Tratamiento del embarazo ectópico implantado en cicatriz de cesárea: estudio de cohorte 2018-2022, Lima, Perú

Objetivos: describir las características clínicas y el tratamiento del embarazo ectópico implantado en la cicatriz de cesárea, así como las complicaciones y el pronóstico obstétrico. Materiales y métodos: estudio de cohorte retrospectivo de gestantes con diagnóstico de embarazo ectópico implantado en la cicatriz de cesárea según los criterios de la Sociedad de Medicina Materno-Fetal, atendidas entre enero de 2018 y marzo de 2022 en dos instituciones de alta complejidad, pertenecientes a la seguridad social, ubicadas en Lima, Perú. Se hizo un muestreo consecutivo. Se midieron variables sociodemográficas y clínicas de ingreso, diagnóstico, tipo de tratamiento, complicaciones y pronóstico obstétrico. Se hace un análisis descriptivo. Resultados: se incluyeron 17 pacientes, de 29.919 partos. De estas, el 41,2 % recibió tratamiento médico y el resto recibió tratamiento quirúrgico. Se realizó un manejo local exitoso con metotrexato en el saco gestacional en dos pacientes con ectópico tipo 2. Cuatro de las pacientes requirieron histerectomía total. Seis pacientes experimentaron una gestación después del tratamiento, y 4 de ellas culminaron el embarazo con una madre y un neonato saludables. Conclusiones: el embarazo ectópico implantado en la cicatriz de una cesárea es una entidad poco frecuente, para la cual se cuenta con alternativas de manejo médico y quirúrgico con aparentes buenos resultados. Se requieren más estudios con mayor calidad metodológica de asignación aleatoria que ayuden a caracterizar la seguridad y la efectividad de las diferentes alternativas terapéuticas para las mujeres con sospecha de esta patología

nQuack: An R package for predicting ploidal level from sequence data using site-based heterozygosity

Premise: Traditional methods of ploidal-level estimation are tedious; using DNA sequence data for cytotype estimation is an ideal alternative. Multiple statistical approaches to leverage sequence data for ploidy inference based on site-based heterozygosity have been developed. However, these approaches may require high-coverage sequence data, use inappropriate probability distributions, or have additional statistical shortcomings that limit inference abilities. We introduce nQuack, an open-source R package that addresses the main shortcomings of current methods. Methods and Results: nQuack performs model selection for improved ploidy predictions. Here, we implement expectation maximization algorithms with normal, beta, and beta-binomial distributions. Using extensive computer simulations that account for variability in sequencing depth, as well as real data sets, we demonstrate the utility and limitations of nQuack. Conclusions: Inferring ploidy based on site-based heterozygosity alone is difficult. Even though nQuack is more accurate than similar methods, we suggest caution when relying on any site-based heterozygosity method to infer ploidy.</p

Supplement 1. R scripts for calculating maximum likelihood estimates, restricted maximum likelihood estimates, and parametric bootstrap likelihood ratio tests of density dependence, for the Ornstein-Uhlenbeck state-space model, using population-abundance data having possibly unequal observation time intervals.

<h2>File List</h2><div> <p><a href="RUNNING-ROUSS.R">RUNNING-ROUSS.R</a> (MD5: c07b061d09a71a54d0a0f70844ef9d77)</p> <p><a href="RUNNING-PBLRT.R">RUNNING-PBLRT.R</a> (MD5: f786fefc7684bd3bd099a1f682babaa5)</p> <p><a href="ROUSSE-1.0.R">ROUSSE-1.0.R</a> (MD5: d3ced6b948020ce1231da2262e3f0648)</p> </div><h2>Description</h2><div> <p>This supplement contains three R scripts: (1) RUNNING-ROUSS.R calculates maximum likelihood and restricted maximum likelihood estimates for the Ornstein Uhlenbeck state space model (stationary and non-stationary), using population-abundance data having possibly unequal observation time intervals. (2) RUNNING-PBLRT.R performs parametric bootstrap likelihood ratio test of exponential growth state space model vs. Ornstein-Uhlenbeck state space model. (3) ROUSSE-1.0.R contains the functions used in statistical inferences for the Ornstein-Uhlenbeck state space model. ROUSSE-1.0.R is called by both RUNNING-ROUSS.R and RUNNING-PBLRT.R and must be present (as a file by that name) in the working directory of R.</p> </div

Reflexiones sobre oportunidades de intervención en tabaquismo en Latinoamérica Reflections on smoking intervention opportunities In Latin America

El tabaquismo es un grave problema de salud pública en Latinoamérica, cuyos países aún muestran en su estructura poblacional una amplia base piramidal formada por grupos etarios de jóvenes que han sido el blanco primordial de la industria tabacalera. Latinoamérica requiere urgentemente de estrategias de prevención y acciones sanitarias para modificar las consecuencias de fumar sobre la salud de la población a través de la cesación del tabaquismo. El tratamiento de la adicción a la nicotina requiere estrategias de intervención eficaces para disminuir la prevalencia de fumadores y evitar su recaída, brindándoles herramientas para el mantenimiento de la abstinencia. En la actualidad, poblaciones pobres y vulnerables (44% de la población latinoaméricana) están condenadas a sufrir las consecuencias sanitarias de esta enfermedad, ya que son las que presentan un mayor consumo de tabaco y las que pueden acceder menos a las intervenciones sanitarias. El Convenio Marco para el Control del Tabaco (CMCT) y el MPOWER, ambos estrategias de la Organización Mundial de la Salud para la lucha contra el tabaco, definen claras líneas de acción pero sus limitaciones están definidas por los recursos que se asignan para las mismas en cada país. La comunidad científica y técnica abocada a la lucha contra este flagelo debe considerar y poner en marcha nuevas perspectivas para lograr colocar en la agenda política la necesidad de obtener y asignar más recursos económicos y humanos para disminuir el consumo del tabaco en todos los grupos de la población. En la lucha contra el tabaco, este es el momento indicado para considerar primordialmente aspectos de equidad y justicia social en salud.The tobacco epidemic is a huge public health problem affecting all Latin American countries. These countries have the characteristic of a wide base of the pyramidal population structure, with many young people who have been natural targets for the tobacco industry. Therefore in this region there is an urgent need to establish prevention and treatment strategies capable to reduce incidence and prevalence of tobacco smoking in the population and as a consequence modify the health effects of tobacco consumption. Treating nicotine addiction requires intervention strategies really effective to reduce the number of current smokers as well as giving them tools to avoid relapse and maintain abstinence. Currently poor and vulnerable groups, which represent 44% of the total population in Latin America, are the most susceptible to suffer the health consequences of smoking since they show the highest prevalence rates and have little or no access to health services. The Framework Convention on Tobacco Control (FCTC) and MPOWER, both strategies proposed by the World Health Organization against tobacco, define clear goals to achieve their purposes, nevertheless they are limited by the economic and human resources assigned by each country. The scientific community involved in the fight against tobacco must think about new ways to place this issue in the political agenda so there will be more opportunities to increase the resources and therefore to reduce tobacco consumption in all the groups of the population. In the fight against tobacco, this is the right time to consider primarily issues related to equity and social justice

Appendix A. Confidence intervals, hypothesis tests, and model selection for the Ornstein-Uhlenbeck state-space model.

Confidence intervals, hypothesis tests, and model selection for the Ornstein-Uhlenbeck state-space model

Entropy, Statistical Evidence, and Scientific Inference: Evidence Functions in Theory and Applications

Scope and Goals of the Special Issue: There is a growing realization that despite being the essential tool of modern data-based scientific discovery and model testing, statistics has major problems [...

Evolution of Diversity in Spatially Structured Escherichia coli Populations▿

The stochastic Ricker population model was used to investigate the generation and maintenance of genetic diversity in a bacterial population grown in a spatially structured environment. In particular, we showed that Escherichia coli undergoes dramatic genetic diversification when grown as a biofilm. Using a novel biofilm entrapment method, we retrieved 64 clones from each of six different depths of a mature biofilm, and after subculturing for ∼30 generations, we measured their growth kinetics in three different media. We fit a stochastic Ricker population growth model to the recorded growth curves. The growth kinetics of clonal lineages descendant from cells sampled at different biofilm depths varied as a function of both the depth in the biofilm and the growth medium used. We concluded that differences in the growth dynamics of clones were heritable and arose during adaptive evolution under local conditions in a spatially heterogeneous environment. We postulate that under nutrient-limited conditions, selective sweeps would be protracted and would be insufficient to purge less-fit variants, a phenomenon that would allow the coexistence of genetically distinct clones. These findings contribute to the current understanding of biofilm ecology and complement current hypotheses for the maintenance and generation of microbial diversity in spatially structured environments