La atención a la diversidad cultural: esencialidades para la formación de los profesores de medicina

La diversidad cultural es el resultado de un proceso que se conforma en el marco de las relaciones sociales, económicas y culturales. Se hace imprescindible que los profesores universitarios estén preparados para atender la diversidad cultural de sus estudiantes, teniendo en cuenta las particularidades de su cultura nacional y la de otros grupos de diferentes procedencias que coexisten en un mismo escenario educativo. La diversidad cultural es un reto de la comunidad educativa y debe estar contemplada en la formación permanente de los profesores de las universidades médicas fundamentalmente por sus contextos, los ambientes socioeconómicos y los problemas de salud, sobre todo por las enfermedades crónicas no trasmisibles debido a su alta prevalencia y su repercusión en el individuo y su familia, en los que influyen los factores de riesgo y las determinantes sociales, condicionados por sus orígenes, creencias, vivencias y representaciones que matizan los contextos interculturales actuales a nivel mundial.

Cultural diversity is the result of a process that is formed within the framework of social, economic and cultural relations. It is essential that university professors are prepared to address the cultural diversity of their students, taking into account the particularities of their national culture and that of other groups of different origins that coexist in the same educational setting. Cultural diversity is a challenge for the educational community and must be considered in the ongoing training of professors at medical universities, fundamentally due to their contexts, socioeconomic environments and health problems, especially chronic non-communicable diseases due to their high prevalence and its impact on the individual and his or her family, influenced by risk factors and social determinants, conditioned by their origins, beliefs, experiences and representations that color current intercultural contexts worldwide.

[Angioplasty with ductal stent: experience at Garrahan Hospital]. / Angioplastia con stent ductal: experiencia en el Hospital Garrahan.

Objective: To describe and evaluate the outcomes of ductal angioplasty with stent placement at a single high-complexity center during the period 2016-2022. Method: A retrospective descriptive cross-sectional study was conducted, including patients under 3 months of age who underwent ductal stent implantation as initial palliative treatment. Demographic, clinical, and anatomical data were collected before the intervention. Mortality, intra- and post-procedural complications, need for re-intervention, intensive care requirements, and hospital stay were recorded. The characteristics at the time of definitive surgery are described. Discrete variables are presented as percentages, and continuous variables are presented with their medians and respective interquartile ranges. Results: Twenty patients who underwent this treatment were reviewed, revealing a success rate of 80%. Complications due to stent dysfunction required surgical resolution. 95% of patients were dischargedfrom the institution after the procedure, and 17 patients reached a second definitive surgical stage. Three patients died afterthe procedure, but with no direct relation to it. Conclusions: Indications for ductal angioplasty with stent as an alternative treatment to systemic-pulmonary anastomosis by surgery are not yet fully defined; the strategy represents a valid alternative in appropriately selected patients. The presented experience shows results similar to international reference centers.

Objetivo: Describir y evaluar los resultados de la angioplastia con stent ductal en un único centro de alta complejidad durante el periodo 2016-2022. Método: Estudio descriptivo retrospectivo de corte transversal en el que se incluyeron pacientes menores de 3 meses a quienes se implantó un stent en el conducto arterioso como tratamiento paliativo inicial. Se recolectaron datos demográficos, clínicos y anatómicos previos a la intervención. Se registraron la mortalidad, las complicaciones intra- y posprocedimiento, la necesidad de reintervención, los requerimientos de cuidados intensivos y la estadía hospitalaria. Se describen las características al momento de la cirugía definitiva. Las variables discretas son presentadas con porcentajes, y las variables continuas con sus medianas y sus respectivos intervalos intercuartílicos. Resultados: Se revisaron 20 pacientes que habían recibido este tratamiento y se evidenció una tasa de éxito del 80%. Las complicaciones por disfunción del stent requirieron resolución quirúrgica. Egresaron de la institución el 95% de los pacientes luego del procedimiento y lograron arribar a un segundo estadio quirúrgico definitivo 17 pacientes. Fallecieron tres pacientes luego del procedimiento, pero sin relación directa con este. Conclusiones: Las indicaciones de angioplastia del conducto con stent como tratamiento alternativo a la realización de una anastomosis sistémico-pulmonar por cirugía todavía no están completamente definidas; la estrategia constituye una alternativa válida en pacientes adecuadamente seleccionados. La experiencia presentada muestra resultados similares a los de otros centros de referencia internacional.

Structural and Electrical Characterization of LaSrAl1-xMgxO4-δ Layered Perovskites Obtained by Mechanical Synthesis.

This work presents the structural and electrical characterization of K2NiF4-type layered perovskites of LaSrAl1-xMgxO4-δ composition to be used as oxide-ion electrolytes for a solid-oxide fuel cell (SOFC). These perovskites were prepared by mechano-chemical synthesis (ball milling), an alternative to traditional synthesis methods such as citrate-nitrates and solid-state reaction. With these methods, two things are avoided: first, the use of nitrate salts, which are more environmentally harmful than oxide precursors, and second, it saves the series of long thermal treatments associated with solid-state reactions. After grinding the precursors, nanometric particles were obtained with a combination of crystalline regions and amorphous regions; this effect was determined by XRD and TEM, showing that Mg has a positive effect on the phase formation by only mechanical synthesis. R2C4: After sintering, it was found by XRD that the sample x = 0.1 only presents the diffraction peaks corresponding to the desired phase, which shows a phase purity greater than 97%, even higher than that of the standard undoped sample. For x = 0.2 and 0.3, there was a segregation of impurities, possibly by the local migration of La and Sr heavy cations; this was determined by SEM and EDS. The electrical characterization of the sintered pellets was carried out by electrochemical impedance spectroscopy, which determined that the incorporation of Mg in the structure improves the ionic conductivity by three orders of magnitude, obtaining conductivities of 1.6 mS/cm at 900 °C for x = 0.2. Although the improvement in conductivity is considerable, many challenges such as densification, the segregation of impurities, and the study of mechanical and thermal properties must be carried out on these materials to endorse them as solid electrolytes in SOFC.

Antioxidant Properties and Secondary Metabolites Profile of Hyptis colombiana at Various Phenological Stages.

Hyptis colombiana (Lamiaceae family), a species also treated as Cantinoa colombiana in a recently segregated genus from Hyptis, is a perennial herb or subshrub native to the Andes of northern South America. H. colombiana leaves are commonly used in traditional medicine to treat respiratory and digestive illnesses. In this study, H. colombiana plants at different phenological stages (vegetative, flowering, and post-flowering) were harvested to obtain essential oils (EOs) and extracts (from fresh plant materials or post-distillation waste) whose chemical compositions and antioxidant activities were determined. H. colombiana EOs distilled by microwave-assisted hydrodistillation were analyzed by GC/MS/FID, and hydroalcoholic extracts obtained from fresh plant materials or post-distillation waste were analyzed by UHPLC-ESI+/--Orbitrap-MS. The antioxidant activity was evaluated by the ABTS+• and ORAC assays. The principal compounds found in EOs were sesquiterpene hydrocarbons (65%); specifically, (E)-ß-caryophyllene and germacrene D. Pyranone, rosmarinic acid, rutin, and p-hydroxybenzoic acid were the main constituents in H. colombiana extracts. After analyzing the chemical composition and antioxidant activity (ORAC) of EOs and hydroethanolic extracts from flowering H. colombiana plants, minimal variations were found. It is advisable to harvest H. colombiana plants during their flowering stage to acquire EOs and extracts that can be utilized in the agro-industry of EOs and their natural derivatives.

Sobre el desarrollo culturalmente pertinente de las comunidades amazónicas: bioemprendimientos, tecnologías apropiadas y otras alternativas para el Buen Vivir

La alta tasa de fracaso de los proyectos de desarrollo impulsados con comunidades locales de la Amazonía peruana en las últimas décadas no ha sido óbice para que se siga cometiendo los mismos errores año tras año, con grandes impactos sociales, ambientales y económicos, pese al carácter 'sostenible' e 'inclusivo' que muchos se atribuyen. Se analizan los factores de fracaso, con énfasis en el desconocimiento de la realidad amazónica y en la falta de pertinencia ambiental y cultural de los modelos de desarrollo replicados de otras regiones. Se propone como alternativa la promoción de bioemprendimientos liderados por las familias y grupos de interés de las comunidades amazónicas, de preferencia con recursos no maderables del bosque en pie, acordes con el perfil "bosquesino" de las sociedades amazónicas tradicionales, y la aplicación de tecnologías y otras soluciones pertinentes culturalmente.

The persistently high rate of failure in development projects involving local communities in the Peruvian Amazon over recent decades has not prevented the recurrence of these same mistakes year after year, resulting in significant social, environmental, and economic impacts, despite claims of 'sustainability' and 'inclusivity' by many. This paper analyses the factors contributing to this failure, with a particular focus on the lack of understanding of the Amazonian reality and the absence of environmental and cultural relevance in development models imported from other regions. As an alternative approach, we propose the promotion of bio-entrepreneurship initiatives led by families and community interest groups in the Amazonian communities. These initiatives should preferably involve non-timber forest resources, in alignment with the 'forest-oriented' profile of traditional Amazonian societies. Additionally, the application of culturally pertinent technologies and other solutions is recommended.

Chemical Composition and In Vitro Antioxidant Activity of Salvia aratocensis (Lamiaceae) Essential Oils and Extracts.

Salvia aratocensis (Lamiaceae) is an endemic shrub from the Chicamocha River Canyon in Santander (Colombia). Its essential oil (EO) was distilled from the aerial parts of the plant via steam distillation and microwave-assisted hydrodistillation and analyzed using GC/MS and GC/FID. Hydroethanolic extracts were isolated from dry plants before distillation and from the residual plant material after distillation. The extracts were characterized via UHPLC-ESI(+/-)-Orbitrap-HRMS. The S. aratocensis essential oil was rich in oxygenated sesquiterpenes (60-69%) and presented τ-cadinol (44-48%) and 1,10-di-epi-cubenol (21-24%) as its major components. The in vitro antioxidant activity of the EOs, measured via an ABTS+• assay, was 32-49 µmol Trolox® g-1 and that measured using the ORAC assay was 1520-1610 µmol Trolox® g-1. Ursolic acid (28.9-39.8 mg g-1) and luteolin-7-O-glucuronide (1.16-25.3 mg g-1) were the major S. aratocensis extract constituents. The antioxidant activity of the S. aratocensis extract, obtained from undistilled plant material, was higher (82 ± 4 µmol Trolox® g-1, ABTS+•; 1300 ± 14 µmol Trolox® g-1, ORAC) than that of the extracts obtained from the residual plant material (51-73 µmol Trolox® g-1, ABTS+•; 752-1205 µmol Trolox® g-1, ORAC). S. aratocensis EO and extract had higher ORAC antioxidant capacity than the reference substances butyl hydroxy toluene (98 µmol Trolox® g-1) and α-tocopherol (450 µmol Trolox® g-1). S. aratocensis EOs and extracts have the potential to be used as natural antioxidants for cosmetics and pharmaceutical products.

Performance of sewage treatment technologies for the removal of Cryptosporidium sp. and Giardia sp.: Toward water circularity.

Cryptosporidium sp. and Giardia sp. are parasites that cause diseases in the population. Most of parasite diseases regarding the consumption of drinking water polluted with sewage are caused by Cryptosporidium sp. or Giardia sp. it is because of the incomplete disinfection of the wastewater treatment. Therefore, in this work the removal or inactivation efficiency of different treatment technologies presented by around 40 scientific studies was evaluated, with a view to water circularity. For Cryptosporidium sp., we conclude that the most efficient secondary technologies are aerobic technologies, which remove between 0.00 and 2.17 log units (Ulog), with activated sludge presenting the greatest efficiency, and that the tertiary technologies with the greatest removal are those that use ultrasound, which reach removal values of 3.17 Ulog. In the case of Giardia sp., the secondary technologies with the greatest removal are anaerobic technologies, with values between 0.00 and 3.80 Ulog, and the tertiary technologies with the greatest removal are those that combine filtration with UV or a chemical disinfection agent. Despite the removal values obtained, the greatest concern remains detecting and quantifying the infectious forms of both parasites in effluents; therefore, although the technologies perform adequately, discharge effluents must be monitored with more sensitive techniques, above all aiming for circularity of the treated water in a context of the water scarcity that affects some parts of the world.

Aplasia pura de células rojas como forma de presentación de lupus eritematoso sistémico / Pure red cell aplasia as a presentig form of systemic lupus erythmatosus

La aplasia pura de células rojas (APCR) es un síndrome definido por anemia normocítica normocrómica, con reticulopenia severa y reducción importante o ausencia absoluta de precursores eritroides en la médula ósea. Ocasionalmente se desencadena en el curso de una colagenopatía o una enfermedad autoinmune. Presentamos el primer caso descripto en la literatura de un varón con APCR como forma de debut de lupus eritematoso sistémico (LES). Se trata de un hombre de 65 años que presentó anemia normocítica normocrómica, ANA 1/5120 y anti-Sm 2,61. Refería úlceras orales, poliartralgias, tumefacción de ambos tobillos y fotosensibilidad. Se realizó estudio de médula ósea con evidencia de hipoplasia de serie roja por paro madurativo a nivel de eritroblasto basófilo, ausencia casi completa de los elementos maduros y contenido muy elevado de proeritroblastos de gran tamaño. Con el diagnóstico de APCR como debut de LES, se lo trató con prednisona con buena respuesta. Podemos concluir que el despistaje de enfermedades sistémicas en pacientes con APCR es esencial para asegurar un correcto manejo y un mejor pronóstico.

Pure red cell aplasia (PRCA) is a syndrome defined by normocytic normochromic anemia with severe reticulocytopenia and marked reduction or absence of erythroid precursors from the bone marrow. Occasionally it is triggered in the course of collagen or autoimmune diseases. We present the first case reported in the literature of a man with PRCA as the onset form of systemic lupus erythematosus (SLE). A 65-year-old man, who presented normocytic normochromic anemia, ANA 1/5120 and anti-Sm 2,61. He reported oral ulcers, polyarthralgia, swelling of both ankles and photosensitivity. Bone marrow examination showed red cell line hypoplasia due to maturation arrest at the level of the basophilic erythroblast, almost absence of mature cells, and a very high content of large proerythroblasts. With the diagnosis of PRCA as the first manifestation of SLE, he was successfully treated with Prednisone. We can conclude that screening for systemic diseases in patients with PRCA is essential to ensure correct management and a better prognosis.

Interaction of the Joining Region in Junctophilin-2 With the L-Type Ca2+ Channel Is Pivotal for Cardiac Dyad Assembly and Intracellular Ca2+ Dynamics.

RATIONALE: Ca2+-induced Ca2+ release (CICR) in normal hearts requires close approximation of L-type calcium channels (LTCCs) within the transverse tubules (T-tubules) and RyR (ryanodine receptors) within the junctional sarcoplasmic reticulum. CICR is disrupted in cardiac hypertrophy and heart failure, which is associated with loss of T-tubules and disruption of cardiac dyads. In these conditions, LTCCs are redistributed from the T-tubules to disrupt CICR. The molecular mechanism responsible for LTCCs recruitment to and from the T-tubules is not well known. JPH (junctophilin) 2 enables close association between T-tubules and the junctional sarcoplasmic reticulum to ensure efficient CICR. JPH2 has a so-called joining region that is located near domains that interact with T-tubular plasma membrane, where LTCCs are housed. The idea that this joining region directly interacts with LTCCs and contributes to LTCC recruitment to T-tubules is unknown. OBJECTIVE: To determine if the joining region in JPH2 recruits LTCCs to T-tubules through direct molecular interaction in cardiomyocytes to enable efficient CICR. METHODS AND RESULTS: Modified abundance of JPH2 and redistribution of LTCC were studied in left ventricular hypertrophy in vivo and in cultured adult feline and rat ventricular myocytes. Protein-protein interaction studies showed that the joining region in JPH2 interacts with LTCC-α1C subunit and causes LTCCs distribution to the dyads, where they colocalize with RyRs. A JPH2 with induced mutations in the joining region (mutPG1JPH2) caused T-tubule remodeling and dyad loss, showing that an interaction between LTCC and JPH2 is crucial for T-tubule stabilization. mutPG1JPH2 caused asynchronous Ca2+-release with impaired excitation-contraction coupling after ß-adrenergic stimulation. The disturbed Ca2+ regulation in mutPG1JPH2 overexpressing myocytes caused calcium/calmodulin-dependent kinase II activation and altered myocyte bioenergetics. CONCLUSIONS: The interaction between LTCC and the joining region in JPH2 facilitates dyad assembly and maintains normal CICR in cardiomyocytes.

Breast cancer, placing drug interactions in the spotlight: is polypharmacy the cause of everything?

PURPOSE: Breast cancer is the most prevalent and lethal cancer among women. Forty-one percent of cases occur in people ≥ 70 years, hindering their treatment given its comorbidities and polypharmacy (PP). Potential drug-drug interactions (PDDI) were analyzed in elderly breast cancer patients between daily and oncospecific treatments and their associations with Age, BMI, Mini Nutritional Assessment (MNA), Frailty categorization, PP, and adverse effects. PATIENTS/METHODS: A cohort of 77 patients ≥ 70 years with breast cancer who underwent a Comprehensive Geriatric Assessment (CGA) were included. Clinical characteristics were collected using medical records. PDDI between treatments were analyzed using two databases. Data were assessed using linear regression, Chi-square, Mann-Whitney U, and Kruskal-Wallis tests. Finally, a multivariate logistic regression model was built and tested to predict adverse effects. RESULTS: From 719 PDDI, 530 (74%) were moderate (r2 = 0.72) and the median number of drugs during oncospecific treatment (r2 = 0.73) was 9 (range 3-26). Overall, 59 patients (77%) had adverse effects associated with Frailty categorization and MNA (p < 0.05). The distribution of major, moderate, minor, and total PDDI was associated with PP at CGA and during oncospecific treatment (p < 0.05). Moreover, it was verified that Frailty categorization protects from adverse effects given the intervention made at CGA. CONCLUSIONS: CGA should be applied in oncologic elderly patients to assess clinical outcomes and categorize them according to their frailty but also to analyze PDDI. Furthermore, we encourage the use of the model in clinical practice for predicting the occurrence of adverse effects, improving therapeutic conciliation.

Structure-properties relationship in the hydronium-containing pyrochlores (H3O)1+pSb1+pTe1-pO6 with catalytic activity in the fructose dehydration reaction.

A series of defect pyrochlores of the composition (H3O)1+pSb1+pTe1-pO6 have been prepared by ion exchange from K-containing pyrochlores K1+pSb1+pTe1-pO6 in sulfuric acid at 280 °C for 24 h. The structural characterization of the hydronium-containing pyrochlores, including the location of the H3O+ units within the three-dimensional framework, was possible from neutron powder diffraction data in undeuterated samples. The crystal structure for all the compounds is defined in the Fd3[combining macron]m space group, and consists of a covalent framework of SbVO6 and TeVIO6 octahedra distributed at random and connected by their vertices with (Sb,Te)-O1-(Sb,Te) angles close to 136°, conforming to large cages where the hydronium species are located off-center. The absence of K+ ions in the ion-exchanged pyrochlores was confirmed by inductively coupled plasma optical emission spectroscopy and scanning electron microscopy coupled with energy dispersive X-ray spectroscopy. The shape and size of the hydronium units evolve along with the series, becoming more compact as the framework covalence and Lewis-basicity decrease upon Sb enrichment of the structure (for greater p values). The amount and lability of the H3O+ species also increase throughout the series, as wanted: a straightforward correlation of the catalytic activity in the fructose dehydration reaction to 5-hydroxymethylfurfural has been observed, reaching conversion rates up to 88.5% of concentrated fructose solution for the p = 0.25 catalyst. Moreover, a pseudo-first-order kinetic mechanism was simulated, and the kinetic constants obtained from diluted and concentrated enhanced reaction systems were determined and compared.

Aspectos bioquímicos y factores de riesgo asociados con el cáncer cervicouterino / Biochemical Aspects and Risk Factors Associated with Cervical Cancer

RESUMEN El cáncer de cuello uterino se encuentra dentro de las principales causas de muerte en la mujer, por lo que representa un serio problema de salud. Se ha demostrado, mediante estudios epidemiológicos, que su principal factor de riesgo es la infección por el virus del papiloma humano. Existen otros factores del propio huésped que lo predisponen al desarrollo del cáncer de cérvix. La lenta evolución de la enfermedad y la accesibilidad del cérvix para su estudio, permiten tener tiempo y herramientas para detectar y erradicar la enfermedad. Conocer los aspectos bioquímicos en su génesis podría contribuir a la búsqueda de métodos de detección y tratamiento más eficaces en las lesiones malignas de cuello uterino. Se realizó una revisión bibliográfica con el objetivo de describir un panorama general sobre los aspectos bioquímicos y los factores de riesgo asociados con este tipo de cáncer. Fueron consultadas las bases de datos científicas: Pubmed, Biomed Central, Medline, Scielo y Google Académico.

ABSTRACT Cervical cancer is among the leading causes of women´s death, which is a serious problem for health. It has been demonstrated, through epidemiological studies, that its main risk factor is infection by human papillomavirus. There are other host factors that predispose women for developing cancer of the cervix. The slow evolution of the disease and the accessibility of the cervix for its study, allow time and tools to detect and eradicate the disease. Knowing the biochemical aspects in its genesis could contribute to the search for more effective detection and treatment methods in malignant lesions of the cervix. A bibliographic review was carried out with the objective of describing a general panorama about the biochemical aspects and the risk factors associated with this type of cancer. The scientific databases were consulted: Pubmed, Biomed Central, Medline, Scielo and Academic Google.

Presencia de factores de riesgo para enfermedades crónicas no transmisibles en población supuestamente sana en Cienfuegos / Presence of Risk Factors for Chronic Non-communicable Diseases in a Supposedly Healthy Population in Cienfuegos

RESUMEN Fundamento: la elevada incidencia y prevalencia de las enfermedades crónicas no transmisibles hacen que su atención adquiera carácter inminente en las proyecciones del sistema de salud para fortalecer el manejo y control de los diferentes factores de riesgo que las acompañan. Objetivo: determinar el comportamiento de las principales enfermedades crónicas no transmisibles y factores de riesgo en población supuestamente sana en Cienfuegos. Métodos: se realizó un estudio descriptivo correlacional en el trimestre comprendido entre el 1ro de julio hasta el 30 de septiembre del 2018, en donantes de sangre del Banco Provincial de Cienfuegos. El universo estuvo constituido por 1200 donantes que asistieron a realizar una donación en el periodo de estudio y la muestra fue de 66 donantes que cumplieron con los criterios de inclusión y exclusión. Las variables analizadas fueron: edad, sexo, color de la piel, enfermedades crónicas, tabaquismo y obesidad. Los datos fueron procesados y analizados con métodos estadísticos acordes al estudio realizado (tasa de prevalencia, frecuencia, porcentaje y X2 de Pearson). Resultados: predominaron los hombres como portadores de enfermedades crónicas (21,31 %), los individuos del color de piel blanca (53,03 %). La enfermedad crónica más prevalente fue la hipertensión arterial (21,21 %), y entre los factores de riesgo, la obesidad (43,93 %) y el tabaquismo (33,33 %). Conclusiones: predominaron los hombres en las edades comprendidas entre 25-44 años. Las enfermedades crónicas y factores de riesgo están presentes mayoritariamente en los hombres. Los factores de riesgo estudiados están presentes tanto en los portadores como en los no portadores de padecimientos crónicos.

