Estrategia educativa mediante las TIC para incrementar las prácticas obstétricas beneficiosas en la provincia del Azuay-Ecuador

La aplicación de prácticas no basadas en evidencias científicas, el incumplimiento de normas de atención establecidas por el Ministerio de Salud Pública (MSP), registro incompleto de datos, escasa capacitación del personal y dificultades en la comunicación, constituyen factores que han obstaculizado el mejoramiento continuo de la calidad de la atención, que se expresa tanto en la aplicación de prácticas inefectivas en la atención materna y neonatal, como en el deficiente cumplimiento de los estándares e indicadores. En estas circunstancias las tasas de mortalidad y morbilidad materna y neonatal continúan elevadas, cuyas causas en su mayoría son prevenibles. En el Ecuador, según el Instituto Ecuatoriano de Estadísticas y Censos (INEC) en el año 2009 murieron 208 mujeres por causas del embarazo, parto y puerperio (96.3 x 100.000 nacidos vivos) como consecuencia de inequidades económicas, sociales, culturales, carencia de recursos en salud y deficiencias en la calidad de la atención. En el estudio “Evaluación de los servicios de cuidados obstétricos y neonatales de emergencia” realizado en las provincias de Azuay y Guayas durante los años 2006 y 2007, con el auspicio de la OPS/OMS, se encontró deficiencias en la calidad de la atención, registros e informes de las atenciones incompletos y desarticulados del sistema de vigilancia epidemiológico provincial. Por otro lado, mediante análisis de bases de datos del SIP de 9000 partos atendidos en los Hospitales Pablo Arturo de Quito,Vicente Corral de Cuenca y Matilde Hidalgo de Guayaquil,se verificaron deficiencias en el cumplimiento de las normas de atención, tales como: uso de administración de hierro y folatos durante el embarazo (48%), VIH solicitado (17.6%), uso de oxitocina en el tercer período del parto (45%), posición supina del recién nacido (53.9%), acompañante durante el parto (27.3%), parto en posición acostada (90.9%), episiotomía (32%), ligadura precoz del cordón (41.3%), cesárea (21.1%)

A Complete Pipeline for Heart Rate Extraction from Infant ECGs

\ua9 2024 by the authors.Infant electrocardiograms (ECGs) and heart rates (HRs) are very useful biosignals for psychological research and clinical work, but can be hard to analyse properly, particularly longform (≥5 min) recordings taken in naturalistic environments. Infant HRs are typically much faster than adult HRs, and so some of the underlying frequency assumptions made about adult ECGs may not hold for infants. However, the bulk of publicly available ECG approaches focus on adult data. Here, existing open source ECG approaches are tested on infant datasets. The best-performing open source method is then modified to maximise its performance on infant data (e.g., including a 15 Hz high-pass filter, adding local peak correction). The HR signal is then subsequently analysed, developing an approach for cleaning data with separate sets of parameters for the analysis of cleaner and noisier HRs. A Signal Quality Index (SQI) for HR is also developed, providing insights into where a signal is recoverable and where it is not, allowing for more confidence in the analysis performed on naturalistic recordings. The tools developed and reported in this paper provide a base for the future analysis of infant ECGs and related biophysical characteristics. Of particular importance, the proposed solutions outlined here can be efficiently applied to real-world, large datasets

Radio-Optically- and Thermally Stimulated Luminescence of Zn(BO2)2:Tb3+ exposed to Ionizing Radiation

The optical absorption of zinc tetraborate at different concentrations of the terbium impurity (0, 0.5, 1, 2, 4, 8 mol%) was analyzed. The radioluminescence (RL) emission spectra was obtained after beta irradiation of a 90Sr/90Y source. The RL spectrum showed the characteristics bands of Tb3+ with two main emissions at 489 nm and 546 nm which corresponding to the5D4→7F6 and 5D4→7F5 transitions respectively in this ion. The OSL and TL characteristics have been analyzed. The stimulation blue light (497 nm) of a diode laser at 500 mA was used to bleach the thermoluminescent (TL) signals obtained with 5Gy of 60Co source. The two main glow peaks (79 and 161 °C) are sensitives under 497 nm stimulation, and they were shifted to higher temperature values and faded their TL intensities. Similar behavior of TL glow curves before and after OSL stimulation with blue light was observed when the samples were exposed to 30 Gy gamma dose of 137Cs irradiator. The OSL signal response was linear with the dose range of 1-10 Gy and increased their response up to 200 Gy gamma dose. The OSL shows a bleaching sensitive shallow traps and diminishing the intensity of the TL glow curves remaining a complex traps distribution. The RL, TL and OSL properties were investigated in Zn(BO2)2:Tb3+ phosphor

Economic impact of improving patient safety using Sugammadex for routine reversal of neuromuscular blockade in Spain

Background: Neuromuscular blocking (NMB) agents are often administered to facilitate tracheal intubation and prevent patient movement during surgical procedures requiring the use of general anesthetics. Incomplete reversal of NMB, can lead to residual NMB, which can increase the risk of post-operative pulmonary complications. Sugammadex is indicated to reverse neuromuscular blockade induced by rocuronium or vecuronium in adults. The aim of this study is to estimate the clinical and economic impact of introducing sugammadex to routine reversal of neuromuscular blockade (NMB) with rocuronium in Spain. Methods: A decision analytic model was constructed reflecting a set of procedures using rocuronium that resulted in moderate or deep NMB at the end of the procedure. Two scenarios were considered for 537, 931 procedures using NMB agents in Spain in 2015: a scenario without sugammadex versus a scenario with sugammadex. Comparators included neostigmine (plus glycopyrrolate) and no reversal agent. The total costs for the healthcare system were estimated from the net of costs of reversal agents and overall cost offsets via reduction in postoperative pneumonias and atelectasis for which incidence rates were based on a Spanish real-world evidence (RWE) study. The model time horizon was assumed to be one year. Costs were expressed in 2019 euros (€) and estimated from the perspective of a healthcare system. One-way sensitivity analysis was carried out by varying each parameter included in the model within a range of +/- 50%. Results: The estimated budget impact of the introduction of sugammadex to the routine reversal of neuromuscular blockade in Spanish hospitals was a net saving of €57.1 million annually. An increase in drug acquisition costs was offset by savings in post-operative pulmonary events, including 4806 post-operative pneumonias and 13, 996 cases of atelectasis. The total cost of complications avoided was €70.4 million. All parameters included in the model were tested in sensitivity analysis and were favorable to the scenario with sugammadex. Conclusions: This economic analysis shows that sugammadex can potentially lead to cost savings for the reversal of rocuronium-induced moderate or profound NMB compared to no reversal and reversal with neostigmine in the Spanish health care setting. The economic model was based on data obtained from Spain and from assumptions from clinical practice and may not be valid for other countries

Experimental arthritis induced by a clinical Mycoplasma fermentans isolate

BACKGROUND: Mycoplasma fermentans has been associated with rheumatoid arthritis. Recently, it was detected in the joints and blood of patients with rheumatoid arthritis, but it is not clear yet how the bacteria enter the body and reach the joints. The purpose of this study was to determine the ability of M. fermentans to induce experimental arthritis in rabbits following inoculation of the bacteria in the trachea and knee joints. METHODS: P-140 and PG-18 strains were each injected in the knee joints of 14 rabbits in order to evaluate and compare their arthritogenicity. P-140 was also injected in the trachea of 14 rabbits in order to test the ability of the bacteria to reach the joints and induce arthritis. RESULTS: M. fermentans produced an acute arthritis in rabbits. Joint swelling appeared first in rabbits injected with P-140, which caused a more severe arthritis than PG-18. Both strains were able to migrate to the uninoculated knee joints and they were detected viable in the joints all along the duration of the experiment. Changes in the synovial tissue were more severe by the end of the experiment and characterized by the infiltration of neutrophils and substitution of adipose tissue by connective tissue. Rabbits intracheally injected with P-140 showed induced arthritis and the bacteria could be isolated from lungs, blood, heart, kidney, spleen, brain and joints. CONCLUSION: M. fermentans induced arthritis regardless of the inoculation route. These findings may help explain why mycoplasmas are commonly isolated from the joints of rheumatic patients

Presence of Mycoplasma fermentans in the bloodstream of Mexican patients with rheumatoid arthritis and IgM and IgG antibodies against whole microorganism

<p>Abstract</p> <p>Background</p> <p>Increasing evidence incriminates bacteria, especially <it>Mycoplasma fermentans</it>, as possible arthritogenic agents in humans. The purpose of this study was to investigate <it>M. fermentans </it>in the bloodstream of patients with rheumatoid arthritis.</p> <p>Methods</p> <p>Two hundred and nineteen blood samples from patients with rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid syndrome, and healthy individuals were screened by bacterial culture and direct PCR in order to detect mycoplasmas; IgM and IgG against <it>M. fermentans </it>PG18 were also detected by ELISA and Immunoblotting assays in patients with rheumatoid arthritis and healthy individuals.</p> <p>Results</p> <p>Blood samples from patients with antiphospholipid syndrome and healthy individuals were negative for mycoplasma by culture or direct PCR. In blood samples from patients with systemic lupus erythematosus were detected by direct PCR <it>M. fermentans </it>in 2/50 (2%), <it>M. hominis </it>in 2/50 (2%) and <it>U. urealyticum </it>in 1/50 (0.5%). In patients with RA <it>M. fermentans </it>was detected by culture in 13/87 blood samples and in 13/87 by direct PCR, however, there was only concordance between culture and direct PCR in six samples, so <it>M. fermentans </it>was detected in 20/87(23%) of the blood samples from patients with RA by either culture or PCR. Antibody-specific ELISA assay to <it>M. fermentans </it>PG18 was done, IgM was detected in sera from 40/87 patients with RA and in sera of 7/67 control individuals, IgG was detected in sera from 48/87 RA patients and in sera from 7/67 healthy individuals. Antibody-specific immunoblotting to <it>M. fermentans </it>PG18 showed IgM in sera from 35/87 patients with RA and in sera from 4/67 healthy individuals, IgG was detected in sera from 34/87 patients and in sera from 5/67 healthy individuals.</p> <p>Conclusion</p> <p>Our findings show that only <it>M. fermentans </it>produce bacteremia in a high percentage of patients with RA. This finding is similar to those reported in the literature. IgM and IgG against <it>M. fermentans </it>PG18 were more frequent in patients with RA than healthy individuals.</p

Selection among and within and combined selection in oil palm families derived from Dura x Dura.

Oil palm, in view of the worldwide consumed oil, is a perennial crop of great importance. Nevertheless, the genetic improvement is still incipient. In this study we applied the selection among and within families and the combined selection, based on the phenotypic values and phenotypic performance (Pi statistic), to verify which strategy obtained the highest genetic gains. Five full-sib families were evaluated in randomized blocks, with five replicates and 12 plants per plot, over five years of successive harvests. The total number of bunches and the total fruit yield per year plant-1 were evaluated. Values of 1.00 and 0.25 for the ratio between the environmental variance among plots and the environmental variance among plants within the plot for both traits, respectively, were adequate for the estimation of the genetic parameters. The existence of genetic variability in the population Dura was verified for both evaluated traits. The combined selection, based either on the phenotypic values or on the underlying Pi statistic, resulted in the highest genetic gains. Despite the satisfactory gains since it translates the true yield potential of the evaluated genotypes and their performance stability

Factors of the epidemiological triad that influence the persistence of human papilloma virus infection in women with systemic lupus erythematosus

We studied the epidemiologic triad-related factors influencing human papilloma virus (HPV) persistence in Mexican women with systemic lupus erythematosus (SLE). Patients aged ?18 years with SLE (American College of Rheumatology criteria), with and without HPV persistence, were selected. Groups were analyzed by (1) host: clinical disease characteristics; (2) agent: (I) infectious (prevalence, incidence, HPV genotype and co-infections (?2 HPV genotypes or mycoplasmas)), (II) chemical (contraceptives and immunosuppressive drugs) and (III) physical (vitamin D deficiency) and (3) environment. A total of 121 SLE patients were selected over a two-year period. (1) Host: mean age 45.8 years and disease duration 12.7 years. (2) Agent: (I) infectious. HPV infection prevalence in the second sample was 26.4%, high-risk HPV genotypes 21.5% and co-infections 7.4%. HPV infection incidence was 13.2%, persistence 13.2% and clearance 15.7%. (II) Chemical: use of oral hormonal contraceptives 5% and immunosuppressive treatment 97.5%. (III) Physical: Vitamin D levels were similar in both groups. (3) Environment: (I) natural. A total of 60.6% of patients were residents of Puebla City. (II) Social: The mean education level was 10.9. Poverty levels were: III degree 52.4%, IV degree 28% and II degree 17%. (III) Cultural behavioral: Onset of sexual life was 20.5 years, 10% had ?3 sexual partners and 51.2% were postmenopausal. In conclusion, no factor of the epidemiologic triad was associated with HPV infection prevalence. © The Author(s) 2018

Brain Sci

Mild cognitive impairment (MCI) (amnestic or non-amnestic) has different clinical and neuropsychological characteristics, and its evolution is heterogeneous. Cardiovascular risk factors (CVRF), such as hypertension, diabetes, or dyslipidemia, and the presence of the Apolipoprotein E epsilon4 (ApoE epsilon4) polymorphism have been associated with an increased risk of developing Alzheimer's disease (AD) and other dementias but the relationship is inconsistent worldwide. We aimed to establish the association between the ApoE epsilon4 carrier status and CVRF on MCI subtypes (amnestic and non-amnestic) in Mexican older adults. Cross-sectional study including 137 older adults (n = 63 with normal cognition (NC), n = 24 with amnesic, and n = 50 with non-amnesic MCI). Multinomial logistic regression models were performed in order to determine the association between ApoE epsilon4 polymorphism carrier and CVRF on amnestic and non-amnestic-MCI. ApoE epsilon4 carrier status was present in 28.8% participants. The models showed that ApoE epsilon4 carrier status was not associated neither aMCI nor naMCI condition. The interaction term ApoE epsilon4 x CVRF was not statistically significant for both types of MCI. However, CVRF were associated with both types of MCI and the association remained statistically significant after adjustment by sex, age, and education level. The carrier status of the ApoE genotype does not contribute to this risk