Manejo del sistema de salud de Ecuador frente a la resistencia antimicrobiana

Introducción: El Sistema de Salud del Ecuador cuenta con el Plan Nacional para la Prevención y Control de la Resistencia a los Antimicrobianos, que persigue la mejora en la calidad de la atención en médica y, desde ahí, llamar la atención en el aumento de la resistencia microbiana, que se ha convertido en un problema de suma relevancia para la salud pública mundial. Objetivo: Sistematizar conocimientos sobre el manejo del sistema de salud del Ecuador frente a la resistencia antimicrobiana. Método: Se llevó a cabo una revisión bibliográfica exhaustiva en buscadores bibliográficos como Scopus, Google Académico y PubMed, con la búsqueda de palabras clave. La indagación se realizó el 20 de mayo de 2022, de los 39 artículos fueron seleccionados según criterios solo 20 artículos. Resultados: Ecuador cuenta con un sistema de salud mixto, constituido por el sector público del Ministerio de Salud Pública (MSP), el Instituto Ecuatoriano de Seguridad Social (IESS), el Instituto de Seguridad de las Fuerzas Armadas (ISSFA) y el Instituto Nacional de Seguridad Policial (ISSPOL); por otro lado, está el sector privado, integrado por la Asociación Nacional de Clínicas y Hospitales Privados del Ecuador. Ambos se encuentran integrados a fin de garantizar el desarrollo integral en salud de toda la población ecuatoriana, regular y controlar las actividades que realizan las entidades tanto públicas como privadas, sin distinción, para combatir la amenaza que representa el incremento en el uso indiscriminado de antimicrobianos, con repercusiones en la salud humana y animal. Consideraciones finales: La forma ineficiente de combatir el riesgo sanitario por resistencia antimicrobiana afecta a la población ecuatoriana como consecuencia del uso indiscriminado e inadecuado de antibióticos, y el insuficiente uso de los tratamientos convencionales.

Introduction: The Health Care System in Ecuador has a National Plan for the Prevention and Control of antimicrobial resistance, which aims to improve the quality of medical care and based from this goal focus attention on the increase in microbial resistance, which has become a highly relevant problem for global public health. Objective: To systematize knowledge on how the Ecuatorian health care system confront the antimicrobial resistance. Method: An exhaustive bibliographic review was carried out in bibliographic search engines such as Scopus, Google Scholar and PubMed, with the use in the search process of expecifics keywords. The research was carried out on May 20, 2022, and of the 39 articles only 20 were selected according to the criteria needed. Results: Ecuador has a mixed health care system, made up by the Ministry of Public Health (MSP), the Ecuadorian Social Security Institute (IESS), the Social Security of the Armed Forces (ISSFA) and the Institute Security National Police (ISSPOL), all representing the public sector; on the other hand, representing the private sector, it´s included the National Association of Private Clinics and Hospitals of Ecuador (Asociación Nacional de Clínicas y Hospitales Privados del Ecuador). Both are integrated to guarantee the integral health development in the entire Ecuadorian population, regulate and control the activities conducted by both public and private entities, without distinction, and to face the threat posed by the increase in the indiscriminate use of antimicrobials and its consequent repercussions on human and animal health. Conclusions: The inefficient way of combating the health risk related to antimicrobial resistance affects the Ecuadorian population due to indiscriminate and inadequate use of antibiotics and the insufficient use of conventional treatments.

Introdução: O Sistema de Saúde equatoriano conta com o Plano Nacional de Prevenção e Controle da Resistência Antimicrobiana, que busca melhorar a qualidade da assistência médica e, a partir daí, chamar a atenção para o aumento da resistência microbiana, que se tornou um problema de grande relevância para a saúde pública global. Objetivo: Sistematizar o conhecimento sobre a gestão do sistema de saúde equatoriano diante da resistência antimicrobiana. Método: Foi realizada revisão bibliográfica exaustiva em buscadores bibliográficos como Scopus, Google Acadêmico e PubMed, com a busca por palavras-chave. A consulta foi realizada no dia 20 de maio de 2022, dos 39 artigos, apenas 20 artigos foram selecionados conforme critérios. Resultados: O Equador possui um sistema de saúde misto, formado pelo setor público do Ministério da Saúde Pública (MSP), Instituto Equatoriano de Previdência Social (IESS), Instituto de Segurança das Forças Armadas (ISSFA) e Instituto Nacional de Segurança Policial (ISSPOL); Por outro lado, existe o setor privado, formado pela Associação Nacional de Clínicas e Hospitais Privados do Equador. Ambos estão integrados para garantir o desenvolvimento integral da saúde de toda a população equatoriana, regular e controlar as atividades realizadas por entidades públicas e privadas, sem distinção, para combater a ameaça representada pelo aumento do uso indiscriminado de antimicrobianos, com repercussões na saúde humana e animal. Considerações finais: A forma ineficiente de combater o risco à saúde devido à resistência antimicrobiana afeta a população equatoriana como consequência do uso indiscriminado e inadequado de antibióticos e do uso insuficiente de tratamentos convencionais.

Chronic intermittent hypoxia promotes early intrahepatic endothelial impairment in rats with nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is a progressive disease that ranges from simple steatosis to cirrhosis. Obstructive sleep apnea syndrome (OSAS) and chronic intermittent hypoxia (CIH) are implicated in the pathogenesis of NAFLD. However, the overlapping consequences of CIH on liver sinusoidal endothelial function over time in NAFLD are largely unknown. We explored endothelial dysfunction in a rat model of NAFLD with a high-fat diet exposed to CIH [12 h/day, every 30 s to fractional concentration of oxygen ([Formula: see text] 8%-10%]. The livers were isolated and perfused, and the endothelial function was determined by testing the vasodilation of the liver circulation to increased concentrations of acetylcholine and von Willebrand factor (vWF) and intercellular adhesion molecule 1 (ICAM-1) expression. Phosphorylated endothelial nitric oxide synthase (p-eNOS), cGMP, and oxidative stress were assessed to determine nitric oxide bioavailability. Inflammation and fibrosis were evaluated by transaminases, myeloperoxidase activity, hydroxyproline, and histological evaluation. Hypoxia-inducible factors (HIFs) were studied as a marker of hypoxia and after a second insult with acetaminophen. CIH exposure provoked typical systemic features of OSAS and provoked a decreased response in vasodilation to acetylcholine. This was associated with increased oxidative stress and reduced p-eNOS and cGMP. The microcirculation impairment due to CIH preceded significant hepatic inflammation and fibrotic changes, despite the presence of HIF expression. In conclusion, CIH exacerbates endothelial dysfunction in NAFLD rats associated with increased oxidative stress and reduced nitric oxide bioavailability. This occurs before inflammation and fibrosis establish. Our results suggest that with CIH endothelial dysfunction should be considered an early target.NEW & NOTEWORTHY We believe the findings are of relevance because we demonstrate that chronic intermittent hypoxia further augments impaired hepatic endothelial dysfunction in nonalcoholic fatty liver disease rats. Because obstructive sleep apnea syndrome is associated with systemic endothelial dysfunction in cardiovascular disorders, and chronic intermittent hypoxia is an independent and reversible risk factor for hypertension and coronary artery disease, we hypothesized that this entity may be of potential relevance in the pathophysiology of nonalcoholic fatty liver disease.

