Uso de aspirina 100 mg / dia para prevenção da pré-eclâmpsia, em gestações de alto risco, em uma coorte da Argentina

Objetivos: El objetivo de este estudio fue analizar la utilidad de la dosis de 100 mg de aspirina como medida de prevención para preeclampsia en pacientes embarazadas de alto riesgo. Métodos: Se realizó un estudio de cohorte retrospectivo de embarazadas de alto riesgo en seguimiento con un protocolo de tensión arterial y se evaluó la utilización de aspirina 100 mg vs la no utilización de la misma, en la incidencia de PREEC. Se realizó estimaciones de riesgos entre ambos grupos sin y con ajuste de variables con modelos de regresión logística binaria. Resultados: Fueron evaluadas 633 embarazadas de alto riesgo con promedio de 30±7 años y 25±8 semanas de gestación, de las cuales 281 mujeres (44,3%) recibieron aspirina. La prevalencia total de PREEC en nuestra muestra fue de 151 embarazadas (23,8%). Las embarazadas que estaban ingiriendo aspirina, desarrollaron menos eventos de PREEC (19.2% vs 27.5%, p=0.019); con OR no ajustado 0.62 (IC95% 0.43-0.91 p= 0.017). Siendo este riesgo similar cuando fue ajustado por edad, antecedentes de preeclampsia, diabetes mellitus e hipertensión arterial crónica. (OR ajustado 0.63 IC95% 0.43-0.92 p= 0.017). Conclusiones: La utilización de aspirina 100 mg por día antes de las 20 semanas de gestación en embarazadas de alto riesgo disminuyó el riesgo de desarrollar PREEC, independientemente de la edad y factores de riesgo.Objectives: The objective of the present study was to analyse the use of 100 g aspirin dose as prevention method for preeclampsia in high risk pregnant patients. Methods: A retrospective cohort study was performed in high risk pregnant patients with a blood pressure protocol, and the use of 100 mg of aspirin vs. its non-use was evaluated in the incidence of PREEC. Estimations between the two groups were performed with and without variable adjustment by means of binary logistic regression models. Results: 633 high risk pregnant patients were evaluated. The average age was 30±7 years old, and 25±8 weeks of pregnancy. 281 women (44.3 %) within this group received aspirin. The total prevalence of PREEC in our sample was 151 pregnant women (23.8 %). Pregnant patients under the aspirin treatment developed less PREEC events (19.2% vs 27.5%, p=0.019); with OR not adjusted 0.62 (IC95% 0.43-0.91 p= 0.017). The risk was similar when it was adjusted by age, preeclampsia history, diabetes mellitus and chronic high blood pressure. (OR adjusted 0.63 IC95% 0.43-0.92 p= 0.017). Conclusions: The use of 100 mg of aspirin a day before the 20th week of pregnancy in high risk pregnant patients decreased the risk of developing PREEC, regardless the age and risk factors.Metas: O objetivo deste estudo foi analisar a utilidade da dose de 100 mg de aspirina como medida preventiva para pré-eclâmpsia em gestantes de alto risco. Métodos: Realizou-se estudo de coorte retrospectivo de gestantes de alto risco em acompanhamento com protocolo de pressão arterial e avaliou-se o uso de aspirina 100 mg versus não uso na incidência de PREEC. As estimativas de risco foram feitas entre os dois grupos sem e com ajuste das variáveis com modelos de regressão logística binária. Resultados: Foram avaliadas 633 gestantes de alto risco com média de 30 ± 7 anos e 25 ± 8 semanas de gestação, sendo que 281 (44,3%) mulheres receberam aspirina. A prevalência total do PREEC em nossa amostra foi de 151 gestantes (23,8%). Mulheres grávidas que estavam tomando aspirina desenvolveram menos eventos PREEC (19,2% vs 27,5%, p = 0,019); com OR não ajustado 0,62 (IC 95% 0,43-0,91 p = 0,017). Esse risco é semelhante quando ajustado para idade, história de pré-eclâmpsia, diabetes mellitus e hipertensão arterial crônica. (OR ajustado 0,63 IC 95% 0,43-0,92 p = 0,017). Conclusões: O uso de Aspirina 100 mg por dia antes da 20ª semana de gestação em gestantes de alto risco diminuiu o risco de desenvolver PREEC, independentemente da idade e dos fatores de risco.Facultad de Ciencias Médica

Incidence and molecular typing of Mycobacterium kansasii in a defined geographical area in Catalonia, Spain

