Alteraciones metabólicas y circadianas en personal de enfermería de un hospital público del noroeste de México / Circadian and metabolic alterations among nursing personnel in a northeastern public hospital in Mexico / Alterações metabólicas e circadianas na equipe de enfermagem de um hospital público no noroeste do México

RESUMEN Introducción Las alteraciones metabólicas se vinculan a los ritmos biológicos, dado que es tos sistemas controlan aspectos fisiológicos como patrones de sueño/vigilia, temperatura corporal, presión arterial y liberación de hormonas endocrinas. Objetivo Identificar la relación entre los componentes del síndrome metabólico y disincro nía circadiana en personal de enfermería de un hospital público. Métodos Estudio correlacional. Muestra censal de 30 profesionales de enfermería de dos turnos. Para la recolección de datos se utilizaron tres cédulas: a) antecedentes biosociode mográficos y laborales; b) síndrome metabólico; c) ciclo circadiano. En el procesamiento de datos se utilizó pruebas Chi-cuadrada, R de Pearson y Rho de Spearman, se verificó el su puesto de normalidad con Shapiro-Wilk. Se contó con autorización del Comité de Ética de la institución de salud y con el consentimiento informado de participantes. Resultados 43.3 % del personal de enfermería cumplió con criterios diagnósticos de síndro me metabólico, 100 % del turno nocturno presentó disincronía circadiana con base en el indicador patrón de sueño. El consumo de alcohol y nivel alto de triglicéridos, mostraron relación positiva estadísticamente significativa con la presencia de insomnio (p ≤ 0.001; p ≤ 0.05). Conclusión El síndrome metabólico es un problema de salud con alta prevalencia entre el personal de enfermería, independientemente del nivel académico o del turno laboral. El peso y los triglicéridos fueron indicadores que mostraron relación con patrones de sueño afectados. Esto enfatiza la importancia de incidir en la prevención y tratamiento del sín drome metabólico como una prioridad en el personal de enfermería, desde la salud laboral.

ABSTRACT Introduction Metabolic alterations are linked to biologic rhythms because these cycles control physiologic patterns including sleep/awake, body temperature, blood pressure, and hormones release. Objective To identify the relationship between the metabolic syndrome components and the circadian alterations among nursing personnel in a public hospital in Mexico. Method This is a correlational study. The sample was constituted of 30 nursing professio nals working in 2 shifts. Data were collected using three registers: a) bio socio-demographic and labor-related backgrounds; b) metabolic syndrome; c) circadian cycle. Chi-square, Pearson's R, Spearman's Rho, and Shapiro-Wilk normality test were calculated. The study approval was granted by the Ethics Committee of the Health Institution. The corresponding informed consent was obtained from all participants. Results 43.3 % of the nursing personnel qualified for the metabolic syndrome diagnostic criteria. 100 % of the nurses working the night shift showed circadian alterations in terms of sleep patterns. Alcohol consumption and high levels of triglycerides were positively and significantly related to insomnia (p ≤ 0.001; p ≤ 0.05). Conclusion The metabolic syndrome is a health problem with a high prevalence in all kinds of nursing personnel. Bodyweight and triglyceride levels were indicators suggesting altered sleep patterns. This situation highlights the importance of designing and implementing strategies aimed at preventing and addressing metabolic syndrome among nursing person nel as a labor health priority.

RESUMO Introdução As alterações metabólicas estão ligadas aos ritmos biológicos, pois esses siste mas controlam aspectos fisiológicos como padrões de sono/vigília, temperatura corporal, pressão arterial e liberação de hormônios endócrinos. Objetivo Identificar a relação entre os componentes da síndrome metabólica e a dissincro nia circadiana na equipe de enfermagem de um hospital público. Métodos Estudo correlacional. Amostra censitária de 30 profissionais de enfermagem com dois turnos. Para a coleta de dados foram utilizados três cartões: a) antecedentes biossociodemográficos e laborais; b) síndrome metabólica; c) ciclo circadiano. No processa mento dos dados foram utilizados os testes Qui-quadrado, R de Pearson e Rho de Spearman, a suposição de normalidade foi verificada com Shapiro-Wilk. Contou-se com a autorização do Comitê de Ética da instituição de saúde e o termo de consentimento informado dos participantes. Resultados 43.3 % da equipe de enfermagem atendeu aos critérios diagnósticos para sín drome metabólica, 100 % do plantão noturno apresentou dissincronia circadiana com base no indicador padrão de sono. O consumo de álcool e o nível elevado de triglicerídeos mos traram relação positiva estatisticamente significativa com a presença de insônia (p ≤ 0.001; p ≤ 0.05). Conclusão A síndrome metabólica é um problema de saúde de alta prevalência entre a equipe de enfermagem, independentemente do nível acadêmico ou turno de trabalho. O peso e os triglicerídeos foram indicadores que mostraram relação com os padrões de sono afetados. Isto ressalta a importância de influenciar a prevenção e o tratamento da síndrome metabólica como prioridade na equipe de enfermagem, desde a saúde do trabalhador.

Clinical features, management and visual outcomes on patients with traumatic hyphema in a reference ophthalmological clinic in Colombia.

Aim. To analyze clinical features, treatment, and results of patients with non-penetrating traumatic hyphema in an ophthalmological center in Colombia. Methods. A retrospective cohort study in which medical records of patients with traumatic hyphema were analyzed between 2013 and 2018. Results. 38 eyes of 37 patients (34 men, 3 women) were included. Average age was 30.6 ± 16.6 years. Sports-related (42.1%) and occupational accidents (34.2%) were the main causes. 67.5% of the eyes had grade I hyphema. 95% received topical corticosteroids, 92.1% topical mydriatics and 52.63% ocular hypotensive eyedrops. Two eyes with hyphema grade I did not receive steroids and resolved uneventfully. None of the eyes rebleeded, even without antifibrinolytics. One patient with grade IV hyphema required surgery. Mean hyphema's clearance time was 8.4 ± 3.2 days. The last mean corrected distance visual acuity was LogMAR 0.25. There were no complications directly related to the hyphema. Conclusions. Working related activities were the second cause of traumatic hyphema in our cohort, which might be attributable to poor awareness of the importance or ocular protection, or limited access to recommended protective devices. Outpatient management enabled adequate outcomes. Corticosteroids and mydriatics were the treatment cornerstone, though seemed not to be imperative when hyphema was grade I. We were not able to support the contributive role from antifibrinolytics, because none of our patients rebleeded in spite of the absence of them. Abbreviations: IOP = intraocular pressure, AC = anterior chamber, CDVA = corrected distance visual acuity.

Prevalence of metabolic syndrome and its association with lower urinary tract symptoms and sexual function. / Prevalencia del síndrome metabólico y su asociación con síntomas del tracto urinario inferior y función sexual.

OBJECTIVES: To estimate the frequency of metabolic syndrome (MetS) in a daily urology practice and to determine its association with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). MATERIAL AND METHODS: A retrospective study was conducted. Data from all male patients aged ≥40 years who attended our outpatient urology clinic from 2010 to 2011 was collected. Prevalence of MetS was determined, and LUTS and ED were assessed. A logistic model was used to determine possible associations, controlling for confounders and interaction factors. RESULTS: A total of 616 patients were included. MetS was observed in 43.8% (95% CI 39.6-48.3). The bivariate model showed an association between MetS and LUTS (p<0.01), but not between MetS and ED. The logistic model showed an association between MetS and the International Prostate Symptom Score (IPSS), while controlling for other variables. Patients exhibiting moderate LUTS had a greater risk for MetS than patients with mild LUTS (OR 1.83, 95% CI 1.14-2.94). After analyzing for individual components of MetS, positive associations were found between diabetes and severe LUTS (OR 1.3, 95% CI 1.24-7.1), and between diabetes and ED (OR 2.57, 95% CI 1.12-5.8). CONCLUSION: This study was able to confirm an association between MetS and LUTS, but not for ED. Specific components such as diabetes were associated to both. Geographical differences previously reported in the literature might account for these findings. Given that MetS is frequent among urological patients, it is advisable that urologists actively screen for it.

Extended pelvic lymphadenectomy in patients with clinically localised prostate cancer: A prospective observational study. / Linfadenectomía pélvica extendida en pacientes con cáncer de próstata clínicamente localizado: estudio observacional prospectivo.

OBJECTIVE: To determine the frequency of lymph node involvement in patients with clinically localised prostate adenocarcinoma who had radical prostatectomy and extended pelvic lymphadenectomy. MATERIAL AND METHODS: A prospective observational study was conducted on 137 patients with clinically localised prostate cancer of low, intermediate or high risk according to the D'Amico classification. All participants underwent radical prostatectomy plus extended pelvic lymphadenectomy in 3 reference centres in Bogota, Colombia, between 2013 and 2014. The following variables were assessed: age, prostate specific antigen levels, Gleason score of the biopsy, probability of lymph node involvement calculated with Partin tables and the histopathology result of the surgical specimen, with the definitive Gleason pattern and the total number of resected and involved lymph nodes per tumour, according to the territory of the dissection. RESULTS: A total of 2,876 lymph nodes were extracted (an average of 20.99 lymph nodes per patient). There was lymph node involvement in 14 (10.22%) patients. The high-risk and intermediate-risk group presented lymph node metastases in 28.57% and 5.25%, respectively. There was no lymph node involvement in the low-risk group. Of the patients at risk of lymph node involvement (≥2% according to the Partin tables), 19.40% had lymph node metastases. CONCLUSION: Lymph node involvement in our population is similar to that reported in the worldwide literature. Extended pelvic lymphadenectomy increased the probability of detecting lymph node metastases in our community.

[Health-related quality of life in children with epilepsy in a Mexican hospital]. / Calidad de vida relacionada con la salud en niños con epilepsia de un hospital mexicano.

INTRODUCTION: Epilepsy is a chronic neurological syndrome that is accompanied by abnormal, synchronic and exaggerated discharges in the cerebral cortex. Epilepsy is inversely related to health-related quality of life (HRQL), although little has been published on this relationship in children in Latin America. AIM: To examine the relation between epilepsy and HRQL in a group of schoolchildren aged 8-12 years who were treated in a paediatric hospital in Sonora, Mexico. PATIENTS AND METHODS: A cross-sectional study was conducted to compare the HRQL of children diagnosed with epilepsy with respect to the HRQL of two control groups. The validated questionnaire Paediatric Quality of Life Inventory was used to evaluate HRQL. Differences were examined by means of an ANOVA test and the association between epilepsy and HRQL was modelled by means of multiple logistic regression. RESULTS: The children with epilepsy displayed the lowest HRQL score (62.4 ± 14.8) of the subjects studied and had 5.2 times as much risk of their HRQL deteriorating (95% confidence interval = 2.43-11.06) compared to healthy children. Deterioration was greater on the cognitive (54.6 ± 15.0) and emotional scales (55.9 ± 23.6). Polypharmacy, i.e. the concomitant ingestion of three or more drugs (p < 0.001), and the chronological progression of suffering (p < 0.001) are factors that significantly deteriorate the HRQL of children with epilepsy. CONCLUSIONS: Epilepsy gives rise to an overall deterioration in the HRQL of children, specifically in the cognitive and emotional spheres, which is related with the chronological progression of the disease and polypharmacy.

TITLE: Calidad de vida relacionada con la salud en niños con epilepsia de un hospital mexicano.Introduccion. La epilepsia es un sindrome neurologico cronico que cursa con descargas anormales, sincronicas y exageradas de la corteza cerebral. La epilepsia se relaciona inversamente con la calidad de vida relacionada con la salud de los pacientes (CVRS); sin embargo, esta relacion se ha documentado poco en niños de Latinoamerica. Objetivo. Examinar la relacion entre epilepsia y la CVRS en un grupo de niños escolares de 8-12 años atendidos en un hospital pediatrico de Sonora, Mexico. Pacientes y metodos. Se comparo transversalmente la CVRS de niños con diagnostico de epilepsia con respecto a la CVRS de dos grupos control. Se utilizo el cuestionario validado Pediatric Quality of Life Inventory para evaluar la CVRS. Las diferencias se examinaron mediante la prueba de ANOVA, y la asociacion entre epilepsia y CVRS se modelo mediante regresion logistica multiple. Resultados. Los niños con epilepsia mostraron la menor puntuacion de CVRS (62,4 ± 14,8) entre los sujetos estudiados, y tuvieron 5,2 veces mas riesgo de deterioro de su CVRS (intervalo de confianza al 95% = 2,43-11,06) en comparacion con el de niños sanos. El deterioro fue mayor en las escalas cognitiva (54,6 ± 15,0) y emocional (55,9 ± 23,6). La polifarmacia ­ingestion concomitante de tres o mas farmacos­ (p < 0,001) y la progresion cronologica de la enfermedad (p < 0,001) son factores que deterioran significativamente la CVRS de niños con epilepsia. Conclusiones. La epilepsia provoca un deterioro global en la CVRS de los niños, especificamente en las esferas cognitiva y emocional, lo que se relaciona con la progresion cronologica de la enfermedad y la polifarmacia.

