Gestational Diabetes Mellitus Subtypes Classified by Oral Glucose Tolerance Test and Maternal and Perinatal Outcomes: Results of a Mexican Multicenter Prospective Cohort Study "Cuido Mi Embarazo".

Purpose: This study explores the impact of gestational diabetes mellitus (GDM) subtypes classified by oral glucose tolerance test (OGTT) values on maternal and perinatal outcomes. Patients and Methods: This multicenter prospective cohort study (May 2019-December 2022) included participants from the Mexican multicenter cohort study Cuido mi Embarazo (CME). Women were classified into four groups per 75-g 2-h OGTT: 1) normal glucose tolerance (normal OGTT), 2) GDM-Sensitivity (isolated abnormal fasting or abnormal fasting in combination with 1-h or 2-h abnormal results), 3) GDM-Secretion (isolated abnormal values at 1-h or 2-h or their combination), and 4) GDM-Mixed (three abnormal values). Cesarean delivery, neonates large for gestational age (LGA), and pre-term birth rates were among the outcomes compared. Between-group comparisons were analyzed using either the t-test, chi-square test, or Fisher's exact test. Results: Of 2,056 Mexican pregnant women in the CME cohort, 294 (14.3%) had GDM; 53.7%, 34.4%, and 11.9% were classified as GDM-Sensitivity, GDM-Secretion, and GDM-Mixed subtypes, respectively. Women with GDM were older (p = 0.0001) and more often multiparous (p = 0.119) vs without GDM. Cesarean delivery (63.3%; p = 0.02) and neonate LGA (10.7%; p = 0.078) were higher in the GDM-Mixed group than the overall GDM group (55.6% and 8.4%, respectively). Pre-term birth was more common in the GDM-Sensitivity group than in the overall GDM group (10.2% vs 8.5%, respectively; p=0.022). At 6 months postpartum, prediabetes was more frequent in the GDM-Sensitivity group than in the overall GDM group (31.6% vs 25.5%). Type 2 diabetes was more common in the GDM-Mixed group than in the overall GDM group (10.0% vs 3.3%). Conclusion: GDM subtypes effectively stratified maternal and perinatal risks. GDM-Mixed subtype increased the risk of cesarean delivery, LGA, and type 2 diabetes postpartum. GDM subtypes may help personalize clinical interventions and optimize maternal and perinatal outcomes.

Detection of breast cancer by ATR-FTIR spectroscopy using artificial neural networks.

In this study, three (3) neural networks (NN) were designed to discriminate between malignant (n = 78) and benign (n = 88) breast tumors using their respective attenuated total reflection Fourier transform infrared (ATR-FTIR) spectral data. A proposed NN-based sensitivity analysis was performed to determine the most significant IR regions that distinguished benign from malignant samples. The result of the NN-based sensitivity analysis was compared to the obtained results from FTIR visual peak identification. In training each NN models, a 10-fold cross validation was performed and the performance metrics-area under the curve (AUC), accuracy, positive predictive value (PPV), specificity rate (SR), negative predictive value (NPV), and recall rate (RR)-were averaged for comparison. The NN models were compared to six (6) machine learning models-logistic regression (LR), Naïve Bayes (NB), decision trees (DT), random forest (RF), support vector machine (SVM) and linear discriminant analysis (LDA)-for benchmarking. The NN models were able to outperform the LR, NB, DT, RF, and LDA for all metrics; while only surpassing the SVM in accuracy, NPV and SR. The best performance metric among the NN models was 90.48% ± 10.30% for AUC, 96.06% ± 7.07% for ACC, 92.18 ± 11.88% for PPV, 94.19 ± 10.57% for NPV, 89.04% ± 16.75% for SR, and 94.34% ± 10.54% for RR. Results from the proposed sensitivity analysis were consistent with the visual peak identification. However, unlike the FTIR visual peak identification method, the NN-based method identified the IR region associated with C-OH C-OH group carbohydrates as significant. IR regions associated with amino acids and amide proteins were also determined as possible sources of variability. In conclusion, results show that ATR-FTIR via NN is a potential diagnostic tool. This study also suggests a possible more specific method in determining relevant regions within a sample's spectrum using NN.

Subjective well-being: Self-perception in beneficiaries of a Social Program in Guanajuato, Mexico / Bienestar subjetivo: autopercepción en beneficiarios de un programa social en guanajuato, méxico

RESUMEN El objetivo fue medir el bienestar subjetivo en beneficiarios de los Centros Impulso Social en el estado de Guanajuato, México. La investigación tiene enfoque cuantitativo y alcance descriptivo; el instrumento fue una encuesta de 76 reactivos aplicada a una muestra incidental de 419 beneficiarios en 54 Centros ubicados en 32 de 46 municipios del estado. En los resultados los beneficiarios perciben una satisfacción vital de 8.89 (escala 0-10); los dominios de satisfacción mejor valorados son vida familiar, vida afectiva y logros personales; el estado de ánimo se inclina hacia emociones positivas; el índice de felicidad es de 8.71 (escala 0-10). Se concluye que el Programa Social sí ha cumplido su objetivo, puesto que el bienestar subjetivo percibido por los beneficiarios es superior a la media estatal y nacional.

ABSTRACT The aim of this investigation is to measure the subjective well-being of the Centros de Impulso Social beneficiaries in the state of Guanajuato (Mexico). The research has a quantitative approach and a descriptive scope; the instrument used was a survey of 76 items applied to an incidental sample of 419 beneficiaries in 54 Centers located in 32 of 46 municipalities in the state. In the results, the beneficiaries of the Program perceive a vital satisfaction of 8.89 (scale 0-10); the best valued domains of satisfaction are family life, emotional life, and personal achievements; the mood leans towards positive emotions; and finally, the happiness index is 8.71 (scale 0-10). It is concluded that the Social Program has fulfilled its objective, since the subjective well-being perceived by the beneficiaries is higher than the state and national average.

Infarto agudo de miocardio en cuatro hospitales de atención secundariaen Cuba en la era COVID-19

Introducción: Las características clínico-epidemiológicas en el diagnóstico, evolu-ción y tratamiento de los pacientes con infarto agudo de miocardio en la era COVID-19 dependen de varios factores.Objetivo: Precisar el comportamiento de algunas variables clínico-epidemiológicas en la atención y tratamiento de los pacientes con infarto agudo de miocardio en el curso de la COVID-19.Método: Se realizó un estudio observacional en cuatro hospitales de atención secundaria en Cuba. Se utilizaron las siguientes variables: número de ingresos por infartos, mortalidad hospitalaria, tiempo de demora mayor de 4 horas desde el inicio de los síntomas y la llegada a la primera asistencia médica y el porcentaje de trombólisis. Se definieron dos grupos, los ingresados entre el 1 de marzo al 30de septiembre de 2019 (Grupo I) y los ingresados en igual período pero del 2020(Grupo II). Las comparaciones entre ambos grupos se realizaron utilizando el test de Chi cuadrado.Resultados: Existió una disminución de 53 ingresos por infarto agudo de miocardio en Las Tunas (112vs. 159, p<0.05), con un incremento del número de ingresosen el Hospital Enrique Cabrera en los pacientes del grupo II (98vs. 68, p<0.05). Se incrementó el número de fallecidos y la mortalidad hospitalaria en el grupo II en todos los centros con relación al grupo I. En la mayoría de los centros se incrementó la demora desde el inicio de los síntomas y la llegada al lugar de la primera asistencia médica. El porciento de trombólisis fue superior al 50porciento en la mayoría delos centros en el grupo II.Conclusiones: Las características de la COVID-19 pueden modificar aspectos clínicos y epidemiológicos en la atención y tratamiento de los pacientes con infarto agudo de miocardio.[AU]

Muerte súbita intrahospitalaria luego de infarto agudo de miocardio en Cuba en los últimos tres años. Análisis de registros institucionales

