Afrontamiento a la muerte en estudiantes de medicina del Paraguay en agosto 2021: estudio multicéntrico / Coping with death in Paraguayan medical students in August 2021: a multicenter study

RESUMEN Introducción: el afrontamiento a la muerte constituye una de las situaciones más difíciles y estresantes a las que se tienen que enfrentar los estudiantes de medicina por el contacto cercano a pacientes en riesgo vital. Objetivos: determinar el nivel de afrontamiento a la muerte en estudiantes de medicina. Metodología: se aplicó diseño con enfoque cuantitativo, de tipo observacional, transversal, multicéntrico. Se incluyó a estudiantes de medicina del Paraguay, de ambos sexos, en agosto 2021, que aceptaban participar del estudio. Se utilizó un cuestionario telemático. Se midieron variables sociodemográficas. El nivel de afrontamiento se determinó con la escala de Bugen. La investigación fue aprobada por Comité de Ética de la Universidad Privada del Este, Asunción. Resultados: se incluyeron 504 estudiantes, siendo del sexo femenino en 74 % y con edad media 22 ± 4 años. El 88 % de los encuestados eran de nacionalidad paraguaya (88 %) y 73 % de religión católica. La mayoría nació en Paraguay (88 %), era católica (73 %), se hallaba inscripta como donante de órganos (60 %) y tenía antecedente reciente de muerte de un familiar o amigo (76 %). La escala de Bugen detectó bajo nivel de afrontamiento a la muerte en 50 %, siendo 52 % en las mujeres y 42 % en los varones (p <0,05). Conclusión: el afrontamiento a la muerte en estudiantes de medicina fue bajo. Se sugiere incluir cursos, talleres y planes formativos dentro de las asignaturas o como actividades de extensión para mejorar ese aspecto en el currículo de las facultades de medicina del Paraguay.

ABSTRACT Introduction: coping with death is one of the most difficult tasks that medical students have to face. Objectives: to determine the level of coping with death in medical students. Methodology: we conducted an observational, cross-sectional, multicenter study. We included men and women, medical students from public and private universities from Paraguay in 2021, who agreed to participate in the study. A telematic questionnaire was used. Sociodemographic variables were measured. The level of coping was determined with the Bugen scale. The research was approved by the Comité de Ética of the Universidad Privada del Este, Asunción. Results: 504 students were included, 74 % being female and with a mean age of 22 ± 4 years. Most were born in Paraguay (88 %), were Catholic (73 %), registered as an organ donor (60 %), and had a recent history of the death of a family member or friend (76 %). The Bugen scale detected a low level of coping with death in 52 % of the women and 42 % of the men (p <0.05). Conclusion: coping with death in medical students was low. It is suggested to include courses or workshops to improve this aspect in the curriculum of the medical schools of Paraguay.

Asociación entre mortalidad por Covid-19 y contaminación atmosférica en ciudades mexicanas / Association between Covid-19 mortality and atmospheric pollution in Mexican cities

Resumen: Objetivo: Analizar la asociación entre la exposición crónica a contaminantes atmosféricos y la tasa de mortalidad por Covid-19 en ciudades mexicanas. Material y métodos: Estudio ecológico en 25 ciudades mexicanas utilizando el reporte de casos diarios de muertes por Covid-19 (febrero a junio 2020) y datos validados de contaminantes atmosféricos, considerando concentraciones promedio en cada ciudad en el último año. Se utilizaron modelos de regresión Poisson, con modelos aditivos generalizados y variables de ajuste. Resultados: Se encontró un incremento significativo de 3.5% (IC95% 2.3-4.7) en la tasa de mortalidad por Covid-19 por incremento de 1µg/m3 de NO2. La asociación con PM2.5 fue no significativa, con un incremento de 1.8% por cada µg/m3. Conclusiones: Los resultados sugieren una asociación entre la mortalidad por Covid-19 y la exposición a NO2. Esta primera aproximación del riesgo asociado con la contaminación del aire requiere de análisis más precisos, pero es consistente con estudios de otras regiones.

Abstract Objective: To analyze the relationship between chronic exposures to air pollution with Covid-19 death rate in Mexican cities. Materials and methods: Ecological study in 25 Mexican cities using the report of daily Covid-19 deaths (from February to June 2020) and validated data of air pollutants, considering average concentrations in each city for the last year. Poisson regression models using generalized additive models with adjustment variables (GAM) were used. Results: A significant increase of 3.5% (95% CI 2.3-4.7) was found in Covid-19 death rate for each 1µg/m3 in annual concentration of NO2. The association with PM2.5 was not significant, with an increase of 1.8% for each 1µg/m3. Conclusions: Results suggest an association between Covid-19 mortality and chronic exposure to NO2. This first approximation of the risk associated with air pollution requires a more precise analysis, but is consistent with what was observed in other studies.

