RESUMEN

BACKGROUND: Preeclampsia is implicated in 14% of maternal deaths worldwide, mostly due to complications such as intracranial hemorrhage and cerebral edema. Cerebral edema increases intracranial pressure, which can be predicted by ultrasonographic measurement of the optic nerve sheath diameter (ONSD). Greater diameters have been reported in women with preeclampsia and eclampsia; however, data are lacking on the possible association with maternal and neonatal adverse outcomes. This study aimed to determine whether there is an association between hypertensive disorders of pregnancy and the ONSD, and between this measurement and maternal and neonatal adverse outcomes. METHODS: This was a cohort study involving 183 women in the third trimester of pregnancy or within 24 h following childbirth, distributed as follows: control group (n = 30), gestational hypertension (n = 14), chronic hypertension (n = 12), preeclampsia without severe features (n = 12), preeclampsia with severe features (n = 62), superimposed preeclampsia (n = 23) and eclampsia (n = 30). The participants underwent ocular ultrasonography, and data on maternal and neonatal outcomes were collected from the medical records. To compare the groups, analysis of variance was used for the normally distributed numerical variables and the Kruskal-Wallis test was used for variables with non-normal distribution. Two-tailed p-values ≤ 0.05 were considered statistically significant. RESULTS: Overall comparison between the seven groups showed no statistically significant difference in the mean ONSD (p = 0.056). Nevertheless, diameters were significantly greater in the eclampsia group compared to the control group (p = 0.003). Greater diameters were associated with maternal admission to the intensive care unit (ICU) (p < 0.01) and maternal near miss (p = 0.01). There was no association between ONSD and admission to the neonatal ICU (p = 0.1), neonatal near miss (p = 0.34) or neonatal death (p = 0.26). CONCLUSIONS: No association was found between ONSD and the hypertensive disorders of pregnancy in the overall analysis; however, ONSD was greater in women with eclampsia compared to controls. Greater diameters were associated with maternal admission to the ICU and maternal near miss. These findings suggest a potential use for bedside ultrasound as an additional tool for stratifying risk in patients with hypertensive disorders of pregnancy.

Asunto(s)

Hipertensión Inducida en el Embarazo , Nervio Óptico , Preeclampsia , Resultado del Embarazo , Humanos , Femenino , Embarazo , Adulto , Nervio Óptico/diagnóstico por imagen , Recién Nacido , Resultado del Embarazo/epidemiología , Estudios de Cohortes , Preeclampsia/epidemiología , Tercer Trimestre del Embarazo , Ultrasonografía , Eclampsia , Estudios de Casos y Controles , Adulto Joven

RESUMEN

Objective: To evaluate early complications in prepectoral breast reconstruction. Methods: A retrospective cohort study including 180 consecutive cases of nipple-sparing mastectomy, comparing immediate breast reconstruction with subpectoral to prepectoral mammary implants in 2012-2022. Clinical and demographic characteristics and complications in the first three months following surgery were compared between the two techniques. Results: The prepectoral technique was used in 22 cases (12.2%) and the subpectoral in 158 (87.8%). Median age was higher in the prepectoral group (47 versus 43.8 years; p=0.038), as was body mass index (25.1 versus 23.8; p=0.002) and implant volume (447.5 versus 409 cc; p=0.001). The prepectoral technique was more associated with an inframammary fold (IMF) incision (19 cases, 86.4% versus 85, 53.8%) than with periareolar incisions (3 cases, 13.6% versus 73, 46.2%); (p=0.004). All cases in the prepectoral group underwent direct-to-implant reconstruction compared to 54 cases (34.2%) in the subpectoral group. Thirty-eight complications were recorded: 36 (22.8%) in the subpectoral group and 2 (9.1%) in the prepectoral group (p=0.24). Necrosis of the nipple-areola complex/skin flap occurred in 27 patients (17.1%) in the subpectoral group (prepectoral group: no cases; p=0.04). The groups were comparable regarding dehiscence, seroma, infection, and hematoma. Reconstruction failed in one case per group (p=0.230). In the multivariate analysis, IMF incision was associated with the prepectoral group (aOR: 34.72; 95%CI: 2.84-424.63). Conclusion: The incidence of early complications was comparable between the two techniques and compatible with previous reports. The clinical and demographic characteristics differed between the techniques. Randomized clinical trials are required.

Asunto(s)

Neoplasias de la Mama , Mamoplastia , Pezones , Complicaciones Posoperatorias , Humanos , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Adulto , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Pezones/cirugía , Mamoplastia/métodos , Neoplasias de la Mama/cirugía , Estudios de Cohortes , Músculos Pectorales , Mastectomía Subcutánea/métodos , Factores de Tiempo , Implantes de Mama

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Objective: To evaluate whether there were differences in the presentation of patients with tubal ectopic pregnancy (EP) during the first year of the COVID-19 pandemic. Methods: We performed a retrospective cohort study of all cases of tubal EP between March 2019 and March 2020 (pre-pandemic) and between March 2020 and March 2021 (pandemic). We compared between these two groups the risk factors, clinical characteristics, laboratory data, sonographic aspects, treatment applied and complications. Results: We had 150 EP diagnoses during the two years studied, of which 135 were tubal EP. Of these, 65 were included in the pre-pandemic and 70 in the pandemic period. The prevalence of lower abdominal pain was significantly higher in the pandemic compared to the pre-pandemic period (91.4% vs. 78.1%, p=0.031). There was no significant difference in shock index, initial beta-hCG level, hemoglobin level at diagnosis, days of menstrual delay, aspect of the adnexal mass, amount of free fluid on ultrasound, and intact or ruptured presentation between the groups. Expectant management was significantly higher during the pandemic period (40.0% vs. 18.5%, p=0.008), surgical management was lower during the pandemic period (47.1% vs. 67.7%, p=0.023), and number of days hospitalized was lower in the pandemic period (1.3 vs. 2.0 days, p=0.003). Conclusion: We did not observe a significant difference in patient history, laboratory and ultrasound characteristics. Abdominal pain was more common during the pandemic period. Regarding treatment, we observed a significant increase in expectant and a decrease in surgical cases during the pandemic period.

