Draft genome sequence of rhamnolipid-producing bacteria Thermoanaerobacter thermocopriae strain CM-CNRG TB177 isolated from an oil reservoir in Mexico.

The draft genome of Thermoanaerobacter thermocopriae CM-CNRG TB177 isolated from an oil reservoir in Mexico was determined and annotated. The organism is a thermophilic and strict anaerobe bacterium that produces rhamnolipids, using glucose as a carbon source. The predicted genome size is 2,496,169 bp and 2,550 genes.

North-south pathways, emerging variants, and high climate suitability characterize the recent spread of dengue virus serotypes 2 and 3 in the Dominican Republic.

BACKGROUND: Dengue fever remains a significant public health challenge in tropical and subtropical regions, with its transmission dynamics being influenced by both environmental factors and human mobility. The Dominican Republic, a biodiversity hotspot in the Caribbean, has experienced recurrent dengue outbreaks, yet detailed understanding of the virus's transmission pathways and the impact of climatic factors remains limited. This study aims to elucidate the recent transmission dynamics of the dengue virus (DENV) in the Dominican Republic, utilizing a combination of genomic sequencing and epidemiological data analysis, alongside an examination of historical climate patterns. METHODS: We conducted a comprehensive study involving the genomic sequencing of DENV samples collected from patients across different regions of the Dominican Republic over a two-year period. Phylogenetic analyses were performed to identify the circulation of DENV lineages and to trace transmission pathways. Epidemiological data were integrated to analyze trends in dengue incidence and distribution. Additionally, we integrated historical climate data spanning several decades to assess trends in temperature and their potential impact on DENV transmission potential. RESULTS: Our results highlight a previously unknown north-south transmission pathway within the country, with the co-circulation of multiple virus lineages. Additionally, we examine the historical climate data, revealing long-term trends towards higher theoretical potential for dengue transmission due to rising temperatures. CONCLUSION: This multidisciplinary study reveals intricate patterns of dengue virus transmission in the Dominican Republic, characterized by the co-circulation of multiple DENV lineages and a novel transmission pathway. The observed correlation between rising temperatures and increased dengue transmission potential emphasizes the need for integrated climate-informed strategies in dengue control efforts. Our findings offer critical insights for public health authorities in the Dominican Republic and similar settings, guiding resource allocation and the development of preparedness strategies to mitigate the impacts of climate change on dengue transmission.

North-south pathways, emerging variants, and high climate suitability characterize the recent spread of dengue virus serotypes 2 and 3 in the Dominican Republic.

We employ a multidisciplinary approach, integrating genomics and epidemiology, to uncover recent dengue virus transmission dynamics in the Dominican Republic. Our results highlight a previously unknown north-south transmission pathway within the country, with the co-circulation of multiple virus lineages. Additionally, we examine the historical climate data, revealing long-term trends towards higher theoretical potential for dengue transmission due to rising temperatures. These findings provide information for targeted interventions and resource allocation, informing as well towards preparedness strategies for public health agencies in mitigating climate and geo-related dengue risks.

Acercamiento teórico a la evaluación de competencias profesionales gerenciales en Medicina Intensiva y Emergencias / A Theoretical Approach to the Assessment of Managerial Professional Competences in Intensive Medicine and Emergencies

Introducción: En Medicina Intensiva y Emergencias se requiere el desarrollo de competencias gerenciales y su evaluación para garantizar una atención de excelencia al paciente grave. Es pertinente un acercamiento teórico a los antecedentes y fundamentos que sustentan dicha afirmación. Objetivo: Determinar los fundamentos teóricos sobre la evaluación de competencias profesionales gerenciales en Medicina Intensiva y Emergencias. Métodos: Investigación cualitativa en la que se realizó la revisión de artículos entre 2000 y 2023, con un 90 por ciento de los últimos cinco años. Las bases de datos consultadas fueron Medline, Scopus y Google académico. Conclusiones: Los fundamentos teóricos parten de las definiciones y el surgimiento del término competencias, sus clasificaciones y descripción de los elementos que la conforman, donde resalta la importancia de la interrelación entre ellos; lo expuesto permitió visualizar la capacidad de desaprender como aspecto esencial y novedoso. La gerencia y su estrecha relación con el desempeño de los intensivistas los define como gerentes asistenciales, lo que representa un aporte teórico y evidencia la importancia del desarrollo de competencias gerenciales en dicha especialidad. Es vital el diseño de estándares como referentes para lograr la evaluación de competencias gerenciales en la práctica asistencial, si se persigue la excelencia en los servicios de atención al paciente grave(AU)

Introduction: In intensive care and emergency medicine, the development of managerial competences and their assessment is required to ensure excellence in the care of critically-ill patients. A theoretical approach to the antecedents and foundations supporting such assertion is pertinent. Objective: To determine the theoretical foundations on the assessment of professional managerial competences in intensive care and emergency medicine. Methods: A qualitative research was carried out through the review of articles from 2000 to 2023, with 90 percent belonging to the latest five years. The consulted databases were Medline, Scopus and Google Scholar. Conclusions: The theoretical foundations start from the definitions and the emergence of the term competences, its classifications and the description of the elements that make it up, highlighting the importance of the interrelation among them; the above allowed visualizing the ability to unlearn as an essential and novel aspect. Management and its close relationship with the performance of intensive care specialists defines them as care managers, which represents a theoretical contribution and evidences the importance of the development of managerial competences in this specialty. It is vital to design standards as a reference for the assessment of managerial competences in the healthcare practice, if excellence is to be pursued in the care of critically-ill patients(AU)

Competencias profesionales gerenciales para el desempeño de los intensivistas cubanos / Professional Managerial Proficiencies for Cuban Intensivists Performance

Introducción: Los intensivistas son gerentes asistenciales que toman decisiones en situaciones de estrés, por lo que su desempeño no solo depende del conocimiento técnico, sino también de las competencias gerenciales que alcancen. Objetivo: Identificar las competencias profesionales gerenciales para el desempeño de los intensivistas cubanos en la actualidad. Métodos: Se realizó una investigación de desarrollo con enfoque mixto, desde junio hasta octubre del 2021. Se emplean métodos teóricos y empíricos, entre los que se encuentran sujetos clave y un cuestionario en el que se pone a consideración de expertos, por método Delphi, las dieciséis competencias gerenciales del modelo por competencias profesionales del especialista en MIE, se utilizó Alfa de Cronbach y análisis de desligamiento multidimensional. Resultados: El Alfa de Cronbach global y por ítems del cuestionario resultó ser alto. En el análisis de desligamiento multidimensional resultó que, de las 16 competencias analizadas, diez se correlacionan entre sí y seis se disgregan del resto. Conclusión: Fueron identificadas tres competencias profesionales gerenciales con diez elementos de competencias imprescindibles para el desempeño de los especialistas en MIE y se evidencia que el desarrollo de la esfera gerencial es esencial en el desempeño de los intensivistas en la actualidad(AU)

Introduction: Intensivists are care managers who make decisions in stressful situations, so their performance not only depends on technical knowledge, but also on the managerial skills they accomplish. Objective: To identify the managerial professional proficiencies for the performance of Cuban intensivists nowadays. Methods: A development research was carried out with a mixed approach, from June to October 2021. Theoretical and empirical methods are used, among which are key individuals are considered beside a questionnaire assessed by experts, by Delphi method, sixteen managerial capabilities of the model by professional capabilities of a MIE specialist. Cronbach's Alpha and multidimensional disengagement analysis were used. Results: The global Cronbach's Alpha and by items of the questionnaire turned out to be high. In the multidimensional decoupling analysis, it turned out that, out of the 16 competencies analyzed, 10 are correlated with each other and six are disaggregated from the rest. Conclusion: Three managerial professional proficiencies were identified with 10 elements of essential proficiencies for the performance of MIE specialists and it is evident that the development of the managerial sphere is essential in the performance of intensivists these days(AU)

Síndrome genitourinario de la menopausia en mujeres del policlínico universitario Dr. Cosme Ordoñez EECarceller, Cuba / Genitourinary syndrome in women at the Dr. Cosme Ordoñez Carceller university polyclinic, Cuba

Resumen Objetivo: Determinar la frecuencia e intensidad del síndrome genitourinario de la menopausia en las mujeres atendidas en la consulta de climaterio y menopausia del Policlínico Universitario "Dr. Cosme Ordoñez Carceller. Materiales y métodos: Investigación tipo observacional, descriptiva y transversal, realizada en el período comprendido entre enero 2018 y diciembre de 2022. El universo de trabajo quedó constituido por 2962 mujeres de edad mediana del policlínico universitario Dr. Cosme Ordoñez Carceller. La muestra fue de 353 mujeres seleccionada mediante un muestreo estratificado simple. Para la recogida de los datos se empleó un modelo de Historia Clínica, de la cual se extrajeron los aspectos referidos a los datos sociodemográficos, la edad de inicio de los síntomas climatéricos y de la menopausia, las alteraciones genitourinarias y su intensidad en relación a la etapa del síndrome climatérico. Resultados: La edad promedio de las mujeres estudiadas fue de 49,4 +/- 5,18 años. La mayor cantidad de ellas se encontraban en la perimenopausia (60,1%), mientras que el porcentaje en las posmenopáusicas alcanzaba el 39,9%. La edad promedio de inicio de los síntomas fue de 45,8 +/- 6,2 años, la mayor frecuencia ocurrió entre los 45 y 49 años (61,5%). La edad promedio de aparición de la menopausia de 48,4+/- 3,7 años, lo que representa que más de dos tercios (81,6%) de las mujeres tuvieron su última menstruación por encima de los 45 años. Las alteraciones genitourinarias predominaron en la perimenopausia y la intensidad leve. Conclusiones: El síndrome genitourinario de la menopausia constituye un grupo de manifestaciones clínicas frecuentes en la mujer en etapa climatérica y afecta a más de dos tercios de las mujeres del policlínico, aparecen con mayor periodicidad entre los 45 y 49 años, en la perimenopausia y con intensidad leve.

Abstract Objective: To determine the frequency and intensity of genitourinary syndrome of menopause in womens treated in the climacteric and menopause consultation of the University Polyclinic 'Dr. Cosme Ordonez Carceller. Methods: Observational, descriptive and cross-sectional research, carried out in the period between January 2018 and December 2022. The universe of work was made up of 2962 middle-aged women from the Dr. Cosme Ordoñez Carceller university polyclinic. The sample consisted of 353 women selected by simple stratified sampling. For data collection, a Clinical History model was used, from which aspects related to sociodemographic data were extracted, the age of onset of climacteric symptoms and menopause, genitourinary disorders and their intensity in relation to the stage of climacteric syndrome. Results: The average age of the women studied was 49.4 +/- 5.18 years. The largest number of them were in perimenopause (60.1%), while the percentage in postmenopausal women reached 39.9%. The mean age of onset of symptoms was 45.8 +/- 6.2 years, the highest frequency occurring between 45 and 49 years (61.5%). The average age of onset of menopause of 48.4+/- 3.7 years, which represents that more than two thirds (81.6%) of the women had their last menstruation over 45 years of age. Genitourinary alterations predominated in perimenopause and mild intensity Conclusions: The genitourinary syndrome of menopause constitutes a group of frequent clinical manifestations in women in the climacteric stage and affect more than two thirds of the women al the policlinic, appearing more frequently between the ages of 45 and 49, in perimenopause and with mild intensity.

Public policies strengthen the relationship between family farming and food security in Brazilian schools - A case study of Paraíba state.

We reviewed the historical pathway that paved the way for the creation and implementation of public policies for food security in Brazilian schools. We then analyzed the implementation of such policies in Paraíba state (northeastern Brazil) in terms of the investment in purchasing food from familiar agriculture, i.e. agricultural production in small farm units where the labor comes from the owner's family that lives on the farm and receives gross income from agriculture. We conducted this study to determine the extent to which public policies for food security in schools promote income to family farmers in Paraíba state. We obtained data from the Management and Accountability System (SIGPC) to quantify the municipalities in Paraíba state that comply with the national school feeding program denominated Programa Nacional de Alimentação Escolar (PNAE). The fiscal years from 2015 to 2017 were used as a reference period because no data is available for the upcoming years. PNAE has been created to underpin programs offering free meals to school-age children, thus allowing for basic learning conditions while tackling hunger among social groups in poverty. PNAE became a public policy subsidiary of familiar agriculture through the Law 11,947 of 2009 which requires the minimal investment of 30% of PNAE funds to purchase food from family farmers. In Paraíba state, 80% of the municipalities buy food through PNAE. However, nearly 40% of the municipalities do not apply the minimum investment to purchase food from family farmers during the evaluated period (2011-2017). We identified that logistics and transportation of food coordinated by the school feeding councils are the main constraints for greater efficiency of the program. Despite such constraints, PNAE offers a unique opportunity to enhance human wellbeing by fostering family farmers to adopt conservation practices and provide healthy, local food to school-aged children.

Quality of life in adult patients using dialyzable leukocyte extract for allergic rhinitis.

Allergic rhinitis (AR) has considerable impact on the general health of individuals. Therefore, treatment trials should include an evaluation of quality of life. We aimed to determine changes in the quality of life of moderate/severe AR patients treated with standard treatment in addition to dialyzable leukocyte extract (DLE), a peptide-based immunomodulator. In a prospective, non-controlled trial, DLE was added to the standard treatment regimen for patients with moderate/severe AR. DLE was administered orally at 2 mg per day for 5 days, followed by 4 mg per week for 5 weeks, and then 2 mg per week for 5 weeks. The primary endpoints were overall improved Standardized Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores, domain scores, and individual item scores of 0.5 points or higher. Statistical significance was defined as P < .05. Thirty patients (50% female) aged 14 to 60 years old (33.4 ± 11.9) were enrolled in this study. The mean overall basal quality of life score was 3.41 ± 1.22. After 11 weeks, the mean RQLQ score was 1.74 ± 1.09 ( P < .0001; 95% confidence interval [CI], 1.05-2.33), and all the domain scores improved (daily activities P < .001, 95% CI 0.91-2.15, sleep P < .001, 95% CI 0.9-2.26, non-hay fever symptoms P = .001, 95% CI 0.51-1.82, practical problems P < .001, 95% CI 1.55-2.85, nasal symptoms P < .001, 95% CI 1.36-2.67, ocular symptoms P < .001, 95% CI 1.05-2.17, emotional P < .001, 95% CI 1.23-2.55). Each of the 28 individual item scores on the RQLQ showed clinical (minimal important difference [MID] ≥ 0.5) and statistical ( P < .05) improvements. DLE might be a beneficial adjuvant treatment for AR. Our results provide preliminary data for future research. Clinical trials registration ID: NCT02506998.

Interacciones bioéticas: el arte del buen trato al adulto mayor

Propósito/Contexto. Conocer cómo necesita ser tratada la persona adulta mayor, identificar los recursos bioéticos involucrados en interacciones de buen trato y determinar que la presencia de recursos bioéticos en las interacciones con personas adultas mayores favorece la percepción del nivel de calidad de vida, facilitando de esta manera el llevar una vida digna. Metodología/Enfoque. Se hizo un diseño cuantitativo, transversal, con alcance descriptivo y correlacional con un muestreo probabilístico estratificado de 200 personas adultas mayores de 60 años cognitivamente aptos y de dos centros de día para personas adultas mayores en Monterrey, Nuevo León, México. Resultados/Hallazgos. Un 79 % de las personas adultas mayores viven en pareja o en familia y un 21 % viven solas, además, el 86,5 % reportó al menos una enfermedad diagnosticada y la sospecha de maltrato se ubicó en un 45,5 %. Se establece que las personas adultas mayores necesitan buen trato mediante: autonomía 25,6 % (respeto y comprensión), solidaridad 31,2 % (le tomen en cuenta y le tengan paciencia), subsidiariedad 34,2 % (atención y cuidados) y sociabilidad 9,0 % (apoyo y amabilidad). Se obtuvo un nivel de calidad de vida de un 87,5 % y una satisfacción con la vida de un 88,5 %. Discusión/Conclusiones/Contribuciones. La presencia de recursos bioéticos de autonomía, solidaridad, subsidiariedad y sociabilidad en las interacciones con personas adultas mayores favorece la percepción de la calidad de vida, facilitando de esta manera el llevar una vida digna.

Purpose/Context. To know how the older adult needs to be treated, to identify the bioethical resources involved in well-treatment interactions, and to determine that the presence of bioethical resources in interactions with older adults favors the perception of the level of quality of life, thus facilitating a dignified life. Methodology/Approach. A quantitative, cross-sectional, descriptive and correlational design was carried out with a stratified probability sampling of 200 cognitively fit adults over 60 years of age and from two day centers for older adults in Monterrey, Nuevo León, Mexico. Results/Findings. Seventy-nine percent of the older adults live with a partner or family and 21% live alone; in addition, 86.5% reported at least one diagnosed disease and 45.5% suspected abuse. It is established that older adults need good treatment through: autonomy 25.6% (respect and understanding), solidarity 31.2% (being taken into account and having patience), subsidiarity 34.2% (attention and care) and sociability 9.0% (support and kindness). A level of quality of life of 87.5 % and life satisfaction of 88.5 % were obtained. Discussion/Conclusions/Contributions. The presence of bioethical resources of autonomy, solidarity, subsidiarity and sociability in interactions with older adults favors the perception of quality of life, thus facilitating a dignified life.

Objetivo/Contexto. Descobrir como o adulto idoso precisa ser tratado, identificar os recursos bioéticos envolvidos nas interações de bem tratar e determinar que a presença de recursos bioéticos nas interações com adultos idosos favorece a percepção do nível de qualidade de vida, facilitando assim uma vida digna. Metodologia/Abordagem. Um desenho quantitativo, transversal, descritivo e correlacional com uma amostra estratificada de probabilidade de 200 adultos idosos com 60 ou mais anos de idade, em centros de dois dias para adultos idosos em Monterrey, Nuevo León, México. Resultados/Descobertas. Setenta e nove por cento dos adultos idosos vivem com um parceiro ou família e 21% vivem sozinhos, 86,5% relataram pelo menos uma doença diagnosticada e 45,5% suspeitaram de abuso. Está estabelecido que os idosos precisam de um bom tratamento através de: autonomia 25,6% (respeito e compreensão), solidariedade 31,2% (ser levado em conta e ter paciência), subsidiariedade 34,2% (atenção e cuidado) e sociabilidade 9,0% (apoio e bondade). Foi obtido um nível de qualidade de vida de 87,5% e uma satisfação de vida de 88,5%. Discussão/Conclusões/Contribuições. A presença de recursos bioéticos de autonomia, solidariedade, subsidiariedade e sociabilidade nas interações com adultos idosos favorece a percepção da qualidade de vida, facilitando assim uma vida digna.

Mejoras de los procesos sanitarios en el departamento de Terapia Física y Rehabilitación del Policlínico Nguyen Van Troi / Improvements of Health Care Processes in the Department of Physical Therapy and Rehabilitation of the Nguyen Van Troi Polyclinic

Introducción: Los servicios de Terapia Física y Rehabilitación constituyen pilar fundamental en el diagnóstico, evaluación, tratamiento y recuperación de pacientes. Objetivo: Presentar una propuesta de organización general del Departamento de Terapia Física y Rehabilitación que permita mejoras de sus procesos. Métodos: Se realizó una investigación descriptiva con enfoque cualitativo, aplicada al proceso de gestión en el Departamento de Terapia Física Rehabilitación del Policlínico Nguyen Van Troi; período 2021-2022. Participaron el total de trabajadores del departamento en diferentes técnicas y métodos relacionados con determinación, análisis, diseño y procesos orientados a problemas de la calidad en el marco de los sistemas y servicios de salud. Resultados: Se identificaron los desperdicios desde la óptica de la gestión por procesos, se aplicó la metodología Lean para eliminar o reducir estos y se revisaron aspectos organizativos y funcionales que requerían ajustes. Se realizó una comparación de cómo se realizan y cómo deberían realizarse las actividades del proceso clave, lo cual elevaría la eficiencia del trabajo, se reducirían los retrasos actuales y se mejoraría la satisfacción de los pacientes y los trabajadores en el servicio. Conclusiones: Los desperdicios identificados afectan el trabajo técnico y profesional que debe realizarse en el servicio para elevar la calidad de la atención sanitaria a los pacientes. Las mejoras están en encaminadas a ajustes en la organización de los procedimientos de trabajo del servicio y de las instituciones encargadas del mantenimiento y el suministro de medicamentos y materiales(AU)

Introduction: Physical Therapy and Rehabilitation services are a fundamental pillar in the diagnosis, evaluation, treatment and recovery of patients. Objective: To identify the actions, routes or activities that can be considered as waste of the health processes and the proposals for the general organization of the Department of Physical Therapy and Rehabilitation that allow improvements of its processes. Methods: A descriptive research with a qualitative approach was carried out, and it was applied to the management process in the Department of Physical Therapy and Rehabilitation of the Nguyen Van Troi Polyclinic; 2021-2022 period. All the department's workers participated in different techniques and methods related to determination, analysis, design and processes aimed at quality problems within the framework of health systems and services. Results: Waste was identified from the perspective of process management, Lean methodology was applied to eliminate or reduce waste, and organizational and functional aspects that required adjustments were reviewed. A comparison was made of how key process activities are performed and how they should be performed, which would increase work efficiency, reduce current delays, and improve patient and worker satisfaction in the service. Conclusions: The identified waste affects the technical and professional work that must be carried out in the service to raise the quality of health care for patients. The improvements are aimed at adjustments in the organization of the working procedures of the service and of the institutions responsible for the maintenance and supply of medicines and materials(AU)

"Does a Respiratory Virus Have an Ecological Niche, and If So, Can It Be Mapped?" Yes and Yes.

Although the utility of Ecological Niche Models (ENM) and Species Distribution Models (SDM) has been demonstrated in many ecological applications, their suitability for modelling epidemics or pandemics, such as SARS-Cov-2, has been questioned. In this paper, contrary to this viewpoint, we show that ENMs and SDMs can be created that can describe the evolution of pandemics, both in space and time. As an illustrative use case, we create models for predicting confirmed cases of COVID-19, viewed as our target "species", in Mexico through 2020 and 2021, showing that the models are predictive in both space and time. In order to achieve this, we extend a recently developed Bayesian framework for niche modelling, to include: (i) dynamic, non-equilibrium "species" distributions; (ii) a wider set of habitat variables, including behavioural, socio-economic and socio-demographic variables, as well as standard climatic variables; (iii) distinct models and associated niches for different species characteristics, showing how the niche, as deduced through presence-absence data, can differ from that deduced from abundance data. We show that the niche associated with those places with the highest abundance of cases has been highly conserved throughout the pandemic, while the inferred niche associated with presence of cases has been changing. Finally, we show how causal chains can be inferred and confounding identified by showing that behavioural and social factors are much more predictive than climate and that, further, the latter is confounded by the former.

Evaluación del Curso de liderazgo para cirujanos ortopédicos en Cuba

Se requiere de estrategias e infraestructuras sostenibles, así como del perfeccionamiento en la gestión y la forma de dirigir las organizaciones sanitarias, para mejorar la atención traumatológica ortopédica. Sin embargo, hay pocas oportunidades para el desarrollo formal del liderazgo, especialmente en América Latina; por ello, la Asociación de Cirujanos Traumatólogos de las Américas realizó un Programa de Desarrollo de Liderazgo adaptado a los cirujanos ortopédicos latinoamericanos. El primer curso se realizó en México en 2019, y esta experiencia se trasladó a La Habana en febrero de 2022. Este documento informa sobre las necesidades para el desarrollo del liderazgo entre los cirujanos ortopédicos cubanos y los estudiantes, el plan de estudio del curso y las impresiones de sus asistentes.

Sustainable strategies and infrastructures, as well as improvements in management and governance of health organizations, are required to improve orthopedic trauma care. However, there are few opportunities for formal leadership development, especially, in Latin America. For this reason, the Association of Traumatologist Surgeons of the Americas carried out a Leadership Development Program adapted to Latin American orthopedic surgeons. The first course was held in Mexico in 2019. This experience was transferred to Havana in February 2022. This document reports on the needs for leadership development among Cuban orthopedic surgeons and students, the course curriculum, and impressions of the attendees.

Caracterización clínica y epidemiológica de la enfermedad COVID-19 en el municipio Sandino, año 2020 / Clinical and Epidemiological Characterization of COVID-19 Disease in Sandino Municipality, year 2020

Introducción: La COVID-19 fue declarada por la Organización Mundial de la Salud como pandemia el 11 de marzo de 2020 por su complejidad y rápida expansión mundial. El municipio de Sandino presentó su primer caso positivo el 6 de octubre de 2020. Objetivo: Caracterizar el comportamiento clínico-epidemiológico de la COVID-19 en Sandino, en el año 2020. Métodos: Se realizó una investigación descriptiva y transversal, del 11 de marzo al 31 de diciembre. Con la información obtenida de historias clínico-epidemiológicas, resultados virológicos, pesquisa domiciliaria y laboral, atenciones por infecciones respiratorias agudas en consultorios y policlínicos, y los partes diarios de la Dirección Municipal de Salud, se realizó un análisis estadístico cuya información fue depositada en base de datos en Excel. Resultados: La tasa de incidencia fue de 528,23 por 100 000 habitantes; sin fallecidos. La mayoría de los casos ocurrieron en la ciudad de Sandino. Hubo mayor frecuencia de afectados, entre 41 y 60 años de edad, y el sexo masculino, mientras el 55,73 por ciento, fueron asintomáticos al diagnóstico. Los síntomas más frecuentes fueron la tos, la fiebre y la congestión nasal. Se diagnosticaron entre uno y 13 casos por día durante los 63 días que hubo positividad. La transmisión familiar fue del 68,23 por ciento y la laboral del 50,52 por ciento de los casos. Conclusiones: La COVID-19 tuvo una alta incidencia en Sandino, y esta predominó en los lugares con mayor densidad poblacional con transmisión familiar y laboral intensa en un corto período de tiempo. Además, en el sexo masculino, el grupo etario en edad laboral y, en los asintomáticos(AU)

Introduction: COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020 due to its complexity and rapid global expansion. Sandino municipality presented its first positive case on October 6, 2020. Objective: To characterize the clinical-epidemiological behavior of COVID-19 in Sandino municipality, in 2020. Methods: A descriptive and cross-sectional research was conducted from March 11 to December 31, 2020. With the information obtained from clinical-epidemiological records, virological results, home and work screening, care for acute respiratory infections in clinics and polyclinics, and the daily reports of the Municipal Health Directorate, a statistical analysis was carried out whose information was inserted in an Excel database. Results: The incidence rate was 528.23 per 100 000 population; no deaths. Most of the cases occurred in the city of Sandino. There was a higher frequency of patients in the ages from 41 and 60, and the male sex; while 55.73 percent were asymptomatic at diagnosis. The most common symptoms were cough, fever and nasal congestion. Between one and 13 cases per day were diagnosed during the 63 days that there was positivity. Family transmission was 68.23 percent and occupational transmission was 50.52 percent of cases. Conclusions: COVID-19 had a high incidence in Sandino municipality, and this predominated in places with higher population density with intense family and work transmission in a short period of time; also, in the male sex, the age group in working ages, and in the asymptomatic patients(AU)

Women's perception of urban insecurity in the Monterrey metropolitan area during COVID-19 / Percepción femenina de la inseguridad urbana en el área metropolitana de Monterrey en tiempos de COVID-19 / A percepção das mulheres sobre a insegurança urbana na área metropolitana de Monterrey em tempos de COVID-19

The purpose of this paper it to explore women's perception of urban insecurity prevailing during the COVID-19 pandemic in the Monterrey metropolitan area (MMA) in Mexico. In recent decades, large cities have grown and with them, so has crime increased. As a result, the issue of urban insecurity has become important, particularly during this COVID-19 pandemic. For this purpose, a cross-sectional, descriptive, non-probabilistic study was conducted involving 69 women aged 18 to 58, with Universidad Autónoma de Nuevo León being taken as the sample frame. Our findings show that 74% of the participants indicate that urban safety near their homes, ranges fair to very bad, while 81% feel the same about safety near their workplaces. Ninety-three per cent say that crime has increased. Meanwhile, 55% say that the situation has affected their quality of life severely to very severely, denoting the MAM population's transition from one of social well-being to one of vulnerability, which has been further aggravated by the health contingency.

Este artículo investiga la percepción femenina de la inseguridad urbana que prevalece durante la pandemia de COVID-19 en el área metropolitana de Monterrey (MAM) en México. En las últimas décadas las grandes urbes han crecido y con esto también se favorece la delincuencia. Por lo tanto, el tema de inseguridad urbana se ha tornado pertinente y, particularmente, ha sido de interés abordarlo durante esta pandemia de COVID-19. Para esto, se realizó un estudio de carácter transversal y descriptivo, no probabilístico, en 69 mujeres de 18 a 58 años, y se consideró la Universidad Autónoma de Nuevo León como el sitio de muestreo. En el presente documento los hallazgos muestran que 74% de las participantes indica que la seguridad urbana cercana a sus casas es regular a muy mala. Similar situación se presenta en sus lugares de trabajo, según afirma el 81%. El 93% asevera que los actos delictivos aumentaron. Entre tanto, el 55% dice que esta situación afectó de grave a muy gravemente su calidad de vida. Esta situación denota la transición de la sociedad en el MAM de bienestar social a otra de vulnerabilidad, que se ha incrementado por el escenario de la contingencia sanitaria que ha padecido.

Este artigo investiga a percepção das mulheres sobre a insegurança urbana prevalecente durante a pandemia COVID-19 na área metropolitana de Monterrey (MMA), no México. Nas últimas décadas, as grandes cidades cresceram e, com isso, a criminalidade também aumentou. Portanto, a questão da insegurança urbana tornou-se relevante e, particularmente, tem sido de interesse abordá-la durante esta pandemia da COVID-19. Para este fim, foi realizado um estudo transversal, descritivo e não-probabilístico entre 69 mulheres de 18 a 58 anos, e a Universidade Autônoma de Nuevo León foi considerada como o local de amostragem. Neste documento, os resultados mostram que 74% dos participantes indicam que a segurança urbana perto de suas casas é justa a muito ruim. Uma situação semelhante é encontrada em seus locais de trabalho, de acordo com 81%. Noventa e três por cento dizem que a criminalidade aumentou. Enquanto isso, 55% dizem que esta situação tem afetado seriamente a qualidade de vida deles. Esta situação reflete a transição da sociedade no MMA de uma situação de bem-estar social para uma situação de vulnerabilidade, que tem aumentado devido ao cenário de contingência de saúde que experimentou.

Assessing Oncologists' Attitudes Concerning Comprehensive Genomic Profiling in Stage IV Lung Adenocarcinoma in Brazil.

Introduction: Advances in comprehensive genomic profiling (CGP) of lung adenocarcinomas (LUADs) led to personalized treatment for patients. This study evaluated medical oncologists' attitudes toward CGP in a scenario where sponsored funding for CGP was available. Methods: We designed an online survey assessing CGP use and treating physicians' confidence, composed of three self-confidence domains, which are as follows: confidence in interpreting CGP results, confidence in treating oncogenic-driven LUAD, and confidence in managing tyrosine kinase inhibitor adverse events. The survey was distributed to medical oncologists who treat lung cancer in Brazil. Comparisons between groups were performed using the chi-square or Fisher's exact test. Univariable and multivariable (adjusted OR) analyses were performed. Results: Among 104 respondents who treat patients with lung cancer, 55% were from the Southeast region, 28% had high lung cancer clinical load, and 33% had in-house molecular testing. More than half (51%) of the participants request CGP systematically to stage IV LUAD. As for provider confidence, 67% stated being confident in all three domains: 76% confident in interpreting CGP, 84% confident in treating oncogenic-driven LUAD, and 81% in managing tyrosine kinase inhibitor adverse events. Providers' confidence was associated with systematically requesting CGP to stage IV LUAD (p = 0.013). After controlling for the variables of interest, systematic requesting CGP for stage IV LUAD revealed a significant association with the provider's confidence (adjusted OR = 0.35, p = 0.028, 95% CI: 0.14-0.84). The major challenge for properly requesting CGP was the long turnaround time and the fear of treatment delays. Conclusions: Even though CGP for stage IV LUAD in Brazil is fully sponsored, only half of the oncologists in our survey systematically request it.. Requesting CGP was associated with providers' confidence. Improving access and promoting providers' awareness of CGP utility is necessary to increase CGP use and better inform treatment decisions.

[Quality of care in patients with prostate cancer treated in Mexico]. / Calidad de atención en pacientes con cáncer de próstata atendidos en México.

Background: Patient-centered care model improves quality of care, decreases unnecessary use of services, optimizes costs and quality of life and survival for cancer patients. Objective: To compare the patient-centered quality of care of prostate cancer patients with and without social security in two oncology hospitals in Mexico City. Material and methods: The information of the 2019 survey of prostate cancer patients in two oncology hospitals, one from the Mexican Institute of Social Security (IMSS) and the other from the Ministry of Health (SSA), was analyzed (n = 307). The survey included sociodemographic and patient-centered quality of care variables. A descriptive and bivariate analysis was performed to compare the quality of care between both hospitals using chi-square test, Fisher's exact test and Student's t test. Results: 234 patients treated at the IMSS and 73 at the SSA were included, with a mean age of 66.6 years. In both hospitals, more than 90% of the patients perceived respectful and coordinated care, as well as clear information. Only 58.9% of patients treated at SSA received information for decision-making, in contrast to 80.8% at IMSS (p = 0.001). Supportive care for biopsychosocial needs was low in both places (IMSS: 23.9%, SSA: 13.7%, p = 0.063). Conclusions: The quality of care focused on patients with prostate cancer was perceived as good, except in the care of biopsychosocial needs; given the importance of this last aspect, it is recommended a multidisciplinary approach in their care.

Introducción: la asistencia centrada en el paciente permite mejorar la calidad de atención, disminuye el uso innecesario de los servicios y optimiza costos y calidad de vida y sobrevida en pacientes con cáncer. Objetivo: : comparar la calidad de la atención en pacientes con cáncer de próstata con y sin seguridad social en dos hospitales de oncología de la Ciudad de México. Material y métodos: se usó información de una encuesta a pacientes con cáncer de próstata del 2019 de dos hospitales de oncología, uno del Instituto Mexicano del Seguro Social (IMSS) y otro de la Secretaría de Salud (SSA), n = 307. La encuesta incluyó variables sociodemográficas y de calidad de atención desde la perspectiva centrada en el paciente. Se hizo análisis descriptivo y bivariado para comparar la calidad de atención de ambos hospitales mediante chi cuadrada, prueba exacta de Fisher y t de Student. Resultados: se incluyeron 234 pacientes atendidos en el IMSS y 73 en la SSA; su edad promedio fue 66.6 años. Más del 90% percibieron una atención respetuosa y coordinada e información clara en ambos lugares. Solo 58.9% de pacientes atendidos en SSA recibieron información para la toma de decisiones en contraste con 80.8% de pacientes del IMSS (p = 0.001). Sin embargo, la atención de las necesidades biopsicosociales fue baja en ambos lugares (IMSS: 23.9%, SSA: 13.7%, p = 0.063). Conclusiones: la calidad de atención centrada en pacientes con cáncer de próstata fue percibida como buena, salvo la atención de necesidades biopsicosociales; dado esto último, se recomienda incorporar un abordaje multidisciplinario en su atención.

Ontogenia Humana y Sistema Osteomioarticular: evolución a través de los programas de estudio de medicina C, D y E / Human Ontogeny and Osteomioarticular System: evolution in the medical plans of study C, D and E

Introducción: Para la formación del médico general de perfil amplio que necesita la sociedad cubana, las ciencias básicas biomédicas tributan a las bases del fundamento científico, el pensamiento médico y la clínica; así como a actitudes, convicciones y valores, en correspondencia con las tendencias de la educación superior contemporánea. Su evolución en la carrera de medicina en Cuba ha incluido una actualización del diseño y la didáctica de la disciplina y las asignaturas. Objetivo: Realizar un análisis crítico del programa analítico de la asignatura Ontogenia y SOMA en los planes de estudio C, D y E. Métodos: Se realizó un estudio cualitativo de carácter descriptivo. Se emplearon el análisis documental, la sistematización, el análisis y la síntesis para los programas de las asignaturas y las revisiones bibliográficas sobre la temática. Los resultados fueron representados de forma comparativa en figuras y tablas. Resultados: Los aspectos del programa que sufrieron grandes cambios fueron: sistema de habilidades, distribución de tiempo, formas de organización de la enseñanza, estrategias docentes y extracurriculares. Tuvieron algunas modificaciones, pero conservaron elementos de diseños anteriores: objetivos y sistema de evaluación. Los menos modificados resultaron contenido y bibliografía. Conclusiones: Los cambios de diseño de la asignatura han incluido paulatinamente la orientación hacia la atención primaria de salud, el rescate de actividades prácticas, la enseñanza problémica, la utilización del organismo vivo como medio de enseñanza, las tecnologías y el protagonismo del estudiante en la construcción de su conocimiento(AU)

Introduction: For the training of the general physician with a broad profile needed by the Cuban society, basic biomedical sciences contribute to the bases of scientific foundation, medical thinking and clinical practice, as well as attitudes, convictions and values, in correspondence with the tendencies of contemporary higher education. Its evolution in the Cuban medical major has included an update of the design and didactics of the discipline and subjects. Objective: To carry out a critical analysis of the analytical syllabus of the subject Ontogeny and Osteomioarticular System in the study plans C, D and E. Methods: A descriptive and qualitative study was carried out. Document analysis, systematization, analysis and synthesis were used for the subjects' syllabi, as well as for the bibliographic reviews on the topic. The results were represented comparatively in figures and tables. Results: The aspects of the program that underwent major changes were the system of skills, distribution of time, teaching organization forms, as well as teaching and extracurricular strategies. Some modifications were introduced, but other were maintained from previous designs, in the objectives and evaluation system. The least modified aspects were content and bibliography. Conclusions: The changes in the subject's design have gradually included the orientation towards primary healthcare, the recovery of practical activities, problem-solving teaching, the use of the living organism as a teaching aid, technologies, and the student's protagonism in the construction of his or her knowledge(AU)

Patients' Preference Between DPP4i and SGLT2i for Type 2 Diabetes Treatment: A Cross-Sectional Evaluation.

Purpose: Despite newer type 2 diabetes (T2D) medications, patients do not always achieve metabolic targets, remaining at risk for cardiorenal complications. Therapeutic decisions are generally made by the healthcare team without considering patients' preferences. We aimed to evaluate patients' T2D treatment preference in two Latin-American countries between two different oral medication profiles, one resembling dipeptidyl peptidase-4 inhibitors (DPP4i) and another resembling sodium-glucose cotransporter-2 inhibitors (SGLT2i). Patients and Methods: In this cross-sectional, multicenter study from June to September 2020, patients with T2D from Argentina and Mexico (n = 390) completed a discrete choice experiment questionnaire to identify preferences between DPP4i (medication profile A) and SGLT2i (medication profile B). The reason behind patients' choice, and the association between their baseline characteristics and their preference were evaluated using logistic regression methods. Results: Most participants (88.2%) preferred SGLT2i's profile. Participants with older age (p = 0.0346), overweight or obesity (p < 0.0001), high blood pressure (BP; p < 0.0001), high total cholesterol (p = 0.0360), and glycosylated hemoglobin (HbA1c) <7% (p = 0.0001) were more likely to choose SGLT2i compared with DPP4i's profile. The most and least important reasons to choose either drug profile were HbA1c reduction and genital infection risk, respectively. The likelihood of selecting the SGLT2i's profile significantly increased in participants with increased body mass index (BMI; odds ratio [OR] = 8.9, 95% confidence interval [CI]: 3.5-22.5, p < 0.05), high BP (OR = 4.9, 95% CI: 1.9-12.4, p < 0.05), and lower education level (OR = 3.6, 95% CI: 1.0-12.6, p < 0.05). Conclusion: Latin-American patients with T2D preferred medication with a profile resembling SGLT2i over one resembling DPP4i as a treatment option. A patient-centered approach may aid the healthcare team in decision-making for improved outcomes.

Case for diagnosis. Radiotherapy-induced pemphigus vegetans.

A 73-year-old male patient developed a poorly differentiated squamous cell carcinoma in the anal canal nine months ago. He was treated with two cycles of 5-fluorouracil and cisplatin and concomitant radiotherapy (6 MeV linear photon accelerator, total dose of 54 Gy), with complete remission. Since forty-five days he presentes a painful perianal and intergluteal erosion with circinate pustular borders. Light microscopy showed pseudoepitheliomatous hyperplasia of the epidermis with microabscesses of inflammatory cells (neutrophils and eosinophils) and acantholytic keratinocytes . Indirect immunofluorescence was positive for IgG, with an intercellular pattern, 1:80 titer. The diagnosis of radiotherapy-induced pemphigus vegetans was established and there was significant regression with oral prednisone (40 mg) and topical betamethasone.

Propuesta de acciones para eliminar mudas en la gestión de los procesos en instituciones de salud cubanas / Proposal of Actions to Eliminate Changes in the Management of Processes in Cuban Health Institutions

Introducción: El conocimiento y desarrollo de habilidades relacionadas con la gestión por procesos en los profesionales sanitarios son vitales para mejorar la calidad de los servicios. Objetivo: Proponer acciones para la eliminación de las mudas en la gestión de los procesos en instituciones de salud cubanas. Métodos: Investigación descriptiva, transversal entre enero-junio 2020 centrada en la búsqueda del conocimiento sobre los procesos en 35 instituciones de salud. Se indagó a partir de preguntas realizadas a los participantes sobre los procesos que realizaban en sus instituciones, sus desperdicios y propuestas de mejora. Se aplicó del enfoque Lean a los procesos estudiados. Resultados: Se identificaron las siguientes mudas: demoras en los tiempos de espera; duplicidad de documentos y exámenes complementarios, exceso de modelajes, traslados innecesarios del personal, errores en la planificación de las acciones de promoción y utilización de recursos humanos en actividades no vinculadas a su formación. Se propusieron para su mejora las siguientes acciones: programación de consultas por horarios escalonados, distribución del modelaje según tipo de institución, utilización de las tecnologías de la información y las comunicaciones, control gerencial de los procesos. Conclusiones: La aplicación del enfoque Lean en la gestión de procesos en instituciones sanitarias permite identificar mudas en su flujo y proponer acciones de mejoras fundamentalmente de tipo organizativo y de control gerencial(AU)

Introduction: The knowledge and development of skills related to process management in health professionals are vital for improving the quality of services. Objective: To propose actions for the elimination of changes in the processes management in Cuban health institutions. Methods: This is a descriptive, cross-sectional research from January to June 2020 focused on the search for knowledge about the processes in 35 health institutions. It was examined from questions asked to the participants about the processes they carried out in their institutions, their waste and proposals for improvement. The Lean approach was applied to the processes studied. Results: The following changes were identified: delays in waiting times; duplication of documents and complementary exams, excessive modeling, unnecessary transfers of personnel, errors in the planning of promotion actions and use of human resources in activities not related to their training. The following actions were proposed for improvement: scheduling of consultations by staggered hours, distribution of modeling according to the type of institution, use of information and communication technologies, managerial control of processes. Conclusions: The application of the Lean approach in the management of processes in health institutions makes it possible to identify their flow changes and propose improvement actions, fundamentally of an organizational and managerial control nature(AU)