A Social Ecological Approach to Latino Immigrant Trauma and Intervention: An Integrative Review.

This paper presents an application that can be taken when conducting mental health intervention within the Latino immigrant population. Using a social ecological lens, it provides an overview of experiences and factors to detail the characteristics, trauma, and resilience factors present within this population. Utilizing Ungar's framework on resilience, that decenters the individual from experiences of trauma to position them alongside their social network and resources, it proposes an application for future intervention and research efforts. Addressing intervention at a foundational level allows for the supplementing and shaping of current methods to address the mental health needs of this community.

Neurological and neuropsychological sequelae of Zika virus infection in children in León, Nicaragua.

Objectives: To describe the presence and persistence of neurological and neuropsychological sequelae among children with acquired Zika virus infection and assess whether those sequelae were more common in children infected with Zika virus compared to uninfected children. Methods: We conducted a prospective cohort study of children with and without Zika virus infection in León, Nicaragua, using a standard clinical assessment tool and questionnaire to collect data on symptoms at three visits, about 6 months apart, and a battery of standardized instruments to evaluate neurocognitive function, behavior, depression, and anxiety at the last two visits. Results: Sixty-two children were enrolled, with no significant differences in demographics by infection group. Children infected with Zika virus had a range of neurological symptoms, some of which persisted for 6 to 12 months; however, no consistent pattern of symptoms was observed. At baseline a small percentage of children infected with Zika virus had an abnormal finger-to-nose test (13%), cold touch response (13%), and vibration response (15%) versus 0% in the uninfected group. Neurocognitive deficits and behavioral problems were common in both groups, with no significant differences between the groups. Children infected with Zika virus had lower cognitive efficiency scores at the 6-month visit. Anxiety and depression were infrequent in both groups. Conclusions: Larger studies are needed to definitively investigate the relationship between Zika virus infection and neurological symptoms and neurocognitive problems, with adjustment for factors affecting cognition and behavior, including mood and sleep disorders, home learning environment, history of neuroinvasive infections, and detailed family history of neuropsychological problems.

Neurological and neuropsychological sequelae of Zika virus infection in children in León, Nicaragua

[ABSTRACT]. Objectives. To describe the presence and persistence of neurological and neuropsychological sequelae among children with acquired Zika virus infection and assess whether those sequelae were more common in children infected with Zika virus compared to uninfected children. Methods. We conducted a prospective cohort study of children with and without Zika virus infection in León, Nicaragua, using a standard clinical assessment tool and questionnaire to collect data on symptoms at three visits, about 6 months apart, and a battery of standardized instruments to evaluate neurocognitive function, behavior, depression, and anxiety at the last two visits. Results. Sixty-two children were enrolled, with no significant differences in demographics by infection group. Children infected with Zika virus had a range of neurological symptoms, some of which persisted for 6 to 12 months; however, no consistent pattern of symptoms was observed. At baseline a small percentage of children infected with Zika virus had an abnormal finger-to-nose test (13%), cold touch response (13%), and vibration response (15%) versus 0% in the uninfected group. Neurocognitive deficits and behavioral problems were common in both groups, with no significant differences between the groups. Children infected with Zika virus had lower cognitive efficiency scores at the 6-month visit. Anxiety and depression were infrequent in both groups. Conclusions. Larger studies are needed to definitively investigate the relationship between Zika virus infec- tion and neurological symptoms and neurocognitive problems, with adjustment for factors affecting cognition and behavior, including mood and sleep disorders, home learning environment, history of neuroinvasive infec- tions, and detailed family history of neuropsychological problems.

[RESUMEN]. Objetivos. Describir la presencia y persistencia de secuelas neurológicas y neuropsicológicas en pacientes pediátricos que contrajeron la infección por el virus del Zika y evaluar si dichas secuelas fueron más comunes en los infectados con el virus del Zika en comparación con los no infectados. Métodos. Se realizó un estudio de cohorte prospectivo en pacientes pediátricos con y sin infección por el virus del Zika en León (Nicaragua), con una herramienta de evaluación clínica estándar y un cuestionario para recopilar datos sobre los síntomas en tres visitas, con aproximadamente seis meses de diferencia, y un con- junto de instrumentos estandarizados para evaluar la función neurocognitiva, el comportamiento, la depresión y la ansiedad en las últimas dos visitas. Resultados. Participaron 62 niños y niñas sin diferencias significativas en la demografía por grupo de infección. Los participantes infectados con el virus del Zika mostraron una variedad de síntomas neurológi- cos, algunos de los cuales persistieron entre 6 y 12 meses; no obstante, no se observó un patrón sistemático en los síntomas. Al inicio del estudio, un pequeño porcentaje de participantes infectados con el virus del Zika mostró resultados anormales a las pruebas dedo-nariz (13%), respuesta al tacto (frío) (13%) y respuesta a la vibración (15%), frente a un 0% en el grupo no infectado. Los déficits neurocognitivos y los problemas de comportamiento fueron comunes en ambos grupos, sin diferencias significativas entre los grupos. Los partic- ipantes infectados con el virus del Zika mostraron puntuaciones de eficiencia cognitiva más bajas en la visita a los 6 meses. La ansiedad y la depresión fueron poco frecuentes en ambos grupos. Conclusiones. Son necesarios estudios más amplios para investigar definitivamente la relación entre la infec- ción por el virus del Zika y los síntomas neurológicos y los problemas neurocognitivos, haciendo ajustes para los factores relacionados con la cognición y el comportamiento, incluidos los trastornos del estado de ánimo y el sueño, el entorno de aprendizaje en el hogar, los antecedentes de infecciones neuroinvasivas y los antecedentes familiares detallados de problemas neuropsicológicos.