Asunto(s)

COVID-19 , Embarazo Tubario , Humanos , Femenino , Embarazo , Estudios Retrospectivos , COVID-19/epidemiología , Adulto , Embarazo Tubario/cirugía , Embarazo Tubario/epidemiología , Embarazo Tubario/diagnóstico , Embarazo Tubario/terapia , SARS-CoV-2 , Factores de Riesgo , Pandemias , Dolor Abdominal/etiología , Brasil/epidemiología , Adulto Joven , Estudios de Cohortes

RESUMEN

PURPOSE: Gallbladder cancer (GBC) is a biliary tract malignancy characterized by its high lethality. Although the incidence of GBC is low in most countries, specific areas such as Chile display a high incidence. Our collaborative study sought to compare clinical and molecular features of GBC cohorts from Chile and the United States with a focus on ERBB2 alterations. METHODS: Patients were accrued at Memorial Sloan Kettering Cancer Center (MSK) or the Pontificia Universidad Católica de Chile (PUC). Clinical information was retrieved from medical records. Genomic analysis was performed by the next-generation sequencing platform MSK-Integrated Mutation Profiling of Actionable Cancer Targets. RESULTS: A total of 260 patients with GBC were included, 237 from MSK and 23 from PUC. There were no significant differences in the clinical characteristics between the patients identified at MSK and at PUC except in terms of lithiasis prevalence which was significantly higher in the PUC cohort (85% v 44%; P = .0003). The prevalence of ERBB2 alterations was comparable between the two cohorts (15% v 9%; P = .42). Overall, ERBB2 alterations were present in 14% of patients (8% with ERBB2 amplification, 4% ERBB2 mutation, 1.5% concurrent amplification and mutation, and 0.4% ERBB2 fusion). Notably, patients with GBC that harbored ERBB2 alterations had better overall survival (OS) versus their ERBB2-wild type counterparts (22.3 months v 11.8 months; P = .024). CONCLUSION: The prevalence of lithiasis seems to be higher in Chilean versus US patients with GBC. A similar prevalence of ERBB2 alterations of overall 14% and better OS suggests that a proportion of them could benefit from human epidermal growth factor receptor type 2-targeted therapies. The smaller cohort of Chile, where the disease prevalence is higher, is a reminder and invitation for the need of more robust next-generation sequencing analyses globally.

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Neoplasias de la Vesícula Biliar , Receptor ErbB-2 , Humanos , Neoplasias de la Vesícula Biliar/genética , Neoplasias de la Vesícula Biliar/epidemiología , Neoplasias de la Vesícula Biliar/patología , Neoplasias de la Vesícula Biliar/mortalidad , Chile/epidemiología , Receptor ErbB-2/genética , Femenino , Masculino , Persona de Mediana Edad , Anciano , Estados Unidos/epidemiología , Mutación , Estudios de Cohortes , Adulto , Genómica , Anciano de 80 o más Años , Secuenciación de Nucleótidos de Alto Rendimiento

RESUMEN

The results of in vitro and in vivo studies have shown the pro-tumor effects of TNF-α, and this cytokine's increased expression is associated with poor prognosis in patients with some types of cancer. Our study objective was to evaluate the possible association of TNF-α genetic polymorphisms and serum levels with susceptibility and prognosis in a cohort of Mexican patients with NB. We performed PCR-RFLP and ELISA methods to analyze the genetics of these SNPs and determine serum concentrations, respectively. The distribution of the -308 G>A and -238 G>A polymorphisms TNFα genotypes was considerably different between patients with NB and the control group. The SNP rs1800629 GG/GA genotypes were associated with a decreased risk of NB (OR = 0.1, 95% CI = 0.03-0.393, p = 0.001) compared with the AA genotype, which was associated with susceptibility to NB (OR = 2.89, 95% CI = 1.45-5.76, p = 0.003) and related to unfavorable histology and high-risk NB. The rs361525 polymorphism GG genotype was associated with a lower risk of developing NB compared with the GA and AA genotypes (OR = 0.2, 95% CI = 0.068-0.63, p = 0.006). Circulating TNF-α serum concentrations were significantly different (p < 0.001) between patients with NB and healthy controls; however, we found no relationship between the analyzed TNF-α serum levels and SNP genotypes. We found associations between the rs1800629AA genotype and lower event-free survival (p = 0.026); SNP rs361525 and TNF-α levels were not associated with survival in patients with NB. Our results suggest the TNF-α SNP rs1800629 as a probable factor of NB susceptibility. The -308 G/A polymorphism AA genotype has a probable role in promoting NB development and poor prognosis associated with unfavorable histology, high-risk tumors, and lower EFS in Mexican patients with NB. It should be noted that it is important to conduct research on a larger scale, through inter-institutional studies, to further evaluate the contribution of TNF-α genetic polymorphisms to the risk and prognosis of NB.

