RIESGO ERGONÓMICO RELACIONADO A LA LUMBALGIA OCUPACIONAL EN ENFERMEROS DEL HOSPITAL DE CONTINGENCIA HERMILIO VALDIZÁN MEDRANO – HUÁNUCO 2018

Objetivo general: Determinar la relación que existe entre los riesgos ergonómicos y la lumbalgia ocupacional en los enfermeros que laboran en el Hospital de Contingencia Hermilio Valdizán Medrano – Huánuco 2018. Métodos: Se realizó un estudio descriptivo relacional con diseño correlacional en 129 profesionales de Enfermeria, aplicando una escala de riesgos ergonómicos y un cuestionario de lumbalgia ocupacional en la recolección de datos. El análisis inferencial se realizó con la prueba de Chi Cuadrado de Independencia con una significancia estadística p<0,05. Resultados: Respecto a los riesgos ergonómicos, 57.4% presento riesgo alto, 31.0% riesgo medio y 11.6% riesgo bajo. En cuanto a la lumbalgia ocupacional, 60,5% no presentaron lumbalgia y 39,5% si tuvieron lumbalgia ocupacional. Los riesgos ergonómicos se relacionaron significativamente con la lumbalgia ocupacional en los profesionales de Enfermería en estudio [X2 = 12,623; p = 0,002]. También se encontró relación entre los riesgos ergonómicos en la dimensión movimientos corporales (p = 0,001); posturas corporales (p = 0,003); manipulación de cargas (p = 0,001); bipedestación prolongada (p = 0,000); y condiciones del ambiente de trabajo (p = 0,001) con la lumbalgia ocupacional en la muestra en estudio. Conclusiones: Los riesgos ergonómicos se relacionan con la lumbalgia ocupacional en los enfermeros en estudio; se rechaza la hipótesis nula y se acepta la hipótesis de investigación.Tesi

Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease

OBJECTIVE: To determine the percentage of children with nonalcoholic fatty liver disease (NAFLD) in whom intervention for low-density lipoprotein cholesterol or triglycerides was indicated based on National Heart, Lung, and Blood Institute guidelines. STUDY DESIGN: This multicenter, longitudinal cohort study included children with NAFLD enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Nonalcoholic Steatohepatitis Clinical Research Network. Fasting lipid profiles were obtained at diagnosis. Standardized dietary recommendations were provided. After 1 year, lipid profiles were repeated and interpreted according to National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction. Main outcomes were meeting criteria for clinically actionable dyslipidemia at baseline, and either achieving lipid goal at follow-up or meeting criteria for ongoing intervention. RESULTS: There were 585 participants, with a mean age of 12.8 years. The prevalence of children warranting intervention for low-density lipoprotein cholesterol at baseline was 14%. After 1 year of recommended dietary changes, 51% achieved goal low-density lipoprotein cholesterol, 27% qualified for enhanced dietary and lifestyle modifications, and 22% met criteria for pharmacologic intervention. Elevated triglycerides were more prevalent, with 51% meeting criteria for intervention. At 1 year, 25% achieved goal triglycerides with diet and lifestyle changes, 38% met criteria for advanced dietary modifications, and 37% qualified for antihyperlipidemic medications. CONCLUSIONS: More than one-half of children with NAFLD met intervention thresholds for dyslipidemia. Based on the burden of clinically relevant dyslipidemia, lipid screening in children with NAFLD is warranted. Clinicians caring for children with NAFLD should be familiar with lipid management

In Children with Nonalcoholic Fatty Liver Disease, Zone 1 Steatosis is Associated with Advanced Fibrosis

Background & Aims Focal zone 1 steatosis, although rare in adults with nonalcoholic fatty liver disease (NAFLD), does occur in children with NAFLD. We investigated whether focal zone 1 steatosis and focal zone 3 steatosis are distinct subphenotypes of pediatric NAFLD. We aimed to determine associations between the zonality of steatosis and demographic, clinical, and histologic features in children with NAFLD. Methods We performed a cross-sectional study of baseline data from 813 children (age <18 years; mean age, 12.8 ± 2.7 years). The subjects had biopsy-proven NAFLD and were enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network. Liver histology was reviewed using the Nonalcoholic Steatohepatitis Clinical Research Network scoring system. Results Zone 1 steatosis was present in 18% of children with NAFLD (n = 146) and zone 3 steatosis was present in 32% (n = 244). Children with zone 1 steatosis were significantly younger (10 vs 14 years; P < .001) and a significantly higher proportion had any fibrosis (81% vs 51%; P < .001) or advanced fibrosis (13% vs 5%; P < .001) compared with children with zone 3 steatosis. In contrast, children with zone 3 steatosis were significantly more likely to have steatohepatitis (30% vs 6% in children with zone 1 steatosis; P < .001). Conclusions Children with zone 1 or zone 3 distribution of steatosis have an important subphenotype of pediatric NAFLD. Children with zone 1 steatosis are more likely to have advanced fibrosis and children with zone 3 steatosis are more likely to have steatohepatitis. To achieve a comprehensive understanding of pediatric NAFLD, studies of pathophysiology, natural history, and response to treatment should account for the zonality of steatosis

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes