A retrospective comparison of IgE-mediated cow's milk protein allergy management strategies in pediatric cohorts.

BACKGROUND: Complete avoidance of milk is the usual management for IgE-mediated cow's milk protein allergy (CMPA). A baked milk ladder is a method of dietary advancement therapy in IgE-mediated CMPA in Ireland, while in Spain, avoidance of milk awaiting natural tolerance acquisition through an oral food challenge (OFC) is employed. The aim of this study was to evaluate the use of dietary advancement therapy using a milk ladder compared with complete avoidance of milk for managing IgE-mediated CMPA. METHODS: This is a retrospective chart review of 371 pediatric patients from the population who have been treated for IgE-mediated CMPA between 2011 and 2020, with the milk ladder (Ireland) or complete avoidance followed by an OFC (Spain). The main outcome was the introduction of cow's milk. RESULTS: Milk ladder patients were 3.67 times more likely to succeed in comparison with milk avoidance (p < .001). Anaphylaxis during the treatment period occurred in 34 patients in the milk avoidance groups, while three patients in the milk ladder group experienced anaphylaxis due to accidental exposure to milk (p < .001). Failure to complete treatment was associated with a higher skin prick test in the milk avoidance group and a raised specific IgE in the milk ladder group. CONCLUSION: This is the first study that compares outcomes of dietary advancement therapy to complete avoidance for CMPA management, demonstrating that cow's milk can be successfully and safely reintroduced using dietary advancement therapy using a milk ladder.

Association of body mass index with anal human papillomavirus infection and histologically confirmed high-grade squamous intraepithelial lesions in people who receive services at the Anal Neoplasia Clinic in Puerto Rico.

Objective: This study aimed to assess the association of body mass index (BMI) with anal high-risk human papillomavirus (HR-HPV) and biopsy-confirmed histologic anal high-grade squamous intraepithelial lesions (HSIL) among a clinic-based sample of Hispanics in Puerto Rico. Methods: This cross-sectional study evaluated medical records of adults who received services at the Anal Neoplasia Clinic of the University of Puerto Rico Comprehensive Cancer Center between October 2014 and December 2022. The study included 543 records with complete clinical information regarding anal HR-HPV and anal HSIL status. Chi-square and logistic regression analyses were performed. Results: Mean age of participants was 44.10 ± 13.24 years, 65.2% were men, 71.7% were HIV-infected, 74.4% had anal HR-HPV infection, and 37.9% had biopsy-confirmed HSIL. Regarding BMI, 2.4% were underweight, 31.9% normal weight, and 39.0 % overweight; while 17.3 % had class I, 5.2% class II, and 4.2% class III obesity. No significant association was observed between BMI and anal HR-HPV infection in adjusted analyses. Lower odds of anal HSIL were observed among overweight individuals (OR: 0.63, 95% CI: 0.41 - 0.99) and those with class II/III obesity (OR: 0.48, 95% CI: 0.22 - 1.01) compared to adults with underweight/normal BMI, after adjusting for potential confounders. No significant association was observed for class I obesity. Conclusion: BMI was not associated with anal HR-HPV infection. Overweight and obese individuals had lower odds of having anal HSIL than adults with underweight/normal BMI. This finding could suggest underdiagnosis of HSIL among overweight/obese individuals, or reduced risk in this group.

Exercise and mind-body exercise for feeding and eating disorders: a systematic review with meta-analysis and meta-regressions.

PURPOSE: To develop a systematic review with meta-analysis to summarize the effectiveness of exercise, regular physical activity, and mind-body exercise on harmful exercise habits, psychological factors, and quality of life in people clinically diagnosed with feeding and eating disorders. MATERIAL AND METHODS: Randomized clinical trials and pilot randomized clinical trials were considered. RESULTS: Twelve studies were included. No studies evaluated athletes. No studies examined regular physical activity as the targeted intervention. Quality of life could not be meta-analyzed. Overall, meta-analyses showed that exercise or mind-body exercise was not more effective than controls in reducing depression symptoms, harmful exercise habits, eating behaviors, or emotional regulation skills. However, important methodological and clinical issues were detected in the included studies. This affected the certainty of evidence of the meta-analyzed outcomes which ranged from low to very low. No studies reported in sufficient detail their interventions to be replicated. CONCLUSIONS: Overall, exercise and mind-body exercise may be ineffective in improving meta-analyzed outcomes. However, the certainty of evidence ranged from low to very low and the body of knowledge in this field needs to be increased to reach robust conclusions.

Exercise and mind-boy exercises were not more effective than controls for eating behaviors in eating disorders.Exercise and mind-boy exercises were not more effective than controls for depression symptoms in eating disorders.Clinicians should be aware no specific exercises can be recommended for treating psychological factors in eating disorders.

Psoriatic arthritis with psychological comorbidities: an overview of systematic reviews on incidence, prevalence, and geographic disparities.

Systematic reviews and meta-analysis evaluating the prevalence, incidence, and psychological comorbidities of psoriatic arthritis (PsA) are increasing, so it's time to perform an overview of systematic reviews. To summarize the pooled prevalence, incidence, and psychological comorbidities rates of PsA, and to explore possible continent disparities. In this overview of systematic reviews the CINAHL, EMBASE, PsycINFO, and PubMed were searched to October 25, 2023. This overview included systematic reviews with meta-analysis of people with PsA, providing the pooled prevalence or incidence rates of PsA in general, or clinical populations and/or psychological comorbidities. The Preferred Reporting Items for Overviews of Reviews (PRIOR) statement was followed. AMSTAR-2 assessed the quality of reviews. The degree of overlap was calculated using the corrected covered area (CCA). Maps were developed using the location of where primary studies were conducted using DataWrapper App. The protocol was prospectively registered with Open Science Framework registry. Pooled prevalence and incidence rates of PsA or its associated psychological comorbidities in general or specific populations. We also collected locations from the primary studies of the included meta-analyses. Only the assessment of prevalence rates of PsA in people with psoriasis showed slight overlap (CCA = 3.3%). Items 2, 3, 4, 7, 8, 10, 12, and 13 were poorly reported in AMSTAR-2. The pooled prevalence of PsA ranged from 0.13 to 0.15% in the general population, and 15.5% to 19.7% in people with psoriasis. The pooled incidence of PsA ranged from 8.26 to 9.27 cases per 100,000 inhabitants to 0.87 cases in individuals with hidradenitis suppurativa. The pooled prevalence of psychological comorbidities was 11.9-20% for depression, 19-33% anxiety, 38% alexithymia, and 72.9% in poor sleep quality. Only the pooled incidence of depression was assessed with 21.3 per 1000-person year. PsA seems to be prevalent and incident not only in people with psoriasis, but also in general population. Depression and anxiety symptoms may be present in some patients with PsA. Finally, continent disparities exist, and methodological and clinical issues were found, which could be helpful in the future agenda of the epidemiology of PsA.

Understanding the certainty of evidence from systematic reviews in rehabilitation science: what do clinicians need to know about GRADE?

PURPOSE: Systematic reviews of interventions are published each year evaluating rehabilitation approaches such as exercise, manual therapy, or electrotherapy. Currently, important methodological approaches are available to make systematic reviews more robust and transparent. One of these approaches is the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system. MATERIAL AND METHODS: A perspective for rehabilitation was conducted aiming to (1) shed light on the meaning and relevance of the GRADE system in systematic reviews with meta-analysis of rehabilitation science, and (2) propose suggestions for helping clinicians improve the interpretation of the GRADE findings. RESULTS: The meaning and relevance of GRADE in rehabilitation science was discussed. Suggestions were proposed to help clinicians in the interpretation of the GRADE findings. We discussed the use of meta-analyses, meta-regressions, subgroups meta-analyses, and sensitivity analyses to increase the objectivity of the domains of GRADE. Finally, a future agenda was provided. CONCLUSION: The use of GRADE is essential for improving the synthesis of evidence that clinicians may often use in rehabilitation practice. However, GRADE is only one hallmark when the findings of systematic reviews are interpreted. The issues of sample size, futile research, pre-registration, switching outcomes, or narrative bias should be also considered.

Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) is helpful in systematic reviews for understanding the certainty of evidence is analyzed.GRADE could detect limitation in the certainty of evidence helping clinicians to choose the best therapeutic option for their patients.Some domains of GRADE (indirectness and inconsistency) are particularly useful for clinicians who aim to translate the conclusions of a synthesis of evidence into clinical practice.

