Sustainable Development Goals' health-related indicators for Brazil and Ecuador: an analysis for the period of 1990-2019.

OBJECTIVE: This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019. STUDY DESIGN: Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study. METHODS: Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries. RESULTS: Both countries have made progress on child stunting (Brazil: PC = -38%; Ecuador: PC = -43%) and child wasting prevalences (Brazil: PC = -42%; Ecuador: PC = -41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = -75%; Ecuador: PC = -60%) and neonatal mortality rates (Brazil: PC = -69%; Ecuador: PC = -51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = -40%; Ecuador: PC = -58%), tuberculosis (Brazil: PC = -27%; Ecuador: PC = -55%) and malaria incidences (Brazil: PC = -97%; Ecuador: PC = -100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = -89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = -37%; Ecuador: PC = -40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = -67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%). CONCLUSIONS: Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters.

Manejo de extrusión forzada ortodóntica: Reporte de un caso / Management and Follow-up of Orthodontic Forced Extrusion: A Case Report

El presente caso clínico se enfoca en el diagnóstico y el tratamiento de erupción forzada en un paciente con trauma dental. Objetivo: Proponer una alternativa de tratamiento multidisciplinario el cual permita incrementar estructura dentaria a través de la extrusión forzada y posteriormente rehabilitarlo en función y estética. Métodos: Se describe el caso de un paciente adulto de 78 años de sexo masculino, sano y sin antecedentes patológicos, acude a la clínica de la Especialidad de Ortodoncia y Ortopedia Dentomaxilo facial, referido por un especialista en Endodoncia, debido a fractura corono-radicular de canino superior derecho, pilar de puente fijo de tres unidades En la exploración intraoral presenta fractura cervical de la corona del canino superior derecho. Como primer paso, se realizó tratamiento endodóntico en la pieza dentaria y colocación de un aditamento intraconducto de soporte (endoposte vaciado), con el objeto de mejorar la tracción ortodóntica. Este aditamento consistió en un poste colado con perforaciones. Se procede a colocar aparatología fija en la arcada superior con técnica MBT (slot 0.022), del molar derecho hasta el canino izquierdo de cementado indirecto y pasivo (con los slots de los brackets alineados). Inmediatamente después, se colocó un arco rectangular 0.019 x 0.025 de acero inoxidable con un doblez de extrusión a nivel del canino superior derecho. En el mismo doblez, se adaptó un loop tipo helix que funcionó como apoyo para colocar la ligadura pasiva (lace back). Resultados : El tratamiento realizado en este paciente es satisfactorio, coadyuvando en su estado de salud general mejorando su autoestima. Conclusión: Aquí se aprovecharon todas las ventajas que ofrece la extrusión ortodóntica forzada, incluso en un paciente adulto mayor, logrando una tracción de cuatro milímetros, que se consiguió gracias al empleo de fuerzas extrusivas ligeras y controladas sobre el órgano dentario afectado. Con la modalidad de tratamiento descrita se puede lograr un alargamiento de corona sin la necesidad de realizar una resección ósea, lo que permite una correcta rehabilitación protésica, devolviendo la función y estética al diente lesionado y brindando un beneficio integral al paciente.

The case of an adult patient with a complicated Crown fracture of the right upper canine due to trauma is reported, diagnosing a class VII Ellis coronal fracture. There are several treatment alternatives that range from the extraction, placement of a bone graft and placement of an implant, to a forced root extrusión with bone removal to allow the biological space and subsequently be restored. In the present case, a multidisciplinary orthodontic forced extrusion treatment is performed, which allows to increase the amount of clinical remnant, preserving the periodontal support and maintaining the biologic thickness, thus achieving to maintain the root remnant with good length so that prosthetic rehabilitation is facilitated. The clinical and radiographic follow-up was 12 months. The multidisciplinary treatment involved: Root canal treatment, forced extrusion with orthodontics, fibrotomy with root planing and fixed prosthesis.

Development of FPGA-based multi-sensor excitation low voltage (MSELV) chassis at Jefferson Lab.

The design and development of the sensor excitation and read back chassis was driven by the requirements for the monitoring and control of two conduction-cooled superconducting magnets in Hall B for the 12 GeV accelerator upgrade. The torus and solenoid superconducting magnets require extensive instrumentation. Sensor selection was accomplished by applying Jefferson Lab's (JLab) risk mitigation process, which employed a failure modes and effects analysis approach. The goal was to accommodate all sensor types for monitoring and control and to develop a generic multisensor excitation low voltage chassis that would be used across both magnet systems with a reduced set of functions. The chassis has been deployed in experimental Hall B at JLab and has been performing successfully since July 2016.

Amaranth addition to enzymatically modified wheat flour improves dough functionality, bread immunoreactivity and quality.

Consumers with gluten-related disorders require gluten-free (GF) foods to avoid an immune response. Alternative to the use of non-gluten containing grains to prepare GF bread, the gluten reactivity has been greatly reduced using a proline specific cleavage enzyme, however, the gluten functionality was lost. The aim of this study was to evaluate the effect of adding an amaranth flour blend (AFB) to enzymatically modified wheat-flour proteins on dough functionality and to evaluate the immunoreactivity and acceptability of the prepared bread. First, wheat flour (20% w/v, substrate) was hydrolyzed using 8.4 U mg-1 protein Aspergillus niger prolyl-endopeptidase (AnPEP) for 8 h at 40 °C under constant agitation. Four types of breads were prepared with the same formulation except for the type of flour (14% w.b.): wheat flour (WF), WF-AFB unmodified not incubated, WF-AFB unmodified incubated and WF-AFB modified. The protein composition and free thiols were analyzed before and after amaranth addition, and the flour and bread proteins were run using SDS-PAGE and immune-detected in blots with IgA from celiac disease patients. The immunoreactive gluten content, specific volume and bread acceptability were evaluated. The polymeric proteins and free thiol groups of WF decreased after AnPEP treatment. The electrophoretic patterns of the modified flour and bread proteins were different and the IgA-immunodetection in blots was highly reduced, particularly for the higher molecular weight subunits. The addition of AFB to the modified wheat flour prepared using AnPEP improved the dough functionality by increasing the thiol groups and allowed the preparation of a sensorially acceptable bread with only 60 mg kg-1 immunoreactive gluten.

The epithelial mesenchymal transition process may contribute to the pathogenesis of amniotic band syndrome.

The etiology of the amniotic band syndrome is unknown, and has been subject of debate since the time of Hippocrates. The most accepted theories fail to cover all the abnomalities found in affected children. During organogenesis the epithelial-mesenchymal transition process (EMTP) participates in adequate formation of different organs from three embryo layers. Altered activation of EMTP occurs when the epithelial homeostasis is disturbed, the resulting myofibroblasts are able to secrete extracellular matrix proteins and deposit them on the tissues contributing to a fibrotic phenotype. If injury occurs during organogenesis, wound healing could be exaggerated and fibrotic response could be triggered. The molecule that regulates both of these processes (EMTP and fibrosis) is the transforming growth factor ß (TGFß); indeed null animals for TGFß isoforms show similar defects than those seen in the amniotic band syndrome. Based on documented evidence this review intends to explain how the epithelial mesenchymal transition process may contribute to the pathogenesis of amniotic band syndrome.

Estudio de caso de una preescolar con déficit en los requisitos universales de autocuidado secundario a osteogénesis imperfecta / Study on a pre-scholar patient with universal requisites self-care deficit due to osteogenesis imperfecta

La elaboración del presente trabajo tiene la finalidad de aplicar el modelo teórico de Dorothea Orem como fundamento teórico para la aplicación del proceso enfermero a una paciente con diagnóstico clínico de osteogénesis imperfecta (OI), mismo que afecta sus requisitos de autocuidado universal. Para la elaboración de los diagnósticos de Enfermería se utilizó el formato PES (Problema, Etiología, Signos y síntomas), se realizó una jerarquización de los mismos con base en prioridades, y posteriormente, para la elaboración del plan de cuidados, recurrimos a la Enfermería Basada en Evidencia, para lo cual se consultaron diferentes bibliotecas virtuales. La evaluación de las intervenciones de Enfermería fue favorable, colaborando a la resolución de los requisitos alterados y a la adquisición de competencias necesarias en la familia para compensar las deficiencias.

The preparation of this paper aims to apply the theoretical model of Dorothea Orem as theoretical foundation for the application of the nursing process in a patient with clinical diagnosis of osteogenesis imperfect (OI), it affects their universal self-care requirements. For the development of nursing diagnoses used the PES format (Problem, Etiology, Signs and Symptoms), there was a hierarchy of them on a priority basis, and subsequently, to the development of the care plan based nursing resort to in evidence, to which were consulted different virtual libraries. Evaluating nursing interventions was favorable, contributing to the resolution of the changed requirements and the acquisition of skills needed in the family to compensate for deficiencies.

Haematophagous bat bites in Ecuadorian Amazon: characterisation and implications for sylvatic rabies prevention.

OBJECTIVE: To characterise the risk factors of haematophagous bat bites and to provide information to contribute to the prevention of rabies in Ecuador. DESIGN: Cross-sectional study based on interviews with 3518 individuals, from which two sets of variables were generated: characteristics of haematophagous bat attacks in the previous year among humans and risk factors for being bitten. METHODS: Data were analysed using multivariate logistic regression models, taking history of bat bites in the previous year as the response variable. RESULTS: In the previous year 723 (20.6%, 95%CI 19.3-21.9) of the participants declared having received haematophagous bat bites and 50.4% in the previous month, giving an incidence rate of 10.4% (95%CI 9.6-11.6) per month. Sleeping on the floor or in a hammock (adjusted odds ratio [aOR] 1.58, 95%CI 1.21-2.06), not using a protective bed net (aOR 1.25, 95%CI 1.03-1.50) and living in a dwelling with permanent openings in the structure (aOR 1.49, 95%CI 1.12-1.95) were associated with a higher probability of bat bites. Those most affected were the group aged ≤12 years (age 13-19 years, aOR 0.39, 95%CI 0.32-0.48; age ≥20 years, aOR 0.67, 95%CI 0.50-0.90). CONCLUSION: Primary prevention based on pre-exposure vaccination would be justifiable given the high dispersion of the population and the high incidence of bat bites. As a secondary protective measure, communities should work towards increasing the use of protective measures and putting barriers in permanent openings in their dwellings.

Risk of tuberculosis in public transport sector workers, Lima, Peru.

SETTING: Delays from symptom onset to the diagnosis and treatment of smear-positive pulmonary tuberculosis (TB) produces possible new cases in persons in close contact with TB cases, especially in confined spaces such as overcrowded public transport, which puts other users and transport workers at risk. OBJECTIVE: To estimate TB incidence rates in patients of a health micro-network, and the percentage of transport sector workers among TB and multidrug-resistant TB (MDR-TB) patients. DESIGN: Crude and indirect standardised incidence rates of TB were calculated from an exhaustive analysis of all clinical histories of incident patients in a health micro-network between 1 January 2007 and 30 June 2008. The percentage of transport sector workers and the association between MDR-TB and working in the transport sector were analysed. RESULTS: Standardised incidence rates for transport sector workers are 2.7-4.5 times higher than those in the total working-age male and global population of the micro-network studied. The association between TB and transport occupation and MDR-TB and transport occupation is high (respectively OR 3.06, 95%CI 2.2-4.2 and OR 3.14, 95%CI 1.1-9.1). CONCLUSION: These results indicate that the use of informal public transport is a risk factor for TB infection and an occupational risk in countries with characteristics similar to those in Peru.

DOTS strategy and community participation: an experience in the Ecuadorian Andes.

SETTING: The Chine community in Angamarca parish, Cotopaxi Province, in the Ecuadorian Andes. OBJECTIVE: To relate the DOTS strategy to the world view of the indigenous community in the diagnosis and treatment of smear-positive pulmonary tuberculosis (TB) patients. DESIGN: Cross-sectional study involving all inhabitants of Chine. RESULTS: Aspects of the community's world view were considered in the community-based application of DOTS. A cure rate of 100% was attained, with 0% defaulting from treatment. CONCLUSION: The results obtained indicate that involving the world view of the community in the management of tuberculosis has several advantages.

