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Introducción: La insuficiencia cardíaca (IC) tiene alta morbilidad y mortalidad. Su diagnóstico temprano en atención primaria de salud (APS) es un reto dada la baja especificidad de sus criterios clínicos y las limitaciones en acceso a técnicas diagnósticas. Objetivo: Analizar la prevalencia de IC, subtipos y pronóstico de pacientes con disnea y/o edema de extremidades inferiores que consultan en APS. Metodología: Se trata de un estudio prospectivo de 340 pacientes en APS, sin diagnóstico previo de IC. Se realizó una evaluación clínica, electrocardiograma, NT-proBNP "point-of-care", ecocardiografía con interpretación telemática por cardiólogos. Utilizando los algoritmos HFA-PEFF y H2FPEF se clasificaron los pacientes como :1) IC con fracción de eyección (FE) reducida (ICFER); 2) IC con FE preservada (ICFEP) y 3) pacientes sin diagnóstico de IC. Se efectuó un análisis de sobrevida de los diferentes grupos. Resultados: La prevalencia de ICFER fue 8%, ICFEP por HFA-PEFF 42% y por H2FPEF 8%. Los algoritmos sugieren efectuar un estudio complementario en el 47% con HFA-PEFF y 76% con H2FPEF (p<0.05). La sobrevida global a 36 meses fue 90±2% y cardiovascular 95±1%. Usando HFA-PEFF, los pacientes con IC tuvieron menor sobrevida que aquellos sin IC (HR 2.3, IC95% 1.14.9; p=0.029). No hubo diferencias de mortalidad con H2FPEF. Conclusiones: En pacientes de APS que consultan por disnea y/o edema de extremidades inferiores sometidos a evaluación con NT-proBNP y ecocardiografía, se observó una prevalencia de IC de hasta 50%, 8% de ICFER y 42% de ICFEP. La caracterización de IC utilizando HFA-PEFF está asociada al pronóstico vital.

Background: Heart failure (HF) is a condition associated with high morbidity and mortality. Its early diagnosis in primary health care (PHC) represents a substantial challenge, considering its non-specific clinical manifestations and the limitations on timely access to diagnostic techniques. Objective: To evaluate the prevalence of HF, characterize subtypes and determine the prognosis of patients consulting in PHC for dyspnea Edema of the lower extremities. Methods: Prospective study in 340 patients who consulted in PHC, without previous diagnosis of HF. Clinical evaluation, electrocardiogram, NT-proBNP point-ofcare and echocardiography with telematic interpretation by cardiologists were performed. Using the HFA-PEFF and H2FPEF algorithms patients were classified as: 1) HF with reduced ejection fraction (HFREF); 2) HF with preserved ejection fraction (HFPEF) and 3) No HF. Actuarial survival analyses were performed. Results: We observed a prevalence of HFREF of 8%, high probability of HFPEF by HFA-PEFF in 42% and by H2FPEF in 8%. Intermediate probability of HFPEF, requiring complementary study, was observed in 47% of patients with HFA-PEFF and 76% of patients with H2FPEF (p<0.05). Overall survival at 36 months was 90±2% and cardiovascular survival at 36 months was 95±1%. Using HFA-PEFF, patients with HF presented lower overall survival compared to patients with no HF (HR 2.3, 95%CI 1.1-4.9; p=0.029). We did not observe mortality differences with H2FPEF. Conclusions: In patients consulting for dyspnea and/or lower extremity edema at PHC and undergoing evaluation with NT-proBNP and echocardiography, we observed a HF prevalence of 50%. HF classification through HFA-PEFF was associated with lower survival rates.

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Growth hormone (GH) release is a process that is well regulated by several factors, including GH secretagogues. GH can mediate the regulation of the fatty acid level and composition. The aim of this study was to determine the effect of a synthetic GH secretagogue peptide (A233) on the growth and fatty acid composition in tilapia (Oreochromis niloticus). To address this objective, we administrated a diet supplemented with A233 to juvenile tilapia for 60 days. The group fed with a diet supplemented with 600 µg of A233 per kg of feed increased in weight (4.81 ± 0.09 g) and specific growth rate (2.49 ± 0.03%/day) compared to the control diet group (3.63 ± 0.08 g, 2.07 ± 0.04%/day; respectively) (p < 0.001). In the muscle, the total lipids for the control diet group were higher than that in the group fed with 600 µg of A233 per kg feed; however, no differences were detected in the liver. In both tissues, the patterns of fatty acid composition and content were generally similar, with some exceptions. Tilapia fed with 600 µg of A233 per kg of feed showed, in liver and muscle, a significantly higher composition and content of n-3 polyunsaturated fatty acids (such as 20:5n-3, 22:5n-3, 22:6n-3) and n-3/n-6 PUFA than animals fed with the control diet. To our knowledge, this is the first report on the the effects of natural or synthetic GH secretagogues (GHS) on fatty acid composition, implying an increase in the nutritional quality of the tilapia.

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Indirect restorations need to be attached with adhesive luting agents to prevent them from becoming dislodged and provide adequate marginal sealing. The aim of this study was to evaluate bond strength to dentin of self-etching resin cements. MATERIALS AND METHODS: 75 flat dentin surfaces were randomly distributed among 5 groups, according to cements used; Group 1: RelyxU100 (3M/ESPE), Group 2: Bis Cem (Bisco), Group 3: Max Cem (Kerr), Group 4: SeT PP (SDI) and Group 5: Relyx ARC (3M/ESPE), control. Ceramic test cylinders (IPS Empress 2 / Ivoclar-Vivadent) 4.1 mm across were prepared and attached to the dentin surfaces using the different cements. A constant 25N load was applied for 1 minute and they were light-polymerized. Following storage for 24 hours at 100% humidity and 37 °C, the specimens were tested for bond strength under shear strain in an Instron testing machine at a crosshead speed of 1 mm/minute; at 7, 14 and 21 days. Data were analyzed by ANOVA and Tukey's test. There were significant differences between materials (p < 0.0001), but not between times or material/time interaction. RelyXARC (Control Group) had the highest bond strength (15.52 MPa). Among the self-etching cements, the best behavior was found for Relyx U100 (10.80MPa), followed by BisCem (6.36 MPa), MaxCem (5.45 MPa) and SeTPP (3.17 MPa). The bond strength of the self-adhesive cements evaluated was lower than that for resin cements which require previous treatment of the dental substrate (control group). This should be taken into account during clinical selection, in particular for tooth preparations with poor retention.

Las restauraciones indirectas deben ser fijadas por medio de agentes cementantes, para evitar su desprendimiento y mantener un adecuado sellado marginal. El objetivo de este trabajo fue evaluar la resistencia adhesiva a dentina de los cementos resinosos de autograbado. Materiales y métodos: Se utilizaron 75 superficies planas de dentina, distribuidos aleatoriamente en 5 grupos, según los medios cementantes; GRUPO 1: RelyxU100 (3M/ESPE), GRUPO 2: Bis Cem (Bisco), GRUPO 3: Max Cem (Kerr), GRUPO 4: SeT PP (SDI) y GRUPO 5: Relyx ARC (3M/ESPE), control. Se confeccionaros probetas cilindricas de cerámica (IPS Empress 2 / Ivoclar-Vivadent) de 4,1 mm de diámetro, las que fueron fijadas a las superficies de dentina mediante los distintos cementos. Se aplicó una carga constante de 25N durante 1 minuto y se realizó la fotopolimerización. Después de 24 horas de almacenamiento en un medio con 100 % de humedad a 37° C, las probetas fueron sometidas a ensayo de resistencia adhesiva bajo tensiones de corte en máquina Instron, con una velocidad del cabezal de 1 mm/minuto; a los 7, 14 y 21 dias. Los datos fueron analizados mediante ANOVA y test de Tukey, mostrando diferencias significativas entre los materiales (p < 0,0001), no asi respecto al factor tiempo ni a su interacción. El mayor valor de resistencia adhesiva lo presentó RelyX ARC (Grupo control) (15,52MPa), De los cementos autograbantes, el mejor comportamiento se obtuvo en Relyx U100 (10,80MPa), seguido por BisCem (6,36MPa), MaxCem (5,45MPa) y SeTPP (3,17MPa): Los cementos autoadhesivos evaluados presentaron menor resistencia adhesiva que los cementos resinosos que requieren tratamiento previo del sustrato dentario (grupo control). Esto deberia ser considerado cuando se realiza su selección clinica, sobre todo en preparaciones dentarias poco retentivas.

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En el 2002, la Facultad de Enfermería de la Pontificia Universidad Católica del Ecuador introdujo la enseñanza de la práctica basada en evidencia científica en el Proyecto de Reforma Curricular y Diversificación de Carreras y una década después se analiza la eficacia de su implementación. Objetivo: realizar una aproximación exploratoria sobre las creencias, las oportunidades de implementación y el apoyo que la institución y su cultura organizativa dan a la formación de enfermería basada en evidencia (EBE). Materiales y métodos: estudio exploratorio cualitativo y cuantitativo. Universo: 18 profesores y 77 estudiantes. Instrumento: dos encuestas (escala Likert) para profesores y estudiantes. Resultados: las encuestas fueron analizados con la diferente estratificación de datos: docentes, estudiantes, los cinco pasos del método EBE y otros criterios. Se aplicó media ponderada; ANOVA de uno y dos factores, con un nivel de significancia α = 0,05; y la prueba de comparaciones múltiples de Tukey-Kramer. Discusión: es contradictorio el hallazgo relacionado con una alta valoración sobre creencias referidas a la EBE, pero esta valoración no se le otorga a la implementación de cambios en la práctica o enseñanza basados en EBE, al comparar las respuestas de ambos grupos. Conclusión: la percepción de docentes y estudiantes según las dimensiones de creencias e implementación de la EBE resultó muy similar en ambos grupos. La dimensión de la cultura organizacional fue diferente y resultó más severa la percepción de los docentes.

In 2002, the School of Nursing at the Pontificia Universidad Católica in Ecuador introduced the teaching of evidence-based practice as part of the Curriculum Reform and Career Diversification Project. Now, over a decade later, the effectiveness of its implementation is being analyzed. Objective: Explore the beliefs, opportunities for implementation and support provided by the institution and its organizational culture to the teaching of evidence-based nursing practice (EBN). Materials and Methods. This is a qualitative and quantitative exploratory study involving 18 teachers and 77 students. The instruments included two surveys (Likert scale): one for professors and another for students. Results: The results of the surveys were analyzed with different data stratification: professors, students, the five steps in the EBN method and other criteria. A weighted mean was applied, as was a one-way and two-way ANOVA, with a significance level of α = 0.05, and Tukey-Kramer's multiple comparison method. Discussion: A comparison of the responses of both groups showed considerable importance was attributed to beliefs about EBN, but not to implementing changes in EBN practice or teaching, which is contradictory. Conclusion: The perception of teachers and students on the dimensions of EBN beliefs and implementation was quite similar in both groups. The dimension of the organizational culture was different and the professors had a more severe view.

Em 2002, a Faculdade de Enfermagem da Pontifícia Universidade Católica do Equador introduziu o ensino da prática baseada em evidência no Projeto de Reforma Curricular e Diversificação de Cursos e, uma década depois, analisa-se a eficácia de sua implantação. Objetivo: realizar uma aproximação exploratória sobre as crenças, as oportunidades de implantação e o apoio que a instituição e sua cultura organizacional dão à formação de enfermagem baseada evidência (EBE). Materiais e método: estudo exploratório qualitativo e quantitativo. Universo: 18 professores e 77 estudantes. Instrumento: dois questionários (escala Likert) para professores e estudantes. Resultados: os questionários foram analisados com a diferente classificação de dados: docentes, estudantes, os cinco passos do método EBE e outros critérios. Aplicou-se média ponderada ANOVA de um e dois fatores, com um nível de significância α = 0,05; e a prova de comparações múltiplas de Tukey-Kramer. Discussão: é contraditória a constatação relacionada com uma alta valoração sobre crenças referidas à EBE, mas essa valoração não outorga à implementação de mudanças na prática ou ensino baseados na EBE, ao comparar as respostas de ambos os grupos. Conclusão: a percepção de docentes e estudantes, segundo as dimensões de crenças e implantação da EBE, resultou muito similar em ambos os grupos. A dimensão da cultura organizacional foi diferente e a percepção dos docentes resultou mais forte.

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Entre 1995 a 2009 se registraron 206 hospitalizaciones en el Instituto Nacional de Salud del Niño debido a accidentes por mordedura canina. La mediana de edad de los pacientes fue cuatro años y para los días de hospitalización tres. El 61,7 por ciento fueron varones. Los accidentes ocurrieron en el domicilio de una tercera persona (39,3 por ciento), en vía pública (33,5 por ciento) y en el domicilio del agredido (27,2 por ciento). El 66,5 por ciento de los episodios fueron precedidos por un estímulo del niño y el 88,8 por ciento causado por animales reconocidos por los lesionados. El 34,0 por ciento reconoció la raza del animal (52,9 por ciento animales cruzados). El 79,1 por ciento fueron lesiones múltiples y la región anatómica más afectada fueron la cabeza y cuello (79,1 por ciento). Se registraron complicaciones en un 20,4 por ciento y secuelas estéticas en el 94,7 por ciento. Las mordeduras caninas afectan la salud física de los niños.

From 1995 to 2009, 206 cases of dog bites were recorded among hospitalized patients at the Children National Health of, Lima-Peru. The median of age was 4 years, and for hospitalization time was 3 days. Most patients were males (61.7 percent). The bites occurred in the house of a third person (39.3 percent), on the street (33.5 percent), or in the victim’s house (27.2 percent). A 66.5 percent of the bites were provoked and 88.8 percent were from animals known to the victim. The dog breed was recognized in 34 percent (52.9 percent were mongrel dogs). Multiple lesions were identified in 79.1 percent, and the most frequently bitten areas were head and neck (79.1 percent). Complications were reported in 20.4 percent and aesthetic sequelae in 94.7 percent.

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Entre 1995 a 2009 se registraron 206 hospitalizaciones en el Instituto Nacional de Salud del Niño debido a accidentes por mordedura canina. La mediana de edad de los pacientes fue cuatro años y para los días de hospitalización tres. El 61,7 percent fueron varones. Los accidentes ocurrieron en el domicilio de una tercera persona (39,3 percent ), en vía pública (33,5 percent ) y en el domicilio del agredido (27,2 percent ). El 66,5 percent de los episodios fueron precedidos por un estímulo del niño y el 88,8 percent causado por animales reconocidos por los lesionados. El 34,0 percent reconoció la raza del animal (52,9 percent animales cruzados). El 79,1 percent fueron lesiones múltiples y la región anatómica más afectada fueron la cabeza y cuello (79,1 percent ). Se registraron complicaciones en un 20,4 percent y secuelas estéticas en el 94,7 percent . Las mordeduras caninas afectan la salud física de los niños. (AU)

From 1995 to 2009, 206 cases of dog bites were recorded among hospitalized patients at the Children National Health of, Lima-Peru. The median of age was 4 years, and for hospitalization time was 3 days. Most patients were males (61.7 percent). The bites occurred in the house of a third person (39.3 percent), on the street (33.5 percent), or in the victims house (27.2 percent). A 66.5 percent of the bites were provoked and 88.8 percent were from animals known to the victim. The dog breed was recognized in 34 percent (52.9 percent were mongrel dogs). Multiple lesions were identified in 79.1 percent, and the most frequently bitten areas were head and neck (79.1 percent). Complications were reported in 20.4 percent and aesthetic sequelae in 94.7 percent. (AU)

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From 1995 to 2009, 206 cases of dog bites were recorded among hospitalized patients at the Children National Health of, Lima-Peru. The median of age was 4 years, and for hospitalization time was 3 days. Most patients were males (61.7 %). The bites occurred in the house of a third person (39.3 %), on the street (33.5 %), or in the victim's house (27.2 %). A 66.5 % of the bites were provoked and 88.8 % were from animals known to the victim. The dog breed was recognized in 34 % (52.9 % were mongrel dogs). Multiple lesions were identified in 79.1 %, and the most frequently bitten areas were head and neck (79.1 %). Complications were reported in 20.4 % and aesthetic sequelae in 94.7 %.

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[Prólogo. La seguridad de los pacientes es un aspecto crítico de la salud pública porque se relaciona con la respuesta organizada que la sociedad da a la población a través de la atención sanitaria. Los determinantes y condicionantes de la seguridad de los pacientes están vinculados con procesos inherentes a la asistencia, como la organización de los servicios y su capacidad para proveer una óptima calidad de atención, cuidar y proteger a los usuarios, anticipar daños y promover ambientes saludables, incluyentes y libres de amenazas a la integridad de las personas... Este libro es resultado del reconocimiento del papel clave que tiene la enfermería en la reducción de este problema continental. Las características de presencia, permanencia y contingencia de los servicios de enfermería sitúan a las enfermeras en una condición crítica, tanto por el riesgo de error como por su capacidad y potencialidad para proveer a la seguridad de los pacientes, en las prestaciones de salud, para promover medidas de protección para todo el equipo y la institución, y para establecer un proceso de vigilancia continua de la calidad de la atención.

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OBJECTIVES: To investigate the effect of altitude on perioperative opioid requirements in otherwise healthy children. AIM: To investigate whether children living and having surgery at high altitude received different doses of fentanyl than those living and having surgery at sea level. BACKGROUND: Recent studies in animals (Anesthesiology, 105, 2006 and 715) and children with obstructive sleep apnea (Anesthesiology, 105, 2006 and 665; Anesthesiology 100, 2004 and 806) suggest that analgesic effects of exogenous opioids are enhanced by hypoxia. However, the effects of hypoxia on perioperative narcotic requirements in otherwise healthy children have not been previously reported. METHODS/MATERIALS: We reviewed retrospectively the opioid requirements of pediatric patients who underwent cleft lip or palate surgery during Smile Network International mission trips to Cusco and Lima, Peru between 2007 and 2009. Patients who had surgery at high altitude were compared to those who had surgery at sea level. All patients received a standardized anesthetic with intravenous fentanyl as the only perioperative opioid. RESULTS: Hundred and two patients had surgery at 3399 m above sea level (masl) (Cusco) and 169 patients had surgery at 150 masl (Lima). Patients at high altitude had significantly lower baseline oxygen saturations (92 ± 4% vs 98 ± 3%; P < 0.001) and received 40% less opioid (1.2 ± 0.8 vs 2.0 ± 1.4 µg·kg(-1) per h; P < 0.001) compared to patients at sea level. CONCLUSIONS: Opioid administration was reduced in otherwise healthy children with altitude-induced chronic hypoxia when compared to non-hypoxic children undergoing similar operations under similar anesthetic regimens. Whether this difference is due to altitude or altitude-induced hypoxia, requires further study.

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Uveítis es un término general que hace referencia a la inflamación del tracto uveal. En el 70 por ciento de los casos es posible establecer una relación causal entre diferentes tipos de uveítis y enfermedades locales y/o sistémicas. El 30 por ciento restante de los casos no es posible asociarlos con enfermedades primarias oculares o sistémicas. Se presenta el caso clínico de un paciente masculino de 52 años de edad, quien consultó por disminución progresiva de la agudeza visual en ambos ojos, de 3 meses de evolución. En la evaluación oftalmológica se planteó el diagnóstico de panuveítis bilateral en estudio. Se realizaron pruebas serológicas (VDRL, FTA-abs y virus de inmunodeficiencia humana), que resultaron negativas. Luego de 21 días de tratamiento, y en vista de la disociación entre la clínica y el laboratorio, se hospitalizó al paciente y se realizó nuevo VDRL sérico y en líquido cefalorraquídeo ambos reactivos, y el Western Blot para virus de inmunodeficiencia humana positivo, se diagnosticó panuveítis sifilítica bilateral, neurosífilis y síndrome de inmunodeficiencia adquirida. Se administró penicilina cristalina (24 000 000 UI/día) durante 21 días, evolucionando satisfactoriamente, con recuperación visual total.

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