Conocimientos y prácticas sobre sífilis materna y congénita en adolescentes embarazadas en un Hospital General de Paraguay: estudio cualitativo

Introducción: La sífilis en embarazadas, sigue siendo un gran problema de salud pública en todo el mundo, y en Paraguay, no es la excepción. La sífilis congénita puede provocar abortos, muertes fetales y neonatales, peso bajo al nacer, prematuridad y otras anomalías congénitas, el conocimiento general de la población en edad fértil es fundamental. Objetivo: Analizar los conocimientos y prácticas sobre sífilis materna y sífilis congénita en adolescentes embarazadas en un Hospital General de Paraguay. Metodología: Se realizó un estudio cualitativo, fenomenológico descriptivo. Para la recolección de datos se utilizó la entrevista, simple que fue grabada con previa autorización del participante, la conclusión y recomendación serán entregados a la institución y a las adolescentes embarazadas. Resultados: Participaron diez adolescentes, en su mayoría de 19 años de edad, cinco conocen que la sífilis se transmite a través de las relaciones sexuales, sin embargo, desconocen acerca de cómo se transmite la sífilis congénita. Cinco de las adolescentes menciona haber iniciado las relaciones sexuales a los 16 años. Dos adolescentes a los 15 años, dos a los 14 años y una a los 17 años, nueve de las adolescentes embarazadas mencionan acudir a sus controles prenatales de forma periódica. Dos aún no se han realizado el test de VDRL. Discusión: Se concluye en cuanto al conocimiento, que solo cinco de diez adolescentes conocen acerca de la sífilis, sin embargo, no conocen sobre la sífilis congénita. En cuanto a las prácticas preventivas, 10 acuden de forma periódica a sus controles prenatales.

Introduction: Syphilis in pregnant women continues to be a major public health problem throughout the world, and in Paraguay, it is no exception. Congenital syphilis can cause abortions, fetal and neonatal deaths, low birth weight, prematurity, and other congenital anomalies; general knowledge of the population of childbearing age is essential. Objective: To analyze the knowledge and practices about maternal syphilis and congenital syphilis in pregnant adolescents in a General Hospital in Paraguay. Methodology: A qualitative, descriptive phenomenological study was carried out. A simple interview was used to collect data, which was recorded with prior authorization from the participant. The conclusion and recommendation will be delivered to the institution and to the pregnant adolescents. Results: Ten adolescents participated, mostly 19 years of age, five know that syphilis is transmitted through sexual relations, however, they do not know how congenital syphilis is transmitted. Five of the adolescent's mention having started sexual relations at the age of 16. Two adolescents at 15 years old, two at 14 years old and one at 17 years old, nine of the pregnant adolescent's mention attending their prenatal check-ups periodically. Two have not yet been tested for VDRL. Discussion: It is concluded in terms of knowledge that only five out of ten adolescents know about syphilis; however, they do not know about congenital syphilis. Regarding preventive practices, 10 attend their prenatal check-ups periodically.

Adherencia de adultos de la compañía Chauria para la vacunación contra la COVID-19

Introducción: La pandemia del COVID-19 ha provocado cambios que afectan a los sistemas sanitarios y al enfoque de las enfermedades infecciosas en todo el mundo. La demanda de vacunas contra el COVID-19 se encuadra en un espectro que va desde el rechazo hasta la demanda, con una aceptación pasiva en el medio. Objetivo: Determinar la adherencia de los adultos a la vacunación contra la COVID-19. Chauria-Caballero, Paraguay 2022. Metodología: Estudio observacional, descriptivo, de corte transversal, con enfoque cuantitativo. El muestreo fue no probabilístico por conveniencia. La muestra estuvo conformada por un total de 225 adultos; los datos fueron recabados por medio de una encuesta elaborada por la investigadora, los datos fueron procesados con el software EPI INFO. Resultados: La mayoría de los sujetos de estudio se vacunaron, y hubo adherencia de la población a la vacuna contra la COVID-19 en un 93 %; diversos factores influyeron en las decisiones de estos; el porcentaje de adultos no vacunados mencionan como motivos su desconfianza (69 %) y el miedo/temor a la vacunación (31 %). Discusión: El estudio encontró una alta adherencia en general, la gran mayoría de los participantes vacunados contra COVID-19, porcentajes significativos se reportaron en Chile, China y Catar, cifras muy altas con relación a la aceptación de la vacuna a nivel país, teniendo una cobertura con un porcentaje mayor a la mitad con al menos una dosis.

Introduction: The coronavirus disease (COVID-19) pandemic has caused changes that affect health systems and the approach to infectious diseases worldwide. The demand for COVID-19 vaccines falls on a spectrum from rejection to demand, with passive acceptance in between. Objective: To determine the adherence of adults to vaccination against COVID-19. Chauria-Caballero, Paraguay 2022. Methods: This was an observational, descriptive, cross-sectional study using a quantitative approach. For convenience, the sampling was non-probabilistic. The sample comprised of 225 adults. The data were collected through a survey elaborated by the researcher, and the data were processed using EPI INFO software. Results: The majority of the study subjects were vaccinated, and there was 93% adherence of the population to the COVID-19 vaccine. Various factors influenced their decisions; the percentage of unvaccinated adults mentioned their distrust (69%) and fear of vaccination (31%). Discussion: The study found high adherence in general, the vast majority of participants were vaccinated against COVID-19, with significant percentages reported in Chile, China, and Qatar, very high figures in relation to the acceptance of the vaccine at the country level, with coverage of more than half with at least one dose.

Role of histaminergic regulation of astrocytes in alcohol use disorder.

Alcohol use disorder (AUD) is a severe, yet not fully understood, mental health problem. It is associated with liver, pancreatic, and gastrointestinal diseases, thereby highly increasing the morbidity and mortality of these individuals. Currently, there is no effective and safe pharmacological therapy for AUD. Therefore, there is an urgent need to increase our knowledge about its neurophysiological etiology to develop new treatments specifically targeted at this health condition. Recent findings have shown an upregulation in the histaminergic system both in alcohol dependent individuals and in animals with high alcohol preference. The use of H3 histaminergic receptor antagonists has given promising therapeutic results in animal models of AUD. Interestingly, astrocytes, which are ubiquitously present in the brain, express the three main histamine receptors (H1, H2 and H3), and in the last few years, several studies have shown that astrocytes could play an important role in the development and maintenance of AUD. Accordingly, alterations in the density of astrocytes in brain areas such as the prefrontal cortex, ventral striatum, and hippocampus that are critical for AUD-related characteristics have been observed. These characteristics include addiction, impulsivity, motor function, and aggression. In this work, we review the current state of knowledge on the relationship between the histaminergic system and astrocytes in AUD and propose that histamine could increase alcohol tolerance by protecting astrocytes from ethanol-induced oxidative stress. This increased tolerance could lead to high levels of alcohol intake and therefore could be a key factor in the development of alcohol dependence.

Calidad de vida y capacidad funcional en pacientes con artritis reumatoide de una asociación de Paraguay 2022 / Quality of life and functional capacity in patients with rheumatoid arthritis in a Paraguayan Association 2022

Introducción. La artritis reumatoide consiste en una enfermedad caracterizada por dolores articulares, por fatiga, incapacidad funcional y contribuye en la depresión del paciente. Objetivo. Evaluar la calidad de vida y la capacidad funcional en pacientes con diagnóstico de artritis reumatoide de los miembros de la Asociación de Guerreros de la Artritis de Paraguay en el año 2022. Metodología. Estudio observacional analítico de corte transversal en el que se incluyó 200 pacientes diagnosticados con artritis reumatoide, seleccionados por conveniencia. La medición se realizó por medio de los cuestionarios en su versión española "calidad de vida (QOL-RA)" y "discapacidad (HAQ)". Resultados. El coeficiente alfa de Cronbach de los instrumentos fueron 0,842 y 0,972, respectivamente. Hubo mayor porcentaje del sexo femenino (89,5%), la edad media fue de 47,5 años y la duración media de la enfermedad 14,07 años. Las subescalas que más incidieron en la calidad de vida fueron dolor, tensión, salud y artritis y la mayor calidad de vida se observó en ayuda e interacción. Con relación a la capacidad funcional se observó menor dificultad en vestirse e higiene, y mayor dificultad en prensión, caminar y levantarse. La calidad de vida de los participantes tuvo una media de 6,61. Existió correlación inversa significativa moderada (r=-0.598) entre la calidad de vida y la capacidad funcional. Conclusión. Los pacientes presentaron una calidad de vida buena, y discapacidad ligera. Hubo correlación inversa significativa moderada entre la calidad de vida y la capacidad funcional.

Introduction.Rheumatoid arthritis is a disease characterized by joint pain, fatigue, functional disability and contributes to the patient's depression. Objective. to evaluate the quality of life and functional capacity in patients diagnosed with rheumatoid arthritis of the members of the Association of Arthritis Warriors in the year 2022 in Paraguay. Methods.Observational cross-sectional analytical study that included 200 patients diagnosed with rheumatoid arthritis, selected with a non-probabilistic sampling. The measurement was made through the Spanish version of "quality of life (QOL-RA)" and "disability (HAQ)" questionnaires. Results.The instruments had a Cronbach's alpha of 0.842 and 0.972, respectively. The participants were mostly females (89.5%), mean age of 47.5 years and a mean duration of the disease 14.07 years. The subscales that most affected quality of life were pain, tension, health and arthritis and the highest quality of life was observed in help and interaction. In relation to functional capacity, less difficulty was observed in dressing and hygiene, and greater difficulty in grasping, walking and getting up. Patients presented a quality of life with a mean of 6.61. There was a moderate significant inverse correlation (r=0.598) between quality of life and functional capacity.

Fractured families and social networks: Identifying risk and resilience factors for supporting positive mental health in Venezuelan immigrant groups.

OBJECTIVES: Language barriers, isolation, and challenges related to social integration, acculturative stress, and systemic discrimination are correlated with poor physical and mental health outcomes among immigrant populations. Emerging literature highlights the importance of social networks for resiliency and well-being. This study explores the experiences of Venezuelan immigrants in central Florida, factors that have promoted resilience, and considerations for mental health providers to meet the needs of this population. METHOD: A phenomenological approach was used to engage Venezuelan immigrants who had been in the United States for at least 6 months (n = 48) in dialogue about forced migration, identity, and adaptation. Five focus groups using a semistructured format were conducted to explore aspects of the experience before, during, and after migration. Recruitment was done through word of mouth and community gatekeepers. RESULTS: Participants were 54% female with an average age of 45, 85% had at least 1 college degree, and more than half left Venezuela since 2011. Themes were identified from the focus group transcripts and clustered into three broad areas: characteristics and individual experiences, mental health, and family and social context. Major findings included the need for culturally responsive mental health support, which appeared to mitigate distress and the centrality of social networks in support of resiliency. CONCLUSIONS: Findings from the present study suggest that community context, support for ethnic identity, and the ability to foster meaningful connections to others with similar experience and identity are critical factors in resilience. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Progresión de los determinantes de factores de riesgo cardiovascular en estudiantes de la Universidad Nacional de Asunción-Paraguay

RESUMEN Los factores de riesgo cardiovascular empiezan a edad temprana de la vida y causan morbimortalidad prematura. Se evaluó la progresión de hipertensión arterial y de otros factores de riesgo cardiovascular en estudiantes de la Universidad Nacional de Asunción- Paraguay. Estudio descriptivo en el que se compararon dos mediciones transversales (año 2013 y 2017). Se estudió a 284 universitarios al inicio y a 240 al final de las carreras. Se midieron variables sociodemográficas, antropométricas, presión arterial, determinaciones bioquímicas, consumo de alcohol y tabaco. La presión arterial se clasificó según el Séptimo informe del Comité Nacional para la Prevención, Detección, Evaluación y Tratamiento de la Hipertensión arterial. Se aplicó la prueba t-Student para variables continuas y Chi cuadrado para variables categóricas y regresión logística para asociación entre hipertensión y factores de riesgo cardiovascular. Se encontró hipertensión en el grupo año 2013 en 6,7% (IC del 95%:3,4-10%) de los estudiantes y en el grupo año 2017 en 21,2% (IC del 95%:17,8-24,6%) de los estudiantes (p= <0,001). En hombres se encontró aumento de la tendencia de c-HDL disminuido, triglicéridos aumentados, consumo de alcohol y en el índice de resistencia a la insulina (p<0,05), y en mujeres aumento del consumo de alcohol, del hábito sedentario y del índice de resistencia a la insulina (p < 0,05). Había una asociación de la hipertensión con la circunferencia abdominal aumentada (OR: 15,7; IC del 95%: 4,6-53,5; p=<0,001). Se encontró aumento de la tendencia de la presión arterial y de otros factores de riesgo cardiovascular en universitarios.

ABSTRACT Cardiovascular risk factors begin at an early age of life and cause premature morbidity and mortality. The progression of arterial hypertension and other cardiovascular risk factors in students of the National University of Asunción-Paraguay was evaluated. Descriptive study in which two cross-sectional measurements (year 2013 and 2017) were compared. Two hundred eighty-four university students were studied at the beginning and 240 at the end of their careers. Sociodemographic, anthropometric, blood pressure, biochemical determinations, alcohol and tobacco consumption were measured. Blood pressure was classified according to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The t-Student test was applied for continuous variables and Chi square for categorical variables and logistic regression for association between hypertension and cardiovascular risk factors. Hypertension was found in the 2013 group in 6.7% (95% CI: 3.4-10%) of the students and in the 2017 group in 21.2% (95% CI: 17.8-24, 6%) of the students (p = <0.001). In men, there was an increase in the tendency of decreased c-HDL, increased triglycerides, alcohol consumption and insulin resistance index (p <0.05), and in women an increase in alcohol consumption, sedentary habits and insulin resistance index (p <0.05). There was an association of hypertension with increased abdominal circumference (OR: 15.7; 95% CI: 4.6-53.5; p = <0.001). An increase was found in the tendency of blood pressure and other cardiovascular risk factors in university students.

Antioxidant Biomolecules and Their Potential for the Treatment of Difficult-to-Treat Depression and Conventional Treatment-Resistant Depression.

Major depression is a devastating disease affecting an increasing number of people from a young age worldwide, a situation that is expected to be worsened by the COVID-19 pandemic. New approaches for the treatment of this disease are urgently needed since available treatments are not effective for all patients, take a long time to produce an effect, and are not well-tolerated in many cases; moreover, they are not safe for all patients. There is solid evidence showing that the antioxidant capacity is lower and the oxidative damage is higher in the brains of depressed patients as compared with healthy controls. Mitochondrial disfunction is associated with depression and other neuropsychiatric disorders, and this dysfunction can be an important source of oxidative damage. Additionally, neuroinflammation that is commonly present in the brain of depressive patients highly contributes to the generation of reactive oxygen species (ROS). There is evidence showing that pro-inflammatory diets can increase depression risk; on the contrary, an anti-inflammatory diet such as the Mediterranean diet can decrease it. Therefore, it is interesting to evaluate the possible role of plant-derived antioxidants in depression treatment and prevention as well as other biomolecules with high antioxidant and anti-inflammatory potential such as the molecules paracrinely secreted by mesenchymal stem cells. In this review, we evaluated the preclinical and clinical evidence showing the potential effects of different antioxidant and anti-inflammatory biomolecules as antidepressants, with a focus on difficult-to-treat depression and conventional treatment-resistant depression.

Cumplimiento de los objetivos del tratamiento en pacientes diabéticos del Hospital Nacional de Itauguá / Compliance with treatment objectives in diabetic patients at the Itauguá National Hospital

Introducción: La diabetes es una enfermedad con una alta morbimortalidad por sus complicaciones. La prevención o el retraso de sus complicaciones requiere del diagnóstico y tratamiento precoz de la misma, con cambios en el estilo de vida y fármacos, pilares del tratamiento. Objetivo: Investigar el cumplimiento de los objetivos del tratamiento en los pacientes diabéticos del Hospital Nacional de Itauguá. Metodología: Se realizó un estudio observacional, descriptivo de corte transversal, donde se incluyeron a pacientes que acudían al consultorio de diabetología del Hospital Nacional de Itauguá. Resultados: Ingresaron al estudio 162 pacientes entre 23 a 80 años de edad (edad promedio: 59 años). El 67,2% no cumplía con su plan nutricional, 72,8% eran sedentarios, 47% no era adherente a la medicación, 72,6% no llegaba a los objetivos de presión arterial, 67,2% no alcanzaba las metas de colesterol LDL, el 60,4% no llegaba a las metas de HDL, 78,4% no llegaba a las metas de glicemia en ayunas y el 63,4% no mantenía una hemoglobina glicada <7 g/dL. Conclusión: La mayoría de los pacientes no cumplía con los objetivos del tratamiento.

Introduction: Diabetes is a disease with high morbidity and mortality due to its complications. Preventing or delaying its complications requires early diagnosis and treatment, with changes in lifestyle and drugs, the mainstays of treatment. Objective: To investigate the compliance of the treatment objectives in diabetic patients of the National Hospital of Itauguá. Methodology: An observational, descriptive cross-sectional study which included patients who attended the diabetology clinic of the National Hospital of Itauguá was carried out. Results: The study included 162 patients aged 23 to 80 years (mean: 59 years), 67.2% did not comply with nutritional plan, 72.8% were sedentary, 47% were not adherent to the medication, 72.6% did not reach the blood pressure goals, 67.2% did not reach the LDL cholesterol, 60.4% did not reach the HDL goals and 78.4% did not reach the fasting blood glucose goals and 63.4% did not keep a glycated hemoglobin <7 g/dL. Conclusion: Most of the patients did not meet the treatment goals.

