Attempted vaginal birth after cesarean: assessment of morbidity and predictors of success / Parto tras cesárea anterior: análisis de la morbimortalidad materno-fetal

Objective: Determining the appropriate approach for delivery after previous cesarean is a very controversial issue. Our objective was to establish whether pregnant women with a previous cesarean have an increased maternal and fetal morbidity and mortality after attempting vaginal delivery as well as to determine which factors may influence the achievement of a vaginal birth after cesarean. Materials and methods: A retrospective observational cohort study including 390 patients (196 cesarean group and 194 nulliparous group) was carried out. We compared neonatal and maternal outcomes between groups. Afterward, a multivariate logistic regression was applied for our second objective. Results: There were higher rates of uterine rupture (2% vs. 0%, p: 0.045) and puerperal hemorrhage (9.7% vs. 3.1%, p: 0.008) in the cesarean group and lower vaginal delivery rate (58.2% vs. 77.8%, p < 0.0005). We found that the induced onset of labor (OR = 2.9) and new born weight (OR = 1.0001) were associated with an increased risk of cesarean section. Conclusions: Our findings stress the need for further investigations in this field, which might provide a basis for a better management of patients with a previous cesarean.

Objetivo: Determinar el abordaje adecuado del tipo de parto tras una cesárea previa es un tema muy controvertido. Nuestro objetivo fue establecer si las gestantes con cesárea previa presentan mayor morbimortalidad materna y fetal tras intentar parto vaginal, así como determinar qué factores pueden influir en conseguir un parto vaginal posterior a la cesárea. Material y métodos: Estudio observacional de cohortes retrospectivo incluyendo 390 pacientes (196 con cesárea previa, 194 nulíparas). Comparamos los datos sobre los resultados neonatales y maternos. Posteriormente se aplicó un modelo de regresión logística multivariante. Resultados: Hubo mayores tasas de ruptura uterina (2% vs. 0%; p = 0.045) y hemorragia puerperal (9.7% vs. 3.1%, p: 0.008) en el grupo de cesárea anterior, así como una tasa de parto vaginal mas baja (58.2% vs. 77.8%, p < 0.0005). La inducción del parto (OR = 2,9) y el peso del recién nacido (OR = 1.0001) se asociaron a un mayor riesgo de cesárea. Conclusión: La probabilidad de parto vaginal en estas pacientes disminuye cuanto mayor sea el peso del recién nacido y con partos inducidos.

Management of Pediatric Urolithiasis Using a Combination of Laparoscopic Lithotomy and Pyeloscopy.

BACKGROUND: Minimally invasive procedures have become the standard option for treatment of urinary stones; the use of more invasive techniques is not a common practice currently. This emergent technology is not always available and laparoscopy is the alternative option. There are few reports of laparoscopic management for urinary lithiasis in pediatric patients. This study is about the use of laparoscopic surgery combined with pyeloscopy as a feasible first-line treatment for pediatric urolithiasis in renal and proximal ureteral locations. PATIENTS AND METHODS: We reviewed the records of 14 patients with renal and proximal ureteral stones who underwent laparoscopic pyelolithotomy and pyeloscopy in a period from January 2011 to July 2016. The outcome measures were needed for auxiliary procedures, treatment success, and complication rates. RESULTS: A total of 16 procedures were carried out in 14 patients, 15 transperitoneal and 1 retroperitoneal laparoscopic pyelolithotomies were done. It was necessary to perform upper ureterolithotomies to remove ureteral stones in 2 cases. The holmium laser and/or pneumatic lithotripter were used to fragment staghorn calculi. Some of the complications were blood transfusion in 12.5% and self-limited urinary leak in 18.7% of the patients. The success rate after undergoing one procedure was 92.8%. CONCLUSIONS: Transperitoneal or retroperitoneal laparoscopic lithotomy is a safe and feasible procedure for the treatment of pediatric urolithiasis. It can be an alternative to shock-wave lithotripsy and percutaneous nephrolithotomy when these are not feasible or possible.

