Assessment of zinc inadequacy among tribal adolescent population of central India - A cross-sectional study

Background & objectives: Zinc is a crucial micronutrient in adolescence, required for promoting growth and sexual maturation. Adolescents of some tribes may be at high risk of zinc deficiency due to dietary inadequacy and poor bioavailability of zinc from plant-based diets. This study aimed to evaluate the risk of zinc deficiency by estimating prevalence of inadequate zinc intake, prevalence of low serum zinc and stunting among tribal adolescents. Methods: A cross-sectional community-based survey was conducted among adolescents (10-19 yr) in three purposively selected districts where Bhil, Korku and Gond tribes were in majority. Structured data collection instrument comprising information about sociodemographic characteristics and dietary recall data was used. Anthropometric assessment was conducted by standardized weighing scales and anthropometry tapes, and blood sample was collected from antecubital vein into trace element-free vacutainers. Serum zinc was estimated using an atomic absorption spectrophotometer. Results: A total of 2310 households were approached for participation in the study, of which 2224 households having 5151 adolescents participated. Out of these enlisted adolescents, 4673 responded to dietary recall (90.7% response rate). Anthropometry of 2437 participants was carried out, and serum zinc was analyzed in 844 adolescents. The overall prevalence of dietary zinc inadequacy was 42.6 per cent [95% confidence interval (CI) 41.2 to 44.1] with reference to the estimated average requirement suggested by International Zinc Nutrition Consultative Group (IZiNCG) and 64.8 per cent (95% CI 63.4 to 66.2) with Indian Council of Medical Research-recommended requirements. Stunting was observed in 29 per cent (95% CI 27.2 to 30.8) participants. According to IZiNCG cut-offs, low serum zinc was detected in 57.5 per cent (95% CI 54.1 to 60.8) of adolescents, whereas it was 34.4 per cent (95% CI: 31.2-37.5) according to the national level cut-off. Interpretation & conclusions: Risk of dietary zinc inadequacy and low serum zinc concentration amongst adolescents of the Gond, Bhil and Korku tribes is a public health concern.

Identifying the Causes of Nutrition Inadequacy in Vietnamese Married Immigrant Women and Korean Spouses through Qualitative Research

This study examined the possible causes of nutritional inadequacy in Vietnamese immigrant women married to Korean husbands. Qualitative in-depth interviews were conducted with a sample of 34 Vietnamese marriage immigrant women and 17 Korean spouses participating in or having experienced Nutrition Plus from four Community Health Centers in Seoul, Korea. The study results showed that the nutritional staus of the Vietnamese marriage immigrant women was affected by the unfamiliar Korean food (cultural factor), low household income (economical factor), difficulty in purchasing Vietnamese food (environmental factor), and low accessibility to nutrition support systems (social factor). The Korean husbands' nutritional status was affected by the unfamiliar Vietnamese food (cultural factor), low household income (economic factor), and irregular working conditions (social factors). Nutritional interventions as a public service to the community needs to be developed and applied. Suggestions are presented regarding the future efforts to better understand and meet the nutrition needs of intermarried couples to respond to their heterogeneous needs and deliver adequate nutrition service to ever increasing intermarried families.

Analysis of risk factors of hyperuricemia and its outcomes of renal function in diabetes mellitus in Shanghai / 上海交通大学学报（医学版）

Objective: To analyze the risk factors of hyperuricemia (HUA) and its outcomes of renal function in patients with diabetes mellitus in Shanghai. Methods: A total of 3 454 patients with diabetes who were admitted to the Shanghai Diabetes Clinical Center from July 2011 to September 2014 were selected. The prevalence of HUA, predisposing factors and renal function of diabetic patients were analyzed. Patients were divided into HUA group (n=548) and normal serum uric acid (SUA) group (n=2 906). General characteristics and clinical parameters of diabetic patients were compared between two groups. Pearson correlation analysis and multivariate Logistic regression were used to analyze the relationship between SUA and renal dysfunction and abnormal proteinuria in diabetic patients. Results: In Shanghai patients with diabetes, the prevalence of HUA was 15.87%, 14.52% in men, 17.80% in women. Glomerular filtration rate (GFR), fasting C-peptide, gender, age, natural logarithm of the ratio of microalbuminuria to creatinine (LnACR), glycated albumin (GA), triacylglycerol (TAG), high density lipoprotein cholesterol (HDL-C) and body mass index (BMI) were independently associated with SUA (all P<0.05). In diabetic patients with HUA, 1-SD increment in the SUA level was associated with a 0.8% increased prevalence of renal dysfunction, 0.3% increased prevalence of incident abnormal albuminuria and 0.5% decreased prevalence of hyperfiltration (all P<0.05). Conclusion: Diabetes has an important impact on HUA. Actively improving insulin resistance and controlling blood glucose may improve HUA. HUA is an independent risk factor for the occurrence and development of diabetic nephropathy. Therefore, monitoring the level of SUA in diabetic patients is of great significance in the prevention of diabetic nephropathy.

An Analysis of Risk Factors of Renal Inadequacy after Postpartum Hemorrhage / 昆明医科大学学报

Objective To investigate the risk factors of renal inadequacy after postpartum hemorrhage. Methods According to the diagnostic criteria of postpartum hemorrhage, 200 cases of postpartum hemorrhage who were admitted to the Intensive Care Unit from January 2010 to December 2014 were collected. The general situation, history of pregnancy induced hypertension and gestational diabetes mellitus, ASA classification, anesthesia method, delivery mode, postpartum hemorrhage and other indicators. The risk factors were analyzed by logistic regression.Results Among 200 cases of postpartum hemorrhage who were admitted in the intensive care unit, 21 cases with renal insufficiency were seenafter delivery (10.5%) aged between 20 and 44 years old with the average age of (29.24 ±4.58) years old. Using the ASA evaluation criteria to evaluate the preoperative situation, we observed179 cases in ASA grade levelⅠ (89.5%), 20 casesin level Ⅱ (10%), one casein level Ⅲ (0.5%) and no case in grade Ⅳ. Among all the women, we found 147 cases of vaginal delivery (73.5%), 53 cases of cesarean section (26.5%),196 cases of spinal anesthesia (including labor analgesia) (98%) and 4 casesof general anesthesia (2%) . There were 12 patients with hypertension during pregnancy (6%), and 188 patients without hypertension (94%) . There were 9 cases of gestational diabetes mellitus (4.5%), and 191patients without gestational diabetes mellitus (95.5%).Conclusions The risk factors of renal insufficiency after postpartum hemorrhage were: age older than 35 years, cesarean delivery, pregnancy history of hypertension or gestational diabetes mellitus.

Mediating effect of feeling of inadequacy on relationship between self consistency and anxiety in medical students / 中华行为医学与脑科学杂志

ObjectiveTo explore the relationship among self consistency and congruence,the feeling of inadequacy(FIS) and anxiety as well as the mediating effect of FIS between self consistency and congruence and anxiety.MethodsA total of 1164 students recruited from two medical colleges in Hebei province using cluster random sampling were investigated with scale for the feeling of inadequacy,self consistency and congruence scale and rating anxiety scale.ResultsThe relevance ratio of anxiety in Hebei medical colleges students was 42.7%.There were significant differences in the detection rate among genders(male:46.4%,female:40.5%),grade(freshman:38.9%,sophomore:41.0%,junior:47.5%)and family economic status(Preferably:38.5%,commonly:40.1%,badly:50.8%) in medical students(all P0.05).Anxiety score was positively correlated with the score of self consistency and congruence(r=0.274,P<0.01),and was negatively correlated with the score of the feeling of inadequacy (r=-0.364,P<0.01).And the score of self consistency and congruence was negatively correlated with the score of feeling inadequacy(r=-0.335,P<0.01).Multiple stepwise regression analysis revealed that factors of the feeling of inadequacy and self consistency and congruence accounted for 35.6% of anxiety variance.The feeling of inadequacy played a mediating role in self consistency and congruence and anxiety.The mediating rate was 60.06%.ConclusionThe anxiety issue of medical students should be paid more attention.It is possible for the high level of feeling of inadequacy and low level of self consistency and congruence to increase the occurrence rate of anxiety.The feeling of inadequacy can strongly predict medical students'anxiety.

