Atención integrada madre-niño. efectos sobre adherencia y conocimientos de métodos anticonceptivos / Integrated mother-child care. Effects on adherence and knowledge of contraceptive methods

Resumen Introducción : La evidencia científica sugiere que es trategias de atención conjunta madre-hijo facilitarían el conocimiento de métodos anticonceptivos (MAC) y su acceso. El objetivo fue evaluar el efecto del Modelo de atención integrada de la madre y el niño sobre la adherencia y conocimientos de MAC en mujeres durante el primer semestre postparto. Métodos : Se realizó un estudio de intervención, se conformaron 2 grupos, GI: grupo de intervención (3 con troles hasta los 6 meses postparto) y GC: grupo control (un control a los 6 meses postparto). La intervención consistió en asesoramiento presencial acerca de MAC combinada con folletería informativa y mensajes de WhatsApp®. Se recabaron datos sociodemográficos, an tecedentes gineco-obstétricos, uso y conocimientos de MAC. Se comparó la adherencia al uso y el conocimiento de MAC en ambos grupos a los 6 meses post parto. El análisis se realizó mediante el software R versión 4.0.3. Resultados : Se incorporaron 39 mujeres en cada grupo. Se halló una diferencia en el uso de MAC entre grupos a los 6 meses (92.3% vs. 64.1%), siendo más eleva do su uso en el GI. Se hallaron diferencias significativas en el conocimiento de algunos MAC a los 6 meses. Un mayor porcentaje de mujeres del GI conocía las pastillas anticonceptivas (p = 0.009), ligadura de trompas (p = 0.04) y la vasectomía (p = 0.010), en comparación con el GC. Discusión : La intervención en el postparto temprano con diversas estrategias de comunicación e información pueden ser útiles para elegir el MAC que se considere más adecuado para cada mujer y su utilización correcta.

Abstract Introduction : Scientific evidence suggests that moth er-child joint care strategies would facilitate knowledge of contraceptive methods (MAC) and their access. The objective was to evaluate the effect of the Integrated Mother and Child Care Model on adherence and knowl edge of CAM in women during the first postpartum semester. Methods : An intervention study was carried out, 2 groups were formed, GI: intervention group (3 controls up to 6 months postpartum) and GC: control group (one control at 6 months postpartum). The intervention con sisted of face-to-face counseling about MAC combined with informative brochures and WhatsApp® messages. Sociodemographic data, gynecological and obstetric history, use and knowledge of contraceptive methods were collected. Adherence to the use and knowledge of MAC were compared in both groups at 6 months post partum. The analysis was performed using R software version 4.0.3. Results : Thirty-nine women were incorporated into each group. A difference was found in the use of MAC between groups at 6 months (92.3% vs. 64.1%), its use being higher in GI. Significant differences were found in the knowledge of some MAC at 6 months. A higher percentage of women in GI knew about birth control pills (p = 0.009), tubal ligation (p = 0.04) and vasectomy (p = 0.010), compared to GC. Discussion : Early postpartum intervention with vari ous communication and information strategies can be useful to choose the MAC that is considered most ap propriate for each woman and its correct use.

Desarrollo y validación de un índice de calidad de dieta basado en recomendaciones de las guías alimentarias para la población Argentina / Development and validation of a diet quality index based on recommendations of the Dietary Guidelines for the Argentine Population

INTRODUCCIÓN: Los índices de calidad de dieta son herramientas útiles para evaluar patrones alimentarios y adherencia a guías alimentarias. El objetivo fue desarrollar y validar un índice basado en las Guías Alimentarias para la Población Argentina (GAPA). MÉTODOS: Se desarrolló un índice basado en las guías locales, se analizó la validez de contenido por expertos y la validez de constructo y confiabilidad mediante un estudio de corte transversal. Se incluyó a voluntarios adultos sanos y se relevó información general y de consumo de alimentos. Se analizó la capacidad de otorgar puntajes variados y hallar diferencias entre grupos. Se evaluó la correlación entre el puntaje total y cada componente, y con la ingesta energética y de nutrientes. Se exploraron dimensiones subyacentes con análisis de componentes principales. Se analizó la consistencia interna mediante alfa de Cronbach. RESULTADOS: Se desarrolló un Índice de Calidad de Dieta Argentino (ICDAr) que refleja ocho mensajes principales de las guías y se halló buena aceptación por expertos (V de Aiken ≥0,8; p<0,05). El ICDAr demostró amplitud de rango (37,36-86,39) y diferencia entre fumadores y no fumadores (p=0,002). Se halló correlación positiva entre el puntaje total y cada componente y una mejor ingesta de nutrientes, pero no con ingesta energética. Se hallaron múltiples dimensiones subyacentes. El alfa de Cronbach fue 0,49. DISCUSIÓN: El ICDAr es válido para evaluar la calidad de dieta según la adherencia a las GAPA.

Exploring factors associated with obesity in Argentinian children using structural equation modeling / Explorando factores asociados a la obesidad en niños argentinos usando un modelo de ecuaciones estructurales / Explorando fatores associados à obesidade em crianças argentinas utilizando a modelagem de equações estruturais

Abstract: Habits and behaviors related to obesity risk are strongly associated with the family environment and are affected by socioeconomic factors. Structural equation modeling (SEM) allows us to hypothesize on how the relationships between these factors occur and measure their impact. This study aimed to explore the relationship between family socioeconomic indicators and childhood obesity, mediated by habits linked to energy balance, applying a SEM. A cross sectional study was performed on 861 Argentinian schoolchildren aged 6-12 years, from 2015 to 2016. The model included three latent variables: socioeconomic status, healthy habits, and obesity. Socioeconomic status indicators and healthy habits were surveyed by self-administered parental questionnaires, whereas obesity indicators were evaluated with anthropometry. The applied model showed an acceptable fit (NFI = 0.966; CFI = 0.979; RMSEA = 0.048). Socioeconomic status positively influenced parental education, health insurance, and car possession, while negatively influenced crowding (p < 0.001). Healthy habits significantly influenced physical activity, meals frequency, and sleep hours, while negatively influenced sedentary hours and mother's nutritional status (p < 0.001). Obesity factor positively influenced body mass index, body fat, and waist-to-height ratio (p < 0.001). Finally, socioeconomic status positively influenced health habits, which in turn negatively influenced obesity factor. Healthy habits (especially physical activity and mother's nutritional status) mediated the relationship between socioeconomic status and child obesity. Further research should include other indicators related to diet, eating habits, and physical activity like neighborhood characteristics.

Resumen: Los hábitos y comportamientos relacionados con el riesgo de obesidad están fuertemente asociados al entorno familiar y se ven afectados por factores socioeconómicos. El modelo de ecuaciones estructurales (MEE) permite plantear hipótesis sobre cómo se dan las relaciones entre estos factores y medir su impacto. El objetivo del presente estudio fue explorar la relación entre los indicadores socioeconómicos familiares y la obesidad infantil, mediada por hábitos relacionados con el balance energético, aplicando un MEE. Se realizó un estudio transversal con 861 escolares argentinos de 6 a 12 años entre 2015 y 2016. El modelo incluyó tres variables latentes: nivel socioeconómico, hábitos saludables y obesidad. Los indicadores nivel socioeconómico y hábitos saludables se midieron mediante cuestionarios autoadministrados a los padres, mientras que los indicadores de obesidad se obtuvieron mediante antropometría. El modelo aplicado presentó un ajuste aceptable (NFI = 0,966; CFI = 0,979; RMSEA = 0,048). El nivel socioeconómico influyó positivamente en la escolaridad de los padres, en el plan de salud y en el hecho de tener automóvil, mientras que influyó negativamente en el hacinamiento (p < 0,001). La variable hábitos saludables influyó significativamente en la actividad física, en la frecuencia de las comidas y en las horas de sueño, pero influyó negativamente en las horas sedentarias y en el estado nutricional materno (p < 0,001). El factor obesidad influyó positivamente en el índice de masa corporal, en la grasa corporal y en la razón cintura/talla (p < 0,001). Finalmente, el nivel socioeconómico influyó positivamente en los hábitos saludables, que, a su vez, influyeron negativamente en la obesidad. Los hábitos saludables, en especial la actividad física y el estado nutricional materno, moderan la relación entre el nivel socioeconómico y la obesidad infantil. Las nuevas investigaciones deberían incluir otros indicadores relacionados con la dieta, con los hábitos alimentarios y con la actividad física, así como con las características del vecindario.

Resumo: Hábitos e comportamentos relacionados ao risco de obesidade estão fortemente associados ao ambiente familiar e afetados por fatores socioeconômicos. A modelagem de equações estruturais (MEE) permite levantar hipóteses sobre como ocorrem as relações entre esses fatores e medir seu impacto. O objetivo do presente estudo foi explorar a relação entre os indicadores socioeconômicos familiares e a obesidade infantil, mediada por hábitos ligados ao balanço energético, aplicando uma MEE. Um estudo transversal foi realizado com 861 escolares argentinos de 6 a 12 anos entre 2015 e 2016. O modelo incluiu três variáveis latentes: nível socioeconômico, hábitos saudáveis e obesidade. Os indicadores do nível socioeconômico e de hábitos saudáveis foram medidos por meio de questionários autoaplicáveis aos pais, enquanto os indicadores de obesidade foram obtidos por meio de antropometria. O modelo aplicado apresentou um ajuste aceitável (NFI = 0,966; CFI = 0,979; RMSEA = 0,048). O nível socioeconômico influenciou positivamente a escolaridade dos pais, o plano de saúde e a posse de automóvel, enquanto influenciou negativamente a aglomeração (p < 0,001). A variável hábitso saudáveis influenciou significativamente a atividade física, a frequência das refeições e as horas de sono, mas influenciou negativamente as horas sedentárias e o estado nutricional materno (p < 0,001). O fator obesidade influenciou positivamente o índice de massa corporal, a gordura corporal e a relação cintura/estatura (p < 0,001). Finalmente, o nível socioeconômico influenciou positivamente os hábitso saudáveis, que por sua vez influenciou negativamente a obesidade. Hábitos saudáveis, especialmente atividade física e estado nutricional materno, mediam a relação entre nível socioeconômico e obesidade infantil. Novas pesquisas devem incluir outros indicadores relacionados à dieta, hábitos alimentares e atividade física, como características da vizinhança.

Enfermedad relacionada a IgG4. Serie clínica de pacientes chilenos / IGG4-related disease. Report of 52 patients

BACKGROUND: IgG4-related disease (IgG4 RD) is an immune-mediated fibro-inflammatory disorder, with tissue infiltration of IgG4+ plasma cells. It causes pseudotumors, tumors, and a wide spectrum of clinical manifestations. AIM: To report the clinical, laboratory, histopathological and treatment characteristics of a group of Chilean patients with IgG4 RD. MATERIAL AND METHODS: Review of medical records of 52 patients aged 18 to 76 years with IgG4 RD seen at six medical centers. RESULTS: Elevated IgG4 serum levels (> 135 mg/dl) were found in 18 of 44 (41%) patients. There was histological confirmation of the disease in 46 patients. The most common sites of involvement were lungs, eyes and kidneys. Eighteen (35%) patients had only one organ involved, 34 (65%) patients had two organs and 13 (25%) patients had three or more organs. The involvement of two organs was significantly more common in men (p < 0.05). In patients with only one organ involvement, the most frequent location was orbital and meningeal. All patients with kidney or lung disease had multiorgan involvement. All patients received corticosteroid therapy, 67% synthetic immunosuppressants, and 16% rituximab. CONCLUSIONS: ER-IgG4 can affect any tissue. Multiorgan involvement was more common in this series, with preference for lungs, eyes and kidneys. An excellent response to steroids is characteristic of the disease, but with a high relapse rate that requires additional immunosuppression.

Primary Cardiac Triple-Hit Lymphoma.

Cardiac double-hit and triple-hit lymphomas (DHLs, THLs) are rare; in fact, studies examining both DHL and THL remain scarce. THL with cardiac involvement constitutes a rare disease with few cases reported so far. Thus, in this study, we report the case of a 67-year-old woman who presented with initial symptoms of pulmonary embolism. Upon further evaluation, a right atrial mass was detected incidentally, and this was surgically removed under the assumption of a cardiac myxoma. Later, immunohistochemistry analysis of the mass revealed a THL. Aggressive treatment with chemotherapy was necessary; however, the patient refused treatment and had a poor prognosis.

[IGG4-related disease. Report of 52 patients]. / Enfermedad relacionada a IgG4. Serie clínica de pacientes chilenos.

BACKGROUND: IgG4-related disease (IgG4 RD) is an immune-mediated fibro-inflammatory disorder, with tissue infiltration of IgG4+ plasma cells. It causes pseudotumors, tumors, and a wide spectrum of clinical manifestations. AIM: To report the clinical, laboratory, histopathological and treatment characteristics of a group of Chilean patients with IgG4 RD. MATERIAL AND METHODS: Review of medical records of 52 patients aged 18 to 76 years with IgG4 RD seen at six medical centers. RESULTS: Elevated IgG4 serum levels (> 135 mg/dl) were found in 18 of 44 (41%) patients. There was histological confirmation of the disease in 46 patients. The most common sites of involvement were lungs, eyes and kidneys. Eighteen (35%) patients had only one organ involved, 34 (65%) patients had two organs and 13 (25%) patients had three or more organs. The involvement of two organs was significantly more common in men (p < 0.05). In patients with only one organ involvement, the most frequent location was orbital and meningeal. All patients with kidney or lung disease had multiorgan involvement. All patients received corticosteroid therapy, 67% synthetic immunosuppressants, and 16% rituximab. CONCLUSIONS: ER-IgG4 can affect any tissue. Multiorgan involvement was more common in this series, with preference for lungs, eyes and kidneys. An excellent response to steroids is characteristic of the disease, but with a high relapse rate that requires additional immunosuppression.

Effectiveness of Additional Risk Minimization Measures for Atezolizumab in the European Union.

