Decomposing the Intraurban Malnutrition Gap Between Poor and Non-poor Children in Colombia : Decomposing the Intraurban Malnutrition Gap Between Poor and Non-poor Children in Colombia.

In Colombia, although it can be said that, on average children living in urban areas have better quality of life than their rural peers, it is also true that within cities, there are high levels of socioeconomic inequality. Our objective is to identify the contribution of the factors that explain the gap in stunting and excess weight between poor and non-poor children under 5 years of age in urban areas of Colombia. We use data from the 2015 National Nutritional Status Survey, and two nonlinear decomposition techniques based on the classical decomposition method developed by Blinder-Oaxaca. With a sample of 6877 observations, the results show that the intraurban gap of stunting between poor and non-poor children in urban areas is 4.8 percentage points. Its main determinants are the mother's educational level (46.5%), affiliation to the health system by the mother (19.4%), and assisted delivery in a medical institution (16.6%). For excess weight, the gap is - 2.1 percentage points, and its main determinants are the mother's educational level (39.2%) and birth attended by a physician (21.8%). This study suggests the coexistence of a double burden of malnutrition (DBM) in children under 5 years of age living in urban areas of Colombia. Stunting is associated with low-income levels while excess weight is associated with higher income levels. The identification of the main determinants of DBM and its relative importance, constitutes a contribution for public policy makers aimed at reducing socioeconomic gaps.

Patients' and caregivers' experiences of virtual care in a primary care setting during the COVID-19 pandemic: A patient-oriented research study.

Objective: This study explored patient and caregiver expectations and experiences of virtual primary care in Manitoba, Canada. This study focused on accessibility of care, acceptability and perceptions of quality from 'users' of primary healthcare services. Due to the rapid implementation of virtual primary care during the COVID-19 pandemic in Canada, patient/public input was largely bypassed. Methods: A mixed method was conducted in collaboration with Patient and Caregiver Community Advisors. Data was obtained from 696 surveys and 9 focus groups (n = 41 patients and caregivers). Results: Data suggest good acceptance of virtual visits, although considered a new experience despite almost exclusive use of the telephone. Participants preferred more input for choosing the type of visit but experienced less stress, time and inconvenience by using virtual care. There were mixed opinions of quality. More complex visits were associated with incomplete consultations and serve as one exemplar of the limitations due to lack of physical presence or contact. Unique communication skills were required to convey health concerns adequately and accurately. A more transactional approach was perceived from the lack of visual cues and the awkwardness associated with pauses during the phone conversation. Virtual care may be better used for certain circumstances but should encompass patient-centred decision making for when and how. Many expressed interests in video options; technology access and user ability are additional considerations for advancing virtual care. Conclusions: The experiences and recommendations from patients and caregivers provide an important contribution to decision-making and integrating and sustaining quality virtual care for patient-centered healthcare service delivery. Keywords: Virtual care experiences, primary care, patient-oriented research, mixed methods, COVID-19.

Influencia del riesgo preconcepcional en la salud materna / Influence of preconceptional risk on maternal health

RESUMEN El riesgo preconcepcional está condicionado por una serie de factores, enfermedades o circunstancias únicas o asociadas que pueden repercutir desfavorablemente en el binomio madre / hijo durante la gestación, parto o puerperio. La prevención de la enfermedad y la muerte durante el proceso de reproducción, es uno de los pilares fundamentales para el desarrollo de la salud reproductiva. La morbilidad materna constituye uno de los aspectos más importantes para reflexionar. El objetivo de esta investigación es valorar la influencia del riesgo preconcepcional en la salud materna. Es indispensable, no solo en la atención de las gestantes, sino también para aquellas mujeres que desean ser madres en algún momento de su vida. Se ha adoptado un nuevo enfoque hacia el riesgo preconcepcional con acciones que contribuyan a mejorar la salud sexual y reproductiva en esta etapa en la vida de hombres y mujeres.

ABSTRACT Preconception risk is conditioned by a series of factors, diseases or unique or associated circumstances that can have an unfavorable impact on the mother - child binomial during pregnancy, delivery or puerperium. The prevention of disease and death during the reproductive process is one of the fundamental pillars for the development of reproductive health. Maternal morbidity is one of the most important aspects to reflect on. The objective of this research is to assess the influence of preconception risk on maternal health. It is essential, not only in the care of pregnant women, but also for those women who want to be mothers at some point in their life. A new approach has been adopted towards preconception risk with actions that contribute to improve sexual and reproductive health at this stage in the lives of men and women.

