Trends in early growth indices in the first 24 months of life in Uruguay over the past decade.

Early growth is an important indicator of health and wellbeing of children and a good predictor of adult health. The objective of this study was to examine trends and determinants of overweight and stunting among infants aged 0 to 23 month(s) over the past decade (1999-2011) in Uruguay. Data were used from four large representative samples of 11,056 infants aged 0-23 month(s), who attended public and private health services in 1999, 2003, 2007, and 2011, using a similar methodology. Linear regression analysis was used for assessing trends in early growth indices and binary logistic regression to estimate the probability of being stunted and overweight. Although prevalence of overweight fell from 12.5% (1999) to 9.5% (2011) and stunting from 13.6% to 10.9% respectively, both rates remained higher than expected. Low birth- weight (LBW) was the main predictor of stunting [OR 6.5 (5.6-7.6)] and macrosomia of overweight [6.7 (5.3-8.3)]. We did not observe changes in LBW (7.8-8.8%) or macrosomia (5.9-6.7%) over the last decade. Boys showed increased chance of being overweight [OR 1.2 (1.04-1.3)]. Being stunted doubles the chances of being overweight [OR 2.5 (2.2-3.0)]. Overweight [OR 7.1 (6.1-8.3)], LBW [OR 13.2 (11.0-15.9)], and non-breastfed infants [OR 1.9 (1.7-2.1)] showed rapid weight gain. Uruguay has taken positive steps to decline the prevalence of stunting and overweight but both remain excessively high.

Control of several emissions during olive pomace thermal degradation.

Biomass plays an important role as an energy source, being an interesting alternative to fossil fuels due to its environment-friendly and sustainable characteristics. However, due to the exposure of customers to emissions during biomass heating, evolved pollutants should be taken into account and controlled. Changing raw materials or mixing them with another less pollutant biomass could be a suitable step to reduce pollution. This work studied the thermal behaviour of olive pomace, pyrenean oak and their blends under combustion using thermogravimetric analysis. It was possible to monitor the emissions released during the process by coupling mass spectrometry analysis. The experiments were carried out under non-isothermal conditions at the temperature range 25-750 °C and a heating rate of 20 °C·min⁻¹. The following species were analysed: aromatic compounds (benzene and toluene), sulphur emissions (sulphur dioxide), 1,4-dioxin, hydrochloric acid, carbon dioxide and nitrogen oxides. The results indicated that pollutants were mainly evolved in two different stages, which are related to the thermal degradation steps. Thus, depending on the pollutant and raw material composition, different emission profiles were observed. Furthermore, intensity of the emission profiles was related, in some cases, to the composition of the precursor.

Extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a systematic review and meta-analysis of randomized clinical trials.

INTRODUCTION: Extracorporeal cardiopulmonary resuscitation (ECPR) is currently recommended as a rescue therapy for selected patients in refractory out-of-hospital cardiac arrest (OHCA). However, there is conflicting evidence regarding its effect on survival and neurological outcomes. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to evaluate whether ECPR is superior to standard CPR in refractory OHCA. METHODS: We performed a systematic search of electronic databases (PubMed, CENTRAL, and Scopus) until March 2023. Studies were eligible if they a) were RCTs, and b) compared ECPR vs. standard CPR for OHCA. Outcomes were defined as survival with a favorable neurological status (cerebral performance category 1 or 2) at both the shortest follow-up and at 6 months, and in-hospital mortality. Meta-analyses using a random-effects model were undertaken. RESULTS: Three RCTs, with a total of four hundred and eighteen patients, were included. Compared with standard CPR, ECPR was associated with a non-statistically significant higher rate of survival with a favorable neurological outcome at the shortest follow-up (26.4% vs. 17.2%; RR 1.47 [95% CI 0.91-2.40], P = 0.12) and at 6 months (28.3% vs. 18.6%; RR 1.48 [95% CI 0.88-2.49], P = 0.14). The mean absolute rate of in-hospital mortality was not significantly lower in the ECPR group (RR 0.89 [95% CI 0.74-1.07], P = 0.23). CONCLUSION: ECPR was not associated with a significant improvement in survival with favorable neurologic outcomes in refractory OHCA patients. Nevertheless, these results constitute the rationale for a well-conducted, large-scale RCT, aiming to clarify the effectiveness of ECPR compared to standard CPR.

Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU).

PURPOSE: Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. METHODS: We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. RESULTS: We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4-46.1) had thrombocytopenia; 23.4% (20-26) had thrombocytopenia at ICU admission, and 19.8% (17.6-22.2) developed thrombocytopenia during their ICU stay. Absence of acquired immune deficiency syndrome (AIDS), non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19-2.42). CONCLUSION: Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.

Thin layer drying kinetics of by-products from olive oil processing.

The thin-layer behavior of by-products from olive oil production was determined in a solar dryer in passive and active operation modes for a temperature range of 20-50 °C. The increase in the air temperature reduced the drying time of olive pomace, sludge and olive mill wastewater. Moisture ratio was analyzed to obtain effective diffusivity values, varying in the oil mill by-products from 9.136 × 10(-11) to 1.406 × 10(-9) m(2)/s in forced convection (m(a) = 0.22 kg/s), and from 9.296 × 10(-11) to 6.277 × 10(-10) m(2)/s in natural convection (m(a) = 0.042 kg/s). Diffusivity values at each temperature were obtained using the Fick's diffusion model and, regardless of the convection, they increased with the air temperature. The temperature dependence on the effective diffusivity was determined by an Arrhenius type relationship. The activation energies were found to be 38.64 kJ/mol, 30.44 kJ/mol and 47.64 kJ/mol for the olive pomace, the sludge and the olive mill wastewater in active mode, respectively, and 91.35 kJ/mol, 14.04 kJ/mol and 77.15 kJ/mol in natural mode, in that order.

[Association between penoscopy data and urethral cytology among men with partners who had cervical lesions associated with human papilloma virus]. / Penoscopia y citología uretral en hombres con parejas que presentan lesiones cervicales por virus del papiloma humano.

OBJECTIVE: The aim of this study was to identify human papillomavirus lesions in a group of men whose sexual partners had cervical intraepithelial lesions associated with low-grade HPV confirmed by PCR-DNA. We carried out a correlation between urethral cytology penoscopy data and PCR-DNA results. METHODS: We studied 100 male volunteers with an age range of 21-45 (median 30 years) and divided them into two groups according to the identified virus; two groups were conformed, a high risk and a low risk virus. RESULTS: For the penoscopy data we included the following: type of hirsutoide papillomatosis in 40 (40%) cases, common warts in 24 (24%) cases, papillomatosis in plaque in 6 (6%) and 47% displayed an urethra with a foamy appearance. In urethral cytology we did not find evidence of koilocytes in 58% and 42% showed no koilocytes. Inflammation was observed in 44 cases; an added infection was noted among 60 cases. Depending on the type of infection we found non-specific bacteria in 8%, bacillary in 10%, mixed infection in 12%, changes suggestive of Gardnerella vs 24%, and Chlamydia treatment in 6%. Dyskeratosis was noted in 47% of study participants. 67 patients were treated with imiquimod cream 5% and 33% received non-specific treatment. Regarding improvement we noted that 67 (67%) cases showed 46/67 hypochromic stains after treatment with imiquimod. Disappearance of the lesions in the penis were observed among 65 cases and only 35 remained with lesions. Regarding high-risk HPV we found a significant difference in odor (p = .004, phi = .004), urethral discharge (p = .007), pearly papules in raphe (p = .023), with inflammation, dyskeratosis and added infection (p = .000 respectively). We also noted hypochromic spots or skin discoloration after treatment with imiquimod among 5% of subjects (p = .046). CONCLUSIONS: In our study we observed that high-risk HPV is associated with increased penile lesions and frank evidence of koilocytes in urethral cytology. We recommend that sexual partners of women with cervical lesions associated with HPV complete a control study with penoscopy data and urethral cytology, since most have concurrent infections and lesions that can treated in early stages.

Combustion analysis of different olive residues.

The Thermogravimetric Analysis (TGA) techniques and concretely the study of the burning profile provide information that can be used to estimate the behaviour of the combustion of carbonous materials. Commonly, these techniques have been used for the study of carbons, but are also interesting for the analysis of biomass wastes, due to the different species present on the wastes affect directly to its thermal properties. In this work, techniques of thermal analysis have been applied to compare the behaviour of different wastes coming from olive oil mills. From these results, it is remarkable that the Concentrated Olive Mill Waste Water (COMWW) presents more unfavourable conditions for its combustion.

[Clinical implications and prognostic significance of the study on the circadian variation of heart rate variability in patients with severe pulmonary hypertension]. / Implicaciones clínicas y pronósticas del estudio circadiano de la modulación simpático-vagal de la variabilidad de la frecuencia cardiaca en pacientes con hipertensión arterial pulmonar grave.

BACKGROUND: A reduction of heart rate variability (HRV) is currently considered an independent risk factor for morbidity, mortality and severity of severalcardiac disease, however, the dynamic sympathovagal modulation on HRV during 24 hr in primary pulmonary hypertension (PPH) had not been described. METHODS: 24 hr Holter monitoring (HA) were recorded in 32 patients (mean age 34, +/-12, 90% female) with severe primary pulmonary hypertension (mean pulmonary pressure, 90:t:12 mm Hg), and in 34 patients (mean age 36 +/-14, 60% female) with Eisenmenger syndrome (ES) secondary to septal ventricular defect or atent ductus arteriosus. A control group (n=44) paired for age, gender and arterial pulmonary pressure was included. HRV time and spectral parameters (mean, SDNN, SDANN, rMSSD, PNN50, LF, HF and LF/HF ratio) were analyzed during three periods: 24 hr; day (8-22:00), night (23-07:00) and also every hour of recording at 5 min-intervals). After detection of sympatho-vagal balance 15 patients were randomized, Treprostinil (prostaglandin) was administered to 6 patients and subcutaneous placebo to 9. RESULTS: HRV frequency parameters during 24 hr HM were significantly different among groups. LF/HF (day) 5.9:1:12.5:1:1P.001 and LF/HF night) 2.8:tlvs.1.5:l:.8.034. Sympathovagal modulation on 24 hr HRV showed that heart rate circadian rhythm is clearly altered in both PPH and ES, but the sympathetic tone in PPH is higher at l 24 hr. (p < .05), after administering treprostinil a recovery of sympathovagal balance was observed CONCLUSIONS: Autonomic cardiac disturbance is clearly present in PPH and ES. The circadian rhythm of HRV is first lost due to an increase of sympathetic tone. These changes may be markers of autonomic disbalance that favor the development of arrhythmias and sudden death. The sympathovagal balance in PPH could be considered an important risk marker.

Mirror Syndrome after Fetoscopic Laser Treatment - A Case Report.

Mirror syndrome is a rare disease with unknown pathophysiology that can be present in different diseases that can cause fetal hydrops. The prognosis is usually bad with a high perinatal mortality. We report an unusual form of mirror syndrome that manifested itself only after a successful treatment for fetal hydrops (caused by twin-twin transfusion syndrome, in Quinteros stage IV) was performed. This syndrome was controlled by medical treatment, and despite the usually bad prognosis seen in these cases, we could extend the pregnancy from the 23rd to the 34th week of gestation, resulting in the birth of 2 live infants.

A Review of Pellets from Different Sources.

The rise in pellet consumption has resulted in a wider variety of materials for pellet manufacture. Thus, pellet industry has started looking for alternative products, such as wastes from agricultural activities, forestry and related industries, along with the combination thereof, obtaining a broad range of these products. In addition, the entry into force of EN ISO 17225 standard makes wood pellet market (among other types) possible for industry and household purposes. Therefore, wastes that are suitable for biomass use have recently increased. In this study, the main characteristics of ten kinds of laboratory-made pellets from different raw materials were analyzed. Thus, we have focused on the most limiting factors of quality standards that determine the suitability for biomass market, depending on the kind of pellet. The results showed considerable differences among the analyzed pellets, exceeding the limits established by the standard in almost all cases, especially concerning ash content and N and S composition. The requirements of the studied standard, very demanding for certain factors, disable the entry of these densified wastes in greater added value markets.

[Premature labour with or without preterm premature rupture of membranes: maternal, obstetric and neonatal features]. / Parto pré-termo com e sem rotura prematura de membranas: características maternas, obstétricas e neonatais.

PURPOSE: Evaluation of maternal, obstetrics e neonatal features in both spontaneous preterm births (PTB) with or without preterm premature rupture of membranes (PPROM). METHODS: Retrospective study of single fetus pregnancies with PTB between 2003 and 2012. INCLUSION CRITERIA: PTB associated with ou without PPROM. Exclusion criterias: PTB by medical indication due to fetal/maternal disease and all non accessible or incomplete clinical files. Different characteristics were compared between two groups of PTB: spontaneous PTB without PPROM (sPTB) versusPPROM. Kolmogorov-Smirnov, Levene, χ2, t Student and Mann-Withney tests were used for statistical analysis. RESULTS: From 2,393 PTB of single fetus, 1,432 files were analysed, from which 596 were sPTB and 836 PPROM. The socioeconomic conditions were similar in both groups. Multiparity (50.7 versus 40.3%), personal history of previous PTB (20.8 versus10.2%), cervical length (18.2 versus27.2 mm), lower body index mass (23.4 versus 24.3 kg/m2) and higher infectious parameters (Protein C Reactive: 2.2 versus1.2 mg/L; Leukocytes: 13.3 versus 12.4 x109) were more frequent in PBTs (p<0,001). Neonatal outcomes, specially neurologic outcomes (4.7 versus2.8%, p<0,001), were worst in PBTs. CONCLUSION: PTB with or without PPROM has a complex etiology. From all evaluated features in our study, only maternal thinness, multiparity with a previous PTB, the cervical length and worst systemic infections parameters were significant in sPTB. This group also showed worst neonatal outcomes, specially on neurological outcomes.

Analysis of Pelletizing of Granulometric Separation Powder from Cork Industries.

Cork industries generate a considerable amount of solid waste during their processing. Its management implies a problem for companies that should reconsider its reuse for other purposes. In this work, an analysis of pelletizing of granulometric separation powder, which is one of the major wastes in cork industries and which presents suitable properties (as an raw material) for its thermal use, is studied. However, its characteristic heterogeneity, along with its low bulk density (which makes its storage and transportation difficult) are restrictive factors for its energy use. Therefore, its densified form is a real alternative in order to make the product uniform and guarantee its proper use in boiler systems. Thus, the cork pellets (from granulometric separation powder) in the study met, except for ash content specification, the specifications in standard European Norm EN-Plus (B) for its application as fuel for domestic use.

Stunting, overweight and child development impairment go hand in hand as key problems of early infancy: Uruguayan case.

BACKGROUND: Stunting, overweight and child development impairment are key problems affecting early infancy and have short and long-term consequences on academic performance, social competence and adult health. The aim of this paper is to identify linkages and factors that may simultaneously contribute to these problems. STUDY DESIGN: A cross sectional study. SUBJECTS: 2,046 children under 5 years in Canelones, Uruguay. OUTCOME MEASURES: For simultaneous assessment of the relationship between stunting, overweight and child development impairment we used multiple logistic regression analyses. We included children, household, maternal and paternal variables as confounder factors. To give the strength of association we performed odds ratios (OR). A significant OR was defined as upper and lower 95% confidence limits not containing the value of one. Significance level was <0.05. RESULTS: Low birthweight was a risk for stunting OR: 3.2 (1.8-5.6) and for reduced head circumference growth OR: 3.9 (1.9-8.0); infants with reduced head circumference had an increased chance of delayed psychomotor development OR: 2.4 (1.17-5.07) and of being stunted OR: 3.2 (1.7-6.3); stunted infants had almost three times risk of being overweight OR: 2.7 (1.8-4.1). Maternal stature <160 cm, low BMI, low education and poverty were also predictor for stunting. Obese mother, maternal stature >160 cm and maternal smoking increased chance of overweight. Some maternal behaviors, such as mother not used to singing songs and maternal smoking increased the likelihood of delaying psychomotor development. CONCLUSIONS: The close linkages between stunting, being overweight and child development impairment suggest they should be targeted together: they coexist in the same infants and predict each other.

Mirror Syndrome after Fetoscopic Laser Treatment - A Case Report / Síndrome do espelho após tratamento laser por fetoscopia - caso clínico

Abstract Mirror syndrome is a rare disease with unknown pathophysiology that can be present in different diseases that can cause fetal hydrops. The prognosis is usually bad with a high perinatal mortality. We report an unusual form of mirror syndrome that manifested itself only after a successful treatment for fetal hydrops (caused by twin-twin transfusion syndrome, in Quinteros stage IV) was performed. This syndrome was controlled by medical treatment, and despite the usually bad prognosis seen in these cases, we could extend the pregnancy from the 23rd to the 34th week of gestation, resulting in the birth of 2 live infants.

Resumo A síndrome do espelho é uma doença rara, de fisiopatologia desconhecida, que se manifesta em situações obstétricas responsáveis pela presença de hidrópsia fetal. Habitualmente o prognóstico é reservado, uma vez que se associa a elevadas taxas de mortalidade perinatal. O presente caso clínico trata de uma situação de síndrome do espelho que se manifestou, atipicamente, após o tratamento eficaz para a hidrópsia fetal associada à síndrome de transfusão feto-fetal. Apesar do mau prognóstico associado a estas situações, conseguiu-se controlar a situação apenas com tratamento médico e, desta forma, prolongar a gravidez durante 12 semanas.

Parto pré-termo com e sem rotura prematura de membranas: características maternas, obstétricas e neonatais / Premature labour with or without preterm premature rupture of membranes: maternal, obstetric and neonatal features

OBJETIVO: Avaliação das caraterísticas maternas, obstétricas e neonatais nos partos pré-termo (PPT) associados ou não à rotura prematura de membranas pré-termo.MÉTODOS: Estudo retrospetivo de gestações de feto único, com um parto pré-termo, entre 2003 e 2012. Critérios de inclusão: a ocorrência de parto associado ou não à rotura prematura de membranas pré-termo. Critérios de exclusão: partos motivados por comorbidades fetal e/ou maternas (iatrogênicos); e processos não disponíveis ou incompletos para consulta. Foram comparadas caraterísticas entre os dois grupos de PPT: PPT espontâneo (PPTe)versusrotura prematura de membranas pré-termo (RPM-PT), tendo sido utilizados na análise estatística os testes Kolmogorov-Smirnov, Levene, χ2, t de Student e Mann-Withney.RESULTADOS: Dos 2.393 partos pré-termo de feto único, foram analisados 1.432, dos quais 596 foram espontâneos (PPTe) e 836 foram associados à RPM-PT. Das variáveis analisadas, os fatores socioeconômicos foram sobreponíveis em ambos os grupos. Foram mais frequentes no grupo PPTe (p<0,001) a multiparidade (50,7 versus40,3%), os antecedentes obstétricos de PPT (20,8 versus10,2%), o comprimento cervical (18,2 versus27,2 mm), o baixo índice de massa corpórea (IMC) (23,4 versus24,3 kg/m2) e a elevação dos marcadores infecciosos como a Proteína C reativa (2,2 versus1,2 mg/L) e os leucócitos (13,3 versus12,4x109). O desfecho neonatal, em termos de comorbilidade, foi mais adverso no grupo PPTe, sobretudo à custa de piores resultados neurológicos (4,7 versus2,8%, p<0,001).CONCLUSÕES: Os mecanismos etiológicos do PPT, com ou sem RPM-PT, são bastante complexos. Das várias caraterísticas analisadas no nosso estudo, apenas o baixo IMC, a multiparidade com PPT anterior, o comprimento cervical foram os piores parâmetros infeciosos que foram predominantes no grupo PPTe. Esse último grupo mostrou ainda piores resultados perinatais sobretudo neurologicamente.

PURPOSE: Evaluation of maternal, obstetrics e neonatal features in both spontaneous preterm births (PTB) with or without preterm premature rupture of membranes (PPROM).METHODS: Retrospective study of single fetus pregnancies with PTB between 2003 and 2012. Inclusion criteria: PTB associated with ou without PPROM. Exclusion criterias: PTB by medical indication due to fetal/maternal disease and all non accessible or incomplete clinical files. Different characteristics were compared between two groups of PTB: spontaneous PTB without PPROM (sPTB) versusPPROM. Kolmogorov-Smirnov, Levene, χ2, t Student and Mann-Withney tests were used for statistical analysis.RESULTS: From 2,393 PTB of single fetus, 1,432 files were analysed, from which 596 were sPTB and 836 PPROM. The socioeconomic conditions were similar in both groups. Multiparity (50.7versus40.3%), personal history of previous PTB (20.8 versus10.2%), cervical length (18.2 versus27.2 mm), lower body index mass (23.4 versus24.3 kg/m2) and higher infectious parameters (Protein C Reactive: 2.2 versus1.2 mg/L; Leukocytes: 13.3 versus12.4x109) were more frequent in PBTs (p<0,001). Neonatal outcomes, specially neurologic outcomes (4.7 versus2.8%, p<0,001), were worst in PBTs.CONCLUSION: PTB with or without PPROM has a complex etiology. From all evaluated features in our study, only maternal thinness, multiparity with a previous PTB, the cervical length and worst systemic infections parameters were significant in sPTB. This group also showed worst neonatal outcomes, specially on neurological outcomes.

[Medical reflections on a case of pulmonary thromboembolism in pregnancy]. / Reflexiones médicas a propósito de un caso de tromboembolia pulmonar en el embarazo.

Maternal mortality is still high in the world. Pulmonary thromboembolism as a cause of death is the second in developed countries. The frequency of reported events in Latin-American is 0.6%, which contrasts with that reported for developed countries (14.9%). This difference may be related to information bias. A review of the current information about this topic is presented, and we report a short case of a pregnant woman who presented pulmonary thromboembolism event at 30 weeks of pregnancy. Appropriate therapy allowed maternal and fetal survival.

Adherencia al tratamiento del paciente con fisura labio-palatina (FLAP) 2006 - 2013 / Adherence to treatment of patients with cleft lip palate (FLAP) 2006-2013

Las Fisuras Labio Palatinas son anomalías congénitas que consisten en una hendidura o separación en el labio superior. Se presentan, frecuentemente, acompañadas de paladar hendido. El presente trabajo tiene por objetivo estudiar la complejidad y grado de adherencia, estudiando el grado de abandono en la rehabilitación del paciente FLAP que concurre a instituciones o servicios adheridos a la Red de Servicios / Instituciones de la Argentina. De un total de 749 pacientes fueron contactados aquellos con más de 200 días de inasistencia al servicio en un total de 162 (21,6%), de los cuales 55 (11,4%) manifestó abandono de tratamiento. El 46,8% de los pacientes no cuentan con cobertura por obra social / prepaga o mutual. El 18,2% posee certificado de discapacidad. El 47,8% de los pacientes requieren entre 1 a 2 horas de traslado para su atención, y el 27,3% más de 2 horas, a lo que se debe sumar los tiempos de espera en las instituciones. Del análisis de las variables seleccionadas se podría estimar que la edad, severidad de la lesión, número de convivientes en el domicilio y ausencia de certificado de discapacidad podrían ser utilizados como indicadores de posible abandono en el tratamiento.

Cleft lip palate is a congenital anomaly consisting of a crack or separation in the upper lip. It is often accompanied by cleft palate. The aims of the study it is to analyze the complexity and degree of rehabilitation adhesion, by abandonment analysis, of the FLAP patient who attends institutions or services belonging to the network of services / institutions in Argentina. A total of 749 patients were contacted those with more than 200 days of absenteeism to the service in a total of 162 (21,6%), of which 55 (11,4%) said abandonment of treatment. 46,8% of patients do not have coverage for work social/insurance/mutual. 18,2% possesses a certificate of disability. 47,8% of patients require between 1-2 hours of transfer for your attention, and 27,3% more than 2 hours, what to add the waiting time at the institutions. Analysis of selected variables you could estimate that the age, severity of injury, number of cohabitants in the domicile and absence of disability certificate could be used as indicators of possible abandonment in the treatment.

Reflexiones médicas a propósito de un caso de tromboembolia pulmonar en el embarazo / Medical reflections on a case of pulmonary thromboembolism in pregnancy

La mortalidad materna en el mundo es aún alta. La tromboembolia pulmonar como causa de muerte ocupa el segundo lugar en países desarrollados. En Latinoamérica, la frecuencia informada es de 0.6%, lo cual contrasta con la señalada para países desarrollados (14.9%). Esta diferencia puede estar relacionada a sesgos de información. Por tal motivo se revisó la información actual del tema y presentamos un breve caso clínico de una mujer quien presentó evento de tromboembolia pulmonar en la semana 30 del embarazo; el manejo adecuado de la misma, permitió la supervivencia materna y fetal.

Maternal mortality is still high in the world. Pulmonary thromboembolism as a cause of death is the second in developed countries. The frequency of reported events in Latin-American is 0.6%, which contrasts with that reported for developed countries (14.9%). This difference may be related to information bias. A review of the current information about this topic is presented, and we report a short case of a pregnant woman who presented pulmonary thromboembolism event at 30 weeks of pregnancy. Appropriate therapy allowed maternal and fetal survival.

Implicaciones clínicas y pronósticas del estudio circadiano de la modulación simpático-vagal de la variabilidad de la frecuencia cardiaca en pacientes con hipertensión arterial pulmonar grave / Clinical implications and prognostic significance of the study on the circadian variation of heart rate variability in patients with severe pulmonary hypertension

Introducción: La reducción en la variabilidad de la frecuencia cardiaca ha sido identificada como factor de riesgo en enfermedad cardiovascular, pero su descripción en hipertensión arterial pulmonar severa se desconoce. Material y métodos: Se estudiaron pacientes con hipertensión arterial pulmonar grave, 32 con hipertensión pulmonar primaria, 34 con hipertensión pulmonar secundaria a cardiopatía congénita (Eisenmenger) y 44 sujetos control sin evidencia de enfermedad. La evaluación del registro ambulatorio de la frecuencia cardiaca se realizó por métodos convencionales. El análisis espectral y la relación a baja y alta frecuencia se realizó utilizando el método de Fourier. Comparaciones entre día y noche se realizó entre los grupos. Después de conocer el perfil circadiano, 15 pacientes con hipertensión pulmonar fueron seleccionados para recibir tratamiento al azar con Treprostinil (Prostaglandina) o placebo por vía subcutánea. Posteriormente (3 meses) se analizaron nuevamente los parámetros de variabilidad de frecuencia cardiaca y de hemodinámica para conocer el impacto de dicha terapéutica. Resultados: Se detectó un estado franco de hipertonía simpática en el grupo de hipertensión pulmonar, sobre todo en los pacientes con hipertensión pulmonar primaria. El efecto de Treprostinil fue claramente asociado con disminución del tono simpático y un aumento de la capacidad física. Conclusiones: Los pacientes con hipertensión arterial pulmonar, cursan con equilibrio simpático-vagal alterado sobre todo durante el día. Hay pérdida del ritmo circadiano. Dichos trastornos pueden ser reversibles con la aplicación de treprostinil. El equilibrio simpáticovagal de la frecuencia cardiaca es un instrumento no invasivo que permite estratificar mejor al paciente con hipertensión arterial pulmonar grave.

BACKGROUND: A reduction of heart rate variability (HRV) is currently considered an independent risk factor for morbidity, mortality and severity of severalcardiac disease, however, the dynamic sympathovagal modulation on HRV during 24 hr in primary pulmonary hypertension (PPH) had not been described. METHODS: 24 hr Holter monitoring (HA) were recorded in 32 patients (mean age 34, +/-12, 90% female) with severe primary pulmonary hypertension (mean pulmonary pressure, 90:t:12 mm Hg), and in 34 patients (mean age 36 +/-14, 60% female) with Eisenmenger syndrome (ES) secondary to septal ventricular defect or atent ductus arteriosus. A control group (n=44) paired for age, gender and arterial pulmonary pressure was included. HRV time and spectral parameters (mean, SDNN, SDANN, rMSSD, PNN50, LF, HF and LF/HF ratio) were analyzed during three periods: 24 hr; day (8-22:00), night (23-07:00) and also every hour of recording at 5 min-intervals). After detection of sympatho-vagal balance 15 patients were randomized, Treprostinil (prostaglandin) was administered to 6 patients and subcutaneous placebo to 9. RESULTS: HRV frequency parameters during 24 hr HM were significantly different among groups. LF/HF (day) 5.9:1:12.5:1:1P.001 and LF/HF night) 2.8:tlvs.1.5:l:.8.034. Sympathovagal modulation on 24 hr HRV showed that heart rate circadian rhythm is clearly altered in both PPH and ES, but the sympathetic tone in PPH is higher at l 24 hr. (p < .05), after administering treprostinil a recovery of sympathovagal balance was observed CONCLUSIONS: Autonomic cardiac disturbance is clearly present in PPH and ES. The circadian rhythm of HRV is first lost due to an increase of sympathetic tone. These changes may be markers of autonomic disbalance that favor the development of arrhythmias and sudden death. The sympathovagal balance in PPH could be considered an important risk marker.