Distribution of Cervicocephalic Atherosclerotic Lesions and Their Correlation with Cardiovascular Risk Factors in a Population of Amerindians. The Atahualpa Project.

BACKGROUND: No information is available on the distribution of cervicocephalic atherosclerosis in Amerindians. We aimed to assess the distribution of these lesions and their correlation with cardiovascular risk factors in Amerindians living in rural Ecuador. METHODS: Atahualpa residents aged ≥40years underwent head CT for assessment of carotid siphon calcifications (CSC) and sonographic examination for measurement of the carotid intima media thickness (cIMT). CSC were used as a surrogate of intracranial atherosclerosis and the cIMT as a surrogate of extracranial atherosclerosis. Linear regression and multinomial logistic regression models were fitted to assess the association between cIMT and CSC, and to evaluate differences in risk factors across individuals with atherosclerosis involving both arterial beds when compared with those with extra- or intracranial atherosclerosis alone, or no atherosclerosis. RESULTS: Of 590 participants, 145 had high calcium content in the carotid siphons and 87 had a cIMT >1mm (25% versus 15%, P < .001). Thirty-eight (7%) individuals had atherosclerosis at both vascular beds, 107 (18%) had intracranial atherosclerosis, and 49 (8%) had extracranial atherosclerosis alone. The cIMT and CSC were independently associated (P = .008). When compared with participants without atherosclerosis, those with atherosclerosis at both vascular beds were older, more often male, hypertensive and diabetic. Subjects with intracranial atherosclerosis alone were older, and those with extracranial atherosclerosis alone reported less physical activity than those without atherosclerosis. CONCLUSION: Intracranial atherosclerosis is more common than extracranial atherosclerosis in Amerindians. Traditional risk factors only explain a minority of cases of cervicocephalic atherosclerosis in this population.

[Human resources for health in Ecuador's new model of care]. / Los recursos humanos en salud según el nuevo modelo de atención en Ecuador.

OBJECTIVE: Describe strategies implemented by Ecuador's Ministry of Public Health (MPH) to strengthen human resources for health leadership and respond to the new model of care, as a part of the reform process in the period 2012-2015. METHODS: A documentary review was carried out of primary and secondary sources on development of human resources for health before and after the reform. RESULTS: In the study period, Ecuador developed a new institutional and regulatory framework for developing human resources for health to respond to the requirements of a model of care based on primary health care. The MPH consolidated its steering role by forging strategic partnerships, implementing human resources planning methods, and making an unprecedented investment in health worker training, hiring, and wage increases. These elements constitute the initial core for development of human resources for health policy and a health-services study program consistent with the reform's objectives. CONCLUSIONS: Within the framework of the reform carried out from 2012 to 2015, intersectoral work by the MPH has led to considerable achievements in development of human resources for health. Notable achievements include strengthening of the steering role, development and implementation of standards and regulatory instruments, creation of new professional profiles, and hiring of professionals to implement the comprehensive health care model, which helped to solve problems carried over from the years prior to the reform.

Temporal bone thickness and texture are major determinants of the high rate of insonation failures of transcranial Doppler in Amerindians (the Atahualpa Project).

PURPOSE: To assess the role of temporal bone characteristics in transcranial Doppler (TCD) insonation failures in Amerindians living in rural Ecuador. METHODS: We evaluated thickness and texture of temporal bones in community-dwelling Amerindians ≥65 years old undergoing TCD. Using receiver operator characteristics curve analysis and generalized estimating equations, we investigated factors associated with insonation failures. RESULTS: Of 65 participants (mean age 74.7 ± 6.7 years, 60% women), 32 (49%) had uni- or bilateral insonation failure through temporal windows. Considering temporal bones independently, 57 of 130 (44%) had poor insonation. Mean thickness was higher (4.7 ± 1.2 versus 2.7 ± 0.9, p < 0.0001), and texture more often heterogeneous (93% versus 22%, p < 0.0001) in bones with poor acoustic windows. Thickness, better predicting poor insonation, was ≥3.6 mm if used alone, and ≥2.7 mm if used together with heterogeneous texture. For every millimeter of increase in thickness, subjects were 2.9 times more likely to have insonation failures. Per se, heterogeneous texture increased by 3.2 times the odds for poor insonation. In all models, being woman increased the odds for poor insonation by six to nine times. CONCLUSIONS: Temporal bone thickness and texture are independent predictors of TCD insonation failure in Amerindians.

