Sociodemographic and health predictors of concern about COVID-19 infection in Cuban patients with type 2 diabetes mellitus

Introduction: Concern about becoming infected is a particularly relevant psychological aspect in the context of a pandemic, as it is associated with social reactions and behavioral changes. Objectives: The present study sought to determine some sociodemographic and health factors associated with concern about COVID-19 infection in Cuban patients with type 2 diabetes mellitus. Methods: 203 patients with type 2 diabetes mellitus, who attended nine primary care areas of four Cuban provinces belonging to different regions of the country (65.52% female, mean age 57.5, SD=19.2), selected through non-probabilistic sampling, participated in the study. A sociodemographic questionnaire, the COVID-19 contagion concern scale (PRE-COVID-19) and an evaluation of blood glucose level were applied. Bivariate associations were examined with a series of analyses of variance (ANOVA). Adjusted (multiple) regression with all predictors running simultaneously was also used. Results: Bivariate analyses showed that age, sex, education, occupation, having comorbidities, and having a family member or friend who had COVID-19 were significantly related to COVID-19 contagion concern. However, when all variables were included simultaneously, only age, technical education, having comorbidities, and having a friend or family member who had COVID-19 remained significant predictors of concern about COVID-19 infection. Conclusions: Male patients, with a technical level of education, with comorbidities and those who had infected family members or friends presented greater concern for the contagion of COVID-19. The public health policies should develop strategies to assess the mental health of people belonging to vulnerable groups and provide interventions to promote mental health in those who show concern about infection

Mortalidad temprana por cáncer de mama en Ciego de Ávila, 2014 a 2016

Introducción: el cáncer de mama es una enfermedad sistémica, multifactorial, polimorfa caracterizada por la proliferación maligna, acelerada y desordenada de las células de los tejidos de la glándula mamaria. Objetivo: determinar la relación de variables epidemiológicas, clínico-patológicas y de tratamiento con la mortalidad a los cinco años de diagnosticadas las pacientes con cáncer de mama en la provincia de Ciego de Ávila.Método: se realizó un estudio observacional, analítico longitudinal retrospectivo de casos y controles. Se revisaron las bases de datos de la consulta de patología de mama, del Hospital Provincial Docente “Antonio Luaces Iraola”; analizándose todas las pacientes que acudieron a esta, desde octubre de 2014 hasta diciembre de 2016, se trabajó con las 318 pacientes que conformaron el universo. Se emplearon medidas de resumen para datos cualitativos y cuantitativos y se evaluó mediante pruebas estadísticas si dos variables categóricas son independientes entre sí o están relacionadas estadísticamente. Resultados: en el estudio (caso vs control), la media de edad (68,1 % vs 55,4 %; p=0,000), la dimensión de la lesión (2,8 % vs 2,0 %; p=0,001), el estadio a partir del IIb (p=0,001), la infiltración ganglionar (52,9 % vs 37,9 %; p=0,035) y las recaídas (54,3 % vs 5,2 %; p=0,000) fueron significativamente mayor en el grupo caso. La localización, el tipo histológico y el tratamiento clínico-quirúrgico, no mostraron diferencias significativas entre los grupos.Conclusiones: la edad, la dimensión de la lesión, el estadio, la infiltración ganglionar y las recaídas, estuvieron relacionados con la mortalidad temprana de estas pacientes

Small bowel enteroscopy - A joint clinical guideline from the spanish and portuguese small bowel study groups

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.Estas recomendações baseadas na evidência detalham o uso da enteroscopia assistida por dispositivo no manejo clínico das doenças do intestino delgado. Um conjunto de Gastrenterologistas diferenciados em patologia do intestino delgado foi selecionado pelos grupos de estudos Espanhol e Português de intestino delgado para rever a evidência disponível sobre as principais indicações desta técnica, o seu papel nos algoritmos de manejo de cada indicação e sobre o seu rendimento diagnóstico e terapêutico. Foi gerado um conjunto de recomendações pelos autores

Clinical Presentation and Outcomes of Kawasaki Disease in Children from Latin America: A Multicenter Observational Study from the REKAMLATINA Network

