External urology consultation quality at a third-level public hospital in Mexico.

INTRODUCTION: Patient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems. OBJECTIVE: To identify the quality of care in the Urology outpatient department of a third-level hospital. MATERIALS AND METHODS: The NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25min was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico. RESULTS: According to responses, 92% (n=230) knew the reason for the consultation. 64.8% (n=162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2h in 29.6% (n=74). As for consultation time, 212 patients responded and the duration was 11-20min in 52.8% (n=112). Finally, 33.2% (n=83) considered the quality of service to be good. CONCLUSIONS: The use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all.

Prospective study of the modified Atkins diet in adult drug-resistant epilepsy: effectiveness, tolerability, and adherence.

INTRODUCTION: Drug-resistant epilepsy presents high worldwide prevalence and is difficult to control despite the wide variety of available antiepileptic drugs (AED). The modified Atkins diet (MAD) is an additional treatment alternative. Several studies have addressed the use of the ketogenic diet and MAD in children with drug-resistant epilepsy, but insufficient research has been conducted into adults with the same condition. OBJECTIVE: To evaluate the effectiveness and tolerability of, and adherence to, the MAD in adults with drug-resistant epilepsy. MATERIAL AND METHODS: We conducted a 6-month pre-post prospective study at a reference hospital. Patients were prescribed the MAD with limited carbohydrate intake and unlimited fat intake. We conducted clinical and electroencephalographic follow-up according to the relevant guidelines, and assessed adverse effects changes in laboratory findings, and adherence. RESULTS: Thirty-two patients with drug-resistant epilepsy were included in the study. Patients' mean age was 30 years, mean disease progression time was 22 years, and all patients had focal or multifocal epilepsy. Thirty-four percent of patients presented > 50% decreases in overall seizure frequency (P =  .001); seizure control was greater in the first month and subsequently declined. These patients presented weight loss (RR: 7.2; 95% CI, 1.3-39.5; P = .02), good to fair adherence only in the first and third months (RR: 9.4; 95% CI, 0.9-93.6; P = .04 and RR: 0.4; 95% CI, 0.30-0.69; P = .02, respectively). Tolerability data showed that the MAD is safe: adverse effects were minor and short-lived in most cases, with the exception of mild to moderate hyperlipidaemia in one-third of patients. The adherence rate was 50% at the end of the study. CONCLUSIONS: In adults with drug-resistant focal epilepsy, the MAD showed adequate tolerability and moderate but decreasing effectiveness and adherence, probably due to a preference for a carbohydrate-based diet.

Poly (vinyl alcohol)/Silk Fibroin/Ag NPs composite nanofibers for bone tissue engineering.

In this work, electrospinning was used for the preparation of composite nanofibrous scaffold, of polyvinyl alcohol (PVA), silk fibroin (SF) extract of Bombyx mori cocoons and silver nanoparticles (Ag NPs), as a substrate for bone tissue engineering. The PVA pristine was prepared at a concentration of 10% wt. The composite nanofibers scaffolds of PVA was prepared with silk fibroin and silver nanoparticles, in relation of PVA: SF (90:10) (v/v) respectively. The formation and presence of AgNPs was confirmed by ultraviolet-visible spectroscopy (Uv-vis). The diameter distribution of the nanofibers was narrow by SEM using Image J software. The chemical composition was determined by FTIR spectra. The wettability was determined using water contact angle. The results showed the average nanofiber diameter of PVA10 pristine was 108.18 nm and to PVA10/SF/Ag NPs was 106.62 nm, no significant changes were noted in the mean diameter, but there were changes in its morphology. The average nanofiber diameter increase with the concentration of PVA at PVA15/SF/Ag NPs was 189.12 nm to PVA18/SF/Ag NPs was 224,23 nm. FTIR spectra indicated characteristic absorption peaks related to the chemical structure of PVA, fibroin and Ag NPs, it demonstrated good interactions between them, caused by strong intermolecular hydrogen bonds. The contact angle of the scaffolds PVA 10%wt decrease with the incorporation of fibroin and show hydrophilic characteristics. The achievements indicate the potential of the nanofibers of PVA15/SF/Ag NPs as a possible substitute for bone tissue engineering.Clinical Relevance-This establishes a possible substrate of PVA/SF/Ag NPs that exhibit desired properties such as porosity and high surface area to volume ratio for bone tissue engineering.

Evaluación de la calidad de vida relacionada con la visión posterior a queratoplastia penetrante / Evaluation of the quality of life related to vision after penetrating keratoplasty

INTRODUCCIÓN: La donación y el trasplante de órganos y tejidos representan el avance terapéutico más importante de los tiempos actuales. La córnea es, por mucho, uno de los tejidos más trasplantados a nivel mundial gracias a los privilegios inmunológicos encontrados en este tejido, además de los avances en microcirugía, la existencia de bancos corneales, la preservación de córneas y la aplicación de terapia contra el rechazo. Sin embargo, muchos pacientes con trasplantes corneales exitosos (con córneas claras) experimentan mala visión en el periodo postoperatorio por astigmatismo irregular u otras complicaciones. OBJETIVO: Evaluar la calidad de vida relacionada con la visión en pacientes sometidos a queratoplastia penetrante. MATERIAL Y MÉTODOS: Estudio transversal-analítico que incluye pacientes con antecedente de queratoplastia penetrante, mayores de 18 años y al menos 6 meses de posquirúrgico. Los pacientes respondieron el Visual Function Questionnaire25 (VFQ-25) de la función visual, instrumento validado para su uso en español, y en el que a mayor puntación mejor calidad de vida. RESULTADOS: Se incluyeron 30 pacientes (20 hombres y 10 mujeres), con una media de edad de 61,2 ± 18,7 años. El tiempo de evolución posterior al trasplante fue de 17,7 ± 4 meses. La puntuación total en la calidad de vida fue de 74,9 ± 21,9, con significación estadística en la agudeza visual (p < 0,001) y en la presencia de enfermedades sistémicas (p = 0,018). No hubo significación estadística en el motivo de trasplante (p= 0,098) ni en la presencia de enfermedades oculares (p = 0,119). CONCLUSIÓN: Los resultados sugieren que la agudeza visual, así como la presencia de enfermedades sistémicas, tienen un impacto significativo en la calidad de vida

INTRODUCTION: Organ and tissue donation and transplantation represent the most important therapeutic advance of current times. The cornea is, by far, one of the most transplanted tissues worldwide due to the immune privilege of this tissue, as well as the advances in microsurgery, existence of cornea banks, preservation of corneas, and use of anti-rejection therapy. However, many patients with successful corneal transplants (with clear corneas) experience poor vision in the post-operative period due to irregular astigmatism, or other complications. OBJECTIVE: To evaluate the quality of life related to vision in patients undergoing penetrating keratoplasty. MATERIAL AND METHODS: A cross-analytical study including patients with a history of penetrating keratoplasty, over 18years of age, and at least 6months after surgery. The patients answered the Visual Function Questionnaire25 (VFQ-25) of visual function, a tool validated for use in Spanish, in which the higher the score, the better the quality of life. RESULTS: Thirty patients (20 men and 10 women), with a mean age of 61.2 ± 18.7 years, were included. The time of evolution after the transplant was 17.7 ± 4 months. The total quality of life score was 74.9 ± 21.9, with significance in visual acuity (P < .001), and the presence of systemic comorbidities (P = .018). There was no significance between the transplant reason (P = .098) or ocular comorbidities (P = .119). CONCLUSION: The results suggest that visual acuity, as well as the presence of systemic comorbidities, has a significant impact on quality of life

Evaluation of the quality of life related to vision after penetrating keratoplasty. / Evaluación de la calidad de vida relacionada con la visión posterior a queratoplastia penetrante.

INTRODUCTION: Organ and tissue donation and transplantation represent the most important therapeutic advance of current times. The cornea is, by far, one of the most transplanted tissues worldwide due to the immune privilege of this tissue, as well as the advances in microsurgery, existence of cornea banks, preservation of corneas, and use of anti-rejection therapy. However, many patients with successful corneal transplants (with clear corneas) experience poor vision in the post-operative period due to irregular astigmatism, or other complications. OBJECTIVE: To evaluate the quality of life related to vision in patients undergoing penetrating keratoplasty. MATERIAL AND METHODS: A cross-analytical study including patients with a history of penetrating keratoplasty, over 18years of age, and at least 6months after surgery. The patients answered the Visual Function Questionnaire25 (VFQ-25) of visual function, a tool validated for use in Spanish, in which the higher the score, the better the quality of life. RESULTS: Thirty patients (20men and 10women), with a mean age of 61.2±18.7years, were included. The time of evolution after the transplant was 17.7±4months. The total quality of life score was 74.9±21.9, with significance in visual acuity (P<.001), and the presence of systemic comorbidities (P=.018). There was no significance between the transplant reason (P=.098) or ocular comorbidities (P=.119). CONCLUSION: The results suggest that visual acuity, as well as the presence of systemic comorbidities, has a significant impact on quality of life.

Characteristics of the puberty in hair ram lambs and its crosses in Colombia under low altitude conditions / Características de la pubertad en corderos de pelo y sus cruces en Colombia en condiciones de baja altitud

ABSTRACT Objective. Aimed to describe the characteristics of the onset of puberty in males in Colombian hair ram lambs (Ovino de Pelo Colombiano, OPC), and their crosses with Katahdin and Santa Inés sheep in a farm located in Villavicencio, Meta. Materials and methods. 15 lambs of three biotypes: OPC x OPC (OPC), Santa Ines x OPC (SO) and Katahdin X OPC (KO) from four until 12 months old. Ram lambs were grazing and they had supplementation with commercial salt and water ad libitum. Monthly body weight (BW), scrotal circumference (SC), testicular volume (TV) were measured and testosterone level were determined by Elisa test, and ultrasound of the two testicles was performed to determine the presence of the testicular mediastinum, also evaluating the presence and detachment of the urethral prolongation and then electro ejaculation was performed to determine the macroscopic and microscopic characteristics of the semen. Results. Genotype effect was significant for evolution of body BW, SC, TV over time. The SO and KO crosses presented the highest values in BW, whereas OPC lambs maintained a lower value until the end of the assay. At six months old, the three biotypes presented a minimum concentration of 150 million of sperm per ml with 30% of individual progressive motility. Conclusions. In non-seasonal tropical conditions in Colombia (Orinoquia), depending on the variables included, body weight, testicular development, pennis morphology, semen quality, sperm concentration and testosterone levels, it is postulated that around six months of age, the onset of puberty is displayed in the three biotypes.

RESUMEN Objetivo. Describir las características del inicio de la pubertad en corderos machos (Ovino de Pelo Colombiano, OPC) y sus cruces en una granja ubicada en Villavicencio, Meta. Materiales y métodos. Se evaluaron 15 corderos de tres razas: OPC x OPC (OPC), Santa Inés x OPC (SO) y Katahdin X OPC (KO), a partir de los cuatro meses de edad, cinco corderos por cruzamiento, manejados en pastoreo rotacional, con sal mineralizada comercial y agua a voluntad. Mensualmente hasta los doce meses de edad, se evaluó el peso corporal (PC), circunferencia escrotal (CE), volumen testicular (VT), y se determinó la concentración de testosterona en suero mediante la prueba de Elisa, se determinó la presencia del mediastino testicular mediante ecografía y se evalúo el desprendimiento de la prolongación uretral. Finalmente se determinaron las características macroscópicas y microscópicas del eyaculado. Resultados. El efecto racial o de cruzamiento fue significativo para los resultados del PC, CE y VT en el tiempo. Los cruces OPC y KO presentaron los valores más altos en PC, mientras que los corderos OPC mantuvieron un valor menor de PC hasta el final de la investigación. Se realizaron al menos cuatro evaluaciones seminales hasta la presentación de una concentración mínima de 150 millones de espermatozoides por ml con un 30% de motilidad progresiva individual. Conclusiones. En condiciones tropicales no estacionales en Colombia (Orinoquia), para las variables peso corporal, desarrollo testicular, morfología del pene, calidad del semen, concentración de espermatozoides y niveles de testosterona, se postula que alrededor de los seis meses de edad, se presenta el inicio de la pubertad en los tres biotipos.

Double-balloon enteroscopy: Indications, approaches, diagnostic and therapeutic yield, and safety. Early experience at a single center. / Enteroscopia de doble balón: indicaciones, abordajes, eficacia diagnóstica y terapéutica y seguridad. Experiencia temprana de un solo centro.

INTRODUCTION AND AIMS: Double-balloon enteroscopy has been improving the visualization of the entire intestine for more than a decade. It is a complementary method in the study of intestinal diseases that enables biopsies to be taken and treatments to be administered. Our aim was to describe its main indications, insertion routes, diagnostic/therapeutic yield, and complications. MATERIALS AND METHODS: All patients referred to our unit with suspected small bowel pathology were included. The insertion route (oral/anal) was determined through diagnostic suspicion. The variables measured were: insertion route, small bowel examination extent, endoscopic diagnosis/treatment, biopsy/histopathology report, complications, and surgical findings. RESULTS: The study included 28 double-balloon enteroscopies performed on 23 patients, of which 10 were women and 13 were men (mean age of 52.95 years). The oral approach was the most widely used (n=21), the main indication was overt small bowel bleeding (n=16), and the general diagnostic yield was 65.21%. The therapeutic intervention rate was 39.1% and the procedure was effective in all the cases. The most widely used treatment was argon plasma therapy (n=7). The complication rate was 8.6%; one patient presented with low blood pressure due to active bleeding and another had deep mucosal laceration caused by the argon plasma. CONCLUSIONS: Double-balloon enteroscopy is a safe and efficacious method for the study and management of small bowel diseases, with an elevated diagnostic and therapeutic yield.

Effects of preoperative dexamethasone on postoperative pain, nausea, vomiting and respiratory function in women undergoing conservative breast surgery for cancer: Results of a controlled clinical trial.

The objective was to evaluate whether preoperative administration of dexamethasone improved postoperative nausea and vomiting (PONV), pain and respiratory function tests in women undergoing conservative surgery for breast cancer. This was a controlled clinical trial conducted between June 2013 and October 2014. Eighty patients were evaluated. Patients received a preoperative dose of 8 mg of dexamethasone (n = 40) or placebo (n = 40). The data on PONV and pain intensity was obtained and forced spirometry tests were performed, 1 hr before and at 1, 6, 12 and 24 hr after surgery. Any use of additional analgesic/antiemetic drugs was recorded. Patients were followed until 30 days after surgery for any surgical or medical complications. The pain intensity was lower in the treatment group for all periods; PONV was lower at 6, 12 and 24 hr; Additional analgesics/antiemetics were required less frequently (all p < .05). Both groups exhibited a restrictive ventilatory pattern immediately after surgery, which was reversed in the following hours. However, spirometric values were higher in the dexamethasone group. There were no pulmonary or metabolic complications after surgery. Our conclusions were that dexamethasone significantly reduced the incidences of PONV, pain and improved respiratory parameters, and reduced the need for additional postoperative analgesic and antiemetic drugs.

Plasma rico en plaquetas en el tratamiento del fotodaño cutáneo en las manos / Platelet-Rich Plasma for the Treatment of Photodamage of the Skin of the Hands

Introducción: El plasma rico en plaquetas (PRP) aporta factores de crecimiento que inducen la síntesis de colágeno y otros componentes de la matriz extracelular, y estimula la activación de fibroblastos. El objetivo de este estudio es evaluar el efecto del PRP en el tratamiento del fotodaño en manos. Material y métodos: Estudio de tipo experimental. Se incluyeron individuos con envejecimiento en el dorso de las manos, de tipo 3 en la escala de fotodaño de Glogau o de clase II de la clasificación de arrugas y elastosis de Fitzpatrick, entre agosto de 2012 y enero de 2013. Se aplicó PRP en la piel del dorso de las manos y se tomaron biopsias cutáneas antes y después del tratamiento para la comparación histológica. Resultados: Se trataron 18 mujeres con una edad media de 47,9 ± 4,3 años. El análisis histológico demostró un incremento en el número de fibroblastos (p = 0,000), número de vasos (p = 0,000) y cantidad de colágeno (p = 0,27), representado como un cambio en la escala de clasificación de arrugas y elastosis de Fitzpatrick (p < 0,001) y en la escala de fotodaño de Glogau (p = 0,01). Conclusiones: El PRP indujo una reducción en los signos y síntomas del envejecimiento cutáneo, con mejoría en las arrugas y elastosis (AU)

Background: Platelet-rich plasma (PRP) provides growth factors that stimulate fibroblast activation and induce the synthesis of collagen and other components of the extracellular matrix. The objective of this study was to evaluate the effect of PRP in the treatment of photodamage of the skin of the hands. Material and methods: Experimental study enrolling persons with photoaged skin on the dorsum of the hands (Glogau photoaging scale, type III, or Fitzpatrick wrinkle classification, type II) were included between August 2012 and January 2013. A histological comparison was made of skin biopsies taken before and after the application of PRP to the skin of the dorsum of the hands. Results: The mean (SD) age of the 18 women enrolled was 47.9 (4.3) years. Histological analysis showed an increase in the number of fibroblasts (P<.001), number of vessels (P<.001), and collagen density (P=.27). These changes produced significant improvements in the Fitzpatrick wrinkle and elastosis scale (P<.001) and in the Glogau photoaging scale (P=.01). Conclusions: PRP induced a reduction in the manifestations of skin aging, including an improvement in wrinkles and elastosis (AU)

Platelet-Rich Plasma for the Treatment of Photodamage of the Skin of the Hands. / Plasma rico en plaquetas en el tratamiento del fotodaño cutáneo en las manos.

BACKGROUND: Platelet-rich plasma (PRP) provides growth factors that stimulate fibroblast activation and induce the synthesis of collagen and other components of the extracellular matrix. The objective of this study was to evaluate the effect of PRP in the treatment of photodamage of the skin of the hands. MATERIAL AND METHODS: Experimental study enrolling persons with photoaged skin on the dorsum of the hands (Glogau photoaging scale, type III, or Fitzpatrick wrinkle classification, type II) were included between August 2012 and January 2013. A histological comparison was made of skin biopsies taken before and after the application of PRP to the skin of the dorsum of the hands. RESULTS: The mean (SD) age of the 18 women enrolled was 47.9 (4.3) years. Histological analysis showed an increase in the number of fibroblasts (P<.001), number of vessels (P<.001), and collagen density (P=.27). These changes produced significant improvements in the Fitzpatrick wrinkle and elastosis scale (P<.001) and in the Glogau photoaging scale (P=.01). CONCLUSIONS: PRP induced a reduction in the manifestations of skin aging, including an improvement in wrinkles and elastosis.

Climate and geochemistry as drivers of eucalypt diversification in Australia.

Eucalypts cover most of Australia. Here, we investigate the relative contribution of climate and geochemistry to the distribution and diversity of eucalypts. Using geostatistics, we estimate major element concentrations, pH, and electrical conductivity at sites where eucalypts have been recorded. We compare the median predicted geochemistry and reported substrate for individual species that appear associated with extreme conditions; this provides a partial evaluation of the predictions. We generate a site-by-species matrix by aggregating observations to the centroids of 100-km-wide grid cells, calculate diversity indices, and use numerical ecology methods (ordination, variation partitioning) to investigate the ecology of eucalypts and their response to climatic and geochemical gradients. We find that ß-diversity coincides with variations in climatic and geochemical patterns. Climate and geochemistry together account for less than half of the variation in eucalypt species assemblages across Australia but for greater than 80% in areas of high species richness. Climate is more important than geochemistry in explaining eucalypts species distribution and change in assemblages across Australia as a whole but there are correlations between the two sets of environmental variables. Many individual eucalypt species and entire taxonomic sections (Aromatica, Longistylus of subgenus Eucalyptus, Dumaria, and Liberivalvae of subgenus Symphyomyrtus) have distributions affected strongly by geochemistry. We conclude that eucalypt diversity is driven by steep geochemical gradients that have arisen as climate patterns have fluctuated over Australia over the Cenozoic, generally aridifying since the Miocene. The diversification of eucalypts across Australia is thus an excellent example of co-evolution of landscapes and biota in space and time and challenges accepted notions of macroecology.

Evaluation of learned helplessness, self-efficacy and disease activity, functional capacity and pain in Argentinian patients with rheumatoid arthritis.

OBJECTIVES: To evaluate the association between learned helplessness (LH) and self-efficacy (SE) with disease activity, functional capacity, and level of pain in patients with rheumatoid arthritis (RA) and to compare LH and SE between patients in remission and patients with active disease. METHOD: This multicentre, cross-sectional study included consecutive patients (aged ≥ 18 years) with RA according to 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria. LH was measured by the Rheumatology Attitude Index (RAI), Spanish version; SE with the Arthritis Self-efficacy Scale (ASES), Spanish version; functional capacity with the Health Assessment Questionnaire, Argentinian version (HAQ-A); and perceived pain by the visual analogue scale (VAS). Disease activity was measured by the Clinical Disease Activity Index (CDAI). RESULTS: A total of 115 patients (82% females) with a mean (± sd) age of 58 ± 13 years were included. We found a significantly positive correlation between LH and perceived pain (p < 0.001), HAQ-A score (p < 0.001), and CDAI (p < 0.001) and a significantly negative correlation between SE and perceived pain (p < 0.001), HAQ-A score (p < 0.001), and CDAI (p < 0.001). We found greater levels of SE and lower grades of LH in patients in remission compared to those with active disease (median 76 vs. 58; p < 0.001 and 6 vs. 11; p < 0.001, respectively). CONCLUSIONS: LH and SE correlated significantly with disease activity, functional capacity, and perceived pain. Levels of SE were higher in patients in remission compared to those with active disease as opposed to levels of LH, which were lower in patients in remission compared to those with active disease. These results show that cognitive factors are related to disease activity and their modifications may have importance in the management of RA.

Body weight changes after adjuvant chemotherapy of patients with breast cancer: results of a Mexican cohort study.

Weight gain is observed in breast cancer patients receiving chemotherapy and is a well-known complication. Several factors that contributing to weight gain have been identified. However, there is a lack of information about factors associated with weight changes following adjuvant chemotherapy. A retrospective cohort of 200 pre- and post-menopausal Mexican patients treated for breast cancer was made. Anthropometric variables were measured before/after treatment. Biomarkers, cellular differentiation and chemotherapy were similar between groups. Weight gain occurred in 85.6% of pre-menopausal and 72.6% of post-menopausal women (p = .03). At the end of chemotherapy, weight and body mass index (BMI) did not differ significantly between pre-menopausal (69.3 ± 12.6 kg; 26.6 ± 4.8 kg/m2 ) and post-menopausal women (69.5 ± 10.9 kg; 27.3 ± 4.4 kg/m2 ) (p = .91 and 0.34). Dexamethasone doses were higher in pre-menopausal (85.7 ± 39.1 g) than post-menopausal patients (79.2 ± 22.5 g; p = .13). Weight loss was observed in 9.2% of pre-menopausal and 20.2% of post-menopausal patients (p = .04). A multivariate analysis revealed that age (OR = 2.7; 95% CI = 1.26-5.79; p = .01), menopausal status (OR = 2.29; 95% CI = 1.09-4.80; p = .03), dexamethasone dosage (OR = 2.1; 95% CI = 1.04-4.23; p = .03) and daily caloric intake (OR = 2.3; 95% CI = 1.12-5.10; p = .02) were independent variables that inducted weight gain. Pre- and post-menopausal women gained weight, but more pre-menopausal patients showed gain. An effort should be made to administer lower steroid doses to reduce weight gain.

Efecto de los micronutrientes en polvo en el estado nutricional y en los valores hemáticos de preescolares sanos. Medellín, 2013 / The effect of powdered micronutrients on the hematologic values and nutritional status of healthy preschoolers. Medellín, 2013 / Efeito dos micronutrientes em pó no estado nutricional e nos valores hemáticos de crianças sadias em idade pré-escolar. Medellín, 2013

Las carencias de micronutrientes son un problema de salud pública común en muchos países, principalmente en aquellos en vía de desarrollo; las deficiencias más prevalentes son las de vitamina A, hierro y yodo, para reducirlas se pueden ejecutar estrategias como la fortificación de alimentos. OBJETIVO: evaluar el efecto de la fortificación de la dieta con micronutrientes en polvo en el estado nutricional y los valores hemáticos de preescolares sanos. METODOLOGIA: ensayo clínico triple ciego, con asignación aleatoria de grupos y controlado con placebo. Se analizaron 90 preescolares sanos a quienes se suministró 1g de mezcla de micronutrientes al día con 12,50 mg de hierro (fumarato ferroso). Antes y después de nueve semanas, se midieron los niveles de hemoglobina, ferritina sérica, transferrina, ácido fólico y los indicadores nutricionales. RESULTADOS :la concentración de hemoglobina disminuyó en el grupo de intervención, pasando de 12,80 g/dL a 12,10 g/dL (p=0,000), mientras que en el grupo placebo no hubo variación (p=0,639); así mismo la transferrina disminuyó significativamente solo en el grupo intervenido (p=0,004); el nivel de ferritina al final del estudio no difirió intra o entre grupos de intervención. Las reacciones adversas fueron similares en ambos grupos: dos niños presentaron náusea y dos tuvieron dolor abdominal, sin diferencias estadísticas. CONCLUSIONES:la fortificación de alimentos durante nueve semanas con los micronutrientes en polvo empleados en el estudio, no mejoró los niveles hematológicos, ni el estado nutricional de los niños sanos estudiados; los alimentos fortificados fueron bien tolerados por los preescolares.

Micronutrient deficiencies are a common public health problem, particularly in developing countries. Vitamin A, iron and iodine deficiencies are the most prevalent. To reduce these, many strategies such as food fortification can be implemented. OBJECTIVE:to assess the effect of a diet fortified with powdered micronutrients on the nutritional status and hematological values of healthy preschoolers. METHODOLOGY: a randomized, triple-blind, placebo-controlled trial conducted with 90 healthy preschoolers who were given 1g of powdered micronutrients per day with 12.5 mg of iron (ferrous fumarate).The levels of hemoglobin, serum ferritin, transferrin, folic acid and the nutritional indicators were measured before and after nine weeks. RESULTS:for the group receiving powdered micronutrients, hemoglobin concentration decreased from 12.80 g / dL to 12.10 g / dL (p = 0.000), whereas the placebo group showed no change (p = 0.639); likewise, transferrin decreased significantly only for the powdered micronutrients group (p = 0.004); the ferritin level showed no difference between groups or inside any of them. Adverse reactions were similar for both groups:two children had nausea and two abdominal pain. There were no statistically significant differences. CONCLUSIONS:fortifying the individuals' diet with the powdered micronutrients used in this study for nine weeks did not improve the hematological levels or the nutritional status of the healthy preschoolers. Additionally, the fortified foods were well tolerated by the children.

As carências de micronutrientes são um problema de saúde pública comum em muitos países, principalmente naqueles em via de desenvolvimento; as deficiências mais prevalentes são de vitamina A, ferro e iodo, para reduzi-las podem ser realizadas estratégias como a fortificação de alimentos. OBJETIVO: avaliar o efeito da fortificação da dieta com micronutrientes em pó no estado nutricional e os valores hemáticos de pré-escolares sadios. METODOLOGIA: ensaio clínico triplo-cego, com afetação aleatória de grupos e controlado com placebo.Foram analisados 90 pré-escolares sadios aos quais foi proporcionado 1g de mescla de micronutrientes por dia com 12,50 mg de ferro (fumarato ferroso).Antes e após nove semanas, foram medidos os níveis de hemoglobina, ferritina sérica, transferrina, ácido fólico e os indicadores nutricionais. RESULTADOS: a concentração de hemoglobina diminuiu no grupo de intervenção, passando de 12,80 g/dL a 12,10 g/dL (p=0,000), enquanto no grupo placebo não houve variação(p=0,639); do mesmo modo, a transferrina apenas diminuiu expressivamente no grupo intervindo (p=0,004); o nível de ferritina no final do estudo não divergiu intra ou entre os grupos de intervenção.As reações adversas foram semelhantes em ambos os grupos:duas crianças apresentaram náusea e duas tiveram dor abdominal, sem diferenças estatísticas. CONCLUSÕES: a fortificação de alimentos durante nove semanas com os micronutrientes em pó utilizados no estudo não melhorou os níveis hematológicos, nem o estado nutricional das crianças saudáveis analisadas; os alimentos fortificados foram bem tolerados pelas crianças.

Síndrome de Burnout en el personal médico de una institución prestadora de servicios de salud de Cartagena de Indias / Burnout syndrome in medical personnel of a health service provider in Cartagena

Introducción: El estrés y las enfermedades psicosomáticas son hoy en día más frecuentes y afectan la salud de los individuos, así como su rendimiento profesional. Objetivo: Determinar la prevalencia de síndrome de Burnout y factores asociados en los médicos de una Institución Prestadora de Servicios de salud privada de la ciudad de Cartagena. Metodología: Se realizó un estudio analítico de corte transversal. La población la constituyen 112 médicos de la ESE. Para la recolección de información se utilizó una encuesta sociodemográfica y el instrumento Maslach Burnout Inventory (MBI) de Maslach y Jackson. Para el análisis estadístico se utilizó el programa SPSS versión 20®, aplicando las pruebas no paramétricas U de Mann-Whitney y Kruskall Wallis para estimar asociaciones entre variables. Resultados: La realización personal y el síndrome de Burnout se encuentran asociados al sexo, los dos fueron más altos en el sexo femenino. Los médicos que cuentan con solo pregrado y con menor antigüedad reportan mayores puntajes en Agotamiento Emocional. El agotamiento emocional varía significativamente según área entre los médicos encuestados.

Introduction: Stress and psychosomatic illnesses are more frequent nowadays and affect health and job performance. Objective: To determine prevalence of Burnout syndrome and associated factors in physicians from a private health services provider institution in Cartagena. Methodology: A crosssectional analytical study was conducted. Sample was constituted by 112 physicians from the private health services provider institution. For data collection, a socio-demographic survey and the Maslach Burnout Inventory (MBI) of Maslach and Jackson were applied. Statistical analysis was made using SPSS ® v.20 functions for non-parametric studies like Mann-Whitney U and Kruskal Wallis tests to estimate associations between variables. Results: Personal accomplishment and burnout syndrome are associated with gender, both being higher in females. General physicians with no residency accomplished and less expertise at work report higher scores on emotional exhaustion. Results can vary significantly depending of the specialization area of the surveyed physicians.

Positive C4d in kidney transplantation biopsy: clinical impact.

BACKGROUND: Deposition of C4d in peritubular capillaries of renal graft is normally associated with the presence of antibody-mediated rejection. The clinical impact of its presence in patients with renal transplant in Colombia is uncertain, as well as the association in acute rejection and the response to the management and survival of the graft. The aim of this study was to determine the risk of having positive C4d in biopsies of patients with episodes of acute cellular rejection. METHODS: We retrospectively reviewed 226 biopsies of kidney transplantation, all of them with acute rejection and histopathological findings classified according to Banff criteria 2009 and performed between January 2005 and December 2012 for graft dysfunction. C4d staining was performed by immunohistochemistry. RESULTS: C4d staining was positive in 25 of 226 biopsies. Rejection time in patients with positive C4d was 15 months in average vs 8 months with negative C4d. CONCLUSIONS: With the use of a multivariate analysis, we found that the unique risk for C4d in our population was the positive panel reactive antibodies and elapsed time between transplant and the rejection (odds ratio: 2.12, P = .034) and that the other variables analyzed are not related to the expression of C4d.

Within herd transmission and evaluation of the performance of clinical and serological diagnosis of foot-and-mouth disease in partially immune cattle herds.

The control of foot-and-mouth disease (FMD) in vaccinated populations relies upon surveillance activities such as clinical inspections (CI) and serological monitoring. New evidence to refine current surveillance guidelines has been provided by evaluating (1) the diagnostic performance of CI and serological tests for detection of FMD virus (FMDV) non-structural proteins (NSP), and (2) the within-herd transmission of the virus in partially immune cattle. Data came from 23 affected herds during an epidemic of FMDV type O in Bolivia, in 2007. All cattle (n=957) in these herds were clinically inspected and serum samples were collected one month after the last animal with clinical signs was detected. Samples were tested for the presence of antibodies against NSP using the PANAFTOSA 3ABC-ELISA test and a subset of samples were tested using the enzyme-linked immunoelectrotransfer blot assay (EITB). Data from clinical and serological diagnoses were analysed using a Bayesian model. The sensitivity Se and specificity Sp of the tests, as well as the prevalence and the within-herd reproduction ratio R of FMDV were estimated. In addition, risk factors for infection were identified. The Se of CI, the 3ABC-ELISA and the EITB tests were estimated to be 0.30, 0.88 and 0.96 respectively. The estimated Sp, in the same order, were 0.88, 0.93 and 0.97. The within-herd prevalence of infected animals ranged from 0.04 to 0.91 and R ranged from 1.02 to 2.68. It was observed that cattle coming from areas with high vaccination coverage had a lower risk of becoming infected than home-bred cattle from the affected herds, where vaccination coverage was thought to be low. Although these estimates come from herds kept under specific conditions, they provide a reference for future surveillance design and can inform simulation models for surveillance and control of FMD in similar cattle populations.

Manejo y administración de hemoderivados por personal de enfermería en un hospital de segundo nivel / Handling and management of blood-derived products by the nursing staff in a second level hospital

Introducción: El manejo y administración de hemoderivados es una actividad que realiza el personal de enfermería, por lo cual es de gran importancia tener presente que un uso inadecuado de éstos puede tener consecuencias graves en los pacientes, siendo fundamental el buen desempeño del personal de enfermería para la práctica segura. Objetivo: Evaluar el desempeño de enfermería en el manejo y administración de hemoderivados en un hospital de segundo nivel. Métodos: Estudio de diseño transversal. Se incluyeron enfermeras durante el 1º Enero al 30 junio del 2013. Se utilizó un instrumento validado que consta de 4 criterios con 27 ítems de respuestas dicotómicas para identificar el desempeño en el manejo y ministración de hemoderivados. La población fue dividida por categoría contractual. Análisis estadístico: prueba Chi-cuadrada y/ exacta de Fisher. Resultados: Se incluyeron un total de 110 observaciones a personal de enfermería que administró hemoderivados. Se obtuvo un índice de eficiencia global parcial (IEG) parcial a excelente de 64.5%. No se encontró asociación en el turno (p=0.16), servicio (p=0.31) y/o categoría contractual (p=0.25). Los porcentajes de excelente en el IEF fueron bajos (por turno: matutino y nocturno de 10 y 13 respectivamente, medicina interna y cirugía general 5 y 7%, y conforme a la categoría contractual, la enfermera general obtuvo en excelente sólo el 7.5%). Conclusiones: Nuestros resultados nos alertan para implantar programas de capacitación a enfermeras, para otorgar atención de calidad, disminuyendo los riesgos que comprometan la vida del paciente.

Introduction: Handling and managing blood-derived products is a nursing staff activity and thus, it is very important to keep in mind that an inadequate handling of these products can have serious consequences on patients. Therefore, a safe practice from the nursing staff is fundamental. Objective: To assess the nursing performance related to the handling and management of blood-derived products in a second level hospital. Methods: A transversal study design. Nurses were observed from January 1 to June 30, of 2013. A validated instrument with 27 dichotomy-items, and based on 4 criteria, to assess the handling and management of blood-derived products was used. The population was divided by contractual category. Statistical analysis: Chi square and/or Fisher exact test. Results: A total of 110 observations to the nursing staff handling and managing blood-derived products were included. An index of global efficiency (IGE) of partial to excellent of 64.5% was obtained. No associations were found with shift (p=.16), service (p=.31) and/or contractual category (p=.25). The percentages of excellent in the IEF were low (per shift: morning and night of 10 and 13 respectively; per service: internal medicine and general surgery 5 and 7%, and according to the contractual category, overall excellent nurse obtained only 7.5%). Conclusions: Our results encourage us to foster training programs for nurses in order to enhance the quality of care and also decrease the life risks on the patients.

[Colorectal surgery in patients over 65 years of age]. / Cirugía colorrectal en pacientes mayores de 65 años.

BACKGROUND: There is a limited functional reserve in patients over 65 years of age which is conducive to more frequent postoperative complications. Disease extension at the time of diagnosis (clinical stage) and complete tumor resection are two independent risk factors that have a direct influence on survival. AIMS: To describe the factors that influence morbidity and mortality in patients over 65 years of age after colorectal surgery. MATERIAL AND METHODS: A retrospective, observational, descriptive study was carried out within the time frame of January 2004 and December 2009 on 105 colon cancer patients after colorectal surgery. They were divided into two groups, one under 65 years of age and the other over 65 years of age, in order to compare preoperative comorbidity, as well as morbidity and mortality 30 days after surgery. RESULTS: Of the 105 patient total (53,3%), 56 were ≤ 65 years of age. There were complications in 42,8% of the patients, and those of early and less severe presentation were the most frequent; late complications were more frequent in patients ≤ 65 vs > 65 years of age (16,0% vs 10,2%). Overweight (BMI > 25 kg/m(2)) was observed in 35,0% of the study population. Patients > 65 years of age had fewer comorbidities. The most common causes of reintervention were anastomosis dehiscence and postoperative hemorrhage. Mortality in the group was 6,6% and sepsis was the most frequent cause of death. CONCLUSIONS: Colorectal surgery in patients over 65 years of age has an acceptable complication frequency and a low mortality rate. Our results suggest that patients older than 65 years of age be treated with the same prospects for cure as younger patients.

Parâmetros hematológicos de jumentas gestantes em diferentes períodos / Hematological parameters of pregnant donkeys in different periods

The hematological parameters and total protein concentration in healthy donkeys during pregnancy, under grass handling conditions in tropical weather, were evaluated. Fifth-two Marchador Brasileiro breed healthy donkeys, ranging from 8 to 16 years old, were evaluated, 36 of which were pregnant. The animals were separated in four groups: non pregnant (control), pregnancy from 25 to 110 days (first phase), from 111 to 210 days (second phase), and from 211 to 340 days (third phase). Total protein, erythrocyte, and leukocytes counts; packed cell volume; hemoglobin concentration; hematimetric absolute rates of mean corpuscular volume (MCV); mean corpuscular hemoglobin (MCH); and mean corpuscular hemoglobin concentration (MCHC) were evaluated. Total protein and eosinophils count decreased in the first phase. Red blood cells, hemoglobin concentration, and MCHC increased in the third phase of pregnancy. However, MCV and MCH decreased in the same phase.