BACKGROUND: A Guide for Healthcare Professionals (HCP Guide) and patient alert card (PAC) for atezolizumab as additional risk minimization measures for physicians were distributed to raise awareness and help in the detection and management of immune-related adverse drug reactions. OBJECTIVES: The main objective of this study was to assess the receipt, knowledge, and behaviors of physicians regarding the atezolizumab HCP Guide and PAC. METHODS: A multi-country, one-wave, observational, cross-sectional, web-based, self-reported physician survey was conducted to assess the level of knowledge of key messages related to immune-related adverse drug reactions summarized in the atezolizumab HCP Guide and PAC among physicians (oncologists, pulmonologists, and urologists) prescribing atezolizumab in six European countries (Denmark, Germany, Italy, Spain, Sweden, and the UK). Responses regarding the receipt, understanding and use of the materials, and knowledge and behavior related to the HCP Guide and PAC are presented as percentages and continuous scores scaled out of 100 points, with corresponding 95% confidence intervals (CIs). RESULTS: Among 313 physicians (255 oncologists, 30 pulmonologists, and 28 urologists), 77.4% received the HCP Guide and 74.2% the PAC. The HCP Guide was read by 71.3% of the 267 physicians who received the materials, and the mean usage score was 69.5 (95% CI 66.0-72.9), and 57.1% of physicians had scores ≥ 70. The HCP Guide was completely understood by 85.4% of physicians who had read it. Mean knowledge scores were 63.9 (95% CI 62.1-65.7) and 39.4% of physicians had correct knowledge scores ≥ 70. Mean knowledge scores were 66.8 (95% CI 64.9-68.7) for receipt of both the HCP Guide and PAC, 59.4 (95% CI 55.5-63.4) for one of the materials, and 60.8 (95% CI 55.4-66.2) for having received none of the materials. Mean behavior scores were 78.9 (95% CI 76.8-81.0), and 74.8% of physicians had behavior scores ≥ 70. The mean behavior score was 79.0 (95% CI 76.5-81.5) for those who received both the HCP Guide and PAC, 76.9 (95% CI 72.2-81.5) for receipt of one of the materials, and 81.5 (95% CI 75.0-88.0) for those who received none of the materials. CONCLUSIONS: The study assessed the effectiveness of the atezolizumab additional risk minimization educational materials among physicians in six European countries, using process indicators. The educational materials reached over 70% of target physicians, 57.1% of whom reported using them. Knowledge and behavior related to immune-related adverse drug reactions for atezolizumab were no better in those who received the additional risk minimization educational materials. The results support the safe use of atezolizumab by these physician groups and contributed to the European Medicines Agency permitting removal of the HCP Guide.

Diversidad de dieta y anemia en mujeres post parto que asisten a un hospital público de La Plata, Buenos Aires / Diet diversity and anemia in postpartum women attending a state hospital in La Plata, Buenos Aires

Resumen Introducción: no se cuenta con información a nivel local de la relación entre la diversidad de dieta y la anemia en mujeres postparto, por lo que se propuso analizar dicha relación en un hospital público de La Plata. Materiales y método: se realizó un estudio analítico transversal en mujeres asistidas durante el primer año postparto, en un Observatorio de Salud del Hospital Sor María Ludovica de la ciudad de La Plata, entre agosto de 2018 y septiembre de 2019. Se obtuvieron datos personales y de laboratorio de las historias clínicas. Los alimentos relevados mediante recordatorios de 24 hs fueron categorizados en 10 grupos. Se consideró diversidad de dieta al consumo ≥5 grupos según el instrumento "Mínimo de diversidad dietaria para mujeres". Se definió anemia como hemoglobina <12 g/dL. La asociación entre la anemia y diversidad de dieta se analizó mediante test exacto de Fisher y se comparó la media de hemoglobina utilizando test de Student. Resultados: se incluyeron 137 mujeres postparto, edad 26 (22;31) años, 53,7% argentinas. 12,4% presentó anemia. 63,5% tuvo diversidad de dieta. "Granos y cereales" fue el grupo más consumido (100%), seguido por "Carne, pollo y pescado" (92,7%) y "Otros vegetales" (85,4%). Los menos consumidos fueron "Legumbres" (6,6%) y "Nueces y semillas" (0,7%). No se halló una asociación estadísticamente significativa entre diversidad de dieta y anemia (p=0,18). Tampoco se halló diferencia en las medias de hemoglobina en mujeres con y sin diversidad de dieta (p=0,99). Conclusiones: la diversidad de dieta no se halló asociada a anemia en mujeres postparto que asisten a un hospital público, esto podría relacionarse a la alta frecuencia de consumo de carnes y cereales fortificados.

Abstract Introduction: there is no information at local level on the relationship between diet diversity and postpartum anemia of women, so we intended to analyze this relationship in a state hospital in La Plata. Materials and method: a cross-sectional analytical study was carried out in women assisted during the first year postpartum, in the Health Observatory of Sor María Ludovica Hospital in La Plata city, between August 2018 and September 2019. Personal and laboratory data were obtained from medical records. Foods surveyed by 24-hour reminders were categorized into 10 groups. Dietary diversity was considered to be the consumption ≥5 groups, according to the "Minimum dietary diversity for women" instrument. Anemia was defined as hemoglobin <12 g / dL. The association between anemia and diet diversity was analyzed using Fisher's exact test and mean hemoglobin was compared using Student's test. Results: 137 postpartum women were included, age 26 (22; 31), 53.7% Argentinian. 12.4% presented anemia. 63.5% had diet diversity. "Grains and cereals" was the most consumed group (100%), followed by "Meat, chicken and fish" (92.7%) and "Other vegetables" (85.4%). The least consumed were "Legumes" (6.6%) and "Nuts and seeds" (0.7%). No statistically significant association was found between diet diversity and anemia (p = 0.18). No difference was found in the hemoglobin means in women with and without diet diversity (p = 0.99). Conclusions: diet diversity was not associated with anemia in postpartum women attending a state hospital, this could be related to the high frequency of consumption of meats and fortified cereals.

Conocimientos, prácticas y valoraciones sobre manipulación de alimentos en hospitales públicos bonaerenses, Argentina, 2020 / Knowledge, practices, and appraisals on food handling in public hospital of Buenos Aires province, Argentina, 2020

INTRODUCCIÓN: La manipulación de alimentos dentro del ámbito hospitalario juega un papel crucial en la cadena causal de enfermedades transmitidas por alimentos. Actualmente no existe información sobre conocimientos, prácticas y valoraciones de los manipuladores de alimentos a nivel local. El objetivo de este estudio fue evaluar a los manipuladores de alimentos de hospitales públicos de la provincia de Buenos Aires y su asociación con características sociodemográficas, laborales y de capacitación. MÉTODOS: Se realizó un estudio transversal analítico. Se envió una encuesta virtual a los hospitales públicos de la provincia para que fuera distribuida a todos los manipuladores de alimentos. Se relevaron datos sociodemográficos, laborales y de capacitación. Se evaluaron conocimientos y prácticas mediante preguntas de opción múltiple y se indagaron valoraciones personales sobre su trabajo. RESULTADOS: La encuesta fue completada por 561 manipuladores de 56 hospitales. Más del 80% había recibido algún tipo de capacitación. El 22,9% presentó conocimientos suficientes y el 15,3%, prácticas adecuadas. La valoración de prácticas adecuadas se asoció a mayor antigüedad, servicios tercerizados y a la realización de 5 o más capacitaciones en servicio. La escasez de elementos de trabajo y la infraestructura inadecuada fueron las principales barreras. DISCUSIÓN: La realización de capacitaciones en servicio y la presencia de personal con mayor antigüedad podrían mejorar la manipulación de alimento.

[Lymphadenopathies in patients with rheumatic diseases. Review of 19 cases]. / Poliadenopatías de origen reumatológico y las claves del diagnóstico diferencial: Análisis de 19 casos.

BACKGROUND: The presence of multiple lymphadenopathies can be a diagnostic challenge. AIM: To describe the clinical, laboratory and imaging characteristics of 19 patients with lymphadenopathies of rheumatologic origin. MATERIAL AND METHODS: Review of medical records of 19 patients aged 16 to 72 years (68%) with lymphadenopathies presumably secondary to a rheumatic disease. RESULTS: Six patients had systemic lupus erythematosus, six had Sjogren's disease, three had sarcoidosis, two had rheumatoid arthritis, one had IgG4 related disease and one had mixed connective tissue disease. A lymph node biopsy was performed in 11 patients and in eight a lymphoid follicular hyperplasia was found. Systemic symptoms were reported by 68% of patients. Blood lactate dehydrogenase was elevated only in cases associated with hemolytic anemia. There was no specific or predictable localization of the lymphadenopathies in imaging studies, except in the cases of sarcoidosis. The average size of the lymphadenopathies was 13.5 mm in diameter in short axis and there was no presence of necrosis, calcification, or conglomerate formation. Only one case presented splenomegaly. All patients responded favorably to corticosteroids. CONCLUSIONS: Lymphadenopathies associated with rheumatologic diseases can occur in a wide variety of diseases, especially systemic lupus erythematosus and Sjögren's disease. The absence of LDH elevation and splenomegaly and the absence of imaging findings such as conglomerates can orient to a rheumatologic origin.

Poliadenopatías de origen reumatológico y las claves del diagnóstico diferencial: Análisis de 19 casos / Lymphadenopathies in patients with rheumatic diseases. Review of 19 cases

Background: The presence of multiple lymphadenopathies can be a diagnostic challenge. Aim: To describe the clinical, laboratory and imaging characteristics of 19 patients with lymphadenopathies of rheumatologic origin. Material and Methods: Review of medical records of 19 patients aged 16 to 72 years (68%) with lymphadenopathies presumably secondary to a rheumatic disease. Results: Six patients had systemic lupus erythematosus, six had Sjogren's disease, three had sarcoidosis, two had rheumatoid arthritis, one had IgG4 related disease and one had mixed connective tissue disease. A lymph node biopsy was performed in 11 patients and in eight a lymphoid follicular hyperplasia was found. Systemic symptoms were reported by 68% of patients. Blood lactate dehydrogenase was elevated only in cases associated with hemolytic anemia. There was no specific or predictable localization of the lymphadenopathies in imaging studies, except in the cases of sarcoidosis. The average size of the lymphadenopathies was 13.5 mm in diameter in short axis and there was no presence of necrosis, calcification, or conglomerate formation. Only one case presented splenomegaly. All patients responded favorably to corticosteroids. Conclusions: Lymphadenopathies associated with rheumatologic diseases can occur in a wide variety of diseases, especially systemic lupus erythematosus and Sjögren's disease. The absence of LDH elevation and splenomegaly and the absence of imaging findings such as conglomerates can orient to a rheumatologic origin.

Valoración del estado nutricional en pacientes pre-quirúrgicos en un hospital de agudos de la provincia de Buenos Aires / Assessment of nutritional status in pre-surgical patients in an acute care hospital in the province of Buenos Aires

Introducción: la desnutrición en pacientes pre-quirúrgicos incrementa el riesgo de padecer complicaciones, aumentando la estancia hospitalaria y los costos para el sistema de salud. Objetivo: Evaluar el estado nutricional de los pacientes admitidos en el servicio de “Clínica Quirúrgica”, antes de someterse a una cirugía programada, durante los meses de marzo a mayo de 2015. Materiales y método: Estudio observacional, descriptivo, de corte transversal. Se evaluaron pacientes ingresados en la institución por el servicio de “Clínica Quirúrgica”, con motivo de cirugía. Las variables estudiadas fueron edad en dos estratos, sexo, grupo de patologías y estado nutricional. Para el diagnóstico de esta última se utilizó la Valoración Global Subjetiva (VGS). El análisis estadístico se realizó a través de la prueba de chi cuadrado (X²) o Fisher. Resultados: Se evaluaron 106 pacientes, de los cuales el 70,7% se categorizaron como bien nutridos, el 25,5% con riesgo de desnutrición o desnutrición moderada y el 3,8% como desnutrición severa. Ser ≥60 años tuvo una diferencia estadísticamente significativa con el riesgo de desnutrición. La prevalencia de desnutrición fue mayor en el grupo de pacientes con patologías de hígado y vía biliar. Dentro de la categoría C de la VGS, el 75% presentaba neoplasias. Conclusión: En la población estudiada se identificó un porcentaje considerable de pacientes con desnutrición, por lo que es necesaria la implementación de una estrategia de tamizaje nutricional al momento de la programación de la cirugía para realizar una intervención oportuna que permita que los pacientes candidatos a cirugía lleguen con el mejor estado nutricional posible.

Benefit-risk analysis of glatiramer acetate for relapsing-remitting and clinically isolated syndrome multiple sclerosis.

BACKGROUND: Glatiramer acetate (GA) and interferon beta-1 are licensed for treating patients with multiple sclerosis (MS). However, they have slightly different indications, side effect profiles, and tolerability. OBJECTIVE: The purpose of this study was to assess the benefit-risk (BR) profile of GA in relapse-remitting MS (RRMS) and clinical isolated syndrome (CIS). METHODS: MEDLINE, EMBASE, and the Cochrane Register were searched for randomized controlled trials and comparative observational cohort studies in patients older than 18 years who were treated with 20 mg daily of subcutaneous GA for RRMS or CIS. Uncommon risks of GA were assessed in the World Health Organization (WHO) global spontaneous adverse reaction (AR) reports database (Vigibase). RESULTS: A total of 248 potentially relevant articles were identified by the search; of these, 11 studies were included in the review: 7 trials and 4 cohort studies with a total of 4759 patients. The proportion of studies included from the search was 4.4% of all titles, 9.3% of all reviewed abstracts, and 45.8% of all eligible articles for review. In patients with RRMS relapse-free rates were higher with GA than with placebo (relative risk [RR] = 1.35; 95% CI, 0.99-1.84) and similar to interferons (IFNs) (RR = 0.99; 95% CI, 0.93-1.06). There was a 33% reduction in clinical progression (RR = 0.69; 95% CI, 0.42-1.13) for GA compared with placebo and an 18% reduction (RR = 0.82; 95% CI, 0.68-0.98) compared with IFNs. Study discontinuations because of adverse events were similar for GA and IFNs (RR = 0.89; 95% CI, 0.57-1.41). In Vigibase, 1271 cases were identified with a suspected relation to GA. Several ARs were identified as statistically strong signals of disproportionate reporting for GA compared with IFNs. WHO critical ARs combined were similar between GA and IFNs, with a reporting rate of 69 per 100,000 person-years for GA. The relative net BR difference was 10.2% in favor of GA compared with placebo and 6.4% compared with IFNs. CONCLUSIONS: GA reduced relapses and clinical progression compared with placebo or standard treatment and clinical progression compared with IFNs. Serious adverse events were comparable in GA and IFNs. The BR assessments that were based on these data found that the clinical benefits of GA outweigh the risks, although results differ, depending on the quantitative BR model used, and are limited by the absence of reliable data for assigning weights to the model.

