High prevalence of syndromic hearing loss in Mexican children undergoing cochlear implantation.

Objective: Studies evaluating genetic sensorineural hearing loss (SNHL) in Hispanic and Latino populations using genomic technologies are lacking. Recent data has shown that Hispanic and Latino children display lower genetic diagnostic rates despite similar prevalence rates of SNHL to their Asian and White counterparts, thus negatively affecting their clinical care. Our objective was to determine the genetic contribution to SNHL in a population of Mexican children undergoing evaluation for cochlear implantation. Methods: Pediatric patients from Mexico with severe to profound SNHL undergoing evaluation for cochlear implantation were recruited. Exome sequencing (ES) or hearing loss gene panel testing was performed. Variant pathogenicity was established in accordance to criteria established by the American College of Medical Genetics, and variants of interest were clinically confirmed via CLIA certified laboratory. Results: Genetic evaluation was completed for 30 Mexican children with severe to profound SNHL. A genetic cause was identified for 47% (14) of probands, and 7% (2) probands had an inconclusive result. Of the diagnoses, 10 (71%) were syndromic or likely syndromic, and 4 (29%) were nonsyndromic. Eight probands (80% of all syndromic diagnoses) were diagnosed with a syndromic form of hearing loss that mimics a nonsyndromic clinical presentation at a young age and so could not be suspected based on clinical evaluation alone without genetic testing. Conclusion: This is the largest study to date to use comprehensive genomic testing for the evaluation of Mexican children with severe to profound SNHL. A significant proportion of children in this cohort were diagnosed with syndromic hearing loss. Future study in a larger cohort of Mexican children with varying degrees of hearing loss is required to improve the efficacy of genetic testing and timely medical intervention within these ethnically diverse populations. Level of evidence: Level 4 (cohort study).

Los corpúsculos gustativos y factores que afectan su función / Taste Corpuscles and Factors that Affect their Function

Resumen El sentido del gusto tiene un papel importante porque ha permitido discriminar entre lo que puede ser alimento y lo que no, e incluso en lo que puede ser tóxico o peligroso al ingerirlo. La búsqueda de nuevos sabores está presente en toda la historia de la humanidad. Desde la antigüedad, las especias aportaron nuevas experiencias gustativas para hacer más palatables los alimentos o incluso para conservarlos durante más tiempo. La búsqueda de especias fue una motivación para realizar viajes que llevaron a descubrimiento de nuevas tierras y continentes. Más recientemente, la pandemia por un virus que altera los sentidos del olfato y del gusto, nos ha hecho recordar la importancia de estos sentidos. El sentido del gusto está determinado por unas pequeñas estructuras que se ubican en las papilas linguales. Hay cuatro tipos que definen cinco sabores y uno que aún está en duda. Las alteraciones de este sentido tienen varios posibles orígenes que se comentan en esta revisión.

Abstract Taste is relevant because it has allowed us to discriminate between what is food and what is not, and even what can be toxic or dangerous when ingested. The search for new flavors is present in history of mankind. Since ancient times, the spices provided new taste experiences to make meals more palatable or as a means of preserving food; the search for spices was a motivation to make voyages that led to the discovery of new lands and continents. More recently, a viral pandemic that damages the olfaction and taste senses made us to remember the relevance of the senses. Small structures, called taste buds, located in the papillae of the tongue are responsible of the sense of taste. There are four types of taste buds that identify five tastes and one whose existence has not yet been fully proven. Taste alterations have different etiologies which will be commented on this review.

La importancia de evaluar el daño al DNA / The Importance of Assessing DNA Damage

Resumen Se calcula que el cuerpo humano está conformado por billones de células, las cuales sufren cientos de miles de lesiones al día en su DNA. Aunque el DNA no es la única biomolécula que sufre daños, su importancia radica en que es la única que no puede ser sustituida por la célula, así que, cuando esta sufre daños, la célula debe repararlos, tolerarlos o, en el caso extremo, activar las vías que la llevarán a la muerte, ya que lo importante es mantener la integridad celular y la homeostasis del organismo. Hay miles de agentes que pueden dañar al DNA, algunos los produce la misma célula y se les denomina 'agentes endógenos', mientras que otros son agentes externos y se les conoce como 'agentes exógenos'. La célula no puede evitar el daño causado por los agentes endógenos, ya que son productos de la actividad metabólica, por ejemplo; así que, cuando suceden se activan de forma inmediata los mecanismos celulares para mitigarlos. Lo mismo pasa con los daños causados por agentes exógenos, ya que la célula hará todo lo posible por disminuir los efectos adversos que pueden causar. El problema se pone de manifiesto cuando la célula no puede reparar los daños o los repara mal o son tantos que los mecanismos de reparación se ven rebasados, es entonces cuando el daño permanece en el DNA y se genera un estado de inestabilidad cromosómica que puede conducir a la célula a la disfunción y a la malignización. Este estado de inestabilidad cromosómica se puede ver reflejado en el aumento de rompimientos de DNA o de micronúcleos en las células expuestas, lo que se puede cuantificar por medio de métodos especiales como el 'Ensayo Cometa' y el 'Ensayo de Micronúcleos', ya que identificar el daño en el DNA es una forma de evaluar el potencial tóxico que tienen los agentes a los que están expuestas las poblaciones, permite conocer los mecanismos de acción que tienen y, además, ayuda a comprender los factores que influyen en el detrimento de la salud poblacional.

Abstract It is estimated that the human body is made of trillions of cells, which suffer hundreds of thousands of DNA lesions every day. Although DNA is not the only biomolecule that suffers damage, its importance lies in the fact that it is the only biomolecule that cannot be replaced by the cell, so when it suffers damage, the cell must repair it, tolerate or, in a extreme case, activate pathways that will lead to death, since the objective is to maintain cell integrity and the homeostasis of the organism.There are thousands of agents that can damage DNA, some are produced by the cell and are called 'endogenous, while others are external agents and are known as 'exogenous. The cell cannot avoid the damage caused by endogenous agents, since they are products of its metabolic activity, for example, so when they occur, cellular mechanisms are immediately activated to mitigate them. The same happens with the damage caused by exogenous agents, since the cell will do everything possible to diminish the adverse effects they can cause. The problem becomes apparent when the cell is unable to repair the damage or poorly repairs it, or repairs so much that the mechanisms are overwhelmed, when the damage remains in the DNA and a state of chromosomal instability is generated that can lead the cell to dysfunction and malignization. This state of chromosomal instability can be reflected in increased DNA breaks or micronuclei in exposed cells, which can be quantified by special methods such as the 'Comet Assay' and the 'Micronucleus Assay'. Since identifying DNA damage is a way of evaluating the toxic potential of the agents to which populations are exposed, it allows us to know their mechanisms of action and helps to understand the factors that influence the detriment in population's health.

Utility of Enteral Contrast Protocols in Pediatric Adhesive Small Bowel Obstruction: A Prospective Multicenter Observational Study.

OBJECTIVE: Our objective was to determine the utility of enteral contrast-based protocols in the diagnosis and management of adhesive small bowel obstruction (ASBO) for children. BACKGROUND: Enteral contrast-based protocols for adults with ASBO are associated with decreased need for surgery and shorter hospitalization. Pediatric-specific data are limited. METHODS: We conducted a prospective observational study between October 2020 and December 2022 at nine children's hospitals who are members of the Western Pediatric Surgery Research Consortium. Inclusion criteria were children aged 1-20 years diagnosed with ASBO who underwent a trial of nonoperative management (NOM) at hospital admission. Comparisons were made between those children who received an enteral contrast challenge and those who did not. The primary outcome was need for surgery. RESULTS: We enrolled 136 children (71% male; median age: 12 y); 84 (62%) received an enteral contrast challenge. There was no difference in rate of operative intervention between the no contrast (34.6%) and contrast groups (36.9%; P=0.93). Eighty-seven (64%) were successfully managed nonoperatively with no difference in median length of stay (P=0.10) or rate of unplanned readmission (P=0.14). Among the 49 children who required an operation, there was no significant difference in time from admission to surgery or rate of small bowel resection based on prior contrast administration. CONCLUSIONS: The addition of enteral contrast-based protocols for management of pediatric ASBO does not decrease the likelihood of surgery or shorten hospitalization. Larger randomized studies may be needed to further define the role of radiologic contrast in the management of ASBO in children.

Terapia oromotora: Estudio de un modelo educativo para cuidadores primarios / Oral-motor therapy: Study of a distance learning educational model for primary caregivers / Terapia motora oral: estudo de um modelo de ensino à distância para cuidadores primários

Los trastornos alimentarios y de deglución afectan considerablemente la calidad de vida de niños y niñas con discapacidades neuromotoras. La pandemia de COVID-19 agravó estos desafíos al limitar el acceso a la atención en salud. Este estudio evaluó un modelo educativo de aprendizaje a distancia en terapia oral-motora, dirigido a personas cuidadoras de niños y niñas con discapacidades neuromotoras en Mérida, México. Participaron incialmente treinta personas cuidadoras de niños y niñas entre 2 y 12 años de edad con trastornos alimentarios y de deglución, quienes recibían atención en siete instituciones. 23 participantes completaron el programa. Se usó un diseño cuasiexperimental de prueba pre y post. El programa incluyó sesiones teóricas y prácticas. Los resultados mostraron mejoras significativas en el conocimiento teórico y en las competencias prácticas, con niveles de competencia superiores al 80%. Aun así, se reconocen limitaciones del estudio como el tamaño de la muestra y la ausencia de un grupo de control. Abordar estas limitaciones en investigaciones futuras fortalecerá la evidencia sobre la efectividad de este enfoque innovador centrado en la persona cuidadora, crucial para gestionar trastornos alimentarios y de deglución de manera efectiva y mejorar la calidad de vida de niños y niñas con discapacidades neuromotoras.

Eating and swallowing disorders are prevalent among children with neuromotor disabilities, significantly impacting their overall quality of life. The COVID-19 pandemic exacerbated the challenges by restricting access to health care, underscoring the necessity for innovative solutions with caregiver involvement. This study investigated the effectiveness of a distance learning educational model in oral-motor therapy for primary caregivers of children with neuromotor impairments in Mérida, Mexico. The quasiexperimental pretest-posttest design included thirty primary caregivers of children aged 2 to 12 with feeding and swallowing disorders from seven institutions. Twenty-three participants completed the program. The program encompassed theoretical sessions on various aspects of oral motor therapy and practical sessions focusing on hands on training. Results revealed substantial enhancements in theoretical knowledge and practical competencies among caregivers, with competence levels exceeding 80% in all evaluated activities. Despite these positive outcomes, the study acknowledges limitations such as a small sample size and the absence of a control group. Addressing these constraints through future research endeavors will bolster the evidence supporting the effectiveness of this innovative caregivercentric approach. Ultimately, integrating caregivers into the care team is imperative for improving the quality of life for children with neuromotor disabilities and effectively managing eating and swallowing disorders.

Os distúrbios da alimentação e da deglutição afetam significativamente a qualidade de vida das crianças com deficiências neuromotoras. A pandemia da COVID-19 exacerbou esses desafios desafios, sendo que limitou o acesso ao atendimento. Este estudo avaliou um modelo educacional de ensino à distância sobre terapia oral-motora, orientado a cuidadores primários de crianças com deficiências neuromotoras em Mérida, México. Trinta cuida- dores de crianças de 2 a 12 anos de idade com distúrbios de alimentação e deglutição de sete instituições participaram, sendo que 23 deles concluíram o programa. Um estudo quase experimental de préteste-pós-teste foi realizado. O programa incluiu sessões teóricas e práticas. Os resultados mostraram melhorias significativas no conhecimento teórico e nas competências práticas, com níveis de competência acima de 80%. Contudo, são reconhecidas algumas limitações do estudo, como o pequeno tamanho da amostra e a falta de um grupo de controle. A abordagem dessas limitações em pesquisas futuras fortalecerá as evidências respeito da eficácia dessa abordagem inovadora centrada no cuidador, crucial para melhorar a qualidade de vida das crianças com deficiências neuromotoras e gerenciar os distúrbios de alimentação e deglutição de forma eficaz.

Prebiotics in Global and Mexican Fish Aquaculture: A Review.

Continued human population growth has resulted in increased demand for products, including those derived from aquaculture. The main challenge in aquaculture is producing more every year. In recent years, environmentally friendly supplements that provide the necessary pathways for optimal production have been emphasized. One of them is prebiotics, selectively utilized substrates by host microorganisms conferring a health benefit. Interest in applying prebiotics in global fish farming has increased in recent years as it has been shown to improve growth, boost the immune system, resist stress conditions, and cause the modulation of digestive enzymes. These effects reflect reduced production and disease costs. However, in Latin American countries such as Mexico, large-scale use of these food supplements is needed as a sustainable alternative to improve fish production. This paper gives a review of the current advances obtained with the application of prebiotics in commercially farmed fish worldwide, mentions the prebiotics to use in the aquaculture industry, and updates the status of studies about the used prebiotics in global commercial fish cultivated in Mexico, as well as freshwater and marine endemic fish in this country. Also, the limitations of prebiotics application in terms of their use and legislation are analyzed.

¡Ey parce! Estoy buscando camello: Cómo las redes de los contactos sociales definen la situación laboral de jóvenes en sectores populares y marginados de Cali

La búsqueda de empleo usando los contactos sociales a pesar de ser una práctica común, en ocasiones no genera los resultados esperados. Con el objetivo de comprobar lo anterior; en este documento se configuran las redes de contactos sociales de un grupo de jóvenes que viven en contextos de marginalidad y violencia de las comunas 1, 14, 16, 18 y 20 de Cali que participaron en el programa denominado Tratamiento Integral a Pandillas - Jóvenes Sin Fronteras (TIP-JSF), un proceso de intervención psicosocial desde una perspectiva integral que promovía la inclusión social. Las redes de contactos sociales halladas a través de una encuesta se caracterizan por ser pequeñas y cerradas, aumentando la probabilidad de que quienes las conforman, presenten el mismo estado laboral: desempleo o informalidad laboral. Es clave, entonces, que las/os jóvenes amplíen sus contactos para que los vinculen con otros que les puedan brindar información de mejores vacantes laborales.

The search for employment using social contacts, despite being a common practice, sometimes does not generate the expected results. In order to verify the above, this paper describes the social contact networks of a group of young people living in contexts of marginality and violence in Cali's communes 1, 14, 16, 18 and 20 who participated in the program called Integral Treatment for Gangs - Youth Without Borders (TIP-JSF), a process of psychosocial intervention from an integral perspective that promoted social inclusion. The social networks found through a survey are characterized by being small and closed, increasing the likelihood that those who make up these networks have the same employment status: unemployment or informal employment. It is essential for young people to expand their contacts and link them with other contacts that can provide them with information on better job vacancies.

