Comunidad compasiva para la inclusión social y calidad de vida de las personas con esclerosis múltiple y sus cuidadores familiares / Comunidade compasiva pela inclusao social e qualidade de vida de pessoãs com esclerose multipla e seus familiares cuidadores / Compassionate community for the social inclusion and quality of life of people with multiple sclerosis and their family caregivers

Objetivo: Evaluar cualitativamente la experiencia de pacientescon esclerosis múltiple (PEM) y cuidadores familiares (CFPEM)vinculados al programa de esclerosis múltiple del HospitalUniversitario Nacional de Colombia (PrEM-HUNC), durantela formación y consolidación de una comunidad compasiva(CC), para la inclusión social y promoción de calidad de vida.Materiales y Método: estudio cualitativo interpretativo, conentrevistas a profundidad a nueve colaboradores. Con elmétodo de análisis de espiral de Creswell y Poth, emergieroncuatro categorías y un tema.Resultados: el tema “Un nido comunitario de crecimientoytransformación” señala el proceso de conformación de la CCcomo una experiencia que posibilitó cambios de significadosen torno a la enfermedad, la situación personal y familiar;revela un proceso de descubrimiento y aprendizaje deconformación de diferentes relaciones y roles.Conclusiones: La CC es una opción para construcción deredes de apoyo, fortalecimiento de las capacidades personalesy familiares, una forma para hacer frente a los diferentesimpactos y retos que implica vivir con esclerosis múltiple,se constituye en una alternativa para la promoción de lacalidad de vida y la inclusión social.(AU)

Objective: to qualitatively evaluate the experienceof patients with multiple sclerosis (PEM) and familycaregivers (CFPEM) linked to the multiple sclerosisprogram of the National University Hospital ofColombia (PrEM-HUNC), during the formation andconsolidation of a compassionate community (CC),for social inclusion and promotion of quality of life.Materials and Method: qualitative interpretativestudy, with in-depth interviews to nine collaborators.With Creswell and Poth's spiral analysis method,four categories and one topic emerged. Results: the theme "A Community Nest of Growth andTransformation" points out the process of shaping theCC as an experience that made possible changes in themeanings surrounding the disease and the personaland family situation; reveals a process of discovery andlearning of shaping different relationships and roles.Conclusions: The CC is an option for building supportnetworks, strengthening personal and family capacities,a way to address the different impacts and challengesof living with multiple sclerosis; it is an alternative tothe promotion of quality of life and social inclusion.(AU)

Objetivo: avaliar qualitativamente a experiência depacientes com esclerose múltipla (PEM) e cuidadoresfamiliares (CFPEM) vinculados ao programa de esclerosemúltipla do Hospital Universitário Nacional de Colombia(PrEM-HUNC), durante a formação e consolidação deuma comunidade compassiva (CC), para a inclusãosocial e promoção da qualidade de vida.Materiais e Método: estudo qualitativo interpretativo,com entrevistas em profundidade com nove colaboradores.Com o método em espiral de Creswell e Poth, quatrocategorias e um tema emergiram.Resultados: o tema “Um ninho comunitário de crescimentoe transformação” revela o processo de conformação daCC como uma experiência que possibilitou mudanças designificados em torno da doença, da situação pessoal efamiliar; revela um processo de descoberta e aprendizagemde obter diferentes relacionamentos e papéis.Conclusões: a CC é uma opção para a construção deredes de apoio, fortalecendo as capacidades pessoais efamiliares, uma forma de enfrentar os diversos impactose desafios que o viver com esclerose múltipla implica,sendo uma opção para a promoção da qualidade devida e inclusão social.(AU)

Efectividad de un programa de automanejo para cuidadores familiares / Effectiveness of a self-management program for family caregivers

INTRODUCCIÓN: La carga de cuidado en los cuidadores familiares (CF), tiene un efecto en la salud física y mental, relaciones familiares, laborales y estado financiero, aumentando la necesidad de intervenciones efectivas para mejorar el automanejo de su condición y el cuidado al familiar en el hogar. OBJETIVO: evaluar la efectividad de un programa para promover el automanejo en CF. METODOLOGÍA: de diseño cuasi experimental con mediciones pre y post intervención, en una muestra no probabilística, intencionada de 19 CF de personas mayores con nivel de dependencia. El programa "Trabajando juntos en colaboración" (TJC), implementado por facilitadores entrenados y certificados, promueve el automanejo y habilidades para cuidar a su familiar en casa. Para evaluar el efecto de la intervención se aplicó pre y post-test el Instrumento de "Automanejo en Cuidadores Familiares", la prueba Shapiro-Wilks, el análisis de diferencias por la t-Student y test de Wilcoxon, se calculó el tamaño del efecto y la potencia estadística (1- ß). RESULTADOS: se encontró una diferencia estadísticamente significativa entre el pre y post intervención, observando un incremento en el resultado de la sumatoria global y en las tres dimensiones del automanejo. Estas diferencias muestran un efecto relevante a considerar (>,80) y una potencia alta (>,80). CONCLUSIÓN: El Programa TJC, muestra efectividad en mejorar el automanejo en CF, con una potencia adecuada que podría permitir generalizar resultados en poblaciones similares. Siendo este un programa genérico, podría ser aplicado en cualquier caso de CF, independiente a la enfermedad o condición de su familiar.

INTRODUCTION: The caregiving burden on family caregivers (FC) has an impact on physical and mental health, family relationships, work, and financial status, increasing the need for effective interventions to improve self-management of their condition and care for the family member at home. OBJECTIVE: to evaluate the effectiveness of a program to promote self-management in FC. METHODOLOGY: The study employed a quasi-experimental design with pre- and post-intervention measurements in a non-probabilistic, purposive sample of 19 FC of older individuals with a level of dependency. The "Trabajando Juntos en Colaboración" (TJC) program, implemented by trained and certified facilitators, promotes self-management and skills to care for their family member at home. To assess the intervention's effect, pre and post-tests were administered using the "Automanejo en Cuidadores Familiares" instrument, along with the Shapiro-Wilks test, t-Student analysis of differences, and Wilcoxon test. Effect size and statistical power (1- ß) were calculated. RESULTS: indicated statistically significant differences between the pre- and post-intervention periods, with an observed increase in the overall sum and in all three dimensions of self-management. These differences demonstrate a relevant effect (>0.80) and high statistical power (>0.80). CONCLUSION: the TJC program proves effective in enhancing self-management in CF, with sufficient power to potentially generalize results to similar populations. As a generic program, it could be applied in any FC case, regardless of the disease or condition of their family member.

Use of Virtual Reality and Three-Dimensional Printing in the Surgical Planning of Slide Tracheoplasty.

Purpose: To describe our experience using virtual reality (VR) and three-dimensional (3D) printing as complements for the surgical planning process of slide tracheoplasty (ST) in patients with congenital tracheal stenosis (CTS). Description: VR and 3D printing are used for the surgical planning of ST as a therapeutic option in three female patients under five years of age with CTS. Evaluation: We assessed the planned surgical procedure, procedural time, postoperative complications, and outcomes, as well as the main surgeon's experience with the use of the applied technologies. Conclusions: The interaction within the VR environment allowed for collaboration of the surgical plan between surgical staff and enhancement of the radiologist-surgeon communication, while procedural simulation with 3D printing prototypes allowed for refining technical abilities for the surgical interventions. Based on our experience, the application of these technologies have added value to the surgical planning of ST and its outcomes in the treatment of CTS.

Significados de familia para familias contemporáneas

(analítico) Frente a la existencia de diferentes formas familiares y para comprender el significado que el ser humano desde su diversidad le da a la familia, se realizó un estudio narrativo con enfoque cualitativo, usando como técnica la entrevista semiestructurada. Participaron integrantes de tres formas familiares: homoparental, con hijos producto de inseminación y adoptiva. Emergieron cinco categorías: definición de familia, aceptación, crianza, actitudes del medio familiar y social. El análisis concluye que el ser humano, desde su diversidad, le da un significado a la familia a partir de sus vivencias, sin diferenciar género, roles o funciones; por tanto, exigen derechos igualitarios frente a la conformación y dinámica familiar de los diferentes modelos y formas familiares, evidenciado la necesidad de ampliar la mirada sobre los significados atribuidos a la familia.

(analytical) Given the existence of different types of families, and with the aim of understanding the meaning that human beings give to the diverse expressions of family that currently exist, a qualitative narrative study using semi-structured interviews was carried out. Members of 3 different types of families participated: homoparental, families with children who are the result of artificial insemination and families that adopted their children. Five categories emerged from the interviews: the meaning of family, acceptance, parenting, social life and attitudes to the family environment. The study finds that human give meaning to their families based on their experiences without differentiating gender, functions or roles. They demand equal rights for the conformation of the different family types and models, demonstrating the need to broaden perspectives on meanings attributed to family.

(analítico) Diante da existência existência de diferentes formas familiares e com o objetivo de compreender o significado que o ser humano dá à família a partir de sua diversidade, foi realizado um estudo narrativo com abordagem qualitativa, utilizando como técnica a entrevista semiestruturada. Participaram membros de 3 formas familiares: homoparental, com filhos produto de inseminação e adotiva. Emergiram cinco categorias: definição de família, aceitação, criação, atitudes da família e ambiente social. Concluise que, a partir de sua diversidade, o ser humano dá sentido à família a partir de suas vivências, sem diferenciar gênero, papéis ou funções, portanto, demandam direitos iguais frente à conformação e dinâmica familiar dos diferentes modelos e formas de família, destacando a necessidade de ampliar o olhar sobre os significados atribuídos à familia.

Percepción de calidad de vida en trabajadores víctimas de accidente laboral que terminó en amputación / Perception of quality of life in workers who are victims of a work accident that ended in amputation / Percepção de qualidade de vida em trabalhadores vítimas de acidente laboral que acabou em amputação

Resumen Objetivo: describir la percepción de calidad de vida de las personas que han sufrido amputación por un accidente laboral. Metodología: investigación cualitativa con la aplicación de entrevista semiestructurada de 10 preguntas abiertas a seis trabajadores que sufrieron un accidente laboral que terminó en amputación. La información fue recolectada, analizada y clasificada de forma manual en categorías emergentes. Resultados: los participantes son de sexo masculino, de 34 y 52 años de edad, su domicilio son los municipios del eje cafetero y norte del valle, el estado civil es 5 casados y 1 separado, el nivel educativo 2 en primaria, 3 con secundaria y 1 técnico profesional. Todos afiliados al sistema de salud. Los segmentos corporales amputados son: 3 amputados del Miembro Superior, los otros tres amputados del Miembro Inferior. Conclusiones: su calidad de vida según las capacidades funcionales humanas centrales definidas por Nussbaum reflejan que posterior al siniestro fue afectada en la pérdida seguridad y confianza en sí mismos, impidiendo las actividades de tipo social. Su condición actual los limita en mejorar sus ingresos por su condición de discapacidad. El dolor crónico y la desadaptación protésica son comunes. Al igual que el uso de aditamentos y las dificultades en el traslado. Es evidente el fortalecimiento de la red de apoyo familiar primaria, sin embargo, al finalizar su rehabilitación hay desinterés en actividades sociales. Los participantes tienen proyectos a futuro concretos que involucran su familia. Finalmente, su proceso de rehabilitación se limitó a lo básico y no contaron con otro tipo de apoyo.

Abstract Objective: to describe the perception of quality of life of people who have suffered amputation due to a work accident. Methodology: qualitative research with the application of a 10 open questions semi-structured interview to six workers who had suffered an occupational accident that ended in amputation. The information was collected, analyzed and classified manually in emerging categories. Results: the participants are 34 and 52 years old males from the municipalities of the coffee triangle area and north of the Department of Valle del Cauca. Their marital status is 5 married and 1 separated, their educational level is 2 primary school, 3 secondary school and 1 professional technician. All of them are affiliated to the health system. The body segments amputated are: 3 upper limb amputees and 3 lower limb amputees. Conclusions: their quality of life, according to the central human functional capacities defined by Nussbaum, reflects that after the accident they were affected by the loss of security and self-confidence, preventing social activities. Their current condition limits them from improving their income due to their disabling condition. Chronic pain and prosthetic maladjustment are common, as well as the use of accessories and the difficulties to move. The strengthening of the primary family support network is evident but, at the end of their rehabilitation, there is a lack of interest in social activities. Participants have concrete future projects that involve their family. Finally, their rehabilitation process was limited to the basics and they did not have any other type of support.

Resumo Objetivo: descrever a percepção da qualidade de vida das pessoas que têm sofrido amputação por um acidente laboral. Metodologia: pesquisa qualitativo com a aplicação de entrevista semiestruturadas de 10 perguntas abertas a seis trabalhadores que sofreram um acidente laboral (trabalho) que acabou em amputação. A informação foi coletada, analisada e classificada de forma manual em categorias emergentes. Resultados: os participantes são de sexo masculino, de 34 e 52 anos de idade, seu domicílio são os municípios do eixo Cafeeiro e norte do departamento do Valle (Colômbia), o estado civil é 5 casados e 1 separado, o nível educativo 2 no ensino primário, 3 com ensino médio e 1 técnico profissional. Todos cadastrados no sistema de saúde. Os segmentos corpóreos amputados são: 3 amputados do Membro Superior, os outros três amputados do Membro Inferior. Conclusões: De acordo com a lista das capacidades humanas de Nussbaum evidencia-se que, após do sinistro, a qualidade de vida das pessoas amputadas foi afetada na perda de segurança e de confiança dos indivíduos em si mesmos, o qual os impede de realizarem atividades de tipo social. Sua condição atual de deficiência limita sua capacidade de melhorar seus ingressos, sendo a dor crónica e a desadaptação protésica fatores comuns, junto com o uso de aditamentos e as dificuldades na locomoção. É evidente o fortalecimento da rede de apoio familiar primária; entretanto, ao finalizar sua reabilitação há desinteresse em atividades sociais. Os participantes têm projetos concretos envolvendo sua família. Finalmente, seu processo de reabilitação se limitou a uma atenção básica e não contaram com outro tipo de apoio.

Effect of flipped classroom methodology on the student performance of gastrointestinal and renal physiology entrants and repeaters.

BACKGROUND: Physiology is a subject that is considered difficult; it is associated with academic failure and causes high levels of stress and anxiety in students. METHODS: This study compared the effectiveness of a traditional lecture-based methodology with that of a flipped classroom scheme focusing on cooperative ludic learning among gastrointestinal and renal physiology students. Two groups were subjected to these two different methods to teach gastrointestinal and renal physiology content divided into 14 topics. Additionally, two subgroups were identified in each group: entrants and repeaters. There were no differences in age or gender between the subgroups. RESULTS: Levels of self-perceived stress (measured by the SISCO scale), biological stress (measured by awakening salivary cortisol levels), and anxiety (measured by the Zung scale) were high in all of the students; the cortisol levels increased in the entrants and some of the scores in SISCO scale increased in the repeaters, throughout the study. The self-reported study time was longer in the students subjected to the flipped classroom-based method. The final exam results were better only in the new students facing the flipped methodology, but not in the repeaters, who scored lower on the final evaluation. The quantitative and qualitative assessments completed by the participants regarding the different aspects of the flipped-classroom-based methodology were favorable; however, the participants believed that traditional lectures should be maintained for specific topics. CONCLUSIONS: A methodology based on flipped teaching was an effective strategy to improve academic performance ingastrointestinal and renal physiology, but only in new students.

Autonomous activation of CaMKII exacerbates diastolic calcium leak during beta-adrenergic stimulation in cardiomyocytes of metabolic syndrome rats.

Autonomous Ca2+/calmodulin-dependent protein kinase II (CaMKII) activation induces abnormal diastolic Ca2+ leak, which leads to triggered arrhythmias in a wide range of cardiovascular diseases, including diabetic cardiomyopathy. In hyperglycemia, Ca2+ handling alterations can be aggravated under stress conditions via the ß-adrenergic signaling pathway, which also involves CaMKII activation. However, little is known about intracellular Ca2+ handling disturbances under ß-adrenergic stimulation in cardiomyocytes of the prediabetic metabolic syndrome (MetS) model with obesity, and the participation of CaMKII in these alterations. MetS was induced in male Wistar rats by administering 30 % sucrose in drinking water for 16 weeks. Fluo 3-loaded MetS cardiomyocytes exhibited augmented diastolic Ca2+ leak (in the form of spontaneous Ca2+ waves) under basal conditions and that Ca2+ leakage was exacerbated by isoproterenol (ISO, 100 nM). At the molecular level, [3H]-ryanodine binding and basal phosphorylation of cardiac ryanodine receptor (RyR2) at Ser2814, a CaMKII site, were increased in heart homogenates of MetS rats with no changes in RyR2 expression. These alterations were not further augmented by Isoproterenol. SERCA pump activity was augmented 48 % in MetS hearts before ß-adrenergic stimuli, which is associated to augmented PLN phosphorylation at T17, a target of CaMKII. In MetS hearts. CaMKII auto-phosphorylation (T287) was increased by 80 %. The augmented diastolic Ca2+ leak was prevented by CaMKII inhibition with AIP. In conclusion, CaMKII autonomous activation in cardiomyocytes of MetS rats with central obesity significantly contributes to abnormal diastolic Ca2+ leak, increasing the propensity for ß-adrenergic receptor-driven lethal arrhythmias.

Visualization of 3D Models Through Virtual Reality in the Planning of Congenital Cardiothoracic Anomalies Correction: An Initial Experience.

We present the case of an nine-year-old girl with double outlet right ventricle with noncommitted ventricular septal defect and malposition of the great arteries who had undergone repair at the age of seven months. Six years later, the patient presented with right ventricular failure, conduit calcification with obstruction, and obstruction of the left ventricular outflow tract. Three-dimensional models reconstructed by Digital Imaging and Communications in Medicine (DICOM) images of the patient were visualized in a virtual reality system to help plan the surgical correction of the intracardiac congenital anomalies. This tool allowed us to inspect the intracardiac anatomy in an immersive environment with a clearer sense of perspective.

Seasonal Influenza Vaccination Patterns Among Pregnant Women in New Mexico.

INTRODUCTION: Seasonal influenza vaccination is recommended for pregnant women, but half of the pregnant women in the United States remain unvaccinated. Vaccine coverage in U.S.-Mexico border states has not been examined in depth even though risk factors for low vaccine coverage exist in these states, especially in the counties bordering Mexico. METHOD: Using 2012-2014 New Mexico (NM) Pregnancy Risk Assessment and Monitoring System data, this study examined the weighted annual seasonal influenza vaccination rates and the relationship of various factors to vaccination among NM residents with a live birth during those years. RESULTS: Among respondents, 53.8% were Hispanic, 15.7% were Native American, and 30.5% were non-Hispanic White. The vaccination rate in NM increased from 49.0% in 2012 to 64.8% in 2014. The adjusted odds of vaccination were higher among women whose health care provider recommended/offered vaccination during the year prior to delivery compared to women whose provider did not (AOR = 11.92, 95% confidence interval [CI: 9.86, 14.42]) and among those living in the U.S.-Mexico nonborder counties compared to those living in the border counties (AOR = 1.23, 95% CI [1.18, 1.25]). CONCLUSION: Efforts to increase the vaccination rate among pregnant women in border states should concentrate on health care providers and the highest risk women, such as those resident in the border region.

La seguridad del paciente en un hospital de bogotá, percepción del profesional de enfermería

Objetivo: Evaluar la percepción del clima de seguridad del paciente en enfermeros que laboran en una unidad de atención de salud en Bogotá. Métodos: Se realizó un estudio transversal y descriptivo que evalúa la percepción del clima de seguridad del paciente, mediante la aplicación del cuestionario elaborado por la Agency for Health Care Research and Quality (AHRQ) para la medición de la cultura de seguridad del paciente en una unidad de atención de salud de Bogotá. Resultados: Un total de 43 enfermeros del área asistencial respondieron el cuestionario. Las dimensiones que obtuvieron mayor coeficiente de Alfa de Cronbach fueron: frecuencia de eventos notificados (0,826), trabajo en equipo en la unidad/servicio (0,824) y problemas en cambios de turno y transiciones entre servicios/unidades (0,785). Mientras que las dimensiones que tuvieron menos coeficiente y se catalogaron como oportunidad de mejora, teniendo en cuenta los resultados de otras investigaciones que utilizaron el mismo instrumento, correspondieron a: dotación de personal (0,533) y respuesta no punitiva a los errores (0,488). Conclusiones: Para alcanzar niveles aceptables de cultura de seguridad del paciente es necesario recurrir al método científico porque ayuda a definir y comprender los problemas asociados con la ocurrencia de fallas y errores que afectan la atención del paciente. Por lo tanto, las dimensiones de personal, la respuesta no punitiva a los errores, los problemas en los cambios de turno y las transiciones entre servicios y unidades son el punto de partida para formular estrategias de mejora que pueden tener un impacto en la institución.

Objective: To evaluate the perception of patient's safety in nurses who work in a health unit service center in Bogota. Method: A cross-sectional and descriptive study was carried out to evaluate perception over patient's safety. We applied a questionnaire from the Agency for Health Care Research and Quality (AHRQ), designed to measure knowledge about patient's safety. It was done in a health unit service center in Bogota. Results: A total of 43 nurses from the health-care services area answered the survey. The sections which threw a higher alpha Cronbach rate were frequency of notified events (0,826); teamwork in the healthcare service unit (0.824) and issues in shift changes and transitions between services (0.785). Whilst sections with a lower rate were classified as chances to improve, taking into account the results of other research works which used the same measuring instrument. They were staffing (0.533) and non-punitive reaction to errors (0,488). Conclusions: In order to reach average levels of knowledge regarding patient's health, it is necessary to use a scientific method which helps define and understand all the problems related to the frequency of flaws and errors that affect patient's care. Thus, sections of staff and non-punitive answer to mistakes, as well as the problems in shifts and transitions between services are a starting point to create strategies to improve and positively create a change in the institution.

Objetivo: avaliar a percepção do clima de segurança do paciente em enfermeiros que trabalham em uma unidade de atendimento de saúde em Bogotá, Colômbia. Métodos: estudo transversal e descritivo que avalia a percepção do clima de segurançã do paciente, mediante a aplicaçãdo de um questionário elaborado pela Agency for Health Care Research and Quality (AHRQ) para medir a cultura de seguranza do paciente em uma unidade de atendimento de saúde de Bogotá. Resultados: um total de 43 enfermeiros da área assistencial respondeu ao questionário. As dimensões que obtiveram maior coeficiente de alfa de Cronbach foram: frequência de eventos notificados (0,826), trabalho em equipe na unidade/serviço (0,824) e problemas na passagem de plantão e transições entre serviços e unidades (0,785). Enquanto as dimensões que tiveram menos coeficiente e se catalogaram como oportunidade de melhoria, considerando os resultados de outras pesquisas que utilizaram o mesmo instrumento, corresponderam a: provisão de pessoal (0,533) e resposta não punitiva aos erros (0,488). Conclusões: para atingir níveis aceitáveis de cultura de segurança do paciente, é necessário recorrer ao método científico, porque ajuda a definir e a compreender os problemas associados com a ocorrência de falhas e erros que afetam o atendimento do paciente. Portanto, as dimensões de pessoal, a resposta não punitiva aos erros, os problemas nas passagens de plantão e as transações entre serviços e unidades são o ponto de partida para formular estratégias de melhoria que podem ter um impacto na instituição.

Impaired Activity of Ryanodine Receptors Contributes to Calcium Mishandling in Cardiomyocytes of Metabolic Syndrome Rats.