Resumen:Objetivo:Analizar el comportamiento de posibles causas predisponentes de muerte súbita (MS) intrahospitalaria luego de un infarto agudo de miocardio (IMA) en registros cubanos.Material y método:Se realizó una búsqueda de registros clínicos de pacientes con IMA en Cuba en las bases de datos de revistas nacionales, Scientific Library On-line (ScieLO) y Medline. Se priorizaron los artículos publicados desde 2016 para ser incluidos. Se definió como muerte súbita aquélla secundaria a arritmias ventriculares malignas (TV y FV), así como los pacientes con rotura cardíaca y actividad eléctrica sin pulso o asistolia como forma de presentación. Con posterioridad se evaluó la relación de este parámetro con la aparición de muerte súbita en 710 pacientes del Registro de Síndromes Coronarios Agudos (RESCUE).Resultados:En el contexto extrahospitalario, más de la mitad de las muertes súbitas cardíacas son secundarias a un infarto agudo de miocardio. En el hospital, la mortalidad en Cuba por IMA es homogénea. Sólo los centros con intervencionismo coronario escapan a este fenómeno. Aunque no del todo letales, las arritmias ventriculares malignas se relacionan con un peor pronóstico y su prevalencia no es homogénea en los registros revisados.Conclusiones:La muerte súbita luego de infarto agudo de miocardio será aún en Cuba una de las principales causas de muerte en los pacientes de fase aguda.[AU]

ATR-FTIR spectroscopy as adjunct method to the microscopic examination of hematoxylin and eosin-stained tissues in diagnosing lung cancer.

Lung cancer remains the leading cause of cancer-related death worldwide. Since prognosis and treatment outcomes rely on fast and accurate diagnosis, there is a need for more cost-effective, sensitive, and specific method for lung cancer detection. Thus, this study aimed to determine the ability of ATR-FTIR in discriminating malignant from benign lung tissues and evaluate its concordance with H&E staining. Three (3) 5µm-thick sections were cut from formalin fixed paraffin embedded (FFPE) cell or tissue blocks from patients with lung lesions. The outer sections were H&E-stained and sent to two (2) pathologists to confirm the histopathologic diagnosis. The inner section was deparaffinized by standard xylene method and then subjected to ATR-FTIR analysis. Distinct spectral profiles that distinguished (p<0.05) one sample from another, called the "fingerprint region", were observed in five (5) peak patterns representing the amides, lipids, and nucleic acids. Principal component analysis and hierarchical cluster analysis evidently clustered the benign from malignant tissues. ATR-FTIR showed 97.73% sensitivity, 92.45% specificity, 94.85% accuracy, 91.49% positive predictive value and 98.00% negative predictive value in discriminating benign from malignant lung tissue. Further, strong agreement was observed between histopathologic readings and ATR-FTIR analysis. This study shows the potential of ATR-FTIR spectroscopy as a potential adjunct method to the gold standard, the microscopic examination of hematoxylin and eosin (H&E)-stained tissues, in diagnosing lung cancer.

Índice de masa corporal y resultados hospitalarios en pacientes de 80 años con infarto de miocardio con elevación del segmento ST. Resultados de un país de bajos ingresos sin intervención coronaria

BackgroundIn most scenarios from low/middle income countries, pharmacological approach for ST elevation Myocardial Infarction is still use. In these setting and increase proportion of elderly patients is awaited. So it is also expected to have older patients with suboptimal treatment and risk stratification.ObjectiveTo investigate the impact of the body mass index (BMI) on in-hospital outcomes in a cohort of elderly (≥80 years) patients, from a center without coronary intervention.MethodsPatient's ≥80 years of age admitted to our institution between June 2014 and May 2019 with STEMI, were divided according BMI tertiles (BMI tertile 1: ≪22.36 kg/m2, BMI tertile2: 22.36–25.71 kg/m2, and BMI tertile 3: ≫25.71 kg/m2). The primary endpoint was all-cause in-hospital mortalityResultsOut of 118 patients, 41 (34.74 Percent) were women. Median age was 84.4 ± 3.5 years and median BMI 24.1 ± 3.7 kg/m2. Women had a higher BMI than men (24.4 ± 4.0 vs 24.0 ± 3.6; p: 0.535). All-cause mortality was 33.3 Percent, 2.5 Percent, and 15 Percent for lower, middle, and higher BMI tertiles (p=0.002). To belong to BMI tertile 1 was associated with an increased all-cause mortality (OR: 5.15, 95 Percent CI 1.84–14.28, p = 0.001); and in patients without administration of streptokinase (OR: 9.52, 95 Percent CI 2.34–38.45, p = 0.001).ConclusionThis study reports association between lower BMI values and increased mortality in elderly patients with and without pharmacological reperfusion with streptokinase.[AU]

Parada cardíaca súbita por arritmia ventricular en pacientes con infarto agudo de miocardio

RESUMEN: Introducción: La muerte súbita cardíaca no ha disminuido de igual manera que la mortalidad por enfermedad coronaria, por la elevada incidencia de las paradas cardíacas súbitas (PCS).Objetivos: Determinar factores predictivos de PCS por arritmia ventricular en pacientes con infarto agudo de miocardio.Método: Se realizó un estudio analítico en el Servicio de Cardiología de Las Tunas entre 2011 y 2017. La población de estudio estuvo conformada por los 917 pacientes ingresados con infarto agudo de miocardio. Los 90 pacientes con PCS en arritmia ventricular constituyeron el «grupo de casos¼; el resto fue el «grupo control¼. Se utilizó estadística descriptiva y un modelo de regresión logística múltiple, y se calculó el índice de probabilidad (odds ratio [OR]), con un 95porciento de confiabilidad para determinar los factores predictivos.Resultados: En los pacientes del grupo de casos predominó el sexo masculino (73porciento), el infarto biventricular (24,7porciento), la fracción de eyección ventricular izquierda (FEVI) < 35porciento (18,9porciento) y los fallecidos (41,1porciento) en relación al grupo control. Al 10,0 porciento se le administró betabloqueadores en la primera asistencia médica. El shock cardiogénico (OR=15,3), la FEVI < 35% (OR=8,51), la creatina quinasa > 1200 UI (OR=2,77), la obesidad (OR=3,16), el hábito de fumar (OR=2,28), el supra/infradesnivel del ST en el electrocardiograma > 15 mm (OR=2,23) y el infarto anterior (OR=2,39) se asociaron a la PCS en arritmia ventricular.Conclusiones: El shock cardiogénico, la FEVI < 35porciento, la creatina quinasa > 1200 UI, la obesidad, el hábito de fumar, el supra/infradesnivel del ST en el electrocardiograma > 15 mm y el infarto anterior fueron factores predictivos de PCS en arritmia ventricular.[AU]

Implementación y evaluación de una estrategia gimnástica colaborativa / Implementation and Evaluation of a Collaborative Gymnastic Strategy

El aprendizaje de las habilidades gimnásticas carece de investigaciones suficientes que se centren en estrategias que puedan contribuir a un desarrollo de estas habilidades de forma colaborativa. Este estudio analiza las percepciones de un grupo de estudiantes de Bachillerato y del profesorado de educación física sobre la implementación de una estrategia colaborativa para el aprendizaje gimnástico en el contexto educativo. Se ha utilizado una metodología cualitativa que ha permitido analizar y categorizar las reflexiones de los participantes. Los resultados muestran que los estudiantes y el profesorado de educación física perciben mejoras en las competencias gimnásticas, en su relación con el grupo, en su capacidad de toma de decisiones y en su grado de satisfacción con la implementación de la estrategia colaborativa

The learning of gymnastic skills lacks sufficient research that focuses on strategies that can contribute to the development of these skills in a collaborative way. This study analyses the perceptions of Secondary Education students and their physical education teachers on the implementation of a collaborative strategy for learning of gymnastic in the educational context. A qualitative methodology has been used to analyse and categorize the reflections of the participants. The results show that the students and the physical education teachers perceive improvements in the gymnastic competences, in their relation with the group, in their capacity of decision-making and in their degree of satisfaction with the implementation of the collaborative strategy

índice de masa corporal y mortalidad intrahospitalaria en pacientes del Registro de Síndromes Coronarios Agudos (RESCuE)

En el Infarto Agudo de Miocardio (IAM), algunos estudios muestran mejor pronóstico del paciente obeso (paradoja de Obesidad). Objetivo: determinar la asociación existente entre Índice de Masa Corporal (IMC) y Mortalidad intrahospitalaria en serie de casos no consecutivos ingre-sados con IMA.Método: Se establecieron 4 grupos: Bajopeso (IMC <20 kg/m2), Normopeso (IMC: +20-25 kg/m2sc), Sobrepeso (IMC: +25-30 kg/m2sc), y Obeso (IMC: +30 kg/m2sc). Se dividieron en dos grupos diagnósticos: pacientes con Infarto Con Elevación de ST (IAMCEST) e IAM. Se estudiaron variables clínicas, complicaciones, estado hemodinámico al ingreso y egreso.Resultados: Con respecto a pacientes con IMC < 20 kg/m2sc, la asociación con mortalidad en pacientes con IAMCEST fue: en Normopesos 0.22 (IC: 0.05-0.86, p:0.001), Sobrepeso: 0.03 (IC: 0.02-0.23, p:0.001), Obesos 0.52 (IC: 0.11-2.4, p:0.41); en IAM: Normopesos 0.3 (0.1-1.18, p:0.007), Sobrepesos 0.05 (0.01-0.32, p:0.001), en Obesos 0.62 (0.14-2.6, p:0.52).[AU]

