Prevalencia de aborto en Gineco Obstetricia y evaluación de la aplicación del protocolo del Ministerio de Salud Publica para el manejo del aborto. Hospital Abel Gilbert Ponton

El aborto desde siempre constituyó una problemática de actualidad ya que como se ve en la historia, el aborto se ha realizado desde la época de Aristóteles, quien consideraba que el feto era humano desde los 40 días de la concepción de igual modo a través de la historia conocemos sobre el uso de diferentes métodos para provocarlo, resultando muchos casos en complicaciones que derivaban en una alta mortalidad materna. Es así como en la actualidad el uso de protocolos de manejo y tratamiento adecuados ayudan a disminuir la mortalidad materna. En este contexto en el área de Emergencia de Ginecología y Obstetricia del Hospital Abel Gilbert Pontón aplicamos el protocolo del Ministerio de Salud Pública para el manejo del aborto. En el año 2010 fueron atendidas 25.030 pacientes, de este grupo, las atenciones entre Junio a Diciembre fueron 14.883 (13.94% del grupo total), de este grupo fueron seleccionadas las pacientes que acudieron por aborto (1.144 pacientes) y de ellas, las de una guardia especifica que constituyeron 141 pacientes que fue el grupo analizado. De este grupo el análisis del estado civil reveló una mayor frecuencia de mujeres en unión libre (64%) seguida de las solteras (21%), casadas (12%), divorciadas (3%) y viudas (0%). De acuerdo al tipo de aborto espontaneo 70%, provocado 30%. Según la paridad de las pacientes, mujeres multíparas (82%), primigestas (18%), El análisis del diagnóstico de ingreso revela aborto incompleto (62%), seguido por aborto diferido (19%) aborto en curso (16 %) y aborto séptico con un 3%. Siendo el legrado uterino instrumental (LIU) el procedimiento más usado en la atención de las pacientes y causante de algunas complicaciones como perforación uterina e intestinal. Finalmente considerándose el uso de la aspiración manual endouterina (AMEU) el procedimiento menos traumático para las pacientes que deben ser sometidas a legrado obstétrico en abortos menores de 12 semanas, se propone al Ministerio de Salud Pública que invierta más recursos en este material. Adicionalmente para disminuir la prevalencia de abortos se recomienda realizar campañas de educación sexual y planificación familiar. Exigir la venta de medicamentos con receta médica y registro sanitario.The abortion has always constituted a problem today as it as seen in history , abortion has been performed since the time of Aristotle , who believed that the human fetus was from 40 days after conception the same way through the history know about the use of different methods to provoke , often resulting in complications deriving a high maternal mortality. Thus, at present the use of management protocols and treatment help to reduce maternal mortality . In this context in the area of Emergency Obstetrics and Gynecology Hospital Abel Gilbert Ponton apply the protocol of the Ministry of Public Health for the management of abortion . In 2010, 25,030 patients were treated , of this group , hospitality from June to December were 14,883 (13.94 % of the total group ) were selected from this group of patients who presented with abortion ( 1,144 patients) and of these, those of specifies that a watch constituted 141 patients was analyzed group . Of this group status analysis revealed a higher frequency of cohabiting women ( 64 % ) followed by single women ( 21 %), married (12 % ) , divorced ( 3% ) and widowed ( 0 % ) . According to the spontaneous abortion rate 70 % , 30 % resulted . According to the parity of the patients , multiparous women ( 82 % ) , primiparous ( 18 % ) , the admission diagnosis analysis reveals incomplete abortion ( 62 % ) , followed by missed abortion ( 19 % ) ongoing abortion ( 16%) and septic abortion with 3% . Being sharp curettage (LIU ), the most common process and causing some complications Finally we recommend considering the use of manual vacuum aspiration (MVA ) the procedure less traumatic for patients should undergo curettage abortions obstetrical under 12 weeks , it is proposed to the Ministry of Health to invest more resources in this material. In addition to reducing the prevalence of abortions is recommended sex education campaigns and family planning. Requiring the sale of prescription drugs and health record .Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduado

Programa De Acompañamiento Y Seguimiento Para La Pertenencia Y Graduación Estudiantil, Paspe

PASPE es un modelo de acompañamiento integral que a través de un seguimiento personalizado y continuo busca identificar, analizar y comprender los factores, variables y patrones de deserción específicos que se presentan en la Institución, recopila información relevante de cada estudiante (datos sociodemográficos, historial de rendimiento académico, acciones de acompañamiento realizadas, etc.) de diferentes fuentes institucionales, que permiten definir estrategias de acompañamiento enfocadas en sus problemáticas actuales. Emprendiendo acciones y optimizando esfuerzos se trabaja articuladamente con la academia, liderado desde la Dirección de Bienestar Estudiantil con el apoyo del Decano y un docente de cada programa se realiza seguimiento a los estudiantes, identificando aquellos que presentan niveles de riesgo de desertar para brindar una intervención oportuna y pertinente a las dificultades que presentan y favorecer el óptimo desempeño académico y personal con miras a la permanencia y la culminación de su proyecto de vida profesional. Las estrategias diseñadas e implementadas en PASPE, buscan fortalecer las competencias personales, académicas, comunicativas y profesionales de la comunidad estudiantil por medio de monitorias, tutorías, cursos, talleres, nivelatorios, asesorías académicas, intervenciones curriculares para disminuir el abandono, entrenamientos en cada uno de sus procesos cognitivos; además, ofrece una orientación psicológica que se realiza a través de asesorías individuales, intervenciones grupales y entrenamientos a solución de problemas que van orientados a la promoción y prevención de la salud mental. Estas estrategias alineadas con los objetivos misionales de la institución, han permitido promover el respeto a la diversidad de etnia, género, orientación sexual, discapacidad, excepcionalidad, edad, credo e identificación de condiciones de atención especial, logrando una evaluación permanente acerca de los temas abordados y una mayor participación de los estudiantes a las actividades y servicios ofrecidos que inciden positivamente en las tasas de deserción. La información obtenida a través de PASPE, permite consultar y generar elementos que faciliten la toma de decisiones y el desarrollo de estrategias basadas en planes de mejora que favorezcan la consecución de los objetivos tanto de la institución como ente formativo, como de los estudiantes en términos de su proyecto de vida. Es por esto que el acompañamiento al estudiante y la comprensión de sus necesidades se convierte en una pieza fundamental de la institución. Desde su inicio en el 2009, PASPE ha implementado actividades que permitieron fuera reconocido por el Ministerio de Educación en el 2015 como una de las quince mejores experiencias significativas para la Permanencia en Educación Superior a nivel nacional

GERENCIAMENTO DA ADESÃO TERAPÊUTICA NOS PACIENTES POLIMEDICADOS EM FARMÁCIAS E DROGARIAS NO INTERIOR DO CEARÁ

O Farmacêutico deve utilizar seu conhecimento técnico e científico com o intuito de promover o uso seguro, racional e apropriado de medicamentos, porém o que acontece na maioria das vezes, é que o farmacêutico da farmácia comunitária, hospitalar ou de serviços de saúde tem uma enorme gama de tarefas burocráticas que o afastam do paciente e isso acaba dificultando a execução de suas atividades assistencialistas. O termo adesão ao tratamento refere-se ao grau de cumprimento das medidas terapêuticas prescritas pelo profissional de saúde habilitado, sejam estas medicamentosas ou não, com o objetivo predefinido e que esteja de acordo com a expectativa de melhora da qualidade de vida do paciente. Todavia, a adesão ao tratamento medicamentoso só pode ser avaliada se o profissional investir o tempo necessário para a avaliação de seus pacientes, principalmente aqueles que fazem uso de vários medicamentos por longo tempo. O estudo científico objetivou averiguar o gerenciamento da adesão terapêutica pelos profissionais farmacêuticos em benefício clínico dos pacientes polimedicados em farmácias e drogarias no município de Morada Nova – CE. O tipo de estudo é transversal, observacional e analítico de natureza quantitativa e foi realizado nas farmácias e drogarias do município de Morada Nova/CE. A coleta dos dados foi realizada no período de março a maio de 2019 através dos dados passados pelo profissional farmacêutico ou gestor com o auxílio do questionário sobre gestão. Se a farmácia possuísse gerência de dados, seria verificado a adesão terapêutica dos pacientes polimedicados através de um segundo questionário. Foram contabilizadas o total de 11 farmácias e drogarias, mas apenas 8 estabelecimentos (72,72%) aceitaram participar da pesquisa. De todas as farmácias, somente 1 (9,09%) providencia o serviço para consulta dos dados sobre o regime farmacoterapêutico. O presente estudo verificou que nesta farmácia que armazenava estes dados mais de 33 % dos pacientes acompanhados tomavam acima de 5 medicamentos regularmente. Do total de 46 medicamentos em uso pela população estudada, foram identificadas a grande utilização de anti-hipertensivos e hipoglicemiantes orais, que são medicações de uso crônico bastante associados à senescência. Diante do exposto, observa-se que as farmácias comunitárias possuem deficiências nos serviços assistencialistas por negligenciar as atividades para as quais o farmacêutico foi capacitado para exercê-las. Não faz sentido o farmacêutico ter habilidades para direcionamento clínico se a instituição na qual ele trabalha ainda não enxergou os benefícios dessa prática

Effect of high Al2O3 content on the microstructure and electrical properties of Co- and Ta-doped SnO2 varistors

Varistor behavior shows signifcant diferences when the addition levels of diferent dopants like In2O3, Cr2O3, and Al2O3 are changed, thus stimulating current investigations on the SnO2–Co3O4–Ta2O5 ceramic system. In this contribution, the infuence of high additions of Al2O3 on the microstructure, structure and the electrical properties of SnO2–Co3O4–Ta2O5 varistors ([98.95-X]%SnO2–1% Co3O4–X% Al2O3–0.05% Ta2O5, where X=0, 0.05, 0.1, 1 or 2 mol%) is investigated. Characterization techniques such as thermal analysis, scanning electron microscopy and X-ray difraction with Rietveld refnement were used for specimen analysis. The endothermic peaks in the ceramic system containing Al2O3 additions between 0.05 and 1% are ascribed to the formation of the Co2SnO4 and CoAl2O4 spinel type phases. Doping the ceramic system with 1 and 2 mol% Al2O3 leads to the formation of 1.163 and 3.449%, respectively, of the spinel phase Al2CoO4, which acts as a grain growth inhibitor because grain size decreases in about 16% for both addition levels. The apparent grains homogeneity and narrowest monomodal grain size distribution for the specimens with 2 mol% Al2O3 confrm the inhibitory role. With the lowest level of Al2O3 (0.05 mol%) the nonlinearity coefcient reaches a maximum, after which it decreases and fades at the highest alumina level. A remarkable decrease of about 50% in the leakage current from the reference specimen´s value to that of the one with 0.05 mol% Al2O3 concurrently with an increase in about 40% in the nonlinearity coefcient favors the potential use of alumina in the SnO2–Co3O4–Ta2O5 ceramic system.El comportamiento del varistor muestra diferencias significativas cuando los niveles de adición de diferentes dopantes como In2O3, Cr2O3 y Al2O3 se modifican, lo que estimula las investigaciones actuales sobre el sistema cerámico SnO2 – Co3O4 – Ta2O5. En esta contribución, el Influencia de altas adiciones de Al2O3 en la microestructura, estructura y propiedades eléctricas de SnO2 – Co3O4 – Ta2O5 varistores ([98.95-X]% SnO2–1% Co3O4 – X% Al2O3–0.05% Ta2O5, donde X = 0, 0.05, 0.1, 1 o 2% mol) se investiga. Técnicas de caracterización como análisis térmico, microscopía electrónica de barrido y difracción de rayos X con refinamiento de Rietveld. fueron utilizados para el análisis de muestras. Los picos endotérmicos en el sistema cerámico que contienen adiciones de Al2O3 entre 0.05 y 1% se atribuyen a la formación de las fases de tipo espinela Co2SnO4 y CoAl2O4. Dopando el sistema cerámico con 1 y 2 mol% de Al2O3 conduce a la formación de 1.163 y 3.449%, respectivamente, de la fase de espinela Al2CoO4, que actúa como un inhibidor del crecimiento del grano porque el tamaño del grano disminuye en aproximadamente un 16% para ambos niveles de adición. La aparente homogeneidad de los granos. y la distribución de tamaño de grano monomodal más estrecha para las muestras con 2% en moles de Al2O3 confirman el papel inhibidor. Con el nivel más bajo de Al2O3 (0.05 mol%) el coeficiente de no linealidad alcanza un máximo, después de lo cual disminuye y se desvanece a El nivel más alto de alúmina. Una disminución notable de aproximadamente el 50% en la corriente de fuga del valor de la muestra de referencia al de aquel con 0.05 mol% Al2O3 concurrentemente con un aumento de aproximadamente 40% en los favores coeficientes no lineales El uso potencial de alúmina en el sistema cerámico SnO2 – Co3O4 – Ta2O5

Implementation of translation techniques, use of software and image editing in legal documents.

