4 research outputs found
PEMBERIAN TUNJANGAN HARI RAYA KEPADA PPPK DI DINAS KESEHATAN KOTA BUKITTINGGI
No full textAparatur Negara dengan Perjanjian Kerja atau yang disebut PPPK memiliki hak yang harus diterima setelah menjalankan kewajiban yang telah ditentukan. Salah satu hak tersebut adalah hak untuk menerima Tunjangan Hari Raya. Pengaturan tentang Tunajangan Hari Raya ini diatur pada Peraturan Pemerintah Nomor 15 Tahun 2023 tentang Pemberian Tunjangan Hari Raya dan Gaji Ketiga Belas Kepada Aparatur Negara. Kota Bukittinggi merupakan salah satu kota yang sudah melakukan pengadaan terhadap pegawai PPPK, salah satunya yaitu pada Dinas Kesehatan Kota Bukittinggi. Di Kota Bukittinggi, pengaturan mengenai pemberian Tunjangan Hari Raya Aparatur Negara ini diatur oleh peraturan daerah yaitu Peraturan Walikota Bukittinggi Nomor 6 Tahun 2023 Tentang Pemberian Tunjangan Hari Raya dan Gaji Ketiga Belas Kepada Aparatur Negara. Dalam pelaksanaannya, ketentuan ini belum berjalan sepenuhnya karena masih ada PPPK yang tidak menerima tunjangan tersebut. Oleh Karena itu, penelitian ini memfokuskan analisis terhadap dua hal utama yaitu: Pertama, Bagaimana pelaksanaan pemberian Tunjangan Hari Raya kepada PPPK di Dinas Kesehatan Kota Bukittinggi? Kedua, Bagaimana penyelesaian permasalahan pegawai PPPK yang tidak mendapatkan THR di Dinas Kesehatan Kota Bukittinggi? Untuk menjawab fokus kajian, penelitian ini menggunakan metode pendeketan empiris (Yuridis Empiris), dengan menggunakan data primer yang diperoleh langsung dari sumber utama yang meliputi Badan Keuangan dan Aset Daerah Kota Bukittinggi dan Dinas Kesehatan Kota Bukittinggi. Teknik pengumpulan data yakni wawancara. Dari hasil penelitian dapat disimpulkan bahwa pelaksanaan pemberian THR kepada PPPK di Dinas Kesehatan Kota Bukittinggi diatur pada Peraturan Walikota Bukittinggi Nomor 6 Tahun 2023 Tentang Teknis Pemberian Tunjangan Hari Raya dan Gaji Ketiga Belas Dari APBD Tahun 2023. THR PPPK di Kota Bukittinggi dananya bersumber dari APBD dan dikelola oleh Badan Keuangan dan Aset Daerah Kota Bukittinggi sesuai dengan Peraturan Walikota Bukittinggi Nomor 46 Tahun 2022 Tentang TUPOKSI Badan Keuangan Kota Bukittingggi. Penyelesaian terhadap 4 orang pegawai PPPK di Dinas Kesehatan Kota Bukittinggi yang tidak mendpatkan THR yaitu terdapat pegawai yang tidak masuk bekerja sejak pelantikannya sehingga sesuai dengan Pasal 5 angka 1 Peraturan Pemerintah Nomor 15 Tahun 2023 pegawai tersebut tidak mendapatkan THR karena cuti diluar tanggungan negara, dan 2 orang pegawai PPPK tidak termasuk namanya dalam pengangkatan PPPK di Dinas Kesehatan Kota Bukittinggi berdasarkan SK nomor 821/001-PPPK/BKPSDM-2023, maka pegawai tersebut tidak memiliki hak sebagai pegawai PPPK salah satunya THR. Dan satu orang pegawai PPPK yang SPM-LS nya tidak sesuai, maka pegawai tersebut tertunda dalam pencairan THR pegawai tersebut dan prosedurnya sesuai dengan Peraturan Pemerintah Nomor 77 Tahun 2020 Tentang Teknis Pedoman Pengelolaan Keuangan Daerah
Decreasing prevalence of anaemia in pregnant women at delivery: a quality improvement initiative
No full textAnaemia in pregnancy is a critical public health challenge associated with adverse maternal and neonatal outcomes. Despite national programmes and guidelines, India continues to face high anaemia prevalence during pregnancy, with 42.2% in Delhi (National Family Health Survey-5). Addressing gaps in systematic screening, timely diagnosis and effective management is essential to reduce anaemia at delivery and improve maternal health outcomes. At AIIMS, New Delhi, baseline data revealed a 35.57% prevalence of anaemia among booked pregnant women at delivery. Key issues included limited screening, inconsistent management and poor patient adherence to anaemia treatment protocols. This prospective quality improvement (QI) initiative employed the Plan–Do–Study–Act (PDSA) cycle methodology to address anaemia in pregnancy. Interventions focused on systematic screening of women at 30–34 weeks gestation using point-of-care haemoglobin testing (HemoCue), the establishment of a dedicated anaemia management room and the development of standardised operating procedures for diagnosis and management. Weekly team meetings facilitated the identification of challenges and iterative improvements. Sustainability measures, such as structured intern orientation, real-time monitoring through WhatsApp and enhanced team communication, addressed barriers like frequent staff rotations and workflow integration. Over four PDSA cycles, screening coverage reached 95%–100%, with a median anaemia prevalence of 20.04% at delivery, reduced from 35.57% at baseline. Sustained improvements were achieved, with a 3-month median prevalence of 15%. Challenges included integrating workflows and ensuring continuity with rotating staff, mitigated through structured protocols and team reorientation. This QI initiative demonstrates a successful model for reducing anaemia at delivery through systematic screening, effective management and multidisciplinary collaboration. The findings provide a replicable framework for addressing anaemia in resource-limited settings, aligning with national initiatives like the ‘T4 Anemia Room’ concept
0003
No full textDAILY PAfcQ AI.TO TIMES, TIKSOAV. JL'LY -7. Uyoa.
*alle palo Hlto Ctmca jj-t^t-Mw-w
r»M*Mrtrffttt«*itt
*Tac salr csoelrji •fully *>*■ the prr-laauU, •*
torn rrsntlst-V
lasssil r*rrr sftrrnoon en*pi Sun Uy, st Ihe
tOCmer sf It ami I I'm Itrnu. --nt R-J
TITj-IsS rCBUSUINC COMPANY
;|CHAS. P. NOTTI
IIAII, SUBSCBIPTION H \TI..
(Para-is is rtwvsacs.)
DkMSSSh
****■ s
■ a-ai Jj
Contractor and Dealer
un,..- 1.70 Alma It.
Ptwa* 4« X
Manila ts A-strati s.
Prom MauUs to Australia la like
going down * river, for one Is out or
sight nt land only two dsys. Tbe
voyage Issts twrnty-on* days, but tbe
rourt-*!- Is Lbrt-.ugb tbe south see lsiaods.
which sccount* tor Its rvsemblame to
river navigation
•t_tm. tmtoA to, C-l Ifswi I---*-e sar-*~is"ii _J
•ja* sglalsas at mntopemitrnm. Article* sss 2
Am as|se4 S- (a* Ins* — *■— — ^
\u
> s fwsrsni
r •f^sseststWous
sf uta wistrr. net
tee of gso- _
IjiVIous S
a. w. si at reins..
TUBBDAY. JULY
w. a KELLY
1»01 St
SANDS ROCKS GRAVELS
Road Building Materials
(il tllKI.l 1*K ItlVKB BSD OlMi ABB GBAVBE-I
tMBATOGA OBMBNT OBAVKL'
MOVTKRKV WHIT* BAKDB AMI (.ntVKIA
BOAD Olt-t AND BlTt'KKJIK
Ths Pon-.sgr-snate
Oriental dyetuaiirr* *-e?ure forty
I stia-ie- of yellow from tb* shell of the
i pomegranate.
Wher, Twrtlss Are Safe
f At a plsce called Kotorn. on the
Prencb Ivory Co**t. tbr ustlrrs be-
Have tbat to cat or destroy a turtle
would mean death to the guilty ooe or
sickness among tbe fa mil*.
Ml.IS III I V. NANUS AND OIUVELfi
0R.IMTB BOCK, TltAP ROCK. CHEVL BOCK
g>gg>»g»*g>»MI*^»rir»s^rg^b
:
:
Cal Hernia.
In prehistoric time* tb* rtilnoee-roe
AoOTisbed ln California. wbUe large
lions aad tiger* lived In tbe Jungle*.
RKDl'tTRll MUNICIPAL KXPBXfl»
An unexpected reduction In lh*; ***mmmmm'mmmat*mmmmmM-
•*•**-« or fuel oil for ihe municipal j asarretary Ilalllnger.
plant I* made In tb* contract Juat If tbare be truth In the rumors
-astarded to ths Associated Otl Com-' concerning the stand .secretary of
r-r-y by the board of public works ' |he ,DterIor Bslllnger ha* token In
The price secured Is reduced from * ...
|1.« . t-xrral of If ..Hop* to ****** lo th* ******* ** *******
tt S-i osats. or to l-t cents a bar-! ****** the »sclaoiattoo service snd
nsl- The same company goto thr* other things In which the public has
«u* trust sad oae reason for the re-; m vital Interest, it would be well for
dnctlon ts snppoeed to be due to th*1 blm to retire to private life and let
fact that tbe bill* are paid promptly. *.** pres**i-t position be filled by some
*>y the dty. j one who has more sympathy tor tbe
Tt*? amount of oil used laat year; people than lm seems to have. No
was 14.411 barrel*, approximate!?.; ,„,„ r-tanda higher In the confidence
oosUag flC.STI.ll. The same of *h« people thaa doe* Mr. Otttord
amount need thla year would coat| i»|n,hot. head ot the forestry service
gtl.tl-SI. making a saving for the. under Secretary Balllnger. Yet it U
year of aometblng over *S.-00. j psnlsleoUy rumored tbat the *e«*r*
I-ut year sll th* bids for furnish-; „-., (i m»klng It unpleasant lor his
ing oil »*r* tbe earn*, showing thst! subordinate u was pincbot. under
a eomblnatlon existed It bad bwn gaxmur) Garfield, wbo bad large
•mppo-ssd that thl* combtnstlon mrWm <,- the public lands withdrawn
woold force the price still higher.1 trom entry In order to prevent vat
and tbat the quotations for a new aabte waterpower altso aod rights' ****** department at Washington ror:
oontract would be |l SO al the least trvtll being privntely grabbed ami ***P0*lt-ng lh the mslla printed
Portnnately for Pslo Alto s differ- monopolised to the great fatare RHUt>f -ordering on the Indecent.
•aot condition obtains , damage of tbe people of the coun-1 *** *** ***** *** r*rtalnly beea;
Tbe board of works alao effected, try. Secretary Balllnger baa. with-, m"*-,,'S: violent efforts st lmprove-:
farther savings on contracts—1411 out giving notice of his Intention to|m*nt There bnve been only three!
•on street sweeping and Kl on street do ._,. restored to entry ebout s mil- ** **** ***l-ooprin table Items la
sprinkling. Then by having the re- \u,u acre* of tbe land withdrawn un- th* **** ***** ****** *■-*** * "light-
port* oa operation and maintenance ,j-r *-,(. pred*c**eor. Secretary Oar- *»provement In tbe ClUsen la prsise-'
•of tbs plaat prepared by the engl-Bsld. The ooly persona who will worthy—whether due to the vtalt ofj
naer-a department a saving or 1600p benefit by the action or Secretary * *'***** States marshal or merely!
la salary Is msde.- These economies' Bellinger are tboee wboae buaineea'to * .*****tofflrt. warning
radace tbe expense of coBductlng |, j- u, build up great power trusts
the sffalr* of tbe city by nearly wni,.a wm greatly oppreea tbe peo- " **--»« ** lndlcro'.*--lf It
6,000 for too yoar. | -a,. t-.€ rarto, ti ftllo ps-nuetaat *** P******—** *** th* Cittoao nuts*j^-TT
• ' . that Sscretary Balllnger Is dadroaa *B »PP«reBt effort to avoid obecealty ********** *****
AM OfURCT laBMOIf. of subeUtuUng eome friend of his' kna ******* beadlong Into publl-
Arttiqu.ty st Csrf.ngs
.Among tbe ancient orients! nation*,
wtth the excepttoo of the Hebrewa.
bbc* and v* mum wore earrtnga. ths
latter c^maldVrlng tbat tbey should be
rserrved for the sole use of the gen-
tier esx. ll.-iiwr unkv-s mention of
this method of adorVMpcni In hla de-
ecrlptlon* of stotues reptostiillng **v-
tnl of tbe mytbottigicsl deltlea
Vtrgll in tbe " Aet.t-ki" drscribsa s boat
,. . . # ._ .race between four Trojan galleya. aud
fuming out of tbe p.-*u.mce last L^ won, -j-,-,,,-*. ta of i,„|Un origin.