Metabolic syndrome (MetS) has become a global epidemic. MetS is a serious health problem because of its related cardiovascular complications, which include hypertension and delayed heart rate recovery after exercise. The molecular bases of cardiac dysfunction in MetS are still under scrutiny and may be related to anomalies in the activity and expression of key proteins involved in the cardiac excitation-contraction coupling (ECC). The cardiac Ca2+ channel/ryanodine receptor (RyR2) participates in releasing Ca2+ from internal stores and plays a key role in the modulation of ECC. We examined alterations in expression, phosphorylation status, Ca2+ sensitivity, and in situ function (by measuring Ca2+ sparks and Ca2+ transients) of RyR2; alterations in these characteristics could help to explain the Ca2+ handling disturbances in MetS cardiomyocytes. MetS was induced in rats by adding commercially refined sugar (30% sucrose) to their drinking water for 24 weeks. Cardiomyocytes of MetS rats displayed decreased Ca2+ transient amplitude and cell contractility at all stimulation frequencies. Quiescent MetS cardiomyocytes showed a decrease in Ca2+ spark frequency, amplitude, and spark-mediated Ca2+ leak. The [3H]-ryanodine binding data showed that functionally active RyRs are significantly diminished in MetS heart microsomes; and exhibited rapid Ca2+-induced inactivation. The phosphorylation of corresponding Ser2814 (a preferential target for CaMKII) of the hRyR2 was significantly diminished. RyR2 protein expression and Ser2808 phosphorylation level were both unchanged. Further, we demonstrated that cardiomyocyte Ca2+ mishandling was associated with reduced SERCA pump activity due to decreased Thr17-PLN phosphorylation, suggesting a downregulation of CaMKII in MetS hearts, though the SR Ca2+ load remained unchanged. The reduction in the phosphorylation level of RyR2 at Ser2814 decreases RyR2 availability for activation during ECC. In conclusion, the impaired in situ activity of RyR2 may also account for the poor overall cardiac outcome reported in MetS patients; hence, the SERCA pump and RyR2 are both attractive potential targets for future therapies.

Using computer-assisted morphometrics of 5-year biopsies to identify biomarkers of late renal allograft loss.

The current Banff scoring system was not developed to predict graft loss and may not be ideal for use in clinical trials aimed at improving allograft survival. We hypothesized that scoring histologic features of digitized renal allograft biopsies using a continuous, more objective, computer-assisted morphometric (CAM) system might be more predictive of graft loss. We performed a nested case-control study in kidney transplant recipients with a surveillance biopsy obtained 5 years after transplantation. Patients that developed death-censored graft loss (n = 67) were 2:1 matched on age, gender, and follow-up time to controls with surviving grafts (n = 134). The risk of graft loss was compared between CAM-based models vs a model based on Banff scores. Both Banff and CAM identified chronic lesions associated with graft loss (chronic glomerulopathy, arteriolar hyalinosis, and mesangial expansion). However, the CAM-based models predicted graft loss better than the Banff-based model, both overall (c-statistic 0.754 vs 0.705, P < .001), and in biopsies without chronic glomerulopathy (c-statistic 0.738 vs 0.661, P < .001) where it identified more features predictive of graft loss (% luminal stenosis and % mesangial expansion). Using 5-year renal allograft surveillance biopsies, CAM-based models predict graft loss better than Banff models and might be developed into biomarkers for future clinical trials.

Desenlace materno-fetal en pacientes con diagnóstico temprano o tardío de diabetes gestacional / Maternal and fetal outcome in early and late diagnosis of gestational diabetes

Resumen OBJETIVO: Comparar el desenlace materno y fetal en pacientes con diabetes gestacional diagnosticada en la primera y segunda mitad del embarazo. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo y analítico que incluyó a todas las pacientes con diabetes gestacional tratadas en el Hospital de la Mujer de la Ciudad de México entre los meses de marzo de 2014 y diciembre de 2017. Las pacientes se dividieron en, grupo 1: diagnosticadas entre las 13 y 20.6 semanas de embarazo y grupo 2: con diagnóstico posterior. Se identificaron y compararon las principales complicaciones maternas y fetales. El análisis incluyó medidas de tendencia central, t de Student y χ2. RESULTADOS: Se incluyeron 459 pacientes; 147 embarazadas en el grupo 1 y 312 en el grupo 2. La enfermedad hipertensiva del embarazo (32.7 vs 17.6% p 0.001) y el hiper e hipotiroidismo (7.5 vs 1.6% p 0.001) fueron más frecuentes en el grupo 1. El peso al nacimiento (3054 ± 718.4 vs. 3156 ± 555.7 g. p 0.04) la talla (48.9 ± 3.49 vs 49.2 ± 2.7 cm p 0.05) y el Capurro (37.9 ± 2.5 vs 38.2 ± 1.4 semanas p 0.01) fueron mayores en los neonatos hijos de madres del grupo 2. CONCLUSIÓN: El desenlace materno y fetal de pacientes con diabetes gestacional se modifica de acuerdo con las semanas de embarazo al momento del diagnóstico; por esto debe insistirse en la detección oportuna de las complicaciones descritas con el propósito de reducir las repercusiones de la diabetes gestacional en la madre y su hijo.

Abstract OBJECTIVE: To compare the fetal maternal outcomes in patients with gestational diabetes detected in the first and second half of pregnancy. MATERIALS AND METHODS: An observational, retrospective and analytical study was carried out including all patients with gestational diabetes treated at the Women's Hospital of Mexico City in the years 2014 to 2017. Were divided into two groups, group 1 inserted those patients diagnosed between 13 and 20.6 weeks of gestation and 2 with subsequent diagnosis, the main maternal and fetal complications were identified and compared. The results analysis included central trend measures, Student's t and square Chi. RESULTS: 495 patients were included; Group 1 was composed of 147 pregnant women and group 2 of 312. Maternal complications such as hypertensive disease of pregnancy (32.7 vs 17.6% p 0.001), hyperthyroidism and hypothyroidism (7.5 vs 1.6% p 0.001) were more frequent at the group 1. The birth weight (3054 ± 718.4 vs. 3156 ± 555.7 g. p 0.04), height (48.9 ± 3.49 vs 49.2 ± 2.7 cm p 0.05) and Capurro rating (37.9 ± 2.5 vs 38.2 ± 1.4 weeks p 0.01) were greater in infants in Group 2. CONCLUSION: The maternal fetal outcome in patients with gestational diabetes are modified by gestational age at the time of diagnosis, so greater emphasis should be placed on the timely detection of these complications in order to reduce the impact of gestational diabetes in the mother's binomial.