Asociación entre el nivel de autovalencia y el estado nutricional en adultos mayores chilenos

RESUMEN Introducción: La malnutrición está relacionada con una disminución de las capacidades funcionales en personas adultas mayores. Estudios en población adulta mayor han demostrado asociación directa entre el índice de masa corporal (IMC) y las limitaciones funcionales. Objetivo: Determinar la relación existente entre el nivel de autovalencia y el estado nutricional en población de adultos mayores chilenos. Metodología: Este estudio de carácter cuantitativo descriptivo transversal, analizó una muestra de 837 sujetos de la comuna Los Andes en Chile, a través de una base de datos anonimizada con las atenciones realizadas el año 2017. Para análisis estadístico se aplicó la prueba Chi-cuadrado con un nivel de confianza del 95%, y se determinó el OR para observar el tipo de asociación. Resultados: Según los resultados estadísticamente significativos, existe una asociación negativa entre el "estado nutricional normal" y la "autovalencia con riesgo" (OR= 0,62 p= 0,0012), comportándose como factor protector. Por otra parte, existe una asociación negativa entre el "estado nutricional de obesidad" y la "autovalencia sin riesgo" (OR= 0,51 p= 0,0001) y una asociación positiva con la "autovalencia con riesgo" (OR= 1,54 p= 0,0067) y la dependencia (OR= 1,68 p= 0,001). Conclusión: Un estado nutricional normal se asoció a un menor riesgo de dependencia en la población adulta mayor. La malnutrición por exceso podría ser un factor de riesgo de dependencia.

ABSTRACT Introduction: Malnutrition is associated with decreased functional abilities in older adults. Studies in the older adult population have shown a direct association between body mass index (BMI) and functional limitations. Objective: To determine the relationship between the level of autovalence and nutritional status in a sample of elderly Chileans. Methodology: This cross-sectional descriptive quantitative study analyzed a sample of 837 subjects from Los Andes, Chile, through an anonymized database from 2017. For statistical analysis, the Chi-square test was applied with a confidence level of 95%, and the OR was determined to observe the type of association. Results: We found a statistically significant protective association between "normal nutritional status" and "self-valence with risk" (OR= 0.62 p= 0.0012). In addition, we found a protective association between "obesity nutritional status" and "self-valence without risk" (OR= 0.51 p= 0.0001) and a positive association with "self-valence with risk" (OR= 1.54 p= 0.0067) and dependence (OR= 1.68 p= 0.001). Conclusion: A normal nutritional status was associated with a lower risk of dependency in a sample of older adults. Excess malnutrition could be a risk factor for dependence.

Características clínicas y epidemiológicas de los pacientes con sepsis de la unidad de terapia intensiva adultos del Hospital Regional de Coronel Oviedo, Paraguay

RESUMEN Introducción: la sepsis es una de las principales causas de ingreso a las unidades de terapia intensiva, siendo la principal causa de muerte no cardiológica. Además de su elevada mortalidad, es una enfermedad que causa secuelas cognitivas y compromete la sobrevida a largo plazo. Objetivo: describir las características clínicas y epidemiológicas de los pacientes con sepsis de la Unidad de Terapia Intensiva Adultos del Hospital Regional de Coronel Oviedo, Paraguay, en periodo 2016-2019. Metodología: se realizó un estudio observacional, descriptivo de corte transversal donde se incluyó a 349 pacientes con diagnóstico de sepsis internados en la Unidad de Terapia Intensiva Adultos del Hospital Regional de Coronel Oviedo de enero 2016 a diciembre 2019. Los datos se expresan en frecuencias, medidas de tendencia central y dispersión. Se respetaron los aspectos éticos. Resultados: la franja estaría estuvo comprendida de 16 a 89 años (52 ± 19 años). El 52,4% fue del sexo femenino y 50,1% provino de la zona rural. El 46,4% ingresó con el diagnóstico de sepsis y en 29,2% el foco de origen fue pulmonar. El 54,1% tuvo falla multiorgánica, 71,1% requirió asistencia respiratoria mecánica y 52,4% obitó. Conclusión: el foco séptico más frecuente fue el de origen pulmonar. Más de la mitad desarrolló falla multiorgánica presentándose falla respiratoria y cardiovascular con mayor frecuencia. La mortalidad fue 52,4%.

ABSTRACT Introduction: Sepsis is one of the main causes of admission to intensive care units, being the main cause of non-cardiac death. In addition to its high mortality, it is a disease that causes cognitive sequelae and compromises long-term survival. Objective: To describe the clinical and epidemiological characteristics of patients with sepsis of the Adult Intensive Care Unit of the Regional Hospital of Coronel Oviedo, Paraguay, in the period 2016-2019. Methodology: An observational, descriptive cross-sectional study was carried out in which 349 patients with a diagnosis of sepsis admitted to the Adult Intensive Care Unit of the Regional Hospital of Coronel Oviedo were included from January 2016 to December 2019. The data were expressed in frequencies, measures of central tendency and dispersion. Ethical aspects were respected. Results: The age range was between 16 to 89 years (52±19 years), 52.4% were female and 50.1% came from rural areas; 46.4% were admitted with the diagnosis of sepsis and in 29.2% the source was from pulmonary origin while 54.1% had multiorgan failure, 71.1% required mechanical ventilation and 52.4% died. Conclusion: The most frequent septic focus was from pulmonary origin. More than half developed multiorgan failure, presenting respiratory and cardiovascular failure more frequently. Mortality frequency was 52.4%.

