Nivel de Conocimiento de las Madres Sobre Estimulación Temprana en Relación al Desarrollo Psicomotor de Menores de 2 Años en el Distrito de Tres de Diciembre - 2013

La investigación parte de siguiente problema de investigación: ¿Cuál es la relación que existe entre el nivel de conocimientos de las madres sobre estimulación temprana y el desarrollo psicomotor de menores de 2 años en el distrito Tres de Diciembre en el año 2015?; la hipótesis formulada fue: existe una relación directa y significativa entre el nivel de conocimientos de las madres sobre estimulación temprana y el desarrollo psicomotor de menores de 2 años en el distrito Tres de Diciembre en el año 2015.El método general empleado fue el método científico y como método específico empleado fue el descriptivo. El tipo de investigación es descriptiva; la investigación parte de una población de 120 madres, se procedió por el muestreo aleatorio de 92 madres con sus respectivos hijos.Las conclusión básica a las que se abordó fue la determinación de una relación significativa entre el nivel de conocimientos de las madres sobre estimulación temprana y el desarrollo psicomotor de menores de 2 años en el distrito Tres de Diciembre en el año 2015Tesi

Efectividad de un programa breve para la reducción de estrés en personal de salud durante el contexto de la pandemia COVID-19: Un estudio piloto

Objective: To determine the influence of a brief stress reduction program in health workers of the National Maternal and Perinatal Institute during the COVID-19 pandemic. Materials and Methods: This research corresponds to a quasi-experimental study, which consist of the elaboration and application of a brief stress reduction program in workers of the Puericulture area of the INMP. The population consisted of 45 workers, 30 of whom complied with the inclusion criteria for the pilot study, from which a sample of 15 participants was distributed, by convenience, for the experimental group and 15 for the control group. The Depression, Anxiety and Stress Scale (Dass21) was applied at the beginning of the investigation and after concluding the program. The analysis of frequencies and percentages of the variable, analysis of adjusted goodness of fit to the normal curve, and Student's t-tests for correlated samples (p<0.05) pre and post intragroup test with a confidence level of 95% were carried out. Results: Significant differences were found in the experimental group in their pre and post treatment measures respectively in the variables Stress (T=5.20, p<0.001, D=0.742, Mean Dif=3.00); Anxiety (T=3.15, p<0.007, D=0.414, Mean Dif=2.20) and Depression (T=3.97, p<0.001, D=0.426, Mean Dif=3.97) reducing the averages of these variables after the application of the pilot program. Conclusion: The brief program for stress reduction is effective for stress reduction, and due to the fact that in its sessions cognitive behavioral strategies for the improvement of mental health were trained, indicators of anxiety and depression present in the sample were reduced in a secondary way.Objetivo. Determinar la influencia de un programa breve de reducción del estrés en trabajadores de salud del Instituto Nacional Materno perinatal durante la pandemia COVID-19. Materiales y Métodos. Esta investigación corresponde a un estudio cuasi experimental, que consiste en la elaboración y aplicación de un programa breve de reducción del estrés en trabajadores del área de Puericultura del INMP. La población estuvo conformada por 45 trabajadores, 30 de ellas cumplieron con los criterios de inclusión para el estudio piloto, de las cuales se distribuyó, por conveniencia, una muestra de 15 participantes para el grupo experimental y 15 para el grupo control. Se aplicó la Escala de Depresión, ansiedad y estrés (Dass21) al inicio de la investigación y luego de concluir con el programa. Se realizó el análisis de frecuencias y porcentajes de la variable, análisis de ajuste de bondad a la curva normal, y pruebas T Student para muestras relacionadas (p<0.05) pre y post test intragrupo con un nivel de confianza al 95%. Resultados.  Se encontró diferencias significativas en el grupo experimental en sus medidas pre y post tratamiento respectivamente en las variables Estrés (T=5.20, p<0.001, D=0.742, Dif medias=3.00); Ansiedad (T=3.15, p<0.007, D=0.414, Dif medias=2.20) y Depresión (T=3.97, p<0.001, D=0.426, Dif medias=3.97) reduciéndose las medias de dichas variables post aplicación del programa piloto. Conclusión. El programa breve para la reducción del estrés es efectivo para la reducción del estrés, a su vez debido a que en sus sesiones se entrenaron estrategias cognitivas conductuales para la mejora de la salud mental, se redujo, de forma secundaria, indicadores de ansiedad y depresión presentes en la muestra

Factores asociados a la reacción de estrés agudo en gestantes con hiperémesis gravídica hospitalizadas en el Instituto Nacional Materno Perinatal, Lima, Perú (2021)

Objective: To determine the factors associated with hyperemesis gravidarum and acute stress reaction in pregnant women with hyperemesis gravidarum hospitalized at the National Maternal Perinatal Institute during 2021. Materials and Methods: This research corresponds to an analytical, observational, case-control study, where the medical records of pregnant patients hospitalized for hyperemesis gravidarum attended by the psychology service who presented an acute stress reaction meeting the inclusion and exclusion criteria were collected. An analysis of frequencies and percentages of the different variables and a multivariate analysis were performed to find the significant factors (p<0.05) and the calculation of the Odds Ratio (OR) with a confidence level of 95%; this model was evaluated using multiple logistic regression. Results: A relationship was found between pregnancy planning (p<0.044, β=0.957 and OR=2.6047) and nausea rejection (p<0.028, β=1.774 and OR=5.893) in pregnant women with hyperemesis gravidarum. A direct relationship was found between the acute stress reaction in pregnant women with hyperemesis gravidarum, with respect to pregnancy loss (p<0.043, β=0.933 and OR=2.542) and hospitalization in the COVID-19 area (p<0.010, β=1.467 and OR=4.335); and inversely, regarding the acceptance of the pregnancy (p<0.014, β=-1.515 and OR=0.220). Conclusion: Two variables were found to be associated with the presence of hyperemesis gravidarum (pregnancy planning and the rejection of nausea). The acute stress reaction was related to two factors associated with the patients (gestational loss and pregnancy acceptance) and one associated with the pandemic (hospitalization in Covid-19 area) which explain 32% of the variance.Objetivo. Determinar los factores que se encuentran asociados a la hiperémesis y reacción de estrés agudo en gestantes hospitalizadas con hiperémesis gravídica en el Instituto Nacional Materno Perinatal, durante el 2021. Materiales y Métodos. Esta investigación corresponde a un estudio analítico, observacional, de tipo casos y controles, donde se recopilaron las historias clínicas de pacientes gestante hospitalizadas por hiperémesis gravídica atendidas por el servicio de psicología las cuales presentaron reacción de estrés agudo cumpliendo los criterios de inclusión y exclusión. Se realizó un análisis de frecuencias y porcentajes de las diferentes variables y un análisis multivariado para encontrar los factores significativos (p<0.05) y el cálculo de los Odds Ratio (OR) con un nivel de confianza del 95%; este modelo fue evaluado mediante una regresión logística múltiple. Resultados. Se encontró relación entre la planificación del embarazo (p<0.044, β=0.957 y OR=2.6047) y el rechazo a las náuseas (p<0.028, β=1.774 y OR=5.893) en gestantes con hiperémesis gravídica. Se halló relación directa entre la reacción de estrés agudo en gestantes con hiperémesis gravídica, respecto a la perdida gestacional (p<0.043, β=0.933 y OR=2.542) y hospitalización en zona COVID-19 (p<0.010, β=1.467 y OR=4.335); e inversa, respecto a la aceptación del embarazo (p<0.014, β=-1.515 y OR=0.220). Conclusión. Se encontraron dos variables asociadas a la presencia de hiperémesis gravídica (planificación del embarazo y el rechazo a las náuseas). La reacción de estrés agudo se ha relacionado con dos factores asociados a las pacientes (perdida gestacional y aceptación del embarazo) y una asociada a la pandemia (hospitalización en zona COVID-19) las cuales explican el 32% de la varianza

Anatomical and functional outcomes of symptomatic idiopathic vitreomacular traction

Purpose: To describe the natural history of eyes with symptomatic idiopathic vitreomacular traction (VMT). Methods: Retrospective multicenter study of 168 eyes with spectral-domain optical coherence tomography (SD-OCT) findings consistent with idiopathic VMT. All eyes were graded according to SD-OCT findings. Grade 1 was defined as incomplete cortical vitreous separation with foveal attachment. Grade 2 was defined as Grade 1 plus intraretinal cysts or clefts. Grade 3 was defined as Grade 2 plus a foveal detachment. All patients were followed for at least 6 months. Results: There were 168 patients (51 men) with a mean age of 68.8 ± 10.7 years. Patients were followed for a mean of 22.7 ± 20.1 months. The mean duration of symptoms before the initial presentation was 3.65 ± 5.42 months. At baseline, 72 eyes had Grade 1, 74 eyes had Grade 2, and 22 eyes had Grade 3 SD-OCT findings. Over the follow-up period, 36 eyes (21.4%) had spontaneous resolution of the VMT with normalization of the foveal anatomy. The mean time to resolution was 12.3 ± 12.6 months. An unfavorable anatomical outcome occurred in 7.7% (13 of 168) of the eyes, with 6 eyes developing a lamellar macular hole and 7 eyes developing a full-thickness macular hole. This occurred at a mean of 10.3 ± 10.7 months after the presentation. Subgroup analysis based on baseline SD-OCT grade showed that 4.1% (3 of 73) of Grade 1 eyes compared with 6.8% (5 of 74) of Grade 2 eyes, and 23.8% (5 of 21) of Grade 3 eyes developed a full-thickness macular hole or lamellar macular hole (P 0.0109, chi-square test). In the remaining 119 eyes, at the last follow-up, 65 eyes had Grade 1, 42 eyes had Grade 2, and 12 eyes had Grade 3 VMT. On average, the best-corrected visual acuity improved from 0.40 ± 0.35 logarithm of the minimum angle of resolution (Snellen, 20/50) at baseline to 0.35 ± 0.36 logarithm of the minimum angle of resolution (Snellen, 20/45; P 0.0372), and the mean central macular thickness improved from 350 ± 132 m to 323 ± 121 m. Conclusion: Spontaneous resolution of VMT occurred in 21.4% (36 of 168) of eyes after a mean follow-up of 11.4 ± 12.6 months. An unfavorable anatomical outcome occurred in 7.7% (13 of 168) of eyes. The baseline SD-OCT grade may predict the progression to full-thickness macular hole

Intravitreal bevacizumab (Avastin®) for diabetic retinopathy at 24-months: The 2008 Juan Verdaguer-planas lecture

Diabetic retinopathy (DR) remains the major threat to sight in the working age population. Diabetic macular edema (DME) is a manifestation of DR that produces loss of central vision. Proliferative diabetic retinopathy (PDR) is a major cause of visual loss in diabetic patients. In PDR, the growth of new vessels is thought to occur as a result of vascular endothelial growth factor (VEGF) release into the vitreous cavity as a response to ischemia. Furthermore, VEGF increases vessel permeability leading to deposition of proteins in the interstitium that facilitate the process of angiogenesis and macular edema. This review demonstrates multiple benefits of intravitreal bevacizumab (IVB) on DR including DME and PDR at 24 months of follow up. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse diabetic macular edema. Therefore, in the future this new therapy could replace or complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to pan-retina photocoagulation so that more selective therapy may be applied. In addition, we report a series of patients in which tractional retinal detachment developed or progressed after adjuvant preoperative IVB in severe PDR. © 2010 Bentham Science Publishers Ltd

Intravitreal bevacizumab in diabetic retinopathy. Recommendations from the Pan-American Collaborative Retina Study Group (PACORES): The 2016 knobloch lecture

The advent of intravitreal anti-vascular endothelial growth factor (anti-VEGF) medications has revolutionized the treatment of diabetic eye diseases. Herein, we report the outcomes of clinical studies carried out by the Pan-American Collaborative Retina Study Group (PACORES), with a specific focus on the efficacy of intravitreal bevacizumab in the management of diabetic macular edema and proliferative diabetic retinopathy. We will also discuss the use of intravitreal bevaci-zumab as a preoperative, adjuvant therapy before vitrectomy for prolif-erative diabetic retinopathy. Copyright © 2017 by Asia Pacific Academy of Ophthalmology

Experiencias de aprendizaje

Libro de experiencias de aprendizaje del grupo de investigación Giteca y de los semilleros de investigación en la que se visualizan las diferentes experiencias lideradas por instructores y aprendices en las diferentes áreas y líneas de formación.Book of learning experiences of the Giteca research group and the research hotbeds in which the different experiences led by instructors and apprentices in the different areas and lines of training are visualized.Propagación in vitro como un camino de aprendizaje para la formación profesional integral -- Experiencias significativas de aprendizaje, laboratorio de hematología y parasitología animal del Complejo Tecnológico para la Gestión Agroempresarial CTPGA-SENA -- Experiencias significativas adquiridas por aprendices en el área de SENNOVA, Complejo Tecnológico para la Gestión Agroempresarial. Regional – Antioquia -- El papel de la prensa escrita en el desarrollo de la competencia textual -- Aprendiendo a Emprender con un emprendedor -- Ven y te cuento sobre ADSI -- Observaciones fenológicas del cultivo de cacao (Theobroma cacao) en los municipios de Tarazá, El Bagre y Caucasia dentro de la formación del programa SENA emprende rural -- Tejiendo sueños desde la formación -- Forraje verde hidropónico como alternativa para disminuir la expansión de la frontera agrícola en el Putumayo -- La importancia del saber hacer para ser competente en el sector agrícola -- Experiencia significativa de aprendizaje semilleros de investigación -- La investigación como ente transformador de pensamientos -- Piscícola Paraguay; Mi Sueño, Mi Proyecto de Vida! -- Estrategia de aprendizaje a través de la investigación y la empresa aplicando un programa de Responsabilidad Social Empresarial –RSE -- Matemática aplicada para procesos agroindustriales de panificaciónna85 página

Secukinumab, an Interleukin-17A Inhibitor, in Ankylosing Spondylitis

Background Secukinumab is an anti–interleukin-17A monoclonal antibody that has been shown to control the symptoms of ankylosing spondylitis in a phase 2 trial. We conducted two phase 3 trials of secukinumab in patients with active ankylosing spondylitis. Methods In two double-blind trials, we randomly assigned patients to receive secukinumab or placebo. In MEASURE 1, a total of 371 patients received intravenous secukinumab (10 mg per kilogram of body weight) or matched placebo at weeks 0, 2, and 4, followed by subcutaneous secukinumab (150 mg or 75 mg) or matched placebo every 4 weeks starting at week 8. In MEASURE 2, a total of 219 patients received subcutaneous secukinumab (150 mg or 75 mg) or matched placebo at baseline; at weeks 1, 2, and 3; and every 4 weeks starting at week 4. At week 16, patients in the placebo group were randomly reassigned to subcutaneous secukinumab at a dose of 150 mg or 75 mg. The primary end point was the proportion of patients with at least 20% improvement in Assessment of Spondyloarthritis International Society (ASAS20) response criteria at week 16. Results In MEASURE 1, the ASAS20 response rates at week 16 were 61%, 60%, and 29% for subcutaneous secukinumab at doses of 150 mg and 75 mg and for placebo, respectively (P<0.001 for both comparisons with placebo); in MEASURE 2, the rates were 61%, 41%, and 28% for subcutaneous secukinumab at doses of 150 mg and 75 mg and for placebo, respectively (P<0.001 for the 150-mg dose and P=0.10 for the 75-mg dose). The significant improvements were sustained through 52 weeks. Infections, including candidiasis, were more common with secukinumab than with placebo during the placebo-controlled period of MEASURE 1. During the entire treatment period, pooled exposure-adjusted incidence rates of grade 3 or 4 neutropenia, candida infections, and Crohn’s disease were 0.7, 0.9, and 0.7 cases per 100 patient-years, respectively, in secukinumab-treated patients. Conclusions Secukinumab at a subcutaneous dose of 150 mg, with either subcutaneous or intravenous loading, provided significant reductions in the signs and symptoms of ankylosing spondylitis at week 16. Secukinumab at a subcutaneous dose of 75 mg resulted in significant improvement only with a higher intravenous loading dose. (Funded by Novartis Pharma; ClinicalTrials.gov numbers, NCT01358175 and NCT01649375.

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030