Effect of the expressive psychotherapy on the feeling of inadequacy and loneliness of chronic schizophrenia inpatients / 中华行为医学与脑科学杂志

Objective To explore the effect of the expressive psychotherapy on the feeling of inadequacy and loneliness of inpatients with chronic schizophrenia.MethodsTotally 120 chronic schizophrenia inpatients met recruited criteria were randomly divided into study group(n=60) and control group(n=60) according to random number table.57 patients in each group finished all the follow-ups finally.The patients in two groups were received normal medications while the patients in intervention group also attended expressive psychotherapy.All the patients were assessed at baseline,6 weeks and 12 weeks of treatment with the feeling of inadequacy scale (FIS) and the status and trait loneliness scale (STLS).Results(1) The FIS score(F=225.19,P<0.01),STLS total score(F=225.20,P<0.01),STLS status score(F=240.40,P<0.01) and STLS trait score(F=106.75,P<0.01) decreased significantly in both groups after intervention.(2) The FIS score of study group was much lower than those of control group at the at 6-week-follow-up(4.93±20.86,57.89±20.48,t=-2.250,P<0.01) and 12-week-follow-up(38.43±17.50,57.21±22.98,t=-4.900,P<0.01).(3) After 6 weeks treatment and 12 weeks treatment,STLS total score(6 weeks:(54.32±12.30) vs (68.46±15.53),t=-5.425,P<0.01,12 weeks:(44.16±10.81) vs (65.75±16.26),t=-8.386,P<0.01),STLS status score (6 weeks:(25.95±6.41) vs (34.31±7.91),t=-6.239,P<0.01,12 weeks:(19.15±5.49) vs (32.58±8.45),t=-10.103,P<0.01) and STLS trait score (6 weeks:(28.37±6.73) vs (34.15±8.45),t=-4.138,P<0.01,12 weeks:(25.00±6.18) vs (33.15±8.22),t=-6.019,P<0.01) in study group were lower than those in control group,and the difference was statistically significant.ConclusionExpressive psychotherapy can effectively improve the loneliness and inadequacy of patients with chronic schizophrenia.

Insuficiencia de convergencia: opciones terapéuticas en dos féminas / Convergence inadequacy: therapeutic options in two women

Se presentan 2 casos clínicos de féminas de 49 y 25 años, que acudieron a la consulta de Optometría en la Facultad de Enfermería y Tecnología de la Salud "Dr. Juan Manuel Páez Inchausti" de Santiago de Cuba, por presentar marcado cansancio visual durante el trabajo prolongado e intolerancia a la nueva corrección óptica. Se efectuó una evaluación optométrica integral, que mostró en ambos casos una insuficiencia de convergencia. Por las características de las pacientes, se decidió indicar prisma inducido por descentración del centro óptico en la que presentaba presbicia, y continuar la adaptación de la nueva corrección óptica, además de ejercicios de convergencia, en la afectada más joven. Con estos procedimientos se eliminaron los síntomas en ellas.

Two case reports of 49 and 25 years women are presented that went to the Optometry Service of "Dr. Juan Manuel Páez Inchausti" Nursing and Health Technology Faculty in Santiago de Cuba, due to a marked visual fatigue during the lingering work and intolerance to the new optic correction. A comprehensive optometric evaluation was made that showed in both cases a convergence inadequacy. Due to the characteristics of the patients, it was decided to indicate prism induced by unfocused optic center in the one presenting presbyopia, and to continue the adaptation of the new optic correction, besides convergence exercises, in the younger affected patient. With these procedures the symptoms were eliminated in them.

Mediating effects of self feeling of inadequacy between resilience and alexithymia in depressive undergraduates / 中华行为医学与脑科学杂志

Objective To study the relationship among resilience,self feeling of inadequacy and alexithymia in depressive undergraduates,and to provide a theoretical basis for the prevention and intervention of depression among undergraduates.Methods 500 undergraduates of two universities in Hebei Province were collected by cluster sampling method.Beck depression scale,adolescent resilience scale,Toronto alexithymia scale and self feeling of inadequacy scale were applied to undergraduates.The survey results were analyzed statistically.Results The detection rate of depression was 28％(119/426) in undergraduates.Total score of Alexithymia Scale(69.99±9.43) was higher than the norm(65.70±7.98),and the difference was statistical significant (P＜0.05).The score of self feeling of inadequacy had a significant difference between male (149.88±28.00) and female(138.58±28.79) (P＜0.01).Neither gender nor grade had significant difference in depression,alexithymia and resilience(P＞0.05).Self feeling of inadequacy was positively correlated with alexithymia (P＜0.05).Resilience was negatively correlated with self feeling of inadequacy and alexithymia(P＜0.05).For the depressive undergraduates,self feeling of inadequacy served as a full mediator between the resilience and alexithymia,whereas for the non depression undergraduates it was a partial mediator.Conclusion Depression undergraduates have serious alexithymia,serious self feeling of inadequacy and poor resilience.Self feeling of inadequacy serves as a mediator between the resilience and alexithymia in depressive and non-depressive undergraduates.

Nutritional Risk Assessment of Eleven Minerals and Trace Elements: Prevalence of Inadequate and Excessive Intakes from the Second French Total Diet Study.

Aims: Adequate coverage of nutrient requirements is a real health concern and surveillance of the nutritional status of a population is a key element for public policies. This study aimed at providing a reliable nutritional risk assessment of the French population based on prevalences of inadequate and excessive intakes of eleven minerals and trace elements. Methodology: Intakes from foods (dietary supplements excluded) were estimated by combining composition data from the second national Total Diet Study (TDS2/2007-2009) and consumption data from the Individual and National Study on Food Consumption. Results were compared with those from other TDSs. Results: Sodium intakes exceeded World Health Organization (WHO) guidance values, respectively for 74% of adults, and for 76% of children. For calcium and magnesium, the prevalence of inadequate intakes in adults and children ranged from approximately 50 to 70% to over 80% in teenagers. Prevalences of inadequacy were 13% in adults and 18% in children for selenium, and 40% in children and 74% in 16-17 year-old girls for iron. Conclusion: These substantial risks of inadequate intakes should be considered in the light of nutritional status biomarkers. Furthermore, effort to reduce excessive intakes of sodium in the French population should be maintained.

Proposition and Application of a Dish-Based Target Pattern for Korean Adolescent Girls / 대한지역사회영양학회지

OBJECTIVES: Maintaining a balanced diet and thus health is crucial for adolescents, and the first step for balanced diet practice is meal planning. Adolescents, however, find it difficult to plan their meals. This study thus was set out to design an easier way of planning meals for adolescent girls. METHODS: A dish-based target pattern for adolescent girls was tabulated, and validity of this was examined. Meal plan applying a dish-based target pattern was prepared by 150 female middle school students, and nutritional adequacies of those meal plans were examined. Validity and adequacy were tested by energy content, energy contribution ratio, nutrient adequacy ratio (NAR), probability of nutrient inadequacy, index of nutritional quality (INQ) calculation. RESULTS: A dish-based target pattern with 11 dish groups was validated for nutritional adequacy. Though the NAR of calcium was 0.96, the INQ of calcium was 1.00. The average energy supply from the meal plans was 2,379 kcal, higher than the estimated energy requirement of a female middle school student, but the energy contribution ratio of carbohydrates, proteins, and fats were all adequate according to the acceptable macronutrient distribution range (AMDR). NAR of all nutrients examined were 1.0, except for calcium. The NAR and INQ of calcium were 0.87 and 0.75, respectively, and the meal plans at risk for calcium inadequacy was 19.30%. CONCLUSIONS: A dish-based target pattern proposed for adolescent girls was valid, but the meal plan prepared by female middle school students using this approach was high in energy and low in calcium supply. To cut down the energy supply from the meal plan, it is necessary to recommend dishes low in fat and use low fat cooking methods. To increase the calcium supply, it is important to recommend seaweed and legume group dishes with higher Ca INQ food items.

Caboclo na cidade / Caboclo in the city / Un mestizo en la ciudad

A partir de um caso clínico de um morador da zona rural que migra para o centro urbano, destaca-se a vivência de inadequação provocada pelo sentimento de desterro. Considera-se que os processos de identificação não se manifestam apenas com pessoas, mas também com o meio onde se convive. Estabelece uma correlação entre a relação idealizada que o paciente estabelecia com a "mãe terra" ao sentimento de exclusão característico da perda da ilusão edípica. Utilizando-se de uma "moda de viola", investiga-se como a angústia gerada na perda da identidade provocou somatizações e sofrimento. A superação desse estado se deu com o desenvolvimento da capacidade de pensar e simbolizar, atribuindo significados psíquicos às vivências afetivas...

From the clinical case of a rural inhabitant that migrates to an urban centre, we highlight the experience of inadequacy caused by the feeling of exile. It is considered that the identification processes do not manifest only with people but also with the environment where one lives. A correlation is established between the idealised relationship the patient had with their "motherland" with the feeling of exclusion, characteristic of the loss of oedipal illusion. Using "country songs", we've tried to investigate how the anxiety generated by the loss of identity caused somatisation and suffering. Overcoming this state occurred with the development of the ability to think and symbolise, assigning psychic meanings to affective experiences...

A partir de un caso clínico que describe un habitante rural que migra a un núcleo urbano, se destaca la vivencia de inadecuación causada por el sentimiento de destierro. Se considera que los procesos de identificación no se manifiestan sólo con las personas, sino también con el entorno donde se vive. El autor establece una correlación entre la relación idealizada que el paciente tenía con la "madre tierra" y el sentimiento de exclusión característico de la pérdida de la ilusión edípica. Usando "canciones folklóricas" se investigó cómo la angustia generada por la pérdida de identidad había provocado somatizaciones y sufrimiento. La superación de esta situación fue posible gracias al desarrollo de la capacidad de pensar y simbolizar, pudiendo asignar significados psíquicos a las experiencias afectivas...

Application value of serum cardiac marker detection in patients with renal dysfunction / 国际检验医学杂志

Objective To explore the change of serum high-sensitivity cardiac troponin T(hs-cTnT),myoglobin(MYO),creatine kinase isoenzyme(CK-MB)mass(CK-MB mass)and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels in the patients with renal dysfunction.Methods The inpatients with renal dysfunction(excluding cardiac and skeletal muscle diseases)in our hos-pital were collected and divided into the compensation period group(30 cases),decompensation period group(24 cases)and uremia group(22 cases)according to serum urea and creatine concentration,and 36 healthy individuals were selected as the control group. Venous blood was collected on an empty stomach and separated for obtaining serum.Serum levels of hs-cTnT,MYO,CK-MB mass and NT-proBNP were measured by the electrochemiluminescent immunoassay.Results Serum hs-cTnT levels in the compensation period group,decompensation period group,uremia group and the control group were 16.4(10.9-24.2),17.0(13.0-25.5),25.9 (16.5-33.8),13.7(9.4 -19.7 )pg/mL respectively.Serum MYO levels were 52.4 (40.0 -96.5 ),87.9 (57.7 -118.3 ),115.7 (94.2-175.8),34.8(24.3-48.1)ng/mL,respectively.Serum CK-MB mass levels were 1.03(0.82 -1.75),1.31 (1.08 -1.69), 1.66(1.01-2.46),1.88(1.63-2.43)ng/mL,respectively.Serum NT-proBNP levels were 292.5(123.3-576.2),363.3(192.3-893.3),1 357.2(536.5 -4 662.9),110.3 (70.1 -196.3)ng/mL,respectively.The serum hs-cTnT,MYO and NT-proBNP levels were increased with renal function decrease.The nonparametric Kruskal-Wallis H test showed statistically significant difference a-mong groups(H =14.46,49.81 and 35.00,P 0.05).Conclusion The patients with renal dysfunction have the higher risk rate for complicating the cardiovascular e-vents.Early detection of cardiac markers conduces to the diagnosis of myocardial injury,the evaluation of the risk rate of myocardial infarction occurrence in future and the diagnosis of heart failure and evaluation of the risk rate of heart failure occurrence in future.

Peri-operative treatment for total hip replacement in patients with hepatic cirrhosis / 中国组织工程研究

BACKGROUND:Hepatic cirrhosis may adversely affect the outcome of major orthopedic surgery, such as total hip arthroplasty. Peri-operative treatment is the chal enge for al orthopedic surgeons. OBJECTIVE:To analyze the safety and feasibility of hip replacement surgeries in patients with hepatic cirrhosis. METHODS:Thirteen patients with hepatic cirrhosis that underwent hip replacement were retrospectively analyzed to evaluate the treatments and their efficacy before and after replacement. RESULTS AND CONCLUSION:Al 13 surgeries were successful y performed. Al cases were fol owed up for more than five months and were graded according to Child-Pugh Criteria for hepatic functional reserve preoperatively and postoperatively. Five cases of the seven preoperative grade A cases preserved grade A postoperatively during a two-week observation, while another two cases rose to grade B and needed hepatic conservation treatment before discharge. Two cases of the six preoperative grade B cases rose to grade C with developed jaundice and ascites. Of the two, one even suffered a complication of upper gastrointestinal hemorrhage 5 days after surgery. Somatostatin and proton pump inhibitors were administered to stop bleeding. Al cases gained a satisfying recovery. Harris hip score at fol ow-up showed favorable hip function. Hip replacement is safe and feasible for patients with hepatic cirrhosis when ful evaluation of hepatic function and appropriate perioperative management are ensured.

Factores determinantes de la deserción escolar en el Policlínico Docente "Frank País García" / Determinant factors of the school desertion in «Frank País García¼ Teaching Polyclinic from Santiago de Cuba

Se realizó un estudio de tipo investigación en el campo de la educación médica de pregrado a 33 estudiantes del primer año de medicina en el primer semestre del curso 2010-2011 en el Policlínico Docente "Frank País García" de Santiago de Cuba, con vistas a identificar los factores determinantes de la deserción escolar de este período. Para obtener la información, se aplicó un cuestionario a los educandos, avalado por criterios de expertos, y se llevaron a cabo métodos teóricos y empíricos (descritos en el trabajo). Se obtuvo que la deserción escolar fuera elevada y entre sus principales causas estuvieron la insuficiencia docente, el abandono y la falta de orientación vocacional.

A study of investigation type was carried out in the field of pregraduate medical education to 33 first year students in the first semester of the course 2010-2011 at "Frank País García" Polyclinic in Santiago de Cuba, with the objective of identifying the determinant factors of the school desertion in this period. To obtain the information, a inquiry was applied to the students, endorsed by experts' criteria, and theoretical and empiric methods (described in the work) were carried out. It was obtained that the school desertion was high and among its main causes there were teaching inadequacy, desertion and the lack of vocational guide.

The effects of pulsatile perfusion during cardiopulmonary bypass procedures on renal inadequacy / 中国医师杂志

Objective To evaluate the clinical effects of pulsatile perfusion on the renal inadequacy during cardiopulmonary bypass ( CPB). Methods From January 2007 to May 2010, 55 patients with renal inadequacy undergoing open heart surgery were randomized into pulsatile group ( n = 28 ) and nonpulsatile group (n =27). Following parameters were examined: urea nitrogen , creatinine,uric acid, urine volume and blood gas, electrolyte and lactic acid before arteriae aorta opening. Results The urine volume during CPB was significant higher in the pulsatile group ( P ＜0. 01). The blood lactate level before arteriae aorta opening were significant lower in the pulsatile group ( P ＜0. 01). Conclusion The pulsatile flow is better than nopulsatile flow in oxygen metabolism of renal protection.

Diet Quality and Food Patterns of Obese Adult Women from Low Income Classes: Based on 2005 KNHANES / 대한지역사회영양학회지

This study aims to identify the dietary patterns relevant to obesity of Korean women among low income classes. Adults 20-64 years were used as study subjects from the data of 2005 Korea National Health and Nutrition Examination Survey. We compared obese and normal-weight women in terms of their nutrients intake, diet quality and food patterns. Diet quality was assessed by using the Nutritional Adequacy Ratio (NAR) and Index of Nutritional Quality (INQ). Our results showed higher prevalence of obesity among lower socioeconomic status women. In men, there were no significant associations with socioeconomic status and prevalence of obesity. Higher risk of nutritional inadequacy was observed among obese women compared to normal weight women. Obese women showed significantly lower INQ for nutrients such as Ca, Fe, Vitamin A, Thiamin, Riboflavin and Vitamin C compared to other women. They consumed significantly higher amount of rice (p < 0.05) and lower amount of vegetables (p < 0.01). By contrast, obese men from low income classes showed higher intake of those nutrients. Obese men also consumed significantly higher amount of meats than normal weight men. Therefore, this study suggests that genderspecific approaches based on economic situation should be considered in developing the intervention program for managing obesity for low income classes.

Factores asociados al uso inadecuado de cefalosporinas en pacientes hospitalizados / Factors associated with an inappropriate use of cephalosporins in admitted patients

Las cefalosporinas se han convertido en un recurso terapéutico valioso, pero su uso inadecuado ha estado asociado al desarrollo de resistencia antimicrobiana, problema de significativa importancia en la práctica clínica diaria. No existen informes sobre el tema en la literatura médica cubana, por lo que se realizó este estudio para identificar la frecuencia y los factores asociados al uso inadecuado de cefalosporinas en pacientes hospitalizados. Se realizó un estudio descriptivo, mediante prevalencias puntuales seriadas, de las prescripciones de cefalosporinas en los pacientes admitidos en el Hospital Joaquín Albarrán (mayo de 2008 a abril de 2009). De los pacientes se obtuvieron las características generales y de la prescripción de las cefalosporinas, y esta información fue analizada por expertos para identificar casos de prescripción inadecuada. Mediante regresión logística se determinó el grado de asociación de la inadecuación con las variables independientes. Se realizó análisis discriminante para identificar las variables que discriminaran los grupos de pacientes en función de la calidad de la prescripción. Se observaron inadecuaciones en el 18,4 por ciento de los 711 pacientes evaluados, y éstas fueron superiores en los pacientes de menor edad (p < 0,001), localización no respiratoria de infección (p < 0,001), de servicio quirúrgico (p < 0,001), antecedente de cirugía reciente (p < 0,05) e insuficiencia renal crónica (p < 0,05). El antecedente de insuficiencia respiratoria crónica se asoció a prescripción adecuada (p < 0,05). Las variables anteriores discriminaron los grupos de pacientes en función de la adecuación de la prescripción. Se identifica la frecuencia de inadecuación y se definen como factores relacionados la edad, la localización no respiratoria de infección, el antecedente de insuficiencia renal crónica, la cirugía reciente y el ser atendido en servicios quirúrgicos(AU)

The cephalosporins become a valuable therapeutical resort but its inappropriate use has been associated with the development of antimicrobial resistance a very significant problem in the daily clinical practice. There are available reports on this subject in the Cuban medical literature, thus a study was made to identify the frequency and the factors associated with the inappropriate use of cephalosporins in admitted patients. A descriptive study was conducted using the serial detailed prevalences of cephalosporins prescriptions in patients admitted in Joaquín Albarrán Hospital (from May, 2008 to April, 2009). From patients we get the general features and of the cephalosporin prescription and this information was analyzed by experts to identify the cases of inappropriate prescription. Using the logistic regression it was determined the unsuitable association degree with the independent variables. A discriminant analysis was carried out to identify the variables to differentiate the patient groups to determine the prescription quality. RESULTS. There was inadequacy in the 18,4 percent of the 711 assessed patients ant these were higher in younger patients (p < 0,001), non-respiratory localization of infection (p < 0,001), of surgical service (p < 0,001), a history of recent surgery (p < 0,005) and chronic renal failure (< 0.05). The history of chronic respiratory failure was associated with a suitable prescription (p < 0,05). The above variables discriminate the patient groups to adapt the prescription. Inadequacy frequency is identified defining as factors related to age, the infection non-respiratory localization, the chronic renal failure background, the recent surgery and being served in surgical services(AU)

