Cuidados de enfermería para prevenir las úlceras por presión durante la estancia hospitalaria / Nursing care for the prevention of pressure ulcer development during hospital stay

Introducción: las úlceras por presión (UPP) son de origen isquémico y comprometen la integridad de la piel y los tejidos. Ocurren en 3-10% de los pacientes hospitalizados, y la tasa de incidencia de una nueva UPP oscila entre 7,7 y 26,9%. Objetivo: describir los cuidados de enfermería para prevenir las UPP en los pacientes durante la estancia hospitalaria. Materiales y métodos: revisión integrativa de la literatura basada en artículos de revistas de ciencias de la salud mediante bases de datos. Se seleccionaron teniendo en cuenta los términos DeCS, MeSH, filtrando por título, resumen y texto completo, organizando según nivel de evidencia y grado de recomendación. Se realizó la lectura crítica usando herramientas como CASPe y Strobe. Según la Ley 23 de 1982 este estudio se clasifica sin riesgo. Resultados: se incluyeron 43 artículos y se construyeron siete temáticas que abarcan elementos e intervenciones en la prevención de UPP cómo eventos adversos frecuentes, además de los obstáculos y complicaciones derivados de la falta de estas acciones. Conclusiones: los cuidados para la prevención de UPP en este estudio se clasifican en intervenciones de enfermería y las herramientas con las que se ejecuta el cuidado, reconociendo que 95% de las lesiones de piel son prevenibles con un manejo adecuado. Los profesionales deben reconocer y aplicar las acciones de cuidado específicas para evitarlas.

Introduction: pressure ulcers (PUs) are ischemic injuries which compromise the integrity of the skin and underlying tissue. They occur in 3-10% of in-patients, and the incidence rate of a new PU ranges from 7.7 and 26.9%. Objective: to describe nursing care for preventing PUs during hospital stay. Materials and methods: an integrative review of the literature based on health sciences journals and databases. Article search was conducted using DeCS and MeSH terms, screened by title, abstract and full text, and organized by levels of evidence and grades of recommendation. Critical Reading was completed using the CASPe and Strobe tools. This study was classified as non-risk according to Law 23 of 1982. Results: forty-three (43) articles were included, and seven topics were constructed including elements and interventions for PUs prevention, as frequent adverse events, as well as the obstacles and complications derived from the lack of these actions. Conclusions: in this study, care provided for PU prevention is classified as nursing care interventions and tools used, acknowledging that 95% of skin lesions are preventable through proper management. Professionals should be aware of and apply specific care interventions to prevent the development of PUs.

Diagnóstico y tratamiento del síndrome de ovario poliquístico

El síndrome de ovario poliquístico es un trastorno endocrino-genético-ginecológico que afecta principalmente a mujeres en edad fértil, con manifestaciones de hiperandrogenismo e infertilidad en etapas tempranas de la vida. Este trabajo tiene por objetivo describir el diagnóstico y tratamiento del síndrome de ovario poliquístico. cuya fisiopatología no ha sido del todo comprendida, de ahí que su diagnóstico continúe siendo por exclusión. Los criterios del consenso de Rotterdam han logrado mejorar la uniformidad diagnóstica; sin embargo, se hace necesario un diagnóstico individualizado, en el cual debe incluirse el estudio de la morfología de los ovarios. Aunque la literatura sugiere la asociación de esta entidad con la presencia de obesidad, resistencia a la insulina e hiperinsulinismo, no se incluyen como parte de los criterios diagnósticos actualmente. El tratamiento incluye cambios en los estilos de vida, unidos a inhibidores de la producción de andrógenos por los ovarios, inhibidores de la acción de los andrógenos y los sensibilizadores a la insulina; se establecerá según los intereses reproductivos de la paciente.

Polycystic ovary syndrome is an endocrine-genetic-gynecological disorder that mainly affects women of childbearing age, with manifestations of hyperandrogenism and infertility in early stages of life. This work aims to describe the diagnosis and treatment of polycystic ovary syndrome whose pathophysiology has not been fully understood, hence its diagnosis continues to be by exclusion. The Rotterdam consensus criteria have managed to improve diagnostic uniformity; however, an individualized diagnosis is necessary, which must include the study of the morphology of the ovaries. Although the literature suggests the association of this entity with the presence of obesity, insulin resistance and hyperinsulinism, they are not currently included as part of the diagnostic criteria. Treatment includes changes in lifestyle, together with inhibitors of androgen production by the ovaries, inhibitors of androgen action and insulin sensitizers; It will be established according to the patient´s reproductive interests.

Alta proporción de macrodisco en pacientes de dos centros oftalmológicos en el occidente de Honduras / High proportion of macrodisc in patients from two ophthalmological centers in western Honduras

Antecedentes: Cuando el nervio óptico presenta una superficie mayor a 2.5 mm2 , y sin patologías asociadas, se trata de un macrodisco, cuya excavación es proporcional al tamaño aumentado del mismo. Con base en la distribución bajo la curva de Gauss, se define como "macrodisco" cuando está por encima de 2 desviaciones estándar arriba de la media. Se espera que solo el 2.3% de la población exceda estos límites. Objetivo: Determinar el tamaño promedio del disco óptico y proporción de macrodisco en la población sin glaucoma ni patologías retinianas que acude a dos clínicas oftalmológicas del occidente de Honduras, en el periodo de julio 2021 hasta julio 2022. Métodos: Estudio retrospectivo descriptivo. Se midieron los parámetros morfométricos del disco óptico mediante Tomografía de Coherencia Óptica ZEISS Cirrus HD Model 4000. Se definió macrodisco como: área del disco óptico >2.5 mm 2 y área del disco más 2 o más desviaciones estándar arriba de la media. Resultados: La proporción de macrodisco fue de 31% tomando en cuenta la definición de área de disco >2.5 mm2 , y 3% considerando la definición con base a la distribución bajo la curva de Gauss (>3.17mm2 ). Se obtuvo un promedio de área de disco óptico de 2.28±0.45 mm 2 , ratio copa/disco (C/D) de 0.59±0.13, ratio C/D vertical de 0.56±0.13, área de anillo neuroretiniano de 1.37±0.22 mm 2 , espesor de Capa de Fibras Nerviosas Retinianas (CFNR) de 97.4±10.664µm. Discusión: El área de disco promedio obtenido es mayor que los caucásicos, similar a lo reportado en los hispánicos, y menor que afrodescendientes y asiáticos...(AU)

Optimal Laboratory Cultivation Conditions of Limnospira maxima for Large-Scale Production.

Cultivating Limnospira maxima, renowned for its abundant proteins and valuable pigments, faces substantial challenges rooted in the limited understanding of its optimal growth parameters, associated high costs, and constraints in the procurement of traditional nitrogen sources, particularly NaNO3. To overcome these challenges, we conducted a comprehensive 4 × 3 factorial design study. Factors considered included white, red, blue, and yellow light spectra, along with nitrogen sources NaNO3 and KNO3, as well as a nitrogen-free control, for large-scale implementation. Optimal growth, measured by Optical Density, occurred with white and yellow light combined with KNO3 as the nitrogen source. These conditions also increased dry weight and Chl-a content. Cultures with nitrogen deprivation exhibited high values for these variables, attributed to carbon accumulation in response to nitrogen scarcity. Phycocyanin, a crucial pigment for nutrition and industry, reached its highest levels in cultures exposed to white light and supplemented with KNO3, with an impressive content of 384.11 g kg-1 of dry weight. These results highlight the efficacy and cost-efficiency of using a combination of white light and KNO3 for large-scale L. maxima cultivation. This strategy offers promising opportunities to address global food security challenges and enhance the production of industrially relevant pigments.

PD-L1 expression complements CALGB prognostic scoring system in malignant pleural mesothelioma.

Background: Programmed death ligand-1 (PD-L1) expression is a predictive biomarker in patients with lung cancer, but its role in malignant pleural mesothelioma (MPM) remains unclear. Evidence suggests that higher PD-L1 expression is correlated with worse survival. CALGB is the main scoring system used to predict the benefit of chemotherapy treatment. This study aimed to determine the prognostic value of PD-L1 expression and its addition to CALGB scoring system in patients with MPM. Methods: In this retrospective analysis, we evaluated samples with confirmed locally advanced or metastatic MPM. PD-L1 Tumor Proportional Score (TPS) was determined by immunohistochemistry at diagnosis. Results: 73 patients were included in this study. A cutoff value of 15 was set for a high or low PD-L1 TPS. In total, 71.2% (n=52) and 28.8% (n=21) of individuals harbored low or high PD-L1 expression, respectively. PD-L1High was associated with worse median progression-free Survival (mPFS) [4.9 vs. 10.8 months; HR 2.724, 95% CI (1.44-5.14); p = 0.002] and Overall Survival (OS) [6.0 vs. 20.9 months; HR 6.87, 95% CI (3.4-8.7); p<0.001] compared to patients with PD-L1Low. Multivariate analysis confirmed that PD-L1 expression was an independent factor for PFS and OS in patients with MPM and CALGB score of 5-6. Conclusion: PD-L1 addition to CALGB scale improves its prognostic estimation of MPM survival and should be considered in future research.

