Abstract It is known that neuronal maturation after birth lasts approximately twenty years and requires a large amount of energy. If a pregnancy occurs before maturation, the energy must be distributed between the mother and the offspring, having an effect on the anatomical and functional processes of the brain. Therefore, the electrical activity of the frontal cortex was compared, as well as the performance of its functions and maternal care in adolescents and young people (less than six months after giving birth). The NEUROPSI test (attention and coding) and a maternal care instrument were applied to primiparous adolescents and young people; electroencephalographic recordings were performed on a sample of this population. Significant differences are observed in the coding and attention processes (F= 4.5, α= 0.03*; F= 79.7, α= 0.00**), and a significant correlation between attention and maternal care (health and affection categories) as well as health care coding. The electrical activity of the frontal lobe was slower in primiparous adolescents as well as maternal care behaviors. The above is related to delay in the neuronal maturation of adolescent mothers.

Resumen Se sabe que la maduración neuronal tras el nacimiento dura aproximadamente veinte años y necesita gran cantidad de energía. Si ocurre un embarazo antes de la maduración, la energía debe repartirse entre la madre y la cría, teniendo efecto en los procesos anatómicos y funcionales del cerebro. Por ello, se comparó la actividad eléctrica de la corteza frontal, así como el desempeño de sus funciones y cuidados maternales en adolescentes y jóvenes (con menos de seis meses posteriores al parto). Se aplicó el test NEUROPSI (atención y codificación) y un instrumento de cuidados maternales a primíparas adolescentes y jóvenes; a una muestra de esta población se les realizó registros electroencefalográficos. Se observan diferencias significativas en los procesos de codificación y atención (F= 4.5, α= 0.03*; F=79.7, α= 0.00**), y una correlación significativa entre la atención y el cuidado maternal (categorías de salud y cariño), así como de la codificación sobre el cuidado de la salud. La actividad eléctrica del lóbulo frontal fue más lenta en las adolescentes primíparas, así como las conductas de cuidado maternal. Lo anterior se relaciona con una menor maduración neuronal de madres adolescentes.

ABSTRACT The activities carried out by the nursing professional produce them health problems, with stress being the first factor that will affect one's own rhythm, causing irritability and anxiety. Physical-sports practice has a positive effect on their physical and mental health because it produces the release of endorphins, which leads to a reduction in anxiety, depression and stress because any type of physical activity, whether low or high impact, releases these substances that act directly on the brain, producing a feeling of well-being and immediate relaxation. A research is presented with a non-experimental design, from the quantitative approach of a cross-sectional comparative descriptive type. Its objective is to determine the relationships between physical activity and emotional regulation of a group of nurses from the Sur Hospital in Chilpancingo, Guerrero, Mexico. The TMMS-24 Emotional Intelligence Assessment Scale and the International Physical Activity Questionnaire (IPAQ) were applied. To determine the relationship between the variables, Spearman's Rho Correlation was used. The dimensions studied are attention, clarity and emotional repair by the dependent variable (Emotional Control) and the High, Medium and Low dimensions by the independent variable (Physical Activity). In the community where the signs and symptoms of nervousness, agitation or tension associated with situations of anxiety and stress were observed, direct correlations were established between the intensity of physical activity and the emotional control of the subjects studied, that is, at a lower intensity of physical activity, less control and emotional regulation.

RESUMO As atividades realizadas pelo profissional de enfermagem causam-lhe problemas de saúde, sendo o estresse o primeiro fator que afetará seu próprio ritmo, causando irritabilidade e ansiedade. A prática físico-esportiva tem um efeito positivo sobre sua saúde física e mental, pois produz uma liberação de endorfinas, o que leva a uma redução da ansiedade, da depressão e do estresse, pois qualquer tipo de atividade física, seja ela de baixo ou alto impacto, libera essas substâncias que atuam diretamente no cérebro, produzindo uma sensação de bem-estar e relaxamento imediato. A pesquisa é apresentada em um desenho não-experimental, a partir de uma abordagem quantitativa, descritiva, comparativa, transversal e de corte transversal. Seu objetivo é determinar a relação entre a atividade física e a regulação emocional em um grupo de enfermeiras do Hospital Sur em Chilpancingo, Guerrero, México. Foram aplicados o Emotional Intelligence Rating Scale TMMS-24 e o International Physical Activity Questionnaire (IPAQ). A Correlação Rho de Spearman foi usada para determinar a relação entre as variáveis. As dimensões estudadas são Atenção, Clareza e Reparação Emocional para a variável dependente (Controle Emocional) e as dimensões Alta, Média e Baixa para a variável independente (Atividade Física). Na comunidade onde foram observados os sinais e sintomas de nervosismo, agitação ou tensão associados a situações de ansiedade e estresse, foram estabelecidas correlações diretas entre a intensidade da atividade física e o controle emocional dos sujeitos investigados, ou seja, quanto menor a intensidade da atividade física, menor o controle e a regulação emocional.