Parallel mapping of genotypes to phenotypes contributing to overall biological fitness.

Laboratory selection is a powerful approach for engineering new traits in metabolic engineering applications. This approach is limited because determining the genetic basis of improved strains can be difficult using conventional methods. We have recently reported a new method that enables the measurement of fitness for all clones contained within comprehensive genomic libraries, thus enabling the genome-scale mapping of fitness altering genes. Here, we demonstrate a strategy for relating these measurements to the individual phenotypes selected for in a particular environment. We first provide a mathematical framework for decomposing fitness into selectable phenotypes. We then employed this framework to predict that single-batch selections would enrich primarily for library clones with increased growth rate, serial-batch would enrich for a broad collection of clones enhanced via a combination of increased growth rate and/or reduced lag times, and that overlap among selected clones would be minimal. We used the SCalar Analysis of Library Enrichments (SCALEs) method to test these predictions. We mapped all genomic regions for which increased copy number conferred a selective advantage to Escherichia coli when cultured via single- or serial-batch in the presence of 1-naphthol. We identified a surprisingly large collection (163 total) of tolerance regions, including all previously identified solvent tolerance genes in E. coli. We show that the majority of the identified regions were unique to the different selection strategies examined and that such differences were indeed due to differences among enriched clones in growth rate and lag times over the solvent concentrations examined. The combination of a framework for decomposing overall fitness into selectable phenotypes along with a genome-scale method for mapping genes to such phenotypes lays the groundwork for improving the rational design of laboratory selections.

A genomics approach to improve the analysis and design of strain selections.

Strain engineering has been traditionally centered on the use of mutation, selection, and screening to develop improved strains. Although mutational and screening methods are well-characterized, selection remains poorly understood. We hypothesized that we could use a genome-wide method for assessing laboratory selections to design selections with enhanced sensitivity (true positives) and specificity (true negatives) towards a single desired phenotype. To test this hypothesis, we first applied multi-SCale Analysis of Library Enrichments (SCALEs) to identify genes conferring increased fitness in continuous flow selections with increasing levels of 3-hydroxypropionic acid (3-HP). We found that this selection not only enriched for 3-HP tolerance phenotypes but also for wall adherence phenotypes (41% false positives). Using this genome-wide data, we designed a serial-batch selection with a decreasing 3-HP gradient. Further examination by ROC analysis confirmed that the serial-batch approach resulted in significantly increased sensitivity (46%) and specificity (10%) for our desired phenotype (3-HP tolerance).

Pulmonary tuberculosis in an indigenous community in the mountains of Ecuador.

SETTING: An aboriginal community of 653 persons. OBJECTIVE: To determine the prevalence of pulmonary tuberculosis (PTB) and to analyse related factors. DESIGN: The total population was surveyed; those with chronic productive cough were asked to provide sputum specimens. PTB was diagnosed by bacilloscopy (acid-fast bacilli [AFB]). An analysis of socio-economic factors and clinical history associated with chronic cough or positive smear for PTB was carried out using multiple correspondence analysis and logistic regression models. RESULTS: Two hundred and two patients were identified with chronic cough and 173 with chronic productive cough. Chronic cough was associated with having a history of PTB (adjusted OR=4.89, 95%CI 2.6-9.4) and with work-related migratory movements (adjusted OR=2.05, 95%CI 1.3-3.3). Of 92 coughers with sputum samples analysed, 44 (47.8%) were PTB-positive, giving a prevalence of 6.7% in the whole population. In the groups aged 15-34 and >or=45 years, women had higher positivity rates than men, whereas in the group aged 35-44 years rates were higher in men. Twenty-seven per cent of families had one to four smear-positive members. CONCLUSION: The Tuberculosis Control Programme in the area studied needs to be strengthened, taking into account the ethnic context, work-related migration and the socio-economic and geographic context.

Malformación congénita: anencefalia a propósito de un caso / Congenital malformation: anencefalia a purpose of a case

La Anencefalia es uno de los defectos congénitos del sistema nervioso central, dado por la ausencia de huesos craneales y tejido encefálico. Este tubo neutral suele cerrarse alrededor de 28 días después de iniciarse el período de crecimiento. El origen de este tipo de malformación es multifactorial asociado principalmente a las deficiencias de folatos por parte de la gestante, igualmente se presume que la exposición a sustancias tóxicas y el consumo de drogas de abuso también se asocian a este tipo de alteración teratogénica. Se presentan en 1-2 de cada 1000 nacidos vivos. El diagnóstico es principalmente dado por estudio ecográfico a partir de la semana 14 de gestación, también se emplea la titulación de alfafetoproteínas y el estudio de líquido anmiótico. Lamentablemente la Anencefalia no tiene tratamiento ya que de sobrevivir al parto el producto vivirá menos de 12 horas. Es preciso que durante el control de la gestación el médico indique la ingesta de ácido fólico y multivitaminicos principalmente B12. Se presenta el caso de una paciente femenina de 27 años de edad, II gestas I para 0 abortos, quien consulta por presentar hallazgo ecográfico que evidencia alteración del cráneo, con una edad gestacional de 24 semanas, por eco, con un embarazo no controlado, refiere antecedente de consumo de drogas por parte de la pareja; igualmente niega ingesta de folatos, hierro o complejo B durante la gestación, refiere trabajar en una empresa productora de alimentos derivados de la papa. Razón por la cual acude a este centro donde se valora y se ingresa para discutir caso; se ingresa con el diagnóstico de embarazo de 25 semanas + 1 día por eco traspolado y ARO por malformación fetal: Anencefalia, no evidenciando alteración al examen físico obstétrico. En sala de hospitalización se realiza eco obstétrico que evidencia malformación fetal anencefalia y se decide trasladar a sala de parto para interrupción del embarazo, se induce trabajo de parto.

A new PCR-based approach for the specific amplification of DNA from different Schistosoma species applicable to human urine samples.

Currently available methods for the diagnosis of human schistosomiasis often lack enough sensitivity and specificity. Recently, several authors have developed more specific and sensitive diagnostic methods, mainly based on the polymerase chain reaction (PCR) technique. Nevertheless, these have been only applied for the diagnosis of 1 out of 4 Schistosoma species affecting man (S. mansoni). Additionally, application of specific PCR has been exclusively used for blood or faecal patients' samples. Here, we develop a new, high sensitive PCR approach that allows the genus- and species-specific amplification of the main 4 Schistosoma species causing disease in man plus S. bovis. We further successfully apply this technique for the detection of parasite DNA in easy-to-handle urine samples from patients with schistosomiasis. With these samples, we have found 94.4% sensitivity and 99.9% specificity when applying a genus-specific (Schistosoma spp.) primer pair, and 100% sensitivity and 98.9% specificity in a species-specific (S. mansoni) PCR.

Leiomioma vascular uterino con foco epiteliode: caso clínico / Uterine leiomyoma with a focus epithelioid vascular: clinical case

Los leiomiomas son los tumores mas frecuentes en la mujer y en términos coloquiales se les conoce como "Fibroides" (1). En las variantes infrecuentes de presentación están los leiomiomas vasculares uterinos que son tumores benignos compuestos por células musculares lisas miometriales y vasos sanguíneos de paredes gruesas (2). Presentamos el caso de una femenina hispana de 36 años de edad con tumoración abdominal, trastornos mestruales y dolor pélvico de tres meses de evolución. Se le realizó ecosonograma pélvico y transvaginal que reportó tumor de ovario derecho ecomixto, fue llevada a quirófano teniendo como hallazgo incidental un útero aumentado de tamaño sin alteración de los anexos, tomándose la decisión de concluir el acto operatorio hasta clarificar el diagnóstico. En un segundo tiempo quirúrgico y posterior a estudios complementarios se le realizó histerectomía. En cuanto a los hallazgos histológicos y por estudios de inmunohistoquímica se diagnósticó un leiomioma vascular uterino intramural, con áreas celulares y foco epiteliode.