Errores de registro en las mediciones de presión arterial realizadas en dos centros de atención primaria de la salud de la ciudad de Salta, Argentina / Innacuracy in records of blood pressure measurements in two primary health centers of Salta City, Argentine

RESUMEN Introducción: El diagnóstico de hipertensión arterial (HTA) se realiza por la toma de la presión arterial (PA) en el consultorio médico (C) o en enfermería (E). Es frecuente aproximar los valores obtenidos a múltiplos de 10. Esto puede causar imprecisiones en el diagnóstico y el control de la HTA. Objetivo: Determinar cuántos registros de PA terminaban en cero en las mediciones realizadas en E y en C en dos centros de atención primaria de la salud de la ciudad de Salta. Material y métodos: Se efectuó un estudio descriptivo, transversal, de febrero a diciembre de 2018. Se utilizó un tensiómetro digital. A cada paciente se le midió la PA dos veces, primero en E y luego en C. Se utilizaron las pruebas de Chi2 y de Wilcoxon. Resultados: Se estudiaron 311 individuos, 60,77% mujeres. Edad media: 56,15 ± 13,8 años. Los registros terminados en cero tuvieron las siguientes frecuencias: PA sistólica en E: 36%; PA diastólica en E: 40,51%; PA sistólica en C: 11,58%; PA diastólica en C: 7,72% (p <0,0001). La PA sistólica y diastólica terminaron simultáneamente en cero en el 30,87% de los casos cuando se midieron en E y en el 0,64% de los casos cuando se midieron en C (p <0,0001). Conclusiones: La PA sistólica y la PA diastólica terminaron en cero con una frecuencia 3 y 5 veces mayor en E que en C, respectivamente, y la frecuencia de registros de PA sistólica y diastólica coincidentemente terminados en cero fue 48 veces mayor en E que en C. Estos resultados refuerzan la necesidad de una capacitación permanente para mejorar el registro en la medición de la PA.

ABSTRACT Background: The diagnosis of hypertension is established by blood pressure (BP) measurements in doctor (DO) or nursing offices (NO). Frecuently BP measurements are recorded as multiples of ten. This can lead to inaccuracy in diagnosis and control of hypertension. Objetive: To determine the percentage of BP measurements ending in zero in DO and NO, in the records of two health primary centers of Salta city. Methods: Observational study from february to december of 2018. Digital blood pressure monitor was used. Each patient BP was measured twice, first in NO and then in DO. Data were analyzed using the Chi2 and Wilcoxon tests. Results: 311 indivuals were enrolled, 60,77% were female. The average age was 56,15 ± 13,8 years. In NO the systolic BP and diastolic BP ending in zero were 36 and 40,51% respectively, while in DO were 11,58 and 7,72% (p <0,0001). The systolic BP and diastolic BP ending in zero simultaneously in NO was 30,87%, while in DO was 0,64% (p <0,0001). Conclusions: The systolic BP and the diastolic BP records ending in zero were three and five times more frequent in NO than in DO. The systolic BP and diastolic BP ending in zero simultaneously in NO were forty-eight times more frequent than in DO. These results reinforce the need of health personnel permanent training to improve precision for measuring and recording BP in medical centers.

Meningitis linfocítica recurrente por virus herpes simple tipo 2 / Recurrent lymphocytic meningitis by herpes simplex virus type 2

La meningitis linfocítica recurrente o meningitis de Mollaret es una entidad asociada a un gran número de etiologías infecciosas, autoinmunes, toxicológicas y neoplásicas. En la actualidad el virus herpes simple tipo 2 (HSV-2) es el agente más frecuentemente aislado. Afecta frecuentemente a mujeres de mediana edad y tiende a autolimitarse sin secuelas dentro de la primera semana de inicio de síntomas. El diagnóstico se basa en la detección de ácidos nucleicos virales en el líquido cefalorraquídeo. Al momento no se ha demostrado beneficio en el uso de tratamiento antiviral en la prevención de recurrencias.

