Surgical experience in cardiac myxomas at a tertiary hospital / Experiencia quirúrgica en mixomas cardiacos en un hospital de tercer nivel

Introduction Cardiac myxomas account for 50% of all benign cardiac tumors. Their clinical presentation varies from embolisms to fever. Our objective was to describe the surgical experience in the resection of cardiac myxomas during an 8-year period.MethodsThis is a retrospective, descriptive study of a series of cases with cardiac myxomas diagnosed from 2014 to 2022 at a tertiary care center. Descriptive statistics were used to define the populational and surgical characteristics. We used Pearson’s correlation to study the relationship between postoperative complications and age, tumor size and affected cardiac chamber.Results31 patients were included, with a predominance of females (1:2 ratio). The prevalence was 0.44%, which was calculated based on the number of cardiac surgeries performed in our unit over the 8-year period. The main clinical manifestation was dyspnea (85%, n = 23), followed by cerebrovascular event (CVE) (18%, n = 5). Atriotomy and resection of the pedicle were performed with preservation of the interatrial septum. Mortality was 3.2%. The postoperative evolution was uneventful in 77%. Tumor recurrence occurred in 2 patients (7%), both debuting with embolic phenomena. No association was observed between postoperative complications or recurrence and tumor size, nor aortic clamping and extracorporeal circulation times with regard to age.ConclusionsFour atrial myxoma resections are performed in our unit per year, with an estimated prevalence of 0.44%. The tumor characteristics described coincide with the previous literature. A relationship between embolisms and recurrences cannot be ruled out. Wide surgical resection of the pedicle and base of tumor implantation may influence tumor recurrence, although further studies are needed. (AU)

Introducción Los mixomas cardíacos representan el 50% de los tumores cardíacos benignos. La presentación clínica varía desde embolismos hasta fiebre. El objetivo fue describir la experiencia quirúrgica en la resección de mixomas cardíacos durante 8 años.MétodosEstudio retrospectivo, descriptivo, de serie de casos de mixomas cardíacos diagnosticados entre 2014 y 2022 en un centro de tercer nivel. Se utilizó estadística descriptiva para definir las características poblacionales y quirúrgicas. Mediante la correlación de Pearson se estudió la relación entre las complicaciones postoperatorias y la edad, el tamaño del tumor y la cavidad cardiaca afectada.ResultadosSe incluyeron 31 pacientes, predominantemente mujeres (1:2). La prevalencia fue 0.44%, calculada en base a las cirugías cardíacas realizadas en nuestra unidad durante 8 años. La principal manifestación fue disnea (85%, n = 23), seguida de EVC (18%, n = 5). Se realizó atriotomía y resección del pedículo con preservación del tabique interauricular. La mortalidad fue del 3.2%. La evolución posquirúrgica fue adecuada en el 77%. La recidiva ocurrió en 2 pacientes (7%), debutando ambos con embolismos. No se observó asociación entre las complicaciones postoperatorias o recurrencia y el tamaño tumoral; ni en pinzamiento aórtico y los tiempos de circulación extracorpórea con respecto a la edad.ConclusionesEn nuestra unidad se realizan cuatro resecciones de mixoma auricular anuales (prevalencia de 0.44%). Las características tumorales descritas coinciden con la literatura previa. No se descarta relación entre embolismos y recurrencias. La resección amplia del pedículo y base del tumor puede influir en la recurrencia tumoral, aunque, se requieren más estudios. (AU)

Surgical experience in cardiac myxomas at a tertiary hospital.

INTRODUCTION: Cardiac myxomas account for 50% of all benign cardiac tumors. Their clinical presentation varies from embolisms to fever. Our objective was to describe the surgical experience in the resection of cardiac myxomas during an 8-year period. METHODS: This is a retrospective, descriptive study of a series of cases with cardiac myxomas diagnosed from 2014 to 2022 at a tertiary care center. Descriptive statistics were used to define the populational and surgical characteristics. We used Pearson's correlation to study the relationship between postoperative complications and age, tumor size and affected cardiac chamber. RESULTS: 31 patients were included, with a predominance of females (1:2 ratio). The prevalence was 0.44%, which was calculated based on the number of cardiac surgeries performed in our unit over the 8-year period. The main clinical manifestation was dyspnea (85%, n = 23), followed by cerebrovascular event (CVE) (18%, n = 5). Atriotomy and resection of the pedicle were performed with preservation of the interatrial septum. Mortality was 3.2%. The postoperative evolution was uneventful in 77%. Tumor recurrence occurred in 2 patients (7%), both debuting with embolic phenomena. No association was observed between postoperative complications or recurrence and tumor size, nor aortic clamping and extracorporeal circulation times with regard to age. CONCLUSIONS: Four atrial myxoma resections are performed in our unit per year, with an estimated prevalence of 0.44%. The tumor characteristics described coincide with the previous literature. A relationship between embolisms and recurrences cannot be ruled out. Wide surgical resection of the pedicle and base of tumor implantation may influence tumor recurrence, although further studies are needed.

Rol de la Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes en la Estrategia Nacional de Vacunación contra la COVID-19 en Uruguay: período noviembre 2020 - julio 2021 / Role of the Honorary Commission for the Fight against Tuberculosis and Prevalent Diseases (CHLA-EP) in the National Vaccination Strategy against COVID-19 in Uruguay: november 2020 - July 2021 / Papel da Comissão Honorária de Luta contra a Tuberculose e Doenças Prevalentes (CHLA-EP) na Estratégia Nacional de Vacinação contra a COVID-19 no Uruguai: período de novembro de 2020 a julho de 2021

La pandemia por la infección por el nuevo coronavirus SARS-CoV-2 determinó que en Uruguay a inicio de marzo de 2020 el gobierno diseñara el Plan Nacional de Contingencia para la enfermedad COVID-19 causada por este virus. Este plan incluyó medidas preventivas no farmacológicas como: higiene de manos, distanciamiento físico, uso de mascarilla de diferentes tipos de acuerdo al riesgo de quien debía utilizarlos, en algunos períodos restricciones varias sobre circulación de personas, actividades educativas o espectáculos públicos, y tránsitos por tierra, aire o mar. Se apeló fuertemente a la libertad responsable. A partir de diciembre 2020 se decidió incorporar a la prevención primaria una Estrategia de Vacunación. El 1/3/2021 se inició la Campaña Vacunación COVID-19 2021, que fue no obligatoria, poblacional, inicialmente para personas mayores de 18 años y a partir de junio incluyó adolescentes entre 12 y 17 años y mujeres embarazadas. El Grupo Asesor Científico Honorario (GACH) del Gobierno Nacional junto a la Comisión Nacional Asesora de Vacunas (CNAV) del Ministerio de Salud Pública (MSP) que cuenta con largos años de aconsejar a las autoridades sanitarias en decisiones científicas sobre la introducción de vacunas, y una Comisión ad Hoc creada para vacunas COVID-19 reunieron a expertos del país para asesorar sobre la estrategia de vacunación. La Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes (CHLA-EP) como brazo operativo del Departamento de Inmunizaciones del MSP estuvo desde el mes de diciembre involucrada con todos los actores para implementar la Campaña de Vacunación poblacional COVID-19 sin descuidar las tareas que le competen en la vacunación para prevenir otras enfermedades infecciosas. Metodología: se realizó un estudio descriptivo, retrospectivo de las estrategias implementadas por el Dpto. Operativo de Inmunizaciones (brazo operativo del Departamento de Inmunizaciones del MSP), Laboratorio A. Calmette, Comisión Honoraria, Coordinación General y los departamentos administrativos: entre los meses de noviembre de 2020 a julio de 2021. Fuente de datos: informes difundidos o aportados especialmente para este trabajo por el Dpto. Operativo de Inmunizaciones, Laboratorio A. Calmette, Dpto. de Inmunizaciones del Ministerio de Salud Pública, Recursos Humanos, Recursos Materiales, Servicio de Apoyo, Comunicación y Diseño, Centros Periféricos, Dirección Ejecutiva y Secretaría General. Resultados: se muestran los resultados de 4 períodos: 1) planificación (noviembre-diciembre 2020); 2) capacitación, contratación de recursos humanos y asesoramiento para la adquisición de recursos materiales (enero-febrero 2021); 3) apertura de centros (hubs), puestos de vacunación COVID-19 y puesta en marcha de la Campaña COVID-19 (marzo 2021); 4) superposición campaña antigripal 2021 (abril-junio 2021) y mantenimiento coberturas de las vacunas del (PNI) 1. Planificación: se tomaron en cuenta las características de las vacunas que se recibirían vacunas a virus muertos, vacunas vectoriales y en particular la RNAm con requerimiento de almacenamiento a -70ºC, traslado y distribución a -25ºC, y reconstitución y uso a +28ºC en los diferentes escenarios. Se realizó análisis de riesgo y análisis de costo. Se intercambió con diferentes empresas que brindan dicho servicio, participando de actividades de capacitación con alguna de ellas, fundamentales a la hora de diseñar una cadena de frío sólida y sin fallas (por ejemplo actividad de entrenamiento con Vac-Q-tec). Se diseñó el traslado de las vacunas hacia los hubs, vacunatorios terciarios o centros periféricos de vacunación. Teniendo en cuenta el sitio de llegada de las vacunas, se plantearon los diferentes escenarios posibles, no solo a nivel central (Montevideo-Aeropuerto Internacional de Carrasco), sino también a nivel nacional utilizando las diferentes terminales aéreas. Así también se planificaron estrategias de distribución de las vacunas por vía terrestre involucrando diferentes actores (públicos o privados), basados en la experiencia de la institución debido al cotidiano trabajo que realizan, tanto en campaña de vacunación como en el mantenimiento del PNI. Se realizó la previsión de compras de insumos para el almacenamiento y distribución de la vacuna, como para la vacunación en sí. Se trabajó en conjunto con Departamento de Compras de Ministerio de Economía y Dirección de Secretaria del MSP. Se participó en la conformación de equipos de vacunación con la consigna de vacunación rápida, universal, gratuita y segura. Se estableciendo roles por equipo de vacunación constituidos por 6 personas. 2. Capacitación, contratación de recursos humanos y asesoramiento para la adquisición de recursos materiales. Se confeccionaron cursos y materiales en calidad y cantidad para que el personal adquiriera conocimientos actualizado sobre SARS-CoV-2 y COVID-19, mecanismos de transmisión, utilización y planificación de uso de equipos de protección personal (EPP) y seguimiento detallado de las vacunas en desarrollo. Análisis minucioso de los posibles candidatos a llegar a Uruguay, focalizándose en tres de ellos (Pfizer BioNtech, CoronaVac, Oxford AZ). Se realizó capacitación por roles (vacunadores, preparadores, administradores, referente de puesto, backup). Especial énfasis tuvo la capacitación en el cuidado de la persona a vacunar, registro del acto vacunal, cadena de frío en todos sus puntos, descarte de materiales utilizados y llenado de planillas de fiscalización. Todos los contenidos y materiales quedaron disponibles en la página web de la institución. Recursos humanos: se destinaron funcionarios para la confección, firma y papeleo de altas de 1.463 nuevos contratos de los equipos de todo el país, RRHH dedicados no sólo a la vacunación en sí, sino a participar activamente en cada uno de los puestos de vacunación. Esto significó que el trabajo se multiplicó por seis para las tareas requeridas durante este período. El Dpto. Recursos Materiales pasó de empaquetar y distribuir de 7 a 15 paquetes a 80 paquetes mensuales para cada centro periférico/vacunatorio. El envío habitual de materiales se cuadruplicó y en los comienzos de la campaña se llegó a quintuplicar y sextuplicar. Algunas de las cifras a destacar son: 3.300.000 jeringas con aguja, 8.800 Litros de alcohol eucaliptado, 852.000 guantes de látex y nitrilo y 141.000 sobreáticos. 3. Apertura de centros (hubs), puestos de vacunación COVID-19 y puesta en marcha de la Campaña COVID-19. Esto generó en forma progresiva la habilitación de centros (hubs) de máxima respuesta (vacunación masiva): ocho en Montevideo, uno en Canelones y uno en Maldonado. Dado que se decidió vacunar de 3 a 5 personas cada 15 minutos, en el hub del Hospital de Clínicas se administaron 211.153 dosis en sus 32 puestos de vacunación y en el hub Antel Arena se administraron 615.637 dosis en sus 15 puestos de vacunación. Al 31 de julio habían 144 puestos de vacunación COVID 19 habilitados en todo el territorio Nacional. La distribución se realizó a nivel nacional: 3.229. 320 dosis de vacuna Sinovac, 97.790 dosis de vacunas AstraZeneca y 1.585452 de vacuna Pfizer. Se participó en la conformación de 60 equipos con un referente (identificación, registro, control), preparador, 2 vacunadores y chofer para la vacunación en los Establecimientos de Larga Estadía de Personas Mayores (ELEPEM) y personas con situaciones especiales. Se participó activamente en la vacunación en ELEPEM, refugios y escuelas especiales, visitándose un total de 1679 Instituciones y se vacunaron 35.006 personas. 4. Superposición campaña antigripal 2021 (abril-junio 2021) y mantenimiento coberturas de las vacunas del (PNI). A partir del 24/04/2021 comenzó la Campaña Antigripal 2021, superponiéndose a la campaña descripta de COVID-19, lo que implicó reforzar las estrategias y ampliar las acciones para poder cumplir con ambas campaña paralelamente, siempre con el objetivo de no desatender el Programa Nacional de Inmunizaciones. Dentro de ésta se llevó a cabo la vacunación en los ELEPEM, como anualmente realiza la comisión y vacunación en territorio de vacunas COVID-19, antigripal y del PNI. Según los datos recibidos al 17 de Julio en el informe de la Unidad de Inmunizaciones del MSP (semana 12), fueron 605.802 dosis registradas, de las cuales al menos 87.802 dosis fueron administradas por la institución. Esta diferencia en relación a las campañas anteriores podría ser atribuida al intenso trabajo realizado en la estrategia de vacunación COVID-19. En el marco de la actividad interinstitucional barrio a barrio las personas vacunadas con vacuna antigripal en el móvil de la CHLA-EP en Montevideo fueron 7.225. La CHLA-EP ha contribuido desde la logística y la vacunación con esquema de dos dosis para las tres plataformas y una dosis de refuerzo para los que recibieron vacunas a virus muertos. La CHLA-EP ha contribuido para alcanzar las cifras de la Campaña de Vacunación COVID-19 entre el 1/3 y el 29/8/21: 5.487.181 dosis aplicadas, 2.65.269 personas que recibieron una dosis de vacuna y de ellas 2.496.290 tienen dos dosis y han recibido dosis de refuerzo 333.662. Conclusiones: la planificación, capacitación, provisión de recursos humanos y materiales lograron llevar a cabo dos campañas de vacunación coexistentes en hubs, vacunatorios, ELEPEM y en territorio que se han considerado exitosas e históricas.

The new Coronavirus SARS CoV-2 pandemic was declared at the beginning of March 2020 when the Uruguayan government appointed the National Contingency Plan for the COVID-19 disease caused by this virus. This plan included non-pharmacological preventive measures such as: hand hygiene, physical distancing, use of different types of masks according to the risk of who should wear them, in some periods, restrictions to mobility, educational activities or public shows, and movement by land, air or sea. Responsible freedom was strongly called for. In December 2020, the Vaccination Strategy was included as a primary prevention mechanism. On 3/1/2021, the COVID-19 2021 Vaccination Campaign began, it was non-mandatory, population-based, initially for people over 19 years of age, and for adolescents between 12 and 17 years of age and pregnant women since June. The National Honorary Scientific Advisory Group (GACH) together with the National Vaccine Advisory Committee (CNAV) of the Ministry of Public Health (MSP) that has vast experience in advising health authorities in scientific decisions on the introduction of vaccines, and an ad-Hoc Commission created for COVID-19 vaccines, brought together experts to advise on the vaccination strategy. The Honorary Commission for the Fight Against Tuberculosis and Prevalent Diseases (CHLA-EP), as the operational branch of the MSP's Department of Immunizations, has participated with all stakeholders since December to implement the COVID-19 Population Vaccination Campaign without neglecting their tasks regarding the vaccination to prevent other infectious diseases. Methodology: a descriptive, retrospective study was carried out regarding the strategies implemented by the Immunization Operational Department (operational branch of the Ministry of Health's Immunization Department), A. Calmette Laboratory, Honorary Commission, General Coordination and Administrative Departments between November, 2020 and July 2021. Data source: reports were issued or provided specially for this work by the Immunization Operational Department, A. Calmette Laboratory, by the Ministry of Public Health's immunization Department, Human Resources, Material Resources, Support, Communication and Design Service, Peripheral Centers, Executive Board and General secretariat. Results: the results of the 4 periods are as follows: 1- Planning (Period November - December 2020), 2- Training, hiring of human resources and advice for the acquisition of qualitative and quantitative material resources (January - February 2021), 3- Opening of COVID-19 vaccination centers (Hubs), posts and launch of the COVID-19 Campaign (March 2021), 4- Overlap of the 2021 flu campaign (April-June) and maintenance of vaccine coverage (National Immunization Programme - PNI). 1- Planning: The characteristics of the different vaccines (dead virus vaccines, vector vaccines and in particular mRNA vaccines, with storage requirements of -70ºC, transfer and distribution requirements of -25ºC, and reconstitution and use of +2 + 8ºC) were taken into account in the different scenarios. Risk and costs analysis were performed. We interchanged data with different companies that provided this service, we participated in training activities with some of them, mainly in the design of a solid cold chain without failures (e.g. a Vac-Q-tec training activity). The transfer of vaccines to hubs, tertiary vaccination centers or peripheral vaccination centers was designed. The different destination site of the vaccines, the different possible scenarios were taken into account, both at local central level (Montevideo - Carrasco International Airport), but also at National level using the different air terminals. Similarly, strategies for the distribution of vaccines by land were planned involving different public or private actors based on the institutions' experience, both regarding the vaccination campaign and in the PNI maintenance. We made a supply acquisition plan for the vaccine's storage and distribution, for the vaccination itself, and for the purchase of supplies jointly with the Procurement Department of the Ministry of Economy and Executive Secretariat of the MSP. Six-people vaccination teams were created with clear roles and with the slogan of rapid, universal, free and safe vaccination for all. 2- Training: Courses and materials were organized for the staff to acquire updated knowledge about SARS CoV 2 and COVID-19, transmission mechanisms, use and planning of use of personal protective equipment (PPE) and of course, a detailed monitoring of the vaccines being developed. We carried out a thorough analysis of the vaccine companies to arrive in Uruguay, we focused on 3 of them (Pfizer BioNtech, CoronaVac, Oxford AZ). Training was carried out by roles (vaccinators, preppers, administrators, position referents, backups). Special emphasis was placed on the training of the care of the person to be vaccinated, registration of the vaccination act, end-to-end cold chain, disposal of used materials and filing out inspection forms. All the contents and materials were available on the Institution's webpage. Human resources: human resources were allocated for the creation, signature and registration of the paperwork for 1,463 new contracts for teams across the country. These resources were allocated not only to vaccination itself, but also to actively participate in each of the vaccination posts. This meant that the work was multiplied by 6 for the tasks required during this period. The Department of Material Resources, went from packaging and distributing from 7 to 15 packages a month to 80 packages a month for each Peripheral/Vaccination Center. Material shipment quadrupled at the beginning of the campaign and it eventually grew by five and sixfold. Some of the key figures to highlight are: 3, 300,000 needle syringes, 8,800 liters of Eucalyptus Alcohol, 852,000 latex and nitrile gloves and 141,000 isolation gowns. 3. COVID-19 Vaccination Hubs, Posts and Campaigns. We gradually opened maximum response mass vaccination Hubs in Montevideo (8), Canelones (1) and Maldonado (1). Since it was had been decided to vaccinate 3 to 5 people every 15 minutes, the primary results at the Hospital de Clínicas Hub were 211,153 doses administered in 32 vaccination posts, and at Antel Arena Hub 615,637 doses were administered in its 15 vaccination posts. As of July 31, there were 144 COVID 19 vaccination posts throughout the national territory. The distribution was made nationwide: 3,229,320 Sinovac vaccine doses, 97,790 Oxford-Astra Zeneca vaccine doses, and 1,585,452 Pfizer-BioNtech vaccine doses. We devised 60 teams including a referent (identification, registration, control), a trainer, 2 vaccinators and vaccination driver for Homes for the Elderly at ELEPEM and people needing special care. They actively participated in the vaccination at ELEPEM, Shelters and Schools for Children with Special Needs and visited a total of 1679 Institutions and overall, 35,006 people were vaccinated. 4- Overlap of the 2021 flu campaign (April-June) and the maintenance of the COVID vaccine coverage (National Immunization Programme - PNI). Since 04/24/2021, the Anti-Flu Campaign began, and it overlapped the COVID-19 campaign described above, which meant reinforcing strategies and expanding actions to be able to carry out both campaigns simultaneously, always with the objective of maintaining the National Immunization Program. Vaccination was carried out at the ELEPEM, as it is performed annually by the commission and vaccination of COVID-19, influenza and PNI was performed on the territory. According to the data received on July 17 in the Ministry of Public Health Immunization Unit Report (week 12), there were 605,802 registered doses, of which at least 87,802 had been administered by the Institution. This difference regarding previous campaigns could have been caused by the intense work carried out during the COVID19 Vaccination Campaign. Within the framework of the inter-institutional activity "Barrio a Barrio" (Vaccination in all Neighborhoods), 7,225 people were vaccinated with the influenza vaccine at the CHLA-EP mobile vaccination bus in Montevideo. The CHLA-EP has contributed with logistics and vaccination with a 2-dose schedule for the 3 platforms and a booster dose for those who received virus vaccines. The CHLA-EP has contributed to achieving the target of the COVID-19 Vaccination Campaign between 1/3 and 8/29/21: 5,487,181 doses were applied, 2,065,269 people received 1 dose of vaccine and 2,496,290 of them received 2 doses and 333,662 have received booster doses. Conclusion: the planning, training, provision of human and material resources has enabled us to successfully carry out two historical simultaneous vaccination campaigns in hubs, vaccination centers, ELEPEM and all along the territory.

A pandemia causada pela infecção pelo novo Coronavírus SARS CoV-2 determinou que no Uruguai no início de março de 2020 o governo elaborasse o Plano Nacional de Contingência para a doença COVID-19 causada por este vírus. Este plano incluía medidas preventivas não farmacológicas como: higiene das mãos, distanciamento físico, uso de diferentes tipos de máscaras dependendo do risco de quem as deve usar, em alguns períodos várias restrições à circulação de pessoas, atividades educativas ou espetáculos públicos e a trânsito por terra, ar ou mar). Foi feito um forte apelo à liberdade responsável. A partir de dezembro de 2020, decidiu-se incorporar uma Estratégia de Vacinação à prevenção primária. Em 01/03/2021 teve início a Campanha de Vacinação COVID-19 2021, não obrigatória, de base populacional, inicialmente para maiores de 18 anos e a partir de junho contempla adolescentes entre 12 e 17 anos e gestantes. O Grupo Honorário de Assessoramento Científico do Governo Nacional juntamente com a Comissão Nacional de Assessoramento de Vacinas (CNAV) do Ministério da Saúde Pública (MSP), que assessora autoridades de saúde em decisões científicas sobre a introdução de vacinas, e uma Comissão ad hoc criada para vacinas contra a COVID-19 reuniu especialistas do país para aconselhar sobre a estratégia de vacinação. A Comissão Honorária de Luta contra a Tuberculose e Doenças Prevalentes (CHLA-EP) como braço operacional do Departamento de Vacinação do MSP envolveu-se desde dezembro com todos os intervenientes na implementação da Campanha de Vacinação da População COVID-19, aliás de realizar as tarefas de vacinação para prevenir outras doenças infecciosas. Metodologia: foi realizado um estudo descritivo e retrospectivo das estratégias implementadas pelo Departamento Operacional de Imunizações (braço operacional do Departamento de Imunizações do MSP), Laboratório A. Calmette, Comissão Honorária, Coordenação Geral e departamentos administrativos: entre os meses de novembro de 2020 a julho de 2021. Fonte de dados: relatórios divulgados ou oferecidos especialmente para este trabalho pelo Departamento Operacional de Imunizações, Laboratório A. Calmette, Departamento de Imunizações do Ministério da Saúde Pública, Recursos Humanos, Recursos Materiais, Serviço de Apoio, Comunicação e Design, Centros Periféricos, Direção Executiva e Secretaria Geral. Resultados: são apresentados os resultados de 4 períodos: 1- Planejamento (novembro - dezembro de 2020), 2- Capacitação, contratação de recursos humanos e assessoria para aquisição de recursos materiais em qualidade e quantidade (janeiro - fevereiro de 2021), 3- Abertura de centros (Hubs), postos de vacinação COVID-19 e implementação da Campanha COVID-19 (março 2021), 4- Sobreposição da campanha da gripe 2021 (abril-junho 2021) e manutenção da cobertura vacinal (PNI) 1- Planejamento: As características das vacinas a receber eram vacinas de vírus mortos, vacinas vetoriais e em particular mRNA com requisitos de armazenamento de temperaturas de -70ºC, transferência e distribuição de -25ºC, e reconstituição e uso de +2 +8ºC nos diferentes cenários. Análise de risco e análise de custo foram realizadas. Realizaram-se intercâmbios com diferentes empresas que prestam este serviço, participando em ações de formação com algumas delas, essenciais na criação de uma cadeia de frio sólida e sem falhas (ex. ação de formação com Vac-Q-tec). Foi projetada a transferência de vacinas para os hubs, centros de vacinação terciários ou periféricos. Tendo em conta o local de chegada das vacinas, foram considerados os diferentes cenários possíveis, não só a nível central (Montevidéu - Aeroporto Internacional de Carrasco), mas também a nível nacional utilizando os diferentes terminais aéreas. Da mesma forma, foram planejadas estratégias de distribuição de vacinas por via terrestre envolvendo diferentes atores (públicos ou privados), com base na experiência da instituição, tanto na campanha de vacinação quanto na manutenção do PNI. A previsão de compra de insumos foi feita tanto para o armazenamento e distribuição da vacina, quanto para a própria vacinação, como também na tomada de decisão na compra de insumos, atuando em conjunto com o Departamento de Compras do Ministério da Economia e Gestão Secretário do MSP. Eles participaram da formação de equipes de 6 pessoas com funções especificas de vacinação com o slogan de vacinação rápida, universal, gratuita e segura. 2- Capacitação, contratação de recursos humanos e assessoria para aquisição de recursos materiais em qualidade e quantidade. Foram organizados cursos e materiais para que os funcionários adquirissem conhecimento atualizado sobre SARS CoV2 e COVID-19, mecanismos de transmissão, uso e planejamento de uso de equipamentos de proteção individual (EPI) e também para o acompanhamento minucioso das vacinas em desenvolvimento. Fizemos a análise minuciosa das possíveis vacinas candidatas para chegar ao Uruguai, e focamos em 3 delas (Pfizer BioNtech, CoronaVac, Oxford AZ). O treinamento foi realizado por funções (vacinadores, treinadores, administradores, posição de referência, backup). Foi dado especial destaque à formação no cuidado da pessoa a vacinar, registo do ato vacinal, rede de frio em todos os seus pontos, eliminação de materiais utilizados e preenchimento de fichas de controlo. Todos os conteúdos e materiais foram disponibilizados na página web da Instituição. Recursos humanos: funcionários foram alocados para a preparação, assinatura e registro de 1.463 novos contratos para complementar as equipes em todo o país, estes recursos humanos estiveram dedicados não apenas à vacinação em si, mas a participar ativamente de cada um dos postos de vacinação. Isso significou que o trabalho se multiplicou por 6 para as tarefas exigidas durante esse período. O Departamento de Recursos Materiais, passou de embalar e distribuir de 7 para 15 embalagens por mês, passando para 80 embalagens para cada Periférico/Centro de Vacinação. A remessa habitual de materiais se quadruplicou e no início da campanha aumentou cinco e seis vezes. Alguns dos números a destacar são: 3.300.000 seringas com agulha, 8.800 litros de álcool de eucalipto, 852.000 luvas de látex e nitrílica e 141.000 túnicas. 3. Abertura de centros e postos de vacinação COVID-19 e lançamento da Campanha COVID-19. Isso gerou progressivamente o estabelecimento de centros de resposta máxima (Hubs) (vacinação em massa) 8 em Montevidéu, um em Canelones e um em Maldonado. Já que decidiu-se vacinar de 3 a 5 pessoas a cada 15 minutos, no Hub. O Hospital de Clínicas administrou 211.153 doses em seus 32 postos de vacinação e na Arena Hub Antel foram administradas 615.637 doses em seus 15 postos de vacinação. Até 31 de julho, havia 144 postos de vacinação contra a COVID 19 habilitados em todo o território nacional. A distribuição foi realizada, 3.229 foram distribuídos em todo o país, 320 doses de vacina Sinovac, 97.790 doses de vacinas AstraZeneca e 1.585452 de vacina Pfizer. Participaram no treinamento de 60 equipes de referência (identificação, registo, controle), treinador, 2 vacinadores e motorista para vacinação em estabelecimentos de longa permanência para idosos (ELEPEM) e pessoas com situações especiais em albergues e escolas especiais, visitando um total de 1.679 Instituições e vacinando a 35.006 pessoas. 4- Sobreposição da campanha de gripe de 2021 (abril a junho de 2021) e manutenção da cobertura vacinal (PNI). A partir de 24/04/2021 teve início a Campanha da Gripe 2021, sobrepondo-se à campanha COVID-19 descrita, o que implicou o reforço de estratégias e ampliação das ações para poder cumprir ambas campanhas em paralelo, sempre com o objetivo de não descurar o Programa Nacional de Imunizações. Foi realizada a vacinação no ELEPEM, conforme anualmente realizada pela comissão e a vacinação no território das vacinas COVID-19, influenza e PNI. De acordo com os dados recebidos até 17 de julho no relatório da Unidade de Imunizações dos Ministérios da Saúde Pública (semana 12), foram registradas 605.802 doses, das quais pelo menos 87.802 doses foram administradas pela Instituição. Essa diferença em relação às campanhas anteriores pode ser atribuída ao intenso trabalho realizado na estratégia de Vacinação COVID19. No âmbito da atividade interinstitucional Bairro a Bairro, 7.225 pessoas foram vacinadas com a vacina contra gripe no celular do CHLAEP de Montevidéu. O CHLA-EP tem contribuído desde a logística e vacinação com um esquema de 2 doses para as 3 plataformas e uma dose de reforço para quem recebeu vacinas de vírus mortos. O CHLA-EP contribuiu para atingir os números da Campanha de Vacinação COVID-19 entre 1/3 e 29/8/21: 5.487.181 doses aplicadas, 2.065.269 pessoas que receberam 1 dose de vacina e delas 2.496.290 têm 2 doses e 333.662 receberam doses de reforço. Conclusões: O planejamento, capacitação, disponibilização de recursos humanos e materiais permitiram a realização de duas campanhas de vacinação coexistentes nos hubs, vacinatórios, ELEPEM e no território, o que pode ser considerado um processo bem sucedido e histórico.

Programa educativo sobre sexualidad para adolescentes con cardiopatías congénitas en el Cardiocentro Pediátrico William Soler

Fundamento: las cardiopatías congénitas son malformaciones frecuentes y constituyen un problema de salud. Las personas con cardiopatías congénitas al llegar a la adolescencia muestran desconocimiento acerca de su sexualidad. El desconocimiento sobre estos temas promueve prácticas poco saludables y emociones negativas que afectan su bienestar. Objetivo: elaborar un programa educativo sobre sexualidad para adolescentes con cardiopatías congénitas que se atienden en el Cardiocentro Pediátrico William Soler de La Habana. Métodos: se realizó una investigación de tipo cualitativa que utiliza un paradigma dialéctico en el Cardiocentro Pediátrico William Soler durante el período del 2019 al 2021. Los instrumentos utilizados para la investigación fueron: observación, entrevista, grupo focal, análisis de documentos y registro de anécdotas. Se describió como categoría principal las necesidades educativas especiales sobre sexualidad, así como, aquellas dificultades en aspectos cognitivos, emocionales y psicosociales, que pueden tener las personas en su proceso de aprendizaje sobre la sexualidad con carácter temporal o duradero. Se utilizó la estadística descriptiva y el análisis de datos para profundizar en este fenómeno. Resultados: en los adolescentes estudiados se identificaron necesidades educativas especiales sobre sexualidad tales como: carencias de información, estereotipos y conocimientos limitados, dificultades para las relaciones personales y de pareja, afectaciones en los procesos autovalorativos, desconocimiento sobre género, salud sexual, cardiopatías congénitas, cambios en la adolescencia, anticoncepción y planificación familiar. Conclusiones: el programa propuesto constituye una herramienta para la modificación de conocimientos, actitudes y comportamientos hacia la sexualidad. Además, tiene la intención de contribuir al desarrollo de otras habilidades como la socialización, toma de decisiones y autonomía.

Background: congenital heart diseases are frequent malformations and constitute a health problem. People with congenital heart disease when they reach their adolescence show doubts about their sexuality. Ignorance about these issues promotes unhealthy practices and negative emotions that affect their well-being. Objective: to develop an educational program on sexuality for adolescents with congenital heart disease who are treated at the William Soler Pediatric Cardiocenter. Methods: a qualitative research was carried out using a dialectical paradigm at the William Soler Pediatric Cardiocenter during the period from 2019 to 2021. The used instruments in the research were: observation, interview, focus group, documents analysis and recording of anecdotes. Special educational needs on sexuality were described as the main category, as well as those difficulties in cognitive, emotional and psychosocial aspects that people may have in their learning process about sexuality on a temporary or lasting basis. Descriptive statistics and data analysis were used to delve into this phenomenon. Results: special educational needs on sexuality were identified in the adolescents studied, such as: lack of information, stereotypes and limited knowledge, difficulties in personal and couple relationships, affectations in self-assessment processes, lack of knowledge about gender, sexual health, congenital heart disease, changes in adolescence, contraception and family planning. Conclusions: the proposed program constitutes a tool for the knowledge modification, attitudes and behaviors towards sexuality. In addition, it is intended to contribute to the development of other skills such as socialization, decision-making and autonomy.

Demographic and Pathogens of Domestic, Free-Roaming Pets and the Implications for Wild Carnivores and Human Health in the San Luis Region of Costa Rica.

Habitat loss and degradation, restricted ranges, prey exploitation, and poaching are important factors for the decline of several wild carnivore populations and additional stress from infectious agents is an increasing concern. Given the rapid growth of human populations in some regions like Costa Rica, pathogens introduced, sustained, and transmitted by domestic carnivores may be particularly important. To better understand the significance of domestic carnivore pathogens for wildlife, we determine the prevalence of infection and possible mechanisms for contact between the two groups. The demographics, role in the household, and pathogens of pet dogs and cats was studied during three annual spay/neuter clinics in San Luis, Costa Rica. Most dogs were owned primarily as pets and guard animals, but ~10% were used for hunting. Cats were owned primarily as pets and for pest control. Both roamed freely outdoors. We detected high prevalences of some pathogens (e.g., carnivore protoparvovirus 1 and Toxoplasma gondii). Some pathogens are known to persist in the environment, which increases the probability of exposure to wild carnivores. This study demonstrated that domestic pets in San Luis, home to a number of protected and endangered wildlife species, are infected with pathogens to which these wild species are potentially susceptible. Additionally, results from our questionnaire support the potential for domestic and wild animal contact, which may result in disease spillover.

Abordaje integral de un caso crónico complejo a través de un equipo interdisciplinar en atención primaria / Integrated approach to a complex chronic case through an interdisciplinary team in primary care

Con este artículo se pretende ilustrar cuáles han sido los mecanismos de coordinación sociosanitaria con el caso práctico de un paciente de 65 años con obesidad, riesgo cardiovascular alto, hipertensión, enolismo, tabaquismo e ictus isquémicos silentes. Divorciado en dos ocasiones y con cinco hijos. Tras su última separación hace 8 años trasladó su residencia a casa de su padre. Mientras vivió su padre, su situación de salud se mantuvo estable y con seguimiento por parte de los profesionales del equipo de atención primaria. Recientemente fue derivado a la trabajadora social del centro de salud por situación de abandono en la higiene personal y de la vivienda. Fruto del trabajo interdisciplinar de la trabajadora social y la enfermera gestora de casos comunitaria se implementó un plan de actuación conjunto. El padre falleció hacía un año y desde entonces no se había vuelto a tener noticias del paciente en el centro de salud y tampoco constaba la retirada de medicación de la farmacia. La vivienda era propiedad por herencia del más pequeño de los cuatro hermanos, que había amenazado con expulsarlo. En la entrevista, el hermano aseguró que no se dejaba ayudar y que solo recibía visitas de uno de sus hijos de manera ocasional para obtener dinero. Se realizaron varias visitas en el domicilio por parte de los profesionales de atención primaria. El paciente se mostró colaborador y participativo a la hora de elaborar un plan conjunto con los profesionales implicados, lo que permitió activar la coordinación sociosanitaria para lograr un buen manejo de sus procesos crónicos

This article tends to illustrate the coordination mechanisms used through an example centred on a case study of a 65 year-old patient who presents obesity, hypertension, high cardiovascular risk, alcoholism, smoking and silent ischaemic strokes; divorced twice and with five children. After his last separation 8 years ago he moved to his father's house. While his father was still alive his health situation was stable and monitored by professionals of the primary care team. He was recently referred to the Social Worker at the Health Centre due to his lack of personal hygiene and housing. The interdisciplinary work of the Social Worker and Community Nurse Case Manager resulted in a shared action plan. His father died a year ago and since then there was no news of the patient in the health centre and also he did not collect his medication from the pharmacy. The house was owned by inheritance by the smallest of the four brothers, who had threatened to expel him. In the interview, the brother claimed that he didn't want to be helped and only received visits from one of his sons occasionally to receive money. Primary care professionals visited him several times at home. The patient was cooperative and engaged when preparing a joint plan with the professionals involved. This joint plan allowed to activate the care coordination for a successful management of his chronic conditions

[Integrated approach to a complex chronic case through an interdisciplinary team in primary care]. / Abordaje integral de un caso crónico complejo a través de un equipo interdisciplinar en atención primaria.

This article tends to illustrate the coordination mechanisms used through an example centred on a case study of a 65 year-old patient who presents obesity, hypertension, high cardiovascular risk, alcoholism, smoking and silent ischaemic strokes; divorced twice and with five children. After his last separation 8 years ago he moved to his father's house. While his father was still alive his health situation was stable and monitored by professionals of the primary care team. He was recently referred to the Social Worker at the Health Centre due to his lack of personal hygiene and housing. The interdisciplinary work of the Social Worker and Community Nurse Case Manager resulted in a shared action plan. His father died a year ago and since then there was no news of the patient in the health centre and also he did not collect his medication from the pharmacy. The house was owned by inheritance by the smallest of the four brothers, who had threatened to expel him. In the interview, the brother claimed that he didn't want to be helped and only received visits from one of his sons occasionally to receive money. Primary care professionals visited him several times at home. The patient was cooperative and engaged when preparing a joint plan with the professionals involved. This joint plan allowed to activate the care coordination for a successful management of his chronic conditions.

La violencia de género en la atención primaria / Gender violence in primary care

En este artículo presentamos la línea de investigación sobre violencia de género en mujeres atendidas en centros de atención primaria por parte de un equipo de profesionales que incluye médicos de familia, trabajadores sociales y personal de enfermería, y se orienta a la investigación-acción. Inicialmente, tras el contacto con mujeres residentes en casas de acogida y con sus hijos, se realizan estudios descriptivos sobre sus características y necesidades de salud, así como se evalúa la efectividad de las intervenciones orientadas a la mejora de la calidad y la adecuación de la atención que se les presta desde los centros de salud. La complejidad del problema y la tendencia a la intervención directiva y unidireccional de los profesionales sanitarios llevan a la necesidad de conocer la perspectiva de las mujeres, utilizando una metodología cualitativa (análisis de relatos biográficos grabados en audio, mediante teoría fundamentada) para responder preguntas de investigación, como los motivos para salir de la situación o permanecer en ella, la visión que de los agresores tienen las mujeres y la adecuación a modelos explicativos como el modelo de estadios de cambio. Como investigación en proyecto está el estudio con igual metodología,de la perspectiva de los hombres que han infligido violencia

In this assay, we present a line of research into gender violence against women as seen in primary care centers by a team of doctors, social workers and nurses who focus on a research-action approach. First, we contacted women and their children who were living in sheltered accommodation, and descriptive studies were made into their characteristics and health needs. In addition, the effectiveness of the actions designed to improve the quality and the adaptation of the attention in primary care centers for this population were evaluated. The complexity of the matter and the health professionals’ tendency to direct the interventions make it necessary to know the women’s views. Qualitative methodology was used (audio recordings were made of biographical narrations and analyzed by Grounded Theory) to answer the main research questions: reasons for leaving or remaining in the situation; the women’s view of their aggressors, and the adaptation to explanatory models, such as the Stages of Change Model. Another research project with the same methodology which focuses on the male aggressor’s view is currently being undertaken.

Linfoma MALT subglótico en un paciente con artritis reumatoide / Subglottic MALT lymphoma of the larynx in a patient with rheumatoid arthritis

No disponible

Self-aggregation of cationic dimeric surfactants in water-ionic liquid binary mixtures.

The micellization of four dimeric cationic surfactants ("gemini surfactants") derived from N-dodecyl-N,N,N-trimethylammonium chloride was studied in pure water and in water-ionic liquid (IL) solutions by a wide range of techniques. The dimeric surfactants are distinguished by their rigid spacer groups separating the two surfactant motifs, which range from C3 to C5 in length. In order to minimize organic ion pairing effects as well as the role of the ionic liquids as potential co-surfactants, ILs with inorganic hydrophilic anions and organic cations of limited hydrophobicity were chosen, namely ethyl, butyl, and hexyl-3-imidazolium chlorides. (1)H NMR two-dimensional, 2D, rotating frame nuclear Overhauser effect spectroscopy measurements, ROESY, supported this premise. The spacer nature hardly affects the micellization process, neither in water nor in water-IL solutions. However, it does influence the tendency of the dimeric surfactants to form elongated micelles when surfactant concentration increases. In order to have a better understanding of the ternary water-IL surfactant systems, the micellization of the surfactants was also studied in aqueous NaCl solutions, in water-ethylene glycol and in water-formamide binary mixtures. The combined results show that the ionic liquids play a double role in the mixed systems, operating simultaneously as background electrolytes and as polar organic solvents. The IL role as organic co-solvent becomes more dominant when its concentration increases, and when the IL alkyl chain length augments.

Binding of cationic single-chain and dimeric surfactants to bovine serum albumin.

The interactions between bovine serum albumin (BSA) and the single-chain surfactants N-benzyl-N,N-dimethyl-N-(1-dodecyl)ammonium bromide (PH12) and N-cyclohexylmethyl-N,N-dimethyl-N-(1-dodecyl)ammonium bromide (CH12) and their two dimeric counterparts, N,N'-[1,3-phenylenebis(methylene)]bis[N,N-dimethyl-N-(1-dodecyl)]ammonium dibromide (12PH12) and N,N'-[cyclohexane-1,3-diylbis(methylene)]bis[N,N-dimethyl-N-(1-dodecyl)]ammonium dibromide (12CH12), respectively, have been investigated by surface tension, fluorescence, circular dichroism, ζ potential, and atomic force microscopy. The results obtained permit the examination of the way an increase in the number of hydrophobic chains and the substitution of a cyclohexyl ring by a phenyl ring, either in the headgroup of single-chain surfactants or in the spacer of dimeric surfactants, affect BSA-surfactant interactions. The comparison of the fluorescence results with those obtained by ζ potential measurements shows that the sites of binding of the surfactants with aromatic rings to the BSA are somewhat different from those of the surfactants with no aromatic rings.

Resultado de un estudio de casos múltiples con niños ciegos de edad temprana de la provincia Ciego de Ávila / Result of a study of multiple cases with blind children of early age from Ciego de Avila province

El juego es la actividad más importante del niño, porque propicia la estimulación de diversos procesos y cualidades psíquicas, tales como: la discriminación perceptual, la concentración de la atención, la generalización de relaciones, el razonamiento, las destrezas motrices, la sensibilidad táctil activa, la actividad motora gruesa, los movimientos finos de la mano y la percepción de la forma, lo que permite conocer el objeto, sus particularidades y propiedades; elementos esenciales a desarrollar en los invidentes. Es por eso que en el proceso de estimulación se requiere tener en cuenta la concepción del desarrollo físico y psíquico de este; y las potencialidades para alcanzarlo, a partir de las vivencias personales y del juego. Los resultados que emergieron del estudio de caso realizado permitieron corroborar la factibilidad de la estimulación temprana para el desarrollo armónico de los recursos compensatorio de los niños ciegos. Se apreciaron elocuentes logros en el desarrollo físico y psíquico de los mismos, también se logró una transformación en el modo de pensar y actuar de los adultos relacionados con el proceso de estimulación, se tornó más enternecedora la relación afectiva del adulto con el niño ciego, del niño ciego con el adulto y del niño ciego con otros niños (AU)

Game is the most important activity of a boy, because causes the psychic stimulation of diverse processes and qualities, such as: perceptual discrimination, concentration of attention, generalization of relations, reasoning, motor skills, active tactile sensitivity, gross motor activity, fine movements of the hand and the perception of the form, what allows to know the object, its particularitities and properties; essential elements to develop in blind persons. That is why in the stimulation process it is required to consider the conception of the physical and psychic development; and the potentialities to reach it, from personal experiences and the game. The results that emerged from the study of carried out case allowed to corroborate the feasibility of the early stimulation for the harmonic development of the compensatory resources of blind children. Eloquent profits in the physical and psychic development were appraised, also managed a transformation in the way of thinking and acting of adults related to the stimulation process, becoming more moving the affective relation of the adult with the blind child, the blind child with the adult and the blind child with other children (AU)

La educación ambiental desde la perspectiva martiana / The environmental education from Martís perspective

El objetivo de este trabajo es contribuir al estudio de la Educación Ambiental, para lo que se toma en consideración la obra de José Martí, su pensamiento y reflexiones para su aplicación en el proceso de enseñanza-aprendizaje. Una de las tareas más importantes de la labor educativa en los momentos actuales es la comprensión de la magnitud que han alcanzado los desastres naturales y la contaminación ambiental por la acción devastadora del hombre, las guerras y la sobrepoblación mundial, en un mundo amenazado por las grandes catástrofes ecológicas. Se hace imprescindible la adquisición de una educación ambiental por parte de todos los miembros de la sociedad, la formación de conceptos y principios medioambientales, de convicciones ambientalistas y de un elevado desarrollo de cualidades políticas, ideológicas, psicológicas y morales, que contribuyan al entendimiento de la realidad y mejoramiento de modos de conductas más responsables para con el medio ambiente (AU)

This paper has the objective to contribute to the study of the Environmental Education, in which the Jose Martís work is considered, his thought and reflections for its application in the education-learning process. Actually, one of the most important tasks of the educative work is the understanding of the magnitude that have reached the natural disasters and the environmental contamination by the devastating action of man, wars and the world-wide overpopulation, in a world threatened by the great ecological catastrophes. The acquisition of an environmental education by all society members is indispensable, the environmental grounding of concepts and principles, environmentalist convictions and an elevated development of political, ideological, psychological and moral qualities, that contribute to the reality understanding and improvement of more responsible behaviour towards environment (AU)

Modelo de estadios de cambio: compatibilidad con relatos biográficos de mujeres que sufren violencia doméstica / Stages of change model: adjustment to biographical narrations of women whose are victims of intimate partner violence

El objetivo es analizar el ajuste de las vivencias de mujeres que sufren violencia inflingida por sus parejas o exparejas al Modelo de Cambio o Transteorético de Prochaska y Di Clemente. Se realiza una investigación cualitativa interpretativa con participación de 35 mujeres que sufren violencia de género, detectadas en atención primaria, que reconocen su situación (maltrato percibido). Se trata de un estudio multicéntrico realizado en seis centros de salud urbanos de Málaga. Se utiliza la técnica de Relato Biográfico mediante entrevista, que es audio grabado y transcrito, sobre el que se realiza el análisis de contenido según fases del Modelo Transteorético. Para la codificación se usa el programa ATLAS-TI 5.0.Las fases más relevante son la precontemplativa y las de mantenimiento y finalización, con poca presencia de las fases de acción. Las principales características de cada fase son la ceguera e inexplicabilidad en la precontemplativa; el análisis de pros y contras en la contemplativa; la dificultad en la toma de decisiones en las fases de acción; el sufrimiento y la lucha por salir adelante en la fase de mantenimiento y la determinación y capacidad de análisis en la de finalización. Se ofrecen claves para la intervención según la fase del proceso (AU)

This study aims to analyze the adjustment of women, victims of intimate partner violence, by applying the Prochaska and Di Clemente Stages of Change Model. An interpretative qualitative study was made in 35 domestic violence victims women detected in primary care, women who recognized their relationship as abusive (perceived maltreatment). This is a multicentric study, with participation of six health centers of Malaga city. Biographical Narration technique by audio-recorded and transcribed interview was used; about this, thematic analysis adjustment to Transtheoretic Model phases was applied. ATLAS-TI 5.0 program was used for codification. Precontemplative, maintenance and ending stages were more represented while action phases were poorly mentioned. Main phases characteristics were: "blindness" and inexplicability in precontemplative stage; pros / cons analysis in contemplative phase; making decisions difficulty in action phases; suffering and going ahead purpose in maintenance stage, and determination and analysis capacity in the ending stage. Keys for intervention according to the phase of the process were offered (AU)

Synthesis and physicochemical characterization of alkanedyil-α-ω-bis(dimethyldodecylammonium) bromide, 12-s-12,2Br-, surfactants with s=7, 9, 11 in aqueous medium.

In this work, three didodecyl dicationic dibromide dimeric surfactants 12-s-12,2Br(-), with different methylene spacer lengths (s=7, 9, and 11) were prepared and characterized and their properties compared to those of 12-s-12,2Br(-) surfactants with s=2, 3, 4, 5, 6, 8, 10, and 12. Information about the critical micelle concentration, the micellar ionization degree, the average aggregation number and the polarity of the interfacial region, and microviscosity of the micellar interior was obtained by using different techniques. Their surface activity was investigated by means of surface tension measurements. Micellization was also studied by using (1)H NMR and diffusion NMR (DOSY) spectroscopy as well as isothermal titration calorimetry. The values of the thermodynamic parameters show that the dimeric surfactants micellization is exothermic and driven by entropy. The occurrence of morphological transitions upon increasing surfactant concentration was studied, and the results indicate that the spacer length, s, plays a key role in the micellar growth of 12-s-12,2Br(-) aggregates. The value of s not only control the magnitude of C(*), the surfactant concentration above which the morphological transition from spherical micelles into elongated ones occurs, but also the sign of the enthalpy change accompanying the sphere-to-rod transition.

Tratando la disfunción eréctil en atención primaria (estudio TRADE-AP): efectividad de la toma a demanda de tadalafilo versus pauta diaria / Treating erectile dysfunction in primary care (TRADE-AP): effectiveness of taking tadalafil on demand versus daily pattern

Objetivo: Valorar la efectividad del tratamiento de la disfunción eréctil con tadalafilo tomado a demanda respecto a la pauta diaria. Material y método: Estudio prospectivo multicéntrico para analizar la disfunción eréctil en atención primaria con un grupo tratado con 20 mg de tadalafilo a demanda versus otro grupo que toma 5 mg de tadalafilo diario, utilizando el índice internacional de función eréctil, el cuestionario de Fulg-Meyer de satisfacción con la vida validado para la disfunción eréctil y la escala visual analógica, con puntuación de 0 a 100, de preferencia de tratamiento por el paciente y la escala visual analógica de preferencia de su pareja, donde se les pregunta su satisfacción con el tratamiento. Resultados: El ascenso medio de puntuación inicial-final de todos los dominios del índice internacional de función eréctil ha sido significativo tanto en el grupo "a demanda" como en el grupo "pauta diaria". Las diferencias observadas en el incremento medio de todos los ítems del cuestionario de satisfacción con la vida en ambos grupos han sido significativas, aunque con mayor intensidad en el grupo "pauta diaria". Respecto a la escala de evaluación analógica, se observaron diferencias significativas entre la puntuación total media inicial y la puntuación total media final en el grupo "a demanda", menores que en el grupo "pauta diaria". Conclusiones: Tanto la terapia a demanda como la pauta diaria con tadalafilo son eficaces en el tratamiento de la disfunción eréctil, pero la mejora en la función sexual, en la calidad de vida y en la satisfacción por la espontaneidad y naturalidad con el tratamiento se manifiestan en mayor medida con la pauta diaria (al menos, en las primeras etapas del tratamiento) debido, básicamente, a la actuación sobre factores psicosexuales que desligan el tratamiento de la relación sexual (AU)

Objective: To assess the effectiveness of the treatment of erectile dysfunction with tadalafil taken on demand versus the pattern daily. Material and method: A prospective, multicenter study was conducted to analyze erectile dysfunction in Primary Care in a group treated with 20 mg tadalafil "on demand" versus another group taking 5 mg of tadalafil "daily" using the international index of erectile function, the LISAT-8 Fulg-Meyer of quality of life validated for erectile dysfunction and the visual analogue scale (EVA with 0 to 100 score) on the treatment preference of the patient and the EVA preference of his partner, in which they are asked about their treatment satisfaction. Results: The mean increase in initial-final score for all domains of the international index of erectile function was significant in both the "on demand" and "daily" group. The differences observed in the mean increase for all the LISAT-8 items in both groups were significant. However, there was greater intensity in the "daily regime." Regarding EVA, significant differences were observed between total mean initial score and total final average score for the "on demand" group, these being lower than in the "daily" group. Conclusions: On demand treatment and the daily regime with tadalafil are effective in the treatment of erectile dysfunction. However, improvement in sexual function, quality of life and satisfactions due to the treatment spontaneity and naturalness are manifested more with the daily regime (at least in the first stages of the treatment), basically because of the action on the psycho-sexual factors that separate the treatment from the sexual relationship (AU)

Binary mixtures with novel monomeric and dimeric surfactants: influence of the head group nature and number of hydrophobic chains on non-ideality.

The micellization and micellar growth in the mixtures of N,N-dimethyl, N-phenyl,N-dodecylammonium bromide, PH12, N,N-dimethyl,N-ciclohexylmethyl,N-dodecylammonium bromide, CH12, and their two dimeric counterparts m-dimethylphenyl-α-ω-bis(dodecyldimethylammonium) bromide, 12PH12, and m-dimethylciclohexyl-α-ω-bis(dodecyldimethylammonium) bromide, 12CH12, with dodecyltrimethylammoniumbromide, DTAB, and with N-decanoyl N-methylglucamide, MEGA10, were investigated at 303 K. Circular dichroism, CD, experiments showed the formation of mixed micelles. Two-dimensional, 2D, rotating frame nuclear Overhauser effect spectroscopy (ROESY) experiments indicated that the arrangement of the rings in the pure and mixed micelles is similar, with the rings bent into the micelle interior avoiding contact with water. Application of different theoretical approaches shows that PH12 and CH12 mixtures with DTAB and with MEGA10 behave almost ideally. The binary systems of 12PH12 and 12CH12 with DTAB and with MEGA10 show a non-ideal behavior. An increment in the solution mole fraction of MEGA10 and DTAB diminishes the tendency of the micellar aggregates to grow.

Study of the reaction 2-(p-nitrophenyl)ethyl bromide + OH⁻ in dimeric micellar solutions.

The dehydrobromination reaction 2-(p-nitrophenyl)ethyl bromide + OH⁻ was investigated in several alkanediyl-α-ω-bis(dodecyldimethylammonium) bromide, 12-s-12,2Br⁻ (with s = 2, 3, 4, 5, 6, 8, 10, 12) micellar solutions, in the presence of NaOH 5 × 10⁻³ M. The kinetic data were quantitatively rationalized within the whole surfactant concentration range by using an equation based on the pseudophase ion-exchange model and taking the variations in the micellar ionization degree caused by the morphological transitions into account. The agreement between the theoretical and the experimental data was good in all the dimeric micellar media studied, except for the 12-2-12,2Br⁻ micellar solutions. In this case, the strong tendency to micellar growth shown by the 12-2-12,2Br⁻ micelles could be responsible for the lack of accordance. Results showed that the dimeric micelles accelerate the reaction more than two orders of magnitude as compared to water.

Flora y vegetación de suelos crioturbados y hábitats asociados en los alrededores del abra Apacheta, Ayacucho - Huancavelica (Perú) / Flora and vegetation on cryoturbated and associates habitats around abra Apacheta, Ayacucho - Huancavelica (Peru)

Se presentan los resultados del estudio de la flora y vegetación de suelos crioturbados y hábitats asociados realizados en la zona del Abra Apacheta, en las provincias de Cangallo (Ayacucho) y Huaytará (Huancavelica). Los objetivos fueron: estudiar la composición de la flora vascular de los altos Andes (por encima de los 4500 m de altitud) y caracterizar la vegetación altoandina. Se aplicaron técnicas convencionales de colecta botánica, así como evaluaciones de la cobertura vegetal mediante transectos. Se registraron 134 especies de plantas vasculares agrupadas en 60 géneros y 23 familias. Las eudicotiledóneas son el grupo dominante con el 74% del total de familias reportadas, 82% en géneros y 77% en especies; seguido por las monocotiledóneas (13% de las familias, 13% de los géneros y 21% de las especies). Los monilófitos (helechos) están representados por dos familias (9%), dos géneros (3%) y dos especies (1%); mientras que para las gimnospermas se registra una sola especie (Ephedra rupestris Benth.). Tres tipos de comunidades en suelos crioturbados fueron caracterizadas y es reportada la presencia de dos tipos de vegetación asociada: pajonales y vegetación de roquedales.

We present results of flora and vegetation studies carried out in cryoturbated soils and its associated habitats around Abra Apacheta, in Cangallo (Ayacucho) and Huaytara (Huancavelica) Provinces. The aims of this study were: to study vascular floristic composition of High Andes (over 4500 m of altitude) and characterize highland vegetation. There were used conventional techniques for botanical collection and vegetation coverage measurements by intersection-line transects and Point Quadrat modifyed method. There were registered 134 species of vascular plants (Pteridophytes, Gymnospems, Eudicots and Monocots) grouped in 60 genera and 23 families. Eudicots were the dominant group with 74% of the total registered, 82% in genera and 77% in species; followed by Monocots with 13%, 13% and 21% in the previous categories. Monilophytes (ferns) were poorly represented by two families (9%), two genera (3%) and two species (1%); while Gymnosperms only registered one specie (Ephedra rupestris Benth.). By the quantitative analysis three types of plant communities associated to cryoturbated soils were characterized, we also report two types of associated vegetation: grasslands and rocky areas.