Development of the PSYCHS: Positive SYmptoms and Diagnostic Criteria for the CAARMS Harmonized with the SIPS.

AIM: To harmonize two ascertainment and severity rating instruments commonly used for the clinical high risk syndrome for psychosis (CHR-P): the Structured Interview for Psychosis-risk Syndromes (SIPS) and the Comprehensive Assessment of At-Risk Mental States (CAARMS). METHODS: The initial workshop is described in the companion report from Addington et al. After the workshop, lead experts for each instrument continued harmonizing attenuated positive symptoms and criteria for psychosis and CHR-P through an intensive series of joint videoconferences. RESULTS: Full harmonization was achieved for attenuated positive symptom ratings and psychosis criteria, and modest harmonization for CHR-P criteria. The semi-structured interview, named Positive SYmptoms and Diagnostic Criteria for the CAARMS Harmonized with the SIPS (PSYCHS), generates CHR-P criteria and severity scores for both CAARMS and SIPS. CONCLUSIONS: Using the PSYCHS for CHR-P ascertainment, conversion determination, and attenuated positive symptom severity rating will help in comparing findings across studies and in meta-analyses.

Emulsification Properties of Garlic Aqueous Extract: Effect of Heat Treatment and pH Modification.

Despite the broad research available in the literature dealing with garlic health benefits, little information is found regarding the functional properties of garlic components. The aim of this study was to evaluate the emulsification properties of garlic water-soluble compounds (GWSC), encompassing proteins, saponins, and carbohydrates, after heat treatment (10 min at 95 °C) or pH adjustments (2.5, 3.5, and 7.8). After the various treatments, the extracts were used as such or filtrated (0.45 µm), and 10% soybean oil-in-water emulsions were prepared using low (0.48%) or high (6.55% wt/wt) extract concentrations. Results showed that whereas at low GWSC concentrations, both heating and acidifying resulted in the formation of bigger oil droplet sizes (i.e., from d32 = 0.36 µm using unmodified extract to d32 = 7-22 µm at pH 2.5 with or without extract filtration), the effects were opposite at the highest GWSC concentration. In the latter, heat treatment clearly reduced the droplet size as observed from the micrographs as well as the degree of creaming, though the occurrence of depletion and/or bridging flocculation was still strong. The acidification of the extract at this high GWSC concentration significantly reduced the droplet size, as observed from the micrographs; however, a strong flocculation was observed. Removal of protein aggregates, and possibly also saponin micelles, from the extract resulted in an obvious increase in emulsion droplet size. This research brings valuable insights on this study and utilisation of novel natural food emulsifiers from plant sources.

Development of the PSYCHS: Positive SYmptoms and Diagnostic Criteria for the CAARMS Harmonized with the SIPS.

Aim: To harmonize two ascertainment and severity rating instruments commonly used for the clinical high risk syndrome for psychosis (CHR-P): the Structured Interview for Psychosis-risk Syndromes (SIPS) and the Comprehensive Assessment of At-Risk Mental States (CAARMS). Methods: The initial workshop is described in the companion report from Addington et al. After the workshop, lead experts for each instrument continued harmonizing attenuated positive symptoms and criteria for psychosis and CHR-P through an intensive series of joint videoconferences. Results: Full harmonization was achieved for attenuated positive symptom ratings and psychosis criteria, and partial harmonization for CHR-P criteria. The semi-structured interview, named P ositive SY mptoms and Diagnostic Criteria for the C AARMS H armonized with the S IPS (PSYCHS), generates CHR-P criteria and severity scores for both CAARMS and SIPS. Conclusion: Using the PSYCHS for CHR-P ascertainment, conversion determination, and attenuated positive symptom severity rating will help in comparing findings across studies and in meta-analyses.

Comparison of capillary blood and plasma samples for the evaluation of seroprevalence to SARS-CoV-2 antibodies by lateral flow immunoassay in a university population in Medellín, Colombia, 2020.

Objectives: The aim of this study was to estimate the seroprevalence of anti-SARS-CoV-2 antibodies using the SARS-CoV-2 antibody test in a university population. Capillary blood and plasma samples were compared and correlated with symptomatology to establish rapid treatment processes and develop a public health strategy within the community. Study design: Descriptive study of seroprevalence of anti-SARS-CoV-2 antibodies in a university population. Methods: Standardised and validated laboratory serological tests were used to assess the immune response detected in capillary blood and plasma samples. In this study, 280 participants from the University Colegio Mayor de Antioquia in the Municipality of Medellín, Colombia, were tested for SARS-CoV-2 antibodies in capillary blood and plasma samples between November 2020 and January 2021. Results: In total, 29 (11.2%) individuals had positive results for anti-SARS-CoV-2 antibodies (IgG/IgM); 28 (96.6%) had positive results in plasma samples and 11 (37.9%) in capillary blood samples. The two tests were compared, and the overall sensitivity and specificity of capillary vs plasma samples was 36.7% and 99.6%, respectively. Conclusions: Anti-SARS-CoV-2 antibodies (IgG/IgM) can be used to estimate the seroprevalence in populations, including immunity by vaccination; however, capillary blood samples should not be used to detect previous infection as they provide low sensitivity compared to plasma samples.

Arabinoxylans as Functional Food Ingredients: A Review.

The health benefits of fibre consumption are sound, but a more compressive understanding of the individual effects of different fibres is still needed. Arabinoxylan is a complex fibre that provides a wide range of health benefits strongly regulated by its chemical structure. Arabinoxylans can be found in various grains, such as wheat, barley, or corn. This review addresses the influence of the source of origin and extraction process on arabinoxylan structure. The health benefits related to short-chain fatty acid production, microbiota regulation, antioxidant capacity, and blood glucose response control are discussed and correlated to the arabinoxylan's structure. However, most studies do not investigate the effect of AX as a pure ingredient on food systems, but as fibres containing AXs (such as bran). Therefore, AX's benefit for human health deserves further investigation. The relationship between arabinoxylan structure and its physicochemical influence on cereal products (pasta, cookies, cakes, bread, and beer) is also discussed. A strong correlation between arabinoxylan's structural properties (degree of branching, solubility, and molecular mass) and its functionalities in food systems can be observed. There is a need for further studies that address the health implications behind the consumption of arabinoxylan-rich products. Indeed, the food matrix may influence the effects of arabinoxylans in the gastrointestinal tract and determine which specific arabinoxylans can be included in cereal and non-cereal-based food products without being detrimental for product quality.

A Phase 2 Randomized, Double-Blind, Placebo-controlled Trial of Oral Camostat Mesylate for Early Treatment of COVID-19 Outpatients Showed Shorter Illness Course and Attenuation of Loss of Smell and Taste.

Importance: Early treatment of mild SARS-CoV-2 infection might lower the risk of clinical deterioration in COVID-19. Objective: To determine whether oral camostat mesylate would reduce upper respiratory SARS-CoV-2 viral load in newly diagnosed outpatients with mild COVID-19, and would lead to improvement in COVID-19 symptoms. Design: From June, 2020 to April, 2021, we conducted a randomized, double-blind, placebo-controlled phase 2 trial. Setting: Single site, academic medical center, outpatient setting in Connecticut, USA. Participants: Of 568 COVID-19 positive potential adult participants diagnosed within 3 days of study entry and assessed for eligibility, 70 were randomized and 498 were excluded (198 did not meet eligibility criteria, 37 were not interested, 265 were excluded for unknown or other reasons). The primary inclusion criteria were a positive SARS-CoV-2 nucleic acid amplification result in adults within 3 days of screening regardless of COVID-19 symptoms. Intervention: Treatment was 7 days of oral camostat mesylate, 200 mg po four times a day, or placebo. Main Outcomes and Measures: The primary outcome was reduction of 4-day log10 nasopharyngeal swab viral load by 0.5 log10 compared to placebo. The main prespecified secondary outcome was reduction in symptom scores as measured by a quantitative Likert scale instrument, Flu-PRO-Plus modified to measure changes in smell/taste measured using FLU-PRO-Plus. Results: Participants receiving camostat had statistically significant lower quantitative symptom scores (FLU-Pro-Plus) at day 6, accelerated overall symptom resolution and notably improved taste/smell, and fatigue beginning at onset of intervention in the camostat mesylate group compared to placebo. Intention-to-treat analysis demonstrated that camostat mesylate was not associated with a reduction in 4-day log10 NP viral load compared to placebo. Conclusions and relevance: The camostat group had more rapid resolution of COVID-19 symptoms and amelioration of the loss of taste and smell. Camostat compared to placebo was not associated with reduction in nasopharyngeal SARS-COV-2 viral load. Additional clinical trials are warranted to validate the role of camostat mesylate on SARS-CoV-2 infection in the treatment of mild COVID-19. Trial registration: Clinicaltrials.gov, NCT04353284 (04/20/20)(https://clinicaltrials.gov/ct2/show/NCT04353284?term=camostat+%2C+yale&draw=2&rank=1).

Chlamydia trachomatis, virus herpes simple-2 y Neisseria gonohrroeae: prevalência y factores de riesgo en estudiantes / Chlamydia trachomatis, herpes simplex virus-2 and Neisseria gonorrhoeae: Prevalence and risk factors in students

RESUMEN Objetivo Determinar la prevalencia de Chlamydia trachomatis (CT), virus herpes simple-2 (VHS-2) y N. gonorrhoeae (NG) y los factores de riesgo relacionados con la infección, en un grupo de estudiantes universitarios de la ciudad de Medellín. Metodología Se realizó un estudio descriptivo en un grupo de 323 estudiantes universitarios. A través de un formulario en línea, se realizó el reporte de los factores de riesgo y síntomas relacionados con infecciones de transmisión sexual (ITS) y luego se determinó la presencia de anticuerpos IgG y IgM para CT y VHS-2 y se realizó una prueba de PCR-RT para detectar NG y CT. Resultados La frecuencia de IgG para CT fue del 13% y la positividad para IgM fue del 11,9%. La frecuencia de IgG para VHS-2 fue del 11,8% y la frecuencia de CT y NG por la prueba PCR-RT fue del 1,5% y del 0%, respectivamente. Los factores de riesgo más frecuentes fueron: vida sexual activa en el 96,9%, uso algunas veces o nunca del condón en un 75,2%. Reportaron que tenían secreción genital el 13,6% de los estudiantes; úlceras, el 2,8%; verrugas, el 5,3%; ardor al orinar, el 15,5%; ampollas, el 4,6%, y diagnóstico previo de una ITS, el 18,9% de los estudiantes. Conclusión Se encontró CT y VHS-2 entre los jóvenes estudiados y además una alta frecuencia de factores de riesgo para la adquisición de ITS. Se recomienda mejorar las campañas de prevención y diagnóstico de las ITS en los jóvenes universitarios.

ABSTRACT Objective The aim of this study was to determine the prevalence of Chlamydia trachomatis (CT), Herpes Simple-2 virus (HSV-2) and N. gonorrhoeae (NG), and the risk factors related to the infection in a group of college students in the city of Medellín, Colombia. Methods A descriptive study was carried out in a group of 323 university students. Through an online form, the risk factors and symptoms related to sexually transmitted infection (STI) were reported, and then the presence of IgG and IgM antibodies for CT and HSV-2 was determined, and RT-PCR testing was performed to detect NG and CT. Results 13% was the IgG frequency for CT while 11.9% was for IgM. The frequency for IgG for VHS-2 was 11.8 while the frequencies determined by RT-PCR for CT and NG were 1.5% and 0.0% respectively. The risk factors most commonly associated were active sex life, 96.9%, and random use of condom, 75.2%. It was also found that 13.6% of the students had genital secretions, 2.8% had ulcers, 5.3% had genital warts, 4.6% had blisters, 15.5% had dysuria, and 18.9% had a previous STI diagnosis. Conclusions CT and HVS-2 were found among college students, besides a series of risk factors associated with STI. It is recomended to improve prevention and diagnosis campaigns among young college students.

Understanding whole-wheat flour and its effect in breads: A review.

Although the consumption of whole grains, including bread made with whole-wheat flour, is promoted for health benefits and reduced risk for disease and mortality, consumer acceptance, and consumption of some whole-wheat products is low compared to that of white breads. This review focuses on the understanding of whole-wheat flours, both their positive and negative aspects, and how to improve those flours for the production of whole-wheat breads. The review addresses genetic aspects, various milling systems, and pretreatment of bran and germ. The baking process and use of additives and enzymes may also improve product quality to help consumers meet dietary recommendations for daily whole-wheat consumption.

Genetic Contribution in Low Back Pain: A Prospective Genetic Association Study.

OBJECTIVES: Chronic pain is one of the most common reasons individuals seek medical attention. It is a major issue because of the wide interindividual variability in the analgesic response. This might be partly explained by the presence of variants in genes encoding molecules involved in pharmacodynamics and pharmacokinetics. The aim was to analyze opioid effectiveness in chronic low back pain (CLBP) relief after opioid titration, unveiling the impact of pharmacogenetics. METHODS: The study included 231 opioid-naïve patients from the Spine Unit; age 63 ± 14 years, 64% female, body mass index 29 ± 6 kg/m2 , visual analog scale pain intensity score 73 ± 16 mm. Clinical data were collected at baseline, 3 months after opioid titration, and after 2 to 4 years of follow-up concerning pain (intensity and relief), quality of life, disability, comorbidities, and drug prescription (opioid dose, rotations, and adverse events). The genotype influence of OPRM1, COMT, UGT2B7, ABCB1, KCNJ6, and CYP3A5*3A in analgesic response was analyzed by reverse-transcription polymerase chain reaction genotyping. RESULTS: Patients with the COMT G472A-AA genotype (rs4680) and KCNJ6 A1032G-A allele (rs2070995) CLBP responded differently to opioid titration, with higher pain intensity requiring higher dosing. Furthermore, GG- genotypes of A118G (OPRM1, rs1799971) and A854G (UGT2B7, rs776746) influenced the neuropathic component. After opioid titration, CLBP intensity, neuropathic component, low back pain disability, anxiety, and depression significantly decreased, while quality of life improved. CONCLUSION: Single-nucleotide polymorphisms in genes involved in pain transmission and opioid metabolism might predispose to exaggerated sensitivity and differences in the opioid analgesic effect in patients with CLBP. We encourage clinical trials for their clinical application in chronic pain management.

Evaluation of Starch⁻Protein Interactions as A Function of pH.

Protein-starch gels are becoming more common in food processing when looking for enriched foods. However, processing conditions scarcely are considered when producing those gels. The aim of this research was to study the effect of processing pH (4.5, 6.0, and 7.5) on the hydration and pasting properties, gel microstructure, and texture of corn starchy gels made with four different proteins (pea, rice, egg albumin, and whey) at a ratio of 1:1 starch/protein and a solid content of 12.28%. The water binding capacity of the starch-protein mixtures was positively influenced by low solubility of the protein used. Acidic pH decreased the apparent peak viscosity of both starch and starch-protein mixtures, with the exception of starch-albumin blends, which increased it. The gels' microstructure showed that the uniformity of the protein-enriched gels was dependent on protein type and pH, leading to diverse hardness. In general, the starchy gels containing animal proteins (albumin and whey) were more affected by pH than those obtained with vegetal proteins (pea and rice). Therefore, processing pH might be an advisable method to modify the functionality of starch-protein gels.

Predictors of Successful HIV Care Re-engagement Among Persons Poorly Engaged in HIV Care.

The Data to Care (D2C) strategy uses HIV surveillance data to identify persons living with HIV (PLWH) who are poorly engaged in care and offers assistance with care re-engagement. We evaluated HIV care re-engagement among PLWH in Seattle & King County, Washington after participation in a D2C program and determined whether variables available at the time of the D2C interview predicted subsequent re-engagement in care. We defined successful re-engagement as surveillance evidence of either continuous care engagement (≥ 2 CD4 counts or HIV RNA results ≥ 60 days apart) or viral suppression (≥ 1 HIV RNA < 200 copies/mL) in the year following the D2C interview. Predictor variables included client characteristics, beliefs about HIV care, and scores on psychosocial assessment scales. Half of participants successfully re-engaged in care. We did not find any significant predictors of re-engagement except viral suppression at the time of the D2C interview. Close follow-up is needed to identify which D2C participants need additional assistance re-engaging in care.

Situações de urgência e emergência na atenção primária reguladas pelo SAMU / Urgency and emergency situations in primary care regulated by SAMU / Situaciones de urgencia y emergencia en la atención primaria regulada por el SAMU

Objetivo: identificar as principais situações de urgência e emergência que chegam aos serviços de atenção primária e que são encaminhadas para serviços de maior complexidade reguladas pelo serviço de atendimento móvel de urgência. Método: estudo longitudinal e prospectivo realizado em 21 unidades de saúde. A coleta de dados ocorreu entre junho de 2014 a maio de 2015. Resultados: Foram realizadas 57 chamadas para o SAMU, sendo 28 originadas de unidades com estratégia de saúde da família. A idade média dos pacientes foi de 40,94+13,21 anos, a maioria era do sexo feminino e o sistema mais afetado foi o cardiovascular seguido pelo neurológico. Tempo médio de deslocamento para o SAMU chegar ao local do chamado foi 31,69±21,50 minutos. Os encaminhamentos realizados foram para unidade de pronto atendimento na sua maioria. Conclusão: Alterações dos sistemas cardiovascular e neurológico foram as mais prevalentes dentre as situações reguladas pelo serviço de atendimento móvel de urgência na atenção primária.

Objective: To identify the main emergency and emergency situations that reach the primary care services and which are sent to more complex services regulated by the mobile emergency service. Method: A prospective longitudinal study performed in 21 health units. Data collection occurred between June 2014 and May 2015. Results: 57 calls were made to SAMU, 28 of which originated from units with a family health strategy. The mean age of the patients was 40.94 + 13.21 years, the majority was female and the system most affected was the cardiovascular followed by the neurological. Average travel time for the SAMU arriving at the named location was 31.69 ± 21.50 minutes. The referrals were made to the nearest emergency care unit. Conclusion: Changes in the cardiovascular and neurological systems were the most prevalent among the situations regulated by the emergency mobile service in primary care.

Objetivo: Identificar las principales situaciones de urgencia y emergencia que llegan a los servicios de atención primaria y que son encaminadas para servicios de mayor complejidad reguladas por el servicio de atención móvil de urgencia. Método: Estudio longitudinal prospectivo realizado en 21 unidades de salud. La recolección de datos ocurrió entre junio de 2014 a mayo de 2015. Resultados: Se realizaron 57 llamadas para el SAMU, siendo 28 originadas de unidades con estrategia de salud de la familia. La edad media de los pacientes fue de 40,94 + 13,21 años, la mayoría era del sexo femenino y el sistema más afectado fue el cardiovascular seguido por el neurológico. Tiempo promedio de desplazamiento para el SAMU llegar al lugar del llamado fue 31,69 ± 21,50 minutos. Los encaminamientos realizados fueron para unidad de pronta atención en su mayoría. Conclusión: Alteraciones de los sistemas cardiovascular y neurológico fueron las más prevalentes entre las situaciones reguladas por el servicio de atención móvil de urgencia en la atención primaria.

A Cluster Randomized Evaluation of a Health Department Data to Care Intervention Designed to Increase Engagement in HIV Care and Antiretroviral Use.

