Description of basic competencies in clinical ultrasound imaging for emergency departments. / Competencias básicas de la ecografía clínica en los servicios de urgencias y emergencias.

TEXT: Recent years have seen great advances in the use of clinical ultrasound imaging in both hospital emergency departments and out-of-hospital settings. However, all new techniques require up-to-date definitions of competencies relevant to the clinical realities of different specialties and the geographic settings in which specialists work. To that end, a group of experts in clinical ultrasound reviewed the evidence available in the literature and strictly applied the Delphi method to define the competencies relevant to emergency physicians. The group worked with the starting premise that clinical ultrasound imaging should be a common competency across the specialty.

TEXTO: En los últimos años, la ecografía clínica (EC) ha sufrido un avance muy importante en su implantación dentro de los servicios de urgencias, tanto hospitalarios como extrahospitalarios, pero como toda técnica requiere un ámbito competencial definido, actualizado y enmarcado, tanto en la realidad clínica de la especialidad que desempeñamos como en la geográfica del país donde ejercemos. Por ello, un grupo de expertos en la materia ha desarrollado el presente documento en el que basándose por un lado en la evidencia disponible en la bibliografía científica y por otro en una metodología Delphi, planteó el objetivo de establecer un claro marco competencial base para todos los urgenciólogos, asumiendo como premisa inicial que la EC debería ser una competencia transversal común.

Cost-effectiveness analysis of molecular diagnosis by next-generation sequencing versus sequential single testing in metastatic non-small cell lung cancer patients from a south Spanish hospital perspective.

BACKGROUND: To assess the cost-effectiveness of using next-generation sequencing (NGS) compared to sequential single-testing (SST) for molecular diagnostic and treatment of patients with advanced non-small cell lung cancer (NSCLC) from a Spanish single-center perspective, the Hospital Universitario Virgen del Rocio (HUVR). RESEARCH DESIGN AND METHODS: A decision-tree model was developed to assess the alterations detection alterations and diagnostic cost in patients with advanced NSCLC, comparing NGS versus SST. Model inputs such as testing, positivity rates, or treatment allocation were obtained from the literature and the clinical practice of HUVR experts through consultation. Several sensitivity analyses were performed to test the robustness of the model. RESULTS: Using NGS for molecular diagnosis of a 100-patients hypothetical cohort, 30 more alterations could be detected and 3 more patients could be enrolled in clinical-trials than using SST. On the other hand, diagnostic costs were increased up to €20,072 using NGS instead of SST. Using NGS time-to-results would be reduced from 16.7 to 9 days. CONCLUSIONS: The implementation of NGS at HUVR for the diagnostic of patients with advanced NSCLC provides significant clinical benefits compared to SST in terms of alterations detected, treatment with targeted-therapies and clinical-trial enrollment, and could be considered a cost-effective strategy.

Polifarmacia y mortalidad en adultos mayores: El rol del sexo y la comorbilidad / Polypharmacy and mortality in the elderly: the role of sex and comorbidity

RESUMEN Introducción: La polifarmacia es frecuente en los adultos mayores. La asociación entre polifarmacia y mortalidad es controvertida debido a la dificultad del control de confusores, como la comorbilidad y la interacción entre ellas y el sexo. Objetivos: Demostrar la asociación entre polifarmacia y mortalidad, así como el rol del sexo y la comorbilidad en adultos mayores. Materiales y Métodos: Estudio observacional, analítico, retrospectivo. Se analizó una base de datos de un estudio realizado en un consultorio externo de geriatría en un hospital militar en Perú. Se incluyeron pacientes ambulatorios ≥ 60 años de edad. Se definió polifarmacia como el consumo de ≥ 5 fármacos por ≥ 90 días. Se realizaron regresiones de Cox ajustadas por edad, estado civil, deterioro cognitivo, fragilidad física, dependencia funcional y número de comorbilidades. Se realizaron análisis de subgrupos para el riesgo de muerte por polifarmacia estratificados por sexo y presencia de comorbilidad. Resultados: La polifarmacia incrementó el riesgo de mortalidad en el modelo ajustado por sexo en 15,16 veces (1,80-21,66) y en 5,55 (2,90-10,06) para mujeres y varones, respectivamente. El Hazard Ratio en pacientes no comórbidos fue de 1,94 (1,17-2,05; IC=95 %). Conclusiones: La polifarmacia es un factor de riesgo para mortalidad independientemente del sexo y las comorbilidades del paciente.

ABSTRACT Introduction: Polypharmacy is frequent in older adults. The association between polypharmacy and mortality is controversial due to the difficulty of controlling confounding factors such as comorbidity or gender. Objective: The main objective of this study was to demonstrate the association between polypharmacy and mortality in older adults. The secondary objective wasto determine the role of sex and comorbidity on the association between polypharmacy and mortality. Material and Methods: A retrospective, analytical, observational cohort study was conducted. A database of an outpatient geriatric clinic in a military hospital in Peru was analyzed. Outpatients ≥ 60 years of age were included. Polypharmacy was defined as the consumption of ≥ 5 drugs for ≥ 90 days. Cox regressions adjusted for age, marital status, cognitive impairment, physical frailty, functional dependence, and number of comorbidities were performed. Subgroup analyzes were performed for the risk of death from polypharmacy, stratified by sex and presence of comorbidity. Results: Polypharmacy increased the risk of mortality. The Hazard Ratio adjusted for sex was 15,16 (1,80-21,66) and 5,55 (2,90-10,06) for women and men, respectively. The Hazard Ratio in non-comorbid patients was 1,94 (1,17-2,05; CI=95 %). Conclusions: Polypharmacy is a risk factor for mortality regardless of the sex and comorbidities of the patient.