Mortalidad neonatal y las infecciones asociadas a la atención sanitaria / Neonatal mortality and healthcare-associated infections

Objetivo: Analizar la mortalidad neonatal y las infecciones asociadas a la atención sanitaria. Método: Se realizó una revisión sistemática de 15 artículos en PubMed y Scielo, los cuales se relacionan directamente con el objetivo de investigación. Conclusión: Las diferentes medidas de asepsia y antisepsia aplicados en UCIN y Neonatología, han disminuido la incidencia de IAAS, aunque, aún hay una alta tasa de mortandad por sepsis, neumonías y meningitis, las cuales provocan hasta una cuarta parte de todas las muertes de recién nacidos, siendo los más afectados los neonatos con un peso menor a 1500 gramos

Objective: To analyze neonatal mortality and healthcare-associated infections. Methods: A systematic review of 15 articles in PubMed and Scielo, which are directly related to the research objective, was carried out. Conclusion: The different asepsis and antisepsis measures applied in NICU and Neonatology have decreased the incidence of HAIs, although there is still a high mortality rate due to sepsis, pneumonia and meningitis, which cause up to a quarter of all newborn deaths, the most affected being neonates weighing less than 1500 grams.

Síntomas gastrointestinales y afectación hepática en pacientes diagnosticados con COVID-19 / Gastrointestinal symptoms and liver involvement in patients diagnosed with COVID-19

Se identificó la relación entre los síntomas gastrointestinales y la afectación hepática en pacientes diagnosticados con COVID-19. El daño hepático en estos pacientes puede ser causado por el virus que infecta directamente las células hepáticas, por ello se debe prestar más atención al estado de la función hepática de los pacientes con COVID-19. Se realizó un estudio observacional, descriptivo y transversal en pacientes diagnosticados con COVID-19, pertenecientes a dos hospitales del cantón Ambato, de enero a julio de 2021. Se seleccionó una muestra no probabilística, de 125 pacientes con los siguientes criterios: no presentar afectación hepática, no estar bajo tratamiento con fármacos hepatotóxicos. Para identificar posible diferencia de medias entre los niveles de las determinaciones de TGP, TGO, GGT y LDH en los pacientes con y sin síntomas se utilizó la prueba t de Student para muestras independientes. Posteriormente, se realizó la prueba estadística Regresión logística binaria con el método Intro. La prueba de bondad de ajuste Hosmer-Lemeshow permitió evaluar el ajuste del modelo. Para todas las pruebas de hipótesis se empleó un nivel de significación del 5%(AU)

The relationship between gastrointestinal symptoms and liver involvement in patients diagnosed with COVID-19 was identified. Liver damage in these patients may be caused by the virus directly infecting liver cells, so more attention should be paid to the liver function status of COVID-19 patients. An observational, descriptive and cross-sectional study was carried out in patients diagnosed with COVID-19, belonging to two hospitals in the Ambato canton, from January to July 2021. A non-probabilistic sample of 125 patients was selected with the following criteria: no liver involvement, no treatment with hepatotoxic drugs. To identify possible mean differences between the levels of TGP, TGO, GGT and LDH determinations in patients with and without symptoms, the Student's t-test was used for independent samples. Subsequently, the binary logistic regression statistical test was performed with the Intro method. The Hosmer-Lemeshow goodness-of-fit test allowed us to evaluate the fit of the model. For all hypothesis tests, a significance level of 5% was used(AU)

Adaptation and Validation of the Authoritative School Climate Survey in a Sample of Chilean Adolescents.

Authoritative school climate is a relevant and novel construct that improves the academic performance and social-emotional development of students. This study aimed to evaluate the psychometric properties of reliability and validity of the Authoritative School Climate Survey (ASCS) in a sample of Chilean adolescents. A cross-sectional study was carried out, in which 808 students from 12 schools in Chile participated (55.1% men and 44.9% women), with a mean age of 15.94 (SD = 1.32). The results obtained through exploratory and confirmatory factor analyzes ratified the hypothesized structure of two correlated factors. As expected, evidence of criterion validity showed significant relationships between the measures of authoritative school climate and attitude toward institutional authority. This study provides evidence regarding the psychometric quality of the scale to assess authoritative school climate, allowing its use in the Chilean context.

Prevalencia del miedo a caer y factores asociados en personas mayores que viven en la comunidad / Prevalence of fear of falling and related factors in community-dwelling older people

OBJETIVO: El objetivo general del estudio es conocer la prevalencia de la preocupación a caer en personas mayores, independientes para la deambulación, que viven en la comunidad, según la versión reducida del FES-I y los factores asociados que influyen en esta preocupación. DISEÑO: Estudio descriptivo transversal. Emplazamiento: Centro de Salud El Greco (Getafe), Gerencia Asistencial de Atención Primaria de Madrid. PARTICIPANTES: Ciento ochenta y nueve pacientes ≥ 70 años independientes o con dependencia funcional leve-moderada (índice de Barthel ≥ 60) e independientes para la deambulación (camina 45 min sin ayuda o con bastón). El estudio se ofreció a 328 personas: 217 aceptaron y rechazaron 111. Mediciones principales: La variable dependiente, miedo a caerse (MC), fue evaluada mediante el cuestionario Short FES-I, considerando como punto de corte para el cribado positivo del MC una puntuación ≥ 11. Como variables independientes se consideraron: índice de Barthel, escala Downton, prueba de fragilidad Short Physical Performance Battery (SPPB), caídas en el último año, lesiones asociadas a las caídas, tiempo desde la última caída, déficit sensorial, uso de dispositivos de la marcha, comorbilidad y tratamiento farmacológico. RESULTADOS: La prevalencia del MC fue del 42,9% (IC 95%: 35,5-50,2). Los factores asociados al MC en el análisis multivariante final fueron: sexo femenino, vivir solo, alto riesgo de caídas, presencia de fragilidad, uso de hipotensores y lesiones asociadas a caídas previas. CONCLUSIONES: La prevalencia del miedo a caer en personas mayores es elevada. Los profesionales de atención primaria deben sistematizar el cribado de este problema de salud, priorizando especialmente en las personas que presentan los siguientes factores de riesgo: ser mujer, vivir solo, tener una puntuación baja en el SPPB (como indicador de fragilidad) o presentar un elevado riesgo de caídas

AIM: To know, in the population over 70, independent for walking, the prevalence of the concern to fall according to the short version of the Short Falls Efficacy Scale-International (FES-I) questionnaire, in old people living in the community and their associated factors. DESIGN: Cross-sectional study. LOCATION: Centro de Salud El Greco, Getafe, Madrid, Spain. PARTICIPANTS: 189 patients ≥ 70 years with a Barthel ≥ 60, independent for walking (walk 45minutes without help or with a cane). The study was offered to a total of 328 people, of these accepted 217 and rejected 111. MAIN MEASUREMENTS: The dependent variable, fear of falling (FOF), was evaluated by means of the short FES-I questionnaire, considering as a cut-off point for the positive screening of the MC a score ≥ 11. As independent variables we considered: Barthel index, Downton scale, the Short Physical Performance Battery (SPPB) fragility test, falls in the last year, injuries associated with falls, time since the last fall, sensory deficit, use of gait devices, comorbidity and pharmacological treatment. RESULTS: The prevalence of FOF was 42.9% (95% CI: 35.5-50.2). The factors associated with FOF in the final multivariate analysis were: female sex, living alone, high risk of falls, presence of frailty (SPPB ≤ 9), use of hypotensive drugs, and injuries associated with previous falls. CONCLUSIONS: The prevalence of FOF in older people is high. Primary Care professionals should systematize the screening of this health problem, prioritizing especially in people who present the following risk factors: being a woman, living alone, having a low score on the SPPB (as an indicator of frailty) or presenting a high risk of falls

[Prevalence of fear of falling and related factors in community-dwelling older people]. / Prevalencia del miedo a caer y factores asociados en personas mayores que viven en la comunidad.

