Educational environment and mental wellbeing of medical and surgical postgraduate residents in Medellin, Colombia.

INTRODUCTION: One of the most important moments in a doctor's life occurs when they do a medical residency. This period imposes stress and academic demands, which, together with the educational environment, allows for greater or lesser mental wellbeing. The objective of this study was to determine how the educational environment and mental wellbeing of medical residents are related. METHODS: Analytical cross-sectional study, in residents of clinical-surgical specialties. The educational environment was assessed using the Postgraduate Hospital Educational Environment Measure (PHEEM), and mental wellbeing was assessed with the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Pearson's linear correlation was determined. Informed consent and approval by the university ethics committee were obtained. RESULTS: The study population comprised 131 students, 43.8% male, with a median age of 28 years (interquartile range 4). In total, 87.9% of residents answered the survey. Of these, 65.9% were doing medical residencies and 34.1% surgical residencies. The mean PHEEM score was 107.96 ±â€¯18.88, the positive emotions subscale was 29.32 ±â€¯5.18 and positive functioning 23.61 ±â€¯3.57, with a mean total mental wellbeing of 52.96 ±â€¯8.44. A positive and moderate correlation was found between the total PHEEM score and each of the two mental wellbeing subscales (p < 0.001). CONCLUSIONS: A positive correlation was found between a better perception of the educational environment and mental wellbeing by residents of clinical and surgical specialties with greater mental wellbeing.

Ambiente educacional y bienestar mental de los residentes de posgrados médicos y quirúrgicos en Medellín, Colombia

Introducción: Uno de los momentos más importantes en la vida de un médico ocurre cuando realiza la especialización médica. Este periodo impone estrés y exigencias académicas, lo cual, junto con el ambiente educacional, permite un mayor o menor bienestar mental. El objetivo del estudio es determinar cómo se relacionan el ambiente educacional y el bienestar mental de los residentes de Medicina. Métodos: Estudio transversal analítico en residentes de especialidades clínico-quirúrgicas. El ambiente educacional se evaluó mediante la escala Postgraduate Hospital Educational Envioro-ment Meassure (PHEEM) y el bienestar mental, con la escala de Warwick-Edinburgh (EBMWE). Se determinó la correlación lineal de Pearson. Se tomó el consentimiento informado y se obtuvo la aprobación del comité de ética universitario. Resultados: Integraron la población de estudio 131 estudiantes, el 43,8% varones, con una mediana de edad de 28 [intervalo intercuartílico, 4] arios. El 87,9% de los residentes respondieron a la encuesta. Hubo un 65,9% de posgrados médicos y un 34,1% de quirúrgicos. La puntuación media en la PHEEM fue de 107,96 ± 18,88; en la subescala de emociones positivas, 29,32 ± 5,18 y en funcionamiento positivo, 23,61 ± 3,57, con una media total de bienestar mental de 52,96 ± 8,44. Se encontró una moderada correlación positiva entre puntuación total de la PHEEM y cada una de las 2 subescalas de bienestar mental (p <0,001). Conclusiones: Se encontró una correlación positiva entre una mejor percepción del ambiente educacional y el bienestar mental de los residentes de especialidades clínicas-quirúrgicas con mayor bienestar mental

Introduction: One of the most important moments in a doctor's life occurs when they do a medical residency. This period imposes stress and academic demands, which, together with the educational environment, allows for greater or lesser mental wellbeing. The objective of this study was to determine how the educational environment and mental wellbeing of medical residents are related. Methods: Analytical cross-sectional study, in residents of clinical-surgical specialties. The educational environment was assessed using the Postgraduate Hospital Educational Environment Measure (PHEEM), and mental wellbeing was assessed with the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Pearson's linear correlation was determined. Informed consent and approval by the university ethics committee were obtained. Results:The study population comprised 131 students, 43.8% male, with a median age of 28 years (interquartile range 4). In total, 87.9% of residents answered the survey. Of these, 65.9% were doing medical residencies and 34.1% surgical residencies. The mean PHEEM score was 107.96 ± 18.88, the positive emotions subscale was 29.32 ± 5.18 and positive functioning 23.61 ± 3.57, with a mean total mental wellbeing of 52.96 ± 8.44. A positive and moderate correlation was found between the total PHEEM score and each of the two mental wellbeing subscales (p < 0.001). Conclusions: A positive correlation was found between a better perception of the educational environment and mental wellbeing by residents of clinical and surgical specialties with greater mental wellbeing.

Mucocutaneous manifestations and their relationship with CD4 T-lymphocyte count in hospitalized patients infected with the human immunodeficiency virus (HIV) in Medellín, Colombia / Manifestaciones mucocutáneas y su relación con el recuento de linfocitos T CD4 en pacientes infectados con el virus de inmunodeficiencia humana hospitalizados en Medellín, Colombia

Introduction: About 80-95% of patients infected with the human immunodeficiency virus (HIV) develop skin manifestations, which are markers of the patients' immune status. Objective: To describe the dermatologic manifestations and the clinical and sociodemographic factors of hospitalized patients diagnosed with HIV and their correlation with CD4 T-lymphocyte count. Materials and methods: We conducted an observational, cross-sectional, and retrospective study of the medical records of 227 adult patients with HIV diagnosis evaluated by dermatology in a hospital in Medellín, Colombia. Results: We included 227 patient records with 433 dermatologic manifestations, 64.4% of them infectious. The most frequent manifestations were oral candidiasis, condylomata acuminata, and drug reactions. Moreover, a statistically significant relationship was found between disseminated herpes zoster virus and secondary syphilis with a CD4 count between 200-499 cells/mm3 (p=0.04 and 0.028, respectively). There was also a statistically significant relationship between oral candidiasis and a CD4 count of less than 100 cells/mm3 (p=0.008). Conclusions: The relationship between disseminated herpes zoster with CD4 between 200-499 cells/mm3 suggests that, despite having high CD4 counts, severe forms of the disease may occur due to possible T-cell dysfunction and depletion of the immune system. Additionally, the relationship between oral candidiasis and CD4 less than 100 cells/mm3 indicates the potential role of oral candidiasis as an essential marker of weakened immune status in HIV patients.

Introducción. Entre el 80 y el 95 % de los pacientes infectados por el virus de inmunodeficiencia humana (HIV) desarrollan manifestaciones en la piel que sirven como marcadores de su estado inmunológico. Objetivos. Describir las manifestaciones dermatológicas y los factores clínicos y sociodemográficos de los pacientes hospitalizados con diagnóstico de HIV y su correlación con el recuento de linfocitos T CD4. Materiales y métodos. Se hizo un estudio observacional de corte transversal y retrospectivo a partir del registro de las historias clínicas de 227 pacientes mayores de edad con diagnóstico de HIV, evaluados por dermatología en un hospital de Medellín, Colombia. Resultados. Los 227 registros daban cuenta de 433 manifestaciones dermatológicas, el 64,4 % de ellas infecciosas. Las tres manifestaciones más frecuentes fueron candidiasis oral, condilomas acuminados y reacciones a medicamentos. Se encontró una relación estadísticamente significativa entre el virus del herpes zóster (HZ) diseminado y la sífilis secundaria, con un recuento de CD4 entre 200 y 499 células/mm3 (p=0,04 y 0,028, respectivamente), y entre la candidiasis oral y un recuento de CD4 menor de 100 células/mm3 (p=0,008). Conclusiones. La relación entre el herpes zóster diseminado y un recuento de CD4 entre 200 y 499 células/mm3 sugiere que, a pesar de los recuentos altos, se pueden presentar formas graves de la enfermedad debido a una posible disfunción de las células T y el agotamiento del sistema inmunológico. La relación entre la candidiasis oral y un recuento de CD4 menor de 100 células/mm3 plantea la posibilidad de considerar esta infección micótica como un marcador importante de debilitamiento inmunológico de los pacientes con HIV.

Educational Environment and Mental Wellbeing of Medical and Surgical Postgraduate Residents in Medellin, Colombia. / Ambiente educacional y bienestar mental de los residentes de posgrados médicos y quirúrgicos en Medellín, Colombia.

INTRODUCTION: One of the most important moments in a doctor's life occurs when they do a medical residency. This period imposes stress and academic demands, which, together with the educational environment, allows for greater or lesser mental wellbeing. The objective of this study was to determine how the educational environment and mental wellbeing of medical residents are related. METHODS: Analytical cross-sectional study, in residents of clinical-surgical specialties. The educational environment was assessed using the Postgraduate Hospital Educational Environment Measure (PHEEM), and mental wellbeing was assessed with the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Pearson's linear correlation was determined. Informed consent and approval by the university ethics committee were obtained. RESULTS: The study population comprised 131 students, 43.8% male, with a median age of 28 years (interquartile range 4). In total, 87.9% of residents answered the survey. Of these, 65.9% were doing medical residencies and 34.1% surgical residencies. The mean PHEEM score was 107.96±18.88, the positive emotions subscale was 29.32±5.18 and positive functioning 23.61±3.57, with a mean total mental wellbeing of 52.96±8.44. A positive and moderate correlation was found between the total PHEEM score and each of the two mental wellbeing subscales (p <0.001). CONCLUSIONS: A positive correlation was found between a better perception of the educational environment and mental wellbeing by residents of clinical and surgical specialties with greater mental wellbeing.

Absentismo laboral por incapacidad médica en un centro de contacto de la ciudad de Medellín en el periodo 2016-2017 / Sickness absence in a contact center of the city of Medellín in the period 2016-2017

Introducción: el absentismo laboral constituye un problema serio para las empresas a nivel mundial y los centros de teleoperadores no son la excepción. Objetivos: determinar las causas de absentismo laboral por incapacidad médica e identificar factores sociodemográficos, laborales y costos directos en un centro de teleoperadores de la ciudad de Medellín en el periodo 2016-2017. Material y Métodos: estudio descriptivo, transversal, donde se analizaron 36.283 registros de absentismo laboral que se registraron de acuerdo a diagnósticos (CIE-10), se reclasificaron según criterio médico. Se calcularon indicadores de absentismo laboral según NTC 3793. Resultados: el 99,3% de las ausencias se debió a enfermedad general. El promedio de ausencia es de 4,28 +/-5,64 días por trabajador. Solo el 5% de las incapacidades superaban los cinco días. Las enfermedades gastrointestinales y de vías respiratorias tuvieron los mayores días de ausencia. Los absentistas repetitivos aportaron en total 44.063 días perdidos. Los absentistas crónicos generaron una pérdida de 223 días por cada 100 trabajadores

Introduction: absenteeism constitutes a serious problem for the companies worldwide. Call centers are not the exception Objectives:to determine causes of absenteeism for sickness absence and to identify sociodemographic and labour factors and direct cost in a call center in Medellín, 2016-2017. Material and Methods: a descriptive, transverse study. The study analysed 36.283 records of absenteeism that were registered in accordance to diagnoses (CIE 10). These records were re-classified according to medical criterion and it was calculated rates of absenteeism in accordance to NTC 3793. Results: 99.3% of absences were due to general illness. The average of absence is 4.28 +/-5.64 days per worker. Only 5% of absenteeism exceeded five days. The gastrointestinal diseases and of respiratory tract had the major days of absence. The repetitive absentee contributed a total 44,063 lost days. The chronic absentee generated a loss of 223 days per 100 workers

A PREDICTIVE MODEL FOR AXILLARY LYMPH NODE PATHOLOGIC COMPLETE RESPONSE IN PREMENOPAUSAL BREAST CANCER PATIENTS AFTER NEOADJUVANT CHEMOTHERAPY: A CROSS-SECTIONAL STUDY IN A L ATIN-AMERICAN POPULATION / Um modelo preditivo para a resposta patológica completa axilar em pacientes com câncer de mama premenopausal após quimioterapia adjuvante: estudo transversal em uma população latino-americana

