Analysis of antiretroviral therapy interruption in people living with HIV during the 2010-2021 Period. / [Artículo traducido] Análisis de la interrupción de la terapia antirretroviral en personas que viven con VIH/sida durante el periodo 2010­2021.

OBJECTIVE: In the context of the advancement of antiretroviral therapy and, as the characteristics of people living with HIV progress toward an aging population, understanding the causes of treatment interruption becomes crucial. The aim of the study was to determine the change in reasons for antiretroviral treatment discontinuation for 12 years. Secondarily, compare annual antiretroviral regimen discontinuation rate and factors associated. METHODS: We conducted an analysis using data from people living with HIV who were receiving antiretroviral therapy and discontinued it for any reason. The study included people with HIV infection who visited an outpatient hospital pharmacy clinic from January 2010 to December 2021. Two periods were differentiated for the analysis: 2010-2015 and 2016-2021. The reasons for antiretroviral treatment discontinuation followed classification described by Swiss cohort. In the context of this study, it is pertinent to note that the term 'interruption' will be consistently used in this article to refer to the act of switching or stopping antiretroviral treatment. To examine factors associated with antiretroviral therapy discontinuation, we utilized Kaplan-Meier methods and Cox proportional models. RESULTS: We included 789 people living with HIV, predominantly male (81,5%). The main reason for discontinuation was clinical decision (50.2%) followed by adverse effects (37.9%). Focusing on clinical decision, we observed a trend change that went from antiretroviral treatment simplification regimen (56.1%) in the first part of the period analyzed to the therapeutic optimization (53.6%) in the second half. Furthermore, factors that were statistically significantly associated with antiretroviral treatment discontinuation were people with HIV ≥50 years (HR 1.60; 95%CI 1.25-2.04), post-discontinuation single-tablet regimen (HR 1.49; 95%CI 1.06-2.11) and antiretroviral drug classes. CONCLUSIONS: Over the 12 years there has been a change in the main cause of antiretroviral treatment discontinuation, currently therapeutic optimization being the main reason. Integrase inhibitors-based regimens and singletablet regimen strategies were less likely to be discontinued than others antiretroviral drug classes, allowing for better clinical management due to the efficacy profile, especially in people living with HIV ≥50 years with comorbidities.

Patch age alters seagrass response mechanisms to herbivory damage.

Natural disturbances can produce a mosaic of seagrass patches of different ages, which may affect the response to herbivory. These pressures can have consequences for plant performance. To assess how seagrass patch age affects the response to herbivory, we simulated the effect of herbivory by clipping leaves of Halodule wrightii in patches of 2, 4 and 6 years. All clipped plants showed ability to compensate herbivory by increasing leaf growth rate (on average 4.5-fold). The oldest patches showed resistance response by increasing phenolic compounds (1.2-fold). Contrastingly, the concentration of phenolics decreased in the youngest patches (0.26-fold), although they had a similar leaf carbon content to controls. These results suggest that younger plants facing herbivory pressure reallocate their phenolic compounds towards primary metabolism. Results confirm the H. wrightii tolerance to herbivory damage and provides evidence of age-dependent compensatory responses, which may have consequences for seagrass colonization and growth in perturbed habitats.

Analysis of antiretroviral therapy interruption in people living with HIV during the 2010-2021 period.

INTRODUCTION: In the context of the advancement of antiretroviral therapy and as the characteristics of people living with HIV progress toward an ageing population, understanding the causes of treatment interruption becomes crucial. The aim of the study was to determine the change in reasons for antiretroviral treatment discontinuation for 12 years. Secondarily, compare annual antiretroviral regimen discontinuation rate and factors associated. METHODS: We conducted an analysis using data from people living with HIV who were receiving antiretroviral therapy and discontinued it for any reason. The study included people with HIV infection who visited an outpatient hospital pharmacy clinic from January 2010 to December 2021. Two periods were differentiated for the analysis: 2010-2015 and 2016-2021. The reasons for antiretroviral treatment discontinuation followed classification described by Swiss cohort. In the context of this study, it is pertinent to note that the term "discontinuation" is employed synonymously with "interruption". The term "discontinuation" will be consistently used in this article to refer to the act of switching or stopping antiretroviral treatment. To examine factors associated with antiretroviral therapy discontinuation, we utilised Kaplan-Meier methods and Cox proportional models. RESULTS: We included 789 people living with HIV, predominantly male (81.5%). The main reason for discontinuation was clinical decision (50.2%) followed by adverse effects (37.9%). Focusing on clinical decision, we observed a trend change that went from antiretroviral treatment simplification regimen (56.1%) in the first part of the period analysed to the therapeutic optimisation (53.6%) in the second half. Furthermore, factors that were statistically significantly associated with antiretroviral treatment discontinuation were people with HIV≥50 years (HR 1.60; 95%CI 1.25-2.04), post-discontinuation single-tablet regimen (HR 1.49; 95%CI 1.06-2.11) and antiretroviral drug classes. CONCLUSION: Over the 12 years, there has been a change in the main cause of antiretroviral treatment discontinuation, currently therapeutic optimisation being the main reason. Integrase inhibitors-based regimens and single-tablet regimen strategies were less likely to be discontinued than others antiretroviral drug classes, allowing for better clinical management due to the efficacy profile, especially in people living with HIV≥50 years with comorbidities.

