Confronting the challenge: a regional perspective by the Latin American pediatric infectious diseases society (SLIPE) expert group on respiratory syncytial virus-tackling the burden of disease and implementing preventive solutions.

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections in children around the world. The post-pandemic era has resulted in a notable increase in reported cases of RSV infections, co-circulation of other respiratory viruses, shifts in epidemiology, altered respiratory season timing, and increased healthcare demand. Low- and middle-income countries are responsible for the highest burden of RSV disease, contributing significantly to health expenses during respiratory seasons and RSV-associated mortality in children. Until recently, supportive measures were the only intervention to treat or prevent RSV-infection, since preventive strategies like palivizumab are limited for high-risk populations. Advances in new available strategies, such as long-acting monoclonal antibodies during the neonatal period and vaccination of pregnant women, are now a reality. As the Regional Expert Group of the Latin American Pediatric Infectious Diseases Society (SLIPE), we sought to evaluate the burden of RSV infection in Latin America and the Caribbean (LAC) region, analyze current strategies to prevent RSV infection in children, and provide recommendations for implementing new strategies for preventing RSV infection in children in LAC region.

Epidemiological and microbiological characteristics of S. aureus pediatric infections in Colombia 2018-2021, a national multicenter study (Staphylored Colombia).

Background: Staphylococcus aureus infections are a significant cause of morbidity and mortality in pediatric populations worldwide. The Staphylo Research Network conducted an extensive study on pediatric patients across Colombia from 2018 to 2021. The aim of this study was to describe the epidemiological and microbiological characteristics of S. aureus in this patient group. Methods: We analyzed S. aureus isolates from WHONET-reporting centers. An "event" was a positive culture isolation in a previously negative individual after 2 weeks. We studied center characteristics, age distribution, infection type, and antibiotic susceptibilities, comparing methicillin sensitive (MSSA) and resistant S. aureus (MRSA) isolates. Results: Isolates from 20 centers across 7 Colombian cities were included. Most centers (80%) served both adults and children, with 55% offering oncology services and 85% having a PICU. We registered 8,157 S. aureus culture isolations from 5,384 events (3,345 MSSA and 1,961 MRSA) in 4,821 patients, with a median age of 5 years. Blood (26.2%) and skin/soft tissue (18.6%) were the most common infection sources. Most isolates per event remained susceptible to oxacillin (63.2%), clindamycin (94.3%), and TMP-SMX (98.3%). MRSA prevalence varied by city (<0.001), with slightly higher rates observed in exclusively pediatric hospitals. In contrast, the MRSA rate was somewhat lower in centers with Antimicrobial Stewardship Program (ASP). MRSA was predominantly isolated from osteoarticular infections and multiple foci, while MSSA was more frequently associated with recurrent infections compared to MRSA. Conclusions: This is the largest study of pediatric S. aureus infections in Colombia. We found MSSA predominance, but resistance have important regional variations. S. aureus remains susceptible to other commonly used antibiotics such as TMP-SMX and clindamycin. Ongoing monitoring of S. aureus infections is vital for understanding their behavior in children. Prospective studies within the Staphylored LATAM are underway for a more comprehensive clinical and genetic characterization.

Implementing a challenge-based learning experience in a bioinstrumentation blended course.

BACKGROUND: Bioinstrumentation is essential to biomedical engineering (BME) undergraduate education and professional practice. Several strategies have been suggested to provide BME students with hands-on experiences throughout the curriculum, promoting their preparedness to pursue careers in industry and academia while increasing their learning and engagement. This paper describes the implementation of challenge-based learning (CBL) in an undergraduate bioinstrumentation blended course over the COVID-19 pandemic. METHODS: The CBL experience was implemented in a third-year bioinstrumentation course from the BME program at Tecnologico de Monterrey. Thirty-nine students enrolled in two sections formed fourteen teams that tackled blended learning activities, including online communication, lab experiments, and in-person CBL activities. Regarding the latter, students were challenged to design, prototype, and test a respiratory or cardiac gating device for radiotherapy. An institutional student opinion survey was used to assess the success of our CBL implementation. RESULTS: Student responses to the end-of-term survey showed that they strongly agreed that this course challenged them to learn new concepts and develop new skills. Furthermore, they rated the student-lecturer interaction very positively despite the blended format. Overall, students assessed their learning experience positively. However, implementing this CBL experience required a substantial time increase in planning, student tutoring, and constant communication between lecturers and the industry partner. CONCLUSION: This work provides an effective instance of CBL for BME education to improve students' learning experience despite decreased resource efficiency. Our claim is supported by the student's performance and the positive feedback from our industrial partner.

Impact of a cuff-based device calibration method on the agreement between invasive and noninvasive aortic and brachial pressure.