La seguridad del paciente en un hospital de Bogotá, percepción del profesional de Enfermería / Patient safety in a hospital in Bogota, perception of the nursing professional / A segurança dos doentes num hospital de Bogotá, segundo a perceção dos profissionais de enfermagem

Objetivo: Evaluar la percepción del clima de seguridad del paciente en enfermeros que laboran en una unidad de atención de salud en Bogotá. Métodos: Se realizó un estudio transversal y descriptivo que evalúa la percepción del clima de seguridad del paciente, mediante la aplicación del cuestionario elaborado por la Agency for Health Care Research and Quality (AHRQ) para la medición de la cultura de seguridad del paciente en una unidad de atención de salud de Bogotá. Resultados: Un total de 43 enfermeros del área asistencial respondieron el cuestionario. Las dimensiones que obtuvieron mayor coeficiente de Alfa de Cronbach fueron: frecuencia de eventos notificados (0,826), trabajo en equipo en la unidad/servicio (0,824) y problemas en cambios de turno y transiciones entre servicios/unidades (0,785). Mientras que las dimensiones que tuvieron menos coeficiente y se catalogaron como oportunidad de mejora, teniendo en cuenta los resultados de otras investigaciones que utilizaron el mismo instrumento, correspondieron a: dotación de personal (0,533) y respuesta no punitiva a los errores (0,488). Conclusiones: Para alcanzar niveles aceptables de cultura de seguridad del paciente es necesario recurrir al método científico porque ayuda a definir y comprender los problemas asociados con la ocurrencia de fallas y errores que afectan la atención del paciente. Por lo tanto, las dimensiones de personal, la respuesta no punitiva a los errores, los problemas en los cambios de turno y las transiciones entre servicios y unidades son el punto de partida para formular estrategias de mejora que pueden tener un impacto en la institución.

Objective: To evaluate the perception of the patient safety climate in nurses working in a health care unit in Bogota. Methods: A cross-sectional and descriptive study was carried out to evaluate the perception of the patient safety climate by applying the questionnaire developed by the Agency for Health Care Research and Quality (AHRQ) to measure the patient safety culture in a health care unit in Bogota. Results: A total of 43 nurses from the health care area answered the questionnaire. The dimensions that obtained the highest Cronbach's alpha coefficient were: frequency of reported events (0.826), teamwork in the unit/service (0.824) and problems in shift changes and transitions between services/units (0.785). While the dimensions that had less coefficient and were categorized as an opportunity for improvement, taking into account the results of other research using the same instrument, corresponded to: staffing (0.533) and non-punitive response to errors (0.488). Conclusions: To achieve acceptable levels of patient safety culture, it is necessary to resort to the scientific method because it helps to define and understand the problems associated with the occurrence of failures and errors that affect patient care. Therefore, the dimensions of staffing, non-punitive response to errors, problems in shift changes and transitions in patient care, as well as the need to define and understand the problems associated with the occurrence of failures and errors that affect patient care, should be considered.

Objetivo: Avaliar a perceção do clima de segurança do doente nos enfermeiros que trabalham numa unidade de cuidados de saúde em Bogotá. Métodos: Foi realizado um estudo transversal e descritivo para avaliar a perceção do clima de segurança do paciente, aplicando o questionário desenvolvido pela Agency for Health Care Research and Quality (AHRQ) para medir a cultura de segurança do paciente numa unidade de saúde em Bogotá. Resultados: Um total de 43 enfermeiros da área de cuidados preencheu o questionário. As dimensões que obtiveram o coeficiente alfa de Cronbach mais elevado foram: frequência de eventos notificados (0,826), trabalho em equipa na unidade/serviço (0,824) e problemas nas mudanças de turno e transições entre serviços/unidades (0,785). Já as dimensões que apresentaram coeficientes mais baixos e foram categorizadas como uma oportunidade de melhoria, tendo em conta os resultados de outras investigações que utilizaram o mesmo instrumento, corresponderam a: recursos humanos (0,533) e resposta não punitiva aos erros (0,488). Conclusões: Para se atingirem níveis aceitáveis de cultura de segurança do doente é necessário recorrer ao método científico, pois este ajuda a definir e a compreender os problemas associados à ocorrência de falhas e erros que afectam os cuidados prestados aos doentes. Assim, são importantes as dimensões do pessoal, a resposta não punitiva aos erros, os problemas nas mudanças de turno e as transições nos cuidados aos doentes.

Diagnóstico prenatal de un feto con doble trisomía con cariotipo 48 XXX +18: reporte de un caso / Prenatal diagnosis of a fetus with double trisomy with karyotype 48 XXX +18: A case report

Resumen ANTECEDENTES: El diagnóstico prenatal de doble aneuploidia es muy raro, incluso la variante de doble trisomía, que implica la expresion de los cromosomas 18 y X. CASO CLÍNICO: Paciente de 43 años, con antecedentes ginecoobstétricos de cuatro embarazos y tres partos, enviada de su centro de salud, en curso del cuarto embarazo. A su ingreso al Hospital de la Mujer, el estudio ecográfico reportó un embarazo de 24.3 semanas de gestación, con feto único, clinodactilia, miembro pélvico derecho con pie equino varo, probable atresia esofágica (ausencia de cámara gástrica, polihidramnios) y cordón umbilical con arteria única. Se estableció el diagnóstico de doble trisomía (48XXX +18) mediante estudio citogenético en líquido amniótico. En la semana 34 acudió al servicio de Urgencias con trabajo de parto en periodo expulsivo y ausencia de vitalidad fetal. La pareja no aceptó el estudio anatomopatológico. CONCLUSION: El diagnóstico prenatal de doble trisomía es raro de establecer en el segundo trimestre del embarazo; su detección oportuna proporciona información valiosa para establecer el pronóstico fetal y ofrecer asesoría genética adecuada. Este caso quizá corresponde al primero documentado en México y el quinto en todo el mundo, diagnosticado mediante estudio citogenético.

Abstract BACKGROUND: Prenatal diagnosis of double trisomy is rare, particular uncommon simultaneous occurrence of double trisomy involving chromosomes 18 and X. CLINICAL CASE: A 43-year-old patient, with a gyneco-obstetric history of four pregnancies and three deliveries, sent from her health center during the fourth pregnancy. Upon admission to the Women's Hospital, the ultrasound study reported a pregnancy of 24.3 weeks of gestation, with a single fetus, clinodactyly, right pelvic member with equinus varus foot, probable esophageal atresia (absence of gastric chamber, polyhydramnios), and umbilical cord. with a single artery. The diagnosis of double trisomy (48XXX +18) was established by cytogenetic study in amniotic fluid. In the week 34, she went to the Emergency Department with labor in the expulsive period and absence of fetal vitality. The couple did not accept the anatomopathological study. CONCLUSION: Prenatal diagnosis of double trisomy is rare in the second trimester of pregnancy, its detection is important because it provides valuable information to establish the fetal prognosis and provide adequate genetic counseling. This case is relevant because it is probably the first documented in Mexico and the fifth internationally diagnosed prenatally by cytogenetic study.

Primer reporte de necrólisis epidérmica tóxica por antibiótico oral en Gambia / First report of toxic epidermal necrolysis due to oral antibiotic in Gambia

Las reacciones adversas medicamentosas más frecuentes son las cutáneas, ocurriendo en un 2% de los tratamientos. La mayoría de las veces se alcanza el diagnóstico por exclusión. La más temida es la necrólisis epidérmica tóxica, de la que se presentan anualmente hasta 4 casos por millón de habitantes, con una mortalidad que alcanza en ocasiones hasta el 70 %. El objetivo fue presentar un paciente con necrólisis epidérmica tóxica por lo infrecuente de esta enfermedad, su alta mortalidad y su evolución clínica característica. Paciente gambiano, de 29 años de edad, con antecedentes de salud, que después de comenzar tratamiento ambulatorio con antibiótico oral para una piodermitis facial, presentó lesiones ampollares que se extendieron por todo el cuerpo. El paciente llevó tratamiento de sostén, esteroideo oral, antibiótico de amplio espectro oral, parenteral y tópico; después de una evolución desfavorable de 30 días, fallece. Resultó llamativa la ausencia de lesiones mucosas a pesar de la extensión total de las lesiones cutáneas. Fue difícil el manejo de este paciente en un hospital de periferia sin el arsenal terapéutico adecuado, ni la unidad idónea para su cuidado (AU).

The most frequent drug adverse reactions are the skin ones, occurring in 2 % of the treatments; most of the times the diagnosis is reached by exclusion. The most feared one is the toxic epidermal necrolysis, presenting yearly up to 4 cases per million of inhabitants with a mortality occasionally reaching 70 %. The objective was presenting the case of a patient with toxic epidermal necrolysis because of the rarity of this disease, its high mortality and characteristic clinical evolution. The patient was a Gambian aged 29 years, with health antecedents, who after beginning an outpatient treatment with oral antibiotic for a facial pyodermitis, presented bullous lesions extended throughout all the body. The patient received support treatment, oral steroidal treatment and oral, parenteral and topic treatment with a wide spectrum antibiotic; after a 30-days unfavorable evolution, he died. It was thought-provoking the absence of mucous lesions in spite of the total extension of the skin lesions. It was difficult the management of this patient in a peripheral hospital without the adequate therapeutic arsenal nor the suitable unit for his care (AU).