Caracterización de estilos de aprendizaje, satisfacción y acceso a residencia médica en participantes de un programa de educación médica continuada bimodal/virtual en Medellín, Colombia, 2017 / Characterization of Learning Styles, Satisfaction, and Access to Medical Residency in Participants of a Bimodal/Virtual Continuing Medical Education Program in Medellín, Colombia, 2017

Introducción: los estilos de aprendizaje son rasgos del estudiante que pueden ayudar a la planificación curricular en educación médica. No se conoce con certeza si algún estilo de aprendizaje específico se relaciona con la satisfacción en educación médica continuada o si aumenta las probabilidades de acceder a una residencia médica. Objetivo: este trabajo buscó categorizar los estilos de aprendizaje en una cohorte de médicos, describir su satisfacción según cada estilo de aprendizaje y el acceso a una residencia médica. Materiales y métodos: estudio de corte transversal en médicos cursando un diplomado de actualización médica. Se categorizaron estilos de aprendizaje y sus combinaciones (activo, reflexivo, teórico y pragmático). Se calculó la diferencia de medias de satisfacción del curso. Posteriormente, se evaluó la asociación entre el estilo de aprendizaje y el acceso a un cupo de residencia médica. Resultados: trescientos once médicos (n=311) aceptaron participar. El 75 % tenían entre uno y dos estilos dominantes, siendo el más frecuente el reflexivo/teórico (n=108; 34,7%). No se encontró una mayor satisfacción global asociada a un estilo en particular. Conclusión: el estilo de aprendizaje dominante es el reflexivo/teórico. La satisfacción global es mayor en la modalidad bimodal. No se encontró asociación con ningún estilo de aprendizaje y el acceso a residencia médica.

Introduction: learning styles are student traits that can aid in curriculum planning in medical education. It is not known for certain if any specific learning style is related to satisfaction in continuing medical education or if it increases the chances of accessing a medical residency. Objective: the learning styles are student traits that can aid in curriculum planning in medical education. This study aimed to categorize learning styles within a cohort of physicians, describe their satisfaction according to each learning style, and assess access to a medical residency program. Methods: a cross-sectional study was conducted with physicians attending a diploma in clinical and surgical areas. Learning styles were categorized according to the CAMEA40 questionnaire. The median differences of course satisfaction was calculated. Subsequently, the association between each learning styles and access to a medical residency post was evaluated. Results: three hundred eleven (n = 311) agreed to participate. A total of 75 % had between one and two dominant learning style, the most frequent being the reflective/theoretical (n = 108; 34,7 %). No greater overall satisfaction associated with a particular learning style was found. Conclusion: one-third of the doctors had a reflective/theoretical profile. The overall satisfaction and access to a medical residency were no associated with any learning style.

Integrating HIV and substance misuse services: a person-centred approach grounded in human rights.

Integrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. We discuss how approaches to integration address two core gaps in current models: a failure to consider human rights when incorporating the perspectives of people living with HIV and people who use drugs, and a failure to reflect critically on structural factors that determine risk, vulnerability, health-care seeking, and health equity. We argue that successful integration requires a person-centred approach, which is grounded in human rights, treats both concerns holistically, and reconnects with underlying social, economic, and political inequalities.

Adapting for the COVID-19 pandemic in Ecuador, a characterization of hospital strategies and patients.

The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19) a global pandemic on 11 March 2020. In Ecuador, the first case of COVID-19 was recorded on 29 February 2020. Despite efforts to control its spread, SARS-CoV-2 overran the Ecuadorian public health system, which became one of the most affected in Latin America on 24 April 2020. The Hospital General del Sur de Quito (HGSQ) had to transition from a general to a specific COVID-19 health center in a short period of time to fulfill the health demand from patients with respiratory afflictions. Here, we summarized the implementations applied in the HGSQ to become a COVID-19 exclusive hospital, including the rearrangement of hospital rooms and a triage strategy based on a severity score calculated through an artificial intelligence (AI)-assisted chest computed tomography (CT). Moreover, we present clinical, epidemiological, and laboratory data from 75 laboratory tested COVID-19 patients, which represent the first outbreak of Quito city. The majority of patients were male with a median age of 50 years. We found differences in laboratory parameters between intensive care unit (ICU) and non-ICU cases considering C-reactive protein, lactate dehydrogenase, and lymphocytes. Sensitivity and specificity of the AI-assisted chest CT were 21.4% and 66.7%, respectively, when considering a score >70%; regardless, this system became a cornerstone of hospital triage due to the lack of RT-PCR testing and timely results. If health workers act as vectors of SARS-CoV-2 at their domiciles, they can seed outbreaks that might put 1,879,047 people at risk of infection within 15 km around the hospital. Despite our limited sample size, the information presented can be used as a local example that might aid future responses in low and middle-income countries facing respiratory transmitted epidemics.

