Abriendo espacios de participación virtual multimodal a jóvenes durante la pandemia covid-19 / Opening multimodal virtual participation spaces for young students during the COVID-19 pandemic / Abrindo espaços virtuais multimodais de participação para estudantes durante a pandemia Covid-19

Resumen (analítico) Las y los estudiantes carecen de espacios para valorar sus experiencias de inclusión/exclusión escolar. La crisis sanitaria obligó a vincularnos virtualmente, sin conocer las posibilidades para el intercambio de significados digitales, representación de experiencias y movilización de relaciones interpersonales. Desde una perspectiva pedagógica, semiótica y social, este estudio analiza una sesión de un taller virtual con nueve estudiantes secundarios de tres escuelas chilenas, preguntándose sobre cómo se materializó la participación de las y los jóvenes. Con herramientas de la multimodalidad se analiza un corpus audiovisual de una cartografía virtual de espacios educativos. Se visibilizan los recursos disponibles para la participación virtual y las maneras en que fueron usados para compartir significados individuales y generar solidaridad co-construyendo relatos de inclusión/exclusión escolar.

Abstract (analytical) Students lack spaces that evaluate their experiences of inclusion/exclusion in school. The health cri-sis forced us to interact online and at first we were not aware of the resources available for the ex-change of digital meanings, representation of experiences and formation of interpersonal relation-ships. Using a pedagogical, semiotic and social approach, this study analyzes the results of an online workshop attended by nine secondary students from three Chilean schools. The aim was to identify the means and resources that facilitated student participation in online environments. Using multi-modal tools, an audiovisual corpus consisting of an Online Cartography of Educational Spaces is explored by the authors. The resources available for online participation were shared by participants. In addition, the article describes semiotic mechanisms for sharing individual meanings and developing solidarity by co-constructing stories about inclusion/exclusion in the classroom.

Resumo (analítico) Os alunos e alunas não têm espaços para avaliar suas experiências de inclusão/exclusão escolar. A crise de saúde pela Covid-19 obrigou as pessoas a termos uma interação virtual, sem conhecer os recursos disponíveis para a troca de significados digitais, a representação de experiências e o desenvolvimento das relações interpessoais. Do ponto de vista pedagógico, semiótico e social, este estudo analisa uma sessão de oficina virtual com nove alunos e alunas do ensino médio de três es-colas chilenas. A pesquisa foca em identificar os significados y recursos que auxiliam a participação dos e das estudantes. Utilizando ferramentas multimodais, foi analisado um corpus audiovisual de uma Cartografia Virtual de Espaços Educacionais. Assim, este estudo mostra os recursos disponíveis para a participação virtual e as formas como foram utilizados para compartilhar significados desde a experiência pessoal, além de promover a solidariedade através da co-construção de relatos de inclusão/exclusão escolar.

Delays to Hospital Presentation in Women and Men with ST-Segment Elevation Myocardial Infarction: A Multi-Center Analysis of Patients Hospitalized in New York City.

PURPOSE: Previous studies have shown longer delays from symptom onset to hospital presentation (S2P time) in women than men with acute myocardial infarction. The aim of this study is to understand the reasons for delays in seeking care among women and men presenting with an ST-Segment Elevation Myocardial Infarction (STEMI) through a detailed assessment of the thoughts, perceptions and patterns of behavior. PATIENTS/METHODS AND RESULTS: A total of 218 patients with STEMI treated with primary angioplasty at four New York City Hospitals were interviewed (24% female; Women: 68.7 ± 13.1 years and men: 60.7 ± 13.8 years) between January 2009 and August 2012. A significantly larger percentage of women than men had no chest pain (62% vs 36%, p<0.01). Compared to men, a smaller proportion of women thought they were having a myocardial infarction (15% vs 34%, p=0.01). A larger proportion of women than men had S2P time >90 minutes (72% of women vs 54% of men, p= 0.03). Women were more likely than men to hesitate before seeking help, and more women than men hesitated because they did not think they were having an AMI (91% vs 83%, p=0.04). Multivariate regression analysis showed that female sex (Odds Ratio: 2.46, 95% CI 1.10-5.60 P=0.03), subjective opinion it was not an AMI (Odds Ratio 2.44, 95% CI 1.20-5.0, P=0.01) and level of education less than high school (Odds ratio 7.21 95% CI 1.59-32.75 P=0.01) were independent predictors for S2P >90 minutes. CONCLUSION: Women with STEMI have longer pre-hospital delays than men, which are associated with a higher prevalence of atypical symptoms and a lack of belief in women that they are having an AMI. Greater focus should be made on educating women (and men) regarding the symptoms of STEMI, and the importance of a timely response to these symptoms.

Mild hyperkalemia and low eGFR a tedious recipe for cardiac disaster in the elderly: an unusual reversible cause of syncope and heart block.

Hyperkalemia affects the myocardial tissue producing electrocardiographic abnormalities, such as prolongation of the P-R interval, tall peaked T waves, a reduction in the amplitude and an increase in the duration of P wave, and atrial and ventricular arrhythmias, including variable degree heart blocks. Elderly patients are particularly predisposed to developing hyperkalemia and the associated abnormalities due to an age-related reduction in glomerular filtration rate and pre-existing medical problems. Therefore, the impact of aging on potassium homeostasis must be taken into consideration, and preventive measures, such as early recognition of possible hyperkalemia in the geriatric population treated with certain medications or supplements must be investigated. The threshold for cardiac arrhythmias in the elderly can be lower than the general population. We report 3 unusual cases of mild hyperkalemia in elderly patients presenting with hypotension, syncope and variable degree heart blocks which resolved spontaneously with the correction of hyperkalemia.

Continuous infusion of furosemide combined with low-dose dopamine compared to intermittent boluses in acutely decompensated heart failure is less nephrotoxic and carries a lower readmission at thirty days.

INTRODUCTION: Furosemide is a potent loop diuretic that is widely used in the management of heart failure. Several reports have suggested that continuous intravenous administration of loop diuretics may be superior to intermittent administration. In addition the effect of low-dose dopamine to improve renal perfusion might be of benefit to this patient cohort. METHODS: We retrospectively evaluated 116 consecutive cardiac care unit patients, who were admitted with acute decompensated heart failure and were divided into two equal groups according to diuretic protocol. Group A patients received furosemide by continuous infusion combined with low-dose dopamine infusion. Group B patients received bolus therapy of intravenous furosemide. The effect on renal function and readmission rate was recorded. RESULTS: Among 116 patients (60% males, average age 71, range 46-96 years) 41% had ischemic cardiomyopathy, NYHA functional Class was 3.5 ± 0.5 and average EF was 21% ± 7%. On admission, patients in Group A had creatinine (Cr) 2.3 ± 0.2 mg/dL, blood urea nitrogen (BUN) 49.2 ± 25 mg/100 ml and median b-type natriuretic peptid (BNP) 1340 pg/mL, compared to group B patients with Cr 1.7 ± 1.2 mg/dL, BUN 32 ± 22 mg/100 ml and median BNP 1106 pg/mL. The average furosemide dose in group A was 7.9 ± 3.5 mg/hr compared to 7.6 ± 2.7 mg/hr for group B (p=NS). At the end of the study, patients in group A had lower Cr 1.8 ± 0.9 (p=0.0001), lower BUN 43.6 ± 22.9 (p=NS), an increase in estimated glomerular filtration rate 57.4 ± 27.4, a shorter hospital stay (p=0.015) and lower readmission rates at 30 days (p=0.0003). CONCLUSIONS: Continuous infusion of furosemide in addition to low-dose dopamine is safe, effective and less nephrotoxic than intermittent boluses in patients admitted with acute decompensated heart failure and portends a shorter hospital stay and lower readmission rates at 30 days.