Punto G: enfoque anatómico y seguridad del paciente / G-spot: anatomical approach and patient safety

Se investiga la región uretro-vaginal (pared posterior de la uretra ­ pared anterior de la vagina), en el área que corresponde a la descripción del "punto G", con el fin de colaborar a la discusión respecto de si existe una estructura morfológica que lo identifique. Se destaca una mayor y ocasional distribución venosa en esta zona, que puede explicar el fenómeno fisiológico descrito por Gräfenberg. Para los ginecólogos, urólogos y sexólogos, el conocimiento de la anatomía funcional de esa región tiene importancia para tratar las disfunciones orgásmicas además de la incontinencia urinaria. Esta situación controvertida influye en el marco actual de la seguridad del paciente

The urethro-vaginal region (posterior wall of the urethra ­ anterior wall of the vagina) is investigated, in the area that corresponds to the description of the "G-spot", in order to contribute to the discussion regarding whether there is a morphological structure that identifies it. A greater and occasional venous distribution in this area stands out, which may explain the physiological phenomenon described by Gräfenberg. For gynecologists, urologists and sexologists, knowledge of the functional anatomy of that region is important to treat orgasmic dysfunctions in addition to urinary incontinence. This controversial situation influences the current framework of patient safety

Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases.

Infectious diseases have consistently served as pivotal influences on numerous civilizations, inducing morbidity, mortality, and consequently redirecting the course of history. Their impact extends far beyond the acute phase, characterized by the majority of symptom presentations, to a multitude of adverse events and sequelae that follow viral, parasitic, fungal, or bacterial infections. In this context, myriad sequelae related to various infectious diseases have been identified, spanning short to long-term durations. Although these sequelae are known to affect thousands of individuals individually, a comprehensive evaluation of all potential long-term effects of infectious diseases has yet to be undertaken. We present a comprehensive literature review delineating the primary sequelae attributable to major infectious diseases, categorized by systems, symptoms, and duration. This compilation serves as a crucial resource, illuminating the long-term ramifications of infectious diseases for healthcare professionals worldwide. Moreover, this review highlights the substantial burden that these sequelae impose on global health and economies, a facet often overshadowed by the predominant focus on the acute phase. Patients are frequently discharged following the resolution of the acute phase, with minimal long-term follow-up to comprehend and address potential sequelae. This emphasizes the pressing need for sustained vigilance, thorough patient monitoring, strategic health management, and rigorous research to understand and mitigate the lasting economic and health impacts of infectious diseases more fully.

Job Satisfaction and Self-Perceptions Among Ecuadorian Medical Doctors During Their Compulsory Rural Community Social Service: A Countrywide Cross-Sectional Analysis.

INTRODUCTION: Job satisfaction has been shown to have important effects at the organizational level. In various corners of the world, physicians are obliged to perform a period of social service, generally at the first level of care in rural or remote areas. OBJECTIVE: To describe the level of job satisfaction and perceptions of Ecuadorian rural physicians regarding compulsory social service. METHODOLOGY: A descriptive, cross-sectional study was conducted based on a self-administered online questionnaire from February to March 2022, in Ecuadorian rural physicians who were performing their compulsory social service. Participants were invited through official outreach groups. A total of 247 surveys were included in this study. We assessed job satisfaction by means of the S20/23 job satisfaction questionnaire and compared these results with sociodemographic variables and job characteristics of the participants. We performed the reliability test (Cronbach's alpha) to find the validity of the S20/23 questionnaire in physicians performing compulsory social service. RESULTS: The majority of participants were women (61.0%), and overall job satisfaction was 4.1/7.0 pts. "indifferent." The only satisfaction factor in which a predominance of dissatisfaction was found related to benefits/remuneration (43.3%). Participants' perceptions of wrong academic guidance during training, insufficient induction, and negative experiences during work were related to higher levels of dissatisfaction (P < .05). CONCLUSION: The level of job satisfaction of Ecuadorian rural physicians during their compulsory social service was low and graduates indicated a neutral attitude toward job satisfaction in general. Negative perceptions with respect to training and expectation formation prior to and during the mandatory social service generated greater dissatisfaction. The Ministry of Health of Ecuador, as an organizational entity, should implement improvements to increase the job satisfaction of recently graduated physicians, given the implications that this experience may have for their professional future.

Dynamics of the impact of COVID-19 on the economic activity of Peru.

BACKGROUND: The COVID-19 virus impacts human health and the world economy, causing in Peru, more than 800 thousand infected and a strong recession expressed in a drop of -12% in its economic growth rate for 2020. In this context, the objective of the study is to analyze the dynamics of the short-term behavior of economic activity, as well as to explain the causal relationships in a Pandemic context based on the basic number of spread (Re) of COVID-19 per day. METHODS: An Autoregressive Distributed Lags (ARDL) model was used. RESULTS: A negative and statistically significant impact of the COVID-19 shock was found on the level of economic activity and a long-term Cointegration relationship with an error correction model (CEM), with the expected sign and statistically significant at 1%. CONCLUSION: The Pandemic has behaved as a systemic shock of supply and aggregate demand at the macroeconomic level, which together have an impact on the recession or level of economic activity. The authors propose changing public health policy from an indiscriminate suppression strategy to a targeted, effective and intelligent mitigation strategy that minimizes the risk of human life costs and socioeconomic costs, in a context of uncertainty about the end of the Pandemic and complemented by economic, fiscal and monetary policies that mitigate the economic recession, considering the underlying structural characteristics of the Peruvian economy.

Prótesis total de fémur en un paciente con quiste óseo hidatídico complicado. Reporte de un caso / Total femoral replacement in patient with complicated bone hydatid cyst. Case report

Resumen Se presenta un caso de un hombre de 31 años con fractura de fémur. Los estudios complementarios mostraron una imagen compatible con lesión quística. El primer estudio por biopsia de dicho quiste informó erróneamente un quiste simple. Se realizó una osteosíntesis con enclavado endomedular. El paciente tuvo una evolución tórpida asociada a imágenes líticas diafisarias y pérdida de la reducción de la fractura. Se retiró el material y se tomaron muestras del canal endomedular, cuyo cultivo reveló Pseudomonas aeruginosa y restos de quistes hidatídicos en la anatomía patológica. En nuestro centro, fue tratado por una seudoartrosis infectada secundaria a un quiste óseo hidatídico complicado. Se le colocó un megaespaciador de cemento con antibiótico y, luego, una prótesis total de fémur como tratamiento definitivo. El compromiso óseo es muy raro y de difícil diagnóstico, y puede llevar a una diseminación severa. Si bien no hay consenso ni tratamiento de elección para los casos graves, el reemplazo femoral total en dos tiempos representa una opción alentadora para conservar el miembro, con resultados satisfactorios a corto y mediano plazo.

Abstract We report the case of a 31-year-old male patient presenting a femoral fracture whose complementary studies revealed an image consistent with a cystic lesion. The first biopsy study of this cyst erroneously reported a simple cyst. Osteosynthesis with intramedullary nailing was performed. The patient had a poor postoperative course associated with diaphyseal osteolytic images and loss of fracture reduction. The material was removed and intramedullary canal specimens were taken, which were positive for Pseudomonas aeruginosa and revealed remains of hydatid cysts through pathologic examination. The patient was referred to our center for the treatment of an infected pseudarthrosis secondary to a complicated hydatid bone cyst. A two-stage procedure was performed. The first stage involved the placement of an antibiotic-impregnated cement mega-spacer and the second stage involved the implantation of a total femur prosthesis as definitive treatment. The bone hydatidosis involves a challenging diagnosis, is very rare, and can cause severe dissemination. While there is no consensus or gold standard treatment for severe cases, two-stage total femoral replacement represents an encouraging option for limb preservation, showing satisfactory short- and medium-term outcomes.

Survey of Methylmercury Exposures and Risk Factors Among Indigenous Communities in Guyana, South America.

BACKGROUND: Gold mining activities in forested areas across Guyana have been a common practice for more than a century. The intensification of artisanal and small-scale gold mining (ASGM) in recent decades caused by global market demand is contributing to the mobilization of mercury into aquatic systems. Indigenous populations who consume high levels of locally sourced fish are greater at risk for methylmercury poisoning from ingestion of contaminated fish. OBJECTIVES: The aim of the present study was to investigate the levels of mercury contamination and identify the risk factors associated with hair mercury levels in four indigenous communities in Guyana. METHODS: Concentrations of total mercury were measured in hair samples from 99 participants from four indigenous communities in the south Rupununi region in Guyana. The findings of this study were compared with those of previous studies to assess the prevalence of mercury contamination in indigenous communities across Guyana. RESULTS: Hair mercury levels were found to be above the World Health Organization (WHO) reference value for residents who live close to ASGM activities and who consume high quantities of locally sourced fish. Our results are not only consistent with those obtained in previous studies, but also evidence that mercury poisoning has become a generalized problem for indigenous communities in Guyana. CONCLUSIONS: Fish is the main source of protein for many riverine communities and consumption of mercury-contaminated fish poses a serious health hazard for these vulnerable populations. The situation is especially dire for community members of Parabara with 100% of participants showing elevated (>15 µg*g-1) hair mercury levels. It is therefore crucial that Parabara residents be evaluated by relevant health agencies for clinical symptoms related to mercury toxicity. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: The study protocol was approved by the Institutional Review Board of the Ministry of Public Health, Guyana. COMPETING INTERESTS: The authors declare no competing financial interests.

Randomized Controlled Trial of Bovine Lactoferrin for Prevention of Sepsis and Neurodevelopment Impairment in Infants Weighing Less Than 2000 Grams.

OBJECTIVES: To determine the effect of bovine lactoferrin on prevention of late-onset sepsis (LOS) and neurodevelopment delay. STUDY DESIGN: Randomized, double-blind, controlled trial in neonates with a birth weight of 500-2000 g in 3 neonatal units in Lima, Peru, comparing bovine lactoferrin 200 mg/kg/day with placebo administered for 8 weeks. The primary outcome was the first episode of culture-proven LOS or sepsis-associated death. Neurodevelopment delay was assessed by the Mullen Scales at 24 months corrected age. RESULTS: Of the 414 infants enrolled, 209 received bovine lactoferrin and 205 received placebo. LOS or sepsis-associated death occurred in 22 infants (10.5%) in the bovine lactoferrin group vs 30 (14.6%) in the placebo group; there was no difference after adjusting for hospital and birth weight; hazard ratio 0.73 (95% CI, 0.42-1.26). For infants with birth weights of <1500 g the hazard ratio was 0.69 (95% CI, 0.39-1.25). The mean age-adjusted normalized Mullen composite score at 24 months was 83.3 ± 13.6 in the bovine lactoferrin group vs 82.6 ± 13.1 in the placebo group. Growth outcomes and rehospitalization rates during the 2-year follow-up were similar in both groups, except for significantly less bronchiolitis in the bovine lactoferrin group (rate ratio, 0.34; 95% CI, 0.14-0.86). CONCLUSIONS: Supplementation with bovine lactoferrin did not decrease the incidence of sepsis in infants with birth weights of <2000 g. Growth and neurodevelopment outcomes at 24 months of age were similar. Neonatal bovine lactoferrin supplementation had no adverse effects. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01525316.

Antibiotic Overuse in Premature Low Birth Weight Infants in a Developing Country.

BACKGROUND: Neonatal sepsis is a leading cause of child morbidity and mortality, especially in premature and low birth weight infants. Prompt antibiotic therapy is warranted, but its inappropriate use leads to bacterial resistance and adverse outcomes. Our objective is to describe the antibiotic use for late-onset sepsis in Peruvian premature infants. METHODS: This study is a prospective study as a secondary analysis of a clinical trial in 3 neonatal care units in Peru. We included infants in the first 72 hours of life, with birth weight (BW) <2000 g. We described the antibiotic use as length of therapy (LOT) per 1000 patient days (PD) and antibiotic courses. RESULTS: We included 408 neonates, with 12,204 PD of follow-up; 253 infants (62%) had a BW ≤1500 g. Total antibiotic use for late-onset sepsis was 2395 LOT (196 LOT/1000 PD). Two-hundred and seventy-one patients (66.4%) did not receive antibiotics for late-onset sepsis during their hospitalization. In total, 204 antibiotic courses were administered; 92 infants (22.5%) received 1 course, and 45 (11.0%) received 2-5 antibiotic courses. Mean duration of antibiotic course was 10.8 days (standard deviation: ±7.3). We found a significant association between a lower BW and increased antibiotic use per day (P < 0.001). The most commonly used antibiotics were vancomycin (143 LOT/1000 PD), carbapenems (115 LOT/1000 PD), aminoglycosides (72 LOT/1000 PD) and ampicillin (41 LOT/1000 PD). CONCLUSIONS: Premature infants receive antibiotics for longer than recommended periods of time. Antibiotic overuse is greater in neonates with lower BW. Vancomycin is the most used antibiotic. There is an urgent need to develop antimicrobial stewardship programs in our setting.

El conocimiento anatómico en el Perú preincaico / The anatomical knowledge in the pre-Inca era in Peru

En el antiguo Perú, en la era preincaica, en la localidad de Sechín, sus habitantes dejaron grabados en piedras una serie de imágenes anatómicas, que tal vez constituyan los testimonios más antiguos de disecciones humanas realizadas en el mundo. (AU)

In Ancient Peru, in the pre-Inca era, in the town of Sechin, its habitants left engravings in stones a series of anatomical images, which may be the oldest testimonies of human dissections made in the world. (AU)

Contribución a la evalaución de la regeneración natural de la mara (Sweitenia macrophylla king) en la concesión la Chonta de la empresa Planet Chonta Investment Ltda / sss

El estudio se realizo en la ciudad de Santa Cruz (Bolivia) en la concesion La Chonta, el cual determino la cantidad de regeneración de mara (sweiteria king) y las variables que influyen en su regeneración, se levanto información de vegetacion en 22 hectareas. De una mancha de mara se evaluó la vegetación acompañante con DAP mayores a 40 cm y todos los fustales brizales de mara se empleo un modelo de regresión multiple para establecer el comportamiento de la mara frente a variables que influyen en su regeneración el 40 por ciento de los individuos posee un DAP entre 10 y 40 cm un 20 por ciento tiene los individuos mayores a 70 cm. de DAP entre 40 y 70 poseen un 40 por ciento de los individuos el número de brizales es de 1.4545/ha...

Update on the pathogenesis and immunotherapy of esophageal squamous cell carcinoma

El carcinoma de células escamosas de esófago (CCEE) es el subitpo histológico predominante de cáncer esofágico, y se caracteriza por su alta mortalidad y diferencias geográficas en cuanto a su incidencia. A pesar de que se ha dedicado mucha investigación en esta área, aún no se conoce la causa excata de esta neoplasia. Nuestro entendimiento de la patogénesis, epidemiología y comportamiento del CCEE continúa en desarrollo con los avances en el campo de la biología molecular. Algunos de estos avances incluyen la investigación en la etiopatogénesis (virus como el papilomavirus humano, y genes susceptibles a cáncer), genes relacionados a tumores (oncogenes, genes y supresores de tumores), así como nuevas formas de inmunoterapia neoadyuvante para el tratamiento de esta neoplasia.

Obtención de ácido deoxirribonucleico (ADN) útil para análisis genético, a partir de uñas recortadas / DNA extraction for genetic analysis obtained from trimmed nails

Obtaining deoxyribonucleic acid (DNA) is the starting point for most genetic analysis. Nails are an accessible source of DNA. The present communication reports the successful extraction of genomic DNA from fresh nails, as well as from nails collected a month before the extraction. Amplification in two different regions of the human beta-globin gene was achieved by of the polymerase chain reaction. The described method, is a simple, non invasive mehod. Nail clipping material may be considered a convenient material for genetic analysis

Variaciones de la bifurcación de las arterias carótidas primitivas / Variations in the fork of the carotid arteries primitive

El sistema arterial carotídeo, lo forman las arterias carótidas primitivas derecha e izquierda, cada una de ellas se bifurca (divide) por lo general a la altura del borde superior del cartílago tiroides, a nivel de la cuarta vértebra cervical (C4) en arterias carótidas interna y externa, cerca del punto de bifurcación, entre las arterias carótida primitiva e interna se encuentra una dilatación, llamada seno carotídeo, en cuyas paredes están los barorreceptores que son estimulados con los cambios de la presión sanguínea; entre las carótidas externa e interna, se encuantra el cuerpo carotídeo, que actúa como quimiorreceptor en la anoxemia, aumentando la presión sanguínea, el ritmo cardíaco y los movimientos rspiratorios. Entre los años 2001 y 2002, en el Anfiteatro de Anatomía Humana de la Facultad de Ciencias de la Salud, se evaluaron 8 cadáveres humanos embalsamados con solución de formol y preservantes, obtenidos de la Morgue Central de Lima, de sexo masculino, raza mestiza, entre 30 y 65 años de edad, identificados con sus respectivos protocolos de necropsia, la posición de la bifurcación de las arterias carótidas primitivas a 4 cm. por encima del borde superior del cartílago tiroides y C4 es la variante más frecuente 37.5 por ciento y la menor 12.5 por ciento a nivel de estos puntos de referencia.

Síndrome de rubéola congénita en diecisiete hospitales del Perú, 1998-2000 / Congenital rubella syndrome prevalence at seventeen peruvian hospitals, 1998-2000

Objetivo: Determinar la presencia de casos de síndrome de rubéola congénita (SRC) en Hospitales Nacionales e Institutos Especializados del Perú. Diseño: Transversal, descriptivo. Material y Métodos: Se revisó historias clínicas de niños hospitalizados entre enero de 1998 y junio de 2000 en 17 hospitales ubicados en 7 departamentos del Perú, niños que presentaron cuando menos alguno de los siguientes diagnósticos: catarata o glaucoma congénitos, retinitis pigmentosa, malformación cardíaca congénita o sordera neurosensorial. Resultados: De 91 102 diagnósticos de egresos hospitalarios en niños menores de 12 años, 361 cumplían con los criterios de inclusión para el estudio; de ellos, 187 (51,8 por ciento) tuvieron sospecha de síndrome de rubéola congénita (SRC), 35 (9,7 por ciento) fueron casos probables y 5 (1,4 por ciento) confirmados. Las principales manifestaciones clínicas fueron cardiovasculares (93,6 por ciento), del sistema nervioso central (29,6 por ciento) y oculares (18,6 por ciento); 11 por ciento de los niños tuvo más de una manifestación clínica. Conclusión: Existe evidencia de niños con SRC que han sido hospitalizados en 17 hospitales en el Perú.

Síndrome de rubéola congénita en 6 colegios para niños con sordera y7o ceguera, en Lima, Cusco y Arequipa, Perú, 1998-2000 / Congenital rubella syndrome in 6 schools for deaf and7or blind children in Lima, Cusco and Arequipa, Peru, 1998-2000

OBJETIVO: Deteminar la presencia de casos de síndrome de rubéola congénita (SRC) en tres ciudades del Perú. Diseño: Transversal, descriptivo. Material y Métodos: En 6 colegios de educación especial para niños sordos y/o ciegos, ubicados en Lima (tres), Cusco (dos) y Arequipa (uno), se analizó la información contenida en registros médicos de niños menores de 12 años. Se incluyó los casos con criterios mayores de la definición de SRC. Resultados: De 364 registros de niños que estudian en colegios especiales, se incluyó 105; de ellos, 64,7 por ciento (75) tuvo manifestaciones del sistema nervioso, 31 por ciento oculares. Utilizando una ficha validada para el estudio, 61,9 por ciento correspondió a casos sospechosos, 21 por ciento probables y dos fueron casos confirmados (1,9 por ciento). Conclusiones: Debido a que 6,6 por ciento (24) del total de niños que estudian en colegios especiales son casos probables y confirmados de SRC, se evidencia que éste es un problema que existe en el país, por lo cual se fundamenta la necesidad de iniciar la vacunación antirubéolica en el país.

La técnica radiográfica de Richards y su relación con la ubicación del conducto dentario inferior respecto al tercer molar inferior / The radiographic technique of Richards and its relation with the location of the inferior dental conduit with respect to third molar inferior

En la actualidad aún se ven, no con tanta frecuencia como antes, complicaciones al intervenir quirúrgicamente el tercer molar inferior y una de éstas es sin duda el compromiso del conducto dentario inferior y su contenido, lo que motivó a evaluar la Técnica Radiográfica de Richards para ubicar dicho conducto con precisión. Se obtuvo que esta estructura anatómica se encontró en mucho mayor porcentaje por vestibular que por lingual de la pieza en mención.