Experiencias de pacientes COVID-19 en su transición por cuidados intensivos: un enfoque fenomenológico

Introducción: La enfermedad por coronavirus desencadena en algunas ocasiones la hospitalización de los pacientes en un área crítica, convirtiéndose en un acontecimiento incierto y desconocido. Objetivo: Explorar las experiencias de pacientes Covid-19 en su transición por cuidados intensivos en la ciudad de Santo Domingo de los Tsáchilas en Ecuador. Métodos: Estudio cualitativo con diseño fenomenológico, se realizó un muestreo por conveniencia en el que participaron ocho pacientes que estuvieron hospitalizados en el área mencionada, a los cuales se aplicó entrevistas semiestructuradas. Resultados: Se obtuvieron las categorías: Aceptación frente al ingreso a la unidad de cuidados intensivos, Sentimientos ante la muerte, Incertidumbre por su enfermedad durante la hospitalización, Valorar la vida posterior al egreso, Sentimientos positivos al egresar de la unidad de cuidado intensivo, Sentimientos negativos al ingresar a la unidad de cuidado intensivo, Permanecer aislado de la familia, Acercamiento a Dios y a la familia y Fortalecimiento de vínculo entre enfermero-paciente. Conclusiones: Ingresar a la unidad de cuidados intensivos generó sentimientos negativos en los pacientes, al ocasionar inseguridad sobre el futuro de los mismos. De modo similar, durante su hospitalización presentaron temor a la muerte e incertidumbre por la enfermedad, sin embargo, tuvieron mecanismos de afrontamiento como el aferrarse a Dios, a la familia y contar con el cuidado de enfermería. En cuanto al egreso de los pacientes, manifestaron alegría y felicidad, valorando una nueva oportunidad de vida.

Introduction: Coronavirus disease sometimes triggers hospitalization of patients in a critical area, becoming an uncertain and unknown event. Objective: To explore the experiences of Covid-19 patients in their transition through intensive care in the city of Santo Domingo de los Tsáchilas in Ecuador. Methods: Qualitative study with phenomenological design, a convenience sampling was carried out with the participation of 8 patients who were hospitalized in the aforementioned area, to whom semi-structured interviews were applied. Results : The following categories were obtained: Acceptance of admission to the intensive care unit, Feelings about death, Uncertainty about their illness during hospitalization, Valuing life after discharge, Positive feelings upon discharge from the intensive care unit, Negative feelings upon admission to the intensive care unit, Remaining isolated from the family, Closeness to God and the family and Strengthening of the nurse-patient bond. Conclusions: Entering the intensive care unit generated negative feelings in patients, causing insecurity about their future. Similarly, during their hospitalization they presented fear of death and uncertainty about the disease; however, they had coping mechanisms such as clinging to God, to the family and counting on nursing care. As for the patients' discharge, they expressed joy and happiness, valuing a new opportunity in life.

Estrés académico en estudiantes de Enfermería durante la pandemia: retos, afrontamientos, perspectivas inmediatas / Academic stress in Nursing students during the pandemic: challenges, coping, immediate perspectives

Introducción: la COVID-19 ha sido un reto considerable para obtener una formación de elevada calidad para los discentes del área de Enfermería porque las universidades continuaban con normas, estrategias anticuadas que no respondían a los cambios. Objetivo: exponer los elementos teóricos relacionados con el estrés académico en los estudiantes de Enfermería, el afrontamiento durante el proceso enseñanza aprendizaje en tiempos de pandemia de COVID-19 y cuáles han sido las estrategias llevadas a cabo por las instituciones de educación superior. Métodos: se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo sobre el contenido de las bibliografías, con una búsqueda documental basada en los 32 artículos científicos originales previamente seleccionados, publicaciones en idioma inglés, español y portugués en las bases de datos Scopus, Pubmed, Dialnet, Scielo, Elsevier, Latindex y Web of Science. Las palabras claves utilizadas fueron: estrés, academia, resiliencia, pandemia y enseñanza virtual. Desarrollo: el cambio del entorno presencial al virtual provocó un viraje significativo en el desarrollo del modo de enseñanza aprendizaje generando estrés, por lo que se deben manejar protocolos de atención para los estudiantes. Conclusiones: la academia fue sorprendida por la pandemia, como sucedió con la población en general. No se articularon suficientes estrategias para poder enfrentar las diferentes situaciones que generaron el estrés académico. Es necesario abordar la resiliencia para todas las eventualidades de salud.

Introduction: COVID-19 has been a considerable challenge to obtain high-quality training for students in the Nursing area because universities continued with norms, outdated strategies that did not respond to changes. Objective: to analyse the characteristics of academic stress in Nursing students during the teaching-learning process in times of the COVID-19 pandemic. Methods: a systematic bibliographic review was carried out to develop a reflective critical analysis on the content of the bibliographies, with a documentary search based on the 32 previously selected original scientific articles, publications in English, Spanish and Portuguese in the Scopus databases, Pubmed, Dialnet, Scielo, Elsevier, Latindex, and Web of Science. The keywords used were stress, academy, resilience, pandemic, and virtual teaching. Development: the change from the face-to-face to the virtual environment caused a significant shift in the development of the teaching-learning mode, generating stress, for which reason care protocols for students must be managed. Conclusions: the academy was surprised by the pandemic, as it happened with the general population. Not enough strategies were articulated to be able to face the different situations that generated academic stress. Resilience needs to be addressed for all health eventualities.

Lisado plaquetario en el tratamiento de la fisura anal crónica y otras indicaciones / Platelet lysate in the treatment of chronic anal fissure and other indications

Introducción: La aplicación del lisado plaquetario alogénico en el tratamiento de la fisura anal crónica es uno de los temas más novedosos y excitantes dentro de las ciencias biomédicas hoy día. Objetivo: Exponer en forma resumida los avances y perspectivas de empleo del lisado plaquetario alogénico en la fisura anal. Métodos: La estrategia de búsqueda abarcó información en diferentes bases de datos como internet y en el buscador google académico, se utilizaron 42 bibliografías seleccionadas para realizar la revisión, 35 publicadas en los últimos cinco años como artículos originales de revisión, monografías y otros documentos científicos especializados en el tema. A partir de la búsqueda se elaboró el presente artículo. Desarrollo: Se hace alusión a la conceptualización de la enfermedad y los pilares terapéuticos, se sustenta la utilización del lisado plaquetario alogénico; los logros alcanzados con su aplicación en el Hospital General Docente Comandante Pinares; del municipio San Cristóbal en la provincia Artemisa en la especialidad; así como a las potencialidades de tan promisorio campo en el presente siglo. Conclusiones: El Lisado plaquetario alogénico en el tratamiento de la fisura anal crónica constituyó una nueva modalidad de tratamiento de la enfermedad(AU)

Introduction: The application of allogeneic platelet lysate in the treatment of chronic anal fissure is one of the most novel and exciting topics within biomedical sciences today. Objective: To summarize the advances and perspectives of the use of allogeneic platelet lysate in anal fissure. Methods: The search strategy included information in different databases such as the internet and the academic google search engine, 42 bibliographies selected for the review were used, 35 published in the last five years as original review articles, monographs and other scientific documents specialized in the subject. The present article was prepared on the basis of the search. Development: Allusion is made to the conceptualization of the disease and the therapeutic pillars, the use of allogeneic platelet lysate is sustained; the achievements reached with its application in the General Teaching Hospital Comandante Pinares; of San Cristóbal municipality in Artemisa province in the specialty; as well as to the potential of such promising field in the present century. Conclusions: Allogeneic platelet lysate in the treatment of chronic anal fissure constituted a new modality of treatment of the disease(AU)

Percepciones del cuidado espiritual de enfermería por pacientes recuperados por Covid-19. Una exploración fenomenológica

Objetivo: Explorar el cuidado espiritual brindado por los profesionales de enfermería en el servicio de emergencia del Hospital General Machala desde la perspectiva de los pacientes infectados por Covid-19. Material y Métodos: Investigación cualitativa, fenomenológica. Se utilizó un muestro intencional para seleccionar a 8 pacientes recuperados por Covid-19. La recolección de los datos se obtuvo mediante entrevistas semiestructurada a profundidad. La transcripción se realizó manualmente lo antes posible. Para el análisis de los datos se utilizó el método creado por Colaizzi. Resultados: Se obtuvieron cuatro categorías principales: 1) Factores de sufrimiento espiritual en los pacientes con Covid-19; 2) Necesidades espirituales de los pacientes con Covid-19; 3) Satisfacción del cuidado espiritual brindado por enfermería; y, 4) Principales barreras percibidas del cuidado Espiritual. Conclusión: Se evidenció que los pacientes recuperados por Covid-19 percibieron experiencias tanto positivas como negativas relacionado con el cuidado espiritual, siendo este un componente clave para evaluar las necesidades espirituales. Sugerimos utilizar los hallazgos encontrados en este estudio para que futuras investigaciones desarrollen un programa estructurado y supervisado por expertos para mejorar el cuidado espiritual en la atención sanitaria.

Objective: To explore the spiritual care provided by the nursing professionals in the emergency service of the Hospital General Machala from the perspective of patients infected by Covid-19. Material and Methods: Qualitative, phenomenological research. An intentional sample was used to select 8 patients recovered from Covid-19. Data collection was obtained through in-depth semi-structured interviews. Transcription was done manually as soon as possible. For data analysis, the method created by Colaizzi was used. Results: Four main categories were obtained: 1) Factors of spiritual suffering in patients with Covid-19; 2) Spiritual needs of Covid-19 patients; 3) Satisfaction of the spiritual care provided by nursing; and, 4) Main barriers perceived to spiritual care. Conclusion: It was shown that patients recovered from Covid-19 perceived both positive and negative experiences related to spiritual care, this being a key component to assess spiritual needs. We suggest using the findings found in this study for future research to develop a structured program supervised by experts to improve spiritual care in health care.

El éxito de las Prácticas pre-profesionales: ¿De qué depende? / Success of pre-professional practices: ¿What does it depend on?

Introducción: La formación profesional sigue siendo uno de los factores críticos al momento de analizar la relación entre calidad de la educación y el desempeño profesional de los maestros, las prácticas preprofesionales son un eslabón fundamental en dicha relación. Objetivo: Analizar cómo se lleva a cabo el proceso de gestión y desarrollo de las prácticas preprofesionales por las instituciones educativas y con ello se constate la posibilidad de existencia o no de algún modelo que establezca la especificidad de tan relevante actividad. Material y Métodos: Se realizó una búsqueda documental/bibliográfica en relación con nuestra variable de estudio "prácticas preprofesionales" de un total de 70 artículos, pertenecientes a las bases de datos: Scopus, Scielo, Dialnet y ERIHPLUS, que fueron analizados de manera inductiva, tras la aplicación de los criterios de inclusión y exclusión se abordó el estudio con de 26. Resultados: Se establece una descripción de datos de revistas indexadas donde se explican las principales características de las prácticas preprofesionales en el ámbito educativo general y en la Educación Médica superior, desde la concepción, organización hasta su evaluación. Se explica el papel generador de esta importante actividad en el proceso de formación de los futuros profesionales; así como de sus falencias y limitaciones. Cuestión que urge resolver por parte de las instituciones de educación superior con la consecuente y necesaria creación de modelos administrativos que pauten tan loable tarea. Conclusiones: La educación médica debe replantearse nuevas formas de enseñanza aprendizaje que mejoren el desarrollo del internado rotativo, una pandemia lo ha evidenciado. No constatamos modelos administrativos, gerenciales, entre otros, únicos que reúnan los criterios para ejecutar tan valioso programa o que pauten dicha actividad(AU)

