Tasas de cobertura vacunal contra el virus del papiloma humano en adolescentes andaluzas y su relación con el riesgo social y la estrategia vacunal / Vaccine coverage rates against human papillomavirus in Andalusian adolescents and their relationship with social risk and vaccination strategy

Objetivo: conocer las tasas de vacunación contra el virus del papiloma humano (VPH) y su relación con la estrategia vacunal y la pertenencia a zonas necesitadas de transformación social (ZNTS). Diseño: estudio descriptivo, auditoría de historias clínicas.Emplazamiento:cuatro centros de salud urbanos (2015-2018).Participantes:adolescentes susceptibles de vacunación contra el VPH.Mediciones principales:tasas vacunales de acceso, cobertura y deserción.Resultados:366 adolescentes (12-16 años). Tasas: acceso 85,5%; cobertura 77,6%; deserción 9,3%. A mayor edad, mejores tasas de acceso (odds ratio [OR]: 6,1) y cobertura (OR: 1,4). La vacunación en el centro de salud se relaciona con una mejor tasa de cobertura (OR: 12,7), pero aumenta significativamente la tasa de deserción (OR: 75,6). Vivir en ZNTS disminuye la tasa de deserción (OR: 0,6).Conclusiones:la vacunación en centros de salud mejora la tasa de cobertura, pero con mayor riesgo de no completar la vacunación. La tasa de deserción es menor en ZNTS.(AU)

Objective: To ascertain the vaccination coverage rates against human papillomavirus (HPV) and its relationship with the vaccination strategy and belonging to poverty areas.Design:Descriptive study, audit of medical records.Setting:Four urban Primary Care centres (2015-2018).Participants:Adolescents susceptible to HPV vaccination.Main measurements:Vaccination Access, Coverage and Dropout Rates.Results:366 adolescents (12-16 years). Vaccination Rates: Access 85.5%; Coverage 77,6% and Dropout 9,3%. The oldest adolescents had higher Access (OR 6,1) and Coverage Rates (OR 1,4). Vaccination at the Primary Care centre was associated with a better Coverage Rate (OR 12,7) but the Vaccine Dropout Rate (OR 75,6) significantly increased. Living in a poverty area led to a decrease in Dropout Rate (OR 0,6).Conclusions:Vaccination in Primary Care centres improved the coverage rate but with a higher risk of not completing the vaccination. Adolescents in poverty areas completed vaccination more frequently.(AU)

Masa quística de mediastino como localización atípica de leishmaniasis visceral / Mediastinal cystic mass as atypical location of visceral leishmaniasis

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Idiopathic pleuroparenchymal fibroelastosis, a new idiopathic interstitial pneumonia: A case report.

Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare disease, idiopathic in most of the cases described in the literature. We report the case of a 55-year-old patient, non-smoker with tuberculosis treated in his youth, starting with progressive dyspnoea and cough, with radiographic abnormalities consisting of pleural thickening, bronchiectasis and structural distortion predominantly in the upper lobes. Due to functional impairment and persistent radiographic abnormalities, biopsy by video-assisted thoracoscopic surgical was decided. The presence of striking elastosis, absence of interstitial damage and abrupt boundary of the fibrous lesion with healthy lung allowed the diagnosis of IPPFE. Currently, the patient has no specific treatment and is in follow-up in the Transplant Unit.

Performance of a q-plate tunable retarder in reflection for the switchable generation of both first- and second-order vector beams.

We examine the performance of a tunable liquid crystal q-plate in a reflective geometry. When the device is tuned to a half-wave retardance, it operates as a q-plate with twice the value (2q) by adding a quarter-wave retarder between the mirror and the q-plate. However, when the device is tuned to a quarter-wave retardance, it acts as the original q-plate without the retarder. Experimental results are shown. Using an input tunable polarization state generator, the system allows the switchable production of all states on both the first- and second-order Poincaré spheres.

[Systematic review of the efectiveness of community-based interventions to decrease neonatal mortality]. / Revisión sistemática sobre la efectividad de intervenciones basadas en la comunidad en la disminución de la mortalidad neonatal.

