The future of allergic rhinitis management: A partnership between healthcare professionals and patients.

Allergic rhinitis (AR) is a chronic respiratory condition that internationally continues to be burdensome and impacts quality of life. Despite availability of medicines and guidelines for healthcare providers for the optimal management of AR, optimisation of its management in the community continues to be elusive. The reasons for this are multi-faceted and include both environmental and healthcare related factors. One factor that we can no longer ignore is that AR management is no longer limited to the domain of healthcare provider and that people with AR make their own choices when choosing how to manage their condition, without seeking advice from a health care provider. We must build a bridge between healthcare provider knowledge and guidelines and patient decision-making. With this commentary, we propose that a shared decision-making approach between healthcare professionals and people with AR be developed and promoted, with a focus on patient health literacy. As custodians of AR knowledge, we have a responsibility to ensure it is accessible to those that matter most-the people with AR.

Caracterización de las actividades de superación profesional relacionadas con el programa materno-infantil en Cuba

Introducción: El Ministerio de Salud Pública tiene implementado un plan de medidas dirigidas a lograr reducir la tasa de mortalidad infantil, menor de un año y la materna, atendiendo a las principales causas de morbi-mortalidad. El texto tiene como objetivo caracterizar las actividades de superación profesional impartidas a los profesionales del sector salud por las universidades de ciencias médicas del país relacionadas con el programa materno-infantil. Método: Se realizó un estudio descriptivo, de corte transversal, de tipo observacional, en la Dirección Nacional de Posgrado de la Dirección General de Docencia del Ministerio de Salud Pública de 2017 al 2020. Resultados: Fueron capacitados en todo el país 222 011 profesionales del Sistema Nacional de Salud en este periodo, con predominio el 2020, utilizando diferentes formas de organización del proceso docente, donde predominó el entrenamiento, seguido de cursos en la atención primaria y secundaria, en esta última mayoritariamente. Discusión: Se reconoce la necesidad de sistematizar acciones para actualizar los conocimientos y desarrollar habilidades, el alcance de las competencias profesionales necesarias en el personal de salud que interviene en el programa materno infantil.

Introduction: Taking into account the main causes of maternal and child morbidity and mortality, the Ministry of Public Health has implemented a plan of measures aimed at reducing the infant, child and maternal mortality rate. The objective of the text is to characterize the professional improvement activities taught by all the medical sciences universities in the country related to the maternal-infant program to professionals in the health sector. Method: A descriptive, cross-sectional, observational study was carried out at the National Postgraduate Directorate of the General Directorate of Teaching of the Ministry of Public Health from 2017 to 2020. Results: 222,011 professionals of the National Health System were trained throughout the country in the last four years, dedicated to the program, predominantly in 2020, using different forms of organization of teaching and a predominance of training, followed by courses in the primary and secondary care, in the latter mostly. Discussion: The need to systematize actions to update knowledge and develop skills is recognized, to achieve the necessary professional skills in health personnel involved in the maternal and child program.

Current allergy educational needs in primary care. Results of the EAACI working group on primary care survey exploring the confidence to manage and the opportunity to refer patients with allergy.

The aim of this survey was to explore the specific educational needs of a cohort of European GPs with regards to allergy training so that future educational initiatives may better support the delivery of allergy services in primary care. METHOD: This study took the form of a cross-sectional observational study in which a structured electronic questionnaire was distributed to primary care providers, in eight languages, across 8 European countries between September 2019 and November 2019. Data associated with demographic parameters, professional qualifications, type of employment, level of confidence regarding competencies for diagnosis and treatment of allergic diseases, referral of patients to allergist and preferred method of learning and assessment were collected. A 5-point Likert scale was used to assess level of confidence. Exploratory analysis was carried out. RESULTS: A total of 687 responses were available for analysis, with 99.3% of responders working within Europe. 70.1% of participants were female; and 48.0% and 48.0% of participants respectively had received some undergraduate and/or postgraduate allergy education. Confidence in dealing with different aspect of allergy management differed between countries. The main reason for specialist referral was a perceived need for tertiary assessment (54.3%), and the main barrier for referral was the consideration that the patient's condition could be appropriately diagnosed and treated in a primary care facility. Up to 44.7% and 55.3% of participants reported that they preferred e-Learning over traditional learning. CONCLUSIONS: This study identified the specific areas of skills training and educational needs of GPs in managing allergic conditions in primary care, and provided insights into possible strategies for more feasible and cost-effective approaches.

Osteomielitis en el pie diabético. Tratamiento médico y cirugía conservadora. Experiencia en la Unidad de Pie / Diabetic foot osteomyelitis. Medical treatment and conservative surgical approach in a Diabetic Foot Unit / Osteomielite em pé diabético. Tratamento clínico e cirurgia conservadora. Experiência na Unidade do Pé

Resumen: La complicación más frecuente de la úlcera del pie diabético (UPD) es la infección, siendo el desencadenante principal de amputaciones menores y mayores. La osteomielitis (OM) está presente hasta en el 60% de los casos y su tratamiento es un desafío, generando controversias según las formas clínicas de presentación. La resección del hueso infectado ha sido el tratamiento estándar, pudiendo generar secuelas funcionales y úlceras recurrentes. En las últimas dos décadas se propuso el tratamiento antimicrobiano con cirugía conservadora o sin cirugía en las lesiones del antepie, con resultados satisfactorios. Objetivo: presentar los resultados del tratamiento médico de la osteomielitis del pie en pacientes diabéticos, priorizando resecciones mínimas que eviten amputaciones desestabilizantes de su biomecánica. Se evaluaron seis pacientes con diabetes mellitus (DM) tratados en la Unidad de Pie, con osteomielitis de falanges, metatarsianos y calcáneo, tratados con antibióticos durante 7±2 semanas y con resecciones limitadas al antepié, con buena evolución. Durante un año de seguimiento hubo ausencia de cualquier signo de infección en el sitio inicial o contiguo de la lesión, preservando el apoyo. Conclusión: la cirugía con resección mínima sin amputación local o de alto nivel tiene éxito en casos seleccionados de osteomielitis del pie diabético. Deben realizarse ensayos prospectivos para determinar sus beneficios frente a otros enfoques.

Abstract: Infection is the most frequent complication in diabetic foot ulcers, and it is the main cause of minor and major lower extremities amputations. Osteomyelitis accounts for 60% of cases and it constitutes a challenge when it comes to treatment, since controversies arise depending on its clinical presentation. Resection of the infected bone has been the golden standard, despite it may cause functional sequelae and recurring ulcers. In the last two decades antibiotic therapy has emerged, combined with a conservative surgical approach or no surgery in forefoot lesions, the results being satisfactory. Objective: to present the results of medical treatment of foot osteomyelitis in diabetic patients, prioritizing minimal resections that avoid amputations which alter the biomechanics of the foot. The study evaluated 6 diabetic patients assisted at the Diabetic Foot Unit, with phalanx, metatarsal and calcaneal osteomyelitis. They received antibiotic therapy for 7 ± 2 weeks and resections were limited to the forefoot, showing good evolution. During a one-year follow-up, there were no signs of infection in the initial site or adjacent to the lesion, support of the foot being preserved. Conclusion: minimum resection surgery with no local or major amputation is a successful therapy in selected cases of diabetic foot osteomyelitis. Prospective trials are necessary to determine benefits of this management when compared to other approaches.

Resumo: A complicação mais frequente da úlcera do pé diabético (UFD) é a infecção, sendo o principal desencadeador de amputações menores e maiores. A osteomielite (OM) está presente em até 60% dos casos e seu tratamento é um desafio, gerando controvérsias dependendo de suas formas clínicas de apresentação. A ressecção do osso infectado tem sido o tratamento padrão, podendo gerar sequelas funcionais e úlceras recorrentes. Nas últimas duas décadas, o tratamento antimicrobiano com cirurgia conservadora ou sem cirurgia tem sido proposto nas lesões do antepé, com resultados satisfatórios. Objetivo: apresentar os resultados do tratamento clínico da osteomielite do pé em pacientes diabéticos, priorizando ressecções mínimas que evitem amputações desestabilizadoras de sua biomecânica. Foram avaliados seis pacientes diabéticos (DM) atendidos na Unidade do Pé, com osteomielite de falanges, metatarsos e calcâneo, tratados com antibióticos por 7±2 semanas e ressecções limitadas ao antepé com boa evolução. Durante um ano de seguimento, não houve sinais de infecção no local inicial ou contíguo da lesão, preservando o suporte. Conclusão: a cirurgia com ressecção mínima sem amputação local ou de alto nível é bem-sucedida em casos selecionados de osteomielite do pé diabético. Ensaios prospectivos devem ser realizados para determinar os benefícios desta em relação a outras abordagens.

Cardiovascular Risk Stratification Based on Oxidative Stress for Early Detection of Pathology.

Aims: Current cardiovascular (CV) risk prediction algorithms are able to quantify the individual risk of CV disease. However, CV risk in young adults is underestimated due to the high dependency of age in biomarker-based algorithms. Because oxidative stress is associated with CV disease, we sought to examine CV risk stratification in young adults based on oxidative stress to approach the discovery of new markers for early detection of pathology. Results: Young adults were stratified into (i) healthy controls, (ii) subjects with CV risk factors, and (iii) patients with a reported CV event. Plasma samples were analyzed using FASILOX, a novel approach to interrogate the dynamic thiol redox proteome. We also analyzed irreversible oxidation by targeted searches using the Uniprot database. Irreversible oxidation of cysteine (Cys) residues was greater in patients with reported CV events than in healthy subjects. These results also indicate that oxidation is progressive. Moreover, we found that glutathione reductase and glutaredoxin 1 proteins are differentially expressed between groups and are proteins involved in antioxidant response, which is in line with the impaired redox homeostasis in CV disease. Innovation: This study, for the first time, describes the oxidative stress (reversible and irreversible Cys oxidation) implication in human plasma according to CV risk stratification. Conclusion: The identification of redox targets and the quantification of protein and oxidative changes might help to better understand the role of oxidative stress in CV disease, and aid stratification for CV events beyond traditional prognostic and diagnostic markers. Antioxid. Redox Signal. 35, 602-617.

Influence of environmental drivers on allergy to pollen grains in a case study in Spain (Madrid): meteorological factors, pollutants, and airborne concentration of aeroallergens.

The aim of this study was to compare airborne levels of Phl p 1 and Phl p 5, with Poaceae pollen concentrations inside and outside of the pollen season, and to evaluate their association with symptoms in grass allergic patients and the influence of climate and pollution. The Hirst and the Burkard Cyclone samplers were used for pollen and allergen quantification, respectively. The sampling period ran from 23 March 2009 to 27 July 2010. Twenty-three patients with seasonal allergic asthma and rhinitis used an electronic symptom card. The aerosol was extracted and quantified for Phl p 1 and Phl p 5 content. Descriptive statistics, non-parametric paired contrast of Wilcoxon, Spearman's correlations, and a categorical principal component analysis (CatPCA) were carried out. Significant variations in pollen, aeroallergen levels, pollen allergen potency, and symptoms score were observed in this study. Phl p 5 pollen allergen potency was higher at the beginning of the 2010 grass pollen season. Presence of Phl p 1 outside the pollen season with positive O3 correlation was clinically relevant. 45.5% of the variance was explained by two dimensions in the CatPCA analysis, showing the symptom relationships dissociated in two dimensions. In the first one, the more important relationship was with grass pollen grains concentration and Phl p 5 and to a lesser extent with Phl p 1 and levels of NO2 and O3, and in the second dimension, symptoms were associated with humidity and SO2. Clinically relevant out-season Phl p 1 was found with a positive O3 correlation. The effect of climate and pollution may have contributed to the higher seasonal allergic rhinitis symptom score recorded in 2009.

Urinary metabolic signatures reflect cardiovascular risk in the young, middle-aged, and elderly populations.

