Puzzling interference in the Siemens tacrolimus assay in a renal transplant patient: A case report.

BACKGROUND: Therapeutic drug monitoring is a key tool for optimizing tacrolimus therapy in transplant recipients. The modified ACMIA assay from Siemens Healthcare Diagnostics is an immunoassay commonly used for tacrolimus monitoring, but it is not known whether this assay is resistant to interference from endogenous substances in real-world use. OBJECTIVE: To describe a case of unexpected interference in tacrolimus monitoring using the modified ACMIA method in a kidney transplant recipient, and to highlight the importance of careful interpretation of laboratory results and effective communication with clinicians in optimizing patient care. CASE DESCRIPTION: This case report describes a significant interference in the monitoring of tacrolimus in a kidney transplant recipient using the new ACMIA method. In this case, when aberrant results for tacrolimus were found using the new ACMIA method, they were re-analyzed using the CMIA method from Abbott. The presence of positive ANCA-MPO autoantibodies was found to be the most likely cause of the interference after an extensive workup. CONCLUSIONS: This is the first report of major interference with the modified ACMIA tacrolimus method and emphasizes the importance of proper interpretation of laboratory results and effective communication with clinicians in optimizing patient care.

Influencia de factores no médicos para el nacimiento por cesárea en un hospital privado / Influence of non-medical factors for cesarean birth in a private hospital

Resumen: OBJETIVO: Encontrar los factores no médicos que intervienen en el criterio del obstetra para elegir que la vía de nacimiento sea por parto o cesárea. MATERIALES Y MÉTODOS: Estudio transversal, retrospectivo, observacional y analítico, efectuado en pacientes atendidas entre 2016 y 2019 en el Hospital Ángeles Lomas, con más de 24 semanas de embarazo y que lo terminaron mediante parto o cesárea. Criterio de exclusión: embarazos múltiples. Variable dependiente: nacimiento por parto o cesárea. Variables independientes: sexo del obstetra, consultorio en el mismo hospital o externo, disponibilidad de asistente médico, mes del año, día de la semana y periodo vacacional. RESULTADOS: Se incluyeron 3906 nacimientos, 1495 cesáreas (38.3%) y 2411 partos (61.7%). Se observó mayor riesgo de cesárea, con significación estadística en: nacimientos atendidos por obstetras externos (OR = 3.81; IC95%: 3.07-4.73), nacimientos atendidos por obstetras del mismo hospital sin asistente médico (OR = 1.75; IC95%: 1.48-2.08), obstetras mujeres (OR = 2.55; IC95%: 2.06-3.16), abril vs diciembre (OR = 1.44; IC95%:1.04-1.98) y miércoles vs domingos (OR = 1.55; IC95%:1.14-2.05). Se registraron más cesáreas en el periodo prevacacional vs vacacional (OR = 1.51; IC95%: 0.94-2.43) sin diferencia estadísticamente significativa. CONCLUSIONES: Existen factores no médicos que aumentan la frecuencia de cesárea. Los relacionados con el obstetra incluyen: no tener el consultorio en el mismo hospital y carecer de asistente médico.

Abstract: OBJECTIVE: To find the non-medical factors that intervene in the obstetrician's criteria for choosing a birth canal or Cesarean section. MATERIALS AND METHODS: Transversal, retrospective, observational and analytical study carried out on patients attended between 2016 and 2019 at Hospital Ángeles Lomas (Mexico City), with more than 24 weeks of pregnancy and who finished it by vaginal delivery or cesarean section. Exclusion criterion: Multiple pregnancies. Dependent variable: birth by delivery or cesarean section. Independent variables: sex of the obstetrician, office in the same hospital or outside, availability of medical assistant, month of the year, day of the week and vacation period. RESULTS: 3906 births, 1495 cesarean sections (38.3%) and 2411 deliveries (61.7%) were included. A higher risk of cesarean section was observed, with statistical significance in: births attended by external obstetricians (OR = 3.81; CI95%: 3.07-4.73), births attended by obstetricians at the same hospital without a physician's assistant (OR = 1. 75; CI95%: 1.48-2.08), female obstetricians (OR = 2.55; CI95%: 2.06-3.16), April vs. December (OR = 1.44; CI95%:1.04-1.98) and Wednesday vs More cesarean sections were recorded in the pre-vacation vs. vacation period (OR = 1.51; IC95%: 0.94-2.43) with no statistically significant difference. CONCLUSIONS: There are non-medical factors that increase the frequency of cesarean section. Those related to the obstetrician included: not having the office in the same hospital and not having a medical assistant.

Estudios de imagen cerebral en el diagnóstico diferencial de enfermedades hipertensivas del embarazo y convulsiones. Reporte de dos casos / Brain imaging studies in the differential diagnosis of patients with hypertensive diseases of pregnancy and seizures. Report of two cases

Resumen ANTECEDENTES: Las crisis convulsivas durante el embarazo son la complicación neurológica más frecuente. Casi todas ocurren en pacientes con epilepsia; cuando aparece la primera durante el embarazo debe establecerse su causa. PRIMER CASO: Paciente de 28 años, con antecedente de hipertensión arterial. Cursaba el puerperio posquirúrgico tardío con preeclampsia sobreagregada cuando tuvo tres crisis convulsivas. Acudió a urgencias y la trataron con sulfato de magnesio: evolucionó a estatus epiléptico. Los estudios de neuroimagen reportaron trombosis de la vena cortical frontal izquierda. Se aplicaron medidas de neuroprotección con adecuada evolución clínica y fue dada de alta del hospital sin déficit motor, sensitivo y cognoscitivo. SEGUNDO CASO: Paciente de 22 años, con antecedente de citopatía mitocondrial del fenotipo oftalmoplejía externa progresiva crónica. Cursaba su primer embarazo sin control prenatal. A la semana 28 sufrió cefalea y una crisis convulsiva. Acudió a urgencias debido a la hipertensión arterial; le prescribieron un antihipertensivo y sulfato de magnesio. Los estudios de neuroimagen reportaron: síndrome de encefalopatía reversible posterior, secundario a eclampsia. Se interrumpió el embarazo y la paciente evolucionó favorablemente. CONCLUSIÓN: Las convulsiones en el embarazo y puerperio en mujeres con enfermedades hipertensivas pueden tener un comportamiento benigno o ser potencialmente mortales. Se propone un algoritmo diagnóstico para tratar a estas pacientes, resalta la sospecha clínica de otras causas de convulsiones como la principal indicación de estudios de imagen.

Abstract BACKGROUND: Seizures during pregnancy are the most frequent neurological complication. Most occur in patients with epilepsy. When the first crisis appears during pregnancy, the cause must be determined. FIRST CASE: A 28-year-old patient with a history of high blood pressure. She was in the late puerperium with over-added preeclampsia when she presented three seizures. She went to the emergency room and started magnesium sulfate, evolving to epileptic status. Neuroimaging studies were performed and reported thrombosis of the left frontal cortical vein. Neuroprotection measures were applied with adequate clinical evolution. She was discharge without motor, sensory and cognitive deficits. SECOND CASE: A 22-year-old patient with a history of a chronic progressive external ophthalmoplegia mitochondrial cytopathy. She was in her first pregnancy without prenatal control. At the 28 week she began with headache and had a seizure. She went to the emergency department with high blood pressure, so she was given antihypertensive therapy and magnesium sulfate. Neuroimaging studies reported a posterior reversible encephalopathy syndrome secondary to eclampsia. The pregnancy was interrupted, and she evolved favorably. CONCLUSION: Seizures in pregnancy and puerperium in women with hypertensive diseases of pregnancy may have benign behavior or may be life-threatening. We propose a diagnostic algorithm for the approach of these patients, highlighting the clinical suspicion of other causes of seizures as the main indication of imaging studies.

Morbilidad y mortalidad del recién nacido en un hospital privado de México / Newborn morbidity and mortality in a private hospital in Mexico

Resumen OBJETIVO: Estimar la morbilidad y mortalidad de los recién nacidos vivos en un hospital privado de México, a través de los ingresos a las unidades de cuidados intensivos neonatales y de terapia intermedia neonatal. MATERIALES Y MÉTODOS: Estudio de serie de casos de recién nacidos en el Hospital Ángeles Lomas, Estado de México, que ingresaron a la unidad de cuidados intensivos neonatales o a la unidad de terapia intermedia neonatal entre 2016 y 2019. Se incluyeron todos los recién nacidos vivos, mayores de 24 semanas de gestación. Se efectuó un análisis descriptivo y se calcularon medias, porcentajes y desviaciones estándar. RESULTADOS: Se registraron 4234 recién nacidos, de ellos 13.7% fueron prematuros. Ingresaron 478 (11.3%) neonatos a cuneros dedicados a la atención de sus morbilidades, 203 a la unidad de cuidados intensivos neonatales (4.8%) y 275 a la unidad de terapia intermedia neonatal (6.5%). Las principales causas de ingreso a cuidados intensivos neonatales fueron: retención de líquido pulmonar (32.5%), enfermedad de membrana hialina (27.6%) y sepsis neonatal (10.3%). Las principales causas de ingreso a la unidad de terapia intermedia neonatal fueron: retención de líquido pulmonar (41%), hiperbilirrubinemia multifactorial (15.2%) e hiperbilirrubinemia por incompatibilidad de grupo (11.6%). La tasa de mortalidad neonatal fue de 2.7 por cada 1000 nacidos vivos, las principales causas de defunción fueron: enfermedad de membranas hialinas complicadas con sepsis neonatal y asfixia perinatal. CONCLUSIÓN: No se encontraron diferencias importantes en el hospital privado estudiado en comparación con otros estudios que valoran la morbilidad y mortalidad neonatal. La tasa de mortalidad en este hospital fue menor a la del país, pero la media de días en la unidad de cuidados intensivos neonatales fue mayor y la tasa de prematuridad ligeramente mayor a la reportada en países desarrollados.

Abstract OBJECTIVE: To estimate the morbidity and mortality of live newborns born in a private hospital in Mexico, through admissions to the neonatal intensive care unit (NICU) and the neonatal intermediate therapy unit (NITU). MATERIALS AND METHODS: A series of cases were carried out of the births of the Hospital Ángeles Lomas (State of Mexico) that have entered the NICU / NITU from 2016 to 2019. All live newborns older than 24 weeks were included. A descriptive analysis was performed calculating means, percentages and standard deviations. RESULTS: 4,234 newborns were registered, of which 13.7% were premature. 478 (11.3%) newborns were admitted to pathological nurseries, 203 to the NICU (4.8%) and 275 to the NITU (6.5%). The main causes of admission to the NICU were retention of pulmonary fluid (32.5%), hyaline membrane disease (27.6%), and neonatal sepsis (10.3%). The main causes of admission to the NITU were retention of pulmonary fluid (41%), multifactorial hyperbilirubinemia (15.2%) and hyperbilirubinemia due to group incompatibility (11.6%). The neonatal mortality rate was 2.7 out of 1000 live births, the main causes of death were hyaline membrane disease complicated by neonatal sepsis and perinatal asphyxia. CONCLUSION: No significant differences were found in the private hospital studied compared to other studies evaluating neonatal morbidity and mortality. The mortality rate in this hospital was lower than that registered countrywide, however the average number of days in the NICU was higher and the prematurity rate slightly higher than that reported in developed countries.

Evaluación del impacto en salud de intervenciones de regeneración en la bahía de Pasaia: percepciones de la población afectada / Health impact assessment of regeneration projects in Pasaia bay (Spain): perceptions of the affected population

Objetivo. Conocer los impactos en salud percibidos por vecinos y agentes sociales como consecuencia de dos intervenciones de regeneración urbana (nueva lonja de pescado y reordenación de La Herrera Norte/Oeste) en la bahía de Pasaia (Gipuzkoa, España) que han sido objeto de una evaluación del impacto en salud (EIS). Método. Metodología cualitativa. Muestreo teórico e intencional. Generación de información mediante 18 entrevistas personales y cinco grupos de discusión. Análisis conforme al modelo de análisis sociológico del discurso. Triangulación y contraste de los resultados preliminares entre miembros del equipo y participantes del estudio. Resultados. Se identifican cuatro áreas interrelacionadas de impacto en salud: calidad urbana, conectividad, cohesión social y, en menor grado, empleo. Se señalan los aspectos concretos de mejora a tener en cuenta en cada ámbito, así como la influencia del contexto sociopolítico y las concepciones sobre la salud. Las repercusiones del proceso de ejecución de las obras y las diferentes perspectivas según los roles y perfiles sociales de los participantes constituyen hallazgos asimismo importantes. Conclusiones. El conocimiento de las percepciones y expectativas de los afectados mediante los métodos cualitativos aporta elementos e interrelaciones novedosas y necesarias para la aplicación de la EIS como herramienta de mejora de la salud y de participación ciudadana (AU)

Aim. To determine the health impact perceived by residents and social players involved in two urban regeneration interventions (a new fish market and the redevelopment of North/West Herrera) in Pasaia Bay (Gipuzkoa, Spain) that have been the subject of a health impact assessment (HIA). Method. Qualitative methodology was used with theoretical and intentional sampling. Information was obtained through 18 personal interviews and five discussion groups and was analyzed in accordance with the sociological analysis model of discourse. The preliminary results were triangulated and contrasted among the team members and those taking part in the study. Results. Four interrelated areas of health impact were identified: urban quality, connectivity, social cohesion, and-to a lesser extent-employment. Specific aspects for improvement were indicated for each field, as well as the influence of the sociopolitical context and conceptions of health. Other significant findings were the impact of the process of carrying out the building work and the distinct perspectives due to the differing roles and social profiles of participants. Conclusions. Knowledge of the perceptions and expectations of affected individuals through qualitative methods provides novel elements and interrelations that are needed to apply HIA as a tool for improving health and for citizen participation (AU)

[Health impact assessment of regeneration projects in Pasaia Bay (Spain): perceptions of the affected population]. / Evaluación del impacto en salud de intervenciones de regeneración en la bahía de Pasaia: percepciones de la población afectada.

AIM: To determine the health impact perceived by residents and social players involved in two urban regeneration interventions (a new fish market and the redevelopment of North/West Herrera) in Pasaia Bay (Gipuzkoa, Spain) that have been the subject of a health impact assessment (HIA). METHOD: Qualitative methodology was used with theoretical and intentional sampling. Information was obtained through 18 personal interviews and five discussion groups and was analyzed in accordance with the sociological analysis model of discourse. The preliminary results were triangulated and contrasted among the team members and those taking part in the study. RESULTS: Four interrelated areas of health impact were identified: urban quality, connectivity, social cohesion, and-to a lesser extent-employment. Specific aspects for improvement were indicated for each field, as well as the influence of the sociopolitical context and conceptions of health. Other significant findings were the impact of the process of carrying out the building work and the distinct perspectives due to the differing roles and social profiles of participants. CONCLUSIONS: Knowledge of the perceptions and expectations of affected individuals through qualitative methods provides novel elements and interrelations that are needed to apply HIA as a tool for improving health and for citizen participation.

Profile of the Patient Who Refuses to Participate in the Expert Patients Program.

The Expert Patients Program (EPP), an educational intervention for chronic diseases aimed at nonprofessionals, has high nonparticipation and dropout rates. We used quantitative and qualitative methods to identify the prevalence of and reasons for nonparticipation in 100 patients with acute myocardial infarction and 69 with stroke. We confirmed a high prevalence of refusal, identifying three groups based on degree of participation: patients who refused to attend (51%), patients who attended and then dropped out (10%), and patients who attended (39%). Patients who refused to participate or dropped out were mainly women and former/current smokers with a better-than-average physical condition. In addition, they were invited to participate in the EPP long after their cardiovascular event. We found that the degree of participation depended upon the patient's individual and social context and the professional profile of the recruiter. Therefore, tailored strategic interventions should be designed for each type of participation.

[Evolution of social representations about health among women from Madrid, 1993-2000]. / La evolución de las representaciones sociales sobre la salud de las mujeres madrileñas, 1993-2000.

BACKGROUND: In 1993, initial research was conducted among the women in Madrid. In 2000, a second research was conducted for the purpose of analyzing the possible evolution of the social representations related to health among women and, if necessary, to therefore reorient the health programs set forth in 1993 in terms of the results of the research. The aim was therefore to analyze the possible advancement of the opinions stated, of the health-related social representations which each one of the five types encountered in 1993 might express throughout the 1993-2000 period. METHODS: The qualitative research conducted in 2000 was based on the holding of 10 discussion groups defined according to the women's "typologies" which had been set out in the 1993 research. The types in question were characterized in terms of different sociodemographic variables and of the role which they had stated as most important in 1993. The analysis of the stated opinions was put into graphic and topological form in order to display the aforementioned trend in the social representations. RESULT: This research revealed some major changes having taken place throughout the 1993-2000 period, the predominant stated opinion-related perspective had evolved out of the "housewife" role to the "working woman" role in 2000, the predominant social representations stressed a dimension more nearing a persona balance in 2000, in which the role of women themselves, outside the bounds of their families, is of major importance. The scope of their concerns also evolved to a concern related to the stress involved in being a working woman plus a housewife. CONCLUSIONS: This study made it possible to reach conclusions of a methodological type related to the ability of the qualitative methodology to make comparative, time-based studies and to conclusions of a more pragmatic type which afforded the possibility of changing the orientation of certain health programs aimed at women along a line more closely in keeping with their true concerns.

La evolución de las representaciones sociales sobre la salud de las mujeres madrileñas, 1993-2000 / The evolution of the social representations regarding health of women from Madrid, Spain, 1993-2000

Fundamentos: En 1993 se realizó una primera investigación entre las mujeres madrileñas. En el año 2000 se llevó a cabo una segunda con el objetivo de analizar la posible evolución de las representaciones sociales sobre la salud en las mujeres y, en consecuencia, reorientar, si fuese necesario, los programas de salud definidos en 1993 en función de los nuevos resultados de la investigación. De esta forma, se pretendía analizar la posible evolución de los discursos, de las representaciones sociales sobre la salud que pudiera expresar entre 1993 y el 2000 cada uno de los cinco tipos encontrados en el 1993. Métodos: La investigación cualitativa en el 2000 se basó en la realización de 10 grupos de discusión, definidos en función de las 'tipologías' de mujeres que se habían construido en la investigación de 1993. La caracterización de los tipos se realizó en función de las distintas variables sociodemográficas y de rol que se habían expresado más importantes en 1993. El análisis de los discursos se tradujo en una forma gráfica, topológica para visualizar la citada evolución de las representaciones sociales. Resultados: La investigación puso de manifiesto importantes cambios entre 1993 y el 2000. En el 2000 la citada perspectiva discursiva había evolucionado del rol de 'ama de casa' al rol de 'mujer trabajadora'; en el 2000 las representaciones sociales dominantes hacían hincapié en una dimensión más cercana al equilibrio personal en lo que el papel de la propia mujer, más allá de su familia, tiene mucha importancia; el ámbito de la preocupaciones también evolucionaba, pasando al estrés por la doble jornada laboral. Conclusiones: El estudio permitió obtener conclusiones de tipo metodológico, vinculadas a la capacidad de la metodología cualitativa para hacer estudios comparativos y temporales, y conclusiones de carácter más pragmático, que permitieron reorientar determinados programas de salud orientados a las mujeres en una línea más cercana a sus preocupaciones (AU)

Background: In 1993, initial research was conducted among the women in Madrid. In 2000, a second research was conducted for the purpose of analyzing the possible evolution of the social representations related to health among women and, if necessary, to therefore reorient the health programs set forth in 1993 in terms of the new results of the research. The aim was therefore to analyze the possible advancement of the opinions stated, of the health-related social representations which each one of the five types encountered in 1993 might express throughout the 1993-2000 period. Methods: The qualitative research conducted in 2000 was based on the holding of 10 discussion groups defined according to the women's "typologies" which had been set out in the 1993 research. The types in question were characterized in terms of different sociodemographic variables and of the role which they had stated as most important in 1993. The analysis of the stated opinions was put into graphic and topological form in order to display the aforementioned trend in the social representations. Result: This research revealed some major changes having taken place throughout the 1993-2000 period. the predominant stated opinion-related perspective had evolved out of the "housewife" role to the "working woman" role in 2000. the predominant social representations stressed a dimension more nearing a persona balance in 2000, in which the role of women themselves, outside the bounds of their families, is of major importance. The scope of their concerns also evolved to a concern related to the stress involved in being a working woman plus a housewife. Conclusions:. This study made it possible to reach conclusions of a methodological type related to the ability of the qualitative methodology to make comparative, time-based studies and to conclusions of a more pragmatic type which afforded the possibility of changing the orientation of certain health programs aimed at women along a line more closely in keeping with their true concerns (AU)

Lactancia materna: actitudes, creencias y prácticas en mujeres embarazadas / Maternal lactation : attitudes, belief and practice in pregnant women

Se realizó un estudio analítico, comparando las creencias, actitudes y prácticas en 100 mujeres embarazadas que asistieron a la consulta externa de la Maternidad "Dr. Manuel Perdomo" del I.D.S.S. y el Centro de Ginecología y Obstetricia, Santo DOmingo, de las cuales se tomó al azar una muestra de 50 embarazadas por cada centro de salud y se le aplicó un cuestionario en el período julio-agosto 1992. De las 100 mujeres estudiadas el 98 por ciento tenia conocimiento sobre lactancia materna. El 53 por ciento piensa amamantar al niño hasta 9 meses o más. El 100 por ciento refirió que la lactancia materna es beneficiosa para la salud del niño. El 36 por ciento tiene una edad comprendida entre 26-30 años. El 32 por ciento tenia nivel educacional profesional. El 98 por ciento piensa amamantar, mientras el 2 por ciento no lo hará para no perder la figura