Serum Folate, Red Blood Cell Folate, and Zinc Serum Levels Are Related with Gestational Weight Gain and Offspring's Birth-Weight of Adolescent Mothers.

BACKGROUND: Gestational weight gain below or above the Institute of Medicine recommendations has been associated with adverse perinatal and neonatal outcomes. Very few studies have evaluated the association between serum and red blood cell folate concentrations and gestational weight gain in adolescents. Additionally, zinc deficiency during pregnancy has been associated with impaired immunity, prolonged labor, preterm and post-term birth, intrauterine growth restriction, low birth weight, and pregnancy-induced hypertension. OBJECTIVE: The purpose of our study is to evaluate the association between serum concentrations of zinc, serum folate, and red blood cell folate, with the increase in gestational weight and the weight and length of the newborn in a group of adolescent mothers from Mexico City. RESULTS: In our study, 406 adolescent-neonate dyads participated. The adolescents' median age was 15.8 years old. The predominant socioeconomic level was middle-low (57.8%), single (57%), 89.9% were engaged in home activities, and 41.3% completed secondary education. Excessive gestational weight gain was observed in 36.7% of cases, while insufficient gestational weight gain was noted in 38.4%. Small for gestational age infants were observed in 20.9% of the sample. Low serum folate (OR 2.1, 95% CI 1.3-3.3), decreased red blood cell folate (OR 1.6, 95% CI 1.0-2.6), and reduced serum zinc concentrations (OR 3.3, 95% CI 2.1-5.2) were associated with insufficient gestational weight gain. Decreased serum zinc levels (OR 1.2, 95% CI 1.2-3.4) were linked to an increased probability of delivering a baby who is small for their gestational age. CONCLUSIONS: Low serum folate, red blood cell folate, and serum zinc concentrations were associated with gestational weight gain and having a small gestational age baby. Both excessive and insufficient gestational weight gain, as well as having a small gestational age baby, are frequent among adolescent mothers.

Determinantes socioeconómicos en la dieta de mujeres embarazadas en zona marginal / Socioeconomic determinants in the diet of pregnant women in a marginal area

Fundamentos: La dieta habitual de embarazadas residentes de zonas con alto grado de marginación, no favorece el mantenimiento de un estado nutricio óptimo. Métodos: Estudio transversal, se analizaron factores socioeconómicos que determinaron la dieta habitual de 71 mujeres embarazadas de un municipio marginal de México. Se aplicaron cuestionarios: sociodemográfico, recordatorio de 24 horas de consumo de alimentos y actividades habituales. Resultados: Más del 80% tuvo consumo dietético insuficiente de múltiples micronutrientes. El ingreso mensual de las mujeres se correlacionó con el nivel educativo (r=0,42, p=0,039), éste se correlacionó con el porcentaje de adecuación de ingesta de energía (r=0.28, p=0,017), carbohidratos (r = -0,32, p = 0,006), proteínas (r= 0,34, p=0,004), lípidos (r=0,30, p =0,012) y vitamina C (r=0,34, p=0,003). El nivel educativo determinó el 8% en la variabilidad de la adecuación de ingesta de energía (r2=0,08, F=5,87, p=0.018). Los indicadores que se correlacionaron con el estado nutricio (p<0,05) fueron, nivel educativo de la pareja, afiliación a un seguro de salud gubernamental, existencia de tiendas de abarrotes y acceso de alimentos en su comunidad. Conclusiones: Las políticas públicas enfocadas en la reducción de la morbilidad materna, deberían considerar como esenciales, el nivel educativo y acceso de variedad de alimentos en estas comunidades. (AU)

Background: Diet of pregnant inhabitants of areas with high levels of marginalization does not favor an optimal nutritional status. Methods: This cross-sectional study analyze the socio-economic factors that determine the usual diet of 71 pregnant woman from a marginal municipality in Mexico. Socio-economic questionnaires, 24-hour diet record consumption and regular activities were applied. Results: More than 80% had insufficient dietary intake of multiple micronutrients. Women's monthly income was correlated with education level (r=0.42, p=0.039) which in turn was correlated with the percentage of intake adequacy of energy (r=0.28, p=0.017), carbohydrates (r = -0.32, p = 0.006), proteins (r= 0.34, p=0.004), lipids (r=0.30, p =0.012) and vitamin C (r=0.34, p=0.003). Education level was responsible for 8% of the variability of intake adequacy of energy (r2=0.08, F=5.87, p=0.018). Couple’s education level, enrollment in the government health insurance, presence of grocery stores and geographical access to food were correlated with indicators of nutritional status (p<0.05). Conclusions: Public policies focused to reduce maternal morbidity should consider the educational level and geographical access to a variety of foods in these communities. (AU)

Effectiveness of 3,3'-Diindolylmethane Supplements on Favoring the Benign Estrogen Metabolism Pathway and Decreasing Body Fat in Premenopausal Women.

The Estrogen Metabolites (2-hydroxyestrogens: 16α-hydroxyestrone) Urine Ratio (EMUR) has been negatively associated with breast cancer; Mexican women have a lower EMUR than other populations. We evaluated the effectiveness of 3,3'-diindolylmethane (DIM) supplementation on increasing EMUR in premenopausal women. A randomized, double-blind clinical trial (NCT02525159 at ClinicalTrial.gov) was carried out on 60 women with an EMUR below 0.9. Patients were assigned randomly to receive a placebo or 75 mg of DIM a day (administered as 300 mg of DIM-BR®) for 30 day. Urine samples were obtained at baseline, at 30 day of supplementation, and 30 day after finishing supplementation. A Mann-Whitney U test was used to compare the EMUR; an ANOVA was used to analyze differences in body composition. EMUR was analyzed using ESTRAMET™ kits. While DIM-treated subjects did not increase their EMUR at 30 day of supplementation (p > 0.05), there was a non-significant positive trend 30 day once supplementation ended (p = 0.06). The DIM group saw a more significant decrease in body fat percentage than the placebo group (p = 0.04). In premenopausal Mexican women, 75 mg of the daily DIM supplement was ineffective in increasing EMUR; further studies are needed to evaluate the effective dosage, time frames, and effect on body fat.

Dietary and Nutrient Intake, Eating Habits, and Its Association with Maternal Gestational Weight Gain and Offspring's Birth Weight in Pregnant Adolescents.

Pregnant adolescents' diet and eating habits are inadequate; however, their association with gestational weight gain (GWG) is uncertain. We aimed to analyze whether there is an association between dietary and nutrient intake and eating habits with GWG among pregnant adolescents and their offspring's birth weight. A longitudinal study was performed with 530 participants. We assessed GWG and applied several tools, such as a food frequency questionnaire and 24-h recall, to obtain dietary and nutrient intake and eating habits. The birth weight of adolescents' offspring was registered. Later, we performed crude and adjusted Poisson models. The mean age was 15.8 ± 1.3 years. Of all food groups, the lowest frequency of adequate intake corresponded to vegetables (7%) and legumes (10.2%). Excessive (36.8%) and insufficient (40.9%) GWG were observed. Pregnant adolescents with inadequate legumes intake increased the probability of excessive GWG: (PR 1.86 95% CI 1.00-3.44). Cereals and grains were positively associated with GWG: (PR 1.65, 95% CI 1.18-2.29). Energy, macronutrient intake, and eating habits were not associated with GWG. Offspring's small gestational age (SGA) increased when pregnant adolescents had inadequate sugar-sweetened beverages intake: PR (1.58, 95% CI 1.01-2.49) and when pregnant adolescent watched television (TV). In our sample of Mexican adolescents, dietary and nutrient intake and eating habits were inadequate. Excessive dietary intake from cereals, grains, and animal-sourced foods along with insufficient legumes were associated with excessive GWG. Watching TV while adolescents ate was associated with the birth weight of the offspring.

Interacción social: Experiencias de mujeres positivas a COVID-19 con riesgo perinatal / Social Interaction: The experiences of COVID-19 positive women with perinatal risk

Resumen La pandemia COVID-19 provocó cambios en la dinámica de la vida de las mujeres en etapa perinatal quienes, ante la crisis sanitaria reconfiguraron prácticas de cuidado y convivencia social. El objetivo fue conocer a través de la interacción social algunas experiencias de mujeres con embarazo de alto riesgo positivas a COVID-19. El trabajo se realizó en un hospital de tercer nivel de atención perinatal. Se empleó metodología cualitativa, se aplicaron cuestionarios y entrevistas a 14 mujeres positivas a COVID-19 en etapa perinatal vía zoom. Se realizó análisis crítico-interpretativo del discurso con base al concepto interacción social y el pensamiento complejo. Para los resultados se desarrollaron tres tipos de interacción social: a) Interacción social primaria: Experiencias ante la notificación de la positividad al COVID-19; b) Interacción social aprendida: Experiencias del cuidado ante el COVID-19; y c) Interacción social resiliente: Experiencias necesarias ante el COVID-19. El vínculo de las experiencias desemboca en nuevas formas de interacciones sociales que van desde la notificación pasando por el cuidado y la resiliencia. Concluimos que las experiencias por el COVID-19 vividas por mujeres en etapa perinatal reinventaron sus modos de convivencia y cuidado dentro de lo institucional, familiar y personal.

Abstract The COVID-19 pandemic induced changes in the dynamics of the life of women in the perinatal phase who, due to the health crisis, restructured social care and coexistence practices. The scope of this paper was to assess the experiences of high-risk perinatal pregnancy risk among COVID-19 positive women through social interaction. The work was conducted in a hospital of tertiary perinatal care. Qualitative methodology was used, whereby questionnaires and interviews were conducted via zoom with 14 COVID-19 positive women in the perinatal phase. Critical-interpretative discourse analysis was applied based on the concept of social interaction and complex thinking. Three types of social interaction were developed to assess the results: a) Initial social interaction: experiences when becoming aware of being COVID-19 positive; b) Acquired social interaction: experiences of care prior to COVID-19; c) Enduring social interaction: experience required in the face of COVID-19. The result of experience leads to new forms of social interaction after notification ranging from care to resilience. The conclusion drawn is that the experience of COVID-19 of women in the perinatal period remodeled their ways of coexistence and care within the institutional, family, and personal spheres.

[Social Interaction: The experiences of COVID-19 positive women with perinatal risk]. / Interacción social: Experiencias de mujeres positivas a COVID-19 con riesgo perinatal.

The COVID-19 pandemic induced changes in the dynamics of the life of women in the perinatal phase who, due to the health crisis, restructured social care and coexistence practices. The scope of this paper was to assess the experiences of high-risk perinatal pregnancy risk among COVID-19 positive women through social interaction. The work was conducted in a hospital of tertiary perinatal care. Qualitative methodology was used, whereby questionnaires and interviews were conducted via zoom with 14 COVID-19 positive women in the perinatal phase. Critical-interpretative discourse analysis was applied based on the concept of social interaction and complex thinking. Three types of social interaction were developed to assess the results: a) Initial social interaction: experiences when becoming aware of being COVID-19 positive; b) Acquired social interaction: experiences of care prior to COVID-19; c) Enduring social interaction: experience required in the face of COVID-19. The result of experience leads to new forms of social interaction after notification ranging from care to resilience. The conclusion drawn is that the experience of COVID-19 of women in the perinatal period remodeled their ways of coexistence and care within the institutional, family, and personal spheres.

La pandemia COVID-19 provocó cambios en la dinámica de la vida de las mujeres en etapa perinatal quienes, ante la crisis sanitaria reconfiguraron prácticas de cuidado y convivencia social. El objetivo fue conocer a través de la interacción social algunas experiencias de mujeres con embarazo de alto riesgo positivas a COVID-19. El trabajo se realizó en un hospital de tercer nivel de atención perinatal. Se empleó metodología cualitativa, se aplicaron cuestionarios y entrevistas a 14 mujeres positivas a COVID-19 en etapa perinatal vía zoom. Se realizó análisis crítico-interpretativo del discurso con base al concepto interacción social y el pensamiento complejo. Para los resultados se desarrollaron tres tipos de interacción social: a) Interacción social primaria: Experiencias ante la notificación de la positividad al COVID-19; b) Interacción social aprendida: Experiencias del cuidado ante el COVID-19; y c) Interacción social resiliente: Experiencias necesarias ante el COVID-19. El vínculo de las experiencias desemboca en nuevas formas de interacciones sociales que van desde la notificación pasando por el cuidado y la resiliencia. Concluimos que las experiencias por el COVID-19 vividas por mujeres en etapa perinatal reinventaron sus modos de convivencia y cuidado dentro de lo institucional, familiar y personal.

Cost-utility analysis of venetoclax in combination with obinutuzumab as first-line treatment of chronic lymphocytic leukaemia in Spain.

OBJECTIVE: Venetoclax in combination with obinutuzumab has significantly improved efficacy versus immunochemotherapy (progression-free survival) in patients with chronic lymphocytic leukaemia who have not  received prior treatment. The objective of this study was to evaluate its efficiency in Spain using a cost-utility analysis. METHOD: Using a partitioned-survival analysis model adapted to the Spanish  context and based on three health states (progression-free survival, survival  after progression, and death), a simulation of the evolution of patients who  were candidates for initiating first-line treatment was conducted for a lifetime  time horizon. Venetoclax in combination with obinutuzumab was compared to  the most commonly used therapeutic options for these patients at the time of  study design: chlorambucil in combination with obinutuzumab, ibrutinib,  fludarabine in combination with cyclophosphamide and rituximab, and  bendamustine in combination with rituximab. In order to estimate survival  curves, efficacy data were derived from the CLL14 trial and a network meta- analysis. The  analysis was conducted from the perspective of the Spanish  National Healthcare System and included direct healthcare costs (i.e.  pharmacological costs and their administration), and those associated with the management of the disease and adverse events. The resource use was validated by an expert group. Quality of life data were used to estimate the  quality-adjusted life years obtained for each alternative. A threshold of  €25,000/quality-adjusted life years was used. The robustness of the model was evaluated using deterministic and probabilistic sensitivity analyses. RESULTS: Venetoclax in combination with obinutuzumab was shown to be a  dominant alternative compared to the rest of the treatment alternatives, with a  lower cost per patient (€-67,869 compared to chlorambucil in combination  with obinutuzumab, €-375,952 compared to ibrutinib, €-61,996 compared to  fludarabine in combination with cyclophosphamide and rituximab, and €- 77,398 compared to bendamustine in combination with rituximab). It also had  a greater gain in quality-adjusted life years (0.551 quality-adjusted life years  gained compared to chlorambucil in combination with obinutuzumab and  ibrutinib, 1.639 quality-adjusted life years gained compared to fludarabine in  combination with cyclophosphamide and rituximab, and 1.186 quality-adjusted  life years gained compared to bendamustine in combination with  rituximab). Between 68% and 85% of the simulations performed in the  sensitivity analysis showed that venetoclax in combination with obinutuzumab  had lower costs and more quality-adjusted life years gained. CONCLUSIONS: Venetoclax in combination with obinutuzumab is an efficient and  dominant alternative for treating previously untreated patients with chronic lymphocytic leukaemia compared to the available  alternatives and from the perspective of the Spanish National Health System.

OBJETIVO: Venetoclax en combinación con obinutuzumab ha mostrado frente a  la inmunoquimioterapia mejoras significativas en términos de eficacia (supervivencia libre de progresión) en pacientes con leucemia  infocítica crónica que no han recibido tratamiento previo. El objetivo de este  estudio fue evaluar su eficiencia en España a partir de un análisis de coste- utilidad.Método: A partir de un modelo de análisis de la supervivencia adaptado al  contexto español y basado en tres estados de salud (supervivencia libre de  progresión, supervivencia tras progresión y muerte), se llevó a cabo una  simulación de la evolución de los pacientes candidatos a iniciar una primera  línea de tratamiento para un horizonte temporal de toda la vida. Venetoclax en  combinación con obinutuzumab se comparó frente a las opciones terapéuticas  más utilizadas para estos pacientes en el momento del diseño del estudio:  clorambucilo en combinación con obinutuzumab, ibrutinib, fludarabina en  combinación con ciclofosfamida y rituximab, y bendamustina en combinación  con rituximab. Los datos de eficacia para estimar las curvas de supervivencia  fueron derivados del estudio CLL14 y de un metaanálisis en red. El análisis  consideró la perspectiva del Sistema Nacional de Salud incluyendo los costes  sanitarios directos, en concreto los farmacológicos y su administración, y los  asociados al manejo de la enfermedad y acontecimientos adversos. El uso de  recursos fue validado por un grupo de expertos. Se emplearon datos de calidad  de vida para estimar los años de vida ajustados por calidad obtenidos  para cada alternativa. Se consideró un umbral de 25.000 €/años de vida  ajustados por calidad. La robustez del modelo se evaluó mediante análisis de  sensibilidad determinísticos y probabilísticos. RESULTADOS: Venetoclax en combinación con obinutuzumab se mostró como  una alternativa dominante frente al resto de alternativas de tratamiento, con  un menor coste por paciente (­67.869 € frente a clorambucilo en combinación  con obinutuzumab, ­375.952 € frente a ibrutinib, ­61.996 € frente a  ludarabina en combinación con ciclofosfamida y rituximab, y ­77.398 € frente  a bendamustina en combinación con rituximab) y una mayor ganancia en años  de vida ajustados por calidad (0,551 años de vida ajustados por calidad  ganados frente a clorambucilo en combinación con obinutuzumab e ibrutinib,  1,639 años de vida ajustados por calidad ganados frente a fludarabina en  combinación con ciclofosfamida y rituximab, y 1,186 años de vida ajustados  por calidad ganados frente a bendamustina en combinación con rituximab).  Entre el 68% y el 85% de las simulaciones realizadas en el análisis de  sensibilidad mostraban a venetoclax en combinación con obinutuzumab con un  menor coste y un mayor número de años de vida ajustados por calidad  ganados. CONCLUSIONES: Venetoclax en combinación con obinutuzumab se muestra como una alternativa eficiente y dominante como tratamiento de  pacientes con leucemia linfocítica crónica no tratados previamente frente a las  alternativas disponibles y desde la perspectiva del Sistema Nacional de Salud.

