Association of adverse childhood experiences with irritable bowel syndrome in Mexican adults: A cross-sectional study.

BACKGROUND: Adverse childhood experiences (ACEs) are linked to the development of gastrointestinal disorders during adulthood, but there is limited research on the prevalence of ACEs in Latin American populations. This study aimed to assess the prevalence and impact of ACEs on Mexican adults with irritable bowel syndrome (IBS). METHODS: In this cross-sectional study, we recruited 290 Mexican adults (aged 18-65), including 90 individuals with IBS and 200 healthy controls. All participants completed four self-reported questionnaires: The Adverse Childhood Experiences Questionnaire (ACEs), Visceral Sensitivity Index, Irritable Bowel Syndrome Symptom Severity Scale, and Hospital Anxiety and Depression Scale. Statistical analyses included mean differences using either the Student's t-test or the Wilcoxon test, correlations assessed with Spearman's correlation coefficient, and logistic regression models. Statistical significance was defined as a p-value less than 0.05. KEY RESULTS: Among IBS subjects, the prevalence of ACEs was 80%, significantly higher than the 59% prevalence observed in controls (p < 0.0001). Individuals with ACEs exhibited elevated levels of anxiety and depression. Seventy-five percent of IBS subjects with severe symptoms reported four or more ACEs. The presence of four or more ACEs was found to be associated with an increased risk of IBS. CONCLUSIONS AND INFERENCES: ACEs are notably prevalent among Mexican individuals with IBS and are positively correlated with the severity of gastrointestinal pain. These findings underscore the critical significance of evaluating and addressing ACEs in the comprehensive management of IBS within Latin American populations.

Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study.

There is no published evidence on the possible differences in multimorbidity, inappropriate prescribing, and adverse outcomes of care, simultaneously, from a sex perspective in older patients. We aimed to identify those possible differences in patients hospitalized because of a chronic disease exacerbation. A multicenter, prospective cohort study of 740 older hospitalized patients (≥65 years) was designed, registering sociodemographic variables, frailty, Barthel index, chronic conditions (CCs), geriatric syndromes (GSs), polypharmacy, potentially inappropriate prescribing (PIP) according to STOPP/START criteria, and adverse drug reactions (ADRs). Outcomes were length of stay (LOS), discharge to nursing home, in-hospital mortality, cause of mortality, and existence of any ADR and its worst consequence. Bivariate analyses between sex and all variables were performed, and a network graph was created for each sex using CC and GS. A total of 740 patients were included (53.2% females, 53.5% ≥85 years old). Women presented higher prevalence of frailty, and more were living in a nursing home or alone, and had a higher percentage of PIP related to anxiolytics or pain management drugs. Moreover, they presented significant pairwise associations between CC, such as asthma, vertigo, thyroid diseases, osteoarticular diseases, and sleep disorders, and with GS, such as chronic pain, constipation, and anxiety/depression. No significant differences in immediate adverse outcomes of care were observed between men and women in the exacerbation episode.

Green Light Photoelectrocatalysis with Sulfur-Doped Carbon Nitride: Using Triazole-Purpald for Enhanced Benzylamine Oxidation and Oxygen Evolution Reactions.

Materials dictate carbon neutral industrial chemical processes. Visible-light photoelectrocatalysts from abundant resources will play a key role in exploiting solar irradiation. Anionic doping via pre-organization of precursors and further co-polymerization creates tuneable semiconductors. Triazole derivative-purpald, an unexplored precursor with sulfur (S) container, combined in different initial ratios with melamine during one solid-state polycondensation with two thermal steps yields hybrid S-doped carbon nitrides (C3 N4 ). The series of S-doped/C3 N4 -based materials show enhanced optical, electronic, structural, textural, and morphological properties and exhibit higher performance in organic benzylamine photooxidation, oxygen evolution, and similar energy storage (capacitor brief investigation). 50M-50P exhibits the highest photooxidation conversion (84 ± 3%) of benzylamine to imine at 535 nm - green light for 48 h, due to a discrete shoulder (≈700) nm, high sulfur content, preservation of crystal size, new intraband energy states, structural defects by layer distortion, and 10-16 nm pores with arbitrary depth. This work innovates by studying the concomitant relationships between: 1) the precursor decomposition while C3 N4 is formed, 2) the insertion of S impurities, 3) the S-doped C3 N4 property-activity relationships, and 4) combinatorial surface, bulk, structural, optical, and electronic characterization analysis. This work contributes to the development of disordered long-visible-light photocatalysts for solar energy conversion and storage.

Growth Parameters and Diffusion Barriers for Functional High-Voltage Thin-Film Batteries Based on Spinel LiNi0.5Mn1.5O4 Cathodes.

Cobalt-free spinel LiNi0.5Mn1.5O4 is one of the most promising and environmentally friendly cathodes, based on its high specific theoretical capacity (147 mAh·g-1) and high electrochemical potential (4.7 V vs Li+/Li), as well as good electronic and Li-ion conductivities. In this work, we present the fabrication of LiNi0.5Mn1.5O4 thin-film cathodes deposited by the industrially scalable AC magnetron sputtering technique on functional and cost-effective stainless steel current collectors. This is the first step toward battery downscaling, envisioning the fabrication of compact microbatteries for low-power energy supply. The thin-film strategy is crucial also for solid electrolyte fabrication that will allow the integration of high-energy-density batteries while overcoming most of the current battery challenges. In this work, the effect of film thickness on the material's electrochemical performance is discussed, correlating the observed structural and morphological evolution with the final electrochemical response. Moreover, the effect of iron diffusion from the current collector substrate into the cathode film is analyzed. The addition of a stable CrN barrier layer in between the substrate and the film is proposed to prevent Fe diffusion, with a direct positive influence on the electrochemical behavior. All in all, the obtained results will facilitate the practical implementation of LiNi0.5Mn1.5O4 thin films as high-voltage cathodes in functional cost-effective microbatteries.

Role of the voltage window on the capacity retention of P2-Na2/3[Fe1/2Mn1/2]O2 cathode material for rechargeable sodium-ion batteries.

P2-Na2/3[Fe1/2Mn1/2]O2 layered oxide is a promising high energy density cathode material for sodium-ion batteries. However, one of its drawbacks is the poor long-term stability in the operating voltage window of 1.5-4.25 V vs Na+/Na that prevents its commercialization. In this work, additional light is shed on the origin of capacity fading, which has been analyzed using a combination of experimental techniques and theoretical methods. Electrochemical impedance spectroscopy has been performed on P2-Na2/3[Fe1/2Mn1/2]O2 half-cells operating in two different working voltage windows, one allowing and one preventing the high voltage phase transition occurring in P2-Na2/3[Fe1/2Mn1/2]O2 above 4.0 V vs Na+/Na; so as to unveil the transport properties at different states of charge and correlate them with the existing phases in P2-Na2/3[Fe1/2Mn1/2]O2. Supporting X-ray photoelectron spectroscopy experiments to elucidate the surface properties along with theoretical calculations have concluded that the formed electrode-electrolyte interphase is very thin and stable, mainly composed by inorganic species, and reveal that the structural phase transition at high voltage from P2- to "Z"/OP4-oxygen stacking is associated with a drastic increased in the bulk electronic resistance of P2-Na2/3[Fe1/2Mn1/2]O2 electrodes which is one of the causes of the observed capacity fading.

Monolithic All-Solid-State High-Voltage Li-Metal Thin-Film Rechargeable Battery.

The substitution of an organic liquid electrolyte with lithium-conducting solid materials is a promising approach to overcome the limitations associated with conventional lithium-ion batteries. These constraints include a reduced electrochemical stability window, high toxicity, flammability, and the formation of lithium dendrites. In this way, all-solid-state batteries present themselves as ideal candidates for improving energy density, environmental friendliness, and safety. In particular, all-solid-state configurations allow the introduction of compact, lightweight, high-energy-density batteries, suitable for low-power applications, known as thin-film batteries. Moreover, solid electrolytes typically offer wide electrochemical stability windows, enabling the integration of high-voltage cathodes and permitting the fabrication of higher-energy-density batteries. A high-voltage, all-solid-state lithium-ion thin-film battery composed of LiNi0.5Mn1.5O4 cathode, a LiPON solid electrolyte, and a lithium metal anode has been deposited layer by layer on low-cost stainless-steel current collector substrates. The structural and electrochemical properties of each electroactive component of the battery had been analyzed separately prior to the full cell implementation. In addition to a study of the internal solid-solid interface, comparing them was done with two similar cells assembled using conventional lithium foil, one with thin-film solid electrolyte and another one with thin-film solid electrolyte plus a droplet of LP30 liquid electrolyte. The thin-film all-solid state cell developed in this work delivered 80.5 mAh g-1 in the first cycle at C/20 and after a C-rate test of 25 cycles at C/10, C/5, C/2, and 1C and stabilized its capacity at around 70 mAh g-1 for another 12 cycles prior to the start of its degradation. This cell reached gravimetric and volumetric energy densities of 333 Wh kg-1 and 1,212 Wh l-1, respectively. Overall, this cell showed a better performance than its counterparts assembled with Li foil, highlighting the importance of the battery interface control.

Revealing In Situ Li Metal Anode Surface Evolution upon Exposure to CO2 Using Ambient Pressure X-Ray Photoelectron Spectroscopy.

Because they deliver outstanding energy density, next-generation lithium metal batteries (LMBs) are essential to the advancement of both electric mobility and portable electronic devices. However, the high reactivity of metallic lithium surfaces leads to the low electrochemical performance of many secondary batteries. Besides, Li deposition is not uniform, which has been attributed to the low ionic conductivity of the anode surface. In particular, lithium exposure to CO2 gas is considered detrimental due to the formation of carbonate on the solid electrolyte interphase (SEI). In this work, we explored the interaction of Li metal with CO2 gas as a function of time using ambient pressure X-ray photoelectron spectroscopy to clarify the reaction pathway and main intermediates involved in the process during which oxalate formation has been detected. Furthermore, when O2 gas is part of the surrounding environment with CO2 gas, the reaction pathway is bypassed to directly promote carbonate as a single product.

Idarucizumab to revert the anticoagulant effect of dabigatran in traumatic acute subdural haematoma: a case report of first use in Latin America.

BACKGROUND: Direct oral anticoagulants (DOAC) are an attractive alternative over vitamin K antagonists. They have several advantages in primary and secondary prevention of thromboembolisms due to atrial fibrillation, as well as in prevention and treatment of thromboembolic venous disease. They have fast onset action, do not need laboratory controls in patients with normal renal function, and they have practically no interference with the patient's diet or medications. The strongest objection to their use was the lack of reversal agents that could be used in case of life-threatening haemorrhage or the need for emergency surgery. Dabigatran was the first DOAC to have its own specific reversal agent: idarucizumab, a monoclonal antibody. CASE SUMMARY: We report here the case of a patient undergoing treatment with dabigatran that suffered an expansive subdural haematoma secondary to a cranial injury. The condition was life-threatening and required emergency surgery. Anticoagulation was successfully reversed with idarucizumab. DISCUSSION: Emergency surgery in patients in treatment with DOAC is associated with an increased risk of bleeding. With the use of a specific antidote to block the action of the anticoagulant, as in the case of idarucizumab with dabigatran, the risk of complications during and after emergency surgery is reduced. This is the first case report with which the successful use of idarucizumab in Latin America is documented.

Toward Stable Electrode/Electrolyte Interface of P2-Layered Oxide for Rechargeable Na-Ion Batteries.

The electrochemical properties of P2-Na2/3Mn0.8Fe0.1Ti0.1O2 layered oxide, which is a promising cathode material for rechargeable Na-ion batteries (NIBs), are evaluated with an optimized in-house ionic liquid (IL)-based electrolyte, and its performance is compared with that using carbonate-based electrolyte. The IL-based system reveals better electrochemical performance at room temperature than the carbonate electrolyte-based one at 0.1C and 1C, especially in terms of cycling stability, with a 97% capacity retention after 100 deep cycles (0.1C). The electrode/electrolyte interface is thoroughly studied in both systems by means of X-ray photoelectron spectroscopy and scanning electron microscopy so as proof that the formed interface is crucial to optimizing the electrochemical performance of NIBs. The carbonate-based system shows a thin, inhomogeneous, and unstable interface layer, while the IL-based one exhibits an even thinner but homogeneous and more stable interface, which may result in safer and longer-lasting NIBs.

Captación tiroidea de yodo radioactivo 131 en 24 horas en adultos jóvenes eutiroideos residentes de gran altitud / Thyroid uptake of radioactive iodine 131 in 24 hours in eutiroid young adults residents at high altitude

INTRODUCCIÓN: el tiroides exhibe una gran avidez por el yodo radioactivo (I131) que al ser fijado por ésta glándula puede determinarse, desde afuera, aprovechando el hecho de que las radiaciones gamma atraviesan los tejidos blandos del cuello y pueden registrarse (Gammagrafía) a distancias apreciables. Desde 1962 Bolivia cuenta con esta tecnología, sin embargo, no cuenta con trabajos similares desde la declaración de país libre de enfermedades secundarias a la deficiencia de Yodo en 1997. El objetivo fue determinar valores de la captación tiroidea de I131 a las 24 horas en adultos jóvenes eutiroideos, residentes de gran altitud. MÉTODO: se realizó un estudio descriptivo transversal, en 76 sujetos obtenidos por intención y seleccionados mediante una entrevista clínica, examen físico dirigido y un consentimiento informado. El procedimiento fue ejecutado por personal calificado en el INAMEN siguiendo las recomendaciones de la OIEA. RESULTADOS: el valor de la captación tiroidea de I131 en 24 horas fue de 18,23 + 5,79% (rango 7,70 ­ 39,70). DISCUSIÓN: los expertos recomiendan establecer valores de referencia actualizados en cada región. Se han descrito variaciones de los valores normales influenciados por el sexo y edad; esta última, aparentemente por una hipofunción tiroidea inversamente proporcional con la edad. CONCLUSIÓN: el valor referencial encontrado en nuestro estudio es concordante con los establecidos en el extranjero, sin embargo, con una tendencia incrementada. Podría deberse a la secuencia cronológica de los estudios comparados en países que ya habían establecido políticas de yodación más tempranamente.

INTRODUCTION: the thyroid exhibits a great avidity for radioactive iodine (I131) which, when fixed by this gland, can be determined from the outside, taking advantage of the fact that gamma radiation passes through the soft tissues of the neck and can be registered (scintigraphy) at appreciable distances. Since 1962, Bolivia has had this technology, however, it does not have similar studies since the declaration of a country free of diseases secondary to iodine deficiency in 1997. The objective was to determine values of the thyroid uptake of I131 at 24 hours in euthyroid young adults, high altitude residents. METHOD: a descriptive cross-sectional study was carried out in 76 subjects obtained by intention and selected by means of a clinical interview, directed physical examination and informed consent. The procedure was carried out by qualified personnel at INAMEN, following IAEA recommendations. RESULTS: the value of the thyroid uptake of I131 in 24 hours was 18.23 + 5.79% (range 7.70 - 39.70). DISCUSSION: experts recommend establishing up-to-date reference values in each region. Variations in normal values influenced by sex and age have been described; the latter, apparently due to a thyroid hypofunction inversely proportional to age. CONCLUSION: the reference value found in our study is consistent with those established abroad, however, with an increased trend. It could be due to the chronological sequence of comparative studies in countries that had already established iodination policies earlier.

Geriatric assessment and prognostic factors of mortality in very elderly patients with community-acquired pneumonia.

INTRODUCTION: To assess the relationship between the parameters obtained in the geriatric assessment and mortality in elderly people with community-acquired pneumonia in an acute care geriatric unit. METHODS: Four hundred fifty-six patients (≥75years). VARIABLES: age, sex, referral source, background, consciousness level, heart rate, breathing rate, blood pressure, laboratory data, pleural effusion, multilobar infiltrates, functional status (activities of daily living) prior to admission [Lawton index (LI), Barthel index (BIp)] prior to and at admission (BIa), cognitive status [Pfeiffer test (PT)], comorbidity [Charlson index (ChI)] and nutrition (total protein, albumin). RESULTS: A hundred ten patients died (24.2%) during hospitalization. These patients were older (86.6±6.4 vs 85.1±6.4, P<.04), had more comorbidity (ChI 2.35±1.61 vs 2.08±1.38; P<.083), worse functional impairment [(LI: 0.49±1.15 vs 1.45±2.32, P<.001) (BIp: 34.6±32.9 vs 54.0±34.1, P<.001) (BIa: 5.79±12.5 vs 20.5±22.9, P<.001)], a higher percentage of functional loss at admission (85.9±23.2 vs 66.4±28.6; P<.0001), worse cognitive impairment (PT: 7.20±3.73 vs 5.10±3.69, P<.001) and malnutrition (albumin 2.67±0.54 vs 2.99±0.49, P<.001). Mortality was higher with impaired consciousness [49.2% (P<.01)], tachypnea [33.3% (P<.01)], tachycardia [44.4% (P<.002), high urea levels [31.8 (P<.001)], anemia [44.7% (P<.02)], pleural effusion [42.9% (P<.002)], and multilobar infiltrates [43.2% (P<.001)]. In the multivariate analysis, variables associated with mortality were: age ≥90years [OR: 3.11 (95%CI: 1.31 to 7.36)], impaired consciousness [3.19 (1.66 to 6.15)], hematocrit <30% [2.87 (1.19 to 6.94)], pleural effusion [3.77 (1.69 to 8.39)] and multilobar infiltrates [2.76 (1.48 to 5.16)]. Female sex and a preserved functional status prior (LI≥5) and during admission (BIa≥40) were protective of mortality [0.40 (0.22 to 0.70), 0.09 (0.01 to 0.81) and 0.11 (0.02 to 0.51)]. CONCLUSIONS: Geriatric assessment parameters and routine clinical variables were associated with mortality.

[Geriatric assessment and factors associated with mortality in elderly patients with heart failure admitted to an acute geriatric unit]. / Valoración geriátrica y factores asociados a mortalidad en ancianos con insuficiencia cardíaca ingresados en una unidad de geriatría de agudos.

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is very prevalent in older adults, and is associated with a high mortality. The prediction of the outcome of HF and the identification of patients in advanced stages is difficult. The present work aims at identifying variables of the geriatric assessment and other clinical variables associated with an increased risk of death at one year in older adults with HF. MATERIAL AND METHODS: Prospective study of 101 patients (mean age, 85.9 ± 6.3 years, 81% women) admitted during 2006 to an Acute Geriatric Unit, with principal diagnosis of HF. We recorded: demographic data, predisposing heart disease, main trigger of exacerbation, comorbidity, number of prescriptions at discharge and specific treatment of HF, average length-of-stay, readmissions, and mortality at one year after discharge. Geriatric assessment included: disability in basic (Barthel index) and instrumental (Lawton index) activities of daily living, cognitive function (Pfeiffer test), comorbidity (Charlson index), and geriatric syndromes. RESULTS: In a multivariable logistic regression model, previous disability (lower Barthel index) (OR [95%CI]=1.03 [1.01-1.06]; P=.040) and higher number of re-admissions (OR [95%CI]=3.53 [1.19-10.44]; P=.023) were associated with 1-year mortality. Female sex had a protective effect (OR [95%CI]=0.15 [0.04-0.59]; P=.007). CONCLUSIONS: Disability in the basic activities of daily living and re-admissions were associated with increased 1-year mortality in older adults, whereas female sex was protective. If confirmed in further studies, these data could reinforce the need for a systematic comprehensive geriatric assessment in older adults with HF.

Perfil bociógeno en estudiantes de Camata Marka, mediante palpación semiológica y respaldo ultrasonográfico. Un estudio de corte / Transversal. Gestión 2014 goitrogenic profile of students from Camata Marka, through semiological palpation and backup ultrasound. A study of cross section. Management 2014

INTRODUCCIÓN: Los Desórdenes por Deficiencia de Yodo (DDI) tienen devastadoras repercusiones en mujeres embarazadas y niños, ocasionando secuelas como el cretinismo y retraso mental, vinculados con el desarrollo económico y social de los pueblos. Un indicador del grado de deficiencia de yodo de una población para el diagnóstico descriptivo de los DDI, son las pesquisas realizadas en niños, adolescentes y mujeres embarazadas. Estudios realizados por Peterson y col, demostraron que el Método Palpatorio de Pérez (MPP), adaptado por la OMS en 1960, continua siendo el método de elección para la clasificación de bocio en países en vías de desarrollo. Se pretende determinar el Perfil Bociógeno en estudiantes de Camata mediante palpación semiológica y Ultrasonografía, en un corte transversal. MÉTODO: Se realizó la pesquisa a 201 estudiantes niños y adolescentes, entre las edades de 5 a 17 años, mediante una Historia Clínica dirigida que permitió obtener datos generales y antropométricos, un examen físico teniendo como referencia el MPP y la Ultrasonografía. RESULTADOS: Los 2 casos de bocio encontrados muestran un valor estadístico de 1,4 %. Empero, este hallazgo en una población sensible para este tipo de estudio, revelan un indicador importante para este sector. DISCUSIÓN: El bocio existe en Bolivia desde los tiempos Precolombinos por un fenómeno geográfico montañoso deficiente de yodo que caracteriza a su territorio, entre ellos Camata Marka, es más, ningún estudio similar fue realizado en esa región. Con este estudio se demuestra que a la fecha existen DDI pese a políticas nacionales de lucha contra el Bocio vigentes.

INTRODUCTION: The Iodine Deficiency Disorders (IDD) have devastating effects on pregnant women and children, causing sequelae such as cretinism and mental retardation linked to economic and social development of peoples. An indicator of iodine deficiency in a population for descriptive diagnosis of IDD, are the investigations conducted in children, adolescents and pregnant women. Studies by Peterson et al, showed that the palpatory method Pérez (PMP), adapted by WHO in 1960, remains the method of choice for the classification of goiter in developing countries. It is intended to determine the profile goitrogenic in students Camata by palpation and ultrasonography semiológica, in cross section. METHOD: The research to 201 children and adolescents students was conducted between the ages of 5-17 years through a medical history that yielded demographic and anthropometric data, physical examination with reference MPP and ultrasonography. RESULTS: The 2 cases of goiter found show a statistical value of 1.4%. However, this finding sensitive to this type of study population, reveal an important indicator for this sector. DISCUSSION: Goiter exists in Bolivia since pre-Columbian times by poor mountainous geographical phenomenon of iodine that characterizes its territory, including Camata Marka also no similar study was conducted in that region. This study shows that to date there IDD despite national policies to combat goiter force.

Valoración geriátrica y factores pronósticos de mortalidad en pacientes muy ancianos con neumonía extrahospitalaria / Geriatric Assessment and Prognostic Factors of Mortality in Very Elderly Patients With Community-Acquired Pneumonia

Introducción: Analizar la relación de parámetros Obtenidos en la valoración geriátrica con la mortalidad en ancianos con neumonía extrahospitalaria (NEH) en una unidad de geriatría de agudos (UGA). Método: Un total de 456 pacientes (≥ 75 años). Variables: edad, sexo, procedencia, antecedentes, nivel de conciencia, frecuencia cardíaca y respiratoria, presión arterial, datos de laboratorio, derrame pleural, afectación multilobar, capacidad funcional (independencia para actividades de la vida diaria) previa al ingreso (índice de Lawton [IL], índice de Barthel previo [IBp]) y en el momento del ingreso (IBi), función cognitiva (test de Pfeiffer [TP]), comorbilidad (índice de Charlson [ICh]) y nutrición (proteínas totales, albúmina). Resultados: Los 110 pacientes que fallecieron durante el ingreso (24,2%) tuvieron mayor edad (86,6 ± 6,4 vs 85,1 ± 6,4; p < 0,04), mayor comorbilidad (ICh 2,35 ± 1,61 vs 2,08 ± 1,38; p < 0,083), menor capacidad funcional (IL: 0,49 ± 1,15 vs 1,45 ± 2,32; p < 0,001; IBp: 34,6 ± 32,9 vs 54,0 ± 34,1; p < 0,001; IBi: 5,79 ± 12,5 vs 20,5 ± 22,9; p < 0,001), mayor porcentaje de pérdida funcional al ingreso (85,9 ± 23,2 vs 66,4 ± 28,6; p < 0,0001), mayor deterioro cognitivo (TP: 7,20 ± 3,73 vs 5,10 ± 3,69; p < 0,001) y mayor desnutrición (albúmina 2,67 ± 0,54 vs 2,99 ± 0,49; p < 0,001). Hubo también mayor mortalidad con alteración de conciencia (49,2%; p < 0,01), taquipnea (33,3%; p < 0,01), taquicardia (44,4%; p < 0,002), urea elevada (31,8; p < 0,001), anemia (44,7%; p < 0,02), derrame pleural (42,9%; p < 0,002) y afectación multilobar (43,2%; p < 0,001). En el análisis multivariado resultaron significativos: edad ≥ 90 años (OR: 3,11 [IC 95%: 1,31-7,36]), alteración de conciencia (3,19 [1,66-6,15]), hematocrito < 30% (2,87 [1,19-6,94]), derrame pleural (3,77 [1,69-8,39]) y afectación multilobar (2,76 [1,48-5,16]). El sexo femenino y la capacidad funcional más conservada previa (IL ≥ 5) y en el momento del ingreso (IBi ≥ 40) fueron protectores de mortalidad (0,40 [0,22-0,70]; 0,09 [0,01-0,81] y 0,11 [0,02-0,51]). Conclusiones: Los parámetros de valoración geriátrica y las variables clínicas habituales estuvieron relacionados con la mortalidad

Introduction: To assess the relationship between the parameters obtained in the geriatric assessment and mortality in elderly people with community-acquired pneumonia in an acute care geriatric unit.MethodsFour hundred fifty-six patients (≥ 75 years). Variables: age, sex, referral source, background, consciousness level, heart rate, breathing rate, blood pressure, laboratory data, pleural effusion, multilobar infiltrates, functional status (activities of daily living) prior to admission [Lawton index (LI), Barthel index (BIp)] prior to and at admission (BIa), cognitive status [Pfeiffer test (PT)], comorbidity [Charlson index (ChI)] and nutrition (total protein, albumin). Results: A hundred ten patients died (24.2%) during hospitalization. These patients were older (86.6 ± 6.4 vs 85.1 ± 6.4, P < 0.04), had more comorbidity (ChI 2.35 ± 1.61 vs 2.08 ± 1.38; P < 0.083), worse functional impairment [(LI: 0.49 ± 1.15 vs 1.45 ± 2.32, P < 0.001) (BIp: 34.6 ± 32.9 vs 54.0 ± 34.1, P < 0.001) (BIa: 5.79 ± 12.5 vs 20.5 ± 22.9, P V< 0.001)], a higher percentage of functional loss at admission (85.9±23.2 vs 66.4 ± 28.6; P < 0.0001), worse cognitive impairment (PT: 7.20 ± 3.73 vs 5.10 ± 3.69, P < 0.001) and malnutrition (albumin 2.67 ± 0.54 vs 2.99 ± 0.49, P < 0.001). Mortality was higher with impaired consciousness [49.2% (P < 0.01)], tachypnea [33.3% (P < 0.01)], tachycardia [44.4% (P < 0.002), high urea levels [31.8 (P < 0.001)], anemia [44.7% (P < 0.02)], pleural effusion [42.9% (P < 0.002)], and multilobar infiltrates [43.2% (P < 0.001)]. In the multivariate analysis, variables associated with mortality were: age ≥ 90 years [OR: 3.11 (95% CI: 1.31-7.36)], impaired consciousness [3.19 (1.66-6.15)], hematocrit < 30% [2.87 (1.19-6.94)], pleural effusion [3.77 (1.69-8.39)] and multilobar infiltrates [2.76 (1.48-5.16)]. Female sex and a preserved functional status prior (LI ≥ 5) and during admission (BIa ≥ M40) were protective of mortality [0.40 (0.22-0.70), 0.09 (0.01-0.81) and 0.11 (0.02-0.51)]. Conclusions: Geriatric assessment parameters and routine clinical variables were associated with mortality

Valoración geriátrica y factores asociados a mortalidad en ancianos con insuficiencia cardíaca ingresados en una unidad de geriatría de agudos / Geriatric assessment and factors associated with mortality in elderly patients with heart failure admitted to an acute geriatric unit