Características de las mujeres diabéticas con síntomas urinarios en el Hospital Nacional de Itauguá / Characteristics of diabetic women with urinary symptoms at the Itauguá National Hospital

Introducción: El diabético tiene mayor susceptibilidad a presentar infecciones bacterianas, virales y fúngicas, debido a alteraciones en sus mecanismos de defensa, generalmente las infecciones son más graves. Objetivo: Determinar las características clínicas de las mujeres diabéticas con síntomas urinarios internadas en el Dpto. de Medicina Interna del Hospital Nacional de Itauguá año 2018 y 2019. Metodología: Se realizó un estudio observacional, descriptivo de corte transversal donde se incluyeron a 152 pacientes internadas en el servicio de clínica médica del Hospital Nacional de Itauguá. Resultados: Ingresaron al estudio 152 pacientes con una edad promedio fue de 61 años y un rango de entre 17 a 92 años de edad. El 11,84% presentó síntomas urinarios y en el 77,78% de las pacientes se pudo lograr aislar el germen causante, aislándose E. coli en el 83,33% de las muestras. Conclusión: La frecuencia de infección urinaria fue de 9,21 %. Se evidencio un alto nivel de mal control metabólico en la población estudiada, la mayoría de los casos de infección urinarias fueron en pacientes que presentaban un mal control metabólico.

Introduction: The diabetic is more susceptible to bacterial, viral and fungal infections, due to alterations in its defense mechanisms, infections are generally more serious. Objective: To determine the clinical characteristics of diabetic women with urinary symptoms admitted to the Internal Medicine Department of the National Hospital of Itauguá in 2018 and 2019. Methodology: An observational, descriptive, cross-sectional study was conducted, including 152 hospitalized patients. in the medical clinic service of the National Hospital of Itauguá. Results: 152 patients entered the study with an average age of 61 years and a range of 17 to 92 years of age. 11.84% presented urinary symptoms and in 77.78% of the patients it was possible to isolate the causative germ, isolating E. coli in 83.33% of the samples. Conclusion: The frequency of urinary infection was 9.21%. A high level of poor metabolic control was evidenced in the studied population, most cases of urinary infection were in patients who presented poor metabolic control.

Conocimiento e intervenciones no farmacológicas para reducir dolor y estrés neonatal / Knowledge and non-pharmacological interventions to reduce neonatal pain and stress

El dolor es una experiencia sensorial y emocional desagradable producida por daño tisular potencial o real y descrito de esta forma por el individuo que lo padece. Sin embargo, los recién nacidos no lo pueden comunicar, esto significa que la experiencia de dolor es subjetiva e implica la expresión de un componente emocional. El estrés es una amenaza real o percibida como tal, provocando una alteración del equilibrio dinámico entre el organismo y el medio. El estudio tuvo por objetivo determinar conocimiento e intervenciones no farmacológicas del profesional de enfermería para reducir dolor y estrés neonatal en el Hospital de Clínicas - Paraguay en el 2016. La investigación fue observacional, descriptiva, corte transversal, con enfoque cuantitativo. La población constó de 36 licenciados en enfermería seleccionados mediante muestreo no probabilístico por conveniencia. El método fue la encuesta, empleando como técnica la entrevista, el instrumento fue el cuestionario. Los datos fueron tabulados en planillas electrónicas Microsoft Excel 2010, interpretados por Epi Info 7.2.0.1., a partir de los resultados se construyeron tablas y gráficos elaborados en Microsoft Excel. La mayoría tenía entre 31 y 40 años de edad, predominaba el sexo femenino, y tenía una antigüedad de entre 1 a 10 años. Se identificó que un reducido grupo conocía las intervenciones no farmacológicas para reducir el dolor y el estrés, y la gran mayoría las realizaba. Estos resultados reflejan la carencia en la base de los conocimientos y la adquisición empírica de las prácticas(AU)

Pain is a disgusting sensorial and emotional experience, produced by potential or real tissue damage, and described in that way by the person who suffers. Nevertheless, newborns cannot communicate it. This means that pain experience is subjective and implies the expression of an emotional component. Stress is a real threat or perceived as such, provoking a disturbance on the dynamic equilibrium between the organism and the medium. The study had as objective to determinate the knowledge and non-pharmacological interventions of the professional nurse in order to reduce neonatal pain and stress at the Hospital de Clínicas in Paraguay during 2016. This was an observational, descriptive, cross-sectional study with quantitative approach. The population consisted of 36 nurses which were selected by non-probabilistic convenience sampling. The method was the survey, using the interview and the questionnaire as the instrument. The data was tabulated on Microsoft Excel 2010 electronic spreadsheets and analyzed by Epi Info 7.2.0.1. Then, tables and graphics were developed from the results elaborated in Microsoft Excel. The majority was between 31 and 40 years old, females predominated and has between 1 to 10 year careers. It was identified that a reduced group knew non-pharmacological interventions and a high percentage practiced them. These results reflect knowledge deficiency and empirical acquisition of practices(AU)

Effort Displayed During Appetitive Phase of Feeding Behavior Requires Infralimbic Cortex Activity and Histamine H1 Receptor Signaling.

The chances to succeed in goal-directed behaviors, such as food or water-seeking, improve when the subject is in an increased arousal state. The appetitive phase of these motivated behaviors is characterized by high levels of behavioral and vegetative excitation. The key decision of engaging in those particular behaviors depends primarily on prefrontal cortical areas, such as the ventromedial prefrontal cortex. We propose that the infralimbic cortex (ILC) located in the medial prefrontal cortex induces an increase in arousal during the appetitive phase of motivated behavior, and that this increase in arousal is, in turn, mediated by the activation of the brain histaminergic system, resulting in higher motivation for getting food rewards. To test this hypothesis, we conduct a progressive ratio operant conditioning to test the degree of motivation for food, while simultaneously manipulating the histaminergic system through pharmacologic interventions. We found that the behavioral responses to obtain food in hungry rats were disrupted when the ILC was inhibited through muscimol infusion, blocking brain H1 histamine receptors by intracerebroventricular infusion of pyrilamine or by satiety. In contrast, the consummatory behavior was not affected by ILC inhibition. The extracellular histamine levels in the ILC were increased in direct correlation with the degree of motivation measured in the progressive ratio test. ILC inhibition also prevented this increase in histamine levels. The rise in extracellular histamine levels during the progressive ratio test was similar (ca. 200%) during the active or the resting period of the day. However, different basal levels are observed for these two periods. Our findings suggest that increased histamine levels during this behavior are not simply explained by the awaked state, but instead, there is a motivation-related release of histamine, suggestive of a specific form of brain activation. Serotonin (another critical component of the ascending arousal system) was also tested. Interestingly, changes in levels of this neuromodulator were not detected during the progressive ratio test. In conclusion, our results suggest that ILC activation and subsequent increase in brain histamine release are both necessary for the normal performance of a motivated behavior such as feeding.

