Parto pre término asociado a dengue en gestantes de Hospital José Cayetano Heredia Piura 2017-2019

A pesar del empeño de los estados miembros para reprimir el impacto de la epidemia, el dengue sigue siendo un dilema de salud pública en las Américas. No ha sido fácil establecer las complicaciones específicas asociadas a dengue en gestantes, sin embargo, las investigaciones a nivel mundial mencionan como principal problema obstétrico el parto pre término. Debido a la falta de investigación comparativa en nuestra ciudad, se consideró desarrollar el presente estudio porque, aparte de haber poca literatura donde asocian el dengue con el embarazo, no existe un tratamiento detallado para este grupo vulnerable de pacientes. OBJETIVO: Determinar si el parto pre término está asociado a dengue en gestantes atendidas en el Hospital III José Cayetano Heredia de Piura durante el 2017-2019. MATERIAL Y MÉTODO: Se realizará una investigación observacional, analítica y retrospectiva. Así mismo se analizarán las historias clínicas de 192 gestantes. RESULTADO: En el año 2017 se registró mayor cantidad de casos (97,4%). El grupo etario 18-29 años (casos: 47,4%, controles: 60,3%), procedencia Piura (casos: 75,6%, controles: 51,3%), paridades multíparas (casos y controles: 64,1%) y método de control FUR (casos: 67,9%, controles: 59,0). Diagnóstico de parto pre término (casos: 43,6%, controles: 34,6%). Relación infección por dengue y parto pre término con un OR 1,460 (IC: 0,765-2,786). Relación severidad de dengue parto pre término con un OR 8,33(IC95%: 2,997-23,175; p <0.05) CONCLUSIONES: El dengue se presentó frecuentemente en las gestantes entre 18-29 años de edad y provenientes de la provincia de Piura. El parto pre término no es una complicación asociada a gestantes con dengue. La edad gestacional al nacimiento en su mayoría se dio entre 37-41 semanas. Las gestantes que tuvieron dengue con signos de alarma mostraron una mayor probabilidad de presentar parto pre término a diferencia de las gestantes que tuvieron dengue sin signos de alarma.Despite the efforts of member states to curb the impact of the epidemic, dengue continues to be a public health dilemma in the Americas. It has not been easy to establish the specific complications associated with dengue in pregnant women, however, worldwide research mentions preterm delivery as the main obstetric problem. Due to the lack of comparative research in our city, it was considered to develop the present study because, apart from having little literature where dengue is associated with pregnancy, there is no detailed treatment for this vulnerable group of patients. OBJECTIVE: Determine if pre-term delivery is related to dengue in pregnant women treated at Hospital III José Cayetano Heredia de Piura during 2017-2019. MATERIAL AND METHOD: An observational, analytical and retrospective investigation will be carried out. Likewise, the medical records of 192 pregnant women will be analyzed. RESULT: In 2017, a greater number of cases were registered (97.4%). The age group 18-29 years (cases: 47.4%, controls: 60.3%), origin Piura (cases: 75.6%, controls: 51.3%), multiparous parities (cases and controls: 64, 1%) and FUR control method (cases: 67.9%, controls: 59.0). Preterm delivery diagnosis (cases: 43.6%, controls: 34.6%). Relationship between dengue infection and pre-term delivery with an OR 1.460 (CI: 0.765-2.786). Dengue severity relationship preterm delivery with an OR 8.33 (95% CI: 2.997-23.175; p <0.05) CONCLUSIONS: Infection by dengue virus in pregnant women was more frequent between 18-29 years of age and from the province of Piura. Preterm delivery is not a complication associated with pregnant women with dengue. The gestational age at birth was mostly between 37-41 weeks. Pregnant women with warning signs had a greater probability of presenting preterm birth than those who had dengue without warning signs.Tesi

Factores asociados a la deserción de métodos anticonceptivos hormonales en mujeres en edad reproductiva que acuden al consultorio ginecológico mujer en todas tus etapas de junio – diciembre 2021

Objetivo: Determinar los factores asociados a la deserción de métodos anticonceptivos hormonales en mujeres en edad reproductiva que acuden al Consultorio Ginecológico Mujer en todas tus etapas, de junio - diciembre del 2021. Material y Métodos: Estudio de enfoque cuantitativo, con diseño analítico, prospectivo; observacional, de corte transversal. Estuvo constituido por una población de 120 mujeres en edad reproductiva que acuden al Consultorio Ginecológico Mujer en todas tus etapas. Se realizó un cuestionario como instrumento para recolectar los datos. Resultados: Se encontró que el 63.3% de las mujeres continuaron con el uso de métodos anticonceptivos hormonales y el 36.7%, desertaron su uso. El método anticonceptivo hormonal más empleado fue el inyectable mensual (27.5%) y el menos utilizado fue el dispositivo intrauterino hormonal (1%) El factor sociodemográfico de la edad (p=0.00) y los factores personales: antecedentes patológicos (p=0.02), olvido de la fecha programada de la cita (p=0.02) y el deseo de tener un embarazo (p=0.04) se encuentran asociados a la deserción de métodos anticonceptivos hormonales. Conclusiones: El factor sociodemográfico y los factores personales están asociados a la deserción de métodos anticonceptivos hormonales

Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients

Autonomic dysfunction is common in Chagas disease and diabetes. Patients with either condition complicated by cardiac autonomic dysfunction face increased mortality, but no clinical predictors of autonomic dysfunction exist. Pupillary light reflexes (PLRs) may identify such patients early, allowing for intensified treatment. To evaluate the significance of PLRs, adults were recruited from the outpatient endocrine, cardiology, and surgical clinics at a Bolivian teaching hospital. After testing for Chagas disease and diabetes, participants completed conventional autonomic testing (CAT) evaluating their cardiovascular responses to Valsalva, deep breathing, and orthostatic changes. PLRs were measured using specially designed goggles, then CAT and PLRs were compared as measures of autonomic dysfunction. This study analyzed 163 adults, including 96 with Chagas disease, 35 patients with diabetes, and 32 controls. PLRs were not significantly different between Chagas disease patients and controls. Patients with diabetes had longer latency to onset of pupil constriction, slower maximum constriction velocities, and smaller orthostatic ratios than nonpatients with diabetes. PLRs correlated poorly with CAT results. A PLR-based clinical risk score demonstrated a 2.27-fold increased likelihood of diabetes complicated by autonomic dysfunction compared with the combination of blood tests, CAT, and PLRs (sensitivity 87.9%, specificity 61.3%). PLRs represent a promising tool for evaluating subclinical neuropathy in patients with diabetes without symptomatic autonomic dysfunction. Pupillometry does not have a role in the evaluation of Chagas disease patients

Umbral de tratamiento del gusano cogollero (Spodoptera frugiperda) en el cultivo de maíz amiláceo (Zea mays L. ssp amiláceo)

El objetivo del estudio fue determinar el umbral de tratamiento (UT) del gusano cogollero (Spodoptera frugiperda) en el cultivo de maíz amiláceo (Zea mays L. ssp amiláceo) en el sector Ccanabamba, distrito de Tamburco, provincia de Abancay, departamento Apurímac, Perú. Se utilizó un diseño completamente aleatorizado, con tres tratamientos químicos (T1: Tifon 2,5% PS; T2: Clorpirifos S480; T3: Cyperklin 25) y un control. Se colectaron 160 larvas, Spodoptera frugiperda, en estadio L3, y se colocó una larva por planta de maíz. La evaluación se realizó cada tres días, a partir de los 28 días de siembra. Los resultados indicaron que, el umbral de tratamiento es 1,86%; 1,43%; 1,38% y 0,00% con el T1, T2, T3 y control, respectivamente; siendo el T1 el de mayor tolerancia a la presencia de la plaga. Además de obtener el más alto rendimiento y precio (1917,57 kg/ha; 5,87 S//kg), seguido del T2 (1872,63 kg/ha; 5,75 S//kg), T3 (1823,99 kg/ha; 5,99 S//kg) y Testigo (1381,35 kg/ha; 5,07 S//kg). Se recomienda utilizar el T1 a fin de minimizar el uso de los plaguicidas, obtener un mayor rendimiento en kg/ha, además de un mejor precio en S//kg de maíz

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

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