Identification of seasonal variation in the diagnosis of acute myeloid leukaemia: a population-based study.

Until now, the role that seasonal factors play in the aetiology of acute myeloid leukaemia (AML) has been unclear. Demonstration of seasonality in AML diagnosis would provide supportive evidence of an underlying seasonal aetiology. To investigate the potential seasonal and long-term trends in AML diagnosis in an overall population and in subgroups according to sex and age, we used population-based data from a Spanish hospital discharge registry. We conducted a larger study than any to date of 26 472 cases of AML diagnosed in Spain between 2004 and 2015. Using multivariable Poisson generalized linear autoregressive moving average modelling, we found an upward long-term trend, with monthly incidence rates of AML annually increasing by 0.4% [95% confidence interval (CI), 0.2%-0.6%; p = 0.0011]. January displayed the highest incidence rate of AML, with a minimum average difference of 7% when compared to February (95% CI, 2%-12%; p = 0.0143) and a maximum average difference of 16% compared to November (95% CI, 11%-21%; p < 0.0001) and August (95% CI, 10%-21%; p < 0.0001). Such seasonal effect was consistent among subgroups according to sex and age. Our finding that AML diagnosis is seasonal strongly implies that seasonal factors, such as infectious agents or environmental triggers, influence the development and/or proliferation of disease, pointing to prevention opportunities.

Cumplimiento de estándares e indicadores de parto y nacimiento humanizado en el centro de salud tipo C Velasco Ibarra, Machala Ecuador / Compliance with standards and indicators of humanized labor and birth in the type C health center Velasco Ibarra, Machala Ecuador

El parto constituye un acontecimiento extraordinario en la vida de la mujer, dado precisamente, por ser la culminación del embarazo humano y al unísono, el inicio de una nueva vida, razón por la que se le atribuye especial interés a nivel universal. Objetivo: Analizar el cumplimiento de estándares e indicadores de parto y nacimiento humanizado en el Centro de Salud Tipo C. Materiales y Métodos: Estudio observacional, descriptivo, prospectivo, de corte transversal. Con una población total de pacientes atendidas en el Servicio de Centro Obstétrico del Instituto "Velasco Ibarra", en Machala Ecuador, de enero a diciembre del 2020. Resultados: 743 pacientes tuvieron control prenatal con más de 5 sesiones, el 100% de los partos fue espontaneo, con ruptura anteparto, sin inducción, en su mayoría con las semanas completas. En cuanto a la presentación del parto 996 casos fueron de presentación cefálica. 862 pacientes no tuvieron acompañantes, sino, el grupo sanitario, médicos y enfermeras y solo a 125 se le permitió tener a su pareja. En cuanto a la posición del parto, 908 estuvieron en posición de litotomía (ginecológica), en cuanto a la analgesia, solo 267 y ninguna requirió anestesia, así como tampoco requirieron sangre, sulfato, hierro ni anticonceptivos postparto. Conclusiones: Se precisa la inclusión del componente humanizador e integral para la concepción del parto como un proceso natural y fisiológico, con la combinación científico-humanista en el logro de una atención con calidad y calidez, donde la mujer ecuatoriana protagonice su proceso de parto como un sujeto de cuidado y no como objeto del mismo(AU)

Childbirth is an extraordinary event in a woman's life, given precisely because it is the culmination of human pregnancy and at the same time the beginning of a new life, which is why special interest is attributed to it at a universal level. Objective: To analyze compliance with humanized childbirth and delivery standards and indicators in the Type C Health Center. Materials and Methods: Observational, descriptive, prospective, cross-sectional study. With a total population of patients treated at the Obstetric Center Service of the "Velasco Ibarra" Institute, in Machala Ecuador from January to December 2020. Results: 743 patients had prenatal control with more than 5 sessions, 100% of deliveries were spontaneous with antepartum rupture, without induction and almost all with complete weeks. And in 3, regarding the presentation of delivery, 996 cases were of cephalic presentation. 862 patients did not have companions, but the health group, doctors and nurses and only 125 were allowed to have their partner. As for the position of delivery, 908 were in the lithotomy (gynecological) position, as for analgesia only 267 and none required anesthesia, nor did they require blood, sulfate, iron, or postpartum contraceptives. Conclusions: the inclusion of the humanizing and integral component is required for the conception of childbirth as a natural and physiological process, with the scientific-humanistic combination in achieving care with quality and warmth, where the Ecuadorian woman is the protagonist of her birth process as a a subject of care and not as its object(AU)

Characterisation of phenolics in Flor-Essence--a compound herbal product and its contributing herbs.

INTRODUCTION: Commercially available herbal mixture FE, a proprietary natural health product manufactured by Flora Manufacturing and Distributing Ltd (Flora), is a unique North American traditional herbal product. FE is a chemically complex mixture of eight herbs and has not been subjected to phytochemical analysis. OBJECTIVE: To develop analytical methods to undertake detailed phytochemical analyses of FE, and its eight contributing herbs, including burdock (Arctium lappa L.), sheep sorrel (Rumex acetosella L.), Turkish rhubarb (Rheum palmatum L.), slippery elm Muhl. (Ulmus rubra), watercress (Nasturtium officinale R. Br.), red clover (Trifolium pratense L.), blessed thistle (Cnicus benedictus L.) and kelp (Laminaria digitata Lmx.). METHODOLOGY: The identification was undertaken by a combination of reversed phase high performance liquid chromatography-diode array detection-atmospheric pressure chemical ionisation-mass selective detection (RP-HPLC-DAD-APCI-MSD) analysis and phenolics metabolomic library matching. RESULTS: New separation methods facilitated the identification of 43 markers in the individual herbs which constitute FE. Sixteen markers could be identified in FE originating from four contributing herbs including four caffeoyl quinic acids, three dicaffeoyl quinic acids and two caffeic acid derivatives from A. lappa, luteolin-7-O-glucoside, luteolin, five apigenin glycosides and apigenin from R. acetocella and N. officinale and sissostrin from T. pretense. A validated method for quantitative determination of three markers is reported with good intraday, interday and interoperator repeatability using a reliable alcohol based extraction technique. CONCLUSION: FE and its contributing herbs predominantly contain phenolics. This methodology can be applied to further develop full-scale validation of this product.

Grado de conocimiento de los signos de alarma de insuficiencia respiratoria aguda y enfermedad diarreica aguda por los cuidadores de niños menores de cinco años / Degree of knowledge of the warning signs of acute respiratory failure and acute diarrheal disease caregivers of children under five years

Introducción: Uno de los principales problemas asociados a la mayor gravedad de las enfermedades en niños menores de 5 años atendidos en los servicios de salud es la falta de conocimiento de los padres y otros responsables del cuidado de los niños al respecto de los signos de alarma que indican que el niño debe recibir atención médica. La demora en la consulta al servicio de salud puede provocar el agravamiento de la enfermedad, y requerir que el niño sea tratado en un hospital, o incluso puede provocar su muerte. Por esta razón es muy importante el reconocimiento de los signos de alarma en un niño enfermo. Es nuestra intención determinar el grado de conocimiento de los signos de alarma de la Insuficiencia respiratoria aguda y enfermedad diarreica aguda; en los cuidadores, al salir de la consulta médica Fundamento y objetivos Las estrategias de la Organización Mundial de la Salud tienen como eje a la familia, por ello es importante que los padres reciban y comprendan la información que brinda el personal de salud (los signos de alarma). El objetivo de este estudio es determinar el nivel de conocimiento sobre los signos de alarma ante una infección respiratoria aguda y/o enfermedad diarreica aguda que reconozcan los cuidadores, posterior a la consulta externa del departamento de pediatría del Instituto Nacional de Salud del Niño. Pacientes y método Se realizó un estudio de tipo observacional transversal, en los consultorios externos del Servicio de Pediatría del Instituto Nacional de Salud del Niño. Se entrevistaron a todos los cuidadores (93 en total) de los niños de 0 meses a 4 años y 11 meses de edad cuyo diagnóstico sea insuficiencia respiratoria aguda o enfermedad diarreica aguda; durante el mes de noviembre del 2009. El análisis estadístico se realizó con el programa estadístico SPSS 15.0...

