Analysis of fetal heart rate fluctuations in women diagnosed with preeclampsia during the latent phase of labor.

Introduction: Fetal heart rate variability (fHRV) is a tool used to investigate the functioning of the fetal autonomic nervous system. Despite the significance of preeclampsia, fHRV during the latent phase of labor has not been extensively studied. This study aimed to evaluate fetal cardiac autonomic activity by using linear and nonlinear indices of fHRV analysis in women diagnosed with preeclampsia without hypertensive treatment during gestation, compared to normotensive women during the latent phase of labor. Methods: A cross-sectional and exploratory study was conducted among pregnant women in the latent phase of labor, forming three study groups: normotensive or control (C, 38.8 ± 1.3 weeks of pregnancy, n = 22), preeclampsia with moderate features (P, 37.6 ± 1.4 weeks of pregnancy n = 10), and preeclampsia with severe features (SP, 36.9 ± 1.2 weeks of pregnancy, n = 12). None of the participants received anti-hypertensive treatment during their pregnancy. Linear and nonlinear features of beat-to-beat fHRV, including temporal, frequency, symbolic dynamics, and entropy measures, were analyzed to compare normotensive and preeclamptic groups. Results: Significantly lower values of multiscale entropy (MSE) and short-term complexity index (Ci) were observed in the preeclamptic groups compared to the C group (p < 0.05). Additionally, higher values of SDNN (standard deviation of R-R intervals) and higher values of low-frequency power (LF) were found in the P group compared to the C group. Conclusion: Our findings indicate that changes in the complexity of fetal heart rate fluctuations may indicate possible disruptions in the autonomic nervous system of fetuses in groups affected by undiagnosed preeclampsia during pregnancy. Reduced complexity and shifts in fetal autonomic cardiac activity could be associated with preeclampsia's pathophysiological mechanisms during the latent phase of labor.

Effect of Brosimum alicastrum Foliage on Intake, Kinetics of Fermentation and Passage and Microbial N Supply in Sheep Fed Megathyrsus maximus Hay.

An experiment was carried out to assess the effect of the incorporation of sun-dried foliage of Brosimum alicastrum into rations based on hay of Megathyrsus maximus on intake, rumen fermentation, kinetics of passage, microbial nitrogen supply to the small intestine, apparent digestibility in Pelibuey hair sheep. Four rations were randomly allotted to four rumen-cannulated lambs (BW = 37.4 ± 4.9 kg) using a 4 × 4 Latin square design to assess the effect of increasing levels (0, 15, 30 and 45% DM basis) of foliage of Brosimum alicastrum on a basal ration of M. maximus. Organic matter intake and water consumption increased linearly (p < 0.01) with increasing levels of B. alicastrum in the ration. The rate and potential extent of rumen fermentation of OM and CP of B. alicastrum were 10.6%/h and 86.6% and 11.4%/h and 95.2%, respectively, but no effect (p > 0.05) was found on the potential rumen degradation of DM (40.2%) or on the rate of degradation of DM (0.033%/h) of M. maximus, although a positive effect was found in the rumen degradation rate of NDF (p < 0.05). VFA and ammonia concentration in the rumen and the rate of passage of solids and liquids through the rumen (k1) increased linearly (p < 0.01) with increasing levels of B. alicastrum. Rumen pH was not affected by the incorporation of B. alicastrum (p > 0.05). Microbial nitrogen supply to the small intestine (p < 0.001), apparent digestibility of dry matter (p < 0.01) and NDF (p < 0.05) of the rations were also significantly increased as a result of the incorporation of B. alicastrum foliage. Results from this experiment suggest that the foliage of Brosimum alicastrum can be readily incorporated at around 30% of the ration of dry matter in hair sheep with beneficial effects on feed intake, rate of passage and microbial N supply to the lower tract.

Prevalence and Consequences of a Delayed Diagnosis in Multiple Myeloma: A Single Institution Experience.