INTRODUCTION: Brachial cuff-based methods are increasingly used to estimate aortic systolic blood pressure (aoSBP). However, there are several unresolved issues. AIMS: to determine to what extent the scheme used to calibrate brachial records (1) can affect noninvasive obtained aoSBP levels, and consequently, the level of agreement with the aoSBP recorded invasively, and (2) how different ways of calibrating ultimately impact the relationship between aoSBP and cardiac properties. METHODS: brachial and aortic blood pressure (BP) was simultaneously obtained by invasive (catheterisation) and noninvasive (brachial oscillometric-device) methods (89 subjects). aoSBP was noninvasive obtained using three calibration schemes: 'SD': diastolic and systolic brachial BP, 'C': diastolic and calculated brachial mean BP (bMBP), 'Osc': diastolic and oscillometry-derived bMBP. Agreement between invasive and noninvasive aoSBP, and associations between BP and echocardiographic-derived parameters were analysed. CONCLUSIONS: 'C' and 'SD' schemes generated aoSBP levels lower than those recorded invasively (mean errors: 6.9 and 10.1 mmHg); the opposite was found when considering 'Osc'(mean error: -11.4 mmHg). As individuals had higher invasive aoSBP, the three calibration schemes increasingly underestimated aoSBP levels; and viceversa. The 'range' of invasive aoSBP in which the calibration schemes reach the lowest error level (-5-5 mmHg) is different: 'C': 103-131 mmHg; 'Osc': 159-201 mmHg; 'SD':101-124 mmHg. The calibration methods allowed reaching levels of association between aoSBP and cardiac characteristics, somewhat lower, but very similar to those obtained when considering invasive aoSBP. There is no evidence of a clear superiority of one calibration method over another when considering the association between aoSBP and cardiac characteristics.

Diagnóstico de la evaluación del desempeño profesional pedagógico del tutor de Medicina General Integral

Introducción: La evaluación del desempeño profesional pedagógico del tutor es vital para elevar la calidad del proceso educativo. Objetivo: Diagnosticar el estado actual de la evaluación del desempeño profesional pedagógico del tutor de Medicina General Integral. Materiales y métodos: Se realizó una investigación descriptiva de corte transversal, con enfoque mixto, entre marzo y septiembre de 2022, en la Filial de Ciencias Médicas Dr. Eusebio Hernández Pérez, de Colón, en la provincia de Matanzas. Variable: el desempeño profesional pedagógico del tutor de Medicina General Integral. Unidades de estudio: 78 tutores, 275 residentes y 44 directivos. Dimensiones: cognoscitiva, procedimental y comportamental. Métodos: teóricos: análisis-síntesis e inducción-deducción; empíricos: análisis documental, encuesta, entrevista, observación; estadísticos: medidas de resumen para variables cualitativas y cuantitativas: frecuencias absolutas y relativas. Procedimientos: parametrización, triangulación metodológica. Resultados: Se identificaron problemas según las dimensiones cognoscitiva (poco dominio de las modalidades de educación en el trabajo y en la didáctica en la tutoría; poca preparación en metodología de la investigación y en buscadores de información científica en salud), procedimental (no correspondencia entre actividades presenciales y las de tutoría, poco nivel para planificar, ejecutar y controlar actividades), y comportamental (poca participación en superación relacionada con la tutoría, en eventos y poca producción científica). Las potencialidades se identificaron según las dimensiones procedimental (nivel de integración de conocimientos; promoción de cooperación y trabajo en equipo; relación entre temas de investigación y el banco de problemas del policlínico), y comportamental (nivel en que estimula el reforzamiento de valores y la ética médica; promoción de empatía y comunicación efectiva con el residente). Conclusiones: El diagnóstico permitió identificar problemas y potencialidades del objeto estudiado. Se propone una alternativa propia de las ciencias de la educación médica para resolver el problema científico, que es la elaboración de una metodología.

Introduction: The evaluation of the professional pedagogical performance of the tutor is vital to raise the quality of the educative process. Objective: To diagnose the current status of the professional pedagogical performance of the tutor of Comprehensive General Medicine. Materials and methods: A descriptive, cross-sectional research, with mixed approach, was carried out between March and September 2022, in the Campus of Medical Sciences Dr. Eusebio Hernández Pérez, from Colon, in the province of Matanzas. Variable: professional pedagogical performance of the tutor of Comprehensive General Medicine. Units of study: 78 tutors, 275 residents and 44 members of the management staff. Dimensions: cognitive, procedural, and behavioral. Methods: theoretical methods: analysis-synthesis and induction-deduction; empirical methods: documentary analysis; surveys; interviews; observation. Statistical methods: summary measures for qualitative and quantitative variables; absolute and relative frequencies. Procedures: parameterization, methodological triangulation. Results: Problems were identified according to the cognitive dimensions (little mastery of the modalities of education at work and tutorship didactics; little training in research methodology and in search engines for scientific information in health); procedural dimension: no correspondence between face-to-face and tutoring activities, low level of planning, executing and controlling activities); and behavioral dimension (little participation in upgrading activities related to tutorship, in events, and little scientific production). Potentialities were identified according to procedural dimensions (level of knowledge integration; promotion of cooperation and teamwork promotion; relationship between research topics and policlinic's problem bank), and behavioral (level at which it stimulates the reinforcement values and medical ethics; promotion of empathy and effective communication with the resident). Conclusions: The diagnosis allowed the authors to identify problems and potentialities of the object studied. An alternative specific of the medical education sciences is proposed to solve the scientific problem, which is the elaboration of a methodology.

Construcción y validación de un instrumento para evaluar el desempeño pedagógico del tutor de Medicina General Integral

Introducción: Para evaluar resulta imprescindible la construcción de herramientas en función de establecer resultados medibles. Objetivo: Construir y validar un instrumento para evaluar el desempeño profesional pedagógico del tutor de la especialidad de Medicina General Integral. Materiales y métodos: Enfoque mixto, diseño transversal analítico. Métodos: teóricos: análisis y síntesis, inducción-deducción, enfoque sistémico; empíricos: análisis documental, encuesta a tutores y residentes, observación y criterio de expertos; estadísticos: estadística descriptiva (valores absolutos y porcentuales), coeficiente alfa de Cronbach, coeficiente W de Kendall. Procedimientos: parametrización y triangulación metodológica. Fases: revisión bibliográfica, parametrización, análisis de validez de contenido, confiabilidad y aplicabilidad. Resultados: Se elaboró un instrumento con tres dimensiones (cognoscitiva, procedimental y comportamental) y 19 indicadores. Se seleccionaron 15 expertos. Más del 70 % evaluaron los ítems según los criterios de Moriyama en la categoría Mucho. El cálculo del coeficiente W de Kendall sugirió una alta concordancia entre los jueces. El instrumento final contó con 18 ítems. El coeficiente alfa de Cronbach resultó en 0,83 (alta confiabilidad). Con su aplicación se identificaron siete problemas y seis potencialidades, lo cual demostró su validez en la práctica para el diagnóstico. Conclusiones: El instrumento construido evidenció buenas condiciones de validez teórica y práctica, lo cual permitirá direccionar las acciones de superación para los tutores de la especialidad de Medicina General Integral. También puede complementar la evaluación profesoral, al particularizar en el cumplimiento de las funciones del tutor.

Introduction: To evaluate, the construction of tools able to establish measurable results is essential. Objective: To build and validate an instrument to evaluate the professional pedagogical performance of the tutor of the Comprehensive General Medicine specialist. Materials and methods: Mixed approach, cross-sectional, analytical design. Theoretical methods: analysis and synthesis; induction-deduction; systemic approach. Empirical methods: documentary analysis; survey to tutors and residents; observation, and experts' judgment. Statistical methods: descriptive statistics (absolute and percentage value), Cronbach Alpha coefficient; Kendall's W coefficient. Procedures: parametrization and methodological triangulation. Phases: bibliographic review; parametrization; analysis of content validity; reliability, and applicability. Results: An instrument was developed with three dimensions (cognitive, procedural and behavioral) and 19 indicators. 15 experts were chosen. More than 70% evaluated the items according to Moriyama criteria in the category A lot. The calculation of the Kendall's W coefficient suggested a high concordance between judges. The final instrument had 18 items. Cronbach Alpha coefficient resulted in 0.83 (high reliability). With its application, seven problems and six potentialities were identified, which demonstrated its validity in practice for diagnostic. Conclusions: The built document showed good conditions of theoretical and practical validity, which will allow directing the training actions for the tutors in the specialty of Comprehensive General Medicine. It can also complement the professorial evaluation, by particularizing in the fulfillment of the tutor's functions.

Supervisión de salud de niños/as con Síndrome de Down realizado por enfermera, desde la mirada de sus cuidadores / Caregivers' perspectives about the health supervision of children with Down Syndrome carried out by a nurse

INTRODUCCION: Los niños con Síndrome de Down (SD) y sus cuidadores requieren de una atención de salud multidisciplinaria que responda a sus necesidades desde una perspectiva integral. OBJETIVO: conocer las experiencias y expectativas que tienen los cuidadores de niños con SD en relación con los cuidados brindados por la enfermera durante el control de supervisión de salud infantil. METOLOGÍA: Estudio cualitativo fenomenológico, muestra intencionada de casos por criterios conformada por 11 cuidadores de niños con SD entre 0 y 9 años, que recibieron prestaciones en el Control de Salud Infantil. Se realizaron entrevistas semiestructuradas, los datos se analizaron siguiendo el esquema de reducción progresiva. Contó con la aprobación de la Dirección de Carrera de Enfermería, Universidad Santo Tomás (Temuco-Chile) (Acta 07-2018). RESULTADOS: se generaron dos categorías: "Experiencia de atención otorgada por la enfermera" y "Expectativas vinculadas a la atención proporcionada por la enfermera", se develó que los cuidadores de niños con SD perciben que los cuidados brindados por la enfermera durante la atención son insuficientes en relación con las necesidades que estos niños presentan. Esto estaría vinculado con la falta de conocimientos sobre esta condición y su abordaje integral. Con respecto a sus expectativas, refieren necesidad de acompañamiento, apoyo, educación y de profesionales de enfermería capacitados. CONCLUSIONES: urge abordar las brechas con respecto a las competencias del profesional de enfermería que realiza controles de salud del niño para poder entregar una atención de calidad a ellos y sus familias.

INTRODUCTION: Children with Down Syndrome (DS) and their caregivers require multidisciplinary health care that meets their needs from a comprehensive perspective. OBJECTIVE: to know the experiences and expectations that caregivers of children with DS have concerning the care provided by the nurse in the Child Health Supervision Attention. METHOD: A qualitative phenomenological study was conducted, an intentional sample of cases by criteria made up of 11 caregivers of children with DS between 0 and 9 years of age, who received benefits at the Child Health Control. Semi-structured interviews were carried out; the data were analyzed following the progressive reduction scheme. It had the approval of the Nursing Career Department, Santo Tomás University (Temuco-Chile) (Acta 07-2018). RESULTS: two categories were generated: "Experience of care provided by the nurse" and "Expectations linked to the care provided by the nurse", it was revealed that caregivers of children with DS perceive that the care provided by the nurse during the control is insufficient with the children's needs also, data showed a link to the lack of knowledge about this condition and its comprehensive approach. Regarding their expectations, they report the need for accompaniment, support, and education from the nurse, in addition to being a trained professional. CONCLUSION: It is urgent to address the gaps regarding the competencies of the nursing professional who performs child health checks to deliver quality care to them and their families.

REVISIÓN NARRATIVA: AUTOMEDICACIÓN EN ESTUDIANTES DEL ÁREA DE LA SALUD RELACIONADO CON SALUD MENTAL EN PANDEMIA COVID-19, 2020 - 2022 / NARRATIVE REVIEW: SELF-MEDICATION IN STUDENTS OF THE HEALTH PROFESSIONS AS RELATED TO MENTAL HEALTH DURING THE COVID-19 PANDEMIC, 2020-2022

INTRODUCCIÓN: Se ha observado desde el inicio de la pandemia cómo ha evolucionado y deteriorado la salud de los estudiantes principalmente en carreras del área de la salud, llevando a una parte de ellos a la automedicación OBJETIVO: Analizar la evidencia científica respecto a la automedicación en estudiantes del área de la salud en relación a problemas de salud mental en la pandemia COVID-19. METODOLOGÍA: Se realizó una revisión narrativa, la investigación se realizó desde abril hasta diciembre del año 2022, los textos incluidos fueron en idioma español, inglés y portugués. Se utilizaron 4 bases de datos. RESULTADOS: 4 artículos fueron identificados y rescatados, 3 latinoamericanos en específico todos de Brasil y un asiático, de universidades tanto públicas como privadas, todas las investigaciones tuvieron el denominador común COVID-19 y su correlación con automedicación solo en estudiantes universitarios del área de la salud, todas publicadas solo entre 2020 y 2022. CONCLUSIONES: Las carreras del ámbito de la salud que más se automedicaron son en orden: medicina, enfermería y farmacia. Los fármacos más utilizados fueron: ansiolíticos, antidepresivos e hipnóticos. Los trastornos de salud mental más evidenciados para la automedicación fueron ansiedad, depresión, alteración en los patrones del sueño, estrés, miedo, crisis de angustia, confusión, impotencia e ira, todas como efectos pandémicos. La automedicación es más frecuente a medida que los estudiantes van avanzando en su formación académica. Factores para la automedicación fueron problemas en el ámbito socioeconómico-familiar, falta de acceso a internet, falta de actividades prácticas, posible contagio.

BACKGROUND: Since the beginning of the pandemic, it has been observed that the health of students, especially those in health-related careers, has evolved and deteriorated, leading some to self-medication OBJECTIVE: To analyze the scientific evidence regarding self-medication of students in the health professions, in relation to mental health problems associated with the COVID-19 pandemic. METHODOLOGY: A narrative review was conducted; the research was carried out from April to December 2022 based on texts in Spanish, English, and Portuguese. 4 databases were used. RESULTS: 4 articles were identified and selected: 3 from Latin America, specifically from Brazil, and one Asian. The articles were from both public and private universities. All the investigations had the common denominator of COVID-19 and its correlation with self-medication in university students from the health professions. All were published between 2020 and 2022. CONCLUSIONS: The health professions careers that include the most self-medicating students are, in order, medicine, nursing and pharmacy. The drugs most used for self-medication are anxiolytics, antidepressants, and hypnotics. The most common mental health disorders for self-medication are anxiety, depression, altered sleep patterns, stress, fear, panic attacks, confusion, impotence, and anger; all as pandemic effects. Self-medication is more common as students' progress in their academic training. Factors for self-medication include problems in the socioeconomic-family environment, lack of internet access, lack of practical activities, and possible contagion.

