RESUMEN Con el objetivo de describir las características clínicas y epidemiológicas de los pacientes fallecidos por dengue durante el 2017 en Piura, se realizó un estudio retrospectivo de revisión de 24 historias clínicas. El 67% de los casos fueron mujeres y tres (12,5%) estaban embarazadas. La diabetes (12,5%) y la hipertensión (16,7%) fueron las comorbilidades más frecuentes. Sólo en el 12,5% se reportó dengue previo. El tiempo transcurrido desde asistencia sanitaria hasta la muerte fue de 4,10 (DE: 5,34) días. Se hicieron transfusiones de glóbulos rojos en el 45,8% de los casos, plasma en el 25%, plaquetas en el 16,8% y crioprecipitado en el 16,8%. También fueron frecuentes la terapia con cristaloides (91,7%) y el tratamiento con fármacos vasoactivos (70,8%). En conclusión, la mortalidad del dengue grave fue mayoritaria en las mujeres adultas y el tiempo de atención desde el primer establecimiento de salud hasta una unidad especializada fue prolongada.

ABSTRACT Objective: To describe the clinical-epidemiological characteristics of patients who died from dengue during 2017. Methods: We conducted a retrospective study of the information related to cases of dengue deaths in the department of Piura. Results: We reviewed 24 medical records. Sixty-seven percent were women and 3 (12.5%) were pregnant. Diabetes (12.5%) and hypertension (16.7%) were the most frequent comorbidities. Previous dengue fever was reported in only 12.5%. The time from health care and death was 4.10 ± 5.34 days. Red blood cell transfusions were performed in 45.8%, plasma in 25%, platelets in 16.8% and cryoprecipitate in 16.8% of cases. Crystalloid therapy (91.7%) and treatment with vasoactive drugs (70.8%) were also frequent. In conclusion, mortality from severe dengue fever was predominantly in adult women, and the time of care from the first health facility to a specialized unit was prolonged.

ABSTRACT Objective: To describe the clinical-epidemiological characteristics of patients who died from dengue during 2017. Methods: We conducted a retrospective study of the information related to cases of dengue deaths in the department of Piura. Results: We reviewed 24 medical records. Sixty-seven percent were women and 3 (12.5%) were pregnant. Diabetes (12.5%) and hypertension (16.7%) were the most frequent comorbidities. Previous dengue fever was reported in only 12.5%. The time from health care and death was 4.10 ± 5.34 days. Red blood cell transfusions were performed in 45.8%, plasma in 25%, platelets in 16.8% and cryoprecipitate in 16.8% of cases. Crystalloid therapy (91.7%) and treatment with vasoactive drugs (70.8%) were also frequent. In conclusion, mortality from severe dengue fever was predominantly in adult women, and the time of care from the first health facility to a specialized unit was prolonged.

RESUMEN Con el objetivo de describir las características clínicas y epidemiológicas de los pacientes fallecidos por dengue durante el 2017 en Piura, se realizó un estudio retrospectivo de revisión de 24 historias clínicas. El 67% de los casos fueron mujeres y tres (12,5%) estaban embarazadas. La diabetes (12,5%) y la hipertensión (16,7%) fueron las comorbilidades más frecuentes. Sólo en el 12,5% se reportó dengue previo. El tiempo transcurrido desde asistencia sanitaria hasta la muerte fue de 4,10 (DE: 5,34) días. Se hicieron transfusiones de glóbulos rojos en el 45,8% de los casos, plasma en el 25%, plaquetas en el 16,8% y crioprecipitado en el 16,8%. También fueron frecuentes la terapia con cristaloides (91,7%) y el tratamiento con fármacos vasoactivos (70,8%). En conclusión, la mortalidad del dengue grave fue mayoritaria en las mujeres adultas y el tiempo de atención desde el primer establecimiento de salud hasta una unidad especializada fue prolongada.

Abstract This paper describes the experience in a public pediatric hospital when implementing the Mexican Health Ministry’s recommendations on the inclusion and importance of a chosen caregiver during the hospitalization of a coronavirus disease 2019 (COVID-19) pediatric patient. The implementation includes the adjustments, observations, and limitations made in real practice and process. In conclusion, the value and benefits of the accompaniment of hospitalized children with COVID-19 by a primary or chosen caregiver are evidenced and supported by family-centered care. Furthermore, the recommendations mentioned result in comprehensive bio-psycho-social care for the benefit of pediatric patients.

Resumen Se describe cómo el Hospital Infantil de México Federico Gómez pone en funcionamiento las recomendaciones publicadas por la Secretaría de Salud sobre la inclusión y la importancia del acompañamiento de un cuidador primario durante la hospitalización del paciente pediátrico con COVID-19. Se incluyen las adecuaciones, las observaciones y las limitaciones del proceso. Se concluye acerca de la importancia de la flexibilidad y el buen uso de los recursos en la implementación de la guía. Además, se examinan la atención biopsicosocial integral en beneficio de los menores y la importancia del acompañamiento, que se sustenta en la atención centrada en la familia y la integración del cuidador como auxiliar en el equipo médico.

Neuromas of the bile duct develop from the sympathetic and parasympathetic nerve fibers that surround the wall of the bile duct. A 44-year-old woman with a history of conventional cholecystectomy six months prior to hospital admission attended emergency due to obstructive jaundice that lasted 15 days. In the imaging studies, the presence of a mass at the level of the bile ducts is considered, considering the diagnosis of a malignant neoplasm. Due to the antecedents, the absence of tumor markers, it was decided to perform a percutaneous biopsy without conclusive results, performing later a surgical intervention with anatomopathological study compatible with neuroma of biliary tract amputation. The amputation neuroma at the level of the bile duct is an infrequent tumor. It can manifest clinically as obstructive jaundice and usually simulates a malignant tumor of the bile ducts. Surgical management is the definitive treatment.

Los neuromas del conducto biliar se desarrollan a partir de las fibras nerviosas simpáticas y parasimpáticas que envuelven la pared de la vía biliar. Mujer de 44 años de edad con antecedente de colecistectomía convencional seis meses previos al ingreso acude a emergencia por ictericia obstructiva de 15 días de evolución. En los estudios de imagen impresiona la presencia de una masa a nivel de las vías biliares considerándose el diagnostico de una neoplasia maligna. Por los antecedentes, ausencia de marcadores tumorales se decide realizar una biopsia percutánea sin resultados concluyente, realizándose posteriormente una intervención quirúrgica con estudio anatomo-patológico compatible con neuroma de amputación de vía biliar. El neuroma de amputación a nivel de la vía biliar es un tumor infrecuente. Puede manifestarse clínicamente como una ictericia obstructiva y suele simular a un tumor maligno de las vías biliares. El manejo quirúrgico es el tratamiento definitivo.

Introduction: Quinoa is a pseudocereal containing low glycemic index carbohydrates, dietary fiber, high biological value protein, phytosterols, and n-3 and n-6 fatty acids, which has generated interest in prediabetes nutritional interventions. This randomized (2:1), placebo-controlled, double-blind study evaluated the effects of processed quinoa on body mass index (BMI), glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and the satiation and fullness (complete) degree in prediabetic patients. Material and method: Thirty patients were randomized (2:1) in two study arms: Kuska Active product (processed quinoa) and placebo (maltodextrin), with an intake period of 28 days. BMI, HbA1c and FPG were determined before starting treatment and at 28-day intake. Satiety and fullness sensation were just assessed by visual analog scale (VAS) at the day 28. ANOVA was performed for repeated measures with two factors to study (within-subject factor: time; intersubject factor: product consumed) to demonstrate the effectiveness of processed quinoa on the study variables. Results: Twenty-nine patients (placebo, n = 10; quinoa, n = 19) completed the study, and the quinoa group shows a significant decrease in BMI (p < 0.05) and HbA1c values (p < 0.001), and an increase in the satiation and fullness (complete) degree (p < 0.001). No significant differences were found in FPG levels from baseline to post-intake period. Conclusions: The results show that processed quinoa intake during 28 days decreases BMI and HbA1c levels, maintains FPG levels, and increases the satiation and fullness (complete) degree in prediabetic patients.

Introducción: la quinua es un pseudocereal que contiene hidratos de carbono de bajo índice glucémico, fibra alimentaria, proteínas de alto valor biológico, fitoesteroles y ácidos grasos n-3 y n-6, y que ha suscitado interés en la intervención nutricional de la prediabetes. Este estudio aleatorizado (2:1), controlado con placebo y doble ciego, evaluó los efectos de la quinua sobre el índice de masa corporal (IMC), hemoglobina glicada (HbA1c), glucemia basal (GB) y el grado de saciedad y plenitud en pacientes prediabéticos. Material y método: se aleatorizaron (2:1) 30 pacientes en dos ramas a estudio: el producto Kuska Active (quinua procesada) y placebo (maltodextrina). El periodo de ingesta fue de 28 días. Antes de iniciar el tratamiento y a los 28 días se determinó el IMC, HbA1c y la GB. La sensación de saciedad y plenitud se evaluó mediante escala visual analógica (EVA). Para demostrar la eficacia de la quinua procesada Kuska Active sobre las variables a estudio se realizó ANOVA para medidas repetidas con dos factores a estudio (factor intrasujeto: tiempo y factor intersujeto: producto consumido). Resultados: finalizaron el estudio un total de 29 pacientes (placebo, n = 10; quinua, n = 19). Se detectó en el grupo quinua procesada una disminución significativa en los valores de IMC (p < 0,05) y HbA1c (p < 0,001) y un aumento en la sensación de saciedad y plenitud (p < 0,001). No se encontraron diferencias significativas en los niveles de GB desde el momento basal hasta el periodo postingesta. Conclusiones: los resultados muestran que la quinua procesada disminuye el IMC y los niveles de HbA1c, mantiene los niveles de GB y aumenta la sensación de saciedad y plenitud en pacientes prediabéticos.

OBJETIVOS: Desenvolver um modelo de predição para o tempo de permanência hospitalar (TPH) em lactentes de muito baixo peso ao nascer (MBPN) e comparar esse resultado entre 20 centros de uma rede neonatal, visto que o TPH é utilizado como uma medida da qualidade da assistência em lactentes de MBPN. MÉTODOS: Utilizamos dados coletados prospectivamente de 7.599 lactentes com peso ao nascer entre 500 e 1.500 g no período entre os anos de 2001 a 2008. O modelo de regressão de Cox foi empregado para desenvolver dois modelos de predição: um modelo prévio com dados do nascimento e outro posterior, que acrescenta morbidades relevantes dos primeiros 30 dias de vida. RESULTADOS: A mediana do TPH estimado e ajustado a partir do nascimento foi de 59 dias; 28 dias depois do tempo de sobrevida de 30 dias. Houve uma alta correlação entre os modelos (r = 0,92). O TPH esperado e o TPH observado variaram bastante entre os centros, mesmo depois de correção para as morbidades relevantes após 30 dias. O TPH mediano (variação: 45-70 dias) e a idade concepcional na alta hospitalar (variação: 36,4-39,9 semanas) refletem uma variabilidade alta entre centros. CONCLUSÃO: Um modelo simples, com fatores apresentados no nascimento, pode predizer o TPH de um lactente de MBPN em uma rede neonatal. Observou-se uma variabilidade nos TPHs considerável entre unidades de terapia intensiva neonatal. Especulamos que os resultados sejam provenientes das diferenças entre as práticas dos centros.

OBJECTIVES: To develop a prediction model for hospital length of stay (LOS) in very low birth weight (VLBW) infants and to compare this outcome among 20 centers within a neonatal network. METHODS: Data from 7,599 infants with birth weights of 500-1,500 g born between the years 2001-2008 were prospectively collected. The Cox regression model was employed to develop two prediction models: an early model based upon variables present at birth, and a late one that adds relevant morbidities for the first 30 days of life. RESULTS: Median adjusted estimated LOS from birth was 59 days ‒ 28 days after 30-day point of survival. There was a high correlation between models (r = 0.92). Expected/observed LOS varied widely among centers, even after correction for relevant morbidity after 30 days. Median observed LOS (range: 45-70 days), and postmenstrual age at discharge (range: 36.4-39.9 weeks) reflect high inter-center variability. CONCLUSION: A simple model, with factors present at birth, can predict a VLBW infant's LOS in a neonatal network. Significant variability in LOS was observed among neonatal intensive care units. We speculate that the results originate in differences in inter-center practices.

Fusarium tucumaniae e F. virguliforme são agentes etiológicos primários da síndrome da morte súbita (sudden death syndrome - SDS) de soja na Argentina e nos Estados Unidos, respectivamente. Cinco isolados de F. tucumaniae e quatro isolados de F. virguliforme foram testados para agressividade relativa à soja, usando-se o método de ponta de palito de dente e duas versões do método de inoculação com solo infestado. A cultivar de soja parcialmente resistente RA629 e a cultivar suscetível A6445RG foram inoculadas separadamente com cada um dos nove isolados. Dois experimentos para cada método de inoculação foram realizados. A análise da variância identificou uma interação tripla significativa entre cultivar*experimento*patógeno SDS (P = 0,01), usando-se os três métodos. Quando os métodos de infestação de solo foram utilizados, F. virguliforme foi mais agressivo que F. tucumaniae. Entretanto, quando foi usado o método do palito de dente, isolados de F. virguliforme e F. tucumaniae foram igualmente agressivos. Embora os três métodos testados tenham discriminado níveis de resistência parcial dos genótipos à SDS, resultados do presente estudo indicam que inoculações no solo com grãos de sorgo infestados representam o melhor método para avaliação de resistência de cultivares de soja à SDS. A existência de interações entre o hospedeiro, patógeno e condições de ambiente destaca a necessidade de estudos adicionais para melhorar a reprodutibilidade de testes de seleção de germoplasmas de soja para resistência à SDS.

Fusarium tucumaniae and F. virguliforme are the primary etiological agents of sudden-death syndrome (SDS) of soybean in Argentina and the United States, respectively. Five isolates of F. tucumaniae and four isolates of F. virguliforme were tested for relative aggressiveness to soybean, using a toothpick inoculation method and two versions of a soil infestation inoculation method. Partially resistant soybean cultivar RA629 and susceptible cultivar A6445RG were inoculated separately with each of the nine isolates. Two experiments for each inoculation method were performed. Analysis of variance identified a significant three-way interaction of soybean cultivar*experiment*SDS pathogen (P = 0.01) using the different methods. When the two soil infestation methods were used, F. virguliforme was more aggressive than F. tucumaniae; however, when using the toothpick method, isolates of F. virguliforme and F. tucumaniae were equally aggressive. Although all three methods discriminated levels of partial resistance of the genotypes to SDS, results of the present study indicated that soil inoculations with sorghum infested grain represent the best method for evaluating soybean cultivar resistance to SDS. The existence of interactions among the host, pathogen and environmental conditions highlights the need for additional studies to improve the reproducibility of tests for screening soybean germplasm for resistance to SDS.

Among the documents concerning the functioning of Queen Isabel de Valois ‘court, it is possible to find fundamental information to know something about the duty of sanitary professionals in the sixteenth century, in this case circumscribe to the royal environment. The necessity to watch over the health of the court was as outstanding as any other matter worthy of the attention of the high civil servants in charge of the correct course in the state affairs. For this reason, the management and administration of the health resources in the court environment generated an interesting documentation preserved in Casa y Sitios Reales of the Archivo General de Simancas, and we will analyze a significant sample of it in this article.

Entre los documentos referentes al funcionamiento de la corte de la reina Isabel de Valois es posible encontrar datos fundamentales para conocer el quehacer de los profesionales médico-sanitarios en el siglo XVI, en este caso circunscritos al ámbito regio. La necesidad de velar por la salud de la Corte resultaba tan relevante como cualquier otro asunto digno de la atención del alto funcionariado encargado de la correcta marcha de los asuntos de Estado. Por este motivo, la gestión y administración de los recursos sanitarios del círculo cortesano generaron una interesante documentación, conservada en la sección Casa y Sitios Reales del Archivo General de Simancas, de la que en este artículo se analiza una significativa muestra.