Educación en salud, prevención y manejo del dolor de espalda bajo el enfoque "integración escuela comunidad desde el área de Educación Física" / Educação sanitária, prevenção e gestão da dor lombar no âmbito da "abordagem integração escola-comunidade da área da Educação Física" / Education in health, prevention and management of back pain under the approach "integration school community from the area of Physical Education"

RESUMEN El estudio tuvo como propósito valorar los alcances de un plan de acción de educación en salud, prevención y manejo del dolor de espalda, con el enfoque Integración Escuela Comunidad desde el Área de Educación Física en el empoderamiento de conocimientos y su aplicación en pro de una salud integral a los miembros de una institución educativa de la ciudad de Quito; tuvo como enfoque metodológico el paradigma sociocrítico, según el método de investigación acción participativa. Se incluyen como sujetos de estudio a representantes de niños inscritos en dicha institución. El estudio se realizó en tres etapas. 1- Diagnóstico participativo, donde el dolor de espalda aparece como afección frecuente. 2- Programa preventivo que integra conocimientos anatómicos, biomecánicos, higiene postural y ejercicios. 3- Evaluación de conocimientos y habilidades adquiridas. Se realizó historia clínica y determinación de factores de riesgo, aplicación de pre y post- test relacionados con cuidado de espalda, postura y ejercicios. Se plantea sobre la base de puntajes obtenidos y observación de habilidades adquiridas se determina, que el plan de acción permitió la adquisición de valores cognitivos, conductuales y procedimentales en todos los participantes. Se considera el enfoque Integración Escuela Comunidad desde el Área de Educación Física como un programa viable de ejecución por parte del Ministerio Ecuatoriano de Educación. Estos elementos tributan al mantenimiento, promoción y prevención en condiciones de salud de los miembros comunitarios.

RESUMO O objectivo do estudo era avaliar o âmbito de um plano de ação para a educação sanitária, prevenção e gestão das dores lombares, utilizando a " Integração Escola - Comunidade da área da Educação Física" na capacitação do conhecimento e sua aplicação em favor da saúde integral dos membros de uma instituição de ensino na cidade de Quito; a abordagem metodológica foi o paradigma sócio crítico, de acordo com o método de investigação de ação participativa. Os representantes das crianças inscritas na instituição são incluídos como sujeitos de estudo. O estudo foi levado a cabo em três fases. 1- Diagnóstico participativo, onde a dor nas costas aparece como uma aflição frequente. 2- Programa preventivo integrando conhecimentos anatómicos e biomecânicos, higiene postural e exercícios. 3- Avaliação dos conhecimentos e das competências adquiridas. Foi realizado um historial clínico e determinação dos fatores de risco, aplicação de pré e pós-testes relacionados com cuidados de costas, postura e exercícios. Com base nas pontuações obtidas e na observação das competências adquiridas, foi determinado que o plano de ação permitiu a aquisição de valores cognitivos, comportamentais e processuais em todos os participantes. A abordagem Escola - Integração Comunitária da Área da Educação Física é considerada um programa viável para implementação pelo Ministério da Educação do Equador. Estes elementos contribuem para a manutenção, promoção e prevenção das condições de saúde dos membros da comunidade.

ABSTRACT The purpose of the study was to assess the scope of an action plan for health education, prevention and management of back pain, with the School Community Integration approach from the Physical Education Area in the empowerment of knowledge and its application in favor of a comprehensive health to members of an educational institution in the city of Quito; it had as a methodological approach the socio-critical paradigm, according to the participatory action research method. Representatives of children enrolled in said institution are included as study subjects. The study was carried out in three stages. 1- Participatory diagnosis, where back pain appears as a frequent condition. 2- Preventive program that integrates anatomical, biomechanical, postural hygiene and exercise knowledge. 3- Evaluation of knowledge and skills acquired. Clinical history and determination of risk factors, application of pre and post-test related to back care, posture and exercises were performed. Based on the scores obtained and the observation of acquired skills, it is determined that the action plan allowed the acquisition of cognitive, behavioral and procedural values in all participants. The Community School Integration approach from the Physical Education Area is considered as a viable program of execution by the Ecuadorian Ministry of Education. These elements contribute to the maintenance, promotion and prevention of health conditions of community members.

The Use of Flavylium Salts as Dynamic Inhibitor Moieties for Human Cb5R.

Cytochrome b5 reductase (Cb5R) is a flavoprotein that participates in the reduction of multiple biological redox partners. Co-localization of this protein with nitric oxide sources has been observed in neurons. In addition, the generation of superoxide anion radical by Cb5R has been observed. A search for specific inhibitors of Cb5R to understand the role of this protein in these new functions has been initiated. Previous studies have shown the ability of different flavonoids to inhibit Cb5R. Anthocyanins are a subgroup of flavonoids responsible for most red and blue colors found in flowers and fruits. Although usually represented by the flavylium cation form, these species are only stable at rather acidic pH values (pH ≤ 1). At higher pH values, the flavylium cation is involved in a dynamic reaction network comprising different neutral species with the potential ability to inhibit the activities of Cb5R. This study aims to provide insights into the molecular mechanism of interaction between flavonoids and Cb5R using flavylium salts as dynamic inhibitors. The outcome of this study might lead to the design of improved specific enzyme inhibitors in the future.

Desarrollo de la motricidad: una aplicación del modelo de aprendizaje microcurricular activo / Desenvolvimento motor: uma aplicação do modelo de aprendizagem micro-curricular ativa / Development of motor skills: an application of the micro curricular active learning model

RESUMEN Las clases de Educación Física desarrolladas en esta pandemia han generado que los docentes busquen nuevas alternativas de enseñanza que se puedan contextualizar con los recursos virtuales. El objetivo de esta investigación es aplicar el Modelo de Aprendizaje Microcurricular Activo de Educación Física en niños de 5 a 6 años, pertenecientes al primer año de Educación General Básica Preparatoria de una escuela particular de la ciudad de Quito. Esta propuesta se diseñó para comprobar si influye significativamente en el desarrollo de la motricidad gruesa. Se realizó un estudio con diseño cuasiexperimental con medidas pre y postest sin grupo control, de corte transversal, descriptivo, analítico y comparativo, en población conformada por 22 niños como grupo experimental, distribuidos en 11 niños y 11 niñas. Se aplicó en la primera mitad del año lectivo 2020-2021, por medio de clases virtuales por Zoom; el pretest se realizó en la primera semana de septiembre y el postest en la tercera semana de enero, con la batería de Mc. Clenaghan y Gallahue y la batería de Ozerestky de motricidad infantil. Se concluyó que existen variaciones significativas en los elementos de la motricidad gruesa, como son: correr, trepar, reptar y saltar. Estadísticamente, quedó demostrado que la aplicación de este modelo es eficaz según los resultados obtenidos y que es de gran importancia para desarrollar la motricidad gruesa; además, que se pueden utilizar recursos virtuales en las clases de Educación Física, potencializándolas para la vida en cada una de las actividades de su diario vivir.

RESUMO As aulas de Educação Física desenvolvidas nesta pandemia levaram os professores a procurar novas alternativas de ensino que podem ser contextualizadas com recursos virtuais. O objetivo desta pesquisa é aplicar o Modelo Ativo de Aprendizagem Microcurricular para Educação Física em crianças de 5 a 6 anos de idade, pertencentes ao primeiro ano da Educação Preparatória Básica Geral em uma escola pública da cidade de Quito. Esta proposta foi projetada para testar se ela tem uma influência significativa no desenvolvimento das habilidades motoras brutas. Foi realizado um estudo de projeto quase-experimental com medidas pré e pós-teste sem grupo de controle, um estudo transversal, descritivo, analítico e comparativo, em uma população de 22 crianças como grupo experimental, distribuídas em 11 meninos e 11 meninas. Foi aplicado na primeira metade do ano escolar 2020-2021, por meio de aulas virtuais Zoom; o pré-teste foi realizado na primeira semana de setembro e o pós-teste na terceira semana de janeiro, com a bateria Mc. Clenaghan e Gallahue e a bateria Ozerestky de habilidades motoras infantis. Concluiu-se que existem variações significativas nos elementos das habilidades motoras brutas, como correr, escalar, rastejar e pular. Estatisticamente, foi demonstrado que a aplicação deste modelo é eficaz de acordo com os resultados obtidos e que é de grande importância para o desenvolvimento das habilidades motoras brutas; além disso, os recursos virtuais podem ser utilizados nas aulas de Educação Física, tornando-os mais potentes para a vida em cada uma das atividades da vida diária.

ABSTRACT The Physical Education classes developed in this pandemic have generated that teachers look for new teaching alternatives that can be contextualized with virtual resources. The objective of this research is to apply the Active Microcurricular Learning Model of Physical Education in children from 5 to 6 years old, belonging to the first year of General Basic Preparatory Education of a private school in the city of Quito. This proposal was designed to check if it significantly influences the development of gross motor skills. A quasi-experimental design study was carried out with pre and post-test measures without control group, cross-sectional, descriptive, analytical and comparative, in a population formed by 22 children as experimental group, distributed in 11 boys and 11 girls. It was applied in the first half of the 2020-2021 school year, through virtual classes by Zoom; the pretest was carried out in the first week of September and the posttest in the third week of January, with the Mc. Clenaghan and Gallahue battery and the Ozerestky battery of infantile motor skills. It was concluded that there are significant variations in the elements of gross motor skills, such as: running, climbing, crawling and jumping. Statistically, it was demonstrated that the application of this model is effective according to the results obtained and that it is of great importance to develop gross motor skills; in addition, virtual resources can be used in Physical Education classes, empowering them for life in each of their daily activities.

Eritrosedimentación extremadamente elevada en pacientes adultos hospitalizados en una institución de alta complejidad en la ciudad de medellín, colombia entre 2016 y 2018 / Extremely elevated erythrosedimentation in adult patients hospitalized in a high complexity institution in the city of medellín, colombia between 2016 and 2018

Resumen Introducción: La eritrosedimentación es una medida indirecta de inflamación, se eleva ante un aumento de proteínas (reactantes de fase aguda) durante trastornos inflamatorios, un valor extremadamente elevado ≥100mm/hora) tiene una alta especificidad para el diagnóstico de enfermedades infecciosas, neoplásicas y autoinmunes. Objetivo: Caracterizar a los pacientes hospitalizados con una elevación extrema de la eritrosedimentación, y explorar su asociación con otros factores determinantes. Métodos: Estudio descriptivo de corte transversal. Se incluyeron pacientes mayores de 18 años, con eritrosedimentación extrema, internados en el Hospital Pablo Tobón Uribe de la ciudad de Medellín, desde Noviembre de 2016 hasta Junio de 2018. Resultados: Se seleccionaron 1007 pacientes de la base de datos del hospital, las infecciones, con 743 (73,8%) afectados, fueron el principal diagnóstico relacionado. Se evidenció una correlación negativa de la eritrosedimentación con la hemoglobina -0.092(-0.155 a -0.029) P <0.01 y con el hematocrito -0.087(-0.150 a -0.024) P 0.01, y una positiva significativa débil con la PCR 0.080 (0.014 a 0.146) p 0.02. Discusión: Acorde a otros estudios, las infecciones representaron el primer grupo de elevación extrema, contrario a otro estudio se evidenció una correlación directa, débil y estadísticamente significativa entre la Proteina C reactiva y la eritrosedimentación extremadamente elevada. Conclusión: Las infecciones fueron el principal grupo de enfermedades con eritrosedimentación extrema, se evidenció una correlación inversa entre la eritrosedimentación con la hemoglobina y el hematocrito, y una correlación positiva débil con la proteína C reactiva. MÉD.UIS.2021;34(3): 39-45.

Abstract Sedimentation rate is an indirect inflammation measure, it rises when increase proteins (acute phase reactants) during inflammatory disorders, extreme high value (≥100mm / hour) has a high specificity for the diagnosis of infectious, neoplastic, and autoimmune diseases. Objective: To characterize inpatients with an extreme elevation of the sedimentation rate, and to establish the correlation between determinant factors and extreme sedimentation. Methods: Observational and cross-sectional study, including patients older than 18 years, with an extremely sedimentation rate, hospitalized in Hospital Pablo Tobon Uribe in Medellin city, during November of 2016 to June of 2018. Results: We selected 1007 patients from the data base, Infections were the most common diagnosis (743, 73.8%), and the main type were urinary tract infections (133, 13%). We evidence a negative correlation with the hemoglobin -0.092(0.155 a -0.029) and with the hematocrit -0.087(0.150 a -0.024), and a positive and weak significant correlation with the C-reactive protein 0.080 (0.014 a 0.146) p 0.02. Discussion: The infections, as in other studies, represent the main etiology associated with an extreme sedimentation. Different to other analyzed investigations, we observed a direct, weak and statistically significant correlation between the PCR and the extreme VSG. Conclusions: Infections were the main cause of extreme sedimentation rate. We evidence an inverse correlation between the blood sedimentation and the hemoglobin and the hematocrit, and a weak correlation with the C-reactive protein. MÉD.UIS.2021;34(3): 39-45.

