Socioeconomic and behavioral factors associated with tuberculosis diagnostic delay in Lima, Peru

Early detection and diagnosis of tuberculosis (TB) is a global priority. Prolonged symptom duration prior to TB diagnosis is associated with increased morbidity, mortality and risk of transmission. We aimed to determine socioeconomic and behavioral factors associated with diagnostic delays among patients with TB. Data were collected from 105 patients with TB using a semi-structured interview guide in Lima, Peru. Factors associated with diagnostic delay were analyzed using negative binomial regression. The median delay from when symptoms commenced and the first positive diagnostic sample in public health facilities was 57 days (interquartile range (IQR): 28-126). In multivariable analysis, greater diagnostic delay was independently associated with patient older age; female sex; lower personal income prior to diagnosis; living with fewer people; and having more visits to professional health facilities prior to diagnosis (all p<0.05). Patients who first sought care at a private health facility had more visits overall to professional health facilities prior to diagnosis than those who first sought care from public or insured employee health facilities and had longer diagnostic delay in analysis adjusted for age and sex. Patients with TB were significantly more likely to first self-medicate than to visit professional health facilities prior to diagnosis (p=0.003). Thus, diagnostic delay was prolonged, greatest among older, low-income women and varied according to the type of care sought by individuals when their symptoms commenced. These findings suggest that TB case finding initiatives should target vulnerable groups in informal and private health facilities, where many patients with TB first seek healthcare

Clima organizacional, síndrome de burnout y afrontamiento en trabajadores de un hospital oncológico de Arequipa

The aim of this article is to show the results of a research in an organizational climate, burnout syndrome and coping styles had been correlated in a simple of workers from Hospital Regional de Enfermedades Neoplásicas de Arequipa. In order to, we use three instruments: Organizational Climate Questionnaire, Maslach Burnout Inventory and Coping Behavior Before Stress Situations Questionnaire. They were tested 93 workersfrom the hospital (67.7% female y 32.3% male) aged between 19 and 62 years old, with a medium age of 34 years. Administrative workers make up 57% of de sample and the remaining 43% consists of health personnel. Three instruments were used: Organizational Climate Questionnaire, ther Maslach Burnout Inventory and the Coping Behaviors Questionnaire Stress Situations. The results show that there are optimal organizational climate and low levels of burnout syndrome in the vast majority of workers. However, the recognition and salary were less satisfactory aspects. No significant relationships were found between organizational climate and burnout, but between organizational climate and active coping style, which was the most predominant. In addition, active coping was related to age, sex, marital status, number of children and type of work performed (p &lt;.05).El objetivo de este estudio fue la valoración del clima organizacional en el Hospital Regional de enfermedades Neoplásicas de Arequipa (IREN-SUR), además de evaluar el síndrome de burnout y los estilos de afrontamiento en los trabajadores, para luego establecer correlaciones entre estas variables. Fueron evaluados 93 trabajadores del hospital (67.7% mujeres y 32.3% varones) con un rango de edad entre 19 y 62 años, con una edad promedio de 34 años. Lostrabajadores administrativos hacen el 57% de la muestra y el restante 43% lo constituyen el personal de salud. Se utilizaron tres instrumentos: el Cuestionario de Clima Organizacional, el Inventario de Burnout de Maslach y el Cuestionario de Conductas de Afrontamiento en Situaciones de Estrés. Los resultados señalan que existen un clima organizacional óptimo y bajos niveles de síndrome de burnout en la gran mayoría de trabajadores. Sin embargo, el reconocimiento y el sueldo fueron los aspectos menos satisfactorios. No se encontraron relaciones significativas entre clima organizacional y burnout, pero sí entre clima organizacional y el estilo de afrontamiento activo, que fue el más predominante. Asimismo, el afrontamiento activo se relaciona con la edad, elsexo, el estado civil, el número de hijos y el tipo de trabajo que se realiza (p&lt;0.05)

Usefulness of an Intrapartum Ultrasound Simulator (IUSim™) for Midwife Training: Results from an RCT

Introduction: We conducted a randomized study to determine whether a training session on a dedicated simulator (IUSim™) would facilitate the midwives in learning the technique of transperineal intrapartum ultrasound. Methods: Following a 30-min multimedia presentation including images and videos on how to obtain and measure the angle of progression (AoP) and the head-perineum distance (HPD), 6 midwives with no prior experience in intrapartum ultrasound were randomly split into 2 groups: 3 of them were assigned to the "training group"and 3 to the "control group."The midwives belonging to the former group were taught to measure the 2 sonographic parameters during a 3-h practical session conducted on IUSim™ under the supervision of an expert obstetrician. In the following 3 months, all the 6 midwives were asked to independently perform transperineal ultrasound during their clinical practice and to measure on the acquired images either the AoP or the HPD. The sonographic images were examined in blind by the teaching obstetrician who assigned a 0-3 score to the image quality (IQS) and to the measurement quality (MQS). Results: A total of 48 ultrasound images (24 patients) from 5 midwives were acquired and included in the study analysis. A midwife of the "training group"declined participation after the practical session. Independently from the randomization group, the image quality score (IQS + MQS) was significantly higher for the HPD compared with the AoP (2.5 ± 0.66 vs. 1.79 ± 1.14; p = 0.01). In the training group, the MQS of either AoP (2.66 ± 0.5 vs.1.46 ± 1.45. p = 0.038) and the HPD (2.9 ± 0.33 vs. 1.87 ± 0.83 p = 0.002) was significantly higher in comparison with the control group, while the IQS of both measurements was comparable between the 2 groups (1.91 ± 1.24 vs. 2.25 ± 0.865; p = 0.28). Conclusion: The use of a dedicated simulator may facilitate the midwives in learning how to measure the AoP and the HPD on transperineal ultrasound images

How the initiating ribosome copes with ppGpp to translate mRNAs

During host colonization, bacteria use the alarmones (p)ppGpp to reshape their proteome by acting pleiotropically on DNA, RNA, and protein synthesis. Here, we elucidate how the initiating ribosome senses the cellular pool of guanosine nucleotides and regulates the progression towards protein synthesis. Our results show that the affinity of guanosine triphosphate (GTP) and the inhibitory concentration of ppGpp for the 30S-bound initiation factor IF2 vary depending on the programmed mRNA. The TufA mRNA enhanced GTP affinity for 30S complexes, resulting in improved ppGpp tolerance and allowing efficient protein synthesis. Conversely, the InfA mRNA allowed ppGpp to compete with GTP for IF2, thus stalling 30S complexes. Structural modeling and biochemical analysis of the TufA mRNA unveiled a structured enhancer of translation initiation (SETI) composed of two consecutive hairpins proximal to the translation initiation region (TIR) that largely account for ppGpp tolerance under physiological concentrations of guanosine nucleotides. Furthermore, our results show that the mechanism enhancing ppGpp tolerance is not restricted to the TufA mRNA, as similar ppGpp tolerance was found for the SETI-containing Rnr mRNA. Finally, we show that IF2 can use pppGpp to promote the formation of 30S initiation complexes (ICs), albeit requiring higher factor concentration and resulting in slower transitions to translation elongation. Altogether, our data unveil a novel regulatory mechanism at the onset of protein synthesis that tolerates physiological concentrations of ppGpp and that bacteria can exploit to modulate their proteome as a function of the nutritional shift happening during stringent response and infection.Russian Foundation for Basic ResearchRevisión por pare

Корреляция генотипа с фенотипом у больных муковисцидозом

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Chronic Diarrhea and Pancolitis Caused by Paracoccidioidomycosis: A Case Report

South American blastomycosis is a systemic micosis caused by infection with Paracoccidioides brasiliensis. The most frequently affected sites are the lower lip buccal mucous membrane, palate, tongue, sublingual region, lymph glands, and lungs. However, colonic involvement is not a common expression of Paracoccidioidomycosis. We report a case of chronic diarrhea and pancolitis caused by Paracoccidioidomycosis with fatal outcome

Dimorphic Fungal Coinfection as a Cause of Chronic Diarrhea and Pancolitis

Histoplasma capsulatum and Paracoccidioides brasiliensis are dimorphic fungi that cause systemic mycosis mostly in tropical South America and some areas of North America. Gastrointestinal involvement is not uncommon among these fungal diseases, but coinfection has not previously been reported. We report a patient with chronic diarrhea and pancolitis caused by paracoccidioidomycosis and histoplasmosis

Optimización estructural en silla de ruedas por modelización con elementos finitos

Disponiendo del conjunto de piezas constitutivas de un modelo de silla de ruedas en formato digital y físico, se ha desarrollado una serie de actividades tendientes a esclarecer el estudio de adaptación de su estructura a las condiciones funcionales deseadas por el fabricante. Las tareas han consistido principalmente en el ensayo de diferentes opciones de mecanizado a partir de las geometrías existentes, con el objetivo de reducir a la mínima expresión el peso total de la estructura sin comprometer su aptitud y funcionalidad. Todas las opciones planteadas, se han estudiado a través de un programa de simulación digital por el método de elementos finitos. Las condiciones operativas se basan en un sujeto de prueba de 100 kg de peso, y la utilización de una aleación de aluminio AA6061 T6 para la construcción estructural. Es importante destacar que sólo se plantean operaciones de mecanizado, ya que las piezas a estudiar se encuentran sometidas a una configuración geométrica de diseño invariable debido a la existencia de un único perfil de matricería para su fabricación. La necesidad de obtener una estructura final de bajo peso se sustenta principalmente en los usuarios de la silla, los cuales tienen como característica lesiones en medula ósea pero cuentan con movilidad propia, por lo que un producto final de menor peso garantizará la independencia por parte del paciente, por ejemplo, al subir y bajar de un automóvil. Luego de llevar a cabo la etapa de modelado y adecuación de piezas mediante operaciones de mecanizado, se ha logrado reducir sustancialmente el peso de la estructura de la silla, en un valor cercano a los 1000 gramos, lo que representa una disminución superior al 10 % respecto de la estructura original.Sección: Mecánica.Facultad de Ingenierí

Optimización estructural en silla de ruedas por modelización con elementos finitos

Disponiendo del conjunto de piezas constitutivas de un modelo de silla de ruedas en formato digital y físico, se ha desarrollado una serie de actividades tendientes a esclarecer el estudio de adaptación de su estructura a las condiciones funcionales deseadas por el fabricante. Las tareas han consistido principalmente en el ensayo de diferentes opciones de mecanizado a partir de las geometrías existentes, con el objetivo de reducir a la mínima expresión el peso total de la estructura sin comprometer su aptitud y funcionalidad. Todas las opciones planteadas, se han estudiado a través de un programa de simulación digital por el método de elementos finitos. Las condiciones operativas se basan en un sujeto de prueba de 100 kg de peso, y la utilización de una aleación de aluminio AA6061 T6 para la construcción estructural. Es importante destacar que sólo se plantean operaciones de mecanizado, ya que las piezas a estudiar se encuentran sometidas a una configuración geométrica de diseño invariable debido a la existencia de un único perfil de matricería para su fabricación. La necesidad de obtener una estructura final de bajo peso se sustenta principalmente en los usuarios de la silla, los cuales tienen como característica lesiones en medula ósea pero cuentan con movilidad propia, por lo que un producto final de menor peso garantizará la independencia por parte del paciente, por ejemplo, al subir y bajar de un automóvil. Luego de llevar a cabo la etapa de modelado y adecuación de piezas mediante operaciones de mecanizado, se ha logrado reducir sustancialmente el peso de la estructura de la silla, en un valor cercano a los 1000 gramos, lo que representa una disminución superior al 10 % respecto de la estructura original.Sección: Mecánica.Facultad de Ingenierí