Modelo estratégico territorial para fomentar el desarrollo sostenible del turismo vivencial en un distrito de Ferreñafe

El presente informe de investigación tiene por finalidad, realizar un diagnóstico del estado situacional del turismo en el Distrito de Incahuasi, Provincia de Ferreñafe. El objetivo, radica en proponer un Modelo Estratégico Territorial para promover el turismo sostenible vivencial en un Distrito de Ferreñafe. Forman parte de los materiales y métodos usados para este informe, las entrevistas, a funcionarios encargados de las áreas de promoción del turismo, así como; las realizadas a especialistas, conocedores del desarrollo del turismo en Ferreñafe; además de lo mencionado, se efectuó una revisión documentaria que permitió evaluar el estado de la planificación estratégica desarrollado por los gestores del turismo en Incahuasi. Los resultados de la investigación demostraron, que Incahuasi cuenta con amplio potencial turístico que merece ser promocionado, pudiéndose en este Distrito, fomentar un turismo vivencial y de aventura. Asimismo, se evidenció que Incahuasi no cuenta con la implementación de los instrumentos de gestión adecuados, para la promoción del turismo

Sleep-disordered breathing and pregnancy outcomes: The impact of maternal oxygen saturation

ObjectiveTo investigate pathological associations between sleep-disordered breathing (SDB) and pregnancy outcomes. MethodsFrom May 2016 to September 2019, obese women during their uncomplicated singleton pregnancies underwent screening sleep questionnaires, oxygen saturation monitoring, and, in proper cases, complete overnight polysomnography. Their medical records were also recorded. ResultsIn all, 112 pregnant women were included in the study cohort; 44 showed an oxygen desaturation index & GE;10, and their newborns had a significantly higher rate of congenital abnormalities and respiratory distress syndrome compared with the women with normal pulse oximetry. Stepwise multivariate regression analysis showed that basal oxygen saturation was independently associated with the occurrence of fetal growth restriction. ConclusionAmong obese pregnant women, the rate of congenital abnormalities is higher in the ones with altered pulse oximetry. Maternal basal oxygen saturation in the first trimester of pregnancy predicts fetal growth restriction independently of maternal age, ethnicity, body mass index, gravidity, and hypertensive disorders of pregnancy

Frequency of positive antiphospholipid antibodies in pregnant women with SARS-CoV-2 infection and impact on pregnancy outcome: A single-center prospective study on 151 pregnancies

Background: At the beginning of the SARS-CoV-2 pandemic, there was a lack of information about the infection’s impact on pregnancy and capability to induce de novo autoantibodies. It soon became clear that thrombosis was a manifestation of COVID-19, therefore the possible contribution of de novo antiphospholipid antibodies (aPL) raised research interest. We aimed at screening SARS-CoV-2 positive pregnant patients for aPL. Methods: The study included consecutive pregnant women who were hospitalized in our Obstetric Department between March 2020 and July 2021 for either a symptomatic SARS-CoV-2 infection or for other reasons (obstetric complications, labour, delivery) and found positive at the admission nasopharyngeal swab. All these women underwent the search for aPL by means of Lupus Anticoagulant (LA), IgG/IgM anti-cardiolipin (aCL), IgG/IgM anti-beta2glycoprotein I (aB2GPI). Data about comorbidities, obstetric and neonatal complications were collected. Results: 151 women were included. Sixteen (11%) were positive for aPL, mostly at low titre. Pneumonia was diagnosed in 20 women (5 with positive aPL) and 5 required ICU admission (2 with positive aPL). Obstetric complications occurred in 10/16 (63%) aPL positive and in 36/135 (27%) negative patients. The occurrence of HELLP syndrome and preeclampsia was significantly associated with positive aPL (p=0,004). One case of maternal thrombosis occurred in an aPL negative woman. aPL positivity was checked after at least 12 weeks in 7/16 women (44%): 3 had become negative; 2 were still positive (1 IgG aB2GPI + IgG aCL; 1 IgM aB2GPI); 1 remained positive for IgG aCL but became negative for aB2GPI; 1 became negative for LA but displayed a new positivity for IgG aCL at high titre. Conclusions: The frequency of positive aPL in pregnant women with SARS- CoV-2 infection was low in our cohort and similar to the one described in the general obstetric population. aPL mostly presented as single positive, low titre, transient antibodies. The rate of obstetric complications was higher in aPL positive women as compared to negative ones, particularly hypertensive disorders. Causality cannot be excluded; however, other risk factors, including a full-blown picture of COVID-19, may have elicited the pathogenic potential of aPL and contributed themselves to the development of complications