The predictive value of traditional cardiovascular risk estimators is limited, and young and elderly populations are particularly underrepresented. We aimed to investigate the urine metabolome and its association with cardiovascular risk to identify novel markers that might complement current estimators based on age. Urine samples were collected from 234 subjects categorized into three age-grouped cohorts: 30-50 years (cohort I, young), 50-70 years (cohort II, middle-aged), and > 70 years (cohort III, elderly). Each cohort was further classified into three groups: (a) control, (b) individuals with cardiovascular risk factors, and (c) those who had a previous cardiovascular event. Novel urinary metabolites linked to cardiovascular risk were identified by nuclear magnetic resonance in cohort I and then evaluated by target mass spectrometry quantification in all cohorts. A previously identified metabolic fingerprint associated with atherosclerosis was also analyzed and its potential risk estimation investigated in the three aged cohorts. Three different metabolic signatures were identified according to age: 2-hydroxybutyrate, gamma-aminobutyric acid, hypoxanthine, guanidoacetate, oxaloacetate, and serine in young adults; citrate, cyclohexanol, glutamine, lysine, pantothenate, pipecolate, threonine, and tyramine shared by middle-aged and elderly adults; and trimethylamine N-oxide and glucuronate associated with cardiovascular risk in all three cohorts. The urinary metabolome contains a metabolic signature of cardiovascular risk that differs across age groups. These signatures might serve to complement existing algorithms and improve the accuracy of cardiovascular risk prediction for personalized prevention. KEY MESSAGES: • Cardiovascular risk in the young and elderly is underestimated. • The urinary metabolome reflects cardiovascular risk across all age groups. • Six metabolites constitute a metabolic signature of cardiovascular risk in young adults. • Middle-aged and elderly adults share a cardiovascular risk metabolic signature. • TMAO and glucuronate levels reflect cardiovascular risk across all age groups.

Síndrome de Klippel Trenaunay Weber y embarazo / Klippel Trenaunay Weber Syndrome and Pregnancy

RESUMEN Introducción: El síndrome de Klippel Trenaunay Weber es una enfermedad vascular congénita, de causas desconocidas, caracterizada por hemangiomas planos, crecimiento excesivo de huesos y tejido blando, y venas varicosas. Cuando se asocia al embarazo incrementa la morbilidad y mortalidad materna y fetal. Objetivo: Describir dos casos clínicos de gestantes con este síndrome las cuales fueron atendidas en el Hospital Ginecobstétrico Docente "Ramón González Coro" en La Habana, Cuba. Métodos: Estudio descriptivo, retrospectivo, de dos casos mediante técnica de recolección de información, análisis de la historia clínica y búsqueda de literatura actualizada. El mismo se efectuó conforme a las reglamentaciones y principios éticos existentes para la investigación en humanos. No fue necesario que las pacientes ofrecieran su consentimiento informado. Presentación de casos: Los dos casos presentados fueron gestantes adolescentes a las cuales se les dio seguimiento en consulta multidisciplinaria y se les realizó cesárea a las 38 semanas, la primera por riesgo de sangrado por las varicosidades pelvianas y la segunda por indicación neurológica. Se obtuvieron en ambos casos recién nacidos femeninos, de 2620 y 3200 gramos respectivamente y en buenas condiciones. Conclusiones: Debe realizarse una correcta anamnesis durante los controles prenatales para identificar los factores de riesgo que se relacionan con esta entidad que es poco frecuente, pero está relacionada con una gran morbilidad. Es indispensable la actuación en equipo y la evaluación integral de estos casos por un grupo especializado de angiólogos, ginecobstetras, anestesistas, cirujanos, clínicos, y de otras especialidades, para lograr un resultado óptimo(AU)

ABSTRACT Introduction: Klippel Trenaunay Weber syndrome is a congenital vascular disease, of unknown causes, characterized by flat hemangiomas, overgrowth of bones and soft tissue, and varicose veins. When associated with pregnancy, it increases maternal and fetal morbidity and mortality. Objective: To describe two clinical cases of pregnant women with this syndrome, which were treated at the Ramón González Coro Gynecobstetric Teaching Hospital in Havana, Cuba. Methods: A descriptive, retrospective study of two cases using the information collection technique, analysis of the medical history, and search for updated literature. It was carried out in accordance with existing regulations and ethical principles for human research. Patients were not required to offer their informed consent. Case reports: The two cases presented were pregnant adolescents who were followed up in a multidisciplinary consultation and underwent caesarean section at 38 weeks, the first due to risk of bleeding as result of pelvic varicosities and the second due to neurological indication. In both cases, female newborns, 2620 and 3200 grams respectively, were obtained in good conditions. Conclusions: Correct anamnesis must be carried out during prenatal controls to identify the risk factors that are related to this entity, which is rare, but is related to high morbidity. Team action and comprehensive evaluation of these cases, by a specialized group of angiologists, gynecologists, anesthetists, surgeons, clinicians, and other specialties, are essential to achieve an optimal result(AU)

Identification of six cardiovascular risk biomarkers in the young population: A promising tool for early prevention.

