Bariatric Surgery: An Opportunity to Improve Quality of Life and Healthy Habits.

Bariatric surgery therapy (BST) is an effective treatment for obesity; however, little is known about its impacts on health-related quality of life (HRQoL) and related factors. This study aimed to evaluate changes in HRQoL and its relationship with weight loss, depression status, physical activity (PA), and nutritional habits after BST. Data were obtained before and 18 months postprocedure from 56 obese patients who underwent BST. We administered four questionnaires: Short Form-36 health survey for HRQoL, 14-item MedDiet adherence questionnaire, Rapid Assessment of PA (RAPA) questionnaire, and Beck's Depression Inventory-II. Multivariable linear regression analysis was used to identify factors associated with improvement in HRQoL. After the surgery, MedDiet adherence and HRQoL improved significantly, especially in the physical component. No changes in PA were found. Patients without previous depression have better mental quality of life, and patients who lost more than 25% of %TBWL have better results in physical and mental quality of life. In the multivariable analysis, we found that %TBWL and initial PCS (inversely) were related to the improvement in PCS and initial MCS (inversely) with the MCS change. In conclusion, BST is an effective intervention for obesity, resulting in significant weight loss and improvements in HRQoL and nutritional habits.

Label-Free Direct Mass Spectrometry Analysis of the Bystander Effects Induced in Chondrocytes by Chondrosarcoma Cells Irradiated with X-rays and Carbon Ions.

BACKGROUND: Radiation-induced bystander effects are induced changes in cells that were not themselves directly irradiated but were in the vicinity of a radiation path. Such effects, which occur in the microenvironment of an irradiated tumor, remain poorly understood and depend on the cell type and irradiation quality. This study aimed to evaluate bystander effects in non-irradiated chondrocytes that received conditioned medium from irradiated chondrosarcoma cells. METHODS: SW1353 chondrosarcoma cells were irradiated with X-rays and carbon ions, each at 0.1 Gy and 2 Gy, and the conditioned media of the irradiated cells were transferred to T/C-28A2 chondrocytes and Human Umbilical Venous Endothelial Cells (HUVECs). The whole proteome of bystander chondrocytes was analyzed by label-free mass spectrometry, and a comparative study was performed by dose and irradiation quality. HUVECs were evaluated for inflammatory cytokine secretion. RESULTS: The bystander response of chondrocytes to X-ray irradiation primarily affected the protein translation pathway (DHX36, EIF3B, EIF3D, EIF3M, EIF5, RPL6, RPLP0, RPS24, SYNCRIP), IL-12 (AIP, BOLA2, MIF, GAS6, MIF, PDGFRB) and the oxidative stress pathway (MGST3, PRDX2, PXDN, SOD2, TXN, TXNL1). Following carbon-ion irradiation, the G1/S pathway (PCBP4, PSMD12, PSME, XIAP) and mitotic G2 DNA damage checkpoint pathway (MRE11, TAOK1, UIMC1) were engaged. Changes in the regulation of chromosome separation (BCL7C, BUB3, CENPF, DYNC1LI1, SMARCA4, SMC4) were associated with only low-dose X-ray and carbon-ion irradiation. Modification of the protein translation pathway represented at least 30% of bystander effects and could play a role, possibly along with stress granules, in reduction in cellular metabolism to protect proteins. Stress granules were significantly enriched according to an interaction map. CONCLUSIONS: All these accessions corresponded to a window of the proteins modulated in response to the bystander effect. Our chondrosarcoma model clarified the nature of the bystander response of chondrocytes and may suggest several interesting new mechanisms that are specific to particular irradiation doses and qualities.

Short-Term Therapeutic Adherence of Hospitalized Older Patients with Oropharyngeal Dysphagia after an Education Intervention: Analysis of Compliance Rates, Risk Factors and Associated Complications.