ABSTRACT Foundation: the high incidence and prevalence of chronic non-communicable diseases make their attention become imminent in the projections of the health system to strengthen the management and control of the different risk factors accompanying them. Objective: to determine the behavior of the main chronic non communicable diseases and risk factors in the supposedly healthy population in Cienfuegos. Methods: a correlational descriptive study was conducted in the trimester from July 1 to September 30, 2018, in blood donors of the Provincial Bank of Cienfuegos. The universe consisted of 1,200 donors who attended a donation in the study period and it shows 66 donors who met the inclusion and exclusion criteria. The variables studied were: age, sex, skin color, chronic diseases, smoking and obesity. The data were processed and analyzed with statistical methods according to the study carried out (prevalence rate, frequency, percentage and Pearson's X2). Results: men predominated as carriers of chronic diseases (21,31 %), individuals of the white race (53,03 %). The most prevalent chronic disease was arterial hypertension (21,21 %). As well as risk factors such as obesity (43,93 %) and smoking (33,33 %). Conclusions: men between 25-44 years old predominated. The chronic diseases studied and risk factors are present mostly in men. The risk factors studied are present in both carriers and non-carriers of chronic diseases.

¿Limitar la presión de distensión protege contra la lesión pulmonar adquirida por la ventilación mecánica (VALI)? / Does limiting the distension pressure protect against lung injury acquired by mechanical ventilation (VALI)? / A limitação da pressão de distensão protege contra lesão pulmonar adquirida por ventilação mecânica (VALI)?

Resumen: El incremento en la presión de las vías respiratorias causa lesión de la membrana alveolar proponiendo el barotrauma como causa de lesión pulmonar adquirida por el ventilador (VALI), esta afección se presenta de forma frecuente, lo que conduce a entender mejor el papel desempeñado por los ajustes del ventilador mecánico, la fisiopatología pulmonar subyacente y su interacción. En la última década se ha dado relevancia al término presión de distensión (PD), que surge del cálculo del delta de presión (∆P = Vt/CRS). La PD representa los cambios dinámicos de la presión que se genera en la vía aérea en cada ciclo ventilatorio. Aunque se instalen medidas de protección pulmonar de manera inicial, existen diversas condiciones que modifican las propiedades elásticas, tales como reanimación hídrica y el balance positivo de líquidos, procesos infecciosos agregados, etc. Sin embargo, aun cuando se cumplan estas medidas de protección puede haber distensión pulmonar excesiva, por lo que la monitorización de la PD puede ser una herramienta útil para determinar de manera sistemática los cambios en la rigidez pulmonar, estableciendo intervenciones. En ausencia de ensayos que usen PD como objetivo al establecer el ventilador, se sugiere que se utilice como complemento y no como un sustituto de parámetros de protección pulmonar.

Abstract: The increase in airway pressure causes injury in the alveolar membrane by proposing barotrauma as the cause of ventilator-acquired Lung Injury (VALI), this condition occurs frequently, which leads to a better understanding of the roles played by the mechanical ventilator settings, underlying lung pathophysiology and their interaction. In the last decade, the term pressure of distension (PD) has emerged, arising from the calculation of the pressure delta (ΔP = Vt/CRS). The PD represents the dynamic changes of the pressure that is generated in the airway in each ventilatory cycle. Although pulmonary protection measures are initially installed, there are several conditions that modify elastic properties, such as fluid resuscitation and positive fluid balance, aggregated infectious processes, etc. However, even if these protective measures are met, excessive pulmonary distention may occur, so PD monitoring may be a useful tool for systematically determining changes in pulmonary stiffness by establishing interventions. In the absence of assays using PD as a target when establishing the ventilator, it is suggested that it be used as a complement and not as a substitute for pulmonary protection parameters.

Resumo: O aumento da pressão das vias aéreas causa lesão da membrana alveolar, propondo o barotrauma como causa de Lesão Pulmonar Adquirida pelo Ventilador (VALI), esta condição ocorre com frequência, o que leva a uma melhor compreensão dos papéis desempenhados pelos ajustes do ventilador mecânico, a fisiopatologia pulmonar subjacente e sua interação. Na última década, o termo pressão de distensão (PD) tem recebido relevância decorrente do cálculo do delta de pressão (ΔP = Vt/CRS). A DP representa as mudanças dinâmicas da pressão gerada na via aérea em cada ciclo ventilatório. Embora as medidas de proteção pulmonar sejam instaladas inicialmente, existem várias condições que modificam as propriedades elásticas, tais como ressuscitação hídrica e balanço hídrico positivo, processos infecciosos agregados, etc. No entanto, mesmo que essas medidas de proteção sejam atendidas, pode haver distensão pulmonar excessiva, de modo que a monitorização da DP possa ser uma ferramenta útil para determinar sistematicamente as mudanças na rigidez pulmonar, estabelecendo intervenções. Na ausência de ensaios que utilizem a PD como objetivo no estabelecimento do ventilador, sugere-se que seja utilizado como complemento e não como substituto dos parâmetros de proteção pulmonar.

Activación y "cuestión social" una apuesta regresiva en el Uruguay Progresista / Ativação e "questão social" uma aposta regressiva no Uruguai progressista / Activation and "social Question" a regressive bet in Uruguay Progressive

Este articulo presenta sumariamente, una concepción de "cuestión social" y un sistema típico ideal (neoliberal, conservador y socialista o de ampliación de la ciudadanía) para comprender el contenido ideológico que expresan. A partir de este sistema es analizado las propuestas de activación contenidas en la política asistencial realizada por el Ministerio de Desarrollo Social del Uruguay. Se concluye que en estas formas de confrontación a la pobreza, los contenidos conservadores y neoliberales se expresan claramente y, de forma apenas semántica, el contenido de extensión de la ciudadanía aparece sin ninguna capacidad operacional.

Este artigo apresenta, sumariamente, uma concepção de questão social e um sistema típico ideal (neoliberal, conservador e Socialista ou de extensão da cidadania) para compreender o conteúdo ideológico que expressam. A partir deste sistema é analisado as Propostas de ativação contidas na política de assistência realizada pelo Ministério do desenvolvimento social do Uruguai. Conclui-se que nessas formas de confronto com a pobreza, os conteúdos conservadores e neoliberais são exibidos, e de forma apenas semântica, o conteúdo do extensão da cidadania está aparecendo, sem qualquer capacidade operacional.

This article summarily presents a conception of social issue and a typical ideal system (neoliberal, conservative and socialist or extension of citizenship) to understand the ideological content they express, from this system is analyzed the Proposals for activation contained in the assistance policy carried out by the Ministry of Social Development of Uruguay. It Is concluded that in these forms of confrontation with poverty, Conservative and neo-liberal content are displayed, and in a just semantic form, content of enlargement of the citizenship is appearing, without any operational capacity.

The Guatemalan Construction Industry: Approach of Knowledge Regarding Work Risks Prevention.

In the present work, the results are presented for the characterization of work risk prevention in the Guatemalan construction industry. This characterization has been carried out using a simple random sampling technique, employing a questionnaire that was structured into 3 groups of variables: 1. General company data; 2. Prevention and management activities regarding health and safety in the company and on the worksite; and 3. Health and safety in the contractor companies. Following the sampling phase, the data were introduced in a database format, and a preliminary analysis was performed on the studied variables, followed by a descriptive analysis and a multiple correspondence analysis. The main findings of the study emphasize that companies in the Guatemalan construction sector are characterized as dedicating most of their activity (52.0%) indistinctly between civil engineering work, building construction and other specialized construction, mainly working as contractors (47.5%). These are "medium-sized" companies, employing an average of 81.1 on-site workers, having an average of 6.8 on-site work crews, and grossing an average turnover of 1.29 million euros annually. Likewise, it found that the larger construction companies adopt better prevention and management measures for worksite health and safety the larger companies are correlated with a high awareness of experiencing worksite accidents, while medium-sized companies have medium-level awareness. Companies with fewer workers manage workplace risk prevention worse, with low accident risk awareness. This correlation between these indicative variables of company size and workplace risk management and prevention is clearly reflected in the four company "clusters" that have been identified as having homogenous characteristics using the multiple correspondence analysis technique. Companies in the Guatemalan construction sector should make a greater effort to improve manager and worker training regarding workplace risk prevention to increase the effectiveness of company prevention management.

Elucidating the Methylammonium (MA) Conformation in MAPbBr3 Perovskite with Application in Solar Cells.

Hybrid organic-inorganic perovskites, MAPbX3 (X = halogen), containing methylammonium (MA: CH3-NH3+) in the large voids conformed by the PbX6 octahedral network, are the active absorption materials in the new generation of solar cells. CH3NH3PbBr3 is a promising member with a large band gap that gives rise to a high open circuit voltage. A deep knowledge of the crystal structure and, in particular, the MA conformation inside the perovskite cage across the phase transitions undergone below room temperature, seems essential to establish structure-property correlations that may drive to further improvements. The presence of protons requires the use of neutrons, combined with synchrotron XRD data that help to depict subtle symmetry changes undergone upon cooling. We present a consistent picture of the structural features of this fascinating material, in complement with photocurrent measurements from a photodetector device, demonstrating the potential of MAPbBr3 in optoelectronics.

Technological aids in uniportal video-assisted thoracoscopic surgery.

With the evolution of uniportal video-assisted thoracoscopic surgery (VATS), the technological aids have come to help skill surgeons to improve the results in thoracic surgery and feasible to perform a complex surgery. The technological aids are divided into three important groups, which make surgical steps easy to perform, besides reducing surgical time and surgical accidents in the hands of experienced surgeons. The groups are: (I) conventional thoracoscopic instruments; (II) sealing devices using in uniportal VATS; (III) high definition cameras, robotic arms prototype and the future robotic aids for uniportal VATS surgery. Uniportal VATS is an example of the continuing search for methods that aim to provide the patient a surgical cure of the disease with the lowest morbidity. That is the reason companies are creating more and new technologies, but the surgeon have to choose properly and to know how, when and where is the moment to use each new aids to avoid mistakes. The future of the thoracic surgery is based on evolution of surgical procedures and innovations to try to reduce even more the surgical and anesthetic trauma. This article summarizes the technological aids to improve and help a thoracoscopics surgeons perform a uniportal VATS feasible and safe.

Prevalence of Burnout Syndrome in staff of juvenile facilities: Differences according to their socio-labour context / Prevalência da síndrome de Burnout em pessoal de centros de menores: diferenças segundo seu contexto socioprofissional / Prevalência del síndrome de Burnout en personal de centros de menores: diferencias según su contexto sociolaboral

Abstract This study is aimed at determining the prevalence of burnout and its three components (emotional exhaustion, depersonalisation and lack of self-fulfilment) in the staff of juvenile facilities in Spain, and to analyze the predictive capacity of various epidemiological and occupational factors regarding the likelihood of suffering the aforementioned syndrome. For this end, a quantitative cross-sectional research was carried out with a sample of 160 professionals by means of an ad hoc questionnaire and the Maslach Burnout Inventory. The burnout results in juvenile facilities show an average impact of emotional exhaustion (40%) and self-fulfilment (41.2%) and a low depersonalisation (55.6%). Likewise, it is confirmed that the location and the age of the centre are significant sources of variation in emotional exhaustion, as well as gender is in depersonalisation, and profession in self-fulfilment. In conclusion, the greatest predisposition to suffer Burnout occurs in unmarried women aged between 34 and 43, with little work experience, permanent contract and working as social educators or social workers in alternate shifts (morning or afternoon) in urban centres.

Resumo O objetivo deste estudo foi determinar a prevalência da síndrome de burnout e de seus três componentes (esgotamento emocional, despersonalização e falta de realização pessoal) no pessoal de alguns centros de menores na Espanha e analisar a capacidade preditiva de diversos fatores epidemiológicos e profissionais sobre a probabilidade de padecer dessa síndrome. Para isso, realizou-se uma pesquisa quantitativa de corte transversal numa amostra de 160 profissionais mediante a aplicação de um questionário elaborado ad hoc e do Maslach Burnout Inventory. Os resultados obtidos mostram uma incidência média em esgotamento emocional (40%) e realização pessoal (41,2%), e uma baixa despersonalização (55,6%) no burnout de profissionais de centros de menores. Além disso, confirma-se que a localização do centro e a antiguidade são fontes significativas de variação no esgotamento emocional, bem como o sexo na despersonalização, e a profissão na realização pessoal. Em conclusão, a maior pré-disposição a sofrer burnout é produzida em mulheres solteiras, com idade entre 34 e 43 anos, com pouca experiência profissional, contrato fixo e que trabalham como educadoras ou trabalhadoras sociais em períodos alternados (manhã ou tarde) dos centros localizados em centros urbanos.

Resumen El objetivo del estudio fue determinar la prevalencia del síndrome de burnout y de sus tres componentes (agotamiento emocional, despersonalización y falta de realización personal) en el personal de algunos centros de menores en España y analizar la capacidad predictiva de diversos factores epidemiológicos y laborales sobre la probabilidad de padecer dicho síndrome. Para ello, se llevó a cabo una investigación cuantitativa de corte transversal en una muestra de 160 profesionales mediante la aplicación de un cuestionario elaborado ad hoc y el Maslach Burnout Inventory. Los resultados obtenidos muestran una incidencia media en agotamiento emocional (40 %) y realización personal (41.2 %), y una baja despersonalización (55.6 %) en el burnout de profesionales de centros de menores. Asimismo, se confirma que la ubicación del centro y la antigüedad son fuentes significativas de variación en el agotamiento emocional, así como el sexo en la despersonalización, y la profesión en la realización personal. En conclusión, la mayor predisposición a sufrir burnout se produce en mujeres solteras y con edades entre los 34 y 43 años, con poca experiencia laboral, contrato fijo, y que trabajan como educadoras o trabajadoras sociales en turnos alternos (mañana o tarde) de los centros ubicados en cascos urbanos.

Subxiphoid approach for a combined right upper lobectomy and thymectomy through a single incision.

The subxiphoid uniportal video assisted thoracoscopic surgery (VATS) is a new interesting approach for the resection of anterior mediastinal masses and lung resections. For this reason in cases with both pathologies is an ideal approach to perform both procedures at the same time without multiple incisions. The evolution in the surgery of thymoma is getting less invasive, from the transsternal thymectomy to the minimally invasive Thoracic surgery improving the recovery of the patients and with satisfactory postoperative results, otherwise the anatomical view of the main structures and the recognition of the vascular anatomy, and his variants is feasible. In those cases with synchronic masses, the Subxiphoid approach is an ideal option in hands of experienced surgeons. In this video, we present the case of a right upper lobectomy and a thymectomy by subxiphoid approach in which the anatomical variations of the thymic artery are well recognized, and both procedures were completed without complications.