Cannabinoid Analgesia in Postoperative Pain Management: From Molecular Mechanisms to Clinical Reality.

Postoperative pain (POP) is a challenging clinical phenomenon that affects the majority of surgical patients and demands effective management to mitigate adverse outcomes such as persistent pain. The primary goal of POP management is to alleviate suffering and facilitate a seamless return to normal function for the patient. Despite compelling evidence of its drawbacks, opioid analgesia remains the basis of POP treatment. Novel therapeutic approaches rely on multimodal analgesia, integrating different pharmacological strategies to optimize efficacy while minimizing adverse effects. The recognition of the imperative role of the endocannabinoid system in pain regulation has prompted the investigation of cannabinoid compounds as a new therapeutic avenue. Cannabinoids may serve as adjuvants, enhancing the analgesic effects of other drugs and potentially replacing or at least reducing the dependence on other long-term analgesics in pain management. This narrative review succinctly summarizes pertinent information on the molecular mechanisms, clinical therapeutic benefits, and considerations associated with the plausible use of various cannabinoid compounds in treating POP. According to the available evidence, cannabinoid compounds modulate specific molecular mechanisms intimately involved in POP. However, only two of the eleven clinical trials that evaluated the efficacy of different cannabinoid interventions showed positive results.

Catalyst-free assembly of giant tris(heteroaryl)methanes: synthesis of novel pharmacophoric triads and model sterically crowded tris(heteroaryl/aryl)methyl cation salts.

A series of giant tris(heteroaryl)methanes are easily assembled by one-pot three-component synthesis by simple reflux in ethanol without catalyst or additives. Diversely substituted indoles (Ar1) react with quinoline aldehydes, quinolone aldehydes, chromone aldehydes, and fluorene aldehydes (Ar2CHO) and coumarins (Ar3) in 1:1:1 ratio to form the corresponding tris(heteroaryl)methanes (Ar1Ar2Ar3)CH along with (Ar1Ar1Ar2)CH triads. A series of new 2:1 triads were also synthesized by coupling substituted indoles with Ar2CHO. The coupling reactions could also be carried out in water (at circa 80 °C) but with chemoselectivity favoring (Ar1Ar1Ar2)CH over (Ar1Ar2Ar3)CH. The molecular structure of a representative (Ar1Ar2Ar3)CH triad was confirmed by X-ray analysis. Model tris(heteroaryl/aryl)methylium salts were generated by reaction with DDQ/HPF6 and studied by NMR and by DFT and GIAO-DFT.

Personalised socially assistive robot for cardiac rehabilitation: Critical reflections on long-term interactions in the real world.

Lack of motivation and low adherence rates are critical concerns of long-term rehabilitation programmes, such as cardiac rehabilitation. Socially assistive robots are known to be effective in improving motivation in therapy. However, over longer durations, generic and repetitive behaviours by the robot often result in a decrease in motivation and engagement, which can be overcome by personalising the interaction, such as recognising users, addressing them with their name, and providing feedback on their progress and adherence. We carried out a real-world clinical study, lasting 2.5 years with 43 patients to evaluate the effects of using a robot and personalisation in cardiac rehabilitation. Due to dropouts and other factors, 26 patients completed the programme. The results derived from these patients suggest that robots facilitate motivation and adherence, enable prompt detection of critical conditions by clinicians, and improve the cardiovascular functioning of the patients. Personalisation is further beneficial when providing high-intensity training, eliciting and maintaining engagement (as measured through gaze and social interactions) and motivation throughout the programme. However, relying on full autonomy for personalisation in a real-world environment resulted in sensor and user recognition failures, which caused negative user perceptions and lowered the perceived utility of the robot. Nonetheless, personalisation was positively perceived, suggesting that potential drawbacks need to be weighed against various benefits of the personalised interaction.

Chitosan Hydrogels Based on the Diels-Alder Click Reaction: Rheological and Kinetic Study.

The Diels-Alder reaction is recognized to generate highly selective and regiospecific cycloadducts. In this study, we carried out a rheological and kinetic study of N-furfuryl chitosan hydrogels based on the Diels-Alder click reaction with different poly(ethylene)glycol-maleimide derivatives in dilute aqueous acidic solutions. It was possible to prepare clear and transparent hydrogels with excellent mechanical properties. Applying the Winter and Chambon criterion the gel times were estimated at different temperatures, and the activation energy was calculated. The higher the temperature of gelation, the higher the reaction rate. The crosslinking density and the elastic properties seem to be controlled by the diffusion of the polymer segments, rather than by the kinetics of the reaction. An increase in the concentration of any of the two functional groups is accompanied by a higher crosslinking density regardless maleimide:furan molar ratio. The hydrogel showed an improvement in their mechanical properties as the temperature increases up to 70 °C. Above that, there is a drop in G' values indicating that there is a process opposing to the Diels-Alder reaction, most likely the retro-Diels-Alder.

A Socially Assistive Robot for Long-Term Cardiac Rehabilitation in the Real World.

What are the benefits of using a socially assistive robot for long-term cardiac rehabilitation? To answer this question we designed and conducted a real-world long-term study, in collaboration with medical specialists, at the Fundación Cardioinfantil-Instituto de Cardiología clinic (Bogotá, Colombia) lasting 2.5 years. The study took place within the context of the outpatient phase of patients' cardiac rehabilitation programme and aimed to compare the patients' progress and adherence in the conventional cardiac rehabilitation programme (control condition) against rehabilitation supported by a fully autonomous socially assistive robot which continuously monitored the patients during exercise to provide immediate feedback and motivation based on sensory measures (robot condition). The explicit aim of the social robot is to improve patient motivation and increase adherence to the programme to ensure a complete recovery. We recruited 15 patients per condition. The cardiac rehabilitation programme was designed to last 36 sessions (18 weeks) per patient. The findings suggest that robot increases adherence (by 13.3%) and leads to faster completion of the programme. In addition, the patients assisted by the robot had more rapid improvement in their recovery heart rate, better physical activity performance and a higher improvement in cardiovascular functioning, which indicate a successful cardiac rehabilitation programme performance. Moreover, the medical staff and the patients acknowledged that the robot improved the patient motivation and adherence to the programme, supporting its potential in addressing the major challenges in rehabilitation programmes.

Entrevista motivacional como estrategia de mejoramiento de la salud bucal de niños y cuidadores. Revisión en sombrilla / Motivational interviewing as a strategy to improve the oral health of children and caregivers. Umbrella review

Objetivo: demostrar la efectividad de la entrevista motivacional (EM) en el mejoramiento de algunos indicadores de salud bucal en niños de 0 a 12 años y sus cuidadores. Material y métodos: estudio de revisión en sombrilla (umbrella review). Se realizó búsqueda en bases de datos electrónicas (PubMed, MEDLINE, SCOPUS, EBSCO) y Google Scholar desde el año 2010 hasta el año 2020, con las siguientes palabras clave: ('motivational interviewing' OR 'motivational interview' OR 'motivational interviewing style' OR 'motivational intervention' OR 'motivational counseling' OR 'brief motivational counseling' OR 'maternal counseling' OR 'behavioral intervention') AND (“caries” OR 'dental caries' OR 'tooth decay' OR 'dental decay' OR 'carious lesions' OR 'DMFT index' OR “ICDAS”) AND ('gingival diseases' OR “gingivitis” OR “CPITN” OR 'gingival bleeding' OR 'dental calculus') AND (“children” OR “families” OR “caregivers”). Se incluyeron artículos originales sobre la efectividad de la entrevista motivacional en salud bucal (EMSB) en niños de hasta 12 años y cuidadores, tipo revisión sistemática de la literatura y metanálisis, desde el año 2010 hasta el 2020. Resultados: 69 artículos (2 revisiones sistemáticas y 4 metanálisis). Los indicadores encontrados fueron: cambios en la presentación de caries de la infancia temprana, higiene bucal, condiciones gingivales y frecuencia de visitas a la consulta odontológica, con resultados alentadores y, en otros, contradictorios. Conclusiones: la evidencia sobre la efectividad de la entrevista motivacional en comparación con la educación convencional muestra cambios positivos en indicadores de salud bucal, como mejoramiento de la higiene dental y de la presentación de la caries en la primera infancia. (AU)

Objective: to demonstrate, the effectiveness of motivational interviewing in improving oral health indicators in children aged 0 to 12 years and their caregivers. Material and method: an umbrella review design. Search in electronic databases (PubMed, MEDLINE, SCOPUS, EBSCO) and Google Scholar since 2010 to 2020, with the following keywords: ('Motivational interviewing' OR 'motivational interview' OR 'motivational interviewing style' OR 'motivational intervention' OR 'motivational counseling' OR 'brief motivational counseling' OR 'maternal counseling' OR 'behavioral intervention') AND (“caries” OR 'dental caries' OR 'tooth decay' OR 'dental decay' OR 'carious lesions' OR 'DMFT index' OR “ICDAS”) AND ('gingival diseases' OR “gingivitis” OR “CPITN” OR 'gingival bleeding' OR 'dental calculus') AND (“children” OR “families” OR “caregivers”), original articles on the effectiveness of motivational interviewing in oral health (EMSB) in children between 0 and 12 years of age and caregivers, type systematic review of the literature and metaanalysis. Results: 69 articles were found (2 systematic reviews and 4 metaanalysis). The indicators found: change in early childhood caries, oral hygiene, gingival conditions and frequency of visits to the dental office with promise results and others contradictories. Conclusion: the evidence on the effectiveness of motivational interviewing compared to conventional education shows positive changes in oral health indicators such as improvement in dental hygiene and the presentation of caries in early childhood, among others. (AU)

Association of General and Abdominal Obesity With Hypertension, Dyslipidemia and Prediabetes in the PREDAPS Study.

INTRODUCTION AND OBJECTIVES: Some anthropometric measurements show a greater capacity than others to identify the presence of cardiovascular risk factors. This study estimated the magnitude of the association of different anthropometric indicators of obesity with hypertension, dyslipidemia, and prediabetes (altered fasting plasma glucose and/or glycosylated hemoglobin). METHODS: Cross-sectional analysis of information collected from 2022 participants in the PREDAPS study (baseline phase). General obesity was defined as body mass index ≥ 30kg/m2 and abdominal obesity was defined with 2 criteria: a) waist circumference (WC) ≥ 102cm in men/WC ≥ 88cm in women, and b) waist-height ratio (WHtR) ≥ 0.55. The magnitude of the association was estimated by logistic regression. RESULTS: Hypertension showed the strongest association with general obesity in women (OR, 3.01; 95%CI, 2.24-4.04) and with abdominal obesity based on the WHtR criterion in men (OR, 3.65; 95%CI, 2.66-5.01). Hypertriglyceridemia and low levels of high-density lipoprotein cholesterol showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.49; 95%CI, 1.68-3.67 and OR, 2.70; 95%CI, 1.89-3.86) and with general obesity in men (OR, 2.06; 95%CI, 1.56-2.73 and OR, 1.68; 95%CI, 1.21-2.33). Prediabetes showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.48; 95%CI, 1.85-3.33) and with abdominal obesity based on the WC criterion in men (OR, 2.33; 95%CI, 1.75-3.08). CONCLUSIONS: Abdominal obesity indicators showed the strongest association with the presence of prediabetes. The association of anthropometric indicators with hypertension and dyslipidemia showed heterogeneous results.

Infecciones en varones por gardnerella vaginalis- revisión bibliográfica

Introducción: Gardnerella vaginalis ha sido aislada de orina, semen, descarga uretral, hisopos endouretrales, rectales y del prepucio, en algunos casos asociada a manifestaciones clínicas; se han descrito uretritis y balanopostitis con diversos porcentajes. Los hallazgos en frotis rectal, semen y prepucio deben interpretarse cuidadosamente para otorgarles significado clínico. Ha quedado demostrado que el hombre la adquiere de sus parejas sexuales y en su forma cohesiva. Objetivo: Explorar el papel patógeno de G. vaginalis como causa de infección en los hombres. Método: La estrategia de búsqueda se realizó en: PubMed/ Medline, Scopus Cochrane Library, SciELO Lilacs, Redalyc; Google Scholar con proveedores como: EB-SCO y tesauros MeSH y DeCS. Resultados: Las diferentes publicaciones indicaron detección de G. vaginalis en muestras uretrales con reportes desde 1,5 %, 4,2 % hasta 14 % con manifestaciones clínicas de uretritis. Otros reportes indican 4,5 %, 5 %, 6,3 %, 7,2 % y 14,5 % sin uretritis. Dos estudios de infecciones del tracto urinario presentan porcentajes de 30,8 % y 67 % de G. vaginalis en hombres con síntomas urinarios. G vaginalis se reporta en frotis rectal, semen e hisopados del prepucio, pero sin clara atribución de etiología patógena. Conclusión: Es recomendable la búsqueda de G. vaginalis en hombres con uretritis no gonocócica, balanopostitis, e infecciones del tracto urinario por su probable significado patógeno, mientras que su papel en semen en pacientes con infertilidad y en el frotis rectal, requiere más estudios de investigación.

Introduction: Gardnerella vaginalis has been isolated from urine, semen, urethral discharge, and endourethral, rectal, and foreskin swabs, in some cases associated with clinical manifestations. Urethritis and balanoposthitis have been described in different percentages. Rectal swab, semen, and foreskin findings must be carefully interpreted for clinical significance. It has been demonstrated that man acquires it from her sexual partners in its cohesive form. Objective: To explore the role of G. vaginalis as a cause of infections in men. Method: Bibliography was searched through PubMed/ Medline, Scopus Cochrane Library, SciELO Lilacs, Redalyc; Google Scholar, and providers like EBSCO and thesauros MeSH y DeCS. Results: Several publications show the detection of G. vaginallis in urethral samples with reports of 1,5%, 4,2%, even 14% of urethritis. Some other reports show a 4,5%, 5%, 6,3%, 7,2% and 14,5% without urethritis. Two studies of urinary tract infections show a 30,8% and 67% of G. vaginalis in men with urinary symptoms. G. vaginalis is reported in rectal smears, semen, and foreskin swabs but without clear attribution of pathogenic etiology. Conclusion: The search for G. vaginalis in men with non-gonococcal urethritis, balanoposthitis, or urinary tract infections is recommended due to its probable pathogenic significance, while its role in patients with infertility and rectal smears requires further investigation, due to the presence in semen.

Consumo de alcohol en entornos urbanos alrededor de una universidad en Bogotá. Resultados de un estudio piloto / Consume of Alcohol in Urban Settings around a University in Bogotá. Results of a Pilot Study

Introducción: El objetivo de este estudio piloto fue caracterizar las percepciones de estudiantes universitarios sobre el consumo de alcohol y la disponibilidad de establecimientos que expenden licor en el perímetro urbano de una universidad de Bogotá. Métodos: Se llevó a cabo un estudio transversal y mixto en 201 estudiantes seleccionados por una muestra no probabilística. Se usó una encuesta autodiligenciada para evaluar percepciones respecto al consumo de alcohol alrededor de la universidad y sistemas de información geográfica para identificar los establecimientos que vendían alcohol. Resultados: El 66% de los participantes informó haber consumido alcohol alrededor del campus universitario. El 26% se mostraba de acuerdo o muy de acuerdo con la implementación de medidas estrictas para restringir el consumo, siendo mayor en personas que no consumieron (41,2%). El análisis geográfico encontró un patrón de concentración de oferta y consumo de alcohol en las inmediaciones de la universidad. Conclusión: Este estudio muestra la potencial relevancia que tiene la oferta y consumo de alcohol alrededor de un campus universitario para la salud pública. Se deben llevar a cabo estudios complementarios para entender, de mejor manera, posibles vínculos entre contextos urbanos universitarios y consumo de alcohol.

Background: The aim of this pilot study was to characterize the perceptions of university students in relation to alcohol consumption and the availability of alcohol outlets in the urban perimeter of a university in Bogotá. Methods: A mixed cross-sectional study was conducted among 201 undergraduate students ages 18 to 27 years using a non-probabilistic sampling design. The perceptions regarding alcohol consumption in the university's surroundings were assessed via a self-reported questionnaire. Geographic Information Systems were used to identify the outlets that sell alcohol. Results: 66% of participants reported alcohol consumption in in the university's surroundings. The proportion of students who agreed with implementing strict measures to control alcohol consumption was 26%, with higher percentages in those who didn't consume alcohol (41,2%). Geographic analysis showed that several urban attributes were correlated with alcohol consumption. Conclusión: The results of this study show the potential relevance that has the availability' of alcohol outlets near a university' campus as a public health issue. Further studies should be conducted in order to better understand the links between urban contexts around universities and alcohol consumption.

Risk factors and prevalence of osteoporosis in premenopausal women from poor economic backgrounds in Colombia.

INTRODUCTION: The prevalence of osteoporosis in premenopausal women along with associated risk factors has not been well elucidated. Recent studies have shown that poverty is a risk factor for osteoporosis. OBJECTIVE: To determine the prevalence of osteoporosis and its risk factors in a group of premenopausal women of poor economic background in Colombia. MATERIALS AND METHODS: The study comprised 1483 women between 35 and 53 years of age with at least one risk factor for osteoporosis. Demographic characteristics, reproductive factors, comorbidities, and risk factors for osteoporosis were evaluated. Lumbar vertebrae (L2-L4) and the femur neck were assessed using dual-energy X-ray absorptiometry. RESULTS: Of the 1483 patients, 1443 (97.3%) had at least one risk factor for osteoporosis and 40 (2.7%) had no risk factors. Patients with one risk factor were referred to have a dual-energy X-ray absorptiometry scan, which 795 women completed. Osteopenia was found in 30.5% and osteoporosis in 4.8% of these women. The majority of these women were homemakers, and 18.5% of the patients with osteoporosis were also illiterate (P < 0.001). The risk factors identified in this population were: hypothyroidism (odds ratio [OR] = 5.19, 95% confience interval [CI]:1.6-16), age over 45 years old (OR = 1.13, 95% CI: 1.0-1.2), a history of malnutrition or low birth weight (OR = 2.35, 95% CI: 1.0-5.2), or early-onset menopause (OR = 3.4, 95% CI: 1.6-7.2). CONCLUSION: Premenopausal Colombian women from impoverished areas showed increased rates of osteopenia and osteoporosis compared with the data described in the current literature. Hypothyroidism was an outstanding risk factor in Colombian premenopausal women with osteoporosis. This shows the influence of poverty and other risk factors on the onset of osteoporosis in women aged 35-53 years.

El papel del psicólogo en la protección de la primera infancia frente a los fenómenos de violencia en Colombia / The psychologist role in the protection of early childhood within violence phenomena in Colombia

Colombia es un país afectado por los fenómenos de violencia; con ello, la primera infancia como población vulnerable se ha visto perjudicada por diversas situaciones que han amenazado el bienestar y desarrollo integral de esta. Hoy en día, existen leyes enfocadas en garantizar los derechos de los niños y niñas que buscan proteger integralmente esta población. Gracias a esto, la atención desde el área de la psicología viene tomando fuerza, en aspectos como la restitución y garantía de los derechos. El psicólogo tiene un lugar importante cuando de protección hacia la primera infancia se refiere, puesto que es el mediador entre la institución y las familias, y ofrece acompañamiento y asesorías en los casos que sea necesario.

Colombia is an affected country by violence phenomenus, and early childhood is a vulnerable population that has been harmed by numerous situations threatening it welfare and the correct development of it. Nowadays, there are laws focused on guarantee children's rights, protecting them in an integral way within this population. Tanks to this, the attention from psychology is getting strong in aspects like restitution and guarantee of rights. The psychologist has very important place in regard to the protection of early childhood, as he is the mediator between the institution and the families, and he also provides accompaniment and counseling in the needed cases.

Atrial myxoma in a patient with patent foramen ovale: evaluation with multimodal imaging. Case report / Mixoma auricular en un paciente con foramen oval permeable: evaluación con imágenes multimodales. Reporte de un caso

Abstract: Primary cardiac tumors in adults are rare and mostly benign, approximately 75%, being the myxoma the most frequent in half of that percentage. One-fourth of the primary cardiac tumors are malignant and 95% of the cases are sarcomas. Metastases are more frequent than primary tumors. Cardiac surgery is indicated specially in benign masses and therapies such as chemotherapy and/or radiotherapy should be reserved for unresectable or metastatic malignancies. Hence the importance of a diagnostic approach, which leads to the best therapeutic conduct and in many cases, a multimodal image approach is necessary, as it is exposed in our case.(AU)

Resumen: Los tumores cardiacos primarios en adultos son raros y en su mayoría benignos, aproximadamente el 75%, siendo el mixoma el más frecuente en la mitad de ese porcentaje. Un cuarto de los tumores cardiacos primarios son malignos y el 95% de los casos son sarcomas. Las metástasis son más frecuentes que los tumores primarios. La cirugía cardiaca está indicada especialmente en masas benignas y las terapias como la quimioterapia y/o la radioterapia deben reservarse para tumores malignos o metástasis irresecables. De ahí la importancia de un enfoque de diagnóstico, que conduzca a la mejor conducta terapéutica y, en muchos casos, es necesario un enfoque de imagen multimodal, como está expuesto en nuestro caso.(AU)

[Ventricular septal defects in adults: 15 years of surgical experience in a single Colombian cardiovascular center]. / Comunicación interventricular en adultos: experiencia quirúrgica de 15 años en un centro cardiovascular Colombiano.

OBJECTIVE: To review the surgical experience with ventricular septal defects in adults in Colombia. METHOD: Descriptive, retrospective study of surgically repaired patients between 1995 and 2010. Clinical, echocardiographic, hemodynamic, and surgical findings were related to hospital and outpatient outcomes. RESULTS: Fifty-two patients were analyzed (mean age 29.3 ± 9.9 years, 54% women). Ventricular septal defects were classified, according to the Society of Thoracic Surgeons, as type 2 (membranous, 84.6%), type 1 (subarterial, 13.5%), and type 3 (inlet, 1.9%). Dyspnea, Qp/Qs ≥ 2, and pulmonary hypertension were the most common indications for surgery. No peri-operative deaths were found. Outpatient mean follow-up was 2.7 ± 3.6 years and was possible for 90% of the original cohort and late mortality was 5% (one case). Despite that residual ventricular septal defects (29%) were frequent, no patient required surgical re-intervention for this reason. Improvements in functional class and pulmonary artery systolic pressure were also observed. CONCLUSIONS: Surgical closure of ventricular septal defects in adults is a safe procedure without early mortality and a low complications index. Residual ventricular septal defects underline the need for life-long follow-up.

Asociación de obesidad general y abdominal con hipertensión, dislipemia y presencia de prediabetes en el estudio PREDAPS / Association of general and abdominal obesity with hypertension, dyslipidemia and prediabetes in the PREDAPS study

Introducción y objetivos: Algunas medidas antropométricas muestran mayor capacidad que otras para discriminar la presencia de factores de riesgo cardiovascular. Este trabajo estima la magnitud de la asociación de diversos indicadores antropométricos de obesidad con hipertensión, dislipemia y prediabetes (glucemia basal o glucohemoglobina alteradas). Métodos: Análisis transversal de la información recogida en 2.022 sujetos del estudio PREDAPS (etapa basal). Se definió obesidad general como índice de masa corporal ≥ 30 kg/m2 y obesidad abdominal con 2 criterios: a) perímetro de cintura (PC) ≥ 102 cm en varones/PC ≥ 88 cm en mujeres, y b) índice cintura/estatura (ICE) ≥ 0,55. La magnitud de la asociación se estimó mediante regresión logística. Resultados: La hipertensión arterial mostró la asociación más alta con la obesidad general en mujeres (OR = 3,01; IC95%, 2,24-4,04) y con la obesidad abdominal según el criterio del ICE en varones (OR = 3,65; IC95%, 2,66-5,01). La hipertrigliceridemia y los valores bajos de colesterol unido a lipoproteínas de alta densidad mostraron la asociación más alta con obesidad abdominal según el criterio del ICE en mujeres (OR = 2,49; IC95%, 1,68-3,67 y OR = 2,70; IC95%, 1,89-3,86) y la obesidad general en varones (OR = 2,06; IC95%, 1,56-2,73 y OR = 1,68; IC95%, 1,21-2,33). La prediabetes mostró la asociación más alta con obesidad abdominal según el criterio del ICE en mujeres (OR = 2,48; IC95%, 1,85-3,33) y con obesidad abdominal según el criterio del PC en varones (OR = 2,33; IC95%, 1,75-3,08). Conclusiones: Los indicadores de obesidad abdominal mostraron la mayor asociación con la presencia de prediabetes. La relación de los indicadores antropométricos con hipertensión y con dislipemia mostró resultados heterogéneos (AU)

Introduction and objectives: Some anthropometric measurements show a greater capacity than others to identify the presence of cardiovascular risk factors. This study estimated the magnitude of the association of different anthropometric indicators of obesity with hypertension, dyslipidemia, and prediabetes (altered fasting plasma glucose and/or glycosylated hemoglobin). Methods: Cross-sectional analysis of information collected from 2022 participants in the PREDAPS study (baseline phase). General obesity was defined as body mass index ≥ 30 kg/m2 and abdominal obesity was defined with 2 criteria: a) waist circumference (WC) ≥ 102 cm in men/WC ≥ 88 cm in women, and b) waist-height ratio (WHtR) ≥ 0.55. The magnitude of the association was estimated by logistic regression. Results: Hypertension showed the strongest association with general obesity in women (OR, 3.01; 95%CI, 2.24-4.04) and with abdominal obesity based on the WHtR criterion in men (OR, 3.65; 95%CI, 2.66-5.01). Hypertriglyceridemia and low levels of high-density lipoprotein cholesterol showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.49; 95%CI, 1.68-3.67 and OR, 2.70; 95%CI, 1.89-3.86) and with general obesity in men (OR, 2.06; 95%CI, 1.56-2.73 and OR, 1.68; 95%CI, 1.21-2.33). Prediabetes showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.48; 95%CI, 1.85-3.33) and with abdominal obesity based on the WC criterion in men (OR, 2.33; 95%CI, 1.75-3.08). Conclusions: Abdominal obesity indicators showed the strongest association with the presence of prediabetes. The association of anthropometric indicators with hypertension and dyslipidemia showed heterogeneous results (AU)

Barriers and opportunities in recalls management at the health care provider level / Barreras y oportunidades en la gestión de retiro de productos farmacéuticos en las instituciones proveedoras de salud / Barreiras e oportunidades na gestão de lembranças no nível do provedor de cuidado da saúde

Abstract One of the operational risks to which a Health Care Provider (HCP) is exposed is the receiving and use of products such as pharmaceuticals and medical devices that could become subject to a health alert. This patient safety issue has to be managed in order to prevent and mitigate adverse events at the last echelon of the supply chain. This article aims to expose a characterization of the alerts response process at the HCP level based on a review of the literature. Additionally, local regulations, strengths and weaknesses were identified. Finally, the study allowed for the identification of the principal opportunities and barriers that should be addressed in order to integrate the recall management process within and outside the HCP. Among these opportunities is traceability along the supply chain, and among the barriers is the high investment in the technology required to facilitate supply chain integration.

Resumen Uno de los riesgos operacionales a los que está expuesto un Proveedor de Atención Médica (HCP por sus siglas en inglés) es la recepción y uso de productos farmacéuticos y dispositivos médicos que podrían estar sujetos a una alerta de salud. Este problema de seguridad del paciente tiene que ser manejado con el fin de prevenir y mitigar los eventos adversos en el último escalón de la cadena de suministro. Este artículo pretende exponer una caracterización del proceso de respuesta de alertas desde el HCP basado en una revisión de la literatura. Además, se identificaron la normativa local, fortalezas y debilidades. Finalmente, el estudio permitió identificar las principales oportunidades y barreras que se deben abordar para integrar el proceso de gestión de retiro de productos dentro y fuera del HCP. Entre estas oportunidades está la trazabilidad a lo largo de la cadena de suministro, y entre las barreras está la alta inversión en la tecnología requerida para facilitar la integración de la cadena de suministro.

Resumo Um dos riscos operacionais aos que está exposto um Provedor de Atenção Médica (HCP) é a recepção e o uso de produtos como produtos farmacêuticos e dispositivos médicos que poderiam estar sujeitos a uma alerta de saúde. Este problema de segurança do paciente tem que ser manejado com o fim de prevenir e mitigar os eventos adversos no último degrau da cadeia de fornecimento. Este artigo pretende expor uma caracterização do processo de resposta de alertas a nível do HCP baseado numa revisão da literatura. Ademais, identificaram-se as regulações locais, fortalezas e debilidades. Finalmente, o estudo permitiu identificar as principais oportunidades e barreiras que devem-se abordar para integrar o processo de gestão de produtos dentro e fora do HCP. Entre estas oportunidades está a traçabilidade ao longo da cadeia de fornecimento, e entre as barreiras está o alto investimento na tecnologia requerida para facilitar a integração da cadeia de fornecimento.

Role of ultrasound in the labor ward.

Intrapartum ultrasound is commonly used to evaluate fetal vitality, presentation and status as well as placental location. Health professionals are increasingly using intrapartum ultrasound for advanced applications that have not yet been shown to be effective by controlled research studies, using advanced ultrasound technologies such as bi-dimensional ultrasound, color ultrasound, pulsed Doppler ultrasound and three-dimensional ultrasound. This article reviews the current applications of intrapartum ultrasound and considers which advanced technologies can add to the standard of care in the delivery ward.

Pacientes con infección del sistema nervioso central / Patients with central nervous system infection

Introducción: las infecciones del sistema nervioso central constituyen un importante problema de salud. La aparición brusca de la sintomatología, el desenlace fatal en pocas horas o la permanencia de secuelas hace que estas enfermedades tengan un gran impacto social. Objetivo: caracterizar las infecciones del sistema nervioso central, su comportamiento y relación con la mortalidad. Métodos: estudio observacional descriptivo y transversal en una muestra de 100 pacientes atendidos en el Hospital Militar Central Dr. Carlos J. Finlay, entre enero de 2009 y diciembre de 2013. La información se recogió a través de las historias clínicas con diagnóstico al egreso de cualquier tipo de sepsis del sistema nervioso central y de los informes de necropsia. Se realizaron análisis estadísticos univariados y bivariados, y se hallaron las distribuciones de frecuencia absoluta y relativa. Resultados: la edad media fue de 44,4 años. Predominó el sexo masculino en el grupo de ≤ 39 años (54,7 por ciento); en el femenino prevaleció el grupo de 40-59 años (34,9 por ciento). En los fallecidos predominó el grupo de 60-79 años (47,8 por ciento) y en los egresados vivos los de ≤ 39 años (53,2 por ciento). Los factores de riesgo se presentaron en el 64 por ciento de los pacientes; las meningoencefalitis bacterianas y virales constituyeron el 77 por ciento. El estudio citoquímico se indicó al 98 por ciento de los pacientes y la positividad fue de 88,8 por ciento. El agente causal más frecuente resultó el Streptococcus pneumoniae (33,3 por ciento). El 33,7 por ciento de los pacientes presentó complicaciones. La mortalidad fue del 23 por ciento.Conclusiones: la mortalidad por infección el sistema nervioso central fue elevada y resultó escaso el aislamiento de microorganismos. El hecho de que más de un tercio de los pacientes se hayan complicado, justifica la alta mortalidad presente en el estudio. (AU)

Introduction: central nervous system infections are a major health problem. The sudden onset of symptoms, the fatal outcome within a few hours or the remaining sequels makes these diseases have a major social impact. Objective: characterize the central nervous system infections, their behavior and relationship to mortality at Dr. Carlos J. Finlay Hospital from January 2009 to December 2013. Methods: an observational descriptive transversal study was carried out with 100 patients at Dr. Carlos J. Finlay Hospital from January 2009 to December 2013. Information was collected through medical records with diagnosis any type of sepsis central nervous system at discharge and from autopsy reports. Univariate and Bivariate statistical analyzes were conducted, and the distributions of absolute and relative frequencies were found. Results: the average age was 44.4 years, there was male predominance in the group ≤ 39 years (54.7 percent), but 40-59 years (34.9 percent) prevailed in the female group. the deceased group, 60-79 years (47.8 percent) majored and those living at discharge, the predominance was ≤ 39 years (53.2 percent). Risk factors occurred in the 64 percent of patients. Bacterial and viral meningencephalitis accounted for the 77 percent. Citochemical testing was performed in 98 percent of the patients and it proved positive in the 88, 8 percent. The most frequent ethiological agent was Streptococcus pneumoniae (33, 3 percent). Complications were present in 33, 7 percent of the patients. The rate mortality reached 23 percent. Conclusions: mortality due to CNS infection was high and the isolation of microorganisms was low. The fact that more than a third of patients have complicated substantiates the high mortality in the study(AU)

Pacientes con infección del sistema nervioso central / Patients with central nervous system infection

INTRODUCCIÓN: las infecciones del sistema nervioso central constituyen un importante problema de salud. La aparición brusca de la sintomatología, el desenlace fatal en pocas horas o la permanencia de secuelas hace que estas enfermedades tengan un gran impacto social. OBJETIVO: caracterizar las infecciones del sistema nervioso central, su comportamiento y relación con la mortalidad. MÉTODOS: estudio observacional descriptivo y transversal en una muestra de 100 pacientes atendidos en el Hospital Militar Central "Dr. Carlos J. Finlay", entre enero de 2009 y diciembre de 2013. La información se recogió a través de las historias clínicas con diagnóstico al egreso de cualquier tipo de sepsis del sistema nervioso central y de los informes de necropsia. Se realizaron análisis estadísticos univariados y bivariados, y se hallaron las distribuciones de frecuencia absoluta y relativa. RESULTADOS: la edad media fue de 44,4 años. Predominó el sexo masculino en el grupo de ≤ 39 años (54,7 %); en el femenino prevaleció el grupo de 40-59 años (34,9 %). En los fallecidos predominó el grupo de 60-79 años (47,8 %) y en los egresados vivos los de ≤ 39 años (53,2 %). Los factores de riesgo se presentaron en el 64 % de los pacientes; las meningoencefalitis bacterianas y virales constituyeron el 77 %. El estudio citoquímico se indicó al 98 % de los pacientes y la positividad fue de 88,8 %. El agente causal más frecuente resultó el Streptococcus pneumoniae (33,3 %). El 33,7 % de los pacientes presentó complicaciones. La mortalidad fue del 23 %. CONCLUSIONES: la mortalidad por infección el sistema nervioso central fue elevada y resultó escaso el aislamiento de microorganismos. El hecho de que más de un tercio de los pacientes se hayan complicado, justifica la alta mortalidad presente en el estudio.

INTRODUCTION: central nervous system infections are a major health problem. The sudden onset of symptoms, the fatal outcome within a few hours or the remaining sequels makes these diseases have a major social impact. OBJECTIVE: characterize the central nervous system infections, their behavior and relationship to mortality at "Dr. Carlos J. Finlay" Hospital from January 2009 to December 2013. METHODS: an observational descriptive transversal study was carried out with 100 patients at "Dr. Carlos J. Finlay" Hospital from January 2009 to December 2013. Information was collected through medical records with diagnosis any type of sepsis central nervous system at discharge and from autopsy reports. Univariate and Bivariate statistical analyzes were conducted, and the distributions of absolute and relative frequencies were found. RESULTS: the average age was 44.4 years, there was male predominance in the group ≤ 39 years (54.7 %), but 40-59 years (34.9 %) prevailed in the female group. the deceased group, 60-79 years (47.8 %) majored and those living at discharge, the predominance was ≤ 39 years (53.2 %).Risk factors occurred in the 64 % of patients. Bacterial and viral meningencephalitis accounted for the 77 %. Citochemical testing was performed in 98 % of the patients and it proved positive in the 88, 8 %. The most frequent ethiological agent was Streptococcus pneumoniae(33, 3 %). Complications were present in 33, 7 % of the patients. The rate mortality reached 23 %. CONCLUSIONS: mortality due to CNS infection was high and the isolation of microorganisms was low. The fact that more than a third of patients have complicated substantiates the high mortality in the study.

Pacientes en ventilación mecánica con traqueostomía / Patients with mechanical ventilation and tracheostomy

Introducción: la traqueostomía es una técnica que habitualmente se indica en enfermos críticos ingresados en las unidades de cuidados intensivos que requieren ventilación mecánica por tiempo prolongado. Objetivo: caracterizar algunos aspectos clínico-epidemiológicos de pacientes en ventilación mecánica que necesitaron traqueostomía. Métodos: estudio observacional, descriptivo, longitudinal y retrospectivo de pacientes en ventilación mecánica que necesitaron traqueostomía, en la Unidad de Cuidados Intensivos del Hospital Militar Central Dr. Carlos J Finlay entre enero de 2011 y diciembre de 2012. La muestra fue de 96 pacientes. Se revisó la base de datos de pacientes ingresados en el servicio y las historias clínicas del archivo del hospital. Resultados: la edad media fue de 55,7 ± 16,9 años. Hubo un predominio del sexo masculino (59,4 por ciento) y el grupo etario de 50-64 años (40,6 por ciento). La hipertensión arterial constituyó el antecedente patológico más frecuente (18,8 por ciento). Más de la mitad de los pacientes egresaron fallecidos (62,5 por ciento); la edad media de este grupo fue superior a la de los egresados vivos (60,6 vs. 47,6 años). El motivo principal de ingreso fue no traumático (63,5 por ciento). La media del valor del APACHE II fue de 17,4; en los fallecidos fue mayor que en los vivos (19,8 vs. 13,4). La mayoría de los pacientes estuvieron ventilados por 7 o menos días (51,0 por ciento) y la estadía fue de 8 o más días (86,5 por ciento). Conclusiones: la traqueostomía no influyó sobre el tiempo de ventilación mecánica ni en la mortalidad global(AU)

Introduction: tracheostomy is a technique usually indicated to manage critically ill patients who are hospitalized in Intensive care units and need mechanical ventilation for a long period of time. Objective: to characterize some clinical and epidemiological aspects of patients with tracheostomy and mechanical ventilation. Methods: a retrospective, longitudinal, observational and descriptive study of patients who required tracheostomy in addition to mechanical ventilation was performed at the Intensive Care Unit of Dr. Carlos J. Finlay Hospital from January 2011 through December 2012. The final sample was 96 patients. The database containing information of hospitalized patients in the intensive care unit as well as their medical histories were checked up. Results: average age of ventilated patients was 55.7 ± 16.9 years old. Males (59.4 percent) and the 50-64 years old group (40.6 percent) prevailed. Hypertension proved to be the most frequent pathologic antecedent (18.8 percent). More than half of the patients died at hospital (62.5 percent). The average age of this group was higher than that of the discharged alive patients (60.6 vs. 47.6 years old). The non traumatic event was most common cause for hospitalization (63.5 percent). The APACHE II value mean was 17, 4 and it was higher in the deceased than in the survivors (19.8 vs. 13.4). Most patients were ventilated for up to seven days (51.0 percent) and stayed in the hospital for eight or more days (86.5 percent). Conclusions: tracheostomy did not influence either the length of mechanical ventilation or the global mortality rate(AU)

Mortalidad y readmisión en la unidad de cuidados intensivos / Mortality and readmission to the intensive care unit

Introducción: la readmisión en las unidades de cuidados intensivos durante la hospitalización se asocia con una significativa mortalidad y un incremento de la estadía y los costos, por lo que existe un creciente interés en identificar los elementos predictores de la readmisión. Objetivo: caracterizar las readmisiones y la mortalidad asociadas a factores de riesgo en la Unidad de Cuidados Intensivos Polivalente del Hospital Militar Central Dr. Carlos J. Finlay. Métodos: estudio descriptivo, longitudinal y retrospectivo, entre el 1ro. de enero al 31 de diciembre de 2008. La muestra estuvo constituida por todos los pacientes readmitidos en el periodo señalado. Se aplicó el estadígrafo t de Student para las variables edad, estadía hospitalaria al ingreso, readmisión o egreso. Resultados: predominaron los pacientes del sexo masculino mayores de 40 años. Hubo un 37,8 por ciento de mortalidad global, principalmente de fallecidos en entidades clínicas. Los pacientes con mayor período entre ingreso-readmisión, presentaron una elevada mortalidad. La sepsis respiratoria fue la causa más frecuente de readmisiones. La tasa de readmisión fue de 3,31 por ciento. Conclusión: la escala APACHE II constituyó un adecuado predictor de riesgo de morir en la Unidad de Cuidados Intensivos. Las variables con impacto sobre la mortalidad fueron edad, sexo masculino, ventilación mecánica y la presencia de enfermedades clínicas. La tasa de readmisiones se comportó por debajo de la media internacional, lo que evidencia un buen trabajo de la Unidad de Cuidados Intensivos en este indicador de calidad(AU)

Introduction: reentry to the ICU during hospitalization is associated with significant mortality and an increase of stay and costs, so that there is a growing interest in identifying predictors of readmission elements. Objective: to characterize reentries and mortality associated to risk factors in the Intensive Care Unit at Dr. Carlos J. Finlay Central Military Hospital. Methods: a descriptive, longitudinal and retrospective study was conducted from January 1st December to 31st 2008. The sample consisted of all patients readmitted within the given period. The Student t statistic for the variables such as age, hospital admission, hospital stay, hospital readmission or discharge was applied.Results: male patients over 40 years were in majority. There was 37.8 percent overall mortality, mainly of deaths in clinical entities. Patients with higher admission- readmission period showed a high mortality. Respiratory sepsis was the most frequent cause of readmissions. The readmission rate was 3.31 percent. Conclusion: APACHE II scale is an adequate predictor of risk of deceases in ICU. Variables with impact on mortality were age, male gender, mechanical ventilation, and the presence of clinical disease. The rate of readmissions was below the international average, which demonstrates good performance of ICU in this quality indicator(AU)