Introducción y objetivos. La insuficiencia cardíaca es muy prevalente y con elevada mortalidad, sobre todo en ancianos. Predecir su curso e identificar pacientes en fase avanzada es difícil. El presente trabajo pretende identificar variables incluidas en la valoración geriátrica integral y otras variables clínicas que se asocien a un incremento de riesgo de muerte al año en ancianos ingresados por insuficiencia cardíaca. Material y métodos. Estudio prospectivo de 101 pacientes (edad media, 85,9 ± 6,3 años, 81% mujeres) que ingresaron durante el año 2006 en una unidad de geriatría de agudos con diagnóstico principal de insuficiencia cardíaca. Se registraron: datos demográficos, cardiopatía predisponente, factor precipitante de la descompensación, comorbilidad, número de fármacos al alta y tratamiento específico de la insuficiencia cardíaca, estancia media, reingresos, mortalidad al año del alta. La valoración geriátrica evaluaba: discapacidad en actividades básicas diarias (índice de Barthel) e instrumentales (índice de Lawton), función cognitiva (test de Pfeiffer), comorbilidad (índice de Charlson) y síndromes geriátricos. Resultados. En un modelo multivariante de regresión logística, los factores relacionados con la mortalidad fueron: mayor discapacidad previa (menor índice de Barthel previo) (OR [IC 95% =1,03 [1,01-1,06]; p = 0,040) y mayor número de reingresos (OR [IC 95%] = 3,53 [1,19-10,44]; p = 0,023). El sexo femenino resultó protector (OR [IC 95%] = 0,15 [0,04-0,59]; p = 0,007). Conclusiones. La discapacidad en actividades diarias y los reingresos se asociaban con mayor riesgo de muerte al año, y el sexo femenino resultó protector. Si fueran confirmados en otros estudios, estos datos podrían reforzar la necesidad de realizar una valoración geriátrica integral sistemática en ancianos con esta patología (AU)

Introduction and objectives. Heart failure (HF) is very prevalent in older adults, and is associated with a high mortality. The prediction of the outcome of HF and the identification of patients in advanced stages is difficult. The present work aims at identifying variables of the geriatric assessment and other clinical variables associated with an increased risk of death at one year in older adults with HF. Material and methods. Prospective study of 101 patients (mean age, 85.9 ± 6.3 years, 81% women) admitted during 2006 to an Acute Geriatric Unit, with principal diagnosis of HF. We recorded: demographic data, predisposing heart disease, main trigger of exacerbation, comorbidity, number of prescriptions at discharge and specific treatment of HF, average length-of-stay, readmissions, and mortality at one year after discharge. Geriatric assessment included: disability in basic (Barthel index) and instrumental (Lawton index) activities of daily living, cognitive function (Pfeiffer test), comorbidity (Charlson index), and geriatric syndromes. Results. In a multivariable logistic regression model, previous disability (lower Barthel index) (OR [95%CI] = 1.03 [1.01-1.06]; P = .040) and higher number of re-admissions (OR [95%CI] = 3.53 [1.19-10.44]; P = .023) were associated with 1-year mortality. Female sex had a protective effect (OR [95%CI] = 0.15 [0.04-0.59]; P = .007). Conclusions. Disability in the basic activities of daily living and re-admissions were associated with increased 1-year mortality in older adults, whereas female sex was protective. If confirmed in further studies, these data could reinforce the need for a systematic comprehensive geriatric assessment in older adults with HF (AU)

Evaluación de la tiroides por palpación, su asociación con la ultrasonografía en mujeres en edad fértil, residentes de gran altitud: validación como un test diagnóstico / Evaluation of the thyroid by palpation, its association with ultrasonography in women of childbearing age, residents of high altitude: validation as a diagnostic test

Existen pocos estudios a gran altitud relativos a la validez del método palpario de Perez para identificar bocio en mujeres en edad fértil. Pregunta de investigación: cuales son los valores de sensibilidad, especificidad y los valores predictivos de la palpación de la glándula tiroides para detectar el bocio en mujeres en edad fértil residentes de gran altitud?. Objetivo: determinar los valores del test diagnóstico palpación de la glandula tiroides frente a un gold estándar comola ultrasonografía de la tiroides. Diseño: test diagnóstico. Lugar y pacientes. gran actitud , en la Facultad de Medicina 177 mujeres en edad fértil. Material y métodos: se seleccionaron mujeres con criterios de elegibilidad. Se cálculo el tamaño muestral para las con bocio y las sin bocio, definidas por palpación de tiroides y de acuerdo a criterios OMS de 1960. Se evalúo por palpación y ultrasonografía la glandula y se realizó un cuestionario de tipo clínico

Unidad de estancia corta: una forma de optimizar recursos hospitalarios / No disponible

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