Practical reflections on a collaboration with healthcare consumers on the development of a simulation.

Background: Healthcare simulations generate moments of 'cultural compression' through which we transmit core values about our professional identities and the families we care for. The engagement of healthcare consumers in this process is useful to evaluate the values we transmit and ensure authenticity in the narratives we share. Methods: A simulation package on febrile neutropenia and port access was written by healthcare staff in consultation with the parent of a child with leukaemia. Healthcare consumer review was focused on the representation of the simulated parent within the simulation scripts. The child and his mother assisted in the development of supportive video resources on family perspectives on port access and demonstration of the procedure. Results: The involvement of healthcare consumers in the development of the scenario had positive impact on the design and the supportive resources, both of which created opportunities for patient advocacy and reinforced the centrality of healthcare consumers within the healthcare team. Conclusions: Healthcare consumer collaboration in scenario design was achievable and impactful without significant increased cost. We hope to promote the benefits of healthcare consumer consultation in simulation design to improve the pursuit of educational and cultural learning objectives.

Evaluación de la colonización bacteriana de la interfase implante-pilar en implantes de conexión interna: estudio piloto / Evaluation of bacterial colonization of the implant-abutment interface in implants with internal connection: pilot study

Introducción: la interfase implante-pilar da lugar a la formación de un espacio, cuyo tamaño varía de acuerdo a variables como las tolerancias de maquinado, los micro- movimientos, el tipo de fabricación de los aditamentos protésicos y el material de los mismos. Este espacio, en cercanía a los tejidos peri-implantares, es una oportunidad para la movilización de microorganismos de forma bidireccional, desencadenando eventualmente respuesta tisular. Objetivo: comparar la filtración de Echerichia coli (E. coli) en la interfase de implantes de conexión interna con pilares prefabricados y personalizados. Materiales y métodos: nueve implantes (Osseotite® Tapered Certain®, 3i Biomet) fueron divididos en tres grupos basados en el tipo de pilar utilizado. Grupo 1 pilares prefabricados Provide®, grupo 2 pilares personalizados Encode® Titanio, grupo 3 pilares personalizados Encode® Zirconia. Los pilares fueron conectados a los implantes y fueron ciclados según la norma ISO 14801:2007 (250.000 ciclos) en un dispositivo de carga dinámica. Fueron sumergidos en caldo infusión cerebro corazón (BHI) inoculado con E. coli. Se tomaron muestras y se midió la turbidez del medio. Se realizó test ANOVA para comparar el tamaño de la interfase implante-pilar. Resultados: se encontró que todas las muestras filtraron en diferentes proporciones. Conclusiones: todas las muestras mostraron filtración de E. coli.

Background: the implant-abutment interface leads to the formation of a space whose size varies according to different variables such as machining tolerances, micro-movements, the type of fabrication of prosthetic devices and the fabrication material. This space in close proximity to the peri-implant tissues is an opportunity for the colonization of microorganism bidirectionally, eventually triggering tissue response. Objective: to compare the filtration of Echerichia coli (E. coli) in the interface of implants of internal connection with prefabricated and customized abutments. Materials ands methods: nine implants (Osseotite® Tapered Certain®, 3i Biomet) were divided into three groups based on the type of abutment used. Group 1 prefabricated abutment Provide®, Group 2 customized abutment Encode® Titanium, Group 3 customized abutment Encode® Zirconia. The implants were connected to the abutments and cycled according to ISO 14801:2007 norm (250,000 cycles) in a dynamic loading device. They were immersed in brain heart infusion (BHI) medium inoculated with E. coli. Samples were taken and the turbidity of the medium was measured. An ANOVA test was performed to compare the size of the implant-abutment interface. Results: All samples were found to be colonized in different proportions. Conclusions: All samples showed E. coli colonization.

Native herbaceous plant species with potential use in phytoremediation of heavy metals, spotlight on wetlands - A review.

Soil, air and water pollution caused by the mobility and solubility of heavy metals significantly damages the environment, human health, plants and animals. One common in situ method used for the decontamination of heavy metals is phytoremediation. This usually involves the use of exotic species. However, these species may exhibit invasive behavior, thereby, affect the environmental and ecological dynamics of the ecosystem into which they are introduced. This paper focuses on some native herbaceous plant species reported on the wetlands of Bogota, Colombia, with potential use in phytoremediation of heavy metals. To do that, the authors identified and searched a bibliography based on key words related to heavy metal decontamination. In addition, authors gathered and analyzed relevant information that allowed the comprehension of the phytoremediation process. This paper suggests the study of 41 native or endemic species regarding their behavior towards heavy metal contamination. From a survey of herbaceous plants reported in Bogota, native and endemic species that belong to predominant families in heavy metal accumulation processes were selected. Although found in Colombian's wetlands, these can also be found worldwide. Therefore, they are of great interest due to their global presence and their potential for use in phytoremediation. The current research about the development of phytoremediation focuses on the identification of new herbaceous species able to decontaminate substratum polluted with heavy metals to contribute with the investigation of the ecology and environment of the nature's remnants in urban wetland ecosystems.

Enfoque práctico del síndrome metabólico en pediatría: [revisión] / Practical approach to metabolic syndrome in pediatrics: [review]

El síndrome metabólico en pediatría identifica a un grupo de niños con alto riesgo de presentar eventos cardiocerebrovascular y de diabetes tipo 2 a partir de los seis años de edad. La detección temprana y tratamiento óptimo constituyen el pilar fundamental para disminuir la morbimortalidad cardiovascular a mediano y largo plazo. Esta terapéutica creará hábitos saludables familiares y promoverá el control de los factores de riesgo como alteraciones metabólicas, hipertensión arterial y obesidad en cada integrante independiente de su edad. El presente artículo muestra un abordaje práctico en el ámbito clínico de los pacientes pediátricos a partir de los seis años...

The metabolic syndrome in pediatrics identify a high risk population for cardiocerebrovascular events and type 2 diabetes since six years old. Early detection and treatment of risk factors constitute the main point of intervention to decrease the morbidity and mortality related with cardiovascular disease in the medium and long terms. This treatment will create healthy family habits and it will promote the control of these risk factors in each family member. This article presents a practical approach on this issue in pediatric clinical care since six years of age...

Evaluación de la implementación del aula virtual en una institución de educación superior / Evaluation of the implementation of the virtual classroom on institution of superior education

El objetivo del presente estudio fue conocer el impacto de la implementación del aula virtual en una institución de educación superior, a través de la evaluación del aprendizaje en los estudiantes yde la percepción del trabajo adelantado con docentes y estudiantes. El estudio se adelantó en varios períodos académicos, la información se recolectó a través de encuestas, un grupo foco, y una prueba objetiva de conocimientos. Se realizó un estudio descriptivo, un diseño ex post facto y un diseño cuasiexperimental. Los resultados de la estrategia no experimental muestran una percepción positiva tanto de estudiantes como de docentes hacia el aula virtual. Los resultados de la estrategia experimental no evidencian diferencias estadísticamente significativas, en el nivel de aprendizaje de los grupos de estudio.

The objective of the present study was to know the impact of the implementation of the virtual classroom in an Institution of Superior Education, through the evaluation of the learning in the students and of the perception of the early work with educational and students. The study was ahead in several academic periods, the information was gathered through surveys, a group focus, and an objective test of knowledge. For such an effect a descriptive study was developed with a design expost-facto and a quasiexperimental design. The results of the No-experimental strategy show a perception positive point of students like of educational toward the virtual classroom. The results of the Experimental strategy don't evidence differences statistically significant, in the level of learning of the study groups.

Qué se debe hacer con un paciente que se rehúsa a recibir la terapia para una enfermedad infectocontagiosa? / What should be done with a patient that denies the acceptance of therapy for a communicable disease?

Algunas enfermedades infecciosas pueden requerir tratamiento farmacológico prolongado, con importante toxicidad o simplemente inconveniente. Se discute el caso de la lepra, su tratamiento y la toxicidad secundaria y se informan las alternativas disponibles en los casos en los que el paciente rehúsa el tratamiento médico

[Relapses after multibacillary leprosy treatment]. / Recidivas postratamiento de la lepra multibacilar.

Leprosy relapses are mainly due to bacillary persistence and diamino-diphenyl-sulphone (DDS) monotherapy. Case histories were examined for 33 patients with lepromatous leprosy (LL), diagnosed 7-48 years before the relapse and treated only with DDS during 4 to 38 years. Twenty-eight patients received irregular non-supervised polychemotherapy (PCT) since 1983. Five patients received only DDS, and presented relapses 13-20 years after the treatment was stopped. Relapses were diagnosed by clinical methods, including the reappearance of lesions or presence of new anesthetic areas. All cases were confirmed by bacilloscopy, and a subset of 20 cases by skin biopsy. Four patients presented indeterminate leprosy (IL) and one patient borderline tuberculoid leprosy (BT) in the biopsy. The latter 5 demonstrated presence of intraneural bacilli; the remainder were LL. Two patients relapsed even with PCT treatment. The others were cured with supervised PCT. Predisposing factors for relapses were as follows: DDS monotherapy, irregular PCT with inadequate dosage, unsupervised treatment, treatment uncompliance, and inadequate relationship between the patient and the health staff. Inspections for relapse in leprosy is recommended for in all multibacillary patients that were treated with DDS. The clinical appearance of new lesions or new anesthetic zones, the bacilloscopy and skin biopsy, used together, are effective in establishing the presence of relapses.

Recidivas postratamiento de la lepra multibacilar / Relapses after multibacillary leprosy treatment

La persistencia de bacilos viables y la monoterapia con diamino-difenil-sulfona (DDS) son los principales factores que favorecen las recidivas de la lepra. Presentamos 33 pacientes con lepra lepromatosa (LL) diagnosticada 7 a 48 años antes de la recidiva, que recibieron monoterapia con DDS durante 4 a 38 años. Veintiocho fueron tratados, además, con poliquimioterapia (PQT) irregular, no supervisada, desde 1983. Cinco sólo recibieron DDS. Éstos presentaron la recidiva entre 13 y 20 años después de suspenderla. Las recidivas se diagnosticaron por reaparición de las lesiones clínicas o por la presencia de nuevas zonas anestésicas; todas se confirmaron con la baciloscopia y, en 20 casos, por la biopsia de piel. Cuatro pacientes presentaron en la biopsia de la recidiva, lepra indeterminada (LI) y uno lepra dimorfa tuberculoide (LDT), todos con presencia de bacilos intraneurales; los demás fueron LL. Dos pacientes recidivaron, aun con PQT razonablemente supervisada. Los demás curaron con PQT supervisada. Los factores predisponentes para la recidiva fueron: monoterapia con DDS por varios años; PQT irregular con dosis inadecuadas, sin supervisión del tratamiento; abandono de la PQT, y relación inadecuada entre el paciente y el personal de salud. Las recidivas de la lepra se deben buscar en todos los pacientes colombianos con lepra multibacilar que fueron tratados con DDS solo durante años. La clínica, la baciloscopia y la biopsia individualmente o en conjunto son métodos confiables para establecer las recidivas.

Leprosy relapses are mainly due to bacillary persistence and diamino-diphenyl-sulphone (DDS) monotherapy. Case histories were examined for 33 patients with lepromatous leprosy (LL), diagnosed 7-48 years before the relapse and treated only with DDS during 4 to 38 years. Twenty-eight patients received irregular non-supervised polychemotherapy (PCT) since 1983. Five patients received only DDS, and presented relapses 13-20 years after the treatment was stopped. Relapses were diagnosed by clinical methods, including the reappearance of lesions or presence of new anesthetic areas. All cases were confirmed by bacilloscopy, and a subset of 20 cases by skin biopsy. Four patients presented indeterminate leprosy (IL) and one patient borderline tuberculoid leprosy (BT) in the biopsy. The latter 5 demonstrated presence of intraneural bacilli; the remainder were LL. Two patients relapsed even with PCT treatment. The others were cured with supervised PCT. Predisposing factors for relapses were as follows: DDS monotherapy, irregular PCT with inadequate dosage, unsupervised treatment, treatment uncompliance, and inadequate relationship between the patient and the health staff. Inspections for relapse in leprosy is recommended for in all multibacillary patients that were treated with DDS. The clinical appearance of new lesions or new anesthetic zones, the bacilloscopy and skin biopsy, used together, are effective in establishing the presence of relapses.

Ingesta de azúcar en la dieta de niños de 0 a 36 meses / Dietary sugar consumption in 0-36 month-old children

Los azúcares son los componentes dietéticos de mayor cariogenicidad. La presencia de caries en infantes y al ingesta de azúcares provenientes de varias fuentes dietéticas determinan la necedidad de estudiar el patrón del consumo de azúcar en esta población. El objetivo del presente estudio fue identificar el momento en que los azúcares son introducidos en la dieta y su frecuencia de consumo en un grupo de niños de 0-36 meses de edad. Para ello se aplicó un cuestionario de opciones múltiples a madres de 385 niños bajo control en el Programa de Crecimiento y Desarrollo del Hospital Nacional Cayetano Heredia, Lima-Perú. En el 73 por ciento de los niños se inició el consumo de azúcar antes de los seis meses de edad. Los principales vehículos fueron líquidos y la razón principal fue dar sabor. El porcentaje de niños que consumían azúcares y su frecuencia de consumo aumentó con la edad. El 30 por ciento de los niños de 0-5 meses de edad consumían azúcares en un promedio de 2.5 veces al día y el 85 por ciento de los niños de 6-11 meses de edad consumían azúcares en un promedio de 3.5 veces al día. Al cumplir el primer año de edad, el 100 por ciento de los niños consumían azúcares en un promedio de 4.6 veces al día, este patrón se repitió durante el segundo año de vida. En su mayoría, los alimentos azucarados fueron ingeridos durante las comidas principales, sin un porcentaje considerable (34.4 por ciento) fue ingerido en refrigerios o entre comidas, en especial antes que el niño vaya a dormir. El presente estudio provee información para formular programas educativos materno-infantiles que permitan disminuir el riesgo de caries en la dentición primaria y formar hábitos alimenticios adecuados.