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Abstract Introduction: In Mexico, cardiac rehabilitation (CR) as an interdisciplinary intervention with therapeutic impact in patients with heart disease is growing. There is the need to know actual conditions of CR in our country. Objectives: The objective of this National Registry is to follow-up those existing and new CR units in Mexico through the comparison between the two previous registries, RENAPREC-2009 and RENAPREC II-2015 studies. This is a descriptive study focused on diverse CR activities such as assistance training, and certification of health professionals, barriers, reference, population attended, interdisciplinarity, permanence over time, growth prospects, regulations, post-pandemic condition, integrative characteristics, and scientific research. Results: Data were collected from 45 CR centers in the 32 states, 75.5% are private practice units, 67% are new, 33% were part of RENAPREC II-2015, and 17 have continued since 2009. With a better distribution of CR units along the territory, the median reference of candidates for CR programs is 9% with a significant reduction into tiempo of enrollment to Phase II admission (19 ± 11 days). Regarding to previous registries, the coverance of Phases I, II, and III is 71%, 100%, and 93%, respectively; and a coverance increases in evaluation, risk stratification, and prescription, more comprehensive attendance and prevention strategies. Conclusions: CR in Mexico has grown in the past 7 years. Even there is still low reference and heterogeneity in specific processes, there are strengths such as interdisciplinarity, scientific professionalization of specialists, national diversification, and an official society that are consolidated over time.

https://doi.org/10.24875/acm.22000235

Saberes pedagógicos en torno a la construcción de paz a partir de relatos de maestros y maestras de la ruralidad dispersa colombiana
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Echavarría-Grajales, Carlos Valerio

; Meza-Rueda, José Luis

; González-Meléndez, Lizeth Lorena

; Bernal-Ospina, Julián Santiago

Revista Electrónica Educare

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aug 2023, Volume 27 N. 2 Pages 355 - 379

Abstract: Pt Es En | Text: Pt Es En | PDF: Pt | PDF: Es | PDF: En

Resumo Objetivo. Identificar os conhecimentos pedagógicos relacionados à construção da paz de professores rurais localizados em seis departamentos da Colômbia. Metodologia. Este artigo é derivado da segunda fase da pesquisa, que se concentrou nas narrativas escritas por 60 professoras e professores de instituições educacionais rurais colombianas, no contexto das missões pedagógicas territoriais. Para a análise, as informações produzidas nas comunidades mistas de pesquisa, formação e inovação que constituíram as professoras e os professores participantes desta pesquisa foram gravadas, transcritas e categorizadas em macroestruturas de sentido. Resultados. O desenvolvimento de competências políticas, éticas e de cidadania contribui para a realização de condições de possibilidade que ampliam as liberdades humanas e institucionais para fazer com que a educação e os direitos de paz sejam restaurados. Embora o discurso político educativo e as experiências dos cidadãos não coincidam, o conhecimento pedagógico sobre a construção da paz resulta numa práxis que, quando refletida, permite a validação de concepções e crenças sobre coexistência, democracia, participação, direitos humanos, respeito à diferença, diálogo, resolução de conflitos e trabalho colaborativo. Conclusões. Construir a paz na escola rural explicita um saber pedagógico relacionado aos propósitos formativos de uma cultura de paz: a memória histórica, a formação cidadã e a dignificação humana.

Resumen Objetivo. Identificar los saberes pedagógicos relacionados con la construcción de paz de maestros y maestras rurales que se ubican en seis departamentos de Colombia. Metodología. Este artículo se deriva de la segunda fase de la investigación, la cual se enfocó en las narrativas escritas por 60 maestras y maestros de instituciones educativas rurales colombianas, en el marco las misiones pedagógicas territoriales. Para el análisis se grabó, se transcribió y se categorizó en macroestructuras de sentido la información producida en las comunidades mixtas de investigación, formación e innovación que constituyeron las maestras y los maestros participantes de esta investigación. Resultados. El desarrollo de las capacidades políticas, éticas y ciudadanas contribuye a la concreción de condiciones de posibilidad que amplían las libertades humanas e institucionales para hacer de la educación y de la paz derechos restituidos. Aunque no coinciden el discurso político educativo y las experiencias ciudadanas, los saberes pedagógicos en torno a la construcción de paz resultan en una praxis que, al ser reflexionada, permite validar concepciones y creencias acerca de la convivialidad, democracia, participación, derechos humanos, respeto por la diferencia, diálogo, resolución de conflictos y trabajo colaborativo. Conclusiones. Construir paz en la escuela rural explicita un saber pedagógico relacionado con los propósitos formativos de una cultura de paz: la memoria histórica, la formación ciudadana y la dignificación humana.

Abstract Objective. To identify the pedagogical knowledge related to peacebuilding of rural teachers located in six departments of Colombia. Methodology. This article is derived from the second phase of the research study focused on the narratives written by 60 teachers from rural educational institutions in Colombia within the framework of territorial pedagogical missions. For the analysis, the information produced in the mixed communities of research, training, and innovation that constituted the participating teachers of this research was recorded, transcribed, and categorized into macrostructures of meaning. Results. The development of political, ethical, and citizenship skills contribute to realizing possible conditions that broaden human and institutional freedoms to make education and peace restored rights. Although the political, educational discourse and citizen experiences do not coincide, the pedagogical knowledge about peacebuilding results in a praxis that, when reflected upon, allows for validating conceptions and beliefs about coexistence, democracy, participation, human rights, respect for differences, dialogue, conflict resolution, and collaborative work. Conclusions. Building peace in rural schools makes a type of pedagogical knowledge explicit; it is related to the formative purposes of a culture of peace: historical memory, citizenship education, and human dignification.

https://doi.org/10.15359/ree.27-2.15901

La muestra en ensayos clínicos aleatorizados con análisis interino
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Saaibi Meléndez, Michelle

; Botero-Rodríguez, Felipe

; Rincón Rodríguez, Carlos Javier

Revista Peruana de Medicina Experimental y Salud Pública

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jun 2023, Volume 40 N. 2 Pages 220 - 228

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

RESUMEN En este artículo se introducen los ensayos clínicos aleatorizados y conceptos básicos de la inferencia estadística. Se presenta como calcular el tamaño de muestra por tipo de desenlace e hipótesis a probar, junto con el código en el lenguaje de programación R para realizar su aplicación. Se presentan cuatro métodos para realizar el ajuste del tamaño de muestra original, cuando se planean análisis interinos. De una manera sencilla y concreta se busca realizar una introducción a estos temas, considerando las expresiones matemáticas que soportan los resultados y su implementación en programas estadísticos disponibles. Con el fin de acercar a los estudiantes de áreas de la salud a la estadística y al uso de programas estadísticos, aspectos poco considerados en su formación.

ABSTRACT This article introduces randomized clinical trials and basic concepts of statistical inference. We present methods for calculating the sample size by outcome type and the hypothesis to be tested, together with the code in the R programming language. We describe four methods for adjusting the original sample size for interim analyses. We sought to introduce these topics in a simple and concrete way, considering the mathematical expressions that support the results and their implementation in available statistical programs; therefore, bringing health students closer to statistics and the use of statistical programs, which are aspects that are rarely considered during their training.

https://doi.org/10.17843/rpmesp.2023.402.12217

An unusual association: chronic coronary syndrome and Bland-White-Garland syndrome
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García-Arias, Mario R.

; Alvarado-Alvarado, José A.

; Duarte-Argüello, José E.

; Argüello-Portillo, Carlos R.

; Patrón-Chi, Sergio A.

; Meléndez-Ramírez, Gabriela

Archivos de cardiología de México

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jun 2023, Volume 93 N. 2 Pages 252 - 255

Abstract: En | Text: En | PDF: En

https://doi.org/10.24875/acm.21000158

La muestra en ensayos clínicos aleatorizados con análisis interino
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Saaibi Meléndez, Michelle

; Botero-Rodríguez, Felipe

; Rincón Rodríguez, Carlos Javier

Revista Peruana de Medicina Experimental y Salud Publica

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apr 2023, Volume 40 N. 2 Pages 220 - 228

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

https://doi.org/10.17843/rpmesp.2023.402.12217

Influence of glutathione-related genetic variants on the oxidative stress profile of Mexican patients with psychotic disorders
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Mayén-Lobo, Yerye G.

; Alcaraz-Zubeldia, Mireya

; Dávila-Ortiz de Montellano, David J.

; Motilla-Frías, Blanca A.

; García-Manteca, Mayumi Y.

; Ortega-Vázquez, Alberto

; Aviña-Cervantes, Carlos L.

; Crail-Meléndez, Edgar D.

; Ríos, Camilo

; López-López, Marisol

; Monroy-Jaramillo, Nancy

Brazilian Journal of Psychiatry

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apr 2023, Volume 45 N. 2 Pages 117 - 126

Abstract: En | Text: En | PDF: En

Objective: The clinical trajectories of patients with psychotic disorders have divergent outcomes, which may result in part from glutathione (GSH)-related high-risk genotypes. We aimed to determine pharmacokinetics of clozapine, GSH levels, GSH peroxidase (GPx) activity, gene variants involved in the synthesis and metabolism of GSH, and their association with psychotic disorders in Mexican patients on clozapine monotherapy and controls. Methods: The sample included 75 patients with psychotic disorders on clozapine therapy and 40 paired healthy controls. Plasma clozapine/N-desmethylclozapine, GSH concentrations, and GPx activity were determined, along with genotyping of GCLC and GSTP1 variants and copy number variations of GSTP1, GSTT1, and GSTM1. Clinical, molecular and biochemical data were analyzed with a logistic regression model. Results: GSH levels were significantly reduced and, conversely, GPx activity was higher among patients than controls. GCLC_GAG-7/9 genotype (OR = 4.3, 95%CI = 1.40-14.31, p = 0.019) and hetero-/homozygous genotypes of GCLC_rs761142 (OR = 6.09, 95%CI = 1.93-22.59, p = 0.003) were found to be risk factors for psychosis. The genetic variants were not related to clozapine/N-desmethylclozapine levels or metabolic ratio. Conclusions: GCLC variants were associated with the oxidative stress profile of patients with psychotic disorders, raising opportunities for intervention to improve their antioxidant defenses. Further studies with larger samples should explore this proposal.

https://doi.org/10.47626/1516-4446-2022-2783

Prevalencia, factores de riesgo y desenlace de delirium en la Unidad de Cuidados Intensivos del Hospital Ángeles del Carmen
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Corona Meléndez, Juan Carlos

; Iñiguez Padilla, Héctor

; Medina Ruíz, Eloy

Medicina crítica (Colegio Mexicano de Medicina Crítica)

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aug 2022, Volume 36 N. 4 Pages 215 - 222

Abstract: En Pt Es | Text: En Pt Es | PDF: En | PDF: Pt | PDF: Es

Abstract: Introduction: Delirium is a common condition in critical care patients, and is associated with multiple risk factors, poor prognosis and high mortality rate. Material and methods: An observational analytic study was conducted in a the Intensive Care Unit during 2017-2018, documenting delirium prevalence, risk factors and their association with mortality, pharmacological and non-pharmacological treatment, using IBM© SPSS© Statistics V24. Results: 563 patients were included, finding a prevalence of 14% (n = 79). The most significant risk factors were preexisting dementia (OR 9.0), sedation (OR 6.7), alcohol abuse (OR 5.0), non-invasive mechanical ventilation (OR 2.8) and age > 67 years (OR 2.7). The general mortality rate was 10.1% (13.9% in patients with delirium, 10.3% in hyperactive/mixed delirium and 23.8% in hypoactive delirium, OR 1.93, CI 95% 0.88-4.19, p = 0.12). Absence of non-pharmacological treatment was associated with higher mortality (30.8 vs 10.6%, OR 2.74, CI 95% 1.02-7.39, p = 0.05). Conclusion: There is a low prevalence of delirium in our unit, with differences in delirium types and risk factors. Hypoactive delirium and absence of non-pharmacological treatment were associated with higher mortality.

Resumo: Antecedentes: Delirium é comum em pacientes críticos e está associado a múltiplos fatores de risco, mau prognóstico e aumento da mortalidade. Material e métodos: Realizou-se um estudo observacional analítico na unidade de terapia intensiva entre 2017 e 2018. Foram documentadas a prevalência de delirium, fatores de risco e sua associação com mortalidade, tratamento farmacológico e não farmacológico. Utilizou-se o pacote estatístico IBM©SPSS©Statistics V24. Resultados: Incluíram-se 563 pacientes. A prevalência foi de 14% (n = 79). Os fatores de risco mais significativos foram demência (OR 9.0), sedação (OR 6.7), alcoolismo (OR 5.0), Euroscore > 5% (OR 4.8), má ingestão (OR 4.6), infecção hospitalar (OR 3.2), ventilação mecânica não invasiva (OR 2.8) e idade > 67 anos (OR 2.7). A mortalidade foi de 10.1% (13.9% com delirium, 10.3% com delirium hiperativo/misto e 23.8% com delirium hipoativo, OR 1.93, IC 95% 0.88-4.19, p = 0.12). A ausência de tratamento não farmacológico foi associada a maior mortalidade (30.8 vs 10.6%, OR 2.74, IC 95% 1.02-7.39, p = 0.05). Conclusão: A prevalência de delirium em nossa unidade é baixa, com proporção diferente por tipo de delirium e diferentes fatores de risco. Delirium hipoativo e omissão de tratamento não farmacológico foram associados a maior mortalidade.

Resumen: Introducción: El delirium es común en pacientes críticos, se asocia con múltiples factores de riesgo, mal pronóstico y aumento de la mortalidad. Material y métodos: Se realizó un estudio observacional analítico en la Unidad de Cuidados Intensivos entre 2017 y 2018. Se documentó la prevalencia de delirium, los factores de riesgo y su asociación con mortalidad, tratamiento farmacológico y no farmacológico. Se utilizó el paquete estadístico IBM© SPSS© Statistics V24. Resultados: Se incluyeron 563 pacientes. La prevalencia fue de 14% (n = 79). Los factores de riesgo más significativos fueron demencia (OR 9.0), sedación (OR 6.7), etilismo (OR 5.0), EuroSCORE > 5% (OR 4.8), ingesta deficiente (OR 4.6), infección nosocomial (OR 3.2), ventilación mecánica no invasiva (OR 2.8) y edad > 67 años (OR 2.7). La mortalidad fue de 10.1% (13.9% con delirium, 10.3% con delirium hiperactivo/mixto y 23.8% con delirium hipoactivo, OR 1.93, IC 95% de 0.88-4.19, p = 0.12). La ausencia de tratamiento no farmacológico se asoció a mayor mortalidad (30.8 vs 10.6%, OR 2.74, IC 95% de 1.02-7.39, p = 0.05). Conclusión: La prevalencia de delirium en nuestra unidad es baja, con diferente proporción por tipo de delirium y diferentes factores de riesgo. El delirium hipoactivo y la omisión de tratamiento no farmacológico se asociaron a mayor mortalidad.

https://doi.org/10.35366/105792

Biología comparada del conejo criollo (Sylvilagus sp.) y el conejo doméstico europeo (Oryctolagus sp.) con antecedentes de su consumo en una ciudad de Venezuela
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Meléndez, Carlos Alberto

; Meléndez, Roy Daniel

Revista de Medicina Veterinaria

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jun 2022, N. 44 Pages 11 - 16

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Las diferencias biológicas entre el conejo criollo Sylvilagus sp. (Lagomorpha: Leporidae) y el conejo europeo (Oryctolagus sp.) son poco conocidas entre cunicultores de Latinoamérica, bien sea porque la cunicultura es una explotación menor, comparada con las de otras especies de animales domésticos, o porque la enseñanza de esta materia en estudios universitarios es escaza. El objetivo central de esta investigación fue examinar comparativamente las diferencias existentes entre conejos Sylvilagus sp. y Oryctolagus sp., en relación con su biología, consumo y explotación comercial. Para ello se usó el sistema del metanálisis de trabajos científicos publicados sobre el tema, noticias de prensa y entrevistas realizadas a consumidores en el lapso del 2000 al 2019. Se tomaron en cuenta características morfológicas, fisiológicas, de origen genético y su comportamiento con relación al medio ambiente. Se organizaron y analizaron estas características para establecer las posibles semejanzas y diferencias entre ambos géneros. Como la familia Leporidae comprende tres géneros en Suramérica, se incluyó el género Lepus sp. solo en un cuadro comparativo de géneros. Se encontraron diferencias biológicas, genéticas y reproductivas significativas entre los géneros Sylvilagus sp. y Oryctolagus sp. que pueden ser imperceptibles para cunicultores inexpertos; por ende, se buscó hacer notar las características de cada género para su identificación práctica. Se determinó que el consumo de la carne de conejo depende de la disponibilidad que exista en el mercado.

Abstract Biologic differences between the native rabbit Sylvilagus sp. (Lagomorpha: Leporidae) and the European rabbit (Oryctolagus sp.) are quite unknown among Latin-American rabbit-breeders, either since rabbit-breeding is scarcely exploited as compared to other species of domestic animals or because this subject is taught very unusually in the college education. This research is aimed at examining comparatively the differences between Sylvilagus sp. and Oryctolagus sp. rabbits regarding their biology, consumption, and business exploitation. To do so, a meta-analysis was carried out on different scientific works dealing with this topic, news, and interviews to consumers during the term 2000 to 2019. Morphological, physiological, and genetic-origin characteristics were considered as well as how they behave in relation to the environment. These characteristics were organized and analyzed to determine the potential similarities and differences between both genuses. As the family Leporidae includes three genuses in South America, then the genus Lepus sp. was included only in a genus comparative table. Significant biologic, genetic and reproductive differences between Sylvilagus sp. And Oryctolagus sp. were found but they can be unnoticed to the unexpert rabbit-breeders. Therefore, characteristics typical to each genus were highlighted to allow a practical identification. It was determined that the consumption of rabbit meat depends on the availability in the market.

https://doi.org/10.19052/mv.vol1.iss44.2 116 downloads

Guía de práctica clínica para el manejo de la neumonía adquirida en la comunidad
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Cortés, Jorge Alberto

; Cuervo-Maldonado, Sonia Isabel

; Nocua-Báez, Laura Cristina

; Valderrama, Martha Carolina

; Sánchez, Edgar Alberto

; Saavedra, Alfredo

; Torres, July Vianneth

; Forero, Diana Paola

; Álvarez-Moreno, Carlos Arturo

; Leal, Aura Lucía

; Pérez, Jairo Enrique

; Rodríguez, Iván Arturo

; Guevara, Fredy Orlando

; Saavedra, Carlos Humberto

; Vergara, Erika Paola

; Montúfar, Franco Eduardo

; Espinosa, Tatiana

; Chaves, Walter

; Carrizosa, Jorge Armando

; Meléndez, Sugeich Del Mar

; Espinosa, Carmelo José

; García, Felipe

; Guzmán, Ingrid Jany

; Cortés, Sergio Leonardo

; Díaz, Jorge Augusto

; González, Nathaly

Revista de la Facultad de Medicina

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jun 2022, Volume 70 N. 2 elocation e93814

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen La neumonía sigue siendo una de las principales causas de consulta y de hospitalización a la que, además de su un alto impacto en términos de morbilidad y mortalidad, se suma la actual problemática de resistencia a los antimicrobianos, por lo que establecer directrices que permitan su adecuado diagnóstico y tratamiento es de gran importancia para obtener mejores desenlaces clínicos y promover un uso racional de antibióticos en estos pacientes. La presente guía de práctica clínica (GPC) contiene recomendaciones basadas en la evidencia para el diagnóstico y tratamiento de la neumonía adquirida en la comunidad en adultos, las cuales fueron realizadas mediante el proceso de adaptación de GPC basadas en la evidencia para el contexto colombiano.

Abstract Pneumonia continues to be one of the main causes of consultation and hospitalization to which, besides its high impact on morbidity and mortality, the current problem of antimicrobial resistance is added; thus, establishing guidelines that allow its adequate diagnosis and treatment is of great importance to obtain better clinical outcomes and promote a rational use of antibiotics in these patients. This clinical practice guideline (CPG) contains evidence-based recommendations for the diagnosis and treatment of community-acquired pneumonia in adult population; these recommendations were made by means of the process of adaptation of evidence-based CPGs for the Colombian context.

https://doi.org/10.15446/revfacmed.v70n2.93814.

10.

Macrosintaxis del discurso persuasivo: el recurso a las emociones a través de lástima como estrategia argumentativa en español actual
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Meléndez Quero, Carlos

Boletín de filología

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2022, Volume 57 N. 2 Pages 111 - 139

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen: Este trabajo estudia elementos lingüísticos de los que se sirve el hablante para expresar la persuasión en español y muestra cómo el recurso a las emociones a través de lástima puede actuar también como mecanismo de fuerza argumentativa, con valor mitigador o intensificador en sus diferentes usos discursivos. Con un enfoque de Lingüística pragmática (Fuentes Rodríguez 2017a [2000], 2017b y 2020a) y afín a la Teoría de la argumentación (Anscombre y Ducrot 1983) y a sus desarrollos recientes en la Teoría de los estereotipos (Anscombre 2001, Donaire 2006), esta investigación describe cómo el significado instruccional de lástima (que) y sus diferentes variantes favorece funciones pragmáticas en la interacción comunicativa y puede ser empleado con fines persuasivos diversos. La comparación de ejemplos en diferentes corpus actuales (MEsA, CORPES y CREA) tiene por objeto el análisis de las funciones discursivas y los fines argumentativos de lástima en el discurso persuasivo, ya sea con valor de autocrítica, en estrategias de cortesía positiva como refuerzo de la imagen y de empatía con la desdicha del interlocutor, como eufemismo que atenúa la descortesía e, incluso, como reforzador o intensificador de la descortesía en ataques directos.

Abstract: This work studies linguistic elements that the speaker uses to express persuasion in Spanish and shows how the use of emotions through lástima can also act as a mechanism of argumentative force, with mitigating or intensifying value in its different discursive uses. With a Pragmatic Linguistics approach (Fuentes Rodríguez 2017a [2000], 2017b and 2020a) and close to the Theory of Argumentation (Anscombre and Ducrot 1983) and its recent developments in the Theory of Stereotypes (Anscombre 2001, Donaire 2006), this research describes how the instructional meaning of lástima (que) and its different variants favor pragmatic functions in communicative interaction and can be used for various persuasive purposes. The comparison of examples in different contemporary corpora (MEsA, CORPES and CREA) aims to analyze the discursive functions and argumentative purposes of lástima in persuasive discourse, whether as a form of self-criticism, in strategies of positive politeness as reinforcement of face and empathy with the misfortune of the interlocutor, as a euphemism that attenuates impoliteness and

11.

Alternativas para la sedación, analgesia, relajación y delirium en pacientes COVID-19. Revisión narrativa
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Ferrer, Leopoldo

; Díaz, Juan Carlos

; Cárdenas, Yenny Rocío

; Vergara, Peter

; Rivera Portilla, Marcela

; Garay Fernández, Manuel

; Gil Valencia, Bladimir Alejandro

; Vargas, Mónica

; Meléndez F, Héctor J

; Dueñas Castell, Carmelo

Medicina crítica (Colegio Mexicano de Medicina Crítica)

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2022, Volume 36 N. 5 Pages 296 - 311

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo: Nos últimos anos, o mundo inteiro se deparou com o manejo de pacientes com uma patologia totalmente nova e desafiadora em termos de compreensão fisiopatológica e estratégias de manejo, enquanto sua taxa de contágio aumentava significativamente. Trata-se da doença COVID-19, causada pelo vírus SARS-CoV-2 que colocou toda a humanidade em alerta. Surgiram, assim, grandes problemas de saúde pública, incluindo a escassez de medicamentos e recursos de primeira linha para o controle da doença, em pacientes em estado crítico afetou-se o manejo do suporte ideal à medida que superavase a complexa resposta imune, que terminava afetando o parênquima pulmonar em seu estágio inicial, e dependendo do estado fisiológico, mórbido e genético do hospedeiro, gerando múltiplas disfunções orgânicas. Este documento estabelece as melhores alternativas para enfrentar a escassez de medicamentos associada à abordagem integral da analgesedação, prevenção e manejo do delirium e abstinência, e a necessidade de relaxamento muscular em cada uma das fases que atravessa o paciente em estado crítico internado na UTI com suporte respiratório invasivo ou não invasivo.

Abstract: In recent years, the entire world has been faced with the management of patients with a totally new and challenging pathology in terms of its pathophysiological understanding and management strategies, while its rate of infection was increased significantly. It is the COVID-19 disease, caused by the SARS-CoV-2 virus, and that put all of humanity on alert. Therefore, major public health problems arose, including shortages of medicines and first-line resources for disease control, and in critical patients, optimal support management was affected as the complex immune response was overcome, which ended up affecting the lung parenchymal in its early stages, and depending on the physiological, morbid and genetic state of the host, generating multiple organ dysfunction. This document establishes the best alternatives to face a shortage of medications associated with the comprehensive approach to analgesia and sedation, prevention and management of delirium and withdrawal, and the need for neuromuscular relaxation in each of the phases that critically hospitalized patients go through in Intensive Care Units with invasive or non-invasive respiratory support.

Resumen: En los últimos años, el mundo entero se vio enfrentado al manejo de pacientes con una patología totalmente nueva y desafiante en términos de su entendimiento fisiopatológico y estrategias de manejo, mientras que su tasa de contagio se incrementaba de manera importante. Se trata de la enfermedad COVID-19, originada por el virus SARS-CoV-2 y que puso en alerta a toda la humanidad. Por lo tanto, se presentaron grandes problemas de salud pública, incluyendo el desabastecimiento de medicamentos y recursos de primera línea para el control de la enfermedad, y en los pacientes críticos se afectó el manejo de soporte óptimo a medida que se superaba la compleja respuesta inmunológica, que terminaba afectando en sus primeros estadios el parénquima pulmonar, y según el estado fisiológico, mórbido y genético del huésped, generando una disfunción orgánica múltiple. En el presente documento se establecen las mejores alternativas para enfrentar un desabastecimiento de medicamentos asociados al abordaje integral de la analgosedación, prevención y manejo de delirium y abstinencia, así como la necesidad de relajación neuromuscular en cada una de las fases por las que atraviesa el paciente crítico hospitalizado en Unidades de Cuidado Intensivo con soporte respiratorio invasivo o no invasivo.

https://doi.org/10.35366/106512

12.

Report of autochthonous cases of localized cutaneous leishmaniasis caused by Leishmania (Leishmania) mexicana in vulnerable, susceptible areas of Southeastern Mexico
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Canché-Pool, Elsy Beatriz

; Canto-Hau, Dulce María

; Vargas-Meléndez, Mirna Alexandra

; Tello-Martín, Raúl

; Reyes-Novelo, Enrique

; Escobedo-Ortegón, Francisco Javier

; Ruiz-Piña, Hugo Antonio

; Cambranes-Puc, Luis Humberto

; Torres-Castro, Jimmy Raymundo

; Palacio-Vargas, Jorge Alfredo

; Durán-Caamal, Celmy

; Cerón-Espinosa, José

; Carpio-Pedroza, Juan Carlos

; Rivera-Hernández, Octavio César

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e35

Abstract: En | Text: En | PDF: En

ABSTRACT Localized cutaneous leishmaniasis (LCL) is an endemic disease in several Mexican States with the main endemic areas located in the South-Southeast region of the country, where 90% of Leishmania (Leishmania) mexicana cases are registered. The Southeast region is located in the Yucatan Peninsula, including Campeche, Quintana Roo and Yucatan States. Campeche and Quintana Roo register more than 60% of the cases in the country each year, while in Yucatan the reports are of imported cases due to residents traveling to endemic areas. However, since 2015, autochthonous cases have been diagnosed by health authorities in municipalities with no previous transmission records. We aimed to identify Leishmania parasite species involved in autochthonous cases by means of the PCR technique. The present study included 13 autochthonous cases of LCL with clinical and parasitological diagnoses during 2018 and 2019 by health authorities, without specific identification of the causal agent. Tissue samples were taken by scraping the margins of active lesions and then they were spotted onto an FTATM Elute Microcard. Next, DNA was eluted and used for PCR amplification of specific Leishmania genus and L. (L.) mexicana species-specific fragments. Molecular analysis showed evidence that L. (L.) mexicana was the causal agent of LCL in 12 of the 13 patients; in one patient, PCR was not performed due to the patient’s refusal to participate in the study. Identifying Leishmania species that cause LCL is necessary to define efficient treatment schemes and control strategies for the disease in vulnerable and susceptible areas of the Yucatan State’s municipalities.

https://doi.org/10.1590/s1678-9946202264035

13.

Sensibilidad antimicrobiana y mortalidad intrahospitalaria de infecciones comunitarias y nosocomiales en la Unidad de Cuidados Intensivos del Hospital Ángeles del Carmen
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Corona Meléndez, Juan Carlos

; Alfaro Rivera, Christian Gerardo

; Piña Hernández, Carlos Yehudi

Medicina crítica (Colegio Mexicano de Medicina Crítica)

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2022, Volume 36 N. 8 Pages 514 - 520

Abstract: Es En Pt | Text: Es En Pt | PDF: Es | PDF: En | PDF: Pt

Resumen: Introducción: el manejo de antibióticos en las unidades de cuidados intensivos (UCI) es un tema prioritario. Conocer la epidemiología bacteriana y su sensibilidad es fundamental para aumentar la sobrevida de nuestros pacientes. Material y métodos: se realizó un estudio tipo cohorte retrospectiva en la Unidad de Cuidados Intensivos del Hospital Ángeles del Carmen durante el periodo de 2018 a 2020 en pacientes con infección documentada y con cultivo positivo. Se obtuvo el patrón de sensibilidad antimicrobiana y se analizó de acuerdo al origen Gram, tipo de infección, reactantes de fase aguda y mortalidad. Se realizó comparación de medias y proporciones con χ2, t de Student y ANOVA. Se obtuvieron razones de desventajas (OR) para identificar variables asociadas a resolución. Se consideró un valor de p < 0.05 para significancia estadística. Resultados: se analizaron 308 cultivos bacterianos obtenidos de 188 pacientes, principalmente de origen respiratorio, urinario y torrente sanguíneo (76.7%), de origen nosocomial (65.3%), con predominio de gram-negativos (65%) multidrogorresistentes. La procedencia comunitaria se asoció más a infección que la nosocomial (85 versus 61.7%, OR 3.5, IC 95% 1.93-6.45, p < 0.001). El porcentaje de infección fue mayor en gram-negativos (71.8 versus 66%, OR 1.10, IC 95% de 0.91-1.32, p = 0.297). Las infecciones por gram-positivos tuvieron menor porcentaje de mortalidad que aquéllas por gram-negativos (17.9 versus 30.7%, OR 0.49, IC 95% de 0.27-0.88, p = 0.016) así como las infecciones comunitarias en comparación con nosocomiales (17.8 versus 30.8%, OR 0.48, IC 95% de 0.27-0.86, p = 0.013). Conclusión: las bacterias predominantes en nuestra unidad de cuidados críticos son bacilos gram-negativos multidrogorresistentes, provenientes de infecciones respiratorias, urinarias y de torrente sanguíneo. Las infecciones por gram-positivos y adquiridas en la comunidad se asociaron a menor riesgo de mortalidad.

Abstract: Introduction: local identification of antimicrobial susceptibility and resistance patterns must be a priority in intensive care units. Material and methods: a cohort study was conducted in the intensive care unit from 2018 to 2020, identifying patients with an infectious diagnosis and a positive culture, with prospective clinical and laboratory follow-up. Antimicrobial resistance patterns were analyzed according to source, gram, type of infection, acute phase reactants and outcome, comparing means and proportions with χ2, Student t and ANOVA. OR were obtained to identify resolution-associated variables. A p < 0.05 value was considered as statistically significant. Results: 308 cultures were analyzed, obtained from 188 patients. Primary souces were respiratory, urinary and bloodstream (76.7%), 65.3% were from in-hospital infections, and 65% were caused by gram-negative multi-drug resistant bacteria. Community cultures were more associated with infection compares with in-hospital cultures (85 vs 61.7%, OR 3.5, 95% CI 1.93-6.45, p < 0.001). Gram-negative bacteria had a greater association with infection compared with gram-positive (71.8 vs 66%, OR 1.10, 95% CI 0.91-1.32, p = 0.297), but infections caused by gram-positive bacteria had a greater association with resolution (82.1 vs 68.8%, OR 2.07, 95% CI 1.16-3.70, p = 0.019), as well as community infections (82.2 vs 68.7%, OR 2.11, 95% CI 1.18-3.77, p = 0.016). Conclusion: multi-drug resistant gram-negative bacteria were the principal isolates found in respiratory, urine and bloodstream infections in our intensive care unit. Community infections and gram-positive isolates were associated with greater resolution rates.

Resumo: Introdução: a gestão de antibióticos em Unidades de Cuidados Intensivos é uma questão prioritária. Conhecer a epidemiologia bacteriana e sua suscetibilidade é essencial para aumentar a sobrevida de nossos pacientes. Material e métodos: foi realizado um estudo de coorte retrospectivo na Unidade de Terapia Intensiva do Hospital Ángeles del Carmen durante o período de 2018 a 2020, em pacientes com infecção documentada e com cultura positiva. O padrão de sensibilidade antimicrobiana foi obtido e analisado segundo origem, grama, tipo de infecção, reagentes de fase aguda e mortalidade. A comparação de médias e proporções foi feita com χ2, teste t de Student e ANOVA. Razões de desvantagem (OR) foram obtidas para identificar variáveis associadas à resolução. Um valor de p < 0.05 foi considerado para significância estatística. Resultados: foram analisadas 308 culturas bacterianas obtidas de 188 pacientes, principalmente de origem respiratória, urinária e sanguínea (76.7%), de origem nosocomial (65.3%), com predominância de gram-negativos (65%) multirresistentes. A origem comunitária foi mais associada à infecção do que a nosocomial (85 vs 61.7%, OR 3.5, IC 95% 1.93-6.45, p < 0.001). A porcentagem de infecção foi maior para gram-negativos (71.8 vs 66%, OR 1.10, IC 95% 0.91-1.32, p = 0.297). As infecções Gram-positivas tiveram uma taxa de mortalidade menor do que as infecções Gram-negativas (17.9 vs 30.7%, OR 0.49, IC 95% de 0.27-0.88, p = 0.016), bem como infecções comunitárias em comparação com as nosocomiais (17.8 vs 30.8%, OR 0.48, IC 95% de 0.27-0.86, p = 0.013). Conclusão: as bactérias predominantes em nossa unidade de terapia intensiva são bacilos gram-negativos multirresistentes, originários de infecções respiratórias, urinárias e de corrente sanguínea. As infecções gram-positivas e adquiridas na comunidade foram associadas a um menor risco de mortalidade.

https://doi.org/10.35366/109172

14.

Determinants of self-efficacy in patients with Parkinson’s disease
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Estrada-Bellmann, Ingrid

; Meléndez-Flores, Jesús Daniel

; Cámara-Lemarroy, Carlos Rodrigo

; Castillo-Torres, Sergio Andrés

Arquivos de Neuro-Psiquiatria

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aug 2021, Volume 79 N. 8 Pages 686 - 691

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT Background: Self-efficacy is the individual’s assessment of his or hers ability to complete a specific task successfully and has been closely related to self-management and quality of life in several diseases. Objective: To investigate self-efficacy in a population of Parkinson’s disease (PD) patients in Mexico and study the factors that are associated with this measure. Methods: We carried out a cross-sectional observational study involving patients with PD in an outpatient neurology clinic in Mexico, using the following instruments: Spanish version of the Chronic Disease Self-Efficacy Scale (CDSES), Quality of Life Questionnaire PDQ-8, Movement Disorders Society-Unified Parkinson's disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment (MoCA), and Non-Motor Symptom Scale (NMSS). Clinical and demographic variables were also recorded. Results: We included 73 patients with a mean age of 65 years and most patients were male. Patients with lower CDSES scores (<7.75) had worse scores in MDS-UPDRS, NMSS, and PDQ-8 scales. CDSES scores were significantly correlated with MDS-UPDRS Part I (r=-0.497, p=<0.001), Part II (r= -0.271, p=0.020), Part III (r=-0.304, p=<0.001), PDQ-8 (r=-0.472, p=<0.001), and NMSS (r=-0.504, p=<0.001). Furthermore, when assessing the simultaneous effect of covariates associated with CDSES score, only Mood/Apathy domain of NMSS was significant (beta= -0.446, t= -3.807, p= 0.012). Conclusions: PD patients with lower self-efficacy scores had worse motor and non-motor symptomatology and quality of life. Mood/Apathy disorders were negatively associated with self-efficacy and contributed significantly to this measure.

RESUMEN Antecedentes: La autoeficacia es la autoevaluación de un individuo sobre su capacidad para completar una tarea con éxito y se ha relacionado con automanejo y calidad de vida en otras enfermedades. Objetivo: Investigar la autoeficacia en una población de pacientes con enfermedad de Parkinson (EP) en México y estudiar factores asociados con esta medida. Métodos: Realizamos un estudio observacional transversal con pacientes con EP en una clínica de neurología en México. Se registraron datos demográficos y escalas que evalúan la función motora (MDS-UPDRS), no motora (NMSS) y cognitiva (MoCA), así como la calidad de vida (PDQ-8). Para valorar autoeficacia se utilizó la versión en español de la Escala de autoeficacia de enfermedades crónicas (CDSES). Resultados: Se incluyeron 73 pacientes, con una edad media de 65 años y la mayoría eran hombres. Pacientes con puntajes CDSES más bajos (<7.75) tuvieron peores puntajes en las escalas MDS-UPDRS, NMSS y PDQ-8. Las puntuaciones de CDSES se correlacionaron significativamente con la escala MDS-UPDRS Parte I (r=-0.497, p=<0.001), Parte II (r= -0.271, p=0.020), Parte III (r=-0.304, p=<0.001), PDQ-8 (r= -0.472, p=<0.001), y NMSS (r=-0.504, p=<0.001). Al evaluar el efecto simultáneo de covariables asociadas con la escala CDSES, solo el dominio estado de ánimo/apatía del NMSS resultó significativo (Beta = -0.449, t = -3.783, p = <0.001). Conclusiones: Los pacientes con menores puntajes de autoeficacia tienen peor calidad de vida y sintomatología motora y no motora. Los trastornos del estado de ánimo contribuyen negativamente a la autoeficacia.

https://doi.org/10.1590/0004-282x-anp-2020-0185 184 downloads

15.

El estudio de casos y contactos. Una aproximación metodológica
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Pantoja Meléndez, Carlos Alberto

; García de la Torre, Guadalupe Silvia

Revista de la Facultad de Medicina (México)

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aug 2021, Volume 64 N. 4 Pages 47 - 55

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract The Case and Contact Study is a quasi-experimental study, used by Applied Epidemiology when health events occur, associated in time, place and person, aiming to cut transmission networks in order to control the appearance of cases and ideally avoid them. The Case and Contacts Study is a field intervention that emphasizes non-pharmacological interventions and that allows the approach to the population at risk in populations with difficult-to-identify limits or large populations, which allows the rapid identification of the population at risk, as well as the control of the event. A diagrammatic description of the study methodology is made, as well as its statistical analysis, where frequency measures such as conversion into contacts are reported. The association measure in this case is the Expansion Ratio, using Mantel and Haenszel's Chi in this case as a measure of statistical significance.

Resumen El estudio de casos y contactos es un estudio cuasi experimental, utilizado por la epidemiología aplicada cuando se presentan eventos de salud, asociados en tiempo, lugar y persona, y tiene como objetivo cortar las redes de trasmisión a fin de controlar la aparición de casos e idealmente evitarlos. El estudio de casos y contactos es una intervención de campo que hace énfasis en las intervenciones no farmacológicas y permite la realización del abordaje de la población en riesgo en poblaciones con límites difíciles de identificar o poblaciones de gran tamaño, que permite la identificación rápida de la población en riesgo, así como el control del evento. Se hace una descripción diagramática de la metodología del estudio, así como de su análisis estadístico, donde se relatan tanto las medidas de frecuencia como la conversión en contactos. La medida de asociación es la razón de expansión, en este caso se utilizó la chi de Mantel y Haenszel como medida significancia estadística.

https://doi.org/10.22201/fm.24484865e.2021.64.4.07 116 downloads

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