Metodología para la formación de la competencia prevención de la salud en estudiantes de medicina / A Methodology for the Formation of Health Prevention Competences among Medical Students

Introducción: Hoy día se requiere formar a estudiantes de la carrera de medicina que sean competentes en el cumplimiento de sus funciones en los niveles de atención en salud. Como parte de las funciones que se deben desarrollar en el estudiante de medicina, se deben formar competencias para la prevención de la salud. Objetivo: Proponer una metodología para la formación de la competencia prevención de la salud en estudiantes de medicina durante el trabajo comunitario integral. Métodos: Se realizó un estudio cuantitativo de tipo preexperimental. La población estuvo conformada por 669 estudiantes de tercer año de medicina de la Universidad de Ciencias Médicas de Holguín. De ellos se obtuvo una muestra de 100 estudiantes mediante un muestreo aleatorio simple. Se emplearon la observación directa en el terreno y la Prueba de Rangos con Signos de Wilcoxon para constar la hipótesis de investigación. Resultados: Se aportó la competencia de prevención de la salud y la metodología para su formación en estudiantes de medicina durante el trabajo comunitario integral, así como los principales logros y deficiencias demostrados durante las acciones realizadas en la educación en el trabajo. Conclusiones: La competencia prevención de la salud forma parte del perfil de competencias laborales que singularizan a la formación de un médico general competente. Es de tipo genérica y requiere para su formación de la combinación de acciones instructivas, educativas y desarrolladoras desde las potencialidades del trabajo comunitario integral que realizan los estudiantes como parte del componente laboral de la carrera(AU)

Introduction: Nowadays, it is necessary to train medical students to be competent in the fulfillment of their functions at the healthcare levels. As part of the functions to be developed among medical students, health prevention competences should be developed. Objective: To propose a methodology for the formation of health prevention competences among medical students during comprehensive community work. Methods: A quantitative preexperimental study was carried out. The population consisted of 669 third-year medical students from Universidad de Ciencias Médicas de Holguín. A sample of 100 students was obtained by simple random sampling. Direct observation in the field and the Wilcoxon's signed-ranks test were used to verify the research hypothesis. Results: The health prevention competence and the methodology for its formation among medical students during comprehensive community work were provided, as well as were the main achievements and deficiencies shown during the actions carried out in education at work. Conclusions: The health prevention competence is part of the profile of occupational competences that singularize the training of a competent general practitioner. It is generic and requires. for its formation. the combination of instructive, educational and developmental actions from the potentialities of comprehensive community work performed by students as part of the occupational component of the major(AU)

Método de aula invertida para la formación en gerontogeritría de estudiantes de la carrera de Medicina

Fundamento: e l aula invertida es una modalidad de enseñanza semipresencial, donde los alumnos aprenden los conceptos por sí mismos, usando normalmente videos educativos, archivos de audio y otras tecnologías, mediante la colaboración entre los compañeros en comunidades en línea. Objetivo: proponer un método de aula invertida para la formación en gerontogeriatría de estudiantes de la carrera de Medicina. Métodos: se realizó un estudio de tipo observacional de corte transversal mediante el empleo de métodos científicos: revisión de documentos, observación directa en el terreno, análisis, síntesis, inducción, deducción, sistémico y de estadística descriptiva. Resultados: se aporta un método de aula invertida para la formación gerontogeriátrica de los estudiantes de la carrea de Medicina que combina las modalidades de presencialidad y virtualidad desde la interacción entre las formas de organización de la docencia médica y de la educación en el trabajo en la Atención Primaria en Salud: consulta y visita de terreno domiciliaria. Conclusiones: el aula invertida es un contexto que favorece la formación gerontogeriátrica del estudiante de la carrera de Medicina ya que dinamiza y transforma las concepciones y enfoques tradicionales de la enseñanza - aprendizaje, al lograr un mayor protagonismo estudiantil, aumento de la autonomía, la instantaneidad, interconexión, multimedialidad y la creatividad e innovación del estudiante en la solución de problemas de salud del adulto mayor, así como el aprovechamiento de las potencialidades de los recursos y entornos virtuales de aprendizaje que posee, combinando modalidades de enseñanza presencial y virtual.

Background: the inverted classroom is a blended learning modality, where students learn the concepts by themselves, usually using educational videos, audio files and other technologies, through collaboration among peers in online communities. Objective: to propose an inverted classroom method for gerontogeriatric training in Medicine students. Methods: a cross-sectional observational study was carried out using scientific methods: document review, direct observation in the field, analysis, synthesis, induction, deduction, systemic and descriptive statistics. Results: an inverted classroom method is provided for the gerontogeriatric training of Medicine students that combines face-to-face and virtual modalities from the interaction between the forms of organization of medical teaching and education at work in the Primary Health Care: consultation and home field visit. Conclusions: the inverted classroom is a context that favors the gerontogeriatric training of the Medicine student since it revitalizes and transforms the traditional conceptions and approaches of teaching-learning, by achieving a greater student role, increased autonomy, instantaneous, interconnection, multimedia and the creativity and innovation of the student in the solution of health problems of the elderly, as well as the use of the resources and virtual learning environments' potential that it possesses, combining face-to-face and virtual teaching modalities.

Efectividad de una metodología de aprendizaje profesional basada en proyectos en la asignatura Biología Molecular / Effectiveness of a project-based professional learning methodology in the Molecular Biology subject

Fundamento: la asignatura Biología Molecular ha presentado insuficiencias en el proceso enseñanza aprendizaje en la Facultad de Ciencias Médicas de Holguín, las que requieren solución. Objetivo: valorar la efectividad de una metodología de aprendizaje profesional basada en proyectos en la asignatura Biología Molecular como forma de perfeccionar el proceso de enseñanza aprendizaje. Métodos: se realizó una investigación de desarrollo en la Facultad de Ciencias Médicas de Holguín durante el curso 2021. Se emplearon los métodos teóricos: histórico-lógico, analítico-sintético y el inductivo-deductivo; empíricos: el análisis documental y el registro de las calificaciones de las preguntas de la primera convocatoria del examen final de la asignatura. Se realizaron pruebas estadísticas a los resultados de la evaluación final. Se utilizó una metodología de aprendizaje basada en proyectos para la implementación de la Biología Molecular, aplicada a una parte del contenido del programa analítico de la asignatura, que utilizó guías didácticas para los estudiantes y orientaciones metodológicas a los profesores, con el soporte de videos complementarios a las conferencias y a contenidos de currículo oculto, relacionados con la vinculación básico-clínica con orientación profesionalizante. Resultados: las preguntas del examen final cuyo contenido fue tratado según la metodología de proyecto de aprendizaje mostraron significativamente mejores resultados que aquellas tratadas de forma convencional. Conclusiones: la metodología de aprendizaje basada en proyectos para la asignatura Biología Molecular se determinó factible para su aplicación y proporcionó la flexibilidad necesaria para el tránsito de la docencia presencial a la modalidad a distancia.

Background: the Molecular Biology subject has presented insufficiencies in the teaching-learning process Holguín Faculty of Medical Sciences, which require a solution. Objective: to assess the effectiveness of a project-based professional learning methodology in the Molecular Biology subject as a way to improve the teaching-learning process. Methods: a development investigation was carried out at the Holguín Faculty of Medical Sciences during the 2021 academic year. Theoretical methods were used: historical-logical, analytical-synthetic and inductive-deductive; Empirical ones: the documentary analysis and the record of the qualifications of the questions of the first call of the final exam of the subject. Statistical tests were performed on the results of the final evaluation. A project-based learning methodology was used for the implementation of Molecular Biology, applied to a part of the content of the analytical program of the subject, which used didactic guides for students and methodological orientations for teachers, with the support of complementary videos to the lectures and hidden curriculum contents, related to the basic-clinical link with a professional orientation. Results: the final exam questions where its content was treated according to the learning project methodology showed significantly better results than those treated conventionally. Conclusions: the project-based learning methodology for the Molecular Biology subject was determined feasible for its application and provided the necessary flexibility for the transition from face-to-face teaching to distance learning.

Identification of Highly Selective Surface Pathways for Methane Dry Reforming Using Mechanochemical Synthesis of Pd-CeO2.

The methane dry reforming (DRM) reaction mechanism was explored via mechanochemically prepared Pd/CeO2 catalysts (PdAcCeO2M), which yield unique Pd-Ce interfaces, where PdAcCeO2M has a distinct reaction mechanism and higher reactivity for DRM relative to traditionally synthesized impregnated Pd/CeO2 (PdCeO2IW). In situ characterization and density functional theory calculations revealed that the enhanced chemistry of PdAcCeO2M can be attributed to the presence of a carbon-modified Pd0 and Ce4+/3+ surface arrangement, where distinct Pd-CO intermediate species and strong Pd-CeO2 interactions are activated and sustained exclusively under reaction conditions. This unique arrangement leads to highly selective and distinct surface reaction pathways that prefer the direct oxidation of CH x to CO, identified on PdAcCeO2M using isotope labeled diffuse reflectance infrared Fourier transform spectroscopy and highlighting linear Pd-CO species bound on metallic and C-modified Pd, leading to adsorbed HCOO [1595 cm-1] species as key DRM intermediates, stemming from associative CO2 reduction. The milled materials contrast strikingly with surface processes observed on IW samples (PdCeO2IW) where the competing reverse water gas shift reaction predominates.

Use of MeNTS, Frailty and Symptom Scales for selecting surgical patients during the SARS-CoV-2 pandemic: A retrospective study / Uso de escalas MeNTS, Fragilidad y Síntomas para la selección de pacientes quirúrgicos durante la pandemia por SARS-CoV-2: Estudio retrospectivo

Abstract Introduction: The SARS-CoV-2 pandemic has led to the cancellation of non-emergent surgeries in order to optimize the use of resources. Once the elective medical services are restored, a technical and ethical strategy becomes critical to select candidate patients for elective surgery. Objective: To describe the results from the implementation of MeNTS (Medically Necessary Time-sensitive Procedures), FI-CGA, and survey on COVID-19 symptoms Scales, as methods for the selection of patients who were candidates for elective surgery during the SARS-CoV-2 pandemic, in a third level institution in Cali, Colombia. Methods: The databases of the results on the administration of MeNTS, frailty index (FI-CGA) and COVID 19 symptoms scales in patients who were candidates for elective surgery in a third level clinic in Cali city, between March 1st and August 31st, 2020 were reviewed. Results: A total of 1,044 patients were included, of which 647 (62.0 %) were females, with a median age of52 years (interquartile range [IQR] 38-62). 98 % of the patients were asymptomatic, the overall median score for MeNTS was 48 (IQR 44-52) and the average for FI-CGA was 0.0 (standard deviation 0.1). Conclusions: MeNTS, FI-CGA and the Symptoms Survey are easily accessible scales amidst the pandemic and are helpful to select patients with intermediate and low risk of perioperative morbidity in elective surgery during the SARS-CoV-2 pandemic. Further studies are required to confirm these findings and to clarify the potential of these tools in the selection of patients that meet the high-risk criteria.

Resumen Introducción: La pandemia por SARS-CoV-2 ha ocasionado la suspensión de cirugías no urgentes con el fin de optimizar los recursos. Una vez los servicios médicos electivos son restablecidos, es fundamental disponer de una estrategia técnica y ética para la selección de los pacientes candidatos a cirugía electiva. Objetivo: Describir los resultados observados durante la implementación de las escalas MeNTS (Medically Necessary Time-sensitive Procedures), IF-VIG y Encuesta de síntomas para COVID-19, como métodos de selección de pacientes candidatos a cirugía electiva durante la pandemia por SARS-CoV-2 en una institución de nivel tres en la ciudad de Cali, Colombia. Metodología: Se revisaron las bases de datos de los resultados de la aplicación de escalas de MeNTS, índice de fragilidad (IF-VIG) y los síntomas para COVID 19, en pacientes candidatos a cirugía electiva en una clínica de tercer nivel en la ciudad de Cali, entre marzo 1 y agosto 31 del 2020. Resultados: En total 1.044 pacientes fueron incluidos, de los cuales 647 (62,0 %) fueron mujeres con una mediana de edad de 52 años (rango intercuartil [RIC] 38-62). El 98 % de los pacientes estuvieron asintomáticos, la mediana general de la puntuación total de MeNTS fue 48 (RIC 44-52) y el promedio para IF-VIG fue de 0,0 (desviación estándar 0,1). Conclusiones: MeNTS, IF-VIG y Encuesta de síntomas, son escalas fácilmente accesibles durante tiempos de pandemia y son de utilidad para seleccionar pacientes de riesgo intermedio y bajo de morbilidad perioperatoria en cirugía electiva durante la pandemia por SARS-CoV-2. Se requieren futuros estudios para confirmar estos hallazgos y para clarificar su potencial en la selección de pacientes con criterios que los definan como de riesgo alto.

Integrated Metabolomics and Proteomics Analyses in the Local Milieu of Islet Allografts in Rejection versus Tolerance.

An understanding of the immune mechanisms that lead to rejection versus tolerance of allogeneic pancreatic islet grafts is of paramount importance, as it facilitates the development of innovative methods to improve the transplant outcome. Here, we used our established intraocular islet transplant model to gain novel insight into changes in the local metabolome and proteome within the islet allograft's immediate microenvironment in association with immune-mediated rejection or tolerance. We performed integrated metabolomics and proteomics analyses in aqueous humor samples representative of the graft's microenvironment under each transplant outcome. The results showed that several free amino acids, small primary amines, and soluble proteins related to the Warburg effect were upregulated or downregulated in association with either outcome. In general, the observed shifts in the local metabolite and protein profiles in association with rejection were consistent with established pro-inflammatory metabolic pathways and those observed in association with tolerance were immune regulatory. Taken together, the current findings further support the potential of metabolic reprogramming of immune cells towards immune regulation through targeted pharmacological and dietary interventions against specific metabolic pathways that promote the Warburg effect to prevent the rejection of transplanted islets and promote their immune tolerance.

In Situ X-ray Absorption Spectroscopy of PtNi-Nanowire/Vulcan XC-72R under Oxygen Reduction Reaction in Alkaline Media.

Studying the oxygen reduction reaction (ORR) in the alkaline electrolyte has proven to promote better catalytic responses and accessibility to commercialization. Ni-nanowires (NWs) were synthesized via the solvothermal method and modified with Pt using the spontaneous galvanic displacement method to obtain PtNi-NWs. Carbon Vulcan XC-72R (V) was used as the catalyst support, and they were doped with NH3 to obtain PtNi-NWs/V and PtNi-NWs/V-NH3. Their electrocatalytic response for the ORR was tested and PtNi-NWs/V provided the highest specific activity with logarithmic values of 0.707 and 1.01 (mA/cm2 Pt) at 0.90 and 0.85 V versus reversible hydrogen electrode (RHE), respectively. PtNi-NWs showed the highest half-wave potential (E 1/2 = 0.89 V) at 1600 rpm and 12 µgPt/cm2 in 0.1 M KOH at 25.00 ± 0.01 °C. Additionally, the catalysts followed a four-electron pathway according to the Koutecký-Levich analysis. Moreover, durability experiments demonstrated that the PtNi-NW/V performance loss was like that of commercial Pt/V along 10,000 cycles. Electrochemical ORR in situ X-ray absorption spectroscopy results showed that the Pt L3 edge white line in the PtNi-NW catalysts changed while the electrochemical potential was lowered to negatives values, from 1.0 to 0.3 V versus RHE. The Pt/O region in the in situ Fourier transforms remained the same as the potentials were applied, suggesting an alloy formation between Pt and Ni, and Pt/Pt contracted in the presence of Ni. These results provide a better understanding of PtNi-NWs in alkaline electrolytes, suggesting that they are active catalysts for ORR and can be tuned for fuel cell studies.

Physical activity, overweight and obesity in public service drivers in the city of Manizales, Colombia / Actividad física, sobrepeso y obesidad en conductores de servicio público de la ciudad de Manizales, Colombia / Atividade física, sobrepeso e obesidade nos motoristas do transporte público em Manizales, Colômbia

Abstract Objective: To determine the level of physical activity, overweight and obesity of public service drivers in the city of Manizales, Colombia. Methodology: quantitative, correlational and cross-sectional research. Simple random probability sampling. A sample of 175 male subjects was obtained from three public taxi service companies. The analysis was carried out with the SPSS v.20 program for Windows. Descriptive statistics were calculated. To determine the relationship between nonparametric variables, the Mann-Whitney U tests, Chi-square and the Pearson correlation index were applied. For the comparison of means in the parametric variables the t-Student test was used with a level of significance of p≤ 0.05. Results: average age, 48.89 ± 16.64 years; average height, 1.68 ± 0.05 m, average abdominal circumference, 94.92 ± 9.0 cm and average body mass index, 27.51 ± 3.4 kg/m2. Intense physical activity was carried out by 19.3%, moderate intensity physical activity was practiced by 27.8%, and low intensity physical activity was carried out by 36.4%, while 16.5% of drivers do not perform any physical activity. Conclusions: Taxi drivers have low levels of intense and moderate physical activity while low levels of physical activity have a higher prevalence. Drivers are characterized because they are 63% overweight and have a high abdominal circumference index with values similar to the national parameters.

Resumen Objetivo: determinar el nivel de actividad física, sobrepeso y obesidad en los conductores de servicio público de la ciudad de Manizales, Colombia. Metodología: investigación de tipo cuantitativo, correlacional y de carácter transversal. Muestreo probabilístico aleatorio simple; se obtuvo una muestra de 175 sujetos del género masculino, de tres empresas de servicio público de taxis. El análisis se realizó con el programa SPSS v.20 para Windows. Se calcularon los estadísticos de tipo descriptivo; para determinar la relación entre variables no paramétricas se aplicaron las pruebas U de Mann-Whitney, Chi-cuadrado y el índice de correlación de Pearson. Para la comparación de medias en las variables paramétricas se usó la prueba t-Student, con un nivel de significancia de p≤ 0,05. Resultados: edad promedio de 48,89±16,64 años; talla de 1,68±0,05 m, circunferencia abdominal de 94,92±9,0 cm y un índice de masa corporal de 27,51±3,4 kg/m2; la actividad física intensa es realizada por el 19,3%; la actividad física de intensidad moderada fue practicada por el 27,8%, y la actividad física de baja intensidad fue realizada por el 36,4%. El 16,5% no realiza actividad física. Conclusiones: Los conductores de taxi tienen bajos niveles de actividad física intensa y moderada, mientras que los niveles de actividad física baja tienen una prevalencia más alta. Se caracterizan por presentar sobrepeso del 63% y un elevado índice de circunferencia abdominal, con valores similares a los parámetros nacionales.

Resumo Objetivo: determinar o nível de atividade física, sobrepeso e obesidade nos motoristas de transporte público da cidade de Manizales, Colômbia. Metodologia: pesquisa de tipo quantitativo, correlacional e de caráter transversal. Amostragem probabilística aleatória simples; foi obtida uma amostra de 175 sujeitos do gênero masculino, de três empresas de transporte público de taxis. A análise se realizou com o programa SPSS v.20 para Windows. Foram calculados os estatísticos de tipo descritivo; para determinar a relação entre variáveis não paramétricas foram aplicados os testes U de Mann-Whitney, Chi-quadrado e o índice de correlação de Pearson. Para a comparação de médias nas variáveis paramétricas foi usado o teste t-Student, com um nível de significância de p≤ 0,05. Resultados: idade média de 48,89±16,64 anos; tamanho de 1,68±0,05 m, circunferência abdominal de 94,92±9,0 cm e um índice de massa corporal de 27,51±3,4 kg/m2; a atividade física intensa é realizada por 19,3%; a atividade física de intensidade moderada é praticada por 27,8%, e a atividade física de baixa intensidade é realizada é 36,4%. O 16,5% não realiza atividade física. Conclusões: Os motoristas de taxi têm baixos níveis de atividade física intensa e moderada, enquanto que os níveis de atividade física baixa têm uma prevalência mais alta. Um 63% dos motoristas apresentou um elevado índice de circunferência abdominal, com valores similares aos parâmetros nacionais.

Método de aprendizaje profesional basado en proyectos para la formación de los trabajadores

Este artículo propone un método de aprendizaje profesional basado en proyectos para la formación inicial o continua de los trabajadores, el cual expresa como novedad científica el establecimiento de una dinámica que sistematiza la regularidad de un método de trabajo tecnológico con un método de enseñanza aprendizaje profesional e integra en periodos alternos por ciclos formativos profesionales a la docencia con la práctica laboral y el trabajo de investigación científica mediante el tratamiento de las relaciones entre lo instructivo con lo educativo y el crecimiento profesional. La investigación se orientó en un enfoque cuantitativo de tipo preexperimental. La muestra objeto de estudio, estuvo constituida por 60 estudiantes del Instituto Tecnológico de Holguin. Se emplearon como métodos el análisis documental, el enfoque sistémico, la observación, el preexperimento pedagógico y el estadígrafo Chi-Cuadrado (X2). Luego de analizar los datos, se encontró la existencia de transformaciones significativas en el aprendizaje de dichos estudiantes que generaron impactos favorables en los procesos productivos y de servicios en las cuales se insertaron laboralmente, concluyendo que este método desde su aspecto externo y estructura interna contribuye a elevar la calidad de la formación profesional del trabajador desde un enfoque más integral flexible y contextualizado.

This article proposes a project-based professional learning method for the initial or continuous training of workers. As a scientific novelty, it establishes a dynamic that systematizes the regularity of the technological work method -professional teaching-learning method- and integrates teaching with work practice and scientific research in alternate periods by professional training cycles by treating the relationships between instruction and educational and profesional growth. The research adopted a quantitative approach of a pre-experimental type. The sample under study consisted of 60 students from the Instituto Tecnológico de Holguin. Documentary analysis, systemic approach, observation, pedagogical pre-experiment, and the Chi-Square statistician (X2) were used as methods. After analyzing the data, significant transformations in these students' learning were found that produced favorable impacts on the productive processes and services in which they were inserted in the workplace. In conclusion, from its external aspect and internal structure, this method contributes to raising the worker's professional training quality from a more comprehensive, flexible, and contextualized approach.

A machine learning approach to predict pancreatic islet grafts rejection versus tolerance.

The application of artificial intelligence (AI) and machine learning (ML) in biomedical research promises to unlock new information from the vast amounts of data being generated through the delivery of healthcare and the expanding high-throughput research applications. Such information can aid medical diagnoses and reveal various unique patterns of biochemical and immune features that can serve as early disease biomarkers. In this report, we demonstrate the feasibility of using an AI/ML approach in a relatively small dataset to discriminate among three categories of samples obtained from mice that either rejected or tolerated their pancreatic islet allografts following transplant in the anterior chamber of the eye, and from naïve controls. We created a locked software based on a support vector machine (SVM) technique for pattern recognition in electropherograms (EPGs) generated by micellar electrokinetic chromatography and laser induced fluorescence detection (MEKC-LIFD). Predictions were made based only on the aligned EPGs obtained in microliter-size aqueous humor samples representative of the immediate local microenvironment of the islet allografts. The analysis identified discriminative peaks in the EPGs of the three sample categories. Our classifier software was tested with targeted and untargeted peaks. Working with the patterns of untargeted peaks (i.e., based on the whole pattern of EPGs), it was able to achieve a 21 out of 22 positive classification score with a corresponding 95.45% prediction accuracy among the three sample categories, and 100% accuracy between the rejecting and tolerant recipients. These findings demonstrate the feasibility of AI/ML approaches to classify small numbers of samples and they warrant further studies to identify the analytes/biochemicals corresponding to discriminative features as potential biomarkers of islet allograft immune rejection and tolerance.

Development of MyCheckTime® software for perioperative safety based on Toyota's Lean Methodology / Desarrollo del software MyCheckTime® para seguridad perioperatoria con base en la metodología Lean de Toyota

Abstract Introduction: In the age of healthcare safety, compliance with checklists and time tracking in surgery continue to be a gray zone in care processes. The technology applied to approach this issue and other scenarios, may contribute to solve a problem that impacts welfare and the healthcare sector economics. Objective: To introduce the design and construction of the MyCheckTime® software that incorporates Toyota's Lean methodology under the concept of Bundles. Materials and methods: Using a conceptual map, 5 measures were incorporated into the bundle; the MyCheckTime® platform was built based on a software code developed in Java8, PHP, Javascript, HTML5, Angular4, MongoDB-MySQL databases, and Docker, Ionic, VertX, Laravel-implemented technologies. Results: A software (MyCheckTime®) was constructed based on an App available for tablets and IOS and Android system-based mobile devices; a web-based platform and a database. The software captures the patient's circuit in the surgical area in real time, and records the times in which the checklists were conducted. Conclusion: MyCheckTime® is a Lean Methodology-based software that potentially enables the surgical team to deliver more efficient, safer, and timely care, allowing real time recording of the patient's circuit in the surgery area.

