Influence of Meteorological Temperature and Pressure on the Severity of Heart Failure Decompensations.

OBJECTIVE: To investigate the relationship between ambient temperature and atmospheric pressure (AP) and the severity of heart failure (HF) decompensations. METHODS: We analysed patients coming from the Epidemioloy Acute Heart Failure Emergency (EAHFE) Registry, a multicentre prospective cohort study enrolling patients diagnosed with decompensated HF in 26 emergency departments (EDs) of 16 Spanish cities. We recorded patient and demographic data and maximum temperature (Tmax) and AP (APmax) the day before ED consultation. Associations between temperature and AP and severity endpoints were explored by logistic regression. We used restricted cubic splines to model continuous non-linear associations of temperature and AP with each endpoint. RESULTS: We analysed 16,545 patients. Daily Tmax and APmax (anomaly) of the day before patient ED arrival ranged from 0.8 to 41.6° and from - 61.7 to 69.9 hPa, respectively. A total of 12,352 patients (75.2%) were hospitalised, with in-hospital mortality in 1171 (7.1%). The probability of hospitalisation by HF decompensation showed a U-shaped curve versus Tmax and an increasing trend versus APmax. Regarding temperature, hospitalisation significantly increased from 20 °C (reference) upwards (25 °C: OR = 1.12, 95% CI = 1.04-1.21; 40 °C: 1.65, 1.13-2.40) and below 5.4 °C (5 °C: 1.21, 1.01-1.46). Concerning the mean AP of the city (anomaly = 0 hPa), hospitalisation increased when APmax (anomaly) was above + 7.0 hPa (atmospheric anticyclone; + 10 hPa: 1.14, 1.05-1.24; + 30 hPa: 2.02. 1.35-3.03). The lowest probability of mortality also corresponded to cold-mild temperatures and low AP, with a significant increased risk only found for Tmax above 24.3 °C (25 °C: 1.13, 1.01-1.27; 40 °C: 2.05, 1.15-3.64) and APmax (anomaly) above + 3.4 hPa (+ 10 hPa: 1.21, 1.07-1.36; + 30 hPa: 1.73, 1.06-2.81). Sensitivity analysis confirmed the main analysis results. CONCLUSION: Temperature and AP are independently associated with the severity of HF decompensations, with possible different effects on the need for hospitalisation and in-hospital mortality.

Telomeres Length Variations in a Rheumatoid Arthritis Patients Cohort at Early Disease Onset and after Follow-Up.

Background: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic synovial joint inflammation, progressive disability, premature immune aging, and telomere length (TL) shortening. Objectives: The objective of the study was to study TL changes in patients at early disease onset and after follow-up. Methods: Relative leukocyte TL (rLTL) was measured by quantitative polymerase chain reaction (qPCR) in 88 at-admission patients (AAP) with < 1 year of symptoms onset, self-compared after follow-up, and a reference group of sex- and age-matched healthy individuals. Correlations between rLTL percentage change after variable disease exposure time (DET) and clinical laboratory disease activity markers and treatments were assessed. Non-parametrical statistics were applied, considering < 0.05 p-value significant. Results: The median (p25, p75) rLTL was lower in patients after DET (0.61, 0.49-0.70) than in AAP (0.64, 0.50-0.77), p = 0.017. Furthermore, telomeres at early stages of RA were shorter than in the reference group (0.77, 0.59-0.92; p = 0.003). HLA-DRB1*04 allele carrier status did not significantly affect rLTL at an early stage and after follow-up. The patients' rLTL shortening was mainly associated with longer at-admission telomeres (OR 16.2, 95%CI: 3.5-74.4; p < 0.0001). Conclusions: At follow-up, RA patients showed significantly shorter rLTL than AAP, particularly in those AAP with longer telomeres, disregarding disease activity and treatments, denoting an rLTL shortening effect influenced by age, DET, and native rLTL.

Telomeres Length Variations in a Rheumatoid Arthritis Patients Cohort at Early Disease Onset and after Follow-Up

ABSTRACT Background: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic synovial joint inflammation, progressive disability, premature immune aging, and telomere length (TL) shortening. Objective: The objective of the study was to study TL changes in patients at early disease onset and after follow-up. Methods: Relative leukocyte TL (rLTL) was measured by quantitative polymerase chain reaction (qPCR) in 88 at-admission patients (AAP) with < 1 year of symptoms onset, self-compared after follow-up, and a reference group of sex- and age-matched healthy individuals. Correlations between rLTL percentage change after variable disease exposure time (DET) and clinical laboratory disease activity markers and treatments were assessed. Non-parametrical statistics were applied, considering < 0.05 p-value significant. Results: The median (p25, p75) rLTL was lower in patients after DET (0.61, 0.49-0.70) than in AAP (0.64, 0.50-0.77), p = 0.017. Furthermore, telomeres at early stages of RA were shorter than in the reference group (0.77, 0.59-0.92; p = 0.003). HLA-DRB1*04 allele carrier status did not significantly affect rLTL at an early stage and after follow-up. The patients' rLTL shortening was mainly associated with longer at-admission telomeres (OR 16.2, 95%CI: 3.5-74.4; p < 0.0001). Conclusion: At follow-up, RA patients showed significantly shorter rLTL than AAP, particularly in those AAP with longer telomeres, disregarding disease activity and treatments, denoting an rLTL shortening effect influenced by age, DET, and native rLTL.

