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En el presente trabajo se muestra el desarrollo de la industria del vestido en dos localidades rurales del estado de Jalisco. El objetivo es señalar la informalidad de este tipo de trabajo en esos lugares, donde los hogares funcionan como maquiladoras y los trabajadores de estos talleres laboran en condiciones precarias, sin salario base y con una total inexistencia de seguridad social, donde asumen ellos mismos algunos costos de producción como la compra de la maquinaria para poder trabajar y el pago de la electricidad para las máquinas. Además, prestan el espacio donde trabajan, guardan sus herramientas, y también sirve de almacén para guardar la mercancía que producen mientras pasan a recogerla los empresarios para quienes trabajan. Todas estas desventajas ayudan a subsidiar los costos de producción. Finalmente, contrario a lo que se puede pensar, estos empleos siguen siendo vigentes en el campo mexicano.

Continuous positive airway pressure (CPAP) is one of the most common therapies for Obstructive Sleep Apnea (OSA). We present a brief, patient-reported outcome measure used to assess patients' levels of adherence with CPAP treatment.A questionnaire was developed based on academic literature. We qualitatively tested a pool of 18 items. It was tested in a sample of 174 patients from the Hospital La Princesa. Next, 1021 patients from Catalonia were evaluated.5 items were removed. Nominal groups referred to three areas: general knowledge about OSA and its risks; CPAP treatment information and expectations; CPAP use, monitoring, and confidence with its use. The 13 retained items maintained the same meaning as the original questionnaire (r=.986; p.001) and the three proposed dimensions detected a significant increase in general knowledge of OSA (t[173]=8.097, p.001); CPAP treatment information (t[173]=15.170, p.001); and CPAP use (t[173]=14.642, p.001). The final 12-item version was reliable (CRI=.793) and its internal structure was adequate (χThe interview could help clinicians prevent some dropouts by targeting patients with lower adherence. It's a tool for assessing patient adherence to CPAP and to promote strategies through education and external motivational stimuli.

Este trabajo tiene como finalidad realizar un estudio comparativo sobre la difusión de los Géneros Periodísticos, por lo que se planteó el objetivo: Identificar los Géneros Periodísticos que utilizan los diarios El Universo y Expreso en sus publicaciones. A través de la investigación bibliográfica se indagó los contenidos científicos y con la Investigación Documental se revisaron los diarios: El Universo y el Expreso. Por otra parte, con el Método Analítico se identificó los tipos de los textos. También se aplicó el Método Estadístico para tabular los datos. Se utilizó el método comparativo para confrontar los textos que difunden los dos medios de comunicación impresos. Debido a los resultados obtenidos, se concluyó que el Género Informativo la noticia es el más utilizado para la divulgación de la información igualmente la publicidad del Género Instrumental.&nbsp

Este trabajo tiene como finalidad realizar un estudio comparativo sobre la difusion de los Generos Periodisticos, por lo que se planteo el objetivo : Identificar los Generos Periodisticos que utilizan los diarios de Universo y Experso en sus publicaciones . A traves de las investigaciones bibliografica se indago los contenidos cientificos y con la investigacion Documental se revisaron los diarios : El universo y el Experso . Por otra parte , con el Metodo Analitico se identifico los tipos de los textos . Tambien se aplico el Metodo Estadistico para tabular los datos . se utilizo el metodo comparativo para confortar los textos que difunden los dos medios de comunicacion impresos . Debido a los resultados obtenidos , se concluyo que el genero Informativo la noticia es el mas utilizado para la divulgacion de la informacion igualmente la publicidad del Genero Instrumental .

Ante el incremento acelerado de aplicaciones móviles en plataformas digitales se observan herramientas tecnológicas que pretenden ser útiles al usuario en la solución inmediata en situaciones laborables, académicas o sociales; al momento de descargar o adquirir las aplicaciones móviles para realizar una tarea o una actividad determinada, se piensa en obtener los resultados sobre la información que se requiere o se solicita; el objetivo de esta investigación es mostrar el nivel de calidad que tiene la App como herramienta para generar información financiera sobre el manejo y control del efectivo; en el desarrollo de la aplicación se sustentó en la norma ISO 13407, esta norma establece el diseño centrado en las necesidades del usuario y los procedimientos para el procesamiento de datos con base en la normatividad de auditoría en donde se sustenta el control interno del rubro sobre el efectivo; para realizar las pruebas sobre el uso de la aplicación se utilizaron datos reales de pymes dedicados a la actividad comercial, industrial y prestación de servicios; en la validación de contendió y resultados participaron 80 contadores públicos certificados, quienes dieron su opinión por escrito sobre el nivel de uso conforme a la norma ISO 25010; los resultados revelan que la herramienta presenta niveles de calidad excelentes debido a que cumple con todas y cada una de las variables de funcionalidad, eficiencia, compatibilidad, usabilidad, confiabilidad, seguridad, mantenibilidad y portabilidad, por tanto es generador de información financiera oportuna, confiable, comprensible y relevante, útil al usuario para una efectiva toma de decisiones en el manejo y control del efectivo.

Introduction: The first-line treatment for obstructive sleep apnoea is (OSA) continuous positive airway pressure (CPAP) therapy, which achieves a high level of efficacy with continuous use. However, daily application of this therapy requires a motivated patient profile, as lack of adherence is the main problem with this therapy. The aim of this study was to determine whether an educational and training program based on motivational interviewing and proper feedback, improved adherence. Methods: A randomized, controlled, single-center trial design was performed. The interventions were standard of care vs MEntA Program based on motivational interview for adherence. The main outcome was the adherence with the CPAP therapy after 90 days of treatment. Secondary outcomes were the motivation, perceived competence, quality of life, sleepiness, emotional state, activities and social relations. Results: For adherence, statistically significant results were obtained in favor of the interventional arm with the MEntA (p

Background COVID-19 patients can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation (IMV). Since interleukin-6 (IL-6) is a relevant cytokine in ARDS, the blockade of its receptor with Tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. Objective To determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. Methods Retrospective observational study performed in hospitalized patients diagnosed of COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with pre- and post-administration of TCZ. Multivariable logistic and linear regressions, and survival analysis were performed depending on outcomes: need for IMV, evolution of arterial oxygen tension/fraction of inspired oxygen ratio (PaO2/FiO2) or mortality. Results One hundred and forty-six patients were studied, predominantly male (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels>30 pg/ml was the best predictor for IMV (OR:7.1; p30 pg/ml predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administration., Baseline IL-6 serum levels>30 pg/ml identify severe COVID-19 patients and should be used to guide the intervention with IL-6R inhibitors, aiming to improve their use in an uncertain and evolving therapeutic scenario.

Coronavirus disease 2019 (COVID-19) was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province (China). Coronavirus is a family of single-stranded RNA viruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted from person to person. Although asymptomatic individuals can transmit the virus, symptomatic patients are more contagious. The incubation period ranges from 3-7 d and symptoms are mainly respiratory, including pneumonia or pulmonary embolism in severe cases. Elevated serum levels of interleukins (IL)-2, IL-6, IL-7 indicate the presence of cytokine release syndrome, which is associated with disease severity. The disease has three main phases: Viral infection, pulmonary involvement, and hyperinflammation. To date, no treatment has proved to be safe or effective. Chest X-ray and computed tomography (CT) are the primary imaging tests for diagnosis of SARS-CoV-2 pneumonia, follow-up, and detection of complications. The main radiological findings are ground-glass opacification and areas of consolidation. The long-term clinical course is unknown, although some patients may develop pulmonary fibrosis. Positron emission tomography-computed tomography (PET-CT) is useful to assess pulmonary involvement, to define the affected areas, and to assess treatment response. The pathophysiology and clinical course of COVID-19 infection remain poorly understood. However, patterns detected on CT and PET-CT may help to diagnose and guide treatment. In this mini review, we analyze the clinical manifestations and radiological findings of COVID-19 infection. Sin financiación No data 2020 UEM

Resumen: Presentamos un nuevo abordaje mínimamente invasivo mediante distracción intraoral de rama mandibular bilateral (bilateral internal ramus distraction) para el tratamiento del síndrome de apnea obstructiva del sueño en el paciente adulto. Tras la planificación virtual 3 D, el paciente es intervenido bajo anestesia general y asistencia endoscópica, dentro de un protocolo de cirugía mayor ambulatoria, y es dado de alta el mismo día de la cirugía. Tras un periodo de 5 días, la rama mandibular se alarga verticalmente durante un periodo que oscila entre 10 y 50 días, a un ritmo de 0,5 a 1 mm diario, hasta que el índice de apnea hipopnea alcanza una cifra inferior a 5 pausas por hora (nivel de curación) o el resalte negativo dentario (overjet) se sitúa en valores que ya superan los 10 mm.La titulación del procedimiento mediante parámetros clínicos, poligráficos o polisomnográficos permite al cirujano personalizar el avance mandibular en cada caso. Tras un alargamiento que suele oscilar entre 10 y 25 mm, los distractores se mantienen durante 6 meses hasta que concluye el periodo de consolidación. La indicación de cirugía maxilar tras el avance mandibular se realizará en dependencia del índice de apnea hipopnea residual, de la oclusión y del análisis facial.La distracción intraoral de rama mandibular bilateral es una técnica altamente efectiva para la curación del síndrome de apnea obstructiva del sueño en pacientes adultos con o sin retrognatia, y podría estar indicada incluso en pacientes con morbilidades asociadas, como enfermedades cardiovasculares graves u obesidad mórbida, en los que un procedimiento quirúrgico de mayor envergadura, como el avance maxilomandibular clásico, se descarta como alternativa quirúrgica. Abstract: An innovative and minimally invasive approach for adult obstructive sleep apnoea by using bilateral internal ramus distraction osteogenesis of the mandible is presented. After a careful virtual 3 D planning, mandibular distraction surgery is performed under general anaesthesia and endoscopic assistance, using a major ambulatory surgery protocol, with the patient being discharged home the same day. After an initial latency of 5 days, the ascending ramus is gradually lengthened vertically during a period varying between 10 and 50 days, at a rate of 0.5 mm to 1 mm daily, until an apnoea-hypopnoea index below 5/h is achieved (cure level), and/or a negative overjet > 10 mm is reached.Titration of the procedure according to clinical criteria with the assistance of polygraphy and/or polysomnography allows the clinician to customise the mandibular advancement to each particular case. After a mandibular ramus lengthening ranging between 10 and 25 mm, the distraction devices are kept in place for 6 months after completion of the consolidation period.Bilateral internal ramus distraction is a highly effective surgical technique in curing obstructive sleep apnoea in adults with or without retrognathia, and could be indicated even in patients with comorbidities, such as cardiovascular disease or morbid obesity, in which a major surgical procedure, i.e. conventional maxillomandibular advancement, should be discouraged. Palabras clave: Apnea obstructiva del sueño, Alteraciones respiratorias del sueño, Cirugía ortognática, Obstrucción respiratoria, Distracción osteogénica mandibular, Cirugía mínimamente invasiva, Avance maxilomandibular, Keywords: Obstructive sleep apnoea, Sleep-disordered breathing, Orthognathic surgery, Respiratory obstruction, Mandibular distraction osteogenesis, Minimally invasive surgery, Maxillomandibular advancement

Background: Severe acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in patients with acute cardiogenic pulmonary edema (ACPE) and obesity hypoventilation syndrome (OHS). Therefore, the objective of the present study was to compare NIV failure rates between patients with severe and non-severe acidosis admitted to a respiratory intermediate care unit (RICU) with AHRF resulting from ACPE, COPD or OHS. Methods: We prospectively included acidotic patients admitted to seven RICUs, where they were provided NIV as an initial ventilatory support measure. The clinical characteristics, pH evolutions, hospitalization or RICU stay durations and NIV failure rates were compared between patients with a pH >= 7.25 and a pH < 7.25. Logistic regression analysis was performed to determine the independent risk factors contributing to NIV failure. (Continued on next page) Results: We included 969 patients (240 with ACPE, 540 with COPD and 189 with OHS). The baseline rates of severe acidosis were similar among the groups (45 % in the ACPE group, 41 % in the COPD group, and 38 % in the OHS group). Most of the patients with severe acidosis had increased disease severity compared with those with non-severe acidosis: the APACHE II scores were 21 +/- 7.2 and 19 +/- 5.8 for the ACPE patients (p < 0.05), 20 +/- 5.7 and 19 +/- 5.1 for the COPD patients (p < 0.01) and 18 +/- 5.9 and 17 +/- 4.7 for the OHS patients, respectively (NS). The patients with severe acidosis also exhibited worse arterial blood gas parameters: the PaCO2 levels were 87 +/- 22 and 70 +/- 15 in the ACPE patients (p < 0.001), 87 +/- 21 and 76 +/- 14 in the COPD patients, and 83 +/- 17 and 74 +/- 14 in the OHS patients (NS)., respectively Further, the patients with severe acidosis required a longer duration to achieve pH normalization than those with non-severe acidosis (patients with a normalized pH after the first hour: ACPE, 8 % vs. 43 %, p < 0.001; COPD, 11 % vs. 43 %, p < 0.001; and OHS, 13 % vs. 51 %, p < 0.001), and they had longer RICU stays, particularly those in the COPD group (ACPE, 4 +/- 3.1 vs. 3.6 +/- 2.5, NS; COPD, 5.1 +/- 3 vs. 3.6 +/- 2.1, p < 0.001; and OHS, 4.3 +/- 2.6 vs. 3.7 +/- 3.2, NS). The NIV failure rates were similar between the patients with severe and non-severe acidosis in the three disease groups (ACPE, 16 % vs. 12 %; COPD, 7 % vs. 7 %; and OHS, 11 % vs. 4 %). No common predictive factor for NIV failure was identified among the groups. Conclusions: ACPE, COPD and OHS patients with AHRF and severe acidosis (pH, Spanish Respiratory Foundation, 2011 (FEPAR)

Cystic fibrosis (CF) is a fatal inherited disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene whose mortality is conditioned by a progressive decline in lung function. Bacterial infections play a key role in this decline. Chronic bacterial infection in CF patients varies over time and the presence of Pseudomonas aeruginosa in sputum is a marker of poor prognosis. P. aeruginosa is eradicated from the airways using inhaled antibiotics administered in various formulations and devices. Antipseudomonal antibiotics have extended the survival of CF patients to 40 years. Tobramycin is a bactericidal aminoglycoside antibiotic with demonstrated activity against gram-negative microorganisms. Initially, the drug was administered as an inhaled parenteral solution. Subsequently, a specific tobramycin inhalation solution was developed. PulmoSphere™ technology enables dry tobramycin powder to be formulated for inhalation (tobramycin inhalation powder) using a small and portable capsule-based breath-activated device (T-326). Chronic colonization by P. aeruginosa is the main indication for aerosol antibiotic therapy. The American Cystic Fibrosis Foundation, European guidelines, and Spanish consensus guidelines provide different recommendations for eradication.