Objetivos: Describir la presentación clínica, el manejo y los resultados de la enfermedad de Kawasaki (EK) en Latinoamérica y evaluar los indicadores pronósticos tempranos de aneurisma de la arteria coronaria (AAC). Diseño del estudio: Se realizó un estudio observacional basado en el registro de la EK en 64 centros pediátricos participantes de 19 países latinoamericanos de forma retrospectiva entre el 1 de enero de 2009 y el 31 de diciembre de 2013, y de forma prospectiva desde el 1 de junio de 2014 hasta el 31 de mayo de 2017. Se recopilaron datos demográficos, clínicos y de laboratorio iniciales. Se utilizó una regresión logística que incorporaba factores clínicos y la puntuación z máxima de la arteria coronaria en la presentación inicial (entre 10 días antes y 5 días después de la inmunoglobulina intravenosa [IGIV]) para desarrollar un modelo pronóstico de AAC durante el seguimiento (>5 días después de la IGIV). Resultados: De 1853 pacientes con EK, el ingreso tardío (>10 días tras el inicio de la fiebre) se produjo en el 16%, el 25% tuvo EK incompleta y el 11% fue resistente a la IGIV. Entre los 671 sujetos con puntuación z de la arteria coronaria notificada durante el seguimiento (mediana: 79 días; IQR: 36, 186), el 21% presentaba AAC, incluido un 4% con aneurismas gigantes. Un modelo pronóstico simple que utilizaba sólo una puntuación z de la arteria coronaria máxima ≥2,5 en la presentación inicial fue óptimo para predecir la AAC durante el seguimiento (área bajo la curva: 0,84; IC del 95%: 0,80, 0,88). Conclusiones: De nuestra población latinoamericana, la puntuación z de la arteria coronaria ≥2,5 en la presentación inicial fue el factor pronóstico más importante que precedió a la AAC durante el seguimiento. Estos resultados resaltan la importancia de la ecocardiografía temprana durante la presentación inicial de la EK. © 2023 Los autoresObjectives: To describe the clinical presentation, management, and outcomes of Kawasaki disease (KD) in Latin America and to evaluate early prognostic indicators of coronary artery aneurysm (CAA). Study design: An observational KD registry-based study was conducted in 64 participating pediatric centers across 19 Latin American countries retrospectively between January 1, 2009, and December 31, 2013, and prospectively from June 1, 2014, to May 31, 2017. Demographic and initial clinical and laboratory data were collected. Logistic regression incorporating clinical factors and maximum coronary artery z-score at initial presentation (between 10 days before and 5 days after intravenous immunoglobulin [IVIG]) was used to develop a prognostic model for CAA during follow-up (>5 days after IVIG). Results: Of 1853 patients with KD, delayed admission (>10 days after fever onset) occurred in 16%, 25% had incomplete KD, and 11% were resistant to IVIG. Among 671 subjects with reported coronary artery z-score during follow-up (median: 79 days; IQR: 36, 186), 21% had CAA, including 4% with giant aneurysms. A simple prognostic model utilizing only a maximum coronary artery z-score ≥2.5 at initial presentation was optimal to predict CAA during follow-up (area under the curve: 0.84; 95% CI: 0.80, 0.88). Conclusion: From our Latin American population, coronary artery z-score ≥2.5 at initial presentation was the most important prognostic factor preceding CAA during follow-up. These results highlight the importance of early echocardiography during the initial presentation of KD. © 2023 The Author(s

Genetic landscape of 6089 inherited retinal dystrophies affected cases in Spain and their therapeutic and extended epidemiological implications

Inherited retinal diseases (IRDs), defined by dysfunction or progressive loss of photoreceptors, are disorders characterized by elevated heterogeneity, both at the clinical and genetic levels. Our main goal was to address the genetic landscape of IRD in the largest cohort of Spanish patients reported to date. A retrospective hospital-based cross-sectional study was carried out on 6089 IRD affected individuals (from 4403 unrelated families), referred for genetic testing from all the Spanish autonomous communities. Clinical, demographic and familiar data were collected from each patient, including family pedigree, age of appearance of visual symptoms, presence of any systemic findings and geographical origin. Genetic studies were performed to the 3951 families with available DNA using different molecular techniques. Overall, 53.2% (2100/3951) of the studied families were genetically characterized, and 1549 different likely causative variants in 142 genes were identified. The most common phenotype encountered is retinitis pigmentosa (RP) (55.6% of families, 2447/4403). The most recurrently mutated genes were PRPH2, ABCA4 and RS1 in autosomal dominant (AD), autosomal recessive (AR) and X-linked (XL) NON-RP cases, respectively; RHO, USH2A and RPGR in AD, AR and XL for non-syndromic RP; and USH2A and MYO7A in syndromic IRD. Pathogenic variants c.3386G > T (p.Arg1129Leu) in ABCA4 and c.2276G > T (p.Cys759Phe) in USH2A were the most frequent variants identified. Our study provides the general landscape for IRD in Spain, reporting the largest cohort ever presented. Our results have important implications for genetic diagnosis, counselling and new therapeutic strategies to both the Spanish population and other related populations.This work was supported by the Instituto de Salud Carlos III (ISCIII) of the Spanish Ministry of Health (FIS; PI16/00425 and PI19/00321), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER, 06/07/0036), IIS-FJD BioBank (PT13/0010/0012), Comunidad de Madrid (CAM, RAREGenomics Project, B2017/BMD-3721), European Regional Development Fund (FEDER), the Organización Nacional de Ciegos Españoles (ONCE), Fundación Ramón Areces, Fundación Conchita Rábago and the University Chair UAM-IIS-FJD of Genomic Medicine. Irene Perea-Romero is supported by a PhD fellowship from the predoctoral Program from ISCIII (FI17/00192). Ionut F. Iancu is supported by a grant from the Comunidad de Madrid (CAM, PEJ-2017-AI/BMD7256). Marta del Pozo-Valero is supported by a PhD grant from the Fundación Conchita Rábago. Berta Almoguera is supported by a Juan Rodes program from ISCIII (JR17/00020). Pablo Minguez is supported by a Miguel Servet program from ISCIII (CP16/00116). Marta Corton is supported by a Miguel Servet program from ISCIII (CPII17/00006). The funders played no role in study design, data collection, data analysis, manuscript preparation and/or publication decisions

4to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

Este volumen acoge la memoria académica de la Cuarta edición del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2017, desarrollado entre el 29 de noviembre y el 1 de diciembre de 2017 y organizado por la Universidad Politécnica Salesiana (UPS) en su sede de Guayaquil. El Congreso ofreció un espacio para la presentación, difusión e intercambio de importantes investigaciones nacionales e internacionales ante la comunidad universitaria que se dio cita en el encuentro. El uso de herramientas tecnológicas para la gestión de los trabajos de investigación como la plataforma Open Conference Systems y la web de presentación del Congreso http://citis.blog.ups.edu.ec/, hicieron de CITIS 2017 un verdadero referente entre los congresos que se desarrollaron en el país. La preocupación de nuestra Universidad, de presentar espacios que ayuden a generar nuevos y mejores cambios en la dimensión humana y social de nuestro entorno, hace que se persiga en cada edición del evento la presentación de trabajos con calidad creciente en cuanto a su producción científica. Quienes estuvimos al frente de la organización, dejamos plasmado en estas memorias académicas el intenso y prolífico trabajo de los días de realización del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad al alcance de todos y todas

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. METHODS: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. FINDINGS: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2-11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75-1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58-1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91-1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70-1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11-0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50-0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38-0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45-0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. INTERPRETATION: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. FUNDING: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

COVID-19 contagion concern scale (PRE-COVID-19): Validation in Cuban patients with type 2 diabetes

ABSTRACT Aims It is important to have valid and reliable measures to determine the psychological impact of COVID-19 in patients with diabetes; however, few instruments have been developed and validated for this population. Therefore, the aim of this study was to validate the Scale of Worry for Contagion of COVID-19 (PRE-COVID-19) in a sample of patients with diabetes mellitus (DM). Materials and methods A total of 219 patients (66.2% female, mean age 58.5 SD = 18.2) participated, selected through non-probabilistic sampling. The PRE-COVID-19 and the Generalized Anxiety Disorder Scale-2 were applied. Reliability analysis was performed for internal consistency, structural equation modeling and item response theory modeling. Results The results show that a unidimensional 5-item model presents satisfactory goodness-of-fit indices and excellent reliability values. Likewise, convergent validity between the PRE-COVID-19 and a measure of anxiety is evident. All items present adequate discrimination parameters, allowing for discerning between those patients with critical concern about COVID-19 contagion from those with severe concern. Conclusion It is concluded that the PRE-COVID-19 is an instrument with adequate psychometric properties to measure concern about COVID-19 infection and the emotional impact in patients with DM

La aterosclerosis carotídea y el tratamiento de sus complicaciones

Se realizó una revisión bibliográfica con el objetivo de describir la aterosclerosis carotidea y el tratamiento de sus complicaciones más frecuente. Se hace referencia a la fisiopatología, síntomas, signos y al diagnóstico de esta enfermedad, así como las opciones terapéuticas utilizadas en el ictus. Por tal motivo se consultaron libros de texto y revistas, así como artículos publicados en redes informáticas para un total de 53 referencias bibliográficas, que reflejaron como las enfermedades cardiovasculares y cerebrales de origen ateroescleróticos son responsables de millones de muertes anuales, siendo la aterosclerosis carotidea una causa prevenible de afectaciones neurológicas que muestra avances terapéuticos alentadores

Publicación de los trabajos presentados en las ediciones 2016 y 2018 del Evento Científico Estudiantil Nacional de Medicina Interna - Medintávila

Introduction: Much of the research works developed by students and presented in scientific events are not published in scientific journals. Objective: To characterize the research works presented in the 2016 and 2018 editions of the Evento Científico Estudiantil Nacional de Medicina Interna (National Student Scientific Event on Internal Medicine - (MEDINTÁVILA) and those published in scientific journals, as well as to identify factors associated with their publication. Materials and methods: Cross-sectional analytical study. A search strategy was carried out in April 2020 in Google Scholar in order to verify if the works presented in the 2016 y 2018 editions of the event had been published, in English or Spanish, in scientific journals. Bivariate analyses were performed to determine whether there were characteristics of the works associated with their publication, calculating prevalence ratios, along with their corresponding 95% confidence intervals and p-values and using generalized linear models (family=Poisson; link=log) in which each university submitting the research work was used as a cluster. A significance level of p&lt;0.05 was considered. Results: Out of the 335 research works analyzed, 180 (53.73%) were presented at the 2016 edition. Regarding typology and the topics they addressed, 190 (56.72%) were classified under the free topics category, and 170 addressed chronic illnesses (50.75%). A total of 24 works were published (7.16%), of which only 9 were cited, and there were authoring changes in 19 (79.17%). No factors associated with the publication of the works were identified in the bivariate analysis. Conclusion: The publication in scientific journals of the research works presented in both editions of the event is very low, thus it is necessary for Cuban universities to provide medical science students with more research-related support, since this could increase the probability of publishing their works.Introducción. Muchas de las investigaciones desarrolladas por estudiantes y presentadas en eventos científicos no se publican en revistas científicas. Objetivos. Caracterizar los trabajos presentados en las ediciones 2016 y 2018 del Evento Científico Estudiantil Nacional de Medicina Interna (Medintávila) y los publicados en revistas científicas, así como identificar los factores asociados a su publicación. Materiales y métodos. Estudio transversal analítico. Mediante una estrategia de búsqueda realizada en abril de 2020 en Google Académico, se constató si los trabajos presentados en 2016 y 2018 en el evento habían sido publicados, en inglés o español, en revistas científicas. Se realizaron análisis bivariados para determinar si hubo características de los trabajos asociadas con su publicación, calculándose razones de prevalencia, junto con sus respectivos intervalos de confianza al 95% y valores p mediante modelos lineales generalizados (familia Poisson, función de enlace log) en los que se usó como clúster a cada universidad que presentó la investigación. Se consideró un nivel de significancia de p&lt;0.05. Resultados. De los 335 trabajos analizados, 180 (53.73%) correspondieron a la edición de 2016. Respecto a la tipología y temática, 190 (56.72%) fueron clasificados bajo la categoría Temas libres y 170 (50.75%) abordaron Enfermedades crónicas. Se publicaron 24 (7.16%) trabajos, de los cuales solo 9 fueron citados, y en 19 (79.17%) hubo cambios de autores. No se identificaron factores asociados a la publicación de los trabajos en el análisis bivariado. Conclusión. La publicación en revistas científicas de los trabajos presentados en ambas ediciones del Medintávila es muy baja, por lo que es necesario que las universidades cubanas brinden más apoyo en investigación a los estudiantes de ciencias médicas, ya que esto podría aumentar las probabilidades de publicación de sus trabajos