Resultados del aislamiento eléctrico de las venas pulmonares en pacientes menores y mayores de 70 años / Outcomes of pulmonary vein electrical isolation in patients younger than and older than 70 years

Resumen Introducción y objetivos: Comparar las características clínicas y los resultados de cohortes contemporáneas de pacientes menores y mayores de 70 años que han sido sometidos a ablación de fibrilación auricular (FA) mediante catéter. Métodos: Se llevó a cabo un estudio de cohortes retrospectivo en pacientes sometidos a ablación con catéter debido a la presencia de FA refractaria. Se realizó un seguimiento mínimo de 12 meses por paciente. Resultados: En el estudio se incluyeron un total de 239 pacientes sometidos a ablación de FA, de los cuales 171 (71,5%) pertenecían al grupo de edad < 70 años y 68 (28,5%) al grupo de edad > 70 años. La edad promedio de la población estudiada fue de 62,4 años (desviación estándar [DE] = 10,87). El grupo < 70 años presentó una edad promedio de 58,03 años (DE = 9,71), mientras que el grupo > 70 años tuvo una edad promedio de 73,4 años (DE = 3,05). Además, se observó una mayor prevalencia de FA paroxística en el grupo de pacientes menores de 70 años, mientras que en el grupo de pacientes mayores de 70 años se encontró una mayor prevalencia de FA persistente. Estas diferencias fueron estadísticamente significativas en ambos casos. Las tasas de recurrencia después del primer procedimiento de ablación fueron similares entre los dos grupos (21,43% en el grupo menor de 70 años frente a 23,53% en el grupo mayor de 70 años, p = 0,79). No se encontraron diferencias significativas en cuanto a complicaciones. El grupo menor de 70 años experimentó 18 complicaciones, mientras que el grupo mayor de 70 años tuvo 5 complicaciones, con un valor de p de 0,472. Conclusión: Los pacientes mayores de 70 años sometidos al primer procedimiento de ablación de FA por catéter presentan resultados clínicos similares a los pacientes menores de 70 años.

Abstract Introduction and objectives: The objective of this study is to compare the clinical characteristics and outcomes of contemporary cohorts of patients undergoing catheter ablation for atrial fibrillation (AF), stratified by age (< 70 years and ≥ 70 years). Methods: This retrospective cohort study included patients who underwent catheter ablation for refractory AF. The minimum follow-up duration per patient was 12 months. Results: A total of 239 patients were included in the study, with 171 (71.5%) in the < 70 years group and 68 (28.5%) in the ≥ 70 years group. The mean age of the study population was 62.4 years (SD 10.87). The < 70 years group had a mean age of 58.03 years (SD 9.71), while the ≥ 70 years group had a mean age of 73.4 years (SD 3.05). Furthermore, a higher proportion of paroxysmal AF was observed in patients < 70 years, whereas a higher proportion of persistent AF was found in patients ≥ 70 years. These differences were statistically significant. The recurrence rates after the initial ablation procedure were similar between the two groups (21.43% in the < 70 years group vs. 23.53% in the ≥ 70 years group, p = 0.79). Additionally, there were no significant differences in terms of complications. The < 70 years group experienced 18 complications, while the ≥ 70 years group had 5 complications (p = 0.472). Conclusion: The findings of this study suggest that patients aged 70 years and older who undergo their first catheter ablation procedure for AF demonstrate similar clinical outcomes compared to patients younger than 70 years.

[Outcomes of pulmonary vein electrical isolation in patients younger than and older than 70 years]. / Resultados del aislamiento eléctrico de las venas pulmonares en pacientes menores y mayores de 70 años.

Introduction and Objectives: The objective of this study is to compare the clinical characteristics and outcomes of contemporary cohorts of patients undergoing catheter ablation for atrial fibrillation (AF), stratified by age (< 70 years and ≥ 70 years). Methods: This retrospective cohort study included patients who underwent catheter ablation for refractory AF. The minimum follow-up duration per patient was 12 months. Results: A total of 239 patients were included in the study, with 171 (71.5%) in the < 70 years group and 68 (28.5%) in the ≥ 70 years group. The mean age of the study population was 62.4 years (SD 10.87). The < 70 years group had a mean age of 58.03 years (SD 9.71), while the ≥ 70 years group had a mean age of 73.4 years (SD 3.05). Furthermore, a higher proportion of paroxysmal AF was observed in patients < 70 years, whereas a higher proportion of persistent AF was found in patients ≥ 70 years. These differences were statistically significant. The recurrence rates after the initial ablation procedure were similar between the two groups (21.43% in the < 7 0 years group vs. 23.53% in the ≥ 70 years group, p = 0.79). Additionally, there were no significant differences in terms of complications. The < 70 years group experienced 18 complications, while the ≥ 70 years group had 5 complications (p = 0.472). Conclusion: The findings of this study suggest that patients aged 70 years and older who undergo their first catheter ablation procedure for AF demonstrate similar clinical outcomes compared to patients younger than 70 years.

Introducción y objetivos: Comparar las características clínicas y los resultados de cohortes contemporáneas de pacientes menores y mayores de 70 años que han sido sometidos a ablación de fibrilación auricular (FA) mediante catéter. Métodos: Se llevó a cabo un estudio de cohortes retrospectivo en pacientes sometidos a ablación con catéter debido a la presencia de FA refractaria. Se realizó un seguimiento mínimo de 12 meses por paciente. Resultados: En el estudio se incluyeron un total de 239 pacientes sometidos a ablación de FA, de los cuales 171 (71,5%) pertenecían al grupo de edad <70 años y 68 (28,5%) al grupo de edad >70 años. La edad promedio de la población estudiada fue de 62,4 años (desviación estándar [DE] = 10,87). El grupo <70 años presentó una edad promedio de 58,03 años (DE = 9,71), mientras que el grupo >70 años tuvo una edad promedio de 73,4 años (DE = 3,05). Además, se observó una mayor prevalencia de FA paroxística en el grupo de pacientes menores de 70 años, mientras que en el grupo de pacientes mayores de 70 años se encontró una mayor prevalencia de FA persistente. Estas diferencias fueron estadísticamente significativas en ambos casos. Las tasas de recurrencia después del primer procedimiento de ablación fueron similares entre los dos grupos (21,43% en el grupo menor de 70 años frente a 23,53% en el grupo mayor de 70 años, p = 0,79). No se encontraron diferencias significativas en cuanto a complicaciones. El grupo menor de 70 años experimentó 18 complicaciones, mientras que el grupo mayor de 70 años tuvo 5 complicaciones, con un valor de p de 0,472. Conclusión: Los pacientes mayores de 70 años sometidos al primer procedimiento de ablación de FA por catéter presentan resultados clínicos similares a los pacientes menores de 70 años.

Resistance and recovery of benthic marine macrophyte communities to light reduction: Insights from carbon metabolism and dissolved organic carbon (DOC) fluxes, and implications for resilience.

A crucial factor in the long-term survival of benthic macrophyte communities under light-reduction stress is how they balance carbon metabolism during photosynthesis and respiration. In turn, the dissolved organic carbon (DOC) released by these communities, which can be highly light-dependent, stands as a source of carbon, fuelling marine communities and playing an important role in the ocean carbon sequestration. This is the first study to evaluate light-reduction stress and recovery in the seagrass Zostera noltei and the macroalga Caulerpa prolifera. Light reduction led to a significant decrease in the production of both communities from autotrophic to heterotrophic. Results indicated that most of the DOC released by vegetated coastal communities comes from photosynthetic activity, and that the net DOC fluxes can be greatly affected by shading events. Finally, both communities showed resilience underpinned by high recovery but low resistance capacity, with C. prolifera showing the highest resilience to unfavourable light conditions.

Seguridad del implante de lente fáquica ACR-128 tras un año de seguimiento / Safety of an ACR-128 phakic lens implant after one year's follow-up

Objetivo: Determinar la seguridad de los lentes fáquicos ACR-128 en la corrección de la alta miopía tras un año de implantados. Método: Se realizó un estudio transversal en 67 ojos de 36 pacientes con miopía corregida con lente fáquica ACR-128 (31 con ambos ojos y 5 con un solo ojo). Se determinó preoperatorio y posoperatorio: tensión ocular, pérdida celular endotelial según conteo, coeficiente de variación celular y hexagonalidad. Además de complicaciones posoperatorias y posición del lente respecto a endotelio y cristalino. El análisis estadístico se realizó con la prueba T para datos pareados, con una significación del 95 por ciento. Resultados: Edad media 28,06 ± 6,14 (25 mujeres y 11 hombres). Las complicaciones inmediatas fueron hipotonía OD: 1 (3,03 por ciento), OI: 1 (2,94 por ciento). La irregularidad de la pupila se presentó OD: 1 (3,03 por ciento), OI: 1 (2,94 por ciento) mediata y OD: 1 (3,03 por ciento), OI: 2 (5.88 por ciento) tardía. Tensión ocular promedio total preoperatorio 14,09 ± 2,51 y posoperatorio 14,22 ± 2,64 (p = 0,90). El conteo celular preoperatorio 2667,27 ± 228,72 y posoperatorio 2591,96 ± 301,21, con 2,94 por ciento pérdida endotelial total 75,31 ± 237,41 (p = 0,06). No hubo diferencias en el coeficiente de variación (p = 0,60) ni la hexagonalidad (p = 0,57). Posición del lente respecto al endotelio 2,09 mm y al cristalino 1,08 mm. Conclusiones: El implante de lente fáquica ACR-128 en la corrección de la alta miopía es un tratamiento seguro al no existir complicaciones posquirúrgico ni modificaciones en la tensión ocular y en el endotelio corneal tras un año del implante(AU)