Síndrome de hiperémesis por cannabis: incidencia y tratamiento con capsaicina tópica / Cannabis hyperemesis syndrome: Incidence and treatment with topical capsaicin

Introducción: Existen pocos estudios en España acerca del síndrome de hiperémesis cannabinoide (SHC), así como sobre el uso de capsaicina tópica para su tratamiento.Métodos:Estudio retrospectivo de pacientes mayores de 14 años atendidos en un servicio de urgencias hospitalario durante 2018 y 2019 con diagnóstico de SHC con base en los siguientes criterios: cuadro clínico compatible, consumo de cannabis menor de 48h y test de cannabis en orina positivo. Se recogieron variables epidemiológicas, clínicas, tiempos asistenciales y tratamiento (incluyendo el uso de capsaicina tópica al 0,075%).Resultados:Se estudiaron 59 asistencias de 29 pacientes (4,4 casos/10.000 visitas, IC 95% 2,8-4,7). Un 50% volvieron a urgencias por SHC, diferenciándose estos solo en más consumo de tabaco (p=0,01) y cocaína (p=0,031). En un 74,6% de las visitas se utilizó capsaicina. El tiempo medio de resolución de los vómitos tras su aplicación fue de 17,87min.Conclusiones:Aunque probablemente esté infradiagnosticado, el SHC presenta una incidencia baja en las urgencias en España, y con alta reincidencia de los pacientes. El uso de pomada de capsaicina es eficiente y seguro. (AU)

There are few studies in Spain on cannabinoid hyperemesis syndrome (CHS), as well as on the use of topical capsaicin as a treatment.Methods:Retrospective study of patients over 14 years of age seen in a hospital emergency department during 2018 and 2019 with a diagnosis of CHS based on the following criteria: compatible clinical picture, cannabis use less than 48h and positive urine cannabis test. Epidemiological and clinical variables, attendance times and treatment (including use of topical capsaicin 0.075%) were collected.Results:Fifty-nine attendances were studied, from 29 patients (4.4 cases/10,000 visits, 95% CI 2.8-4.7). Fifty per cent returned for CHS, differing only in more tobacco (P=.01) and cocaine (P=.031) use. Capsaicin was used in 74.6% of visits. The mean time to resolution of vomiting after application was 17.87min.Conclusions:Although probably underdiagnosed, CHS has a low incidence in the emergency department in Spain, with high patient recurrence. The use of capsaicin ointment is efficient and safe. (AU)

A photographic data set of reef and coral communities across Venezuela.

This dataset contains 2850 photographs of the seafloor in coral communities from Venezuela that were taken during 2017 and 2018. We used a hierarchical experimental design with four random factors representing four different spatial scales: (1) region (hundreds of kilometers), (2) localities (tens of kilometers), (2) reef sites (hundreds of meters) and (3) transects (a couple meters) across the Venezuelan coast. At each site, four 30-m transects were deployed parallel to the coastline, and 15 pictures were taken every other meter at each transect, containing an area of at least 80 × 90cm with enough resolution to identify benthic groups. This dataset covers spatial scales from a few meters to hundreds of kilometers; marine protected areas, and non-protected areas; coastal zones, continental and oceanic islands. These images have the potential to be further used for training researchers in benthic organisms identification, and training artificial intelligence classification algorithms. Also, they represent and updated baseline to perform spatial and temporal comparisons in Venezuela or further studies involving multiple spatial scales in the region.

A Novel, Likely Pathogenic MAX Germline Variant in a Patient With Unilateral Pheochromocytoma.

