Enhanced Two-Step Extraction from Biomass of Two Cymbopogon Species Cultivated in Santander, Colombia.

The insertion of circular economy principles into the essential oil (EO) production chain aims to reduce waste generation and make integral use of harvested plant material. Higher profits from integral use with reduced waste generation contribute to the eventual use of the EO value chain as an alternative to illicit crops in Colombia (mostly coca). In this study, Java-type citronella (Cymbopogon winterianus) and palmarosa (C. martinii) plant materials were used in two consecutive processes to obtain EOs and extracts. The residual biomass after EO distillation was subjected to ultrasound-assisted hydroethanolic extraction to afford extracts that contained bioactive compounds. Citronella and palmarosa were distilled with typical EO yields (1.0 ± 0.1% for citronella; 0.41 ± 0.06% for palmarosa; n = 5) either through hydrodistillation assisted by microwave radiation or through steam distillation, and their composition (determined via GC/FID/MS analysis) and physicochemical parameters fell within their ISO standard specifications. The concentration of citronellal, the major compound of citronella oil, was 500 ± 152 mg/g. Geraniol, the main component of palmarosa oil, was found at 900 ± 55 mg/g. The citronella and palmarosa hydroalcoholic extracts (4-11% yield) were analyzed with UHPLC-ESI-Orbitrap-MS, which permitted the identification of 30 compounds, mainly C-glycosylated flavones and hydroxycinnamic acids. Both extracts had similar antioxidant activity values, evaluated using the ABTS+● and ORAC assays (110 ± 44 µmol Trolox®/g extract and 1300 ± 141 µmol Trolox®/g extract, respectively).

Exploring physicians' perception of diagnostic information in clinical practice.

A well-informed diagnostic process results in better health outcomes and less overdiagnosis. While there have been studies conducted to explore doctors' knowledge, attitudes, and practice regarding diagnostic test information, there are no reports from Latin America. We invited physician readers of a Latin American medical journal to answer a survey on their professional and demographic characteristics and previous exposure to diagnostic information training. Two hundred fifteen responded, of whom 88% agreed to some extent that diagnostic information is helpful for clinical practice and that more training is needed. This brief exploratory survey underscores the need for more resources to train in the diagnostic process and the utilization of diagnostic information in clinical practice. However, given the limitations of this study, more evidence is needed.

Un proceso de diagnóstico bien informado da lugar a mejores resultados de salud y a menos sobrediagnósticos. Aunque se han realizado estudios para explorar los conocimientos, las actitudes y la práctica de los médicos en relación con la información sobre las pruebas diagnósticas, no existen estudios realizados en América Latina. Invitamos a los médicos lectores de una revista médica latinoamericana a responder una encuesta de opinión sobre sus características profesionales y demográficas y su exposición previa a la formación en información diagnóstica. Recibimos 215 respuestas, de las cuales el 88% estuvo de acuerdo en que la información diagnóstica es útil para la práctica clínica, y que se necesita más capacitación. Esta breve encuesta exploratoria subraya la necesidad de dedicar más recursos en la formación sobre el proceso diagnóstico y la utilización de la información diagnóstica en la práctica clínica. Sin embargo, dado las limitaciones de este estudio se hace necesario mayor evidencia al respecto.

Exploring physicians' perception of diagnostic information in clinical practice / Exploración de la percepción de los médicos sobre la información diagnóstica en la práctica clínica

A well-informed diagnostic process results in better health outcomes and less overdiagnosis. While there have been studies conducted to explore doctors' knowledge, attitudes, and practice regarding diagnostic test information, there are no reports from Latin America. We invited physician readers of a Latin American medical journal to answer a survey on their professional and demographic characteristics and previous exposure to diagnostic information training. Two hundred fifteen responded, of whom 88% agreed to some extent that diagnostic information is helpful for clinical practice and that more training is needed. This brief exploratory survey underscores the need for more resources to train in the diagnostic process and the utilization of diagnostic information in clinical practice. However, given the limitations of this study, more evidence is needed.

Un proceso de diagnóstico bien informado da lugar a mejores resultados de salud y a menos sobrediagnósticos. Aunque se han realizado estudios para explorar los conocimientos, las actitudes y la práctica de los médicos en relación con la información sobre las pruebas diagnósticas, no existen estudios realizados en América Latina. Invitamos a los médicos lectores de una revista médica latinoamericana a responder una encuesta de opinión sobre sus características profesionales y demográficas y su exposición previa a la formación en información diagnóstica. Recibimos 215 respuestas, de las cuales el 88% estuvo de acuerdo en que la información diagnóstica es útil para la práctica clínica, y que se necesita más capacitación. Esta breve encuesta exploratoria subraya la necesidad de dedicar más recursos en la formación sobre el proceso diagnóstico y la utilización de la información diagnóstica en la práctica clínica. Sin embargo, dado las limitaciones de este estudio se hace necesario mayor evidencia al respecto.

Contribución de la neuroimagen al diagnóstico y seguimiento de la esquizofrenia: una breve revisión sistemática / The neuroimaging contribution to the schizophrenia diagnosis and monitoring: a brief systematic review

RESUMEN: Introducción: La neuroimagen estructural y funcional en la esquizofrenia ha tomado fuerza en los últimos años, por lo que esta revisión tiene por objetivo describir hallazgos de esta técnica que contribuyen a la fisiopatología, diagnóstico y pronóstico de esta patología. Métodos: Se realizó una búsqueda en PubMed/Medline de estudios clínicos que abordan el estudio con neuroimágenes en la esquizofrenia. Resultados: La búsqueda arrojó 2200 resultados, de los cuales fueron incluidos 13 estudios, los que arrojaron hallazgos que se tradujeron en alteraciones neurocognitivas, tales como alteraciones funcionales y estructurales de la amígdala asociada a síntomas negativos, reducción morfométrica de la región frontal, alteraciones en la perfusión del giro del cíngulo anterior y la corteza parietal inferior izquierda, desregulación de la enzima histona deacetilasa, entre otros. Conclusiones: Esta revisión brinda una visión actualizada sobre los hallazgos de la neuroimagenología que pueden aportar a la comprensión de los mecanismos patológicos detrás de este trastorno psicótico, así como su utilidad diagnóstica y potencial contribución al seguimiento de esta enfermedad.

ABSTRACT Introduction: Structural and functional neuroimaging in schizophrenia has gained strength in recent years, so this review aims to describe neuroimaging findings that contribute to the physiopathological understanding, monitoring, and diagnosis of this pathology. Methods: A PubMed/Medline search was conducted for clinical studies addressing neuroimaging in schizophrenia. Results: The search yielded 2200 results, from which 13 studies were included, which provided findings, such as functional and structural alterations of the amygdala, which have shown to be associated with negative symptoms; morphometric reduction of the frontal region, alterations in the perfusion of the anterior cingulate gyrus and the lower-left parietal cortex, deregulation of the histone deacetylase enzyme, among others which translate clinically in neurocognitive deficits. Conclusions: This review provides an updated view on the findings of neuroimaging that can contribute to the understanding of the pathological mechanisms behind this psychotic disorder, its diagnostic usefulness, and its potential contribution to the prognosis and follow-up of this disease.

Incongruencia de género en adolescentes con trastorno del espectro autista: Evaluación e intervención transafirmativa / Gender incongruence in adolescents within the autism spectrum disorder: Transaffirmative evaluation and intervention

En la población con incongruencia de género (IG) hay un alto número de personas con Trastornos del Espectro Autista (TEA). Existe reciente y escaso conocimiento respecto de la co-ocurrencia de estas entidades, por lo que los objetivos de este estudio son, en primer lugar, realizar una revisión bibliográfica en relación a la prevalencia, etiología, desarrollo, salud mental en la población adolescente con esta co-ocurrencia IG, TEA y género diverso y a partir de esta descripción poder, en segundo lugar, entregar sugerencias para profesionales respecto del apoyo en evaluación e intervención de estas condiciones. Método: Se realizó una búsqueda en PUBMED, Scielo y Google académico, artículos en inglés y español, desde el año 2005 a 2021. Resultados: Se informa de una prevalencia de 5,0 a 26% aproximadamente de personas TEA en población IG, sobre todo en mujeres asignadas al nacer. En la evaluación se requiere profesionales que conozcan tanto el área de IG y TEA. No debe excluirse a las personas con TEA de las intervenciones médicas y se debe realizar seguimiento de las dificultades sensoriales. Conclusiones: Es importante apoyar a estas (os, es) adolescentes en la afirmación de sus necesidades de género de manera individual y/o grupal, al igual que a sus familias.

Abstract. Introduction: In the population with gender incongruence (GI), there is a high prevalence of people with autism spectrum disorder (ASD). However, there is scarce and fairly recent knowledge about its co-occurrence. As a result, the purpose of this study is, first, to make a bibliographic review regarding the prevalence, etiology, development, mental health of the adolescent population with a co-occurrence of GI, ASD, and gender diversity, and from this description, to provide suggestions to professionals to support assessments and interventions when facing these conditions. Methods: A search was made in PUBMED, Scielo, and Google Scholar, for articles in English and Spanish, from 2005 to 2021. Results: A prevalence of approximately 5.0 to 26% is reported, of people with ASD in the GI population, especially among women assigned at birth. In the assessment, professionals that know both areas are required. People with ASD must not be excluded from medical interventions, and a follow-up must be made on sensory issues. Conclusions: It is important to support these adolescents, as well as their families, in the affirmation of their gender needs, whether individually and/or in groups.

Autoinmunidad, convulsiones y epilepsia: breve revisión sistemática / Autoimmunity, seizures and epilepsy: a brief systematic review

INTRODUCCIÓN: La epilepsia es un desorden neurológico crónico caracterizado por crisis convulsivas recurrentes, y constituye uno de los trastornos neurológicos con mayor prevalencia global. Una de las etiologías que ha cobrado mayor relevancia en el último tiempo es la autoinmunidad, la que ha venido a dar explicación a muchos casos de epilepsia idiopática o refractaria a tratamientos convencionales. MÉTODOS: Se realizó una búsqueda avanzada asociada a filtros en la plataforma PubMed con los términos "epilepsy" y "autoimmunity". Se seleccionaron 17 artículos de un total de 98 publicados desde el año 2010 en adelante, y que aportaban mas datos desde la fisiopatología. RESULTADOS: En base a la literatura, se describen los principales mecanismos de autoinmunidad que generan epilepsia entre los destacan generación de auto-anticuerpos, desregulación del perfil de citoquinas y pérdida del control de linfocitos T autorreactivos, fenómenos que redundan en neuroinflamación y que se originan en el contexto de infecciones, síndromes paraneoplásicos, autoinmunidad materna transferida a hijos, encefalitis autoinmune, entre otras. CONCLUSIONES: En los últimos años ha habido grandes avances en la comprensión de la epilepsia autoinmune, sin embargo, aún queda mucho por comprender. Pese a lo prometedor que es el descubrimiento de anticuerpos, existen muchos casos de epilepsia con seronegatividad, o casos con la presencia de anticuerpos, pero no la epilepsia autoinmune. Cabe destacar que se debe precisar mecanismos diagnósticos eficaces y específicos que permitan generar protocolos terapéuticos atingentes y resolutivos.

Epilepsy is a neurological chronic disorder which is characterized by recurrent seizures and constitutes one of the most prevalent neurological disorders worldwide. One of the etiologies that has gained a lot of strength is autoimmunity, which has explained a lot of cases of idiopathic epilepsy or epilepsies refractory to common treatment. METHODS: An advanced search was made in the PubMed platform using filters with the terms "epilepsy" and "autoimmunity", showing 98 publications from 2010 onwards, leaving only 17 selected articles because of their pathophysiological information. RESULTS: Based on the literature, we described the main mechanisms of autoimmunity as a cause of epilepsy, standing out the ones related to auto-antibodies production, cytokines disregulation and autoreactive T lymphocytes control alteration, phenomenons related to neuroinflammation that arise from the context of infections, paraneoplastic syndromes, maternal autoimmunity transmitted to their babies, autoimmune encephalitis, etc. CONCLUSIONS: Great advances has been made on the understanding of autoimmune epilepsy in the last years, but despite this there's a lot that we need to comprehend. Although how promising was the discovery of antibodies there's still a lot of seronegative cases or cases with antibodies but without the epilepsy. It is worth mentioning that it becomes necessary to establish efficient and specific diagnostic mechanisms that allow us to create suitable and resolutive therapeutic protocols.

Analysis of the relationship between treatment networks and the evolution of patients with Type 2 Diabetes Mellitus.

Type 2 Diabetes Mellitus (T2DM) is a chronic disease that has been increasing in prevalence in recent years and that can cause severe complications. To ensure patient care is administered correctly, it is necessary for medical treatment teams to be both multidisciplinary and cohesive. The analysis of health processes is a constant challenge due to their high variability and complexity. This paper proposes a method based on the analysis of social networks to detect treatment networks, and to identify a relationship between these networks and patient evolution, as measured by glycated hemoglobin (HbA1c) levels. The networks were segmented based on patient adherence to their medical appointments and their mean time of delay. We applied this method on a sample of 1574 patients diagnosed with T2DM. Results show that participatory treatment -in which a patient sees a particular group of professionals on a recurrent basis - together with high levels of adherence are associated to those patients who improve their HbA1c levels in the case of high levels of adherence, while those who continually experience referrals to different professionals, remain unstable and, in some cases, get worse. On the other hand, in order to maintain a patient as stable, continuous control of the patient is enough, regardless of the recurrence to the same professionals.

[Severe sepsis and septic shock by Escherichia coli, clinical and microbiological analysis in Medellin, Colombia]. / Análisis clínico y microbiológico de la sepsis grave y el choque séptico por Escherichia coli en Medellín, Colombia.

BACKGROUND: Escherichia coli is a common cause of a broad spectrum of infections, from non-complicated urinary tract infection, to severe sepsis and septic shock, that are associated to high impact outcomes, such as ICU admission and mortality. AIMS: To establish differences in mortality, ICU admission, ESBL positive strains and antibiotic treatment, between patients with E. coli related severe sepsis and septic shock, with or without bacteremia and its variability based on the source of infection. METHOD: Secondary data analysis of a multicentric prospective cohort study. RESULTS: From 458 patients with E. coli isolation, 123 had E. coli exclusively in blood culture, 222 solely in urine culture, and 113 in both samples. Escherichia coli isolation exclusively in blood culture was associated with higher frequency of ICU admission (n = 63; 51.2%), higher rate of mechanical ventilation requirement (n = 19; 15.5%), higher mortality and longer hospital stay (n = 22; 18%; median of 12 days, IQR= 7 - 17, respectively); but with a lower occurrence of ESBL strains, compared to patients with positive urine culture and positive blood/urine cultures (n = 20; 17.7% and n = 46; 20.7%, respectively). 424 patients (92.6%) received antibiotic treatment in the first 24 hours. The most commonly prescribed was piperacilin/tazobactam (n = 256;60.3%). The proportion of patients empirically treated with carbapenems vs non-carbapenems was similar in the three groups. DISCUSSION: The source of infection, associated with ESBL strains risk factors, are useful tools to define prognosis and treatment in this population, because of their clinical and microbiological variability. CONCLUSION: Patients with E. coli isolation exclusively in the blood culture had higher frequency of non-favorable outcomes in comparison to patients with E. coli in urine culture with or without bacteremia. Additionally, in our population patients with E. coli solely in blood culture have lower prevalence of ESBL positive strains.

Análisis clínico y microbiológico de la sepsis grave y el choque séptico por Escherichia coli en Medellín, Colombia / Severe sepsis and septic shock by Escherichia coli, clinical and microbiological analysis in Medellin, Colombia

Resumen Introducción: Escherichia coli es causa frecuente de un amplio espectro de infecciones, desde una infeccion urinaria no complicada hasta la sepsis grave y el choque septico, asociadas con desenlaces de alto impacto como ingreso a UCI y mortalidad. Objetivos: Determinar las diferencias en mortalidad. ingreso a UCI/UCE, presencia de cepas BLEE y tratamiento antimicrobiano en pacientes con sepsis grave y choque séptico por E. coli, con o sin bacteriemia, asi como su variabilidad dependiendo del foco infeccioso. Material y Métodos: Análisis secundario de estudio de cohorte prospective multicéntrico. Resultados: De 458 pacientes que tenian infeccion por E. coli, 123 tenian aislamiento solo en hemocultivo, 222 solo en urocultivo y 113 en ambas muestras. El aislamiento solo en hemocultivo se asocio mayor frecuencia de ingreso a UCI (n = 63; 5,2%). mayor necesidad de ventilacion mecánica (n = 19; 15,5%), mayor mortalidad y estancia hospitalaria (n = 22; 18%; mediana de 12 dias, RIQ= 7-17, respectivamente), pero con menor presencia de cepas productoras de BLEE en comparacion con urocultivos y hemocultivo, urocultivo (n = 20; 17,7% y n = 46; 20,7%, respectivamente). Recibieron tratamiento antimicrobiano en las primeras 24 h 424 pacientes (92,6%), con mas frecuencia piperacilina/ tazobactam (n = 256,60,3%). La proporcion de pacientes tratados empiricamente con carbapenemicos vs no carbapenemicos fue similar en los tres grupos. Discusión: El foco infeccioso. sumado a factores de nesgo para cepas productoras de BLEE, son herramientas utiles para definir pronostico y tratamiento en esta población, debido a la variabilidad clínica y microbiologica en los distintos aislados. Conclusión: Los pacientes con aislamiento de E. coli solo en hemocultivo presentan con mayor frecuencia desenlaces desfavorables en comparación con los pacientes con E. coli en urocultivo, con o sin bacteriemia. Llama la atencion en nuestro medio la menor cantidad de cepas productoras de BLEE en los pacientes con solo hemocultivo positivo.

Background: Escherichia coli is a common cause of a broad spectrum of infections, from non-complicated urinary tract infection, to severe sepsis and septic shock, that are associated to high impact outcomes, such as ICU admission and mortality. Aims: To establish differences in mortality, ICU admission, ESBL positive strains and antibiotic treatment, between patients with E. coli related severe sepsis and septic shock, with or without bacteremia and its variability based on the source of infection. Method: Secondary data analysis of a multicentric prospective cohort study. Results: From 458 patients with E. coli isolation, 123 had E. coli exclusively in blood culture, 222 solely in urine culture, and 113 in both samples. Escherichia coli isolation exclusively in blood culture was associated with higher frequency of ICU admission (n = 63; 51.2%), higher rate of mechanical ventilation requirement (n = 19; 15.5%), higher mortality and longer hospital stay (n = 22; 18%; median of 12 days, IQR= 7 - 17, respectively); but with a lower occurrence of ESBL strains, compared to patients with positive urine culture and positive blood/urine cultures (n = 20; 17.7% and n = 46; 20.7%, respectively). 424 patients (92.6%) received antibiotic treatment in the first 24 hours. The most commonly prescribed was piperacilin/tazobactam (n = 256;60.3%). The proportion of patients empirically treated with carbapenems vs non-carbapenems was similar in the three groups. Discussion: The source of infection, associated with ESBL strains risk factors, are useful tools to define prognosis and treatment in this population, because of their clinical and microbiological variability. Conclusion: Patients with E. coli isolation exclusively in the blood culture had higher frequency of non-favorable outcomes in comparison to patients with E. coli in urine culture with or without bacteremia. Additionally, in our population patients with E. coli solely in blood culture have lower prevalence of ESBL positive strains.

Analysis of the Relationship between the Referral and Evolution of Patients with Type 2 Diabetes Mellitus.

Type 2 Diabetes Mellitus (T2DM) is a chronic disease that has risen in prominence in recent years and can cause serious complications. Several studies show that the level of adherence to different types of treatment has a direct correlation with the positive evolution of chronic diseases. While such studies relate to patient adherence to medication, those that concern adherence to medical appointments do not distinguish between the different disciplines that attend to or refer patients. This study analyses the relationship between adherence to referrals made by three distinct disciplines (doctors, nurses, and nutritionists) and the results of HbA1c tests from a sample of 2290 patients with T2DM. The aim is to determine whether a relationship exists between patient improvement and the frequency with which they attend scheduled appointments in a timely manner, having been previously referred from or to a particular discipline. Results showed that patients tended to be more adherent when their next appointment is with a doctor, and less adherent when it is with a nurse or nutritionist. Furthermore, patients that remained stable had higher rates of adherence, whereas those with lower adherence tended to be more decompensated. The results can enable healthcare professionals to monitor patients and place particular emphasis on those who do not attend their scheduled appointments in a timely manner.

Ronda clínica y epidemiológica: club de revistas / Clinical and epidemiological round: journal club

RESUMEN En esta edición de la Ronda Clínica y Epidemiológica presentamos cuatro artículos que desde la práctica clínica consideramos de especial interés. Wan-Chuan, et al., contribuyen con una revisión sistemática y meta-análisis a la discusión de las metas ideales de presión arterial en pacientes hipertensos, esta vez desde una perspectiva diferente: impacto de metas intensivas de presión arterial en pacientes no diabéticos con enfermedad renal crónica. Adicionalmente, Valent, et al., realizan un ensayo clínico aleatorizado para estudiar el efecto de la profilaxis antibiótica postoperatoria en el riesgo de infección de sitio operatorio en gestantes obesas llevadas a cesárea. Por otro lado, Miro, et al., siguen una cohorte de pacientes con falla cardíaca aguda para probar la posibilidad de predecir la mortalidad usando información que puede obtenerse desde el ingreso a urgencias. Para finalizar, Andersson, et al., traen una propuesta prometedora para mejorar el enfoque diagnóstico de pacientes con sospecha de apendicitis y el impacto en el uso de recursos en esta población.

SUMMARY In this edition of the clinical and epidemiological round, we present four articles that we consider relevant from a clinical point of view. Wan-Chuan, et al., contribute with a systematic review and meta-analysis to the discussion of the ideal blood pressure goals, this time from a different perspective: impact of intensive blood pressure goals in non-diabetic patients with chronic kidney disease. In addition, Valent et al., performed a randomized clinical trial to study the effect of the post-operatory prophylaxis in the risk of infection of the surgical site in obese pregnant women underwent a cesarean section. On the other hand, Miro et al. followed a cohort of patients with acute heart failure to prove the possibility to predict mortality using information which can be taken in the emergency room. To conclude, Andersson et al., bring a promising proposal to improve the diagnostic approach in patients in which an appendicitis is suspected, as well as its impact in the use of the resources.

Discovering role interaction models in the Emergency Room using Process Mining.

OBJECTIVES: A coordinated collaboration among different healthcare professionals in Emergency Room (ER) processes is critical to promptly care for patients who arrive at the hospital in a delicate health condition, claiming for an immediate attention. The aims of this study are (i) to discover role interaction models in (ER) processes using process mining techniques; (ii) to understand how healthcare professionals are currently collaborating; and (iii) to provide useful knowledge that can help to improve ER processes. METHODS: A four step method based on process mining techniques is proposed. An ER process of a university hospital was considered as a case study, using 7160 episodes that contains specific ER episode attributes. RESULTS: Insights about how healthcare professionals collaborate in the ER was discovered, including the identification of a prevalent role interaction model along the major triage categories and specific role interaction models for different diagnoses. Also, common and exceptional professional interaction models were discovered at the role level. CONCLUSIONS: This study allows the discovery of role interaction models through the use of real-life clinical data and process mining techniques. Results show a useful way of providing relevant insights about how healthcare professionals collaborate, uncovering opportunities for process improvement.

Ronda clínica y epidemiológica: club de revistas / Clinical and epidemiological round: journal club

RESUMEN En esta edición de la Ronda Clínica y Epidemiológica analizamos cuatro artículos que consideramos importantes para la práctica clínica. El estudio del grupo SPIROMICS busca replantear la necesidad de la espirometría para el diagnóstico de enfermedad pulmonar obstructiva crónica (EPOC), especialmente en los pacientes con antecedente de tabaquismo que tienen función pulmonar normal, pero desarrollan desenlaces de enfermedad pulmonar crónica. Borja-Gómez y colaboradores, por otro lado, validan un enfoque sistemático para descartar infecciones bacterianas invasivas en niños febriles menores de 3 meses. El estudio de Talan y colaboradores estima la utilidad del tratamiento antibiótico con trimetoprim-sulfametoxazol, adicional al drenaje quirúrgico, como una estrategia para mejorar la curación de abscesos en piel en una población con alta prevalencia de Staphylococcus aureus resistente a meticilina (MRSA). Por último, el estudio del grupo EAT que analiza la introducción de alimentos alergénicos en lactantes a partir de los 3 meses, como una estrategia para proteger contra el desarrollo de reacciones alérgicas alimentarias posteriores.

SUMMARY In this edition of Ronda Clínica y Epidemiológica four articles that we consider important for clinical practice are analyzed. The study by the SPIROMICS group wanted to rethink the use of spirometry for the diagnosis of chronic obstructive pulmonary disease (COPD), mainly in symptomatic patients with smoking history and preserved pulmonary function, but with outcomes similar to those developed in chronic pulmonary disease. Borja Gómez et al. aimed at validating a step-by-step approach for young febrile infants, in order to discard an invasive bacterial infection. The study by Talan et al. wanted to demonstrate that antibiotic therapy with trimethoprim-sulfamethoxazole, in addition to surgical drainage, was associated with a higher cure rate for cutaneous abscesses compared to placebo in a population with high prevalence of methicillinresistant Staphylococcus aureus (MRSA) infection. Lastly, the EAT study analyzed the early introduction of allergenic foods in breast-fed infants, starting at the age of 3 months, as a strategy to protect them against the development of posterior food allergy.

Sistema de evaluación de habilidades psicomotrices en cirujanos de laparoscopia / An Assessment of Psychomotor Skills in Laparoscopy / Sistema de avaliação de habilidades psicomotoras em cirurgiões de laparoscopia

Objetivo: este estudio tiene como propósito diseñar y validar un sistema de evaluación objetivo y práctico de habilidades psicomotrices en laparoscopia que permita discriminar la competencia de los cirujanos. Materiales y métodos: fue llevado a cabo en el Centro de Simulación Clínica de la Universidad Javeriana. Voluntariamente participaron seis cirujanos expertos, seis residentes de cirugía y seis estudiantes de Medicina. Cada participante hizo una evaluación compuesta por ocho actividades en simuladores de caja con instrumental regular de laparoscopia. Los resultados obtenidos en los tres grupos fueron analizados por medio de un Anova y un test de Tukey. Además, se hizo un análisis de validez por fuentes de evidencia y la fiabilidad del sistema de evaluación se valoró con alfa de Cronbach. Resultados: tres actividades evaluativas discriminaron los tres grupos de estudio o grados de competencia (novato, intermedio y experto) y otras dos actividades revisaron dos de los grupos. La validez del sistema de evaluación fue comprobada al considerar el contenido, la respuesta del proceso, la estructura interna y las consecuencias de la evaluación. La fiabilidad del sistema de evaluación fue sobresaliente (alfa de Cronbach=0,90). Conclusión: el sistema de evaluación propuesto es una herramienta viable en procesos de formación de cirujanos que permite complementar el método tradicional de evaluación.

Objective: this study aims at designing and validating an objective and practical assessment of psychomotor skills in laparoscopy. This assessment would allow a classification of the surgeons and residents by their psychomotor competence. Materials and methods: this study evaluated the psychomotor competence of three groups of voluntaries: experts (6 senior surgeons), residents (6 surgery residents), and novices (6 students of medical school). The assessment was performed at the Clinical Simulation Center in the Pontificia Universidad Javeriana. The assessment was designed as a composition of eight different activities to be performed by each of the participants in a box trainer and using minimally invasive surgical instruments. The results were analyzed using an Anova and a Tukey's test. Additionally, a validity test by evidence source and the assessment reliability was evaluated using a Cronbach's alpha analysis. Results: three of the eight assessment's activities correctly discriminated three study groups, and other two activities only discriminate two of the three groups. The validity of the assessment was positively evaluated using a content analysis, the response to the assessment, the internal structure and the possible future consequences of the assessment. The reliability of the assessment was considered excellent (Cronbach's alpha=0,90). Conclusion: the propose assessment is a good alternative in formative processes of surgeons and allows to complement the traditional assessment method in surgery education.

Objetivo: este estudo tem como objetivo desenhar e validar um sistema de avaliação objetiva e prática de habilidade psicomotoras em laparoscopia que permita discriminar o nível de competência dos cirurgiões. Metodologia: O estudo foi levado a cabo no Centro de Simulação Clínica da Universidad Javeriana onde voluntariamente participaram 6 cirurgiões expertos, 6 residentes de cirurgia e 6 estudantes de medicina. Cada participante realizou uma avaliação composta por oito atividades em simuladores de caixa com instrumental regular de laparoscopia. Os resultados obtidos pelos três grupos de participantes foram analisados através de um ANOVA e um teste de Tukey. Adicionalmente, realizou-se uma análise de validez por fontes de evidência e a fiabilidade do sistema de avaliação valorou-se empregando uma análise de Alpha de Cronbach. Resultados: três atividades avaliativas discriminaram os três grupos de estudo ou níveis de competência (novato, intermédio e experto), e outras duas atividades discriminaram dois dos grupos. A validez do sistema de avaliação foi comprovada ao considerar o conteúdo, a resposta do processo, a estrutura interna e as consequências da avaliação. A fiabilidade do sistema de avaliação foi sobressalente (Alpha de Cronbach=0,90). Conclusão: O sistema de avaliação proposto é uma ferramenta viável em processos de formação de cirurgiões que permite complementar o método tradicional de avaliação de médicos cirurgiões.

Ronda clínica y epidemiológica: club de revistas / Clinical and epidemiological round: journal club / Ronda clínica e epidemiológica: clube de revistas

En esta nueva edición de la Ronda Clínica y Epidemiológica analizamos cuatro estudios que consideramos importantes para la práctica clínica. El estudio SOME, en el cual Carrier y colaboradores evaluaron la eficacia de la tamización para el cáncer oculto en pacientes con primer episodio no provocado de tromboembolia venosa. El estudio de Freedman y colaboradores muestra que el uso de jugo de manzanas y líquidos elegidos libremente no es inferior a las soluciones hidroelectrolíticas en la terapia de rehidratación oral en pacientes pediátricos con gastroenteritis aguda de bajo riesgo. Gágyor y colaboradores investigaron sobre el uso de ibuprofeno comparado con el de fosfomicina en el tratamiento sintomático de las infecciones urinarias no complicadas. Finalmente, el metaanálisis de Martindale y colaboradores consolida una información valiosa respecto a las pruebas que se deben hacer en el diagnóstico de falla cardíaca aguda.

In this new edition of Ronda Clínica y Epidemiológica, four studies that we consider important for clinical practice are analyzed. The SOME study, in which Carrier et al., evaluated the efficacy of a screening strategy for occult cancer in patients with a first unprovoked venous thromboembolism. The study by Freedman et al., shows that the use of apple juice is not inferior to oral electrolyte maintenance solution in children with mild gastroenteritis. Gágyor et al., investigated about the use of ibuprofen versus fosfomycin for treating symptoms of uncomplicated urinary tract infection. Finally, the meta-analysis of Martindale et al., provided valuable information about the tests that should be done in the diagnosis of acute heart failure.

Nesta nova edição da Ronda Clínica e Epidemiológica analisamos quatro estudos que consideramos importantes para a prática clínica. O estudo SOME, no qual Carrier e colaboradores avaliaram a eficácia da tamisação para o câncer oculto em pacientes com primeiro episódio não provocado de tromboembolia venosa. O estudo de Freedman e colaboradores mostra que o uso de suco de maçãs e líquidos elegidos livremente não é inferior às soluções hidroeletrolíticas na terapia de reidratação oral em pacientes pediátricos com gastroenterite aguda de baixo risco. Gágyor e colaboradores investigaram sobre o uso de Ibuprofeno comparado com o de Fosfomicina no tratamento sintomático das infeções urinárias não complicadas. Finalmente, a meta-análise de Martindale e colaboradores consolida uma informação valiosa com respeito às provas que se deve fazer no diagnóstico de falha cardíaca aguda.

Trauma severity indices / Trauma severity scores

Introduction: Throughout the years, several methods have been developed to help determine injury severity and obtain accurate prognoses in trauma patients. Trauma scores that have been used for more than 40 years are extremely useful in clinical practice as well as in research. Objective: To conduct a review of the most relevant literature on trauma and to make a description of each of the scoring tools, focusing on their limitations and their application in clinical trials. Materials and methods: Narrative review conducted in different databases such as PubMed, ScienceDirect and OVID. A manual search was also conducted of articles on the subject in both English and Spanish. Results: The review articles provided an adequate description of each of the scores, the way they are calculated, the main limitations in their application, and the most relevant findings in the literature. Conclusion: There is a wide range of severity scores used in trauma patients for anticipating clinically significant outcomes with varying degrees of accuracy. Creating and validating a single, universally valid score is a huge challenge; consequently, the selection of the scoring tool is based, to a large extent, on experience, the context and the available evidence.

Introducción: a lo largo de la historia se han creado varios métodos para evaluar la gravedad de las lesiones y brindar un pronóstico exacto en pacientes con trauma. Los puntajes en trauma que se han utilizado por más de 40 años son una herramienta de gran utilidad tanto para el contexto clínico como investigativo. Objetivo: elaborar una revisión de la literatura más relevante sobre los puntajes en trauma y hacer una descripción de cada una de estas herramientas, haciendo énfasis en sus limitaciones y en la aplicación en estudios clínicos. Materiales y Métodos: revisión narrativa, se consultaron diferentes bases de datos como PubMed, ScienceDirect y OVID; además, se hizo búsqueda manual de artículos en inglés y en español sobre el tema. Resultados: los artículos revisados permitieron hacer una descripción adecuada de cada uno de los puntajes, de la forma en que se calculan, sus principales limitaciones al momento de aplicarlos y los hallazgos más notables en la literatura. Conclusión: existe una gran variedad de puntajes de gravedad para pacientes con trauma que permiten anticipar con diferente exactitud los desenlaces clínicamente significativos. La creación y validación de un único puntaje universalmente válido es todo un reto; por ello la selección de esta herramienta está basada en gran parte en la experiencia, el contexto y la evidencia disponible.