Objective: Determine the safety of ACR-128 phakic lenses for high myopia correction one year after implantation. Method: A cross-sectional study was conducted of 67 eyes of 36 patients with myopia corrected with ACR-128 phakic lens implants (31 in both eyes and 5 in one eye). Pre- and postoperative determination was made of ocular tension, endothelial cell loss by count, cell variation coefficient and hexagonality, as well as of postoperative complications and lens position with respect to the endothelium and the crystalline lens. Statistical analysis was based on the paired T-test with a significance level of 95 percent Results: Mean age was 28.06 ± 6.14 (25 women and 11 men). An immediate complication was hypotonia: RE: 1 (3.03 percent), LE: 1 (2.94 percent). Pupil irregularity was mediate: RE: 1 (3.03 percent), LE: 1 (2.94 percent) and late: RE: 1 (3.03 percent), LE: 2 (5.88 percent). Total average ocular tension was 14.09 ± 2.51 preoperative and 14.22 ± 2.64 postoperative (p = 0.90). Cell count was 2667.27 ± 228.72 preoperative and 2591.96 ± 301.21 postoperative, with 2.94 percent total endothelial loss 75.31 ± 237.41 (p = 0.06). Differences were not found in the variation coefficient (p = 0.60) or in hexagonality (p = 0.57). Lens position was 2.09 mm with respect to the endothelium and 1.08 mm with respect to the crystalline lens. Conclusions: ACR-128 phakic lens implantation for high myopia correction is a safe procedure with no postoperative complications or modifications in ocular tension or the corneal endothelium after one year's follow-up(AU)

Síndrome de contracción capsular bilateral / Bilateral capsule contraction syndrome

El síndrome de contracción capsular se describe como una reducción progresiva y acelerada del diámetro de la capsulorrexis y del saco capsular tras la extracción extracapsular del cristalino. Se reporta el caso de una paciente femenina, con antecedentes de miopía elevada, a quien se le realizó cirugía de catarata de ambos ojos sin complicaciones transquirúrgicas, y regresa con síndrome de contracción capsular bilateral al mes de operada. Se comenta la conducta seguida en ambos ojos(AU)

Capsule contraction syndrome is described as progressive, accelerated reduction in capsulorhexis and capsular bag diameter after extracapsular crystalline lens extraction. A case is presented of a female patient with a history of high myopia who underwent cataract surgery of both eyes without any intraoperative complication. One month after surgery the patient presents with bilateral capsule contraction syndrome. Comments are made on the clinical management of each eye(AU)

Sorpresa refractiva tras la cirugía de catarata en paciente con lente fáquica / Refractive surprise after cataract surgery in a patient with a phakic lens implant

El implante de una lente intraocular fáquica puede resultar una opción lógica para los pacientes sumamente miopes que buscan liberarse de las gafas y de los lentes de contacto. Esta es una alternativa para corregir los grados de miopía extremos, y se diseñaron para permanecer dentro del ojo por muchos años. Con el cursar del tiempo, fisiológicamente comienza a opacarse el cristalino. Ante la necesidad de removerlo y de calcular una lente de potencia adecuada para el saco capsular y así conseguir la emetropía, surge un nuevo reto. El cálculo inexacto de la potencia dióptrica de la lente a implantar en la intervención quirúrgica es un problema y con él aparece la sorpresa refractiva; de ahí el objetivo de presentar con este caso la causa más frecuente de sorpresa refractiva tras la cirugía de catarata en un paciente miope con lente fáquica implantada. Se destaca la importancia de la longitud axil, sobre todo si esta se modifica después del implante de la lente fáquica para el correcto cálculo de la lente a implantar, así como el método ideal para su obtención: la interferometría óptica, sin olvidar la historia clínica previa al implante de la lente fáquica(AU)

Phakic intraocular lens implantation may be a logical option for extremely myopic patients who wish to get rid of their eyeglasses and contact lenses. This alternative was developed to correct extremely high degrees of myopia and remain inside the eye for many years. However, with the passing of time and due to physiological processes, the crystalline lens tends to become opaque. A new challenge is posed by the need to remove it and select a lens with an optical power appropriate to the capsular sac, thus achieving emmetropia. Inaccurate calculation of the dioptric power of the lens to be implanted in the surgical intervention is a problem leading to refractive surprise. Hence the interest in presenting a case illustrating the most common cause of refractive surprise after cataract surgery in a myopic patient with a phakic lens implant. The importance of axial length is highlighted, particularly whether it is modified after phakic lens implantation for accurate calculation of the lens to be implanted and the ideal method to obtain it: optical interferometry, without disregarding the medical record data preceding the phakic lens implantation(AU)

Efectividad del implante de lente fáquica ACR-128 tras un año de seguimiento / Effectiveness of an ACR-128 phakic lens implant after one year's follow-up

Introducción: La corrección de ametropías moderadas-severas mediante lentes fáquicas permite conservar la acomodación, además, de obtener una mejor calidad óptica, reversibilidad del procedimiento y la opción de corregir defectos refractivos residuales mediante cirugía corneal mínima invasiva. Objetivo: Determinar la efectividad de los lentes fáquicos ACR-128 en la corrección de la alta miopía tras un año de su implante. Método: Se realizó un estudio transversal en 67 ojos de 36 pacientes con miopía corregida con lente fáquica ACR-128. Se determinaron las características biométricas y refractivas por ojo, relación entre el componente esférico esperado y el observado, distribución por ojos el componente esférico esperado y el observado, relación entre cilindro queratométrico pre y posoperatorio y relación entre la agudeza visual sin corrección y la agudeza visual mejor corregida en el pre y posoperatorio. Resultados: La edad media fue 28,06 ± 6,14(25 mujeres, 11 hombres) el equivalente esférico preoperatorio OD promedio de -10,77 ± 4,23 dioptrías y OI promedio de -10,77 ± 3,72 dioptrías. El componente esférico en dioptrías esperado (-0,56 ± 0,38) y observado (-0,43 ± 0,69) sin diferencias estadísticamente significativas (p = 0,14). El cilindro queratométrico en dioptrías, pre (1,41 ± 0,74) y posoperatorio (1,24 ± 0,88) sin astigmatismo inducido (p = 0,12). El 100 por ciento tenía agudeza visual sin corrección preoperatoria ≤ 0,1 y posoperatoria ≥ 0,5. Conclusiones: Un año después del implante de lente fáquica ACR-128 en la corrección de la alta miopía el tratamiento continúa efectivo, pues reduce el componente esférico al deseado y mantenerlo, no inducir astigmatismo y mantener mejor agudeza visual(AU)

Introduction: Correction of moderate-severe ametropia with phakic lenses makes it possible to preserve accommodation and provides better optical quality, reversibility of the procedure and the option of correcting residual refractive defects by minimally invasive corneal surgery. Objective: Determine the effectiveness of ACR-128 phakic lenses for high myopia correction one year after implantation. Method: A cross-sectional study was conducted of 67 eyes of 36 patients with myopia corrected with ACR-128 phakic lenses. Determination was made of the biometric and refractive characteristics of each eye, the relationship between the expected and the observed spherical component, the distribution of the expected and the observed spherical component per eye, the relationship between the pre- and postoperative keratometric cylinder, and the relationship between pre- and postoperative uncorrected and best corrected visual acuity. Results: Mean age was 28.06 ± 6.14 (25 women, 11 men). Average preoperative spherical equivalent was -10.77 ± 4.23 diopters RE and -10.77 ± 3.72 diopters LE. Spherical component in diopters: expected (-0.56 ± 0.38) and observed (-0.43 ± 0.69), without statistically significant differences (p= 0.14). Keratometric cylinder in diopters: preoperative (1.41 ± 0.74) and postoperative (1.24 ± 0.88), without induced astigmatism (p = 0.12). In 100 percent visual acuity without correction was #8804; 0.1 preoperative and ≥ 0.5 postoperative. Conclusions: One year after ACR-128 phakic lens implantation for high myopia correction, the treatment remains effective, reducing the spherical component and maintaining it at the desired level, not inducing astigmatism and preserving best visual acuity(AU)

Sugarcane Straw Recovery for Bioenergy Generation: A Case of an Organic Farm in Colombia.

In Latin America, the energy potential from sugarcane straw, such as tops, secondary stalk, and leaves, has been debated, but the literature associated with organic crops and its implementation for energy purposes is limited. Sugarcane straw is either left in the field for soil recovery or used for animal feed. This paper presents an analysis of using organic sugarcane straw for energy generation. We have characterized the physicochemical properties of this organic sugarcane straw, including caloric value, moisture, carbon, and ash content, and have explored the environmental benefits of using biomass to replace coal as an energy source. The study showed that it is possible to achieve the replacement of coal using 16% of the residual biomass, with the benefit of generating lower CO2 emissions compared to coal combustion. Additionally, emissions derived from transporting the biomass from the field to the farm are 68% lower than those involved in transporting coal. The residual biomass from the organic crop showed similar properties relative to bagasse. The use of organic sugarcane straw biomass will result in the reduction of energy costs and will generate green energy with lower emission of CO2.

La salud pública como pilar para la educación de los profesionales de salud en Colombia / Public Health as a Cornerstone for the Education of Health Professionals in Colombia

Introducción: La educación médica en Colombia ha sido un tema ampliamente debatido y que han requerido múltiples cambios. En la actualidad, se encuentran diversas organizaciones a nivel mundial que se encargan de la formulación de recomendaciones para mejorar la educación médica y la atención integral a las personas, con la salud pública como piedra angular del proceso. Objetivo: Identificar la importancia de la Salud Pública en el proceso educativo de los profesionales de la salud colombianos. Desarrollo: El potencial de la educación médica para crear recomendaciones que promuevan la atención integral, la calidad humana y las estrategias para mejorar la salud de la población dentro del proceso, debe ser reconocido desde la importancia de incluir a la salud pública durante el pregrado, lo que prospectivamente le permite al profesional de la salud una adecuada y apropiada preparación para su vida laboral, así como el conocimiento de las necesidades de la población y la posibilidad de anticiparse a estas por medio del uso de la atención primaria de salud. Conclusiones: Con el fin de favorecer los diferentes niveles de prevención, desde la promoción de la salud y las políticas públicas, se disminuyen las brechas de inequidad en salud desde los determinantes sociales en salud. Asimismo, debe existir un equilibrio entre el modelo biomédico tradicional y el enfoque social de las profesiones de la salud, ya que la vida del estudiante promedio de medicina se encuentra, en su mayoría, dentro de un escenario hospitalario, lo que propicia la idea del modelo hospitalocentrista y deja de lado la mirada integral(AU)

Introduction: Medical education in Colombia has been a widely debated topic and has required multiple changes. Currently, several organizations worldwide are responsible for formulating recommendations to improve medical education and comprehensive care for people, being public health the cornerstone of the process. Objective: To identify the importance of public health in the educational process of Colombian health professionals. Development: The potential of medical education to create recommendations that promote comprehensive care, human quality and strategies for improving the health of the population within the process must be recognized based on the importance of including public health during undergraduate formation, which prospectively allows health professional an adequate and appropriate training for their working life, as well as the knowledge of the needs of the population and the possibility of anticipating them through the use of primary health care. Conclusions: In order to favor the different levels of prevention, from the promotion of health and public policies, the inequality gaps in health are reduced based on the social determinants of health. Likewise, there must be a balance between the traditional biomedical model and the social approach of the health professions, since the life of the average medical student is mostly within a hospital setting, which fosters the idea of hospitalocentrist model and set aside the comprehensive perspective(AU)

The HEART score in the era of the European Society of Cardiology 0/1-hour algorithm.

BACKGROUND: The European Society of Cardiology's 0/1-hour algorithm improves the early triage of patients towards "rule-out" or "rule-in" of non-ST-segment elevation myocardial infarction. The HEART score is a risk stratification tool for patients with undifferentiated chest pain. We sought to evaluate the performance of the European Society of Cardiology 0/1-hour algorithm and the HEART score to evaluate chest pain patients in the emergency department. METHODS: In this prospective study, we applied the European Society of Cardiology 0/1-hour algorithm and the HEART score in 1355 consecutive patients who presented to the emergency department with symptoms suggestive of acute coronary syndrome without ST-segment elevation. Patients were followed for non-ST-segment elevation myocardial infarctions and major adverse cardiac events at 30 days: death, non-ST-segment elevation myocardial infarction, or unplanned coronary revascularization. RESULTS: The European Society of Cardiology 0/1-hour algorithm classified 921 (68.0%) patients as "rule-out" and the HEART score classified 686 (50.6%) patients as "low-risk". The 30-day incidence of non-ST-segment elevation myocardial infarctions was 0.32% in the European Society of Cardiology 0/1-hour algorithm "rule-out" patients versus 0.29% in the HEART score "low-risk" patients (p=0.75). The rate of major adverse cardiac events was 7.7% in the European Society of Cardiology 0/1-hour algorithm "rule-out" patients versus 1.1% in the HEART score "low-risk" patients (p<0.001). CONCLUSION: The European Society of Cardiology 0/1-hour algorithm identified more patients with low risk of non-ST-segment elevation myocardial infarctions at 30 days whereas for major adverse cardiac events, the HEART score had a greater capacity to detect low-risk patients.

Telemedicina en la práctica del otorrinolaringólogo en el período de contingencia del COVID-19 / Telemedicine in the practice of the otolaryngologist in the contingency period of COVID-19

Introducción: la pandemia por el nuevo coronavirus nos ha afectado a todos y muchos hemos tenido que cerrar o disminuir sustancialmente nuestra práctica. Sin embargo, es necesario mantener la comunicación con nuestros pacientes que continúan requiriendo de nuestra atención y manejo. Es aquí donde la telemedicina en otorrinolaringología desempeña un papel muy importante. Métodos: se realizó una revisión narrativa de la literatura mediante una búsqueda en PUB-MED y EMBASE a conveniencia con respecto a la información disponible sobre telesalud y telemedicina en el área de la otorrinolaringología. Además, se incluyó literatura de asociaciones de otorrinolaringología a nivel mundial y lineamientos y normas del gobierno colombiano. Discusión: la telemedicina es una herramienta útil para la atención de pacientes durante esta contingencia. Debemos seguir ciertos parámetros, elegir adecuadamente a los pacientes y actuar con honestidad y buena fe. Se realizan sugerencias del beneficio de la telesalud y telemedicina, consideraciones especiales en nuestra práctica médica, alcances de los servicios mencionados e implementación de estos en nuestros consultorios e instituciones basados en la literatura disponible, normas legales y experiencia de los autores. Conclusión: en la práctica del otorrinolaringólogo, es posible implementar la telemedicina con el aval de las aseguradoras y la aceptación de los pacientes. Se debe ser extremadamente cuidadoso con el diligenciamiento de la historia clínica, con la formulación de medicamentos y la selección adecuada de los pacientes. La telemedicina en otorrinolaringología es una herramienta valiosa, que nos permite continuar atendiendo a pacientes seleccionados, al tiempo que los cuidamos a ellos y a nosotros.

Introduction: The pandemic due to the novel Coronavirus has affected all of us affecting substantially our practice. However, it is necessary to maintain communication with our patients who continue to require our services. It is here where telehealth and telemedicine in Otolaryngology play an important role. Methods: A narrative review of the literature was carried out through a search in PUB-MED and EMBASE regarding the information available on telehealth and telemedicine in the area of Otolaryngology. In addition, literature from Otolaryngology societies worldwide and guidelines and regulations of the Colombian government were included. Discussion: Telemedicine is useful for patient care in this contingency. We must follow certain parameters, carefully choose patients, and act in good faith. Suggestions are made on the benefit of telehealth and telemedicine, special considerations in our medical practice, the scope of the aforementioned services and their implementation in our offices and institutions based on the available literature, legal regulations and the authors' experience. Conclusion: In the practice of the Otolaryngologist it is possible to implement telemedicine with the endorsement of the insurers and the acceptance of patients. One must be extremely careful with the medical record and the prescription of medications and select patients appropriately. Otolaryngology telemedicine is a valuable tool that allows us to continue caring for selected patients by keeping them and ourselves safe.

Recent trend reversal for declining European seagrass meadows.

Seagrass meadows, key ecosystems supporting fisheries, carbon sequestration and coastal protection, are globally threatened. In Europe, loss and recovery of seagrasses are reported, but the changes in extent and density at the continental scale remain unclear. Here we collate assessments of changes from 1869 to 2016 and show that 1/3 of European seagrass area was lost due to disease, deteriorated water quality, and coastal development, with losses peaking in the 1970s and 1980s. Since then, loss rates slowed down for most of the species and fast-growing species recovered in some locations, making the net rate of change in seagrass area experience a reversal in the 2000s, while density metrics improved or remained stable in most sites. Our results demonstrate that decline is not the generalised state among seagrasses nowadays in Europe, in contrast with global assessments, and that deceleration and reversal of declining trends is possible, expectingly bringing back the services they provide.

Resultados de los primeros pacientes con sospecha de síndrome coronario agudo evaluados con el algoritmo de 1 hora propuesto por la Sociedad Europea de Cardiología / Results of the First Patients with Suspected Acute Coronary Syndrome Evaluated with the 1-hour Algorithm Proposed by the European Society of Cardiology

RESUMEN Introducción: La Sociedad Europea de Cardiología recomienda para la evaluación del dolor torácico un algoritmo con medición seriada de dos troponinas de alta sensibilidad separadas por una hora. Sin embargo, la alta eficacia y seguridad solo se han estimado según supuestos basados en modelos teóricos. Probamos por primera vez su desempeño en nuestro medio cuando se integra en la rutina diaria. Métodos: Estudio prospectivo unicéntrico que incluyó a pacientes no seleccionados que presentaban sospecha de infarto sin elevación del ST en el servicio de emergencias, a los que se les practicó el algoritmo SEC 0/1h utilizando troponina T de alta sensiblidad. Se evaluó el comportamiento en términos de incidencia a 30 días de los eventos de infarto agudo de miocardio, muerte cardiovascular y el combinado de infarto agudo de miocardio, muerte o revascularización coronaria. Resultados: Se incluyeron 1351 pacientes con una edad media de 61 ± 14 años, 12,4% de diabéticos y 35,8% de evento coronario previo. La tasa de infarto agudo de miocardio fue del 11% con una mortalidad del 0,29%. De acuerdo con la aplicación del algoritmo, 917 pacientes fueron catalogados como "externar" (67%); 270, como "observar" (20%); y 164, como "internar" (13%). La tasa del evento infarto agudo de miocardio resultó del 0,3% en "externar"; del 7%, en "observar"; y del 77,4%, en "internar" (p < 0,001). Por su lado, la muerte o revascularización coronaria resultó de 7,7% en "externar"; del 17,7%, en "observar"; y del 80,4%, en "internar" (p < 0,001). Conclusiones: El algoritmo de 1 hora presentó una buena capacidad para estratificar a pacientes que consultan con sospecha de infarto agudo de miocardio con un gran valor predictivo negativo para excluir el evento de infarto a los 30 días, aunque dicho valor disminuye cuando el evento considerado es la necesidad de revascularización coronaria.

ABSTRACT Background: The European Society of Cardiology (ESC) recommends an algorithm for the evaluation of chest pain with serial measurement of two high sensitivity troponins separated by one hour. However, the high efficacy and safety of the algorithm has only been estimated according to assumptions based on theoretical models. We tested for the first time its performance in the real world by incorporating it into the daily routine of our center. Methods: This is a prospective, single center study using the ESC 0/1h algorithm with high sensitivity troponin T on unselected patients who presented at the emergency department with suspected non-ST-segment elevation acute myocardial infarction. Efficacy and safety were assessed in terms of the 30-day incidence of acute myocardial infarction, cardiovascular death and the composite of acute myocardial infarction, death or coronary revascularization. Results: A total of 1,351 patients were included in the study. Mean age was 61±14 years, 12.4% were diabetics and 35.8% had previous history of coronary events. The rate of acute myocardial infarction was 11% and the rate of mortality 0.29%. According to the application of the algorithm, 917 patients were catalogued as "rule out" (67%), 270 as "observe" (20%) and 164 as "rule in" (13%). The rate of acute myocardial infarction was 0.3% in "rule out", 7% in "observe" and 77.4% in "rule in" (p <0.001). Moreover, death or coronary revascularization was 7.7% in "rule out", 17.7% in "observe" and 80.4% in "rule in" (p <0.001). Conclusions: The 1-hour algorithm showed a good capacity to stratify patients presenting with suspicion of acute myocardial infarction and a high negative predictive value to exclude infarction at 30 days, although this capacity decreases when the event considered is the need for coronary revascularization.

Utilidad de la mamografía con contraste en el diagnóstico del cáncer de mama. Nuestra experiencia y revisión de la literatura / Use of Contrast Mammography in The Diagnosis of Breast Cancer. Our Experience and Literature Review

La mamografía, como método de tamizaje, ha demostrado disminuir la mortalidad al detectar de manera temprana el cáncer de mama; sin embargo, en mamas muy densas se dificulta la detección, por lo que se han venido generando nuevos métodos de tamizaje y diagnóstico. La mamografía con contraste espectral (CESM) es uno de estos métodos que, con la utilización de medio de contraste, facilita la detección de lesiones sospechosas. Será tema de revisión de este artículo su técnica e historia, repasando su comparación con la mamografía convencional y con una serie de casos se expondrán sus indicaciones, ventajas y desventajas.

Mammography as a screening method has been shown to reduce mortality by early detection of breast cancer; however, in very dense breasts it is difficult to detect, so new methods of screening and diagnosis have been devised. Contrast enhanced spectral contrast mammography (CESM) is one of these methods that, with the use of contrast medium, facilitates the detection of suspicious lesions. We will briefly discuss the CESM technique and history, review its comparison with conventional mammography, and with a series of cases we will discuss its indications, advantages and disadvantages.

Altos umbrales de desfibrilación en un paciente con miocardiopatía hipertrófica con implante de catéter de desfibrilación subcutáneo. Reporte de un caso y revisión de la literatura / High defibrillation thresholds in a patient with hypertrophic cardiomyopathy that needed subcutaneous desfibrillation catheter

Presentamos un paciente joven con miocardiopatía hipertrófica y altos umbrales de desfibrilación que necesitó recambio de generador por agotamiento. Durante el procedimiento utilizando un desfibrilador de alta salida y luego de probar varios cambios de configuración no fue efectiva la terminación de la FV inducida por lo que requiere la colocación de un catéter de desfibrilación subcutáneo con lo que se lograron adecuados márgenes de seguridad. Se realiza una revisión de la literatura acerca de las opciones en casos de altos umbrales de desfibrilación

We present a young patient with hypertrophic cardiomyopathy and high defibrillation thresholds that needed a generatior replacement. During the procedure, a high-output defibrillator was not effective for the termination of induced ventricular fibrillation (FV), even after testing several configurations. Alternatively, safety margin were reached by placing a subcutaneous defibrillator catheter. A literature review is performed exploring options for cases where defibrillation thresholds are high

Global and local disturbances interact to modify seagrass palatability.

Global change, such as warming and ocean acidification, and local anthropogenic disturbances, such as eutrophication, can have profound impacts on marine organisms. However, we are far from being able to predict the outcome of multiple interacting disturbances on seagrass communities. Herbivores are key in determining plant community structure and the transfer of energy up the food web. Global and local disturbances may alter the ecological role of herbivory by modifying leaf palatability (i.e. leaf traits) and consequently, the feeding patterns of herbivores. This study evaluates the main and interactive effects of factors related to global change (i.e. elevated temperature, lower pH levels and associated ocean acidification) and local disturbance (i.e. eutrophication through ammonium enrichment) on a broad spectrum of leaf traits using the temperate seagrass Cymodocea nodosa, including structural, nutritional, biomechanical and chemical traits. The effect of these traits on the consumption rates of the generalist herbivore Paracentrotus lividus (purple sea urchin) is evaluated. The three disturbances of warming, low pH level and eutrophication, alone and in combination, increased the consumption rate of seagrass by modifying all leaf traits. Leaf nutritional quality, measured as nitrogen content, was positively correlated to consumption rate. In contrast, a negative correlation was found between feeding decisions by sea urchins and structural, biomechanical and chemical leaf traits. In addition, a notable accomplishment of this work is the identification of phenolic compounds not previously reported for C. nodosa. Our results suggest that global and local disturbances may trigger a major shift in the herbivory of seagrass communities, with important implications for the resilience of seagrass ecosystems.