Development and Usage Patterns of a Home-Grown Drug Information Tool.

Drug information tools help avoid medication errors, a common cause of avoidable harm in health care systems. We sought to describe the design, development process and architecture of an electronic drug information tool, as well as its overall use by health professionals. We developed a tool that can be accessed by all health professionals in a tertiary level university hospital. The functionalities of eDrugs are organized into two main parts: Drug Summary sheet, and Prescription Simulator. Most users accessed eDrugs to use the Drug summary sheet. Clinical information and antimicrobial drugs were the most accessed drug information and drug group. The analysis of log data provides insights into the information priorities of health professionals.

An Improved Immunization Record to Support Vaccination During the COVID-19 Pandemic at a University Hospital in Argentina.

WHO and UNICEF highlight vaccination as the most cost-effective method of prevention of infectious diseases. An effective public health strategy requires efficient tracking of vaccination to assess coverage, safety, and efficacy of these vaccines. Paper-based immunization records are still being used in most low and middle-income countries. Adequate Electronic Logistic Management Information Systems, Immunization Registries and Records are crucial for proper data collection and analysis, and for making better decisions at an individual and at a population level. In this paper we share our experience in the redesign of an interoperable immunization record to track vaccination, including the recently developed vaccines for the novel coronavirus SARS-CoV-2 (COVID-19).

Decision Support Tools for Drugs Prescription Process in a Hospital in Argentina.

While medications can improve the health of patients, the prescription process is complex and prone to errors. The structured medical order entry systems (CPOE) with clinical decision support (CDS) are increasingly implemented to improve patient safety, however the organizations that decide to implement them will have several challenges: understanding which classes of CDS can admit their systems, ensure that clinical knowledge is adequate and design tools for proper monitoring. We share our experience of over ten years of development and implementation of clinical decision support tools during drugs prescription process and tools that have allowed us to monitor them correctly.

In silico strategies to couple production of bioethanol with growth in cyanobacteria.

Cyanobacteria have been considered as promising candidates for sustainable bioproduction from inexpensive raw materials, as they grow on light, carbon dioxide, and minimal inorganic nutrients. In this study, we present a genome-scale metabolic network model for Synechocystis sp. PCC 6803 and study the optimal design of the strain for ethanol production by using a mixed integer linear problem reformulation of a bilevel programming problem that identifies gene knockouts which lead to coupling between growth and product synthesis. Five mutants were found, where the in silico model predicts coupling between biomass growth and ethanol production in photoautotrophic conditions. The best mutant gives an in silico ethanol production of 1.054 mmol·gDW -1 ·h -1 .

Whitebark pine facilitation at treeline: potential interactions for disruption by an invasive pathogen.

In stressful environments, facilitation often aids plant establishment, but invasive plant pathogens may potentially disrupt these interactions. In many treeline communities in the northern Rocky Mountains of the U.S. and Canada, Pinus albicaulis, a stress-tolerant pine, initiates tree islands at higher frequencies than other conifers - that is, leads to leeward tree establishment more frequently. The facilitation provided by a solitary (isolated) P. albicaulis leading to tree island initiation may be important for different life-history stages for leeward conifers, but it is not known which life-history stages are influenced and protection provided. However, P. albicaulis mortality from the non-native pathogen Cronartium ribicola potentially disrupts these facilitative interactions, reducing tree island initiation. In two Rocky Mountain eastern slope study areas, we experimentally examined fundamental plant-plant interactions which might facilitate tree island formation: the protection offered by P. albicaulis to leeward seed and seedling life-history stages, and to leeward krummholz conifers. In the latter case, we simulated mortality from C. ribicola for windward P. albicaulis to determine whether loss of P. albicaulis from C. ribicola impacts leeward conifers. Relative to other common solitary conifers at treeline, solitary P. albicaulis had higher abundance. More seeds germinated in leeward rock microsites than in conifer or exposed microsites, but the odds of cotyledon seedling survival during the growing season were highest in P. albicaulis microsites. Planted seedling survival was low among all microsites examined. Simulating death of windward P. albicaulis by C. ribicola reduced shoot growth of leeward trees. Loss of P. albicaulis to exotic disease may limit facilitation interactions and conifer community development at treeline and potentially impede upward movement as climate warms.

Absceso cerebral, a proposito de un caso / Brain abscess, apropos of a case

Los abscesos cerebrales onstituyen la forma más común de supuración intracraneal en los niños, son más frecuentes entre los 4 a 8 años de edad, el tipo de germen que lo causa depende del proceso primario y de la llocalización del absceso.

Sindrome de Williams Beuren; reporte de un caso / Williams Beuren syndrome, a case report

Se presente el caso clínico de un niño de 1 año y 5 meses de edad, que fue atendido en el Hospital Materno Infantíl de la ciudad de Trinidad y que por las características clínicas se concluye que se trata de un síndrome de Williams Beuren.

Acceptability of emergency contraception in Brazil, Chile, and Mexico: 1 - Perceptions of emergency oral contraceptives.

This article presents the results of a study on the acceptability of emergency contraception (EC) in Brazil, Chile, and Mexico. Opinions of potential users and possible providers were obtained through discussion groups and those of authorities and policy-makers through semi-structured interviews. Most participants had a positive opinion of EC, based on the view that it can help reduce unplanned pregnancy, adolescent pregnancy, and unsafe abortion. Several interviewees felt that all women should be informed about EC, while others viewed it as a method for special situations such as rape and unprotected first sexual intercourse. Concern was expressed that its introduction might be associated with a decrease in condom use, increase in sexually transmitted diseases, and irresponsible or promiscuous sexual behavior among adolescents. The need for EC was clearly perceived by most participants, leading to the conclusion that health authorities have the responsibility of implementing programs for its introduction. Training of health care personnel should include the discussion of reproductive health problems that could be prevented by EC.

Acceptability of emergency contraception in Brazil, Chile, and Mexico. 2 - Facilitating factors versus obstacles

Foram identificados fatores que poderiam facilitar ou dificultar a introdução da anticoncepção de emergência (AE) no Brasil, Chile e México. Foram levantadas informações sobre o contexto sócio-cultural, político e legal bem como sobre as características dos serviços da saúde reprodutiva. As opiniões de potenciais usuários e possíveis provedores foram obtidas por meio de grupos de discussão, e as das autoridades e outras pessoas influentes por intermédio de entrevistas semi-estruturadas. Os obstáculos incluíram: percepção da AE como abortiva; oposição da Igreja Católica; pouco reconhecimento dos direitos sexuais e reprodutivos; pouca educação sexual; e falta de sensibilidade frente às questões de gênero. Os facilitadores foram: percepção da AE como um método que poderia prevenir o aborto e a gravidez entre adolescentes e vítimas de estupro; interesse no método mostrado por potenciais usuárias, bem como por alguns provedores e autoridades. Parece possível reduzir as barreiras identificadas com o apoio dos segmentos da sociedade comprometidos com a melhora da saúde sexual e reprodutiva, e com o treinamento adequado dos provedores de saúde.

Acceptability of emergency contraception in Brazil, Chile, and Mexico: 1 - Perceptions of emergency oral contraceptives

This article presents the results of a study on the acceptability of emergency contraception (EC) in Brazil, Chile, and Mexico. Opinions of potential users and possible providers were obtained through discussion groups and those of authorities and policy-makers through semi-structured interviews. Most participants had a positive opinion of EC, based on the view that it can help reduce unplanned pregnancy, adolescent pregnancy, and unsafe abortion. Several interviewees felt that all women should be informed about EC, while others viewed it as a method for special situations such as rape and unprotected first sexual intercourse. Concern was expressed that its introduction might be associated with a decrease in condom use, increase in sexually transmitted diseases, and irresponsible or promiscuous sexual behavior among adolescents. The need for EC was clearly perceived by most participants, leading to the conclusion that health authorities have the responsibility of implementing programs for its introduction. Training of health care personnel should include the discussion of reproductive health problems that could be prevented by EC

Acceptability of emergency contraception in Brazil, Chile, and Mexico. 2 - Facilitating factors versus obstacles.

A multi-center study was performed in Brazil, Chile, and Mexico to identify factors that may facilitate or hinder the introduction of emergency contraception (EC) as well as perceptions concerning emergency contraceptive pills. Background information on the socio-cultural, political, and legal context and the characteristics of reproductive health services was collected. The opinions of potential users and providers were obtained through discussion groups, and those of authorities and policymakers through semi-structured interviews. Barriers to introduction included: perception of EC as an abortifacient, opposition by the Catholic Church, limited recognition of sexual and reproductive rights, limited sex education, and insensitivity to gender issues. Facilitating factors were: perception of EC as a method that would prevent abortion and pregnancy among adolescents and rape victims; interest in the method shown by potential users as well as by some providers and authorities. It appears possible to reduce barriers through support from segments of society committed to improving sexual and reproductive health and adequate training of health care providers.

Health and growth of infants breastfed by Norplant contraceptive implants users: a six-year follow-up study.

The objective of the study was to evaluate safety to infants whose mothers used Norplant levonorgestrel implants during breastfeeding. A nonrandomized clinical trial design was used. Participants were 220 and 222 healthy breastfed infants of mothers initiating use of Norplant or T-Cu IUD, respectively, at 55 days to 60 days postpartum. Infants were followed from birth through age 6 years. Breastfeeding pattern, infant growth, and disease events were recorded monthly in the first year, three-monthly in the second, and annually thereafter. Most mothers continued use of Norplant (96.4%) and T-Cu (94.1%) during lactation, and 2140 months of infant exposure to levonorgestrel were accumulated. Breastfeeding pattern and infants growth, from admission through age 6 years, were similar in both groups. In the first year, breastfed infants in the Norplant group had higher incidence rates (p < 0.05) of mild episodes of respiratory infections (adjusted RR 1.17, CI 1.08-1.27), skin conditions (adjusted RR 1.46, CI 1.20-1.79), and eye infections (unadjusted RR 1.49, CI 1.03-2.18) than the control group. Later on, a higher proportion of infants in the T-Cu group showed neurological conditions. Although breastfeeding patterns and infant growth is not affected by Norplant use during lactation, the effect on infants' health of steroidal contraception should be further evaluated.

Contraceptive implants and lactation.

The safety and efficacy of four contraceptive implants, plant, Implanon, Nestorone and Elcometrine, have been evaluated during use in the postpartum period by lactating women. These implants provide highly effective contraceptive protection with no negative effect on breastfeeding or infant growth and development. Breastfeeding women initiating Norplant use in the second postpartum month experience significantly longer periods of amenorrhea than do untreated women or intrauterine device users. After weaning, the bleeding pattern is similar to that observed in non-nursing women. Norplant use does not affect bone turnover and density during lactation. Norplant and Implanon release orally active progestins while Nestorone and Elcometrine implants release an orally inactive progestin, which represents an advantage since the infant should be free of steroidal effects. The infant's daily intake of steroids (estimated from concentrations in maternal milk during the first month of use) range from 90 to 100 ng of levonorgestrel (Norplant), 75-120 ng of etonogestrel (Implanon), and 50 ng and 110 ng of Nestorone (Nestorone and Elcometrine implants, respectively). Nursing women needing contraception may use progestin-only implants when nonhormonal methods are not available or acceptable. Implants that deliver orally active steroids should only be used after 6 weeks postpartum to avoid transferring of steroids to the newborn.

Incidencia, prevalencia y recuperabilidad de la esquizofrenia en diferentes países / Incidence, prevalence and outcome schizophenia in different countries

Mediante una investigación bibliográfica, se revisan estudios en diferentes lugares del mundo y se analizan cómo influyen los contextos sociales, políticos y económicos, las diferentes culturas y actitudes en la evolución y pronóstico de la esquizofrenia. Los síntomas de la esquizofrenia están presentes en todas las culturas, aproximadamente en la misma proporción. Sin embargo, la incidencia, prevalencia y recuperabilidad de la esquizofrenia varían por la influencia y la interacción de diversos factores como el nivel socioeconómico, el mercado laboral, el contexto urbano o rural, las relaciones familiares, especialmenteel matrimonio, el estigma y el aislamiento social y otros. Por otra parte, el curso y pronóstico de la esquizofrenia es mejor en países en desarrollo. Este resultado paradójico -ya que los pacientes de países industrializados generalmente reciben más ayuda técnica que los de países en desarrollo- es lo que se analiza en este trabajo

Patología anexial no inflamatoria durante el uso de implantes de levonorgestrel (Norplant) o dispositivos intrauterinos / Annexial pathology non inflammatory during levonorgestrel implant use (Norplant) or intrauterine devices

Se revisan las fichas clínicas de 477 mujeres usuarias de Norplant y 200 portadoras de T-Cobre que reúnen 28548 y 9752 meses de exposición, respectivamente. Se evaluó la presencia de masas anexiales no inflamatorias iguales o mayores de 5 cm, analizando su frecuencia, evolución natural y terminaciones. En 54 usuarias de Norplant (11,3%) se diagnosticaron 62 episodios de masas anexiales que corresponden a 2,6 episodios por 1.200 meses de uso. En 7 usuarias de T-Cobre (3,5%) se diagnosticaron 8 episodios, con una tasa de 1,0 episodios por 1.200 meses de uso. Las masas fueron casi siempre ováricas y unilaterales y se interpretaron en su mayoría como quístes ováricos funcionales por sus características clínicas y ecográficas y por su evolución. En 2 mujeres de cada grupo la masa se ubicó en la trompa y correspondió a embarazos tubarios. La incidencia de embarazo tubario en el grupo Norplant fue de 1 por 100 años mujer, inferior a lo ocurrido en el grupo T-Cobre y a lo referido con otras progestinas. En la mayoría de los casos (72,6% en el grupo Norplant y 62,5% en el grupo T-Cobre) la masa anexial era asintomática y se detectó en un control ginecológico de rutina. Los motivos de consulta en los otros casos fueron algia pelviana y sangrado anormal. Los episodios regresaron espontáneamente en el 90,4% de las usuarias de Norplant y en el 62,5% del grupo T-Cobre, la mayoría de ellos en los 60 días que siguieron al diagnóstico. Las indicaciones quirúrgicas en usuarias de Norplant fueron 2 embarazos tubarios, 2 quistes foliculares y 2 tumores neoplásicos. En el grupo T-Cobre las indicaciones quirúrgicas fueron 2 embarazos ectópicos y un quiste ovárico simple. Se concluye que los quistes funcionales ováricos son más frecuentes en mujeres portadoras de implantes Norplant que en los controles, que generalmente son asintomáticos y regresan espontáneamente. Deben ser vigilados hasta su desaparición por la posibilidad que se trate de una masa anexial de otra etiología que requiera tratamiento quirúrgico