The prevalence of mental disorders in suicide attempts, HPS - Porto Alegre, RS

O suicídio é um risco presente nos pacientes com transtornos psiquiátricos e, através da prática desempenhada no Serviço de Saúde Mental do Hospital de Pronto Socorro de Porto Alegre/RS, notase que a ocorrência de tentativas de suicídio tem-se evidenciado com índices elevados. O presente trabalho aborda aspectos sobre as tentativas de suicídio enquanto fenômeno social, tema pouco discutido e divulgado. Objetivos: estimar a prevalência de transtornos mentais e descrever o perfil sociodemográfico nas tentativas de suicídio. Método: estudo de caso não controlado, sendo incluídos pacientes que realizaram uma tentativa de suicídio e foram avaliados pelo Serviço de Psicologia deste Hospital. Resultados: evidenciou-se que os pacientes que tentaram suicídio por intoxicação exógena eram na maioria do sexo feminino, sem companheiro fixo, encontrando-se na fase jovem adulto. Os achados tiveram alto grau de risco de suicídio (83%), portanto, considera-se que a maior parte dos sujeitos tem maior predisposição para realizar nova tentativa de suicídio. Conclusões: a relevância desta discussão encontra-se associada à importância de uma melhor compreensão a respeito dos pacientes que realizaram uma tentativa de suicídio associada à prevalência de transtornos mentais, podendo-se desta forma compreender os motivos/efeitos da ocorrência e tomar as decisões mais adequadas sobre intervenções e encaminhamentos.Suicide is a risk present in patients with psychiatric disorders and, through the practice performed in the Mental Health Department of the Hospital de Pronto Socorro de Porto Alegre/RS, it is noted that the occurrence of suicide attempts has been quite high. This paper will address aspects of suicide attempts as a social phenomenon, little discussed and disclosed theme. Objectives: To estimate the prevalence of mental disorders and describe the sociodemographic in attempted suicides. Methods: Case study uncontrolled and included patients who had attempted suicide and were evaluated by the psychology of the Hospital Service. Results: It was observed that patients who attempted suicide by exogenous intoxication, most female without fixed companions, finding themselves in adult young stage. The findings had a high degree of suicide risk (83%), so it is considered that most subjects have a greater predisposition to perform a new suicide attempt. Conclusions: The relevance of this discussion is linked to the importance of a better understanding of the patients who underwent an attempt of suicide associated with the prevalence of mental disorders, therefore you can understand the reason/purpose of the event and make the most appropriate decisions about referrals interventions

Planeamiento estratégico territorial como herramienta para fomentar el turismo como eje estratégico del desarrollo sostenible de la Provincia de Ferreñafe

La presente tesis tiene como objetivo general analizar la contribución del planeamiento estratégico en el desarrollo del turismo como eje del desarrollo sostenible en la provincia de Ferreñafe, basados en el enfoque del desarrollo sostenible y la teoría de planificación estratégica territorial considerada por el Centro Nacional de Planificación Estratégica-CEPLAN. El tipo de investigación es cualitativa y se ha empleado como método de recolección de datos a la entrevista, aplicándosele a los funcionarios responsables de la planificación estratégica de las municipalidades, como aquellos responsables del turismo. Mediante los resultados se llegó a la conclusión que el planeamiento estratégico desarrollado en la provincia de Ferreñafe no se encuentra vinculado al servicio de turismo, por ello el aporte de este servicio al desarrollo sostenible de la provincia es inexistente, así también se ha determinado que la provincia tiene como fortaleza la existencia en su territorio de recursos turísticos importantes, los cuales carecen de una adecuada administración y fomento

Insulinoma Identified in Puerperium: Association with Pregnancy and Literature Review

Postpartum hypoglycemia in non-diabetic women is a rare condition. We report the case of a 34-year-old woman who experienced neuroglycopenia 2 days after delivery. Corresponding to severe hypoglycemia, we found inappropriately elevated insulin and C-peptide levels. Following magnetic resonance imaging a lesion of 10×8 mm was detected in the head of the pancreas. An ultrasound-guided fine needle aspiration of the mass confirmed the diagnostic suspicion of a pancreatic neuroendocrine tumor. Complete surgical enucleation of the insulinoma resulted in immediate and permanent resolution of the hypoglycemia. The postoperative course was uneventful. Histopathological and immunohistochemical analyses were consistent with insulinoma. The diagnostic approach to postpartum hypoglycemia represents a challenge for multidisciplinary teamwork

Primary Hyperparathyroidism in Pregnancy: A Case Report

Primary hyperparathyroidism (PHP) is the third most common endocrine disorder. We report the case of a 28-year-old woman who experienced general weakness, hyperemesis gravidarum and hypercalcemia at 11 weeks of gestation. Corresponding to hypercalcemia, we found inappropriately elevated parathyroid hormone levels. Through neck computed tomography a solitary adenoma of the parathyroid gland, measuring 6 × 2.9 × 11 mm has been documented. An ultrasound-guided fine needle aspiration from the mass confirmed the suspicious of a benign tumor. Left superior parathyroidectomy resulted in immediate and permanent resolution of hypercalcemia. The postoperative course was uneventful. Histopathological and immunohistochemical analyses were consistent with parathyroid adenoma. The diagnostic approach to hypercalcemia in pregnancy represents a challenge for multidisciplinary teamwork

The role of second trimester uterine artery Doppler in pregnancies with systemic lupus erythematosus

OBJECTIVE: The aim of this article is to assess the predictive value of second trimester mean uterine artery Doppler pulsatility index (mUtA PI) for pregnancy complications in women with systemic lupus erythematosus (SLE). METHODS: Cohort study of consecutive pregnancies complicated with SLE during a period of 12 years is used. SLE diagnosis was made before pregnancy. mUtA PI was measured between 23 + 0 and 26 + 6 weeks' gestation. Pregnancy and neonatal outcomes were collected. Small for gestational age (SGA) was defined as birth weight <10th percentile. Adverse pregnancy outcome (APO) was defined as one of the following: pre-eclampsia (PE), SGA, placental abruption, stillbirth, or neonatal death. Differential diagnosis between PE and renal flare was made according to SLE-disease activity index. RESULTS: There are 70 pregnancies in 64 women. PE was observed in four cases (6%), SGA in five cases (7%), and APO in seven cases (10%). mUtA PI showed a sensitivity and a specificity of 1.0 (95% CI 0.5-1.0) and 1.0 (95% CI 0.95-1.0) for PE, 0.40 (95% CI 0.12-0.77) and 0.97 (95% CI 0.89-0.99) for SGA, and 0.57 (95% CI 0.25-0.84) and 1.0 (95% CI 0.94-1.0) for APO, respectively. CONCLUSION: Our findings suggest that uterine artery Doppler is confirmed to be a high sensitivity and a high specificity test for predicting PE even in SLE patients

The role of second trimester uterine artery Doppler in pregnancies with systemic lupus erythematosus

OBJECTIVE: To assess the predictive value of second trimester mean uterine artery Doppler pulsatility-index (mUtA PI) for pregnancy complications in women with systemic lupus erythematosus (SLE). METHODS: Cohort study of consecutive pregnancies complicated with SLE during a 12 years period. SLE diagnosis was made before pregnancy. mUtA PI was measured between 23 + 0 and 26 + 6 weeks' gestation. Pregnancy and neonatal outcomes were collected. Small for gestational age (SGA) was defined as birth weight <10th percentile. Adverse pregnancy outcome (APO) was defined as one of the following: pre-eclampsia, SGA, placental abruption, stillbirth or neonatal death. Differential diagnosis between pre-eclampsia and renal flare was made according to SLE-disease activity index (SLEDAI) index. RESULTS: 70 pregnancies in 64 women. Pre-eclampsia was observed in 4 cases (6%), SGA in 5 (7%) and APO in 7 (10%). mUtA PI showed a sensitivity and a specificity of 1.0 (95% CI 0.5-1.0) and 1.0 (95% CI 0.95-1.0) for pre-eclampsia, 0.40 (95% CI 0.12-0.77) and 0.97 (95% CI 0.89-0.99) for SGA, 0.57 (95% CI 0.25-0.84) and 1.0 (95% CI 0.94-1.0) for APO, respectively. CONCLUSION: Our findings suggest that uterine artery Doppler is confirmed to be a high sensitivity and high specificity test for predicting pre-eclampsia even in SLE patients