Factores socioambientales en el neurodesarrollo de trillizos prematuros. Reporte de un caso / Social and environmental factors of premature triplets' neurodevelopment. Case report

Resumen La epidemia de nacimientos prematuros es fruto de la compleja interacción entre los factores genéticos, sociales y ambientales. Gracias a los avances tecnológicos, la supervivencia de prematuros de menor edad y peso se ha incrementado, así como el riesgo de las secuelas que ello puede provocar. Este trabajo busca caracterizar los factores ambientales y sociales que pueden afectar el neurodesarrollo; el análisis se realizó en un modelo de intervención temprana en el Instituto Nacional de Pediatría (INP). Se presenta el reporte de un caso de embarazo múltiple asistido donde los factores genéticos y ambientales fueron similares, con diferencias en los factores biológicos, así como la interacción de la díada y su evolución en el neurodesarrollo durante el primer año de vida.

Abstract The premature birth epidemic is the result of genetic, social and environmental complex interactions. As smaller and lower-weight children survive, sequelae increase. This paper characterizes the environmental and social factors related to neurodevelopment as a component of an early intervention program at the National Pediatrics Institute. We present the case report of an assisted multiple pregnancy with similar genetic and environmental factors, but biologic and dyadic interaction differences, and report the neurodevelopmental evolution over the first year of life.

Epidemiology of Chronic Obstructive Pulmonary Disease (COPD)

COPD is a major cause of morbidity and mortality. Its social and economic burden is expected to increase worldwide in coming decades. COPD is under-recognised and under-diagnosed. It results in disproportionately more numbers of physician visits, emergency department visits and hospitalisations than most other diagnoses. It is increasingly recognised that COPD is commonly accompanied by co-morbid medical conditions, cardiovascular disease, hypertension, diabetes, osteoporosis, chronic kidney disease, cognitive impairment and depression, due to systemic inflammation which impact on quality of life and survival. The prevalence of COPD among adults aged 40 and above varies widely from 8% to 26%. The most widely recognised risk factor for COPD is smoking, but non-smoking factors include biomass fuel, occupational exposure to dusts and gases, history of pulmonary tuberculosis, chronic asthma, respiratory-tract infections during childhood, outdoor air pollution, and poor socioeconomic status.