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INTRODUCTION AND OBJECTIVES: The Colegio Mexicano de Reumatología (CMR) is a corporation whose brand has two elements-image and identity-that differentiate it from other corporations. We evaluated aspects of CMR's corporate image and identity. SUBJECTS AND METHODS: To assess corporate image, we designed a survey using proof-of-concept and discrete-choice-experiments approaches. It assessed which definition (orthopedist, rheumatologist, or rehabilitator) was most meaningful in four pain scenarios in healthy adults from the country's Western region. We used discourse analysis and five readability indices of the CMR website to assess corporate identity. RESULTS: In total, 700 respondents were included. For every rheumatologist chosen in the hand scenario, respondents chose 1.13 orthopedists and 0.70 rehabilitators. For every rheumatologist chosen in the knee scenario, respondents chose 2.36 orthopedists and 0.64 rehabilitators, whereas 0.85 orthopedists and 0.58 rehabilitators were chosen in the arthritis scenario. Only 38% of the respondents preferred the CMR's definition of a rheumatologist to describe a rheumatologist. The younger age group preferred orthopedists to rheumatologists (50% vs. 31%, p<0.001). In the arthritis scenario, the choice of rheumatologist increased from 27% in the elementary school group to 49% in the university group (p<0.001). Mother was the most influential in healthcare seeking. The discursive analysis revealed that the CMR is positioned as a "we" restricted to "colleagues;" the patient did not have agentive representation. The semiotic structure of the CMR's mission/vision was deemed imprecise and lacking in statements of value and purpose; the readability scores indicated that the text was challenging and dry. CONCLUSIONS: The CMR's corporate image does not differentiate it from other health providers. CMR's identity seems ambiguous with restricted directionality. It seems pertinent to redefine the CMR.
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Corporações Profissionais , Humanos , Feminino , Adulto , Masculino , Pessoa de Meia-Idade , México , Reumatologia , Ortopedia , Idoso , Adulto Jovem , Inquéritos e QuestionáriosRESUMO
ABSTRACT: The purpose of this article is to describe the activities developed within the framework "Regional Workshop on Optimization of Protection in Pediatric Interventional Radiology in Latin American and Caribbean countries," developed between October 16th and 19th of the year 2023 in the city of San José, Costa Rica. The workshop was carried out as part of a joint work between the Pan American Health Organization (PAHO) and the World Health Organization (WHO), in cooperation with the International Atomic Energy Agency (IAEA). The main objective of the regional workshop was to gather the experiences and future work planning among participants in the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean (OPRIPALC) program. It involved professionals from 14 centers across 11 countries in the region, along with 4 experts from PAHO/WHO/IAEA. The work modalities during the workshop consisted of keynote presentations, individual presentations, group work, and general discussions. An online survey was carried out after the workshop, with the objective of knowing the opinion of the event participants and determining the impact and projection of the OPRIPALC program. During the workshop the centers had to present their experiences: the use of the DOLQA dose management system was presented and work was done on the consensus document on good practices. The activities, topics and organization of the workshop were valued positively by the participants. There is unanimity among the centers that the OPRIPALC program has had a positive impact and they wish to continue actively participating in the next biennium.
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Objetivo: desarrollar un puntaje predictivo de mortalidad para pacientes con covid-19. Materiales y méto-dos: estudio retrospectivo, analítico, observacional y transversal, realizado en dos fases. Se revisaron 620 historias clínicas con una cohorte de derivación de 320 pacientes y una de validación de 300 pacientes. Las variables se analizaron con test de Anova, chi cuadrado de Pearson y análisis multivariante con regresión binaria, que determinaron sensibilidad, especificidad y valor predictivo negativo y positivo. Los puntajes se compararon mediante curvas cor con los scoresnews y hews. Resultados: los dos puntajes obtenidos incluyeron valores de edad, conteo de linfocitos, SatO2/FiO2, leucocitos, plaquetas, ausencia de síntomas, hipertensión arterial, epid y dhl. El área bajo la curva (abc) fue de 0.838 para el puntaje con dhl, con una mortalidad del 100 % para 7.75 puntos o más, y un abc de 0.826 para el primer puntaje. En la cohorte de validación, el abc para el primer puntaje fue de 0.831 y para el score con dhl fue 0.855. El puntaje hewsobtuvo un abc de 0.451, y el news, un abc de 0.396. Conclusiones: se desarrollaron dos herramientas para predecir mortalidad en pacientes con covid-19, con alto poder de discriminación, superior a los puntajes británicos hews y news
Objetivo: desarrollar un puntaje predictivo de mortalidad para pacientes con covid-19. Materiales y méto-dos: estudio retrospectivo, analítico, observacional y transversal, realizado en dos fases. Se revisaron 620 historias clínicas con una cohorte de derivación de 320 pacientes y una de validación de 300 pacientes. Las variables se analizaron con test de Anova, chi cuadrado de Pearson y análisis multivariante con regresión binaria, que determinaron sensibilidad, especificidad y valor predictivo negativo y positivo. Los puntajes se compararon mediante curvas cor con los scoresnews y hews. Resultados: los dos puntajes obtenidos incluyeron valores de edad, conteo de linfocitos, SatO2/FiO2, leucocitos, plaquetas, ausencia de síntomas, hipertensión arterial, epid y dhl. El área bajo la curva (abc) fue de 0.838 para el puntaje con dhl, con una mortalidad del 100 % para 7.75 puntos o más, y un abc de 0.826 para el primer puntaje. En la cohorte de validación, el abc para el primer puntaje fue de 0.831 y para el score con dhl fue 0.855. El puntaje hewsobtuvo un abc de 0.451, y el news, un abc de 0.396. Conclusiones: se desarrollaron dos herramientas para predecir mortalidad en pacientes con covid-19, con alto poder de discriminación, superior a los puntajes británicos hews y news
Objetivo: desenvolver um escore preditivo de mortalidade para pacientes com covid-19. Materiais e Métodos: estudo retrospectivo, analítico, observacional e transversal, realizado em duas fases. Foram revisados 620 prontuários, com uma coorte de derivação de 320 pacientes e uma coorte de validação de 300 pacientes. As variáveis foram analisadas com teste anova, qui-quadrado de Pearson e análise multivariada com regressão binária, determinando sensibilidade, especificidade, valor preditivo nega-tivo e positivo. As pontuações foram comparadas por meio de curvas cor com as pontuações news e hews. Resultados: os dois escores obtidos incluíram valores de: idade, contagem de linfócitos, SatO2/FiO2, leucócitos, plaquetas, ausência de sintomas, hipertensão arterial, epid e dhl. A área sob a curva (abc) foi de 0,838 para o escore dhl, com 100 % de mortalidade para 7,75 pontos ou mais, e uma abc de 0,826 para o primeiro escore. Na coorte de validação, a abc para o primeiro escore foi de 0,831 e para o escore com dhl foi de 0,855. A pontuação hews obteve abc de 0,451 e o news uma abc de 0,396. Conclusões: foram desenvolvidas duas ferramentas para prever mortalidade em pacientes com covid-19, com alto poder de discriminação, superior aos escores britânicos hews e news
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Humanos , Idoso Fragilizado , Comportamento AutodestrutivoRESUMO
This article presents the development, advancements, challenges and achievements of the "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) program. This international initiative is led by the World Health Organization, the Pan American Health Organization and the International Atomic Energy Agency. The main objectives of OPRIPALC are to foster a culture of radiological protection in pediatric interventions, enhance these procedures' quality, and define optimization strategies such as the use of diagnostic reference levels (DRLs). Currently, 33 centers from 12 countries participate actively in the program. Significant progress has been made towards the proposed objectives, overcoming the challenges posed by the COVID-19 pandemic. Through many virtual meetings for coordination, planning, training and follow-up, a comprehensive set of DRLs for both diagnostic and therapeutic procedures, categorized by weight and age, have been established and are in use. A consensus document on good practices is in the final stage of development. The program's continuation into at least a second phase is essential to address pending issues, including the integration of automatic dose management systems, the levels of occupational radiation doses, their correlation with pediatric patient doses, and strategies to reduce them.
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OBJECTIVE: The purpose of this study was to assess the association between serum 25-hydroxyvitamin D [25(OH)D] levels and depressive symptoms in Mexican older adults 70 years and older. METHODS: A total of 326 adults aged 70 or older from Coyoacán Cohort Study were included in this study. The depressive symptoms were assessing by Center for Epidemiologic Studies Depression Scale (CES-D) and serum 25-hydroxyvitamin D [25(OH)D] levels were measured by commercially available enzyme-linked immunosorbent assay (ELISA). RESULTS: Overall, the prevalence of depressive symptoms was 36.5%. The mean age was 79 years, and 53.4% were women. The total serum 25-hydroxyvitamin D [25(OH)D] levels were lower in older adults with depressive symptoms when compared with older adults without depressive symptoms (p = .006). Logistic regression models showed a significant association between low serum 25(OH)D levels and depressive symptoms even after adjusting for potential confounders (OR = 2.453; 95% CI:1.218-4.939; p = .012). In addition, linear regression model to predict the effect of 25-hydroxyvitamin D [25(OH)D] levels on the CES-D score as a continuous variable, was statistically significant [F(1,324) = 8.54, p = .004], and the R-squared value was .026, indicating that this regression model explains 2.6% of the change in the CES-D score. CONCLUSION: These results suggest that older Mexican adults with lower serum 25-hydroxyvitamin D [25(OH)D] levels are at higher risk of presenting depressive symptoms.
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Introducción: El hemangioendotelioma retiforme es una neoplasia de grado intermedio o potencialmente maligna, su incidencia es entre la segunda y cuarta década de la vida, más frecuente 2:1 en mujeres, la etiología es incierta, se manifiesta generalmente como lesión nodular o en forma de placa en tronco o extremidades. El diagnóstico es por histopatología e inmunohistoquímica, su tratamiento es resección de la lesión, con una recurrencia del 60% posterior al manejo quirúrgico. Caso clínico: Se describe un caso atípico de hemangioendotelioma retiforme en tórax, en una paciente de sexo femenino de 43 años, su padecimiento inicia con aumento de volumen de 6 meses en axila derecha, acompañándose de dolor y limitación de la movilidad. Se realiza tomografía de tórax con reporte de tumoración del musculo pectoral de 83 mm. Se realiza exéresis de tumoración con reporte histopatológico de: hemangioendotelioma retiforme e inmunohistoquímica positiva a CD34.
Background: Retiform hemangioendothelioma is an intermediate grade or potentially malignant neoplasm, its incidence is between the second and fourth decade of life, more frequent 2:1 in women. Etiology is uncertain, it generally manifests as a nodular or plaque-shaped lesion on the trunk or extremities, the diagnosis is made by histopathology and immunohistochemistry, the treatment is resection of the lesion, presenting a recurrence of 60%. Clinical case: A case of retiform hemangioendothelioma is describes, a 43-year-old female began her condition with a 6-month increase in volume in the right armpit, with pain and limited mobility. A chest tomography was performed with a report of 83 mm pectoral muscle tumor, a tumor excision was performed with a histopathological report of: retiform hemangioendothelioma and CD34 positive immunohistochemistry.
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We identified patient and healthcare system factors related to receipt of screening results and attendance to colposcopy among patients with positive screening results in a cervical cancer screening program in Mexico City, Mexico. We analyzed data from 1,351 patients with high-risk human papillomavirus (HPV)-positive results from two screening demonstration studies conducted between 2017 and 2018. Factors associated with receipt of screening results and with adherence to a colposcopy appointment were identified using multivariable logistic regression. Participants had a median age of 40 years (IQR = 32-48), 60% had less than high school education, and 74% had a previous Pap screening in the last 5 years. Fifty-five percent of participants retrieved their screening results at the healthcare facility (HCF) without any reminder. Providing an email address for contact information, attending a HCF with family medicine, and receiving care from experienced nurses were associated with greater adherence to obtaining screening test results. Fifty-seven percent of participants attended their first scheduled colposcopy appointment. Providing a phone number improved adherence to colposcopy, whereas longer travel times between the HCF and the colposcopy clinic was associated with a decrease in colposcopy adherence. Having a Pap test in the last 5 years was positively associated with better compliance with both outcomes. Securing contact information may help to overcome barriers to future follow-up. Additional research is necessary on strategies for obtaining screening test results and scheduling appointments, which may help address barriers to access, such as limited staff availability, distance from the clinic, and travel costs.
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INTRODUCTION: A case of spontaneous fetal bladder rupture occurring in a woman with SARS-CoV-2 pneumonia receiving invasive ventilatory support is reported. CASE: A 33-year-old woman was admitted at 30.6 weeks' gestation with the diagnosis of severe pneumonia due to COVID-19. The patient required invasive mechanical ventilation on day 2. Propofol, fentanyl, midazolam, and dexmedetomidine were administered for sedation, pain relief, and to improve patient-ventilator interaction. A bedside ultrasound on day 3 revealed fetal megacystis. Follow-up scan two days later showed urinary ascites and a collapsed bladder. The diagnosis of fetal bladder rupture was confirmed postpartum. Bladder repair was performed on day 5, with an uneventful recovery. DISCUSSION: Transplacental transfer of opioids during invasive ventilatory support in pregnancy may cause acute fetal bladder atony leading to severe urine retention and, potentially, bladder rupture. This can be a serious complication of adjunctive therapy in women with severe SARS-CoV-2 pneumonia.
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COVID-19 , Dexmedetomidina , Propofol , Adulto , Analgésicos Opioides , COVID-19/complicações , Feminino , Fentanila/uso terapêutico , Humanos , Midazolam , Gravidez , SARS-CoV-2 , Bexiga UrináriaRESUMO
El objetivo del presente artículo ha sido describir el programa "Optimización de la Protección en Radiología Intervencionista Pediátrica en América Latina y el Caribe" (OPRIPALC) que nace el año 2018 como respuesta conjunta de la Organización Panamericana de la Salud y la Organización Mundial de la Salud, en cooperación con el Organismo Internacional de Energía Atómica, para colaborar con sus Estados miembros en asegurar que las exposiciones a la radiación de los pacientes pediátricos sean las mínimas necesarias durante los procedimientos intervencionistas. Actualmente, hay 18 centros de los siguientes 10 países que participan: Argentina, Brasil, Chile, Colombia, Costa Rica, Cuba, Ecuador, México, Perú y Uruguay. Para el desarrollo del programa se plantean una serie de objetivos, productos, actividades y resultados esperados. La puesta en marcha de la WEB de OPRIPALC ha significado un instrumento muy válido para seguir la información actualizada del programa. Un programa actualizado de formación en radioprotección para los profesionales implicados en el programa, se está realizando por medio de "webinars". Se deberá seguir actuando en la aplicación del programa de control de calidad básico para los equipos de rayos X participantes y validar los valores de los Niveles de Referencia para Diagnóstico (NRDs). Se propone formar un equipo de trabajo entre los Físicos Médicos y Tecnólogos Médicos participantes de OPRIPALC para implicarse en las pruebas de control básicas que todos los centros debieran realizar. Se han presentado algunos resultados iniciales de OPRIPALC en eventos científicos internacionales. Se está avanzando en proponer unos primeros valores sobre NRDs en procedimientos de intervencionismo cardiológico pediátrico por bandas de edad y peso. OPRIPALC es una de las pocas iniciativas de carácter regional para obtener valores de NRDs en procedimientos intervencionistas pediátricos. Se espera que tanto los valores de referencia como la metodología empleada en OPRIPALC, puedan ser utilizados en otras regiones del mundo.
