Síndrome de abstinencia asociado al uso recreativo de fentanilo: serie de dos casos / Withdrawal syndrome associated with recreational use of fentanyl: case series

El abuso de sustancias como los opioides ha venido en aumento durante la última década, siendo responsable de gran número de muertes en Estados Unidos. El consumo especialmente de fentanilo se ha convertido en una epidemia que afecta la salud pública y el bienestar socioeconómico de algunos países. Colombia no es ajena a este panorama, y en los últimos años se han descrito casos de consumo de fentanilo como droga de abuso. En este artículo se presentarán dos reportes de casos de uso de fentanilo recreativo parenteral que desarrollaron síndrome de abstinencia y requirieron manejo intrahospitalario en la ciudad de Medellín-Colombia. (AU)

The abuse of substances such as opioids has been increasing over the last decade, being responsible for a large number of deaths in the United States. The consumption, especially of fentanyl, has become an epidemic that affects public health and the socioeconomic well-being of some countries. Colombia is no stranger to this panorama; in recent years, cases of fentanyl consumption as a drug of abuse have been described. In this article, two case reports of parenteral recreational fentanyl use that developed withdrawal syndrome and required in-hospital management in the city of Medellín-Colombia will be presented. (AU)

Consensus statement on the use of alemtuzumab in daily clinical practice in Spain.

INTRODUCTION: Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis. OBJECTIVE: A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain. DEVELOPMENT: A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group. CONCLUSION: The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice.

Alteraciones metabólicas y circadianas en personal de enfermería de un hospital público del noroeste de México / Circadian and metabolic alterations among nursing personnel in a northeastern public hospital in Mexico / Alterações metabólicas e circadianas na equipe de enfermagem de um hospital público no noroeste do México

RESUMEN Introducción Las alteraciones metabólicas se vinculan a los ritmos biológicos, dado que es tos sistemas controlan aspectos fisiológicos como patrones de sueño/vigilia, temperatura corporal, presión arterial y liberación de hormonas endocrinas. Objetivo Identificar la relación entre los componentes del síndrome metabólico y disincro nía circadiana en personal de enfermería de un hospital público. Métodos Estudio correlacional. Muestra censal de 30 profesionales de enfermería de dos turnos. Para la recolección de datos se utilizaron tres cédulas: a) antecedentes biosociode mográficos y laborales; b) síndrome metabólico; c) ciclo circadiano. En el procesamiento de datos se utilizó pruebas Chi-cuadrada, R de Pearson y Rho de Spearman, se verificó el su puesto de normalidad con Shapiro-Wilk. Se contó con autorización del Comité de Ética de la institución de salud y con el consentimiento informado de participantes. Resultados 43.3 % del personal de enfermería cumplió con criterios diagnósticos de síndro me metabólico, 100 % del turno nocturno presentó disincronía circadiana con base en el indicador patrón de sueño. El consumo de alcohol y nivel alto de triglicéridos, mostraron relación positiva estadísticamente significativa con la presencia de insomnio (p ≤ 0.001; p ≤ 0.05). Conclusión El síndrome metabólico es un problema de salud con alta prevalencia entre el personal de enfermería, independientemente del nivel académico o del turno laboral. El peso y los triglicéridos fueron indicadores que mostraron relación con patrones de sueño afectados. Esto enfatiza la importancia de incidir en la prevención y tratamiento del sín drome metabólico como una prioridad en el personal de enfermería, desde la salud laboral.

ABSTRACT Introduction Metabolic alterations are linked to biologic rhythms because these cycles control physiologic patterns including sleep/awake, body temperature, blood pressure, and hormones release. Objective To identify the relationship between the metabolic syndrome components and the circadian alterations among nursing personnel in a public hospital in Mexico. Method This is a correlational study. The sample was constituted of 30 nursing professio nals working in 2 shifts. Data were collected using three registers: a) bio socio-demographic and labor-related backgrounds; b) metabolic syndrome; c) circadian cycle. Chi-square, Pearson's R, Spearman's Rho, and Shapiro-Wilk normality test were calculated. The study approval was granted by the Ethics Committee of the Health Institution. The corresponding informed consent was obtained from all participants. Results 43.3 % of the nursing personnel qualified for the metabolic syndrome diagnostic criteria. 100 % of the nurses working the night shift showed circadian alterations in terms of sleep patterns. Alcohol consumption and high levels of triglycerides were positively and significantly related to insomnia (p ≤ 0.001; p ≤ 0.05). Conclusion The metabolic syndrome is a health problem with a high prevalence in all kinds of nursing personnel. Bodyweight and triglyceride levels were indicators suggesting altered sleep patterns. This situation highlights the importance of designing and implementing strategies aimed at preventing and addressing metabolic syndrome among nursing person nel as a labor health priority.

