The utility HBA1c test as a screening biomarker for detecting gestational diabetes mellitus.

BACKGROUND: Glycated Hb (HbA1c) has not been used for the diagnosis of gestational diabetes mellitus (GDM). Measurement of HbA1c levels is less complicated and more comfortable than glucose challenge test (GCT) for pregnant women. We studied HbA1c as a biomarker of GDM and as a screening test to avoid the use of GCT. METHODS: A prospective case-control study involves 745 pregnant women between 24th and 28th gestation week. HbA1c levels were measured and GDM was diagnosed according to Carpenter-Coustan criteria. Mean and SD were calculated for GCT value, HbA1c, age, and body mass index (BMI). A receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of HbA1c test in diagnosing GDM. Cut-off points were calculated to rule out GDM and sensitivity (Se) and specificity (Sp) were also determined. A study of the implementation of HbA1c cut-offs was performed to avoid the GCT or to perform the confirmatory oral glucose tolerance test (OGTT). RESULTS: The area under the curve (AUC) was 0.67 (0.58-0.76). Using 4.6% HbA1c as a cut-off prevented false negatives but only decreased the number of GCTs performed by 7.2%. However, using 4.7% HbA1c resulted in one false negative (reduction of 15.0%). Finally, by selecting 4.8% HbA1c, we found two false negatives, but there were 25.9% who do not require a GCT. CONCLUSIONS: Adoption of HbA1c as a screening test for GDM may eliminate the need of GCT. Although the HbA1c test does not have sufficient Se and Sp to be used as the only diagnostic test, the use of a rule-out strategy in combination with the OGTT could be useful.

Training effects of attention and EF strategy-based training "Nexxo" in school-age students.

Given the importance of attention and executive functions in children's behavior, programs directed to improve these processes are of interest. Nexxo-training combines the use of the Nexxo touchscreen application (go/no-go and stop signal tasks) with procedural metacognitive strategies. The present paper reports a test of Nexxo's impact on children aged 6-7 and 8-9 years. We conducted a randomized active-controlled trial involving 108 typically-developing children: 1st grade (N = 61, M = 6.46 years, SD = 0.35) and 3rd grade (N = 47, M = 8.5 years, SD = 0.27), randomly assigned to: (1) experimental, (2) active-control, or (3) passive-control groups. A 2-month follow-up was carried out after the intervention. The 3rd grade experimental group displayed a significant reduction in attentional problems at follow-up compared to both control groups. Executive Function problems were also reduced at follow-up in the experimental group. Participants in this group improved in Supervision (self-monitoring) at post-intervention and follow-up compared to passive-controls. Although group effect was not significant at t1, it was significant at post measures in experimental group compared to passive-controls. Nexxo-training revealed a trend-level improvement in attention and executive functions for children in the 3rd grade.

[Evaluation of the educational intervention in orthopaedic and traumatology residents for the taking, measurement and preparations of the hamstring graft]. / Evaluación de la intervención educativa en residentes de ortopedia y traumatología para la toma, medición y preparación del injerto de isquiotibiales.

INTRODUCTION: The education process is understood as an activity focused on developing competencies through the use of educational tools and strategies that can be evaluated. The training of the residents in traumatology and orthopedics requires you to acquire knowledge and develop skills that will affect the diagnosis, treatment and prognosis of the patient. Therefore, what will be the evaluation of the educational intervention on the theoretical and practical knowledge in this group of physicians on the technique of taking, measuring and preparation of hamstring graft for the reconstruction of anterior cruciate ligament? MATERIAL Y METHODS: A prospective, quasi-experimental study was conducted to evaluate the impact of educational intervention in 23 Traumatology and orthopaedic residents on the use of hamstring in the anterior cruciate ligament reconstruction through theoretical sessions and Practice on cadaverous knees with preand post-intervention evaluations. RESULTS: The correlation between the pre and post evaluation educational intervention, both theoretical and practical, was statistically significant (p = 0.004 and p = 0.4, respectively). CONCLUSION: The statistically significant correlation between preand post-educational intervention evaluations speaks of the value of learning strategies, in the case of this study, the intervention through a theoretical and practical session by a simulated patient promotes knowledge acquisition and development of skills.

INTRODUCCIÓN: El proceso de educación se entiende como una actividad enfocada a desarrollar competencias mediante el empleo de herramientas y estrategias educativas que pueden ser sometidas a evaluación. La formación del médico residente de Traumatología y Ortopedia le exige adquirir conocimientos y desarrollar destrezas que repercutirán en el diagnóstico, tratamiento y pronóstico del paciente. Por lo tanto, ¿cuál será la evaluación de la intervención educativa sobre los conocimientos teóricos y prácticos en residentes de la especialidad de traumatología y ortopedia sobre la técnica de toma, medición y preparación de injerto de isquiotibiales para la reconstrucción de ligamento cruzado anterior? MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo, cuasiexperimental para evaluar el impacto de la intervención educativa en 23 residentes de Traumatología y Ortopedia sobre el uso de isquiotibiales en la reconstrucción de ligamento cruzado anterior mediante sesiones teórica y práctica en rodillas cadavéricas con evaluaciones pre- y postintervención. RESULTADOS: La correlación entre la evaluación pre- y postintervención educativa, tanto teórica como práctica, fue estadísticamente significativa (p = 0.004 y p = 0.4, respectivamente). CONCLUSIONES: La correlación estadísticamente significativa entre evaluaciones pre- y postintervención educativa refiere el valor de las estrategias de aprendizaje, en el caso de este estudio, la intervención a través de una sesión teórica y práctica mediante un paciente simulado (práctica necroquirúrgica) promueve la adquisición de conocimientos y el desarrollo de habilidades y destrezas.

Evaluación de la intervención educativa en residentes de Ortopedia y Traumatología para la toma, medición y preparación del injerto de isquiotibiales / Evaluation of the educational intervention in orthopaedic and traumatology residents for the taking, measurement and preparations of the hamstring graft

Resumen: Introducción: El proceso de educación se entiende como una actividad enfocada a desarrollar competencias mediante el empleo de herramientas y estrategias educativas que pueden ser sometidas a evaluación. La formación del médico residente de Traumatología y Ortopedia le exige adquirir conocimientos y desarrollar destrezas que repercutirán en el diagnóstico, tratamiento y pronóstico del paciente. Por lo tanto, ¿cuál será la evaluación de la intervención educativa sobre los conocimientos teóricos y prácticos en residentes de la especialidad de traumatología y ortopedia sobre la técnica de toma, medición y preparación de injerto de isquiotibiales para la reconstrucción de ligamento cruzado anterior? Material y métodos: Se realizó un estudio prospectivo, cuasiexperimental para evaluar el impacto de la intervención educativa en 23 residentes de Traumatología y Ortopedia sobre el uso de isquiotibiales en la reconstrucción de ligamento cruzado anterior mediante sesiones teórica y práctica en rodillas cadavéricas con evaluaciones pre- y postintervención. Resultados: La correlación entre la evaluación pre- y postintervención educativa, tanto teórica como práctica, fue estadísticamente significativa (p = 0.004 y p = 0.4, respectivamente). Conclusiones: La correlación estadísticamente significativa entre evaluaciones pre- y postintervención educativa refiere el valor de las estrategias de aprendizaje, en el caso de este estudio, la intervención a través de una sesión teórica y práctica mediante un paciente simulado (práctica necroquirúrgica) promueve la adquisición de conocimientos y el desarrollo de habilidades y destrezas.

Abstract: Introduction: The education process is understood as an activity focused on developing competencies through the use of educational tools and strategies that can be evaluated. The training of the residents in Traumatology and Orthopedics requires you to acquire knowledge and develop skills that will affect the diagnosis, treatment and prognosis of the patient. Therefore, what will be the evaluation of the educational intervention on the theoretical and practical knowledge in this group of physicians on the technique of taking, measuring and preparation of hamstring graft for the reconstruction of anterior cruciate ligament? Material y methods: A prospective, quasi-experimental study was conducted to evaluate the impact of educational intervention in 23 Traumatology and Orthopaedic residents on the use of hamstring in the anterior cruciate ligament reconstruction through theoretical sessions and Practice on cadaverous knees with preand post-intervention evaluations. Results: The correlation between the pre and post evaluation educational intervention, both theoretical and practical, was statistically significant (p = 0.004 and p = 0.4, respectively). Conclusion: The statistically significant correlation between preand post-educational intervention evaluations speaks of the value of learning strategies, in the case of this study, the intervention through a theoretical and practical session by a simulated patient promotes knowledge acquisition and development of skills.

Preoperative serum albumin as a predictor of complications following total hip replacement in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis is a chronic inflammatory disease characterized by polyarthritis with progressive articular wear, immunologic abnormalities and increasing physical limitation. Surgical correction with hip replacement comes as a successful solution for patients with advanced articular destruction. Following intervention, surgical site infection (SSI), venous thromboembolism, sepsis, renal and major cardiovascular complications are among the most cited in the literature. No consensus exists as to the detection of preoperative hypoalbuminemia in patients with rheumatoid arthritis. METHODS: This study retrospectively evaluated the preoperative serum albumin of 75 patients with rheumatoid arthritis and analyzed its relevance in terms of appearance of postoperative complications with a six-month follow-up. Complications in the group of patients with low serum albumin and the group of patients with normal serum albumin were reviewed to identify the effect of each variable. Odds ratio for each variable was calculated (hospital readmission, surgical site infection, renal and cardiac complications, non-infectious wound complications and the presence of residual hip pain), as well as p-value and confidence intervals. RESULTS: Surgical site infection showed a statistically significant relation with low serum albumin (OR: 6.125, p = 0.018) as did non-infectious wound complications (OR: 3.714, p = 0.026) and residual hip pain (OR: 3.149, p = 0.022). CONCLUSION: Preoperative low serum albumin has a direct relation with the rate of postoperative complications including SSI, non-infectious wound complications (seroma formation, wound dehiscence) and residual hip pain. Preoperative serum albumin is a reliable marker of nutrition, which may establish preventive strategies to reduce postoperative complications in patients with rheumatoid arthritis.

INTRODUCCIÓN: La artritis reumatoide es una enfermedad inflamatoria crónica con desgaste articular progresivo, anomalías inmunológicas y aumento de la limitación física. La corrección quirúrgica con el reemplazo de la cadera es una solución a la destrucción articular avanzada. Después de la intervención, la infección del sitio quirúrgico (SSI), el tromboembolismo venoso, la sepsis y las complicaciones cardiovasculares o renales se encuentran entre las más citadas en la literatura. No existe consenso en cuanto a la detección de hipoalbuminemia preoperatoria en pacientes con artritis reumatoide. MÉTODOS: Estudio retrospectivo evaluando la albúmina de suero preoperatoria de 75 pacientes con artritis reumatoide, se analizó su importancia en términos de complicaciones postoperatorias en los primeros seis meses de seguimiento. Las complicaciones en el grupo de pacientes con albúmina de suero baja y el grupo de pacientes con albúmina de suero normal fueron repasadas para identificar el efecto de cada variable. Se calculó el odds ratio para cada variable (reingreso hospitalario, infección del sitio quirúrgico, complicaciones renales y cardíacas, complicaciones no infecciosas de la herida y presencia de dolor de cadera residual), así como el valor p y los intervalos de confianza. RESULTADOS: La infección del sitio quirúrgico demostró una relación estadística significativa con la albúmina de suero baja (o: 6.125, p = 0.018) al igual que complicaciones no infecciosas de la herida (o: 3.714, p = 0.026) y dolor residual de la cadera (o: 3.149, p = 0.022). CONCLUSIÓN: La albúmina sérica baja preoperatoria tiene una relación directa con la tasa de complicaciones postoperatorias: infección, formación de seromas, dehiscencia de la herida y dolor residual.

