Impacto del confinamiento por la pandemia de la COVID-19 en la vivencia del embarazo y la maternidad de mujeres colombianas / Impact of confinement due to the COVID-19 pandemic on the experience of pregnancy and motherhood of Colombian women

Objetivo: Analizar el impacto del confinamiento por la pandemia de la COVID-19 en la vivencia del embarazo y la maternidad de mujeres colombianas. Métodos: Cualitativo, basado en la teoría fundamentada. Se analizaron 17 entrevistas semiestructuradas realizadas a seis mujeres embarazadas y a 11 madres primerizas con bebés de hasta 11 meses de edad. El estudio fue realizado en varias ciudades de Colombia entre abril y junio de 2021. Resultados: Se identificaron cuatro categorías centrales que describen el impacto del confinamiento sobre la vivencia del embarazo y la maternidad: el apoyo social, especialmente limitado en el contacto con la familia y la pérdida de rituales de celebración de la maternidad; las emociones, reflejadas en la experiencia de agotamiento, ansiedad, soledad, frustración, y en el miedo al parto, al contagio y a las posibles secuelas del confinamiento en el desarrollo de los bebés; los cambios producto de la maternidad, evidenciados en roles y decisiones laborales; y los aspectos positivos de la pandemia, como los permisos de maternidad ampliados, la conciliación familiar y la mayor presencia e implicación de las parejas. Conclusión: La pandemia por COVID-19 afectó a la experiencia habitual del embarazo y a la maternidad de las mujeres colombianas que fueron entrevistadas. Este estudio permitió conocer sus experiencias emocionales, los principales retos a los que se enfrentaron y las estrategias que les permitieron adaptarse a esta coyuntura. (AU)

Objective: To analyse the impact of confinement due to the COVID-19 pandemic on Colombian women's experience of pregnancy and motherhood. Methods: Qualitative, based on grounded theory. Seventeen semi-structured interviews with six pregnant women and 11 new mothers with babies up to 11 months old were analysed. The study was conducted in several cities in Colombia between April and June 2021. Results: Four central categories that describe the impact of confinement on the experience of pregnancy and motherhood were identified: social support, especially limited contact with family and the loss of rituals for celebrating motherhood; emotions, reflected in the experiences of exhaustion, anxiety, loneliness, frustration, fear of childbirth, contagion, and the possible consequences of confinement on the development of babies; changes resulting from motherhood, evidenced in roles and work decisions; and the positive aspects of the pandemic, such as extended maternity leave, family balancing, and the greater presence and involvement of partners. Conclusion: The COVID-19 pandemic disrupted Colombian women's normal pregnancy and motherhood experiences. This study allowed us to learn about their emotional experiences, their main challenges, and the strategies that allowed them to adapt to these circumstances. (AU)

Seroprevalence of IgM and IgG anti-SARS-COV-2 and associated factors among agricultural workers in Colombia.

Background: The population of South America has been severely affected by the COVID-19 pandemic. In this region, during the year 2020, high seroprevalence percentages were reported, which have been associated with the socioeconomic characteristics of the population, mainly in urban areas. However, a relative lack of information on the dynamics of the pandemic in rural areas of these countries, where the population is more vulnerable, is still present. This study determined antibody prevalence against SARS-CoV-2 in urban and rural food producing workers in Colombia. Methods: A total of 1242 workers, urban and rural, linked to poultry, dairy, and meat production and supply chains, were analyzed through a sociodemographic survey and two serological tests against S and N proteins of SARS-CoV-2. Results: 78.7% were male. 50.9% of the participants were rural inhabitants, with an average age of 40.9 years old. 39.2% had IgM and IgG against SARS-CoV-2 S protein and 31.3% against N protein for the same virus; 83.6% had not been tested with an RT-PCR test for COVID-19 and 75.7% did not report symptoms related to the disease. The associated risk factors were low education, OR: 1.46, greater number of cohabitants, OR: 1.36, and contact with people infected with COVID-19, OR: 2.03. Conclusions: The seroprevalences found suggest an important interconnectivity between rural and urban areas, where asymptomatic subjects and sociodemographic factors facilitate the virus' spread in the population.

Meropenem antimicrobial stewardship program: clinical, economic, and antibiotic resistance impact.

There are few prospective studies with sufficient duration in time to evaluate clinical and antibiotic resistance impact of antibiotic stewardship programs (ASP). This is a descriptive study between January 2012 and December 2017, pre-post intervention. A meropenem ASP was initiated in January 2015; in patients who started treatment with meropenem, an infectious disease physician performed treatment recommendations to prescribers. Prospective information was collected to evaluate adequacy of meropenem prescription to local guidelines and to compare results between cases with accepted or rejected intervention. Analysis was performed to verify variables associated with intervention acceptance and with any significant change in meropenem consumption, hospital-acquired multidrug-resistant (MDR) bloodstream infections (BSIs), and 30-day all-cause crude death in MDR BSIs. Adequacy of meropenem prescription and de-escalation from meropenem treatment to narrower-spectrum antibiotic improved progressively over time, after ASP implementation (p < 0.001). Interventions on prescription were performed in 330 (38.7%) patients without meropenem justified treatment; in 269, intervention was accepted and in 61 not. Intervention acceptance was associated with shorter duration of treatment, cost, and inpatient days (p < 0.05); intervention rejection was not associated with severity of patient. During the period 2015-2017, meropenem consumption decreased compared with 2012-2014 (rate ratio [RR] 0.67; 95% CI 0.58-0.77, p < 0.001). Also decreased were hospital-acquired MDR BSI rate (RR 0.63; 95% CI 0.38-1.02, p = 0,048) and 30-day all-cause crude death in MDR BSIs (RR 0.45; 95% CI 0.14-1.24, p = 0.096), coinciding in time with ASP start-up. The decrease and better use of meropenem achieved had a sustained clinical, economic, and ecological impact, reducing costs and mortality of hospital-acquired MDR BSIs.

[New case of intradural extramedullary capillary haemangioma]. / Nuevo caso de hemangioma capilar intradural extramedular.

TITLE: Nuevo caso de hemangioma capilar intradural extramedular.

Asociación entre el síndrome de movilidad articular limitada y el riesgo de caídas accidentales en pacientes diabéticos / Association between limited joint mobility syndrome and risk of accidental falls in diabetic patients

Introducción: El síndrome de movilidad articular limitada (SMAL) aparece exclusivamente en pacientes con diabetes, tanto tipo 1 como tipo 2. Se manifiesta como una limitación en la movilidad articular que inicialmente afecta a las falanges proximales de las manos, seguidas, por orden de frecuencia, por muñecas, codos, hombros, rodillas y esqueleto axial. El diagnóstico se puede realizar mediante pruebas sencillas, como «el test de la oración». El objetivo fue conocer la prevalencia de pacientes diabéticos con SMAL, evaluar la asociación entre el SMAL y el grado de control glucémico y el riesgo de caídas accidentales. Pacientes y métodos: Estudio observacional transversal en el Centro de Salud de San Fernando II, Madrid (periferia). La muestra fueron 184 pacientes con un diagnóstico de diabetes superior a 5 años entre noviembre-marzo de 2013. Se utilizó el test de la oración para evaluar si los pacientes presentaban SMAL. El riesgo de caídas fue determinado según el test Timed Up & Go. Resultados: Un total de 99 pacientes (53,8%) (IC 95% 46,6-61) presentaron un test de la oración positivo. No se obtuvo una relación estadísticamente significativa con la HbA1c, en cambio, sí que se vio una asociación entre el test Timed Up & Go y el SMAL (p < 0,001) (IC 95% 1,173-1,611). Los pacientes con SMAL presentaban un riesgo moderado de caídas frente a aquellos sin SMAL, que presentaban un riesgo bajo. Conclusiones: Existe una alta prevalencia de SMAL en nuestro medio. Presentamos el primer estudio en donde se relaciona el SMAL con el riesgo de caídas en los pacientes diabéticos (AU)

Introduction: Limited joint mobility syndrome (LJMS) appears exclusively in both type 1 and type 2 diabetic patients. It is characterized by a limited range of digital motion, with involvement of small joints of the hands. It initially affects the proximal interphalangeal joints, followed by wrists, elbows, shoulders, knees, and axial skeleton. The diagnosis can be made by the simple «prayer sign» test. The objective was to study the prevalence of diabetic patients with LJMS, and to evaluate the association between LJMS and metabolic control, and the risk of accidental falls. Patients and methods: A cross-sectional study was conducted in the San Fernando II Health Centre, Madrid (suburbs). The sample consisted of 184 patients with a diagnosis of diabetes of over 5 years from November to March, 2013. The prayer sign was used to define which patients had LJMS. Fall risk was determined using the Timed Up & Go test. Results: A total of 99 patients (53.8%) (95% CI 46.6 to 61) had a positive prayer sign. No statistically significant relationship was found with HbA1c, but there was an association with the Timed Up & Go test (P < .001) (95% CI 1.173 to 1.611). The patients with LJMS had a moderate risk of falls compared with those without LJMS, which was of low risk. Conclusions: The prevalence of LJMS is high. This is the first study that shows a relationship between LJMS and the risk of falls in diabetic patients (AU)

[Association between limited joint mobility syndrome and risk of accidental falls in diabetic patients]. / Asociación entre el síndrome de movilidad articular limitada y el riesgo de caídas accidentales en pacientes diabéticos.

INTRODUCTION: Limited joint mobility syndrome (LJMS) appears exclusively in both type 1 and type 2 diabetic patients. It is characterized by a limited range of digital motion, with involvement of small joints of the hands. It initially affects the proximal interphalangeal joints, followed by wrists, elbows, shoulders, knees, and axial skeleton. The diagnosis can be made by the simple "prayer sign" test. The objective was to study the prevalence of diabetic patients with LJMS, and to evaluate the association between LJMS and metabolic control, and the risk of accidental falls. PATIENTS AND METHODS: A cross-sectional study was conducted in the San Fernando II Health Centre, Madrid (suburbs). The sample consisted of 184 patients with a diagnosis of diabetes of over 5 years from November to March, 2013. The prayer sign was used to define which patients had LJMS. Fall risk was determined using the Timed Up & Go test. RESULTS: A total of 99 patients (53.8%) (95% CI 46.6 to 61) had a positive prayer sign. No statistically significant relationship was found with HbA1c, but there was an association with the Timed Up & Go test (P<.001) (95% CI 1.173 to 1.611). The patients with LJMS had a moderate risk of falls compared with those without LJMS, which was of low risk. CONCLUSIONS: The prevalence of LJMS is high. This is the first study that shows a relationship between LJMS and the risk of falls in diabetic patients.

Valoración anestésica preoperatoria y preparación del paciente quirúrgico / Preoperative anesthesia assessment and patient preparation for surgery

La recientemente publicada Declaración de Helsinki para la seguridad del paciente en anestesiología establece que la seguridad y calidad de los cuidados que recibe el paciente relacionado con su situación perioperatoria es responsabilidad directa del anestesiólogo. Esta declaración de seguridad del paciente, avalada por la totalidad de las sociedades europeas de anestesiología, propugna la necesidad de elaboración de protocolos que faciliten el manejo del paciente durante sus cuidados perioperatorios. Uno de los temas propuestos en la Declaración es el manejo preoperatorio y la preparación del paciente quirúrgico. En este artículo se pretende hacer una revisión bibliográfica basada en la evidencia acerca del cuidado preoperatorio del paciente, así como proponer un protocolo sobre los aspectos más importantes del tema, que permita a cada hospital adaptarlo a sus necesidades e incorporarlo a su rutina de trabajo. Se destaca la importancia que tiene la realización de una correcta evaluación preoperatoria, reduciendo la morbimortalidad del paciente quirúrgico. El empleo de cuestionarios preoperatorios y la solicitud dirigida de pruebas complementarias preoperatorias facilita esta labor y reduce costes innecesarios. Finalmente se revisan las recomendaciones más aceptadas sobre normas de ayuno preoperatorio y el manejo de la medicación crónica preoperatoria (AU)

The recently published “Helsinki Declaration on Patient Safety in Anesthesiology” establishes that the safety and quality of the perioperative care received by patients is the responsibility of anesthesiologists. This declaration has been accepted by all the European societies of anesthesiology and stipulates that all institutions providing perioperative anesthesia care to patients should design protocols to guide perioperative patient management. The present article aims to provide an evidenced-based review of preoperative assessment and preparation and to propose a protocol that can be adapted to the needs of each hospital and be incorporated into their routine practice. Emphasis is placed on the importance of correct preoperative evaluation in reducing morbidity and mortality in the surgical patient. This task can be aided by the use of preoperative questionnaires and the rational use of preoperative tests, which will also reduce unnecessary costs. Finally, the most widely accepted recommendations on preoperative fasting and the perioperative management of chronic medication are discussed (AU)

Diseño de una base de datos informatizada para la gestión clínica y básica del melanoma uveal / Design of computerised database for clinical and basic management of uveal melanoma

Propósito: El melanoma uveal es el tumor intraocular primario más frecuente en la edad adulta. El objetivo de este trabajo es mostrar cómo se ha construido una base de datos informatizada con aplicaciones, tanto clínicas como de investigación concretas, a un grupo extenso de pacientes diagnosticados de melanoma de la úvea. Métodos: Para el diseño de la base de datos se realizó una selección de categorías, atributos y valores basándose en las clasificaciones y parámetros dados por diferentes autores en artículos que han tenido gran relevancia en el campo del melanoma uveal en los últimos años. Resultados: La base de datos cuenta en la actualidad con más de 250 registros de pacientes, con información específica sobre su clínica, diagnóstico, tratamiento y evolución. Nos permite realizar búsquedas sobre cualquier parámetro del registro y hacer estudios estadísticos de estos de una forma rápida y sencilla. Conclusión: Los modelos de bases de datos se han convertido en un arma fundamental para la práctica clínica, pues constituyen una forma eficaz tanto de almacenamiento como de recopilación y búsqueda selectiva de información. A la hora de realizar una base de datos es muy importante la definición de una estrategia común y el uso de un idioma normalizado (AU)

Purpose: The uveal melanoma is the most common primary intraocular tumour in adults. The objective of this work is to show how a computerised database has been formed with specific applications, for clinical and research use, to an extensive group of patients diagnosed with uveal melanoma. Method: For the design of the database a selection of categories, attributes and values was created based on the classifications and parameters given by various authors of articles which have had great relevance in the field of uveal melanoma in recent years. Results: The database has over 250 patient entries with specific information on their clinical history, diagnosis, treatment and progress. It enables us to search any parameter of the entry and make quick and simple statistical studies of them. Conclusion: The database models have been transformed into a basic tool for clinical practice, as they are an efficient way of storing, compiling and selective searching of information. When creating a database it is very important to define a common strategy and the use of a standard language (AU)

[Design of computerised database for clinical and basic management of uveal melanoma]. / Diseño de una base de datos informatizada para la gestión clínica y básica del melanoma uveal.

PURPOSE: The uveal melanoma is the most common primary intraocular tumour in adults. The objective of this work is to show how a computerised database has been formed with specific applications, for clinical and research use, to an extensive group of patients diagnosed with uveal melanoma. METHOD: For the design of the database a selection of categories, attributes and values was created based on the classifications and parameters given by various authors of articles which have had great relevance in the field of uveal melanoma in recent years. RESULTS: The database has over 250 patient entries with specific information on their clinical history, diagnosis, treatment and progress. It enables us to search any parameter of the entry and make quick and simple statistical studies of them. CONCLUSION: The database models have been transformed into a basic tool for clinical practice, as they are an efficient way of storing, compiling and selective searching of information. When creating a database it is very important to define a common strategy and the use of a standard language.

Manejo de vía aérea difícil secundario a bocio multinodular gigante / No disponible

No disponible

[Acute renal failure secondary to hemolytic uremic syndrome in a pregnant woman with pre-eclampsia]. / Fracaso renal agudo secundario a síndrome hemolítico urémico en gestante con preeclampsia.

Acute renal failure is a serious complication of pregnancy associated with a high rate of morbidity and mortality; the incidence is currently 1 per 10,000 pregnancies. The most common causes are gestational hypertension, bleeding, sepsis, and intrinsic renal disease. Other less common pregnancy-related syndromes, such as HELLP syndrome or thrombotic microangiopathy, may also lead to kidney failure. Hemolytic uremic syndrome and thrombotic thrombocytopenic purpura are forms of thrombotic microangiopathy and although neither is specific to pregnancy, the incidence of these entities rises during gestation. The classic symptoms are fever, hemolytic microangiopathic anemia, thrombopenia, neurologic dysfunction, and kidney abnormalities. When renal involvement is the predominant manifestation, the diagnosis is usually hemolytic uremic syndrome.

Fracaso renal agudo secundario a síndrome hemolítico urémico en gestante con preeclampsia / Acute renal failure secondary to hemolytic uremic syndrome in a pregnant woman with pre-eclampsia

El fracaso renal agudo relacionado con el embarazoes una grave complicación con una elevada tasa de morbi-mortalidad asociada. Actualmente la incidencia es de1 caso cada 10.000 embarazos, siendo las causas másprevalentes los estados hipertensivos del embarazo,hemorragias, sepsis, enfermedad renal intrínseca y otrossíndromes más raros relacionados con el embarazo,como el síndrome de HELLP y las microangiopatíastrombóticas. El síndrome hemolítico urémico (SHU) y lapúrpura trombocitopénica trombótica (PTT) se incluyendentro de estas últimas y, si bien ninguna es específicadel embarazo, su incidencia aumenta durante el mismo.Los síntomas clásicos son: fiebre, anemia hemolíticamicroangiopática, trombopenia, afectación neurológica yafectación renal. Cuando la afectación renal es predominante,el diagnóstico suele ser el SHU(AU)

Acute renal failure is a serious complication ofpregnancy associated with a high rate of morbidity andmortality; the incidence is currently 1 per 10 000pregnancies. The most common causes are gestationalhypertension, bleeding, sepsis, and intrinsic renaldisease. Other less common pregnancy-relatedsyndromes, such as HELLP syndrome or thromboticmicroangiopathy, may also lead to kidney failure.Hemolytic uremic syndrome and thromboticthrombocytopenic purpura are forms of thromboticmicroangiopathy and although neither is specific topregnancy, the incidence of these entities rises duringgestation. The classic symptoms are fever, hemolyticmicroangiopathic anemia, thrombopenia, neurologicdysfunction, and kidney abnormalities. When renalinvolvement is the predominant manifestation, thediagnosis is usually hemolytic uremic syndrome(AU)

Técnicas de depuración extracorpórea: tratamiento de soporte en la sepsis y en el síndrome de disfunción multiorgánica / Extracorporeal hemofiltration techniques: support treatment in sepsis and multiple-organ dysfunction syndrome

No disponible

[General anesthesia in mentally disabled patients undergoing dental surgery]. / Anestesia general en pacientes con discapacidad intelectual sometidos a cirugía dental.

OBJECTIVE: To describe the anesthetic technique used, the evaluation of airway patency, and the perioperative complications in patients with lower than average intelligence (mentally disabled) who are administered general anesthesia for dental surgery. MATERIAL AND METHODS: We carried out a prospective, descriptive, comparative study of mentally disabled ASA 2-3 patients. The patients were distributed in 2 groups: mild to moderate mental disability and severe to very severe mental disability. Induction was via intravenous or inhaled anesthesia depending on availability of venous access. Maintenance was with sevoflurane in oxygen and air at variable concentrations in order to maintain a bispectral index (BIS) between 40 and 60. Statistical comparisons were based on the chi2 test, the log-rank test and the t test. RESULTS: Forty-seven patients were enrolled. The anesthetic technique maintained hemodynamic stability in both groups. No statistically significant differences were found in Mallampati classification, Cormack-Lehane classification, or level of disability. The incidence of complications was higher in the group with more severe disability; the most common complication was difficult tracheal intubation. Bradycardia was the most common complication in the group with mild to moderate mental disability. CONCLUSIONS: The anesthetic technique used in this study proved to be safe and effective in this type of patient. A higher degree of mental disability led to less effective examination of the airway and more difficult direct laryngoscopy. BIS was as effective for monitoring in this population as it is in the general population.

Comparación de la eficacia analgésica de codeína más paracetamol vs tramadol en el tratamiento del dolor por cáncer / Comparison of the analgesic effectiveness of codeine plus paracetamol vs tramadol in the treatment of cáncer pain

Pain is the principal symptom in 70% of patients with severe cáncer. Analgesics therapy with a proper management controls pain in 80-90% of patients. Objective. Compare the analgesic efficacy and tolerability of codeine plus acetaminophen (CA) and tramadol clorhydrate (T) in the relief of cáncer pain. Method. A double blind, randomize controlled clinical trial was perform in patients with modérate to severe pain intensity. Randomly patients were assigned in a group for receiving codeine plus acetaminophen and in other group for receiving tramadol chlorhydrate for a three weeks period. Pain intensity was measure using a numeric scale from zero to ten in which modérate pain goes from 5-7, and severe pain goes from 8-10. Analgesic treatment was considered to be effective when pain disappear or become mild, 1-4 in the numeric scale. Results. One hundred fifteen patients participated, 59 receive CA and 56 T. In the group of patients that receive CA, 58% achieved pain relief with the initial dose of 150 mg/d and 8% responded to the double dose; 34% didn't experience pain relief. In the group patients treated with T pain relief occurred in 62% of patients with the initial dose of 200mg/d and 11% with the double dose; 27% didn't experienced pain relief. Differences between both groups were not significant in the analgesic efficacy. The tramadol group experienced in a significant way a higher incidence of adverse events of mild intensity: nausea (p: 0.05, RR: 0.62; IC95%: 0.38-1.01), dizziness (p: 0.04; RR: 0.58; IC95%: 0.33-1.01) and lost of appetite (p: 0.001; RR: 0.08; IC95%: 0.01-0.59). Conclusion. Efficacy of C and T during a treatment of 23 days was similar, no statistical differences were found. There were no differences in the analgesic effectiveness between CA and T in the management of cáncer pain. With the use of T a higher incidence of adverse events of mild intensity were reported (AU)

El dolor es el síntoma más importante en 70% de pacientes que padecen cáncer avanzado. La terapia con analgésicos utilizada en forma adecuada, controla el dolor en 80-90% de los pacientes. Objetivos. Comparar la eficacia analgésica y seguridad de la codeína más acetaminofén (CA) y Clorhidrato de Tramadol (T) en el alivio del dolor por cáncer. Método. Se realizó un ensayo clínico controlado doble ciego, en pacientes con dolor por cáncer de intensidad moderada o severa. En forma aleatoria se asignó un grupo de pacientes para ser tratados con la combinación de Codeína más paracetamol, mientras que el otro grupo recibió Clorhidrato de Tramadol por un periodo de tres semanas. La intensidad del dolor fue medida con una escala numérica de cero a diez, considerándose como dolor de intensidad moderada el marcado en la escala entre 5-7 y de intensidad severa de 8-10. El tratamiento analgésico se consideró eficaz cuando el dolor desapareció o disminuyó a una intensidad leve, comprendida entre 1-4. Resultados. Se incluyeron 115 pacientes: 59 recibieron CA y 56 recibieron T. En el grupo de pacientes que recibió CA 58% aliviaron con una dosis inicial de codeína de 150 mg/día y 8% con la dosis doblada; 34% no aliviaron. En el grupo de pacientes tratado con T el dolor alivió en 62% de los pacientes con la dosis inicial de 200mg/día y 11% con la dosis doblada, mientras que 27% no experimentó alivio. Las diferencias entre los dos grupos no fueron significativas en cuanto a su eficacia analgésica. El grupo que recibió Tramadol presentó en forma significativa, mayor incidencia de efectos colaterales de intensidad leve: náusea (p: 0.05, RR: 0.62; IC95%: 0.38-1.01), mareo (p: 0.04; RR: 0.58; IC95%: 0.33-1.01) y pérdida de apetito (p: 0.001; RR: 0.08; IC95%: 0.01-0.59). Conclusión. No existen diferencias en cuanto a la eficacia analgésica de CA y T en el tratamiento del dolor por cáncer. Con el uso de T se presentó una mayor incidencia de efectos colaterales de intensidad leve

Anestesia general en pacientes con discapacidad intelectualsometidos a cirugía dental / General anesthesia in mentally disabled patients undergoing dental surgery

OBJETIVO: Describir la técnica anestésica empleada,valorar la vía aérea y analizar las complicaciones perioperatoriasen pacientes con discapacidad intelectual (DI)sometidos a anestesia general para cirugía dental.MATERIAL Y MÉTODOS: Estudio prospectivo, descriptivoy comparativo de pacientes ASA II-III con DI. Se distribuyeronen dos grupos: DI leves-moderados y DI graves-muy graves. La inducción fue intravenosa oinhalatoria según la disponibilidad de acceso venoso. Elmantenimiento se realizó con oxígeno/aire, y sevofluoranoa concentración variable para mantener un BIS entre40-60. El análisis estadístico incluyó X2 de Mantel yHaensel, t de Student.RESULTADOS: Se incluyeron 47 pacientes. La técnicaanestésica mantuvo la estabilidad hemodinámica enambos grupos. No se encontraron diferencias estadísticamentesignificativas entre la clasificación Mallampati,la clasificación de Cormack-Lehane y el grado de discapacidad.La incidencia de complicaciones fue mayor enel grupo de mayor discapacidad, siendo la más frecuentela dificultad de intubación endotraqueal. La bradicardiafue la complicación más frecuente en los DI levesmoderados.CONCLUSIONES: La técnica anestésica empleada eneste tipo de pacientes se mostró segura y eficaz. Mayorgrado de DI conlleva peor exploración de la vía aérea ypeor laringoscopia directa. El BIS se mostró igualmenteeficaz que en la población sin discapacidad (AU)

OBJECTIVE: To describe the anesthetic technique used,the evaluation of airway patency, and the perioperativecomplications in patients with lower than averageintelligence (mentally disabled) who are administeredgeneral anesthesia for dental surgery.MATERIAL AND METHODS: We carried out a prospective,descriptive, comparative study of mentally disabled ASA 2-3 patients. The patients were distributed in 2 groups: mildto moderate mental disability and severe to very severemental disability. Induction was via intravenous or inhaledanesthesia depending on availability of venous access.Maintenance was with sevoflurane in oxygen and air atvariable concentrations in order to maintain a bispectralindex (BIS) between 40 and 60. Statistical comparisonswere based on the χ2 test, the log-rank test and the t test.RESULTS: Forty-seven patients were enrolled. Theanesthetic technique maintained hemodynamic stabilityin both groups. No statistically significant differenceswere found in Mallampati classification, Cormack-Lehane classification, or level of disability. The incidenceof complications was higher in the group with moresevere disability; the most common complication wasdifficult tracheal intubation. Bradycardia was the mostcommon complication in the group with mild tomoderate mental disability.CONCLUSIONS: The anesthetic technique used in thisstudy proved to be safe and effective in this type ofpatient. A higher degree of mental disability led to lesseffective examination of the airway and more difficultdirect laryngoscopy. BIS was as effective for monitoringin this population as it is in the general population (AU)

Evolutionary history of the ABCB2 genomic region in teleosts.

Gene duplication, silencing and translocation have all been implicated in shaping the unique genomic architecture of the teleost MH regions. Previously, we demonstrated that trout possess five unlinked regions encoding MH genes. One of these regions harbors ABCB2 which in all other vertebrate classes is found in the MHC class II region. In this study, we sequenced a BAC contig for the trout ABCB2 region. Analysis of this region revealed the presence of genes homologous to those located in the human class II (ABCB2, BRD2, psiDAA), extended class II (RGL2, PHF1, SYGP1) and class III (PBX2, Notch-L) regions. The organization and syntenic relationships of this region were then compared to similar regions in humans, Tetraodon and zebrafish to learn more about the evolutionary history of this region. Our analysis indicates that this region was generated during the teleost-specific duplication event while also providing insight about potential MH paralogous regions in teleosts.