Diagnostic Algorithm for Intracranial Lesions in the Emergency Department: Effectiveness of the Relative Brain Volume and Hounsfield Unit Value Measured by Perfusion Tomography.

Background Early treatment of intracranial lesions in the emergency department is crucial, but it can be challenging to differentiate between them. This differentiation is essential because the treatment of each type of lesion is different. Cerebral computed tomography perfusion (CTP) imaging can help visualize the vascularity of brain lesions and provide absolute quantification of physiological parameters. Compared to magnetic resonance imaging, CTP has several advantages, such as simplicity, wide availability, and reproducibility. Purpose This study aimed to assess the effectiveness of Hounsfield units (HU) in measuring the density of hypercellular lesions and the ability of CTP to quantify hemodynamics in distinguishing intracranial space-occupying lesions. Methods A retrospective study was conducted from March 2016 to March 2022. All patients underwent CTP and CT scans, and relative cerebral blood volume (rCBV) and HU were obtained for intracranial lesions. Results We included a total of 244 patients in our study. This group consisted of 87 (35.7%) individuals with glioblastomas (GBs), 48 (19.7%) with primary central nervous system lymphoma (PCNSL), 45 (18.4%) with metastases (METs), and 64 (26.2) with abscesses. Our study showed that the HUs for METs were higher than those for GB (S 57.4% and E 88.5%). In addition, rCBV values for PCNSL and abscesses were lower than those for GB and METs. The HU in PCNSL was higher than those in abscesses (S 94.1% and E 96.6%). Conclusion PCT parameters provide valuable information for diagnosing brain lesions. A comprehensive assessment improves accuracy. Combining rCBV and HU enhances diagnostic accuracy, making it a valuable tool for distinguishing between lesions. PCT's widespread availability allows for the use of both anatomical and functional information with high spatial resolution for diagnosing and managing brain tumor patients.

An Overview on Research in a University Hospital, Using a Payback Framework Categorization Approach.

BACKGROUND AND OBJECTIVE: Little information is available on how to assess the impact of research studies conducted in government hospitals in Latin America and specifically in Mexico. We aimed to determine the returns on investment of the research projects that were carried out in the Hospital General "Dr. Manuel Gea Gonzalez" (HGMGG), a general university hospital located in Mexico City, using a categorization model. METHODS: We conducted a study including bibliometric analyses of publications associated with all research studies performed during the period 2016-2019 in the HGMGG and investigator interviews, according to the payback framework categorization model. RESULTS: All studies analyzed had a positive impact based on outcomes in 5 "payback categories": (1) knowledge; (2) research targeting, capacity building, and absorption; (3) policy and product development; (4) health benefits; and (5) broader economic benefits. CONCLUSIONS: To date, it has not been possible to establish a set of indicators that show the results of the investigations carried out by medical specialists in training, who carry out the bulk of medical care in general hospitals and in the National Institutes of Health in Mexico. We identified, in the 5 categories of the payback framework model, different areas of opportunity to improve the benefits of the hospital's medical services through the development of scientific research projects.

Assessing the Malignancy Risk of a Meningioma by Its Location.

BACKGROUND: Meningiomas represent 30% of primary intracranial tumors. The current incidence is up to 4.5 cases per 100,000 habitants worldwide. Although there is no prognostic difference among benign histopathological subtypes, atypical meningiomas and malignant meningiomas (WHO grade II and III respectively) may extend to the adjacent brain parenchyma, dura mater, and osseous tissue with a recurrence score (21-49%). This manuscript analyzes the malignancy risk according to neoplastic localization through a logistic retrospective analysis from a total sample of 452 patients with grade I, II, and III (WHO) meningiomas. METHODS: Detailed data collection through a three-year retrospective analysis (January 2008 to December 2011) was applied at Mexico's National Neurology and Neurosurgery Institute including patients with intracranial or spinal-cord meningioma, preoperative imaging study availability and post-surgical histopathological diagnosis. Formal written consent was not required with a waiver by the appropriate national research ethics committee in accordance with the provisions of the regulations of the general health law of Mexico. RESULTS: Convexity lesions displayed an increased risk of malignancy turning for non-benign meningiomas with an odds ratio of 3.1 (95% CI 1.6 to 5.7, p=0.0002) meanwhile skull-base meningiomas present an inverse risk with an odds ratio of 0.4 (95% CI 0.2 to 0.9, p=0.02), as well as spinal-cord meningiomas with an odds ratio of 0.3 (95% CI 0.1 to 0.9). CONCLUSION: Skull base and spinal cord meningiomas usually have benign behavior, meanwhile grade II or III meningiomas within this location are rare. The present work provides an additional criterion for decision making, according to the meningioma's location.

Clinical, Therapeutic, and Prognostic Experience in Patients With Glioblastoma.

BACKGROUND: Glioblastoma (GB) represents the most aggressive type of glioma with a poor prognosis despite the therapies used. As of today, data availability for therapeutic and prognosis experiences is limited. The cornerstone for this study is to create a framework overview of Mexico´s experience throughout 17 years of research. METHODS: Retrospective analysis from 2000 to 2017 including patients with a histological diagnosis of GB was performed. Data were collected from the ABC Medical Center and the Neurology and Neurosurgery National Institute. RESULTS: One hundred and thirty-seven patients were included with a mean age of 54 years. Histological diagnosis was made in all patients, of which 58.1% had a total resection, 31.6% had a partial resection, and 10.3% of them underwent biopsy. In all cases, patients received treatment under the following conditions: 10 patients were treated exclusively with stereotactic radiotherapy (RT). In 55 patients, a combination of RT and TMZ was used, the other 40 patients received RT plus CBP. Eighteen patients RT added to nitrosourea medication and lastly, 14 patients received a combination of RT/TMZ and Bevacizumab, a monoclonal antibody that inhibits the formation of blood vessels (BVZ). The progression-free survival (PFS) and overall survival (OS) were higher in the RT/TMZ/BVZ group (16.5 to 22.9 months) and the RT/TMZ group (11 to 17 months), the prognostic parameters included: Isocitrate dehydrogenase 1 mutation (IDH1), usage of BVZ and TMZ in the PLS and OS, considering as well, age range (<70 years) as a favorable prognostic factor. CONCLUSIONS: GB represents the most frequent intracranial neoplasia. Combined fractionated stereotactic RT added to Temozolomide and Bevacizumab received in our population reports favorable and superior results compared to the ones described in the literature. Further studies are necessary to know the biological behavior of our population.

Intestinal pneumatosis: a rare and misdiagnosed entity

Intestinal pneumatosis is a rare entity, usually found incidentally, and in most cases asymptomatic. We present the case of an 84-year-old man who underwent colonoscopy for adenomatous polyps surveillance and presented typical endoscopic images of intestinal pneumatosis. Some of the most important aspects of the disease are highlighted and even if the endoscopic image is quite impressive, conservative management is the treatment of choice. (AU)

Intestinal pneumatosis: a rare and misdiagnosed entity.

Intestinal pneumatosis is a rare entity, usually found incidentally, and in most cases asymptomatic. We present the case of an 84-year-old man who underwent colonoscopy for adenomatous polyps surveillance and presented typical endoscopic images of intestinal pneumatosis. Some of the most important aspects of the disease are highlighted and even if the endoscopic image is quite impressive, conservative management is the treatment of choice.

Magneto-Primed Triticale Seeds Studied by Micro-Raman Spectra.

The spectroscopy technique of Micro-Raman is an appropriate method to investigate the microscopic structure of internally heterogeneous (i.e., composed of multiple layers) agro-food products. The effects of applying magnetic fields (magneto-priming technique) and imbibition on the chemical makeup of Triticale seed were studied, particularly in its pericarp, germ and endosperm parts, with the help of Micro-Raman. In light of the results obtained, the magneto-primed seeds soaked in water presented a greater number of chemical compounds than the control seeds, although those treatments were not as effective as the ones with only magneto-priming. The effects of the magneto-priming treatment were especially noticeable in the endosperm due to the large number of chemical compounds identified. The seed composition differences among treatments showed that the use of Micro-Raman jointly with magneto-priming is an appropriate method to obtain and analyse information of the key components of Triticale seeds, notably regarding their pericarp and endosperm.

Application of Hyperspectral Imaging in the Assessment of Drought and Salt Stress in Magneto-Primed Triticale Seeds.

Hyperspectral imaging is an appropriate method to thoroughly investigate the microscopic structure of internally heterogeneous agro-food products. By using hyperspectral technology, identifying stress symptoms associated with salinity, before a human observer, is possible, and has obvious benefits. The objective of this paper was to prove the suitability of this technique for the analysis of Triticale seeds subjected to both magneto-priming and drought and salt stress conditions, in terms of image differences obtained among treatments. It is known that, on the one hand, drought and salt stress treatments have negative effects on seeds of almost all species, and on the other hand, magneto-priming enhances seed germination parameters. Thus, this study aimed to relate hyperspectral imaging values-neither positive nor negative in themselves-to the effects mentioned above. Two main conclusions were reached: Firstly, the hyperspectral application is a feasible method for exploring the Triticale structure and for making distinctions under different drought and salt stress treatments, in line with the data variability obtained. Secondly, the lower spectral reflectance in some treatments-in the 400-1000 nm segment-is the result of a great number of chemical compounds in the seed that could be related to magneto-priming.

Schwann cell hamartoma as an incidental finding in a colonoscopy / Hamartoma de células de Schwann como hallazgo incidental en una colonoscopia

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Adenocarcinoma de colon sobre adenoma serrado tradicional / No disponible

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Colonic adenocarcinoma arising from traditional serrated adenoma.

We report the case of a 59-year-old male who underwent a screening colonoscopy after a positive fecal occult blood test. Several polyps were removed during the colonoscopy: two pedunculated tubular adenomas of 7 mm, a tubular adenoma with high-grade dysplasia of 25 mm and a pedunculated polyp of 20 mm in the descending colon. Histopathological analysis of the pedunculated polyp revealed a well-differentiated adenocarcinoma (G1) with a mucinous component that invaded the submucosa (T1). The resection margins were less than 1 mm, lymphovascular invasion was present and high budding (10 or more) with an invasive component of 8 mm.

Epidemiología del descontrol de la epilepsia en un servicio de urgencias neurológicas / Acute seizure epidemiology in a neurological emergency department

Introducción. El descontrol de la epilepsia representa un potencial daño neurológico, por lo que deben investigarse sus causas. Objetivo. Explorar la epidemiología de pacientes mexicanos con descontrol agudo de epilepsia en un servicio de urgencias neurológicas. Pacientes y métodos. Análisis prospectivo descriptivo de pacientes con diagnóstico previo de epilepsia que acuden a un servicio de urgencias por descontrol de las crisis. Resultados. Se analizó a 100 pacientes entre agosto de 2016 y enero de 2017. Ochenta y seis fueron crisis focales, de las cuales 76 fueron focales a bilaterales tonicoclónicas, dos fueron con alteración de la consciencia de inicio motor y tres de inicio no motor, una sin alteración de la consciencia de inicio motor y cuatro de inicio no motor. Catorce fueron generalizadas de inicio generalizado motor. Las causas de descontrol fueron: 26 pacientes por falta de adhesión al tratamiento antiepiléptico, 21 de causa desconocida, 19 por infección, 13 por privación de sueño, 10 por ajuste de tratamiento, tres por estrés, tres por menstruación, dos por uso de alcohol y tres por otras razones. En los 26 pacientes con falta de adhesión, 10 fueron por olvido de dosis, siete por negarse a tomar el medicamento, seis por causas económicas y tres por indicación de médico ajeno a la institución. Conclusiones. En México, la falta de adhesión al tratamiento representa un 25% de los casos de descontrol de la epilepsia, lo que es un área de oportunidad para incrementar la educación de higiene de crisis y disminuir la frecuencia de éstas

Introduction. Acute seizures in patients with epilepsy are a potential of source of neurological damage; their causes must be researched. Aim. To explore the epidemiology of acute seizure exacerbations in patients with epilepsy in a neurological emergency department in Mexico City. Patients and methods. Descriptive prospective study of patients with a previous diagnosis of epilepsy that receive medical care in an emergency department due to acute seizures. Results. 100 patients were analyzed between august 2016 and January 2017. 86 patients presented with focal seizures, of which 76 were focal to bilateral tonic-clonic, 2 with impaired awareness and motor onset, 3 with impaired awareness and non-motor onset, 1 without impaired awareness and motor onset, and 4 without impaired awareness and non-motor onset. 14 patients had generalized seizures with motor onset. The causes of exacerbation were as follows: 26 patients due to antiepileptic dose omission, 21 due to a unknown cause, 19 due to infection, 13 due to sleep deprivation, 3 due to stress, 3 were catamenial, 2 due to alcohol abuse and 3 due to other reasons. Of the 26 patients with dose omission, 10 were due to forgetfulness, 7 refused to comply with their prescription, 6 could not afford to buy their prescription and 3 had their prescription changed by another doctor. Conclusions. In Mexico, antiepileptic drug dose omission represents up to 25% of patients with acute seizure exacerbations; increased patient education on epilepsy hygiene measures may be an area of opportunity for reducing its frequency

Linfoma primario del sistema nervioso central: experiencia clínica en un centro neurológico / Primary central nervous system lymphoma: clinical experience in a neurological center

Introducción. El linfoma primario del sistema nervioso central es una variedad de linfoma no Hodgkin que representa el 4-5% de los tumores intracraneales y el 5% de todos los linfomas. Se origina en el encéfalo, los ojos, la leptomeninge y la médula espinal sin evidencia sistémica de actividad linfomatoide; el subtipo de linfoma mayoritariamente es de células de tipo B. Pacientes y métodos. Estudio descriptivo de los pacientes diagnosticados con linfoma cerebral primario que fueron atendidos en centros de tercer nivel en México entre los años 1980 y 2016. Se incluyó a los pacientes que contaran con cribado para búsqueda de linfoma sistémico. Los resultados se analizaron mediante frecuencias simples; en el caso del tiempo libre de enfermedad y supervivencia global, mediante curvas de Kaplan-Meier, y las diferencias entre curvas, mediante log rank. Resultados. En un total de 215 pacientes sólo hubo 74 casos. El 45% fueron mujeres y el 55%, hombres. El 36,7% eran mayores de 60 años. Las manifestaciones clínicas más frecuentes fueron déficit motor (60%) y alteraciones cognitivas (52%). La mayoría recibió alguna forma de quimioterapia (89%). El único factor significativo para respuesta radiológica y pronóstico clínico era el uso combinado de radioquimioterapia (p = 0,04493). Conclusión. El linfoma representa una patología tumoral con alta respuesta clinicorradiológica al tratamiento, aunque la respuesta no es duradera. Es fundamental su identificación temprana y el tratamiento multidisciplinario para el mejor pronóstico de estos pacientes

Introduction. Primary lymphoma of the central nervous system is a variety of non-Hodgkin’s lymphoma that accounts for 4-5% of intracranial tumours and 5% of all lymphomas. It has its origin in the brain, the eyes, the leptomeninges and the spinal cord with no systemic evidence of lymphomatoid activity; the subtype of lymphoma is predominantly of B-type cells. Patients and methods. We conducted a descriptive study of the patients diagnosed with primary brain lymphoma who were attended to at third-level centres in Mexico between the years 1980 and 2016. Patients who had been screened for systemic lymphoma were included. The results were analysed by means of simple frequencies, and disease-free and overall survival time was analysed by Kaplan-Meier curves; the differences among curves were analysed by means of log rank. Results. Of a total of 215 patients, there were only 74 cases. By sex, 45% were females and 55% were males. Regarding age, 36.7% were over 60 years old. The most frequent clinical manifestations were motor loss (60%) and cognitive disorders (52%). Most patients received some form of chemotherapy (89%). The only significant factor for radiological response and clinical prognosis was the combined use of radiochemotherapy (p = 0.04493). Conclusion. Lymphoma is a tumorous condition with a high clinicoradiological response to treatment, although the response is not long-lasting. Its early identification and multidisciplinary management are essential for a more favourable prognosis in these patients

The Comparative Treatment of Intraventricular Chemotherapy by Ommaya Reservoir vs. Lumbar Puncture in Patients With Leptomeningeal Carcinomatosis.

Object: Leptomeningeal Carcinomatosis (LCM) represents a state of systemic malignant disease with poor prognosis. The purpose of this study is to compare overall survival (OS) between intraventricular chemotherapy through Ommaya reservoir (OR) and chemotherapy through lumbar puncture (LP) in LCM. Patients and Methods: Forty adult patients with LCM were included. All patients underwent lumbar puncture and Magnetic resonance imaging (MRI). Thirty patients received chemotherapy through LP and 10 undergone colocation of Ommaya reservoir for intraventricular chemotherapy. Results: The most common symptom was headache (Present in 50%). The cranial nerves most affected were VI and VII. Leptomeningeal enhancement was the most frequent finding in MRI. The OS in the LP group was 4 months and Ommaya group was 9.2 months (p = 0.0006; CI:1.8-3), with statistical differences in favor to Intraventricular treatment. Proportional hazard regression showed that receiving chemotherapy through Ommaya reservoir was a protective factor (Hazard ratio = 0.258, Standard Error = 0.112, p = 0.002 and 95% CI 0.110-0.606). Using KPS as a factor did not affect the hazard ratio of Ommaya reservoir itself. Conclusions: OS was significantly higher in patients with Ommaya reservoir in spite of Karnofsky Performance Status (KPS) previous to chemotherapy. Therefore, intraventricular chemotherapy should be preferred over lumbar puncture chemotherapy administration if there are resources available.

Energy expenditure is associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy.

INTRODUCTION: proper estimation of energy requirements in children with cerebral palsy (CP) is essential in ensuring that their energy needs are optimally met. OBJECTIVE: therefore, the purpose of this study was to demonstrate that resting energy expenditure (REE) and total energy expenditure (TEE) are associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy. METHODS: a cross-sectional study included 79 participants with spastic CP from 24 months to 16 years nine months. Weight and height (estimated by lower leg length) were obtained; body composition and energy expenditure were estimated by bioelectrical impedance analysis. ANOVA, post hoc tests, the Pearson correlation and determination coefficients (R2) were performed. RESULTS: significant gradual increases according to age in REE and TEE (both in kcal/d) were observed. There were highly significant positive correlations between REE and TEE (kcal/d, kcal/cm/d) with fat-free mass (FFM) and fat mass (FM), but negative correlations between REE (kcal/ kg/d) with body composition and energy indicators. FFM and total body water, and to a lesser extent FM, explained a high percentage of the direct variability of REE and TEE in kcal/d and the inverse in kcal/kg/d. CONCLUSIONS: as age increased, energy expenditure also increased. The estimated energy expenditure in kcal/cm/d did not differ with age and sex. The estimated energy expenditure, based on height, would be a practical and reliable method for estimating energy expenditure and ensuring adequate nutritional status.

[Primary Tumors of the Central Nervous System. Clinical Experience at a Third Level Center].

