Job burnout, cognitive functioning, and Brain-derived neurotrophic factor expression among hospital Mexican nurses.

AIM: To analyze the relationship between burnout syndrome, cognitive functions, and sBDNF (Serum Brain-derived Neurotrophic Factor) in Mexican nurses. METHOD: A descriptive cross-sectional design was used. This study target staff nurses working in hospitals in Guanajuato, México. Demographic and working condition data were collected via questionnaire. The Maslach Burnout Inventory (MBI) was used to evaluate burnout. A blood sample were collected and processed by ELISA technique to measure sBDNF. Finally, the General Cognitive Assessment (CAB) of the Cognifit© neuropsychological battery was used to evaluated cognitive functions. RESULTS: Findings showed that there are sociodemographic characteristics and working conditions associated with burnout syndrome among nurses. Furthermore, the data demonstrated a significant decrease in sBDNF levels in burnout nurses and a negative correlation between BDNF levels and burnout syndrome. Additionally, these burnout nurse also revealed significant cognitive impairment in reasoning, memory, and attention as well as total scores of CAB. Interestingly, we found a positive correlation between sBDNF levels and the cognitive deficits in burnout nurse. CONCLUSION: Reduced BDNF levels could be a biological indicator or part of the pathological process of burnout, which could affect cognitive abilities. Reduced cognitive function in nurses has relevant implications and emphasizes the need for specialized preventive strategies because nurses make clinical decisions concerning their patients, whose situations are constantly changing.

Effects of Mexican Ganoderma lucidum extracts on liver, kidney, and the gut microbiota of Wistar rats: A repeated dose oral toxicity study.

Well-characterized and standardized extracts of a Mexican genotype of Ganoderma lucidum (Gl), a medicinal mushroom, cultivated on oak sawdust (Gl-1) or oak sawdust plus acetylsalicylic acid (Gl-2, ASA), have been shown to exert antioxidant, hypocholesterolemic, anti-inflammatory, prebiotic, and anticancer properties. However, toxicity analyses still need to be carried out. Different doses of these Gl-1 or Gl-2 extracts were administered to Wistar rats for 14 days in a repeated dose oral toxicity study. We assessed the external clinical signs, biochemical parameters, liver and kidney tissues, injury and inflammation biomarkers, gene expression, inflammatory responses, proinflammatory mediators, and gut microbiota. Gl extracts had no significant adverse, toxic or harmful effects on male and female rats compared to the control groups. No injury or dysfunction were recorded in the kidney or liver, as there were no significant abnormal variations in organ weight, tissue histopathology, serum biochemical parameters (C-reactive protein, creatinine, urea, glucose, ALT and AST transaminases, TC, LDL-c, TG, HDL-c), urinary parameters (creatinine, urea nitrogen, albumin, the albumin-to-creatinine ratio, glucose), injury and inflammatory biomarkers (KIM-1/TIM-1, TLR4, and NF-кB protein expression; IL-1ß, TNF-α and IL-6 gene expression), or the expression of genes linked to cholesterol metabolism (HMG-CoA, Srebp2, Ldlr). Gl-1 and Gl-2 extracts showed prebiotic effects on the gut microbiota of male and female Wistar rats. Bacterial diversity and relative bacterial abundance (BRA) increased, positively modulating the Firmicutes/Bacteroidetes ratio. The ASA (10 mM) added to the substrate used for mushroom cultivation changed properties and effects of the Gl-2 extract on Wistar rats. The no-observed-adverse-effect-level (NOAEL) was 1000 mg/kg body weight/day of Gl-1 or Gl-2 extracts. Clinical trials are recommended for further exploring the potential therapeutic applications of studied extracts.

Sleep Disturbances and Mental Well-Being of Preschool Children during the COVID-19 Pandemic in Mexico.

COVID-19 pandemic confinement caused changes in families and children's routines worldwide. Studies conducted at the beginning of the pandemic have examined the harmful effects of these changes on mental health, including sleep disturbances. As sleep is essential for optimal childhood development, this study was designed to determine preschool-aged (3-6 years old) children's sleep parameters and mental well-being during the COVID-19 pandemic in Mexico. Using a cross-sectional design, a survey was applied to parents of preschool children, inquiring about their children's confinement status, routine changes, and electronics use. The parents responded to the Children's Sleep Habits Questionnaire and the Strengths and Difficulties Questionnaire to assess children's sleep and mental well-being. To provide objective sleep data, the children wore wrist actigraphy for seven days. Fifty-one participants completed the assessment. The children's mean age was 5.2 years, and the prevalence of sleep disturbances was 68.6%. The use of electronic tablets in the bedroom near bedtime and symptoms of mental health deterioration (i.e., emotional distress and behavioral difficulties) were associated with sleep disturbances and their severity. The COVID-19 pandemic's confinement-related routine changes greatly impacted preschool children's sleep and well-being. We recommend establishing age-tailored interventions to manage children at higher risk.

Psychosocial factors in adherence to pharmacological treatment and diabetes mellitus control in patients over 65.

AIM: To explore the influence of anxiety/depression symptoms and social risk in patients older than 65 years with type 2 diabetes mellitus (T2DM) both in non-adherence to pharmacological treatment (Non-AdhT) and in poor control of T2DM. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Adults over 65 years of age with T2DM treated at the Madrid Primary Care Service. MAIN MEASUREMENTS: Data collection: Electronic Health Record database. VARIABLES: Poor control of T2DM (HBA1c) and Non-AdhT (Morisky-Green test); main clinical variables: symptoms of depression/anxiety and social risk. Global multivariate logistic regression models and disaggregated by sex were used to Non-AdhT and poor T2DM control. RESULTS: Data were obtained on 884 subjects. Non-AdhT prevalence: 4.4%; prevalence of poor T2DM control: 37.2%. Multivariate logistic regression models for No-AdhT in men showed a higher risk if they had symptoms of anxiety/depression (OR: 3.88; 95%CI: 1.15-13.07); and in women, if they had social risk (OR: 5.61; 95%CI: 1.86-16.94). Multivariate logistic regression models for poor control of T2DM in men revealed a higher risk if they did not have AdhT (OR: 3.53; 95%CI: 1.04-12.02). CONCLUSIONS: In people over 65 years with T2DM, although Non-AdhT is low, the prevalence of poor T2DM control is high. Symptoms of depression or anxiety are a risk factor to Non-AdhT in men, while social risk has the same effect in women. Non-AdhT in men increases the risk of poor T2DM control. From a gender perspective, it is important to detect social and mental health problems in older adults with diabetes and to reinforce strategies to improve their adherence to drug treatment in these patients.

Comparative Study on the Quality of Microcrystalline and Epitaxial Silicon Films Produced by PECVD Using Identical SiF4 Based Process Conditions.

Hydrogenated microcrystalline silicon (µc-Si:H) and epitaxial silicon (epi-Si) films have been produced from SiF4, H2 and Ar mixtures by plasma enhanced chemical vapor deposition (PECVD) at 200 °C. Here, both films were produced using identical deposition conditions, to determine if the conditions for producing µc-Si with the largest crystalline fraction (XC), will also result in epi-Si films that encompass the best quality and largest crystalline silicon (c-Si) fraction. Both characteristics are of importance for the development of thin film transistors (TFTs), thin film solar cells and novel 3D devices since epi-Si films can be grown or etched in a selective manner. Therefore, we have distinguished that the H2/SiF4 ratio affects the XC of µc-Si, the c-Si fraction in epi-Si films, and the structure of the epi-Si/c-Si interface. Raman and UV-Vis ellipsometry were used to evaluate the crystalline volume fraction (Xc) and composition of the deposited layers, while the structure of the films were inspected by high resolution transmission electron microscopy (HRTEM). Notably, the conditions for producing µc-Si with the largest XC are different in comparison to the fabrication conditions of epi-Si films with the best quality and largest c-Si fraction.

Use of herbal medicine for diabetes mellitus in adults from the central-western region of Mexico.

OBJECTIVE: This study aims to assess the prevalence of herbal medicine (HM) use and factors influencing HM usage including the identification of the main plants consumed by patients with type 2 diabetes mellitus (T2DM) in central-western Mexico. DESIGN: A total of 1862 patients with diabetes were surveyed in public and private hospitals in four states (Guanajuato, Jalisco, Michoacan, and San Luis Potosi) of the central-western region of Mexico. The chi-square test was used to assess associations between HM use and demographic characteristics, such as glucose levels, presence of complications and comorbidities, as well as the selected therapy to treat T2DM. RESULTS: The prevalence of HM use (59.2%) in patients with T2DM was mainly associated with education level (p = 0.001), time of diagnosis of T2DM (p = 0.004), presence of complications (p < 0.001) and comorbidities (p = 0.018) and the use of insulin (p < 0.001). These patients report a higher consumption of herbal medicine compared to those on glycemic control (p < 0.001). The most frequently used medicinal plants to treat T2DM were nopal (54.9%), moringa (26.7%), and aloe (22.1%). CONCLUSION: The prevalence of HM use to treat T2DM in west-central Mexico is high (59.2%) and its consumption is mostly carried out without the recommendation of a health professional (91.9%). The use of HM increases mainly when the patient uses insulin, during complications of the disease or in patients with an inadequate glycemic control.

Fabrication of Microbolometer Arrays Based on Polymorphous Silicon-Germanium.

This work reports the development of arrays of infrared sensors (microbolometers) using a hydrogenated polymorphous silicon-germanium alloy (pm-SixGe1-x:H). Basically, polymorphous semiconductors consist of an amorphous semiconductor matrix with embedded nanocrystals of about 2-3 nm. The pm-SixGe1-x:H alloy studied has a high temperature coefficient of resistance (TCR) of 4.08%/K and conductivity of 1.5 × 10-5 S∙cm-1. Deposition of thermosensing film was made by plasma-enhanced chemical vapor deposition (PECVD) at 200 °C, while the area of the devices is 50 × 50 µm2 with a fill factor of 81%. Finally, an array of 19 × 20 microbolometers was packaged for electrical characterization. Voltage responsivity values were obtained in the range of 4 × 104 V/W and detectivity around 2 × 107 cm∙Hz1/2/W with a polarization current of 70 µA at a chopper frequency of 30 Hz. A minimum value of 2 × 10-10 W/Hz1/2 noise equivalent power was obtained at room temperature. In addition, it was found that all the tested devices responded to incident infrared radiation, proving that the structure and mechanical stability are excellent.

Ejercicio Físico en el Paciente con Falla Renal / Physical Exercise in the Patient with Renal Failure

Resumen La enfermedad renal es una patología que afecta gravemente a los riñones, generando alteraciones en la capacidad de filtrar toxinas y otras sustancias de desecho en la sangre. Evidenciar los efectos y el rol de la intervención fisioterapéutica en pacientes con enfermedad renal. Se realizó una revisión sistemática, con análisis retrospectivo y descriptivo, de artículos científicos publicados en bases de datos indexadas entre enero del 2007 a noviembre del 2018. Se realizó la búsqueda de estudios en las bases de datos EBSCO, SciELO, MEDLINE, Medscape, PubMed Central, EMBASE, REDALYC, DOAJ, OVID y diferentes revistas sobre el tema. Se utilizaron los criterios de inclusión de estudios para revisiones sistemáticas de la Declaración PRISMA, y la evaluación del riesgo de sesgo se realizó mediante la evaluación de la Colaboración Cochrane y la escala de PEDro. Se recuperaron 68.620 artículos científicos antes de aplicar los filtros correspondientes. Luego de ellos, se obtuvieron 20 artículos que fundamentan la existencia de una mejoría en la calidad de vida, fuerza, capacidad física, consumo de oxígeno, bienestar físico, mental y social, en pacientes con falla renal. La realización de ejercicio físico en pacientes con falla renal mejora la respuesta física, social y mental, como también, las actividades de la vida diaria. Estos efectos se obtienen con una evaluación, prescripción y monitoreo adecuado del ejercicio. Por esto, concluimos que resulta indispensable que un profesional en fisioterapia participe en el equipo interdisciplinario necesario para el tratamiento de la enfermedad renal.

Abstract Kidney disease is a pathology where the kidneys are seriously damaged, generating alterations in the ability to filter toxins and other waste substances in the blood. The aim of this study was to evidence the effects and role of physiotherapeutic intervention in patients with kidney disease. A systematic review was conducted, with retrospective and descriptive analysis, of scientific articles published in indexed databases between January 2007 and November 2018. The search was performed for studies in the EBSCO, SciELO, MEDLINE, Medscape, PubMed databases, as well as in Central, EMBASE, REDALYC, DOAJ, OVID and several journals on the subject. The criteria for inclusion of studies were used for systematic reviews of the PRISMA Statement, and a risk-of-bias assessment was performed through the evaluation of the Cochrane Collaboration and the PEDro scale. 68,620 scientific articles were recovered before applying the corresponding filters. After that, 20 articles were obtained which support the existence of an improvement in the quality of life, strength, physical capacity, oxygen consumption, physical, mental and social well-being in patients with renal failure. The performance of physical exercise in patients with renal failure improves the physical, social and mental response, as well as the activities of daily living. These effects are the result of an evaluation, prescription and adequate monitoring of the exercise. Therefore, we conclude it is essential that a professional in physiotherapy should participate in the interdisciplinary team necessary for the treatment of kidney disease.

Effect of organophosphorus pesticides in juveniles of Litopenaeus vannamei: alteration of glycogen, triglycerides, and proteins.

The presence of pesticides has recently been reported in shrimp farms adjacent to agricultural areas on the east coast of the Gulf of California. This study assessed the possible effect of organophosphorus pesticides in the coastal environment of Sinaloa, México, using the white shrimp Litopenaeus vannamei as a bioindicator since their presence, abundance or behavior indicate some process or state of the system in which they live. Sublethal bioassays were performed on shrimps in intermolt state using commercial brands of organophosphorus pesticides, chlorpyrifos (0.0015 mg l-1), diazinon (0.0120 mg l-1), methamidophos (1.207 mg l-1), azinphos-methyl (0.0101 mg l-1), and methyl parathion (0.0075 mg l-1) were tested. Results showed reductions in glycogen, triglycerides, and total protein concentrations in shrimp muscle, except for the diazinon treatments, in which an increase in triglyceride level was detected. The observed alterations in the three cellular components were probably due to the metabolic compensation mechanism of the shrimp in reaction to the stress produced by organophosphorus pesticides, which act as endocrine disruptors. The establishment of continuous environmental monitoring programs of the coastal zone of Northwestern Mexico is strongly recommended.

Complicaciones intraoperatorias y posquirúrgicas tempranas en cirugía lumbo-laparoscópica urológica / Early intraoperative and postsurgical complications in urological lumbo-laparoscopic surgery

Se realizó un estudio descriptivo de 103 pacientes que recibieron cirugía lumbo-laparoscópica en el Servicio de Urología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, durante el período de enero de 2011 a diciembre de 2014, con vistas a describir las complicaciones intraoperatorias y posquirúrgicas tempranas según algunas variables seleccionadas. Entre los principales hallazgos de la serie se obtuvo que 73 operaciones fueron realizadas por vía de acceso transperitoneal y 30 por vía retroperitoneal, la mayoría de los pacientes correspondían al sexo masculino y en el total de intervenciones se notificaron 15 complicaciones, con mayor frecuencia del hidrocele reaccional y el drenaje prolongado, que fueron clasificadas en el grado I según el sistema de Clavien-Dindo. Pudo concluirse que la aparición de complicaciones guardó relación directa con la complejidad de los procedimientos efectuados y el acceso quirúrgico retroperitoneal; no obstante ello, la cirugía lumbo-laparoscópica urológica constituye una técnica segura para el tratamiento de estos pacientes(AU)

A descriptive study of 103 patients who received lumbo-laparoscopic surgery in the Urology Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out during the period of January, 2011 to December, 2014, aimed at describing early intraoperative and postsurgical complications according to some selected variables. Among the main discoveries of the series it was obtained that 73 surgeries were carried out through transperitoneal access and 30 through retroperitoneal access, most of the patients corresponded to the male sex and in all surgeries 15 complications were notified, with higher frequency of the reactional hydrocele and prolonged drainage, which were classified in degree according to the Clavien-Dindo system. It is concluded that the emergence of complications was closely related to the complexity of the procedures carried out and the surgical retroperitoneal access; however, the urologic lumbo-laparoscopic surgery constitutes a reliable technique for the treatment of these patients(AU)

Caracterización epidemiológica, diagnóstica y terapéutica de pacientes con priapismo / Epidemiological, diagnostic and therapeutical characterization of patients with priapism

Se realizó un estudio descriptivo y transversal de 32 pacientes con priapismo, atendidos en el Servicio de Urología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero de 2008 hasta diciembre de 2014, a fin de caracterizarles desde los puntos de vista epidemiológico, diagnóstico y terapéutico. En la serie predominaron el grupo etario de 20-29 años, el color de piel negra y la etiología idiopática como la más frecuente. En 53,1 por ciento de los pacientes no se determinó el tipo de priapismo y 46,9 por ciento de ellos tenían más de 24 horas de evolución antes de recibir asistencia médica. De los que presentaron entre 12-24 horas solo 7,1 por ciento recibió tratamiento quirúrgico. El tratamiento médico fue inefectivo en 76,5 por ciento de los pacientes y 54,9 por ciento de ellos presentó disfunción eréctil(AU)

A descriptive and cross-sectional study of 32 patients with priapism, assisted at the Urology Service of the Saturnino Lora Torres Provincial Teaching Clinical Surgical Hospital in Santiago de Cuba, was carried out from January, 2008 to December, 2014, in order to characterize them from the epidemiological, diagnostic and therapeutical points of view. The 20-29 age group and the black skin color predominated in the series, as well as and the idiopathic etiology as the most frequent one. In the 53.1 percent of the patients priapism type was not determined and 46.9 percent of them had more than 24 hours of clinical course before receiving medical assistance. Of those who arrived between 12-24 hours only 7.1 percent received surgical treatment. The medical treatment was not effective in 76.5 percent of the patients and 54.9 percent of them presented erectile dysfunction(AU)

Complicaciones intraoperatorias y posquirúrgicas tempranas en cirugía lumbo-laparoscópica urológica / Early intraoperative and postsurgical complications in urological lumbo-laparoscopic surgery

Se realizó un estudio descriptivo de 103 pacientes que recibieron cirugía lumbo-laparoscópica en el Servicio de Urología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el período de enero de 2011 a diciembre de 2014, con vistas a describir las complicaciones intraoperatorias y posquirúrgicas tempranas según algunas variables seleccionadas. Entre los principales hallazgos de la serie se obtuvo que 73 operaciones fueron realizadas por vía de acceso transperitoneal y 30 por vía retroperitoneal, la mayoría de los pacientes correspondían al sexo masculino y en el total de intervenciones se notificaron 15 complicaciones, con mayor frecuencia del hidrocele reaccional y el drenaje prolongado, que fueron clasificadas en el grado I según el sistema de Clavien-Dindo. Pudo concluirse que la aparición de complicaciones guardó relación directa con la complejidad de los procedimientos efectuados y el acceso quirúrgico retroperitoneal; no obstante ello, la cirugía lumbo-laparoscópica urológica constituye una técnica segura para el tratamiento de estos pacientes.

A descriptive study of 103 patients who received lumbo-laparoscopic surgery in the Urology Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out during the period of January, 2011 to December, 2014, aimed at describing early intraoperative and postsurgical complications according to some selected variables. Among the main discoveries of the series it was obtained that 73 surgeries were carried out through transperitoneal access and 30 through retroperitoneal access, most of the patients corresponded to the male sex and in all surgeries 15 complications were notified, with higher frequency of the reactional hydrocele and prolonged drainage, which were classified in degree according to the Clavien-Dindo system. It is concluded that the emergence of complications was closely related to the complexity of the procedures carried out and the surgical retroperitoneal access; however, the urologic lumbo-laparoscopic surgery constitutes a reliable technique for the treatment of these patients.

Caracterización epidemiológica, diagnóstica y terapéutica de pacientes con priapismo / Epidemiological, diagnostic and therapeutical characterization of patients with priapism

Se realizó un estudio descriptivo y transversal de 32 pacientes con priapismo, atendidos en el Servicio de Urología del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde enero de 2008 hasta diciembre de 2014, a fin de caracterizarles desde los puntos de vista epidemiológico, diagnóstico y terapéutico. En la serie predominaron el grupo etario de 20-29 años, el color de piel negra y la etiología idiopática como la más frecuente. En 53,1 % de los pacientes no se determinó el tipo de priapismo y 46,9 % de ellos tenían más de 24 horas de evolución antes de recibir asistencia médica. De los que presentaron entre 12-24 horas solo 7,1 % recibió tratamiento quirúrgico. El tratamiento médico fue inefectivo en 76,5 % de los pacientes y 54,9 % de ellos presentó disfunción eréctil.

A descriptive and cross-sectional study of 32 patients with priapism, assisted at the Urology Service of the "Saturnino Lora Torres" Provincial Teaching Clinical Surgical Hospital in Santiago de Cuba, was carried out from January, 2008 to December, 2014, in order to characterize them from the epidemiological, diagnostic and therapeutical points of view. The 20-29 age group and the black skin color predominated in the series, as well as and the idiopathic etiology as the most frequent one. In the 53.1% of the patients priapism type was not determined and 46.9% of them had more than 24 hours of clinical course before receiving medical assistance. Of those who arrived between 12-24 hours only 7.1% received surgical treatment. The medical treatment was not effective in 76.5% of the patients and 54.9% of them presented erectile dysfunction.

Observaciones críticas en torno a la apendicectomía videolaparoscópica / Critical observations regarding videolaparoscopic appendicectomy

La apendicitis aguda es la causa más común de abdomen agudo que requiere tratamiento quirúrgico inmediato. A pesar de que muchos pacientes han recibido los beneficios de la apendicectomía videolaparoscópica, existen controversias respecto a su empleo sistemático en esta enfermedad. A tales efectos se realizó una revisión bibliográfica en la que se exponen algunos elementos actualizados sobre esta técnica, la cual, dada su utilidad diagnóstica y terapéutica, va ocupando progresivamente su lugar como proceder de elección en cualquier fase en que se encuentre el proceso morboso. Todo ello justifica la necesidad de profundizar en los principales aspectos cognoscitivos relacionados con este tema, pues solo así podrá elevarse la calidad asistencial en los hospitales y, con esa premisa, contar con protocolos de actuación uniformes, que beneficiarán a quienes presenten esta enfermedad tan frecuente(AU)

Acute appendicitis is the most common cause of acute abdomen requiring immediate surgical treatment. Although many patients have received the benefits of the videolaparoscopic appendicectomy, there are controversies regarding its systematic use in this disease. To achieve this, a literature review was carried out in which some updated elements on this technique are exposed, which, given its diagnostic and therapeutic usefulness, is progressively occupying its place as election procedure in any phase during the morbid process. All these justifies the necessity of deepening in the main cognitive aspects related to this topic, because this is the way to rise the assistance quality in hospitals and, with that premise, to have uniform performance protocols that will benefit those who present this frequent disease(AU)

Observaciones críticas en torno a la apendicectomía videolaparoscópica / Critical observations regarding videolaparoscopic appendicectomy

La apendicitis aguda es la causa más común de abdomen agudo que requiere tratamiento quirúrgico inmediato. A pesar de que muchos pacientes han recibido los beneficios de la apendicectomía videolaparoscópica, existen controversias respecto a su empleo sistemático en esta enfermedad. A tales efectos se realizó una revisión bibliográfica en la que se exponen algunos elementos actualizados sobre esta técnica, la cual, dada su utilidad diagnóstica y terapéutica, va ocupando progresivamente su lugar como proceder de elección en cualquier fase en que se encuentre el proceso morboso. Todo ello justifica la necesidad de profundizar en los principales aspectos cognoscitivos relacionados con este tema, pues solo así podrá elevarse la calidad asistencial en los hospitales y, con esa premisa, contar con protocolos de actuación uniformes, que beneficiarán a quienes presenten esta enfermedad tan frecuente.