RESUMO Introdução As alterações metabólicas estão ligadas aos ritmos biológicos, pois esses siste mas controlam aspectos fisiológicos como padrões de sono/vigília, temperatura corporal, pressão arterial e liberação de hormônios endócrinos. Objetivo Identificar a relação entre os componentes da síndrome metabólica e a dissincro nia circadiana na equipe de enfermagem de um hospital público. Métodos Estudo correlacional. Amostra censitária de 30 profissionais de enfermagem com dois turnos. Para a coleta de dados foram utilizados três cartões: a) antecedentes biossociodemográficos e laborais; b) síndrome metabólica; c) ciclo circadiano. No processa mento dos dados foram utilizados os testes Qui-quadrado, R de Pearson e Rho de Spearman, a suposição de normalidade foi verificada com Shapiro-Wilk. Contou-se com a autorização do Comitê de Ética da instituição de saúde e o termo de consentimento informado dos participantes. Resultados 43.3 % da equipe de enfermagem atendeu aos critérios diagnósticos para sín drome metabólica, 100 % do plantão noturno apresentou dissincronia circadiana com base no indicador padrão de sono. O consumo de álcool e o nível elevado de triglicerídeos mos traram relação positiva estatisticamente significativa com a presença de insônia (p ≤ 0.001; p ≤ 0.05). Conclusão A síndrome metabólica é um problema de saúde de alta prevalência entre a equipe de enfermagem, independentemente do nível acadêmico ou turno de trabalho. O peso e os triglicerídeos foram indicadores que mostraram relação com os padrões de sono afetados. Isto ressalta a importância de influenciar a prevenção e o tratamento da síndrome metabólica como prioridade na equipe de enfermagem, desde a saúde do trabalhador.

Clinical features, management and visual outcomes on patients with traumatic hyphema in a reference ophthalmological clinic in Colombia.

Aim. To analyze clinical features, treatment, and results of patients with non-penetrating traumatic hyphema in an ophthalmological center in Colombia. Methods. A retrospective cohort study in which medical records of patients with traumatic hyphema were analyzed between 2013 and 2018. Results. 38 eyes of 37 patients (34 men, 3 women) were included. Average age was 30.6 ± 16.6 years. Sports-related (42.1%) and occupational accidents (34.2%) were the main causes. 67.5% of the eyes had grade I hyphema. 95% received topical corticosteroids, 92.1% topical mydriatics and 52.63% ocular hypotensive eyedrops. Two eyes with hyphema grade I did not receive steroids and resolved uneventfully. None of the eyes rebleeded, even without antifibrinolytics. One patient with grade IV hyphema required surgery. Mean hyphema's clearance time was 8.4 ± 3.2 days. The last mean corrected distance visual acuity was LogMAR 0.25. There were no complications directly related to the hyphema. Conclusions. Working related activities were the second cause of traumatic hyphema in our cohort, which might be attributable to poor awareness of the importance or ocular protection, or limited access to recommended protective devices. Outpatient management enabled adequate outcomes. Corticosteroids and mydriatics were the treatment cornerstone, though seemed not to be imperative when hyphema was grade I. We were not able to support the contributive role from antifibrinolytics, because none of our patients rebleeded in spite of the absence of them. Abbreviations: IOP = intraocular pressure, AC = anterior chamber, CDVA = corrected distance visual acuity.

Prevalencia del síndrome metabólico y su asociación con síntomas del tracto urinario inferior y función sexual / Prevalence of metabolic syndrome and its association with lower urinary tract symptoms and sexual function

Objetivos: Estimar la frecuencia de síndrome metabólico (SMet) en la consulta urológica ambulatoria y su asociación con los síntomas del tracto urinario inferior y la disfunción eréctil. Material y métodos: Estudio retrospectivo que incluyó a todos los hombres de ≥ 40 años que consultaron ambulatoriamente entre 2010 y 2011. Se calculó la prevalencia de SMet, síntomas del tracto urinario inferior y disfunción eréctil. Se utilizó un modelo logístico para comprobar posibles asociaciones, controlando por interacciones y factores de confusión. Resultados: Se incluyeron 616 pacientes. Se encontró SMet en el 43,8% (IC 95%: 39,6-48,3) de los pacientes. El análisis bivariado demostró una asociación entre SMet y síntomas del tracto urinario inferior (p < 0,01), pero no con disfunción eréctil. El modelo logístico demostró una asociación independiente entre SMet y la severidad de los síntomas urinarios por puntuación en el IPSS, siendo mayor el riesgo de SMet en aquellos con síntomas moderados que con síntomas leves (OR: 1,83; IC 95%: 1,14-2,94). Se analizaron por separado los diferentes componentes del SMet y se encontraron asociaciones positivas entre diabetes, síntomas severos (OR: 1,3; IC 95%: 1,24-7,1) y disfunción eréctil (OR: 2,57, IC 95%: 1,12-5,8). Conclusión: Se confirmó la asociación entre SMet y síntomas del tracto urinario inferior, pero no para disfunción eréctil. La diabetes, un componente específico del SMet sí se asoció con ambas condiciones. Las diferencias geográficas previamente reportadas en la literatura podrían explicar estos resultados. Debido a que el SMet es frecuente entre los pacientes urológicos, un tamizado activo por parte de los urólogos es recomendable

Objectives: To estimate the frequency of metabolic syndrome (MetS) in a daily urology practice and to determine its association with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Material and methods: A retrospective study was conducted. Data from all male patients aged ≥ 40 years who attended our outpatient urology clinic from 2010 to 2011 was collected. Prevalence of MetS was determined, and LUTS and ED were assessed. A logistic model was used to determine possible associations, controlling for confounders and interaction factors. Results: A total of 616 patients were included. MetS was observed in 43.8% (95% CI 39.6-48.3). The bivariate model showed an association between MetS and LUTS (p < 0.01), but not between MetS and ED. The logistic model showed an association between MetS and the International Prostate Symptom Score (IPSS), while controlling for other variables. Patients exhibiting moderate LUTS had a greater risk for MetS than patients with mild LUTS (OR 1.83, 95% CI 1.14-2.94). After analyzing for individual components of MetS, positive associations were found between diabetes and severe LUTS (OR 1.3, 95% CI 1.24-7.1), and between diabetes and ED (OR 2.57, 95% CI 1.12-5.8). Conclusion: This study was able to confirm an association between MetS and LUTS, but not for ED. Specific components such as diabetes were associated to both. Geographical differences previously reported in the literature might account for these findings. Given that MetS is frequent among urological patients, it is advisable that urologists actively screen for it

Prevalence of metabolic syndrome and its association with lower urinary tract symptoms and sexual function. / Prevalencia del síndrome metabólico y su asociación con síntomas del tracto urinario inferior y función sexual.

OBJECTIVES: To estimate the frequency of metabolic syndrome (MetS) in a daily urology practice and to determine its association with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). MATERIAL AND METHODS: A retrospective study was conducted. Data from all male patients aged ≥40 years who attended our outpatient urology clinic from 2010 to 2011 was collected. Prevalence of MetS was determined, and LUTS and ED were assessed. A logistic model was used to determine possible associations, controlling for confounders and interaction factors. RESULTS: A total of 616 patients were included. MetS was observed in 43.8% (95% CI 39.6-48.3). The bivariate model showed an association between MetS and LUTS (p<0.01), but not between MetS and ED. The logistic model showed an association between MetS and the International Prostate Symptom Score (IPSS), while controlling for other variables. Patients exhibiting moderate LUTS had a greater risk for MetS than patients with mild LUTS (OR 1.83, 95% CI 1.14-2.94). After analyzing for individual components of MetS, positive associations were found between diabetes and severe LUTS (OR 1.3, 95% CI 1.24-7.1), and between diabetes and ED (OR 2.57, 95% CI 1.12-5.8). CONCLUSION: This study was able to confirm an association between MetS and LUTS, but not for ED. Specific components such as diabetes were associated to both. Geographical differences previously reported in the literature might account for these findings. Given that MetS is frequent among urological patients, it is advisable that urologists actively screen for it.

Ultrasound and histological measurements of dividing membrane thickness in twin gestations.

OBJECTIVE: To determine how prenatal ultrasound measurements of dividing membrane thickness correlate with postnatal histological measurements and chorionicity in twin gestations. METHODS: This was a prospective, longitudinal cohort study of twin gestations. Dividing membrane thickness was measured by transabdominal ultrasound, with the insonation beam both parallel and perpendicular to the membrane, in the second or third trimester, depending on when care was established. Ultrasound examinations were performed every 4 weeks following initial assessment until delivery. Measurements of membrane thickness from the first ultrasound examination were compared with histological measurements after delivery. RESULTS: A total of 45 twin pregnancies (32 dichorionic, 13 monochorionic) were included. Mean gestational age at initial ultrasound examination was 24.1 ± 7.3 weeks. Parallel ultrasound measurements of membrane thickness were 1.6 ± 0.8 mm for monochorionic and 2.5 ± 0.9 mm for dichorionic gestations (P = 0.001). Perpendicular ultrasound measurements were 1.6 ± 0.3 mm for monochorionic and 2.2 ± 0.8 mm for dichorionic gestations (P = 0.009). Inter- and intraobserver reliability of ultrasound measurements were 0.847 and 0.950, respectively. Parallel and perpendicular ultrasound measurements correlated better with each other (R = 0.807, P < 0.001) than with histological measurements of membrane thickness (Rparallel = 0.538, P < 0.001; Rperpendicular = 0.529, P < 0.001). Receiver-operating characteristics curve analyses to predict histological membrane thickness > 50th percentile resulted in an area under the curve (AUC) of 0.828 for parallel (P < 0.001) and 0.874 for perpendicular (P < 0.001) measurements with a cut-off value of 1.9 mm for both approaches. The AUCs for parallel and perpendicular measurements to predict dichorionicity were 0.892 (P < 0.001) and 0.823 (P < 0.001) with cut-off values of 1.9 and 1.8 mm, respectively. CONCLUSION: Prenatal ultrasound measurement of twin dividing membrane thickness is positively correlated with postnatal histological measurement. Dichorionicity can be determined by a magnified dividing membrane thickness ≥ 1.9 mm. Measurements with the ultrasound beam parallel to the dividing membrane may be more accurate than perpendicular measurements. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Linfadenectomía pélvica extendida en pacientes con cáncer de próstata clínicamente localizado: estudio observacional prospectivo / Extended pelvic lymphadenectomy in patients with clinically localised prostate cancer: A prospective observational study

Objetivo: Determinar la frecuencia de compromiso ganglionar en pacientes con adenocarcinoma de próstata clínicamente localizado llevados a prostatectomía radical y linfadenectomía pélvica extendida. Material y métodos: Se realizó un estudio observacional prospectivo con 137 pacientes con cáncer de próstata clínicamente localizado, de riesgo bajo, intermedio y alto según la clasificación de D’Amico. Todos los sujetos fueron llevados a prostatectomía radical más linfadenectomía pélvica extendida en 3 centros de referencia en Bogotá, Colombia, entre los años 2013 a 2014. Se evaluaron las siguientes variables: edad, PSA, Gleason de la biopsia, probabilidad de compromiso ganglionar por tablas de Partin, y el resultado histopatológico del espécimen quirúrgico con el patrón de Gleason definitivo y el total de ganglios resecados y comprometidos por el tumor, de acuerdo al territorio de la disección. Resultados: Se extrajeron un total de 2.876 ganglios, en promedio 20,99 ganglios por paciente. Se encontró compromiso ganglionar en 14 (10,22%) pacientes. El grupo de riesgo alto e intermedio presentaron metástasis ganglionares en el 28,57% y el 5,25% respectivamente. No hubo compromiso ganglionar en el grupo de bajo riesgo. De los pacientes con un riesgo de compromiso ganglionar ≥ 2%, según las tablas de Partin, el 19,40% presentó metástasis ganglionares. Conclusión: El compromiso ganglionar en nuestra población es similar al reportado en la literatura mundial. La linfadenectomía pélvica extendida aumentó la probabilidad de detección de metástasis ganglionares en nuestro medio

Objective: To determine the frequency of lymph node involvement in patients with clinically localised prostate adenocarcinoma who had radical prostatectomy and extended pelvic lymphadenectomy. Material and methods: A prospective observational study was conducted on 137 patients with clinically localised prostate cancer of low, intermediate or high risk according to the D’Amico classification. All participants underwent radical prostatectomy plus extended pelvic lymphadenectomy in 3 reference centres in Bogota, Colombia, between 2013 and 2014. The following variables were assessed: age, prostate specific antigen levels, Gleason score of the biopsy, probability of lymph node involvement calculated with Partin tables and the histopathology result of the surgical specimen, with the definitive Gleason pattern and the total number of resected and involved lymph nodes per tumour, according to the territory of the dissection. Results: A total of 2,876 lymph nodes were extracted (an average of 20.99 lymph nodes per patient). There was lymph node involvement in 14 (10.22%) patients. The high-risk and intermediate-risk group presented lymph node metastases in 28.57% and 5.25%, respectively. There was no lymph node involvement in the low-risk group. Of the patients at risk of lymph node involvement (≥ 2% according to the Partin tables), 19.40% had lymph node metastases. Conclusion: Lymph node involvement in our population is similar to that reported in the worldwide literature. Extended pelvic lymphadenectomy increased the probability of detecting lymph node metastases in our community

COPAIA 7. Alianza estratégica para la creación de capacidades en análisis de riesgos para la inocuidad de los alimentos en las Américas

El principal objetivo de este trabajo es brindar las bases para un esfuerzo coordinado con el fin de crear capacidad de análisis de riesgos para la inocuidad de los alimentos en la región de América Latina y el Caribe (ALC) reuniendo a organizaciones internacionales (Organización Panamericana de la Salud-OPS, Organización de las Naciones Unidas para la Alimentación y la Agricultura -FAO e Instituto Interamericano de Cooperación para la Agricultura-IICA) y universidades (Universidad de Nebraska-Lincoln, Universidad de Maryland, Universidad de Minnesota y Universidad Tecnológica de Texas) mediante la Alianza Estratégica para la Creación de Capacidades en Análisis de Riesgos para la Inocuidad de los Alimentos (AECAR). Esperamos que este trabajo, creado por la alianza, logre: a) generar confianza y fortalecer la comunicación entre todas las organizaciones que trabajan en la región; b) proporcionar las bases para enfoques coordinados, consistentes y efectivos para crear capacidad y desarrollar programas de estudio; y c) facilitar la implementación del marco para análisis de riesgos en la región. Este trabajo presenta los recursos actuales de los autores, considera algunos ejemplos exitosos de implementación de análisis de riesgos en la región (de los sectores académicos y gubernamentales), los desafíos experimentados al implementar el análisis de riesgos, y una hoja de ruta para la creación de capacidad propuesta por esta alianza para ampliar la adopción de análisis de riesgos en la región.

The main goal of this paper is to provide the foundation for a coordinated effort for food safety risk analysis capacity building in the Latin American and Caribbean (LAC) region by bringing together international organizations (Panamerican Health Organization-PAHO, Food and Agriculture Organization of the United Nations-FAO and the Interamerican Institute for Cooperation in Agriculture-IICA) and universities (University of Nebraska-Lincoln, University of Maryland, University of Minnesota and Texas Tech University) through the Strategic Alliance in Risk Analysis Capacity Building (SARAC). We expect that this paper, authored by the alliance, will: a) build trust and strengthen communication among all the organizations that work in the region; b) provide the foundation for coordinated, consistent, and effective approaches to capacity building and curriculum development; and c) facilitate the implementation of the risk analysis framework within the region. This paper provides the current resources by the authors, discusses some successful examples of risk analysis implementation in the region (from academia and government sectors), the challenges experienced on implementing risk analysis and a capacity building roadmap proposed by this alliance to enhance the adoption of risk analysis in the region.