Recurrent lymphocytic meningitis or Mollaret´s meningitis is a rare condition caused by a number of infectious, autoimmune, toxic and neoplastic diseases. Herpes simplex type 2 is the most commonly isolated agent. It usually compromises middle aged women, with a self-limited clinical presentation that resolves within a week leaving no sequelae. Its diagnosis is mainly based on nucleic acid detection on cerebrospinal fluid. Antiviral prophylaxis has not shown conclusive to avoid recurrences.

Association between perceived family functionality and teenage pregnancies

Background@#Teenage pregnancy is a public health concern because of its increasing incidence and its dire consequences. Numerous studies document the role of family in initiating sexual activity and teenage pregnancy, but there is a lack of studies that assess the effects of families and peers on teenage sexual behavior in the Philippines.@*Objective@#To determine the association between perceived family functionality as measured by the Family APGAR and teenage pregnancy in selected barangays in District 2, Quezon City, Philippines@*Methodology@#The study enrolled 233 women who are residents of Barangays Commonwealth and Payatas in Quezon City. Cases consisted of 133 women aged 18 to 24 years at the time of the interview who have become pregnant in 2011-2016, while they were 13 to 19 years old, while controls (N=100) were similar but had never been pregnant before age 20. Consecutive respondents who consented to participate in the study were enrolled and interviewed using the Filipino version of the Family APGAR. Respondents were then classified as having functional or dysfunctional families. Odds ratio was computed to determine the relationship between family functionality and teenage pregnancy.@*Results@#Family dysfunction based on the Family APGAR score was significantly associated with increased risk of teenage pregnancy with an OR 16.69, 1.93-144 (p=0.010) along with having both parents as caregivers with an OR of 29.69, 2.46-345, and teenage pregnancy in the mother with an OR of 15.87, 2.006-125.@*Conclusion@#Perception of dysfunction in the family based on the Family APGAR score, having both parents as caregivers and teenage pregnancy in the mother are associated with teenage pregnancy. Future researches should investigate the interactions of these factors but targeting family functionality may be key to curbing teenage pregnancies.

Calidad de control metabólico en pacientes ambulatorios con diabetes tipo 2 atendidos en una clínica privada / Quality of metabolic control in outpatients with type 2 diabetes seen in a private clinic

Objetivo: Evaluar la calidad de control metabólico en pacientes ambulatorios con diabetes mellitus tipo 2 (DM2) de una clínica privada en Lima, Perú. Materiales y métodos: Estudio de corte transversal en la consulta externa del Servicio de endocrinología de una clínica privada de Lima, Perú. Se recolectó información socio demográfica, historia de enfermedad, autorreporte de complicaciones y comorbilidades, medidas antropométricas y presión arterial. Además, se tomó muestras de sangre para análisis de prueba rápida de glucosa, hemoglobina glicosilada (HbA1c) y perfil lipídico. Se consideró pobre control metabólico si el participante tenía HbA1c >7%, colesterol LDL (LDL-c) =100 mg/dl, y presión arterial =130/80 mmHg. Se aplicaron cuestionarios adicionales, para medir la adherencia al tratamiento, actividad física, calidad de vida, autoeficacia y depresión. Resultados: Se incluyó a 60 participantes, 53,3% (32/60) fueron de sexo femenino y la media de edad fue 63,1 ±13,2 años. Se encontró pobre control metabólico en 85% (51/60) de los participantes; presión arterial controlada en 71,2% (42/60), LDL-c controlado en 10% (6/60) y HbA1c controlado en 48,3% (29/60) de los participantes respectivamente. Complicaciones crónicas como retinopatía se autorreportó en el 3,3% (2/60) participantes, neuropatía en 10% (6/60), nefropatía en 1,7% (1/60), presión arterial alta en 30% (18/60) y enfermedad cerebro vascular en 5% (3/60) de los participantes. Conclusión: La prevalencia de control metabólico no controlado es elevada, a pesar del contexto de atención en una clínica privada. Regulación y medidas para mejorar el control en centros privados es necesario

