De lo complejo a lo simple… deshidrogenasa láctica como marcador de severidad en pacientes con infección por SARS-CoV-2 / From complex to simple... lactic dehydrogenase as a severity marker in patients with SARS-CoV-2 infections / Do complexo ao simples… Desidrogenase láctica como marcador de gravidade em pacientes com infecção por SARS-CoV-2

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Abstract: Introduction: The reference standard for the diagnosis of COVID-19 remains reverse transcriptase polymerase chain reaction (RT-PCR)-positive, while plain chest computed tomography (CT) has been more sensitive and specific in severity classification. In defining the severity of SARS-CoV-2, clinical, imaging and laboratory criteria have been specified, mentioning several markers, including lactate dehydrogenase (LDH). Historically, LHD has been of interest as a biomarker associated with lung damage, with a greater peak during the influenza A H1N1 pandemic, and taken as a marker in the definition of severity. Objective: To determine the diagnostic performance of serum LHD levels on admission to the ICU as a marker of severity in patients with SARS-CoV-2 infection. Material and methods: Observational, analytical, longitudinal and prospective study, carried out in two stages, the first (April 1, 2020 to September 30, 2020) consisted of a correlation study between serum LHD levels at Intensive Care Unit (ICU) admission and simple chest CT, a moderate correlation was obtained between serum LHD levels and severity score by pulmonary tomography, with an r = 0.5 and p < 0.0001; a severity-associated serum LHD cut-off point of 396 U/dL was obtained (p < 0.001, sensitivity 86.02%, specificity 75%). The second stage was extended until December 31, 2020, in which analysis is performed for diagnostic test performance, in inferential statistics correlation tests are performed, a multiple linear regression model is built, analysis was performed for diagnostic tests by building two-by-two contingency Tables, determining sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and Bayesian analysis. Results: 155 patients were included in the study to determine the diagnostic performance of serum LHD levels in patients with severe SARS-CoV-2 infection; by multiple linear regression analysis, it was determined that LHD levels on admission to the ICU is a predictor of severity in patients with SARS-CoV-2. A sensitivity of 0.92, specificity 0.41, with PPV 0.854, NPV 0.57 and an accuracy of 0.83, an LR + 1.57 and LR- 0.63 were obtained. In the post-test probability results, patients with DHL > 396 U/dL have a 86.3% probability of developing severe COVID-19. DHL levels have a direct correlation with ICU days of stay and days of invasive mechanical ventilation with statistical significance (p = 0.001, p = 0.033 respectively). Conclusion: Serum LHD levels have a high sensitivity to diagnose COVID-19 severity; and in the absence of simple chest CT, it can predict severe lung damage. It constitutes a test with high screening power in severe cases of COVID-19; with a probability of almost double (LR + 1.6) that of predicting a severe case.

Resumo: Introdução: O padrão de referência para o diagnóstico de COVID-19 continua sendo a reação em cadeia da polimerase com transcriptase reversa positiva (RT-PCR), enquanto a tomografia computadorizada (TC) de tórax simples tem se mostrado mais sensível e específica na classificação de gravidade. Na definição da gravidade do SARS-CoV-2, foram especificados critérios clínicos, de imagem e laboratoriais, mencionando vários marcadores, incluindo a desidrogenase láctica (DHL). A DHL ao longo da história tem sido de interesse como biomarcador associado a danos pulmonares, com maior boom durante a pandemia de influenza A H1N1, e tomado como marcador na definição de gravidade. Objetivo: Determinar o desempenho diagnóstico de dois níveis séricos de DHL na admissão à UTI como marcador de gravidade em pacientes com infecção por SARS-CoV-2. Métodos: Estudo observacional, analítico, longitudinal e prospectivo, realizado em duas etapas, a primeira (01 de abril de 2020 a 30 de setembro de 2020) consistiu em um estudo de correlação entre os níveis séricos de DHL na admissão na UTI e TC simples de tórax, um foi obtida correlação entre os níveis séricos de DHL e o escore de gravidade pela tomografia pulmonar, com r 0.5 ep < 0.0001; um ponto de corte para DHL sérico associado à gravidade de 396 U/dL foi obtido (p < 0.001, sensibilidade 86.02%, especificidade 75%). A segunda etapa foi estendida até 31 de dezembro de 2020, na qual são realizadas análises para realização de testes diagnósticos, testes de correlação em estatística inferencial, construção de um modelo de regressão linear múltipla, análise para testes diagnósticos, construção tabelas de contingência dois a dois, determinando sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo, razões de verossimilhança e análise Bayesiana. Resultados: 155 pacientes foram incluídos no estudo para determinar o desempenho diagnóstico dos níveis séricos de DHL em pacientes com infecção grave por SARS-CoV-2; pela análise de regressão linear múltipla, determina-se que os níveis de DHL na admissão à UTI é um preditor de gravidade em pacientes com SARS-CoV-2. Obteve-se sensibilidade de 0.92, especificidade de 0.41, com VPP 0.854, VPN 0.57 e exatidão de 0.83, LR+ 1.57 e LR- 0.63. Nos resultados de probabilidade pós-teste, pacientes com DHL > 396 U/Dl têm probabilidade de 86.3% de desenvolver doença grave por COVID-19. Os níveis de DHL têm correlação direta com os dias de permanência na UTI e os dias de tratamento invasivo ventilação mecânica com significância estatística (p = 0.001, p = 0.33 respectivamente). Conclusão: Os níveis séricos de DHL têm alta sensibilidade para diagnosticar gravidade por COVID-19; e na ausência de TC simples de tórax, pode predizer danos pulmonares graves. Constitui um teste com alto poder de escrutínio em casos graves de COVID-19; com quase o dobro da probabilidade (LR + 1.6) de predizer uma condição grave.

Altrenogest en cerdas primíparas: efecto sobre la aparición de celo y el tamaño de la camada

El objetivo del presente trabajo fue evaluar el efecto del tratamiento con Altrenogest sobre la aparición de celo y el tamaño de la camada en cerdas primíparas. Setenta y dos hembras (Landrace x Yorkshire) con un peso promedio de 155 ± 5 kg se asignaron aleatoriamente en dos grupos: GT = grupo tratamiento (n=36), al cual se le aplicó un protocolo de sincronización de celo con Altrenogest durante 18 días (20 mg/día) sobre el alimento y GC = grupo control (n=36). Se registró la concentración de los celos del grupo tratamiento para medir la eficacia del progestágeno. El número de lechones nacidos vivos (LNV), muertos (LNM) y totales (LNT) fue registrado en ambos grupos para su comparación a través de un ANOVA, usando el software estadístico INFOSTAT. No se encontraron diferencias significativas para el número de LNM y LNT, mientras que el número de LNV se vio favorecido por el tratamiento (p<0.05). El 91% de los celos se concentraron entre el cuarto y quinto día de finalizado la administración del progestágeno. Podemos concluir que el tratamiento con Altrenogest en cerdas primíparas, mejoró el número de LNV a la vez que logra concentrar eficazmente la presentación de celos entre los días 4 y 6 post-tratamiento.

The objective of this study was to evaluate the effect of Altrenogest administration on estrus manifestation and litter size of primiparous sows. Seventy-two primiparous sows (Landrace x Yorkshire) with a weight of 155 ± 5 kg were randomly assigned to two groups: 1) GT or treatment group (n=36) that received Altrenogest administration during 18 days (20 mg./day) in the food and 2) GC or control group (n=36). Estrus manifestation was recorded as well as number of piglets born alive, stillborn and litter size. ANOVA was used for mean comparisons using INFOSTAT statistical software. No differences between treatments were observed for number of stillborn and litter size whereas number of piglets born alive was increased by Altrenogest administration (p<0.05). Estrus manifestation was observed between fourth and sixth day following Altrenogest treatment. We can conclude that the treatment of Altrenogest in primiparous sows improved the number of piglets born alive and synchronized estrus.

Intervención educativa para el manejo del dolor en personal de enfermería / Educational intervention study in the management of pain in nursing staff

Resumen En la actualidad, el dolor es considerado co-то el quinto signo vital. El objetivo del trabajo fue determinar la efectividad de un programa educativo para el personal de enfermería sobre manejo de dolor en pacientes con problemas crónicos degenerativos y quirúrgicos. El método usado fue el diseño pre-experimental con pretest-postest. La población de estudio estuvo integrada por personal de enfermería (42) de dos instituciones de salud de segundo nivel de atención, del sector público. Se utilizó el cuestionario Conocimiento y Actitudes Respecto al Dolor. La media de respuestas correctas del conocimiento pretest fue de 50.9 (DE = 9.65), valor mínimo de 28.1 y máximo 78.1; y en el postest la media fue de 70.4 (DE = 10.9) valor mínimo de 40.6 y máximo 90.6. Posterior a la intervención educativa, se encontró mayor conocimiento en el personal de enfermeria (t (41)= - 12.98; p < 0.001). El estudio de intervención educativa del personal de enfermería fue efectivo para mejorar el conocimiento sobre el manejo del dolor en los pacientes, ya que los primeros brindaron una mejor atención y cuidados, posteriores a la intervención educativa, no obstante, este fue insuficiente para la mayoría del personal participante.

Abstract Pain is currently considered as the fifth vital sign. The objective of the study was to determine the effectiveness of an educational program for nurses on pain management for patients with chronic degenerative and surgical problems. The employed method was a pre-experimental design with a pre-test and a posttest. The research population was made up of 42 nurses from two secondary health care institutions in the public sector. The Nurse's Knowledge and Attitudes Survey Regarding Pain was used. Results showed that the pre-test mean knowledge of correct answers was 50.9 (SD = 9.65), with a minimum value of 28.1 and a maximum value of 78.1. The post-test mean was 70.4 (SD = 10.9) with a minimum value of 40.6 and a maximum value of 90.6. After the educational intervention, nurses demonstrated an increased level of knowledge regarding pain management (t (41) = -12.98; p < 0.001). The educational intervention study for nurses was effective in improving their knowledge regarding pain management in patients, since the participating nurses provided better attention and care after the educational intervention. This, however, was insufficient for most of the participating personnel.

Pioderma gangrenoso vulvar: revisión de la literatura a propósito de un caso causado por rituximab / Vulvar pyoderma gangrenosum: review of the literature on a case caused by rituximab

RESUMEN El Pioderma Gangrenoso (PG) es una enfermedad inflamatoria necrotizante crónica, que pertenece al espectro de las dermatosis neutrofílicas. Histológicamente se caracteriza por mostrar un infiltrado inflamatorio denso de neutrófilos de origen no infeccioso. El PG suele asociarse a enfermedades sistémicas como la enfermedad inflamatoria intestinal, la artritis reumatoide o diversas enfermedades hematológicas. Presenta fenómeno de patergia y suele responder satisfactoriamente a tratamientos inmunosupresores. Su etiología no está bien definida. En la literatura se han publicado 15 casos de pioderma gangrenoso vulvar asociado al uso de rituximab. Nosotros presentamos un nuevo caso, que tuvo lugar en una mujer de 37 años en tratamiento de mantenimiento con rituximab por un linfoma no Hodgkin folicular. El rituximab (MabThera®) es un anticuerpo que reconoce la molécula CD20, que es una proteína no glucosilada que se expresa en la superficie de los linfocitos B. Este fármaco se ha utilizado para el tratamiento de diferentes enfermedades reumatológicas en los últimos años.

ABSTRACT Pyoderma Gangrenosum is a chronic necrotizing inflammatory disease that belongs to the spectrum of Neutrophilic Dermatoses. Histologically, it is characterized by a dense inflammatory infiltrate of non-infectious neutrophils. Etiology is not yet well defined. It is usually associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis or hematological diseases. It presents pathergy phenomenon and usually respond satisfactorily to immunosuppressive treatments. There have been published only 15 cases of vulvar pyoderma gangrenosum associated with the use of rituximab. We present a new case, which occurred in a 37-year-old woman on maintenance treatment with rituximab for a follicular non-Hodgkin's lymphoma. Rituximab (MabThera®) is an antibody that recognizes the CD20 molecule, which is a non-glycosylated protein that is expressed on the surface of B lymphocytes. This drug has been used for the treatment of different rheumatic diseases in recent years.

Efecto de edulcorantes no calóricos en la aceptabilidad sensorial de un producto horneado / Effect of non-caloric sweeteners in sensory acceptability of a baked product

Samples of cakes (baked biscuit-type products) made with sugar (control) and samples prepared with non-caloric sweeteners (stevia, saccharin and sucralose) were developed and acceptability evaluated using a 5-point hedonic scale test for color, aroma and flavor. The color and aroma results indicated that the cakes made with sugar have significantly larger acceptability than cakes made with non-caloric sweeteners (p< 0.05). In assessing the acceptability of taste there are significant differences between all samples of cakes, with the following descending order according to the sweetener used: sugar > stevia > sucralose > saccharin. Replacement of sugar by non-caloric sweeteners in cakes, decreased the acceptability of the products. One explanation may be because no non-enzymatic browning reactions occur such as Maillard reaction and caramelization, which generate compounds related to color, aroma and flavor of baked foods.

Se elaboraron muestras de queques (productos horneados tipo bizcocho) con azúcar (control) y con edulcorantes no calóricos (estevia, sacarina y sucralosa). Los queques se evaluaron sensorialmente mediante una prueba de aceptabilidad con una escala hedónica de 5 puntos para los parámetros de color, aroma y sabor. Los resultados de color y aroma indican que los queques elaborados con azúcar tienen una aceptabilidad significativamente mayor que los queques elaborados con los edulcorantes no calóricos (p< 0,05). En la evaluación de sabor hubo diferencias significativas entre todas las muestras de queques, con el siguiente orden decreciente según el edulcorante utilizado: azúcar > estevia > sucralosa > sacarina. El reemplazo de azúcar por edulcorantes no calóricos en los queque, disminuyó la aceptabilidad de los productos. Una explicación posible es que no se producen reacciones de pardeamiento no enzimático como reacción de Maillard y caramelización, las que generan compuestos relacionados con el color, aroma y sabor de productos horneados.

Lepra lepromatosa peneal en paciente con enfermedad de chagas. Reporte de un caso / Penile lepromatous leprosy in a patient with chagas disease. a case report

Se presenta el caso de un paciente masculino de 52 años con fimosis secundaria a una masa pseudotumoral prepucial. El paciente presentaba una historia de enfermedad de Hansen con afectación de piel, laringe y bronquios. Previa a la circuncisión, el examen físico revelaba, además de las alteraciones lepromatosas, un mega esófago secundario a estenosis en la porción distal. El análisis laboratorial mediante la técnica de ELISA dio positivo para Trypanosoma cruzi, patógeno responsable de la enfermedad de Chagas. Sólo pudimos encontrar un caso previo reportado de lepra lepromatosa con afectación prepucial. La coexistencia de lepra y miocardiopatía chagásica es inusual pero bien conocida por casos reportados en Brasil e India. Sin embargo, de acuerdo a nuestros conocimientos, éste es el primer caso reportado de una asociación entre lepra lepromatosa y mega esófago chagásico en un paciente con fimosis.

We are presenting a 52-year-old patient with phimosis due a tumor like mass, which on pathological evaluation was diagnosed as lepromatous leprosy. The patient had a history of Hansen's disease involving the skin, the larynx and the bronchial tree. Before a circumcision, a physical examination revealed in addition to the lepromatous changes the presence of megaesophagus secondary to stenosis of the distal portion. Laboratory analysis for Tripanosomacruzii using ELISA technique was positive for Chagas Disease. We could find only one previous report of lepromatous leprosy affecting the foreskin. The coexistence of leprosy and myocardial Chagas disease is unusual but well known in reports from Brazil and India. However, this is, to our knowledge, the first case reported of an association of lepromatous leprosy and chagasicmegaesophagus in a patient with phimosis.

Evaluación y corrección neuropsicológica del lenguaje en la infancia / Neuropsychological Assessment and Correction of Language in Children / AvaliaçÃo e correçÃo neuropsicológica da linguagem na infância

Objetivos. Las alteraciones del lenguaje constituyen un problema frecuente durante el desarrollo de los niños. Esta investigación se basó en el estudio de caso de una niña de cinco años y tres meses de edad con problemas de lenguaje, particularmente, en el diseño y aplicación de un programa de intervención, elaborado de acuerdo con la postura histórico-cultural; el cual tuvo como objetivo principal mejorar la percepción y articulación adecuada de fonemas del idioma español y como objetivos complementarios el desarrollo de los actos motores finos, la formación de la imagen de objetos y la orientación espacial. Método. La evaluación y el diagnóstico se realizaron a partir de la aplicación de protocolos cualitativos del enfoque histórico-cultural, determinando, en la evaluación preintervención, debilidad funcional en la integración cinestésica y organización motora secuencial del lenguaje. Después de la evaluación inicial se realizó la aplicación de un programa de corrección neuropsicológica. Resultados. Se realizó una revaloración control, posterior a la intervención, que permitió observar cambios favorables en la expresión y comprensión verbal de la niña. Conclusión. Se enfatiza la necesidad de reconsiderar el diagnóstico y los programas de corrección infantil tradicionales del lenguaje, los cuales se realizan a partir de una sola función psicológica sin permitir hacer un análisis sindrómico ni la posibilidad de una aproximación integral para su corrección y desarrollo.

Objective. Language alterations constitute a frequent issue during childhood. This research is based on the case study of a 5 year old female patient with language problems. Diagnosis was established by designing and applying an intervention program, drawn up according to the historic-cultural theoretical-methodological approach. The main objective was to improve the articulation and proper coordination of phonemes of the Spanish language, and as a complementary objective, the development of fine motor skills, the formation of images of objects, and spatial orientation. Method. The evaluation and diagnostic was carried out based on the application of qualitative protocols with a historical-cultural approach, determining, in the pre-intervention evaluation, a functional weakness in kinesthetic integration and sequential motor organization of language. After the initial evaluation the application of a corrective neuropsychological program was performed. Results. Re-evaluation was carried out after the intervention, which showed favourable changes in the girl's verbal comprehension and expression skills. Conclusion. A reconsideration of the classical diagnosis and correction schemes is proposed, which are based on a single psychological function, and do not allow neither an integral syndromic analysis to be carried out, nor an integral approximation for correction and development to be made.

Escopo. As alterações da linguagem constituem um problema frequente durante o desenvolvimento das crianças. Esta pesquisa esteve baseada no estudo de caso de uma menina de cinco anos e três meses de idade com problemas de linguagem, particularmente em desenhar e aplicar um programa de intervençÃo, elaborado de acordo à postura teórica-metodológica histórico - cultural, que teve como escopo principal melhorar a percepçÃo e articulaçÃo adequada de fonemas da língua espanhola e como escopos complementários o desenvolvimento dos atos motores finos, a formaçÃo da imagem de objetos e a orientaçÃo espacial. Metodologia. A avaliaçÃo e o diagnóstico foram feitos a partir da aplicaçÃo de protocolos qualitativos do enfoque histórico-cultural, determinando na avaliaçÃo pre-intervençÃo debilidade funcional em integraçÃo cenestésica e organizaçÃo motora sequencial da linguagem. Depois da avaliaçÃo inicial foi aplicado um programa de correçÃo neuropsicológica. Resultados. Foi feita uma revaloraçÃo e controle posterior à intervençÃo que permitiu observar mudanças favoráveis no desenvolvimento da menina. ConclusÃo. é enfatizada a necessidade de reconsiderar o diagnóstico e os programas de correçÃo infantil tradicionais da linguagem, os quais sÃo feitos a partir de uma funçÃo psicológica só e nÃo permitem fazer uma análise sindrómica e possibilidade de uma aproximaçÃo integral para sua correçÃo e desenvolvimento.

University Of Malaya Dental Studentsâ’ Perception On Competency Based Test

This study was undertaken to explore the perception of Year IV and Year V University of Malaya dentalstudents on different domains related to the competency based test (CBT). Methodology: A questionnairewas constructed and a survey conducted to explore the students’ perception on four domains related tothe competency test: 1) benefits, 2) readiness to take, 3) timing and 4) lecturers’ supervision. Results: Ingeneral, majority of the students agreed that they benefited from the competency test and felt adequatelyprepared for each test. Students’ agreeing on feeling confident to sit for each test ranged from 70.0%-81.4% for Year IV and 45.1%-70.4% for Year V. Majority of Year IV and Year V students perceived thatthe timing of each competency test was ‘just right’. There was a high response of ‘Strongly agree/agree’to availability of patients for practice and assessment, self-confidence and amount and distribution ofclinical session as factors affecting when they take the CBT. Majority of Year IV students agreed that theassessment of lecturers was consistent for each tests while Year V had a high percentage of ‘Neutral’response. Students’ agreeing that there was feedback after the test was 52.9%-71.4% for Year IV and31.0%-56.5% for Year V. ‘Strongly agree/agree’ response of 68.6%-75.0% for Year IV and 36.6%-52.1%for Year V was recorded for the level of supervision being the same after passing the test. Conclusion:Overall, majority of students gave positive perception towards CBT in relation to four main domainsexplored in this research.

Cirugía plástica periodontal en coronas clínicamente cortas para rehabilitación protésica / Periodontal plastic surgery performed in clinically short crowns for prosthetic rehabilitation

Introducción: La estética ha cobrado gran importancia en los tratamientos dentales en los últimos años y los pacientes tienen altas expectativas al respecto. Se establece en función de la armonía determinada por la sonrisa con base en la posición y dimensión de dientes, encía y labios. Las condiciones que afectan la dimensión de la corona clínica dental requieren la intervención de distintas áreas odontológicas para devolver función y estética. El alargamiento de corona quirúrgico permite aumentar la longitud coronaria supracrestal y reestablecer el espesor biológico para balancear la necesidad estética y restaurativa con salud periodontal. Presentación del caso: Paciente femenino que presenta erupción pasiva retardada. Es referida por el Departamento de Prótesis para realizar alargamiento de corona para rehabilitación protésica. Conclusiones: El alargamiento de corona permite la preparación de los tejidos obteniendo estabilidad fisiológica y estética, logrando el acceso a márgenes protésicos; manteniendo así, una adecuada unidad protésico-periodontal.

In recent years, esthetics has become paramount in dental treatments, raising high expectations in patients. Esthetic harmony is determined by the smile, which in turn is influenced by the position and dimension of teeth, gums and lips. Conditions affecting dental clinical crowns require intervention of several dental disciplines to restore function and esthetics. Lengthening of the surgical crown allows for the increase of supra-crest crown length as well as the re-establishment of biological thickness to balance restorative esthetic requirements with periodontal health. Case presentation: A female patient afflicted with delayed passive eruption was referred from the Prosthetics Department to undergo lengthening of crown to achieve prosthetic rehabilitation. Conclusions: Crown lengthening allows tissue preparation and achieves esthetic and physiological stability, achieving access to prosthetic margins preserving thus suitable prosthetic-periodontal unity.

Narraciones escritas en niños con Trastorno Específico del Lenguaje (TEL) / Written Narration in Specific Language Impairment (SLI)

El presente estudio examinó las narraciones escritas, así como la influencia de las variables lingüísticas sobre la competencia narrativa de los niños con Trastorno Específico del Lenguaje (TEL). Veinticinco niños con TEL y 25 niños con desarrollo normal del lenguaje, equilibrados en edad e inteligencia, realizaron una tarea de narración escrita. Los resultados indican que ambos grupos difieren en la producción de narraciones. Los niños con TEL no solo escribieron historias más cortas, sino también de menor organización y coherencia. Además cometieron significativamente más errores de ortografía natural y de sintaxis. Los análisis de regresión jerárquica mostraron que diferentes medidas lingüísticas -memoria secuencial auditiva, comprensión auditiva y expresión verbal- tienen un peso predictivo de la competencia narrativa.

The present study examined the written narrations and the influence of linguistic measures on narrative competence of children with specific language impairment (SLI). A narration task was used to assess narrative abilities in 25 children with SLI and 25 normally developing children, matched on age and IQ. Results indicated that the two groups did differ in the production of narratives. The children with SLI provided short narratives, poorly organized and less cohesive. Also, writings were characterized by more syntax errors and had high proportion of phonologically inaccurate spelling errors. Hierarchical regression analysis showed that different linguistic measures - auditory comprehension, verbal fluency and sequential auditory memory - played a predictive role in narrative competence.

Comparison of levels of antiretroviral drugs with efficacy in children with HIV infection.

Objective. To determine the prevelance of low and high antiretroviral (ARV) plasma levels and to analyze correlation between ARV concentrations and the appearance of therapeutic failure and toxicity. Methods. The authors present here a study evaluating antiretroviral plasma concentrations in HIV infected children on nonnucleoside reverse transcriptase inhibitors and protease inhibitors based therapy. The authors carried out a multicentre, crosssectional study, including HIV-infected children from five large Hospitals in Madrid, Spain. Clinical, haematological, biochemical and immuno-virological parameters were assessed. Antiretroviral plasma trough levels were performed using a validated high performance liquid chromatography method. Results. Between April 2006 and April 2008, 129 children were enrolled in the present study, with median treatment duration of 39.2 months. 25.5% of the non-nucleoside reverse transcriptase inhibitors levels were low and 17.6%, high. 27.9% percent of the protease inhibitors levels were low and 12.5%, high. A correlation was found among adequate or high levels of antiretrovirals and normal CD4 percentage and low viral load. Lopinavir/ritonavir plasma levels were correlated with an increase in lipodystrophy. Patients with Tanner stage 1 presented the lowest ARV plasma levels. Full adherence was reported for all the participants by a questionnaire. Conclusion. Many HIV-infected children show ARV plasma levels out of the therapeutic range which demands a child-adjusted approach. However, larger studies are urgently needed in pediatric populations to define optimal reference values.

Clima organizacional en una unidad de segundo nivel de atención / Organizational climate in a unit of second level attention

Introducción: el clima organizacional está constituido por el conjunto de características que los trabajadores perciben del ambiente laboral y sirve como fuerza primordial para influir en su conducta de trabajo. Objetivo: identificar el clima organizacional de un hospital general de zona del Puerto de Veracruz. Metodología: estudio transversal descriptivo. Se incluyeron 166 trabajadores seleccionados por conveniencia del equipo multidisciplinario del área de la salud. Se aplicó un instrumento validado con 42 reactivos, basado en la teoría de clima organizacional de Likert, el cual evalúa siete dimensiones y 14 factores. El análisis de datos se realizó con estadística descriptiva. Resultados: la dimensión método de mando se obtuvo una media de 14.8 (adecuado), fuerzas motivacionales, proceso de comunicación, toma de decisiones, planificación, relaciones sociales y control, obtuvieron una media de 12.7 (regular). Conclusiones: el clima organizacional del Hospital General de Zona es regular, y la dimensión método de mando es la que predomina.

Background: organizational climate is constituted by the cluster of characteristics that workers perceive and it works as the primary force to influence in their working behavior. Objective: to identify the organizational climate in a Zonal General Hospital of the Veracruz's Harbor. Methodology: Descriptive, transversal, study. 166 workers were included and selected by convenience from a multidisciplinary team of the health field. A validated instrument was applied with 42 items, based on the theory of Likert´s organizational climate which evaluates 7 dimensions and 14 factors. The data analysis was done with descriptive statistics. Results: on the dimension method of command a media of 14.8 was obtained (adequate), motivational forces, communication process, making decisions, plannification, social relationships and control, obtained a media of 12,7 (regular). Conclusions: organizational climate of the Zonal General Hospital is regular, and the dimension method of command is what predominates.

Factores asociados con el auto-reporte de maltrato en adultos mayores en México / Factors associated with self-reporting of abuse in seniors citizens in Mexico

Objetivo: Identificar algunos factores sociodemográficos, de salud física y mental, apoyo social y de utilización de servicios de salud asociados con el auto-reporte de maltrato en una muestra de hombres y mujeres adultos mayores viviendo en colonias urbano-marginales de cuatro municipios de México. Método: Se llevó a cabo un estudio transversal entre junio del 2004 y agosto del 2005 con una muestra propositiva de 799 adultos mayores que residían en colonias urbanas, identificadas como de "muy alta" y "alta marginación" en los municipios de Cuernavaca, Chilpancingo, Guadalajara y Culiacán. Un cuestionario dirigido a los adultos mayores fue utilizado para explorar tanto la variable dependiente (auto-reporte de maltrato) como las variables asociadas: características sociodemográficas, estado de salud física y mental, apoyo social y familiar y utilización de servicios de salud. Para el análisis estadístico se emplearon pruebas no paramétricas así como un modelo multivariado de regresión logística. Resultados: En esta muestra de ancianos, el 23 por ciento de las mujeres y el 9 por ciento de los hombres reportaron haber sido maltratados como consecuencia de problemas familiares. Los resultados sugieren que los factores que se relacionan con el maltrato en los adultos mayores incluidos en este estudio son: sexo femenino (RM=3.73;IC=1.76-4.24), edad de 60 a 69 años (RM=1.61;IC=1.06-2.42), ser divorciado o separado (RM=2.28;IC=1.32-3.96), padecer un mayor número de enfermedades (RM=1.07;IC=1.01-1.17), presentar lesiones evidentes a la observación (RM= 2.89;IC=1.01-3.58), presentar sintomatología depresiva (RM=1.68;IC=1.04-2.72), y no contar con apoyo familiar adecuado RM=2.91;IC=1.86-4.55). Conclusión: Los sistemas de salud enfrentan un reto importante en el maltrato del adulto mayor debido, por un lado, al rápido aumento de este grupo poblacional y, por otro, a las carencias de recursos materiales y de recursos humanos especializados.

Objective: Identify some sociodemographic factors, in physical and mental health, social support and utilization of health services, associated with the self-reporting of abuse in a sample of male and female senior citizens living in urban, marginalized settlements in four municipalities of Mexico. Method: A cross sectional study was carried out between June of 2004 and August of 2005, with a purposive sample of 799 seniors who live in urban settlements identified as having "very high" or "high marginalization," in the municipalities of Cuernavaca, Chilpancingo, Guadalajara and Culiacán. A survey directed at seniors was used to explore the dependent variable (self-reporting of abuse) as well as the associated variables: sociodemographic characteristics, state of physical and mental health, social and family support and utilization of health services. For the statistical analysis non-parametric tests were used as well as a multivariate logistic regression model. Results: In this sample of seniors, 23 percent of the women and 9 percent of the men reported having been abused as a consequence of family problems. The factors included in this study that are related to abuse of seniors are: female gender (OR=3.73;CI=1.76-4.24), age of 60 to 69 (OR=1.61;CI=1.06-2.42), being divorced or separated (OR=2.28;CI=1.32-3.96), suffering from a higher number of diseases (OR=1.07;CI=1.01-1.17), presenting evident, observable injuries, (OR=2.89;CI=1.01-3.58), presenting depressive symptoms (OR=1.68;CI=1.04-2.72), and not having adequate family support (OR=2.91;CI=1.86-4.55). Conclusion: Health systems face an important challenge in abuse of seniors which is due, on one hand, to the rapid increase of this population, and on the other, a lack of material and specialized human resources.

Lesiones accidentales en adultos mayores: un reto para los sistemas de salud / Accidental injuries in older adults: a challenge for the health systems

OBJETIVO: Identificar los factores sociodemográficos, de salud y apoyo social relacionados con las lesiones accidentales en adultos mayores residentes de colonias urbanas marginales de las ciudades de Cuernavaca, Chilpancingo, Guadalajara y Culiacán. MATERIAL Y MÉTODOS: En 2004-2005 se llevó a cabo un estudio transversal; mediante muestra no probabilística, se entrevistó a 799 adultos mayores; se emplearon pruebas no paramétricas y un modelo multivariado de regresión logística. RESULTADOS: Del total de entrevistas, 37 por ciento notificaron lesiones y la causa principal fueron las caídas (54 por ciento). El hogar fue el sitio con mayor número de accidentes (52 por ciento). Los factores de riesgo asociados fueron edad avanzada, trabajar, mayor número de enfermedades, mayor consumo de medicamentos, remedios y bebidas alcohólicas, percepción de "mala salud", apoyo familiar inadecuado y ser cuidador de otros. CONCLUSIONES: La multicausalidad obliga, por una parte, a que toda la sociedad participe y, por la otra, a la intervención del área de la salud para prevenir y atender el problema.

OBJECTIVE: To identify factors (sociodemographic, health, and social support) associated with the presence of accidental injuries in older adults living in deprived urban neighborhoods in four Mexican municipalities. MATERIAL AND METHODS: Cross-sectional survey carried out in 2004-2005, with a non-probabilistic, intentional sample of 799 male and female elderly living in deprived urban areas in four Mexican municipalities. For the statistical analysis, non-parametric tests and multivariate logistic regression models were used. RESULTS: More than a third (37 percent) of the sample reported injuries; with falls being the main cause. Home was the venue where most accidents took place (52 percent). Risk factors for accidental injuries were: advanced age, working, greater number of illnesses, consumption of more medicines and remedies, self-perception of "poor" health , consumption of alcoholic beverages, inadequate family support and being a caretaker of others. CONCLUSIONS: The multi-causality of accidental injuries in older adults demands the participation of all sectors of society, and particularly public health interventions.

Prevalencia de iiabetes mellitus en pacientes con fibrosis pulmonar idiopática

La prevalencia de diabetes mellitus tipo 2 (DM2) en México es del 10%. Objetivo: Determinar la prevalencia de DM2 en pacientes con fibrosis pulmonar idiopática (FPI), neumonitis por hipersensibilidad (NH) y cáncer pulmonar (CP) en la ciudad de México. Casos: 136 pacientes con FPI; controles: 53 pacientes con NH y 263 con CP. El diagnóstico de DM2 se basó en dos glicemias en ayuno por arriba de 126mg/dL. Resultados: Veintinueve pacientes (21.3%) con FPI, 4 (7.5%) con NH y 25 (9.5%) con CP, tuvieron DM2, con una prevalencia significativamente mayor en la FPI en relación con la NH razón de momios 3.3 (intervalo de confianza 95% 1.1-9.6) p < 0.01 y con CP [razón de momios 2.5 (intervalo de confianza 95% 1.4-4.6) p<0.01]. No se observaron diferencias estadísticamente significativas en relación con el género, obesidad y nivel socioeconómico Conclusión: La prevalencia de DM2 en FPI, es mayor que en los controles y en la población general. La obesidad, género y nivel socioeconómico no influyeron en la DM2.

Prevalence of type 2 diabetes mellitus (DM2) in Mexico is 10%. Objective: to describe the prevalence of DM2 in Idiopathic pulmonary fibrosis (IPF), hypersensitivity pneumonitis (HP) and lung cancer patients (LC) in Mexico City. Cases: 136 patients with IPF. The control groups were 53 hypersensitivity pneumonitis patients (HP) and 263 lung cancer patients (LC). DM2 was determined by two preprandial serum glucose levels higher than 126 mg/dL. Results: 29 (21.3%) IPF patients, 4 (7.5%) HP patients and 25 (9.5%) LC patients had DM2, revealing a significantly higher prevalence of DM2 in IPF/HP [odds ratio 3.3 (95% CI 1.1-9.6) p<0.01] and IPF/LC [odds ratio 2.5 (95% CI 1.4-4.6) p<0.01]. No differences were seen when IPF patients were divided by gender, obesity and economic level. Conclusions: These results suggest that there is a higher prevalence of DM2 in IPF patients in comparison with HP, LC patients and the general population in Mexico City.

Desempeño profesional de los egresados de Escuelas de Enfermería en Nuevo León / Professional nursery practice of the graduates from IMSS school and others schools in Nuevo León

Introducción: El departamento de Comportamiento Laboral del IMSS considera el desempeño como la aplicación de habilidades y capacidades que el puesto requiere del ocupante para el manejo eficiente de sus funciones. Objetivo: Describir el desempeño de la práctica profesional de los egresados de escuelas de enfermería en Nuevo León. Metodología: Estudio transversal comparativo a 21 enfermeras generales egresadas de la escuela de enfermería del IMSS y a 23 egresadas de otras escuelas de enfermería. Se visitaron 13 unidades de mediana familiar y hospitales del área metropolitana. El instrumento utilizado fue la cédula de desempeño de evaluación del comportamiento laboral, con 30 reactivos estructurados, contestada por el jefe inmediato. Resultados: EI 100% correspondió al sexo femenino, el estado civil más frecuente fue el de solteras con 52%. El desempeño general de la escuela de enfermería del IMSS obtuvo una mediana de 98 y de otras escuelas de 92, (p=0.0003). De acuerdo al tipo de contratación y estado civil se presentaron diferencias significativas. Conclusiones: El desempeño, habilidades, capacidades y desempeño general de la práctica profesional de egresados de la escuela de enfermería del IMSS es de bueno a excelente y fue mayor en relación a otras escuelas.

Introduction: the laboral behavior department of IMSS defines the professional nursery practice as the application of abilities and capacities the job requires from the worker in order to make him do his best in his workplace, handling his functions in an efficient way. Objective: describe the professional practice development of the graduate students from the IMSS Nursery School, to be compared with the development students from others schools have. Methodology: transversal comparative study to 21 General Nurses from IMSS Nursery School, as well as 23 graduates from others schools. Thirteen Familiar Medical Units and hospitals around downtown were visited. The used instrument was the document of development of laboral evaluation with 30 structured items, which was answered by the immediate cheaf. Results: 100% of interviewed people were female. The marital status with the highest percentage, 52%, was single. The 48% studied in the IMSS Nursery School; 21% were from UANL Nursery College and 31% from different schools. The General Development of the IMSS Nursery School got an average of 98, while others schools got 92 (p=0.0003). According to the types of contracts and marital status, meaningful differences appeared. Conclusions: We can measure the development, abilities, capacities and general development of the professional practice of graduates from IMSS Nursery School, from good to excellent. And results were better than in any other school.

Evaluación del desarrollo organizacional en enfermería / Evaluation of the organizational development of nursing

Introducción: es relevante para el departamento de enfermería evaluar los subsistemas técnico, humano y organización al como parte fundamental para el crecimiento de las instituciones de salud. El responsable de la administración del trabajo en las áreas operativas es el directivo de enfermería, quien participa en la toma de decisiones, liderazgo, manejo de conflictos y comunicación; por tanto, resulta importante conocer cómo evalúa la enfermera el desarrollo organizacional del departamento de enfermería. Objetivo: evaluar el Desarrollo Organizacional (D.O.) del departamento de enfermería en un hospital de tercer nivel. Material y métodos: Estudio descriptivo y transversal, muestreo por conveniencia, n=43 enfermeras, con la utilización del "Modelo Socio técnico" de la organización. Resultados: En la evaluación del desarrollo organizacional en el departamento de enfermería, procesos sociales obtuvo mayor promedio (87.18) y el menor estructura organizacional (8608). Discusión y conclusiones: el Departamento de Enfermería como sistema abierto, susceptible de administrarse bajo la modalidad de D.O. evaluado por el instrumento "Modelo Sociotécnico", puede mejorar su administración sustantiva mediante la mejora continua y de acuerdo a resultados dicho instrumento puede emplearse en las Instituciones de Salud.

Introduction: it is excellent the nursing department, to evaluate the subsystems technician, human and organizational as fundamental part for the growth of the institutions of health. Being responsable for the administration of the work in the operativo areas, the nursing directiva who participates in taking of decisions, leadership, handling of conflicts and communication. It is important to know like the nurse floor boss evaluates the organizational development of the department of de nursing of the HECMR. Objetive: to evaluate the Organizational Development (DO.) of the nursing department in a hospital of third level. Material and methods: I Study descriptive and traverse, sampling for convenience, n=43 nurses, with the use of the "Model Technical Partner of the organization. Results: in the evaluation of the organizational development in the nursing department, social processes obtained bigger average (87.18) and the smallest organizational structure (86.08). Discussion and conclusions: the Department of nursing like open system, susceptible of being administered under the modality of D.O. evaluated by the instrument "Model Sociotécnico", It can improve their administration substantive by means of the continuous improvement and according to results this instrument it can be used in the Institutions of Health.

Actinomicosis renal. Presentación de un caso / Renal actinomicosis. Report of a case

Se presenta un caso de actinomicosis renal, en una mujer de 25 años de edad, con antecedentes de apendicectomía y absceso subfrénico, posterior. Nueve meses después presento sintomatología urinaria sugestiva de absceso o tumor renal .