Extended pelvic lymphadenectomy in patients with clinically localised prostate cancer: A prospective observational study. / Linfadenectomía pélvica extendida en pacientes con cáncer de próstata clínicamente localizado: estudio observacional prospectivo.

OBJECTIVE: To determine the frequency of lymph node involvement in patients with clinically localised prostate adenocarcinoma who had radical prostatectomy and extended pelvic lymphadenectomy. MATERIAL AND METHODS: A prospective observational study was conducted on 137 patients with clinically localised prostate cancer of low, intermediate or high risk according to the D'Amico classification. All participants underwent radical prostatectomy plus extended pelvic lymphadenectomy in 3 reference centres in Bogota, Colombia, between 2013 and 2014. The following variables were assessed: age, prostate specific antigen levels, Gleason score of the biopsy, probability of lymph node involvement calculated with Partin tables and the histopathology result of the surgical specimen, with the definitive Gleason pattern and the total number of resected and involved lymph nodes per tumour, according to the territory of the dissection. RESULTS: A total of 2,876 lymph nodes were extracted (an average of 20.99 lymph nodes per patient). There was lymph node involvement in 14 (10.22%) patients. The high-risk and intermediate-risk group presented lymph node metastases in 28.57% and 5.25%, respectively. There was no lymph node involvement in the low-risk group. Of the patients at risk of lymph node involvement (≥2% according to the Partin tables), 19.40% had lymph node metastases. CONCLUSION: Lymph node involvement in our population is similar to that reported in the worldwide literature. Extended pelvic lymphadenectomy increased the probability of detecting lymph node metastases in our community.

Evaluating best practices for Campylobacter and Salmonella reduction in poultry processing plants.

Poultry processing plants in the United States were surveyed on their current Campylobacter and Salmonella control practices. Following surveys, data were collected to develop a baseline for prevalence rates of Salmonella and Campylobacter; then changes in practices were implemented and evaluated for improvements in pathogen control. Surveys were sent to the plant Quality Assurance managers to determine production levels, antimicrobial interventions, and current pathogen testing practices. Initial sampling was performed at 6 plants with similar production volumes, at sites that included carcass samples before any pre-evisceration intervention, after exiting the inside-outside bird washer (IOBW), after exiting the pre-chiller, after exiting the primary chiller, and after exiting any post-chill intervention, as well as a water sample from each scalder, pre-chiller, primary chiller, and post-chill dip tank or finishing chiller. Enumerations and enrichments were performed for Campylobacter and Salmonella. Following the baseline sampling, changes in practices were suggested for each plant and a second sampling was conducted to determine their effectiveness. Results demonstrated that peracetic acid (PAA) was the most effective (P < 0.05) antimicrobial currently in use. The use of a post-chill antimicrobial immersion tank and/or use of a cetylpyridinium chloride (CPC) spray cabinet also displayed a further reduction in microbial levels (P < 0.05) when the primary chiller was not sufficient (P > 0.05). Microbial buildup in the immersion tanks demonstrates the need for effective cleaning, sanitation practices, and chiller maintenance to reduce contamination of poultry with Campylobacter and Salmonella.

[Health-related quality of life in children with epilepsy in a Mexican hospital]. / Calidad de vida relacionada con la salud en niños con epilepsia de un hospital mexicano.

INTRODUCTION: Epilepsy is a chronic neurological syndrome that is accompanied by abnormal, synchronic and exaggerated discharges in the cerebral cortex. Epilepsy is inversely related to health-related quality of life (HRQL), although little has been published on this relationship in children in Latin America. AIM: To examine the relation between epilepsy and HRQL in a group of schoolchildren aged 8-12 years who were treated in a paediatric hospital in Sonora, Mexico. PATIENTS AND METHODS: A cross-sectional study was conducted to compare the HRQL of children diagnosed with epilepsy with respect to the HRQL of two control groups. The validated questionnaire Paediatric Quality of Life Inventory was used to evaluate HRQL. Differences were examined by means of an ANOVA test and the association between epilepsy and HRQL was modelled by means of multiple logistic regression. RESULTS: The children with epilepsy displayed the lowest HRQL score (62.4 ± 14.8) of the subjects studied and had 5.2 times as much risk of their HRQL deteriorating (95% confidence interval = 2.43-11.06) compared to healthy children. Deterioration was greater on the cognitive (54.6 ± 15.0) and emotional scales (55.9 ± 23.6). Polypharmacy, i.e. the concomitant ingestion of three or more drugs (p < 0.001), and the chronological progression of suffering (p < 0.001) are factors that significantly deteriorate the HRQL of children with epilepsy. CONCLUSIONS: Epilepsy gives rise to an overall deterioration in the HRQL of children, specifically in the cognitive and emotional spheres, which is related with the chronological progression of the disease and polypharmacy.

TITLE: Calidad de vida relacionada con la salud en niños con epilepsia de un hospital mexicano.Introduccion. La epilepsia es un sindrome neurologico cronico que cursa con descargas anormales, sincronicas y exageradas de la corteza cerebral. La epilepsia se relaciona inversamente con la calidad de vida relacionada con la salud de los pacientes (CVRS); sin embargo, esta relacion se ha documentado poco en niños de Latinoamerica. Objetivo. Examinar la relacion entre epilepsia y la CVRS en un grupo de niños escolares de 8-12 años atendidos en un hospital pediatrico de Sonora, Mexico. Pacientes y metodos. Se comparo transversalmente la CVRS de niños con diagnostico de epilepsia con respecto a la CVRS de dos grupos control. Se utilizo el cuestionario validado Pediatric Quality of Life Inventory para evaluar la CVRS. Las diferencias se examinaron mediante la prueba de ANOVA, y la asociacion entre epilepsia y CVRS se modelo mediante regresion logistica multiple. Resultados. Los niños con epilepsia mostraron la menor puntuacion de CVRS (62,4 ± 14,8) entre los sujetos estudiados, y tuvieron 5,2 veces mas riesgo de deterioro de su CVRS (intervalo de confianza al 95% = 2,43-11,06) en comparacion con el de niños sanos. El deterioro fue mayor en las escalas cognitiva (54,6 ± 15,0) y emocional (55,9 ± 23,6). La polifarmacia ­ingestion concomitante de tres o mas farmacos­ (p < 0,001) y la progresion cronologica de la enfermedad (p < 0,001) son factores que deterioran significativamente la CVRS de niños con epilepsia. Conclusiones. La epilepsia provoca un deterioro global en la CVRS de los niños, especificamente en las esferas cognitiva y emocional, lo que se relaciona con la progresion cronologica de la enfermedad y la polifarmacia.

Calidad de vida relacionada con la salud en niños con epilepsia de un hospital mexicano / Health-related quality of life in children with epilepsy in a Mexican hospital

Introducción. La epilepsia es un síndrome neurológico crónico que cursa con descargas anormales, sincrónicas y exageradas de la corteza cerebral. La epilepsia se relaciona inversamente con la calidad de vida relacionada con la salud de los pacientes (CVRS); sin embargo, esta relación se ha documentado poco en niños de Latinoamérica. Objetivo. Examinar la relación entre epilepsia y la CVRS en un grupo de niños escolares de 8-12 años atendidos en un hospital pediátrico de Sonora, México. Pacientes y métodos. Se comparó transversalmente la CVRS de niños con diagnóstico de epilepsia con respecto a la CVRS de dos grupos control. Se utilizó el cuestionario validado Pediatric Quality of Life Inventory para evaluar la CVRS. Las diferencias se examinaron mediante la prueba de ANOVA, y la asociación entre epilepsia y CVRS se modeló mediante regresión logística múltiple. Resultados. Los niños con epilepsia mostraron la menor puntuación de CVRS (62,4 ± 14,8) entre los sujetos estudiados, y tuvieron 5,2 veces más riesgo de deterioro de su CVRS (intervalo de confianza al 95% = 2,43-11,06) en comparación con el de niños sanos. El deterioro fue mayor en las escalas cognitiva (54,6 ± 15,0) y emocional (55,9 ± 23,6). La polifarmacia -ingestión concomitante de tres o más fármacos- (p < 0,001) y la progresión cronológica de la enfermedad (p < 0,001) son factores que deterioran significativamente la CVRS de niños con epilepsia. Conclusiones. La epilepsia provoca un deterioro global en la CVRS de los niños, específicamente en las esferas cognitiva y emocional, lo que se relaciona con la progresión cronológica de la enfermedad y la polifarmacia (AU)

Introduction. Epilepsy is a chronic neurological syndrome that is accompanied by abnormal, synchronic and exaggerated discharges in the cerebral cortex. Epilepsy is inversely related to health-related quality of life (HRQL), although little has been published on this relationship in children in Latin America. Aim. To examine the relation between epilepsy and HRQL in a group of schoolchildren aged 8-12 years who were treated in a paediatric hospital in Sonora, Mexico. Patients and methods. A cross-sectional study was conducted to compare the HRQL of children diagnosed with epilepsy with respect to the HRQL of two control groups. The validated questionnaire Paediatric Quality of Life Inventory was used to evaluate HRQL. Differences were examined by means of an ANOVA test and the association between epilepsy and HRQL was modelled by means of multiple logistic regression. Results. The children with epilepsy displayed the lowest HRQL score (62.4 ± 14.8) of the subjects studied and had 5.2 times as much risk of their HRQL deteriorating (95% confidence interval = 2.43-11.06) compared to healthy children. Deterioration was greater on the cognitive (54.6 ± 15.0) and emotional scales (55.9 ± 23.6). Polypharmacy, i.e. the concomitant ingestion of three or more drugs (p < 0.001), and the chronological progression of suffering (p < 0.001) are factors that significantly deteriorate the HRQL of children with epilepsy. Conclusions. Epilepsy gives rise to an overall deterioration in the HRQL of children, specifically in the cognitive and emotional spheres, which is related with the chronological progression of the disease and polypharmacy (AU)

Detección de VPH en boca y cérvix de pacientes con diagnóstico citológico sugestivo de infección genital / HPV detection in the mouth and cervix of patients with histological diagnosis suggestive of genital infection

En este trabajo se evaluó la presencia de VPH en la cavidad bucal (mediante oroscopia y citología oralexfoliativa) y su relación con la infección genital en mujeres con diagnóstico citológico sugestivo de infección por VPH. La muestra consistió en 60 pacientes a quienes se les realizó oroscopia, citología y determinación viral en boca y cérvix por PCR, utilizando los iniciadores genéricos MY09/MY11 y MPCR. Se detectó ADN de VPH en las mucosas oral y genital en 48,33 % y 73,3% de las pacientes, respectivamente, obteniéndose una concordancia de 44,2% (k=0,44 indicando grado de acuerdo moderado). Los tipos virales más frecuentes fueron de bajo riesgo, especialmente el tipo 6, encontrado en 86,2% de las muestras bucales y 65,9% de las muestras cervicales, solo o en combinación con otros tipos debajo (11) o de alto riesgo oncogénico (16, 18, 33), con una concordancia de 10,45% (k=0,1 indicando grado de acuerdo muy bajo); sin embargo, particularmente en relación al tipo 6, hubo una concordancia de 75,86% (k=0,7 indicando grado de acuerdo alto). La citología de la cavidad bucal tuvo una sensibilidad de 3,5 % y especificidad de 93,6 %. Para la oroscopia, la sensibilidad fue de 27,6 % y la especificidad de 74,2 %. Los resultados señalan que la infección por VPH en cavidad bucal de pacientes con infección genital pudiera ser frecuente. La baja concordancia global entre los tipos virales sugiere que la infección por VPH en boca y cérvix presenta un comportamiento biológico diferente(AU)

This work evaluated HPV infection in the oral cavity (using oroscopy and exfoliative oral cytology) and its relation to genital infection in women with cytological diagnosis suggestive of HPV infection. The sample consisted of 60 patients who underwent oroscopy, cytology and viral determination in mouth and cervix by PCR using generic primers MY09/MY11 and MPCR. HPV DNA was detected in oral and genital mucosa in 48.33% and73.3% of patients, respectively, yielding a concordance of 44.2% (k=0.44, moderate agreement). The most common viral types were low risk, especially type 6,found in 86.2% of oral samples and 65.9% of cervical specimens, alone or in combination with other types of low (11) or high oncogenic risk (16, 18, 33), with a concordance of 10.45% (k = 0.1, insignificant agreement). However, in relation to type 6, there was a concordance of 75.86% (k=0.7, high agreement). The cytology of the oral cavity had a sensitivity of 3.5% and a specificity of93.6%. For oroscopy, sensitivity was 27.6% and specificity was 74.2%. The results indicate that HPV infection in the oral cavity of patients with genital infection could be frequent. The low concordance between HPV types suggests that HPV infection in the mouth and cervix has a different biological behavior(AU)

Effect of kosher salt application on microbial profiles of poultry carcasses.

The effect of conventionally applied kosher salt on the microbiological profile of posteviscerated chicken carcasses obtained from a local commercial processing facility was evaluated. The broiler carcasses were divided into treatments 1 through 8. Standard sampling methods were used to evaluate Salmonella prevalence, aerobic plate counts, coliforms, generic Escherichia coli, and psychrotroph counts. Results indicate significant reductions in microbial populations in all the salted groups compared with controls. Significant reductions (1.45, 2.31, 2.81, and 1.48 log cfu/mL of rinse) were obtained for aerobic plate count (APC), coliforms, generic E. coli, and psychrotroph counts, respectively, on prechill salt-treated carcasses compared with controls. Salt-treated carcasses sampled after chilling had lower microbial populations compared with control chilled samples with significant reductions in coliforms and generic E. coli (1.25 and 1.77 log, respectively). Salt-treated samples had lower counts on APC and psychrotrophs after 10 d of refrigerated storage compared with controls. Finally, drip loss of salt-treated carcasses was lower after 24 h compared with nontreated controls. Based on the results, it can be concluded that salting process is an effective contributor to microbial reductions during processing that needs further investigation as a possible intervention in commercial poultry processing settings.

Effects of dietary combination of n-3 and n-9 fatty acids on the deposition of linoleic and arachidonic acid in broiler chicken meats.

To minimize the amount of n-6 fatty acids in broiler chicken meat, 120 Cobb × Ross male broilers were divided into 6 different groups and fed a basal corn-soybean meal diet containing 5% fat from 5 different lipid sources: 1) a commercial mix of animal and vegetable oil, 2) soybean oil and olive oil (2.5% each), 3) flaxseed oil and olive oil (2.5% each), 4) flaxseed oil, eicosapentaenoic acid (C20:5; EPA; n-3), and olive oil (2.45, 0.05, and 2.5% respectively; FEO), 5) flaxseed oil, docosahexaenoic acid (C22:6; DHA; n-3), and olive oil (2.45, 0.05, and 2.5% respectively; FDO), and 6) fish oil and olive oil (2.5% each; FHO). At 6 and 9 wk, one bird per pen (4 pens per treatment) was processed, and liver, breast, and thigh samples were collected and used for fatty acid profiles or Δ6- and Δ9-desaturase mRNA gene expression levels. The deposition of linoleic acid (C18:2; n-6) or arachidonic acid (C20:4; n-6) was decreased in breast and thigh muscles of chickens fed n-3 fatty acids for 9 wk compared with chickens fed animal and vegetable oil and soybean oil and olive oil diets (P < 0.05). The addition of EPA to the diet (FEO; P > 0.05) did not reduce the deposition of linoleic acid and arachidonic acid as much as DHA (FDO; P < 0.05), and it suppressed the expression of Δ6- and Δ9-desaturase. When EPA and DHA were blended (FHO) and supplied to broiler chickens for 9 wk, EPA and DHA combination effects were observed on the deposition of LA and arachidonic acid in breast and thigh muscles. Thereby, the addition of a mixed EPA and DHA to a broiler chicken diet may be recommendable to reduce arachidonic acid accumulation in both broiler chicken breast and thigh meats, providing a functional broiler chicken meat to consumers.

[HPV detection in the mouth and cervix of patients with histological diagnosis suggestive of genital infection]. / Detección de VPH en boca y cérvix de pacientes con diagnóstico citológico sugestivo de infección genital.

This work evaluated HPV infection in the oral cavity (using oroscopy and exfoliative oral cytology) and its relation to genital infection in women with cytological diagnosis suggestive of HPV infection. The sample consisted of 60 patients who underwent oroscopy, cytology and viral determination in mouth and cervix by PCR using generic primers MY09/MY11 and MPCR. HPV DNA was detected in oral and genital mucosa in 48.33% and 73.3% of patients, respectively, yielding a concordance of 44.2% (k=0.44, moderate agreement). The most common viral types were low risk, especially type 6, found in 86.2% of oral samples and 65.9% of cervical specimens, alone or in combination with other types of low (11) or high oncogenic risk (16, 18, 33), with a concordance of 10.45% (k = 0.1, insignificant agreement). However, in relation to type 6, there was a concordance of 75.86% (k=0.7, high agreement). The cytology of the oral cavity had a sensitivity of 3.5% and a specificity of 93.6%. For oroscopy, sensitivity was 27.6% and specificity was 74.2%. The results indicate that HPV infection in the oral cavity of patients with genital infection could be frequent. The low concordance between HPV types suggests that HPV infection in the mouth and cervix has a different biological behavior.

Dietary combination effects of conjugated linoleic acid and flaxseed or fish oil on the concentration of linoleic and arachidonic acid in poultry meat.

This study was conducted to determine the effects of the combination of dietary conjugated linoleic acid (CLA) and n-3 fatty acids on the linoleic acid (C18:2n-6) and arachidonic acid (C20:4n-6) concentrations of broiler chicken breast and thigh muscles. One hundred and twenty broilers were raised to 6 wk of age. All chicks were fed a basal corn-soybean meal diet containing 5 different fat sources at an inclusion level of 2% total fat: 1) CLA, 2) flaxseed oil, 3) menhaden fish oil, 4) CLA and flaxseed oil, and 5) CLA and menhaden fish oil. Eight broilers from each treatment were processed at 4 and 6 wk of age. Breast and thigh muscle samples were collected and analyzed for total fat content and fatty acid composition. The results showed that broilers from the CLA and fish oil treatment had lower arachidonic acid concentrations in both breast and thigh muscles than those fed the flaxseed oil diet or the CLA and flaxseed oil diet (P < 0.05). The arachidonic acid concentration and n-6:n-3 ratio of breast and thigh samples from the menhaden fish oil diet were similar to those of the CLA and fish oil diet (P > 0.05), but the inclusion of linoleic acid into chicken thigh muscles of broilers fed the CLA and menhaden fish oil diet improved significantly when compared with that of the diet containing menhaden fish oil only. Thus, the combination of CLA and menhaden fish oil is recommended to reduce the concentrations of linoleic and arachidonic acids in broiler chicken breast and thigh muscles.

[A case-control study of the impact of tuberculosis on the quality of life of patients]. / Impacto de la tuberculosis pulmonar en la calidad de vida de los pacientes. Un estudio de casos y controles.

A prospective study was conducted on 72 patients of pulmonary tuberculosis (TB) and 201 healthy controls in a third level hospital. The HRQoL questionnaire (12-Item Short Form Health Survey, SF-12) was used to assess the QoL at the onset of treatment DOTS. Patients with TB had significantly lower mean scores than controls for overall QoL (51.1 +/- SD 22.6) versus 75.9 (+/- SD 17.6), p < 0.0001. The most affected domains were physical and psychological. Active TB patients shown difficulties in activities of daily living and alterations of the psychological state.