Los conocimientos, actitudes y prácticas (CAP) de los médicos en los servicios de neonatología del Ecuador en relación al tratamiento del dolor / Knowledge, attitudes and practices of physicians in neonatal units in ecuador pertinent to treatment of pain

Contexto: Los neonatos hospitalizados en una unidad neonatal, diariamente son sometidos a intervenciones diagnósticas y terapéuticas dolorosas. El personal de salud tiene un papel importante en la valoración y control del dolor neonatal. El dolor es una percepción subjetiva, y hoy en día se sabe que los neonatos expresan el dolor con indicadores comportamentales, fisiológicos, hormonales, y debería ser adecuadamente evaluados para instaurar un manejo farmacológico y no farmacológico que evite daños nocivos a corto y a largo plazo. Propósito: Evaluar el nivel de conocimientos, actitudes y prácticas del personal médico del Ecuador sobre la valoración y manejo del dolor neonatal. Sujetos y métodos: Estudio multicéntrico, no experimental, cuantitativo, descriptivo de corte transversal. La herramienta de evaluación fue una encuesta vía online, semi estructurada y auto administrada, a todos los médicos de 16 provincias del Ecuador que trabajan directamente con neonatos y aceptaron participar en el estudio. La encuesta fue aplicada desde el 1 de noviembre hasta el 30 de noviembre del 2018. La encuesta tuvo 25 preguntas, y una duración estimada de 5 a 8 minutos. Su objetivo fue valorar los conocimientos, las actitudes y las prácticas de los médicos con relación al dolor neonatal. Resultados: Participaron 183 médicos en la encuesta; el 70% fueron mujeres; la edad promedio fue 34; el 82,5% labora en la sierra. El 56,8% tiene título de tercer nivel y 43,2% título de cuarto nivel; 10,5% trabaja en un hospital de nivel I, 29,3% en un hospital de nivel II y 60,2% en un hospital de nivel III. A nivel general del cuestionario CAP se observó un resultado significativamente deficiente en todos los grupos: 82% en los médicos de 25 a 35 años y 52,8% en aquellos 36 a 56 años. También se encontró que la calificación del CAP fue significativamente mala en todos los niveles de titulación siendo peor en los médicos con título de tercer nivel (81,8% vs. 49,4%) que en los de cuarto nivel. Conclusiones: Existe una abrumadora deficiencia en el conocimiento, las actitudes y las prácticas en manejo del dolor neonatal en médicos del Ecuador.

Context: Neonates hospitalized in a neonatal unit are subjected daily to painful diagnostic and therapeutic interventions. Health personnel have an important role in the assessment and control of neonatal pain. Pain is a subjective perception, and nowadays it is known that neonates express pain with behavioral, physiological, hormonal indicators, and it should be adequately evaluated to establish a pharmacological and non-pharmacological management that avoids harmful damages in the short and long term. Objective: Evaluate the level of knowledge, attitudes and practices of the medical staff of Ecuador on the assessment and management of neonatal pain. Subjects and Methods: Multicenter, non-experimental, quantitative, descriptive, cross-sectional study. The evaluation tool was an online survey, semi-structured and self-administered, sent to all the doctors of 16 Provinces of Ecuador who work directly with neonates, who agreed to participate in the study. The survey was applied from November 1 to November 30, 2018. The survey had 25 questions, which took an estimated time of 5 to 8 minutes. Its objective was to evaluate the knowledge, attitudes and practices of Physicians in relation to neonatal pain. Results: 183 physicians participated in the survey; 70% were women; the average age was 34.4 years; 82.5% work in the sierra region, 56.8% have a third level degree and 43.2% have a fourth level degree. 10.5% work in a level I hospital, 29.3% in a level II hospital and 60.2% in a level III. The CAP questionnaire revealed a significantly deficient result in every group: 82% of physicians between 25 and 35 years of age and 52.8% among those between 36 and 56. The CAP evaluation showed a significant deficiency in every level of education but it was worse among physicians with third level degree than among those with fourth level degree (81.8% vs. 49.4%). Conclusions: There is an overwhelming deficiency in knowledge, attitudes and practices in neonatal pain management among physicians in Ecuador.

Experiencia Programa de Intercambio Residentes Neuropediatría Chile-Hospital de Niños de Boston / Interchange Program Experience Pediatric Neurology Residents of Chile-Boston Children's Hospital

Cada dos años, residentes de Neuropediatría de distintos centros en Chile visitan el Boston Children's Hospital a fin de dar vida a un intercambio académico bilateral, que se constituye como una valiosa instancia de aprendizaje bilateral. Pensamos que es importante relatar nuestra experiencia y al mismo tiempo hacer algunas reflexiones sobre esta instancia formativa. Palabras Claves: Residentes; Intercambio; Neuropediatría; Educación médica

Every two year, residents of pediatric neurology from different Chilean Universities visit the Boston Children's Hospital for a bilateral academic exchange, that constitutes a valuable learning instance. We think that it is important to relate our experience and share our thoughts about this interchange. Key words: Residents; Interchange; Pediatric Neurology; Medical Education.

Primer caso de tratamiento ex utero intraparto realizado por vía vaginal en un feto con síndrome de obstrucción congénita de la vía aérea superior / The first case of exutero intrapartum treatment performed using the vaginal route in a fetus with congenital high airway obstruction syndrome

El síndrome de obstrucción congénita de la vía aérea superior (CHAOS), es una condición infrecuente que causa asfixia o muerte perinatal inmediata, de no mediar una estrategia terapéutica que permita permeabilizar la vía aérea del paciente durante el nacimiento. El diagnóstico prenatal, es fundamental para delinear estrategias de tratamiento perinatal con el fin de minimizar la morbimortalidad de niños con anomalías congénitas. El tratamiento ex-útero intraparto (EXIT) es el procedimiento de elección. Clásicamente se realiza mediante una cesárea programada, manteniendo el soporte fetal a través de la circulación útero-placentaria. Se requiere un equipo altamente calificado y un trabajo coordinado para concretar el procedimiento en estas condiciones. Objetivo: El objetivo es reportar un caso de Síndrome de CHAOS, en el que se realizó un procedimiento EXIT en un niño nacido por parto vaginal, con la participación de un equipo multidisciplinario de profesionales de dos Instituciones Públicas de la Ciudad de Buenos Aires, en el marco de un Programa Conjunto de Diagnóstico y Tratamiento Fetal (AU)

Congenital high airway obstruction syndrome (CHAOS) is a rare entity causing perinatal asphyxia or immediate death if no therapeutic strategy is undertaken to correct airway patency at birth. Prenatal diagnosis is essential to plan perinatal strategies to decrease morbidity and mortality in children with congenital anomalies. The exutero intrapartum treatment (EXIT) is the procedure of choice. Classically, a programmed cesarean section is performed while the fetus is maintained on uteroplacental circulation. A highly trained team is required in the coordinated effort to perform the procedure. Aim: The aim of this study was to report on a case of CHAOS managed with an EXIT procedure in a child born through vaginal delivery performed by a multidisciplinary team of professionals belonging to two public institutions of the city of Buenos Aires in the framework of the Joint Program of Fetal Diagnosis and Treatment (AU)

The First Report of Tomato spotted wilt virus on Gerbera and Chrysanthemun in Venezuela.

