Aproximación hacia la evaluación de la aptitud clínica en residentes de cardiología. Diseño multicéntrico / Approach to cardiology residents clinical aptitude evaluation. Multicenter design

Resumen Introducción: Hasta donde se tiene conocimiento, la investigación que se presenta constituye el primer trabajo multicéntrico en México que estudia el desarrollo de la aptitud clínica en unidades formadoras de cardiólogos. Objetivo: Determinar el grado de desarrollo de la aptitud clínica en residentes de cardiología en tres unidades médicas de alta especialidad. Métodos: Diseño transversal multicéntrico. Se analizaron todos los estudiantes del ciclo académico 2019-2020. Se construyó un instrumento que evaluó la aptitud clínica a partir de ocho indicadores y 170 ítems; la validez conceptual/de contenido y la confiabilidad fueron valoradas por cinco cardiólogos con experiencia docente y en investigación educativa. Resultados: Por indicador y año de residencia se observaron diferencias estadísticas significativas en la sede CMN20Nov; en HCSXXI e INCICh se observaron diferencias estadísticamente significativas en uno de ocho indicadores. Se estimaron diferencias entre residentes R1 (n = 41) de las tres sedes por indicador, con significación estadística en tres de ocho indicadores. El resultado fue semejante al comparar R2 (n = 35) y R3 (n = 43). Conclusiones: El grado de desarrollo de la aptitud clínica se puede considerar medio en las tres sedes académicas, probablemente debido a que el instrumento exploró situaciones clínicas problematizadas que exigieron del residente la reflexión crítica de su experiencia clínica.

Abstract Introduction: To the best of our knowledge, the research herein presented is the first multicenter study in Mexico to analyze the development of clinical aptitude in medical units that train cardiologists. Objective: To determine the degree of development of clinical aptitude in cardiology residents at three High Specialty Medical Units. Methods: Multicenter, cross-sectional design. All students of the 2019-2020 academic year were included in the study. An instrument was constructed that evaluated clinical aptitude based on eight indicators and 170 items; conceptual/content validity and reliability were assessed by five cardiologists with teaching and educational research experience. Results: By indicator and year of residence, significant statistical differences were observed in the CMN20Nov academic site. At HCSXXI and INCICh, statistically significant differences were observed in one of eight indicators. Differences between R1 residents (n = 41) of all three academic sites were estimated by indicator, with statistical significance being recorded in three of eight indicators. Between R2 (n = 35) and between R3 residents (n = 43), the result was similar. Conclusions: The degree of clinical aptitude development can be considered intermediate in all three academic sites, probably because the instrument explored problematized clinical situations that required the residents to critically reflect on their clinical experience.

Uso do gérmen de milho desengordurado, com e sem adição de um complexo enzimático, em dietas para cães / [Use of defatted corngerm with and without the addition of an enzyme complex in dog diets]

Objetivou-se avaliar o coeficiente de digestibilidade aparente (CDA) dos nutrientes, a palatabilidade das dietas e as características fecais de cães alimentados com uma dieta controle e uma dieta contendo 20% de gérmen desengordurado (GD), com e sem adição de complexo enzimático (amilase, xilanase, betaglucanase e mananase). Para o experimento de digestibidade e das características fecais, foram utilizados 12 cães adultos, distribuídos em delineamento em blocos ao acaso, em esquema fatorial 2 x 2 (dieta x enzima). O segundo experimento avaliou a palatabilidade, por meio da primeira escolha e da razão de ingestão (RI) da dieta DC vs. 20% de GD, utilizando-se 16 cães. O teste de palatabilidade contou com três dias consecutivos, totalizando 48 repetições. A dieta com inclusão de 20% de GD teve os menores valores de CDA da MS, da EB e da EM (P<0,05). A inclusão do complexo enzimático melhorou o CDA da MS, da EB e da EM (P<0,05). Não foram observadas diferenças nas características fecais (P>0,05). Em relação à palatabilidade, os cães preferiram a dieta 20% de GD, tanto na primeira escolha como na RI (P<0,05). A inclusão de enzimas às dietas melhora a digestibilidade dos nutrientes e da EM, sendo um aditivo com potencial uso na alimentação de cães.(AU)

The objective was to evaluate the apparent digestibility coefficient (ADC) of nutrients, diet palatability and fecal characteristics of dogs fed diets containing degreased germ (DG), and a control diet (DC) - both with and without the addition of enzyme complex (amylase, xylanase, betaglucanase and mananase). For the digestibility and fecal characteristics experiment 12 adult dogs were used, distributed in a randomized block design, in a 2 x 2 factorial scheme (diet x enzyme). The second experiment evaluated palatability using the first choice and ingestion ratio (IR) of DC diet vs. 20%gD, using 16 dogs. The palatability test had three consecutive days, totaling 48 repetitions. The diet with inclusion of 20% DG had the lowest ADC values of DM, GE and ME (P <0.05). Inclusion of the enzyme complex improved ADC of DM, GE and ME (P <0.05). No differences in fecal characteristics were observed (P >0.05). Regarding palatability, dogs preferred the 20% DG diet in both first choice and IR (P <0.05). Inclusion of enzymes in diets improves nutrient digestibility and ME, being an additive with potential use in dog food.(AU)

Cranberries (Vaccinium macrocarpon Aiton) in dog nutrition: influence on diet digestibility and palatability and in the course of urinary tract infections / [Cranberrys (Vaccinium macrocarpon Aiton) na nutrição de cães: influência na digestibilidade e palatabilidade da dieta e no curso de infecções do trato urinário

The objective was to evaluate the effects of cranberry on blood and urinary parameters of dogs (experiment I), digestibility of nutrients (experiment II), palatability of diet (experiment III) and the influence of cranberry on E. coli UPEC-MRHA fimbriae in vitro (experiment IV). For experiment I and II, ten dogs were fed with diets containing 0% or 0.4% cranberry for 30 days. Experiment III compared the diets containing 0% and 0.4% cranberry using 16 adult dogs. There were no statistical differences (P>0.05) in the blood parameters evaluated. Dogs consuming cranberry presented lighter color and appearance of urine, compared to the control group (P<0.05). The diet containing cranberry showed higher digestibility of dry matter, organic matter, ether extract, higher metabolizable energy (P<0.05) and reduced fecal sialic acid concentration (P<0.05) compared to the control diet. There was no influence of cranberry on the formation of fimbriae of E. coli UPEC-MRHA. There was a lower intake ratio of the diet containing cranberry (P<0.05). The inclusion of 0.4% cranberry increases the digestibility of nutrients and influences the color and appearance of urine of dogs. However, it reduces diet palatability and does not alter the adhesion of E. coli UPEC-MRHA in vitro.(AU)

O objetivo foi avaliar os efeitos do cranberry nos parâmetros sanguíneos e urinários de cães (experimento I), na digestibilidade dos nutrientes (experimento II), na palatabilidade da dieta (experimento III) e a influência do cranberry sobre E. coli UPEC-MRHA fimbriae in vitro (experimento IV). Para os experimentos I e II, 10 cães foram alimentados com dietas contendo 0% ou 0,4% de cranberry por 30 dias. O experimento III comparou as dietas contendo 0% e 0,4% de cranberry usando 16 cães adultos. Não houve diferenças estatísticas (P>0,05) nos parâmetros sanguíneos avaliados. Cães que consumiram cranberry apresentaram cor e aparência mais claras da urina, em comparação com o grupo controle (P<0,05). A dieta contendo cranberry apresentou maior digestibilidade da matéria seca, extrato etéreo, matéria orgânica, maior energia metabolizável (P<0,05) e menor concentração de ácido siálico fecal (P<0,05) comparada à dieta controle. Não houve influência do cranberry na formação de fímbrias de E. coli UPEC-MRHA. Houve uma menor taxa de ingestão da dieta contendo cranberry (P<0,05). A inclusão de 0,4% de cranberry aumenta a digestibilidade dos nutrientes, influencia a cor e a aparência da urina dos cães. No entanto, reduz a palatabilidade da dieta e não altera a adesão de E. coli UPEC-MRHA in vitro.(AU)

Dispersión hídrica de enteroparásitos en una zona agropecuaria de gran altitud, en Los Andes Ecuatorianos / Water dispersion of enteroparasites in a high-altitude agricultural area, in The Ecuadorian Andes

La finalidad de esta investigación fue determinar las especies de enteroparásitos que son vehiculizadas por agua de regadío, entubada y estancada, como factor de riesgo asociado a la transmisión en una comunidad rural de la provincia de Chimborazo-Ecuador. Se realizó una investigación de campo, transversal, con muestreo no probabilístico intencional, en el que se incluyeron 214 muestras de agua: 37 de canales de riego, 147 que surten las viviendas y 30 estancadas. Las muestras se analizaron mediante Sedimentación espontánea, técnica de Bailenger (modificada) y coloración de Ziehl Neelsen (modificada). El agua de regadío y la estancada, obtuvieron el 100% de contaminación parasitaria y en menor grado la entubada, con 57,14%. La mayor proporción fue de protozoarios (70,56%), seguidos de chromistas (40,65%) y helmintos (13,08%). Entre los parásitos transmisibles, se destacan: Blastocystis spp. (40,65%), Amebas de vida libre (5,61%), Entamoeba spp. (8,41%), Giardia duodenalis (6,54%), Balantidium spp. (13,51%), Cryptosporidium spp. (17,76%), Cyclospora spp. (3,74%), Cystoisospora spp. (2,34%), Eimeria spp. (13,55%), Dibothriocephalus spp. (0,47%) y larvas de nemátodos (13,08%). Los resultados evidencian la presencia de parásitos de transmisión hídrica en los tres cuerpos de agua estudiados, lo que constituye un riesgo de infección humana, veterinaria y de contaminación para los productos agrícolas

The purpose of this investigation was to determine the species of enteroparasites that are carried by irrigated, piped and stagnant water, as a risk factor associated with transmission in a rural community in the province of Chimborazo-Ecuador. A cross-sectional field investigation was carried out, with an intentional non-probability sampling, in which 214 water samples were included: 37 from irrigation canals, 147 that supply the houses and 30 stagnant. The samples were analyzed by spontaneous sedimentation, Bailenger technique (modified) and Ziehl Neelsen staining (modified). Irrigation and stagnant water obtained 100% of parasitic contamination and to a lesser extent piped, with 57.14%. The highest proportion was of protozoa (70.56%), followed by chromists (40.65%) and helminths (13.08%). Among the transmissible parasites, the following stand out: Blastocystis spp. (40.65%), Free-living amoebas (5.61%), Entamoeba spp. (8.41%), Giardia duodenalis (6.54%), Balantidium spp. (13.51%), Cryptosporidium spp. (17.76%), Cyclospora spp. (3.74%), Cystoisospora spp. (2.34%), Eimeria spp. (13.55%), Dibothriocephalus spp. (0.47%) and nematode larvae (13.08%). The results show the presence of parasites of water transmission in the three bodies of water studied, which constitutes a risk of human, veterinary infection and contamination for agricultural products

Association Of Risk Factors Of Cerebral Palsy – A Matched Case Control Study

Background: Cerebral palsy (CP) is one of the leading causes of childhood disability worldwide. The exact etiology of CP is poorly understood, but many risk factors are related to problems during pregnancy, labor, and delivery. The age and sex-matched control study were done to evaluate the association of perinatal risk factors with the development of CP among children in a rural area. Methods: The study was conducted in the Division of Physical Medicine and Rehabilitation (PMR). Seventy clinically diagnosed CP children as cases and 70 children without CP as controls were included. Information regarding perinatal risk factors was collected from the parents of the children. Data were collected and statistically analyzed by using the Mc-Nemar chi-square test. Results: The study results suggested that children with male sex (53%) had a higher incidence of CP compared to female (47%) children. Spastic diplegia (60%) was the most common subtype of CP. The significant ‘p’ value (< 0.01) reveals that all the perinatal risk factors are associated with the development of CP. Conclusion: This study concluded that spastic diplegia was the most common subtype of CP. The perinatal risk factors such as preterm, low birth weight, birth asphyxia, and neonatal seizures had a significant association with the development of CP.