A busca de emprego usando contatos sociais, apesar de ser uma prática comum, às vezes não gera os resultados esperados. Para verificar isso, este artigo descreve as redes de contatos sociais de um grupo de jovens que vivem em contextos de marginalidade e violência nas comunas 1, 14, 16, 18 e 20 de Cali e que participaram do programa chamado Tratamento Integral para Gangues - Jovens Sem Fronteiras (TIP-JSF), um processo de intervenção psicossocial de uma perspectiva holística que promoveu a inclusão social. As redes sociais encontradas por meio de uma pesquisa são caracterizadas por serem pequenas e fechadas, aumentando a probabilidade de que aqueles que as formam tenham a mesma situação de emprego: desemprego ou emprego informal. É fundamental, portanto, que os jovens ampliem seus contatos para conectá-los a outras pessoas que possam lhes fornecer informações sobre melhores vagas de emprego.

El endotelio sano y su disfunción en el riesgo cardiovascular / Healthy Endothelium and its Dysfunction in Cardiovascular Risk

Resumen El endotelio es una monocapa formada por células aplanadas llamadas w, que revisten la parte más interna del corazón, los vasos sanguíneos y los linfáticos. Es considerado un órgano que tiene una función de barrera, pero además se encarga de regular la permeabilidad y tono vascular, hemostasia, inflamación y angiogénesis. Esta revisión se centra sobre todo en las generalidades del endotelio vascular sano y su disfunción. Se analizan los conceptos de activación y disfunción, en donde la activación se considera como un proceso autolimitado, indispensable para la hemostasia y la inflamación. La disfunción endotelial, en cambio, es un proceso patológico, de mayor duración y que se presenta cuando el endotelio ya no puede autorregularse y cambia a un fenotipo proinflamatorio y protrombótico permanente. Esta disfunción es el primer cambio que lleva a la ateroesclerosis y al aumento del riesgo cardiovascular, por esta razón se revisan los principales biomarcadores de disfunción endotelial y riesgo cardiovascular. A medida que se avance en el conocimiento básico del endotelio y su disfunción, será posible diseñar nuevas medidas preventivas o terapéuticas que puedan disminuir dicho riesgo.

Abstract The endothelium is a monolayer of flatten cells named endothelial cells that form the inner layer of the heart, blood, and lymphatic vessels. Its function is not just as a barrier, but it is a regulator of vascular permeability and tone, hemostasis, inflammation, and angiogenesis. This review is about the general aspects of vascular endothelium and endothelial dysfunction that leads to increased vascular risk. Activation and dysfunction are discussed, considering the endothelial activation as a self-limiting process, necessary to promote inflammation and hemostasis. Endothelial dysfunction is a pathological process in which the endothelium loses its ability for self-regulation and acquires a prothrombotic and proinflammation phenotype. Endothelial dysfunction is the initial step for atherosclerosis and increased cardiovascular risk, so the main biomarkers of endothelial dysfunction are reviewed. As basic knowledge about endothelium increases, preventive or therapeutic measures can be designed as treatment or prevention the risk of its dysfunction.

Recovery of Mixtures of Construction Waste, PET and Sugarcane Bagasse for the Manufacture of Partition Blocks.

The building industry generates millions of tons of construction and demolition waste annually (12 million tons/year are generated in Mexico, of which only 4% is reused or recycled). Concomitantly, the demand for goods and services by the building industry causes significant environmental impacts. On the other hand, plastic waste is also difficult to assimilate into the environment in the short term, and its recovery is of special interest. Therefore, this research focuses on the feasibility of the manufacture of Partition Blocks (essential building element) through the combination of construction and demolition waste (CDW), polyethylene terephthalate (PET) plastic flakes, dust from tire shredding, and residue from the sugar industry (bagasse). The results of this study show that the Partition Blocks made with CDW and PET reach an average compressive strength of 115.003 kgf/cm2 (11.278 MPa) (suitable for structural use according to Mexican regulations); the use of lime enhances the consistency of the mixture of CDW and PET (increases its cohesion and homogeneity); and finally, these Partition Blocks have a cost comparable to the current conventional Partition Blocks made with virgin material, thus, conferring them validity as a feasible recycling option for these residues.

Exposing the Hepatotoxicity of Medicinal Plants: A Review of Copalchi Stem Bark (Hintonia latiflora) / Exponiendo la hepatotoxicidad de las plantas medicinales: una revisión de palo amargo (Hintonia latiflora)

Resumen Se estima que el 80% de la población mundial utiliza diversas plantas medicinales para el tratamiento o control de diversas enfermedades, ya sean agudas o crónicas, debido a su accesibilidad y bajo costo, observándose en los últimos años un aumento en el consumo sin una observación médica adecuada. México es considerado como el segundo país más importante del mundo en cuanto al conocimiento de la medicina tradicional, solo después de china. El uso de las plantas medicinales se ha reportado desde tiempos prehispánicos como una opción terapéutica, sin embargo, el único enfoque que se tiene es la parte curativa y no se ha reflexionado en que las plantas poseen metabolitos secundarios (compuestos químicos producidos por las plantas con actividad biológica en los seres vivos) que, además de tener efectos terapéuticos poseen efectos tóxicos en las personas que las consumen, observándose en algunos casos efectos reversibles después de suspender su consumo. El copalchi o palo amargo es una planta medicinal que proviene de la corteza del árbol de Hintonia latiflora (sin. Coutarea latiflora), la cual ha sido utilizada principalmente como tratamiento alternativo para pacientes con diabetes tipo 2, ya que se ha demostrado que tiene efecto hipoglucemiante. Sin embargo, se han reportado casos de hepatotoxicidad aguda con un incremento en las transaminasas hepáticas (ALT y AST) por el consumo continuo de dicha corteza, no obstante el procesamiento de las plantas medicinales utilizando medios físicos (calentar o hervir) puede alterar la actividad farmacológica de los constituyentes orgánicos, los cuales pueden verse también afectados en su concentración dependiendo de los factores ambientales de cultivo, localización del suelo, humedad y temperatura ambiental, así como la temporada de cosecha (tallos, hojas, flores, raíces, semillas). El consumo de esta planta medicinal es por medio de infusiones calientes o en cápsulas con extracto.

Abstract Approximately 80% of the world's population uses various medicinal plants for the treatment or control of various diseases, whether acute or chronic, due to their accessibility and low cost, observing in recent years an increase in consumption without proper medical observation. Mexico is considered the second most important country in the world in terms of traditional medicine knowledge, only after China. The use of medicinal plants has been reported since pre-Hispanic times as a therapeutic option; however, the only focus is on the curative part and it has not been considered that plants have secondary metabolites (chemical compounds produced by plants with biological activity in living beings) that, besides having therapeutic effects, have toxic effects in people who consume them, and in some cases reversible effects are observed after suspending their consumption. Copalchi or palo amargo is a medicinal plant obtained from the bark of the Hintonia latiflora tree (syn. Coutarea latiflora), which has been used mainly as an alternative treatment for patients with type 2 diabetes, since it has been shown to have a hypoglycemic effect. However, cases of acute hepatotoxicity have been reported with an increase in hepatic transaminases (ALT and AST) by the continuous consumption of this bark. However, the processing of medicinal plants using physical means (heating or boiling) can alter the pharmacological activity of the organic constituents, which can also be affected in their concentration depending on the environmental factors of cultivation, soil location, humidity, and environmental temperature, as well as the harvesting season (stems, leaves, flowers, roots, seeds). The consumption of this medicinal plant is by means of hot infusions or in capsules with extract.

Tire Ground Rubber Biodegradation by a Consortium Isolated from an Aged Tire.

Rubber is a natural product, the main car tire component. Due to the characteristics acquired by this material after its vulcanization process, its degradation under natural conditions requires very long times, causing several environmental problems. In the present work, the existence of a bacterial consortium isolated from a discarded tire found within the Socabaya River with the ability to degrade shredded tire rubber without any chemical pretreatment is explored. Taking into consideration the complex chemical composition of a rubber tire and the described benefits of the use of pretreatments, the study is developed as a preliminary analysis. The augmentative growth technique was used, and the level of degradation was quantified as a percentage through the analysis of microbial respiration. Schiff's test and the use of comparative photographs of scanning electron microscopy (SEM) were also used. The consortium using next generation genetic sequencing was analyzed. A 4.94% degradation point was obtained after 20 days of experimentation, and it was found that the consortium was mostly made up with Delftia tsuruhatensis with 69.12% of the total genetic readings of the consortium and the existence of 15% of unidentified microbial strains at the genre level. The role played by the organisms in the degradation process is unknown. However, the positive results in the tests carried out show that the consortium had action on the shredded tire, showing a mineralization process.

Principles, Scope, and Limitations of the Methodological Triangulation / Principios, alcances y limitaciones de la triangulación metodológica / Princípios, alcances e limitações da triangulação metodológica

Abstract This article sought to collect basic and relevant information about methodological triangulation and make a first approach to the principles underlying its use, potentiality and scope, advances and limitations, and some alternative proposals to surpass them. In that sense, it is an attempt to operationalize concepts and present the procedures to conduct it rigorously. In the first place, conceptual aspects and types of triangulation are presented, and in the second place, the principles, uses and difficulties. But, beyond what must be done, an approach is made to how to do it. The assumption underlying through the article is the complementarity among methods. It is emphasized in the principle through which the nature of objects must guide the selection of the methods and of the most effective techniques to approach and account for phenomena that are socially pertinent of being studied.

Resumen El presente artículo pretende levantar información básica y relevante sobre la triangulación metodológica y hacer una primera aproximación a los principios que subyacen en su uso, su potencialidad y alcance, sus avances y limitaciones, y algunas propuestas alternativas para superarlas. En ese sentido, es un intento de operacionalizar los conceptos y presentar los procedimientos para llevarla a cabo en forma rigurosa. En primer lugar, se presentan los aspectos conceptuales y los tipos de triangulación, y en segundo lugar los principios, los usos y las dificultades. Pero, más allá del qué hacer, se hace una aproximación al cómo hacerlo. El supuesto que subyace a través del artículo es la complementariedad entre los métodos. Se enfatiza en el principio mediante el cual, la naturaleza de los objetos debe guiar la escogencia de los métodos y de las técnicas más eficaces para aproximarse y dar cuenta de los fenómenos que son pertinentes socialmente, de ser estudiados.

Resumo Este artigo tem como objetivo coletar informações básicas e relevantes sobre triangulação metodológica e fazer uma primeira aproximação aos princípios que fundamentam sua utilização, seu potencial e alcance, sua avanços e limitações, e algumas propostas alternativas para superá-los. Nesse sentido, é uma tentativa de operacionalizar os conceitos e apresentar os procedimentos para realizá-lo com rigor. Em primeiro lugar, são apresentados os aspectos conceituais e os tipos de triangulação e, em segundo lugar, os princípios, usos e dificuldades. Mas, além do que fazer, é feita uma abordagem de como fazer. A hipótese subjacente ao longo do artigo é a complementaridade entre os métodos. A ênfase é colocada no princípio pelo qual a natureza dos objetos deve orientar a escolha dos métodos e técnicas mais eficazes para abordar e dar conta dos fenômenos socialmente relevantes, se estudados.

Percepciones de estudiantes de fonoaudiología sobre el aprendizaje basado en simulación y gamificación / Perceptions of phonoaudiology students on simulation-based gamified learning

Introducción: El aprendizaje basado en simulación y gamificación emerge como propuesta pedagógica a las necesidades de los estudiantes contemporáneos, quienes se desarrollan en entornos de avance tecnológico continuo. Más aún, favorecen la adquisición y el desarrollo de razonamientos y habilidades clínicas, lo que mejora la seguridad del paciente. Objetivo: Evaluar la percepción de los estudiantes de cuarto año de Fonoaudiología sobre la propuesta de simulación y gamificación aplicada de Clínica Otoneurológica y Laberintología en la Universidad de Nacional de Córdoba, Argentina. Métodos: Investigación transversal, descriptiva y correlacional. Los participantes (n = 89) completaron tres cuestionarios de valoración: para la actividad de simulación de movimientos oculares, para la actividad de gamificación en clínica audiológica y acerca de aspectos generales de la asignatura. Para el análisis de los datos se utilizó la estadística descriptiva y multivariada. Se estudiaron las asociaciones multivariadas entre los ítems de los cuestionarios, mediante análisis de componentes principales. Resultados: Se obtuvo un alto porcentaje de aceptación de ambas actividades. El análisis multivariado logró explicar un 59 por ciento de la variabilidad, y reveló una asociación positiva entre la simulación y la gamificación. Más aún, estas propuestas pedagógicas se correlacionaron positivamente con los indicadores de aprendizaje significativo, los objetivos del currículo, los métodos de evaluación y los recursos didácticos aplicados. Conclusiones: Estas herramientas generan entornos organizativos y facilitadores del proceso de enseñanza-aprendizaje, especialmente en temas otoneurológicos. Los resultados expanden la aplicabilidad de la simulación y gamificación en la educación universitaria(AU)

Introduction: Simulation-based gamified learning is emerging as a pedagogical proposal to meet the needs of contemporary students, who develop themselves in settings of continuous technological advancement. Moreover, they favor the acquisition and development of clinical reasoning and skills, which improves patient safety. Objective: To evaluate the perception of fourth-year Phonoaudiology students on the simulation and gamification proposal applied in the otoneurology and labyrinthology clinic at the National University of Córdoba, Argentina. Methods: In this cross-sectional, descriptive and correlational research, the participants (n=89) completed three assessment questionnaires: for the eye movement simulation activity, for the gamification activity in audiological clinic, and about general aspects of the subject. Descriptive and multivariate statistics were used for data analysis. The multivariate associations between questionnaire items were studied by means of principal component analysis. Results: A high percentage was obtained regarding acceptance of both activities. Multivariate analysis permitted to explain 59 percent of the variability, and revealed a positive association between simulation and gamification. Moreover, these pedagogical proposals were positively correlated with meaningful learning indicators, the curriculum objectives, the evaluation methods and the didactic resources applied. Conclusions: These tools generate organizational and facilitating settings for the teaching-learning process, especially in otoneurological subjects. The results increase the applicability of simulation and gamification in university education(AU)

Bacterial and parasite co-infection in Mexican golden trout (Oncorhynchus chrysogaster) by Aeromonas bestiarum, Aeromonas sobria, Plesiomonas shigelloides and Ichthyobodo necator.

BACKGROUND: Bacterial infections are responsible of high economic losses in aquaculture. Mexican golden trout (Oncorhynchus chrysogaster) is a threatened native trout species that has been introduced in aquaculture both for species conservation and breeding for production and for which no studies of bacterial infections have been reported. CASE PRESENTATION: Fish from juvenile stages of Mexican golden trout showed an infectious outbreak in a farm in co-culture with rainbow trout (Oncorhynchus mykiss), showing external puntiform red lesions around the mouth and caudal pedunculus resembling furuncles by Aeromonas spp. and causing an accumulated mortality of 91%. Isolation and molecular identification of bacteria from lesions and internal organs showed the presence of Aeromonas bestiarum, Aeromonas sobria, Plesiomonas shigelloides and Ichthyobodo necator isolated from a single individual. All bacterial isolates were resistant to amoxicillin-clavulanic acid and cefazoline. P. shigelloides was resistant to third generation ß-lactamics. CONCLUSIONS: This is the first report of coinfection by Aeromonas bestiarum, Aeromonas sobria, Plesiomonas shigelloides and Ichthyobodo necator in an individual of Mexican golden trout in co-culture with rainbow trout. Resistance to ß-lactams suggests the acquisition of genetic determinants from water contamination by human- or livestock-associated activities.

Prevalencia de consumo de sustancias psicoactivas y su relación con características sociodemográficas, familiares y de personalidad en estudiantes en formación tecnológica / Prevalence of psychoactive substance use and its relationship with characteristics sociodemographic, family and personality in students in technology training

Resumen. El objetivo del estudio fue determinar la prevalencia del consumo de sustancias psicoactivas y los factores asociados con las caracteristicas sociodemográficas, familiares y de personalidad. El estudio se realizó en un Instituto de formación tecnológica de carácter público Medellin, 2016. La muestra estuvo conformada por 891 estudiantes a quienes se les aplicó los instrumentos ASSIT, APGAR Familiar, NEO-FFI, ERI y un cuestionario de variables sociodemográficas. Los resultados mostraron que la prevalencia de consumo de sustancias psicoactivas fue de 51,6%; con mayor consumo de alcohol (49,7%). La prueba de regresión logistica sugiere que ser hombre (OR= 2,97), con edad entre 18 y 24 años (OR= 2,72), con expresión en estado bajo en las relaciones intrafamiliares (OR= 1,63) y prestar un nivel muy bajo en amabilidad (Or=9,32) se asocia de forma negativa con el consumo de sustancias psicoactivas. Se resalta la importancia de fortalecer aspectos de la personalidad relacionados con la amabilidad (confianza, franqueza, actitud conciliadora, sensibilidad a los demás), además de las relaciones intrafamiliares y aspectos que faciliten prevenir el consumo de sustancias psicoactivas en los estudiantes.

Abstract. The objective of this study was to stablish the prevalence of psychoactive substances consumption among students and to associate this consumption with the socio-demographic, family structures, and personality traits. The study was set on a public technological institute of Medellin, Colombia during 2016. The next tests were applied once to the students: ASSIT, APGAR Family, NEO-FFI, ERI and a test of sociodemographic variables. The primary outcome in this study was the prevalence of consumption of psychoactive substances among students. In order to stablish the association between psychoactive substances and sociodemographic, family structures, and personality traits, a logistic regression model was fit. A total of 891 students participated in this study. The prevalence of psychoactive substances use among students was 51.6%. The logistic regression conducted on the data proved that males, among 18 to 24 years, with intrafamily deficit, and with low kindness were positively associated with greater PAS use (OR = 2.97, 2.72, 1.63, 9.32, respectively). Kindness aspects (e.g., confidence, frankness, counseling, sensitivity to others) and family relationships should be improved in order to prevent psychoactive substances use among students.

Calidad de la atención en salud en ataque cerebrovascular en un hospital de referencia en Colombia / Quality of health care in stroke in a reference hospital in Colombia

RESUMEN INTRODUCCIÓN: La evaluación de la calidad de la atención del ataque cerebrovascular (ACV) es una prioridad para los sistemas de salud, debido a su relación con la disminución de la discapacidad y la muerte. En este estudio se analizan los marcadores de calidad en ACV en un hospital de referencia en Nariño, Colombia. OBJETIVO: Evaluar los marcadores de calidad de atención en ACV en el Hospital Universitario Departamental de Nariño E. S. E., entre junio del 2018 y diciembre del 2019. Como referencia se comparó con los registros de Colombia en la plataforma RES-Q. MATERIALES Y MÉTODOS: Estudio descriptivo retrospectivo de pacientes con ACV atendidos intrahospitalariamente. La recolección de datos se realizó mediante la plataforma RES-Q, en tanto que el análisis se efectuó por medio de estadísticos descriptivos y frecuencias absolutas y relativas y las diferencias con pruebas analíticas. RESULTADOS: Se evaluaron 457 pacientes con predominio de ACV isquémico y se llevó a cabo trombólisis endovenosa al 7,2% en el 2018 y al 9,2 % en el 2019, el 27,7 % con tiempo puerta aguja menor a 60 minutos en el 2018 y el 42,8 % en el 2019. Entre los marcadores de calidad, se encontró mejoría en realización de NIHSS, evaluación de disfagia en las primeras 24 horas, realización de doppler carotideo en los primeros siete días. En comparación con Colombia, se encontró un porcentaje inferior en trombólisis endovenosa y trombectomía. La mayoría de los indicadores de atención en ACV es similar al promedio nacional. CONCLUSIONES: La mejoría en el cumplimiento de marcadores de calidad en ACV refleja el impacto de programas de atención en ACV. El monitoreo de los parámetros de calidad permite generar programas para fortalecer la atención integral del ataque cerebrovascular en la región.

