Validación de la escala de gravedad percibida de la violencia de pareja contra la mujer en población ecuatoriana

Introducción: La violencia de pareja contra la mujer (VPM) es un problema de salud pública a nivel global cuya prevalencia en Ecuador es de las más elevadas de Latinoamérica. La gravedad percibida de la VPM influye en las actitudes públicas hacia la VPM, como la aceptabilidad, el sentido de responsabilidad personal o la disposición a intervenir en casos de VPM. Método: En este estudio se presenta la adaptación de la escala española de gravedad percibida de la VPM (PS-IPVAW) al contexto cultural ecuatoriano, en una muestra de 652 participantes. Resultados: Los resultados mostraron que la escala PS-IPVAW tiene una buena consistencia interna, que sus ítems tienen una baja carga de deseabilidad social, que es invariante entre géneros y que se relaciona con la culpabilidad a la víctima, la aceptabilidad de la VPM y el sexismo hostil. Discusión: La escala PS-IPVAW es un instrumento con suficientes evidencias de fiabilidad y validez para evaluar la gravedad percibida de la VPM en Ecuador y representa un importante aporte para mejorar las estrategias de prevención, intervención y erradicación de este tipo de violencia en el contexto ecuatoriano.

Introduction: Intimate partner violence against women (IPVAW) is a global public health problem whose prevalence in Ecuador is among the highest in Latin America. The perceived severity of IPV influences public attitudes toward IPVAW, such as acceptability, sense of personal responsibility, or willingness to intervene in cases of IPV. Method: This study presents the adaptation of the Spanish scale of perceived severity of IPVAW (PS-IPVAW) to the Ecuadorian cultural context, in a sample of 652 participants. Results: Our results showed that the PS-IPVAW scale has good internal consistency, its items presented low loadings of social desirability, that it is invariant across genders and that it is related to victim blaming, acceptability of IPV and hostile sexism. Discussion: The PS-IPVAW scale showed adequate evidence.

Incidence of perioperative delirium at the hospital nacional arzobispo loayza, october to December 2021, Lima Peru / Incidencia de delirium perioperatorio en el Hospital Nacional Arzobispo Loayza, octubre a diciembre 2021, Lima Perú

OBJETIVO: Determinar la incidencia de delirium perioperatorio (DPO) en el Hospital Nacional "Arzobispo Loayza", de octubre a diciembre del 2021. MÉTODOS: Estudio observacional cualicuantitativo y prospectivo, realizado en una población de 910 pacientes, en los que se aplicó: AMT Test Confussion Assessment Method (CAM) y el cuestionario de Pfeiffer (Short Portable Mental Status Questionnaire, SPMSQ). Utilizamos Chi2 para demostrar la existencia de asociación y las pruebas de V de Cramer y Phi para cuantificar la intensidad de dicha relación en caso existiera. RESULTADOS: Del total de pacientes (910) el 18,46% presentaron de delirium perioperatorio. El sexo y la religión no influye en esta. La edad si influye en la presentación del DPO puesto que el 50% (145) de los pacientes de 61 años o más la presentaron, a diferencia de los que tenían entre 36 -60 años solo el 5,31 % y los de 18 ­ 35 solo el 0,88 % presentaron DPO. Según el nivel de instrucción: el 100% sin instrucción presentaron DPO, el 73,1 con primaria presentaron DPO, el 18,5 con secundaria presentaron DPO y el 5,8 % con educación superior presentaron DPO. Según la técnica anestésica se encontró DPO en el 28,9% (60) del tipo raquídea con sedación, el 22,4% (11) del tipo epidural con sedación, el 16,7% (83) del tipo General TIVA TCI, el 12,9% (4) del tipo Bloqueo con sedación, el 9,5% (10) del tipo General balanceada; para los tipos de anestesia General TIVA manual, General Multimodal y Raquídea sin sedación no se presentaron casos de DPO. Según el tiempo operatorio: el 100% (9) de los pacientes con más de 6 horas de tiempo operatorio, el 27,1% (38) de los pacientes que tienen de 3 a 6 horas de tiempo operatorio y el 16,5% (121) de los pacientes que tienen de 1 a 3 horas de tiempo operatorio presentaron casos de DPO. Según el tiempo de hospitalización previo a la cirugía: el 48% (36) de los pacientes con tiempo de hospitalización de 16 a 30 días, el 20,5% (26) de los pacientes con tiempo de hospitalización de 8 a 15 días y el 16% (97) de los pacientes con tiempo de hospitalización de 3 a 7 días presentaron casos de DPO. Según la presencia de comorbilidades: el 51,6% (16) que tienen HTA y ER, el 41,7% (30) que tienen Diabetes y el 40,8% (20) que tienen HTA y DM2 presentan casos de DPO. Según presencia de demencia: el 100% (6) de los pacientes que tienen historia de demencia y el 17,9% (162) de los pacientes que no tienen historia de demencia presentaron DPO. según historia de antecedentes psiquiátricos, el 68,4% (13) de los que si tienen historia de trastorno psiquiátrico y el 17,4% (155) de los que no tienen historia de trastorno psiquiátrico presentaron DPO. Según historia de tratamiento psiquiátrico: el 100% (6) de los que si tienen historia de tratamiento y el 17,9% (162) de los que no tienen historia de tratamiento psiquiátrico presentaron DPO. Según cuestionario PFEIFFER pre-quirúrgico y post-quirúrgico: el 100% de los que tienen deterioro cognitivo leve, moderado o severo según el cuestionario PFEIFFER PRE QX presentaron DPO. Según diagnóstico de delirio pre-quirúrgico y post-quirúrgico: el 100% presentaron DPO. CONCLUSIONES: No existe una asociación entre el sexo y la religión y la presentación de DPO. Si existe una asociación entre la edad, grado de instrucción, tipo de anestesia, tiempo operatorio, tiempo de hospitalización previo a la cirugía, comorbilidades, historia de demencia, historia de trastorno psiquiátrico, historia de tratamiento psiquiátrico, cuestionario Pfeiffer pre, post quirúrgico, delirio pre quirúrgico y delirio post quirúrgico y la presentación de DPO,