Alteraciones en estudiantes y profesionales zurdos de la Estomatología debido a la lateralidad forzada / Alterations in students and left-handed professionals of Dentistry due to forced laterality

RESUMEN Fundamento: en Cuba los sillones estomatológicos están diseñados para los diestros, por lo que los estudiantes zurdos (los cuales han aumentado en número en la provincia de Cienfuegos) deben cambiar su lateralidad sin tener en cuenta su dominancia cerebral, lo cual podría afectar su desempeño, pues la práctica estomatológica depende en gran medida de las habilidades manuales. Objetivo: determinar alteraciones debido a la lateralidad forzada en estudiantes y profesionales zurdos de Estomatología. Métodos: estudio descriptivo retrospectivo realizado en la provincia de Cienfuegos en el periodo comprendido septiembre de 2017 hasta junio del 2018. Fueron incluidos 49 zurdos (17 estudiantes de 4to y 5to año y 32 graduados) Las variables fueron: sexo, lateralidad, habilidades prácticas, alteraciones por lateralidad forzada, especialidades estomatológicas, años de trabajo. Resultados: 55,10 % fueron del sexo femenino; el 55,10 % manifestó lateralidad cruzada; 100 % percibió la mejoría de sus habilidades prácticas en el 8vo semestre. Entre las alteraciones se encontraron el dolor muscular (69,38 %) principalmente en la mano, región cervical y espalda, de ellos, 51,02 % son Estomatólogos Generales Integrales. Los dolores aumentaron con los años de trabajo, además de sentimientos de inseguridad (79,60 %), ansiedad (89,80 %), y miedo (91,84 %). El 34,69 % no presentó ningún síntoma doloroso, de ellos 20, 40 % hombres. Estuvieron vinculados a las especialidades de ortodoncia, cirugía maxilofacial, prótesis, administrativos y docentes. Conclusiones: la lateralidad forzada influyó en la adquisición de las habilidades prácticas, así como en el desarrollo de alteraciones en estudiantes y profesionales de la estomatología.

ABSTRACT Foundation: in Cuba, dental chairs are designed for right-handed, so left-handed students (who have increased by number in the province of Cienfuegos) should change their laterality without taking into account yjeir brain dominance, which could affect their performance, as dental practice depends largely on manual skills. Objective: to determine alterations due to forced laterality in left-handed students and dentistry professionals. Methods: retrospective descriptive study conducted in the Cienfuegos province in the period from September 2017 to June 2018. A number of 49 left-handers were included (17 students of 4th and 5th year and 32 graduates) The variables were: sex, laterality, practical skills, alterations due to forced laterality, dental specialties, years of work. Results: 55.10% were female; 55.10% reported cross laterality; 100% perceived the improvement of their skill practices in the 8th semester. Among the alterations were muscle pain (69.38%) mainly in the hand, cervical region and back, out of them, 51.02% are Comprehensive General Dentists. Pains increased with years of work, in addition feelings of insecurity (79.60%), anxiety (89.80%), and fear (91.84%). A 34.69% did not show any painful symptoms, from them 20, 40% men. They were from orthodontics, maxillofacial surgery, prostheses, administrative and professors.

Período de adaptação a dietas com baixa ou alta fibra sobre a digestibilidade e as características fecais em cães / Adaptation period to diets with low or high fiber on digetibility and faecal characteristics in dogs

Objetivou-se avaliar três períodos de adaptação, cinco, 10 e 15 dias, a dietas com baixa ou alta fibra sobre a digestibilidade e características fecais. Foram utilizadas duas dietas, uma contendo 0% de casca de soja (0%CS) e outra com 15% de casca de soja (15%CS), fornecidas a 12 cães adultos. Ao final de cada período, houve coleta total de fezes para avaliação dos coeficientes de digestibilidade aparente (CDA), energia metabolizável (EM) e características fecais. Além disso, foi avaliada a palatabilidade das dietas. Como resultado, não houve efeito do período de adaptação sobre a digestibilidade das dietas (P>0,05). A dieta 15%CS apresentou menor CDA da matéria seca (MS) e EM, em relação à dieta 0%CS (P<0,05). A consistência fecal dos cães não diferiu entre as dietas e os períodos (P>0,05). Houve redução no pH e na amônia fecal dos cães alimentados com a dieta 15%CS (P<0,05), após 10 dias de alimentação. Não houve diferença na palatabilidade das dietas (P>0,05). Períodos de adaptação à dieta superiores a cinco dias não alteram a digestibilidade e a maioria das características fecais de cães, exceto a amônia fecal. A inclusão de 15%CS na dieta reduz a digestibilidade da MS e a EM, bem como o pH e a amônia fecal.(AU)

This study aimed to evaluate three periods of adaptation, 5, 10 and 15 days, to diets with low or high fiber on digestibility and fecal characteristics. Two diets were used, one containing 0% (0% SH) and one containing 15% soybean hulls (15% SH). Diets were provided to 12 adult dogs. At the end of each period there was total collection of feces to evaluate the apparent digestibility coefficients (ADC), metabolizable energy (ME) and fecal characteristics. We also evaluated diet palatability. There was no effect of the adaptation period on digestibility of diets (P> 0.05). The 15% SH diet reduced ADC of dry matter (DM) and ME, compared to the 0% SH diet (P< 0.05). Fecal consistency of the dogs did not differ among diets and periods (P> 0.05). There was a decrease in fecal pH and ammonia in dogs fed the diet with 15% SH (P< 0.05) after 10 days of feeding (P< 0.05). There was no difference in diet palatability (P> 0.05). Diet adaptation longer than 5 days did not alter the digestibility and most fecal characteristics of dogs, except for fecal ammonia. The inclusion of 15% SH in diet reduces DM digestibility and fecal pH and ammonia in dogs.(AU)

