A new set of estimated cardiorespiratory fitness equations are associated with cognitive performance in older adults.

This study aimed to develop new equations to estimate cardiorespiratory fitness specifically for older adults and, secondly, to analyze the associations of cardiorespiratory fitness, both objectively measured and estimated using new equations, with cognitive performance. Ninety-two older adults (41 females, 65-75 years) from baseline data of a randomized controlled trial were analyzed ("ClinicalTrials.gov" Identifier: NCT03923712). Participants completed 4 measurement sessions including (i) physiological and health indicators in a laboratory setting, (ii) field-based fitness tests, (iii) sociodemographic and physical activity questionnaires, and (iv) a battery of neuropsychological tests to evaluate cognitive performance. The main findings were as follows: (i) a set of new equations with good predictive value for estimated cardiorespiratory fitness were developed (74-87%), using different scenarios of complexity and/or equipment requirements, and (ii) higher estimated cardiorespiratory fitness, even using its simplest equation (eCRF = - 1261.99 + 1.97 × 6 min walking test (m) + 1.12 × bioimpedance basal metabolic rate (kcal/day) + 5.25 × basal heart rate (bpm)), was associated with better cognitive performance evaluated by several neuropsychological tests (i.e., language, cognitive flexibility, fluency, attention, and working memory), similar to using objectively measured cardiorespiratory fitness. In summary, a new set of estimated cardiorespiratory fitness equations have been developed with predictive values ranging from 74 to 87% that could be used based on necessity, availability of equipment, resources, or measurement context. Moreover, similar to objectively measured cardiorespiratory fitness, this measure of estimated cardiorespiratory fitness was positively associated with performance on language, fluency, cognitive flexibility, attention, and working memory, independently of sex, age, and education level.

A Systematic Review and Meta-Analysis of the Relationship Between the Severity of Dental Fluorosis and Fluoride Biomarkers in Endemic Areas.

The intake of high concentrations of fluoride, mainly through drinking water, diet and fluoridated dentifrices, produces fluorosis, which in its early stages is manifested as dental fluorosis (DF). To recognize exposure to fluoride in endemic areas and to evaluate the risk of developing health impairment, the WHO has established several biomarkers that are used to determine systemic fluorine (F-) exposure. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the relationship between the severity of DF and fluoride biomarkers in endemic areas. The protocol of this study was previously registered as CRD42021244974. A digital search was carried out in PubMed/Medline, SpringerLink, Scopus, Cochrane and Google Scholar by employing the keywords "urine", "nails", "hair", "plasma", "saliva" and "dental fluorosis" for the original studies with content associated with F- for the biomarkers and DF. The mean difference was established as the effect measure for the meta-analysis. Seven studies fulfilled the eligibility criteria, among which five assessed urine and two employed nails as fluoride biomarkers. A positive significant difference was found between the biomarkers and the severity of DF (0.27, p < 0.001) and individually for each biomarker (urine: 0.14, p = 0.001; nails: 0.88, p < 0.05). The F- concentration in urine and nails is correlated with the severity of DF, with the most evident differences between healthy individuals and those with mild severity. Both biomarkers are adequate to assess this relationship in endemic areas of fluoride and DF.

Association of Age and Temperamental Traits with Children's Behaviour during Dental Treatment.

During paediatric dental treatment, cooperation by children is essential, and temperament can determine their behaviour style. This study aimed to associate temperamental traits and age with behaviour during paediatric dental treatment. This was an observational and cross-sectional study of patients aged 3-10 years. To determine the temperamental traits, an Emotionality Activity and Sociability Temperament Survey (EAS) was performed with the children's parents. The type of behaviour was determined with Frankl's criteria. The total scores for temperamental traits, means, and standard deviations were obtained. The chi-squared test, one-way ANOVA and Student's t-test were applied. A total of 140 patients, who were 5 ± 2.1 years old, participated in the study. Age was determinant for negative behaviour, with a greater frequency in children ≤5 years old (p < 0.05), and a significant negative correlation between age and behaviour (rho = -0.245, p = 0.001). Patients with higher emotionality and activity presented negative and definitely negative behaviours more frequently (p < 0.01). The values for sociability and shyness were similar for positive or negative behaviours. In conclusion, the temperamental traits of emotionality and activity were more frequent in children with disruptive behaviours; therefore, conducting a survey on temperamental traits can be useful for planning behavioural approaches in paediatric dentistry.