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Predisposición Genética a la Enfermedad , Neuroblastoma , Polimorfismo de Nucleótido Simple , Factor de Necrosis Tumoral alfa , Humanos , Factor de Necrosis Tumoral alfa/genética , Factor de Necrosis Tumoral alfa/sangre , Neuroblastoma/genética , Neuroblastoma/sangre , Neuroblastoma/mortalidad , Neuroblastoma/patología , Masculino , Femenino , México , Preescolar , Lactante , Niño , Pronóstico , Genotipo , Estudios de Cohortes , Estudios de Casos y Controles

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BACKGROUND: Continued breastfeeding reduces infant mortality and provides nutritional, immunological, and developmental benefits for the child. OBJECTIVES: A prospective cohort study conducted in 2015 followed 608 children who were breastfed between 6 and 24 months. The study assessed the risk of breastfeeding interruption at 12, 18, and 24 months, as well as the factors associated with this outcome, in a cohort of newborns in Rio Branco, using the life table method. METHODS: The factors associated with breastfeeding cessation and their 95% confidence intervals (CI95%) were analyzed using both crude and adjusted Cox proportional hazards regression in a hierarchical model. The risks of breastfeeding cessation at 12, 18, and 24 months were 19%, 65%, and 71%, respectively. RESULTS: Factors positively associated with the risk of breastfeeding cessation include the use of a pacifier before 6 weeks of age (HR = 1.62; CI: 95% 1.24-2.11) and the use of a bottle during the first year of life (HR = 1.41; CI: 95% 1.11-1.78). Maternal return to work after the birth of the baby (HR = 0.78; CI: 95% 0.62-0.97) was found to be negatively associated with the risk of breastfeeding interruption. CONCLUSIONS: Early pacifier use before 6 weeks and the introduction of a bottle in the first year affect continued breastfeeding. Maternal employment was associated with reduced risk of breastfeeding cessation, contrary to most studies.

Asunto(s)

Lactancia Materna , Chupetes , Humanos , Lactancia Materna/estadística & datos numéricos , Brasil/epidemiología , Femenino , Lactante , Estudios Prospectivos , Chupetes/estadística & datos numéricos , Masculino , Recién Nacido , Adulto , Factores de Riesgo , Cohorte de Nacimiento , Alimentación con Biberón/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Preescolar , Adulto Joven , Estudios de Cohortes

RESUMEN

BACKGROUND: Hand osteoarthritis (HOA) is a highly prevalent disease that may be impacted by social inequalities. Few studies in HOA are from underdeveloped regions. We intend to contribute to fill this gap presenting clinical characteristics of our low-income HOA cohort (LIHOA). METHODS: Data from 119 patients with a HOA diagnosis fulfilling ACR criteria seen between August 2019 and May 2023 in Fortaleza/Brazil. Evaluations included pain (VAS, visual analogue scale), X-ray (KL, Kellgren-Lawrence), grip and pinch strength (KgF), Cochin hand functional scale (CHFS), FIHOA, and SF-12 scores. Social data included monthly (<1, 1≥/<3, ≥3 MW) minimum wage earnings, occupation, and literacy [4 IF nodes. OA in other joints: 37 (36.2%) spine, 28 (29.4%) knee, 21 (20.5%) bunions. Functional impairment was mild [8 (5-14) median FIHOA]. Median serum CRP was 0.2 mg/dL (0.1-0.4) with 14 (20%) patients above reference value. Mean total KL score was 27.6 ± 13.6 with 21 (23%), 38 (41.7%), and 33 (36.2%) KL2, KL3, and KL4, respectively; 51 (54.8%) and 42 (45.2%) patients declared 9SY including 37.2% with a university degree. Individuals earning <3 MW had lower pinch (p < 0.004) and grip strength (p < 0.01), and higher FIHOA scores (p < 0.007), as compared to ≥3 MW earning group. Literacy or occupation did not impact outcome. SYSADOA were used by 13 (12.7%), 6 used oral and 3 topical anti-inflammatory drugs and 2 used 5 mg/d prednisone. CONCLUSION: Clinical characteristics in our LIHOA cohort mirror those reported in affluent regions. Socioeconomic disparities influenced functional outcome in LIHOA cohort.

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Fuerza de la Mano , Osteoartritis , Pobreza , Humanos , Femenino , Masculino , Osteoartritis/fisiopatología , Persona de Mediana Edad , Anciano , Brasil , Articulaciones de la Mano/fisiopatología , Obesidad/complicaciones , Dislipidemias , Síndrome Metabólico , Estudios de Cohortes , Fuerza de Pellizco/fisiología , Dimensión del Dolor , Comorbilidad , Escala Visual Analógica , Alfabetización

RESUMEN

BACKGROUND: Queiroz et al. showed that the application of cluster methodology for classifying gastric cancer is suitable and efficient within a Brazilian cohort, which is known for its population heterogeneity. The study highlighted the potential utilization of this method within public health services due to its low-cost, presenting a viable means to improve the diagnosis and prognosis of gastric cancer. BACKGROUND: Our Brazilian cohort with gastric cancer has a distinct distribution between mutated and normal p53. BACKGROUND: New genetic marker-based classifications improve gastric cancer diagnosis accuracy. BACKGROUND: Machine learning integration enhances predictive value in gastric cancer diagnosis. BACKGROUND: Molecular biomarkers complement clinical decisions, advancing personalized medicine. OBJECTIVE: Gastric adenocarcinoma remains an aggressive disease with a poor prognosis, as evidenced by a 5-year survival rate of approximately 31%. The histological classifications already proposed do not accurately reflect the high biological heterogeneity of this neoplasm, particularly in diverse populations, and new classification systems using genetic markers have recently been proposed. Following these newly proposed models, we aimed to assess the cluster distribution in a Brazilian cohort. Furthermore, we evaluated whether the inclusion of other clinical and histological parameters could enhance the predictive value. METHODS: We used a previously described four-immunohistochemistry/EBER-ISH marker to classify a cohort of 30 Brazilian patients with gastric adenocarcinoma into five different clusters and compared the distribution with other genetically diverse populations. Furthermore, we used artificial intelligence methods to evaluate whether other clinical and pathological parameters could improve the results of the methodology. RESULTS: Disclosing the genetic variability between populations, we observed a more balanced distribution of the aberrant/normal p53 ratio (0.6) between patients negative for the other markers tested, unlike previous studies with Asian and North American populations. In addition, decision tree analysis reinforced the efficiency of these new classifications, as the stratification accuracy was not altered with or without additional data. CONCLUSION: Our study underscores the importance of local research in characterizing diverse populations and highlights the complementary role of molecular biomarkers in personalized medicine for gastric adenocarcinoma, enhancing diagnostic accuracy and potentially improving survival rates.

Asunto(s)

Adenocarcinoma , Biomarcadores de Tumor , Neoplasias Gástricas , Proteína p53 Supresora de Tumor , Neoplasias Gástricas/genética , Neoplasias Gástricas/clasificación , Neoplasias Gástricas/patología , Humanos , Brasil , Proteína p53 Supresora de Tumor/genética , Proteína p53 Supresora de Tumor/análisis , Masculino , Femenino , Adenocarcinoma/genética , Adenocarcinoma/clasificación , Adenocarcinoma/patología , Persona de Mediana Edad , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/análisis , Estudios de Cohortes , Anciano , Análisis por Conglomerados , Mutación , Inmunohistoquímica , Adulto , Pronóstico , Anciano de 80 o más Años

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BACKGROUND: Jomar et al. demonstrated that death due to COVID-19 did not affect the time under exclusive palliative care among patients with advanced cancer, even during the first year of the pandemic caused by a hitherto little-known disease. BACKGROUND: ◼ Fatality due to COVID-19 does not alter the time under oncological palliative care. BACKGROUND: ◼ The retrospective design of this pioneering study allows causal inference. BACKGROUND: ◼ Access to oncological palliative care frequently approaches terminality of life. OBJECTIVE: This study aimed at investigating the extent to which COVID-19-induced fatalities affect the duration of palliative care among patients with advanced cancer. METHODS: A retrospective cohort study was conducted at the Palliative Care Unit of the Brazilian Instituto Nacional de Câncer in Rio de Janeiro, Brazil, on 1,104 advanced cancer patients who died under exclusive palliative care between March 11, 2020, and March 31, 2021. Wilcoxon rank-sum (Mann-Whitney U) and log-rank tests were performed to examine statistical differences between the medians of time, and the Kaplan-Meier estimator was used to graphically illustrate survival over time under exclusive palliative care contingent upon the underlying causes of death of the two experimental groups (cancer versus COVID-19). RESULTS: A total of 133 (12.05%) patients succumbed to COVID-19. In both groups, the median time under exclusive palliative care was less than one month. The exclusive palliative care survival curves did not exhibit any statistically significant difference between the groups. CONCLUSION: Death due to COVID-19 did not modify the duration of exclusive palliative care among patients with advanced cancer.

Asunto(s)

COVID-19 , Neoplasias , Cuidados Paliativos , Humanos , COVID-19/mortalidad , COVID-19/terapia , Cuidados Paliativos/estadística & datos numéricos , Neoplasias/mortalidad , Neoplasias/terapia , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Brasil/epidemiología , Anciano , Factores de Tiempo , SARS-CoV-2 , Pandemias , Anciano de 80 o más Años , Adulto , Estudios de Cohortes

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This study aimed to evaluate the association between the questionnaires SARC-F and SARC-CalF with risk of mortality in patients undergoing hemodialysis (HD). A cohort study, with patients on HD age ≥ 18 years, both sex, between June 2019 and April 2023. Body composition (anthropometry and bioelectrical impedance), muscle functional (handgrip strength and gait speed), screening of sarcopenia using the SARC-F and SARC-CalF, nutritional status and laboratory data were assessed. Follow-up for mortality up to 47 months. The sample consisted of 243 participants and the prevalence of risk of sarcopenia using SARC-F and SARC-CalF were 30% and 45%, respectively; 65 died for all reasons and three patients were censored due to transplantation. Multivariate analysis identified SARC-CalF as predictor of mortality in HD patients [hazard ratio 1.96; 95% CI (1.01-3.79); p = 0.04]. The survival analysis showed that there was a significant difference in the survival curves among the groups stratified by SARC-F and SARC-CalF for log-rank test. A higher specificity was found for SARC-CalF than SARC-F (80% vs. 77%) in receiver operating characteristic (ROC) curve. Both questionnaires were associated with anthropometric, parameters of body composition, physical measurements, and SARC-CalF was predictor of risk for mortality in HD patients.

Asunto(s)

Diálisis Renal , Sarcopenia , Humanos , Diálisis Renal/mortalidad , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios de Cohortes , Sarcopenia/mortalidad , Composición Corporal , Encuestas y Cuestionarios , Curva ROC , Factores de Riesgo , Fuerza de la Mano , Adulto

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BACKGROUND: Understanding the timing of food introduction in infants is essential for promoting optimal complementary feeding practices. However, existing studies often rely on cross-sectional data, limiting the ability to capture age-specific patterns. We aimed to describe food introduction during the first year of life by identifying patterns related to age at food introduction and associated factors in a cohort of Brazilian infants. METHODS: Data were collected through standardized questionnaires administered to mothers via face-to-face interviews during the infant's first month of life and at 3, 6, 9, and 12 months of age. Additionally, two telephone interviews were conducted at 2 and 4 months of age. Information regarding food intake was assessed using a list of 48 foods, with two key aspects recorded: whether the food was introduced (yes/no) and the age at introduction. To define food introduction patterns, we employed k-means cluster analysis. Hierarchical Poisson multiple regression was employed to examine the associations between sociodemographic, biological, and healthcare factors and patterns of food introduction. RESULTS: Three distinct patterns were identified and named according to their main characteristics: Pattern 1 - "Low Infant Formula and Timely CF Introduction"; Pattern 2 - "High Infant Formula and Early CF Introduction"; and Pattern 3 - "High Infant Formula and Later Ultra-processed Food Introduction". Breastfeeding at six months showed a positive association with Pattern 1 (PR = 1.40; 95% CI = 1.10-1.80), while bottle use at four months was negatively associated with Pattern 1 (PR = 0.68; 95% CI = 0.53-0.87). No variables studied exhibited an association with Pattern 2. For Pattern 3, higher prevalences were observed among children whose mothers were aged < 20 years (PR = 1.54; 95% CI = 1.13-2.01) or > 34 years (PR = 1.42; 95% CI = 1.04-1.93). Not receiving guidance on the recommended duration of breastfeeding and complementary feeding during prenatal care was associated with a higher prevalence of children in this pattern (PR = 1.35; 95% CI = 1.01-1.80). CONCLUSIONS: We identified three distinct patterns of age at food introduction in the study population, although none perfectly aligned with Brazilian or WHO dietary recommendations. These findings underscore the need for targeted interventions to promote timely and healthy complementary feeding practices in Brazilian infants.

Asunto(s)

Lactancia Materna , Fenómenos Fisiológicos Nutricionales del Lactante , Humanos , Lactante , Brasil , Femenino , Lactancia Materna/estadística & datos numéricos , Masculino , Fórmulas Infantiles , Alimentos Infantiles/estadística & datos numéricos , Conducta Alimentaria , Adulto , Recién Nacido , Factores de Edad , Estudios de Cohortes

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Bloodstream infection is one of the most important and increasing complications in patients with severe burns. Most of the species affecting this population are Gram-negative bacilli that exhibit antimicrobial resistance. We conducted this study to determine the antimicrobial susceptibility profile and resistance mechanisms of these bacterial infections and their clinical associations on morbidity and mortality. We analyzed a retrospective cohort of burn patients. All patients included in this study had monobacterial blood stream infections during their hospital stay. We performed phenotypic and genotypic tests to determine the antimicrobial resistance mechanism and profile of each strain. Univariate and multivariate logistic regression analysis was performed between variables. We found 109 patients with monobacterial bacteremia. Pseudomonas spp. (50.7%), A. baumannii (46.4%), and Klebsiella spp. (13.8%) were the most common causative microorganisms. The Pseudomonas spp. isolates showed resistance to imipenem (81.5%), mainly by class A and class B carbapenemases. The A. baumannii isolates conferred resistance to imipenem (56.2%), mainly by class D carbapenemases. One quarter of Klebsiella spp. showed resistance to 3rd generation cephalosporins. We also observed that a total body surface area greater than 40% and three or more different types of invasive procedures might be related to increased mortality. Multidrug resistance is highly present. The extent of the burned area and a high number of different types of invasive procedures had an impact in decreasing survivorship in burn patients with bacteremia.

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Antibacterianos , Bacteriemia , Quemaduras , Humanos , Quemaduras/microbiología , Quemaduras/complicaciones , Masculino , Femenino , Bacteriemia/microbiología , Bacteriemia/tratamiento farmacológico , Persona de Mediana Edad , Adulto , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Estudios Retrospectivos , Pruebas de Sensibilidad Microbiana , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Anciano , Farmacorresistencia Bacteriana Múltiple , Estudios de Cohortes

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OBJECTIVES: This study aims to evaluate the gender inequalities in accelerometer-based physical activity (PA) across different age groups using data from 5 Pelotas (Brazil) cohorts. METHODS: The data come from 4 birth cohort studies, covering all live births in the urban area of Pelotas for each respective year (1982, 1993, 2004, and 2015), and the Como vai? cohort study focusing on 60 years and above. Raw accelerometry data were collected on the nondominant wrist using GENEActive/ActiGraph devices and processed with the GGIR package. Overall PA was calculated at ages 1, 2, 4, 6, 11, 15, 18, 23, 30, and 60+ years, while moderate to vigorous PA was calculated from 6 years onward. Absolute (difference) and relative (ratio) gender inequalities were calculated and intersectionality between gender and wealth was also evaluated. RESULTS: The sample sizes per cohort ranged from 965 to 3462 participants. The mean absolute gender gap was 19.3 minutes (95% confidence interval, 12.7-25.9), with the widest gap at 18 years (32.9 min; 95% confidence interval, 30.1-35.7) for moderate to vigorous PA. The highest relative inequality was found in older adults (ratio 2.0; 95% confidence interval, 1.92-2.08). Our intersectionality results showed that the poorest men being the most active group, accumulating around 60 minutes more moderate to vigorous PA per day compared with the wealthiest women at age 18. CONCLUSIONS: Men were more physically active than women in all ages evaluated. PA gender inequalities start at an early age and intensify in transition periods of life. Relative inequalities were marked among older adults.

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Acelerometría , Ejercicio Físico , Humanos , Brasil , Femenino , Masculino , Persona de Mediana Edad , Adulto , Adolescente , Niño , Factores Sexuales , Preescolar , Adulto Joven , Factores de Edad , Estudios de Cohortes , Lactante , Anciano , Factores Socioeconómicos

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Introducción. La hipotermia terapéutica (HT) reduce el riesgo de muerte o discapacidad en niños con encefalopatía hipóxico-isquémica (EHI) moderada-grave. Objetivo. Describir una población de pacientes con EHI que requirió HT y su evolución hasta el alta hospitalaria. Población y métodos. Estudio descriptivo de cohorte retrospectivo. Se analizaron todos los pacientes que ingresaron a HT entre 2013 y 2022. Se evaluaron datos epidemiológicos, clínicos, de monitoreo, tratamiento, estudios complementarios y condición al alta. Se compararon los factores de riesgo entre pacientes fallecidos y sobrevivientes, y de estos, los que requirieron necesidades especiales al alta (NEAS). Resultados. Se incluyeron 247 pacientes. Mortalidad: 11 %. Evento centinela más frecuente: período expulsivo prolongado (39 %). Inicio del tratamiento: mediana 5 horas de vida. Convulsiones: 57 %. Eritropoyetina intravenosa: 66,7 %. Patrón anormal de monitoreo de función cerebral: 52 %. Normalización del monitoreo: mediana 24 horas. Resonancia magnética patológica: 42 %. Variables predictoras de mortalidad: Sarnat y Sarnat grave, y ecografía patológica al ingreso. Conclusión. La mortalidad global fue del 11 %. Las derivaciones aumentaron en forma más evidente a partir del año 2018. El horario de inicio de HT fue más tardío que en reportes anteriores. Los signos neurológicos de gravedad según la escala de Sarnat y Sarnat y la ecografía cerebral basal patológica fueron predictores independientes de mortalidad al alta. Los pacientes con NEAS presentaron normalización del trazado del electroencefalograma de amplitud integrada más tardío. El hallazgo más frecuente en la resonancia fue la afectación de los ganglios basales. No se encontraron diferencias clínicas ni de complicaciones estadísticamente significativas entre los pacientes que recibieron eritropoyetina.

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Introduction. Therapeutic hypothermia (TH) reduces the risk of death or disability in children with moderate to severe hypoxic ischemic encephalopathy (HIE). Objective. To describe a population of patients with HIE that required TH and their course until discharge. Population and methods. Retrospective, descriptive, cohort study. All patients admitted to TH between 2013 and 2022 were studied. Epidemiological, clinical, monitoring, and treatment data were assessed, together with supplementary tests and condition at discharge. Risk factors were compared between deceased patients and survivors; and, among the latter, those requiring special healthcare needs (SHCN) at discharge. Results. A total of 247 patients were included. Mortality: 11%. Most common sentinel event: prolonged second stage of labor (39%). Treatment initiation: median of 5 hours of life. Seizures: 57%. Intravenous erythropoietin: 66.7%. Abnormal pattern in brain function monitoring: 52%. Normalization of monitoring: median of 24 hours. Pathological magnetic resonance imaging: 42%. Predictor variables of mortality: severe Sarnat and Sarnat staging and pathological ultrasound upon admission. Conclusion. The overall mortality rate was 11%. Referrals increased more markedly since 2018. The time of TH initiation was later than in previous reports. Severe neurological signs as per the Sarnat and Sarnat staging and a pathological baseline cranial ultrasound were independent predictors of mortality at discharge. Patients with SHCN at discharge showed a normalized tracing in the amplitude-integrated electroencephalography performed later. The most common finding in the magnetic resonance imaging was basal ganglia involvement. No statistically significant differences were observed in terms of clinical characteristics or complications among patients who received erythropoietin.

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Humanos , Masculino , Femenino , Recién Nacido , Hipoxia-Isquemia Encefálica/mortalidad , Hipoxia-Isquemia Encefálica/terapia , Hipotermia Inducida/métodos , Factores de Tiempo , Estudios Retrospectivos , Factores de Riesgo , Estudios de Cohortes , Centros de Atención Terciaria , Hospitales Públicos

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OBJECTIVE: to analyze the occurrence of difficulty in the peripheral insertion of the central catheter and the presence of complications in the use of this device in hospitalized adults who received peripheral intravenous therapy through a short peripheral intravenous catheter and to identify whether there is an association between peripheral intravenous therapy and the presence of complications in the use of the peripherally inserted central catheter. METHOD: retrospective cohort, with patients aged 18 years or over, in a tertiary teaching hospital, with a peripherally inserted central catheter, who had at least one previous short peripheral intravenous catheter. Data were analyzed using descriptive statistics and Poisson regression. RESULTS: the sample consisted of 76 patients. There was an association between difficulty in the insertion procedure and number of punctures (p<0.01) and insertion in the external jugular vein compared to the upper limbs (p<0.01). The insertion site was also associated with the removal of the peripherally inserted central catheter due to complications in the robust analysis of variance (p=0.02). No associations were identified between: difficulty inserting the device and time on peripheral intravenous therapy (crude model p=0.23; adjusted model p=0.21); difficulty in insertion with administration of irritating and vesicant medication (crude model p=0.69; adjusted model p=0.53); complication in the use of peripherally inserted central catheter and time of peripheral intravenous therapy (crude and adjusted models p=0.08); and secondary migration of the catheter tip with the device insertion site (p=0.24). CONCLUSION: it was possible to identify secondary migration as one of the main complications, resulting in premature removal of the device. Furthermore, the greater the number of puncture attempts to insert the PICC, the greater the difficulty in inserting it. Insertion into the external jugular vein was recurrent, with a higher risk of removal due to complications in relation to the upper limbs.

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Cateterismo Periférico , Humanos , Estudios Retrospectivos , Masculino , Femenino , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/instrumentación , Persona de Mediana Edad , Estudios de Cohortes , Adulto , Anciano , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Administración Intravenosa/efectos adversos

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Background/Objectives: Sterilization in dental practice is crucial for infection prevention. The aim of this study was to identify the presence and causes of bacterial growth using biological indicators in dental sterilization equipment in San Luis Potosí, S.L.P., Mexico, with different consecutive measurements over a year. Methods: This longitudinal cohort, conducted from January 2022 to January 2024 in San Luis Potosí, Mexico, aimed to identify the presence and causes of bacterial growth in dental sterilization equipment using biological indicators. A total of 207 dental offices were approached, and 175 participated, providing data through questionnaires and monitoring sterilization cycles with BIs. The checks were bimonthly for one year, with a total of six checks. Results: (a) An 11% (n = 1188) incidence of bacterial growth was observed, with a higher percentage in dry heat equipment (13%). (b) Upon analyzing the six consecutive verifications over a year, no statistically significant differences were observed in the failures of the sterilization cycles when comparing the two pieces of equipment. (c) Error in temperature and time of the equipment (OR = 4.0, 95% CI = 1.6-3.9, p = 0.0001) was significantly associated with the presence of bacterial growth during the one-year period. Conclusions: Monitoring sterilization cycles and identifying the causes of bacterial growth with different consecutive verifications decreased the presence of bacterial growth (failures) during the one-year period.

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Consultorios Odontológicos , Esterilización , México/epidemiología , Estudios Longitudinales , Esterilización/métodos , Esterilización/normas , Humanos , Estudios de Cohortes , Falla de Equipo/estadística & datos numéricos , Contaminación de Equipos/estadística & datos numéricos , Encuestas y Cuestionarios

RESUMEN

In order to document the prevalence, clinical features, hematology and outcome of the aplastic crisis in homozygous sickle cell disease (HbSS), a cohort study has been conducted from birth. Newborn screening of 100 000 deliveries at the main government maternity hospital, Kingston, Jamaica between 1973 and 1981 detected 311 cases of HbSS who have been followed at the Medical Research Council Laboratories at the University of the West Indies, Kingston, Jamaica. Clinically defined aplastic crises occurred in 118 (38%) patients at a median age of 7.5 years (range 0.5-23.0 years). All but one event seroconverted to parvovirus B19, the exception being a 9.3 year male with classic aplasia but subsequent IgG did not exceed 3 IU. Defined by zero reticulocyte counts, 94 patients presented with a median hemoglobin of 3.7 g/dL (range 18-87 g/L) representing a median fall from steady state levels of 3.8 g/dL. Clear epidemic peaks occurred at 1979-1980, 1984-1986, and 1990-1993 and the admission rate and use of blood cultures fell with each epidemic, reflecting increased familiarity with the complication. Symptoms were usually nonspecific and all but 7 were transfused. No patient had a recurrence and two died from aplasia (one with remote rural residence and the other following an incorrect diagnosis). Of those seroconverting to parvovirus B19, 68% manifested aplasia and 24% had no hematologic change. Correctly diagnosed and managed, the aplastic crisis is essentially benign. (230 words).

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Anemia Aplásica , Anemia de Células Falciformes , Humanos , Jamaica/epidemiología , Masculino , Anemia de Células Falciformes/epidemiología , Anemia de Células Falciformes/diagnóstico , Anemia de Células Falciformes/terapia , Anemia de Células Falciformes/complicaciones , Adolescente , Niño , Femenino , Preescolar , Anemia Aplásica/epidemiología , Anemia Aplásica/diagnóstico , Anemia Aplásica/terapia , Anemia Aplásica/etiología , Lactante , Recién Nacido , Estudios de Cohortes , Adulto Joven , Adulto , Prevalencia , Tamizaje Neonatal

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INTRODUCTION: Seroma is the most common early complication following surgical breast cancer treatment. Its development is associated with pain, scar complications, adjuvant therapy delays, the need for outpatient visits, and increased care costs. OBJECTIVE: Assess seroma incidence and risk factors in women undergoing mastectomies. METHOD: This study comprises a prospective cohort encompassing women aged 18 or over undergoing mastectomies as a breast cancer treatment. Patients underwent physiotherapy on the 1st, 7th, and 30th postoperative days for kinetic-functional, skin, and wound healing assessments and were attended to by nurses for surgical wound care, draining liquid on the 7th, 14th, and 21st postoperative days. Seroma was defined as the presence of local fluctuations requiring puncture, regardless of the punctured volume. RESULTS: A total of 249 women were evaluated, with a mean age of 57.5 (SD = 11.8). A total of 77.1% were classified as overweight or obese, 60.2% were hypertensive, 21.3% were diabetic, 66.7% underwent neoadjuvant chemotherapy and 62.7% underwent axillary lymphadenectomies. Seroma incidence was 71.1%, requiring, on average, two aspiration punctures until condition resolution. Overweight or obese women and those who underwent axillary lymphadenectomies exhibited 1.92- and 2.06-fold higher risk for seroma development (OR = 1.92; 95% CI 1.02-3.61; p = 0.042; and OR = 2.06; 95% CI 1.17-3.63; p = 0.012), respectively. CONCLUSION: Seroma incidence was very high. Being overweight or obese and undergoing axillary lymphadenectomy comprise independent seroma development risk factors. This study is part of a randomized clinical trial evaluating the effectiveness of applying compressive taping to prevent post-mastectomy seroma, which was approved by the Brazilian National Cancer Institute, Research Ethics Committee (2,774,824), and it is registered in the ClinicalTrials.gov (NCT04471142, on July 15, 2020).

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Neoplasias de la Mama , Mastectomía , Seroma , Humanos , Femenino , Seroma/etiología , Seroma/epidemiología , Neoplasias de la Mama/cirugía , Persona de Mediana Edad , Factores de Riesgo , Estudios Prospectivos , Incidencia , Mastectomía/efectos adversos , Mastectomía/métodos , Anciano , Adulto , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Escisión del Ganglio Linfático/efectos adversos , Escisión del Ganglio Linfático/métodos , Estudios de Cohortes

RESUMEN

BACKGROUND: The relationship between the dietary inflammatory index and blood pressure has been evaluated in European and American populations. This association remains unexplored in Mexico, where outcomes may differ due to the populace's ancestral heritage and its diverse dietary habits. METHODS: We used the Health Workers Cohort Study (2004 to 2018). DII intake was assessed using a food frequency questionnaire. Blood pressure was measured following standardized procedures and techniques. Fixed-effects linear regression and Cox regression models were utilized as the statistical approaches. RESULTS: In the first approach, we observed a positive association between changes in DII intake and changes in both systolic (SBP ß: 3.23, 95% CI 1.11, 5.34) and diastolic blood pressure (DBP ß: 1.01, 95% CI -0.43, 2.44). When stratified by hypertension, these associations were magnified in participants with hypertension (SBP ß: 6.26, 95% CI 2.63, 9.89; DBP ß: 1.64, 95% CI -0.73, 4.02). In the second approach, interactions between sex and age categories were explored. Participants in the highest DII category were associated with an increased risk of hypertension, particularly among young women (HR: 3.16, 95% CI 1.19, 8.43). CONCLUSIONS: Results suggest that a pro-inflammatory diet is associated with an increase in blood pressure over time among Mexican population.

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Presión Sanguínea , Dieta , Hipertensión , Inflamación , Humanos , Femenino , México/epidemiología , Masculino , Adulto , Hipertensión/epidemiología , Persona de Mediana Edad , Dieta/efectos adversos , Factores de Riesgo , Estudios de Cohortes , Conducta Alimentaria

RESUMEN

Background/Objectives: Increasing evidence indicates that body composition can significantly influence prognosis in women with breast cancer. However, alterations in body composition, particularly among young women (<40 years), remain largely unknown and underexplored. This study aimed to investigate the relationship of computed tomography (CT)-derived body composition with mortality rates among young women recently diagnosed with breast cancer, identifying the best-correlated cutoff value. Methods: This is a bi-set cohort study with retrospective data collection. Women newly diagnosed with ductal invasive breast cancer, aged 20 to 40 years, treated in reference oncology units were included. Body composition was assessed using CT scans at the third lumbar vertebra (L3) level, including muscle and adipose compartments. The outcome of interest was the incidence of overall mortality. A maximally selected log-rank Cox-derived analysis was employed to assess the cutoffs associated with mortality. Results: A total of 192 women were included before any form of treatment (median age of 35 years, IQ range: 31-37). Overall mortality occurred in 12% of the females. Stages III-IV were the most frequent (69.5%). Patients who died had a significantly lower muscle area index. CT-derived muscle area was inversely associated with mortality. Each 1 cm2/m2 decrease in skeletal muscle index increased the mortality hazard by 9%. Higher values of adiposity compartments were independently associated with higher mortality. Conclusions: Our study highlights the predictive significance of skeletal muscle area and adipose tissue in predicting survival among young women recently diagnosed with breast cancer.

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Composición Corporal , Neoplasias de la Mama , Tomografía Computarizada por Rayos X , Humanos , Femenino , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/diagnóstico por imagen , Adulto , Tomografía Computarizada por Rayos X/métodos , Estudios Retrospectivos , Adulto Joven , Músculo Esquelético/diagnóstico por imagen , Factores de Riesgo , Pronóstico , Adiposidad , Estudios de Cohortes