Análisis coste-utilidad de venetoclaxen combinación con obinutuzumab comotratamiento de primera línea de la leucemia linfocítica crónica en España / Cost-utility analysis of venetoclax in combination with obinutuzumab as first-line treatment of chronic lymphocytic leukaemia in Spain

Objetivo: Venetoclax en combinación con obinutuzumab ha mostradofrente a la inmunoquimioterapia mejoras significativas en términos de eficacia(supervivencia libre de progresión) en pacientes con leucemia linfocíticacrónica que no han recibido tratamiento previo. El objetivo de este estudiofue evaluar su eficiencia en España a partir de un análisis de coste-utilidad.Método: A partir de un modelo de análisis de la supervivencia adaptadoal contexto español y basado en tres estados de salud (supervivencia librede progresión, supervivencia tras progresión y muerte), se llevó a cabouna simulación de la evolución de los pacientes candidatos a iniciar unaprimera línea de tratamiento para un horizonte temporal de toda la vida. Venetoclax en combinación con obinutuzumab se comparó frente a lasopciones terapéuticas más utilizadas para estos pacientes en el momentodel diseño del estudio: clorambucilo en combinación con binutuzumab,ibrutinib, fludarabina en combinación con ciclofosfamida y rituximab, ybendamustina en combinación con rituximab. Los datos de eficacia paraestimar las curvas de supervivencia fueron derivados del estudio CLL14 y de un metaanálisis en red. El análisis consideró la perspectiva del Sistema Nacional de Salud incluyendo los costes sanitarios directos, en concreto losfarmacológicos y su administración, y los asociados al manejo de la enfermedady acontecimientos adversos. El uso de recursos fue validado por ungrupo de expertos. Se emplearon datos de calidad de vida para estimarlos años de vida ajustados por calidad obtenidos para cada alternativa.Se consideró un umbral de 25.000 €/años de vida ajustados por calidad. La robustez del modelo se evaluó mediante análisis de sensibilidad determinísticosy probabilísticos.

Objective: Venetoclax in combination with obinutuzumab has significantlyimproved efficacy versus immunochemotherapy (progression-freesurvival) in patients with chronic lymphocytic leukaemia who have notreceived prior treatment. The objective of this study was to evaluate itsefficiency in Spain using a cost-utility analysis.Method: Using a partitioned-survival analysis model adapted to theSpanish context and based on three health states (progression-free urvival,survival after progression, and death), a simulation of the evolutionof patients who were candidates for initiating first-line treatment wasconducted for a lifetime time horizon. Venetoclax in combination withobinutuzumab was compared to the most commonly used therapeuticoptions for these patients at the time of study design: chlorambucil incombination with obinutuzumab, ibrutinib, fludarabine in combinationwith cyclophosphamide and rituximab, and bendamustine in combinationwith rituximab. In order to estimate survival curves, efficacy datawere derived from the CLL14 trial and a network meta-analysis. The analysis was conducted from the perspective of the Spanish NationalHealthcare System and included direct healthcare costs (i.e. pharmacologicalcosts and their administration), and those associated with themanagement of the disease and adverse events. The resource use wasvalidated by an expert group. Quality of life data were used to estimatethe quality-adjusted life years obtained for each alternative. A thresholdof €25,000/quality-adjusted life years was used. The robustness of themodel was evaluated using deterministic and probabilistic sensitivityanalyses.

Impact of coronavirus of 2019 on the delivery of pharmacy services to patients with cancer: An international survey of oncology pharmacy practitioners.

INTRODUCTION: The coronavirus of 2019 pandemic has necessitated vast and rapid changes in the way oncology pharmacy services are delivered around the world. METHODS/AIMS: An international survey of oncology pharmacists and technicians was conducted via the International Society of Oncology Pharmacy Practitioners and collaborating global pharmacy organisations to determine the impact that the coronavirus of 2019 has had on pharmacy service delivery, pharmacy practitioners and oncology practice. RESULTS: The survey received 862 responses from 40 different countries from September to October 2020. The majority of respondents were pharmacists (n = 841, 97.6%), with 24% involved in the direct care of patients with the coronavirus of 2019. Of the survey participants, 55% increased their time working remotely, with remote activities including dispensing, patient assessment/follow-up and attending multi-disciplinary rounds. Respondents reported a 72% increase in the use of technology to perform remote patient interaction activities and that participation in educational meetings and quality improvement projects was reduced by 68% and 44%, respectively. Workforce impacts included altered working hours (50%), cancelled leave (48%) and forced leave/furloughing (30%). During the pandemic, respondents reported reduced access to intensive care (19%) and anti-cancer (15%) medications. In addition, 39% of respondents reported reduced access to personal protective equipment, including N95 masks for chemotherapy compounding. Almost half of respondents (49%) reported that cancer treatments were delayed or intervals were altered for patients being treated with curative intent. A third of practitioners (30%) believed that patient outcomes would be adversely impacted by changes to pharmacy services. Sixty-five percent of respondents reported impacts on their mental health, with 12% utilising support services. CONCLUSION: The coronavirus of 2019 pandemic has altered the way oncology pharmacy services are delivered. These results demonstrate the adaptability of the oncology pharmacy profession and highlight the importance of formal evaluation of the varied practice models to determine the evidence-based practices that enhance pharmacy services and, thus, should be reinstated as soon as practical and reasonable.

Association of depression and functional outcomes in patients treated surgically for cervical spondylotic myelopathy through an anterior approach.

OBJECTIVE: To determine the association of Depression with clinical outcomes in patients treated surgically for cervical spondylotic myelopathy (CSM) using an anterior approach. METHOD: An observational study was conducted in patients with ECM. The Beck scale, modified scale of the Japanese Orthopedic Association (mJOA), neck disability index (NDI) and the Visual Analogue Scale (VAS) were used preoperatively, one month and 3 months after surgery. RESULTS: Initial VAS showed more severe degrees in patients with depression. At one month and third month after surgery, there was a significant decrease in pain in the group without depression (p = 0.03). The mJOA at one month and three months was observed that the degree of severity decreased in both groups, being more noticeable in the group without depression (p = 0.02). Presurgical NDI was higher in the group with depression. At three months in both groups the improvement was noticeable with respect to the degree of preoperative disability. CONCLUSIONS: There is a favorable relationship in patients with ECM undergoing surgical treatment in the absence of depression prior to surgery and clinical evolution, with the possibility of promoting multidisciplinary management prior to surgery in patients with depression.

OBJETIVO: Determinar la asociación de depresión con los resultados clínicos en pacientes tratados quirúrgicamente por mielopatía espondilótica cervical (MEC) mediante abordaje anterior. MÉTODO: Se realizó un estudio observacional en pacientes con MEC. Se utilizaron la escala de Beck, la escala modificada de la Japanese Orthopaedic Association (mJOA), el índice de discapacidad del cuello (NDI) y la escala visual análoga (EVA) de forma prequirúrgica, al mes y 3 meses posterior a la cirugía. RESULTADOS: La EVA inicial mostró mayor gravedad en los pacientes con depresión. Al mes y al tercer mes posteriores a la cirugía hay una disminución significativa del dolor en el grupo sin depresión (p = 0.03). En la mJOA al mes y a los 3 meses se observó que la gravedad disminuyó en ambos grupos, siendo más notorio en el grupo sin depresión (p = 0.02). El NDI prequirúrgico fue mayor en el grupo con depresión. A los 3 meses, en ambos grupos la mejoría fue notoria con respecto al grado de incapacidad preoperatorio. CONCLUSIONES: Existe una relación favorable en los pacientes con MEC sometidos a tratamiento quirúrgico entre la ausencia de depresión previa a cirugía y la evolución clínica, con la posibilidad de promover un manejo multidisciplinario previo a la cirugía en los pacientes con depresión.

Vitamin D Status and Its Determinants in Mexican Pregnant Women from a Rural and an Urban Area: A Comparative Study.

BACKGROUND: During pregnancy, vitamin D requirements are higher due to fetal growth and development. Vitamin D production occurs mainly through sunlight exposure, which is affected by geographic location and lifestyle factors. METHODS: This was a case-control study nested within two cohorts of adult pregnant women (n = 298): urban (Mexico City) and rural (Cuetzalan). To reduce confounding, pairs were selected by age, pregestational body mass index, and pregnancy trimester. Generalized linear models were used to assess the two groups according to their vitamin D status. RESULTS: A total of 298 adult women were studied: 149 from a rural area and 149 from an urban area. Vitamin D deficiency and insufficiency were observed in 28% and 38.2% of women, respectively. A trend for higher 25(OH)D concentrations was observed in women from the rural area (27.5 ng/mL vs. 25.8 ng/mL), probably related to the type of job, where women with partial jobs showing less probability of having vitamin D deficiency (OR = 0.26; CI = 0.06-1.16; p = 0.08) and vitamin D insufficiency (OR = 0.24; CI = 0.06-0.99; p = 0.05). Women whose Last Menstrual Period occurred in spring showed lower vitamin D concentration compared to those whose LMP occurred in winter (p < 0.01). CONCLUSIONS: A high prevalence of vitamin D deficiency was observed in both rural and urban areas. Women living in rural areas tended to have higher 25(OH)D concentrations, probably related to more sunlight exposure associated with their type of job.

Association of Pregestational BMI and Gestational Weight Gain with Maternal and Neonatal Outcomes in Adolescents and Adults from Mexico City.

During pregnancy, adolescents experience physiological changes different from adults because they have not concluded their physical growth. Therefore, maternal and neonatal outcomes may not be the same. This paper aimed to analyze the association between pregestational BMI (pBMI) and gestational weight gain (GWG) with maternal and neonatal outcomes in adolescent and adult pregnant women. The authors performed an observational study that included 1112 women, where 52.6% (n = 585) were adolescents. Sociodemographic information, pBMI, GWG, neonatal anthropometric measures, and maternal and neonatal outcomes were obtained. Adolescent women had a mean lower (21.4 vs. 26.2, p ≤ 0.001) pBMI than adults and a higher gestational weight gain (12.3 vs. 10.7 kg, p ≤ 0.001). According to Poisson regression models, gestational diabetes is positively associated with insufficient GWG and with pregestational obesity. Furthermore, the probability of developing pregnancy-induced hypertension increased with pBMI of obesity compared to normal weight. Preeclampsia, anemia, and preterm birth were not associated with GWG. Insufficient GWG was a risk factor, and being overweight was a protective factor for low birth weight and small for gestational age. We conclude that pBMI, GWG, and age group were associated only with gestational diabetes and low birth weight.

Encuesta de situación de la atención farmacéutica oncohematológica en España / Survey of oncohematological pharmaceutical care situation in Spain

Objetivo: Conocer la situación basal de las unidades de farmacia oncohematológica de los hospitales españoles para detectar ámbitos de mejora. Método: Se diseñó una encuesta acorde con los objetivos establecidos en el Plan Estratégico de Atención Farmacéutica al paciente oncohematológico del Grupo de Farmacia Oncológica de la Sociedad Española de Farmacia Hospitalaria (GEDEFO 2020). La encuesta se alojó en la página web de GEDEFO durante marzo y abril de 2017. Se recogieron datos de actividad del año 2016. Resultados: Respondieron la encuesta 95 hospitales. Un 76% disponían de un sistema de información integral de gestión del proceso farmacoterapéutico, encontrándose variabilidad en los procesos tecnológicos y organizativos. El farmacéutico oncohematológico lideraba la aplicación de los principios de medicina basada en la evidencia y de los resultados obtenidos en la práctica clínica habitual, y se comprobó que un 88% de los hospitales contaba con protocolos estandarizados. En cuanto a prácticas de seguridad, en un 83% de los hospitales el farmacéutico oncohematológico participaba activamente en el desarrollo y mantenimiento del programa de gestión de riesgos aplicado a la prevención de errores. La preparación estaba centralizada en un 89% de los hospitales. Se observó variabilidad en la atención farmacéutica en función de dónde se atendía al paciente. En el 92% de los hospitales existía farmacéutico de referencia para oncohematología, aunque con distintos niveles de capacitación. Las mayores deficiencias se observaron en los programas de formación y docencia. Un 53% de los farmacéuticos oncohematológicos había sido investigador en los últimos tres años. Conclusiones: Estos resultados marcan el punto de partida de las unidades de farmacia oncohematológicas españolas para el desarrollo de estrategias de mejora de la calidad de la atención farmacéutica ofrecida a los pacientes oncohematológicos liderado por GEDEFO, jefes de servicio y los propios farmacéuticos oncohematológicos

Objective: To learn about the baseline of Oncohematological Pharmacy Units in Spanish hospitals in order to identify areas for improvement. Method: A survey in line with the objectives set in GEDEFO 2020 Strategic Plan of Pharmaceutical Care for oncohematological patients was designed. The survey was hosted on GEDEFO's website during March and April 2017. Activity data for 2016 was collected. Results: A total of 95 hospitals responded to the survey. Out of which, 76% had an integrated information system of pharmacotherapeutic process management, where a variability in technological and organizational processes were found. The oncohematological pharmacist led the implementation of the principles of medicine, based on evidence and results obtained in routine clinical practice. It was shown that 88% of hospitals had standardized protocols. As for safety practices, in 83% of hospitals, oncohematological pharmacists actively participated in the development and maintenance of risk management program, implemented to prevent errors. Preparation was centralized in 89% of hospitals. Variability was observed in pharmaceutical care depending on where the patient was attended. In 92% of hospitals, pharmacists served as reference for Oncohematology, although with different levels of training. Major deficiencies were observed in training programs and teaching. Of all oncohematological pharmacists, 53% had been a researcher over the past three years. Conclusions: These results mark the starting point for Spanish Oncohematological Pharmacy Units to develop strategies for improving the quality of pharmaceutical care offered to oncohematological patients and led by GEDEFO, heads of service, and oncohematological patients themselves

Survey of oncohematological pharmaceutical care situation in Spain.

OBJECTIVE: To learn about the baseline of Oncohematological Pharmacy Units in Spanish hospitals in order to identify areas for  improvement. METHOD: A survey in line with the objectives set in GEDEFO 2020  Strategic Plan of Pharmaceutical Care for oncohematological patients  was designed. The survey was hosted on GEDEFO's website during  March and April 2017. Activity data for 2016 was collected. Results: A total of 95 hospitals responded to the survey. Out of which, 76% had an integrated information system of  pharmacotherapeutic process management, where a variability in  technological and organizational processes were found. The  oncohematological pharmacist led the implementation of the principles  of medicine, based on evidence and results obtained in routine clinical  practice. It was shown that 88% of hospitals had standardized  protocols. As for safety practices, in 83% of hospitals,  oncohematological pharmacists actively participated in the development  and maintenance of risk management program, implemented to prevent  errors. Preparation was centralized in 89% of hospitals. Variability was observed in pharmaceutical care depending on  where the patient was attended. In 92% of hospitals, pharmacists  served as reference for Oncohematology, although with different levels  of training. Major deficiencies were observed in training programs and  teaching. Of all oncohematological pharmacists, 53% had been a  researcher over the past three years. CONCLUSIONS: These results mark the starting point for Spanish  Oncohematological Pharmacy Units to develop strategies for improving  the quality of pharmaceutical care offered to oncohematological patients  and led by GEDEFO, heads of service, and oncohematological  patients themselves.

Objetivo: Conocer la situación basal de las unidades de farmacia  oncohematológica de los hospitales españoles para detectar ámbitos de  mejora.Método: Se diseñó una encuesta acorde con los objetivos establecidos en el Plan Estratégico de Atención Farmacéutica al paciente  oncohematológico del Grupo de Farmacia Oncológica de la  Sociedad Española de Farmacia Hospitalaria (GEDEFO 2020). La  encuesta se alojó en la página web de GEDEFO durante marzo y abril de  2017. Se recogieron datos de actividad del año 2016.Resultados: Respondieron la encuesta 95 hospitales. Un 76%  disponían de un sistema de información integral de gestión del proceso farmacoterapéutico, encontrándose variabilidad en los procesos  tecnológicos y organizativos. El farmacéutico oncohematológico lideraba  la aplicación de los principios de medicina basada en la evidencia y de  los resultados obtenidos en la práctica clínica habitual, y se comprobó  que un 88% de los hospitales contaba con protocolos estandarizados. En  cuanto a prácticas de seguridad, en un 83% de los hospitales el  farmacéutico oncohematológico participaba activamente en el desarrollo  y mantenimiento del programa de gestión de riesgos  aplicado a la prevención de errores. La preparación estaba centralizada  en un 89% de los hospitales. Se observó variabilidad en la atención  farmacéutica en función de dónde se atendía al paciente. En el 92% de  los hospitales existía farmacéutico  de referencia para oncohematología,  aunque con distintos niveles de capacitación. Las mayores deficiencias  se observaron en los programas de formación y docencia. Un 53% de  los farmacéuticos oncohematológicos había sido investigador en los  últimos tres años.Conclusiones: Estos resultados marcan el punto de partida de las  unidades de farmacia oncohematológicas españolas para el desarrollo de estrategias de mejora de la calidad de la atención farmacéutica ofrecida a los pacientes oncohematológicos liderado por GEDEFO, jefes de  servicio y los propios farmacéuticos oncohematológicos.

An atypical presentation of diabetic myonecrosis.

Objective: Diabetes myonecrosis, also called diabetic muscle infarction (DMI), is a rare complication of diabetes. Given its rarity, our understanding of the underlying causes or the optimal management of DMI cases remains unclear. Methods: We report on a patient who experienced 2 episodes of DMI and we also review the literature. Results: A 46-year-old male with longstanding type 2 diabetes mellitus with multiple microvascular complications presented with acute-onset painful right thigh induration. On physical examination, he had right thigh swelling, tenderness, and crepitus. Blood tests showed leukocytosis, elevated creatine phosphokinase, and elevated acute-phase reactants. Microbiological cultures were negative. Glycated hemoglobin was 6.4% (46 mmol/mol). Magnetic resonance imaging demonstrated T2 hyperintensity involving the quadriceps group. The clinical and laboratory signs suggested a muscle infection. A muscle biopsy was suggestive of DMI. Eleven months later, the patient presented again with a 4-week history of left thigh pain and weakness in both legs. On examination, he had bilateral thigh anterior tenderness without evidence of swelling or induration. He also had marked bilateral proximal motor deficiency and inability to stand or ambulate. Despite a different clinical presentation, imaging features were consistent with DMI. The patient was managed with conservative therapy. His strength improved significantly after 3 months of follow up. Conclusion: The typical clinical presentation of DMI includes unilateral acute-onset pain in the quadriceps, local swelling, and the appearance of a palpable painful mass. The second episode in our patient illustrates an atypical clinical presentation of DMI and shows the importance of the correlation of clinical and imaging findings for the diagnosis of DMI.

Ectopic ACTH Syndrome With Association of Multiple Pulmonary Sclerosing Pneumocytomas and Multiple Carcinoid Tumorlets.

We present the case of multiple sclerosing pneumocytomas (SPs) associated with ACTH-secreting carcinoid tumorlets responsible for an ectopic Cushing syndrome (ECS). SP is a rare benign tumor originating from pulmonary epithelial cells. An 18-year-old male presented with shortness of breath and right-sided chest pain after exercise. Chest radiograph indicated right pneumothorax and bilateral lung nodules. CT imaging showed innumerable bilateral hypodense pulmonary nodules and a wedge resection gave the definitive diagnosis of SP with associated carcinoid tumorlets. Two years later, he presented with severe back pain in context of thoracic vertebral compression fracture. He had central fat accumulation, violaceous striae, proximal muscle weakness, hypertension, and diabetes. MRI of the pituitary gland showed a 7-mm adenoma. Inferior petrosal sinus sampling with no central-to-periphery gradient suggested an ectopic origin of ACTH, which was confirmed by ACTH expression in a subset of tumorlet cells in the lung lesions. The patient was started on ketoconazole and subsequently underwent a bilateral adrenalectomy. During follow-up, CT scans showed no growth of the lesions, except for the most recent CT scan, in which an increase in the size of the largest nodule was described. Ten years after the diagnosis, the patient remains asymptomatic of his pulmonary lesions. This article provides a case of ECS in the setting of multiple SP with associated carcinoid tumorlets.

Percepciones y experiencias de usuarias sobre las limitaciones sanitarias para la promoción de lactancia materna / Perceptions and experiences of users about health limitations for the promotion of breastfeeding / Percepções e experiências das usuárias sobre as limitações de saúde para a promoção do aleitamento materno

RESUMEN Objetivo Comprender las percepciones y experiencias que usuarias de distintos servicios de salud han desarrollado respecto a las limitaciones sanitarias para la promoción de la Lactancia Materna. Metodología Investigación cualitativa con enfoque fenomenológico. Se aplicaron entrevistas en profundidad a 12 madres que habitan en una comunidad clasificada con alto nivel de marginación en San Luis Potosí, México, cuyos partos fueron atendidos en servicios de salud públicos, privados y de seguridad social. Se realizó análisis fenomenológico sobre las entrevistas trascritas en totalidad. Resultados Con independencia del tipo de atención sanitaria, las mujeres reciben poca capacitación para la lactancia durante la etapa prenatal y la mayor parte de esta ocurre de manera impersonal. La mayoría narra experiencias de exigencia y juzgamiento, más que de consejería, por parte del personal de salud. Conclusión La lactancia materna es contemplada como derivada de una decisión personal e individual, en la que no impacta la consejería del personal sanitario. Es necesario impulsar procesos de capacitación y sensibilización dirigidos a fortalecer las habilidades de acompañamiento para la Lactancia Materna en el personal de salud, con el fin de ejercer la función de consejería de manera asertiva.(AU)

ABSTRACT Objective To understand the perceptions and experiences of users of different health services about the limitations for the promotion of breastfeeding. Materials and Methods Qualitative research with a phenomenological approach. In-depth interviews were applied to 12 mothers who live in a community with a high level of marginalization of San Luis Potosí, Mexico, whose deliveries were attended by public, private and social security health services. Phenomenological analysis was carried out on the interviews transcribed in full. Results Regardless of the type of health care service, women receive little training on breastfeeding during the prenatal stage and most of this is provided through impersonal strategies. Most women state that the experiences were more related to demand and judgment, rather than to counseling by health personnel. Conclusion Breastfeeding is considered as result of a personal and individual decision, which does not impact the counseling provided by the health personnel. It is necessary to promote training and awareness to strengthen accompaniment skills regarding breastfeeding in health personnel, in order to provide counseling in an assertive manner.(AU)

RESUMO Objetivo Compreender as percepções e experiências que as usuárias de diferentes serviços de saúde têm desenvolvido sobre as limitações de saúde para a promoção do Aleitamento Materno. Metodologia Pesquisa qualitativa com abordagem fenomenológica. Entrevistas em profundidade foram aplicadas a 12 mães que vivem em uma comunidade classificada com alto nível de marginalização em San Luis Potosí, México, cujos partos foram atendidos em serviços de saúde públicos, privados e previdenciários. Uma análise fenomenológica foi realizada em todas as entrevistas transcritas. Resultados Independentemente do tipo de assistência à saúde, as mulheres recebem pouco treinamento em amamentação durante o pré-natal, e a maior parte ocorre de forma impessoal. A maioria narra experiências de exigência e julgamento, em vez de aconselhamento, por parte do pessoal de saúde. Conclusão A amamentação é vista como derivada de uma decisão pessoal e individual, na qual o aconselhamento do pessoal de saúde não tem impacto. É necessário promover processos de formação e sensibilização voltados ao fortalecimento das competências de apoio ao Aleitamento Materno nos profissionais de saúde, de forma a exercer a função de aconselhamento de forma assertiva.(AU)

[Perceptions and experiences of users about health limitations for the promotion of breastfeeding]. / Percepciones y experiencias de usuarias sobre las limitaciones sanitarias para la promoción de lactancia materna.

