Disminución del nivel de estrés en madres de prematuros en la unidad de cuidados intensivos / Decrease of premature mothers' stress levels in the intensive care unit

Objetivo: Determinar la eficacia del programa «Creating Opportunities for Parent Empowerment» (COPE) en la disminución del nivel de estrés en madres de prematuros en la unidad de cuidado intensivo neonatal (UCIN). Métodos: Ensayo clínico realizado en Colombia en el cual se incluyeron las madres de recién nacidos menores de 34 semanas de gestación, hospitalizados, sin antecedentes de hijos prematuros. Se excluyeron las madres con enfermedades psiquiátricas, trastornos del lenguaje, antecedentes de consumo de sustancias psicoactivas y cuyo recién nacido tuviera malformación congénita. Grupo intervención con el programa COPE y grupo control con el manejo usual institucional. Asignación aleatoria por bloques y enmascaramiento para madres y evaluadores. Se aplicó la Escala de Estrés Parental: UCIN. Se realizó la prueba de normalidad Shapiro Wilk, el test de Wilcoxon y análisis de covarianza (ANCOVA), con un nivel de significación de p < 0,05 e IC del 95%. Resultados: Participaron 66 madres. Los dos grupos fueron similares en sus características demográficas y en la puntuación del nivel de estrés inicial. El grupo control aumentó la puntuación final de estrés en dos categorías y el grupo intervención disminuyó valores finales en todas las categorías. La puntuación inicial y final del nivel de estrés general total mostró disminución estadísticamente significativa (p < 0,01), pero al realizar la comparación mediante el análisis ANCOVA no hubo diferencia significativa (p = 0,4). Conclusiones: El programa COPE disminuye el nivel de estrés materno, fortaleciendo aspectos durante la hospitalización como son: el apoyo emocional, el fortalecimiento de su rol como cuidadoras, la interacción con sus bebés y el desarrollo de un ambiente amigable en la UCIN

Objective: To determine the effectiveness of the 'Creating Opportunities for Parent Empowerment' (COPE) programme in reducing stress levels in mothers of preterm infants in the neonatal intensive care unit (NICU). Methods: Clinical trial performed in Colombia, including mothers of infants younger than 34 weeks of gestation, hospitalized, without a history of premature delivery. The mothers with psychiatric illnesses, language disorders, history of use of psychoactive substances and whose newborns had a congenital malformation were excluded. A group intervened with the COPE programme and a control group with the usual institutional management were formed. Block randomization and masking was used for mothers and evaluators. The Parental Stress Scale was applied: NICU; Shapiro Wilk normality test, Wilcoxon test and covariance analysis (ANCOVA) with a significance level of p < .05, 95% CI. Results: 66 mothers were enrolled. The two groups were similar in their demographic characteristics and in the initial stress level score. The control group increased the final stress score in two categories and the intervention group decreased final values in all categories. The initial and final scores of the overall general stress level showed a significant decrease (p < .01), but when comparing with the ANCOVA analysis there was no significant difference (p = .4). Conclusions: The COPE programme reduces the level of maternal stress, strengthening aspects during hospitalization, such as: emotional support, strengthening their role as caregivers and interaction with their babies and the development of a friendly environment in the NICU

Decrease of premature mothers' stress levels in the intensive care unit. / Disminución del nivel de estrés en madres de prematuros en la unidad de cuidados intensivos.

OBJECTIVE: To determine the effectiveness of the 'Creating Opportunities for Parent Empowerment' (COPE) programme in reducing stress levels in mothers of preterm infants in the neonatal intensive care unit (NICU). METHODS: Clinical trial performed in Colombia, including mothers of infants younger than 34 weeks of gestation, hospitalized, without a history of premature delivery. The mothers with psychiatric illnesses, language disorders, history of use of psychoactive substances and whose newborns had a congenital malformation were excluded. A group intervened with the COPE programme and a control group with the usual institutional management were formed. Block randomization and masking was used for mothers and evaluators. The Parental Stress Scale was applied: NICU; Shapiro Wilk normality test, Wilcoxon test and covariance analysis (ANCOVA) with a significance level of p<.05, 95% CI. RESULTS: 66 mothers were enrolled. The two groups were similar in their demographic characteristics and in the initial stress level score. The control group increased the final stress score in two categories and the intervention group decreased final values in all categories. The initial and final scores of the overall general stress level showed a significant decrease (p<.01), but when comparing with the ANCOVA analysis there was no significant difference (p=.4). CONCLUSIONS: The COPE programme reduces the level of maternal stress, strengthening aspects during hospitalization, such as: emotional support, strengthening their role as caregivers and interaction with their babies and the development of a friendly environment in the NICU.

Evaluation of the physical properties and conservation of the antioxidants content, employing inulin and maltodextrin in the spray drying of blueberry juice.

In this work, two carbohydrate polymers, inulin (I) and maltodextrin (MX), were compared as carrying agents in the spray drying of blueberry juice (BJ). The physicochemical properties and the conservation of the antioxidants content were characterized. Both systems, showed non-agglomerated particles and light-purple color appearance. Powders were subjected to the adsorption of water, and the glass transition temperature (Tg) decreased with the water activity. The evolution of the microstructure in the MX-BJ remained unchanged, while the I-BJ presented an abrupt change from amorphous to crystalline. This was corroborated by scanning electron microscopy (SEM), observing in the I-BJ system, the change from spherical into irregular shape particles. In the conservation of the antioxidants content, the MX-BJ showed a better performance. Anyhow, the performance of both carbohydrate polymers as carrying agents in the spray drying of BJ was effective.

Physical properties of inulin and inulin-orange juice: physical characterization and technological application.

In this work two systems based on a carbohydrate polymer were studied: inulin as model system and inulin-orange juice as complex system. Both system were stored at different water activity conditions and subsequently characterized. Water adsorption isotherms type II were fitted by the GAB model and the water monolayer content was determined for each system. From thermal analyzes it was found that at low water activities (aw) systems were fully amorphous. As aw increased, crystallinity was developed. This behavior was corroborated by X-ray diffraction. In the inulin-orange juice system, crystallization appears at lower water activity caused by the intensification of the chemical interaction of the low molecular weight species contained in orange juice. Glass transition temperature (Tg), determined by modulated differential scanning calorimeter, decreased with aw. As water is adsorbed, the physical appearance of samples changed which could be observed by optical microscopy and effectively related with the microstructure found by scanning electron microscopy.

Lesiones osteomusculares de miembros superiores y región lumbar: caracterización demográfica y ocupacional. Universidad Nacional de Colombia, Bogotá 2001- 2009 / Musculoskeletal disorders of the upper and the lumbar region: demographic and occupational characterization, Universidad Nacional de Colombia, Bogotá 2001- 2009

Objetivo: Caracterizar variables demográficas y ocupacionales de casos de lesiones osteomusculares de miembros superiores y región lumbar. Metodología: Estudio descriptivo, corte transversal. Se realizó búsqueda y revisión de literatura científica para conocer factores de riesgo laborales asociados a lesiones osteomusculares de miembros superiores, región lumbar y determinar variables relevantes. Las variables demográficas y ocupacionales en casos de lesiones osteomusculares, se obtuvieron de registros de la base de datos diseñada por la División Nacional de Salud Ocupacional de la Universidad Nacional de Colombia. Resultados: Se identificaron 99 registros de trabajadores con diagnóstico positivo de lesiones osteomusculares de miembros superiores y región lumbar. El género femenino y grupo etáreo entre 41 a 50 años reportó 60% y 43.43% de casos de lesiones osteomusculares respectivamente. El porcentaje de casos según grupo ocupacional para docentes y otros administrativos presentó distribución similar 28.28%. Se encontró que movimientos repetitivos de codo, muñeca, dedos para miembros superiores y postura prolongada para región lumbar son factores de riesgo más frecuentes. En trabajadores los segmentos corporales más comprometidos con lesiones osteomusculares fueron muñeca y zona lumbar. Escoliosis e hiperlordosis fueron las alteraciones de columna vertebral con mayor frecuencia entre la población participante. La mejoría y/o desaparición de los síntomas con descanso y reaparición o agravamiento durante el trabajo fue el criterio más representativo para considerar posible origen laboral de casos de lesiones osteomusculares para miembros superiores y región lumbar. Conclusión: El conocimiento de las variables asociadas a lesiones osteomusculares permite realizar intervenciones preventivas (AU)