BACKGROUND: Multiple myeloma (MM) is a disease with unspecific initial symptoms which may lead into a delay in the diagnosis, seemingly increasing the risk of complications and in turn reducing the overall survival (OS). OBJECTIVE: To analyze the consequences of a delayed diagnosis of MM in both the OS and the progression-free survival (PFS) of the patients in a single center in México. METHODS: The study included patients with MM who were diagnosed at Clínica Ruiz, Puebla, México, between 1983 and 2022. According to the time elapsed between the onset of symptoms to the establishment of the definite diagnosis of MM, 4 groups were constructed: 1) Less than 3 months, 2) 3-6 months, 3) 6-12 months, and 4) More than 12 months. RESULTS: About 136 patients had a complete clinical record and at least a 3-month follow up period. A delay in the diagnosis of MM (more than 3 months from the onset of symptoms) was recorded in 92/136 persons (68%). The median follow-up for the whole group was 24.7 months, median OS was 131.4 months, whereas median PFS was 85.4 months. There was a significant trend for being in earlier stages of the disease and being diagnosed within 3 months from the onset of symptoms (P = .049). Both OS and PFS were similar in the patients diagnosed before or after 3 months from the symptoms onset (P = .772). The 6-12 months group was the group with the better median both OS (197.4 months) and DFS (197.4) from the diagnosis. The median OS for the other groups were similar among them. CONCLUSION: A delay in the diagnosis of MM is very frequent in México (68% of cases); despite the fact that there was a significant trend for being in earlier stages of the disease and being diagnosed within 3 months from the onset of symptoms, we did not find a relationship between a delay on the diagnosis of the disease and a higher risk of complications and/or poor prognosis. Possible explanations to these findings are discussed.

Neutrophil to lymphocyte ratio and systemic immune-inflammatory index as markers of response to autologous hematopoietic stem cell transplantation in persons with multiple sclerosis.

INTRODUCTION: Biomarkers that help to evaluate the immune system and could be useful in multiple sclerosis (MS) are the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune-inflammatory index (SII). The objective of this work is to evaluate the significance of the SII index, PLR, and NLR before and after transplantation in individuals with MS who underwent autologous hematopoietic stem cell transplant (aHSCT) at a single institution. METHODS: Patients with MS who received an aHSCT between 2017 and 2022 were included in the study. NLR, PLR, and SII index were calculated prior to the transplant and 100 days after, and evaluation of the expanded disability status scale (EDSS) was done before the transplant and 12 months after. The cohort was divided into two groups: aHSCT responders (R) and nonresponders (NR). RESULTS: Fifty-eight individuals were examined: 37 patients in the responders group R group and 21 in NR group. There was no statistically significant difference in the SII, NLR, and PLR prior to the transplant, however at 100 days post-HSCT, NLR in the R group was 1.8 versus 3.1 in the NR group (p = 0.003), PLR was 194 versus 295, respectively (p = 0.024), meanwhile SII index was 489.5 versus 729.3 (p < 0.001). CONCLUSION: High NLR and SII index values after the aHSCT were associated with a worsening in the EDSS score. However, since this is the first ever study that compared NLR and SII index with the aHSCT response in persons with MS, further studies must be performed to corroborate this information.

Effect of Chitosan and Naringin on Enteric Methane Emissions in Crossbred Heifers Fed Tropical Grass.

In order to meet consumer needs, the livestock industry is increasingly seeking natural feed additives with the ability to improve the efficiency of nutrient utilization, alternatives to antibiotics, and mitigate methane emissions in ruminants. Chitosan (CHI) is a polysaccharide with antimicrobial capability against protozoa and Gram-positive and -negative bacteria, fungi, and yeasts while naringin (NA) is a flavonoid with antimicrobial and antioxidant properties. First, an in vitro gas production experiment was performed adding 0, 1.5, 3.0 g/kg of CHI and NA under a completely randomized design. The substrate containing forage and concentrate in a 70:30 ratio on a dry matter (DM) basis. Compounds increased the concentration of propionic acid, and a significant reduction in methane production was observed with the inclusion of CHI at 1.5 g/kg in in vitro experiments (p < 0.001). In a dry matter rumen degradability study for 96 h, there were no differences in potential and effective degradability. In the in vivo study, six crossbred heifers fitted with rumen cannulas were assigned to a 6 × 6 Latin square design according to the following treatments: control (CTL), no additive; chitosan (CHI1, 1.5 g/kg DMI); (CHI2, 3.0 g/kg DMI); naringin (NA1, 1.5 g/kg DMI); (NA2, 3.0 g/kg DMI) and a mixture of CHI and NA (1.5 + 1.5 g/kg DMI) given directly through the rumen cannula. Additives did not affect rumen fermentation (p > 0.05), DM intake and digestibility of (p > 0.05), and enteric methane emissions (p > 0.05). CHI at a concentration of 1.5 g/kg DM in in vitro experiments had a positive effect on fermentation pattern increasing propionate and reduced methane production. In contrast, in the in vivo studies, there was not a positive effect on rumen fermentation, nor in enteric methane production in crossbred heifers fed a basal ration of tropical grass.

Internal ballistics of polygonal and grooved barrels: A comparative study.

As a parameter important ballistic, the research about polygonal and grooved barrels' behavior has not been widely carried out. The pressures, velocities, stresses, deformations, and strains generated by the firing of 9 mm × 19 mm ammunition in weapons with polygonal barrels are analyzed numerically and experimentally, compared with those generated in pistols with grooved barrels. The Finite Element Method with equal boundary and loading conditions was used in both types of guns, specifying the actual materials of the projectile and the barrels. Subsequently, experimental tests were carried out on various weapons with 9 mm ammunitions of 115, 122, and 124 gr. The results show that the 9 mm bullet fired in a polygonal barrel undergoes a maximum deformation towards its exterior of 0.178 mm and interior of 0.158 mm, with stress up to 295.85 MPa. Compared with 0.025 mm maximum external deformation and 0.112 mm internal deformation of 9 mm projectiles fired in a grooved barrel, with stress up to 269.79 MPa. The deformation in the polygonal barrel is in a greater area, but the rifling impression left is less deep, making its identification more difficult. Although there are differences in the stresses and strains obtained, similar velocity and pressure parameters are achieved in the two types of barrels. This has application in the development and standardization of new kinds of barrels and weapons.

Increase in Milk Yield from Cows through Improvement of Forage Production Using the N2-Fixing Legume Leucaena leucocephala in a Silvopastoral System.

The objective was to evaluate milk production, N2-fixation and N transfer, forage yield and composition (under two cutting intervals) in a silvopastoral system (SPS) with Leucaena leucocephala-Megathyrsus maximus and M. maximus-monoculture (MMM) with crossbred cows in a completely randomized design. Forage yield in the SPS was 6490 and 6907 kg DM ha-1 for cutting intervals (CI) of 35 and 50 days. Forage yield for the MMM was 7284 and 10,843 kg DM ha-1, and forage crude protein (CP) was 29.0% and 26.1% for L. leucocephala, harvested at 35 and 50 days, respectively. CP for the associated M. maximus was 9.9% and 7.8% for CI 35 and 50 days, respectively, and for MMM was 7.4% and 8.4%, harvested at 35 and 50 days. Milk production was 4.7 kg cow-1 day-1 for cows grazing MMM and 7.4 kg cow-1 day-1 under SPS. Nitrogen fixation in L. leucocephala (%Ndfa) was estimated to be 89% and 95%, at 35 and 50 days, with an N2 transfer to the associated grass of 34.3% and 52.9%. SPS has the potential to fix and transfer important amounts of N2 to the associated grass, and increase forage CP content and milk production.

Influence of energy supplementation on dietary nitrogen utilization and milk production in cows fed foliage of Leucaena leucocephala.

The aim of the study was to assess the effect of four energy supplements (two highly fermentable; two starch-based carbohydrates) on blood urea nitrogen (BUN), urinary urea excretion, and milk yield, in dual-purpose cows fed foliage of Leucaena leucocephala (Leucaena). Five Holstein-Zebu cows with 450 kg body weight in their second third of lactation were used in a 5 × 5 Latin square design. Cows were fed (dry basis) a mixture of 45% Leucaena and 55% Pennisetum purpureum grass. Treatments were supplementation with (i) sugarcane molasses (Mo), (ii) sorghum grain (So), (iii) fresh citrus pulp (CitP) or (iv) rice polishing (RP), all of them incorporated into the diet at 25 MJ of ME/cow/day. There was a control group (Cont) without energy supplementation. The study comprised five periods of 20 days (15 days adaptation, 5 days measurements). Dry matter intake (kg/day) was lower (P < 0.05) for Cont (9.4) compared with Mo (12.1), So (12.0), CitP (11.9) and RP (11.9) but no difference was observed among energy supplements (P > 0.05). Milk yield (kg/day) was higher (P < 0.05) in cows supplemented with starch supplements (4.7 for So; 4.9 for RP) compared with Cont (3.3). Milk yield from highly fermentable supplements (Mo and CitP) did not differ (P > 0.05) from Cont or other treatments. Milk protein, fat and lactose were not different among treatments (P > 0.05). Blood urea nitrogen and urinary urea excretion were both reduced (P < 0.05) by energy supplementation. Urinary urea excretion was not different (P > 0.05) among cows fed different sources of energy. It is concluded that in dual-purpose cows fed Leucaena foliage, supplementation with sugarcane molasses, citrus pulp or rice polishing reduced blood urea nitrogen and urinary urea excretion. Milk yield was increased by sorghum and rice polishing whereas energy supplementation did not affect milk composition.

