Salmonella in Chicken and Pork Meat as a Likely Major Contributor to Foodborne Illness in Peru.

Nontyphoidal Salmonella is one of the major causes of self-limiting diarrheal disease and the most common foodborne pathogen worldwide. It is an important contributor to the burden of foodborne illness in South America, including Peru, where chicken and pork are important vehicles for Salmonella infection. Salmonella infections are underreported, particularly in low- and middle-income countries where concerted action tackling Salmonella along the chicken and pork chains, from primary production to retail, is urgently needed. To support and inform the implementation of new strategies to reduce Salmonella contamination of chicken and pork, this study describes the frequency and distribution of foodborne outbreaks attributed to Salmonella in Peru and evaluates the level of Salmonella in chicken and pork meat sold in markets of three regions of Peru. To that end, we analyzed historical reports of foodborne outbreaks, levels of Salmonella in chicken and pork sold in markets, and the number of mesophiles in the collected meat samples. As a result, the microbiological analysis reveals a widespread contamination of chicken (77.1%) and pork (26.8%) with Salmonella. It also pinpoints Salmonella as the causative agent in nearly half of the outbreaks (47.0%) where the potential origin is identified over a 11-year period with chicken, mayonnaise, and pork being the most likely food vehicles. These results suggest that Salmonella is a major contributor to foodborne illness in Peru and that the monitoring of mesophiles could be a good strategy for surveillance, generating data to support source attribution studies and ultimately evidence-informed policies.

Epidemiological Characteristics of Deaths from COVID-19 in Peru during the Initial Pandemic Response.

BACKGROUND AND AIM: Peru is the country with the highest mortality rate from COVID-19 globally, so the analysis of the characteristics of deaths is of national and international interest. The aim was to determine the epidemiological characteristics of deaths from COVID-19 in Peru from 28 March to 21 May 2020. METHODS: Deaths from various sources were investigated, including the COVID-19 Epidemiological Surveillance and the National System of Deaths (SINADEF). In all, 3851 deaths that met the definition of a confirmed case and had a positive result of RT-PCR or rapid test IgM/IgG, were considered for the analysis. We obtained the epidemiological variables and carried out an analysis of time defined as the pre-hospital time from the onset of symptoms to hospitalization, and hospital time from the date of hospitalization to death. RESULTS: Deaths were more frequent in males (72.0%), seniors (68.8%) and residents of the region of Lima (42.7%). In 17.8% of cases, the death occurred out-of-hospital, and 31.4% had some comorbidity. The median of pre-hospital time was 7 days (IQR: 4.0-9.0) and for the hospital time was 5 days (IQR: 3.0-9.0). The multivariable analysis with Poisson regression with robust variance found that the age group, comorbidity diagnosis and the region of origin significantly influenced pre-hospital time; while sex, comorbidity diagnosis, healthcare provider and the region of origin significantly influenced hospital time. CONCLUSION: Deaths occurred mainly in males, seniors and on the coast, with considerable out-of-hospital deaths. Pre-hospital time was affected by age group, the diagnosis of comorbidities and the region of origin; while, hospital time was influenced by gender, the diagnosis of comorbidities, healthcare provider and the region of origin.

Hospitalization, death, and probable reinfection in Peruvian healthcare workers infected with SARS-CoV-2: a national retrospective cohort study.

BACKGROUND: Peru has some of the worst outcomes worldwide as a result of the SARS-CoV-2 pandemic; it is presumed that this has also affected healthcare workers. This study aimed to establish whether occupation and other non-occupational variables were risk factors for possible reinfection, hospitalization, and mortality from COVID-19 in cohorts of Peruvian healthcare workers infected with SARS-CoV-2. METHODS: Retrospective cohort study. Healthcare workers who presented SARS-CoV-2 infection between March 1, 2020, and August 6, 2021, were included. Occupational cohorts were reconstructed from the following sources of information: National Epidemiological Surveillance System, molecular tests (NETLAB), results of serology and antigen tests (SICOVID-19), National Registry of Health Personnel (INFORHUS), and National Information System of Deaths (SINADEF). The incidence of probable reinfection, hospitalization, and death from COVID-19 was obtained in the cohorts of technicians and health assistants, nursing staff, midwives, dentists, doctors, and other healthcare workers. We evaluated whether the occupation and other non-occupational variables were risk factors for probable reinfection, hospitalization, and death from COVID-19 using log-binomial and probit binomial models, obtaining the adjusted relative risk (RRAJ). RESULTS: 90,398 healthcare workers were included in the study. Most cases were seen in technicians and health assistants (38.6%), and nursing staff (25.6%). 8.1% required hospitalization, 1.7% died from COVID-19, and 1.8% had probable reinfection. A similar incidence of probable reinfection was found in the six cohorts (1.7-1.9%). Doctors had a higher incidence of hospitalization (13.2%) and death (2.6%); however, they were also those who presented greater susceptibility linked to non-occupational variables (age and comorbidities). The multivariate analysis found that doctors (RRAJ = 1.720; CI 95: 1.569-1.886) had a higher risk of hospitalization and that the occupation of technician and health assistant was the only one that constituted a risk factor for mortality from COVID-19 (RRAJ = 1.256; 95% CI: 1.043-1.512). CONCLUSIONS: Peruvian technicians and health assistants would have a higher risk of death from COVID-19 than other healthcare workers, while doctors have a higher incidence of death probably linked to the high frequency of non-occupational risk factors. Doctors present a higher risk of hospitalization independent of comorbidities and age; likewise, all occupations show a similar risk of probable reinfection.

Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 Reinfections After a Second Wave With Predominance of Lambda in Lima and Callao, Peru.

Background: Coronavirus disease 2019 (COVID-19) infection is a major public health problem in the world and reinfections are becoming more frequent. Our main objective was to describe the epidemiological, clinical, and genomic characteristics of the confirmed cases of reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the capital of Lima and Callao, Peru. Methods: We searched in the Peruvian laboratory information system from April 2020 up to May 2021, looking for cases having 2 positive molecular tests for SARS-CoV-2 with more than 90 days between them. We performed genomic sequencing to the available pairs of samples and described the clinical characteristics, epidemiological impact, and genomic analysis of the confirmed reinfections. Results: There were 1 694 164 people with a positive diagnostic test for SARS-CoV-2 in Lima/Callao during the study period. Of these, 1695 had 2 positive molecular tests with more than 90 days between them. Two hundred eleven had both samples available for genomic analysis according to our selection criteria, and these were retrieved and submitted to sequencing. Thirty cases were confirmed to be SARS-CoV-2 reinfections with 2 different lineages in the 2 episodes. The variant Lambda (C.37) was the most common during the second infection and accounted for 19 (63.3%) of the 30 cases. Conclusions: We report 30 cases of confirmed SARS-CoV-2 reinfections. The Lambda variant was the most common cause of the second infections, in concordance with its predominant circulation during Peru's second wave. This report describes the largest series of confirmed reinfections by SARS-CoV-2 in Latin America.We describe the epidemiological, clinical, and genomic characteristics of the confirmed cases of reinfection by severe acute respiratory syndrome coronavirus 2 in Lima and Callao, durante la segunda ola en Peru. The Lambda variant (C.37) was the most common cause of the second infections.

Organic matter mineralization in modern and ancient ferruginous sediments.

Deposition of ferruginous sediment was widespread during the Archaean and Proterozoic Eons, playing an important role in global biogeochemical cycling. Knowledge of organic matter mineralization in such sediment, however, remains mostly conceptual, as modern ferruginous analogs are largely unstudied. Here we show that in sediment of ferruginous Lake Towuti, Indonesia, methanogenesis dominates organic matter mineralization despite highly abundant reactive ferric iron phases like goethite that persist throughout the sediment. Ferric iron can thus be buried over geologic timescales even in the presence of labile organic carbon. Coexistence of ferric iron with millimolar concentrations of methane further demonstrates lack of iron-dependent methane oxidation. With negligible methane oxidation, methane diffuses from the sediment into overlying waters where it can be oxidized with oxygen or escape to the atmosphere. In low-oxygen ferruginous Archaean and Proterozoic oceans, therefore, sedimentary methane production was likely favored with strong potential to influence Earth's early climate.

Eficacia de la Litotripsia Extracorpórea por Ondas de Choque en el tratamiento de litiasis renal en el Servicio de Endourología del Hospital José Carrasco Arteaga. Bienio 2015-2016 / Efficacy of Extracorporeal Shock Wave Therapy as a treatment for nephrolithiasis at the Endourology Service of Hospital Jose Carrasco Arteaga. Biennium 2015-2016.

INTRODUCCIÓN: La litiasis renal es la tercera patología urológica más frecuente, después de las infecciones y la patología prostática. Una de las opciones de tratamiento es la litotripsia extracorpórea por ondas de choque (LEOCH); se trata de una técnica mínimamente invasiva, de fácil repetición, efectiva, de baja morbilidad y bajo costo. El objetivo del presente estudio fue mostrar la eficacia de la LEOCH en el tratamiento de litiasis renal y su asociación con diferentes factores. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo, observacional, de corte transversal, con datos retrospectivos, con pacientes diagnosticados de litiasis renal, que recibieron tratamiento con LEOCH en el Servicio de Endourología del Hospital José Carrasco Arteaga, durante los años 2015 y 2016. La muestra fue de 146 pacientes. La información se obtuvo de las historias clínicas de los pacientes. Para el análisis, se empleó el programa SPSS v19.0. Los resultados se mostraron a través de frecuencias y porcentajes en tablas, se aplicó Chi cuadrado para medir la asociación entre las variables. RESULTADOS: La ubicación de los litos fue principalmente intrarenal y del lado izquierdo. El tamaño medio de los cálculos fue de 12.66 mm y la densidad media de 996.97UI. Al control tomográfico posterior a la LEOCH, en el 22.6% de los pacientes se destruyó totalmente el lito y en casi un tercio de los pacientes no se apreciaron cambios. Luego de la LEOCH, la mayoría de los pacientes recibieron tratamiento expulsivo. 97% de los pacientes no tuvieron complicaciones. CONCLUSIÓN: La efectividad de la LEOCH disminuyó con la edad, en las mujeres resultó igualmente menos eficaz, aunque las diferencias no fueron significativas. La ubicación del lito, así como su tamaño resultaron tener asociación estadísticamente significativa con la efectividad del tratamiento; los litos ureterales y pequeños se destruyeron completamente con mayor frecuencia que los renales y de gran tamaño. La densidad no mostró relación significativa con la efectividad de la LEOCH.

BACKGROUND: nephrolithiasis is the third most common urological pathology, followed by infections and prostatic pathologies. One of the treatment options is extracorporeal shock wave therapy (ESWT); it is a minimally invasive technique, easy to repeat, effective, with low morbidity and low cost. The aim of this study was to demonstrate the effectiveness of ESWT as a treatment for nephrolithiasis and its association with some factors. METHODS: We carried out a descriptive, observational, cross-sectional study with retrospective data, with patients diagnosed of nephrolithiasis and treated with ESWT at the Endourology Service of Hospital José Carrasco Arteaga, during the years 2015 and 2016. The sample was constituted of 146 patients. Data was Results are shown with frequencies and percentages in charts, Chi square was applied to measure the association between variables. RESULTS: The location of the stones was mainly intrarenal and on the left side. The mean size of the stones was 12.66 mm and the mean density was 996.97IU. After ESWT, tomographic control reported complete destruction of the stone in 22.6% of the patients and in almost a third of the patients there were no changes. After ESWL, most of the patients received expulsive treatment. 97% of the patients had no complications. CONCLUSION: The effectiveness of ESWL decreased with age, also it was less effective in women, but the association was not statistically significant. The location of the stone, and its size had statistically significant association with the effectiveness of the treatment; ureteral and small stones were completely destroyed more frequently than renal and big stones. The stone density had no association with LEOCH effectiveness.

Caso raro: trauma penetrante craneoencefálico por un cuchillo. Actualización del diagnóstico y tratamiento / Rare case: penetrating head trauma by a knife. Diagnosis and treatment update

El trauma penetrante craneoencefálico representa alrededor del 0.4% de los casos, pocos son los descritos en la literatura, por lo cual, no existe un manejo protocolizado del mismo.Describimos un caso de un paciente masculino de 24 años que sufre un trauma penetrante a nivel de región parietal izquierda con arma blanca "cuchillo", dejando incrustada la hoja del mismo. La Tomografía computarizada simple de cráneo con reconstrucción en 3 dimensiones más angiografía, confirma el diagnóstico y descarta el compromiso vascular. Se realiza la extirpación completa del cuerpo extraño, sin complicaciones. Evolución favorable con mejoría de la sintomatología neurológica al alta.Este tipo de trauma es una emergencia que puede poner en riesgo la vida del paciente dependiendo del área afectada. La extirpación del cuerpo extraño debe realizarse en un medio hospitalario por la afectación de grandes vasos. Se debe tener una alta sospecha diagnóstica asociada al antecedente.

Craneoencephalic penetrating trauma represents about 0.4% of cases, few are described in the literature, therefore, there is no protocolized management of them.We describe a case of a 24-year-old male patient who suffers penetrating trauma at left parietal region with a "knife", leaving the blade embedded. Simple Computed Tomography of the Skull with Reconstruction in 3 dimensions plus angiography, confirms the diagnosis without vascular compromise. The complete removal of the foreign body was performed, without complications. Evolution is favorable and was discharged with improvement neurological symptoms.This type of trauma is an emergency that can put the life at risk depending on the affected area. The removal of the foreign body must be performed in a hospital environment due to the involvement of large vessels. There must be a high diagnostic suspicion associated with the antecedent.

Reporte de Caso Clínico: Linfangioma quístico de epiplón / Case Report: Cystic lymphangioma of the omentum

INTRODUCCIÓN: El linfangioma mesentérico es un tumor quístico congénito, benigno y raro de los vasos linfáticos, que se presenta en menos del 5% de los casos a nivel abdominal. Se presentan con mayor frecuencia durante la infancia. Esta patología se debe considerar como diagnóstico diferencial de abdomen agudo y masas abdominales pediátricas. CASO CLÍNICO: Niño de 6 años de edad, presentó cuadro de dolor abdominal y peritonismo. Presentó febrícula, signo de rebote positivo, además leucocitosis y neutrofilia. Ecografía evidenció abundante líquido libre en abdomen y pelvis. EVOLUCIÓN: Se realizó laparotomía exploratoria, con hallazgo de masa quística dependiente de epiplón mayor, la misma que se resecó. La histopatología fue negativa para malignidad y compatible con linfangioma quístico, la inmunohistoquímica con marcador D2-40 positi-vo. El paciente evolucionó favorablemente sin complicaciones quirúrgicas y sin evidencia de recurrencia hasta el año de seguimiento. CONCLUSION: El linfangioma quístico mesentérico puede debutar con sintomatología de abdomen agudo, puede también tener una evolución crónica. La resección completa es el tratamiento de elección, actualmente se realizan procedimientos mínimamente invasivos, con resultados favorables. La ecografía es útil para realizar un seguimiento a largo plazo.(AU)

BACKGROUND: Mesenteric lymphangioma is a rare, benign congenital cystic tumor of the lym-phatic vessels, which occurs in less than 5% pf the cases at the abdomen. They appear most often during childhood. This tumor should be considered as a differential diagnosis of acute abdomen and other abdominal masses. CASE REPORT: A 6-year-old boy presented with abdominal pain and peritonism. He presented a low-grade fever, a positive rebound sign, as well as leukocytosis and neutrophilia. Ultrasono-graphy showed abundant free fluid in abdomen and pelvis. EVOLUTION: Exploratory laparotomy was performed, finding a cystic mass dependent on the greater omentum, this mass was resected. Histopathology was negative for malignancy and compatible with cystic lymphangioma, immunohistochemistry was positive for D2-40 marker. The patient evolved favorably without surgical complications and without evidence of recurrence up to one year of follow-up. CONCLUSION: Mesenteric cystic lymphangioma can present with symptoms of acute abdomen, it can also have a chronic evolution. Complete resection is the treatment of choice, currently minimally invasive procedures are performed with favorable results. Ultrasound is useful for long-term follow-up.(AU)

Meteorological factors and childhood diarrhea in Peru, 2005-2015: a time series analysis of historic associations, with implications for climate change.

BACKGROUND: Global temperatures are projected to rise by ≥2 °C by the end of the century, with expected impacts on infectious disease incidence. Establishing the historic relationship between temperature and childhood diarrhea is important to inform future vulnerability under projected climate change scenarios. METHODS: We compiled a national dataset from Peruvian government data sources, including weekly diarrhea surveillance records, annual administered doses of rotavirus vaccination, annual piped water access estimates, and daily temperature estimates. We used generalized estimating equations to quantify the association between ambient temperature and childhood (< 5 years) weekly reported clinic visits for diarrhea from 2005 to 2015 in 194 of 195 Peruvian provinces. We estimated the combined effect of the mean daily high temperature lagged 1, 2, and 3 weeks, in the eras before (2005-2009) and after (2010-2015) widespread rotavirus vaccination in Peru and examined the influence of varying levels of piped water access. RESULTS: Nationally, an increase of 1 °C in the temperature across the three prior weeks was associated with a 3.8% higher rate of childhood clinic visits for diarrhea [incidence rate ratio (IRR): 1.04, 95% confidence interval (CI): 1.03-1.04]. Controlling for temperature, there was a significantly higher incidence rate of childhood diarrhea clinic visits during moderate/strong El Niño events (IRR: 1.03, 95% CI: 1.01-1.04) and during the dry season (IRR: 1.01, 95% CI: 1.00-1.03). Nationally, there was no evidence that the association between temperature and the childhood diarrhea rate changed between the pre- and post-rotavirus vaccine eras, or that higher levels of access to piped water mitigated the effects of temperature on the childhood diarrhea rate. CONCLUSIONS: Higher temperatures and intensifying El Niño events that may result from climate change could increase clinic visits for childhood diarrhea in Peru. Findings underscore the importance of considering climate in assessments of childhood diarrhea in Peru and globally, and can inform regional vulnerability assessments and mitigation planning efforts.

Contaminación del aire y su influencia en la incidencia de enfermedades respiratorias en Santa Elena Ecuador 2020 / Air pollution and its influence on the incidence of respiratory diseases in Santa Elena Ecuador 2020

El uso de combustibles sólidos para cocinar representa el principal riesgo ambiental en América, afectando a 90 millones de personas y causando el fallecimiento de 83.000 personas en el continente en 2016, mientras que en el mundo esta última cifra alcanza más de 4 millones de personas. Al quemar combustibles sólidos como madera, carbón en fogones o estufas se emite monóxido de carbono y elevados niveles de material particulado que quedan suspendidas en el aire. Por su parte, el monóxido de carbono es un reconocido contaminante atmosférico, con gran capacidad para afectar el organismo humano, con propiedades inoloras, incoloras y no irritantes que dificultan su detección. El grado de exposición al monóxido de carbono es evaluado mediante la medición de la saturación de Carboxihemoglobina en sangre, que se determina con técnicas como espectrofotometría de absorción en disolución. Esta investigación se realizó en la comuna de Ayangue, Ecuador, en comedores que continúan la tradición de cocinar en leña como atrayente para los turistas. Se halló una correlación positiva moderada entre el valor promedio de COHb con las horas de la jornada diaria de trabajo (r = 0,674); con el uso de leña o carbón para cocinar en el trabajo (r = 0,537; 88%); y con la presencia de síntomas físicos como el dolor de cabeza (r = 0,616) y náuseas (r = 0,524). Estas alteraciones fisiológicas se presentan durante o inmediatamente después de la jornada de trabajo, según el 88% de los sintomáticos(AU)

The use of solid fuels for cooking represents the main environmental risk in America, affecting 90 million people and causing the death of 83,000 people on the continent in 2016, while in the world this last figure reaches more than 4 million people. Burning solid fuels such as wood, charcoal in stoves or stoves emits carbon monoxide and high levels of particulate matter that are suspended in the air. For its part, carbon monoxide is a recognized atmospheric pollutant, with a great capacity to affect the human organism, with odorless, colorless and non-irritating properties that make it difficult to detect. The degree of exposure to carbon monoxide is evaluated by measuring the saturation of carboxyhemoglobin in blood, which is determined with techniques such as absorption spectrophotometry in solution. This research was carried out in the Ayangue commune, Ecuador, in dining rooms that continue the tradition of cooking on firewood as an attraction for tourists. A moderate positive correlation was found between the average COHb value and the hours of the daily working day (r = 0.674); with the use of firewood or charcoal for cooking at work (r = 0.537; 88%); and with the presence of physical symptoms such as headache (r = 0.616) and nausea (r = 0.524). These physiological alterations appear during or immediately after the work day, according to 88% of the symptomatic ones(AU)

Impact of Rotavirus Vaccination Varies by Level of Access to Piped Water and Sewerage: An Analysis of Childhood Clinic Visits for Diarrhea in Peru, 2005-2015.

BACKGROUND: We conducted a national impact evaluation of routine rotavirus vaccination on childhood diarrhea in Peru, accounting for potential modifying factors. METHODS: We utilized a dataset compiled from Peruvian governmental sources to fit negative binomial models investigating the impact of rotavirus vaccination, piped water access, sewerage access and poverty on the rate of diarrhea clinic visits in children under 5 years old in 194 Peruvian provinces. We considered the interaction between these factors to assess whether water access, sanitation access, or poverty modified the association between ongoing rotavirus vaccination and childhood diarrhea clinic visits. We compared the "pre-vaccine" (2005-2009) and "post-vaccine" (2010-2015) eras. RESULTS: The rate of childhood diarrhea clinic visits was 7% [95% confidence interval (CI): 3%-10%] lower in the post-vaccine era compared with the pre-vaccine era, controlling for long-term trend and El Niño seasons. No impact of rotavirus vaccination was identified in provinces with the lowest access to piped water (when <40% of province households had piped water) or in the lowest category of sewerage (when <17% of province households had a sewerage connection). Accounting for long-term and El Niño trends, the rate of childhood diarrhea clinic visits was lower in the post-vaccine era by 7% (95% CI: 2%-12%), 13% (95% CI: 7%-19%) and 15% (95% CI: 10%-20%) in the second, third and fourth (highest) quartiles of piped water access, respectively (compared with the pre-vaccine era); results for sewerage access were similar. CONCLUSION: Improved water/sanitation may operate synergistically with rotavirus vaccination to reduce childhood clinic visits for diarrhea in Peru.

Video Caso Clínico: Disección Aórtica Rota Tipo Stanford A. Resolución Quirúrgica: Cirugía de Bentall De Bono / Video Case Report: Rupture Aortic Dissection Stanford Type A. Surgical Resolution: Surgery Bentall and De Bono

La disección aórtica rota que compromete la raíz y la aorta ascendente es una emergencia que requiere cirugía inmediata, debido al mal pronóstico y sus complicaciones agudas: ruptura, insuficiencia aórtica aguda, hematoma intramural y endocarditis aguda; con elevadas tasas de morbilidad y mortalidad posoperatoria temprana, estimada en las 24 horas el 1 % por cada hora, a las 48 horas 29 %, en la primera semana 44 % y a las 2 semanas 50 %; con una mortalidad global de 15 % a 35 % y una sobrevida del 65 % al 75 % en un rango de 5 años [1 - 3]. En Ecuador se llevó a cabo un estudio tipo prospectivo que incluyo 120 pacientes, llevado a cabo desde 1999 a 2000, en Guayaquil; en el que reportaron 34 casos, con edad promedio de 64 años, sexo masculino, cuyo factor de riesgo más importante fue hipertensión arterial. Se presentó en el 100 % de los casos, dolor torácico transfictivo, soplo aórtico diastólico en el 70 % y solo el 2 % presentaron infarto de miocardio posteroinferior transmural sin fibrinólisis, por ser contraindicado en pacientes con disección aórtica [4]. El tratamiento quirúrgico consiste en la resección y reemplazo de la porción rota por una prótesis vascular asociada o no al reemplazo valvular aórtico dependiendo del grado de insuficiencia. El tratamiento estará orientado en función del grado de afectación de la disección y la rotura, pudiendo requerir un reemplazo convencional de la aorta ascendente (RCAA) con o sin reemplazo total del arco aórtico (RTAA); el tratamiento de elección de la disección rota tipo A es el reemplazo de la raíz y la aorta ascendente con injerto tubular valvulado, denominado procedimiento de Bentall De Bono [1 - 3, 5, 6]. Dentro de las complicaciones postquirúrgicas se encuentran: pseudoaneurisma, disección radical recurrente o residual, cambios importantes en el diámetro de la raíz o insuficiencia aórtica significativa [7]

The rupture aortic dissection that compromises the root and the ascending aorta is an emergency that requires immediate surgery; for it is poor prognosis, acute complications: rupture, acute aortic insufficiency, intramural hematoma and acute endocarditis, with high morbidity rates and early postoperative mortality, estimated at first 24 hours in 1 % per each hour, 48 hours 29 %, in the first week 44 % and at 2 weeks 50 %; with a global mortality of 15 % to 35 % and a survival of 65 % to 75 % in a range of 5 years [1-3]. In Ecuador, a prospective study realized that included 120 patients, since 1999 to 2000, in Guayaquil; in that they reported 34 cases with an average age of 64 years, male, whose most important risk factor was hypertension. The patients presented, 100 % transfictive chest pain, diastolic aortic murmur in 70 %, and only 2 % had transmural posteroinferior myocardial infarction without fibrinolysis, as it was contraindicated in patients with aortic dissection [4]. Surgical treatment consists of the resection and replacement of the broken portion by a vascular prosthesis associated or not with aortic valve replacement depending on the degree of insufficiency. The treatment will be oriented according to the degree of involvement of the dissection and rupture, and may require a conventional replacement of the ascending aorta (CRAA) with or without total aortic arch replacement (TRAA); the treatment of choice for the rupture aortic dissection type A is the replacement of the root and the ascending aorta with valvular tubular graft, called the Bentall De Bono surgery [1 - 3, 5, 6]. Of the postsurgical complications we found: pseudoaneurysm, radical or recurrent radical dissection, important changes in the diameter of the root or significant aortic insufficiency

Salud sexual reproductiva en estudiantes universitarios: conocimientos y prácticas / Sexual and reproductive health in university students: beyond knowledge and practices / Saúde sexual reprodutiva em estudantes universitários: conhecimentos e práticas

Objetivo: Describir el conocimiento y las prácticas relacionadas con la salud sexual y reproductiva en los estudiantes de una Universidad del suroccidente colombiano. Materiales y métodos: Investigación cuantitativa, descriptiva y prospectiva de corte transversal realizada con estudiantes matriculados en I y II semestre en el primer periodo académico 2016. El cálculo de la muestra se obtuvo utilizando la fórmula de varianza desconocida y población total conocida (3.489), obteniendo un tamaño de muestra de 415 estudiantes. Se utilizó un instrumento tipo encuesta estructurado a partir del formato de consejería del programa de salud sexual y reproductiva universitario. Los datos se procesaron a través de Excel y el paquete estadístico SPSS versión 22. Para determinar la significación de la asociación se utilizó la prueba Chi cuadrado con una confiabilidad de 95 %. Resultados: En la población estudiada se encontró un predominio masculino del 50,7 %, la edad promedio fue de 19 años, encontrando que el 81 % está en una etapa de adolescencia tardía, el 62 % tiene un nivel de conocimientos defi cientes sobre salud sexual y reproductiva, el 78 % inició vida sexual con edad promedio de 16 años, un gran porcentaje de estos estudiantes tiene entre 1 y 3 compañeros(as) sexuales al año. El 70 % utilizó condón en su primera relación sexual y el 12,3 % de la población utilizó la píldora de emergencia. Conclusiones: El nivel de conocimiento acerca de salud sexual y reproductiva es deficiente. La mayoría de los estudiantes encuestados utiliza al menos un método de planificación familiar en sus relaciones sexuales.

Objective: To describe the knowledge and practices related to Sexual and Reproductive Health in the students of a University of the Suroccidente Colombiano. Materials and methods: Quantitative descriptive prospective cross-sectional study; was carried out in students enrolled in I and II semester in the first academic period 2016; the calculation of the sample was obtained using the formula of unknown variance and known total population (3,489), obtaining a sample size of 415 students. A structured survey-type instrument was developed based on the counseling format of the university's sexual and reproductive health program. Data were processed through Excel and the SPSS version 22 statistical package, to determine the significance of the association was used Chi square test with a reliability of 95%. Results: A male prevalence of 50.7% was found in the study population, the mean age was 19 years, and 81% were in the late teens, 62% had a poor level of knowledge about sexual health and reproductive, 78% start sexual life with average age of 16 years, a large percentage of these students have between 1 and 3 sexual partners a year. Seventy percent used a condom at their first sexual intercourse and 12.3% of the population used the emergency pill. Conclusions: The level of knowledge about sexual and reproductive health is deficient. Most students surveyed use at least one method of family planning in their sexual relationships.

Objetivos: Descrever os conhecimentos e práticas relacionados com a saúde sexual e reprodutiva em estudantes de uma Universidado sudoeste Colombiano. Materiais e Métodos: A pesquisa quantitativa transversal descritiva prospectiva; foi realizado em estudantes matriculados em I e II, semestre 2016; cálculo da amostra foi obtida utilizando a fórmula de variância desconhecida e a população total conhecido (3489), obtendo-se um tamanho de amostra de 415 estudantes. Foi utilizado um tipo de instrumento de pesquisa estruturada. Os dados foram processados pelo pacote estatístico Excel versão 2010 e SPSS versão 22, para determinar o significado do teste foram utilizados do qui-quadrado de associação com uma confiabilidade de 95%. Resultados: Na população estudada predominância do sexo masculino de 50,7%, a idade média dos alunos era de 19 anos, descobrindo que 81% estão em uma fase de adolescência tardia, 62% têm um nível de conhecimentos regulares saúde sexual e reprodutiva, 78% inicio vida sexual com uma idade média de 16 anos, uma grande porcentagem desses estudantes estão entre 1 e 3 parceiro (s) ano sexual. 70% usam preservativo em sua primeira relação sexual e 12,3% da população usava a pílula de emergência. Conclusões: O nível de conhecimento sobre a saúde sexual e reprodutiva é regular. A maioria dos estudantes pesquisados usar pelo menos um método de planejamento familiar em suas relações sexuais.

Valoración de la prescripción inadecuada en pacientes mayores de 65 años atendidos en un hospital de tercer nivel / Evaluation of inappropriate prescriptions on patients over 65 years old in a third level hospital

No disponible

Gerencia de sistemas conductuales y diagnóstico de cambio organizacional en partidos políticos / Behavioral systems management and diagnosis of organizational change in political parties / Gerência de sistemas comportamentais e diagnóstico de mudança organizacional nos partidos políticos

Se describió el funcionamiento de un partido político "ejemplar" a través del Sistema de Desempeño Total, un recurso de diagnóstico organizacional del enfoque conceptual de Gerencia de Sistemas Conductuales. Igualmente,, diez dirigentes de partidos políticos fueron entrevistados con respecto a los cambios necesarios para el desarrollo, transformación y modernización de los partidos políticos en Venezuela. El estudio fue transversal y descriptivo, con características cualitativas y cuantitativas. Resultó notorio el hecho de que ninguno de los dirigentes consideró a los beneficiarios (simpatizantes, militantes y ciudadanía en general) como elemento a ser considerado en el proceso de cambio. Sólo uno resaltó la necesidad de comunicarse y recibir información de retorno de clientes, simpatizantes y público en general. Estos resultados sugieren la necesidad de las organizaciones políticas venezolanas de revisar sus procesos de dirección y lo que concierne a sus políticas y prácticas de comunicación intra y extra-organizacional. Se proporcionan argumentos a favor de la relevancia del diagrama de desempeño total y del enfoque de sistemas conductuales para explicar y comprender el funcionamiento de partidos políticos como organizaciones.

The organizational functioning of an "exemplary" political party was described using "The Total Performance System", an organizational diagnostic tool of the Behavioral Systems Management theoretical approach. In addition, ten leaders of political parties were interviewed with regard to changes needed for the development, transformation and modernization of political parties in Venezuela. The analysis was carried out using the Behavioral System Management Model (BSM). The study was transversal and descriptive, with qualitative and quantitative characteristics. It was significant that none of the leaders interviewed regarded clients of political parties (militants, sympathizers or general citizens) as an element to take into account for the change process. Only one of them mentioned the need to communicate or receive feedback from party members, sympathizers or citizens at large. These results suggest the need for Venezuelan political parties to review and change their strategic planning and especially the communication process at the intra and extra-organizational level. Arguments are provided to support the relevance of both the total performance system diagram and the behavioral systems management approach for explaining and understanding the functioning of political parties as organizations.

Foi descrito o comportamento de um partido político "exemplar" através do sistema de desempenho total, um recurso de diagnóstico organizacional da abordagem de gerência de sistemas comportamentais. Foram entrevistados dez dirigentes de partidos políticos sobre as mudanças necessárias para o desenvolvimento, a transformação e modernização dos partidos políticos em Venezuela. O estudo foi transversal e descritivo, com caraterísticas qualitativas e quantitativas. Foi notório o fato que ninguém dos dirigentes envolveu aos beneficiários (simpatizantes, militantes e cidadania) no processo de mudança. Somente um ressaltou a necessidade de receber informação de retorno de usuários, simpatizantes e público. Estes resultados sinalam a necessidade das organizações políticas venezolanas revisarem os seus processos de direção e as suas políticas e práticas de comunicação intra e extra-organizacional. Subministram-se argumentos em favor da importância do diagrama de desempenho total e da abordagem de sistemas comportamentais para explicar o funcionamento de partidos políticos com organizações.

Las mujeres en la historia de Bolivia imagenes y realidades del siglo XX (1900-1950) / The women in the history of Bolivia images and realities of the 20th century (1900-1950)

La presente antologia recupera documentos,datos de la realidad,imágenes y percepciones no solo del ambito doméstico sino de la vida social económica,política y de las representaciones simbólicas que se han producido sobre la mujer en le territorio de Bolivia

Las mujeres en la historia de bolivia. imágenes y realidades del siglo xx (1900-1950)

Este volumen muestra una serie de hitos femeninos que testimonian los cambios acelerados de este periodo. Los logros y frustraciones seculares de las mujeres en sus luchas hacia mejores niveles de vida con reconocimiento de su cualidad de género son la base que ha hecho posible las veloces y trascendentales transformaciones de las últimas décadas del siglo XX.