Genome sequencing of the first SARS-CoV-2 reported from patients with COVID-19 in Ecuador.

SARS-CoV-2, the etiological agent of COVID-19 was first described in Wuhan in December 2019 and has now spread globally. Ecuador was the second country in South America to report confirmed cases. The first case reported in Quito, the capital city of Ecuador, was a tourist who came from the Netherlands and presented symptoms on March 10th, 2020 (index case). In this work we used the MinION platform (Oxford Nanopore Technologies) to sequence the metagenome of the bronchoalveolar lavage (BAL) from this case reported, and subsequently we sequenced the whole genome of the index case and other three patients using the ARTIC network protocols. Our data from the metagenomic approach confirmed the presence of SARS-CoV-2 coexisting with pathogenic bacteria suggesting coinfection. Relevant bacteria found in the BAL metagenome were Streptococcus pneumoniae, Mycobacterium tuberculosis, Staphylococcus aureus and Chlamydia spp. Lineage assignment of the four whole genomes revealed three different origins. The variant HEE-01 was imported from the Netherlands and was assigned to B lineage, HGSQ-USFQ-018, belongs to the B.1 lineage showing nine nucleotide differences with the reference strain and grouped with sequences from the United Kingdom, and HGSQ-USFQ-007 and HGSQ-USFQ-010 belong to the B lineage and grouped with sequences from Scotland. All genomes show mutations in their genomes compared to the reference strain, which could be important to understand the virulence, severity and transmissibility of the virus. Our findings also suggest that there were at least three independent introductions of SARS-CoV-2 to Ecuador.

Chromosomal polymorphism and molecular variability in the pearly razorfish Xyrichtys novacula (Labriformes, Labridae): taxonomic and biogeographic implications.

The pearly razorfish Xyrichtys novacula (Linnaeus, 1758) is a sedentary benthic species distributed in both sides of the Atlantic Ocean and in the Mediterranean Sea. Previous cytogenetic analysis reported different diploid numbers in samples from Italy, Venezuela and Brazil. This research aims to test the hypothesis that samples from American Atlantic coast and Mediterranean Sea belong to the same single evolutionary lineage, characterized by intra-specific chromosome polymorphism. To this purpose a cytogenetic and molecular (mitochondrial COI sequences) survey was undertaken. Results revealed the existence of three different pearly razorfish molecular lineages: one present in Mediterranean Sea and two in the central and south American area, which are characterized by different karyotypes. One of these lineages shows substantial intra-population chromosomal polymorphism (2n = 45-48) determined by Robertsonian fusions that produce large metacentric chromosomes. On the whole data suggest that specimens morphologically identified as X. novacula correspond to three cryptic species.

Nasolabial propeller perforator flap: Anatomical study and case series.

PURPOSE: The previous cadaveric studies of facial artery perforators have frequently reported high variability, and those results remain to be validated in the Colombian population. Thus, we aimed to describe the vascular anatomy of the lateral nasal artery cutaneous branches and their clinical applications using Colombian cadavers. MATERIALS AND METHODS: Nine hemifaces from six fresh cadavers were included in the study. Terminal branches of the facial artery and cutaneous perforators of the lateral nasal artery were dissected. The quality, number, and distribution of the perforators were assessed. In addition, we present results of seven clinical cases for nasal alar reconstruction. RESULTS: Cutaneous perforators were found in all hemifaces, and zone 2 was the most common location. In our clinical case series, all flaps used to reconstruct the nasal alar defects survived. There were two cases of venous congestion but no additional procedures were needed. CONCLUSIONS: Although nasal alar reconstruction continues to be a challenging plastic surgery procedure, the nasolabial propeller perforator flap is an excellent choice for such because it allows a precise skin island design, is less bulky, has a wide arc of rotation, and facilitates one-staged reconstruction without increasing the rate of complications.

Cirugía de catarata en el paciente con fragilidad endotelial. Revisión de la literatura y aproximación para evaluación del riesgo / Cataract surgery in the patient with endothelial fragility. Review of the literature and approach for risk assessment

Propósito: Revisar Los factores de riesgo preoperatorios y quirúrgicos más importantes de daño corneal en pacientes que requieren cirugía de catarata y arrojar una herramienta para estratificar el riesgo y personalizar el abordaje quirúrgico. Diseño: Revisión de la literatura. Métodos: Se realizó una revisión de la literatura utilizando los siguientes términos DeCS: "fragilidad endotelial", "patología corneal" y "riesgo endotelial en cirugía de catarata" en los buscadores PubMed, Scopus, SciELO, Cochrane Library y Google Scholar. Además se utilizaron palabras clave como "endotelio corneal", "Distrofia endotelial de Fuchs", "Queratopatia bulosa pseudofaquica" y "descompensación corneal". Resultados: Un total de 39 artículos de 1978-2017 fueron revisados. Los mayores factores de riesgo de daño endotelial fueron identificados con énfasis en la distrofia endotelial de Fuchs. Con base en parámetros cuantitativos y cualitativos de la función endotelial, la dureza de la catarata y la profundidad de la cámara anterior, se diseñó la Matriz de Evaluación de Riesgo Endotelial para evaluar y asignar un puntaje a cada caso. Dependiendo del puntaje, el cirujano puede elegir entre opciones quirúrgicas como: procedimiento triple, técnicas libres de ultrasonido o facoemulsificación con protección endotelial. Conclusiones: La intersección entre fragilidad endotelial, dureza de la catarata y trauma endotelial en cirugía determina el riesgo de descompensación corneal. La valoración preoperatoria del riesgo usando la Matriz de Evaluación de Riesgo Endotelial tiene el potencial de ayudar en la selección del paciente y de la técnica quirúrgica.

Purpose: To review the most important pre-operative and surgical risk factors for endothelial damage in patients undergoing cataract surgery and to provide a tool for risk stratification and guidelines to customize the surgical approach. Design: Review of the literature. Methods: We performed a review of the literature using the following MeSH terms: "endothelial fragility", "corneal pathology" and "endothelial risk in cataract surgery" in PubMed, Scopus, SciELO, Cochrane Library and Google Scholar. In addition, keywords such as "corneal endothelium", "Fuchs' endothelial dystrophy", "pseudophakic bullous keratopathy" and "corneal decompensation" were used. Results: A total of 39 articles from 1978-2017 were reviewed. The major systemic, ocular and intraoperative factors causative of endothelial cell damage were identified, emphasizing on Fuchs' endothelial dystrophy. Based on selected qualitative and quantitative parameters of endothelial function, nuclear cataract density and anterior chamber depth, the Endothelial Risk Assessment Matrix was designed to evaluate each case and assign a particular score. Depending on the score, the surgeon can decide between options such as triple procedure, zero- ultrasound techniques or phacoemulsification with endothelial protection. Conclusions: The intersection of endothelial fragility, cataract hardness and intraoperative endothelial trauma determines the risk of corneal decompensation. Preoperative evaluation of endothelial risk by scoring with the Endothelial Risk Assessment Matrix has the potential to aid in patient selection and surgical customization.

Chlorination of lanthanum oxide.

The reactive system La(2)O(3)(s)-Cl(2)(g) was studied in the temperature range 260-950 °C. The reaction course was followed by thermogravimetry, and the solids involved were characterized by X-ray diffraction, scanning electron microscopy, and energy dispersive spectroscopy. The results showed that the reaction leads to the formation of solid LaOCl, and for temperatures above 850 °C, the lanthanum oxychloride is chlorinated, producing LaCl(3)(l). The formation of the oxychloride progresses through a nucleation and growth mechanism, and the kinetic analysis showed that at temperatures below 325 °C the system is under chemical control. The influence of diffusive processes on the kinetics of production of LaOCl was evaluated by studying the effect of the reactive gas flow rate, the mass of the sample, and the chlorine diffusion through the boundary layer surrounding the solid sample. The conversion curves were analyzed and fitted according to the Johnson-Mehl-Avrami description, and the reaction order with respect to the chlorine partial pressure was obtained by varying this partial pressure between 10 and 70 kPa. The rate equation was obtained, which includes the influence of the temperature, chlorine partial pressure, and reaction degree.

Reporte de un caso de tiña negra en Medellín / Report a case of tinea nigra in Medellín

Presentamos el caso de un paciente que consultó por una “mancha oscura” en la palma derecha. El examen microbiológico determinó que la infección había sido producida por el hongo pigmentado, Hortaea werneckii, agente etiológico de la tiña negra. Esta es una infección benigna que tiene tratamiento eficaz cuando se hace el diagnóstico adecuado. Mediante una técnica no invasiva es posible establecer un diagnóstico etiológico y descartar otras enfermedades más graves que se pueden confundir en el examen clínico.

Comparative cytogenetic and allozyme analysis of Mugil rubrioculus and M. curema (Teleostei: Mugilidae) from Venezuela

Se presentan los resultados del análisis comparativo citogenético y aloenzimático entre las especies simpátricas Mugil rubrioculus y M. curema de Venezuela. Los especímenes de M. rubrioculus presentan un cariotipo con 2n=48 cromosomas exclusivamente acrocéntricos (NF=48), NORs intersticiales localizados en el par cromosómico número 8 y heterocromatina constitutiva distribuida en posición pericentromérica en todos los cromosomas. Los especímenes de M. curema presentan características citogenéticas significativamente diferentes de M. rubrioculus en términos de número cromosómico y morfología (2n=24 cromosomas de dos brazos y NF=48) y localización de las NORs (región terminal del par metacéntrico más grande). El análisis electroforético en gel de almidón de 20 loci presuntivos reveló una diferenciación genética reducida entre las dos especies. De hecho, aún cuando un total de diez alelos específicos hayan sido identificados, no hay loci que no compartan alelos entre las dos especies y el valor de distancia genética (Nei) obtenido (D= 0,060) es más bajo que el obtenido entre otras especies congenéricas de mugílidos. Así, los datos citogenéticos y los alozímicos indican diversos grados de divergencia entre el M. rubrioculus y M. curema. Esto podría reflejar una subestimación de la divergencia molecular por variación críptica o diferentes tasas de evolución molecular y cromosómica. De cualquier manera, este estudio confirma el poder de los datos cariotípicos para discriminar especies de Mugilidae.

Cytogenetic analysis of three species of the genus Haemulon (Teleostei: Haemulinae) from Margarita Island, Venezuela.

This paper describes the karyotype analysis of Haemulon aurolineatum, Haemulon bonariensis and Haemulon plumierii, by Giemsa staining, C-banding, Ag-staining and fluorescent in situ hybridization (FISH), to locate the 18S and 5S rRNA genes. Diploid modal count in the three species was 2n = 48 acrocentric elements. Except for pair 24, which exhibited an unmistakable secondary constriction in all three species, it was not possible to classify them as homologous to each other because differences in chromosome size were too slight between adjacent pairs within a size-graded series. Ag-NOR clusters were located in pair 24 in the three species with signal located on the secondary constriction of these chromosomes. C-banding demonstrated that the three species share the same distribution pattern of the constitutive heterochromatin with centromeric heterochromatic blocks in the 23 chromosome pairs and a pericentromeric block in pair 24 which is coincident with the NORs. FISH experiments showed that 18S rDNA sequences were located coincident with the Ag-NOR site in the three species; however, differences in both the number and chromosome distribution of 5S-rDNA cluster were detected among them. Our data suggest that chromosome evolution of Haemulon has been preserved from major changes in the karyotypic macrostructure, whereas microstructural changes have occurred.

Intubación orotraqueal en pacientes con sospecha de trauma cervical con Airtraq. Reporte de dos casos / Orotraqueal Intubación in patients with suspicion of cervical trauma with Airtraq. Report of two cases

El AIRTRAQ® es un dispositivo óptico de intubación orotraqueal, de uso único, que permite una completa visualización d la glotis sin requerir la hiperextensión cervical. Presentamos 2 casos de pacientes con sospecha de trauma cervical en los que se utiliza este dispositivo con diferentes resultados y se discute el manejo de la vía aérea difícil anticipada en este contexto...

Corneal keloid mimicking a recurrent limbal dermoid.

We report a 12-year-old boy who presented with the clinical appearance of a limbal dermoid recurrence. Histologic study of the lesion revealed it to be a corneal keloid. In the event of a recurrent mass following dermoid excision, keloid should be considered in the differential diagnosis.