Paratireoidectomia subtotal no tratamento do hiperparatireoidismo secundário à doença renal crônica / Subtotal parathyroidectomy in the treatment of secondary hyperparathyroidism to chronic renal disease

Objetivos: apresentar os resultados obtidos com a paratireoidectomia (PTX) subtotal em pacientes com hiperparatireoidismo (HPT) secundário àinsuficiência renal crônica (IRC), enfocando a contribuição e as dificuldades técnicas da cirurgia. Pacientes e Métodos: no período de janeiro de 1998 ajunho de 2005 foram operados consecutivamente no Hospital Universitário Antonio Pedro, 33 pacientes renais crônicos portadores de HPT secundário. Ascirurgias foram realizadas pelo mesmo cirurgião e a mesma equipe de nefrologista se encarregou do controle pré e pós-operatório. Esse grupo foiconstituído por 19 homens e 14 mulheres com idade média de 40,5 (16/68) anos e todos se encontravam em tratamento dialítico regular, com tempo médiode diálise de 113 (20/189) meses. Além dos cuidados habituais, todos os pacientes receberam calcitriol após as três últimas sessões de diálise queantecederam a cirurgia. Resultados: os resultados mais expressivos se refletiram sobre o aparelho músculo-esquelético e foram muito significativas as remissões das queixas de dor ósteo-articular, fraqueza e prurido; as calcificações não vasculares foram reabsorvidas e sinais de remineralização ósseaforam identificados após a cirurgia. As complicações pós-operatórias mais freqüentes foram a rouquidão transitória (21%), a hiperpotassemia (12%) e osangramento pós-operatório (12%). Nesse grupo há uma recidiva comprovada e já reoperada e dois pacientes encontram-se em fase de investigação, por provável insucesso na cirurgia, já que o PTH continua elevado. Os resultados menos favoráveis foram mais freqüentes nos casos onde foram encontradas apenas três glândulas paratireóides. Não houve mortalidade operatória. Conclusões: a PTX subtotal pode ser realizada com segurança e é efetiva para a remissão de diversas manifestações do HPT secundário, desde que continuem sob rigoroso controle clínico para evitar possíveis recidivas por hiperplasia do resíduo glandular.

Objective: to report the results obtained with subtotal parathyroidectomy (PTX) in patients with hyperparathyroidism (HPT) secondary to chronic renaldisease (CRD), focusing on the contribution and technical difficulties of the surgery. Methods: From January of 1998 to June of 2005, thirty-three end-stagerenal disease (ESRD) patients consecutively underwent PTX in the university hospital. Their mean age was 40.5 years; Nineteen were male, and 14 female.Mean time on dialysis was 113 months. Surgeries were accomplished by the same surgeon and the same nephrologist was in charge of the pre- andpostoperative care of the whole patients. Among the clinical manifestations those related to the osteopathy were the most prevalent ones. All patientsunderwent preoperative care and received calcitriol after the last three dialysis sessions that preceded the surgery. Results: the most expressiveimprovements pertained to the muscle-skeletal system. The alleviation of bone pain, joint pain, muscle weakness and itch were marked. Extra-vascularcalcifications were reabsorbed and radiological signs of bone remineralization were identified after the surgery. The most frequent postoperativecomplications were temporary hoarseness (21%), hyperkalemia (12%), and postoperative bleeding (12%). So far, we have faced one proven recurrencethat was managed by a surgical reintervention. In addition, PTH continues to be high in two patients who are undergoing prepare for a new surgery. Bad results seemed to be more frequent on patients in which only three parathyroid glands were found during the operation. Surgery was not associated to fatalities. Conclusions: subtotal PTX can be accomplished with safety in ESRD patients being effective for the alleviation of several manifestations of the secondary HPT. Patients should be maintained under strict clinical control to monitor for recurrences due to hyperplasia of the residual glandular tissue.

Velopharyngeal inadequacy: review of 16 consecutive cases