Resumen Introducción: En la era de la seguridad en la atención en salud, la de atención. La tecnología aplicada a esta problemática, al igual que adherencia a las listas de verificación y el seguimiento de tiempos otros escenarios, podrá contribuir a solucionar un problema que en el área de cirugía, continúan siendo puntos grises en los procesos de atención. La tecnología aplicada a esta problemática, al igual que otros escenarios, podrá contribuir a solucionar un problema que impacta el bienestar y la economía en el sector salud. Objetivo: Presentar el diseño y construcción del software MyCheckTime® que incorpora la metodología Lean de Toyota, bajo el concepto Bundles. Materiales y métodos: Mediante un mapa conceptual se incorporaron cinco medidas al paquete y se construyó una plataforma llamada MyCheckTime® con un código de software desarrollado en Java8, PHP, Javascript, HTML5, Angular4, bases de datos MongoDB-MySQL y tecnologías implementadas Docker, Ionic, VertX, Laravel. Resultados: Se construyó un software (MyCheckTime® ), compuesto por una App disponible para tabletas y móviles con sistema IOS o Android; una plataforma en la web y una base de datos. El software captura en tiempo real el circuito del paciente en el área de cirugía y registra los momentos en que se realizaron las listas de verificación. Conclusión: MyCheckTime® es un software basado en la Metodología Lean que potencialmente permitirá al equipo quirúrgico brindar una atención más eficiente, segura, y oportuna, permitiendo el registro en tiempo real del circuito que el paciente hace en el área de cirugía.

Metodología para la formación de competencias laborales en los médicos residentes de medicina natural y tradicional / Methodology for the training of labor competences in resident doctors in natural and traditional medicine

La presente investigación parte de la determinación a través de un estudio diagnóstico realizado, de las insuficiencias que presentan en el desempeño laboral los médicos residentes de Medicina Natural y Tradicional, lo cual limita el cumplimiento de sus roles docentes, asistenciales e investigativos en las unidades de salud pública. Como vía de solución al problema detectado se propone una metodología para la formación de competencias laborales en estos futuros especialistas que integran el componente académico, laboral e investigativo desde el vínculo entre la instrucción, la educación y el desarrollo de su personalidad. Este resultado se sustentó teóricamente en el enfoque de formación basada en competencias en el contexto de la Educación Médica Superior. Para su elaboración se emplearon los métodos de análisis, síntesis, revisión de documentos y enfoque de sistema. Puede generalizarse al resto de las especialidades de Medicina Natural y Tradicional a nivel nacional e internacional, con flexibilidad y adaptabilidad al contexto laboral donde transcurra su proceso formativo.

The present investigation is based on the determination, through a diagnostic study carried out, of the insufficiencies that the resident doctors of Natural and Traditional Medicine present in the laboral performance, which limits the fulfillment of their teaching, assistance and research roles in the units of public health. As a solution to the problem detected, a methodology is proposed for the training of laboral competences in these future specialists who integrate the academic, labor and research component from the link between instruction, education and the development of their personality. This result was theoretically based on the training approach based on laboral skills in the context of Higher Education. For its elaboration the methods of analysis, synthesis, document review and system approach were used. It can be generalized to the rest of the specialties of Natural and Traditional Medicine at national and international level, with flexibility and adaptability to the work context where your training process takes place.

Locally advanced breast cancer: Tumor-infiltrating lymphocytes as a predictive factor of response to neoadjuvant chemotherapy.

OBJECTIVE: To evaluate the pathologic response after neoadjuvant chemotherapy in patients with breast cancer according to the stromal tumor-infiltrating lymphocytes (TILs) as well as the evaluation of overall and disease-free survival according to TILs. METHODS: A six years (2008-2013) review was done including patients with locally advanced breast cancer that received neoadjuvant therapy and then surgery. An evaluation of the percentage of TILs was done in the pretreatment biopsies and a correlation analysis and survival curves were done. RESULTS: 187 patients were evaluated. The pathological complete response (pCR) in patients with TILs ≥30% was 58.5%, and in patients with TILs < 30% was 11% (p <0.001). An Odds Ratio of 8.85 was obtained in patients with TILs ≥30% to achieve a pCR. This relationship was seen in patients with HER2-enriched and triple-negative subtypes. No correlation between TILs and survival was obtained (OS: log-rank; p = 0.834; DFS: log-rank; p = 0.937). CONCLUSIONS: The study of TILs is important because they represent an additional tool to predict the response to neoadjuvant treatment mostly in HER2-enriched and triple-negative subtypes of breast cancer.

De la farmacocinética a la farmacodinámica, ¿estamos listos para los software 3D? / From pharmacokinetics to pharmacodynamics -Are we ready for 3D software?