Gerbera (Gerbera jamesonii) and Chrysanthemum (family Asteraceae) are two of the top 10 cut flowers of the world, with great commercial value. Since 1998, Venezuela began a floral industry to produce and export fresh cut gerbera and chrysanthemum, with 40% of nurseries concentrated in Altos Mirandinos (Miranda State, north central region of the country). For the past 2 years, greenhouse-grown gerbera and chrysanthemum have been observed displaying symptoms resembling those associated with tospoviruses. Symptomatic plants showed concentric rings, irregular chlorotic blotches, and deformation on leaves. Disease incidence was estimated at 30%. Mechanical inoculation with extracts of symptomatic leaves reproduced the typical concentric ring symptoms on indicator plants Arachis hypogaea L. cv. San Martín, Capsicum chinense, and G. jamesonii 6 to 15 days after inoculation. In initial tests, leaves from each 30 symptomatic gerbera and chrysanthemum species from several greenhouse facilities in Altos Mirandinos reacted positively when tested by DAS-ELISA with polyclonal antisera (ATCC, Rockville, MD) raised against Tomato spotted wilt virus (TSWV). Total RNA was extracted with the RNeasy Plant Mini kit (QIAGEN, Hilden, Germany) from two gerbera and two chrysanthemum ELISA-positive samples. The TSWV coat protein gene was amplified by conventional reverse transcription (RT)-PCR using primers CP1 TSWV (TTAACTTACAGCTGCTTT) and CP2 TSWV (CAAAGCATATAAGAACTT) (1). A single DNA product of ~823 bp was amplified from all samples. RT-PCR products were directly sequenced in both orientations and sequences were deposited in GenBank (Accession Nos. KF146700 and KF146701 derived from chrysanthemum, KF146702 and KF146703 derived from gerbera). The resulting sequences showed over 99% identity with each other. and were found to be closely related (over 99%) with TSWV isolates deposited in GenBank originating from different hosts from France (FR693058, FR693055), Montenegro (GU339506, GU339508, GU355940), Italy (HQ830187), New Zealand (KC494501), South Korea (KC261967), and the United States (AY744476). To our knowledge, this is the first confirmed report of TSWV infecting gerbera and chrysanthemum in Venezuela. The relatively widespread occurrence of TSWV in Miranda State underscores the need for systematic surveys to assess its incidence and impact on ornamental crops so that appropriate management tactics can be developed. Reference: (1) R. A. Mumford et al. J. Virol. Methods 57:109, 1996.

Use of the mitochondria toxicity assay for quantifying the viable cell density of microencapsulated jurkat cells.

The mitochondria toxicity assay (MTT assay) is an established method for monitoring cell viability based on mitochondrial activity. Here the MTT assay is proposed for the in situ quantification of the living cell density of microencapsulated Jurkat cells. Three systems were used to encapsulate the cells, namely a membrane consisting of an interpenetrating polyelectrolyte network of sodium cellulose sulphate/poly(diallyldimethylammonium chloride) (NaCS/PDADMAC), a calcium alginate hydrogel covered with poly(L-lysine) (Ca-alg-PLL), and a novel calcium alginate-poly(ethylene glycol) hybrid material (Ca-alg-PEG). MTT results were correlated to data obtained by the trypan blue exclusion assay after release of the cells from the NaCS/PDADMAC and Ca-alg-PLL capsules, while a resazurin-based assay was used for comparison in case of the Ca-alg-PEG material. Analysis by MTT assay allows quick and reliable determination of viable cell densities of encapsulated cells independent of the capsule material. The assay is highly reproducible with inter-assay relative standard deviations below 10%.

Life-cycle and freshwater withdrawal impact assessment of water supply technologies.

Four alternative cases for water supply were environmentally evaluated and compared based on the standard environmental impact categories from the life-cycle assessment (LCA) methodology extended with a freshwater withdrawal category (FWI). The cases were designed for Copenhagen, a part of Denmark with high population density and relatively low available water resources. FWI was applied at local groundwater catchments based on data from the national implementation of the EU Water Framework Directive. The base case of the study was the current practice of groundwater abstraction from well fields situated near Copenhagen. The 4 cases studied were: Rain & stormwater harvesting from several blocks in the city; Today's groundwater abstraction with compensating actions applied in the affected freshwater environments to ensure sufficient water flow in water courses; Establishment of well fields further away from the city; And seawater desalination. The standard LCA showed that the Rain & stormwater harvesting case had the lowest overall environmental impact (81.9 µPET/m(3)) followed by the cases relying on groundwater abstraction (123.5-137.8 µPET/m(3)), and that desalination had a relatively small but still important increase in environmental impact (204.8 µPET/m(3)). Rain & stormwater harvesting and desalination had a markedly lower environmental impact compared to the base case, due to the reduced water hardness leading to e.g. a decrease in electricity consumption in households. For a relevant comparison, it is therefore essential to include the effects of water hardness when comparing the environmental impacts of water systems of different hardness. This study also emphasizes the necessity of including freshwater withdrawal respecting the relevant affected geographical scale, i.e. by focusing the assessment on the local groundwater catchments rather than on the regional catchments. Our work shows that freshwater withdrawal methods previously used on a regional level can also be applied to local groundwater catchments and integrated into the standard LCA as an impact category. When standard LCA is extended to include impacts of freshwater withdrawal, rain & stormwater and seawater (0.09-0.18 compared to 11.45-17.16 mPET/m(3)) were the resources resulting in least overall environmental impact.

Life cycle assessment of central softening of very hard drinking water.

Many consumers prefer softened water due to convenience issues such as avoidance of removing limescale deposits from household appliances and surfaces, and to reduce consumption of cleaning agents and laundry detergents leading to lower household expenses. Even though central softening of drinking water entailed an increased use of energy, sand and chemicals at the waterworks, the distributed and softened drinking water supported a decrease in consumption of energy and chemical agents in the households along with a prolonged service life of household appliances which heat water. This study used Life Cycle Assessment (LCA) to quantify the environmental impacts of central softening of drinking water considering both the negative effects at the waterworks and the positive effects imposed by the changed water quality in the households. The LCA modeling considered central softening of drinking water from the initial hardness of the region of study (Copenhagen, Denmark) which is 362 mg/L as CaCO(3) to a final hardness as CaCO(3) of 254 (a softening depth of 108) mg/L or 145 (a softening depth of 217) mg/L. Our study showed that the consumer preference can be met together with reducing the impact on the environment and the resource consumption. Environmental impacts decreased by up to 3 mPET (milli Personal Equivalent Targeted) and the break-even point from where central softening becomes environmentally beneficial was reached at a softening depth of only 22 mg/L as CaCO(3). Both energy-related and chemically related environmental impacts were reduced as well as the consumption of resources. Based on scarcity criteria, nickel was identified as the most problematic non-renewable resource in the system, and savings of up to 8 mPR (milli Person Reserve) were found.

Life cycle assessment of three water systems in Copenhagen--a management tool of the future.

Environmental life-cycle assessment (LCA) was applied to evaluate three different water systems of the water sector in Copenhagen, Denmark, including technologies within water supply, facilities recycling water and treatment of sewer overflow. In these three water systems LCA was used to evaluate the environmental impacts of each of the processes involved. The overall conclusion was that LCA is suitable as a decision support tool in the water sector as it provides a holistic evaluation platform of the considered alternatives categorised in environmental impact categories. The use of LCA in the water sector of this region has limitations since it does not yet consider impact categories assessing freshwater scarcity and ecological sustainability.

First Report of Tomato yellow leaf curl virus in Venezuela.

Tomato yellow leaf curl virus (TYLCV), a member of the family Geminiviridae, is a serious production constraint to tomato worldwide. In the new world, the virus had been identified as the causal agent of tomato yellow leaf curl disease in the Caribbean countries of the Dominican Republic, Cuba, and Guadeloupe and also in Florida and the Yucatan Peninsula (1). Molecular data from these TYLCV isolates identified the virus as the TYLCV prototype from Israel. During April 2004, tomato plants showing symptoms such as chlorotic leaf edges, upward leaf cupping, leaf mottling, and reduced leaf size indicative of TYLCV were observed in commercial fields in Zulia state, Venezuela. Whiteflies (Bemisia tabaci Gennadius) were present in the field and appeared to be associated with the disease. Leaf samples from nine symptomatic plants were collected and brought to the lab at Instituto Venezolano de Investigaciones Científicas (IVIC) for further analyses. Geminivirus infection of samples was confirmed by PCR amplification with the degenerate primer pair PAL1v1978 and PAR1c494 (2). TYLCV coat protein gene-specific primers KL04-06_TYLCV CP F and KL04-07_TYLCV CP R (3) were used to confirm the diagnosis. These primers amplified the expected 842-bp PCR product from the nine symptomatic samples. One of the resulting amplicons was cloned into the pCR-TOPO vector (Invitrogen, Carlsbad, CA) and sequenced (GenBank Accession No. DQ302033). Sequence comparison with those available in the NCBI database indicated that the sequenced portion of the genome shared 99% nucleotide identity with the TYLCV mild strain from Portugal (GenBank Accession No. AF105975) and 98% nucleotide identity with the TYLCV mild strain from Spain (GenBank Accession No. AF071228), TYLCV Israel isolate (GenBank Accession No. AM234066), and TYLCV Mexico isolate (GenBank Accession No. DQ631892). To our knowledge, this is the first report of TYLCV infecting tomato crops in South America. Further studies are needed to clarify how TYLCV has been introduced into Venezuela. References: (1) J. E. Polston and P. K. Anderson. Plant Dis. 81:1358, 1997. (2) M. R. Rojas et al. Plant Dis. 77:340, 1993. (3) K. S. Ling et al. Plant Dis. 90:379, 2006.

