Impact of a hybrid medical care model in the rheumatoid arthritis patient-reported outcomes: A non-inferiority crossover randomized study.

OBJECTIVE: Patients and physicians can naturally adopt hybrid healthcare models that combine face-to-face consultations with telemedicine. The study's objective was to compare the impact of two healthcare interventions, hybrid care modality and face-to-face consultation, on the patient-reported outcomes of rheumatoid arthritis patients, during the COVID-19 pandemic. METHODS: Consecutive outpatients reincorporated to a clinic previously in lockdown were invited to a non-inferiority, randomized study (October 2020--May 2022). Patients were randomized to 6 months of face-to-face consultation or hybrid care modality (intervention period-1) and then the converse modality (intervention period-2). The primary outcome was disease activity/severity behavior (Routine Assessment of Patient Index Data 3). Additional patient-reported outcomes were disability (Health Assessment Questionnaire Disability Index), quality-of-life (World Health Organization quality of life questionnaire-brief version), adherence and satisfaction with medical care, and treatment recommendation. Sample size calculation established 55 patients/healthcare interventions. RESULTS: There were 138 patients invited to participate, 130 agreed and 121 completed their study participation. Sixty-one and 60 patients respectively, received face-to-face consultation and hybrid care modality over intervention period-1. Patients were primarily middle-aged females (90.1%), with (median, IQR) 12 (9-16) years of education, long-standing disease, working (62.8%), receiving disease-modifying anti-rheumatic drugs (96.7%), and corticosteroids (61.2%). Patients had low disease activity (median Routine Assessment of Patient Index Data 3: 2.7) and Health Assessment Questionnaire Disability Index score that translated into the absence of disability, while quality of life was compromised. Baseline characteristics were similar between patients assigned to each healthcare intervention. Differences in Routine Assessment of Patient Index Data 3 behavior were below the non-inferiority margin. Results considered the order in which patients received the intervention and baselines scores, and extended to the patient-reported outcomes left. CONCLUSIONS: Hybrid care modality was non-inferior to in-person consultations in achieving patient-reported outcomes during the COVID-19 pandemic in rheumatoid arthritis patients.

Comparison of Teleconsultations and In-Person Consultations from Outpatients with Rheumatoid Arthritis, During the COVID-19 Pandemic: An Internal Audit of Medical Notes.

Introduction: The objectives of this study were to compare the quality-of-care and compliance with medical record regulations between in-person consultations (QIP and CIP) and telephone consultations (QTP and CTP), from rheumatoid arthritis (RA) outpatients, during the COVID-19 pandemic, and to explore the impact of the consultation modality on the treatment. Methods: Data from 324 medical notes corresponding to rheumatic consultations between July and December 2020 were abstracted. Notes were selected considering a stratified (in-person and telephone consultations) random sampling strategy. QIP, CIP, QTP, and CTP were scored based on prespecified criteria as percentages, where higher numbers translated into better standards. Logistic regression analysis investigated the association between the consultation modality and the treatment recommendation (dependent variable). Results: There were 208 (64.2%) medical notes related to in-person consultations and 114 (35.2%) to telephone consultations. Overall, medical notes corresponded to middle-aged women with long-standing disease. QIP was superior to QTP (median, interquartile range): 60% (60-75%) versus 50% (25-60%), p ≤ 0.001, and differences were related to disease activity and prognosis documentation (81.3% vs. 34.5% and 55.8% vs. 33.6%, respectively, p ≤ 0.001) and the prolonged prescription of glucocorticoids with a documented management plan (58.5% vs. 30.4%, p = 0.045). Meanwhile, CIP and CTP were similar. Telephone consultation was a significant risk factor for no changes in the treatment recommendation (odds ratio: 2.113, 95% confidence interval: 1.284-3.479, p = 0.003), and results were consistent in the 142 medical notes with documented absence of disease activity. Conclusions: In the clinical context of RA, the quality-of-care provided by telephone consultations is below the standard of care and impacts the treatment.

Polymyalgia rheumatica: A case series from Colombia and analysis of Latin America.