Abstract The relationship between the dose and plasma concentration of a drug is determined by pharmacokinetics. However, difficulties arise when more than one drug is administered simultaneously. There is currently a gap in the teaching model when trying to convey the significance of pharmacodynamic interactions. In this article the authors reflect on the importance of developing a software that simplifies the pharmacokinetic concepts of two drugs, turning them into one single variable in space as a function of time. Together with depth of anesthesia monitoring and the pain control variables, this model will bring pharmacokinetics and pharmacodynamics together and provide a teaching tool for improved understanding of these concepts.

Resumen La relación entre la dosis y la concentración plasmática de un fármaco está determinada por la farmacocinética. Sin embargo, se presentan dificultades cuando hay más de un medicamento administrado de forma simultánea. En la actualidad hay un vacío en el modelo de enseñanza cuando se pretende difundir la importancia de las interacciones farmacodinámicas. En el presente artículo los autores hacen una reflexión sobre la importancia de poder construir un software que simplifique los conceptos farmacocinéticos de dos medicamentos, convirtiéndolos en una sola variable de espacio en función del tiempo. Este modelo permitiría, junto con la monitorización de la profundidad anestésica y las variables de control del dolor, acoplar la farmacocinética a la farmacodinámica, y brindaría una herramienta de educación para la comprensión de estos conceptos.

Frozen section evaluation of sentinel lymph nodes in breast carcinoma: a retrospective analysis.

OBJECTIVE: To determine the false-negative rate, sensitivity, and diagnostic accuracy of the frozen section analysis of the sentinel lymph node (SLN) biopsy in early-stage breast cancer compared to the definitive section and to identify the factors that could be associated with the appearance of false-negative cases. Secondarily, to evaluate the pathological results of cases submitted to completion axillary lymph node dissection (ALND) for positive SLN. METHODS: We performed a five-year review of cases (2011-2015), including patients with early-stage breast cancer undergoing SLN biopsy, with frozen section evaluation and subsequent definitive pathological analysis. These results were compared to calculate the false-negative rate and the factors associated with it. The histopathological findings were also evaluated in patients submitted to completion ALND. RESULTS: A total of 281 patients were evaluated, identifying 18 cases with frozen section results as false negative (false-negative rate: 23.7%), and 55.5% of these cases were micrometastases. The false-negative rate in SLN with macrometastasis was 13.1% and for micrometastasis cases was 66.7% (p < 0.001). True-positive patients that were submitted to completion ALND had additional axillary lymph nodes with metastases in 28% of cases, whereas the group of false negatives had additional positive axillary lymph nodes in 40% of patients (p = 0.62). CONCLUSION: Frozen section analysis had a false-negative rate acceptable in SLN biopsy in our institution, and the micrometastasis in the SLN was the most important factor associated with the appearance of this phenomenon.

El mundo oculto de las interacciones farmacológicas en anestesia / The hidden world of drug interactions in anesthesia

Abstract Drug interactions represent the cornerstone in the basic anesthetic triangle and knowledge about such interactions contributes to a solid foundation for administering medications. This article dwells on the anesthetic drug interactions: pharmaceutical (mixing or not mixing), pharmacokinetic (alterations in distribution, metabolism, or clearance), pharmacodynamics (synergism, additive effect) and thermodynamic (affinity and intrinsic activity). The basic anesthetic triangle is a current concept and drug interactions are the cornerstone for safe anesthesia. These interactions are currently neglected and hence the anesthetist should recognize any drug interactions for a safer practice of anesthesia.

Resumen Las interacciones farmacológicas constituyen los pilares de la tríada básica de la anestesia y su conocimiento contribuye a tener unas bases sólidas en la administración de medicamentos. El presente artículo tiene como objetivo hacer una reflexión sobre las interacciones farmacológicas en anestesia: farmacéuticas (mezclar o no mezclar), farmacocinéticas (alteración en la distribución, metabolismo o eliminación), farmacodinámicas (sinergismo, adición) y termodinámicas (afinidad y actividad intrínseca). La tríada básica de la anestesia es un concepto vigente y sus interacciones farmacológicas son los pilares de una anestesia segura. En la actualidad estas interacciones no se tienen en cuenta, razón por la cual es pertinente que el anestesiólogo las tenga presentes para hacer un ejercicio más seguro de los medicamentos que administra.

Efecto de dos concentraciones plasmáticas de remifentanilo a través de TACAN sobre la frecuencia e intensidad de la tos durante la extubación: Ensayo Clínico Controlado Aleatorizado / Effect on cough frequency and intensity during extubation of two plasma concentrations of remifentanil using TACAN: Randomised controlled clinical trial

Introduction: Cough at the time of extubation may trigger anaesthesia-related adverse events. A technique that has been found to limit cough during this stage of the anaesthesia procedure is the use of remifentanil. Objective: To compare cough frequency and intensity at the time of extubation with two different plasma concentrations of remifentanil, 3-4 ng/ml and 2-3 ng/ml, using target controlled anaesthesia. Materials and methods: Randomised controlled clinical trial carried out at the Institute for Blind and Deaf Children in Valle del Cauca, in patients taken to elective ear surgery. Patients were randomly assigned to one of two groups. The first group (T) received an infusion of remifentanil at a plasma concentration of 3-4 ng/ml (n = 50). The second group (U) received an infusion of remifentanil at a plasma concentration of 2-3 ng/ml (n = 51). Data were analysed using the Student t test and the non-parametric Mann Whitney U test; the Chi square test was used for determining associations. Results: Cough intensity and frequency were less in group T compared to group U (OR: 3.73; 95% CI: 1.3-10.7), and there was no difference between the two groups regarding emergence from anaesthesia. Conclusions: The presence of at least one cough episode during extubation is less with plasma concentrations of remifentanil of 3-4 ng/ml than 2-3 ng/ml.

