Desabastecimiento de dispositivos médicos en centros de salud tipo A del sector público en el cantón Milagro 2021

Esta investigación busco determinar las diferencias significativas de desabastecimiento de dispositivos médicos en los centros de salud tipo A del sector público del cantón Milagro 2021. Diseñado bajo un estudio cuantitativo, un tipo de investigación básica, con un diseño de estudio no experimental comparativo, descriptivo simple, donde para la recolección de datos la técnica utilizada fue cuatro fichas de observación directa de los registros de abastecimiento de dispositivos médicos y de las recetas dispensadas que guardan en las bodegas zonales, además de una encuesta dirigida al personal administrativo y auxiliar de farmacia sobre la inexactitud del inventario, donde fueron sometidos a criterio de expertos y expresados a pruebas de confiabilidad de Cronbach. Con resultados que demuestran un desabastecimiento del 59.3% en las zonas rurales, así como el 76% de recetas con novedades. Además que el personal de la institución menciona que no existe un desabastecimiento por inexactitud del inventario. Concluyendo que además del desabastecimiento en zonas rurales, hay una planificación incorrecta por parte de los centros de salud, teniendo un déficit de logística, además no existe una inexactitud del inventario, no existen demandas imprevistas significativas y no existe dispensaciones parciales que ayuden al desabastecimiento de estos dispositivos

Evaluación preliminar de la diversidad genética del leoncillo Callithrixpygmaea (Primates: Cebidae: Callithrichinae) mediante microsatélites (SSR: Short Sequence Repeat)

The pygmy marmoset (Callithrix pygmaea) is one of the most specialized Ecuadorian pri­mate species. Its high specialization in habitat and diet, and the increase of human activities in the Amazon region may cause pygmy marmosets to go through population bottle necks, losing genetic diversity. To estimate the magnitude of this threat, since 2008 we carried out a pilot study for evaluating the genetic diversity of four wild groups of this species in a population located on the margins of the Aguarico river. For the genetic analyses we used 50 fecal samples collected from September 2008 to February 2009; 50% of the samples belonged to group P4, groups P1, P2 and P5 provided the remaining 50%. We extracted DNA from the feces using the QLAamp DNA Stool Mini Kit (QIAGEN). With PCR we amplified 9 microsatellite primers reported for a related species of Callitrichinae. DNA bands were visualized in polyacrylamide (6 %) and urea (5M) gels. Statistical analyses we­re carried out with GenAlEx 6 software. Three to eight alleles were found per locus. The Hardy-Weinberg equilibrium test suggested that inbreeding may be occurring in group P4. Expected heterocigocity in groups P1 and P2 is 0.5, while in group P4 ranges from 05. to 0.836. Nei’s genetic distance between groups P1 and P2 is 1.211, whereas group P4 differs 0.612 and 0.485 from groups P2 and P1, respectively. This is the first study of this type for this species in Ecuador and elsewhere, the results point out the need to evaluate human impact on the genetic diversity of Ecuadorian species.El leoncillo (Callithrix pygmaea) es uno de los primates ecuatorianos con mayor grado de especialización de hábitat y de dieta. Esta alta especialización y la intensificación de las actividades humanas en la Amazonia ecuatoriana podrían causar que las poblaciones del leoncillo atraviesen por cuellos de botella y pierdan su diversidad genética. Con el fin de estimar la magnitud de esta amenaza, desde el año 2008, se realizó un estudio piloto para evaluar el nivel de variabilidad genética de cuatro grupos de esta especie de una población a orillas del rio Aguarico. Para la realización del análisis genético se utilizó un total de 50 muestras de heces, colectadas durante el periodo de septiembre 2008 y febrero 2009; el 50% de las muestras correspondió al grupo P4, los grupos P1, P2 y P5 aportaron con el restante 50%. A partir de estas muestras se extrajo ADN con el kit QIAamp DNA Stool Mini Kit (QIAGEN). Mediante la técnica de PCR se amplificaron nueve primers de mi­crosatélites reportados para otra especie de Callitrichinae. La visualización de bandas se realizó en geles denaturantes de poliacrilamida al 6% y Urea 5M. El análisis estadístico fue realizado con el programa GenAlEx 6. Los resultados obtenidos muestran que existen de 3 a 8 alelos/locus, la prueba de equilibrio Hardy-Weinberg sugiere que en el grupo P4 puede estar sucediendo endogamia, la heterocigocidad esperada en los grupos P1 y P2 tiene valores de 0.5, mientras que los valores del grupo P4 varían de 0.5 a 0.836. La distancia genética de Nei entre los grupos P1 y P2 es de 1.211, mientras que el grupo P4 difiere 0.612 y 0.485 con respecto de los grupos P2 y P1. Este estudio es pionero en este campo y evidencia la necesidad de continuar con investigaciones para evaluar el impacto humano sobre la diversidad genética en esta y otras especies ecuatorianas

Denervación renal en el tratamiento de la hipertensión arterial. Posicionamiento conjunto de la SEH-LELHA y la ACI-SEC

Hypertension is the most prevalent cardiovascular risk factor. Despite pharmacological treatment, a high percentage of patients do not achieve an adequate blood pressure control. Renal sympathetic denervation is a minimally invasive intervention for the management of hypertension involving the interruption of the renal artery sympathetic nervous system using a catheter-based approach. The early studies showed promising results, but the controversial results coming from the SYMPLICITY HTN-3 trial sent this technique into oblivion. Over the last 3 years, new clinical trials have appeared including new devices used in different populations, which definitively proves the effectiveness of renal sympathetic denervation. This joint position statement from the Spanish Society of Hypertension-Spanish League for Combating High Blood Pressure (SEH-LELHA), and the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) reviews the evidence available on the efficacy and safety profile of renal sympathetic denervation for the management of hypertension. Based on the results of clinical trials, recommendations have been established on what patients may be eligible for renal sympathetic denervation and under what circumstances

The role of vacancy defects and holes in the fracture of carbon nanotubes."

Abstract We present quantum mechanical calculations using density functional theory and semiempirical methods, and molecular mechanics (MM) calculations with a Tersoff-Brenner potential that explore the role of vacancy defects in the fracture of carbon nanotubes under axial tension. These methods show reasonable agreement, although the MM scheme systematically underestimates fracture strengths. One-and two-atom vacancy defects are observed to reduce failure stresses by as much as 26% and markedly reduce failure strains. Large holes -such as might be introduced via oxidative purification processes -greatly reduce strength, and this provides an explanation for the extant theoretical-experimental discrepancies. Ó 2004 Published by Elsevier B.V

Professional Quality of Life and Perceived Stress in Health Professionals before COVID-19 in Spain: Primary and Hospital Care

This study aimed to analyze the professional quality of life and the perceived stress of health professionals before COVID-19 in Spain, in primary and hospital care professionals. A cross-sectional observational study on health professionals working in health centers during the health crisis caused by COVID-19 was conducted. Professional Quality of Life (ProQoL) and Perceived Stress (PSS-14) were measured, along with socio-demographic and labor variables through an online questionnaire. A descriptive and correlation analysis was performed. A total of 537 professionals participated, both in hospital care (54.7%) and in primary care (45.3%). There was a predominance of medium Compassion Satisfaction, high Compassion Fatigue and medium Burnout. Mean scores for compassion fatigue and compassion satisfaction were slightly higher in primary care, while burnout was higher in hospital care. When primary care participants were grouped by profession, significant differences were found in relation to perceived stress and to the three subscales of professional quality of life. In hospital care, the differences were observed when comparing compassion fatigue and perceived stress by gender. In addition, with respect to Burnout it was carried out by type of contract and shift and in relation to perceived stress grouped by sex, contract and profession. The COVID-19 health crisis has had an impact on mental health and the quality of professional life of health professionals. There is a need to implement long-term contingency programs aimed at improving the emotional well-being of health service professionals

Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

Life-threatening `breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS- CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals ( age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto- Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-a2 and IFN-., while two neutralized IFN-omega only. No patient neutralized IFN-ss. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population

Autoantibodies against type I IFNs in patients with life-threatening COVID-19

Interindividual clinical variability in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is vast. We report that at least 101 of 987 patients with life-threatening coronavirus disease 2019 (COVID-19) pneumonia had neutralizing immunoglobulin G (IgG) autoantibodies (auto-Abs) against interferon-w (IFN-w) (13 patients), against the 13 types of IFN-a (36), or against both (52) at the onset of critical disease; a few also had auto-Abs against the other three type I IFNs. The auto-Abs neutralize the ability of the corresponding type I IFNs to block SARS-CoV-2 infection in vitro. These auto-Abs were not found in 663 individuals with asymptomatic or mild SARS-CoV-2 infection and were present in only 4 of 1227 healthy individuals. Patients with auto-Abs were aged 25 to 87 years and 95 of the 101 were men. A B cell autoimmune phenocopy of inborn errors of type I IFN immunity accounts for life-threatening COVID-19 pneumonia in at least 2.6% of women and 12.5% of men