The effect of sowing time on the growth of chia (Salvia hispanica L.): What do nonlinear mixed models tell us about it?

Chia (Salvia hispanica L.) is an annual short-day plant whose growth has not been studied extensively in low-altitudes and at temperatures outside of its optimal range. The objective of this study was to describe the growth dynamics of a chia crop from an experimental plantation in south-east Mexico, on three different sowing dates. The chia grew at temperatures (18-37°C) and an altitude (9 m a.s.l.) outside of the recommended conditions (20-30°C, 500-1000 m a.s.l.). Three individual-plant responses were measured weekly, before seed harvest: height, number of leaves and number of inflorescences. Three theoretical nonlinear growth models were fitted to the data, a different model for each response. Mixed-effect model parameters were estimated by maximum likelihood, and the goodness of fit for each model was evaluated using two criteria: Modeling Efficiency and Root Mean Square Error. Chia seed yield was also measured in each treatment. Estimated parameters for plant height confirmed that medium sowing time (MST) and late sowing time (LST) plants had smaller heights than the early sowing time (EST) plants. Moreover, at the end of their life cycle, EST plants had a greater number of leaves and inflorescences, and higher seed yield. All of these differences were associated to the extended time of vegetative growth of EST plants favored by optimal photoperiod and temperature. Growth dynamics of chia during its ontogenic phases was explored, in more detail, with relative growth parameters derived from fitted models: a decrease in photoperiod influences the beginning of the reproductive phase, with the consequent reduction in speed of vegetative growth. In addition, nonlinear mixed-effects models can be useful in understanding the relation between growth parameters, plant maturity, and the suitable time for chia seed harvest. Our results suggest chia crops are adaptable to non-conventional environmental conditions.

[Segmental portal hypertension with splenic vein thrombosis caused by pancreatitis]. / Hipertensión portal segmentaria por trombosis de la vena esplénica causada por pancreatitis.

BACKGROUND: Splenic vein thrombosis is a complication of pancreatic carcinoma, pancreatitis or pancreatic pseudocyst. It may lead to segmental portal hypertension and bleeding from gastric varices. CLINICAL CASE: A 31 year-old man was diagnosed with pancreatitis of two weeks of evolution and was referred to our hospital in 2013. He had a history of alcohol consumption. Physical examination showed no stigmata of liver cirrhosis. Laboratory analyses revealed hemoglobin 9.5 g/dL, and leukocytes and platelets were normal. Liver function tests were normal as well. Abdominal CT showed a pseudocyst, which was drained by percutaneous puncture. By pseudocyst recurrence, drainage and necrosectomy by retroperitoneal laparascopy were performed. The patient presented hyperglycemia during his treatment in hospital. He was discharged, but he returned to emergency room because of gastrointestinal bleeding without hemodynamic instability. Gastroscopy showed bleeding gastric varices. The colonoscopy showed normal results. Liver biopsy was also normal. Abdominal CT angiography revealed blockage of the splenic vein. Patient underwent splenectomy and was discharged. CONCLUSION: This case is rare due to the high frequency of portal hypertension and cirrhosis. The isolated gastric varices with normal liver function are a sign of splenic thrombosis. The definitive treatment is splenectomy.

