bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Affected Unprotected Anal Intercourse among Men Who Have Sex with Men in Solok Indonesia
Authors: Faiz Nur Hanum  , Rosfita Rasyid  , Nur Afrainin Syah  , Tika Afriani
Published: March 2021

Unprotected Anal Intercourse (UAI) was the primary factor in transmission HIV among MSM. The aimof this study was to examine factors that affected UAI among MSM in Solok, Indonesia. This study usinga design mix method approach, a study combination between quantitative among 70 MSM and qualitativeamong 19 informants. The result of this study shows that 77.1% reported engagement in UAI during sex inthe previous six months. Multivariate analysis shows that UAI was associated with partner status (p=0.017,OR: 3.958; 95% CI:1.230 to 12.736), and knowledge about HIV/AIDS (p= 0.01, OR: 9.8; 95% CI: 2.555 to37.587). The qualitative study shows that preference and lack of MSM identification were the other factorsthat affected UAI among MSM.
Effect of Modified Ankle Foot Orthoses (AFO) along with Goal-Oriented Physiotherapy in a Child with Spastic Diplegic Cerebral Palsy–An Interesting Case Report
Authors: Kovela Rakesh Krishna  , Pamidigantam Raghava Priya  , Archana Rupanagudi  , Shilpa Sankeesa
Published: March 2021

Cerebral Palsy (CP) is considered as a neurological condition caused by a non-progressive damage ormalformation of the brain that occurs during the developmental process. Body movement and musclesynchronization are mainly impaired in children with Cerebral Palsy. Each cerebral palsy case is uniqueto the person. One person may have complete paralysis and need continuous treatment, while another mayhave mild movement tremors with partial paralysis but require little assistance. The form and the timing ofthe injury to the developing brain are the main reasons for such impairments. Orthoses are primarily used totreat the secondary musculoskeletal problems of muscle contracture and bony deformity. In the Present Casereport a modified Ankle Foot Orthoses (AFO) is used bilaterally by using an extra malleolar orthosis, medialblock to prevent forefoot adduction and an extra strap to prevent navicular drop for a 7-year-old SpasticDiplegic girl child who was in Gross Motor Functional Classification System (GMFCS) grade III. After a3-month goal-oriented physiotherapy treatment program primarily focusing on gait, we observed decreasedNavicular drop, increased ankle stability (Twisting was not seen), improvement in Gait Parameters such asIncreased stride length, Cadence and improved gait velocity.
Prediction Analysis of Cancer Cells Using ML Classification Algorithms
Authors: M. Parvathi  , Ch. Manaswini
Published: March 2021

Background: Breast Cancer is one of the most occurring cancers among all the diseases in medical science.About 1 in 8 women are suffering from breast cancer in their lifetime. In 2020, an estimated 276,480 newcases of invasive breast cancer are expected to be diagnosed in women along with 48,530 new cases ofnon-invasive breast cancer. Apart from women, men are also suffering from breast cancer, but the rate ofoccurrence is low in men.Aim: To classify the breast cancer cells from original mammographic images using processing steps ofGaussian smoothing, Threshold segmentation, Feature Extraction.Methodology: Breast cancer datasets are collected and preprocessed using attributes-like Menopause,Node-Capes, INV Nodes, Irradiate and Class. Three Machine Learning classifiers such as Bagging, NaiveBayes, and Naive Bayes Multinomial are applied for the classification analysis.Results: Bagging classifier gives efficiency in the range of 77-86% when we consider Menopause, NodeCapes and Irradiate attributes and Naive Bayes classifier gives efficiency in the range of 71-78% for INVNodes and Class attributes.Conclusion: It is observed that the bagging classifier gives best efficiency when we consider Menopause,Node-Capes and Irradiate attributes and Naive Bayes is best suits for INV-Nodes and Class attributes.
Feeding Pattern Followed by Hospitals for Patients with Dengue Fever: An Observational Study
Authors: Poornima S.  , Anees Fathima Thabassum Z  , Khyrunnisa Begum
Published: March 2021

Background: Dengue is an acute viral infection and occurs in three different conditions- Dengue fever (DF),dengue hemorrhagic fever (DHF) and dengue shock syndrome. Supportive and symptomatic treatment isindicated during infection, however less is known about feeding care obligatory in its management.Objective: it was aimed to study feeding care offered to DF patients admitted to hospitals.Materials and Method: An observational study was conducted on 48 patients (16 children and 32 adults)diagnosed for dengue fever and admitted to hospital (3 -government and 2-private hospitals were included)during the months of January to May. Details regarding medical symptoms, body temperature, state ofconsciousness, food tolerance and food intake from day 1 to day 5 was obtained. Oral intake of water andIV infused were recorded.Results: Relationship existed between symptoms, state of consciousness and tolerance to food and water;accordingly patients were classified as seriously sick, moderately sick and mildly sick. Patients with bodytemperature ?102°F, abdomen pain, hepatomegaly and dehydration was associated with food intolerance andnon-responsiveness (seriously sick), they took significantly longer time to develop food tolerance comparedto their counterpart with less serious conditions (p ? 0.0001). Severity of sickness affected hospital stay,severely sick patients stayed longer as compared to the mildly sick (children 4.67±0.94 vs 4±0; adults6.43±3.16 vs 3.67± 1.11 days).Majority of adults (71.9%) and children (56.3%) received normal diet. Energy and protein intake of patients(adults and children) in all the three groups were markedly lower than the RDA. Energy intake increasedsignificantly from 1st to 5th day in all three groups. Differences in energy intake (adults-5.0±2.6 Kcals to18.0±6.5 and children 10.0±3.8 - 29.0±6.8 Kcal/kg/day) was extremely significant (p? 0.001) among severelysick compared to the moderately (adults 11.0±1.6- 17.0±4.9 and children 20.0±2.9- 23.0±6.9 Kcal/kg/day)and mildly sick patients (adults 17.0±2.1- 21.0±3.8 and children 38.0±7.8- 39.0±5.7 Kcal/kg/day). Proteinintake among both adults and children was very low. All patients regardless of the conditions received IVfluids at time of hospital admission. Severely sick received higher volumes of IV infusions and less quantityof oral fluids compared to the moderate and mildly sick. With improvement in conditions, it crisscrossedwith reduced IV infusions and increased oral intakes. Each patient had different fluid needs and varied eachday.Conclusion: Presently, diet management ofDF patient is less judicious. In view of poortolerance and unconsciousness that prevail,food selection should be carefully managed.Easily digestible and nutritious drinks suchas fruits juices and soups should be included to complement for improving electrolytedisturbance and dehydration. Data base shouldbe developed about feeding requirements forDF patients.
Demographic Trends of Acute Poisoning in a Rural Teaching Hospital of Telangana
Authors: Ranga Rao Beemathati  , Shyam Siddharth Rao Patharla  , Souri Reddy Pyreddy  , Shilpa Narsimhulu Panthagan
Published: March 2021

Background: It is estimated that poisoning accounts for over 1 million morbidities worldwide annually.Poisoning is a significant problem in rural India. The objective of this study was to understandthe patternand demographic profile of poisoning in a tertiary care teaching hospital.Method: A retrospective cross-sectional record based study was carried out at Kamineni Institute of MedicalSciences, Nalgonda,Indiain the year 2019. Demographic details such as age, sex, type of poison consumed,route of exposure, factors affecting morbidity (need for ventilator support) and outcome of the patient werecollected and documented in a structured format.Results: A total of 255 acute poisoning cases were admitted during the year 2019. The ratio of males(56.47%) and females(43.53%) was nearly 1:1. Poisoning was seen highest in the age group of 14-30years (36%) followed by the 31-50 years age group (23.92%). The most common route of exposure wasby ingestion. Overall, the mortality rate was 11.76%. The common poisonous agents consumed wereinsecticides(26.66%) followed by pharmaceutical products(15.68%).Conclusion: Insecticides were the most common agent for poisoning in our setting. It was found thatthe younger age group of 14-30 years is most vulnerable to acute poisoning and consequent mortality.Efforts should be made to create awareness and to educate the population regarding the importance of earlyadmission and its effect on reduction in mortality. Poison-associated morbidity and mortality rates vary byregion and may change over a certain period of time as new drugs and chemicals are introduced. Furtherstudies to understand the reasons for coming into contact with poisons could possibly contribute to theprevention and early treatment of poisoning
Monitoring of Water Quality the Need of Present Day House Hold Water Management
Authors: Sindhu Kizhakkeppattu  , D. Karaline Karunagari
Published: March 2021

WHO 2019 report on drinking water says that In 2017, 71% of the global population (5.3 billion people)used a safely managed drinking-water service – that is, one located on premises, available when needed, andfree from contamination.. Most countries, the proportions of piped and other-improved water supplies arefaecally contaminated sources due to lack of basic sanitary protection against contamination. Contaminatedwater is an important contributor to water borne disease including hepatitis A,cholera, typhoid, andpoliomyelitis.1 For people with enough water supply can treat their water at home after testing water qualityto ensure microbiological quality. Treating water at the household level or other point of use also reduces therisk of waterborne disease arising from recontamination during collection, transport, and use in the home.This article mainly focuses on need for water quality monitoring,water quality, types of water quality testingthe importance of water quality monitoring and reviews related to water quality testing.
Introducción
Authors: Sánchez-Mesa Martínez Domingo , Alberich-Pascual Jordi
Published: March 2021

Introducción al dossier monográfico.
Rompiendo el sistema de autoría. Prácticas cinematográficas colaborativas y narrativas transmediales en la era digital
Authors: Balaguer Pérez Juanjo , Alberich-Pascual Jordi
Published: March 2021

El presente artículo analiza diferentes propuestas de creación cinematográfica colaborativa que rechazan la autoría única. En primer lugar, se muestra el alcance y la significación de dos agrupaciones de cineastas en ámbito español, el Colectivo Cine de Clase y el Colectivo Cine Sin Autor. Perteneciendo a distintas épocas, ambos colectivos encuentran un vínculo en su creación colaborativa, que además implica una ruptura en relación a la mitologización de la autoría única. El artículo aborda esta eliminación común de una narrativa individual en los equipos de creación audiovisual, para después centrarse tanto en su fundamentación social como en su intento de establecer nuevos modos de representación. Posteriormente, se examinan otras tipologías de audiovisual participativo, características de la era digital, que también asumen una autoría colectiva. Incorporan con frecuencia formatos, procesos y enfoques recientes de creación, entre los que destacamos las narrativas transmediales, que en ocasiones originan nuevas perspectivas sobre la autoría. Tras ofrecer una discusión sobre las aportaciones y las limitaciones que encuentra el modelo de creación colaborativa al que pertenecen los casos seleccionados, indicamos algunas contribuciones que estos enfoques de creación, especialmente las narrativas transmediales, pueden ofrecer al audiovisual colaborativo contemporáneo y a la autoría colectiva.
“Un gran monstruo prehistórico en el centro del cuerpo”. La representación del envejecimiento en “La respiración cavernaria” de Samanta Schweblin
Authors: Salamanca Vázquez Mariana
Published: March 2021

El presente trabajo examina el cuento “La respiración cavernaria” de Samanta Schweblin a la luz de los estudios literarios sobre la vejez. Se sostiene que la representación del envejecimiento a través de la experiencia de Lola, la protagonista, erosiona los códigos hegemónicos de la construcción social de la ancianidad. Se propone el relato de Schweblin como una obra que teoriza sobre el proceso del envejecimiento, con base en la propuesta de Amelia DeFalco en su libro Uncanny Subjects: Aging in Contemporary Narrative. A través de la disposición del espacio doméstico y la carga significativa de sus objetos, el cuento captura la pérdida de memoria de su protagonista. Esto se refleja en la narración deficiente que imita el pensamiento de Lola, así como en algunas herramientas narrativas afines a la literatura fantástica. La vejez conlleva un costo afectivo, por lo cual se hace referencia a las ideas de Sara Ahmed en La política cultural de las emociones para desmontar el vínculo entre el envejecimiento y la vergüenza. Lola pierde paulatinamente la habilidad de narrar y se aferra a vínculos afectivos que le permiten tener continuidad identitaria. Así, el cuento explora la relación inestable entre la construcción de la identidad y la capacidad narrativa.
Ways of Creating a Comic Effect in Stand-Up Shows and Challenges of Their Translation from Spanish into Russian
Authors: Зайцева Е.С.
Published: March 2021

В статье рассматривается жанр стендап-комедии как пространство коммуникации, позволяющее изучать лингвокультурологические особенности конкретного языка.Приводится краткая история возникновения данного жанра, описываются его основные характеристики, анализируются приемы создания комического эффекта, а также особенности их перевода. Стендап-выступления представляют собой аудиовизуальные тексты, формирование значения которых происходит благодаря взаимодействию различных кодов. При переводе аудиовизуальных текстов с комическим эффектом акт коммуникации рассматривается как возможность образования пересекающихся множеств сообщений и текстов. Экстралингвистическая составляющая аудиовизуального сообщения оказывает значительное влияние на формирование смысла адресантом сообщения и его адекватное восприятие адресатом. На конкретных примерах выступлений испанских стендап-комиков рассматриваются приемы создания комического эффекта, отмечаются специфические национальные черты испанского юмора.

The article deals with stand-up comedy seen as a communication field that permits us to study linguistic and cultural peculiarities of a foreign language. The paper gives the main characteristics of stand-up comedy and a brief overview of its history. Ways of creating a comic effect in stand-up comedy and means of comic utterances translation are analyzed taking into account the non-verbal component. Stand-up performances are viewed as audiovisual texts whose meaning is formed thanks to interaction of different codes. The communication act may involve intersecting messages and allusions, which should be considered in translation. The extralinguistic part of an audiovisual message has a bearing on the illocutionary effect produced by the addresser and its correct perception by the addressee. The paper offers examples drawn from Spanish stand-up monologues, which illustrate different ways of creating a comic effect and show specific national traits of Spanish humor.
On some singular mean-field games
Authors: Cirant Marco , Gomes Diogo A. , Pimentel Edgard A. , Sánchez-Morgado Héctor
Published: March 2021

Here, we prove the existence of smooth solutions for mean-field games with a singular mean-field coupling; that is, a coupling in the Hamilton-Jacobi equation of the form \begin{document}$ g(m) = -m^{- \alpha} $\end{document} with \begin{document}$ \alpha>0 $\end{document}. We consider stationary and time-dependent settings. The function \begin{document}$ g $\end{document} is monotone, but it is not bounded from below. With the exception of the logarithmic coupling, this is the first time that MFGs whose coupling is not bounded from below is examined in the literature. This coupling arises in models where agents have a strong preference for low-density regions. Paradoxically, this causes the agents move towards low-density regions and, thus, prevents the creation of those regions. To prove the existence of solutions, we consider an approximate problem for which the existence of smooth solutions is known. Then, we prove new a priori bounds for the solutions that show that \begin{document}$ \frac 1 m $\end{document} is bounded. Finally, using a limiting argument, we obtain the existence of solutions. The proof in the stationary case relies on a blow-up argument and in the time-dependent case on new bounds for \begin{document}$ m^{-1} $\end{document}.
Usage of Maize Storage Technologies for Postharvest Loss Prevention in OkeOgun/Saki Area of Oyo State, Nigeria
Authors: Benson Olusola B. , Afolabi Adewale A. , Ajayi Ajibade O. , Taiwo Temitope S. , Omotuyi Oluwabunmi M. , Okonkwo Egobude U.
Published: March 2021

This study assessed the usage of traditional and improved maize storage technologies by farmers in Saki/Oke-Ogun area of Oyo State. The study was conducted from April-July, 2019; using a validated structured questionnaire for data collection. A multi-stage sampling technique was adopted to draw a sample of 191 maize farmers. Grain storage technologies usage frequency was measured on afour-point Likert-type numerical scale 4-1 as regularly, occasionally, seldom, and never respectively. Descriptive analysis of collected data revealed regular usage of both raffia woven basket (98.9%) and traditional crib (96.1%) by respondents. Sampled maize farmers overwhelmingly indicated non-usage of rhombus (98.0%) to store their produce; with a substantial number (88.2%) rarely using containers. Further analysis shows maize farmers used improved crib regularly (76.5%). Inert atmosphere silo (80.4%), conventional silo (76.5%), purdue improved crop storage (90.2%) and zerofly™ (65.4%) bags were never used to store maize by farmers. Chisquare )  analysis revealed significant (p≤0.05) associations between technology  30 usage and socioeconomic characteristics of maize farmers. The cost and bulk storage nature of improved storage technology could be traced to its never used; while awareness is also very low on the use of those cost effective bagged technologies.

Keywords: Storage usage, traditional grain technology.
Page Kidney: A Secondary Cause of Hypertension
Authors: Agnew Matthew , Renno Anas , Mahmood Asif
Published: March 2021

Page kidney is a rare cause of secondary hypertension in adults that occurs due to extrinsic compression of the kidney due to a subcapsular collection, such as a hematoma or urinoma. Usually these subcapsular formations are a result of trauma to the kidney such as from a biopsy or motor vehicle accident. Here we present a case of a 61-year old African American male who presented to the hospital with worsening shortness of breath for 2 days, a blood pressure of 203/156, and a BNP of 206. He was admitted and treatment was begun for diastolic congestive heart failure and hypertensive emergency. Clinically, he was improving but his systolic blood pressure continued to be in the 150’s despite multiple blood pressure medications. Due to this difficulty in controlling blood pressure and a negative renal ultrasound, an abdominal CT scan with contrast was ordered and revealed a subcapsular fluid collection indenting the lateral margin of the left kidney measuring approximately 7.1 x 5.4 x 2.3 cm that was suggestive of a Page kidney per radiology. Upon further history taking it was found that the patient has had received extracorporeal shock wave lithotripsy for nephrolithiasis in past several months which is a known risk factor for subcapsular hematoma formation. Ultimately it was determined that this subcapsular hematoma was resolving on its own and no intervention was needed other than follow-up as an outpatient. We feel this case is noteworthy for not only being a presentation of a Page kidney, but also demonstrates the importance of considering a secondary cause to hypertension in patients with difficult to control hypertension.
Enterprise Risk Management Maturity Levels of the Insurance Industry in Botswana
Authors: Ngwenya Moreblessing , Ngwenya Sam
Published: March 2021

Enterprise Risk Management (ERM) has become a necessity in the financial sector to fulfil stakeholder expectations. Studies confirm that ERM impacts positively on the performance of firms. The main objective of the study was to assess ERM maturity levels of the insurance industry in Botswana. This was achieved through first designing a framework to measure enterprise risk management maturity levels. The ERMMF incorporated elements from COSO’s ERM framework and the AON risk maturity model obtained through literature review. Data were sourced from four strata; 9 long term insurance companies (15 respondents), 11 short-term insurance companies (19 respondents), 3 reinsurers (5 respondents), and 44 brokerages (75 respondents). While all organisations in the population were used, a sample of 114 out of possible 134 respondents was used. Data were analysed using SPSS version 16. The findings revealed that the insurance industry in Botswana had somewhat implemented ERM. It is therefore recommended that the insurance industry in Botswana should take ERM as a continuous process for growth in ERM maturity levels as such an improvement is highly likely to enhance their performance.
Discipleship in Three Dimensions: Implications for Home, School and Church as Learning Institutions
Authors: Vitus Ndaruhekeye Isacka
Published: March 2021

This article intended to explore the three mentoring aspects as discipleship dimensions within the three Training avenues, attempting to show the significance of each one. ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬Literary method was engaged in this study whereas bibliographical data were collected to placate the concern. The article was divided into two major parts. The first part disclosed the prominence of the three mentoring dimensions; rational, relational and missional which began with evaluation aspect. In this study, the three dimensions work as catalysts for the growth of any Christ’s follower. The second part discussed the prominent training avenues for the faithful and trustworthy disciples. This part displayed the family, the church and the school as the precious avenues for mentoring and discipleship. It is anticipated that this paper will contribute to the knowledge and skills on how to enhance students’ commitment to faith in Christian learning institutions. As far as discipleship is concerned, the study is in harmony with the following statement, “prevention is better than cure.” For the bright future of the Christian church, students need to be guarded morally before it is too late.
Emotion reactivity a key factor in post-traumatic stress disorder symptoms severity among amputees
Authors: Ifzonia Babar  , Saadia Dildar  , Haziq Mehmood
Published: March 2021

Published in May - 2021
Knowledge and Consumption Practices on Probiotics in Selected Low to Middle-Income Class Filipino Mothers in an Urban City
Authors: Bayaga Cecile Leah T. , Pico Marietoni B. , Belano Jethro Ian G. , Bongga Demetria C. , Gabriel Alonzo A.
Published: March 2021

Objective. Mothers are exposed to various functional food components, including probiotics, which have a direct effect on the quality of their breast milk. Probiotics enhance the microbial composition of breast milk, making it more beneficial for the infant’s gut health. This study aimed to explore the extent of knowledge and dietary practices on probiotics among low- to middle-income healthy Filipino mothers in an urban area.Methods. Data was gathered using three focus group discussions (FGD) participated in by low- to middle-income healthy Filipino mothers residing in Barangays West Rembo and Rizal in Makati City, Philippines. Prior to the FGD, preliminary interviews of selected participants and market surveys were done to determine the food items to be included in the FGD questionnaire.Results. A total of 19 mothers participated in the FGDs. The most common probiotic sources identified were yogurt, fermented milk product (Yakult), miso and tausi. The most consumed probiotic source was fermented milk product (94.7% of participants), at least once a month; followed by powdered milk (78.9%), consumed daily. The most commonly reported influence for consumption of these food items was advertisements from television (89.5%). About 53% of the participants related probiotics to better digestion and increased immunity as heard from advertisements and through counselling by physicians. When asked to elaborate on how probiotics influence digestion and immunity, almost all participants had difficulty explaining the benefits.Conclusion. Although majority of the participants consumed food sources of probiotics, they had limited knowledge on its other non-food sources and benefits. In addition, the consumed food source was confined to the food item that was most advertised on television. Thus, there is a need for health and nutrition experts to exert a stronger influence in the community by disseminating information regarding probiotics.
URDU: جیل اور دارالامان میں شیر خوار بچے کے قیام کا مسئلہ: اسلامی تعلیمات کی روشنی میں تحقیقی جائزہ
Authors: Jamaal Fanoos , Qarshi Dr. Hussain Muhammad
Published: March 2021