Relación entre estado funcional y complicaciones quirúrgicas en adultos mayores varones con cáncer / The Relationship between Functional Status and Surgical Complications in Male Older Adults with Cancer

Introducción: La pérdida de funcionalidad es una condición común en adultos mayores con cáncer y la decisión de intervenir quirúrgicamente depende de las comorbilidades y estado funcional. Objetivo: Determinar la asociación entre el estado funcional y complicaciones quirúrgicas en adultos mayores varones con cáncer en el Centro Médico Naval. Métodos: Se realizó un estudio de tipo cohorte retrospectiva, análisis secundario de una base de datos de adultos mayores varones con cáncer, seguidos por dos años y atendidos en el Centro Médico Naval del Perú. Las variables fueron: complicaciones quirúrgicas, estado funcional, comorbilidades, síndromes geriátricos y tipo de cáncer. Resultados: Se evaluó a 385 participantes, edad promedio de 79,69 años (desviación estándar = 4,55). El 39,74 por ciento (n =153) presentó complicaciones quirúrgicas, con una asociación a la presencia de comorbilidades, presencia de dos o más síndromes geriátricos 69,93 por ciento (n =107), dependencia funcional para actividades básicas 51,63 por ciento (n =79) y dependencia funcional para actividades instrumentales 35,95 por ciento (n = 55). De acuerdo con la frecuencia de complicaciones según el tipo de neoplasia se encontró más frecuente para cáncer colorrectal en un 46,41 por ciento (n = 71). Conclusiones: Existe una asociación significativa entre la dependencia funcional y complicaciones quirúrgicas, por lo que es importante no solamente para el tratamiento quirúrgico sino también farmacológico, considerar el estado funcional del paciente para un tratamiento favorable y por lo tanto un mejor pronóstico(AU)

Introduction: Loss of functionality is a common condition in older adults with cancer, while any decision to intervene surgically depends on comorbidities and functional status. Objective: To determine the association between functional status and surgical complications in male older adults with cancer at Centro Médico Naval. Methods: A retrospective cohort-type study was carried out, with secondary analysis of a database of male older adults with cancer followed up for two years and treated at Centro Médico Naval of Peru. The variables were surgical complications, functional status, comorbidities, geriatric syndromes and type of cancer. Results: A number of 385 participants were assessed. Their mean age was 79.69 years (standard deviation: 4.55). 39.74 percent (n=153) presented surgical complications, with an association to the presence of comorbidities, the presence of two or more geriatric syndromes in 69.93 percent (n=107), functional dependence for basic activities in 51.63 percent (n=79), and functional dependence for instrumental activities in 35.95 percent (n=55). Regarding the frequency of complications according to type of neoplasm, the most frequent occurrence was that of colorectal cancer, accounting for 46.41 percent (n=71). Conclusions: There is a significant association between functional dependence and surgical complications, a reason why it is important, not only in surgical but also in pharmacological treatment, to consider the functional status of the patient in view of a favorable treatment and, therefore, a better prognosis(AU)

La integración disciplinaria para combatir la pandemia / Disciplinary integration to combat the pandemic

Webinar N° 51 del ORAS-CONHU, realizado el 25 de febrero de 2021. La integración disciplinaria ha sido fundamental y necesaria para combatir la pandemia producida por la COVID-19. Es pertinente que miembros de diferentes disciplinas se encuentren representados dentro del equipo de salud y que desde el inicio tengan punto de encuentro, y da como resultado: mejorar la salud de las personas y el acceso a la atención de la salud, mejorar las prácticas y la productividad en el ambiente de trabajo y aumenta la confianza de los profesionales de la salud. Se logró analizar econocer y valorar los enfoques integradores, participativos, y la confluencia de disciplinas en Salud Pública como eje fundamental y necesario para combatir la pandemia producida por la COVID-19. Conto con la participación del Director de Salud Ambiental del Centro de Investigación en Salud Poblacional del Instituto Nacional de Salud Pública de México, el Asesor Regional en Desarrollo de Recursos Humanos de salud de la OPS/OMS WDC y la Directora General de Personal de la Salud del Ministerio de Salud de Perú.

Polypharmacy Is Associated with Frailty, Nutritional Risk and Chronic Disease in Chilean Older Adults: Remarks from PIEI-ES Study.

AIM: To analyze the relationship between polypharmacy and variables as frailty and other chronic comorbidities in Chilean older adults. DESIGN: Cross-sectional study. PARTICIPANTS: One thousand two hundred and five older adults aged 65 and older. METHODS: The presence or absence of frailty syndrome was determined according to Fried criteria. Data collection was made through questionnaires conducted by an interview. RESULTS: The prevalence of polypharmacy was 37.59%. The prevalence of hyperpolypharmacy was 2%. Increased prevalence of frailty was demonstrated regarding the progression of the state of polypharmacy. When analyzing the contribution of frailty respect polypharmacy condition, frail state, nutritional risk and obesity are founded as a factor associated with polypharmacy. Regarding chronic disease, hypertension (OR: 8.039, p<0.0001), type 2 diabetes (OR: 4.001, p<0.0001) and respiratory diseases (OR: 2.930, p<0.0001) were associated to polypharmacy. It was found a strong and significant positive correlation between polypharmacy prevalence and frailty score (polypharmacy condition, Spearman R: 0.89, p=0.033; hyperpolypharmacy condition, Spearman R: 0.94, p=0.016). When analyzing the contribution of the polypharmacy to the presence of frailty, polypharmacy condition (OR: 1.510, p<0.05), cognitive impairment (OR: 3.887, p<0.001), obesity (OR: 1.560, p<0.01) and nutritional risk (OR: 2.590, p<0.001) are associated to frailty. CONCLUSION: Frailty and chronic conditions as nutritional risk, obesity, hypertension, type 2 diabetes and respiratory disease are an important risk factor for the development of polypharmacy in Chilean older adults. Likewise, polypharmacy condition was observed to be a risk factor for frailty, demonstrating the bidirectional relationship between both conditions. Frailty syndrome evaluation in Chilean older adults could be an important alternative for polypharmacy prevention.

Revisión sistemática de las causas y tratamientos para las grietas en los pezones durante la lactancia materna / Systematic review of causes and treatments for cracked nipples during breastfeeding / Revisão sistemática das causas e tratamentos para fissuras mamilares durante a amamentação

Resumen El objetivo de este estudio fue identificar los factores más frecuentemente relacionados con las grietas en los pezones y los distintos tratamientos utilizados para tratar este problema en madres que lactan, a través de una revisión de la literatura científica. La búsqueda se realizó utilizando las bases de datos: SCIENCE DIRECT EMBASE, PROQUEST, SCOPUS y SCIELO, publicados entre 2000 al 2018, además referencias bibliográficas citadas en los artículos seleccionados. Los términos utilizados fueron en inglés y español, estandarizados en los sistemas de descriptores para inglés y español, pero también se utilizaron términos no estandarizados identificados en algunos artículos. Los resultados arrojan que el uso de lanolina, compresas de agua tibia, leche materna extraída y la aplicación de menta son referidos como más efectivos para el trauma del pezón. Considerando los tratamientos encontrados, aquellos que contienen mejores efectos en la estimulación del crecimiento epitelial del pezón agrietado son: lanolina, la colágenas y apósitos de hidrogel. De acuerdo a lo anterior, no se recomienda un tratamiento por encima de otro, debido a que los métodos encontrados mostraron ser eficaces y beneficiosos tanto para el manejo del dolor como la disminución de trauma del pezón.

Abstract To identify the factors most frequently related to cracks in the nipples and the different treatments used to treat this problem in nursing mothers was do a review of the scientific literature. The search was conducted using the databases: SCIENCE DIRECT, EMBASE, PROQUEST SCOPUS and SCIELO, published between 2000 and 2018, and bibliographic references cited in some of the selected articles were added. The terms used were in English and Spanish, standardized in the descriptor systems for both languages, but non-standardized terms identified in some articles were also used. The results show that the use of lanolin, warm water compresses, expressed breast milk and the application of mint are the most effective for nipple trauma. Considering the treatments found, those that contain better effects in the stimulation of the epithelial growth of the cracked nipple are: lanolin, collagenase and hydrogel dressings. According to the above, one treatment is not recommended over another because the methods found to be effective and beneficial both for the management of pain and the reduction of nipple trauma.

Resumo O objetivo deste estudo foi identificar os fatores mais frequentemente relacionados às fissuras nos mamilos e os diferentes tratamentos utilizados para tratar esse problema em nutrizes, através de uma revisão da literatura científica. A busca foi realizada nas bases de dados SCIENCE DIRECT, EMBASE, PROQUEST, SCOPUS e SCIELO, publicadas entre 2000 e 2018, além de referências bibliográficas citadas nos artigos selecionados. Os termos utilizados foram em inglês e espanhol, padronizados nos sistemas descritores para inglês e espanhol, mas também foram utilizados termos não padronizados identificados em alguns artigos. Os resultados mostram que o uso de lanolina, compressas de água morna, leite materno extraído e a aplicação de hortelã-pimenta são referidos como mais eficazes no trauma mamilar Considerando os tratamentos encontrados, aqueles que contêm os melhores efeitos sobre a estimulação do crescimento epitelial do mamilo trincado são: pensos de lanolina, colágeno e hidrogel. De acordo com o exposto, um tratamento não é recomendado em relação a outro, porque os métodos encontrados se mostraram eficazes e benéficos para o manejo da dor e a redução do trauma mamilar

Factores asociados al sedentarismo en jóvenes estudiantes de educación superior. Perú, 2017 / Factors associated with sedentary lifestyle in higher education young students. Peru, 2017