OBJECTIVE: To understand the perceptions and experiences of users of different health services about the limitations for the promotion of breastfeeding. MATERIALS AND METHODS: Qualitative research with a phenomenological approach. In-depth interviews were applied to 12 mothers who live in a community with a high level of marginalization of San Luis Potosí, Mexico, whose deliveries were attended by public, private and social security health services. Phenomenological analysis was carried out on the interviews transcribed in full. RESULTS: Regardless of the type of health care service, women receive little training on breastfeeding during the prenatal stage and most of this is provided through impersonal strategies. Most women state that the experiences were more related to demand and judgment, rather than to counseling by health personnel. CONCLUSION: Breastfeeding is considered as result of a personal and individual decision, which does not impact the counseling provided by the health personnel. It is necessary to promote training and awareness to strengthen accompaniment skills regarding breastfeeding in health personnel, in order to provide counseling in an assertive manner.

OBJETIVO: Comprender las percepciones y experiencias que usuarias de distintos servicios de salud han desarrollado respecto a las limitaciones sanitarias para la promoción de la Lactancia Materna. METODOLOGÍA: Investigación cualitativa con enfoque fenomenológico. Se aplicaron entrevistas en profundidad a 12 madres que habitan en una comunidad clasificada con alto nivel de marginación en San Luis Potosí, México, cuyos partos fueron atendidos en servicios de salud públicos, privados y de seguridad social. Se realizó análisis fenomenológico sobre las entrevistas trascritas en totalidad. RESULTADOS: Con independencia del tipo de atención sanitaria, las mujeres reciben poca capacitación para la lactancia durante la etapa prenatal y la mayor parte de esta ocurre de manera impersonal. La mayoría narra experiencias de exigencia y juzgamiento, más que de consejería, por parte del personal de salud. CONCLUSIÓN: La lactancia materna es contemplada como derivada de una decisión personal e individual, en la que no impacta la consejería del personal sanitario. Es necesario impulsar procesos de capacitación y sensibilización dirigidos a fortalecer las habilidades de acompañamiento para la Lactancia Materna en el personal de salud, con el fin de ejercer la función de consejería de manera asertiva.

Psychopathological Symptoms and Psychological Wellbeing in Mexican Undergraduate Students.

College life involves a process of adaptation to changes that have an impact on the psycho-emotional development of students. Successful adaptation to this stage involves the balance between managing personal resources and potential stressors that generate distress. This epidemiological descriptive and transversal study estimates the prevalence of psychopathological symptomatology and psychological well-being among 516 college students, 378 (73.26%) women and 138 (26.74%) men, ages between 17 and 24, from the city of Monterrey in Mexico. It describes the relationship between psychopathological symptomatology and psychological well-being, and explores gender differences. For data collection, two measures were used: The Symptom Checklist Revised and the Scale of Psychological Well-being. Statistical analyses used were t test for independent samples, Pearson's r and regression analysis with the Statistical Package for the Social Sciences (SPSS v21.0). Statistical analyses showed that the prevalence of psychopathological symptoms was 10-13%, being Aggression the highest. The dimension of psychological well-being with the lowest scores was Environmental Mastery. Participants with a higher level of psychological well-being had a lower level of psychopathological symptoms, which shows the importance of early identification and prevention. Gender differences were found on some subscales of the psychopathological symptomatology and of the psychological well-being measures. This study provides a basis for future research and development of resources to promote the psychological well-being and quality of life of university students.

Serum Concentration of Leptin in Pregnant Adolescents Correlated with Gestational Weight Gain, Postpartum Weight Retention and Newborn Weight/Length.

Introduction: Gestational weight gain is an important modifiable factor known to influence fetal outcomes including birth weight and adiposity. Leptin is normally correlated with adiposity and is also known to increase throughout pregnancy, as the placenta becomes a source of leptin synthesis. Several studies have reported positive correlations between cord blood leptin level and either birthweight or size for gestational age, as well as body mass index (BMI). Objective: To determine the correlation of prenatal leptin concentration in pregnant adolescents with their gestational weight gain, postpartum weight retention, and weight/length of their newborn. Methods: A cohort study was conducted on pregnant Mexican adolescents from Gestational Week 26-28 to three months postpartum (n = 168 mother-child dyads). An anthropometric assessment was made of each pregnant adolescent, and the serum level of leptin and the intake of energy were determined. The newborn was evaluated each month during postpartum. Clinical records were reviewed to obtain sociodemographic data. Bivariate correlations, tests for repeating measurements and logistic regression models were performed. Results: Leptin concentration gradually increased during the third trimester of pregnancy. At Gestation Week 36, leptin level correlated with gestational weight gain. When comparing adolescents that had the lowest and highest concentration of leptin, the former presented a mean of 6 kg less in gestational weight gain (inter-subject leptin concentration, p = 0.001; inter-subject energy intake, p = 0.497). Leptin concentration and gestational weight gain exerted an effect on the weight of the newborn (inter-subject leptin concentration for Week 32, p = 0.024; inter-subject gestational weight gain, p = 0.011). Newborn length was associated with leptin concentration at Week 28 (leptin effect, p = 0.003; effect of gestational weight gain, p = 0.722). Conclusions: Pregnant adolescents with leptin concentration over 20 ng/mL showed a greater gestational weight gain. Leptin concentration correlated with length and weight of the newborn.