Women constitute over half of the world’s population, but they are deprived of their due rights. Illiteracy, poverty, domestic violence, poor health facility and the denial of their basic rights are the major problems facing by women in our society. When a woman left her home and seeks shelter at “Darul Aman” then she faces different kinds of problems e.g she deprives from every social and economic activity, education and freedom like other women at homes etc. Among these problems, one is the living of infants in prison and Darul Aman with her mother.  Actually, suckling is the foremost obligation of the mother and if she does not feed her child without a valid reason, she will be sinner and she cannot present any demand of payment for suckling from her husband because it is her own duty. This research article consists of three parts: Basic factors responding for women to take shelter in Darul Aman. Problems concerning to the living of infants in prison and Darul Aman. Suggestions for the betterment of women’s living in prison and Darul Aman.
Costo de la atención médica y su relación con los resultados y los valores para el paciente
Authors: Arrea Baixench Carlos
Published: March 2021

"El costo de la atención médica a nivel mundial muestra un crecimiento tan pronunciado que, si no se encuentra un sistema para disminuirlo, se arribará a una realidad tan grave que ningún país en el mundo tendrá la capacidad financiera para sufragarlo, y muchas familias se arruinarán al tratar de pagar los gastos que una enfermedad les ha ocasionado, o morirán sin tratamiento. Este fenómeno obedece al crecimiento en el número de las personas de mayor edad con padecimientos crónicos, cuyos tratamientos son muy caros; al desarrollo de nuevos medicamentos y tecnologías; a una administración que no conoce el costo de cada paciente ni ha analizado los pasos del tratamiento que producen valor para el paciente, y los que no lo aportan, pero sí aumentan su costo..."
Nefrectomía laparoscópica: impacto de su implementación
Authors: López Arias Roy , González Salas Mario
Published: March 2021

"En este documento se describe la experiencia de establecer el programa denefrectomía laparoscópica en el servicio de urología del Hospital “Dr. Rafael A. Calderón Guardia” de Costa Rica, que atiende una población aproximada de 1 236 997 pacientes y cuenta con 14camas para varones y 4 camas para mujeres, destinadas a urología."
Tumores de células germinales del mediastino. Experiencia con 29 pacientes
Authors: Mainieri Hidalgo José A. , Rees Alpízar Valeria , Gamboa González Isabel , Mainieri Breedy Marcelo
Published: March 2021

"Previa autorización del Comité de Ética del Hospital, se realizó un análisis descriptivo de la información acumulada en la base de datos del Servicio de Cirugía de Tórax y los expedientes clínicos de 29 pacientes con tumores de células germinales del mediastino, operados entre 1986 y 2012."
Foro sobre salud mental 2011, conclusiones y pasos futuros
Authors: Contreras Rojas Javier , Raventós Henriette
Published: March 2021

"La salud es un proceso social que tiene como fin el bienestar físico y mental del individuo a través de todas las etapas de su vida. A pesar de numerosos esfuerzos, en Costa Rica, el abordaje en salud mental se ha basado principalmente en la atención de la enfermedad y muy poco en la prevención. Se resumen las conclusiones sobre el Foro de Salud Mental."
La problemática de la Caja Costarricense del Seguro Social desde la óptica de los determinantes de la salud
Authors: Ávila Agüero María L.
Published: March 2021

"La problemática que rodea a la Caja Costarricense de Seguro Social (CCSS), va más allá de dificultades financieras: abarca un grave problema de gestión y entrabamiento burocrático que ha hecho de la institución, una estructura sumamente rígida, incapaz de satisfacer las necesidades y las demandas de la población con la agilidad requerida."
Dr. José Manuel Quirce Morales
Authors: Cabezas Solera Edgar
Published: March 2021

"Llegar a describir a una persona y su obra puede ser fácil y también difícil. Yo creo que con el Dr. Quirce suceden ambas cosas. Fácil, porque hay mucho para escoger: la persona, el profesional, su obra. Difícil, porque también hay mucho que resumir, y se puede incurrir en injusticia al no ser explícito."
Descripción epidemiológica y tratamiento de los pacientes con Enfermedad de Crohn
Authors: Castro Kryssia Isabel Rodríguez , Ramírez Carolina Gutiérrez , Alvarado Gerardo Avendaño
Published: March 2021

"Antecedentes: la enfermedad de Crohn es un proceso inflamatorio crónico granulomatoso que puede afectar todo el tracto digestivo. Se diagnostica cada vez más frecuentemente en nuestro medio, y es causa importante de morbimortalidad en los pacientes afectados. El presente estudio tiene como objetivo conocer la prevalencia de esta enfermedad, sus manifestaciones clínicas más frecuentes, los diversos tratamientos utilizados y la respuesta a estos."
Neumonía por Stenotrophonomas
Authors: Franco Verny Huertas , Pallais María Isabel Lacayo
Published: March 2021

La Stenotrophomonas maltophilia es un bacilo gram negativo ambiental emergente que ha venido posicionándose entre el grupo de microorganismos multirresistentes como causa de infección en diversos órganos en ambiente hospitalario y en la comunidad. Se reporta este caso de insuficiencia respiratoria con neumonía severa por S. maltophilia adquirida en la comunidad en una paciente inmunocompetente que tuvo una rápida respuesta a tratamiento con trimetoprim sulfametoxazol cuando se logró identificar la bacteria.
Enfermedad de la orina de jarabe de arce: repaso de transporte de aminoácidos en membranas de tejidos no cerebrales
Authors: Montealegre Carlos de Céspedes
Published: March 2021

Con este ensayo se procura compaginar trabajo experimentaly clínico en relación con las alteraciones metabólicas –específicamente el transporte de aminoácidos en membranasde tejidos no cerebrales- como base para mejor orientar eltratamiento de la enfermedad de la orina del jarabe de arce(MSUD por sus siglas en inglés). La MSUD resulta de un bloqueoen la degradación de los aminoácidos ramificados, leucina,isoleucina y valina, lo que lleva a su excesiva acumulación,sobre todo del primero.
Distrofia muscular de Duchenne y defecto de oxidación de ácidos grasos en un paciente pediátrico
Authors: Gualandri Alejandra Acosta , Hernández Mildred Jiménez
Published: March 2021

Paciente pediátrico, con el diagnóstico de distrofia muscular de Duchenne y deficiencia de acil-CoA deshidrogenasa de cadenas medias, ambas patologías confirmadas por medio de análisis molecular, al detectarse la deleción de los exones 45 al 50 en el gen DMD, y la mutación A985G en estado homocigoto del gen ACADM.
Detección del receptor tipo 2 del factor de crecimiento epidérmico humano (her2/neu)
Authors: Alpízar José Luis Quirós , Jiménez Isabel Arce , Acosta Gabriel Torrealba , Montero Ernesto Jiménez , Cordero Raquel Barrientos
Published: March 2021

La incidencia y mortalidad por cáncer de mama han presentado un aumento neto. Uno de los tipos de esta heterogénea enfermedad se caracteriza por la amplificación y alta expresión del gen ERBB2, que codifica el receptor tipo 2 del factor de crecimiento epidérmico humano (HER- 2). Este receptor estimula procesos oncogénicos y dichos tumores se asocian a un peor pronóstico. El objetivo del estudio fue analizar las características de tumores HER-2+ en un grupo de pacientes con carcinoma de mama.
Instrucciones para Autores
Authors: Costarricense Acta Médica
Published: March 2021

Acta Médica Costarricense
Características clínicas de los casos de demencia diagnosticados en la Clínica de Memoria del Hospital Nacional de Geriatría y Gerontología
Authors: Valverde Erick Miranda , Aguilar Daniel Valerio , Garabain Henri Jacques Hernández , Araya Cinthya Chaves , Azofeifa Monserrat Peralta , Campos Luis Emilio Corrales , Moncada Johan Córdoba , Alfaro Ana Maricela Carballo , Martínez Fernando Morales , Salazar Alejandra Arias
Published: March 2021

Antecedentes: la demencia es una entidad clínica cada vez más prevalente en nuestro medio, cuya incidencia aumenta con la edad. El objetivo del presente estudio es identificar los principales tipos de demencia atendidos en una unidad de trastornos de memoria.
Tumores del timo. Estudio retrospectivo de 38 casos operados en el hospital “Dr. Rafael Ángel Calderón Guardia” entre 1996 y 2013
Authors: Hidalgo José A. Mainieri , Breedy Marcelo Mainieri
Published: March 2021

Resultados se intervino a 38 pacientes por tumores del timo en los 17 años evaluados, 20 hombres y 18 mujeres con promedio edad de 50 años. En 26 casos se realizó resección, la cual en 19 fue macroscópicamente completa. Se reportó 20 tumores malignos y 18 benignos. De los 20 casos con tumores malignos, a 9 pacientes se les realizó resección, en 6 la resección fue completa y en 3 incompleta, y a 11 solamente biopsia. 16 de los 20 casos con tumores malignos recibieron quimioterapia. De los casos con tumores malignos 15 tenían más de 5 años de establecido el diagnóstico, y de estos 7 se encontraban vivos, lo que corresponde a una sobrevida a 5 años de un 47%. Los timomas representaron un 17% de todos los tumores del mediastino. Los síntomas manifestados por los pacientes se debieron a la compresión causada por el tumor.
Salud mental y derechos humanos: El caso de los seguros médicos privados
Authors: González Ricardo Millán , Espinoza Olger Ignacio González
Published: March 2021

La salud es un derecho fundamental reconocido por la Constitución Política de Costa Rica y diversos tratados internacionales, de los cuales el Estado es parte. A pesar de lo anterior, muchos contratos de seguro médico privado excluyen (o restringen severamente) diversas condiciones médicas, entre las que se encuentran las clasificadas como psiquiátricas. Este tipo de prácticas resulta no solo estigmatizante, sino que también revela una falta de garantía de la protección integral de la salud general de las personas aseguradas. Resulta indispensable, por lo tanto, que las aseguradoras modifiquen su postura de continuar excluyendo servicios básicos, mientras que el Estado, por su parte, debe ejercer su obligación de velar por la efectiva garantía de los derechos humanos, en particular mediante una adecuada supervisión del derecho a la salud.
Plasmaseparacion en el manejo de la tormenta tiroidea
Authors: Rodríguez Hernán Bolaños , Vega Ademir Alvarado , Segura Donato Salas
Published: March 2021

Considerada como la forma de presentación más severa del hipertiroidismo, la tormenta tiroidea es una condición clínica en la cual el estado severo de tirotoxicosis puede tener repercusiones hemodinámicas importantes que pueden poner en peligro la vida de los pacientes. Se reporta un caso clínico de un paciente masculino de 41 años conocido portador de enfermedad de Graves con tratamiento irregular el cual ingresa al servicio de emergencias con un cuadro de dolor torácico atípico, evidenciándose una arritmia cardiaca por fibrilación atrial y al examen físico con exoftalmos bilateral, franca atrofia muscular y presencia de bocio grado II. El cuadro clínico evoluciona de forma tórpida a una insuficiencia cardiaca congestiva y posteriormente a uso de vasopresores e intubación endotraqueal. Dada la necesidad de disminuir rápidamente la fracción libre de la hormona tiroidea, asociando mediacamentos antitiroideos se decide iniciar terapia con plasmaseparación.
Análisis de las bacteremias por Klebsiella pneumoniae en pacientes del Hospital México
Authors: Alfaro Christian Ramírez , Vindas Juan Villalobos
Published: March 2021

En los últimos años a nivel mundial ha habido un incremento de bacteremias por Klebsiella pneumoniae  productora de BLEA, que han contribuido como un factor importante de resistencia a los antibióticos β -lactámicos, y de morbilidad y mortalidad intrahospitalaria.
Más sobre el trabajo en equipo
Authors: Baixench Carlos Arrea
Published: March 2021

Los avances tecnológicos y científicos han aumentado tanto los conocimientos en las ciencias de la salud, que no es posible que una sola persona logre dominarlos todos con propiedad. Esto ha obligado a dividirlos y a que algunos profesionales se dediquen a áreas específicas, dando origen a profesiones como: Farmacia, Enfermería, Microbiología y muchas, otras dentro de las que debemos incluir las tecnologías médicas y las relacionadas con la Informática.
Piomiositis y espondilodiscitis hematógena en un paciente inmunocompetente
Authors: Prado Leonardo Chacón , Sibaja Jorge Cervantes , Cuadra Juan Ignacio Padilla
Published: March 2021

La piomiositis es una infección bacteriana primaria de músculo esquelético. Anteriormente era una enfermedad solo de pacientes de zonas de clima tropical, por lo que se conocía como piomositis tropical. No obstante, se ha dado un aumento en la aparición de casos en zonas no tropicales en especial en pacientes inmunocomprometidos. Esta condición puede asociarse a bacteremia y por ende a la aparición de focos infecciosos de diseminación hematógena. Se reporta un caso de espondilodiscitis bacteriana secundaria a bacteremia, derivada de una piomiositis de músculo iliopsoas. El paciente consulta por lumbalgia y se le diagnostica absceso en musculo psoas, el cual requirió drenaje percutáneo. No obstante, desarrolla paraplejia fláccida y se sospecha compresión medular. La tomografía espinal demuestra compresión a nivel de segmento C5-C6 secundario a espondilodiscitis, que precisó tratamiento quirúrgico y drenaje de colección. Se aisló también Staphylococcus aureus  de este sitio. El caso ilustra la diseminación hematógena de una piomiositis hacia proceso vertebral con déficit neurológico, por compresión medular en un paciente inmunocompetente.
Colgajo Perforante en Propela de la Arteria Tibial Posterior: Reporte de un caso
Authors: Ramírez Carlos Alberto Centeno , Rodríguez Madelein Centero
Published: March 2021

Históricamente la reconstrucción de tejidos blandos del tercio distal de la pierna ha constituido un gran desafío quirúrgico para el cirujano plástico, a pesar de los múltiples avances en materia de colgajos pediculados y libres. En la actualidad los colgajos perforantes en propela son una excelente opción reconstructiva muy utilizada para cubrir defectos de tejidos blandos a este nivel con o sin exposición ósea, tendinosa, vascular y/o nerviosa. Esta técnica reconstructiva tiene como ventajas que no requiere anastomosis microquirúrgicas lo cual reduce el tiempo operatorio y que la localización precisa de los vasos perforantes puede realizarse fácilmente con un doppler manual por parte de los cirujanos en sala de operaciones.
Peritonitis terciaria por Candida famata: infección por una levadura atípica
Authors: Betancourt Alfredo A. Sánchez , Álvarez Pablo Sibaja
Published: March 2021

La Candida famata es una levadura halotolerante, sobreproductora de vitamina B2, asociada infrecuentemente a infecciones en seres humanos, cuyo uso es común en procesos industriales. En nuestro servicio, se había detectado un único caso en el contexto de mediastinitis con un desenlace mortal. Se carecía de experiencia en cuanto al manejo de la infección por este agente. Posterior a una exhaustiva revisión bibliográfica, se demuestra la ausencia de reportes de infecciones por este agente en el contexto de la peritonitis terciaria. Se reporta el caso de un pacientede 37 años de edad que sufrió una herida de arma blanca en abdomen, y que después de múltiples complicaciones asociadas a este evento, desarrolló una peritonitis terciaria por C. famata; fue tratado satisfactoriamente con caspofungina y un abdomen abierto con terapia de presión negativa e instilación. Se espera que esta experiencia sirva de referente al detectar algún paciente con esta condición en el futuro.
Aislamiento de componentes y efecto hipoglicemiante del extracto metanólico de albahaca (Ocium basilicum), en ratas C57bl/6 con hiperglicemia experimental
Authors: Jimenez Manuel Alejandro Meléndez , Cuevas Ángel Raúl Rivero , Pivat Isis Helga Vivas , Lugo Gustavo Adolfo Naylander
Published: March 2021

Antecedentes: la albahaca (Ocium basilicum) es una hierba perteneciente a la familia laminaceae, caracterizada por sus bondades medicinales. Se ha referido su uso en la terapéutica del cáncer, vitíiigo, hipercolesterolemia y la diabetes mellitus.
El retiro de la escalera analgésica de la OMS y sus limitaciones como estrategia para el control del dolor relacionado con cáncer
Authors: Carvajal-Valdy Gabriel , Rocha-Romero Andrés
Published: March 2021

En 1986, la Organización Mundial de la Salud (OMS) desarrolló un modelo para la introducción simple y progresiva de analgésicos en el paciente con dolor relacionado con cáncer, conocida como escalera analgésica de la OMS.1 En 2020, esta organización ha publicado la decisión de retirar sus guías principales en el uso de opioides para tratamiento del dolor,2-4 y nuevas recomendaciones han sido publicadas.5A pesar de que la escalera analgésica ha sido activamente promovida como una solución cuasi-universalmente eficaz para el control del dolor crónico relacionado con cáncer, existe evidencia de una frecuente respuesta analgésica subóptima.

Treinta años después de la publicación de estas recomendaciones escalonadas, queremos señalar algunas limitaciones de ese enfoque terapéutico:

Evaluación incompleta de componentes no sensitivo - discriminativos del dolor

Ausencia de un algoritmo específico para el tratamiento del dolor neuropático, para el cual los opioides no constituyen un tratamiento de primera línea.

Ausencia de técnicas no farmacológicas, como el tratamiento intervencionista del dolor o la radioterapia paliativa.

La escalera analgésica de la OMS fue un constructo intelectual importante, el cual permitió generalizar el tratamiento del dolor para millones de pacientes con cáncer y legitimar el uso de opioides en el paciente con dolor severo, superando estigmas que limitaban el acceso a estas terapias en el mundo. Sin embargo, existe controversia respecto de la evidencia que justificaba generalizar este abordaje, así como ante los conflictos de interés entre la OMS y las empresas encargadas de comercializar opioides potentes, actualmente en debate.
Girlfags and guydykes: “Too queer for straights and too straight for queers”
Authors: Lindqvist Siri , Carlström Charlotta
Published: March 2021

The aim of the article is to highlight the experiences of those who call themselves “girlfags” and “guydykes” and to interpret the identity labels associated with these terms. Online, the communities that refer to themselves by these terms all define the labels and what they signify in terms of identity differently. These include descriptions of people who consider themselves gay but “in the wrong body”, for example, when a woman is sexually oriented toward gay men or when a man is sexually oriented toward lesbian women, most often with a gender or queer element to the definitions. Little to no previous research can be found on these identities, and what is known is mainly found on internet blogs and forums. The participants were sought through a Facebook forum, resulting in a total of 11 interviews with two guydykes and nine girlfags. The results were analyzed within the framework of social constructionism and applied with Butler’s (1990) concept of the heterosexual matrix and van Anders’ (2015) Sexual Configurations Theory (SCT), involving concepts of gender/sex sexuality, nurturance, and eroticism. The results show that those who identify as girlfags and guydykes are proud of their identity, but the complexity of the identity nevertheless affects many aspects of their lives. The respondents reveal how the labels involve one’s sense of self and gender identity. In addition, they touch upon transgender issues, sexual identity, sexual orientation, and other relational aspects. These identities break gender norms, sexual practices, and even sexual orientations within the LGBT context. The results indicate the need for further research on transgender issues; in particular, the relational and social aspects of the girlfag and guydyke identities.
Peripherally Inserted Central Catheters in Pediatric Patients Performed by Radiologists Using Fluoroscopy
Authors: Shane Amanda , Premji Zahra
Published: March 2021

Evidence from 2 clinical studies showed that there was no difference in the rates of infection and complications between peripherally inserted central catheter (PICC) insertion at the bedside and insertion in Interventional Radiology (IR) suites. However, each of these studies focused on small subgroups of the larger pediatric population and had other methodological limitations.

Evidence from 1 clinical study in a single quaternary, non-cardiac, pediatric intensive care unit suggested that the median time from PICC line order to successful insertion was longer for lines placed in the IR compared to at the bedside.

Two guidelines were identified that recommend ultrasound guidance for insertion of central venous access devices (CVAD), including PICCs: 1 was aimed at all pediatric patients and 1 was aimed at onco-hematological pediatric patients who had numerous quality limitations.
“Good Teachers” with “Good Intentions”: Misappropriations of Culturally Responsive Pedagogy
Authors: Evans Leanne M. , Turner Crystasany R. , Allen Kelly R.
Published: March 2021

This conceptual work examines the misappropriation of culturally responsive pedagogy by identifying ways in which misappropriations commonly occur in urban teaching and learning environments. They include culturally responsive practices as a smokescreen of good intentions, culture as a hook to gain students’ attention, and culturally responsive pedagogy as a tool of assimilation. As teacher educators, we see a need to critically examine pedagogical approaches to specifically identify the perpetuation of historical inaccuracies, harmful stereotypes, and masks of good intentions. Three premises are proposed that reflect a commitment to defining and identifying culturally responsive teacher education practices.