Fundamentos para un currículo nacional en Cirugía General basado en competencia: Consenso Delphi de la División de Educación de la Asociación Colombiana de Cirugía / Foundations for a national competence-based curriculum in General Surgery: Delphi Consensus of the Division of Education of the Colombian Association of Surgery

Frente a los desafíos de la Educación Basada en Competencia, este consenso Delphi de la División de Educación de la Asociación Colombiana de Cirugía informa sobre las mínimas competencias profesionales esperadas del cirujano egresado de los veinte programas de Especialización en Cirugía General en Colombia. Un total de 105 profesores de los programas de especialización evaluaron tres áreas de competencia profesional: 1) atributos profesionales generales del residente durante su formación, 2) competencias prácticas (procedimientos quirúrgicos) que los residentes deben realizar al final de su entrenamiento y 3) Actividades Profesionales Confiables (APC) que los residentes deben ejecutar sin supervisión al final de su entrenamiento. Los resultados informan un alto nivel de consenso en el 100 % los atributos profesionales generales y APC, y del 75 % en diferentes procedimientos quirúrgicos. El consenso abre la puerta para el desarrollo de un currículo nacional de la especialidad y tiene implicaciones para la práctica educativa e investigación futura

Faced with the challenges of Competence-Based Education, this Delphi consensus from the Education Division of the Colombian Association of Surgery reports on the minimum professional competencies expected of the surgeon who graduated from the twenty residency programs in General Surgery in Colombia. A total of 105 professors from the training programs evaluated three areas of professional competence: 1) general professional attributes of the resident during their training, 2) practical skills (surgical procedures) that residents must perform at the end of their training, and 3) Activities Trusted Professionals (APC) that residents must run unsupervised at the end of their training. The results report a high level of consensus in 100% general professional attributes and APC, and 75% in different surgical procedures. The consensus opens the door for the development of a national specialty curriculum and has implications for educational practice and future research

Fundamentos para un currículo nacional en Cirugía General basado en competencia: Consenso Delphi de la División de Educación de la Asociación Colombiana de Cirugía / Foundations for a national competence-based curriculum in General Surgery: Delphi Consensus of the Division of Education of the Colombian Association of Surgery

Frente a los desafíos de la Educación Basada en Competencia, este consenso Delphi de la División de Educación de la Asociación Colombiana de Cirugía informa sobre las mínimas competencias profesionales esperadas del cirujano egresado de los veinte programas de Especialización en Cirugía General en Colombia. Un total de 105 profesores de los programas de especialización evaluaron tres áreas de competencia profesional: 1) atributos profesionales generales del residente durante su formación, 2) competencias prácticas (procedimientos quirúrgicos) que los residentes deben realizar al final de su entrenamiento y 3) Actividades Profesionales Confiables (APC) que los residentes deben ejecutar sin supervisión al final de su entrenamiento. Los resultados informan un alto nivel de consenso en el 100 % los atributos profesionales generales y APC, y del 75 % en diferentes procedimientos quirúrgicos. El consenso abre la puerta para el desarrollo de un currículo nacional de la especialidad y tiene implicaciones para la práctica educativa e investigación futura

Faced with the challenges of Competence-Based Education, this Delphi consensus from the Education Division of the Colombian Association of Surgery reports on the minimum professional competencies expected of the surgeon who graduated from the twenty residency programs in General Surgery in Colombia. A total of 105 professors from the training programs evaluated three areas of professional competence: 1) general professional attributes of the resident during their training, 2) practical skills (surgical procedures) that residents must perform at the end of their training, and 3) Activities Trusted Professionals (APC) that residents must run unsupervised at the end of their training. The results report a high level of consensus in 100% general professional attributes and APC, and 75% in different surgical procedures. The consensus opens the door for the development of a national specialty curriculum and has implications for educational practice and future research

Prenylated Flavonoids with Potential Antimicrobial Activity: Synthesis, Biological Activity, and In Silico Study.

Prenylated flavonoids are an important class of naturally occurring flavonoids with important biological activity, but their low abundance in nature limits their application in medicines. Here, we showed the hemisynthesis and the determination of various biological activities of seven prenylated flavonoids, named 7-13, with an emphasis on antimicrobial ones. Compounds 9, 11, and 12 showed inhibitory activity against human pathogenic fungi. Compounds 11, 12 (flavanones) and 13 (isoflavone) were the most active against clinical isolated Staphylococcus aureus MRSA, showing that structural requirements as prenylation at position C-6 or C-8 and OH at positions C-5, 7, and 4' are key to the antibacterial activity. The combination of 11 or 12 with commercial antibiotics synergistically enhanced the antibacterial activity of vancomycin, ciprofloxacin, and methicillin in a factor of 10 to 100 times against drug-resistant bacteria. Compound 11 combined with ciprofloxacin was able to decrease the levels of ROS generated by ciprofloxacin. According to docking results of S enantiomer of 11 with ATP-binding cassette transporter showed the most favorable binding energy; however, more studies are needed to support this result.

Biological Properties and Absolute Configuration of Flavanones From Calceolaria thyrsiflora Graham.

Flavanones (-)-(2S)-5,4'-dihydroxy-7-methoxyflavanone (1) and (-)-(2S)-5,3',4'-trihydroxy-7-methoxyflavanone (2) were isolated from the extracts of Calceolaria thyrsiflora Graham, an endemic perennial small shrub growing in the central zone of Chile. The absolute configuration of these compounds was resolved by optical rotation experiments and in silico calculations. Three analogs (3, 4, and 5) were synthesized to do structure-activity relationships with the biological assays studied. Biological tests revealed that only flavanone 2 exhibited a moderate inhibitory activity against the methicillin-resistant strain S. aureus MRSA 97-77 (MIC value of 50 µg/ml). In addition, flavanone 2 showed a potent, selective, and competitive inhibition of 5-hLOX, which supports the traditional use of this plant as an anti-inflammatory in diseases of the respiratory tract. Also, 2 exhibited cytotoxic and selective effects against B16-F10 (8.07 ± 1.61 µM) but 4.6- and 17-fold lesser activity than etoposide and taxol.

Educación quirúrgica durante la pandemia de COVID-19: primer consenso nacional de la División de Educación de la Asociación Colombiana de Cirugía / Surgical education during the COVID-19 pandemic: First national consensus of the Education Division of the Colombian Association of Surgery

Este consenso presenta las recomendaciones de la División de Educación de la Asociación Colombiana de Cirugía para los programas de especialización en cirugía general del país, con el fin de enfrentar la pandemia de la COVID-19 en los próximos años. Las recomendaciones se formularon mediante un método informal de consenso de expertos conformado por todos los directores de los programas de especialización en cirugía general en Colombia. Las principales recomendaciones se relacionan con los procesos de selección en los programas, investigación, bioseguridad, vigilancia de volumen operatorio, evaluación, simulación y virtualidad, rotaciones especiales, esquemas de trabajo y evaluación de la calidad programática

This consensus presents the recommendations of the División de Educación of the Asociación Colombiana de Cirugía for the Colombian surgical residency programs, in order to face the COVID-19 pandemic in the coming years. The recommendations were formulated using an informal method of consensus of experts made up of all program directors of residency programs in the country. The main recommendations are related to the selection processes in the programs, research, biosecurity, surveillance of operative volume, evaluation, simulation and virtual education, special rotations, work schemes and evaluation of program quality.

Modeling Cost, Energy, and Total Organic Carbon Trade-Offs for Stormwater Spreading Basin Systems Receiving Recycled Water Produced Using Membrane-Based, Ozone-Based, and Hybrid Advanced Treatment Trains.

To address water scarcity, cities are pursuing options for augmenting groundwater recharge with recycled water. Ozone-based treatment trains comprising ozone and biologically activated carbon potentially offer cost-effective alternatives to membrane-based treatment, the standard process for potable reuse in numerous countries. However, regulations in multiple states effectively limit the extent to which ozone-based treatment alone can produce recycled water for groundwater recharge. To investigate the trade-offs between treatment costs and regulatory constraints, this study presents methods for modeling and optimizing designs for (1) producing recycled water using membrane-based treatment, ozone-based treatment, and hybrid treatment trains comprising ozone-based treatment with a membrane sidestream, and (2) delivering that water to stormwater spreading basins. We present a case study of Los Angeles, CA, to demonstrate the model's application under realistic conditions, including regulations that limit spreading recycled water based on its concentration of total organic carbon and the extent of dilution. While the membrane-based treatment train exhibits economies of scale, we demonstrate how regulatory constraints create a diseconomies of scale effect for hybrid treatment systems because larger scales necessitate a higher proportion of recycled water undergo membrane treatment. Nevertheless, relative to membrane-based treatment, we identify opportunities for ozone-based or hybrid treatment trains to reduce treatment costs and energy use by up to 62% and 59%, respectively, for systems with up to 1 m3/s (23 million gallons per day) mean water recycling rate, potentially lowering the barrier for decentralized water recycling systems. This modeling approach could inform planning and policy regarding recycled water projects for groundwater recharge through spreading basins and, with additional modification, other potable reuse applications.

Minociclina como alternativa en el tratamiento de pulpotomía de dientes temporales / Minocycline as an alternative in the treatment of pulpotomy in temporary teeth

Objetivo.Determinar la eficacia de la minociclina en gel de liberación prolongada siendo un agente antimicrobiano en el tratamiento de la pulpotomía infantil y la eficacia de la minociclina aplicada como medicamento en el tratamiento de pulpotomía. Métodos. A 39 órganos dentales se les realizó el tratamiento de pulpotomía de acuerdo a la técnica descrita por Sweet y cols., previo y posterior a la colocación del medicamento minocicli-na, se tomó una muestra (colocación de punta de papel) y se realizó conteo de microor-ganismos por método de conteo de placa. Resultados. Se realizó una revisión clínica y radiográfica, haciéndolo a los 15, 30, 90 y 180 días, los resultados se registraron de acuer-do al instrumento clínico y radiográfico de la Asociación Americana de Odontología Pe-diátrica (AAPD). Se presentó tres casos de fracaso que representa apenas el 8%, teniendo un éxito de 92% este tratamiento.Conclusiones. Se concluyó que la medicación con minociclina resulta un auxiliar valioso en la desinfección local de la cámara pulpar y por tanto para el tratamiento de pulpotomías. Palabras clave: Odontología; Pulpotomía; Minociclina (fuente: DeCS BIREME).

Objetive. To determine the effectiveness of the minocycline gel prolonged release as an antimicrobial agent in the treatment of pulpotomy in child and the effectiveness of the minocycline applied as a drug in the treatment of pulpotomy. Methods. Pulpotomy treatment was perfomed in 39 dental samples according to the technique described by Sweet et al., before and after the minocycline drug was placed. A sample was taken (paper tip placement) and microorganisms were counted, by plate counting method. Results. A clinical and radiographic review was performed at 15, 30, 90 and 180 days. The results were recorded according to the clinical and radiographic instrument of the American Pediatric Dentistry Association (AAPD). There were three cases of failure, representing only 8%, with 92% success in this treatment. Conclusions. It was concluded that the medication with minocycline is a valuable auxiliary in the local disinfection of the pulp chamber and therefore for the treatment of pulpotomies. Keywords: Dentistry; Pulpotomy; Minocycline (source: MeSH NLM).

Biotransformation of geranylated- and acetylated-phloroglucinols by Gibberella fujikuroi into molecules with increased antifungal activity against Botrytis cinerea.

Terpenylated phenols possess interesting biological activities. These properties vary mainly according to the type of terpene associated and the degree of oxidation of the molecule. The search for new active molecules for application in different areas of knowledge includes the structural modification of these through ecological methodologies, such as biotransformation. The aims of this study were the biotransformation of geranylated- and acetylated-phloroglucinol by the fungus Gibberella fujikuroi and the evaluation of the antifungal activity of the derivatives. Five major derivatives were identified after biotransformation, highlighting the formation of specific monoacetylated products. In vitro antifungal activity assays against the phytopathogenic fungus Botrytis cinerea indicated that deacetylated derivatives possess higher activity compared to the precursor molecule. In other biotransformation reactions, a relationship between the release of the alkyl chain from the aromatic ring with a decrease of the antifungal activity, was observed. The in vivo tests in infected tomato plants with B. cinerea confirmed the antifungal activity of the derivatives observed in in vitro experiments.

Antioxidant, phenolic and antifungal profiles of Acanthus mollis (Acanthaceae).

Acanthus mollis is used as ornamental and medicinal plant. The ethnopharmacology reports indicate that extracts have anti-inflammatory activity. Phytoconstituents profile was evaluated by estimating the content of anthraquinones, flavonoids and phenols. In addition, the antioxidant activity was evaluated using four methods: Hydrogen atoms transfer (TRAP, ORAC and DPPH assays), and single electron transfer (FRAP assay). Finally, antifungal activity was determined by the M27-A2 test. The results shown that ethanol extracts have the highest concentration of phenols, anthraquinones and flavonoids. Total antioxidant capacity, extracts of ethyl acetate and ethanol are those with the highest activity, which correlates strongly with the presence of phenols. The antifungal activity measured in various strains of Candida is concentrated in ethyl acetate extracts of flower and leaf ethanol, a phenomenon may be related to antioxidant activity.

Chemical Composition and Anti-phytopathogenic Activity of the Essential Oil of Beilschmiedia miersii.

Belschmiedia miersii (Gay) Kosterm. (Lauraceae) ("Belloto del Norte") is a little-studied tree endemic of the Central Zone of Chile. Hydrodistillation of leaves and stem bark of B. miersii yielded 0.2% essential oil. GC-MS analysis allowed identification of 31 components. The most abundant compounds were three phenylpropanoids: Sarisan (45.8%), eugenol methyl ether (27.7%) and safrole (5.8%). The oil of B. miersii showed high antioxidant content (TEAC: 750.8 ±9.6 µmol/100 g of essential oil). The anti-phytopathogenic activity was evaluated against pathogens of plants: Fungi (Botrytis cinerea, Gibberella fujikitroi and Phytophthora cinnamomi) and bacteria: (Erwinia carotovora, Pseudomonas syringae and Agrobacterium tumefaciens) . The oil showed anti- phytopathogenic activity against all tested bacteria and fungi, especially against A. tumefaciens (IC50= 5 µg / mL) and P. cinnamomi (IC50 = 200 µg /mL). This study demonstrates that the essential oil of B. iniersii has great potential for applications in food and agricultural industries.

Determination of antioxidant properties of 26 Chilean honeys and a mathematical association study with their volatile profile.

Radical scavenging activity (RSA), antioxidant content (TEAC), total phenolic compounds content (TPCC) and volatile profile (VOCs) were measured in 26 honeys obtained from the Valparaiso Region (Chile). Persea americana honey was the most interesting sample according to these evaluated parameters. A Projection to Latent Structures (PLS) based algorithm was used to model the possible relationship between antioxidant activity, total phenolic compounds content and volatile profile. Concerning the volatile profile, only nine volatile compounds, of a total of fifty, showed dependence on antioxidant activity and total phenolic compounds content.

Synthesis and DPPH radical scavenging activity of prenylated phenol derivatives.

The synthesis of twenty six prenylated phenols derivatives is reported. These compounds were obtained under mild conditions via Electrophilic Aromatic Substitution (EAS) coupling reactions between phenol derivatives containing electron-donor subtituents and 3-methyl-2-buten-1-ol using BF(3)×OEt(2). Dialkylations were also produced with this method. The formation of a chroman ring by intramolecular cyclization between a sp2 carbon from the prenyl group with the hydroxyl substituent in the ortho position occurred with some phenols. All the synthesized compounds were evaluated as antioxidants according to a DPPH radical scavenging activity assay. IC(50) values of five synthesized compounds indicated they were as good antioxidants as Trolox™.

Amniotic membrane is an immunosuppressor of peripheral blood mononuclear cells.

UNLABELLED: Amniotic membrane (AM) is the inner layer of the placenta, which is in contact with the fetus; it has been used for transplantation in ocular surface diseases. It has been reported that amniotic membrane promotes epithelialization, inhibits angiogenesis and diminishes ocular inflammation. A persistent epithelial defect is the delay in epithelial wound healing caused by infiltrating inflammatory cells into the cornea and amniotic membrane transplantation has been successfully used in its treatment, however the mechanism of action in inhibiting inflammation it is not well understood. This study was aimed at determining whether denuded amniotic membrane (dAM) induces anti-inflammatory effects on peripheral blood mononuclear cells. METHODS: Human peripheral blood mononuclear cells (PBMC) were cultured on dAM. Proliferation and apoptosis assays were performed on PBMC; and synthesis and secretion of pro-inflammatory cytokines by these cells was analyzed. RESULTS: dAM induced apoptosis and inhibited cell proliferation of PBMC; and abolished the synthesis and the secretion of pro-inflammatory cytokines even when they were LPS stimulated. In contrast, when PBMC were cultured on hydrophilic membrane cell culture inserts, apoptosis was not significantly induced, cell proliferation was conserved, and synthesis and secretion of pro-inflammatory cytokines were not affected. CONCLUSIONS: Taken together, these results could explain the anti-inflammatory in vivo effects observed when the amniotic membrane is used as a transplant.

Toxicología de las dioxinas y su impacto en la salud humana / Dioxins toxicology and its impact in human health

Las dioxinas son contaminantes de síntesis que se forman de manera espontánea en diversos procesos industriales. Son compuestos organoclorados muy estables en el medio ambiente, capaces de permanecer en los tejidos humanos y animales; y por ello hacen bioacumulación, lo que facilita la presentación de toxicidad crónica, dentro de la que se destaca la carcinogenicidad, la mutagenicidad y el efecto disruptor endocrino. Se hace referencia a las características físicoquímicas de estos compuestos, a su toxicodinamia y efectos adversos, para finalmente,relacionar la toxicidad de estos compuestos con la salud humana y con la responsabilidad de producir alimentos inocuos para el ser humano...

Participación del odontólogo en la determinación del diagnóstico de la causa de muerte y del intervalo post-mortem / Participation of the dentist in determining the diagnosis of the cause of death and postmortem interval

La serie de conocimientos teórico-prácticos de las ciencias básicas forenses que confluyen sobre el odontólogo forense, incitan para que por medio de sus peritajes y/o experticia, tenga como fin último servir a la justicia. Este artículo pretende realzar las capacidades de auxilio que puede desempeñar el odontólogo forense dado la magnitud de su campo de acción y debido a que es un profesional altamente capacitado para poner de manifiesto la importancia de los fenómenos cadavéricos que se describen en esta revisión. Se tratarán las manifestaciones evidentes de los fenómenos cadavéricos sobre el sistema estomatognático en múltiples causas de muerte, sus métodos de establecimiento, los factores individuales y ambientales en los que son partícipes, sus leyes, sus etapas, sus excepciones, et., para que a partir de allí pueda conjeturarse la participación del odontólogo forense en el área judicial como tal.

Evidence of in vitro differential secretion of 72 and 92 kDa type IV collagenases after selective exposure to lipopolysaccharide in human fetal membranes.

Premature rupture of chorioamniotic membranes complicated with intrauterine infection has been associated to degradation of extracellular matrix (ECM), which could explain local morphological changes. We used a culture system in which the chorioamniotic membranes form two independent chambers, allowing for the selective stimulation of either the amnion (AMN) and/or the choriodecidua (CHD) regions. Lipopolysaccharide (500 ng/ml) was added to the AMN and/or the CHD; secretions and gelatinolytic activity of matrix metalloproteinase (MMP)-2 and MMP-9 were measured in both compartments by enzyme-linked immunosorbent assay (ELISA) and zymography. Secretions of TIMP-1, TIMP-2 and TIMP-4 were measured by ELISA. Both metalloproteinases were immunolocalized in tissue sections. All stimulation modalities induced a similar proMMP-2 and proMMP-9 secretion pattern in the CHD with concentrations of 2.49 ng/ml and 90.91 pg/ml, respectively; the AMN showed no significant changes. The active forms of both enzymes did not change with any stimulation modality. TIMP-1, TIMP-2 and TIMP-4 secretions remained without significant changes (P = 0.41). ECM degradation and structural disarrangement were evident after stimulation. Secretion of proMMP-2 and proMMP-9 mainly in the CHD, presence of active forms associated to the tissue and minor changes in TIMPs secretion could favor ECM degradation and explain the weakening and thinning associated with the pathological rupture of chorioamniotic membranes.

