Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level.

OBJECTIVE: To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. DESIGN: Ambispective descriptive multicenter cohort study. SETTING: Two intensive care units (ICU) from Colombia at 2600m a.s.l. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. RESULTS: The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001). CONCLUSIONS: At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.

Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level / Correlación y validez de la PaO2/FiO2 y SpO2/FiO2 imputadas en pacientes con ventilación mecánica invasiva a 2.600 metros sobre el nivel del mar

Objective To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. Design Ambispective descriptive multicenter cohort study. Setting Two intensive care units (ICU) from Colombia at 2600m a.s.l. Patients or participants Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. Interventions None. Variables Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. Results The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81–0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80–0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79–0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81–0.87, p<0.001). Conclusions At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions (AU)

Objetivo Establecer la correlación y validez entre PaO2/FiO2 obtenida en gases arteriales versus métodos no invasivos (imputación lineal, no lineal, logarítmica de PaO2/FiO2 y SpO2/FiO2) en pacientes bajo ventilación mecánica que viven en altitudes elevadas. Diseño Estudio de cohorte multicéntrico descriptivo ambispectivo Ámbito Dos unidades de cuidados intensivos de Colombia a 2.600 m s.n.m. Pacientes o participantes Se incluyeron pacientes consecutivos en estado crítico mayores de 18 años con al menos 24h de ventilación mecánica desde junio de 2016 a junio de 2019. Intervenciones Ninguna. Variables Las variables analizadas fueron demográficas, fisiológicas, hallazgos de laboratorio, índice de oxigenación y estado clínico. Se utilizaron fórmulas de imputación no lineales, lineales y logarítmicas para calcular la PaO2 a partir de la SpO2, y al mismo tiempo la SpO2/FiO2 mediante el diagnóstico de hipoxemia severa. Se calculó el coeficiente de correlación intraclase, el área bajo la curva ROC, la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo, la razón de verosimilitud positiva y negativa. Resultados La correlación entre PaO2/FiO2 obtenida a partir de gases arteriales, PaO2/FiO2 derivada de uno de los métodos propuestos (fórmula lineal, no lineal y logarítmica) y SpO2/FiO2 medida por el coeficiente de correlación intraclase fue alta (mayor a 0,77, p<0,001). Los diferentes métodos de imputación y SpO2/FiO2 tienen un rendimiento diagnóstico similar en pacientes con hipoxemia severa (PaO2/FiO2<150). PaO2/FiO2 imputación lineal AUC ROC 0,84 (IC 0,81-0,87; p<0,001), PaO2/FiO2 imputación logarítmica AUC ROC 0,84 (IC 0,80-0,87; p<0,001), PaO2/Imputación no lineal de FiO2 AUC ROC 0,82 (IC 0,79-0,85; p<0,001), oximetría de SpO2/FiO2 AUC ROC 0,84 (IC 0,81-0,87; p<0,001). Conclusiones A gran altitud, el cociente SaO2/FiO2 y el cociente PaO2/FiO2 (AU)

Prior influenza vaccine is not a risk factor for bacterial coinfection in patients admitted to the ICU due to severe influenza / La vacuna previa contra la influenza no es un factor de riesgo de coinfección bacteriana en pacientes ingresados en la UCI por influenza severa

Objective To determine whether the prior usage of the flu vaccine is a risk factor for bacterial co-infection in patients with severe influenza. Design This was a retrospective observational cohort study of subjects admitted to the ICU. A propensity score matching, and logistic regression adjusted for potential confounders were carried out to evaluate the association between prior influenza vaccination and bacterial co-infection. Settings 184 ICUs in Spain due to severe influenza. Patients Patients included in the Spanish prospective flu registry. Interventions Flu vaccine prior to the hospital admission. Results A total of 4175 subjects were included in the study. 489 (11.7%) received the flu vaccine prior to develop influenza infection. Prior vaccinated patients were older 71 [61–78], and predominantly male 65.4%, with at least one comorbid condition 88.5%. Prior vaccination was not associated with bacterial co-infection in the logistic regression model (OR: 1.017; 95%CI 0.803–1.288; p=0.885). After matching, the average treatment effect of prior influenza vaccine on bacterial co-infection was not statistically significant when assessed by propensity score matching (p=0.87), nearest neighbor matching (p=0.59) and inverse probability weighting (p=0.99). Conclusions No association was identified between prior influenza vaccine and bacterial coinfection in patients admitted to the ICU due to severe influenza. Post influenza vaccination studies are necessary to continue evaluating the possible benefits (AU)

Objetivo Determinar si el uso previo de la vacuna antigripal es un factor de riesgo para coinfección bacteriana en pacientes con influenza grave. Diseño Este fue un estudio de cohorte observacional retrospectivo de sujetos ingresados en la UCI. Se realizó un emparejamiento por puntuación de propensión y una regresión logística ajustada para posibles factores de confusión para evaluar la asociación entre el antecedente de vacunación contra la gripe y la coinfección bacteriana. Ámbito Ciento ochenta y cuatro ingresos en UCI españolas por gripe grave. Pacientes Pacientes incluidos en el registro prospectivo español de gripe. Intervenciones Vacuna antigripal previa al ingreso hospitalario. Resultados Se incluyó en el estudio un total de 4.175 sujetos. Recibieron la vacuna contra la influenza antes de desarrollar la infección por influenza 489 (11,7%). Los pacientes previamente vacunados eran mayores de 71 años (RIC 61-78), predominantemente varones (65,4%) y con al menos una condición comórbida (88,5%). La vacunación previa no se asoció con la coinfección bacteriana en el modelo de regresión logística (OR: 1,017; IC95% 0,803-1,288; p=0,885). Después del emparejamiento, el efecto promedio del tratamiento del antecedente de vacuna contra la influenza sobre la coinfección bacteriana no fue estadísticamente significativo cuando se evaluó mediante el emparejamiento por puntuación de propensión (p=0,87), por emparejamiento del vecino más cercano (p=0,59) y mediante la ponderación de probabilidad inversa (p=0,99). Conclusiones No se identificó asociación entre el antecedente de vacuna antigripal y coinfección bacteriana en pacientes ingresados en UCI por influenza severa. Más estudios para evaluar los efectos de la vacunación contra la gripe son necesarios para continuar evaluando los posibles beneficios (AU)

Prior influenza vaccine is not a risk factor for bacterial coinfection in patients admitted to the ICU due to severe influenza.

OBJECTIVE: To determine whether the prior usage of the flu vaccine is a risk factor for bacterial co-infection in patients with severe influenza. DESIGN: This was a retrospective observational cohort study of subjects admitted to the ICU. A propensity score matching, and logistic regression adjusted for potential confounders were carried out to evaluate the association between prior influenza vaccination and bacterial co-infection. SETTINGS: 184 ICUs in Spain due to severe influenza. PATIENTS: Patients included in the Spanish prospective flu registry. INTERVENTIONS: Flu vaccine prior to the hospital admission. RESULTS: A total of 4175 subjects were included in the study. 489 (11.7%) received the flu vaccine prior to develop influenza infection. Prior vaccinated patients were older 71 [61-78], and predominantly male 65.4%, with at least one comorbid condition 88.5%. Prior vaccination was not associated with bacterial co-infection in the logistic regression model (OR: 1.017; 95%CI 0.803-1.288; p=0.885). After matching, the average treatment effect of prior influenza vaccine on bacterial co-infection was not statistically significant when assessed by propensity score matching (p=0.87), nearest neighbor matching (p=0.59) and inverse probability weighting (p=0.99). CONCLUSIONS: No association was identified between prior influenza vaccine and bacterial coinfection in patients admitted to the ICU due to severe influenza. Post influenza vaccination studies are necessary to continue evaluating the possible benefits.

Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level.

OBJECTIVE: To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. DESIGN: Ambispective descriptive multicenter cohort study. SETTING: Two intensive care units (ICU) from Colombia at 2600m a.s.l. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. RESULTS: The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001). CONCLUSIONS: At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.