Introduction : Professional training continues to be one of the critical factors for the analysis of the relationship between the quality of education and the teachers' professional performance, including pre-professional practices as an essential link in this relationship. Objective : To analyze how the process of management and development of pre-professional practices is carried out by educational institutions in an attempt to prove the possibility of the existence of a model that establishes the specificity of such relevant activity. Material and Methods : A bibliographic and documentary search that included "pre-professional practices" as our study variable was carried out on 70 articles belonging to Scopus, Scielo, Dialnet and ERIHPLUS databases. All the articles were inductively analyzed. After applying the inclusion and exclusion criteria, the study was undertaken to address the topic in a total of 26 articles. Results : A description of data is established among indexed journals that explain the main characteristics of pre-professional practices in the general educational field and the higher medical education which go from their conception and organization until their evaluation. The generating role of this important activity in the training process of future professionals, as well as its shortcomings and limitations are explained. This is an urgent issue to be solved by the centers of higher education with the consequent and necessary creation of administrative models aimed at guiding such a praiseworthy task. Conclusions : The medical education should consider new forms of teaching and learning aimed at improving the rotating internship, which has been evidenced during the course of the pandemic. Administrative, management, unique models, as well as others that meet the criteria to implement such a valuable program or guide the above-mentioned activity have not been observed in our analysis(AU)

Metabolic shifts during fruit development in pungent and non-pungent peppers.

Fruit pungency is caused by the accumulation of capsaicinoids, secondary metabolites whose relation to primary metabolism remains unclear. We have selected ten geographically diverse accessions of Capsicum chinense Jacq with different pungency levels. A detailed metabolic profile was conducted in the fruit placenta and pericarp at 20, 45, and 60 days after anthesis aiming at increasing our understanding of the metabolic changes in these tissues across fruit development and their potential connection to capsaicin metabolism. Overall, despite the variation in fruit pungency among the ten accessions, the composition and metabolite levels in both placenta and pericarp were uniformly stable across accessions. Most of the metabolite variability occurred between the fruit developmental stages rather than among the accessions. Interestingly, different metabolite adjustments in the placenta were observed among pungent and non-pungent accessions, which seem to be related to differences in the genetic background. Furthermore, we observed high coordination between metabolites and capsaicin production in C. chinense fruits, suggesting that pungency in placenta is adjusted with primary metabolism.

Formación del docente de Enfermería en metodologías activas de aprendizajes: ¿Es necesario en los saberes? / Nursing teacher training in active learning methodologies: ¿Is it necessary for knowledge?

Introducción: La formación del docente de Enfermería tiene ante sí el reto de su profesionalización, en un mundo caracterizado por la globalización, un acelerado desarrollo de la ciencia, las tecnologías y complejos procesos de cambios que requieren de nuevas transformaciones del conocimiento; es una necesidad la actualización de saberes más avanzados en metodologías activas en el docente de enfermería como un proceso continuo y simultáneo para alcanzar multihabilidades y valores. Objetivo: Describir los aspectos fundamentales que conforman el proceso de formación del docente de Enfermería en metodologías activas de aprendizajes en las instituciones de educación superior. Material y Métodos: El presente estudio es de diseño descriptivo, con un análisis de la información de manera inductiva, se examinaron 76 textos en las bases de datos Scopus, Scielo, Eric, empleadas como fuentes de investigación. Tras aplicar los criterios de inclusión y exclusión se abordó el estudio con un total de 27 artículos. Conclusiones: Todas las profesiones, oficios se verán afectados de una manera u otra en esta crucial avanzada por lo que es imprescindible el papel de las instituciones de educación superior en la emergente implementación y enseñanza de las metodologías activas que hoy anhelan ser aplicadas de manera insoslayable en los diferentes saberes; la profesión y ciencia de Enfermería no está exenta de ello; lo que busca un proceso transformador de profesionales competentes hacia una sociedad laboral competitiva(AU)

Introduction: Nursing teacher training is a professional challenge in a world characterized by globalization, accelerated development of science and technologies and complex processes of change that require new transformations of knowledge; an updating of the most advanced knowledge in active methodologies for nursing professors as a continuous and simultaneous process to promote multi-abilities and values is a must. Objective: To describe the main aspects that make up the Nursing teacher training process in active learning methodologies in higher education centers. Material and Methods: Descriptive study with an inductive content analysis. A total of 76 bibliographies were examined in the Scopus, Scielo, and Eric databases, which were used as research sources. After applying the inclusion and exclusion criteria, the study was approached with a total of 27 articles. Conclusions: All professions and experiences will be affected in one way or another in this crucial advance, so the role of higher education centers is essential in the emerging implementation and teaching of active methodologies that today yearn to be applied in an unavoidable way in the different fields of knowledge. The profession and Nursing science is not exempt from this trend and looks for a transforming process of competent professionals towards a competitive society of labor(AU)

[Levels of 25 hydroxy vitamin D of serum and broncho-alveolar lavage in patients with pulmonary tuberculosis]. / Concentraciones de 25 hidroxi vitamina D séricas y en lavado bronco-alveolar en pacientes con tuberculosis pulmonar.

