Undervalued professionals: placement of nutritionist in the Ecuadorian health system.

BACKGROUND: Currently, many public health issues are directly related to malnutrition, and are made worse by social inequities. Nutrition professionals must be a key player in improving epidemiological aspects of nutrition-related diseases and must be part of clinical teams to control nutritional concerns. OBJECTIVE: To identify and analyze the nutritionists´ employment situation in Ecuador and areas of work covered and determine if type of university has an impact over work situation. METHODOLOGY: A cross-sectional study was conducted, approved by the ethics committee of Universidad San Francisco de Quito. It included 442 nutritionists in Ecuador who graduated in 13 universities (5 private (PR) and 8 public (PU)) between 2008 and 2019. It implied an online survey that questioned their satisfaction with their education and current work situation. All the statistical analyses were performed using R version 4.0.3, two-sided weighted chi-square test was performed to estimate the difference between public and private university graduates, IC 95%, p between 0.01 and 0.05. RESULTS: 38,6% of participants are unemployed, 68,28% private university graduates (PR) are currently employed and 58.87% work as nutritionists, compared to 56,86% from a public university (PU) currently working and 44.69% working in the field. 76% have reported being unemployed at some point in their careers, being difficulty finding jobs the main reason. Regarding the professional field, most professionals have their own business, and the less common area of work was public and community nutrition. One third of the participants had another paid activity. The main salary is 800USD per month and graduated from PR perceived better salaries than from PU. CONCLUSION: There is a lack of job opportunities for Ecuadorian nutritionists despite the high demand in every level of the health system. Most have been unemployed at some point in their careers due to difficulties finding jobs. There is a minimum nutrition staff working in community and public health nutrition.

Result of the implementation of telematic consultations in orthopaedic surgery and traumatology during COVID-19 laparoscopic surgery. / Resultado de la implantación de consultas telemáticas en cirugía ortopédica y traumatología durante la pandemia COVID-19.

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.

Agro-industrial residue from starch extraction of Pachyrhizus ahipa as filler of thermoplastic corn starch films.

Biocomposites films based on thermoplastic corn starch (TPS) containing 0.5% w/w fibrous residue from Pachyrhizus ahipa starch extraction (PASR) were obtained by melt-mixing and compression molding. PASR is mainly constituted by remaining cell walls and natural fibers, revealed by Scanning Electron Microscopy (SEM). Chemical composition of the residue indicated that fiber and starch were the principal components. Biocomposites thermo-stability was determined by Thermo-Gravimetric Analysis. A continuous PASR-TPS interface was observed by SEM, as a result of a good adhesion of the fibrous residue to starch matrix. Likewise, films containing PASR presented fewer superficial cracks than TPS ones, whereas their fracture surfaces were more irregular. Besides, the presence of PASR increased starch films roughness, due to fibers agglomerates. Films reinforced with PASR showed significantly lower water vapor permeability (WVP). In addition, PARS filler increased maximum tensile strength and Young's modulus of TPS films, thus leading to more resistant starch matrixes.

Evaluation of by-products from the biodiesel industry as fermentation feedstock for poly(3-hydroxybutyrate-co-3-hydroxyvalerate) production by Cupriavidus necator.

Utilization of by-products from oilseed-based biodiesel production (crude glycerol, rapeseed meal hydrolysates) for microbial polyhydroxyalkanoate (PHA) production could lead to the replacement of expensive carbon sources, nutrient supplements and precursors for co-polymer production. Batch fermentations in shake flasks with varying amounts of free amino nitrogen led to the production of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (P(3HB-co-3HV)) with a 2.8-8% 3HV content. Fed-batch fermentations in shake flasks led to the production of 10.9g/L P(3HB-co-3HV) and a 55.6% P(3HB-co-3HV) content. NaCl concentrations between 2 and 6g/L gradually became inhibitory to bacterial growth and PHA formation, whereas in the case of K(2)SO(4), the inhibitory effect was observed only at concentrations higher than 20g/L. Differential scanning calorimetry (DSC), thermogravimetric analysis (TGA) and nuclear magnetic resonance ((13)C NMR) demonstrated that the incorporation of 3HV into the obtained P(3HB-co-3HV) lowered glass transition temperature, crystallinity and melting point as compared to polyhydroxybutyrate. Integrating PHA production in existing oilseed-based biodiesel plants could enhance the viability and sustainability of this first generation biorefinery.

