unknown location (PPUL), when the risk for EP was ≥ 5%; (ii) low risk, probable intrauterine pregnancy (IUP), when the risk of EP was < 5% and the likelihood of IUP was greater than that of a failed pregnancy of unknown location (FPUL); and (iii) low risk, probable FPUL, when the risk of EP was < 5% and the likelihood of a FPUL was greater than that of an IUP. The predictive performance of the M4 model for EP and its ability to discriminate between high- and low-risk pregnancies was assessed using the final pregnancy outcome at 11 to 13 weeks of gestation as reference, which was classified as EP/PPUL, FPUL or IUP. RESULTS: The sensitivity and specificity of the M4 model in detecting a high-risk pregnancy (EP/PPUL) were 60.0% (95% CI, 43.6-74.4%) and 79.8% (95% CI, 73.8-84.7%), respectively. The area under the receiver-operating-characteristics curve of the M4 model for discriminating between high-risk and low-risk (FPUL/IUI) pregnancies was 0.72 (95% CI, 0.62-0.81). The model had a positive likelihood ratio of 2.97 (95% CI, 2.03-4.36) and a negative likelihood ratio of 0.50 (95% CI, 0.33-0.76). The kappa index was 0.30 (95% CI, 0.16-0.43), indicating a low degree of agreement between the model classification and the final diagnosis. No serious adverse events related directly to the application of the M4 model were observed, although 14 pregnancies classified ultimately as high risk had been categorized initially as low risk by the M4 model. Of these, seven resolved with expectant management, five with methotrexate (MTX) and two required laparoscopic surgery (one after failure of medical treatment with MTX and one after deviation from the follow-up protocol). There were no cases of EP/PPUL with additional complications or need for blood or other blood product transfusion. Of the 243 ART pregnancies with low ß-hCG concentration in early gestation, only 47 (19.3%) had an IUP, half (24/47) of which had an early miscarriage, resulting in only 9.5% (23/243) cases having an ongoing pregnancy. CONCLUSIONS: Application of the M4 model in pregnancies conceived by ART with low ß-hCG concentration in early gestation showed limited capacity in classifying them as being at low or high risk for EP, therefore, its use in pregnancies of this type is not recommended. No serious adverse events or complications related to the use of the model were observed. These pregnancies have a low probability of ending in an IUP as well as a high rate of early miscarriage. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Analysis of phenanthrene degradation by Ascomycota fungi isolated from contaminated soil from Reynosa, Mexico.

Polycyclic aromatic hydrocarbons (PAHs) are organic compounds generated mainly by anthropogenic sources. They are considered toxic to mammals, since they have carcinogenic, mutagenic and genotoxic properties, among others. Although mycoremediation is an efficient, economical and eco-friendly technique for degrading PAHs, the fungal degradation potential of the phylum Ascomycota has not been widely studied. In this work, we evaluated different fungal strains from the polluted soil of 'La Escondida' lagoon in Reynosa, Mexico to know their potential to degrade phenanthrene (PHE). Forty-three soil isolates with the capacity to grow in the presence of PHE (0·1% w/v) were obtained. The fungi Aspergillus oryzae MF13 and Aspergillus flavipes QCS12 had the best potential to degrade PHE. Both fungi germinated and grew at PHE concentrations of up to 5000 mg l-1 and degraded 235 mg l-1 of PHE in 28 days, with and without an additional carbon source. These characteristics indicate that A. oryzae MF13 and A. flavipes QCS12 could be promising organisms for the remediation of sites contaminated with PAHs and detoxification of recalcitrant xenobiotics.

Prognostic factors in patients with primary cutaneous anaplastic large cell lymphoma: a multicentric, retrospective analysis of the Spanish Group of Cutaneous Lymphoma.

BACKGROUND: Reliable prognostic factors for patients with primary cutaneous anaplastic large cell lymphoma (PCALCL) are lacking. OBJECTIVE: To identify prognostic factors for specific survival in patients with PCALCL. METHODS: Using the convenience sampling method, patients with PCALCL diagnosed from May 1986 to August 2017 in 16 University Departments were retrospectively reviewed. RESULTS: One hundred eight patients were included (57 males). Median age at diagnosis was 58 years. All of them showed T1-3N0M0 stages. Seventy per cent of the cases presented with a solitary lesion, mostly at the limbs. Complete response rate after first-line treatment was 87%, and no advantage was observed for any of them (surgery, radiotherapy, chemotherapy or other approaches). Nodal and visceral progression rate was 11% and 2%, respectively. 5-year specific survival (SSV) reached 93%; 97% for T1 patients and 84% for T2/T3 patients (P = 0.031). Five-year SSV for patients developing early cutaneous relapse was 64%; for those with late or no relapse, 96% (P = 0.001). Estimated median SSV for patients showing nodal progression was 103 months (95% CI: 51-155 months); for patients without nodal progression, estimated SSV did not reach the median (P < 0.001). Nodal progression was an independent predictive parameter for shorter survival (P = 0.011). CONCLUSION: Multiple cutaneous lesions at presentation, early skin relapse and nodal progression portrait worse prognosis in patients with PCALCL.