BACKGROUND: Alteration of vitamin D is a risk factor for tuberculosis (TB). AIM: To evaluate the pulmonary and serum levels of 25-hydroxy vitamin D (25OHD) in patients with and without pulmonary TB. METHODS: Two-stage study: the first part was retrospective cross-sectional and the second prospective. Those > 18 years of age who underwent fiberoptic bronchoscopy for suspected pulmonary TB and in whom the infection was confirmed were included. Patients with another type of infection without TB and non-infectious diseases were taken as controls for the first stage and infectious controls without TB in the prospective phase. The measurement of 25OHD was performed by ELFA (enzyme-linked fluorescence assay). The Kruskal-Wallis test was used to evaluate association, considering a value of p < 0.05 to be significant. The data were processed with the SPSS version 23 program. RESULTS: The total sample was 77 patients (35 in the first stage and 42 in the second). The characteristics between the groups were homogeneous. Serum (second phase) and broncho-alveolar lavage (first and second phase) levels of 25OHD were lower in TB patients compared to controls and were independent of serum calcium level (serum: 22.4 ng/mL vs 33 ng/mL, p = 0.006 and broncho-alveolar lavage: 9.7 ng/mL vs 12.2 ng/mL; p = 0.012). CONCLUSIONS: There was a significant difference between the levels of 25OHD in both serum and broncho-alveolar lavage in patients with pulmonary TB in relation to their controls.

Quantitative and qualitative evaluation of the COMPASS mobile app: a citizen science project.

To evaluate the usability of the COMPASS application with mixed-methodology, using a citizen science approach. Parents/tutors of 10-11 years old children attending a primary school in Barcelona, Spain, were invited to take part in the study. We conducted semi-structured interviews on a subset (n = 7) of participants, two weeks after using the app for the first time. A list of suggestions of improvement was extracted from the interviews. The System Usability Scale (SUS, range 0-100) was administered to all participants before and after the improvements were implemented. We provide both a quantitative analysis (t-test of change in SUS scores) and a qualitative thematic analysis of the interviews. A total of 22 participants were included in the study. The mean score before implementation of changes was 68.5 (Standard deviation, SD = 11.1), and improved to 73.1 (10.5) (p-value = 0.025). Regarding the qualitative assessment, we obtained 24 codes and grouped them into 3 categories. It uncovered problems in the installation phase and the main barriers to use: lack of time and the need for the app to evolve. The new version of COMPASS, improved by taking into account the participants' comments and suggestions, was more usable than the initial version.

Downregulation of the E2 Subunit of 2-Oxoglutarate Dehydrogenase Modulates Plant Growth by Impacting Carbon-Nitrogen Metabolism in Arabidopsis thaliana.

In Arabidopsis thaliana, two genes encode the E2 subunit of the 2-oxoglutarate dehydrogenase (2-OGDH), a multimeric complex composed of three subunits. To functionally characterize the isoforms of E2 subunit, we isolated Arabidopsis mutant lines for each gene encoding the E2 subunit and performed a detailed molecular and physiological characterization of the plants under controlled growth conditions. The functional lack of expression of E2 subunit isoforms of 2-OGDH increased plant growth, reduced dark respiration and altered carbohydrate metabolism without changes in the photosynthetic rate. Interestingly, plants from e2-ogdh lines also exhibited reduced seed weight without alterations in total seed number. We additionally observed that downregulation of 2-OGDH activity led to minor changes in the levels of tricarboxylic acid cycle intermediates without clear correlation with the reduced expression of specific E2-OGDH isoforms. Furthermore, the e2-ogdh mutant lines exhibited a reduction by up to 25% in the leaf total amino acids without consistent changes in the amino acid profile. Taken together, our results indicate that the two isoforms of E2 subunit play a similar role in carbon-nitrogen metabolism, in plant growth and in seed weight.

Concentraciones de 25 hidroxi vitamina D séricas y en lavado bronco-alveolar en pacientes con tuberculosis pulmonar / Levels of 25 hydroxy vitamin D of serum and broncho-alveolar lavage in patients with pulmonary tuberculosis

INTRODUCCIÓN: La alteración de la vitamina D es un factor de riesgo para enfermar de tuberculosis (TBC). OBJETIVO: Evaluar la concentración pulmonar y sérica del compuesto 25-hidroxi-vitamina D (25OHD) en pacientes con y sin TBC pulmonar. METODOLOGÍA: Estudio de dos etapas: la primera parte fue de corte transversal, retrospectiva, y la segunda prospectiva. Se incluyeron > 18 años a los que se les realizó fibrobroncoscopia por sospecha de TBC pulmonar y en quienes se confirmó la infección. Se tomaron como controles a pacientes con otro tipo de infección no TBC, y enfermedades no infecciosas para la primera etapa y controles infecciosos sin TBC en la fase prospectiva. La medición de 25OHD se realizó mediante ELFA (ensayo de fluorescencia ligado a enzima). Se empleó la prueba de Kruskal-Wallis para evaluar asociación considerando significativo un valor de p < 0,05. Los datos se procesaron con el programa SPSS versión 23. RESULTADOS: La muestra total fue de 77 pacientes (35 en la primera etapa y 42 en la segunda). Las características entre los grupos fueron homogéneas. Las concentraciones en suero (segunda fase) como en el lavado bronco-alveolar (primera y segunda fase) de 25OHD fueron más bajas en pacientes con TBC comparado con los controles e independientes de la concentración de calcio sérico (suero: 22,4 ng/mL vs 33 ng/mL, p = 0,006 y lavado bronco-alveolar: 9,7 ng/mL vs 12,2 ng/mL; p = 0,012). CONCLUSIONES: Hubo una diferencia significativa entre las concentraciones de 25OHD, tanto en suero como en lavado bronco-alveolar, en pacientes con TBC pulmonar con relación a sus controles.

BACKGROUND: Alteration of vitamin D is a risk factor for tuberculosis (TB). AIM: To evaluate the pulmonary and serum levels of 25-hydroxy vitamin D (25OHD) in patients with and without pulmonary TB. METHODS: Two-stage study: the first part was retrospective cross-sectional and the second prospective. Those > 18 years of age who underwent fiberoptic bronchoscopy for suspected pulmonary TB and in whom the infection was confirmed were included. Patients with another type of infection without TB and non-infectious diseases were taken as controls for the first stage and infectious controls without TB in the prospective phase. The measurement of 25OHD was performed by ELFA (enzyme-linked fluorescence assay). The Kruskal-Wallis test was used to evaluate association, considering a value of p < 0.05 to be significant. The data were processed with the SPSS version 23 program. RESULTS: The total sample was 77 patients (35 in the first stage and 42 in the second). The characteristics between the groups were homogeneous. Serum (second phase) and broncho-alveolar lavage (first and second phase) levels of 25OHD were lower in TB patients compared to controls and were independent of serum calcium level (serum: 22.4 ng/mL vs 33 ng/mL, p = 0.006 and broncho-alveolar lavage: 9.7 ng/mL vs 12.2 ng/mL; p = 0.012). CONCLUSIONS: There was a significant difference between the levels of 25OHD in both serum and broncho-alveolar lavage in patients with pulmonary TB in relation to their controls.

Análisis cuantitativo, uso de Escala Braden por enfermería en el servicio de Medicina Interna del Hospital Santo Domingo / Quantitative analysis of the use of Braden Scale by nursing in the Internal Medicine service of the Hospital Santo Domingo

Resumen El objetivo de este estudio fue evaluar, mediante un análisis cuantitativo, el uso y aplicación de la Escala de Braden por el personal de enfermería en pacientes de medicina interna del Hospital Santo Domingo, año 2018. Es un estudio cuantitativo, transversal y descriptivo; la población total fue de 1017 pacientes con una muestra de 30 (12 masculinos y 18 feminas), ingresados al área de medicina interna del Hospital General Santo Domingo, provincia Santo Domingo de los Tsáchilas, de julio a agosto del 2018. Se les realizó una revisión de su historia clínica para conocer el puntaje que determinaba el riesgo de desarrollar úlceras por presión (UPP), según la valoración que recibieron mediante la escala. Durante la aplicación de la Escala de Braden, se pronosticó riesgo bajo a 15 pacientes, riesgo medio a 10 y riesgo alto a 5, quienes presentaron alteraciones neurológicas o enfermedades crónicas como: accidente cerebrovascular, diabetes mellitus, cirrosis hepática. Se concluye que el personal de enfermería no realiza una aplicación adecuada de la Escala de Braden ni desde el ingreso del paciente ni durante su reevaluación en el servicio de medicina interna, lo que trae consigo que la atención no se realice con la calidad requerida. Factor favorable para complicaciones como las UPP.

Abstract The objective of this study was to evaluate, through a quantitative analysis, the use and application of the Braden Scale by the nursing staff in internal medicine patients of the Santo Domingo Hospital, year 2018. It is a quantitative, cross-sectional and descriptive study; The total population was 1017 patients with a sample of 30 (12 males and 18 females), admitted to the internal medicine area of the Santo Domingo General Hospital, Santo Domingo de los Tsáchilas province, from July to August 2018. They underwent a review of their medical history to know the score that determined the risk of developing pressure ulcers (UPP), according to the assessment they received using the scale. During the application of the Braden Scale, low risk was predicted for 15 patients, medium risk for 10 and high risk for 5, who presented neurological disorders or chronic diseases such as: stroke, diabetes mellitus, liver cirrhosis. It is concluded that the nursing staff does not carry out an adequate application of the Braden Scale, neither since the patient's admission nor during his reevaluation in the internal medicine service, which means that the care is not performed with the required quality. Favorable factor for complications such as UPP.

Resumo O objetivo deste estudo foi avaliar, por meio de uma análise quantitativa, o uso e a aplicação da Escala de Braden pela equipe de enfermagem em pacientes de medicina interna do Hospital Santo Domingo, ano de 2018. Trata-se de um estudo quantitativo, transversal e descritivo; A população total foi de 1017 pacientes, com uma amostra de 30 (12 homens e 18 mulheres), admitidos na área de medicina interna do Hospital Geral de Santo Domingo, província de Santo Domingo de los Tsáchilas, de julho a agosto de 2018. Eles foram submetidos a uma revisão do histórico médico para conhecer o escore que determinou o risco de desenvolver úlceras por pressão (UPP), de acordo com a avaliação que receberam usando a escala. Durante a aplicação da Escala de Braden, foram previstos baixo risco para 15 pacientes, risco médio para 10 e alto risco para 5, que apresentavam distúrbios neurológicos ou doenças crônicas como: acidente vascular cerebral, diabetes mellitus, cirrose hepática. Conclui-se que a equipe de enfermagem não realiza uma aplicação adequada da Escala de Braden, nem desde a admissão do paciente nem durante sua reavaliação no serviço de medicina interna, o que significa que o cuidado não é realizado com a qualidade exigida. Fator favorável a complicações como UPP.

Aneurisma de arteria pulmonar: un hallazgo incidental / Pulmonary artery aneurysm: an incidental finding

Resumen Los aneurismas de la arteria pulmonar son entidades infrecuentes y su tratamiento es tema de discusión. Desde el punto de vista etiológico pueden ser congénitos o adquiridos. Los primeros, generalmente se asocian a malformaciones cardiacas que producen hipertensión pulmonar, siendo el ductus arterioso la más frecuente. Otras anomalías incluyen defectos auriculares o ventriculares. Las causas adquiridas pueden ser idiopáticas o estar asociadas a infecciones (tuberculosis, sífilis), traumatismos o colagenopatías. Presentamos el caso de una mujer de 62 años, quien consultó por un cuadro clínico en el que se destacaba su sintomatología neurológica e infecciosa, con posterior progresión a un choque séptico y en quien los hallazgos de las imágenes mostraron un aneurisma gigante de la arteria pulmonar siendo este un hallazgo incidental y sin relación a la sintomatología de la paciente.

Abstract Aneurysms of the pulmonary artery are rare entities and their treatment is a matter of discussion. From the etiological point of view, they can be congenital or acquired. Those in the first group are generally associated with cardiac malformations that generate pulmonary hypertension, with the ductus arteriosus being the most frequent. Other abnormalities include atrial or ventricular defects. The acquired causes may be idiopathic or associated with infections (tuberculosis, syphilis), trauma, or collagen disease. We present the case of a 62-year-old woman, which consulted for a clinical condition where neurological and infectious symptoms stood out, with subsequent progression to a state of septic shock, and in whom the imaging finding showed a giant pulmonary artery aneurysm. this being an incidental finding and unrelated to the patient's symptoms.

Biochemical and functional characterization of a mitochondrial citrate carrier in Arabidopsis thaliana.

A homolog of the mitochondrial succinate/fumarate carrier from yeast (Sfc1p) has been found in the Arabidopsis genome, named AtSFC1. The AtSFC1 gene was expressed in Escherichia coli, and the gene product was purified and reconstituted in liposomes. Its transport properties and kinetic parameters demonstrated that AtSFC1 transports citrate, isocitrate and aconitate and, to a lesser extent, succinate and fumarate. This carrier catalyzes a fast counter-exchange transport as well as a low uniport of substrates, exhibits a higher transport affinity for tricarboxylates than dicarboxylates, and is inhibited by pyridoxal 5'-phosphate and other inhibitors of mitochondrial carriers to various degrees. Gene expression analysis indicated that the AtSFC1 transcript is mainly present in heterotrophic tissues, and fusion with a green-fluorescent protein localized AtSFC1 to the mitochondria. Furthermore, 35S-AtSFC1 antisense lines were generated and characterized at metabolic and physiological levels in different organs and at various developmental stages. Lower expression of AtSFC1 reduced seed germination and impaired radicle growth, a phenotype that was related to reduced respiration rate. These findings demonstrate that AtSFC1 might be involved in storage oil mobilization at the early stages of seedling growth and in nitrogen assimilation in root tissue by catalyzing citrate/isocitrate or citrate/succinate exchanges.

Green nanotechnology-based drug delivery systems for osteogenic disorders.

Introduction: Current treatments for osteogenic disorders are often successful, however they are not free of drawbacks, such as toxicity or side effects. Nanotechnology offers a platform for drug delivery in the treatment of bone disorders, which can overcome such limitations. Nevertheless, traditional synthesis of nanomaterials presents environmental and health concerns due to its production of toxic by-products, the need for extreme and harsh raw materials, and their lack of biocompatibility over time.Areas covered: This review article contains an overview of the current status of treating osteogenic disorders employing green nanotechnological approaches, showing some of the latest advances in the application of green nanomaterials, as drug delivery carriers, for the effective treatment of osteogenic disorders.Expert opinion: Green nanotechnology, as a potential solution, is understood as the use of living organisms, biomolecules and environmentally friendly processes for the production of nanomaterials. Nanomaterials derived from bacterial cultures or biomolecules isolated from living organisms, such as carbohydrates, proteins, and nucleic acids, have been proven to be effective composites. These nanomaterials introduce enhancements in the treatment and prevention of osteogenic disorders, compared to physiochemically-synthesized nanostructures, specifically in terms of their improved cell attachment and proliferation, as well as their ability to prevent bacterial adhesion.

Conocimiento y prácticas del profesional de enfermería sobre prevención de neumonía asociada a ventilación mecánica / Knowledge and practice of nursing personnel in the prevention of mechanical ventilation associated pneumonia

RESUMEN Fundamento: la neumonía asociada a ventilación mecánica representa uno de los mayores problemas en las unidades de cuidados intensivos debido a que agrava el cuadro clínico del paciente, prolonga su estancia en el hospital e incrementa el costo, por todo esto es que el personal de enfermería es el principal actor en el control de estas infecciones ya que estos son eventos asociados a la asistencia sanitaria y en su mayoría prevenibles. Objetivo: evaluar el conocimiento y la práctica del personal de enfermería acerca de las medidas de prevención de neumonía nosocomial en los pacientes con ventilación mecánica. Métodos: se realizó un estudio transversal con enfoque cuantitativo durante el 1ro de junio hasta 31 agosto de 2018, la población de estudio fueron el personal de enfermería de la unidad de cuidados intensivos constituida por 22 enfermeros a los que se les aplicó un cuestionario y una guía de observación estructurada. Resultados: de los enfermero/as evaluados, se evidencia que poseen conocimientos teóricos y prácticos, se resalta los relacionados con el uso de barreras de protección, posición adecuada para realizar la aspiración endotraqueal así como la frecuencia en que se debe aplicar. Conclusiones: existe un adecuado conocimiento teórico y desempeño práctico del personal de enfermería en la atención al paciente crítico ventilado, donde se evidencia que la cantidad de la experiencia laboral no afecta la calidad del cuidado brindada a los pacientes.

ABSTRACT Background: ventilator associated pneumonia represents one of the major problems in the intensive care unit due to the fact that it aggravates the patient's clinical condition, prolongs hospital stay and increases the cost of hospitalization. As infection is preventable and healthcare related, its control is mainly attributed to the nursing staff. Objective: to evaluate the knowledge and nursing practice involved in the methods of prevention of hospital acquired pneumonia in patients with mechanical ventilation. Methods: a quantitative, cross-sectional study was employed from June 1st until August 31st, 2018. A structured, observational guide and a questionnaire was applied to the population composed of 22 nursing personnel in the intensive care unit. Results: of the evaluated nurses, it was found out that they possess knowledge of both theory and practice, particularly, regarding the use of protective barriers, correct position for endotracheal aspiration and as well as the number of times the procedure should be applied. Conclusions: adequate knowledge about theory and practice exists among nurses who attended mechanically ventilated patients in critical condition. Moreover, the quantity of nursing work experience does not affect the quality of care given to the patients.

Uso de la medicina no convencional por pacientes diabéticos / Use of non-conventional medicine for patients with diabetes

RESUMEN Fundamento: el interés en las terapias alternativas utilizadas por las personas con diferentes enfermedades ha crecido de manera considerable en los últimos tiempos. Se estima que un gran porcentaje de las personas en regiones menos desarrolladas emplean la medicina tradicional con plantas para el cuidado de la salud. Objetivo: determinar el uso de medicina no convencional en pacientes diabéticos. Métodos: se realizó un estudio observacional descriptivo de corte transversal, dirigido a pacientes que pertenecen al club de diabéticos del Centro Clínico Quirúrgico Hospital del Día Santo Domingo, Ecuador, desde el 5 de junio hasta el 31 de julio de 2018. La población universo estuvo compuesta de 1 300 personas. De acuerdo a los criterios de inclusión y exclusión. Se obtuvo una muestra de 100 personas a las cuales se les aplicó la encuesta como instrumento de investigación. Resultados: se identificó que el sexo femenino fue el que más predominó. De esta población la mayor parte utiliza la medicina no convencional por costumbres familiares. La fitoterapia fue la más conocida y más empleada por los pacientes diabéticos. Las plantas medicinales de mayor uso fueron: Insulina (Costus igneus) y la Zarzgoza (Glycyrrhiza glabra). Conclusiones: se constató que la población diabética hace uso de la medicina no convencional para el tratamiento de su enfermedad, la misma en pocas ocasiones es recomendada por el médico, aunque no se notificaron efectos adversos algunos, la fitoterapia y la acupuntura son las más utilizadas.

ABSTRACT Background: in recent years, the use of alternative medicine as a treatment for different diseases has increased. It is considered that a great percentage of people belonging to less developed communities use alternative medicine for health care. Objective: to determine the use of non-conventional treatment in diabetic patients. Methods: an observational, cross-sectional study was used to a group of patients belonging to a diabetic club at Centro Clínico Quirúrgico Hospital del Día Santo Domingo from June 5th to July 31st, 2018. The population was composed of 1300 persons. Survey was used as research instrument and was applied to the sample of 100 persons. Results: there was predominance of the female gender. The majority used non-conventional medication for family practices. Phytotherapy was identified as the most employed and known alternative therapy used by diabetic patients. The medicinal plants used primarily was Insulina (Costus igneus) and Zarzgoza (Glycyrrhizaglabra). Conclusions: it was found that the diabetic population used non-conventional medicine for the treatment of illness and in some occasions, it was recommended by the physician although no adverse effects were reported. Phytotherapy and acupuncture were the most used procedures.

Reference ranges of glycated hemoglobin (HbA1c) in capillary blood in the Spanish population.

Cross-sectional analysis describing HbA1c reference values by sex and age in a randomly selected Mediterranean general population sample. Using two methods, Point-of-Care systems and centralized laboratory, results show that HbA1c values increase with age. Almost half of the sample aged 65 years or older had median values >5.7% (prediabetes cut-off point).

