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Abstract Background A Strategic Guiding Council (SGC) was created within a Family Carer Decisions Support study, to engage family carers of persons with advanced dementia as advisors to inform the design and implementation of the study. The SGC consists of an international group of family advisors from Canada, the Republic of Ireland, the United Kingdom, the Netherlands, and the Czech Republic. There are limited studies that have explored the integration of Patient and Public Involvement (PPI) in dementia research, end-of-life care and long-term care. Therefore, this study explores PPI engagement in health research with family carers to understand further their interest in being involved in the SCG within the FCDS intervention which is focused on supporting caregivers to make decisions about end-of-life care for residents with advanced dementia. Methods This study utilized an interpretive descriptive design and explored the motivations of ten family advisors from Canada, the Republic of Ireland, the United Kingdom, and the Netherlands in being part of the SGC. Semi-structured interviews were conducted by phone or videoconferencing and were recorded, transcribed, and analyzed using thematic analysis. Results Three themes generated from the findings of the study were (1) engaging in reciprocal learning; (2) using lived experience to support other family carers; and (3) creating a collective momentum for advocacy and change. Conclusions Family carers motivations to being part of the SCG was driven by their intent to help carers navigate the health system and to create a psychosocial support system for other carers experiencing end-of-life with their loved ones. Being part of the SCG provided a benefit to family carers which provided a venue for them to contribute meaningful information from their experience, learn from other health professionals, research and other advisors and an avenue for advocacy work to improve access to end-of-life care supports through education. To our knowledge, this is the first study that explores the motivations of an international group of family advisors’ engagement in health research to promote integration of a palliative approach to dementia care in long-term care homes. This study further contributes to the literature from an international perspective the importance of PPI in research. Further research is warranted that explores PPI in research to improve access to end-of-life supports.

Abstract In humans, blood Classical CD14+ monocytes contribute to host defense by secreting large amounts of pro-inflammatory cytokines. Their aberrant activity causes hyper-inflammation and life-threatening cytokine storms, while dysfunctional monocytes are associated with ‘immunoparalysis’, a state of immune hypo responsiveness and reduced pro-inflammatory gene expression, predisposing individuals to opportunistic infections. Understanding how monocyte functions are regulated is critical to prevent these harmful outcomes. We reveal platelets’ vital role in the pro-inflammatory cytokine responses of human monocytes. Naturally low platelet counts in patients with immune thrombocytopenia or removal of platelets from healthy monocytes result in monocyte immunoparalysis, marked by impaired cytokine response to immune challenge and weakened host defense transcriptional programs. Remarkably, supplementing monocytes with fresh platelets reverses these conditions. We discovered that platelets serve as reservoirs of key cytokine transcription regulators, such as NF-κB and MAPK p38, and pinpointed the enrichment of platelet NF-κB2 in human monocytes by proteomics. Platelets proportionally restore impaired cytokine production in human monocytes lacking MAPK p38α, NF-κB p65, and NF-κB2. We uncovered a vesicle-mediated platelet-monocyte-propagation of inflammatory transcription regulators, positioning platelets as central checkpoints in monocyte inflammation.

Abstract Background Recent meta-analyses and randomized studies have shown that among patients with acute ischemic stroke undergoing endovascular thrombectomy, general anesthesia with mechanical ventilation is associated with better functional status compared to local anesthesia and sedation, and they recommend its use. But once the procedure is completed, when is the optimal moment for extubation? Currently, there are no guidelines recommending the optimal moment for extubation. Prolonged mechanical ventilation time could potentially be linked to increased complications such as pneumonia or disturbances in cerebral blood flow due to the vasodilatation produced by most anesthetic drugs. However, premature extubation in a patient who has suffered a stroke could led to complications such as agitation, disorientation, abolished reflexes, sudden fluctuations in blood pressure, alterations in cerebral blood flow, respiratory distress, bronchial aspiration, and the need for reintubation. We therefore designed a randomized study hypothesizing that early compared with delayed extubation is associated with a better functional outcome 3 months after endovascular thrombectomy treatment under general anesthesia for acute ischemic stroke. Methods This investigator-initiated, single-center, prospective, parallel, evaluated blinded, superiority, randomized controlled trial will include 178 patients with a proximal occlusion of the anterior circulation treated with successful endovascular thrombectomy (TICI 2b-3) under general anesthesia. Patients will be randomly allocated to receive early (

Objetivo: describir las características demográficas y clínicas y determinar los factores precipitantes de la insuficiencia cardiaca. La importancia de conocer estos factores permitirá aplicar medidas que impidan o retrasen las descompensaciones cardiacas. Métodos: se aplicó un diseño estudio observacional, descriptivo, de corte transversal. La muestra se constituyó con varones y mujeres, mayores de edad, que ingresaban por insuficiencia cardiaca descompensada al Servicio de Clínica Médica entre abril y octubre del 2023. Se utilizó un muestreo de casos consecutivos y se midieron variables demográficas y clínicas. Se aplicó estadística descriptiva. El estudio fue aprobado por el Comité de ética de la Universidad Privada del Este, Paraguay. Resultados: la muestra se constituyó con 130 sujetos, siendo 65 varones con edad media 64 ± 16 años y 65 mujeres con edad media 62 ± 15 años. Las comorbilidades más frecuentes fueron la hipertensión arterial (93,8%) y la diabetes mellitus (56,9%). Los grados funcionales predominantes fueron III (36,1%) y IV (25%). El valor de NT-proBNP se halló elevado sobre todo en el grado funcional IV (mediana 3138 pg/mL). Las causas de descompensación fueron varias en el mismo paciente y predominaron la crisis hipertensiva (71,4%), ingesta excesiva de agua y sal (64,6%) y síndrome coronario agudo (51,5%). La mortalidad fue 0,78%. Conclusiones: las principales causas de descompensación de la insuficiencia cardiaca fueron factores modificables: crisis hipertensiva, falta de adherencia a dieta y síndrome coronario agudo. Se recomienda aplicar medidas preventivas basadas en estos datos, pues las mismas son reversibles.

Summary: Background: BTK inhibitors have been concurrently administered with anti-CD20 monoclonal antibodies (mAbs) in chronic lymphocytic leukemia (CLL). However, the optimal regimen for combining these two drugs remains pending. Methods: This multi-center phase 2 study aimed to analyze whether consolidation with ofatumumab improved the response in patients with CLL receiving front-line treatment with ibrutinib. Patients received 12 cycles of ibrutinib monotherapy. Those who achieved CR after this induction were maintained on ibrutinib. Conversely, those who did not attain CR continued with ibrutinib in addition to a consolidation, which involved 7 doses of ofatumumab. The primary objective was the complete response (CR) rate at cycle 20. This study is registered within the EU Clinical Trials Register (EudraCT 2016-004937-26). Findings: Between September 8, 2017, and May 21, 2018, 84 patients (median age, 69 years) were included. After completion of 12 cycles of ibrutinib (n = 80), 4 patients (5%) were in CR, 67 (84%) in partial response (PR), and 6 patients (7%) had a PR with lymphocytosis (PRL). After consolidation with ofatumumab, 20 patients improved the response from PR to CR and 6 patients with PRL obtained a PR. Seventy-one patients (85%) completed 20 cycles of treatment, with a CR rate of 24/71 (34%). According to the intention-to-treat analysis at cycle 20, the ORR was 69/84 (82.2%), with a CRR of 24/84 (28.6%). Progression-free survival and overall survival at 48-months were 89.9% (CI: 82.4–95.5) and 92.2% (CI: 85.3–97.1), respectively. Interpretation: These findings underscore the potential for a consolidation strategy in CLL, wherein the addition of a mAb in patients with low tumor burden might enhance the quality of the response. Funding: The study was funded by Janssen that also supplied ibrutinib, whereas ofatumumab was supplied by Novartis.

Introducción: La microfiltración apical es uno de los principales causantes de fracasos endodónticos donde hay invasión de bacterias y líquidos periapicales a la parte interna del conducto radicular y material de relleno. Materiales y Métodos: La muestra estuvo conformada por 60 dientes premolares unirradiculares que fueron seccionados en la unión amelocementaria, la instrumentación biomecánica se realizó con técnica rotatoria e irrigación con hipoclorito de sodio al 5.25% y EDTA 17%, se dividió aleatoriamente en 4 grupos (n=15) para cada tipo de cemento, la obturación se realizó con la técnica de condensación lateral, a nivel coronal se obturó con Ionómero vidrio base y resina, se colocaron en una incubadora a 37° sumergidos en NaCL 0.9% por 5 días hasta el fraguado de los cementos, para observar la microfiltración se utilizó el método filtración de tinta china y la diafanización con la técnica de Robertson. Las medidas de microfiltración apical se observaron utilizando el Estereomicroscopio. Resultados: El valor promedio fue menor para el cemento Adseal 0,33mm, seguido por los cementos Fillapex 0,87mm, Roeko seal 1,00mm y Endofill 1,30mm respectivamente. Hubo diferencias estadísticamente significativas en la microfiltración apical de los cuatro cementos endodónticos (p=0.00) Conclusiones: El cemento Adseal presentó menor microfiltración en comparación a los cementos Fillapex, Roeko seal y Endofill. Palabras clave: Filtración dental, Ápice del diente, Endodoncia, Obturación del conducto radicular, Materiales de Obturación del Conducto Radicular.

Summary: Background: The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods: The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020–2022). Findings: The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation: Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding: Not applicable.

Introduction: Pediatric extreme hydrocephalus (PEH) is a complex condition with uncertain prognostic outcomes. Objectives: In this study, we analyze the long-term change in cerebral parenchymal thickness of pediatric patients with extreme hydrocephalus after shunting. Methods: A retrospective observational study was conducted on patients with PEH treated at the General Hospital of Mexico from 2009 to 2016. Cerebral parenchymal thickness was measured in computed tomography studies before surgical intervention, at 5 months, and 4 years post-surgery. The average change in thickness in millimeters was analyzed, and its normalized value was assessed using the Wilcoxon test and the R2 of a linear function. Results: Twelve patients, including 5 females and 7 males, were studied. Nine cases were congenital, while the remaining 3 cases were 6 months, 7, and 10-years-old. At 5.2 months PostOp., patients showed an average increase of 160% in cerebral parenchymal thickness, which increased to 270% at 4.3 years. However, 4 cases (33.3%) had an increase of < 10% from the original thickness. One patient at 4.3 years exhibited a 594% increase compared to the baseline. In the congenital cases, pre-operative thickness had a good correlation (R2 = 0.70) with post-operative thickness, but pre-operative age of patients did not correlate with post-operative thickness (R2 = 0.03). Conclusions: In this study, 3 out of 12 cases of PEH showed a long-term increase of > 200% compared to preoperative thickness. Even in cases of extreme hydrocephalus, significant long-term improvement can occur. Rapid treatment of these cases is crucial to increase the likelihood of improvement.

Background: Hearing disabilities in pediatrics are a prevalent pathology with a high impact on quality of life. This study describes the internal ear morphometry of a Mexican pediatric population. The aim is to compare sensorineural hearing loss (SNHL) and control groups. Methods: An observational, cross-sectional, retrospective, and comparative study was conducted utilizing HRCT study images. Variables were measured with the Horos for Mac program. All variables were measured in 108 temporal bones (26 girls and 28 boys) and analyzed by groups, laterality, and sex. Results: The overall cochlear length mean was 35.62 ± 4.06 mm. Internal canal width significantly differed between the control and SNHL groups (p = 0.039). Conclusions: Our findings may be useful to determine control and SNHL pediatric population characteristics to facilitate preoperative management of cochlear implant surgery.

IntroductionThis study aims to discuss and assess the impact of three prevalent methodological biases: competing risks, immortal-time bias, and confounding bias in real-world observational studies evaluating treatment effectiveness. We use a demonstrative observational data example of COVID-19 patients to assess the impact of these biases and propose potential solutions.MethodsWe describe competing risks, immortal-time bias, and time-fixed confounding bias by evaluating treatment effectiveness in hospitalized patients with COVID-19. For our demonstrative analysis, we use observational data from the registry of patients with COVID-19 who were admitted to the Bellvitge University Hospital in Spain from March 2020 to February 2021 and met our predefined inclusion criteria. We compare estimates of a single-dose, time-dependent treatment with the standard of care. We analyze the treatment effectiveness using common statistical approaches, either by ignoring or only partially accounting for the methodological biases. To address these challenges, we emulate a target trial through the clone-censor-weight approach.ResultsOverlooking competing risk bias and employing the naïve Kaplan-Meier estimator led to increased in-hospital death probabilities in patients with COVID-19. Specifically, in the treatment effectiveness analysis, the Kaplan-Meier estimator resulted in an in-hospital mortality of 45.6% for treated patients and 59.0% for untreated patients. In contrast, employing an emulated trial framework with the weighted Aalen-Johansen estimator, we observed that in-hospital death probabilities were reduced to 27.9% in the “X”-treated arm and 40.1% in the non-“X”-treated arm. Immortal-time bias led to an underestimated hazard ratio of treatment.ConclusionOverlooking competing risks, immortal-time bias, and confounding bias leads to shifted estimates of treatment effects. Applying the naïve Kaplan-Meier method resulted in the most biased results and overestimated probabilities for the primary outcome in analyses of hospital data from COVID-19 patients. This overestimation could mislead clinical decision-making. Both immortal-time bias and confounding bias must be addressed in assessments of treatment effectiveness. The trial emulation framework offers a potential solution to address all three methodological biases.

Las conductas alimentarias de riesgo son el resultado de los tipos de hábitos alimentarios de una persona. Estas conductas ponen en peligro las condiciones físicas, emocionales e incluso su entorno social debido a las prácticas erróneas del control del peso que, en efecto, al no ser detectadas y abordadas a tiempo, pueden manifestarse e incluso acumularse hasta el punto de convertirse en una patología alimentaria. Por tanto, por medio de esta investigación se pretende analizar las conductas alimentarias de riesgo y su relación con el índice de masa corporal de los adolescentes, debido a que, por los cambios que experimentan en esta etapa de la vida, son más vulnerables a la insatisfacción de su imagen corporal, por lo que representa un motivo de preocupación al momento de establecer relaciones interpersonales con la sociedad, por el deseo de conseguir o mantener un cuerpo delgado.

Introduction Pregnant women and their offspring are often at increased direct and indirect risks of adverse outcomes during epidemics and pandemics. A coordinated research response is paramount to ensure that this group is offered at least the same level of disease prevention, diagnosis, and care as the general population. We conducted a landscape analysis and held expert consultations to identify research efforts relevant to pregnant women affected by disease outbreaks, highlight gaps and challenges, and propose solutions to addressing them in a coordinated manner.Methods Literature searches were conducted from 1 January 2015 to 22 March 2022 using Web of Science, Google Scholar and PubMed augmented by key informant interviews. Findings were reviewed and Quid analysis was performed to identify clusters and connectors across research networks followed by two expert consultations. These formed the basis for the development of an operational framework for maternal and perinatal research during epidemics.Results Ninety-four relevant research efforts were identified. Although well suited to generating epidemiological data, the entire infrastructure to support a robust research response remains insufficient, particularly for use of medical products in pregnancy. Limitations in global governance, coordination, funding and data-gathering systems have slowed down research responses.Conclusion Leveraging current research efforts while engaging multinational and regional networks may be the most effective way to scale up maternal and perinatal research preparedness and response. The findings of this landscape analysis and proposed operational framework will pave the way for developing a roadmap to guide coordination efforts, facilitate collaboration and ultimately promote rapid access to countermeasures and clinical care for pregnant women and their offspring in future epidemics.

Introducción: la hipersensibilidad por fármacos es inducida por una respuesta aberrante del sistema inmune; por lo general, impredecible, dosis independiente y amenazante para la vida del paciente. Las reacciones de hipersensibilidad por fármacos con compromiso mucocutáneo se dan en alrededor del 2%-3% de los pacientes hospitalizados. Objetivo: describir un caso de necrólisis tóxica epidérmica por un fármaco a base de caléndula y acetilcisteína como los presuntos desencadenantes. Presentación del caso: hombre de 39 años, quien asistió a emergencias, por malestar general, artralgias, mialgias, astenia y adinamia de un día de evolución. Tres días después refirió la aparición de lesiones purpúricas progresivas que se extendieron por cara, extremidades y glúteos; delimitadas; no dolorosas, y sin desaparecer a la digitopresión, asociado con disnea, inestabilidad hemodinámica y cardiovascular. Al sexto día de hospitalización, se interrogó al paciente, quien se había automedicado un fármaco de origen desconocido, presuntamente de extracto herbal a base de caléndula más acetilcisteína para artralgias, osteomialgias y disfagia. A la mañana siguiente, presentó lesiones purpúricas y ulcerativas extensas. Se observaron lesiones purpúricas progresivas y ulcerativas en cara extremidades y glúteos. Mediante la sospecha clínica y la evaluación histopatológica, se confirmó la necrólisis tóxica epidérmica. Conclusiones: las reacciones adversas medicamentosas severas que amenazan la vida del paciente son relativamente raras, pero representan un verdadero desafío diagnóstico y terapéutico. Es necesario profundizar en la investigación para esclarecer la causa de este tipo de reacción medicamentosa.

Abstract Background Patient and public involvement (PPI) is a critical priority in research, policy, academia and advocacy organizations. PPI in dementia research is gaining momentum. However, these efforts are missing in international projects aimed at those living with advanced dementia in long‐term care (LTC) homes. Additional complexities can arise in enacting PPI within the context of integration of a palliative approach to care and experiences around end‐of‐life in (EOL) dementia. The mySupport study involved implementing the Family Carer Decision Support (FCDS) intervention for care partners of those living with advanced dementia in LTC in six countries. Research Design and Objective An interpretive description study was conducted to explore the perspectives of international researchers from six countries on engaging people with lived experiences of dementia and EOL care in research processes. The findings from this study informed the development of a PPI strategy and a subsequent toolkit for the FCDS intervention. Findings Thirty‐eight interviews were completed with project researchers: 12 from the United Kingdom, 8 from Canada, 7 from Ireland, 4 each from Italy and The Netherlands and 3 from the Czech Republic. Four broad themes describe international researchers' perspectives on advancing methods of engagement for people with lived experiences of dementia and EOL in international PPI activities: (1) Groundwork to engage in research; (2) planning for research activities is key; (3) focus on meaningful engagement and (4) having foresight for practical issues shaping PPI. Discussion and Implications International projects that involve PPI can present many sources of challenges. The findings in this study highlight important considerations for foundational work for incorporating PPI in international projects. Learning from world leaders and those with lived experiences in various regions can be insightful and help share tools and resources. Patient or Public Contribution PPI was envisioned as a critical part of conducting the mySupport study. The findings from this study informed the development of a PPI strategy and an international Strategic Guiding Council that included family carers of those living with advanced dementia in LTC homes in six countries. This manuscript focused on the perspectives of researchers on their engagement with people with lived experiences of dementia and EOL. The perspectives of persons with lived experiences on engaging in the mySupport research study will be reported in a forthcoming manuscript.

Objetivo. Identifcar la relación entre la sobrecarga y la presencia de estrés, ansiedad y depresión en los cuidadores de personas con discapacidad. Métodos. El estudio fue cuantitativo, de alcance correlacional y diseño transversal. Un total de 384 cuidadores de personas con discapacidad formaron parte de la muestra de estudio, seleccionada a partir de un muestreo por conveniencia. Se aplicó una encuesta con 47 preguntas. Los análisis estadísticos fueron desarrollados en Statistical Package for Social Sciences 24, calculando tanto la normalidad de los datos como las correlacionales de las variables. Resultados. Existía relación entre la sobrecarga del cuidador y la presencia de estrés, ansiedad y depresión en los cuidadores de personas con discapacidad. puesto que el exceso de actividades generadas a raíz del cuidado de personas con discapacidad se relacionó fuertemente con la presencia de estrés y de manera moderada con la ansiedad y la depresión. Conclusión. Se identifcó que la sobrecarga del cuidador influye en la presencia de ansiedad, depresión y estrés.

Objetivo. El objetivo del estudio consistió en determinar la influencia de los estados emocionales negativos (estrés, ansiedad y depresión) en la salud mental de los servidores de la salud en tiempos de pandemia. Métodos. Se trata de un estudio cuantitativo de alcance descriptivo y diseño transversal. El cuestionario estuvo conformado por 21 preguntas que fueron tomadas de la escala del DASS 21 propuesta por Lovibond y Lovibond (1995), y fue aplicado a 229 servidores de la salud de Santo Domingo de los Tsáchilas (Ecuador). Los análisis estadísticos fueron desarrollados a través de Excel y SPSS 21. Resultados. El estrés y la ansiedad fueron severos en los servidores de la salud mayores a 31 años que laboran en hospitales públicos y privados; mientras que la ansiedad afectó de manera extremadamente severa a todos los participantes del estudio. Conclusiones. El estudio es el primero en exponer los resultados respecto a la influencia de los estados emocionales negativos en los servidores de la salud de Santo Domingo de los Tsáchilas y pone en evidencia que el estrés, la ansiedad y la depresión fueron factores que influyeron considerablemente en tiempos de pandemia. COMENTARIOS SOBRE EL ARTÍCULO

Introducción. El síndrome metabólico (SM) constituye una serie de desórdenes metabólicos que en conjunto son considerados factor de riesgo para desarrollar diabetes y enfermedad cardiovascular. Objetivo. Determinar la prevalencia del SM y sus componentes en estudiantes del campus San Lorenzo de la Universidad Nacional de Asunción en el periodo 2015-2016. Materiales y métodos. Estudio observacional descriptivo de corte transverso con un muestreo por conglomerados. Se incluyeron a 163 estudiantes de facultades o institutos seleccionados. Se aplicó un cuestionario para datos sociodemográficos y actividad física, y se realizaron mediciones de circunferencia de cintura (CC), peso y altura, además de niveles séricos en ayunas de glucosa, colesterol-HDLc y triglicéridos, conjuntamente con medición de presión arterial para determinar la presencia de SM según los criterios del Panel III (NCEP-ATP-III). Los datos fueron resguardados con estricta confidencialidad. Resultados. El 50,92% de los participantes era del sexo masculino, con edad promedio de 21,6± 2,4 años. El 49,7% fueron considerados sedentarios, 25,16% presentó sobrepeso, 8,59% obesidad, 6,75% CC elevada y 16,56% hipertensión. El 2,45% y 4,9% presentaron glicemia basal y triglicérido elevados, respectivamente, y 37,42% HDL-c bajo. La prevalencia del SM fue del 4,91%, el 52,15 % presentó al menos un factor del NCEP-ATP-III para SM Conclusión. Alrededor de la mitad de los participantes presentó al menos un factor de riesgo de SM, y los componentes más frecuentes fueron la baja concentración de HDLc, y la hipertensión arterial. Se recomienda acciones preventivas en la población juvenil basadas en actividad física y alimentación saludable.

Abstract Background Real-world observational data are an important source of evidence on the treatment effectiveness for patients hospitalized with coronavirus disease 2019 (COVID-19). However, observational studies evaluating treatment effectiveness based on longitudinal data are often prone to methodological biases such as immortal time bias, confounding bias, and competing risks. Methods For exemplary target trial emulation, we used a cohort of patients hospitalized with COVID-19 (n = 501) in a single centre. We described the methodology for evaluating the effectiveness of a single-dose treatment, emulated a trial using real-world data, and drafted a hypothetical study protocol describing the main components. To avoid immortal time and time-fixed confounding biases, we applied the clone-censor-weight technique. We set a 5-day grace period as a period of time when treatment could be initiated. We used the inverse probability of censoring weights to account for the selection bias introduced by artificial censoring. To estimate the treatment effects, we took the multi-state model approach. We considered a multi-state model with five states. The primary endpoint was defined as clinical severity status, assessed by a 5-point ordinal scale on day 30. Differences between the treatment group and standard of care treatment group were calculated using a proportional odds model and shown as odds ratios. Additionally, the weighted cause-specific hazards and transition probabilities for each treatment arm were presented. Results Our study demonstrates that trial emulation with a multi-state model analysis is a suitable approach to address observational data limitations, evaluate treatment effects on clinically heterogeneous in-hospital death and discharge alive endpoints, and consider the intermediate state of admission to ICU. The multi-state model analysis allows us to summarize results using stacked probability plots that make it easier to interpret results. Conclusions Extending the emulated target trial approach to multi-state model analysis complements treatment effectiveness analysis by gaining information on competing events. Combining two methodologies offers an option to address immortal time bias, confounding bias, and competing risk events. This methodological approach can provide additional insight for decision-making, particularly when data from randomized controlled trials (RCTs) are unavailable.

Introducción: El glaucoma constituye un problema de salud pública por su alta prevalencia, los costos directos y la calidad de vida deteriorada de los pacientes que lo sufre. Objetivo: Determinar los costos directos y calidad de vida de los pacientes adultos con glaucoma atendidos en la Clínica Central de la Fundación Visión de noviembre 2022 a febrero 2023. Material y métodos: estudio observacional, descriptivo, corte transversal que incluyó pacientes con diagnóstico de glaucoma por muestreo por conveniencia. Resultados: Se incluyeron 140 pacientes entre 29 y 90 años, 52,9% femenino, 43,6% primaria incompleta, 32,1% desempleado. El tratamiento médico se realizó en el 81%, laser en 42% y procedimiento quirúrgico en 32%. Se informó un gasto promedio anual de 3.639.800gs ($ 503.93) por paciente. El estado emocional afectado se informó en el 35,7% de los pacientes, y calidad de vida deteriorada en el 48,6%; el 55% de los pacientes tiene dependencia para sus cuidados personales. Conclusión: El glaucoma implica grandes costos directos debido al tratamiento, además los pacientes tienen deterioro de la calidad de vida.

El objetivo de este estudio es analizar el impacto de un monitor ambulatorio de presión arterial (M.A.P.A.) en el control de los pacientes hipertensos del programa de seguimiento farmacoterapéutico de una clínica de atención primaria. En cuanto a la metodología del presente trabajo, se lleva a cabo un estudio observacional prospectivo con los pacientes hipertensos que fueron referidos desde mayo de 2018 hasta febrero de 2019, donde los valores de presión arterial se comprobaron con el M.A.P.A. Asimismo, el impacto del programa de seguimiento farmacoterapéutico se analiza por medio del valor de presión arterial, frecuencia cardiaca, presión arterial media, índice de masa corporal (IMC) y nivel de creatinina, así como la adherencia al tratamiento antes y después de ser parte del programa de seguimiento farmacoterapéutico a través del análisis con t-Student. En relación con los resultados, se incluyen a 30 pacientes, de los cuales el 40 % presentaban la presión arterial normal u óptima al realizarse el mapeo con M.A.P.A. Por este motivo, se incluyeron a 18 pacientes (60 %) para el seguimiento farmacoterapéutico. Se identificaron 283 resultados negativos asociados a la medicación, 171 problemas relacionados con los medicamentos y un 11 % de adherencia al tratamiento; posterior a las intervenciones realizadas se logró un 100 % de adherencia al tratamiento. En conclusión, la utilización de un monitor ambulatorio de presión arterial (M.A.P.A.) permite identificar pacientes con hipertensión descontrolada y realizar intervenciones farmacéuticas adecuadas, con el fin de evitar la prescripción de medicamentos innecesarios y de aumentar la adherencia al tratamiento. Palabras clave: Hipertensión, Educación en Farmacia, Servicios Farmacéuticos, Cumplimiento y adherencia al tratamiento. Fuente: DeCS/MeSH.

Background: the presence of hypertension-increased abdominal circumference phenotypes is considered a cardiometabolic deterioration prognostic index.Objective: to determine the frequency of women with altered waist phenotypes and to establish the association between these and the main cardiovascular risk factors, as well as to estimate the global cardiovascular risk at 10 years.Methods: descriptive, correlational, cross-sectional study, which included 100 women who attended the Provincial Climacteric Consultation, at the Gustavo Aldereguía Lima Cienfuegos Hospital, from March 2016 to 2020. The analyzed variables were: age, skin color, smoking, arterial hypertension, obesity, physical activity, diabetes mellitus, body mass index, abdominal circumference, total cholesterol, uric acid, and triglycerides. The prevalence ratio was determined with a significance level of 95%.Results: the likelihood ratio showed a higher risk of presenting the phenotype in people over 45 years of age (1.47), obese (5.57), hypertensive (3.71) and diabetic (1.67). A significant association was found between smoking and physical activity with a probability ratio of 5.80 and 18, respectively.Conclusions: there is a significant relationship between altered abdominal waist phenotypes and the main cardiovascular risk factors, such as increased age, cardiovascular risk, diabetes mellitus, arterial hypertension, smoking, physical inactivity and obesity.

PurposeTo know the discontinuation rate and characterize predictors and reasons of contraceptive implant removal within 12 months of insertion in our community setting.MethodsThis prospective cohort study included women receiving the etonogestrel contraceptive implant at sexual and reproductive health centers between September 2019 and September 2020. The variables collected were implanted insertion timing, reproductive and demographic characteristics, medical conditions, sexual activity and counseling. Our primary outcome was implant discontinuation. Kaplan–Meier survival curves were used to show the cumulative discontinuation rate of implants contraceptive within the first year of insertion. We also identified factors that increased the risk of implant removal using the log-rank test and the Cox regression model. Reasons for discontinuation were documented.Results199 women were followed up. Implant discontinuation was documented in 17.1% of implant users prior to 12 months. Factors that increase the risk of implant removal are living with a partner, being aged 25–34 years and not receiving comprehensive and structured counseling from the midwife. The main reason for removal was unsatisfactory bleeding (97.1%), but this was combined with other reasons such as cessation of sexual intercourse (58.8%), worsening mood (58.8%), weight gain (55.9%) or decreased libido (50.0%).ConclusionThe rate of discontinuous implant uses in the first year is relevant in relation to cost-effectiveness, there is room for improvement that should not be overlooked. Comprehensive and structured midwife-led counseling can reduce early implant abandonment removal. The development in different countries of the role of midwives in the management of contraceptives can contribute to the economic benefit of health services and the satisfaction of women.

Introduction: Infectious intestinal diseases (diarrhea) are a major cause of morbidity and mortality worldwide. In 2015, it constituted the ninth leading cause of death for all ages. Objective: To describe the epidemiological characteristics of mortality due to infectious intestinal diseases (diarrhea) in Paraguay from 2015 to 2019. Methods: Descriptive, ecological, cross-sectional, retrospective, and non-probabilistic sampling of consecutive cases was performed. ICD-10 deaths included cholera (A01), typhoid and paratyphoid fever (A01), shigellosis (A03), other bacterial intestinal infections (A04), other bacterial food poisoning (A05), amebiasis (A06), other intestinal diseases due to protozoa (A07), intestinal infections due to viruses (A08), and diarrhea and gastroenteritis of presumed infectious origin (A09). Open access data were obtained from the WEB page of the General Directorate of Strategic Information in Health of the MSP and BS of all the Departments of the country. Crude and adjusted rates (per 100,000 inhabitants) were calculated. Excel and EPI INFO 7.0 were used. Results: 495 deaths were registered; the highest prevalence was in 2019 (adjusted rate of 1.83) and the lowest in 2017 (1.36). The months with the highest mortality rates were January and July (9.9%). 51.72% were women (256), 30.91% were over 80 years old and 28.28% (140) were under 5 years old, average age 50.8, single 56.77% (281) and without any type of education 41.82% (207). A total of 80.61% (399) of the respondents resided in urban areas. The highest rates were registered in Boquerón (33.3) and Amambay (15.2). Diarrhea and gastroenteritis of infectious origin accounted for 95.56% of the cases (473). Discussion: There was a high percentage of mortality from infectious diarrhea. Extremes of life were the most vulnerable populations.

Introduction: In the assessment of the second specialty training programs, the opinion of residents and graduates is essential to know the degree of satisfaction with the training received. The aimed was to assess the perceptions of Peruvian nephrology residents and graduates regarding their training. Material: A descriptive, cross-sectional study included all final-year residents and graduates of the nephrology program in 2022. An anonymous virtual survey assessed sociodemographic aspects, nephrology tutoring, clinical training, external rotations, research, the impact of the COVID-19 pandemic, and overall perception of their training. Results: With a response rate of 79.68%, 51 participants were evaluated. 76.48% of the participants rated their overall training during the residency as good. 58% agreed or strongly agreed that their tutor's performance was good. 66.6% agreed or strongly agreed that their theoretical training was good, with less certainty in genetic kidney diseases. 90% agreed or strongly agreed that their practical training was good, with less certainty in training in slow therapies, renal biopsies, acute peritoneal dialysis, and peritoneal dialysis catheter placement. 80.4% agreed or strongly agreed that the pandemic affected their training. The general perception had a positive correlation with the tutor's performance as good (r=0.50; P

Summary: Background: Patients with chronic lymphocytic leukemia (CLL) have a higher risk of developing other malignancies (OMs) compared to the general population. However, the impact of CLL-related risk factors and CLL-directed treatment is still unclear and represents the focus of this work. Methods: We conducted a retrospective international multicenter study to assess the incidence of OMs and detect potential risk factors in 19,705 patients with CLL, small lymphocytic lymphoma, or high-count CLL-like monoclonal B-cell lymphocytosis, diagnosed between 2000 and 2016. Data collection took place between October 2020 and March 2022. Findings: In 129,254 years of follow-up after CLL diagnosis, 3513 OMs were diagnosed (27.2 OMs/1000 person-years). The most common hematological OMs were Richter transformation, myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Non-melanoma skin (NMSC) and prostate cancers were the most common solid tumors (STs).The only predictor for MDS and AML development was treatment with fludarabine and cyclophosphamide with/without rituximab (FC ± R) (OR = 3.7; 95% CI = 2.79–4.91; p

BackgroundThe COVID-19 pandemic intensified the use of scarce resources, including extracorporeal membrane oxygenation (ECMO) and mechanical ventilation (MV). The combinatorial features of the immune system may be considered to estimate such needs and facilitate continuous open-ended knowledge discovery.Materials and methodsComputer-generated distinct data patterns derived from 283 white blood cell counts collected within five days after hospitalization from 97 COVID-19 patients were used to predict patient’s use of hospital resources.ResultsAlone, data on separate cell types—such as neutrophils—did not identify patients that required MV/ECMO. However, when structured as multicellular indicators, distinct data patterns displayed by such markers separated patients later needing or not needing MV/ECMO. Patients that eventually required MV/ECMO also revealed increased percentages of neutrophils and decreased percentages of lymphocytes on admission.Discussion/conclusionFuture use of limited hospital resources may be predicted when combinations of available blood leukocyte-related data are analyzed. New methods could also identify, upon admission, a subset of COVID-19 patients that reveal inflammation. Presented by individuals not previously exposed to MV/ECMO, this inflammation differs from the well-described inflammation induced after exposure to such resources. If shown to be reproducible in other clinical syndromes and populations, it is suggested that the analysis of immunological combinations may inform more and/or uncover novel information even in the absence of pre-established questions.

Objetivo. Determinar los niveles de sobrepeso, obesidad y autoestima de los adolescentes de la parroquia rural Valle Hermoso, Santo Domingo de los Colorados (Ecuador). Métodos. El estudio fue cuantitativo, de alcance descriptivo y diseño transeccional. Fue aplicado a 384 estudiantes de la Unidad Educativa Valle Hermoso, en la Provincia de Santo Domingo, Ecuador. Se utilizó una encuesta con 10 preguntas tomadas del cuestionario para explorar la autoestima de Rosemberg. La prueba de consistencia interna del instrumento fue desarrollada a través de un test alfa de Cronbach; los datos se analizaron a nivel descriptivo. Resultados. El 13 % de los estudiantes presentó bajo peso, el 61 % normo peso, y el 26 % mostraron niveles de sobrepeso y obesidad (leve, media y mórbida). A su vez, se identificó que los mayores índices de afección en la autoestima (media y baja) se presentaron en los adolescentes con sobrepeso y obesidad leve. Conclusiones. Se evidencia mayor presencia de autoestima baja en los adolescentes con sobrepeso, y a medida que incrementan los niveles de obesidad su autoestima incrementa, dando a entender que empiezan un proceso de aceptación con su aspecto físico.

Fundamento: la Chlamydia trachomatis es el agente causal de una de las infecciones de transmisión sexual más comunes en el mundo. Provoca cervicitis, endometritis y salpingitis; las secuelas incluyen enfermedad inflamatoria pélvica, embarazo ectópico e infertilidad por obstrucción tubárica.Objetivo: determinar la prevalencia de infección por Chlamydia trachomatis en pacientes sometidas a técnicas de reproducción asistida.Métodos: estudio de serie de casos desarrollado en el Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos, durante el periodo comprendido del 2016- 2018. Incluyó pacientes sometidas a técnicas de reproducción asistida que estaban infestadas con Chlamydia trachomatis. Se analizaron las variables edad, antecedentes patológicos personales y ginecobstétricos, número de parejas sexuales, años de infertilidad, antecedentes de uso de dispositivo intrauterino, antecedentes de enfermedad inflamatoria pélvica, resultado del test de Chlamydia, así como criterio o no de fertilización in vitro, como indicador de que ocurrió daño a nivel de las trompas.Resultados: la edad estuvo comprendida entre los 19 y 40 años, con promedio de 35,7 años. El germen se detectó en el 42 % de las parejas, con predominio de las de Cienfuegos. El 47,6 % de las pacientes que tenían una chlamydiasis refirió haber tenido de una a tres parejas. El 54 %, por su afectación, requería de fertilización in vitro. Hubo una alta incidencia en el tiempo siendo infértiles, con el 72,6 % con más de cuatro años.Conclusiones: las infecciones por Chlamydia trachomatis pueden influir en la fertilidad de las mujeres.

La bioética estudia la conducta humana en los campos de las ciencias biológicas y de la atención de la salud. Es imprescindible que el contenido programático de las facultades de ciencias de la salud divulgue su significado e importancia. Todo aquel que pretenda una práctica profesional en la cual interaccione directamente con la vida, debe adquirir competencias desde el campo de la bioética con fundamentos arraigados en los principios éticos de no maleficencia, beneficencia, autonomía y justicia. De tal forma que desarrollen capacidad de reflexión crítica sobre los conflictos éticos provocados por los avances de la ciencia de la vida y la medicina. Cada día se propone más el uso de herramientas audiovisuales en la docencia, para facilitar el abordaje de dilemas éticos, crear espacios de análisis, discusión, que ayudan a la comprensión, memoria e interpretación de este tema entre los estudiantes. En este artículo se pretende divulgar la experiencia a través de una estrategia pedagógica que involucra el cineforo como medio de aprendizaje en bioética en un grupo de estudiantes posgrado en salud.

Introduction: Because of the the complex physiopathology of spasticity, it is distinguished as one of the most significant positive clinical signs of upper motor neuron syndrome, constituting a clinical feature that has great impact in the neurorehabilitation setting. Thus, the current study aimed to determine the prevalence, onset, evolution, and prediction of spasticity after a stroke. Materials and Methods: A correlational, longitudinal design was used. A total of 136 patients were evaluated at the following times: 10 days (T1), 3 months (T2), and 12 months (T3) poststroke. The initial evaluation included sociodemographic and clinical data (T1). Muscle tone was measured (T1, T2, and T3) using the Modified Ashworth Scale. Results: The prevalence of poststroke spasticity in the elbow was 37.5% at T1 and 57.4% at T2 and T3. Among patients with motor damage, the onset of spasticity occurred at T1 in 44.7%, between T1 and T2 in 23.7%, and between T2 and T3 in 0.9%. Significant predictors of the alteration in muscular tone for at least two of the evaluation times were ethnic self-classification, type, area, extent of stroke, and number of sessions. Conclusions: Spasticity onset occurs during the first 10 days after a stroke. More clinical than sociodemographic variables predicted spasticity.

BackgroundTachypnea is among the earliest signs of pulmonary decompensation. Contactless continuous respiratory rate monitoring might be useful in isolated COVID-19 patients admitted in wards. We therefore aimed to determine whether continuous monitoring of respiratory patterns in hospitalized patients with COVID-19 predicts subsequent need for increased respiratory support.MethodsSingle-center pilot prospective cohort study in COVID-19 patients who were cared for in routine wards. COVID-19 patients who had at least one escalation of pulmonary management were matched to three non-escalated patients. Contactless respiratory monitoring was instituted after patients enrolled, and continued for 15 days unless hospital discharge, initiation of invasive mechanical ventilation, or death occurred. Clinicians were blinded to respiratory rate data from the continuous monitor. The exposures were respiratory features over rolling periods of 30 min, 24 h, and 72 h before respiratory care escalation. The primary outcome was a subsequent escalation in ventilatory support beyond a Venturi mask.ResultsAmong 125 included patients, 13 exhibited at least one escalation and were each matched to three non-escalated patients. A total of 28 escalation events were matched to 84 non-escalation episodes. The 30-min mean respiratory rate in escalated patients was 23 breaths per minute (bpm) ranging from 13 to 40 bpm, similar to the 22 bpm in non-escalated patients, although with less variability (range 14 to 31 bpm). However, higher respiratory rate variability, especially skewness over 1 day, was associated with higher incidence of escalation events. Our overall model, based on continuous data, had a moderate accuracy with an AUC 0.81 (95%CI: 0.73, 0.88) and a good specificity 0.93 (95%CI: 0.87, 0.99).ConclusionOur pilot observational study suggests that respiratory rate variability as detected with continuous monitoring is associated with subsequent care escalation during the following 24 h. Continuous respiratory monitoring thus appears to be a valuable increment over intermittent monitoring.Strengths and limitationsOur study was the initial evaluation of Circadia contactless respiratory monitoring in COVID-19 patients who are at special risk of pulmonary deterioration. The major limitation is that the analysis was largely post hoc and thus needs to be confirmed in an out-of-sample population.

BackgroundSquamous cell carcinoma (SCC) arising in a sacrococcygeal pilonidal sinus is rare, with cases of metastatic disease being even rarer. Among published cases, almost none have reported on systemic treatment.ObjectiveThis disease has a poorer prognosis than other forms of cutaneous SCC; therefore, our objective is to shed some light on the treatment of metastatic disease.MethodsWe present a series of nine cases treated at a single center, four of whom received systemic treatment. Additionally, other previously reported cases of metastatic disease are included in an attempt to draw stronger conclusions.ResultsFour patients were treated under several treatment regimens, with a median progression-free survival of only 2 months and two instances of partial response (18%). The best result was achieved with cemiplimab. Across all the cases, there was a trend toward a benefit of the use of systemic treatment (HR 0.41, 95% CI 0.15–1.12, p = 0.083; median overall survival 13 vs. 8 months).LimitationsLimitations include the significant lack of information on previously published cases and the extremely heterogeneous nature of the existing information.ConclusionThe initial systemic treatment should be an anti-PD-1, as with other SCCs. After progression on anti-PD-1, there is no strong evidence to support the recommendation of a specific treatment or sequence: options include cetuximab and/or chemotherapy (platinum, paclitaxel, 5-fluorouracyl).

Summary: Background: While a low CD4/CD8 ratio during HIV treatment correlates with immunosenescence, its value in identifying patients at an increased risk for clinical events remains unclear. Methods: We analyzed data from the CoRIS cohort to determine whether CD4 count, CD8 count, and CD4/CD8 ratio at year two of antiretroviral therapy (ART) could predict the risk of serious non-AIDS events (SNAEs) during the next five years. These included major adverse cardiovascular events, non-AIDS-defining malignancies, and non-accidental deaths. We used pooled logistic regression with inverse probability weighting to estimate the survival curves and cumulative risk of clinical events. Findings: The study included 4625 participants, 83% male, of whom 200 (4.3%) experienced an SNAE during the follow-up period. A CD4/CD8 ratio

Summary: Background: In a parallel-group, international, phase 3 study (ClinicalTrials.gov NCT04762680), we evaluated prototype (D614) and Beta (B.1.351) variant recombinant spike protein booster vaccines with AS03-adjuvant (CoV2 preS dTM-AS03). Methods: Adults, previously primed with mRNA (BNT162b2, mRNA-1273), adenovirus-vectored (Ad26.CoV2.S, ChAdOx1nCoV-19) or protein (CoV2 preS dTM-AS03 [monovalent D614; MV(D614)]) vaccines were enrolled between 29 July 2021 and 22 February 2022. Participants were stratified by age (18–55 and ≥ 56 years) and received one of the following CoV2 preS dTM-AS03 booster formulations: MV(D614) (n = 1285), MV(B.1.351) (n = 707) or bivalent D614 + B.1.351 (BiV; n = 625). Unvaccinated adults who tested negative on a SARS-CoV-2 rapid diagnostic test (control group, n = 479) received two primary doses, 21 days apart, of MV(D614). Anti-D614G and anti-B.1.351 antibodies were evaluated using validated pseudovirus (lentivirus) neutralization (PsVN) assay 14 days post-booster (day [D]15) in 18–55-year-old BNT162b2-primed participants and compared with those pre-booster (D1) and on D36 in 18–55-year-old controls (primary immunogenicity endpoints). PsVN titers to Omicron BA.1, BA.2 and BA.4/5 subvariants were also evaluated. Safety was evaluated over a 12-month follow-up period. Planned interim analyses are presented up to 14 days post-last vaccination for immunogenicity and over a median duration of 5 months for safety. Findings: All three boosters elicited robust anti-D614G or -B.1.351 PsVN responses for mRNA, adenovirus-vectored and protein vaccine-primed groups. Among BNT162b2-primed adults (18–55 years), geometric means of the individual post-booster versus pre-booster titer ratio (95% confidence interval [CI]) were: for MV (D614), 23.37 (18.58–29.38) (anti-D614G); for MV(B.1.351), 35.41 (26.71–46.95) (anti-B.1.351); and for BiV, 14.39 (11.39–18.28) (anti-D614G) and 34.18 (25.84–45.22 (anti-B.1.351). GMT ratios (98.3% CI) versus post-primary vaccination GMTs in controls, were: for MV(D614) booster, 2.16 (1.69; 2.75) [anti-D614G]; for MV(B.1.351), 1.96 (1.54; 2.50) [anti-B.1.351]; and for BiV, 2.34 (1.84; 2.96) [anti-D614G] and 1.39 (1.09; 1.77) [anti-B.1.351]. All booster formulations elicited cross-neutralizing antibodies against Omicron BA.2 (across priming vaccine subgroups), Omicron BA.1 (BNT162b2-primed participants) and Omicron BA.4/5 (BNT162b2-primed participants and MV D614-primed participants). Similar patterns in antibody responses were observed for participants aged ≥56 years. Reactogenicity tended to be transient and mild-to-moderate severity in all booster groups. No safety concerns were identified. Interpretation: CoV2 preS dTM-AS03 boosters demonstrated acceptable safety and elicited robust neutralizing antibodies against multiple variants, regardless of priming vaccine. Funding: Sanofi and Biomedical Advanced Research and Development Authority (BARDA).

Objetivo. Determinar el nivel de influencia de la creatividad y la resiliencia en la policronicidad de las enfermeras que atienden en áreas de emergencia en hospitales públicos y privados de Santo Domingo de los Colorados, Ecuador. Métodos. El estudio fue cuantitativo, de alcance correlacional y diseño transversal. La población de estudio estuvo conformada por profesionales de la salud del área de enfermería de hospitales públicos y la muestra fue de 411 enfermeras. Para la recolección de los datos se utilizó una encuesta conformada por 15 preguntas y las pruebas estadísticas se las desarrolló a través de análisis factoriales exploratorias (AFE), análisis factorial confrmatorio (AFC) y modelado de ecuaciones estructurales (MEE); desarrollados a través de SPSS 21 y AMOS 24. Resultados. Los análisis estadísticos permitieron identifcar que la creatividad influye considerablemente en la policronicidad de las enfermeras, mientras que la resiliencia lo hace moderadamente. Conclusiones. Se concluye que la capacidad de desarrollar varias actividades a la vez o policronicidad, dentro de las actividades laborales en áreas de emergencia, se ve condicionada por el nivel de creatividad que tengan estos profesionales de la salud. A su vez, el estar continuamente al cuidado de pacientes con niveles graves de enfermedad o propensos al fallecimiento ha conllevado a que las enfermeras se vuelvan resilientes ante estas situaciones; sin embargo, esto no condiciona sus niveles de creatividad

Este trabajo de investigación se realizó con la finalidad de promover la gestión ambiental como estrategia de salud pública y desarrollo en la provincia de Esmeraldas. Metodológicamente se basa en el estudio documental – descriptivo y en el cual se recolectó la información a través de la revisión documental de la Constitución de la República de Ecuador, la Ley de Gestión Ambiental, el Plan de Ordenamiento Territorial y Desarrollo de la Provincia de Esmeraldas, el Decreto Nº 1589 y otros trabajos de investigación realizados a nivel nacional. Existe la necesidad de hacer seguimiento y supervisar las actividades de las empresas de la región, haciendo énfasis en la reducción de la producción de gases o residuos tóxicos que aumenten los niveles de contaminación del aire, agua o cualquier otro daño al ambiente; por otra parte, se considera necesario informar desde los primeros niveles de educación con el fin de transformar a los ciudadanos en actores conscientes y decididos a cuidar el ambiente, y con ello también mejorar su salud y calidad de vida, además, crear campañas de información para fomentar la conciencia de los ciudadanos en cuanto a las acciones necesarias para la protección de los espacios naturales, disminución de los niveles de contaminación y actividades sustentables para el desarrollo de las comunidades.

Background: atopic dermatitis is a chronic inflammatory dermatological disease that produces structural and functional alteration in the outermost layer of the epidermis. There are certain factors that worsen your symptoms and are related to depression and anxiety linked to emotional stress.Objective: to evaluate the incidence of mental health disorders in patients with atopic dermatitis during the COVID-19 pandemic to establish protection parameters in people belonging to the city of Latacunga.Methods: a descriptive cross-sectional study was carried out in the period from January 2021 to August 2022. The study population consisted of 25 patients from the ZENSE Health Center of the Latacunga Dermatology Clinic, Cotopaxi, Ecuador. The variables studied were: age, sex, modality of confinement during the pandemic, psychological disorders present during COVID-19, predominant symptoms, severity of dermatitis, and areas with the greatest disease. A structured survey was applied to collect the data. The data is presented in tables and graphs, absolute and relative frequencies.Results: the predominant symptoms were those corresponding to the anxious state, with a worsening due to psychological factors. Patients diagnosed with atopic dermatitis influenced by psychological disorders are more likely to develop poor quality of life, the female sex is more susceptible to suffering from this pathology. The predominant symptomatology was itching located on the back of the hands and feet.Conclusions: during the stage of confinement by COVID-19, mental health has been affected and with it the worsening of various psychological disorders that later affect skin manifestations such as atopic dermatitis.

Facelift, currently, is one of the most demanded aesthetic procedures and considered as the Ultimate Facial Rejuvenation Surgery. The purpose of this present technique is to offer an alternative surgical procedure of reduced scars, limited to the peri-auricular area, easily reproducible, without the need of extended incisions far beyond the retro-auricular sulcus neither the need of flaps for the temporal region. Our technique is based on a block reposition of the pre auricular area, cervical flaps movilization and rotation of a retro auricular flap, avoiding flaps and incisions in the temporal and occipital region; therefore, minimizing visible scars (occipital pre-pilose scar), wide-tissue undermining, and in addition reducing the risk of damaging nerve structures with less recovery time for our patients, achieving natural and long lasting results.

