Lower plasma melatonin levels in non-hypoxic premature newborns associated with neonatal pain.

We analyzed plasma melatonin levels in different groups of preterm newborns without hypoxia and their relationship with several perinatal variables like gestational age or neonatal pain. Prospective cohort study of preterm newborns (PTNB) without perinatal hypoxia, Apgar > 6 at 5 min, and oxygen needs on the third day of life. We compared melatonin levels at day 3 of life in different groups of non-hypoxic preterm infants (Student's t-tests, Mann-Whitney U, and chi2) and analyzed the relationship of melatonin with GA, birth weight, neonatal pain (Premature Infant Pain Profile (PIPP) scale), caffeine treatment, parenteral nutrition, or the development of free radical diseases (correlation study, linear regression) and factors associated with moderate/intense pain and free radical diseases (logistic regression analysis). Sixty-one preterm infants with gestational age (GA) of 30.7 ± 2.0 weeks with no oxygen requirements at day 3 of life were studied with plasma melatonin levels of 33.8 ± 12.01 pg/ml. Preterm infants weighing < 1250 g at birth had lower plasma melatonin levels (p = 0.05). Preterm infants with moderate or severe pain (PPIPP > 5) have lower melatonin levels (p = 0.01), and being preterm with PIPP > 5 is associated with lower plasma melatonin levels (p = 0.03). Being very preterm (GA < 32 GS), having low weight for gestational age (LWGA), receiving caffeine treatment, or requiring parenteral nutrition did not modify melatonin levels in non-hypoxic preterm infants (p = NS). Melatonin on day 3 of life in non-hypoxic preterm infants is not associated with later development of free radical diseases (BPD, sepsis, ROP, HIV, NEC). CONCLUSION: We observed that preterm infants with moderate to severe pain have lower melatonin levels. These findings are relevant because they reinforce the findings of other authors that melatonin supplementation decreases pain and oxidative stress in painful procedures in premature infants. Further studies are needed to evaluate whether melatonin could be used as an analgesic in painful procedures in preterm infants. TRIAL REGISTRATION: Trial registration was not required since this was an observational study. WHAT IS KNOWN: • Melatonin is a potent antioxidant and free radical scavenger in newborns under stress conditions: hypoxia, acidosis, hypotension, painful procedures, or parenteral nutrition. • Pain stimulates the production of melatonin. • Various studies conclude that melatonin administration decreases pain during the neonatal period. WHAT IS NEW: • Non-hypoxic preterm infants with moderate to severe pain (PIPP>5) have lower levels of melatonin. • Administration of caffeine and treatment with parenteral nutrition do not modify melatonin levels in non-hypoxic preterm infants.

Neuroendoscopic access to the third ventricle in patients with narrow foramen of monro without stenosis/obstruction: role of foraminoplasty.

OBJECT: One of the critical steps for the success of intraventricular neuroendoscopic procedures is the entry into the third ventricle and passage of the endoscopy system through the foramen of Monro (FM). A diameter larger than that of the instrument used is considered a prerequisite for safely performing the technique, as damage to this structure can lead to alterations in the fornix and vascular structures. When the foramen diameter is narrow and there is no obstruction/stenosis, the role of foraminoplasty in reducing the risk of complications has not been adequately assessed in the literature. METHODS: A review of endoscopic procedures conducted at our center since 2018 was undertaken. Cases in which preoperative imaging indicated a FM diameter < 6 mm and foraminoplasty technique was applied were examined to determine the technical and functional success of the procedure. The technical success was determined by completing the neuroendoscopic procedure with the absence of macroscopic lesions in the various structures comprising the foramen and without complications in the follow-up imaging tests. Functional success was defined as the absence of cognitive/memory alterations during the 3-month postoperative follow-up. Additionally, a review of the various forms of foraminoplasty described in the literature is conducted. RESULTS: In our cohort, six patients were identified with a preoperative FM diameter < 6 mm without obstruction or stenosis. Foraminoplasty was planned for these cases to facilitate various intraventricular neuroendoscopic procedures. In all instances, the technique was successfully performed without causing macroscopic damage to the structures comprising the foramen. Follow-up visits included various cognitive tests to assess potential sequelae related to microscopic damage to the fornix. None of the patients exhibited anomalies. CONCLUSION: Foraminoplasty in patients with a narrow FM without signs of stenosis/obstruction is a useful technique to reduce the risk of complications during the passage of the endoscopy system through this structure, enabling the safe performance of neuroendoscopic procedures.

Environmental Exposure to Pesticides and the Risk of Child Neurodevelopmental Disorders.

Background and Objectives: Neurodevelopment is a fragile brain process necessary for learning from the beginning of childhood to adulthood. During the procedure, several risks could affect it, including environmental factors such as neurotoxic chemicals or environmental pollutants and, within them, exposure to pesticides. Materials and Methods: This ecological descriptive study attempted to assess the association between environmental exposure to pesticides and neurodevelopmental disorders. This study was conducted on 4830 children diagnosed for 11 years in a total population of 119,897 children in three areas: high, medium, and low greenhouse concentrations. Results: Chromosomal abnormalities were the most common prenatal disorder (28.6%), while intrauterine physical factors were the least common (0.5%). Among perinatal diagnoses, gestational age less than 32 weeks was the most common (25%), while hyperbilirubinemia requiring exchange transfusion and birth complications was the least common (0.4%). Brain damage was the most common problem detected in postnatal diagnosis (36.7%), while unspecified postnatal abnormalities were the least common (3.1%). Conclusions: The areas with the highest greenhouse concentration had higher incidences of neurodevelopmental disorders, particularly in boys, and lower age of referral. Chromosomal abnormalities were prevalent for prenatal diagnoses, gestational age below thirty-two weeks for perinatal diagnoses, and brain damage for postnatal diagnoses. Future studies should analyze the connection between pesticide exposure and neurodevelopmental disorders using spatial point pattern analysis.

The problem of calculating the prevalence of sexual dysfunction: a meta-analysis attending gender.

INTRODUCTION: Sexuality is an integral part of human health, and sexual dysfunctions are prevalent issues that affect men and women. While reviews on sexual dysfunctions in various diseases have been conducted, overall data are scarce. OBJECTIVES: To update the overall prevalence of sexual dysfunctions from available prevalence studies on both sexes. METHODS: We used a 2-phase selection process to include cross-sectional studies that were conducted on the adult population and published between 2017 and 2022. The extracted data were prevalence, methodology, sample size, and location. Sensitivity and subgroup analyses were conducted to assess heterogeneity. RESULTS: This review analyzed 4407 studies. Twenty-three met the established criteria: 9 on the male population and 14 on the female population. The meta-analysis included 7 articles on males and 13 on females. The prevalence of sexual dysfunction was 31% in men and 41% in women, with significant heterogeneity among the studies. Sociocultural differences and use of varying measurement methods were identified as the main factors contributing to heterogeneity. Subgroup analysis revealed decreased heterogeneity among studies that used the Female Sexual Function Index as a diagnostic tool for females. CONCLUSIONS: The review highlights the notable variability in results due to methodological and geographic variations. Therefore, enhancing the training of professionals and standardizing the recording of patient data-through the Female Sexual Function Index and Male Sexual Health Questionnaire or by developing new ones for this purpose-could improve the consistency of research on sexual health.

Neuropsychiatric symptoms of patients two years after experiencing severe COVID-19: A mixed observational study.

BACKGROUND: The impact of SARS-CoV-2 infection (COVID-19) on mental health has not been extensively studied in the medium and long term. This study assessed how clinical, biological, and social factors affect mental health in patients who recovered from severe COVID-19. The evaluation was done 90 days after hospital discharge and followed up at 12 and 24 months. METHODS: A retrospective-prospective cohort mixed observational study was conducted on patients over 18 years of age who required hospitalization in Internal Medicine or ICU for severe COVID-19 pneumonia during 2020 and 2021. Demographic information, clinical variables, and data for the scales were obtained from electronic medical records and telephone interviews. For comparisons of the different variables in each clinical variable (insomnia, depression, anxiety), the Student's t-test for independent samples has been used (normal distribution); otherwise, the Mann-Whitney test will be used. All tests and intervals will be performed with a confidence level of 95. Fisher's exact or Pearson's Chi-square test has been used as appropriate for qualitative variables. RESULTS: 201 patients were recruited. 37.3% presented insomnia, 22.4% anxiety, and 21.4% depressive symptoms. A direct association was established between female sex and depressive symptoms. Psychotropic history, fatigue, and C-reactive protein levels (CRP) were correlated with depression. Anosmia and ageusia, CRP, cognitive symptoms, and dyspnea predicted insomnia. Sex, orotracheal intubation (OTI), pain, fatigue, mental health history, and academic level were independent predictors of anxiety. High percentages of depressive, anxiety, and insomnia symptoms were detected in the second month after discharge and persisted at 12 and 24 months. The fatigue variable maintained a significant relationship with depressive symptoms at 2, 12 and 24 months. A possible limitation could be recall bias in retrospective data collection. CONCLUSIONS: This is a novel study to follow up on mental health for two years in patients with severe COVID-19. Clinical, biological, and psychosocial variables could be predictors of depressive symptoms, anxiety, and insomnia. The psychiatric symptoms persisted throughout the 2-year follow-up. These findings are critical for the follow-up of these patients and open the possibility of further studies in the medium and long term.

Sepsis mortality prediction with Machine Learning Tecniques.

OBJECTIVE: To develop a sepsis death classification model based on machine learning techniques for patients admitted to the Intensive Care Unit (ICU). DESIGN: Cross-sectional descriptive study. SETTING: The Intensive Care Units (ICUs) of three Hospitals from Murcia (Spain) and patients from the MIMIC III open-access database. PATIENTS: 180 patients diagnosed with sepsis in the ICUs of three hospitals and a total of 4559 patients from the MIMIC III database. MAIN VARIABLES OF INTEREST: Age, weight, heart rate, respiratory rate, temperature, lactate levels, partial oxygen saturation, systolic and diastolic blood pressure, pH, urine, and potassium levels. RESULTS: A random forest classification model was calculated using the local and MIMIC III databases. The sensitivity of the model of our database, considering all the variables classified as important by the random forest, was 95.45%, the specificity was 100%, the accuracy was 96.77%, and an AUC of 95%. . In the case of the model based on the MIMIC III database, the sensitivity was 97.55%, the specificity was 100%, and the precision was 98.28%, with an AUC of 97.3%. CONCLUSIONS: According to random forest classification in both databases, lactate levels, urine output and variables related to acid.base equilibrium were the most important variable in mortality due to sepsis in the ICU. The potassium levels were more critical in the MIMIC III database than the local database.

Dynamic Workflow Proposal for Continuous Frameless Electromagnetic Neuronavigation in Rigid Neuroendoscopy.

BACKGROUND: Ventriculoscopic neuronavigation has been described in several articles. However, there are different ventriculoscopes and navigation systems. Due to these different combinations, it is difficult to find detailed neuronavigation protocols. We describe, step-by-step, a simple method to navigate both the trajectory until reaching the ventricular system, as well as the intraventricular work. METHODS: We use a rigid ventriculoscope (LOTTA, KarlStorz) with an electromagnetic stylet (S8-StealthSystem, Medtronic). The protocol is based on a modified or 3-dimensionally printed trocar for navigating the extraventricular step and on a modified pediatric nasogastric tube for the intraventricular navigation. RESULTS: This protocol can be set up in less than 10 minutes. The extraventricular part is navigated by introducing the electromagnetic stylet inside the modified or 3-dimensionally printed trocar. Intraventricular navigation is done by combining a modified pediatric nasogastric tube with the electromagnetic stylet inside the endoscope's working channel. The most critical point is to obtain a blunt-bloodless ventriculostomy while achieving perfect alignment of all targeted structures via pure straight trajectories. CONCLUSIONS: This protocol is easy-to-set-up, avoids head rigid-fixation and bulky optical-based attachments to the ventriculoscope, and allows continuous navigation of both parts of the surgery. Since we have implemented this protocol, we have noticed a significant enhancement in both simple and complex ventriculoscopic procedures because the surgery is dramatically simplified.

Coste y ahorro potencial generado por una web de eSalud de pediatría para padres / Cost and potential savings generated by a paediatrics e-Health web site for parents

INTRODUCCIÓN: Son pocas las intervenciones de eSalud dirigidas a padres que analizan sus costes y el ahorro potencial que pueden generar. Los objetivos de este trabajo consistieron en calcular los costes de desarrollo y mantenimiento de una web de pediatría para padres, el coste por visita y por visitante, y el ahorro potencial generado en función de las visitas médicas evitadas como consecuencia de su uso. MÉTODOS: Para los costes de la web se consideraron los costes tecnológicos y del trabajo de los profesionales. El cálculo del coste de los profesionales y de ahorro potencial se basó en los honorarios oficiales y en los precios públicos del Sistema Sanitario Público de Andalucía. RESULTADOS: Durante los 5 años y 6 meses del estudio el coste total de la web fue de 45.201,56 (Euro). El coste por visita recibida fue de 0,0155 (Euro), y por cada visitante único, de 0,0186 (Euro). Entre los 516 usuarios que participaron en el estudio se evitaron visitas presenciales a las consultas de pediatría de atención primaria y a los servicios de urgencias de pediatría por un valor de 22.263,89 (Euro). CONCLUSIONES: Los costes de desarrollo de una web de eSalud de pediatría para padres escrita en español, usando tecnología existente y gratuita, son bajos en comparación a otras formas de desarrollo de eSalud. Además, los costes son considerablemente bajos si se dividen entre el número de visitas totales o el número de visitantes. También existe un potencial considerable de ahorro económico al contribuir a evitar visitas presenciales

INTRODUCTION: There are few studies on e-Health interventions directed at parents that analyse their costs and any potential savings that may occur. The aims of this study consisted of calculating the costs of the development and maintenance of paediatric web site for parents, including the costs per visit and per visitor, and the potentially savings made as regards medical visits avoided as a result of its use. METHODS: The technology costs as well as the work of the professionals were considered as costs of the web site. The calculation of the cost of the professionals and the potential savings were based on the official fees and public prices of the Andalusian Public Health Service. RESULTS: During 5 years and 6 months of the study, the total cost of the web site was (Euro)45,201.56. The cost per visit received was (Euro) 0.0155(Euro), and (Euro) 0.0186 for each single visitor. Among the 516 users that took part in the study, face-to-face visits to Primary Care paediatric clinics were avoided, as well as those to Paediatric Emergency Department, at a savings of (Euro) 22,263.89. CONCLUSIONS: The costs of developing a paediatric e-Health website for parents written in Spanish, using existing and free technologies, are low compared to other forms of e-Health development. Furthermore, the costs are considerably low if they are divided by the total number of visits or the number of visitors. There is also a considerable potential financial saving on contributing to avoid face-to-face visits

Validation of the Interpersonal Exchange Model of Sexual Satisfaction Questionnaire in adults with a same-sex partner / Validación del Interpersonal Exchange Model of Sexual Satisfaction Questionnaire en adultos con pareja del mismo sexo

BACKGROUND/OBJECTIVE: The Interpersonal Exchange Model of Sexual Satisfaction Questionnaire (IEMSSQ) is one of the few instruments that has been developed from a theoretical model and assess sexual satisfaction. In addition, it has been successfully validated in Spanish heterosexual population. The objective of this study is to adapt and examine its psychometric properties (reliability, evidence of validity, and measurement invariance across sexual orientation and sex) in gay people in a relationship. METHOD: A sample of 1,820 adults, of whom 50% are gay people and 55% men, answered the Spanish version of the IEMSSQ. In addition, subjects with gay orientation answered the Massachusetts General Hospital-Sexual Functioning Questionnaire and the Dyadic Adjustment Scale. RESULTS: When comparing by sex and sexual orientation, the IEMSSQ has a strict invariant structure. Its reliability is good, and the evidence of construct and concurrent validity is adequate. However, the components of equality are moderate. CONCLUSIONS: The IEMSSQ makes it possible to compare the sexual satisfaction between gay/heterosexual men and women, presenting good psychometric properties in gay people, constituting an useful instrument in the clinical and research field

ANTECEDENTES/OBJETIVO: El Interpersonal Exchange Model of Sexual Satisfaction Questionnaire (IEMSSQ) es uno de los escasos instrumentos que evalúan la satisfacción sexual desde un modelo teórico y ha sido validado con éxito en población española heterosexual. El objetivo de este estudio es adaptar y examinar sus propiedades psicométricas (fiabilidad, evidencias de validez e invarianza según orientación sexual y sexo) en adultos gais con una relación de pareja. MÉTODO: Una muestra de 1.820 adultos, de los cuales el 50% son gais/lesbianas y el 55% hombres, contestó a la versión española del IEMSSQ. Además, los sujetos con orientación gay contestaron el Massachusetts General Hospital-Sexual Functioning Questionnaire y la Escala de Ajuste Diádico. RESULTADOS: El IEMSSQ posee una estructura invariante estricta, por sexo y orientación sexual. Su fiabilidad es buena, y las evidencias de validez de constructo y concurrente adecuadas, aunque moderadas en los componentes de igualdad. CONCLUSIONES: El IEMSSQ permite comparar la satisfacción sexual entre hombres gais y mujeres lesbianas y heterosexuales, presentando buenas propiedades psicométricas en adultos gais, constituyendo un instrumento útil en el ámbito clínico y en el de la investigación

Infección por coronavirus Covid-19 y lactancia materna: una revisión exploratoria / Coronavirus Covid-19 infection and breastfeeding: an exploratory review

OBJETIVO: El nuevo coronavirus es una enfermedad infecciosa causada por el virus SARS-Cov-2, considerada por la Organización Mundial de la Salud (OMS) una emergencia de salud pública de interés internacional (ESPII), la cual podría tener consecuencias negativas durante la lactancia materna. El objetivo de este trabajo fue conocer el plan de actuación sobre la lactancia materna ante una mujer recién parida enferma de SARS-CoV-2 y su recién nacido. MÉTODOS: Se realizó una búsqueda de la literatura a través de las bases de datos Medline, Web of Science, Scopus, BVS y Cuiden. Se evaluó la calidad metodológica de los artículos mediante la herramienta "Grading of Recommendations Assessment, Development and Evaluation" (GRADE). No se registró en PROSPERO. RESULTADOS: En total se encontraron 14 documentos, de los cuales 9 estudios empíricos estaban realizados mayormente en China, Italia, EEUU y Australia, estando basados en 114 madres infectadas de coronavirus SARS-CoV-2 y sus respectivos recién nacidos. Los estudios analizados afirmaron que lo mejor para el recién nacido es ser alimentado con la leche materna, ya que se analizaron muestras de leche de madres infectadas por coronavirus detectándose la presencia de anticuerpos del virus en las mismas, siendo un factor protector contra la infección del virus. CONCLUSIONES: La lactancia materna en recién paridas con SARS-CoV-2 es muy recomendable para el recién nacido, si el estado de salud de la madre y del neonato lo permiten, favoreciéndose el amamantamiento de forma directa y teniendo siempre las medidas adecuadas de higiene respiratoria. En el caso de que el estado de salud de la madre no permita el amamantamiento directo se debería alimentar con leche materna extraída previamente de su madre y sin pasteurizar, o procedente de un banco de leche

BACKGROUND: The new coronavirus disease is an infectious disease caused by the SARS-Cov-2 virus, considered by the World Health Organization (WHO) an international public health emergency that may have negative consequences during breastfeeding. The objective of this work is to investigate the action plan on breastfeeding in postpartum women with SARS-CoV-2 and her newborn. METHODS: A literature search has been conducted through the Medline, Web of Science, Scopus, BVS, and Cuiden databases. The methodological quality of the articles has been assessed using the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE). This study has not been registered in PROSPERO. RESULTS: A total of 14 documents have been found, of which 9 are observational empirical studies. Most of the studies were conducted in China, Italy, the USA, and Australia. A total of 114 mothers infected with coronavirus with their respective newborns have been assessed. The analyzed investigations state that it is best for the newborn to be breastfed; given that mother's milk samples were analyzed, detecting the presence of antibodies of the coronavirus in them, being a protective factor against infection. CONCLUSIONS: Breastfeeding in postpartum women with SARS-CoV-2 is highly recommended for the newborn, if the health of the mother and newborn allow it. When direct breastfeeding is favoured, the appropriate respiratory hygiene measures always have to be considered. Whether the mother's health does not permit direct breastfeeding, her breast milk should be previously extracted and kept unpasteurized. To secure the newborn feeding, milk banks are also an appropriate option

Factores de riesgo asociados con embarazos no deseados en mujeres estudiantes de medicina / Risk factors associated with unwanted pregnancies in female medical students

Resumen Introducción: La mayoría de los embarazos en adolescentes y adultos jóvenes son involuntarios y muchos son consecuencia del uso inconsistente de los métodos anticonceptivos. Objetivo: Analizar los factores de riesgo que pueden influir en las adolescentes que presentan embarazos no deseados. Método: Estudio descriptivo transversal en estudiantes de medicina de Ecuador, para el cual se utilizó la Encuesta Nacional de Salud Sexual y Reproductiva 2013, escala APGAR familia y escala socioeconómica de Graffar-Méndez Castellanos. Resultados: Existió diferencia estadísticamente significativa en la edad de inicio de la vida sexual activa (18.11 ± 1.45) de las estudiantes que se embarazaron en comparación con las que no se embarazaron (19.22 ± 2.28). La edad promedio al embarazo fue de 20.41 ± 2.18); no usaron protección en su primera relación sexual, 59.3 % de las que tuvieron embarazo y 32 % de las que no lo tuvieron. El embarazo fue más frecuente en las residentes de ciudades (100 %), católicas (85.2 %), pertenecientes a estrato socioeconómico medio alto (55.6 %) y a familias con disfunción moderada (40.7 %). Conclusiones: Un porcentaje importante de estudiantes de medicina tuvo algún embarazo no deseado a temprana edad; la mayoría procedía de familias con disfunción moderada y de un nivel socioeconómico medio alto.

Abstract Introduction: Most pregnancies in adolescents and young adults are unwanted and many are the consequence of inconsistent contraception use. Objective: To analyze the risk factors that may influence on female adolescents with unwanted pregnancies. Method: Cross-sectional, descriptive study in Ecuadorian female medical students, where the 2013 National Sexual and Reproductive Health Survey, the family APGAR scale, and the Graffar-Méndez Castellanos socio-economic scale were used. Results: There was statistically significant difference in the age of active sexual life initiation between those who became pregnant (18.11 ± 1.45) and those who did not (19.22 ± 2.28). Average age at pregnancy was 20.41 ± 2.18; 59.3 % of those who had a pregnancy and 32% of those without pregnancy did not use protection in their first intercourse. Pregnancy was more common in city residents (100%), Catholic females (85.2%), who belonged to middle-high (55.6%) and middle-high socioeconomic strata (29.6%) and to families with moderate dysfunction (40.7%). Conclusions: A significant percentage of adolescents in our study had an unwanted pregnancy at an early age despite being young undergraduate medical students, coming from moderately dysfunctional families and belonging to a middle-high socioeconomic status.

Characterization and evaluation of liver fibrosis grade in patients with chronic hepatitis B virus infection and normal transaminases

BACKGROUND/AIMS: The objective of our study was to determine the epidemiological, laboratory, and serological characteristics of patients with chronic hepatitis B virus (HBV) infection and normal transaminases. The study also aimed to evaluate liver damage by measuring the liver fibrosis (LF) grade and to identify possible factors associated with the presence of fibrosis. METHODS: A retrospective observational study was conducted in patients with chronic HBV infection and classified as inactive carriers or immune-tolerant. Epidemiological variables of age, sex, immigrant, alcohol consumption, and body mass index (BMI), as well as virological variables (HBV DNA) and transaminase level were collected throughout the follow-up. The LF grade was evaluated by transient elastography. The cutoff value for significant fibrosis (SF) was liver stiffness ≥7.9 kPa. RESULTS: A total of 214 patients were included in the analysis, and 62% of them had a BMI ≥25 kg/m². During follow-up, 4% of patients showed transaminase elevation ( < 1.5 times normal). Most patients had a viral DNA level < 2,000 IU/mL (83%). Data on LF were available in 160 patients; of these, 14% had SF, 9% F3, and 6% F4. The variables associated with the presence of SF were transaminase alteration during follow-up, as 23% of patients with SF had elevated transaminases versus 3% of patients without SF (P < 0.005), and BMI, as the vast majority of patients with SF (88%) had a BMI ≥25 kg/m² versus 56% of patients without SF (P < 0.05). CONCLUSIONS: In patients with chronic HBV infection and normal transaminases, liver damage does not seem to be related to DNA levels, alcohol consumption, or immigrant status. SF seems to be associated with transaminase alteration during follow-up and elevated BMI. It is therefore recommended to measure LF grade with validated non-invasive methods in such patients.

Calidad de vida en los pacientes obesos y su cambio tras cirugía bariátrica a medio y largo plazo / Quality of life in obese patients and change after bariatric surgery medium and long term

Introducción: La obesidad mórbida ha crecido enormemente en las últimas décadas, representando un grave problema de Salud Pública. Se caracteriza por el acúmulo de grasa corporal y la presencia de enfermedades asociadas a ella, que repercute en el plano físico, psíquico y social. Se ha considerado a la ciguría bariátrica como el tratamiento más eficaz para la pérdida de peso, consiguiendo el bienestar de la persona obesa en los planos anteriormente descritos. Objetivo: Evaluar el impacto en la calidad de vida de las personas obesas antes y después de ser intervenidas de cirugía bariátrica, mediante la técnica de gastrectomía vertical laparoscópica (GVL) en un seguimiento a corto, medio y largo plazo. Metodo: La población de estudio son todas las personas con obesidad mórbida y son candidatos a cirugía, que acuden al Servicio de Cirugía Bariátrica del Hospital Torrecárdenas (Almería). El diseño es un estudio descriptivo, longitudinal, prospectivo. Resultados: Tras la evaluación del pacientes obeso al año, a los dos años y a los cinco años de la cirugía, se ha observado disminución del peso, por tanto, descenso en el IMC y en el grado de obesidad, la mejoría o desaparición de las comorbilidades y un aumento en las variables de CV. Discusión: La GVL consigue disminuir el exceso de peso y por tanto el IMC y el grado de obesidad, al igual que el número de enfermedades asociadas a la obesidad, aumentando asi la CV (AU)

Introduction: Morbid obesity has grown enormously in recent decades, representing a serious public health problem. It is characterized by the accumulation of body fat and the presence of diseases associated with it, which affects the physical, psychological and social level. It has been considered bariatric ciguría as the most effective treatment for weight loss, getting the welfare of the obese person in the above-described drawings. Objective: To evaluate the impact on the quality of life of obese people before and after bariatric surgery be tapped using the technique of laparoscopic gastrectomy (GVL) in a follow short, medium and long term. Method: The study population are all people with morbid obesity and are candidates for surgery, presenting at Torrecárdenas Bariatric Surgery Hospital (Almería). The design is a descriptive, longitudinal study, prospective. Results: After evaluation of the obese patients a year, two years and five years after surgery, there has been decrease in weight, therefore decrease in BMI and the degree of obesity, improvement or disappearance of comorbidities and increased CV variables. Discussion: The GVL gets reduce excess weight and therefore BMI and the degree of obesity, as well as the number of obesity-associated diseases, thus increasing the CV (AU)

El valor de la MAPA y de los parámetros de lesión subclínica de órgano diana en el diagnóstico de hipertensión refractaria / The value of ABPM and subclinical target organ damage parameters in diagnosis of resistant hypertension

Introducción: El presente estudio tiene como objetivo destacar la importancia de la monitorización ambulatoria de la presión arterial (MAPA) y de los parámetros de lesión subclínica de órgano diana en el diagnóstico de hipertensión refractaria (HR). Métodos: Se estudiaron pacientes con diagnóstico de HR (n = 112). Se analizaron variables demográficas, antropométricas, riesgo cardiovascular y lesión subclínica de órgano diana y se relacionaron con la confirmación de HR a través de la MAPA. Resultados: Del total de 112 pacientes con el diagnóstico de HR derivados desde atención primaria se confirmaron mediante MAPA el 61,6% de los casos (n = 69). Se observaron diferencias estadísticamente significativas (p < 0,001) en la aparición de lesión subclínica de órgano diana en los hipertensos refractarios respecto a los pseudorrefractarios. Un 84% de los pacientes con HR presentaban microalbuminuria: 66,25 ± 30,7 mg/dl). El 44,9% tienen una enfermedad renal crónica estadio 3 con filtrado glomerular medio de 59 ml/min/1,73 m2. El 56,5% presentaba hallazgos ecocardiográficos de hipertrofia de ventrículo izquierdo. El examen de fondo de ojo reveló que un 64% de los pacientes presentaban retinopatía hipertensiva. Las 3 variables que se asociaron a mayor riesgo de HR fueron la presencia de microalbuminuria, retinopatía hipertensiva e hipertrofia de ventrículo izquierdo por ecocardiograma (OR 5,7, 6,2 y 11,2, respectivamente). Conclusiones: Nuestro estudio demuestra que la búsqueda sistemática de daño de órgano diana, especialmente en lo referente a albuminuria, es una herramienta sencilla y barata, con un valor predictivo de HR alto (85%). Podría ser de utilidad en circunstancias en las que es necesario priorizar la realización de MAPA

Introduction: We aimed to assess the effectiveness of ambulatory blood pressure monitoring (ABPM) and subclinical target organ damage parameters for diagnosis of resistant hypertension (RH). Methods: We assessed demographic and anthropometric variables, the incidence of cardiovascular events and subclinical target organ damage (n = 112). We also studied the relationship between these variables and the ABPM results. Results: Of the 112 patients referred from primary care with a diagnosis of RH, 69 (61.6%) were confirmed by ABPM. We found statistically significant differences (P < .001) between patients with RH and pseudo-resistant hypertension in the appearance of subclinical target organ damage. A percentage of 84 of the patients had microalbuminuria: 66.25 ± 30.7 mg/dl); 44.9% had stage 3 chronic kidney disease: the average glomerular filtration was 59 ml/min/1.73m2; and 56.5% had left ventricular hypertrophy on echocardiography. Fundoscopy revealed that 64% of the patients had hypertensive retinopathy. Three variables were associated with an increased HR risk: microalbuminuria, hypertensive retinopathy and left ventricular hypertrophy (OR 5.7, 6.2 and 11.2, respectively). Conclusions: This study shows that the systematic testing for target organ damage, particularly in terms of albuminuria, is a simple and inexpensive tool, with a high predictive value for RH (85%), which could be useful for prioritising patients who need ABPM

Quality of life in perimenopausal women working in the health and educational system / Qualidade de vida em mulheres climatéricas que trabalham no sistema sanitário e educativo / Calidad de vida en mujeres climatéricas que trabajan en el sistema sanitario y educativo

The objective of this study was to determine the association between the professional activity and the perceived quality of life in climacteric women who work in Health and Education. A descriptive and cross-sectional study was developed in a sample of 203 climacteric women, together with a correlation analysis of labor factors’ influence on health-related quality of life. Significant differences were found between working women’s quality of life and some labor conditions. The perceived quality of life in perimenopausal women who work in Education is higher than that of those working in Health (p=0.004). Nursing professionals can develop health programs that deal with the work conditions that negatively influence the perceived quality of life in climacteric women.

O objetivo deste estudo foi determinar a associação entre a atividade profissional e a qualidade de vida percebida em mulheres climatéricas que trabalham nas áreas da saúde e educação. Realizou-se estudo descritivo e transversal, numa amostra de 203 mulheres climatéricas, juntamente com análise correlacional da influência dos fatores de trabalho na qualidade de vida, relacionada à saúde. Encontraram-se diferenças significativas entre a qualidade de vida das trabalhadoras e algumas variáveis laborais. A qualidade de vida percebida pelas mulheres perimenopáusicas que trabalham na área da educação é superior à daquelas que trabalham na área da saúde (p=0,004). Os profissionais de enfermagem podem elaborar programas de saúde que abordem as condições de trabalho que influenciam negativamente a qualidade de vida percebida pelas mulheres climatéricas.

El objetivo de este estudio fue determinar la asociación entre la actividad profesional y la calidad de vida percibida en mujeres climatéricas que trabajan en las áreas sanitaria y educativa. Se realizó un estudio descriptivo y transversal, en una muestra de 203 mujeres climatéricas, junto al análisis correlacional de la influencia de los factores laborales en la calidad de vida relacionada con la salud. Se encontraron diferencias significativas entre la calidad de vida de las trabajadoras y algunas condiciones laborales. La calidad de vida percibida por las mujeres perimenopáusicas que trabajan en educación es superior a la de las que trabajan en salud (p=0,004). Los profesionales de Enfermería pueden elaborar programas de salud, que aborden las condiciones de trabajo que influyen negativamente en la calidad de vida percibida por las mujeres climatéricas.

Factores relacionados con la no participación en el programa de detección precoz de cáncer de mama / Factors related to non-participation in a breast cancer early detection program

Objetivo: Conocer las causas de no participación en el Programa de Detección Precoz de Cáncer de Mama (PDPCM) en mujeres del Área de Gestión Sanitaria Norte de Almería. Métodos: Estudio de casos y controles. Se eligió una muestra de mujeres invitadas a participar en el PDPCM, entre octubre de 2002 y febrero de 2004. Se recogieron las variables sociodemográficas y las cargas familiares, las variables relacionadas con el programa (conocimiento, accesibilidad, actitudes), los antecedentes familiares y personales, y el estado de salud. Se analizó si había diferencias entre las mujeres que acudieron al programa y las que no, mediante análisis bivariado, y multivariado mediante regresión logística. Se calculó la odds ratio (OR) y su intervalo de confianza del 95% (IC95%). Resultados: Se realizaron 720 encuestas 350 casos y 370 controles. Se sustituyó a 291 mujeres (un 40,4% de la muestra). Las variables que de forma independiente se encontraron asociadas a no acudir al programa fueron no recibir carta (OR=11,2; IC95%: 4,6¿26,9), haberse realizado mamografía fuera del programa (OR=4,4; IC95%: 2,8¿6,9), no tener enfermedades que requieren revisiones médicas (OR=2; IC95%: 1,3¿3) y manifestar miedo al resultado de la mamografía (OR=1,8; IC95%: 1,2¿2,6). Conclusiones: Se ha encontrado un mayor riesgo de no acudir al programa en las mujeres que no han recibido carta o que tienen una mamografía realizada fuera del programa, y de ahí la necesidad de mejorar la depuración de la base de datos. Hay que seguir divulgando el programa y realizando educación sanitaria en las mujeres con miedo al resultado(AU)

Objective: To determine the causes of non-participation in a breast cancer early detection program for women in the northern area of Almería (Spain). Methods: We performed a case-control study. A sample of women included in a breast cancer early detection program between October 2002 and February 2004 was chosen. Participants were interviewed about family, sociodemographic and program-related variables (knowledge, accessibility, attitudes), family and personal history, and health status. Possible differences among women who attended the program and those who did not were analyzed through bivariate analysis and multivariate logistic regression. Odds ratio (OR) and 95% confidence interval (95%CI) were calculated. Results: A total of 720 questionnaires were completed (350 cases and 370 controls) and 291 women (40.4% of the sample) were replaced. The variables found to be independently associated with non-participation in the program were as follows: not receiving a letter (OR=11.2; 95%CI: 4.6¿26.9), undergoing mammography outside the program (OR=4.4; 95%CI: 2.8¿6.9), not having illnesses requiring medical examinations (OR=2; 95%CI: 1.3¿3), and expressing fear of the result of mammography (OR=1.8; 95%CI: 1.2¿2.6). Conclusions: Women who did not receive a letter or who underwent mammography outside the program had a greater risk of not attending the program, hence the need to improve the quality of the database. Awareness of the program should be increased among women and health education should be provided to women fearing the outcome(AU)

Brote con síntomas respiratorios en la provincia de Almería por una posible exposición a microalgas tóxicas / An epidemic outbreak with respiratory symptoms in the province of Almeria [Spain] due to toxic microalgae exposure

Objetivos: Describir un brote con clínica de irritación de lasvías respiratorias, notificado en una localidad de la costa almerienseen agosto de 2006, así como la investigación etiológicarealizada.Métodos: Estudio descriptivo y de casos y controles. Se dividióla localidad en 3 zonas según su mayor o menor cercaníaal mar (de 1 a 3). La sintomatología fue valorada subjetivamentede menor a mayor gravedad (1 a 3). Se estimaronlas tasas de ataque (TA). Para relacionar la gravedad de lossíntomas por zonas y el tipo de exposición se calcularon lasodds ratio (OR) y sus intervalos de confianza del 95% (IC95%).También se utilizó la prueba de la 2 y el test exacto de Fisher.Se realizó una investigación ambiental.Resultados: Se encuestó a 57 casos y 26 controles. Se estimóuna TA del 69%. El síntoma más frecuente fue el estornudo(87,7%). Los individuos de la zona 1 presentaron mayorriesgo de padecer sintomatología de más gravedad que losde la zona 3 (OR = 46,7; IC95%: 4,7-2.067,4). Los que indicaronuna mayor permanencia fuera de la vivienda tuvieronmayor riesgo de enfermar (OR = 12,2; IC95%: 1,1-615,1). Enagua de mar se detectaron 1.200 células/l de dinoflageladosOstreopsis.Conclusiones: Se trata de un brote con sintomatología respiratoria,con distinto grado de afectación según la cercaníaal mar de la vivienda. Según la investigación epidemiológicay ambiental, lo más probable es que se haya debido a la presenciade microalgas tóxicas Ostreopsis(AU)

Aim: To describe an outbreak with symptoms of respiratorytract irritation reported in a village located on the Almerian coastin August 2006, as well as the etiological research performed.Methods: We performed a descriptive case-control study. Thevillage was divided into three areas (from 1 to 3) accordingto the distance from the sea. Symptomatology was subjectivelyassessed on an ascending severity scale (from 1 to 3).Attack rates (AR) were estimated. To correlate symptom severityby areas and type of exposure, odds ratios (OR) with95% confidence intervals were estimated. The chi-square testand Fisher’s exact test were used. Environmental research wasperformed.Results: Fifty-seven cases and 26 controls were surveyed.An AR of 69% was estimated. The most frequent symptomwas sneezing (87.7%). Residents in area 1 had a higher riskof more severe symptoms than those in area 3 (OR = 46.7;95%CI: 4.7-2,067.4). Residents who reported having spentmore time outside had a higher risk of more severe symptoms(OR = 12.2; 95%CI: 1.1-615.1). A concentration of dinoflagellatesOstreopsis of 1200 cells/l was determined in sea water.Conclusions: An outbreak with respiratory symptoms and withdiffering severity depending on the distance of housing fromthe sea occurred. According to the environmental and epidemiologicalresearch, the symptoms were probably related tothe presence of Ostreopsis toxic microalgae(AU)

Ingesta nutricional de migrados marroquíes en Almería: estudio comparativo en el lugar de origen y con la población española / Nutritional intake of north african migrants in Almeria: comparative study in the native place and with the spanish population

Objetivo: Analizar la ingesta de energía y nutrientes de los inmigrantes marroquíes en Almería con respecto al país de origen, Marruecos, comparando su adecuación a las ingestas dietéticas recomendadas (IDRS) y al consumo nutricional de los españoles. Metodología: Estudio epidemiológico transversal en 95 marroquíes en Almería (MA) y 30 en Marruecos (MM). Para determinar la ingesta alimentaria se ha utilizado un cuestionario de frecuencia de consumo de alimentos semanal y un recuerdo de consumo de 24 horas, con valoración de la ingesta de calorías y nutrientes mediante programa informatizado. Resultados: Los inmigrantes residentes en Almería tienen una ingesta calórica y de grasas significativamente mayor que en Marruecos (p<0.01). Presentan déficit de micronutrientes y vitamina D respecto a la IDR y al consumo de los españoles. Conclusiones: Los inmigrados marroquíes, cuando se trasladan a Almería, realizan una “dieta de transición” que se adapta mejor a las ingestas recomendadas internacionalmente y al patrón alimentario de la dieta mediterránea, con aumento del consumo de hidratos de carbono y menos grasas saturadas y proteínas de origen animal que la dieta occidental (AU)

Objectives: To compare calorie, macronutrient and micronutrient intake among Moroccan immigrants in Almeria, Spain to the intake in their country of origin (Morocco), international recommendations and intake among the host population. Methods: Cross-sectional study including 95 Moroccan in Almeria (MA) and 30 in Morocco (MM). Dietary intake was recorded by using a weekly food frequency questionnaire and a 24-recall questionnaire; intake of calories and nutrients was calculated using computer software. Results: Fat and calorie intake among immigrants residing in Almeria is significantly higher than that in Morocco (p <0.01); protein intake was the same, whereas carbohydrate intake was less (p <0.01). They present micronutrient and vitamin D deficiencies according to the RDI and to Spanish consumption patterns (p <0.01). Conclusions: When Moroccan immigrants move to Almeria, they follow a “transitional diet” which is closer to the internationally recommended intake and to the patterns of the Mediterranean diet, which has increased carbohydrates consumption and less saturated fat and animal protein consumption than that found in the Western diet (AU)