Epithelial-Mesenchymal Transition Associated with Head and Neck Squamous Cell Carcinomas: A Review.

Head and neck squamous cell carcinomas (HNSCCs) are aggressive, recurrent, and metastatic neoplasms with a high occurrence around the world and can lead to death when not treated appropriately. Several molecules and signaling pathways are involved in the malignant conversion process. Epithelial-mesenchymal transition (EMT) has been described in HNSCCs, a major type of aggressive carcinoma. EMT describes the development of epithelial cells into mesenchymal cells, which depends on several molecular interactions and signaling pathways that facilitate mesenchymal conversion. This is related to interactions with the microenvironment of the tumor, hypoxia, growth factors, matrix metalloproteinases, and the presence of viral infections. In this review, we focus on the main molecules related to EMT, their interactions with the tumor microenvironment, plasticity phenomena, epigenetic regulation, hypoxia, inflammation, their relationship with immune cells, and the inhibition of EMT in the context of HNSCCs.

Recent Biomarkers for Monitoring the Systemic Fluoride Levels in Exposed Populations: A Systematic Review.

Fluorides are compounds that can be found in the minerals of soil with volcanic rocks. Different populations are exposed to high levels of fluorides through drinking water that, due to their chronic intake, cause several types of damage to health. Nails and hair, denominated as recent biomarkers, have been employed for monitoring systemic fluoride from long-term exposure to fluorides. The aim of this study was to perform a systematic review of the use of recent biomarkers for monitoring systemic fluoride levels in exposed populations and verify their validity in the measurement of the fluorine (F-) concentration within the body. A digital search was performed in the databases PubMed/Medline, Springer Link, Cochrane, and Scopus of original articles that employed recent biomarkers for monitoring systemic F-. Seventeen articles were included in this analysis; the recorded variables were the F- amount in each assessed biomarker, source of exposure, and total daily fluoride intake (TDFI). TDFI was associated with F- in nails and hair, as well as the exposure through drinking water. In conclusion, recent biomarkers are adequate for monitoring the systemic fluoride levels by evaluating the chronic/subchronic exposure through different sources, mainly drinking water, considering nails better than hair for this purpose.

Current concepts in ameloblastoma-targeted therapies in B-raf proto-oncogene serine/threonine kinase V600E mutation: Systematic review.

BACKGROUND: Ameloblastomas are common benign epithelial odontogenic neoplasms that present an aggressive and unpredictable behavior that may modify treatment strategies. Different signaling pathways that participate in the progression of these tumors have been identified. B-raf proto-oncogene serine/threonine kinase (BRAF) is a protein involved in the behavior of ameloblastomas, and it is related to many cell mechanisms. BRAF gene mutations have been identified in ameloblastomas, of which the BRAF V600E (valine substituted by glutamic acid at amino acid 600) mutation has been the most common and can be present concomitantly with other mutations that may be involved in its behavior. Targeted therapies have been used as an alternative in the case of resistance or contraindications to conventional treatments. AIM: To document the presence of BRAF V600E and additional mutations, their behavior, and targeted therapies in these tumors. METHODS: An electronic literature search was conducted according to PRISMA guidelines in PubMed/MEDLINE, Cochrane, EMBASE, and SpringerLink using the terms "ameloblastomas", "BRAF V600E", "additional mutations", and "targeted therapies". Ameloblastomas were classified according to WHO guidelines. Inclusion criteria were articles in English, published not more than 10 years ago, and studies with laboratory works related to BRAF V600E. Articles were evaluated by two independent reviewers and retrieved for full-text evaluation. The EBLIP Critical Appraisal Checklist was used to evaluate the quality of the eligible studies. Descriptive statistical analysis was performed. RESULTS: Two independent reviewers, with a substantial concordance indicated by a kappa coefficient of k = 0.76, evaluated a total of 19 articles that were included in this study. The analysis registered 521 conventional ameloblastomas (AM), 81 unicystic ameloblastomas (UA), 13 ameloblastic carcinomas (AC), three metastatic ameloblastomas (MA), and six peripheral ameloblastomas (PA), of which the histopathological type, anatomic location, laboratory tests, expression of BRAF mutation, and additional mutations were registered. The BRAF V600E mutation was found in 297 AM (57%), 63 UA (77.7%), 3 AC (23%), 1 MA (50%), and 5 PA (83.3%). Follicular type predominated with a total of 116 cases (40%), followed by plexiform type with 63 cases (22.1%). Furthermore, both types presented additional mutations, in which alterations in JAK3 P132T, SMARCB1, PIK3CA, CTNNB1, SMO, and BRAF G606E genes were found. Four case reports were found with targeted therapy to BRAF V600E. CONCLUSION: The identification of BRAF V600E and additional mutations as an aid in targeted therapies has been a breakthrough in alternative treatments of ameloblastomas where surgical treatments are contraindicated.