BACKGROUND: Many US health departments have implemented Data to Care interventions, which use HIV surveillance data to identify persons who are inadequately engaged in HIV medical care and assist them with care reengagement, but the effectiveness of this strategy is uncertain. METHODS: We conducted a stepped-wedge, cluster-randomized evaluation of a Data to Care intervention in King County, Washington, 2011 to 2014. Persons diagnosed as having HIV for at least 6 months were eligible based on 1 of 2 criteria: (1) viral load (VL) greater than 500 copies/mL and CD4 less than 350 cells/µL at the last report in the past 12 months or (2) no CD4 or VL reported to the health department for at least 12 months. The intervention included medical provider contact, patient contact, and a structured individual interview. Health department staff assisted patients with reengagement using health systems navigation, brief counseling, and referral to support services. We clustered all eligible cases in the county by the last known medical provider and randomized the order of clusters for intervention, creating contemporaneous intervention and control periods (cases in later clusters contributed person-time to the control period at the same time that cases in earlier clusters contributed person-time to the intervention period). We compared the time to viral suppression (VL <200 copies/mL) for individuals during intervention and control periods using a Cox proportional hazards model. RESULTS: We identified 997 persons (intention to treat [ITT]), 18% of whom had moved or died. Of the remaining 822 (modified ITT), 161 (20%) had an undetectable VL reported before contact and 164 (20%) completed the individual interview. The hazard ratio (HR) for time to viral suppression did not differ between the intervention and control periods in ITT (HR, 1.21 [95% confidence interval, 0.85-1.71]) or modified ITT (HR, 1.18 [95% confidence interval, 0.83-1.68]) analysis. CONCLUSIONS: The Data to Care intervention did not impact time to viral suppression.

Modulation of the IL-33/IL-13 Axis in Obesity by IL-13Rα2.

In obesity, IL-13 overcomes insulin resistance by promoting anti-inflammatory macrophage differentiation in adipose tissue. Endogenous IL-13 levels can be modulated by the IL-13 decoy receptor, IL-13Rα2, which inactivates and depletes the cytokine. In this study, we show that IL-13Rα2 is markedly elevated in adipose tissues of obese mice. Mice deficient in IL-13Rα2 had high expression of IL-13 response markers in adipose tissue, consistent with increased IL-13 activity at baseline. Moreover, exposure to the type 2 cytokine-inducing alarmin, IL-33, enhanced serum and tissue IL-13 concentrations and elevated tissue eosinophils, macrophages, and type 2 innate lymphoid cells. IL-33 also reduced body weight, fat mass, and fasting blood glucose levels. Strikingly, however, the IL-33-induced protection was greater in IL-13Rα2-deficient mice compared with wild-type littermates, and these changes were largely attenuated in mice lacking IL-13. Although IL-33 administration improved the metabolic profile in the context of a high fat diet, it also resulted in diarrhea and perianal irritation, which was enhanced in the IL-13Rα2-deficient mice. Weight loss in this group was associated with reduced food intake, which was likely related to the gastrointestinal effects. These findings outline both potentially advantageous and deleterious effects of a type 2-skewed immune response under conditions of metabolic stress, and identify IL-13Rα2 as a critical checkpoint in adipose tissues that limits the protective effects of the IL-33/IL-13 axis in obesity.

Reverse smokers's and changes in oral mucosa. Department of Sucre, Colombia.

OBJECTIVES: This work is intended to establish the prevalence of reverse smokers at the villages of Hato Nuevo, San Francisco and Cayo de Palma, Department of Sucre, Colombia, characterizing their socio-culture conditions, clinical and histological changes in the oral mucosa. DESIGN OF STUDY: A descriptive study was done through a home to home inquiry to select the people with inclusion criteria for a posterior clinical test and a biopsy of the affected oral mucosa. RESULTS AND CONCLUSIONS: Reverse smokers's prevalence was from the 15%, mainly women (p<0.001) with an age average of 59.3 years. The lesions were classified clinically in mild, moderate and severe changes. Tongue moderate lesions presented the higher frequency (80%), followed by severe lesions on palate (74%). Oral cancer prevalence was 10.8% in the San Francisco village and 18.2% in Cayo de Palma village, no new cases were reported in Hato Nuevo village. This was the highest prevalence reported in comparison with other studies with similar population. The clinical and histological findings agree with the reported in literature, no relation was found between the degree of clinical severity and the dysplasia itself. Cases of oral submucous fibrosis-like lesions were found, which had never been reported in Latin America. Further studies are required in order to decrease the morbidity for this habit and to identify other related risk factors.

