Quiste de colédoco y embarazo. Reporte de 3 casos y revisión de la bibliografía

ResumenAntecedentesLos quistes de colédoco son una enfermedad rara que afecta principalmente a mujeres en la infancia, pero que pueden presentarse durante el embarazo. Sus síntomas y signos están opacados por los cambios en esta fase, por lo que el diagnóstico puede ser tardío y sus complicaciones poner en peligro tanto a la madre como al producto.ObjetivoPresentar 3 casos de quiste de colédoco en embarazadas, tratadas en un hospital de tercer nivel.Casos clínicosPresentamos 3 pacientes con diagnóstico de quiste de colédoco durante el embarazo. Dos desarrollaron datos de colangitis; la primera fue intervenida quirúrgicamente con anastomosis hepaticoyeyunal, pero abortó y falleció al décimo día del postoperatorio. La segunda tuvo una cesárea pretérmino por sufrimiento fetal; 4 semanas después fue intervenida con anastomosis hepaticoyeyunal, pero tuvo una perforación gástrica y falleció por complicaciones sépticas. La tercera no desarrolló colangitis, tuvo un embarazo sin complicaciones, se le realizó anastomosis hepaticoyeyunal 4 semanas después, con buenos resultados.ConclusionesEl tratamiento de los quistes de colédoco durante el embarazo está relacionado con la presencia de colangitis. Cuando no responden al tratamiento médico, la descompresión de la vía biliar está indicada. El tratamiento definitivo debe realizarse una vez resuelto el embarazo.AbstractBackgroundCholedochal cysts are rare. They usually present during childhood in women, but it can also be seen during pregnancy. Clinical signs and symptoms are obscured during this time, thus it can complicate the diagnosis and represent a life threatening complication for both the mother and the child.ObjectiveTo communicate the case of 3 pregnant patients with choledochal cyst.Clinical casesThree pregnant women in which choledochal cyst were diagnosed. Two developed signs of cholangitis. The first one underwent a hepatic-jejunostomy, but had an abortion and died on postoperative day 10. The second one had a preterm caesarean operation due to foetal distress and underwent a hepatic-jejunostomy 4 weeks later; during her recovery she had a gastric perforation and died of septic complications. The third one did not develop cholangitis or jaundice. She had an uneventful pregnancy and had a hepatic-jejunostomy 4 weeks later with good results.ConclusionsManagement of choledochal cysts during pregnancy is related to the presence of cholangitis. When they do not respond to medical treatment, decompression of the biliary tree is indicated. Definitive treatment should be performed after resolution of the pregnancy

Prevalence and Predictors of Burnout in Midwives: A Systematic Review and Meta-Analysis

The prevalence of burnout in midwives has been briefly studied. Given the negative effects of burnout syndrome in the physical and mental health, and also related to the quality of care provided, rates of absenteeism and sick leave; identifying related factors for the syndrome are needed. The aim was to determine the prevalence, levels, and factors related to the burnout syndrome, measured with the Copenhagen Burnout Inventory in midwives. A systematic review and meta-analysis were selected from CINAHL, LILACS, ProQuest, PsycINFO, PubMed, SciELO, and Scopus databases, with the search equation “burnout AND (midwife OR midwives OR nurses midwives)”. Fourteen articles were found with a total of 8959 midwives. Most of the studies showed moderate levels of personal burnout. The prevalence obtained was 50% (95% CI = 38–63) for personal burnout; 40% (95% CI = 32–49) for work-related burnout; and 10% (95% CI = 7–13) for client-related burnout. Midwives’ age, less experience, and living alone constitute the main related factors, as well as, the scarcity of resources, work environment, and the care model used. Most midwives present personal and work-related burnout, which indicates a high risk of developing burnout. Personal factors and working conditions should be taken into account when assessing burnout risk profiles of midwives

Amoxicillin and Clarithromycin Mucoadhesive Delivery System for Helicobacter pylori Infection in a Mouse Model: Characterization, Pharmacokinetics, and Efficacy

Helicobacter pylori is the main pathogen responsible for gastric ulcers and a predisposing factor of stomach cancer. Although current treatment is usually successful, it requires high doses and frequent administration. An innovative mucoadhesive system (Mucolast®) loaded with amoxicillin and clarithromycin is proposed to improve the efficacy of treatment against H. pylori. The drug product was optimized based on its viscoelastic properties to obtain long-term stability of the vehicle. The drug release mechanisms were different for both antibiotics based on their solubilization status. A systemic and stomach pharmacokinetic profile was obtained after three different doses were administered to mice, obtaining similar systemic exposure levels but an increase in drug concentration in the stomach. The efficacy results in mice infected with H. pylori also demonstrated the superiority of the antibiotics when administered in Mucolast®, as shown by the bacterial count in stomach tissue and under histopathological and biochemical evaluation. The proposed treatment was efficacious and safe and is presented as a realistic alternative to current treatment options to improve patient compliance and to reduce bacterial resistance.Ministerio de Ciencia e Innovación. Gobierno de España (programa RETOS)-RTC-2015-4437-

Ultrassonografia, mamografia e correlação histopatológica no diagnóstico de câncer de mama em Guantánamo, 2010-2015

Introduction: since ancient times, breast cancer has been studied. It is current the most important invasive neoplasm in women and considered the leading cause of cancer deaths in women worldwide. Objective: to assess the ultrasound, mammographic and histopathological correlation for the diagnosis of breast cancer in Guantanamo province. Method: an observational, descriptive, and retrospective study was conducted in 140 patients during the period 2010-2015 at the Hospital General Docente "Dr. Agostinho Neto" in Guantánamo. The primary information was obtained from the Provincial Registry Database of Cancer with the diagnosis of malignant breast tumor.Results: the highest incidence of the disease was recorded in patients 45 plus years of age (80%), the average age at diagnosis was 57 ± 15 years. The left breast was more frequently affected than the right breast (53% vs. 46%), it was not common for both breasts be affected synchronously (less than 1%). The 53% of patients presented a lesion with a speculated appearance on mammography, solid appearance on ultrasound. This lesion, as per histology criteria, it corresponded to an infiltrating ductal carcinoma. Conclusions: there is a correlation between ultrasound, mammographic diagnoses and the breast cancer related definitive histopathological diagnosis.Introducción: el cáncer de mama se conoce desde épocas remotas, el tumor de mama es la neoplasia maligna más importante en la mujer. Se considera la primera causa de muerte por cáncer en las mujeres en el mundo. Objetivo: evaluar la correlación ecográfica, mamográfica e histopatológica del carcinoma de mama en la provincia de Guantánamo. Método: se realizó un estudio observacional, descriptivo, retrospectivo en 140 pacientes durante el período de 2010 a 2015 en el Hospital General Docente “Dr. Agostinho Neto” de Guantánamo. El dato primario se obtuvo del Registro Provincial de Cáncer con diagnóstico de tumor maligno de mama. Resultados: la mayor incidencia de la enfermedad se registró a partir de los 45 años (80 %), el promedio de edad del diagnóstico fue de 57 más menos 15 años. La mama izquierda tuvo una mayor frecuencia a verse afectada con respecto a la mama la derecha (53 % vs. 46 %), fue poco frecuente que ambas mamas se encontrasen afectadas de forma sincrónica (menos del 1 %). El 53 % presentó una lesión de aspecto espiculado en la mamografía, de aspecto sólido en la ecografía y correspondiente a un carcinoma ductal infiltrante por histología.  Conclusiones: existe correlación entre los diagnósticos ecográficos, mamográficos y el diagnóstico definitivo histopatológico del cáncer de mama.Introdução: o câncer de mama é conhecido desde a antiguidade, sendo o tumor de mama a neoplasia maligna mais importante na mulher. É considerada a principal causa de morte por câncer em mulheres no mundo. Objetivo: avaliar a correlação ecográfica, mamográfica e histopatológica do carcinoma de mama na província de Guantánamo. Método: estudo observacional, descritivo, retrospectivo, realizado em 140 pacientes durante o período de 2010 a 2015 no Hospital General Docente “Dr. Agostinho Neto” de Guantánamo. Os dados primários foram obtidos do Registro Provincial de Câncer com diagnóstico de tumor maligno de mama. Resultados: a maior incidência da doença foi registrada após 45 anos (80%), a média de idade do diagnóstico foi de 57 anos mais ou menos 15 anos. A mama esquerda teve maior frequência de acometimento em relação à mama direita (53% vs. 46%), sendo raro que ambas as mamas fossem acometidas de forma síncrona (menos de 1%). 53% apresentavam lesão com aspecto espiculado na mamografia, aspecto sólido na ultrassonografia e correspondendo a carcinoma ductal infiltrante pela histologia. Conclusões: existe correlação entre os diagnósticos ultrassonográfico e mamográfico e o diagnóstico histopatológico definitivo de câncer de mama