Oropharyngeal dysphagia (OD) is associated with adverse outcomes that require a multidisciplinary approach with different strategies. Our aim was to assess the adherence of older patients to dysphagia management recommendations during hospitalization, after a specific nurse guided dysphagia education intervention and to identify short term complications of OD and their relationship with short-term adherence. We carried out a prospective observational study in an acute and an orthogeriatric unit of a university hospital over ten months with a one-month follow-up. Four hundred and forty-seven patients (mean age 92 years, 70.7% women) were diagnosed with dysphagia using Volume-Viscosity Swallow Test (V-VST). Compensatory measures and individualized recommendations were explained in detail by trained nurse. Therapeutic adherence was directly observed during hospital admission, after an education intervention, and self-reported after one-month. We also recorded the following reported complications at one month, including respiratory infection, use of antibiotics, weight loss, transfers to the emergency department, or hospitalization). Postural measures and liquid volume were advised to all patients, followed by modified texture food (95.5%), fluid thickeners (32.7%), and delivery method (12.5%). The in-hospital compliance rate with all recommendations was 37.1% and one-month after hospital discharge was 76.4%. Both compliance rates were interrelated and were lower in patients with dementia, malnutrition, and safety signs. Higher compliance rates were observed for sitting feeding and food texture, and an increase in adherence after discharge in the liquid volume and use of thickeners. Multivariate logistic regression analysis showed that adherence to recommendations during the month after discharge was associated with lower short-term mortality and complications (i.e., respiratory infection, use of antibiotics, weight loss, transfers to the emergency department, or hospitalization). One-third of our participants followed recommendations during hospitalization and three-quarters one month after admission, with higher compliance for posture and food texture. Compliance should be routinely assessed and fostered in older patients with dysphagia.

Queratoconjuntivitis por fenilefrina confirmada con pruebas alérgicas tras una exploración ordinaria / Phenylephrine keratoconjunctivitis confirmed by allergy testing after routine examination

Las reacciones alérgicas tras el uso de colirios oftálmicos son comunes y pueden manifestarse con queratoconjuntivitis y dermatitis periorbitaria. La introducción reciente de nuevos fármacos tópicos facilita la sospecha clínica, pero en ocasiones se trata de un uso simultáneo de varios medicamentos y la identificación del alérgeno específico se convierte en un reto. Debido a ello, en muchas ocasiones el diagnóstico es de exclusión, ya que no se llega a confirmar con estudio alergológico el agente desencadenante de la reacción. Tal es el caso de la alergia ocular a fenilefrina, dado que son pocos los cuadros clínicos descritos en la literatura donde hay una clara causa inmunológica. Presentamos un caso poco frecuente, una forma grave de queratoconjuntivitis alérgica tras un examen oftalmológico ordinario confirmada tras estudio alergológico completo

Allergic reactions after using ophthalmic eye drops are very common and frequently manifested by ketaconjuntivitis and periorbital dermatitis. Previous introduction of new topical drugs makes the clinical suspicion easier but sometimes the patient uses multiple medications simultaneously and the specific allergen identification become a challenge. That is the reason why in many occasions the diagnosis is of exclusion since the agent triggering the reaction is not confirmed with an allergologic study. Such is the case of ocular allergy to phenylephrine: there are few clinical cases where there is a clear immunologic cause. We report an uncommon case of a patient who develops a severe form of allergic keratoconjuntivitis after routine ophthalmological examination confirmed by complete allergologic study

Tumour Markers in the Differential Diagnosis of Patients With Isolated Involuntary Weight Loss.

BACKGROUND/AIM: Paraneoplastic syndrome symptoms include isolated involuntary weight loss (IIWL). The differential diagnosis of cancer from other diseases may require a significant number of tests. Tumour markers (TMs) can be used for the diagnosis and stratification of patients according to cancer risk. PATIENTS AND METHODS: This study included 606 patients (48% females) seen at the rapid diagnostic unit for IIWL. We determined the levels of TMs carcinoembryonic antigen, carbohydrate antigen 19-9, soluble fragments of cytokeratin 19, carbohydrate antigen 15-3, carbohydrate antigen 125, neuron specific enolase, alpha-fetoprotein, prostatic specific antigen using the multiparametric analyser COBAS 601. Two cut-off points were established, the upper reference limit described by the manufacturer and a high cut-off point suggested by Molina et al., to stratify patients according to cancer risk. RESULTS: Patients were classified according to TM levels as follows: I) all TMs below the upper reference limit; II) highest number of TMs between the two cut-offs; III) at least one TM above the higher cut-off. The odds ratio for malignancy was 4.3 for group II and 248 for group III. These results indicate that when at least one TM is above the higher cut-off, neoplasia is highly probable. CONCLUSION: TM determination allowed to establish cancer risk in patients with IIWL.

Development of Conformational Antibodies to Detect Bcl-xL's Amyloid Aggregates in Metal-Induced Apoptotic Neuroblastoma Cells.

Bcl-xL, a member of the Bcl-2 family, is a pro-survival protein involved in apoptosis regulation. We have previously reported the ability of Bcl-xL to form various types of fibers, from native to amyloid conformations. Here, we have mimicked the effect of apoptosis-induced caspase activity on Bcl-xL by limited proteolysis using trypsin. We show that cleaved Bcl-xL (ΔN-Bcl-xL) forms fibers that exhibit the features of amyloid structures (BclxLcf37). Moreover, three monoclonal antibodies (mAbs), produced by mouse immunization and directed against ΔN-Bcl-xL or Bcl-xL fibers, were selected and characterized. Our results show that these mAbs specifically target ΔN-Bcl-xL in amyloid fibers in vitro. Upon metal-stress-induced apoptosis, these mAbs are able to detect the presence of Bcl-xL in amyloid aggregates in neuroblastoma SH-SY5Y cell lines. In conclusion, these specific mAbs directed against amyloidogenic conformations of Bcl-xL constitute promising tools for studying, in vitro and in cellulo, the contribution of Bcl-xL in apoptosis. These mAbs may further help in developing new diagnostics and therapies, considering Bcl-xL as a strategic target for treating brain lesions relevant to stroke and neurodegenerative diseases.

High Prevalence of Oropharyngeal Dysphagia in Acutely Hospitalized Patients Aged 80 Years and Older.

OBJECTIVES: Oropharyngeal dysphagia is a geriatric syndrome that is usually underdiagnosed in older patients. The aim of this study was to determine the prevalence and identify the main risk factors of dysphagia in the oldest old patients admitted to an acute geriatric unit. DESIGN: Observational prospective study. SETTING AND PARTICIPANTS: Older patients admitted to an acute geriatric unit of a university hospital. MEASURES: 329 patients (mean age 93.5 years, range 81-106) were assessed for oropharyngeal dysphagia within 48 hours of hospital admission using the Volume-Viscosity Swallow Test. Demographic characteristics, geriatric assessment, geriatric syndromes, comorbidities, drug treatment, and complications were examined to determine their association with the presence of dysphagia. RESULTS: Oropharyngeal dysphagia was present in 271 (82.4%) of the participants. Multivariate logistic regression showed that malnutrition [odds ratio (OR) 3.62, 95% confidence interval (CI) 1.01-12.93; P = .048], admission for respiratory infection (OR 2.89, 95% CI 1.40-5.94; P = .004), delirium (OR 2.89, 95% CI 1.40-5.94; P = .004), severe dependency (OR 3.23, 95% CI 1.23-8.87; P = .017), and age (OR 1.11, 95% CI 1.01-1.21; P = .03) were significantly associated with dysphagia. The use of a calcium antagonist at the time of admission was associated with a reduced risk of dysphagia (OR 0.39, 95% CI 0.16-0.92; P = .03). CONCLUSIONS AND IMPLICATIONS: The prevalence of oropharyngeal dysphagia is high in the oldest old patients admitted to an acute geriatric unit when assessed with an objective diagnostic method. Our findings suggest that objective swallowing assessment should be routinely performed on admission in order to start early interventions to avoid complications of dysphagia in this complex population.

Surface modulation of single-walled carbon nanotubes for selective bacterial cell agglutination.

BACKGROUND: Bacterial resistance to antibiotics is one of the biggest challenges facing medicine today. Anti-adhesive therapy, using inhibitors of bacterial adhesion to epithelial cells, one of the first stages of infection, is a promising approximation in this area. The size, shape, number of sugar and their placement are variables that have to be taken into account in order to develop multivalent systems able to inhibit the bacterial adhesion based on sugar-lectin interaction. MATERIALS AND METHODS: In the present work we report a modular approach for the synthesis of water-soluble 1D-carbon nanotube-sugar nanoconstructs, with the necessary flexibility to allow an efficient sugar-lectin interaction. The method is based on the reaction of aryl diazonium salts generated in situ from aniline-substituted mannose and lactose derivatives with single wall carbon nanotubes (SWCNTs) sidewalls. RESULTS: Two hybrid nanosystems, I-II, exposing mannose or lactose and having a tetraethylene glycol spacer between the sugar and the nanotube sidewall were rapidly assembled and adequately characterized. The sweet nano-objects were then tested for their ability to agglutinate and selectively inhibit the growth of uropathogenic Escherichia coli. These studies have shown that nanosystem I, exposing mannose on the nanotube surface is able to agglutinate and to inhibit the bacterial growth unlike nano-objects II exposing lactose. CONCLUSION: The results reported constitute a proof of principle in using mannose-coated 1D-carbon nanotubes as antiadhesive drugs that compete for FimH binding and prevent the uropathogenic bacteria from adhering to the urothelial surface.

Incidencia y factores condicionantes del insomnio en pacientes ingresados en hospital de alta tecnología / Incidence and Conditioning Factors of Insomnia in Patients Admitted in High-technology Hospital

RESUMEN Introducción: La población sufre insomnio en 30-35 por ciento, pero esta proporción aumenta con la hospitalización. Es necesario un sueño adecuado para una mejor recuperación del paciente ingresado. Objetivo: Analizar la incidencia y los factores condicionantes del insomnio en pacientes hospitalizados. Métodos: Estudio descriptivo observacional transversal. La población objeto de estudio fueron pacientes ingresados en unidades de hospitalización con episodio de insomnio durante su ingreso. De 4650 ingresos anuales, se obtuvo una muestra de 362 pacientes. Se utilizó la Escala Atenas de Insomnio para evaluar el grado de insomnio de los pacientes y listado de causas de insomnio para identificar motivos desencadenantes entre los pacientes con algún episodio declarado. Resultados: Con incidencia de 11 por ciento de insomnio agudo hospitalario, la puntuación total de la Escala Atenas del Insomnio fue de media 7,81 (IC95 por ciento 7,34 8,27) en un rango de 0-24. La habitación doble empeoró los resultados de insomnio (p < 0,01). Las edades mínimas y máximas de la muestra obtuvieron los peores resultados de insomnio, y el tratamiento hipnótico hospitalario mejoró los resultados (p < 0,01). Los problemas respiratorios coincidieron con los peores resultados del test (p < 0,01). Las causas de insomnio con repercusión en los peores resultados fueron "Molestias compañero de habitación", "Ruidos en Unidad de Hospitalización", "Incomodidad de cama/colchón", "Miedo/Ansiedad y "Dolor". Género y acompañamiento familiar no influyeron en insomnio (p > 0,05). Conclusiones: La incidencia de insomnio agudo de pacientes ingresados fue baja, debido principalmente a edad, tratamiento somnífero, enfermedad respiratoria, tipo de habitación, ruido, miedo/ansiedad y dolor, sin influencia del acompañamiento familiar(AU)

ABSTRACT Introduction: 30-35 percent of the population suffers from insomnia, but this proportion increases with hospitalization. Adequate sleep is necessary for a better recovery of the hospitalized patient. Objective: To analyze the incidence and the factors conditioning insomnia in hospitalized patients. Methods: Cross-sectional, observational and descriptive study. The study population consisted of patients admitted to hospitalization units and who presented insomnia during admission. Of 4650 annual admissions, a sample of 362 patients was obtained. The Athens Insomnia Scale was used for assessing the degree of insomnia of the patients and listing the causes of insomnia in order to identify triggers among patients with a declared episode. Results: With an incidence of 11 percent of acute hospital insomnia, the total average score of the Athens Insomnia Scale was 7.81 (95 percent CI 7.34; 8.27) in a range of 0-24. The double room worsened the results of insomnia (p < 0.01). The minimum and maximum ages of the sample obtained the worst results of insomnia, and the hypnotic hospital treatment improved the results (p < 0.01). Respiratory problems coincided with the worst test results (p < 0.01). The causes of insomnia with an impact on the worst results were discomfort caused by the roommate, noise in the hospitalization unit, bed or mattress discomfort, fear/anxiety, and pain. Gender and family support did not influence insomnia (p >0.05). Conclusions: The incidence of acute insomnia in admitted patients was low, mainly due to age, sleeping treatment, respiratory disease, type of room, noise, fear/anxiety, and pain, without the influence of family support(AU)

Síndromes de neoplasia endocrina múltiple: revisión radiológica / Multiple Endocrine Neoplasia Syndromes: Radiological Review

Los síndromes de neoplasia endocrina múltiple (MEN), incluyen una serie de enfermedades con alteraciones genéticas que se caracterizan por la presencia de tumores que afectan a dos o más glándulas endocrinas. Son síndromes con una herencia autosómica dominante e incluyen tres patrones: MEN 1 (síndrome de Wermer), MEN 2 (que incluye MEN 2A o síndrome de Sipple y MEN 2B o síndrome de Wagenmann-Froboese) y MEN 4. Los adenomas paratiroideos y el carcinoma medular tiroideo, son los tumores más frecuentes del MEN tipo 1 y 2 respectivamente. Esos síndromes son más comunes en pacientes jóvenes, con patología de afectación bilateral, múltiple o multifocal y, sobre todo, en pacientes con antecedentes familiares. Es necesario el trabajo en equipo de endocrinólogos, cirujanos, oncólogos y radiólogos para optimizar el tratamiento de esos pacientes.

Multiple endocrine neoplasia (MEN) encompasses a serial of familial genetically disorders in wich tumors simultaneusly occur in two or more endocrine organs. MEN síndromes are autosomal-dominant disorders categorized into three main patterns: MEN 1 (Wermer syndrome), MEN 2 (includes MEN 2A o Sipple syndrome and MEN 2B o Wagenmann-Froboese syndrome) and MEN 4. Parathyroid adenomas and medullary thyroid carcinoma are the most frecuent tumors in MEN 1 and MEN 2 respectively. These entities will be suspected in younger patients, bilateral, multiple or multifocal disease and, specially, in patients with family background. Cooperation between endocrinologist, surgeons, oncologists and radiologists is pivotal for optimizing patient treatment.

Effect of continuous renal-replacement therapy on paraoxonase-1-related variables in patients with acute renal failure caused by septic shock.

BACKGROUND: Acute renal failure in patients with sepsis is associated with high mortality. Studies have highlighted alterations in serum paraoxonase-1 in severe infections. However, the published literature has no insight into the clinical evolution of these parameters in patients with sepsis and acute renal failure treated with extra-renal depuration techniques. METHODS: We studied 25 patients with sepsis and acute renal failure who were treated with continuous renal-replacement therapy. Blood for laboratory analyses was collected at days 0, 1, 2, 5, 7, and 10. We measured serum paraoxonase-1 activity and concentration, lipid profile, aminotransferase activities, pH, and lactate, urea, creatinine and C-reactive protein concentrations. Values were compared with those of 50 healthy individuals. RESULTS: Patients with sepsis and acute renal failure had lower serum paraoxonase-1 activity, lower high-density lipoprotein cholesterol concentrations, and higher serum paraoxonase-1 concentrations than the control group. We found a significant inverse correlation between serum paraoxonase-1 concentrations and the Acute Physiology And Chronic Health Evaluation II score in survivors as well as non-survivors, and a significant inverse correlation between serum paraoxonase-1 concentrations and the Sequential Organ Failure Assessment score only in survivors. Extra-renal depuration techniques produced a further increase in this enzyme related to the duration of treatment, and to serum urea concentration. CONCLUSION: Our results show an inverse relationship between the concentration of paraoxonase-1 and the disease severity of patients with renal failure caused by septic shock. These results highlight relationships between paraoxonase-1 and infectious diseases and sepsis, with insights into potential clinical evolution of treatment.

[The infection risk assessment visit in haemodialysis, a new tool]. / La visite de risque infectieux en hémodialyse, un nouvel outil.

Haemodialysis is a speciality with a high risk of infection, due in part to the frailty of the patients (immunosuppressed, high prevalence of carriers of multi-drug resistant bacteria), as well as to the invasive procedures carried out (inserting central venous catheters, using these catheters and arteriovenous fistulas). The infection risk assessment visit in haemodialysis is a tool which contributes to the safety of care.

Resilience in Men and Women Experiencing Sexual Assault or Traumatic Stress: Validation and Replication of the Scale of Protective Factors.

The literature on sexual assault (SA) typically has been generalized to women and children. However, both men and women experience SA. Research shows that not all individuals experience the negative impacts of SA in the same way. The ability to buffer the negative effects of SA may lie in specific protective factors that determine resilience. Resilience scales used in adult populations have not been validated for use in SA samples. The purpose of the present study was to replicate the factor structure of a resilience scale, the Scale of Protective Factors (SPF), in a sample of emerging adults (n = 571) and to validate the replicated model on a subsample of the participants who reported SA (n = 173). Additionally, we sought to examine gender differences in mental health outcomes including depression and anxiety, and the availability of protective factors that determine resilience among those participants who reported experiencing SA (n = 173) as compared to other forms of traumatic stress (n = 132). The SPF achieved good model fit in the larger emerging adult sample and adequate model fit was achieved in the SA subsample. Results indicated significant gender differences in mental health outcomes with η2 ranging between .03 and .21. Implications and future directions are discussed.

Compliance with standard precautions: Results of a French national audit.

BACKGROUND: Standard precautions (SPs) aim to reduce the risk of cross-transmission of microorganisms. The objectives of the present study were to assess institutional policies for SPs promotion, available resources for SPs implementation, and education of health care workers (HCWs) and their compliance with SPs. METHODS: A multisite mixed-methods audit was conducted in 2011. Self-assessment questionnaires were administered at institution, ward, and HCW levels in French health care facilities (HCFs). Results were given as percentage of objectives achieved (POA) or percentage of "never or sometimes," "often," and "always" responses for each question. RESULTS: A total of 1599 HCFs participated, including 14,968 wards and 203,840 HCWs. At an institutional level, the POA was 88%, covering SPs promotion (91%), procedures (99%), and SPs evaluation (63%). At the ward level, the POA was 94%, covering procedures (95%) and resources (93%). HCWs reported the best compliance for changing gloves between patients (94.5% "always"), and the worst compliance for the use of gloves for intramuscular injection and the use of eye protection in cases of blood exposure risk (34.5% and 24.4% of "always," respectively). CONCLUSIONS: A literature review found no other study of SPs that included such a large study group. These results led to SPs promotion actions at local and regional levels. Reinforcement of SPs observance will be prioritized in the next national program from the French Ministry of Health.

The Development of the Scale of Protective Factors: Resilience in a Violent Trauma Sample.

This research developed the Scale of Protective Factors (SPF-24) to measure protective factors contributing to resilience. We investigated the factor structure of 35 items. After exploratory factor analysis, we subjected 25 items representing 2 social-interpersonal and 2 cognitive-individual factors to confirmatory factor analysis. The sample consisted of 942 college students from 3 studies and 2 institutions. To examine the diagnostic function of the SPF, we used clinical criteria to identify a subsample of participants who had experienced violent trauma and scored low, moderate, or high on an established resilience scale. Results showed that the low-resilient group scored significantly lower on all subscales of the SPF with marked differences in prioritizing/planning behavior. Implications for the research and clinical settings are discussed.

Novel equation to determine the hepatic triglyceride concentration in humans by MRI: diagnosis and monitoring of NAFLD in obese patients before and after bariatric surgery.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is caused by abnormal accumulation of lipids within liver cells. Its prevalence is increasing in developed countries in association with obesity, and it represents a risk factor for non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Since NAFLD is usually asymptomatic at diagnosis, new non-invasive approaches are needed to determine the hepatic lipid content in terms of diagnosis, treatment and control of disease progression. Here, we investigated the potential of magnetic resonance imaging (MRI) to quantitate and monitor the hepatic triglyceride concentration in humans. METHODS: A prospective study of diagnostic accuracy was conducted among 129 consecutive adult patients (97 obesity and 32 non-obese) to compare multi-echo MRI fat fraction, grade of steatosis estimated by histopathology, and biochemical measurement of hepatic triglyceride concentration (that is, Folch value). RESULTS: MRI fat fraction positively correlates with the grade of steatosis estimated on a 0 to 3 scale by histopathology. However, this correlation value was stronger when MRI fat fraction was linked to the Folch value, resulting in a novel equation to predict the hepatic triglyceride concentration (mg of triglycerides/g of liver tissue = 5.082 + (432.104 * multi-echo MRI fat fraction)). Validation of this formula in 31 additional patients (24 obese and 7 controls) resulted in robust correlation between the measured and estimated Folch values. Multivariate analysis showed that none of the variables investigated improves the Folch prediction capacity of the equation. Obese patients show increased steatosis compared to controls using MRI fat fraction and Folch value. Bariatric surgery improved MRI fat fraction values and the Folch value estimated in obese patients one year after surgery. CONCLUSIONS: Multi-echo MRI is an accurate approach to determine the hepatic lipid concentration by using our novel equation, representing an economic non-invasive method to diagnose and monitor steatosis in humans.

[Hand hygiene and the prevention of infectious diseases in pediatrics]. / Hygiène des mains et prévention des maladies infectieuses en pédiatrie.

To prevent infections in paediatrics certain hygiene rules must be respected. Hand washing constitutes the most important measure. The aim is to limit as much as possible the risk of spreading of hand-borne infections, in particular during an epidemic.

[Risk factors associated, diagnostic methods and treatment for endometriosis, used in clinical service endometriosis gynecology Hospital General de Mexico (2009-2011)]. / Factores de riesgo asociados, métodos diagnósticos y tratamiento para endometriosis, utilizados en la clínica de endometriosis del servicio de ginecología del Hospital General de México (2009- 2011).

BACKGROUND: Endometriosis no ectopic endometrial stroma and glands. Have different risk factors. Four theories explain it: the theory of coelomic metaplasia, embryonic cell debris, deployment and immunological. Clinical data are pain and infertility. For the American Fertility Society (AFS) is divided into minimal, mild, moderate and severe. Diagnostic studies are antigen Ca 125, Magnetic Resonance, and abdominal ultrasound. The ideal method is direct visualization with histological confirmation. The medical and surgical treatment. OBJECTIVE: To determine the risk factors, diagnosis of Endometriosis and effectiveness of treatments used in clinical Endometriosis Gynecology Unit at the General Hospital of Mexico OD. MATERIAL AND METHODS: A descriptive, longitudinal and retrospective duration of 2 years 6 months in 30 patients diagnosed with endometriosis in the clinical treatment of Endometriosis General Hospital of Mexico OD. RESULTS: The most affected age group was 21 to 25 years, the risk factors are Gesta 1, a resident of Mexico, Mullerian malformation. The symptom was dysmenorrhea. In 16 were diagnosed as a surgical finding and laparoscopically diagnosed. CONCLUSIONS: It is important to study the risk factors. The diagnosis is made using clinical data, quantification of CA125 antigen and imaging studies. Medical treatment is indicated both in the preoperative as well as postoperative surgical treatment and seeks to eradicate the lesions.