Impact of Aspirin Supplementation for Pre-Eclampsia Prevention on Neonatal Outcomes

Introduction. Preeclampsia affects approximately 4.6% of pregnancies worldwide. In 2018, ACOG updated their low dose aspirin (LDA) supplementation recommendation to include pregnant women at moderate risk for preeclampsia. In addition to the potential benefit of LDA supplementation for delaying or preventing preeclampsia, LDA supplementation can affect neonatal outcomes. We study the association of LDA supplementation with six neonatal outcomes: length of stay (LOS) in hospital, NICU admission, hospital readmission, birth weight (BW), one-minute Apgar score, and five-minute Apgar score in a sample of mostly minority pregnant women from Hispanic and Black race/ethnicities. Methods. This was a retrospective study of 634 patients from January 2018 through April 2021.Our main predictor variable was maternal LDA supplementation on 6 neonatal outcomes: NICU admission, neonatal readmission, one and five minute Apgar scores, neonatal BW and hospital LOS. We adjusted for demographics, comorbidities and maternal high- or moderate-risk designation per ACOG guidelines. Results. We found that high-risk designation was associated with neonatal increased rate of NICU admission (OR: 3.80, 95% CI: 2.02, 7.13, p<0.001), LOS (B=0.15, SE=0.04, p<0.001) and decreased birthweight (B=-442.10, SE=75.07, p <0.001). We found no significant association with LDA supplementation and NICU admission, readmission, low one and five minute Apgar scores, BW and LOS. Conclusions. We did not find any association of LDA supplementation with NICU admission, hospital readmission, low one-minute or five-minute Apgar score, birthweight, and LOS. Clinicians recommending maternal LDA supplementation should be aware that LDA supplementation does not appear to provide any benefits for these neonatal outcomes

Impact of Aspirin Supplementation for Pre-Eclampsia Prevention on Neonatal Outcomes

Introduction. Preeclampsia affects approximately 4.6% of pregnancies worldwide. In 2018, ACOG updated their low dose aspirin (LDA) supplementation recommendation to include pregnant women at moderate risk for preeclampsia. In addition to the potential benefit of LDA supplementation for delaying or preventing preeclampsia, LDA supplementation can affect neonatal outcomes. We study the association of LDA supplementation with six neonatal outcomes: length of stay (LOS) in hospital, NICU admission, hospital readmission, birth weight (BW), one-minute Apgar score, and five-minute Apgar score in a sample of mostly minority pregnant women from Hispanic and Black race/ethnicities. Methods. This was a retrospective study of 634 patients from January 2018 through April 2021.Our main predictor variable was maternal LDA supplementation on 6 neonatal outcomes: NICU admission, neonatal readmission, one and five minute Apgar scores, neonatal BW and hospital LOS. We adjusted for demographics, comorbidities and maternal high- or moderate-risk designation per ACOG guidelines. Results. We found that high-risk designation was associated with neonatal increased rate of NICU admission (OR: 3.80, 95% CI: 2.02, 7.13, p<0.001), LOS (B=0.15, SE=0.04, p<0.001) and decreased birthweight (B=-442.10, SE=75.07, p <0.001). We found no significant association with LDA supplementation and NICU admission, readmission, low one and five minute Apgar scores, BW and LOS. Conclusions. We did not find any association of LDA supplementation with NICU admission, hospital readmission, low one-minute or five-minute Apgar score, birthweight, and LOS. Clinicians recommending maternal LDA supplementation should be aware that LDA supplementation does not appear to provide any benefits for these neonatal outcomes

Predictive value of serum ferritin in combination with alanine aminotransferase and glucose levels for noninvasive assessment of NAFLD: Fatty liver in obesity (FLiO) study

