Choriocapillaris and choroidal thickness in all Leber hereditary optic neuropathy stages using swept source technology.

PURPOSE: The role of the choroid in Leber hereditary optic neuropathy (LHON) remains unclear. The literature is scarce, with conflicting results and lacks axial length measurements. Therefore, we aimed to analyse the choriocapillaris (CC) vessel density (VD) and choroidal thickness (ChT) in all stages of LHON using swept source (SS) technology and considering the possible influence of axial length on choroidal parameters. METHODS: This was a prospective cross-sectional observational study. A total of 119 eyes of 60 patients with molecularly confirmed LHON across all stages and 120 eyes of 60 control participants were included. We obtained the CC VD using optical coherence tomography angiography maps centred on the fovea. ChT was measured from the Bruch's membrane to the choroid-sclera interface in the macular and peripapillary regions. RESULTS: The CC VD was not significantly affected in any sector or average, except for a slight change in the superior region of chronic eyes (52.08 ± 1.62% vs. 53.50 ± 2.29%, p = 0.002). ChT demonstrated a trend towards decreased values in asymptomatic eyes and increased values in the symptomatic stages that failed to reach statistical significance in sectors corresponding to the papillomacular bundle except for the macular nasal inner sector of chronic eyes (281.10 ± 67.12 µm vs. 252.08 ± 70.55 µm, p = 0.045). No significant correlations were observed between visual acuity and CC VD or ChT. CONCLUSION: The CC VD remained stable across the LHON stages. Choroidal vasculature does not appear to play a role in LHON pathophysiology. Further research is needed on ChT as a potential biomarker of LHON.

Quantitative assessment of macular and circumpapillary retinal vessel density across all stages of Leber hereditary optic neuropathy using swept source optical coherence tomography angiography.

PURPOSE: To investigate the macular and circumpapillary retinal microvasculature across all stages of Leber hereditary optic neuropathy (LHON) using swept source optical coherence tomography angiography (OCTA). METHODS: This prospective, multicentre, cross-sectional, observational study analysed a total of 119 eyes of 60 patients with molecularly confirmed LHON across all stages and 120 eyes of 60 control subjects. Optical coherence tomography angiography maps centred on the fovea and optic disc were obtained to measure vessel densities (VDs) in the macular superficial (SCP) and deep (DCP) capillary plexuses, and the radial peripapillary capillary plexus (RPCP) respectively. RESULTS: In asymptomatic eyes, only the SCP showed significant changes on average (B coefficient = -0.72, 95% CI = -1.34 to -0.10, p = 0.022) or in sectors representing the papillomacular bundle (PMB) (B coefficient = -1.17, 95% CI = -2.23 to -0.11, p = 0.031). However, in chronic eyes, the greatest magnitude of change was found in the temporal sector of the RPCP (B coefficient = -12.36, 95% CI = -14.49 to -10.23, p < 0.001). The RPCP showed the strongest correlations with visual acuity (VA, logarithm of the minimum angle of resolution; R = -0.677, p < 0.001) and structural parameters (R = 0.747, p < 0.001). CONCLUSIONS: Retinal VD changes in the circumpapillary region of the PMB appear later than in the macula but end up being more profound and correlate better with VA and structural parameters. Further studies are needed to assess the clinical utility of retinal VDs as potential LHON biomarkers.

Multirresistencia, resistencia extendida y panresistencia a antibacterianos en el norte de México.

OBJETIVO: Describir el perfil de multirresistencia (MDR), resistencia extendida (XDR) y panresistencia (PDR) a antibacterianos en aislados de muestras de pacientes de un hospital privado de tercer nivel en el norte de México. MÉTODO: Se realizó un estudio retrospectivo durante el periodo comprendido de febrero de 2016 a abril de 2019. A partir de 156 muestras clínicas de orina, heridas, sangre, expectoración y otros fluidos se aislaron 166 bacterias; 10 de las muestras incluyeron dos microorganismos. Los microrganismos aislados se clasificaron en MDR, XDR o PDR. RESULTADOS: El 78% de los aislados gramnegativos y el 69% de los aislados grampositivos mostraron MDR, XDR o PDR. Staphylococcus epidermidis fue la bacteria grampositiva con multirresistencia más frecuentemente aislada. Escherichia coli y Klebsiella sp. se encontraron entre los gramnegativos MDR más frecuentes. En dos casos, los aislados clínicos de Pseudomonas aeruginosa procedentes de la unidad de cuidados intensivos neonatales mostraron PDR. CONCLUSIÓN: Los servicios de terapia intensiva, cirugía y unidad de cuidados intensivos neonatales merecen especial atención por la alta proporción de aislados MDR y la presencia de PDR a causa de P. aeruginosa. OBJECTIVE: To describe the profile of multidrug-resistance (MDR), extensively resistance (XDR) and pandrug-resistance (PDR) to antibacterial drugs in isolates from patient samples from a third level private hospital in the North of Mexico. METHOD: A retrospective study was carried out during the period from February 2016 to April 2019. From 156 clinical samples of urine, wounds, blood, expectoration and other fluids, 166 bacteria were isolated; 10 samples included two microorganisms. Isolated microorganisms were classified into MDR, XDR or PDR. RESULTS: 78% of the Gram negative and 69% of the Gram positive isolates showed MDR, XDR or PDR. Staphylococcus epidermidis was the most frequently isolated MDR Gram positive bacteria. Escherichia coli and Klebsiella sp. were among the most frequent MDR Gram negative. In two cases, the clinical isolates of Pseudomonas aeruginosa from the neonatal intensive care unit showed PDR. CONCLUSIONS: The intensive care, surgery and neonatal intensive care unit services deserve special attention due to the high proportion of MDR isolates and the presence of PDR due to P. aeruginosa.

Impacto de la primera ola pandémica de COVID-19 en el personal de salud en un hospital privado / Impact of the first pandemic wave of COVID-19 on health-care workers in a private hospital

El personal de salud (PS) está más expuesto que la población general a enfermar por SARS-CoV-2, por lo que debe utilizar elementos de protección personal (EPP) en todas las atenciones. El PS de Clínica Las Condes (CLC) que requirió licencia médica (LM) por COVID-19 durante el periodo de estudio, fue evaluado por Organismo Administrador según Ley 16.744, categorizando cada caso de contacto estrecho (CE) o contagio, en común o laboral. Además, fue contactado en su totalidad por equipo de RRHH y de IAAS, para conocer estado de salud, factores de riesgo y evolución. El objetivo fue caracterizar los casos y CE de PS que tuvieron LM, relacionándolas con diferentes eventos ocurridos en la institución y la comunidad durante el periodo comprendido entre el 12 de febrero y el 31 de julio. Un 21% del PS requirió LM en el periodo y un 12,97% presentó infección confirmada por PCR. En cuanto a la distribución por sexo y edad de casos y CE, esta no difiere de la distribución observada en el total de funcionarios de CLC. Se observa que, en los casos, la mayoría corresponde a categoría intrahospitalaria, en cambio los CE, la mayor parte correspondió a comunitario. En relación con casos confirmados intrahospitalarios, destaca que el primer caso ocurrió 63 días después del primer paciente hospitalizado en CLC con diagnóstico de COVID-19, y cuando ya estaba instalada la epidemia en la Región Metropolitana (RM) de Santiago , lo que refleja la efectividad de las medidas de prevención adoptadas al interior de CLC.

Health care workers (HCW) are at higher risk to get sick from SARS-CoV-2 than general population, so they must use personal protective equipment (PPE) in all care situations. The HCW at Clinica las Condes (CLC) that required a sick leave (SL) during the study period was evaluated by the Administrative Institution according to Law 16.744, which categorized each case of close contact (CC) or confirmed case, as community-acquired (CA) or health care-associated (HCA). In addition, all of them were traced by the HR and Infection Control team, to find out health status, risk factors and evolution. The aims were to characterize the confirmed cases and CC, their association with key events that occurred in the institution and the community between February 12th and July 31th. 21%

Identification of cell-surface glycans that mediate motility-dependent binding and internalization of Pseudomonas aeruginosa by phagocytes.

Phagocytic cells are critical to host defense against Pseudomonas aeruginosa, a Gram-negative bacterium that is an opportunistic pathogen. Accordingly, susceptible individuals frequently have impaired innate immune responses, including those with cystic fibrosis or neutropenia. Previous studies identified that the downregulation, or loss, of bacterial flagellar motility enables bacteria to evade interactions with phagocytic cells that result in phagocytic uptake of the bacteria. However, the mechanistic bases for motility-dependent interactions between P. aeruginosa and host cell surfaces that lead to phagocytic uptake of the bacteria are poorly understood. A recent insight is that exogenous addition of a negatively charged phospholipid, phosphatidylinositol-(3,4,5)-triphosphate (PIP3), promotes the engagement of non-motile strains of P. aeruginosa with phagocytes leading to uptake of the bacteria. Thus, we hypothesized that the engagement of P. aeruginosa by phagocytic cells is mediated by motility-dependent interactions with cell-surface polyanions. Here we report that endogenous polyanionic N-linked glycans and heparan sulfate mediate bacterial binding of P. aeruginosa by human monocytic cells. These specific interactions resulted in P. aeruginosa phagocytosis, bacterial type 3 secretion system (T3SS)-mediated cellular intoxication and the IL-1ß response of host innate immune cells. Importantly, the bacterial interactions with the glycans were motility-dependent and could be recapitulated with purified, immobilized glycans. Therefore, this work describes novel interactions of P. aeruginosa with specific phagocyte cell-surface glycans that modulate relevant host innate immune responses to the bacteria, including phagocytosis, inflammation and cytotoxicity.

Similarity corpus on microbial transcriptional regulation.

BACKGROUND: The ability to express the same meaning in different ways is a well-known property of natural language. This amazing property is the source of major difficulties in natural language processing. Given the constant increase in published literature, its curation and information extraction would strongly benefit from efficient automatic processes, for which corpora of sentences evaluated by experts are a valuable resource. RESULTS: Given our interest in applying such approaches to the benefit of curation of the biomedical literature, specifically that about gene regulation in microbial organisms, we decided to build a corpus with graded textual similarity evaluated by curators and that was designed specifically oriented to our purposes. Based on the predefined statistical power of future analyses, we defined features of the design, including sampling, selection criteria, balance, and size, among others. A non-fully crossed study design was applied. Each pair of sentences was evaluated by 3 annotators from a total of 7; the scale used in the semantic similarity assessment task within the Semantic Evaluation workshop (SEMEVAL) was adapted to our goals in four successive iterative sessions with clear improvements in the agreed guidelines and interrater reliability results. Alternatives for such a corpus evaluation have been widely discussed. CONCLUSIONS: To the best of our knowledge, this is the first similarity corpus-a dataset of pairs of sentences for which human experts rate the semantic similarity of each pair-in this domain of knowledge. We have initiated its incorporation in our research towards high-throughput curation strategies based on natural language processing.

RegulonDB v 10.5: tackling challenges to unify classic and high throughput knowledge of gene regulation in E. coli K-12.

RegulonDB, first published 20 years ago, is a comprehensive electronic resource about regulation of transcription initiation of Escherichia coli K-12 with decades of knowledge from classic molecular biology experiments, and recently also from high-throughput genomic methodologies. We curated the literature to keep RegulonDB up to date, and initiated curation of ChIP and gSELEX experiments. We estimate that current knowledge describes between 10% and 30% of the expected total number of transcription factor- gene regulatory interactions in E. coli. RegulonDB provides datasets for interactions for which there is no evidence that they affect expression, as well as expression datasets. We developed a proof of concept pipeline to merge binding and expression evidence to identify regulatory interactions. These datasets can be visualized in the RegulonDB JBrowse. We developed the Microbial Conditions Ontology with a controlled vocabulary for the minimal properties to reproduce an experiment, which contributes to integrate data from high throughput and classic literature. At a higher level of integration, we report Genetic Sensory-Response Units for 200 transcription factors, including their regulation at the metabolic level, and include summaries for 70 of them. Finally, we summarize our research with Natural language processing strategies to enhance our biocuration work.

Strategies towards digital and semi-automated curation in RegulonDB.

Experimentally generated biological information needs to be organized and structured in order to become meaningful knowledge. However, the rate at which new information is being published makes manual curation increasingly unable to cope. Devising new curation strategies that leverage upon data mining and text analysis is, therefore, a promising avenue to help life science databases to cope with the deluge of novel information. In this article, we describe the integration of text mining technologies in the curation pipeline of the RegulonDB database, and discuss how the process can enhance the productivity of the curators. Specifically, a named entity recognition approach is used to pre-annotate terms referring to a set of domain entities which are potentially relevant for the curation process. The annotated documents are presented to the curator, who, thanks to a custom-designed interface, can select sentences containing specific types of entities, thus restricting the amount of text that needs to be inspected. Additionally, a module capable of computing semantic similarity between sentences across the entire collection of articles to be curated is being integrated in the system. We tested the module using three sets of scientific articles and six domain experts. All these improvements are gradually enabling us to obtain a high throughput curation process with the same quality as manual curation.

Diagnosis and Treatment of Atrial Fibrillation.

Atrial fibrillation is a supraventricular arrhythmia that adversely affects cardiac function and increases the risk of stroke. It is the most common arrhythmia and a major source of morbidity and mortality; its prevalence increases with age. Pulse rate is sensitive, but not specific, for diagnosis, and suspected atrial fibrillation should be confirmed with 12-lead electrocardiography. Because normal electrocardiographic findings do not rule out atrial fibrillation, home monitoring is recommended if there is clinical suspicion of arrhythmia despite normal test results. Treatment is based on decisions made regarding when to convert to normal sinus rhythm vs. when to treat with rate control, and, in either case, how to best reduce the risk of stroke. For most patients, rate control is preferred to rhythm control. Ablation therapy is used to destroy abnormal foci responsible for atrial fibrillation. Anticoagulation reduces the risk of stroke while increasing the risk of bleeding. The CHA2DS2-VASc scoring system assesses the risk of stroke, with a score of 2 or greater indicating a need for anticoagulation. The HAS-BLED score estimates the risk of bleeding. Scores of 3 or greater indicate high risk. Warfarin, dabigatran, factor Xa inhibitors (e.g., rivaroxaban, apixaban, edoxaban), and aspirin are options for stroke prevention. Selection of therapy should be individualized based on risks and potential benefits, cost, and patient preference. Left atrial appendage obliteration is an option for reducing stroke risk. Two implantable devices used to occlude the appendage, the Watchman and the Amplatzer Cardiac Plug, appear to be as effective as warfarin in preventing stroke, but they are invasive. Another percutaneous approach to occlusion, wherein the left atrium is closed off using the Lariat, is also available, but data on its long-term effectiveness and safety are still limited. Surgical treatments for atrial fibrillation are reserved for patients who are undergoing cardiac surgery for other reasons.

[Outbreak due to Serratia marcescens associated with intrinsic contamination of aqueous chlorhexidine]. / Brote de infección nosocomial por Serratia marcescens asociado a contaminación intrínseca de clorhexidina acuosa.

Serratia marcescens is a widely distributed gram-negative rod, often associated to nosocomial infections. Some outbreaks linked to contaminated antiseptic solutions have been reported. In this study we report a nosocomial outbreak of surgical site infection and catheter insertion site infection due to S. marcescens. 33 patients with positive cultures were studied after an index case was identified. Epidemiological, microbiological and molecular analysis demostrated an intrinsic contamination of alcohol free chlorhexidine solution as causal factor. Positive cultures were associated with 13 clinical infections, 9 colonized patients, 6 pseudobacteremia episodes and 5 patients without documented exposure. Hospital and national recall of contaminated chlorhexidine solution was performed after this study. Intrinsic contamination of antiseptic solutions is an infrequent cause of nosocomial infections with major epidemiological relevance.