Objective: To assess the quality of metabolic control among outpatients with type 2 diabetes mellitus (DM2) in a private clinic in Lima, Peru. Materials and methods: This is a cross-sectional study in the outpatient endocrinology service of a private clinic in Lima, Peru. Socio-demographic information, history of diabetes, self-report of complications and comorbidities, anthropometric measures and blood pressure data were collected. Blood samples were taken for assessing fasting blood glucose, glycated hemoglobin (HbA1c) and lipid profile. A poor metabolic control was considered if the participant had HbA1c >7%, LDL cholesterol (LDL-c) =100 mg/dl, and blood pressure =130/80 mmHg. Additional questionnaires were administered for measuring adherence to therapy, physical activity, quality of life, self-efficacy and depression. Results: Sixty participants were included; 53.3% (32/60) were female and their mean age was 63.1 ±13.2 years. Poor metabolic control was found in 85% (51/60) of all participants; controlled blood pressure in 71.2% (42/60), controlled LDL-C levels in 10% (6/60), and controlled HbA1c values in 48.3% (29/60) participants, respectively. Chronic complications such as retinopathy were found in 3.33% (2/60) participants, neuropathy in 10% (6/60), nephropathy in 1.7% (1/60), high blood pressure in 30% (18/60) and cerebrovascular disease in 5% (3/60) of all participants. Conclusion: There is a high prevalence of poor metabolic control in patients with type 2 diabetes, despite being taken care of in a private clinic. It is necessary to take actions in order to improve the metabolic control in patients with type 2 diabetes attending the private health care sector

Morphology of the axial skeleton of seven bat genera (Chiroptera: Phyllostomidae)

ABSTRACT Here we present detailed descriptions and comparisons of the axial skeleton of seven species of bats belonging to five subfamilies of Phyllostomidae of different trophic guilds. The material examined consisted of 34 complete skeletons of seven species. For five of the studied species, previous descriptions have not been conducted, and for the vampires only limited information is available, so that descriptions for these species are here completed. The axial skeleton has characters that allow grouping of the species phylogenetically of the same subfamily and by feeding habits. At the same time, there are characters that associate species from different subfamilies with different types of diet or ways to obtain food.

New records of bat ectoparasites (Diptera, Hemiptera and Siphonaptera) from northern Argentina / Nuevos registros de insectos ectoparásitos de murciélagos (Diptera, Hemiptera y Siphonaptera) del norte de la Argentina

New species of bat-ectoparasite insects are added to the fauna of Argentina and distributional limits are extended for others, based on information obtained from 21 species of bats collected. New data is reported for the distribution of 23 species of bat ectoparasites, of which 17 belong to the Order Diptera [14 Streblidae: Anastrebla caudiferae Wenzel, Anatrichobius scorzai Wenzel, Aspidoptera phyllostomatis (Perty), Megistopoda aranea (Coquillett), M. proxima (Sèguy), Metelasmus pseudopterus Coquillett, Noctiliostrebla aitkeni Wenzel, N. dubia (Rudow), Paradyschiria fusca Speiser, Paradyschiria sp., Strebla chrotopteri Wenzel, Strebla diaemi Wenzel, Trichobius parasiticus Gervais y Xenotrichobius noctilionis Wenzel, and three Nycteribiidae: Basilia carteri Scott, B. plaumanni Scott y B.neamericana Schuurmans Stekhoven (Jr)], three belong to the Order Siphonaptera [one Ischnopsyllidae: Myodopsylla isidori (Weyenbergh), one Tungidae: Rhynchopsyllus pulex Haller, and one Stephanocircidae: Craneopsylla m. minerva (Rothschild)] and three belong to Order Hemiptera [two Polyctenidae: Hesperoctenes fumarius (Westwood) and H. vicinus Jordan, and one Cimicidae: Latrocimex spectans Lent]. Some records are new for Argentina, while others are new for the provinces of Corrientes, Chaco, Entre Ríos, Jujuy, Misiones and Salta. Also new host-parasite relationships are reported.

Se agregan nuevas especies de insectos ectoparásitos de murciélagos a la fauna de Argentina y se extiende los límites de distribución de otras, mediante ejemplares colectados de 21 especies de murciélagos. Se reportan novedades distribucionales para 23 especies de ectoparásitos de las cuáles 17 pertenecen al Orden Diptera [14 Streblidae: Anastrebla caudiferae Wenzel, Anatrichobius scorzai Wenzel, Aspidoptera phyllostomatis (Perty), Megistopoda aranea (Coquillett), M. proxima (Sèguy), Metelasmus pseudopterus Coquillett, Noctiliostrebla aitkeni Wenzel, N. dubia (Rudow), Paradyschiria fusca Speiser, Paradyschiria sp., Strebla chrotopteri Wenzel, Strebla diaemi Wenzel, Trichobius parasiticus Gervais y Xenotrichobius noctilionis Wenzel, y tres Nycteribiidae: Basilia carteri Scott, B. plaumanni Scott y B.neamericana Schuurmans Stethoven (Jr)], tres pertenencen al Orden Siphonaptera [un Ischnopsyllidae: Myodopsylla isidori (Weyenbergh), un Tungidae: Rhynchopsyllus pulex Haller y un Stephanocircidae: Craneopsylla m. minerva (Rothschild)] y tres al Orden Hemiptera [dos Polyctenidae: Hesperoctenes fumarius (Westwood) y H. vicinus Jordan, y un Cimicidae: Latrocimex spectans Lent]. Algunos registros son nuevos para Argentina, mientras que otros son nuevos para las provincias de Corrientes, Chaco, Entre Ríos, Jujuy, Misiones y Salta. Además se registran nuevas asociaciones hospedador-ectoparásito.

Scintigraphic lymph node mapping in malignant vulvar melanoma

Nodal status is an important prognosticating factor in patients with melanoma. Metastasis to the lymph nodes would affect surgical treatment plan. Sentinel node mapping, otherwise known as lymphoscintigraphy, has become an integral part in the management of melanoma. This is a case report of the use of scintigraphic lymph node mapping in a patient with a very rare case of vulvar melanoma. The protocols and principles utilized in routine lymph node mapping have been applied in this case. The patient's lymphoscintigraphy revealed unilateral nodal drainage to the left, probably, corresponding to the obturator or internal and external iliac chains. This guided the attending physician to perform unilateral, left-sided nodal dissection only, as opposed to the usual bilateral nodal dissection. Thus, the possibility for post-operative morbidity was greatly minimized in this patient.

Empiema subdural como complicación de sinusitis / Subdural empyema secondary to sinusitis

El empiema subdural es una complicación infrecuente de la sinusitis en niños. Esta condición se acompaña de una alta morbi mortalidad, por lo que es considerada una emergencia neuro-quirúrgica. Se describe la evolución clínico imagenológica de un escolar previamente sano que cursa con un empiema subdural secundario a una pansinusitis y se discute la presentación clínica, diagnóstico imagenológico y tratamiento médico-quirúrgico de esta patología en base a una revisión de la literatura.

Performance of patients with intermittent claudication undergoing physical training, with or without an aggravation of arterial disease: retrospective cohort study / Desempenho de pacientes com claudicação intermitente submetidos ao treinamento físico em resposta ao agravamento da doença arterial: estudo retrospectivo de coorte

PURPOSE: This was a retrospective cohort study aiming to investigate the clinical outcome of patients with intermittent claudication undergoing physical training in whom there was an aggravation of the arterial disease. METHOD: Three hundred and sixty-four patients with claudication who presented with femoropopliteal or tibioperoneal obstructions in at least 1 of the lower limbs and who did not have aortic or bilateral iliac obstructions were included. Forty patients developed new stenoses in previously spared arterial segments (confirmed by duplex scanning), which were proximal to preexisting lesions, and formed the progression group, in contrast to the stable group of patients (n = 324) who did not exhibit this worsening of the disease. Follow-up was 276 and 277 days for stable and progression groups, respectively. All patients underwent an unsupervised program of submaximal walking 4 days a week. Changes in maximal walking distance at a progressive treadmill test were appraised during follow-up, with special interest directed to the periods between admission, diagnosis of arterial worsening, and the end of follow-up. RESULTS: Performance was not significantly different between groups during the entire follow-up period. Furthermore, patients with claudication who evolved with progression of their arteriopathy did not present a reduction of their maximal walking distance in response to the development of new arterial lesions at any time during their follow-up. CONCLUSION: Worsening of the peripheral arterial disease in patients with claudication undergoing physical training, manifested as de novo arterial occlusion in proximal and previously spared segments, does not imply in an impairment of their claudication distance.

OBJETIVO: Estudo retrospectivo de coorte para investigar o desfecho clínico de pacientes com claudicação intermitente submetidos a treinamento físico nos quais houve um agravamento da arteriopatia. MÉTODO: Trezentos e sessenta e quatro pacientes com claudicação que apresentavam obstruções fêmoro-poplíteas ou tíbio-peroneiras em ao menos um dos membros inferiores e que não tinham obstrução de aorta ou de ambas artérias ilíacas foram incluídos. Quarenta pacientes desenvolveram novas estenoses em segmentos arteriais previamente poupados (confirmadas por duplex scan), que eram proximais às lesões pré-existentes, e constituiram o grupo progressivo, em contraste com o grupo estável, de pacientes que não apresentou essa piora da doença. O tempo de seguimento foi de 276 e 277 dias para os grupos estável e progressivo, respectivamente. Todos os pacientes passaram por um programa não supervisionado de caminhadas submáximas 4 vezes por semana. Alterações na distância máxima de claudicação num teste de esteira com carga progressiva foram avaliadas durante o seguimento, com interesse especial nos períodos entre a admissão e o diagnóstico da progressão da arteriopatia e o final do acompanhamento. RESULTADOS: A performance não foi significantemente diferente entre ambos grupos, considerando todo o período de seguimento. Ademais, os claudicantes que evoluíram com progressão da arteriopatia não apresentaram, em nenhum momento de seu seguimento, qualquer redução da distância máxima de caminhada em resposta ao desenvolvimento de novas lesões arteriais. CONCLUSÃO: A piora da doença arterial periférica em claudicantes submetidos ao treinamento físico, manifestada por novas oclusões em segmentos arteriais proximais previamente poupados, não implica necessariamente numa piora da distância de claudicação.

Dengue viruses in the Caribbean. Twenty years of dengue virus isolates from the Caribbean Epidemiology Centre

The first isolate of a dengue virus in the Americas was obtained in Trinidad and Tobago in 1953, and several dengue virus isolates were obtained in subsequent years. However, the systematic isolation and typing of dengue viruses in support of virus surveillance and outbreak investigations did not start until the creation of the Caribbean Epidemiology Centre (CAREC) in 1975. Since then, over two thousand viral isolates have been obtained and typed from many countries in the English and Dutch-speaking Caribbean. In this communication, virological data from 17 countries between 1977 and 1996 are presented and analyzed together for the first time with available epidemiological data. Types 1, 2 and 4 were isolated over the period, and geographic and temporal patterns in the distribution of the most prevalent strains are presented. The historical surveillance data is critically assessed. A temporal correlation with reported dengue incidence and rainfall data in Trinidad and Tobago is reported. Recent changes in epidemiological patterns are described, including reference to two large later outbreaks. Risk assessment of complicated forms of dengue virus infections in the Caribbean has been attempted, with some success. The importance of ongoing systematic surveillance is discussed

Creación y validación de un instrumento para el seguimiento de pacientes con enfermedad cerebrovascular / Creation and validation of an instrument for the follow-up of stoke patients

Se realizó un estudio para crear y validar un instrumento para el seguimiento de pacientes con enfermedad cerebrovascular, y determinar las variables necesarias para evaluarlos y establecer procedimientos para obtener un puntaje y estratificación por grupos que permitan una clasificación pronóstica y evolutiva de nuevos casos. Se analizó una muestra multicéntrica, de 1 218 enfermos, por métodos estadísticos: V de Cramer. Detector Automático de Interacciones, Chi cuadrado, regresión logística, método de Spearman, escalamiento óptimo, análisis factorial, etc., sobre bases de datos EXCEL transferida al paquete estadístico para Ciencias Sociales. Se obtuvo un instrumento manual y 2 implementados en sistema computadorizado: clínico y general, con porcentajes correctos de clasificación superiores a 90 y válidos en resultado global con 90,09; 92,98 y 94,14 por ciento, respectivamente. Los puntajes y clasificación se realizaron sobre la base de los coeficientes obtenidos en un intervalo de 0-1. Resultaron 3 grupos de riesgo: bajo (vivo sin discapacidad: 0 ú puntaje ú 0,33), medio (vivo con discapacidad 0,33 < puntaje < 0,67) y alto (fallecido 0,67 ú puntaje ú 1), algunos clasifican directamente por interacciones. Se obtuvo un instrumento de rigor científico cuanticualitativo, único en el país, de fácil aplicación, para atender pacientes con enfermedad cerebrovascular y, sobre esta base tomar decisiones para ejecutar una práctica médica de mayor calidad

Health system inequalities and inequalities in Latin America and the Caribbean: findings and policy implications

This paper summarizes the results of studies on health system inequalities, inequities, and poverty carried out within the framework of the World Bank's EquiLAC Project and the PAHO/UNDP-sponsored Investments in Health Equity and Poverty Project (IHEP)

Angio - RM com contraste e angiografia convencional na avaliaçäo do paciente com claudicaçäo intermitente: estudo comparativo / Gadolinium - Enhanced MR aortography and convencional aortography to evaluate patients with intermitent claudication: comparative study

Objetivos: comparar o valor da angio-RM com contraste e a angiografia convencional na avaliaçäo de pacientes com claudicaçäo intermitente, quanto ao diagnostico da doença e escolha do tratamento.Material e Método: o material consta de 15 pacientes, com queixa de claudicaçäo intermitente e examinados através de angiografia convencional e angio-RM com contraste.Foi realizado estudo prospectivo duplo cego, com dois examinadores em consenso, com o intuito de se medir a concordância entre os dois métodos quanto a indicaçäo e tratamento, utilizando-se o teste de discordância de Mc Nemar.Resultados: nos 15 casos examinados houve concordância entre os resultados obtidos através da angio-RM com contraste e a angiografia convencional.O tratamento proposto foi concordante em todos os casos.A simples inspeçäo dos resultados permite concluir que houve concordância em 100 porcento dos casos, dispensando qualquer analise estatística.Conclusäo: os resultados obtidos através da angio-RM com contraste e angiografia convencional no estudo de pacientes com claudicaçäo intermitente säo superponíveis e concordantes, quanto ao diagnostico e indicaçäo do tratamento.

Invención en la clínica con niños: comentarios sobre el caso “Marina” / Intervention in the clinic with children: comments about the “Marina” case

A partir del caso Mariana, este trabajo presenta algunas conclusiones teóricas – siguiendo, a su vez, a J. Lacan – acerca de la clínica con niños. Fundamentalmente acerca del saber hacer los anudamientos adecuados de los tres registros – R.S.I -, desde la transferencia con relación al niño y a la familia, posibilitando un acotamiento de los goces excesivos (incestuosos) que saque al niño del lugar fijo (soldado) de objeto del Otro y que así, pueda advenir sujeto del propio deseo.

El concepto de pobreza y las políticas públicas / The poverty concept and the publics politics

Este artículo plantea la necesidad de reconceptuar el fenómeno de la pobreza como paso necesario para plantear políticas públicas más útiles en hacer frente al problema. Discutiendo los conceptos de la economía del bienestar que dan sustento hoy a muchas de las políticas que se aplican, presenta los aportes de dos miradas alternativas: las de las necesidades básicas y la de las capacidades para funcionar en la sociedad. Utilizando el ejemplo del tratamiento de "la familia" y el hogar, desnuda las limitacxiones de las conceptualizaciones actuales y el concecuente alcance restringido de las políticas asistenciales que hoy se utilizan. Por el contrario, rescata la necesidad de observar los componentes subjetivos del fenómeno de la pobreza y su característica multifuncional; de identificar sus raíces en el conflicto distributivo; y de ubicar a los agentes involucrados dentro del ambiente en el cual funcionan, realzando las situaciones de subordinación y control diferencial sobre los recursos