ABSTRACT
En América Latina, los primeros meses del 2016 estuvieron marcados por crecientes reportes de microcefalia, que poco después se demostró estaba causado por el virus zika. Inicialmente su transmisión fue caracterizada como metaxénica (a través del mosquito del dengue, Aedes aegypti), para luego encontrarse evidencias de transmisión sexual. Por ello, el Ministerio de Salud (MINSA) del Perú solicitó evaluar la capacidad de respuesta de sus servicios de salud reproductiva en las áreas de mayor riesgo de contagio, el área nororiental del Perú y Lima, a fin de identificar necesidades y nudos críticos y elaborar un plan de mejora de la oferta de servicios. En el caso de Lima, también se incluyeron dos establecimientos de EsSalud. Mediante entrevistas individuales, grupales, listas de chequeo y guías de observación, se analizaron variables claves del sistema de salud. El presupuesto en las regiones fue siempre menor al solicitado, mientras que el de planificación familiar recibía otros usos. Los horarios de atención fueron limitados, en tanto que se requiere actualizar las competencias del personal para usar el dispositivo intrauterino (DIU) y métodos de larga duración. El 83% de establecimientos tenía desabastecimiento del inyectable mensual, mientras que 17% presentó substock. Asimismo, resultó clara la necesidad de capacitar al personal para la prevención del zika durante las relaciones sexuales, así como antes y durante el embarazo. No se reconoció los vínculos con la violencia sexual. Los servicios orientados a usuarias/os adolescentes brindaban atención con horarios restringidos, además de otras limitaciones a su acceso. Solo el 22% de usuarias había recibido información de parte de los proveedores.
In Latin America, the first months of 2016 were marked by the increasing reports of microcephaly, which was shortly afterwards shown to have been caused by the Zika virus. Initially, its transmission was typified as metaxenic (caused by the Dengue mosquito Aedes aegypti); later, evidences of sexual transmission were detected. Thus, the Ministry of Health of Peru required to evaluate the response capacity of the reproductive health services to needs and critical knots and to draft a plan to improve the offer. In the case of Lima, EsSalud facilities were also included. Through individual and group interviews, and check lists and observation lists, key variables of the health system were analyzed. The budget of the regions was always lower than that requested; the family planning budget was expended in other uses. Office hours were limited. The staff skills on both intrauterine device (IUD) and long-acting reversible contraception (LARC) use needed to be updated. 83% of the facilities had shortage of monthly injectable contraception, and 17% were sub-stocked. Likewise, the staff needed to be trained on Zika prevention during sexual activity, and before and during pregnancy. The links with sexual violence were not recognized. The services for adolescent users had restricted office hours, and other access limitations. Only 22% of the users had received information from the suppliers.
ABSTRACT
BACKGROUND AND OBJECTIVE: Although it has been reported that pulmonary hypertension is more frequent in patients with obesity-hypoventilation syndrome than in patients with 'pure' obstructive sleep apnoea syndrome, little is known about the haemodynamic repercussions of this entity. The aim was to describe the haemodynamic status, as assessed by echocardiography and 6-min walk test (6MWT), of patients with a newly diagnosed, most severe form of obesity-hypoventilation syndrome, and to evaluate the impact of non-invasive ventilation in these patients. METHODS: A prospective, descriptive, and single-centre follow-up study was conducted. At baseline, patients underwent echocardiography, spirometry, static lung volume measurement, 6MWT, overnight pulse-oximetry and polygraphic recording. Changes in echocardiography and 6MWT were assessed after 6 months of non-invasive ventilation. Right ventricular overload was defined on the basis of right ventricular dilatation, hypokinesis, paradoxical septal motion and/or pulmonary hypertension. RESULTS: Thirty patients (20 women; mean age 69 ± 11) were tested. The percentage of patients with right ventricular overload did not change significantly after non-invasive ventilation (43.3-41.6%; P = 0.24). In patients with right ventricular overload at diagnosis, pulmonary artery systolic pressure decreased significantly at six months (58 ± 11 to 44 ± 12 mm Hg; P = 0.014), and mean distance on 6MWT increased from 350 ± 110 to 426 ± 78 m (P = 0.006), without significant changes in body mass index. CONCLUSIONS: Right ventricular overload is a frequent finding in patients with the most severe form of obesity-hypoventilation syndrome. Treatment with non-invasive ventilation is associated with a decrease in pulmonary artery systolic pressure at six months and an increase in the distance covered during the 6MWT.
Subject(s)
Hemodynamics/physiology , Noninvasive Ventilation/methods , Obesity Hypoventilation Syndrome/physiopathology , Obesity Hypoventilation Syndrome/therapy , Aged , Aged, 80 and over , Echocardiography/methods , Exercise Test , Female , Humans , Hypertension, Pulmonary/physiopathology , Middle Aged , Oximetry/methods , Polysomnography/methods , Respiratory Function Tests/instrumentation , Respiratory Function Tests/methods , Severity of Illness Index , Ventricular Dysfunction, Right/physiopathology , Ventricular Dysfunction, Right/therapyABSTRACT
OBJECTIVE: To summarise the evidence about the efficacy and safety of using GH in adults with GH deficiency focusing on quality of life and body composition. DATA SOURCES: We searched MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and Scopus through April 2011. We also reviewed reference lists and contacted experts to identify candidate studies. STUDY SELECTION: Reviewers, working independently and in duplicate, selected randomised controlled trials (RCTs) that compared GH to placebo. DATA SYNTHESIS: We pooled the relative risk (RR) and weighted mean difference (WMD) by the random effects model and assessed heterogeneity using the I(2) statistic. RESULTS: Fifty-four RCTs were included enrolling over 3400 patients. The quality of the included trials was fair. GH use was associated with statistically significant reduction in weight (WMD, 95% confidence interval (95% CI): -2.31âkg, -2.66 and -1.96) and body fat content (WMD, 95% CI: -2.56âkg, -2.97 and -2.16); increase in lean body mass (WMD, 95% CI: 1.38, 1.10 and 1.65), the risk of oedema (RR, 95% CI: 6.07, 4.34 and 8.48) and joint stiffness (RR, 95% CI: 4.17, 1.4 and 12.38); without significant changes in body mass index, bone mineral density or other adverse effects. Quality of life measures improved in 11 of the 16 trials although meta-analysis was not feasible. RESULTS: GH therapy in adults with confirmed GH deficiency reduces weight and body fat, increases lean body mass and increases oedema and joint stiffness. Most trials demonstrated improvement in quality of life measures.
Subject(s)
Body Composition/drug effects , Growth Hormone/therapeutic use , Quality of Life , Adult , Clinical Trials as Topic , Female , Humans , Male , Pituitary Diseases/drug therapyABSTRACT
OBJECTIVES: To describe the supply and demand of clinical fields for undergraduate students of Peru. MATERIALS AND METHODS: A descriptive study was considering as supply of clinical fields the total number of existing hospital beds in Peru. The demand was calculated using the total number of alumni registered in health science carrers following the clinical years or the internship. We calculated the number of beds per student and the coverage of clinical fields nationally and in some selected regions (Lima, Arequipa, La Libertad and Lambayeque). RESULTS: In 2009, Peru had 34,539 hospital beds, 78.5% of which pertained to the public sector and 48.4% are from Lima. We estimated that in 2008 44,032 alumni needed clinical fields, 70% from private universities, which grew 65% since 2005. The coverage of clinical fields, considering only interns from four carreers (medicine, nursery, obstetrics and dentistry) was only 31.5% at the national level. The number of beds per student oscillated between 0.5 in La Libertad to 0.82 in Lima with a national mean of 0.45. CONCLUSIONS: The supply of clinical fields for teaching undergraduates is insufficient to satisfy the demand, which continues to grow because of private universities, and hence requires urgent regulation.
Subject(s)
Education, Medical, Undergraduate/statistics & numerical data , Hospital Bed Capacity/statistics & numerical data , PeruABSTRACT
CONTEXT: The diagnostic accuracy of tests used to diagnose GH deficiency (GHD) in adults is unclear. OBJECTIVE: We conducted a systematic review and meta-analysis of studies that provided data on the available diagnostic tests. DATA SOURCES: We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Sciences, and Scopus) through April 2011. STUDY SELECTION: Review of reference lists and contact with experts identified additional candidate studies. Reviewers, working independently and in duplicate, determined study eligibility. DATA EXTRACTION: reviewers, working independently and in duplicate, determined the methodological quality of studies and collected descriptive, quality, and outcome data. DATA SYNTHESIS: Twenty-three studies provided diagnostic accuracy data; none provided patient outcome data. Studies had fair methodological quality, used several reference standards, and included over 1100 patients. Several tests based on direct or indirect stimulation of GH release were associated with good diagnostic accuracy, although most were assessed in one or two studies decreasing the strength of inference due to small sample size. Serum levels of GH or IGF1 had low diagnostic accuracy. Pooled sensitivity and specificity of the two most commonly used stimulation tests were found to be 95 and 89% for the insulin tolerance test and 73 and 81% for the GHRH+arginine test respectively. Meta-analytic estimates for accuracy were associated with substantial heterogeneity. CONCLUSION: Several tests with reasonable diagnostic accuracy are available for the diagnosis of GHD in adults. The supporting evidence, however, is at high risk of bias (due to heterogeneity, methodological limitations, and imprecision).
Subject(s)
Diagnostic Tests, Routine/standards , Growth Disorders/diagnosis , Growth Disorders/metabolism , Human Growth Hormone/deficiency , Human Growth Hormone/physiology , Adult , Cross-Sectional Studies , Diagnostic Tests, Routine/methods , Diagnostic Tests, Routine/trends , Evidence-Based Medicine/methods , Evidence-Based Medicine/standards , Human Growth Hormone/biosynthesis , Humans , Longitudinal StudiesABSTRACT
Objetivos. Describir la oferta y demanda de campos clínicos para los estudiantes de pregrado del Perú. Materiales y métodos. Se realizó un estudio descriptivo, se consideró como oferta de campos clínicos al total de camas hospitalarias existentes en el Perú. La demanda fue calculada con el número total de alumnos matriculados en las carreras de ciencias de la salud que cursan años clínicos o internado. Se calculó el número de camas por alumno y la cobertura del campo clínico tanto a nivel nacional como en algunas regiones seleccionadas (Lima, Arequipa, La Libertad y Lambayeque). Resultados. Para el 2009 el Perú tiene 34 539 camas hospitalarias, 78,5 por ciento pertenecen al sector público y 48,4 por ciento están ubicadas en Lima. Para el año 2008 se estimó que 44 032 alumnos requirieron de campos clínicos, 70 por ciento provenían de universidades privadas, las cuales crecieron 65 por ciento desde el 2005. La cobertura de campos clínicos, solo considerando a internos de cuatro carreras (medicina, enfermería, obstetricia y odontología), llega al 31,5 por ciento a nivel nacional. El número de camas por estudiante osciló entre 0,5 en La Libertad a 0,82 en Lima siendo el promedio nacional de 0,45. Conclusiones. La oferta de campos clínicos para la enseñanza de pregrado en el Perú es insuficiente para satisfacer la demanda, que continúa en crecimiento a expensas de universidades privadas, por lo que se requiere con urgencia de una regulación.
Objectives: To describe the supply and demand of clinical fields for undergraduate students of Peru. Materials and methods. A descriptive study was considering as supply of clinical fields the total number of existing hospital beds in Peru. The demand was calculated using the total number of alumni registered in health science carrers following the clinical years or the internship. We calculated the number of beds per student and the coverage of clinical fields nationally and in some selected regions (Lima, Arequipa, La Libertad and Lambayeque). Results. In 2009, Peru had 34,539 hospital beds, 78.5 percent of which pertained to the public sector and 48.4 percent are from Lima. We estimated that in 2008 44,032 alumni needed clinical fields, 70 percent from private universities, which grew 65 percent since 2005. The coverage of clinical fields, considering only interns from four carreers (medicine, nursery, obstetrics and dentistry) was only 31.5 percent at the national level. The number of beds per student oscillated between 0.5 in La Libertad to 0.82 in Lima with a national mean of 0.45. Conclusions. The supply of clinical fields for teaching undergraduates is insufficient to satisfy the demand, which continues to grow because of private universities, and hence requires urgent regulation.