Introduction: A large group of lymph node-positive breast cancer patients receive neoadjuvant chemotherapy and subsequently undergo axillary lymph node dissection. It has been previously proposed that axillary lymph node dissection may be avoided ­ and it's associated reduced morbidity ­ in patients showing pathologic complete response. Therefore, the purpose of this study was to develop a nomogram to predict axillary node pathologic response to neoadjuvant chemotherapy in breast cancer patients in order to guide the surgical treatment decision-making process for this group of patients. Methods: A cross-sectional, secondary data study was carried out between 2013-2016 on 222 lymph node-positive breast cancer patients who received neoadjuvant chemotherapy followed by locoregional management, including axillary lymph node dissection. Logistic regression analysis was performed to determine the association of the axillary pathologic complete response with the different clinical and pathological variables. Variables found to be statistically significantly associated with axillary pCR (pathologic complete response) were used to create the logistic regression model and the nomogram in pre-menopausal patients. Axillary pCR was defined as absence of residual disease in the breast and of micro-metastasis in axillary lymph nodes. Samples with isolated tumor cells were considered as positive for residual disease. Results: a total of 222 patients were included, of which 131 were premenopausal at the time of diagnosis. Axillary pathologic complete response was observed in 55.7% (73 of 131) of patients, and was significantly associated with estrogen receptor (ER) negative tumors (OR 2.59, 95%CI 1.21-5.53), progesterone receptor (PR) negative tumors (OR 2.63, 95%CI 1.28-5.38), and Her2 positive tumors (OR 0.40, 95%CI 0.19-0.84), for which a significant correlation with increased probability of achieving axillary pathologic complete response was evidenced. Conclusion: The performance of this model to predict axillary pCR in pre-menopausal patients was weak, and therefore the decision to avoid surgical axillary dissection should not be based solely on the developed nomogram. However, further studies may lead to validation of this model

Introdução: Um grande grupo de pacientes com câncer de mama linfonodo-positivo recebe quimioterapia neoadjuvante, que subsequentemente são submetidos a dissecção de linfonodos axilares. Foi proposto anteriormente que a dissecção de linfonodos axilares pode ser evitada ­ assim como a redução de sua morbidade - em pacientes que apresentam resposta patológica completa. Portanto, o objetivo deste estudo foi desenvolver um nomograma para prever a resposta patológica do linfonodo axilar à quimioterapia neoadjuvante em pacientes com câncer de mama, a fim de orientar o processo de decisão do tratamento cirúrgico para este grupo de pacientes. Metodologia: Foi realizado um estudo transversal, de dados secundários, entre os anos de 2013-2016 em 222 pacientes com câncer de mama linfonodo-positivo, que receberam quimioterapia neoadjuvante seguida de tratamento locorregional, incluindo dissecção de linfonodos axilares. A análise de regressão logística foi realizada para determinar a associação da resposta completa patológica axilar com as diferentes variáveis clínicas e patológicas. Variáveis estatisticamente associadas à pCR axilar (resposta completa patológica) foram usadas para criar o modelo de regressão logística e nomograma em pacientes na pré-menopausa. A pCR axilar foi definida como ausência de doença residual na mama e de micro-metástase nos linfonodos axilares. Amostras com células tumorais isoladas foram consideradas positivas para doença residual. Resultados: foram incluídos 222 pacientes, dos quais 131 estavam na prémenopausa no momento do diagnóstico. A resposta patológica axilar completa foi observada em 55,7% (73 de 131) dos pacientes, e foi significativamente associada a tumores negativos para receptores de estrogênio(RE) (OR 2,59; IC 95% 1,21-5,53) e negativos para receptores de progesterona (RP) (OR 2.63, IC 95% 1.28-5.38), e Her2 positivos (OR 0.40, IC 95% 0.19-0.84), para o qual foi evidenciada uma correlação significativa com o aumento da probabilidade de atingir resposta completa patológica axilar. Conclusão: O desempenho deste modelo para prever a pCR axilar em pacientes na pré-menopausa era fraco e, portanto, a decisão de evitar a dissecção axilar cirúrgica não deve ser baseada apenas no nomograma desenvolvido. No entanto, estudos posteriores podem levar à validação desse modelo

Association of epicardial adipose tissue with incidence, severity and recurrences of atrial fibrillation: results of a systematic review / Asociación del tejido adiposo epicárdico con la incidencia, la gravedad y las recurrencias de la fibrilación auricular: resultados de una revisión sistemática

Abstract: Introduction: Atrial fibrillation is the most prevalent arrhythmia in clinical practice. Evidence has recently shown a relationship between epicardial adipose tissue and atrial fibrillation, which may be stronger than that for traditional obesity markers. Objective: To analyse the available evidence associating adipose epicardial tissue with incidence, severity and recurrences of atrial fibrillation. Methods: A systematic search in PubMed, EBSCO, Cochrane, SciELO and LILACS databases for observational studies published in the last 10 years, evaluating the association between atrial fibrillation and epicardial adipose tissue was undertaken. All articles were evaluated by two authors and differences were solved by consensus. Results: After having screened and evaluated articles for quality, 15 were selected for the qualitative synthesis. All studies reported a statistically significant association between total fat and periatrial epicardial adipose tissue and the presence of atrial fibrillation, which persisted after adjustment of covariates. The evidence was not uniform regarding arrhythmia severity. Periatrial epicardial fat was significantly higher in patients who had a recurrent disease. Conclusion: the presence of epicardial adipose tissue (total and periatrial) is significantly associated with atrial fibrillation and arrhythmia recurrence.(AU)

Resumen: Introducción: La fibrilación auricular es la arritmia más prevalente en la práctica clínica. Recientemente se ha demostrado una relación entre el tejido adiposo epicárdico y la fibrilación auricular, que puede ser más fuerte que la de los marcadores de obesidad tradicionales. Objetivo: Analizar las pruebas disponibles que asocian el tejido epicárdico adiposo con la incidencia, gravedad y recurrencia de la fibrilación auricular. Métodos: Se realizó una búsqueda sistemática en las bases de datos PubMed, EBSCO, Cochrane, SciELO y LILACS de estudios observacionales publicados en los últimos 10 años, evaluando la asociación entre la fibrilación auricular y el tejido adiposo epicárdico. Dos autores evaluaron todos los artículos y las diferencias se resolvieron por consenso. Resultados: Después de haber examinado y evaluado la calidad de los artículos, se seleccionaron 15 para la síntesis cualitativa. Todos los estudios informaron una asociación estadísticamente significativa entre la grasa total y el tejido adiposo epicárdico periatrial y la presencia de fibrilación auricular, que persistió después del ajuste de las covariables. Las evidencias no fueron uniformes con respecto a la gravedad de la arritmia. La grasa epicárdica periatrial fue significativamente mayor en los pacientes que tuvieron una enfermedad recurrente. Conclusión: La presencia de tejido adiposo epicárdico (total y periatrial) se asocia significativamente con fibrilación auricular y recurrencia de arritmia.(AU)

Cataratas y exposición a radiación ionizante en personal de cardiología intervencionista / Cataracts and exposition to ionizing radiation in interventional cardiology staf

Objetivo: Evaluar la evidencia reciente sobre la relación entre la exposición a radiación ionizante y las cataratas en personal de cardiología intervencionista. Métodos: Se realizó una búsqueda bibliográfica de artículos científicos publicados en los últimos 10 años en las bases de datos Clinical Key, EBSCO, Science Direct, LILACS y Pubmed de estudios observacionales analíticos que evaluaran la relación entre aparición de cataratas y exposición a radiación ionizante en personal de cardiología intervencionista. Resultados:A través de criterios de inclusión y exclusión se seleccionaron 6 artículos en total, sobre estudios que fueron realizados en personal de cardiología intervencionista laboralmente activos aplicando las escalas LOCS III y Merriam-Fotch para calcular la opacidad corneal. Se encontró que existe una relación estadísticamente significativa entre la exposición a radiación ionizante y el riesgo de padecer cataratas Conclusiones: Los resultados encontrados apoyan la hipótesis de que la exposición a radiación ionizante podría aumentar el riesgo de cataratas en personal de cardiología intervencionista. Se requieren más estudios para tener una mayor acerca de esta relación y establecer la dosis límite segura. Se recomienda el uso de gafas de seguridad y equipo de protección especial para disminuir los efectos oculares de la radiación (AU)

Objective: Evaluate the most recent evidence about the relation between exposure to ionizing radiation and cataracts in interventional cardiology personnel. Methods: A bibliographic search was conducted of scientific articles published in the last 10 years in the databases Clinical key, EBSCO, Science Direct, LILACS and Pubmed; about observational analytical studies that support the association between cataracts and exposure to ionizing radiation in interventional cardiology staff. Results: By means of the inclusion and exclusion criteria, a total of 6 articles were selected, about studies performed among occupational active interventional cardiology personnel using the LOCS III and Merriam-Fotch scales to calculate corneal opacity. It was found that there is a statistically significant relation between exposure to ionizing radiation and the risk of cataracts. Conclusions: The results support the hypothesis that exposure to ionizing radiation could increase the risk of cataracts in interventional cardiology personnel. Further studies are needed to get a better understanding of this relation and to establish the limit dose. Use of radiation safety glasses and special protective equipment is recommended to reduce the ocular effects of radiation (AU)

Condiciones de trabajo, riesgos ergonómicos y presencia de desórdenes músculo-esqueléticos en recolectores de café de un municipio de Colombia / Work conditions, ergonomic risks and the presence of musculoskeletal disorders in coffee collectors in a municipality in Colombia

Introducción: la presencia de desórdenes músculo esqueléticos son problemas de salud pública importantes entre los agricultores. Pocos estudios han examinado los riesgos ergonómicos y las condiciones de trabajo asociadas con la presencia estos desórdenes. El objetivo de este estudio es describir las características sociodemográficas, de seguridad social, las condiciones laborales, el riesgo ergonómico y los desórdenes musculo esqueléticos en un grupo de recolectores de café del municipio de Andes. Materiales y métodos: Estudio descriptivo, transversal, en un grupo de 70 recolectores de café en el municipio de Andes Antioquia, aplicando un instrumento asistido y una valoración con el método OWAS para la identificación de factores de riesgo posturales y el cuestionario nórdico para la identificación de desórdenes musculo esqueléticos que pudieran estar asociados con los riesgos posturales y a otros factores laborales y sociodemográficos explorados. Resultados: Se observó mayor prevalencia de riesgo de presentar lumbalgia y cervicalgia en las mujeres recolectoras de café. Se observa una tendencia a un mayor reporte de cervicalgia y lumbalgia en aquellos trabajadores que refirieron haber presentado accidentes laborales y enfermedades laborales, sin embargo, la asociación no fue estadísticamente significativa. Conclusión: Se encontró que el 64.3% de los recolectores de café del municipio encuestados presentaron mediano riesgo ergonómico, asociado a posturas inadecuadas y/o mantenidas, y al relacionar lo anterior con los desórdenes musculo esqueléticos, el 30% de los encuestados refirió lumbalgia. No se encontró asociación estadísticamente significativa entre la presencia de desórdenes musculo esqueléticos y las condiciones de trabajo (AU)

Introduction: The presence of musculoskeletal disorders are important public health problems among farmers. Few studies have examined the ergonomic risks and working conditions associated with the presence of these disorders. The objective of this study is to describe the socio-demographic characteristics, social security, working conditions, ergonomic risk and musculoskeletal disorders in a group of coffee collectors in the municipality of Andes. Materials and methods: a cross-sectional study was conducted in a group of 70 coffee collectors in the municipality of Andes, Antioquia, applying an assisted instrument and an assessment using the OWAS method for the identification of postural risk factors, and the Nordic questionnaire for the identification of musculoskeletal disorders that could be associated with the postural risks and other labour and socio-demographic factors. Results: The study showed a higher prevalence of low back pain and neck pain in female workers compared with male workers. There was a trend towards a higher rate of cervicalgia and low back pain in workers who reported having had work-related accidents and occupational diseases, but the association was not statistically significant. Conclusion:It was found that 64.3% of the municipal coffee collectors surveyed presented medium risk associated with inadequate and / or maintained postures, and when related to musculoskeletal disorders, 30% of the respondents reported low back pain. There was no statistically significant association between the presence of musculoskeletal disorders and working conditions (AU)

Caracterización de las gestantes tamizadas para Streptococcus agalactiae y su relación con sepsis neonatal temprana, en la Clínica del Prado de Medellín (Colombia), año 2010 / Characterization of pregnant women screened for Streptococcus agalactiae and its relationship with early neonatal sepsis, at the Clínica del Prado de Medellín (Colombia), 2010

Streptococcus agalactiae (S. agalactiae) es el principal microorganismo causante de sepsis neonatal temprana (SNT) en el mundo. La profilaxis basada en la tamización rectovaginal de las gestantes es una estrategia eficaz para prevenir la SNT. Objetivo: Describir la prevalencia de colonización rectovaginal por S. agalactiae en gestantes tamizadas en la Clínica del Prado de Medellín durante 2010 y establecer la relación entre colonización materna y SNT. Materiales y métodos: Estudio observacional, descriptivo y de corte transversal, para determinar la prevalencia de colonización rectovaginal por S. agalactiae , mediante revisión de historias clínicas y resultados de laboratorio. Se incluyó aleatoriamente a 182 gestantes de 540 tamizadas. Resultados: La prevalencia de colonización rectovaginal por S. agalactiae determinada fue de 17,6%. La edad promedio de las gestantes fue 25 años (14-44), la edad gestacional promedio fue 35,4 semanas. Se suministró profilaxis con penicilina cristalina en 21,4% de las mujeres tamizadas y en 44% de las colonizadas, entre las que el 17% tuvieron el parto por cesárea y recibieron profilaxis con cefazolina. En el 48,9% no se suministró profilaxis. Ninguno de los hijos de las madres incluidas desarrolló SNT. Entre los nacidos en 2010 la prevalencia de esta entidad fue 0,14%. No se encontró asociación estadística (p = 0,062) entre el tamización rectovaginal y la administración de profilaxis antibiótica. Conclusión: La prevalencia de colonización rectovaginal por S. agalactiae hallada apoya la recomendación de adoptar la tamización sistemática de las gestantes para conocer su estado de portador y tomar medidas oportunas que disminuyan la incidencia de SNT.