Survey of aflatoxins in maize tortillas from Mexico City.

In Mexico, maize tortillas are consumed on a daily basis, leading to possible aflatoxin exposure. In a survey of 396 2-kg samples, taken over four sampling days in 2006 and 2007 from tortilla shops and supermarkets in Mexico City, aflatoxin levels were quantified by HPLC. In Mexico, the regulatory limit is 12 µg kg⁻¹ total aflatoxins for maize tortillas. In this survey, 17% of tortillas contained aflatoxins at levels of 3-385 µg kg⁻¹ or values below the limit of quantification (12 µg kg⁻¹ and 87% were below the regulatory limit. Average aflatoxin concentrations in 56 contaminated samples were: AFB1 (12.1 µg kg⁻¹); AFB2 (2.7 µg kg⁻¹); AFG1 (64.1 µg kg⁻¹) and AFG2 (3.7 µg kg⁻¹), and total AF (20.3 µg kg⁻¹).

Effect of subcutaneous lidocaine infiltration on blood loss secondary to corporal lipoaspiration: a prospective, randomized, double-masked clinical trial.

BACKGROUND: Lipoaspiration is one of the most frequently performed aesthetic surgical procedures worldwide. The use of tumescent solution containing lidocaine to infiltrate subcutaneous fat before surgery has been accepted as the standard of care for these procedures. Its objective is to diminish postoperative analgesic necessities and secondary blood loss, but its role in hematocrit reduction is not clear at this time. This study aimed to measure the effect of subcutaneous lidocaine infiltration on blood loss secondary to corporal liposuction. METHODS: A prospective, randomized, double-masked clinical trial was performed. Between November 2005 and July 2007, 70 consecutive female patients submitted to corporal liposuction as a single surgery were included in the study. All the patients were randomly assigned to two groups. The study group received tumescent solution containing lidocaine and epinephrine, whereas the control group received tumescent solution containing only epinephrine. Hematocrit was measured preoperatively, then 2 to 4, 12, and 24 h postoperatively. RESULTS: The comparison between the two groups did not show significant statistical differences with respect to age, body mass index, infiltrated volume, aspirated fat volume, surgical time, hospital stay, preoperative hematocrit, or comparison of the areas lipoaspirated. The mean hematocrit reduction in the study group was 10.8% +/- 2.9% compared with 8.8% +/- 2.6% in the control group (P = 0.004). CONCLUSION: The use of lidocaine in the tumescent solution for subcutaneous fat infiltration significantly increases postoperative anemia compared with the results obtained when epinephrine infiltration alone is used.

[Cost-effectiveness of managing familial hypercholesterolemia using atorvastatin-based preventive therapy]. / Coste-efectividad del manejo de la hipercolesterolemia familiar con estrategias de tratamiento preventivo basadas en atorvastatina.

INTRODUCTION AND OBJECTIVES: A cost-effectiveness model was developed to evaluate the efficiency of different preventive strategies in familial hypercholesterolemia (FH) in comparison with routine clinical practice (CP): atorvastatin monotherapy, 40 mg (A40) or 80 mg (A80, and atorvastatin combined with ezetimibe, 10 mg (A40+E10 or A80+E10). METHODS: A longitudinal population model with a time horizon for life-expectancy was developed within the context of the Spanish public healthcare system. Life tables for the Spanish population (2002) were modified using the standardized mortality rate for individuals with FH. Effectiveness was expressed in life-years gained (LYG), after taking into account reductions for risk (ie, Framingham risk score) and cardiovascular mortality. The costs (in 2005 terms) of the intervention (CI) and care (CC) were discounted at 6%, while effects were discounted at 3%. RESULTS: Routine CP, based on the Spanish FH registry: 1.97 LYG per patient vs. no treatment; CI euro5321, CC euro23,389. A40: 2.59 LYG; reduction in CC compared with CP 4.5%; total costs (TC) euro30 569. A80: 2.75 LYG; reduction in CC 6.4%; TC euro30 133. A40+E10: 3.38 LYG; reduction in CC 14.3%; TC euro36 104. A80+E10: 3.62 LYG; reduction in CC 17.6%; TC euro35 317. From most to least efficient strategy, the incremental cost-effectiveness per LYG compared with CP was: a) A80: euro1821; b) A40: euro3012; c) A80+E10: euro4021, and d) A40+E10: euro5250. CONCLUSIONS: Preventive treatment of FH with atorvastatin was cost-effective. The greatest cost-effectiveness was obtained with atorvastatin monotherapy, 80 mg. The addition of ezetimibe could produce further benefits at an acceptable incremental cost.

Ambiente educacional y calidad de la docencia en la escuela de medicina / Eucational environment and quality of teaching in our school of medicine

El ambiente educacional es un concepto que cada vez cobra mayor relevancia en la educación médica por su impacto en el proceso de enseñanza, aprendizaje y posterior vida laboral. Existen numerosos instrumentos para evaluar el ambiente, según el ciclo de formación o el tipo de rotación. En la Escuela de Medicina de la Pontificia Universidad Católica de Chile se han utilizado las encuestas DREEM y PHEEM, que se complementan con otros instrumentos aplicados a los estudiantes, generados por el Centro de Educación Médica y la American Association of Medical Colleges (AAMC) en el contexto del proceso de la evaluación de la Escuela de Medicina. Todos estos confirman que el ambiente educacional en general es adecuado. Las fortalezas detectadas están relacionadas con el ambiente académico y la calidad de los profesores. Los aspectos deficitarios están relacionados con la retroalimentación, el proceso de evaluación y áreas de desarrollo social. La constante medición del ambiente educacional dentro de la Escuela de Medicina nos permitirá a futuro detectar las fortalezas, mejorar las áreas deficitarias y evaluar el impacto de las modificaciones curriculares.

The Educational Environment has increased its relevance in medical education due to the impact in the process of teaching and learning and later professional work. There are numerous instruments to evaluate the environment, according to the cycle of formation or the kind of rotation. In the Medical School of Pontificia Universidad Católica de Chile it has been used the DREEM and PHEEM questionnaires, which complement with other instruments applied to the students, developed by the Center of Medical Education and the American Association of Medical Colleges (AAMC) in the context of the School of Medicine evaluation. All these instruments confirm that the educational environment in general is good. The strengths are related to the academic atmosphere and the quality of teachers. The weaknesses are related to feedback, evaluation and areas related to social development. The measurement of the educational climate within the Medical School will allow in the future detecting the strengths, in order to improve the deficit areas and to evaluate the impact of curricular changes.

Informatización de la red de bibliotecas de las unidades de la atención primaria en Cuba / Automation of the library network in Cuban primary health care units

Se aborda el proceso de informatización de las bibliotecas de los policlínicos de la red de la atención primaria de salud en Cuba. Se trata la interrelación: salud-atención primaria-información, el crecimiento de esta última y la necesidad nacional de transformar las bibliotecas de los policlínicos para lograr llevar la información disponible en Infomed las unidades de información situadas en la atención primaria. Se describen las actividades fundamentales relacionadas con la implantación de las bibliotecas de nuevo tipo en los policlínicos, a saber: distribución de los equipos y el mobiliario, capacitación de los recursos humanos y elaboración de los lineamientos y principios, que rigen la actividad de esta clase de instituciones de información en el país

Las trabajadoras de la salud: vida, trabajo y trastornos mentales / Female health workers: lifestyle, work, and psychiatric disorders

Se estudió la relación entre condiciones de vida, trabajo y trastornos mentales en trabajadoras de la salud del Instituto Mexicano del Seguro Social (IMSS). La población se integró por médicas, enfermeras, personal de laboratorio y asistentes médicas (n = 170). La información principal se obtuvo de una encuesta, validada en población trabajadora mexicana. Se encontró que los trastornos mentales están relacionados con todos los ámbitos de la vida de las mujeres. En relación con el ámbito doméstico, se muestra que las mujeres con mayor morbilidad mental son: las que son madres; las que tienen un mayor número de hijos; aquéllas que no cuentan con ayuda para el trabajo doméstico; y las que tienen pareja. En relación con el trabajo asalariado, la morbilidad mental se encontró asociada con la duración de la jornada, el ausentismo y la falta de contenido del trabajo. El desarrollo de habilidades, la satisfacción y la creatividad fueron aspectos "protectores" o preventivos de trastornos mentales y de fatiga. Los principales riesgos y exigencias que actuaron como causantes de estrés fueron: el calor, el ruido, el esfuerzo físico, las posiciones forzadas y el trabajo intenso y repetitivo.