Comparative effectiveness and duration of protection of ChAdOx1, CoronaVac, BNT162b2, mRNA-1273, and Ad26.COV2.S COVID-19 vaccines for symptomatic and hospitalized Mu, Delta, and Omicron: A test-negative case-control study.

OBJECTIVE: We carried out a study to estimate the vaccine effectiveness (VE) of homologous vaccination schedules against COVID-19, using data from mandatory information systems from Bogota, Colombia. METHODS: A test-negative case-control study in adults from Bogota (Colombia), between March 1st of 2021 and February 25th of 2022. We assess VE among symptomatic COVID-19 cases during the Mul, Delta, and Omicron predominance periods in Bogota, with controls matched by sex, age (±5 years), and date of testing (±7 days), using a case:control ratio of 1:1. We selected homologous vaccination schedules with ChAdOx1, CoronaVac, BNT162b2, mRNA-1273, and Ad26.COV2.S. VE was reported as one minus the odds ratio in adjusted conditional logistic regressions, with their 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant. RESULTS: 52,913 cases were matched to controls, 16,722 for Mu, 14,094 for Delta, and 22,097 for Omicron. VE was high against COVID-19 during Mu weeks with full vaccination using the monovalent BNT162b2 (VE: 69; 95% CI, 65 to 72) vaccine and ChAdOx1 (VE: 64; 95% CI, 31 to 81) and significantly lower with CoronaVac (P < 0.001) and Ad26.COV2.S (P = 0.005). During Delta, VE against COVID-19 was higher with BNT162b2 (VE: 55; 95% CI, 51 to 58). The VE for COVID-19 cases during Omicron was higher with a booster dose of monovalent BNT162b2 (VE: 45; 95% CI, 34 to 54). The VE of primary series and booster for ChAdOx1, Ad26.COV2.S, and CoronaVac did not show protection for Omicron. CONCLUSION: Our study provides further evidence on the protective effect of mRNA vaccines for Omicron, and warrant that the duration of protection against symptomatic infection may last for only a few months.

Efectos deletéreos en el desarrollo de los niños a causa de la exposición temprana a pantallas: revisión de la literatura / Deleterious effects on children's development due to early screen exposure: a review of the literature

Desde la década de los 90 debido al aumento en el consumo de material audiovisual y particularmente desde el inicio del confinamiento por la pandemia de COVID-19, la humanidad ha estado más expuesta al uso de pantallas, siendo los niños una población vulnerable al estímulo ambiental debido a que están atravesando períodos críticos importantes en su desarrollo. Se realizó una búsqueda de la literatura en PubMed, Google Scholar y Lilacs. Aplicando los criterios de exclusión e inclusión se obtuvieron 53 referencias de las cuales se desarrolló la revisión. Se encontró que la excesiva exposición a pantallas es perjudicial para los niños al producir alteraciones del lenguaje, la sociabilidad, ciclo sueño-vigilia, el sistema límbico, la conducta y el sistema mesolímbico dopaminérgico; los cuales pueden afectar su desarrollo normal, dependiendo principalmente de la edad al momento de la exposición, del tiempo y si hay acompañamiento o no.

Since the 1990s, due to the increase in the consumption of audiovisual material and particularly since the onset of the COVID-19 pandemic confinement, the population has been more exposed to development. A literature search was conducted in PubMed, Google Scholar and Lilacs. Applying the exclusion and inclusion criteria, 53 references were obtained, from which the review was developed. It was found that excessive exposure to screens is harmful to children as it produces alterations in language, sociability, sleep-wake cycle, limbic system, behavior and mesolimbic dopaminergic system; which can affect the normal development of a child, depending mainly on the age at the time of exposure, the time and whether there is accompaniment or not.

Consecuencias neurobiológicas del abuso sexual en la infancia: revisión de literatura / Neurobiological consequences of child sexual abuse: literature review / Consequências neurobiológicas do abuso sexual infantil: revisão da literatura

RESUMEN Objetivo: Describir las consecuencias neurobiológicas en ninos, ninas y adolescentes con antecedente de abuso sexual infantil (ASI). Metodologia: Se realizó una revisión de literatura entre los años 2015 al 2020 en tres bases de datos (Pubmed, Scopus, Scielo), utilizando las palabras clave: abuso sexual infantil, neurobiologia. Se recopiló información acerca de los tipos de alteraciones neurobiológicas (estructurales, funcionales, endocrinos, psicológicos, inmunológicos y genéticos) en ninos, ninas y adolescentes con antecedente de ASI. Se excluyeron articulos cuyo titulo o resumen no incluyeran los temas de esta revisión. Resultados: Se seleccionaron 99 estudios asociados a las consecuencias neurobiológicas del ASI, con las consecuentes alteraciones estructurales, funcionales, endocrinas, inmunológicos y genéticos que afectan a un importante número de victimas. Conclusiones: Diversos autores han encontrado una relación entre la exposición al ASI y los cambios neurobiológicos, visibilizando asi, el impacto que esto ocasiona en la salud de las victimas, por tal, se hace importante promover intervenciones tempranas y tratamiento adecuado por las múltiples consecuencias que genera, algunas irreversibles.

ABSTRACT Objective: To describe the neurobiological consequences in children and adolescents with a history of child sexual abuse (CSA). Methodology: A literature review was carried out between the years 2015 and 2020 in three databases (Pubmed, Scopus, Scielo), using the keywords: child sexual abuse, neurobiology Information was collected about the types of neurobiological alterations (structural, functional, endocrine, psychological, immunological and genetic) in children and adolescents with a history of CSA. Articles whose title or abstract did not include the topics of this review were excluded. Results: 99 studies associated with the neurobiological consequences of CSA were selected, with the consequent structural, functional, endocrine, immunological and genetic alterations that affect a significant number of victims. Conclusions: Various authors have found a relationship between exposure to CSA and neurobiological changes, thus making visible the impact that this causes on the health of the victims, therefore, it is important to promote early interventions and adequate treatment due to the multiple consequences that generates, some irreversible.

RESUMO Objetivo: Descrever as conseqüências neurobiológicas em crianças e adolescentes com histórico de abuso sexual infantil (CSA). Metodologia: Entre 2015 e 2020 foi realizada uma revisão bibliográfica em três bancos de dados (Pubmed, Scopus, Scielo), utilizando as palavras-chave: abuso sexual infantil, neurobiologia. Foram coletadas informações sobre os tipos de alterações neurobiológicas (estruturais, funcionais, endócrinas, psicológicas, imunológicas e genéticas) em crianças e adolescentes com histórico de CSA. Foram excluidos os artigos cujo titulo ou resumo não incluia os tópicos desta revisão. Resultados: Foram selecionados 99 estudos associados às conseqüências neurobiológicas da CSA, com conseqüentes alterações estruturais, funcionais, endócrinas, imunológicas e genéticas que afetam um número significativo de vitimas. Conclusões: Vários autores encontraram uma relação entre a exposição à CSA e as mudanças neurobiológicas, tornando assim visivel o impacto que isso tem na saúde das vitimas, por isso é importante promover intervenções precoces e tratamento adequado para as múltiplas conseqüências que ela gera, algumas das quais são irreversiveis.

Circumfusicillium cavernae gen. et sp. nov. (Bionectriaceae, Hypocreales) Isolated from a Hypogean Roman Cryptoporticus.

Stone monuments and relics are prone to biodeterioration processes prompted by microbial proliferation and activity. Among the distinct microbes capable of stone colonization, fungi are known to strongly contribute to stone biodeterioration. During the ongoing efforts aiming to study fungi thriving in dolomitic limestone walls of the Coimbra's hypogean Roman cryptoporticus (Portugal), two unknown Bionectriaceae isolates were retrieved. The aim of this work was to depict the molecular and phenotypic characteristics of these microorganisms. The phylogenetic analyses revealed that the studied strains could not be assigned to any of the currently known Bionectriaceae genera. Moreover, the isolates exhibited distinctive and peculiar characteristics, such as the packing of conidia by surrounding hyphal segments and the formation of rope-like microsclerotia with a textura globose. Taking into account all the data obtained, a novel genus and species, Circumfusicillium cavernae gen. et sp. nov. in Bionectriaceae (Hypocreales), is proposed here.

Abordaje de hipertensión secundaria en adultos mayores: reporte de caso / Secondary hypertension approach in older adults: a case report

Resumen La hipertensión arterial secundaria es poco frecuente y está asociada con una causa que puede ser tratable, por lo cual su diagnóstico y tratamiento oportuno son importantes. La orientación diagnóstica se hace con base en los datos obtenidos en la anamnesis y examen físico del paciente buscando posibles etiologías. Se presenta el caso de un hombre de 63 años, con hipertensión arterial resistente, sin otra sintomatología ni antecedentes personales o familiares. Se realizaron estudios iniciales que documentaron hipopotasemia, lo que hizo sospechar hiperaldosteronismo primario, se solicitaron pruebas complementarias con aldosterona plasmática elevada, actividad de la renina plasmática baja, además con imagen diagnóstica por resonancia nuclear magnética que mostró nódulo suprarrenal derecho. Se considero llevar a adrenalectomía derecha, con reporte de patología compatible con adenoma cortical adrenal. Durante el seguimiento en atención primaria presento adecuado control en cifras de presión arterial con disminución del número de medicamentos antihipertensivos requeridos.

Abstract Secondary arterial hypertension is rare, it is associated with a cause that can be treatable, for which its diagnosis and treatment are not important.The diagnostic orientation is made based on the data obtained in the anamnesis and physical examination of the patient, looking for possible etiologies.We present the case of a 63-year-old man with resistant hypertension, without other symptoms or personal or family history. Initial studies were performed that documented hypokalemia, which led to the suspicion of primary hyperaldosteronism. Complementary tests were requested with high plasma aldosterone, low plasma renin activity, in addition to a diagnostic magnetic resonance imaging that showed an adrenal nodule. A right adrenalectomy was considered, with a report of pathology compatible with adrenal cortical adenoma.During the follow-up in primary care, patient presented adequate control in blood pressure figures with a decrease in the number of antihypertensive drugs required.

A Case-Control Study Evaluating Risk Factors and Outcomes of Hospitalized Children With ESBL-UTI.

Urinary tract infections (UTIs) are among the most common causes of hospitalization in children, with a rising prevalence of extended-spectrum beta-lactamase-producing organisms (ESBL). The purpose of this study was to identify risk factors and treatment outcomes of children with ESBL-UTI. A retrospective case-control study of hospitalized children was performed from July 2014 till December 2017. Medical records from patients with a positive urine culture were reviewed and included in the study if they met criteria for UTI. Cases were defined as ESBL-UTI, while controls were defined as non-ESBL-UTI patients. This study confirmed that there are certain risk factors, such as previous UTI, recent antibiotic use, urinary tract abnormalities, recent hospital admission, and nonrenal comorbidities, that are associated with ESBL-UTI. Most of the patients with ESBL-UTI responded to discordant antibiotics. Other significant outcomes in patients with ESBL-UTI included a longer length of stay and longer intravenous antibiotic therapy.

Prevalence and Safety of COVID-19 Vaccination in Community-Dwelling People with Dementia: Findings from a Tertiary Memory Clinic in Italy.

This study aimed to explore the prevalence and safety of SARS-CoV-2 vaccination in individuals with dementia. Patients with mild cognitive impairment or dementia were recruited at a tertiary memory clinic, from March 15 to September 15, 2021. Information on COVID-19 vaccination and adverse events experienced after vaccine administration were collected from caregivers. Two-hundred-seventy subjects were finally recruited. Among them, 253 (93.7%) had received the vaccine and only 69 (27.3%) experienced adverse events. Cognitive and behavioral changes following immunization were only rarely reported. COVID-19 vaccination is safe and well-tolerated in patients with cognitive impairment who should be prioritized in the vaccination campaign.

Regulation of growth, invasion and metabolism of breast ductal carcinoma through CCL2/CCR2 signaling interactions with MET receptor tyrosine kinases.

