DEMOGRAPHIC FACTORS AFFECTING COMMON ERRORS IN TENSE IN ENGLISH AMONG NINTH STANDARD STUDENTS

This descriptive study aims to find out the differential effect of gender, residential locale and medium of instruction on the errors made by the ninth grader students in the usage of English tenses. Three null hypotheses were tested by collecting data from a random sample of 291 ninth grade students from schools in Coimbatore district. The English Tense Error Analysis Test was administered to find out the common errors committed by the students in using the language. Independent sample t-test revealed significant differential effect of gender, residential locale and medium of instruction on common errors in English tense usage of ninth grade students. Boys compared to girls, rural students compared to urban students and Tamil medium students compared to English medium students make significantly high mistakes in English tense.

Bilateral Anophthalmia: Literature, Review and Case Report

Introduction:Anophthalmia which is the congenital absence of the eyes could be bilateral or congenital, it occurs globally although it is rare. It is usually in association with other systemic congenital abnormalities. Case Report:A case of a female baby delivered at a primary health center in Port Harcourt, Nigeria who had bilateral anophthalmia is reported here along with review of literature Magnetic Resonant Imaging (MRI) of brain and orbit was used to confirm the diagnosis which showed absence of both globes, with hypoplasia of the orbits as well as the extraocular muscles, the optic nerves could not be differentiated from the visualized intra-orbital structures. All other systems were essentially normal. This is an exceptional case in Port Harcourt, Nigeria, as literature search shows that no other case has been reported in Port Harcourt. She is currently being followed up at the paediatric, ophthalmology and ENT clinics of the University of Port Harcourt teaching hospital.

Tuberculosis in Children Aged 0-5 Years at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria - How Common is HIV in Children with Tuberculosis

Background: Tuberculosis (TB) is a leading cause of death in young children and the risk of progression from infection to disease is higher in the very young especially among those with Human Immunodeficiency Virus (HIV) infection. This study therefore aimed to examine the method of TB diagnosis and how common HIV infection is among children 0-5 years with tuberculosis at the University of Port Harcourt Teaching Hospital (UPTH).Methods: Information of children aged 0-5 years from 1stJanuary, 2011 to 31stDecember 2014 were retrieved from the TB register of the Directly Observed Treatment Short course (DOTS) clinic of UPTH. This included the age, sex, HIV status, Sputum AFB status, method of diagnosis of tuberculosis and the treatment outcome of the patients.Ethical approval for the study was obtained from the Research and Ethics committee of the University of Teaching Hospital. Results:Three hundred and thirty five children were treated for TB and 179 (53.43%) of them were aged 0-5 years. There were 93 (51.96%) males and 86 (48.04%) females, with male: female ratio of 1.08:1. Their mean age was 1.96 ±1.45. The sputum or gastric lavage of 21 (11.73%) were positive for acid fast bacilli (AFB). The common method of TB diagnosis was clinical/ radiological method and this constituted 158 (88.27%) of the patients with TB. Ninety (50.28%) children with TB were less than one year of age and there was no statistical significant relationship between age and method of TB diagnosis (x2= 2.78, p= 0.249). More males 93 (51.96%) than females 86 (48.04%) had TB but more females 13 (61.90%) than males 8 (38.10%) were AFB positive, however, these were not statistically significant. (x 2 =1.26 p-value=0.262). Seventy two (40.22%) of the children with TB were HIV positive. One hundred and thirty five (75.42%) of the children recovered following treatment while 44 (24.58%) were referred to Dots centres closest to the patients. No child died. Conclusion: The prevalence of TB among under-fives especially among infants is high. Clinical and radiological methods were the common methods of TB diagnosis. HIV prevalence among children with TB was lower than expected by the authors, however, the treatment outcome was good. Re-training of clinicians to improve their expertise on clinical diagnosis of TB and a more in depth search of TB in the community among children 0-5 years who are HIV sero-negative with persistent cough is advocated

Equipos de salud y su funcionalidad: oportunidades para el tratamiento del tabaquismo / Health teams and their functionality: opportunities for smoking cessation

Resumen Este capítulo propone acciones para una adecuada implementación de las estrategias definidas en las Primeras Guías de Práctica Clínica del Tratamiento del Tabaquismo, Chile 2017. En el subsistema público por una parte se han hecho esfuerzos importantes y progresivos para realizar la detección de fumadores y la consejería breve ABC en los distintos dispositivos de la red. En el subsistema privado por otra parte se han llevado adelante servicios especializados: Terapia Intensiva de Cesación del Tabaquismo. Se detecta un déficit de integración de servicios a partir de metas claras y compartidas que permitan alcanzar un impacto poblacional relevante. Se proponen lineamientos a seguir para lograr éxito en las intervenciones para el tratamiento de los fumadores.

This chapter proposes actions for an adequate implementation of the strategies defined in the Guidelines of Clinical Practice for Tobacco Treatment, Chile 2017. In the public subsystem, significant and progressive efforts have been made to carry out smoking detection and counseling ABC on the various devices in the network. In the private subsystem on the other hand specialized services have been carried out: Intensive Therapy for Smoking Cessation. A deficit of integration of services is detected based on clear and shared goals that allow to reach a relevant population impact. Guidelines are proposed to be followed to achieve success in the interventions for the treatment of smokers.

Actividad Física y Tabaquismo / Physical activity and Smoking

Resumen En Chile, según la Encuesta Nacional de salud 2009-10, el 88,6% de la población general no realiza deporte o actividad física en su tiempo libre, y esta conducta de inactividad física aumenta con la edad y es mayor en los niveles educacionales bajos y en las mujeres. La evidencia reporta que utilizar la AF para la cesación del tabaquismo es débil, sin embargo, existe fuerte evidencia de que la actividad física reduce los síntomas de abstinencia, el deseo de fumar y el aumento de peso durante el abandono del tabaco. Los adultos de 18 a 64 años necesitan dedicar al menos 150 min semanales a la actividad física aeróbica, de intensidad moderada, o bien 75 min de actividad física aeróbica vigorosa cada semana, o bien una combinación equivalente de actividades moderadas y vigorosas para protegerse de mortalidad por diversas causas.

The Chilean National Health Survey 2009-10, evidences that 88.6% of the general population does not engage in sports or physical activity in their free time, and this behavior increases with age, low educational levels, and in women. According to evidence, using physical activity for smoking cessation has a weak. However, there is strong evidence that physical activity reduces withdrawal symptoms, craving, and weight gain during smoking cessation. Adults aged 18-64 need to spend at least 150 minutes a week on moderate intensity aerobic physical activity or 75 minutes of vigorous aerobic physical activity each week or an equivalent combination of moderate and vigorous activities to protect thenrselves against mortality from diverse causes.

Amiloidosis por cadenas livianas de inmunoglobulina con compromiso gástrico al debut: revisión de la literatura basada en un caso clínico / Gastric AL amyloidosis as initial manifestation: literature review from a case report

Systemic amyloidosis comprises a group of diseases characterized by low molecular weight subunit protein deposit in organs, including the gastrointestinal tract. The most frequent clinical manifestations are gastrointestinal bleeding, malabsorption syndrome, protein-losing enteropathy and chronic intestinal dysmotility. The diagnosis is confirmed with gastrointestinal tissue biopsy positive to Congo red stain or recognizing the amyloid fibrils by electron microscopy. The treatment is based in the management of gastrointestinal symptoms and chemotherapeutic drugs, including melphalan and prednisone or cyclophosphamide, bortezomib and prednisone. The bone marrow transplant is reserved for 70-year-old patients or younger without advanced comorbidities. We present a case of a patient with weight loss, anorexia, nausea and early satiety.

La amiloidosis sistémica a un conjunto de enfermedades caracterizadas por el depósito de subunidades fibrilares proteicas de bajo peso molecular en órganos, incluyendo el sistema digestivo. Sus manifestaciones clínicas más frecuentes son la hemorragia digestiva, síndrome malabsortivo, gastro-enteropatía perdedora de proteínas y dismotilidad gastrointestinal crónica. El diagnóstico se confirma con una biopsia de tejido gastrointestinal positiva a tinción rojo Congo o la visualización de fibrillas de amiloide mediante microscopia electrónica. El tratamiento está basado el manejo de los síntomas gastrointestinales y el oncológico, donde destacan esquemas quimioterapéuticos que incluyen melfalan y prednisona o ciclofosfamida, bortezomib y prednisona. El trasplante de médula ósea está reservado a pacientes menores de 70 años sin comorbilidades avanzadas. Presentamos en este artículo el caso de un paciente con baja de peso, anorexia, náuseas y saciedad precoz.

Rehabilitación respiratoria en pacientes EPOC: experiencia en Atención Primaria de Salud / Respiratory rehabilitation in COPD patients: Experience in a rural Primary Health Care Center

Respiratory rehabilitation improves physical capacity and quality of life in COPD patients as it has been previously reported. In Chile there are few and unpublished experiences on respiratory rehabilitation programs (RRP) implemented in primary health care (PHC). Our aim was to evaluate RRP outcome in COPD patients carried out in a rural PHC center. Methods: A prospective descriptive study of RRP in a PHC center implemented in Talagante (a village located 40 km from Santiago). COPD patients were enrolled in the study from July 2012 to May 2014. Patients having the inclusion criteria were admitted to a 12 weeks-long RPP This program included a 90 minute-long sessions of aerobic training (walking), strength training of upper and lower limbs (dumbbell, ankle support and elastic bands) and respiratory muscle training (threshold valve), twice a week. Quality of life, strength of trained muscles, six-minutes walking test (TM6), BODE index and dyspnea index, were measured before and after completing RRP Results were expressed as mean ± SD. Results: Out of 79 patients initially assessed, 54 were admitted to the RRP and 39 patients completed the program and were included in the analysis. Their mean age was 67.3 ± 8.5 years, 64% were female. In average BMI was 26.97 ± 4.3 kg/m², and FEVi was 1.17 ± 0.57 liters. We demonstrated a statistically significant improvement after RRP in 6-minute walk test (445.9 ± 77.9 m versus 498.2 ± 82.8 m, p < 0.001); Saint George’s Respiratory Questionnaire score (45.1 ± 16.1 versus 18.5 ± 11.5, p < 0.0001), PIMax (48.95 ± 18.8 versus 57.2 ± 19.4 cm H2O, p < 0.0001), BODE index (2.76 ± 1.37 versus 1.53 ± 1.0, p < 0.0001), and mMRC dyspnea scale (2.54 ± 0.75 versus 1.18 ± 0.56, p < 0.0001). Conclusions: Our results are consistent with those reported in the literature, demonstrating that COPD patients get beneficial effects with the respiratory rehabilitation program. We also showed that RRP can be implemented in primary health care using simple tools, with reasonable costs.

La rehabilitación respiratoria ha demostrado beneficios en mejorar la capacidad física y calidad de vida en los pacientes con EPOC. Sin embargo, en Chile no existe información de programas de rehabilitación respiratoria (PRR) en la atención primaria de salud. El objetivo de nuestro trabajo fue evaluar los resultados de la implementación de un programa de rehabilitación respiratoria (PRR) en pacientes con EPOC en la atención primaria de salud. Material y Método: Estudio prospectivo descriptivo realizado en un centro de salud familiar de Talagante en pacientes con diagnóstico confirmado de EPOC, durante el período julio de 2012 a mayo de 2014. Fueron ingresados al PRR, de 12 semanas de duración, aquellos pacientes que cumplían los criterios de inclusión. Se realizó entrenamiento aeróbico (caminata), entrenamiento de fuerza de extremidades superiores e inferiores (mancuernas, tobilleras y bandas elásticas) y entrenamiento de musculatura respiratoria (válvula umbral), 2 veces por semana y de 90 min de duración cada sesión. Al iniciar y al finalizar el PRR se evaluó: calidad de vida, fuerza muscular, test de marcha de 6 min (TM6); índice BODE y disnea. Resultados: De un total de 79 pacientes con EPOC evaluados, 54 ingresaron al PRR y 39 finalizaron el programa. La edad promedio fue 67,3 ± 8,5 años, 64% de género femenino, índice de masa corporal: 26,97 ± 4,3 kg/m² y VEF1 1,17 ± 0,57 L. Al comparar los valores iniciales y finales del PRR se encontraron diferencias estadísticamente significativas en: TM6 (445,9 ± 77,9 vs 498,2 ± 82,8 m, p < 0,001); Puntaje del cuestionario de St. George (45,1 ± 16,1 vs 18,5 ± 11,5, p < 0,0001), PIMáx 48,95 ± 18,8 vs 57,2 ± 19,4 cm H2O, p < 0,0001), índice BODE (2,76 ± 1,37 vs 1,53 ± 1,0, p < 0,0001), y escala de disnea mMRC (2,54 ± 0,75 vs 1,18 ± 0,56, p < 0,0001). Conclusiones: Los resultados de nuestro estudio son concordantes con lo descrito en la literatura y demuestran los beneficios significativos obtenidos con la rehabilitación respiratoria en pacientes con EPOC. También, se demuestra que en Chile se puede implementar un PRR en la atención primaria utilizando implementos simples y con un bajo costo.

Home Management of Diarrhoea by Caregivers Presenting at the Diarrhoea Training Unit of a Tertiary Hospital in Southern Nigeria.

Background: Diarrhoea is a leading cause of under – five morbidity and mortality. Diarrhoea deaths can be prevented by adequate case management of diarrhoeal episodes in children. With majority of cases being treated initially or completely in the home and community, the level of awareness of diarrhoea and simple home management practices among caregivers are key determining factors to reducing diarrhoea morbidity and mortality in children. Aim: To determine caregivers’ perception, knowledge and practice of home management of diarrhoea of children under five years of age presenting to the Diarrhoea Training Unit of a tertiary hospital in Southern Nigeria. Study Design: A clinic – based descriptive cross sectional study. Place and Duration of Study: The study was carried out in the Diarrhoea Training Unit of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria from July to December 2013. Methodology: A structured pre–tested questionnaire was used to collect data from caregivers on demographic characteristics, knowledge and practice of diarrhoea home treatment. There were 8 knowledge and 10 practice questions; each was scored a point. Background: Diarrhoea is a leading cause of under – five morbidity and mortality. Diarrhoea deaths can be prevented by adequate case management of diarrhoeal episodes in children. With majority of cases being treated initially or completely in the home and community, the level of awareness of diarrhoea and simple home management practices among caregivers are key determining factors to reducing diarrhoea morbidity and mortality in children. Aim: To determine caregivers’ perception, knowledge and practice of home management of diarrhoea of children under five years of age presenting to the Diarrhoea Training Unit of a tertiary hospital in Southern Nigeria. Study Design: A clinic – based descriptive cross sectional study. Place and Duration of Study: The study was carried out in the Diarrhoea Training Unit of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria from July to December 2013. Methodology: A structured pre–tested questionnaire was used to collect data from caregivers on demographic characteristics, knowledge and practice of diarrhoea home treatment. There were 8 knowledge and 10 practice questions; each was scored a point.

Presentación clínica de la trisomía 13 mosaico con mayor pronóstico de vida: reporte de un caso / Clinical presentation of mosaic trisomy 13 with longer life expectancy: case report

INTRODUCCIÓN: La trisomía del cromosoma 13, antes llamado Síndrome de Patau, es una enfermedad genética que resulta de la presencia de un cromosoma 13 supernumerario. Fue descubierta en 1960 por el Dr. Klaus Patau y actualmente es la trisomía reportada menos frecuente en la especie humana. Se suele asociar con un problema meiótico materno más que paterno y, como el síndrome de Down, el riesgo aumenta con la edad de la mujer. Los afectados mueren poco tiempo después de nacer, la mayoría a los3 meses de edad. Entre el 80-90 por ciento de los fetos con el síndrome no llegan a término. PRESENTACIÓN DEL CASO: Se presenta el caso de un recién nacido (RN) con diagnóstico de trisomía 13, asociado a malformaciones características de la trisomía, destacando la Tetralogia de Fallot y la laringotraqueomalacia. Al nacimiento, evoluciona con múltiples complicaciones secundarias a su patología de base, interfiriendo con la evolución y pronóstico de la enfermedad. El pronóstico de vida se relaciona claramente con la gravedad de las malformaciones cerebrales, renales y cardiacas; que a su vez se relacionan con el grado de alteración cromosómica que presenta el individuo, siendo la menos complicada el mosaicismo, como se describirá más adelante. DISCUSIÓN: Últimamente la visibilidad de los casos de trisomía 13 han aumentado por la mayor práctica en el diagnóstico de este mismo y además de su sobrevida por las nuevas intervenciones que se han descubierto en la medicina.

INTRODUCTION: Trisomy of chromosome 13, also known as Patau Syndrome, is a genetic disorder resulting from a supernumerary chromosome 13. It was discovered in 1960 by Patau and is currently reported less frequent trisomy in humans. It isusually associated with a maternal rather than paternal meiotic disorder and, like Down syndrome, its incidence increases with maternal age. Affected infants die shortly after birth, mostly before 3 months old. It is believed that 80-90 percent of affected fetuses do not reach term gestational age. CASE REPORT: The case of a male newborn with diagnosis of trisomy 13 is presented, with charasteristic features such as pink Tetrallogy of Fallot and laryngotracheomalacia. At birth, the patient manifests multiple complications related to his condition, altering the evolution and prognosis. Survival of the patient exceeded expectations, which is strictly related to the severity of cerebral, cardiac and renal malformations, which in turn is directly related to the degree of chromosomal alterations of the infant, with mosaicism being the less clinically affected. DISCUSSION: Recently the visibility of trisomy 13 cases have increased by more practiced in the diagnoses of the same and in addition to its survival by new interventions that have been discovered in medicine.

Programa de mejoramiento continuo en mamografía / Mammography continuous improvement program

In different areas, the quality concept has been conceived like the fulfillment of "controls of quality" and standards defined in accreditation processes. This paradigm is being replaced by the one of "total quality", being based on cycles of continuous improvement and the use of tools of control for processes analysis. This paper shows the requirements in the implementation of the principles of "total quality" in the continuous quality of image improvement in the Mamography´s Unit of the "Centro de Imagenología, Hospital Clínico Universidad de Chile".

En distintas áreas, el concepto de calidad ha sido concebido como el cumplimiento de "controles de calidad" y estándares definidos en procesos de acreditación. Este paradigma está siendo reemplazado por el de "calidad total", basado en ciclos de mejora continua y el uso de herramientas de control para el análisis de los procesos. Este trabajo muestra los requerimientos en la implementación de los principios de "calidad total" en el mejoramiento continuo de la calidad de imagen en la Unidad de Mamografía del Centro de Imagenología del Hospital Clínico de la Universidad de Chile.

Indicadores de calidad en la gestión del personal / Quality indicators in personnel management

El desarrollo de sistemas de evaluación que midan el desempeño y motiven al cumplimiento de las metas institucionales es fundamental en la gestión del personal. Nuestro centro ha desarrollado indicadores de calidad y productividad que pueden ser utilizados con este fin. La reducción de la capacidad instalada, de dos a un tomógrafo computado y de cinco a cuatro salas de radiología convencional, además de los distintos cambios en los procesos, hicieron imprescindible un aumento en las competencias del personal de las unidades involucradas.

Alteraciones electrocardiográficas en consumidores de pasta base de cocaína del área metropolitana / Electrocardiographic alterations in cocaine base paste consumers in the metropolitan area

The adverse effects of cocaine use mainly occur in the heart and cebtral nervous system. To study the effects of cocaine base paste consumption on the cardiovascular system, 35 chronic cocaine base paste consumers, 26 males, aged 15 to 43 years old were studied. A clinical assessment and a resting EKG were performed. Results were compared with those of 82 healthy controls. Sixty percent of cocaine consumers had EKG abnormalities, compared with 43 percent of controls. Forty one percent of cocaine users and 33 percent of controls had a prolonged QTc. Likewise, 36 percent of cocaine users and 46 percent of controls had an incomplete right bundle branch block. Among cocaine users, an active nodal rhythm, an ischemic and a QS anteroseptal image were observed. A slightly higher frequency of EKG abnormalities were observed in chronic cocaine users, when compared with healthy controls