AIM: To know, in the population over 70, independent for walking, the prevalence of the concern to fall according to the short version of the Short Falls Efficacy Scale-International (FES-I) questionnaire, in old people living in the community and their associated factors. DESIGN: Cross-sectional study. LOCATION: Centro de Salud El Greco, Getafe, Madrid, Spain. PARTICIPANTS: 189 patients ≥70years with a Barthel ≥60, independent for walking (walk 45minutes without help or with a cane). The study was offered to a total of 328 people, of these accepted 217 and rejected 111. MAIN MEASUREMENTS: The dependent variable, fear of falling (FOF), was evaluated by means of the short FES-I questionnaire, considering as a cut-off point for the positive screening of the MC a score ≥11. As independent variables we considered: Barthel index, Downton scale, the Short Physical Performance Battery (SPPB) fragility test, falls in the last year, injuries associated with falls, time since the last fall, sensory deficit, use of gait devices, comorbidity and pharmacological treatment. RESULTS: The prevalence of FOF was 42.9% (95%CI: 35.5-50.2). The factors associated with FOF in the final multivariate analysis were: female sex, living alone, high risk of falls, presence of frailty (SPPB≤9), use of hypotensive drugs, and injuries associated with previous falls. CONCLUSIONS: The prevalence of FOF in older people is high. Primary Care professionals should systematize the screening of this health problem, prioritizing especially in people who present the following risk factors: being a woman, living alone, having a low score on the SPPB (as an indicator of frailty) or presenting a high risk of falls.

Management of an Unsuccessful Regenerative Endodontic Procedure after Tooth Fracture: A Case Report.

Dental trauma is a very frequent occurrence in children and adolescents, which creates a great impact on the esthetics, functions, and phonetics. Traumatic dental injuries can range from simple enamel fractures to permanent tooth loss. This case report presents an eight-year-old patient with an uncomplicated crown fracture of tooth 21, and 30 days after trauma, it was diagnosed as necrotic pulp. The first treatment choice was a regenerative endodontic procedure (REP), however, the failure led to apexification with Mineral Trioxide Aggregate (MTA). The chosen rehabilitation was a composite veneer. Concerning the available literature and fracture enamel dentin, the treatment approach proposed for the case provided good functional and esthetic outcomes.

Contribution of Cyclooxygenase End Products and Oxidative Stress to Intrahepatic Endothelial Dysfunction in Early Non-Alcoholic Fatty Liver Disease.

INTRODUCTION: Metabolic syndrome induces endothelial dysfunction, a surrogate marker of cardiovascular disease. In parallel, metabolic syndrome is frequently associated with non-alcoholic fatty liver disease (NAFLD), which may progress to cirrhosis. The aim of the present study was to evaluate intrahepatic endothelial dysfunction related to cyclooxygenase end products and oxidative stress as possible mechanisms involved in the pathophysiology of NAFLD. MATERIALS AND METHODS: Sprague-Dawley rats were fed standard diet (control-diet, CD) or high-fat-diet (HFD) for 6 weeks. Metabolic syndrome was assessed by recording arterial pressure, lipids, glycemia and rat body weight. Splanchnic hemodynamics were measured, and endothelial dysfunction was evaluated using concentration-effect curves to acetylcholine. Response was assessed with either vehicle, L-NG-Nitroarginine (L-NNA), indomethacin, tempol, or a thromboxane receptor antagonist, SQ 29548. We quantified inflammation, fibrosis, oxidative stress, nitric oxide (NO) bioavailability and thromboxane B2 levels. RESULTS: HFD rats exhibited metabolic syndrome together with the presence of NAFLD. Compared to control-diet livers, HFD livers showed increased hepatic vascular resistance unrelated to inflammation or fibrosis, but with decreased NO activity and increased oxidative stress. Endothelial dysfunction was observed in HFD livers compared with CD rats and improved after cyclooxygenase inhibition or tempol pre-incubation. However, pre-incubation with SQ 29548 did not modify acetylcholine response. CONCLUSIONS: Our study provides evidence that endothelial dysfunction at an early stage of NAFLD is associated with reduced NO bioavailability together with increased cyclooxygenase end products and oxidative stress, which suggests that both pathways are involved in the pathophysiology and may be worth exploring as therapeutic targets to prevent progression of the disease.

Three exonic mutations in polycystic kidney disease-2 gene (PKD2) alter splicing of its pre-mRNA in a minigene system.

Exonic mutations are usually classified as missense, synonymous or nonsense mutations, however, they can affect pre-mRNA splicing either by disrupting splice sites, by creating new ones or by changing splicing regulatory sequences. In this study, we examined 21 mutations of the PKD2 gene, encoding polycystin-2, previously reported as missense or synonymous for their possible effects on pre-mRNA splicing using bioinformatics tools. All these mutations except one have been identified in patients with autosomal dominant polycystic kidney disease, a common genetic disorder characterized by the development and progressive enlargement of cysts in the kidneys leading to end-stage renal disease. We selected 12 missense mutations and 1 synonymous variant for the minigene assay, and found that three, c.1532A>T (p.D511V), c.1716G>A (p.K572K) and c.2657A>G (p.D886G) caused alterations in pre-mRNA splicing. Mutation c.1532A>T resulted in skipping of exon 6 and incorporation of a defective exon lacking the 3' end, while c.1716G>A led to skipping of exon 7. Mutation c.2657A>G resulted in incorporation of an incomplete exon 14, which is in agreement with previous results obtained with the patient's lymphoblast RNA. Our findings should be taken into account with regard to the pathogenicity of these PKD2 exonic mutations. These results together with previous reports highlight the importance to evaluate the effects of exonic single nucleotide substitutions in autosomal dominant polycystic kidney disease.

[Association of grip strength with gender age and handedness in 116 older people]. / Fuerza prensil de mano y su asociación con la edad, género y dominancia de extremidad superior en adultos mayores autovalentes insertos en la comunidad: Un estudio exploratorio.

BACKGROUND: Hand grip strength could be influenced by gender, age and handedness. AIM: To describe differences in grip strength for age, gender and upper extremity handedness in non-disabled community-dwelling older adults. MATERIAL AND METHODS: We studied 47 males aged 72.3 ± 5.6 years and 69 females 72.4 ± 6.0 years who were divided in two age groups (65-70 and ≥ 71 years old). Grip strength was determined by a standardized protocol using a hand dynamometer. RESULTS: There was an inverse correlation between grip strength and age in both hands only among men (p ≤ 0.05). When analyzing both genders, there was a significant inverse correlation between grip strength and age only in the dominant hand (p ≤ 0.05). Strength was higher in the dominant hand in both genders (p ≤ 0.05). It was also higher in men, compared to women in the two age groups studied (p ≤ 0.05). CONCLUSIONS: Grip strength is higher in men than women, it decreases with age and is higher in the dominant hand.

Fuerza prensil de mano y su asociación con la edad, género y dominancia de extremidad superior en adultos mayores autovalentes insertos en la comunidad: Un estudio exploratorio / Association of grip strength with gender age and handedness in 116 older people

Background: Hand grip strength could be influenced by gender, age and handedness. Aim: To describe differences in grip strength for age, gender and upper extremity handedness in non-disabled community-dwelling older adults. Material and Methods: We studied 47 males aged 72.3 ± 5.6 years and 69 females 72.4 ± 6.0 years who were divided in two age groups (65-70 and ≥ 71 years old). Grip strength was determined by a standardized protocol using a hand dynamometer. Results: There was an inverse correlation between grip strength and age in both hands only among men (p ≤ 0.05). When analyzing both genders, there was a significant inverse correlation between grip strength and age only in the dominant hand (p ≤ 0.05). Strength was higher in the dominant hand in both genders (p ≤ 0.05). It was also higher in men, compared to women in the two age groups studied (p ≤ 0.05). Conclusions: Grip strength is higher in men than women, it decreases with age and is higher in the dominant hand.

Splicing defects caused by exonic mutations in PKD1 as a new mechanism of pathogenesis in autosomal dominant polycystic kidney disease.

