Restricción de líquidos en pacientes con sepsis / Fluid Restriction in Patients with Sepsis

Introducción: La sepsis es una respuesta inflamatoria del cuerpo a una infección. En la actualidad continúa como una causa importante de morbimortalidad en todo el mundo. La administración temprana de líquidos es una estrategia fundamental en el manejo de la sepsis. Sin embargo, la cantidad y el tipo de líquidos administrados en pacientes con sepsis es aún objeto de debate. Objetivo: Evaluar los resultados de ensayos clínicos aleatorios para una comprensión más profunda de la efectividad de la restricción de líquidos en pacientes con sepsis. Métodos: Se realizó una búsqueda sistemática en diferentes bases de datos para realizar una evaluación crítica acerca de los artículos incluidos, se utilizaron las herramientas de evaluación de riesgo de sesgo cochrane y análisis de datos. Resultados: Se incluyeron 13 ensayos clínicos aleatorios controlados que compararon la restricción de líquidos versus la administración de líquidos en pacientes adultos con sepsis. Conclusiones: Se encontró que la restricción de líquidos se asoció con una reducción en la mortalidad y un menor número de días de soporte respiratorio y cardiovascular en pacientes con sepsis. Sin embargo, algunos estudios no encontraron diferencias significativas en la mortalidad entre la restricción de líquidos y la administración de líquidos(AU)

Introduction: Sepsis is an inflammatory response of the body to an infection. Currently it continues as a major cause of morbidity and mortality worldwide. Early fluid administration is a fundamental strategy in the management of sepsis. However, the amount and type of fluids administered in patients with sepsis is still a matter of debate. Objective: To evaluate the results of randomized clinical trials for a deeper understanding of the effectiveness of fluid restriction in patients with sepsis. Methods: A systematic search was carried out in different databases to carry out a critical evaluation of the included articles, the Cochrane risk of bias assessment tools and data analysis were used. Results: Thirteen randomized controlled trials were included, which compared fluid restriction versus fluid administration in adult patients with sepsis. Conclusions: We found that fluid restriction was associated with a reduction in mortality and a lower number of days of respiratory and cardiovascular support in patients with sepsis. However, some studies found no significant difference in mortality between fluid restriction and fluid administration(AU)

Apendicitis aguda en inicio de trabajo de parto. Reporte de caso / Acute appendicitis atthe onset of labor.A Case Report

Apendicitis aguda es la secuencia de inflamación, perforación, formación de absceso y peritonitis, causado con mayor frecuencia por obstrucción del lumen apendicular. La apendicitis es la patología quirúrgica no obstétrica más frecuente en el embarazo. Su incidencia puede ser variable y se presenta con mayor proporción durante el primer y segundo trimestre de gestación. Se presenta el caso de una paciente de 34 años de edad, con 36 semanas de gestación. Se diagnostica abdomen agudo quirúrgico y posible apendicitis aguda complicada. En sala de operaciones se confirma diagnóstico de apendicitis aguda complicada, revelando un plastrón apendicular y evolución favorable. Durante la gestación el diagnóstico de la apendicitis es difícil debido a los cambios anatómicos y fisiológicos que se producen, por lo que recalcamos la importancia de describir esta condición en el embarazo. Palabras Clave: apendicitis; embarazo; abdomen agudo.

Acute appendicitis is the sequence of inflammation, perforation, abscess formation and peritonitis, most frequently caused by obstruction of the appendicular lumen. Appendicitis is the most frequent non-obstetric surgical pathology in pregnancy. Its incidence can be variable and occurs with a greater proportion during the first and second trimester of pregnancy. The case of a 34-year-old patient with 36 weeks of gestation is presented. Surgical acute abdomen and possible complicated acute appendicitis are diagnosed. In the operating room, the diagnosis of acute appendicitis was confirmed, revealingan appendiceal plastron and favorable evolution. During pregnancy, the diagnosis of appendicitis is difficult due to the anatomical and physiological changes thatoccur, so we emphasize the importance of describing this condition during pregnancy. Key Words:appendicitis; pregnancy; acute abdomen.

Etnofarmacología de plantas utilizadas por pacientes diabéticos tz'utujiles en Santiago Atitlán, Sololá, Guatemala / Ethnopharmacology of plants used by Tz'utujil diabetic patients in Santiago Atitlán, Sololá, Guatemala

La diabetes mellitus tipo 2 es una afección crónica con una elevada prevalencia en las comunidades rurales e indígenas de Guatemala, en las cuales se ha reportado el uso de plantas medicinales para su tratamiento. Con el propósito de conocer qué plantas son utilizadas en la población para esta afección, se realizó un estudio etnofarmacológico con 36 sujetos de la población tz'utujil de Santiago Atitlán, Sololá, por medio de un análisis antropológico y farmacológico-toxicológico de entrevistas semiestructuradas y cuestionarios abiertos. Se identificaron 19 plantas, y se calculó el índice de consenso de enfermedad (ICE) y el valor de uso (VU) para evaluar el conocimiento y la importancia relativa de cada especie; ambos valores ayudan a comprender la relevancia cultural, es decir, la importancia de las especies medicinales para la población. Las cinco plantas con mayor relevancia cultural fueron Neurolaena lobata R.Br. ex Cass. (ICE=0.4074, VU=0.0084), Artemisia absinthium L. (ICE=0.1481, VU=0.0027), Psidium guajava L. (ICE=0.1111, VU=0.0023), Tanacetum parthenium (L.) Sch.Bip. (ICE=0.0741, VU=0.0015) y Coffea arabica L. (ICE=0.0741, VU=0.0015). Se determinó que N. lobata y P. guajava tienen un alto potencial para tratar la diabetes, C. arabica y T. parthenium pueden provocar efectos adversos e interacciones con ciertos medicamentos y A. absinthium puede ser peligrosa para su consumo. No obstante, se requieren estudios de los metabolitos secundarios aislados responsables de la actividad antidiabética para establecer dosis seguras, efectos adversos, interacciones y toxicología.

Type 2 diabetes mellitus is a chronic disease with a high prevalence in rural and indigenous communities of Guatemala, in which the use of medicinal plants for its treatment has been reported. In order to know which plants are used by the population for this condition, an ethnopharmacological study was carried out with 36 individuals from the Tz'utujil population of Santiago Atitlán, Sololá, through an anthropological and pharmacological-toxicological analysis of semistructured interviews and open questionnaires. Nineteen plants were identified, and the disease consensus index (DCI) and the value in use (UV) were calculated to assess the knowledge and relative importance of each species; both values help to understand the cultural relevance, that is, the importance of medicinal species for the population. The five plants with the higher cultural relevance were Neurolaena lobata R.Br. ex Cass. (DCI = 0.4074, UV = 0.0084), Artemisia absinthium L. (DCI = 0.1481, UV = 0.0027), Psidium guajava L. (DCI = 0.1111, UV = 0.0023), Tanacetum parthenium (L.) Sch.Bip. (DCI = 0.0741, UV = 0.0015) and Coffea arabica L. (DCI = 0.0741, UV = 0.0015). It was determined that N. lobata and P. guajava have a high potential to treat diabetes, C. arabica and T. parthenium can cause adverse effects and interactions with certain medications, and A. absinthium can be dangerous if consumed. However, further studies of the isolated secondary metabolites responsible for antidiabetic activity are required to establish safe doses, adverse effects, interactions and toxicology

Impact of Common Reflecting and Absorbing Building Materials on THz Multipath Channels.

THz band communication has the potential to meet the high data rate demands of many current and future applications. However, before these networks are realized, extensive channel measurements are needed in order to characterize the wireless channel at these frequencies, in order to inform system design and deployment. In the current paper, we present a set of double-directional channel measurements that are conducted in several relevant indoor and outdoor scenarios. Our aim is to see the effect of common building materials that might be particularly reflective or absorptive (such as energy-saving glass, window blinds, or metallic reflectors), and how their presence changes the channel characteristics. Among other effects we find that - depending on the considered dynamic range - presence/absence of these materials can increase the required equalizer length by an order of magnitude.

Data Compression in the NEXT-100 Data Acquisition System.

NEXT collaboration detectors are based on energy measured by an array of photomultipliers (PMT) and topological event filtering based on an array of silicon photomultipliers (SiPMs). The readout of the PMT sensors for low-frequency noise effects and detector safety issues requires a grounded cathode connection that makes the readout AC-couple with variations in the signal baseline. Strict detector requirements of energy resolution better than 1% FWHM require a precise baseline reconstruction that is performed offline for data analysis and detector performance characterization. Baseline variations make it inefficient to apply traditional lossy data compression techniques, such as zero-suppression, that help to minimize data throughput and, therefore, the dead time of the system. However, for the readout of the SiPM sensors with less demanding requirements in terms of accuracy, a traditional zero-suppression is currently applied with a configuration that allows for a compression ratio of around 71%. The third stage in the NEXT detectors program, the NEXT-100 detector, is a 100 kg detector that instruments approximately five times more PMT sensors and twice the number of SiPM sensors than its predecessor, the NEXT-White detector, putting more pressure in the DAQ throughput, expected to be over 900 MB/s with the current configuration, which will worsen the dead time of the acquisition data system. This paper describes the data compression techniques applied to the sensor data in the NEXT-100 detector, which reduces data throughput and minimizes dead time while maintaining the event rate to the level of its predecessor, around 50 Hz.

Validación de un cuestionario sobre el estilo de vida de médicos especialistas antes y durante la pandemia COVID-19 / Validation of a lifestyle questionnaire for physicians specialists before and during the COVID-19 pandemic

RESUMEN Introducción. Las estrategias de aislamiento y distanciamiento social para controlar la pandemia COVID-19, pudieron tener repercusón negativa en el estilo de vida de los médicos. Objetivo. Diseñar y validar un cuestionario para evaluar el estilo de vida de los médicos antes y durante la pandemia. Métodos. Estudio psicométrico. Se admitieron a 204 médicos especialistas de un hospital nacional de Lima-Perú, que respondieron virtualmente el cuestionario. Resultados. Se realizó la validez del contenido con un comité de expertos, con resultado de Q de Cochran de 7 y valor p de 0,50. En la relevancia, representatividad y claridad de los ítems la V de Aiken global fue de 0,97. La prueba piloto demostró una confiabilidad adecuada (alfa de Cronbach 0,842). Para la validez del constructo, se evaluó la adecuación muestral global por medio de la prueba de esfericidad de Bartlett, antes (X2=4235,75, p<0,01) y durante (X2=4328, p<0,01) la pandemia. Además la prueba de Kaiser-Meyer-Olkin (KMO) tuvo un valor global antes y durante la pandemia de 0,78 y 0,76 respectivamente. El análisis factorial exploratorio estructuró cinco dominios. Se estimaron las cargas factoriales (correlaciones policoricas y rotación de Oblimin), y la correlación entre los dominios fue adecuada. El análisis factorial confirmatorio indicó un adecuado ajuste del modelo. Conclusión. El instrumento mostró propiedades psicométricas adecuadas, por lo que se puede considerar como un instrumento útil, válido y fiable para evaluar el estilo de vida de los médicos antes y durante la pandemia COVID-19.

ABSTRACT Introduction. Isolation and social distancing strategies to control the COVID-19 pandemic probably had a negative impact on physicians' lifestyles. Objective. To design and validate a questionnaire to assess physicians' lifestyle before and during the pandemic. Methods. We carried out a psychometric study. A total of 204 medical specialists from a national hospital in Lima-Peru were admitted to the study and answered the questionnaire virtually. Results. Content validity was carried out with a committee of experts, with a Cochran's Q of 7 and p of 0.50. In the relevance, representativeness and clarity of the items, the global Aiken's V was 0.97. The pilot test showed adequate reliability (Cronbach's alpha 0.842). For construct validity, overall sample adequacy was assessed by Bartlett's test of sphericity, before (X2=4235.75, p<0.01) and during (X2=4328, p<0.01) the pandemic. In addition, the Kaiser-Meyer-Olkin (KMO) test had an overall value before and during the pandemic of 0.78 and 0.76 respectively. Exploratory Factor Analysis structured five domains. Factor loadings (polychoric correlations and Oblimin rotation) were estimated, and the correlation between domains was adequate. Confirmatory Factor Analysis indicated adequate model fit. Conclusion. The instrument shows adequate psychometric properties, so it can be considered as a useful, valid, and reliable instrument to assess the lifestyle of physicians before and during the COVID-19 pandemic.

Características obstétricas y perinatales en gestantes con SARS-CoV-2. Hospital Nacional Dos de Mayo

Introducción: La pandemia COVID-19 se inicia en Perú en marzo de 2020. Al parecer la evolución a formas graves de la enfermedad en las embarazadas no es frecuente. Las complicaciones más frecuentes son la rotura prematura de membranas, parto prematuro y sufrimiento fetal. La transmisión vertical no ha sido demostrada. Los estudios nacionales son en su mayoría solo de la primera etapa de la pandemia. Objetivo: determinar las características epidemiológicas, obstétricas y perinatales en gestantes con SARS-CoV-2. Material y métodos: Se realizó un estudio descriptivo en el Hospital Nacional Dos de Mayo. Se admitieron 579 gestantes positivas al SARS-CoV-2 y 533 recién nacidos. Se procedió a la revisión de historias clínicas. Se realizó una estadística descriptiva. El estudio está registrado en PRISA con código EI00002469. Resultados: El SARS-CoV-2. fue detectado por anticuerpos serológicos en 91,0%, y en 8,0% por prueba antigénica. El 94,5% (547/579) de los casos, permanecieron asintomáticas. 19 casos (3,3%) se complican con neumonía COVID-19. En 65,5% no se presentaron complicaciones obstétricas; las más comunes fueron rotura prematura de membranas (9,7%), pre eclampsia (8,2%) e infección del tracto urinario (5,0%). Las características neonatales como edad gestacional, peso al nacer y Apgar, tuvieron en la mayoría resultados dentro de los límites normales. Conclusión: las gestantes con SARS-CoV-2 son asintomáticas en su mayoría, tienen baja frecuencia de complicaciones y los recién nacidos no presentan complicaciones mayores.

Introduction: The COVID-19 pandemic starts in Peru in March 2020. It appears that progression to severe forms of the disease in pregnant women is infrequent. The most frequent complications are premature rupture of membranes, premature delivery and fetal distress. Vertical transmission has not been demonstrated. National studies are mostly only from the first stage of the pandemic. Objective: determine the epidemiological, obstetric and perinatal characteristics in pregnant women with SARS-CoV-2. Material and methods: A descriptive study was conducted at the Hospital Nacional Dos de Mayo. A total of 579 SARS-CoV-2 positive pregnant women and 533 newborns were admitted. Medical records were reviewed. Descriptive statistics were performed. The study is registered in PRISA with code EI00002469. Results: SARS-CoV-2 was detected by serological antibodies in 91.0% and in 8.0% by antigenic test. Of the cases, 94.5% (547/579) remained asymptomatic. Nineteen cases (3.3%) were complicated by COVID-19 pneumonia. There were no obstetric complications in 65.5%; the most common were premature rupture of membranes (9,7%), preeclampsia (8,2%) and urinary tract infection (5,0%). Neonatal characteristics such as gestational age, birth weight and Apgar were mostly within normal limits. Conclusion: that pregnant women with SARS-CoV-2 are mostly asymptomatic, have a low frequency of complications and the newborns do not present major complications.

Complicaciones obstétricas y perinatales por el SARS-CoV-2 en un hospital de referencia de la región Huancavelica / Obstetric and perinatal complications due to SARS-CoV-2 in a referral hospital in the Huancavelica region / Complicações obstétricas e perinatais devidas à SRA-CoV-2 em um hospital de referência na região de Huancavelica

Objetivos determinar las repercusiones obstétricas y perinatales gestantes SARS-CoV-2 positivas del Hospital Departamental de Huancavelica. Métodos estudio descriptivo de marzo 2020 a octubre 2021.Se realizó análisis documental de historias clínicas de gestantes con culminación del embarazo en la institución, y de los recién nacidos. Se empleó una ficha de recolección de datos validada Las gestantes admitidas eran positivas al SARS-CoV-2 con una prueba de laboratorio. Se realizó una estadística descriptiva. El estudio figura en el Registro Nacional de Investigaciones en Salud (CÓDIGO: EI00002480). Resultados Se admitieron 148 gestantes, con edad promedio de 27 años. Un 53,4% fueron controladas. La mayoría multíparas (80/54,1%). El diagnóstico del SARS-CoV-2 se realizó con detección de anticuerpos (85,6%). El 90,5% (134/148) fueron asintomáticas. Se registró neumonía por el SARS-Cov-2 en 8 casos. El aborto representó el 16,2%. La mayoría tenía edad gestacional a término (109/86,5%). La vía del parto fue similar para cesárea/parto vaginal (51,6%/48.4%). No hubo complicaciones obstétricas en 65,5%. Las complicaciones más frecuentes fueron: ruptura prematura de membranas y pre eclampsia. Los recién nacidos tuvieron puntajes de Apgar adecuados (94,4% al minuto/96,8% a los cinco minutos). Los prematuros representaron el 11,9%. En la mayoría hubo peso adecuado (86,5%). No se registraron neonatos positivos al SARS Cov-2. Conclusiones las gestantes atendidas en el Hospital Departamental de Huancavelica positivas al SARS-CoV-2 son asintomáticas en su mayoría, con complicaciones obstétricas más comunes la rotura prematura de membranas y la pre eclampsia. Los resultados perinatales de los recién nacidos son adecuados en la gran mayoría.

Objective. To determine obstetric and perinatal complications in SARS-CoV-2 pregnant women at the Departmental Hospital of Huancavelica. Methods. A descriptive, with documentary analysis of the medical records of pregnant women who completed their pregnancy at the institution and of the newborns. A validated data collection form was used. Admitted pregnant women were positive for SARS-CoV-2 with a laboratory test. Descriptive statistics were performed, establishing frequencies, averages and percentages. The study is included in the National Health Research Registry. Results. A total of 148 pregnant women were admitted, average age 27 years. A 53.4 % were controlled. The majority, 54.1 % (80), were multiparous. The diagnosis of SARS-CoV-2 was made by detection of antibodies (85.6 %). A total of 90.5 % (134/148) were asymptomatic. SARS-Cov-2 pneumonia was recorded in 8 cases. Abortion accounted for 16.2 %. The majority, 86.5 % (109), were of term gestational age. The route of delivery was similar for cesarean/vaginal delivery (51.6 %/48.4 %). There were no obstetric complications (65.5 %). The most frequent complications were: premature rupture of membranes and preeclampsia. The newborns had adequate Apgar scores (94.4 % at one minute/96.8 % at fve minutes). Preterm infants accounted for 11.9 %. Most of them had adequate weight (86.5 %). There were no SARS Cov-2 positive neonates. Conclusions. Most of the pregnant women attended at the Departmental Hospital, positive for SARS-CoV-2, were asymptomatic. The most frequent obstetric complications were premature rupture of membranes and preeclampsia. The perinatal outcomes of the newborns were adequate in the great majority

Para determinar as complicações obstétricas e perinatais em mulheres grávidas com SARS-CoV-2 no Hospital Departamental de Huancavelica. Métodos. Estudo estudo descritivo, com análise documental das histórias clínicas de mulheres grávidas com gravidez na instituição e dos recém-nascidos. Um validado foi utilizado um formulário de coleta de dados validado. As mulheres grávidas admitidas foram positivas para SARS-CoV-2 com um teste de laboratório. Foram realizadas estatísticas descritivas, freqüências, médias e porcentagens foram estabelecidas. O estudo está incluído no Registro Nacional de Pesquisa em Saúde. Resultados. Um total de 148 mulheres grávidas foram admitidas. mulheres grávidas, idade média de 27 anos. Cerca de 53,4 % foram controlados. A maioria, 54,1 % (80) eram multiparos. O diagnóstico do SARS-CoV-2 foi feito pela detecção de anticorpos (85,6 %). detecção de anticorpos (85,6 %). 90,5 % (134/148) eram assintomáticos. Pneumonia devido à SARS foi A pneumonia SARS-Cov-2 foi registrada em 8 casos. O aborto representou 16,2 %. O A maioria, 86,5 % (109), era de idade gestacional. A rota de entrega foi semelhante para cesariana/vaginal (51,6 %/48,4 %). Não houve complicações obstétricas (65,5 %). As complicações mais freqüentes foram: ruptura prematura de membranas e pré-eclâmpsia. membranas e pré-eclâmpsia. Os recém-nascidos tiveram pontuações Apgar adequadas (94,4% a um minuto). pontuações (94,4 % a um minuto/96,8 % a cinco minutos). Bebês prematuros representou 11,9 %. A maioria tinha peso adequado ao nascimento (86,5 %). Sem SAR positivo não foram registrados neonatos positivos SARS Cov-2. Conclusões. A maioria dos A maioria das gestantes positivas do SARS-CoV-2 vistas no hospital eram assintomáticas. As complicações obstétricas mais freqüentes foram a ruptura prematura das membranas e a pré-eclâmpsia. membranas e pré-eclâmpsia. Os resultados perinatais dos recém-nascidos foram adequados em sua grande maioria.

Links between types of value orientations and consumer behaviours. An empirical study.

The present study concerns the phenomenon of the co-dependence of value orientations and consumer behaviours. Although the idea of the overall connections between both areas is not new, the article contributes to the knowledge about relations between very specific consumer behaviours and social value orientations among people married or in an informal partnership. Using the obtained data, we examine to what extent the prosocial, reciprocal, and egoistic value orientations coexist with compensative, compulsive, and demonstrative buying. The analysis confirms the hypotheses that representatives of the reciprocal and egoistic orientations show susceptibility to compensative and compulsive buying to a greater extent than persons preferring other value orientations. In addition, the data show co-dependence of the reciprocal value orientation and demonstrative buying, while the prosocial value orientation seems to protect against compulsive buying. According to the regression analysis, this effect disappears if prosocially oriented persons suffer from low self-esteem at the same time being characterised by strong materialism. All hypothesised relations between value orientations and consumer behaviours have been analysed in multidimensional models considering materialism, self-esteem, age, and gender as the main factors of compensative and compulsive buying. The findings come from the 2017 survey based on a statistically representative sample of 1,121 adult Poles who were then married or in an informal partnership. The German Compulsive Buying Indicator and Lange's Scale of Demonstrative Buying were introduced to measure consumer behaviours.

Inhibición de la a-amilasa por medio de extractos de plantas medicinales como tratamiento complementario/alternativo de la diabetes y la caries / Inhibition of a a-amylase by means of extracts of medicinal plants as complementary/alternative treatment of diabetes and caries

Los inhibidores selectivos de la α-amilasa salival y pancreática humana, son un medio eficaz para controlar los niveles de azúcar en la saliva y la sangre, durante el control de la caries y la diabetes. En la presente revisión, después de identificar las principales funciones de la enzima, se discutieron exponen algunas de las respuestas observadas después de la exposición de la α-amilasa a las plantas, en escala molecular y entera. Diferentes tipos de moléculas de plantas medicinales actúan como inhibidores de la α-amilasa, como una terapia alternativa o complementaria en el tratamiento de la diabetes en y en el control de uno de los factores de la formación la caries (dieta) (AU)

Selective inhibitors of human salivary and pancreatic α-amylase are an effective means of controlling saliva and blood sugar levels in the management of caries and diabetes. In the present review, after identifying the main functions of the enzyme, it was exposed some of the observed responses after exposure to α-amylase at the molecular and whole plants scale. Different types of medicinal plants molecules have been found to act as α-amylase inhibitors, as an alternative or complementary therapy in the management of diabetes and control to one of the predisposing factors to caries (diet) (AU)

Impact of the Z potential technique on reducing the sperm DNA fragmentation index, fertilization rate and embryo development.

BACKGROUND: In assisted reproduction procedures, we need to develop and enhance new protocols to optimize sperm selection. The aim of this study is to evaluate the ability of the Z potential technique to select sperm with intact DNA in non-normospermic patients and evaluate the impact of this selection on embryonic development. METHODS: We analyzed a total of 174 human seminal samples with at least one altered parameter. We measured basal, post density gradients, and post density gradients + Z potential DNA fragmentation index. To evaluate the impact of this technique on embryo development, 54 cases were selected. The embryo development parameters evaluated were fertilization rate, cleavage rate, top quality embryos at the third day and blastocysts rate. RESULTS: We found significant differences in the study groups when we compared the sperm fragmentation index by adding the Z potential technique to density gradient selection vs. density gradients alone. Furthermore, there was no significant difference in the embryo development parameters between the low sperm fragmentation index group vs. the moderate and high sperm fragmentation index groups, when selecting sperms with this new technique. CONCLUSIONS: The Z potential technique is a very useful tool for sperm selection; it significantly reduces the DNA fragmentation index and improves the parameters of embryo development. This technique could be considered routine for its simplicity and low cost.

An Unprecedented High Content of the Bioactive Flavone Tricin in Huperzia Medicinal Species Used by the Saraguro in Ecuador.

The flavone tricin (5,7,4'-trihydroxy-3',5'-dimethoxyflavone) is considered to be a selective potent inhibitor of different cancer cell lines and a potential colorectal cancer chemopreventive agent. In this paper we describe a reliable UHPLC-UV-ESIMS method for the determination of tricin in Huperzia plants used in the traditional medicine of the Saraguro community living in Southern Ecuador. An unusually high amount of tricin was found in H. brevifolia and H. compacta, which exceeded the content of this flavone determined so far in other plants.

Morbilidad y mortalidad en gestantes adolescentes según paridad. Hospital Nacional Dos de Mayo 2009-2013 / Morbidity and mortality in adolescents pregnant according to parity. National Hospital Dos de Mayo 2009-2013

Objetivo: Determinar las diferencias en la morbilidad y mortalidad en gestantes adolescentes según la paridad, atendidas en el Hospital Nacional Dos de Mayo de Enero de 2009 a Diciembre de 2013. Metodología: Estudio de casos y controles realizado en el Hospital Nacional Dos de Mayo del año 2009 al 2013. Se realizó un análisis documental de las historias clínicas de 1,383 gestantes adolescentes atendidas en la institución. Se utilizó una ficha de recolección de datos previamente elaborada. Los datos fueron organizados en una base utilizando el programa estadístico SPSS versión 22.0. Para la estadística inferencial se realizó la prueba de Chi cuadrado. Para las variables estadísticamente significativas se realizó una regresión logística multinomial. Los cálculos se realizaron con un intervalo de confianza del 95 por ciento. Resultados: De las 1,383 gestantes adolescentes admitidas al estudio, 342 fueron multigestas representando un 24,7 por ciento. Se presentaron 334 casos de morbilidad, siendo las más frecuentes la anemia (50,3 por ciento), la infección vaginal (18,7 por ciento) y la rotura prematura de membranas (11,4 por ciento). Solo existió asociación estadísticamente significativa entre ser multigesta y la hipertensión inducida por el embarazo (p 0,032) (OR=0,54 IC 95 por ciento [0,31-0,96]); en las otras entidades no existió asociación estadísticamente significativa. Conclusiones: La condición de multigesta adolescente protege en el 46 por ciento de los casos a padecer de una hipertensión inducida por el embarazo. No existe diferencia en la presentación de anemia, infección vaginal, rotura prematura de membranas, parto pre término, amenaza de parto pre término y desgarro perineal, entre las primigestas y multigestas adolescentes.

Objective: To determine differences in morbidity and mortality in pregnant adolescent according parity, treated at the National Hospital Dos de Mayo January 2009 to December 2013. Methodology: Case-control study conducted at the National Hospital Dos de Mayo 2009 to 2013. Documentary analysis of the medical records of 1383 pregnant adolescents attended at the institution was performed. Tab of data collection previously prepared was used. The data were organized into a database using the SPSS version 22.0. For inferential statistics chi square test was performed. Statistically significant variables for a multinomial logistic regression was performed. Calculations were performed with a confidence interval of 95 per cent. Results: Of the 1383 pregnant adolescents admitted to the study, 342 were multigravids, representing 24.7 per cent. 334 cases of disease were presented, the most frequent anemia (50.3 per cent), vaginal infection (18.7 per cent) and premature rupture of membranes (11.4 per cent). Only association between multigesta and pregnancy-induced hypertension being statistically significant (p 0.032) (OR = 0.54 95 per cent CI [0.31 to 0.96]); in others there was no statistically significant association. Conclusions: The condition of adolescent multigesta protects 46 per cent of cases suffer from a pregnancy-induced hypertension. There is no difference in the presentation of anemia, vaginal infection, premature rupture of membranes, preterm delivery, perineal tear and threat of preterm birth, among primiparous and multiparous adolescents.

Aspectos socio culturales de las multigestas adolescentes / Socio cultural aspects of adolescents multigravid

Objetivo: Identificar los aspectos socioculturales de las multigestas adolescentes. Metodología: Estudio descriptivo, transversal y retrospectivo, realizado en el Hospital Nacional Dos de Mayo del año 2009 al 2013. Se realizó un análisis documental de las historias clínicas de 342 multigestas adolescentes atendidas en la institución. Resultados: El 99,7% (341) fueron adolescentes tardías. La mayoría eran solteras (68,7%). El grado de instrucción predominante fue la secundaria, 161 (47,1%) completa, y 125 (36,5%) incompleta. El rango de edad para la menarquia fue de 9 a 17 años, siendo más frecuente a los 12 años (29,2%). El inicio de las relaciones sexuales tuvo un rango de 8 a 18 años, siendo más frecuente a los 15 años (31,0%). El tiempo entre la menarquia y el inicio de las relaciones sexuales fue con mayor frecuencia entre los dos y cuatro años. El 20,5% utilizó métodos anticonceptivos, siendo el más frecuente la ampolla trimensual 35,7%. La mayoría (128/37,4%) no tuvieron control prenatal. En un 19,0% el embarazo culmino en aborto, y la vía del parto más común fue la cesárea (52,0%). Conclusiones: Las multigestas adolescentes son en su mayoría solteras, con secundaria completa, con poco acceso a métodos anticonceptivos y con un control prenatal inadecuado.

Objective: Identify the sociocultural aspects of adolescent multigravid. Methodology: Descriptive, cross sectional study conducted at the Hospital Nacional Dos de Mayo 2009 to 2013. A documentary analysis of medical records of 342 multi gravid adolescents seen at the institution was performed. Results: 9.7% (341) were late adolescents. Most were single (68.7%). The predominant level of education was high school, 161 (47.1 %) completed, and 125 (36.5%) incomplete. The age for menarche was 9-17 years, with more frequent at age 12 (29.2%). The beginning of sexual intercourses ranged from 8-18 years, with more frequent at age 15 (31.0%). The time between menarche and the start time of sexual intercourses was most often between two and four years. Only 20.5% used contraceptive methods, the most frequent trimonthly blister (35.7%). Most (128/37.4%) had no prenatal care. 19.0% pregnancy ended in abortion, and the most common way of delivery was cesarean section (52,0%). Conclusions: Adolescent multigravid are mostly single, with complete secondary, with little access to contraception and inadequate prenatal care.

Impacto del tratamiento no farmacológico de la hipertensión arterial en pacientes de un consultorio médico de la familia / Impact of the non-pharmacological treatment of arterial hypertension in patients from a family doctors office

Se realizó un estudio de intervención, con el objetivo de evaluar el impacto de los cambios en el estilo de vida en pacientes hipertensos, pertenecientes al Consultorio Médico de la Familia 158-01, área de salud del Policlínico Docente Manuel Fajardo Rivero, municipio de Las Tunas, Cuba; durante el período comprendido entre abril de 2013 y diciembre de 2014. El universo estuvo constituido por toda la población dispensarizada con hipertensión arterial esencial y la muestra con los diagnosticados en el Estadio 1, Grupos A y B. Los pacientes se controlaron mensualmente. En un buen número de pacientes el tratamiento no farmacológico fue suficiente para el control de las cifras de presión arterial y en otros se asoció al tratamiento medicamentoso, lo que disminuyó el número de fármacos utilizados. Su cumplimiento fue muy bajo al inicio de la intervención, lo que se revirtió después. Los pacientes que cumplieron estrictamente el tratamiento no farmacológico presentaron mejores controles de las cifras de presión arterial (AU)

An intervention study was carried out with the objective of assessing the impact of lifestyle modifications in hypertensive patients belonging to the family doctors office 158-01 of Manuel Fajardo Rivero Teaching Polyclinic health area in Las Tunas, Cuba, from April, 2013 to December, 2014. The universe was made up of the whole population identified with essential hypertension and the sample included those diagnosed in stage 1, groups A and B. The patients were monitored every month. The non-pharmacological treatment was enough for controlling the blood pressure numbers in a great number of patients; in others, it was associated to the pharmacological treatment, what diminished the number of drugs used. Its accomplishment was very low at the beginning, what was later reverted. Those patients that completed rigorously the non-pharmacological treatment presented a better control of the blood pressure numbers (AU)

[Access to drugs and the situation of the pharmaceutical market in Ecuador]. / Acceso a medicamentos y situación del mercado farmacéutico en Ecuador.

In the area of public health, it is fundamental to understand the structure and dynamics of the Ecuadorian pharmaceutical market, its segmentation between the public and private sectors, and its relationship with supply and demand, both for generic and brand-name drugs. To achieve this, an observational descriptive study was conducted with information obtained from the available scientific, institutional, technical-administrative, and economic databases. Furthermore, the scientific information concerning the Ecuadorian and regional pharmaceutical market was reviewed through the PubMed and Ovid search engines. In Ecuador, 69.6% of dispensed drugs are brand-name and 30.4% are generics. Of all registered drugs in the country, 1,829 (13.6%) are considered over-the-counter and 11,622 (86.4%) are for sale under medical prescription. In terms of sales, 93.15% correspond to brand-name drugs and only 6.85% to generics. Ninety percent of the pharmacies are located in urban areas and only 10% in rural areas. In the last five years, prices have increased by 12.5% for brand-name drugs and 0.86% for generics. Brand-name drugs are dispensed and consumed 2.3 times more than generics. The majority of pharmacies are located in urban areas, showing that there is a relationship between purchasing power and access to drugs. Although the regulatory authority stipulates that 13% of drugs should be over-the-counter, approximately 60% of the population acquires drugs without a medical prescription.

Acceso a medicamentos y situación del mercado farmacéutico en Ecuador / Access to drugs and the situation of the pharmaceutical market in Ecuador

Resulta fundamental, en el área de la salud pública, conocer la estructura y dinámica del mercado farmacéutico ecuatoriano, su segmentación entre el sector público y privado, así como su relación con la demanda y oferta de medicamentos tanto genéricos como de marca. Para esto, se realizó un estudio descriptivo observacional con la información obtenida de las bases de datos científicos, institucionales, técnico-administrativas y económicas disponibles. Además, se revisó la información científica referente al mercado farmacéutico ecuatoriano y regional a través de los buscadores PubMed y Ovid. Los medicamentos de marca dispensados en el país corresponden 69,6% a marcas y los genéricos a 30,4%. En Ecuador, del total de medicamentos registrados, 1 829 (13,6%) son considerados de venta libre y 11 622 (86,4%) son de venta bajo prescripción médica. De las ventas, 93,15% corresponden a medicamentos de marca y solo 6,85% a genéricos. El 90% de las farmacias se hallan en la zona urbana y solo 10% a nivel rural. El incremento de precios en los últimos cinco años fue de 12,5% para los medicamentos de marca y de 0,86% para genéricos. La dispensación y consumo de medicamentos de marca es 2,3 veces mayor que la de genéricos. La mayoría de las farmacias se localizan en la zona urbana, demostrando que existe una relación entre el poder adquisitivo y el acceso a los medicamentos. A pesar de que la autoridad reguladora estipula que 13% de medicamentos son de venta libre, aproximadamente 60% de la población accede a medicamentos sin prescripción médica.

In the area of public health, it is fundamental to understand the structure and dynamics of the Ecuadorian pharmaceutical market, its segmentation between the public and private sectors, and its relationship with supply and demand, both for generic and brand-name drugs. To achieve this, an observational descriptive study was conducted with information obtained from the available scientific, institutional, technical-administrative, and economic databases. Furthermore, the scientific information concerning the Ecuadorian and regional pharmaceutical market was reviewed through the PubMed and Ovid search engines. In Ecuador, 69.6% of dispensed drugs are brand-name and 30.4% are generics. Of all registered drugs in the country, 1 829 (13.6%) are considered over-the-counter and 11 622 (86.4%) are for sale under medical prescription. In terms of sales, 93.15% correspond to brand-name drugs and only 6.85% to generics. Ninety percent of the pharmacies are located in urban areas and only 10% in rural areas. In the last five years, prices have increased by 12.5% for brand-name drugs and 0.86% for generics. Brand-name drugs are dispensed and consumed 2.3 times more than generics. The majority of pharmacies are located in urban areas, showing that there is a relationship between purchasing power and access to drugs. Although the regulatory authority stipulates that 13% of drugs should be over-the-counter, approximately 60% of the population acquires drugs without a medical prescription. .

Osteomielitis crónica y terapia con oxígeno hiperbárico como coadyuvante terapéutico

La osteomielitis crónica es una infección latente, usualmente prolongada, que afecta el tejido óseo y es causada, principalmente, por bacterias y hongos. Suelen ocurrir procesos de reagudización en intervalos de semanas, meses y hasta años. Este tipo de infecciones son muy difíciles de controlar, debido a que los antibióticos y las células del sistema inmunológico no pueden actuar efectivamente en este tipo de tejido. El tratamiento de este tipo de infecciones implica el uso de grandes dosis de antibióticos por tiempos prolongados, procedimientos quirúrgicos e incluso se puede llegar a la amputación del miembro afectado. En el Ecuador se han registrado 8967 egresos hospitalarios desde el año 2001 al 2011, siendo los más afectados niños y adolescentes menores de 15 años. La terapia hiperbárica de oxígeno aumenta la disponibilidad de oxígeno en el organismo del paciente, generando efectos beneficiosos como: control de infecciones, desarrollo de nuevos tejidos y cicatrización rápida. En varios estudios se han reportado las ventajas de la aplicación de esta terapia en pacientes de osteomielitis crónica. En Ecuador existen cinco cámaras hiperbáricas, las cuales podrían ser utilizadas para aplicar esta terapia como coadyuvante en el tratamiento de este tipo de infección, reduciendo tiempo de hospitalización y reemplazando el uso de cirugías

Chronic osteomyelitis is a long-lasting infection of the osseous tissue by bacteria or fungi. During this time, acute infection symptoms can appear at intervals of week, months or even years. This type of infection is very diffcult to control, because the antibiotics and the cells of the immune system cannot function effectively in this type of tissue. The treatment involves the use of large doses of antibiotics for prolonged periods, and even surgical procedures that can reach the amputation of the affected limb. In Ecuador there have been 8967 hospital discharges from 2001 to 2011, children and adolescents below 15 years have been the most affected. Hyperbaric oxygen therapy increases the availability of oxygen in the patient's body, producing benefcial effects such as infection control, development of new tissue and rapid healing. Several studies have reported the advantages of the application of this therapy in patients with chronic osteomyelitis. In Ecuador, there are fve hyperbaric chambers, which could be used to implement this therapy as an adjunct in the treatment of this type of infection, reducing hospitalization time and replacing the use of surgeries