Reverse smokers’s and changes in oral mucosa. Department of Sucre, Colombia

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Objectives: This work is intended to establish the prevalence of reverse smokers at the villages of Hato Nuevo, San Francisco and Cayo de Palma, Department of Sucre, Colombia, characterizing their socio-culture conditions, clinical and histological changes in the oral mucosa.Design of study: A descriptive study was done through a home to home inquiry to select the people with inclusion criteria for a posterior clinical test and a biopsy of the affected oral mucosa.Results and conclusions: Reverse smokers’s prevalence was from the 15%, mainly women (p<0.001) with an ageaverage of 59.3 years. The lesions were classified clinically in mild, moderate and severe changes. Tongue moderate lesions presented the higher frequency (80%), followed by severe lesions on palate (74%). Oral cancer prevalence was 10.8% in the San Francisco village and 18.2% in Cayo de Palma village, no new cases were reported in Hato Nuevo village. This was the highest prevalence reported in comparison with other studies with similar population. The clinical and histological findings agree with the reported in literature, no relation was found between the degree of clinical severity and the dysplasia itself. Cases of oral submucous fibrosis-like lesions were found, which had never been reported in Latin America. Further studies are required in order to decrease the morbidity for this habit and to identify other related risk factors (AU)

Elaboración de un cuadro de mandos para la gestión clínica en un hospital / Development of a control panel for clinical management in a hospital

Objetivo: Elaborar una serie de indicadores clínicos del funcionamiento del hospital y de sus servicios clínicos para que constituyan una herramienta útil en la gestión clínica. Material y métodos: Se formó un grupo de trabajo con representantes de documentación y archivo, farmacia hospitalaria, medicina preventiva, epidemiología clínica, bioestadística y calidad. El grupo elaboró una propuesta de documento de indicadores para cada servicio hospitalario, que incluía indicadores de servicio y del hospital en conjunto con sus comparaciones con los indicadores del año anterior y con los procedentes de otros hospitales semejantes. Se difundió el documento a todos los servicios clínicos dependientes de dirección médica y se modificó tras recoger las sugerencias de los destinatarios. Resultados: Se describen los indicadores de servicio (indicadores de codificación, clínicos, de reingreso, de estancia preoperatoria, de prescripción farmacéutica, de gasto farmacéutico y de infección quirúrgica por tipo de cirugía) e indicadores hospitalarios (mortalidad evitable, mortalidad por infarto agudo de miocardio como diagnóstico principal, mortalidad en 48 h tras cirugía programada, tasas de prevalencia de pacientes con úlceras de decúbito y tasas de prevalencia de infecciones nosocomiales) que forman parte del cuadro de mandos. Conclusiones: Los indicadores incluidos en el cuadro de mandos transmiten a los servicios la información que necesitan para la gestión clínica y constituyen un instrumento útil para la mejora de la calidad asistencial (AU)

Síndrome de Budd-Chiari durante a gravidez: apresentaçäo de um caso / Budd-Chiari syndrome during pregnancy: report of a case

A síndrome de Budd-Chiari consiste na obstruçäo das veias de drenagem do fígado desde a veia eferente do lóbulo até a desembocadura da cava inferior no átrio direito. Clinicamente caracteriza-se por dor abdominal, ascite e hepatomegalia. neste relato é apresentado o casod e uma paciente que desenvolveu a síndrome de Budd-Chiari durante a gravidez. Na vigência do uso de anticoncepcional oral