Elective Cesarean Section as a Risk Factor Associated with Neonatal Respiratory Distress Syndrome

Fundamentos: La cesárea electiva es un procedimiento quirúrgico que ha incrementado en todo el mundo en los últimos años. Las morbilidades respiratorias constituyen las complicaciones más frecuentes en neonatos nacidos por esta vía, en especial por la ausencia de trabajo de parto. Objetivo: Determinar, a partir de una revisión bibliográfica sistemática, la cesárea electiva como factor de riesgo para la morbi-mortalidad por distress respiratorio en recién nacidos. Métodos: se incluyeron 14 artículos en relación a este tema los cuales cumplieron determinados criterios de inclusión. La búsqueda se realizó en diferentes revistas como Scielo, Cochrane, Medwave, Redalyc, PubMed, entre otros, publicadas en los últimos 5 años, en idioma inglés y español. Se empleó el software Mendeley para la organización de la información. Resultados: los países subdesarrollados presentan tasas de cesáreas electivas superiores al 40%, en especial en el sector privado. La morbi-mortalidad respiratoria neonatal aumenta por cesárea electiva siendo hasta 3 veces superior a comparación del parto vaginal. La Taquipnea Transitoria del Recién Nacido fue la entidad más frecuente del Síndrome de Distress Respiratorio Neonatal. Conclusiones: la cesárea electiva constituye una problemática en países subdesarrollados ya que trae consigo complicaciones fetales importantes como la Taquipnea Transitoria del Recién Nacido, patología que se puede prevenir: en primera instancia educando adecuadamente a la madre, la adopción de medidas como el trabajo de parto previo en pacientes con antecedentes de cesárea anterior, el uso de corticoides antenatales y la administración de oxitocina.Foundations: Elective Cesarean section is a surgical procedure that has increased worldwide in recent years. Respiratory morbidities are the most frequent complications in neonates born in this way, especially due to the absence of labor. Objective: To determine, from a systematic literature review, elective cesarean section as a risk factor for respiratory distress morbidity and mortality in newborns. Methods: Fourteen articles were included on this topic that met certain inclusion criteria. The search was carried out in different journals such as Scielo, Cochrane, Medwave, Redalyc, PubMed, among others, published in the last 5 years, in English and Spanish language. Mendeley software was used to organize the information. Results: Developing countries have rates of the elective cesarean section above 40%, especially in the private sector. Neonatal respiratory morbidity-mortality increases by elective cesarean section being up to 3 times higher compared to vaginal delivery. Transient Tachypnea of the Newborn was the most frequent entity of Neonatal Respiratory Distress Syndrome. Conclusions: Elective cesarean section is a problem in underdeveloped countries because it brings with it important fetal complications such as Transient Tachypnea of the Newborn, a pathology that can be prevented: firstly by properly educating the mother, adopting measures such as premature labor in patients with a history of previous cesarean section, the use of antenatal steroids and the administration of oxytocin

IMC-calcium series of children and adolescents in rural schools of Cañar city, period January - June 2019

Introducción: El consumo de calcio en la dieta, en particular el proveniente de lácteos, se asocia con la reducción de peso corporal. Objetivo: Evaluar la ingesta de calcio y su relación con el sobrepeso y la obesidad en niños y adolescentes de 4 a 12 años escuelas rurales del cantón Cañar, periodo enero- junio 2019. Metodología: Estudio descriptivo, prospectivo transversal y cuasi experimental. Se evaluó el estado nutricional de 122 niños y adolescentes utilizando indicadores tales como el IMC, con resultados de sobre peso. Por otra parte, se obtuvieron muestras de sangre para obtener el calcio sérico de cada uno de los adolescentes y clasificarlos según los valores normales de este indicador. A lo largo de 6 meses se inició un plan de suplementos de calcio a base de leche semidescremada. Después de este tiempo a cada uno de los adolescentes se evaluó el IMC obteniendo resultados importantes. Resultados: Los intervalos de IMC 22 y 24, se encontraron en 42 adolescentes categorizados con sobrepeso y obesidad. En cuanto a los valores de calcio sérico de los adolescentes en estudio se encontró que en un porcentaje del 63,3% tenían valores normales, por otra parte, un 41,7 % obtuvo hipocalcemia. Por último, se obtuvo una asociación significativa entre los valores de calcio y el IMC tomados antes y después de la suplementación de calcio, a partir de la aplicación del coeficiente de Pearson. Conclusión: Existe relación entre la ingesta de calcio y el IMC en los adolescentes analizados.Introduction: The consumption of calcium in the diet particularly that from dairy products, is associated with the reduction of body weight. Objective: Evaluate calcium intake and its relationship with overweight and obesity in children and adolescents from 4 to 12 years old, rural schools of the Cañar canton, January-June 2019 period.Methodology: Study descriptive, prospective transversal and quasi-experimental. The nutritional status of 122 children and adolescents was evaluated using indicators such as BMI, with overweight results. On the other hand, blood samples were obtained to obtain the serum calcium of each of the adolescents and classify them according to the normal values ​​of this indicator. A calcium supplement plan based on semi-skimmed milk was started over 6 months. After this time, each of the adolescents was evaluated for BMI, obtaining important results. Results: BMI intervals 22 and 24 were found in 42 adolescents categorized with overweight and obesity. Regarding the serum calcium values ​​of the adolescents under study, it was found that in a percentage of 63.3% they had normal values, on the other hand, 41.7% obtained hypocalcemia. Finally, a significant association was obtained between calcium and BMI values ​​taken before and after calcium supplementation, based on the application of the Pearson coefficient.Conclusion: There is a relationship between calcium intake and BMI in the adolescents analyzed

Systemic lupus erythematosus, clinical manifestations, diagnosis and treatment

Introducción: El Lupus Eritematoso Sistémico o LES, es una enfermedad anómala, de carácter autoinmune, con mayor prevalencia en la población femenina en edad reproductiva. Su etiología es desconocida, sin embargo, conlleva un sinnúmero de manifestaciones clínicas e irremediables complicaciones a corto, mediano y largo plazo, siendo entendida como uno de los retos de mayor connotación para los diferentes profesionales de la salud. Objetivo: Determinar las manifestaciones clínicas, diagnóstico y tratamiento que conlleva el Lupus Eritematoso Sistémico. Metodología: Estudio de tipo revisión bibliográfica (RB), con un enfoque cualitativo, previa revisión de un protocolo que sustentó su desarrollo; 11 estudios incluidos, cuya publicación date del 2016, obtenidos de diferentes bases de datos como Google Scholar, SciELO, Redalyc, Medline, Scopus, Elsevier, Latindex y otras bibliotecas virtuales de salud. Resultados: El LES es una enfermedad autoinmune crónica e inflamatoria que se origina en el tejido conjuntivo, afectando un sin número de órganos y articulaciones, incluyendo el corazón, la piel, los pulmones, riñones y el sistema nervioso. Los criterios clasificatorios del LES son: ACR 1997; SLICC 2012 y EULAR/ACR. No tiene cura, pero su tratamiento puede llevarse a cabo de manera convencional, farmacológica, biológica y fisioterapia. Conclusiones: El LES es una enfermedad autoinmune que no tiene cura, pero que, a la fecha, se puede controlar y prevenir el daño a nivel orgánico, mejorando la calidad de vida del paciente. En Ecuador, no existe un registro actualizado donde se refleje la cantidad de individuos que padezcan de esta silenciosa enfermedad.Introduction: Systemic Lupus Erythematosus or SLE, is an anomalous autoimmune disease with a higher prevalence in the female population of reproductive age. Its etiology is unknown, however, it carries several clinical manifestations and irremediable complications in the short, medium, and long term, being understood as one of the challenges of a greater connotation for different health professionals. Objective: was to determine the clinical manifestations, diagnosis, and treatment that SLE entails. Methodology: Study of bibliographic revision type (RB), with a qualitative approach, previous revision of a protocol that supported its development; 11 studies included, published from 2016 they were obtained from different databases such as Google Scholar, SciELO, Redalyc, Medline, Scopus, Elsevier, Latindex and other virtual health libraries. Results: SLE is a chronic and inflammatory autoimmune disease of the connective tissue, which affects many organs and joints, including the heart, skin, lungs, kidneys, and the nervous system. The classification criteria of SLE are ACR 1997; SLICC 2012 and EULAR/ACR. It has no cure, but its treatment can be carried out in a conventional, pharmacological, biological, and physiotherapeutic way. Conclusions: SLE is an autoimmune disease that cannot be healed, but can be controlled and thus prevent damage at the organic level, improving the quality of life of the patient. In Ecuador, there is not an updated register with the number of individuals suffering from this disease

Prevalence of bipolar disorder and associated factors in the rural parishes of Cuenca city

Introducción: El trastorno bipolar es una patología del estado de ánimo que se caracteriza por episodios que cambian entre manía y depresión; el objetivo del estudio fue conocer la prevalencia y factores asociados del trastorno bipolar en la población de las parroquias rurales del cantón Cuenca.  Materiales y métodos: Se realizó un estudio de tipo transversal analítico. El universo estuvo conformado por 199.506 habitantes, a través de una muestra polietápica se evaluaron a 984 individuos de las parroquias El Valle, Tarqui y Checa. Se aplicó una entrevista sociodemográfica y el test MINI (Mini Entrevista Neuropsiquiátrica Internacional para adultos). Se incluyó personas de 18 años en adelante y se excluyó a individuos con alteraciones cognitivas y conductuales graves. Resultados: Se encontró que 32 personas presentaron trastorno bipolar actual que corresponde a una prevalencia del 3,30% de los cuales el 1,42%, se reportaron como trastorno único. Las personas que sufren manía actualmente representaron el 1,70% de la población; mientras que los que sufren hipomanía fueron el 1,50%. Se encontró un mayor porcentaje en el sexo femenino. El único factor asociado es el no convivir con una pareja, con un chi cuadrado de 11,60 (p: 0.00) con un OR de 2,20 (IC 1,39 – 3,50).  No existe asociación con estructura y funcionalidad familiar, situación laboral, migración, edad y sexo. Se consideró como comorbilidades: ansiedad y dependencia-abuso de alcohol y sustancias. Conclusiones: El trastorno bipolar tiene una prevalencia del 3,30%. El principal factor asociado fue vivir sin una pareja.Introduction: Bipolar disorder is a pathology of mood that is characterized by episodes that change between mania and depression; The objective of the study was to know the prevalence and associated factors of bipolar disorder in the population of the rural parishes of the Cuenca city. Materials and methods: A cross sectional analysis study was carried out. The universe was made up of 199,506 inhabitants, through a multi-stage sample 984 individuals from the parishes El Valle, Tarqui and Checa were evaluated. A sociodemographic interview and the MINI test (International Mini Neuropsychiatric Interview for adults) were applied. People 18 years of age and older were included and individuals with severe cognitive and behavioral disorders were excluded. Results: It was found that 32 people had current bipolar disorder corresponding to a prevalence of 3.30% of which 1.42%, were reported as a single disorder. People suffering from mania currently accounted for 1.70% of the population; while that suffering hypomania were 1.50%. A higher percentage was found in the female sex. The only associated factor is not living with a couple, with a chi-square of 11.60 (p: 0.00) with an OR of 2.20 (CI 1.39 - 3.50). There is no association with family structure and functionality, employment status, migration, age and sex. Comorbidities were considered: anxiety and dependence-abuse of alcohol and substances. Conclusions: Bipolar disorder has a prevalence of 3.30%. The main associated factor was living without a partner

Caracterización fitoquímica y actividad antimicrobiana del aceite esencial de diente de león (Taraxacum Officinale) frente a microorganismos patógenos

Introduction: Antibiotic resistance has aroused great interest in evaluating the antimicrobial properties of natural plants. Taraxacum officinale is widely used as a medicinal plant in folklore for its diuretic, anti-rheumatic, and anti-inflammatory properties. However, there are some reports on antimicrobial properties. Objective: The objective of the study was to explore the photochemical composition of the extracts of the essential oils of the Taraxacum officinale plant and their antibacterial activity against bacterial strains of clinical importance. Methodology: The antibacterial properties of the essential oil of Taraxacum officinale were examined through the agar disc diffusion method and the minimum inhibitory concentration (MIC). Results: The evaluation of the antimicrobial activity developed by the diffusion method in solid medium, MIC and CMM showed that bacterial strains such as Staphylococcus aureus and yeasts such as Candida Albicans were sensitive to the antimicrobial activity of the essential oil studied but intermediate activity. with gram negative bacteria such as Escherichia coli. Conclusion: the essential oil of Taraxacum officinale has a high antibacterial activity and its use as a natural antimicrobial alternative in pharmaceutical industries could be suggested.Introducción. La resistencia a los antibióticos ha despertado un gran interés en evaluar las propiedades antimicrobianas de las plantas naturales. El Taraxacum officinale se utiliza ampliamente como una planta medicinal del folclore por sus propiedades diuréticas, antirreumáticas y antiinflamatorias. Sin embargo, hay algunos informes sobre las propiedades antimicrobianas. El objetivo del estudio fue explorar la composición fotoquímica de los extractos de los aceites esenciales de la planta Taraxacum officinale y su actividad antibacteriana contra cepas bacterianas de importancia clínica. Metodología Las propiedades antibacterianas del aceite esencial de Taraxacum officinale, fueron examinado a través del método de difusión en disco de agar, y la concentración mínima inhibitoria (MIC). Resultados: La evaluación de la actividad antimicrobiana desarrollada por el método de difusión en medio sólido, la MIC y la CMM mostraron que las cepas bacterianas como Staphylococcus aureus y las levaduras como Cándida Albicans fueron sensibles a la activiada antimicrobiana del aceite esencial estudiado, pero actividad intermedia con bacterias gram negativas como la Escherichia coli. Conclusión: el aceite esencial de Taraxacum officinale presenta una alta actividad antibacteriana y se podría sugerir su uso como alternativa antimicrobiana natural en las industrias farmacéuticas

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Prevalencia y factores de riesgo asociados a episiotomía en mujeres primigestas atendidas en el hospital “Luis F. Martínez”, año 2016

Determinar la prevalencia y factores de riesgo asociados a la episiotom&iacute;a en mujeres primigestas atendidasen el Hospital &ldquo;Luis F. Mart&iacute;nez&rdquo;, durante el a&ntilde;o 2016. Se dise&ntilde;&oacute; un estudio descriptivo, retrospectivo, de tipo transversal y de campo, la investigaci&oacute;n se iniciacon la recolecci&oacute;n de datos de las historias cl&iacute;nicas, con base en los criterios de inclusi&oacute;n. Se elaboraron tablas ygr&aacute;ficos utilizando Microsoft Excel 2016 y el programa SPSS, versi&oacute;n 20. Se encontr&oacute; que el n&uacute;mero de partos eut&oacute;cicos o normales en el a&ntilde;o 2016 fue de 453, de las cuales 300(66,2 %) son mult&iacute;paras y 153 (33,8 %) son nul&iacute;paras. La prevalencia de episiotom&iacute;a en pacientes primigestas enel a&ntilde;o de estudio fue de 64,1 %, valor superior al recomendado por la Organizaci&oacute;n Mundial de la Salud y a otrosobtenidos en investigaciones regionales semejantes. El tipo de episiotom&iacute;a realizada fue medio lateral en el 100 %de los casos. Se demuestra una alta prevalencia de episiotom&iacute;a en el hospital Luis F. Mart&iacute;nez&rdquo;, a&ntilde;o 2016;los factores de riesgo asociados a la episiotom&iacute;a, incluyen: per&iacute;metro cef&aacute;lico, peso del neonato y edad maternacumplida. La posici&oacute;n vertical al momento del parto es un factor de protecci&oacute;n.To determine the prevalence and risk factors associated with episiotomy in nulliparous women treated atthe Hospital &ldquo;Luis F. Mart&iacute;nez&rdquo;, during 2016. A descriptive, retrospective, cross-sectional and field study was designed, the research begins with thecollection of data from the medical records, based on the inclusion criteria. Charts and graphs were created using Microsoft Excel 2016 and the SPSS program, version 20. It was found that the number of eutocic deliveries in the year 2016 was 453, of which 300 (66.2%) aremultiparous and 153 (33.8%) are nulliparous. The prevalence of episiotomy in nulliparous patients in the year ofstudy was 64.1%, a value higher than that recommended by the World Health Organization and others obtained insimilar regional investigations. The type of episiotomy performed was mid-lateral in 100% of the cases. A high prevalence of episiotomy is demonstrated at the &ldquo;Luis F. Martinez Hospital&rdquo;, 2016; the riskfactors associated with episiotomy include: cephalic perimeter, weight of the newborn y maternal age. The verticalposition of the mother at the time of delivery is a protective factor

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted