Preventable incidence cases from non-communicable diseases attributable to insufficient physical activity in Chile.

OBJECTIVES: Lack of sufficient physical activity (PA) has been associated with an increased risk of several non-communicable diseases (NCDs) and all-cause mortality. This study aimed to estimate the number of preventable incidence cases of NCDs attributable to insufficient PA in the Chilean population. STUDY DESIGN: Comparative risk assessment modelling study. METHODS: This study examined data from 5834 participants aged ≥20 years from the Chilean National Survey (2016-2017). PA was assessed by the Global Physical Activity Questionnaire (GPAQ), and metabolic equivalent of tasks (METs) were assigned according to PA intensity. Estimated incidence cases of NCDs in Chile in 2019 were obtained from the Global Burden of Disease study. Relative risks for breast cancer, colon cancer, ischaemic heart disease, diabetes and stroke were obtained from a published meta-analysis and applied to the prevalence of insufficient PA estimates through the potential impact fraction equation. RESULTS: High levels of PA (≥8000 MET-min/week) could potentially avoid more than 22,000 (64.6 %) incidence NCD cases, ranging from 498 (10.1 %) preventable cases of breast cancer to 5629 (14.7 %) cases of diabetes. Other modelled scenarios also showed to reduce the incidence cases of all five NCDs but to a lesser extent; where at least PA recommendation was achieved, preventable NCDs were reduced by 6522 cases (18.7 %), and where a 10 % relative reduction in insufficient PA level in the population was achieved, preventable NCDs were reduced by 651 (1.8 %) cases. CONCLUSIONS: The study results provide estimates for the incidence cases of preventable NCDs attributable to insufficient PA, highlighting the important role of PA in NCD prevention in Chile.

Participation of leukaemia inhibitory factor in follicular development and steroidogenesis in rat ovaries.

Leukaemia inhibitory factor (LIF) is a cytokine belonging to the interleukin-6 family that is important at the reproductive level in the uterine implantation process. However, there is very little evidence regarding its effect at the ovarian level. The aim of this work was to study the local involvement of the LIF/LIFRß system in follicular development and steroidogenesis in rat ovaries. To carry out this research, LIF/LIFR/GP130 transcript and protein levels were measured in fertile and sub-fertile rat ovaries, and in vitro experiments were performed to assess STAT3 activation. Then, in in vivo experiments, LIF was administered chronically and locally for 28 days to the ovaries of rats by means of an osmotic minipump to enable us to evaluate the effect on folliculogenesis and steroidogenesis. It was determined by quantitative polymerase chain reaction and western blot that LIF and its receptors are present in fertile and sub-fertile ovaries and that LIF varies during the oestrous cycle, being higher during the oestrus and meta/dioestrus stages. In addition to this, it was found that LIF can activate STAT3 pathways and cause pSTAT3 formation. It was also observed that LIF decreases the number and size of preantral and antral follicles without altering the number of atretic antral follicles and can increase the number of corpora lutea, with a notable increase in the levels of progesterone (P4). It is therefore possible to infer that LIF exerts an important effect in vivo on folliculogenesis, ovulation and steroidogenesis, specifically the synthesis of P4.

Lurbinectedin, a selective inhibitor of oncogenic transcription, in patients with pretreated germline BRCA1/2 metastatic breast cancer: results from a phase II basket study.

BACKGROUND: Lurbinectedin, a selective inhibitor of oncogenic transcription, has shown preclinical antitumor activity against homologous recombination repair-deficient models and preliminary clinical activity in BRCA1/2 breast cancer. PATIENTS AND METHODS: This phase II basket multitumor trial (NCT02454972) evaluated lurbinectedin 3.2 mg/m2 1-h intravenous infusion every 3 weeks in a cohort of 21 patients with pretreated germline BRCA1/2 breast cancer. Patients with any hormone receptor and human epidermal growth factor receptor 2 status were enrolled. The primary efficacy endpoint was overall response rate (ORR) according to RECIST v1.1. Secondary endpoints included duration of response (DoR), progression-free survival (PFS), overall survival (OS) and safety. RESULTS: Confirmed partial response (PR) was observed in six patients [ORR = 28.6%; 95% confidence interval (CI) 11.3% to 52.2%] who had received a median of two prior advanced chemotherapy lines. Lurbinectedin was active in both BRCA mutations: four PRs in 11 patients (36.4%) with BRCA2 and two PRs in 10 patients (20.0%) with BRCA1. Median DoR was 8.6 months, median PFS was 4.1 months and median OS was 16.1 months. Stable disease (SD) was observed in 10 patients (47.6%), including 3 with unconfirmed response in a subsequent tumor assessment [ORR unconfirmed = 42.9% (95% CI 21.8% to 66.0%)]. Clinical benefit rate (PR + SD ≥ 4 months) was 76.2% (95% CI 52.8% to 91.8%). No objective response was observed among patients who had received prior poly (ADP-ribose) polymerase inhibitors. The most common treatment-related adverse events (AEs) were nausea (61.9%), fatigue (38.1%) and vomiting (23.8%). These AEs were mostly grade 1/2. The most common grade 3/4 toxicity was neutropenia (42.9%: grade 4, 23.8%: with no febrile neutropenia). CONCLUSIONS: This phase II study met its primary endpoint and showed activity of lurbinectedin in germline BRCA1/2 breast cancer. Lurbinectedin showed a predictable and manageable safety profile. Considering the exploratory aim of this trial as well as previous results in other phase II studies, further development of lurbinectedin in this indication is warranted.

Taenia hydatigena larvae vesicular concentrate reduces the egg shedding of Haemonchus contortus associated with the overexpression of abomasal cytokines in lambs.

The expression patterns of some cytokines were compared by RT-qPCR between lambs with and without Taenia hydatigena larvae vesicular concentrate (ThLVC) administration and subsequent infection with Haemonchus contortus. Lambs that received ThLVC prior to infection with H. contortus showed lower (p < 0.03) cumulative FEC (AUC = 18450 ± 3384) than infected lambs who did not receive ThLVC (AUC = 31081 ± 3277). Lambs infected with H. contortus, in general, overexpressed Th1 and Th2 cytokines in abomasal mucosa and abomasal lymph nodes, which seems to indicate a generalized and nonpolarized activation of the immune response by H. contortus. The main immunomodulatory effects of ThLVC were observed in the abomasal fundic region. The lambs that were given ThLVC prior to infection strongly overexpressed most of the studied cytokines representing the Th1 (IFNγ and IL2) and Th2 profiles (IL4, IL5, IL6 and IL10), proinflammatory cytokines (SOD1 and PRDX6) and IgE receptor; in contrast, lambs that were infected but did not receive ThLVC only moderately overexpressed IFNγ, IL4 and IL6. The absence of the significant overexpression of cytokines in lambs that only received ThLVC suggests that this derived from T. hydatigena does not have a stimulating effect per se; however, the presence of H. contortus did produce the highest expression (p < 0.01) cytokine profile among lambs that received ThLVC prior to infection compared to those who did not receive it, so its effect seems to be immunomodulatory and not only immunostimulatory.

Urgencia pediátrica: la primera línea de atención hospitalaria del paciente pediátrico con virus SARS-COV-2: el desafío que tenemos / Emergency room: the first line in the hospital medical attention of the pediatric patient with SARS-COV-2 virus: the challenge we have

The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed great challenges for both public health and medical clinical practice since the first cases reported in Wuhan, China. Coronavirus disease (CoVID-19) is a zoonotic disease caused by an RNA virus. SARS-CoV-2 is transmitted through respiratory droplets and fomites, and it has a lethality estimated at 4%. In the pediatric population it mainly produces mild cases, but it also can cause severe cases with hypoxemia, respiratory distress, and multiple organ failure. Children have been recognized as an important disease vector than can spread disease to higher risk groups. It is fundamental to rearrange emergency department functioning, in order to achieve an adequate patient flow that reduces the risk of disease transmission. In the following, we lay out the recommendations for patient care in the emergency room.

La emergencia mundial del virus SARS-CoV-2 (CoV2) ha producido grandes desafíos para la salud pública y para la atención clínica, desde la aparición de los primeros casos en Wuhan, China. La enfermedad, CoVID-19, es una infección zoonótica producida por un virus RNA (1). Se transmite a través de gotitas y fómites con una letalidad estimada en 4%. En pediatría, provoca cuadros respiratorios en su mayoría leves, pero también cuadros severos con hipoxemia y distrés respiratorio (2). Se ha reconocido al niño como un vector importante que aumenta los contagios en personas que tendrán probablemente cuadros de gravedad. La organización adecuada de los servicios de urgencias es fundamental para lograr un flujo y áreas especiales para los pacientes sospechosos de CoVID-19 y así evitar nuevos contagios. A continuación, se detallan las principales recomendaciones para la atención de estos pacientes en un servicio de urgencias.