Construcción de una escala para evaluar factores situacionales y externos asociados al rendimiento desportivo / Construção de uma escala para avaliar fatores situacionistas e externos associados ao desempenho esportivo / Construction of an instrument to assess situational and external factors associated to sports performance

Existen principalmente tres grupos de factores que afectan el rendimiento de los deportistas: situacionales, externos y de personalidad o internos (González- Boto et al., 2006; Márquez, 2004; Weinberg & Gould, 1996), y aunque existen diversos instrumentos para evaluar factores de personalidad, no los hay para medir las fuentes situacionales y externas que pueden afectar el rendimiento de los deportistas. Conocer estos factores, permitirá diseñar estrategias para optimizar su desempeño. Objetivo: construir y validar un instrumento para medir los factores situacionales y externos que afectan a los deportistas de alto rendimiento. Método: se contó con la participación de 243 deportistas. Resultado: el resultado final fue un instrumento de 19 reactivos distribuidos en cuatro subescalas: Incertidumbre, Importancia de la competencia, Percepción hábitos de descanso y alimentación, y Percepción de Entrenamiento, con un nivel de confiabilidad total de .724, el cual se encuentra en un rango aceptable para la investigación básica. Conclusión: no obstante es necesario seguir trabajando teórica y estadísticamente para obtener mejores niveles de confiabilidad. Sin embargo, ya se cuenta con un instrumento útil para identificar los factores externos y situacionales que inciden en el rendimiento de los deportistas.

Existem principalmente três grupos de fatores que afetam o desempenho dos esportistas: situacionistas, externos e de personalidade ou internos(González- Boto et al., 2006; Márquez, 2004; Weinberg & Gould, 1996),e, embora existam vários instrumentos para medir os fatores da personalidade,não existem ainda para medir as fontes situacionistas e externasque podem afetar o desempenho dos esportistas. Conhecer estes fatores permitira desenhar estratégias para aperfeiçoar o desempenho. Objetivo:Construir e validar um instrumento para medir os fatores situacionistas e externos que afetam aos esportistas de alto desempenho. Método: Contou-se com a participação de 243 esportistas. Resultado: O resultado final foi um instrumento de 19 reagentes distribuídos em quatro sue-escalas:Incerteza, Importância da competição, Percepção costumes de descanso e alimentação, e Percepção do treino, com um nível de confiabilidade totalde, 724, o qual se encontra numa faixa aceitável para a pesquisa básica.Conclusão: não obstante, é preciso continuar trabalhando teórica e estatisticamente para obter melhores níveis de confiabilidade. No entanto,conta-se com um instrumento útil para identificar os fatores externos e situacionistas que incidem no desempenho dos esportistas.

There are mainly three groups of factors that influence the performance ofathletes: situational, external and personality or internal (González- Botoet al., 2006; Márquez, 2004; Weinberg & Gould, 1996), even though thereare several instruments to assess personality factors, there are none toasses the external and situational sources that may affect the performanceof athletes. A deeper knowledge of these factors will allow the design ofperformance optimizing strategies. Objective: Construct and validate aninstrument intended to measure the situational and external factors thatinfluence high-performance athletes. Method: A total of 243 athletes participated.Results: The final result was a 19-item instrument, distributed infour subscales: Uncertainty, Importance of competition, Perception of restingand feeding habits, and Perception of Training, with a Cronbach’s alphaof .724, within an acceptable range for basic research. Conclusion: Eventhough it is necessary to continue working at both theoretical and statisticallevels in order to reach higher internal consistency, the present is a usefulinstrument to identify external and situational factors that affect the performanceof athletes.

Brote de infección nosocomial por Serratia marcescens asociado a contaminación intrínseca de clorhexidina acuosa / Outbreak due to Serratia marcescens associated with intrinsic contamination of aqueous chlorhexidine

Serratia marcescens is a widely distributed gram-negative rod, often associated to nosocomial infections. Some outbreaks linked to contaminated antiseptic solutions have been reported. In this study we report a nosocomial outbreak of surgical site infection and catheter insertion site infection due to S. marcescens. 33 patients with positive cultures were studied after an index case was identified. Epidemiological, microbiological and molecular analysis demostrated an intrinsic contamination of alcohol free chlorhexidine solution as causal factor. Positive cultures were associated with 13 clinical infections, 9 colonized patients, 6 pseudobacteremia episodes and 5 patients without documented exposure. Hospital and national recall of contaminated chlorhexidine solution was performed after this study. Intrinsic contamination of antiseptic solutions is an infrequent cause of nosocomial infections with major epidemiological relevance.

Serratia marcescens es un bacilo gramnegativo de amplia distribución, frecuentemente asociado a infecciones nosocomiales. Se han descrito brotes asociados a la contaminación de diversas soluciones antisépticas. Describimos a continuación un brote de infección de sitio operatorio (ISO) y de infección de sitio de inserción de catéter vascular (ISC) por S. marcescens. A raíz de un caso índice se estudió un total de 33 pacientes con cultivo positivo para S. marcescens. El análisis epidemiológico, microbiológico y molecular logró demostrar la contaminación intrínseca de un lote de clorhexidina acuosa, como fuente común de exposición. Las muestras positivas correspondieron a 13 infecciones clínicas, nueve colonizaciones, seis pseudo-bacteriemias y cinco pacientes sin exposición demostrada. Los resultados de este estudio determinaron el retiro del producto de la institución y posteriormente a nivel nacional. La contaminación intrínseca de antisépticos es una causa poco frecuente de brotes de infecciones nosocomiales cuya identificación posee un gran impacto epidemiológico.

Funciones ejecutivas y sintomatología asociada con los trastornos de la conducta alimentaria / Executive functions and symptoms associated with eating disorders

Estudios recientes coinciden en que las pacientes con trastornos de la conducta alimentaria (TCA) presentan ineficiencias en las funciones ejecutivas secundarias al padecimiento. Así, el objetivo de este trabajo fue explorar la posibilidad de que tales ineficiencias formen parte del endofenotipo de los TCA y que no sean únicamente consecuencias de los mismos. Para ello, se evaluaron 69 mujeres: 23 con TCA, 23 con sintomatología asociada a los TCA y 23 sin sintomatología de riesgo a desarrollarlas. Todas las participantes respondieron el cuestionario de actitudes hacia la alimentación, la entrevista diagnóstica de trastornos alimentarios-IV, la Torre de Londres y la prueba de clasificación de tarjetas de Wisconsin. Los resultados mostraron ineficiencias en las funciones ejecutivas, específicamente en la planeación y en la flexibilidad de pensamiento, en el grupo con sintomatología asociada a los TCA similares a las que presentaron las participantes con TCA; hallazgos que abren la posibilidad de que las dificultades sean previas al establecimiento y que incluso pudiesen constituirse como un factor de riesgo.

Recent studies agree in that patients with Eating Disorders (ED) suffer from inefficiencies in Executive Functions as a consequence of the disease. In order to determine whether or not such inefficiencies make part of the endophenotype of ED-not that they result as a mere consequence of ED-69 women were evaluated: 23 diagnosed with ED, 23 with symptoms associated to ED and 23 women without any ED or risks for developing them. All participants were administered the Eating Attitude Test (EAT -40), the Interview for Diagnosis of Eating Disorders-IV (IDED -IV), the Tower of London Test and the Wisconsin Card Sorting Test. The results showed inefficiencies in executive functions-specifically in planning and cognitive flexibility for both the analogous symptoms group and the diagnosed ED group. The findings suggest that these alterations could be present prior to the establishment of the ED, and that they can actually constitute a risk factor.