Prior influenza vaccine is not a risk factor for bacterial coinfection in patients admitted to the ICU due to severe influenza.

OBJECTIVE: To determine whether the prior usage of the flu vaccine is a risk factor for bacterial co-infection in patients with severe influenza. DESIGN: This was a retrospective observational cohort study of subjects admitted to the ICU. A propensity score matching, and logistic regression adjusted for potential confounders were carried out to evaluate the association between prior influenza vaccination and bacterial co-infection. SETTINGS: 184 ICUs in Spain due to severe influenza. PATIENTS: Patients included in the Spanish prospective flu registry. INTERVENTIONS: Flu vaccine prior to the hospital admission. RESULTS: A total of 4175 subjects were included in the study. 489 (11.7%) received the flu vaccine prior to develop influenza infection. Prior vaccinated patients were older 71 [61-78], and predominantly male 65.4%, with at least one comorbid condition 88.5%. Prior vaccination was not associated with bacterial co-infection in the logistic regression model (OR: 1.017; 95%CI 0.803-1.288; p=0.885). After matching, the average treatment effect of prior influenza vaccine on bacterial co-infection was not statistically significant when assessed by propensity score matching (p=0.87), nearest neighbor matching (p=0.59) and inverse probability weighting (p=0.99). CONCLUSIONS: No association was identified between prior influenza vaccine and bacterial coinfection in patients admitted to the ICU due to severe influenza. Post influenza vaccination studies are necessary to continue evaluating the possible benefits.

Effects of progestogens used in menopause hormone therapy on the normal breast and benign breast disease in postmenopausal women.

Hormone replacement therapy in menopause is used to improve climacteric syndrome in women whose quality of life is affected. However, given the wide variety of progestogens available, it is important to evaluate their differential benign changes (radiological, cellular, and clinical) on the breast. This review aimed to determine the different benign changes of progestogens used in postmenopausal combined hormone therapy on the breast (radiological, cellular, and clinical), in women without mammary pathology, in order to establish their safety profile. A systematic review of the literature was carried out with a balanced search strategy for the identification of relevant references in the MEDLINE, BVSalud, EMBASE, ProQuest, and Cochrane databases until November 2019. The search terms used were 'menopause' or 'hormonal replacement therapy' or 'progestins' or 'estrogen' or 'mastodynia' or 'benign breast disease' or 'mammography'. Data were collected from the 'eligible' articles by two researchers (ARF and SHA), and possible discrepancies in inclusion were resolved by consensus. A total of 1886 articles were identified; 60 full-text articles were reviewed, and 17 articles that met the inclusion criteria were included for the qualitative analysis. In conclusion, combined hormone replacement therapy is associated with benign effects on the breast, such as mastodynia and increased mammographic density.

Inflammatory Bowel Disease and Eating Disorders: A systematized review of comorbidity.

OBJECTIVE: Research has shown that there is an association between Inflammatory Bowel Disease, anxiety and mood disorders, however little is known about their association with Eating Disorders. In this paper we will present a case of a young female with a comorbid diagnosis of Inflammatory Bowel Disease and Eating Disorder, and then discuss the results from a systematic review of the literature, describing published cases of patients with the same condition. METHODS: A systematized review of the literature was conducted according to MOOSE guidelines. A computerized literature search of MEDLINE, PsycINFO and EMBASE, and a manual search through reference lists of selected original articles were performed to identify all published case-reports, case series and studies of Inflammatory Bowel Disease and Eating Disorders. RESULTS: Fourteen articles were included, encompassing 219 cases, including ours. The vast majority were females ranging from 10 to 44years old. Anorexia Nervosa (n=156) and Crohn's Disease (n=129) was the most frequent combination (n=90) reported in the literature. These cases present a poor prognosis because of corticoid refusal, medication abandon and/or deliberate exacerbation of IBD symptoms, in the context of trying to lose weight. CONCLUSION: Recent evidence suggests there is a possible association between Inflammatory Bowel Disease and Eating Disorders, although the mechanisms involved in its ethiopathogenesis are still unknown. To be aware of this association is important because a delayed diagnosis of this comorbidity may lead to worse prognosis. Further research and a multidisciplinary approach could facilitate earlier diagnosis and provide therapeutic interventions.

Evaluación de la portación de cándida spp en pinzas ortodóncicas post utilización / Evaluation of candida spp carriage on orthodontic pliers, after using them

Objetivo: evaluar el nivel de contaminación por Candida spp, post uso del instrumental de ortodoncia que se utiliza intrabucalmente en pacientesColombianos y Argentinos. Materiales y métodos: Se incluyeron pacientesentre 16 y 65 años, de ambos sexos, con armado de brackets superior e inferior. Criterios de Exclusión: pacientes con brackets de autoligado, con enfermedades autoinmunes, con enfermedades sistémicas con manifestaciones en el periodonto, pacientes fumadores, menores de 16 años y con armado de brackets en un solo maxilar. Se analizaron los alicates de corte distal Hu Friedy luego de ser utilizados para seccionar el arco por distal del último tubo presente enboca. Se estudiaron 80 pacientes agrupados en: Grupo A 40 pacientesColombianos, Grupo B 40 pacientes argentinos. Se realizó una primer tomaintrabucal con un hisopo estéril y se llevó a un tubo con medio de Stuart. Se cortaron las 4 secciones distales de los arcos en boca tardando al menos 1 minuto. Con un segundo hisopo estéril se frota toda la superficie del alicate post uso y se llevaron a otro tubo. Se sembraron en Chromagar Candida y se realizaron pruebas microbiológicas convencionales. Resultados: Las pinzas estériles aparecen contaminadas post corte distal delos alambres en el 95% de los casos en ambos países. Hubo diferencia entrelos pacientes colombianos y los argentinos respecto a las especies, ya que enlos primeros la especie con mayor prevalencia fue Candida tropicalis tanto en lapinza como en la cavidad bucal, mientras que en los argentinos fue Candidaalbicans. Conclusión: las pinzas de ortodoncias se contaminan con Candidaspp post utilización en boca y son un fómite a partir del cual puede generarsediseminación sistémica así como infección cruzada.

A New Quantitative Approach to Assessing Noncompliance With Medical Recommendations in Heart Transplant Recipients.

BACKGROUND: Failure of compliance with medical regimen is one of the major risk factors associated with morbidity and mortality in heart transplant (HT) recipients. Nevertheless, to date, there is no specific, gold-standard, comprehensive set of tools for assessing compliance in these patients. OBJECTIVE: The objective of the present study was to develop a specific instrument for the assessment of noncompliance with medical recommendations in HT recipients. METHODS: This prospective observational study used a nonprobability sampling method, which was performed from January 2006 to December 2012. All of the patients met clinical criteria for being included on the waiting list for a HT. We designed a scale for measuring the compliance degree at 12 months after heart transplantation. This scale included the most important aspects of the medical regimen, using nine discrete quantitative variables. The total score was described as the patient's Noncompliance Factor (NCF). The results were analysed by mean, ranks, and percentages. RESULTS: The sample was constituted of 61 participants who underwent surgical HT intervention and completed the 12-month follow-up assessment. The overall incidence of noncompliance was around 30% and only 43.1% of the recipients had an acceptable degree of compliance. CONCLUSIONS: The overall incidence of noncompliance in HT recipients is high and this can generate worse clinical outcomes. Evaluation by specific screening instruments like the one proposed in the present study can be useful for a systematic detection of this phenomenon.

