An exploratory study of client and provider experience and perceptions of facility-based childbirth care in Quiché, Guatemala.

INTRODUCTION: Respectful maternity care (RMC) is fundamental to women's and families' experience of care and their decision about where to give birth. Studies from multiple countries describe the mistreatment of women during facility-based childbirth, though only a small number of studies from Guatemala have been published. Less information is available on women's negative and positive experiences of childbirth care and health workers' perceptions and experiences of providing maternity care. METHODS: As part of a program implemented in the Western Highlands of Guatemala to improve quality of reproductive maternal newborn and child health care, a mixed methods assessment was conducted in three hospitals and surrounding areas to understand women's and health workers' experience and perceptions of maternity care. The quantitative component included a survey of 31 maternity health workers and 140 women who had recently given birth in these hospitals. The qualitative component included in-depth interviews (IDIs) and focus group discussions (FGDs) with women and maternity health workers and managers. RESULTS: Women reported a mix of positive and negative experiences of childbirth care related to interpersonal and health system factors. 81% of surveyed women reported that health workers had treated them with respect while 21.4% of women reported verbal abuse. Fifty-five percent and 12% of women, respectively, reported not having access to a private toilet and bath or shower. During IDIs and FGDs, many women described higher rates of verbal abuse directed at women who do not speak Spanish. A regression analysis of survey results indicated that speaking Ixil or K'iche at home was associated with a higher likelihood of women being treated negatively during childbirth in a facility. Health worker survey results corroborated negative aspects of care described by women and also reported mistreatment of health workers by clients and families (70.9%) and colleagues (48.2%). CONCLUSIONS: This study adds to the literature on women's experience of institutional childbirth and factors that influence this experience by triangulating experience and perceptions of both women and health workers. This assessment highlights opportunities to address mistreatment of both women and health workers and to build on positive care attributes to strengthen RMC for all women.

Ozonoterapia mediante infiltración en pacientes con síndrome del túnel carpiano / Ozonetherapy by means of infiltration in patient with Syndrome of the Carpal Tunnel

Introducción: El síndrome del túnel del carpo de naturaleza idiopática constituye hoy la neuropatía periférica más recurrente. Se reconoce su alta prevalencia y se asocia a condiciones discapacitantes y dolencias desde sus primeras fases. Objetivo: Evaluar los resultados de la ozonoterapia mediante infiltración en pacientes con síndrome del túnel del carpo. Métodos: Se realizó un estudio descriptivo prospectivo en el Hospital Clínico Quirúrgico Lucía Iñiguez Landín de Holguín en el periodo comprendido entre enero del 2018 a enero del 2020. La población del estudio fue de 170 pacientes. La muestra fue de 119 pacientes seleccionadas por muestreo aleatorio simple. Se determinaron las variables clínicas tiempo de evolución de la enfermedad, evolución de los síntomas durante el tratamiento con ozonoterapia y el efecto del tratamiento y uso de analgésicos. Resultados: La mayor proporción de los pacientes fueron mujeres (90,76 por ciento) y predominaron los pacientes en las edades comprendidas entre 50 y 59 años (40,33 por ciento); predominó el antecedente de trabajo manual previo entre 1 y 3 años (48,73 por ciento) y el antecedente de diabetes mellitus y artritis reumatoide (17,64 por ciento en ambas); según el índice de Katz se obtuvo que el 29,41 por ciento presentó caso clásico de la mano derecha, mientras que el 17,64 por ciento solo de la mano izquierda. A los 3 meses de tratamiento, 50 pacientes habían tenido resultados muy buenos (42,01 por ciento), de ellos 31 solo necesitaron analgésicos ocasionalmente y 5 no necesitaron analgésicos, 48 pacientes obtuvieron resultados buenos de los cuales el 17,64 por ciento tomaron analgésicos de forma ocasional. No se presentaron efectos adversos. Conclusiones: El tratamiento con ozonoterapia mediante infiltración fue muy bueno. Se logró reducir el uso de analgésicos, disminuyó la sintomatología de la enfermedad y se mejoró la función de la mano(AU)

Introduction: The idiopathic carpal tunnel syndrome is today the most recurrent peripheral neuropathy. Its high prevalence is recognized and it is associated with disabling conditions and ailments from its early stages. Objective: To evaluate the results of ozone therapy through infiltration in patients with carpal tunnel syndrome. Methods: A prospective descriptive study was conducted at the Lucía Iñiguez Landín Clinical Surgical Hospital in Holguín in the period from January 2018 to January 2020. The study population was 170 patients. The sample consisted of 119 patients selected by simple random sampling. The clinical variables, time of evolution of the disease, evolution of symptoms during treatment with ozone therapy and the effect of treatment and use of analgesics were determined. Results: The highest proportion of patients were women (90.76 percent) and patients between 50 and 59 years of age predominated (40.33 percent); A history of previous manual work between 1 and 3 years prevailed (48.73 percent) and a history of diabetes mellitus and rheumatoid arthritis (17.64 percent in both); according to the Katz index, it was obtained that 29.41 percent presented a classic case of the right hand, while 17.64 percent only had the left hand. At 3 months of treatment, 50 patients had had very good results (42.01 percent), of them 31 only needed analgesics occasionally and 5 did not need analgesics, 48 patients obtained good results of which 17.64 percent took analgesics from occasional way. There were no adverse effects. Conclusions: Treatment with ozone therapy by infiltration was very good. The use of analgesics was reduced, the symptoms of the disease decreased and the function of the hand improved(AU).

Cortically-controlled population stochastic facilitation as a plausible substrate for guiding sensory transfer across the thalamic gateway.

The thalamus is the primary gateway that relays sensory information to the cerebral cortex. While a single recipient cortical cell receives the convergence of many principal relay cells of the thalamus, each thalamic cell in turn integrates a dense and distributed synaptic feedback from the cortex. During sensory processing, the influence of this functional loop remains largely ignored. Using dynamic-clamp techniques in thalamic slices in vitro, we combined theoretical and experimental approaches to implement a realistic hybrid retino-thalamo-cortical pathway mixing biological cells and simulated circuits. The synaptic bombardment of cortical origin was mimicked through the injection of a stochastic mixture of excitatory and inhibitory conductances, resulting in a gradable correlation level of afferent activity shared by thalamic cells. The study of the impact of the simulated cortical input on the global retinocortical signal transfer efficiency revealed a novel control mechanism resulting from the collective resonance of all thalamic relay neurons. We show here that the transfer efficiency of sensory input transmission depends on three key features: i) the number of thalamocortical cells involved in the many-to-one convergence from thalamus to cortex, ii) the statistics of the corticothalamic synaptic bombardment and iii) the level of correlation imposed between converging thalamic relay cells. In particular, our results demonstrate counterintuitively that the retinocortical signal transfer efficiency increases when the level of correlation across thalamic cells decreases. This suggests that the transfer efficiency of relay cells could be selectively amplified when they become simultaneously desynchronized by the cortical feedback. When applied to the intact brain, this network regulation mechanism could direct an attentional focus to specific thalamic subassemblies and select the appropriate input lines to the cortex according to the descending influence of cortically-defined "priors".

Subthreshold sodium current underlies essential functional specializations at primary auditory afferents.

Primary auditory afferents are generally perceived as passive, timing-preserving lines of communication. Contrasting this view, identifiable auditory afferents to the goldfish Mauthner cell undergo potentiation of their mixed--electrical and chemical--synapses in response to high-frequency bursts of activity. This property likely represents a mechanism of input sensitization because they provide the Mauthner cell with essential information for the initiation of an escape response. Consistent with this synaptic specialization, we show here that these afferents exhibit an intrinsic ability to respond with bursts of 200-600 Hz and this property critically relies on the activation of a persistent sodium current, which is counterbalanced by the delayed activation of an A-type potassium current. Furthermore, the interaction between these conductances with the membrane passive properties supports the presence of electrical resonance, whose frequency preference is consistent with both the effective range of hearing in goldfish and the firing frequencies required for synaptic facilitation, an obligatory requisite for the induction of activity-dependent changes. Thus our data show that the presence of a persistent sodium current is functionally essential and allows these afferents to translate behaviorally relevant auditory signals into patterns of activity that match the requirements of their fast and highly modifiable synapses. The functional specializations of these neurons suggest that auditory afferents might be capable of more sophisticated contributions to auditory processing than has been generally recognized.

Etomidate reduces initiation of backpropagating dendritic action potentials: implications for sensory processing and synaptic plasticity during anesthesia.

Anesthetics may induce specific changes that alter the balance of activity within neural networks. Here we describe the effects of the GABA(A) receptor potentiating anesthetic etomidate on sensory processing, studied in a cerebellum-like structure, the electrosensory lateral line lobe (ELL) of mormyrid fish, in vitro. Previous studies have shown that the ELL integrates sensory input and removes predictable features by comparing reafferent sensory signals with a descending electromotor command-driven corollary signal that arrives in part through parallel fiber synapses with the apical dendrites of GABAergic interneurons. These synapses show spike timing-dependent depression when presynaptic activation is associated with postsynaptic backpropagating dendritic action potentials. Under etomidate, almost all neurons become tonically hyperpolarized. The threshold for action potential initiation increased for both synaptic activation and direct intracellular depolarization. Synaptically evoked inhibitory postsynaptic potentials (IPSPs) were also strongly potentiated and prolonged. Current source density analysis showed that backpropagation of action potentials through the apical dendritic arborization in the molecular layer was reduced but could be restored by increasing stimulus strength. These effects of etomidate were blocked by bicuculline or picrotoxin. It is concluded that etomidate affects both tonic and phasic inhibitory conductances at GABA(A) receptors and that increased shunting inhibition at the level of the proximal dendrites also contributes to increasing the threshold for action potential backpropagation. When stimulus strength is sufficient to evoke backpropagation, repetitive association of synaptic excitation with postsynaptic action potential initiation still results in synaptic depression, showing that etomidate does not interfere with the molecular mechanism underlying plastic modulation.

Pooled spike trains of correlated presynaptic inputs as realizations of cluster point processes.

The pooled spike trains of correlated presynaptic terminals acting synchronously upon a single neuron are realizations of cluster point processes: the notions of spikes synchronizing in bursts and of points bunching in clusters are conceptually identical. The primary processes constituent specifies the timing of the cluster series; subsidiary processes and poolings specify burst structure and tightness. This representation and the Poisson process representation of independent terminals complete the formal approach to pooled trains. The notion's usefulness was illustrated by expressing physiological questions in terms of those constituents, each possessing a clear biological embodiment; constituents provided the control variables in simulations using leaky integrate-and-fire postsynaptic neurons excited by multiple weak terminals. Regular or irregular primary processes and bursts series determined low or high postsynaptic dispersions. When convergent set synchrony increased, its postsynaptic consequences approached those of single powerful synapses; concomitantly, output spike trains approached periodic, quasiperiodic, or aperiodic behaviors. The sequence in which terminals fired within bursts affected the predictee and predictor roles of presynaptic and postsynaptic spikes; when inhibition was added, EPSP and IPSP delays and order were influential (summation was noncommutative). Outputs to different correlations were heterogeneous; heterogeneity was accentuated by conditioning by variables such as DC biases.

Dendritic spike back propagation in the electrosensory lobe of Gnathonemus petersii.

Spike timing-dependent plasticity that follows anti-Hebbian rules has been demonstrated at synapses between parallel fibers and inhibitory interneurons known as medium ganglionic layer (MG) neurons in the cerebellum-like electrosensory lobe of mormyrid fish. This plasticity is expressed when presynaptic activation is associated with a characteristically broad, postsynaptic action potential, lasting 7-15 ms, occurring within a window of up to 60-80 ms following synaptic activation. Since the site of plastic change is presumably in the apical dendrites, it is important to know where, when and how this broad spike is generated and the manner in which such events propagate within the intrinsic network of the electrosensory lobe. The electrosensory lobe has a strict layered organization that makes the preparation suitable for one dimension current source density analysis. Using this technique in an 'in vitro' interface slice preparation, we found that following either parallel fiber stimulation or an orthogonal field stimulus, a sink appeared in the ganglionic layer and propagated into the molecular layer. Intracellular records from MG somata showed these stimuli evoked broad action potentials whose timing corresponds to this sink. TTX application in the deep fiber layer blocked the synaptically evoked ganglionic layer field potential and the 'N3' wave of the outer molecular layer field potential simultaneously, while the molecular layer 'N1' and 'N2' waves corresponding to synaptic activation of the apical dendrites remained intact. These results confirm the hypothesis that the broad spikes of MG cells originate in the soma and propagate through the molecular layer in the apical dendritic tree, and suggest the possibility that this backpropagation may contribute to 'boosting' of the synaptic response in distal apical dendrites in certain circumstances.

Pre-receptor profile of sensory images and primary afferent neuronal representation in the mormyrid electrosensory system.

Afferent responses to the fish's own electric organ discharge were explored in the electrosensory lobe of the mormyrid fish Gnathonemus petersii. In order to understand the neural encoding of natural sensory images, responses were examined while objects of different conductivities were placed at different positions along the skin of the fish, i.e. at different points within, and also outside, peripheral receptive fields. The presence of an object in the fish's self-generated electric field produces local modulation of transcutaneous current density. Measurement of the local electric organ discharge shows that object images formed at the electroreceptive sensory surface have an opposing center-surround, 'Mexican hat' profile. This is a pre-receptor phenomenon intrinsic to the physical nature of the sensory stimulus that takes place prior to neural lateral inhibition and is independent of such central inhibition. Stimulus intensity is encoded in the latency and number of action potentials in the response of primary afferent fibers. It is also reflected in changes in the amplitude and area of extracellular field potentials recorded in the deep granular layer of the electrosensory lobe. Since the object image consists of a redistribution of current density over the receptive surface, its presence is coded by change in the activity of receptors over an area much larger than the skin surface facing the object. We conclude that each receptor encodes information coming from the whole scene in a manner that may seem ambiguous when seen from a single point and that, in order to extract specific object features, the brain must process the electric image represented over the whole sensory surface.

Electric images of two low resistance objects in weakly electric fish.

Electroreceptive fish detect nearby objects by processing the information contained in the pattern of electric currents through their skin. In weakly electric fish, these currents arise from a self-generated field (the electric organ discharge), depending on the electrical properties of the surrounding medium. The electric image can be defined as the pattern of transepidermal voltage distributed over the receptive surface. To understand electrolocation it is necessary to know how electric image of objects are generated. In pulse mormyrids, the electric organ is localized at the tail, far from the receptors and fires a short biphasic pulse. Consequently, if all the elements in the environment are resistive, the stimulus at every point on the skin has the same waveform. Then, any measure of the amplitude (for example, the peak to peak amplitude) could be the unique parameter of the stimulus at any point of the skin. We have developed a model to calculate the image, corroborating that images are spread over the whole sensory surface and have an opposite center-surround, "Mexican-hat" shape. As a consequence, the images of different objects superimpose. We show theoretically and by simulation that the image of a pair of objects is not the simple addition of the individual images of these objects.

Variación entre dos observadores en la evaluación radiográfica de las articulaciones sacroiliacas: I Estudio en poblaciones con riesgo y sin riesgo de sacroiliítis / Interobserver variations in the radiographic evaluation of the sacroiliac joints. I. Comparative study with high and low of the sacroiliitis risk

Antecedentes. La interpretación radiográfica de las articulaciones sacroilíacas está sujeta a variaciones entre observadores. Objetivo. Determinar el grado de concordancia de las interpretaciones dos observadores con experiencia diferente. Material y métodos. Dos reumatólogos certificados en un intervalo de 10 años, evaluaron en forma independiente un total de 1320 variables en 55 radiografías de la pelvis (cegados y codificados) de familiares de pacientes con espondilitis anquilosante juvenil después de un consenso para definir cada una de las variables. La concordancia de los datos obtenidos (presentes o ausentes) fue analizada con una prueba de Kappa ponderada al total de observaciones realizadas. Resultados. El grado de concordancia fue menor al evaluar el tercio superior de las articulaciones sacroiliacas y la variable "anquilosis". Ambos observadores registraron una proporción de "ausencia" mayor que la de "presencia" para cada variable; sin embargo, el observador con menor experiencia registró "presencia" con mayor frecuencia. La calificación final (graduación de sacroiliítis) tuvo una concordancia moderada (kappa: 0.546 y 0.500). Conclusiones. La concordancia de los observadores en este estudio fue, en general, moderada. Las discrepancias más importantes se encuentran en la evaluación de "disminución del espacio articular" y "esclerosis subcondral". La concordancia en la interpretación de todas las variables en el tercio superior y de algunas de ellas en el tercio medio es razonable y mayor en el tercio inferior