Introduction: One of the main problems associated with increased severity of disease in children under 5 years treated at health services is lack of knowledge of parents and other caretakers of children to respect warning signs indicating that the child should receive medical attention. The del ay in consulting the health service can lead to worsening of the disease, and require the child to be treated in a hospital, or may even cause death. For this reason it is important to recognize the warning signs in a sick child. We intend to determine the degree of knowledge of the warning signs of acute respiratory failure and acute diarrheal disease, in caregivers, leaving the medical center. Background and objectives The strategies of the World Health Organization are at the heart of the family, so it is important that parents receive and understand the information provided by health staff (warning signs). The aim of this study is to determine the level of knowledge about the warning signs before an acute respiratory infection and / or acute diarrheal disease that recognize the caregivers, after the outpatient department of pediatrics at the National Institute of Child Health. Patients and Methods A cross-sectional observational study in the outpatient service of the Pediatric Service of the National Institute of Child Health. We interviewed all caregivers (93 in total) for children from O months to 4 years and 11 months of age whose diagnosis is acute respiratory failure or acute diarrhea, during the month of November 2009. Statistical analysis was performed using SPSS 15.0 package. Results The most important warning signs for acute respiratory failure were fever (67.7 per cent) and rapid breathing (61.3 per cent), whereas for acute diarrheal disease, was the increased frequency of bowel movements (68.8 per cent) and fever (61.3 per cent)...

Clinical research on probiotics: the interface between science and regulation.

Although there exists some evidence of the safety and efficacy of probiotics for treatment of disease, many of the clinical trials have lacked methodological quality, particularly with regard to protocol design, selection of population, and product characterization. Depending on the regulatory route, data need to be collected carefully to satisfy regulatory requirements in the United States and elsewhere. This article discusses how the regulations for probiotics affect clinical research. It also describes clinical trial design and issues that affect the design of trials for probiotics conducted to improve the scientific evidence for these products.

Review of clinical trials evaluating safety and efficacy of milk thistle (Silybum marianum [L.] Gaertn.).

Milk thistle extracts have been used as traditional herbal remedies for almost 2000 years. The extracts are still widely used to protect the liver against toxins and to control chronic liver diseases. Recent experimental and clinical studies suggest that milk thistle extracts also have anticancer, antidiabetic, and cardioprotective effects. This article reviews clinical trials of milk thistle conducted in the past 5 years including pharmacokinetic and toxicity studies, herb-drug interactions, and other safety issues. Several trials have studied the effects of milk thistle for patients with liver diseases, cancer, hepatitis C, HIV, diabetes, and hypercholesterolemia. Promising results have been reported in the protective effect of milk thistle in certain types of cancer, and ongoing trials will provide more evidence about this effect. In addition, new established doses and improvement on the quality and standardization of this herb will provide the much-awaited evidence about the efficacy of milk thistle in the treatment of liver diseases. Milk thistle extracts are known to be safe and well tolerated, and toxic or adverse effects observed in the reviewed clinical trials seem to be minimal. The future of milk thistle research is promising, and high-quality randomized clinical trials on milk thistle versus placebo may be needed to further demonstrate the safety and efficacy of this herb.

PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies.

PURPOSE: Postdural puncture headache (PDPH) is an iatrogenic complication of neuraxial blockade. We systematically reviewed the literature on parturients to determine the frequency, onset, and duration of PDPH. METHODS: Citations on PDPH in the obstetrical population were identified by computerized searches, citation review, and hand searches of abstracts and conference proceedings. Citations were included if they contained extractable data on frequency, onset, or duration of PDPH. Using meta-analysis, we calculated pooled estimates of the frequency of accidental dural puncture for epidural needles and pooled estimates of the frequencies of PDPH for epidural and spinal needles. RESULTS: Parturients have approximately a 1.5% [95% confidence interval (CI) 1.5% to 1.5%) risk of accidental dural puncture with epidural insertion. Of these, approximately half (52.1%; 95% CI, 51.4% to 52.8%) will result in PDPH. The risk of PDPH from spinal needles diminishes with small diameter, atraumatic needles, but is still appreciable (Whitacre 27-gauge needle 1.7%; 95% CI, 1.6% to 1.8%). PDPH occurs as early as one day and as late as seven days after dural puncture and lasts 12 hr to seven days. CONCLUSION: PDPH is a common complication for parturients undergoing neuraxial blockade.