Factors associated with ever use of mammography in a limited resource setting. A mixed methods study.

OBJECTIVE: To evaluate facilitators and barriers influencing mammography screening participation among women. DESIGN: Mixed methods study. SETTING: Three hospital catchment areas in Hidalgo, Mexico. PARTICIPANTS: Four hundred and fifty-five women aged 40-69 years. INTERVENTION: Three hundred and eighty women completed a survey about knowledge, beliefs and perceptions about breast cancer screening, and 75 women participated in semi-structured, in-person interviews. Survey data were analyzed using logistic regression; semi-structured interviews were transcribed and analyzed using elements of the grounded theory method. MAIN OUTCOME MEASURE: Women were categorized as never having had mammography or having had at least one mammogram in the past. RESULTS: From survey data, having had a Pap in the past year was associated with ever having had breast screening (odds ratio = 2.15; 95% confidence interval 1.30-3.54). Compared with never-screened women, ever-screened women had better knowledge of Mexican recommendations for the frequency of mammography screening (49.5% vs 31.7% P < 0.001). A higher percentage of never-screened women perceived that a mammography was a painful procedure (44.5% vs 33.8%; P < 0.001) and feared receiving bad news (38.4% vs 22.2%; P < 0.001) compared with ever-screened women. Women who participated in semi-structured, in-person interviews expressed a lack of knowledge about Mexican standard mammographic screening recommendations for age for starting mammography and its recommended frequency. Women insured under the 'Opportunities' health insurance program said that they are referred to receive Pap tests and mammography. CONCLUSIONS: Local strategies to reduce mammogram-related pain and fear of bad news should work in tandem with national programs to increase access to screening.

Percepción de cultura de seguridad del paciente por el profesional de enfermería de un hospital de tercer nivel de atención / Patient safety culture by the nursing professional of a Third Level Hospital

La percepción de la cultura de seguridad del paciente se relaciona con actitudes y valores que asume el personal de salud en su práctica, para que el paciente no experimente daño asociado a la atención en la salud, lo que conlleva, que la cultura de seguridad del paciente sea evaluado en dimensiones de calidad asistencial, estableciendo con particular interés actitudes y percepciones como determinante para una atención segura. Objetivo: Evaluar el estado actual de la cultura de seguridad del paciente que tiene el personal de enfermería de un hospital de tercer nivel de atención. Material y método: Estudio descriptivo-cuantitativo con diseño transversal de un hospital de tercer nivel de atención ubicado en la ciudad de México. La muestra fue aleatoria probabilística con un total de 258 enfermeras. Se utilizó la encuesta de la Agency for Healthcare Research and Quality, (AHQR), validada como Cuestionario de Seguridad del paciente versión española por Hospital Survey en Patient Safety. Se determinaron 12 dimensiones, con reactivos de percepción y grado global de seguridad del paciente. Se utilizaron pruebas de estadística descriptiva e inferenciales. Resultados: Se obtuvieron un total de siete dimensiones consideradas como oportunidad de mejora; comunicación sobre los errores 53%, respuesta no punitiva al error 61%, dotación del personal 60%, apoyo en la gerencia del hospital 66%, percepción de seguridad del paciente 58%, franqueza de la comunicación 62%, cuatro como dimensiones normales; frecuencia de eventos adversos 46%, expectativa de aprendizaje organizacional/mejora continua y acciones de dirección 48%, aprendizaje organizacional/mejora continua 68%, trabajo en equipo entre unidades 45% y uno dimensión considerada como fortaleza; trabajo en equipo en la unidad/servicio 82%. El grado de percepción de cultura de seguridad global fue de (77%) como aceptable y con un (12%) como muy bueno. Conclusión: Por lo que se sugiere realizar trabajos de investigación que sustentes los elementos importantes que componen una cultura de seguridad desde personal gerencial y administrativo hasta personal operativo, implementado realizar estrategias dirigidas a fomentar una alta percepción de cultura hacia la seguridad del paciente.

The perception of the patient's safety culture is related to attitudes and values assumed by health personnel in their practice, so that the patient does not experience harm associated with health care, which implies that the safety culture of the patient patient is evaluated in dimensions of quality of care, establishing with particular interest attitudes and perceptions as a determinant for safe care. Objective: To evaluate the current state of the patient safety culture of the nursing staff of a third-level care hospital. Method: Descriptive-quantitative study with cross-sectional design of a third-level care hospital located in Mexico City. The random sample was probabilistic with a total of 258 nurses. The survey of the Agency for Healthcare Research and Quality (AHQR) was used, validated as the Spanish Patient Safety Questionnaire by Hospital Survey in Patient Safety. Twelve dimensions were determined, with perception reagents and overall degree of patient safety. Descriptive and inferential statistics tests were used. Results: A total of 7 dimensions considered as opportunities for improvement were obtained; communication about errors 53%, non-punitive response to error 61%, staffing 60%, support in hospital management 66%, perception of patient safety 58%, communication frankness 62%, 4 as normal dimensions; frequency of adverse events 46%, expectation of organizational learning / continuous improvement and management actions 48%, organizational learning / continuous improvement 68%, teamwork between units 45% and 1 dimension considered as strength; Teamwork in the unit / service 82%. The degree of perception of global security culture was (77%) as acceptable and with (12%) as very good. Conclusions: Therefore, it is suggested to carry out research that sustains the important elements that make up a safety culture from managerial and administrative personnel to operative personnel, implementing strategies aimed at promoting a high perception of culture towards patient safety.

Double-balloon enteroscopy: Indications, approaches, diagnostic and therapeutic yield, and safety. Early experience at a single center. / Enteroscopia de doble balón: indicaciones, abordajes, eficacia diagnóstica y terapéutica y seguridad. Experiencia temprana de un solo centro.

INTRODUCTION AND AIMS: Double-balloon enteroscopy has been improving the visualization of the entire intestine for more than a decade. It is a complementary method in the study of intestinal diseases that enables biopsies to be taken and treatments to be administered. Our aim was to describe its main indications, insertion routes, diagnostic/therapeutic yield, and complications. MATERIALS AND METHODS: All patients referred to our unit with suspected small bowel pathology were included. The insertion route (oral/anal) was determined through diagnostic suspicion. The variables measured were: insertion route, small bowel examination extent, endoscopic diagnosis/treatment, biopsy/histopathology report, complications, and surgical findings. RESULTS: The study included 28 double-balloon enteroscopies performed on 23 patients, of which 10 were women and 13 were men (mean age of 52.95 years). The oral approach was the most widely used (n=21), the main indication was overt small bowel bleeding (n=16), and the general diagnostic yield was 65.21%. The therapeutic intervention rate was 39.1% and the procedure was effective in all the cases. The most widely used treatment was argon plasma therapy (n=7). The complication rate was 8.6%; one patient presented with low blood pressure due to active bleeding and another had deep mucosal laceration caused by the argon plasma. CONCLUSIONS: Double-balloon enteroscopy is a safe and efficacious method for the study and management of small bowel diseases, with an elevated diagnostic and therapeutic yield.

First-line treatment in lymphomatoid papulosis: a retrospective multicentre study.

BACKGROUND: Data regarding response to treatment in lymphomatoid papulosis (LyP) are scarce. AIM: To assess the daily clinical practice approach to LyP and the response to first-line treatments. METHODS: This was a retrospective study enrolling 252 patients with LyP. RESULTS: Topical steroids, methotrexate and phototherapy were the most common first-line treatments, prescribed for 35%, 20% and 14% of the patients, respectively. Complete response (CR) was achieved in 48% of treated patients. Eczematous lesions significantly increased relative risk (RR) of not achieving CR (RR = 1.76; 95% CI 1.16-2.11). Overall median time to CR was 10 months (95% CI 6-13 months), and 78% of complete responders showed cutaneous relapse; both results were similar for all treatment groups (P > 0.05). Overall estimated median disease-free survival (DFS) was 11 months (95% CI 9-13 months) but DFS for patients treated with phototherapy was 23 months (95% CI 10-36 months; P < 0.03). Having the Type A LyP variant (RR = 2.04; 95% CI 0.96-4.30) and receiving a first-line treatment other than phototherapy (RR = 5.33; 95% CI 0.84-33.89) were significantly associated with cutaneous early relapse. Of the 252 patients, 31 (13%) had associated mycosis fungoides unrelated to therapeutic approach, type of LyP or T-cell receptor clonality. CONCLUSIONS: Current epidemiological, clinical and pathological data support previous results. Topical steroids, phototherapy and methotrexate are the most frequently prescribed first-line treatments. Although CR and cutaneous relapse rates do not differ between them, phototherapy achieves a longer DFS. Presence of Type A LyP and use of topical steroid or methotrexate were associated with an increased risk of early relapse.