Complicaciones y mortalidad en pacientes neurocríticos / Complications and mortality in neurocritic patients

Objetivo: Relacionar las complicaciones y el riesgo de muerte en pacientes neurocríticos admitidos en la unidad de cuidados intensivos (UCI) del Hospital Universitario de Caracas durante un período de 5 meses. Métodos: investigación observacional, prospectiva, descriptiva. La muestra estuvo conformada por 65 pacientes neurocríticos, ≥ 18 años, con patologías médicas o quirúrgicas, ingresados en la UCI. El análisis estadístico incluyó la determinación de frecuencias, promedios, porcentajes y medias para descripción de variables y el T de Student. Resultados: La edad promedio fue 50,98 ± 16,66 años; la población masculinarepresentó el 50,76%. Entre las complicaciones, la mayor incidencia correspondió a las no infecciosas (70,77 %) y los trastornos ácido-básicos de tipo metabólico, la anemia y las alteraciones electrolíticas fueron las más frecuentes; el 29,23% de los pacientes presentaron complicaciones infecciosas, y la neumonía asociada a ventilación mecánica fue la más frecuente (73,91 %). La comorbilidad con mayor incidencia fue hipertensión arterial sistémica (53,84%). El 90.70% requirió ventilación mecánica y el tiempo en VM fue 4.29 ± 6.43 días. La estancia en UCI fue 5.96 ± 7.72 días. El 29,23% presentó un puntaje en la escala APACHE II entre 5-9; el SAPS II presentó mayor incidencia entre los 6-21 y 22-37 puntos con (66,70%); el SOFA al ingreso se reportó < 15 puntos en 98,46% y > 15 en 1,53%. La mortalidad del grupo fue 23,08 % (n=15). Conclusiones: Las complicaciones no infecciosas predominaron sobre las infecciosas las primeras íntimamente relacionadas con la mortalida(AU)

Objective: To relate complications and the risk of death in neurocritical patients admitted to the intensive care unit (ICU) of the University Hospital of Caracas during a period of 5 months. Methods: observational, prospective, descriptive research. The sample was made up of 65 neurocritical patients, ≥ 18 years old, with medical or surgical pathologies, admitted to the ICU.The statistical analysis included the determination of frequencies, averages, percentages and meansfor description of variables and Student's T.Results: The average age was 50.98 ± 16.66 years; the male population represented 50.76%. Among the complications, the highest incidence corresponded to non-infectious complications (70.77%) and metabolic acid-base disorders, anemia and electrolyte alterations were the most frequent; 29.23% of patients presented infectious complications, and pneumonia associated with mechanical ventilation was the most frequent (73.91%). The comorbidity with the highest incidence was systemic arterial hypertension (53.84%), 90.70% required mechanical ventilation and the time on MV was 4.29 ± 6.43 days. The ICU stay was 5.96 ± 7.72 days. 29.23% had a score on the APACHE II scale between 5-9; SAPS II presented the highest incidence between 6-21 and 22-37 points with (66.70%); The SOFA upon admission was reported to be < 15 points in 98.46% and > 15 in 1.53%. The mortality of the group was 23.08% (n=15). Conclusions: Non-infectious complications predominated over infectious complications, the former being closely related to mortalit(AU)

Prevalence of Anemia in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis / 生物医学与环境科学（英文）

OBJECTIVE@#Anemia is a common public health concern in patients with type 2 diabetes worldwide. This study aimed to identify the prevalence of anemia among patients with diabetes.@*METHODS@#Electronic databases, including PubMed, Scopus, Web of Sciences, and Google Scholar, were searched systematically for studies published between 2010 and 2021. After removing duplicates and inappropriate reports, the remaining manuscripts were reviewed and appraised using theNewcastle-Ottawa Scale (NOS) tool. A random-effects model was used to calculate the pooled estimates of the extracted data using Stata version 17. Heterogeneity of the studies was assessed using the Q statistic.@*RESULTS@#A total of 51 articles containing information on 26,485 patients with diabetes were included in this study. The articles were mainly from Asia (58.82%) and Africa (35.29%). The overall prevalence of anemia was 35.45% (95% CI: 30.30-40.76), with no evidence of heterogeneity by sex. Among the two continents with the highest number of studies, the prevalence of anemia in patients with diabetes was significantly higher in Asia [40.02; 95% CI: 32.72-47.54] compared to Africa [28.46; 95% CI: 21.90-35.50] ( P for heterogeneity = 0.029). Moreover, there has been an increasing trend in the prevalence of anemia in patients with diabetes over time, from [15.28; 95% CI: 9.83-22.21] in 2012 to [40.70; 95% CI: 10.21-75.93] in 2022.@*CONCLUSION@#Globally, approximately 4 in 10 patients with diabetes suffer from anemia. Therefore, routine anemia screening and control programs every 3 months might be useful in improving the quality of life of these patients.

Association of ABCB1 gene polymorphisms rs1128503, rs2032582, rs4148738 with anemia in patients receiving dabigatran after total knee arthroplasty / 中华创伤杂志(英文版)

PURPOSE@#Dabigatran is usually prescribed in recommended doses without monitoring of the blood coagulation for the prevention of venous thromboembolism after joint arthroplasty. ABCB1 is a key gene in the metabolism of dabigatran etexilate. Its allele variants are likely to play a pivotal role in the occurrence of hemorrhagic complications.@*METHODS@#The prospective study included 127 patients with primary knee osteoarthritis undergoing total knee arthroplasty. Patients with anemia and coagulation disorders, elevated transaminase and creatinine levels as well as already receiving anticoagulant and antiplatelet therapy were excluded from the study. The association of ABCB1 gene polymorphisms rs1128503, rs2032582, rs4148738 with anemia as the outcome of dabigatran therapy was evaluated by single-nucleotide polymorphism analysis with a real-time polymerase chain reaction assay and laboratory blood tests. The beta regression model was used to predict the effect of polymorphisms on the studied laboratory markers. The probability of the type 1 error (p) was less than 0.05 was considered statistically significant. BenjaminiHochberg was used to correct for significance levels in multiple hypothesis tests. All calculations were performed using Rprogramming language v3.6.3.@*RESULTS@#For all polymorphisms there was no association with the level of platelets, protein, creatinine, alanine transaminase, prothrombin, international normalized ratio, activated partial thromboplastin time and fibrinogen. Carriers of rs1128503 (TT) had a significant decrease of hematocrit (p = 0.001), red blood count and hemoglobin (p = 0.015) while receiving dabigatran therapy during the postoperative period compared to the CC, CT. Carriers of rs2032582 (TT) had a significant decrease of hematocrit (p = 0.001), red blood count and hemoglobin (p = 0.006) while receiving dabigatran therapy during the postoperative period compared to the GG, GT phenotypes. These differences were not observed in carriers of rs4148738.@*CONCLUSION@#It might be necessary to reconsider thromboprophylaxis with dabigatran in carriers of rs1128503 (TT) or rs2032582 (TT) polymorphisms in favor of other new oral anticoagulants. The long-term implication of these findings would be the reduction of bleeding complications after total joint arthroplasty.