Technical difficulties due to poor acoustic insonation during transcranial Doppler recordings in Amerindians and individuals of European origin. A comparative study.

BACKGROUND: There is no information on transcranial Doppler (TCD) failures due to poor insonation among native inhabitants of Latin America. METHODS: Seventy Ecuadorian natives and 70 age- and sex-matched individuals of European origin underwent TCD. The same investigators performed all exams using the same equipment and protocol. Using the McNemar's test for correlated proportions, we compared TCD failures related to poor insonation across ethnic groups. RESULTS: Out of 140 participants, 56 (40%) had one or more suboptimal/absent acoustic windows. These persons were older (p = 0.01) and were more often women (p < 0.0001) than those with all optimal windows (irrespective of race/ethnicity). In the matched-pair analysis, Amerindians were more likely to have suboptimal/absent acoustic windows than individuals of European origin (OR: 2.8, 95% CI: 1.3-6.5, p = 0.006). CONCLUSION: Amerindians are almost three times more likely to have insonation failures related to poor acoustic windows than their European counterparts.

Lenvatinib-Loaded Poly(lactic-co-glycolic acid) Nanoparticles with Epidermal Growth Factor Receptor Antibody Conjugation as a Preclinical Approach to Therapeutically Improve Thyroid Cancer with Aggressive Behavior.

BACKGROUND: Lenvatinib, a tyrosine kinase inhibitor (TKI) approved for the treatment of progressive and radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC), is associated with significant adverse effects that can be partially mitigated through the development of novel drug formulations. The utilization of nanoparticles presents a viable option, as it allows for targeted drug delivery, reducing certain side effects and enhancing the overall quality of life for patients. This study aimed to produce and assess, both in vitro and in vivo, the cytotoxicity, biodistribution, and therapeutic efficacy of lenvatinib-loaded PLGA nanoparticles (NPs), both with and without decoration using antibody conjugation (cetuximab), as a novel therapeutic approach for managing aggressive thyroid tumors. METHODS: Poly(lactic-co-glycolic acid) nanoparticles (NPs), decorated with or without anti-EGFR, were employed as a lenvatinib delivery system. These NPs were characterized for size distribution, surface morphology, surface charge, and drug encapsulation efficiency. Cytotoxicity was evaluated through MTT assays using two cellular models, one representing normal thyroid cells (Nthy-ori 3-1) and the other representing anaplastic thyroid cells (CAL-62). Additionally, an in vivo xenograft mouse model was established to investigate biodistribution and therapeutic efficacy following intragastric administration. RESULTS: The NPs demonstrated success in terms of particle size, polydispersity index (PDI), zeta potential, morphology, encapsulation efficiency, and cetuximab distribution across the surface. In vitro analysis revealed cytotoxicity in both cellular models with both formulations, but only the decorated NPs achieved an ID50 value in CAL-62 cells. Biodistribution analysis following intragastric administration in xenografted thyroid mice demonstrated good stability in terms of intestinal barrier function and tumor accumulation. Both formulations were generally well tolerated without inducing pathological effects in the examined organs. Importantly, both formulations increased tumor necrosis; however, decorated NPs exhibited enhanced parameters related to apoptotic/karyolytic forms, mitotic index, and vascularization compared with NPs without decoration. CONCLUSIONS: These proof-of-concept findings suggest a promising strategy for administering TKIs in a more targeted and effective manner.

Thyroid hormones selectively regulate the posttranslational processing of prothyrotropin-releasing hormone in the paraventricular nucleus of the hypothalamus.

Over the last few years, our laboratory has demonstrated that different physiological conditions or stressors affect the posttranslational processing of hypophysiotropic and nonhypophysiotropic proTRH and, consequently, the output of TRH and other proTRH-derived peptides. These alterations in proTRH processing are generally associated with parallel changes in the levels of two members of the family of prohormone convertases 1/3 and 2 (PC1/3 and PC2). An important regulator of proTRH is thyroid hormone, which is the peripheral end product of the hypothalamic (TRH)-pituitary (TSH)-thyroid (T3/4) (HPT) axis. In this study we investigated the effect of thyroid status on the processing of proTRH inside and outside the HPT axis. Our data showed that high levels of thyroid hormone down-regulated PC1/3 and PC2 and TRH synthesis, which led to an accumulation of intermediate forms of proTRH processing. Conversely, low levels of thyroid hormone up-regulated proTRH synthesis and PC1/3 and PC2 levels. Control of the activity of PCs and proTRH processing occurred specifically in the paraventricular nucleus, whereas no change due to thyroid status was found in the lateral hypothalamus or preoptic area. The posttranslational regulation of proTRH processing in the paraventricular nucleus by thyroid status is a novel aspect of the regulation of the HPT axis, which may have important implications for the pathophysiology of hypo- and hyperthyroidism.

[WEIGHT GAIN DURING PREGNANCY AND PERINATAL OUTCOMES IN PREGNANT ADOLESCENTS WITH A HISTORY OF SEXUAL ABUSE]. / GANANCIA DE PESO DURANTE LA GESTACIÓN Y RESULTADOS PERINATALES EN ADOLESCENTES EMBARAZADAS CON ANTECEDENTE DE ABUSO SEXUAL.

OBJECTIVE: the purpose of the present study was to describe some perinatal outcomes in two groups of pregnant adolescents: one group with history of sexual abuse and one group without sexual abuse antecedent. METHODS: we designed an observational, retrolective study. Participants were primigravid adolescents between 10 to 16 years, with a singleton pregnancy, and at least three prenatal medical evaluations. Participants were grouped according to sexual abuse antecedent: 55 adolescents had sexual abuse antecedent, and 110 participants had not sexual abuse antecedent. We obtained the clinical data from medical records: socio-demographic characteristics, sexually transmitted infections, illicit drugs use, pre-gestational body mass index, gestational weight gain, and newborn weight. The data were analyzed using association tests and mean comparisons. RESULTS: the adolescents with sexual abuse history had higher prevalence of human papilloma virus infection. The newborns weight of mothers without sexual abuse antecedent was about 200 grams higher than the newborns of mothers with sexual abuse antecedent (p = 0.002); while the length of the first group was 2 centimeters longer than the length of the newborns on the second group (p = 0.001). Gestational weight increase was 5 kilograms lower in adolescents with sexual abuse antecedent compared to adolescent without the antecedent (p = 0.005). Illicit drug use was similar in the two groups and it was associated to low newborn weight. CONCLUSIONS: the sexual abuse antecedent in pregnant adolescents was associated to higher frequency of human papilloma virus infections, lower newborn weight, and lower gestational weight increase on pregnant adolescents.

Introducción: la mayoría de las adolescentes con antecedente de abuso sexual inician su control prenatal tardíamente, incrementando el riesgo de eventos perinatales adversos. Objetivo: analizar la ganancia de peso gestacional materna, peso y longitud neonatales de adolescentes con y sin el antecedente de abuso sexual. Métodos: estudio observacional, retrolectivo con adolescentes embarazadas, entre 10 y 16 años, primigestas, con embarazo único y con al menos tres consultas prenatales. Las adolescentes fueron divididas en dos grupos: 55 casos con antecedente de abuso sexual (AAS) y 110 sin antecedente de abuso sexual (SAAS). Se obtuvieron datos: sociodemográficos, presencia de infecciones de transmisión sexual, toxicomanías, índice de masa corporal pregestacional y ganancia de peso gestacional maternos, así como peso y longitud del neonato. Se calcularon pruebas de asociación y comparación de medias. Resultados: las adolescentes con AAS tuvieron mayor prevalencia de virus del papiloma humano. El peso y longitud de los neonatos del grupo SAAS fue mayor, con cerca de 200 g (p = 0,002) y 2 cm (p = 0,001) que el grupo con AAS. El aumento de peso gestacional fue 5 kg inferior en las adolescentes con AAS (p = 0,005). El consumo de drogas ilegales fue similar en ambos grupos y se asoció con menor peso de los recién nacidos. Conclusiones: el antecedente de abuso sexual en adolescentes embarazadas se asoció con mayor frecuencia al virus del papiloma humano, menor peso y longitud en los recién nacidos y menor aumento de peso gestacional en la madre. El uso de drogas ilícitas fue similar en ambos grupos y se asoció con menor peso al nacer.

Los recursos humanos en salud según el nuevo modelo de atención en Ecuador / Human resources in health according to the new model of care in Ecuador

RESUMEN Objetivo Describir las estrategias implementadas por el Ministerio de Salud Pública del Ecuador (MSP) para fortalecer la rectoría de los recursos humanos en salud y responder al nuevo modelo de atención, como parte del proceso de reforma durante el periodo 2012–2015. Métodos Se realizó una revisión documental sobre el desarrollo del recurso humano en salud antes y después de la reforma recabando información en fuentes primarias y secundarias. Resultados En el periodo de estudio, Ecuador generó un nuevo marco institucional y normativo para desarrollar recursos humanos en salud a fin de responder a los requisitos de un modelo de atención basado en la Atención Primaria en Salud (APS). El MSP consolidó su papel rector estableciendo alianzas estratégicas, aplicando métodos de planificación de los recursos humanos y realizando una inversión sin precedentes en la formación del personal sanitario, contrataciones e incrementos salariales. Estos elementos constituyen los ejes iniciales para la construcción de una política de recursos humanos en salud y una carrera sanitaria coherentes con los objetivos de la reforma. Conclusiones En el marco de la reforma realizada entre 2012 y 2015, el desarrollo del recurso humano en salud muestra logros importantes gracias al trabajo intersectorial realizado por el MSP. Entre dichos logros destacan el fortalecimiento de la rectoría, el desarrollo e implementación de normativa e instrumentos regulatorios, la creación de nuevos perfiles de profesionales, y el contrato de profesionales con el objetivo de implementar el Modelo de atención integral de salud (MAIS), lo cual contribuyó a resolver problemas arrastrados durante los años previos a la reforma.

ABSTRACT Objective Describe strategies implemented by Ecuador’s Ministry of Public Health (MPH) to strengthen human resources for health leadership and respond to the new model of care, as a part of the reform process in the period 2012–2015. Methods A documentary review was carried out of primary and secondary sources on development of human resources for health before and after the reform. Results In the study period, Ecuador developed a new institutional and regulatory framework for developing human resources for health to respond to the requirements of a model of care based on primary health care. The MPH consolidated its steering role by forging strategic partnerships, implementing human resources planning methods, and making an unprecedented investment in health worker training, hiring, and wage increases. These elements constitute the initial core for development of human resources for health policy and a health-services study program consistent with the reform’s objectives. Conclusions Within the framework of the reform carried out from 2012 to 2015, intersectoral work by the MPH has led to considerable achievements in development of human resources for health. Notable achievements include strengthening of the steering role, development and implementation of standards and regulatory instruments, creation of new professional profiles, and hiring of professionals to implement the comprehensive health care model, which helped to solve problems carried over from the years prior to the reform.

Las tecnologías de la comunicación e información (TIC) en salud: un modelo para aplicar en la carrera de enfermería / Information and communications technology (ICT) in health: a model to be applied in nursing training

Resumen:

Objetivo: diseñar una propuesta de gestión curricular y docente para el desarrollo de habilidades en el uso de las tecnologías de la información y comunicación (TIC) en las competencias de la formación de enfermería. Método: estudio observacional, descriptivo, analítico y transversal. El universo constituye 38 carreras de la Universidad Católica de Quito. Resultados: se establecieron bases teórico-metodológicas del modelo curricular y docente con orientación al desarrollo de habilidades profesionales, basados en un diagnóstico situacional. Discusión: la aplicación de las TIC porta al perfeccionamiento del conocimiento, sin embargo, su distribución no es equitativa y ocasionalmente subutilizada generando la “brecha digital” que impide alcanzar el desarrollo de competencias profesionales. La integración del qué y cómo en el ámbito docente y del estudiante deben estar fuertemente ligadas al quehacer de cada profesión, ya que en caso contrario pierde impacto en la meta de formación profesional. Conclusiones: el análisis situacional distingue a la universidad como cooperante, con aspectos organizativos y educativos de alta interacción de TIC; la práctica docente refiere una integración con menor presencia en la formación continua y vocacional; caracteriza el liderazgo al tipo impulsador. Las carreras denotan deficiencias en el uso de bases de datos, de herramientas multimedia (realidad virtual) así como de herramientas de audio y vídeo. El conocimiento sobre las políticas sobre TIC evidencia un bajo indicador. El diseño de la propuesta concentra la intervención en: infraestructura tecnológica y equipamiento, recurso humano, administración y organización.

Abstract:

Purpose: to design a proposal for curricular and teaching management in order to develop skills in use of information and communications technology (ICT) in nursing training competences. Methods: an observational, descriptive, analytical, cross-sectional study was performed. Universe included 38 curricula at Catholic University of Quito.

Results: theoretical and methodological bases were established for a curricular and teaching model oriented to professional skills development and based on situation diagnosis. Discussion: ICT application results in knowledge improvement; however its distribution is not equitable and sometimes it is underused, which results in a "digital gap" preventing professional competences to be successfully developed. Integration of what and how in teaching settings and in students should be closely linked with professional tasks; otherwise its impact on professional training is lost. Conclusions: situation analysis considers university as a contributor, with organizational and educational items having a high interaction with ICT; teaching practice shows a lower integration in continuous and professional education and is typical in driving leadership. Current university curricula show deficiencies in use of databases, multimedia tools (virtual reality) and audiovisual tools. Data regarding policies on ICT show a low level. Proposal design is focused on interventions on: technological infrastructure and equipment, human resources, administration and organization.

Objetivo: desenhar uma proposta de currículo e ensino de gestão para desenvolvimento de habilidades no uso de Tecnologia da Informação e Comunicação (TIC) nas competências específicas de ensino de enfermagem. Método: estudo observacional, transversal, descritivo e analítico.O universo de estudo é de 38 carreiras da Universidade Católica do Quito. Resultados: foram estabelecidos um modelo teórico e metodológico orientado para o desenvolvimento de competências profissionais com base em uma análise situacional. Discussão: a aplicação das TIC na educação é uma contribuição para a melhoria do conhecimento, no entanto, não está distribuída uniformemente e muitas vezes é subutilizado, de modo que o "fosso digital" que impede a consecução do desenvolvimento de habilidades profissionais. A integração do que? E como? No âmbito docente e do estudante debe estar intimamente ligado ao trabalho de cada profissão caso contrário perde o impacto sobre o objetivo da formação profissional.

Conclusões: a análise da situação diferencia da Universidade como uma instituição que coopera nos aspectos organizacionais e educacionais são as interações elevadas das TIC; dentro da prática de ensino referese a integração, mas com uma menor presença na formação contínua e profissional; caracterizada pela sua inovação e liderança. As carreiras denotam uma deficiência na utilização de bases de dados multimédia, ferramentas (realidade virtual), assim como ferramentas de áudio e vídeo. Conhecimento das políticas de TIC, mostram um baixo indicador. O projeto da proposto centra-se em intervenção: infra-estrutura tecnológica e equipamentos, recursos humanos, administração e organização.

Cellular colocalization and coregulation between hypothalamic pro-TRH and prohormone convertases in hypothyroidism.