Direct estimation of central aortic pressure from measured or quantified mean and diastolic brachial blood pressure: agreement with invasive records.

Background: Recently it has been proposed a new approach to estimate aortic systolic blood pressure (aoSBP) without the need for specific devices, operator-dependent techniques and/or complex wave propagation models/algorithms. The approach proposes aoSBP can be quantified from brachial diastolic and mean blood pressure (bDBP, bMBP) as: aoSBP = bMBP2/bDBP. It remains to be assessed to what extent the method and/or equation used to obtain the bMBP levels considered in aoSBP calculation may affect the estimated aoSBP, and consequently the agreement with aoSBP invasively recorded. Methods: Brachial and aortic pressure were simultaneously obtained invasively (catheterization) and non-invasively (brachial oscillometry) in 89 subjects. aoSBP was quantified in seven different ways, using measured (oscillometry-derived) and calculated (six equations) mean blood pressure (MBP) levels. The agreement between invasive and estimated aoSBP was analyzed (Concordance correlation coefficient; Bland-Altman Test). Conclusions: The ability of the equation "aoSBP = MBP2/DBP" to (accurately) estimate (error <5 mmHg) invasive aoSBP depends on the method and equation considered to determine bMBP, and on the aoSBP levels (proportional error). Oscillometric bMBP and/or approaches that consider adjustments for heart rate or a form factor ∼40% (instead of the usual 33%) would be the best way to obtain the bMBP levels to be used to calculate aoSBP.

Carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-haematopoietic stem cell transplant: a retrospective cohort study.

BACKGROUND: Risk factors for carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-HSCT have not been thoroughly explored. METHODS: All children with cancer or post-HSCT who developed Enterobacterales bloodstream infections in two cancer referral centres in major Colombian cities between 2012 and 2021 were retrospectively examined. When the infection episode occurred, carbapenem resistance mechanisms were evaluated according to the available methods. Data were divided in a training set (80%) and a test set (20%). Three internally validated carbapenem-resistant Enterobacterales (CRE) prediction models were created: a multivariate logistic regression model, and two data mining techniques. Model performances were evaluated by calculating the average of the AUC, sensitivity, specificity and predictive values. RESULTS: A total of 285 Enterobacterales bloodstream infection episodes (229 carbapenem susceptible and 56 carbapenem resistant) occurred [median (IQR) age, 9 (3.5-14) years; 57% male]. The risk of CRE was 2.1 times higher when the infection was caused by Klebsiella spp. and 5.8 times higher when a carbapenem had been used for ≥3 days in the previous month. A model including these two predictive variables had a discriminatory performance of 77% in predicting carbapenem resistance. The model had a specificity of 97% and a negative predictive value of 81%, with low sensitivity and positive predictive value. CONCLUSIONS: Even in settings with high CRE prevalence, these two variables can help early identification of patients in whom CRE-active agents are unnecessary and highlight the importance of strengthening antibiotic stewardship strategies directed at preventing carbapenem overuse.

Non-invasive central aortic pressure measurement: what limits its application in clinical practice?

The following article highlights the need for methodological transparency and consensus for an accurate and non-invasive assessment of central aortic blood pressure (aoBP), which would contribute to increasing its validity and value in both clinical and physiological research settings. The recording method and site, the mathematical model used to quantify aoBP, and mainly the method applied to calibrate pulse waveforms are essential when estimating aoBP and should be considered when analyzing and/or comparing data from different works, populations and/or obtained with different approaches. Up to now, many questions remain concerning the incremental predictive ability of aoBP over peripheral blood pressure and the possible role of aoBP-guided therapy in everyday practice. In this article, we focus on "putting it on the table" and discussing the main aspects analyzed in the literature as potential determinants of the lack of consensus on the non-invasive measurement of aoBP.

Importancia social de la preparación pedagógica del tutor en la formación del médico general integral

Introducción: la figura del tutor es de vital importancia en la formación del especialista en medicina general integral. Objetivo: fundamentar la importancia del desempeño profesional pedagógico del tutor en la formación del especialista en medicina general integral en la sociedad cubana. Materiales y métodos: se realizó un análisis documental a partir de una búsqueda sobre el tema, de enero de 2020 a agosto de 2022, en las bases de datos PubMed y SciELO, y en el motor de búsqueda Google Académico. Se evaluaron artículos de revisión, de investigación y páginas web -en español, portugués e inglés- que hicieran referencia al tema a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Conclusiones: la medicina familiar es eminentemente social, por su objeto y misión en la comunidad, de ahí que garantizar la formación de profesionales integrales que involucren en su desarrollo los contenidos y habilidades de la especialidad, junto a valores y formas de actuación acorde con los principios de la sociedad socialista, supondrá una mayor resolutividad de los problemas de salud de la población y, por ende, una mayor calidad de vida.