First Report of Celery mosaic virus Infecting Celery in Venezuela.

Celery mosaic virus (CeMV) is a significant pathogen of celery (Apium graveolens) worldwide (1). In 2005, in a produce market located in Los Salias, Miranda, celery plants with mottling and leaf malformation were noticed. Electron microscopic analysis of leaf-dip preparations from three symptomatic samples revealed flexuous viral particles that were 750 nm long. Infected cells contained pinwheel inclusions typical of those associated with potyvirus infection. Inoculation of healthy celery plants with leaf extracts from four symptomatic plants produced symptoms identical to those first observed. A survey of five produce markets in Miranda was conducted to determine the prevalence of virus infection in celery using serological and molecular analyses. Mottling and malformation of celery leaflets were observed in all the markets visited. Symptoms were noted in all five markets in each of three visits during a 3-month period. A total of 125 postharvested symptomatic plants were collected from five markets on March 29, 2005 and tested for CeMV using double-antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA) with antiserum provided by F. Rabenstein, BAX, Aschersleben, Germany. Of the 125 samples collected during the survey, 53% were ELISA positive. Twenty ELISA-positive samples were also tested using reverse transcription-polymerase chain reaction (RT-PCR) with general primers for the family Potyviridae (2). All 20 samples produced an amplicon of the expected size (1.7 kbp) after RT-PCR. Amplicons from three samples were cloned into the pCR-TOPO vector (Invitrogen, Carlsbad, CA). Sequence analysis of one clone revealed more than 98% nt to a CeMV isolate from Australia (GenBank Accession No AF203532). To our knowledge, this is the first report of CeMV in Venezuela. Our results suggest that the disease may be widely spread on celery crops growing in the areas surrounding produce markets in Miranda State. References: (1) A. Brunt et al. Viruses of Plants. CAB International, Wallingford, Oxon, UK. 1996. (2) J. Chen et al. Arch. Virol. 146:757, 2001.

A phytotoxicity test using transpiration of willows.

A short-term acute toxicity assay for willow trees growing in contaminated solution or in polluted soil was developed and tested. The test apparatus consists of an Erlenmeyer flask with a prerooted tree cutting growing in it. Growth and reduction of transpiration are used to determine toxicity. Transpiration is closely related to photosynthesis and growth, but is easier and faster to measure and can be measured without disturbance of the test system. Plants are grown for 24 h in uncontaminated nutrient solution before the toxicant is added to determine the initial transpiration. The loss of weight is expressed as % decrease after 48 and 72 h or longer compared to the initial transpiration, divided by the transpiration of control plants. More toxicity parameters are growth and water use efficiency of the plants. The sensitivity of the test was evaluated with 3,5-dichlorophenol. EC(50) values between 5.8 and 9.6 mg/L were found. This is similar to the results from algal growth rate tests. The willow tree toxicity test may be useful for determining the site-specific toxicity of polluted soils and for terrestrial risk assessment of new chemicals and pesticides.