ABSTRACT Introduction: Blood transfusion is one of the most common medical practices worldwide. However, current scientific literature has shown that the immunomodulatory effects of blood transfusion are associated with an increased likelihood of infection, prolonged hospitalization, and morbimortality. Also, it means high costs for healthcare systems. Methods: In this context, acknowledging that blood transfusions are essentially heterologous cell transplantations, the use of therapeutic options has gained strength and is collectively known as the patient blood management (PBM) program. PBM is an approach based on three main pillars: (1) treating anemias and coagulopathies in an optimized manner, especially in the preoperative period; (2) optimizing perioperative hemostasis and the use of blood recovery systems to avoid the loss of the patient's blood; (3) anemia tolerance, with improved oxygen delivery and reduced oxygen demand, particularly in the postoperative period. Results: Current scientific evidence supports the effectiveness of PBM by reducing the need for blood transfusions, decreasing associated complications, and promoting more efficient and safer blood management. Thus, PBM not only improves clinical outcomes for patients but also contributes to the economic sustainability of healthcare systems. Conclusion: The aim of this review was to summarize PBM strategies in a comprehensive, evidence-based approach through a systematic and structured model for PBM implementation in tertiary hospitals. The recommendations proposed herein are from researchers and experts of a high-complexity university hospital in the network of the Sistema Único de Saúde, presenting itself as a strategy that can be followed as a guideline for PBM implementation in other settings. Introduction worldwide However infection hospitalization morbimortality Also Methods context transplantations (PBM program pillars 1 (1 manner period 2 (2 s 3 (3 tolerance demand Results complications Thus Conclusion comprehensive evidencebased hospitals highcomplexity complexity Saúde settings (

Non-alcoholic fatty liver disease (NAFLD) has a high prevalence and risk of progression to cirrhosis and other complications in patients with type 2 diabetes mellitus (T2DM). Likewise, the presence of NAFLD implies a high risk of developing T2DM, determining a bidirectional relationship between them. The diabetology and hepatology societies, developed a joint initiative aiming to unify criteria, reviewing the definitions, diagnostic criteria, risk stratification, treatment, and follow-up of patients with NAFLD and T2DM. The key questions to be discussed were defined by a panel of specialists in diabetology and hepatology. The Delphi methodology was used to reach consensus on the respective recommendations. Based on the discussion generated among the experts, diagnostic and treatment algorithms were proposed, as well as an indication for referral and the role of the different specialists involved in the management of these patients. Strengthening multidisciplinary work with patients with NAFLD and T2DM will allow the early recognition of the disease, the prevention of the progression to cirrhosis, and reducing the associated complications.

ABSTRACT Introduction: Incorporation of ISO standards into university management represents a more efficient use of human and financial resources and the satisfaction of society, since services are received that meet expectations. The success of any institutional accreditation process depends on control work, so academic auditing becomes a tool for managing such components. Objective: To reflect on the role of academic auditing as a tool for evaluating quality in institutional accreditation processes. Methods: The scientific method was used, supported by document analysis of the results from research carried out by different authors about academic auditing, and quality in the processes of training and institutional accreditation. Systematization and triangulation of sources were combined to operationalize a definition for academic auditing in quality management towards institutional accreditation processes. Results: Academic auditing was proposed to be included as an effective tool in the control of processes, since it provides information for the university to improve performance. Conclusions: Institutional accreditation, as a process, starts from the development of self-assessment and external assessment; therefore, academic auditing can contribute to the evaluation of these requirements from a systemic perspective.

RESUMEN Introducción: La incorporación de las normas ISO a la gestión universitaria representa un uso más eficiente de los recursos humanos, financieros y la satisfacción de la sociedad, al recibir servicios que cumplen con sus expectativas. El éxito de todo proceso de acreditación institucional depende del trabajo de control, por lo que la auditoría académica se convierte en una herramienta para la gestión de sus componentes. Objetivo: Reflexionar acerca del papel de la auditoría académica como herramienta para la evaluación de la calidad en los procesos de acreditación institucional. Métodos: Se utilizó el método científico, sustentado en el análisis documental de los resultados de las investigaciones realizadas por diferentes autores acerca de auditoría académica, calidad en los procesos de formación y acreditación institucional. Se combinaron la sistematización y la triangulación de fuentes para definir operacionalmente la auditoría académica en la gestión de la calidad en los procesos de acreditación institucional. Resultados: Se propuso incluir las auditorías académicas como una herramienta eficaz en el control de los procesos, ya que proporciona información a la universidad para mejorar su desempeño. Conclusiones: La acreditación institucional, como proceso, se inicia a partir del desarrollo de la autoevaluación y la evaluación externa; de ahí que la auditoría académica puede contribuir a la evaluación de dichos requisitos desde una perspectiva sistémica.

RESUMO Objetivo Avaliar o efeito de um programa, baseado em jogos, sobre estudantes de enfermagem da disciplina cuidados paliativos, medindo o medo da morte por meio da Escala Collett-Lester. O desafio é inovar e integrar, na sala de aula, teoria e experiências próximas ao contexto do luto. Método Estudo quase-experimental. Realizaram os questionários 101 e 11 estudantes, antes e depois da intervenção dos jogos, respectivamente. Disciplina ministrada no primeiro semestre do terceiro ano. Resultados Os estudantes obtiveram valores médios moderados na variável “medo da morte” (entre 14 e 19) para os dois momentos (pré e pós). Homens e mulheres aumentam esses valores de medo no pós-teste, ao mesmo tempo que diminuem sua “percepção sobre preparo emocional”, evidenciando-se o valor dos jogos ao expor o estudante a situações próximas às reais. Conclusões Consideramos que a ferramenta didática dos jogos, aplicada no contexto da sala de aula, fornece ao estudante a oportunidade de reconhecer o medo que a proximidade da morte gera, tanto no doente e na família, quanto nele próprio.

ABSTRACT Objective To evaluate the effect of a games-based intervention on palliative care nursing students’ scores on the Collett-Lester Fear of Death Scale. The challenge was to innovate and integrate grief-related theory and experiences into the classroom. Method Quasi-experimental study. Before and after the games-based intervention, 101 and 111 students completed the questionnaires, respectively. The intervention was performed in the context of a palliative care class taught during the first semester of the third year of the nursing programme. Results The students obtained moderate mean scores on the variable fear of death (between 14 and 19) at both time points (pre- and post-intervention). Both men and women indicated a heightened sense of fear post-intervention and a decrease in self-perceived emotional preparedness, which support the value of the games for exposing the student to situations that closely approximated reality. Conclusion The use of games as a didactic tool in the classroom context helped the students recognize the fear generated by proximity to death in the patient and family and in the student him- or herself.

RESUMEN Objetivo Evaluar el efecto de un programa, basado en juegos, sobre estudiantes de enfermería de la asignatura cuidados paliativos, midiendo el miedo a la muerte mediante la Escala Collett-Lester. El desafío es innovar, e integrar en el aula, teoría y experiencias cercanas al contexto de duelo. Método Estudio cuasi-experimental. Realizaron los cuestionarios 101 y 111 estudiantes, antes y después de la intervención de los juegos, respectivamente. Asignatura impartida en el primer semestre de tercer curso. Resultados Los estudiantes obtuvieron valores medios moderados en la variable “miedo a la muerte” (entre 14 y 19) para ambos momentos (pre y post). Hombres y mujeres aumentan estos valores de miedo en el post-test, a la vez que disminuyen su “percepción sobre preparación emocional”, evidenciando el valor de los juegos, al exponer al estudiante a situaciones cercanas a las reales. Conclusión Consideramos que la herramienta didáctica de los juegos, aplicada en el contexto del aula, facilita que el estudiante pueda reconocer el miedo que genera la cercanía de la muerte, tanto en el enfermo y familia, como el propio.

ABSTRACT Objective To evaluate the effect of a games-based intervention on palliative care nursing students’ scores on the Collett-Lester Fear of Death Scale. The challenge was to innovate and integrate grief-related theory and experiences into the classroom. Method Quasi-experimental study. Before and after the games-based intervention, 101 and 111 students completed the questionnaires, respectively. The intervention was performed in the context of a palliative care class taught during the first semester of the third year of the nursing programme. Results The students obtained moderate mean scores on the variable fear of death (between 14 and 19) at both time points (pre- and post-intervention). Both men and women indicated a heightened sense of fear post-intervention and a decrease in self-perceived emotional preparedness, which support the value of the games for exposing the student to situations that closely approximated reality. Conclusion The use of games as a didactic tool in the classroom context helped the students recognize the fear generated by proximity to death in the patient and family and in the student him- or herself.

RESUMEN Objetivo Evaluar el efecto de un programa, basado en juegos, sobre estudiantes de enfermería de la asignatura cuidados paliativos, midiendo el miedo a la muerte mediante la Escala Collett-Lester. El desafío es innovar, e integrar en el aula, teoría y experiencias cercanas al contexto de duelo. Método Estudio cuasi-experimental. Realizaron los cuestionarios 101 y 111 estudiantes, antes y después de la intervención de los juegos, respectivamente. Asignatura impartida en el primer semestre de tercer curso. Resultados Los estudiantes obtuvieron valores medios moderados en la variable “miedo a la muerte” (entre 14 y 19) para ambos momentos (pre y post). Hombres y mujeres aumentan estos valores de miedo en el post-test, a la vez que disminuyen su “percepción sobre preparación emocional”, evidenciando el valor de los juegos, al exponer al estudiante a situaciones cercanas a las reales. Conclusión Consideramos que la herramienta didáctica de los juegos, aplicada en el contexto del aula, facilita que el estudiante pueda reconocer el miedo que genera la cercanía de la muerte, tanto en el enfermo y familia, como el propio.

RESUMO Objetivo Avaliar o efeito de um programa, baseado em jogos, sobre estudantes de enfermagem da disciplina cuidados paliativos, medindo o medo da morte por meio da Escala Collett-Lester. O desafio é inovar e integrar, na sala de aula, teoria e experiências próximas ao contexto do luto. Método Estudo quase-experimental. Realizaram os questionários 101 e 11 estudantes, antes e depois da intervenção dos jogos, respectivamente. Disciplina ministrada no primeiro semestre do terceiro ano. Resultados Os estudantes obtiveram valores médios moderados na variável “medo da morte” (entre 14 e 19) para os dois momentos (pré e pós). Homens e mulheres aumentam esses valores de medo no pós-teste, ao mesmo tempo que diminuem sua “percepção sobre preparo emocional”, evidenciando-se o valor dos jogos ao expor o estudante a situações próximas às reais. Conclusões Consideramos que a ferramenta didática dos jogos, aplicada no contexto da sala de aula, fornece ao estudante a oportunidade de reconhecer o medo que a proximidade da morte gera, tanto no doente e na família, quanto nele próprio.

Los factores bióticos y abióticos determinan la composición de ácidos grasos AG en los peces, información relevante por la asociación existente entre su consumo y los beneficios para la salud humana. El objetivo de esta investigación fue identificar la variación en la concentración de AG, según diferentes factores, en diez especies marinas de pescado comestible en México: Euthynnus alletteratus, Sciaenops ocellatus, Bairdiella chrysoura, Sphyraena guachancho, Symphurus elongatus, Istiophorus platypterus, Ophichthus rex, Eugerres plumieri, Eucinostomus entomelas y Oreochromis mossambicus. La determinación de AG se llevó a cabo mediante cromatografía de gases. El contenido de lípidos totales varió entre 0.93 y 1.95g/100g en E. entomelas y O. mossambicus, respectivamente. E. alletteratus, B. chrysoura, S elongatus, I. platypterus, O. rex y E. plumieri presentaron el siguiente orden en la concentración de AG: AG poliinsaturados AGPAG saturados AGSAG monoinsaturados AGM. S. ocellatus, S. guachancho y E. entomelas: AGSAGPAGM; mientras que tan solo O. mossambicus presentó AGSAGMAGP. Este tuvo la mayor concentración de AGS 559.40mg/100g y AGM 422.60mg/100g, mientras que B. chrysoura presentó el mayor contenido mg/100g de AGP 663.03, AGn-3 514.03, EPA+DHA 506.10 y AGn-6 145.80. Factores bióticos y abióticos influyeron significativamente en la concentración de AG. Las especies subtropicales presentaron una concentración 42.1 mayor de EPA+DHA que las tropicales. Los valores presentados pueden cambiar según modificaciones en el ecosistema y en las características de cada especie, sin embargo, el conocimiento aquí generado es útil para mejorar las recomendaciones sobre el consumo de pescado.

Different biotic and abiotic factors determine the fatty acid FA composition of fish tissues and organs. This information is useful for humans due to the fact that fish consumption is associated with health benefits. The aim of the present study was to identify the variation in the concentration of fatty acids, according to different factors, among ten edible marine fish species in Mexico, collected from June to December 2009 in the largest fish market in Mexico city: Euthynnus alletteratus, Sciaenops ocellatus, Bairdiella chrysoura, Sphyraena guachancho, Symphurus elongatus, Istiophorus platypterus, Ophichthus rex, Eugerres plumieri, Eucinostomus entomelas and Oreochromis mossambicus. Lipid content was gravimetrically quantified, the fatty acids were determined using a gas chromatograph and the results were statistically analyzed. Total lipid content ranged from 0.93 to 1.95g/100g in E. entomelas and O. urolepis hornorum, respectively. presented the following order in FA concentration: Polyunsaturated FA PUFASaturated FA SFAMonounsaturated FA MUFA. E. alletteratus, B. chrysoura, S. elongatus, I. platypterus, O. rex and E. plumieriS. ocellatus, S. guachancho and E. entomelas presented SFAPUFAMUFA; and only O. mossambicus presented SFAMUFAPUFA. O. mossambicus had the highest concentration mg/100g of SFA 559.40 and MUFA 442.60, while B. chrysoura presented the highest content mg/100g of PUFA 663.03, n-3 PUFA 514.03, EPA+DHA 506.10 and n-6 PUFA 145.80. Biotic and abiotic factors of the analyzed fish significantly influenced their FA concentration. Subtropical species presented 42.1 more EPA+DHA than tropical specie. Values presented here will vary according to the changes in the ecosystem and characteristics of each fish species, however the information generated in the present study is useful for improving fish consumption recommendations.

Existe una relación directa entre el estado de salud y la dieta. y dentro de ésta algunos componentes, como los ácidos grasos (AG.), influyen mayormente en la prevención de ciertas enfermedades (coronarias, respuesta inmune, respuesta inflamatoria, tensión arterial). Una de las principales fuentes de AG esenciales son los productos de origen marino; el atún es un alimento marino de amplio consumo en México dada su acequibilidad y bajo costo. El objetivo de este trabajo fue determinar el perfil de ácidos grasos (AG) en atún de tres localidades del Pacifico mexicano, enlatado en aceite y en agua. Se obtuvieron aleatoriamente 7 marcas comerciales de atún en aceite (AA) y 5 de atún en agua (AW) procedentes de las siguientes zonas pesqueras: Baja California Sur (LI), Colima (L2) y Mazatlán (L3). Las muestras sin drenar se licuaron para la posterior obtención de los ésteres metílicos de los ácidos grasos, que se analizaron por cromatografía de gases con FID. En las tres localidades (LI, L2 y L3) y los dos grupos (AA y AW) se identificaron 20 AG (mg/100g); tres AG omega 3 (EPA, DHA y linolénico) y dos omega 6 (linoleico y araquidónico). En los AA de las tres localidades los AG saturados más abundantes fueron el esteárico y palmítico, el monoinsaturado más abundante fue el cis-vaccenico, seguido del oleico. El comportamiento de los omega 3 en los AA de las tres localidades fue similar: niveles bajos de linolénico (447-755), seguidos por el EPA (979-1323) y finalmente elevadas concentraciones de DHA (1862- 3327). En el AW el DHA fue el ácido graso más abundante en todas las localidades (1086-4456), el saturado más abundante fue el palmítico (640-3809). Se observó la presencia de AG trans en ambos grupos, pero en AW la concentración fue muy elevada: linolelaídico (1394-1495) y elaídico (377-1234). La relación omega 3/ omega 6 en los AA fue similar entre las localidades l y 2 y menor en L3; en AW fue similar entre L2 y L3 y menor en L1. En conclusión, existe variación evidente en el contenido de AG entre localidades; se puede considerar al AA de L3 como el más rico en AG omega 3 y omega 6, lo mismo que para el AW de L2. En general, el AW es un alimento más rico en AG omega 3 y omega 6 que el AA, independientemente de la localidad

Fatty acids of the tuna of different fishing areas of the Mexican Pacific, canned in oil and water. A direct relationship exists between the state of health and the diet, and inside this some components, such as the fatty acids (FA). influence mostly in the prevention of certain illnesses (coronary heart disease, hypertension, rheumatoid arthritis, inflammatory answer, and arterial pressure). One of the main sources of essential FA are the marine products; the tuna is a marine food of wide consumption in Mexico due its readiness and low cost. The objective of this work was to determine the profile of fatty acids (FA) in tuna canned in oil and in water coming from three fishing areas of the Mexican Pacific. There were randomly obtained 7 oil-tuna commercial marks (AA) and 5 water- tuna (AW) coming from the next fishery areas: Baja California Sur (LI), Colima (L2) and Mazatlán (L3). The samples without draining were liquefied and thereafter it was obtained the methyl esters of fatty acids that were analyzed by gas chromatography with a flame ionization detector. In all the areas were identified 20 FA (mg/100g); three AGomega 3 (EPA, DHA and linolenic) and two omega 6 (linoleic and arachidonic). In the AA of the three areas the most abundant saturated FA were estearic and palmitic acids, the most abundant monounsaturated fatty acid was the cis-vaccenic, followed by the oleic acid. The behavior of those omega 3 in the AA of the three areas were similar: with the less quantity was the linolenic acid (447-755), continued by the EPA (979-1323) and finally high concentrations of DHA (1862-3327). In the AW the DHA was the most abundant fatty acid in all the areas (1086- 4456), the most abundant monounsaturated fatty acid was the palmitic (640-3809). It was observed the presence of trans fatty acids in high quantities in AW: linolelaidic (1394-1495) and elaidic (377-1234). The relationship omega 3/omega 6 in the AA was similar in L1 and L2, and lower in L3; in AW was higher in L2 and L3. In conclusion, evident variation exists in the content of FA among afeas; it could be considered that the AA of L3 and A W of L2 as the richest in omega 3 and omega 6 FA. In general, the tuna in water is a richer food in FA omega 3 and omega 6 that the tuna in oil, independently of the fishery area

Numerosas investigaciones han señalado la importancia que los ácidos grasos tienen en el proceso salud-enfermedad y que los recursos marinos son excelentes fuentes de los ácidos grasos de las series omega 3 y omega 6. En México, la sardina es un producto de origen marino de amplio consumo debido a su alta disponibilidad y bajo costo. El objetivo del presente trabajo fue determinar el perfil de ácidos grasos (AG.) en sardina enlatada en salsa de tomate procedente de diferentes zonas pesqueras del Pacífico mexicano. Se obtuvieron aleatoriamente 8 marcas comerciales de sardina en salsa de tomate (5 latas de cada marca); se clasificaron de acuerdo al lugar en donde se procesaron en sardina de Baja California Sur (L1), Sonora (L2) y Sinaloa (L3). Las muestras sin drenar se licuaron para la posterior obtención de los ésteres metílicos de los ácidos grasos, que se analizaron por cromatografía de gases con FID. En todas las localidades se identificaron y cuantificaron 3 AGomega 3 (linolénico, EPA y DHA) y 2 AGomega 6 (linoleico y araquidónico); este alimento es rico en AG monoinsaturados y también presenta una cantidad considerable de AG trans (18:1n9t y 18:2n6t). El DHA fue el AG más abundante en todas las localidades (3064-4704 mg/100g); finalmente, la relación omega 3/omega 6 fue desde 3.5(L1) hasta 8.9(L3). En conclusión la sardina en salsa de tomate del Pacífico mexicano es una excelente fuente de ácidos grasos omega -3 y omega -6 independientemente del área en donde se procese

Fatty acids in sardine canned in tomato sauce from different fishing areas of the Mexcan Pacific. Numerous investigations have pointed out the importance that the fatty acids have in the process health-illness, and that the marine resources are excellent sources of the series omega 3 and omega 6. In Mexico, the sardine is a product of marine origin of wide consumption due to its high readiness and low cost. The objective of the present study was to determine the fatty acids profile (FA) in sardine canned in tomato sauce coming from different fishing areas (A) of the Mexican Pacific. There were randomly obtained 8 commercial mark (5 cans of each mark) of sardine canned in tomato sauce; they were classified in sardine of South Baja California Sur (A1), Sonora (A2) and Sinaloa (A3). The samples without draining were liquified and thereafter were obtained the methyl esters of fatty acids that were analyzed by gas chromatography with a flame ionization detector. In all the areas they were identified and quantified as 3 FAomega 3 (linolenic, EPA and DHA) and 2 AGomega 6 (linoleic and arachidonic); this source is rich in FA monounsaturated and also presents a considerable quantity of trans FA (18:1n9t and 18:2n6t). The DHA was the most abundant AG in all the areas (3064-4704 mg/100g); finally, the relationships omega 3/omega 6 were from 3.5 (A1) up to 8.9 (A3). In conclusion, sardine canned in tomate sauce of the mexican Pacific is a rich food in omega -3 and omega -6 FA, independently of the procesing area