Morbilidad y mortalidad materna en una institución de salud en el año 2012 / Morbidity and mortality maternal health in an institution 2012

Objetivo: Analizar la morbilidad y mortalidad materna en una institución de salud en 2012. Materiales y método: Estudio descriptivo transversal retrospectivo. La población estudiada fue tomada de la base datos del Comité materno-infantil del Hospital Universidad del Norte (hun). Casos que clasificaron en los criterios mme establecidos durante 2012. Ya obtenida la información, en el análisis de los datos se utilizó la herramienta Statgraphics, para gestionar y analizar los valores estadísticos. También se utilizó Microsoft Word y Excel para organizar gráficos, tablas y redactar su respectivo análisis. Resultados: Del total de casos presentados, un alto porcentaje (97 %) presentó morbilidad materna extrema, seguido de un 3 % que presentó mortalidad materna en 2012. Del total de casos presentados, un alto porcentaje (72 %) se presentó en el primer semestre y un 28 % en el segundo semestre. Conclusión: Este tipo de análisis es el punto de partida para obtener una mayor comprensión del problema de Morbimortalidad Materna. Después de hacer una primera aproximación mediante la descripción de la situación, es decir, conocer los criterios que más incidencia tienen, el siguiente paso es identificar los factores determinantes que están influyendo para su presentación, pero ante todo, reconocer cuáles fueron las conductas o las condiciones que impidieron que estas madres murieran, con el fin de aplicar este conocimiento en la atención de futuras mujeres.

Methods: Retrospective cross-sectional descriptive study. The study population is taken from the datábase of mother to infant Committee Hospital Universidad del Norte (hun). Cases classified mme criteria established in 2012. Since the information obtained in the data analysis Stat graphics tool was used to manage and analyze statistical values. Also used Microsoft Word and Excel to organize graphics, tables and write their analysis Results Influencingfor presentation, but above all, recognize what were the behaviors or conditions that prevented these mothers die, in order to apply this knowledge in the care of future women. Of the cases presented a high percentage (97 %) presented extreme maternal morbidity, followed by a 3 % maternal mortality presented in 2012. Of the cases presented a high percentage (72 %) occurred in the first half, 28 % occurred in the second half. Conclusión: This type of analysis is the starting point for a better understanding of the problem of Maternal Morbidity. After a first approximation by describing the situation, that is to say, knowing the greatest incidence criteria, the next step is to identify the de-terminants that are.

Obstructive sleep apnea: a diagnostic and treatment guide.

Patients with this common sleep disorder often fit the classic profile- - but not always. Here' s help knowing what to look for and when to test, as well as how best to treat it.

Atrial fibrillation: diagnosis and treatment.

Atrial fibrillation is the most common cardiac arrhythmia. It impairs cardiac function and increases the risk of stroke. The incidence of atrial fibrillation increases with age. Key treatment issues include deciding when to restore normal sinus rhythm, when to control rate only, and how to prevent thromboembolism. Rate control is the preferred management option in most patients. Rhythm control is an option for patients in whom rate control cannot be achieved or who have persistent symptoms despite rate control. The current recommendation for strict rate control is a resting heart rate of less than 80 beats per minute. However, one study has shown that more lenient rate control of less than 110 beats per minute while at rest was not inferior to strict rate control in preventing cardiac death, heart failure, stroke, and life-threatening arrhythmias. Anticoagulation therapy is needed with rate control and rhythm control to prevent stroke. Warfarin is superior to aspirin and clopidogrel in preventing stroke despite its narrow therapeutic range and increased risk of bleeding. Tools that predict the risk of stroke (e.g., CHADS2) and the risk of bleeding (e.g., Outpatient Bleeding Risk Index) are helpful in making decisions about anticoagulation therapy. Surgical options for atrial fibrillation include disruption of abnormal conduction pathways in the atria, and obliteration of the left atrial appendage. Catheter ablation is an option for restoring normal sinus rhythm in patients with paroxysmal atrial fibrillation and normal left atrial size. Referral to a cardiologist is warranted in patients who have complex cardiac disease; who are symptomatic on or unable to tolerate pharmacologic rate control; or who may be candidates for ablation or surgical interventions.