Saturday evening soni.-l.- i> ssk-j xberr U good evldenre to abow tbat
J. P Parklnaon. "Who owna the tbtf* w*« boat race* on the Nile very
Tribune?" Thl* soon began to look early tn ths t-ourse nf Kgyptlan til"l<iry.
runny. After a general laugh a lit- --s
tie later aomebody altered tbe query \ Oec oar |**-ree for Job Priatlng
to ."Who will own the Trihuno iniTJ
month?" Still another . i.-iige wasXmo * 1" 1 X* lw
rung on thla pointed Question about D6&tltlfUl K6DCII6S
our Mtepmed contemporary. "V?ho! __, _ ■
would have owned the Tribune If J. A OT t_yAl6
Hall Henry's 11.100 bill for printing!
thr charter had be<*i t-nglneered!
through the town board
It Is not known wbeth«*r tbe Cltl-
j sen bas been reproved by tbe post-
■ In the Valley, in the Foothills
and on thr Mountains.
From 3 io 15 rmlrs (romQ
Sunloni University.
Kigbteesi Area* 1 1*4 miles l*o*
Alto*. 10 acrea thrifty vineyard,
scree yoang orchard, modern bouse,
grand view, abundance beet water;
part exebaege for residence, balance
eaah *AV
geveu-tra-a aad Owe-Half Arrre,
two miles Los Altos, beautiful ele-
' ration, grand view: cottage, barn,
! abundance timber and beet water;
I six scree to bearing orchard. Ooe-
M7 scree over the monntatn sum
salt. IS mil*** trom the Ualvaralty, '■
mile* from t-s Honda, one-half Ul
f-toadrartUlngc.mp.Ign thst haa. l^ wrsrlc». Mr. 1«-. H. l^iregll. ";^»i ^""^V'm"° """ *" *°* "^* ■"i talrtas. abundance timber. grant
been conducted by the promotion ****** *** ****** msny powerful; *** ***** *a* ******* ****** *t the, ^UtMrt) „,._ ^n* snd
committee Is the demonstration to ******** ******** *t hi. steadfast re- \™*** ****** *>**** ********* p" .treams; 40 head stock, team, tools.
-On* ef the most valuable results 'or *■• Ptonenl head of the rer la in a-
sensuality aad Maa of tbe flesh In
tba baslnees men of the adrantag*' *****
lhat sceross from k*eplng their who ***** *° ****
basineas before the people, not onlv them«.lv*e af the expense of tbe
of tbe city bnt of nil the snrround- onblle. Balllnger. wbo wa* head of
lag country. *** **a* drpartm-,nt under Hecreta-
1-aJo Alto ha* drawn trade dar- ** Qorflald. and resigned ander
lag the laat two months from farthi-- i*r«snr*. seems u, iv a sort or .
aflr-ld tbsn ever before, snd lh.- *"l-"'r'' •*** ■'' * ^0',,"' *x"*li h"
•suburban realdent. are Ss-t(.iirlng **** *** *■* The wort of lb* oeere-
the habit of coming to Palo Alto '-*> ',r "■*** interior Is ao Important
They bave le*rU-*d thai as good **•* **** l»rtfollo ahould be Ih thai-writs ara kept here at as fsvorable ***** ot *>** »*° ,**',or» **• *******
-fj-rtree as sra offered In tbe Urge- ****** **•** ■sndgrabtH'rs and power
towna, and li Is more r-»ovenlenl nionopollsera llBlltng»*r should ra
for them to come ner*. **** lt h-* ■*■*» nul da **** **'
Bat it will be esay to lose the Presldeat Tsft remote til in and put
forward stop lhat has been galntvt "> h,-» •>**** someone who will sd-.
anlees the merrhanta roatlnn* lo mlnls-er lhe affairs of the om**e Inj
make special offerings end to keep *** ******** **»• *** *>*o.c tkoaplm]
the country people Informed of the rather then In the Interest of a ra-
sAaract-rr of their commodities and **• °' ntonopollsta Oakland Kn
the prieee offered It la aow to be- 1<-Irpr
*Dome more the effort of Individuals "■
bo carry 00 this work, snd no doubt fatarral to Be Head Tharsdey.
It will be well done by tbr progrea- The funeral services for Mr. K O.
sdva merchants I Oreeae will be held in tbe Congre-
, ■-,- „-s- —-■■ j gatlonal Church parlors Thursday.
CHy Ooaadl. Jul) I»th. st 5 p. m.
Tba dfy council will meet tonight' Mr. Oreene will be laid to rest h.--
aiad a number of mstters of Interset' side bis two children In tbe old
-ara likely to be considered. Afler home cemetery st St. Albans. Vt.
this meeting the coanr.11 will meet -s
rr-nSls-fty bat once s month, oa the A girl stands being redheaded br
-evening ot the second Tuesday ' calling It aome other name.
play Into the bands of tboee I ***** ** *** ****** *** ******* ***
dvaotag* for|isr of the pit. Judaa snd liruius
' Bra champed in the very teeth ef
Sstsn.
etc.:
Belirr vulgsr allusions than sr
atari snd misleading attacks on the
iii-osp-rtril)' of thr* whole titto tn unity
Personal baseness affects chleg*
(tni-self Treaaon , may destroy a
pSPOls The CIHion la rordlslty
n>nimi>nded to Canto a-EXTY of tbe
Inferno
The Home Insurance Co.
NEW YORK
M- Oasfa tapllal en.OOO.OOO.
ABSET8 Jauary 1, 10OO , gM-a*vo,4IW.O--i
I.MnfWTlP-S (Including capital) I I, I T:t.nTT..M
RRtfEllVE AS A f-iXP1_%t*U\TIOX Sl'HPI.t S. IWO.OOO.fMi
NKT SCni'l.t'S (over all IlaUllttosaud rrs>r»-rrs) 0.flMl.fr£l.l>l
Sl'Hl-I IS AS BBOABM POUCV HOMiKiis t-v.iw_.Kjt,.-I
Ijoenee paid stare orgaatsrstlnn over lllVOetO,0*W.OO
When yvva pay for prut***tl.m get that which la HWoi.l'Ti:-
1VY Sl*RB. ao w-sttcr hew maay roaaagnUlriios tepp-r* aay-
Vt5tKTr.
Pi*opeiiy t-i-vrners. -wretsiiii-'i-**.. SBtateaaaeo aiwl tm.1.1-*. desir-
log the best aad sarrst lo-ursnn- will appcrrUtr the fa«i that
th** net aasets of the HOMK-—tho sarplas fands r. ..n.-tl ror
tbe evrlastvt-- protertloa of Its pnHryhohlrrs ■ -ars* gn*nti-r than
th-se of aay VIrt* Insaranr- Company iip-4*vwtlag la this troat*-
rry. Ttse HOMK IS r-*fj*ci-*'nied cvcla-dvely at Pah. Alto aad
Waarord rnh-orstty by MAItSHAI.I. It) U u
_X\t r« I verslty Avraae. Tri-r-rdstMse ITH.
#•*?**«*?*■" I
good buildings for farm; grand
ocean view ana*, per s
Twelve acres near Loa Altoa, fin*
orchard, good buildings, modern;
beat water plant;1-*, sure buy If seen
and examined .$&.'
Klevra acres nsar Lo* Alio*, fair
building*, beautiful view orer bay;
all In young bearing orchard, variety: beat water gl.ooo
Two acres adjoining Los Altos.
100 young trees, small house; beautiful location main road, bargain SI. I * m
Teat acres. 91,000: to acres.
g&OOO; si acres. gs.ftoO; 14 acres:
g_t.OOO, with line spring, timber.
rolling, frontage two roads; oaly 4
i miles distant. All these ranches sltu-
• continued from page I.) ' al# fl„ mua rt- mli«, rroB Ubi-,--
or the season, ss shown by tbe large ititTt Mayfield end Los Altos and are
crowds thai bave attended them. 'excellent bargains, situate In midst
Psyment waa ordered for the of thrm_ homes: good soli, aban-
t.0«0 letters aeat oat. but at a ra-jgaa,-, -^ter. and advancing rapidly
dnced price, a* the Ssn Francisco ] |n »»iUe
firm tbst did the printing failed to, We have the largest ranch lists
Earle & Company
Headquarters fer
Fine Groceries
All srdar. earafallr — lotted aad prompllr delivered ta
eloas csadrttoo.
OUB MOTTO: Ftr.t-43_» l-ada, I'erfert BsUafaelloB (
T.Uph.o. 17 sa* have vour QroesrlBS. Krult. aod VaaatatalB,
d.ll.*r*d br *ar apaelal dalrrary.
Come and see us—no trouble to show
you our stock
All Frasts aad Tou-lln la asar—a. Freak Irp aae Batter
159 University Avenue
A Soft, Velvety Qimplexion
Is the Pride of Every Woman
The world grants every woman the
privilege of caring (or her skin by aiding nature in keeping it soft and velvety.
Every woman should use
VVKCK'S WITCHAZEL CREAM
This preparation is made especially
for California and Nevada women. It
contains nothing injurious, is easily applied and has given excellent satisfaction
wherever used.
wren s
r»IICHA2EI
CIITAM
iWEINGARTNER ® CO.
_ iiriiir-nr* a^rwi a sra w st sr t-s t-s*-. *_-_-» -
WHITE STAR LAUNDRY
alSI. riaasrlata,.
S 0—7 h.od-.otk Japaa Ma I auBdrr. Oood work a apaa—Itr. S
Paxatlr waBklBaa- To. eaa al .... tad ss at II. EasaraaB ——SS, S
Pal. Alta. Thaa. -tax g
Band Concerts
Will Be Continued
taaue tbem on time
A general discussion of the que*-
tlon of forming a board of trade wss
bsd end tbe sentiment wa* unanimous In favor of aucb action, bat no
definite recommendation waa made
All of the member* of tbe committee were outspoken In their condemnation of the ClUsen In lu attack upon tbe hnslnesa Intereata of
tb* city. It waa considered that the
opposition of the publisher ot that
paper to the provisions of the charter does not Justify bb attach noon
business intereet* to the Injury of
all the residents of the ctty.
Ih-llt.hi.il With Palo Alto.
Mr. and Mra. W h Beal are enjoying a delightful visit from some
former neighbors. Mr. and Mrs.
James Allison of Wichita. Kan., who
in company wltb Mlsa Irma Talma-age or Oblo are traveling through
California on their way to Seattle,
Mr and Mrs Alllaon and the Boats
bave been cloee frir.d* many years
aad they felt that t;is was aa opportunity not to be io** fn paying _
lang-dcferrcd vlsll. The gut-sts are
charmed with California, and particularly with Palo Alto. They will
remain here a few weeka. end tr
Mr. Allison's business Interests were
not so closely lden*ifl*-J wltb Wichita there Is small donbt that Pato
Alto would soon hav- another estimable family added to Ita population.
for sale la the county aad advise aa
early call. Open every day.
t-TtriiKRtC RKBARI. * CO..
TQ STXCH AKOht
Seven-room bones, bran new and
modern. In one ot the beat locations
in Berkeley Will exchange far
small air-rage near Palo Alto or
Maytteld
POR fsAl-B
Arrange tbat will rut from t 1-3
io 3 tons ot hay per acre. Will sell
for tit) per acre.
Nine-room hoaae snd large lot.
Ideal home. In Palo Alto. Will as-
rhange for acreage la Santa Clara
county.
Several ranches and aome small
pieces of acreage with Improve-
VOR RKVT
Three, four and five room boa***,
furnished snd unfurnished
Call or Inqnlra of
J, B. n \i i'.
t-KIT BsUaaaW|Ba ***ti**cet, Pslo Alto. Osl.
J Coder RoOf Manag.-mest J
: WE KLEAN KLOTHES ♦
• PAIX» ALTO ut'lMMi CO. ♦
X llwme 2AX—TRY l*»~ e
O-A Ramoraa Street.
BUICK MODEL to
Come la And See It
STANFORD AUTO AND MANUFACTURING CO.
Sll ALMA
Japanese Cleaning Contractor
Ave.. Pale AM*, Oal. PbMSto g-»-LTOOO. HgO Bryant St.. meow WmttA
Cleaning of stores, office* aod residences, especial care and faithful work being given to new buildings and uno-**cupled nouses, sad especially such bca-aes I will gat ready for yoa before yoo move la. by eea-
tract. Doing of aay kind of garden aad house work by tbe boor, day
or weak, or by contract.
t:** a- SB. *i-d after B:aa) p. as.
Psistss sis* Mg-s.
The stndv of the art of putting
things ts to be recotameodeil to every
ooe who me.] I rate- a plunge Into print.
Bvea tbe writing of a death notice tn-
retves a cevtaia stnoont of genius tr
tbe author wlabea to keep clear end
well defined tbe fragile line which llee
between tbe eertVaas sad lb* funny.
That this Is true ts shown by certain
qootattons from s I^lpxlg paper given
In Bishop John r Hunt's "Ufe and
I I'.-r.f.tfs- |„ tb- |'sth-rUii.l " Tflere
arc a tow *rnti-e*-**e extractad from
tbese obituary aotk-ee:
"T"dsT desih tore away from us f.ir
tbe third time our ooly child."
"Loot night *t r. .TO tbe Lord took to
blmseir during a visit to tbe grand-
parweta <*r little daughter Antolne of
leetblug"
Tbe u*( epenka l-mer than 11 knew
'Here died alalia Wieget. who was
tool tier and wean-wtress nf ebHdr.>n
Mstall-c Maid,
it I ilktii't know lhat Mlaa
a ••.•liege grudaatr. dH voo?
- Ti. la- BOI* I did SV I*
s.it;; Ilium i>f Vaster - Boa-
Health of Hew Ytwfc Ctty.
Tbe fruits of public lnatrnctton In
j aanltary -feattaffS and a stricter en-
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Enfermedad de Chagas, evasión de la respuesta inmune y perspectivas terapéuticas - revisión de literatura-
No full textLa enfermedad de Chagas es una enfermedad causada por el protozoario flagelado
Trypanosoma cruzi (T. cruzi), este circula en sangre y puede alterar la función de
órganos como el corazón, colon y esófago aumentando el tamaño de los mismos.
Es transmitida principalmente vía vectorial por las heces de diversos triatóminos
entre ellos el Rhodnius prolixus. Al ser catalogada una enfermedad desatendida
representa un problema de salud pública en América Latina.
T. cruzi, durante su ciclo evolutivo atraviesa por diferentes estadios: Tripomastigote,
amastigote y epimastigote. Cada estadio expresa un patrón de proteínas
específicas, las cuales proveerán al parásito de características propias en cuanto a
biología, morfología y función que se asocian con la virulencia y la infección de este,
por consecuente la dificultad para emplear tratamientos efectivos. Además de que
el parásito cuenta con diversos mecanismos de evasión que son obstáculo en la
recuperación de la enfermedad. La revisión bibliográfica permitió indagar acerca de
los diversos mecanismos de evasión inmune y relacionarlos con posibles
perspectivas terapéuticas funcionales en contraparte con el tratamiento
convencional, añadido se expone un algoritmo diagnostico que permita la valoración
oportuna de la enfermedad de acuerdo a la vía de transmisión. En ese sentido, se
realizó una búsqueda de revistas científicas, libros y otras fuentes sobre los temas
objeto de estudio. Se encontró como el mecanismo de evasión más reportado el del
complemento por la inhibición de la porción C3, de otro modo las perspectivas
terapéuticas las más prometedoras se enfocan en la inhibición del metabolismo del
parásito.RESUMEN 15
INTRODUCCIÓN 16
OBJETIVOS 18
1. ANTECEDENTES 19
2. MARCO TEÓRICO 23
2.1 ENFERMEDAD DE CHAGAS 23
2.1.1 Agente etiológico 23
2.1.2 Vector 27
2.1.3 Ciclo de vida 29
2.1.4 Vías de transmisión 32
2.1.5 Manifestaciones clínicas 32
2.1.5.1 Fase aguda 32
2.1.5.2 Fase indeterminada y Fase crónica 33
2.2 EPIDEMIOLOGÍA 33
2.3 DIAGNÓSTICO 37
2.3.1 Métodos directos 37
2.3.2 Métodos indirectos. 38
2.3.3 Métodos Serológicos 40
2.4 DETERMINANTES ANTIGÉNICOS 45
2.4.1 Mucinas 45
2.4.2 GP72 45
2.4.3 Superfamilia GP85/ TSA 45
2.4.4 Gp90 47
2.4.5 Gp35/50 47
2.4.6 Gp30 47
2.4.7 HSP70 47
2.4.8 Cruzipaina o Gp57/51 48
2.4.9 Oligopeptidasa B 49
2.5 INVASIÓN CELULAR DE Trypanosoma cruzi. 49
2.6 RESPUESTA INMUNE FRENTE A INFECCIÓN POR Trypanosoma cruzi51
2.6.1 Innata 51
2.6.2 Adaptativa 54
2.6.2.1 Celular 54
2.6.3 Humoral 55
2.7 EVASIÓN DE LA RESPUESTA INMUNE POR Trypanosoma cruzi 56
2.7.1 Invasión celular y sobrevida al stress oxidativo 56
2.7.2 Escape del fagolisosoma 60
2.7.3 Inactivación del complemento 61
2.7.3.1 Proteínas involucradas en la evasión del complemento. 62
2.7.4 Inmunomodulación a partir de la activación de patrones de
reconocimiento molecular 65
2.7.5 Activación policlonal de células B de forma inespecífica 67
2.7.6 Inmunodominancia 67
2.8 TRATAMIENTOS 68
2.8.1 Convencionales 68
2.8.1.1 Benzonidazol 68
2.8.1.2 Nifurtimox 70
2.8.2 Perspectiva de medicamentos 71
2.8.2.1 Itraconazol 71
2.8.2.2 Amiodarona 71
2.8.2.3 Alopurinol 72
2.8.2.4 Fexinidazol 72
2.8.3 Esquema terapéutico 73
2.8.4 Intervención en el metabolismo del parásito 74
2.8.4.1 Bloqueo de la proteína Cruzipaina 74
2.8.4.2 Inducción de estrés 75
2.8.4.3 Inhibición de metabolismo de pirofosfatos 75
2.8.5 Resincronización cardiaca 75
2.8.6 Vacunas contra Trypanosoma cruzi 76
3. DISEÑO METODOLÓGICO 79
3.1 TIPO DE INVESTIGACIÓN 79
3.2 UNIVERSO 79
3.3 POBLACIÓN 79
3.4 MUESTRA 80
3.5 CRITERIOS 80
3.5.1 Criterios de inclusión 80
3.5.2 Criterios de exclusión 80
3.6 PROCEDIMIENTOS 80
3.6.1 Obtención de la información 81
3.6.2 Análisis de la información 81
4. RESULTADOS 82
4.1 TIPO DE DOCUMENTOS 82
4.2 AÑO DE PUBLICACIÓN 83
4.3 PAÍS DE PUBLICACIÓN 83
4.4 IDIOMA DE PUBLICACIÓN 84
4.5 TEMA DE LOS DOCUMENTOS 85
4.6 MECANISMOS DE EVASIÓN INMUNE 86
4.7 TRATAMIENTOS UTILIZADOS 86
4.7.1 Tratamientos convencionales 86
4.7.2 Perspectivas terapéuticas 87
4.7.3 Tipos de Vacunas 88
4.8 TRATAMIENTO Y PERSPECTIVAS FRENTE A LA EVASION DEL
SISTEMA INMUNE 88
4.9 ALGORITMOS DIAGNÓSTICOS BASADOS EN LA LITERATURA 89
4.9.1 Transmisión vectorial 90
4.9.2 Transmisión pos-transfusional 91
4.9.3 Transmisión congénita 92
4.9.4 Transmisión en paciente inmunosuprimido 93
4.9.5 Transmisión Oral 95
4.9.6 Transmisión por accidente en el laboratorio 96
4.10 ALGORITMO TERAPÉUTICO BASADO EN LA LITERATURA 98
4.10.1 Fase Aguda 98
4.10.2 Fase indeterminada y crónica 99
5. DISCUSIÓN 101
6. CONCLUSIONES 110
7. REFERENCIAS BIBLIOGRÁFICAS 111PregradoBacteriólogo(a) y Laboratorista Clínic
