Impacto de la pandemia de COVID-19 en los profesionales de Atención Primaria y propuestas de mejora / Impact of the COVID-19 pandemic on Primary Care professionals and proposals for betterment

La pandemia de la COVID-19 ha supuesto un cambio brusco en el abordaje habitual de la promoción de la salud, la prevención, el tratamiento y la rehabilitación de las enfermedades. La Atención Primaria (AP) ha sufrido un importante impacto debido a la situación de pandemia y sus profesionales han tenido un papel fundamental, al mismo tiempo que tanto su vida profesional como personal han sufrido grandes alteraciones.El objetivo del estudio fue conocer y comprender el impacto de la pandemia en las esferas personales y profesionales de quienes trabajan en AP, así como también analizar y exponer propuestas a nivel organizativo y de atención.Se hizo un estudio cualitativo mediante cuatro grupos focales interdisciplinares en el que participaron 26 profesionales de AP (auxiliares administrativos, técnicos de cuidados auxiliares de enfermería [TCAE], enfermeras y médicas). Para hacer el análisis, se utilizó la metodología de análisis inductivo del contenido a través del método de comparaciones constantes de Glaser y Strauss y el programa informático Atlas Ti.Los cuatro grupos focales se transcribieron, y las citas analizadas se agruparon en trece categorías que se englobaron en cinco metacategorías: impacto de la pandemia en los profesionales, cambios en la atención familiar y comunitaria, repercusión de la pandemia en la población, trabajo en equipo y propuestas de mejora.Como conclusiones se obtuvieron: el miedo de los profesionales en la etapa inicial de la pandemia que se transformó en frustración, cansancio y tristeza en fases posteriores, la ruptura con la AP tradicional, así como diversas propuestas de mejora (empoderamiento del paciente, potenciación de los equipos multidisciplinares…). (AU)

The COVID-19 pandemic has entailed a sudden change in the usual approach to health promotion, prevention, treatment and rehabilitation of diseases. Primary care has undergone a significant impact due to the pandemic situation and its professionals have played an essential role. At the same time both their professional and personal lives have undergone major changes.The aim of the study was to know and understand the impact of the pandemic on the personal and professional spheres of primary care, as well as analyze and present proposals at the organizational and attention level.A qualitative study was performed by means of four interdisciplinary focus groups in which 26 primary care professionals took part (administrative assistants, nursing assistants, nurses and doctors).To perform the analysis, inductive content analysis methodology was used by means of the method of constant comparisons of Glaser and Strauss and Atlas TI computer software.The four focus groups were transcribed, and the citations analyzed were grouped into thirteen categories. They were included in five meta-categories: impact of the pandemic on professionals, changes in family and community care, impact of the pandemic on the population, teamwork and proposals for betterment.Conclusions drawn were the fear felt by professionals at the initial stage of the pandemic, which turned into frustration, tiredness and sadness in later phases, the break with traditional primary care, as well as various proposals for improvement (patient empowerment, enhancement of multi-disciplinary teams, etc.) (AU)

Maternal Supplementation with Herbal Antioxidants during Pregnancy in Swine.

The effects of a combined supplementation with herbal antioxidants during pregnancy on reproductive traits and piglet performance (number of live, dead, and mummified newborns and litter weight at birth and individual body weight at both birth and weaning) were assessed in a total of 1027 sows (504 treated and 523 control females) kept under commercial breeding conditions. The supplementation increased the number of live-born piglets (13.64 ± 0.11 vs. 12.96 ± 0.13 in the controls; p = 0.001) and the total litter weight, decreasing the incidence of low-weight piglets without affecting the number of stillbirths and mummified newborns. Such an effect was modulated by the number of parity and the supplementation, with supplementation increasing significantly the number of living newborns in the first, second, sixth, and seventh parities (0.87, 1.10, 1.49, and 2.51 additional piglets, respectively; p < 0.05). The evaluation of plasma vitamin concentration and biomarkers of oxidative stress (total antioxidant capacity, TAC, and malondialdehyde concentration, MDA) performed in a subset of farrowing sows and their lighter and heavier piglets showed that plasma levels of both vitamins were significantly higher in the piglets than in their mothers (p < 0.05 for vitamin C and p < 0.005 for vitamin E), with antioxidant supplementation increasing significantly such concentrations. Concomitantly, there were no differences in maternal TAC but significantly higher values in piglets from supplemented sows (p < 0.05). On the other hand, supplementation decreased plasma MDA levels both in the sows and their piglets (p < 0.05). Finally, the piglets from supplemented mothers showed a trend for a higher weaning weight (p = 0.066) and, specifically, piglets with birth weights above 1 kg showed a 7.4% higher weaning weight (p = 0.024). Hence, the results of the present study, with high robustness and translational value by offering data from more than 1000 pregnancies under standard breeding conditions, supports that maternal supplementation with herbal antioxidants during pregnancy significantly improves reproductive efficiency, litter traits, and piglet performance.

High-flow nasal cannula for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19.

INTRODUCTION: High-flow nasal cannula oxygen therapy (HFNC) has been shown to be a useful therapy in the treatment of patients with Acute Respiratory Distress Syndrome (ARDS), but its efficacy is still unknown in patients with COVID-19. Our objective is to describe its utility as therapy for the treatment of ARDS caused by SARS-CoV-2. METHODS: A retrospective, observational study was performed at a single centre, evaluating patients with ARDS secondary to COVID-19 treated with HFNC. The main outcome was the intubation rate at day 30, which defined failure of therapy. We also analysed the role of the ROX index to predict the need for intubation. RESULTS: In the study period, 196 patients with bilateral pneumonia were admitted to our pulmonology unit, 40 of whom were treated with HFNC due to the presence of ARDS. The intubation rate at day 30 was 52.5%, and overall mortality was 22.5%. After initiating HFNC, the SpO2/FiO2 ratio was significantly better in the group that did not require intubation (113.4±6.6 vs 93.7±6.7, p=0.020), as was the ROX index (5.0±1.6 vs 4.0±1.0, p=0.018). A ROX index less than 4.94 measured 2 to 6 h after the start of therapy was associated with increased risk of intubation (HR 4.03 [95% CI 1.18 - 13.7]; p=0.026). CONCLUSION: High-flow therapy is a useful treatment in ARDS in order to avoid intubation or as a bridge therapy, and no increased mortality was observed secondary to the delay in intubation. After initiating HFNC, a ROX index below 4.94 predicts the need for intubation.

Actualización de medicamentos asociados a necrosis avascular de los maxilares: perspectiva y revisión de literatura / Update of medications associated with avascular necrosis of the jaws: a perspective and literature review

La osteonecrosis de los maxilares está definida como la exposición de hueso necrótico en la región maxilofacial al menos por ocho semanas en pacientes que están recibiendo medicamentos antirresortivos para el tratamiento del cáncer primario o metastásico hacia el hueso, osteoporosis o enfermedad de Paget, sin historia previa de radiación. Desde el año 2003, la terminología utilizada estaba en relación con los bifosfonatos, en la actualidad ha sido introducido el término osteonecrosis de los maxilares relacionada por medicamentos (OMAM). La cirugía oral (implantología o cirugía periapical) incrementa el riesgo de OMAM, así como los desbalances concomitantes de la salud oral (inflamación dental y formación de abscesos). Las estrategias conservadoras en el tratamiento varían desde el cuidado local conservador hasta la resección quirúrgica radical del hueso necrótico. En el presente artículo se expone un análisis sistemático retrospectivo de la literatura en páginas como PubMed, ScienceDirect y Springer, Cochrane Library. Con el objetivo de resaltar el aumento de la incidencia de OMAM a nivel mundial con el uso de antirresortivos y otros medicamentos asociados en su patogenia en el Hospital Regional «General Ignacio Zaragoza¼ del ISSSTE, UNAM, en la Ciudad de México (AU)

Osteonecrosis of the jaws is defined as the exposure of necrotic bone in the maxillofacial region for at least 8 weeks in patients receiving antiresorptive medications for the treatment of primary or metastatic cancer towards the bone, osteoporosis, or Paget's disease, without previous history of radiation. Since 2003, the terminology used was related to bisphosphonates, the term medication-related osteonecrosis of the jaws has now been introduced. Oral surgery (implantology or periapical surgery) increases the risk of avascular necrosis, as well as concomitant imbalances in oral health (dental inflammation and abscess formation). Conservative strategies in treatment vary from conservative local care to radical surgical resection of the necrotic bone. In this article, a systematic retrospective analysis of the literature is presented on pages such as PubMed, Science Direct and Springer, Cochrane Library. And in which the objective is to highlight the increase in the incidence of medication related osteonecrosis of the jaws worldwide with the use of antiresorptive, and other associated medications in its pathogenesis at the Hospital Regional «General Ignacio Zaragoza¼ ISSSTE, UNAM in Mexico City (AU)

Craneoplastía con implante de polimetilmetacrilato (PMMA)para corregir secuela de trauma. Reporte de caso / Craneoplasty with a polymethylmethacrylate (PMMA) Implant to correct trauma sequel. A case report

Introducción: los defectos del cráneo y las anomalías del hueso craneofacial que requie-ren reconstrucción son comunes en una variedad de procedimientos neuroquirúrgicos. Después de una craniectomía o de fracturas craneofaciales posteriores a traumatismos cráneoencefálicos, los pacientes pueden desarrollar defectos cosméticos importantes. Algunos de estos son la depresión de la piel y un defecto de hundimiento que lleva a una apariencia asimétrica de la cabeza, sin dejar de lado las repercusiones físicas, neu-rológicas y psicológicas que estas lesiones conllevan. La reconstrucción craneofacial y la craneoplastía tienen una larga historia, pero las nuevas técnicas quirúrgicas y una multitud de opciones de materiales han impulsado recientemente el avance en esta área. Los implantes de polimetilmetacrilato (PMMA) han demostrado ser estables, bio-compatibles, no conductores, radiotransparentes y de bajo costo. Es así que se pueden colocar y modificar fácilmente, con lo que se elimina la morbilidad del sitio donante. Presentación del caso: en este artículo presentamos un caso de craneoplastía de defec-to frontal, posterior a traumatismo, cuya reconstrucción fue realizada mediante una prótesis de polimetilmetacrilato (PMMA) en el Hospital General Xoco de la Cuidad de México. Conclusión: se reporta la reducción del tiempo quirúrgico, además de un costo de la prótesis accesible para el paciente; de esta manera, se obtuvieron resultados sa-tisfactorios y mejoras en el contorno estético facial, en tanto se permitió cobertura y protección para el tejido encefálico.

Introduction: Skull defects and craniofacial bone abnormalities that require reconstruction are common in a variety of neurosurgical procedures. After craniectomy or craniofacial fractures following cranioencephalic trauma, patients can develop important cosmetic defects, such as depression of the skin and a sunken flap that can lead to an asymmetrical appearance of the head, without neglecting the physical and psychological repercussions. neurological that these injuries carry. Craniofacial reconstruction and cranioplasty have a long history, but new surgical techniques and a multitude of material options have recently fueled progress in this area. Polymethylmethacrylate (PMMA) implants have proven to be stable, biocompatible, non-conductive, radiolucent, and inexpensive. They can be easily placed and modified and the morbidity of the donor site is eliminated. Clinical case: In this article, we present a case of frontal defect cranioplasty after trauma performed using a polymethylmethacrylate (PMMA) prosthesis at the General Hospital Xoco in Mexico City. Conslusion: The surgical time could be reduced, in addition to the cost of the prosthesis. It was accessible to the patient and obtained satisfactory results such as improvements in the facial aesthetic contour and obtained coverage and protection for the brain tissue.

Tercer molar heterotópico en el reborde orbitario: Reporte de un caso y revisión de literatura / Heterotopic third molar in the orbital rim: Report of a case and literature review

Los terceros molares heterotópicos son órganos dentarios que se encuentran en un sitio anatómico fuera de lo habitual, pueden ser supernumerarios, deciduos o un diente permanente, el cual ha sido reportado en diferentes posiciones, incluyendo la región coronoidea, cavidad nasal, seno maxilar, región orbitaria, palatina, cóndilo mandibular. La etiología de la erupción heterotópica/ectópica es desconocida, aunque hay varias teorías como la discrepancia óseo-dentaria por la evolución. Los órganos dentarios heterotópicos/ectópicos son comunes en la mandíbula y en el género femenino y pueden ocurrir en ambas denticiones. Algunos terceros molares heterotópicos/ectópicos son asintomáticos durante el periodo de vida y son usualmente detectados en hallazgos clínicos y radiográficos de manera incidental. Existen casos documentados desde 1887 hasta la actualidad cuya localización es en el reborde orbitario. En el presente artículo se expone un caso clínico de una extracción quirúrgica de un tercer molar superior heterotópico en el reborde orbitario descrita bajo el protocolo de las retenciones dentales. Dicho caso fue establecido en el Hospital Regional «General Ignacio Zaragoza¼ del ISSSTE en la Ciudad de México, con el que se obtuvieron resultados favorables, fue el primer reporte de la literatura en México. Se realizó una revisión aleatoria de la literatura en páginas como PubMed, ScienceDirect y Springer, Cochrane Library y se desarrolló el reporte de caso clínico de una paciente con un tercer molar superior heterotópico ubicado en el piso de órbita derecho (AU)

Heterotopic third molars are dental organs that are in an anatomical site out of the ordinary, can be supernumerary, deciduous or a permanent tooth, which has been reported in different positions, including the coronoid region, nasal cavity, maxillary sinus, orbital region, palatal, mandibular condyle. The etiology of the heterotopic/ectopic eruption is unknown, although there are several theories such as bone-dental discrepancy due to evolution. The heterotopic/ectopic teeth are common in the jaw and in the female gender and can occur in both dentitions. Some heterotopic/ectopic third molars are asymptomatic during the lifetime and are usually found incidentally in clinical and radiographic findings. There are documented cases from 1887 to the present that its location is in the orbital rim. In the present article we present a clinical case of a surgical extraction of a third upper molar heterotopic in the orbital rim and that is described under the dental retention protocol established in the Regional Hospital «General Ignacio Zaragoza¼ of the ISSSTE in the City of Mexico, with which they obtain favorable results, first report of the literature in Mexico. A randomized review of the literature was made on pages such as PubMed, ScienceDirect and Springer, Cochrane Library and the clinical case report of a patient with a heterotopic upper third molar located on the floor of the right orbit was developed (AU)

Mucormicosis rinocerebral de origen dental, reporte de un caso clínico y revisión de la literatura / Odontogenic rhinocerebral mucormycosis, report of a clinical case and review of the literature

Se presenta el caso clínico de un hombre de 46 años de edad, con antecedentes patológicos de diabetes metabólicamente descompensada de 4 an˜ os de evolución, quien posterior a una odontectomía de primer molar superior izquierdo, cursó con proceso infeccioso en región maxilar de evolución aguda que fue diagnosticado histopatologicamente como mucormicosis rinocerebral. La mucormicosis es una enfermedad de baja prevalencia frecuentemente fatal y rápidamente progresiva causada por hongos de la familia Mucoraceae del orden mucorales. Es la enfermedad fúngica fatal de más rápida evolución en los humanos. Es una entidad importante de considerar, porque su rápida detección y tratamiento son los elementos claves para la supervivencia (AU)

A clinical case is presented on a 46-year-old male who, after an odontectomy of the first upper left molar, developed an infection in the upper jaw. The patient already has a chronic systemic disease, uncontrolled diabetes. The infectious process of acute onset was diagnosed histopathologically as Rhinocerebral Mucormycosis. Mucormycosis is a disease of low prevalence, frequently fatal and rapidly progressive, caused by fungi of the family Mucoraceae, of the order Mucorales. It is an acute fungal disease with a high mortality rate. It is the most rapidly fatal fungal disease in humans. It is an important condition to consider as early detection and treatment are the key elements to survival (AU)

Glomerulopathy in spontaneously obese rhesus monkeys with type 2 diabetes: a stereological study.

BACKGROUND: Animal models could provide insights into the diabetic nephropathy pathogenesis; however, available rodent models do not mirror the heterogeneity of lesions in type 2 diabetic patients, and do not progress to end-stage renal disease. Previous studies showed that spontaneously obese type 2 diabetic rhesus monkeys develop many of the features of human diabetic glomerulopathy, and may progress to end-stage renal disease. Here, in order to further characterize diabetic glomerulopathy in this model, we used electron microscopic stereology. METHODS: Renal biopsies from 17 diabetic, 17 pre-diabetic/metabolic syndrome and 11 non-diabetic monkeys were studied. Fractional volumes of mesangium [Vv(Mes/glom)], mesangial matrix [Vv(MM/glom)] and mesangial cells [Vv(MC/glom)], glomerular basement membrane width and peripheral glomerular basement membrane surface density per glomerulus [Sv(PGBM/glom)] were estimated. Glomerular filtration and albumin excretion rates were measured in a limited number of animals. Glomerular structural and biochemical/metabolic data were compared among the groups. RESULTS: Compared to non-diabetic monkeys, diabetic rhesus monkeys showed classic diabetic nephropathy changes, including glomerular basement membrane thickening (p = 0.001), increased fractional volumes of mesangium (p = 0.02), and reduced peripheral glomerular basement membrane surface density per glomerulus (p = 0.03) compared to non-diabetic monkeys. Increased fractional volumes of mesangium was primarily due to increased mesangial matrix (p = 0.03). Glomerular structural parameter inter-relationships in diabetic monkeys mirrored those of human diabetic glomerulopathy. Albumin excretion rate was greater (p = 0.03) in diabetic vs. non-diabetic monkeys. There was trend for a positive correlation between albumin excretion rate and fractional volumes of mesangium. CONCLUSIONS: This rhesus primate model shares many features of human diabetic glomerulopathy. Mesangial expansion in this model, similar to human diabetic nephropathy and different from available rodent models of the disease, is primarily due to increased mesangial matrix.

Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study.

OBJECTIVES: To evaluate the role of primary vesicoureteral reflux (VUR) in increasing the frequency and severity of urinary tract infections (UTIs) and renal parenchymal damage among patients with acute pyelonephritis and to determine whether urinary antibiotic prophylaxis reduces the frequency and/or severity of UTIs and/or prevents renal parenchymal damage among patients with mild/moderate VUR. METHODS: Patients 3 months to 18 years of age with acute pyelonephritis, with or without VUR, were assigned randomly to receive urinary antibiotic prophylaxis or not. Patients were monitored every 3 months for 1 year. Dimercaptosuccinic acid renal scans were repeated at 6 months or if there was a recurrence of febrile UTI. Urinalysis and urine culture were performed at each clinic visit. Renal ultrasound scans and voiding cystourethrograms were repeated at the end of 1 year of follow-up monitoring. RESULTS: Of the 236 patients enrolled in the study, 218 completed the 1-year follow-up monitoring. Groups were similar with respect to age, gender, and reflux grade distribution for those with VUR. No statistically significant differences were found among the groups with respect to rate of recurrent UTI, type of recurrence, rate of subsequent pyelonephritis, and development of renal parenchymal scars. CONCLUSIONS: After 1 year of follow-up monitoring, mild/moderate VUR does not increase the incidence of UTI, pyelonephritis, or renal scarring after acute pyelonephritis. Moreover, a role for urinary antibiotic prophylaxis in preventing the recurrence of infection and the development of renal scars is not supported by this study.

Hierro y Manganeso en acuíferos costeros de la Provincia de Buenos Aires

Este trabajo surge del estudio hidrogeológico regional llevado a cabo por el Consejo Federal de Inversiones y la Pcia. de Bs.As., para establecer las características de la fuente de agua subterránea y su factibilidad de aprovechamiento para abastecimiento público al Partido de la Costa

Acuíferos costeros de la provincia de Buenos Aires; sector Punta Rasa - Punta Médanos, parte I, hidrogeología, hidrodinámica e hidráulica

Tiene por objetivo la identificación, delimitación, evaluación y cuantificación del recurso hídrico subterráneo de la región, lo cual permitirá realizar la formulación de proyectos de obras y selección de alternativas de provisión, con las respectivas pautas de uso y manejo racional de la fuente analizada. Los estudios realizados para la región I (Punta Rasa-Punta Médanos) apuntan al conocimiento geohidrológico del sector en su totalidad en el que se integran estudios previos que permiten realizar modelos de diagnóstico, explotación y pronóstico del comportamiento del agua subterránea frente a su uso actual y potencial

Acuíferos costeros de la provincia de Buenos Aires; sector Punta Rasa - Punta Médanos, parte I, hidrogeología, hidrodinámica e hidráulica

Tiene por objetivo la identificación, delimitación, evaluación y cuantificación del recurso hídrico subterráneo de la región, lo cual permitirá realizar la formulación de proyectos de obras y selección de alternativas de provisión, con las respectivas pautas de uso y manejo racional de la fuente analizada. Los estudios realizados para la región I (Punta Rasa-Punta Médanos) apuntan al conocimiento geohidrológico del sector en su totalidad en el que se integran estudios previos que permiten realizar modelos de diagnóstico, explotación y pronóstico del comportamiento del agua subterránea frente a su uso actual y potencial