[RESUMO]. Objetivos. Descrever a presença e a persistência de sequelas neurológicas e neuropsicológicas em crianças com infecção pelo vírus zika e avaliar se essas sequelas foram mais comuns em crianças infectadas pelo vírus zika em comparação com crianças não infectadas. Métodos. Realizamos um estudo de coorte prospectivo em crianças com e sem infecção pelo vírus zika em León, Nicarágua, usando uma ferramenta de avaliação clínica padrão e um questionário para coletar dados de sintomas em três consultas, com cerca de 6 meses de intervalo, além de um conjunto de ferramentas padronizadas para avaliar função neurocognitiva, comportamento, depressão e ansiedade nas duas últimas consultas. Resultados. Foram incluídas 62 crianças, sem diferenças significativas nas características demográficas por grupo de infecção. As crianças infectadas pelo vírus zika tinham uma gama de sintomas neurológicos, alguns dos quais persistiram por 6 a 12 meses. Entretanto, não se observou nenhum padrão consistente de sintomas. No início do estudo, uma pequena porcentagem de crianças infectadas com o vírus zika apresen- tou resultado anormal na prova índex-nariz (13%), resposta ao toque frio (13%) e sensibilidade vibratória (15%), em comparação a 0% no grupo não infectado. Déficits neurocognitivos e problemas comportamentais foram frequentes em ambos os grupos, mas sem diferenças significativas entre eles. As crianças infectadas com o vírus zika tiveram resultados mais baixos de eficiência cognitiva na consulta de 6 meses. Ansiedade e depressão não foram observadas com frequência em ambos os grupos. Conclusões. São necessários estudos mais amplos para investigar a relação exata entre a infecção pelo vírus zika e sintomas neurológicos e problemas neurocognitivos, com ajuste para fatores que afetam a cog- nição e o comportamento, incluindo distúrbios do humor e do sono, ambiente de aprendizagem em casa, história de infecções neuroinvasivas e história familiar detalhada de problemas neuropsicológicos.

Neurological and neuropsychological sequelae of Zika virus infection in children in León, Nicaragua / Secuelas neurológicas y neuropsicológicas de la infección por el virus del Zika en niños y niñas en León, Nicaragua / Sequelas neurológicas e neuropsicológicas da infecção pelo vírus zika em crianças em León, Nicarágua

ABSTRACT Objectives. To describe the presence and persistence of neurological and neuropsychological sequelae among children with acquired Zika virus infection and assess whether those sequelae were more common in children infected with Zika virus compared to uninfected children. Methods. We conducted a prospective cohort study of children with and without Zika virus infection in León, Nicaragua, using a standard clinical assessment tool and questionnaire to collect data on symptoms at three visits, about 6 months apart, and a battery of standardized instruments to evaluate neurocognitive function, behavior, depression, and anxiety at the last two visits. Results. Sixty-two children were enrolled, with no significant differences in demographics by infection group. Children infected with Zika virus had a range of neurological symptoms, some of which persisted for 6 to 12 months; however, no consistent pattern of symptoms was observed. At baseline a small percentage of children infected with Zika virus had an abnormal finger-to-nose test (13%), cold touch response (13%), and vibration response (15%) versus 0% in the uninfected group. Neurocognitive deficits and behavioral problems were common in both groups, with no significant differences between the groups. Children infected with Zika virus had lower cognitive efficiency scores at the 6-month visit. Anxiety and depression were infrequent in both groups. Conclusions. Larger studies are needed to definitively investigate the relationship between Zika virus infection and neurological symptoms and neurocognitive problems, with adjustment for factors affecting cognition and behavior, including mood and sleep disorders, home learning environment, history of neuroinvasive infections, and detailed family history of neuropsychological problems.

RESUMEN Objetivos. Describir la presencia y persistencia de secuelas neurológicas y neuropsicológicas en pacientes pediátricos que contrajeron la infección por el virus del Zika y evaluar si dichas secuelas fueron más comunes en los infectados con el virus del Zika en comparación con los no infectados. Métodos. Se realizó un estudio de cohorte prospectivo en pacientes pediátricos con y sin infección por el virus del Zika en León (Nicaragua), con una herramienta de evaluación clínica estándar y un cuestionario para recopilar datos sobre los síntomas en tres visitas, con aproximadamente seis meses de diferencia, y un conjunto de instrumentos estandarizados para evaluar la función neurocognitiva, el comportamiento, la depresión y la ansiedad en las últimas dos visitas. Resultados. Participaron 62 niños y niñas sin diferencias significativas en la demografía por grupo de infección. Los participantes infectados con el virus del Zika mostraron una variedad de síntomas neurológicos, algunos de los cuales persistieron entre 6 y 12 meses; no obstante, no se observó un patrón sistemático en los síntomas. Al inicio del estudio, un pequeño porcentaje de participantes infectados con el virus del Zika mostró resultados anormales a las pruebas dedo-nariz (13%), respuesta al tacto (frío) (13%) y respuesta a la vibración (15%), frente a un 0% en el grupo no infectado. Los déficits neurocognitivos y los problemas de comportamiento fueron comunes en ambos grupos, sin diferencias significativas entre los grupos. Los participantes infectados con el virus del Zika mostraron puntuaciones de eficiencia cognitiva más bajas en la visita a los 6 meses. La ansiedad y la depresión fueron poco frecuentes en ambos grupos. Conclusiones. Son necesarios estudios más amplios para investigar definitivamente la relación entre la infección por el virus del Zika y los síntomas neurológicos y los problemas neurocognitivos, haciendo ajustes para los factores relacionados con la cognición y el comportamiento, incluidos los trastornos del estado de ánimo y el sueño, el entorno de aprendizaje en el hogar, los antecedentes de infecciones neuroinvasivas y los antecedentes familiares detallados de problemas neuropsicológicos.

RESUMO Objetivos. Descrever a presença e a persistência de sequelas neurológicas e neuropsicológicas em crianças com infecção pelo vírus zika e avaliar se essas sequelas foram mais comuns em crianças infectadas pelo vírus zika em comparação com crianças não infectadas. Métodos. Realizamos um estudo de coorte prospectivo em crianças com e sem infecção pelo vírus zika em León, Nicarágua, usando uma ferramenta de avaliação clínica padrão e um questionário para coletar dados de sintomas em três consultas, com cerca de 6 meses de intervalo, além de um conjunto de ferramentas padronizadas para avaliar função neurocognitiva, comportamento, depressão e ansiedade nas duas últimas consultas. Resultados. Foram incluídas 62 crianças, sem diferenças significativas nas características demográficas por grupo de infecção. As crianças infectadas pelo vírus zika tinham uma gama de sintomas neurológicos, alguns dos quais persistiram por 6 a 12 meses. Entretanto, não se observou nenhum padrão consistente de sintomas. No início do estudo, uma pequena porcentagem de crianças infectadas com o vírus zika apresentou resultado anormal na prova índex-nariz (13%), resposta ao toque frio (13%) e sensibilidade vibratória (15%), em comparação a 0% no grupo não infectado. Déficits neurocognitivos e problemas comportamentais foram frequentes em ambos os grupos, mas sem diferenças significativas entre eles. As crianças infectadas com o vírus zika tiveram resultados mais baixos de eficiência cognitiva na consulta de 6 meses. Ansiedade e depressão não foram observadas com frequência em ambos os grupos. Conclusões. São necessários estudos mais amplos para investigar a relação exata entre a infecção pelo vírus zika e sintomas neurológicos e problemas neurocognitivos, com ajuste para fatores que afetam a cognição e o comportamento, incluindo distúrbios do humor e do sono, ambiente de aprendizagem em casa, história de infecções neuroinvasivas e história familiar detalhada de problemas neuropsicológicos.

Anthropometric predictors for cardiovascular risk in Indigenous women in Mexico: an inexpensive alternative in rural clinical practice.

INTRODUCTION: Cardiovascular diseases are one of the leading causes of death in Mexico. Although the use of anthropometric indicators facilitates the diagnosis of cardiovascular risk (CVR), their use is limited in rural communities with limited resources. This article evaluated and demonstrated predictive capacity of three anthropometric indexes for CVR in Indigenous women in Mexico from Matlatzinca ethnic group. METHODS: A cross-sectional study of 93 Indigenous women was carried out. CVR was calculated with the Framingham risk score and used as the reference method by comparing it with waist circumference (WC), conicity index (CoI) and waist-height index (WHI). Receiver operating characteristic (ROC) curves were used to analyze the area under the curve (AUC), sensitivity and specificity for each anthropometric index. RESULTS: Cut-off points (and AUC) for each anthropometric index were WHI 0.63 (0.763), CoI 1.29 (0.756) and WC 91 (0.663). CONCLUSION: In this population, WHI presented the greatest discrimination power; it was considered the best predictor of CVR because of its high sensitivity. It was demonstrated that the anthropometric indexes WC, CoI and WHI could be used in clinical practice in rural areas without sufficient resources for serological tests.

Rectovaginal group B streptococcus colonization among pregnant women in Nicaragua: a systematic review and meta-analysis.

BACKGROUND: Maternal colonization with group B Streptococcus (GBS) is a predictor of neonatal sepsis. In Nicaragua, neonatal sepsis is a major cause of hospitalization, but it can be prevented with intrapartum antibiotic prophylaxis. We undertook this study to estimate the pooled prevalence of rectovaginal GBS colonization among pregnant women 35-40-week gestation in Nicaragua, and sensitivity of GBS isolates to various antibiotics. METHODS: We systematically searched electronic databases of peer-reviewed and unpublished literature using prespecified search terms. We included English- and Spanish-language studies of rectovaginal GBS colonization and/or antibiotic sensitivity of GBS isolates that followed internationally-recognized diagnostic standards, from various sites and years. Two reviewers independently abstracted data and assessed risk of study bias. We then meta-analyzed the pooled prevalence of rectovaginal GBS colonization and antibiotic sensitivity of GBS isolates. We performed subgroup analyses by geographic location, urbanicity, and study risk of bias. MAIN RESULTS: Prevalence of rectovaginal GBS colonization from 13 samples in 11 studies was 0.14 (95% CI: 0.09, 0.21). Effect size heterogeneity was identified between coastal (0.12 [95% CI: 0.07, 0.19]) and central study sites (0.23 [95% CI: 0.18, 0.28]), and between predominantly rural (0.06 [95% CI: 0.02, 0.10]) and urban (0.28 [95% CI: 0.19, 0.37]) samples of pregnant women. GBS sensitivity to penicillin, the first-line antibiotic for intrapartum prophylaxis, was 0.89 (95% CI: 0.71, 1.00) based on seven studies. CONCLUSIONS: Maternal GBS colonization was substantial in some study sites. Most GBS isolates are sensitive to recommended antibiotics, and intrapartum antibiotic prophylaxis may effectively prevent neonatal sepsis in Nicaragua.

Human-Induced Pluripotent Stem Cell Culture Methods Under cGMP Conditions.

The discovery of induced pluripotent stem cells (iPSCs) revolutionized the approach to cell therapy in regenerative medicine. Reprogramming of somatic cells into an embryonic-like pluripotent state provides an invaluable resource of patient-specific cells of any lineage. Implementation of procedures and protocols adapted to current good manufacturing practice (cGMP) requirements is critical to ensure robust and consistent high-quality iPSC manufacturing. The technology developed at Allele Biotechnology for iPSC generation under cGMP conditions is a powerful platform for derivation of pluripotent stem cells through a footprint-free, feeder-free, and xeno-free reprogramming method. The cGMP process established by Allele Biotechnology entails fully cGMP compliant iPSC lines where the entire manufacturing process, from tissue collection, cell reprogramming, cell expansion, cell banking and quality control testing are adopted. Previously, we described in this series of publications how to create iPSCs using mRNA only, and how to do so under cGMP conditions. In this article, we describe in detail how to culture, examine and storage cGMP-iPSCs using reagents, materials and equipment compliant with cGMP standards. © 2020 The Authors. Basic Protocol 1: iPSC Dissociation Support Protocol 1: Stem cell media Support Protocol 2: ROCK inhibitor preparation Support Protocol 3: Vitronectin coating Basic Protocol 2: iPSC Cryopreservation Basic Protocol 3: iPSC Thawing.

Acciones para la preparación pedagógica de los alumnos ayudante en ciencias básicas biomédicas / Actions aimed at the pedagogical training of student teachers of basic biomedical sciences

Introducción: El proceso de formación docente en las ciencias médicas, específicamente en las ciencias básicas biomédicas, exige de nuevas concepciones teóricas y metodológicas en la actualidad. Objetivo: Elaborar acciones que favorezcan la preparación de los alumnos ayudantes en ciencias básicas biomédicas desde una perspectiva pedagógica. Métodos: Se realizó un estudio descriptivo, con enfoque cualicuantitativo en la Facultad de Ciencias Médicas de Artemisa, en el período comprendido desde noviembre de 2018 hasta octubre de 2019. Se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción para los referentes teóricos del tema; y empíricos: revisión documental, encuesta a estudiantes, observación científica y entrevista a informantes clave. Resultados: Los resultados mostraron que existen insuficiencias en los alumnos ayudante de ciencias básicas biomédicas acerca del conocimiento de sus funciones pedagógicas, la mayoría no mostró motivación para impartir docencia, no poseen los conocimientos esenciales básicos sobre la pedagogía y el proceso de enseñanza-aprendizaje, necesarias para su desempeño, por lo que se elaboraron acciones científico-metodológicas para resolver estas carencias. Conclusiones: Las acciones elaboradas fortalecen el dominio de la pedagogía en la formación de los alumnos ayudantes para su futuro desempeño como profesionales de las ciencias de la salud, vinculados a la docencia de las ciencias básicas biomédicas y fueron valoradas por los especialistas como pertinentes, factibles y de gran valor pedagógico

Introduction: At present the teacher training process in medical sciences, particularly in basic biomedical sciences, requires new theoretical and methodological foundations. Objective: Develop actions contributing to the training of student teachers of basic biomedical sciences from a pedagogical perspective. Methods: A descriptive qualitative-quantitative study was conducted at the School of Medical Sciences of Artemisa from November 2018 to October 2019. The theoretical methods applied were analysis-synthesis and induction-deduction for the theoretical referents of the topic. The empirical methods used were document review, a survey with students, scientific observation and an interview with key informants. Results: Results point to the existence of deficiencies among student teachers of basic biomedical sciences concerning knowledge about their pedagogical functions. Most did not show any motivation to teach and do not have the basic essential knowledge about pedagogy and the teaching-learning process required for their work. Scientific-methodological actions were developed to correct such deficiencies. Conclusions: The actions developed strengthen the command of pedagogy in the training of student teachers for their future work as health science professionals involved in the teaching of basic biomedical sciences. These actions were evaluated by specialists as relevant, feasible and of great pedagogical value

Calidad de los formatos escritos del consentimiento informado en pacientes graves / Quality of written forms of informed consent in critically ill patients

RESUMEN Fundamentación: el consentimiento informado es un proceso cuyo objetivo es el respeto a la autonomía del paciente y consta de la aceptación verbal y escrita de una intervención médica, después que el médico le haya informado de forma adecuada. Objetivo: evaluar la calidad de los formatos escritos de consentimiento informado en pacientes graves. Métodos: se realizó un estudio descriptivo trasversal con 335 formatos escritos del consentimiento informado aplicados a familiares y pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Joaquín Albarrán Domínguez, La Habana, Cuba, del 30 de septiembre de 2017 al 22 de septiembre de 2018. Se realizó la prueba de Chi cuadrado a las frecuencias de los cumplimientos. Fue significativo un valor de p ≤ 0,05. Resultados: aunque el predominio de los formatos escritos fue en pacientes con perfil clínico, los mejores documentos fueron los de perfil quirúrgico. El cumplimiento de los datos generales de los formatos escritos fue adecuado, sin embargo, los formularios del perfil clínico, no cumplieron adecuadamente con la información respecto a los procederes médicos, fue pobre la evacuación de las dudas respecto a la condición médica de los pacientes. En ningún caso se solicitó el autorizo para investigaciones médicas ni se entregó copia del documento escrito a los interesados. Conclusiones: la calidad de los formatos fue mala, aún hay que mejorar la calidad de la información e implementar de manera habitual la solicitud para investigaciones médicas y mecanismos que faciliten la entrega de una copia del documento escrito.

ABSTRACT Background: Informed Consent is the acceptance of a medical intervention by a patient, in a free, voluntary and conscious way, after the doctor has informed him of the nature of the intervention, risks, benefits and alternatives. Objective: to assess the quality of structure and content of the informed consent forms in severe patients. Methods: cross-sectional retrospective descriptive study was carried out with 335 IC written forms applied to family members and/or patients admitted to the Intensive Care Unit of the Joaquín Albarrán Domínguez Hospital, Havana, Cuba, from September 30, 2017 to September 22, 2018. The Chi-square test was performed the frequencies of compliance. A value of p ≤ 0.05 was significant. Results: predominantly, the written formats in patients with a clinical profile complied with the completion of the document and the best were those of surgical profile. In compliance with the general data in the IC written format, there was an adequate compliance, in the forms of the clinical profile, they did not comply with writing the name and description of medical procedures. There was no consent forms to authorize medical researches and it was not delivered a copy of the written document to the interested persons. Conclusions: the quality of the formats was bad, we still have to improve the information offered, clarify the doubts, as well as the request for authorization for medical research and implement mechanisms that facilitate the delivery of a copy of the written document.

Introducing SYPRENE: An International Practice Research Network for Strategic and Systemic Therapists and Researchers.

SYPRENE, a new international Systemic Practice Research Network (PRN), has been established to fill the gap in practice-based research on the effectiveness and efficiency of strategic therapies. This article presents the rationale for the creation of SYPRENE and describes data collection methods, and the encoding system implemented within this PRN. More developments are expected in the recruitment of practitioners, the types of data collected, findings, and the implementation of SYPRENE in supervision, trainings, and professional schools.

SYPRENE, una nueva red internacional sistémica de investigación basada en la práctica (PRN), se ha establecido para llenar vacíos en la investigación basada en la práctica sobre la eficacia y la eficiencia de las terapias estratégicas. Este artículo presenta las razones de la creación de SYPRENE y describe los métodos de recopilación de datos y el sistema de codificación implementado dentro de esta red de investigación basada en la práctica. Se esperan más novedades en la contratación de profesionales, los tipos de datos recogidos, los hallazgos y la implementación de SYPRENE en supervisión, capacitaciones y escuelas profesionales.

Desarrollo de un programa formativo transversal e integral en competencias clínicas, de comunicación e investigación en el 6. o curso del Grado en Medicina / Development of a cross-cutting and comprehensive training program skills clinics, communication and research in the 6th course of the Degree in Medicine

INTRODUCCIÓN: Durante el curso académico 2015-16 se implantó el 6.o curso del Grado de Medicina en la Facultad de Medicina y Ciencias de la Salud de la Universidad de Alcalá. Comprende prácticas clínicas tuteladas y trabajo fin de grado/máster. La Facultad de Medicina y Ciencias de la Salud quería que el programa formativo fuera integral e integrador centrado en la adquisición y potenciación de competencias clínicas, de comunicación e investigación, con una estructura de coordinación que permitiera una evaluación y detección continua de desviaciones, y por supuesto establecer una evaluación de los resultados a medio y largo plazo. El objetivo de este trabajo es presentar el programa formativo desarrollado. MATERIALES Y MÉTODOS: Se formó un equipo de docente y estudiantes para diseñar el curso, con un calendario de reuniones y un programa de acciones a llevar a cabo, siempre intentando que todas las decisiones fueran consensuadas, se tuvieran en cuenta los diferentes escenarios, con herramientas comunes didácticas y de evaluación, flexibles y adaptadas a los diferentes entornos. RESULTADOS: El curso tiene diversidad de entornos y actividades docentes. Las rotaciones integran al estudiante en los servicios y unidades asistenciales. Además, se realizan actividades innovadoras transversales en la Facultad. Se ha diseñado una estructura de coordinación del programa y para su valoración los instrumentos tanto de evaluación del estudiante como del programa son variados y complejos. Se han diseñado numerosas encuestas de opinión que reflejan una satisfacción muy elevada y los resultados académicos son excelentes. CONCLUSIONES: Se ha conseguido desarrollar un programa formativo integral e integrador, con una estructura de coordinación y unos instrumentos de evaluación adecuados. Los indicadores académicos y de opinión son muy positivos e indican que los objetivos de aprendizaje se cumplen con éxito. La coordinación es eficaz y homogeniza la docencia en entornos diferentes, facilitando la detección y subsanación de deficiencias

INTRODUCTION: During 2015-16 academic implanted the 6th course of medicine degree in the Faculty of Medicine and Health Sciences of the Universidad de Alcalá. Includes clinical practices and master's dissertation. The Faculty of Medicine and Health Sciences wanted the training program to be integral and integrator focused on the acquisition and promotion of clinical skills, communication and research, with a coordination structure that would enable an assessment and continuous detection of deviations, and of course establish an assessment of results in the medium and long term. The objective of this work is to present the developed training programme. MATERIALS AND METHODS: A team of teachers and students was formed to design the course, with a calendar of meetings and a program of actions to be carried out, always trying to that all decisions were consensual, the different took into account scenarios, with common teaching tools and assessment, flexible and adapted to the different environments. RESULTS: The course has diversity of environments and teaching activities. Rotations integrated student services and healthcare units. In addition, are cross-cutting innovative activities at the Faculty. A coordination of the program structure is designed and for their evaluation, both of student assessment and program, instruments are varied and complex. Numerous opinion tests that reflect a very high satisfaction and academic results are excellent have been designed. CONCLUSIONS: We have managed to develop a training program comprehensive and inclusive, with a coordination structure and appropriate assessment tools. Academic and opinion indicators are very positive and indicate that the learning objectives are met with success. He has been established very effective coordination to homogenize the teaching in different environments, and facilitates the detection and correction of deficiencies

Validation of the Hearing Handicap Inventory for Adults Scale for Spanish-Speaking Patients.

OBJECTIVE: To perform translation, cross-cultural adaptation, and validation of the hearing handicap inventory for adults scale (HHIA) to the Spanish language. STUDY DESIGN: Prospective study. SETTING: Tertiary neurotologic referral center. PATIENTS: The study included 104 hearing impaired persons. Inclusion criteria were adults with untreated hearing loss, diagnosed in the past 12 months. A control group of 30 normal hearing subjects was also recruited. INTERVENTION: HHIA was translated and translated back, and a pretest trial was performed. Feasibility, internal consistency, test-retest reliability, construct validity, and ceiling and floor effects were assessed for the present study. MAIN OUTCOME MEASURES: The mean overall score of the HHIA was 31.9 (0-100 scale, lowest to highest handicap). Cronbach's α was 0.95. Intraclass correlation coefficient was performed for each item, with an overall score of 0.95. The k coefficient scores ranged between moderate and almost perfect in all patients. The emotional score of the HHIA was correlated with the mental component of the SF-12. CONCLUSIONS: Feasibility, internal consistency, reliability, and construct validity outcomes in the current study support the validity of the Spanish version of the HHIA.

The expression of oxidative stress response genes is modulated by a combination of resveratrol and N-acetylcysteine to ameliorate ototoxicity in the rat cochlea.

Aminoglycoside antibiotics are used widely in medicine despite their ototoxic side-effects. Oxidative stress and inflammation are key mechanisms determining the extent and severity of the damage. Here we evaluate the protective effect of a treatment with resveratrol plus N-acetylcysteine on the ototoxic actions of kanamycin and furosemide in the rat. Resveratrol (10 mg/kg) and N-acetylcysteine (400 mg/kg) were administered together to Wistar rats on 5 consecutive days. The second day, a concentrated solution of kanamycin and furosemide was placed on the round window to induce ototoxicity. Hearing was assessed by recording auditory brainstem responses before and 5, 16 and 23 days after the beginning of the treatment. Cochlear samples were taken at day 5 (end of the treatment) and at day 23, and targeted PCR arrays or RT-qPCR were performed to analyze oxidative balance and inflammation related genes, respectively. In addition, the cytoarchitecture and the presence of apoptosis, oxidative stress and inflammation markers were evaluated in cochlear sections. Results indicate that administration of resveratrol plus N-acetylcysteine reduced the threshold shifts induced by ototoxic drugs at high frequencies (≈10 dB), although this protective effect fades after the cessation of the treatment. Gene expression analysis showed that the treatment modulated the expression of genes involved in the cellular oxidative (Gpx1, Sod1, Ccs and Noxa1) and inflammatory (Il1b, Il4, Mpo and Ncf) responses to injury. Thus, co-administration of resveratrol and NAC, routinely used individually in patients, could reduce the ototoxic secondary effects of aminoglycosides.

A balance between elongation and trimming regulates telomere stability in stem cells.

Telomere length maintenance ensures self-renewal of human embryonic stem cells (hESCs) and induced pluripotent stem cells (hiPSCs); however, the mechanisms governing telomere length homeostasis in these cell types are unclear. Here, we report that telomere length is determined by the balance between telomere elongation, which is mediated by telomerase, and telomere trimming, which is controlled by XRCC3 and Nbs1, homologous recombination proteins that generate single-stranded C-rich telomeric DNA and double-stranded telomeric circular DNA (T-circles), respectively. We found that reprogramming of differentiated cells induces T-circle and single-stranded C-rich telomeric DNA accumulation, indicating the activation of telomere trimming pathways that compensate telomerase-dependent telomere elongation in hiPSCs. Excessive telomere elongation compromises telomere stability and promotes the formation of partially single-stranded telomeric DNA circles (C-circles) in hESCs, suggesting heightened sensitivity of stem cells to replication stress at overly long telomeres. Thus, tight control of telomere length homeostasis is essential to maintain telomere stability in hESCs.

Development and validation of a short version of the Spanish pediatric voice handicap index (P-VHI-10).

OBJECTIVES: A child's voice is used both as a tool for communication and as a form of emotional expression. Thus, voice disorders suffered by children have negative effects on their quality of life, which can be assessed using the "Pediatric Voice Handicap Index" (P-VHI). This questionnaire is completed by the parents of dysphonic patients and it has been validated in different languages: Italian, Korean, Arabic, and Spanish. More recently, the "Children Voice Handicap Index-10" test (C-VHI-10) was developed and validated, an Italian version reduced into 10 items that is answered by children themselves. The objective of this study was to develop and validate a short Spanish version of the P-VHI (P-VHI-10) and to assess whether it is comparable to the Italian C-VHI-10. MATERIALS AND METHODS: We conducted a cross-sectional study on 27 patients between 6-15 years of age. We developed an abbreviated version of the P-VHI that consisted of 10 statements to be answered by parents of children with dysphonia (P-VHI-10). These statements were based on the 10 items with the highest score in the validated Spanish version of the P-VHI. In addition, the validated Italian version of C-VHI-10 was translated into Spanish and this translation was reviewed and modified by three specialists, resulting in an adapted version to be answered by parents (C*-VHI-10). The parents and children included in the study of this index were the same patients as those included in the study to validate the Spanish P-VHI. RESULTS: There were no significant differences in the results obtained with the extended version of the P-VHI (17.4) and with the P-VHI-10 (18.7: Pearson coefficient = 0.602, p < 0.36). A paired student's t-test identified significant differences (p < 0.0001) when comparing the P-VHI-10 and C*-VHI-10, both of which were answered by parents, with average scores of 18.7 and 9.48, respectively. Both these reduced versions have good internal consistency, with a satisfactory Cronbach's alpha coefficient (α = 0.75 to P-VHI-10 and α = 0.73 in C*-VHI-10). No statistically significant differences were found when the average total score between the C-VHI-10 and C*-VHI-10 were compared, with a Pearson's correlation coefficient of 0.559 (p < 0.9). CONCLUSION: The short version of the P-VHI10 questionnaire is a clinically valid tool that has good internal consistency.

Indicaciones actuales de la osteoplastia frontal / Current indications for the osteoplastic flap

Introducción y objetivos: La cirugía endoscópica nasosinusal es la técnica de elección en la mayoría de los procesos patológicos del seno frontal, tanto inflamatorios como tumorales, quedando relegadas las indicaciones del abordaje externo mediante osteoplastia frontal para casos con dificultades por vía endoscópica. El objetivo de este trabajo es revisar las indicaciones actuales de la osteoplastia frontal en la patología del seno frontal mediante un estudio retrospectivo de pacientes intervenidos de esta técnica. Métodos: Se realiza un estudio retrospectivo de 14 pacientes intervenidos de osteoplastia frontal en el que se revisaron los criterios de las indicaciones quirúrgicas, tipo de patología del seno frontal, existencia de cirugía endoscópica previa, hallazgos quirúrgicos, complicaciones y recidiva. Resultados: La patología del seno frontal fue de un osteoma (7,1%), 3 papilomas invertidos (21,4%) y 10 mucoceles (71,4%). Nueve pacientes habían sido intervenidos previamente de cirugía endoscópica. Diez pacientes presentaron una dehiscencia orbitaria (9 casos de mucocele y un caso de papiloma). El osteoma frontal era de grado iv y los 3 casos de papilomas correspondían a un grado iii de Krouse. El 21,4% requirieron una revisión quirúrgica. Conclusiones: Las principales indicaciones son la extensión lateral y la neo-osteogénesis del receso frontal en el caso de la enfermedad inflamatoria del seno frontal, el tamaño del tumor en el caso de los osteomas, y la implantación multifocal con origen en la pared anterior y lateral en el caso de los papilomas invertidos. En todos los casos la indicación de osteoplastia frontal debe hacerse de forma individualizada (AU)

Introduction and objectives: Endoscopic sinus surgery is the technique of choice in most of the frontal sinus diseases, both inflammatory and tumour-related. This is why the external approach using osteoplastic flap (OF) would be limited to cases with a difficult endoscopic approach. Our aim was to review the current indications of the osteoplastic flap in the treatment of frontal sinus pathology, through a retrospective study of patients undergoing this technique. Methods: We performed a retrospective study of 14 patients who were treated with the osteoplastic flap procedure. All the surgical indication criteria, type of sinus disease, presence or absence of prior endoscopic surgery, surgical findings, complications and recurrence were reviewed. Results: The pathologies found were 1 osteoma (7.1%), 3 inverted papilloma (21.4%) and 10 mucoceles (71.4%). Nine patients had a prior endoscopic surgery and 10 patients had an orbital dehiscence (9 mucocele, 1 papilloma). Frontal osteoma was Grade IV and the papilloma cases were Krouse Stage III. Surgical revision was required for 21.4%. Conclusions: The main indications for an OF in patients with inflammatory disease are lateral extension and frontal recess neo-osteogenesis. In osteoma cases, it depends on the size of the tumour. In inverted papilloma cases, the indication is multifocal implantation with origin in the anterior and lateral wall. In all cases, performing the osteoplastic flap must be individualised (AU)

Current indications for the osteoplastic flap.

INTRODUCTION AND OBJECTIVES: Endoscopic sinus surgery is the technique of choice in most of the frontal sinus diseases, both inflammatory and tumour-related. This is why the external approach using osteoplastic flap (OF) would be limited to cases with a difficult endoscopic approach. Our aim was to review the current indications of the osteoplastic flap in the treatment of frontal sinus pathology, through a retrospective study of patients undergoing this technique. METHODS: We performed a retrospective study of 14 patients who were treated with the osteoplastic flap procedure. All the surgical indication criteria, type of sinus disease, presence or absence of prior endoscopic surgery, surgical findings, complications and recurrence were reviewed. RESULTS: The pathologies found were 1 osteoma (7.1%), 3 inverted papilloma (21.4%) and 10 mucoceles (71.4%). Nine patients had a prior endoscopic surgery and 10 patients had an orbital dehiscence (9 mucocele, 1 papilloma). Frontal osteoma was Grade IV and the papilloma cases were Krouse Stage III. Surgical revision was required for 21.4%. CONCLUSIONS: The main indications for an OF in patients with inflammatory disease are lateral extension and frontal recess neo-osteogenesis. In osteoma cases, it depends on the size of the tumour. In inverted papilloma cases, the indication is multifocal implantation with origin in the anterior and lateral wall. In all cases, performing the osteoplastic flap must be individualised.

The role of gene variants of the inflammatory markers CRP and TNF-α in cardiovascular heart disease: systematic review and meta-analysis.

It is widely acknowledged that cardiovascular heart disease (CHD) has a genetic influence. Several studies have investigated the role of inflammatory markers like C-reactive protein (CRP) and tumor necrosis factor α (TNF-α) in the causation of cardiovascular diseases. Although there have been several positive studies associating CRP and TNF-α genes with CHD, the evidence is not entirely consistent. Therefore, we performed a meta-analysis to gain a better understanding into this issue. The meta-analysis was conducted with 22 articles of genetic association studies of CRP (G1059C rs1800947, C1444T rs1130864, C717T rs2794521 and G3872A rs1205) and TNF-α (C857T rs1799724, C863A rs1800630 and T1031C rs1799964) genes. To analyze the association of these variants with CHD we used the following models: allelic, additive, dominant and recessive. In addition, we performed a sub-group analysis by Caucasian population using the same four models. CRP and TNF-α gene polymorphisms showed a positive significant association with CHD. This study provides evidence that rs2794521 of the CRP gene and rs1799724, rs1800630 and rs1799964 of the TNF-α gene polymorphisms may be risk factors to manifest CHD. The analysis of rs1800947 and rs1205 of the CRP gene yielded a protective effect in the pathogenesis of this disease. Only the analysis of the rs1130864 polymorphism showed a lack of association with CHD. To have conclusive outcomes it is necessary to integrate more studies to confirm our findings.

Adaptation and validation of Spanish version of the pediatric Voice Handicap Index (P-VHI).

OBJECTIVES: The voice in childhood is a communication tool and a form of emotional expression. It is estimated that 6 to 23% of children may have voice disorders. There is a test, the Pediatric Voice Handicap Index (P-VHI), validated in English to assess the specific impact on quality of life of children with speech pathology. Spanish is the second most widely used language in the world in terms of number of speakers, with over 500 million native speakers, so it is necessary to have tools that allow us to evaluate the effects of dysphonia in Spanish-speaking children. The aim of our study is the validation of the Spanish version of the P-VHI. MATERIAL AND METHODS: We performed a cross-sectional study including patients between 4 and 15 years of age. The English P-VHI validated version was translated into Spanish and this translation was reviewed and modified by three specialists in Otorhinolaryngology. There were two study groups, children who had dysphonia (n=44) and a control group of children without alterations in voice (n=44). The questionnaire was always answered by parents. RESULTS: Significant differences were found between the group of children with dysphonia and the control group in the overall P-VHI score and the different subscales (p<0.001). Optimal internal consistency with a good Cronbach's alpha (α=0.81) was found, with high test-retest reliability (Wilcoxon z: -0847, p>0.05). CONCLUSIONS: The Spanish version of the P-VHI is a validated tool that has good internal consistency. It is a reliable test that evaluates the Voice Handicap Index in the pediatric population, with easy application for daily clinical practice.

Corrigendum to: Swept-sine noise-induced damage as a hearing loss model for preclinical assays.

[This corrects the article on p. 7 in vol. 7, PMID: 25762930.].