The objective of this article has been to describe the program "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) that was born in 2018 as a joint response of the Pan American Health Organization and the World Organization of the Health, in cooperation with the International Atomic Energy Agency, to collaborate with its member states in ensuring that radiation exposures of pediatric patients are the minimum necessary during interventional procedures. Currently, there are 18 centers from the following 10 countries participating: Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Peru and Uruguay. For the development of the program, a series of objectives, products, activities and expected results are proposed. The launch of the OPRIPALC WEBSITE has been a very valid instrument for following up-to-date information on the program. An updated training program in radiation protection for the professionals involved in the program is being carried out through webinars. It should continue acting in the application of the basic quality control program for the participating X-ray equipment and validate the values of the Diagnostic Reference Levels (DRLs). It is proposed to form a work team among the OPRIPALC participating medical physicists to get involved in the basic control tests that all centers should carry out. Some initial results of OPRIPALC have been presented at international scientific events. Progress is being made in proposing first values on DRLs in pediatric cardiac intervention procedures by age and weight bands. OPRIPALC is one of the few regional initiatives to obtain DRLs values in pediatric interventional procedures. It is expected that both the reference values and the methodology used in OPRIPALC can be used in other regions of the world.
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Humanos , Criança , Pediatria/normas , Proteção Radiológica/normas , Cardiologia/normas , Controle de Qualidade , Padrões de Referência , Valores de Referência , Segurança , Radiologia Intervencionista , Região do Caribe , Técnicas de Diagnóstico Cardiovascular , Otimização de Processos , Níveis de Referência de Diagnóstico , América LatinaRESUMO
La ascitis quilosa (AQ) es una entidad rara, y puede manifestarse como una reacción peritoneal llamada peritonitis quilosa aguda (PQA). Presentamos el caso de un varón de 26 años, con cuadro abdominal agudo, por lo que es intervenido quirúrgicamente, encontrándose líquido lechoso turbio, en cavidad abdominal, realizándose una apendicectomía profiláctica, aspiración y lavado de cavidad, con colocación de drenajes. El análisis de líquido mostró aumento de triglicéridos y amilasa, gram y cultivos negativos; y la tomografía reveló una pancreatitis aguda (Baltazar C), todo ello confirmando el diagnóstico de AQ secundaria a pancreatitis. Paciente cursa con una evolución favorable con hidratación, analgésicos y dieta vía oral a tolerancia. En la literatura se han descrito muy pocos casos de PQA, y su asociación con pancreatitis aguda es bastante inusual. Pudiendo simular un cuadro abdominal agudo quirúrgico, cuyo tratamiento consiste en la exploración quirúrgica con drenaje peritoneal, pudiendo o no, requerir apoyo nutricional.
Chylous ascites (CA) is a rare condition, and it can present as a peritoneal reaction named acute chylous peritonitis (ACP). We report the case of a 26-year old male who developed acute abdomen. He underwent surgery and turbid milky fluid was found in his abdominal cavity. A prophylactic appendectomy was performed, as well as aspiration and lavage of the abdominal cavity. Drainage tubes were placed. Studies of the fluid revealed increased triglyceride and amylase contents. Gram-staining and cultures were negative. A computed tomography scan revealed acute pancreatitis (Balthazar C), so a diagnosis of chylous ascites secondary to pancreatitis was confirmed. The patient did well, he received hydration, analgesics, and oral diet according to tolerance. Very few cases of ACP have been reported in the literature, and its association with acute pancreatitis is very unusual. This condition may resemble surgical acute abdomen, and its management includes surgical exploration with peritoneal drainage. Nutritional support may also be needed.
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Trauma to peripheral vascular organ is a very frequent condition during military conflicts. Fortunately, comprehensive understanding of local and systemic pathophysiology, in addition to the development of innovative surgical techniques and technological advances, have improved the outcome regarding to survival and anatomic and functional conservation of the limbs. In this manuscript, we perform an historical and state of the art review related to the approach of the peripheral vascular trauma, on the basis of an heroical episode from the Mexico City's Campaign, during North American invasion 1846-1848: the defense of Chapultepec's Castle by cadet Agustin Melgar.
El trauma del órgano vascular periférico es una condición muy frecuente en los conflictos militares. Por fortuna, la comprensión integral de la fisiopatología local y sistémica, en adición al desarrollo de técnicas quirúrgicas innovadoras y avances tecnológicos, ha mejorado el pronóstico relativo a la sobrevida y la conservación anatómica y funcional de las extremidades. En este trabajo se hace una revisión histórica y del estado actual del abordaje del trauma vascular periférico, sobre la base de un episodio heroico de la Campaña por la Ciudad de México durante la invasión norteamericana de 1846-1848: la defensa del Castillo de Chapultepec por el cadete Agustín Melgar.
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Vasos Sanguíneos/lesões , Militares , Procedimentos Cirúrgicos Vasculares/história , Lesões Relacionadas à Guerra/cirurgia , História do Século XIX , Humanos , MéxicoRESUMO
Nowadays, the global energy system is in a transition phase, in which the integration of renewable energy is among the main requirements for attenuating climate change. Wind power is a major alternative to supply clean energy; hence, its widespread penetration is being pursued in all end-use sectors. In particular, it is currently noteworthy to analyze the feasibility of deploying small-scale wind power technology to provide cleaner and cheaper energy in the residential sector. As a first step, a technical assessment must be carried out to provide crucial information to intensive energy consumers, providers of small-scale wind power technology, electric energy distribution utilities, and any other party, to help them decide whether or not to deploy small-scale wind turbines. With this aim, we propose to perform such an analysis using a suitable probabilistic paradigm to solve complex decision-making problems with uncertainty, namely Bayesian Intelligence, since wind resources and energy demands are intermittent variables, properly characterized by probability distribution functions. Then, the problem of determining the technical feasibility can be formulated as an investigation into whether or not small-scale wind turbine technology can produce enough energy to cover the excess demand of intensive energy residential consumers to get off high-priced tariffs. For this purpose, we introduce a novel model based on probabilistic reasoning to assess the suitability of small-scale wind turbine technology to produce the said energy, taking into consideration the availability of wind resources and the energy pricing structure. To demonstrate the usefulness and performance of the proposed model, we consider a case study of deploying 5 and 10 kW wind turbines and analyze the feasibility of their implementation in Mexico, where the energy pricing structure and scattered wind resource availability pose difficult challenges.
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Centrais Elétricas , Inteligência Artificial , Teorema de Bayes , Mudança Climática , Eletricidade , México , Energia Renovável , VentoRESUMO
Resumen: Introducción: en Uruguay, en los últimos años, se ha constatado un incremento en la prevalencia de sobrepeso y obesidad. La evidencia científica ha demostrado que las condiciones en la primera infancia son determinantes. Objetivo: determinar la prevalencia de sobrepeso, obesidad y los niveles de presión arterial (PA) braquial e identificar factores de riesgo asociados en niños de nivel 5 que concurren a jardines públicos de Montevideo. Método: estudio transversal (7/2016-6/2017) en una muestra representativa de 771 niños de nivel 5 de jardines públicos de Montevideo. Se relevó historia y comportamiento alimentario, actividad física, hábitos de sueño, peso y talla materna. En cada niño se registró antropometría y PA braquial. Resultados: la prevalencia de sobrepeso u obesidad fue 40,6% (IC95%: 37,4-44,3), obesidad 16,5% (IC95%: 13,9-19,1) y obesidad abdominal 12,9% (IC95%: 11,0-15,8). Reportaron sobrepeso 29,4% de las madres y obesidad 21,9%. Se observó sedentarismo en 58,3%, exposición prolongada a pantallas en 60,4% y escasas horas de sueño en 40,9%. El consumo frecuente de alfajores, obleas y bizcochos en el desayuno, de embutidos entre semana, la preferencia de alimentos con publicidad, y el reporte de sobrepeso u obesidad materna se asociaron con obesidad infantil. Los niños con sobrepeso, obesidad u obesidad abdominal presentaron mayores niveles de PA braquial. Conclusiones: la prevalencia de sobrepeso y obesidad en niños de nivel 5 de jardines públicos de Montevideo es elevada. El sobrepeso, la obesidad materna y los hábitos en relación con la alimentación, actividad física y sueño se asocian con su presencia.
Summary: Introduction: in recent years, Uruguay has seen an increase of the prevalence of overweight and obesity. Scientific evidence has shown that early childhood conditions are determinant. Objective: to determine the prevalence of overweight, obesity and brachial blood pressure levels and identify associated risk factors in 5-year-old children who attend public preschool centers in Montevideo. Method: transversal study (7/2016-6/2017) in a representative sample of 771 5-year-old children from preschool centers in Montevideo. We assessed their history, eating habits, physical activity, sleeping habits, weight and maternal size. We recorded anthropometry and brachial blood pressure for each child. Results: the prevalence of overweight or obesity was 40.6% (CI 95%: 37.4- 44.3), obesity 16.5% (CI 95%: 13.9-19.1) and abdominal obesity 12.9% (CI 95%: 11.0-15.8). 29.4% of mothers reported overweight and 21.9% of them reported obesity. Sedentary lifestyle was found in 58.3%, long screen viewing in 60.4% and inadequate sleep in 40.9%. Frequent consumption of pastries, wafers and biscuits for breakfast, cold cuts during week days, preference of food they see in advertisements, and reported maternal overweight or obesity were associated to child obesity. Children with overweight and/or abdominal obesity evidenced higher levels of brachial blood pressure. Conclusions: prevalence of overweight and obesity in 5-year-old children from public preschool centers in Montevideo is high. Maternal overweight and obesity and habits in connection with eating, physical activity and amount of sleep are associated with this condition.
Resumo: Introdução: nos últimos anos observou-se um aumento da prevalência de sobrepeso e obesidade no Uruguai. A evidência científica mostra que as condições de vida na primeira infância são determinantes. Objetivo: determinar a prevalência de sobrepeso, obesidade e os niveles de pressão arterial (PA) braquial e identificar fatores de risco associados em crianças com 5 anos que frequentam jardines de infância públicos em Montevidéu. Métodos: estudo transversal (7/2016-6/2017) em uma amostra representativa de 771 crianças com 5 anos de jardins de infância públicos de Montevidéu. Foram coletados dados sobre a história e o comportamento alimentar, atividade física, hábitos de sono e peso e altura materna. Os dados antropométricos e PA braquial de todas as crianças foram registrados. Resultados: a prevalência de sobrepeso ou obesidade foi de 40,6% (I.C.95%:37,4-44,3), obesidade 16,5% (I.C.95%:13,9-19,1) e obesidade abdominal 12,9% (I.C.95%:11,0-15,8). 29,4% das mães informaram sobrepeso e 21,9% obesidade. Observou-se sedentarismo em 58,3%, exposição prolongada a telas de equipamentos eletrônicos em 60,4% e poucas horas de sono em 40,9%. O consumo frequente de alfajores, obleias e pães com altos teores de açúcar e gordura no café da manhã, de embutidos nos dias de semana, preferência de alimentos com publicidade, e a informação de sobrepeso ou obesidade materna estava associado a obesidade infantil. As crianças com sobrepeso, obesidade e/ou obesidade abdominal apresentaram niveles mais altos de PA braquial. Conclusões: a prevalência de sobrepeso e obesidade em crianças com 5anos de jardins de infância públicos de Montevidéu é elevada. O sobrepeso e obesidade materna e os hábitos relacionados à alimentação, atividade física e sono, estão associados à sua presença.