ABSTRACT INTRODUCTION: The evaluation of the quality of care for Stroke is a priority for health systems, given its relationship with disability and death. In this study, Stroke quality markers are analyzed in stroke in a referral hospital in Narino, Colombia. OBJECTIVE: To evaluate the markers of quality of care in stroke in the Hospital Departamental Universitario de Narino E.S.E between June 2018 and December 2019. As a reference, the outcomes were compared with the Colombian registries on RES-Q platform. MATERIALS AND METHODS: A retrospective descriptive study of patients treated in-hospital with stroke, data collection was performed using the RES-Q platform. The analysis was carried out using descriptive statistics and absolute and relative frequencies and the differences with analytical tests. RESULTS: 457patients were evaluated, with ischemic stroke predominance, endovenous thrombolysis was performed in 7.2 % in 2018, and 9.2 % in 2019, 27.7 % of patients had door to needle time less than 60 minutes in 2018 and 42.8 % in 2019. Among the quality markers evaluated, an improvement was found in the performance of NIHSS, dysphagia evaluation, and carotid doppler performance in ischemic stroke. Compared with Colombian registry, a lower percentage was found in endovenous thrombolysis and thrombectomy. Most of Stroke Care Markers are similar to national average. CONCLUSIONS: The improvement in compliance of standard of Stroke Care Quality Markers reflects the impact of stroke care programs. The monitoring of quality parameters allows the generation of comprehensivestroke care programs in the region.

Complexity of Genomic Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Isolates in Colombia Urges the Reinforcement of Whole Genome Sequencing-Based Surveillance Programs.

BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging public health problem. This study explores the specifics of CRKP epidemiology in Colombia based on whole genome sequencing (WGS) of the National Reference Laboratory at Instituto Nacional de Salud (INS)'s 2013-2017 sample collection. METHODS: A total of 425 CRKP isolates from 21 departments were analyzed by HiSeq-X10®Illumina high-throughput sequencing. Bioinformatic analysis was performed, primarily using the pipelines developed collaboratively by the National Institute for Health Research Global Health Research Unit (GHRU) on Genomic Surveillance of Antimicrobial Resistance (AMR), and AGROSAVIA. RESULTS: Of the 425 CRKP isolates, 91.5% were carbapenemase-producing strains. The data support a recent expansion and the endemicity of CRKP in Colombia with the circulation of 7 high-risk clones, the most frequent being CG258 (48.39% of isolates). We identified genes encoding carbapenemases blaKPC-3, blaKPC-2, blaNDM-1, blaNDM-9, blaVIM-2, blaVIM-4, and blaVIM-24, and various mobile genetic elements (MGE). The virulence of CRKP isolates was low, but colibactin (clb3) was present in 25.2% of isolates, and a hypervirulent CRKP clone (CG380) was reported for the first time in Colombia. ST258, ST512, and ST4851 were characterized by low levels of diversity in the core genome (ANI > 99.9%). CONCLUSIONS: The study outlines complex CRKP epidemiology in Colombia. CG258 expanded clonally and carries specific carbapenemases in specific MGEs, while the other high-risk clones (CG147, CG307, and CG152) present a more diverse complement of carbapenemases. The specifics of the Colombian situation stress the importance of WGS-based surveillance to monitor evolutionary trends of sequence types (STs), MGE, and resistance and virulence genes.

Oral Motor Treatment Efficacy: Feeding and Swallowing Skills in Children with Cerebral Palsy.

This study is aimed at identifying the relationship between oral motor treatment and the improvement of abilities for feeding and swallowing in boys and girls with CP residing in the state of Yucatán. The sample consisted of 30 patients with a diagnosis of CP and the presence of ADT, with gross motor function levels from II to V, between 3 and 14 years old, of which 50% received oral motor treatment. The predominant diagnosis was spastic CP and tetraplegia. An interview was carried out with the tutor, the application of the gross motor skills scale, and an assessment of feeding skills. The feeding and swallowing skills that improved significantly with the oral motor treatment were mandibular mobility, tongue activity, abnormal reflexes, control of breathing, and general oral motor skills (p ≤ 0.05). Within the sample that did not receive oral motor treatment, 46% presented low or very low weight and 40% referred recurrent respiratory diseases. In the end, it was concluded that feeding skills improve significantly with oral motor treatment, regardless of the severity of gross motor involvement. Likewise, oral motor treatment was associated with a lower presence of respiratory diseases and nutritional compromise.

Leachate treatment: comparison of a bio-coagulant (Opuntia ficus mucilage) and conventional coagulants using multi-criteria decision analysis.

The main aim of this research was to compare a bio-coagulant, organic coagulant, and a conventional coagulant applied to the treatment of leachates. Coagulant options were Stage 1 FeCl3, Stage 2 Polyamine, and Stage 3 Opuntia ficus mucilage (OFM). Optimal conditions for maximum chemical oxygen demand (COD) removal were determined by experimental data and Response Surface Methodology. The application of Multiple Criteria Decision Analysis using Multi-Criteria Matrix (MCM) was explored by evaluating the Coagulation-Flocculation processes. Maximum COD removal (%) and the best MCM scores (on a scale from 0 to 100) were: Stage 1: 69.2±0.9 and 48.50, Stage 2: 37.8±1.1 and 79.0, and Stage 3: 71.1±1.7, and 81.5. Maximum COD removal using FeCl3 and OFM was not statistically different (p 0.15 < 0.05). OFM extraction process was evaluated (yield 0.70 ± 1.17%, carbohydrate content 32.6 ± 1.18%). MCM allows the evaluation of additional technical aspects, besides oxygen COD removal, as well as economic aspects, permitting a more comprehensive analysis. Significant COD removals indicate that the use of OFM as a coagulant in the treatment of stabilized leachate was effective. Opuntia ficus cladodes, a residue, were used to treat another residue (leachates).