The identification of affordable noninvasive biomarkers for the diagnosis and characterization of nonalcoholic fatty liver disease (NAFLD) is a major challenge for the research community. This study aimed to explore the usefulness of ferritin as a proxy biomarker of NAFLD condition, alone or in combination with other routine biochemical parameters. Subjects with overweight/obesity and ultrasound-confirmed liver steatosis (n = 112) from the Fatty Liver in Obesity (FLiO) study were assessed. The hepatic evaluation considered magnetic resonance imaging, ultrasonography, and credited routine blood liver biomarkers. Anthropometry and body composition, dietary intake (by means of a validated 137-item food frequency questionnaire), and specific biochemical markers were also determined. Serum ferritin levels were analyzed using a chemiluminescent microparticle immunoassay kit. Lower serum ferritin concentrations were associated with general better liver health and nutritional status. The evaluation of ferritin as a surrogate of liver damage by means of quantile regression analyses showed a positive association with alanine aminotransferase (ALT) (β = 19.21; p ≤ 0.001), liver fat content (β = 8.70; p = 0.008), and hepatic iron (β = 3.76; p ≤ 0.001), after adjusting for potential confounders. In receiver operating characteristic (ROC) analyses, the panel combination of blood ferritin, glucose, and ALT showed the best prediction for liver fat mass (area under the curve (AUC) 0.82). A combination of ferritin and ALT showed the higher predictive ability for estimating liver iron content (AUC 0.73). This investigation demonstrated the association of serum ferritin with liver health as well as with glucose and lipid metabolism markers in subjects with NAFLD. Current findings led to the identification of ferritin as a potential noninvasive predictive biomarker of NAFLD, whose surrogate value increased when combined with other routine biochemical measurements (glucose/ALT)

Association of the SH2B1 rs7359397 gene polymorphism with steatosis severity in subjects with obesity and non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a major cause of liver disease worldwide. Some genetic variants might be involved in the progression of this disease. The study hypothesized that individuals with the rs7359397 T allele have a higher risk of developing severe stages of NAFLD compared with non-carriers where dietary intake according to genotypes could have a key role on the pathogenesis of the disease. SH2B1 genetic variant was genotyped in 110 overweight/obese subjects with NAFLD. Imaging techniques, lipidomic analysis and blood liver biomarkers were performed. Body composition, general biochemical and dietary variables were also determined. The SH2B1 risk genotype was associated with higher HOMA-IR p equal 0.001; and Fatty Liver Index (FLI) p equal 0.032. Higher protein consumption (p equal 0.028), less mono-unsaturated fatty acid and fiber intake (p equal 0.045 and p equal 0.049, respectively), was also referred to in risk allele genotype. Lipidomic analysis showed that T allele carriers presented a higher frequency of non-alcoholic steatohepatitis (NASH) (69.1/100 vs. 44.4/100; p equal 0.006). In the genotype risk group, adjusted logistic regression models indicated a higher risk of developing an advanced stage of NAFLD measured by FLI (OR 2.91) and ultrasonography (OR 4.15). Multinomial logistic regression models showed that risk allele carriers had higher liver fat accumulation risk (RRR 3.93) and an increased risk of NASH (RRR 7.88). Consequently, subjects carrying the T allele were associated with a higher risk of developing a severe stage of NAFLD. These results support the importance of considering genetic predisposition in combination with a healthy dietary pattern in the personalized evaluation and management of NAFLD

Cuentos de nunca acabar. Aproximaciones desde la interculturalidad

Cuentos de nunca acabar. Aproximaciones desde la interculturalidad, surge después de la pandemia y su imposibilidad de socializar “en persona” con los compañeros de eventuales encuentros, porque la Comprensión Lectora tenía que reinventarse para su nueva reflexión cognitiva, adaptación contextual y reconstrucción del conocimiento. Este renovado enfoque de la realidad postpandemia, concebido en el marco de la educación intercultural comunitaria, busca potencializar los entornos naturales, sociales y culturales como recursos de aprendizaje multidisciplinario a través del lenguaje animado de los cuentos. En este marco, había que dinamizar la asignatura de Comunicación Oral y Escrita, que se dicta en los Primeros Niveles de los Centros de Apoyo de Otavalo, Cayambe, Latacunga y Riobamba, mediante un eje transversal donde los estudiantes escriban fundamentados en valores de la cosmovisión andina, considerando que provienen de varios lugares de la sierra y amazonía ecuatoriana. Todo surgió del encuentro presencial de un sábado cualquiera donde los estudiantes realizaban ejercicios narrativos, logrando una apreciable respuesta de imaginación, más emotiva que la clásica tarea de las Unidades, tanto así que, pasados unos días, seguían llegando sus escritos a mi correo. Entonces nos pusimos manos a la obra, cada estudiante tendría dos opciones como Actividad Integradora, la primera consistía en escribir un cuento de su propia inspiración, y la segunda analizar un clásico para comentar sus valores y antivalores. La mayor parte de estudiantes decidió escribir su propio cuento, de donde se escogieron algunas participaciones que podrían considerarse originales, para una edición que, respetando la transcripción de la tradición oral que prima en los sectores comunitarios, nos concretamos en revisar la puntuación y ortografía para publicarlos. Con esto buscamos innovar la Actividad Integradora, por algo más práctico y operativo para configurar los Objetos de Aprendizaje que buscamos. Así nació, en medio del camino, este libro de Cuentos de nunca acabar. Aproximaciones desde la interculturalidad, que ponemos en sus manos. Hernán Hermosa Mantilla Quito, junio de 202

Prevalence of vertebral artery origin stenosis and occlusion in outpatient extracranial ultrasonography

Most data on the prevalence of vertebral artery origin (VAo) disease is derived from hospital-based studies of patients with posterior circulation strokes and TIA. The prevalence of VAo disease in patients without posterior circulation symptoms or asymptomatic patients is poorly characterized. Our objective was to examine the prevalence of VAo stenosis and occlusion in consecutive patients, presenting for extracranial ultrasonography to an outpatient laboratory. We retrospectively identified 2490 consecutive extracranial duplex studies performed in an ambulatory neurovascular ultrasound laboratory. All studies were reviewed for the presence of >50% VAo stenosis, defined as a PSV > 114 cm/s, and VA occlusion. We also reviewed the prevalence of >50% carotid stenosis, defined as a PSV > 120 cm/s, in the same population, to draw comparisons with VAo stenosis prevalence. We identified right VAo stenosis in 52/1955 (2.7%) and occlusion in 74/1955 (3.9%) and left-sided VAo stenosis in 45/1973 (2.5%) and occlusion in 64/1973 (3.6%). The prevalence of having any (either right or left) VAo stenosis or occlusion was 8.2% and 1.4% had bilateral VAo stenosis or occlusion. Right carotid stenosis and occlusion was found in 236/2399 (9.8%) and 53/2399 (2.2%) and left carotid stenosis and occlusion in 236/2397 (9.8%) and 45/2397 (1.9%), respectively. Any carotid disease, either right or left, was present in 18.9% and 4.7% had bilateral carotid disease. Although less prevalent than cervical carotid disease, we found that approximately 8% of patients who presented to an ambulatory ultrasound laboratory had >50% VAo disease

Abstract 3422: Prevalence Of Vertebral Artery Origin Stenosis In Outpatients Referred For Extracranial Duplex

Introduction: Extracranial atherosclerotic stenosis of the vertebral artery occurs characteristically at the vertebral artery origin (VAo) and is an important cause of posterior circulation stroke. The proximal segment of the vertebral artery is technically difficult to insonate. Only a few studies have reported on the prevalence of VAo disease in patients with stroke and little is known about its prevalence in non-hospitalized populations. Our objective was to determine the prevalence of VAo stenosis in subjects referred for outpatient extracranial ultrasonography. Methods: All studies performed in an outpatient neurosonology laboratory, affiliated with an academic medical center were retrospectively reviewed for VAo stenosis. The proximal vertebral segments were insonated following a standard protocol. VAo stenosis was diagnosed if the peak systolic velocity (PSV) > 114cm/sec, according to previously validated criteria. We also considered the VAo to be occluded if no flow signal could be found in any of its pre-and intraforaminal segments. Studies were also analyzed for internal carotid artery origin (ICAo) stenosis >50% to allow comparison between prevalence of carotid and VAo stenosis. Results: A total of 2490 subjects were available for analysis. The right and left VAo could not be insonated in18% and 25% of patients. Right-sided VAo stenosis or occlusion was present in 52/1955 (2.7%) and 74/1955 (3.9%) respectively; left-sided VAo stenosis or occlusion was present in 45/1793 (2.5%) and 64/1973 (3.6%) respectively. Overall, in those with at least one VAo insonated, 204/ 2119 (8.2%) patients had VAo stenosis or occlusion. In 29/ 2119 (1.4%), bilateral VAo stenosis or occlusion was found. Mean flow velocities were significantly lower in patients without stenosis (right 54.2±18.9 vs.149.0±57.8cm/s; left 53.5±17.5 vs.143.9±31.4cm/s). The prevalence of having either right or left ICAo stenosis or occlusion was 453/ 2401 (18.9%) and bilateral ICAo stenosis or occlusion was 112/ 2401 (4.7%). In univariate analysis, but not multivariate analysis, hypertension and diabetes were risk factors for VAo stenosis. Conclusion: The prevalence of VAo stenosis and occlusion was 8.2% in a diverse population of patients presenting to an ambulatory ultrasound laboratory. We found the prevalence of ICAo stenosis to be higher than VAo stenosis in the same population. Our findings contribute to the understanding of the prevalence of proximal vertebral artery disease in non-hospitalized patients

Análisis de la situación actual de los pequeños productores de banano objeto de la reforma agraria en los corregimientos de Sevilla Y Guacamayal (Magdalena).

El estudio se centró fundamentalmente en el análisis de las condiciones económicas de producción, teniendo como punto de partida el manejo de dos hipótesis centrales de trabajo: La primera consistió en comprobar que subsiste en los pequeños productores que fueron objeto de Reforma Agraria, una limitación en su capacidad de gestión empresarial generada por su curva de experiencia como asalariado; la segunda hipótesis que se trabaja hace referencia al tamaño de las parcelas que dado el tipo de producción, el área asignada, supera la necesaria para que la unidad familiar pueda vivir dignamente. La población estudiada se analizó separadamente pus se encontró que de los inicialmente beneficiarios, solo el 50% logró conservar sus parcelas. El análisis así realizado nos permitió comprobar las hipótesis dada la diferencia en los logros de la gestión empresarial adelantada por los productores beneficiarios y los productores no beneficiarios. 2 La información procesada estuvo constituida por datos cuantitativos tanto a nivel físico como son la producción, productividad y uso de recursos; como a nivel de valoración para verificar su aspecto económico; uno y otro criterio caracterizó la comprobación de la hipótesis

Tratamiento homeopático en pacientes hipertensos de preoperatorio de urgencia

Se realiza un estudio explicativo experimental, de carácter prospectivo, en la sala de preoperatorio de la unidad quirúrgica del Hospital General Docente “Dr. Agostinho Neto, en el período comprendido desde noviembre de 2008 hasta abril de 2009, con el objetivo de comprobar la efectividad del tratamiento homeopático en pacientes hipertensos. Se atienden 107 pacientes hipertensos de diferentes estadios para intervención quirúrgica urgente. Se asignan cuatro grupos: grupo G (Glonoinum), grupo P (Phosphorus), grupo R (Rescue Remedy) y grupo N (Nifedipina, grupo control). La terapia es eficaz en los grupos G y P, en los casos del Rescue Remedy y Nifedipina se comportan de forma similar. Hay escasos efectos indeseables en las terapias naturales a diferencia de la Nifedipina.