Análisis comparativo de las características clínicas, evolución y mortalidad de pacientes hospitalizados por COVID-19 durante la primera y segunda ola de la pandemia (REGISTRO ECCOVID) / Comparative analysis of clinical characteristics, evolu tion and mortality of hospitalized patients with COVID-19 during the first and second wave of the pandemic (ECCOVID STUDY)

Resumen Introducción : Las características clínicas y evolutivas de los pacientes con diagnóstico de COVID-19 pueden diferir entre las distintas olas de la pandemia. El objetivo de este estudio fue comparar las características clínicas, evolución y mortalidad de pacientes hospitalizados por COVID-19 durante la primera y segunda ola en Argentina. Métodos : Registro multicéntrico y prospectivo de pacientes ≥ 18 años con diagnóstico confirmado de COVID-19 internados en 18 hospitales de Argentina durante la primera (marzo a octubre 2020) y la segunda ola (marzo a julio 2021) de la pandemia. Se compararon variables demográficas, características clínicas, y evolu ción a 30 días. Resultados : Se incluyeron un total de 1691 pacien tes (primera ola n = 809, segunda ola n = 882). Los pa cientes hospitalizados durante la segunda ola tenían mayor edad (mediana 53 años vs. 61 años, p < 0.001), comorbilidades (71% vs. 77%, p = 0.007) y requerimiento de oxígeno (21% vs. 62%, p < 0.001). Durante la hospi talización, los pacientes de la segunda ola requirieron más oxigenoterapia (49% vs. 85%, p < 0.001), asistencia mecánica respiratoria (12% vs. 22%, p <0,001) y presen taron mayor mortalidad (11% vs. 26%, p < 0.001). Compa rando únicamente a los que requirieron oxigenoterapia durante la hospitalización, la mortalidad a los 30 días fue de 20% y 30% p < 0.001 en la primera y segunda ola respectivamente. Conclusión : Comparados con los pacientes interna dos durante la primera ola, los internados durante la segunda ola de SARS-CoV-2 en Argentina presentaron mayor gravedad y mortalidad.

Abstract Introduction : Clinical features and outcomes of SARS-CoV-2 infections may change between different waves of the pandemic. The objective of this study was to compare clinical characteristics and outcomes between two cohorts of patients hospitalized for COVID-19 during the first and second waves in Argentina. Methods : Multicenter and prospective registry of patients ≥18 years old with a confirmed diagnosis of COVID-19 admitted to 18 hospitals in Argentina during the first wave (March to October 2020) and second wave (March to July 2021) of the pandemic. Demographics, clinical characteristics, and outcomes of these patients were compared. Results : A total of 1691 patients were included (first wave n = 809, second wave n = 882). Hospitalized pa tients during the second wave were older (median 53 years vs. 61 years, p < 0.001), had more comorbidities (71% vs. 77%, p=0.007) and required more supplemental oxygen at admission (21% vs 62%, p < 0.001). During hos pitalization, patients of the second wave required more supplemental oxygen (49% vs. 85%, p < 0.001), invasive ventilation (12% vs. 22%, p < 0.001) and had higher 30- day mortality (11% vs. 26%, p < 0.001). Comparing only patients who required supplemental oxygen during hos pitalization, 30-day mortality was 20% and 30% p < 0.001 for the first and second wave, respectively. Conclusion : Compared to patients admitted during the first wave, patients admitted with SARS-CoV2 dur ing the second wave in Argentina were more seriously ill and had a higher mortality.

Shedding of infectious SARS-COV-2 in two asymptomatic children / Excreción de SARS-CoV-2 infeccioso en dos niños asin tomáticos

Abstract Asymptomatic infections with SARS-CoV-2 are associ ated with viral transmission and have a key role in the propagation of the pandemic. Understanding viral shed ding during asymptomatic infections is critical. Unfor tunately, data on asymptomatic SARS-CoV-2 infection in children is extremely limited. To determine the presence of viral viable shedding, we prospectively followed two healthy children of a family where both parents devel oped mild COVID-19 (April 2021). SARS-CoV-2 detection was made by RT-PCR and virus isolation by cell culture from saliva samples. Positive samples were sequenced to identify variants of SARS-CoV-2. Serum samples were evaluated to determine the presence of antibodies using a single enzyme-linked immunosorbent assay (ELISA, COVIDAR IgG). Both children were SARS-CoV-2 positive and asymptomatic. In addition, the virus grew in cell cul ture from saliva samples. Furthermore, one child showed viable SARS-CoV-2 for at least 17 days after the onset symptoms from his father. The recommended isolation period for asymptomatic contacts during the acquisition of data had been established for 10 days; however, this child remained with viable virus beyond that period. The positive samples from both children were consistent with B.1.1.28.1 lineage (Gamma). In both asymptomatic children, anti-Spike IgG was detected. Asymptomatic children may represent a source of infection that should not be underestimated during this pandemic.

Resumen Las infecciones asintomáticas por SARS-CoV-2 están asociadas a la transmisión viral y tienen un papel cla ve en la propagación de la pandemia. Comprender la excreción viral durante las infecciones asintomáticas es fundamental. Desafortunadamente, los datos sobre la infección asintomática por SARS-CoV-2 en niños son extremadamente limitados. Para determinar la presencia de excreción de virus viable, se siguió prospectivamente a dos niños sanos de una familia en la que ambos padres desarrollaron COVID-19 leve (abril 2021). La detección de SARS-CoV-2 se realizó por RT-PCR y el aislamiento del virus por cultivo celular a partir de muestras de saliva. Las muestras positivas se secuenciaron para identificar variantes de SARS-CoV-2. En las muestras de suero se determinó la presencia de anticuerpos utilizando un ensayo de ELISA (COVIDAR IgG). Ambos niños fueron positivos para SARS-CoV-2 y asintomáticos. Además, el virus creció en cultivos celulares a partir de muestras de saliva. Uno de los niños mantuvo SARS-CoV-2 via bles durante al menos 17 días después de la aparición de los síntomas de su padre. El período de aislamiento recomendado para contactos asintomáticos durante la adquisición de datos se había establecido en 10 días, sin embargo, este niño permaneció con virus viable más allá de ese período. Las muestras positivas de estos niños correspondieron al linaje B.1.1.28.1 (Gamma). En ambos niños asintomáticos se detectó anticuerpos IgG anti-Spike. Concluimos que los niños asintomáticos pueden representar una fuente de infección que no debe subestimarse durante esta pandemia.

Saliva screening of health care workers for SARS-CoV-2 detection / Análisis del personal de salud a partir de saliva para detección de SARS-CoV-2

Abstract Health care workers (HCWs) are at high risk for SARS-CoV-2. In addition, pre-symptomatic or asymptomatic transmission accounts for around half of the cases. Saliva testingis an option to detect SARS-CoV-2 infection. To determine the performance of saliva samplesfor screening, HCWs were tested for SARS-CoV-2 by RT-PCR. Those with a positive result insaliva were tested by nasopharyngeal swabbing for viral RNA detection and blood collectionto search for the presence of specific antibodies. In September---October 2020, 100 HCWs wereenrolled and followed up. Six subjects (6%) tested positive in saliva. Of them, 5/6 were positivein a subsequent nasopharyngeal swab and 4/6 developed signs and symptoms compatible withCOVID-19. Among the latter, 3 seroconverted while asymptomatic HCWs remained seronega-tive. Saliva screening was helpful for identifying SARS-CoV-2 infection in HCWs. This screeningpermitted rapid personnel isolation avoiding further transmission of the virus in the hospitalsetting.

Resumen El personal de salud (PS) tiene un alto riesgo de contraer SARS-CoV-2. La transmisión presintomática/asintomática representa alrededor de la mitad de los casos y el análisis a partir de muestras de saliva puede ser una opción para detectar la infección. Para determinar el rendimiento de estas muestras, 100 voluntarios del PS se sometieron a la detección de SARS-CoV-2 por RT-PCR en muestras de saliva en el período septiembre-octubre de 2020. De aquellos con resultado positivo en saliva, se tomaron hisopados nasofaríngeos para detectar ARN viral y muestras de suero para evaluar anticuerpos específicos. Se detectó ARN viral en la saliva de seis individuos (6%). De ellos, 5/6 fueron SARS-CoV-2 positivos en hisopado nasofaríngeo y 4/6 desarrollaron signos y síntomas compatibles con COVID-19. Entre estos últimos, tres serocon-virtieron, en tanto que los voluntarios asintomáticos permanecieron seronegativos. La muestra de saliva fue útil para identificar la infección por SARS-CoV-2 en esta cohorte del personal de salud y así proceder al rápido aislamiento de los individuos infectados, lo que evitó una mayor transmisión del virus en el ámbito hospitalario.

Disección coronaria espontánea posterior a envenenamiento por escorpión / Spontaneous coronary artery dissection following scorpion poisoning

Resumen Hombre de 44 años que acude al servicio de urgencias posterior a picadura de escorpión. Presentaba parestesias, dolor toracoabdominal y náuseas. Desde el momento del ingreso presentó dolor torácico atípico, dolor abdominal epigástrico de intensidad leve, asociado a náuseas. Se realizó electrocardiograma que no evidenció alteraciones. La troponina fue elevada, por lo que se llevó a cuidado intensivo y se inició manejo antiisquémico, corroborando posteriormente en la angiografía una disección coronaria tipo 1 en el ramus intermedio como causante de su evento coronario. El paciente recibió un vial de suero antiescorpiónico en primer nivel de atención y posteriormente se indicó manejo con betabloqueante, antiagregación con ácido acetilsalicílico y clopidogrel, con disminución progresiva de sus síntomas. Es egresado asintomático. Se reporta un caso de infarto agudo de miocardio tipo 2 por disección coronaria posterior a una picadura de escorpión, del cual no hay casos reportados previamente en el mundo.

Abstract A 44-year-old man was admitted to the emergency department after a scorpion sting. He presented paresthesia, thoracoabdominal pain and nausea. From the moment of admission, he presented atypical chest pain, epigastric abdominal pain of mild intensity, associated with nausea. An ECG was taken that did not show alterations, troponin was elevated, he was admitted to intensive care unit, management was initiated, subsequently corroborating in the angiography, a type 1 coronary artery dissection in the intermediate ramus as the cause of coronary event. The patient received a vial of antiscorpionic serum in the first level of care, later treatment with beta-blocker, antiaggregation with acetylsalicylic acid and clopidogrel was indicated, with progressive reduction of his symptoms. He is an asymptomatic graduate. A case of type 2 acute myocardial infarction due to coronary dissection after a scorpion sting is reported, there are no previously reported cases in the world.

Vólvulo gástrico agudo: cuadro clínico infrecuente / Acute gastric volvulus: an uncommon presentation

RESUMEN El vólvulo gástrico agudo (VGA) es una entidad infrecuente, con elevada mortalidad de hasta 50%, y su diagnóstico se basa en un alto nivel de sospecha clínica. En el paciente estable se puede plantear manejo no operatorio, pero en el inestable se impone el tratamiento quirúrgico. Presentamos el caso de un paciente con VGA e inestabilidad hemodinámica, en el cual se realizó laparotomía y devolvulación gástrica, pero falleció en el posoperatorio inmediato por shock refractario.

ABSTRACT Acute gastric volvulus (AGV) is an uncommon condition with high mortality (up to 50%) and its diagnosis is based on high level of suspicion. Conservative management can be attempted in stable patients, but the surgical approach is indicated in unstable cases. We report the case of a patient with AGV and hemodynamic instability who underwent laparotomy with reduction of the volvulus but who died in the immediate postoperative period due to refractory shock.

Tétanos generalizado: Una amenaza persistente, reporte de tres casos y revisión de la literatura / Generalized tetanus: A persistent threat, review of the literature and report of three cases

RESUMEN INTRODUCCIÓN: El tétanos es una enfermedad inmunoprevenible, ocasionada por la bacteria Clostridium tetani, desencadenando una enfermedad caracterizada por espasmos musculares, insuficiencia respiratoria y disautonomías, potencialmente mortal. MATERIALES Y MÉTODOS: Presentamos una serie de tres pacientes que consultaron al servicio de urgencias por presentar trismus, rigidez muscular generalizada y dificultad respiratoria, requiriendo manejo en la unidad de cuidados intensivos, con relajación muscular y administración intramuscular e intratecal de inmunoglobulina antitetánica, con evolución satisfactoria en todos los casos. DISCUSIÓN: Su tratamiento está divido en dos grandes secciones; la primera parte, el control de la infección y eliminación del agente causal, con lavado y desbridamiento de heridas, administración de antibióticos y neutralización de la neurotoxina. La segunda parte del tratamiento está en el soporte vital en la unidad de cuidados intensivos, con la administración de sedación, relajación muscular, control de disautonomías y manejo de complicaciones. CONCLUSIONES: El tétanos a pesar de los avances en vacunación aún es una enfermedad presente, cuyo diagnóstico y tratamiento rápido y adecuado, permite sobrevivir a los pacientes, como en los casos aquí reportados.

ABSTRACT INTRODUCTION: Tetanus is an immuno-preventable disease, produced by the bacterium Clostridium tetani, that causes a disease characterized by muscle spasms, respiratory insufficiency and life-threatening dysautonomia. MATERIALS AND METHODS: We present a series of three patients who consulted for trismus, muscle stiffness and respiratory failure, which required intensive care management, muscle relaxation, intramuscular and intrathecal administration of tetanus immu-noglobulin, with satisfactory outcomes in all the cases. DISCUSSION: Its treatment is divided into two main sections; the first part, the control of infection and elimination of the causative agent, with washing and debridement of wounds, administration of antibiotics and neutralization of the neurotoxin. The second part is life support in the intensive care unit, with the administration of sedation, muscular relaxation and control of dysautonomia and the management of complications. CONCLUSIONS: Despite the advances in vaccination, tetanus is still a present disease, whose diagnosis and rapid and adequate treatment allows patients to survive, as in the cases reported here.

Deficiencia de alfa-1 antitripsina y neumotórax espontáneo. ¿Solo una coincidencia? / Alpha-1 antitrypsin deficiency and spontaneous pneumothorax. Just a coincidence?

Resumen La deficiencia de alfa-1 antitripsina (AAT) es uno de los trastornos hereditarios más frecuentes y con mayor incidencia en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Se desconoce su prevalencia en aquellos con neumotórax espontáneo. El objetivo fue estimar la prevalencia de deficiencia de AAT en sujetos con neumotórax espontáneo. El estudio fue prospectivo y de corte transversal en pacientes con neumotórax espontáneo primario. Se excluyeron aquellos con neumotórax secundario. Se realizó cuantificación de AAT en suero por nefelometría y posterior genotipificación rápida (PCR en tiempo real) para detectar los alelos de deficiencia más prevalentes (Z y S) en aquellos con concentraciones séricas ≤ 120 mg/dl. Se incluyeron 58 pacientes con neumotórax espontáneo primario. La edad promedio fue de 34 ± 13 años con predominio de sexo masculino (72%) y alta prevalencia de tabaquismo actual y pasado (60%). Del total, el 26% (IC95%: 15-39) presentó concentraciones de AAT ≤ 120mg/dl. Encontramos 7 formas deficitarias (12%; IC 95%: 5-23%). Un paciente presentó una forma grave Pi*ZZ (1.7%), 3 fueron heterocigotos Z (5.2%) y 3 heterocigotos S (5.2%). La prevalencia de variantes deficitarias de AAT fue alta en este grupo con neumotórax espontáneo.

Abstract Alpha-1 antitrypsin (AAT) deficiency is one of the most common inherited disorders with a higher incidence in patients with chronic obstructive pulmonary disease (COPD). Its prevalence in patients with spontaneous pneumothorax is unknown. The objective was to estimate the prevalence of AAT deficiency in patients with spontaneous pneumothorax. This was a prospective cross-sectional study, in patients with spontaneous pneumothorax, where those with secondary pneumothorax were excluded. Quantification of serum AAT by nephelometry and subsequent rapid genotyping (real time PCR) was performed, in order to detect the most prevalent deficiency alleles (Z and S) in those subjects with serum AAT concentrations ≤ 120 mg/dl. Fifty-eight patients with primary spontaneous pneumothorax were included. The average age was 34 ± 13 years with male predominance (72%) and high prevalence of current and past smoking (60%). Twenty six percent of them (95% CI: 15-39) presented AAT serum concentrations ≤ 120mg/dl. We found 7 deficiency variants (12%; IC 95%: 5-23%). One patient presented a severe Pi*ZZ form (1.7%), 3 were heterozygotes Z (5.2%) and 3 heterozygotes S (5.2%). The prevalence of AAT deficient variants was high in patients with spontaneous pneumothorax.

Protective effects of alpha stone on monosodium glutamate-induced uterine hyperplasia in female wistar rats

Background: Uterine leiomyomas (fibroids), a menace of the reproductive age, is characterized byproliferation of smooth muscle cells (hyperplasia) of the uterus. Alpha Stone Decoction is a poly-herbalformulation that is used for the shrinkage and prevention of uterine fibroids in folkore medicine.Objective: We investigated the efficacy and safety of Alpha Stone Decoction (ASD), on monosodiumglutamate (MSG) induced uterine hyperplasia.Materials and methods: Twenty-eight mature virgin female rats were randomly divided into four studygroups: A-control B- MSG (200 mg/kgbw), C- MSG þ ASD (100 mg/kgbw) and D- ASD 100 mg/kgbwalone. The administration was carried out by as a single daily dose via intraperitoneal route for 14 days.Total protein, triglycerides, estradiol (estrogen), progesterone, and total cholesterol levels in sera weredetermined using appropriate kits. Uterine hyperplasia was assessed via histomorphometric methodusing the mitotic image plus software to compute the fibroblast cell count density while the uteri andovaries of animals were stained with mason-tricon stain for histological examination.Results: Administration of MSG for 14 days resulted heavy deposits of collagen connective tissue withinthe myometrium layers of the uteri. ASD significantly (p < 0.05) reduced fibroblast cell count inMSG-treated animals and also protected against MSG-induced damage observed in the myometrium ofthe uteri and ovaries of the animals. Significant increases (p < 0.05) in levels of total protein;triglycerides, progesterone, cholesterol and estrogen in the MSG-treated animals were amelioratedfollowing administration of ASD.Conclusion: These findings suggest that ASD contains bioactive agents which reversed MSG-induceduterine hyperplasia. It may therefore be useful in reducing the proliferation of fibroblast cells andmanaging other symptoms associated with uterine myoma.

Composición corporal y somatotipo de rugbistas chilenos y su relación con la posición de juego / Body composition and somatotype of chilean rugby players and their relationship with the game position

RESUMEN: El objetivo del estudio fue describir las características morfoestructurales, por posición de juego, en rugbistas de la región de Valparaíso, Chile. La estatura, peso, índice de masa corporal (IMC) y otros 25 parámetros antropométricos fueron obtenidos desde 121 rugbistas competitivos (24,2 ± 4,9 años), siguiendo los estándares de medición de la Sociedad Internacional para el Avance de la Kinantropometría (ISAK). La composición corporal fue descrita en 5 componentes a través del método propuesto por Kerr, estos son masa muscular, adiposa, residual, ósea y piel. El uso del somatotipo descrito por Carter y Heath, permitió describir los componentes de endomorfía, mesomorfía y ectomorfía. Para comparar las características morfoestructurales de los rugbistas por posición de juego, estos fueron separados en forwards y backs. El peso corporal, la estatura sentado y de pie, el IMC y la sumatoria de 8 pliegues fueron mayores en los forwards que los backs (p<0,0001). En relación a las masas corporales, el tejido adiposo y muscular absoluto fueron mayores en los forwards que en los backs (P< 0,01), no así el relativo. El somatotipo evidenció mayor endomorfía y mesomorfía, y menor ectomorfía, en los forwards 4,8-6,9-0,7 (1,8-1,3-0,8) que los backs 3,7-6,1-1,2 (1,8-1,1-0,8) con P<0,01. En conclusión, la posición de juego en el rugby es determinante en la definición de características físicas básicas y morfológicas. El mayor peso corporal de los forwards respecto a los backs se encuentra influenciado por la presencia de más tejido muscular y adiposo. Esto último se relacionó con un mayor componente mesomórfico y endomórfico del somatotipo, y menor del ectomórfico, en los forwards. A pesar de estas diferencias ambos grupos se encuentran en una clasificación de endo-mesomorfo.

SUMMARY: The objective of the study was to describe the morpho-structural characteristics according to playing position, in rugby players from the region of Valparaíso, Chile. Height, weight, body mass index (BMI) and other 25 anthropometric parameters were obtained from 121 competitive rugby players (24.2 ± 4.9 years), following the recommendations of the International Society for the advancement of Kinanthropometry. The body composition was described in 5 components through the method proposed by Kerr, they are muscle, fat, residual, bone and skin. The somatotype described by Carter and Heath, allowed to describe the components of endomorphy, mesomorphy and ectomorphy. To compare the morphostructural characteristics of the rugby players by playing position, these were separated into forwards and backs. Body weight, sitting and standing height, BMI and S 8-fold were higher in the forwards than the backs (p <0.0001). In relation to body mass, adipose tissue and absolute muscle were higher in the forwards than in the backs (P <0.01), but not in the relative. The somatotype showed significant differences in the averages of the three components between forwards 4.8-6.9-0.7 (1.8-1.3-0.8) and backs 3.7-6.1-1, 2 (1.8-1.1-0.8) with P <0.01. In conclusion, the playing position in rugby is decisive in the definition of basic physical and morphological characteristics. A higher body weight of the forwards versus backs is influenced by a greater muscle and adipose tissues. Latter was related to a greater mesomorphic and endomorphic component of the somatotype, and lower ectomorphic in the forwards. Despite these differences, both groups are classified as endo-mesomorph.

Haematological values in a healthy adult population in Yaoundé, Cameroon

Background: Haematological values derived from local populations are useful in laboratories to improve diagnoses for local patients. In Cameroon, these data are not yet available. Moreover, there is great variation in baseline parameters pertaining to full blood cell count among medical laboratories.Objectives: This study aimed to determine values for the complete blood cell count of a healthy adult Cameroonian population for use in locally derived ranges in our medical laboratories.Methods: A cross-sectional study was conducted among blood donors attending three blood banks in Yaoundé from November 2015 to September 2016. We expected to obtain at least 120 venous blood samples from both men and women. Tests were performed for (1) HIV, (2) complete blood cell count, (3) hepatitis B virus, (4) malaria, (5) syphilis, (6) C-reactive protein and (7) hepatitis C virus.Results: We enrolled 294 healthy participants (161 men, 133 women) aged 18 to 55 years. The median haemoglobin concentration was 135 g/L in men and 114 g/L in women (p < 0.001). The median reticulocyte count was 60 × 109/L in men and 40 × 109/L in women (p < 0.001).Significant variation by sex was observed for the platelet count. The median white blood cell count was 4.1 × 109/L in men and 4.6 × 109/L in women (p = 0.008). Conclusion: This study provides locally derived ranges for complete blood cell and reticulocyte counts for a healthy adult population in Yaoundé, Cameroon. These results can be used pending larger studies

Consideraciones anestésicas en el paciente con enfermedad por virus dengue / Anesthetic considerations in the patient with dengue virus disease

El dengue continúa siendo un problema de salud pública en América. Suele presentarse como una enfermedad febril leve, sin embargo, los pacientes con enfermedad grave pueden presentar síndromes hemorrágicos y choque por dengue. Diferentes circunstancias pueden surgir en el curso evolutivo de los pacientes con dengue impactando en la posibilidad de que sea necesario realizar en ellos una intervención quirúrgica, ante lo cual es necesario plantear las consideraciones anestésicas que deben ser tenidas en cuenta para el correcto abordaje. El presente texto tiene como objetivo establecer consideraciones clínicas útiles para el manejo anestésico en el paciente con enfermedad por dengue para reducir el riesgo de complicaciones peri-operatorias y muerte.

Dengue fever continues to be a public health problem in America. It usually presents as a mild febrile illness, however, patients with severe disease may have hemorrhagic syndromes and dengue shock. Different circumstances can arise in the evolutionary course of patients with dengue impacting on the possibility that it is necessary to perform a surgical intervention, before which it is necessary to raise the anesthetic considerations that must be taken into account for the correct approach. The present text aims to establish useful clinical considerations for anesthetic management in the patient with dengue disease to reduce the risk of peri-operative complications and death.

Alfabetización en salud y control de la diabetes en pacientes de un hospital universitario de Argentina / Health literacy and diabetes control in patients attending a university outpatient clinic in Argentina

La alfabetización en salud (AS) es una medida de la capacidad de los pacientes de leer, comprender y tomar decisiones en base a instrucciones médicas. La inadecuada AS se asocia con peor estado de salud en pacientes con enfermedades crónicas. Es escasa la información sobre el nivel de alfabetización en pacientes diabéticos en Argentina. Se realizó este estudio con el objeto de estimar la relación de inadecuada AS y el control de la diabetes, evaluada a través del valor de la hemoglobina A1c en diabéticos tratados con insulina que concurren a un hospital universitario de Argentina. La AS se evaluó con el Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA) y se evaluó el control de la glucemia por el último valor de hemoglobina A1c. Participaron 156 pacientes seleccionados en forma aleatoria, 58% mujeres. El puntaje promedio de SALHSA fue 35 (rango: 11-50). Se encontró inadecuada AS en 94 pacientes (60.3%). La HbA1c promedio en los pacientes con inadecuada AS fue 8.15% vs 7.15% entre los que tenían adecuada AS (p = 0.0001). La regresión lineal múltiple mostró que la inadecuada AS se asocia en forma significativa con el mal control de la glucemia (β = -0.05 IC 95% -0.07; -0.02, p < 0.001). En conclusión, sería necesario implementar medidas para garantizar la educación de los pacientes con limitada AS.

Health literacy (HL) is a measure of a patient ability to read, understand and to take decisions on medical instructions. Patients with inadequate HL have poorer health outcomes than those with adequate HL. There is little information on HL levels in diabetic patients in Argentina. The aim of this study was to explore the association between HL and glycemic control in diabetic patients from a university hospital in Argentina. HL was assessed with the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA), glycemic control through glycosylated hemoglobin A1c (HbA1c); 156 patients (58% women) took part in the study. Average SAHLSA score was 35 (range: 11-50). Patients with inadequate values of HL had HbA1c of 8.15% vs. 7.15% among those with adequate HL (p = 0.0001). The multiple linear regression shows that inadequate HL was significantly associated with poorer glycemic control (β = -0.05 IC 95% -0.07; -0.02, p < 0.001). Efforts should focus on developing interventions to improve glycemic control among patients with inadequate HL.

Educación prenatal e inicio de la lactancia materna: Revisión de la literatura / Prenatal education and the commencement of breastfeeding: A literature review / Educação pré-natal e início do aleitamento materno: revisão da literatura

Introducción: Las recomendaciones universales para la alimentación infantil incluyen la lactancia materna (LM) exclusiva durante los primeros 6 meses de vida y posteriormente alimentación complementaria hasta los 2 años, así como la importancia del inicio de la lactancia en la primera hora de vida. Metodología: Búsqueda sistemática en diversas bases de datos del área de la salud cuyo objetivo fue determinar la influencia de la educación prenatal impartida, en general por los profesionales de la salud y en particular por la matrona, en la decisión de optar por la LM. Resultados y discusión: El éxito de la LM depende de la información y del apoyo proporcionado a la familia. Influye negativamente en su instauración y mantenimiento la falta de información y apoyo, las prácticas sanitarias inadecuadas y la escasa formación de los profesionales. Contribuye positivamente haber sido atendida por una matrona durante el embarazo. Existe evidencia, con categoría A, de que las clases prenatales realizadas por matronas aumentan la prevalencia, la duración y la exclusividad de la lactancia, así como el establecimiento de la lactancia al alta hospitalaria tras el parto. Se recomienda, con un grado B, proporcionar a los padres información sobre lactancia en las clases prenatales. No hay diferencias significativas en cuanto a los motivos por los cuales se abandona la lactancia entre las mujeres que realizaron educación prenatal con las que no la realizaron. Conclusiones: La educación maternal realizada por matronas desde la primera visita prenatal es un factor protector en el inicio y mantenimiento de la LM y debe incluir explicaciones sobre los beneficios que comporta y guías sencillas para resolver dudas y complicaciones.

Introduction: The recommendations on child nourishment include starting maternal breastfeeding within the first hour of life, and continuing it, exclusively, during the first 6 months of life; thereafter, a complementary diet can be included. Methodology: A systematic search in diverse databases related to the health area was conducted with the objective of determining the influence of prenatal education provided, in general by the health professionals, and in particular by midwives, on the mothers' decision to breastfeed. Results and discussion: The success of maternal breastfeeding depends on the information and the support provided to her family. Barriers to breastfeeding include the lack of information and support, the inadequate sanitary practices, and the poor preparation of the health professionals. Promoters to breastfeeding include having been assisted by a midwife during the partum. There is category-A evidence, that prenatal classes given by midwives, and the early establishment of maternal breastfeeding -following the partum- both increment the prevalence, duration, and exclusivity of breastfeeding. There were no significant differences related to the motives of abandoning breastfeeding among women who had prenatal education and who did not. Conclusions: The maternal education provided by midwives from the first prenatal visit is a promoting factor to establishing and maintaining breastfeeding. In general, prenatal education should include explanations of the benefits of breastfeeding, as well as simple guidelines related to the possible doubts.

Introdução: As recomendações universais para a alimentação infantil incluem o aleitamento materno (AM) exclusivo durante os primeiros 6 meses de vida e posteriormente alimentação complementar até os dois anos, assim como a importância do início do aleitamento na primeira hora de vida. Metodologia: Busca sistemática em diversas bases de dados da área de saúde, cujo objetivo foi determinar a influência da educação pré-natal ensinada, en geral pelos profissionais da saúde e em particular pela parteira, na decisão de optar pelo AM. Resultados e discussão: O sucesso do AM depende da informação e o apoio proporcionado à família. Influi negativamente em sua instauração e na manutenção pela falta de informação e apoio, as práticas sanitárias inadequadas e a escassa formação dos profissionais. Influi positivamente ter sido atendida por uma parteira durante a gravidez. Existe evidência, com categoria A, de que as aulas pré-natais realizadas por parteiras aumentam a prevalência, duração e exclusividade do aleitamento. Assim como o estabelecimento do aleitamento após a alta hospitalar trás o parto. Recomenda-se, com um grau B, proporcionar aos pais informação sobre aleitamento nas aulas pré-natais. Não há diferenças significativas quanto aos motivos pelos quais se abandona o aleitamento entre as mulheres que realizaram educação pré-natal com as que não. Conclusões: A educação materna realizada por parteiras desde a primeira visita pré-natal é um fator protetor no início e de manutenção do AM e deve incluir explicações sobre os benefícios que proporciona e guias simples para resolver dúvidas e complicações.

Aged garlic extract and S-allylcysteine prevent apoptotic cell death in a chemical hypoxia model

BACKGROUND: Aged garlic extract (AGE) and its main constituent S-allylcysteine (SAC) are natural antioxidants with protective effects against cerebral ischemia or cancer, events that involve hypoxia stress. Cobalt chloride (CoCl2) has been used to mimic hypoxic conditions through the stabilization of the α subunit of hypoxia inducible factor (HIF-1α) and up-regulation of HIF-1α-dependent genes as well as activation of hypoxic conditions such as reactive oxygen species (ROS) generation, loss of mitochondrial membrane potential and apoptosis. The present study was designed to assess the effect of AGE and SAC on the CoCl2-chemical hypoxia model in PC12 cells. RESULTS: We found that CoCl2 induced the stabilization of HIF-1α and its nuclear localization. CoCl2 produced ROS and apoptotic cell death that depended on hypoxia extent. The treatment with AGE and SAC decreased ROS and protected against CoCl2-induced apoptotic cell death which depended on the CoCl2 concentration and incubation time. SAC or AGE decreased the number of cells in the early and late stages of apoptosis. Interestingly, this protective effect was associated with attenuation in HIF-1α stabilization, activity not previously reported for AGE and SAC. CONCLUSIONS: Obtained results show that AGE and SAC decreased apoptotic CoCl2-induced cell death. This protection occurs by affecting the activity of HIF-1α and supports the use of these natural compounds as a therapeutic alternative for hypoxic conditions

Actinomicosis torácica: presentación de un caso / Thoracic actinomycosis: report of a case

La actinomicosis es una enfermedad producida por bacterias del género Actinomyces. La forma torácica representa el 30% de los casos. La evolución es habitualmente crónica, con clínica variable. Se presenta una nina de 11 años de edad con tumefacción subescapular derecha de un mes de evolución, asociada a fiebre, hiporexia y pérdida de peso. Se diagnosticó actinomicosis torácica producida por Actinomyces meyeri. Recibió tratamiento antibiótico durante un año, con resolución completa. Aunque es poco frecuente, debe ser tenida en cuenta como diagnóstico diferencial en cuadros de tumoración torácica de larga evolución con compromiso del estado general. Debe informarse al microbiólogo la sospecha diagnóstica por lo difícil de su desarrollo en los medios de cultivo habitual.

Actinomycosis is a disease produced by bacteria of the genus Actinomyces. The thoracic form represents 30% of the cases. Signs and symptoms are generally unspecific. A previously healthy 11 year old girl was admitted with a chest mass of a month of evolution associated with fever, hyporexia and weight loss. Thoracic actinomycosis was diagnosed with the isolation of Actinomyces meyeri in the mass drainage. She received antibiotic treatment for a year with complete resolution. Although rare, it should be taken into account as a differential diagnosis in long evolution thoracic tumor affecting the general condition. The microbiologist must be warned about the suspected diagnosis because it is difficult to find it in routinely used culture media.

Caracterización morfológica del músculo bíceps femoral del perro / Morphological characterization of biceps femoris muscle in the dog

A partir de estudios previos realizados sobre la anatomía del musculo bíceps femoral en el perro y con el objetivo de avanzar en la caracterización inmunohistoquímica y nerviosa de este musculo, estudiamos la existencia de subvolúmenes musculares. Utilizamos la disección roma en piezas musculares aisladas fijadas y tratadas con ácido nítrico al 25%. Las divisiones de las ramas del nervio isquiático involucradas fueron utilizadas como guía en la disección. Se determinaron tres subvolúmenes, uno involucrando a la cabeza caudal y dos en el vientre correspondiente a la cabeza craneal que fueron denominados caudal, proximal y distal respectivamente. Realizamos mediciones del largo de las fibras musculares, dirección, dirección y densidad macroscópica de las mismas para caracterizar los compartimientos. Estos subvolúmenes deberán tenerse en cuanta al realizar estudios electromiográficos del musculo bíceps femoral y al evaluar las alteraciones en la locomoción producto de las alteraciones nerviosas y musculares en el nervio pelviano del canino.

From previous studies on the anatomy of the femoral biceps muscle in the dog and with the aim of advancing in immunohistochemical and nervous characterization of this muscle, we studied the existence of subvolumes in muscle structure. We used blunt dissection in isolated muscle pieces fixed and treated with 25% nitric acid. The divisions of the sciatic nerve branches involved were used to guide the dissection. Three subvolumes were identified; one, involving the caudal head, and two in the cranial head belly; they were called caudal, proximal and distal respectively. We measured muscle fiber length, orientation, and macroscopic density to characterize these compartments. These subvolumes must be considered when muscle electromyography research is carried out, and for locomotion changes evaluation due to lesions in nerve and muscle structure of the canine pelvic limb.

