UNASSIGNED: In recent years, cesarean section (CS) rates have increased alarmingly. The World Health Organization (WHO) proposes to use the Robson classification system as a global standard, which contributes to a better analysis of CS indications, making it possible to establish strategies to reduce them.
UNASSIGNED: To analyze the classification of CS by Robson groups from July to September 2020 at the Hospital General de Zona No. 4 (District General Hospital [DGH] No. 4), in Celaya, Guanajuato.
UNASSIGNED: Retrospective study which included 160 records of women undergoing CS. Robson\'s group classification was used, and descriptive statistics and cluster analysis were performed to better understand the classification groups.
UNASSIGNED: The average age was 27.6 ± 5.6 years. 53.1% had secondary school; 46.9% was a housewife; 46.3% was laborer; 42.8% were cohabitating; 50% had 1 or more births; 42.5% previous CS; 96.9% 1 fetus; 91.9% cephalic presentation; 78.8% 37 weeks of gestational age or more. Robson\'s group 5 (previous CS) had the highest percentage (42.5%), followed by group 2 (primiparous) with 20.6%, and group 10 (premature) 13.1%. Cluster analysis formed 3 groups, where cluster 1 and 3 contained group 5 of Robson\'s classification.
UNASSIGNED: DGH No. 4 must carry out the necessary strategies so that women with a previous cesarean section can have a vaginal delivery, without compromising the well-being of the mother-child pair, in addition to interventions to avoid primary CS, because women in group 1 and 2 will potentially belong to group 5, in the next obstetric event.
UNASSIGNED: recientemente las tasas de cesárea han aumentado de manera alarmante. La Organización Mundial de la Salud (OMS) propone utilizar el sistema de clasificación Robson como estándar global, lo cual contribuye a un mejor análisis de las indicaciones de cesárea y posibilita el establecimiento de estrategias para reducirlas.
UNASSIGNED: analizar la clasificación de cesáreas por grupos de Robson de julio a septiembre de 2020 en el Hospital General de Zona (HGZ) No. 4, en Celaya, Guanajuato.
UNASSIGNED: estudio retrospectivo que incluyó 160 expedientes de mujeres sometidas a cesárea. Se utilizó la clasificación por grupo de Robson y se usó estadística descriptiva y análisis de clúster para entender mejor los grupos de clasificación.
UNASSIGNED: la edad promedio fue 27.6 ± 5.6 años; 53.1% tenía secundaria; 46.9% era ama de casa; 46.3% obrera; 42.8% vivía en unión libre; 50% tuvo 1 o más partos; 42.5% cesárea previa; 96.9% un feto; 91.9% presentación cefálica, y 78.8% 37 semanas de gestación o más. El grupo 5 de Robson (cesárea previa) tuvo el mayor porcentaje (42.5%); el grupo 2 (primigestas) tuvo 20.6%, y el grupo 10 (prematuros) 13.1%. El análisis de clúster creó 3 agrupaciones, donde el clúster 1 y 3 contuvieron el grupo 5 de la clasificación de Robson.
UNASSIGNED: el HGZ No. 4 debe establecer estrategias necesarias para que las mujeres con cesárea previa puedan tener un parto vaginal sin comprometer el bienestar del binomio madre-hijo, además de intervenciones para evitar la cesárea primaria, dado que las mujeres del grupo 1 y 2 potencialmente formarán parte del grupo 5 en el próximo evento obstétrico.

OBJECTIVE: The study aims to characterise Postintensive Care Syndrome by classifying the severity of the disease and identifying the variables of influence in two highly complex intensive care units for adults in Colombia.
METHODS: A descriptive, cross-sectional, prospective study was carried out to characterise survivors of critical illness using the Healthy Aging Brain Care -Monitor in a sample of 135 patients. Postintensive Care Syndrome severity was classified using Gaussian Mixture Models for clustering, and the most influencing variables were identified through ordinal logistic regression.
RESULTS: Clustering based on Gaussian Mixture Models allowed the classification of Postintensive Care Syndrome severity into mild, moderate, and severe classes, with an Akaike Information Criterion of 308 and an area under the curve of 0.80, which indicates a good fit; Thus, the mild class was characterised by a score on the HABC-M Total scale ≤9; the moderate class for a HABC-M Total score ≥10 and ≤42 and the severe class for a HABC-M Total score ≥43. Regarding the most influencing variables, the probability of belonging to the moderate or severe classes was related to male sex (91%), APACHE II score (22.5%), age (13%), intensive care units days of stay (10.6%), the use of sedation, analgesia and neuromuscular blockers.
CONCLUSIONS: Intensive care units survivors were characterised using the Healthy Aging Brain Care-Monitor scale, which made it possible to classify Postintensive Care Syndrome through Gaussian Mixture Models clustering into mild, moderate, and severe and to identify variables that had the major influence on the presentation of Postintensive Care Syndrome.

OBJECTIVE: To assess the positioning that patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and their proxies give to their diseases.
METHODS: Subjects completed a self-administered questionnaire to rank 11 diseases from \"worst\" to \"least bad\". Then they defined the \"worst\" disease and ranked 10 diseases from highest to lowest importance from a list including \"my rheumatic disease/my relative\'s disease\". The lists of the included diseases represented the mindshare from a sample of healthy adults.
RESULTS: There were 570 respondents (104 SLE, 99 RA, 82 AS, and 285 proxies). Rheumatoid arthritis was considered the third-worst disease (recoded ranking first by 41% of patients and 43% proxies, second by 49% and 44%, and third by 10% and 13%). A disease that kills was the preferred definition for the worst disease. \"My disease/my relative\'s disease\" was ranked fourth in importance (first by 41% of patients, second by 38%, and third by 21%). Rankings were not associated with age, schooling, disease duration, or setting.
CONCLUSIONS: Most respondents ranked their own disease considerably lower than other non-rheumatic conditions.

BACKGROUND: The applications of artificial intelligence, and in particular automatic learning or \"machine learning\" (ML), constitute both a challenge and a great opportunity in numerous scientific, technical, and clinical disciplines. Specific applications in the study of multiple sclerosis (MS) have been no exception, and constitute an area of increasing interest in recent years.
OBJECTIVE: We present a systematic review of the application of ML algorithms in MS.
METHODS: We used the PubMed search engine, which allows free access to the MEDLINE medical database, to identify studies including the keywords \"machine learning\" and \"multiple sclerosis.\" We excluded review articles, studies written in languages other than English or Spanish, and studies that were mainly technical and did not specifically apply to MS. The final selection included 76 articles, and 38 were rejected.
CONCLUSIONS: After the review process, we established 4 main applications of ML in MS: 1) classifying MS subtypes; 2) distinguishing patients with MS from healthy controls and individuals with other diseases; 3) predicting progression and response to therapeutic interventions; and 4) other applications. Results found to date have shown that ML algorithms may offer great support for health professionals both in clinical settings and in research into MS.

Hypertrophic cardiomyopathy (HCM) is a clinical condition, but its name has been subjected to frequent changes over the years, largely because of its morphological and functional heterogeneity, which leads the clinician who is focused on its study to have difficulty in understanding how to diagnose it and when and how to treat it. Regarding its name, it has been called in more than 75 different ways, and it has being classified with difficulty through echocardiography for more than 40 years. Today, it is necessary to understand that the diverse phenotypic behavior, as well as the evolutionary stages of the disease, must be approached in a practical and effective way, so that it easier to understand its clinical behavior and prognosis, as well as the therapeutic needs in each particular case. We review the aspects related to the name of the condition and propose a new classification that could provide the clinical and surgical cardiologist a better understanding of HCM in its various morphological and functional aspects.
La Miocardiopatía Hipertrófica es una entidad clínica que ha sido sometida durante años a cambios frecuentes en su denominación, en gran parte consecuencia de su heterogeneidad morfológica y funcional, lo que hace que el clínico enfocado a su estudio, tenga dificultad en el entendimiento de cómo hacer el diagnóstico y cuándo y cómo tratarle. Nominativamente ha sido llamada de más de 75 formas diferentes y clasificada con dificultad mediante ecocardiografía hace ya más de 40 años. Hoy en día es necesario entender que su comportamiento fenotípico diverso así como las etapas evolutivas de la enfermedad, deben ser abordadas de una forma práctica y eficaz, de tal forma que ello facilite el entendimiento de su comportamiento clínico y su pronóstico, así como de las necesidades terapéuticas en cada caso en particular. Se hace una revisión de los aspectos nominativos de la entidad y proponemos una nueva clasificación que podría facilitar al cardiólogo clínico y quirúrgico un mejor entendimiento de la Miocardiopatía Hipertrófica en sus diversas formas morfológicas y funcionales.

Although some sectors have made significant progress in learning from failure, there is currently limited consensus on how a similar transition could best be achieved in conservation and what is required to facilitate this. One of the key enabling conditions for other sectors is a widely accepted and standardized classification system for identifying and analyzing root causes of failure. We devised a comprehensive taxonomy of root causes of failure affecting conservation projects. To develop this, we solicited examples of real-life conservation efforts that were deemed to have failed in some way, identified their underlying root causes of failure, and used these to develop a generic, 3-tier taxonomy of the ways in which projects fail, at the top of which are 6 overarching cause categories that are further divided into midlevel cause categories and specific root causes. We tested the taxonomy by asking conservation practitioners to use it to classify the causes of failure for conservation efforts they had been involved in. No significant gaps or redundancies were identified during this testing phase. We then analyzed the frequency that particular root causes were encountered by projects within this test sample, which suggested that some root causes were more likely to be encountered than others and that a small number of root causes were more likely to be encountered by projects implementing particular types of conservation action. Our taxonomy could be used to improve identification, analysis, and subsequent learning from failed conservation efforts, address some of the barriers that currently limit the ability of conservation practitioners to learn from failure, and contribute to establishing an effective culture of learning from failure within conservation.
Introducción de una taxonomía común como apoyo al aprendizaje a partir del fracaso en la conservación Resumen Mientras que algunos sectores han progresado significativamente en el aprendizaje a partir del fracaso, actualmente hay un consenso limitado sobre cómo podría lograrse una transición similar en la conservación y qué se requiere para facilitarla. Una de las condiciones habilitantes más importantes en otros sectores es un sistema de clasificación estandarizado y aceptado por la mayoría para la identificación y análisis de las causas fundamentales del fracaso. Diseñamos una taxonomía completa de las causas fundamentales del fracaso que afecta a los proyectos de conservación. Para desarrollarla, solicitamos ejemplos de esfuerzos de conservación reales que de alguna manera se consideraron como fracasos, identificamos las causas fundamentales no aparentes de su fracaso y luego las usamos para desarrollar una taxonomía genérica de tres niveles de las maneras en las que fracasan los proyectos, en cuyo nivel superior están seis categorías de causas generales que después se dividen en categorías de nivel medio de categorías de causas y causas fundamentales específicas. Pusimos a prueba la taxonomía al pedirle a los practicantes de la conservación que la usaran para clasificar las causas del fracaso de los esfuerzos de conservación en los que han participado. No identificamos vacíos o redundancias importantes durante esta fase de prueba. Después, analizamos la frecuencia con la que los proyectos de esta muestra se enfrentaron a causas fundamentales particulares, lo que sugirió que algunas causas fundamentales tienen mayor probabilidad de ocurrir y que un número reducido de causas fundamentales tiene mayor probabilidad de ocurrir en proyectos que implementan ciertos tipos de acciones de conservación. Nuestra taxonomía podría usarse para mejorar el análisis, identificación y aprendizaje subsecuente a partir del fracaso de los esfuerzos de conservación; tratar algunas de las barreras que en la actualidad limitan a los practicantes de la conservación a aprender del fracaso; y contribuir al establecimiento de una cultura efectiva del aprendizaje a partir del fracaso dentro de la conservación.
虽然一些部门能够很好地从失败中吸取教训, 但目前对于如何在保护中最好地实现类似的转变及其必需条件的共识仍十分有限。其他部门的关键赋能条件之一是有一个广泛被接受和标准化的分类系统来识别和分析失败的根本原因。本研究设计了一个影响保护项目失败的根本原因的综合分类法。为了建立这一套分类法, 我们收集了现实世界中被认为在某些方面失败了的保护工作的案例, 确定了其失败的根本原因, 并利用这些案例制定了一个通用的项目失败方式三层分类法, 其顶端是六个总体原因类别, 并进一步分为中层原因类别和具体根源。我们要求保护实践者使用该分类法对他们所参与的保护工作的失败原因进行分类, 以对该分类法进行测试。在测试阶段没有发现明显的空缺或冗余。接下来, 我们分析了测试样本项目遇到特定失败根源的频率, 结果表明一些根源更为常见, 少数根源更有可能在实施特定类型保护行动的项目中出现。我们的分类法可用于改进对失败保护工作的识别、分析及随后的教训学习, 解决目前限制保护实践者从失败中学习的能力的一些障碍, 并有助于在保护中建立有效的从失败中学习的文化。【翻译: 胡怡思; 审校: 聂永刚】.

OBJECTIVE: The treatment of cholesteatoma is surgical in most cases. When it is indicated, it is preferable to choose a reconstructive surgical technique with the dual purpose of eradicating the disease and preserving or improving the patient\'s hearing. In 2017, the European Academy of Otology and Neuro-Otology/Japanese Otological Society (EAONO/JOS) published a new cholesteatoma classification. The aims of this study were to determine the influence of the surgical technique used and this classification on patient\'s hearing outcomes.
METHODS: A retrospective study that included patients who underwent reconstructive surgery of cholesteatoma between 2012 and 2017 was carried out. Based on pre-surgical computed tomography (CT) images, disease was staged according to the EAONO/JOS classification. Hearing outcomes obtained by pre and postoperative pure tone audiometry were analysed according to the surgical technique used and according to the stage of the disease.
RESULTS: 143 patients with no statistically significant differences in hearing thresholds before surgery were included. One year after surgery, all the patients\' (P = .01 and P = .001) airpure tone average (PTA) and mean differential auditory threshold had improved significantly. Those patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy presented better postsurgical air PTA and postsurgical mean differential auditory threshold outcomes (P = .007 and P = .014) than those patients who underwent tympanoplasty with canal wall down mastoidectomy. Moreover, the patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy had improved air PTA and mean differential auditory threshold one year after the surgery with statistical significance (P = .001, P = .013). The mean differential auditory threshold was also better (P = .008) in the patients who underwent tympanoplasty with canal wall down mastoidectomy one year after the procedure.
CONCLUSIONS: Reconstructive surgical techniques improve hearing one year after surgery. In our study, this improvement was significantly greater with tympanoplasty with two-stage canal wall up mastoidectomy.

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BACKGROUND: Mirizzi\'s Syndrome (MS) is a rare pathology, known to be a challenge for the surgeon. In the surgical management, open approach vs laparoscopic is a topic of discussion due to anatomic variations. The aim of this study is to analyze our experience in the laparoscopic management of this condition in Type Va.
METHODS: We made a descriptive retrospective study of patients diagnosed with MS type Va and treated by laparoscopic approach from 2014 to 2019, in two high volume centers of Bogotá, Colombia.
RESULTS: 1073 patients who presented complications from gallstones were evaluated, of which 16 were diagnosed with MS type Va. 75% were females and 25% males; 80% presented jaundice and 90% abdominal pain; 12 patients showed cholecystoduodenal fistula and 4 cholecystocolic fistula. All patients underwent laparoscopic management, total cholecystectomy and fistula resection with primary closure was possible on a 100% of the patients. Conversion rate was 0%. The follow up was 18 months.
CONCLUSIONS: Laparoscopic management of MS is feasible and safe; the experience of the surgery group and selection of the patients is the key to a successful outcome.