OBJECTIVE: Polymyalgia rheumatica (PMR) is the most common inflammatory disease in patients over 50 years. Information about the disease in Latin America (LATAM) is scarce. We aimed to evaluate a group of Colombian patients with PMR and to conduct a systematic review of PMR in LATAM. METHODS: A multicentric retrospective study was performed. Medical records of 256 PMR patients were evaluated. Patients were divided into two groups, those fulfilling the 2012 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for PMR and those who did not (i.e., clinical diagnosis). A systematic literature review and meta regression was performed comparing Colombian vs LATAM patients. RESULTS: From 256 patients, 145 (56.6%) fulfilled the 2012 EULAR/ACR criteria, and 111 (43.3%) were classified by clinical diagnosis. Inflammatory bilateral shoulder pain, pelvic girdle aching, morning stiffness >45 min, elevated erythrocyte sedimentation rate (ESR), and C-reactive protein (CPR), and Methotrexate (MTX) prescription were more common in the 2012 EULAR/ACR group. None of the included patients presented overt polyautoimmunity (PolyA), whereas up to 24% exhibited latent PolyA. In addition, these patients showed high frequency of malignancy (7.59%). In the meta regression analysis, Colombian patients exhibited lower ESR levels, and were less likely to develop giant cell arteritis (GCA) as compared to the rest of LATAM data. CONCLUSION: Patients with PMR in LATAM exhibit similar phenotypes from other cohorts worldwide. Malignancy, GCA and latent PolyA should be considered in the routine clinical follow-up of patients with PMR.

Parámetros de laboratorio clínico en pacientes con la COVID-19 / Clinical laboratory parameters in patients with COVID-19

Introducción: Conocer las alteraciones en exámenes de laboratorio clínico, es de utilidad en el diagnóstico y el progreso de pacientes con la COVID-19. Objetivo: Describir los parámetros de laboratorio clínico en pacientes diagnosticados con la COVID-19. Métodos: Estudio descriptivo en 82 pacientes hospitalizados con la COVID-19. Las variables analizadas fueron edad, sexo, comorbilidad, reporte de paciente, estado al egreso, hemoglobina, recuento de glóbulos blancos, conteo absoluto de neutrófilos, conteo absoluto de linfocitos, conteo de plaquetas, eritrosedimentación, dímero D, creatinina, urea, alanina aminotransferasa, aspartato aminotransferasa, #947;-glutamil transpeptidasa, fosfatasa alcalina, lactato deshidrogenasa, relación neutrófilos/ linfocitos y de plaquetas/ linfocitos. Resultados: La edad promedio fue de 55,61 ± 22,04, fue mayoría el sexo femenino (57,3 por ciento), hipertensos (41,5 por ciento), el 18,3 por ciento reportados de grave y el 14,6 por ciento falleció. La edad avanzada y la comorbilidad se asociaron al reporte de gravedad. Hubo disminución significativa de la hemoglobina, linfocitos; elevación de la eritrosedimentación, dímero D, creatinina, #947;-glutamil transpeptidasa y lactato deshidrogenasa, sobre todo en graves. La relación neutrófilos/ linfocitos y de plaquetas/ linfocitos alertaron sobre el agravamiento del paciente y la posibilidad de fallecer. Conclusiones: Los pacientes tenían una media de edad de 55,61, del sexo femenino, con hipertensión arterial; egresaron vivos, reportados de no graves. Disminuyen los valores medios de hemoglobina, conteo global de los linfocitos, sobre todo en graves; aumenta el dímero D, creatinina, ALT, AST, ALP, GGT, y LD. La relación neutrófilos/ linfocitos y de plaquetas/ linfocitos muestran valores medios altos, sobre todo en graves y en quienes fallecieron (AU)

Introduction: Knowing the alterations in clinical laboratory tests is useful in the diagnosis and progress of patients with COVID-19. Objective: To describe the clinical laboratory parameters in patients diagnosed with COVID-19. Methods: Descriptive study in 82 hospitalized patients with COVID-19. The variables analyzed were age, sex, comorbidity, patient report, discharge status, hemoglobin, white blood cell count, absolute neutrophil count, absolute lymphocyte count, platelet count, erythrocyte sedimentation rate, D-dimer, creatinine, urea, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase, alkaline phosphatase, lactate dehydrogenase, neutrophil / lymphocyte and platelet / lymphocyte ratio. Results: The average age was 55.61 ± 22.04, the majority were female (57.3 percent), hypertensive (41.5 percent), 18.3 percent reported serious and 14.6 percent died. Advanced age and comorbidity were associated with the severity report. There was a significant decrease in hemoglobin, lymphocytes; elevated erythrocyte sedimentation rate, D-dimer, creatinine, γ-glutamyl transpeptidase, and lactate dehydrogenase, especially in severe patients. The neutrophil / lymphocyte and platelet / lymphocyte ratio warned about the worsening of the patient and the possibility of death. Conclusions: The patients a mean age of 55.61, female, with arterial hypertension; they were discharged alive, reported as not serious. Mean hemoglobin values ​​decrease, global lymphocyte count, especially in severe patients; increases D-dimer, creatinine, ALT, AST, ALP, GGT, and LD. The neutrophil / lymphocyte and platelet / lymphocyte ratio show high mean values, especially in severely ill patients and in those who died(AU)

Dinámica temporal de la disponibilidad de agua y microclima en aguadas del biotopo protegido Dos Lagunas, Petén, Guatemala / Temporal dynamics of water availability and microclimate in seasonal water ponds in the Dos Lagunas Biotopo Protegido, Peten, Guatemala

En el territorio de la Selva Maya se han identificado a los cuerpos de agua estacionales denominados localmente aguadas, como un recurso crítico para la supervivencia de especies de fauna silvestre, ya que son su principal fuente de agua durante la temporada seca. En el presente estudio se registró en cinco aguadas, la dinámica temporal de la acumulación de agua empleando una cámara automática, así como la temperatura y la humedad relativa utilizando sensores automáticos a lo largo de abril a agosto del 2016. En cuanto a la disponibilidad de agua, esta fue disminuyendo hasta agotarse al final de la temporada seca en el mes de abril, y fue aumentando al inicio de la temporada lluviosa en junio. Para la temporada seca se registró una temperatura promedio (desviación estándar) de 27.65 (4.52 ) oC y una humedad relativa de 71.30 (19.00) %, mientras que para la temporada lluviosa la temperatura promedio fue de 26.09 (3.21) oC y humedad relativa promedio de 86.16 (14.15) %. Sin embargo no se encontró una diferencia significativa entre los valores registrados en las "distintas" aguadas. Se encontró una correlación significativa entre los valores registrados en las aguadas con los registrados por la estación meteorológica automá- tica (EMA) Calakmul II, por lo que para estudios futuros es posible utilizar los valores de la EMA para representar la dinámica en las aguadas. Entre las estrategias para reducir los potenciales efectos del cambio climático para la fauna es la conservación de las aguadas manteniendo la conectividad entre las mismas.

In the Maya Forest, the seasonal water ponds locally known as aguadas have been identified as a critical resource for the survival of wild species, as they are the main source of fresh water during the dry season. In the present study, in five aguadas, we recorded the availability of water using a camera-trap, as well as the temperature and relative humidity using data loggers, from April to August 2016. Regarding water availability, the water quantity was diminishing at the end of the dry season in April until it ran out, and increased as the rainy season started on June. For the dry season we recorded an average temperature (standard deviation) of 27.65 (4.52) oC and average relative humidity of 71.30 (19.00) %, and on the rainy season, the average temperature was 26.09 (3.21) oC and average relative humidity of 86.16 (14.15) %. Nevertheless we didn't found a significant difference between the values recorded at the aguadas. We founded a significant correlation between the values recorded at the aguadas and the Automatic Meteorological Station (AME) Calakmul II, so for future research the AME values can be used to represent the dynamics at the aguadas. Among the strategies to reduce the potential impacts of Climate Change on animal species is the conservation of aguadas, maintaining the connectivity within them.

Resultados del uso del ácido acetilsalicílico y los suplementos de calcio en la prevención de la preeclampsia / Results of the Use of Acetylsalicylic Acid and Calcium Supplements in Preventing Preeclampsia

Introducción: la preeclampsia en una afección que complica el embarazo y es responsable entre 10-15 por ciento de la mortalidad materna y perinatal. En Villa Clara, constituyen la primera causa de ingreso en los Servicios de Cuidados Maternos y perinatales. Objetivo: demostrar la efectividad y la seguridad de la aspirina y los suplementos de calcio en embarazadas con riesgo. Métodos: se realizó una investigación observacional, prospectiva en la consulta provincial de riesgo de preeclampsia del Hospital Universitario Ginecobstétrico Mariana Grajales, de Villa Clara, desde enero del 2014 hasta diciembre del 2015. Resultados: se comprobó que el uso de la aspirina y el calcio, a las dosis empleadas, resultaron ser efectivas en la disminución de la incidencia de preeclampsia y sus formas severas. Existieron beneficios mayores con las medidas preventivas empleadas, para algunos grupos específicos de riesgo como: hipertensión arterial crónica, obesidad, historia de preeclampsia previa y pacientes con ecografía Doppler alterada. No se observó un incremento de eventos adversos sobre la madre y el feto. Conclusiones: no se observó un incremento de eventos adversos sobre la madre y el neonato en las pacientes tratadas(AU)

Introduction: preeclampsia in a condition that complicates pregnancy and it is responsible for 10-15 percent of maternal and perinatal mortality. In Villa Clara, it constitutes the first cause of admission to the Maternal and Perinatal Care Services. Objective: demonstrate the effectiveness and safety of aspirin and calcium supplements in pregnant women at risk. Methods: an observational, prospective investigation was conducted in the provincial consultation for risk of preeclampsia at Mariana Grajales Gyneco-Obstetric University Hospital, in Villa Clara, from January 2014 to December 2015. Results: the use of aspirin and calcium, at the doses used, proved to be effective in reducing the incidence of preeclampsia and its severe forms. There were greater benefits with the preventive measures used, for some specific risk groups such as chronic hypertension, obesity, history of previous preeclampsia and patients with altered Doppler ultrasound. There was no increase in adverse events on the mother and the fetus. Conclusions: there was no increase in adverse events on the mother and the newborn in the treated patients(AU)

Melatonin enhances neural stem cell differentiation and engraftment by increasing mitochondrial function.

Neural stem cells (NSCs) are regarded as a promising therapeutic approach to protecting and restoring damaged neurons in neurodegenerative diseases (NDs) such as Parkinson's disease and Alzheimer's disease (PD and AD, respectively). However, new research suggests that NSC differentiation is required to make this strategy effective. Several studies have demonstrated that melatonin increases mature neuronal markers, which reflects NSC differentiation into neurons. Nevertheless, the possible involvement of mitochondria in the effects of melatonin during NSC differentiation has not yet been fully established. We therefore tested the impact of melatonin on NSC proliferation and differentiation in an attempt to determine whether these actions depend on modulating mitochondrial activity. We measured proliferation and differentiation markers, mitochondrial structural and functional parameters as well as oxidative stress indicators and also evaluated cell transplant engraftment. This enabled us to show that melatonin (25 µM) induces NSC differentiation into oligodendrocytes and neurons. These effects depend on increased mitochondrial mass/DNA/complexes, mitochondrial respiration, and membrane potential as well as ATP synthesis in NSCs. It is also interesting to note that melatonin prevented oxidative stress caused by high levels of mitochondrial activity. Finally, we found that melatonin enriches NSC engraftment in the ND mouse model following transplantation. We concluded that a combined therapy involving transplantation of NSCs pretreated with pharmacological doses of melatonin could efficiently restore neuronal cell populations in PD and AD mouse models depending on mitochondrial activity promotion.

Umbilical Artery Half-Peak Systolic Velocity Deceleration Time in Fetal Growth Restriction.

OBJECTIVE: To study the umbilical artery (UA) half-peak systolic velocity deceleration time (hPSV-DT) in pregnancies complicated by fetal growth restriction (FGR). METHODS: The study included 266 singleton, high-risk pregnancies with an estimated fetal weight <10th percentile, which were examined between 24 and 40 weeks' gestation and delivered within a week from the last ultrasound evaluation. UA hPSV-DT was measured with Doppler ultrasound in the same wave used to measure the pulsatility index. UA hPSV-DT values were correlated with perinatal outcome. RESULTS: UA hPSV-DT <5th percentile was found in 87 and 98% of fetuses with moderate and severe FGR, respectively. 94% of fetuses with a UA hPSV-DT <90 ms had poor perinatal outcome including perinatal death or prolonged admission to the neonatal intensive care unit. None of the fetuses had a UA hPSV-DT <70 ms. Perinatal death occurred in 39 fetuses; UA hPSV-DT was abnormal in all of them, with 95% of these fetuses having values of ≤120 ms. In the group of fetuses with absent/reverse end-diastolic velocity in the UA, the perinatal mortality rate was 51% for those with a UA hPSV-DT ≤90 ms and only 23% for those having a UA hPSV-DT >90 ms (p < 0.01). CONCLUSIONS: UA hPSV-DT seems to be a useful technique in the evaluation of pregnancies at risk for FGR and perinatal death. Additionally, hPSV-DT was shown to be a good predictor of perinatal death, with values of <90 ms corresponding to imminent risk of intrauterine demise and values of <70 ms being likely to be incompatible with intrauterine life.