The prohormone convertases (PCs), PC1/3 and PC2, are involved in the tissue-specific endoproteolytic posttranslational processing of many hormonal precursors within the secretory pathway. One important prohormone, pro-thyrotropin-releasing hormone (TRH), is expressed in both hypophysiotropic (where it regulates the secretion of thyroid-stimulating hormone) and nonhypophysiotropic regions of the brain. Pro-TRH is processed at specific sites in the secretory pathway, primarily by PC1/3 followed by PC2. We hypothesized that thyroid hormone status in specific nuclei of the brain would alter pro-TRH processing by inducing changes in PC1/3 and PC2 expression. Therefore, we examined pro-TRH, PC1/3, and PC2 coexpression and coregulation in the paraventricular nucleus (PVN), lateral hypothalamus (LH), and ventromedial nucleus (VMN) of hypothyroid and euthyroid rats. Our results show that 6-n-propyl-2-thiouracil (PTU) treatment producing hypothyroidism induced a significant increase in the expression of PC1/3, PC2, and pro-TRH in the PVN and LH, but not VMN. When confocal studies were performed, an increase in colocalization of PC1/3 or PC2 in pro-TRH was observed only in PVN, a response that was especially prominent in the ventral and medial areas of the PVN. PTU did not regulate colocalization in the VMH or LH. Regulation of colocalization of processing enzyme and prohormone expression is a novel mechanism to alter hormonal biosynthesis.

Megaesófago chagásico. Informe de un caso / Megaesophagus by chagas disease. Case report

El Trypanosoma cruzi es un parásito protozoario que causa la enfermedad de Chagas, que es endémica en México. Los riesgos de infección están relacionados a la exposición a insectos que albergan a T. cruzi o por transfusión sanguínea de un donador infectado. La enfermedad de Chagas es uno de los problemas de salud pública más importantes en México y Sudamérica. La migración de zonas rurales a zonas urbanas ha contribuido a diseminar la enfermedad. Los blancos principales de la enfermedad dentro del cuerpo son: el corazón, el aparato digestivo y el sistema nervioso. En la fase aguda de la enfermedad el parásito responsable puede ser identificado por un examen sanguíneo directo

Edema pulmonar no cardiogénico secundario a laringoespasmo posterior a anestesia general / Laryngospasm induced pulmonary edema following general anesthesia. A case report

Se presenta el caso clínico de un paciente joven, sano, que desarrolló edema pulmonar no cardiogénico secundario a laringoespasmo posterior a la extubación, no detectándose el problema en forma inmediata, sino hasta 24 hrs después cuando se manifestó con taquicardia y desaturación por oximetría de pulso. La radiografía de tórax, mostró infiltrados alveolares bilaterales difusos y zona de confluencia en el lóbulo superior del pulmón derecho. No requirió reintubación. La terapia consistió en oxígeno suplementario por puntas nasales, restricción de líquidos, diuréticos, esteroides, broncodilatadores y antibióticos. Después del tratamiento establecido, hubo franca mejoría 24 hrs después, confirmado clínica y radiológicamente

Rótula alta y lateral. Pateoloplastía por angostamiento rotuliano y descenso-centraje de la rótula, mediante tenotomía diagonal y tenorrafia rotuliana con material absorbible / High riding patella. Lateral narrowing pateloplasty and medial and inferior patelar advancement by oblique tenotomy of the patelar ligament and tenorraphy by absorbable material

Se presenta una primera serie de seis casos de adultos con rótula alta y lateral, que fueron operados entre 1993 y 1994, y se describe la técnica de pateloplastía y tenorrafia de descenso y medialización rotuliana. Consiste en reducción por angostamiento del margen lateral de la rótula y tenotomía diagonal del tendón rotuliano, dirigida medial y distalmente así como su sutura con materia absorbible. Se hizo además liberación del vasto externo sobre su borde lateral, sin desinsertarlo de la rótula al estilo Insall. Los resultados han sido uniformemente satisfactorios. Con esta técnica se han eliminado la lateralización de la rótula, su situación elevada y la pérdida de fuerza del músculo cuadríceps. También se ha eliminado el severo dolor que se presenta en otras técnicas de descenso de la inserción del tendón rotuliano, ya que el tendón es poco sensible y muy noble en cuanto a su cicatrización.