ABSTRACT
Objetivo: Analizar el potencial de innovación en apósitos para tratar heridas crónicas en la Ciudad de Lima. Métodos: Se realizó un estudio cualitativo mediante una encuesta y análisis de las entrevistas realizadas a expertos médicos y gestores de compras en insumos para el tratamiento de heridas de difícil resolución en 8 instituciones representativas de salud pública con categorías 1 4 dentro de las 54 existentes solo en Lima Metropolitana, Perú - 2018. Resultados: Se determinó que en las instituciones de salud pública son atendidos un promedio 17 pacientes mensualmente (60% provenientes de hospitalización y 40% de consultorio externo). Equivale decir que 11,016 pacientes presentan heridas crónicas de difícil resolución al año, los cuales requerirán de tratamiento especializado y una demanda anual promedio de 110,160 apósitos en stock. Los apósitos con mayor demanda corresponden a los Hidrogeles e Hidrocoloides, respectivamente que son utilizados por los resultados positivos que ofrecen en la curación de las heridas, aunque en ocasiones la limitante es el aspecto económico. En el mercado, el precio unitario oscila entre los 20 y 90 soles, esto representa una inversión económica de 1500 soles en promedio por paciente, produciendo en algunos casos complicaciones o abandono del tratamiento cuando los recursos son escasos. Conclusiones: La demanda de pacientes con heridas crónicas de difícil resolución en las instituciones de salud públicas de Lima metropolitana es alta. Es importante promover e incentivar la investigación de nuevas alternativas terapéuticas y/o dispositivos biomédicos que favorezcan su curación.
Objective: To analyze the potential for innovation in dressings to treat chronic wounds in the City of Lima. Methods: A qualitative study was carried out by means of interviews to medical experts and purchasing managers of medical supplies for the treatment of difficult-to-resolve wounds in 8 representative public health institutions with categories 1-4 within the only 54 of Lima, Peru - 2018. Results: It was determined that an average of 17 patients is treated in public health institutions on a monthly basis (60% from hospitalization and 40% from an outpatient office). It is equivalent to say that 11,016 patients present chronic wounds of difficult resolution each year, which will require specialized treatment and an average annual demand of 110,160 dressings in stock. The dressings with the highest demand correspond to the Hydrogels and Hydrocolloids, respectively; used because of the positive results they offer in wound healing, despite economic limitations. The market price per unit ranges between 20 and 90 soles (S/.), representing an economic investment of 1500 soles on average per patient, in some cases causing complications or abandonment of treatment when resources are scarce. Conclusions: There is a high demand for patients with chronic wounds of difficult resolution in the public health institutions of Lima. It is important to promote and incentivize the investigation of new therapeutic alternatives and / or biomedical devices that favor its treatment.
ABSTRACT
BACKGROUND: Interpregnancy interval (IPI) <6 months is a potentially modifiable risk factor for adverse perinatal health outcomes. OBJECTIVE: This systematic review evaluated the international literature on the risk of perinatal death associated with IPI. SEARCH STRATEGY: Two independent reviewers screened titles and abstracts identified in MEDLINE, EMBASE and Scopus from inception to 4 April 2019 (Prospero Registration #CRD42018092792). SELECTION CRITERIA: Studies were included if they provided a description of IPI measurement and perinatal death, including stillbirth and neonatal death. DATA COLLECTION AND ANALYSIS: A narrative review was performed for all included studies. Random effects meta-analysis was used to compare unadjusted odds of perinatal death associated with IPI <6 months and IPI ≥6 months. Analyses were performed by outcome of the preceding pregnancy and study location. MAIN RESULTS: Of the 624 unique articles identified, 26 met the inclusion criteria. The pooled unadjusted odds ratio of perinatal death for IPI <6 months was 1.34 (95% CI 1.17-1.53) following a previous live birth, 0.85 (95% CI 0.73-0.99) following a previous miscarriage and 1.07 (95% CI 0.84-1.36) following a previous stillbirth compared with IPI ≥6 months. However, few high-income country studies reported an association after adjustment. Fewer studies evaluated the impact of long IPI on perinatal death and what evidence was available showed mixed results. CONCLUSIONS: Results suggest a possible association between short IPI and risk of perinatal death following a live birth, particularly in low- to middle-income countries. TWEETABLE ABSTRACT: Short IPI <6 months after a live birth was associated with greater risk of perinatal death than IPI ≥6 months.
Subject(s)
Birth Intervals/statistics & numerical data , Perinatal Death , Female , Humans , Infant, Newborn , Pregnancy , Risk Assessment , Risk FactorsABSTRACT
Dos décadas atrás Baker dio el concepto de Programación Fetal (PF), donde asociaba el ambiente prenatal y el desarrollo del feto. En consecuencia, la PF representaría "la inducción de las respuestas fetales debido al entorno uterino" que condicionará cambios funcionales y estructurales en el propio feto, con repercusión a corto y largo plazo. En consecuencia, si el ambiente prenatal es adverso en el desarrollo, tendremos posiblemente patologías en la vida extra uterina. Las evidencias señalan, que procesos implicados en el desarrollo de diversas funciones de los sistemas orgánicos complejos, se iniciarían mucho antes del nacimiento y conformarían problemáticas de salud a futuro.
ABSTRACT
SETTING: Randomised Phase IIB clinical trial. OBJECTIVES: To assess whether increasing the dose of rifampicin (RMP) from 10 mg/kg to 15 or 20 mg/kg results in an increase in grade 3 or 4 hepatic adverse events and/or serious adverse events (SAE). METHODS: Three hundred human immunodeficiency virus negative patients with newly diagnosed microscopy-positive pulmonary tuberculosis (TB) were randomly assigned to one of three regimens: 1) the control regimen (R10), comprising daily ethambutol (EMB), isoniazid (INH), RMP and pyrazinamide for 8 weeks, followed by INH and RMP daily for 18 weeks; 2) Study Regimen 1 (R15), as above, with the RMP dose increased to 15 mg/kg body weight daily for the first 16 weeks; and 3) Study Regimen 2 (R20), as above, with RMP increased to 20 mg/kg. Serum alanine transferase (ALT) levels were measured at regular intervals. RESULTS: There were seven grade 3 increases in ALT levels, 1/100 (1%) among R10 arm patients, 2/100 (2%) in the R15 arm and 4/100 (4%) in the R20 arm (trend test P = 0.15). One (R15) patient developed jaundice, requiring treatment modification. There were no grade 4 ALT increases. There was a non-significant increase in culture negativity at 8 weeks with increasing RMP dosage: 75% (69/92) in R10, 82.5% (66/80) in R15 and 83.1% (76/91) R20 patients (P = 0.16). CONCLUSIONS: No significant increase in adverse events occurred when the RMP dose was increased from 10 mg/kg to 15 mg/kg or 20 mg/kg.