The translation process goes beyond the exchange of ideas from the source language to the target language. It requires a deep analysis of what is to be conveyed, the type of technique it is convenient to use, the purpose, and the audience it is addressed to. Each document has its own relevance, so each one must be treated professionally and with due respect toward its final recipient. Therefore, in this document we present a compilation of important translated documents, from English to Spanish and vice-versa, the ones we worked with throughout the specialization course, including, translated images, a birth, marriage, and divorce certificate, a university transcript, a diploma, and a protocol of agreement. We chose the right process of translation with seven important steps: reading the text, analysis, and research, translation, taking a break, comparing the two versions, editing and proofreading, and final review. In addition, the new era requires the use of different software such as Pixlr, Photopea, Cat tools that help to speed up long translation files and facilitates image editing. Despite being a complex job, it is gratifying to see the result of hours of work, and the ability we have now to transmit into our mother tongue those ideas that were originally written in a foreign language. A professional translator must be able to make the reader perceive the text as the original, not as a text that has undergone a process of transformation, a good translator is one who remains invisible to the reader's eyes

Postcoital Bioavailability and Antiviral Activity of 0.5% PRO 2000 Gel: Implications for Future Microbicide Clinical Trials

The pharmacokinetics and pharmacodynamics of vaginal microbicides are typically assessed among sexually abstinent women. However, the physical act of sex may modulate gel distribution, and preclinical studies demonstrate seminal plasma interferes with the antiviral activity of several microbicides. This study compared the biological activity and concentration of PRO 2000 in cervicovaginal lavage (CVL) collected in the absence or following coitus.CVL samples were collected from ten heterosexual couples at baseline, after sex, after a single dose of 0.5% PRO 2000 gel and sex, and after gel application without sex. The impact of CVL on HIV-1 infection of TZM-bl cells and HSV-2 infection of CaSki cells was monitored by luciferase and plaque assay, respectively. PRO 2000 concentrations were measured by fluorescence.CVL collected after PRO 2000 application significantly inhibited HIV-1 and HSV-2 (p = 0.01). However, the antiviral activity was reduced following sex and no significant protective effect was observed in postcoital CVL obtained in the presence compared to the absence of PRO 2000 for HIV (p = 0.45) or HSV-2 (p = 0.56). Less PRO 2000 was recovered in postcoital CVL, which, in conjunction with interference by seminal plasma, may have contributed to lower antiviral activity.Postcoital responses to PRO 2000 differ from precoital measures and the results obtained may provide insights into the clinical trial findings in which there was no significant protection against HIV-1 or HSV-2. Postcoital studies should be incorporated into clinical studies before embarking on large-scale efficacy trials

Genomic and Geographic Context for the Evolution of High-Risk Carbapenem-Resistant Enterobacter cloacae Complex Clones ST171 and ST78

Recent reports have established the escalating threat of carbapenem-resistant Enterobacter cloacae complex (CREC). Here, we demonstrate that CREC has evolved as a highly antibiotic-resistant rather than highly virulent nosocomial pathogen. Applying genomics and Bayesian phylogenetic analyses to a 7-year collection of CREC isolates from a northern Manhattan hospital system and to a large set of publicly available, geographically diverse genomes, we demonstrate clonal spread of a single clone, ST171. We estimate that two major clades of epidemic ST171 diverged prior to 1962, subsequently spreading in parallel from the Northeastern to the Mid-Atlantic and Midwestern United States and demonstrating links to international sites. Acquisition of carbapenem and fluoroquinolone resistance determinants by both clades preceded widespread use of these drugs in the mid-1980s, suggesting that antibiotic pressure contributed substantially to its spread. Despite a unique mobile repertoire, ST171 isolates showed decreased virulence in vitro. While a second clone, ST78, substantially contributed to the emergence of CREC, it encompasses diverse carbapenemase-harboring plasmids, including a potentially hypertransmissible IncN plasmid, also present in other sequence types. Rather than heightened virulence, CREC demonstrates lineage-specific, multifactorial adaptations to nosocomial environments coupled with a unique potential to acquire and disseminate carbapenem resistance genes. These findings indicate a need for robust surveillance efforts that are attentive to the potential for local and international spread of high-risk CREC clones. IMPORTANCE Carbapenem-resistant Enterobacter cloacae complex (CREC) has emerged as a formidable nosocomial pathogen. While sporadic acquisition of plasmid-encoded carbapenemases has been implicated as a major driver of CREC, ST171 and ST78 clones demonstrate epidemic potential. However, a lack of reliable genomic references and rigorous statistical analyses has left many gaps in knowledge regarding the phylogenetic context and evolutionary pathways of successful CREC. Our reconstruction of recent ST171 and ST78 evolution represents a significant addition to current understanding of CREC and the directionality of its spread from the Eastern United States to the northern Midwestern United States with links to international collections. Our results indicate that the remarkable ability of E. cloacae to acquire and disseminate cross-class antibiotic resistance rather than virulence determinants, coupled with its ability to adapt under conditions of antibiotic pressure, likely led to the wide dissemination of CREC

Effects of urate, a natural inhibitor of peroxynitrite-mediated toxicity, in the response of Arabidopsis thaliana to the bacterial pathogen Pseudomonas syringae

Urate, a natural peroxynitrite scavenger, has been used to investígate the possible role of peroxynitrite during plant-pathogen interactions. Urate greatly reduced lesión formation in Arabidopsis leaves treated with an abiotic peroxynitrite-generating system or with a peroxynitrite solution, indicating that it can act as an effective scavenger in planta. In the interaction with the avirulent Pseudomonas syringae pv. phaseolicola [avrRPNW], cell death in the inoculated área was strongly reduced by urate, without compromising disease resistance. In contrast, urate promoted discrete cell death in response to an isogenic Pseudomonas syringae (awRPMT), which did not trigger an HR when inoculated alone, and it induced resistance and arrest of pathogen growth. Scavenging of peroxynitrite did not modify the response of Arabidopsis to an avirulent strain of Xanthomonas campestris pv campestris, that showed a high resistance to NO and peroxynitrite. Our data indícate that peroxynitrite plays a significant role in the responses of plants to Pseudomonas syrin

A Randomized Trial to Assess Anti-HIV Activity in Female Genital Tract Secretions and Soluble Mucosal Immunity Following Application of 1% Tenofovir Gel

Preclinical and early phase clinical microbicide studies have not consistently predicted the outcome of efficacy trials. To address this gap, candidate biomarkers of microbicide pharmacodynamics and safety were evaluated in a double-blind, placebo-controlled trial of tenofovir gel, the first microbicide to demonstrate significant protection against HIV acquisition.30 women were randomized to apply a single daily dose of tenofovir or placebo gel for 14 consecutive days. Anti-HIV activity was measured in cervicovaginal lavage (CVL) on Days 0, 3, 7, 14 and 21 by luciferase assay as a surrogate marker of pharmacodynamics. Endogenous activity against E. coli and HSV-2 and concentrations of immune mediators were quantified in CVL as candidate biomarkers of safety. Tenofovir levels were measured in CVL and blood.A significant increase in anti-HIV activity was detected in CVL from women who applied tenofovir gel compared to their endogenous anti-HIV activity in genital tract secretions on Day 0 and compared to activity in CVL from women in the placebo group. The activity correlated significantly with CVL concentration of tenofovir (r = 0.6, p<0.001) and fit a sigmoid E(max) pharmacodynamic model. Anti-HIV activity in CVL from women who applied tenofovir persisted when virus was introduced in semen, whereas endogenous anti-HIV activity decreased. Tenofovir did not trigger an inflammatory response or induce sustained loss in endogenous antimicrobial activity or immune mediators.Tenofovir gel had no deleterious impact on soluble mucosal immunity. The increased anti-HIV activity in CVL, which persisted in the presence of semen and correlated with tenofovir concentration, is consistent with the efficacy observed in a recent clinical trial. These results promote quantified CVL anti-HIV activity as a surrogate of tissue pharmacodynamics and as a potential biomarker of adherence to product. This simple, feasible and inexpensive bioassay may promote the development of models more predictive of microbicide efficacy.ClinicalTrials.gov NCT00594373

Association of genetic ancestry with colorectal tumor location in Puerto Rican Latinos

Colorectal cancer (CRC) is the first cause of cancer deaths among Puerto Ricans. The incidence and mortality of CRC in Puerto Rico continue to be on the rise. The burden of CRC in Puerto Rico is higher than among US Hispanics and is second only to African Americans, thus supporting the importance of studying this CRC health disparity. The genetic background of the Puerto Rican population is a mix of European, African, and Amerindian races, which may account, in part, for the differences observed in the CRC mortality rates among Puerto Ricans. The objective of the study was to assess the role of genetic ancestry in CRC risk and its association with clinicopathological features of CRC tumors in Puerto Ricans. We used a validated panel of 105 ancestry informative markers (AIMs) to estimate genetic ancestry in 406 Puerto Rican CRC cases and 425 Puerto Rican controls. We examined the association of genetic ancestry with CRC risk and tumor clinicopathological characteristics. The mean ancestry proportions in the study population were 61% European, 21% African, and 18% Amerindian. No association was observed between genetic ancestry and risk of CRC. However, African ancestry was associated with an increased risk of developing rectal tumors (OR = 1.55, 95% CI 1.04-2.31). Additional studies are needed to fully elucidate the role of African ancestry in CRC carcinogenesis.National Institute on Minority Health and Health Disparities (NIMHD) [MD007587]; National Institute of Allergy and Infectious Diseases (NIAID) [MD007587]; National Cancer Institute (NCI) [CA130034, CA096297/CA096300]; Center for Collaborative Research in Health Disparities RCMI [G12MD007600]Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]