Interrupción voluntaria del embarazo en mujeres de un distrito sanitario de Almería durante el período 1998-2002 / Voluntary Interruption of Pregnancy among Women in an Health District within the 1998-2002 Period. Almeria, Spain

Fundamento: En Andalucía y concretamente en Almería, haaumentado la población inmigrante. Los distritos sanitarios de atenciónprimaria gestionan las solicitudes de interrupción voluntaria deembarazo. El objetivo de este trabajo es describir la evolución de lassolicitudes de interrupción voluntaria de embarazo en mujeres inmigrantesy no inmigrantes en el Distrito Sanitario Levante-AltoAlmanzora de Almería.Métodos: Estudio descriptivo realizado para el período 1998-2002. Material de estudio: solicitudes de interrupción voluntaria deembarazo, datos demográficos del IEA, tarjetas de reconocimientotemporal. Variables estudiadas: Edad, fecha de solicitud, gestación ³o < a 12 semanas, tipo de población según fuera inmigrante o no. Secalcularon tasas de interrupción voluntaria de embarazo por 1.000mujeres de 15 a 49 años y el riesgo relativo con intervalos de confianzay significación estadística para estudiar relación entre númerode interrupciones y tipo de población.Resultados: Se estudiaron 224 solicitudes. El mayor número seprodujo en el año 2002, tasa de 3,1. El grupo de edad con más solicitudesfue el de 20-24 años (29,5%). El 95% de las mujeres presentabagestación inferior a 12 semanas. El 52,7% eran mujeres inmigrantes.Con mayor riesgo de solicitar interrupción voluntaria de embarazoen inmigrantes respecto a autóctonas, RR de 66,45 (IC 95%:36,11-122,28) en 2001; 292,8 (IC 95%: 91,12-940,9) en 1999.Conclusiones: En el período estudiado se observa un aumentode la interrupción voluntaria de embarazo en los servicios públicos,sobre todo en mujeres inmigrantes

Background: The immigrant population has undergone anincrease in Andalusia as a whole and in Almeria in particular. Theprimary healthcare districts manage the requests for voluntary interruptionof pregnancy. This study is aimed as describing the trend inrequests for voluntary interruption of pregnancy among immigrantand non-immigrant women in the "Levante-Alto Almanzora"Health District of Almeria.Methods: Descriptive study conducts during the 1998-2002period. Study material: requests for voluntary interruption of pregnancy,Andalusian Institute of Statistics demographic data, temporarymedical care cards. Variables studied: Age, date of request, pregnancy³, or < 12 weeks, type of population (immigrant or non-immigrant).Voluntary interruption of pregnancy rates were calculated per 1000women within the 15-49 age range and the relative risk with confidenceintervals and statistical significance for studying the relationshipbetween the number of interruptions and populations type.Results: A total of 224 requests were studied. The largest numberwere made in 2002, for a 3.1 rate. The age group making the largestnumber of requests was the 20-24 age range (29.5%). Ninetyfivepercent (95%) of the women were less than 12-weeks pregnant.A total of 52.7% were immigrant women, a greater risk of requestingvoluntary interruption of pregnancy having been found amongimmigrants as compared to native Spanish women, RR of 66.45 (CI95%: 36.11-122.28) in 2001; 292.8 (CI 95%: 91.12-940.9) in 1999.Conclusions: Voluntary interruption of pregnancy was found tohave increased in the public services, particularly among immigrantwomen, within the period studied

Estudio serológico de agrupación de casos de hepatitis b en seis familias de raza china en Almería / Hepatitis B case grouping serological study among six Chinese families in Almería, Spain

Fundamento: Tras la detección de dos casos de serología positiva para el virus de la hepatitis B en miembros de 6 familias chinas se inició un estudio de convivientes. El objetivo fue conocer la amplitud de la infección en el entorno familiar de los casos detectados. Métodos: Estudio descriptivo. Población de estudio: 24 miembros de 6 familias de raza china. Variables: Edad, sexo, diagnóstico serológico, factores de riesgo, actitud sanitaria. Fuentes de información: Historias clínicas, datos serológicos, encuesta epidemiológica y cartillas de vacunación. Se realizó un enfoque familiar y se utilizó el genograma. Análisis de datos: Distribución binomial para cálculo de probabilidad de ocurrencia del proceso a estudiar. Resultados: Se estudió a 14 hombres (58,3%) y 10 mujeres (41,7%) con edades comprendidas entre 1 y 54 años. El grupo de edad con más sujetos estudiados fue el de 21-30 años (37,5%). Se registraron 12 infecciones crónicas de hepatitis B (50%). No se encontró relación con los factores de riesgo estudiados en la encuesta epidemiológica realizada. La probabilidad de ocurrencia de este número de hepatitis crónica fue de 0,066 x 10. Conclusiones: Se concluye que probablemente la prevalencia de infección encontrada se debiera a transmisión intrafamiliar. Dada la baja probabilidad de ocurrencia de un proceso de estas características, se considera que la agrupación de casos encontrada es elevada (AU)

Background: Following the detection of two cases of members of 6 Chinese families having tested positive for the hepatitis B virus, a study of those living in these families was begun for the purpose of knowing the spread of the infection within the family environment of the cases detected. Methods: Descriptive study. Population under study: 24 members of six Chinese families. Variables: Age, sex, serological diagnosis, risk factors, healthcare-related attitude. Information sources: Clinical records, serological data, epidemiological survey and immunization cards. A family focus was employed and the genogram used. Data Analysis: Distribution Binomial spread for calculating probability of occurrence of the process to be studied. Results: A total of 14 males (58.3%) and 10 females (41.7%) ranking from 1 to 54 years of age were studied. The age group having the largest number of subjects studied was the age 21-30 group (37.5%). Twelve chronic hepatitis B infections were recorded (50%). No relationship was found to exist with the risk factors studied in the epidemiological survey conducted. The probability of this number of chronic hepatitis cases occurring was 0.066 x 10. Conclusions: It was concluded that the prevalence of infection found was probable due to intra-family transmission. Given the low probability of occurrence of a process of this type, the case grouping found is considered to be high (AU)