Vértigo en gestantes: presentación clínica, impacto en la calidad de vida y factores asociados / Vertigo in pregnancy: clinical presentation, impact on quality of life and associated factors

OBJETIVO: Evaluar las características clínicas, el impacto en la calidad de vida y los factores asociados con vértigo en gestantes hospitalizadas en una institución de alta complejidad. MÉTODO: Estudio transversal. Se realizó una encuesta dirigida a la presencia de vértigo y sus características clínicas en 2020-2021. La calidad de vida se evaluó con el cuestionario Dizziness Handicap Inventory (DHI). El análisis estadístico incluyó un modelo lineal generalizado. RESULTADOS: De 103 mujeres, el 19,4% indicaron vértigo principalmente en el segundo trimestre de gestación (60%), con una mediana de 3,5 (rango intercuartil: 1,5-7,5) episodios. Fueron referidos vértigos episódicos asociados con cambios posicionales (40%), acompañados de inestabilidad (60%), cefalea (60%), fotopsias (55%) y tinnitus (45%). Las mujeres con vértigo presentaron mayor frecuencia de discapacidad moderada a grave en las dimensiones del DHI emocional (30 vs. 2,4%; p = 0,001), funcional (40 vs. 2,4%; p < 0,001) y física (55 vs. 2,4%; p < 0,001) en comparación con las mujeres sin la patología. La hospitalización durante el embarazo Razón de proporción (RP): 4,02; intervalo de confianza del 95% [IC95%]: 1,64-9,85; p = 0,002) y la presencia de vértigo pregestacional (RP: 2,37; IC95%: 1,15-4,88; p = 0,019) se identificaron como factores asociados. CONCLUSIONES: La alta frecuencia de vértigo en las gestantes sugiere la importancia de estudiar esta condición durante el embarazo, para lograr un manejo integral y generar acciones de prevención y control efectivas.

OBJECTIVE: To evaluate clinical characteristics, impact on quality of life and factors associated with vertigo in pregnant women hospitalized in a highly complex institution. METHOD: A cross-sectional study was conducted in 2021-2022. One focused survey including Dizziness Handicap Inventory (DHI) was performed. The statistical analysis was performed using a generalized lineal regression. RESULTS: 103 patients were included, 19.4% indicated vertigo mostly during the second semester (60%). A median of 3.5 episodes was obtained (RIC: 1.5-7.5). Positional and episodic vertigos (40%) associated with unsteadiness (60%), headache (60%), photopsia (55%) and tinnitus (45%) were described. DHI in pregnant females with vertigo compared to those without vertigo, presented higher rates of moderate to severe disability in the emotional (30 vs. 2.4%: p = 0.001), functional (40 vs. 2.4%; p < 0.001) and physical (55 vs. 2.4%; p < 0.001) dimensions. Hospitalizations during the pregnancy (RP: 4.02; 95%CI: 1.64-9.85; p = 0.002) and previous episodes before pregnancy (RP: 2.37; 95%CI: 1.15-4.88; p = 0.019) were identified as associated factors with current vertigo episodes. CONCLUSIONS: The high frequency of vertigo in pregnant women suggests the importance of studying this condition during pregnancy, to achieve comprehensive management and generate effective prevention and control actions.

High levels of docosahexaenoic acid are present in eight New World silversides (Pisces: Atherinopsidae)

Docosahexaenoic acid (DHA) is the most critical and least available omega-3 fatty acid in the Western human diet. Currently, the source of omega-3 long chain polyunsaturated fatty acids (LC-PUFA) is mainly dependent on wild fisheries, making this resource unsustainable in the foreseeable future. In recent years, a high rate of biosynthesis and accumulation of DHA has been discovered in a freshwater species (Chirostoma estor) belonging to the Atherinopsidae family. Interest in evaluating fatty acid composition in other members of the family has emerged, so this study compiles original data of flesh composition of eight atherinopsid species from freshwater and brackish environments, either wild or cultured. High levels of DHA (16 to 31%) were found in all analyzed members of the family, except in C. grandocule, independently of their habitat or origin. The analyzed species of the Jordani group (C. estor, C. promelas and C. humboldtianum) showed high DHA and low EPA levels (<0.5%) as previously reported for cultured C. estor. The low trophic niche of these atherinopsids and their fatty acid accumulation capabilities are factors that make these species noteworthy candidates for sustainable aquaculture.(AU)

O ácido docosahexaenóico (DHA) é o ácido graxo ômega-3 mais importante e menos disponível na dieta humana ocidental. Atualmente, a fonte de ácidos graxos poliinsaturados de cadeia longa ômega-3 (LC-PUFA) depende principalmente da pesca extrativista, tornando esse recurso insustentável em um futuro próximo. Nos últimos anos, uma alta taxa de biossíntese e acúmulo de DHA foi descoberta em uma espécie de água doce (Chirostoma estor) pertencente à família Atherinopsidae. Deste modo, surgiu o interesse em avaliar a composição de ácidos graxos em outros membros da família. Portanto, este estudo compila dados originais da composição de carne de oito espécies de aterinopsídeos de ambientes de água doce e salobra, selvagens ou cultivadas. Altos níveis de DHA (16 a 31%) foram encontrados em todos os membros da família analisados, exceto em C. grandocule, independentemente de seu habitat ou origem. As espécies analisadas do grupo Jordani (C. estor, C. promelas e C. humboldtianum) apresentaram altos níveis de DHA e EPA baixos (<0,5%), como relatado anteriormente para C. estor cultivado. O baixo nicho trófico desses aterinopsídeos e sua capacidade de acumulação de ácidos graxos são fatores que tornam essas espécies notáveis candidatas à aquicultura sustentável.(AU)

Seguridad de la sedación con propofol administrado por gastroenterólogos en endoscopia digestiva / Safety of propofol sedation administered by gastroenterologists in digestive endoscopy

Resumen Objetivo: tradicionalmente, la sedación con propofol ha estado a cargo de especialistas en anestesiología; sin embargo, una extensa cantidad de información publicada ha demostrado que la sedación con propofol administrado por no anestesiólogos, es segura y eficaz. El estudio se realizó con el objetivo de evaluar la seguridad en la administración de propofol por gastroenterólogos, para la realización de procedimientos en endoscopia digestiva. Métodos: se hizo un estudio retrospectivo en el cual se revisaron los expedientes de 1135 pacientes sometidos a endoscopias digestivas diagnósticas y terapéuticas, en el período comprendido entre enero de 2016 y marzo de 2017. Los pacientes se organizaron por su: edad, género, clasificación de riesgo de la Sociedad Americana de Anestesiólogos, indicación para la endoscopia, y dosis utilizada de propofol. Se registraron los efectos adversos asociados al uso de Propofol, tales como: episodios de hipoxemia transitoria, complicaciones cardiopulmonares serias y muerte. Resultados: se incluyeron los datos de 1135 pacientes (56 % fueron mujeres) que se practicaron endoscopia digestiva bajo sedación con propofol administrado por gastroenterólogos, en un período de 14 meses. La dosis promedio utilizada de propofol fue de 154 +/- 66 mg. Según la clasificación de riesgo de la Sociedad Americana de Anestesiólogos, el 84 % de los pacientes corresponde a las clasificaciones I y II, un 14,8 % a pacientes con clasificación de riesgo III y un 1,1 %, riesgo IV. Los estudios efectuados fueron mayoritariamente gastroscopias (52,6 %) y según la indicación, el 79,6 % corresponde a estudios diagnósticos, seguido de un 12,1% para los sangrados digestivos altos de emergencia. En cuanto a las complicaciones documentadas, se identificaron 70 episodios de hipoxemia que corresponden a un 6,2 % de las sedaciones realizadas. (IC 95%, 4,7-7,6). Solamente un 3,7 % de los pacientes presentó un episodio de hipoxemia por debajo del 80 %. Todos los episodios de hipoxemia, excepto uno, resolvieron con maniobras simples, como la elevación del mentón. Durante el estudio no se presentaron complicaciones cardiopulmonares serias o muertes. Se identificaron, como factores de riesgo para la aparición de hipoxemia, una clasificación de riesgo de la Sociedad Americana de Anestesiólogos mayor a 3, y la realización del estudio endoscópico para dilatación esofágica o colocación de gastrostomía percutánea. Conclusiones: el uso de sedación con propofol administrado por no anestesiólogos en el estudio, no evidenció incremento en la aparición de complicaciones cardiopulmonares serias, ni en los episodios de hipoxemia.

Abstract Aim: Traditionally, sedation with propofol has been approved exclusively for use by anethesiologists, however, an extensive amount of published information has shown that sedation with propofol administered by non-anesthesiologists is safe and effective. The present study was conducted with the objective of evaluating the safety in the administration of propofol by gastroenterologists for the performance of procedures in digestive endoscopy. Methods: A retrospective study was conducted in which the records of 1135 patients who underwent digestive and therapeutic digestive endoscopies were reviewed in the period between January 2016 and March 2017. The patients were classified by age, gender, risk classification of the American Society of Anesthesiologists (ASA), indication for endoscopy, and dose of propofol. The adverse effects associated with the use of propofol were recorded, such as episodes of transient hypoxemia, serious cardiopulmonary complications and death. Results: We included data from 1135 patients (56% were women) who underwent gastrointestinal endoscopy under sedation with propofol administered by gastroenterologist in a period of 14 months. The average dose used for propofol was 154 +/- 66 mg of propofol. According to the American Society of Anesthesiologists risk classification, 84% of the patients correspond to risk I and II, 14.8% to risk level III and 1.1% to risk level IV. The study carried out the most were gastroscopies (52.6%) and according to the indication, 79.6% corresponded to diagnostic studies, followed by 12.1% for upper gastrointestinal bleeding. Regarding the documented complications,70 episodes of hypoxemia were identified, corresponding to 6.2% of the sedations performed. (95% CI, 4.7-7.6). Only 3.7% of patients had an episode of hypoxemia below 80%. All episodes of hypoxemia, except one, resolved with simple maneuvers such as chin elevation. There were no serious cardiopulmonary complications or deaths during the study. We identified as risk factors for the appearance of hypoxemia a risk classification of the American Society of Anesthesiologists greater than 3 and performance of the endoscopic study for esophageal dilation or percutaneous gastrostomy placement. Conclusions: The use of sedation with propofol administered by non-anesthesiologists in the present study did not show an increase in the appearance of serious cardiopulmonary complications, or in episodes of hypoxemia.

Indicadores de calidad para la realización de colonoscopia

La colonoscopia se considera como la prueba de elección para el tamizaje del cáncer colorrectal. Su eficacia dependerá de múltiples factores entre los que se incluyen una preparación adecuada, una inspección meticulosa al realizar la exploración, apego a las recomendaciones de seguimiento y una capacitación óptima del colonoscopista. Para asegurar que los endoscopistas a nivel nacional brinden una colonoscopia de calidad, surge la iniciativa de establecer indicadores de calidad locales. A continuación, la Asociación Costarricense de Gastroenterología y Endoscopia Digestiva propone los indicadores de calidad para la realización de colonoscopias seguras y efectivas.

Colonoscopy is considered as the gold standard study for colorectal cancer. The efficacy of colonoscopy depends on multiple factors, including a correct bowel preparation, careful inspection tecnique, close following of the screening guidelines and adecuate training of the colonoscopist. The initiative of establishing local quality indicatorsarise from the necessity to arise the quality of the colonospy delivered by Costarican endoscopists. On this document, the Costarican Society of Gastroenterology and Digestive Endoscopy establishes quality indicators for performing safe and effective colonoscopy.