Background: Central nervous system (CNS) tumors are a group of neoplasms that originate from various cells in the CNS. The increasing incidence and prevalence of this type of tumor in developing countries are striking; however, there are few current studies in Latin America including Mexico estimating the impact of these pathological entities on the general population. Objective: The objective of the study was to study the characteristics of primary CNS tumors over a period of 52 years. Methods: A review of records from patients with a histopathological diagnosis of CNS neoplasm over a period of 52 years was conducted at a tertiary-care academic medical center. Patients were grouped by sex, age, and the tumor's anatomical location. Results: A sample of 9615 patients with tumor lesions was obtained; 51% were female, 49% were male, and their mean age was 42 years. The tumors with the highest prevalence were neuroepithelial tumors (38.6%), followed by meningeal tumors (22.8%). Neuroepithelial tumors accounted for 64% in the group of patients under 40 years of age and 56% among those above 40 years of age. The most frequently involved location was supratentorial, in 78.9% of cases. Conclusions: Although retrospective in nature and based on a small sample, this study reports the epidemiology and characteristics of primary brain tumors in the Mexican population.

Energy expenditure is associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy / El gasto energético se asocia con la edad, los indicadores antropométricos y la composición corporal en niños con parálisis cerebral espástica

Introduction: proper estimation of energy requirements in children with cerebral palsy (CP) is essential in ensuring that their energy needs are optimally met. Objective: therefore, the purpose of this study was to demonstrate that resting energy expenditure (REE) and total energy expenditure (TEE) are associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy. Methods: a cross-sectional study included 79 participants with spastic CP from 24 months to 16 years nine months. Weight and height (estimated by lower leg length) were obtained; body composition and energy expenditure were estimated by bioelectrical impedance analysis. ANOVA, post hoc tests, the Pearson correlation and determination coefficients (R2) were performed. Results: significant gradual increases according to age in REE and TEE (both in kcal/d) were observed. There were highly significant positive correlations between REE and TEE (kcal/d, kcal/cm/d) with fat-free mass (FFM) and fat mass (FM), but negative correlations between REE (kcal/ kg/d) with body composition and energy indicators. FFM and total body water, and to a lesser extent FM, explained a high percentage of the direct variability of REE and TEE in kcal/d and the inverse in kcal/kg/d. Conclusions: as age increased, energy expenditure also increased. The estimated energy expenditure in kcal/cm/d did not differ with age and sex. The estimated energy expenditure, based on height, would be a practical and reliable method for estimating energy expenditure and ensuring adequate nutritional status

Introducción: la estimación adecuada de los requerimientos de energía en niños con parálisis cerebral (PC) es indispensable para garantizar que sus necesidades energéticas se cumplan de manera optima. Objetivo: demostrar que el gasto de energía en reposo (GER) y el gasto energético total (GET) se asocian con la edad y los indicadores antropométricos y de composición corporal en niños con parálisis cerebral (PC) espástica. Métodos: un estudio transversal incluyo 79 participantes con PC espástica de 24 meses a 16 años y nueve meses de edad. Se obtuvieron el peso y la talla (estimados por la longitud de la pierna inferior); la composición corporal y el gasto de energía se estimaron mediante análisis de impedancia bioelectrica. Se realizaron ANOVA, pruebas post hoc, los coeficientes de correlación y determinación de Pearson (R2). Resultados: se observaron incrementos graduales significativos según la edad en GER y GET (ambos en kcal/d). Hubo correlaciones positivas altamente significativas entre GER y GET (kcal/d, kcal/cm/d) con masa libre de grasa (MLG) y masa grasa (MG) y correlaciones negativas entre GER (kcal/kg/d) con la composición corporal e indicadores de energía. La MLG y el agua corporal total, y en menor grado la MG, explicaron un porcentaje elevado de la variabilidad de GER y GET en kcal/d y en kcal/kg/d Conclusiones: conforme aumento la edad, aumento también el gasto de energía. El gasto energético estimado en kcal/cm/d no difirió con la edad y el sexo. Por tanto, el gasto energético basado en la talla seria un método practico y confiable para garantizar un estado nutricio adecuado

Limitantes para la lactancia materna del recién nacido pretérmino hospitalizado / Limitations for breastfeeding newborn preterm hospitalized

Resumen:

Introducción: en el recién nacido hospitalizado se incrementa el riesgo de complicaciones e infecciones nosocomiales relacionadas con la hospitalización y el compromiso inmunológico, en esta condición la lactancia materna exclusiva puede ayudar disminuir la morbimortalidad durante este período.

Objetivo: describir las causas que limitan la lactancia materna del recién nacido pretérmino hospitalizado en una unidad de cuidados intensivos neonatales.

Metodología: estudio descriptivo, se aplicó un instrumento estructurado con cinco secciones, la 1 y 2 con datos generales y antecedentes patológicos de la madre-hijo; las secciones 3, 4 y 5 abordan aspectos de información y prácticas sobre lactancia materna y solicitud de leche; se realizó una entrevista cara a cara a 36 madres de 36 recién nacidos hospitalizados. Se utilizó estadística descriptiva. Resultados: el 52.8 % de los recién nacidos fueron prematuros y con alimentación el 50 % de ellos. En 68 % de los casos la principal limitante para la lactancia fue la información deficiente en la conservación y traslado de la leche materna al hospital.

Conclusiones: la deficiente información de las madres sobre la conservación y traslado de la leche materna está relacionado con la no extracción de leche, se recomienda el fortalecimiento de las estrategias de educación a las madres del recién nacido hospitalizado, para la extracción y conservación de la leche, así como de los beneficios que aporta al sistema inmunológico.

Abstract:

Introduction: Hospital newborn complications and the risk of nosocomial infections related to hospitalization and increases immunocompromised, in this condition of exclusive breastfeeding can help reduce morbidity and mortality this critical period.

Objective: To describe the causes that limit breastfeeding newborn hospitalized in the Neonatal Intensive Care Unit.

Methodology: Descriptive study, a structured instrument with five sections, the 1 and 2 with general data and medical history of the mother-son was applied; Sections 3, 4 and 5 information, aspects of the practice of breastfeeding and milk demand; We face to face 36 to 36 mothers of newborns hospitalized interview was conducted. For data analysis Descriptive statistics were used. Results: 52.8% of newborns are premature and supply 50% of them; the average maternal age was 27 years, engaged in household 83.3% and 52.7% higher average education. In 68% of cases the main constraint to breastfeeding was poor reporting on conservation and transfer of breast milk to the hospital, the low milk 20%, 8% and fatigue work 4%.

Conclusions: Poor mother's information on the conservation and transfer of breast milk is related to the non-extraction of milk, strengthening education strategies is recommended to mothers of newborn hospitalized for extraction and conservation Milk and on the benefits to immune support.

Transarterial chemoembolisation in intermediate-stage hepatocellular carcinoma. Survey on clinical practice in hospitals in the Madrid Region.

BACKGROUND: Transarterial chemoembolisation (TACE), having demonstrated survival benefits, is the treatmentof choice in intermediate-stage hepatocellular carcinoma, although there is great heterogeneity in its clinical application. MATERIAL AND METHODS: A survey was sent to the Madrid Regional hospitals to assess applicability, indications and treatment protocols. The assessment was made overall and according to the type of hospital (groups A vs. B and C). RESULTS: Seventeen out of 22 hospitals responded (8/8 group A, 9/ 14 group B-C). All do/indicate transarterial chemoembolisation, 13/17 at their own facilities. Eight of the 17 hospitals have multidisciplinary groups (5/8 A, 3/9 B-C). Nine hospitals perform > 20 procedures/year (7 group A), and 6 from group B-C request/perform < 10/year. It is performed on an "on-demand" basis in 12/17. In 5 hospitals, all the procedures use drug-eluting beads loaded with doxorubicin. The average number of procedures per patient is 2. The mean time from diagnosis of hepatocellular carcinoma to transarterial chemoembolisation is ≤ 2 months in 16 hospitals. In 11/17 hospitals, response is assessed by computed tomography. Radiological response is measured without specific criteria in 12/17 and the other five hospitals (4 group A) assessed using standardised criteria. CONCLUSION: Uniformity among the Madrid Regional hospitals was found in the indication and treatment regimen. The use of DEB-TACE has become the preferred form of TACE in clinical practice. The differentiating factors for the more specialised hospitals are a larger volume of procedures, decision-making by multidisciplinary committees and assessment of radiological response more likely to be standardised.