Riesgo para trastorno alimentario, ansiedad, depresión y otras emociones asociadas a la exposición de imágenes publicitarias / Risk for eating disorders, anxiety, depression and other emotions related to publicitary images exposure

Con el objetivo de explorar los niveles de ansiedad, depresión, y las emociones producidas por las imágenes presentadas en los medios de comunicación, y su relación con el riesgo para los trastornos de la conducta alimentaria, se realizó un estudio test-postest en el que participaron un total de 376 mujeres, 140 fueron expuestas a imágenes de mujeres delgadas, 127 a imágenes de mujeres con sobrepeso y 109 a imágenes de mujeres ejercitándose o comiendo de manera “saludable.” Todas las participantes fueron evaluadas con la Prueba de Actitudes hacia la Alimentación (EAT-40), el Inventario de Ansiedad Rasgo-Estado (IDARE), la lista de adjetivos de Axelrod y un Cuestionario de Emociones. Los resultados revelaron que tanto los niveles de depresión como los de ansiedad se elevan en las participantes con riesgo a trastorno alimentario después de observar las imágenes, pero que disminuyen en el resto de las jóvenes. Pero, en general, las participantes que se expusieron a imágenes de mujeres delgadas reportaron emociones más negativas hacia sus cuerpos que aquellas que fueron expuestas a imágenes de mujeres con sobrepeso. Los hallazgos sugieren que el ideal transmitido a través de los medios de comunicación promueve emociones desagradables que pueden poner en riesgo la conducta alimentaria de las jóvenes (AU)

In order to explore the anxiety and depression levels, the emotions produced by images taken from media and risk for eating disorderes, a total of 376 women participated in this test-postest study, 140 of the participants were exposed to thin women images, 127 to overweight women images and 109 to women exercising or eating in a “healthy” way images. All participants were evaluated with the Eating Attitude Test (EAT-40), the State-Trait Anxiety Inventory (STAI), the Axelrod Adjective Checklist and an Emotion Questionary. Results revealed that depression and anxiety levels increased in all participants at risk for eating disorders after exposure to images, but levels decreased for the rest of the participants. However, participants exposed to thin women images reported more negative emotions towards their bodies than those who were exposed to overweight women images. Findings suggest that the ideal transmitted through media promote disgusting emotions in young women, which may put them at risk for eating disorder (AU)

Visoconstructive deficits and risk of developing eating disorders.

In order to explore if neuropsychological deficits on visual constructional ability could be related to risk eating behaviors, a total of 102 women were evaluated, 51 of the participants had been formally diagnosed with eating disorders and 51 did not. All participants were given the Eating Attitude Test (EAT-40), The Rey-Osterrieth Complex Figure and The Tower of London Task. Results revealed the existence of a deficit on visual integration similar to those observed in other studies with diagnosed patients. The group at risk showed a comparatively reduced ability on the tasks and the control participants' execution was on the average. Findings revealed the need for designing studies to evaluate neuropsychological processes as possible risk factors which predict eating disorders.

Visoconstructive Deficits and Risk of Developing Eating Disorders

In order to explore if neuropsychological deficits on visual constructional ability could be related to risk eating behaviors, a total of 102 women were evaluated, 51 of the participants had been formally diagnosed with eating disorders and 51 did not. All participants were given the Eating Attitude Test (EAT-40), The Rey-Osterrieth ComplexFigure and The Tower of London Task. Results revealed the existence of a deficit on visual integration similar to those observed in other studies with diagnosed patients. The group at risk showed a comparatively reduced ability on the tasks and the control participants’ execution was on the average. Findings revealed the need for designing studies to evaluate neuropsychological processes as possible risk factors which predict eating disorders (AU)

A fin de explorar si las deficiencias neuropsicológicas en el proceso visoconstructivo están relacionadas con conductas alimentarias de riesgo, se evaluó un total de 102 mujeres, 51 presentaban conductas de riesgo y 51 no las presentaban. A todas las participantes se les aplicó el Cuestionario de Actitudes hacia la Alimentación (EAT-40); la Figura Compleja de Rey-Osterrieth y la Torre de Londres. Los resultados revelaron la existencia de un déficit en la integración visual similar al observado en otros estudios realizados con pacientes diagnosticadas. El grupo con riesgo mostró una reducción en tales habilidades en comparación con el desempeño de los participantes sin riesgo, mismo que estuvo dentro del promedio. Los hallazgos revelan la necesidad de diseñar estudios que evalúen los procesos neuropsicológicos como posibles factores predictores de los trastornos de la conducta alimentaria (AU)