CONTEXT: Inherited MYC-associated factor X (MAX) gene pathogenic variants (PVs) increase risk for pheochromocytomas (PCCs) and/or paragangliomas (PGLs) in adults and children. There is little clinical experience with such mutations. OBJECTIVE: This report highlights an important approach. METHODS: Clinical assessment, including blood chemistry, imaging studies, and genetic testing were performed. RESULTS: A 38-year-old Hispanic woman was diagnosed with PCC in 2015, treated with adrenalectomy, and referred to endocrinology clinic. Notably, she presented to her primary care physician 3 years earlier complaining of left flank pain, intermittent diaphoresis, and holocranial severe headache. We confirmed severe hypertension (180/100 mm Hg) over multiple antihypertensive regimens. Biochemical and radiological studies workup revealed high plasma metanephrine of 255 pg/mL (normal range, < 65 pg/mL) and plasma normetanephrine of 240 pg/mL (normal range, < 196 pg/mL). A noncontrast computed tomography scan of the abdomen revealed a 4.2 × 4.3 × 4.9-cm, round-shaped and heterogenous contrast enhancement of the left adrenal gland, and a 2-mm nonobstructive left kidney stone. A presumptive diagnosis of secondary hypertension was made. After pharmacological therapy, laparoscopic left adrenalectomy was performed and confirmed the diagnosis of pheochromocytoma. Based on her age, family history, and a high suspicion for genetic etiology, genetic testing was performed that revealed the presence of a novel likely pathogenic variant involving a splice consensus sequence in the MAX gene, designated c0.64-2A > G. CONCLUSION: The phenotype of MAX PV-related disease and paraganglioma are highlighted. The novel c0.64-2A > G mutation is reported here and should be considered in the diagnostic workup of similar cases.

The use of pseudo-multivariate standard error to improve the sampling design of coral monitoring programs.

The characteristics of coral reef sampling and monitoring are highly variable, with numbers of units and sampling effort varying from one study to another. Numerous works have been carried out to determine an appropriate effect size through statistical power; however, these were always from a univariate perspective. In this work, we used the pseudo multivariate dissimilarity-based standard error (MultSE) approach to assess the precision of sampling scleractinian coral assemblages in reefs of Venezuela between 2017 and 2018 when using different combinations of number of transects, quadrats and points. For this, the MultSE of 36 sites previously sampled was estimated, using four 30m-transects with 15 photo-quadrats each and 25 random points per quadrat. We obtained that the MultSE was highly variable between sites and is not correlated with the univariate standard error nor with the richness of species. Then, a subset of sites was re-annotated using 100 uniformly distributed points, which allowed the simulation of different numbers of transects per site, quadrats per transect and points per quadrat using resampling techniques. The magnitude of the MultSE stabilized by adding more transects, however, adding more quadrats or points does not improve the estimate. For this case study, the error was reduced by half when using 10 transects, 10 quadrats per transect and 25 points per quadrat. We recommend the use of MultSE in reef monitoring programs, in particular when conducting pilot surveys to optimize the estimation of the community structure.

Catalytically Impaired TYK2 Variants are Protective Against Childhood- and Adult-Onset Systemic Lupus Erythematosus in Mexicans.

Type I interferon (IFN-I) pathway plays a central role in the systemic lupus erythematosus (SLE) pathogenesis. Recent data suggest that SLE is associated with variants in IFN-I genes, such as tyrosine kinase 2 (TYK2), which is crucial in anti-viral immunity. Here, five TYK2 single nucleotide polymorphisms (SNPs) were genotyped in 368 childhood-onset SLE Mexican patients and 516 sex-matched healthy controls. Allele frequencies were also estimated in four indigenous groups. SLE protection was associated with TYK2 risk infection variants affecting residually its catalytic domain, rs12720356 (OR = 0.308; p = 0.041) and rs34536443 (OR = 0.370; p = 0.034), but not with rs2304256, rs12720270, and rs280500. This association was replicated in a 506 adult-onset SLE patients sample (OR = 0.250; p = 0.005, and OR = 0.277; p = 0.008, respectively). The minor alleles of both associated SNPs had a lower frequency in Mestizos than in Spaniards and were absent or rare in indigenous, suggesting that the presence of these alleles in the Mexican Mestizo population was derived from the Spaniards. For the first time, we report genetic variants with a protective effect in childhood- and adult-onset SLE Mexican population. Our results suggest that the frequency of IFN-I alleles associated with SLE, may have been shaped in populations exposed to infectious diseases for long periods, and this could be an explanation why Native American ancestry is associated with a higher SLE prevalence and an earlier onset.

Respuesta del crecimiento de Pinus oocarpa a variables climáticas en Chiapas, México / Growth response of Pinus oocarpa to climatic variables in Chiapas, Mexico

Resumen Los estudios dendrocronológicos se utilizan para reconstruir algunas variables climáticas; en México, estos estudios se han centrado en los bosques templados del centro y del norte, donde los árboles presentan anillos anuales bien definidos. Pocos estudios se han llevado a cabo en la parte sur del país, donde el crecimiento anual del anillo no se identifica fácilmente y, por lo tanto, esto hace que la datación se dificulte. Se analizó el potencial dendrocronológico de Pinus oocarpa para la reconstrucción de variables climáticas en la porción noroeste de Lagunas de Montebello, Chiapas. Empleando un muestreo selectivo se recolectaron 65 núcleos de incremento de 34 árboles. Aunque las muestras presentaron una alta frecuencia de anillos falsos (8 a 60 %), se logró fechar 30 muestras de 22 árboles (46 %) mediante técnicas dendrocronológicas estándar y el desarrollo de cronologías de anillo total, madera temprana y madera tardía para un período de 91 años (1925-2015). Se encontró una influencia significativa de la precipitación media y de la temperatura media máxima y mínima del período 1961-2004 sobre el crecimiento anual de P. oocarpa. Los resultados muestran que la precipitación inviernoprimavera (enero-mayo) fue la más importante para el crecimiento del anillo anual de la especie. Sin embargo, la correlación más alta se observó entre la precipitación de primavera (marzo-mayo) y la cronología de la madera temprana (r = 0.719, P < 0.05). La cronología de la madera temprana también mostró potencial para reconstruir la temperatura mínima (marzo a mayo) (r = 0.732, P < 0.05), mientras que la cronología de madera tardía registra potencial para reconstruir la temperatura máxima (septiembreenero) (r = 0.714, P < 0.05). Estos resultados muestran que P. oocarpa puede emplearse para reconstruir variables climáticas en los trópicos mexicanos. Se recomienda explorar nuevas áreas con árboles más viejos a fin de aumentar la extensión de las cronologías y reconstruir los registros climáticos varios siglos en el pasado.(AU)

Abstract Dendrochronological studies are used to reconstruct some climatic variables; in México these studies have focused on central and Northern temperate forests where trees present well defined annual rings. Few studies have been carried out in the Southern part of the country where annual ring growth is not easily identified and thus makes cross-dating problematic. We analyzed the dendrochronological potential of Pinus oocarpa Schiede for reconstructing climatic variables in the Northwest portion of Lagunas de Montebello, Chiapas. We used a selective sampling approach and collected 65 increment cores from 34 trees. While our samples showed a high frequency of false rings (8 to 60 %), we were able to date 30 samples from 22 trees (46 %) using standard dendrochronological techniques and developed total chronologies for total ring width, earlywood, and latewood for a period of 91 years (1925-2015). We found a significant influence of mean precipitation and mean maximum and minimum temperature over the annual ring growth of P. oocarpa in the period 1961-2004. Our results show that winter-spring precipitation (January-May) was the most important for the species' annual ring growth. However, we found the highest correlation between spring (March-May) precipitation and the earlywood chronology (r = 0.719, P < 0.05). The earlywood chronology also showed potential for reconstructing minimum temperatures (March to May) (r = 0.732, P < 0.05), while the latewood chronology had the potential for reconstructing the maximum temperature (September to January) (r = 0.714, P < 0.05). These results showed that P. oocarpa can be used to reconstruct climatic variables in the Mexican tropics. We recommend that new areas with older trees should be explored in order to increase the depth of chronologies and reconstruct climate records several centuries into the past.(AU)

Factores de riesgo para hipotensión en anestesia regional subaracnoidea para cesárea. Papel del Índice Cintura Cadera e Índice de Masa Corporal / Risk factors for hypotension in regional spinal anesthesia for cesarean section. Role of the Waist-to-Hip Ratio and Body Mass Index

Abstract Introduction: Because of its incidence, hypotension under spinal anesthesia has been the subject of study and debate. Studies have been aimed at defining risk factors, clarifying pathophysiology, and creating prophylaxis and management protocols. There are no studies of anthropometric measurements, such as waist-to-hip ratio (WHR) and body mass index (BMI), associated with maternal hypotension. The higher the content of the abdominal cavity, the greater the likelihood of aorto-caval compression syndrome and the higher the risk of hypotension. Objective: To determine if the WHR and the BMI correlate with the probability of developing hypotension in pregnant women undergoing cesarean section under subarachnoid anesthetic block. Materials and methods: A prospective cohort study of 231 women undergoing cesarean section under regional anesthesia. Anthropometric measurements were made before anesthesia, and vital signs were recorded during the procedure at predetermined time points to analyze the hemodynamic status. Hypotension was defined as a systolic blood pressure below 90 mm Hg. Results: The incidence of hypotension was 38%; 45.8% of the women had a WHR >0.99, with an incidence of 21.7% versus 15.2%, and a nonsignificant risk ratio of 2.12 (95% confidence interval [CI] 1.52-3.54, P = 0.021). Women with a BMI >29 had an incidence of 42.8% versus 57.14%, without a significant difference (P = 0.576). There was a significant association between the weight of the newborn >3900g and the risk of hypotension (relative risk 2.12, 95% CI 1.52-3.54, P = 0.021). Conclusion: There was no positive correlation between WHR and BMI, and the risk of developing hypotension. The weight of the newborn must be further analyzed in future studies.

Resumen Introducción: La hipotensión bajo anestesia regional subaracnoidea ha sido tema de estudio y debate, dada su alta incidencia. Los estudios se han encaminado a encontrar factores de riesgo, estudiar fisiopatología, crear protocolos de manejo y profilaxis. No hay estudios de medidas antropométricas, como el índice de relación cintura-cadera (IRCC) e Índice de masa corporal (IMC) asociados a hipotensión en maternas. A mayor contenido en cavidad abdominal, mayor probabilidad de síndrome de compresión aorto-cava y mayor riesgo de hipotensión. Objetivo: Determinar si el Índice de Relación Cintura Cadera y el Índice de masa Corporal se correlacionan con la probabilidad de desarrollar hipotensión en gestantes sometidas a Cesárea bajo anestesia subaracnoidea. Materiales y métodos: estudio analítico de cohorte prospectivo. 231 maternas sometidas a cesárea bajo anestesia regional; se tomaron medidas antropométricas antes de anestesia, se registraron signos vitales durante el procedimiento en momentos preestablecidos para analizar el comportamiento hemodinámico. Se definió hipotensión como tensión arterial sistólica < 90 mmHg. Resultados: La incidencia de hipotensión fue 38%. El 45,8% tuvieron IRCC >0,99 con incidencia de hipotensión de 21,7% vs 15.2% y RR no significativo de 2.12 (IC95% 1.52-3.54 p = 0.021). Pacientes con IMC>29 la incidencia de hipotensión fue 42,8% versus 57.14%, sin diferencias significativas. (p = 0,576). El peso del recién nacido >3.900 gramos se asoció significativamente con riesgo de hipotensión; RR:2.12 (IC95% 1.523.54 p=0.021). Conclusiones: EL Índice Cintura Cadera y el Índice de Masa Corporal no presentaron correlación positiva con el riesgo de presentar hipotensión. El peso del recién nacido debe documentarse en futuros estudios.

Hipotensión bajo anestesia regional subaracnoidea en población no obstétrica / Hypotension under regional spinal anesthesia in non-obstetric population

RESUMEN Introducción: la anestesia regional subaracnoidea es una técnica muy útil; sin embargo, su principial efecto secundario afecta el sistema cardiovascular. Los estudios en población no obstetrica son escasos; la variedad de comorbilidades y tipos de pacientes dificultan el diagnóstico y manejo. Objetivo: revisar la fisiopatología, enfatizar en factores de riesgo y actualizar el manejo de la hipotensión bajo anestesia subaracnoidea en pacientes no obstétricos. Metodología de Búsqueda: se realizó una búsqueda en las bases bibliográficas PubMed, Science Direct, EbscoHost, MEDLINE; se excluyeron aquellos artículos que incluían únicamente población obstétrica. 63 artículos cumplieron los criterios. Conclusiones: los factores de riesgo identificados fueron edad, estado físico previo, hipertensión y obesidad. Aunque no hay consenso en el manejo, identificar pacientes en riesgo permite la intervencion preventiva y tomar decisiones que disminuyan complicaciones mayores. Los líquidos intravenosos como co-carga mantienen vigencia. El uso de vasopresores profilácticos debe limitarse en pacientes con factores de riesgo. MÉD.UIS. 2017;30(1):73-8.

ABSTRACT Introduction: regional subarachnoid anesthesia is a very useful technique. however, the leading side effect affects the cardiovascular system. Few studies regarding non-obstetric population are published. Comorbidities and the variety of patients make the diagnosis and management difficult to establish. Objective: to review physiopathology, and emphasize risk factors and management of hypotension under regional spinal anesthesia. Searching Methodology: literature search was performed using PubMed, Science Direct, EbscoHost and MEDLINE; those exclusively including obstetric population were excluded. 63 articles matched the criteria. Conclusions: the risk factors that were identified were age, physical status, hypertension and obesity. Although there is no consensus in the management protocol, identifying these patients at risk allows a preventive intervention and the taking of measures that avoid major complications. Intravenous fluids as co-loading still remain valid; vasopressors should be limited to patients at risk. MÉD.UIS. 2017;30(1):73-8.

