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INTRODUCTION: A rapid deploy of unexpected early impact of the COVID pandemic in Spain was described in 2020. Oncology practice was revised to facilitate decision-making regarding multimodal therapy for prevalent cancer types amenable to multidisciplinary treatment in which the radiotherapy component searched more efficient options in the setting of the COVID-19 pandemic, minimizing the risks to patients whilst aiming to guarantee cancer outcomes. METHODS: A novel Proton Beam Therapy (PBT), Unit activity was analyzed in the period of March 2020 to March 2021. Institutional urgent, strict and mandatory clinical care standards for early diagnosis and treatment of COVID-19 infection were stablished in the hospital following national health-authorities' recommendations. The temporary trends of patients care and research projects proposals were registered. RESULTS: 3 out of 14 members of the professional staff involved in the PBR intra-hospital process had a positive test for COVID infection. Also, 4 out of 100 patients had positive tests before initiating PBT, and 7 out of 100 developed positive tests along the weekly mandatory special checkup performed during PBT to all patients. An update of clinical performance at the PBT Unit at CUN Madrid in the initial 500 patients treated with PBT in the period from March 2020 to November 2022 registers a distribution of 131 (26%) pediatric patients, 63 (12%) head and neck cancer and central nervous system neoplasms and 123 (24%) re-irradiation indications. In November 2022, the activity reached a plateau in terms of patients under treatment and the impact of COVID pandemic became sporadic and controlled by minor medical actions. At present, the clinical data are consistent with an academic practice prospectively (NCT05151952). Research projects and scientific production was adapted to the pandemic evolution and its influence upon professional time availability. Seven research projects based in public funding were activated in this period and preliminary data on molecular imaging guided proton therapy in brain tumors and post-irradiation patterns of blood biomarkers are reported. CONCLUSIONS: Hospital-based PBT in European academic institutions was impacted by COVID-19 pandemic, although clinical and research activities were developed and sustained. In the post-pandemic era, the benefits of online learning will shape the future of proton therapy education.
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COVID-19 , Neoplasias de Cabeça e Pescoço , Terapia com Prótons , Humanos , Criança , Pandemias/prevenção & controle , COVID-19/epidemiologia , HospitaisRESUMO
The aim of this research was to evaluate the physiological and behavioural parameters in Saanen goat kids treated with flunixin meglumine compared with no analgesic treatment after cautery disbudding using a device fueled by propane gas. At 7 days of age, 30 goat kids were randomly allocated to three groups: Sham (Sh) control, (i.e., simulating disbudding); Disbudding (Di), using thermal cauterization; Disbudding + Flunixin (DiFl), thermal cauterization + flunixin meglumine (2.2 mg/kg body weight, 15 min before treatment). Each kid was video-recorded for 30 min before and after treatment to evaluate the frequency of head shaking, head scratching, body shaking, grooming, head rubbing, jumping, running, and bleating. Blood samples were taken 30 min after disbudding to evaluate serum cortisol concentrations and white blood cell count. Heart rate (HR) and respiratory rate (RR) were measured using a stethoscope. Liveweight of goat kids was recorded at birth, -24 h and 7 days after treatment, and at 25 days of age. The mean frequency of head shaking and head scratching was higher (p = 0.0001) after disbudding in Di (37.5 ± 47.8 and 33.32 ± 31.2) group compared to Sh (3.42 ± 3.58 and 2.2 ± 1.8) and DiFl, (4.02 ± 2.76 and 4.42 ± 3.72) groups. The frequency of jumping was higher (p = 0.022) for Di (3.74 ± 2.24) than that of DiFl (0.39 ± 0.92). The remaining behaviours did not show differences (p > 0.05). HR and RR were higher (HR: p < 0.0048; RR: p < 0.035) in group Di (HR: 156 ± 13.6; RR: 66 ± 14.8) than in Sh (HR: 138 ± 8.48; RR: 55.6 ± 5.4) and in DiFl (HR: 136 ± 6.38; RR: 52.8 ± 4.13). No differences were detected between live weight, serum cortisol and white blood cell count data (p > 0.05). Results show that flunixin meglumine was effective at reducing pain-related behaviours when given at the time of disbudding.
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Hidrocortisona , Dor , Animais , Dor/tratamento farmacológico , Dor/etiologia , Dor/veterinária , Cauterização/veterinária , CabrasRESUMO
INTRODUCTION: Mexico is one of the countries that is most affected by mortality due to COVID-19. Once infected, the indigenous population living in the lower-income states had worse outcomes. Our objectives were to analyze outcomes by ethnic group, and determine the association between state-level income and the incidence, hospitalizations, outpatients, and death rates per 100,000 population. METHODOLOGY: We analyzed 1,037,567 confirmed COVID-positive cases from February 29 to November 13, 2020 recorded in the Mexican COVID-19 cases database. Sociodemographic characteristics, comorbidities, and outcomes were analyzed. Data was allocated according to the state where the patients were treated. Statistical association between age-adjusted incidence and death rates with state-level GDP per capita (as a measure of income), were ascertained using Spearman correlations. Kruskal-Wallis tests examine the association of cumulative incidence, hospitalizations, outpatients, and death rates, with income quartiles. When significant, a follow-up analysis (Mann-Whitney) was conducted. RESULTS: Respective cumulative incidence rates and death rates were: 900.3 (non-indigenous) and 94.4 (indigenous), and 87.1 (non-indigenous) and 13.9 (indigenous). Spearman correlation coefficients of income with age-standardized incidence and death rates were 0.657 and 0.607 (p < 0.001 for both). Kruskal-Wallis H-Values indicate significant median differences by income in total population rates: cumulative incidence 13.47 (p < 0.01), hospitalizations 11.67 (p < 0.01), outpatients 12.86 (p < 0.01), and deaths 8.92 (p < 0.05). CONCLUSIONS: Cumulative incidence, hospitalizations, outpatients, and mortality rates presented a reversed socioeconomic status health gradient in Mexico. Less adverse outcomes were observed in the lowest-income states compared to higher-income states.
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COVID-19 , COVID-19/epidemiologia , Etnicidade , Hospitalização , Humanos , Renda , México/epidemiologia , Pacientes AmbulatoriaisRESUMO
The aims were to study the epidemiology and the effect of gastrointestinal nematodes (GINs) on yearling cattle in a semiarid region in Argentina and to evaluate the mineral serum levels. Ten- to twelve-month-old calves were monitored between November and April 2019. Animals were divided into three groups: untreated control (CONG; n = 20); group treated with moxidectin (MXD, 200 µg/kg) every 30-40 days (MXDG; n = 20); group equally MXD treated and mineral supplementation administered in November and January (MMG; n = 20). Individual GIN egg counts (epg) and fecal cultures were made every 30-40 days. Animal live weight gain was determined. On 7-11-18, 25-1-19, and 3-4-19, serum levels of Se, Cu, Zn, Mg, and Ca were determined by atom absorption spectrophotometry. At the start of the trial, epg values were low (xÌ = 5.5), which increased only in CONG towards the end of the assay (xÌ = 229). In both GMXD and MMG, epg remained very low (xÌ = 4.1). Cooperia spp. (81%) prevailed over Haemonchus spp. (9%) and Oesophagostomum spp. (9%). Deficiency of Se ranged between marginal and important, except for MMG, although mean values were always below normal. Cu was marginally deficient in CONG and MXDG on the first two sampling dates, whereas MMG had normal values after treatment. Mg had low values in the three groups (xÌ = 1.5 mg/dl), whereas Ca and Zn exhibited normal values. Live weight gain (LWG) was higher in MMG than in MXDG, with significant differences (p < 0.05) by mid-January and then, when epg increased, dewormed groups showed higher LWG (p < 0.034) than CONG. A negative effect of GINs on LWG was observed, as well as low to marginal levels of Se, Cu, and Mg.