Factores que afectan al proceso de inmunización en la comunidad étnica Chachis, Ecuador 2018 / Factors that affect the immunization process in the ethnic community of Chachis, Ecuador 2018

RESUMEN Fundamento: la inmunización es un componente esencial del derecho a la salud a través de las vacunas, la Estrategia Nacional de Inmunizaciones tiene como objetivo contribuir a reducir la morbilidad y mortalidad infantil de las enfermedades prevenibles por vacunación, por lo cual, se considera una intervención sanitaria eficaz y de bajo costo que salva la vida de millones de niños. Sin embargo, los niños de madres indígenas presentan mayor vulnerabilidad de contraer enfermedades inmunoprevenibles al no recibir las vacunas; en el grupo étnico se identificaron diversos factores que afectan al proceso de inmunización, ya sea por desconocimientos, actitudes y prácticas propias de la etnia. Objetivo: identificar los factores que afectan al proceso de inmunización en la comunidad étnica Chachis. Métodos: se realizó un estudio con enfoque cuantitativo de carácter descriptivo y de corte transversal, dirigida a las familias con niño/as de hasta cinco años de edad en la comunidad étnica Chachis, Santo Domingo de los Tsáchilas-Ecuador del 15 abril al 10 agosto del año 2018. El universo de estudio estuvo conformado por 170 nativos de la comunidad Chachis, a los que se les aplicó criterios de inclusión y exclusión donde quedó como muestra representativa 30 miembros de la comunidad. Resultados: el proceso de inmunización se ve afectado por factores como el nivel instrucción académica, seguida por la realización de prácticas propias de su cultura y por no recibir un trato cordial por el personal de salud hacia los Chachis. Conclusiones: existe un inadecuado proceso de inmunización en la comuna indígena Chachis motivado por factores socioculturales, lo que trae consigo que dicha población no se encuentra apta para enfrentar enfermedades infecciosas prevenibles.

ABSTRACT Background: the immunization is an important component of the right to health. The National Strategy of Immunization has the objective of contributing to the reduction of infant morbidity and infant mortality due to preventable diseases through immunization. Vaccination is considered to be an effective and low-cost procedure that saves lives of millions of children. However, the children of indigenous communities are vulnerable to preventable diseases by vaccination due to being non-recipient of immunization. Factors that affect the immunization process are: lack of knowledge, attitude, and ethnic practices. Objective: to identify the factors that affect the immunization process in ethnic community of Chachis. Methods: a quantitative, descriptive, cross-sectional study was used for families with children up to 5 years old in the ethnic community of Chachis, Santo Domingo de los Tsáchilas, Ecuador from April 15th to August 10th, 2018. The population was composed of 170 natives of Chachis community while the sample was 30 members of the community to whom the criteria of inclusion and exclusion were applied. Results: the immunization process was affected by factors such as: educational level, cultural practices and hostile treatment of health personnel towards the Chachis. Conclusions: there is an inadequate immunization process in the indigenous community of Chachis due to socio-cultural factors. Due to this, the mentioned community is not prepared to face preventable infectious diseases.

Eventos adversos en servicios de Cuidados Intensivos y de Medicina Interna / Adverse Events in Intensive Care Services and Internal Medicine

RESUMEN Fundamento: un evento adverso es un suceso que origina una lesión al paciente, causado por procedimientos sanitarios. La atención en salud conlleva riesgos que se derivan de un sin número de factores que favorecen la aparición de los mismos, entre estos se encuentran los factores intrínsecos, los extrínsecos y los del sistema. De igual manera las consecuencias son diversas: morbilidad, mortalidad, hospitalizaciones prolongadas, atención de alta complejidad, discapacidades y problemas legales institucionales. Es necesario referir que los profesionales de enfermería cumplen un papel importante con la de atención y seguridad del paciente. Objetivo: describir la incidencia de los eventos adversos en los servicios de Cuidados Intensivos y Medicina Interna. Métodos: se realizó un estudio transversal con enfoque cuantitativo observacional, descriptivo en pacientes hospitalizados en la unidad de cuidados intensivos y servicio de medicina interna del Hospital General Dr. Gustavo Domínguez Zambrano de Santo Domingo de los Tsáchilas de junio a julio de 2018. La muestra estuvo constituida por 125 pacientes. Se diseñó una lista de chequeo validado por un grupo de jueces expertos que recogía datos clínicos, factores de riesgo y el evento adverso asociado. Resultados: de los 125 pacientes evaluados, el 63 % presentaron al menos un evento adverso. Medicina Interna fue el área donde se evidenció mayor incidencia de estos; con una estancia hospitalaria mayor a siete días; de igual manera en el mismo servicio la flebitis fue el más reportado. Conclusiones: es notorio la elevada incidencia de eventos adversos encontrados en ambos servicios durante la investigación, lo que hace plantear la necesidad vital de revisar la atención que se brinda a los pacientes con la finalidad de lograr la calidad y calidez.

ABSTRACT Background: an adverse event is an injury acquired by the patient through medical procedure. Health care involves many risks that arises from factors such as intrinsic, extrinsic, and including those of the system. The consequences are diverse: morbidity, mortality, prolonged hospitalization, high complexity care, disability and legal problems for the health institution. Nursing professionals that give importance to quality attention and patient safety play an important role in health institutions. Objective: to describe the occurrence of an adverse event in the intensive care unit and internal medicine unit. Methods: a cross sectional study of quantitative, observational and descriptive type among hospitalized patients in the intensive care unit and internal medicine unit of Dr. Gustavo Domínguez General Hospital in Santo Domingo de los Tsáchilas, from June to July of 2018. The sample of the study was 125 patients. A checklist for collecting clinical data, risk factors and associated adverse event was designed and validated by a group of experts. Results: among the 125 patients evaluated, 63 % presented at least 1 adverse event. Internal Medicine is the unit that showed the highest occurrence of adverse events, specifically, among patients with hospital stay of more than seven days. In the same area, phlebitis was the adverse event most reported. Conclusions: the high incidence of adverse events found in both wards during the research study suggests that there is a need to review the attention given to patients in order to achieve quality healthcare which is the main goal of health professionals in the Ecuador.