Acute appendicitis is the most common cause of acute abdomen requiring immediate surgical treatment. Although many patients have received the benefits of the videolaparoscopic appendicectomy, there are controversies regarding its systematic use in this disease. To achieve this, a literature review was carried out in which some updated elements on this technique are exposed, which, given its diagnostic and therapeutic usefulness, is progressively occupying its place as election procedure in any phase during the morbid process. All these justifies the necessity of deepening in the main cognitive aspects related to this topic, because this is the way to rise the assistance quality in hospitals and, with that premise, to have uniform performance protocols that will benefit those who present this frequent disease.

Disease severity and mortality caused by dengue in a Dominican pediatric population.

Millions are infected with dengue yearly. We evaluated the epidemiological and clinical characteristics of pediatric patients infected with dengue in the Dominican Republic. The applicability of World Health Organization (WHO) warning signs for predicting severe dengue and mortality was also studied. This study was a cross-sectional retrospective review of patients with a clinical diagnosis of dengue. Univariate and multivariate analyses were performed to evaluate characteristics associated with severity and mortality. The study included 796 subjects: 288 subjects were classified as dengue, 290 subjects had alarm signs, and 207 subjects were classified as severe dengue. Common findings included thrombocytopenia (96%), abdominal pain (71%), and vomiting (59%). The most important factors associated with severe dengue were rash (P < 0.01), severe thrombocytopenia (P < 0.01), and anemia (P < 0.01). These signs and symptoms were also associated with mortality. This study validates the current WHO warning signs of severity. Rash and severe thrombocytopenia may be early warning signs and need additional study.

Prenatal prevalence of skeletal dysplasias and a proposal ultrasonographic diagnosis approach.

OBJECTIVE: To determine the prevalence of fetal bone dysplasias diagnosed at the Department of Maternal Fetal Medicine (UNIMEF) of the Instituto Nacional de Perinatologia (INPer); and to describe the most frequent skeletal dysplasias and to propose a diagnostic flow chart. MATERIALS AND METHODS: This is a case series study including skeletal dysplasias cases from January 1995 until December 2009 at the UNIMEF Statistical analysis was performed using SPSS 12 statistical software. RESULTS: A total of 81,892 births were registered at the institution during the study period. The prevalence of bone dysplasia was 8.1 per 10,000 births. We used a diagnostic flow chart that was developed at our institution to diagnose skeletal dysplasias. Micromelia (n = 40, 59.7%) and both rhizomelia and mesomelia (n = 17, 25.3%) were highly prevalent. We found other structural anomalies in 40 cases (61.1%), which were associated with different skeletal dysplasias; these other anomalies were mainly congenital heart diseases (12 cases) with a predominance of ventricular septal defects. There was polyhydramnios in 43.2% of cases. The mean of the gestational age at diagnosis was 24.5 weeks (SD 5.66). The karyotype was obtained in 11.9% (8/67) of cases. A total of 7 stillbirths and 11 neonatal deaths were registered, of which only 10 cases received a necropsy. Births occurred in the third trimester for 88% of cases, of which 85% were born via Cesarean section, whereas in the second trimester, the vaginal approach was chosen in 100% of cases. CONCLUSIONS: The prenatal diagnosis of bone dysplasias is challenging due to the late development of the diagnostic features. Nevertheless, using ultrasonography in a systematic approach, in conjunction with a multidisciplinary approach, is a key factor in the diagnosis of this disease during the fetal period.

Hacia una necesaria transformacion del curru­culo de postgrado en cirugì­a videolaparoscopica

Se realizó un estudio retrospectivo y prospectivo del currículo del residente de cirugía general y su estructura modular, en los servicios de Cirugía de los Hospitales Docentes Clínico-Quirúrgicos de la ciudad de Santa Clara provincia de Villa Clara. Se rediseñó el programa teniendo en cuenta el desarrollo actual de las nuevas tecnologías de las informaciones y las comunicaciones y el avance de las ciencias pedagógicas, así como su aplicación en el campo de la medicina, incluyéndosele un módulo de cirugía videolaparoscópica, sin modificar el número de años de la especialidad ni omitir ningún módulo(AU)