Therapeutic drug monitoring for sirolimus in whole blood of organ transplants by high-performance liquid chromatography with ultraviolet detection.

We developed and validated an accurate, sensitive, precise and rapid HPLC method with UV detection for the determination of sirolimus in blood samples from renal, cardiac and hepatic transplants. This method overcomes most of the problems related to previously published assays using a narrow-bore column with base deactivated C18 reversed phase. Whole blood samples were purified by a combination of a precipitating blood matrix with zinc sulphate and a single step liquid-liquid extraction with acetone and 1-chlorobutane. Calibration curves (range 2.5-150 ng/ml), were linear with coefficients of correlation better than 0.996. The relative standard deviation was determined to be less than 8%. The present method has also been validated by a reference laboratory (St. George's Hospital Medical School, London, UK). More of 300 clinical samples have been analysed with this method.

Comportamiento de las afecciones cutáneas en el adulto mayor. Policlínico Docente Héroes del Moncada. Municipio Cárdenas. Matanzas / Behaviour of skin affections in elder people. Teaching Policlinic Heroes del Moncada. Municipality of Cardenas. Matanzas

RESUMEN Introducción: el incremento de la calidad de vida de la población y del adulto mayor, la integración de todas las disciplinas médicas, las acciones de prevención y ambientales conllevarán a lograr una longevidad satisfactoria. Objetivo: describir el comportamiento de las afecciones cutáneas en el adulto mayor. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo, acerca del comportamiento de afecciones cutáneas en pacientes adultos mayores, vistos en la consulta de Dermatología en el policlínico docente Héroes del Moncada en el municipio de Cárdenas en el período correspondiente a los años 2015 y 2016. La muestra estuvo constituida por 707 pacientes atendidos en consulta por afecciones cutáneas, en el período estudiado. Para la obtención de los datos se revisaron las hojas de cargo del departamento de estadística. Resultados: en los pacientes atendidos prevaleció el sexo masculino en los adultos mayores, las afecciones más frecuentes diagnosticadas fueron las micosis superficiales, los tumores malignos y las lesiones precancerosas y se detectaron más de una afección en un mismo paciente. Conclusiones: las dermatosis en el adulto resultó de frecuente incidencia en consulta, predominando el sexo masculino (AU).

ABSTRACT Introduction: The population's and elder peoples´ increment of the quality of life, the integration of all the medical disciplines, health and environmental prevention will lead to achieve a satisfactory longevity. Objective: Describing the behavior of cutaneous affections in the adult principal. Material and methods: A descriptive, retrospective study was conducted on the behavior of cutaneous disorders in elderly patients, seen in the Dermatology clinic in the Héroes del Moncada teaching polyclinic in the municipality of Cárdenas in the period corresponding to the years 2015 and 2016. The sample It was constituted by 707 patients attended in consultation for cutaneous affections, in the period studied. To obtain the data, the charge sheets of the statistics department were reviewed. Results: In the patients attended the male sex prevailed in the elderly, the most frequent conditions diagnosed were superficial mycoses, malignant tumors and precancerous lesions and more than one condition was detected in the same patient. Conclusions: Them dermatosis in adult frequent music demands counselling, fundamentally in the masculine sex (AU).

Poroqueratosis de Mibelli. Presentación de caso / Mibelli's porokeratosis. Presentation of case

RESUMEN Se realizó la presentación de dos pacientes con poroqueratosis de Mibelli por ser una dermatosis poco frecuente, por lo que debe ser de interés para los profesionales de diferentes disciplinas, bien por relacionarse con el cáncer de piel o con disímiles enfermedades. Los pacientes estudiados fueron: paciente femenino de 62 años de edad, piel blanca y ocupación ama de casa. Fue remitida por presentar piel con fototipo cutáneo II, una lesión en placa de color amarillento, bordes elevados, hiperqueratósicos, centro atrófico de 1 cm de diámetro; localizada en cara ántero-externa de pierna derecha. El otro paciente, de 59 años, sexo masculino, piel blanca, y ocupación pescador. Solicitó los servicios por presentar piel fototipo cutáneo II lesión en placa de color amarillento, bordes elevados, hiperqueratósicos, centro atrófico de 2cm de diámetro, localizada en cara póstero-externa de antebrazo derecho. Se les realizó biopsia de ambas lesiones. El diagnóstico fue la poroqueratosis de Mibelli para la prevención del cáncer de piel. Ambos pacientes presentaron en común fototipo cutáneo II y otras manifestaciones cutáneas inducidas por la exposición solar. La terapéutica utilizada fue la extirpación quirúrgica, que resultó también el proceder diagnóstico Se orientaron medidas para la prevención del cáncer de piel con bloqueadores solares, y protegerse de los rayos solares con ropa adecuaday otros accesorios (AU).

ABSTRACT Two patients with Mibelli´s porokeratosis were presented because it is a few frequent dermatosis that might be of interest for professionals of different disciplines since it is related to skin cancer and to several other diseases. The first studied patients was 62 years old, female, white, and a housewife, remitted due to presenting skin with cutaneous phototype II, a yellowish lesion in plaque, risen, hyperkeratoid borders and atrophic center of 1 cm diameter, located in the anterior-external face of the right leg. The other patient was 59 years old, male, white, and a fisherman. He assisted the service presenting skin with cutaneous phototype II, a yellowish lesion in plaque, risen, hyperkeratoid borders and atrophic center of 2 cm diameter, located in the posterior-external face of the right forearm. A biopsy of both lesions was carried out. The diagnosis was Mibelli´s porokeratosis. Both patients presented a common cutaneous phototype II and skin manifestations induced by the sun exposition. The used therapeutic was the surgical removal, that also was the diagnosis procedure. Preventing skin cancer with sun blockers was oriented and also wearing adequate clothes and other accessories (AU).

Caracterización de la salud familiar en estudiantes de Medicina / Characterization of the family health in medicine students’ families

Introducción: la familia es básica como determinante de salud y constituye la red de apoyo más eficaz de ajuste en la vida social. El cumplimiento de sus funciones es esencial para el desarrollo pleno de sus miembros, propiciar la responsabilidad y actitudes positivas hacia el estudio y el trabajo. Objetivo: caracterizar la salud familiar en familias de estudiantes de Medicina. Materiales y métodos: se realizó una investigación descriptiva transversal, en 45 familias de estudiantes de Medicina del Policlínico Universitario Héroes del Moncada, del área urbana de Cárdenas, Matanzas. Fueron utilizadas las técnicas de observación y entrevista en la confección de la historia de salud familiar, y el test de percepción del funcionamiento familiar para el diagnóstico de salud familiar a través de la dinámica relacional. Resultados: las familias nucleares constituyeron el 60 %, y las extensas el 35,6 %. El 64,5 % son familias medianas, seguidas de las pequeñas con 15, y 2,2 % son grandes. El 73,3 % son bigeneracionales y 11 son trigeneracionales. Predominaron las familias nucleares biparentales con 15, que constituyen el 55,6 %; 7 reconstituidas, para un 25,9 % de las familias nucleares, y 5 monoparental. El 88,9 % del total son familias funcionales y el resto moderadamente funcionales. Conclusiones: predominaron las familias nucleares, bigeneracionales y medianas. Las biparentales fueron las más frecuentes, seguidas de las reconstituidas. En aproximadamente la mitad de la muestra conviven los dos padres, cónyuges de primeras nupcias. Prevaleció el diagnóstico de familia funcional. No se diagnosticó disfuncionalidad.

Background: family is basic as a health determinant and it is the most adjusting efficacious net in social life. The fulfillment of its functions is essential for the full development of its members, and for propitiating responsibility and positive attitudes toward study and work. Aim: to characterize family health in Medicine students’ families. Material and methods: we carried out a cross-sectional descriptive research, in 45 families of Medicine students belonging to the University Policlinic Heroes del Moncada, urban area of Cardenas, Matanzas. In the elaboration of the family health history, the techniques of observation and interviewing were used, and also the family functioning perception test for diagnosing family health through the relational dynamic. Results: 60 % are nuclear families and 35,6 % are extensive ones. 64,5 % are median families, followed by the little ones with 15, and 2,2 % are big. 73,3 % of the families are bi-generational and 11 are tri-generational. Nuclear bi-parental families are predominant with 15, being 55,6 %; 7 are reconstituted, for 25,9 % of all the nuclear families, and 5 are monoparental ones. 88,9 % of the total are functional families, and the rest are moderately functional. Conclusions: There it was a predominance of nuclear, bi-generational and median families. The biparental families were the most frequent, followed by the reconstituted ones. In around half of the sample, both parents live together, being married for the first time. There it was a diagnosis prevalence of functional family. No dysfunctional family was diagnosed.

Stereoselective pharmacokinetic analysis of tramadol and its main phase I metabolites in healthy subjects after intravenous and oral administration of racemic tramadol.

The kinetics of tramadol enantiomers are stereoselective when doses of the racemic drug are given orally. To document whether the route of administration determines the stereoselective kinetics of tramadol enantiomers, healthy volunteers received 100 mg oral or intravenous doses of racemic tramadol, and serial blood samples were obtained to assay tramadol enantiomers and their main phase I metabolites, O-demethyltramadol and N-demethyltramadol. To assess accurately the involvement of their metabolites in the pharmacokinetics of tramadol, it is essential to determine the rate and extent of the formation of the enantiomers of these metabolites. A simultaneous pharmacokinetic model describing the plasma concentration-curves of the generated metabolites and the parent compounds after intravenous and oral drug administration is developed and presented. Tramadol and O-demethyltramadol were the major compounds detected in plasma after intravenous administration. Nevertheless, the N-demethylation of tramadol showed a significant increase when the oral route was used. After both oral and intravenous doses, the kinetics of the tramadol enantiomers were stereoselective. The AUC for (R )-(+)-tramadol was greater than the AUC for (S)-(-)-tramadol. The formation of N-demethyltramadol also was enantioselective after oral administration of racemic tramadol, with a greater AUC for (R)-(+)-N-demethyltramadol than for (S)-(-)-N-demethyltramadol. In the opposite form, (S)-(-)-O-demethyltramadol was formed faster than (R)-(+)-O-demethyltramadol. The metabolism of tramadol was also route-dependent with a different enantiomeric ratio for tramadol and its main phase I metabolites after intravenous and oral administration. The disposition of N-demethyltramadol was concentration-dependent.

Publicaciones de autores de la provincia de Matanzas en las revistas medicas nacionales entre 1980 y 1994 / Publications of Authors from Matanzas Province in the National Medical Journals between 1980 and 1994

Se analiza el comportamiento de la produccion de trabajos cientificos de la provincia de Matanzas publicados en 24 revistas medicas nacionales cubanas durante el periodo comprendido entre 1980 y 1994. Se revisaron las tablas de contenido de las revistas y se localizaron los trabajos elaborados por medicos y personla paramedico en ejercicio en distintas unidades de la provincia. En esos 15 anos se publicaron 142 trabajos de autores matanceros. Mientras que entre 1980 y 1988 se publicaron 129, en el periodo 1989-1994 solo aparecieron 13 articulos de autores radicados en dicha provincia. Se comprobo que los hospitales fueron las unidades que mas publicaron, las especialidades de cardiologia y ginecologia y obstetricia las que mas trabajos aportaron y que el promedio de tres autores por articulo fue el que predomino

Suplementación de vitamina E y sus efectos en el sistema inmunológico / Suplementación of vitamin and and its effects in immunological system

El presente es un estudio experimental realizado en cuatro conejos los mismos que fueron repartidos en 2 grupos A y B con dos especímenes cada uno, siendo el grupo a el de control y del grupo B el de estudio, el cual recibió durante un período de 25 días ininterrumpidos una dieta normal complementada con vitamina E, para evidenciar sus efectos sobre su sistma inmunológico. En el día cero se realizaron tres actividades: medición del peso, toma de sangre para una biometría, administración de la vacuna BCG. Al final de la suplementación de vitamina E se realizó una segunda biometría y una prueba de PPd. Los resultados obtenidos demostraron un leve acercamiento a los objetivos planteados.