Preoperative serum albumin as a predictor of complications following total hip replacement in patients with rheumatoid arthritis / Albúmina sérica preoperatoria como un predictor de complicaciones posterior al reemplazo total de cadera en pacientes con artritis reumatoide

Abstract: Background: Rheumatoid arthritis is a chronic inflammatory disease characterized by polyarthritis with progressive articular wear, immunologic abnormalities and increasing physical limitation. Surgical correction with hip replacement comes as a successful solution for patients with advanced articular destruction. Following intervention, surgical site infection (SSI), venous thromboembolism, sepsis, renal and major cardiovascular complications are among the most cited in the literature. No consensus exists as to the detection of preoperative hypoalbuminemia in patients with rheumatoid arthritis. Methods: This study retrospectively evaluated the preoperative serum albumin of 75 patients with rheumatoid arthritis and analyzed its relevance in terms of appearance of postoperative complications with a six-month follow-up. Complications in the group of patients with low serum albumin and the group of patients with normal serum albumin were reviewed to identify the effect of each variable. Odds ratio for each variable was calculated (hospital readmission, surgical site infection, renal and cardiac complications, non-infectious wound complications and the presence of residual hip pain), as well as p-value and confidence intervals. Results: Surgical site infection showed a statistically significant relation with low serum albumin (OR: 6.125, p = 0.018) as did non-infectious wound complications (OR: 3.714, p = 0.026) and residual hip pain (OR: 3.149, p = 0.022). Conclusion: Preoperative low serum albumin has a direct relation with the rate of postoperative complications including SSI, non-infectious wound complications (seroma formation, wound dehiscence) and residual hip pain. Preoperative serum albumin is a reliable marker of nutrition, which may establish preventive strategies to reduce postoperative complications in patients with rheumatoid arthritis.

Resumen: Introducción: La artritis reumatoide es una enfermedad inflamatoria crónica con desgaste articular progresivo, anomalías inmunológicas y aumento de la limitación física. La corrección quirúrgica con el reemplazo de la cadera es una solución a la destrucción articular avanzada. Después de la intervención, la infección del sitio quirúrgico (SSI), el tromboembolismo venoso, la sepsis y las complicaciones cardiovasculares o renales se encuentran entre las más citadas en la literatura. No existe consenso en cuanto a la detección de hipoalbuminemia preoperatoria en pacientes con artritis reumatoide. Métodos: Estudio retrospectivo evaluando la albúmina de suero preoperatoria de 75 pacientes con artritis reumatoide, se analizó su importancia en términos de complicaciones postoperatorias en los primeros seis meses de seguimiento. Las complicaciones en el grupo de pacientes con albúmina de suero baja y el grupo de pacientes con albúmina de suero normal fueron repasadas para identificar el efecto de cada variable. Se calculó el odds ratio para cada variable (reingreso hospitalario, infección del sitio quirúrgico, complicaciones renales y cardíacas, complicaciones no infecciosas de la herida y presencia de dolor de cadera residual), así como el valor p y los intervalos de confianza. Resultados: La infección del sitio quirúrgico demostró una relación estadística significativa con la albúmina de suero baja (o: 6.125, p = 0.018) al igual que complicaciones no infecciosas de la herida (o: 3.714, p = 0.026) y dolor residual de la cadera (o: 3.149, p = 0.022). Conclusión: La albúmina sérica baja preoperatoria tiene una relación directa con la tasa de complicaciones postoperatorias: infección, formación de seromas, dehiscencia de la herida y dolor residual.

[Risk factors associated with the conformation of the medial longitudinal arch and the symptomatic flat foot in a metropolitan school population in Mexico]. / Factores de riesgo asociados a la conformación del arco longitudinal medial y del pie plano sintomático en una población escolar metropolitana en México.

INTRODUCTION: The investigation on the medial longitudinal arch is aimed at addressing the diagnostic problems of flat foot. The diagnosis is currently based on clinical tests and the appropriate identification of both postural and gait abnormalities. Risk factors are associated with pre-school ages, but there is no adequate analysis of such factors during school ages, when the longitudinal arch reaches its conformational maturity. MATERIAL AND METHODS: Probabilistic methods were used to obtain a sample of 476 patients from elementary schools in the Federal District and the state of Puebla. Once the approval of the research committee was obtained, an analytical, prospective, cross-sectional study was conducted. Anthropometric measurements were performed, together with anamnesis, physical exam of the students, and conventional wet footprint analysis in a standardized and duplicate way. RESULTS: Of the 476 patients, 101 had flat foot (21.2%) and 49 of them had pain symptoms in the feet, knees or both (48.5%), accounting for 10.2% of the patients examined. Forefoot pronation and valgus hindfoot resulted in an increased risk of symptomatic flat foot in the school population in the study. CONCLUSIONS: In cases of flat or cavus foot, the presence of foot and/or knee pain symptoms in the school population was associated in a statistically significant way with one or more of the factors analyzed (overweight, genu valgus, valgus hindfoot, forefoot pronation and claw toes). Girls with such factors had a 3-7 higher chance of having symptomatic flat foot.

Novelty preference in patients with developmental amnesia.

To re-examine whether or not selective hippocampal damage reduces novelty preference in visual paired comparison (VPC), we presented two different versions of the task to a group of patients with developmental amnesia (DA), each of whom sustained this form of pathology early in life. Compared with normal control participants, the DA group showed a delay-dependent reduction in novelty preference on one version of the task and an overall reduction on both versions combined. Because VPC is widely considered to be a measure of incidental recognition, the results appear to support the view that the hippocampus contributes to recognition memory. A difficulty for this conclusion, however, is that according to one current view the hippocampal contribution to recognition is limited to task conditions that encourage recollection of an item in some associated context, and according to another current view, to recognition of an item with the high confidence judgment that reflects a strong memory. By contrast, VPC, throughout which the participant remains entirely uninstructed other than to view the stimuli, would seem to lack such task conditions and so would likely lead to recognition based on familiarity rather than recollection or, alternatively, weak memories rather than strong. However, before concluding that the VPC impairment therefore contradicts both current views regarding the role of the hippocampus in recognition memory, two possibilities that would resolve this issue need to be investigated. One is that some variable in VPC, such as the extended period of stimulus encoding during familiarization, overrides its incidental nature, and, because this condition promotes either recollection- or strength-based recognition, renders the task hippocampal-dependent. The other possibility is that VPC, rather than providing a measure of incidental recognition, actually assesses an implicit, information-gathering process modulated by habituation, for which the hippocampus is also partly responsible, independent of its role in recognition.

Haemophilic arthropathy: the usefulness of intra-articular oxytetracycline (synoviorthesis) in the treatment of chronic synovitis in children.

Synoviorthesis is already widely used in the treatment of chronic haemophilic synovitis. The aim of this study was evaluate the effectiveness of oxytetracicline synoviorthesis on the frequency of haemarthrosis in haemophilic children with chronic synovitis and its impact on joint function. Between January 2001 and October 2006, we performed 34 synoviorthesis in 28 paediatric patients (6-16 years old) with diagnosis of haemophilic arthropathy stage I-II. At each joint were administered five doses of oxytetracycline for five consecutive weeks at doses of 100 mg in elbow and ankle and 250 mg in the knee. The frequency of haemarthrosis and range of joint mobility were evaluated before and after of treatment. The results were analysed with Student t-test and descriptive statistics. Thirty-four joints were treated, including 20 knees (58.8%), eight elbows (23.5%) and six ankles (17.6%). Median follow-up was 46.3 months (range 12-71 months). The frequency of haemarthrosis was recorded before treatment 47.3 year(-1) (range 12-96, P < 0.0001) and decreased to 3.5 year(-1) (range 0-15, P = 0.0119) after treatment. The range of joint motion in flexion-extension before treatment was 84.9°, while after this was 97.5° (P = 0.0119). The synoviorthesis with oxytetracycline has shown a favourable effect in the treatment of chronic haemophilic synovitis in reducing the frequency of haemarthrosis and improvement was observed consistently in the range of motion.

[Endocannabinoid system and CNR1 gene polymorphisms in schizophrenia and addictive disorders]. / Sistema endocannabinoide y polimorfismos del gen CNR1 en la esquizofrenia y los trastornos adictivos.

Substance abuse is the most prevalent comorbid psychiatric condition associated with schizophrenia. Cannabis is a drug frequently used for schizophrenic patients. In the last decades the endocannabinoid system and their endogenous ligands have been discovered. Endogenous cannabinoids act in the brain on cannabinoid CB1 receptor. On the other hand this system may be involved in several brain functions through neuromodulation dopaminergic and other neurotransmitter system involved in schizophrenic and substance abuse disorders. Advances of genetic research have addressed the focus on the search of candidate genes for both disorders. In this review we have summarized the studies published about the CNR1 gene on schizophrenia and substance abuse disorders.

Sistema endocannabinoide y polimorfismos del gen CNR1 en la esquizofrenia y los trastornos adictivos / Endocannabinoid system and CNR1 gene polymorphisms in schizophrenia and addictive disorders

La esquizofrenia presenta una alta comorbilidad con los trastornos adictivos, siendo el cannabis una de las sustancias más frecuentemente consumidas por estos pacientes. En los últimos años hemos asistido al descubrimiento del sistema endocannabinoide, conociéndose que las acciones centrales de los endocannabinoides se vehiculan a través de los receptores cerebrales de tipo 1 (CB1) codificados por el gen CNR1. El sistema endocannabinoide interviene en una gran cantidad de procesos cerebrales a través de su interacción con otros sistemas de neurotransmisión, encontrándose implicado a su vez en la neurobiología de la esquizofrenia y de los trastornos adictivos. La investigación genética en los últimos años se ha dirigido en pacientes con estos trastornos psiquiátricos al estudio de marcadores polimórficos de genes candidatos, entre ellos el gen CNR1. En esta revisión se describen los estudios realizados con el gen CNR1 en ambos trastornos

Substance abuse is the most prevalent comorbid psychiatric condition associated with schizophrenia. Cannabis is a drug frequently used for schizoprenic patients. In the last decades the endocannabinoid system and their endogenous ligands have been discovered. Endogenous cannabinoids act in the brain on cannabinoid CB1 receptor. On the other hand this system may be involved in several brain functions through neuromodulation dopaminergic and other neurotransmitter system involved in schizophrenic and substance abuse disorders. Advances of genetic research have addressed the focus on the search of candidate genes for both disorders. In this review we have summarized the studies published about the CNR1 gene on szhizophrenia and substance abuse disorders

Aplicación del método de hanlon en la priorización de riesgos y daños para la salud / Application of the hanlon method while priorizing health risks and damages

En la Jurisdicción Sanitaria Ecatepec, se realizó un taller de Riesgos y Daños para la salud con el propósito de priorizar el daño a la salud susceptible a ser intervenido a través de la aplicación del método de Hanlón, por los estudiantes de posgrado de Enfermería en salud pública y el equipo multidisciplinario de la jurisdicción. Participaron 48 personas con cargos normativos y operativos de los Centros Municipales de Salud (COMUSA), DIF, CONALEP, y Salud Municipal a quienes se les capacitó sobre la utilidad y aplicación del Método de Hanlón, proporcionándoles la información estadística para hacer los cálculos respectivos. Los resultados de la priorización de mayor a menor puntuación fueron: Diabetes Mellitus tipo 2, Neumonía e Influenza, Enfermedades del corazón, Tumores malignos, Accidentes, agresiones y suicidios, Enfermedades del hígado, SIDA, e insuficiencia renal. Tomando en cuenta que en las primeras cuatro causas ya han sido trabajadas por generaciones previas de estudiantes de la Especialidad, se determinó que la causa a ser intervenida es: accidente, agresiones y suicidios.

In the Health Jurisdiction Ecatepec, a risk and darrage workshop health was carried out which used the Hanlon method in order to prioritize the possible damage and give the attention through the multidisciplinary staff and the Public Health Nursing speciality students. The number of participants in the workshop were 48 from health Municipality Centers, DIF, CONALEP, whom were trained about the features and how to use Hanlon method. The statistical information was given to do the respective calculation. The results of prioritize were ordered from the highest to the lowest score: diabetes mellitus type 2, Pneumania and influenza, heart illness, malign tumors, accidents, agrressions and suicides, liver sickeness, AIDS, renal insufficiency. Because the first 4 causes had been studied before, it was determined that the causes to be intervened will be accidents, agrressions and suicides.