Determinants of unmet need for modern contraception andreasons for non-use among married women in rural areas of Burkina Faso

Burkina-Faso (TFR=6.0) is among the top-ten high fertility countries world-wide and CPR (15) among women is low. This study examined the factors associated with non-use of modern contraception among married women residing in the rural areas of Burkina-Faso. The study used 2010 Burkina Faso Demographic and Health Survey data-set and focussed on married women aged 15-49 years (n=7;191). Chi-square and logistic regression techniques were used for the analysis (a=5). Mean number of living children was significantly higher among women who have UNMC (3.92) than those with met need (3.01). Modern CPR and UNMC among married women was 12.7 and 40.7 respectively. The multivariate analysis reveals that being married more than once increases the likelihood of UNMC (OR=1.304; C.I=1.0821.571; p0.05). Husbands' approval of FP is a protective factor of UNMC (OR

Prevalence and Determinants of Unintended Pregnancies in Malawi

Available statistics indicate high levels of unintended pregnancies in Africa. This study examines the prevalence and determinants of unintended pregnancies in Malawi based on 2;144 pregnant women extracted from the 2010 Malawi Demographic and Health Survey. Data were analyzed using univariate; bivariate and multinomial logistic regression models. Nearly 43 of the pregnancies were unintended of which 25 were mistimed. Multivariate analysis indicated that mistimed pregnancies are significantly influenced by the age of the respondent; fertility preference and number of children ever born. Among the variables that significantly increased the likelihood of unwanted pregnancies are age of respondent; wealth status; fertility preference; and region of residence even though potential confounding factors were used as control. The study recommends the strengthening of family planning services in order to reduce the level of unintended pregnancies. Focus should be on couples in Central Region and those having large number of children

Correlación de los hallazgos endoscópicos pre y postoperatorios en pacientes sometidos a cirugía bariátrica / Correlation of pre and postoperative endoscopic findings in patients subjected to bariatric surgery

Objetivo: Establecer una correlación de los hallazgos endoscópicos preoperatorios con los síntomas gastrointestinales y hallazgos endoscópicos en el seguimiento de los pacientes sometidos a algún tipo de cirugía bariátrica. Sede: Hospital General ''Dr. Manuel Gea González''. Tercer Nivel de Atención Médica. Diseño: Estudio retrospectivo, descriptivo, transversal y comparativo. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas y χ². Pacientes y método: Pacientes que se operaron en la clínica de obesidad, de junio 2006 a junio 2010, a los cuales se les realizó endoscopia preoperatoria con un seguimiento mínimo de un año. Se identificaron las patologías gastrointestinales con mayor incidencia, hallazgos histopatológicos y la correlación de la endoscopia postoperatoria en el seguimiento de pacientes que por sus síntomas requirieron control endoscópico. Resultados: De un total de 137 pacientes que cumplieron con los criterios de inclusión (111 mujeres, 26 hombres), con edad promedio de 36.41, IMC promedio de 42.04, la patología con mayor incidencia fue gastritis inespecífica no erosiva (45.25%), el resultado histopatológico más frecuente fue gastritis asociada a Helicobacter pylori (HP) (38.6%). A un seguimiento promedio de tres años (DE ± 1.31) a 35 pacientes (25.5%) se les realizó endoscopia de seguimiento por síntomas gastrointestinales; los hallazgos endoscópicos fueron: gastritis inespecífica no erosiva (54.28%), sin alteraciones (31.42%) y estenosis de anastomosis (14.7%). Conclusión: La endoscopia preoperatoria es de gran utilidad, ya que permite identificar patologías que se pueden asociar a otras complicaciones y tomar todas las medidas para prevenirlas.

Objective: To establish a correlation between the pre-operative endoscopic findings with the gastrointestinal syndrome and endoscopic findings during follow-up of patients subjected to bariatric surgery. Setting: General Hospital ''Dr. Manuel Gea González'' (third level health care center). Design: A retrospective, descriptive, cross-sectional, comparative study. Statistical analysis: Percentages as summary measures for qualitative variables and χ². Patients and method: Patients operated in the obesity clinic from June 2006 to June 2010, in whom a preoperative endoscopy was performed with a follow-up of at least 1 years. We identified the gastrointestinal pathologies with the highest incidence, histopathological findings, and the correlation with the postoperative endoscopy during the follow-up of patients, who, due to their symptoms, required endoscopic control. Results: In a total of 137 patients that complied with the inclusion criteria (111 women and 26 men), average age of 36.41 years, average BMI of 42.04, the pathology with the highest incidence was non-specific non-erosive gastritis (45.25%), the most frequent histopathological result was gastritis associated to Helicobacter pylori (HP) (38.6%). At an average follow-up of three years (SD ± 1.31), 35 patients (25.5%) were subjected to follow-up endoscopy due to gastrointestinal symptoms. Endoscopic findings were: non-specific, non-erosive gastritis (54.28%), without alterations (31.42%), and stenosis of the anastomoses (14.7%). Conclusion: Preoperative endoscopy is very useful as it allows identifying pathologies that can be associated to other complications and taking the necessary measures to prevent them.