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Background: Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects. Objective: To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia. Methods: Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Generalized Linear Model (GLM) for non-normally distributed data. The effect size was estimated with Eta Square ([Formula: see text]), considering values ≥0.38 as indicative of large effects. A two-tailed p-value < 0.05 was deemed statistically significant. Results: Statistically significant differences in pain scores were noted at 0 and 6 hours post-surgery (p<0.01). The TAP block group reported lower pain scores at 0 hours (mean=0.04) and 6 hours (mean=1.16) compared to the epidural group, reflecting a substantial effect size. Conclusion: The TAP block proves advantageous in mitigating postoperative pain for women post-caesarean delivery, particularly in the initial 6 postpartum hours. This relief promotes early mother-infant bonding and facilitates breastfeeding.
RESUMO
Resumen El proceso de enseñanza en medicina tiene desafíos que pueden inducir estrés académico y con ello afectaciones a la salud mental, por lo que es imprescindible el cuidado de la salud mental de los futuros médicos. Este estudio quiso identificar los factores asociados a la salud mental de estudiantes de medicina de una universidad privada en Colombia, ajustados por estrés académico. Mediante un diseño transversal, se reclutaron 443 estudiantes (68.4% mujeres, 31.6% hombres) quienes completaron un cuestionario con variables sociodemográficas, académicas, el Inventario Cognitivo Sistémico para el Estudio del Estrés Académico y el inventario Symptom Checklist-90-Revised. Los factores de riesgo se analizaron utilizando un Modelo Lineal Generalizado por la familia de Poisson y log link. El 38,3% de los estudiantes presentó un nivel de riesgo en salud mental. Los factores protectores incluyeron actividad física regular (RPa = 0.78) y actividades extracurriculares (RPa = 0.75), mientras que los factores de riesgo fueron uso de sustancias psicoactivas (RPa = 1.36), bebidas energéticas (RPa = 1.35) y tener una ocupación alternativa al estudio (RPa = 1.47). La salud mental de los estudiantes de medicina presenta riesgos más allá de la misma exigencia académica. Hay elementos del individuo y la institución formadora que pueden actuar como factores protectores, lo que se convierte en un insumo para la creación de programas de cuidado y mantenimiento de la salud mental.
Abstract The teaching process in medicine has challenges that can induce academic stress and thus affect mental health, so it is essential to take care of the mental health of future physicians. This study aimed to identify the factors associated with the mental health of medical students at a private university in Colombia, adjusted for academic stress. Using a cross-sectional design, 443 students were recruited (68.4% women, 31.6% men) who completed a questionnaire with sociodemographic and academic variables, the Systemic Cognitive Inventory for the Study of Academic Stress and the Symptom Checklist-90-Revised inventory. Risk factors were analyzed using a Generalized Linear Model by Poisson family and log link. Thirty-eight point three percent of the students presented a level of mental health risk. Protective factors included regular physical activity (RPa = 0.78) and extracurricular activities (RPa = 0.75), while risk factors were psychoactive substance use (RPa = 1.36), energy drinks (RPa = 1.35) and having an alternative occupation to studying (RPa = 1.47). The study provided information on the need for intervention in factors beyond academic stress, seeking to maintain the well-being of students and thus avoid academic dropout.
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ABSTRACT One of the main challenges in the clinical management of dengue is the early identification of cases that could progress to severe forms of the disease. A biomarker that may enable this identification is the presence of genetic polymorphisms in genes associated with immune responses. The objective of this study was to perform a systematic review of the Latin American literature on these genes. An electronic literature search was carried out in PubMed, Scopus, Lilacs, and the Virtual Health Library, and reference lists of systematic reviews in the area. Case-control studies conducted in Latin American countries examining at least one form of genetic polymorphism related to immune responses against severe dengue were included. In total, 424 articles were identified and 26 were included in this systematic review. Of the 26 selected articles, 16 reported polymorphisms associated with the risk of developing severe dengue (Risk); Similarly, 16 articles reported polymorphisms associated with a decreased risk of severe dengue (Protective). The final analysis revealed that multiple polymorphisms in immune system genes were early markers of the progression of dengue in Latin Americans and found that polymorphisms of the TNF-alpha gene may have a critical role in dengue pathogenesis.