BACKGROUND AND AIMS: The predictive value of traditional CV risk calculators is limited. Novel indicators of CVD progression are needed particularly in the young population. The main aim of this study was the identification of a molecular profile with added value to classical CV risk estimation. METHODS: Eighty-one subjects (30-50 years) were classified in 3 groups according to their CV risk: healthy subjects; individuals with CV risk factors; and those who had suffered a previous CV event. The urine proteome was quantitatively analyzed and significantly altered proteins were identified between patients' groups, either related to CV risk or established organ damage. Target-MS and ELISA were used for confirmation in independent patients' cohorts. Systems Biology Analysis (SBA) was carried out to identify functional categories behind CVD. RESULTS: 4309 proteins were identified, 75 of them differentially expressed. ADX, ECP, FETUB, GDF15, GUAD and NOTCH1 compose a fingerprint positively correlating with lifetime risk estimate (LTR QRISK). Best performance ROC curve was obtained when ECP, GDF15 and GUAD were combined (AUC = 0.96). SBA revealed oxidative stress response, dilated cardiomyopathy, signaling by Wnt and proteasome, as main functional processes related to CV risk. CONCLUSIONS: A novel urinary protein signature is shown, which correlates with CV risk estimation in young individuals. Pending further confirmation, this six-protein-panel could help in CV risk assessment.

Association between seasonal allergic rhinitis and air pollution, meteorological factors, and grass pollen counts in Madrid (1996 and 2009)

OBJECTIVE: The aim of this study was to assess the relationship between meteorological and pollution-related variables and the symptoms of patients with seasonal allergic rhinitis due to sensitization to grass pollen during 2 different time periods in Madrid, Spain. METHODS: Between March 23 and December 31 in 1996 and 2009, we carried out a daily count of grass pollen grains (Burkard spore trap) and recorded the rhinitis symptom scores in 2 groups of patients with a history of seasonal allergic rhinitis (n=25 in 1996 and n=23 in 2009). Descriptive statistics of the same variables during the study periods were recorded. Associations between variables were assessed using the paired-samples Wilcoxon test and categorical principal component analysis (CatPCA, SPSS24 package). RESULTS: The mean symptom score was low in 1996 and moderate in 2009. The 1996 and 2009 CatPCA analysis explained around 66.4% and 70.5% of the variance, respectively. The strongest relationships in 1996 were between symptoms and grass pollen counts (R=0.55) and between temperature and ozone (R=0.63). In 2009, the association between temperature and pollution-related variables was even stronger than in 1996 (ozone [R=0.53] and PM10 [R=0.34], with a positive sign in both cases). CONCLUSIONS: The effect of temperature and pollution (mainly ozone, even at lower atmospheric concentrations than in established guidelines for effects on health) may have contributed to the higher seasonal allergic rhinitis symptom score recorded in 2009

INTRODUCCIÓN: El objetivo de este estudio fue evaluar las relaciones de las variables meteorológicas y contaminantes en los síntomas de los pacientes con rinitis alérgica estacional con sensibilización al polen de gramíneas durante dos períodos diferentes en Madrid. MÉTODOS: Durante el período del 23 de marzo al 31 de diciembre de 1996 y 2009, se realizó un recuento diario de granos de polen de gramíneas (Burkard spore trap) y puntuación de síntomas de rinitis en dos grupos de pacientes (n = 25 en 1996 y n = 23 en 2009) con historia de rinitis alérgica estacional. Para describir cómo se relacionan las variables, se realizaron estadísticas descriptivas de las mismas variables en los períodos de estudio de 1996 y 2009, contraste no paramétrico pareado de Wilcoxon y un análisis de componentes principales (CatPCA, SPSS24). RESULTADOS: El valor medio de la puntuación de síntomas en 1996 fue bajo y en 2009 moderado. El análisis CatPCA de 1996 y 2009 explica aproximadamente el 66,4% y el 70,5% de la varianza, respectivamente. La relación más fuerte en 1996 fue entre los síntomas y los recuentos de polen de gramíneas (R = 0,55), la temperatura y el O3 (R = 0,63). En 2009, la relación entre la temperatura y las variables de contaminación fue incluso mayor que en el período de 1996: O3 (R = 0,53) y con PM10 (R = 0,34), en ambos casos con un signo positivo. CONCLUSIONES: El efecto de la temperatura y la contaminación (principalmente O3, incluso a concentraciones atmosféricas más bajas que las pautas establecidas sobre sus efectos en la salud), podría contribuir a la mayor puntuación de síntomas de rinitis alérgica estacional observada en 2009

Mola hidatiforme parcial del segundo trimestre / Second trimester partial hydatidiform mole

La mola hidatiforme coexistente con un feto vivo es una entidad infrecuente que se caracteriza por la degeneración hidrópica de las vellosidades coriales, hiperplasia del trofoblasto y evidencia macroscópica de un feto. El objetivo del trabajo fue describir el caso clínico de una paciente con diagnóstico de mola parcial y edad gestacional de 23 semanas. Presentamos una paciente de 31 años remitida de consulta de perinatología con 22,5 semanas de gestación, tensión arterial elevada, signo de más y ecografía con 20 semanas que describe placenta con lagos venosos; con antecedentes de alfafetoproteína elevada. En el hospital empeoró su estado con una preeclampsia agravada, y con ecografía evolutiva que describe placenta de 71 mm, con múltiples lagos venosos. Se plantea posible enfermedad trofoblástica y se discute para interrupción del embarazo. Se realizó microcesárea, se obtiene feto muerto femenino de 600 gramos, con placenta de 400 gramos con múltiples vesículas que recuerdan la mola parcial, diagnóstico que se confirma posteriormente con estudio histopatológico. En la mola parcial, el embrión rara vez sobrevive hasta el segundo trimestre. Si no se realizan pruebas citogenéticas, posiblemente no se diagnostiquen porque los cambios histológicos suelen ser sutiles. La clínica, la fracción beta de la gonadotropina coriónica y el estudio de la placenta, el feto o ambos, son los que permitirán realizar el diagnóstico definitivo para determinar el seguimiento y disminuir las complicaciones(AU)

The hydatidiform mole coexisting with a living fetus is a rare entity that is characterized by hydropic degeneration of the chorionic villi, hyperplasia of the trophoblast and macroscopic evidence of a fetus. The objective of the study was to describe the clinical case of a patient with a diagnosis of partial mole and gestational age of 23 weeks. We present a 31-year-old patient referred for perinatology consultation with 22.5 weeks of gestation, high blood pressure, plus sign and ultrasound with 20 weeks describing placenta with venous lakes; and history of high alpha-fetoprotein. In the hospital, her condition worsened with aggravated preeclampsia, and with an evolving ultrasound, that describes a 71 mm placenta with multiple venous lakes. Possible trophoblastic disease arises and is discussed for termination of pregnancy. Micro-cesarean surgery was performed, a female fetus weighing 600 grams was obtained, a placenta of 400 grams with multiple vesicles that resemble partial mole. This diagnosis is later confirmed with histopathological study. In partial mole, the embryo rarely survives until the second trimester. If cytogenetic tests are not performed, they may not be diagnosed because the histological changes are usually subtle. The clinic, the beta fraction of the chorionic gonadotropin and the study of the placenta, the fetus or both, are the ones that will make the definitive diagnosis to determine the follow-up and decrease the complications(AU)

Disability in Mexico: a comparative analysis between descriptive models and historical periods using a timeline.

Some interpretations frequently argue that three Disability Models (DM) (Charity, Medical/Rehabilitation, and Social) correspond to historical periods in terms of chronological succession. These views permeate a priori within major official documents on the subject in Mexico. This paper intends to test whether this association is plausible by applying a timeline method. A document search was made with inclusion and exclusion criteria in databases to select representative studies with which to depict milestones in the timelines for each period. The following is demonstrated: 1) models should be considered as categories of analysis and not as historical periods, in that the prevalence of elements of the three models is present to date, and 2) the association between disability models and historical periods results in teleological interpretations of the history of disability in Mexico.

Asociación entre la mejora en el perfil de riesgo cardiovascular y los cambios en la incapacidad temporal: resultados del estudio ICARIA / Association between improvement in cardiovascular risk profile and changes in sickness absence: results of the ICARIA study

Introducción y objetivos: El propósito de este estudio es investigar si los cambios en el riesgo cardiovascular (RCV) se asocian con la duración y los costes de la incapacidad temporal. Métodos: Se evaluó una cohorte prospectiva de 179.186 sujetos. Se calculó su RCV (SCORE) en 2 exámenes médicos consecutivos, separados aproximadamente 1 año (365 ± 90 días). Se categorizó el RCV en < 4% o ≥ 4% y se crearon 4 grupos de pacientes en función de los cambios en el RCV entre los 2 exámenes. Después de la segunda estimación, se realizó un seguimiento de 1 año para evaluar la incapacidad temporal. Las diferencias entre los 4 grupos en el recuento total de días de incapacidad temporal se evaluaron mediante modelos de regresión de Poisson. Resultados: Tras ajustar por covariables, los sujetos que mejoraron su RCV tuvieron un menor recuento de días de incapacidad temporal que los que empeoraron su RCV y aquellos cuyo riesgo permaneció estabilizado en ≥ 4% (RR, 0,91; IC95%, 0,84-0,98). Comparados con los que no mejoraron el nivel de RCV, entre los que sí mejoraron más individuos habían dejado de fumar (+17,2%; p < 0,001) y habían controlado su presión arterial (+26,0%; p < 0,001), el colesterol total (+9,3%; p < 0,001), el colesterol unido a lipoproteínas de baja densidad (+14,9%; p < 0,001) y los triglicéridos (+14,6%; p < 0,001). Conclusiones: Nuestros resultados indican que la mejora del RCV se acompaña de una disminución de la incapacidad temporal en el seguimiento a 1 año (AU)

Introduction and objectives: The purpose of this study was to investigate whether changes in cardiovascular risk (CVR) are associated with the length and cost of sickness absence. Methods: A prospective cohort of 179 186 participants was evaluated. Each participant's CVR (SCORE) was assessed on 2 consecutive medical examinations, approximately 1 year apart (365 ± 90 days). Cardiovascular risk was categorized as < 4% or ≥ 4%, and participants were divided into 4 groups according to changes in their risk between the 2 assessments. After the second CVR estimate, a 1-year follow-up was carried out to assess sickness absence. Differences between the 4 groups in terms of the total count of sickness absence days during the follow-up period were tested using Poisson regression models. Results: After adjustment for covariates, participants who showed an improvement in CVR had a lower count of sickness absence days compared with both those who showed a worsening in risk and those who remained stable at ≥ 4% (RR, 0.91; 95%CI, 0.84-0.98). In comparison with participants whose CVR did not improve, more of the participants whose risk did improve had quit smoking (+17.2%; P < .001), and had controlled their blood pressure (+26.0%, P < .001), total cholesterol (+9.3%; P < .001), low-density lipoprotein cholesterol (+14.9%; P < .001), and triglyceride levels (+14.6%; P < .001). Conclusions: Our results suggest that an improvement in CVR profile is accompanied by a decrease in sickness absence during a 1-year follow-up (AU)

Embarazo ectópico del segundo trimestre / Ectopic Pregnancy of the Second Trimester

Se considera embarazo ectópico a todo aquel que anida fuera de la cavidad endometrial. La incidencia global es de 1-2 por ciento del total de gestaciones, y en 97 por ciento de los casos se localiza en la trompa. El objetivo es describir un caso clínico peculiar de una paciente con embarazo ectópico tubárico que alcanzó el segundo trimestre. Se presenta una paciente de 32 años de edad que con 17 semanas de edad gestacional que fue remitida de su área por ecografía con diagnóstico de gemelar con un saco anembriónico. Se realizó laparotomía exploradora y como hallazgos se observó hemoperitoneo de 400 mL, embarazo tubario derecho de 17 semanas fisurado en región ampular, anejo izquierdo normal, útero de consistencia blanda con mioma de dos centímetros en la cara anterior del útero. Se realizó anexectomía derecha. No hubo complicaciones. Anatomía patológica: Biopsia 16-255: Embarazo ectópico tubárico. El embarazo tubárico que cursa de forma asintomática en el segundo trimestre es raro; y las publicaciones médicas sobre este tema son limitadas. La ecografía es útil para el diagnóstico del embarazo ectópico y localización topográfica, sobre todo para diferenciar la gestación tubárica de la abdominal ya que el manejo médico y quirúrgico es diferente en ambas localizaciones(AU)

Ectopic pregnancy is considered to be any which nests outside the endometrial cavity. The overall incidence is 1-2 percent of the total of pregnancies, and in 97 percent of cases is located in the tube. The objective is to describe a peculiar clinical case of a patient with tubal ectopic pregnancy that extended to the second trimester. We present a 32-year-old patient with 17 weeks of gestational age who was referred from her doctor. Twin pregnancy with an anembryonic sac was diagnosed by ultrasound. Exploratory laparotomy was performed. A hemoperitoneum of 400 mL was observed. A 17-week right tubal pregnancy was fissured in the ampullary region, the left annex was normal, the uterus was soft anad there was a 2 cm myoma on the anterior side of the uterus. Right adnexectomy was performed. There were no complications. The results of the pathological anatomical study showed (Biopsy 16-255) tubal ectopic pregnancy. The tubal pregnancy that occurs in the second trimester asymptomatically is rare. Medical publications on this subject are limited. Ultrasound is useful for the diagnosis and topographic location of ectopic pregnancy, especially to differentiate tubal from abdominal gestation since medical and surgical managements are different in both locations(AU)

Embarazo ectópico del segundo trimestre / Ectopic Pregnancy of the Second Trimester

Se considera embarazo ectópico a todo aquel que anida fuera de la cavidad endometrial. La incidencia global es de 1-2 por ciento del total de gestaciones, y en 97 por ciento de los casos se localiza en la trompa. El objetivo es describir un caso clínico peculiar de una paciente con embarazo ectópico tubárico que alcanzó el segundo trimestre. Se presenta una paciente de 32 años de edad que con 17 semanas de edad gestacional que fue remitida de su área por ecografía con diagnóstico de gemelar con un saco anembriónico. Se realizó laparotomía exploradora y como hallazgos se observó hemoperitoneo de 400 mL, embarazo tubario derecho de 17 semanas fisurado en región ampular, anejo izquierdo normal, útero de consistencia blanda con mioma de dos centímetros en la cara anterior del útero. Se realizó anexectomía derecha. No hubo complicaciones. Anatomía patológica: Biopsia 16-255: Embarazo ectópico tubárico. El embarazo tubárico que cursa de forma asintomática en el segundo trimestre es raro; y las publicaciones médicas sobre este tema son limitadas. La ecografía es útil para el diagnóstico del embarazo ectópico y localización topográfica, sobre todo para diferenciar la gestación tubárica de la abdominal ya que el manejo médico y quirúrgico es diferente en ambas localizaciones(AU)

Ectopic pregnancy is considered to be any which nests outside the endometrial cavity. The overall incidence is 1-2 percent of the total of pregnancies, and in 97 percent of cases is located in the tube. The objective is to describe a peculiar clinical case of a patient with tubal ectopic pregnancy that extended to the second trimester. We present a 32-year-old patient with 17 weeks of gestational age who was referred from her doctor. Twin pregnancy with an anembryonic sac was diagnosed by ultrasound. Exploratory laparotomy was performed. A hemoperitoneum of 400 mL was observed. A 17-week right tubal pregnancy was fissured in the ampullary region, the left annex was normal, the uterus was soft anad there was a 2 cm myoma on the anterior side of the uterus. Right adnexectomy was performed. There were no complications. The results of the pathological anatomical study showed (Biopsy 16-255) tubal ectopic pregnancy. The tubal pregnancy that occurs in the second trimester asymptomatically is rare. Medical publications on this subject are limited. Ultrasound is useful for the diagnosis and topographic location of ectopic pregnancy, especially to differentiate tubal from abdominal gestation since medical and surgical managements are different in both locations(AU)