Factors associated with high-risk human papillomavirus infection and high-grade cervical neoplasia: A population-based study in Paraguay.

BACKGROUND: Cervical cancer (CC) is one of the leading causes of cancer mortality among women from Paraguay, with high incidence and mortality rates (31.2 and 16 per 100 000 women, respectively). Although the risk factors associated with high-risk human papillomavirus (hrHPV) infection and preneoplastic cervical lesions are widely studied, population-based characteristics of particular settings may influence the feasibility of HPV-based CC screening implementation. This study aimed to explore factors associated with hrHPV infection and high-grade cervical neoplasia in hrHPV-positive (hrHPV+) women from Paraguay. METHODS: A total of 5677 women aged 30-64 years from the Central Department of Paraguay were screened with HPV test (Hybrid Capture 2) and Pap smear. Sociodemographic and risk factor interviews were conducted. hrHPV+ women were referred to colposcopy and women with an abnormal colposcopy had a biopsy taken. The outcomes recorded were the hrHPV status and the presence of high-grade cervical intraepithelial neoplasia or worse (CIN2+) among hrHPV+ women. Associations were investigated using multivariate logistic regressions. RESULTS: hrHPV prevalence was 13.8% (95%CI 13.0-14.8). This value decreased with the age of women (p-trend<0.001) and increased with the lifetime number of sexual partners (p-trend<0.001) and number of previous female partners of their current male partner if women had had one lifetime sexual partner (p-trend<0.001), increasing from 3.06 (95%CI 0.073-20.9) if partners had had one previous female partner to 9.19 (95%CI 2.36-61.1) if they had had eight or more. In hrHPV+ women, CIN2+ prevalence was 10.7% (95%CI 8.58-13.2) and increased with time since the last Pap smear (p-trend<0.001) and with the increasing number of pregnancies (p-trend = 0.05). CONCLUSION: In these settings, the sexual behavior of women and their male partners is associated with hrHPV infection. In hrHPV+ women, underscreening practices and multiple pregnancies are associated with CIN2+. This knowledge can contribute to public health policies for CC prevention and control in Paraguay.

Periodontal inflammation correlates with systemic inflammation and insulin resistance in patients with recent diagnosis of type 2 diabetes / La inflamación periodontal se correlaciona con la inflamación sistémica y la insulina. resistencia en pacientes con diagnóstico reciente de diabetes tipo 2

Background: diabetes and periodontitis are common comorbidities; however, the clinical implications of this association remain only partially known. This study was aimed to characterize the periodontal status of type 2 diabetic (T2D) patients and its correlation with metabolic and inflammatory parameters. Methods: patients (n = 30) with 5 or less years since the diagnosis of T2D (18 ­ 65 years old) were recruited. Anthropometric (Body Mass Index, BMI), metabolic (fasting glucose, glycated hemoglobin, insulin, HOMA-IR, HDL, LDL and total cholesterol, triglycerides) and inflammatory parameters (ultrasensitive C reactive protein, usCRP) were quantified. Periodontal evaluation included clinical attachment level (CAL), probing depth (PD), gingival level (GL) and bleeding on probing (BOP) average. Statistical significance was assessed by Mann-Whitney and Spearman correlation tests. Results: mean values of BOP, CAL, PD and GL were 39.3, 2.8, 2.8, and 0.1, respectively. BOP significantly correlated with BMI and HOMA-IR and was higher in patients with elevated usCRP >3 mg/L (p<0.05). Age and duration of T2D directly and inversely correlated with CAL and GL, respectively. BOP correlated with HOMA-IR and usCRP but not with patients´age, duration of T2D or BMI. Conclusions: in patients with recent diagnosis of T2D, BOP is associated with usCRP and HOMA-IR levels, suggesting that periodontal inflammation promotes insulin resistance possibly by increasing systemic inflammation. (AU)

Antecedentes: la diabetes y la periodontitis son comorbilidades comunes; sin embargo, las implicaciones clínicas de esta asociación siguen siendo solo parcialmente conocidas. El objetivo de este estudio fue caracterizar el estado periodontal de los pacientes con diabetes tipo 2 (T2D) y su correlación con los parámetros metabólicos e inflamatorios. Métodos: se reclutaron pacientes (n = 30) con 5 años o menos desde el diagnóstico de DM2 (18-65 años). Se cuantificaron parámetros antropométricos (índice de masa corporal, IMC), metabólicos (glucosa en ayunas, hemoglobina glucosilada, insulina, HOMA-IR, HDL, LDL y colesterol total, triglicéridos) y parámetros inflamatorios (proteína reactiva C ultrasensible, usCRP). La evaluación periodontal incluyó el nivel de inserción clínica (CAL), la profundidad de sondaje (PD), el nivel gingival (GL) y el promedio de sangrado al sondaje (BOP). La significación estadística se evaluó mediante pruebas de correlación de Mann-Whitney y Spearman. Resultados: los valores medios de BOP, CAL, PD y GL fueron 39.3, 2.8, 2.8 y 0.1, respectivamente. La BOP se correlacionó significativamente con el IMC y el HOMA-IR y fue mayor en pacientes con una usCRP elevada> 3 mg / L (p <0.05). La edad y la duración de T2D se correlacionaron directa e inversamente con CAL y GL, respectivamente. La BOP se correlacionó con HOMA-IR y usCRP pero no con la edad de los pacientes, la duración de T2D o IMC. Conclusiones: en pacientes con diagnóstico reciente de T2D, la BOP está asociada con los niveles de usCRP y HOMA-IR, lo que sugiere que la inflamación periodontal promueve la resistencia a la insulina posiblemente al aumentar la inflamación sistémica. (AU)

Are Polyunsaturated Fatty Acids Implicated in Histaminergic Dysregulation in Bipolar Disorder?: AN HYPOTHESIS.

