Mediación de conflictos, competencia no difundida en médicos en formación: revisión / Conflict mediation, an undisclosed skill among medical students: A review

RESUMEN El ser humano es un ser social por naturaleza, y los desacuerdos y conflictos son situaciones comunes e inherentes a sus diferentes actividades sociales. En esta revisión se pretende describir el origen de los conflictos y las técnicas de mediación en la atención sanitaria. Se sabe de la necesidad de aprender las habilidades para la solución de conflictos, y se reconocen dentro de las prioridades cambiantes de los educandos del profesional sanitario. El desacuerdo y el conflicto son inevitables entre los miembros de los equipos clínicos, así como con los pacientes y sus familias durante el curso de la atención sanitaria. A pesar de la importancia que representa esta competencia, no se ha establecido como una necesidad educacional en los planes de estudio de los profesionales de la salud, no obstante de que los médicos requieren negociar y resolver conflictos de manera continua en los entornos sanitarios. Nuestra función como educadores es la de analizar el contexto profesional empírico cambiante y otorgar a los educandos las herramientas pertinentes para su desarrollo profesional con la mayor posibilidad de éxito en sus actividades cotidianas. Los invitamos a leer, analizar y criticar esta propuesta, que consideramos muy importante para que sea contemplada en los planes de estudio desde el pregrado y posgrado de las diferentes ramas de los profesionales de la salud, que incluyen tanto a médicos de las diferentes especialidades, el personal de enfermería y todos aquellos profesionales que trabajamos con el objetivo común de brindar asistencia sanitaria de calidad.

ABSTRACT Human beings are social beings by nature, and disagreements and conflicts are common situations inherent in their different social activities. This review aims to describe the origin of conflicts and the mediation techniques in healthcare. It is well known that conflict resolution skills are needed to be learned, and such skills are considered within the changing priorities of healthcare students. Disagreement and conflict are inevitable between members of clinical care teams, as well as with patients and their families during healthcare. Despite the importance of these skills, they have not been established as an educational need in healthcare professionals' curricula, even though physicians are required to negotiate and resolve conflicts on an ongoing basis in healthcare settings. Our role as educators is to analyze the changing empirical professional context, and provide our students with the relevant tools with the greatest chance of success for their professional development in their daily activities. We invite you to read, analyze and criticize this proposal, which we consider very important to be included in the undergraduate and graduate curricula of the different fields of healthcare professionals, i.e. specialist physicians, nursing staff and all those professionals who work with the common goal of providing quality healthcare.

Tuberculosis laríngea secundaria a foco pulmonar primario inadvertido: caso clínico / Laryngeal tuberculosis secondary to an inadvertent primary pulmonary focus: clinical case

Introducción: La tuberculosis laríngea es una entidad sumamente rara en países del primer mundo, sin embargo, en nuestro medio no es extraño, como país latinoamericano, sospechar esta patología como una de las causas de disfonía y lesiones granulomatosas en la actualidad. La tuberculosis laríngea debe considerarse dentro de las patologías en pacientes con disfonía de larga evolución que no responden al tratamiento común, esta entidad puede ser confundida con neoplasias. Reporte de caso: Se presenta el caso de una mujer en la cuarta década de la vida con disfonía crónica de 6 meses de evolución, que fue remitida para laringoscopia. Se localizaron neoformaciones granulomatosas acompañadas de edema en ambas cuerdas vocales, sometidas a biopsia, con resultados con la tinción de hematoxilina-eosina de células gigantes multinucleadas de Langhans y la tinción Zielh-Nielsen fue positiva para bacilo alcohol ácido resistente. La radiografía de tórax mostró lesiones reticulonodulares sugestivas de tuberculosis pulmonar. Conclusión: Un alto nivel de sospecha y un diagnóstico temprano pueden limitar las complicaciones y facilitar un manejo oportuno de estos casos. Es necesario sospechar de tuberculosis laríngea en pacientes que presentan disfonía crónica, especialmente cuando se asocia con síntomas constitucionales, aunque no siempre los presentan, por otro lado, en algunos casos, no existe asociación con inmunodeficiencia.

Introduction: Laryngeal tuberculosis is an extremely rare entity in first world countries, however, it is not strange in our environment as a Latin American country to suspect this pathology as one of the causes of dysphonia and granulomatous lesions today. Laryngeal tuberculosis should be considered within the pathologies in patients with long-standing dysphonia that do not respond to common treatment, this entity can be confused with neoplasms. Case report: We present the case of a female in the fourth decade of life with chronic dysphonia of six months of evolution, who was referred for laryngoscopy, granulomatous neoformations accompanied by edema in both vocal cords were located, subjected to biopsy with results with hematoxylin staining. Langhans multinucleated giant cell eosin and Zielh-Nielsen staining were positive for acid-fast bacillus. Chest X-ray showed reticule-nodular lesions suggestive of pulmonary tuberculosis. Conclusion: A high level of suspicion and an early diagnosis can limit complications and facilitate timely management of these cases. It is necessary to suspect laryngeal tuberculosis in patients with chronic dysphonia, especially when associated with constitutional symptoms, although they do not always present them; on the other hand, in some cases, there is no association with immunodeficiency

Revistas depredadoras y su identificación: revisión sistemática / Predatory Journals and their Identification: Systematic Review

Introducción: las revistas depredadoras son una amenaza global debido a que aceptan manuscritos para su publicación por honorarios, sin realizar los controles de calidad prometidos. Los lectores ingenuos no son las únicas víctimas, investigadores novicios también han sido engañados para que envíen sus manuscritos a estas revistas. Objetivo: el objetivo fue identificar las características de una revista depredadora. Materiales y métodos: se llevó a cabo una revisión sistemática siguiendo las directrices PRISMA (Preferred Reporting Items for Systematic reviews and Meta Analyse) de los estudios empíricos encontrados en PubMed, SciELO, Elsevier y Google Académico con los términos MeSH ("revistas depredadoras" o "predatory journal and systematic review"). Resultados: se localizaron 81 escritos con los términos señalados y se seleccionaron seis posibles artículos, de los que solo se tuvo acceso a cuatro. Conclusiones: no existe una lista de verificación única e infalible, pero se señalan que las revistas depredadoras carecen de registros en DOAJ (Directory of Open Access Journals), ICMJE (International Committee of Medical Journal Editors) y COPE (Committee on Publication Ethics); así mismo, es necesario verificar si el editor es miembro de organizaciones editoriales conocidas, si el sitio web de las revistas contiene información actual y confiable, y si está indexada en PubMed; para esto, consulte MEDLINE.

Introduction: Predatory journals are a global threat, because they accept manuscripts for publication for fees, without performing the promised quality controls. Naïve readers are not the only victims, novice researchers have also been tricked into submitting their manuscripts to these journals. Objective: The objective was to identify the characteristics of a predatory magazine. Materials and methods: A systematic review has been carried out following the PRISMA Preferred Reporting Items for Systematic reviews and Meta-Analyse guidelines of the empirical studies found in PubMed, SciELO, Elsevier and academic Google with the MeSH terms ("predatory journals" or "predatory journal and systematic review"). Results: 81 writings with the indicated terms were located, selecting six possible articles, in which only four writings were accessed. Conclusions: There is no single and infallible checklist, but it is pointed out that predatory journals: lack records in DOAJ, ICMJE, COPE, likewise it is necessary to verify if the editor is a member of known publishing organizations, if the website of journals contains current and reliable information, if indexed in PubMed; for this, see MEDLINE.

Structure and Function of the Cytochrome P450 Monooxygenase Cinnamate 4-hydroxylase from Sorghum bicolor.

Cinnamate 4-hydroxylase (C4H; CYP73A) is a cytochrome P450 monooxygenase associated externally with the endoplasmic reticulum of plant cells. The enzyme uses NADPH-cytochrome P450 reductase as a donor of electrons and hydroxylates cinnamic acid to form 4-coumaric acid in phenylpropanoid metabolism. In order to better understand the structure and function of this unique class of plant P450 enzymes, we have characterized the enzyme C4H1 from lignifying tissues of sorghum (Sorghum bicolor), encoded by Sobic.002G126600 Here we report the 1.7 Å resolution crystal structure of CYP73A33. The obtained structural information, along with the results of the steady-state kinetic analysis and the absorption spectroscopy titration, displays a high degree of similarity of the structural and functional features of C4H to those of other P450 proteins. Our data also suggest the presence of a putative allosteric substrate-binding site in a hydrophobic pocket on the enzyme surface. In addition, comparing the newly resolved structure with those of well-investigated cytochromes P450 from mammals and bacteria enabled us to identify those residues of critical functional importance and revealed a unique sequence signature that is potentially responsible for substrate specificity and catalytic selectivity of C4H.

Characterization and Regulation of Aquaporin Genes of Sorghum [Sorghum bicolor (L.) Moench] in Response to Waterlogging Stress.

Waterlogging is a significant environmental constraint to crop production, and a better understanding of plant responses is critical for the improvement of crop tolerance to waterlogged soils. Aquaporins (AQPs) are a class of channel-forming proteins that play an important role in water transport in plants. This study aimed to examine the regulation of AQP genes under waterlogging stress and to characterize the genetic variability of AQP genes in sorghum (Sorghum bicolor). Transcriptional profiling of AQP genes in response to waterlogging stress in nodal root tips and nodal root basal regions of two tolerant and two sensitive sorghum genotypes at 18 and 96 h after waterlogging stress imposition revealed significant gene-specific pattern with regard to genotype, root tissue sample, and time point. For some tissue sample and time point combinations, PIP2-6, PIP2-7, TIP2-2, TIP4-4, and TIP5-1 expression was differentially regulated in tolerant compared to sensitive genotypes. The differential response of these AQP genes suggests that they may play a tissue specific role in mitigating waterlogging stress. Genetic analysis of sorghum revealed that AQP genes were clustered into the same four subfamilies as in maize (Zea mays) and rice (Oryza sativa) and that residues determining the AQP channel specificity were largely conserved across species. Single nucleotide polymorphism (SNP) data from 50 sorghum accessions were used to build an AQP gene-based phylogeny of the haplotypes. Phylogenetic analysis based on single nucleotide polymorphisms of sorghum AQP genes placed the tolerant and sensitive genotypes used for the expression study in distinct groups. Expression analyses suggested that selected AQPs may play a pivotal role in sorghum tolerance to water logging stress. Further experimentation is needed to verify their role and to leverage phylogenetic analyses and AQP expression data to improve waterlogging tolerance in sorghum.

Enhancing cellulose utilization for fuels and chemicals by genetic modification of plant cell wall architecture.

Cellulose from plant biomass can serve as a sustainable feedstock for fuels, chemicals and polymers that are currently produced from petroleum. In order to enhance economic feasibility, the efficiency of cell wall deconstruction needs to be enhanced. With the use of genetic and biotechnological approaches cell wall composition can be modified in such a way that interactions between the major cell wall polymers­cellulose, hemicellulosic polysaccharides and lignin­are altered. Some of the resulting plants are compromised in their growth and development, but this may be caused in part by the plant's overcompensation for metabolic perturbances. In other cases novel structures have been introduced in the cell wall without negative effects. The first field studies with engineered bioenergy crops look promising, while detailed structural analyses of cellulose synthase offer new opportunities to modify cellulose itself.