Objetivo: Determinar las variables asociadas al sedentarismo en jóvenes estudiantes de un instituto público de educación superior en Lima, Perú. Materiales y métodos: Estudio observacional, transversal, analítico, retrospectivo. Los datos fueron tomados de las fichas de evaluación médica y registros académicos de los estudiantes. La muestra estuvo conformada por 187 estudiantes de educación superior, se exploró las variables edad, sexo, peso, talla, perímetro abdominal, ciclo académico de estudios, rendimiento académico y programa académico. La evaluación médica anual en los estudiantes incluyó el desarrollo del cuestionario International Physical Activity Questionnaire (IPAQ). Para la identificación de las variables asociadas al sedentarismo se usó la prueba de Chi-Cuadrado. Se aceptó un nivel de significancia del 95 % (p<0.05). Resultados: La edad promedio fue 18,6 años (IC 16,9 - 20,3). El 80 % de los participantes fueron de sexo masculino, 39 % tuvieron obesidad/sobrepeso, y la obesidad abdominal se presentó en el 12 % de los participantes. 32 % de los estudiantes pertenecían al programa de enfermería y 73,8 % tuvieron rendimiento académico moderado o bajo. Se determinó sedentarismo en el 65,8 % de los casos, con un promedio de equivalentes metabólicos (EMT min/semana en los estudiantes sedentarios de 242,17; mientras que para los estudiantes con actividad física fue 5371,13. Se evidenció la existencia de asociación estadísticamente significativa del sedentarismo con el sobrepeso/obesidad (p=0.023), obesidad abdominal (p=0.048), rendimiento académico moderado (p=0.012) y el programa académico de computación e informática (p=0.036). Conclusiones: Existe un alto nivel de sedentarismo en los estudiantes evaluados y no se cumplen las recomendaciones de la Organización Mundial de la Salud (OMS) en materia de actividad física (>=600 EMT/semana). El estado nutricional sobrepeso/obesidad y el rendimiento académico moderado estuvieron significativamente asociadas al sedentarismo

Objective: To determine the variables associated with sedentary lifestyle in young students of a public institution of higher education in Lima-Peru. Materials and methods: An observational, cross-sectional, analytical, retrospective study. Data was collected from the students' medical evaluation form and academic records. The sample consisted of 187 higher education students. Variables such as age, sex, weight, height, abdominal perimeter, academic term, academic performance and academic program were assessed. The students' annual medical evaluation included answering the International Physical Activity Questionnaire (IPAQ). For the identification of the variables associated with sedentary lifestyle, the chi square-test was used. A significance level of 95 % was accepted (p <0.05). Results: The average age was 18.6 years (CI 16.9 - 20.3), 80 % were male, 39 % were obese/overweight, 12 % had abdominal obesity, 32 % were attending the nursing program, and 73.8 % had a moderate or low academic performance. A sedentary lifestyle was determined in 65.8 % of the cases. Sedentary students had on average 242.17 MET min/week, while students with physical activity achieved 5371.13 MET min/week. A statistically significant association of sedentary lifestyle with overweight/obesity (p = 0.023), abdominal obesity (p = 0.048), moderate academic performance (p = 0.012), and the Computer Science Academic Program (p = 0.036) was evidenced. Conclusions: There is a high level of sedentary lifestyle in the evaluated students, ignoring the recommendations of the World Health Organization (WHO) on physical activity (≥600 EMT min/week). The nutritional status of overweight/obesity and moderate academic performance were significantly associated with a sedentary lifestyle

In vivo evaluation of the genotoxicity and oxidative damage in individuals exposed to 10% hydrogen peroxide whitening strips.

OBJECTIVE: This study assessed the impact of 10% hydrogen peroxide whitening strip exposure on the genotoxicity and oxidative damage by means of the buccal micronucleus cytome assay by counting nuclear abnormalities (NAs) in buccal mucosa and attached gingiva cells and by analyzing in whole saliva the molecule 8-hydroxy-2'-deoxyguanosine (8-OHdG). MATERIALS AND METHODS: The study was conducted on 113 subjects divided into two groups: group 1 or control (n = 53), non-whitening strip exposed, and group 2 (n = 60), whitening strip exposed (Crest® 3D Whitestrips® premium plus, 10% hydrogen peroxide). Oral epithelial cells and whole saliva samples were taken at the beginning and 30 days later for group 1 and immediately before bleaching and 15 and 30 days after the end of the bleaching for group 2. RESULTS: An increased frequency of NAs (p < 0.05) and higher levels of 8-OHdG (p < 0.05) were observed after bleaching exposure. Also, a positive correlation exists between oxidative stress produced by hydrogen peroxide and micronuclei was found. CONCLUSION: Individuals exposed to 10% hydrogen peroxide whitening strips exhibit NAs increased in oral epithelial cells and 8-OHdG in saliva, which is directed related to nuclear and oxidative DNA damage, respectively. CLINICAL SIGNIFICANCE: Hydrogen peroxide is the active agent of tooth whitening and this compound induced DNA damage. Individuals exposed to whitening strips with 10% hydrogen peroxide exhibit increased genotoxic and oxidative damage. Therefore, self-application of bleaching agents should be handled carefully since it could be a risk to human health.

Seroprevalencia de infección por Helicobacter pylori en población adulta de Lima, Perú 2017 / Seroprevalence of Helicobacter pylori infection among an adult population of Lima, Peru 2017

Objetivo: Conocer la seroprevalencia de infección por Helicobacter pylori en población adulta de Lima, Perú 2017. Materiales y métodos: Estudio descriptivo, prospectivo, transversal. Población conformada por voluntarios mayores de 18 años, de ambos sexos, con o sin molestias gastroenterológicas generales. Campaña de despistaje realizada en los distritos de Magdalena y Chorrillos de la ciudad de Lima, Perú en el mes de enero del 2017. Para el diagnóstico se utilizó la prueba rápida OnSite H. pylori Ab Combo Rapid Test CE de CTK Biotech. Resultados: Se evaluó a 140 pacientes, edad media 36.6 años, 22.1% de sexo masculino y 77.9% de sexo femenino. La seroprevalencia para Helicobacter pylori fue 63.6%. Conclusiones: Nosotros concluimos que la infección por Helicobacter pylori es frecuente en el área de la ciudad de Lima, sin diferencia entre género y edad

Objective: To know the seroprevalence of Helicobacter pylori infection among an adult population of Lima, Peru 2017. Materials and methods: Descriptive, prospective, cross-sectional study. Population of volunteers older than 18 years, of both sexes, with or without general gastrointestinal discomfort. A screening campaign was carried out in the districts of Magdalena and Chorrillos in the city of Lima, Peru, in January 2017. For the diagnosis, CTK Biotech's OnSite H. pylori Ab Combo Rapid Test CE was used. Results: One hundred forty (140) patients were evaluated, with a mean age of 36.6 years old, being 22.1% male and 77.9% female. The seroprevalence of Helicobacter pylori infection was 63.6%. Conclusions: We conclude that Helicobacter pylori infection is common in the city of Lima, with no difference between gender and age

Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) case presentation and comparison with other polyarthritides affecting older people.

Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome mainly affects elderly men and responds well to steroids. Since this syndrome can resemble other diseases, its diagnosis is a significant challenge. Through the following paper, we hope to improve the diagnosis of RS3PE by presenting a table comparing RS3PE to two other common polyarthritic conditions affecting the elderly.

Factores de riesgo asociados a complicaciones intrahospitalarias en adultos mayores del Hospital Nacional Edgardo Rebagliati Martins Lima, 2010 / Risk factors associated with nosocomial complications in older adults the National Hospital Edgardo Rebagliati Martins de Lima, 2010

La prolongación de la esperanza de vida; la prevalencia de enfermedades crónicas; los cambios fisiológicos que ocurren en el envejecimiento; el deterioro del estado funcional; y el uso frecuente de los servicios hospitalarios, exponen a los adultos mayores a complicaciones intrahospitalarias. Por esta razón se propone determinar los principales factores de riesgo asociados a complicaciones intrahospitalarias en adultos mayores del Hospital Nacional Edgardo Rebagliati Martins, Lima. Material y Métodos: Se diseñó un estudio de casos y controles pareados (2:1); Casos: adultos mayores con complicaciones intrahospitalarias, registrados en el sistema de vigilancia epidemiológica activa, definidas con criterios del Centro de Control de Enfermedades (CDC); durante noviembre del 2010 a febrero del 2011 y como controles: adultos mayores, sin complicaciones intrahospitalarias registrados en el sistema de gestión hospitalaria. Se aplicó una encuesta estructurada que! incluyó, factores de comorbilidad previa (índice de Charlson) y el estado funcional basal y la pérdida funcional durante la hospitalización (índice de Barthel); y las complicaciones intrahospitalarias más frecuentes acorde a definiciones del Centro de Control de Enfermedades. Resultados: Se evaluó 228 adultos mayores (76 casos y 152 controles). Los principales factores de riesgo asociados encontrados en modelo de regresión logística múltiple fueron cáncer (OR: 44,45; IC: 12,5-175,10), enfermedad pulmonar obstructiva crónica (OR:9,51; IC:3,10-29,16), enfermedad arterial periférica (OR:7,57; IC: 2,24-25,58), diabetes (OR:5,1886; IC:12,5-157,10), insuficiencia cardíaca OR:4,5931; IC:1,2971-16,26), deterioro del estado funcional basal (OR:10,20; IC:2,31- 44,93) y carga total de comorbilidad (OR:17,08; IC:1,52-191,70). Los otros factores (demencia, insuficiencia renal crónica, enfermedades cerebro vasculares y la pérdida funcional durante la hospitalización), no tuvieron significación estadística...

The prolongation of life expectancy; the prevalence of chronic diseases; the physiological changes that occur in aging; deterioration in functional status; and frequent use of hospital services; expose older adults to hospital complications. We want to identify the main risk factors associated with hospital complications in older adults in Edgardo Rebagliati Martins National Hospital, Lima. Material and Methods: A matched case controls study (2: 1) was designed; Cases: older adults with hospital complications, registered in the system of active surveillance, defined criteria of the Center for Disease Control (CDC); during November 2010 to February 2011 and as controls: seniors, no hospital complications recorded at the hospital management system. A structured questionnaire that included factors prior comorbidity (Charlson index) and baseline functional status and functional loss during hospitalization (Barthel) was applied; and frequently chord definitions of the Center for Disease Control hospital complications. Results: 228 older adults (76 cases and 152 controls) .The main risk factors associated found in multiple logistic regression model were cancer (OR: 44.45 CI 12.5 to 175.10), chronic obstructive pulmonary disease (OR: 9.51, CI 3.10 to 29.16), peripheral arterial disease (OR: 7.57, CI: 2.24 to 25.58), diabetes (OR = 5.1886; IC : 12.5 to 157.10), heart failure (OR: 4.5931 CI: 1.2971 to 16.26), impaired baseline functional status (OR: 10.20; CI: 2,31 to 44.93) and total burden of comorbidity (OR; 17.08; CI 1.52 to 191.70). The other factors (dementia, chronic renal failure, cerebrovascular disease and functional decline during hospitalization), had no statistical significance...

Influence of composition and roughness on the pigment mapping of paintings using mid-infrared fiberoptics reflectance spectroscopy (mid-IR FORS) and multivariate calibration.

Mid-infrared fiberoptics reflectance spectroscopy (mid-IR FORS) is a very interesting technique for artwork characterization purposes. However, the fact that the spectra obtained are a mixture of surface (specular) and volume (diffuse) reflection is a significant drawback. The physical and chemical features of the artwork surface may produce distortions in the spectra that hinder comparison with reference databases acquired in transmission mode. Several studies attempted to understand the influence of the different variables and propose procedures to improve the interpretation of the spectra. This article is focused on the application of mid-IR FORS and multivariate calibration to the analysis of easel paintings. The objectives are the evaluation of the influence of the surface roughness on the spectra, the influence of the matrix composition for the classification of unknown spectra, and the capability of obtaining pigment composition mappings. A first evaluation of a fast procedure for spectra management and pigment discrimination is discussed. The results demonstrate the capability of multivariate methods, principal component analysis (PCA), and partial least squares discrimination analysis (PLS-DA), to model the distortions of the reflectance spectra and to delimitate and discriminate areas of uniform composition. The roughness of the painting surface is found to be an important factor affecting the shape and relative intensity of the spectra. A mapping of the major pigments of a painting is possible using mid-IR FORS and PLS-DA when the calibration set is a palette that includes the potential pigments present in the artwork mixed with the appropriate binder and that shows the different paint textures.

Utilidad del CONUT frente al MNA en la valoración del estado nutricional del paciente adulto mayor hospitalizado / Utility of CONUT against MNA for assessing the status of hospitalized elderly patients

Objetivo: conocer la utilidad del CONUT frente a la aplicación del instrumento MNA y evaluación bioquímica, en la valoración del estado nutricional de pacientes adultos mayores (AM), hospitalizados en el Servicio de Medicina Interna 6C del Hospital Nacional Edgardo Rebagliati Martins de EsSalud. Material y Métodos: estudio transversal, en el que se aplió a 74 pacientes AM hospitalizados, el cuestionario MNA y el CONUT. El análisis estad¡stico se realiz¢ usando el chi cuadrado y análisis de varianza. Resultados: la edad promedio fue 75.65 ñ 4.8 años, predominó el sexo masculino. El peso fue de 66.95 ñ 10 kg; talla 1.62 ñ 0.07 mts; el IMC 27.4 ñ 6.6; albúmina 3.26 ñ 0.5 g/dL; colesterol 184.3 ñ 59.3 mg/d; y el recuento de linfocitos, 1847 ñ 967 cel/mm3. El resultado del MNA identificó 26 desnutridos (35.15%), 32 con riesgo de desnutrición (43.25%) y 16 con estado nutricional normal (21.60%). Según las variables del CONUT, asociada a los resultados del MNA, se comprueba que a medida que aumenta el grado de desnutrición, los valores de albúmina, colesterol y linfocitos descienden. Los porcentajes de las categorías del MNA, para los distintos grados de nutrición según las categor¡as de CONUT, se asocian significativamente en la variable albúmina. La sensibilidad y la especificidad para el CONUT frente al MNA, fue alta (86% y 62% respectivamente). Concluciones: estadísticamente, el CONUT se asociócon el MNA en la identificación de pacientes hospitalizados con riesgo de desnutrición.

Objective: to determine the usefulness of CONUT against the application of MNA instrument and biochemical evaluation in the assessment of the nutritional status of elderly patients (EP), hospitalized in the Internal Medicine 6C National Hospital Edgardo Rebagliati Martins EsSalud. Material and Methods: Cross-sectional study, in which CONUT MNA questionnaires were applied to 74 hospitalized EP. Statistical analysis was performed using the chi square test and analysis of variance. Results: the mean age was 75.65 ñ 4.8 years, predominantly male. The weight was 66.95 ñ 10 kg, height 1.62 ñ 0.07 m, BMI 27.4 ñ 6.6, 3.26 ñ 0.5 g albumin / dL, cholesterol 184.3 ñ 59.3 mg / d, and the lymphocyte count, 1847 ñ 967 cells/mm3. The result of the MNA identified 26 malnourished (35.15%), 32 with risk of malnutrition (43.25%) and 16 with normal nutritional status (21.60%). According to CONUTïs variables associated with the results of MNA, we found that with increasing degree of malnutrition, albumin, cholesterol and lymphocyte levels decline. The percentages of the categories of MNA, for different degrees of nutrition as CONUT categories are significantly associated in the variable albumin. The sensitivity and specificity for the CONUT against MNA was high (86% and 62% respectively). Conclusions: statistically, CONUT was associated with MNA in the identification of hospitalized patients at risk of malnutrition.

Evaluation of MidIR fibre optic reflectance: detection limit, reproducibility and binary mixture discrimination.

MidIR fibre optic reflectance (MidIR-FORS) is a promising analytical technique in the field of science conservation, especially because it is non-destructive. Another advantage of MidIR-FORS is that the obtained information is representative, as a large amount of spectral data can be collected. Although the technique has a high potential and is almost routinely applied, its quality parameters have not been thoroughly studied in the specific application of analysis of artistic materials. The objective of this study is to evaluate the instrumental capabilities of MidIR-FORS for the analysis of artwork materials in terms of detection limit, reproducibility, and mixture characterisation. The study has been focused on oil easel painting and several paints of known composition have been analysed. Paint layers include blue pigments not only because of their important role along art history, but also because their physical and spectroscopic characteristics allow a better evaluation of the MidIR-FORS capabilities. The results of the analysis indicate that MidIR-FORS supplies a signal affected by different factors, such as the optical, morphological and physical properties of the surface, in addition to the composition of materials analysed. Consequently, the detection limits established are relatively high for artistic objects (Prussian blue - PB 2.1-6.5%; Phthalocyanine blue - Pht 6.3-10.2%; synthetic Ultramarine blue - UM 12.1%) and may therefore lead to an incomplete description of the artwork. Reproducibility of the technique over time and across surface has been determined. The results show that the major sources of dispersion are the heterogeneity of the pigments distribution, physical features, and band shape distortions. The total dispersion is around 4% for the most intense bands (oil) and increases up to 26% when weak or overlapped bands are considered (PB, Pht, UM). The application of different pre-treatments (cutoff of fibres absorption, Savizky-Golay smoothing algorithm, polynomial baseline offset, Standard Normal Variate algorithm - SNV) to the raw spectra allows improving these results to maximum values of 15%. Finally, the capabilities of PCA and MidIR-FORS to discriminate between binary mixtures were tested. The results demonstrate that it is possible to differentiate mixtures depending on the range of concentration of their components, within specific limits of detection.

Caracterización clínica, epidemiológica y social de una población geriátrica hospitalizada en un Centro Geriátrico Militar / Clinical, epidemiological and social hospitalized population in a Military Geriatric Center

OBJETIVO: Determinar la prevalencia de algunas características de los pacientes hospitalizados. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y transversal, realizado en el Centro Geriátrico Naval, Callao, Perú en una población de 711 pacientes de 60 años o más, de uno y otro sexo, hospitalizados entre Enero del 2010 y Noviembre del 2011. Se utilizó la base de datos de la Unidad de Agudos del Centro Geriátrico Naval de los pacientes hospitalizados durante este periodo. Se midió riesgo de malnutrición (MNA), funcionalidad (Índice de Barthel), riesgo de problema social (Escala de Gijón), depresión (Escala Geriátrica de depresión de Yesavage) y deterioro cognitivo (MMSE). El análisis se realizó con el programa STATA versión 11. RESULTADOS: La edad promedio fue: 78 ± 8,2 años. Se registró polifarmacia en 650 (91,4%) casos, hipertensión en 492 (69,2%), estreñimiento en 399 (56,1%), diabetes mellitus tipo 2 en 329 (46,3%), malnutrición y caídas en 250 (35,2%), incontinencia urinaria en 199 (28%) e hipotirodismo en 113 (16%). En el aspecto social, se registró 264 (37,1%) casos de dependencia funcional y 252 (35,4%) casos con problema social. Finalmente, en el aspecto mental, se encontró una prevalencia de 422 (62,2%) casos de depresión y 244 (34,4%) de deterioro cognitivo. CONCLUSIONES: Los adultos mayores hospitalizados tienen una alta prevalencia de distintas condiciones clínicas como el estreñimiento, la hipertensión arterial, la depresión. Con riesgo de deterioro durante la hospitalización. Los servicios geriátricos actuales deben interferir en la prevención para una mejor calidad de vida del anciano.

OBJETIVE: To determine the prevalence of certain characteristics, of hospitalized patients. MATERIALS AND METHOD: Cross-sectional observational study, at Centro Geriátrico Naval, Callao, Peru in a population of 711 patients of 60 years and over, hospitalized during the period of January 2010 to November 2011. We used a database of Naval Medical Center´s hospitalized patients during this period. We mesured risk of malnutrition (MNA), independence of perform Daily Living Activities (Barthel Index), social problem risk (Gijon Scale), depression (Geriatric Depression Scale of Yesavage) and cognitive impairment (MMSE). The analysis was performed using STATA version 11. RESULTS: The mean age of participants was 78 ± 8.2 years old. Polypharmacy was recorded in 650 (91.4%) patients, hypertension in 492 (69.2%), constipation in 399 (56.1%), diabetes mellitus type 2 in 329 (46.3%), malnutrition an falls in 250 (35.2%), urinary incontinence in 199 (28%) and hipotirodism in113 (16%). There were 264 (37.1%) participants with functional dependence and 252 (35.4%) cases with social problems. Finally, in mental aspects, we found a prevalence of 422 (62.2%) cases of depression and 244 (34.4%) of cognitive impairment. CONCLUSIONS: In hospitalized older adults, there is a high prevalence of different clinical conditions such as constipation, hypertension, depression, among others, pretending a risk of deterioration during hospitalization. Current geriatric services should interfere in prevention for a better quality of life of elderly.

Satisfacción con la atención médica que reciben niños y adolescentes con leucemia linfoblástica aguda: experiencia en México con pacientes afiliados al Seguro Popular / Satisfaction with medical care of children and adolescents with acute lymphoblastic leukemia: experience in Mexico with patients affiliated with the Seguro Popular insurance program

Introducción. La satisfacción forma parte de la evaluación de la calidad de la atención. Se refiere a la percepción de la cobertura de las necesidades de salud. El objetivo de este trabajo fue identificar el grado de satisfacción con la atención que reciben los pacientes pediátricos con leucemia linfoblástica aguda afiliados al Seguro Popular. Métodos. Tras realizar una revisión de la literatura sobre la satisfacción de la atención médica de pacientes pediátricos con cáncer, se llevaron a cabo entrevistas a familias de pacientes pediátricos con leucemia linfoblástica aguda en 20 hospitales que reciben apoyo del Seguro Popular. Resultados. En la revisión se encontró información limitada sobre la satisfacción con la atención de niños con cáncer. A pesar de ello, se observó que, en general, las familias se encuentran satisfechas con la atención recibida, y que la comunicación con el equipo de salud es el factor más destacado. Al evaluar la satisfacción de las familias de pacientes afiliados al Seguro Popular se observan fortalezas en cuanto al trato y la información que reciben los pacientes. Se detectaron áreas de oportunidad para mejorar la calidad de la atención relacionadas con los tiempos de espera y la comprensión de la información. El 91.9% de los entrevistados estuvieron total o parcialmente de acuerdo en que el Seguro Popular ha contribuido a mejorar la atención de las unidades médicas. Conclusiones. Los familiares de los pacientes pediátricos con leucemia linfoblástica aguda afiliados al Seguro Popular se encuentran satisfechos con la atención médica recibida. Sin embargo, se detectaron áreas de oportunidad para mejorar la calidad de la atención.

Background. Satisfaction is part of the evaluation of the quality of care and refers to the perception of the coverage of health needs. The aim of this study was to identify the level of satisfaction with care received by pediatric patients with ALL in Mexico affiliated with the Seguro Popular insurance program. Methods. The first phase of this study was a review of the literature about satisfaction with medical care of pediatric patients with cancer. The second phase consisted of family interviews of pediatric ALL patients in 20 hospitals supported by the Seguro Popular insurance program. Results. The literature review found limited information on satisfaction with the care of children with cancer; nevertheless, we observed that families, in general, are satisfied with the health care, and communication with the health team is the most relevant factor. When assessing patient satisfaction of families affiliated with the Seguro Popular insurance program, we observed strengths in the areas of care and information received by patients and families. We identified improvement opportunities in the quality of care in relation to waiting times and understanding of information provided; 91.9% of respondents are completely or partially in agreement that the Seguro Popular insurance program has helped to improve the quality of health care provided by the medical units. Conclusions. Families of pediatric ALL patients affiliated with the Seguro Popular insurance program are satisfied with the delivery of health care; however, some improvement opportunities in the quality of care were detected.

Formas extrapulmonares de la tuberculosis: situación en un nuevo siglo / No disponible

No disponible

MicroRNA-mediated down-regulation of PRDM1/Blimp-1 in Hodgkin/Reed-Sternberg cells: a potential pathogenetic lesion in Hodgkin lymphomas.

PRDM1/Blimp-1, a master regulator in terminal B-cell differentiation, has been recently identified as a tumor suppressor target for mutational inactivation in diffuse large B-cell lymphomas of the activated B-cell type. Our studies here demonstrate that PRDM1/blimp-1 is also a target for microRNA (miRNA)-mediated down-regulation by miR-9 and let-7a in Hodgkin/Reed-Sternberg (HRS) cells of Hodgkin lymphoma (HL). MiRNA expression profiling by direct miRNA cloning demonstrated that both of these miRNAs are among the most highly expressed in cultured HRS cells. These miRNAs functionally targeted specific binding sites in the 3' untranslated region of PRDM1/blimp-1 mRNA and repressed luciferase reporter activities through repression of translation. In addition, high levels of miR-9 and let-7a in HL cell lines correlated with low levels of PRDM1/Blimp-1. Similar to their in vitro counterparts, the majority of HRS cells in primary HL cases showed weak or no PRDM1/Blimp-1 expression. Over-expression of miR-9 or let-7a reduced PRDM1/Blimp-1 levels in U266 cells by 30% to 50%, whereas simultaneous inhibition of their activities in L428 cells resulted in an approximately 2.6-fold induction in PRDM1/Blimp-1. MiRNA-mediated down-regulation of PRDM1/Blimp-1 may contribute to the phenotype maintenance and pathogenesis of HRS cells by interfering with normal B-cell terminal differentiation, thus representing a novel molecular lesion, as well as a potential therapeutic target in HL.