Subject(s)
Education, Medical, Undergraduate/statistics & numerical data , Hospital Bed Capacity/statistics & numerical data , PeruABSTRACT
OBJECTIVE: This study reports the expression of proinflammatory cytokines in temporomandibular joint (TMJ) of patients affected with temporomandibular osteoarthritis (OA). DESIGN: In twelve OA of the TMJ (OA-TMJ) affected patients and in six healthy volunteer subjects studied as control, the expression of IL1beta (interleukin-1beta), IL2, IL4, IL5, IL6, IL10, IL12p35, IL12p40, IL17, IFNgamma (interferon-gamma), TNFalpha (tumor necrosis factor-alpha), and TNFbeta mRNAs was evaluated. Using quantitative real-time RT-PCR technique, the cytokine levels, reported as Ct (cycle threshold), DeltaCt (Ct cytokine-Ct 18S rRNA) and RQ (relative quantification), in patient and control groups were compared. RESULTS: Expression of IL1beta, IL2, IL12p35, IL12p40, IL17, TNFalpha, TNFbeta, and IFNgamma mRNAs was significantly higher in patients as compared with controls. In particular, IL12 was the predominant cytokine expressed in patients (IL12p35 RQ=30.2 and IL12p40 RQ=29.0). Conversely, IL10 mRNA levels were higher in controls (RQ=1.8). CONCLUSIONS: These data suggest that not only IL1beta, IFNgamma, and TNFalpha but also IL10, IL12, and IL17 are involved in the OA-TMJ pathogenesis. Furthermore, an inflammatory response characterised by the predominant expression of IL12 mRNA and down-regulated expression of IL10 mRNA is associated with the degenerative changes observed in OA-TMJ.
Subject(s)
Cytokines/biosynthesis , Inflammation Mediators/metabolism , Osteoarthritis/metabolism , Temporomandibular Joint Disorders/metabolism , Adult , Cytokines/genetics , Female , Gene Expression , Humans , Male , RNA, Messenger/genetics , Reverse Transcriptase Polymerase Chain Reaction/methods , Synovial Fluid/metabolism , Temporomandibular Joint/metabolismABSTRACT
Con el presente trabajo deseamos hacer nuestro aporte a todo un proceso que los indígenas colombianos venimos impulsando en la búsqueda de recuperar nuestros legítimos derechos de pueblos aborígenes. Dentro de este espíritu hemos querido adelantar este trabajo claro, breve y específico de medicina tradicional, en el cual pretendemos dejar conceptos sobre nuestros métodos de curación tradicional y su importancia para nuestras comunidades.
Subject(s)
Humans , Medicine, Traditional , Colombia , Health of Indigenous PeoplesABSTRACT
El caso de estudio propiamente dicho empieza con una introduccion en el que se hace mencion a los requisitos del por que se debio realizar la elaboracion y ejecucion del proyecto. En la seccion diagnostica, en el punto de antecedentes se indica que con la construccion del gasoducto Bolivia-Brasil que pasa por los puntos remotos de Rio Grande, Yacuses y Mutun requiere comunicacion con el punto central Santa Cruz de voz y datos,para la gestion y control del gasoducto a traves del sistema Scada.Justificando de esta manera la ejecucion del proyecto.En la seccion propositiva se incluye la metodologia seguida, el desarrollo del caso de estudio, la alternativa tecnica de comunicacion, el metodo de calculo, el modelo circuital, el presupuesto, la planificacion-ejecucion y los resultados del proyecto implementacion de la Red Satelital de Telecomunicaciones de Petrogasbol.resaltando los enlaces satelitales que se utilizan en el proyecto, satelite con el que se trabaja, ubicacion geografica de los puntos remotos y los equipos que se ocupan.