OBJECTIVE: To determine the incidence of perioperative delirium (POD) at the Hospital nacioanl Arzobispo Loayza, from October to December 2021. METHODS: Qualitative and prospective observational study, carried out in a population of 910 patients, in which the AMT Test Confusion Assessment Method (CAM) and the Pfeiffer questionnaire (Short Portable Mental Status Questionnaire, SPMSQ) were applied. We used Chi2 to demonstrate the existence of association and Cramer's V and Phi tests to quantify the intensity of said relationship if it existed. RESULTS: Of the total of patients (910), 18.46% presented perioperative delirium. Sex and religion do not influence this. Age does influence the presentation of POD since 50% (145) of the patients 61 years of age or older presented it, unlike those between 36 -60 years of age only 5.31% and those of 18 - 35 only 0.88% presented POD. According to the level of education: 100% with no education, 73.1% with primary education, 18.5% with secondary education and 5.8% with higher education, presented DPO. According to the anesthetic technique, POD was found in 28.9% (60) of the spinal type with sedation, 22.4% (11) of the epidural type with sedation, 16.7% (83) of the General TIVA TCI type, 12.9% (4) of the Block type with sedation, 9.5% (10) of the General balanced type; for the types of general anesthesia manual TIVA, General Multimodal and Spinal anesthesia without sedation there were no cases of POD. According to the operative time: 100% (9) of the patients with more than 6 hours of operative time, 27.1% (38) of the patients who have 3 to 6 hours of operative time and 16.5% (121) of the patients who have 1 to 3 hours of operative time presented cases of POD. According to hospitalization time prior to surgery: 48% (36) of patients with hospitalization time of 16 to 30 days, 20.5% (26) of patients with hospitalization time of 8 to 15 days and 16% (97) of the patients with hospitalization time of 3 to 7 days presented POD. According to the presence of comorbidities: 51.6% (16) with AHT and RD, 41.7% (30) with Diabetes and 40.8% (20) with AHT and DM2 present POD. According to the presence of dementia: 100% (6) of the patients with a history of dementia and 17.9% (162) of the patients with no history of dementia presented POD. According to psychiatric history, 68.4% (13) of those who did have a history of psychiatric disorder and 17.4% (155) of those who did not have a history of psychiatric disorder presented POD. According to history of psychiatric treatment: 100% (6) of those who do have a history of treatment and 17.9% (162) of those who do not have a history of psychiatric treatment presented POD. According to the pre-surgical and post-surgical PFEIFFER questionnaire: 100% of those with mild, moderate or severe cognitive impairment according to the PFEIFFER PRE QX questionnaire presented POD. According to diagnosis of pre-surgical and post-surgical delirium: 100% presented POD. CONCLUSIONS: There is no association between sex and religion and the presentation of POD. If there is an association between age, educational level, type of anesthesia, operative time, hospitalization time prior to surgery, comorbidities, history of dementia, history of psychiatric disorder, history of psychiatric treatment, pre-, post-surgical Pfeiffer questionnaire, pre-surgical delirium and post-surgical delirium and the presentation of POD,

Flutter auricular neonatal: presentación de tres casos / Neonatal atrial flutter: Presentation of three cases

Resumen Introducción: El flutter auricular es un tipo poco frecuente de arritmia fetal y neonatal. A pesar de que puede conducir a graves morbilidades, como hidrops fetal o incluso el fallecimiento, el diagnóstico y tratamiento precoz confieren un buen pronóstico a la mayoría de los casos. Pacientes y métodos: Se presentan tres casos de flutter auricular, dos de inicio en periodo fetal y uno en periodo neonatal, y se revisa la literatura en relación con las características clínicas, diagnósticas y terapéuticas del flutter auricular fetal y neonatal. Resultados y discusión: En el flutter auricular fetal la terapia materna con fármacos antiarrítmicos es el tratamiento más empleado durante la gestación. El tratamiento postnatal más utilizado es la cardioversión eléctrica sincronizada. El flutter auricular no suele asociar cardiopatía estructural; la recidiva neonatal es poco habitual y normalmente no precisa la administración de tratamiento profiláctico.

Abstract Introduction: Atrial flutter is a rare type of fetal and neonatal arrhythmia. Although it can lead to serious morbidities such as fetal hydrops or even death, diagnosis and early treatment confer a good prognosis in most cases. Patients and methods: Three cases of atrial flutter are presented, two of which start in the fetal period and one in the neonatal period. The literature is reviewed in relation to the clinical, diagnostic and therapeutic characteristics of fetal and neonatal atrial flutter. Results and discussion: In fetal atrial flutter maternal therapy with antiarrhythmic drugs is the most used treatment during pregnancy. The most used postnatal treatment is synchronized electrical cardioversion. Atrial flutter does not usually associate structural heart disease, neonatal recurrence is uncommon and usually does not require prophylactic treatment.

Short-term outcomes of the use of intraventricular ribavirin in Filipino patients with subacute sclerosing panencephalitis

@#<p style="text-align: justify;"><strong>Background.</strong> Subacute sclerosing panencephalitis (SSPE) is a fatal neurodegenerative disease caused by prolonged persistent infection of the central nervous system with a measles virus mutant. Though various treatment modalities have been tried, there is no effective treatment to completely cure SSPE and new therapeutic strategies are needed.</p><p style="text-align: justify;"><strong>Objective.</strong> This is a prospective uncontrolled observational open label trial to describe the short-term outcomes and safety of intraventricular ribavirin in combination with oral isoprinosine in Filipino SSPE patients.</p><p style="text-align: justify;"><strong>Methods.</strong> Sixteen (16) unrelated SSPE patients between ages 3-26 years and in various clinical stages were included in this study. Demographic data were described. Intraventricular instillation of ribavirin (1-3 mg/kg/dose) through an Ommaya reservoir was given for a duration of 3-6 months in 13 patients. The duration of follow-up was 48 weeks. The clinical outcome was assessed before, during, and after treatment using the Neurological Disability Index (NDI), Brief Assessment Examination (BAE), and clinical staging using the Jabbour Classification. Adverse side effects from intraventricular ribavirin were enumerated.</p><p style="text-align: justify;"><strong>Results.</strong> Six of 13 (46.15%) patients mostly in Stage III illness had clinical improvement showing decreasing NDI and BAE scores during treatment and the clinical improvement was maintained or improved further during the 48-week follow-up period. Clinical improvement manifested as improved mental alertness, decrease in spasticity and reduction of seizures. The clinical staging of those who improved remained stable during and after treatment was discontinued. Five (38.46%) patients in Stage II disease worsened and progressed to Stage III despite ribavirin therapy including 1 (7.6%) patient who died after the treatment phase due to pneumonia and brainstem failure. The clinical course of two (15.38%) patients remained unchanged. Minor adverse side effects of ribavirin included transient fever, rash, oral sores, seizure episodes, drowsiness, bladder retention and mild increase in transaminases. Ommaya reservoir infection was a serious adverse event in 5 (31.25%) patients.</p><p style="text-align: justify;"><strong>Conclusion.</strong> There is still no definitive cure for SSPE. Although ribavirin may help alleviate some of the symptoms of SSPE and prolong life, it may not reverse or halt the progression of the disease. Long term follow-up of these patients and continuous use of intraventricular ribavirin will better clarify its role in modifying the fatal course of SSPE. The role of ribavirin in Stage I patients and a controlled clinical trial in Stage II SSPE needs further studies.</p>

Atención integral y manejo del paciente con hemofilia en el contexto de la pandemia de COVID-19 / Comprehensive care and patient management with hemophilia, in the context of COVID-19 pandemic

Resumen El espectro clínico de la hemofilia severa ha evolucionado a lo largo de la historia desde una condición catastrófica y altamente fatal a principios del siglo xx, hasta un trastorno crónico y «manejable¼ en las últimas décadas, gracias a los notables avances en el tratamiento alcanzados en los últimos 40 años, avances impulsados y reforzados por algunas experiencias catastróficas pasadas, como lo fue el desastre biológico en la década de 1980 debido a infecciones virales fatales transmitidas por trasfusión, como hepatitis y virus de la inmunodeficiencia humana/sida, a partir de lo cual la aparición de nuevos agentes infecciosos son una preocupación constante para la comunidad de hemofilia, como lo es actualmente el caso al que nos enfrentamos con la pandemia de enfermedad por coronavirus 2019, que ha creado una situación extremadamente desafiante para los miembros de la comunidad mundial de trastornos hemorrágicos. Ante esta pandemia han surgido interrogantes sobre la posibilidad de si los pacientes con hemofilia tendrán mayor riesgo de infección y si la deficiencia de factor y su tratamiento podrían influir en las manifestaciones de la infección, su curso natural, tratamiento y complicaciones; aunado a la preocupación de que parece claro que la pandemia actual tendrá consecuencias definitivas sobre el manejo de la hemofilia en todo el mundo. Tales interrogantes han dado lugar a la revisión de la literatura, guías, consensos de expertos, incluyendo las recomendaciones de la Federación Mundial de Hemofilia, en un intento de responder a dichas interrogantes, generando así tanto pautas para la atención como ampliando algunas de ellas, impulsando el desarrollo de nuevos protocolos de investigación.

Abstract The clinical spectrum of severe hemophilia has evolved throughout history from a catastrophic and highly fatal condition in the early 20th century to a chronic and “manageable” disorder in recent decades, thanks to the remarkable advances in treatment achieved. in the last 40 years, advances driven and reinforced by some past catastrophic experiences, such as the biological disaster in the 1980s due to fatal viral infections transmitted by transfusion, such as hepatitis and HIV/AIDS, from which, the appearance of new infectious agents are an ongoing concern for the hemophilia community, as is currently the case facing us with the coronavirus disease 2019 pandemic, which has created an extremely challenging situation for members of the global bleeding disorders community. Faced with this pandemic, questions have arisen regarding the possibility of whether patients with hemophilia will have a higher risk of infection and whether factor deficiency and its treatment could influence the manifestations of the infection, its natural course, treatment and complications; coupled with the concern that it seems clear that the current pandemic will have definitive consequences on the management of hemophilia around the world. Such questions have led to a review of the literature, guidelines, and expert consensus, including the recommendations of the World Federation of Hemophilia, in an attempt to answer these questions, thus generating both guidelines for care, and expanding some of them, promoting the development of new research protocols.

Trastorno por déficit de atención con o sin hiperactividad aislado en consulta de Neuropediatría. Serie de casos / Isolated attention deficit disorder with/without hyperactivity in clinical practice. Series of cases

El trastorno por déficit de atención e hiperactividad afecta al 5 % de los niños en edad escolar. Se presenta una serie de 82 niños con este trastorno no asociado a enfermedades neurológicas ni a discapacidad intelectual o trastorno del espectro autista, atendidos durante un período de 8 meses en Neuropediatría: 57 casos de tipo combinado, 23 de tipo inatento y 2 de predominio hiperactivo. Tiempo medio de seguimiento: 7 ± 2,8 años (rango: 4-14,6). Compartían seguimiento con Psiquiatría 16 pacientes. Nunca recibieron tratamiento por decisión parental 12 pacientes. De los 70 que recibieron, en 20, hubo demora en el inicio del tratamiento. Tiempo medio de demora: 20 meses ± 1,6 años (rango: 1 mes y 6 años). Tiempo medio de tratamiento: 44 meses ± 2,6 años (rango: 1 mes y 10,5 años). El 90 % de los pacientes (63) que iniciaron tratamiento continuaban tomándolo en la última revisión

Attention deficit disorder with hyperactivity has a high prevalence affecting 5 % of school-age children. We present a case series of 82 children with said disorder not associated with neurological diseases or intellectual disability or autism spectrum disorder, treated during a period of 8 months in a neuropediatrics clinic: 57 cases of combined type, 23 of inattentive type and 2 of overactive predominance. Average follow-up time: 7 ± 2.8 years (range: 4-14.6); 16 patients shared follow-up with Psychiatry; 12 patients never received treatment by parental decision. Of the 70 who received it, in 20 there was a delay in the start of treatment. Average delay time: 20 months ± 1.6 years (range: 1 month and 6 years). Average treatment time: 44 months ± 2.6 years (range: 1 month and 10.5 years); 90 % of the patients (63) who started treatment were under treatment at the last control

Adaptación y validación de la Escala de Actitudes de Culpabilización de la Víctima en Casos de Violencia de Pareja contra la Mujer (VB-IPVAW) en población ecuatoriana / Adaptation and validation of the Victim-Blaming Attitudes in Cases of Intimate Partner Violence Against Women (VB-IPVAW) Scale in Ecuadorian population

Resumen La violencia de pareja contra la mujer (VPM) constituye un grave problema de salud pública con importantes consecuencias para la salud física y psicológica de las mujeres. Las ac titudes de culpabilización de la víctima pueden contribuir a crear un clima de aceptación social en el que la VPM se perciba como una conducta normativa, influyendo en las respuestas de los individuos, comunidades, e instituciones frente a este problema. Ecuador es uno de los países de Latinoamérica donde la prevalencia de VPM es más alta, y las investigaciones sobre esta temática son todavía escasas. El objetivo de este estudio es adaptar y validar la Escala Española de Actitudes de Culpabilización de la Víctima (VB-IPVAW) al entorno cultural ecuatoriano. Para ello se ana lizaron las propiedades psicométricas de la escala en una muestra de 1122 ecuatorianos, así como su invarianza factorial entre hombres y mujeres con una segunda muestra de 400 estudiantes universitarios. Se examinó también el posible sesgo por deseabilidad social de los ítems de este instrumento. Los resultados mostraron que la escala VB-IPVAW tiene una excelente consistencia interna, que se relaciona con otros constructos como la gravedad percibida de la VPM y el sexis mo ambivalente, que sus ítems tienen una baja carga de deseabilidad social y que es invariante entre géneros. La adaptación de la escala VB-IPVAW al contexto cultural ecuatoriano representa un avance clave en el estudio y la comprensión de las actitudes de culpabilización a la víctima, proporcionando un instrumento fiable y válido para evaluar estas actitudes.

Abstract Intimate partner violence against women (IPVAW) is a major public health problem with serious consequences for women's physical and psychological health. Victim-blaming attitudes can shape a social climate of acceptance where IPVAW can be perceived as normative, affecting the responses of individuals, communities, and institutions to this problem. Ecuador is one of the countries with the highest prevalence of IPVAW in Latin America, and research addressing this is sue is still scarce. The aim of this study is to adapt and validate the Spanish Scale of Victim-Blaming Attitudes in Cases of Intimate Partner Violence Against Women (VB-IPVAW) to the Ecuadorian cultural context. To this end, the psychometric properties of this scale were assessed in a sample of 1122 Ecuadorian participants, and also its measurement invariance across gender in a second sample of 400 college students. The potential social desirability bias of the items was also ex amined. Results showed that the VB-IPVAW scale has an excellent internal consistency, is related to other constructs, such as perceived severity of IPVAW and ambivalent sexism, their items presented low loadings of social desirability, and its invariant across gender. The adaptation of the VB-IPVAW scale to the Ecuadorian cultural context constitutes a step forward in the study and understanding of victim-blaming attitudes, providing a reliable and valid instrument to assess these attitudes.

Adaptación y validación de la Escala de Actitudes de Culpabilización de la Víctima en Casos de Violencia de Pareja contra la Mujer (VB-IPVAW) en población ecuatoriana

La violencia de pareja contra la mujer (VPM) constituye un grave problema de salud pública con importantes consecuencias para la salud física y psicológica de las mujeres. Las ac titudes de culpabilización de la víctima pueden contribuir a crear un clima de aceptación social en el que la VPM se perciba como una conducta normativa, influyendo en las respuestas de los individuos, comunidades, e instituciones frente a este problema. Ecuador es uno de los países de Latinoamérica donde la prevalencia de VPM es más alta, y las investigaciones sobre esta temática son todavía escasas. El objetivo de este estudio es adaptar y validar la Escala Española de Actitudes de Culpabilización de la Víctima (VB-IPVAW) al entorno cultural ecuatoriano. Para ello se ana lizaron las propiedades psicométricas de la escala en una muestra de 1122 ecuatorianos, así como su invarianza factorial entre hombres y mujeres con una segunda muestra de 400 estudiantes universitarios. Se examinó también el posible sesgo por deseabilidad social de los ítems de este instrumento. Los resultados mostraron que la escala VB-IPVAW tiene una excelente consistencia interna, que se relaciona con otros constructos como la gravedad percibida de la VPM y el sexis mo ambivalente, que sus ítems tienen una baja carga de deseabilidad social y que es invariante entre géneros. La adaptación de la escala VB-IPVAW al contexto cultural ecuatoriano representa un avance clave en el estudio y la comprensión de las actitudes de culpabilización a la víctima, proporcionando un instrumento fiable y válido para evaluar estas actitudes.

Intimate partner violence against women (IPVAW) is a major public health problem with serious consequences for women's physical and psychological health. Victim-blaming attitudes can shape a social climate of acceptance where IPVAW can be perceived as normative, affecting the responses of individuals, communities, and institutions to this problem. Ecuador is one of the countries with the highest prevalence of IPVAW in Latin America, and research addressing this is sue is still scarce. The aim of this study is to adapt and validate the Spanish Scale of Victim-Blaming Attitudes in Cases of Intimate Partner Violence Against Women (VB-IPVAW) to the Ecuadorian cultural context. To this end, the psychometric properties of this scale were assessed in a sample of 1122 Ecuadorian participants, and also its measurement invariance across gender in a second sample of 400 college students. The potential social desirability bias of the items was also ex amined. Results showed that the VB-IPVAW scale has an excellent internal consistency, is related to other constructs, such as perceived severity of IPVAW and ambivalent sexism, their items presented low loadings of social desirability, and its invariant across gender. The adaptation of the VB-IPVAW scale to the Ecuadorian cultural context constitutes a step forward in the study and understanding of victim-blaming attitudes, providing a reliable and valid instrument to assess these attitudes.

Neurologic outcome of Filipino children diagnosed with central nervous system infection

@# Neurologic infections are related to chronic and life-long neurologic impairment. We aim to describe the outcomes of Filipino children with neurologic infections upon, and within one year from discharge. This data will be useful in developing programs for the prevention and improvement of outcomes in children with neurologic infections. Methods: This is a multicenter, cross-sectional, retrospective cohort study at six tertiary hospitals across the Philippines within four years (2007-2010). A standardized report form was used to collect clinical profile and outcome using inpatient and outpatient records. Neurologic outcome was classified and staged at 3-, 6-, 9- and 12-months postdischarge. Results: A total of 480 patients were included in the analysis (mean age 4.7 ± 5.3 y), most were bacterial in etiology (275 cases, or 57.3%). Severity of illness on admission (Stage 3, p <0.001) and etiologic agent (viral, p <0.001) were correlated with poor neurologic outcome on discharge. Of the 154 patients that had follow-up, 91 cases were observed to have neurologic deficits (severe, 50; moderate, 29; and mild 12). Twenty patients had improvement of neurologic impairment on subsequent follow-up. Motor deficits (64 cases), cognitive disorders (26 cases) and seizures (17 cases) are the most common neurologic sequela

Diagnosis and management of childhood tuberculosis in public health clinics in a rural area in the Philippines: Results from a community surveillance

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Childhood tuberculosis (TB) remains a significant health problem worldwide despite the increase in its emphasis on national health programs.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to describe how TB in children is identified and managed in a routine TB program in a rural setting in a high-burden country.</p><p style="text-align: justify;"><strong>METHODS:</strong> This is a prospective, community-based surveillance study in public rural clinics in the Philippines. Observations on case finding and management of TB in children as well as contact tracing in an existing TB program are described.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Out of 266 children with presumptive TB, 41 (15.4%) were cases of TB, 15 (5.6%) had latent TB infection (LTBI), 81 (30.5%) had TB exposure, and 129 (48.5%) had no TB. There were 37 (90%) TB cases who were clinically diagnosed. Ninety-three percent (93%) of children with TB disease were cured or completed treatment. Among 25 children targeted for isoniazid preventive therapy (IPT) for LTBI and TB exposure, only 12 (52%) completed the recommended 6 months of IPT. Only 40 (43%) children aged 0 to 4 years exposed to smear-positive TB cases were screened.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Barriers in the diagnosis, low IPT completion, and problems in contact tracing may hinder the successful implementation of TB programs for children.</p>

The burden of congenital rubella syndrome in the Philippines: results from a retrospective assessment

Introduction: In line with the regional aim of eliminating rubella and congenital rubella syndrome (CRS), phased introduction of rubella-containing vaccines (RCV) in the Philippines’ routine immunization programme began in 2010. We estimated the burden of CRS in the country before widespread nationwide programmatic RCV use. Methods: We performed a retrospective chart review in four tertiary hospitals. Children born between 1 January 2009 and 31 December 2014 and identified as possible CRS cases based on the presence of one or more potential manifestations of CRS documented in hospital or clinic charts were reviewed. Cases that met the clinical case definition of CRS were classified as either confirmed (with laboratory confirmation) or probable (without laboratory confirmation). Cases that did not fulfil the criteria for either confirmed or probable CRS were excluded from the analysis. Results: We identified 18 confirmed and 201 probable cases in this review. Depending on the hospital, the estimated incidence of CRS ranged from 30 to 233 cases per 100 000 live births. The estimated national burden of CRS was 20 to 31 cases per 100 000 annually. Discussion: This is the first attempt to assess the national CRS burden using in-country hospital data in the Philippines. Prospective surveillance for CRS and further strengthening of the ongoing measles-rubella surveillance are necessary to establish accurate estimates of the burden of CRS and the impact of programmatic RCV use in the future.

Las técnicas nucleares y la formación de profesionales en el InSTEC / Nuclear techniques and nuclear professional education at InSTEC

Se resumen los principales resultados obtenidos en los últimos 25 años por el Grupo de Aplicaciones Nucleares del InSTEC, en el desarrollo de técnicas nucleares y su aplicación en diferentes sectores de la sociedad. Se presenta el impacto que han tenido las investigaciones aplicadas en la formación de pregrado y posgrado en carreras nucleares y en el reconocimiento social de la comunidad universitaria.

The paper includes the most relevant results obtained by InSTEC´s Group of Nuclear Applications in the last 25 years, in the development of nuclear techniques and its application in different social areas. The impact of applied research on graduated and post graduated education in nuclear careers as well as the social recognition of the university community are presented.

Influence of sociodemographic factors and environmental conditions on husbands' behavior toward maternal healthcare

Improving maternal health depends on husband's behavior which is affected by certain sociodemographic factors and environmental conditions. The study aimed to assess the husband's behavior toward maternal healthcare and emergency first aid measures for pregnancy and obstetric risks that might put life of women at risk of maternal death. The study also determined the socio-demographic factors and environmental conditions that influenced husband's behavior and attitude toward antenatal care providers and providers of assisted delivery. One thousand husbands of women in childbearing period were randomly selected through a community-based study that was conducted in 23 rural villages of four chosen districts of Benisuef and Al Fayoum governorates of Egypt. The study is a cross-sectional investigation conducted over a period of 8 months starting from July 2010 until February 2011. Data were collected from interviews of husbands on their sociodemographic characteristics, environmental conditions, and their knowledge, attitudes, intention, and practices toward maternal healthcare and services provided as well as toward providers of maternal healthcare. The study revealed that husbands who were younger than 20 years at the time of marriage, had a lower middle environmental score, and an upper middle income were nearly two or more times as likely of being unaware of the risk symptoms during pregnancy [odds ratio [OR] = 2.73, 1.37, and 1.59, respectively], during delivery [OR = 1.93, 1.31, and 1.76, respectively], and during the postnatal period [OR = 2.42, 1.36, and 1.77, respectively] compared with those older than 20 at the time of marriage, who had an upper middle environmental score, and a lower middle income. It is recommended to target husbands as an influential factor among high-risk wives by educating them on maternal health risks and by increasing their accessibility to maternal and obstetric health services, with special emphasis on younger men and those living under poor environmental conditions irrespective of their economic status

Helicobacter pylori infection: seroprevalence and predictors among healthy individuals in Al Madinah, Saudi Arabia

Background: Helicobacter pylori infection is one of the most common chronic bacterial infections among humans worldwide. However, there is no information on the epidemiology of H. pylori infection in Al Madinah, Saudi Arabia

Objective: This study was conducted to determine the seroprevalence of H. pylori in asymptomatic healthy individuals and the possible relationship between H. pylori infection and sociodemographic, lifestyle, and environmental factors in this region

Methods: A hospital-based cross-sectional study was conducted on a consecutive sample of asymptomatic healthy individuals. A pilot-tested interview format was used as the research tool. Venous blood was collected from individuals and sera were separated. The enzyme-linked immunosorbent assay was used to determine H. pylori IgG antibody levels in all serum samples

Results: A total of 456 samples were collected. H. pylori antibodies were found in 129 [28.3%] individuals. Seroprevalence of 16.9% was found in individuals younger than 20 years of age, which gradually increased with age and reached 36.8% by the age of 50. After controlling for the confounding factors, significant independent predictors of seropositive state were: rural residence [odds ratio [OR]=2.5, 95% confidence interval [CI]=1.3, 4.7], crowded housing [OR=1.6, 95% CI=1.1, 2.6], low socioeconomic status [OR=3.3, 95% CI=1.6, 8.8], using tanks for drinking water supply [OR=2.2, 95% CI=1.2, 7.4], active smoking [OR=5.6, 95% CI=3.2, 9.8], alcohol drinking [OR=2.3, 95% CI=1.5, 6.2], eating raw vegetables [OR=3.2, 95% CI=1.4, 7.1], eating spicy food [OR=2.1, 95% CI=1.3, 3.5], and presence of asthmatic/atopic symptoms [OR=2.5, 95% CI=1.3, 5.9]. No associations were found between infection and age, gender, source of sewage disposal, eating fruits, or family history of upper gastrointestinal symptoms

Conclusion and recommendations: Infection with H. pylori is declining among healthy individuals of Al Madinah, Saudi Arabia. Infection is acquired at an early age and reaches up to 36.9% as age advances. The risk of H. pylori seropositivity was related to socioeconomic, lifestyle, and environmental factors. A nationwide epidemiological study is warranted to determine the seroprevalence of H. pylori in Saudi Arabia

Role of diffusion weighted magnetic resonance imaging in evaluation of suspicious breast lesions

Diffusion weighted Imaging "DWI" is a specific modality to produce images of tissues weighted with the local microstructural characteristics of water diffusion. DWI can give information as regards cellularity of breast lesions and it can be used for distinguishing between benign and malignant breast lesions, differentiating surgical scar from recurrence and monitoring therapies in locally advanced breast cancer To assess the diagnostic value of diffusion weighted imaging as an adjuvant to breast magnetic resonance imaging for detection and differentiation of suspicious breast lesions and correlation with histopathologic findings, available clinical data or follow up. The studied group included 50 female patients referred for MRI breast for workup of a suspicious clinical, mammographic, or sonographic abnormality. Diffusion weighted imaging [DWI] was added to the routine study. Results of the contrast enhanced bilateral breast MRI and DWI of the 50 patients were all reported and compared with the histo-pathological results of surgery or biopsy and with the results of follow up of lesions that were not surgically removed or biopsied. there was a highly significant relation between DWI and histopathological/ Follow Up results with p value = 0.000. The sensitivity, specificity, positive and negative predictive values of DWI for characterization of suspicious breast lesions in patients included in the study, were 89.5%, 100%, 100%, and 93.94% respectively. DWI is a short unenhanced scan that can be inserted easily into standard clinical breast MRI protocols as a potential adjunct that can be added routinely to conventional breast MRI, and can accurately differentiate benign from malignant breast lesions with high sensitivity and specificity

Reafirmación vocacional en el proceso docente educativo en el segundo año de la carrera de Medicina / Vocational reaffirmation in the teaching/educational process in the 2nd year of medical studies

Objetivo: identificar como influyó el trabajo de reafirmación vocacional en el proceso docente educativo en la carrera de medicina durante el curso escolar 2009 -2010. Método: se realizó un estudio descriptivo, se calculó frecuencia y porcentaje, a un grupo de 80 estudiantes de segundo año de la carrera de Medicina, pertenecientes a 5 policlínicos docentes del municipio Playa, en Ciudad de La Habana. La muestra fue seleccionada por conveniencia. Se aplicó una encuesta para evaluar el estado de opinión acerca de las actividades de reafirmación vocacional. Resultados: los principales resultados demuestran que más de la mitad de los alumnos no tienen conocimiento acerca del plan de reafirmación vocacional y la mayoría no recibieron alguna actividad del plan durante su primer año de la carrera. Conclusiones: se confeccionó una propuesta de un plan específico que ayudará a ejercer una mayor influencia en los estudiantes desde el punto de vista emocional y en la formación de intereses, hábitos, habilidades y destrezas

Objective: to identify how the vocational reaffirmation work influenced the teaching and educational process in the 2009-2010 academic year of the medical career. Method: a descriptive study, which estimated frequency and percentages, was conducted in a group of 80 second year medical students from 5 teaching polyclinics of Playa municipality, La Habana. The selection of the sample was based on convenience. A survey was administered to assess the opinions about the activities of vocational reaffirmation. Results: the main results showed that over half of the students were unaware of the vocational reaffirmation plan and most of them were not involved in any activity of this plan during the first year of the medical studies. Conclusions: the proposal of a specific plan was prepared that will help to have more influence on the students, from the emotional viewpoint, and on the formation of personal interests, habits, skills and dexterities

Clinical outcome of acute upper gastrointestinal hemorrhage among patients admitted to a government hospital in Egypt

Acute upper gastrointestinal hemorrhage [AUGIH] is a life-threatening emergency that results in high morbidity and mortality. The mortality rate varies between 4% and 14%. The aim of the study was to determine the clinical outcome of AUGIH among patients admitted to a government hospital in Egypt. This was a cross-sectional hospital-based study performed in 1000 patients presenting with AUGIH over a 7-year period between January 2004 and January 2011. One thousand patients were analyzed. Fifty-four percent were male. Mean age was 52 +/- 17 years. Eighty-eight percent were emergency admissions and 12% were inpatients at the time of bleeding. At presentation 68% had major comorbidity and 50% had liver disease. Seven hundred and twenty-four patients [72%] underwent endoscopy. Bleeding varices accounted for 31% of AUGIH and peptic ulcer 28%. Two hundred and thirty-two patients had endoscopically diagnosed bleeding varices or peptic ulcer with a visible vessel or active bleeding. These received endoscopic therapy. Initial hemostasis was achieved in 207 [89%]. Thirteen patients [6%] had therapy at a subsequent endoscopy for further bleeding. Surgery was performed on 9 patients [0.9%] with AUGIH. Complications were reported in 70 patients [7%] mainly liver failure [4%]. Six hundred and eighty-four patients [68%] were discharged improved, 162 [16%] left hospital without a diagnosis and 4 [0.4%] were referred to another facility. The overall mortality was 15%. Mortality was 24% in patients>/=60 years, 37% among inpatients, and 21% in those who had a major comorbidity. Mortality was 22% in patients who had liver disease and 9% in variceal bleeding. The most common cause of AUGIH was variceal in origin. Endoscopic therapy was successful in most cases. Mortality after AUGIH was particularly high among elderly patients, inpatients, and patients who had a major comorbidity, liver disease, and variceal bleeding

Adherence to and outcome of isoniazid chemoprophylaxis among household contact children of adults having pulmonary tuberculosis in Alexandria, Egypt

Background: Current international guidelines recommend 6-9 months of isoniazid [INH] preventive chemotherapy to prevent the development of active tuberculosis [TB] in susceptible children exposed to Mycobacterium tuberculosis. However, this is dependent on good adherence, as shown by previous studies

Objectives: This study was conducted to describe the outcome of screening of contact children aged 5 years or less with household exposure to an adult pulmonary TB index case to determine the prevalence and possible risk factors of infection among contact children and to determine the extent and outcome of adherence of contact children to unsupervised INH chemoprophylaxis for 6 months

Methods: A descriptive facility-based cross-sectional study was conducted from March 2009 to August 2010. Research settings were three of the National TB control program chest dispensaries [primary care facilities] in Alexandria, Egypt. Facility-based TB treatment registers of the previous 3 months were used to identify all new adult pulmonary TB cases. All children aged 5 years or less living in the same house as the index cases were identified and screened for TB. The contact children were given unsupervised INH preventive chemotherapy once active TB was excluded. Adherence to and outcome of preventive chemotherapy were followed up. Preventive chemotherapy consisted of unsupervised INH monotherapy for 6 months with monthly collection of tablets from the clinic. Adherence was documented after completion of the 6-month preventive treatment period. Adherence was considered reasonable if tablets were collected for more than 4 months, poor if collected for 2-4 months, and very poor if collected for less than 2 months

Outcome measures: [a] Prevalence of infection and disease and the possible risk factors among contacts. [b] The extent and outcome of adherence to unsupervised INH chemoprophylaxis among contact children. [c] Factors behind poor adherence

Results: In total, 197 adult TB index cases from 187 households were identified. In all, 297 children aged 5 years or less experienced household exposure, of whom 252 [84.9%] were fully evaluated. Tuberculin test was positive in 136 of the 252 child contacts [54.0%], of whom 130 were contacts of sputum-positive patients and six were contacts of sputum-negative patients. The important risk factors for transmission of TB infection were younger age, male sex, severe malnutrition, absence of BCG vaccination, contact with a sputum-positive adult who was a source case, household overcrowding, and exposure to environmental tobacco smoke. Thirty-three children were diagnosed and treated for TB at the baseline screening and 217 received preventive INH chemotherapy. Of the children who received preventive chemotherapy, only 36 [16.6%] completed at least 4 months of unsupervised INH monotherapy. During the subsequent follow-up period, eight children developed TB [secondary attack rate for TB disease was 3.7%], of whom four received no preventive chemotherapy and four were poorly adherent

Conclusion: The prevalence of TB infection and clinical disease among children in household contact with adult patients is high, and risk is significantly increased because of child contact, index patients and environmental factors. Adherence to 6 months of unsupervised INH chemoprophylaxis was very poor

Effect of hypothyroid status on lipid peroxidation, antioxidant defences and susceptibility to oxidative stress under amiodarone therapy in female rats

The effect of free radicals on human beings has attracted considerable attention due to their close relation to health and disease. This study was carried out to investigate the antioxidant status in thyroid and liver due to treatment with amiodarone [AM] and the relationship between AM treatment and thyroid function in case of pre-existence of hypothyroidism. The present study comprised of two experiments, each of them extended for 2 months. The first one was designed to induce hypothyroidism and the second for treatment with AM. Serum malondialdehyde [MDA] and reduced glutathione [GSH] levels were measured as indicators of redox status. The levels of serum triiodothyronine [T3], thyroxine [T4] levels and thyroid stimulating hormone [TSH] were measured the agonist/antagonist interactions between the drug and thyroid hormones. Liver enzymes-Alanine aminotransaminase [ALT] and Aspartate aminotransaminase [AST] activities-and lipid parameters were measured in serum as well. In addition, hisopathological examinations for thyroid and liver tissues were done. The results showed that: 1] serum T3 and T4 levels were increased, while TSH levels were decreased in hypothyroid AM treated group, whereas in euthyroid AM treated group, serum T3 was decreased but serum T4 and TSH levels increased. 2] total cholesterol and LDL increased in both AM treated groups showing a state of hyperlipidemia. 3] serum MDA level was increased while serum GSH was decreased in AM treated hypothyroid group and in euthyroid AM treated one as well, inducing a state of oxidative stress. Serum MDA levels were decreased while serum GSH were increased in Hypo+. 4] ALT and AST increased in all AM treated groups. 5] hisopathological examination of thyroid and liver tissues showed some structural abnormalities due to AM treatment. Based on these results, patients with hypothyroidism should be monitored periodically their thyroid and liver functions during AM therapy due to its stimulation for the formation of reactive oxygen species, causing oxidative damage in both liver and thyroid functions and their tissues. These findings suggested that a state of hypothyroidism may exert beneficial protective and curative effects on this situation by decreasing T3, T4, ALT and AST levels, attenuating the endogenous antioxidant levels and decreasing lipid peroxidation

Gender differences in healthcare-seeking behaviour for urinary incontinence in Alexandria

Urinary incontinence [UI] is a common condition, but previous studies have shown that only about 20% of individuals with UI seek medical care for treatment of their symptoms. The determincnts of treatment seeking are not well understood. Little is known about the effect of gender on health care-seeking behaviors. The objective of this study was to determine gender differentials in factors associated with patients' decisions to seek treatment for urinary incontinence This was a descriptive, hospital based case series study. It was carried out during the first half of the year 2008 in the Urology and Obstetrics and Gynaecology departments of Main University Hospital and El-Shatby University Hospital, Alexandria. As part of purposeful sampling, all participants were selected from the clinic and admission lists. All studied subjects were enrolled by the investigators after signing informed consent and provided they complied with inclusion/exclusion criteria. Data were collected using pre-tested, precoded interview format. In-depth interview was carried out by the investigators themselves to answer the questions because the topic is poorly understood and the research is perception-oriented. We hypothesized that gender differences in treatment seeking for UI would not be explained only by socio-demographic factors, clinical presentation, and symptom impact, but also some important psychosocialfactors of the respondent as well. To test the hypothesis, we developed a multivariate logistic regression modelfor each gender. Information was collected from 353 UI patients out of a total of 374 patients registered in those clinics and admission list during the recruitment period of the study. Thus the response rate was 94.4%. There were 113 [32.0%] males and 240 [68.0%] females. Thus male to female ratio was 1: 2.12. The present study found differences in males and females regarding specific psychosocial factors motivating health care-seeking behaviour. Certain inequality was observed in hospital admission, use of diagnostic procedures, days of hospital stay and surgeries in thai they proved less frequent among women. More women suffered from at least one negative impact on their social lives compared to men. Additionally, the impact of UI on sexual life was not associating with seeking treatment for both men and women. The impact of symptoms on quality of life appears to be the main trigger for seeking help for UI in both men and women. After adjustment for confounders, women's decisions to seek treatment for urinary incontinence were significantly associated with mixed type of UI, severe UI, perceptions about underlying causes of UI, attitude towards health care use, worse social impact score and worse diseasespecific quality of life scores. However, illiteracy and self care practices were adversely affect women's care seeking behavior. In men help-seeking was related to the presence of co-morbid condition, severe UI, associated lower urological complaints, satisfaction with medical care offered, high expectation of benefit from treatment and worse disease-specific quality of life scores. Since the present results revealed gender differences in determinants of UI health care seeking behaviour, strategies to enhance care-seeking for urinary incontinence should consider the role of gender in personal knowledge, needs and behaviors for UI management in adults. Educating physicians and the public about the factors associated with treatment seeking as well as the available treatment options may help women and men to seek and receive more timely care for incontinence symptoms