ABSTRACT
Introduction: Pregnant women and health providers in rural areas of low-income and middle-income countries face multiple problems concerning high-quality obstetric care. This study was performed to identify changes in maternal and perinatal indicators after implementing a model based on education and telecare between a high-complexity hospital in 10 low-complexity hospitals in a southwestern region of Colombia. Methods: A quasiexperimental study with a historic control group and without a pretest was conducted between 2017 and 2019 to make comparisons before and after obstetric emergency care through the use of teleassistance from 10 primary care centers to the referral center (Fundación Valle del Lili, FVL). Results: A total of 470 patients were treated before teleassistance implementation and 154 patients were treated after teleassistance implementation. After program implementation, the maternal clinical indicators showed a 65% reduction in the number of obstetric patients who were referred with obstetric emergencies. The severity of maternal disease that was measured at the time of admission to level IV through the Modified Early Obstetric Warning System score was observed to decrease. Conclusion: The implementation of a model based on education and teleassistance between low-complexity hospitals and tertiary care centers generated changes in indicators that reflect greater access to rural areas, lower morbidity at the time of admission, and a decrease in the total number of emergency events.
ABSTRACT
INTRODUCTION: Maternal morbidity and mortality rates associated with perinatal care remain a significant public health concern. Rural populations from low and middle-income countries have multiple barriers to access that contribute to a lack of adherence to prenatal care, and high rates of maternal mortality and morbidity. An intervention model based on telehealth and education was implemented between a tertiary high complex care hospital and a second-level hospital from a limited source region. OBJECTIVES: We sought to identify an association in maternal and perinatal care quality indicators after implementing a model based on telehealth and education for patients with obstetric emergencies between two hospitals in a southwestern region of Colombia. METHODS: We conducted an ecological study between 2017 and 2019 to compare before and after obstetric emergency care through telemedicine from a secondary care center (Hospital Francisco de Paula Santander-HFPS) to the referral center (Fundación Valle del Lili-FVL). The intervention included verification visits to determine the installed capacity of care, a concerted improvement plan, and on-site educational training modules in obstetric and perinatal care. RESULTS: There were 102 and 148 patients treated before and after telemedicine implementation respectively. Clinical indicators after model implementation showed a reduction in perinatal mortality of 29%. In addition, a reduction in the need for transfusion of blood products due to postpartum hemorrhage was observed as well as the rate of eclampsia. CONCLUSIONS: Implementing a model based on telehealth and education between secondary and tertiary care centers allowed the strengthening of the security of care in obstetric emergencies and had a positive effect on perinatal mortality.
Subject(s)
Perinatal Death , Telemedicine , Colombia/epidemiology , Emergencies , Female , Humans , Maternal Mortality , Perinatal Mortality , PregnancyABSTRACT
El objetivo del trabajo fue demostrar la actividad inhibitoria de plantas in vitro de Drosera capillaris (Droseraceae) sobre Mycobacterium tuberculosis. Las plantas de D. capillaris fueron propagadas en cultivos in vitro a partir de plántulas y hojas adultas. Se utilizó metanol como solvente de extracción y el sistema de cromatografía a gas en la determinación de los metabolitos secundarios. El medio de cultivo Lowenstein-Jensen, suplementado con las concentraciones 1,25; 2,5 y 5mg/mL de la fracción clorofórmica del extracto crudo metanólico, fue utilizado en la evaluación del crecimiento de cinco cepas de M. tuberculosis. Los resultados indicaron que plantas de 3 5 cm de altura fueron obtenidas después de 10 12 meses de cultivo in vitro. La naftoquinona plumbagina fue determinada por comparación con el tiempo de retención del patrón correspondiente, así como de otros compuestos hidrocarbonados similares de cadena larga. El crecimiento de M. tuberculosis fue inhibido en un rango de 40 93,1% en los tratamientos 2,5 y 5 mg/mL. La concentración inhibitora mínima (CIM) y CIM90 fue 1,25 mg/mL y 2,5 5 mg/mL, respectivamente. Se demostró la acción antibacteriana del extracto metanólico de plantas in vitro de D. capillaris, probablemente por acción de la plumbagina y de los otros metabolitos secundarios detectados.
Subject(s)
Droseraceae , Phytotherapy , Mycobacterium tuberculosis , Reproduction, AsexualABSTRACT
En Venezuela la rabia se ha presentado en forma endemo-epidémica, causando pérdidas económicas a la ganadería y afectando la salud humana. Para reportar la situación epidemiológica de la rabia en el estado Lara, período enero-diciembre 2007, se analizaron 228 muestras de tejido nervioso pertenecientes a un humano y a distintas especies de animales domésticos y silvestres, recolectadas en esa región y estados limítrofes. Para evidenciar la presencia del virus, se utilizó la prueba de inmunofluorescencia directa (IFD). La amplificación viral se efectuó en ratones lactantes. La caracterización antigénica se realizó por inmunofluorescencia indirecta con anticuerpos monoclonales dirigidos contra la nucleocápside viral. Se evaluó la potencia de la vacuna antirrábica utilizada durante el brote, por el método NIH y se determinó el título de anticuerpos antirrábicos a 51 muestras de suero de bovinos por el método de seroneutralización en ratones jóvenes. Dieciocho muestras resultaron positivas en el estado Lara, en tejidos de humano (1), bovinos (8), equino (1), caprinos (3), ovinos (3) y vampiros Desmodus rotundus (2). Se detectó un equino positivo en el estado Cojedes. Las cepas virales se clasificaron como Variante Antigénica 3, indicando que el principal transmisor de la enfermedad fue el Desmodus rotundus. La vacuna antirrábica utilizada mantuvo su potencia relativa en 7,58 UI/mL y el índice de protección antirrábica promedio resultó 1:163 DE50/0,03 mL, demostrado en el 94% de los sueros analizados. Este brote se originó en el Municipio Morán del estado Lara, evidenciando el gran peligro que la rabia silvestre representa para la salud humana.
In Venezuela, rabies has evolved as endemic-epidemic, causing economic losses to livestock and affecting human health. To report the epidemiological situation of rabies in the State of Lara, Venezuela, from January to December 2007, a total of 228 samples of nervous tissue belonging to a human pacient and various species of domestic and wild animals harvested in the region and in bordering states was analyzed. To detect the presence of the rabies virus antigen, a direct immunofluorescence test (DIF) was used. Virus amplification was carried out in suckling mice. Antigenic characterization was performed by indirect immunofluorescense test using monoclonal antibodies directed against the viral nucleocapsid. Potency of rabies vaccine used during the outbreak was assessed by the NIH method and rabies antibodies title was determined in 51 bovine serum samples by means of the serum neutralization method in young mice. The distribution of the eighteen positive samples in Lara State was as follows: 1 human, 8 cattle, 1 horse, 3 goats, 3 sheeps, and 2 vampire bats (Desmodus rotundus). One horse was detected positive in Cojedes State. Viral strains were classified as type-3 antigenic variant, indicating that the main source of the disease was the Desmodus rotundus. The rabies vaccine used maintained its relative potency in 7.58 IU/mL and the average index of rabies protection was 1:163 DE50/0.03 mL, which was detected in 94% of the sera. This outbreak originated in the Morán Municipality of Lara State, underscoring the great risk that wild rabies represents to human health.
