La revisión crítica tuvo como objetivo determinar la seguridad y eficacia de la alimentación enteral continua en pacientes hospitalizados en la UCI en comparación con la alimentación enteral intermitente. Se trabajó bajo una investigación secundaria y metodología de la Enfermería Basada en la evidencia. De la problemática analizada surgió la pregunta clínica según el esquema PICOT: ¿Cuál es la eficacia de la nutrición enteral continua versus nutrición enteral intermitente, en pacientes de la UCI? Para la selección de las palabras claves, se usó la terminología según MESH/DECS, para incrementar los criterios de búsqueda se tradujo cada una de las palabras al inglés y al portugués. Se formaron ecuaciones de búsqueda, las cuales se introdujeron en bases de datos como Epistemonikos, Pubmed y BVS. Del total de 32 trabajos de investigación, finalmente se seleccionaron seis. Posteriormente pasaron el primer filtro mediante la aplicación de la guía de validación de Gálvez Toro, donde se seleccionó la investigación titulada “Alimentación por sonda enteral continua versus intermitente para pacientes críticamente enfermos: estudio prospectivo y aleatorizado”, en donde se utilizó la lista de comprobación CASPE, obteniendo un nivel de evidencia 1+ y grado de recomendación moderada. Como respuesta a la pregunta clínica planteada se tuvo que, en comparación con la estrategia de alimentación enteral intermitente, la estrategia de alimentación continua mostró una mejora significativa en el cumplimiento de las necesidades nutricionales. Por otra parte, no hubo diferencias entre ambas estrategias en cuanto a mortalidad o intolerancia gastrointestinal. / The critical review aimed to determine the safety and efficacy of continuous enteral feeding in patients hospitalized in the UCI compared with intermittent enteral feeding. We worked under secondary research and evidence-based nursing methodology. From the problem analyzed, the clinical question arose according to the PICOT scheme: What is the effectiveness of continuous enteral nutrition versus intermittent enteral nutrition in ICU patients? For the selection of the keywords, the terminology according to MESH/DECS was used; to increase the search criteria, each of the words was translated into English and Portuguese. Search equations were formed, which were entered into databases such as Epistemonikos, Pubmed and BVS. Of the total of 32 research papers, six were finally selected. Subsequently, they passed the first filter by applying the Gálvez Toro validation guide, where the research titled “Continuous versus intermittent enteral tube feeding for critically ill patients: prospective and randomized study” was selected, where the checklist was used. CASPE, obtaining a level of evidence 1+ and a moderate recommendation grade. In response to the clinical question posed, compared to the intermittent enteral feeding strategy, the continuous feeding strategy showed a significant improvement in meeting nutritional needs. On the other hand, there were no differences between both strategies in terms of mortality or gastrointestinal intolerance.

Introduction: Emergence of resistance to artemisinin-based combination therapy (ACT) is a major threat to combat Plasmodium falciparum malaria. Regular therapeutic studies to monitor treatment efficacy is essential, and genotyping of molecular makers is useful for mapping development and spread of resistance. Aims: The study aims are to assess efficacy of artesunate-amodiquine (ASAQ) and prevalence of molecular markers of drug resistance in Zanzibar in 2017. Methods: Treatment efficacy of the clinical trial conducted in 2017 was compared with efficacies in 2002 and 2005. A total of 142 samples were genotyped for single nucleotide polymorphisms (SNPs) in the P. falciparum chloroquine resistance transporter gene (pfcrt) gene, the P. falciparum multi drug resistance 1 (pfmdr1) gene, and in the P. falciparum Kelch 13 (PfK13) propeller region. Prevalence of SNPs were assessed during the period 2002-2017. Results: Cure rate was 100% in 2017, compared to 94% and 96%, in 2002-2003 and 2005, respectively. Day 3 fever clearance rate were also high 93% (2002-3), 99% (2005) and 98% (2017) in all studies. Prevalence of pfcrt 76T, pfmdr1 86Y, 184Y and 1246Y and pfmdr1 (86Y, 184Y and 1246Y) YYY haplotypes were significantly decreased between 2002-3 and 2017 (p &lt; 0.001). No SNP in the PfK13 gene related to artemisinin resistance was identified. Conclusion: Efficacy of ASAQ remains high after fourteen years as first-line treatment, despite the wide-scale use of ASAQ, and there is no evidence of selection of resistance markers in Zanzibar. Continuous monitoring of drug efficacy and resistance markers is recommended. / <p>This master thesis is a collaboration project between Institutionen för kvinnors och barns hälsa, Department of Women's and Children's Health, Uppsala Universtiy and Anders Björkman group, Department of Microbiology, Tumor and Cell Biology (MTC), C1, Karolinska Institutet. Laboratory examinations were mainly conducted at MTC house, Karolinska Institutet.</p>