Spiritual well-being, faith, meaning in life, peace, and purpose in life for cancer-related fatigue: systematic review with meta-analysis and meta-regressions.

BACKGROUND: Cancer-related fatigue is associated with spiritual distress. Spiritual well-being, characterized by the presence of factors such as meaning in life or purpose in life, seems to play an important role in the management of symptoms of cancer. Currently, the number of studies evaluating the association between cancer-related fatigue and spiritual well-being is increasing and no systematic review has been conducted. AIM: To summarize the association between cancer-related fatigue and spiritual well-being, faith, meaning in life, peace, and purpose in life. DESIGN: A systematic review with meta-analysis. DATA SOURCES: The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to 9 October 2023. We considered studies evaluating the cross-sectional or longitudinal association between cancer-related fatigue and the spiritual factors above mentioned. The Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and the Quality in Prognosis Studies tool assessed the methodological quality of cross-sectional and longitudinal studies, respectively. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system rated the certainty of evidence. Meta-analyses, meta-regressions, subgroup meta-analyses, and sensitivity analyses were conducted. RESULTS: A total of 13 studies were included and no longitudinal findings were found. One meta-analysis showed that cancer-related fatigue may be negatively correlated with spiritual well-being (r = - 0.37 (95%CI - 0.44 to - 0.28) p < 0.01). In addition, another meta-analysis found the correlation between cancer-related fatigue and faith was not statistically significant (r = - 0.25 (95%CI - 0.66 to 0.28) p = 0.36). CONCLUSIONS: Cancer-related fatigue may be correlated with spiritual well-being. However, the certainty of evidence was very low across the meta-analyzed outcomes. IMPLICATIONS FOR CANCER SURVIVORS: A negative correlation was observed between spiritual well-being and cancer-related fatigue.

Online pain neuroscience education and graded exposure to movement in breast cancer survivors: protocol of a randomized controlled trial.

Introduction: Cancer-related chronic pain is an important sequelae that damages the quality of life of breast cancer survivors. Pain neuroscience education and graded exposure to movement are therapeutic tools that have been shown to be effective in the management of chronic pain in other populations. However, there are no previous studies that combine them after breast cancer. Objective: To evaluate the effectiveness of an online physiotherapy focused-person program which combines pain neuroscience education and graded exposure to movement for quality of life improvement in breast cancer survivors. Methodology: This protocol is a randomized controlled trial with a sample size of 40 breast cancer survivors with pain in the last 6 months. Participants will be allocated to the experimental or control group using a fixed size block randomization method. The evaluator and statistician will be blinded to participant allocation. Participants in the experimental group will receive a 12-week intervention based on pain neuroscience education and therapeutic yoga as a graded exposure to movement exercise; participants in the control group will continue with their usual cancer-related symptoms care. Both groups will receive an education booklet. The main outcome will be quality of life, measured by the Functional Assessment of Cancer Therapy - Breast (FACT-B+4); secondary, four outcomes related to pain experience (catastrophising, self-efficacy, kinesiophobia and fear-avoidance behaviors) will be also assessed. All variables will be assessed by two blinded evaluators at four timepoints. A mixed-model analyses of variance ANOVA (2 × 4) will be used to study the effects of the treatment on the dependent variables. All statistical tests will be performed considering a confidence interval of 95%. SPSS program will be used for the data analysis. Discussion: This research is expected to contribute to breast cancer rehabilitation field. The proposed intervention is also expected to improve self-care skills related to chronic pain and to empower women regarding the management of their symptoms and quality of life.Clinical trial registration: https://clinicaltrials.gov/, NCT04965909.

Exercise or mind-body exercises for psychiatry symptoms and quality of life in schizophrenia spectrum and other psychotic disorders: an overview of systematic reviews with meta-analysis.

PURPOSE: This overview of systematic reviews with meta-analysis aimed to summarize the effects of exercise, regular physical activity, and mind-body exercises on negative symptoms, depression symptoms, and quality of life in schizophrenia spectrum and other psychotic disorders. MATERIAL AND METHODS: The CINAHL, Embase, PubMed, SPORTDiscus, and the Cochrane Library databases were searched up to November 10, 2023. AMSTAR 2 was used and the overlap between reviews was calculated. RESULTS: Eighteen reviews were included. No reviews meta-analyzed regular physical activity. Aerobic exercise may be more effective than yoga, treatment-as-usual, or multiple controls for reducing negative symptoms. Tai chi may be more effective than multiple controls for decreasing negative symptoms. Aerobic exercise or multimodal exercise programs may be more effective than multiple controls for reducing depression symptoms. Yoga may be more effective than waitlist for decreasing depression symptoms. Aerobic exercise may be more effective than multiple controls for improving quality of life. Yoga may be more effective than treatment-as-usual for improving quality of life. The rest of the meta-analyses found no differences between groups or combined different types of interventions in their meta-analyses. CONCLUSIONS: Despite these results, important methodological concerns were detected that precluded us from making sound clinical recommendations. PROTOCOL REGISTRATION: https://doi.org/10.17605/OSF.IO/7V5QZ.

This overview of reviews evaluates exercise and mind-body exercise for schizophrenia and other psychotic disorders.Aerobic exercise or tai chi may reduce negative symptoms in these psychiatric disorders.Yoga may reduce depression symptoms and improve quality of life in these psychiatric disorders.

How can clinicians enhance self-efficacy beliefs in osteoarthritis? An overview of systematic reviews with meta-analysis.

This overview of reviews aimed to synthesize the effectiveness of non-pharmacological approaches to enhance self-efficacy in people with osteoarthritis. The CINAHL, Embase, PsycINFO, PubMed, SPORTDiscus, and the Cochrane Library databases were searched from inception to December 2023. We considered systematic reviews with meta-analysis of randomized clinical trials evaluating any non-pharmacological intervention. We used AMSTAR 2 to assess the methodological quality of reviews. The overlap between reviews was calculated. We included eight systematic reviews with meta-analysis evaluating 30 different clinical trials. Overall, mind-body exercises, psychological interventions, and self-management strategies may improve arthritis self-efficacy. Specifically, the meta-analyses showed tai chi exercises, coping skills training, and the arthritis self-management program are more effective than controls to enhance arthritis self-efficacy in people with hip and/or knee osteoarthritis. In addition, inconsistent results were detected across meta-analyses regarding the effectiveness of multidisciplinary interventions. Finally, the degree of overlap between all reviews was moderate (CCA = 6%) and many included reviews reported most of the items of AMSTAR 2. Tai chi exercises, coping skills training, and the arthritis self-management program may be beneficial for enhancing arthritis self-efficacy. Open Science Framework Registration: https://doi.org/10.17605/OSF.IO/VX2T6 .

The prevalence of anxiety and depression in cancer around the world: An overview of systematic reviews evaluating 128 meta-analyses.

BACKGROUND: This overview of systematic reviews with meta-analysis summarized the prevalence of anxiety and depression in different types of tumors around the world. METHODS: The quality of reviews was assessed. The degree of overlap between reviews was calculated. The regional prevalence of anxiety and depression was shown in the main text based on the World Health Organization regions. RESULTS: Twenty-five reviews including 128 meta-analyses of interest were selected. The pooled prevalence of anxiety in breast tumors was in Africa (19 %), the Americas (38 %), Eastern Mediterranean (56 %), Europe (38 %), South-East Asia (42 %), and Western Pacific (26 %). The pooled prevalence of depression in breast tumors was in Africa (40 %), the Americas (23-25 %), Eastern Mediterranean (49-51 %), Europe (27-29 %), South-East Asia (23-33 %), Western Pacific (29 %). The pooled prevalence of depression in digestive tumors was in the Americas (4-44 %), Eastern Mediterranean (42 %), Europe (20-27 %), South-East Asia (66 %), and Western Pacific (24-40 %). The pooled national prevalence of anxiety and depression was mainly evaluated in China and Iran. LIMITATIONS: Important methodological issues were identified. For example, no reviews judged the certainty of evidence. CONCLUSIONS: The Eastern Mediterranean region showed the highest prevalence of anxiety and depression for breast tumors. The South-East Asian region showed the highest prevalence of depression for digestive tumors. In these regions, many countries are considered low-income and middle-income countries. Further research funding would help increase the investigation on this topic, which may allow the development of preventive strategies that reduce the prevalence of anxiety and depression.

The prevalence of burnout in oncology professionals: an overview of systematic reviews with meta-analyses including more than 90 distinct studies.

PURPOSE: This overview of reviews aimed to summarize the prevalence of burnout and the dimensions of burnout (emotional exhaustion, depersonalization, and personal accomplishment) in oncology professionals around the world. METHODS: The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to September 13, 2023. AMSTAR 2 was used to assess the quality of reviews. The overlap between reviews was calculated. RESULTS: Twelve reviews were included. Overall, reviews showed that burnout was prevalent in oncologists and oncology nurses. On the other hand, no reviews meta-analyzed the prevalence of burnout in oncology radiation therapists. In addition, the dimensions of burnout, high emotional exhaustion, high depersonalization, and low personal accomplishment were highly prevalent across reviews in oncologists, oncology nurses, and oncology radiation therapists. In oncologists, the Americas (specifically Canada) showed the highest prevalence rates for high emotional exhaustion, whereas high depersonalization and low personal accomplishment were mainly prevalent in Europe and Asia, respectively. In oncology nurses, high emotional exhaustion and high depersonalization were mainly prevalent in Asia, whereas low personal accomplishment was more prevalent in the Americas (specifically Canada). The prevalence of overall levels of burnout was not meta-analyzed by continents. CONCLUSION: Some methodological improvements may help to make more robust the findings of this overview (e.g., specific subgroup meta-analyses by oncology specialties), which may help readers reach more precise, direct, and consistent findings. PROTOCOL REGISTRATION: https://doi.org/10.17605/OSF.IO/QPWG5 .

Multimodal exercise programs may improve posttraumatic stress disorders symptoms and quality of life in adults with PTSD: An overview of systematic reviews with meta-analysis.

OBJECTIVE: This overview of reviews aimed to summarize the effectiveness of exercise, regular physical activity or mind-body exercises on posttraumatic stress disorder (PTSD) symptoms and comorbidities associated with PTSD (e.g. depression symptoms) among individuals without age, gender, race, ethnicity or setting restrictions. DATA SOURCES: The CINAHL, Embase, PubMed and SPORTDiscus databases were searched from inception to November 16, 2023. REVIEW METHODS: Systematic reviews with meta-analysis of randomized clinical trials evaluating exercise, regular physical activity or mind-body exercises were considered. Control groups and outcome measures were not restricted. AMSTAR 2 assessed the methodological quality of reviews. The overlap between reviews was calculated. RESULTS: A total of 14 systematic reviews were included meta-analyzing 23 distinct randomized clinical trials. There was a very high overlap between reviews (corrected covered area = 16%). PTSD symptoms, depression symptoms, anxiety symptoms, sleep quality, substance abuse and quality of life were meta-analyzed. No reviews meta-analyzed the effects of regular physical activity. Overall, the meta-analyses found multicomponent exercise programs may have positive results in reducing PTSD symptoms and improving quality of life. In addition, the results of yoga were inconsistent across the meta-analyses for PTSD symptoms, and no differences between groups were found in favor of yoga for depression symptoms. Finally, no specific conclusions could be made about anxiety symptoms, sleep quality and substance abuse. CONCLUSION: A multicomponent exercise program may be effective in improving PTSD symptoms and quality of life, whereas yoga may be ineffective for depression symptoms in adults with PTSD.

Association of tobacco use and the presence of anal warts in people who attend the anal Neoplasia clinic in Puerto Rico.

Background: Limited research exists regarding the association between smoking and anal warts. In this study, we evaluated this association among a clinic-based Hispanic population in Puerto Rico. Methods: Cross-sectional study among eligible patients seen at the Anal Neoplasia Clinic of the University of Puerto Rico Comprehensive Cancer Center (2016-2023) (n = 920). Sociodemographic and clinical variables were collected from medical records. Patients underwent a high-resolution anoscopy (HRA) during the clinical visit; physicians assessed anal condylomas on HRA. Poisson regression models with robust standard errors were used to evaluate the association between smoking and anal warts. Demographic and clinical factors were also assessed. Results: The mean age of participants was 45.8 ± 13.1 years, 66.4 % were men, and 21.6 % were current smokers. While 10.8 % self-reported a history of anogenital condylomas, 18.9 % had anal condylomas on clinical evaluation. A higher prevalence of anal condylomas was observed among current smokers (PR = 1.28, 95 % CI: 0.94-1.75) in comparison to non-smokers in adjusted analysis, but this was not statistically significant. However, a higher prevalence of anal condylomas was observed among younger individuals (PR = 0.96, 95 % CI: 0.96-0.98) and individuals with anal high-grade squamous intraepithelial lesions (HSIL) as compared to those with benign histology (PR = 1.74. 95 % CI: 1.09-2.77). Conclusions: Although current smoking seemed to be positively associated with anal condylomas in this high-risk Hispanic population, this finding was not statistically significant as the power to detect an association was limited. However, younger age and HSIL diagnosis were associated with a higher prevalence of anal condylomas.

Accidental Poisoning with Nerium Oleander in Dairy Goat in the Santiago Metropolitan Region in Chile / Intoxicación accidental con Nerium oleander en lechería caprina en la Región Metropolitana de Santiago en Chile / Intoxicação acidental com oleandro de Nerium em laticínios de cabras na região metropolitana de Santiago, no ChileResumo

Abstract A small dairy goat farm in central Chile stocked their troughs with ornamental plants and grasses, which were obtained after pruning the gardens of neighboring sectors. Twelve hours after the goats ingested this food, the farm registered a death toll of eight goats, all of which were adult females in their productive stage, before entering the milking parlor. The mortality episode lasted 84 hours and produced mortality and morbidity values of 48 and 54 percent, respectively (n = 52). During a visit to the farm, clinic inspections, autopsies, and sample tissues were obtained for microscopic analysis (the tissues specimens were fixed in 10% buffered formaldehyde solution). The clinic inspection and microscopic analysis both confirmed that the animals had cardiovascular disease. The lesions were compatible with those produced by cardiac glycosides. During the site visit, Nerium oleander was found in the troughs, which suggested that the animals were poisoned by eating this plant. There was a high presence of this plant in the poisoned area, and it was not associated with the mortality episode before the on-site visit, which indicates that the authors should conduct training and inform producers about the handling and feeding of their animals.

Resumen En establecimiento de pequeño productor caprino (n = 52) en la zona central de Chile, se les administraron en comederos plantas ornamentales y pastos que fueron obtenidos posterior a la poda de jardines en sectores aledaños. A las 12 horas post ingesta de este alimento se encuentran 8 caprinos, hembras, adultos, productivos muertos previo al ingreso a sala de ordeña. El episodio de mortandad se extendió por 84 horas generando una mortalidad del 48 % y una morbilidad del 52 %. Se realizó visita, inspección clínica, necropsia y análisis microscópico de especímenes fijados en solución formolada tamponada al 10 %. La inspección clínica confirma la presencia de animales con afección cardiovascular, al igual que el análisis microscópico. Las lesiones son compatibles con las producidas por glucósidos cardiotóxicos, al recorrer el lugar se observa la presencia de Nerium oleander en comederos de lote afectado, lo que sugiere la intoxicación de estos animales. La presencia de esta planta en la zona de la intoxicación es elevada y antes de nuestra visita no fue asociada al episodio de mortandad, lo que nos indica que se debe realizar capacitación e informar a productores sobre el manejo y alimentación de sus animales.

Resumo No estabelecimento de um pequeno produtor de cabras (n = 52) na zona central do Chile, plantas ornamentais e pastagens foram administradas em alimentadores que foram posteriormente podados por jardins em setores próximos. Às 12 horas após a ingestão deste alimento, são oito cabras, fêmeas, adultos, mortos produtivos antes de entrar na sala de ordenha. O episódio da morte prolongou-se por 84 horas, gerando uma mortalidade de 48% e uma morbidade de 52%. Foram realizadas visita, inspeção clínica, necropsia e análise microscópica das amostras fixadas em solução formolada tamponada a 10%. A inspeção clínica confirmou a presença de animais com doença cardiovascular e a análise microscópica. As lesões são compatíveis com as produzidas pelos glicosídeos cardiotóxicos, ao atravessar o local, observa-se a presença de oleandro de Nerium nos alimentadores do lote afetado, o que implica na intoxicação desses animais. A presença desta planta na zona de envenenamento é alta e, antes da nossa visita, não estava associada ao episódio da morte, o que indica que o treinamento deve ser realizado e informa os produtores sobre o manuseio e a alimentação de seus animais.

Hemorragia subaracnoidea aneurismática en la unidad de cuidados intensivos del Hospital Luis Vernaza, Guayaquil, Ecuador / Aneurysmal subarachnoid hemorrhage in the intensive care unit of Luis Vernaza Hospital, Guayaquil, Ecuador

La hemorragia subaracnoidea puede producirse por un traumatismo cráneo encefálico o cuando el denominado aneurisma (defecto en la estructura de la pared de un vaso sanguíneo) se rompe produciendo flujo de sangre en el espacio subaracnoideo. Al respecto, se desarrolló un estudio con enfoque mixto, de tipo no experimental, descriptivo, longitudinal prospectivo; cuyo fin fue describir la hemorragia subaracnoidea aneurismática en pacientes atendidos en la unidad de cuidados intensivos del Hospital Luis Vernaza, en la ciudad de Santiago de Guayaquil, Ecuador, durante el período comprendido desde enero hasta septiembre de 2016. En el mismo participa-ron 31 pacientes con diagnóstico de hemorragia subaracnoidea aneurismática, los que fueron atendidos en ese servicio de la institución en cuestión. Entre los resultados observados se puede destacar que: 24 de los 31 involucrados eran de género femenino, más del 90% de la población de estudio tenían más de 40 años de edad; la arteria comunicante posterior resultó la más afecta-da en los pacientes estudiados (32,26 %); el 58,33% de los casos tuvo compromiso cerebral con distintos grados de afectación; el 38,71% de la población de estudio desarrolló isquemia cere-bral tardía; se estableció una relación estadísticamente significativa entre esa última complica-ción y la administración de ácido tranexámico como parte del tratamiento para evitar resangra-do, el que se presentó solamente en el 16,13% de los pacientes participantes.

Subarachnoid hemorrhage can be caused by a traumatic brain injury or when the so-called aneu-rysm (defect in the structure of the wall of a blood vessel) ruptures causing blood flow in the subarachnoid space. Based on this, it was developed a study with a mixed approach, of a non-ex-perimental, descriptive, longitudinal, prospective type in order to describe aneurysmal subara-chnoid hemorrhage in patients treated in the intensive care unit of Luis Vernaza Hospital, in the city of Santiago de Guayaquil, Ecuador, during the period from January to September 2016. The study population was constituted by 31 patients diagnosed with aneurysmal subarachnoid hemo-rrhage and treated at the service mentioned above. The results were: 24 of the 31 patients were female, more than 90% of the study population were over 40 years of age. The posterior commu-nicating artery was the most affected in the patients representing 32.26%, 58.33% of the cases had cerebral involvement with different degrees of involvement, 38.71% of the patients develo-ped late cerebral ischemia. A statistically significant relationship was established between this last complication and the administration of tranexamic acid as part of the treatment to avoid rebleeding, which occurred only in 16.13% of the participating patients.

Enfermedad de Kawasaki en niños hospitalizados en cinco centros de Barranquilla, Colombia, 2002-2008 / Kawasaki disease in children admitted to five centers in Barranquilla, Colombia, 2002-2008

Introducción: La enfermedad de Kawasaki se ha convertido en la principal causa de cardiopatíaadquirida en los niños. Sin embargo,aunque existen criterios diagnósticos bien definidos, éstos pueden presentarse dispersos a lo largo del curso de la enfermedad o simulardiferentes enfermedades, lo que ocasiona retraso en el diagnóstico y, con esto, mayor riesgo de afección cardiaca. El objetivo de este estudio fue reconocer las características clínicas y epidemiológicas de la enfermedad de Kawasaki en los niños hospitalizados en cinco centros de Barranquilla, entre 2002 y 2008. Pacientes y métodos: Se trata de un estudio retrospectivo, a partir de las historias clínicas de los pacientes menores de 14 añoshospitalizados en cinco centros asistenciales (Hospital Pediátrico, Hospital Niño Jesús, Clínica del Caribe, Clínica La Asunción y Clínica La Merced) de Barranquilla (Atlántico) desde el 1º de febrero de 2002 hasta el 31 de mayo de 2008, con diagnóstico de enfermedadde Kawasaki. Se estimaron parámetrosdescriptivos y prueba no paramétrica(test de los signos). Resultados: El 40% de los casos ocurrió en menores de un año. El 65% de los casos fueron niños procedentes del área urbana. La fiebre fue el principal motivo de consulta en 65% de los casos y el 95% se clasificó como enfermedad típica. Las alteraciones cardíacas se presentaron en el 30%. Los exámenes determinantes para medir la efectividad del tratamiento fueron los cambios en el recuento de plaquetas, la velocidad de sedimentación globular y la prueba de la proteína C reactiva (PCR). Conclusiones: La enfermedad de Kawasaki en nuestro medio presenta características clínicas y epidemiológicas similares a lasdescritas en otras latitudes. Se observaron variaciones en la velocidad de sedimentación globular, plaquetas y PCR en aquellos sujetos que recibieron gammaglobulina. La afección cardiaca es frecuente y se relaciona con la edad, el retraso en el diagnóstico y eltratamiento oportuno.

Introduction: Kawasaki disease has become the leading cause of acquired heart disease in children. However, although there are well-defined diagnostic criteria, these can occur scattered throughout the course of the disease or simulate different pathologiesleading to delayed diagnosis and increased risk of a heart condition. The purpose of this study is to recognize the clinical and epidemiologicalcharacteristics of Kawasaki diseasein children admitted to five medical centers in Barranquilla from 2002 to 2008. Patients and Methods: This is a retrospective study based on the medical records of patients less than 14 years old hospitalized in five medical centers in the city of Barranquilla, Atlántico, (Pediatric Hospital, Hospital Niño Jesús, Clinics: Caribbean, Assumption and La Merced) and diagnosed with Kawasaki disease from February 1, 2002 to May 31, 2008. Descriptive statistical parameters and non-parametric tests (sign test) have been estimated. Results: Forty percent of the cases occurred in infants less than one year old. Sixty percent (65%) of the patients were male children from the urban area. Fever was the main reason for consulting in 65% of the cases, and 95% of the patients were classified as having the typical disease. Ultrasonographic cardiac abnormalities were documented in 30% of the instances. The test measures for determining the effectiveness of treatment were based on changes in theplatelet count, the sedimentation rate, and the C-reactive protein (CRP).Conclusions: Kawasaki disease in ourenvironment shows clinical and epidemiological features similar to those described in other latitudes. There are variations in the sedimentation rate (ESR), platelet count, and CRP in those subjects who received intravenousimmunoglobulin. The heart conditionis common and is associated to age, delayed diagnosis, and timely treatment.

Valor predictivo positivo de test de screening para drogas en orina / Positive predictive value for drugs in urine screening tests

Con el objeto de conocer el Valor Predictivo Positivo (VPP) del test de screening para canabinoides y cocaína, a 3049 trabajadores pertenecientes a una empresa del rubro comercio se les realizó una muestra de orina entre el 28 de noviembre de 1999 y el 28 de agosto de 2000. En una primera instancia, la muestra fue sometida a un test de screening (Enzimoinmunoensayo Rapid test d.a.u. de DADE BEHRING). Los test de screening con resultado positivo, en una segunda instancia fueron sometidos a un examen de confirmación con la técnica cromatografía gaseosa acoplada a espectrofotometría de masas (CG/MSD). Se realizaron 6098 test de screening para canabinoides y cocaína. 46 test de screening resultaron positivos para canabinoides, cocaína o ambas. El examen de confirmación fue positivo en 35 de 46 test de screening (76 por ciento). El porcentaje de confirmación para canabinoides y cocaína fue de 75,7 por ciento (25 de 33) y 76,9 por ciento (10 de 13), respectivamente; es decir, aproximadamente 1 de cada 4 test de screening positivo para canabinoides o cocaína no permite hacer el diagnóstico de consumo con certeza, para lo cual es necesario realizar una confirmación, la que puede ser instrumental (CG/MSD, por ejemplo) o preguntándole directamente al trabajador (verbal). En general, en el ámbito laboral propiciamos la confirmación verbal