Associated factors for mortality in a COVID-19 colombian cohort: is the third wave relevant when Mu variant was predominant epidemiologically?

OBJECTIVES: To evaluate the association between Colombia's third wave when the Mu variant was predominant epidemiologically (until 75%) in Colombia and COVID-19 all-cause in-hospital mortality. METHODS: In this retrospective cohort, we included hospitalized patients ≥18 years with SARS-CoV-2 infection between March 2020 to September 2021 in ten hospitals from three cities in Colombia. Description analysis, survival, and multivariate Cox regression analyses were performed to evaluate the association between the third epidemic wave and in-hospital mortality. RESULTS: A total of 25,371 patients were included. The age-stratified time-to-mortality curves showed differences according to epidemic waves in patients ≥75 years (log-rank test p = 0.012). In the multivariate Cox analysis, the third wave was not associated with increased mortality relative to the first wave (aHR 0.95; 95%CI 0.84-1.08), but there was an interaction between age ≥75 years and the third wave finding a lower HR for mortality (aHR 0.56, 95%CI 0.36-0.86). CONCLUSIONS: We did not find an increase in in-hospital mortality during the third epidemic wave in which the Mu variant was predominant in Colombia. The reduced hazard in mortality in patients ≥75 years hospitalized in the third wave could be explained by the high coverage of SARS-CoV-2 vaccination in this population and patients with underlying conditions.

Estimation of moisture in live fuels in the mediterranean: Linear regressions and random forests.

The live fuel moisture content is an important factor in estimating the risk of forest fires and their rate of spread. However, due to a lack of research, the FMC values in the Mediterranean region of Andalusia, Spain, must be obtained by sample collection. This study is therefore the first to provide tools for estimating the moisture content of the most widespread plant species in Andalusia. First, samples were collected to estimate the moisture content of the plants; these data were collected from May 2007 to the present. Each species has its own range of moistures that depend on the time of year and the physiological state in which they are found. Secondly, an extensive database was obtained for each day of sample collection from the nearest weather station with free access. The statistics are performed at 12 solar hours on the day of sample collection and 24 h before collection, and then at 7 days, 14 days, 1 month, 3 months and 6 months before the day of collection. Finally, this database was statistically analyzed in two ways: Multiple linear regressions and random forest for each species. The predictive capacity of random forest is superior (R2 > 0.89) to that obtained in linear regression (R2 < 0.86). The highest root mean square error obtained in the case of the random forest is 0.74479 while in the linear regressions it was 1.29184. Consequently, uncertainty regarding fire behavior in the case of forest fires is reduced.

Endotracheal tube microbiome in hospitalized patients defined largely by hospital environment.

BACKGROUND: Studies of the respiratory tract microbiome primarily focus on airway and lung microbial diversity, but it is still unclear how these microbial communities may be affected by intubation and long periods in intensive care units (ICU), an aspect that today could aid in the understanding of COVID19 progression and disease severity. This study aimed to explore and characterize the endotracheal tube (ETT) microbiome by analyzing ETT-associated microbial communities. METHODS: This descriptive study was carried out on adult patients subjected to invasive mechanical ventilation from 2 to 21 days. ETT samples were obtained from 115 patients from ICU units in two hospitals. Bacteria isolated from endotracheal tubes belonging to the ESKAPE group were analyzed for biofilm formation using crystal violet quantification. Microbial profiles were obtained using Illumina sequencing of 16S rRNA gene. RESULTS: The ETT microbiome was mainly composed by the phyla Proteobacteria, Firmicutes and Bacteroidetes. Microbiome composition correlated with the ICU in which patients were hospitalized, while intubation time and diagnosis of ventilator-associated pneumonia (VAP) did not show any significant association. CONCLUSION: These results suggest that the ICU environment, or medical practices, could be a key to microbial colonization and have a direct influence on the ETT microbiomes of patients that require mechanical ventilation.

Diagnostic performance of two different maternal near-miss approaches in a High Obstetric Risk Unit.

Maternal near-miss (MNM) is a maternal quality care indicator. The World Health Organization (WHO) defines it as a state in which a woman nearly dies but survives due to a complication during pregnancy, birth, or puerperium. The Latin American Federation of Obstetrics and Gynecology (FLASOG) and the Colombian National Health Institute (INS) established recommendations for the event's epidemiological surveillance; nonetheless, the operational definitions of the cases are different. This retrospective study examined the approaches of FLASOG and INS versus the WHO approach (gold standard) for the assessment of MNM in a high obstetric risk unit. Patients admitted with at least one criterion of the WHO, FLASOG, or INS approach for the definition of MNM from March 2016 to March 2017 were included. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were evaluated, as well as the Receiver Operating Characteristics (ROC) curve of the FLASOG and INS. MNM classification compared to WHO system as reference. The results highlight that the WHO classification establishes very high boundaries for some of the diagnostic criteria and the lack of standardization of the MNM criteria among the different proposals in Latin America hinders the applicability in Colombia and other countries with a similar situation.

CRISPR/Cas9 mutations in the rice Waxy/GBSSI gene induce allele-specific and zygosity-dependent feedback effects on endosperm starch biosynthesis.

KEY MESSAGE: Induced mutations in the waxy locus in rice endosperm did not abolish GBSS activity completely. Compensatory mechanisms in endosperm and leaves caused a major reprogramming of the starch biosynthetic machinery. The mutation of genes in the starch biosynthesis pathway has a profound effect on starch quality and quantity and is an important target for plant breeders. Mutations in endosperm starch biosynthetic genes may impact starch metabolism in vegetative tissues such as leaves in unexpected ways due to the complex feedback mechanisms regulating the pathway. Surprisingly this aspect of global starch metabolism has received little attention. We used CRISPR/Cas9 to introduce mutations affecting the Waxy (Wx) locus encoding granule-bound starch synthase I (GBSSI) in rice endosperm. Our specific objective was to develop a mechanistic understanding of how the endogenous starch biosynthetic machinery might be affected at the transcriptional level following the targeted knock out of GBSSI in the endosperm. We found that the mutations reduced but did not abolish GBSS activity in seeds due to partial compensation caused by the upregulation of GBSSII. The GBSS activity in the mutants was 61-71% of wild-type levels, similarly to two irradiation mutants, but the amylose content declined to 8-12% in heterozygous seeds and to as low as 5% in homozygous seeds, accompanied by abnormal cellular organization in the aleurone layer and amorphous starch grain structures. Expression of many other starch biosynthetic genes was modulated in seeds and leaves. This modulation of gene expression resulted in changes in AGPase and sucrose synthase activity that explained the corresponding levels of starch and soluble sugars.

Trichomonas vaginalis and Giardia lamblia Growth Alterations by Low-Frequency Electromagnetic Fields.

BACKGROUND: There is an increasing interest in using physical factors such as magnetic fields as antimicrobial strategy, with variable results. The current study was aimed to evaluate the influence of extremely low-frequency electromagnetic fields (ELF-EMFs) on the axenically-cultured parasite protozoans Trichomonas vaginalis and Giardia lamblia growth. METHODS: Bioassays were developed using T. vaginalis, GT-13 and G. lamblia IMSS-0989 strains cultured at 37 ºC in TYI-S-33 medium. The following treatment regimens and controls were considered: (a) cells exposed to ELF-EMFs, (b) untreated cells, (c) cells treated with Metronidazole, used as positive controls, and (d) cells co-exposed to ELF-EMFs and Metronidazole. When cultures reached the end of logarithmic phase, they were exposed to ELF-EMFs for 72 h, in a standardized magnetic field exposure facility. For determining cytotoxic effects, trophozoite density was blindly evaluated in a Neubauer chamber. RESULTS: A significant decrease in trophozoite growth was observed for T. vaginalis, in magnetic field-treated cultures. On the other hand, cultures co-exposed to ELF-EMFs and Metronidazole showed no significant differences when compared with cultures treated with Metronidazole alone. On the contrary, an increased trophozoite density was observed in G. lamblia cultures after exposure to magnetic fields. An absence of a synergistic or antagonistic effect was observed. CONCLUSION: ELF-EMFs induced T. vaginalis and G. lamblia growth alterations, indicating a potential effect in cell cycle progression.

Fetoscópica y fotocoagulación láser en el síndrome de transfusión intergemelar: ¿en qué estadio realizarla? una revisión sistemática de la literatura / Fetoscopic and laser photocoagulation in intergemelar transfusion syndrome: in what stage do it? systematic review of the literature

Objetivo: Realizar una revisión sistemática de la literatura que compare la eficacia del tratamiento con fotocoa-gulación láser entre los estadios tempranos vs tardíos en el Síndrome de transfusión intergemelar, según la cla-sificación de Quintero y col. Estrategia de búsqueda: Se realizó una revisión sistemática de la literatura que se llevó a cabo en las bases de datos MEDLINE, PubMed, EMBASE y Cochrane Library, sin limitar la búsqueda de artículos publicados exclusivamente en idioma inglés; las publicaciones se registraron entre enero de 1990 a mar-zo de 2015, con base en las palabras clave: síndrome de transfusión de gemelo a gemelo, la fotocoagulación con láser endoscópica, embarazo de gemelos monocoriales, placenta vasos comunicantes, vasos comunicantes. Resultados: De 67 estudios, con un total de 32 cumplieron los criterios de inclusión, y una revisión sistemática de la literatura técnica se utilizó para estudiar los 8 ensayos controlados aleatorios con 951 mujeres con embarazo gemelar monocorial y síndrome de transfusión de gemelo a gemelo. La supervivencia observada en el síndrome de transfusión de gemelo a gemelo tratados con cirugía láser fetoscópica fue en general el 67 % para ambos fetos y 85 % para un feto; resultados todavía lejos de ser satisfactorios, porque las tasas de mortalidad varían de 20 % a 48 %, sin definir el escenario en el que se debe realizar el procedimiento. Conclusiones: La fotocoagulación con láser bajo guía fetoscópica parece ser el tratamiento óptimo para estadios II a IV, no dependiendo de la técnica quirúrgica; sin delimitar adecuadamente el mejor estadio para realizar este procedimiento.

Objetive: To conduct a systematic review of the literature to define, as rated by Quintero et al., the best stage for treatment with endoscopic laser photocoagulation syndrome twin-twin transfusion. Results: From 67 studies, a total of 32 studies met our inclusion criteria, and a systematic review of the literature technique was used to study the 8 randomized controlled trials involving 951 women with monochorionic twin pregnancy and twin-twin transfusion syndrome. The survival observed in the syndrome of twin-twin transfusion treated with laser surgery fetoscopic was overall 67 % for both fetuses and 85 % for one fetus; results still far from satisfactory, because mor-tality rates range from 20 % to 48 %, without defining the stage on which to perform the procedure. Conclusions: Laser photocoagulation under fetoscopic guide seems to be the optimal treatment for stages II to IV, does not depending on the surgical technique; without adequately delimiting the best stadium to perform this procedure.

[Experiences of bullying in medical residents]. / Experiencias de maltrato y hostigamiento en médicos residentes.

BACKGROUND: Harassment and abuse are forms of persistent intimidating behavior against a person and in medical practice those are accepted and justified at all levels of education and are considered specific to the hospital culture. OBJECTIVE: To identify the frequency of harassment and some factors related to its existence on residents of medical specialties in Mexico City. METHOD: A linear study was carried out in which a total of 260 interns pertaining to the following medical specialties: surgery, internal medicine, gynecology and obstetrics, and pediatrics participated. The study took place in three general hospitals in Mexico City. Two evaluations with Leymann Inventory of Psychological-Terrorization (LIPT-60) with 6 months between assessments were performed. RESULTS: Comparison between the first and second evaluations did not show differences in any of the harassment measurements obtained. Of all residents, 265 (98.5%) claimed to have experienced some type of harassing behavior against them at least once during the previous 6 months, with a 1.4 (±0.5) average intensity, showing no difference between men and women. Women received a higher grade than men on the communication block scale. Harassing behaviors that obtained the highest average values were evident intimidation and occupational discredit. Among all harassment measurements, the specialty of gynecology and obstetrics showed the highest grade. The hospital influenced the reported harassment. CONCLUSIONS: The most common harassing behaviors were occupational discredit, verbal threats, shouting, and mockery. The high frequency of harassment that medical residents experience during their hospital training deserves our attention.

Antecedentes: el hostigamiento y el maltrato son conductas intimidantes persistentes que se ejercen contra una persona; en la práctica médica, son aceptadas y justificadas en todos los niveles de la formación y propias de la cultura hospitalaria. Objetivo: conocer la frecuencia del acoso y algunos factores relacionados en médicos residentes de la Ciudad de México. Material y métodos: estudio longitudinal en el que participaron 260 residentes de las especialidades médicas de cirugía, medicina interna, ginecología y obstetricia y pediatría de tres hospitales generales de la Ciudad de México. Se realizaron dos evaluaciones con seis meses de diferencia utilizando el Leymann Inventory of Psychological-Terrorization (LIPT-60). Resultados: la comparación entre la primera y la segunda aplicación no mostró cambios en ninguna de las medidas de acoso. Del total de residentes, 256 (98.5%) manifestaron haber sufrido por lo menos una conducta de acoso durante los últimos seis meses, con una intensidad promedio de 1.4 (DE ± 0.5), sin diferencias entre hombres y mujeres. Las mujeres calificaron más alto en la escala de bloqueo de la comunicación que los hombres. Las conductas de acoso con promedios más altos fueron la intimidación manifiesta y el desprestigio laboral. La especialidad de ginecología y obstetricia tuvo los puntajes más elevados en todas las medidas de acoso. El hospital influyó sobre los reportes de esta conducta. Conclusiones: las formas de acoso con los puntajes mayores fueron: el demérito del trabajo, amenazas verbales, gritos o ridiculización. La alta frecuencia de acoso dentro de la formación de los médicos residentes amerita atención.

Las actividades docentes de los profesores clínicos del PUEM desde la perspectiva de sus residentes / PUEM's clinical professors' teaching activities from their residents' perspective

Introducción: Se busca describir las actividades docentes en el ámbito clínico desde la perspectiva de los residentes del PUEM. Objetivos: 1) Identificar la frecuencia con que los profesores clínicos realizan actividades educativas en 4 áreas: docencia, supervisión, organización y relaciones interpersonales, 2) distinguir por especialidad el desempeño de los instructores, 3) indagar diferencias en la evaluación del docente según el grado académico de los residentes. Material y métodos: La "Encuesta de Alumnos del PUEM 2010" incluyó en la sección del desempeño docente 13 preguntas de frecuencia y 2 de valoración. Se consideraron actividades educativas de las 4 áreas mencionadas en 10 especialidades. La muestra fue de 1816 casos y se buscaron asociaciones significativas (p < 0.05) entre las variables. Resultados: En las opciones de respuesta "siempre" y "casi siempre", las relaciones interpersonales fueron las mejor valoradas (> 80%), la organización continua de actividades académicas y asistenciales fue mencionada en más de 2 terceras partes de las respuestas. La frecuencia de actividades docentes vinculadas a la estructura curricular, y la supervisión se ubicaron en promedio por debajo de la media. Las mejores calificaciones fueron para los profesores de Medicina Familiar y las más bajas para Ortopedia. Por grado académico, R1 y R5 consideraron que la labor docente fue más constante y los R2 menos. Discusión: La relación personal entre profesores y residentes es adecuada y los estudiantes se perciben integrados a sus servicios; no obstante, el apego a los programas académicos y la supervisión no sucede con suficiente frecuencia.

Introduction: The aim is to describe the teaching activities in the clinical context from the residents' perspective. Objectives: 1) To determine how frequently clinical professors perform teaching activities in the four areas: teaching, supervision, organization and interpersonal relationships, 2) to distinguish professors' performance by specialty 3) To inquire differences in the evaluation of professors according the residents' academic year. Materials and methods: The "Survey among PUEM's Students 2010" included 13 frequency questions and 2 of valuation in the section of teaching performance. Teaching activities from the four previously mentioned areas in ten specialties were considered. The sample was 1816 cases; significant associations (p <0.05) among variables were assessed. Results: In the answer choices: "always" and "almost always", interpersonal relationships obtained the highest score (>80%), the regular organization of academic and healthcare activities was mentioned in more than 2/3 of the answers. The frequency of teaching activities related to the curricular structure, and supervision were situated below average. The highest scores were for family medicine professors and the lowest for orthopedia. By academic grade, first and fifth year residents considered that teaching activities were more constant; while second year students considered them the least constant. Discussion: Personal relationships between clinical professors and residents are adequate. Students perceive themselves integrated to their wards; however the fulfillment of academic programs and supervision are not frequent enough.

[The role of minimal invasive surgery in surgical education.]

The first laparoscopic cholecystectomy carried out in 1985 generated a great enthusiasm about the new surgical technique; however, it was evident that educational techniques required improvement because this new procedure presented a higher prevalence of injuries in the biliary tract than conventional surgery. Minimally invasive surgery has a number of advantages over open surgery. Some of these advantages allowed the use of technology in order to generate experts, evaluate them objectively, document the process in video, assess their competence and use simulators to improve overall surgical education.

[Minimally invasive surgery of small intestine]. / Cirugía de invasión mínima en intestino delgado.

Since the first laparoscopic surgery was performed by Erick Mühe in 1986, multiple minimally invasive techniques have been developed. The small intestine presents several technical difficulties for the application of these techniques, namely: its size, mobilization inside the abdominal cavity, difficulty defining the site under manipulation and the distension association by an ileo or an occlusion. The development of new technology with better cameras and coagulation equipment such as the Harmonic Scalpel and the Ligasure, cutting linear staplers, have permitted the evolution of surgical techniques for the small intestine. Indications for the use of minimally invasive interventions in the treatment of the small intestine are classified as urgent and elective. Lesions secondary to an abdominal cavity puncture were the first to be treated in the small intestine. Abdominal trauma due to a sharp instrument can also be treated through this method. Intestinal occlusion treated without a great dilation can be solved in 55 to 65% of cases. Crohn's disease various surgical treatments are performed by laparoscopy. Obesity surgical treatments, particularly derivative gastroplasty have been carried out successfully by minimally invasive surgery. Gastrojejunoanastomosis or cystojejunoanastomosis are specialized techniques which are performed with minimal invasion; any kind of digestive or urinary stoma can be performed with these techniques. As the surgeon's surgical skills evolve, surgical minimally invasive indications for the small intestine become wider.

Mapas conceptuales: un recurso didactico / Conceptual maps: a didactic resource

Dentro de la teoría general de los esquemas se incluye la elaboración de mapas conceptuales, que se utilizan como un recurso didáctico importante a todos los niveles de enseñanza-aprendizaje, por lo que su empleo en las escuelas de medicina pueden tener gran aceptación. Los mapas conceptuales se van a formar con nodos que son los conceptos o ideas principales, ordenados jerárquicamente y unidos por líneas de relación, rutas o conexiones. La elaboración del mapa conceptual, va precedida de una cuidadosa lectura de comprensión del o de los textos básicos, de donde se extraerán los conceptos que conformarán una lista de ellos. Para esto se destacarán en el texto subrayándolos. Esta lectura permite comprender el tema, sin lo cual no es posible la construcción del mapa. Una vez formada la lista de conceptos se evaluarán, para formar grupos a los que se dará una jerarquía según su importancia y un orden secuencial o convencional. Dentro de cada grupo el orden de los conceptos será de acuerdo a su trascendencia, que es mayor cuando abarcan o engloban a otros menos complejos. Los grupos de conceptos se rodean de una elipse que les da realce y los destaca para subrayar su importancia. Establecido el orden de los conceptos que integran el mapa, siempre bajo una jerarquía que supedita los menos extensos dentro de los que tienen mayor connotación, se obtiene un panorama sobre un tema específico. Que se completa al establecer las relaciones entre los grupos de conceptos a través de lo que se ha denominado palabras enlace. Terminado el mapa se está en aptitud de leerlo o hacer una descripción escrita que revela el grado de aprendizaje del tema

El efecto de los bloqueadores H2 en la flora bacteriana gástrica / Effect of H2 hisamine antagonists on gastric bacterial flora

El objetivo del presente trabajo es indagar, si hay crecimiento bacteriano y qué bacterias se encuentran en el estómago, después de la administración de bloqueadores H2, a diferentes dosis. Se formaron cuatro grupos de 10 pacientes cada uno en forma aleatoria en un estudio prospectivo, experimental, transverasal, comparativo y abierto. Se incluyeron pacientes menores de 50 años, sin antecedentes de enfermedad úlcero-péptica, y que fueron sometidos a cirugía electiva (colecistectomía), el grupo IV se formó con pacientes de la Unidad de Cuidados Intensivos, a los cuales se les administró bloqueadores H2 como parte de su terapéutica, y con diagnóstico de sepsis severa. El grupo I se tomó como control, a los grupos II y III se les administró cimetidina a dosis de 200 mg y 40 mg respectivamente, por vía endovenosa, 8 y 2 horas previas a la cirugía. A todos los grupos se les tomó muestra de jugo gástrico. Para determinar pH, y realizar cultivo del mismo para gérmenes aerobios. El grupo I presentó desarrollo en el 20 por ciento de casos con pH medio de 2.1; los grupos II y III desarrollaron gérmenes en el 100 por ciento de casos y pH promedio de 7.1 y 7.2 respectivamente, el grupo IV desarrolló gérmenes en el 70 por ciento de casos y pH promedio 3.4. A partir de un pH de 4 se observa mayor crecimiento bacteriano. El análisis estadístico fue la t de Student la cual mostró r=0.4 y P=< 0.05. Se puede concluir que los bloqueadores H2, a dosis terapéuticas elevan el pH gástrico en el paciente sano, no así en el paciente séptico. Este incremento produce desarrollo bacteriano tanto de gérmenes aerobios como anaerobios. En este estudio, la administración de bloqueadores H2 en pacientes que se operaron en forma electiva, no produjo sepsis postoperatoria. La administración de antibióticos en el paciente grave no reduce el crecimiento bacteriano gástrico aerobio, sí el anaerobio