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Doenças dos Bovinos , Nematoides , Infecções por Nematoides , Animais , Argentina/epidemiologia , Bovinos , Doenças dos Bovinos/epidemiologia , Fezes , Trato Gastrointestinal , Infecções por Nematoides/epidemiologia , Infecções por Nematoides/veterinária , Contagem de Ovos de Parasitas/veterináriaRESUMO
Resumen El estrés por frío en los terneros puede ser muy perjudicial para su salud y rendimiento futuro. El objetivo del presente trabajo fue evaluar el efecto de las condiciones de manejo de la crianza artificial y su relación con estrés por frío en terneros de tambo. Se evaluaron 160 terneros durante las primeras horas de la mañana, y se registró si los animales poseían capa o no y si disponían o no de cama. Se observó si contaban con reparo para limitantes climáticas. También se registró la temperatura rectal y si temblaban o no. Se consideró que terneros con temperatura rectal igual o inferior a 37,2 °C se encontraban en estrés por frio. El análisis estadístico de los datos se hizo mediante la prueba no paramétrica de Chi cuadrado y se calculó la probabilidad de ocurrencia mediante Odds Ratio. Encontrándose que los terneros en condiciones de estrés presentaron 4,93 veces mayor probabilidad de temblar; que disponer de cama fue favorable para prevenir el estrés (0,027), que las capas plásticas incrementaron la probabilidad de sufrir de estrés (0,006) y que proveer reparo a los animales tiene un efecto positivo en la prevención del estrés por frío (p = 0,027) en los terneros de tambo.
Abstract Cold stress in calves can be very detrimental to their health and performance. The aim of this work was to evaluate the effect of artificial rearing management conditions and their relationship to cold stress in dairy calves. A total of 160 calves were evaluated during the early morning hours and it was recorded whether or not the animals had cape and whether or not they had bed in pens. Also, it was observed if they had protection for climatic limitations. Rectal temperature and whether or not they were shivering were also recorded. Calves with rectal temperature equal to or lower than 37.2 °C were considered to be in cold stress. The statistical analysis of the data was performed using the non-parametric Chi-square test and the probability of occurrence was calculated using Odds Ratio. It was found that calves under stress conditions were 4.93 times more likely to shiver; that having bed in pens was favorable for preventing stress (0.027), that plastic cape increased the probability of suffering from stress (0.006) and that providing shelter to animals had a positive effect on the prevention of cold stress (p = 0.027) in dairy calves.
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Resumen El Valle de Lerma (VDL) es una región ubicada en la parte central de la provincia de Salta, República Argentina, la cual da origen a la mayor parte de la producción láctea provincial. La nematodiasis gastrointestinal es uno de los problemas sanitarios de mayor impacto económico en los sistemas productivos de base pastoril. El objetivo de este trabajo fue caracterizar la variación estacional de la eliminación de huevos y géneros de nematodos al medio ambiente. Mensualmente se tomaron muestras de materia fecal en bovinos de recría para conteo de huevos por gramo (HPG) y coprocultivo para determinación de géneros en tres establecimientos ganaderos de la región. En todos ellos se observaron dos picos en los valores medios de HPG, que ocurrieron entre principios de verano y fines de otoño. Los géneros/especies más prevalentes fueron Cooperia pectinata, Haemonchus spp. y Cooperia punctata, seguidos por Oesophagostomum spp., Trichostrongylus spp. y Ostertagia spp. Estos resultados aportan nueva evidencia al conocimiento de la epidemiología de los nematodos gastrointestinales de los bovinos en la región del VDL.
Abstract The Lerma Valley (LV) is a region located in the central part of the province of Salta, Argentine Republic. The largest dairy production in the province originates in this region. Gastrointestinal nematodiasis is one of the health problems with the greatest economic impact in pastoral-based production systems. The objective of the present work was to characterize the seasonal variation of the elimination of eggs and genera of nematodes to the environment. Fecal matter samples were taken from rearing cattle to count eggs per gram (Epg) and culture for gender determination monthly in three farms in the region. In these, it was possible to observe that the Epg values showed two peaks, which occurred between the beginning of summer and the end of autumn. Regarding the genera/species, the most prevalent were Cooperia pectinata, Haemonchus sp. and Cooperia punctata, followed by Oesophagostomum spp., Trichostrongylus spp. and Ostertagia spp. These results contribute with new evidence to the knowledge of the epidemiology of gastrointestinal nematodes of cattle in the LV region.
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Resumen El objetivo de este trabajo fue conocer la seroprevalencia de Neospora caninum en los bovinos de los tambos del Valle del Lerma (Salta, Argentina) y los factores de riesgo asociados a la transmisión de este parásito en esta región. Se tomaron muestras de suero de aproximadamente 40 vacas en cada tambo, que fueron analizadas por ELISA indirecto para detectar anticuerpos contra N. caninum. También se discriminó entre infecciones crónicas y agudas midiendo la avidez de dichos anticuerpos. Todos los tambos presentaron al menos un bovino seropositivoy la media fue de 35,3 ± 14,9% de animales positivos. También se detectaron anticuerpos específicos en caninos presentes en 9 de los 16 tambos, con un valor de seropositi- vidad del 71,7 ± 19,9%. El 56,3% de los bovinos seropositivos cursaban infecciones agudas. Se halló una asociación negativa entre la seroprevalencia y el índice de avidez de los anticuerpos específicos, lo que indica que la presencia de animales con infecciones agudas se asocia a mayor seroprevalencia. Los campos con pastoreo presentaron mayor cantidad de infecciones recien tes. Estos resultados revelan por primera vez la importancia de este parásito en los tambos de la región y la necesidad de propiciar el desarrollo de programas de control considerando los distintos factores de riesgo que afectan la situación epidemiológica de la enfermedad.
Abstract The objective of this work was to determine the seroprevalence of Neospora caninum in cattle in Valle de Lerma, province of Salta, Argentina, and the risk factors associated with the disease. Serum samples were taken from 40 cows in each dairy herd, which were analyzed by indirect ELISA to detect antibodies against N. caninum. Chronic and acute infections were discriminated by measuring the avidity of these antibodies. All the herds exhibited at least one seropositive animal, the mean being 35.3 ± 14.9% of positive animals. Specific antibodies were also detected in dogs present in 9of the herds, which showed a seropositivity value of 71.7% ± 19.9%. Among the seropositive animals, 56.3% showed acute infections. A negative association was found between seroprevalence and the avidity index of specific antibodies, indicating that the presence of animals with acute infections is associated with higher seroprevalence. Fields with grazing showed more recent infections. These results show for the first time the importance of this parasite in this particular region and the need to promote the development of control programs considering the different risk factors that affect the epidemiological situation of the disease.
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Animais , Bovinos , Cães , Feminino , Doenças dos Bovinos , Coccidiose , Neospora , Argentina/epidemiologia , Ensaio de Imunoadsorção Enzimática , Anticorpos Antiprotozoários , Doenças dos Bovinos/epidemiologia , Estudos Soroepidemiológicos , Fatores de Risco , Coccidiose/veterinária , Coccidiose/epidemiologia , FazendasRESUMO
The objective of this work was to determine the seroprevalence of Neospora caninum in cattle in Valle de Lerma, province of Salta, Argentina, and the risk factors associated with the disease. Serum samples were taken from 40 cows in each dairy herd, which were analyzed by indirect ELISA to detect antibodies against N. caninum. Chronic and acute infections were discriminated by measuring the avidity of these antibodies. All the herds exhibited at least one seropositive animal, the mean being 35.3 ± 14.9% of positive animals. Specific antibodies were also detected in dogs present in 9of the herds, which showed a seropositivity value of 71.7% ± 19.9%. Among the seropositive animals, 56.3% showed acute infections. A negative association was found between seroprevalence and the avidity index of specific antibodies, indicating that the presence of animals with acute infections is associated with higher seroprevalence. Fields with grazing showed more recent infections. These results show for the first time the importance of this parasite in this particular region and the need to promote the development of control programs considering the different risk factors that affect the epidemiological situation of the disease.
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Doenças dos Bovinos , Coccidiose , Neospora , Animais , Anticorpos Antiprotozoários , Argentina/epidemiologia , Bovinos , Doenças dos Bovinos/epidemiologia , Coccidiose/epidemiologia , Coccidiose/veterinária , Cães , Ensaio de Imunoadsorção Enzimática , Fazendas , Feminino , Fatores de Risco , Estudos SoroepidemiológicosRESUMO
Selective breeding of genetically resistant animals is considered a promising strategy to face the problem of nematode resistance to anthelmintics and mitigate concerns about the presence of chemical residues in animal food products and the environment. Gastrointestinal nematode resistance is a complex, multifactorial trait related to host immunity. However, the mechanisms underlying host resistance and response to infection remain to be fully elucidated. In this context, the objective of this study was to provide insight into the chromosomal regions determining nematode resistance and resilience in Corriedale and resistance in Pampinta sheep breeds. A total of 170 single nucleotide polymorphisms (SNP) from 76 candidate genes for immune response were studied in 624 Corriedale and 304 Pampinta animals. Lambs underwent artificial or natural challenges with infective larvae mainly from Haemonchus contortus. Fecal egg counts, estimated breeding values for fecal egg counts, and rate of packed cell volume change and FAMACHA© score change over the challenge were used, when available, as indicators of host parasite resistance or resilience. Phenotype-genotype association studies were conducted and significance values obtained were adjusted for multiple testing errors. Eight SNPs, located on OARs 3, 6, 12, and 20, reached significance in Corriedale sheep under artificial challenge. Those SNP represent allelic variants from the MHC-Ovine Lymphocyte Antigen-DRA, two C-type lectin domain families, the Interleukin 2 receptor ß, the Toll-like receptor 10, the Mannan binding lectin serine peptidase 2, and the NLR family, CARD domain containing 4 genes. On Pampinta lambs under natural challenge, we found three significant SNPs, located in the TIMP metallopeptidase inhibitor 3, the FBJ murine osteosarcoma viral oncogene homolog, and the Interleukin 20 receptor alpha genes, on OARs 3, 7, and 8, respectively. The results obtained herein confirm genomic regions previously reported as associated with nematode resistance in other sheep breeds, reinforcing their role in host response to parasites. These findings contribute to gain knowledge on parasite resistance and resilience in Corriedale sheep and report for the first time SNPs associated with resistance to gastrointestinal parasite infections in Pampinta breed.
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Resistência à Doença/genética , Hemoncose/genética , Haemonchus , Helmintíase Animal/genética , Polimorfismo de Nucleotídeo Único , Doenças dos Ovinos/genética , Ovinos/genética , Animais , Argentina , Ovinos/parasitologia , Doenças dos Ovinos/parasitologiaRESUMO
Introducción: La definición de prioridades de investigación en salud dirige los esfuerzos de investigación para promover ciencia, tecnología e innovación en salud. Material y Métodos: La definición de estas en el Seguro Social de Salud peruano para el periodo 2020-2022 se realizó en cuatro etapas y de forma sistemática, estructurada, participativa y secuencial. Resultados: Primero, se evaluó el avance de investigación en las prioridades del periodo 2017-2019. En la segunda etapa, se consultó diversas fuentes y se identificó necesidades de investigación orientadas a enfermedades y se estableció el marco para prioridades orientadas a sistemas de salud e intervenciones sanitarias. La tercera etapa consistió en una consulta ampliada para seleccionar los temas prioritarios orientados a enfermedades. Finalmente, se desarrolló un taller participativo y multidisciplinario para seleccionar temas, subtemas y áreas prioritarias de investigación. Conclusión: El producto final fue la definición de 11 temas prioritarios, siete para enfermedades y cuatro para sistemas de salud e intervenciones sanitarias.
Introduction: Health research priorities definition address research efforts to the promotion of health science, technology, and innovation. Material and Methods: Health research priorities in the Peruvian Social Security for the period 2020-2022 was carried out in four stages using a systematic, structured, participatory and sequential process. Results: First, the progress of the research in the priorities of the period 2017-2019 was evaluated. In the second stage, various sources were consulted to identify disease-oriented research needs and the framework for priorities oriented to health systems and health interventions. The third stage consisted of an expanded consultation to select priority disease-oriented topics. Finally, a participatory and multidisciplinary workshop was developed to select themes, subtopics, and priority areas for research. Conclusion: The final product was the definition of 11 priority themes, seven for diseases and four for health systems and health interventions
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Neospora caninum infection of cattle can be vertically transmitted, resulting in abortion or birth of infected calves. Vertical transmission occurs both in acutely or chronically infected cattle. There is little information on the immune response needed to prevent endogenous transplacental transmission, particularly from chronically infected cattle to their offspring in a natural environment. In this study, N. caninum seropositive pregnant cattle from three different farms with high avidity antibodies and low IgM titers were selected and their newborn colostrum-deprived calves were tested for anti-N. caninum antibodies. Based on these results, dams were grouped according to their congenital transmission status. The analysis of the immune profile of the chronically-infected pregnant cattle revealed that higher ratio between IgG1 and IgG2 anti-N. caninum serum titers and higher levels of systemic IFN-γ were associated with diminished vertical transmission rates, compared to dams with the opposite profile. Our results evidenced an association between the immune profile and vertical transmission in non-aborting chronically infected dams, and confirm that vertical transmission, even when not leading to abortion, is related to a defined immune profile. This is important information to accomplish successful vaccine development efforts.
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Coccidiose/imunologia , Coccidiose/transmissão , Imunoglobulina G/sangue , Transmissão Vertical de Doenças Infecciosas/veterinária , Interferon gama/sangue , Aborto Animal/imunologia , Animais , Animais Recém-Nascidos , Anticorpos Antiprotozoários/sangue , Bovinos , Doenças dos Bovinos/imunologia , Doenças dos Bovinos/transmissão , Indústria de Laticínios , Ensaio de Imunoadsorção Enzimática , Feminino , Imunoglobulina M/sangue , Masculino , Neospora , Gravidez , Complicações Parasitárias na Gravidez/veterináriaRESUMO
The aim of this work was to study the effect of gastrointestinal nematodes (GINs) on copper (Cu) and phosphorus (P) in blood of beef cattle in two ranches (R1 and R2) located in northwestern Argentina. In 2015-2016 (R1) and 2016-2017 (R2), in each ranch, 22 weaned female calves were divided into two groups: calves treated systematically with 200 mcg/kg moxidectin every 45-50 days (TG) and untreated calves (UTG). The following parameters were measured: number of fecal eggs (epg), fecal cultures, serum Cu and P levels, and live weight gain (LWG). Differences between groups were compared using analysis of variance and Tukey test. GIN infections in both ranches were subclinical and moderate, showing the highest epg (R1 = 907 ± 754; R2 = 1049 ± 1040) by mid-winter. Epg values of TG groups were always negligible (> 93% of moxidectin efficacy). The dominant nematode genera were Cooperia and Haemonchus. The average serum Cu values (µg/dl) indicated low (R1 = 49.7 ± 18) and severe (R2 = 27.2 ± 14) deficiency. The effect of treatments was evident in both ranches from late winter, with TG showing significantly (p < 0.01) higher serum levels in winter, spring, and early autumn (R1 = 65.1, 50.9, and 60.3; R2 = 48.0, 25.7, and 22.4) than UTG (R1 = 44.3, 33.9, and 32.9; R2 = 25.5, 18.2, and 16.4). There were no differences in serum P levels between groups. LWG of TG increased significantly (p < 0.008) (27.2% in R1 and 38.6% in R2), with respect to those of UTG. This study showed a negative effect of GIN on serum Cu values in moderately infected growing calves.
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Doenças dos Bovinos/fisiopatologia , Cobre/sangue , Gastroenteropatias/veterinária , Nematoides/fisiologia , Infecções por Nematoides/veterinária , Fósforo/sangue , Animais , Antinematódeos/administração & dosagem , Argentina , Bovinos , Doenças dos Bovinos/parasitologia , Cobre/deficiência , Feminino , Gastroenteropatias/parasitologia , Gastroenteropatias/fisiopatologia , Macrolídeos/administração & dosagem , Infecções por Nematoides/parasitologia , Infecções por Nematoides/fisiopatologia , Fósforo/deficiênciaRESUMO
In this report we present a systematic structural and magnetic analysis of Co-doped ZnO nanoparticles prepared via a microwave-assisted hydrothermal route. The structural data confirm the incorporation of Co ions into the wurtzite ZnO lattice and a Co concentration mainly near/at the surface of the nanoparticles. This Co spatial distribution is set to passivate the surface of the ZnO nanoparticles, inhibiting the nanoparticle growth and suppressing the observation of a ferromagnetic phase. Based on experimental and theoretical results we propose a kinetic-thermodynamic model for the processes of nucleation and growth of the Co-doped ZnO nanoparticles, and attribute the observed ferromagnetic order to a ferromagnetism associated with specific defects and adsorbed elements at the surface of the nanoparticle. Our findings give valuable contribution to the understanding of both the doping process at the nanoscale and the nature of the magnetic properties of the Co-doped ZnO system.
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Objetivos. Describir el proceso de priorización para el desarrollo de guías de práctica clínica (GPC) en el Seguro Social de Salud del Perú (EsSalud). Métodos. El proceso de priorización se realizó mediante un análisis multicriterio en tres pasos: identificar las variables, obtener información de las mismas y asignarles una ponderación. Finalmente, se obtuvo una lista ordenada que fue puesta a consideración de los decisores de política. Resultados. Las cinco enfermedades con mayor número de AVISA (años de vida saludable perdidos) fueron: artrosis, glaucoma, esquizofrenia, osteoporosis y fracturas patológicas, y diabetes mellitus. Las de mayor gasto en medicamentos fueron: hemofilia, el grupo de nefritis, nefrosis (principalmente insuficiencia renal crónica), artritis reumatoide, cáncer de mama y SIDA. Las enfermedades prioritarias desde el punto de vista de la oferta de servicios fueron aquellas con alta mortalidad y alta discapacidad. Conclusiones. Se realizó el primer proceso de priorización de GPC en el Perú. Las 5 primeras enfermedades priorizadas fueron: artrosis, diabetes mellitus, glaucoma, enfermedad renal crónica y lumbago.
Objectives. To describe the prioritization process for developing the clinical practice guidelines (GPC) in the Seguro Social del Peru (EsSalud). Methods. The prioritization process was carried out through a multicriteria analysis in three steps: identify the variables, obtain information from them and assign them a weighting. Finally, an ordered list was obtained that was put to the consideration of the policy makers. Results. The five diseases with the highest number of DALY (disability adjusted life year) were osteoarthritis, glaucoma, schizophrenia, osteoporosis and pathological fractures, and diabetes mellitus. The most spending for drugs were hemophilia, the nephritis group, nephrosis (mainly chronic renal failure), rheumatoid arthritis, breast cancer and AIDS. Priority diseases from the point of view of the services offered were those with high mortality and high disability. Conclusions. This is the first process of guidelines prioritizing in Peru. The first 5 diseases prioritized were: osteoarthritis, diabetes mellitus, glaucoma, chronic kidney disease and lumbago.
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En el Perú, la elaboración de guías de práctica clínica tiene exigencia normativa desde el año 2005 (NT N° 027-MINSA/DGSP-V.01); sin embargo, su desarrollo ha ténido poco énfasis en la calidad metodológica de las mismas, prefiriendo el tipo narrativo. Desde hace varios años se realizan esfuerzos dispersos para mejorar la calidad metodológica, principalmente que su elaboaración esté basada en evidencias científicas. Actualmente se cuenta con una nueva normativa (NT N° 302-2015/MINSA) que pone mayor enfasis en esta exigencia y algunas instituciones ya trabajan para adecuarse a estandares internacionales y poder generar impactos positivos en nuestro sistema de salud a través del adecuado desarrollo de guias de practica clínica en nuestro pais
There has been a regulation for generating clinical practice guidelines in Peru since 2005 (NT N° 027-MINSA/DGSP-V.01), which was issued by the Ministry of Health. However, its use has had little emphasis in the methodological quality of such guidelines, and a narrative style was preferred. Some isolated efforts aiming to improve the quality of such guidelines have taken place, especially with respect to have such documents produced based on evidence. Now we have a new regulation (NT N° 302-2015/MINSA), which places more emphasis in this requirement; and some institutions are already working in such way, in order to comply with international standards and be able to generate a positive impact in our healthcare system through the adequate development of clinical practice guidelines in our country
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The aim of this work was to study the epidemiology and harmful effects of gastrointestinal nematodes (GINs) on dairy goats maintained in an intensive system. Two groups of goats were studied: untreated group (UG) (subdivided into UGjun goats that kidded in June, and UGjul goats that kidded in July) and treated group (TG) (with no subgroups, treated with monepantel: 3.75 mg/kg, orally, monthly). Eggs per gram (epg) in faeces were counted, faecal culture was performed to differentiate nematode genera and milk production was measured. Differences between groups were compared using least squares means analysis of variance (milk production and milking period length) and Kruskal-Wallis test (faecal egg counts). Nematode infection was moderate, with Haemonchus and Trichostrongylus being the dominant genera; the faecal egg counts reached the level of 2000 only once throughout the study. Goats that kidded in June had higher egg count after parturition (UGjun = 1564 epg), with significant differences (p < 0.04) from those that still had not kidded (UGjul = 962 epg). Over the entire trial period, the mean total milk production of TG (399.5 L ± 34.0 L) was significantly higher (p < 0.05) than that of UG (281.6 L ± 37.5 L), representing an increase of 41.8% in total milk yield. The results of this study show a post-partum peak in egg count and a negative effect of GINs on milk yield, even with moderate infections.