A retrospective population-based study was conducted between January 1990 and December 1998 to investigate the incidence of Mycobacterium kansasii disease and the heterogeneity of the isolates in a well-defined geographical area in Catalonia, Spain. A total of 136 patients were identified. Overall incidence and incidence in AIDS patients was 1. 5 (95% CI 1.2-1.8) and 1089.6 (95% CI 689-1330) cases/100 000 persons per year respectively, which is comparable to that reported from most of other geographical areas. Surprisingly, although 7 subtypes of M. kansasii have been consistently reported, in the present study 91 of the 93 isolates (97.8%) tested for genotype were subtype I, regardless of HIV status of the patients. In conclusion, the high rate of infection observed in the AIDS population contributes significantly to the burden of the M. kansasii disease in our area. M. kansasii disease in our geographical area was almost exclusively caused by subtype I regardless of HIV status

Mis casos clínicos de especialidades odontológicas

Libro que muestra la atención de casos clínicos particulares referente a las diferentes especialidades odontológicasLibro que muestra la atención de casos clínicos particulares referente a las diferentes especialidades odontológicasUniversidad Autónoma de Campeche Universidad Autónoma del Estado de Hidalgo Universidad Autónoma del Estado de Méxic

La cantidad y calidad de la energía en el agua

"La energía se ha convertido en el primer factor estratégico para la vida de cualquier nación.

Isolated nocturnal hypertension in individuals with human immunodeficiency virus

Introducción: La hipertensión nocturna aislada se asocia a mayor cantidad de eventos cardiovasculares y daño de órgano blanco por hipertensión arterial. La prevalencia en poblaciones especiales no se encuentra del todo descrita. El objetivo del siguiente estudio es describir la prevalencia de hipertensión nocturna aislada en población conviviendo con el virus de la inmunodeficiencia humana, y observar su relación con las categorías de presión arterial en el consultorio y los fenotipos de la medición ambulatoria de presión arterial de 24 h. Metodología: Se realizó una cohorte retrospectiva en una población con el virus de la inmunodeficiencia humana en un hospital público de España, se registraron características clínico epidemiológicas, mediciones de presión arterial en consultorio y medición ambulatoria de presión arterial de 24 h (MAPA). Se realizó un análisis en función de los diferentes fenotipos de presión arterial por MAPA, así como también en función de las diferentes categorías de presión arterial de consultorio se calcularon los riesgos para la hipertensión nocturna aislada. Resultados: Se incluyeron en el análisis 116 individuos, sin medicación antihipertensiva ni antecedentes de enfermedad cardiovascular establecida. Se describió una prevalencia de hipertensión nocturna del 23,3%. No se pudo demostrar diferencias significativas entre fenotipos por MAPA de ninguna variable propia del VIH. No hubo diferencias de riesgo ajustadas entre las diferentes categorías de normotensos en consultorio. Conclusiones: La hipertensión nocturna aislada es más frecuente en pacientes con VIH, y los valores de presión arterial de consultorio en normotensos no son suficientes para predecir HTA nocturna aislada.Introduction: Isolated nocturnal hypertension is associated with a greater number of cardiovascular events and target organ damage due to arterial hypertension. It has been observed that patients in the general population with this entity do not have high blood pressure figures in the office; and it is necessary to perform an outpatient measurement to unmask it. The prevalence in special populations is not fully described. The objective of the following study is to describe the prevalence of isolated nocturnal hypertension in a population living with the human immunodeficiency virus and to observe its relationship with the categories of office blood pressure and the phenotypes of the 24-hour ambulatory blood pressure measurement. Methodology: A retrospective cohort was carried out in a population with human immunodeficiency virus in a public hospital in Spain, clinical epidemiological characteristics, office blood pressure measurements and 24-hour ambulatory blood pressure measurement (ABPM) were recorded. An analysis was performed based on the different ABPM blood pressure phenotypes, as well as based on the different office blood pressure categories, the risks for isolated nocturnal hypertension were calculated. Results: One hundred and sixteen individuals, without antihypertensive medication or history of established cardiovascular disease, were included in the analysis. A prevalence of nocturnal hypertension of 23.3% was described. It was not possible to demonstrate significant differences between phenotypes by ABPM of any variable specific to HIV. There were no adjusted risk differences between the different categories of office normotensives. Conclusions: Isolated nocturnal hypertension is more frequent in patients with HIV and office blood pressure values in normotensive patients are not sufficient to predict isolated nocturnal hypertension.Facultad de Ciencias Médica

Enfermedad periodontal en pacientes con discapacidad en custodia versus pacientes con discapacidad independientes

Objetivo: Identificar el estado de salud periodontal en pacientes con discapacidad en custodia versus pacientes independientes en su higiene oral. Material y métodos: Se examinaron pacientes con discapacidad, ambos sexos, 3 a 19 años que acuden al Servicio de Odontopediatría del Centro de Rehabilitación Infantil Teletón (CRIT) Tamaulipas mediante revisión de cavidad oral y aplicación del Índice de Higiene Oral Simplificado (IHOS), Índice Periodontal Comunitario de la Necesidad de Tratamiento (IPCNT) y entrevista con su cuidador primario. Se agruparon en dos categorías: Independientes y de Custodia. Resultados: En el total de la muestra la Media y Desviación estándar (D.E.) de IPCNT fue de 0.89±0.54, así como el IHOS de 1.88±0.77. El IPCNT en pacientes con discapacidad de Custodia fue 0.91±0.57 e Independientes de 0.86±0.49 (p=0.70), IHOS en pacientes de Custodia 1.89±0.78 e Independientes 1.87±.0.74 (p=.93). IPCNT en géneros masculino 1.03±0.54 y femenino 0.75±0.51 (p=.009). IHOS en pacientes que habitan área rural 2.41±1.25 y área urbana 1.83±0.68 (p=.02). Relación entre la edad y la necesidad de tratamiento periodontal (p=0.001). Frecuencia del cepillado del grupo Independientes 2.03±0.56 y de Custodia 2.00±0.75 (p=.84). Conclusiones: No existe diferencia en el estado de salud periodontal y el grado de higiene oral entre pacientes con discapacidad Independientes y de Custodia. La mayoría de los pacientes Independientes y de Custodia tienen una necesidad de tratamiento de Instrucción de Higiene Oral (TN1) y tienen Higiene Oral Regular

Confirmation of Carex pseudobrizoides Clavaud (Cyperaceae) in the Iberian Peninsula and other contributions to the knowledge of the iberian Carex

This article shows some contributions to the knowledge of the genus Carex (Cyperaceae) in the Iberian Peninsula. Among them we highlight the confirmation of C. pseudobrizoides Clavaud for the Iberian Peninsula (Basque Country). The results of the morphological study carried out to differentiate this species from the closely related C. brizoides L., also present in the territory, are showed. A map of the Iberian distribution of C. praecox Schreb. is provided. C. umbrosa is cited for the first time for the Iberian System, the presence of C. montana L. in this mountain system is rejected, the distribution area of C. riparia in Eastern Andalusia is discussed, and a new chromosome number for C. olbiensis Jord. is reporte

Trace element contents in fine particulate matter (PM2.5) in urban school microenvironments near a contaminated beach with mine tailings, Chañaral, Chile

Air quality in schools is an important public health issue because children spend a considerable part of their daily life in classrooms. Particulate size and chemical composition has been associated with negative health effects. We studied levels of trace element concentrations in fine particulate matter (PM2.5) in indoor versus outdoor school settings from six schools in Chaaral, a coastal city with a beach severely polluted with mine tailings. Concentrations of trace elements were measured on two consecutive days during the summer and winter of 2012 and 2013 and determined using X-ray fluorescence. Source apportionment and element enrichment were measured using principal components analysis and enrichment factors. Trace elements were higher in indoor school spaces, especially in classrooms compared with outdoor environments. The most abundant elements were Na, Cl, S, Ca, Fe, K, Mn, Ti, and Si, associated with earth's crust. Conversely, an extremely high enrichment factor was determined for Cu, Zn, Ni and Cr; heavy metals associated with systemic and carcinogenic risk effects, whose probably origin sources are industrial and mining activities. These results suggest that the main source of trace elements in PM2.5 from these school microenvironments is a mixture of dust contaminated with mine tailings and marine aerosols. Policymakers should prioritize environmental management changes to minimize further environmental damage and its direct impact on the health of children exposed.Fondo Nacional de Investigacion y Desarrollo en Salud (FONIS) SA11/2224 School of Public Health Grant s/n, Faculty of Medicine, University of Chil

Indoor-outdoor concentrations of fine particulate matter in school building microenvironments near a mine tailing deposit

Indoor air quality in school classrooms is a major pediatric health concern because children are highly susceptible to adverse effects from xenobiotic exposure. Fine particulate matter (PM2.5) emitted from mining waste deposits within and near cities in northern Chile is a serious environmental problem. We measured PM2.5 in school microenvironments in urban areas of Chañaral, a coastal community whose bay is contaminated with mine tailings. PM2.5 levels were measured in six indoor and outdoor school environments during the summer and winter of 2012 and 2013. Measurements were taken during school hours on two consecutive days. Indoor PM2.5 concentrations were 12.53–72.38 μg/m3 in the summer and 21.85–100.53 μg/m3 in winter, while outdoor concentrations were 11.86–181.73 μg/m3 in the summer and 21.50–93.07 μg/m3 in winter. Indoor/outdoor ratios were 0.17–2.76 in the summer and 0.64–4.49 in winter. PM2.5 levels were higher in indoor microenvironments during the winter, at times exceeding national and international recommendations. Our results demonstrate that indoor air quality Chañaral school microenvironments is closely associated with outdoor air pollution attributable to the nearby mine tailings. Policymakers should enact environmental management strategies to minimize further environmental damage and mitigate the risks that this pollution poses for pediatric health

Hypertension arising after 20 weeks of gestation: gestational hypertension or chronic masked hypertension?

Introducción: Los trastornos hipertensivos del embarazo han sido divididos en hipertensión arterial (HA) crónica vs HA gestacional. El monitoreo ambulatorio de la presión arterial (MAPA) podría modificar esta clasificación pues una proporción de las pacientes con HA gestacional pueden tener HA enmascarada. Objetivo: determinar la proporción de embarazadas con HA gestacional que tienen HA crónica enmascarada y el riesgo de desarrollar PE Material y Métodos: 227 embarazadas de alto riesgo (edad 32 ± 6 años) fueron evaluadas antes de la semana 20 de gestación con MAPA. Las normotensas que desarrollaron HA gestacional fueron reclasificadas de acuerdo al MAPA basal en HA gestacional verdadera (MAPA normal) y pseudo HA gestacional (MAPA con hipertensión enmascarada). Los riesgos de PE fueron estimados con regresión logística. Resultados: La prevalencia de HA crónica fue 29,5%. De las 160 embarazadas sin HA crónica, 39 desarrollaron HA gestacional (16 HA gestacional verdadera y 23 pseudo HA gestacional). Desarrollaron PE el 23,3% de la cohorte. Los riesgos absolutos de PE fueron 15,7%, 12,5%, 43,5% y 32,8% para normotensión, HA gestacional verdadera, pseudo HA gestacional verdadera e HA crónica, respectivamente. Comparadas con normotensión, la HA gestacional verdadera no incrementó el riesgo de desarrollar PE (OR 0,76, IC95% 0,16-6,65) mientras que la pseudo HA gestacional aumentó > 4 veces (0R 4,13 IC 1,58-10,77). Conclusión: 59% de las embarazadas clasificadas como HA gestacional, tenían HA crónica enmascarada. Este subgrupo tiene más de cuatro veces de incremento del riesgo de desarrollar PE, mientras que las verdaderas HA gestacionales no mostraron mayor riesgoObjectives: the aims were 1- to evaluate the prevalence of masked chronic hypertension in pregnant women classified as gestational hypertension 2- to compare the risks of developing preeclampsia in true gestational hypertension vs those women classified as having gestational hypertension but who had had masked hypertension in the first half of pregnancy. Methods: We performed a cohort study in consecutive high-risk pregnancies and evaluated before 20 weeks of gestation. Women who developed hypertension (office BP ≥ 140/90 mmHg and/or antihypertensive treatment) after 20 weeks of gestation was classified, according to the ABPM performed before 20 weeks of gestation, as having “true” gestational hypertension (if their ABPM before 20 weeks of gestation was normal) or “pseudo” gestational hypertension (if there had chronic masked hypertension). Risks for preeclampsia (PE) were estimated and compared with normotensive women. Results: Before 20 weeks of gestation, 227 were analyzed (age 32 ± 6 years, median gestation age 15 weeks); 67 had chronic hypertension (29.5%). Of the remaining 160, 39 developed gestational hypertension (16 had true gestational and 23 pseudo gestational hypertension, because they had masked hypertension in the first half of pregnancy). Compared normotensive pregnant women, true gestational hypertension did not increase the risk of developing PE (OR=0.76, 95%CI=0.16-6.65). Conversely, pseudo gestational hypertension increased the risk for PE more than 4 times (0R=4.47 CI=1.16-12.63). Risk estimation did not change substantially after adjustment for multiple possible confounders. Conclusion: 59% of women diagnosticated as gestational hypertension had indeed chronic masked hypertension and a very risk for developed PE.Facultad de Ciencias Médica