The correct splicing of precursor-mRNA depends on the actual splice sites plus exonic and intronic regulatory elements recognized by the splicing machinery. Surprisingly, an increasing number of examples reveal that exonic mutations disrupt the binding of splicing factors to these sequences or generate new splice sites or regulatory elements, causing disease. This contradicts the general assumption that missense mutations disrupt protein function and that synonymous mutations are merely polymorphisms. Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited disorder caused mainly by mutations in the PKD1 gene. Recently, we analyzed a substantial number of PKD1 missense or synonymous mutations to further characterize their consequences on pre-mRNA splicing. Our results showed that one missense and 2 synonymous mutations induce significant defects in pre-mRNA splicing. Thus, it appears that aberrant splicing as a result of exonic mutations is a previously unrecognized cause of ADPKD.

Defective pre-mRNA splicing in PKD1 due to presumed missense and synonymous mutations causing autosomal dominant polycystic disease.

Autosomal dominant polycystic kidney disease is the most common human monogenic disorder and is caused by mutations in the PKD1 or PKD2 genes. Most patients with the disease present mutations in PKD1, and a considerable number of these alterations are single base substitutions within the coding sequence that are usually predicted to lead to missense or synonymous mutations. There is growing evidence that some of these mutations can be detrimental by affecting the pre-mRNA splicing process. The aim of our study was to test PKD1 mutations, described as missense or synonymous in the literature or databases, for their effects on exon inclusion. Bioinformatics tools were used to select mutations with a potential effect on pre-mRNA splicing. Mutations were experimentally tested using minigene assays. Exons and adjacent intronic sequences were PCR-amplified and cloned in the splicing reporter minigene, and selected mutations were introduced by site-directed mutagenesis. Minigenes were transfected into kidney derived cell lines. RNA from cultured cells was analyzed by RT-PCR and DNA sequencing. Analysis of thirty-three PKD1 exonic mutations revealed three mutations that induce splicing defects. The substitution c.11156G>A, previously predicted as missense mutation p.R3719Q, abolished the donor splice site of intron 38 and resulted in the incorporation of exon 38 with 117bp of intron 38 and skipping of exon 39. Two synonymous variants, c.327A>T (p.G109G) and c.11257C>A (p.R3753R), generated strong donor splice sites within exons 3 and 39 respectively, resulting in incorporation of incomplete exons. These three nucleotide substitutions represent the first PKD1 exonic mutations that induce aberrant mRNAs. Our results strengthen the importance to evaluate the consequences of presumed missense and synonymous mutations at the mRNA level.

Enfermería en Atención Primaria: nuestra responsabilidad con la población (experiencia del área 9) / Nursing in Primary Health Care: our responsability with the population (Experience of area 9)

La incorporación de distintos profesionales en los equipos de Atención Primaria de salud en España hace necesaria la definición de la aportación específica de cada uno en la mejora de los servicios a la población. Esta definición en enfermería no ha sido homogénea, encontrándonos distintas situaciones dependiendo del equipo o área de salud. En el área 9 de Atención Primaria de Madrid se inició una experiencia de Gestión por procesos como forma de conseguir la mejora en los servicios ofrecidos por las enfermeras. Tras una autoevaluación se definió la misión, visión y valores de la organización para enfermería. Posteriormente, y compatible con la cartera de servicios del INSALUD, se ha elaborado un listado de procesos/responsabilidades de enfermería agrupados en 4 niveles de intervención: procedimientos técnicos básicos, conductas generadoras de salud/actividades preventivas, promoción del autocuidado y seguimiento y control de problemas de afrontamiento y adaptación. Estos niveles de intervención y procesos de enfermería se relacionan, mediante un esquema, con los servicios del EAP y con las clasificaciones NANDA, NIC y NOC de diagnósticos, intervenciones y resultados de enfermería. Para el conjunto de procesos se han establecido unos diagramas de flujo que muestran las relaciones entre cada uno de los distintos niveles de intervención. Además cada proceso tiene definidos sus criterios de inclusión, lo que permite la medición. El modelo propuesto permite definir la responsabilidad propia de enfermería, desarrollar un sistema de medición del desempeño, lo que redunda en una mejor rentabilidad para el conjunto de la organización. Para su puesta en marcha es necesario el esfuerzo de médicos, directivos, universidades y de las propias enfermeras y enfermeros

Características sociofamiliares y morbilidad materno-infantil del embarazo en adolescentes / Pregnancy in adolescents. Social familial characteristics and child maternal morbidity

Introducción. Las consecuencias del embarazo en adolescentes abarcan aspectos maternos y fetales físicos, además de psicosociales que interfieren en la madurez y aceptación sociofamiliar de la madre y en la salud del producto. En este estudio se presentan las características sociales, la actitud materna y la morbilidad materno-infantil de un grupo de madres menores de 18 años. Material y métodos. Se aplicó una encuesta descriptiva a 499 madres adolescentes de 12 a 18 años de edad, en relación con los factores psicosociales que condicionan el embarazo y la morbilidad materno-infantil. Esta encuesta fue diseñada por un grupo multidisciplinario en la atención integral del adolescente y constó de: ficha de identificación, 10 reactivos sobre características sociofamiliares y 9 sobre el seguimiento médico de la madre y el producto. Aplicándose en el último trimestre del embarazo y durante el puerperio inmediato. Los reactivos sobre salud materno-fetal fueron llenados por el obstetra y el pediatra que atendieron a la madre y al recién nacido. Resultados. Entre los hallazgos encontrados se mencionan: madres solteras 29 por ciento, en unión libre 48 por ciento y con matrimonio civil 27 por ciento. Fracaso escolar antes del embarazo en 74 por ciento de ellas, con ingresos económicos menores al salario mínimo en 77 por ciento. Un 25 por ciento de las embarazadas tuvieron control médico prenatal insuficiente, que se correlacionó con 25 por ciento de morbilidad materna relacionada con el embarazo y 19 por ciento de patología de feto y del recién nacido. Las enfermedades maternas más frecuentes fueron las infecciones cervicovaginales, caries dentales e infecciones de vías urinarias. En el recién nacido las enfermedades más comunes fueron: hipoxia perinatal, prematurez y desnutrición en útero. Conclusión. El embarazo en adolescentes y acciones educativas y previativas para disminuir la frecuencia de relaciones coitales desprotegidas, que dan como resultado embarazos no deseados y enfermedades de transmisión sexual

La salud de los estudiantes adolescentes: resultados de una encuesta / The health in student teenagers: test results

Con el objeto de conocer la problemática de salud de la población adolescente de las instituciones escolares de una Delegación de la Ciudad de México, se realizó una encuesta a 3,909 estudiantes de nivel medio y medio superior. La edad varió entre 11 y 22 años, 53 por ciento fueron del sexo femenino y 47 por ciento del masculino. Las principales causas de consulta médica fueron: infecciones respiratorias agudas, problemas psicológicos, cefaleas, trastornos de la dinámica familiar y síndrome diarreico

Evaluación técnico asministrativa de la Maternidad Concepción Palacios año 1990 / Administrative technique evaluation of the Maternidad Concepción Palacios year 1990

Nuestra labor fue la de aproximarnos al diagnóstico de una Institutción tan compleja como la Maternidad Concepción Palacios.La tarea fue ardua y ameritó el esfuerzo de todos para desmembrar la esencia de los problemas institucionales existentes que entorpecen la prestación de un mejor servicio a un mejor costo. En este trabajo presentamos la evaluación técnico-administrativa de la Maternidad Concepción Palacios; haciendo análisis y proponiendo soluciones creemos que podemos aproximarnos a llenar las expectativas de quienes con los brazos abiertos nos recibieron en esa casa de nacimiento de gran número de venezolanos