Factores asociados con el éxito o fracaso del parto cefalovaginal posterior a una cesárea, en el Hospital Gíneco Obstétrico de Nueva Aurora Luz Elena Arismendi, durante el período junio 2016 – junio 2017.

Objetivo: Identificar los factores asociados con el éxito o fracaso del parto vaginal en pacientes con labor de parto y antecedente de cesárea. Materiales y métodos: Estudio de casos y controles de mujeres con antecedente de cesárea y embarazo, que acudieron al Hospital Gíneco Obstétrico de Nueva Aurora Luz Elena Arismendi, durante el período Junio 2016 – Junio 2017. Se identificó y calculó la tasa de parto vaginal, los factores que predicen el éxito y el fracaso de parto vaginal mediante Odds Ratio y las complicaciones. Resultados: Se incluyeron 163 pacientes, de las cuales 99 fueron el grupo casos y 64 el grupo control, obteniéndose una tasa de 60.74% para el parto vaginal después de una cesárea, los factores que se asociaron con el éxito de parto vaginal fueron, antecedente de parto vaginal OR: 2.9; (IC 95% 1.22-6.83), dilatación cervical mayor o igual a 4 cm en el momento del ingreso OR: 3.96; (IC; 95%: 2.00-7.84), los factores que se asociaron con fracaso de parto vaginal fueron, edad materna mayor de 35 años OR: 0.23; (IC 95% 0.09-0.53), índice de masa corporal mayor a 30 Kg/m2, (OR: 0.46; IC 95% 0.24-0.88), edad gestacional mayor a 41 semanas, OR 10.13; (IC; 95%: 1.19-86.32). No se obtuvo diferencias estadísticamente significativas en relación a la existencia de una patología asociada con el embarazo, al igual que el sexo y peso neonatal, ni complicaciones. Conclusiones: El parto vaginal después de cesárea es un método seguro de terminación de embarazo, los factores que incrementan la probabilidad de parto vaginal son antecedente de parto vaginal e ingreso con dilatación mayor o igual a 4 cm

Tumor Borderline del ovario en paciente de 40 años: reporte de caso clínico y revisión de literatura

Borderline or low malignant potential ovarian tumors are an intermediate entity of benign and malignant tumors whose histological alterations of the ovarian epithelial cells do not meet specific criteria for benignity or malignancy. They are tumors that generally appear during the 3rd - 4th decade of a woman's life and are diagnosed limited to the ovary in 80% of cases. In this way, the biological-oncological behavior is very good with a global survival to 10 years of 90% for initial stages and 60-70% for advanced stages. Clinically show few symptoms such as abdominal distension and oppressive pain. Imaging studies are important since it can help to consider your diagnosis, it is recommended to first perform an abdominopelvic ultrasound and then an abdominopelvic tomography. We present a 40-year-old patient case, nulliparous with a desire to preserve fertility, performing an early diagnosis and subsequent intervention with exploratory laparotomy plus left adnexectomy with a satisfactory evolution in 48 hours.Los tumores borderline o de bajo potencial maligno de ovario son una entidad intermedia de tumores benignos y malignos cuyas alteraciones histológicas de las células del epitelio ovárico no cumplen criterios específicos de benignidad ni de malignidad. Son tumores que se presentan generalmente durante la 3ª - 4ª década de la vida de la mujer y se diagnostican limitados al ovario en el 80% de los casos. De esta forma, el comportamiento biológico-oncológico es muy bueno con una sobrevida global a 10 años del 90% para estadios iniciales y del 60-70% para estadios avanzados. Clínicamente muestran pocos síntomas como distensión abdominal y dolor de tipo opresivo, siendo fundamental los estudios de imagenología ya que puede ayudar a considerar su diagnóstico, se recomienda primero la realización de ultrasonido abdomino-pélvico y luego la tomografía abdomino-pélvica. Se presenta el caso de una paciente de 40 años de edad, nulípara con deseo preservar fertilidad, realizándose un diagnóstico temprano y posterior intervención con laparotomía exploratoria más anexectomía izquierda con una evolución satisfactoria en 48 horas

The role of ethylene in plant growth and development

Ethylene has a profound effect on the shape of plants. It determinesmany aspects of vegetative development by interacting with other hormones. Foremost, ethylene relies on a tight collaboration with auxin to influence plant growth and can stimulate or inhibit elongation of roots and shoots. This stimulatory or inhibitory action depends on the species and on growth conditions and is controlled by modification of cellwall properties. Later in life, ethylene regulates floral transition, and in some species the gender of the flowers. In determining these architectural features, ethylene allows the plants to reach a high level of plasticity to adapt to multiple environmental challenges

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BackgroundEstimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period.Methods22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.FindingsGlobal all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.InterpretationGlobal adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic