Diabetes mellitus y nefropatía diabética

La diabetes mellitus engloba un grupo de enfermedades que se caracterizan por hiperglucemias producto de alteraciones en la secreción o en la acción de la insulina en el cuerpo. El tratamiento resulta un factor fundamental para buscar la mejora del paciente y la prevención de futuras complicaciones, que pueden comprometer la calidad de vida y supervivencia del paciente como es el caso de la Nefropatía Diabética, para ello, factores como el ejercicio o una dieta equilibrada pueden utilizarse como apoyo al tratamiento. El objetivo de este trabajo fue la actualización de información médico científica respecto del manejo y prevención de la nefropatía diabética como una de las complicaciones de la diabetes mellitus. Se realizó una búsqueda bibliográfica en las principales bases de datos con criterios de inclusión y exclusión, de los últimos años, entre los resultados hallados, los autores precisaron que se debe tomar en cuenta el perfil de la persona que padece diabetes para tomar las medidas de prevención en cuanto a ejercicio y dieta. Además, se ha plasmado la información sobre nuevos tratamientos orales para la DMT2 (diabetes mellitus tipo 2) y sus mecanismos de acción. Se abstrae entonces que un buen tratamiento y medidas de prevención deben estar ajustadas al perfil de cada paciente en beneficio de su bienestar global

Una mirada distinta al embarazo adolescente

Introduction: Adolescent pregnancy (AP), which has high rates in Ecuador, is considered a public health problem related to the increased risk of maternal and perinatal complications and the psychosocial development of adolescents Objective: To determine the risk factors for AP in adolescents in the city of Loja, Ecuador. Material and Methods:632 teenage female students from high school institutions in Loja, Ecuador (January 2017-January 2018) were studied. The risk factors for AP studied were age of initiation of sexual life, domestic or partner violence, belief in myths about sex-uality, and being the daughter of an adolescent mother. A non-probabilistic convenience sampling was carried out, and a semi-structured survey was applied with dichotomous questions about the risk factors for AP, prior to which the informed consent of the representatives and informed assent of the adolescents was requested. Results: The total frequency of AP was 3.6%. The risk factors for adolescent pregnancy determined in this study were being the daughter of an adolescent mother (AMF) (OR = 8.12; 95% CI 2.51-26.24) and intimate partner violence (VP) (OR = 6, 11; 95% CI 1.12-37.04). Con-clusions: Intimate partner violence and being the daughter of an adolescent mother are the risk factors for adolescent pregnancy identified in this study.Introdução: A gravidez na adolescência (PA), que apresenta altas taxas no Equador, é considerada um problema de saúde pública relacionado ao aumento do risco de complicações maternas e perinatais e ao desenvolvimento psicosso-cial das adolescentes. Objetivo: Determinar os fatores de risco para PA em adolescentes na cidade de Loja, Equador. Material e métodos: foram estudadas 632 alunas adolescentes de instituições de ensino médio em Loja, Equador (janeiro de 2017 a janeiro de 2018). Os fatores de risco para PA estudados foram idade de início da vida sexual, violência doméstica ou conjugal, crença em mitos sobre a sexualidade e ser filha de mãe adolescente. Realizou-se amostragem não probabilística por conveniência e aplicou-se questionário semiestruturado com questões dicotômicas sobre os fatores de risco para PA, antes da solicitação do consentimento informado dos representantes e consentimento informado dos adolescentes. Resultados: A frequência total de PA foi de 3,6%. Os fatores de risco para gravidez na adolescência de-terminados neste estudo foram ser filha de mãe adolescente (AMF) (OR = 8,12; IC95% 2,51-26,24) e violência por parceiro íntimo (VP) (OR = 6, 11; IC95% 1.12-37.04). Conclusões: Violência por parceiro íntimo e ser filha de mãe adolescente são os fatores de risco para gravidez na adolescência identificados neste estudo.Introducción: El embarazo adolescente (EA), es considerado un problema de salud pública respecto del mayor riesgo de complicaciones maternas, perinatales y para el desarrollo psicosocial de la adolescente, evidenciándose altas tasas de este  en Ecuador. Objetivo: Determinar los factores de riesgo para EA en adolescentes escolarizadas de la ciudad de Loja, Ecuador. Material y Métodos: Se estudiaron 632 adolescentes mujeres, estudiantes de instituciones de educación media de Loja, Ecuador (enero 2017- enero 2018). Los factores de riesgo para EA estudiados fueron: edad de inicio de vida sexual, violencia intrafamiliar o en la pareja, creencia en mitos sobre sexualidad y ser hija de madre adolescente. Se realizó un muestreo no probabilístico por conveniencia, y se aplicó una encuesta semiestructurada con preguntas dicotómicas sobre los factores de riesgo para EA, previo a lo cual se pidió el consentimiento informado de los representantes y asentimiento informado de las adolescentes. Resultados: La frecuencia total de EA fue de 3,6 %. Los factores de riesgo para embarazo adolescente determinados en este estudio fueron ser hija de madre adolescente (HMA) (OR=8,12; IC95 % 2,51-26,24) y la violencia de pareja (VP) (OR=6,11; IC95% 1,12-37,04). Conclusiones: La violencia en la pareja y el ser hija de madre adolescente son los factores de riesgo para embarazo adolescente identificados en este estudio

Knowledge and Perceptions about Cervical Cancer and HPV Screening in Women in Rural Areas of Ecuador: A Qualitative Research Study

Background: Cervical cancer continues to be a major health problem in developing countries. Educational programs, as well as Pap and HPV screening and vaccination, are important tools to reduce the morbidity and mortality rates associated with this disease. The objective of this study is to explore the diverse knowledge and perceptions about cervical cancer and the different diagnostic tests for HPV of populations living in the rural parish “El Valle”. Method: A qualitative study was conducted through eight focus groups, which included 46 participants from mixed ethnic groups. A phenomenological analysis was performed. Results: Four topics and seven sub-topics were identified. By analyzing all the narratives, it was possible to identify that the perception of cervical cancer was focused on its severity, secondary to its infectious process and screening periodicity. However, despite the diverse knowledge, indigenous people do not relate it to the human papilloma virus; in addition, there is also certain resistance to undergo the Pap smear test, for reasons such as inaccessibility and its sampling process. Conclusions: It is necessary to develop educational programs for the prevention of cervical cancer and to implement diagnostic alternatives to reach populations with precarious accessibility, as well as women who refuse to undergo the Pap smear test

Knowledge and perceptions about cervical cancer and HPV screening in women in rural areas of Ecuador : a qualitative research study

Background: Cervical cancer continues to be a major health problem in developing countries. Educational programs, as well as Pap and HPV screening and vaccination, are important tools to reduce the morbidity and mortality rates associated with this disease. The objective of this study is to explore the diverse knowledge and perceptions about cervical cancer and the different diagnostic tests for HPV of populations living in the rural parish “El Valle”. Method: A qualitative study was conducted through eight focus groups, which included 46 participants from mixed ethnic groups. A phenomenological analysis was performed. Results: Four topics and seven sub-topics were identified. By analyzing all the narratives, it was possible to identify that the perception of cervical cancer was focused on its severity, secondary to its infectious process and screening periodicity. However, despite the diverse knowledge, indigenous people do not relate it to the human papilloma virus; in addition, there is also certain resistance to undergo the Pap smear test, for reasons such as inaccessibility and its sampling process. Conclusions: It is necessary to develop educational programs for the prevention of cervical cancer and to implement diagnostic alternatives to reach populations with precarious accessibility, as well as women who refuse to undergo the Pap smear test

Percepciones de los curanderos indígenas ecuatorianos sobre su relación con el sistema formal de salud: barreras y oportunidades

El nuevo paradigma de las políticas interculturales se centra en repensar la cultura pública común. En Ecuador, el plan “ Buen Vivir ” busca incorporar los conocimientos médicos ancestrales, la experiencia y las creencias de los curanderos tradicionales a los servicios formales de salud. Este estudio explora visiones sobre el sistema formal de salud desde la perspectiva de los curanderos pertenecientes a las etnias kichwa y shuar del sur del Ecuador.The new paradigm of intercultural policies focuses on rethinking the common public culture. In Ecuador, the “Buen Vivir” plan seeks to incorporate the ancestral medical knowledge, experience and beliefs of traditional healers into the formal health services. This study explores views on the formal health system from the perspective of the healers belonging to the Kichwa and Shuar ethnicities in the South of Ecuador

Role of self-sampling for the diagnosis of human papillomavirus in rural areas from Cuenca Ecuador: Acceptance, sensitivity and specificity among urine sampling, self-sampling and clinician sampling

Background/Objectives: Background: During 2020, 1534 new cases of cervical cancer were reported in Ecuador and 813 women died from this cause. Pap smear has decreased mortality of (CC), however in Ecuador 41.6% of women in their reproductive age have been never screened. Different barriers for CC screening have been identified, among them: long waiting times, pain, embarrassment, lack of risk perceptions are related with this low coverage. High sensitivity tests for primary screening of HPV are useful for an early detection of cervical pathology. Self-sampling techniques could overcome barriers and increase participation in screening and participation. Objectives 1.- To compare the sensitivity and specificity of urine and vaginal self-sampling test versus clinician sampling test, for HPV diagnosis. 2.- To compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women Methods: A diagnostic test study was conducted in a rural parish of Cuenca, Ecuador. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for HPV testing. The latter was considered as the golden standard. All three samples were processed with the same amplification and hybridization protocol for HPV detection (Hybribio) following the manufacturer's instructions. After sample collection a questionnaire to qualify device and technique and individual acceptability was applied and additional overall preference of three sample tests was evaluated Results: A total of 120 women participated main chracteristicas are: median age 35 years; 40.8% married; 46.7% had a primary level of education; median age of sexual onset, 17.6 years Sensitivity The prevalence of any type of HPV with clinician sampling was 15.0%, 17.5% with urine sampling and 18.3% with vaginal self-sampling. Self-sampling sensitivity reached 94.4% (IC 74.2-99.9), and specificity 92.1% (IC 85.2-95.9). Urine sampling had a sensitivity of 88.8% (IC 67.2, 96.9), and specificity 94.1% (IC 67.2-96.9). The negative predictive value was 98.9% (IC 94.2-99.8) for vaginal self-sampling and 97.6% (IC 92.6-99.4) for urine sampling. Conclusions: This study shows that vaginal and urine self-sampling methods have similar sensitivity and specificity compared with clinician sampling for the diagnosis of HPV. The correlation between HPV genotypes among the three tests is satisfactory. Acceptability Compared with clinician sampling, both vaginal self-sampling OR 20.12 (7.67-52.8) and urine sampling OR16.63 (6.79-40.72), were more comfortable, granted more privacy: vaginal self-sampling OR 8.07 (3.44-18.93); urine sampling OR 19.5 (5.83-65.21, were less painful: vaginal self-sampling OR 0.07 (0.03-0.16); urine sampling OR 0.01 (0-0.06) and less difficult to apply: vaginal self-sampling OR 0.16 (0.07-0.34) urine sampling OR 0.05 (0.01-0.17). Overall preference has shown an advantage for vaginal self-sampling 4.97 (2.71-9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: This study shows that vaginal and urine self-sampling methods have similar sensitivity and specificity compared with clinician sampling for the diagnosis of HPV. The correlation between HPV genotypes among the three tests is satisfactory. Self sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appears to be a limitation on the acceptabilityBilba

Evaluation of Urine and Vaginal Self-Sampling versus Clinician-Based Sampling for Cervical Cancer Screening: A Field Comparison of the Acceptability of Three Sampling Tests in a Rural Community of Cuenca, Ecuador

Self-sampling methods for HPV testing have been demonstrated to be highly sensitive and specific. The implementation of these methods in settings with a lack of infrastructure or medical attention has been shown to increase the coverage of cervical cancer screening and detect cervical abnormalities in the early stages. The aim of this study is to compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for Pap smear and HPV testing. After the sample collection, a questionnaire to qualify the device, technique, and individual acceptability was applied, and the additional overall preference of three sample tests was evaluated. Results: The characteristics of the participants were as follows: median age of 35 years; 40.8% were married; 46.7% had a primary level of education; median age of sexual onset of 17.6 years. Compared with clinician sampling, both vaginal self-sampling, OR 20.12 (7.67–52.8), and urine sampling, OR 16.63 (6.79–40.72), were more comfortable; granted more privacy: vaginal self-sampling, OR 8.07 (3.44–18.93), and urine sampling, OR 19.5 (5.83–65.21); were less painful: vaginal self-sampling, OR 0.07 (0.03–0.16), and urine sampling, OR 0.01 (0–0.06); were less difficult to apply: vaginal self-sampling, OR 0.16 (0.07–0.34), and urine sampling, OR 0.05 (0.01–0.17). The overall preference has shown an advantage for vaginal self-sampling, OR 4.97 (2.71–9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: Self-sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appear to be a limitation on its acceptability. However, the training and education of the community could increase the uptake of these methods

Role of Self-Sampling for Cervical Cancer Screening: Diagnostic Test Properties of Three Tests for the Diagnosis of HPV in Rural Communities of Cuenca, Ecuador

Background: HPV primary screening has shown effectiveness for cancer prevention; however, gynaecological examination is considered uncomfortable. Self-sampling methods increase the acceptance of screening. The aim of this study is to compare the sensitivity and specificity of clinician sampling versus vaginal and urine self-sampling for HPV diagnosis. Methods: A diagnostic test study was conducted in a rural parish of Cuenca, Ecuador. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for HPV testing. The latter was considered as the golden standard. All three samples were processed with the same amplification and hybridization protocol for HPV detection (Hybribio) following the manufacturer’s instructions. Results: Characteristics of the participants were: median age 35 years; 40.8% married; 46.7% had a primary level of education; and median age of sexual onset, 17.6 years. The prevalence of any type of HPV with clinician sampling was 15.0%, 17.5% with urine sampling and 18.3% with vaginal self-sampling. Self-sampling sensitivity reached 94.4% (IC 74.2–99.9), and specificity 92.1% (IC 85.2–95.9). Urine sampling had a sensitivity of 88.8% (IC 67.2, 96.9), and specificity 94.1% (IC 67.2–96.9). The negative predictive value was 98.9% (IC 94.2–99.8) for vaginal self-sampling and 97.6% (IC 92.6–99.4) for urine sampling. Conclusions: This study shows that vaginal and urine self-sampling methods have similar sensitivity and specificity compared with clinician sampling for the diagnosis of HPV. The correlation between HPV genotypes among the three tests is satisfactory

Evaluation of urine and vaginal self-sampling versus clinician-based sampling for cervical cancer screening: a field comparison of the acceptability of three sampling tests in a rural community of Cuenca, Ecuador

Self-sampling methods for HPV testing have been demonstrated to be highly sensitive and specific. The implementation of these methods in settings with a lack of infrastructure or medical attention has been shown to increase the coverage of cervical cancer screening and detect cervical abnormalities in the early stages. The aim of this study is to compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for Pap smear and HPV testing. After the sample collection, a questionnaire to qualify the device, technique, and individual acceptability was applied, and the additional overall preference of three sample tests was evaluated. Results: The characteristics of the participants were as follows: median age of 35 years; 40.8% were married; 46.7% had a primary level of education; median age of sexual onset of 17.6 years. Compared with clinician sampling, both vaginal self-sampling, OR 20.12 (7.67–52.8), and urine sampling, OR 16.63 (6.79–40.72), were more comfortable; granted more privacy: vaginal self-sampling, OR 8.07 (3.44–18.93), and urine sampling, OR 19.5 (5.83–65.21); were less painful: vaginal self-sampling, OR 0.07 (0.03–0.16), and urine sampling, OR 0.01 (0–0.06); were less difficult to apply: vaginal self-sampling, OR 0.16 (0.07–0.34), and urine sampling, OR 0.05 (0.01–0.17). The overall preference has shown an advantage for vaginal self-sampling, OR 4.97 (2.71–9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: Self-sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appear to be a limitation on its acceptability. However, the training and education of the community could increase the uptake of these methods