Streptococcus agalactiae (S. agalactiae) is the main worldwide cause of early onset neonatal sepsis (EONS). Antibiotic prophylaxis based on vaginal-rectum screening of pregnant women is an effective strategy to prevent EONS. Objective: To describe the prevalence of vaginal-rectum S. agalactiae colonization in pregnant women screened at the Clinica del Prado in Medellin during 2010 and to establish a relationship between maternal colonization and EONS. Materials and methods: This was an observational, descriptive and, cross-sectional study to determine the prevalence of vaginal-rectum colonization by S. agalactiae , through a review of medical records and laboratory test results. A total of 182 pregnant women out of 540 screened were randomly included. Results: The prevalence of vaginal-rectum S. agalactiae colonization was 17.6%. The average age of the women was 25 years (14-44 range); the mean gestational age was 35.4 weeks. Prophylaxis with crystalline penicillin was given to 21.4% of the screened women and to 44% of those colonized. A total of 17% had cesarean deliveries and cephazolin prophylaxis was given. A total of 48.9% did not receive prophylaxis. None of the children of mothers included in the treatment developed EONS. The prevalence of EONS among the children born in 2010 was 0.14%. There was no statistical association (P =0,062) between vaginal-rectum screening and antibiotic prophylaxis. Conclusions: The prevalence of vaginal-rectum S. agalactiae colonization found supports a universal screening strategy in pregnant women, to know their carrier status and to take appropriate actions to minimize the incidence of EONS.

Transversus abdominis plane block after ambulatory total laparoscopic hysterectomy: randomized controlled trial.

OBJECTIVE: To determine if transversus abdominis plane anesthetic blockage (TAP block) diminishes early postoperative pain scores and facilitates ambulatory management following total laparoscopic hysterectomy. DESIGN: Randomized triple blind trial. SETTING: Gynecological endoscopy unit at a referral center for laparoscopic surgery. POPULATION: A total of 197 patients. METHODS: Comparison of a treatment group receiving TAP block with bupivacaine 0.25% and placebo group with comparably placed bilateral injection of sterile saline solution. MAIN OUTCOME MEASURES: Pain scores at discharge 24, 48 and 72 h after surgery, opioid requirement after procedure. RESULTS: Patients who had TAP block had a significant reduction in their pain score at discharge compared with the placebo group (p = 0.017). There were no significant differences in the pain scores between groups at 24 h (95% CI 1.36-0.133, p = 0.237), 48 h (95% CI 0.689-0.465, p = 0.702) and 72 h (95% CI -0.631 to 0.223, p = 0.347). No differences were found between the groups regarding opioid requirements following the procedure (χ(2)  = 3.62, p = 0.46). CONCLUSION: Although TAP block after a total laparoscopic hysterectomy reduced the pain score at discharge compared with placebo, its role in this setting is debatable due to the possible lack of clinical significance of the small difference found.

Genetic counseling for hereditary breast and ovarian cancer among Puerto Rican women living in the United States.

BACKGROUND: Little is known about barriers to Hereditary Breast and Ovarian Cancer (HBOC) genetic counseling among Puerto Rican women. OBJECTIVE: This study reviews existing literature to identify individual, interpersonal, and systems level factors that may impact the use of HBOC genetic services among Puerto Rican women living in the United States. METHODS: A systematic search of articles published between the years 1995-2014 was performed in PubMed and ISI Web of Science. Additionally, the bibliography of relevant articles was reviewed for additional potential articles. RESULTS: Individual level barriers most frequently identified included: a lack of knowledge or awareness about HBOC or genetic counseling and testing, and facilitators included high levels of interest in genetic counseling/genetic testing. Interpersonal level barriers included worry about knowing a family member's risk, and conversely, a facilitator was the ability to help family members. Systems level barriers included concerns about the cost, having competing life demands, whereas facilitators included holding private insurance. CONCLUSION: Puerto Rican women are a unique ethnic minority group with specific perceptions, beliefs and levels of education about genetic counseling and testing for HBOC. Addressing individual, interpersonal and systems level factors unique to this group may improve knowledge and awareness. Policy and structural changes may be needed to improve system level barriers.

Short term serum pharmacokinetics of diammine silver fluoride after oral application.

BACKGROUND: There is growing interest in the use of diammine silver fluoride (DSF) as a topical agent to treat dentin hypersensitivity and dental caries as gauged by increasing published research from many parts of the world. While DSF has been available in various formulations for many years, most of its pharmacokinetic aspects within the therapeutic concentration range have never been fully characterized. METHODS: This preliminary study determined the applied doses (3 teeth treated), maximum serum concentrations, and time to maximum serum concentration for fluoride and silver in 6 adults over 4 h. Fluoride was determined using the indirect diffusion method with a fluoride selective electrode, and silver was determined using inductively coupled plasma-mass spectrometry. The mean amount of DSF solution applied to the 3 teeth was 7.57 mg (6.04 µL). RESULTS: Over the 4 hour observation period, the mean maximum serum concentrations were 1.86 µmol/L for fluoride and 206 nmol/L for silver. These maximums were reached 3.0 h and 2.5 h for fluoride and silver, respectively. CONCLUSIONS: Fluoride exposure was below the U.S. Environmental Protection Agency (EPA) oral reference dose. Silver exposure exceeded the EPA oral reference dose for cumulative daily exposure over a lifetime, but for occasional use was well below concentrations associated with toxicity. This preliminary study suggests that serum concentrations of fluoride and silver after topical application of DSF should pose little toxicity risk when used in adults. CLINICAL TRIALS REGISTRATION: NCT01664871.

Clasificación de los hogares según su perfil de salud, para la focalización de recursos destinados a prevención, promoción y recuperación, Medellín, 2004 / Classification of homes according to health profile for the purpose of prevention, promotion and recovery resource focus, Medellin, 2004

Objetivo: obtener un constructo de salud para clasificar hogares de la ciudad de Medellín según sus condiciones de vida y salud. Materiales y métodos: para la creación del constructo de salud, se partió de los datos obtenidos en la Encuesta de Calidad de Vida, Medellín, 2004, de donde se seleccionaron las variables referentes a condiciones de vida y determinantes de la salud. Se realizó un análisis de componentes principales para escoger aquellos que explicaban la mayor variabilidad de los hogares; posteriormente se hizo el análisis de conglomerados en dos pasos para agrupar los hogares según sus condiciones de vida y salud. Resultados: las correlaciones observadas estaban en la dirección prevista. Doce componentes principales explican el 69% de la variabilidad de los datos, aportando una mayor proporción de variabilidad las variables de las condiciones de vida. En Medellín se identificaron cinco tipologías de hogares que comparten las mismas condiciones de vida y salud. Conclusión: las técnicas multivariantes permiten concluir que la clasificación de los hogares de Medellín en cinco tipologías con respecto a los determinantes de la salud ofrece oportunidades para la formulación de programas de intervención a escala poblacional.

Objective: to obtain a health profile to classify homes of Medellín city, according to similarities due to life and health conditions. Materials and methods: for the creation of a health profile, information was taken from the data collected in the Quality of Life Survey, Medellín, 2004, where variables referring to life conditions and health determinants were selected. An analysis of mean components was made to choose those that explained the greater variability among homes, then a cluster analysis in 2 steps was performed to group the homes according to their life and health conditions. Results: the observed correlations appeared in the expected directions. A total of 12 components explain 69% of the variability of the data, contributing to a greater proportion of variability the variables of life conditions. In Medellín, 5 types of homes were identified sharing the same conditions of life and health. Conclusion: multivariant techniques allow to conclude that Medellín’s home classification into 5 types regarding their determinants of health provides opportunities to make formulation of intervention programs at the population level possible.