The aim of this study was to characterize demographic and occupational variables of cases of upper limb and lower back musculoskeletal injuries. Methodology: In a descriptive, cross-sectional study, we searched and reviewed scientific literature to learn about occupational risk factors associated with musculoskeletal injuries of upper limbs, the lower back and to determine relevant variables. The demographic and occupational variables in musculoskeletal injury cases were obtained from records in the database designed by the National Occupational Health Division at Universidad Nacional de Colombia. Results: We identified 99 records of workers with positive diagnosis of upper limb and lower back musculoskeletal injuries. The female gender and age group between 41 to 50 years reported 60% and 43.43% of the cases of musculoskeletal injuries respectively. The percentage of cases by occupational group for teachers and administrative workers showed a similar distribution of 28.28%. We found that repetitive movements of elbow, wrist, fingers for upper limbs and an extended position for lumbar region are the most common risk factors. In workers, wrist and lower back were the most prominent musculoskeletal injuries. Scoliosis and hyperlordosis were spinal disorders more frequent among participants. The improvement and / or disappearance of symptoms with rest and recurrence or worsening during the work time was the more representative criterion for considering the possible cases of occupational origin of musculoskeletal injuries to upper limbs and lower back. Conclusion: The knowledge of these variables associated with musculoskeletal injuries allows for preventive interventions(AU)

Atrial Fibrillation and Stroke Risk After Coronary Artery Bypass Grafting Surgery.

Background: The present multicentre study was aimed at determining the effect of preoperative atrial fibrillation (preop-AF) as stroke risk factor in coronary artery bypass graft surgery (CABG) during the perioperative period. Methods: Patients undergoing isolated CABG surgery were enrolled from 21 Spanish centers. Baseline variables related with perioperative stroke risk were recorded and analysed. The Northern New England Cardiovascular Disease Study Group (NNECVDSG) stroke risk schema was used to stratify stroke risk and compare predicted vs observed neurologic outcomes in this study. Results: 26347 patients were enrolled in the study. Prevalence of preop-AF was 4.2%, and was associated significantly with major cardiovascular comorbidities. The stroke rate was 1.38% (365 strokes), and it was slightly higher for patients with preop-AF vs non preop-AF, 1.82% vs 1.36%, p = 0.2. NNECVDSG schema showed good predictive ability calculating the area under the receiver operating characteristic curve (c-statistic 0.696; 95% CI 0.668 to 0.723). To investigate the associations of baseline preoperative variables with perioperative CABG-stroke a logistic regression model was performed. Preop-AF impact on perioperative stroke was lower that other variables. Preop-AF did not show an adverse impact in the quartiles groups according to NNECVDSG Stroke Risk Index. Conclusion: Risk of perioperative stroke in isolated CABG surgery patients is not significantly increased by preop-AF.

Frecuencia de presentación del síndrome de piernas inquietas y su asociación con apnea obstructiva del sueño / Restless legs syndrome, frequency and its association with obstructive sleep apnea syndrome

Antecedentes. La prevalencia del síndrome de piernas inquietas oscila entre el 2,5 y el 29%. Objetivos. Determinar la frecuencia de presentación del SPI en un grupo de pacientes adultos a quienes se les realizó un estudio polisomnográfico (PSG) por condiciones diferentes al SPI, en la Clínica de Sueño del Hospital Universitario Fundación Santa Fe de Bogotá, en el período entre el 1º de enero y el 31 de diciembre del 2006, y determinar su correlación con la severidad del SAOS. Material y métodos. Se hizo un estudio de prevalencia analítica. Los pacientes llenaron un cuestionario en el que se incluyen preguntas relacionadas con los criterios diagnósticos del SPI y su frecuencia de presentación. Los pacientes fueron agrupados por género, edad e índice de masa corporal. Se evaluó la latencia para el inicio del sueño y se agruparon según la severidad del SAOS. Resultados. Se obtuvo una muestra de 301 pacientes, 72% hombres, de los cuales 43 cumplieron con los criterios diagnósticos para SPI. Se encontró una prevalencia global del 14,3%, para las mujeres fue del 18,3% y para los hombres del 12,8%. Se identificó una mayor prevalencia en el grupo de pacientes entre los 50-59 años, tanto en el total de la población como en el grupo de pacientes hombres (18,4% y 16,4% respectivamente), en las mujeres la prevalencia fue mayor en el grupo mayor de 70 años (28,6%). La prevalencia fue mayor en el grupo de pacientes obesos en ambos géneros (p = 0,003). La latencia para el inicio del sueño fue más prolongada en los pacientes con SPI (p = 0,003). En relación con el grado de severidad del SAOS, se encontró una mayor frecuencia del SPI en mujeres con SAOS leve y moderado, en los hombres no se halló relación significativa entre las entidades. Conclusiones. La prevalencia en nuestra población de estudio fue similar a la reportada en otros países latinoamericanos...

Meningitis neonatal tardía por germen atípico / Atypical germ-induced delayed neonatal meningitis

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Fracturas desplazadas del radio distal en niños. Fijación percutánea con clavos de Kirschner. Retos y realidades: serie de casos / Displaced distal radius fractures in children. Percutaneous fixation with Kirschner wire. Challenges and realities: case series

Estudio observacional descriptivo, tipo serie de casos, realizado entre agosto de 1995 y mayo de 2001, en 60 pacientes menores de 15 años con diagnóstico de fractura de radio distal. A 30 de ellos con severo desplazamiento y parámetros de riesgo de redesplazamiento se les realizó como primera opción reducción cerrada bajo anestesia general, fijación percutánea con clavos de Kirschner e inmovilización con yeso. A los 30 restantes se les inició tratamiento conservador, 8 perdieron la reducción alcanzada y requirieron nueva reducción y fijación percutánea, una de ellas abierta. Al final, todos obtuvieron un resultado satisfactorio sin o con algún grado menor de pérdida de anatomía o función que recuperaron con la remodelación final. Un seguimiento a cuatro años demostró que la técnica de fijación percutánea conlleva mínimos riesgos y buena aceptación, garantizando así los objetivos sin contratiempos en el tratamiento de la fractura con mayor frecuencia en niños.

[Large myxoma of the right atrium]. / Mixoma de gran tamaño en la aurícula derecha.

We describe the case of a patient in whom two-dimensional echocardiography, performed due to dissociated cholestasis and jugular ingurgitation, demonstrated a huge mass in the right atrium which prolapsed in the right ventricle. Intraoperative transesophageal echocardiography was performed to further assess the dimension and characteristics of the mass and to discard the involvement of associated structures. The patient underwent a cardiopulmonary bypass surgery and the mass (12 * 5 cm) was removed without complications. Histologic examination confirmed the diagnosis of myxoma. This case is of interest because of the size of the mass, and is centered in the diagnosis following clinical suspicion due to the pattern of dissociated cholestasis and jugular ingurgitation leading to surgery to prevent the potential embolic complications.

Effects of hypoxia and glutathione depletion on hemoglobin- and myoglobin-mediated oxidative stress toward endothelium.

We investigated the toxicity of hemoglobin/myoglobin on endothelial cells under oxidative stress conditions that include cellular hypoxia and reduced antioxidant capacity. Bovine aorta endothelial cells (BAECs), grown on microcarrier beads, were subjected to cycles of hypoxia and reoxygenation in a small volume of medium, and endothelial cell monolayers were depleted of their intracellular glutathione (GSH) by treatment with buthionine sulfoximine. Incubation of diaspirin cross-linked hemoglobin (DBBF-Hb) or horse skeletal myoglobin (Mb) with BAECs subjected to 3 h of hypoxia caused transient oxidation of the hemoproteins to the ferryl form (Fe(4+)). Formation of the ferryl intermediate was decreased in a concentration-dependent manner by the addition of L-arginine, a substrate of NO synthase, after 3 h of hypoxia. Optimal inhibition of ferryl formation, possibly due to the antioxidant action of NO, was achieved with 900 microM L-arginine. Addition of hydrogen peroxide to GSH-depleted cells in the presence of DBBF-Hb or Mb significantly decreased cell viability. Ferryl Mb, but not ferryl DBBF-Hb, was observed in samples analyzed at the end of treatment, which may explain the greater toxicity observed with Mb as opposed to DBBF-Hb. This model may be utilized to identify causative agent(s) associated with hemoprotein cytotoxicity and in designing strategies to suppress or control heme-mediated injury under physiologically relevant conditions.

Left ventricular outflow tract obstruction with mitral mechanical prosthesis.

Left ventricular outflow tract obstruction after mitral valve replacement may occur when the native mitral apparatus is preserved intact. Although it has usually been reported using bioprostheses, we present one case using a low-profile mechanical prosthesis. The reduction of left ventricular dimensions and valvular redundancy contributed to this complication. We obtained definitive relief of left ventricular outflow tract obstruction by transaortic exposure and partial resection of the obstructing tissue with the help of video-assisted cardioscopy.

Evaluating the Role of Plantations as Carbon Sinks: An Example of an Integrative Approach from the Humid Tropics

/ Despite their fast growth, tropical plantations are a small sink of atmospheric carbon because they occupy only a small area in relation to other land uses worldwide. Proper design and management of plantations can increase biomass accumulation rates, making them more effective C sinks. However, fast-growing plantations can extract large amounts of nutrients from the soil, and site fertility declines may limit sustained plantation forestry after a few rotations. We measured aboveground biomass accumulation, carbon sequestration, and soil chemistry in three young plantations of 12 indigenous tree species in pure and mixed designs in the humid lowlands of Costa Rica. Annual biomass increments for the three mixed plantations ranged from 10-13 Mg/ha. The mixtures of four species gave higher biomass per hectare than that obtained by the sum of one fourth hectare of each species in pure plots. At this early age of the plantations, estimated annual C sequestration values were comparable to other reports from young plantations of exotic species commonly grown in the tropics. Four years after planting, decreases in soil nutrients were apparent in pure plots of some of the fastest growing species, while beneficial effects on soils were noted under other species. The mixed plots showed intermediate values for the nutrients examined and, sometimes, improved soil conditions. A mixture of fast and slower growing species yields products at different times, with the slower growing species constituting a longer term sink for fixed carbon. Examination of the role of tropical plantations as C sinks necessitates integrative approaches that consider rates of C sequestration, potential deleterious effects on ecosystem nutrients, and economic, social, and environmental constraints.KEY WORDS: Native trees; Aboveground biomass; Stem increments; Rotation length; Soil nutrients; Economics

Recovery from rabies in man.

A 45-year-old woman from Mendoza, Argentina, was severely bitten by a dog that died 4 days later. Before death, the dog was nervous, aggressive, and had occasional seizures. Ten days after the woman had been bitten, rabies vaccine treatment was begun: 14 daily doses of suckling mouse brain vaccine followed by 2 booster doses. Twenty-one days after the biting episode, she developed a cerebellar striatal syndrome, which persisted throughout several months, and severe encephalitic symptoms, which persisted for 75 days. After 13 months, recovery was nearly complete. The patient's serum and cerebrospinal fluid contained rabies-neutralizing antibodies reaching maximum titers of 1:640 000 and 1:160 000, respectively. Titers of this magnitude have never been previusly recorded after suckling mouse brain vaccine treatment. This phenomenon, together with the epidemiologic, clinical, and laboratory data presented, supports the conclusion of a nonfatal case of rabies in man.