Uji Kepekaan Bakteri Yang Diisolasi Dari Urin Penderita Infeksi Saluran Kemih (Isk) Terhadap Beberapa Antibiotika Pada Periode Maret–juni 2008

Urinary tract infections (UTI) was an inflammatory response of the urethra whenattacked by microorganisms. This disease can happen to people at all ages beginningwith asymptomatic to moderately symptomatic infections. Thus far, antibiotic treat-ment was the best for curing the UTI although the chances for being resistance tothe antibiotics were also high. Resistance to gram negative bacteri,a in particular,often occur with the antibiotics treatment. Our study at the Faculty of Medicine,University of Indonesia (UI), Bacterial isolation from patient urine sample wasperformed in the microbiology laboratory of UI. A total of 50 urine samples werecollected from X patients volunteered in our study for bacterial isolation, however,only 23 bacterial isolates were successfully obtained. Study was carried out to moni-tor the susceptibility of bacterial isolate towards several types of antibiotics (ofloksazim,amoxyicillin, fosfomisin and sefepim) using Cakram disffusion method. Study re-sults demonstrated that susceptibility of oflokazim to both gram positive and nega-tive bacteria was very low while amoxycillin showed desecding trend of efficacytowards all types of bacteria. Fosfomisin and sefepim, on the other hand, demon-strated strong susceptibility to both gram positive and negative bacteria found in theisolates. Furthermore, it is very interesting to observe ofloksazim was resistant to gram postivie and negative bacteria. Collectively, these research findings stronglyillustrated the susceptibility patten and resistance scale of baterial isolates towards various antibiotic tested in the study

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Estudio de la acción del Ácido tricloroacético en el tratamiento de lesiones intraepiteliales causadas por el Virus del Papiloma Humano

El presente estudio se desarrolló en la ciudad de Guayaquil en la Cooperativa Balerio Estacio Cuarta Etapa, en pacientes atendidas en el área de Ginecología en la Fundación Mariana de Jesús Centro Médico de Especialidades “San José Obrero”. El propósito fue Evaluar la acción del Ácido Tricloroacético en el tratamiento de Lesiones Intraepiteliales causadas por VPH; también se inquirió en conocer la concentración que es aplicado este acido. Se tomó los datos de las Historias Clínicas de las pacientes atendidas en los meses de Enero a Julio del 2015 y solo fueron seleccionadas las pacientes tratadas con Ácido Tricloroacético. Se realizaron encuestas a pacientes que visitaron el área de Ginecología en 10 días hábiles que corresponden del 22 de Junio al 3 de Julio del 2015. Los resultados con el tratamiento con el TCA tienen relación directa con la disciplina de las paciente pues la recuperación total en las lesiones cervicales (100%) se evidenció en las pacientes HPV positivo mientras que en los casos de cervicitis se dieron buenos resultados

Sistematización de una normativa sanitaria en el etiquetado de aceites y grasas comestibles procesadas

Objetivo: Implementar una modalidad complementaria a la normativa sanitaria de etiquetado vigente aplicando GDA lo que permitiría al consumidor conocer el contenido saludable de los alimentos que adquiere. Materiales y métodos: El presente proyecto aplicará una metodología bibliográfica/ documental, debido a que se basa en una secuencia lógica de actividades conducentes a la obtención de información necesaria para generar más conocimiento a partir del uso apropiado y creativo de dicha información, utiliza técnicas bibliográfica/ documental y manejo de habilidades de información, como: conocimiento de fuentes, recursos, servicios y productos de información del área de interés. Resultados: Con respecto al análisis porcentual de los nutrientes críticos declarados en los envases de las margarinas en la presentación comercial 1 kg, se puede considerar que dichos valores están totalmente elevados tanto en la grasa total por porción están en el orden de 10 g para Dorina® y Girasol®, y 9 g para Bonella®; esta información nos da como resultado que la grasa total por envase es de 710 g para Dorina® y Girasol®, y 639 g para Bonella®; en cuanto a sus porcentajes totales se establece que existen 71% para Dorina® y Girasol®, y 64% para Bonella® si comparamos estos resultados estadísticos con el VDR (valor diario recomendado) para las grasas totales esto es 15% para Dorina® y Girasol®, y 14% para Bonella® y según el VDR para grasa total es de 65 g según la OMS y FAO se puede claramente deducir que los niveles de grasas totales declarados por los fabricante corresponde en sus envases están totalmente elevados. Conclusiones: Establecer un modelo sistematizado y complementario a la normativa sanitaria de etiquetado vigente aplicando GDA lo que permitirá al consumidor conocer el contenido saludable de los alimentos que adquiere sobre todo en los nutrientes críticos declarados en los envases de las margarinas en las diferentes presentaciones comerciales, considerando que de acuerdo con los resultados de la investigación, dichos valores están totalmente elevados tanto en la grasa total como en sodio, no asi para los carbohidratos en razón de que en debido a que en la formulación de las margarinas no hay presencia de ingredientes que aporten cuantitativamente a dicho parámetro

Structural analysis of health-relevant policy-making information exchange networks in Canada

Abstract Background Health systems worldwide struggle to identify, adopt, and implement in a timely and system-wide manner the best—evidence-informed—policy-level practices. Yet, there is still only limited evidence about individual and institutional best practices for fostering the use of scientific evidence in policy-making processes The present project is the first national-level attempt to (1) map and structurally analyze—quantitatively—health-relevant policy-making networks that connect evidence production, synthesis, interpretation, and use; (2) qualitatively investigate the interaction patterns of a subsample of actors with high centrality metrics within these networks to develop an in-depth understanding of evidence circulation processes; and (3) combine these findings in order to assess a policy network’s “absorptive capacity” regarding scientific evidence and integrate them into a conceptually sound and empirically grounded framework. Methods The project is divided into two research components. The first component is based on quantitative analysis of ties (relationships) that link nodes (participants) in a network. Network data will be collected through a multi-step snowball sampling strategy. Data will be analyzed structurally using social network mapping and analysis methods. The second component is based on qualitative interviews with a subsample of the Web survey participants having central, bridging, or atypical positions in the network. Interviews will focus on the process through which evidence circulates and enters practice. Results from both components will then be integrated through an assessment of the network’s and subnetwork’s effectiveness in identifying, capturing, interpreting, sharing, reframing, and recodifying scientific evidence in policy-making processes. Discussion Knowledge developed from this project has the potential both to strengthen the scientific understanding of how policy-level knowledge transfer and exchange functions and to provide significantly improved advice on how to ensure evidence plays a more prominent role in public policies

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele