Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article.

The POCUS-CA (Point-of-care ultrasound in cardiac arrest) is a diagnostic tool in the Intensive Care Unit and Emergency Department setting. The literature indicates that in the patient in a cardiorespiratory arrest it can provide information of the etiology of the arrest in patients with non-defibrillable rhythms, assess the quality of compressions during cardiopulmonary resuscitation (CPR), and define prognosis of survival according to specific findings and, thus, assist the clinician in decision-making during resuscitation. This narrative review of the literature aims to expose the usefulness of ultrasound in the setting of cardiorespiratory arrest as a tool that allows making a rapid diagnosis and making decisions about reversible causes of this entity. More studies are needed to support the evidence to make ultrasound part of the resuscitation algorithms. Teamwork during cardiopulmonary resuscitation and the inclusion of ultrasound in a multidisciplinary approach is important to achieve a favorable clinical outcome.

Humanización de los Cuidados Intensivos: Un llamado a la acción durante y después del COVID-19 / Humanization of Critical Medicine and Intensive Care: A call for action amid and beyond COVID-19

En las últimas décadas, secundario al desarrollo científico y tecnológico, las prácticas de la medicina crítica y los cuidados intensivos se han caracterizado por alcanzar una mayor supervivencia asociada a prácticas poco humanizadas, la cual se enfoca de forma exclusiva en el manejo de una patología, dejando un vacío en importantes aspectos característicos de cada paciente y su familia. Actualmente, durante la pandemia de SARS-CoV-2, la implementación de prácticas de humanización para el paciente gravemente enfermo y sus familiares es una necesidad imperiosa para los sistemas de salud (AU)

In recent decades, due to scientific and technological development, the practices of critical care and intensive medicine have been characterized by achieving greater survival associated with practices that are not very humanized, which focuses exclusively on the management of a pathology leaving a gap in the aspects that are important for patients and relatives. Currently, during the SARS-CoV-2 pandemic, the implementation of humanization practices for the seriously ill patient and their families, it is a pressing need for health systems (AU)

Programa de entrenamiento vacacional en investigación: una propuesta de estudiantes de medicina colombianos / Vacational research training program: a proposal of Colombian medical students

INTRODUCCIÓN: La investigación es una prioridad en la formación académica en el pregrado de medicina; se asocia a positivismo, motivación y pensamiento crítico. Las asociaciones científicas formas un papel fundamental en el fomento de la investigación en el pregrado. El objetivo de este estudio fue describir los resultados del programa vacacional en investigación propuesto por estudiantes de medicina colombianos y evaluar la importancia de fomentarlos en América Latina. MATERIALES Y MÉTODOS: La población de estudio incluyó a los estudiantes de la Universidad Tecnológica de Pereira (Risaralda, Colombia) participantes, quienes resolvieron un cuestionario sobre aspectos asociados a la investigación y publicación científica; además, se utilizó el cuestionario de actitudes hacia la investigación. Se realizó una segunda encuesta a un grupo de estudiantes latinoamericanos que incluyó la importancia de realizar programas vacacionales de investigación. Los análisis estadísticos se hicieron en STATA. RESULTADOS: Ser parte de una asociación aumenta las posibilidades de ganar un premio en un congreso (86%), presentar un trabajo de investigación en un congreso (68%) y tener una publicación científica (59%). El 82,2% dedicaría al menos 5h diarias de forma ininterrumpida a la investigación durante su periodo vacacional. En vacaciones tienen en promedio 5,5 h frente a 2,2 h durante jornada académica para investigar. CONCLUSIONES: La investigación es de gran importancia en la formación del médico; los estudiantes de medicina desean que en sus universidades se realicen cursos o programas vacacionales en investigación científica porque es cuando más tiempo disponen para actividades complementarias

INTRODUCTION: Research has become a priority in academic training among medical undergraduate students, and it has been associated with positivism, motivation, and critical thinking. Scientific associations also play a role in the research training for undergraduate students. The objective of this study was to describe the results of a research program during holiday periods proposed by Colombian medical students and to evaluate the importance of promoting them in Latin America. MATERIALS AND METHODS: The study population included students from the Universidad Tecnológica de Pereira (Risaralda, Colombia) who had completed a questionnaire on aspects associated with scientific research and publications. Furthermore, a questionnaire of attitudes towards research was also completed. A second survey was conducted by a group of Latin America students, which included the importance of conducting research-based programs. The statistical analysis was performed using the STATA program. RESULTS: To be a member of an association increased the chances of winning an award at a congress (89%), as well as presenting a research paper at congress (68%), and to have a scientific publication (59%). The large majority of them (82,2%) would spend at least 5hours a day continuously on research during their vacation time. During their vacation, they spend a mean of 5.5hours per day, and 2.2hours in an academic day. CONCLUSIONS: Research is important in medical training. Medical students would like to receive courses or programs during holiday periods about scientific research, as they have more free time for these complementary activities

Improving the anesthetic process by a fuzzy rule based medical decision system.

OBJECTIVE: The main objective of this research is the design and implementation of a new fuzzy logic tool for automatic drug delivery in patients undergoing general anesthesia. The aim is to adjust the drug dose to the real patient needs using heuristic knowledge provided by clinicians. A two-level computer decision system is proposed. The idea is to release the clinician from routine tasks so that he can focus on other variables of the patient. METHODS: The controller uses the Bispectral Index (BIS) to assess the hypnotic state of the patient. Fuzzy controller was included in a closed-loop system to reach the BIS target and reject disturbances. BIS was measured using a BIS VISTA monitor, a device capable of calculating the hypnosis level of the patient through EEG information. An infusion pump with propofol 1% is used to supply the drug to the patient. The inputs to the fuzzy inference system are BIS error and BIS rate. The output is infusion rate increment. The mapping of the input information and the appropriate output is given by a rule-base based on knowledge of clinicians. RESULTS: To evaluate the performance of the fuzzy closed-loop system proposed, an observational study was carried out. Eighty one patients scheduled for ambulatory surgery were randomly distributed in 2 groups: one group using a fuzzy logic based closed-loop system (FCL) to automate the administration of propofol (42 cases); the second group using manual delivering of the drug (39 cases). In both groups, the BIS target was 50. CONCLUSIONS: The FCL, designed with intuitive logic rules based on the clinician experience, performed satisfactorily and outperformed the manual administration in patients in terms of accuracy through the maintenance stage.

Sintomatología depresiva en una población universitaria de Colombia: Prevalencia, factores relacionados y validación de dos instrumentos para tamizaje / Depressive symptoms in a university population in Colombia: prevalence, related factors, and validation of two scores for screening

Resumen Introducción: La depresión en adolescentes es un problema silente de salud mundial, la cual, en ausencia de tratamiento, tiene efectos deletéreos en la salud física, bienestar psicosocial y rendimiento académico. Se requiere la validación de un instrumento que pueda emplearse como tamizaje en población adolescente, que permita conocer la prevalencia síntomas depresivos en una población universitaria. Objetivo: Calcular la prevalencia, de síntomas depresivos, factores asociados y validar dos instrumentos que puedan emplearse como método de tamizaje en poblaciones universitarias. Método: Estudio de corte transversal en adolescentes mayores de 18 años matriculados durante el primer semestre de 2016 en la Universidad Tecnológica de Pereira. La información recopilada incluye variables sociodemográficas y los resultados de la escala del Centro de Estudios Epidemiológicos para Depresión (CES-D) y el test de depresión de ZUNG. Resultados: Se obtuvo una muestra de 350 adolescentes, de los cuales se identificaron síntomas depresivos en la última semana de 8,85% y 36,28% para la escala de ZUNG y el CES-D respectivamente. La presencia de sintomatología depresiva se vio asociada con inactividad física (odds ratio [OR] = 2,1; intervalo de confianza de 95% [IC 95%], 1,1-5,8), consumo de alcohol (OR = 3,1; IC 95%, 1,8-5,3) y de sustancias psicoactivas (OR = 3,6; IC 95%, 1,9-6,6). Conclusiones: Se realiza por primera vez en el Eje Cafetero Colombiano una validación de la escala de ZUNG y CES-D, las cuales pueden ser utilizadas en población universitaria para tamizaje de sintomatología depresiva, siendo ambas equiefectivas con alpha de Cronbach de 0,84 y 0,87 respectivamente.

Background: Adolescent depression is a silent global health problem, untreated depression has detrimental effects on physical health, psychosocial well-being, and academicproductivity. Validation of an instrument that can be used as screening in adolescents and which would allow determination of its prevalence is required. Objectives: Estimate the prevalence of depressive symptoms, associated factors and validate two instruments that can be used as a screening tool in university students. Methodology: Cross-sectional study in adolescents 18 years and older enrolled in first half of 2016 at the Universidad Tecnológica de Pereira. Information collected included sociodemographic variables and the results of scale epidemiological studies center for depression (CES-D) and the Zung depression test. Results: A sample of350 adolescents, of whom depressive symptoms were identified in the last week of 8.85% and 36.28% for the Zung scale and CES-D was obtained respectively. The presence of depressive symptoms was associated with physical inactivity (odds ratio [OR] = 2.1; confidence interval 95% [95% CI], 1.1 to 5.8), alcohol consumption (OR = 3,1; 95% CI, 1.8 to 5.3) andpsychoactivesubstances (OR = 3.6,95% CI 1.9 to 6.6). Conclusions: For the first time in Coffe region area is realized the validation of the Zung and CES-D depression test, which can be used in university population screening for depressive symptoms, both of them are equieffective with Cronbach's alpha of 0.84 and 0.87 respectively.

Pyramidal neuron conductance state gates spike-timing-dependent plasticity.

Neocortical neurons in vivo process each of their individual inputs in the context of ongoing synaptic background activity, produced by the thousands of presynaptic partners a typical neuron has. Previous work has shown that background activity affects multiple aspects of neuronal and network function. However, its effect on the induction of spike-timing dependent plasticity (STDP) is not clear. Here we report that injections of simulated background conductances (produced by a dynamic-clamp system) into pyramidal cells in rat brain slices selectively reduced the magnitude of timing-dependent synaptic potentiation while leaving the magnitude of timing-dependent synaptic depression unchanged. The conductance-dependent suppression also sharpened the STDP curve, with reliable synaptic potentiation induced only when EPSPs and action potentials (APs) were paired within 8 ms of each other. Dual somatic and dendritic patch recordings suggested that the deficit in synaptic potentiation arose from shunting of dendritic EPSPs and APs. Using a biophysically detailed computational model, we were not only able to replicate the conductance-dependent shunting of dendritic potentials, but show that synaptic background can truncate calcium dynamics within dendritic spines in a way that affects potentiation more strongly than depression. This conductance-dependent regulation of synaptic plasticity may constitute a novel homeostatic mechanism that can prevent the runaway synaptic potentiation to which Hebbian networks are vulnerable.