[Frequency of smoking among hospitalized patients]. / Consumo de tabaco en pacientes hospitalizados en Clínica Alemana de Santiago de Chile.

BACKGROUND: Smoking is one of the most relevant public health problems worldwide and one of the main causes of preventable premature death. In-hospital treatment and subsequent follow-up are effective in terms of cessation. AIM: To determine the frequency of smoking habits among patients hospitalized at a private clinic in Santiago. MATERIAL AND METHODS: Hospitalized patients were invited to answer a structured and adapted questionnaire on smoking habits. RESULTS: The survey was answered by 294 patients (56% women). Twenty three percent of respondents were smokers. Among smokers, 50% indicated a consumption from 1 to 5 cigarettes per day, 19% smoked during the first hour after waking, and 43% lived with another smoker in their home. Eighty three percent thought about quitting and made unsuccessful attempts to quit using different strategies. CONCLUSIONS: The percentage of smokers in this group of patients is lower than that reported in the national health survey. The high proportion of respondent that are attempted to quit and failed, justifies the availability of structured quitting programs at the hospital and follow-up strategies after discharge.

Consumo de tabaco en pacientes hospitalizados en Clínica Alemana de Santiago de Chile / Frequency of smoking among hospitalized patients

Background: Smoking is one of the most relevant public health problems worldwide and one of the main causes of preventable premature death. In-hospital treatment and subsequent follow-up are effective in terms of cessation. Aim: To determine the frequency of smoking habits among patients hospitalized at a private clinic in Santiago. Material and Methods: Hospitalized patients were invited to answer a structured and adapted questionnaire on smoking habits. Results: The survey was answered by 294 patients (56% women). Twenty three percent of respondents were smokers. Among smokers, 50% indicated a consumption from 1 to 5 cigarettes per day, 19% smoked during the first hour after waking, and 43% lived with another smoker in their home. Eighty three percent thought about quitting and made unsuccessful attempts to quit using different strategies. Conclusions: The percentage of smokers in this group of patients is lower than that reported in the national health survey. The high proportion of respondent that are attempted to quit and failed, justifies the availability of structured quitting programs at the hospital and follow-up strategies after discharge.

Estudio piloto de un programa basado en Internet para la prevención e intervención temprana de la depresión en adolescentes / Feasibility and effectiveness of an Internet-based program for the prevention and early intervention of depression inInternet adolescents

Resumen Antecedentes: la alta prevalencia de depresión en la adolescencia y sus graves consecuencias, asociadas a su falta de detección y tratamiento, estimulan el interés en la investigación respecto a su prevención e intervención tempranas. Las intervenciones basadas en las tecnologías de la información y la comunicación (TIC), dada su flexibilidad y capacidad de difusión, representan oportunidades innovadoras; no obstante, en Latinoamérica hay poca evidencia sobre su impacto y eficacia. Objetivo y metodología: se realiza un estudio piloto cuantitativo cuasiexperimental que busca evaluar la factibilidad del programa basado en Internet "Cuida tu Ánimo", mediante las variables de uso y aceptabilidad, y la estimación del efecto, en 215 adolescentes (103 grupo activo, 112 grupo control) de dos instituciones educativas de la ciudad de Medellín. Se evaluaron las interacciones de los adolescentes con el Programa, su uso-aceptabilidad, el nivel de sintomatología depresiva y otros aspectos relacionados. Resultados: los adolescentes reportan alta aceptación y uso muy moderado del Programa. Señalan el aprendizaje sobre depresión y detección temprana del riesgo que les proporcionó el Programa; y recomiendan aumentar la interactividad de la plataforma web, generar contenidos más diversos y entretenidos, y aumentar los niveles de presencialidad de la intervención. Conclusiones: los programas basados en las TIC pueden ser un complemento favorable para la prevención e intervención tempranas de la depresión en adolescentes. Dada la dificultad de asociar la estimación del efecto del Programa con su uso, se recomienda en estudios futuros utilizar un diseño que permita relacionar los indicadores de uso con los de resultado (dosis-efecto).

Abstract Background: the high prevalence of depression in adolescence and its serious consequences, associated with its lack of detection and treatment, stimulate interest in research regarding its early prevention and intervention. Interventions based on information and communication technologies (ICT), given their flexibility and capacity for dissemination, represent innovative opportunities; however, in Latin America there is little evidence on their impact and efficacy. Objective and Methods: a quasi-experimental quantitative pilot study was carried out to evaluate the feasibility, through the variables of use and acceptability, and the estimated effect of the Internet-based program "Cuida tu Ánimo", in 215 adolescents (103 active group, 112 control group) from two educational institutions. The adolescents' interactions with the program, its use-acceptability, and the level of depressive symptomatology and other related aspects were evaluated. Results: the adolescents report high acceptance and very moderate use of the Program. They point out that the program allowed them to learn about depression and early detection of risk; also, they recommend increasing the interactivity of the web platform, designing more diverse and entertaining content, and increasing the presence of the intervention. Conclusions: Internet-based programs such as Cuida tu Ánimo can be a favorable complement for the prevention and early intervention of depression in adolescents. Considering the difficulty in relating the estimation of the Program's effect with its use, it is recommended that future studies include a design that permits associating the use indicators with the outcome indicators (dose-effect).

Aproximación al consumo de alimentos recomendables y no recomendables en la primera ola de la pandemia por Covid-19 en México.

OBJETIVO: Estimar la frecuencia con la que se consumen algunos alimentos recomendables y no recomendables du-rante la pandemia por Covid-19 en México, y su asociación con características sociodemográficas y seguridad alimentaria. Material y métodos. Se analizó la Encuesta de Seguimien-to de los Efectos del Covid en el Bienestar de los Hogares Mexicanos (Encovid-19). Se identificaron cuatro grupos con información de la frecuencia de su consumo y se estimaron modelos de regresión logística ajustando por características sociodemográficas y seguridad alimentaria. RESULTADOS: Los niveles socioeconómicos más altos A/B y C se asociaron con una mayor frecuencia de consumo de alimentos recomenda-bles y no recomendables. La inseguridad leve se asoció con un menor consumo de alimentos recomendables, y la inseguridad moderada y severa se asociaron con un menor consumo de todos los grupos estudiados. CONCLUSIONES: Comprender la experiencia de la inseguridad alimentaria durante una cri-sis como la pandemia puede indicar la necesidad de incluir grupos de población tradicionalmente no considerados en los programas de apoyo.

Quantifying the Probing and Selection of Microenvironmental Pores by Motile Immune Cells.

Immune cells are constantly on the move through multicellular organisms to explore and respond to pathogens and other harmful insults. While moving, immune cells efficiently traverse microenvironments composed of tissue cells and extracellular fibers, which together form complex environments of various porosity, stiffness, topography, and chemical composition. In this protocol we describe experimental procedures to investigate immune cell migration through microenvironments of heterogeneous porosity. In particular, we describe micro-channels, micro-pillars, and collagen networks as cell migration paths with alternative pore size choices. Employing micro-channels or micro-pillars that divide at junctions into alternative paths with initially differentially sized pores allows us to precisely (1) measure the cellular translocation time through these porous path junctions, (2) quantify the cellular preference for individual pore sizes, and (3) image cellular components like the nucleus and the cytoskeleton. This reductionistic experimental setup thus can elucidate how immune cells perform decisions in complex microenvironments of various porosity like the interstitium. The setup further allows investigation of the underlying forces of cellular squeezing and the consequences of cellular deformation on the integrity of the cell and its organelles. As a complementary approach that does not require any micro-engineering expertise, we describe the usage of three-dimensional collagen networks with different pore sizes. Whereas we here focus on dendritic cells as a model for motile immune cells, the described protocols are versatile as they are also applicable for other immune cell types like neutrophils and non-immune cell types such as mesenchymal and cancer cells. In summary, we here describe protocols to identify the mechanisms and principles of cellular probing, decision making, and squeezing during cellular movement through microenvironments of heterogeneous porosity. © 2022 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Immune cell migration in micro-channels and micro-pillars with defined pore sizes Support Protocol 1: Epoxy replica of generated and/or published micro-structures Support Protocol 2: Dendritic cell differentiation Basic Protocol 2: Immune cell migration in 3D collagen networks of variable pore sizes.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

resumen está disponible en el texto completo

Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

Rapid communication: effects of cadmium exposure on the growth-related genes of Daphnia magna.

Few data are available regarding the effects of gene expression on growth in Daphnia magna. The aim of this study was to determine the influence of cadmium (Cd) exposure on global gene transcription and growth-related genes in D. magna using RNASeq generated data. Our results demonstrated that Cd exposure decreased gene expression, but did not adversely affect the expression of growth-related genes, suggesting differential allocation of resources to growth avoids the deleterious effect of the toxicant on this trait.

Evaluación de la percepción de riesgo cardiovascular en mujeres posterior a un programa de rehabilitación cardíaca / Perception of cardiovascular risk in women after a rehabilitation program

RESUMEN: Introducción: La rehabilitación cardíaca después de padecer un evento cardiovascular (CV) grave es un proceso en el cual el paciente establece una relación cercana con el equipo médico, brindando la oportunidad de conocer factores psicosociales que influyeron en el desenlace cardíaco y los eventuales aprendizajes de la experiencia. El objetivo de este estudio fue conocer la percepción sobre su propia salud de mujeres que participaron de un programa de rehabilitación cardíaca. Método: Se invitó a participar a 35 mujeres de 35 a 75 años con diverso nivel educativo, ingreso familiar y situación laboral. Los datos se recolectaron por medio de entrevistas presenciales semiestructuradas. Resultados: A pesar de haber pasado por un proceso de rehabilitación posterior a un evento CV las mujeres mencionaron en forma mayoritaria al cáncer de mama como la principal eventual causa de muerte. En relación con los factores de riesgo de CV, el más nombrado fue el estrés (57%), aunque solo el 29% de las entrevistadas realizó con posterioridad actividades orientadas a su manejo y control. En cuanto a las motivaciones más frecuentes para realizar cambios de hábitos, destacaron el cuidado de la familia (29%), el vivir más (26%) y el deseo de sentirse mejor (23%). Conclusión: Estos resultados sugieren la necesidad de una educación más integral en la mujer durante la rehabilitación, promoviendo no solo hábitos más saludables desde el punto de vista físico, sino también psicológico. Se sugiere integrar el manejo del estrés en los programas de prevención y rehabilitación CV.

ABSTRACT: Introduction: After suffering a serious cardiovascular event (CV), cardiac rehabilitation is a process in which the patient establishes a close relationship with the medical team, providing an opportunity to learn about psychosocial factors that influence cardiac outcome and eventual learnings from the experience. The objective of this study was to learn about women´s perception of their own health after participating in a cardiac rehabilitation program. Method: 35 women from 35 to 75 years of age with varying educational level, household income and employment status were invited to participate. Data was collected through semi-structured face-to-face interviews. Results: Women mentioned breast cancer as the leading cause of death (60%) despite having gone through a post-CV rehabilitation process. Stress was mentioned as the main CV risk factor (57%). Only 29% of responders subsequently carried out activities aimed at their management and control. The most common motivations for making changes in habits, were family care (29%), living longer (26%) and a desire to feel better (23%). Conclusion: These results suggest the need for a more comprehensive education in women during rehabilitation, promoting not only healthier habits from a physical but also from a psychological points of view. The introduction of stress management into CV prevention and rehabilitation programs is suggested.

Prescripciones de benzodiacepinas y barbitúricos en Costa Rica 2011-2015 / Benzodiazepines and barbiturates prescriptions in Costa Rica 2011-2015 / Prescriçãode benzodiazepinas e barbitúricos na Costa Rica 2011-2015 / Prescriptions de benzodiazépines et de barbituriques au Costa Rica 2011-2015

Resumen Objetivo Identificar la prescripción de benzodizepinas y barbitúricos psicotrópicos: Clobazam, Tiopental, Clonazepam, Lorazepam, Fenobarbital y Diazepam en la Caja Costarricense del Seguro Social (CCSS) en Costa Rica en el periodo 2011-2015. Materiales y métodos La población estuvo constituida por 1 488 989 prescripciones de psicotrópicos dentro de la CCSS en Costa Rica en el periodo de enero del 2011 a diciembre del 2015. El estudio es de tipo descriptivo retrospectivo. Resultados Del total analizado, casi la mitad (un 47,15%) corresponden a Clonazepam. Le siguen el Lorazepam y el Diazepam con un 22,80% y un 22,53%, respectivamente. Finalmente, Fenobarbital, Clobazam y Tiopental son las menos prescritas con un 7,07%, 0,24% y 0,22% respectivamente. En cuanto a la distribución por sexo las mujeres recibieron el 62,65% de las prescripciones, el restante 37,35% fueron para hombres. Conclusión Existe un aumento exponencial en el consumo de estos fármacos en el quinquenio en estudio. Las personas al final de su ciclo productivo (40 años o más) alcanzan los mayores porcentajes de consumo que luego decrecen alrededor de los 70 años o más; las mujeres son a quienes más se les prescriben este tipo de medicamentos. Por tanto, es necesaria una monitorización continúa que favorezca un uso adecuado de estos fármacos y evite generar potenciales problemas a la salud de la población especialmente a los adultos mayores.

Abstract Objective To identify the prescription of benzodiazepines and psychotropic barbiturates: Clobazam, Thiop ental, Clonazepam, Lorazepam, Phenobarbital and Diazepam at the Costa Rican Social Security Fund (CCSS) in Costa Rica in the period 2011-2015. Materials and methods The population was constituted by 1 488 989 prescriptions of psychotropics within the CCSS in Costa Rica in the period from January 2011 to December 2015. The study is of a retrospective descriptive type. Results Of the total analyzed, almost half (47.15%) corresponded to Clonazepam. It is followed by Lorazepam and Diazepam with 22.80% and 22.53%, respectively. Finally, Phenobarbital, Clobazam and Thiopental are the least prescribed with 7.07%, 0.24% and 0.22% respectively. In terms of gender distribution, women received 62.65% of prescriptions, while the remaining 37.35% were for men. Conclusion There is an exponential increase in the consumption of these drugs in the five-year period under study. People at the end of their productive cycle (40 years or more) reached the highest percentages of consumption, which then fell to around 70 years or more; women were prescribed this type of drug the most. Therefore, continuous monitoring is necessary in order to promote the adequate use of these drugs and avoid generating potential health problems in the population, especially among the elderly.

Resumo Objectivo Identificar a prescrição de benzodiazepinas e barbitúricos psicotrópicos: Clobazam, Thiopental, Clonazepam, Lorazepam, Phenobarbital e Diazepam no Fundo de Seguraba Social da Costa Rica (CCSS), na Costa Rica, no período 2011-2015. Materiais e métodos A população foi constituida por 1 488 989 prescribes de psicotrópicos dentro do CCSS na Costa Rica, no período de Janeiro de 2011 a Dezembro de 2015. O estudo é de tipo descritivo retrospectivo. Resultados Do total analisado, quase metade (47,15%) correspondia ão Clonazepam. Segue-se Lorazepam e Diazepam com 22,80% e 22,53%, respectivamente. Finalmente, Phenobarbital, Clobazam e Thiopental são os menos prescritos com 7,07%, 0,24% e 0,22%, respectivamente. Em termos de distribuição por género, as mulheres receberam 62,65% das receitas, enquanto os restantes 37,35% foram para os homens. Conclusão Verifica-se um aumento exponencial do consumo destes medicamentos no periodo de cinco anos em estudo. As pessoas no final do seu ciclo produtivo (40 anos ou mais) atingiram as percentagens mais elevadas de consumo, que depois diminuíram para cerca de 70 anos ou mais; as mulheres foram as que mais receitaram este tipo de medicamentos. Por conseguinte, é necessário um acompanhamento continuo a fim de promover o uso adequado destes medicamentos e evitar a criação de potenciais problemas de saúde na população, especialmente entre os idosos.

Résumé Objectif Identifier la prescription de benzodiazépines et de barbituriques psychotropes : Clobazam, Thiopental, Clonazepam, Lorazepam, Phenobarbital et Diazepam, dans les établissements de la Caisse Costaricienne de Sécurité Sociale (CCSS), au Costa Rica, durant la période 2011-2015. Matériels et méthodes La population a été constituée de 1 488 989 prescriptions de psychotropes au sein de la CCSS au Costa Rica durant la période de janvier 2011 a décembre 2015. L'étude est de type descriptif rétrospectif. Résultats Sur le total des prescriptions analysées, pres de la moitié (47,15 %) correspondent au Clonazépam. Viennent ensuite le Lorazépam et le Diazépam (22,80 % et 22,53 % respectivement). Enfin, le Phénobarbital, le Clobazam et le Thiopental sont les moins prescrits (7,07%, 0,24% et 0,22% respectivement). En termes de distribution par sexe, les femmes ont reçu 62,65 % des prescriptions, les 37,35 % restants ont été destinés aux hommes. Conclusion On observe une augmentation exponentielle de la consommation de ces substances au cours des cinq années a l'étude. Les pourcentages de consommation les plus élevés correspondent aux personnes arrivant a la fin de l'étape du cycle de vie généralement la plus productive (40 ans ou plus) ; ils diminuent ensuite aux alentours de 70 ans ou plus. Les femmes reçoivent plus fréquemment ce type de prescriptions. Une surveillance continue est donc nécessaire afin de promouvoir l'utilisation adéquate de ces substances et d'éviter de générer d'éventuels problemes de santé dans la population, en particulier chez les personnes âgées.

Prescripción de lorazepam dentro de la caja Costarricense del seguro social / Prescription of lorazepam within the Costa Rican social insurance Prescrição de lorazepam no fundo de seguro social da Costa Rica / Prescrição de lorazepam no fundo de seguro social da Costa Rica

Objetivo: describir la prescripción de lorazepam dentro de la caja Costarricense del seguro social. Método: el estudio es descriptivo y retrospectivo, de enero de 2011 a diciembre de 2015. La investigación consistió en 339,484 prescripciones de lorazepam. El tratamiento estadístico de los datos se centró en las estadísticas descriptivas de las cinco unidades generadas a partir de las variables, que fueron analizadas por el programa R. Resultados: se observó un aumento exponencial en la prescripción de lorazepam durante el período investigado. El lorazepam ha sido indicado principalmente para adultos mayores de 60 años. Para todos los grupos de población se encontraron recetas por encima de la dosis diaria definida. Las prescripciones fueron realizadas principalmente por médicos generales y en áreas rurales. Conclusión: en vista de este escenario, es necesario revisar las estrategias de prescripción, dispensación y seguimiento para los usuarios de este medicamento, a fin de evitar efectos adversos y daños a la salud de la clientela.

Objective: to describe the prescription of lorazepam in the social insurance fund of Costa Rica. Method: the study is descriptive and retrospective, from January 2011 to December 2015. The investigation consisted of 339,484 lorazepam prescriptions. The statistical treatment of the data was focused on the descriptive statistics of the five units generated from the variables, which were analyzed by the R program. Results: exponential increase in lorazepam prescription was observed during the investigated period. Lorazepam has been mainly indicated for adults over 60 years old. For all population groups prescriptions above the defined daily dose were found. The prescriptions were performed mainly by general practitioners and in rural areas. Conclusion: In view of this scenario, there is a need to review the prescription, dispensing and follow-up strategies for users of this medication, in order to avoid adverse effects and harm to clientele's health.

Objetivo: descrever a prescrição de lorazepam no fundo de seguro social da Costa Rica. Método: o estudo é descritivo e retrospectivo. A investigação foi constituída por 339.484 prescrições de lorazepam. O tratamento estatístico dos dados foi focado na estatística descritiva das cinco unidades geradas, a partir das variáveis, que foram analisadas pelo programa R. Resultados: foi verificado aumento exponencial na prescrição de lorazepam durante o periodo investigado. O lorazepam foi indicado principalmente para idosos de 60 anos. Para todos os grupos populacionais foram encontradas prescrições acima da dose diária definida. As prescrições foram realizadas principalmente por médicos generalistas e em áreas rurais. Conclusão: frente a este cenário, há necessidade de rever as estratégias de prescrição, dispensação e acompanhamento aos usuários dessa medicação, a fim de evitar efeitos adversos e prejuízos para a saúde da clientela.

Percepción sobre mortalidad cardiovascular femenina en trabajadoras de la salud / Perception of cardiovascular disease as a cause of mortality among working women

ABSTRACT BACKGROUND: Most women perceive oncological disease as their principal cause of death. However, it has been shown that cardiovascular disease (CVD) is currently the leading cause of mortality in women in developed countries. Aim: to evaluate how this perception has changed in relation to health education campaigns present in Chile during the study period. Method: A survey was performed in 2007 (n= 409) and repeated in 2016 (n=431), including women working at a health institution, divided in 2 groups: professionals with a university degree (U) or health administrative and technical workers (W). The overall perception of CVD as a cause of death increased from 20% in 2007 to 37% in 2016 (p<0.01). The increase in the % of women perceiving CVD as main cause of death was greater in W women (14% to 34%, p<0.01) than in U women (39% to 44%, NS). Oncological diseases, mainly breast cancer, continued to be perceived as the main mortality cause in both groups of women in 2016. Conclusion: Although significant, the increase in % of women naming CVD as the main cause of death at a health institution was relatively small. Campaigns to increase the awareness of the significance of CVD in women should probably be revised.

Ejercicio: una herramienta clave en la prevención cardiovascular: Consenso de la Sociedad Chilena de Cardiología y Cirugía Cardiovascular y de la Sociedad Chilena de Kinesiología en Cardiología y Cirugía Cardiovascular / Excercise, a key intervention in Cardiovascular Prevention: Consensus of the Chilean Society of Cardiology and Cardiovascular Surgery and the Chilean Society of Kinesiology in Cardiology and Cardiovascular Surgery

This is a Document from de Chilean Society of Cardiology and Cardiovascular Surgery, along with the Chilean Society of Physical Therapy of Cardiology and Cardiovascular Surgery.

Circulating microparticles in cardiovascular disease: going on stage!

Context: Cardiovascular diseases (CVDs) are the leading cause of death worldwide. In spite of the fact that treatments are based on risk calculators which in turn are based on population characteristics, it is well known that these methods have definite levels of uncertainty. Recently, more precise diagnostic or predictive methods have been developed based on indicators of vascular and/or cardiac damage in order to supplement this risk evaluation. Objective: In this review, we describe the main discoveries leading to the idea of using circulating microparticles as a promising and complementary tool in the evaluation of cardiovascular risk. Methods: A Medline search for the terms cardiovascular diseases, microparticles, miRNAs, diagnosis, prognosis, biomarkers and microvesicles was performed. Results: We found (i) nine articles, which were relevant to forming the idea of using microparticles as biomarkers in CVDs, and (ii) 15 and 12 experimental clinical studies which describe their potential in primary and secondary CVD prevention, respectively. Conclusions: The levels of circulating microparticles have been associated with cardiovascular damage in asymptomatic patients as well as in patients who suffered a cardiovascular event, becoming promising diagnostics or prediction biomarkers in recent years.

Percepción en médicos del impacto de la enfermedad cardiovascular en la mortalidad femenina / Knowledge among physicians of the main cause of death in women

Background: There is a misconception that the main cause of death among women is breast cancer, even among physicians, who may neglect cardiovascular preventive measures in this gender Aim: To assess the knowledge among physicians about the main cause of death among women. Material and methods: A survey was answered by 231 physicians attending a Cardiology and a Gynecology Meeting. Results: Sixty eight percent of respondents indicated that cardiovascular diseases are the main cause of death among women. A higher proportion of specialists than trainees, answered correctly the question (72 and 56% respectively). No gender differences in the answers were recorded. Conclusions: The knowledge about cardiovascular risk in women should be reinforced among physicians.

Prescripción de clonazepam en Costa Rica / Prescription of clonazepam in Costa Rica

Las benzodiazepinas son un grupo de medicamentos prescritos para varios problemas de salud como lo son el insomnio y la ansiedad. Dentro del grupo de medicamentos que conforman las benzodiazepinas se encuentra el clonazepam cuya indicación terapéutica principal es como anticonvulsivante; sin embargo, se utiliza también en trastorno del pánico, trastornos de ansiedad, en caso de manía aguda y para facilitar el tratamiento de la abstinencia de otras benzodiazepinas. El objetivo de la presente investigación es describir el comportamiento en la prescripción del clonazepam dentro de la Caja Costarricense del Seguro Social (CCSS) en el periodo del 2011 al 2015. La población de la presente investigación estuvo constituida por 701.999 prescripciones de clonazepam dentro de la CCSS en Costa Rica. Se enmarca en una investigación cuantitativa exploratoria. Dentro de los resultados se encontró que en la composición de las prescripciones por sexo del paciente, el 33,90% de estas fueron prescritas para hombres. Este medicamento fue prescrito mayoritariamente por médicos generales y en términos generales las dosis prescritas están por debajo de la DDD establecida para este medicamento. Dentro de las principales conclusiones se encuentra la necesidad de mayor investigación sobre la temática para profundizar los hallazgos de la presente investigación

Benzodiazepines are a group of medications prescribed for various health problems such as insomnia and anxiety. Clonazepam is part of the group of drugs that form benzodiazepines. Its main therapeutic indication is as an anticonvulsant; it is however also used in panic disorder, anxiety disorders, in cases of acute mania and to facilitate the withdrawal from other benzodiazepines. The objective of the present investigation is to describe the behavior in the prescription of clonazepam within the Caja Costarricense del Seguro Social (CCSS) in the period from 2011 to 2015. The population of the present investigation was constituted by 701,999 prescriptions of clonazepam within the CCSS in Costa Rica. It is part of a piece of exploratory quantitative research. Within the results it was found that in the composition of the prescriptions by patient’s sex, 33.90% of these were prescribed for men. This medication was prescribed mostly by general practitioners and in general terms the prescribed doses are below the DDD defined for this medication. One of the main conclusions is the need for more research on the subject in order to extend the findings of this work

[Knowledge among physicians of the main cause of death in women]. / Percepción en médicos del impacto de la enfermedad cardiovascular en la mortalidad femenina.

BACKGROUND: There is a misconception that the main cause of death among women is breast cancer, even among physicians, who may neglect cardiovascular preventive measures in this gender Aim: To assess the knowledge among physicians about the main cause of death among women. MATERIAL AND METHODS: A survey was answered by 231 physicians attending a Cardiology and a Gynecology Meeting. RESULTS: Sixty eight percent of respondents indicated that cardiovascular diseases are the main cause of death among women. A higher proportion of specialists than trainees, answered correctly the question (72 and 56% respectively). No gender differences in the answers were recorded. CONCLUSIONS: The knowledge about cardiovascular risk in women should be reinforced among physicians.

Guías para la monitorización ambulatoria de presión arterial de 24 horas: documento de la Sociedad Chilena de Cardiología y Cirugía Cardiovascular / 24 hour blood pressure monitoring: recommendations from the Chilean Society of Cardiology and Cardiovascular Surgery

Abstracts: 24 hour blood pressure monitoring. Recommendations from the Chilean Society of Cardiology and Cardiovascular Surgery. The recommendations for blood pressure monitoring from the Chilean Society of Cardiology and Cardiovascular Surgery are analyzed. Emphasis is placed on indications for the procedure, according to different classes and causes of hypertension. Implications of different types of hypertension for prognosis and indications for adequate therapy are discussed.

Circulating miR-19b and miR-181b are potential biomarkers for diabetic cardiomyopathy.

Diabetic cardiomyopathy is characterized by metabolic changes in the myocardium that promote a slow and silent dysfunction of muscle fibers, leading to myocardium remodelling and heart failure, independently of the presence of coronary artery diseases or hypertension. At present, no imaging methods allow an early diagnosis of this disease. Circulating miRNAs in plasma have been proposed as biomarkers in the prognosis of several cardiac diseases. This study aimed to determine whether circulating miRNAs could be potential biomarkers of diabetic cardiomyopathy. Mice that were fed with a high fat diet for 16 months, showed metabolic syndrome manifestations, cardiac hypertrophy (without hypertension) and a progressive cardiac function decline. At 16 months, when maximal degree of cardiac dysfunction was observed, 15 miRNAs from a miRNA microarray screening in myocardium were selected. Then, selected miRNAs expression in myocardium (at 4 and 16 months) and plasma (at 4, 12 and 16 months) were measured by RT-qPCR. Circulating miR-19b-3p and miR-181b-5p levels were associated with myocardium levels during the development of diabetic cardiomyopathy (in terms of cardiac dysfunction), suggesting that these miRNAs could be suitable biomarkers of this disease in asymptomatic diabetic patients.

Acetaminofén intravenoso en el cierre del conducto arterioso permeable en prematuros / Intravenous acetaminophen in closure of patent ductus arteriosus in preterm infants

Reportamos el caso de tres recién nacidos de 26, 29 y 32 semanas de edad gestacional, con pesos de 810, 1.300 y 1.670 gr, respectivamente. A quienes se les diagnosticó clínicamente conducto arterioso permeable con repercusión hemodinámica. Se confirmó con ecocardiograma transtorácico, mostrando conducto arterioso de 1.5, 3,2 y 3.9 mm. Por sus condiciones clínicas inestables que contraindicaban cierre farmacológico convencional con antiinflamatorios no esteroideos (AINES), y alto riesgo quirúrgico. Se optó por cierre farmacológico con acetaminofén intravenoso a 15 mg/kg una dosis cada 6 horas. Control ecocardiográfico cada 24 horas, se corroboró el cierre total del conducto arterioso a los 3, 5 y 7 días de tratamiento, respectivamente. Se les realizó enzimas hepáticas 24 horas antes y 48 horas posteriores a la administración del acetaminofén. Todos tuvieron seguimiento clínico y ecocardiográfico al mes, 3 y 6 meses. Descartando la reapertura del conducto arterioso.

We report the case of three 26, 29 and 32 week-old newborns, with a birthweight of 810, 1,300 and 1,670 g respectively, who were clinically diagnosed with patent ductus arteriosus with hemodynamic repercussion. It was confirmed by means of a transthoracic echocardiogram that showed a ductus arteriosus of 1.5, 3.2 and 3.9 mm. Due to their unstable clinical condition, which contraindicated conventional pharmacological closure with nonsteroidal anti-inflammatory medications (NSAIDs) and posed a high surgical risk, it was decided to perform pharmacological closure with intravenous acetaminophen at 15 mg/kg, one dose every 6 hours. Echocardiographic control every 24 hours confirmed total closure of tha ductus arteriosus after 3, 5 and 7 treatment days respectively. Liver enzymes were analysed 24 hours before and 48 hours after administering acetaminophen. All of them had clinical and echocardiographic follow-ups after one, 3 and 6 months which ruled out any reopening of the ductus arteriosus.

Abordaje anterior a la columna cervical desde C3 a C7. técnica paso a paso / Approach anterior to the cervical spine from C3 to C7. step by step technique

Introducción: El abordaje cervical anterior es ampliamente utilizado en cirugía espinal para tratar patología degenerativa, infecciosa, traumática y tumoral como única vía o combinada.Objetivo: Describir la técnica del abordaje cervical anterior detallando las claves de cada paso a fin de guiar al neurocirujano en formación. Descripción de técnica: Se describen detalladamente los siguientes pasos: posicionamiento del paciente, elección del lado de abordaje, marcación, elección del instrumental adecuado, incisión de piel, disección de platisma, disección de fascia superficial, disección de fascia media, disección de fascia profunda, elementos neurovasculares a tener en cuenta, disección de fascia prevertebral y músculos prevertebrales, marcación de nivel bajo radioscopia, cierre. Discusión: Se analizan los siguientes puntos: elección del lado (ventajas y desventajas de cada lado), tipo de incisión (horizontal vs. vertical y alcance de las mismas), marcación anatómica vs radioscópica, ventajas y desventajas de colocación de drenaje durante el cierre. Conclusión: Se describió el abordaje con cada uno de sus pasos y tips para que el neurocirujano en formación utilice una guía detallada a la hora de realizarlo en su práctica diaria y de esa manera disminuir el margen de error.

Introduction: The anterior cervical approach is commonly used in spinal surgery to treat degenerative disease, infectious pathology, traumatic and tumors. Objective: to describe in detail the cervical anterior approach technique in order to guide the neurosurgeons.Technique description: position, side selection, approach planification, skin incision, superficial dissection, middle and Deep dissection, neurovascular components, closure. Discussion: advantages and disadvantages of side election, incision (horizontal vs vertical), radioscopic vs anatomic level location, drainage use.Conclusion: We described the cervical anterior approach technique to give neurosurgeons a guide and to make a safe surgery.