Infección por el virus del papiloma humano y su correlación con situaciones ginecológicas u obstétricas de relevancia clínica: estudio transversal / Human papillomavirus infection and its correlates with clinically relevant gynecological and obstetric conditions: A cross-sectional study

Antecedentes y objetivo: Analizar la prevalencia de la infección por el virus del papiloma humano (VPH) y la posible asociación epidemiológica con las situaciones de relevancia clínica en las mujeres. Material y métodos: Se llevó a cabo un estudio transversal en la ciudad de México desde enero de 2012 a diciembre de 2014. Se realizó la detección molecular del VPH sobre muestras cervicales. Los datos se analizaron utilizando las pruebas estadísticas adecuadas. Resultados: Se analizó a un total de 1.604 mujeres (mediana 47, rango intercuartílico 38-54). La prevalencia global de infección para cualquier VPH fue del 9,91% (IC 95% 8,6-11,3). Se calculó la asociación entre la infección por VPH-16 y el número de abortos (NA) (OR=1,427; IC 95% 1,091-1,866) mediante el univariate regression model (UVRM, ‘modelo de regresión univariada’). Además, la menarquia (OR=1,566; IC 95% 1,079-2,272), el NA (OR=1,570; IC 95% 1,106-2,227) y el número de embarazos (NE) (OR=0,461; IC 95% 0,260-0,818) tienen una asociación directa e inversa con la infección con el genotipo 18 del VPH, respectivamente. También, la infección por los genotipos VPH-HR tiene una asociación inversa con el NE (OR=0,791; IC 95% 0,707-0,884), los partos normales (OR=0,867; IC 95% 0,767-0,979) y el NA (OR=0,715; IC 95% 0,534-0,959) (UVRM), y una asociación directa con el número de parejas sexuales (OR=1,082; IC 95% 1,015-1,154). El inicio de la actividad sexual tiene una asociación inversa con la infección por el genotipo 16 (UVRM: OR=0,814; IC 95% 0,715-0,926; multinomial regression model (MNRM, ‘modelo de regresión multinomial’): OR=0,803; IC 95% 0,702-0,918) y VPH-HR (UVRM: OR=0,933; IC 95% 0,889-0,980; y MNRM: OR=0,912; IC 95% 0,867-0,959). Todos los valores de p fueron inferiores a 0,03. Conclusiones: La prevalencia de la infección cervical por VPH es diferente en relación con la edad, y está asociada a diversas situaciones médicas de relevancia clínica en las mujeres (AU)

Background and objective: To analyze the prevalence of human papillomavirus (HPV) infection and the possible epidemiological association with conditions of clinical relevance in women. Material and methods: A cross-sectional study from Mexico City was conducted from January 2012 to December 2014. HPV molecular detection was performed on cervical samples. Data were analyzed with appropriated statistic tests. Results: A total of 1,604 females (median 47, interquartile range 38-54) were analyzed. Global prevalence of infection for any HPV is 9.91% (95% CI 8.6-11.3). An association between infection with 16-HPV and number of abortions (NA) (OR=1.427; 95% CI 1.091-1.866), by univariate regression model (UVRM) was estimated. Moreover, menarche (OR=1.566; 95% CI 1.079-2.272), NA (OR=1.570; 95% CI 1.106-2.227) and number of pregnancies (NP) (OR=0.461; 95% CI 0.260-0.818) have a direct and inverse association with infection by genotype 18 of HPV, respectively. Also, infection with HR-HPV genotypes has an inverse association with NP (OR=0.791; 95% CI 0.707-0.884) by normal labor (OR=0.867; 95% CI 0.767-0.979) and NA (OR=0.715; 95% CI 0.534-0.959) (UVRM), and a direct association with number of sexual partners (OR=1.082; 95% CI 1.015-1.154). Onset of sexual activity has an inverse association with infection by genotype 16- (UVRM: OR=0.814; 95% CI 0.715-0.926; multinomial regression model (MNRM): OR=0.803; 95% CI 0.702-0.918) and HR-HPV (UVRM: OR=0.933; 95% CI 0.889-0.980, and MNRM: OR=0.912; 95% CI 0.867-0.959), allP values were lower than .03. Conclusions: Prevalence of HPV cervical infection is different according to age and it is associated with several medical conditions of clinical relevance in women (AU)

[Human papillomavirus infection and its correlates with clinically relevant gynecological and obstetric conditions: A cross-sectional study]. / Infección por el virus del papiloma humano y su correlación con situaciones ginecológicas u obstétricas de relevancia clínica: estudio transversal.