Introduction: the figure of the tutor is of vital importance in the training of the specialist in comprehensive general medicine. Objective: to base the importance of the professional pedagogical performance in the training of the specialist in comprehensive general medicine in Cuban society. Materials and methods: a documental analysis was carried out froma search on the subject, from January 2020 to August in PubMed and SciELO databases and in the Google Scholar search engine. Review and research articles and web pages-in Spanish, Portuguese and English-that referred to the subject in the title were evaluated. Articles that did not meet this condition were excluded. Conclusions: family medicine is eminently social, due to its objective and mission in the community, hence guaranteeing the training of comprehensive professionals who involve the contents and skills of the specialty in their development, along with values and forms of action in accordance with the principles of the socialist society, will suppose a better resolution of the health problems of the population, and therefore, a better quality of life.

Influence of seasonal variation to the population growth and ecophysiology of Typha domingensis (Typhaceae).

Precipitation is an important climatic element that defines the hydrological regime, and its seasonal variation produces annual dry and wet periods in some areas. This seasonality changes wetland environments and leverages the growth dynamics of macrophytes present, including Typha domingensis Pers. This study aimed to evaluate the influence of seasonal variation on the growth, anatomy and ecophysiology of T. domingensis in a natural wetland. Biometric, anatomical and ecophysiological traits of T. domingensis were evaluated over one year at four-month intervals. Reductions in photosynthesis were evidenced at the end of the wet periods and during the dry periods, and these reductions were associated with thinner palisade parenchymas. Increased stomatal indexes and densities as well as thinner epidermis observed at the beginning dry periods can be associated with higher transpiration rates during this period. The plants maintained their water contents during the dry periods, which may be related to the storage of water in leaf trabecular parenchyma, as this is the first time that results indicate the function of this tissue as a seasonal aquiferous parenchyma. In addition, increasing proportions of aerenchymas were evident during the wet periods, which may be related to a compensation mechanism for soil waterlogging. Therefore, the growth, anatomy and ecophysiology of T. domingensis plants change throughout the year to adjust to both the dry and wet periods, providing conditions for the survival of the plants and modulating population growth.

Transdisciplinary experiential learning in biomedical engineering education for healthcare systems improvement.

BACKGROUND: The growing demand for more efficient, timely, and safer health services, together with insufficient resources, put unprecedented pressure on health systems worldwide. This challenge has motivated the application of principles and tools of operations management and lean systems to healthcare processes to maximize value while reducing waste. Consequently, there is an increasing need for professionals with the appropriate clinical experience and skills in systems and process engineering. Given their multidisciplinary education and training, biomedical engineering professionals are likely among the most suitable to assume this role. In this context, biomedical engineering education must prepare students for a transdisciplinary professional role by including concepts, methods, and tools that commonly belong to industrial engineering. This work aims to create relevant learning experiences for biomedical engineering education to expand transdisciplinary knowledge and skills in students to improve and optimize hospital and healthcare care processes. METHODS: Healthcare processes were translated into specific learning experiences using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model. This model allowed us to systematically identify the context where learning experiences were expected to occur, the new concepts and skills to be developed through these experiences, the stages of the student's learning journey, the resources required to implement the learning experiences, and the assessment and evaluation methods. The learning journey was structured around Kolb's experiential learning cycle, which considers four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. Data on the student's learning and experience were collected through formative and summative assessments and a student opinion survey. RESULTS: The proposed learning experiences were implemented in a 16-week elective course on hospital management for last-year biomedical engineering undergraduate students. Students engaged in analyzing and redesigning healthcare operations for improvement and optimization. Namely, students observed a relevant healthcare process, identified a problem, and defined an improvement and deployment plan. These activities were carried out using tools drawn from industrial engineering, which expanded their traditional professional role. The fieldwork occurred in two large hospitals and a university medical service in Mexico. A transdisciplinary teaching team designed and implemented these learning experiences. CONCLUSIONS: This teaching-learning experience benefited students and faculty concerning public participation, transdisciplinarity, and situated learning. However, the time devoted to the proposed learning experience represented a challenge.

Semi-supervised COVID-19 volumetric pulmonary lesion estimation on CT images using probabilistic active contour and CNN segmentation.

Purpose: A semi-supervised two-step methodology is proposed to obtain a volumetric estimation of COVID-19-related lesions on Computed Tomography (CT) images. Methods: First, damaged tissue was segmented from CT images using a probabilistic active contours approach. Second, lung parenchyma was extracted using a previously trained U-Net. Finally, volumetric estimation of COVID-19 lesions was calculated considering the lung parenchyma masks.Our approach was validated using a publicly available dataset containing 20 CT COVID-19 images previously labeled and manually segmented. Then, it was applied to 295 COVID-19 patients CT scans admitted to an intensive care unit. We compared the lesion estimation between deceased and survived patients for high and low-resolution images. Results: A comparable median Dice similarity coefficient of 0.66 for the 20 validation images was achieved. For the 295 images dataset, results show a significant difference in lesion percentages between deceased and survived patients, with a p-value of 9.1 × 10-4 in low-resolution and 5.1 × 10-5 in high-resolution images. Furthermore, the difference in lesion percentages between high and low-resolution images was 10 % on average. Conclusion: The proposed approach could help estimate the lesion size caused by COVID-19 in CT images and may be considered an alternative to getting a volumetric segmentation for this novel disease without the requirement of large amounts of COVID-19 labeled data to train an artificial intelligence algorithm. The low variation between the estimated percentage of lesions in high and low-resolution CT images suggests that the proposed approach is robust, and it may provide valuable information to differentiate between survived and deceased patients.

Propuesta de competencias profesionales específicas para la formación de los especialistas en gastroenterología / A proposal of specific professional competences for the training of gastroenterology specialists

Introducción: La formación con calidad del capital humano en el sector salud constituye un reto para la educación médica cubana contemporánea. La formación académica, en particular la especialidad, tiene el cometido de formar un profesional con alta competencia y avanzadas capacidades para el desempeño especializado, solidez de los principios ético-morales y elevada calificación científico-técnica, por lo que el desarrollo de competencias profesionales resulta una prioridad para la formación de los especialistas biomédicos. Objetivo: Elaborar una propuesta de competencias profesionales específicas para la formación de los especialistas en gastroenterología. Métodos: Se realizó un estudio educacional, de investigación aplicativa, bajo el enfoque general dialéctico-materialista, con fundamento en teorías y enfoques filosóficos, psicológicos y legales de las leyes de la educación, y de la educación médica en particular. Asimismo, se utilizaron métodos teóricos, empíricos y estadístico-matemáticos. Resultados: Se elaboró una definición operativa de competencias profesionales específicas en gastroenterología, a partir del estudio del sistema de competencias y de la sistematización de los documentos rectores en dicha formación. También se identificaron y definieron las competencias profesionales específicas en las áreas asistencial, docente, investigativa y de dirección, que posibilitaron la mejora en el desempeño profesional de los futuros especialistas. Conclusiones: La formación basada en el desarrollo de competencias profesionales específicas constituye una prioridad para la educación médica y la salud pública cubana contemporánea, en aras de elevar la calidad del proceso formativo en la especialidad de gastroenterología y la atención médica que brindan estos galenos en los niveles de atención en salud(AU)

Introduction: The quality training of human capital in the health sector is a challenge for contemporary Cuban medical education. Academic training, particularly the residence, has the task of training a professional with high competence and advanced capabilities for specialized performance, solid ethical-moral principles and high scientific-technical qualification; therefore, the development of professional competences is a priority for the training of biomedical specialists. Objective: To elaborate a proposal of specific professional competences for the training of gastroenterology specialists. Methods: An educational study of applicative research was carried out under the general dialectical-materialistic approach and based on philosophical, psychological and legal theories and approaches of the laws of education and, particularly, of medical education. Theoretical, empirical and statistical-mathematical methods were also used. Results: An operational definition of specific professional competences in gastroenterology was elaborated, based on the study of the system of competences and the systematization of the guiding documents for such training. Specific professional competences were also identified and defined in the care, teaching, research and management areas, which allowed to improve the professional performance of future specialists. Conclusions: Training based on the development of specific professional competences is a priority for contemporary Cuban public health and medical education, in view of raising the quality of the training process in the specialty of gastroenterology and the medical care provided by these physicians at the levels of healthcare(AU)

Academic interest in the therapeutic use of cannabis in nursing students from a private university in Chile / Interés académico sobre uso terapéutico de cannabis en estudiantes de enfermería de una universidad privada de Chile

Introduction: Cannabis therapeutic use is increasingly prominent.Objective: To identify the academi interested related to the therapeutic use of cannabis in nursing students. Methods: It is an investigation from Gadamer's hermeneutical paradigm. The non-probabilistic sample of cases by criteria was made up of 20 key informants from the 3rd and 4th years of the Nursing Career; inclusion criteria: be a student enrolled in the school year and be up to date on the degree. Data collection was through the formation of two focus groups in 2018. Data reduction was manual, data transcription was performed using the Jefferson formula, rigorous and ethical criteria were met. Results: 3 categories emerged: Academic node, Disciplinary roles and Ethical-legal considerations. Students acknowledge linking the therapeutic use of cannabis to their curriculum, displaying relationships between it and its environment in the disciplinary functions related to the care role in care management, they view the educational role towards the community and consider a lack of research in the area, bioethics and legal aspects are mentioned for the third category. Conclusions: There is academic interest in incorporating the therapeutic use of cannabis into university education, the care action is strongly recognized, the educational role is identified and is related to strategies and interventions towards the population; lack of thematic research development, administrative management is not mentioned. It is mentioned to involve bioethics and legal aspects in training specifically in the therapeutic use of cannabis.

Introducción: El uso terapéutico de cannabis es cada vez más destacado. Objetivo: Identificar el interés académico relacionado con uso terapéutico de cannabis en estudiantes de Enfermería. Métodos: Es una investigación desde el paradigma hermenéutico de Gadamer. La muestra no probabilística de casos por criterios se conformó de 20 informantes claves de 3º y 4º año de la Carrera de Enfermería; criterios de inclusión: ser estudiante matriculado en el año lectivo y estar al día en la carrera. La recolección de datos fue mediante la conformación de dos grupos focales en el año 2018. La reducción de datos fue de tipo manual, la transcripción de datos se realizó mediante la fórmula de Jefferson, se cumplió con criterios de rigor y éticos. Resultados: Emergieron 3 categorías: Nódulo académico, Roles disciplinares y Consideraciones ético-legal. Los estudiantes reconocen vincular el uso terapéutico de cannabis a su curriculum, desplegando relaciones de este y su entorno en las funciones disciplinares relativas al rol asistencial en la gestión del cuidado, del rol educativo lo visualizan hacia la comunidad y consideran falta de investigaciones en el área, bioética y aspectos legales son mencionados para la tercera categoría.Conclusiones:  Existe interés académico de incorporar el uso terapéutico de cannabis dentro de la formación universitaria, se reconoce fuertemente la acción asistencial, son identificados el rol educativo y esté relacionado con estrategias e intervenciones hacia la población; falta de desarrollo investigativo temático, no se menciona la gestión administrativa. Se menciona involucrar bioética y aspectos legales en la formación en específico en uso terapéutico de cannabis.

Effectiveness of BNT162b2 Vaccination During Pregnancy in Preventing Hospitalization for Severe Acute Respiratory Syndrome Coronavirus 2 in Infants.

OBJECTIVE: To assess the clinical effectiveness of the BNT162b2 vaccine during pregnancy in preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hospitalizations of infants. STUDY DESIGN: A retrospective, multicenter, 1:3 case-control (test-negative) study. Symptomatic hospitalized infants less than 6 months of age, with a positive SARS-CoV-2 polymerase chain reaction test between January 3, 2021, and March 11, 2021, were matched by age and time to negative controls, hospitalized with symptoms compatible with SARS-CoV-2 infection. Mothers were defined as fully vaccinated who received 2 doses of BNT162b2 with the second given 2 weeks to 6 months before delivery; or partially vaccinated, if they received only 1 dose or 2 doses with the second given more than 6 months or less than 2 weeks before delivery. Severe SARS-CoV-2 was defined as a need for assisted ventilation. RESULTS: We matched 116 SARS-CoV-2 positive infants with 348 negative controls with symptoms compatible with SARS-CoV-2 infection. The effectiveness of fully vaccinated mothers was 61.6% (95% CI, 31.9-78.4) and the effectiveness of partially vaccinated mothers was not significant. Effectiveness was higher in infants 0-2 vs 3-6 months of age. The effectiveness (57.1%; 95% CI, 22.8-76.4) was similar when excluding mothers who were infected with SARS-CoV-2 during pregnancy. The OR of severe infection in infants born to unvaccinated vs fully vaccinated mothers was 5.8. CONCLUSIONS: At least 2 doses of BNT162b2 vaccine administered during the second or third trimester of pregnancy had an effectiveness of 61.6% in decreasing hospitalization for SARS-CoV-2 infection in infants less than 6 months of age.

Doppler echocardiography in a healthy, non-sedated Southern Sea Lion (Otaria flavescens) - a preliminary approach about the feasibility and clinical utility.

Echocardiography is commonly used in veterinary clinical practice for many species but is not as easily applied in non-sedated marine mammals. Additionally, Doppler echocardiography provides further information on hemodynamics, estimation of cardiac output, characterization of flow patterns, and diastolic function. However, its applications in marine mammals have not been as widely explored either. The present report aimed to characterize the left ventricle structure and function of the Southern Sea Lion (Otaria flavescens) through a Doppler echocardiography study. Data were obtained from a healthy animal trained for different veterinary examination routines. This communication constitutes the first report of Doppler echocardiography with stroke volume, and cardiac output measurement in pinnipeds, and the first report of measurement of myocardial performance index in aquatic mammals. This data brought initial information about in vivo structure and function of the heart of the Southern Sea Lion that can be safely and effectively evaluated with the use of transthoracic Doppler echocardiography. Our data have both clinical and research implications for future studies evaluating diseases of the cardiopulmonary system in pinnipeds, and cardiovascular physiology investigation in diving mammals.