Introducción: La presencia de tos al momento de la extubación puede desencadenar eventos adversos asociados a la anestesia. Una técnica reportada para disminuir la tos durante esta parte del acto anestésico es la extubación con remifentanilo. Objetivo: Comparar la frecuencia y la intensidad de la tos en el momento de la extubación con dos concentraciones plasmáticas de remifentanilo de 3-4 y de 2-3 ng/ml, a través de la técnica anestésica con objetivo controlado. Materiales y métodos: Se realizó un ensayo clínico controlado aleatorizado en el Instituto para Niños Ciegos y Sordos del Valle del Cauca, en pacientes sometidos a cirugía programada de oído. Los pacientes fueron divididos aleatoriamente en dos grupos. El primer grupo (T) recibió una infusión de remifentanilo con una concentración plasmática entre 3-4ng/ml (n = 50). El segundo grupo (U) recibió una infusión de remifentanilo con una concentración plasmática entre 2-3ng/ml (n = 51). Los datos se analizaron mediante la prueba estadística de la t de Student y la prueba no paramétrica de la U de Mann Whitney; para establecer asociaciones se realizó la prueba Chi-cuadrado. Resultados: La intensidad y la frecuencia de la tos fue menor en el grupo T que en el grupo U (OR: 3.73; IC 95%: 1.3-10.7); el tiempo de despertar no mostró diferencia entre ambos grupos. Conclusiones: La presencia de al menos un episodio de tos durante la extubación es menor cuando se alcanzan concentraciones plasmáticas de remifentanilo entre 3-4 ng/ml que entre 2-3 ng/ml.

A ketogenic diet modifies glutamate, gamma-aminobutyric acid and agmatine levels in the hippocampus of rats: A microdialysis study.

The ketogenic diet (KD) is acknowledged as an unconventional option in the treatment of epilepsy. Several lines of investigation point to a possible role of glutamate and gamma-aminobutyric acid (GABA) as main contributors in this protective effect. Other biomolecules could also be involved in the beneficial consequence of the KD, for example, the diamine agmatine has been suggested to block imidazole and glutamate NMDA receptor and serves as an endogenous anticonvulsant in different animal models of epilepsy. In the present report, we have used microdialysis coupled to capillary electrophoresis to monitor microdialysate levels of GABA, glutamate and agmatine in the hippocampus of rats submitted to a KD for 15days compared to rats on a normal rat chow diet. A significant increase in GABA and agmatine levels while no change in glutamate levels was observed. These results support the notion that the KD modifies different transmitters favoring inhibitory over excitatory neurotransmitters.

Correlation between plasma levels of arginine and citrulline in preterm and full-term neonates: Therapeutical implications.

BACKGROUND: Preterm neonates exhibit several deficiencies that endanger their lives. Understanding those disturbances will provide tools for the management of preterm neonates. The present work focuses on arginine and citrulline which has been flagged among the biochemical landmarks of prematurity. METHODS: We examined blood samples of preterm newborns as compared with mature neonates to determine the levels of arginine and citrulline by capillary zone electrophoresis with laser induced fluorescence detection (CZE-LIFD). RESULTS: Significantly lower levels of arginine and citrulline were found in preterm neonates than in mature neonates (P<.01). Interestingly there was a highly significant correlation between the two amino acids in mature neonates (P<.0001). Such correlation was present in preterm neonates too (P<.01). Pearson coefficient showed that 60% of the citrulline concentration depends on arginine concentration in mature neonates. Only 20% of the citrulline concentration depends on arginine concentration in preterm neonates. Although the ratio arginine/citrulline was lower in preterm neonates than in mature neonates the difference was not statistically significant. CONCLUSIONS: These results suggest that less arginine is converted to citrulline to form nitric oxide in preterm than in full-term neonates. The result is discussed in terms of the immature enzymatic systems in the preterm neonate.

Exigencias didácticas para la enseñanza de la medicina tradicional y natural en los estudiantes de la carrera de medicina / Didactic requirements for the teaching of traditional and natural medicine in medical students

El presente artículo ofrece un conjunto de exigencias didácticas para la enseñanza de la Medicina Tradicional y Natural en los estudiantes de la carrera de Medicina, las cuales se fundamentan en la enseñanza desarrolladora como enfoque de la Pedagogía contemporánea que se aplica en la Educación Médica Superior. Las exigencias didácticas fueron concebidas mediante la aplicación del método sistémico estructural funcional y pueden ser aplicadas mediante las diferentes formas de organización de la docencia que se imparten en las diferentes disciplinas de la carrera de Medicina.