NADPH oxidase 1 as a new regulator of the WNT pathway and the protective effect of vitamin D in colorectal cancer

Trabajo presentado en el 43rd Annual Meeting of the SEBBM, celebrado en Barcelona (España) del 19 al 22 de julio de 2021.Worldwide, colorectal cancer (CRC) is the third most common malignant neoplasm and the second leading cause of cancer-associated mortality, with an estimated increase in global prevalence of 60% by 2030 (1,2). Mutational inactivation of adenomatous polyposis coli (APC) is the hallmark of CRC and leads to an overactivation of WNT signaling that favors the development and progression of CRC (3). Large epidemiological studies suggest that the diabetic population is at increased risk for site-specific cancers, including CRC (4). Our laboratory has shown that hyperglycemia induces the accumulation of ROS in CRC but not healthy cells, driving the activation of a newly described ROS/AMPK/EP300 axis that enhances Wnt/b-catenin signaling. Increased EP300 leads to increased acetylation of β-catenin at K354, a requirement for nuclear accumulation and transcriptional activation of WNT target genes (5,6). The critical role driven by ROS suggest a possible involvement of the NADPH oxidases (NOX family, as a source of ROS. Specifically, NOX 1 and NOX 4 are expressed in colon epithelial cells, and their overexpression in CRC cells promotes cell proliferation and invasiveness (7,8,9,10). Our results indicate that hyperglycemia significantly increases NOX1 levels, in correlation with increased ROS production in CRC cells, suggesting a possible regulation of the ROS/ AMPK/EP300 axis by NOX1. Antioxidant mechanisms dealing with NOX1-induced ROS should be effective against CRC. Vitamin D (1α, 25-dihydroxyvitamin D3) is a powerful antioxidant that inhibits proliferation and promotes differentiation of CRC cells at least partially through inhibition of Wnt/β-catenin signalling. Consequently, vitamin D deficiency is associated with poor survival to CRC (11,12). Our results indicate that vitamin D causes a reduction in the levels and / or activity of some members of the NOX family by turning off the ROS/AMPK/EP300/β-catenin axis and its proliferative and tumorigenic effects. The data suggest a new antitumor mechanism of vitamin D linked to its anti-oxidant action. Our results integrate independent epidemiological links between vitamin D deficiency, diabetes and cancer in one overarching and unifying mechanism

Comportamiento agronómico del Cenchrus purpureus vc. Cuba OM-22 en los llanos venezolanos

Antecedentes: El Cenchrus purpureus Cuba OM-22 es un forraje promisorio para la ganadería venezolana, por su alta producción y calidad. Objetivo. Evaluar los indicadores agronómicos y su relación con la edad de la planta y elementos del clima en los períodos lluviosos y poco lluvioso del año. Métodos: Se realizó un corte de uniformidad al inicio de cada período. Cada 15 días se determinaron la altura, longitud y ancho del cuarto par de hojas completamente abiertas y entrenudo, contenido de hojas y tallos, área foliar y rendimiento hasta los 75 días, según diseño de bloques al azar con cuatro réplicas. Se realizó un análisis de varianza y los valores se compararon según la prueba de rangos múltiples de comparación de medias y se establecieron ecuaciones de regresión. Resultados: Las variables agronómicas mostraron diferencias significativas (P<0,05) a medida que aumento la edad de rebrote, con efecto marcado en el porcentaje de hojas y tallos. Se establecieron ecuaciones lineales múltiples (P<0,001) (R2>0,90) para el rendimiento y porcentaje de hojas y tallos con la edad, las temperaturas medias y máximas y las precipitaciones. La curva de rendimiento mantuvo su fase logarítmica hasta los 75 días, donde mostró los mayores valores. Conclusiones: La edad y los elementos del clima mostraron un marcado efecto sobre los indicadores agronómicos. Los modelos de regresión mostraron alta relación de las variables evaluadas con la temperatura máxima y las precipitaciones. Palabras clave: factores climáticos, forraje, hoja, tallo, producción (Fuente: AIMS