With over 60,000 cases diagnosed annually in the US, ductal carcinoma in situ (DCIS) is the most prevalent form of early-stage breast cancer. Because many DCIS cases never progress to invasive ductal carcinomas (IDC), overtreatment remains a significant problem. Up to 20% patients experience disease recurrence, indicating that standard treatments do not effectively treat DCIS for a subset of patients. By understanding the mechanisms of DCIS progression, we can develop new treatment strategies better tailored to patients. The chemokine CCL2 and its receptor CCR2 are known to regulate macrophage recruitment during inflammation and cancer progression. Recent studies indicate that increased CCL2/CCR2 signaling in breast epithelial cells enhance formation of IDC. Here, we characterized the molecular mechanisms important for CCL2/CCR2-mediated DCIS progression. Phospho-protein array profiling revealed that CCL2 stimulated phosphorylation of MET receptor tyrosine kinases in breast cancer cells. Co-immunoprecipitation and proximity ligation assays demonstrated that CCL2-induced MET activity depended on interactions with CCR2 and SRC. Extracellular flux analysis and biochemical assays revealed that CCL2/CCR2 signaling in breast cancer cells enhanced glycolytic enzyme expression and activity. CRISPR knockout and pharmacologic inhibition of MET revealed that CCL2/CCR2-induced breast cancer cell proliferation, survival, migration and glycolysis through MET-dependent mechanisms. In animals, MET inhibitors blocked CCR2-mediated DCIS progression and metabolism. CCR2 and MET were significantly co-expressed in patient DCIS and IDC tissues. In summary, MET receptor activity is an important mechanism for CCL2/CCR2-mediated progression and metabolism of early-stage breast cancer, with important clinical implications.

Actividad física como factor de modificación en la mortalidad por COVID-19 / Physical activity as a modifying factor in mortality due to COVID-19

Objetivo: Analizar la actividad física como factor de modificación en la mortalidad por COVID-19. Método: Se realizó una revisión sobre actividad física como factor de modificación en la mortalidad por COVID-19 en diferentes artículos científicos recuperados en las bases de datos como: Frontiers, Wiley, Pubmed, Scielo y Google académico. Resultados y conclusiones: La inmensa mayoría de la población declaró no solo una reducción significativa de la actividad física diaria a, así como un aumento del tiempo sedentario, de manera general el encierro impuesto por la pandemia provocó un aumento expresivo de la conducta sedentaria con una elevación en el tiempo de mirar televisión (72,3%), conectarse a las redes sociales (81,9%) y utilizar aparatos electrónicos (82,7%). Por lo tanto, se registró una reducción del 40% -60% del tiempo dedicado a algunos ejercicios aeróbicos.

Objective: To analyze physical activity as a modifying factor in COVID-19 mortality. Methods: A review on physical activity as a modifying factor in COVID-19 mortality was carried out in different scientific articles retrieved from databases such as: Frontiers, Wiley, Pubmed, Scielo and Google Scholar. Results and conclusions: The vast majority of the population declared not only a significant reduction in daily physical activity a, as well as an increase in sedentary time, in a general way the confinement imposed by the pandemic caused an expressive increase in sedentary behavior with an elevation in the time spent watching television (72.3%), connecting to social networks (81.9%) and using electronic devices (82.7%). Thus, there was a 40% -60% reduction in time spent in some aerobic exercises.

COVID-19 y complicaciones cardiovasculares / COVID-19 and cardiovascular complications

RESUMEN Objetivo: Analizar el COVID - 19 y complicaciones cardiovasculares. Método: revisión sistemática. Análisis de los resultados: Una gran proporción de pacientes tiene enfermedad cardiovascular subyacente y factores de riesgo cardíaco. Los factores asociados con la mortalidad incluyen el sexo masculino, la edad avanzada y la presencia de comorbilidades como las enfermedades cardiovasculares. La lesión cardíaca aguda determinada por niveles elevados de troponina de alta sensibilidad se observa comúnmente en casos graves y está fuertemente asociada con la mortalidad, al igual que el síndrome de dificultad respiratoria aguda. Conclusión: La infección por el SARS-CoV-2 presenta una baja mortalidad en la mayoría de los casos, pero un porcentaje significativo de los infectados sufren una enfermedad pulmonar con diferentes grados de afección sistémica que sí conlleva mayor mortalidad. Estos pacientes presentan grados variables de afección miocárdica, tanto directa por el virus como por la situación sistémica grave, que incrementan el riesgo de muerte.

Objective: To analyze COVID-19 and cardiovascular complications. Methods: Systematic review. Analysis of results: A large proportion of patients have underlying cardiovascular disease and cardiac risk factors. Factors associated with mortality include male sex, advanced age and the presence of comorbidities such as cardiovascular disease. Acute cardiac injury as determined by elevated high-sensitivity troponin levels is commonly seen in severe cases and is strongly associated with mortality, as is acute respiratory distress syndrome. Conclusion: SARS-CoV-2 infection has a low mortality in most cases, but a significant percentage of those infected have pulmonary disease with varying degrees of systemic involvement that does lead to increased mortality. These patients have varying degrees of myocardial involvement, both direct from the virus and from the severe systemic situation, which increase the risk of death.

La atención primaria en salud renovada: el caso de Bogotá en un escenario de pandemia de COVID-19

La atención primaria en salud es la estrategia central definida por la organización Panamericana de la Salud (OPS) para alcanzar el objetivo de "Salud Para Todos" propuesto desde 1978 por Alma Ata. En la región de las américas esta estrategia ha sido incluida dentro de los sistemas de salud y se ha interpretado y adaptado a los contextos políticos, culturales, sociales y económicos de los países en vía de desarrollo. En Colombia esta propuesta ha estado inmersa y algunas normas la definen y acotan para el desarrollo en los municipios. Bogotá ha incluido esta propuesta desde hace ya varios años, y en cada cambio de gobierno se le da una connotación particular acorde con las propuestas de los planes territoriales de salud y las propuestas en los planes de desarrollo, con mayor o menor énfasis en sus postulados. Este artículo muestra el abordaje que se da desde la atención primaria en los últimos periodos de gobierno y cómo interactúa en una pandemia como la de COVID-19.

Primary health care is the central strategy defined by the Pan American Health Organization (PAHO) to achieve the goal of "Health for All" proposed since 1978 by Alma Ata. In the region of the Americas, this strategy has been included within health systems and has been interpreted and adapted to the political, cultural, social and economic contexts of developing countries. In Colombia this setting has been immersed and some regulations define and limit it for development in the municipalities. Bogotá has included this position for several years now, and in each change of government it is given a particular connotation according to the proposals of the territorial health plans and the proposals in the development plans, with or not greater emphasis on its postulates. This article shows the approach that is given from primary care in the last periods of government and how it interacts in a pandemic such as the one presented by COVID-19.

Noise intensity and its impact on the perception and concentration level among forest harvesting workers in industrial forest plantation, North Sumatera, Indonesia.

Background: Noise has the potential to affect the comfort and health of workers. The objective of this research was to find out the effect of noise caused by the timber harvesting process using chainsaws on the concentration of workers in an industrial forest plantation. Methods: This experimental study included 20 respondents which consisted of 10 chainsaw operators/helpers and 10 non-chainsaw operators. All respondents were exposed to the sound of a chainsaw in three different conditions (idle, half gas and racing conditions) with and without personal protective equipment (PPE). The sound intensity produced by the chainsaw and the noise received by the respondents were measured using a sound level meter. Respondents' perception toward noise was recorded using a Likert scale. Respondents' concentration level was assessed by giving 25 math-questions to be answered within 10 minutes. Wilcoxon sign rank test was used to analysed paired data. Results: The average sound intensity received by respondents' left and right ears were lower than the average sound intensity produced by the chainsaw. The use of earmuffs leads to better perception towards noise when compared with the use of earplugs and the absence of any PPE. The Wilcoxon test result showed that noise did not have significant impact on the concentration level of chainsaw operators, whilst the contrary result is true for non-chainsaw operators. Conclusions: The research indicated that although the noise produced by the chainsaw machine was considered noisy for both chainsaw operators and non-chainsaw operator, it did not have a significant effect on the concentration level of chainsaw operators and only affected the non-chainsaw operators. Therefore, given that the non-chainsaw operators were still affected by the noise, noise control measures are still needed to ensure occupational safety and health for the workers.

Tinnitus pulsátil asociado con shunt arteriovenosos de origen dural: reporte de caso / Pulsatile tinnitus associated with shunt arteriovenous of dural origin: case report

El tinnitus es una entidad común y al ser de características pulsátiles es importante identificar su etiología dado los riesgos y morbilidad que conlleva, como tumores de origen vascular o malformaciones arteriovenosas. Objetivo: se describe el caso de una paciente con tinnitus pulsátil asociado con un shunt arteriovenoso de origen dural que recibió tratamiento endovascular. Resultados: mostrar el seguimiento clínico y endovascular de una paciente con tinnitus pulsátil con malformación arteriovenosa y resolución de síntomas a los 18 meses de seguimiento. Discusión: la importancia de estudiar los pacientes con tinnitus pulsátil radica en determinar posibles causas de origen vascular que expliquen sus síntomas, las cuales, en su mayoría, no son evidentes en la valoración inicial. Conclusión: realizar un diagnóstico adecuado permite optimizar el tratamiento de cada paciente; en el tinnitus pulsátil asociado con shunts arteriovenosos la embolización selectiva suele ser exitosa y segura, y logra resolver por completo los síntomas.

Tinnitus is a commun entity, as it's pulsatile characteristics, it's important to identify its etiology given the risk and morbidity that entails, such as tumors of vascular origin or arteriovenous malformations. Objective: to describe the clinical case of a patient with pulsatile tinnitus associated with an arteriovenous shunt of dural origin, this patient received endovascular treatment. Results: To show the clinical followup and endovascular findings of a patient with pulsatile tinnitus with arteriovenous malformation who required endovascular treatment, the patient shows resolution of symptoms in the follow-up at 18 months. Discussion: The importance of studying patients with pulsatile tinnitus lies in determining possible causes of vascular origin that explain their symptoms, wich're mostly not evident in the initial evaluation. Conclusion: Making an adequate diagnosis allows optimizing the treatment of each patient, in pulsatile tinnitus associated with arteriovenous shunts, selective embolization's usually successful and safe, allowing the symptoms to be completely resolved.

Percepción estudiantil sobre el modelo educativo basado en la simulación / Student perception of the educational model based on simulation

Objetivo: evaluar la percepción de los estudiantes sobre un modelo educativo basado en simulación, en una escuela de medicina privada ubicada en Medellín, Colombia, respecto a su capacidad para desempeñarse en escenarios clínicos reales. Materiales y métodos: estudio transversal. La muestra fueron estudiantes de medicina del IV al XIII período académico. Los datos se recolectaron en fuentes primarias, mediante el diseño y aplicación de un cuestionario. Resultados: la muestra incluyó 300 estudiantes durante sus prácticas clínicas y pasantías y la edad promedio fue de 21,9 años. El 68,3% (n = 205) de la muestra eran mujeres. Se evaluó el nivel de satisfacción con la experiencia de usar simulación clínica; el 65,3% (n = 196) describió la experiencia como satisfactoria, el 2% (n = 6) y el 23% (n = 69) como insatisfactoria y moderadamente satisfactoria respectivamente; los participantes restantes 9,7% (n = 29) describieron la experiencia como totalmente satisfactoria. En cuanto a la percepción de las competencias desarrolladas bajo el modelo educativo se destacan el razonamiento clínico, 98% (n = 294) y la toma de decisiones, 95% (n = 285). Conclusión: los estudiantes encuestados percibieron que la simulación facilita el aprendizaje al posibilitar el desarrollo de habilidades como el trabajo en equipo y la comunicación, lo que genera un alto grado de satisfacción en los estudiantes con respecto a su proceso de formación..(Au)

Objective: to assess perception of the students on a simulation-based educational model, in a private medical school located at the municipality of Medellín, Colombia, regarding with their ability to perform in real clinical scenarios. Materials and methods: a cross sectional study. Sample were medical students from IV to the XIII academic period. Data was collected from primary sources, through the design and application of a questionnaire. Results: the sample included were 300 students during their clinical practices and clerkship, the mean age was 21.9 years. 68.3% (205) of the sample were female. We assess the level of satisfaction with the experience of using clinical simulation; 65.3% (n=196) described the experience as satisfactory, 2% (n=6) and 23% (n=69) as unsatisfactory and moderately satisfactory respectively; remaining participants described the experience as full satisfactory. Regarding the perception of the competences developed under the simulation-based education model, the main ones were 98% (n=294) clinical reasoning and 95% (n=285) decision making. Conclusion: surveyed students perceived that simulation facilitates learning by making possible the development of skills such as teamwork and communication, which generates a high degree of satisfaction in students regarding their training process..(Au)