A Stepped-Wedge Randomized Controlled Trial: Effects of eHealth Interventions for Pain Control Among Adults With Cancer in Hospice.

CONTEXT: Unrelieved cancer pain at the end of life interferes with achieving patient-centered goals. OBJECTIVE: To compare effects of usual hospice care and PAINRelieveIt® on pain outcomes in patients and their lay caregivers. METHODS: In a five-step, stepped-wedge randomized, controlled study, 234 patients (49% male, 18% Hispanic, 51% racial minorities) and 231 lay caregivers (26% male, 20% Hispanic, 54% racial minorities) completed pre-pain/post-pain measures. They received usual hospice care with intervention components that included a summary of the patient's pain data, decision support for hospice nurses, and multimedia education tailored to the patient's and lay caregiver's misconceptions about pain. RESULTS: The intervention effect on analgesic adherence (primary outcome) was not significant. Post-test worst pain intensity was significantly higher for the experimental group, but the difference (0.70; CI = [0.12, 1.27]) was not clinically meaningful. There was nearly universal availability of prescriptions for strong opioids and adjuvant analgesics for neuropathic pain in both groups. Lay caregivers' pain misconceptions (0-5 scale) were significantly lower in the experimental group than the usual care group (mean difference controlling for baseline is 0.38; CI = [0.08, 0.67]; P = 0.01). CONCLUSION: This randomized controlled trial was a negative trial for the primary study outcomes but positive for a secondary outcome. The trial is important for clearly demonstrating the feasibility of implementing the innovative set of interventions.

Keys to Recruiting and Retaining Seriously Ill African Americans With Sickle Cell Disease in Longitudinal Studies: Respectful Engagement and Persistence.

OBJECTIVES: Sickle cell disease (SCD) is a serious illness with disabling acute and chronic pain that needs better therapies, but insufficient patient participation in research is a major impediment to advancing SCD pain management. The purpose of this article is to discuss the challenges of conducting an SCD study and approaches to successfully overcoming those challenges. DESIGN: In a repeated-measures, longitudinal study designed to characterize SCD pain phenotypes, we recruited 311 adults of African ancestry. Adults with SCD completed 4 study visits 6 months apart, and age- and gender-matched healthy controls completed 1 visit. RESULTS: We recruited and completed measures on 186 patients with SCD and 125 healthy controls. We retained 151 patients with SCD with data at 4 time points over 18 months and 125 healthy controls (1 time point) but encountered many challenges in recruitment and study visit completion. Enrollment delays often arose from patients' difficulty in taking time from their complicated lives and frequent pain episodes. Once scheduled, participants with SCD cancelled 49% of visits often because of pain; controls canceled 30% of their scheduled visits. To facilitate recruitment and retention, we implemented a number of strategies that were invaluable in our success. CONCLUSION: Patients' struggles with illness, chronic pain, and their life situations resulted in many challenges to recruitment and completion of study visits. Important to overcoming challenges was gaining the trust of patients with SCD and a participant-centered approach. Early identification of potential problems allowed strategies to be instituted proactively, leading to success.

Sensitivities to Thermal and Mechanical Stimuli: Adults With Sickle Cell Disease Compared to Healthy, Pain-Free African American Controls.

Evidence supports, but is inconclusive that sensitization contributes to chronic pain in some adults with sickle cell disease (SCD). We determined the prevalence of pain sensitization among adults with SCD pain compared with pain-free healthy adults. In a cross sectional, single session study of 186 African American outpatients with SCD pain (age 18-74 years, 59% female) and 124 healthy age, gender, and race matched control subjects (age 18-69 years, 49% female), we compared responses to standard thermal (Medoc TSA II) and mechanical stimuli (von Frey filaments). Although we observed no significant differences in thermal thresholds between controls and patients, patients with SCD had lower pain thresholds to mechanical stimuli and reported higher pain intensity scores to all thermal and mechanical stimuli at a non-painful body site. Compared with controls, about twice as many patients with SCD showed sensitization: 12% versus 23% at the anterior forearm site (P = .02), and 16% versus 32% across 3 tested sites (P = .004). Among patients with SCD, 18% exhibited some element of central sensitization. Findings indicate that persistent allodynia and hyperalgesia can be part of the SCD pain experience and should be considered when selecting therapies for SCD pain. PERSPECTIVE: Compared with matched healthy controls, quantitative sensory testing in adults with pain and sickle cell disease (SCD) demonstrates higher prevalence of sensitization, including central sensitization. The findings of allodynia and hyperalgesia may indicate neuropathic pain and could contribute to a paradigm shift in assessment and treatment of SCD pain.

Thermal and mechanical quantitative sensory testing values among healthy African American adults.

PURPOSE: Only a few studies have reported quantitative sensory testing (QST) reference values for healthy African Americans, and those studies are limited in sample size and age of participants. The study purpose was to characterize QST values in healthy, pain-free African American adults and older adults whose prior pain experiences and psychological status were also measured. We examined the QST values for differences by sex, age, and body test site. PATIENTS AND METHODS: A cross-sectional sample of 124 pain-free African American adults (age 18-69 years, 49% female) completed demographic and self-reported pain, fatigue and psychosocial measures. QST was performed to obtain thermal and mechanical responses and associated pain intensity levels. RESULTS: We found thermal detection values at the anterior forearm were (29.2 °C±1.6) for cool detection (CD) and (34.5 °C±1.2) for warm detection (WD). At that site the sample had cold pain threshold (CPTh) (26.3 °C±5.0), heat pain threshold (HPTh) (37.8 °C±3.6), and mechanical pain thresholds (MPTH) (16.7±22.2 grams of force, gF). There was a significant between sex difference for WD, with women being more sensitive (q=0.027). Lower body sites were less sensitive than upper body sites across all thermal modalities (q<0.003), but not for the mechanical modality. CONCLUSION: The QST values from this protocol at the anterior forearm indicate that the healthy African American adults had average thermal pain thresholds close to the temperature of adaptation and average MPTh under 20 gF. Differences in responses to thermal and mechanical stimuli for upper verses lower body were consistent with prior research.

Transición epitelial mesenquimal en carcinomas de células escamosas de cavidad oral relacionado al comportamiento

En la actualidad, a nivel mundial, el carcinoma oral de células escamosas (COCE) es el tumor maligno de aparición más común de la región, el cual representa la sexta entidad principal de cáncer por incidencia, con la aparición de más de 300 000 casos anuales y alrededor de 150 000 muertes.El COCE se caracteriza por su agresividad, alta recurrencia y metástasis linfática y hematógena, además de resistencia al tratamiento y un bajo índice de supervivencia a los 5 años. Un factor que ejerce amplia influencia en la progresión de las células tumorales y el mal pronóstico es el fenómeno de transición epitelial mesenquimal (TEM), el cual se define como la adquisición de características estromales de una célula epitelial, perdiendo su capacidad adhesiva, lo que le permite adoptar un comportamiento agresivo e invasivo.

En la actualidad, a nivel mundial, el carcinoma oral de células escamosas (COCE) es el tumor maligno de aparición más común de la región, el cual representa la sexta entidad principal de cáncer por incidencia, con la aparición de más de 300 000 casos anuales y alrededor de 150 000 muertes.El COCE se caracteriza por su agresividad, alta recurrencia y metástasis linfática y hematógena, además de resistencia al tratamiento y un bajo índice de supervivencia a los 5 años. Un factor que ejerce amplia influencia en la progresión de las células tumorales y el mal pronóstico es el fenómeno de transición epitelial mesenquimal (TEM), el cual se define como la adquisición de características estromales de una célula epitelial, perdiendo su capacidad adhesiva, lo que le permite adoptar un comportamiento agresivo e invasivo.

Molecular Markers of Anticancer Drug Resistance in Head and Neck Squamous Cell Carcinoma: A Literature Review.

This manuscript provides an update to the literature on molecules with roles in tumor resistance therapy in head and neck squamous cell carcinoma (HNSCC). Although significant improvements have been made in the treatment for head and neck squamous cell carcinoma, physicians face yet another challenge-that of preserving oral functions, which involves the use of multidisciplinary therapies, such as multiple chemotherapies (CT) and radiotherapy (RT). Designing personalized therapeutic options requires the study of genes involved in drug resistance. This review provides an overview of the molecules that have been linked to resistance to chemotherapy in HNSCC, including the family of ATP-binding cassette transporters (ABCs), nucleotide excision repair/base excision repair (NER/BER) enzymatic complexes (which act on nonspecific DNA lesions generated by gamma and ultraviolet radiation by cross-linking and forming intra/interchain chemical adducts), cisplatin (a chemotherapeutic agent that causes DNA damage and induces apoptosis, which is a paradox because its effectiveness is based on the integrity of the genes involved in apoptotic signaling pathways), and cetuximab, including a discussion of the genes involved in the cell cycle and the proliferation of possible markers that confer resistance to cetuximab.

Implementing the PAIN RelieveIt Randomized Controlled Trial in Hospice Care: Mechanisms for Success and Meeting PCORI Methodology Standards.

This purpose of this article is to describe how we adhere to the Patient-Centered Outcomes Research Institute's (PCORI) methodology standards relevant to the design and implementation of our PCORI-funded study, the PAIN RelieveIt Trial. We present details of the PAIN RelieveIt Trial organized by the PCORI methodology standards and components that are relevant to our study. The PAIN RelieveIt Trial adheres to four PCORI standards and 21 subsumed components. The four standards include standards for formulating research questions, standards associated with patient centeredness, standards for data integrity and rigorous analyses, and standards for preventing and handling missing data. In the past 24 months, we screened 2,837 cancer patients and their caregivers; 874 dyads were eligible; 223.5 dyads consented and provided baseline data. Only 55 patients were lost to follow-up-a 25% attrition rate. The design and implementation of the PAIN RelieveIt Trial adhered to PCORI's methodology standards for research rigor.

Reproductive Health CHOICES for Young Adults with Sickle Cell Disease or Trait: Randomized Controlled Trial Outcomes over Two Years.

Interventions to assist reproductive health decision-making in populations affected by sickle cell disease (SCD) or trait (SCT) lack proven efficacy over time. Our aim was to compare effects of CHOICES, a Web-based multimedia education program on implementing informed reproductive plans, and usual care education (e-Book) on reproductive knowledge, intention, and behavior over 24 months. We randomized 234 participants with SCD (n = 138) or SCT (n = 96) (age 18-35 years, 35 % male, 94 % African American) to CHOICES and e-Book groups. Participants completed a sickle cell-specific reproductive measure before and four times after the intervention (6, 12, 18 and 24 months). Compared to the e-Book group the CHOICES group had significantly more improvement in knowledge over time (p = .004) but not intention (p = .18) or behavior (p = .69). At baseline, 114 (48.7 %) participants reported having partners who would not put the couple at risk for their children inheriting SCD. Of the 116 (49.6 %) at-risk participants, a higher poroportion of those who were in the CHOICES group chose partners that reduced their risk by the last visit than the e-Book group (p = .04). Study findings provide important insights for designing a national trial of the CHOICES intervention focusing on subjects whose partner status puts them at risk for having a child with SCD.

Riesgo cardiovascular en los empleados de la Universidad Autónoma de Chihuahua, México / Cardiovascular risk in employees of the Autonomous University of Chihuahua, Mexico

Introducción: La prevalencia de las Enfermedades Crónicas No Transmisibles (ECNT) se ha incrementado en los últimos años presentándose un gran número de padecimientos como lo son; la obesidad, diabetes, enfermedades cardiovasculares en las que están incluidas la aterosclerosis, isquemias miocárdiacas y cerebrales, hipertensión arterial y enfermedades cerebrovasculares. Objetivo: Evaluar el estado de salud integral del personal académico y administrativo en activo, de la Universidad Autónoma de Chihuahua, dentro del marco de las Campañas de Salud realizadas por el Sindicato de Trabajadores-UACH en Noviembre 2012. Métodos: Estudio descriptivo de corte transversal en 31 trabajadores de la UACH, se evaluaron variables de alimentación, parámetros bioquímicos (triglicéridos, colesterol total, LDL, HDL). Se determinó el índice aterogénico y el riesgo cardiovascular con la escala Framingham-Wilson. Resultados: La ingesta dietética media de colesterol diario fue de 579.1 mg en hombres y 363.4 mg en mujeres. La ingesta de fibra diaria fue de 9.7 g en hombres y 9.8 g en mujeres. Con respecto a la ingesta de grasas saturadas por día fue de 48.8 g (16.5% del VCT) en hombres y 36.3g (15.5% del VCT) en mujeres. El índice aterogénico en los hombres fue de 5.6±2.0 y 4.1±0.9 puntos en las mujeres.El riesgo cardiovascular según Framingham fue de 32.2% de los hombres presentó riesgo alto. Discusión y conclusiones: La prevalencia de sobrepeso, obesidad, así como las alteraciones de los lípidos sanguíneos, presentan el patrón clásico de la dislipidemia aterogénica, que implica un riesgo elevado en el desarrollo de cardiopatía isquémica. Los malos hábitos alimentarios (alta ingesta de colesterol, grasas saturadas y baja ingesta de fibra) contribuyen al desarrollo de enfermedades cardiovasculares (AU)

Introduction: The prevalence of Chronic Noncommunicable Diseases (NCDs) has increased in recent years, presenting a large number of ailments such as; obesity, diabetes, cardiovascular disease in atherosclerosis, myocardial and cerebral ischemia, hypertension and cerebrovascular diseases are included. Objective: To evaluate the overall health status of the academic and administrative staff active at the Autonomous University of Chihuahua, within the framework of the Health Campaigns conducted by the workers union-UACH, November 2012. Methods: Cross-sectional study in 31 workers UACH supply variables, biochemical (triglycerides, total cholestero LDL, HDL) they were evaluated parameters. Atherogenic index and cardiovascular risk with the Framingham-Wilson scale was determined. Results: The average daily dietary intake of cholesterol in men was 579.1 mg and 363.4 mg in women. Daily fiber intake was 9.7 g in men and 9.8 g in women. Saturated fat intake per day was 48.8 g (16.5% of the total caloric value) in men and 36.3 g (16.5% of the total caloric value) in women. The calculation of atherogenic index in men was 5.6 ± 2.0 and 4.1 ± 0.9 points in women. The calculation of cardiovascular risk according to Framingham 32.2% of men had a high risk. Discussion and Conclusions: The prevalence of overweight, obesity and alterations in blood lipids, have the classic pattern of atherogenic dyslipidemia, which involves a high risk to develop coronary heart disease. Poor eating habits (high intake of cholesterol, saturated fat and low fiber intake) contribute to the development of cardiovascular diseases (AU)

[Meckel's diverticulum duplication. Case report and literature review]. / Doble divertículo de Meckel. Presentación de caso y revisión de la bibliografía.

BACKGROUND: Meckel's diverticulum is the most frequent congenital abnormality of the gastrointestinal tract. Preoperative diagnosis is difficult due to its variable clinical presentation that can simulate several causes of gastrointestinal bleeding or abdominal pain. CLINICAL CASE: We present the case of a 61-year-old female patient with multiple abdominal surgeries who developed intestinal occlusion during several admissions beginning 8 months earlier. She was treated with conservative measures. During her last admission, she developed dehydration, persistent abdominal pain and bowel dilation with failure to respond to conservative treatment. Surgical intervention was decided upon, ruling out adhesions and revealing the presence of two diverticular defects at 40 and 70 cm from the ileocecal valve with torsion. Histological report described gastric heterotrophic mucosa and inflammatory hemorrhagic process. CONCLUSION: Presence of duplicated Meckel's diverticulum is a rare finding with only nine reports in the international literature to date. Diagnosis is frequently made during surgery. Treatment for symptomatic diverticulum is surgical, whereas management for asymptomatic diverticulum is controversial and relies on the surgeon's decision and clinical characteristics of the patient.

Antecedentes: el divertículo de Meckel es la anomalía congénita más común del tubo digestivo. El diagnóstico preoperatorio es difícil de establecer, por su variable presentación clínica. Caso clínico: paciente femenina de 61 años de edad, con antecedente de cuadros de oclusión intestinal repetitivos ocho meses antes de nuestra valoración. En el último internamiento tuvo: desequilibrio hidroelectrolítico, dolor persistente y falta de respuesta al tratamiento médico; por esto se le realizó una laparotomía exploradora que descartó el síndrome adherencial, y como hallazgo dos defectos diverticulares a 40 y 70 cm de la válvula ileocecal, con torsión sobre su eje. El reporte histopatológico confirmó la existencia de dos divertículos de Meckel con cambios de tipo inflamatorio hemorrágico y mucosa gástrica heterotópica de tipo antral. Conclusión: la duplicación del divertículo de Meckel es un hallazgo raro, con solo nueve casos publicados en la bibliografía internacional. El diagnóstico se realiza, frecuentemente, como hallazgo transoperatorio. El tratamiento del divertículo sintomático es quirúrgico; sin embargo, en el asintomático existe controversia y depende del criterio del cirujano y de las características propias de cada paciente.

Reproductive health choices for young adults with sickle cell disease or trait: randomized controlled trial immediate posttest effects.

BACKGROUND: People with sickle cell disease (SCD) or sickle cell trait (SCT) may not have information about genetic inheritance needed for making informed reproductive health decisions. CHOICES is a Web-based, multimedia educational intervention that provides information about reproductive options and consequences to help those with SCD or SCT identify and implement an informed parenting plan. Efficacy of CHOICES compared with usual care must be evaluated. OBJECTIVE: The purpose was to compare immediate posttest effects of CHOICES versus an attention-control usual care intervention (e-Book) on SCD-/SCT-related reproductive health knowledge, intention, and behavior. METHODS: In a randomized controlled study, we recruited subjects with SCD/SCT from clinics, community settings, and online networks with data collected at sites convenient to the 234 subjects with SCD (n = 136) or SCT (n = 98). Their ages ranged from 18 to 35 years; 65% were women, and 94% were African American. Subjects completed a measure of sickle cell reproductive knowledge, intention, and behavior before and immediately after the intervention. RESULTS: Compared with the e-Book group, the CHOICES group had significantly higher average knowledge scores and probability of reporting a parenting plan to avoid SCD or SCD and SCT when pretest scores were controlled. Effects on intention and planned behavior were not significant. The CHOICES group showed significant change in their intention and planned behavior, whereas the e-Book group did not show significant change in their intention, but their planned behavior differed significantly. DISCUSSION: Initial efficacy findings are encouraging but warrant planned booster sessions and outcome follow-ups to determine sustained intervention efficacy on reproductive health knowledge, intention, and actual behavior of persons with SCD/SCT.

[Preventive program for postoperative delirium in the elderly]. / Programa preventivo del delirio postoperatorio en ancianos.

BACKGROUND: Delirium is a poorly recognized entity in surgical patients that may commonly be mistaken for dementia or cognitive dysfunction. It is of great importance to know the measures that can lower its incidence and insure early recognition in order to begin specific treatment. The main objective of this study was to prove that implementation of an educational program for health care professionals is an effective strategy to reduce delirium incidence and to help in early detection. METHODS: A preventive program was developed based on non-pharmacological measures and with support from patient relatives consisting of educational sessions, didactic material and questionnaires, as well as specific strategies for all patients above 65 years old admitted to the hospital and within inclusion criteria. Two evaluations were made by physician and nursing personnel before and after implementation of the program. RESULTS: We observed an improvement in ability to identify disease (initial 22% vs. 93%; p= 0.000). 200 patients were included in the study group in one year where only one case of delirium developed showing an important reduction compared to the previous incidence in our hospital (10% vs. 0.5% p= 0.000) whereas in the surgical patients group no patient developed delirium (4.8% vs. 0% p= 0.01, NNT= 21). CONCLUSIONS: Implementation of a delirium prevention program is feasible. Due to the satisfactory results in our study it should be considered as an effective strategy for reducing incidence of this condition that may cause greater postoperative morbidity and mortality.K.