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Humanos , Pré-Escolar , Sobrepeso/epidemiologia , Obesidade Infantil/epidemiologia , Prevalência , HipertensãoRESUMO
BACKGROUND: Nowadays, there are few differences between civilian and military trauma, requiring to surgeons serving at urban hospitals, the acquisition of competences leading to implementation of management strategies for these cases. For their training, instructional designs related to surgical education, incorporating multimedia resources and favoring the multichannel teaching-learning process, have demonstrated remarkable benefits on competences acquisition by participants. METHOD: Using an instructional design sustained on problems based learning and problems resolution, a digital video and its associated flat text were reviewed by the General Surgery residents, with the further application of a wide-answer problem-resolution questionnaire. Questionnaire's results were evaluated by an information-management analytic rubric, leading to obtain evidence related to competences acquisition. RESULTS: In this series, 17 general surgery residents were included. Using the didactic strategy of the instructional design, 76.5% (n = 13) of participants acquired the expected level-5 generic instrumental methodologic competence, consisting in a relevant making-decisions process for problems resolution. DISCUSSION: Incorporation of multimedia resources into instructional designs leads a significant multichannel learning and generic instrumental-methodologic competences, so that their preferential use is recommended.
INTRODUCCIÓN: Hoy en día hay pocas diferencias entre los traumatismos civiles y militares, demandando al cirujano que labora en hospitales urbanos la adquisición de competencias para implementar estrategias de manejo de los casos. Para capacitarlos, los diseños instruccionales de educación quirúrgica que incorporan recursos multimedia y favorecen el proceso multicanal de enseñanza-aprendizaje han demostrado marcados beneficios en la adquisición de competencias por los participantes. MÉTODO: Con un diseño instruccional sustentado en el aprendizaje basado en problemas y en la solución de problemas, médicos residentes de cirugía general revisaron un video digital y un texto plano asociado, aplicando posteriormente un cuestionario de resolución de problemas con respuesta amplia. Los resultados del cuestionario se evaluaron con una rúbrica analítica de manejo de información, a fin de obtener evidencia de la adquisición de competencias. RESULTADOS: Se incluyeron 17 residentes de cirugía general. Con la estrategia didáctica del diseño instruccional, el 76.5% (n = 13) de los participantes adquirieron la competencia genérica instrumental metodológica de nivel 5 esperada, consistente en la toma pertinente de decisiones para la resolución de problemas. DISCUSIÓN: La incorporación de recursos multimedia a los diseños instruccionales promueve significativamente el aprendizaje multicanal y la adquisición de competencias genéricas instrumentales metodológicas; por lo anterior, se recomienda su uso preferencial.
Assuntos
Competência Clínica , Educação Médica/métodos , Cirurgia Geral/educaçãoRESUMO
Instituida bajo recomendaciones objetivas, la toracotomía en el departamento de urgencias (TDU) se ha descrito como una maniobra quirúrgica salvatoria de la vida en pacientes traumatizados in extremis. Sin embargo, hay pocos reportes acerca de la experiencia con su empleo en la actividad eléctrica sin pulso no traumática. Describimos el caso de una paciente obstétrica exanguinada por sangrado masivo transoperatorio, en la que se realizó una TDU con un resultado óptimo para la vida y la función neurológica. Adicionalmente, evaluamos la literatura correspondiente al tema, que en lo mejor de nuestro conocimiento es crítica para expandir los protocolos de abordaje del ritmo de paro cardiaco no traumático en los hospitales de alto volumen.Instituted under objective recommendations, Emergency Department Thoracotomy (EDT) has been described as a life-saving surgical maneuver in trauma patients arriving "in extremis." Nevertheless, there are few reports related to the experience regarding the use of the procedure in non-traumatic cardiopulmonary arrest. We describe the case of an obstetric patient exsanguinated by operative massive bleeding, where EDT was instituted reaching an optimal result for the survival and neurologic function. Additionally, we evaluate the literature related to this issue, which to the best of our knowledge, is critical to expand protocols of approach in non-traumatic cardiac arrest rhythm in high-volume hospitals.
Assuntos
Tratamento de Emergência/métodos , Parada Cardíaca/cirurgia , Toracotomia , Adulto , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/fisiopatologia , Hemorragia/complicações , Humanos , Gravidez , Complicações Hematológicas na Gravidez , Pulso ArterialRESUMO
BACKGROUND: Maternal morbidity and mortality pose a significant impact on national public health, being medical attention of obstetric emergencies (OE) and non-emergencies (ONE) of capital importance. METHODS: Descriptive and epidemiologic analysis of OE/ONE at a 3rd level military echelon. RESULTS: During a 34-months span, 48 patients were approached at the emergency department (1.4 admissions/month). Mean age: 29 ± 3 years (17-41). Eight patients (17%) were considered OE and 40 (83%) ONE. Fifty-eight percent (n = 28) of patients were admitted to our institution; 32% (n = 9) were managed under non-surgically basis and 68% (n = 19) underwent surgical therapy. Most important cause of admission: postoperative hemorrhage (22%; n = 6). Most frequent operative interventions: surgical hemostasis maneuvers (31.5%; n = 6). Eighty-two percent (n = 23) of admissions required management at intensive care unit (ICU), with mean length of stay of 6.4 ± 4.9 days (2-21). Thirty-five percent (n = 8) required mechanical ventilation. Mean score of APACHE II at ICU: 19.4 ± 8.4; predicted probability of death: 35.5%. Global morbidity rate: 27% (1.8 complications/patient). Global mortality rate: 6.2%; specific mortality for pregnant patients 0% (n = 0) and for post-partum patients12.5% (n = 3). Mortality rate at ICU: 4.3% (n = 1). CONCLUSIONS: Central Military Hospital has delineated and defined several procedures to decrease maternal morbidity and mortality. Appropriate practice of these procedures contributes to reach the desired institutional objectives.
INTRODUCCIÓN: La morbimortalidad materna posee un significativo impacto en la salud pública nacional, siendo la atención médica de las emergencias obstétricas (EO) y urgencias obstétricas (UO) de capital importancia. MÉTODO: Análisis descriptivo y epidemiológico de EO/UO en un escalón militar de tercer nivel. RESULTADOS: Durante 34 meses se abordaron en el departamento de urgencias 48 pacientes (1.4 admisiones/mes). La edad media fue de 29 ± 3 años (rango: 17-41). Ocho pacientes (17%) se consideraron EO y 40 (83%) UO. El 58% (n = 28) de las pacientes se admitieron a la institución; el 32% (n = 9) se manejaron médicamente y el 68% (n = 19) con tratamiento quirúrgico. La causa más importante de admisión fue la hemorragia posoperatoria (22%; n = 6). Las intervenciones quirúrgicas más frecuentes fueron maniobras de hemostasia quirúrgica (31.5%; n = 6). El 82% (n = 23) de las admisiones requirieron manejo en la unidad de medicina intensiva (UMI), con una estancia media de 6.4 ± 4.9 días (rango: 2-21). El 35% (n = 8) requirieron ventilación mecánica. La puntuación media APACHE II en la UMI fue de 19.4 ± 8.4, y la probabilidad predicha de muerte fue del 35.5%. La tasa global de morbilidad fue del 27% (1.8 complicaciones/paciente). La tasa de mortalidad global fue del 6.2%; la mortalidad específica para pacientes embarazadas del 0% (n = 0) y para pacientes puérperas del 12.5% (n = 3). La tasa de mortalidad en la UMI fue del 4.3% (n = 1). CONCLUSIONES: El Hospital Central Militar ha delineado y definido diversos procedimientos para abatir la morbimortalidad maternas. La correcta práctica de estos procedimientos contribuirá a alcanzar los objetivos institucionales deseados.
Assuntos
Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Emergências , Tratamento de Emergência , Feminino , Hospitais Militares , Humanos , Gravidez , Complicações na Gravidez/terapia , Adulto JovemRESUMO
INTRODUCTION: Endothelial function at high altitude has been measured only in populations that are genetically adapted to chronic hypoxia. The objective of this study was to evaluate endothelial dysfunction (ED) in a nongenetically adapted high-altitude population of the Andes mountains, in Huancayo, Peru (3,250 meters above sea level). METHODS: Participants included 61 patients: 28 cases and 33 controls. The cases were subjects with hypertension, diabetes mellitus, obesity, or a history of stroke or coronary artery disease. Flow-mediated vasodilation (FMD) of the brachial artery was measured in the supine position, at noon, after 5 minutes of resting. The brachial artery was identified above the elbow. Its basal diameter was measured during diastole, and FMD was tested after 5 minutes of forearm ischemia. Intima-media complex in the right carotid artery was also determined. An increase in the artery's baseline diameter <10% indicated a positive test. Endothelium-independent vasodilation was evaluated with sublingual nitrate administration. The intima-media complex in the right carotid artery was also measured. RESULTS: 100% of diabetics had ED; ED was also found in 68.8% of obese individuals, 55% of hypertensive patients, and 46.5% of controls. Age, height, body mass index, and waist diameter were higher in the cases as compared with the controls. A total of 57.9% (n=11) of the cases and 45.2% (n=19) of the controls presented ED. Patients without ED had a mean increase in brachial artery diameter of 23.16%, while in those with ED it was only 3.84%. Individuals with diabetes or hypertension had a greater thickness of the carotid artery intima media layer (1.092 versus 0.664 cm) (p=0.037). A positive test for ED was associated with a greater basal diameter of the brachial artery (4.66±0.62 versus 4.23±0.59 cm) (p=0.02). A total of 7 patients presented paradoxical response, developing posthyperemia vasoconstriction. DISCUSSION: The proportion of ED was high among controls and among patients with risk factors. Controls showed better FMD profiles than subjects studied in Tibet and the Himalayas.
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Altitude , Artéria Braquial/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus/fisiopatologia , Endotélio Vascular/fisiopatologia , Obesidade/fisiopatologia , Vasoconstrição , Vasodilatação , Aclimatação , Administração Sublingual , Idoso , Artéria Braquial/efeitos dos fármacos , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Endotélio Vascular/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nitratos/administração & dosagem , Obesidade/diagnóstico , Obesidade/epidemiologia , Peru/epidemiologia , Fluxo Sanguíneo Regional , Fatores de Risco , Vasodilatação/efeitos dos fármacos , Vasodilatadores/administração & dosagemRESUMO
BACKGROUND: Most large, prospective studies of the effects of diabetes on mortality have focused on high-income countries where patients have access to reasonably good medical care and can receive treatments to establish and maintain good glycemic control. In those countries, diabetes less than doubles the rate of death from any cause. Few large, prospective studies have been conducted in middle-income countries where obesity and diabetes have become common and glycemic control may be poor. METHODS: From 1998 through 2004, we recruited approximately 50,000 men and 100,000 women 35 years of age or older into a prospective study in Mexico City, Mexico. We recorded the presence or absence of previously diagnosed diabetes, obtained and stored blood samples, and tracked 12-year disease-specific deaths through January 1, 2014. We accepted diabetes as the underlying cause of death only for deaths that were due to acute diabetic crises. We estimated rate ratios for death among participants who had diabetes at recruitment versus those who did not have diabetes at recruitment; data from participants who had chronic diseases other than diabetes were excluded from the main analysis. RESULTS: At the time of recruitment, obesity was common and the prevalence of diabetes rose steeply with age (3% at 35 to 39 years of age and >20% by 60 years of age). Participants who had diabetes had poor glycemic control (mean [±SD] glycated hemoglobin level, 9.0±2.4%), and the rates of use of other vasoprotective medications were low (e.g., 30% of participants with diabetes were receiving antihypertensive medication at recruitment and 1% were receiving lipid-lowering medication). Previously diagnosed diabetes was associated with rate ratios for death from any cause of 5.4 (95% confidence interval [CI], 5.0 to 6.0) at 35 to 59 years of age, 3.1 (95% CI, 2.9 to 3.3) at 60 to 74 years of age, and 1.9 (95% CI, 1.8 to 2.1) at 75 to 84 years of age. Between 35 and 74 years of age, the excess mortality associated with previously diagnosed diabetes accounted for one third of all deaths; the largest absolute excess risks of death were from renal disease (rate ratio, 20.1; 95% CI, 17.2 to 23.4), cardiac disease (rate ratio, 3.7; 95% CI, 3.2 to 4.2), infection (rate ratio, 4.7; 95% CI, 4.0 to 5.5), acute diabetic crises (8% of all deaths among participants who had previously diagnosed diabetes), and other vascular disease (mainly stroke). Little association was observed between diabetes and mortality from cirrhosis, cancer, or chronic obstructive pulmonary disease. CONCLUSIONS: In this study in Mexico, a middle-income country with high levels of obesity, diabetes was common, glycemic control was poor, and diabetes was associated with a far worse prognosis than that seen in high-income countries; it accounted for at least one third of all deaths between 35 and 74 years of age. (Funded by the Wellcome Trust and others.).
Assuntos
Causas de Morte , Diabetes Mellitus/mortalidade , Adulto , Idade de Início , Idoso , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Feminino , Seguimentos , Hemoglobinas Glicadas/análise , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , PrognósticoRESUMO
BACKGROUND: Okihiro syndrome is an autosomal-dominant condition characterized by radial ray malformations associated with Duane anomaly and other clinical characteristics. SALL4 mutations have been identified in 80-90% of patients with Duane- Radial ray defects/Okihiro syndrome. We report the clinical findings and results of SALL4 sequencing from a group of Mexican patients with this disorder. OBJECTIVE: Clinical description and identification of SALL4 mutations in Mexican subjects with radial defects and Duane anomaly. MATERIALS AND METHODS: Five unrelated index cases were studied. Complete ophthalmologic and general physical examination was performed in all patients. Polymerase chain reaction amplification and automated nucleotide sequencing of coding exons and intron-exon junctions of SALL4 gene were carried out in genomic DNA. RESULTS: A novel heterozygous deletion was identified in one patient. Intragenic heterozygous single nucleotide polymorphisms on SALL4 gene ruled out deletions of some exons in other affected patients in whom non-pathogenic variants were identified by Sanger sequencing. Likewise, multiplex ligation-dependent probe amplification analysis ruled out large deletions in this gene. CONCLUSION: We observed a low frequency of SALL4 mutations in Mexican patients with clinical criteria of Okihiro syndrome.
Assuntos
Síndrome da Retração Ocular/genética , Deleção de Genes , Fatores de Transcrição/genética , Adolescente , Sequência de Bases , Criança , Síndrome da Retração Ocular/fisiopatologia , Éxons , Feminino , Heterozigoto , Humanos , Lactente , Íntrons , Masculino , México , Mutação , Reação em Cadeia da Polimerase , Polimorfismo de Nucleotídeo ÚnicoRESUMO
BACKGROUND: Animal bites are a major public health problem, it is estimated that 2% of the population is bitten each year. Most bites are by dogs and the risk factors include young children, men, certain breeds of dogs and untrained dogs. The risk of infection after bites differs between animal species and depends on the animal teeth and oral flora. CONCLUSIONS: Animal bites are still a major cause of morbidity in patients of all ages and have caused several preventable childhood deaths. These wounds often become infected. If the wound requires it, early surgical evaluation must be performed. The use of antibiotics is only recommended for high risk bite wounds.