Impact of Covid-19 pandemic on patients with immune thrombocytopaenia

Background and Objectives: The aim of this study was to determine the impact of the COVID-19 pandemic on the lives of patients with immune thrombocytopaenia (ITP) treated at our hospital. Materials and Methods: The study was conducted in the Community of Madrid, which has the highest number of COVID-19 cases in Spain. We included 143 adult patients with ITP (130 with chronic ITP, 8 with persistent ITP, and 5 with newly diagnosed ITP). We conducted a telephone survey to collect the data and created a registry. Materials and Methods: Overall, 24 patients presented symptoms suggestive of COVID-19, which was confirmed by RT-PCR in 8 cases. The cumulative incidence of confirmed SARS-CoV-2 infection was higher in the patients with ITP than in the Madrid population. There were no differences in the disease incidence or clinical course of infection in the patients treated with immunosuppressants. Almost all of the patients reported adherence to the prescribed treatment, although 49.2% of the hospital visits were either cancelled or postponed, 17.2% because of the patients’ fear of coming to the centre. Nearly half of the cohort was considered vulnerable, and 17% had been granted a dependency or disability benefit. Conclusions: COVID-19 had a major impact on the psychosocial, occupational, and quality of care of patients with ITP.This study was supported by FIS-Fondos FEDER PI19/00631 and PI19/00772 and by the Platelet Disorder Support Associatio

Principales medidas de profilaxis en endoscopia bariátrica. Guía Española de Recomendación de Expertos

Bariatric endoscopy (BE) encompasses a number of techniques -some consolidated, some under development- aiming to contribute to the management of obese patients and their associated metabolic diseases as a complement to dietary and lifestyle changes. To date different intragastric balloon models, suture systems, aspiration methods, substance injections and both gastric and duodenal malabsorptive devices have been developed, as well as endoscopic procedures for the revision of bariatric surgery. Their ongoing evolution conditions a gradual increase in the quantity and quality of scientific evidence about their effectiveness and safety. Despite this, scientific evidence remains inadequate to establish strong grades of recommendation allowing a unified perspective on prophylaxis in BE. This dearth of data conditions leads, in daily practice, to frequently extrapolate the measures that are used in bariatric surgery (BS) and/or in general therapeutic endoscopy. In this respect, this special article is intended to reach a consensus on the most common prophylactic measures we should apply in BE. The methodological design of this document was developed while attempting to comply with the following 5 phases: Phase 1: delimitation and scope of objectives, according to the GRADE Clinical Guidelines. Phase 2: setup of the Clinical Guide-developing Group: national experts, members of the Grupo Español de Endoscopia Bariátrica (GETTEMO, SEED), SEPD, and SECO, selecting 2 authors for each section. Phase 3: clinical question form (PICO): patients, intervention, comparison, outcomes. Phase 4: literature assessment and synthesis. Search for evidence and elaboration of recommendations. Based on the Oxford Centre for Evidence-Based Medicine classification, most evidence in this article will correspond to level 5 (expert opinions without explicit critical appraisal) and grade of recommendation C (favorable yet inconclusive recommendation) or D (inconclusive or inconsistent studies). Phase 5: External review by experts. We hope that these basic preventive measures will be of interest for daily practice, and may help prevent medical and/or legal conflicts for the benefit of patients, physicians, and BE in general

Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients' information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms)