RESUMO
This paper presents a practical application of health technology assessment for 21 mechanical ventilators, located at a secondary care Hospital in the State of Mexico, Mexico. A global indicator is obtained, by using a mathematical tool, which involves 14 variables grouped into three partial indicators: technical, clinical and economic. The final aim of this approach is to provide evidence for decision-making, in order to prioritize the replacement of medical equipment, taking into consideration its performance features, the needs of demand for care, and the economic implications for the Hospital.Clinical Relevance-Invasive Mechanical Ventilation (IMV), is a clinical procedure which implies a total or partial replacement of lung function. Given the life support implications, it is important to assure security and reliability in medical equipment intended for this therapy. Therefore, in order to keep updated the IMV devices, in addition to requiring preventive maintenance programs, medical technology replacement programs are necessary.
Assuntos
Atenção Secundária à Saúde , Ventiladores Mecânicos , México , Reprodutibilidade dos Testes , HospitaisRESUMO
La infección del tracto urinario (ITU) es una patología frecuente en pediatría. Su diagnóstico ytratamiento precoz son fundamentales. Para un adecuado tratamiento, es importante conocer la sensibilidadantimicrobiana local. Objetivo: Identificar los agentes etiológicos más frecuentes y su sensibilidad antimicrobiana en urocultivos confirmatorios de ITU, solicitados en Servicio de Urgencia de Pediatría (SUP) del Hospital San Martin de Quillota (HSMQ). Materiales y métodos: Se analizaron todos los urocultivos solicitados desde el SUP del HSMQ entre enero 2013 julio 2014. Se efectuó análisis por sexo y grupos etarios. La etiología y susceptibilidad microbiana se analizó con la técnica de difusión en agar. Resultados: Se analizaron 298 urocultivos, de los cuales el 80,5 por ciento correspondieron a mujeres. La bacteria encontrada más frecuente, en un 87,4 por ciento fue la Escherichia coli. La sensibilidad antibiótica de E.coli para ampicilina, cefalotina, cefixime, ciprofloxacino, ceftriaxona, gentamicina, nitrofurantoina y cotrimoxazol, correspondieron a un 23,3 por ciento; 32,8 por ciento; 96,6 por ciento; 92,7 por ciento; 97,7 por ciento; 94,5 por ciento; 99,6 por ciento; y 71,9 por ciento, respectivamente. Conclusión: El agente etiológico más frecuente en urocultivos confirmatorios solicitados en el SUP del HSMQ fue E. coli. Respecto a su sensibilidad antimicrobiana demostró una alta resistencia y sensibilidad intermedia a cefalosporinas de primera generación y una alta sensibilidad a cefalosporinas de tercera generación, nitrofurantoína, gentamicina y fluoroquinolonas...
Urinary tract infection (UTI) is a common pediatric disease. Early diagnosis and treatment are essential. For proper treatment, it is important to know the local antimicrobial susceptibility. Objective: Identify the most common etiologic agents and their antimicrobial susceptibility in urine cultures in Pediatrics Emergency Service (PES) of San Martin Hospital, Quillota. Summary of work: All the urine cultures requested from the PES between January 2013 and July 2014 were analyzed by sex and age groups. The etiology and microbial susceptibility was analyzed with the agar diffusion technique. Summary of Results: 298 urine cultures were analyzed, 80.5 percent were women. The most common bacteria found was Escherichia coli with 87.4 percent.The antimicrobial susceptibility of E.coli to ampicillin, cephalothin, cefixime, ciprofloxacin, ceftriaxone, gentamicin, cotrimoxazole and nitrofurantoin were 23.3 percent; 32.8 percent; 96.6 percent; 92.7 percent; 97.7 percent; 94.5 percent; 99.6 percent; and 71.9 percent, respectively. Conclusion: The most common etiologic agent in urine cultures requested in PES was E. coli. The antimicrobial susceptibility showed a high resistance and intermediate susceptibility to first generation cephalosporins and high susceptibility to thirdgeneration cephalosporins, nitrofurantoin, gentamicin andfluoroquinolones...
Assuntos
Humanos , Masculino , Feminino , Criança , Antibacterianos/farmacologia , Bactérias , Infecções Urinárias/microbiologia , Testes de Sensibilidade Microbiana , Fatores Etários , Farmacorresistência Bacteriana , Escherichia coli/isolamento & purificação , Urina/microbiologia , Proteus mirabilis/isolamento & purificação , Fatores SexuaisRESUMO
Ante un brote de una enfermedad infecto-contagiosa, el estudio de contactos limita la transmisión de esta. El objetivo de este trabajo fue identificar a los contactos de los posibles casos de influenza en trabajadores de la UNAM para establecer una comunicación y proporcionar educación para la salud sobre medidas higiénicas. Material y métodos: Se elaboró un cuestionario, se estableció contacto con los casos por vía telefónica y se llevó a cabo una visita domiciliaria. Se llevó a cabo un análisis descriptivo de los datos y una descripción de las experiencias y percepciones durante las visitas. Resultados: Se identificó que la mayoría de los contactos eran familiares directos de los casos, que no contaban con un esquema de vacunación completo, ni contra la influenza y la frecuencia de síntomas varió de 1 hasta 4. Comentarios finales: Ante una situación de este tipo (la Pandemia del Virus de la Influenza Humana A (H1N1)) el papel de la enfermera en salud pública es de suma importancia no solo en la búsqueda de los casos y sus contactos, sino también en la orientación y educación de la población en relación a las medidas preventivas.
In the view of an infectious and contagious disease epidemic, the identification of the contacts limits its transmission. The objective of this work was to identify the contacts of the possible cases of UNAM workers in order to establish communication and provide health education about hygiene measures. Material and methods: A questionnaire was prepared, telephone contact was established with the cases, and a home visit was arranged. A descriptive analysis of the data was carried out, as well as, a description of the experiences and perception during the home visit. Results: Most identified contacts were relatives of the cases, which did not have a complete vaccine scheme, no even against influenza, and the frequency of symptoms varied between 1 a 4. Final comments: In a situation like this (A(H1N1) human influenza virus pandemic) the public health nurse roll is of great importance, not just in the identification of the cases and its contacts, but also in the orientation and education of the population in relation to preventive measures.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Influenza Humana , Prevenção Primária , Saúde PúblicaRESUMO
Fifty-eight nursing Zebu cows averaging 5922 days postpartum were used to evaluate the early embryonic development by ultrasound under a natural mating system (bulls A to F). Three consecutive mating periods of 21 days were established. Sixty two percent of the animals were diagnosed as pregnant (36/58). During the first period (AB) 76% (27/36) of the animals become pregnant, 17% (6/36) during the second (CD) and 9% (3/36) in the last mating period (EF). Sixty two percent of the animals were true positives (animals found pregnant diagnosed by ultrasound (US), and conforming with the embryonic scale proposed by Rosiles et al. (2006); 12% (n = 7) of false negatives (pregnant cows by US but not conforming with the scale); 2% (n = 1) of false positives (pregnant cows, evaluated with US and conforming with the embryonic scale but not pregnant at the end of the study); and a 26% (n = 15) of true negatives (not pregnancy evaluated with US). The sensitivity of the test was 97%, with a specificity of 68% with a positive predictive value of 83% and a negative predictive value of 6%. Relation between the measuring scale of embryo development and the results obtained by ultrasonography was k = 0.69. No significant correlation were observed between body condition score (BCS) evaluation and body fat (BF) measurement at any of the three evaluations performed after mating, however, measurements of BCS and BF among time showed a positive correlation (0.48 P < 0.05, 0.29, P < 0.07, respectively) from the beginning of the evaluation period to the end of the trial. Ultrasonography to monitor embryonic development to determine the early establishment of pregnancy in natural mating reproductive programs can be a valuable technique to monitor reproductive efficiency.
Assuntos
Bovinos/embriologia , Desenvolvimento Embrionário/fisiologia , Ultrassonografia Pré-Natal/veterinária , Animais , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Masculino , Estado Nutricional/fisiologia , Período Pós-Parto , Valor Preditivo dos Testes , Gravidez , Sensibilidade e Especificidade , Clima Tropical , Ultrassonografia Pré-Natal/normasRESUMO
BACKGROUND: Although the frequency of menopausal symptoms may vary according to the studied population, in general severe intensity has been related to lower quality of life. OBJECTIVE: To assess the frequency of menopausal symptoms and involved risk factors in an Ecuadorian postmenopausal population. METHODS: Postmenopausal women that participated in a metabolic syndrome screening program were interviewed with the Menopause-specific quality of life questionnaire (MENQOL) in order to determine the most frequently presenting menopausal symptoms and correlate these symptoms with socio-demographic data and the main results of the screening program. RESULTS: Three hundred and twenty-five postmenopausal women (n = 325) were surveyed with the MENQOL. Mean age of participants was 55.9 +/- 8.1 years (median: 54 years). The most frequently presenting symptoms were: hot flushes (53.3%), sweating (49.2%), poor memory (80.6%), feeling depressed (67.4%), aching in muscles and joints (84%), drying of their skin (85.5%), avoiding intimacy (76.2%) and change in their sexual desire (76.5%). Multivariate analysis determined that abdominal obesity was a significant risk factor for presenting hot flushes, depression and muscle and joint pain. High triglyceride levels were associated to higher rates of sweating and depression. While women with basal hyperglycemia were associated to dry skin and changes in sexual desire in a higher proportion, those who were older and with more years of menopause onset were related less frequently to vasomotor symptoms. Older age was also significantly associated in a higher rate to dry skin. CONCLUSION: In this postmenopausal Ecuadorian population, the frequency of menopausal symptoms, as assessed with the MENQOL, was found to be relatively similar to other Latin and non-Latin American populations and associated to age, hormonal status and related metabolic conditions.
Assuntos
Síndrome Metabólica/diagnóstico , Pós-Menopausa , Adulto , Idoso , Estudos Transversais , Equador , Feminino , Inquéritos Epidemiológicos , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Pós-Menopausa/fisiologia , Pós-Menopausa/psicologia , Qualidade de Vida , Fatores de Risco , Saúde da MulherRESUMO
In the anesthetized and paralyzed cat, spontaneous negative cord dorsum potentials (nCDPs) appeared synchronously in the L3 to S1 segments, both ipsi- and contralaterally. The acute section of both the intact sural and the superficial peroneal nerve increased the variability of the spontaneous nCDPs without affecting their intersegmental coupling. On the other hand, the synchronization between the spontaneous nCDPs recorded in segments L5-L6 was strongly reduced following an interposed lesion of the left (ipsilateral) dorsolateral spinal quadrant and it was almost completely abolished by an additional lesion of the contralateral dorsolateral quadrant at the same level. Our observations support the existence of a system of spontaneously active dorsal horn neurons that is bilaterally distributed along the lumbosacral segments and affects, in a synchronized and organized manner, impulse transmission along many reflex pathways, including those mediating presynaptic inhibition.
Assuntos
Potenciais de Ação/fisiologia , Vias Aferentes/fisiologia , Vias Neurais/fisiologia , Nervos Periféricos/fisiologia , Células do Corno Posterior/fisiologia , Nervos Espinhais/fisiologia , Vias Aferentes/lesões , Vias Aferentes/fisiopatologia , Animais , Gatos , Denervação , Lateralidade Funcional/fisiologia , Interneurônios/citologia , Interneurônios/fisiologia , Vértebras Lombares , Vias Neurais/citologia , Traumatismos dos Nervos Periféricos , Nervos Periféricos/fisiopatologia , Células do Corno Posterior/citologia , Reflexo/fisiologia , Pele/inervação , Nervos Espinhais/lesões , Nervos Espinhais/fisiopatologia , Transmissão Sináptica/fisiologiaRESUMO
Bioactivity-directed fractionation of a CHCl(3)-MeOH (1:1) extract prepared from the seeds of Rollinia mucosa led to the isolation of a mixture of eight novel tryptamine amides. Extensive HPLC allowed the isolation of the major component of the mixture, which was characterized as N-lignoceroyltryptamine (6) using a combination of spectroscopic and chemical methods. The minor amides were identified by GC-MS analysis as N-palmitoyltryptamine (1), N-stearoyltryptamine (2), N-arachidoyltryptamine (3), N-behenoyltryptamine (4), N-tricosanoyltryptamine (5), N-pentacosanoyltryptamine (7), and N-cerotoyltryptamine (8). Two lignans (pinoresinol dimethyl ether and magnolin) and six acetogenins [membranacin (9), desacetyluvaricin (10), rolliniastatin 1, bullatacin, squamocin, and motrilin] were also isolated. The cytotoxicity of membranacin (9) and desacetyluvaricin (10) against six human solid tumor cell lines was determined. The absolute configuration of the former is reported.
Assuntos
Antineoplásicos Fitogênicos/isolamento & purificação , Furanos/isolamento & purificação , Lactonas/isolamento & purificação , Plantas Medicinais/química , Triptaminas/isolamento & purificação , Antineoplásicos Fitogênicos/farmacologia , Ensaios de Seleção de Medicamentos Antitumorais , Furanos/farmacologia , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Hidrólise , Lactonas/farmacologia , México , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Sementes/química , Espectrometria de Massas de Bombardeamento Rápido de Átomos , Espectrofotometria Ultravioleta , Triptaminas/farmacologia , Células Tumorais CultivadasRESUMO
This article describes a flexible primary health care methodology which was developed by Andean Rural Health Care and its colleagues in Bolivia, South America. This methodology, the census-based, impact-oriented (CBIO) approach to primary health care, involves determining local health priorities as defined both by locally acquired epidemiologic information and by the local people themselves. The CBIO approach to primary health care is now functioning successfully at seven program sites in Bolivia, which together serve 75,000 people in urban and rural communities in three distinct cultural and ecological regions of the country. High levels of coverage of basic health services can be achieved through a system of 'epidemographic' surveillance of all families and through home delivery, when needed, of priority services to those at risk. When the services provided are based on local health priorities, when they are provided in a technically effective manner, and when the community has a strong partnership in planning, implementation and evaluation, then the CBIO approach to primary health care will lead to measurable health improvements as defined by changes in population-based rates of mortality and illness in the community. On the basis of our experience, we believe that the CBIO approach offers great potential for strengthening the effectiveness of local health programs in impoverished communities around the world in a way which fosters community ownership and, hence, long-term sustainability.
Assuntos
Participação da Comunidade , Atenção à Saúde , Atenção Primária à Saúde , Saúde da População Rural , Bolívia , Atenção à Saúde/organização & administração , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Atenção Primária à Saúde/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de SaúdeRESUMO
A novel water quality intervention that consists of point-of-use water disinfection, safe storage and community education was field tested in Bolivia. A total of 127 households in two periurban communities were randomized into intervention and control groups, surveyed and the intervention was distributed. Monthly water quality testing and weekly diarrhoea surveillance were conducted. Over a 5-month period, intervention households had 44% fewer diarrhoea episodes than control households (P = 0.002). Infants < 1 year old (P = 0.05) and children 5-14 years old (P = 0.01) in intervention households had significantly less diarrhoea than control children. Campylobacter was less commonly isolated from intervention than control patients (P = 0.02). Stored water in intervention households was less contaminated with Escherichia coli than stored water in control households (P < 0.0001). Intervention households exhibited less E. coli contamination of stored water and less diarrhoea than control households. This promising new strategy may have broad applicability for waterborne disease prevention.
Assuntos
Participação da Comunidade , Diarreia/prevenção & controle , Desinfetantes , Educação em Saúde/métodos , Purificação da Água/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Bolívia , Criança , Pré-Escolar , Diarreia/etiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Vigilância da População , Fatores de Risco , Microbiologia da ÁguaRESUMO
Locum tenens programs were independently developed by the University of New Mexico Health Sciences Center and East Carolina University School of Medicine to address health care needs within their states. The programs represent distinct models to provide locum tenens services for practices in rural and medically underserved regions through collaboration with stage government representatives and agencies. Differences between programs include years of operation, days of coverage provided, types of learners and providers involved, sources of funding, costs of the programs, and extent of institutional support. Common beneficial outcomes of the programs include coverage for struggling practices, training in rural medicine for locum tenens providers, recruitment of physicians to rural practice sites, and improved relationships with program partners. Adequate funding and institutional support are essential for success of locum tenens programs.
Assuntos
Área Carente de Assistência Médica , Modelos Organizacionais , Faculdades de Medicina , Escolha da Profissão , Governo , Humanos , New Mexico , North Carolina , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , População RuralRESUMO
Two novel cytotoxic acetogenins, purpurediolin (1) and purpurenin (2), were isolated from the seeds of Annona purpurea. Their structures were elucidated by a combination of chemical and spectral methods including MS and NMR measurements. In addition, six known acetogenins were obtained, namely, bullatacin, squamocin (annonin I), motrilin (squamocin C), annoglaucin, xylomatenin, and annonacin A. Compounds 1 and 2 exhibited potent cytotoxic activity in vitro against six human solid tumor cell lines.
Assuntos
4-Butirolactona/análogos & derivados , Antineoplásicos Fitogênicos/isolamento & purificação , Furanos/isolamento & purificação , Plantas Medicinais/química , 4-Butirolactona/química , 4-Butirolactona/isolamento & purificação , 4-Butirolactona/farmacologia , Animais , Antineoplásicos Fitogênicos/química , Antineoplásicos Fitogênicos/farmacologia , Decápodes/efeitos dos fármacos , Furanos/química , Furanos/farmacologia , Humanos , Espectroscopia de Ressonância Magnética , Espectrometria de Massas/métodos , Sementes/química , Espectrofotometria Ultravioleta , Árvores/química , Células Tumorais CultivadasRESUMO
This paper describes the effectiveness for child health of a primary health care approach developed in Bolivia by Andean Rural Health Care and its colleagues, the census-based, impact-oriented (CBIO) approach. Here, we describe selected achievements, including child survival service coverage, mortality impact, and the level of resources required to attain these results. As a result of first identifying the entire programme population through visits at least biannually to all homes and then targeting selected high-impact services to those at highest risk of death, the mortality levels of children under five years of age in the established programme areas was one-third to one-half of mortality levels in comparison areas. Card-documented coverage for the complete series of all the standard six childhood immunizations among children 12-23 months of age was 78%, and card-documented coverage for three nutritional monitorings during the previous 12 months among the same group of children was 80%. Coverage rates in comparison areas for similar services was less than 21%. The local annual recurring cost of this approach was US $8.57 for each person (of all ages) in the programme population. This cost includes the provision of primary care services for all age groups as well as targeted child survival services. This cost is well within the affordable range for many, if not most, developing countries. Manpower costs for field staff in Bolivia are relatively high, so in countries with lower salary scales, the overall recurring cost could be substantially less. An Expert Review Panel reviewed the CBIO approach and found it to be worthy of replication, particularly if stronger community involvement and greater reliance on volunteer or minimally paid staff could be attained. The results of this approach are sufficiently promising to merit implementation and evaluation in other sites, including sites beyond Bolivia.
Assuntos
Censos , Proteção da Criança/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Bolívia/epidemiologia , Área Programática de Saúde , Criança , Planejamento em Saúde Comunitária , Política de Saúde , Pesquisa sobre Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Programas de Imunização/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Serviços de Saúde Rural , Análise de SobrevidaRESUMO
La presente revisión trata de la enfermedad trafoblástica gestacional haciendo referencia a los tumores de origen placentario que se derivan del tejido epitelial coriónico. Se describe la clasificación según la OMS, resaltando ls sintomatología clásica de esta patología, así como también los métodos de laboratorio más utilizados como son: La ecosonografía, La dosificación de HCG. Gamagrafía, TAC, estudios de histopatología, medición de alfa feto proteínas dosificación de calcio calmodulina y de CAMP-A quinasa, por último se revisan los esquemas terapéuticos más usados hoy en día.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Luxação Congênita de Quadril/epidemiologia , Luxação Congênita de Quadril/etiologia , Neoplasias , Doenças Placentárias/classificação , Doenças Placentárias/diagnóstico , Luxação Congênita de Quadril , Luxação Congênita de Quadril/terapia , Doenças Placentárias/sangue , Doenças Placentárias/embriologia , Doenças Placentárias/etiologia , Doenças Placentárias/genética , Doenças Placentárias/terapiaRESUMO
El presente estudio se realiza mediante la revisión retrospectiva de 61 historias clínicas de pacientes que fueron admitidas en Sala de Partos del HCAM, con el diagnóstico de Embarazo Ectópico, desde enero de 1990 hasta diciembre de 1992. La edad promedio de las pacientes fue de 30 mas o menos 3.4 años; el número de embarazos fluctúa entre 2 y 3, con el antecedente de abortos anteriores en 22 casos, y del embarazo ectópico previo en 6 pacientes. Entre los signos y síntomas mas frecuentes encontramos el dolor pélvico, la hemorragia vaginal y la amenorrea. Los métodos de diagnóstico más utilizados fueron la ecosonografía, la laparoscopia, culdocentesis y prueba de embarazo. El procedimiento quirúrgico más frecuente realizado fue la salpingectomía total.
Assuntos
Humanos , Feminino , Adulto , Gravidez Ectópica/cirurgia , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/patologia , Gravidez Ectópica/prevenção & controle , Planejamento Familiar/métodosRESUMO
We tested the value of the radiographic indexes in 16 patients with the diagnosis of pulmonary hypertension of unknown etiology. The index PL/T (lung-lobe-thoracic) was abnormal in 62.5%, the Osawa-Kanemoto index (DPA(T/2] was also abnormal in 62.5% of the cases, the r/h index (which measures the ratio right pulmonary artery thickness/right lung field) was abnormal in 81% of the cases. There was no relationship between the above mention indexes and the pulmonary artery pressure. Seven of the 16 patients displayed a new radiographic image that we have named "reticulo-vascular pattern", this radiographic sign may be important in the diagnosis of primary pulmonary hypertension.
Assuntos
Hipertensão Pulmonar/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
Se valoro la utilidad de los indices radiologicos que se emplean para apoyar el diagnostico de hipertension arterial pulmonar en 16 pacientes con esta condicion y cuya etiologia era desconocida. El indice PL/T (o pulmonar lobar toracico) y de Osawa-Kanemoto (o DPA (T/2)) fueron anormales en 10 de 16 pacientes (62.5%).El indice r/h (que expresa la relacion del grosor de la rama derecha de la arteria pulmonar con el hemitorax ipsilateral) fue anormal en 11 de 16 pacientes (68.7%) y el indice R (diametro de la rama derecha de la arteria pulmonar a nivel de la pars interlobaris), que fue el que tuvo mayor sensibilidad, fue anormal en 13 de 16 pacientes (81%). No hubo correlacion directa entre los indices y la presion arterial pulmonar. En 7 de los 16 pacientes se demostro una nueva imagen radiologica que se disigno como "patron-reticulo-vascular" que puede apoyar el diagnostico de hipertension arterial pulmonar primaria