Bipolar disorder (BD) is an extremely disabling psychiatric disease, characterized by alternate states of mania (or hypomania) and depression with euthymic states in between. Currently, patients receive pharmacological treatment with mood stabilizers, antipsychotics, and antidepressants. Unfortunately, not all patients respond well to this type of treatment. Bipolar patients are also more prone to heart and metabolic diseases as well as a higher risk of suicide compared to the healthy population. For a correct brain function is indispensable a right protein and lipids (e.g., fatty acids) balance. In particular, the amount of fatty acids in the brain corresponds to a 50-70% of the dry weight. It has been reported that in specific brain regions of BD patients there is a reduction in the content of unsaturated n-3 fatty acids. Accordingly, a diet rich in n-3 fatty acids has beneficial effects in BD patients, while their absence or high levels of saturated fatty acids in the diet are correlated to the risk of developing the disease. On the other hand, the histamine system is likely to be involved in the pathophysiology of several psychiatric diseases such as BD. Histamine is a neuromodulator involved in arousal, motivation, and energy balance; drugs acting on the histamine receptor H3 have shown potential as antidepressants and antipsychotics. The histaminergic system as other neurotransmission systems can be altered by fatty acid membrane composition. The purpose of this review is to explore how polyunsaturated fatty acids content alterations are related to the histaminergic system modulation and their impact in BD pathophysiology.

Conocimiento y experiencias de estudiantes de enfermería en la administración de principales opioides en el tratamiento del dolor / Knowledge and experiences of nursing students in the administration of major opioids in the treatment of pain

Los opioides constituyen fármacos que cumplen un papel fundamental en el manejo del dolor, pueden producir efectos adversos, conocerlos permite su prevención y tratamiento. La enfermería actúa en el final del proceso de la terapia medicamentosa, aumentando su responsabilidad en evidenciar e impedir fallos. El objetivo fue determinar el conocimiento y experiencias de estudiantes de enfermería en la administración de opioides en el tratamiento del dolor. Estudio observacional descriptivo, transverso. Se aplicó un cuestionario organizado en: características demográficas, conocimientos sobre opioides y dolor y experiencia en la administración de opioides. La muestra conformaron 202 estudiantes de enfermería, Instituto Dr. Andrés Barbero-Universidad Nacional de Asunción. Se destaca el conocimiento global sobre opioides de 37,6% (76), mientras que 62,4% (126) desconocía el tema. Los aspectos más conocidos: concepto de analgésicos, analgésicos opioides y dolor, clasificación del dolor, acciones de enfermería en presencia del dolor, principal clase farmacológica que se emplea en el tratamiento agudo del dolor, los ítems relacionados a la morfina superaron el 60% de conocimiento. Los porcentajes por debajo del 60% fueron concepto de nociceptores, clasificación de opioides y grupo de opioides. Se constató que 14,87% tuvo experiencia en la administración de opioides, de los cuales 43,3% (13) tenía conocimiento global acerca de los opioides y 56,7% (17) no conocía. Se concluye que solo un poco más de la cuarta parte de los estudiantes conocían de la administración de principales opioides en el tratamiento del dolor, sin embargo, no existe asociación significativa entre los que conocen y administran.

Opioids are drugs that play a fundamental role in the management of pain, they canproduce adverse effects, and knowing them allows prevention and treatment. Nursingacts at the end of the drug therapy process, increasing its responsibility to evidenceand prevent failures. The objective was to determine the knowledge and experiencesof nursing students in the administration of opioids in the treatment of pain. This wasa descriptive, transverse observational study. An organized questionnaire was appliedin: demographic characteristics, knowledge about opioids and pain and experience inthe administration of opioids. The sample consisted of 202 nursing students from theDr. Andrés Barbero Institute-National University of Asunción. The overall knowledgeabout opioids was 37.6% (76), while 62.4% (126) did not know about them . Themost well-known aspects were: concept of analgesics, opioid analgesics and pain,classification of pain, nursing actions in the presence of pain, the mainpharmacological class used in the acute treatment of pain, the morphine-related items exceeded 60% of knowledge. The percentages below 60% were concept ofnociceptors, opioid classification and opioid group. It was found that 14.87% hadexperience in the administration of opioids, of which 43.3% (13) had global knowledgeabout opioids and 56.7% (17) did not know them. It is concluded that only a littlemore than a quarter of the students knew about the administration of principal opioidsin the treatment of pain, however, there was no significant association between thosewho know and administer.

Conocimiento y consumo de drogas ilegales en estudiantes de un colegio público / Knowledge and consumption of illegal drugs in students ofa public school

Las drogas impactan y modifican múltiples órganos, especialmente el cerebro, con consecuencias más severas entre los jóvenes. Se determinó la asociación entre el conocimiento y consumo de drogas ilegales en estudiantes. El diseño de estudio fue observacional, descriptivo con un componente analítico. La población estuvo constituida por 222 alumnos de los Bachilleratos Científico y Técnico del primer al tercer curso de un colegio público que fueron seleccionados por un muestreo no probabilístico por conveniencia. Se aplicó un cuestionario impreso con 27 preguntas que abarcaban tres aspectos: datos sociodemográficos, conocimiento y consumo, y que fue autoadministrado en forma anónima. Se concluyó que más de la mitad de los estudiantes tenían conocimientos sobre drogas ilegales y la mayoría no consumió drogas ilegales. En la minoría que si consumió droga, la más frecuente fue la marihuana, con una edad de inicio de 15 años, una periodicidad de consumo de una vez por semana en compañía de amigos/as y en la casa de un amigo/a o familiar. Se determinó asociación significativa entre el conocimiento y el consumo de drogas ilegales. Se sugiere que los programas de educación preventiva se enfoquen en estudiantes de 14 a 15 años y que en ellos se haga énfasis en las drogas según nivel de dependencia y los efectos negativos de la marihuana.

Drugs affect and modify multiple organs, especially the brain, with more severeconsequences among young people. The association between knowledge and consumptionof illegal drugs in students was determined. The study design was observational, descriptivewith an analytical component. The population consisted of 222 students of the Scientific andTechnical High School from the first to the third year of a public school who were selectedby a non-probabilistic convenience sampling. A printed questionnaire with 27 questionscovering three aspects: sociodemographic data, knowledge and consumption was applied,and self-administered anonymously. It was concluded that more than half of the studentshad knowledge about illegal drugs and most did not consume illegal drugs. In the minoritythat consumed drugs the most frequent was marijuana, and the starting age was 15 years,with a frequency of consumption of once a week in the company of friends and at the houseof a friend or family member. A significant association was identified between knowledgeand use of illegal drugs. It is suggested that preventive education programs focus onstudents aged 14 to 15 years emphasizing on drugs according to dependency level andnegative effects of marijuana.

Detección molecular del papilomavirus humano de alto riesgo en el seguimiento de mujeres tratadas por lesión escamosa intraepitelial / Molecular detection of high risk human papillomavirus in following women treated for squamous intraepithelial lesion

El cáncer de cuello uterino (CCU) es la primera causa de muerte por cáncer en mujeres en países en vías de desarrollo. La infección persistente por el virus papiloma humano (VPH) es un factor necesario en lesiones preneoplásicas y CCU. La citología cervicovaginal es el método mayormente utilizado para detectar el CCU y su uso combinado con la de detección de ADN viral seis meses post-tratamiento aumenta la efectividad para identificar mujeres tratadas con riesgo de lesión residual/recidiva. El objetivo fue describir la frecuencia de VPH de alto riesgo (AR) en mujeres tratadas por lesión escamosa intraepitelial (SIL) que acudieron al Servicio de Patología Cervical del Hospital San Pablo de enero-diciembre/2014. Se realizó un estudio descriptivo de corte transverso, que incluyó 80 pacientes que acudieron al servicio para control post-tratamiento por SIL. Se utilizó Cobas 4800 HPV Test (Roche) para la detección individual de VPH-16 y 18, y un pool de 10 VPH-AR (31,33,35,39,45,51,52,56,58,59) y dos de “probable” alto riesgo (66,68). Se encontró infección viral en el 7,5% (6/80) de las pacientes tratadas; identificándose VPH-16 en 3/6 de los casos positivos. En Paraguay existe alta incidencia de lesiones pre-neoplásicas y CCU siendo un problema de salud pública. Los datos observados sugieren que la utilización de este sistema para la detección viral puede llevar a optimizar el seguimiento post-tratamiento y la identificación de VPH-16 y 18 podría contribuir a la selección de pacientes en mayor riesgo de desarrollar una lesión cervical que deben someterse a una vigilancia frecuente y meticulosa.

Cervical cancer is the leading cause of cancer death in women in developing country.Persistent infection with human papillomavirus (HPV) is a necessary factor in premalignantlesions and cervical cancer. The Pap smear is the method most commonly used to detect thecervical cancer and its combined with the detection of viral DNA six months post-treatment increases effectiveness to identify women treated in risk with residual/recurrent lesion. Theaim was to describe the frequency of high-risk HPV (HR) in treated women for squamousintraepithelial lesion (SIL) who attended the Cervical Pathology Service of Hospital San Pablofrom January to December/2014. It is cross sectional, descriptive study which included 80patients who attended the service for post-treatment control. The 4800 Cobas HPV Test(Roche) was used, which detects HPV-16 and 18, and a pool of 10 HR-HPV(31,33,35,39,45,51,52,56,58,59) and two "probable" high risk (66,68). Viral infection wasfound in 7.5% (6/80) of patients treated; identifying HPV-16 in 3/6 of positive cases. InParaguay there is a high incidence of pre-neoplastic lesions and cervical cáncer remains apublic health problem. The observed data suggest that the use of this system for viraldetection can lead to optimize the post-treatment monitoring and the identification of HPV-16and 18 could contribute to the selection of patients at increased risk of developing cervicalinjury should undergo to frequent and careful monitoring.

The Histaminergic Tuberomamillary Nucleus Is Involved in Appetite for Sex, Water and Amphetamine.

The histaminergic system is one component of the ascending arousal system which is involved in wakefulness, neuroendocrine control, cognition, psychiatric disorders and motivation. During the appetitive phase of motivated behaviors the arousal state rises to an optimal level, thus giving proper intensity to the behavior. Previous studies have demonstrated that the histaminergic neurons show an earlier activation during the appetitive phase of feeding, compared to other ascending arousal system nuclei, paralleled with a high increase in arousal state. Lesions restricted to the histaminergic neurons in rats reduced their motivation to get food even after 24 h of food deprivation, compared with intact or sham lesioned rats. Taken together, these findings indicate that the histaminergic system is important for appetitive behavior related to feeding. However, its role in other goal-directed behaviors remains unexplored. In the present work, male rats rendered motivated to obtain water, sex, or amphetamine showed an increase in Fos-ir of histaminergic neurons in appetitive behaviors directed to get those reinforcers. However, during appetitive tests to obtain sex, or drug in amphetamine-conditioned rats, Fos expression increased in most other ascending arousal system nuclei, including the orexin neurons in the lateral hypothalamus, dorsal raphe, locus coeruleus and laterodorsal tegmental neurons, but not in the ventral tegmental area, which showed no Fos-ir increase in any of the 3 conditions. Importantly, all these appetitive behaviors were drastically reduced after histaminergic cell-specific lesion, suggesting a critical contribution of histamine on the intensity component of several appetitive behaviors.