Assessing Agreement Level between Actual Stature and Regression Estimates using Foot Length of Adults

Introduction: Stature can be determined using measurementsof different body parts. Forensic anthropology uses regressionequation for determining stature from body part. The aim ofthe present study is to assess the agreement level betweenactual and estimated stature using regression equation fromright foot length (RFL) among both sexes in Chennai region.Material and methods: In this cross sectional study, 619subjects of both sexes with age ranging from 18 to 59 yearswere studied for determination of stature. Simple regressionequations were formulated from RFL. They were appliedfor determination of stature of an individual of both sexesseparately. Then they were assessed for their agreementbetween actual and estimated stature.Results: The present study found a satisfactory agreementbut not very good agreement between actual and estimatedstature with regression equation from RFL in both sexes.According to the Bland-Altman plot, there was a bias asnegative predicted higher than the actual stature values andfew observations were found moving beyond lower and upperlimits (95% confidence limit).Conclusion: When actual stature cannot be determined,regression equation could be the most appropriate forprediction of stature using foot length in adults.

Prediction of Stature with Regression Equation and Multiplication Factor using Foot Length in Adults: A Comparative Study

Introduction: Stature estimation is important in medicolegalinvestigations and anthropological studies. Regressionequation and multiplication factor are used for estimationof stature from body segment. The objective of this studyis to find out any significant difference exists between theregression equation and multiplication factor estimates usingright foot length in predicting the stature.Material and methods: A total of 619 study subjects thatincluded both males and females with age ranged from 18to 59 years were selected for estimation of stature. Simpleregression equation and multiplication factor were formulatedfrom RFL. They were used for estimation of stature of bothmale and female study subjects separately. Then both themethods were analyzed for their accuracy and to find out anydifference between them.Results: It was statistically significant for multiplication factorwhen compared with regression equation for determiningstature from RFL in males (p=0.018) and females (p=0.002).Conclusion: The present study found that multiplicationfactor was better than regression equation in determiningstature from RFL in both sexes among population in Chennairegion

Prevención de hemorragias en el posoperatorio temprano de cirugía bariátrica: Papel de la vitamina K / Prevention of hemorrhage in the early postoperative period of bariatric surgery: Role of vitamin K

Introducción: la cirugía bariátrica es el tratamiento más eficaz para la obesidad mórbida. La hemorragia se presenta en el 0,5-5% de las pacientes. La preparación prequirúrgica con dieta líquida y el uso de antibióticos para Helicobacter pylori podría alterar el metabolismo de la vitamina K y asociarse a hemorragia. Objetivo: describir el comportamiento de la concentración de protrombina (basal = B-PT y prequirúrgica = preQ-PT) en estos pacientes. Material y métodos: se realizó un estudio de cohorte prospectivo donde se comparó la concentración de B-PT (15-180 días previos a la cirugía) y la preQ-PT (24 horas previas a la cirugía). Resultados: se incluyeron 194 pacientes, de los cuales el 72% (n = 139) fueron mujeres, de entre 19 y 69 años, con BMI (IMC) 45 (33 a 58) y pérdida de peso prequirúrgica del 7% (-2 a 17). El promedio de B-PT fue 91,9% (DE 9,529), el promedio de la preQ-PT fue 81,1% (DE 10,760); descendió un 10,8% (p < 0,001). No hubo diferencias significativas cuando se comparó el comportamiento en la preQ-PT entre los diferentes subgrupos (uso de antibióticos para Helicobacter pylori, de acuerdo con la pérdida de peso y en relación con la suplementación de vitamina K); sin embargo, siempre se detectó descenso de la preQ-PT. No hubo ninguna complicación hemorrágica (necesidad de transfusiones o reoperación); tampoco hubo muerte por hemorragias ni eventos tromboembólicos. Conclusión: realizar dosaje de protrombina 24 horas antes de la cirugía bariátrica permite detectar alteraciones iatrogénicas de la coagulación inducidas por la dieta y el uso de antibióticos.

Background: bariatric surgery is the most efficient treatment for morbid obesity. Bleeding occurs in 0.5-5% of patients. Pre-surgical preparation with liquid diet and the use of antibiotics for Helicobacter pylori could alter the metabolism of vitamin K and be associated with hemorrhage. Objective: to describe the behavior of the concentration of Prothrombin (basal = B-PT and pre-surgical = preQ-PT) in these patients. Material and methods: a prospective cohort study comparing B-PT concentration (15-180 days prior to surgery) and preQ-PT (24 h prior to surgery) was performed. Results: a total of 194 patients were included in the study, with 72% (n = 139) women aged 19-69 years, BMI 45 (33 to 58) and preoperative weight loss of 7% (-2 to 17). The media B-PT was 91.9% (SD 9.529), the media pre-PT was 81.1% (SD 10.760); declined 10.8% (p <0.001). There was no significant difference when comparing the behavior in the preQ-PT among different subgroups (use of antibiotics for Helicobacter pylori, according to weight loss and in relation to vitamin K supplementation), however, there was always a decrease of the preQ-PT. There were no bleeding complications (need for transfusions or re-intervetion), nor was there death for bleeding or thromboembolic events. Conclusion: prothrombin measurement 24 hours before bariatric surgery allows the detection of iatrogenic coagulation alterations induced by diet and the use of antibiotics.

Avaliação da forma de inclusão de zeólita e do nível de consumo sobre a digestibilidade da dieta e as características fecais de cães / Evaluation of zeolite inclusion and level of food intake on diet digestibility and faecal characteristics of dogs

Objetivou-se avaliar a forma de inclusão da zeólita e de níveis de consumo sobre a digestibilidade da dieta e as características fecais de cães. O experimento 1 avaliou o efeito do nível de consumo (normal e 50% a mais do que as necessidades) e da inclusão de zeólita (0 e 15g/kg) sobre a digestibilidade e as características fecais de 12 cães. No experimento 2, foi avaliada a inclusão de 5, 15 e 25g/kg de zeólita adicionada na massa ou por cobertura, em seis cães, sobre a digestibilidade da dieta e as características fecais. O experimento 3 avaliou o odor fecal de nove cães consumindo dietas contendo 0 e 15g/kg de zeólita incluída na massa ou por cobertura. A quantidade consumida e a inclusão de zeólita não afetaram a digestibilidade das dietas. O escore e a matéria seca fecal aumentaram com a inclusão de zeólita. A inclusão de zeólita na massa propiciou aumento na digestibilidade das dietas, independentemente do nível de inclusão. A inclusão de 15g/kg de zeólita, adicionada na massa e por cobertura reduziu o odor fecal dos cães. A inclusão de zeólita na massa aumenta a digestibilidade da dieta, a consistência fecal e reduz o odor fecal de cães.(AU)

This study aimed to evaluate the form of inclusion of zeolite and consumption levels on diet digestibility and fecal characteristics of dogs. The first experiment examined the effect of consumption level (normal and 50% higher than the requirements) and zeolite level (0 and 15g/kg) on diet digestibility and fecal characteristics of 12 dogs. In experiment 2 the inclusion of 5, 15 and 25g/kg of added zeolite in dough or coating in six dogs on diet digestibility and fecal characteristics was evaluated. The third experiment assessed the fecal odor of nine dogs fed diets containing 0 and 15g/kg of zeolite included in the dough or coating. The amount consumed, as well as the inclusion of zeolite, did not affect diet digestibility. Fecal score and dry matter increased with the inclusion of zeolite. The inclusion of zeolite in the dough provided an increase in diet digestibility, regardless of the level of inclusion. The inclusion of 15g/kg zeolite added to the dough and by coating reduced fecal odor of dogs. The inclusion of zeolite in dough increases diet digestibility, fecal consistency, and reduces the fecal odor of dogs.(AU)

A comparative observational multicenter analysis of the clinical performance of vascular compression devices following transradial arterial access / Análisis comparativo multicéntrico observacional del desempeño clínico de dispositivos de compresión vascular posterior a acceso arterial transradial

Abstract: Introduction: Multiple vascular compression aimed for transradial access have been developed. We aimed to compare the time required to achieve hemostasis in three different radial vascular compression devices. Methods: ST and non-ST elevation MI, unstable and stable angina as well as diagnostic coronary angiograms patients with transradial vascular access (TVA) in 2 centers were enrolled between June 2010-November 2010. Patients were divided according the TVA compression device (TAVCD) used. Group I received TR Band(tm) (Terumo, Tokyo, Japan), Group II received Neptuno(tm) (Biotronik, Berlin, Deutschland) and Group III received Finale(tm) (Merit Medical, South Jordan, UT).Patients were evaluated immediately after TVACD implantation and 24 hour post-procedure follow up. Results: 60 patients were enrolled in this observational study (Group I = 22 patients; Group II = 18; Group III = 20). All patients demonstrated evidence of radial pulse after hemostasis. 28% developed a superficial hematoma (Group I, 31%; Group II, 30%; Group III, 22%). Pain at the access site was uncommon among patients in both immediate and follow-up evaluations, however, 3% (Group I and II) presented paresthesia immediately following the procedure that resolved by the 24-hour evaluation. Conclusion: In our study, all three evaluated radial compression devices successfully achieved hemostasis regardless of the slight alterations of mechanism, yet similarity in aim of non-occlusive compression. Group I (TR band) had a slight increase in compression time recorded but all groups required an approximate three hours to display no evidence of bleeding. None of the patients in the study presented major vascular complications. We consider that further investigation of radial compression devices as compared to manual compression are necessary to evaluate their advantages and may further simplify the procedure

Resumen: Introducción: Múltiples dispositivos de compresión vascular para el acceso radial han sido desarrollados. Nuestro objetivo es comparar el tiempo requerido para lograr la hemostasis con tres diferentes dispositivos de compresión vascular radial. Métodos: Pacientes de angiografía coronaria de diagnóstico, con elevación y no elevación del ST, con angina de pecho inestable y estable, así como pacientes con acceso vascular radial (AVR) en dos centros, fueron incluidos entre junio y noviembre de 2010. Los pacientes fueron divididos según el dispositivo de compresión AVR (DCAVR) usado. Al Grupo I se le dio el TR Band(tm) (Terumo, Tokio, Japón), el Grupo II recibió el Neptuno(tm) (Biotronik, Berlín, Alemania) y el grupo III recibió el Final(tm) (Merit Medica, South Jordan, UT). Los pacientes fueron evaluados inmediatamente después de la implantación del DCAVR y a las 24 horas de postprocedimiento para seguimiento. Resultados: 60 pacientes fueron incluidos en este estudio observacional (Grupo I = 22 pacientes; Grupo II = 18; Grupo III = 20). Todos los pacientes mostraron evidencia de pulso radial después de la hemostasis. 28% desarrolló un hematoma superficial (Grupo I, 31%; Grupo II, 30%; Grupo III, 22%). El dolor en el sitio de acceso fue poco común entre los pacientes de los dos evaluaciones inmediatas y de seguimiento, sin embargo, el 3% (Grupo I y II) presentó parestesias inmediatamente después del procedimiento que se resolvieron para la evaluación de 24 horas. Conclusión: En nuestro estudio, los tres dispositivos de compresión radiales evaluados lograron con éxito la hemostasis sin importar las pequeñas variaciones del mecanismo, dando resultados similares en el objetivo de la compresión no oclusiva. Grupo I (Banda TR) tuvo un ligero aumento en el tiempo de compresión registrado pero todos los grupos requieren un tiempo aproximado de tres horas para mostrar ninguna evidencia de sangrado. Ninguno de los pacientes en el estudio presentó mayores complicaciones vasculares. Consideramos necesario hacer investigación adicional de los dispositivos de compresión radiales, en comparación con la compresión manual para evaluar sus ventajas y poder simplificar aún más el procedimiento.