Introducción: la obstrucción aislada de la vena esplénica es una complicación de carcinoma pancreático, pancreatitis o pseudoquiste del páncreas. La trombosis de la vena esplénica puede conducir a hipertensión portal segmentaria y sangrado de várices gástricas. Caso clínico: un hombre de 31 años de edad fue referido a nuestro hospital en 2013 con el diagnóstico de pancreatitis de dos semanas de evolución. Tenía el antecedente de consumo de alcohol. El examen físico no mostró estigmas de cirrosis hepática. El laboratorio reveló hemoglobina de 9.5 g/dL con leucocitos y plaquetas normales. Las pruebas de función hepática fueron normales. La TAC abdominal mostró un pseudoquiste, el cual fue drenado por punción percutánea. Por recurrencia del pseudoquiste, se efectuó drenaje y necrosectomía por laparoscopia retroperitoneal. El paciente presentó hiperglucemia durante su estancia. Después de haber egresado, acudió a urgencias por sangrado gastrointestinal superior sin inestabilidad hemodinámica. La gastroscopia mostró várices gástricas sangrantes. La colonoscopia mostró resultados normales. La biopsia de hígado también resultó normal. La angio-TAC abdominal mostró obstrucción de la vena esplénica. Se sometió a esplenectomía y fue egresado. Conclusión: este caso es raro en nuestro medio debido a la alta frecuencia de hipertensión portal por cirrosis. Las várices gástricas aisladas con función hepática normal son un signo de trombosis de la vena esplénica. El tratamiento definitivo es la esplenectomía.

[Bouveret's syndrome: A rare presentation of gallstone ileus]. / Síndrome de Bouveret: una rara variante de íleo biliar.

BACKGROUND: Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a gallstone which passes into the duodenal bulb through a cholecystoduodenal fistula. CLINICAL CASE: We reported the case of a 46-year-old woman who presented intermittent epigastric pain, nausea, vomiting, and weight loss of 2-months duration. The patient admitted alcohol and methamphetamine abuse. She had not fever, dehydration or jaundice. Amylase, electrolytes, enzymes, and creatinine level were within normal limits. Seven months previously she was seen in the emergency department for acute cholecystitis. In that occasion, an abdominal ultrasound was reported with cholelithiasis without dilatation of the intra/extra-hepatic bile duct. Abdominal plain radiographs showed no relevant findings. A laparoscopic surgery was performed. During the procedure a sub-hepatic plastron with firm adhesions was found. The gallbladder was found attached to the duodenal bulb and an impacted calculus in the duodenum. The procedure was converted to surgery. Surgeon decided to perform a Bilroth 1 as the best choice. Seven days later, she was discharged. CONCLUSIONS: The clinical manifestations of the Bouveret's syndrome are nonspecific. Preoperative diagnosis is a challenge for clinicians because of the rarity of this condition. Treatment must be individualized.

Introducción: el síndrome de Bouveret se caracteriza por una obstrucción de la salida gástrica, causado por un cálculo en el bulbo duodenal, después de pasar a través de una fístula colecistoduodenal. Caso clínico: reportamos el caso clínico de una mujer de 46 años de edad, quien se presentó con dolor epigástrico intermitente, nausea, vómito y pérdida de peso de 2 meses de duración. No tenía fiebre, deshidratación o ictericia. La paciente admitió uso de alcohol y abuso de metanfetamina. La amilasa, enzimas, electrolitos y creatinina estuvieron dentro de los límites normales. Siete meses antes había ingresado a Urgencias por colecistitis aguda. El ultrasonido fue reportado como colelitiasis sin dilatación de la vía biliar intra/extrahepática. Las radiografías simples de abdomen no mostraron hallazgos relevantes. Recibió tratamiento conservador y fue egresada. Se programó para cirugía laparoscópica. Durante el procedimiento se encontró un plastrón subhepático con adherencias firmes, por lo que se efectuó cirugía abierta. La vesícula se encontró adherida al bulbo duodenal y un cálculo impactado en el duodeno. Se removió el calculo por enterotomía. Habia leve distension gastrica. Debido a la inflamacion regional, el cirujano decidio efectuar Bilroth 1; no hubo complicaciones. Conclusiones: las manifestaciones clínicas del síndrome de Bouveret son inespecíficas. El diagnóstico preoperatorio es un desafío para el clínico por la rareza del padecimiento. El tratamiento debe individualizarse.

Performance of growing rabbits fed increasing levels of discarded Salvia hispanica L. (chia) seed.

This experiment was carried out to evaluate the effect of including five levels of discarded chia seed (DCS) on growth, energy, and economic efficiency in rabbits. Fifty crossbred (New Zealand × Californian) weaning rabbits, weighing 798 ± 170 g, were randomly assigned to the following treatments: 0 % (control), 10 % (Ch10), 20 % (Ch20), 30 % (Ch30), and 40 % (Ch40) of DCS. Ten unsexed rabbits were allocated to each treatment and housed individually in cages; the experimental period was 6 weeks. There were no statistically significant differences between treatments in final body weight (2050 g), body weight gain (30 g/rabbit/day), and carcass weight (1010 g); however, feed intake (91 g/rabbit/day in Ch20 vs. 80 g/rabbit/day in Ch40), feed conversion ratio (2.77 in control and Ch40 vs. 2.95 in Ch10, Ch20, and Ch30), energy conversion ratio (32 MJ/kg in Ch20 vs. 29 MJ/kg on average in control, Ch10, Ch20, Ch30, and Ch40), and economic efficiency (358 % in control vs. 433 % in Ch40) showed differences (P < 0.05) between treatments. Discarded chia seed can be included up to 40 % in growing rabbit diets without any adverse effects on growth and carcass weight, and increased economic efficiency.

Concordance of Expert and Parental Opinion about Hypospadias Surgical Outcome Is Severity Dependent.

INTRODUCTION: Hypospadias is a male congenital condition where the opening of the urethral meatus is not located in the typical anatomical position. It has been a challenge for empirical studies to ascertain the level of concordance of opinion among parents and urologists with regard to surgical outcomes according to hypospadias severity. MATERIALS AND METHODS: Parents of children who had undergone hypospadias repair were recruited for this study (n = 104). A set of questionnaires that included some items with Likert scale were created to evaluate postsurgical satisfaction by parents and urologists. SAHLSA-50, a validated instrument for adult Spanish-speaking adults, was used to assess health literacy. Cohen's kappa (κ) coefficient was used to assess interobserver agreement and Chi Square "Goodness of Fit" Test was used to determine probability of satisfaction. FINDINGS: Concordance on the level of satisfaction with surgical outcomes for Type cases I was slight (κ = 0.20; CI 95% 0-0.60), for Type II cases was moderate (κ = 0.54; CI 95% 0.13-0.94), and for Type III cases was substantial (κ = 0.62; CI 95% 0-0.56). However, the probability of satisfaction did not change according to severity (Chi Square "Goodness of Fit" Test; parents, p = 0.84; pediatric urologists, p = 0.92). These results cannot be explained by parental health literacy according to SAHLSA-50 test scores. CONCLUSION: The level of concordance of opinion among parents and urologists with regard to their level of satisfaction with surgical outcomes is related to hypospadias severity, whereby the greatest level of concordance of opinion was achieved among most severe cases. This study underscores the need for longer follow-up to properly assess satisfaction with hypospadias repair, especially for the less severe forms of the condition.

Trastornos y calidad de sueño en trabajadores industriales de turno rotatorio y turno fijo diurno / Sleep disorders and sleep quality in shift and daytime industrial workers

El objetivo de este estudio fue estimar la prevalencia de los trastornos de sueño y conocer su relación con la calidad de sueño, el estrés, la depresión y variables médicas en una muestra de personal operativo, así como comparar dichas variables entre trabajadores con turno rotatorio (173) y trabajadores con turno fijo (153). Se encontró que los trabajadores con turno rotatorio presentan más trastornos del sueño como insomnio, ronquido, excesiva somnolencia diurna, entre otros; reportan una peor calidad de sueño y tienen una puntuación mayor en depresión en comparación con los trabajadores con turno habitual. Es importante continuar con investigaciones dirigidas a los trabajadores por turnos con el fin de buscar estrategias para mejorar su calidad de vida.

The aim of this study was to estimate the prevalence of sleep disorders and their relationship with the sleep quality, stress, depression and medical variables in a sample of operational staff and compare these variables among shift workers (173 ) and fixed workers (153). We found that shift workers have more sleep disorders such as insomnia, snoring, excessive daytime sleepiness, among others, reported a poorer quality of sleep and have a higher score on depression compared with usual fixed workers. It is important to continue research with shift workers to seek strategies to improve their quality of life.

Risk factors, prevalence trend, and clustering of hypospadias cases in Puerto Rico.

OBJECTIVE: The aim was to determine the distribution pattern of hypospadias cases across a well-defined geographic space. MATERIALS AND METHODS: The dataset for this study was produced by the Birth Defects Prevention and Surveillance System of the Department of Health of Puerto Rico (BDSS-PR), which linked the information of male newborns of the Puerto Rico Birth Cohort dataset (PRBC; n=92,285) from 2007 to 2010. A population-based case-control study was conducted to determine prevalence trend and to estimate the potential effects of maternal age, paternal age, birth-related variables, and health insurance status on hypospadias. Two types of geographic information systems (GIS) methods (Anselin Local Moran's I and Getis-Ord G) were used to determine the spatial distribution of hypospadias prevalence. RESULTS: Birthweight (<2500 g), age of mother (40+years), and private health insurance were associated with hypospadias as confirmed with univariate and multivariate analyses at 95% CI. A cluster of hypospadias cases was detected in the north-central region of Puerto Rico with both GIS methods (p≤0.05). CONCLUSIONS: The clustering of hypospadias prevalence provides an opportunity to assess the underlying causes of the condition and their relationships with geographical space.

Análisis ético del consentimiento informado en pacientes tratados por tuberculosis / Ethical analysis of informed consent in patients treated for tuberculosis

El presente trabajo de tesis constituye un análisis ético sobre cómo se administra en la actualidad el consentimiento informado en los pacientes tratados por tuberculosis en los establecimientos de salud del primer nivel de atención en el ámbito geográfico de la Red de Salud de Lima Ciudad, de la jurisdicción de la Dirección de Salud V Lima Ciudad, Ministerio de Salud de Perú. Se realiza un análisis de cómo ello influye en el nivel de comprensión del paciente y esto en el ejercicio de sus derechos en salud. Para ello, se evalúa a través de una lista de chequeo, el contenido en cantidad y calidad del documento de consentimiento informado que actualmente se aplica en nuestro medio, las condiciones de privacidad en las que se brinda ésta información, así como también la percepción del paciente en cuanto al nivel de comprensión y ejercicio de derechos, esto último a través de una encuesta de satisfacción del usuario. Finalmente se harán recomendaciones basadas en el análisis y consideraciones bioéticas respecto a la persona humana.

This thesis work constitutes an ethical analysis about how is actually administrated informed consent in patients treated for tuberculosis in the local primary health care in the geographic area of Lima Health Network City, the jurisdiction of the Health City V Lima, Peru Health Ministry. It's analyzed too, how this influence in the patients comprehension and in the exercise of their health rights. This is assessed through a checklist, content quantity and quality of informed consent document that currently applies in our setting, the privacy in the information that it provides, as well as the perception of patient in the level of understanding and exercise of rights through a user satisfaction survey. Finally, recommendations will be made based on the analysis and bioethical considerations regarding the human person.

Determinación de cromo en heces bovinas: variaciones en los resultados en función de la fuente de heces para la preparación de la curva de calibración / Analysis of chromium in cattle faeces: variations in the results due to the source of faeces for standard curve calibration

Introducción. El cromo es utilizado en pruebas de digestibilidad, en determinaciones de tasa de pasaje gastrointestinal y consumo voluntario de rumiantes en estudios de nutrición animal. Objetivo. Con el objeto de corregir posibles errores en la metodología analítica de su determinación se evaluó el efecto de la inclusión de heces bovinas de diferente origen en la preparación de la solución patrón y curvas de calibración. Materiales y métodos. Se colectaron heces de cuatro bovinos con diferentes dietas, y se utilizaron para elaborar curvas de calibración para medición espectrofotométrica de cromo. Las pendientes e interceptos de las curvas de calibración resultantes fueron analizadas estadísticamente para evaluar el efecto de la incorporación de heces de diferente origen. Resultados. No se encontró diferencia (p>0.05) en las pendientes de las curvas de calibración entre heces provenientes de bovinos con diferentes dietas. El intercepto de la curva de calibración fue diferente entre animales (p<0.001). Sin embargo, las diferencias encontradas fueron de mínima magnitud (<0.013 unidades de absorbancia), lo que carece de relevancia práctica. Conclusión. Para la preparación de curvas de calibración para la medición de cromo en heces bovinas, estas pueden provenir de uno o varios animales sin afectar la precisión de los resultados.

Epidemiología, ideología y el discurso del desarrollo en El Salvador

Content also in this Issue:1-Neocolonialism and epidemiology2-Nationalism, international public health assistance, and epidemiologic transitions3-Epidemiology is more than discourse: critical thoughts from Latin America4-Epidemiology and (neo-)colonialism5-Public health and colonialism: a new or old problem?

Epidemiology as discourse: the politics of development institutions in the Epidemiological profile of El Salvador

The article takes a descriptive epidemiological study of El Salvador, Epidemiological profile, conducted in 1994 by the US Agency for International Development, as a case study. The methods include discourse analysis in order to uncover the ideological basis of the report and its characteristics as a discourse of development. To determine the ways in which institutions devoted to international development influence epidemiological studies.