Asociación entre mortalidad por Covid-19 y contaminación atmosférica en ciudades mexicanas.

Objetivo. Analizar la asociación entre la exposición crónica a contaminantes atmosféricos y la tasa de mortalidad por Covid-19 en ciudades mexicanas. Material y métodos. Estudio ecológico en 25 ciudades mexicanas utilizando el reporte de casos diarios de muertes por Covid-19 (febrero a junio 2020) y datos validados de contaminantes atmosféricos, considerando concentraciones promedio en cada ciudad en el último año. Se utilizaron modelos de regresión Poisson, con modelos aditivos generalizados y variables de ajuste. Resultados. Se encontró un incremento significativo de 3.5% (IC95% 2.3-4.7) en la tasa de mortalidad por Covid-19 por incremento de 1µg/m3 de NO2. La asociación con PM2.5 fue no significativa, con un incremento de 1.8% por cada µg/ m3. Conclusiones. Los resultados sugieren una asociación entre la mortalidad por Covid-19 y la exposición a NO2. Esta primera aproximación del riesgo asociado con la contami-nación del aire requiere de análisis más precisos, pero es consistente con estudios de otras regiones.

[Association between Covid-19 mortality and atmospheric pollution in Mexican cities]. / Asociación entre mortalidad por Covid-19 y contaminación atmosférica en ciudades mexicanas.

Objective. To analyze the relationship between chronic exposures to air pollution with Covid-19 death rate in Mexican cities. Materials and methods. Ecological study in 25 Mexican cities using the report of daily Covid-19 deaths (from February to June 2020) and validated data of air pollutants, considering average concentrations in each city for the last year. Poisson regression models using generalized additive models with adjustment variables (GAM) were used. Results. A significant increase of 3.5% (95% CI 2.3-4.7) was found in Covid-19 death rate for each 1µg/m3 in annual concentration of NO2. The association with PM2.5 was not significant, with an increase of 1.8% for each 1µg/m3. Conclusions. Results suggest an association between Covid-19 mortality and chronic exposure to NO2. This first approximation of the risk associated with air pollution requires a more precise analysis, but is consistent with what was observed in other studies.

The chelating effect of citric acid, oxalic acid, amino acids and Pseudomonas fluorescens bacteria on phytoremediation of Cu, Zn, and Cr from soil using Suaeda vera.

Phytoextraction is a green technique for the removal of soil contaminants by plants uptake with the subsequent elimination of the generated biomass. The halophytic plant Suaeda vera Forssk. ex J.F.Gmel. is an native Mediterranean species able to tolerate and accumulate salts and heavy metals in their tissues. The objective of this study was to explore the potential use of S. vera for soil metal phytoextraction and to assess the impact of different chelating agents such as natural organic acids (oxalic acid [OA], citric acid [CA]), amino acids (AA) and Pseudomonas fluorescens bacteria (PFB) on the metal uptake and translocation. After 12 months, the highest accumulation of Cu was observed in the root/stem of PFB plots (17.62/8.19 mg/kg), in the root/stem of CA plots for Zn (31.16/23.52 mg/kg) and in the root of OA plots for Cr (10.53 mg/kg). The highest accumulation of metals occurred in the roots (27.33-50.76 mg/kg). Zn was the metal that accumulated at the highest rates in most cases. The phytoextraction percentages were higher for Cu and Zn (∼2%) with respect to Cr (∼1%). The percentages of metal removal from soil indicate the need to monitor soil properties, to recognize the influence of each treatment and to increase the concentration of bioavailable metals by the use of agricultural management practices aimed at promoting plant growth.

Economic Feasibility of Wireless Sensor Network-Based Service Provision in a Duopoly Setting with a Monopolist Operator.

We analyze the feasibility of providing Wireless Sensor Network-data-based services in an Internet of Things scenario from an economical point of view. The scenario has two competing service providers with their own private sensor networks, a network operator and final users. The scenario is analyzed as two games using game theory. In the first game, sensors decide to subscribe or not to the network operator to upload the collected sensing-data, based on a utility function related to the mean service time and the price charged by the operator. In the second game, users decide to subscribe or not to the sensor-data-based service of the service providers based on a Logit discrete choice model related to the quality of the data collected and the subscription price. The sinks and users subscription stages are analyzed using population games and discrete choice models, while network operator and service providers pricing stages are analyzed using optimization and Nash equilibrium concepts respectively. The model is shown feasible from an economic point of view for all the actors if there are enough interested final users and opens the possibility of developing more efficient models with different types of services.

Effect of different lignocellulosic wastes on Hericium americanum yield and nutritional characteristics.

BACKGROUND: The aim of this study was to investigate the possibility of using cottonseed hulls (CSH) and olive press cake (OPC) as new supplement materials for substrate preparation in Hericium americanum cultivation. Some chemical properties of the substrates prepared by mixtures of oak sawdust (OS) with wheat bran (WB), CSH and OPC in different ratios were determined. In addition, the effect of mixtures of OS:CSH and OS:OPC on spawn run time, yield and biological efficiency (BE), average mushroom weight and nutrition content of the fruiting body were compared with the control substrate (8OS:2WB). RESULTS: The yield, BE and average mushroom weight of substrates containing CSH and OPC were higher than the control substrate and increased with an increase in the rate of CSH and OPC in the mixtures. Hericium americanum showed (on a dry weight basis) 8.5-23.7% protein, 9.9-21.2 g kg-1 P, 26.6-35.8 g kg-1 K, 0.63 - 1.33 g kg-1 Mg, 0.19 - 0.23 g kg-1 Ca, 1.34-1.78 g kg-1 Na, 49.5-72.2 mg kg-1 Fe, 6.22-10.11 mg kg-1 Mn, 32.8-82.8 mg kg-1 Zn and 8.6-11.2 mg kg-1 Cu on different growing substrates. The nutritional value of mushrooms was greatly affected by the growing media. CONCLUSION: The results revealed that CSH and OPC could be used as new supplement materials for substrate preparation in H. americanum cultivation. © 2016 Society of Chemical Industry.

Biomagnetic monitoring of heavy metals contamination in deposited atmospheric dust, a case study from Isfahan, Iran.

Tree leaves are considered as one of the best biogenic dust collectors due to their ability to trap and retain particulate matter on their surfaces. In this study, the magnetic susceptibility (MS) and the concentration of selected heavy metals of plane tree (Platanus orientalis L.) leaves and deposited atmospheric dust, sampled by an indirect and a direct method, respectively, were determined to investigate the relationships between leaf magnetic parameters and the concentration of heavy metals in deposited atmospheric dust. The objective was to develop a biomagnetic method as an alternative to the common ones used for determining atmospheric heavy metal contaminations. Plane tree leaves were monthly sampled on the 19th of May to November, 2012 (T1-T7), for seven months from 21 different sites in the city of Isfahan, central Iran. Deposited atmospheric dust samples were also collected using flat glass surfaces from the same sites on the same dates, except for T1. MS (χlf, χhf) values in washed (WL) and unwashed leaves (UL) as well as Cu, Fe, Mn, Ni, Pb, and Zn concentrations in UL and deposited atmospheric dust samples were determined. The results showed that the MS content with a biogenic source was low with almost no significant change during the sampling period, while an increasing trend was observed in the MS content of UL samples due to the deposition of heavy metals and magnetic particles on leaf surfaces throughout the plant growth. The latter type of MS content could be reduced through washing off by rain. Most heavy metals examined, as well as the Tomlinson pollution load index (PLI) in UL, showed statistically significant correlations with MS values. The correlation between heavy metals content in atmospheric dust deposited on glass surfaces and leaf MS values was significant for Cu, Fe, Pb, and Zn. Moreover, the similarity observed between the spatial distribution maps of leaf MS and deposited atmospheric dust PLI provided convincing evidence regarding the suitability of the biomagnetic approach as a relatively rapid and inexpensive method for identifying highly polluted urban areas with selected heavy metals, especially those subjected to anthropogenic and other traffic related sources.

Differential binary encoding method for calibrating image sensors based on IOFBs.

Image transmission using incoherent optical fiber bundles (IOFBs) requires prior calibration to obtain the spatial in-out fiber correspondence necessary to reconstruct the image captured by the pseudo-sensor. This information is recorded in a Look-Up Table called the Reconstruction Table (RT), used later for reordering the fiber positions and reconstructing the original image. This paper presents a very fast method based on image-scanning using spaces encoded by a weighted binary code to obtain the in-out correspondence. The results demonstrate that this technique yields a remarkable reduction in processing time and the image reconstruction quality is very good compared to previous techniques based on spot or line scanning, for example.

A focusing method in the calibration process of image sensors based on IOFBs.

A focusing procedure in the calibration process of image sensors based on Incoherent Optical Fiber Bundles (IOFBs) is described using the information extracted from fibers. These procedures differ from any other currently known focusing method due to the non spatial in-out correspondence between fibers, which produces a natural codification of the image to transmit. Focus measuring is essential prior to carrying out calibration in order to guarantee accurate processing and decoding. Four algorithms have been developed to estimate the focus measure; two methods based on mean grey level, and the other two based on variance. In this paper, a few simple focus measures are defined and compared. Some experimental results referred to the focus measure and the accuracy of the developed methods are discussed in order to demonstrate its effectiveness.

Sensor for high speed, high precision measurement of 2-d positions.

A sensor system to measure the 2-D position of an object that intercepts a plane in space is presented in this paper. This sensor system was developed with the aim of measuring the height and lateral position of contact wires supplying power to electric locomotives. The sensor comprises two line-scans focused on the zone to be measured and positioned in such a way that their viewing planes are on the same plane. The report includes a mathematical model of the sensor system, and details the method used for calibrating the sensor system. The procedure used for high speed measurement of object position in space is also described, where measurement acquisition time was less than 0.7 ms. Finally, position measurement results verifying system performance in real time are given.

Sensor for distance measurement using pixel grey-level information.

An alternative method for distance measurement is presented, based on a radiometric approach to the image formation process. The proposed methodology uses images from an infrared emitting diode (IRED) to estimate the distance between the camera and the IRED. Camera output grey-level intensities are a function of the accumulated image irradiance, which is also related by inverse distance square law to the distance between the camera and the IRED. Analyzing camera-IRED distance, magnitudes that affected image grey-level intensities, and therefore accumulated image irradiance, were integrated into a differential model which was calibrated and used for distance estimation over a 200 to 600 cm range. In a preliminary model, the camera and the emitter were aligned.

Sensor for Distance Estimation Using FFT of Images.

In this paper, the problem of how to estimate the distance between an infrared emitter diode (IRED) and a camera from pixel grey-level intensities is examined from a practical standpoint. Magnitudes that affect grey level intensity were defined and related to the zero frequency component from the FFT image. A general model was also described and tested for distance estimation over the range from 420 to 800 cm using a differential methodology. Method accuracy is over 3%.

Sensor Calibration Based on Incoherent Optical Fiber Bundles (IOFB) Used For Remote Image Transmission.

Image transmission using incoherent optical fiber bundles (IOFB) requires prior calibration to obtain the spatial in-out fiber correspondence in order to reconstruct the image captured by the pseudo-sensor. This information is recorded in a Look-Up Table (LUT), used later for reordering the fiber positions and reconstructing the original image. This paper presents a method based on line-scan to obtain the in-out correspondence. The results demonstrate that this technique yields a remarkable reduction in processing time and increased image quality by introducing a fiber detection algorithm, an intensity compensation process and finally, a single interpolation algorithm.

[Antimicrobial susceptibility of uropathogens and outcome following antibiotic treatment for urinary tract infections in primary health care]. / Sensibilidad antimicrobiana de los uropatógenos y resultados del tratamiento antibiótico de las infecciones urinarias en atención primaria.

BACKGROUND AND OBJECTIVE: An increase in the resistance to antimicrobial agents among bacteria causing urinary tract infections (UTI) has been reported. The aim of this study was to relate uropathogen susceptibility to prescribed antibiotics for UTI to the clinical outcome after therapy in primary health care patients. METHODS: A prospective longitudinal study, including 118 women diagnosed with UTI was carried out in primary health care centers. The results of urine culture, antimicrobial susceptibility testing and the prescribed antibiotic treatment were recorded. The patients' clinical outcome and the results of follow-up urine cultures after therapy were also recorded. RESULTS: The uropathogens isolated were susceptible to the prescribed antibiotic in 86% of patients. Clinical improvement at two weeks was observed in 91% of patients with bacteria sensitive to the prescribed antibiotics and 7% of patients with resistant bacteria (P = 0.06). At 4-6 weeks, there were no clinical symptoms in 88% of patients with sensitive bacteria and 71% of patients with resistant bacteria (p = 0.23). In follow-up urine cultures, bacteria had been eradicated in 74% of patients with sensitive bacteria and 50% with resistant bacteria (p = 0.34). CONCLUSIONS: The majority of women diagnosed with UTI in primary health care had uropathogens sensitive to the prescribed antibiotic and treatment was effective at short term in this study. The results of antimicrobial susceptibility testing were not always related to the clinical outcome; bacterial resistance may overestimate the risk of therapeutic failure in UTI.

