Complicaciones perinatales en recién nacidos de madres adolescentes en el Hospital Regional Manuel Nuñez Butrón. julio - diciembre 2014

Introducción: Se conoce que la gestación en edades extremas puede repercutir en el recién nacido, responsabilizando a la edad materna de algunas de las complicaciones perinatales, sin embargo no hay muchos estudios en la región que se dediquen a investigar los embarazos en estas edades, en especial en adolescentes, por lo que en este estudio se indagará lo que ocurre en los recién nacidos de madres adolescentes en el Hospital Regional Manuel Nuñez Butron de Puno. Materiales y Métodos: Mediante un estudio analítico, longitudinal y prospectivo, se trató de determinar las complicaciones perinatales en recién nacidos de madres adolescentes (10-19 años) en el Hospital Regional Manuel Nuñez Butron de Puno. Julio-Diciembre 2014. Resultados: Hubo un total de 172 partos de adolescentes en el HRMNB en el periodo mencionado, nuestra muestra fue de 92 recién nacidos de madres adolescentes con edad promedio de 16.7 años, 7% de ellas (6) pertenecientes a la adolescencia temprana. En cuanto a controles prenatales un total de 45 (49%) madres no tuvo o tuvo un control inadecuado, es decir menos de 6 controles. El parto pre termino ocurrió en 4.3%, la tasa de cesárea fue de 36%, el 91.2 % de los recién nacidos pesó entre 2500g y 3999g y 9% menos de 2500g. Se obtuvo un total de17 recién nacidos pequeños para edad gestacional, representando un 19% del total. Además se obtuvo en orden las siguientes patologías, sospecha de sepsis neonatal precoz 17 (18.4%), ictericia patológica 12(13.4%), dificultad respiratoria neonatal 9 (9.7%), anomalías congénitas 1 (1.09%), depresión moderada 6 (6%) depresión severa 8 (9%). Conclusiones: Las principales complicaciones perinatales en nuestro estudio en el periodo de tiempo establecido son: recién nacidos pequeños para la edad gestacional (PEG) en un total de 17 recién nacidos, esto representa el 19% del total, asimismo, recién nacidos con bajo peso siendo estos 8 (9%) del total de la muestra, considerándose a los que pesaron menos de 2500 gramos, sospecha de sepsis neonatal precoz 17 (18.4%), ictericia patológica 12(13.4%), dificultad respiratoria neonatal 9 (9.7%), anomalías congénitas 1 (1.09%), depresión moderada 6 (6%), depresión severa 8 (9%). Cerca de la mitad de las madres adolescentes no tuvo un adecuado o no tuvo controles prenatales siendo estos menos de 6, en un total de 45 adolescentes, esto representa un 49%. La culminación del embarazo en gestantes adolescentes por cesárea, fue más de la tercera parte de todos los partos realizados a adolescentes, en un número de 33, lo que representa un 36%. La adolescencia por si misma se constituye en un factor de riesgo para el futuro ser en la medida que afecta su crecimiento intrauterino adecuado y por lo tanto conlleva a mayor riesgo de morbilidad en el periodo neonatal.Tesi

Condrosarcoma de alto grado de localización infrecuente

Chondrosarcoma is a skeletal malignant neoplasm characterized by the production of neoplastic cartilage, it represents only 20% of bone tumors, and its most frequent location is in the pelvis and proximal extremities. Location in small bones is very rare. A 44-year-old man with a 1-year illness who attended the trauma emergency at the hospital with an increase in volume of the back of the right foot accompanied by intense pain. A wide margin resection of the tumor was performed. The pathology department reported high-grade chondrosarcoma. Currently the patient is evaluated by the oncology service.El condrosarcoma es una neoplasia maligna esquelética caracterizada por la producción de cartílago neoplásico, representa sólo un 20% de los tumores óseos, y su localización más frecuente es en pelvis y extremidades proximales. Su localización en huesos pequeños es rara. Se presenta el caso de un varón de 44 años con un tiempo de enfermedad de 1 año que acude a la emergencia de traumatología con un aumento de volumen de parte posterior del pie derecho acompañado de intenso dolor. Se le realizó una resección con margen amplio del tumor. El servicio de anatomía patológica informó condrosarcoma de alto grado. Actualmente el paciente es evaluado por el servicio de oncología

Search for Eccentric Black Hole Coalescences during the Third Observing Run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass $M>70$ $M_\odot$) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities $0 < e \leq 0.3$ at $0.33$ Gpc$^{-3}$ yr$^{-1}$ at 90\% confidence level.Comment: 24 pages, 5 figure

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ultralight vector dark matter search using data from the KAGRA O3GK run

Among the various candidates for dark matter (DM), ultralight vector DM can be probed by laser interferometric gravitational wave detectors through the measurement of oscillating length changes in the arm cavities. In this context, KAGRA has a unique feature due to differing compositions of its mirrors, enhancing the signal of vector DM in the length change in the auxiliary channels. Here we present the result of a search for U(1)B−L gauge boson DM using the KAGRA data from auxiliary length channels during the first joint observation run together with GEO600. By applying our search pipeline, which takes into account the stochastic nature of ultralight DM, upper bounds on the coupling strength between the U(1)B−L gauge boson and ordinary matter are obtained for a range of DM masses. While our constraints are less stringent than those derived from previous experiments, this study demonstrates the applicability of our method to the lower-mass vector DM search, which is made difficult in this measurement by the short observation time compared to the auto-correlation time scale of DM

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M&gt;70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0&lt;e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level

Search for gravitational-lensing signatures in the full third observing run of the LIGO-Virgo network

Gravitational lensing by massive objects along the line of sight to the source causes distortions of gravitational wave-signals; such distortions may reveal information about fundamental physics, cosmology and astrophysics. In this work, we have extended the search for lensing signatures to all binary black hole events from the third observing run of the LIGO--Virgo network. We search for repeated signals from strong lensing by 1) performing targeted searches for subthreshold signals, 2) calculating the degree of overlap amongst the intrinsic parameters and sky location of pairs of signals, 3) comparing the similarities of the spectrograms amongst pairs of signals, and 4) performing dual-signal Bayesian analysis that takes into account selection effects and astrophysical knowledge. We also search for distortions to the gravitational waveform caused by 1) frequency-independent phase shifts in strongly lensed images, and 2) frequency-dependent modulation of the amplitude and phase due to point masses. None of these searches yields significant evidence for lensing. Finally, we use the non-detection of gravitational-wave lensing to constrain the lensing rate based on the latest merger-rate estimates and the fraction of dark matter composed of compact objects