Introducción. La meningitis es una emergencia que requiere diagnóstico y tratamiento inmediato. La epidemiología cambió con las vacunas conjugadas, pero la carga de la enfermedad y las muertes siguen altas. Objetivo. Describir las características epidemiológicas de la mortalidad por meningitis en Paraguay en el periodo 2015-2019. Materiales y métodos. Estudio ecológico y descriptivo en el que se obtuvieron datos de acceso abierto disponibles en la página WEB de la Dirección General de Información Estratégica en Salud del Ministerio de Salud Pública y Bienestar Social de todas las regiones sanitarias del país. Se calcularon las tasas crudas y ajustadas (por 100.000 habitantes) por Excel y EPI INFO 7.0. Resultados. Se registraron 125 muertes, la mayor prevalencia fue en el 2018, con una tasa ajustada de 0,55 por 100.000 habitantes y la menor en 2017, con 0,27 por 100.000 habitantes. Los meses con mayor mortalidad fueron agosto (15,2%) y diciembre (11,2%). El 58,40% de los fallecidos fueron varones (73), 21,60% (27) menores de 4 años, en su mayoría mujeres y 12% (11) adultos mayores (60-70 años), mayoría varones. La edad promedio fue 37,76 años, solteros el 67,20% (84) y no escolarizados el 26,40% (33). El 80,80% (101) residía en el área urbana. Las mayores tasas se registraron en Paraguarí (6,8 por 100.000 habitantes) y Caazapá (3,3 por 100.000 habitantes), no se registraron casos en Alto Paraguay. Conclusión. Los extremos de la vida siguen siendo una población vulnerable para la meningitis.

Objetivo: Describir las características clínicas de los pacientes pediátricos oncológicos que fueron diagnosticados con Neutropenia Febril (NF) ingresados por primera vez a la Unidad de Cuidados Intensivos (UCI) de la Unidad Nacional de Oncología Pediátrica (UNOP). Métodos: Estudio descriptivo y retrospectivo, se caracteriza un total de 211 pacientes que desarrollaron NF y requirieron ingreso a la UCI, entre los años 2017 a 2021. Resultados: La edad promedio fue de 8 años, 46% fueron hombres y 54% mujeres. Se presentó neutropenia severa en el 72.77% de los casos y la leucemia (81.99%) fue el diagnóstico oncológico destacado. Dentro de todos los tratamientos, el 38.39% de los pacientes se encontraban en fase de inducción. En un 33.18% se logró identificar un agente infeccioso asociado. Las bacterias de tipo Gram-negativo fueron el agente infeccioso causal más frecuente (13.74%). La media del tiempo de estancia en UCI fue de 6.75 ± 5.79 días. Un 91.62% de pacientes no ameritaron ventilación mecánica y la complicación más frecuentemente asociada a NF fue Sepsis en un 65.88% de los casos. Conclusión: La mayoría de los casos de Neutropenia Febril son severos, las neoplasias hematológicas (LLA y LMA) son la enfermedad de base más frecuente para el desarrollo de NF y las bacterias de tipo Gram-negativo son el agente infeccioso más frecuente. La mayoría de los pacientes no ameritan ventilación mecánica y las complicaciones más frecuentemente asociadas son Sepsis y Neumonía.

Objetivo: Determinar los predictores de mortalidad, clínicos, bioquímicos y de imagen, en pacientes con COVID-19. Método: Cohorte retrospectiva que incluyó a mayores de 19 años, hospitalizados, con diagnóstico de COVID-19. Se consideraron como predictores de mortalidad: antecedentes clínicos, marcadores bioquímicos y de imagen al momento del ingreso hospitalario. Se calcularon la razón de momios (RM) y su intervalo de confianza del 95% (IC95%) a partir de modelos de regresión logística mútliple. Resultados: Se incluyeron 604 pacientes, con una media de edad de 58.9 años y un tiempo de evolución de 18 días, con una mortalidad del 37.3%. Los predictores de mortalidad fueron la edad > 50 años (RM: 1.9; IC95%: 1.1-2.3), la enfermedad renal crónica (ERC) (RM: 2.4; IC95%: 1.2-4.8), la obesidad (RM: 1.6; IC95%: 1.0-2.5), el índice neutrófilo/linfocito (N/L) > 12 (RM: 2.0; IC95%: 1.3-3.2), la proteína C reactiva (PCR) > 10 (RM: 4.2; IC95%: 2.4-7.1), la deshidrogenasa láctica (DHL) > 250 (RM: 3.4; IC95%: 1.6-7.3), las plaquetas < 150 (RM: 2.8; IC95%: 1.5-5.4) y el puntaje de tomografía computarizada (TC) > 16 (RM: 3.4; IC95%: 2.1-5.4). Conclusiones: La edad > 50 años, la presencia de ERC, la obesidad, el índice N/L, la PCR > 10, la DHL > 250, las plaquetas < 150 y el puntaje de TC > 16 puntos son predictores de mortalidad en pacientes con COVID-19.

El género Corallus contiene serpientes esbeltas y arbóreas, que habitan en bosques tropicales y que presentan una amplia distribución; sin embargo, Corallus blombergi es una especie poco común en Colombia, con un número limitado de reportes. En este estudio se presenta el primer registro de C. blombergi para el departamento del Chocó, a partir de dos hembras, colectadas en zonas de bosque pluvial tropical, en los corregimientos de salero y Pacurita, convirtiéndose en la tercera y cuarta localidad donde se registra la presencia de esta especie. Los nuevos registros, amplían la distribución de la especie a 471,50 km, desde su último registro en Tumaco.

Las serotecas son espacios destinados para el resguardo de Muestras Biológicas (MB) de procesos diagnósticos y científicos. El Instituto de Investigaciones en Ciencias de la Salud (IICS) cuenta con ocho congeladores de Ultra Baja Temperatura (UBT) distribuidos en dos serotecas. El sistema de monitoreo diseñado se evaluó durante cuatro meses, mientras registraba y enviaba alertas de tres UBT instalados en una de las serotecas y de su temperatura ambiente. Se recabó información de los usuarios respecto al rango de las temperaturas de cada UBT, tipo de MB almacenadas y su criterio de conservación. Se emplearon controladores de temperatura con sensores PT 100 conectados a un convertidor RS485/Ethernet en cada congelador. El sistema monitoreó, registró y alertó vía correo electrónico a los usuarios y técnicos biomédicos sobre los incidentes por temperaturas fuera del rango y falla de comunicación. En total se registraron 25 incidentes, 17 referentes al tiempo de apertura de puerta, 5 por temperatura elevada del ambiente y 3 por problemas en la conexión de red. La aplicación de la telemática fue determinante para monitorear en tiempo real las temperaturas de los congeladores UBT y del ambiente para garantizar que la cadena de frío no se vea afectada. De esta forma se cuenta con una herramienta que notifica a los usuarios de serotecas y biobancos los incidentes eléctricos o eventos que afecten el rango de temperatura necesario para la preservación de los materiales biológicos, permitiéndoles realizar una intervención oportuna y así garantizar la correcta preservación de las MB.

Objetivo. Desarrollar una plataforma virtual de aprendizaje (PVA) para el entrenamiento de razonamiento clínico en estudiantes de fonoaudiología. Método. Investigación aplicada en base al desarrollo de software; se utilizó lenguaje de programación PHP en su versión 7.3.26, gráficas y transiciones en framework Laravel 8 y Vue 2 con Vuetify. El manejo de base de datos se ejecutó en MySql 5.5. Resultados. Se creó una PVA para el almacenamiento y uso de guiones clínicos basados en la teoría de concordancia de guiones (scripts). La operatividad de la plataforma contempló tres perfiles diferenciados para docentes, estudiantes y gestores. Los estudiantes accedieron a un corpus aleatorio de guiones clínicos previamente validados. El profesor contó con acceso a las estadísticas de usabilidad y notas de los estudiantes y el gestor pudo cargar nuevos guiones, revisar estadísticas, resolver dificultades de soporte y asignar roles. Conclusiones. La PVA desarrollada ofrece un soporte informático para la metodología de entrenamiento del RC scripts en fonoaudiología. Los procesos de innovación educativa diversifican las estrategias de aprendizaje y promueven el desarrollo de competencias relevantes para la toma de decisiones clínicas en los ámbitos de diagnóstico, estudio e intervención.