Aplicación del análisis de componentes principales en la investigación de aguas de pozo para el consumo humano

El efecto adverso de los residuos orgánicos sobre la calidad de las aguas subterráneas puede llegar a ser un serio problema para la salud humana. El objetivo de este estudio fue evaluar la contaminación con nitritos, nitratos y bacterias coliformes en muestras de agua subterránea en el área rural del Departamento de Caaguazú. La concentración de nitritos y nitratos se determinó por destilación con arrastre de vapor y el número de bacterias fue determinado mediante de la técnica de número más probable en el caldo de Mc Conkey. Ningún pozo examinado presentó concentraciones de nitratos que excedieron al valor crítico de 10mg % de agua establecido por la Agencia de Salud Pública de EEUU para el consumo humano. Las concentraciones altas de nitratos se registraron en pozos ubicados en áreas que tuvieron un uso agrícola intensivo, con aplicación de fertilizantes a largo plazo. Con respecto a la presencia de bacterias coliformes, 23 de las muestras analizadas presentaron igual o menos de 3 NMP de bacterias coliformes por 100 ml de agua, que es uno de los criterios establecidos para aguas de consumo humano por el ministerio de Salud Pública y Bienestar Social, sugiriendo un alto riesgo sanitario. Se deberían establecer mejores prácticas de manejo para maximizar la producción de los cultivos, al mismo tiempo que se minimiza el riesgo de contaminación ambiental

Utilización de Prótesis Testicular Alternativa (artesanal) en la Cátedra de Urología del Hospital de Clínicas, Asunción – Paraguay Facultad de Ciencias Médicas – Universidad Nacional de Asunción

INTRODUDCCIÓN: Las orquiectomías se realizan por razones muy variadas y justificadas. La falta de los testículos no solo puede ocasionar un problema psicológico, sino también físico o estético, por lo que se impone la búsqueda de soluciones alternativas a dicho problema. El objetivo de la presente investigación fue reportar resultados obtenidos con la confección de una prótesis testicular artesanal. MATERIALES Y MÉTODOS: Estudio observacional, analítico, transversal, con muestreo no probabilístico de casos consecutivos, de pacientes sometidos a orquiectomía, entre enero de 2010 y agosto de 2014. Se utilizó como prótesis una sonda de Foley 18 de silicona. Los datos se expresan en proporciones. Para la comparación de los grupos se consideró una p < 0,05 como significativa. RESULTADOS: Incluimos 61 pacientes entre 14 y 89 años (45,5 ± 26,2), 34 (55,7%) procedentes del interior. La indicación fue por cáncer de próstata en 23 (37,7%) casos, cáncer de testículo en 30 (49,2%), torsión de cordón en 7 (11,5%) y por criptorquidia en 1 (1,6%). 22 (36,1%) fueron del lado derecho, 16 (26,2%) izquierdo y 23 (37,7%) bilaterales. 8 (13,1%) fueron ambulatorios y con anestesia local. En 33 (54,1%) se realizó acceso por vía inguinal. Se instiló solución fisiológica al 0,9% en 52 (85,2%) pacientes y en 9 (14,8%) xilocaína gel al 2%. El balón fue insuflado entre 10 cc y 25 cc (15±4,3). 8 (13%) presentaron complicaciones. En cuanto a las asociaciones: diagnóstico y lado (p = 0,000), edad y diagnóstico (p = 0,000), acceso quirúrgico y complicaciones (p = 0,018), diagnóstico y complicaciones (p = 0,085), tipo de complicaciones y acceso quirúrgico (p = 0,001). El costo de la prótesis fue de alrededor de 10 dólares americanos. DISCUSIÓN: La prótesis artesanal testicular constituye una alternativa eficaz, de bajo costo y poca morbilidad

Tamizaje de salud mental mediante el test M.I.N.I. en estudiantes del ciclo básico de medicina de la Universidad Nacional de Asunción

INTRODUCCIÓN: Los estudiantes de medicina están expuestos a un mayor número de trastornos mentales que los de la población general por las exigencias propias de la carrera, resaltan entre estos trastornos los de ansiedad y depresión cuyos valores son superiores a los encontrados en la población general. La Mini International Neuropsychiatric Interview (MINI) es una entrevista breve y altamente estructurada de los principales trastornos psiquiátricos del CIE-10. MATERIALES Y MÉTODOS: Fue un estudio observacional analítico con corte transversal realizado en la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción (UNA). Las variables epidemiológicas y sociodemográficas fueron recolectadas con un formulario previamente validado. Se evaluó la frecuencia de trastornos de salud mental en los alumnos utilizando el test MINI, validado en español, como método de tamizaje. RESULTADOS: Se evaluó 91 estudiantes, 58 del sexo femenino (63,7%) y 33 de sexo masculino (36,3%); la media de la edad fue de 21 ± 1 años; 35 alumnos (58,2%) tuvieron al menos un trastorno mental. Los diagnósticos más frecuentes fueron: episodio hipomaniaco pasado (21 alumnos; 23,1%), trastorno depresivo actual (21; 23,1%), trastorno de ansiedad generalizada (15; 16,5%) y agorafobia (14; 15,4%). DISCUSIÓN: los problemas de salud mental fueron frecuentes en la población universitaria que estudiamos siendo el episodio hipomaniaco pasado, el episodio depresivo mayor actual, el trastorno de ansiedad generalizada y la agorafobia, los problemas más frecuentes

Management of intra-abdominal infections : recommendations by the WSES 2016 consensus conference

This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.Peer reviewe

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<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 (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<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

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions