Rol de fisioterapeuta respiratorio en los criterios de destete ventilatorio: estrategias y predicotres

El destete de la ventilación mecánica es el proceso mediante el cual el paciente sometido a ventilación mecánica retorna a la ventilación espontanea sin necesidad de volver a ser conectado. Este proceso de destete consta de dos partes; el cese de la ventilación mecánica y la retirada del tubo endotraqueal llamado extubación. Mediante los indicadores y predictores podemos predecir el éxito o el fracaso del proceso de destete, ya sea con la prueba de ventilación espontanea con tubo en T o presión de soporte, evaluando los niveles basales ideales para el inicio de destete, el índice de Tobin, índice de CROP, índice de PImax, siendo los primeros los que cuentan con mayor predicción. En la mayoría de casos el destete es fallido y el paciente es reintubado complicando su estado y desarrollando complicaciones que terminan eventualmente en su deceso. La terapia física forma parte del equipo multidisciplinario tratando la parte muscular, manejo de secreciones, movilidad y fuerza de los músculos respiratorios en el pre y pos destete

Estudio de genes codificantes de proteínas de reserva, mapeo genético, análisis de QTLs y estudio de genes de resitencia a "Ascochyta lentis" en "Lens"

252 p.La tesis doctoral se centra en el estudio de distintas características que afectan a la lenteja cultivada (Lens culinaris) por su importancia en la alimentación humana al ser una de las primeras leguminosas domesticada y estar implantada en amplias zonas del subcontinente de la India y en ciertas regiones del Mediterráneo. Los distintos estudios que la forman se centran en analizar los aspectos que afectan negativamente al desarrollo de la planta y en cómo favorecer la obtención de un alto rendimiento y semilla de calidad, especialmente con un contenido proteico alto y equilibrado en su composición de aminoácidos. Para el desarrollo de la presente tesis, como material vegetal de trabajo se utilizaron distintas variedades de lenteja cultivada (Lens culinaris culinaris ) y su antecesor silvestre (L. culinaris orientalis) que se caracterizarán para su resitencia a sequía y al hongo Ascochyta lentis. También se utilizaron poblaciones segregantes formadas por un conjunto de líneas consanguíneas recombinantes obtenidas en el laboratorio de Genética de la Universidad de Leó

Efecto regenerador del ácido hialurónico en defectos óseos circunferenciales en ratas albinas Wistar.

Objective: To determine the regenerating effect of hyaluronic acid on circumferential bone defects in albino Wistar rats. Material and Methods: An experimental type study was designed and carried out with 15 albino male Wistar rats, 4 months old and weighing between 250 and 350 grams. Two circumferential bone defects 3mm in diameter and 0.8mm deep were created in the calvaria of the parietal bone (on both sides of the midline). One defect was filled with a demineralized bone matrix (control group); while the other defect was filled with the combination of a demineralized bone matrix plus hyaluronic acid (experimental group). Five experimental rats were euthanized at 30, 60 and 90 days after surgery and they were histologically evaluated following the parameters proposed by Heiple. Results: The experimental group presented a better degree of bone regeneration at 30 and 60 postoperative days. Conclusion: Hyaluronic acid is effective in bone regeneration of circumferential bone defects.Objetivo: Determinar el efecto regenerador del ácido hialurónico en defectos óseos circunferenciales en ratas albinas Wista. Material y Métodos: Se diseñó un estudio de tipo experimental y se trabajó con 15 ratas albinas Wistar (todas macho) de 4 meses de edad y con un peso entre 250 a 350 gr. Se crearon en todas 2 defectos óseos circunferenciales de 3mm de diámetro y 0.8 mm de profundidad en la calota del hueso parietal (a ambos lados de la línea media). Un defecto fue rellenado con una matriz ósea desmineralizada (grupo control); mientras que el otro defecto fue rellenado con la combinación de una matriz ósea desmineralizada más el ácido hialurónico (grupo experimental). Se realizó la eutanasia a 05 ratas de experimentación a los 30, 60 y 90 días postquirúrgicos y se evaluaron histológicamente siguiendo los parámetros propuestos por Heiple. Resultados: El grupo experimental presentó un mejor grado de regeneración ósea en los 30 y 60 días postoperatorios. Conclusiones: El ácido hialurónico es eficaz en la regeneración ósea de defectos óseos circunferenciales

Tecnología para el control del COVID-19: Una revisión del caso peruano

Carta al editor (sin resumen

Level of Physical Activity in Adolescents who Attend Secondary School in Lima Institute

Foundation: the lack of physical activity is linked to high levels of sedentary behavior, which constitutes an important risk factor for the development of chronic diseases such as: overweight and obesity, which in adolescents has become a health problem worldwide. Objective: to determine the level of physical activity of the students of the secondary level of a public school in Lima. Method: a descriptive and cross-sectional study was carried out in which students between the ages of 12 and 17 enrolled in the 2019 school year were included. The population consisted of 470 high school students from the Institución Educativa Simón Bolívar school in the Palomino Urbanization of Cercado de Lima. The Inventory of Habitual Physical Activity for Adolescents and the eating behaviors module of the World Health Survey of Schoolchildren were applied. Simple random probabilistic sampling was used. Results: 52.3 % of the patients were male, the most frequent age range was 13 to 15 years with 70.1 %. Most presented a normal nutritional status (83.3 %). The level of habitual physical activity was mostly moderate with 62 % followed by low with 19.5 % and high with 18.3 %. Conclusions: the level of total habitual physical activity presented by the students of this educational institution is moderate, which does not meet the recommended levels of physical activity for children and adolescents

Attitudes towards research in medical residents of a public pediatric hospital

Introduction: Research is an intentional process of constructing new knowledge and ideas, promoting the transformation of society. Health professionals must develop positive attitudes towards research since this will improve their professional performance and therefore improve the quality of patient care. Objective: Identify the attitudes towards research in resident doctors of a public pediatric hospital. Methods: The study was descriptive cross-sectional; 200 resident doctors were included. The "Research Attitudes Scale (EACIN)" of 39 items was applied. The T-Student test for independent samples was used to determine the difference in the scores of research attitudes, and the variables sex, type of specialty and work experience, while the Mann Whitney U test was used for the weekly work hours variable. Results: 58.5 % were female, 25 % (48) showed a positive affective attitude, 98 % (196) a positive cognitive attitude, 94 % (188) a positive behavioral attitude. In general, 96 % (192) had a positive attitude and 4 % (8) had a neutral attitude. The score obtained by resident physicians who performed surgical specialties was higher than that of those who performed clinical specialties (115.69 ± 6.02 versus 113.29 ± 5.93; p= 0.012). Conclusions: Most resident doctors have positive attitudes towards research, which could be beneficial to implement training programs and/or activities related to research in the hospital

Multirresistencia en Escherichia coli asociada a Betalactamasas de Espectro Extendido en urocultivos obtenidos en pacientes de una provincia de la Amazonía Peruana

Background: Beta-lactam antibiotics are the most used in the treatment of urinary infections in Peru. Bacterial resistance is frequently produced by the presence of Extended Spectrum Betalactamases (ESBL) in Enterobacteriaceae. Objective: To determine the multi-resistance in E. coli associated to extended spectrum beta-lactamases in urine cultures from adults residing in the province of Tambopata-Madre De Dios. The study: Non-experimental, descriptive study, detection and confirmation of ESBL was performed with the double disc technique using ceftazidime, cefotaxime, cefepime, aztreonam and amoxicillin plus clavulanic acid. Microbial resistance and susceptibility was identified using the diffusion disk technique. Findings: 162 strains of E. coli were isolated. Strains with resistance to the antibiotics ampicillin (71%), trimethoprine sulfamethoxazole (49%), ciprofloxacin acid (37%), nalidixic acid (37%) and aztreonam (31%) were identified. Conclusion: There is antimicrobial resistance mediated by ESBL-producing strains of E. coli.Introducción: Los antibióticos betalactámicos son los más utilizados en el tratamiento de las infecciones urinarias en el Perú. La resistencia bacteriana se produce frecuentemente por la presencia de Betalactamasas de Espectro Extendido (BLEE) en enterobacterias. Objetivo: Determinar la multirresistencia en E. coli asociada a betalactamasas de espectro extendido en urocultivos de adultos que residen en la provincia de Tambopata-Madre De Dios. El estudio: Estudio no experimental, descriptivo, la detección y la confirmación de BLEE se realizó con la técnica de doble disco usando ceftazidima, cefotaxima, cefepime, aztreonam y amoxicilina más ácido clavulánico. La resistencia y susceptibilidad microbiana se identificó usando la técnica de disco de difusión. Hallazgos: Se aislaron 162 cepas de E. coli. Se identificaron cepas con resistencia a los antibióticos ampicilina (71%), trimetoprim sulfametoxazol (49%), ácido ciprofloxacino (37%), ácido nalidíxico (37%) y aztreonam (31%). Conclusión: Existe resistencia antimicrobiana mediada por cepas de E. coli productoras BLEE

Evaluación de Tecnologías Sanitarias (ETS) en el Perú: estado actual y retos futuros

A health technology (drug, vaccine, medical device, procedure) is submitted to a systematic evaluation procedure, called Health Technology Assessment (HTA). The HTA process involves analyzing the properties, benefits, risks and costs of a technology applied to health care, and issuing evidence-based information, linking research and its findings with decision-making in the field of health. Based on the recommendations obtained as a result of the HTA, decision-makers in the health sector choose to admit or reject the incorporation of new health technologies. In Peru, as in the rest of the world, the health technology assessment process has been implemented for approximately ten years, and there are institutions with experience in preparing reports with the results of the HTA. This article provides a general overview of HTA in the world, with special emphasis on their evolution and development in Peru.Una tecnología sanitaria (medicamento, vacuna, dispositivo médico, procedimiento) es sometida a un procedimiento sistemático de valorización, denominado evaluación de tecnologías sanitarias (ETS). El proceso de ETS conlleva analizar una tecnología aplicada a la atención sanitaria, y emitir información basada en evidencias, vinculando la investigación y sus hallazgos con la toma de decisiones en el ámbito de la salud. En base a las recomendaciones obtenidas como resultado de la ETS, los encargados de decidir en el sector salud optan por admitir o rechazar la inclusión de nuevas tecnologías en el ámbito sanitario. En el Perú, al igual que en el resto del mundo, la ETS se ha implementado desde hace aproximadamente diez años, existiendo instituciones con experiencia en la elaboración de informes con los resultados de la ETS. El presente artículo brinda un panorama general de las ETS en el mundo, con especial énfasis en su evolución y desarrollo en el Perú

Balance de Descentralización Educativa : período 2011-2012

Identifica los avances y nudos críticos de la gestión descentralizada en educación, en el período 2011-2012, habiéndose construido a partir de los diálogos sostenidos entre la Mesa Interinstitucional de Gestión y Descentralización que lidera el Consejo Nacional de Educación y diversos actores y autoridades de los gobiernos regionales y gobiernos locales, del Ministerio de Educación, y expertos. Asimismo, ha requerido de la revisión y análisis del marco normativo, los instrumentos de gestión y el acercamiento a procesos de cambio que se están llevando a cabo en los gobiernos subnacionales

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