21Managing cardiotoxicity induced by chemotherapy in centersfrom low income countries

Abstract. Cardiovascular diseases and cancer account for 60% of deaths in the Western world. They havecommon risk factors, such as obesity and diabetes, and are often found in the same patient. It is morecommon in a patient with tumour disease who develops cardiovascular involvement secondary to treat-ment with cytostatic or radiotherapy. A protocol of in-hospital management of cardiotoxicity induced bycytostatic is proposed with the objective of providing specialized care to patients with cancer and a his-tory of cardiovascular disease or who develop cardiac complications during cancer therapy, in centres oflow-income countries. Care and follow-up criteria are established; guidelines to identify patients who are atrisk of developing cardiac dysfunction, and strategies are proposed to prevent or minimize the risk before,during and after the therapy. Finally, suggestions are presented to treat specific complications: ischemia,systemic embolism, more frequent arrhythmias, pulmonary and systemic hypertension. Ref. 42, on-line fulltext (Free, PDF) www.cardiologyletters.sk.[AU]

AbstractDiabetes is a major risk factor for heart disease. Diabetic cardiomyopathy is a long-lasting process that affects the myocardium in patients who have no other cardiac conditions. The condition has a complex physiopathology which can be subdivided into processes that cause diastolic and/or systolic dysfunction. It is believed to be more common than reported, but this has not been confirmed by a large study. Diagnosis can involve imaging; biomarkers cannot be used to identify diabetic cardiomyopathy at an early stage. In people with diabetes, there should be a focus on prevention and, if diabetic cardiomyopathy develops, the objective is to delay disease progression. Further studies into identifying and managing diabetic cardiomyopathy are essential to reduce the risk of heart failure in people with diabetes.[AU]

AbstractDiabetes is a major risk factor for heart disease. Diabetic cardiomyopathy is a long-lasting process that affects the myocardium in patients who have no other cardiac conditions. The condition has a complex physiopathology which can be subdivided into processes that cause diastolic and/or systolic dysfunction. It is believed to be more common than reported, but this has not been confirmed by a large study. Diagnosis can involve imaging; biomarkers cannot be used to identify diabetic cardiomyopathy at an early stage. In people with diabetes, there should be a focus on prevention and, if diabetic cardiomyopathy develops, the objective is to delay disease progression. Further studies into identifying and managing diabetic cardiomyopathy are essential to reduce the risk of heart failure in people with diabetes.[AU]

Estratificación del riesgo de cardiotoxicidad inducida por quimioterapia

El riesgo de cardiotoxicidad alto corresponde a 6 puntos o más. La actual clasificación se subdivide en bajo (menos de 3 puntos), intermedio (3-4 puntos), alto (5-6 puntos) y muy alto (más de 6 puntos). Asimismo, la conducta ulterior se basará en el riesgo de CIQ obtenido.A los pacientes con bajo riesgo no se les modificará el esquema terapéutico, ni se impondrá tratamiento. A aquellos en riesgo intermedio se les evaluará el riesgo-beneficio del tratamiento, antes de su inicio. Los pacientes con alto riesgo se tratarán con inhibidores de la enzima convertidora de angiotensina (IECA) o antagonistas de los receptores de angiotensina 2 (ARA-2), junto con betabloqueantes (carvedilol, de preferencia) y estatinas. Mientras que a aquellos pacientes con alto riesgo de CIQ se les pospondrá el tratamiento con citostáticos por una semana, para lograr una adecuada adherencia a dosis máxima tolerada del tratamiento anterior.Considero que una adecuada profilaxis y un diagnóstico temprano de la CIQ, serán pilares fundamentales para disminuir o retrasar, en los próximos años, la aparición de disfunción ventricular e insuficiencia cardíaca clínica en gran parte de la población afectada por enfermedades tumorales.Evitemos una epidemia

Combined 5-FU and ChoKα inhibitors as a new alternative therapy of colorectal cancer: evidence in human tumor-derived cell lines and mouse xenografts.

BACKGROUND: Colorectal cancer (CRC) is the third major cause of cancer related deaths in the world. 5-fluorouracil (5-FU) is widely used for the treatment of colorectal cancer but as a single-agent renders low response rates. Choline kinase alpha (ChoKα), an enzyme that plays a role in cell proliferation and transformation, has been reported overexpressed in many different tumors, including colorectal tumors. ChoKα inhibitors have recently entered clinical trials as a novel antitumor strategy. METHODOLOGY/PRINCIPAL FINDINGS: ChoKα specific inhibitors, MN58b and TCD-717, have demonstrated a potent antitumoral activity both in vitro and in vivo against several tumor-derived cell line xenografts including CRC-derived cell lines. The effect of ChoKα inhibitors in combination with 5-FU as a new alternative for the treatment of colon tumors has been investigated both in vitro in CRC-tumour derived cell lines, and in vivo in mouse xenografts models. The effects on thymidilate synthase (TS) and thymidine kinase (TK1) levels, two enzymes known to play an essential role in the mechanism of action of 5-FU, were analyzed by western blotting and quantitative PCR analysis. The combination of 5-FU with ChoKα inhibitors resulted in a synergistic effect in vitro in three different human colon cancer cell lines, and in vivo against human colon xenografts in nude mice. ChoKα inhibitors modulate the expression levels of TS and TK1 through inhibition of E2F production, providing a rational for its mechanism of action. CONCLUSION/SIGNIFICANCE: Our data suggest that both drugs in combination display a synergistic antitumoral effect due to ChoKα inhibitors-driven modulation of the metabolization of 5-FU. The clinical relevance of these findings is strongly supported since TCD-717 has recently entered Phase I clinical trials against solid tumors.

Diastereoselective, multicomponent access to trans-2-aryl-4-arylamino-1,2,3,4-tetrahydroquinolines via an AA'BC sequential four-component reaction and their application to 2-arylquinoline synthesis.

The CAN-catalyzed reaction between 3,5-disubstituted anilines, vinyl ethers and aromatic aldehydes leads to trans-2-aryl-4-arylaminotetrahydroquinolines, in an AA'BC sequential multicomponent transformation related to the Povarov reaction that was also extended to the use of a second aniline as the C-4 substituent. The unusual trans stereochemistry was explained by stabilization of the corresponding intermediate by intramolecular hydrogen bonding. The presence of the 4-anilino substituent allowed adapting the method to the synthesis of 4-unsubstituted 2-arylquinolines, by treatment of the crude product from the MCR with FeCl(3) in methanol.

One-pot access to a library of structurally diverse nicotinamide derivatives via a three-component formal aza [3 + 3] cycloaddition.

The three-component formal [3 + 3] aza-annulation between chalcones, ß-ketoamides, and ammonium acetate in the presence of CAN as a Lewis acid affords good to excellent yields of highly substituted nicotinamides or their fused derivatives. This transformation leads to the formation of one C-C and two C-N bonds in a single synthetic operation and involves up to five individual steps.

[Evaluation of perioperative nutritional therapy in patients with gastrointestinal tract neoplasms]. / Evaluación de la terapia nutricional perioperatoria en pacientes con neoplasia del tracto gastrointestinal superior.

OBJECTIVES: Cancer is usually associated to an important level of desnutrition together with a postoperative morbidity and mortality increase. The purpose of this study was evaluating its efficacy perioperative nutritional support to reduce surgical complications, stances and mortality significantly in patients undergoing higher digestive tract procedures. METHOD: A prospective, randomized trial was done among a sample of neoplasic patients undergoing higher intestinal tract resective surgery during a period of 4 years. After a nutritional assessment, a perioperative immune-enhancing formula was randomly assigned to a group of patients who presented malnourished preoperatively (DS) while well-nourished and the rest of malnourished patients (DNS) received pre-surgical dietetic guidance and intravenous fluids after surgery until the reintroduction of normal diet. The variables studied were: age, sex, tumor stage and length of hospital stay. Nutritional status at admission and discharge, mortality, outcome from surgery and gastrointestinal side effects (tolerability, diarrhoea, vomits or distension) were also collected. Statistical analyses were performed with the with the chi2 for qualitative variables, ANOVA and the Turkey post-hoc tests for the quantitative ones, with a significance of 95%. RESULTS: Sample conformed by 50 patients in 3 groups that were compared for all baseline and surgical characteristics. Significant differences were observed in the incidence of gastrointestinal and infectius complications with better progress in DS group. It was obtained a reduction in the length of hospital stay in 12.29 days in DS group in contrast to DNS group (P=0.224). CONCLUSIONS: Significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. A statistically significant decrease in the incidence of postoperative gastrointestinal symptoms, a reduction in the length of hospital stay and less morbidity occurred on the group that received perioperative nutrition.

[Perioperative nutritional support in patients with colorectal neoplasms]. / Apoyo nutricional perioperatorio en pacientes con neoplasia colorrectal.

OBJECTIVES: Malnutrition is clearly associated with increased morbidity and mortality after elective abdominal surgery. The purpose of this study was to compare perioperative nutritional support with traditional postoperative dietary management, evaluating its efficacy to reduce surgical complications, stances and mortality significantly in patients undergoing major colorectal procedures. METHOD: A prospective, randomized trial was done among a sample of neoplasic patients undergoing intestinal resective surgery during a period of near 3 years. A perioperative immune-enhancing formula was randomly assigned to a group of patients who presented malnourished preoperatively (DS) while well-nourished and the rest of malnourished patients (DNS) received conventional postoperative intravenous fluids until the reintroduction of normal diet. The variables studied were: age, sex, tumor stage and length of hospital stay. Nutritional status at admission and discharge, mortality, outcome from surgery and gastrointestinal side effects (tolerability, diarrhoea, vomits or distension) were also collected. Statistical analyses were performed with the with the chi2, ANOVA and the Turkey post-hoc tests, with a significance of 95%. RESULTS: Sample conformed by 82 patients. The 3 groups were comparable for all baseline and surgical characteristics. Significant differences were observed in the incidence of gastrointestinal complications, length of hospital stay (DS: 13.15±5.26; DNS: 19.34±9.6; p=0.001) and mortality (DS: 13.8%, DNS:30%, p=0,004). CONCLUSIONS: Significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. A statistically significant decrease in the incidence of postoperative gastrointestinal symptoms, a reduction in the length of hospital stay and less morbidity and mortality occurred on the group that received perioperative nutrition.

Situación del brote epidémico de tularemia durante el año 2007 en el Hospital Universitario Río Hortega de Valladolid / Prevalence of epidemic outbreak of tularemia in the Hospital Universitario Río Hortega (Spain) in the year 2007

Introducción: El presente trabajo de investigación es relativo a los resultados analíticos sobre el brote de tularemia aparecido en poblaciones del noroeste de Castilla y León en el verano de 2007. Pacientes y métodos: Se obtuvieron 302 sueros de residentes en el Área de Salud Oeste de Valladolid, atendidos en el Hospital Universitario Río Hortega de SACYL. A todos ellos se les realizó una prueba de aglutinación en tubo para detectar anticuerpos anti-Fancisella tularensis. Resultados: Se detectaron anticuerpos anti-F. tularensis en 59 (19%) de los 302 sueros estudiados. Las formas clínicas más frecuentes de presentación de la enfermedad sugieren la vía inhalatoria como puerta de entrada del germen. Conclusiones: Al comparar el actual brote de tularemia humana con el de finales de 1997 observamos un menor número de casos positivos y diferencias en cuanto a vía de transmission y forma clínica de presentación predominante (AU)

Introduction: This present research study presents the analytic results of an outbreak of tularemia (Francisella tularensis) that occurred in the Northwest areas of Castilla y León in Northern Spain in late June 2007. Patients and methods: Serum was obtained from 302 patients from a West Valladolid health area, attended in the University Hospital of Río Hortega of the Castilla y León Health Care Service, with suspicion of tularemia. A tube agglutination test was performed in all of them to detect anti-F. tularensisantibodies. Results: Anti-F. tularensis antibodies were detected in 59 (19%) of reported cases (302 sera). The most frequent clinical presentations of the disease suggest that the main transmission pathway was through inhalation of the bacteria. Conclusions: When the 2007 outbreak of human tularemia was compared with that which occurred in 1997, we observed a lower number of positive cases in the recent outbreak as well as a difference in the transmission pathway and predominant form of clinical presentation of the disease (AU)