Sensibilidad antimicrobiana de los uropatógenos y resultados del tratamiento antibiótico de las infecciones urinarias en atención primaria / Antimicrobial susceptibility of uropathogens and outcome following antibiotic treatment for urinary tract infections in primary health care

Antecedentes y objetivo. Se ha descrito un aumento de las resistencias a los antimicrobianos en las bacterias productoras de infecciones del tracto urinario (ITU). El objetivo del estudio fue relacionar la sensibilidad de los microorganismos al tratamiento antibiótico prescrito con la evolución clínica de las pacientes con ITU diagnosticadas en atención primaria. Métodos. Estudio longitudinal y prospectivo en centros de atención primaria, que incluyó a 118 mujeres diagnosticadas de ITU. Se analizaron los resultados de los urocultivos, los antibiogramas y el tratamiento antibiótico prescrito. Se realizó un seguimiento de la evolución clínica de las pacientes y de los resultados de los urocultivos de control. Resultados. Las bacterias del urocultivo fueron sensibles al antibiótico prescrito en el 86% de las pacientes tratadas. El 91% de las pacientes con bacterias sensibles al antibiótico prescrito y el 71% de las pacientes con un microorganismo resistente refirieron una mejoría clínica a las 2 semanas (p = 0,06). No presentaron síntomas clínicos a las 4-6 semanas el 88% de las pacientes con bacterias sensibles y el 71% de las pacientes con bacterias resistentes (p = 0,23). En los urocultivos de control se erradicaron las bacterias en el 74% de las pacientes con bacterias sensibles y en el 50% de las pacientes con bacterias resistentes (p = 0,34). Conclusiones. En este estudio, la mayoría de las mujeres diagnosticadas de ITU en atención primaria tuvieron uropatógenos sensibles a los antibióticos prescritos y el tratamiento a corto plazo fue efectivo. Los resultados del antibiograma no siempre se correlacionan con el resultado clínico y las resistencias antimicrobianas pueden sobreestimar el riesgo de fracaso terapéutico en las ITU (AU)

Background and objective. An increase in the resistance to antimicrobial agents among bacteria causing urinary tract infections (UTI) has been reported. The aim of this study was to relate uropathogen susceptibility to prescribed antibiotics for UTI to the clinical outcome after therapy in primary health care patients. Methods. A prospective longitudinal study, including 118 women diagnosed with UTI was carried out in primary health care centers. The results of urine culture, antimicrobial susceptibility testing and the prescribed antibiotic treatment were recorded. The patients' clinical outcome and the results of follow-up urine cultures after therapy were also recorded. Results. The uropathogens isolated were susceptible to the prescribed antibiotic in 86% of patients. Clinical improvement at two weeks was observed in 91% of patients with bacteria sensitive to the prescribed antibiotics and 7% of patients with resistant bacteria (P = 0.06). At 4-6 weeks, there were no clinical symptoms in 88% of patients with sensitive bacteria and 71% of patients with resistant bacteria (p = 0.23). In follow-up urine cultures, bacteria had been eradicated in 74% of patients with sensitive bacteria and 50% with resistant bacteria (p = 0.34). Conclusions. The majority of women diagnosed with UTI in primary health care had uropathogens sensitive to the prescribed antibiotic and treatment was effective at short term in this study. The results of antimicrobial susceptibility testing were not always related to the clinical outcome; bacterial resistance may overestimate the risk of therapeutic failure in UTI (AU)

Agudeza visual en escolares del municipio de Naucalpan / Visual acuity in school children from the Naucalpan Municipality

El presente estudio determinó la agudeza visual en escolares del Municipio de Naucalpan, Edo. de México; en el ciclo escolar 1985-1986 (septiembre-junio) en 23 escuelas de educación primaria, utilizando la cartilla de Snellen para valorar la agudeza visual. Se examinaron 15,702 escolares entre seis y 13 años (divididos en cuatro grupos de edades). Se tomó agudeza visual normal (emetropía) la de 20/20 pies y a partir de 20/25 hasta 20/200 como ametropía. De los 15,702 escolares se detectaron 1,890 niños (12.03 por ciento) con baja agudeza visual; 926 fueron hombres y 964 mujeres. Del total, el 98 por ciento presentaron afectación en ambos ojos. Se detectó un mayor número de afectados en edades tempranas (6-7 años); en las escalas 20/25 y 20/30, disminuye el porcentaje a mayores edades; sin embargo , aumenta en estos últimos el grado de ametropía o baja agudeza visual. Recomendamos como rutina, la revisión de la agudeza visual a edades tempranas, con lo cual se puede iniciar la rehabilitación y evitar o disminuir la severidad de ametropía en edades mayores, mejorando a su vez el desempeño escolar