RESUMEN Introducción: La sífilis en embarazadas, sigue siendo un gran problema de salud pública en todo el mundo, y en Paraguay, no es la excepción. La sífilis congénita puede provocar abortos, muertes fetales y neonatales, peso bajo al nacer, prematuridad y otras anomalías congénitas, el conocimiento general de la población en edad fértil es fundamental. Objetivo: Analizar los conocimientos y prácticas sobre sífilis materna y sífilis congénita en adolescentes embarazadas en un Hospital General de Paraguay. Metodología: Se realizó un estudio cualitativo, fenomenológico descriptivo. Para la recolección de datos se utilizó la entrevista, simple que fue grabada con previa autorización del participante, la conclusión y recomendación serán entregados a la institución y a las adolescentes embarazadas. Resultados: Participaron diez adolescentes, en su mayoría de 19 años de edad, cinco conocen que la sífilis se transmite a través de las relaciones sexuales, sin embargo, desconocen acerca de cómo se transmite la sífilis congénita. Cinco de las adolescentes menciona haber iniciado las relaciones sexuales a los 16 años. Dos adolescentes a los 15 años, dos a los 14 años y una a los 17 años, nueve de las adolescentes embarazadas mencionan acudir a sus controles prenatales de forma periódica. Dos aún no se han realizado el test de VDRL. Discusión: Se concluye en cuanto al conocimiento, que solo cinco de diez adolescentes conocen acerca de la sífilis, sin embargo, no conocen sobre la sífilis congénita. En cuanto a las prácticas preventivas, 10 acuden de forma periódica a sus controles prenatales.

ABSTRACT Introduction: Syphilis in pregnant women continues to be a major public health problem throughout the world, and in Paraguay, it is no exception. Congenital syphilis can cause abortions, fetal and neonatal deaths, low birth weight, prematurity, and other congenital anomalies; general knowledge of the population of childbearing age is essential. Objective: To analyze the knowledge and practices about maternal syphilis and congenital syphilis in pregnant adolescents in a General Hospital in Paraguay. Methodology: A qualitative, descriptive phenomenological study was carried out. A simple interview was used to collect data, which was recorded with prior authorization from the participant. The conclusion and recommendation will be delivered to the institution and to the pregnant adolescents. Results: Ten adolescents participated, mostly 19 years of age, five know that syphilis is transmitted through sexual relations, however, they do not know how congenital syphilis is transmitted. Five of the adolescent’s mention having started sexual relations at the age of 16. Two adolescents at 15 years old, two at 14 years old and one at 17 years old, nine of the pregnant adolescent’s mention attending their prenatal check-ups periodically. Two have not yet been tested for VDRL. Discussion: It is concluded in terms of knowledge that only five out of ten adolescents know about syphilis; however, they do not know about congenital syphilis. Regarding preventive practices, 10 attend their prenatal check-ups periodically.

ABSTRACT The growing development in the automation of technological processes requires process engineers to know basic aspects of automatic regulation systems. In Plan E of Chemical Engineering, the subject Instrumentation and Controls is taught so that the graduate can conceive a regulation and control scheme for a technological process. The objective of the work is: Design a support software for Topic 3 of the Instrumentation and Controls subject, for the tuning of controllers using different criteria and the analysis of continuous time automatic regulation systems of technological processes. The AnaReg_V1 software was designed, which in the main window presents the regulation system block diagram that serves as an interface for the exchange of information, allowing to obtain the parameters of the first-order approximate model, tuning of either controllers or regulators of different types via different adjustment criteria and graph the temporal behavior of the regulation system variables. It is presented how employing AnaReg_V1 is obtained the approximated model, the tuning of an integral proportional controller according to the Ziegler-Nichols criterion and the temporary behavior of the variables of the regulation system taking as a study case the heat exchanger temperature control.

RESUMEN El creciente desarrollo en la automatización de procesos tecnológicos impone que los ingenieros de procesos conozcan aspectos básicos de los sistemas de regulación automática. En el plan E de Ingeniería Química se imparte la asignatura Instrumentación y Controles para que el egresado conciba un esquema de regulación y control para un proceso tecnológico. El objetivo del trabajo es: Diseñar un software de apoyo al Tema 3 de la asignatura Instrumentación y Controles, para el ajuste de controladores bajo diferentes criterios y el análisis de los sistemas de regulación automática de tiempo continuo de procesos tecnológicos. Se diseñó el software AnaReg_V1, el cual en la ventana principal presenta el diagrama de bloques de un sistema de regulación que sirve de interfaz para el intercambio de información, permitiendo obtener los parámetros del modelo aproximado de primer orden, ajustar controladores o reguladores de diferentes tipos bajo diferentes criterios de ajuste y graficar el comportamiento temporal de las variables del sistema de regulación. Se presenta como con AnaReg_V1 se obtiene el modelo aproximado, el ajuste de un controlador proporcional integral según el criterio Ziegler-Nichols y el comportamiento temporal de las variables del sistema de regulación tomando como caso de estudio el control de la temperatura de un intercambiador de calor.

Abstract Between 37 and 63% of the logged timber in Peru has an illegal origin. This study aims to describe this supply chain in Ucayali region. The main contribution is the elaboration (and diagramming) of a sequence of processes, activities, and tasks (supported by the collection of management documents, field interviews and observation, based on the crime-script methodology), and the identification of mechanisms of evasion of environmental, tax and labour controls which explain the illegal origin. The severe gap between the supply chain and the regulatory structure developed by the State shows formal instruments supported by declarative mechanisms that lead to proposing the idea of a State that performs control, carrying out a formal theatricalization of surveillance, while assuming the existence of a widespread illegal logic.

Resumo Entre 37 e 63% da madeira extraída no Peru tem origem ilegal. Este estudo tem como objetivo descrever essa cadeia de suprimentos na região Ucayali. A principal contribuição é a elaboração (e diagramação) de uma sequência de processos, atividades e tarefas (apoiada na coleta de documentos de gestão, entrevistas de campo e observação, com base na metodologia crime-script), e a identificação de mecanismos de evasão de crimes. controles ambientais, fiscais e trabalhistas que explicam a origem ilegal. A grave lacuna entre a cadeia de abastecimento e a estrutura regulatória desenvolvida pelo Estado evidencia instrumentos formais apoiados em mecanismos declarativos que levam a propor a ideia de um Estado que exerce o controle, realizando um processo de teatralização formal da vigilância, ao mesmo tempo que assume a existência duma estendida lógica ilegal.

Resumen Entre 37 y 68% de la madera peruana tendría origen ilegal. El objetivo de este estudio es describir esta cadena de suministro en la región de Ucayali. El principal aporte es la elaboración y diagramación de una secuencia de eslabones, actividades y tareas (sostenida en la recolección de documentos de gestión, entrevistas en terreno y observación, basada en la metodología de los crime-scripts), mediante la cual se identifican mecanismos de evasión de los controles ambientales, tributarios y laborales, que explicarían el origen ilegal. Se identifica una severa brecha entre la cadena de suministro y la estructura normativa desarrollada por el Estado, lo que muestra instrumentos formales sostenidos en mecanismos declarativos que conducen a plantear la idea de un Estado que “performa” el control, realizando una teatralización formal de la vigilancia, mientras asume la existencia de una lógica ilegal extendida.

Resumen Se evaluó la percepción sobre las barreras para el acceso al control prenatal (ACP) de las embarazadas atendidas en el Centro de Salud Tipo C Dr. Arnaldo Calderón de Tosagua, Manabí, Ecuador, durante marzo-agosto 2023. Se realizó una investigación observacional, descriptiva de corte transversal. La mayoría de las embarazadas era de procedencia rural (77,78 %), tenía un nivel de escolaridad secundaria (37,91 %) y trabajaba (47,71 %). El 83,01 % de las embarazadas inició el control prenatal en el primer trimestre; el 56,86 % tuvo entre 4 y 6 controles prenatales y un período intergenésico de 1 a 2 años (47,71 %). La accesibilidad fue considerada lejos y difícil (68,83 %) y la calidad de las instalaciones fue buena (43,14 %). El horario de atención se percibió como conveniente y el tiempo de espera fue de entre 15 y 30 minutos (60,78 %). El 71,9 % tuvo dificultades para el acceso al ginecólogo. Las principales barreras individuales/psicosociales fueron embarazo no planificado, no deseado, con síntomas de depresión y desmotivación y dificultad para asistir a las consultas por el cuidado de los demás hijos. Las dificultades económicas (90,2 %), dificultades para el traslado a la institución (93,46 %) y dificultad por quehaceres domésticos (87,58 %), fueron las barreras socioeconómicas que más afectaron el ACP. También incidieron en el ACP, el difícil acceso a las citas para la consulta (98,69 %), tiempo de espera prolongado para su atención (97,38 %) y poco tiempo de duración de la consulta (96,08 %).

Abstract The perception of barriers to access to prenatal care (APC) of pregnant women treated at the Dr. Arnaldo Calderón Type C Health Center in Tosagua, Manabí, Ecuador, from March to August 2023, was evaluated. An observational, descriptive, cross-sectional research was carried out. The majority of pregnant women were from rural origins (77,78%), had a secondary education level (37,91%), and worked (47,71%). 83,01% of pregnant women began prenatal care in the first trimester; 56.86% had between 4 and 6 prenatal care visits and an intergenic period from 1 to 2 years (47,71%). Accessibility was considered far and difficult (68,83%), and the quality of the facilities was good (43,14%). The opening hours were perceived as convenient, and the waiting time was between 15 and 30 minutes (60,78%). The 71,9% had difficulties accessing the gynecologist. The primary individual/psychosocial barriers were unplanned, unwanted pregnancy, with symptoms of depression, lack of motivation, and difficulty attending appointments to care for the other children. Economic difficulties (90,2%), difficulties transferring to the institution (93,46%), and difficulties due to household chores (87,58%) were the socioeconomic barriers that most affected the APC. Difficult access to consultation appointments (98,69%), prolonged waiting time for care (97,38%), and short duration of the consultation (96,08%) also had an impact on the APC.

Resumo Objectivos: Estudar o tipo de queda de cabelo mais frequente em diferentes faixas etárias e a deficiência prevalente de micronutrientes associada à queda de cabelo. Comparar a associação dos níveis séricos de ferritina, vitamina D e vitamina B12 com queda de cabelo entre casos e controles. Métodos: Este foi um estudo transversal que incluiu um total de 100 indivíduos com 50 casos de queda de cabelo e 50 controles pareados por idade e sexo. Os níveis séricos de vitamina D, vitamina B12 e ferritina foram medidos em todos os indivíduos. Resultados: A maioria dos sujeitos tinha entre 20 e 30 anos de idade. Houve predomínio do eflúvio telógeno seguido da alopecia androgenética masculina em todas as faixas etárias. As mulheres apresentaram níveis consideravelmente mais baixos de ferritina sérica em comparação aos homens entre os casos, com valor p de 0,0001. A vitamina D, a vitamina B12 e a ferritina sérica foram significativamente baixas entre os casos em comparação aos controles, com valores de p de 0,0001, 0,01 e 0,006, respectivamente. Conclusão: Este estudo sugere que baixos níveis séricos de vitamina B12 e ferritina sérica e particularmente vitamina D podem desempenhar um papel apreciável na perda de cabelo, especialmente no eflúvio telógeno entre as mulheres. A avaliação destes parâmetros poderia ajudar o médico a optar por uma modalidade terapêutica mais precisa, mas a identificação da etiologia exacta continua a ser uma preocupação primordial, uma vez que é multifactorial, o que abre o caminho para um tratamento adequado e eficaz.

Abstract Objectives: The objective of this study was to study the most frequent type of hair loss in different age groups, and the prevalent micronutrient deficiency linked to hair loss and to compare the association of serum ferritin, vitamin D, and vitamin B12 levels with hair loss among cases and controls. Methods: This was a cross-sectional study which included a total of 100 subjects with 50 hair loss cases and 50 age and sex-matched controls. Serum levels of vitamin D, vitamin B12, and ferritin were measured in all subjects. Results: Most of the subjects were between 20 and 30 years of age. There was a predominance of telogen effluvium followed by male androgenetic alopecia in all age groups. Females had considerably lower levels of serum ferritin compared to males among cases, with p-value of 0.0001. Vitamin D, vitamin B12, and serum ferritin were significantly low among cases compared to controls, with p-values of 0.0001, 0.01, and 0.006, respectively. Conclusion: This study suggests that low levels of serum vitamin B12 and serum ferritin and particularly vitamin D might play an appreciable role in hair loss especially telogen effluvium among females. Evaluation of these parameters could aid the clinician in opting for a more precise therapeutic modality, but identification of the exact etiology remains a primary concern as it is multifactorial, which paves path to appropriate and effective treatment.

Abstract We conducted a nested case-control study within a cohort with the aim of studying the association between illicit drug use and congenital syphilis (CS). Cases were diagnosed based on treponemal and non-treponemal tests conducted both in the mother and the newborn (NB). Multivariate analysis with logistic regression was performed. A total of 6171 births with a mean gestational age of 37.8 weeks were recorded and 62 CS events were diagnosed (incidence 10.5 events/1000 NB). Associated maternal factors were illicit drug use (OR 14.08, 95% CI 1.19-166.6), <5 prenatal visits (OR 2.9, 95% CI 1.12-7.53), more than two sexual partners (OR 3.76, 95% CI 1.62-8.71) and professional education level (OR 0.06, 95% CI 0.005-0.85). Among the mothers of the cases presented, the prevalence of illicit drug use was 22.6% and the most frequent drugs were methamphetamines and cannabis.

Resumen Realizamos un estudio de casos y controles anidado en una cohorte con el objetivo de estudiar la asociación del consumo de drogas ilícitas y sífilis congénita (SC). Los casos se diagnosticaron mediante pruebas treponémicas y no treponémicas en la madre y el recién nacido (RN). Se realizó un análisis multivariado con regresión logística. Se registraron 6.171 nacimientos con edad gestacional promedio 37,8 semanas y se diagnosticaron 62 eventos de SC (incidencia: 10,5 eventos/1.000 RN). Los factores maternos asociados fueron el uso de drogas ilícitas (OR = 14,08; IC 95% = 1,19-166,6), menos de cinco consultas en el control prenatal (OR = 2,9; IC 95% = 1,12-7,53), más de dos parejas sexuales (OR = 3,76; IC 95% = 1,62-8,71) y estudios universitarios (OR = 0,06; IC 95% = 0,005-0,85). Entre las madres de los casos, la prevalencia del consumo de drogas ilícitas fue de 22,6% y las más frecuentes fueron las metanfetaminas y la marihuana.

Resumo Os programas de padronização da creatinina permanecem válidos. O objetivo é descrever a experiência adquirida durante o desenvolvimento de um programa de padronização de creatinina em uma província com poucos recursos e mostrar os aspectos que devem ser levados em consideração para sua escalabilidade em um contexto semelhante. O programa foi desenvolvido em etapas: Na primeira (2010), foi realizado um levantamento de 49 laboratórios clínicos (LC) distribuídos em toda a provincia do Chaco, na Argentina. Na segunda etapa (2012) o erro aleatório (EA) foi ajustado através da aplicação de protocolos internacionais (CLSI EP-5A). Na terceira etapa (2014-2015), foram processados paineis de soros com concentrações atribuídas por método rastreável à referência e ao padrão internacional (CG-IDMS). Protocolos internacionais foram aplicados para avaliar o erro total (ET) da determinação em cada laboratório (CLSI EP-10A). Em 2016, aplicando ferramentas de qualidade, foram avaliadas as barreiras no processo. Observou-se na EA: para o nível de 1,00 mg/dL nenhuma LC atingiu os níveis desejáveis; para um nível de 2,5 mg/dL, apenas 9 (23%) os atingiram. Concluídas a segunda e terceira etapas, apenas 18 laboratórios (48,7%) conseguiram ajustar o EA e/ou o ET, mas foi difícil sustentá-lo ao longo do tempo. No que diz respeito aos reagentes, calibradores e controles, eles são produzidos pela indústria. dependendo do estado o seu controle. A homogeneidade do equipamento depende da acessibilidade econômica e do volume de trabalho. O meio ambiente, a temperatura e a qualidade da água continuam sendo uma dificuldade para a escalabilidade.

Resumen Los programas de estandarización de creatinina mantienen su vigencia. El objetivo es describir la experiencia adquirida durante el desarrollo de un programa de estandarización de creatinina en una provincia de bajos recursos y mostrar los aspectos que se deben considerar para su escalabilidad en un contexto semejante. El programa se desarrolló en etapas: en la primera (2010) se realizó el relevamiento de 49 laboratorios clínicos (LC) distribuidos en toda la provincia del Chaco, Argentina. En la segunda (2012) se ajustó el error aleatorio (EA) aplicando protocolos internacionales (CLSI EP-5A). En la tercera etapa (2014-2015) se procesaron paneles de sueros con concentraciones asignadas por un método trazable al de referencia y al estándar internacional (CG-IDMS). Se aplicaron protocolos internacionales para evaluar el error total (ET) de la determinación en cada laboratorio (CLSI EP-10A). En 2016, aplicando herramientas de calidad, se evaluaron las barreras en el proceso. Se observó en el EA: para un nivel de 1,00 mg/dL, ningún LC alcanzó los niveles deseables; para un nivel de 2,5 mg/dL solo 9 (23%) los alcanzaron. Concluida la segunda y tercera etapa, solo 18 laboratorios (48,7%) lograron ajustar el EA y/o ET, pero resultó dificultoso sostenerlo en el tiempo. Los reactivos, calibradores y controles son producidos por la industria y depende del estado el control de los mismos. La homogeneidad del equipamiento depende de la accesibilidad económica y del volumen de trabajo. El medio ambiente, la temperatura y la calidad del agua siguen siendo una dificultad para la escalabilidad.

Abstract Creatinine standardisation programmes remain valid. The objective of this work is to describe the experience acquired during the development of a creatinine standardisation programme in a low-resource province and show the aspects that should be considered for its scalability in a similar context. The programme was developed in stages. The first one was carried out in 2010. It consists of a structured survey completed by 49 clinical laboratories (CL) distributed throughout the province. In the second stage (2012) the random error (RE) was adjusted by applying international protocols (CLSI EP-5A). In the third stage (2014-2015), panels of sera were processed with concentrations assigned by a method traceable to the reference and the international standard (CG-IDMS). International protocols were applied to evaluate the total error (TE) of the determination in each laboratory (CLSI EP-10A). In 2016, applying quality tools, the barriers in the process were evaluated. In the RE, it was observed: for a level of 1.00 mg/dL, no CL reached the desirable levels; for a level of 2.5 mg/dL only 9 (23%) CL achieved them. Once the second and third stages were completed, only 18 laboratories (48.7%) managed to adjust the RE and/or TE, but it was difficult to sustain it over time. With respect to materials, reagents, calibrators, and controls, they are produced by the industry depending on the state of their control. The homogeneity of the equipment depends on economic accessibility and volume of work. The environment, temperature, and water quality are a barrier to scalability.

Resumo A participação em programas de avaliação externa da qualidade (PEECs) voltados para o diagnóstico de doenças genéticas permite obter uma mensuração objetiva do desempenho técnico e analítico dos laboratórios e é requisito para a acreditação dos laboratórios clínicos sob a norma ISO 15189. O objetivo desse estudo foi avaliar retrospectivamente o desempenho nos esquemas EMQN (European Molecular Genetics Quality Network) e CF Network (Cystic Fibrosis European Network) no período 2014-2022. Participou-se em um total de 88 esquemas. Foram coletadas informações de nossos escores e das médias dos laboratórios participantes nas categorias genotipagem, interpretação e precisão da informação do paciente/laudo. 90,9% (n=80) dos esquemas foram informados em sua totalidade. O desempenho na genotipagem apresentou escores acima da média em 89,3% dos esquemas; 0,8% dos laudos corresponderam a falsos negativos. Na interpretação, 66,7% dos esquemas apresentaram desempenho acima da média e 33,3% abaixo da média. A precisão das informações do paciente/laudo apresentou escores acima da média em 97,6% dos esquemas. Observou-se diferença estatisticamente significativa no percentual de esquemas com pontuação acima da média no ano de 2022 (10/12 esquemas) em relação ao ano de 2014 (1/6 esquemas) na categoria interpretação (p=0,0128). Em conclusão, a participação regular em PEECs teve um impacto positivo na qualidade dos estudos e permite fazer melhorias contínuas com base nas recomendações sugeridas por esses programas.

Resumen La participación en programas de evaluación externa de la calidad (PEEC) dirigidos al diagnóstico de enfermedades genéticas permite obtener una medida objetiva del desempeño técnico y analítico de los laboratorios y es un requisito para la acreditación de los laboratorios clínicos bajo la norma ISO 15189. El objetivo de este estudio fue evaluar retrospectivamente el desempeño en los esquemas EMQN (European Molecular Genetics Quality Network) y CF Network (Cystic Fibrosis European Network) en el período 2014-2022. Se participó en un total de 88 esquemas. Se recolectó la información de nuestros puntajes y las medias de los laboratorios participantes en las categorías genotipificación, interpretación y exactitud de la información del paciente/informe. Se informó en forma completa el 90,9% (n=80) de los esquemas. El desempeño en genotipificación mostró puntajes superiores a la media en el 89,3% de los esquemas; 0,8% de los informes correspondieron a falsos negativos. En interpretación, el 66,7% de los esquemas evidenció un desempeño superior a la media y el 33,3% debajo de la media. La exactitud de la información del paciente/informe presentó puntajes superiores a la media en el 97,6% de los esquemas. Se observó una diferencia estadísticamente significativa en el porcentaje de esquemas con puntaje por encima de la media en el año 2022 (10/12 esquemas) respecto al año 2014 (1/6 esquemas) en la categoría interpretación (p=0,0128). En conclusión, la participación regular en PEEC tuvo impacto positivo en la calidad de los estudios y permite realizar mejoras continuas a partir de las recomendaciones sugeridas por estos programas.

Abstract Participation in external quality assessment programmes focused on rare genetic diseases makes it possible to assess the laboratory technical and analytical performance and it is a prerequisite for accreditation according to ISO 15189. The objective of this study was to perform a retrospective evaluation of our performance in the EMQN (European Molecular Genetics Quality Network) and the CF Network (Cystic Fibrosis European Network) programmes in the 2014-2022 period. The laboratory performance on genotyping, interpretation and clerical accuracy and patient identifiers in a total of 88 schemes were assessed. The information of our scores and the mean scores of all participating laboratories in the three categories were collected. A total of 90.9% of the schemes were fully completed. The performance in genotyping showed scores above the mean scores in 89.3% of the schemes; 0.8% of the reports correspond to false negative results. Regarding interpretation category, 66.7% of the schemes presented scores above the mean scores and 33.3% below the mean scores. The clerical accuracy and patient identifiers were above the mean scores in 97.6% of the schemes. A statistically significant difference in the percentage of schemes with a score above the mean for the interpretation category in the year 2022 (10/12 schemes) was observed compared to the year 2014 (1/6 schemes) (p=0.0128). In conclusion, regular participation in external quality assessment programmes had a positive impact on the quality of the studies and allows for continuous improvements based on the recommendations suggested by these programmes.

ABSTRACT A 27-year-old primigravida patient without a relevant medical history and appropriate prenatal control received attention for vaginal delivery at 39 weeks of gestation. One -hour later, she experienced holocranial headache with right predominance, treated with anti-inflammatories and muscle relaxants by the indication of a neurologist. Hours after her discharge, on the third day post-partum, she developed bilateral tonic-clonic seizures.. Following a urine test in the emergency room with proteinuria (+) in a dipstick, we tested 24-hour protein count in 1094 mg (normal values 0-140). Magnetic resonance with contrast at admission was normal. She received Phenytoin and Magnesium Sulfate during her hospitalization. The evolution was favorable, and he was discharged at five days with ambulatory controls in the medical office without headache, proteinuria, and/or hypertension.

RESUMEN Paciente primigesta de 27 años, sin antecedentes médicos de importancia y con un apropiado control prenatal, quien recibió atención por parto vaginal a las 39 semanas de gestación con anestesia epidural. Una hora después del parto, presentó cefalea holocraneana a predominio derecho, tratada con antiinflamatorios y relajantes muscular por indicación del servicio de neurología. Horas después de su alta, al tercer día posparto, presentó convulsiones tónico-clónicas bilaterales. Por un examen de orina con proteinuria (+) en tira reactiva y elevaciones discretas de la presión arterial, se solicitó un conteo de proteínas en 24 horas, con valores en 1094,5 mg (valor normal: 0-140). La resonancia magnética con contraste solicitada durante su admisión fue normal, recibiendo tratamiento con fenitoína y sulfato de magnesio durante su hospitalización. Fue dada de alta al quinto día, con controles posteriores por consultorio externo, sin cefalea, proteinuria y/o hipertensión.

Abstract Background: Exclusive breastfeeding (BF) has the greatest potential impact on child mortality of any preventive intervention. Skin-to-skin contact (SSC) during the first hour of life is beneficial for initiating BF; however, routine separation of mother and infant is still common. This work aimed to demonstrate that SSC during the first hour of life is associated with a greater frequency and duration of exclusive BF. Methods: This is an observational case–control study. We reviewed the medical records of patients born between 2016 and 2022 classified as cases or controls based on the history of SSC in the first hour of life. Statistical analysis was performed using SPSS version 28. Results: We included 362 medical records, of which 200 (55.2%) had SSC and were considered cases; the 162 (44.8%) who did not have SSC were considered controls. Those who received SSC were more likely to receive exclusive BF at 3 (163 [81.5%] vs. 94 [58%], p < 0.001) and 6 months of age (147 [73.5%] vs. 83 [51.2%], p < 0.001). Conclusions: Patients who received SSC in the first hour of life were more likely to receive exclusive BF at 3 and 6 months of age. Promoting and respecting this practice is essential to increase the possibility of a newborn to be exclusively breastfed for the first 6 months of life.

Resumen Introducción: La lactancia materna exclusiva (LME) es la intervención preventiva con mayor impacto en mortalidad infantil. El contacto piel con piel (CPP) durante la primera hora de vida es un periodo crítico para establecer la lactancia; sin embargo, la separación rutinaria del recién nacido de su madre es frecuente. El objetivo de este trabajo fue demostrar que el CPP durante la primera hora se asocia con mayor frecuencia y duración de LME. Métodos: Se llevó a cabo un estudio observacional de casos y controles. Se revisaron expedientes de pacientes de nuestra consulta pediátrica que nacieron entre 2016 y 2022. Se clasificaron como casos y controles de acuerdo con el antecedente de haber recibido CPP durante la primera hora de vida. Se realizó el análisis estadístico en SPSS version 28. Resultados: Se incluyeron 362 expedientes, de los cuales 200 (55.2%) recibieron CPP en la primera hora de vida y fueron considerados casos; los 162 (44.8%) que no lo hicieron fueron considerados controles. Aquellos que recibieron CPP tuvieron con mayor frecuencia LME a los 3 (163 [81.5%] vs. 94 [58%], p < 0.001) y 6 meses de edad (147 [73.5%] vs. 83 [51.2%], p < 0.001). Conclusiones: La frecuencia con la cual los pacientes lograron tener lactancia materna exclusiva a los 3 y 6 meses es mayor en aquellos en los que se respeta el CPP en la primera hora de vida. Promover y respetar esta práctica es fundamental para incrementar las probabilidades de que los lactantes reciban LME durante sus primeros 6 meses de vida.

RESUMEN El liposarcoma es un tumor de origen mesenquimal que se presenta comúnmente en el retroperitoneo; es de crecimiento lento y su capacidad de producir metástasis depende de su tipo histológico. Este trabajo tiene como propósito presentar un caso de liposarcomas paratesticulares simultáneos con diferentes tipos histológicos, en un paciente masculino, de 80 años con antecedentes de salud y nivel socioeconómico bajo que venía presentando desde hacía dos años aumento de volumen en la región inguinal izquierda y testículo ipsilateral, al inicio fue indoloro; luego, a medida que aumentó de tamaño se tornó doloroso, abarcando la región inguinoescrotal derecha en su totalidad. El examen físico, incluido el signo de la transiluminación fue negativo. El estudio analítico mostró solamente velocidad de sedimentación globular en 95 mm/h y la LDH en 650 U/l; la ecografía testicular mostró una masa heterogénea, solida e hiperecoica, de aspecto graso inguinoescrotal y de más de 30 cm, sin llegarse a observar el testículo. Se realizó exéresis tumoral encontrándose tres tumores liposarcomatosos, dos de ellos con características histopatológicas similares y el otro con patrón histológico diferente. Luego del tratamiento quirúrgico el paciente se recuperó satisfactoriamente y no ha presentado recidiva según los controles periódicos realizados. Se consideró la publicación del caso pues los liposarcomas pueden llegar a confundirse a la exploración clínica con la presencia de una hernia inguinal de contenido graso con sintomatología similar a estas; por lo que debe hacerse una exploración clínica exhaustiva para realizar un correcto diagnóstico. El estudio histopatológico confirmó el diagnóstico de la enfermedad que, además, reveló la presencia de tres tumores liposarcomatosos y dos variantes histopatológicas del mismo, de lo cual no se encontraron reportes en la literatura revisada.

ABSTRACT Liposarcoma is a mesenchymal origin tumor that commonly occurs in the retroperitoneum; It is slow growing and its ability to produce metastasis depends on its histological type. The purpose of this work is to present a case of simultaneous paratesticular liposarcomas with different histological types, in an 80-years-old male patient with a health history and low socioeconomic level; For two years he had been experiencing an increase in volume in the left inguinal region and ipsilateral testicle, which at first was painless; Then, as it increased in size, it became painful, covering the entire right inguinoscrotal region. Physical examination, including transillumination sign, was negative. The analytical study only showed erythrocyte sedimentation rate at 95 mm/h and LDH at 650 U/l; The testicular ultrasound showed heterogeneous, solid and hyperechoic mass, with a fatty inguinoscrotal appearance and measuring more tan 30 cm, without the testicle being observed. Tumor excision was performed and three liposarcomatous tumors were found, two of them with similar histopathological characteristics and the other with a different histological pattern. After the surgical treatment, the patient recovered satisfactorily and has not had a recurrence according to the periodic controls carried out. The publication of the case was considered because liposarcomas can be confused on clinical examination with the presence of an inguinal hernia with fatty content with symptoms similar to these; Therefore, a thorough clinical examination must be performed to make a correct diagnosis. The histopathological study confirmed the diagnosis of the disease; which, in addition, revealed the presence of three liposarcomatous tumors and two histopathological variants of the same, from which no reports were found in the reviewed literature.

RESUMEN Fundamento: la elevada frecuencia de recién nacidos con peso inferior al adecuado, en relación con la anemia materna, la atención prenatal insuficiente y la condición de madre soltera, puede tener importantes repercusiones en la salud de las madres y los niños. Objetivo: identificar la relación entre el control prenatal, la anemia materna y la condición de ser madre soltera con el bajo peso al nacer de los infantes. Método: se realizó un estudio observacional, analítico y retrospectivo de casos y controles en gestantes atendidas en un hospital de la región Sierra de Ecuador durante el año 2022. La muestra fue de 280 pacientes. El grupo de casos lo conformaron las gestantes con hijos con bajo peso al nacer (n = 70) y el grupo de control por gestantes con recién nacidos con peso normal (n = 210). Se realizó la prueba de Chi cuadrado de independencia y se calculó el Odds Ratio y su intervalo de confianza del 95 % para el nivel de asociación entre las variables. Resultados: la relación de la variable asistencia a controles prenatales con respecto al bajo peso al nacer mostró una asociación protectora (OR = 0,5). Se identificaron como factores de riesgo, la anemia materna (OR = 3,1) y la condición de madre soltera (OR = 2,3) por sus altos valores de asociación positiva y directa. Conclusiones: el control prenatal, la anemia materna y la condición de madre soltera resultaron tener un nivel de asociación significativa con el bajo peso al nacer.

ABSTRACT Foundation: the high frequency of newborns with less than adequate weight, in relation to maternal anemia, insufficient prenatal care and single mother status, can have important repercussions on the health of mothers and children. Objective: to identify the relationship between prenatal control, maternal anemia and the condition of being a single mother with low birth weight of infants. Method: an observational, analytical and retrospective case-control study was carried out in pregnant women treated in a hospital in the Sierra region of Ecuador during the year 2022. The sample was 280 patients. The case group was made up of pregnant women with children with low birth weight (n = 70) and the control group was made up of pregnant women with newborns with normal weight (n = 210). The Chi square test of independence was performed and the Odds Ratio and its 95 % confidence interval were calculated for the level of association between the variables. Results: the relationship between the variable attendance at prenatal check-ups and low birth weight showed a protective association (OR = 0,5). Maternal anemia (OR = 3,1) and being a single mother (OR = 2,3) were identified as risk factors due to their high values of positive and direct association. Conclusions: prenatal control, maternal anemia and single mother status turned out to have a significant level of association with low birth weight.

Abstract Objective: Obesity is a global epidemic affecting developing countries. The relationship between obesity and perioperative outcomes during elective lumbar spine surgery remains controversial, especially in those without morbid disease. Materials and methods: We retrospectively revised the medical records of patients with lumbar spine degeneration subjected to elective surgery. The data retrieved included demographic and clinical characteristics, body mass index (BMI), obesity status (BMI ≥ 30), surgical interventions, estimated blood loss (EBL), operative time, length of stay (LOS), and post-operative complications. Perioperative outcomes were compared between Grade I-II obese and non-obese individuals. Results: We enrolled 53 patients, 18 with Grade I-II obesity. Their median age was 51, with no differences in gender, comorbidities, laboratory parameters, and surgical procedures received between groups. No clinically relevant differences were found between grade I-II obese and non-obese participants in EBL (300 mL vs. 250 mL, p = 0.069), operative time (3.2 h vs. 3.0 h, p = 0.037), and LOS (6 days vs. 5 days, p = 0.3). Furthermore, BMI was not associated with the incidence of significant bleeding and long stay but showed a modest correlation with operative time. Conclusion: Grade I-II obesity does not increase surgical complexity nor perioperative complications during open lumbar spine surgery.

Resumen Objetivo: La obesidad es una epidemia mundial que afecta a países subdesarrollados. Su relación con los resultados de la cirugía de columna lumbar electiva sigue siendo controvertida, especialmente en obesos sin enfermedad mórbida. Métodos: Se revisaron los expedientes de pacientes con degeneración de la columna lumbar sometidos a cirugía. Los datos recuperados incluyeron características demográficas y clínicas, índice de masa corporal (IMC), estado de obesidad (IMC > 30), intervenciones quirúrgicas, sangrado estimado, tiempo operatorio, tiempo de estancia y complicaciones. Los resultados se compararon entre individuos obesos grado I-II y controles. Resultados: Se incluyeron 53 pacientes, 18 con obesidad de grado I-II. La edad media fue de 51 años, sin diferencias en el sexo, las comorbilidades, los parámetros de laboratorio y los procedimientos quirúrgicos recibidos entre grupos. No se encontraron diferencias relevantes entre los participantes obesos y los no obesos en sangrado (300 vs. 250 mL, p = 0.069), tiempo operatorio (3.2 vs. 3.0 horas, p = 0.037) y estancia (6 vs. 5 días, p = 0.3). El IMC no se asoció con hemorragia y larga estancia, pero mostró una correlación modesta con el tiempo operatorio. Conclusiones: La obesidad grado I-II no predispone a complicaciones durante la cirugía de columna lumbar.

Abstract Objective: The aim of this study was to assess the risk factors associated with 30-day hospital readmissions after a cholecystectomy. Methods: We conducted a case–control study, with data obtained from UC-Christus from Santiago, Chile. All patients who underwent a cholecystectomy between January 2015 and December 2019 were included in the study. We identified all patients readmitted after a cholecystectomy and compared them with a randomized control group. Univariate and multivariate analyses were conducted to identify risk factors. Results: Of the 4866 cholecystectomies performed between 2015 and 2019, 79 patients presented 30-day hospital readmission after the surgical procedure (1.6%). We identified as risk factors for readmission in the univariate analysis the presence of a solid tumor at the moment of cholecystectomy (OR = 7.58), high pre-operative direct bilirubin (OR = 2.52), high pre-operative alkaline phosphatase (OR = 3.25), emergency admission (OR = 2.04), choledocholithiasis on admission (OR = 4.34), additional surgical procedure during the cholecystectomy (OR = 4.12), and post-operative complications. In the multivariate analysis, the performance of an additional surgical procedure during cholecystectomy was statistically significant (OR = 4.24). Conclusion: Performing an additional surgical procedure during cholecystectomy was identified as a risk factor associated with 30-day hospital readmission.

Resumen Objetivo: El objetivo de este estudio fue evaluar los factores de riesgo asociados al reingreso hospitalario en los primeros 30 días post colecistectomía. Métodos: Estudio de casos-controles con datos obtenidos del Hospital Clínico de la UC-Christus, Santiago, Chile. Se incluyeron las colecistectomías realizadas entre los años 2015-2019. Se consideraron como casos aquellos pacientes que reingresaron en los 30 primeros días posterior a una colecistectomía. Se realizó un análisis univariado y multivariado de diferentes posibles factores de riesgo. Resultados: De un total de 4866 colecistectomías, 79 pacientes presentaron reingreso hospitalario. Los resultados estadísticamente significativos en el análisis univariado fueron; tumor sólido al momento de la colecistectomía (OR = 7.58) bilirrubina directa preoperatoria alterada (OR = 2.52), fosfatasa alcalina preoperatoria alterada (OR = 3.25), ingreso de urgencia (OR = 2.04), coledocolitiasis al ingreso (OR = 4.34) realización de otros procedimientos (OR = 4.12) y complicaciones postoperatorias. En el análisis multivariado sólo la realización de otro procedimiento durante la colecistectomía fue estadísticamente significativa (OR = 4.24). Conclusión: La realización de otros procedimientos durante la colecistectomía es un factor de riesgo de reingreso hospitalario en los 30 días posteriores a la colecistectomía.

Resumo Durante o presente estudo, o estresse oxidativo mediado pelo cobre (Cu) foi medido que induziu danos ao DNA por concentração nos tecidos de peixes, Catla catla (14,45 ± 1,24g; 84,68 ± 1,45mm) (Hamilton, 1822). Os alevinos foram retidos em 5 grupos por 14, 28, 42, 56, 70 e 84 dias do período de exposição. Eles foram tratados com 2/3, 1/3, 1/4 e 1/5 (T1-T4) de 96h de concentração letal de cobre. Os controles foram executados junto com todos os tratamentos para as mesmas durações. Uma significativa (p <0,05) concentração dependente do tempo e da dose de Cu foi observada nas brânquias, fígado, rim, músculos e cérebro de C. catla. Entre os órgãos, o fígado apresentou uma concentração significativamente maior de cobre, seguido por guelras, rins, cérebro e músculos. O acúmulo de cobre nesses órgãos causou uma variação significativa nas atividades das enzimas viz. superóxido dismutase (SOD), catalase (CAT) e peroxidase (POD). A atividade de SOD variou significativamente em resposta ao tempo de exposição de Cu como 56> 70> 42> 84> 28> 14 dias, enquanto a atividade de CAT exibiu uma relação inversa com o aumento na concentração de Cu. A atividade POD mostrou um aumento significativo com um aumento na duração da exposição ao Cu. O ensaio do cometa exibiu dano significativo ao DNA induzido por Cu nos eritrócitos periféricos de C. catla. Entre as quatro concentrações de exposição, 2/3 do LC50 (T1) causou danos significativamente maiores aos núcleos em comparação com o controle. O aumento da atividade de POD e SOD, bem como uma diminuição na atividade de CAT em resposta ao Cu, demonstra o envolvimento de um mecanismo protetor contra espécies reativas de oxigênio (ROS), enquanto o aumento de ROS resultou em maior dano ao DNA. Esses marcadores moleculares mencionados acima podem ser usados de forma eficiente para o biomonitoramento de ambientes aquáticos e conservação da ictiofauna comestível.

Abstract During present study, the copper (Cu) mediated oxidative stress was measured that induced DNA damage by concentrating in the tissues of fish, Catla catla (14.45±1.24g; 84.68±1.45mm) (Hamilton,1822). Fish fingerlings were retained in 5 groups for 14, 28, 42, 56, 70 and 84 days of the exposure period. They were treated with 2/3, 1/3, 1/4 and 1/5 (T1-T4) of 96h lethal concentration of copper. Controls were run along with all the treatments for the same durations. A significant (p < 0.05) dose and time dependent concentration of Cu was observed in the gills, liver, kidney, muscles, and brain of C. catla. Among organs, the liver showed a significantly higher concentration of Cu followed by gills, kidney, brain, and muscles. Copper accumulation in these organs caused a significant variation in the activities of enzymes viz. superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD). The SOD activity varied significantly in response to the exposure time of Cu as 56 > 70 > 42 > 84 > 28 > 14 days while CAT activity exhibited an inverse relationship with the increase in Cu concentration. POD activity showed a significant rise with an increase in Cu exposure duration. Comet assay exhibited significant DNA damage in the peripheral erythrocytes of Cu exposed C. catla. Among four exposure concentrations, 2/3rd of LC50 (T1) caused significantly higher damage to the nuclei compared to control. Increased POD and SOD activity, as well as a decrease in CAT activity in response to Cu, demonstrates the involvement of a protective mechanism against reactive oxygen species (ROS), whereas increased ROS resulted in higher DNA damage. These above-mentioned molecular markers can be efficiently used for the biomonitoring of aquatic environments and conservation of edible fish fauna.