[HPV detection in the mouth and cervix of patients with histological diagnosis suggestive of genital infection]. / Detección de VPH en boca y cérvix de pacientes con diagnóstico citológico sugestivo de infección genital.

This work evaluated HPV infection in the oral cavity (using oroscopy and exfoliative oral cytology) and its relation to genital infection in women with cytological diagnosis suggestive of HPV infection. The sample consisted of 60 patients who underwent oroscopy, cytology and viral determination in mouth and cervix by PCR using generic primers MY09/MY11 and MPCR. HPV DNA was detected in oral and genital mucosa in 48.33% and 73.3% of patients, respectively, yielding a concordance of 44.2% (k=0.44, moderate agreement). The most common viral types were low risk, especially type 6, found in 86.2% of oral samples and 65.9% of cervical specimens, alone or in combination with other types of low (11) or high oncogenic risk (16, 18, 33), with a concordance of 10.45% (k = 0.1, insignificant agreement). However, in relation to type 6, there was a concordance of 75.86% (k=0.7, high agreement). The cytology of the oral cavity had a sensitivity of 3.5% and a specificity of 93.6%. For oroscopy, sensitivity was 27.6% and specificity was 74.2%. The results indicate that HPV infection in the oral cavity of patients with genital infection could be frequent. The low concordance between HPV types suggests that HPV infection in the mouth and cervix has a different biological behavior.

Dietary combination effects of conjugated linoleic acid and flaxseed or fish oil on the concentration of linoleic and arachidonic acid in poultry meat.

This study was conducted to determine the effects of the combination of dietary conjugated linoleic acid (CLA) and n-3 fatty acids on the linoleic acid (C18:2n-6) and arachidonic acid (C20:4n-6) concentrations of broiler chicken breast and thigh muscles. One hundred and twenty broilers were raised to 6 wk of age. All chicks were fed a basal corn-soybean meal diet containing 5 different fat sources at an inclusion level of 2% total fat: 1) CLA, 2) flaxseed oil, 3) menhaden fish oil, 4) CLA and flaxseed oil, and 5) CLA and menhaden fish oil. Eight broilers from each treatment were processed at 4 and 6 wk of age. Breast and thigh muscle samples were collected and analyzed for total fat content and fatty acid composition. The results showed that broilers from the CLA and fish oil treatment had lower arachidonic acid concentrations in both breast and thigh muscles than those fed the flaxseed oil diet or the CLA and flaxseed oil diet (P < 0.05). The arachidonic acid concentration and n-6:n-3 ratio of breast and thigh samples from the menhaden fish oil diet were similar to those of the CLA and fish oil diet (P > 0.05), but the inclusion of linoleic acid into chicken thigh muscles of broilers fed the CLA and menhaden fish oil diet improved significantly when compared with that of the diet containing menhaden fish oil only. Thus, the combination of CLA and menhaden fish oil is recommended to reduce the concentrations of linoleic and arachidonic acids in broiler chicken breast and thigh muscles.

La anticoncepción de emergencia es un derecho / The emergency contraception is a right

Amparada por sus derechos a la libertad de pensamiento y de conciencia en en ejercicio de su autonomía reproductiva es la mujer a quien corresponde en su fuero interno decidir si evita o no un embarazo, acudiendo por ejemplo a la anticoncepción de emergencia

[Experience with radical prostatectomy as treatment of localized cancer of the prostate at the Fundación Santa Fe de Bogotá, Colombia]. / Experiencia con prostatectomía radical como tratamiento del cáncer localizado de la próstata en la Fundación Santa Fe de Bogotá, Colombia.

OBJECTIVE: To analyze the experience of the Fundación Santa Fe de Bogotá with radical prostatectomy in the treatment of localized prostatic cancer. METHODS: A retrospective study was conducted on 108 patients with localized carcinoma of the prostate stage T1-T2NxM0 submitted to radical prostatectomy from 1989 to 1994. RESULTS: Preoperatively, 50% of the patients had a PSA < 10 ng/ml and 14% had values that fell within the normal ranges of 0-4 mg/ml. A family history of prostate cancer was detected in 9.3% of the patients. The prostate cancer was clinically understaged in 75% of the patients, particularly those with stages T2a and T2b, and less significantly in those with stage T2c. Considering only those patients in whom the pathological staging had disclosed the cancer was not localized, this incidence accounted for 52% (n = 57). The presence of surgical margins was approximately 36%. The tumor recurrence rate was 26.9% and the complication rate was 6.8%. CONCLUSION: The relatively low complication rate in the present series shows that radical prostatectomy is a safe procedure that achieves good results if the cases are carefully selected and the diagnostic test are widely utilized.

[Preoperative assessment in adults]. / La valoración preoperatoria en el adulto.

UNLABELLED: The scope of this work is to analyze the usefulness and indications of preoperative evaluation. PATIENTS AND METHODS: 791 consecutive patients candidate for surgical treatment, were studied prospectively under the next inclusion criteria: 40 years old or less than 40 years old. Blood count cell, glucose, urea, creatinine, sodium, potassium, prothrombin time, partial thromboplastin time, platelets count, liver function tests, chest x-ray and electrocardiograph made before entry. In the the post liver, lung, bleeding, infectious or metabolic complications was done, while visiting the patients every day until discharge. Relative risk (RR) was calculated for every variable, analyzing differences with X2 and Fisher's Test. Those variables with statistical significance value were analyzed with logistic regression. Only 751 patients were studied, there were 335 male (44%) and 416 female (56%), with mean age of 63.9 years. Metabolic disorders (16.9%) and postoperative infections (7.0%) were the more frequent complications. Hemorrhage during of after surgery occurred in 2.2% of the patients. There were seventeen deaths (2.2%) related directly with surgery, with systemic illness or with postoperative complications. Selection of auxiliary tests for preoperative evaluation must be agree with clinical evaluation. The major objective of clinical evaluation is to estimate risk factors for surgery.

Giant cystic arachnoid granulations: a rare cause of lytic skull lesions.

Arachnoid granulations provide the pathway for drainage of cerebrospinal fluid from the subarachnoid space into the dural venous sinus system. They frequently produce small, well-defined indentations on the inner table of the calvarium that are easily recognized on radiographic studies and gross examination of the skull. We report a series of four giant cystic arachnoid granulations presenting as large "destructive" osteolytic lesions that required surgical exploration. The cysts were filled with cerebrospinal fluid and were delineated by a thin fibrous wall that contained peripheral clusters of arachnoid cells. We discuss the pathologic and radiographic differential diagnosis of osteolytic skull lesions and present a hypothesis regarding the formation of giant cystic arachnoid granulations.

Large soft tissue tumor of the chest occurring after trauma.

The unusual soft tissue tumor we have described may be the largest yet reported. The tumor was considered benign, and its histologic features were most consistent with fibromatosis arising in a region that had been previously traumatized. Although the patient is doing well, it is premature (2 years later) to conclude that the tumor will not recur.

Calcific tendinitis in unusual sites associated with cortical bone erosion.

Five cases of calcific tendinitis with radiographic evidence of cortical bone erosion are presented. All five cases arose at unusual sites: two at the pectoralis major insertion on the proximal humerus, two at the insertion of the gluteus maximus, and one at the insertion of the adductor magnus. Biopsy was performed in four cases and revealed areas of histiocytic infiltration, amorphous spherules of calcification, and areas of giant cell reaction extending into the cortex. To our knowledge, calcific tendinitis presenting with radiographic evidence of bone erosion has not been reported previously.