Dolor abdominal agudo en el anciano en el Hospital de Caldas / Acute abdominal pain in the elderly in Hospital de Caldas

Objetivos: Determinar las enfermedades causales de dolor abdominal agudo, en pacientes mayores de 65 años que se presentaron al servicio de urgencias con este síntoma, su presentación clínica, correlación diagnóstica entre diagnósticos de ingreso y egreso, tardanza diagnóstica, estancia hospitalaria y morbilidad y mortalidad asociada. Diseño: Estudio descriptivo de casos incidentes durante 12 meses (marzo de 2000 a febrero de 2001), de los ancianos que consultaron al servicio de urgencias y se hospitalizaron a causa de dolor abdominal agudo no traumático. Escenario: Hospital de Caldas, tercer nivel de atención Resultados: Fueron 209 pacientes, 129 mujeres y 80 hombres, con una edad promedio de 75 años. Como principales causas se encontraron enfermedad del tracto biliar (22.5%), enfermedad ácido péptica (20.6%) y enfermedades cardiovasculares (11%). Los síntomas asociados fueron inespecíficos (predominantemente anorexia, náuseas y vómito), presentando signos físicos sólo el 66% de los casos; 66 pacientes (31.6%) requirieron cirugía. Hubo correlación entre el diagnóstico inicial y el final en el 49.5% Se presentaron complicaciones en 48.8% de los casos con mortalidad global de 28 pacientes (13.4%), predominantemente del grupo sometido a tratamiento quirúrgico (18 casos), y enfermedades concomitantes en el 84% de los pacientes. La estancia hospitalaria promedio fue de 7.8 días. Conclusiones: El diagnóstico del dolor abdominal agudo en ancianos es difícil por la falta relativa de síntomas y signos físicos. Se destaca el amplio predominio de las enfermedades del tracto biliar y la enfermedad ácido péptica. En los pacientes sometidos a tratamiento quirúrgico hay tendencia a presentar mayores complicaciones y mortalidad. Las complicaciones son poco toleradas por los ancianos, enfatizando la importancia de su predicción y prevención.

Objectives: to determine the causal illnesses of acute abdominal pain, in patients older than 65 years old that consult to the emergency service with this symptom, their clinical presentation, correlation between initial and definitive diagnosis, delay in diagnosis, hospital stay and morbilility and associate mortality. Design: descriptive study of incident cases during 12 months (March of 2000 to February of 2001), of the ancient patients that consulted to the emergency service and were hospitalized because of none traumatic acute abdominal pain. Scenario: Hospital of Caldas, third level of attention, Manizales, Colombia. Results: there were 209 patients, 129 female and 80 male, with an average age of 75 years. As main causes of illness were biliary tract diseases (22.5%), peptic disease (20.6%) and cardiovascular diseases (11%). The associate symptoms were none especific (predominantly anorexia, nauseas and vomit), only presenting physical signs in 66% of the cases; 66 patients (31.6%) of them required surgical tratment. There was correlation between the initial and the definitive diagnsosis in 49.5%. Complications presented in 48.8% of the cases, with 28 patients as the global mortality (13.4%), predominantly in the group submitted to surgical treatment (18 cases), and concomitant diseases in 84% of the patients. The average hospital stay was of 7.8 days. Conclusions: diagnosis of the acute abdominal pain in ancient patients is difficult because of the relative lack of symptoms and physical signs. Is evident the wide prevalence of the biliary tract disease and the peptic disease. In the patients submitted to surgical treatment there is a tendency to present higher complication and mortality rate. Complications are bad tolerated by the older patients, emphasizing the importance of their prediction and prevention.