Evolución de las características epidemiológicas y clínicas de pacientes adultos del programa nacional al inicio de la terapia anti-retroviral en la Cohorte Chilena de SIDA, 2001-2015 / Evolution of epidemiological and clinical characteristics of adults patients belonging to the national program at start of antiretroviral therapy in the Chilean AIDS Cohort, 2001-2015

Background: Chilean AIDS Cohort is the oldest and extensive in Latin America and one of most numerous and with longer follow up time to international level. Records information from 14,873 patients out of approximately 22,000 in antiretroviral therapy in the public system and its results have allowed to know the national reality and have contributed to the adoption of public policies. Aim: To describe the demographic, clinical and immunological characteristics of patients who have started ART in Chile and its evolution over the past 15 years. Patients and Methods: The cases were stratified by five-year periods: 2001-2005, 2006-2010 and 2011-2015. The data analysis included calculating proportions, their respective confidence intervals 95% and X² test for significance analysis was applied. Results: 17.4% of patients starting ART are women and the proportion has remained relatively constant. The highest proportion of new HIV cases are 30 and 39 years old, nevertheless the layer of 15-29 years demonstrates a significant increase from 21.7 to 36.4% in 2011-2015 especially in men. 12.1% of new cases are older than 50 years old with a stable trend over time; however, women over 50 have increased from 11.0 to 15.6%. Antiretroviral therapy initiation with CD4+ T lymphocytes less than 200 cells/mm³ has decreased from 79.7 to 42.4% and in stage C from 45.4 to 22.6%. Late presentation to antiretroviral therapy is higher in men but this gap has narrowed in the last five years. Pneumocystis jiroveci, wasting syndrome, tuberculosis, Kaposi’s sarcoma and esophageal candidiasis are the most common opportunistic diseases without significant changes in the three-year periods analyzed. In the last five years, 15.5% of opportunistic diseases occurs in patients with CD4+ TL > 200 cells/mm3. Discussion: Despite the limitations of observational studies present report describes the characteristics and evolution of the epidemics in Chile in the last 15 years. The infection occurs at younger ages in men, whereas in women there is an increase over 50 years old. Despite advances in treatment access have reduced late presentation to therapy, important challenges remain to achieve more timely initiation of antiretroviral therapy in accordance with WHO 90-90-90 goals.

Introducción: La Cohorte Chilena de SIDA es la más antigua y extensa de Latinoamérica y una de las más numerosas y con mayor tiempo de seguimiento a nivel internacional. Registra información de 14.873 pacientes de los aproximadamente 22.000 en TARV en el sistema público y sus resultados han permitido conocer la realidad nacional y han contribuido a la adopción de políticas públicas. El objetivo de este estudio es describir las características demográficas, clínicas e inmunológicas de los pacientes que han comenzado TARV en Chile y su evolución en los últimos 15 años. Pacientes y Métodos: Los casos fueron estratificados por quinquenios: 2001-2005, 2006-2010 y 2011-2015. El análisis de los datos incluyó el cálculo de proporciones, sus respectivos intervalos de confianza 95% y se aplicó test de X² para análisis de significación. Resultados: El 17,4% de los casos que inician TARV corresponde a mujeres y la proporción se ha mantenido relativamente constante. Por edad, destaca el grupo de adultos entre 30 y 39 años aunque el estrato de 15-29 años evidencia un importante aumento desde 21,7 a 36,4% en 2011-2015, especialmente en hombres. Un 12,1% del total de los inicios de TARV son mayores de 50 años con una tendencia estable en el tiempo; sin embargo, las mujeres mayores de 50 años han aumentado de 11,0 a 15,6%. El inicio de TARV con LT CD4 menor de 200 céls/mm³ ha disminuido desde 79,7 a 42,4% y en etapa C desde 45,4 a 22,6%. La presentación tardía a TARV es mayor en hombres pero esta diferencia se ha reducido en el último quinquenio. Neumonía por Pneumocystis jiroveci, síndrome consuntivo, tuberculosis, sarcoma de Kaposi y candidiasis esofágica son las enfermedades oportunistas más frecuentes sin cambios significativos en los tres quinquenios analizados. En el último quinquenio, 15,5% de las enfermedades oportunistas se presenta en pacientes con LT CD4 > 200 céls/mm³. Discusión: Pese a las limitaciones de los estudios observacionales el presente reporte describe las características y evolución de la epidemia en Chile en los últimos 15 años. La infección se presenta a edades más jóvenes en hombres, mientras que en mujeres hay un aumento en mayores de 50 años. Pese a los avances en acceso a tratamiento que han permitido reducir la presentación a tardía a terapia, aún persisten importantes desafíos para alcanzar un inicio de TARV más oportuno, en concordancia con las metas 90-90-90 de OMS.

[Evolution of epidemiological and clinical characteristics of adults patients belonging to the national program at start of antiretroviral therapy in the Chilean AIDS Cohort, 2001-2015]. / Evolución de las características epidemiológicas y clínicas de pacientes adultos del programa nacional al inicio de la terapia anti-retroviral en la Cohorte Chilena de SIDA, 2001-2015.

BACKGROUND: Chilean AIDS Cohort is the oldest and extensive in Latin America and one of most numerous and with longer follow up time to international level. Records information from 14,873 patients out of approximately 22,000 in antiretroviral therapy in the public system and its results have allowed to know the national reality and have contributed to the adoption of public policies. AIM: To describe the demographic, clinical and immunological characteristics of patients who have started ART in Chile and its evolution over the past 15 years. PATIENTS AND METHODS: The cases were stratified by five-year periods: 2001-2005, 2006-2010 and 2011-2015. The data analysis included calculating proportions, their respective confidence intervals 95% and X² test for significance analysis was applied. RESULTS: 17.4% of patients starting ART are women and the proportion has remained relatively constant. The highest proportion of new HIV cases are 30 and 39 years old, nevertheless the layer of 15-29 years demonstrates a significant increase from 21.7 to 36.4% in 2011-2015 especially in men. 12.1% of new cases are older than 50 years old with a stable trend over time; however, women over 50 have increased from 11.0 to 15.6%. Antiretroviral therapy initiation with CD4+ T lymphocytes less than 200 cells/mm³ has decreased from 79.7 to 42.4% and in stage C from 45.4 to 22.6%. Late presentation to antiretroviral therapy is higher in men but this gap has narrowed in the last five years. Pneumocystis jiroveci, wasting syndrome, tuberculosis, Kaposi's sarcoma and esophageal candidiasis are the most common opportunistic diseases without significant changes in the three-year periods analyzed. In the last five years, 15.5% of opportunistic diseases occurs in patients with CD4+ TL > 200 cells/mm3. DISCUSSION: Despite the limitations of observational studies present report describes the characteristics and evolution of the epidemics in Chile in the last 15 years. The infection occurs at younger ages in men, whereas in women there is an increase over 50 years old. Despite advances in treatment access have reduced late presentation to therapy, important challenges remain to achieve more timely initiation of antiretroviral therapy in accordance with WHO 90-90-90 goals.

Surgical site infection rates in 4 cities in Colombia: findings of the International Nosocomial Infection Control Consortium (INICC).

BACKGROUND: Surgical site infections (SSIs) are a threat to patient safety. However, there are no available data on SSI rates stratified by surgical procedure (SP) in Colombia. METHODS: From January 2008-December 2010, a prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in 4 hospitals in 4 cities within Colombia using the definitions of the Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN). SPs were classified into 10 types, according to ICD-9 criteria. RESULTS: We recorded 193 SSIs associated with 5,063 SPs. SSI rates per type of SP were the following, compared with INICC and CDC-NHSN rates, respectively: 9.1% for laminectomy (vs 1.7% and 1.0%), 8.3% for cardiac surgery (vs 5.6% and 1.3%), 3.9% for appendix surgery (vs 2.9% and 1.4%), 5.5% for abdominal hysterectomy (vs 2.7% and 1.6%), 4.4% for prostate surgery (vs 2.1% and 1.2%), 4.5% for spleen surgery (vs 5.6% and 2.3%), 4.3% for vaginal hysterectomy (vs 2.0% and 0.9%), and 3.0% for gallbladder surgery (vs 2.5% and 0.6%). CONCLUSIONS: Compared with CDC-NHSN rates, SSIs rates in our study hospitals were higher in most types of SPs, whereas compared with INICC, they were similar in 5 of the analyzed types, and higher in 4 types. This study represents an important advance toward knowledge of epidemiology in Colombia that will allow us to introduce targeted interventions.

Prevención de la transmisión vertical y efectos secundarios de la terapia anti-retroviral en hijos nacidos de madres seropositivas para VIH en el área Sur-Oriente de Santiago, Chile: perspectiva de 15 años / Prevention of vertical transmission and side effects of antiretroviral therapy in children born to HIV-positive South Eastern area of Santiago, Chile: 15-years perspective

Antiretroviral therapy (ART) has shown to be an effective measure in decreasing HIV vertical transmission (VT). Nevertheless, it is not free from adverse effects in the newborn: risk of prematurity, low birth weight, metabolic disorders, among others. Despite the importance of the subject, there are few national data that analyze the problem. We performed a retrospective analysis of a cohort of HIV positive mother/child binomial, followed between 1995 and 2010. Ninety-four pregnancies and 96 children (2 twin pregnancies) were analyzed. The rate of VT was 2.1%. Adverse effects attributed to ART were found on 85.4% of the newborn; highlighting the presence of anemia (70.8%) and several metabolic disorders [elevated lactate without acidosis (29.2%), lactic acidosis (12.5%), hyperkalemia (14.6%), metabolic acidosis (9.4%)]. Maternal exposure to protease inhibitors proved to be an independent risk factor for the development of metabolic disorders in newborns (OR 0.15 [0.04-0.48], p < 0.01). In our series, ART was effective in reducing the VT, however exposed newborns showed a high frequency of adverse effects, so it is advisable to implement programs for monitoring these patients to prevent sequelae.

La terapia anti-retroviral (TARV) es efectiva en disminuir la transmisión vertical (TV) del VIH, pero no está exenta de efectos adversos en los recién nacidos: riesgo de prematurez, bajo peso al nacer, alteraciones metabólicas y otros. Pese a lo relevante del tema, existen pocos datos nacionales que analicen el problema. Realizamos un estudio observacional, retrospectivo, de una serie de binomios madre infectada por VIH/hijo atendidos entre los años 1995 y 2010. Se analizaron 94 embarazos y 96 hijos (2 embarazos gemelares). La tasa de TV fue 2,1%. De los recién nacidos, 85,4% presentó efectos adversos atribuibles a la exposición a TARV destacando la presencia de anemia (70,8%) y alteraciones metabólicas varias [hiperlactacidemia sin acidosis (29,2%), acidosis láctica (12,5%), hiperkalemia (14,6%) y acidosis metabólica (9,4%). La exposición materna al uso de IP demostró ser un factor de riesgo independiente para el desarrollo de alteraciones metabólicas en los recién nacidos (OR 4 [1,58-10,12], p 0,003). En nuestra serie, la TARV demostró ser efectiva en reducir la TV. Sin embargo, los recién nacidos expuestos presentaron alta frecuencia de efectos adversos, por lo que es recomendable la implementación de programas de seguimiento de estos pacientes para prevenir secuelas.

Hypoglycemic effect of Bumelia sartorum polyphenolic rich extracts.

Bumelia sartorum (Sapotaceae) is used ethnomedicinally for treatment of several diseases, including diabetes mellitus. The aim of this work was to investigate the hypoglycemic effect of B. sartorum extracts, rich in polyphenolic compounds, and the possible mechanisms of action. Assessment of B. sartorum hypoglycemic activity was performed from the blood glucose level in normoglycemic mice after administration of the extract by oral gavage. The hypothesis that sarco/endoplasmic reticulum Ca(2+)-ATPase (SERCA) inhibition could prolong the increase in cytoplasmic Ca2+ concentration, thus leading to an increase of insulin release was evaluated. The enzyme inhibition was measured by ATP hydrolysis using SERCA1 isolated from rabbit skeletal muscle. The total content of phenolic compounds was determined by the Folin-Ciocalteau method. The ethyl acetate (EtOAc) partition and F5 fraction obtained from B. sartorum, both of them rich in polyphenolics, were shown to have a hypoglycemic effect on normoglycemic mice, more significant than that of the known antidiabetic drug, glibenclamide used as a standard comparable compound. Both samples significantly inhibited SERCA activity. Different extracts of B. sartorum, rich in polyphenolic compounds, were able to reduce blood glucose in normoglycemic mice and inhibit SERCA activity. SERCA inhibition may be one of the possible mechanisms involved in glucose decrease.

[Prevention of vertical transmission and side effects of antiretroviral therapy in children born to HIV-positive South Eastern area of Santiago, Chile: 15-years perspective]. / Prevención de la transmisión vertical y efectos secundarios de la terapia anti-retroviral en hijos nacidos de madres seropositivas para VIH en el área Sur-Oriente de Santiago, Chile: perspectiva de 15 años.

Antiretroviral therapy (ART) has shown to be an effective measure in decreasing HIV vertical transmission (VT). Nevertheless, it is not free from adverse effects in the newborn: risk of prematurity, low birth weight, metabolic disorders, among others. Despite the importance of the subject, there are few national data that analyze the problem. We performed a retrospective analysis of a cohort of HIV positive mother/child binomial, followed between 1995 and 2010. Ninety-four pregnancies and 96 children (2 twin pregnancies) were analyzed. The rate of VT was 2.1%. Adverse effects attributed to ART were found on 85.4% of the newborn; highlighting the presence of anemia (70.8%) and several metabolic disorders [elevated lactate without acidosis (29.2%), lactic acidosis (12.5%), hyperkalemia (14.6%), metabolic acidosis (9.4%)]. Maternal exposure to protease inhibitors proved to be an independent risk factor for the development of metabolic disorders in newborns (OR 0.15 [0.04-0.48], p < 0.01). In our series, ART was effective in reducing the VT, however exposed newborns showed a high frequency of adverse effects, so it is advisable to implement programs for monitoring these patients to prevent sequelae.

Reduced brain insulin-like growth factor I function during aging.

Peripheral insulin-like growth factor I (IGF-I) function progressively deteriorates with age. However, whereas deterioration of IGF-I function in the aged brain seems probable, it has not been directly addressed yet. Because serum IGF-I can enter into the brain through the cerebrospinal fluid (CSF), we examined this route of entrance in aged mice. To distinguish endogenous murine IGF-I from exogenously applied IGF-I, we used human IGF-I. We found that after intraperitoneous injection, CSF levels of human IGF-I were significantly higher in old mice (2 year-old) as compared to young ones (4-month-old). In spite of this increase capacity to take IGF-I from the circulation, brain and plasma IGF-I levels were reduced in naive old mice. Moreover, IGF-I signaling was deteriorated in the brain of aged animals. Basal as well as IGF-I-induced activation of the brain IGF-I receptor/Akt/GSK3 pathway was markedly reduced even though old mice have higher levels of brain IGF-I receptors. These data suggest that increases in brain IGF-I receptors and in the capacity to take up serum IGF-I result ineffective because IGF-I function is reduced and aged mice are cognitively impaired, a trait dependant on preserved serum IGF-I input to the brain.

Taenia crassiceps: A secretion-substance of low molecular weight leads to disruption and apoptosis of seminiferous epithelium cells in male mice.

The present research was performed to isolate and study the effects of a low molecular weight (<1300Da) parasite-associated substance, obtained from peritoneal fluids of female mice infected with Taenia crassiceps cysticerci, on seminiferous epithelium cells of male mice testis. The results showed an intense disruption of Sertoli cells and germ cells within the seminiferous tubules of experimental mice, along with the destruction of their gap junction (GJ). Significant generalized apoptosis of germ cells within seminiferous tubules was determined by TUNEL staining (P=0.0159). In addition, a significant number of infiltrating macrophages were found in the luminal space of these seminiferous tubules (P<0.0001). Finally, electron microscopy studies revealed structural and morphological abnormalities in the somatic cells (Sertoli and Leydig cells) and in the germ cells, primarily in the round and elongate spermatids.

Taenia crassiceps: infections of male mice lead to severe disruption of seminiferous tubule cells and increased apoptosis.

This research was carried out to study the effects of infection with Taenia crassiceps cysticerci on the seminiferous epithelium histoarchitecture in the testes of male mice. Our results showed a severe disruption of the histoarchitecture of the testis epithelium in infected mice. In these animals, a significant infiltration of macrophages within seminiferous tubules was observed (P < 0.001). Generalized apoptosis of germ cells within the seminiferous tubules was observed, as assessed by TUNEL assay and apoptotic nuclei were quantified. The total number of fluorescent objects (DNA) (including clusters, singles, and objects in clusters) was significantly higher in the infected cells than in the control group (P = 0.0286). Observation of the interstitial tissue showed disorder and deterioration of many Leydig cells of infected mice, as well as intense vacuolization and destruction of their inter-cellular junctions. Several ultrastructural abnormalities were observed through electron microscopy as well. The observed pathology could lead to a state of infertility.

La integración docente, asistencial e investigativa en la Atención Primaria de Salud / The teaching, healthcare and research integration in Primary Health Care

Se realizó un trabajo de revisión para expresar las principales realidades acerca de la fusión docente, asistencial e investigativa en la Atención Primaria de Salud, relacionar los principales factores que influyen en este proceso y proponer algunas medidas que pudieran contribuir a mejorarlo. Se revisaron documentos oficiales de la Dirección de Ciencia y Técnica del Ministerio de Salud Pública, los principales planteamientos de un grupo de expertos formado para la discusión del tema por la dirección del Ministerio y materiales bibliográficos recientes. Existen un grupo de dificultades que impiden que se logre una investigación a la altura de la calidad del proceso docente que se lleva a cabo. Es necesaria la preparación de los directivos de forma integral, una estructura adecuada, organización de los procesos, análisis de salud y diagnósticos situacionales adecuados, motivación, estimulación, estabilidad del personal, preparación metodológica y recursos, entre otras necesidades imprescindibles. La inclusión de los tres procesos en un único sistema de trabajo a los cuales se le da la misma prioridad para llegar al mismo fin, es la clave del éxito. La docencia y la asistencia médica tienen un desarrollo mayor en la atención primaria de salud que la investigación. Esta última se ha ido desarrollando en todos los niveles del sistema, pero la integración docente, asistencial e investigativa es hoy un principio que se da en un grado cualitativamente inferior al que debía, de acuerdo a las potencialidades de los recursos humanos con los que cuenta el sistema de atención primaria(AU)

A review paper was carried out to express the main realities on the teaching, healthcare and research fusion in Primary Health Care, to relate the main factors influencing in this process and to propose some measures that may to contribute to its improvement. Authors made a review of the official documents from the Science and Technique Management of Public Health Ministry, the main proposals of a trained group of experts to discuss this subject by the management of above mentioned Ministry as well as a recent bibliographic material. There are some difficulties avoiding the achievement of a research on a par with the quality of the ongoing teaching process. It is necessary the integral training of the managers, a appropriate structure, processes organization, health analysis and adequate locating diagnosis, motivation, stimulation, staff stability, methodological training and resources among other indispensable needs. Inclusion of the three processes in a only-work system with a maximal priority to achieve the same objective, is the success key. Teaching and medical attention have a great development in primary health care than research. This latter is ongoing at all system levels but the teaching; healthcare and research integration is nowadays a principle with a qualitative degree lower than the necessary, according to potentials of human resources available for the primary care system(AU)

La integración docente, asistencial e investigativa en la Atención Primaria de Salud / The teaching, healthcare and research integration in Primary Health Care

Se realizó un trabajo de revisión para expresar las principales realidades acerca de la fusión docente, asistencial e investigativa en la Atención Primaria de Salud, relacionar los principales factores que influyen en este proceso y proponer algunas medidas que pudieran contribuir a mejorarlo. Se revisaron documentos oficiales de la Dirección de Ciencia y Técnica del Ministerio de Salud Pública, los principales planteamientos de un grupo de expertos formado para la discusión del tema por la dirección del Ministerio y materiales bibliográficos recientes. Existen un grupo de dificultades que impiden que se logre una investigación a la altura de la calidad del proceso docente que se lleva a cabo. Es necesaria la preparación de los directivos de forma integral, una estructura adecuada, organización de los procesos, análisis de salud y diagnósticos situacionales adecuados, motivación, estimulación, estabilidad del personal, preparación metodológica y recursos, entre otras necesidades imprescindibles. La inclusión de los tres procesos en un único sistema de trabajo a los cuales se le da la misma prioridad para llegar al mismo fin, es la clave del éxito. La docencia y la asistencia médica tienen un desarrollo mayor en la atención primaria de salud que la investigación. Esta última se ha ido desarrollando en todos los niveles del sistema, pero la integración docente, asistencial e investigativa es hoy un principio que se da en un grado cualitativamente inferior al que debía, de acuerdo a las potencialidades de los recursos humanos con los que cuenta el sistema de atención primaria

A review paper was carried out to express the main realities on the teaching, healthcare and research fusion in Primary Health Care, to relate the main factors influencing in this process and to propose some measures that may to contribute to its improvement. Authors made a review of the official documents from the Science and Technique Management of Public Health Ministry, the main proposals of a trained group of experts to discuss this subject by the management of above mentioned Ministry as well as a recent bibliographic material. There are some difficulties avoiding the achievement of a research on a par with the quality of the ongoing teaching process. It is necessary the integral training of the managers, a appropriate structure, processes organization, health analysis and adequate locating diagnosis, motivation, stimulation, staff stability, methodological training and resources among other indispensable needs. Inclusion of the three processes in a only-work system with a maximal priority to achieve the same objective, is the success key. Teaching and medical attention have a great development in primary health care than research. This latter is ongoing at all system levels but the teaching; healthcare and research integration is nowadays a principle with a qualitative degree lower than the necessary, according to potentials of human resources available for the primary care system

Estudio cuali-cuantitativo de la mortalidad femenina por causas externas y su relación con la violencia de género / A quali-quantitative study of female mortality due to external causes and its relationship with gender-based violence

RESUMEN. En los últimos años, ha crecido el interés por las causas de violencia de género contra las mujeres en Argentina. OBJETIVO: obtener un cuadro de situación agregado y actualizado sobre esta problemática, visualizar su peso y gravedad e identificar las consecuencias en salud que produce. MÉTODO: estudio cuali-cuantitativo, descriptivo y exploratorio en tres etapas: 1) Se realizó un mapeo nacional de la mortalidad de las mujeres por causas externas a partir de las estadísticas vitales nacionales y de estadísticas policiales. Se desagregaron datos sobre suicidios, homicidios y accidentes, y se relacionaron los resultados entre jurisdicciones con el fin de establecer heterogeneidades regionales en el mapeo. 2) Se relevaron las noticias sobre casos de muertes por causas externas que se vincularon con situaciones de violencia hacia las mujeres en los principales diarios del país durante 2005. 3) Se relevaron los registros de casos de violencia contra mujeres en el Hospital Álvarez de Buenos Aires. RESULTADOS: las principales causas de suicidio en mujeres relevadas en estadísticas vitales oficiales son por ahorcamiento y por utilización de armas de fuego, en tanto que para los forenses estas causas son las menos frecuentes. CONCLUSIONES: algunos casos consignados como suicidios podrían en realidad tratarse de femicidios, hipótesis que requiere de futuras investigaciones específicas.

ABSTRACT. In recent years, has increased interest in the causes of gender violence against women in Argentina. OBJECTIVE: to get a picture of the situation added and updated on this issue, evaluate their weight and gravity and identify the health consequences it produces. METHOD: qualitative and quantitative, descriptive, exploratory study in 3 stages:1) A national mapping of mortality from external causes women was built with national vital statistics and policestatistics. Data on suicides, homicides and accidents were disaggregated, and outcomes compared between jurisdiction sin order to establish regional heterogeneities in themapping. 2) News on deaths from external causes related to situations of violence against women were analyzed in 4 major newspapers. 3) Search of records of violence against women in a public hospital in Buenos Aires city. RESULTS: the more frequent causes of suicide in women from the vital statistics are by hanging and use of firearms For the forensics, these causes are the less frequent ones. CONCLUSIONS: it can be suspected that some cases considered assuicides would actually be femicide cases. This hypothesis should be verified in future research.

El sistema de ciencia e innovación tecnológica en salud y su universalización a todo el sistema nacional de salud / Science and technologic innovate system and its extension to all health national system

La incorporación progresiva de los policlínicos y otras unidades de la atención primaria de salud, como escenarios idóneos para la formación de los recursos humanos que necesita el sistema y la transformación de los policlínicos docentes en policlínicos facultad, garantizan una formación más pertinente, lo que propicia un ambiente universitario en dichas unidades que requiere de la actividad científico-técnica tanto en el pregrado como en el posgrado. La extensión de la investigación científica en salud es imprescindible dado el desarrollo alcanzado por el sistema nacional de salud, y conlleva a que constituya una necesidad y una inversión para todo el sistema, un elemento de futuro. Para ello se constituyó un grupo de expertos que identificó los problemas presentes en el sistema nacional de salud y en la atención primaria de salud para la extensión del sistema de ciencia e innovación tecnológica. Se elaboró un plan de medidas que originó acciones para superar los problemas identificados cuya ejecución se inició en el último trimestre de 2008 y debe concluir en su proceso organizativo en el 2009. Se concluye que el trabajo de la ciencia e innovación tecnológica requiere tanto de estructura como de logística para la ejecución de sus procesos y la obtención de resultados científico-técnicos de alto valor agregado(AU)

The progressive incorporation of polyclinics and other primary health care units, as suitable scenarios for training of human resources needing a system and a transformation of teaching polyclinic in Faculty units, to guarantees a more appropriate training system, allowing a university environment in such units requiring of scientific-technologic activity in pregraduate and in postgraduate stage. Extension of scientific health research is essential by the development achieved by national health system, a future element. Thus, an expert group was designed who identified current problems in health national system, and the health primary care to extend the science and technologic innovation system. We create a measure plan causing actions to overcome identified problems whose execution was started in last trimester of 2008, and that must to conclude in its organizing process in the 2009. We conclude that the task of science and technologic innovation requires a logistic structure to execute processes, and the achievement of scientific-technologic results of a high aggregate value(AU)

El sistema de ciencia e innovación tecnológica en salud y su universalización a todo el sistema nacional de salud: [revisión] / Science and technologic innovate system and its extension to all health national system: [review]

La incorporación progresiva de los policlínicos y otras unidades de la atención primaria de salud, como escenarios idóneos para la formación de los recursos humanos que necesita el sistema y la transformación de los policlínicos docentes en policlínicos facultad, garantizan una formación más pertinente, lo que propicia un ambiente universitario en dichas unidades que requiere de la actividad científico-técnica tanto en el pregrado como en el posgrado...

The progressive incorporation of polyclinics and other primary health care units, as suitable scenarios for training of human resources needing a system and a transformation of teaching polyclinic in Faculty units, to guarantees a more appropriate training system, allowing a university environment in such units requiring of scientific-technologic activity in pregraduate and in postgraduate stage...

Quinolinate-induced rat striatal excitotoxicity impairs endoplasmic reticulum Ca2+-ATPase function.

Excessive activation of NMDA glutamate receptors and the resulting loss of intracellular Ca(2+) homeostasis may be lethal (excitotoxic) to neurons. Such excitotoxicity can be induced in vivo by intrastriatal infusion of quinolinate, as this substance selectively activates NMDA receptors. The aim of the present research was to investigate whether the in vivo treatment of striatal tissue with quinolinate would lead to an early impairment of sarco/endoplasmic reticulum Ca(2+)-ATPase (SERCA) activity or mitochondrial Ca(2+) sequestration, two intracellular mechanisms involved in Ca(2+) homeostasis and signaling. Sodium quinolinate was infused intrastriatally into adult rats, and 6 h later the brains were removed and the corpora striata dissected. At this time point, striatal sections stained with Fluoro-Jade, a cellular marker of cell death, showed initial signs of neuronal degeneration. In addition, SERCA activity decreased 39% in relation to the activity observed in the control striata. A corresponding decrease of the same magnitude in (45)Ca(2+) uptake by striatal microsomes was also found in the treated striata. Western blot analysis did not indicate any decrease in SERCA levels in striatal tissue after quinolinate infusion. Mitochondrial Ca(2+) sequestration was still preserved in quinolinate-treated striatal tissue when the assay was carried out in the presence of physiological concentrations of ATP and Mg(2+). These results suggest that impairment of the SERCA function may be an early event in excitotoxicity.

SILMARILL: una interfaz para el desarrollo de la ciencia y la innovación en la provincia Holguín / SILMARILL: an Interface for the development of science and innovation in the province of Holguín

La aparición del Sistema de Ciencia e Innovación Tecnológica (SCIT) favoreció la planificación del trabajo por proyectos del Laboratorio de Cultivo de Tejidos del Centro de Investigaciones y Servicios Ambientales y Tecnológicos de Holguín, Cuba. La experiencia previa, acumulada por el laboratorio en la tecnología de elaboración y gerencia de proyectos, posibilitó entonces la creación de un servicio para asistir a otras instituciones en esta esfera, denominado Servicio de análisis y elaboración de proyectos de Ciencia e Innovación (SILMARILL). Se describe y analiza el impacto del servicio, estructurado en ocho etapas: planificación, recolección, análisis, producción, protección, diseminación, conservación y evaluación(AU)

SILMARILL: una interfaz para el desarrollo de la ciencia y la innovación en la provincia Holguín / SILMARILL: an Interface for the development of science and innovation in the province of Holguín

La aparición del Sistema de Ciencia e Innovación Tecnológica (SCIT) favoreció la planificación del trabajo por proyectos del Laboratorio de Cultivo de Tejidos del Centro de Investigaciones y Servicios Ambientales y Tecnológicos de Holguín, Cuba. La experiencia previa, acumulada por el laboratorio en la tecnología de elaboración y gerencia de proyectos, posibilitó entonces la creación de un servicio para asistir a otras instituciones en esta esfera, denominado Servicio de análisis y elaboración de proyectos de Ciencia e Innovación (SILMARILL). Se describe y analiza el impacto del servicio, estructurado en ocho etapas: planificación, recolección, análisis, producción, protección, diseminación, conservación y evaluación

The establishment of the System of Science and Technological Innovation (SSTI) favored the planning of the work by projects of the Tissue Cultivation Laboratory of the Center of Research and Technological and Environmental Services of Holguín, Cuba. The previous experience, accumulated by the laboratory in the elaboration technology and project management, enabled the creation of a service to assist other institutions in this sphere, called Service of Analysis and Elaboration of Science and Innovation Projects (SILMARILL). It is described and analyzed the impact of the service, structured in eight phases: planning, collection, analysis, production, protection, dissemination, conservation and evaluation...

Ca2+-transport in sea urchin unfertilized eggs: regulation by endogenous sulfated polysaccharides and K+.

Previous data from our laboratory showed that the reticulum of the sea cucumber smooth muscle body wall retains both a sarco/endoplasmic reticulum Ca(2+)-ATPase (SERCA) and a sulfated polysaccharide. In this invertebrate, the transport of Ca(2+) by the SERCA is naturally inhibited by these endogenous sulfated polysaccharides. The inhibition is reverted by K(+) leading to an enhancement of the Ca(2+) transport rate. We now show that vesicles derived from the endoplasmic reticulum of unfertilized eggs from the sea urchin Arbacia lixula retain a SERCA that is able to transport Ca(2+) at the expense of ATP hydrolysis. As described for the sea cucumber SERCA isoform, the enzyme from the sea urchin is activated by K(+) but not by Li(+) and is inhibited by thapsigargin, a specific inhibitor of SERCA. A new sulfated polysaccharide was identified in the sea urchin eggs reticulum composed mainly by galactose, glucose, hexosamine and manose. After extraction and purification, this sulfated polysaccharide was able to inhibit the mammal SERCA isoform found in rabbit skeletal muscle and the inhibition is reversed by K(+). These data suggest that the regulation of the SERCA pump by K(+) and sulfated polysaccharides is not restricted to few marine invertebrates but is widespread.