Potencial cicatricial da Bixa orellana L. em feridas cutâneas: estudo em modelo experimental / Therapeutic potential of Bixa orellana L. in skin wounds: a study in the rat model of open wound healing

O uso de fitoterápicos é uma alternativa de baixo custo e de fácil acesso para o tratamento de feridas cutâneas. Objetivou-se avaliar a ação do extrato oleoso de urucum na cicatrização de feridas cutâneas abertas. Inicialmente, identificaram-se os principais ácidos graxos do óleo de urucum. Foi realizado ensaio citotóxico para determinar as concentrações a serem utilizadas no ensaio in vivo. No experimento, feridas cutâneas em ratos Wistar foram diariamente tratadas com: extrato de urucum 0,1% (U 0,1%), extrato de urucum 0,01% (U 0,01%), vaselina (V) e solução fisiológica (SF), por até 21 dias. Aos quatro, sete, 14 e 21 dias, foi avaliada clinicamente a presença de exsudato, crosta e epitelização. Determinaram-se as áreas da lesão, e amostras de pele, fígado e rins foram coletadas para avalição histológica. Aos 21dias, amostras de pele foram coletadas para análise tensiométrica. Clinicamente, todos os grupos de tratamento apresentaram evolução cicatricial fisiológica. Os grupos U 0,1% e U 0,01% apresentaram maior presença de epitelização aos sete dias e maior retração cicatricial aos quatro dias. Na histologia, U 0,1% e U 0,01% apresentaram aos quatro e sete dias maior quantidade de fibrina e inflamação que V e SF, e, nos demais momentos, não houve diferenças entre os grupos. Quanto à fase cicatricial, aos quatro dias todos os grupos encontravam-se na fase inflamatória, aos sete dias U 0,1% e U 0,01% permaneciam na fase inflamatória, diferindo de SF e V, que se caracterizavam na fase proliferativa. Aos 14 dias, os grupos apresentavam-se em transição de fase proliferativa para maturação e, aos 21dias, estavam todos na fase de maturação. Os grupos tratados com urucum expressaram menor resistência à tensão que V e SF. Concluiu-se com este estudo que o extrato oleoso de urucum acelera o processo cicatricial nos primeiros dias, mas proporciona uma cicatriz de baixa qualidade.

Phytotherapies are a low cost, easily accessible alternative to traditional medicines in wound healing management. The purpose of this study was to assess the oil extract of Bixa orellana L. as a healing agent in the rat model of open wound healing. Initially, the oil was obtained and characterized through gas chromatography. Furthermore, the cytotoxic potential of the oil was verified in cell cultures to determine the doses used in animal experiments. Wounds were surgically produced in Wistar rats, these were treated with the oil extract at 0.1% (U 0.1%), 0.01% (U 0.01%), petrol jelly (V) and saline (SF) for up to 21 days. At four, seven and 14 days of treatment the wounds were assessed clinically regarding the presence of exudate, crust and epithelialization. The wound area was also determined and skin, kidney and liver tissues were harvested for histopathology. At 21 days of treatment the skins were also harvested for tension resistance assessment. Clinically, all groups evolved similarly, however, those treated with U 0.1% and U 0.01% had a greater amount of epithelialized wounds by day seven, and grater shrinkage by day four. Histopathologicaly, the skin samples of oil treated wounds had more lesions in the inflammatory phase at seven days, when compared to the controls, which were majorly in the proliferation phase. By 14 days no difference was observed among groups, which were all in the transition from the proliferation to the maturation phase. By day 21, all wounds were in the maturation phase. Oil treated wounds also had more fibrin in the first two assessment dates, when compared to the controls. Tension resistance of the oil treated wounds was, however, inferior to that of the controls. This study shows that B. orellana L. oil will hasten the onset of the healing process and its initial phases, but will ultimately produce a scar of poorer quality.

Study on utilization of health care services at secondary level setting and satisfaction among out patients.

Background: Patient care is the primary function of a hospital. Hospital performance can be best assessed by measuring patient satisfaction. Patient satisfaction with the health care services largely determines their compliance with the treatment and thus contributes to the positive influence on health. Patient satisfaction is considered as one of the desired out comes of health care and is directly related with utilization of health. The objective of the study was to assess the level of satisfaction among out patients attending secondary level hospital and to assess the utilization of health care services. Methods: A cross sectional study was conducted among out patients (aged 18 – 85 years) attending Chidambaram Government Hospital, Tamilnadu, India. Systematic random sampling technique was used to select the respondents. A total of 152 outpatients were taken for the study purpose. A self designed, pretested, semi structured questionnaire was developed to draw the patient‟s satisfaction to the health care services. Results: 99.3% of the patients were highly satisfied with the cleanliness of the hospital.91.4% of the respondents were satisfied with the doctor‟s behavior. 62.5% of the out patient were neutral with drinking water facility. Overall satisfaction among the patients was a mean of 3.75 out of 5 (75%). Conclusions: Patients are generally satisfied with the hospital facilities. Patients inputs on various deficiencies should always be taken care by the hospital administration to improve its services to the patients satisfaction.

Use of Triticum aestivum in open wound healing: a clinical, pathological, and tensiometric assessment in the rabbit model / Uso de Triticum aestivum na cicatrização de feridas: um ensaio clínico, histopatológico e tensiométrico em coelhos

While Triticum sp. has been shown to act in wound healing, stimulating collagen synthesis by fibroblasts, the use of this plant extract has yet to be assessed in vivo, in commercially viable presentations. This study used rabbits and assessed, on days seven, 14, and 21, the presence or absence of granulation tissue and epithelialization, histopathological structures, and scar quality through the breaking and tension strength. Treatments, performed for 21 days, were aqueous extract of T. aestivum at a concentration of 2mg/mL (group I) and 10mg/mL (group II) and a nonionic cream (control group). We demonstrate that the formation of granulation tissue was not significantly different between treatments. In the analysis of epithelial tissue, wounds in group II differed from other treatments by day 7. On days 14 and 21 there was no significant clinical difference between groups. In the histopathological evaluation, scar quality and rupture strength did not differ between the groups in the studied period. In the tension strength evaluation, group I differed from the others, presenting a higher tension strength overall. The studied treatments did not differ regarding healing evolution of the skin wounds, but T. aestivum extract, at 2mg/mL, presents better results in the tension strength evaluation...

O extrato de trigo (Triticum sp.) vem sendo usado na cicatrização de feridas por estimular a síntese de fibroblastos, entretanto a sua aplicabilidade in vivo em apresentações comercialmente viáveis ainda tem de ser demonstrada. Neste estudo, avaliaram-se feridas cutâneas de coelhos tratadas com extrato aquoso de T. aestivum quanto à presença de tecido de granulação e epitelização, estruturas histológicas, qualidade cicatricial, além de ensaio tensiométrico. As feridas foram tratadas diariamente, por 21 dias, com diferentes concentrações do extrato (grupo I = 2mg/mL; grupo II = 10mg/mL) ou apenas o veículo (grupo controle = creme não iônico), e avaliadas nos dias sete, 14 e 21. A formação de tecido de granulação não diferiu entre os tratamentos. A epitelização aconteceu em menor tempo em feridas do grupo II, mas aos 14 dias já não havia diferença neste parâmetro. Na avaliação histopatológica, a qualidade cicatricial e a força de ruptura não diferiram no período estudado, entretanto a resistência tensiométrica das feridas do grupo I foi maior que a dos demais tratamentos. Dessa forma, conclui-se que, mesmo não havendo diferença na evolução cicatricial de feridas tratadas ou não com extrato aquoso de T. aestivum, o uso desse composto, a 2mg/mL, resultou em tecidos cicatriciais mais resistentes à tração...

Seroprevalencia de anticuerpos contra dengue en niños de uno a nueve años luego de una epidemia, Aguilares, Tucumán, 2009 / Seroprevalence of Dengue Antibodies in One-to Nine-Year-Old Children after an Outbrea, Aguilares, Tucumán 2009

INTRODUCCIÓN: El brote de dengue de 2009 constituyó el primero con casos autóctonos en Tucumán. Los departamentos de Río Chico y Capital fueron los más afectados. Hubo baja notificación de niños de uno a nueve años (2,6/1.000). Este hallazgo impulsó a conocer el real impacto del brote en la población infantil. OBJETIVO: Estimar la incidencia de dengue en niños de uno a nueve años. MÉTODOS: Se realizó un estudio transversal de sero prevalencia(IgG) en julio de 2009 en Aguilares (Departamento de Río Chico),con una muestra probabilística de niños de uno a nueve años que habían residido allí en los últimos seis meses. Los criterios de exclusión fueron: hogar inhabitado, rechazo a participar o niño con enfermedad aguda. Se utilizó una prueba de neutralización por reducciónde placas. RESULTADOS: Se obtuvieron muestras de 118 niños. Hubo 18 rechazos a participar. El 24...

INTRODUCTION: The 2009 dengue outbreak became the first with autochthonous cases in Tucumán. The departments of Río Chico and Capital were the most affecte dones. There was low incidence in one- to nine-year-old children(2.6/1000). This finding led to a study to know the real impact of the outbreak on children. OBJECTIVE: To estimate dengue incidence in one- to nine-year-old children. METHODS: Across-sectional seroprevalence (IgG) study was carried out in July 2009 in Aguilares (Department of Río Chico), with aprobability sample composed by one- to nine-year-old children who had lived there in the last six months. Exclusion criteria were: uninhabited home, refusal to participate or seriously illchild. The laboratory study consisted of a plaque reduction neutralization test. RESULTS: A total of 118 samples were obtained. There were 18 refusals to participate. 24...

Promotor de la enseñanza media en Estomatología: Dr. José Felipe López Campo / Promoter of secondary education in Stomatology: Dr. José Felipe López Campo

El profesor José Felipe López Campos es un ejemplo de formación de las nuevas generaciones. Destacado en la participación en actividades revolucionarias y sociales, la formación de recursos humanos universitarios y nivel medio en Estomatología. Profesor de varias asignaturas de pregrado y posgrado, y responsable nacional de la formación del personal para-estomatológico. Se realizó una investigación histórica para recopilar los datos biográficos más generales del Dr. José Felipe López Campo. Se consultaron como fuentes documentales el expediente de cuadros de la Facultad de Estomatología y la documentación aportada por la familia. La información fue organizada según su desempeño político, su labor docente-administrativa, su actividad científica, así como las condecoraciones que recibió. Gracias a este hombre fue sembrada la semilla del futuro árbol estomatológico en Cuba después del triunfo de la Revolución y se convirtió así en un precursor de la Docencia Médica Media y Profesional de la Estomatología.

Professor López Campo, example training new generations. Featured in revolutionary activities and participation in social, human resource training and university level over Stomatology, Professor of several undergraduate courses and graduate and as a national staff training para-stomatological. Historical research was conducted to gather more general biographical data of Dr. José Felipe Lopez Field. It was as documentary sources record box, Faculty of Stomatology and documentation provided by the family. The information was organized according to their political performance, their teaching-administrative, scientific activity and the decorations he received from others. Thanks, this man who sow the seeds of future stomatological tree in Cuba after the triumph of the Revolution, becoming a forerunner of Medical teaching and Professional Media Stomatology.

Disección traumática de la arteria carótida interna y embolismo cerebral en un jugador de fútbol: reporte del primer caso / Blunt carotid injury and brain embolism in soccer player: first case report

Reportamos el caso de un varón de 18 años quien sufrió contusión cervical por impacto con balón de fútbol. Tres días después fue hospitalizado con hemiplejia derecha directa y afasia de expresión. La resonancia magnética cerebral mostró lesión isquémica izquierda en ganglios basales. El doppler carotideo evidenció trombo desde el origen de la arteria carótida común izquierda extendida a la arteria carótida interna izquierda (CII) y la angiotomografía documentó disección de CII (lesión traumática carotídea tipo IV). Se optó por anticoagulación con warfarina y fisioterapia de rehabilitación; con evolución favorable. La incidencia de la injuria traumática carotídea es muy rara, más aún en futbolistas; el tratamiento es aún controversial, por lo que consideramos de interés el reporte de este caso.

We report the case of an 18-year-old male patient who suffered cervical trauma with a soccer ball. He presented three days after with right hemiparesis and expressive aphasia. The magnetic resonance image showed an ischemic lesion on the left basal ganglia area. The Doppler ultrasound revealed a thrombus extending from the left common carotid artery to the left internal carotid artery, and the angio-computed tomographic scan revealed a dissection of the left internal carotid artery (carotid lesion type IV). Anticoagulation with warfarin and physiotherapy were started with good clinical evolution. The traumatic injury of the carotid artery is very rare. Treatment is controversial, so we consider interest report of this case.

Comparação da digestibilidade de um alimento seco extrusado entre cães adultos e filhotes / Digestibility of dry extruded food in adult dogs and puppies

Os diversos alimentos completos para cães existentes no mercado objetivam atender as necessidades nutricionais do animal quanto ao estádio fisiológico, conforme as alterações que possam ocorrer no aproveitamento dos nutrientes. Com a finalidade de comparar os coeficientes de digestibilidade aparente (CDA) e as características das fezes de um alimento seco extrusado de cães adultos e filhotes, foram utilizados 12 cães da raça Beagle, sendo seis adultos, cinco anos, e seis filhotes, cinco-seis meses, mantidos em gaiolas metabólicas e distribuídos em delineamento inteiramente ao acaso. Os animais foram alimentados duas vezes ao dia com um alimento completo seco extrusado para filhotes, por um período de adaptação de cinco dias seguidos por cinco dias de coleta total de fezes. Houve diferença apenas para o CDA do extrato etéreo em hidrólise ácida, sendo maior para os filhotes - 95,3 vs 89,5 por cento. Em relação às características das fezes, os filhotes apresentaram pior escore fecal, devido às fezes terem se mostrado mais úmidas, além de maior pH em fezes secas e maior teor de amônia, culminando em pior qualidade. Conclui-se que filhotes de 5-6 meses de idade apresentam maior digestibilidade da gordura quando comparado a cães adultos, porém defecam fezes com pior escore fecal.

Comportamiento de la bronquiolitis en pacientes ingresados / Behavior of bronchiolitis in admitted patients

INTRODUCCION: la bronquiolitis es una enfermedad aguda respiratoria baja, que ocasiona un alto número de ingresos en lactantes. OBJETIVO: identificar el comportamiento de la bronquiolitis para poder tomar decisiones y trazar estrategias sanitarias y administrativas, así como pautas institucionales para el Servicio de Urgencias, en relación con los criterios de ingreso y la prevención de los factores de riesgo modificables más frecuentes que presentan estos pacientes. MÉTODOS: estudio descriptivo, retrospectivo y transversal de 67 lactantes egresados con el diagnóstico de bronquiolitis durante los meses de septiembre 2005, febrero 2006, septiembre 2006 y febrero 2007. Se revisaron las historias clínicas de 70 lactantes, y se excluyeron 3 por no tener los elementos al examen físico para clasificar la severidad de la enfermedad. RESULTADOS: 57 pacientes fueron menores de 6 meses (85 por ciento), 43 del sexo masculino (64 por ciento), 54 de nuestros casos (80 por ciento) tuvieron una lactancia materna inadecuada, en 44 niños (66 por ciento ) existían fumadores en la vivienda, 49 de los pacientes (73 por ciento) fueron clasificados según la severidad de la enfermedad en moderados y graves. CONCLUSIONES: el 100 por ciento de nuestros pacientes presentaron algún factor de riesgo de la enfermedad, con predominio de la edad menor de 6 meses, sexo masculino, lactancia materna inadecuada o ausente, y fumadores en la vivienda. En cuanto a la severidad de la enfermedad predominaron los pacientes evaluados como moderados

INTRODUCTION: bronchiolitis is a low respiratory acute disease provoking a high number of admissions in breast-fed babies. OBJECTIVE: to identify the behavior of the bronchiolitis to take decisions and to design administrative and health strategies, as well as institutional guidelines for the Emergence Service, related to the admission criteria and prevention of the more frequent modifiable risk factors present in these patients. METHODS: a cross-sectional, retrospective and descriptive study was conducted in 67 breast-fed children discharged and diagnosed with bronchiolitis during September, 2005, February, 2006 and February, 2007. The medical records from 70 breast-fed children were reviewed excluding three of them due to a lack of elements in the physical examination to classify the severity of the entity. RESULTS: fifty five patients were aged under 6 months (85 percent), 43 of male sex (64 percent), and 54 of our cases (80 percent) had a inappropriate breastfeeding, 44 children(66 percent) had a history of family smokers, 49 of patients (73 percent) were classified as moderate and severe according the severity of the entity. CONCLUSIONS: the 100 percent of our patients had some risk factor of the disease, with predominance of an age under 6 months, male sex, inappropriate or lacking breastfeeding and a history of family smokers. As regards the severity of disease there was predominance of patients assessed as moderate