First Ecuadorian statement consensus for the evaluation and treatment of osteoporosis.

Osteoporosis management has become more relevant as the life expectancy increases. In Ecuador, approximately 19% of adults over 65 years of age have been diagnosed with osteoporosis. There is no national consensus for the management and prevention of the disease being this proposal the first Ecuadorian consensus. INTRODUCTION: In Ecuador, it is estimated that around 19% of adults over 65 years of age have osteoporosis. Due to the increase in life expectancy in the world population, the evaluation and management of osteoporosis has become more relevant. Currently, there is no national consensus for the management and prevention of the disease. The Ecuadorian Society of Rheumatology presented the project for the elaboration of the first Ecuadorian consensus for the management and prevention of osteoporosis. METHODS: A panel of experts in multiple areas and extensive experience was invited to participate. The consensus was carried out using the Delphi method. Six working dimensions were created: definition and epidemiology of osteoporosis, fracture risk prediction tools, non-pharmacological treatment, pharmacological treatment, calcium and vitamin D, and glucocorticoid-induced osteoporosis. RESULTS: The first round was held in December 2021, followed by the second round in February 2022 and the third round in March 2022. The data was shared with the specialists at the end of each round. After three rounds of work, a consensus was reached for the management and prevention of osteoporosis. CONCLUSION: This is the first Ecuadorian consensus for the management and treatment of postmenopausal osteoporosis.

Dependencia al dispositivo móvil e impulsividad en estudiantes universitarios de Riobamba-Ecuador / Mobile device dependence and impulsivity in university students from Riobamba-Ecuador

El uso excesivo de la telefonía celular crea situaciones problemáticas, resaltando la dependencia. Se realizó un estudio con el objetivo de determinar la relación entre los niveles de dependencia al dispositivo móvil y los tipos de impulsividad en universitarios; con enfoque cuantitativo, de tipo no experimental correlacional. La población de estudio estuvo conformada por 2533 estudiantes de 18 a 26 años de la Facultad de Ciencias de la Salud de la Universidad Nacional de Chimborazo, matriculados en el periodo académico agosto 2019 ­ marzo 2020. La recolección de los datos se hizo a través del Test de Dependencia al Móvil y la Escala de Impulsividad (BIS-11). La media de la edad fue de 21,3 años. El 66,5% de la muestra mostró un nivel modera-do de dependencia del dispositivo móvil. El 85,03% tenía impulsividad no planificada, con un puntaje de nivel medio de impulsividad en cada subescala y globalmente. Entre ambas variables fundamentales de estudio se estableció una correlación positiva, maderada y estadísticamente significativa

Excessive use of smartphones creates problematic situations, highlighting dependency. This study was carried out to determine the relationship between the levels of dependence on the mobile device and the types of impulsivity in university students. This research included a quantitative approach, and a non-experimental correlational type. The study population consisted of 2533 students aged 18 to 26 from the Faculty of Health Sciences of the National University of Chimborazo, enrolled in the academic period August 2019 - March 2020. Data collection was done through the Mobile Dependence Test and Impulsivity Scale (BIS-11). The mean age was 21.3 years. 66.5% of the sample showed a moderate level of dependence on the mobile device. 85.03% had unplanned impulsivity, with a score of medium level of impulsivity in each subscale and globally. A positive, lumpy, and statistically significant correlation was established between both fundamental study variables

The Hemodynamic Mass Action of a Central Pattern Generator.

The hemodynamic response is a neurovascular and metabolic process in which there is rapid delivery of blood flow to a neuronal tissue in response to neuronal activation. The functional magnetic resonance imaging (fMRI) and the functional near-infrared spectroscopy (fNIRS), for instance, are based on the physiological principles of such hemodynamic responses. Both techniques allow the mapping of active neuronal regions in which the neurovascular and metabolic events are occurring. However, although both techniques have revolutionized the neurosciences, they are mostly employed for neuroimaging of the human brain but not for the spinal cord during functional tasks. Moreover, little is known about other techniques measuring the hemodynamic response in the spinal cord. The purpose of the present study was to show for the first time that a simple optical system termed direct current photoplethysmography (DC-PPG) can be employed to detect hemodynamic responses of the spinal cord and the brainstem during the functional activation of the spinal central pattern generator (CPG). In particular, we positioned two DC-PPG systems directly on the brainstem and spinal cord during fictive scratching in the cat. The optical DC-PPG systems allowed the trial-by-trial recording of massive hemodynamic signals. We found that the "strength" of the flexor-plus-extensor motoneuron activities during motor episodes of fictive scratching was significantly correlated to the "strengths" of the brainstem and spinal DC-PPG signals. Because the DC-PPG was robustly detected in real-time, we claim that such a functional signal reflects the hemodynamic mass action of the brainstem and spinal cord associated with the CPG motor action. Our findings shed light on an unexplored hemodynamic observable of the spinal CPGs, providing a proof of concept that the DC-PPG can be used for the assessment of the integrity of the human CPGs.

Resetting the Respiratory Rhythm with a Spinal Central Pattern Generator.

There is evidence that a variety of central and afferent stimuli, including swallowing, can produce phase resetting in the respiratory rhythmicity. Also, there are reports about the intrinsic linkage between locomotion and respiration. However, little is known about the interaction between the central pattern generators (CPGs) for scratching and respiration. The present study aims to examine whether the activation of scratching CPG produces phase resetting of the respiratory rhythm. We employed decerebrate cats to apply brief tactile stimuli to the pinna during the inspiratory-expiratory transition. We observed that those stimuli to the pinna not eliciting fictive scratching did not reset the respiratory rhythm. However, when the pinna stimuli elicited fictive scratching, then the respiratory rhythm exhibited a significant phase resetting. We also found interneurons in the medulla oblongata exhibiting phase resetting related to scratching-CPG episodes. This second finding suggests that this type of resetting involves brainstem components of the respiratory CPG. These results shed new light on the resetting action from a spinal CPG on the respiratory rhythm.

Fortalezas y debilidades para una lactancia materna exclusiva exitosa en madres que asisten al Hospital General Docente Riobamba, Ecuador / Strengths and weaknesses for successful exclusive breastfeeding in mothers attending the general teaching hospital of the city of Riobamba, Ecuador

Introducción: la leche materna es la mejor fuente alimentaria para el niño menor de seis meses, aporta los nutrientes para un crecimiento y desarrollo óptimo, sin embargo en las últimas décadas se han reportado una disminución. Objetivo: identificar las fortalezas y debilidades de una lactancia materna exclusiva (LME) exitosa, en madres que asisten al Hospital General Docente Riobamba (HGDR). Métodos: se investigó a 331 binomios madre ­ hijo de 6 a 24 meses de edad, en diseño observacional, descriptivo, transversal y mediante. Resultados: las madres son residentes de Riobamba, el 14% tienen trabajo estable, la mayoría son amas de casa o estudiantes, con edad promedio de 25 años y el 23% son solteras. El 72% ha mantenido LME, lo que difiere significativamente (p < 0.05) con lo reportado en la Encuesta Nacional de Salud, Alimentación y Nutrición (ENSANUT), 2011-2013. Además se observó que existe una disminución de LME en madres menores de 19 años. Son fortalezas, el apoyo de los profesionales de salud, la convicción de dar a su hijo/ja la mejor alimentación para evitar las enfermedades y tengan un crecimiento óptimo y el apoyo familiar. La principales debilidades son el ingreso de la madre al trabajo y la disminución en la producción de leche. Conclusión: hay necesidad de motivar, educar y brindar asesoría alimentaria nutricional para una LME exitosa en especial a madres menores de 19 años.

Introduction: breast milk is the best food source for the child under six months, it provides the nutrients for optimal growth and development, however in recent decades a decrease in breast-feeding has been reported. Objective: to identify the strengths and weaknesses of successful exclusive breastfeeding in mothers attending the Hospital General Docente Riobamba (HGDR). Methodology: We investigated 331 mother-child pairs from 6 to 24 months of age, in an observational, descriptive and cross-sectional study. Results: regarding the profile of the mothers, they are residents of Riobamba, 14% have a stable job, most are housewives or students, with an average age of 25 years, 23% are single mothers. 72% of mothers have maintained exclusive breast-feeding, which significantly differs (p < 0.05) from that reported by the la Encuesta Nacional de Salud, Alimentación y Nutrición (ENSANUT), 2011-2013. It was also observed a decrease exclusive breast feeding in mothers under 19 years of age. Several strengths were observed: support provided by health professionals, personal conviction of giving the child the best nutrition to avoid illnesses and to ensure their optimal growth, and support provided by the couple and family. The main weaknesses were the mother's incorporacion to work and the decrease in milk production. Conclusion: there is need of motivation, education and food nutritional counseling for a successful exclusive breast-feeding, especially in mothers younger than 19 years old.

Afterdischarges of Spinal Interneurons Following a Brief High-Frequency Stimulation of Ia Afferents in the Cat.

Spinal motoneurons exhibit sustained afterdischarges and plateau potentials following a brief high-frequency stimulation of Ia afferents. Also, there is evidence that spinal cord interneurons exhibit plateau potentials. However, to our knowledge, there are no reports about the possible afterdischarge behavior of lumbar spinal interneurons activated by Ia afferents. Given that there are spinal interneurons receiving monosynaptic inputs from Ia afferents, these cells could then be activated in parallel to motoneurons after repetitive muscle stretch. We explored this possibility in cats with a precollicular-postmammillary decerebration. We found that a brief high-frequency stimulation of Ia afferents produces afterdischarges that are highly correlated to a DC slow potential recorded at the cord dorsum. We conclude that in the cat spinal cord, not only the motoneurons but also the interneurons from the superficial and deep dorsal horn produce sustained afterdischarges, thus highlighting the importance of interneurons in the spinal neuronal circuitry. The significance of our finding is that it opens the possibility that the spinal cord interneurons activated by Ia afferents could also exhibit bistability, a relevant phenomenon well-characterized in the motoneurons.

Factores asociados a la automedicación en pacientes que acuden a Servicios de Odontología de Hospitales del Perú / Factors associated with self-medication in patients who come to the Dentistry Services of Peru Hospitals

Objetivo: Determinar la frecuencia y factores asociados a la automedicación en pacientes que acuden a los Servicios de Odontología de los Hospitales de Piura, Cajamarca e Iquitos en el 2015. Material y métodos: Diseño observacional, transversal y analítico. La población estuvo conformada por todos los pacientes que se atienden en los Servicios de Odontología de los Hospitales de Piura, Cajamarca e Iquitos con un tamaño muestral de 130 pacientes respectivamente. Resultados: Pacientes mayores de 18 años, en donde el 100% de los pacientes se automedican por factores como edad cuyo rango oscila de 18 a 25 años en Cajamarca y de 36 a 50 años en Piura e Iquitos, grado de instrucción se halló con mayor porcentaje el nivel secundario (Piura 40%, Cajamarca 34,62% e Iquitos 47,69%), persona que recomienda la medicación fue el farmacéutico (Piura 34,62% y Cajamarca 45,38%), el tipo de dolencia fue el dolor dental (Piura 53,85%, Cajamarca 68,46% e Iquitos 65,38%). Conclusiones: Las personas encuestadas en los tres Hospitales de Piura, Cajamarca e Iquitos se automedican y los factores asociados a la automedicación fueron: edad, grado de instrucción, tipo de dolencia, motivo por el cual se automedican

Objective: To determine the frequency and factors associated with self-medication in patients who come to the Dentistry Services of the Hospitals of Piura, Cajamarca and Iquitos in 2015. Material and methods: Observational, transversal and analytical design. The population was conformed by all the patients that are attended in the Dentistry Services of the Hospitals of Piura, Cajamarca and Iquitos with a sample size of 130 patients respectively. Results: Patients older than 18 years, where 100% of patients self-medicate for factors such as age range from 18 to 25 years in Cajamarca and 36 to 50 years in Piura and Iquitos. Regarding the level of education, the secondary level was found with a higher percentage (Piura 40%, Cajamarca 34.62% and Iquitos 47.69%); also, regarding the person who recommended the medication was the Pharmacist (Piura 34.62% and Cajamarca 45.38%); in the same way, the type of ailment was dental pain (Piura 53.85%. Conclusions: The people surveyed in the three hospitals of Piura, Cajamarca and Iquitos self-medicated and the factors associated with self-medication were: age, level of education, type of ailment, reason for self-medication, place of acquisition of the medication and type of medication.

A single-center, six-year evaluation of the role of pulsed-field gel electrophoresis in suspected burn center outbreaks.

INTRODUCTION: Pulsed-field gel electrophoresis (PFGE) has been used as an adjunct to traditional hospital epidemiology in numerous outbreak investigations, including in burn centers. However, its most effective real-world application remains unclear, with few longitudinal descriptions of use. SETTING AND METHODS: A 425 bed military tertiary hospital with a 40 bed burn center, from July 2007 to July 2013; retrospective evaluation of hospital infection prevention records was performed and results of PFGE where used in outbreak investigation. RESULTS: Twenty-two inquiries for suspected outbreaks were performed. 418 isolates were collected from 168 subjects during this time. 325 (78%) of the isolates originated from the burn intensive care unit. 17 inquiries were for gram-negative bacteria, comprised of 5 for Acinetobacter baumannii-calcoaceticus complex, 4 Klebsiella pneumoniae, 3 Stenotrophomonas maltophilia, 2 Pseudomonas aeruginosa, and 1 of each of the following: Enterobacter cloacae, Raoultella planticola, and Aeromonas hydrophila. The other 5 inquiries were specifically for Staphylococcus aureus. The majority of investigations revealed a combination of clonal and non-clonal isolates, and in no instance did PFGE contribute to targeting of interventions. CONCLUSION: PFGE contributed little to infection prevention interventions, and outbreaks resolved with increased focus on basic practices. Longitudinal studies including greater numbers of outbreaks in different settings are needed to clarify the utility of molecular typing in routine investigations.

A survey of invasive catheter practices in U.S. burn centers.

Burn-specific guidelines for optimal catheter rotation, catheter type, insertion methods, and catheter site care do not exist, and practices vary widely from one burn unit to another. The purpose of this study was to define current practices and identify areas of practice variation for future clinical investigation. An online survey was sent to the directors of 123 U.S. burn centers. The survey consisted of 23 questions related to specific practices in placement and maintenance of central venous catheters (CVCs), arterial catheters, and peripherally inserted central catheters (PICCs). The overall response rate was 36%; response rate from verified centers was 52%. Geographic representation was wide. CVC and arterial catheter replacement varied from every 3 days (24% of sites) to only for overt infection (24% of sites); 23% of sites did not use the femoral position for CVC placement. Nearly 60% of units used some kind of antiseptic catheter. Physicians inserted the majority of catheters, and 22% of sites used nonphysicians for at least some insertions. Ultrasound was routinely used by less than 50% of units. A wide variety of post-insertion dressing protocols were followed. PICCs were used in some critically injured patients in 37% of units; the majority of these users did not rotate PICCs. Thus, it can be surmised that wide practice variation exists among burn centers with regard to insertion and maintenance of invasive catheters. Areas with particular variability that would be appropriate targets of clinical investigation are line rotation protocols, catheter site care protocols, and use of PICCs in acute burns.

Comparison of PCR/electron spray ionization-time-of-flight-mass spectrometry versus traditional clinical microbiology for active surveillance of organisms contaminating high-use surfaces in a burn intensive care unit, an orthopedic ward and healthcare workers.

BACKGROUND: Understanding nosocomial pathogen transmission is restricted by culture limitations. Novel platforms, such as PCR-based electron spray ionization-time-of-flight-mass spectrometry (ESI-TOF-MS), may be useful as investigational tools. METHODS: Traditional clinical microbiology (TCM) and PCR/ESI-TOF-MS were used to recover and detect microorganisms from the hands and personal protective equipment of 10 burn intensive care unit (ICU) healthcare workers providing clinical care at a tertiary care military referral hospital. High-use environmental surfaces were assessed in 9 burn ICU and 10 orthopedic patient rooms. Clinical cultures during the study period were reviewed for pathogen comparison with investigational molecular diagnostic methods. RESULTS: From 158 samples, 142 organisms were identified by TCM and 718 by PCR/ESI-TOF-MS. The molecular diagnostic method detected more organisms (4.5 ± 2.1 vs. 0.9 ± 0.8, p < 0.01) from 99% vs. 67% of samples (p < 0.01). TCM detected S. aureus in 13 samples vs. 21 by PCR/ESI-TOF-MS. Gram-negative organisms were less commonly identified than gram-positive by both methods; especially by TCM. Among all detected bacterial species, similar percentages were typical nosocomial pathogens (18-19%) for TCM vs. PCR/ESI-TOF-MS. PCR/ESI-TOF-MS also detected mecA in 112 samples, vanA in 13, and KPC-3 in 2. MecA was associated (p < 0.01) with codetection of coagulase negative staphylococci but not S. aureus. No vanA was codetected with enterococci; one KPC-3 was detected without Klebsiella spp. CONCLUSIONS: In this pilot study, PCR/ESI-TOF-MS detected more organisms, especially gram-negatives, compared to TCM, but the current assay format is limited by the number of antibiotic resistance determinants it covers. Further large-scale assessments of PCR/ESI-TOF-MS for hospital surveillance are warranted.