Antecedentes: el delirium es un padecimiento poco reconocido en los pacientes quirúrgicos que frecuentemente se confunde con deterioro cognitivo o demencia. Es de vital importancia conocer las medidas que pueden disminuir su incidencia y reconocerlo de manera temprana para iniciar el tratamiento específico. Objetivo: implementar un programa educativo en delirium para el equipo de salud, con el propósito de disminuir su incidencia. Material y métodos: estudio observacional, longitudinal y analítico basado en medidas no farmacológicas y con apoyo de los familiares con quienes se tuvieron sesiones educativas, material didáctico, cuestionarios y estrategias específicas para todos los pacientes mayores de 65 años. Se realizaron dos evaluaciones al personal médico y de enfermería antes y después de implementar el programa.Resultados: se observó mejoría en la capacidad para dentificar el delirium (22% inicial vs 93%; p= 0.000). Se incluyeron 200 pacientes en el grupo de ensayo a un año y se encontró un solo caso de delirium que mostró reducción importante respecto a la incidencia previa en el hospital (10 vs 0.5% p= 0.000), mientras que en el subgrupo de 98 pacientes quirúrgicos no hubo ningún caso de delirium (4.8% inicial vs 0% p= 0.01, NNT= 21). Conclusiones: la implementación de un programa preventivo para el delirium es factible. Los resultados fueron satisfactorios, por lo que puede considerarse una estrategia efectiva para reducir la incidencia de esta afección que puede causar gran morbilidad y mortalidad postoperatoria.

Pesquisa del cáncer de ovario en mujeres posmenopáusicas / Inquiry of cancer of ovary in woman postmenopausal

Evaluar la utilidad del ultrasonido transvaginal y el antígeno carbohidrato 125 como métodos de pesquisa en el diagnóstico precoz del cáncer de ovario en mujeres posmenopáusicas. Estudio prospectivo, descriptivo, transversal entre junio 1998 y mayo 1999 en 361 pacientes posmenopáusicas asintomáticas desde el punto de vista ginecológico. La muestra es descrita con medidas de tendencias central y porcentaje; además se calcula la sensibilidad, especifidad y valores predictivos positivo y negativo. Servicio de Cirugía II, Hospital Domingo Luciani, Instituto Venezolano de los Seguros Sociales, Caracas. Se estudiaron 361 pacientes, de las cuales 22 tuvieron diagnóstico por ultrasonido transvaginal de tumor anexial. A este grupo se le practicó laparatomía exploradora evidenciándose en dos cáncer de ovario primario. Ambas presentaron niveles elevados de antígenos carbohidrato 125. El ultrasonido transvaginal mostró una sensibilidad de 100 y una especificidad de 94 con valor predictivo positivo 9 y valor predictivo negativo 100. El antígeno carbohidrato 125 mostró una sensibilidad de 100 y especificidad de 80 con valor predictivo positivo de 40 y valor predictivo negativo 100. Los dos métodos combinados mostraron una sensibilidad de 100, especificidad 75, valor predictivo positivo 29 y valor predictivo negativo 100. La pesquisa de cáncer de ovario utilizando el ultrasonido transvaginal resultó ser un método seguro, bien tolerado, fácil de realizar y representa en nuestro medio el método de elección de pesquisa. El valor predictivo positivo de la ecografía resulta muy bajo para justificar su uso de rutina, aunque combinado con el antígeno carbohidrato 125 en pacientes con patología tumoral ovárica detectada por el ultrasonido se eleva el valor predictivo positivo hasta un 29 por ciento. Esto hace pensar que definitivamente deben tomarse en cuenta ambos métodos para el diagnóstico de patología ovaríca en posmenopáusicas

Amigdalectomía como factor de riesgo para desarrollar el síndrome de inmunodeficiencia adquirida / Tonsillectomy as a risk factor for developing acquired immuno-deficiency syndrome

Se realizó un estudio retrospectivo en 321 pacientes de la consulta externa de Infectología del Hospital Central Militar de la Cd. de México, D.F. y del Centro Médico ®La Raza¼, IMSS en los cuales se tenía el diagnóstico de SIDA. La edad de los pacientes fue de 18 a 69 años con un promedio de 24. Predominó el sexo masculino con 83 por ciento de los casos. Se investigó la relación existente con amigdalectomía encontrándose que 29.7 por ciento de los pacientes presentaban este antecedente. Comparado con el grupo control (paciente sin SIDA con el antecedente de amigdalectomía fue menos frecuente (9 por ciento) que en el grupo de estudio (29.7 por ciento). Se encuentra una relación estadística significativa entre el antecedente de amigdalectomía y la presentación de SIDA posteriormente. Clínicamente se necesitan más estudios para confirmar esto