Condiciones sociodemográficas y perfil de salud de los adultos mayores indígenas del departamento de Nariño / Sociodemographic Conditions and Health Profile in the Indigenous Elderly of the Department of Nariño / Condições sociodemográficas e perfil de saúde nos idosos indígenas do departamento de Nariño

Resumen Introducción: en América Latina, la etnicidad es un determinante crítico de pobreza, desigualdad y exclusion social; además, puede constituir una situación doble de vulnerabilidad, pues los grupos poblacionales minoritarios requieren atención diferencial. El presente estudio determina los factores sociodemográficos y el perfil de salud de un grupo de adultos mayores indígenas. Materialesy métodos: estudio analítico de tipo descriptivo transversal, con una muestra por conveniencia de 518 adultos mayores ambulatorios indígenas de la exprovincia de Obando, Nariño, Colombia. Mediante una encuesta personal, se recogieron datos sociodemográficos y de antecedentes médicos. La valoración nutricional se realizo con el Mini Nutritional Assessment; la evaluación cognitiva, con el Mini-Mental State Examination; los sintomas depresivos, con la Escala de Depresión Geriátrica de Yesavage; y la capacidad funcional con el índice de Barthel y la escala de Lawton y Brody. Finalmente, con respecto al análisis estadístico, se empleó el enfoque del análisis de clases latentes, con el objetivo de identificar subgrupos o clases, de acuerdo con los patrones de comorbilidad. Resultados: en cuanto a los datos sociodemográficos, el 44.6 % son de género femenino, el 40.2 % es analfabeta, el 63.5 % está casado, el 91.7 % reside en áreas rurales, y el 53.43 % no posee ingresos. En cuanto a los antecedentes médicos, el 47.7 % tiene artritis, seguido por el 23 %, que tiene cataratas. El 26 % presenta riesgo nutricional; un 65 %, sintomatología depresiva; el 54 %, deterioro cognitivo; y el 35 %, dependencia funcional. El análisis de clases latentes mostro predominio de comorbilidad en un 55 %. Conclusión: en la población de adultos mayores indígenas prevalecen condiciones sociodemográfi-cas y de salud precarias que tienen mayor incidencia que en otros grupos etáreos.

Abstract Introduction: In Latin America, ethnicity is a critical determinant of poverty, inequality, and social exclusion. This is a situation of double vulnerability, since it is a population group that requires differential attention. The present study determines the socio-demographic factors and health profile in a group of indigenous older adults. Materials and methods: The paper presents an analytical study of transversal descriptive type, with a convenience sample of 518 indigenous outpatients from the Exprovince of Obando Nariño, Colombia. Through a personal survey, sociodemographic and medical background data were collected, the nutritional assessment was performed with the Mininutritional scale, for the cognitive evaluation the Minimental questionnaire was used, as well as the Yesavage test for depressive symptoms. Finally, functional capacity was measured through Barthel's index and Lawton's and Brody's scale. Regarding the statistical analysis, the latent class analysis approach was used to identify subgroups or classes according to comorbidity patterns. Results: 46.7 % are female, 40.2 % are illiterate, 63.5 % are married, 91.7 % live in rural areas, and 53.43 % have no income. Arthritis occurs in 47.7 %, followed by Cataracts (23 %>), (26 %>) evidence nutritional risk, (65 %>) depressive symptomatology, (54 %>) cognitive impairment, and functional dependency presents (35 %>). The analysis of latent classes showed the predominance of comorbidity by 55 %>. Conclusion: Poor sociodemographic and health conditions prevail in the population of indigenous older adults with a highest incidence than in other age groups.

Resumo Introdução: na América Latina, a etnicidade é um determinante crítico de pobreza, desigualdade e exclusão social; paralelamente, se gera uma situação de dupla vulnerabilidade, pois trata-se de um grupo populacional que requere atenção diferencial. O presente estudo determina os fatores sociodemográficos e perfil de saúde em um grupo de idosos indígenas. Materiais e métodos: estudo analítico de tipo descritivo transversal, com uma amostra por conveniência de 518 idosos ambulatórios indígenas da antiga província de Obando, Nariño, na Colômbia. Mediante uma enquete pessoal recolhem-se dados sociodemográficos e de antecedentes médicos, a valoração nutricional se realiza com escala Mini Nutricional, para a avaliação cognitiva utiliza-se o questionário Mini Mental, o Teste Yesavage para sintomas depressivos. Finalmente, a capacidade funcional mede-se através do índice de Barthel e Escala de Lawton e Brody. Respeito à análise estatística se empregou o enfoque da análise de classes latentes para identificar subgrupos ou classes de acordo com os patrões de comorbidade. Resultados: o 44.6 % são de gênero feminino, um 40.2 % é analfabeta, são casados o 63.5 %, reside em área rural o 91.7 %, e o 53.43 % no possui ingressos. Se apresenta artrite em um 47.7 %, seguido de Cataratas (23 %), o 26 % evidencia risco nutricional, um 65 % evidencia sintomatologia depressiva, o 54 % deterioro cognitivo e dependência funcional apresenta um 35 %. A análise de classes latentes mostrou predomínio de comorbidade em um 55 %. Conclusão: na população de idosos indígenas prevalecem condições sociodemográficas e de saúde precárias de mais incidência que em outros grupos etários.

Hepatocellular carcinoma tumour burden score to stratify prognosis after resection.

BACKGROUND: Although the Barcelona Clinic Liver Cancer (BCLC) staging system has been largely adopted in clinical practice, recent studies have emphasized the need for further refinement and subclassification of this system. METHODS: Patients who underwent hepatectomy with curative intent for BCLC-0, -A or -B hepatocellular carcinoma (HCC) between 2000 and 2017 were identified using a multi-institutional database. The tumour burden score (TBS) was calculated, and overall survival (OS) was examined in relation to TBS and BCLC stage. RESULTS: Among 1053 patients, 63 (6·0 per cent) had BCLC-0, 826 (78·4 per cent) BCLC-A and 164 (15·6 per cent) had BCLC-B HCC. OS worsened incrementally with higher TBS (5-year OS 77·9, 61 and 39 per cent for low, medium and high TBS respectively; P < 0·001). No differences in OS were noted among patients with similar TBS, irrespective of BCLC stage (61·6 versus 58·9 per cent for BCLC-A/medium TBS versus BCLC-B/medium TBS, P = 0·930; 45 versus 13 per cent for BCLC-A/high TBS versus BCLC-B/high TBS, P = 0·175). Patients with BCLC-B HCC and a medium TBS had better OS than those with BCLC-A disease and a high TBS (58·9 versus 45 per cent; P = 0·005). On multivariable analysis, TBS remained associated with OS among patients with BCLC-A (medium TBS: hazard ratio (HR) 2·07, 95 per cent c.i. 1·42 to 3·02, P < 0·001; high TBS: HR 4·05, 2·40 to 6·82, P < 0·001) and BCLC-B (high TBS: HR 3·85, 2·03 to 7·30; P < 0·001) HCC. TBS could also stratify prognosis among patients in an external validation cohort (5-year OS 79, 51·2 and 28 per cent for low, medium and high TBS respectively; P = 0·010). CONCLUSION: The prognosis of patients with HCC varied according to the BCLC stage but was largely dependent on the TBS.

ANTECEDENTES: Aunque el sistema de estadificación del Barcelona Clinic Liver Cancer (BCLC) ha sido adoptado en gran medida en la práctica clínica, estudios recientes han enfatizado la necesidad de un mayor refinamiento y subclasificación del sistema BCLC. MÉTODOS: Los pacientes con carcinoma hepatocelular (hepatocellular cancer, HCC) BCLC-0, A y B que se sometieron a una hepatectomía con intención curativa entre 2000 y 2017 fueron identificados utilizando una base de datos multi-institucional. Se calculó la puntuación de carga tumoral (tumour burden score, TBS) y se examinó la supervivencia global (overall survival, OS) en relación con la TBS y los estadios BCLC. RESULTADOS: En la serie de 1.053 pacientes, 63 (6%) tenían HCC BCLC-0, 826 (78,4%) HCC BCLC-A y 164 (15,6%) HCC BCLC-B. La OS disminuyó de forma incremental en función de la mayor TBS (OS a 5 años; TBS baja: 77,9% versus TBS media: 61% versus TBS alta: 39%, P < 0,001). No se observaron diferencias en la OS entre pacientes con una puntuación TBS similar, independientemente del estadio BCLC (BCLC-A/TBS media: 61,6% versus BCLC-B/TBS media: 58,9%, P = 0,93; BCLC-A/TBS alta: 45,1% versus BCLC-B/TBS alta: 12,8%, P = 0,175). Los pacientes con BCLC-B/TBS media tuvieron una mejor OS que los pacientes con BCLC-A/TBS alta (58,9% versus 45,1%, P = 0,005). En el análisis multivariable, la TBS se mantuvo asociada a la OS en el caso de BCLC-A (TBS media: cociente de riesgos instantáneos, hazard ratio, HR = 2,07, i.c. del 95%: 1,42-3,02, P < 0,001; TBS alta: HR = 4,05, i.c. del 95%: 2,40-6,82, P < 0,001) y BCLC-B pacientes (TBS alta: HR = 3,85, i.c. del 95%: 2,03-7,30, P < 0,001). La TBS también pudo estratificar el pronóstico entre pacientes en una cohorte de validación externa (OS a 5 años; TBS baja: 78,7% versus TBS media: 51,2% versus TBS alta: 27,6%, P = 0,01). CONCLUSIÓN: El pronóstico de los pacientes con HCC varió según el estadio BCLC, pero dependió en gran medida de la TBS.

Sinusitis infantil: Comportamiento clínico, radiológico y bacteriológico en niños en una provincia de Ecuador / Childhood sinusitis: clinical, radiological and bacteriological behavior in children in a province of Ecuador

INTRODUCCIÓN: Las infecciones respiratorias en pediatría son la primera causa de morbi-mortalidad en niños en todo el mundo, y en este contexto la sinusitis actualmente es la cuarta causa de consulta privada y pública. Su etiología puede ser viral y bacteriana. El diagnóstico se basa en criterios clínicos, de imagen y factores de riesgo a los que se expone la población infantil. OBJETIVOS: Caracterizar el comportamiento clínico de la sinusitis en niños y adolescentes para proponer criterios clínicos, para el diagnóstico y sugerir un tratamiento empírico basado en la sensibilidad de los patógenos estudiados. Determinar la prevalencia de valores elevados de IgE y su relación con la ceniza volcánica como factor de riesgo. METODOLOGÍA: Estudio descriptivo, transversal, que incluyó pacientes entre 1 a 17 años de edad, clasificados en tres grupos etareos, que asistieron a la consulta externa del Hospital General Ambato - Ecuador con diagnóstico de sinusitis aguda, durante el período de enero de 2015 a diciembre de 2016. RESULTADOS: La prevalencia de sinusitis fue mayor en el grupo de edad entre 4 a 10 años (60,8%), quienes además mostraron una elevación de IgE (69,4%), presumiendo un despertar de expresión atópica secundaria a exposición a ceniza volcánica. Se identificaron criterios mayores y menores por grupos etareos, encontrando a los puntos de Valleix, Clearance faríngeo y obstrucción nasal como signos y síntomas presentes en todos los grupos. Los gérmenes aislados en cultivos fueron Staphylococcus aureus, Moraxella catarrhalis, Haemophilus influenzae tipo III, gérmenes que mostraron sensibilidad a antibióticos convencionales. CONCLUSIÓN: El Clearance faríngeo, obstrucción nasal y la positividad en los puntos de Valleix fueron los síntomas y signos más frecuentes para sinusitis en todos los grupos de edad. El patógeno aislado con mayor prevalencia fue el S. aureus y el H. influenzae biotipo III. La exposición a ceniza volcánica debe ser considerada como factor de riesgo

INTRODUCTION: Respiratory infections in pediatrics are the first cause of morbidity and mortality worldwide; in this context, sinusitis has increased in the pediatric population, currently constituting the fourth cause of private and public consultation, caused by viral and bacterial infections. The diagnosis is based on clinical criteria, imaging and risk factors to which the child population is exposed. OBJECTIVES: Characterize the clinical behavior of sinusitis in children and adolescents to propose clinical criteria for diagnosis and suggest an empirical treatment based on the sensitivity of the pathogens studied. To determine the prevalence of high IgE values and its relationship with volcanic ash as a risk factor. METHODOLOGY: A descriptive, cross-sectional study was included patients between 1 and 17 years of age, classified in three staging groups, who attended the external consultation of the Ambato General Hospital - Ecuador with a diagnosis of acute sinusitis, during the period of January 2015 - December 2016. RESULTS: The prevalence of sinusitis was higher in the age group between 4 and 10 years (60.8%), who also showed an elevation of IgE (69.4%), presuming an awakening of atopic expression secondary to exposure to volcanic ash. Major and minor criteria were identified by age groups, finding Valleix points, Pharyngeal clearance and nasal obstruction as signs and symptoms present in all age groups. The pathogens isolated in cultures were Staphylococcus aureus, Moraxella catarrhalis, Haemophilus influenzae type III, germs that showed sensitivity to conventional antibiotics. CONCLUSION: Pharyngeal clearance, nasal obstruction and positivity in Valleix points were the most frequent symptoms and signs for sinusitis in all age groups. The most prevalent isolated pathogen was Staphylococcus aereus and Haemophilus influenzae biotype III. Exposure to volcanic ash should be considered as a risk factor

Compuestos disruptores endocrinos como inductores de procesos de estrés oxidativo en organismos acuáticos. Una revisión / Endocrine disruptors as inductor of oxidative processes in aquatic organisms. A review

Las estaciones depuradoras de aguas residuales reciben una gran cantidad de compuestos disruptores endocrinos procedentes de domicilios, hospitales e industrias. Estas sustancias terminan por ser eliminadas, tratadas o no, al medio ambiente acuático próximo, detectándose a concentraciones muy bajas (ng/L o mig/L) en los efluentes de las plantas de tratamiento, en las aguas superficiales y en los sedimentos. A pesar de las bajas concentraciones, estas sustancias son biológicamente activas y pueden originar efectos adversos, entre otros procesos de estrés oxidativo y daño celular en las proteínas, ADN, carbohidratos y especialmente en los lípidos (peroxidación lipídica), en los organismos acuáticos. Tales procesos son consecuencia de la formación de especies reactivas generadas a partir de dichos compuestos. En este trabajo, se recopilan las concentraciones de los compuestos disruptores endocrinos que potencialmente originan situaciones de estrés oxidativo en organismos acuáticos, detectadas, así como los efectos de estos compuestos en biomarcadores de estrés oxidativo (niveles de glutatión reducido, actividades superóxido dismutasa, catalasa, glutatión peroxidasa) y daño celular (niveles de malondialdehído y de sustancias que reaccionan con el ácido tiobarbitúrico) de tales organismos

A large amount of endocrine disrupting compounds from homes, hospitals and industries are transported to wastewater treatment plants. These substances end up being discharged, treated or not, into the nearby aquatic environment, being found at very low concentrations ranging between nanograms and micrograms per liter in the effluents of the treatment plants, in the surface waters and in the sediments. These concentrations are sufficient to cause oxidative stress processes and cellular damage in proteins, ADN, carbohydrates, and especially in lipids (lipid peroxidation) in aquatic organisms. Such processes are a consequence of the formation of reactive species generated from these compounds. In this work, concentrations of endocrine disrupting compounds capable of causing oxidative stress in organisms from aquatic compartment are collected, as well as the effects of these in oxidative stress biomarkers (levels of reduced glutathione, activities superoxide dismutase, catalase, glutathione peroxidase) and cellular damage biomarkers (levels of malondialdehyde and substances that react with thiobarbituric acid) in such as organisms

Manejo actual de la pancreatitis aguda idiopática y la pancreatitis aguda recurrente / Current management of acute idiopathic pancreatitis and acute recurrent pancreatitis

La pancreatitis aguda es una entidad de notable importancia debido a su elevada incidencia y a su no desdeñable morbimortalidad. Se conoce como pancreatitis aguda idiopática aquella en la que no se consigue determinar la causa del cuadro tras un estudio básico inicial. Conocer la etiología subyacente permite plantear un tratamiento dirigido para así disminuir el riesgo de recurrencia. La ecoendoscopia y la colangiografía por resonancia magnética son las pruebas de elección para profundizar en el estudio etiológico. La principal causa es la enfermedad litiásica no diagnosticada en el estudio inicial, cuyo tratamiento de elección es la colecistectomía. Por otra parte, la pancreatitis aguda recurrente se diagnostica tras la existencia de 2 o más episodios de pancreatitis aguda. El objetivo de esta revisión es proporcionar una aproximación actualizada de estas 2 entidades, repasando aspectos de su epidemiología, diagnóstico y alternativas terapéuticas disponibles

Acute pancreatitis is an entity of notable importance due to its high incidence and its non-negligible morbidity and mortality. Idiopathic acute pancreatitis is that in which the cause of the clinical condition cannot be determined after an initial basic study. Understanding the underlying aetiology enables clinicians to propose a targeted treatment to reduce the risk of recurrence. Endoscopic ultrasonography and magnetic resonance cholangiopancreatography are the tests of choice to deepen the aetiological study. The main cause is undiagnosed lithiasic disease in the initial study, whose treatment of choice is cholecystectomy. Moreover, recurrent acute pancreatitis is diagnosed after 2 or more episodes of acute pancreatitis. The objective of this review is to provide an updated approach for these 2 entities, reviewing aspects of their epidemiology, diagnosis and available alternative therapies

Current management of acute idiopathic pancreatitis and acute recurrent pancreatitis. / Manejo actual de la pancreatitis aguda idiopática y la pancreatitis aguda recurrente.

Acute pancreatitis is an entity of notable importance due to its high incidence and its non-negligible morbidity and mortality. Idiopathic acute pancreatitis is that in which the cause of the clinical condition cannot be determined after an initial basic study. Understanding the underlying aetiology enables clinicians to propose a targeted treatment to reduce the risk of recurrence. Endoscopic ultrasonography and magnetic resonance cholangiopancreatography are the tests of choice to deepen the aetiological study. The main cause is undiagnosed lithiasic disease in the initial study, whose treatment of choice is cholecystectomy. Moreover, recurrent acute pancreatitis is diagnosed after 2 or more episodes of acute pancreatitis. The objective of this review is to provide an updated approach for these 2 entities, reviewing aspects of their epidemiology, diagnosis and available alternative therapies.

Emotional distress in haemophilia: Factors associated with the presence of anxiety and depression symptoms among adults.

INTRODUCTION: Haemophilia is related to several clinical and psychosocial challenges that have been associated with increased emotional distress. These may impact on disease adjustment and health outcomes, reinforcing the attention given to psychosocial health of people with haemophilia (PWH), in the scope of optimal comprehensive care. AIM: To identify potentially modifiable factors associated with the presence of anxiety and depression symptoms among adult PWH. METHODS: This was a cross-sectional observational study examining socio-demographic, clinical and psychosocial variables among 102 patients with haemophilia A or B who participated on a mail survey of haemophilia in Portugal. RESULTS: People with haemophilia revealing higher anxiety and depression symptoms were more likely to have had, in the previous year, more urgent hospital visits due to haemophilia, more bleeding episodes, more affected joints and pain, as well as worst levels of perceived functionality and quality of life. After controlling for demographic (age and education) and clinical (haemophilia severity and joint deterioration) variables in multivariate hierarchical logistic regression analyses, professional status (OR = 4.646, P = .004; OR = 3.333, P = .029) and pain interference (OR = 1.397, P = .011; OR = .1.347, P = .037) were significantly associated with both anxiety and depression symptoms. Additionally, physical activity (OR = 0.302, P = .024) and the perception of consequences underlying haemophilia (OR = 1.600, P = .012) also emerged as key factors significantly associated with depression symptoms. CONCLUSION: Current findings increased knowledge on factors associated with anxiety and depression among PWH. These highlight potential intervention targets, which are amenable to change through evidence-based tailored interventions aiming to decrease emotional distress, promote well-being and improving haemophilia-related health outcomes among these patients.

Effect of surgeon's experience on complications from laparoscopic hysterectomy.

OBJECTIVE: To analyze the effect of learning in two surgeons on complications and conversion to laparotomy during total and subtotal laparoscopic hysterectomy. MATERIAL AND METHODS: We analyzed retrospectively 236 total and subtotal laparoscopic hysterectomies done by two surgeons from the time they first performed the procedure. The interventions were classified in three groups based on the surgeon's experience: the first 75 hysterectomies ("novice period"), the subsequent 75 hysterectomies ("intermediate"), and the subsequent 86 hysterectomies ("routine period"). RESULTS: Patient's characteristics changed as surgeons gained experience, with more complex operations (greater obesity, previous surgery and malignant disease) becoming more frequent. During the second group of operations when surgeons had an intermediate level of experience, the risk of major complications decreased (adjusted odds ratio: 0.28, 95% confidence interval: 0.10-0.85), as did the risk of type III complications of Clavien-Dindo classification (adjusted odds ratio 0.15, 95% confidence interval: 0.03-0.93). However, the percent rate of conversion to laparotomy remained stable in the second (intermediate experience) group. In the third group, after the surgeons had performed 150 procedures and when the risk of any type of complication was lowest, the risk of conversion to laparotomy decreased compared to the routine group. CONCLUSIONS: The surgeon's experience in performing laparoscopic hysterectomy plays an essential role in the decrease in the risk of complications, and this finding supports the importance of providing appropriate training for residents and gynecologists to enable them to perform this procedure with an optimal degree of competence and safety.

Thermographic Analysis of Tooth Vascularization Using Thermal Stimulation.

OBJECTIVE: The current pulp diagnostic techniques based on subjective patient response to electrical or thermal stimuli are unable to assess tooth vascularization, which is a true indicator of pulp vitality. The present study evaluates thermography as a pulp vitality test, assessing tooth recovery following thermal stimulation. METHODS: A model simulating intrapulpal circulation was developed. Superficial thermographic measurements were obtained from teeth with and without elevation of the intracoronal temperature before and after applying thermal stress with cold. The data were analyzed using analysis of variance (ANOVA), and the level of significance was set at P<0.05. RESULTS: The model obtained could help differentiate between teeth with and without simulated pulp circulation. Recovery following application of thermal stress showed significant differences between the two types of teeth. CONCLUSION: Thermography has the potential to be used as a diagnostic tool for the vascularity status of the dental pulp.

Stroop Color-Word Interference Test: Normative data for Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the Stroop Word-Color Interference test in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the Stroop Word-Color Interference test as part of a larger neuropsychological battery. The Stroop Word, Stroop Color, Stroop Word-Color, and Stroop Interference scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models showed main effects for age on all scores, except on Stroop Interference for Guatemala, such that scores increased linearly as a function of age. Age2 affected Stroop Word scores for all countries, Stroop Color scores for Ecuador, Mexico, Peru, and Spain; Stroop Word-Color scores for Ecuador, Mexico, and Paraguay; and Stroop Interference scores for Cuba, Guatemala, and Spain. MLPE affected Stroop Word scores for Chile, Mexico, and Puerto Rico; Stroop Color scores for Mexico, Puerto Rico, and Spain; Stroop Word-Color scores for Ecuador, Guatemala, Mexico, Puerto Rico and Spain; and Stroop-Interference scores for Ecuador, Mexico, and Spain. Sex affected Stroop Word scores for Spain, Stroop Color scores for Mexico, and Stroop Interference for Honduras. CONCLUSIONS: This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate approach to interpret the Stroop Word-Color Interference test in pediatric populations.

Etiología y factores asociados a las crisis convulsivas febriles en Ecuador / Etiology and factors associated with febrile seizures in Ecuador

Introducción: Las convulsiones febriles son sucesos comunes en la infancia y de carácter benigno, que se producen en niños de 6 meses a 6 años de edad, afectando del 2 al 5% de la población infantil. Se ha implicado la interleukina 1β en la génesis de las convulsiones en un terreno fértil genéticamente determinado y mapeado en los cromosomas 8 y 19p en las áreas FEB1 y FEB2; sin embargo, han sido implicados factores de riesgo como prematuridad, anemia, polimorfismos genéticos, antecedente familiar de epilepsia e historia de inmunizaciones. Objetivos. Identificar las principales causas de convulsiones febriles en la edad pediátrica en el Hospital General Ambato, la caracterización de las mismas y su asociación con la edad, género e historia familiar. Metodología. Se realizó un estudio descriptivo transversal epidemiológico de cohorte, en 115 pacientes hospitalizados con el diagnóstico de convulsión febril, de junio 2012 a agosto 2016. Resultados. Los hallazgos evidenciaron que el género masculino fue el más afectado, con el 51,3%, y la enfermedad diarreica aguda y la gingivoestomatitis herpética fueron las responsables de la fiebre en el 31,3% y 15,6%, respectivamente. La expresión semiológica de la crisis en la mayoría de los casos fue tónico-clónica generalizada. Del total de casos, el 84,3% no presentaron antecedentes familiares, pero los que presentaron tienen mayor riesgo de recurrencia. El 93% de los pacientes tuvieron una edad gestacional a término. Conclusión: Las enfermedades infecciosas son las principales causas de estos eventos convulsivos en esta serie de casos; es prioritario identificar factores de riesgo asociados para decidir una conducta oportuna y el seguimiento de acuerdo al caso

Introduction: Febrile seizures are common events in childhood and benign in nature. Typically affecting 2-5% of the children population between the ages of 6 months and 6 years of age. Interleukin 1β has been implicated in the genesis of seizures in genetically determined fertile ground and mapped on chromosomes 8 and 19p in areas FEB1 and FEB2, although risk factors such as premature birth, anemia, genetic polymorphisms, known family history of epilepsy and immunization have been associated. Objective. This study sought to identify the main causes of febrile seizures in children at the General Hospital Ambato, as well as characterizing them and their association to age, gender and family history. Patients and Method. A descriptive transversal epidemiological cohort study was carried, including 115 patients with febrile seizure diagnosis, from june 2012 to august 2016. Results. Findings showed that males presented more seizure events at 51.3%. Acute diarrheal disease and her petic gingivostomatitis were responsible for fevers in 31.3% and 15.6% respectively. The semiological expression in most cases were generalized tonic-clonic type. Of the total cases of seizures, 84.3% did not express family history, but the ones who did presented with a higher risk of reccurance. 93% of patients were full-term infants. Conclusions: Infectious diseases were the primary cause of seizure events in this cases series. It is of high priority to identify risk factors associated to determine an appropriate approach and follow-up according to the case