[SARS-CoV-2 seroprevalence among workers in a hospital in Madrid.] / Seroprevalencia frente a SARS-CoV-2 en los trabajadores de un hospital de Madrid.

OBJECTIVE: The impact of the first wave of the pandemic due to SARS-CoV-2 has been enormous in Spanish hospitals, being Madrid one of the most affected communities. The aim of this study was to analyze the impact of the pandemic on the workers of a hospital located in one of the most affected areas of Madrid (Alcalá de Henares) using a chemiluminescence immunoassay (CLIA). METHODS: We conducted a seroprevalence survey between June 25th and July 31st, 2020, over hospital workers from our institution. This study population was previously analyzed using a diagnostic approach which consisted of PCR and a serologic rapid test. For the present survey, prevalence of IgG antibodies against SARS-CoV-2 was studied using chemiluminescence. We analyzed the prevalence in healthcare workers (HCW) and non-healthcare workers (nHCW). Information about professional category, use of personal protective equipment (PPEs) and previous COVID-19 contacts was collected to determine the risk factors associated with SARS-CoV-2 seropositivity. Comparisons were made using the Mann-Whitney U test (continuous variables) and the two-tailed Fisher's exact test (categorical variables). Risk factors for seropositivity were analyzed using multivariate logistic regression. RESULTS: A total of 2,219 workers were included and 847 of them (38.2%) presented IgG antibodies against SARS-CoV-2, being seroprevalence significantly higher for HCW (39.3%) than for nHCW (30.7%, p=0.006). We found no differences regarding positivity rates compared with the first diagnostic approach for symptomatic and asymptomatic workers, or infected workers per professional category. In the multivariate logistic regression analysis, the use of PPE (protective, OR=0.65; 95%CI: 0.48-0.89; p<0.001) and previous contact with COVID-19 patients (risk factor, OR=1.93; 95%CI: 1.37-2.72; p<0.001) were independent factors that were associated with SARS-CoV-2 seropositivity. CONCLUSIONS: More than 38% of our workers presented IgG antibodies against SARS-CoV-2. We found no differences in the positivity rates between diagnostic approaches. The use of PPE (protective) and previous contact with COVID-19 patients (risk factor) were associated with infection.

OBJETIVO: El impacto de la primera oleada de la pandemia debida a SARS-CoV-2 ha sido enorme en los hospitales españoles, siendo Madrid una de las comunidades más afectadas. El objeto de este estudio fue analizar el impacto de la pandemia en los trabajadores de un hospital situado en una de las zonas más afectadas de Madrid (Alcalá de Henares) mediante un inmunoensayo de quimioluminiscencia. METODOS: Realizamos un estudio de seroprevalencia entre el 25 de junio y el 31 de julio de 2020 entre los trabajadores de nuestro centro, que se estudió previamente utilizando otra aproximación diagnóstica (PCR y test rápido serológico). Para este estudio, analizamos la prevalencia de anticuerpos tipo IgG contra SARS-CoV-2 mediante quimioluminiscencia. Analizamos la prevalencia en personal sanitario (PS) y no sanitario (PNS). Se recopiló información sobre la categoría profesional, uso de equipos de protección individual (EPI) y contactos COVID-19 para determinar los factores de riesgo asociados con la seropositividad. Las comparaciones se hicieron con el test de la U de Mann-Whitney (variables continuas) y la prueba exacta de Fisher de dos colas (variables categóricas). Los factores de riesgo para la seropositividad se analizaron mediante regresión logística multivariable. RESULTADOS: Incluimos a 2.219 trabajadores, de los cuales 847 (38,2%) presentaron anticuerpos IgG, siendo la seroprevalencia significativamente mayor en PS (39,3%) que en PNS (30,7%, p=0,006). No encontramos diferencias respecto a la primera aproximación diagnóstica en los porcentajes de positividad para personal sintomático, asintomático, o estratificando por categoría profesional. Mediante regresión logística multivariable, el uso de EPI (protector, OR=0,65; IC95%:0,48-0,89; p<0,001) y el contacto previo con pacientes COVID-19 (factor de riesgo, OR=1,93; IC95%:1,37-2,72; p<0,001) fueron factores asociados de forma independiente con la seropositividad. CONCLUSIONES: Más del 38% de nuestros trabajadores presentaron anticuerpos IgG contra SARS-CoV-2. No encontramos diferencias en los porcentajes de positividad entre ésta y la anterior aproximación diagnóstica. El uso de EPI (protector) y el contacto con pacientes con COVID-19 (factor de riesgo) se asociaron de forma independiente con la infección.

Phenotype and progression among patients with dilated cardiomyopathy and RBM20 mutations.

BACKGROUND: Over 70 genes that encode different cell components have been involved in the aetiology of dilated cardiomyopathy. Genotype-phenotype interactions are an unsolved problem, and to a large extent the effects of mutations in the expression mechanisms involved in the disease remain unknown, although associations are increasingly being established which have clinical and prognostic implications. METHODS AND RESULTS: The objective of our work was to describe our population that has cardiomyopathy associated with mutations in the gene RBM20, and study the genotype-phenotype relationship. We studied 8 cases undergoing follow-up at our Unit, and collected data for demographic, clinical and diagnostic testing variables. The mean age on diagnosis was 55 years [52-59], with a median follow-up of 31.5 months [26.0-67.3]. It is worth noting that 62.5% of the patients in our group had a history of cardiomyopathy in first degree relatives, and 37.5% of them had a family history of sudden death. One of the genetic variations of the sample was shared by three subjects who had no apparent family relationship with each other, and this variation had not been described in controls. It is also interesting that arrhythmic events were found in 37.5% of the sample, and 50% of patients had an indication for implantable cardiac defibrillator. CONCLUSION: This is the first analysis of patients with RBM20 mutations conducted in our country, and it indicates a profile with prominent arrhythmogenesis, a high penetrance of familial cardiomyopathy, and sudden death.

Continuation Rates of the 52-mg Levonorgestrel-releasing Intrauterine System according to the Primary Reason for its Use.

OBJECTIVE: To evaluate whether continuation rates with the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) up to 5 years after placement differed between women using the method exclusively for contraception and those using the device for medical reasons alone. METHODS: A retrospective cohort study was conducted in a family planning clinic with 5,034 LNG-IUS users: 4,287 using the method exclusively for contraception and 747 for medical reasons alone. The continuation rate at 1 to 5 years of use was calculated by life table analysis. RESULTS: Initially, the continuation rate was significantly higher in the contraception group: 85.8 versus 83.4 and 77.4 versus 76.0 per 100 women-years in the 1st and 2nd years of use, respectively. There were more discontinuations due to bleeding/spotting in the medical reasons group in the first two years. The discontinuation rate according to reason for use was not significantly different from the third to the fifth year of use. No women discontinued due to amenorrhea in either group. CONCLUSION: The continuation rate was significantly higher in the contraception group in the first two years of use. Amenorrhea was not a reason for discontinuation in either group, suggesting that counselling in this respect was adequate. Nevertheless, counselling could perhaps have been better with regards to the expected long period of bleeding and spotting in the first two years after placement.

OBJETIVO: Avaliar a taxa de continuação até 5 anos de uso do sistema intrauterino liberador de 52-mg levonorgestrel por dia (SIU LNG) -IUS) é diferente entre mulheres que o usam exclusivamente como anticoncepcional que entre as que usam exclusivamente por razões médicas. MéTODOS: Estudo retrospectivo realizado em uma clínica de Planejamento Familiar 5.034 usuárias de SIU LNG, 4.287 que optaram pelo método apenas como anticoncepcional e 747 que o usavam somente por razoes médicas. A taxa de continuação de um até cinco ano foi calculada por meio de análise de tabela de vida RESULTADOS: No início a taxa de continuação foi significativamente maior no grupo da anticoncepção: 85,8 versus 83,4 e 77,4 versus 76,0 por 100 anos-mulher no 1° e 2° ano de uso, respectivamente. Houve mais descontinuações por sangrado-manchado no grupo de razões médicas nos dos primeiros anos. A taxa de continuação não foi significativamente diferente desde o terceiro até o quinto ano de uso. Nenhuma mulher de ambos os grupos descontinuou por amenorreia. CONCLUSãO: A taxa de continuação foi significativamente maior no grupo de anticoncepção durante os dos primeiros anos de uso. Amenorreia não foi motivo de descontinuação em ambos os grupos, sugerindo que a orientação a esse respeito foi adequada. Entretanto, a orientação referente ao longo período de sangramentos irregulares nos dois primeiros anos após a inserção, precisaria ser melhorado.

The Great Italian Masquerade.

Tuberculosis and sarcoidosis are both granulomatous diseases centered on the lung but capable of myriad extrapulmonary manifestations. Because of substantial similarity in their presentations, these two entities can be notoriously challenging to differentiate. This can be particularly true of countries in which tuberculosis is rarely encountered because of a reflexive tendency to ascribe granulomatous inflammation in the lung to sarcoidosis, especially if the granulomas are non-necrotizing. However, as our case from a non-endemic country reminds, sarcoidosis can be comfortably diagnosed only after convincing exclusion of infectious causes of granulomas. Distinguishing these two diseases is of utmost importance as, despite their overlapping presentations, they have completely non-overlapping treatments which can lead to harm if erroneously applied. At the end of our discussion, we summarize the clinical features favoring one diagnosis over the other.

Hammering home the sickle: an instructive case of endobronchial anaplastic large cell lymphoma.

It is extremely unusual for primary pulmonary lymphoma, an uncommon occurrence in any form, to be of T-cell origin and to manifest as an endobronchial lesion. Each of these characteristics is rare individually, so cases that combine them are exceptional. We report a patient in whom primary pulmonary anaplastic large cell lymphoma, a T-cell neoplasm, presented with obstruction of the left upper lobe bronchus, resulting in left upper lobe atelectasis and creating the radiographic luftsichel sign. We briefly discuss anaplastic large cell lymphoma as a whole, place our case in the context of previously published literature on endobronchial anaplastic large cell lymphoma, and review the genesis of the luftsichel sign.

Continuation rates of the 52-mg levonorgestrel-releasing intrauterine system according to the primary reason for its use / Taxas de continuação com o sistema intrauterino de liberação de levonorgestrel de 52mg de acordo com o motivo principal de seu uso

Abstract Objective To evaluate whether continuation rates with the 52-mg levonorgestrelreleasing intrauterine system (LNG-IUS) up to 5 years after placement differed between women using the method exclusively for contraception and those using the device for medical reasons alone. Methods A retrospective cohort study was conducted in a family planning clinic with 5,034 LNG-IUS users: 4,287 using the method exclusively for contraception and 747 for medical reasons alone. The continuation rate at 1 to 5 years of use was calculated by life table analysis. Results Initially, the continuation rate was significantly higher in the contraception group: 85.8 versus 83.4 and 77.4 versus 76.0 per 100 women-years in the 1st and 2nd years of use, respectively. There were more discontinuations due to bleeding/spotting in the medical reasons group in the first two years. The discontinuation rate according to reason for use was not significantly different from the third to the fifth year of use. No women discontinued due to amenorrhea in either group. Conclusion The continuation rate was significantly higher in the contraception group in the first two years of use. Amenorrhea was not a reason for discontinuation in either group, suggesting that counselling in this respect was adequate. Nevertheless, counselling could perhaps have been better with regards to the expected long period of bleeding and spotting in the first two years after placement.

Resumo Objetivo Avaliar a taxa de continuação até 5 anos de uso do sistema intrauterino liberador de 52-mg levonorgestrel por dia (SIU LNG) -IUS) é diferente entre mulheres que o usam exclusivamente como anticoncepcional que entre as que usam exclusivamente por razões médicas. Métodos Estudo retrospectivo realizado em uma clínica de Planejamento Familiar 5.034 usuárias de SIU LNG, 4.287 que optaram pelo método apenas como anticoncepcional e 747 que o usavamsomente por razoesmédicas. A taxa de continuação de um até cinco ano foi calculada por meio de análise de tabela de vida Resultados No início a taxa de continuação foi significativamente maior no grupo da anticoncepção: 85,8 versus 83,4 e 77,4 versus 76,0 por 100 anos-mulher no 1° e 2° ano de uso, respectivamente. Houve mais descontinuações por sangrado-manchado no grupo de razões médicas nos dos primeiros anos. A taxa de continuação não foi significativamente diferente desde o terceiro até o quinto ano de uso. Nenhuma mulher de ambos os grupos descontinuou por amenorreia. Conclusão A taxa de continuação foi significativamente maior no grupo de anticoncepção durante os dos primeiros anos de uso. Amenorreia não foi motivo de descontinuação em ambos os grupos, sugerindo que a orientação a esse respeito foi adequada. Entretanto, a orientação referente ao longo período de sangramentos irregulares nos dois primeiros anos após a inserção, precisaria ser melhorado.

Comparison of In Vitro Efficacy of Six Disinfectants on the Hatching of Larval Eggs of Toxocara canis.

BACKGROUND: The environmental contamination with Toxocara canis eggs increases the risk of dissemination and transmission of the parasite in dogs and paratenic hosts such as humans. We aimed to evaluate different disinfectants to compare their effect on T. canis eggs. METHODS: For its realization, 850 embryonated eggs were obtained, which were suspended in a solution of 5% formaldehyde and distilled water in Eppendorf tubes. In the tubes containing the 850 embryonated eggs, researchers was added 0.5 mL of each solution (enzymatic solution, sodium hypochlorite, iodopovidone, quaternary of ammonium, benzalkonium chloride, and super oxidation solution). After mixing, an aliquot was taken, observed under the microscope, and the number of broken eggs counted at different times to find the most effective ovicidal moment. RESULTS: The enzymatic disinfectant present a significant difference (P = 0.05) with 276.06 broken eggs followed by ammonium with 105.20 broken eggs. After 10 min, the ammonium solution was the one that showed a significant difference of 50.50 hatched eggs, followed by the enzymatic 26.80 and hypochlorite 25.00 treatments. After 20 min, the enzymatic solution treatment showed a significant difference with the other solutions showing an increase of 98.80 broken eggs. In the 30 and 40-min times, only the enzymatic treatment showed a significant difference of 334.10 and 381.70 of broken eggs respectively. CONCLUSION: The enzymatic solution has the greatest ovicidal effect against the eggs of T. canis to present a greater number of broken eggs in a given time between 20 and 40 minutes.

Cellular Origins of the Lymphatic Endothelium: Implications for Cancer Lymphangiogenesis.

The lymphatic system plays important roles in physiological and pathological conditions. During cancer progression in particular, lymphangiogenesis can exert both positive and negative effects. While the formation of tumor associated lymphatic vessels correlates with metastatic dissemination, increased severity and poor patient prognosis, the presence of functional lymphatics is regarded as beneficial for anti-tumor immunity and cancer immunotherapy delivery. Therefore, a profound understanding of the cellular origins of tumor lymphatics and the molecular mechanisms controlling their formation is required in order to improve current strategies to control malignant spread. Data accumulated over the last decades have led to a controversy regarding the cellular sources of tumor-associated lymphatic vessels and the putative contribution of non-endothelial cells to this process. Although it is widely accepted that lymphatic endothelial cells (LECs) arise mainly from pre-existing lymphatic vessels, additional contribution from bone marrow-derived cells, myeloid precursors and terminally differentiated macrophages, has also been claimed. Here, we review recent findings describing new origins of LECs during embryonic development and discuss their relevance to cancer lymphangiogenesis.

Educación Física significativa: propuesta para la contextualización de contenidos curriculares / Educação Física significativa: proposta para a contextualização de conteúdos curriculares / Meaningful Physical Education: proposal for the contextualization of curricular contents

Resumen El ajuste del currículo nacional de Educación Física del Ecuador 2016, demanda que el docente posea un nuevo perfil profesional alineado a los nuevos enfoques y contenidos curriculares. El objetivo de esta investigación fue presentar una propuesta de contextualización para el fomento del aprendizaje significativo en los estudiantes; esta se basó en la valoración de las apreciaciones que tuvieron los docentes sobre los contenidos y la adaptación de metodologías activas. La investigación se desarrolló bajo el modelo cualitativo descriptivo. La población fue de 22 docentes de Educación Física pertenecientes a siete instituciones educativas particulares de Quito, por lo que se definió una muestra censal. Se aplicó la técnica de la entrevista con un instrumento validado por juicio de siete expertos en una sola circulación; los ítems del cuestionario se refirieron a las necesidades de contextualizar los contenidos curriculares, la adaptación de estrategias metodológicas activas y la alineación docente al ajuste curricular para que los aprendizajes sean significativos. Este trabajo contribuyó con una propuesta curricular desarrollada con la intención de contextualizar e interpretar los elementos delas destrezas con criterio de desempeño del currículo de Educación Física, lo que facilitará la aplicación de metodologías activas que garanticen que el aprendizaje sea significativo y se alcance el perfil de salida del bachiller ecuatoriano, generando en el estudiante un alto grado de autonomía, que permita replicar en cualquier momento de su vida la práctica de actividad física.

Resumo A adaptação do currículo nacional de Educação Física do Equador para 2016 exige que os professores tenham um novo perfil profissional em conformidade com as novas abordagens e conteúdos curriculares. O objectivo desta investigação foi apresentar uma proposta de contextualização de modo a promover uma aprendizagem significativa entre os estudantes. A investigação foi desenvolvida no âmbito do modelo descritivo qualitativo. A população era constituída por 22 professores de educação física de sete escolas privadas de Quito, definindo a amostra censitária A técnica da entrevista foi aplicada com um instrumento validado pelo julgamento de sete peritos numa única circulação. Os itens do questionário referiam-se à necessidade de contextualizar o conteúdo curricular, à adaptação de estratégias metodológicas ativas e ao alinhamento dos professores para que a aprendizagem fosse significativa. Este trabalho contribuiu com uma proposta curricular desenvolvida com a intenção de contextualizar e interpretar os elementos das competências com critérios de desempenho do currículo de Educação Física, o que facilitará a aplicação de metodologias ativas que garantem que a aprendizagem seja significativa e que se atinja o perfil de saída do graduado do ensino médio equatoriano, gerando no aluno um alto grau de autonomia, o que lhe permite replicar a prática da atividade física em qualquer momento da sua vida.

Abstract The adjustment of Ecuador's national Physical Education 2016 curriculum requires teachers to have a new professional profile in line with the new approaches and curricular content. The objective of this research was to present a proposal for contextualization in order to foster meaningful learning among students; it was based on the evaluation of teachers' assessments of the contents and the adaptation of active methodologies. The research was developed under the qualitative descriptive model. The population was 22 physical education teachers from seven private schools in Quito. The interview technique was applied with an instrument validated by the judgment of seven experts in a single circulation. The items of the questionnaire referred to the need to contextualize curricular content, the adaptation of active methodological strategies, and teacher alignment to curricular adjustment in order for learning to be meaningful. This work contributed with a curricular proposal developed with the intention of contextualizing and interpreting the elements of the skills with performance criteria of the Physical Education curriculum, which will facilitate the application of active methodologies that guarantee that learning is meaningful and that the exit profile of the Ecuadorian high school graduate is reached, generating in the student a high degree of autonomy, which allows him/her to replicate the practice of physical activity at any time in his/her life.

Comentario sobre la asociación entre la vía de parto y el daño perineal e incontinencia urinaria y fecal / Comment on the association between the route of delivery and perineal damage and urinary and fecal incontinence

RESUMEN El parto vaginal se asocia con un riesgo más alto de daño perineal, incontinencia urinaria y fecal comparado con el parto cesárea. Dicho riesgo aumenta con el parto instrumental (ej. fórceps) y disminuye cuando la posición al momento del parto reduce la compresión sobre el sacro o si el parto ocurre bajo el agua. En otros factores que aumentan el riesgo de incontinencia se incluyen: la gran multiparidad, la duración del trabajo de parto, el peso fetal y tamaño de su cabeza, la edad muy joven al momento del primer parto, la inducción del trabajo de parto, la obesidad, la diabetes, la constipación, el tabaquismo y la historia de incontinencia urinaria o fecal. Factores sociales que se asocian a incontinencia incluyen la falta de educación, malas condiciones de hábitat, trabajo manual intenso, la falta de actividad física y el divorcio.

ABSTRACT Vaginal delivery is associated with a higher risk of perineal injury, and urinary and fecal incontinence as compared with caesarean delivery; The risk is higher in case of operative vaginal delivery and lower if the position at delivery takes the weight off the sacrum or is carried out under water immersion; A number of other factors increase the risk of incontinence, including higher parity, duration of labour, fetal weight or size of fetal head, younger age at first delivery, induction of labour, obesity, diabetes, constipation, smoking and history of urinary or fecal incontinence. Social factors such as lack of education, poor living environment, intense manual labour, the absence of physical exercise and divorce, are also associated with incontinence.