Conocimiento de las puérperas sobre los efectos perinatales del tabaquismo materno y factores sociodemográficos asociados al consumo / Knowledge of puerperal women about the effects rates of maternal smoking and factors sociodemographics associated with consumption

Objetivo. El tabaquismo materno es un factor de riesgo conductual, evitable y cuyos efectos perjudiciales alcanzan todo el ciclo vital del niño. El objetivo es valorar el conocimiento de una población de puérperas atendidas en el Hospital de la Línea de la Concepción, sobre los efectos perinatales del tabaquismo materno. Material y métodos. Estudio exploratorio, transversal (septiembre a noviembre de 2022). Muestreo consecutivo y aplicación de encuesta a 151 puérperas/ expedientes de neonatos, para recolectar información sociodemográfica, clínica obstétrica y del neonato, de consumo de tabaco y de conocimiento sobre efectos perinatales del tabaquismo materno con preguntas cerradas. Estadísticas descriptivas y comparación de grupos independientes con las pruebas t de Student y chi-cuadrado. Resultados. El consumo de tabaco previo al embarazo distinguió un 32% (48/151) de fumadoras. Se obtuvo un nivel global de aciertos entre el 45% y el 76,8%; mayor proporción de aciertos entre no fumadoras (rango 45,6-79,6%) que entre fumadoras (rango 37,5-72,9%). Para cada enunciado, el nivel de aciertos resultó sin diferencias (p>0,05) entre ambos grupos. Conclusiones. El nivel de conocimientos registrado no mostró diferencias entre fumadoras y no fumadoras. Se discuten alternativas para profundizar en la investigación y acciones integrales orientadas a reducir y eliminar el consumo de tabaco por la población femenina general y las mujeres embarazadas. (AU)

Objective. Maternal smoking is an avoidable behavioral risk factor whose harmful effects reach the entire life cycle of the child. The objective is to evaluate the knowledge of a population of puerperal women treated at the Hospital de la Linea de la Concepción (Cádiz, Spain), about the perinatal effects of maternal smoking. Material and methods. Exploratory, cross-sectional study –September to November 2022. Consecutive sampling and survey application to 151 puerperal women/newborn records, to collect sociodemographic, obstetric, and neonatal clinic information on tobacco use and knowledge about the perinatal effects of maternal smoking with closed questions. Descriptive statistics and comparison of independent groups with Student’s t and chi-square tests. Results . Tobacco use prior to pregnancy distinguished 32% (48/151) smokers. A level global of hits between45% and 76.8% was obtained; higher proportion of correct answers among non-smokers (range 45.6%-79.6%) than among smokers (range 37.5%-72.9%). For each statement, the level of correct answers was not different between both groups (p>0.05). Conclusions. The level of knowledge registered did not show differences between smokers and non-smokers. Alternatives are discussed to deepen the research and integral actions aimed at reducing and eliminating tobacco use by the general female population and pregnant women. (AU)

Uso de las reglas de Ottawa para medio pie y tobillo en un hospital de referencia en Perú / Use of Ottawa ankle rules in a referral hospital in Peru Perú

Objetivo: Evaluar la validez y seguridad de las reglas de Ottawa para medio pie y tobillo (ROmPT) en el servicio de urgencias de un hospital de referencia en Perú. Materiales y métodos: El estudio fue observacional, transversal con duración de 5 meses (de febrero a junio de 2016). La población fueron los pacientes mayores de 18 años con un traumatismo de pie y/o tobillo que acudieron al servicio de urgencias. Se realizó un muestreo no aleatorizado por conveniencia. Se aplicaron las ROmPT y se realizaron rayos X de pie y/o tobillo a los pacientes que cumplieron los criterios de inclusión y exclusión. Los datos fueron tabulados y analizados con el programa SPSS v. 20.0. Se calcularon medidas de validez diagnóstica (sensibilidad, especificidad), seguridad diagnóstica (valor predictivo positivo, valor predictivo negativo) y likelihood ratio positiva y negativa. Resultados: Se evaluaron 428 pacientes. El uso de las ROmPT obtuvo una sensibilidad del 97,2%, una especificidad del 30,3%, un valor predictivo positivo del 22,0%, un valor predictivo negativo del 98,2%, una likelihood ratio positiva de 1,39 y negativa de 0,09. Con la aplicación de las ROmPT, se evidenció una reducción del 31,2% del total de rayos X, que pudo generar un ahorro de 1.165$. Conclusiones: Se concluye que la validez y seguridad de las ROmPT en nuestro medio son comparables a las de estudios internacionales, con una posible reducción del uso de rayos X. Son necesarios estudios multicéntricos, con mayor tiempo de duración y cantidad de pacientes, para protocolizar el uso de este método en servicios de urgencias.(AU)

Objective: The aim of the study was to evaluate the validity and safety of Ottawa's ankle rules (OAR) in the urgency department of referral hospital in Peru. Materials and methods: An observational-transversal study was conducted for a duration of 5 months (April-June 2016). Target population were all patients older than 18 years with a foot and ankle injury who came to the urgency department. A convenience non-randomized sampling was used. The OAR test was applied and X-rays of the foot and/or ankle were performed in all patients who met the inclusion and exclusion criteria. The data obtained was analyzed using the SPSS 20.0 software. Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio positive and negative were calculated from statistical analysis. Results: A total of 428 patients were evaluated. The OAR test's sensitivity was 97.2%, specificity was 30.3%, positive predictive value was 22.0%, negative predictive value was 98.2%, likelihood ratio positive and negative were 1.39 and 0.09, respectively. With the application of the OAR test, a reduction of 31.2% of the total X-rays was evidenced, which could generate a saving of US $1165. Conclusions: In conclusion, OAR's validity and safety in our environment are comparable to international data, with a reduction in the unnecessary use of radiographs. Multicentric studies involving a larger sample and longer study time are necessary to protocolize OAR in emergency units.(AU)

Use of Ottawa ankle rules in a referral hospital in Peru / Uso de las reglas de Ottawa para medio pie y tobillo en un hospital de referencia en Perú

Objetivo: Evaluar la validez y seguridad de las reglas de Ottawa para medio pie y tobillo (ROmPT) en el servicio de urgencias de un hospital de referencia en Perú. Materiales y métodos: El estudio fue observacional, transversal con duración de 5 meses (de febrero a junio de 2016). La población fueron los pacientes mayores de 18 años con un traumatismo de pie y/o tobillo que acudieron al servicio de urgencias. Se realizó un muestreo no aleatorizado por conveniencia. Se aplicaron las ROmPT y se realizaron rayos X de pie y/o tobillo a los pacientes que cumplieron los criterios de inclusión y exclusión. Los datos fueron tabulados y analizados con el programa SPSS v. 20.0. Se calcularon medidas de validez diagnóstica (sensibilidad, especificidad), seguridad diagnóstica (valor predictivo positivo, valor predictivo negativo) y likelihood ratio positiva y negativa. Resultados: Se evaluaron 428 pacientes. El uso de las ROmPT obtuvo una sensibilidad del 97,2%, una especificidad del 30,3%, un valor predictivo positivo del 22,0%, un valor predictivo negativo del 98,2%, una likelihood ratio positiva de 1,39 y negativa de 0,09. Con la aplicación de las ROmPT, se evidenció una reducción del 31,2% del total de rayos X, que pudo generar un ahorro de 1.165$. Conclusiones: Se concluye que la validez y seguridad de las ROmPT en nuestro medio son comparables a las de estudios internacionales, con una posible reducción del uso de rayos X. Son necesarios estudios multicéntricos, con mayor tiempo de duración y cantidad de pacientes, para protocolizar el uso de este método en servicios de urgencias.(AU)

Objective: The aim of the study was to evaluate the validity and safety of Ottawa's ankle rules (OAR) in the urgency department of referral hospital in Peru. Materials and methods: An observational-transversal study was conducted for a duration of 5 months (April-June 2016). Target population were all patients older than 18 years with a foot and ankle injury who came to the urgency department. A convenience non-randomized sampling was used. The OAR test was applied and X-rays of the foot and/or ankle were performed in all patients who met the inclusion and exclusion criteria. The data obtained was analyzed using the SPSS 20.0 software. Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio positive and negative were calculated from statistical analysis. Results: A total of 428 patients were evaluated. The OAR test's sensitivity was 97.2%, specificity was 30.3%, positive predictive value was 22.0%, negative predictive value was 98.2%, likelihood ratio positive and negative were 1.39 and 0.09, respectively. With the application of the OAR test, a reduction of 31.2% of the total X-rays was evidenced, which could generate a saving of US $1165. Conclusions: In conclusion, OAR's validity and safety in our environment are comparable to international data, with a reduction in the unnecessary use of radiographs. Multicentric studies involving a larger sample and longer study time are necessary to protocolize OAR in emergency units.(AU)

How we approach the treatment of patients with high-risk neuroblastoma with naxitamab: experience from the Hospital Sant Joan de Déu in Barcelona, Spain.

Naxitamab [humanized 3f8 (hu3F8)] is a humanized monoclonal antibody (mAb) targeting the disialoganglioside GD2. It was approved in 2020 by the United States Food and Drug Administration (FDA) in combination with granulocyte-macrophage colony-stimulating factor (GM-CSF) for treatment of pediatric and adult patients with relapsed/refractory high-risk neuroblastoma, limited to the bone or bone marrow (BM). The team at Sant Joan de Déu Children's Hospital in Barcelona, Spain, have been using naxitamab to treat neuroblastoma under clinical trial protocols [e.g. Trial 201, and hu3F8, irinotecan, temozolomide, and sargramostim (GM-CSF) (HITS) study] and compassionate use since 2017. The team has experience with two primary regimens: naxitamab with GM-CSF only, or naxitamab in combination with irinotecan, temozolomide, and GM-CSF (chemoimmunotherapy). This article aims to provide a practical overview of the team's experience with naxitamab to date, including preparing the treatment room and selecting the team. Adverse event management, including the use of ketamine to manage pain during anti-GD2 mAb infusions, is also discussed. We hope this will provide practical information for other health care providers considering offering this treatment.

Rates of Epidural Blood Patch following Lumbar Puncture Comparing Atraumatic versus Bevel-Tip Needles Stratified for Body Mass Index.

BACKGROUND AND PURPOSE: Postdural puncture headache, a known complication of lumbar puncture, typically resolves with conservative management. Symptoms persist in a minority of patients, necessitating an epidural blood patch. One method of decreasing rates of postdural puncture headache is using atraumatic, pencil-point needles rather than bevel-tip needles. To the best of our knowledge, this is the first study comparing epidural blood patch rates between pencil- and bevel-tip needles with a subgroup analysis based on body mass index. MATERIALS AND METHODS: This single-institution retrospective study identified 4435 patients with a recorded body mass index who underwent a lumbar puncture with a 22-ga pencil-tip Whitacre needle, a 20-ga bevel-tip Quincke needle, or a 22-ga Quincke needle. The groups were stratified by body mass index. We compared epidural blood patch rates between 22-ga pencil-tip Whitacre needles versus 22-ga Quincke needles and 22-ga Quincke needles versus 20-ga bevel-tip Quincke needles using the Fischer exact test and χ2 test. RESULTS: Postdural puncture headache necessitating an epidural blood patch was statistically more likely using a 22-ga Quincke needle in all patients (P < .001) and overweight (P = .03) and obese (P < .001) populations compared with using a 22-ga pencil-tip Whitacre needle. In the normal body mass index population, there was no statistically significant difference in epidural blood patch rates when using a 22-ga pencil-tip Whitacre needle compared with a 22-ga Quincke needle (P = .12). There was no significant difference in epidural blood patch rates when comparing a 22-ga Quincke needle versus a 20-ga bevel-tip Quincke needle in healthy (P = .70), overweight (P = .69), or obese populations (P = .44). CONCLUSIONS: Using a 22-ga pencil-tip Whitacre needle resulted in lower epidural blood patch rates compared with a 22-ga Quincke needle in all patients. Subgroup analysis demonstrated a statistically significant difference in epidural blood patch rates in overweight and obese populations, but not in patients with a normal body mass index.

[The methodology of calculation of indices of provision of population with beds of palliative medical care].

The enhancement of organization of palliative medical care to increase life quality of terminally ill patients is one of directions of development of health care system. To elaborate measures of improving accessibility and quality of palliative medical care, it is necessary to apply single unified methodology of calculating indices and criteria. One of them is provision of bed capacity. The purpose of the study is to elaborate methodology of calculating control indices of provision population with beds to render palliative medical care. The indices are calculated on the basis of statistical processing of monitoring corresponding data in the subjects of the Russian Federation.

Noncoding RNAs as potential biomarkers for DIPG diagnosis and prognosis: XIST and XIST-210 involvement

Purpose Diffuse intrinsic pontine gliomas (DIPGs) are the most fatal primary brainstem tumors in pediatric patients. The identification of new molecular features, mediating their formation and progression, as non-coding RNAs (ncRNAs), would be of great importance for the development of effective treatments. Methods We analyzed the DIPGs transcriptome with the HTA2.0 array and it was compared with pediatric non-brainstem astrocytoma expression profiles (GSE72269). Results More than 50% of the differentially expressed transcripts were ncRNAs and based on this, we proposed a DIPGs ncRNA signature. LncRNAs XIST and XIST-210, and the HBII-52 and HBII-85 snoRNA clusters were markedly downregulated in DIPGs. qPCR assays demonstrated XIST downregulation in all non-brainstem astrocytomas, in a gender, age, and brain location-independent manner, as well as in DIPGs affecting boys; however, DIPGs affecting girls showed both downregulation and upregulation of XIST. Girls’ with longer survival positively correlated with XIST expression. Conclusions The involvement of ncRNAs in DIPGs is imminent and their expression profile is useful to differentiate them from non-neoplastic tissues and non-brain stem astrocytomas, which suggests their potential use as DIPG biomarkers. In fact, XIST and XIST-210 are potential DIPG prognostic biomarkers (AU)

Noncoding RNAs as potential biomarkers for DIPG diagnosis and prognosis: XIST and XIST-210 involvement.

PURPOSE: Diffuse intrinsic pontine gliomas (DIPGs) are the most fatal primary brainstem tumors in pediatric patients. The identification of new molecular features, mediating their formation and progression, as non-coding RNAs (ncRNAs), would be of great importance for the development of effective treatments. METHODS: We analyzed the DIPGs transcriptome with the HTA2.0 array and it was compared with pediatric non-brainstem astrocytoma expression profiles (GSE72269). RESULTS: More than 50% of the differentially expressed transcripts were ncRNAs and based on this, we proposed a DIPGs ncRNA signature. LncRNAs XIST and XIST-210, and the HBII-52 and HBII-85 snoRNA clusters were markedly downregulated in DIPGs. qPCR assays demonstrated XIST downregulation in all non-brainstem astrocytomas, in a gender, age, and brain location-independent manner, as well as in DIPGs affecting boys; however, DIPGs affecting girls showed both downregulation and upregulation of XIST. Girls' with longer survival positively correlated with XIST expression. CONCLUSIONS: The involvement of ncRNAs in DIPGs is imminent and their expression profile is useful to differentiate them from non-neoplastic tissues and non-brain stem astrocytomas, which suggests their potential use as DIPG biomarkers. In fact, XIST and XIST-210 are potential DIPG prognostic biomarkers.

[Assessment model for evaluating the preparedness plan for COVID-19 in a tertiary care hospital]. / Modelo de evaluación del plan de respuesta frente a la pandemia de COVID-19 en un hospital de tercer nivel.

BACKGROUND AND PURPOSE: During the first wave of the epidemic caused by SARS-CoV-2, hospitals have come under significant pressure. This scenario of uncertainty, low scientific evidence, and insufficient resources, has generated significant variability in practice between different health organisations. In this context, it is proposed to develop a standards-based model for the evaluation of the preparedness and response system against COVID-19 in a tertiary hospital. MATERIALS AND METHODS: The study, carried out at the University Hospital of Vall d'Hebron in Barcelona (Spain), was designed in two phases: 1) development of the standards-based model, by means of a narrative review of the literature, analysis of plans and protocols implemented in the hospital, a review process by expert professionals from the centre, and plan of action, and 2) validation of usability and usefulness of the model through self-assessment and hospital audit. RESULTS: The model contains 208 standards distributed into nine criteria: leadership and strategy; prevention and infection control; management of professionals and skills; public areas; healthcare areas; areas of support for diagnosis and treatment; logistics, technology and works; communication and patient care; and information and research systems. The evaluation achieved 85.2% compliance, with 42 areas for improvement and 96 good practices identified. CONCLUSIONS: Implementing a standards-based model is a useful tool to identify areas for improvement and good practices in COVID-19 preparedness and response plans in a hospital. In the current context, it is recommended to repeat this methodology in other non-hospital and public health settings.

In vitro redox activity of haemozoin and ß-haemozoin interacting with the following antimalarials: artemether, lumefantrine and quinine.

OBJECTIVE: Malaria parasites invade, grow and multiply inside erythrocytes and obtain nourishment from haemoglobin. Then, the released haem group is oxidized to haematin and inert dimeric haemozoin bio-crystals form, which provides the parasite a unique way to avoid the toxicity associated with the haem group. Therefore, antimalarial drugs are designed to inhibit dimer formation; however, recent electrochemical studies indicate that an inert dimer also promotes a toxic oxidizing environment. Therefore, this work explores drug reactivity in the presence of monomers and dimers to evaluate their contribution to redox activity. MATERIALS AND METHODS: Three medicines mixed with haemozoin or ß-haemozoin in carbon paste electrodes were tested using cyclic voltammetry. RESULTS: The data indicated again that the substances modify the natural redox state of haemozoin and ß-haemozoin. This effect could be attributed to the natural oxidation potential of the drugs. In addition, it was found that the oxidation potential decreased through quinine, lumefantrine and artemether with the same tendency in the presence of haemozoin but with less current density. Additionally, it was observed that the oxidation response between the monomer haemozoin and antimalarial drugs is carried out at more negative potentials. CONCLUSIONS: Together, the total results indicate that antimalarials per se can contribute to oxidation processes and that in combination with monomeric or dimeric haemozoin can increase or decrease the oxidizing power of the haemozoin forms. The various oxidizing environments suggest that the cell membranes can also be damaged by the unique presence of the antimalarial.

Factors associated with infection of primary total knee prosthesis in older adults in a referral hospital in Peru. 2012-2015. / Factores asociados a infección de prótesis total de rodilla primaria en adultos mayores en un hospital de referencia en Perú. 2012-2015.

OBJECTIVE: To determine the risk factors associated with prosthetic knee infection in elderly patients in a referral hospital in Peru. PATIENTS AND METHODS: A case and control study was performed. The calculated sample was 44 cases and 132 controls. The data were collected retrospectively from clinical records. U-Mann Whitney and Chi-square tests were performed in the comparison of cases and controls. Odds ratios (OR) were calculated in a binary logistic regression analysis to identify the risk factors, a P<.05 and a 95% confidence interval (CI) were considered significant. RESULTS: Significant (P<.05) risk factors evidenced in the bivariate analysis were obesity (OR=9.72; 95%CI: 4.47-21.14), smoking (OR=4.06; 95%CI: 1.59-10.39), rheumatoid arthritis (OR=4.66; 95%CI: 1.52-14.32), diabetes mellitus type2 (OR=5.63; 95%CI: 2.69-11.78), persistent drainage (OR=9.27; 95%CI: 3.85-22.31), superficial infection (OR=6.87; 95%CI: 3.25-14.49) and prolonged hospital stay (OR=4.67; 95%CI: 2.26-9.64). In the multivariate analysis where it was adjusted for confounding variables, it was determined that risk factors were obesity (ORa=9.14; 95%CI: 3.28-25.48), diabetes mellitus (ORa=3.77; 95%CI: 1.38-10.32), persistent drainage (ORa=4.64; 95%CI: 1.03-20.80) and superficial wound infection (ORa=27.35; 95%CI: 2.57-290.64). CONCLUSIONS: Risk factors for prosthetic knee infection identified in this study are preventable. The main risk factors were obesity, diabetes mellitus type2, superficial wound infection and persistent drainage, which were considered together or separately to be risk factors in the population studied.

[The attitude to health in modern family].

The purpose of survey is to identify behavioral characteristics in family life-style and intra-family educational practices in dynamics of observation as health indicator. The life-style is analyzed according the results of questionnaire survey of 297 respondents, fostering school age children. The comparative analysis of behavior of adults and children is carried out based on the results of questionnaire surveys in 2007 and 2013. The verbal affirmations concerning importance of health and observance of healthy life-style in family have no concordance with actual behavior. The deterioration of of family function in healthy generation fostering is established. About 36,7% of parents pay no attention to their children. The passivity concerning organization of comfortable domestic conditions and inadequate medical activity in children health support are manifested by parents. The responsibility of parents for health of their children decreases too. The changing of priorities in hierarchy of life values occurs. The health loses its primary value. The decreasing of health in adults and children is logical due to effect relationship between life-style and health.

Determination of the seroprevalence of Leptospira spp. and the main serovars circulating in cattle in the province of Manabí, Ecuador. / Determinación de la seroprevalencia de Leptospira spp. y los principales serovares circulantes en el ganado bovino en la provincia de Manabí, Ecuador.

Leptospirosis is a transmissible zoonotic disease caused by pathogenic strains of the genus Leptospira. Clinical signs in cattle are fever, haematuria, haemoglobinuria, meningitis, abortion, birth of weak calves and infertility; in the most severe cases, it can cause death to the animal. The few studies conducted in Ecuador, and in particular the province of Manabí, have revealed varying prevalence rates, ranging from 35.8% to 75%. The objective of this study is to determine the seroprevalence of leptospirosis in cattle and to ascertain the main serovars circulating in the province of Manabí. A cross-sectional epidemiological study was conducted from November 2015 to March 2016, for which seven cantons were selected at random and a total of 854 animals from 67 herds were investigated. The samples were processed in the laboratories of the Animal Diagnostics Directorate of the Ecuadorian Agency for Agriculture Quality Assurance (AGROCALIDAD) in Tumbaco, using the microscopic agglutination test. The sera were analysed to check whether they contained any of the eight serovars of Leptospira interrogans circulating most frequently in the country: Canicola, Hardjo, Pomona, Icterohaemorrhagiae, Grippotyphosa, Wolffi, Bratislava and Copenhageni. Overall seroprevalence at herd level was 97.01%, with the most common serovars being Pomona, Icterohaemorrhagiae, Grippotyphosa, Bratislava and Canicola. It was concluded that there is high seroprevalence at herd level in the province of Manabí.

La leptospirose est une maladie zoonotique infecto-contagieuse causée par des souches pathogènes du genre Leptospira. Chez les bovins, le tableau clinique de la maladie se caractérise par de la fièvre, une hématurie, une hémoglobinurie, une méningite, des cas d'avortement ou la naissance de veaux faibles et une infertilité ; dans les cas les plus graves, la maladie peut provoquer la mort de l'animal. En Équateur et plus précisément dans la province de Manabí, les rares études effectuées jusqu'à ce jour ont rapporté des taux de prévalence allant de 35,8 % à 75 %. Les auteurs présentent les résultats d'une étude visant à déterminer la prévalence sérologique de la leptospirose dans le cheptel bovin de la province de Manabí ainsi que les principaux sérovars présents. Une enquête épidémiologique transversale a été conduite de novembre 2015 à mars 2016 dans sept cantons choisis de manière aléatoire. Au total, 854 animaux appartenant à 67 élevages ont été testés. Les prélèvement ont été préparés par les laboratoires de la Direction du diagnostic vétérinaire de l'Agence équatorienne de la qualité agricole (AGROCALIDAD) de Tumbaco et soumis à une épreuve d'agglutination microscopique afin de déterminer s'ils contenaient l'un ou plusieurs des huit sérovars de Leptospira interrogans présents dans le pays, à savoir Canicola, Hardjo, Pomona, Icterohaemorrhagiae, Grippotyphosa, Wolffi, Bratislava et Copenhageni. La séroprévalence globale au niveau des troupeaux était de 97,01 %, les sérovars les plus fréquents étant Pomona, Icterohaemorrhagiae, Grippotyphosa, Bratislava et Canicola. Les auteurs en concluent que la séroprévalence au niveau des troupeaux est élevée dans la province de Manabí.

La leptospirosis es una enfermedad zoonótica infectocontagiosa causada por cepas patógenas del género Leptospira. En el ganado bovino, clínicamente se caracteriza por fiebre, hematuria, hemoglobinuria, meningitis, abortos y/o nacimiento de animales débiles e infertilidad, y, en los casos más graves, puede provocar la muerte de los animales. En Ecuador, y en concreto en la provincia de Manabí, los escasos estudios realizados denotan prevalencias variables, que van del 35,8% al 75%. El objetivo del presente estudio es determinar la seroprevalencia de la leptospirosis en el ganado bovino y conocer los principales serovares circulantes en la provincia de Manabí. Se realizó un estudio epidemiológico de tipo transversal en el período comprendido entre noviembre de 2015 y marzo de 2016, para el cual se seleccionaron siete cantones al azar y se investigaron un total 854 animales pertenecientes a 67 hatos. Las muestras se procesaron en los Laboratorios de la Dirección de Diagnóstico Animal de la Agencia Ecuatoriana para la Calidad del Agro (AGROCALIDAD) de Tumbaco utilizando la técnica de aglutinación microscópica, y los sueros se analizaron para comprobar si contenían cada uno de los ocho serovares de Leptospira interrogans de mayor circulación en el país: Canicola, Hardjo, Pomona, Icterohaemorrhagiae, Grippotyphosa, Wolffi, Bratislava y Copenhageni. La seroprevalencia general a nivel de hatos fue del 97,01%, siendo los más frecuentes los serovares Pomona, Icterohaemorrhagiae, Grippotyphosa, Bratislava y Canicola. Se llegó a la conclusión de que en la provincia de Manabí existe una alta seroprevalencia a nivel de hatos.

[Why Is It So Important to Invest into Breast-Feeding and How to Ameliorate Its Practice?]

Nowadays, the breast-feeding, despite the approved advantages, is not a standard in many communities. The multi-factorial determinants determining its prevalence need to be supported at various levels - from legal and legislative one to views and values of society, conditions of women's labor and also health care system that can develop a favorable environment for breast-feeding. The breast-feeding effects positively on health, economic development and ecology and therefor it is a benefit for children, women and whole society in short-term and long-term perspective. The defense, propaganda and support of breast-feeding need a political will, and financial investments to implement its advantages.

Prospective comparison among three intrarectal anesthetic treatments combined with periprostatic nerve block during transrectal ultrasonography-guided prostate biopsy.

BACKGROUND: Recent trends in prostate biopsy analgesia suggest a combination anesthetic to provide better pain relief than periprostatic nerve block (PPNB) alone. This study aimed to demonstrate the efficacy and safety of three intrarectal local anesthesia (IRLA) combined with PPNB in patients undergoing transrectal ultrasonography (TRUS)-guided prostate biopsy. METHODS: In this prospective, randomized study, 120 prostate biopsy patients were equally divided into four IRLA groups: group 1 (placebo) received simple lubrication; group 2 received 2% lidocaine gel; group 3 received 100 mg indomethacin suppository and group 4 received 5% prilocaine/lidocaine (EMLA) cream. PPNB with 2% lidocaine was applied in all groups. A ten-point visual analog scale evaluated both pain associated with the probe insertion and pain associated with prostate sampling. Adverse effects or complications due to anesthesia during and after the procedure were documented. RESULTS: Compared with group 1, groups 3 and 4 had significantly lower pain scores at both probe insertion and prostate sampling while group 2 showed no significant differences at both pain scores. Moreover, group 4 showed significantly lower pain scores at probe insertion compared to group 3, while no significant difference was observed at prostate sampling. Mild complications were observed in all groups with no significant difference in the incidence of complications between groups. CONCLUSION: Intrarectal application of EMLA cream is a more efficient pain reduction than either 2% lidocaine gel or 100 mg indomethacin suppository when applied combined with PPNB. This combination represents an effective option of pain relief for patients undergoing TRUS-guided prostate biopsy.

Chemical composition and physicochemical properties of Phaeodactylum tricornutum microalgal residual biomass.

The production of photosynthetic biofuels using microalgae is a promising strategy to combat the use of non-renewable energy sources. The microalgae residual biomass is a waste by-product of biofuel production; however, it could prove to have utility in the development of sustainable nutraceuticals and functional foods. In this study, a comprehensive characterisation of the under-utilised Phaeodactylum tricornutum microalgae residual biomass is presented. Proximal composition, antioxidant capacity (using three different antioxidant assays; oxygen radical absorbance capacity; radical cation activity, ABTS; and radical scavenging activity, DPPH), and total phenolic content of free and bound polyphenols were determined. Additionally, the physicochemical properties of water activity, pH, water absorption index, water solubility index, and dispersibility were evaluated. Results revealed that P. tricornutum microalgae residual biomass exhibits a relatively high protein and carbohydrate content, with values of 36.67% and 46.78%, respectively; and most carbohydrates were found as total dietary fibre (45.57%), of which insoluble dietary fibre was the most predominant (43.54%). Antioxidant capacity values for total phytochemicals of 106.22, 67.93, 9.54 µM TE g-1 dw were determined by oxygen radical absorbance capacity, ABTS, and DPPH assays, respectively. Total phenolic content was found to be 2.90 mg GAE g-1 dw. Interestingly, antioxidant capacity and total phenolic content were higher in bound than in free phytochemical extracts. The physicochemical analysis showed P. tricornutum microalgae residual biomass to have suitable properties for the generation of a beverage with Aw, pH, water absorption index, water solubility index, and dispersibility values of 0.45, 7.12, 3.40 g gel g-1 dw, 2.5 g solids 100 g-1 dw, and 90%, respectively. Hence, P. tricornutum microalgae residual biomass could be considered a potential source of bioactive compounds suitable for the production of functional food exhibiting antioxidant capacity and high dietary fibre content.

Thrombin generation as objective parameter of treatment response in patients with severe haemophilia A and high-titre inhibitors.

In Mexico, 15% of haemophilia A (HA) patients develop inhibitory alloantibodies in response to replacement therapy with factor VIII (FVIII), requiring bypass therapy such as activated prothrombin complex concentrate (APCC). Because bypass therapy has not been broadly available in Mexico even in recent years, this study aimed to evaluate the thrombin generation assay (TGA) in assessing the response to FVIII or APCC treatment in patients with severe HA positive to inhibitors. We studied 189 patients with severe HA. Clinical severity was verified by one-stage APTT-based clotting assay. Inhibitors to FVIII were investigated by the Nijmegen-Bethesda (N-B) method, and type of inhibition was assessed through serial plasma dilutions. Thrombin generation was measured with the calibrated automated thrombogram in inhibitor-positive plasmas previously spiked and incubated with FVIII or APCC. Data were analysed using anova, Student or Fisher's exact tests. We detected 47 (24.9%) subjects with high-titre (5-1700 N-B U mL(-1)) and 25 (13.2%) subjects with low-titre inhibitor antibodies (0.6-4.7 N-B U mL(-1)). We found an association between kinetic behaviour and clinical response to FVIII (P = 0.0049) or vs. FVIII response evaluated with TGA (P = 0.0007). Global concordance between clinical and in vitro response was 70%. By evaluating the capacity of thrombin formation in a plasma sample, TGA predicts the response to FVIII or APCC therapy and allows individual optimization of resources in patients with severe HA and high-titre inhibitors. The inhibition pattern of the antibodies to FVIII:C correlated with the TGA parameters and showed an association with the clinical response to FVIII.

Duplication of the Miller-Dieker Critical Region in a Patient with a Subtelomeric Unbalanced Translocation t(10;17)(p15.3;p13.3).

Submicroscopic duplications in the Miller-Dieker critical region have been recently described as new genomic disorders. To date, only a few cases have been reported with overlapping 17p13.3 duplications in this region. Also, small deletions that affect chromosome region 10p14→pter are rarely described in the literature. In this study, we describe, to our knowledge for the first time, a 5-year-old female patient with intellectual disability who has an unbalanced 10;17 translocation inherited from the father. The girl was diagnosed by subtelomeric FISH and array-CGH, showing a 4.43-Mb heterozygous deletion on chromosome 10p that involved 14 genes and a 3.22-Mb single-copy gain on chromosome 17p, which includes the critical region of the Miller-Dieker syndrome and 61 genes. The patient's karyotype was established as 46,XX.arr 10p15.3p15.1(138,206-4,574,436)x1,17p13.3(87,009-3,312,600)x3. Because our patient exhibits a combination of 2 imbalances, she has phenotypic features of both chromosome abnormalities, which have been reported separately. Interestingly, the majority of patients who carry the deletion 10p have visual and auditory deficiencies that are attributed to loss of the GATA3 gene. However, our patient also presents severe hearing and visual problems even though GATA3 is present, suggesting the involvement of different genes that affect the development of the visual and auditory systems.