BACKGROUND AND OBJETIVE: To analyze the prevalence of human papillomavirus (HPV) infection and the possible epidemiological association with conditions of clinical relevance in women. MATERIAL AND METHODS: A cross-sectional study from Mexico City was conducted from January 2012 to December 2014. HPV molecular detection was performed on cervical samples. Data were analyzed with appropriated statistic tests. RESULTS: A total of 1,604 females (median 47, interquartile range 38-54) were analyzed. Global prevalence of infection for any HPV is 9.91% (95% CI 8.6-11.3). An association between infection with 16-HPV and number of abortions (NA) (OR=1.427; 95% CI 1.091-1.866), by univariate regression model (UVRM) was estimated. Moreover, menarche (OR=1.566; 95% CI 1.079-2.272), NA (OR=1.570; 95% CI 1.106-2.227) and number of pregnancies (NP) (OR=0.461; 95% CI 0.260-0.818) have a direct and inverse association with infection by genotype 18 of HPV, respectively. Also, infection with HR-HPV genotypes has an inverse association with NP (OR=0.791; 95% CI 0.707-0.884) by normal labor (OR=0.867; 95% CI 0.767-0.979) and NA (OR=0.715; 95% CI 0.534-0.959) (UVRM), and a direct association with number of sexual partners (OR=1.082; 95% CI 1.015-1.154). Onset of sexual activity has an inverse association with infection by genotype 16- (UVRM: OR=0.814; 95% CI 0.715-0.926; multinomial regression model (MNRM): OR=0.803; 95% CI 0.702-0.918) and HR-HPV (UVRM: OR=0.933; 95% CI 0.889-0.980, and MNRM: OR=0.912; 95% CI 0.867-0.959), all P values were lower than .03. CONCLUSIONS: Prevalence of HPV cervical infection is different according to age and it is associated with several medical conditions of clinical relevance in women.

Lack of concordance and linkage disequilibrium among brothers for androgenetic alopecia and CAG/GGC haplotypes of the androgen receptor gene in Mexican families.

BACKGROUND: Androgenetic alopecia (AGA) or common baldness is the most prevalent form of hair loss in males. Familial predisposition has been recognized, and heritability estimated in monozygotic twins suggests an important genetic predisposition. Several studies indicate that the numbers of CAG/GGC repeats in exon 1 of the androgen receptor gene (AR) maybe associated with AGA susceptibility. AIMS: To investigate a possible correlation between AR CAG/GGC haplotypes and the presence or not of alopecia in sibships with two or more brothers among them at least one of them has AGA. PATIENTS/METHODS: Thirty-two trios including an alopecic man, one brother alopecic or not, and their mother were enrolled. Sanger sequencing of the exon 1 of the AR gene was conducted to ascertain the number of CAG/GGC repeats in each individual. Heterozygous mother for the CAG/GGC haplotypes was an inclusion criterion to analyze the segregation haplotype patterns in the family. Concordance for the number of repeats and AGA among brothers was evaluated using kappa coefficient and the probability of association in the presence of genetic linkage between CAG and GGC repeats and AGA estimated by means of the family-based association test (FBAT). RESULTS: The median for the CAG and GGC repeats in the AR is similar to that reported in other populations. The CAG/GGC haplotypes were less polymorphic than that reported in other studies, especially due to the GGC number of repeats found. Kappa coefficient resulted in a concordance of 37.3% (IC 95%, 5.0-69.0%) for the AGA phenotype and identical CAG/GGC haplotypes. There was no evidence of linkage disequilibrium. CONCLUSION: Our results do not confirm a possible correlation or linkage disequilibrium between the CAG/GGC haplotypes of the AR gene and androgenetic alopecia in Mexican brothers.

Incidental consequences of antihelmintic treatment in the central nervous system.

BACKGROUND: Neurocysticercosis (NCC) is the most common parasitic infection in the central nervous system and the most common cause of acquired neurological symptoms in young adults living in developing countries. Many "asymptomatic" patients begin experiencing neurological symptoms after the use of antiparasitic drugs for gastrointestinal treatment. Patients who are previously diagnosed with NCC require special care during cysticidal treatment because of the inflammatory effects caused by the interaction between the drug, the parasite, and the host. CASE DESCRIPTION: Of a series of 46 cases, we selected five patients with a history of being "asymptomatic" and who began experiencing neurologic symptoms after the use of albendazole, which led to a diagnosis of cysticercosis. Another case of the patient, who already had been diagnosed of ventricular cysticercosis, was given a drug treatment without consulting the neurosurgeon and had a fatal outcome attributable to secondary meningoencephalitis. RESULTS: In the first five cases, with new neurological symptoms after antihelmintic treatment, the self-prescription is remarkable. The symptoms appear between the third and fifth day of treatment. All of them had a clinical course without complications. Only two cases minimally invasive techniques were required. The case who had been already diagnosed developed meningoencephalitis and died after eight days of antihelmintic treatment. CONCLUSIONS: Anthelminthic drug treatment requires tailor-based prescription considering risk-benefit ratio with the drug-parasite-host interaction in mind. Treatment is not harmless so patients have to be closely watched. In select cases, medical treatment cannot replace surgical procedures, which can be the primary approach with drug treatment as a complement.

Long-term follow-up and pregnancy in a patient with neurenteric cyst: case report.

BACKGROUND: Neurenteric cysts (NC) are rare congenital anomalies. Cysts are secretory with an epithelial lining and features that resemble those of gastrointestinal and/or respiratory mucosa. They originate embryologically and result from an incomplete separation of the neurenteric canal from the foregut. CLINICAL CASE: We describe the 21-year follow-up of a female patient with a history of partial control of urinary and anal sphincters. The patient had a 6-month course of pain associated with saddle hypoesthesia, limited gait, chronic constipation, plus inferior paresthesia of the limbs. These features, along with the MRI findings, were compatible with the diagnosis of neurenteric cyst. The patient underwent two surgical procedures. We used a nonradical approach because of the connection of the cyst with the rectum and nerves in the deep plane. At age 22, she became pregnant and, after an uneventful gestation, gave birth to a healthy newborn. DISCUSSION: The selection of surgical strategy is oriented to mass effect resolution. In accordance with the literature, evaluation of the best choice for each patient is mandatory to obtain a balance of the risk and the potential functional preservation. This report demonstrates the importance of sensory and motor function preservation instead of using aggressive treatment. CONCLUSION: Our goal in each procedure was symptom alleviation, reduction of cyst size, clearance of the mass effect, and an attempt to resect the cyst capsule as much as possible without compromising quality of life and neurological functions.

La Comunicación en la relación médico-paciente / Communication in physician-patient relationship

La Relación Médico Paciente (RMP) se obtiene en una atmósfera distendida donde el paciente exprese con sus palabras y desde su punto de vista, sus Estudios realizados por diferentes autores demuestran que la mejor Relación manifestaciones físicas, psíquicas y emocionales, a lo que el médico debe prestar una escucha atenta y ponerse en el lugar de este. En la relación, el problema de la Comunicación ocupa un primer plano, en tanto que el paciente recibe beneficios o daños no solo con el medicamento sino con la conducta afectiva del médico, con su capacidad de empatía y ello depende en gran medida de las habilidades de la comunicación del médico y su preocupación por los aspectos personales, familiares y sociales. Para identificar los principales problemas que interfieren en la Comunicación de la RMP, se realizó un estudio observacional–descriptivo de tipo prospectivo utilizando la encuesta y la técnica de observación participativa en cinco servicios de salud del Municipio Las Tunas de 1999-2000. La poca privacidad, la mala escucha, el papel posesivo y dominante del médico y la falta de empatía fueron detectados como formas que obstaculizan la comunicación afectiva y el intercambio de información y retroalimentación mutua entre médico y paciente. La comunicación verbal y extraverbal se vieron afectadas por diferentes factores como: interrumpir al paciente cuando habla, el uso inadecuado del lenguaje médico, la no observación de los gestos, la expresión facial y la mirada del paciente. Es necesario desarrollar acciones y estrategias para perfeccionar la comunicación en la RMP(AU)

Studies carried out by different authors have proved that the best doctor-patient relationship is achieved in a relaxing atmosphere where the patient is given the chance to freely express with his own words and from his point of view his physical, psychological and emotional manifestations to which the doctor should keep close attention without offering any judgment and being able to place himself in the patients position. In this relationship, the act of communication places a role of paramount importance since the patient can receive benefits or can even be hurt not only with the treatment, but with the affective attitude of the doctor as well, and it largely depends on the doctors communication skills and his concern about the personal, family and social aspects of the patient. To identify the main problems which interfere in the doctor-patient communication, an observational, descriptive and prospective study was carried out by means of survey, and observational technique in five health areas of Las Tunas Municipality. Lack of privacy, poor listening, the dominant role of the doctor, and lack of empathy were detected as the main barriers which seriously damage the effective communication and exchange of information and mutual feedback between the doctor and the patient. Verbal and non-verbal communication are being affected by different factors such as: interrupting the patient while talking, inadequate use of medical language, non observation of gestures and facial expression among others. It is necessary to implement different strategies in order to improve communication in the doctor-patient relationship(AU)

Calidad de la atención al paciente con traumatismo multiple en la República Dominicana / The quality of the attention to the patient with multipple trauma in Dominican Republic

Se evaluaron consecutivamente 952 pacientes admitidos con traumatismo múltiple para determinar la calidad de la atención recibida desde el rescate hasta su alta del hospital. Ninguno fue rescatado por personal calificado. Sólo tres llegaron en ambulancia. La causa fue accidental en 712 (74.8//) e intencional en 229 (24.1//). Los miembros inferiores fueron los más afectados observándose en 513 (53.9//) pacientes. Cuatrocientos quince pacientes (43.6//) requirieron uno o más procedimientos quirúrgicos. La mayoría fueron tratados por el Servicio de Ortopedia. Hubo complicaciones en 39 (4.1//). Murieron 49 (4.8//), de los cuales 36 (73.5//) presentaban trauma craneoencefálico. Nosotros concluimos que las atenciones tempranas al paciente con traumatismo múltiple son deficientes por carecer de un sistema organizado de rescate en la República Dominicana, lo que ha determinado que los individuos que presentan traumatismos graves con peligro de muerte inmediata o intermedia no alcanzan a llegar al hospital