La participación: determinante social en la construcción de políticas públicas / Participation: social determinant in the development of public policy

En este artículo se presentan los resultados de una investigación realizada durante 2009 y 2010 con actores políticos, técnicos y sociales, quienes participaron en la Política Pública de Mejoramiento Alimentario y Nutricional de Antioquia (MANA) de la Gobernación de Antioquia, como un modelo de construcción participativa que promueve la salud y el bienestar. OBJETIVO: comprender el proceso de participación de los diferentes actores en el diseño de la Ordenanza No 17 que fija la Política Pública de Mejoramiento Alimentario y Nutricional de Antioquia (MANA). MÉTODOS:utilizando un enfoque cualitativo se hizo un estudio de caso, de tipo interpretativo instrumental. La información obtenida con entrevistas a los actores y revisión documental fue sometida a un análisis de carácter heurístico. RESULTADOS :el proceso fue una participación activa donde los actores, tanto políticos, como técnico-metodológicos y sociales, hacen variados aportes en los diferentes momentos de la construcción de la Política Pública de Mejoramiento Alimentario y Nutricional de Antioquia. CONCLUSIONES:el Plan y la Política se convirtieron en un referente para la construcción de otras políticas, planes o programas similares, fue trascendental por su transformación comunitaria y legitimidad, y aunque tuvo dificultades en el proceso, demostró la importancia del trabajo intersectorial y de una mirada integral frente a problemas sociales tan complejos.

This paper presents the results of a research carried out in 2009 and 2010 with individuals from the political, technical and social fields who participated in the Public Policy for Food and Nutritional Improvement created by the Government of Antioquia. This program was conceived as a model of participatory construction that promotes health and welfare. OBJECTIVE:to understand the participation process of different people in the design of Ordinance 17, which establishes the Food and Nutritional Improvement Public Policy. METHODOLOGY: an interpretive instrumental case study was conducted using a qualitative approach. The information obtained from interviews with the participants and from the literature review was heuristically analyzed. RESULTS:individuals from political, technical-methodological and social areas participated actively in this project. Likewise, they made several contributions at different moments of the construction of the Food and Nutritional Improvement Public Policy for Antioquia. CONCLUSION: The Plan and The Policy became a referent for the construction of other policies, plans or similar programs. They were significant because it transformed the community and was legitimate; even though there were difficulties during the process, they proved the importance of having intersectoral work and an integral view of such complex social problems.

Consensus guidelines from The American Society of Peritoneal Surface Malignancies on standardizing the delivery of hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal cancer patients in the United States.

BACKGROUND: The American Society of Peritoneal Surface Malignancies (ASPSM) is a consortium of cancer centers performing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). This is a position paper from the ASPSM on the standardization of the delivery of HIPEC. METHODS: A survey was conducted of all cancer centers performing HIPEC in the United States. We attempted to obtain consensus by the modified method of Delphi on seven key HIPEC parameters: (1) method, (2) inflow temperature, (3) perfusate volume, (4) drug, (5) dosage, (6) timing of drug delivery, and (7) total perfusion time. Statistical analysis was performed using nonparametric tests. RESULTS: Response rates for ASPSM members (n = 45) and non-ASPSM members (n = 24) were 89 and 33 %, respectively. Of the responders from ASPSM members, 95 % agreed with implementing the proposal. Majority of the surgical oncologists favored the closed method of delivery with a standardized dual dose of mitomycin for a 90-min chemoperfusion for patients undergoing cytoreductive surgery for peritoneal carcinomatosis of colorectal origin. CONCLUSIONS: This recommendation on a standardized delivery of HIPEC in patients with colorectal cancer represents an important first step in enhancing research in this field. Studies directed at maximizing the efficacy of each of the seven key elements will need to follow.

Reconocimiento del niño con síndrome de Down como un sujeto de crianza / Recognizing a child with Down's syndrome as a subject of parenting

OBJETIVOS:Describir el reconocimiento del niño con síndrome de Down como sujeto de crianza y de acompañamiento por parte de la madre. METODOLOGIA:investigación etnográfica con participación de 20 madres de niños con síndrome de Down, mediante entrevistas semiestructuradas y observaciones de campo, con análisis categorial y revisión documental. RESULTADOS las madres experimentan tristeza y ansiedad frente al encuentro de un niño con síndrome de Down, dadas las concepciones culturales y sociales, pero en la convivencia y en el vínculo madre-hijo surge un sujeto posible de crianza igual a otro sin síndrome. DISCUSION: el niño se transforma en sujeto social para su madre cuando logra metas en su crecimiento y desarrollo y así ella lo percibe. CONCLUSION las madres de este estudio descubren en la convivencia con su hijo que emerge un sujeto social con la condición de síndrome de Down, con potencialidades de acompañarlo en su crianza y, por tanto, realizarse como madre.

OBJECTIVE: to describe how the children with Down`s syndrome are recognized by mothers as subjects of parenting and accompaniment. METHODOLOGY an ethnographic study whose participants were 20 mothers of children with Down's syndrome. Data were collected using semi-structured interviews and field observations. Similarly, this study included a categorical analysis and a literature review. RESULTS : given the cultural and social conceptions regarding this condition, mothers experience sadness and anxiety upon giving birth to a child with Down's syndrome. Despite this, and thanks to coexistence and to the mother-child bond, the child is later perceived as a subject of parenting who is equal to another person without the syndrome. DICUSSION: children become social subjects when they achieve their goals in growth and development, and mothers can perceive this. CONCLUSION: by living with their sons, the mothers participating in this study discovered that their sons emerge as social persons with Down's syndrome. The mothers also discovered that these individuals have their own potential and that it is possible to accompany them through parenting and therefore to realize themselves as mothers.

Comunicación de la noticia del nacimiento de un niño o niña con Síndrome de Down: el efecto de una predicción desalentadora / Communication from the news of the birth of a child with Down Syndrome: the effect of a discouraging prediction

OBJETIVO: conocer la forma como los trabajadores de la salud comunican la noticia del nacimiento de un niño o niña con Síndrome de Down (SD). METODOLOGIA: estudio cualitativo, de corte etnográfico. Participaron 20 madres y una abuela, se realizaron entrevistas semiestructuradas y observaciones en el campo. Resultados: la noticia del nacimiento del niño o niña con SD se da en forma fría y deshumanizada, deSDe una mirada de la discapacidad sin solución. DISCUSION: las madres perciben, en los trabajadores de la salud, desinterés por sus circunstancias. La mayoría les trasmiten la idea de un niño o niña anormal y con una discapacidad que generará muchos problemas. La manera como reciben la noticia no favorece el encuentro con el hijo, y pone en incertidumbre la visión de futuro de madre-niño. CONCLUSIONES: el personal de salud carece de preparación académica para dar la noticia del nacimiento de un niño o niña con SD y de la sensibilidad para apoyar a la madre en el encuentro con su hijo. RECOMENDACIONES: preparar a los estudiantes de las áreas de la salud para dar los diferentes tipos de noticia dentro de un ambiente humanizante en el cual tenga tanto valor la dimensión biológica como la social y psicoafectiva.

OBJECTIVE: to know how health workers give the news of the birth of a child with Down syndrome (DS). METHODOLOGY: qualitative, ethnographic. Involved 20 mothers and one grandmother were semistructured interviews and field observations. RESULTS: the news of the birth of the child with ds occurs in a cold, dehumanized, from an unresolved disability. DISCUSSIONS: mothers perceived health workers disregard for their circumstances. Most will convey the idea of an abnormal child with a disability that will create many problems. The way that mother receive the news is not conducive to meeting with the child, and puts in uncertainty the future vision of mother-child relationship. CONCLUSIONS: the health academically untrained to break the news of the birth of a child with ds and sensitivity to support her in meeting her son. Recommendations: to prepare students in the areas of health to provide different types of news in humanizing environment in which it has much value as the biological and social psicoafective.

Effect of reactive oxygen species scavengers, antiinflammatory drugs, and calcium-channel blockers on carbon dioxide pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model.

BACKGROUND: Postoperative adhesions are a clinical problem. They can cause female infertility, intestinal obstruction, chronic pelvic pain, and difficulties at the time of reoperation. A variety of approaches described to prevent adhesions have shown variable and inconsistent results. Therefore, this study aimed to evaluate most known substances in a laparoscopic mouse model to obtain quantitative and comprehensive information on adhesion prevention. Specifically, this first study aimed to investigate the effects of reactive oxygen species (ROS) scavengers, antiinflammatory agents, and a calcium-channel blocker on pneumoperitoneum-enhanced adhesions. METHODS: Adhesions were induced during laparoscopy in BALB/c female mice by creation of a bipolar lesion. Carbon dioxide (CO2) pneumoperitoneum was maintained for 60 min using humidified CO2. Six experiments were conducted to evaluate the effects of ROS scavengers (superoxide dismutase [SOD], catalase, melatonin, and ascorbic acid), antiinflammatory agents (dexamethasone, tenoxicam, ibuprofen, parecoxib, nimesulide, anti-tumor necrosis factor [TNF]-alpha), and a calcium-channel blocker (diltiazem). Adhesions were scored after 7 days during laparotomy. RESULTS: Adhesions were reduced by SOD (p < 0.01, proc general linear methods (GLM) of experiments 1 and 2), diltiazem (p = 0.05, Wilcoxon), and dexamethasone (p < 0.03), but not by nonsteroidal antiinflammatory drugs (NSAIDs) nor by anti-TNF-alpha. When all the experiments were grouped for analysis, adhesions also decreased with one and three doses of SOD (p < 0.01 and p < 0.01, respectively) and with one and three doses of ascorbic acid (p < 0.02 and p = 0.05, respectively). CONCLUSIONS: These experiments confirm that SOD, diltiazem, and dexamethasone can decrease adhesion formation. The absence of effect from the other antiinflammatory drugs and anti-TNF-alpha is surprising.

La educación en el Programa de Crecimiento y Desarrollo en un contexto surcado por tensiones / Education in a tension crossed context in the Growth and Development Monitoring Program

Objetivo: presentar aquellos resultados relacionados con el contexto del Sistema General de Seguridad Social en Salud colombiano que influyen en el proceso educativo del Programa de Crecimiento y Desarrollo, derivados de una investigación dirigida a comprender sus efectos e impacto. Metodología: en un estudio de casos múltiples con perspectiva etnográfica, se acompañó un grupo de niños y adultos participantes de cuatro instituciones de Medellín, durante el ingreso, y tres controles del primer año de vida; se realizaron observaciones y entrevistas a adultos significativos y miembros de los aequipos de salud. Resultados: Varios factores influyen sobre la educación en el programa: la Ley 100 de 1993 constituye para algunos una oportunidad y para otros una amenaza; algunas condiciones del modelo actual pueden traducirse en limitaciones para el proceso educativo; la norma técnica de la resolución 412 de 2000 presenta contradicciones conceptuales y entra en tensión con la perspectiva de promoción de salud de la propuesta SIPI; cada institución aplicó de manera diferente la norma. Algunos actores perciben ambientes poco propicios para la educación; se requiere por ello que las políticas provean condiciones que fortalezcan el programa y una propuesta educativa basada en el diálogo de saberes.

First European interlaboratory study of the analysis of benzoxazinone derivatives in plants by liquid chromatography.

Six laboratories from four different countries participated in the first European interlaboratory comparison exercise within the framework of the "Fate and toxicity of allelochemicals (natural plant toxins) in relation to environment and consumer" (FATEALLCHEM) European Union Project. The study, organized between November 2002 and March 2003, involved the analyses of seven benzoxazinone derivatives in two standard solutions and one purified extract of root material. Results are reported from the first phase of the study that examined the variability associated with different detection methods and different laboratories. The analytical strategies were based on liquid chromatography (LC) with diode array detection, LC coupled to mass spectrometry (MS) and LC coupled to tandem MS. When data from all laboratories were pooled, the relative standard deviation values ranged from 2 to 14% for the determination of target compounds in standard solutions, and between 19 and 47% for the analysis in root material. Comparison of the three detection techniques leads to the conclusion that MS approaches are the most accurate and precise techniques for the determination of benzoxazinone derivatives at ng/microL level in plant material.