Experiencia personal de paternidad o maternidad como principal predictor del conocimiento de la lactancia materna en los médicos de familia / Personal experience of paternity or maternity as the main predictor of knowledge of breastfeeding in family doctors

Introducción: Los médicos de familia juegan un papel fundamental en la promoción de las prácticas adecuadas de la lactancia materna (LM), por lo que deben tener un conocimiento adecuado sobre el tema.ObjetivoEvaluar el conocimiento sobre la LM y los factores asociados en los médicos de familia en una unidad de primer nivel de atención de Cuernavaca, México.Material y métodosSe realizó un estudio transversal, en 93 médicos adscritos y residentes de medicina de familia. El conocimiento sobre la LM se evaluó mediante el cuestionario ECoLa de 20 ítems, considerando variables familiares y demográficas. Se realizó una estadística descriptiva de los datos y los factores asociados al nivel de conocimiento se evaluaron mediante un modelo de regresión logística.ResultadosDe la muestra, el 72% fueron mujeres; 41% estaban casados y 55% tenían al menos un hijo, el 23% había tomado al menos un curso de LM. Se obtuvo una media de 11,5 aciertos en el cuestionario ECoLa, 52% se clasificaron en un nivel de conocimiento bajo, 45% en regular y 3% en adecuado. Después del ajuste por edad, cursos de lactancia y estado civil, las principales variables asociadas a un conocimiento regular/bueno fueron tener al menos un hijo (OR 4,63 IC 95% 1,1-19,42) y el sexo (mujer OR 5,75 IC 95% 1,58-20,94).ConclusionesEl 52% de los médicos de familia mostró un conocimiento bajo sobre la LM. La experiencia personal de la paternidad o maternidad de los médicos de familia se asocia al mejor conocimiento de la LM, superando a las capacitaciones y a los cursos. (AU)

Introduction: The Family doctors play a fundamental role in promoting an adequate breastfeeding practices, so they must have an adequate knowledge of this matters.ObjectiveEvaluate the knowledge about breastfeeding in family doctors of a first level care unit in Cuernavaca, Mexico.Material and methodsThe study was cross-sectional with 93 Family doctors and family medicine residents. The knowledge about breastfeeding was evaluated using the ECoLa questionnaire of 20 items, considering family and demographic variables. Were performed descriptive statistics and the factors associated with the level of knowledge were evaluated using a logistic regression model.ResultsFrom the sample 72% were women, 41% were married and 55% had at least one child, 23% had taken at least one breastfeeding course. On average 11.5 hits out in ECoLa questionnaire, 52% were classified as low knowledge level, 45% as regular and 3% as good. After adjustment for age, lactation courses, and marital status. The main variables associate to knowledge regular / good were had at least one child, (OR 4.63 95% CI 1.1-19.42), and sex (woman OR 5.75 95% CI 1.58-20.94).Conclusions52% of family doctors showed low knowledge about breastfeeding. The personal experience of paternity or maternity of family doctors is a relevant factor associated with better knowledge of exclusive breastfeeding, surpassing training and courses. (AU)

[MIA 2021, Comprehensive Asthma Management. Guidelines for Mexico]. / MIA 2021, Manejo Integral del Asma. Lineamientos para México.

BACKGROUND: Asthma continues to be one of the most frequent chronic respiratory diseases in our country. New methods for diagnosis and treatment have been described; accordingly, the international guidelines were renewed. OBJECTIVE: To create a national platform for the development of updated guidelines, solidly based on evidence: Comprehensive Asthma Management (Spanish acronym: MIA). METHODS: MIA uses the ADAPTE method. The MIA development group consists of experts in pulmonology-allergology-methodology and representatives of 13 institutions and societies of specialties that manage asthma. The international reference guidelines (selected with AGREE-II): GINA 2020, GEMA 5.0, BTS/SIGN 2019 and ATS/ERS consensus document 2014-2019 on severe asthma. MIA covers suspected asthma, diagnosis, treatment, and special groups. Key clinical questions were formulated on treatment steps 1-3, biomarkers and severe asthma. RESULTS: Based on evidence, safety, cost and local reality, the core group developed responses. Through a Delphi process the broad MIA development group suggested adjustments until consensus was reached. CONCLUSION: A document was generated with multiple figures and algorithms, solidly based on evidence about asthma management, adjusted for Mexico with a broad base among different societies that participated in its development. It does not include guidelines for acute asthma.

Antecedentes: El asma sigue siendo una patología respiratoria crónica frecuente en México. Se han descrito nuevos métodos para el diagnóstico y tratamiento conforme se renuevan las guías internacionales. Objetivo: Crear la plataforma nacional Manejo Integral del Asma (MIA), para el desarrollo de lineamientos actualizados con base en evidencia. Métodos: Se utilizó el método ADAPTE. El grupo de desarrollo de MIA estuvo integrado por expertos en neumología, alergología y metodología y representantes de 13 instituciones y sociedades de especialidades que manejan asma. Las guías internacionales de referencia (seleccionadas con AGREE-II) fueron GINA 2020, GEMA 5.0, BTS/SIGN 2019 y consenso ATS/ERS 2014-2019. En MIA se aborda sospecha de asma, diagnóstico, tratamiento y grupos especiales. Se formularon preguntas clínicas clave sobre tratamiento en los pasos 1 a 3, biomarcadores y asma grave. Resultados: Con base en evidencia, seguridad, costo y realidad local, el grupo nuclear desarrolló respuestas. Mediante proceso Delphi, el grupo amplio de desarrollo sugirió ajustes hasta que se logró el consenso. Conclusión: El documento generado contiene múltiples figuras y algoritmos, está sólidamente basado en evidencia acerca del manejo del asma y fue ajustado para México con participación de diferentes sociedades para su desarrollo; no se incluyeron lineamientos para la crisis asmática.

[Continuous monitoring of cortical visual evoked potentials by means of subdural electrodes in surgery on the posterior optic pathway. A case report and review of the literature]. / Monitorización continua de los potenciales evocados visuales corticales mediante electrodos subdurales en la cirugía de la vía óptica posterior. Caso clínico y revisión de la bibliografía.

INTRODUCTION: Intraoperative monitoring of functional language and motor areas is a commonly used technique which makes it possible to minimise the post-operative sequelae and to perform an optimal resection of lesions in these areas. Monitoring of the visual cortex, however, is not usually carried out nowadays. The scarce spatial resolution and its sensitivity to anaesthesia are some of the technical difficulties that reduce its clinical usefulness. The study reports a case of resection of an occipital lesion under general anaesthetic, with intraoperative monitoring of the cortical visual evoked potentials (VEP) by means of subdural electrodes. CASE REPORT: A 50-year-old female who underwent surgery involving the resection of an occipital lesion that was suggestive of radionecrosis. The VEP were monitored by administering flashing light at 4.1 Hz and recording with subdural strip electrodes on the occipital cortex. During the operation, a progressive lowering of the amplitude of the cortical VEP was observed when 50% of the baseline amplitude was exceeded, and thus the resection was finished. The increase in latency was below 10% of the baseline value. The patient recovered well during the post-operative period and her sight did not present any changes with respect to the baseline values. CONCLUSIONS: In our case, monitoring the cortical VEP by cortical recordings produced stable recordings with a good correlation with the post-operative visual function. Cortical recordings performed either directly or by means of subdural electrodes make it possible to achieve adequate spatial resolution and response intensity. Further studies need to be conducted with a greater number of patients in order to obtain decisive conclusions.

Monitorización continua de los potenciales evocados visuales corticales mediante electrodos subdurales en la cirugía de la vía óptica posterior. Caso clínico y revisión de la bibliografía / Continuous monitoring of cortical visual evoked potentials by means of subdural electrodes in surgery on the posterior optic pathway. A case report and review of the literature

Introducción. La monitorización intraoperatoria de áreas funcionales del lenguaje y motoras está ampliamente difundida,lo que permite minimizar las secuelas postoperatorias y optimizar la resección de lesiones en estas áreas. La monitorización de la corteza visual, sin embargo, no se realiza de forma habitual en la actualidad. La escasa resolución espacial y su sensibilidad a la anestesia son algunas de las dificultades técnicas que disminuyen su utilidad clínica. Se presenta un caso de resección de una lesión occipital bajo anestesia general, con monitorización intraoperatoria de los potenciales evocados visuales (PEV) corticales mediante electrodos subdurales. Caso clínico. Mujer de 50 años, intervenida quirúrgicamente para la resección de una lesión occipital, sugestiva de radionecrosis. Se monitorizaron los PEV mediante administración de luz intermitente a 4,1 Hz y registro con tira subdural en la corteza occipital. Durante la cirugía, se observó disminución progresiva de la amplitud de los PEV corticales cuando superó el 50% de la amplitud basal, por lo que se finalizó la resección. El incremento de la latencia fue inferior al 10% del valor basal. La paciente tuvo una buena evolución postoperatoria, y su función visual no presentó cambios respecto a la basal. Conclusiones. La monitorización de los PEV corticales mediante registros corticales produjo en nuestro caso registros estables y con una buena correlación con la función visual postoperatoria. Los registros corticales directos o con electrodos subdurales permiten conseguir una resolución espacial e intensidad de respuesta adecuadas. Es necesario llevar a cabo estudios con un número mayor de pacientes para obtener conclusiones definitivas (AU)

Introduction. Intraoperative monitoring of functional language and motor areas is a commonly used technique which makes it possible to minimise the post-operative sequelae and to perform an optimal resection of lesions in these areas. Monitoring of the visual cortex, however, is not usually carried out nowadays. The scarce spatial resolution and its sensitivity to anaesthesia are some of the technical difficulties that reduce its clinical usefulness. The study reports a case of resection of an occipital lesion under general anaesthetic, with intraoperative monitoring of the cortical visual evoked potentials (VEP) by means of subdural electrodes. Case report. A 50-year-old female who underwent surgery involving the resection of an occipital lesion that was suggestive of radionecrosis. The VEP were monitored by administering flashing light at 4.1 Hz and recording with subdural strip electrodes on the occipital cortex. During the operation, a progressive lowering of the amplitude of the cortical VEP was observed when 50% of the baseline amplitude was exceeded, and thus the resection was finished. The increase in latency was below 10% of the baseline value. The patient recovered well during the post-operative period and her sight did not present any changes with respect to the baseline values. Conclusions. In our case, monitoring the cortical VEP by cortical recordings produced stable recordings with a good correlation with the post-operative visual function. Cortical recordings performed either directly or by means of subdural electrodes make it possible to achieve adequate spatial resolution and response intensity. Further studies need to be conducted with a greater number of patients in order to obtain decisive conclusions (AU)