RESUMEN Las actividades que realiza el profesional de la enfermería les producen quebranto en la salud, siendo el estrés el primer factor que va a afectar el ritmo propio, ocasionando irritabilidad y ansiedad. La práctica físico-deportiva tiene un efecto positivo sobre su salud física y mental debido a que produce liberación de endorfinas, lo que conlleva una reducción de la ansiedad, la depresión y el estrés, ya que cualquier tipo de actividad física, ya sea de bajo o alto impacto, libera estas sustancias que actúan directamente sobre el cerebro, produciendo sensación de bienestar y relajación inmediata. Se presenta una investigación con un diseño no experimental, desde el enfoque cuantitativo de tipo descriptivo comparativo de corte transversal. Tiene como objetivo: determinar las relaciones entre actividad física y regulación emocional de un grupo de enfermeras (o) s del Hospital Sur en Chilpancingo, Guerrero, México. Se aplicó la Escala para Evaluación de la Inteligencia Emocional TMMS-24 y el Cuestionario Internacional de Actividad Física (IPAQ). Para determinar la relación entre las variables se empleó la Correlación del Rho de Spearman. Las dimensiones estudiadas son la atención, claridad y reparación emocional por parte de la variable dependiente (Control emocional) y las dimensiones Alta, Media y Baja por la variable independiente (Actividad física). En la comunidad donde se observaron los signos y síntomas de nerviosismo, agitación o tensión asociados a situaciones de ansiedad y estrés, se establecen correlaciones directas entre la intensidad de la actividad física y el control emocional de los sujetos investigados, o sea, a menor intensidad de la actividad física menor control y regulación emocional.

Resumen El trastorno depresivo mayor (TDM) ha ganado relevancia en los últimos años, ya que es una de las principales causas de discapacidad a nivel mundial y ejerce un impacto significativo en la vida diaria de quienes lo experimentan. La relación entre la disbiosis intestinal y el TDM ha surgido como un componente crucial en el ámbito de la salud mental. La microbiota intestinal, que abarca una amplia diversidad de microorganismos, establece una conexión bidireccional con el TDM a través del eje microbiota-intestino-cerebro, la neuroinflamación y alteración de la función cerebral. El presente trabajo tuvo como objetivo, analizar la relación entre los problemas de equilibrio de los microorganismos en el intestino (fenómeno conocido como “disbiosis”) y el TDM. Se adoptó un enfoque cualitativo que combinó análisis bibliográfico y descriptivo, priorizando fuentes primarias en psicología, neurociencia y microbiología. Se examinaron investigaciones en inglés y español desde 2019 hasta 2023 utilizando motores de búsqueda y bases de datos reconocidas. En este contexto, se observó que el uso de probióticos se ha vuelto cada vez más relevante como parte del tratamiento complementario para el TDM. Los probióticos, como Lactobacillus plantarum DP189 y la bacteria Roseburia intestinalis, ejercen un impacto positivo en la microbiota intestinal, integridad de la barrera hematoencefálica y producción de neurotransmisores. La revisión destaca el papel crucial de la microbiota intestinal en el TDM y la prometedora utilidad de los probióticos como tratamiento complementario. Esto sugiere nuevas perspectivas terapéuticas y subraya la importancia de futuras investigaciones para comprender mejor esta compleja interacción.

Abstract Major depressive disorder (MDD) has gained relevance in recent years, as it is one of the main causes of disability worldwide and has a significant impact on the daily lives of those who experience it. The relationship between gut dysbiosis and MDD has emerged as a crucial component in the field of mental health. The gut microbiota, which encompasses a wide diversity of microorganisms, establishes a bidirectional connection with MDD through the microbiota-gut-brain axis, neuroinflammation and alteration of brain function. The objective of this work was to analyze the relationship between problems with the balance of microorganisms in the intestine (a phenomenon known as “dysbiosis”) and MDD. A qualitative approach was adopted that combined bibliographic and descriptive analysis, prioritizing primary sources in psychology, neuroscience and microbiology. Research in English and Spanish from 2019 to 2023 was examined using recognized search engines and databases. In this context, it was observed that the use of probiotics has become increasingly relevant as part of complementary treatment for MDD. Probiotics, such as Lactobacillus plantarum DP189 and the bacteria Roseburia intestinalis, have a positive impact on the intestinal microbiota, blood-brain barrier integrity, and neurotransmitter production. The review highlights the crucial role of gut microbiota in MDD and the promising utility of probiotics as a complementary treatment. This suggests new therapeutic perspectives and underlines the importance of future research to better understand this complex interaction.

INTRODUCTION: The rising prevalence of stroke in sub-Saharan Africa necessitates the exploration of the role of occupational therapy in rehabilitation of stroke. In the southern African country of South Africa, occupational therapy aligns with healthcare policies and laws, and this article presents a review of synthesized evidence of occupational therapy intervention in stroke care and rehabilitation. METHOD: Rapid review methodology was used to develop a research question about cerebrovascular accident - intervention by occupational therapists., The Cochrane Library and MEDLINE databases were searched for relevant articles published between 2018 and 2023. Twenty four articles met the inclusion criteria and were analysed according to quantitative and qualitative parameters. RESULTS: Evidence of occupational therapy intervention with post-stroke upper limb impairment was found in 37,5% of articles. Occupational therapy for global improvement in function, cognitive rehabilitation, balance, social participation, work, and leisure comprised 45,8% of articles, and one article each reported evidence for occupational therapy addressing ADL and caregiver interventions. CONCLUSION: Evidence from the past five years reflect diverse occupational therapy interventions with clients with stroke. Gaps in recent evidence remain in relation to context-specific interventions, especially from low- and middle-income countries. IMPLICATIONS FOR PRACTICE Occupational therapists adopt a holistic approach to stroke rehabilitation, tailoring interventions to address the multifaceted needs and goals of individual stroke survivors. The effectiveness of individualised, occupation-based approaches across various domains are highlighted. • Therapists stay informed and up to date about emerging technologies and evidence-based practice to enhance their effectiveness in stroke rehabilitation. • This review provides evidence of the prevalence of upper limb impairments post-stroke, which will enable therapists to be well-versed in the diverse intervention approaches for upper limb rehabilitation as outlined in the literature reviewed, including technologies like Brain Computer Interface, Mental Practice, Mirror Therapy, and Action Observation Therapy. • Occupational therapy is vital in addressing cognitive impairments in stroke survivors, and practitioners can apply the evidence provided on interventions such as Virtual Reality and computer-assisted cognitive rehabilitation that have shown promise in improving cognition and ADL.

ABSTRACT Foundation: cerebrovascular disease is any alteration of one or more brain areas, whether temporary or permanent, secondary to a cerebral circulation disorder of ischemic or hemorrhagic origin. For many years it has been considered one of the main causes of death worldwide. It is among the main causes of death in Ecuador. Objective: to describe the risk factors for cerebrovascular diseases in adult patients diagnosed with cerebrovascular diseases at the Tulcán Sur Health Center over a period of 1 year. Methods: a descriptive and cross-sectional study was carried out at the Tulcán Sur Health Center, over a period of 1 year, from September 2022 to September 2023. The universe consisted of 130 patients. The sociodemographic variables were analyzed: age and sex; clinical: presence or absence of high blood pressure, smoking, alcoholism, diabetes mellitus, dyslipidemia, atrial fibrillation and sedentary lifestyle. The normality of the data distribution was analyzed using the Kolmogorov-Smirnov test. Categorical variables were expressed in absolute and relative frequencies. Quantitative variables were described using the mean and standard deviation. Results: the mean age of the population was 61.0 ± 16.5. The male sex predominated with 70 patients (53.8 %). High blood pressure, smoking and obesity were the most common cardiovascular risk factors with 73 (56.5 %), 79 (60.7 %), 64 (49.2 %) patients respectively. Conclusions: high blood pressure, smoking and obesity were the most prevalent risk factors.

RESUMEN Fundamento: la enfermedad cerebrovascular es toda alteración de una o varias áreas encefálicas, ya sea de forma transitoria o permanente, secundaria a un trastorno de la circulación cerebral de origen isquémico o hemorrágico. Por muchos años ha sido considerada una de las principales causas de muerte a nivel mundial. Está entre las principales causas de muerte en Ecuador. Objetivo: describir los factores de riesgo de enfermedades cerebrovasculares en pacientes adultos diagnosticados con enfermedades cerebrovasculares en el Centro de Salud Tulcán Sur en un periodo de 1 año. Métodos: se realizó un estudio descriptivo y transversal, en el Centro de Salud Tulcán Sur, en un periodo de 1 año, desde septiembre del 2022 a septiembre del 2023. El universo lo constituyeron 130 pacientes. Se analizaron las variables sociodemográficas: edad y sexo; clínicas: presencia o no de hipertensión arterial, tabaquismo, alcoholismo, diabetes mellitus, dislipidemia, fibrilación auricular y sedentarismo. La normalidad de la distribución de los datos fue analizada utilizando la prueba de Kolmogorov-Smirnov. Las variables categóricas fueron expresadas en frecuencias absoluta y relativa. Las variables cuantitativas se describieron utilizando la media y la desviación típica. Resultados: la media de edad de la población fue de 61,0 ± 16,5. El sexo masculino predominó con 70 pacientes (53,8 %). La hipertensión arterial, el tabaquismo y la obesidad fueron los factores de riesgo cardiovascular más frecuentes con 73 (56,5 %), 79 (60,7 %), 64 (49,2 %) pacientes respectivamente. Conclusiones: la hipertensión arterial, el tabaquismo y la obesidad fueron los factores de riesgo con más prevalencia.

Abstract Introduction : Chia and flax seeds are rich in alpha-linolenic acid (ALA), which is bioconverted into the active derivatives eicosapentaenoic (EPA) and doco sahexaenoic (DHA) having multiple beneficial effects. However, there is limited knowledge about the anti-inflammatory effects of chia and flax integral flours diets rich in ALA. Objective : The study aimed to evaluate the anti-inflammatory effect of dietary supplementation with integral chia and flax flours in a murine model of LPS-induced systemic inflammation. Methods : Balb/c mice were distributed into three groups: diet A (control), diet B (supplemented with inte gral chia flour), and diet C (supplemented with integral flax flour). Nutritional, hematological, and biochemical determinations were performed. ALA, EPA, and DHA were assessed by GC-MS in the liver, brain, cardiac and skeletal muscles. NF-kB immunoassays were per formed in kidney, liver, and peritoneal macrophages, respectively. The phagocytic capacity was determined in peritoneal macrophages and the expression of the pro- and anti-inflammatory cytokines was assessed by RT-qPCR in the kidney, liver, and spleen. Results : Diets B and C exhibited optimal nutritional adequacy and caused increased levels of ALA, EPA, and DHA in critical tissues compared to the control. The phagocytic capacity of murine peritoneal macrophages (p< 0.01) and IL-10 transcription increased, whereas the expression of NF-κB, IL-1β, IL-6, and TNF-α decreased in animals fed both experimental diets. Conclusions : This work contributes to the current knowledge of the anti-inflammatory effects of chia and flax integral flours rich in ALA and reinforces the health advantages of their consumption.

Resumen Introducción : Las semillas de chía y lino son ricas en ácido alfa-linolénico (ALA), sus derivados activos eico sapentaenoico (EPA) y docosahexaenoico (DHA) ejercen probados efectos beneficiosos. Existe un conocimiento limitado sobre los efectos protectores de ambas semillas bajo la forma de harinas integrales, siendo de particular interés el efecto antiinflamatorio. Objetivo : El objetivo de este trabajo fue evaluar el efecto antiinflamatorio de la suplementación dietaria con harinas integrales de semillas de chía y lino en un modelo murino de inflamación sistémica inducido por LPS. Métodos : Ratones de la cepa Balb/c fueron distribui dos en tres grupos: dieta A (control), dieta B (suplemen tada con harina integral de chía) y dieta C (suplementa da con harina integral de lino). Se efecturaron determi naciones nutricionales, hematológicas y bioquímicas. El contenido de ALA, EPA y DHA en hígado, cerebro, corazón y músculo esquelético se determinó por cromatografía GC-MS. Se realizó la inmunodetección de NF-kB en macrófagos peritoneales, riñón e hígado. Se determinó la capacidad fagocítica de macrófagos peritoneales y se evaluó la expresión de citoquinas pro y antiinflamatorias por RT-qPCR en riñón, hígado y bazo. Resultados : Las dietas B y C mostraron una adecua ción nutricional óptima y generaron niveles elevados de ALA, EPA y DHA en tejidos críticos. La capacidad fagocítica de los macrófagos peritoneales (p< 0.01) y la transcripción de IL-10 aumentó, mientras que la expre sión de NF-κB, IL-1β, IL-6 y TNF-α disminuyó en animales de los grupos B y C. Conclusiones : Este trabajo contribuye al conocimien to actual de los efectos antiinflamatorios de ambas hari nas integrales y refuerza los beneficios de su consumo.

Organ donation after a circulatory determination of death is possible in selected patients where consent is given to support donation and the patient has been legally declared dead by two doctors. The National Health Act (61 of 2003) and regulations provide strict controls for the certification of death and the donation of organs and tissues after death. Although the National Health Act expressly recognises that brain death is death, it does not prescribe the medical standards of testing for the determination of brain death (neurological determination of death), circulatory death (circulatory determination of death) or for determination of death based on somatic criteria. However, in all cases of organ donation, including after circulatory death, the National Health Act mandates that two doctors certify the death, with one doctor possessing more than 5 years of experience. Additionally, both doctors must be independent from the transplant team. The standard for such determination, as for brain death, aligns with accepted medical standards. The Critical Care Society of Southern Africa has published South African (SA) Guidelines on Death Determination that outline rigorous standards for death determination in hospital settings by either a neurological or circulatory method. Legislation and the Health Professions Council of SA's (HPCSA) professional guidance direct clinicians on obtaining informed consent for donation either from the patient or in cases of incapacity from their surrogate decision maker. Collectively, the legislation, regulations and professional guidelines in SA provide a robust ethical framework that supports organ donation after circulatory death.

Resumo Introdução: A prevalência da infeção pelo vírus da imunodeficiência humana (VIH) parece haver estabilizado nos 0,7%, enquanto em alguns países continua a aumentar. Durante muitos anos estava apenas associada ao continente africano e a populações específicas, mas atualmente constata-se um aumento de incidência nos países desenvolvidos. Esta infeção pode ser assintomática ou ter sintomas inespecíficos. Estes dependem do estádio da doença, da carga viral ou do estado imune do hospedeiro. Este caso mostra o desafio do diagnóstico de VIH, relatando uma forma de apresentação sintomática rara. Descrição do caso: Homem de 21 anos de idade, de nacionalidade angolana, que recorre à consulta aberta nos cuidados de saúde primários por quedas frequentes no último mês associadas a sensação de falta de força nos membros inferiores. À avaliação física constata-se uma discreta diminuição global da força nas quatro extremidades, com maior tradução no membro superior esquerdo. Nega práticas sexuais de risco ou consumo de drogas parenterais. Após realização de estudo analítico, estudo eletromiográfico e tomografia computorizada crânio-encefálica, da coluna cervical e lombar, constata-se um resultado positivo para a infeção por VIH como a causa desencadeante da sintomatologia apresentada. Comentário: O que inicialmente pareciam sintomas relacionados com uma doença neuromuscular incipiente veio a revelar-se o diagnóstico de uma infeção vírica. Pela inespecificidade dos seus sintomas é importante manter um elevado nível de suspeição para a infeção por VIH. No caso relatado, a neuropatia periférica era a única manifestação desta infeção. Ainda que tenha uma prevalência de até 60% entre os infetados, é rara como manifestação isolada. A sua etiopatologia não é ainda clara, sabe-se que é multifatorial e progressiva. Presentemente o doente encontra-se estável com o início da terapêutica antirretroviral, com melhoria da sintomatologia.

Abstract Introduction: The prevalence of human immunodeficiency virus (HIV) infection seems to be stabilized at 0.7% but in some countries, it continues to rise. For many years it was only associated with the African continent and specific populations, but today there is an increase in the incidence in developed countries. This infection can be asymptomatic or have non-specific symptoms. Those depend on the stage of the disease, the viral load, or the host’s immune status. This case shows how the diagnosis of HIV remains a real challenge, reporting a rare form of symptomatic presentation. Case description: A 21-year-old male, with Angolan nationality, went to primary health care consultation due to frequent falls in the last month associated with a sensation of lack of strength in the lower limbs. During physical evaluation, a discrete global reduction of strength in the four extremities was noted, most markedly in the left upper limb. The patient denied risky sexual practices or parenteral drug consumption. After carrying out complementary analytical studies, an electromyographic study, and computed tomography of the brain, cervical, and lumbar spine, the results came back positive for HIV infection as the cause of the presented symptoms. Comment: What at first seemed to be symptoms related to an incipient neuromuscular disease turned out to be the diagnosis of a viral infection. Due to the nonspecificity of the symptoms, it is important to maintain a high level of suspicion of HIV infection. In this case, peripheral neuropathy was the only manifestation reported. Although it has a prevalence of up to 60% among the infected, it is rare as an isolated sign. Its aetiopathology is still unclear, but it is known to be multifactorial and progressive. Nowadays the patient is stable after the initiation of antiretroviral therapy, with improvement in symptomology.

ABSTRACT Introduction: The ischemic cerebrovascular disease has a high frequency due to the population aging mainly. Objective: To compare clinical characteristics of patients with ischemic cerebrovascular of two age groups. Methods: A descriptive, cross-sectional, retrospective study was carried out in the Neurology and Neurosurgery Institute in Havana, from January to December, 2017 in patients with ischemic cerebrovascular disease; 36 individuals of both age groups. In this regard, demographic variables, risk factors, clinical manifestations, coma scale and neurological deficiency, etiology and localization of the ischemic ictus were analyzed. Results: The 65 years group had a significant increase of hypertensive patients (88.9%). The average of the National Institute of Health stroke scale was superior in these patients (median [10-90 percentile]: 9.5 [4-19]). There was statistical increment of over 65 years patients with partial paralysis of the look and ataxia, but monoparesis and visual extinction in the age under 65 years. Such a scale had a statistical increase in the atherothrombotic and cardioembolic ictus in comparison with other etiologies in both patient groups. The over 65 years patients with just one risk factor or and those with hypertension had a higher punctuation of the scale. Conclusions: The degree of neurological affectation was higher in over 65 years patients that had a risk factor and in those with hypertension. As a result it could be suggested that the molecular and pathophysiolologic mechanisms of these patients vary with the age.

RESUMEN Introducción: La enfermedad cerebrovascular isquémica tiene una alta frecuencia debida, fundamentalmente, al envejecimiento poblacional. Objetivo: Comparar las características clínicas de pacientes con enfermedad cerebrovascular isquémica de dos grupos etarios. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo en 36 pacientes con enfermedad cerebrovascular isquémica correspondientes a dos grupos etarios (65 y menos años y mayores de 65), quienes fueron atendidos en el Instituto de Neurología y Neurocirugía, La Habana, de enero a diciembre del 2017. Al respecto, se analizaron variables demográficas y clínicas y se aplicaron diferentes pruebas estadísticas para comparar. Resultados: Se obtuvo un aumento significativo de pacientes hipertensos (88,9 %) en el grupo etario mayor de 65 años. La mediana de la escala de ictus del National Institute of Health fue superior en estos pacientes (mediana [10-90 percentil]: 9,5 (4-19]). Hubo incremento estadístico de los mayores de 65 años con parálisis parcial de la mirada y ataxia; en tanto, la monoparesia y la extinción visual predominaron en los de 65 y menos años. Dicha escala mostró un aumento estadístico en el ictus aterotrombótico y cardioembólico en comparación con otras causas en ambos grupos. Los pacientes mayores de 65 años con solo un factor de riesgo o ninguno y los que eran hipertensos tuvieron mayor puntuación de la escala. Conclusiones: El grado de afectación neurológica fue superior en los mayores de 65 años que tenían un factor de riesgo y en aquellos con hipertensión arterial. Puede sugerirse que los mecanismos moleculares y fisiopatológicos de estos pacientes varían según la edad.

ABSTRACT In this article we propose to analyze how healthcare personnel involved in organ and tissue procurement activities use black humor during their daily work. The objective here is twofold: on the one hand, following previous studies, we are interested in showing the role of black humor as a way of dealing with death. On the other hand, we suggest that, in a parallel and complementary way, in this context black humor exposes a performative sense as a form of agency that attempts to modify an adverse reality. This work combines the methodological tools provided by ethnography and conducting open, multi-session interviews. The events revealed during the fieldwork and interviews that associate humor and brain death show the uses, limits and ways in which black humor operates in daily healthcare work of physical and emotional complexity.

RESUMEN En este artículo nos proponemos analizar cómo el personal de salud vinculado a la actividad de procuración de órganos y tejidos utiliza el humor negro durante su labor cotidiana. Aquí el objetivo es doble: por un lado, siguiendo estudios anteriores, nos interesa mostrar el rol del humor negro como modo de lidiar con la muerte. Por otro lado, sugerimos que, de forma paralela y complementaria, el humor negro en este contexto expone un sentido performático como forma de agencia que intenta modificar una realidad adversa. Este trabajo combina las herramientas metodológicas brindadas por la etnografía y la realización de entrevistas abiertas de sesiones múltiples. Los acontecimientos relevados durante el trabajo de campo y las entrevistas que asocian el humor y la muerte encefálica evidencian los usos, límites y modos en los que el humor negro opera en la labor cotidiana sanitaria de complejidad física y emocional.

ABSTRACT Proton pump inhibitors (PPIs) are the most potent drugs to inhibit gastric acid secretion, being used in the treatment of most inflammatory conditions of the gastric mucosa. They are among the most prescribed and overprescribed medications worldwide; for example, in the United States, according to the National Health and Nutrition Examination Survey, they almost doubled their use in adults aged 40 years and older from 4.9 % to 8.3 % between 1999 and 2012. Although they are generally considered well tolerated, some epidemiological studies extracting information from large databases have reported a number of adverse effects associated with their prolonged use, including cognitive impairment, chronic kidney disease, myocardial infarction, stroke, bone fractures and even death, among others. The objective was to conduct a narrative review of the literature on the effects of chronic use of PPIs on cognitive impairment in older adults. Articles were reviewed based on a search in the PubMed, Scopus and SciELO databases using both English and Spanish keywords and related MeSH/DeCS terms. Neurological side effects induced by chronic PPI use may be indirectly related to secondary systemic disorders (magnesium and vitamin B12 deficiency) or to direct effects on neuronal functioning after passing through the blood-brain barrier. Although several neurobiological mechanisms by which PPIs could favor the development of dementia-which involve Tau protein function, beta-amyloid [βA] accumulation and cobalamin deficiency, among others-have been described, most of the available clinical evidence has not shown a significant association between PPI use and the risk of dementia or cognitive impairment. To establish the adverse clinical effects of chronic PPI use more clearly, especially on brain functioning, well-designed cohort studies with large sample sizes and long follow-up periods, with a reliable method to adjust for standardized confounders, as well as subgroup analyses are needed.

RESUMEN Los inhibidores de la bomba de protones (IBP) son los medicamentos más potentes para inhibir la secreción gástrica ácida, y se utilizan en el tratamiento de la mayor parte de las afecciones inflamatorias de la mucosa gástrica. Forman parte de los fármacos más recetados y sobreprescritos en todo el mundo; por ejemplo, en los Estados Unidos, según la Encuesta nacional de salud y nutrición, casi duplicaron su uso en los adultos de 40 años de un 4,9 % hasta un 8,3 %, entre los años 1999 a 2012. Aunque, en general, se consideran bien tolerados, algunos estudios epidemiológicos ―que extraen información a partir de grandes bases de datos― han reportado una serie de efectos adversos asociados con su uso prolongado, entre los cuales están el deterioro cognitivo, la enfermedad renal crónica, el infarto de miocardio, el accidente cerebrovascular, las fracturas óseas e incluso la muerte, entre otros. El objetivo fue realizar una revisión narrativa de la literatura acerca de los efectos del uso crónico de los IBP sobre el deterioro cognitivo en los adultos mayores. Se revisaron artículos a partir de una búsqueda en las bases de datos Pudmed, Scopus y Scielo con las palabras clave y términos Mesh/DeCS relacionados tanto en inglés como en español. Los efectos secundarios a nivel neurológico inducidos por el uso crónico de los IBP pueden estar relacionados indirectamente con la presencia de alteraciones sistémicas secundarias (deficiencia de magnesio y vitamina B12) o con efectos directos sobre el funcionamiento neuronal después de pasar a través de la barrera hematoencefálica. Si bien se han descrito varios mecanismos neurobiológicos por medio de los cuales los IBP podrían favorecer el desarrollo de la demencia ―que comprenden el funcionamiento de la proteína tau, la acumulación de beta amiloide (βA) y la deficiencia de cobalamina, entre otros―, la mayor parte de la evidencia clínica disponible no ha encontrado una asociación significativa entre el uso de los IBP y el riesgo de demencia o el deterioro cognitivo. Para establecer de una manera más clara los efectos clínicos adversos del uso crónico de los IBP, en especial, en el funcionamiento cerebral, se necesitan estudios de cohorte bien diseñados, con tamaños de muestra grandes y periodos de seguimiento prolongados, con un método confiable para ajustar los factores de confusión estandarizados y, además, realizar análisis por subgrupos.

ABSTRACT Despite the numerous efforts of the international community to eradicate all forms of violence against women, this problem is far from being resolved. According to the UN, one in three women has suffered physical or sexual violence from an intimate partner, sexual violence outside the couple, or both at least once in their life. Addressing this problem as a social health need of population groups allows an approach to gender violence as a collective health problem. At the level of physical violence, strangulation/suffocation has been identified as one of the most lethal forms of domestic violence and sexual assault. Victims of domestic violence who have been choked or strangled are 7.5 times more likely to be killed by their partner. A victim of strangulation/suffocation can lose consciousness in seconds or die within minutes, days or weeks after the attack, as well as suffer permanent brain damage or disability or emotional trauma. Recently, legal changes have been generated in the configuration of this crime, the penalties have increased in United Kingdom, the United States, Australia and New Zealand. The current non-systematic narrative review of literature sought to explore updated medico-legal aspects of non-fatal strangulation/suffocation in the context of gender violence, and are highlightedrelevant implications for clinical practice.

RESUMEN A pesar de los numerosos esfuerzos de la comunidad internacional en pos de erradicar todas las formas de violencia contra las mujeres, esta problemática se encuentra lejos de ser resuelta. Según la ONU, una de cada tres mujeres ha sufrido violencia física o sexual por parte de la pareja, violencia sexual fuera de la pareja, o de ambas, al menos una vez en su vida. El abordaje de esta problemática, en tanto necesidad social de salud de grupos poblacionales, permite una aproximación a la violencia de género como un problema de salud colectiva. En el plano de la violencia física, la estrangulación/sofocación ha sido identificada como una de las formas más letales de violencia doméstica y agresión sexual; se ha reportado que una víctima que es estrangulada una primera vez tiene 7,5 más probabilidades de ser asesinada posteriormente por el mismo abusador. Una víctima de estrangulación/sofocación puede perder la conciencia en segundos o morir en minutos, días o semanas después del ataque o sufrir daño cerebral permanente o invalidez, además del trauma emocional. Recientemente, se han generado cambios legales en la configuración de este delito; las penas han aumentado en el Reino Unido, Estados Unidos, Australia y Nueva Zelandia. El propósito de esta revisión de literatura de tipo narrativo, no sistemática, está orientada a presentar aspectos médico-legales actualizados de la estrangulación/sofocación no fatal en el contexto de la violencia de género, y se resaltan aquellas implicancias relevantes para la práctica clínica.

RESUMEN No todos sentimos lo mismo ante un estímulo físico, cada uno expresa una sensación con diferentes palabras, no todos describimos de igual forma las sensaciones respi ratorias y, por qué no decirlo, no todos los profesionales entienden lo que el paciente les relata. La psicofísica de la disnea (las relaciones cuantitativas entre un estímulo respiratorio y una sensación), los descriptores para referirse a la falta de aire (el lenguaje de la disnea) pueden ayudar a romper las barreras comunicacionales entre pacientes, familia y personal de salud. Los datos generales apoyan una red cortical-límbica para la percepción de la disnea. Hay acuerdo en que la corteza insular es un elemento central esencial para el circuito neuronal, mientras que la corteza cingulada anterior y la corteza prefrontal dorsolateral se cree que modulan la magnitud de la percepción de disnea y su alivio. La disnea como un fenómeno del sistema nervioso central y con dimensiones tanto sensoriales como afectivas, esto ha sido confirmado en estudios de neuroimágenes. Se ha establecido firmemente que la disnea es una experiencia com pleja de la mente y el cuerpo, que comprende diferentes sensaciones que solo pueden ser percibidas por el individuo. Los componentes afectivos impulsan los sentimientos acompañantes de angustia, miedo y ansiedad, y es el cerebro, no los pulmones, el que genera estos fenómenos.

ABSTRACT When confronted with a physical stimulus, not everyone feels the same way; each one expresses a sensation with different words; not all of us describe respiratory sensations in the same way; and, why not say it, not all professionals understand what the patient tells them. The psychophysics of dyspnea (the quantitative relationships between a re spiratory stimulus and a sensation) and descriptors for shortness of breath (the dyspnea language) can aid in breaking down communication barriers between patients, families, and health care personnel. The insular cortex is widely agreed to be an important cen tral component of neural circuitry, while the anterior cingulate cortex and dorsolateral prefrontal cortex are thought to modulate the magnitude of dyspnea perception and its relief. Dyspnea is a central nervous system phenomenon, and neuroimaging studies have confirmed this with both sensory and affective dimensions. Dyspnea is a complex mind-body experience that consists of different sensations that can only be perceived by the individual. The accompanying feelings of distress, fear, and anxiety are driven by affective components, which are generated by the brain rather than the lungs.

RESUMEN No todos sentimos lo mismo ante un estímulo físico, cada uno expresa una sensación con diferentes palabras, no todos describimos de igual forma las sensaciones respiratorias y, por qué no decirlo, no todos los profesionales entienden lo que el paciente les relata. La psicofísica de la disnea (las relaciones cuantitativas entre un estímulo respiratorio y una sensación), los descriptores para referirse a la falta de aire (el lenguaje de la disnea) pueden ayudar a romper las barreras comunicacionales entre pacientes, familia y personal de salud. Los datos generales apoyan una red cortical-límbica para la percepción de la disnea. Hay acuerdo en que la corteza insular es un elemento central esencial para el circuito neuronal, mientras que la corteza cingulada anterior y la corteza prefrontal dorsolateral se cree que modulan la magnitud de la percepción de disnea y su alivio. La disnea como un fenómeno del sistema nervioso central y con dimensiones tanto sensoriales como afectivas, esto ha sido confirmado en estudios de neuroimágenes. Se ha establecido firmemente que la disnea es una experiencia compleja de la mente y el cuerpo, que comprende diferentes sensaciones que solo pueden ser percibidas por el individuo. Los componentes afectivos impulsan los sentimientos acompañantes de angustia, miedo y ansiedad, y es el cerebro, no los pulmones, el que genera estos fenómenos.

ABSTRACT When confronted with a physical stimulus, not everyone feels the same way; each one expresses a sensation with different words; not all of us describe respiratory sensations in the same way; and, why not say it, not all professionals understand what the patient tells them. The psychophysics of dyspnea (the quantitative relationships between a respiratory stimulus and a sensation) and descriptors for shortness of breath (the dyspnea language) can aid in breaking down communication barriers between patients, families, and health care personnel. The insular cortex is widely agreed to be an important central component of neural circuitry, while the anterior cingulate cortex and dorsolateral prefrontal cortex are thought to modulate the magnitude of dyspnea perception and its relief. Dyspnea is a central nervous system phenomenon, and neuroimaging studies have confirmed this with both sensory and affective dimensions. Dyspnea is a complex mind-body experience that consists of different sensations that can only be perceived by the individual. The accompanying feelings of distress, fear, and anxiety are driven by affective components, which are generated by the brain rather than the lungs.