Factores de riesgo maternos y fetales en recién nacidos con macrosomía / Maternal and fetal risk factors in neonates with macrosomia

Introducción: el Colegio Americano de Obstetras y Ginecólogos define la macrosomía fetal como el peso al nacimiento igual o superior a 4 500 gramos; esta entidad se asocia a una morbilidad y mortalidad maternas y perinatales elevadas. Objetivo: determinar el comportamiento de los factores de riesgo en pacientes con macrosomía. Método: se realizó un estudio observacional descriptivo y transversal. Del total de nacidos vivos con macrosomía fetal en el período estudiado, se escogieron al azar 123 pacientes mediante un muestreo aleatorio simple; las variables estudiadas fueron los factores de riesgo para la macrosomía, los cuales se dividieron en maternos y fetales, edad materna, vía del parto y peso al nacer. Resultados: el mayor número de nacimientos macrosómicos ocurrieron entre 20-34 años de edad, predominaron la obesidad materna y el peso aproximado fetal mayor o igual a 4 500 gramos en las pacientes con parto distócico (p = 0,003 y p = 0,000, respectivamente). El mayor número de recién nacidos pesaron entre los 4 500 gramos-4999 gramos, y la mayoría de las pacientes tenían uno o más factores de riesgo para la macrosomía. Conclusiones: la presencia de factores de riesgo es frecuente en pacientes con macrosomía fetal; su adecuado reconocimiento y atención favorecerán los mejores resultados maternos y perinatales.

Introduction: the American College of Obstetricians and Gynecologists define fetal macrosomia as having a birth weight equal or greater than 4 500 grams; this entity is associated with a high perinatal and maternal mortality and morbidity. Objective: to determine the manifestation of risk factors in patients with macrosomia. Method: a transversal and descriptive observational study was performed. A number of 123 patients were chosen randomly from the total of born alive with fetal macrosomia in the period studied by means of a simple random sampling; the studied variable were risk factors for macrosomia, which were divided in maternal and fetal, maternal age, delivery way and birth weight. Results: the greater number of macrosomic births occurred between 20 to 34 years of age, maternal obesity predominated and estimated fetal weight was equal or greater than 4500 grams in patients with dystocic delivery (p = 0,003 and p = 0,000, respectively). The greater number of newly born infants weighed between 4500 and 4999 grams, and most of the patients had one or more risk factors for macrosomia. Conclusions: the presence of risk factors is very frequent in patients with fetal macrosomia; their adequate recognition and follow-up will favor best maternal and perinatal results.

Factores de riesgo ocular y experiencia del cirujano en las complicaciones de la cirugía de catarata / Ocular risk factors and the surgeon's experience to manage complications in the cataract surgery

OBJETIVO: determinar influencia de factores de riesgo ocular y experiencia del cirujano en las complicaciones de 158 pacientes operados de catarata en el Centro Oftalmológico de Holguín entre abril y octubre de 2010. MÉTODOS: se realizó un estudio descriptivo de corte transversal donde se analizaron variables como edad, sexo, factores de riesgo ocular, complicaciones transoperatorias y posoperatorias inmediatas relacionadas con factores de riesgo y experiencia del cirujano. RESULTADOS: el grupo de edad que predominó fue el de 70-79 años con 38,6 % y el sexo femenino en 58,8 %. El factor de riesgo más frecuente fue la madurez e hipermadurez del cristalino en 51,2 %. La complicación transoperatoria que más incidió fue la ruptura de cápsula posterior con pérdida de vítreo en 8,2 % relacionada con madurez del cristalino y pupila pequeña. El edema corneal constituyó la complicación posoperatoria inmediata que predominó en 6,3 % relacionada fundamentalmente con pupila insuficiente y catarata madura. En la cirugía realizada por residentes predominaron las complicaciones en 15,8 %. CONCLUSIONES: la intervención de cataratas en etapas de madurez e hipermadurez asociada a pupilas insuficientes expuso a estos ojos a un riesgo mayor de ruptura de cápsula posterior con o sin pérdida de vítreo y al edema corneal. La cirugía de catarata en pacientes con factores de riesgo oculares fue más propensa a complicaciones cuando la realizaron residentes y oftalmólogos con menos entrenamiento y experiencia.

OBJECTIVE: to determine the influence of ocular risk factors and the surgeon's experience on complications affecting 158 patients operated on for cataract at the Ophthalmologic Center in Holguin from April to October, 2010. METHODS: cross-sectional descriptive study in which variables such as age, sex, ocular risk factors, immediate transoperative and postoperative complications related to risk factors and the surgeon's experience were analyzed.RESULTS: the 70-79 years-old group prevailed with 38,6 %, and the females accounted for 58,8 % in the group. The most frequent risk factors were the maturity and hypermaturity of the crystalline lens in 51,2 % of cases. The transoperative complication that mostly affected the patients was the rupture of the posterior capsule with vitreous loss in 8,2 % of cases, associated with maturity of the crystalline lens and the small pupil. The corneal edema represented the predominant immediate postoperative complication in 6,3 % of cases, due to insufficient pupil and mature cataract. The complications were more frequent in surgeries performed by residents in 15,8 % of patients. CONCLUSIONS: operating cataracts at maturity and hypermaturity stages due to insufficient pupils meant higher risk of the posterior capsule rupture with or without vitreous loss and of corneal edema. Cataract surgery in patients with ocular risk factors was proner to complications when they are performed by residents or by ophthalmologists with less training and experience in this field.

The subventricular zone is able to respond to a demyelinating lesion after localized radiation.

Radiation is a common tool in the treatment of brain tumors that induces neurological deficits as a side effect. Some of these deficits appear to be related to the impact of radiation on the neurogenic niches, producing a drastic decrease in the proliferative capacity of these regions. In the adult mammalian brain, the subventricular zone (SVZ) of the lateral ventricles is the main neurogenic niche. Neural stem/precursor cells (NSCs) within the SVZ play an important role in brain repair following injuries. However, the irradiated NSCs' ability to respond to damage has not been previously elucidated. In this study, we evaluated the effects of localized radiation on the SVZ ability to respond to a lysolecithin-induced demyelination of the striatum. We demonstrated that the proliferation rate of the irradiated SVZ was increased after brain damage and that residual NSCs were reactivated. The irradiated SVZ had an expansion of doublecortin positive cells that appeared to migrate from the lateral ventricles toward the demyelinated striatum, where newly generated oligodendrocytes were found. In addition, in the absence of demyelinating damage, remaining cells in the irradiated SVZ appeared to repopulate the neurogenic niche a year post-radiation. These findings support the hypothesis that NSCs are radioresistant and can respond to a brain injury, recovering the neurogenic niche. A more complete understanding of the effects that localized radiation has on the SVZ may lead to improvement of the current protocols used in the radiotherapy of cancer.

Ethical implications in the use of embryonic and adult neural stem cells.

The advent and growth of technological advances have led to new routes of knowledge. Thereby, we currently face new challenges. We have just started to get a glimpse of the structural and functional role of neural stem cells in differentiation and migration processes, the origin of synaptic networks, and subsequent readjustments in specific circuits. A whole range of treatment possibilities originates from this knowledge that potentially can be used for different neurological diseases in humans. Although this is an encouraging scenario, it implies that the human brain is the object of such study, as well as its potential manipulation and transplantation. It is, therefore, pertinent that ethical principles should be followed in such research to have proper balance between what can be done and what should be done, according to every specific context. Hence, it is wise to consider ethical implications in every research project, along with potential clinical applications, under the principle of causing no harm, following risk and benefit rules in decision making and with respect of the human condition as a priority.

Resultados de la atención a pacientes con riesgo de preeclampsia-eclampsia / Outcomes of patient care at risk of preeclampsia-eclampsia

Introducción:en la consulta de Riesgo de preeclampsia-eclampsia se realiza el diagnóstico precoz de formas graves y tempranas de preeclampsia. Objetivos: demostrar los resultados de la atención a gestantes con riesgo de preeclampsia eclampsia. Métodos: estudio descriptivo de corte transversal en el municipio de Santa Clara, provincia Villa Clara, en el año 2010. La muestra se conformó con 181 gestantes a las que se les aplicó una encuesta que incluyen los factores de riesgo, se diseñaron estrategias de seguimiento y diagnóstico precoz de formas graves e incipientes de la preeclampsia. Resultados: las edades extremas resultaron el 58,01 porciento del total, con 105 mujeres a predominio del subgrupo de la avanzada edad materna 69 (38,12 porciento)...

Introduction: early diagnosis of serious and early forms of pre-eclampsia is made in the consultation for pre-eclampsia eclampsia. Objectives: to show the results in the care of pregnant women at pre-eclampsia eclampsia risk. Methods: a cross sectional study in the municipality of Santa Clara, Villa Clara during 2010. The sample consisted of 181 pregnant women to whom they were given a survey including risk factors; strategies were designed for monitoring and early diagnosis of serious and emerging forms of preeclampsia. Results: the extreme ages were 58.01 percent out of the total, 105 women with a predominance of the subgroup of advanced maternal age 69 (38.12 percent)...

Caracterización del riesgo cardiovascular y del síndrome metabólico en gestantes con riesgo de preeclampsia/eclampsia / Characterization of cardiovascular risk and metabolic syndrome in pregnant women at risk of preeclampsia / eclampsia

Entre los factores de riesgo de preeclampsia eclampsia se incluye el riesgo cardiovascular y del síndrome metabólico. Objetivos: identificar factores de riesgo cardiovascular y del síndrome metabólico en una población de gestantes con riesgo de preeclampsia eclampsia. Método: estudio descriptivo de corte transversal en el Municipio de Santa Clara, Villa Clara, en el año 2011. La muestra se conformó con 181 gestantes con al menos dos factores de riesgo...

Satisfacción con la atención médica de pacientes hospitalizados en un servicio clínico docente y en uno no docente / Satisfaction of health care in hospitalized patients in a teaching hospital and a non teaching hospital

Introducción: En Chile, una proporción importante de hospitales públicos son docente-asistenciales. El objetivo del presente estudio fue determinar y comparar los niveles de satisfacción con la atención médica entre un centro asistencial docente y uno no docente. Material y método: Estudio de corte transversal. Se aplicó un cuestionario para evaluar satisfacción con la atención médica y grado de aceptación hacia estudiantes de Medicina, a pacientes hospitalizados en servicios de urología del Hospital Dr. Gustavo Fricke (no docente) y Hospital Carlos Van Buren (docente), entre septiembre y noviembre de 2009. Se utilizó razón de validez de contenido (CVR) como criterio de inclusión para los diferentes ítems del cuestionario final, que consideró 14 ítems, además de evaluarse su consistencia interna. Resultados: Fueron encuestados 140 pacientes en total, 70 de cada servicio. No hubo diferencia en la satisfacción por servicio (90 por ciento y 88,6 por ciento). Respecto a las variables demográficas, hubo diferencia en edad, proporción de pensionados, y nivel educacional, por servicios La única variable que mostró asociación con satisfacción fue el sexo, apreciándose en un 95 por ciento de hombres contra un 81,4 por ciento de mujeres (p=0,01). Un 94,3 por ciento de los pacientes aceptó la presencia de los estudiantes en el servicio docente. Discusión: En la muestra estudiada, estar internado en uno u otro centro no afectó la satisfacción de los pacientes. La única variable que se asoció a la satisfacción fue el ser hombre, y la presencia del estudiante fue aceptada por la gran mayoría de pacientes.

Material and method: Cross-sectional study. A survey was carried out to evaluate satisfaction with health care and the level of acceptance of medical students by hospitalized patients in urology services in Gustavo Frike Hospital (non teaching) and Carlos Van Buren (teaching), between September and November of 2009. Content validity ratios (CVR) was used as inclusion criteria for the 14 different items on the questionnaire, and it was evaluated for internal consistency. Results: 140 patients completed the questionnaire, 70 at each hospital. There was no difference in the level of satisfaction between hospitals (90 percent and 88.6 percent). With respect to the demographic variables, between the two hospitals there were differences according to age of patients, proportion of retirees, and level of education. The only variable that was associated with satisfaction was sex, found in 95 percent of men and 81.4 percent of women (p=0.01). 94.3 percent of patients accepted the presence of students at the teaching hospital. Discussion: In this sample, hospitalization in the teaching or the non teaching hospital did not affect patient satisfaction. The only variable that was associated with satisfaction was sex, and the presence of students was accepted by the majority of patients.

La histerectomía obstétrica como terapéutica segura en la morbilidad extremadamente grave / Obstetric hysterectomy as a safe therapy in the extremely severe morbidity

Introducción: la histerectomía obstétrica se define como la extirpación del útero después de un evento obstétrico, opción terapéutica vinculada con estados de morbilidad obstétrica extremadamente grave. Objetivo: determinar características obstétricas y generales en una población de pacientes con morbilidad obstétrica extremadamente grave a las cuales se les realizó histerectomía obstétrica. Métodos: estudio descriptivo de corte transversal, realizado desde enero del 2007 a diciembre del 2009, en el Hospital Ginecobstétrico Mariana Grajales de Santa Clara, Villa Clara. Se revisaron los expedientes de 71 pacientes a quienes se hizo histerectomía obstétrica. Se calculó la incidencia y se identificaron las características clínicas y obstétricas, la relación con el tipo de parto y los principales hallazgos anatomopatológicos asociados a la histerectomía obstétrica. Resultados: se realizó una histerectomía obstétrica cada 463 partos. El promedio de edad de las pacientes fue de 33,8 + 6,78 años. El 78,6 por ciento tenía antecedentes de cesárea. Predominó la histerectomía total abdominal en el 63,3 por ciento de la muestra y en 27 pacientes se realizaron ligaduras de las arterias hipogástricas, 38 por ciento. Se requirió el ingreso en la terapia intensiva en un 69 por ciento de las pacientes histerectomizadas. No se reportaron muertes maternas vinculadas con las histerectomías obstétricas en estos tres años en la provincia. Conclusiones: la histerectomía obstétrica es una opción terapéutica asociada a la morbilidad obstétrica extremadamente grave, donde el accionar oportuno, con dominio técnico y cumpliendo las indicaciones pertinentes se convierte en una herramienta que garantiza la vida de muchas pacientes en momentos críticos

Introduction: the obstetric hysterectomy is defined as the removal of uterus after an obstetric event, therapeutic option linked to stages of extremely severe obstetric morbidity. Objective: to determine the obstetric and general features in a group of patients presenting with an extremely severe obstetric morbidity underwent to obstetric hysterectomy. Methods: a cross-sectional and descriptive study was conducted from January, 2007 to December, 2009 in the Mariana Grajales Gynecology and Obstetrics Hospital of Santa Clara, Villa Clara province. The medical records of l71 patients were reviewed who underwent obstetric hysterectomy. Incidence was estimated identifying the clinical and obstetric features, the relation with the type of labor and the main anatomical-pathological findings associated with obstetric hysterectomy. Results: an obstetric hysterectomy was performed by 463 labors. The mean age of patients was of 33.8 ± 6.78 years. The 78.6 percent had a history of cesarean section. There was predominance of abdominal total hysterectomy in the 63.3 percent of the sample and in 27 patients ligatures of hypogastric arteries were performed (38 percent). It was necessary the admission in intensive therapy service of the 69 percent of hysterectomy patients during this past year in the province. Conclusions: the obstetric hysterectomy is a therapeutic option associated with the extremely severe obstetric morbidity, where a timely action, a technical mastery and fulfilling the pertinent indications, it become a tool to guarantee the life of many patients in critical situations

Resultados preliminares de un protocolo de atención a gestantes con riesgo de preeclampsia eclampsia, Hospital Universitario de Gineco-obstétrico Mariana Grajales / Preliminary results of a protocol of care to pregnant women at risk of preeclampsia eclampsia, University Hospital of Gynecology and Obstetric Mariana Grajales

Se presentan los resultados preliminares del protocolo de atención a gestantes con riesgos de preeclampsia eclampsia en municipio de Santa Clara, Villa Clara en el período desde noviembre del 2009 a abril del 2010 con el ojetivo de demostrar la incidencia de factores predisponentes de la preeclampsia en un grupo de gestantes de riesgo y las acciones de salud que pueden mejorar la atención prenatal con estos grupos para disminuir la morbilidad y mortalidad asociada a estas entidades...

Comportamiento materno y perinatal de un grupo de gestantes con preeclampsia grave / Maternal and perinatal behavior present in pregnants with severe pre-eclampsia

OBJETIVO: describir los principales resultados maternos y perinatales asociados a la preeclampsia grave. MÉTODOS: se realizó un estudio descriptivo de corte transversal en un grupo de 377 gestantes que ingresaron en la sala de Cuidados Perinatales en el Hospital Universitario Ginecoobstétrico "Mariana Grajales" de Santa Clara, Villa Clara, en el período de enero de 2006 a diciembre de 2008. Se utilizaron diferentes variables: edad materna, estado civil, antecedentes obstétricos, paridad, edad gestacional al nacimiento, tipo de parto, peso del recién nacido, Apgar y mortalidad perinatal. RESULTADOS: en el grupo estudio existe un predominio de mujeres en edades extremas de la vida: adolescentes 30,5 por ciento y mayores de 35 años, 28,6 por ciento, que en un 50,1 por ciento resultaron nulíparas. La prematuridad en 68 pacientes, 18,03 por ciento y el bajo peso al nacer 55,43 por ciento, con una media de 1553 gramos ± 172,51 fueron los resultados perinatales más significativos en este grupo. CONCLUSIONES: la preeclampsia grave es una enfermedad que genera alteraciones en el feto y que lo pueden llevar a la muerte.

OBJECTIVE: to describe the main moternal and perinatal results associated with the severe pre-eclampsia. METHODS: authors made a cross-sectional and descriptive study in a cohort of 377 pregnants admitted in perinatal care ward of the "Mariana Grajales" of Genecology and Obstetric University Hospital in Santa Clara municipality, Villa Clara province from January, 2006 to December, 2008. We used different variables: mother age, marital status, obstetric backgrounds, parity, and gestational age at birth, type of delivery, infant birth weight, Apgar score, and perinatal mortality. RESULTS: in study group there is a female predominance in extreme life age: adolescents 30,5 percent, and older than 35 years, 28,6 percent where a 50,1 percent were nulliparous. Prematurity in 68 patients, 18,03 percent and in low-birth weight 55,43 percent, with a mean of 1553 g ± 172,51 were the more significant perinatal results in this group. CONCLUSIONS: severe pre-eclampsia is a disease generating alterations in fetus and its possible death.