ABSTRACT BACKGROUND: The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear. OBJECTIVE: To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND SETTING: Retrospective observational study in a tertiary-level hospital in Spain. METHODS: Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable. RESULTS: 690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism. CONCLUSIONS: This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.

ABSTRACT Introduction: Type 2 diabetes mellitus is a chronic disease that is considered as an important health problem worldwide due to its high socioeconomic prevalence and repercussion. Objective: To characterize patients with type 2 diabetes mellitus according to clinical and epidemiological variables. Methods: A retrospective study of 96 patients with this disease was carried out, selected by simple random sampling who were admitted in the Internal Medicine Service of the Guillermo Luis Fernández Hernández-Baquero Teaching General Hospital in Moa, Holguín, from July to November, 2018. Results: In the series there was a prevalence of women (58.3 %), mainly in the ages of 50 to 59 (34.3 %), and the family history of diabetes mellitus as risk factor (63.5 %), as long as polyneuropathy was the most serious complication in the patients (47.9 %). It was also evidenced, that the greater clinical course time of the disease and the risk factors conditioned the emergence of complications, what prolonged the hospital stay. Conclusions: The results coincided with those of several national studies, what demonstrates that type 2 diabetes mellitus have a devastating impact in the human being health and, therefore, an important socioeconomic repercussion.

RESUMEN Introducción: La diabetes mellitus de tipo 2 es una enfermedad crónica, considerada como un importante problema de salud a nivel mundial por su alta prevalencia y repercusión socioeconómica. Objetivo: Caracterizar a pacientes con diabetes mellitus de tipo 2 según variables clínicas y epidemiológicas. Métodos: Se realizó un estudio retrospectivo de 96 pacientes con dicha enfermedad (seleccionados por muestreo aleatorio simple), quienes estuvieron ingresados en el Servicio de Medicina Interna del Hospital General Docente Dr. Guillermo Luis Fernández Hernández-Baquero del municipio de Moa, en Holguín, en el periodo de julio a noviembre del 2018. Resultados: En la serie predominaron el sexo femenino (58,3 %), sobre todo en las edades de 50 a 59 años (34,3 %), el antecedente familiar de diabetes mellitus como factor de riesgo (63,5 %) y la polineuropatía como complicación de mayor gravedad en los pacientes (47,9 %). Se evidenció, además, que el mayor tiempo de evolución de la enfermedad y los factores de riesgo condicionaron la aparición de complicaciones, lo que alargó la estadía hospitalaria. Conclusiones: Los resultados coincidieron con los de varios estudios, lo que demuestra que la diabetes mellitus de tipo 2 tiene un impacto demoledor en la salud del ser humano y, por tanto, una importante repercusión socioeconómica.

ABSTRACT Introduction: acupuncture and suction cups constitute an alternative therapy to relieve various conditions, especially acute sacrolumbalgia; it improves the satisfaction level and the life quality of the patients who suffer from it. Objective: to evaluate the effectiveness of the treatment with acupuncture and suction cups in patients with acute sacrolumbalgia. Method: a phase III randomized therapeutic clinical trial was conducted in patients who attended the Natural and Traditional Medicine service of the rehabilitation room in Juan Manuel Páez Inchauthi Polyclinic of Moa municipality, Holguín province, Cuba, in the period from July to December,2017. The study universe was made up of 80 patients who went to the consultation; the sample was randomly selected and consisted of 60 patients in two study groups, 30 in each one: group I who received acupuncture treatment, and group II, suction cup therapy. Both were diagnosed post-Bi syndrome. Results: in the study, men prevailed with 63.3%, and the study group II, with 66.7%. The 40-49 age group was the most affected. Both were dominated by the exogenous wind factor. Bi-wind syndrome was found to benefit most from acupuncture therapy, as it did when the suction cup was applied. Conclusions: for both groups there was 100% effectiveness of the acupuncture and suction cup therapy in the improvement or cure of acute sacrolumbalgia.

RESUMEN Introducción: la acupuntura y las ventosas constituyen una terapia alternativa para aliviar distintas afecciones, en especial la sacrolumbalgia aguda, que mejora el nivel de satisfacción e impacta en la calidad de vida de los pacientes que la padecen. Objetivo: evaluar la eficacia del tratamiento con acupuntura y ventosa en pacientes con sacrolumbalgia aguda. Métodos: se realizó un ensayo clínico terapéutico fase III aleatorizado, en pacientes que acudieron al servicio de Medicina Natural y Tradicional de la sala de rehabilitación del Policlínico Juan Manuel Páez Inchauthi, del municipio de Moa, provincia de Holguín, Cuba, en el período de julio a diciembre del año 2017. El universo de estudio estuvo constituido por 80 pacientes que acudieron a la consulta; la muestra fue seleccionada de forma aleatoria y quedó conformada por 60 pacientes en dos grupos de estudio, el grupo I, que recibió tratamiento acupuntural, y el II, con ventosas, integrados por 30 pacientes cada uno. A ambos se les realizó diagnóstico pos síndrome Bi. Resultados: en el estudio predominaron los hombres, con el 63,3%, y el grupo de estudio II, con el 66,7%. El grupo etario de 40 a 49 años fue el más afectado. En ambos predominó el factor exógeno viento. Se observó que el síndrome Bi viento es el más beneficiado con la terapéutica acupuntural, al igual que cuando se aplicó la ventosa. Conclusiones: en ambos grupos existió una efectividad del 100% de la terapéutica acupuntural y la ventosa, en la mejoría o la cura de la sacrolumbalgia aguda.

Resumo Este trabalho teve como objetivos estimar coeficientes de repetibilidade, determinar o número mínimo de frutos necessários para seleção de genótipos e estimar coeficientes de correlação fenotípica entre caracteres morfoagronômicos de frutos de cupuaçuzeiros. Foram avaliados 22 genótipos de um sistema agroflorestal implantado no município de Cantá - RR. Foram coletados 10 frutos por genótipo, os quais foram avaliados quanto ao comprimento longitudinal, ao diâmetro transversal, ao peso total, à espessura da casca e ao peso da casca, da polpa, da placenta e de sementes úmidas. Foram utilizados quatro métodos estatísticos para estimar os coeficientes de repetibilidade: análise de variância; componentes principais com base na matriz de correlações e na matriz de covariâncias, e análise estrutural com base na matriz de correlações. O número de medições necessárias para predizer o valor real dos genótipos e os coeficientes de correlação de Pearson entre os caracteres foi também estimado. Os coeficientes de repetibilidade variaram de baixo a moderado, sendo no geral necessários 10 frutos por planta, considerando 85% de confiança, para que seja realizada uma seleção efetiva para a maioria dos caracteres estudados. Há possibilidades de ganhos indiretos para frutos com maior quantidade de polpa por meio da seleção de frutos maiores e/ou mais pesados.

Abstract The objective of this study was to estimate coefficients of repeatability, to determine the minimum number of fruits necessary for genotype selection and to estimate phenotypic correlation coefficients between morpho-agronomic characters of Theobroma grandiflorum fruits. It was evaluated twenty - two genotypes of an agroforestry system implanted in the municipality of Cantá - RR. Ten fruits per genotype were collected and evaluated for longitudinal length, transverse diameter, total weight, peel thickness, peel weight, pulp weight, placental weight and wet seed weight. Four statistical methods were used to estimate the repeatability coefficients: variance analysis, main components based on the correlation matrix and the covariance matrix, and structural analysis based on the correlation matrix. The number of measurements needed to predict the real value of the genotypes and the Pearson correlation coefficients among the characters were also estimated. The repeatability coefficients ranged from low to moderate, with 10 fruits per plant generally required, with 85% of confidence, in order to make an effective selection for most of the characters studied. There are possibilities of indirect gains for fruits with greater amount of pulp through the selection of larger and / or heavier fruits.

Aim: The aim of the present study is to evaluate the effect of human milk feeding during the first weeks of life in very low birth weight infants on weight gain at discharge, length of hospitalization, postmenstrual age at discharge and nutritional assessment, growth and neurodevelopment at two and five years. Material and methods: Longitudinal study of very-low-birth-weight infants (< 1,500 grams) admitted to the Neonatal Intensive Care Unit of La Paz University Hospital, from January 1st 2009 to December 31st 2009, followed in the follow-up clinic. Their parents agreed to perform a more exhaustive anthropometric study at five years, classified according to the type of feeding at the time of discharge (exclusive human milk, formula milk or mixed). Initial hospital duration and anthropometry at discharge were evaluated. At two years of age, anthropometric data (weight, height and head circumference) were collected and neurodevelopment was assessed according to the Bayley scale of child development. Data at five years were collected prospectively. Measurements of weight, height and head circumference, waist circumference, hip, relaxed and contracted arm, thigh and middle leg, bicipital, triceps, subscapular, suprailiac and leg skin folds were performed. For patients older than five years, the Kaufman test battery for children was used. The effect of human milk on the variables of interest was investigated using a multivariate analysis correcting for gestational age and weight at birth. Results: One hundred and fifty-two infants born in 2009 were discharged from our unit: exclusive breast milk (59), formula (55) or mixed milk (38). More detailed follow-up was carried out for 61 of them. Human milk during the first admission decreases the initial hospital stay, and is associated with a higher head circumference at two and five years, and a better score in the global and verbal cognitive area at five years. Conclusions: Our results suggest that maternal milk feeding during initial admission should be encouraged because it can improve neurodevelopment at five years of age.

Objetivo: el objetivo del presente estudio es evaluar el efecto de la alimentación con leche materna durante las primeras semanas de vida en los recién nacidos de muy bajo peso sobre: la ganancia ponderal en el momento del alta, la duración de la estancia hospitalaria, la edad posmenstrual al alta y el estado nutricional, el crecimiento y el neurodesarrollo a los dos y cinco años. Material y métodos: estudio longitudinal de recién nacidos de muy bajo peso al nacer (< 1.500 gramos), ingresados en la Unidad de Cuidados Intensivos Neonatales del Hospital Universitario La Paz del 1 de enero de 2009 al 31 de diciembre de 2009, cuyo seguimiento se está realizando en la consulta de Neonatología y sus padres aceptaron realizar un estudio antropométrico más exhaustivo a los cinco años, teniendo en cuenta la ingesta al alta de leche materna exclusiva, leche de fórmula o mixta. Se evaluaron la estancia hospitalaria y la antropometría al alta. A los dos años de edad se recogieron datos antropométricos (peso, talla y perímetro cefálico) y se realizó valoración del neurodesarrollo según la escala de Bayley II de desarrollo infantil. Los datos a los cinco años fueron recogidos prospectivamente. Se realizaron medidas de peso, talla y perímetro cefálico, perímetros de cintura, cadera, brazo relajado y contraído, muslo y pierna media, pliegues bicipitales, tricipital, subescapular, suprailiaco y pierna. Para los pacientes mayores de cinco años, se utilizó la batería de evaluación de Kaufman para niños. El efecto de la ingesta de leche materna en las variables de interés se investigó usando un análisis multivariante corrigiendo por edad gestacional y peso de recién nacido. Resultados: ciento cincuenta y dos niños fueron dados de alta: leche materna exclusiva (59), leche de fórmula (55) o mixta (38). A 61 de ellos se les realizó un seguimiento más exhaustivo. La ingesta de leche materna durante el primer ingreso disminuye la estancia hospitalaria inicial, y se asocia con mayor perímetro cefálico a los dos y a los cinco años y mejor puntuación en el área cognitiva global y verbal a los cinco años. Conclusiones: nuestros resultados sugieren que la alimentación con leche de la propia madre durante el ingreso inicial debe ser fomentada porque puede mejorar el neurodesarrollo a los cinco años de edad.

Prolonged parenteral nutrition (PN) leads to liver damage. Recent interest has focused on the lipid component of PN. A lipid emulsion based on w-3 fatty acids decrease conjugated bilirubin. A mixed lipid emulsion derived from soybean, coconut, olive, and fish oils reverses jaundice. Here we report the reversal of cholestasis and the improvement of enteral feeding tolerance in 1 infant with intestinal failure-associated liver disease. Treatment involved the substitution of a mixed lipid emulsion with one containing primarily omega-3 fatty acids during 37 days. Growth and biochemical tests of liver function improved significantly. This suggests that fat emulsions made from fish oils may be more effective means of treating this condition compared with an intravenous lipid emulsion containing soybean oil, medium -chain triglycerides, olive oil, and fish oil.

La nutrición parenteral prolongada produce daño hepático. Recientemente se ha comunicado el efecto de las emulsiones lipídicas intravenosas basadas exclusivamente en ácidos grasos omega-3 en la resolución de la colestasis. Lo mismo se ha observado con el uso de emulsiones lipídicas mixta derivadas del aceite de soja, coco, oliva y pescado. Comunicamos la desaparición de colestasis y mejoría de la tolerancia enteral en un niño con enfermedad hepática asociada a nutrición parenteral. El tratamiento consistió en sustituir una emulsión lipídica mixta por otra que contenía de forma exclusiva aceite de pescado durante 37 días. El crecimiento y los datos bioquímicos de función hepática mejoraron de forma significativa. Este caso sugiere que emulsiones lipídicas intravenosas a partir de aceite de pescado pueden ser mas eficaces para tratar la colestasis si se comparan con emulsiones mixtas.

El síndrome metabólico tiene una fuerte asociación con la patogénesis de la diabetes tipo 2, la hipertensión arterial y las enfermedades cardiovasculares. Los niveles plasmáticos de adiponectina estás disminuidos en los pacientes con síndrome metabólico y diversos estudios demuestran que esta hormona ejerce efectos favorables sobre la aterogénesis, la función endotelial y el remodelado vascular. Esta revisión abordará los estudios tanto epidemiológicos como experimentales que sustentan los efectos pleiotrópicos de la adiponectina en el sistema cardiovascular.

The metabolic syndrome has a strong association with the pathogenesis of type 2 diabetes, arterial hypertension and other cardiovascular diseases. Adiponectin plasma levels are reduced in patients suffering the metabolic syndrome and in many basic and clinical studies have demonstrated that adiponectin improves endothelial function, vascular remodelling and atherogenesis. This review will consider the epidemiological and experimental findings bringing support to the pleiotropic effects adiponectin on the cardiovascular system.