We evaluated the efficacy/effectiveness of community-based interventions to decrease neonatal mortality. A systematic review of randomized controlled trials, cluster randomized trials and cohort studies of interventions on pregnant women, neonates (up to 28 days after birth) or both was made. Thirty four studies were evaluated (n=844,989): 20 in pregnant women (n=406,172), 6 in neonates (n=24,994), and 8 in both (n=413,823). Risk of bias was generally low. There was heterogeneity among interventions. Interventions such as maternal health education and maternal and neonatal home care were associated to a decrease in neonatal mortality in half of the 6 studies of each group. Supplementation with multiple micronutrients, kangaroo mother care, and maternal supplementation with vitamin A did not decrease neonatal mortality. A few heterogeneous community-based interventions demonstrated a decrease in neonatal mortality.

Analysis of a segmented q-plate tunable retarder for the generation of first-order vector beams.

In this work we study a prototype q-plate segmented tunable liquid crystal retarder device. It shows a large modulation range (5π rad for a wavelength of 633 nm and near 2π for 1550 nm) and a large clear aperture of one inch diameter. We analyze the operation of the q-plate in terms of Jones matrices and provide different matrix decompositions useful for its analysis, including the polarization transformations, the effect of the tunable phase shift, and the effect of quantization levels (the device is segmented in 12 angular sectors). We also show a very simple and robust optical system capable of generating all polarization states on the first-order Poincaré sphere. An optical polarization rotator and a linear retarder are used in a geometry that allows the generation of all states in the zero-order Poincaré sphere simply by tuning two retardance parameters. We then use this system with the q-plate device to directly map an input arbitrary state of polarization to a corresponding first-order vectorial beam. This optical system would be more practical for high speed and programmable generation of vector beams than other systems reported so far. Experimental results are presented.

Revisión sistemática sobre la efectividad de intervenciones basadas en la comunidad en la disminución de la mortalidad neonatal / Systematic review of the efectiveness of community-based interventions to decrease neonatal mortality

Se evalúa la eficacia/efectividad de las intervenciones basadas en la comunidad, destinadas a disminuir la mortalidad neonatal. Se realizó una revisión sistemática de ensayos controlados aleatorizados, ensayos aleatorizados de comunidad y estudios de cohortes de intervenciones dirigidas a la mujer gestante, al neonato (hasta 28 días de nacido) o a ambos. Se evaluaron 34 estudios (n=844,989): 20 en mujeres gestantes (n=406,172); 6 en neonatos (n=24,994), y 8 en ambos grupos (n=413,823). El riesgo de sesgo fue generalmente bajo. Hubo heterogeneidad entre los tipos de intervenciones. Las intervenciones educación materna en salud y cuidado en casa de madres y neonatos estuvieron asociadas con disminución de mortalidad neonatal en la mitad de los seis estudios de cada grupo. La suplementación materna con multimicronutrientes, el cuidado de madre canguro y la suplementación materna prenatal con vitamina A no disminuyeron la mortalidad neonatal. Pocas intervenciones comunitarias heterogéneas han demostrado disminuir la mortalidad neonatal...

We evaluated the efficacy/effectiveness of community-based interventions to decrease neonatal mortality. A systematic review of randomized controlled trials, cluster randomized trials and cohort studies of interventions on pregnant women, neonates (up to 28 days after birth) or both was made. Thirty four studies were evaluated (n=844,989): 20 in pregnant women (n=406,172), 6 in neonates (n=24,994), and 8 in both (n=413,823). Risk of bias was generally low. There was heterogeneity among interventions. Interventions such as maternal health education and maternal and neonatal home care were associated to a decrease in neonatal mortality in half of the 6 studies of each group. Supplementation with multiple micronutrients, kangaroo mother care, and maternal supplementation with vitamin A did not decrease neonatal mortality. A few heterogeneous community-based interventions demonstrated a decrease in neonatal mortality...

Variabilidad de los síntomas respiratorios en la EPOC grave / Variability of Respiratory Symptoms in Severe COPD

Introducción: Mientras se reconoce que los síntomas en el asma tienen un patrón muy variable, la creencia general es que los síntomas respiratorios en los pacientes con EPOC presentan habitualmente poca o ninguna variabilidad. Sin embargo, los pacientes con EPOC refieren tener «días malos». El objetivo del presente trabajo fue evaluar la variabilidad de los síntomas respiratorios y su impacto en las actividades de la vida diaria en una cohorte de pacientes españoles. Método: Se presentan los resultados de los pacientes españoles participantes en un estudio epidemiológico transversal realizado en 17 países europeos. Neumólogos y médicos de familia reclutaron pacientes con EPOC grave estable (FEV1<50%). La percepción de los pacientes sobre la variación de sus síntomas se recogió mediante entrevista telefónica. Resultados: Un total de 472 pacientes aportaron datos válidos para el análisis. La edad media fue de 68,6 años, el 93% fueron hombres y el FEV1(%) medio fue del 41%. El 84,1% de los pacientes experimentaron al menos un síntoma respiratorio en la semana previa y el 60,9% afirmaron que sus síntomas variaban a lo largo del día o de la semana. El momento del día donde los síntomas se percibían con mayor intensidad fue por la mañana. Conclusiones: Una proporción importante de pacientes con EPOC grave percibe variabilidad de sus síntomas respiratorios, con una mayor intensidad por la mañana. Esta observación puede tener implicaciones para el tratamiento de los pacientes con EPOC grave, ya que la variabilidad puede ser un signo inicial de descompensación de la enfermedad(AU)

Introduction: While it is known that asthma symptoms have a very variable pattern, the general belief is that the respiratory symptoms in COPD patients usually present little or no variability. Nevertheless, COPD patients report having "bad days". The objective of this present study was to evaluate the variability of the respiratory symptoms and their impact on the daily activities of a cohort of Spanish COPD patients. Method: We present the results of the Spanish patients who participated in a cross-sectional epidemiological study carried out in 17 European countries. Pulmonologists and Family Care physicians recruited patients with stable severe COPD (FEV1<50%). The perception of the patients on the variation in their symptoms was recorded by telephone interviews. Results: A total of 472 patients provided data that was valid for analysis. Mean age was 68.6; 93% were men; mean FEV1(%) was 41%. 84.1% of the patients experimented at least one respiratory symptom in the previous week and 60.9% affirmed that their symptoms varied over the course of the day or week. The moment of the day when the symptoms were perceived to be more intense was during the morning. Conclusions: An important proportion of severe COPD patients perceive variability in their respiratory symptoms, with a greater intensity in the morning. The observation can have implications in treating patients with severe COPD as variability can be an initial sign of decompensation of the disease(AU)

Variability of respiratory symptoms in severe COPD.

INTRODUCTION: While it is known that asthma symptoms have a very variable pattern, the general belief is that the respiratory symptoms in COPD patients usually present little or no variability. Nevertheless, COPD patients report having "bad days". The objective of this present study was to evaluate the variability of the respiratory symptoms and their impact on the daily activities of a cohort of Spanish COPD patients. METHOD: We present the results of the Spanish patients who participated in a cross-sectional epidemiological study carried out in 17 European countries. Pulmonologists and Family Care physicians recruited patients with stable severe COPD (FEV1<50%). The perception of the patients on the variation in their symptoms was recorded by telephone interviews. RESULTS: A total of 472 patients provided data that was valid for analysis. Mean age was 68.6; 93% were men; mean FEV1(%) was 41%. 84.1% of the patients experimented at least one respiratory symptom in the previous week and 60.9% affirmed that their symptoms varied over the course of the day or week. The moment of the day when the symptoms were perceived to be more intense was during the morning. CONCLUSIONS: An important proportion of severe COPD patients perceive variability in their respiratory symptoms, with a greater intensity in the morning. The observation can have implications in treating patients with severe COPD as variability can be an initial sign of decompensation of the disease.

Factores asociados a infección de cúpula vaginal en pacientes sometidas a histerectomía vaginal en el Hospital Nacional Arzobispo Loayza / Factors associated with vaginal vault infection in patients undergoing vaginal hysterectomy at the Hospital Nacional Arzobispo Loayza

Objetivos: Determinar los factores asociados a la infección de cúpula vaginal y su frecuencia en las pacientes sometidas a histerectomía vaginal. Material y métodos: Estudio analítico observacional de casos y controles. Se revisaron historias clínicas de 114 pacientes sometidas a histerectomía vaginal en el Servicio de Ginecología y del Hospital Nacional Arzobispo Loayza entre el 1 de enero del 2005 y el 31 de diciembre del 2006. El grupo de controles con 76. Se determinó la incidencia de la infección de cúpula vaginal y se realizó un análisis multivariado de las variables asociadas con un intervalo de confianza de 95%. Resultados: Se realizaron con un total de 822 histerectomías vaginales de las cuales 8,1% presentaron infección de cúpula vaginal. Las variables que se constituyeron en factores de riesgo fueron: la edad menor de 60 años con OR 3,01 CI 95% (1,22-7,42), el haber tenido relaciones sexuales previas al internamiento con OR 3.85 CI 95% (1,57-9,55), el antecedente de flujos vaginales con OR 3,29 CI 95% (1,29-8,46). Conclusiones: La frecuencia de infección de cúpula vaginal en pacientes sometidas a histerectomía vaginal en nuestro hospital es similar a la reportada en otros centros. Tener menos de 60 años, el antecedente de flujos vaginales y las relaciones sexuales previas al internamiento constituye factores de riesgo para infección de cúpula vaginal en histerectomía vaginal.

Conocimientos, intenciones de conducta y prácticas sobre bartonelosis en la localidad de Sartimbamba, Provincia Sánchez Carrión, Dpto. de La Libertad: Enero-Marzo 2005 / Knowledge, practices and intentions of conduct on bartonellosis in the town of Sartimbamba, Sanchez Carrion Province, Dep. La Libertad: January-March 2005

La Bartonelosis, también denominada “verruga peruana” o “Enfermedad de Carrión”, es una enfermedad infecciosa, producida por la bacteria Bartonella bacilliformis, y transmitida por la picadura de insectos hematófagos hembras del género Lutzomya. Es endémica en determinadas zonas del ande peruano como Ancash, Cajamarca, Amazonas y Cusco. Si bien han existido casos en la región La Libertad, estos eran escasos y esporádicos, pero a mediados del2002 se inició un brote en la provincia Sánchez Carrión, siendo una de las zonas más afectadas la localidad deSartimbamba. Objetivo: Determinar el nivel de conocimiento, así como las intenciones de conducta y prácticas dela población con respecto a Bartonelosis. Material y métodos: Se utilizó una encuesta preelaborada, cuyos datosfueron tabulados siguiendo un patrón de tabulación automatizada, usando el paquete estadístico SPSS 11.0. Resultados: El 26,8% presentó un conocimiento MEDIO, mientras que 73,2% presentó un nivel BAJO de conocimiento. Se observó que las intenciones de conducta fueron adecuadas en la mayoría de los encuestados tanto hacia eltratamiento en establecimientos del MINSA (71,9%) como hacia la realización de medidas preventivas (57,1%); pero con respecto a las prácticas se encontró que no coinciden con las intenciones de conducta referidas en la encuesta, hallándose contradicciones sorprendentes como la no implementación de medidas preventivas y el no acudir a las charlas programadas por el MINSA. Conclusión: Se encontró que el nivel de conocimiento de la población en general sobre Bartonelosis es muy bajo.

Bartonellosis, also called “Carrion’s Disease” or “Peruvian Wart” is an infectious disease caused by Bartonellabacilliformis and transmitted by hematofogous female insects of Lutzomya genus. It is an endemic disease in certain zones of Peruvian Andes, like Ancash, Cajamarca, Amazonas, and Cusco. In the Region of La Libertad there were few temporary cases, but in the middle of 2002 an outbreak began in the Province of Sanchez Carrion, so that the town of Sartimbamba ended up being the most affected. Objective: To determine the level of knowledge, the conduct intentions, and practices in the population with regard to Bartonellosis disease. Material and methods: Apre elaborated survey was deployed and the input was stored on a database to be subsequently processed by SPSS 11.0 statistic software. Results: 26,8% has average knowledge, whereas 73,2% shows a low level of knowledge. The intent of the population towards the treatment (71,9%) and preventive measures (57,1%) that the Public Health Service offers is appropriate, practices do not agree with it. Thus, we observe surprising contradictions, such as the absolute lack of implementation of proventive measures and the lack of interest in attending the talks programmed by the Public Health Service. Conclusion: The population knows very little about this subjec.

Tracheal diverticulum: a review of the literature.

Tracheal diverticulum is a rarely encountered entity. It may be congenital or acquired, the difference residing mainly in the histologic features of the wall. Most cases are asymptomatic, but when symptoms are present they are usually nonspecific. Congenital diverticulum is not normally detected in infancy unless it is suggested by recurrent episodes of tracheobronchial infection or in associated with other malformations. Imaging techniques are useful for diagnosis because the point of communication with the trachea is difficult to detect with bronchoscopy. In the absence of symptoms, management should be conservative. We review the entity and report two new cases, one a casual finding in a 49-year-old man and the other in a 63-year-old woman who presented with occasional bloody sputum.

Pleural aspergillosis with bronchopleurocutaneous fistula and costal bone destruction: a case report.

A 65-year-old man who, when young, had had tuberculosis treated by therapeutic pneumothorax, consulted his family physician for a constitutional syndrome and dyspnea. At this time radiologic studies showed left pleural effusion with bilateral calcified plaques, an infiltrate in the upper left lobe, and a picture compatible with aspergilloma, all suggesting semi-invasive aspergillosis. The patient failed to show up for his followup visit, so no therapy could be started or further diagnostic tests ordered. One month later he was admitted to this hospital for a bronchopleural fistula (empyema necessitatis) with subsequent spontaneous hydropneumothorax and costal bone involvement. The patient underwent surgery because of his rapid worsening condition. Biopsy examination revealed a large pleural aspergilloma. Despite immediate antifungal therapy, the patient died. We believe this to be the first report of pleural Aspergillus with a bronchopleurocutaneous fistula and costal bone destruction.

Uso del sistema de información geográfica para determinar la relación entre la severidad de la crisis asmática en niños y la cercanía a fábricas con chimeneas en un distrito de Lima - Perú / Usage of geographic information in order to determine the relationship between the severity of asthmatic crisis in children and the proximity of factories with chimneys in one district of Lima - Peru

Objetivo: Determinar la relación geográfica entre la severidad de las crisis asmáticas en niños atendidos en el sevicio de emergencia del Hospital Nacional Cayetano Heredia (HNCH) entre enero 1997 y diciembre 1998 y la localización de fábricas con chimenea en el distrito de San Martín de Porras (SMP), Lima-Perú. Materiales y métodos: Estudio transversal analítico. Utilizando la información de registros e historias clínicas, se consignó edad, sexo, número de crisis severas del último año, hospitalización previa por crisis asmática, domicilio del paciente y puntaje de Bierman y Pierson al ingreso. Mediante el mapa digitalizado de SMP indexado a la base de datos de la ubicación geográfica, se obtuvo la dirección de los pacientes y las de 10 fábricas con chimeneas. Se definió como área de impacto aquella que tenía fábricas con chimenea y 2-4 casos de crisis asmática severa. Por modelamiento geoespacial se determinaron zonas de impacto y de no impacto asociadas a más casos y presencia de fábricas. Resultados: Se concluyeron 932 niños con edad promedio de 6,5 ñ1,2 vs 1,8 ñ 0,7, p<0,05) que aquellos residentes de las áreas de no impacto. Conclusiones: Existe mayor número de crisis asmáticas severas y hospitalizaciones en pacientes que viven cerca de las fábricas de chimenea del distrito de SMP.