A qualitative approach for a situation analysis of AMR risks in the food animal production sector.

In response to the need to manage Antimicrobial Resistance (AMR), countries have produced National Action Plans (NAPs), which require detailed information of the AMR situation in all sectors. Considering the limited information that is publicly available for an analysis of the AMR situation in animal production, the FAO Regional Office for Latin America and the Caribbean (FAO RLC) developed the "FAO tool for a situation analysis of AMR risks in the food and agriculture sectors." The objective of this paper is to present the methodology developed for a qualitative evaluation of the risk factors of AMR toward animal and human health, based on terrestrial and aquatic production systems and their associated national public and private mitigation measures. The tool was developed reflecting the AMR epidemiological model and the guidelines to conduct a risk analysis of AMR from the Codex Alimentarius and WOAH. Applied in four stages of progressive development, the objective of the tool is to provide a qualitative and systematic assessment of the risks of AMR from animal production systems, to animal and human health, and to identify gaps in cross cutting factors in AMR management. The tool consists of three instruments: (i) a survey to collect data for a situation analysis of AMR risks; (ii) a methodological procedure for the analysis of the information obtained; (iii) instructions for the preparation of a national roadmap for the containment of AMR at a national level. Based on the results from the information analysis, a roadmap is prepared by guiding and prioritizing the needs and sectoral actions for the containment of AMR under an intersectoral, multidisciplinary and collaborative approach, and according to country priorities and resources. The tool helps to determine, visualize and prioritize the risk factors and challenges that contribute to AMR from the animal production sector and that need to be addressed to manage AMR.

Diffuse Large B-Cell Lymphoma in Chile: The Impact of Combined CHOP Plus Rituximab in the Public Health System.

PURPOSE: Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype. The purpose of this study was to evaluate the clinical features, prognostic factors, and results of DLBCL that was treated in the cancer centers of the public health system in Chile and compare cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). PATIENTS AND METHODS: Patients age > 15 years who were treated in 18 cancer centers in the country between 2001 and 2017 were included. The Kaplan-Meier method was used to calculate overall survival (OS), and Cox proportional hazard regression modeling was used to evaluate the effect of the addition of rituximab to CHOP on OS. RESULTS: A total of 1,807 patients were evaluated. The median age at diagnosis was 62 (range, 15-95) years, with a female predominance (53%). Half of the patients were age ≥ 60 years. Serology for HIV infection was positive in 5% of cases (96 cases). International Prognostic Index scores were available for 90% of patients, of which 45% had low-risk, 25% low-intermediate-risk, 18% high-intermediate-risk, and 11% high-risk scores. CHOP was administered to 986 patients (55%; median follow-up, 13.2 years) and R-CHOP to 821 patients (45%; median follow-up, 8.4 years). R-CHOP was associated with superior OS compared with CHOP (5-year 66% v 48%, and 10-year 53% v 35%; P < .001). CONCLUSION: Rituximab improved the survival of patients with DLBCL diagnosed and treated in Chile. The benefit was sustained over time, with curative rates of > 50%. This intervention shows that the inclusion of this biological drug justified the expenses incurred by the Ministry of Health in the National Lymphoma Protocols in Chile.

Machine Learning-Based Prediction of Specific Energy Consumption for Cut-Off Grinding.

Cut-off operation is widely used in the manufacturing industry and is highly energy-intensive. Prediction of specific energy consumption (SEC) using data-driven models is a promising means to understand, analyze and reduce energy consumption for cut-off grinding. The present article aims to put forth a novel methodology to predict and validate the specific energy consumption for cut-off grinding of oxygen-free copper (OFC-C10100) using supervised machine learning techniques. State-of-the-art experimental setup was designed to perform the abrasive cutting of the material at various cutting conditions. First, energy consumption values were predicted on the bases of input process parameters of feed rate, cutting thickness, and cutting tool type using the three supervised learning techniques of Gaussian process regression, regression trees, and artificial neural network (ANN). Among the three algorithms, Gaussian process regression performance was found to be superior, with minimum errors during validation and testing. The predicted values of energy consumption were then exploited to evaluate the specific energy consumption (SEC), which turned out to be highly accurate, with a correlation coefficient of 0.98. The relationship of the predicted specific energy consumption (SEC) with material removal rate agrees well with the relationship depicted in physical models, which further validates the accuracy of the prediction models.

[The impact of novel drugs on the survival of patients with multiple myeloma in two chilean centers]. / Mieloma múltiple en Chile. Uso de drogas noveles en dos centros nacionales.

BACKGROUND: The incorporation of novel drugs, such as proteasome inhibitors and immunomodulators, improved considerably the survival of patients with multiple myeloma. AIM: To evaluate the effect on survival of proteasome inhibitors and immunomodulators in patients with multiple myeloma in two national hospitals. MATERIAL AND METHODS: Review of clinical records from two hospitals of Santiago. Epidemiological, clinical, laboratory and therapeutic data was obtained from 144 patients with multiple myeloma diagnosed between 2002 and 2016. RESULTS: Information was retrieved from 78 patients at one center and from 66 at the other center. The mean age at diagnosis was 58 and 62 years, the proportion of males was 53% and 52%, and presentation at stage III was 34% and 46%, respectively. The use of novel drugs, mainly bortezomib, was 90% in one of the centers and 3% in the other one. The use of autologous stem-cell transplantation was 47% and 3% respectively. The median overall survival of patients from the centers with and without access to novel drugs was 117 and 71 months respectively (p < 0.05). The five-year overall survival was 93 and 43% respectively (p < 0.05). CONCLUSIONS: The use of novel drugs, especially bortezomib, and autologous stem-cell transplantation significantly improved the survival of multiple myeloma patients treated in national hospitals. It is necessary to include them as a first line treatment.

Mieloma múltiple en Chile. Uso de drogas noveles en dos centros nacionales / The impact of novel drugs on the survival of patients with multiple myeloma in two chilean centers

BACKGROUND: The incorporation of novel drugs, such as proteasome inhibitors and immunomodulators, improved considerably the survival of patients with multiple myeloma. Aim: To evaluate the effect on survival of proteasome inhibitors and immunomodulators in patients with multiple myeloma in two national hospitals. MATERIAL AND METHODS: Review of clinical records from two hospitals of Santiago. Epidemiological, clinical, laboratory and therapeutic data was obtained from 144 patients with multiple myeloma diagnosed between 2002 and 2016. Results: Information was retrieved from 78 patients at one center and from 66 at the other center. The mean age at diagnosis was 58 and 62 years, the proportion of males was 53% and 52%, and presentation at stage III was 34% and 46%, respectively. The use of novel drugs, mainly bortezomib, was 90% in one of the centers and 3% in the other one. The use of autologous stem-cell transplantation was 47% and 3% respectively. The median overall survival of patients from the centers with and without access to novel drugs was 117 and 71 months respectively (p < 0.05). The five-year overall survival was 93 and 43% respectively (p < 0.05). CONCLUSIONS: The use of novel drugs, especially bortezomib, and autologous stem-cell transplantation significantly improved the survival of multiple myeloma patients treated in national hospitals. It is necessary to include them as a first line treatment.

Rol regulador del estado peruano en ensayos clínicos: las autorizaciones. Estudio cualitativo

Objetivos : Explicar el rol del Estado Peruano relacionado a los procesos participativos de los diversos actores que influyen en la regulación concerniente a la autorización de ensayos clínicos (EC). Metodología : Se presenta parte del estudio de caso correspondiente a una tesis de doctor llevada a cabo entre los años 2015 y 2017. Se utilizó información documental y se realizaron 14 entrevistas semiestructuradas a informantes claves. También se sistematizaron experiencias relacionadas a la autorización e inspección de ensayos clínicos, así como la verificación de centros de investigación. Se contó también con la información pública disponible del Instituto Nacional de Salud del Perú. El análisis se realizó dentro de un marco epistemológico y hermenéutico con la aprobación del Comité de Ética de la Facultad de Medicina de San Fernando. Resultados : Los temas identificados fueron los siguientes: demora en los tiempos regulatorios que autorizan los ensayos, aumento de las no autorizaciones en un determinado lapso de 3 años, suspensión de las autorizaciones para ejecutar EC en niños, lo que llevó a una progresiva reducción de las solicitudes y por consiguiente de los ensayos clínicos desde el año 2009 en adelante. Conclusiones : En el estudio realizado, la regulación del Estado Peruano en cuanto a la autorización de EC se ha debilitado al reducir el ejercicio de ciudadanía en salud de los participantes y las fortalezas de algunos actores, particularmente la generación de competencias de los investigadores para desarrollar EC.

Objectives : To explain the role of the Peruvian Government related to participation of different stakeholders influencing regulations for authorizing clinical trials (CT). Methodology : We present part of a case study corresponding to a PhD thesis performed between 2015 and 2017. We used document information and 14 semi-structured interviews with key informants were performed. We also systematized experiences related to clinical trial authorization and inspection, as well as verification of investigation sites. We also had access to publicly available information from the Peruvian National Institute of Health. The analysis was performed within epistemological and hermeneutical frameworks, and it was approved by the Ethics Committee from San Fernando Public Medicine School. Results : Issues identified were as follows: Delay in regulatory times authorized for CTs; suspension of authorizations for performing CTs in children, which led to progressive reduction in requests and consequently to a reduction in CTs from 2009 on. Conclusions : According to this study, regulations by Peruvian authorities have weakened, since participants and some stakeholders are not able to exert their rights, particularly with respect to competence generation for researchers when trying to develop CTs.

Prevención de infecciones asociadas a la atención de salud: conocimientos y prácticas en médicos residentes / Prevention of health care-associated infections: knowledge and practices in resident physicians

RESUMEN Objetivos. Determinar el nivel de conocimientos y prácticas sobre las medidas de prevención de las infecciones asociadas a la atención de salud (IAAS) y sus factores asociados en médicos residentes ingresantes 2018 de una universidad de Lima, Perú. Métodos. Estudio transversal en el cual se aplicó un cuestionario validado a 171 médicos residentes. Las variables estudiadas fueron edad, sexo, tiempo como profesional, capacitaciones previas, procedencia, tipo de universidad de procedencia, entre otras. Resultados. 52% de los participantes fueron de sexo femenino, el 49% tenía 2 o menos años de tiempo como profesional médico, el 49% provenía de una universidad del interior del país, solo el 34% ocupó una vacante cautiva y el 71,9% tuvo capacitaciones previas sobre medidas de prevención de IAAS. El 83% de los médicos residentes ingresantes estudiados mostró poco conocimiento sobre medidas de prevención de las IAAS mientras que el 68,4% mostró prácticas no adecuadas sobre medidas de prevención de las IAAS. El ingreso a una especialidad de medicina estuvo asociado a un menor riesgo de tener poco conocimiento (OR: 0,32, IC 95%: 0,11-0,93). El mayor tiempo como profesional se relacionó a un menor riesgo de tener prácticas inadecuadas (OR: 0,936, IC 95%: 0,89-0,99). Conclusiones. Existe un bajo nivel de conocimientos sobre medidas de prevención de IAAS y una elevada proporción de los residentes ingresantes 2018 tuvo prácticas no adecuadas sobre medidas de prevención de IAAS. Se observó que el tipo de especialidad fue un factor asociado al nivel de conocimientos y el tiempo de experiencia profesional fue un factor asociado al tipo de práctica.

ABSTRACT Objectives. To determine level of knowledge and practices on the measures of prevention of infections associated with health care (HAI) and factors associated with in incoming resident physicians 2018 of a university of Lima, Peru. Methods. A validated questionnaire was applied to 171 resident physicians in a cross-sectional study. Variables studied were age, sex, time as a professional, previous training, origin, type of university of origin, among others. Results. It was observed that 52% are female, 49% had 2 or less years as a medical professional, 49% came from a university in the interior of the country, only 34% occupied a captive vacancy and 71.9% had previous training on HAI prevention measures. 83% of the incoming resident physicians studied showed a low level of knowledge about HAI prevention measures while 68.4% of the incoming resident physicians studied showed inappropriate practices on HAI prevention measures. When performing the multivariate analysis, it showed that entering a medicine specialty was associated with a lower risk of having low level of knowledge (OR: 0.32, 95% CI: 0.11-0.93). The bivariate analysis showed that the longest time as a professional was related to lower risk of having inappropriate practices, this being confirmed when performing the multivariate analysis (OR: 0.936, 95% CI: 0.89-0.99). Conclusions. There is a low level of knowledge about HAI prevention measures and a high proportion with inappropriate practices in incoming residents 2018 on HAI prevention measures. It was observed that the type of specialty is a factor associated with the level of knowledge and the time of professional experience is a factor associated with the type of practice.

Surface Damaging of Brass and Steel Pins when Sliding over Nitrided Samples Cut by Finishing and Roughing EDM Conditions.

In the forging industry, surface quality and surface treatments of dies are crucial parameters to extend their life. These components are usually machined by milling or by Electrical Discharge Machining (EDM), and the final surface roughness depends on the machining techniques and operational conditions used in its fabrication. After milling, a nitriding treatment is widely applied to extend its service life. Nevertheless, no scientific report that informs about nitriding after EDM has been found. Accordingly, this work focuses on the wear and friction behavior of pins made of brass and medium carbon steel sliding over AISI H13 discs, made by wire EDM in the conditions of finishing and roughing. The discs are plasma nitride, and their effect on the wear during pin-on-disc tests is evaluated. In this sense, the analysis of the surface damage for the different pins will help us to understand the service life and wear evolution of the forging dies. The results show that plasma nitride reduces the friction and prevents the degradation of the pin, independently of the material of the pin, when sliding over finishing and roughing EDM conditions.

Estimation of Specific Cutting Energy in an S235 Alloy for Multi-Directional Ultrasonic Vibration-Assisted Machining Using the Finite Element Method.

The objective of this work is to analyze the influence of the vibration-assisted turning process on the machinability of S235 carbon steel. During the experiments using this vibrational machining process, the vibrational amplitude and frequency of the cutting tool were adjusted to drive the tool tip in an elliptical or linear motion in the feed direction. Furthermore, a finite element analysis was deployed to investigate the mechanical response for different vibration-assisted cutting conditions. The results show how the specific cutting energy and the material's machinability behave when using different operational cutting parameters, such as vibration frequency and tool tip motion in the x-axis, y-axis, and elliptical (x-y plane) motion. Then, the specific cutting energy and material's machinability are compared with a conventional turning process, which helps to validate the finite element method (FEM) for the vibration-assisted process. As a result of the operating parameters used, the vibration-assisted machining process leads to a machinability improvement of up to 18% in S235 carbon steel. In particular, higher vibration frequencies were shown to increase the material's machinability due to the specific cutting energy decrease. Therefore, the finite element method can be used to predict the vibration-assisted cutting and the specific cutting energy, based on predefined cutting parameters.

Impacto de la cirugía bariátrica en la mejora de la diabetes mellitus tipo 2. Estudio en un hospital del Seguro Social de Lima, Perú / Impact of metabolic surgery on the improvement of mellitus diabetes type 2. Study in a hospital del Seguro Social de Lima, Perú

INTRODUCCIÓN: en pacientes obesos con diabetes mellitus 2 (DM2), es difícil el manejo convencional para su control, particularmente en aquellos con obesidad aumentada o mórbida. Al respecto, para el control de la DM2 se está haciendo uso de la cirugía bariátrica (CB) en los últimos años. OBJETIVO: Evaluar el impacto de la CB en la mejora de la DM2 a los 12 meses de la intervención a pacientes diabéticos obesos. MÉTODOS: Se hizo un estudio de cohorte retrospectivo de pacientes diabéticos obesos en Lima-Perú. El grupo expuesto tuvo CB y el grupo no expuesto recibió tratamiento convencional. Se evaluaron glicemia y hemoglobina glicosilada (Hbg), antes y después de las intervenciones. Se evalúo el efecto de las intervenciones en los pacientes. Se incluyó 173 pacientes diabéticos obesos (41 expuestos y 132 no expuestos). Se calcularon incidencias acumuladas, riesgo relativo (RR), reducción absoluta del riesgo (RAR) y reducción relativa del riesgo (RRR). RESULTADOS: La técnica de CB mayormente utilizada fue by pass gástrico en 27 (67,8%) pacientes. Se observó que la reducción de la mediana de hemoglobina glicosilada y de la glicemia en ayunas después de la CB fueron estadísticamente significativas (p < 0,01), a diferencia del grupo no expuesto que no mostraron cambios. La incidencia anual de DM2 en los expuestos fue 29,3% (IC95%: 14,1; 44,4) mientras que en los no expuestos fue 90,1% (IC95%: 85,6; 96,2), siendo el RR de DM2 de 0,32 (IC 95%: 0,2; 0,5). La reducción absoluta del riesgo (RAR) fue 60,8%, y la reducción relativa del riesgo (RRR) 67,8%. Discusion: los resultados son similares a algunos estudios realizados, en los que además, no hubo fallecidos, complicaciones quirúrgicas y ningún tuvo pie diabético. CONCLUSIONES: Las CB evidencian efectos benéficos en los pacientes con DM2 y obesidad, asi como limitaciones del tratamiento convencional en este tipo de pacientes

INTRODUCTION: in obese diabetes mellitus 2 (DM2) patients, is difficult conventional medical management for controlling, particulary in those with increased or morbid obesity. In this regard, bariatric surgery has been used in recent years to control DM2 associated to obesity. OBJECTIVE: To evaluate the impact of bariatric surgery on the improvement of DM2 12 months after surgery. METHODOLOGY: A retrospective cohort of obese diabetic patients managed in an Esalud hospital in Lima- Perú was done. The exposed group was subjected to bariatric surgery and the non-exposed group received the conventional treatment. Glycemia and glycosylated hemoglobin (Hbg) were evaluated, before and after the interventions. The effect of the interventions on the patients was evaluated. We included 173 obese diabetic patients (41 exposed and 132 unexposed). Cumulative incidences, relative risk (RR), absolute risk reduction (RAR) and relative risk reduction (RRR) were calculated. RESULTS: the most widely used technique of CB was gastric bypass in 27 (67.8%) patients. It was observed that the reduction in median glycosylated hemoglobin and fasting glycemia after bariatric surgery was statistically significant (p < 0.01), unlike the unexposed group who showed no change. The annual incidence of DM2 in those exposed was 29.3% (CI95%: 14.1; 44.4) while in the unexposed it was 90.1% (CI95%: 85.6; 96.2), being the RR of DM2 of 0.32 (CI 95%: 0.2; 0.5). The absolute risk reduction (RAR) was 60.8%, and the relative risk reduction (RRR) was 67.8%. DISCUSSION: the results are similar to some studies related to bariatric surgery in obese DM2 patients, in which besides, there were not deaths, no surgical complications and no diabetic foot. CONCLUSIONS: The results of the study show that bariatric surgery evidences beneficial effects in patients with DM2 and obesity, as well as the limitations of conventional treatment on this type of patients

CAUSES OF MATERNAL DEATH IN THE CALLAO REGION, PERÚ. DESCRIPTIVE STUDY, 2000-2015.

OBJETIVE: To identify the causes of maternal mor- tality in the Callao Region between 2000 and 2015. METHODS: Case series study conducted in public and private healthcare institutions in the region of Callao in Perú. Overall, 131 women who met the selection criteria were included as cases of maternal mortality (MM). MM was defined as death of a woman during pregnancy, childbirth or the postpartum period (within the first 42 days after childbirth) in healthcare institutions in Callao. MM clinical-epidemiological records were reviewed. The analysis was performed using percent frequencies and means. RESULTS: Of the causes of MM, 61.1 % were direct and 38.9 % were indirect. The most frequent direct causes were hypertensive disorders of pregnancy, obstetric bleeding and miscarriage. Average time between the onset of discomfort and the decision to ask for assistance was 20 minutes; mean time to arrive at the healthcare institution after making the decision was 20 minutes; and mean delay time between arrival to the institution and provision of care was 7 minutes. Of the total number of maternal deaths, 96.9 % occurred in a healthcare institution. CONCLUSION: The study showed that the causes of MM are mainly of a direct type, primarily due to hypertensive disorders of pregnancy, obstetric bleeding and miscarriage, while indirect causes of MM were less frequent, consisting mainly of infectious causes..

TITULO: CAUSAS DE MUERTE MATERNA EN LA REGIÓN DE CALLAO, PERÚ. ESTUDIO DESCRIPTIVO, 2000-2015. OBJETIVO: Identificar las causas de mortalidad ma- terna en la región de Callao, entre los años 2000 y 2015. METODOS: Estudio de serie de casos en establecimientos de salud (ES) públicos y priva- dos de la región de Callao en Perú. Se incluyeron 131 mujeres como casos de muerte materna (MM) que cumplían los criterios de selección. Se consideró MM, mujer fallecida durante el embarazo, parto o posparto (dentro de los 42 días posparto), en ES del Callao. Se revisaron las historias clínico-epi- demiológicas de MM. El análisis se realizó usando frecuencias porcentuales y promedios. RESULTADOS: El 61,1 % de las causas fueron directas y el 38,9 % indirectas. Las causas directas más frecuentes fueron los trastornos hipertensivos del embarazo, las hemorragias obstétricas y el aborto. La mediana del tiempo que tardó la gestante desde el inicio de las molestias hasta que decidió pedir atención fueron 20 minutos, la mediana del tiempo que tardó en llegar al ES luego de decidir la atención fue de 20 minutos, y la mediana del tiempo de demora desde que llegó la gestante al ES hasta ser atendida fue de 7 minutos. El 96,9 % de las muertes maternas se produjeron en ES. CONCLUSIONES: El estudio demostró que la principal causa de MM es la directa, principalmente debido a trastornos hipertensivos del embarazo; la hemo- rragia obstétrica y el aborto, mientras que en menor proporción fueron las MM indirectas, principal- mente enfermedades infecciosas.

Model Based on an Effective Material-Removal Rate to Evaluate Specific Energy Consumption in Grinding.

Grinding energy efficiency depends on the appropriate selection of cutting conditions, grinding wheel, and workpiece material. Additionally, the estimation of specific energy consumption is a good indicator to control the consumed energy during the grinding process. Consequently, this study develops a model of material-removal rate to estimate specific energy consumption based on the measurement of active power consumed in a plane surface grinding of C45K with different thermal treatments and AISI 304. This model identifies and evaluates the dissipated power by sliding, ploughing, and chip formation in an industrial-scale grinding process. Furthermore, the instantaneous positions of abrasive grains during cutting are described to study the material-removal rate. The estimation of specific chip-formation energy is similar to that described by other authors on a laboratory scale, which allows to validate the model and experiments. Finally, the results show that the energy consumed by sliding is the main mechanism of energy dissipation in an industrial-scale grinding process, where it is denoted that sliding energy by volume unity decreases as the depth of cut and the speed of the workpiece increase.

Causes of maternal death in the callao region, perú. descriptive study, 2000-2015 / Causas de muerte materna en la región de callao, perú. estudio descriptivo, 2000-2015

ABSTRACT Objective: To identify the causes of maternal mortality in the Callao Region between 2000 and 2015. Materials and methods: Case series study conducted in public and private healthcare institutions in the region of Callao in Perú. Overall, 131 women who met the selection criteria were included as cases of maternal mortality (MM). MM was defined as death of a woman during pregnancy, childbirth or the postpartum period (within the first 42 days after childbirth) in healthcare institutions in Callao. MM clinical-epidemiological records were reviewed. The analysis was performed using percent frequencies and means. Results: Of the causes of MM, 61.1 % were direct and 38.9 % were indirect. The most frequent direct causes were hypertensive disorders of pregnancy, obstetric bleeding and miscarriage. Average time between the onset of discomfort and the decision to ask for assistance was 20 minutes; mean time to arrive at the healthcare institution after making the decision was 20 minutes; and mean delay time between arrival to the institution and provision of care was 7 minutes. Of the total number of maternal deaths, 96.9 % occurred in a healthcare institution. Conclusion: The study showed that the causes of MM are mainly of a direct type, primarily due to hypertensive disorders of pregnancy, obstetric bleeding and miscarriage, while indirect causes of MM were less frequent, consisting mainly of infectious causes.

RESUMEN Objetivo: identificar las causas de mortalidad materna en la región de Callao, entre los años 2000 y 2015. Materiales y métodos: estudio de serie de casos en establecimientos de salud (ES) públicos y privados de la región de Callao en Perú. Se incluyeron 131 mujeres como casos de muerte materna (MM) que cumplían los criterios de selección. Se consideró MM, mujer fallecida durante el embarazo, parto o posparto (dentro de los 42 días posparto), en ES del Callao. Se revisaron las historias clínico-epidemiológicas de MM. El análisis se realizó usando frecuencias porcentuales y promedios. Resultados: el 61,1 % de las causas fueron directas y el 38,9 % indirectas. Las causas directas más frecuentes fueron los trastornos hipertensivos del embarazo, las hemorragias obstétricas y el aborto. La mediana del tiempo que tardó la gestante desde el inicio de las molestias hasta que decidió pedir atención fueron 20 minutos, la mediana del tiempo que tardó en llegar al ES luego de decidir la atención fue de 20 minutos, y la mediana del tiempo de demora desde que llegó la gestante al ES hasta ser atendida fue de 7 minutos. El 96,9 % de las muertes maternas se produjeron en ES. Conclusión: el estudio demostró que la principal causa de MM es la directa, principalmente debido a trastornos hipertensivos del embarazo; la hemorragia obstétrica y el aborto, mientras que en menor proporción fueron las MM indirectas, principalmente enfermedades infecciosas.

[Survival of 1,103 Chilean patients with multiple myeloma receiving different therapeutic protocols from 2000 to 2016]. / Mieloma múltiple en Chile: pasado, presente y futuro del programa nacional de drogas antineoplásicas (PANDA). Revisión de 1.103 pacientes.

BACKGROUND: Multiple myeloma (MM) is one of the most common malignancies found in hematology. AIM: To describe the features of patients with MM and perform a survival analysis according to the different treatment protocols used between 2000 and 2016. MATERIAL AND METHODS: Analysis of the database of the Chilean national anti-neoplastic drug program. Information was obtained from 1,103 patients, with a median age of 64.5 years (range 27-95) and a male to female ratio of 1:1.2. RESULTS: The mean overall survival (OS) of patients receiving or not receiving Thalidomide was 46 and 30 months, respectively (p < 0.01). The mean OS of patients treated before 2007 (treated with melphalan and prednisone) and between 2007 and 2012 (treated with thalidomide and dexamethasone) was 36 and 48 months respectively. In the group starting in 2013 (treated with cyclophosphamide, thalidomide and dexamethasone) the median survival had not been reached at 20 months of follow up (p = 0.01 for all comparisons). Autologous transplantation (AT) was carried out in only 18% of the eligible patients. The median OS of the patients who receive an AT had not been reached at 48 month compared with 36 month among those who did not received the procedure (p < 0.01). CONCLUSIONS: Even though overall survival has improved with time, new drugs must be introduced in our protocols to obtain similar results to those obtained worldwide.

[Effectiveness of mobile technology and weight gain in pregnant women in Callao, Peru]. / Eficacia de la tecnología móvil y ganancia de peso en gestantes en Callao, Perú.

OBJECTIVE: To evaluate the effectiveness of mobile technology in the appropriate weight gain of pregnant women. MATERIALS AND METHODS: A quasi-experimental study. The sample included 117 pregnant women attending health facilities at la Dirección Regional de Salud (Diresa), Callao. Messages were sent to 58 pregnant women who formed the experimental group to improve their lifestyles and assistance to prenatal care (APC), while 59 pregnant women received routine education provided for pregnants. Messages were sent every three days. The nutritional status of the pregnant women was evaluated using the pre gestational BMI at the first visit of the APC. The weight gain was obtained from the difference between pre-gestational weight and weight recorded during the last controls. RESULTS: The adequate weight gain was 27.6% of intervened pregnancies and 25.4% in the non-intervened. The 79.3% pregnant had six or more NPC in the group intervened and 54.2% in the non-intervened. The weight gain was excessive in 5.1% in the non-intervened pregnant and 1.7% in the intervened. The highest percentage of pregnant women with adequate weight gain (32.0%) was observed in the intervened pregnancies with pre-gestacional overwhegith. CONCLUSIONS: There was no statistic difference in the use of mobile technology for a proper weight gain between both study groups. There were greater fulfillment of APC in intervened pregnancies compared to the non-intervened (p<0.05).

OBJETIVO: Evaluar la eficacia de la tecnología móvil en la ganancia adecuada de peso de las gestantes estudiadas. MATERIALES Y MÉTODOS: Estudio cuasi-experimental. Se incluyó a 117 gestantes que acudieron a establecimientos de salud de la Dirección Regional de Salud (Diresa), Callao. Se envió mensajes a 58 gestantes que conformaban el grupo experimental para mejorar sus estilos de vida y asistencia al control prenatal (CPN), mientras que 59 gestantes recibieron la educación rutinaria durante la gestación. Los mensajes se enviaron cada tres días. En la primera visita del control pre natal se evaluó el estado nutricional de las gestantes tomando como referencia el IMC pre gestacional. La ganancia de peso se obtuvo por diferencia entre el peso pre-gestacional y peso registrado durante los últimos controles. RESULTADOS: La ganancia de peso adecuada fue 27,6% de gestantes intervenidas y 25,4% en las no intervenidas. El 79,3% de gestantes tuvieron seis o más CPN en el grupo intervenido y 54,2% en las no intervenidas. La ganancia de peso fue excesiva en 5,1% en las gestantes no intervenidas y solo 1,7% en las intervenidas. El mayor porcentaje de gestantes con ganancia de peso adecuada (32,0%) se observó en las gestantes intervenidas con sobrepeso pre gestacional. CONCLUSIONES: No hubo diferencia estadística al usar la tecnología móvil para la adecuada ganancia de peso entre los grupos de estudio. Existió mayor cumplimiento de asistencia al CPN en el grupo de gestantes intervenidas comparado con el no intervenido (p<0,05).

Mieloma múltiple en Chile: pasado, presente y futuro del programa nacional de drogas antineoplásicas (PANDA). Revisión de 1.103 pacientes / Survival of 1, 103 Chilean patients with multiple myeloma receiving different therapeutic protocols from 2000 to 2016

Background: Multiple myeloma (MM) is one of the most common malignancies found in hematology. Aim: To describe the features of patients with MM and perform a survival analysis according to the different treatment protocols used between 2000 and 2016. Material and Methods: Analysis of the database of the Chilean national anti-neoplastic drug program. Information was obtained from 1,103 patients, with a median age of 64.5 years (range 27-95) and a male to female ratio of 1:1.2. Results: The mean overall survival (OS) of patients receiving or not receiving Thalidomide was 46 and 30 months, respectively (p < 0.01). The mean OS of patients treated before 2007 (treated with melphalan and prednisone) and between 2007 and 2012 (treated with thalidomide and dexamethasone) was 36 and 48 months respectively. In the group starting in 2013 (treated with cyclophosphamide, thalidomide and dexamethasone) the median survival had not been reached at 20 months of follow up (p = 0.01 for all comparisons). Autologous transplantation (AT) was carried out in only 18% of the eligible patients. The median OS of the patients who receive an AT had not been reached at 48 month compared with 36 month among those who did not received the procedure (p < 0.01). Conclusions: Even though overall survival has improved with time, new drugs must be introduced in our protocols to obtain similar results to those obtained worldwide.

[Sanitary management and resistance to antimicrobial agents in production animals]. / Gestión sanitaria y resistencia a los antimicrobianos en animales de producción.

The important benefits of antimicrobial agents in disease control have turned them into a fundamental tool in animal production. Nevertheless, its elevated use and, often, misuse, has contributed to one of the main public health problems in the world: resistance to antimicrobial agents. At the animal production level, the applications in terms of health management allow decreasing the need to use antimicrobial agents and, in the cases where they are needed, the good practices reduce their potential to cause resistance to a minimum. Despite this, the application and development of new strategies that allow facing the problem on a trans-sectoral basis are required, integrating all participants in the public and private sector.

Los importantes beneficios de los antimicrobianos en el control de enfermedades los han transformado en una herramienta fundamental en la producción animal. Sin embargo, su elevado uso y, muchas veces, mal uso, ha contribuido a uno de los principales problemas de la salud pública a nivel mundial: la resistencia a los antimicrobianos. A nivel de la producción animal, las aplicaciones de manejos sanitarios permiten disminuir la necesidad de uso de antimicrobianos y en caso de necesitar su utilización, las buenas prácticas reducen al mínimo la posibilidad de generar resistencia. A pesar de esto, es necesario la aplicación y el desarrollo de nuevas estrategias que permitan enfrentar el problema de manera intersectorial, integrando a todos los participantes del sector público y privado.

Influence of the Regime of Electropulsing-Assisted Machining on the Plastic Deformation of the Layer Being Cut.

In this article, the influence of electropulsing on the machinability of steel S235 and aluminium 6060 has been studied during conventional and electropulsing-assisted turning processes. The machinability indices such as chip compression ratio ξ , shear plane angle ϕ and specific cutting energy (SCE) are investigated by using different cutting parameters such as cutting speed, cutting feed and depth of cut during electrically-assisted turning process. The results and analysis of this work indicated that the electrically-assisted turning process improves the machinability of steel S235, whereas the machinability of aluminium 6060 gets worse. Finally, due to electropluses (EPs), the chip compression ratio ξ increases with the increase in cutting speed during turning of aluminium 6060 and the SCE decreases during turning of steel S235.