Prevention and clinical management of pre-eclampsia and eclampsia: Evidence-based clinical practice guidelines from the national reference institute in maternal health of Peru

Introducción. En Perú, los trastornos hipertensivos del embarazo son la segunda causa de mortalidad materna. Objetivo. La presente guía de práctica clínica basada en evidencias (GPC-BE) brinda recomendaciones para la prevención y tratamiento de la pre-eclampsia y eclampsia. Métodos. Se elaboró una GPC-BE adaptada mediante un proceso sistemático, riguroso y transparente con un grupo elaborador conformado por metodólogos y profesionales de la salud expertos en el manejo de la enfermedad. La guía cuenta con dieciséis preguntas clínicas y dieciséis recomendaciones. Se realizó la búsqueda y preselección de GPC, las mismas que fueron evaluadas mediante el instrumento “Appraisal of Guidelines for Research and Evaluation II” (AGREEII), para su adaptación. La búsqueda sistemática de evidencias para responder las preguntas clínicas se realizó en múltiples bases de datos: MEDLINE/PubMed, EMBASE/Ovid, Cochrane Library, LILACS y SciELO. Las evidencias fueron seleccionadas y analizadas críticamente por pares clínicos y metodológicos; las recomendaciones fueron elaboradas mediante la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados. Con la participación de un panel de expertos clínicos del Instituto Nacional Materno Perinatal, redes de salud y otras instituciones de referencia, se elaboraron 16 recomendaciones dirigidas a la prevención y tratamiento de mujeres gestantes en riesgo de pre-eclampsia, gestantes con pre-eclampsia, eclampsia o enfermedad hipertensiva. Conclusiones. Este artículo resume la guía de práctica clínica basada en evidencias para la prevención y tratamiento de pre-eclampsia y eclampsia en gestantes en el instituto de referencia nacional en salud materna y neonatal del Perú.Introduction. In Peru, hypertensive disorders of pregnancy are the second cause of maternal mortality. Objective. This evidence-based clinical practice guideline (EB-CPG) provides recommendations for the prevention and treatment of pre-eclampsia and eclampsia. Methods. An adapted EB-CPG was elaborated through a systematic, rigorous and transparent process with a group consisting of methodologists and health professionals who are experts in the management of the disease. The guide has sixteen clinical questions and sixteen recommendations. The search and pre-selection of EB-CPGs were performed, which were evaluated through the “Appraisal of Guidelines for Research and Evaluation II” tool (AGREE-II), for its adaptation. The systematic search for evidence to answer the 16 clinical questions were made in multiple databases: MEDLINE / PubMed, EMBASE / Ovid, Cochrane Library, LILACS and SciELO. Evidences were selected and analyzed critically by clinicians and methodologists in pairs, recommendations were elaborated through the Grading of Recommendations Assessment, Development, and Evaluation methodology (GRADE). Results. With the participation of a panel of clinical experts from the National Perinatal Maternal Institute, representatives from health care networks and other reference institutions, 16 recommendations were established for the prevention and treatment of pregnant women at risk of pre-eclampsia, for pregnant women with pre-eclampsia, eclampsia or hypertensive disease. Conclusions. This article summarizes the evidence-based clinical practice guidelines for the prevention and treatment of preeclampsia and eclampsia in peruvian pregnant women for the national reference institute for maternal and neonatal health of Peru

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

MDR1 C3435T polymorphism in Mexican patients with breast cancer

We investigated whether the MDR1 C3435T polymorphism is associated with fibrocystic changes (FCC), infiltrating ductal breast cancer (IDBC), and/or clinical-pathological features of IDBC in Mexican patients. Samples from women who received surgical treatment in 2007 at the Centro M�dico de Occidente (M�xico) were included in the analysis. Genotyping was performed by polymerase chain reaction-restricted fragment length polymorphisms in 64 paraffin-embedded breast samples with IDBC, 64 samples with FCC, and 183 peripheral blood samples of healthy females designated as the healthy group (HG). The frequency of the T allele was 41, 45, and 52% for the FCC, IDBC, and HG samples, respectively. Significant differences were only found between the FCC and HG samples [odds ratio (OR) = 0.64, 95% confidence interval (CI) = 0.43-0.96; P = 0.032]. The prevalence of the T/T genotype was 8, 13, and 24% for FCC, IDBC, and HG samples, respectively. Again, statistical differences were only found between FCC and HG samples for the T/T genotype (OR = 0.28, 95%CI = 0.106-0.77; P = 0.009). Although the T allele and the T/T genotype were less frequent in the IDBC group than in the HG, the differences were not significant. Furthermore, no associations were found between the C3435T polymorphism and clinical-pathological features of the IDBC group. Both the FCC and IDBC groups had a high frequency of the C allele relative to the HG in this sample of women from Western Mexico. � FUNPEC-RP

MDR1 C3435T polymorphism in mexican children with acute lymphoblastic leukemia and in healthy individuals

To determine the influence of the MDR1 C3435T polymorphism on the development of childhood acute lymphoblastic leukemia (ALL), we studied 107 children with ALL and 111 healthy subjects. All subjects were genotyped for the C3435T polymorphism using the polymerase chain reaction-restriction fragment length polymorphism bmethod. The genotype frequencies in the patients were 17% homozygous CC, 61% heterozygous CT, and 22% homozygous TT; in healthy individuals the genotype frequencies were 14% CC, 53% CT, and 33% TT. In patients with ALL the allele frequencies were 0.47 for the C allele and 0.53 for the T allele; in the healthy group these allele frequencies were 0.40 and 0.60 for the C and T alleles, respectively. No significant differences in allele frequency (p > 0.176) and genotype frequency (p > 0.255) were detected between the two groups. These findings suggest that the CT or TT genotype does not increase the risk for childhood ALL in Mexican patients. On the other hand, significant differences in allele frequencies were detected in the comparison of Mexican healthy subjects with other populations. Whether these differences are fortuitous or related to diverse genetic backgrounds remains to be elucidated. � 2008 Wayne State University Press

Association of LEP and ADIPOQ common variants with colorectal cancer in Mexican patients

Leptin and adiponectin are cytokines produced by adipose tissue with opposite effects on tumor growth: the former stimulate whereas the latter inhibit it. The objective was to analyze the association of LEP A19G and ADIPOQ+45 T/G and +276 G/T polymorphisms in Mexican patients with colorectal cancer (CRC). 68 unrelated patients with CRC (study group) and 102 blood donors (control group); all subjects were Mestizos from western Mexico. The polymorphisms were established by PCR-RFLP on DNA samples obtained from peripheral blood. The LEP A19G polymorphism showed significant differences between CRC patients and control group (p= 0.01 for G/A genotype and p= 0.02 for the recessive model G/G +G/A); yet, in the analysis stratified by gender, this difference remained significant only in males. The ADIPOQ polymorphisms did not shown any significant differences. Our results suggest that the A19G LEP polymorphism is associated with CRC in Mexican patients. Zapotitlán 2010-IOS Press and the authors. All rights reserved

Prevención y manejo clínico de pre eclampsia y eclampsia: Guía de práctica clínica basada en evidencias del instituto de referencia nacional en salud materna del Perú

Introducción. En Perú, los trastornos hipertensivos del embarazo son la segunda causa de mortalidad materna. Objetivo. La presente guía de práctica clínica basada en evidencias (GPC-BE)brinda recomendaciones para la prevención y tratamiento de la pre-eclampsia y eclampsia. Métodos. Se elaboró una GPC-BE adaptada mediante unproceso sistemático, riguroso y transparentecon un grupo elaborador conformado por metodólogos y profesionales de la salud expertos en el manejo de la enfermedad. La guía cuenta con dieciséis preguntas clínicas y dieciséis recomendaciones. Se realizó la búsqueda y preselección de GPC, las mismas que fueron evaluadas mediante el instrumento “Appraisal of Guidelines for Research and Evaluation II” (AGREE-II), para su adaptación. La búsqueda sistemática de evidencias para responder las preguntas clínicas se realizó en múltiples bases de datos: MEDLINE/PubMed, EMBASE/Ovid, Cochrane Library, LILACS y SciELO. Las evidencias fueron seleccionadas y analizadas críticamente por pares clínicos y metodológicos; las recomendaciones fueron elaboradas mediante la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados. Con la participación de un panel de expertos clínicos del Instituto Nacional Materno Perinatal, redes de salud y otras instituciones de referencia, se elaboraron 16 recomendaciones dirigidas a la prevención y tratamiento de mujeres gestantes en riesgo de pre-eclampsia, gestantes con pre-eclampsia, eclampsia o enfermedad hipertensiva. Conclusiones. Este artículo resume la guía de práctica clínica basada en evidencias para la prevención y tratamiento de pre-eclampsia y eclampsia en gestantes en el instituto de referencia nacional en salud materna y neonatal del Perú.Introduction. In Peru, hypertensive disorders of pregnancy are the second cause of maternal mortality. Objective. This evidence-based clinical practice guideline (EB-CPG) provides recommendations for the prevention and treatment of pre-eclampsia and eclampsia. Methods. An adapted EB-CPG was elaborated through a systematic, rigorous and transparent process with a group consisting of methodologists and health professionals who are experts in the management of the disease. The guide has sixteen clinical questions and sixteen recommendations. The search and pre-selection of EB-CPGs were performed, which were evaluated through the “Appraisal of Guidelines for Research and Evaluation II” tool (AGREE-II), for its adaptation. The systematic search for evidence to answer the 16 clinical questions were made in multiple databases: MEDLINE / PubMed, EMBASE / Ovid, Cochrane Library, LILACS and SciELO. Evidences were selected and analyzed critically by clinicians and methodologists in pairs, recommendations were elaborated through the Grading of Recommendations Assessment, Development, and Evaluation methodology (GRADE). Results. With the participation of a panel of clinical experts from the National Perinatal Maternal Institute, representatives from health care networks and other reference institutions, 16 recommendations were established for the prevention and treatment of pregnant women at risk of pre-eclampsia, for pregnant women with pre-eclampsia, eclampsia or hypertensive disease. Conclusions. This article summarizes the evidence-based clinical practice guidelines for the prevention and treatment of pre-eclampsia and eclampsia in peruvian pregnant women for the national reference institute for maternal and neonatal health of Per

Assessment of Sustainability Using a Synthetic Index

[EN] The Sustainable Society Index measures the three fundamental pillars of sustainability (the economy, the environment, and development) for154 countries around the world. It assigns the same weighting to all the indicators, without any aggregation of the pillars. This study proposes the use of cross-efficiency in order to overcome these shortcomings and obtain a more accurate sustainability index that allows countries to be ranked in terms of their environmental situation as well as their economic and social development. First, cluster analysis is used to classify the countries into homogeneous groups, according to their environmental position. Then, two sustainability indices are produced to measure environmental as well as economic and social aspects. 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Historia comparada de las Américas : perspectivas de la integración cultural

La presente obra responde al creciente y renovado interés que hoy despierta el tema de la integración cultural en sus múltiples dimensiones. Este volumen reúne veintisiete trabajos preparados por destacados especialistas provenientes de distintos ámbitos académicos, quienes se hicieron eco de la invitación a presentar sus respectivas propuestas y perspectivas, así como a repensar el vínculo entre integración y cultura desde el mirador de la experiencia americana. 'Integración' y 'cultura' constituyen ya en sí mismos dos conceptos de enorme complejidad a través de los que se busca dar cuenta de todo un amplio espectro de procesos, prácticas, discursos, políticas, de vital importancia para la historia de la religión. El estudio de ambos conceptos ha generado a su vez auténticas constelaciones de temas y problemas, y ha dado lugar a reflexiones de muy amplios alcances, líneas de investigación altamente productivas y campos de estudio interdisciplinario en plena etapa de expansión. Así lo confirman los trabajos aquí publicados, que aportan, con gran solvencia, perspectivas de análisis y líneas de discusión de gran riqueza. Una y múltiple, la inquietud por la integración no ha dejado de acompañar a los americanos a lo largo del tiempo. El recorrido histórico, espacial y temático; la reflexión teórica y la preocupación por estrategias concretas; el asomo a miradas de conjunto y a estudios de caso; el particular énfasis en algunos de los posibles nuevos caminos para pensar la integración cultural: muchas de estas perspectivas se hacen presentes en este volumen, a través de reflexiones que confirman que el tema sigue siendo no sólo vigente sino de imperiosa y decisiva actualidad.                                                                         Libro