Anemia y el desarrollo de la psicomotricidad en la primera infancia / Anemia and the development of psychomotor skills in early childhood / Anemia e desenvolvimento psicomotor na primeira infância

Los bajos niveles de hemoglobina se definen como una concentración baja de hemoglobina en la sangre. La activad metabólica cerebral está vinculada con el desarrollo psicomotor. El desarrollo psicomotor durante la infancia se desarrolla a partir de los reflejos innatos, se organizan en esquemas de conducta, se internalizan durante el segundo año de vida como modelos de pensamiento. En Perú, se contabilizan el 50.99% de los niños con bajos niveles de concentración de hemoglobina en menores de 3 años. Objetivo. Identificar la relación entre la anemia y el desarrollo de la psicomotricidad en la primera infancia. Materiales y Métodos. Para evaluar los niveles de hemoglobina se empleó el método de la azidametahemoglobina, con un hemoglobinómetro, y para evaluar el desarrollo psicomotor se empleó la escala del desarrollo psicomotor. En el estudio participaron 32 niños de 6 a 24 meses de edad. Resultados. El 40,6% presenta niveles de hemoglobina entre 14,2 - 17.2 g/dl, el 31,3% presenta niveles de hemoglobina entre 13.2 -14.1 g/dl seguido del 25,0% que presenta niveles de hemoglobina entre 10,2 -13.1 g/dl y el 3.1% presenta niveles de hemoglobina <10.2 g/dl; respecto al desarrollo psicomotor expresados en coeficiente de desarrollo se evidencia que el 59.4% de niños muestran un desarrollo normal seguido del 31.3% de niños que presenta un desarrollo en riesgo y 9.4% en retraso. Conclusiones. El coeficiente de desarrollo del niño(a) se encontró que la mayoría tiene un desarrollo psicomotor normal seguido de riesgo y de retraso, a pesar que mayoría tiene un coeficiente de desarrollo normal

Low hemoglobin levels are defined as a low hemoglobin concentration in the blood. Brain metabolic activity is linked to psychomotor development. Psychomotor development during infancy develops from innate reflexes, which are organized in behavioral schemes and internalized during the second year of life as thought models. In Peru, 50.99% of children under 3 years of age have low hemoglobin concentration levels. Objective. To identify the relationship between anemia and psychomotor development in early childhood. Materials and Methods. To evaluate hemoglobin levels, the azidametahemoglobin method was used, with a hemoglobinmeter, and to evaluate psychomotor development the psychomotor development scale was used. Thirty-two children aged 6 to 24 months participated in the study. Results. 40.6% presented hemoglobin levels between 14.2 - 17.2 g/dl, 31.3% presented hemoglobin levels between 13.2 -14.1 g/dl followed by 25.0% presenting hemoglobin levels between 10.2 -13.1 g/dl and 3.1% presented hemoglobin levels <10. 2 g/dl; with respect to psychomotor development expressed in development coefficient, 59.4% of children show normal development followed by 31.3% of children with development at risk and 9.4% with delayed development. Conclusions. The development coefficient of the child showed that most of the children have a normal psychomotor development followed by at risk and retardation, although most of them have a normal development coefficient.

Níveis baixos de hemoglobina são definidos como uma baixa concentração de hemoglobina no sangue. A atividade metabólica do cérebro está ligada ao desenvolvimento psicomotor. O desenvolvimento psicomotor durante a infância se desenvolve a partir de reflexos inatos, que são organizados em padrões de comportamento e internalizados durante o segundo ano de vida como padrões de pensamento. No Peru, 50,99% das crianças com menos de 3 anos de idade têm baixas concentrações de hemoglobina. Objetivo. Identificar a relação entre a anemia e o desenvolvimento psicomotor na primeira infância. Materiais e métodos. Para avaliar os níveis de hemoglobina, foi usado o método da azidameta-hemoglobina, com um hemoglobinômetro portátil HemoCue® Hb 201+ e, para avaliar o desenvolvimento psicomotor, foi usada a escala de desenvolvimento psicomotor. Trinta e duas crianças com idade entre 6 e 24 meses participaram do estudo. Resultados. 40,6% tinham níveis de hemoglobina entre 14,2 - 17,2 g/dl, 31,3% tinham níveis de hemoglobina entre 13,2 -14,1 g/dl, seguidos por 25,0% com níveis de hemoglobina entre 10,2 -13,1 g/dl e 3,1% com níveis de hemoglobina <10. 2 g/dl; com relação ao desenvolvimento psicomotor expresso em coeficiente de desenvolvimento, é evidente que 59,4% das crianças apresentam um desenvolvimento normal, seguido por 31,3% de crianças que apresentam um desenvolvimento em risco e 9,4% em atraso. Conclusões. O coeficiente de desenvolvimento infantil mostrou que a maioria das crianças tem um desenvolvimento psicomotor normal, seguido por risco e atraso, embora a maioria delas tenha um coeficiente de desenvolvimento normal.

Iron deficiency and child psychomotor development in a rural region of Chota, Peru, 2022 / Deficiencia de hierro y desarrollo psicomotor infantil en una zona rural de Chota, Perú 2022 / Deficiência de ferro e desenvolvimento psicomotor infantil em uma área rural de Chota, Peru 2022

Introduction: Iron deficiency and psychomotor developmental delay are two public health problems that cause high childhood morbidity and mortality worldwide, which can be related to social, economic, cultural and health factors that affect the environment where children and their family live. Objective: To determine the relationship between iron deficiency anemia and psychomotor development in children aged 2 to 4 years treated at the Cuyumalca Clinic, Chota. Materials and methods: Relational, cross-sectional study conducted on 48 children, who underwent hemoglobin testing through a portable hemoglobinometer and were subjected to the Psychomotor Development Test. Results: 31.2% of the children displayed some type of anemia, with the most common being moderate anemia (17.7%). On average, 10.9% showed some type of psychomotor developmental delay, including coordination (6.3%), language (8.4%), motor skills (16.7%), and overall development (12.5%). 4.2% of the children who had minor to moderate anemia showed developmental delay risks in the three assessed areas as well as in their overall development. Conclusion: There is no statistically significant relationship between iron deficiency anemia and several domains of psychomotor development, including coordination, language, motor skills as well as overall development.

Introducción: La deficiencia de hierro y las alteraciones en el desarrollo psicomotor son dos problemas de salud pública que causan una alta morbimortalidad infantil alrededor del mundo. Los estudios apuntan a que esto se relaciona con los factores sociales, económicos, culturales y sanitarios en los que el niño y su familia vive. Objetivo: Determinar la relación entre anemia ferropénica y desarrollo psicomotor en niños de 2 a 4 años atendidos en el Puesto de Salud de Cuyumalca, Chota. Materiales y métodos: Estudio relacional, transversal, desarrollado con 48 niños a quienes se les realizó un dosaje de hemoglobina con hemoglobinómetro portátil y se les aplicó el Test de Desarrollo Psicomotor. Resultados: El 31,2% de niños presentaron algún tipo de anemia, siendo la anemia moderada la más frecuente (16,7%); en promedio 10,9% evidenciaron alguna alteración en el desarrollo psicomotor en coordinación (6,3%), lenguaje (8,4%), motricidad (16,7%) y desarrollo global (12,5%). El 4,2% de niños con riesgo para el desarrollo presentaron anemia leve o moderada en las tres áreas evaluadas, al igual que en el desarrollo global. Conclusión: No existe relación estadística significativa entre anemia ferropénica y desarrollo psicomotor para las áreas de coordinación, lenguaje y motricidad; además del desarrollo global.

Introdução: A deficiência de ferro e as alterações no desenvolvimento psicomotor são dois problemas de saúde pública que causam elevada morbidade e mortalidade infantil em todo o mundo. Estudos sugerem que isso está relacionado aos fatores sociais, econômicos, culturais e de saúde em que vivem a criança e sua família. Objetivo: Determinar a relação entre anemia ferropriva e desenvolvimento psicomotor em crianças de 2 a 4 anos atendidas no Posto de Saúde Cuyumalca, Chota. Materiais e métodos: Estudo relacional, transversal, desenvolvido com 48 crianças que realizaram dosagem de hemoglobina com hemoglobinômetro portátil e foi aplicado o Teste de Desenvolvimento Psicomotor. Resultados: 31,2% das crianças apresentaram algum tipo de anemia, sendo a anemia moderada a mais frequente (16,7%); em média, 10,9% apresentaram alguma alteração no desenvolvimento psicomotor na coordenação (6,3%), linguagem (8,4%), motricidade (16,7%) e desenvolvimento global (12,5%). 4,2% das crianças em risco de desenvolvimento apresentaram anemia leve ou moderada nas três áreas avaliadas, bem como no desenvolvimento global. Conclusão: Não há relação estatística significativa entre anemia ferropriva e desenvolvimento psicomotor para as áreas de coordenação, linguagem e motricidade; bem como o desenvolvimento global.

Lesión pulmonar aguda producida por transfusión (TRALI): Reporte de caso / Transfusion-induced acute lung injury (TRALI): Case report

Introducción: La lesión pulmonar aguda (TRALI) y la sobrecarga circulatoria (TACO) son las principales causas de morbilidad y mortalidad relacionadas con la transfusión. La TRALI se presenta durante o después de las transfusiones de plasma y sus derivados, o por inmunoglobulinas en alta concentración intravenosa; se asocia a procesos sépticos, cirugías y transfusiones masivas. La TACO es la exacerbación de manifestaciones respiratorias en las primeras 6 horas postransfusión. Reporte caso: Paciente de sexo masculino de 38 días de vida, ingresó al servicio de urgencias con un cuadro clínico de 8 días de evolución, caracterizado por dificultad respiratoria dado por retracciones subcostales y aleteo nasal sin otro síntoma asociado, con antecedentes de importancia de prematuridad y bajo peso al nacer. El reporte de hemograma arrojó cifras compatibles con anemia severa, por lo que requirió transfusión de glóbulos rojos empaquetados desleucocitados. El paciente presentó un cuadro respiratorio alterado en un periodo menor a 6 horas, por lo que se descartaron causas infecciosas y finalmente se consideró cuadro compatible con TRALI. Conclusiones: Se debe considerar una lesión pulmonar aguda relacionada con una transfusión de sangre si se produce una insuficiencia respiratoria aguda durante o inmediatamente después de la infusión de hemoderivados que contienen plasma.

Introduction: Acute lung injury (TRALI) and circulatory overload (TACO) are the main causes of transfusion-related morbidity and mortality. TRALI occurs during or after transfusions of plasma or its derivatives, or by immunoglobulins in high intravenous concentration; it is associated with septic processes, surgeries, and massive transfusions. TACO is the exacerbation of respiratory manifestations in the first 6 hours post transfusion. Case report: A 38-day-old male was admitted to the emergency department with clinical symptoms experienced over the course of 8 days and characterized by respiratory distress due to subcostal retractions and nasal flaring with no other associated symptoms. Important antecedents included prematurity and low birth weight. The hemogram report showed figures compatible with anemia, which benefited from transfusion of packed red blood cells without leukocytes. In a period of less than 6 hours, the patient presented altered respiratory symptoms, practitioners ruled out infectious causes and finally considered clinical signs compatible with TRALI. Conclusion: Acute lung injury related to blood transfusion should be considered if acute respiratory failure occurs during or immediately after infusion of plasma-containing blood products.

Hemoglobina Denver, una causa de desaturación en oximetría de pulso. Reporte de caso en un paciente pediátrico / Hemoglobin Denver, a cause of desaturated pulse oximetry. A pediatric case report

Las hemoglobinopatías son trastornos genéticos que afectan a la molécula de hemoglobina (Hb). Las mutaciones en las cadenas a o b que alteran el tetrámero de Hb pueden modificar la capacidad de la molécula para unirse al oxígeno. Las hemoglobinopatías con baja afinidad al oxígeno pueden presentarse con cianosis y una lectura alterada de la oximetría de pulso, lo que lleva a pruebas innecesarias y, a veces, invasivas para descartar afecciones cardiovasculares y respiratorias. En el siguiente reporte de caso, presentamos a una paciente pediátrica, asintomática, que se presentó a la consulta por detección de desaturación en oximetría de pulso. Las pruebas de laboratorio iniciales mostraron una anemia normocítica, normocrómica. Las muestras de gas venoso demostraron una p50 elevada. Después de extensas herramientas de diagnóstico, se diagnosticó una variante de Hb con baja afinidad al oxígeno, Hb Denver.

Hemoglobinopathies are genetic disorders that affect the hemoglobin (Hb) molecule. Mutations in the alpha or beta chains altering the Hb tetramer may modify the molecule's oxygen-binding capacity. Hemoglobinopathies with low oxygen affinity may occur with cyanosis and an altered pulse oximetry reading, leading to unnecessary and sometimes invasive tests to rule out cardiovascular and respiratory conditions. In the case report described here, we present an asymptomatic pediatric patient who consulted for desaturated pulse oximetry. Her initial laboratory tests showed normocytic, normochromic anemia. Venous blood gas samples showed an elevated p50. After using extensive diagnostic tools, a variant of Hb with low oxygen affinity was diagnosed: Hb Denver.

Diseño y Validación de una Aplicación Móvil, para el Diagnóstico de Anemia en Pre-Escolares. Estudio de Precisión Diagnóstica / Design and Validation of a Mobile Application for the Diagnosis of Anemia in Preschoolers. Diagnostic Accuracy Study

La anemia afecta a miles de niños. Para el diagnóstico se cuantifica la hemoglobina (Hb); técnica que no se encuentra al alcance de toda la población. Contar con un instrumento validado de fácil aplicación, puede ayudar al diagnóstico. El objetivo de este estudio fue validar una aplicación móvil (APP) para diagnosticar anemia en niños de 2 a 5 años, aplicable por padres o tutores. Estudio de validación de escalas. Mediante búsqueda bibliografía se recopilaron ítems y dominios relacionados con anemia en niños. Una vez reducidos, se construyó un cuestionario para pilotaje, con tres hematólogos pediatras. El resultado de este fue posteriormente validado por 22 expertos mediante aplicación de escalas tipo Likert. Los ítems validados, se contrastaron con la Hb de niños de 267 niños de 2 a 5 años de los andes ecuatorianos (2.560 msnm). Se determinó asociación de los ítems con Hb y con los resultados obtenidos y se construyó la APP. 14 ítems fueron analizados. Todos ellos puntuaron sobre la mediana de la distribución (35,5 puntos) y fueron valorados por, al menos el 50 % de los expertos. Se seleccionaron palidez palmar, astenia y sueño en horas no habituales. Todos mostraron asociación significativa con anemia (p<0,05), y fueron aplicados como preguntas a padres o tutores y contrastados con el valor de Hb. Sensibilidad y especificidad para palidez fue: 85,1 % y 85,0 %; astenia: 72,3 % y 87,7 %; sueño en horas no habituales: 68,1 % y 87,7 %; palidez más astenia o sueño: 95,7 % y 74,6 %; y debilidad más sueño: 92,5 % y 76,8 %. Se desarrolló y validó una APP para diagnóstico de anemia en niños de 2 a 5 años aplicable por padres o tutores.

SUMMARY: Anemia affects thousands of children, and to reach a diagnosis, hemoglobin (Hb) is quantified. This technique however, is not always accessible to the general population. Therefore, the availability of a validated instrument can be useful in the diagnosis. The aim of this study was to validate a mobile application (APP), to diagnose anemia in children from 2 to 5 years old, applicable by parents or guardians. Scale validation study. Through a bibliographic search, items and domains related to anemia in children were collected. Once reduced, a pilot questionnaire was constructed with three pediatric hematologists. The result was later validated by 22 experts through the application of the Likert-type scales. The validated items were contrasted with the Hb of children of 267 children from 2 to 5 years of age from the Ecuadorian Andes (2,560 meters above sea level). The association of the items with Hb and with the results obtained was determined, and the APP was constructed. 14 items were analyzed. All of them scored above the median of the distribution (35.5 points) and were valued by at least 50 % of the experts. Palmar pallor, asthenia, and sleep at unusual hours were selected. All showed a significant association with anemia (p<0.05) and were applied as questions to parents or guardians and contrasted with the Hb value. Sensitivity and specificity for pallor was: 85.1 % and 85.0 %; asthenia: 72.3 % and 87.7 %; sleep at unusual hours: 68.1 % and 87.7 %; paleness plus fatigue or sleepiness: 95.7 % and 74.6 %; and weakness plus sleep: 92.5 % and 76.8 %. An APP for the diagnosis of anemia in children from 2 to 5 years old applicable by parents or guardians was developed and validated.

Efectividad del mousse de sangrecita y nivel de hemoglobina en los niños de 3 años en las instituciones educativas iniciales, Ica-Perú / Effectiveness of sangrecita mousse little blood and hemoglobin level in children from 3 years of age in the initial educational institutions Ica-Peru

El estudio tuvo como Objetivo: Evaluar la efectividad del mousse de sangrecita en los niveles de hemoglobina en los niños de dos instituciones Educativas iniciales. Materiales y métodos: Estudio Experimental con diseño cuasi experimental de corte longitudinal, la población de estudio estuvo conformada por 80 niños los cuales todos participaron (consentimiento de los padres), 52 niños fueron de la IEI de Ica y 28 de la IEI de Comatrana, para la muestra se realizó un muestreo no probabilístico mediante el descarte de anemia utilizando el analizador de hemoglobina (hemoQ), microcubetas, lancetas y demás implementos, de ellos 9 niños tuvieron una hemoglobina <=11gr/dl quienes ingresaron al programa de mousse de sangrecita. Se elaboró una ficha de control. Resultados: Después de 7 semanas de consumir el mousse de sangrecita los 9 niños que ingresaron al programa de las dos IEI, se evidencio un incremento en sus niveles de hemoglobina superior al primer control. Conclusiones: El consumo de mousse de sangrecita es efectiva en el tratamiento de la anemia en niños de la IEI incrementando el nivel de hemoglobina. (AU)

The Objective of the study was to evaluate the effectiveness of blood mousse on hemoglobin levels in children from two initial educational institutions. Materials and Methods: Study experimental Quasi-experimental desing of longitudinal cut, the study population was made up of 80 children who all participated (parental consent), 52 children were from the IEI of Ica and 28 from the IEI of Comatrana, for the sample a non-probability sampling was carried out by discarding anemia using the hemoglobin analyzer (hemoQ), microcuvettes, lancets andother implements, of them 9 children had a hemoglobin < = 11gr / dl who would enter the blood mousse program. A control sheet was drawn up. Results: After 7 weeks of consuming the blood mousse of the 9 children who entered the program of the two IEI, there was evidence of an increase in their hemoglobin levels higher than the first control. Conclusions: The consumption of blood mousse is effective in the treatment of anemia in children with IEI by increasing the level of hemoglobin. (AU)

Mielopatía por déficit de cobre: serie de casos y revisión de la literatura / Myelopathy due to copper deficiency: A case series and review of the literature

El déficit de cobre puede presentarse como una mielopatía y manifestarse como una ataxia sensorial secundaria a una desmielinización de los cordones posteriores de la médula espinal. Puede acompañarse de citopenias, principalmente anemia y leucopenia. Se presenta una serie de casos de tres pacientes con mielopatía por déficit de cobre, diagnosticados y manejados desde el año 2020 al 2022 en un hospital universitario de alta complejidad en Colombia. Dos de los casos eran mujeres. El rango de edad fue entre 57 y 68 años. En los tres casos, los niveles séricos de cobre estaban disminuidos y en dos de ellos, se descartaron diferentes causas de mielopatía que afectan los cordones posteriores de la médula espinal como el déficit de vitamina B12, vitamina E y ácido fólico, tabes dorsal, mielopatía por virus de la inmunodeficiencia humana, esclerosis múltiple e infección por el virus linfotrópico humano de tipo I y II, entre otras. Sin embargo, un paciente tenía deficiencia de vitamina B12 asociada con de cobre en el momento del diagnóstico de la mielopatía. En los tres casos hubo ataxia sensitiva y en dos, la paraparesia fue el déficit motor inicial. Se deben incluir siempre la determinación de los niveles de cobre dentro del abordaje diagnóstico de todo paciente con enfermedad gastrointestinal crónica, con diarrea crónica, síndrome de mala absorción o reducción significativa de la ingestión en la dieta, y que desarrolle síntomas neurológicos sugestivos de compromiso de los cordones, ya que se ha reportado que el retraso en el diagnóstico de las mielopatías se asocia con pobres desenlaces neurológicos.

Copper deficiency can present as myelopathy by the manifestation of sensory ataxia, secondary to demyelination of the posterior cords of the spinal cord, accompanied by cytopenia, mainly anemia, and leukopenia. Case series study of three patients with myelopathy due to copper deficiency, diagnosed and managed from 2020 to 2022 in a highly complex university hospital in Colombia. Regarding gender, two cases were female patients. The age range was between 57 and 68 years. In all three cases serum copper levels were decreased, and in two of these, different causes of myelopathy affecting the posterior cords of the spinal cord were ruled out, such as vitamin B12, vitamin E and folic acid deficiency, tabes dorsalis, myelopathy due to human immunodeficiency virus, multiple sclerosis and infection by the human lymphotropic virus type I and II, among others. However, at the moment of the myelopathy diagnosis, one patient had vitamin B12 deficiency associated with copper insufficiency. All three cases presented sensory ataxia, and in two, paraparesis was the initial motor deficit. The diagnostic approach must include copper levels assessment in every case of patients with chronic gastrointestinal pathology, chronic diarrhea, malabsorption syndrome, or significant reduction in dietary intake; and the development of neurological symptoms that may suggest cord involvement. It has been reported that a delay in diagnosis can lead to poor neurological outcomes.

Degeneración combinada subaguda / Subacute combined degeneration

Introducción: La degeneración combinada subaguda (DCS) es un trastorno caracterizado por la degeneración difusa de la sustancia blanca a nivel del SNC, que afecta específicamente los cordones posteriores y laterales de la médula espinal, con pérdida de la mielinización periférica y central. De manera frecuente, las manifestaciones clínicas son parestesias y debilidad generalizada causada por deficiencia de vitamina B12. Presentación del caso: Paciente masculino de 79 años, con cuadro clínico de 3 meses de evolución de limitación funcional para la marcha acompañado de desorientación. Al examen físico evidenció desorientación, cuadriparesia e hiporreflexia, con niveles séricos bajos de vitamina B12, RM cervical con focos hiperintensos en el segmento C3/C6 y endoscopia de vías digestivas altas con atrofia de la mucosa gástrica. Presentamos un caso clínico de DCS. Discusión: Este es un caso de DCS que se manifiesta por medio de una alteración neuropsiquiátrica, con una presentación inicial inespecífica que comprende deterioro de la marcha, movimientos anormales con afectación cognitiva y psiquiátrica dada por alucinaciones visuales y desorientación. Su sospecha es importante en pacientes con factores de riesgo por medio del conocimiento de la patología, para una adecuada sospecha diagnóstica y una instauración oportuna de reposición vitamínica, la cual presenta una excelente respuesta. Conclusión: La DCS es un trastorno en el que se evidencia anemia con deficiencia de vitamina B12, des-mielinización del tejido nervioso y en muchos casos signos sugestivos de atrofia gástrica, y para ello es crucial la detección temprana de esta enfermedad por medio de la determinación de niveles séricos de vitamina B12, asociado a síntomas neurológicos, para así lograr su adecuado diagnóstico y tratamiento.

Introduction: Subacute combined degeneration (DCS) is a disorder characterized by diffuse degeneration of white matter at the CNS level, specifically affecting the posterior and lateral cords of the spinal cord, also with loss of peripheral and central myelination, frequently the clinical manifestations are paresthesias and generalized weakness caused by vitamin B12 deficiency. Case presentation: A 79-year-old male patient with a 3-month history of functional limitation for walking accompanied by disorientation. On physical examination, he revealed disorientation, quadriparesis, and hyporeflexia, with low serum levels of vitamin B12, cervical MRI with hyperintense foci in segment C3/C6, and upper digestive tract endoscopy with atrophy of the gastric mucosa. We present a clinical case of DCS. Discussion: This is a case of DCS that manifests itself through neuropsychiatric alteration with a nonspecific initial presentation with gait impairment, abnormal movements with cognitive and psychiatric affectation given by visual hallucinations and disorientation. Its suspicion is important in patients with risk factors. risk through knowledge of the pathology for an adequate diagnostic suspicion and a timely establishment of vitamin replacement for which it presents an excellent response. Conclusion: DCS is a disorder where anemia with vitamin B12 deficiency, demyelination of the nervous tissue and in many cases signs suggestive of gastric atrophy are evident, for which early detection of this disease is crucial through the determination of serum levels of vitamin B12 associated with neurological symptoms, in order to achieve its proper diagnosis and treatment.

Cuidados de Enfermagem a Puérpera com Anemia: Relato de Caso / Cuidados de enfermería para mujeres puérperas con anemia: informe de un caso / Nursing Care for Puerperal Women with Anemia: Case Report

Objetivo: Elaborar proposta de plano de cuidados de enfermagem com enfoque na anemia em uma puérpera. Método: Relato de caso referente a uma puérpera de 24 anos, parto eutócico às 39 semanas com valor de hemoglobina sérica pós-parto 7,9 gr/dL. Utilizado Modelo Teórico do Déficit de Autocuidado de Dorothea Orem e a taxonomia da Classificação Internacional para a Prática de Enfermagem. Resultados: Foram identificados 9 diagnósticos de enfermagem, Intolerância à atividade; Risco de queda; Padrão de repouso anormal; Processo familiar comprometido; Ansiedade; Dor; Risco de infeção; Amamentação comprometida; Baixo Conhecimento sobre autocuidado e cuidados com o recém-nascido após a alta. Conclusão: O desenvolvimento deste estudo de caso favoreceu a identificação das necessidades de cuidados da puérpera, sendo o ponto de partida para o desenvolvimento de intervenções de enfermagem, dando subsídio na prestação de cuidados com qualidade e individuais, possibilitando responder as necessidades identificadas e as particularidades da puérpera com anemia.

Objective: To develop a nursing care plan proposal focusing on anemia in a puerperal woman. Method: Case report of a 24-year-old puerperal woman, eutocic delivery at 39 weeks with a postpartum serum hemoglobin value of 7.9 g/dL. Dorothea Orem's Theoretical Model of Self-Care Deficit and the taxonomy of the International Classification for Nursing Practice were used. Results: Nine nursing diagnoses were identified: Activity intolerance; Risk of falling; Abnormal resting pattern; Compromised family process; Anxiety; Pain; Risk of infection; Compromised breastfeeding; Low knowledge about self-care and care for the newborn after discharge. Conclusion: The development of this case study favored the identification of the care needs of the puerperal woman, and is the starting point for the development of nursing interventions, providing support for the provision of quality and individual care, making it possible to respond to the identified needs and to the particularities of puerperal women with anemia.

Objetivo: Elaborar una propuesta para un plan de cuidados de enfermería con foco en la puérpera con anemia. Método: Reporte de caso de una puérpera de 24 años, parto eutócico a 39 semanas con valor de hemoglobina sérica posparto 7,9 gr/dL. Se utilizaron el Modelo Teórico del Déficit de Autocuidado de Dorothea Orem y una taxonomía de la Clasificación Internacional para la Práctica de Enfermería. Resultados: Se identificaron 09 diagnósticos de enfermedad: Intolerancia a la actividad; Riesgo de caída; Patrón de descanso anormal; Proceso familiar comprometido; Ansiedad; Dolor; Riesgo a infección; Amamantamiento comprometido; y Bajo Conhecimento sobre autocuidado y cuidados con el recién nacido tras el alta. Conclusión: El desarrollo de este estudio de caso identificó las necesidades de los cuidados de la puérpera, que son el punto de partida para las intervenciones de enfermería, dando lugar a la prestación de cuidados individuales y de calidad, lo que puede dar respuesta a las necesidades identificadas y a las particularidades de la puérpera con anemia.

Síndrome de cascanueces: una causa infrecuente de hematuria / Nutcracker Syndrome: a Rare Cause of Hematuria

La hematuria en pediatría responde habitualmente a etiologías benignas. Una causa poco frecuente es el síndrome de cascanueces, que se define como la compresión de la vena renal izquierda entre la aorta y la arteria mesentérica superior, que deriva en una presión elevada en la vena renal izquierda con el desarrollo de venas colaterales y dilataciones varicosas. La prevalencia de este síndrome se desconoce. Cuando es sintomático ocasiona hematuria, proteinuria y dolor pélvico crónico. En la pubertad, el crecimiento rápido y el desarrollo de los cuerpos vertebrales pueden producir un estrechamiento del ángulo entre la aorta y la arteria mesentérica superior. Se describe el caso de una adolescente con diagnóstico de carcinoma mucoepitelial metastásico óseo múltiple que presenta hematuria anemizante. Se arribó al diagnóstico de síndrome de cascanueces y se discutieron las opciones de tratamiento. Finalmente, con el uso de realce del calzado para corrección de la escoliosis, se atenuó significativamente la hematuria. (AU)

In pediatrics, hematuria usually responds to benign etiologies. A rare cause is nutcracker syndrome, defined as compression of the left renal vein between the aorta and the superior mesenteric artery, resulting in elevated pressure in the left renal vein with the development of collateral veins and varicose dilatation. The prevalence of this syndrome is unknown. When symptomatic, it causes hematuria, proteinuria, and chronic pelvic pain. At puberty, the rapid growth and development of the vertebral bodies can produce a narrowing of the angle between the aorta and the superior mesenteric artery.We describe the case of a teenage girl diagnosed with multiple metastatic mucoepithelial carcinoma of bone who presented anemia-producing hematuria. The diagnosis of nutcracker syndrome was arrived at with consideration of the therapeutic options. Finally, with shoe enhancement for scoliosis correction, hematuria was significantly lessened. (AU)

Importance of assessing biomarkers and physiological parameters of anemia-induced tissue hypoxia in the perioperative period

Abstract Anemia is associated with increased risk of Acute Kidney Injury (AKI), stroke and mortality in perioperative patients. We sought to understand the mechanism(s) by assessing the integrative physiological responses to anemia (kidney, brain), the degrees of anemia-induced tissue hypoxia, and associated biomarkers and physiological parameters. Experimental measurements demonstrate a linear relationship between blood Oxygen Content (CaO2) and renal microvascular PO2 (y = 0.30x + 6.9, r2= 0.75), demonstrating that renal hypoxia is proportional to the degree of anemia. This defines the kidney as a potential oxygen sensor during anemia. Further evidence of renal oxygen sensing is demonstrated by proportional increase in serum Erythropoietin (EPO) during anemia (y = 93.806*10−0.02, r2= 0.82). This data implicates systemic EPO levels as a biomarker of anemia-induced renal tissue hypoxia. By contrast, cerebral Oxygen Delivery (DO2) is defended by a profound proportional increase in Cerebral Blood Flow (CBF), minimizing tissue hypoxia in the brain, until more severe levels of anemia occur. We hypothesize that the kidney experiences profound early anemia-induced tissue hypoxia which contributes to adaptive mechanisms to preserve cerebral perfusion. At severe levels of anemia, renal hypoxia intensifies, and cerebral hypoxia occurs, possibly contributing to the mechanism(s) of AKI and stroke when adaptive mechanisms to preserve organ perfusion are overwhelmed. Clinical methods to detect renal tissue hypoxia (an early warning signal) and cerebral hypoxia (a later consequence of severe anemia) may inform clinical practice and support the assessment of clinical biomarkers (i.e., EPO) and physiological parameters (i.e., urinary PO2) of anemia-induced tissue hypoxia. This information may direct targeted treatment strategies to prevent adverse outcomes associated with anemia.

Estado nutricional y anemia en niños de etnia shuar / Nutritional status and anemia in children of the Shuar ethnic group

Introducción: El estado nutricional se entiende como una condición de salud que valora patologías nutricionales como anemia y malnutrición en grupos de edades consideradas vulnerables. El objetivo del presente estudio fue determinar la relación entre estado nutricional y anemia en la población shuar de 6 meses a 5 años de edad, de la Comunidad Shimpis, Cantón Logroño, Morona Santiago-Ecuador desde agosto 2018-agosto 2019. Métodos: El presente estudio transversal. Universo de 235 y muestra de 163 tomada del Epi Info. Los datos se obtuvieron de historias clínicas y Sistema de Vigilancia Alimentaria Nutricional. El estado nutricional se analizó con software WHO Anthro. La anemia se basó en valores de referencia de hemoglobina establecidos por Organización Mundial y Ministerio de Salud Pública. Los datos fueron tabulados en el programa estadístico SPSS 25. Se realizaron tablas simples de frecuencia y porcentaje, tablas de asociación considerando valor P<0.05 estadísticamente significativo. Resultados: Se incluyeron 163 niños, 46.0% hombres, 54% mujeres, el grupo etario predominante fue de 2-5 años con porcentaje de 56.4%. Frecuencia de anemia fue 38%. Niños con anemia y desnutrición crónica fueron: 42, con desnutrición aguda: 10, con desnutrición global: 3, con sobrepeso: 2, en eutróficos 5. Al relacionar ambas variables se obtuvo valor p estadísticamente significativo (P< 0.001). Conclusiones: el grupo etario es un factor predisponente en la alteración del estado nutricional en niños. También se observó que el estado nutricional alterado tiene mayor predisposición a presentar anemia.

Introduction: Nutritional status is a health condition that assesses nutritional pathologies such as anemia and malnutrition in vulnerable age groups. The objective of this study was to determine the relationship between nutritional status and anemia in the Shuar population from 6 months to 5 years of age from the Shimpis Community, Logroño Canton, Morona Santiago-Ecuador, from August 2018-August 2019. Methods: The present cross-sectional study. A total of 235 samples and 163 samples were taken from Epi Info. The data were obtained from medical records and the Nutritional Food Surveillance System, and nutritional status was analyzed using WHO Anthro software. Anemia was based on hemoglobin reference values established by the World Organization and the Ministry of Public Health. The data were tabulated in the statistical program SPSS 25. Simple tables of frequency and percentage were made, and tables of association considering P value <0.05 were statistically significant. Results: A total of 163 children were included, 46.0% men and 54% women, and the predominant age group was 2-5 years, with a percentage of 56.4%. The anemia frequency was 38%. There were 42 children with anemia and chronic malnutrition, 10 with acute malnutrition, 3 with global malnutrition, 2 with overweight, and 5 with eutrophy. When relating both variables, a statistically significant p-value was obtained (P < 0.001). Conclusions: The age group is a predisposing factor in the alteration of nutritional status in children. It was also observed that altered nutritional status has a greater predisposition to anemia.

Desafíos en el manejo del sarcoma de Ewing en una paciente testigo de Jehová / Challenges in the care of Ewing's sarcoma in a Jehovah's Witness patient

El sarcoma de Ewing es una neoplasia de hueso y tejidos blandos, cuyo manejo se relaciona con toxicidad hematológica. Este aspecto representa un desafío médico y ético en los pacientes testigos de Jehová quienes, por sus creencias religiosas, rechazan la aplicación de hemoderivados, con riesgo de que se descontinúe la quimioterapia o de que se utilicen dosis subóptimas. Se presenta el caso de una mujer colombiana de 34 años, testigo de Jehová, con diagnóstico de sarcoma de Ewing con estadificación clínica IIB (T1N0M0) en las regiones maxilar y mandibular izquierdas, tratada con quimioterapia, quien presentó un valor mínimo de hemoglobina de hasta 4,5 g/dl y tuvo indicación quirúrgica como parte del tratamiento. En estos pacientes, la decisión de practicar una transfusión comprende implicaciones éticas que requieren alternativas terapéuticas y un abordaje multidisciplinario.

Ewing's sarcoma is a bone and soft tissue neoplasm, whose management is related to hematological toxicity. This aspect represents a medical and ethical challenge in Jehovah's Witnesses patients, who, due to their religious beliefs, reject the blood component transfusion, with the risk of discontinuing chemotherapy or using suboptimal doses. We present the case of a 34-year-old Colombian woman, Jehovah's Witness, diagnosed with Ewing's sarcoma with clinical stage IIB (T1N0M0) in the left maxillary and mandibular regions, treated with chemotherapy, who presented a hemoglobin nadir of up to 4.5 g/dL, and surgical indication as part of the treatment. In these patients, the transfusion decision has ethical implications that require therapeutic alternatives and a multidisciplinary approach.

Factores asociados a la anemia en niños menores de cinco años de un distrito de Huaraz, Ancash / Factors associated to anemia in children below five years of age in a district of Huaraz, Ancash

Objetivos: Identificar los factores asociados a la anemia en niños menores de cinco años de edad del distrito de La Libertad, Huaraz, Ancash. Material y métodos: Estudio de tipo cuantitativo, observacional, serie de casos comparativa, retrospectiva. Cuya población de estudio fueron los niños menores de cinco años de edad del distrito de La Libertad, Huaraz, 2019. El muestreo fue de tipo probabilístico. Se recolectaron datos de la historia clínica en torno a los factores intrínsecos y extrínsecos para anemia. Se realizó un análisis exploratorio para determinar los factores asociados. Se analizó la información en hojas de cálculo del software Microsoft Excel 2013® y en el programa estadístico IBM SPSS Statistics 22. Resultados: Predominó el nivel de anemia moderado con 30%. Tanto el sexo masculino (OR=3,66; IC 95%: 1,65-8,08) y la edad mayor de 1 año (OR=13,99; IC 95%: 3,07-63,77) fueron factores intrínsecos asociados a la mayor frecuencia de anemia (p<0,05). Respecto a los factores extrínsecos, el pertenecer a un caserío diferente a Cajamarquilla (OR=3,63; IC 95%: 1,44-9,16) y el no contar con servicios básicos completos (OR=2,72; IC 95%: 1,24-5,97) se asociaron también a un incrementado número de casos (p<0,05). Conclusiones: Los factores asociados a una mayor frecuencia de casos de anemia fueron el sexo masculino, la edad mayor de 1 año, el pertenecer a un caserío diferente a Cajamarquilla y el no contar con servicios básicos completos.

SUMMARY Objectives: To identify associated factors to anemia in children under five years of age in La Libertad District, Huaraz, Ancash. Methods: It is a quantitative, observational, comparative case series, retrospective study. The population was children under five years of age in La Libertad District, Huaraz, 2019. The sampling was Probabilistic. Medical history data were collected around intrinsic and extrinsic factors for anemia. An exploratory analysis was performed to determine the associated factors. The information was analyzed in Microsoft Excel 2013 software spreadsheets® and in IBM SPSS Statistics 22 program. Results: The level of moderate anemia prevailed with 30%. Both males (OR=3.66; CI 95%: 1.65-8.08) and age older than 1 year (OR=13.99; 95% CI: 3.07-63.77) were intrinsic factors associated with the higher frequency of anemia (p<0.05). Regarding the extrinsic factors, belonging to a hamlet different to Cajamarquilla (OR=3.63; CI 95%: 1.44-9.16) and not having complete basic services (OR=2.72; CI 95%: 1.24-5.97) were also associated with a higher number of cases (p<0.05). Conclusions: The factors associated with a higher frequency of anemia cases were male sex, age over 1 year, belonging to a hamlet different to Cajamarquilla and not having complete basic services.

Detecção molecular de Anaplasma platys, Ehrlichia canise Babesia spp. em cães atendidos em clínica da região metropolitana do estado do Rio de Janeiro / Molecular detection of Anaplasma platys, Ehrlichia canis and Babesia spp. in dogs served at a clinic in the metropolitan region of the state of Rio de Janeiro

O presente estudo teve como objetivo detectar por meio da Reação em cadeia da Polimerase (PCR) a frequência de Ehrlichiacanis, Babesia spp. e Anaplasma platys em cães, relacionando a prevalência dos achados hematológicos aos resultados positivos pela PCR. Foram avaliadas 209 amostras de sangue de cães atendidos em clínica veterinária particular do município de Queimados, RJ, Brasil, no período de julho a outubro de 2014. Foram realizados hemograma completo e extração de DNA para técnica de PCR. Do total de 209 animais, 19,1% (40/209) animais apresentaram resultado positivo para hemoparasitos pela técnica de PCR. Destes, 52,5% (21/40) foram positivos para E. canis, 27,5% (11/40) positivos para Babesia spp. e 10% (4/40) positivos para A. platys. Quatro animais (1,91%), dos 209 testados, foram positivos para pelo menos dois agentes, caracterizando assim coinfecção. Dos 40 cães positivos para algum dos agentes testados, 25 (62,5%) estavam trombocitopênicos. Ou seja, 15 cães (37,5%) reagiram positivos para hemoparasitos, mas não apresentavam trombocitopenia. A anemia foi um achado comum, sobretudo nas infecções por Babesia spp., 100% (11/11) e E.canis, 90,5% (19/21). A técnica de PCR foi um importante método diferencial na detecção das principais hemoparasitoses caninas, juntamente com os achados clínicos e hematológicos para o diagnóstico preciso da infecção em questão.

The present study aimed to detect, by means of Polimerase chain reaction (PCR), the frequency of Ehrlichia canis, Babesia spp. and Anaplasma platys in dogs, relating the prevalence of hematological findings to positive PCR results. A total of 209 blood samples from dogs treated at a private veterinary clinic in the city of Queimados, RJ, Brazil, from July to October 2014 were evaluated. Complete blood count and DNA extraction were performed for the PCR technique. Of the total of 209 animals, 19.1% (40/209) animals were positive for hemoparasites by the PCR technique. Of these, 52.5% (21/40) were positive for E. canis, 27.5% (11/40) were positive for Babesia spp. and 10% (4/40) positive for A. platys. Four animals (1.91%) of the 209 tested were positive for at least two agents, thus characterizing coinfection. Of the 40 dogs positive for any of the agents tested, 25 (62.5%) were thrombocytopenic. That is, 15 dogs (37.5%) were positive for hemoparasites, but did not have thrombocytopenia. Anemia was a common finding, especially in infections by Babesia spp., 100% (11/11) and E. canis, 90.5% (19/21). The PCR technique was an important differential method in the detection of the main canine hemoparasitoses, together with the clinical and hematological findings for the accurate diagnosis of the infection in question.