[Tortuous retinal vessels in neurofibromatosis type 1]. / Tortuosidad retiniana vascular en neurofibromatosis tipo 1.

CASE REPORT: We report a 4-year-old patient with neurofibromatosis type 1 (NF-1) who had tortuous retinal vessels of first, second and third order which ended in a corkscrew appearance. DISCUSSION: Vascular retinal abnormalities can be present in patients with NF-1.

Tortuosidad retiniana vascular en neurofibromatosis tipo 1 / Tortuous retinal vessels in neurofibromatosis type 1

Caso clínico: Se describe un paciente de 4 años con neurofibromatosis tipo 1 (NF-1) y vasos retinianos tortuosos de primer, segundo y tercer orden que terminaban en forma de sacacorcho.Discusión: Los pacientes con NF-1 pueden tener anomalías retinianas vasculares

Case report: We report a 4-year-old patient with neurofibromatosis type 1 (NF-1) who had tortuous retinal vessels of first, second and third order which ended in a corkscrew appearance. Discussion: Vascular retinal abnormalities can be present in patients with NF-1

Lesiones inadvertidas en el trauma penetrante abdominal / Unnoticed lesions in abdominal trauma

Antecedentes: Los traumatismos en general y los abdominales en particular están aumentando en todas las sociedades. Las lesiones inadvertidas son una realidad con independencia de la sistemática que se utiliza, tanto en el estudio como en el tratamiento. Objetivos: Analizar la frecuencia y las causas de las lesiones no percibidas tanto en el pre como en el intraoperatorio. Lugar de aplicación: Servicio de Cirugía General, Complejo Hospitalario. Diseño: Estudio retrospectivo. Material y métodos: En una serie de 600 pacientes heridos de bala en abdomen tratados entre diciembre de 1984 y diciembre del 2000 se hallaron 16 lesiones inadvertidas. Las formas clínicas de presentación fueron: hemorragia y shock hipovolémico en cinco casos, peritonitis en cuatro casos, sepsis cuatro casos, salida de orina por los drenajes 2 casos y disartria con tendencia al coma un caso. Resultados: De su análisis se desprende que los errores fueron cometidos tanto en la evaluación preoperatoria (4 casos con un paciente fallecido), como en la exploración intraoperatoria (12 casos con dos fallecidos). En 15 casos inadvertidas aun dentro del área corporal en la cual se produjo la injuria. En un caso la lesión se halló fuera del área corporal de mayor foco de atención. Conclusiones: En nuestra serie las lesiones no percibidas se observaron en el 2,5 por ciento. La frecuencia de aparición en la literatura mundial consultada se halla entre un 3 y un 12 por ciento. En las mismas relatan alta morbimortalidad, la cual en la presente serie fue del 18,7 por ciento. A nuestro entender hay ciertas regiones del abdomen particularmente proclives a presentar este tipo de lesiones

Lesiones inadvertidas en el trauma penetrante abdominal / Unnoticed lesions in abdominal trauma

Antecedentes: Los traumatismos en general y los abdominales en particular están aumentando en todas las sociedades. Las lesiones inadvertidas son una realidad con independencia de la sistemática que se utiliza, tanto en el estudio como en el tratamiento. Objetivos: Analizar la frecuencia y las causas de las lesiones no percibidas tanto en el pre como en el intraoperatorio. Lugar de aplicación: Servicio de Cirugía General, Complejo Hospitalario. Diseño: Estudio retrospectivo. Material y métodos: En una serie de 600 pacientes heridos de bala en abdomen tratados entre diciembre de 1984 y diciembre del 2000 se hallaron 16 lesiones inadvertidas. Las formas clínicas de presentación fueron: hemorragia y shock hipovolémico en cinco casos, peritonitis en cuatro casos, sepsis cuatro casos, salida de orina por los drenajes 2 casos y disartria con tendencia al coma un caso. Resultados: De su análisis se desprende que los errores fueron cometidos tanto en la evaluación preoperatoria (4 casos con un paciente fallecido), como en la exploración intraoperatoria (12 casos con dos fallecidos). En 15 casos inadvertidas aun dentro del área corporal en la cual se produjo la injuria. En un caso la lesión se halló fuera del área corporal de mayor foco de atención. Conclusiones: En nuestra serie las lesiones no percibidas se observaron en el 2,5 por ciento. La frecuencia de aparición en la literatura mundial consultada se halla entre un 3 y un 12 por ciento. En las mismas relatan alta morbimortalidad, la cual en la presente serie fue del 18,7 por ciento. A nuestro entender hay ciertas regiones del abdomen particularmente proclives a presentar este tipo de lesiones (AU)

Suspensión de talco para efusión pleural maligna / Talc suspension to treat malignant pleural effusion

El talco es uno de los agentes esclerosantes más efectivos de los que se dispone actualmente para el tratamiento de la efusión pleural maligna. Al no existir como preparado comercial es necesario proceder a su formulación, siendo el aspecto más problemático la esterilización.En el presente trabajo se describe la preparación de una suspensión de talco, usando como método de esterilización el calor húmedo. La fórmula que se propone es segura, de fácil elaboración, efectiva y de bajo coste. Asimismo se valora la efectividad de dicha fórmula en un total de 10 pacientes, obteniendo un porcentaje de efectividad del 80 por ciento. La incidencia de efectos adversos fue baja y concordante con los datos publicados en la literatura (AU)

[Analysis of drug consumption with indicators of prescription quality]. / Análisis del consumo de medicamentos utilizando indicadores de calidad en la prescripción.

OBJECTIVE: To evaluate the quality of pharmaceutical prescription by means of various indicators. DESIGN: Cross-sectional, retrospective study. SETTING: Non-hospital prescription in all the INSALUD provinces, except Ceuta and Melilla, for a year (1997). MEASUREMENTS: Different quality indicators were analysed for the following groups of medicines: oral diabetes drugs, anti-platelet aggregation drugs, anti-hypertension drugs, non-steroidal anti-inflammatories, tranquillisers and hypnotic drugs, antibiotics, anti-asthmatic drugs and the omeprazol efficiency indicator. Consumption was expressed in defined daily doses (DDD) and in DDD per 1000 persons and per day (DID). A prescription quality indicator was indicated on the basis of weighing up the indicators. RESULTS: The sulphonylurea drugs varied greatly (15-56%) and deviated negatively a lot from the standard value. AAS and ticlopidine made up 74% of the anti-platelet aggregation drugs. Consumption of calcium antagonists was three times greater than of beta-blockers. Captopril and enalapril were 65% of the ACE inhibitors. Ibuprofen, naproxen and diclofenac made up between 34 and 50% of the NSAIDs. The DID of hypnotics was 44 against a standard figure of 24. Use of first-level antibiotics was 77%. Inhaled adrenergic drugs came to 80% of total anti-asthmatic drugs. The cost of omeprazol treatment per day was 267 pesetas/DID, which was inefficient in comparison with the standard of 190. All provinces had a prescription quality indicator above six out of ten. CONCLUSIONS: The ACE inhibitors, anti-asthmatic drugs and antibiotics were close to the standard. The use of sulphonylurea drugs, beta-blockers, NSAIDs and hypnotics was a long way from standard. The prescription level was acceptable in the different provinces.

A comparison of no medication versus methyldopa or labetalol in chronic hypertension during pregnancy.

Three hundred women with mild chronic hypertension at 6 to 13 weeks' gestation were randomly allocated to receive either methyldopa or labetalol or be in the control group. Thirty-seven women (12%) were excluded for various reasons. Of the remaining 263 patients, 90 received no drug, 87 received methyldopa, and 86 received labetalol. All 263 were followed throughout pregnancy with serial renal function tests and serial assessment of fetal status. There were no differences among the three groups in mean systolic or diastolic blood pressures, mean gestational age, or initial laboratory findings at time of entry. Patients treated with medications had significantly lower (p less than 0.0001) systolic and diastolic blood pressures throughout gestation compared with the no-medication group. Among the control group there was a spontaneously significant lowering (p less than 0.0001) of both systolic and diastolic blood pressures at 14 to 26 weeks' gestation. However, there were no differences among the three groups regarding the incidences of either superimposed preeclampsia (15.6%, 18.4%, and 16.3%, respectively), abruptio placentae (2.2%, 1.1%, and 2.3%, respectively), or preterm delivery (10%, 12.5%, and 11.6%, respectively). In addition, there were no differences among the groups regarding gestational age at delivery, birth weight, incidence of fetal growth retardation, or neonatal head circumference. There was one midtrimester loss in the methyldopa group and one stillbirth in each of the other groups. We conclude that treatment of maternal blood pressure in mild chronic hypertension during pregnancy did not improve perinatal outcome.

Acute renal failure in hypertensive disorders of pregnancy. Pregnancy outcome and remote prognosis in thirty-one consecutive cases.

The purpose of this study is to report short-term pregnancy outcome, subsequent pregnancy outcome, and remote prognosis (follow-up from 0.3 to 9.8 years) in 31 cases complicated by acute renal failure. Eighteen patients had "pure" preeclampsia and 12 patients (13 pregnancies) had chronic hypertension, parenchymal renal disease, or both before pregnancy. All patients had serial evaluation of renal function, urine microscopy, and electrolyte studies at the onset of acute renal failure and on follow-up. There were three immediate maternal deaths (two in the pure preeclampsia group and one in the other group). Nine patients (50%) in the "pure" group required dialysis during hospitalization and all 18 patients had acute tubular necrosis. Five patients (42%) in the other group required immediate dialysis and three patients had bilateral cortical necrosis. The majority of pregnancies in both groups were complicated by abruptio placentae and hemorrhage. All 16 surviving patients in the pure preeclampsia group had normal renal function on long-term follow-up (average 4.0 +/- 3.1 years). Conversely, nine of the 11 surviving patients in the second group required long-term dialysis on follow-up and four of them ultimately died of end-stage renal disease. We conclude that proper management of acute renal failure in patients with pure preeclampsia-eclampsia does not result in residual function impairment.

Magnesium supplementation during pregnancy: a double-blind randomized controlled clinical trial.

Four hundred young normotensive primigravid women between 13 and 24 weeks' gestation were randomly allocated to one of two study groups. One group received placebo tablets and the other group received 365 mg of elemental magnesium daily (as magnesium aspartate hydrochloride). Three hundred seventy-four patients completed the study, 189 in the placebo group and 185 in the treatment group. There were no significant differences between the two groups regarding serum calcium, uric acid, or electrolyte levels. However, the magnesium-supplemented group had significantly higher magnesium levels at delivery (1.68 +/- 0.03 mg/dl vs. 1.56 +/- 0.03 mg/dl, p less than 0.01). There were no significant differences in either systolic or diastolic blood pressures between both groups either at time of enrollment or at subsequent gestational ages later during pregnancy. Analysis of variance for repeated measurements and Fisher's least significant difference testing indicated a significant increase (p less than 0.01) in blood pressure from the level at the time of enrollment to the level achieved at or beyond 37 weeks' gestation in each group. There were no significant differences between the two groups regarding any of the following parameters: incidences of preeclampsia, fetal growth retardation, preterm labor, birth weight, gestational age at delivery, or number of infants admitted to the special care unit. Magnesium supplementation during pregnancy did not improve pregnancy outcome in our population.

Plasma volume, umbilical artery Doppler flow, and antepartum fetal heart testing in high-risk pregnancies.

The purpose of this clinical study is to investigate the diagnostic value of plasma volume (PV), nonstress test (NST), contraction stress test (CST), and umbilical artery Doppler (UAD) in detecting fetal compromise in 81 patients (83 fetuses) at risk for fetal growth retardation. Neither PV nor UAD studies were used in the clinical management. There were two stillbirths and three neonatal deaths for a perinatal mortality of 6%. Twenty-seven infants (32.5%) were small for gestational age (SGA), seven (8.6%) had cord pH 7.20 or less, and five (6.2%) had 5-minute Apgar scores less than 7. Overall, PV had the highest sensitivity and NST the highest specificity regarding delivery of SGA infants. The positive and negative predictive values for infants with low cord pH and low Apgar scores were similar among the various tests. There were nine fetuses with zero or reverse diastolic flow: seven were SGA (four perinatal deaths) and all of them had both nonreactive NST and positive CST. The other two infants were appropriate for gestational age with all other tests being normal. Antepartum fetal heart rate testing appears to be similar to other tests in predicting poor fetal outcome in high-risk pregnancies.

Clinical significance of elevated mean arterial blood pressure in second trimester and threshold increase in systolic or diastolic blood pressure during third trimester.

The purpose of this investigation was to determine the diagnostic value of an average mean arterial blood pressure in the second trimester of greater than or equal to 90 mm Hg and a threshold increase in diastolic blood pressure of greater than or equal to 15 mm Hg or in systolic blood pressure of greater than or equal to 30 mm Hg, on two occasions, 6 hours apart, in predicting preeclampsia. The study population consisted of 700 young normotensive primigravid women who were evaluated prospectively during pregnancy. Systolic and diastolic blood pressures were carefully measured at each prenatal visit, and the mean arterial blood pressure in the second trimester was calculated for each measurement. An average greater than 90 mm Hg was considered abnormal. One hundred thirty-seven patients had preeclampsia, for an overall incidence of 19.6%. An average greater than 90 mm Hg had a sensitivity of 8% and a positive predictive value of 23%. The respective values for a threshold increase of greater than 15 mm Hg in diastolic pressure were 39% and 32%. For a threshold increase of greater than 30 mm Hg in systolic pressure, values were 22% and 33%. The negative predictive values for all tests studied ranged between 81% and 85%. Neither a mean arterial blood pressure in the second trimester of greater than 90 mm Hg nor a threshold increase in systolic or diastolic blood pressure during the third trimester was significantly predictive of the development of preeclampsia.

Ampicillin prophylaxis in preterm premature rupture of the membranes: a prospective randomized study.

It is hypothesized that ampicillin may treat subclinical deciduitis and prolong the "effective" latent period in patients with preterm premature rupture of the membranes. We studied 82 patients with preterm rupture of membranes who were managed expectantly and were randomly assigned either to receive ampicillin prophylaxis (n = 43) or not to receive ampicillin prophylaxis (n = 39). Patients were excluded from study entry on admission if they had suspected or frank chorioamnionitis, active preterm labor, a history of penicillin allergy, multiple gestation, or cervical cerclage. There were no significant differences between the groups in duration of membrane rupture prior to admission, gestational age at membrane rupture, use of steroids and tocolysis, and demographic factors. Life-table analysis showed that the risk of delivery was significantly lower for the group of patients receiving prophylactic ampicillin. The incidence of neonatal infection was significantly lower in the ampicillin group, 1 (2%) versus 6 (17%), p less than 0.04.

Eclampsia.

The incidence of eclampsia has decreased over the past two decades. Proper prenatal care with early identification and hospitalization of patients with mild pre-eclampsia is responsible for this reduction. Modifications of current obstetrics teachings designed to heighten awareness of the risk of both midtrimester and late-postpartum eclampsia could further reduce its occurrence. However, there will always be a small number of women in whom eclampsia is not preventable. Eclamptic patients should be counseled regarding the increased risk of pre-eclampsia or eclampsia in their sisters and daughters as well as their increased risk for both recurrence of the disease and perinatal death in subsequent pregnancies.