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RESUMEN Introducción: Las infecciones asociadas al catéter venoso central son la principal causa de morbilidad y mortalidad en los pacientes en hemodiálisis. El personal de enfermería es el que principalmente realiza la manipulación del acceso vascular en el momento de la inserción, mantenimiento o retirada del catéter. El papel del personal de enfermería es fundamental en la prevención de infecciones locales y sistémicas. Objetivo: Determinar las principales intervenciones implementadas por el personal de enfermería para reducir el número de infecciones asociadas a catéter en hemodiálisis. Metodología: Se realizó una revisión bibliográfica en el periodo agosto 2021 a enero 2022. La búsqueda fue realizada en bases de datos como PubMed, Scopus, Access Medicine, Wed of Science, Medigraphic, EBSCO, Science Direct, y Google Scholar. Los términos de búsqueda fueron: (infections) AND (hemodialysis) AND (nursing). Resultados: Se seleccionaron 94 estudios de los cuales se identificaron las principales medidas para la prevención de infecciones durante la instalación, mantenimiento y remoción del catéter para hemodiálisis. Ademas, se identificaron las limitantes de la evidencia para algunos procedimientos y los puntos que requieren mayor investigación. Conclusiones: Las principales estrategias utilizadas para reducir la bacteriemia relacionada con los catéteres en hemodiálisis son: 1) el uso estricto de medidas higiénicas por parte del personal sanitario, 2) el uso de profilaxis antibiótica en el lugar de salida 3) la impregnación en la luz del catéter con solución antimicrobiana de bloqueo, 4) la formación continua y 5) la aplicación de un protocolo. ABSTRACT Introduction: Central venous catheter-associated infections are the main cause of morbidity and mortality in hemodialysis patients. The nursing staff is the one who mainly performs the manipulation of the vascular access at the time of insertion, maintenance or removal of the catheter. The role of the nursing staff is fundamental in the prevention of local and systemic infections. Objective: To determine the main interventions implemented by nursing staff to reduce the number of catheter-associated infections in hemodialysis. Methodology: A literature review was conducted from August 2021 to January 2022. A search was conducted in databases such as PubMed, Scopus, Access Medicine, Wed of Science, Medigraphic, EBSCO, Science Direct, and Google Scholar. The search terms were: (infections) AND (hemodialysis) AND (nursing). Results: Ninety-four studies were selected from which the main measures for infection prevention during hemodialysis catheter installation, maintenance, and removal were identified. 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The debate regarding the cutoff point in the treatment of patients with subclinical hypothyroidism (Shypo) is ongoing. Generally, two different groups are identified for treatment by levels of 10 and 20 mIU/L. Nevertheless, the question remains, “what cutoff point should be chosen?” We have written a selective nonsystematic review focused on the 97.5 percentile reference value reported in healthy subjects in a number of countries and observed important disparities, which partly show the challenge of identifying a single cutoff point for those patients needing medication. We identified studies of TSH on the natural history of subclinical hypothyroidism from population-based prospective cohort studies, which follow up patients for several years. The evolution of TSH levels in these patients is variable. Some cases of TSH may return to lower levels at different stages over the years, but others may not, possibly even developing into overt thyroid failure, also variable. We analyzed factors that may explain the normalization of serum TSH levels. In addition, we found that thorough population-based prospective cohort studies following up on TSH levels, thyroid antibodies, and ultrasonography are important in decisions made in the treatment of patients. However, the 97.5 percentile reference value varies in different countries; therefore, an international cutoff point for subclinical hypothyroidism cannot be recommended.

Background: Obesity during childhood is a risk factor for developing cardiovascular diseases during adulthood. Aim: To measure insulin and glucose levels and parameters of insulin resistance in obese, overweight and normal weight Mexican children. Material and Methods: Comparative study of 21 obese children with a body mass index (BMI) over percentile 95, aged 10 ± 1 years (10 males), 14 children aged 10 ± 2 (7 males) with a BMI between percentiles 85 and 94 and 16 children aged 9 ± 2 years (3 males) with a body mass index between percentiles 10 and 84. Body weight, blood pressure and waist circumference were measured and a blood sample was obtained to measure fasting glucose and insulin levels. Homeostasis model of insulin resistance (HOMA) and quantitative insulin sensitivity check index (QUICKI) were calculated. Results: Among obese, overweight and normal weight children, insulin levels were 14.9 (95% CI 10.90-18.99), 7.20 (CI 5.12-9.28) and 4.73 (CI 95% 1.92-7.53) uU/ml, respectively. The figures for HOMA were 3.16 (95% CI 2.20-4.12), 1.49 (95% CI 1.03-1.94) and 0.97 (95% CI 0.35-1.60), respectively. The figures for QUICKI were 0.331 (95% CI 0.319-0.343), 0.371 (95% CI 0.349-0.393) and 0.419 (95% CI 0.391-0.446), respectively. Compared to their normal weight counterparts, the risk of obese children and those with a waist circumference over percentile 90 of having a HOMA over 3.16 was 17 and 10 times higher, respectively. BMI correlated better than waist circumference with insulin levels. Conclusions: Obese children have higher levels of insulin resistance than their normal weight counterparts.