ABSTRACT Objective: To evaluate the antibacterial effect of electrolytically generated hypochlorous acid on Streptococcus gordonii, Fusobacterium nucleatum, and Porphyromonas gingivalis. Material and Methods: In this in vitro experiment, the effect of hypochlorous acid (HOCl) on the strains S. gordonii, F. nucleatum, and P. gingivalis was evaluated using 4% sodium hypochlorite, 0.12% chlorhexidine, and distilled water as controls. The four groups were placed on each plate, and each group was replicated five times. The agar diffusion method by zones measurement was used. The data were processed with SPSS using the Kruskal-Wallis test and multiple comparison tests. Results: Hypochlorous acid showed an average inhibition halo of 9.28 mm on S. gordonii. As expected with distilled water, no zone of inhibition was noted for any of the bacteria, nor were zones of inhibition observed with HOCl for F. nucleatum and P. gingivalis. Conclusion: Hypochlorous acid showed antimicrobial properties against only S. gordonii and was less effective than 4% sodium hypochlorite and 0.12% chlorhexidine, although no significant differences were found between the latter.

Abstract Objective: To assess the antibacterial activity of Psidium guajava fractions and their effects on adhesion of a multispecies biofilm consisting of Streptococcus gordonii, Fusobacterium nucleatum, and Porphyromonas gingivalis in vitro. Material and Methods: Guava leaves were obtained from the mountains of northern Peru, where they grow wild and free of pesticides. The antimicrobial activity of 25 mg/mL petroleum ether, 25 mg/mL dichloromethane and 25 mg/mL methanol fractions of P. guajava was evaluated by measuring inhibition halos, as well as the effect on the adhesion of multispecies biofilms at 4, 7 and 10 days of growth by measuring the optical density. In addition, antimicrobial susceptibility was compared using the Kruskal-Wallis test and its multiple comparison tests, and differences in mean biofilm adhesion between each fraction were assessed by repeated measures analysis and the Tukey multiple comparison test. Results: The rank-based Kruskal-Wallis test highlighted differences in the effects of the fractions on the zone of inhibition for each oral bacterium, including S. gordonii (p=0.000), F. nucleatum (p=0.000), and P. gingivalis (p=0.000), the Tukey test showed that the group treated with 0.12% chlorhexidine exhibited the least amount of adhesion, followed by the group treated with the 1.56 mg/mL methanol fraction. Conclusion: The methanol fraction of P. guajava had an antibacterial effect on S. gordonii and P. gingivalis, and the 1.56 mg/mL methanol fraction decreased biofilm adhesion.

Abstract Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease characterized by rapid and fatal evolution, producing a great emotional impact on both the patient and their family. The role of the Nurse Case Manager in the monitoring, evaluation, and control of the patient and their family from the diagnosis of ALS, and as the main expert reference in care, positions her as a point of reference for the union of the multidisciplinary team and the family unit. Their role within the interdisciplinary team helps to improve the assistance that the informal caregiver provides, avoiding the overload of the caregiver role, increasing patient safety, and therefore the quality of life for both, thus also improving communication and information and family satisfaction. In practice, it is difficult to maintain a continuity of comprehensive care throughout the disease process, from diagnosis to the last days.

Resumen La Esclerosis Lateral Amiotrófica (ELA) es una enfermedad neurodegenerativa caracterizada por una evolución rápida y mortal, produciendo un gran impacto emocional tanto en el paciente, como en su familia. El papel de la enfermera Gestora de Casos en el seguimiento, evaluación y control del paciente y su familia desde el diagnóstico de ELA, y como principal referente experta en cuidados, la posiciona como referente de nexo de unión del equipo multidisciplinar y la unidad familiar. Su papel dentro del equipo interdisciplinar ayuda a mejorar la asistencia que el cuidador familiar proporciona, evitando la sobrecarga del rol de cuidador, aumentando la seguridad del paciente, y por tanto la calidad de vida de ambos, mejorando así también la comunicación e información y la satisfacción familiar. En la práctica, resulta complicado mantener una continuidad de cuidados integrales a lo largo de todo el proceso de la enfermedad, desde el diagnóstico, hasta los últimos días.

ABSTRACT Objective: To identify proteins associated with the formation of Streptococcus gordonii and Fusobacterium nucleatum biofilms. Material and Methods: Biofilms composed of two bacterial species, S. gordonii and F. nucleatum, were cultured for 1, 4, 7, and 10 days. The presence of both species was confirmed via amplification of the srtA and radD genes using real-time PCR. The concentrations of proteins associated with the biofilms and individual species were quantified using Western blotting. Results: The protein profiles of S. gordonii and F. nucleatum from individual cultures determined using one-dimensional electrophoresis revealed proteins found in S. gordonii and in F. nucleatum. Ct and reciprocal Ct values were determined for the exposed S. gordonii and F. nucleatum biofilms. Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) protein was detected in biofilms and F. nucleatum, whereas HSP40 protein was present only in biofilms after 7 and 10 days of formation. Conclusion: HSP40 was detected only in the formed biofilms; thus, HSP40 is an essential proteins for adhesion.

Abstract: This article proposes a reading of Writing of Raimundo Contreras (1929) by Paul Rokha. The goal is to find traces (signs) of the presence and referentiality of the subject of enunciation within the discourse which he produces, that is, evidencing those textual marks that allow to understand how in Typing a subject of enunciation that turns the boundaries of the first person singular unstable emerges. Specifically, I propose to pay attention to identity configuration models that the subject of enunciation displays. Through which/what rhetorical strategies does the/this subject express his/their self? The identification of such strategies will allow me to determine the ideological implications and ethical opinions and prejudices underlying the Rokhian writing from the first decades of the last century.

Resumen: Este artículo propone una relectura de Escritura de Raimundo Contreras (1929) de Pablo de Rokha. El objetivo es encontrar huellas (signos) de la presencia y referencialidad del sujeto de la enunciación al interior del discurso que él mismo produce, o sea, evidenciar aquellas marcas textuales que permiten comprender cómo en Escritura emerge un sujeto de la enunciación que torna inestables los límites de la primera persona singular. De manera específica, propongo poner atención en los modelos de configuración identitaria que despliega el sujeto de la enunciación: ¿A través de qué estrategias retóricas este sujeto enuncia su yo? La identificación de tales estrategias permitirá determinar las implicaciones ideológicas y los (pre) juicios éticos que subyacen la escritura rokhiana de las primeras décadas del siglo pasado.

Abstract Objective: To determine the in vitro antibacterial effect of different concentrations of the ethanol extract of Plantago major (plantain) on Porphyromonas gingivalis and Fusobacterium nucleatum. Material and Methods: Bacterial susceptibility tests were used in conjunction with the agar diffusion test and the minimum inhibitory concentration (MIC) test using the broth macrodilution technique. Results: Different concentrations of ethanol extract (25%, 50%, 75% and 100%) dissolved in 70% ethanol were used, with a positive control (0.12% chlorhexidine + 0.05% cetyl-pyridinium chloride) and a negative control (70% alcohol). The extracts at 75% and 100% showed inhibition halos against both strains studied. With 0.12% chlorhexidine + 0.05% cetyl-pyridinium chloride, inhibition halos averaged 14.9 mm, in contrast to 70º alcohol, where no bacterial inhibition was observed. The MIC was 50% for both species. Conclusion: The ethanol extract of Plantago major presents an in vitro antibacterial effect on Porphyromonas gingivalis, they may have potential applications in food and pharmaceutical products.

La ética clínica se refiere a un campo emergente en la medicina clínica que se centra en el proceso de toma de decisiones éticas en un entorno clínico. Se ha desarrollado como resultado de una creciente conciencia de que la medicina moderna -caracterizada por el progreso tecnológico, la diversidad cultural y los problemas sociales- está planteando una serie de nuevos "dilemas éticos" que la ciencia médica por sí sola no puede resolver. Por esta razón, la ética clínica suele estar relacionada con la "consulta ética", que consiste en los servicios prestados por un especialista en ética, un equipo ético o un comité de ética para abordar las cuestiones éticas implicadas en un caso clínico específico. Si bien la ética clínica se desarrolló al principio esencialmente como un análisis metodológico para llegar a una justificación de las decisiones éticas clínicas, rápidamente se hizo evidente que la dificultad en la toma de decisiones clínicas es solo un aspecto de los problemas éticos más amplios relacionados con la relación médico-paciente en su totalidad y, muy probablemente, con el valor fundamental de la profesión médica. El método de principios generalmente se presenta como el enfoque metodológico más extendido para el análisis de casos clínicos. Sin embargo, una fuerte crítica de este modelo se ha manifestado, y se hace referencia a otros enfoques alternativos, como el modelo de la casuística. Recientemente, se han producido importantes contribuciones de la medicina narrativa y la ética de la virtud. De acuerdo con estas metodologías, una sana antropología y una buena relación con el enfermo son elementos clave requeridos de cualquier persona que trabaje en la práctica médica que pretende ser auténticamente apropiada desde una perspectiva ética.

Clinical ethics refers to an emerging field in clinical medicine that focuses on the process of ethical decision-making in a clinical setting. It has developed as a result of a growing awareness that modern medicine - characterized by technological progress, cultural diversity and social challenges - is posing a range of new "ethical dilemmas" that medical science alone cannot solve. For this reason, clinical ethics is often linked to "ethics consultation," which consists of services provided by an individual ethicist, ethics team or committee to address the ethical issues involved in a specific clinical case. Although clinical ethics developed in the beginning mainly as a methodological analysis to arrive at a justification for clinical ethical decisions, it quickly has become clear that the difficulty in clinical decision-making is only one aspect of wider ethical problems pertaining to the doctor-patient relationship as a whole and, most likely, to the core value of the medical profession. The principles method is usually presented as the most popular methodological approach to an analysis of clinical cases. However, strong criticism of this model has been voiced, and other alternative approaches are referred to, such as the casuistry model. Recently, significant contributions have been made by narrative medicine and virtue ethics. According to these methodologies, sound anthropology and a good relationship with the sick person are key elements required of any person engaged in medical practice who aims to be genuinely appropriate from an ethical perspective.

A ética clínica se refere a um campo emergente na medicina clínica que se concentra no processo de tomada de decisões éticas num contexto clínico. Tem se desenvolvido como resultado de uma crescente consciência de que a medicina moderna -caracterizada pelo progresso tecnológico, pela diversidade cultural e pelos problemas sociais- está propondo uma série de novos "dilemas éticos" que a ciência médica por si só não pode resolver. Por essa razão, a ética clínica costuma estar relacionada com a "consulta ética", que consiste nos serviços prestados por um especialista em ética, por uma equipe ética ou por um comitê de ética para abordar as questões éticas implicadas num caso clínico específico. Embora a ética clínica tenha se desenvolvido a princípio essencialmente como uma análise metodológica para chegar a uma justificativa das decisões éticas clínicas, rapidamente se tornou evidente que a dificuldade na tomada de decisões clínicas é só um aspecto dos problemas éticos mais amplos relacionados com a relação médico-paciente em sua totalidade e, bem provável, com o valor fundamental da profissão médica. O método de princípios geralmente se apresenta como o enfoque metodológico mais difundido para a análise de casos clínicos. Contudo, uma forte crítica desse modelo vem se manifestando e fazendo referência a outros enfoques alternativos, como o modelo da casuística. Recentemente, têm sido produzidas relevantes contribuições da medicina narrativa e da ética da virtude. De acordo com essas metodologias, uma antropologia saudável e uma boa relação com o paciente são elementos-chave exigidos de qualquer pessoa que trabalhe na prática médica que pretenda agir de forma apropriada segundo uma perspectiva ética.

Introduction. The implementation of the Bolonia's process has meant a methodological change in the Spanish university during the last years. This has affected the teaching quality, specifically in the degree of Medicine, which has changed from a traditional and unidirectional teaching methodology into another situation, in which the students acquire importance in the learning process and the continuous evaluation gets a more important role. Subjects and methods. In the academic year 2010-2011 the student level of satisfaction and participation in the subject 'Epidemiology and Health Demography' (an obligatory study course from the third year of the degree) and their relationship with the academic performance achieved were assessed by the 'Ad hoc questionnaire of teaching improvement'. A total of 215 students answered the questionnaire. The association between the students' implication and their level of satisfaction with this evaluation system and their academic performance were evaluated with multiple lineal regression models. Results. The 40.8% of students indicated a very high level of satisfaction with the continuous evaluation system. It was observed that the higher attendance to lectures the higher marks obtained at the final test (p < 0.05 and p < 0.001, respectively). Also, the students implication in the activities scheduled were positively associated with their qualifications at the final test (p < 0.001). Conclusion. The use of a continuous evaluation system in 'Epidemiology and Health Demography' resulted in a better academic performance by the students.

Introducción. La implantación del proceso de Bolonia ha supuesto un cambio metodológico en la universidad española en los últimos tiempos. Ello revierte en la calidad de la docencia, específicamente en la titulación de medicina, que se ha ido transformando desde una metodología docente tradicional y unidireccional a otra, más actual, donde el estudiante ocupa un papel principal en el proceso de aprendizaje y donde la evaluación continuada va adquiriendo cada vez más protagonismo. Sujetos y métodos. En el curso académico 2010-2011 se evaluó, mediante el 'cuestionario ad hoc de mejora de la docencia', el grado de satisfacción y participación del alumnado en la asignatura de 'Epidemiología y demografía sanitaria', materia obligatoria de tercer curso de medicina en la Universidad de Granada, y se relacionó con el rendimiento académico obtenido. Un total de 215 alumnos contestaron al cuestionario. La asociación entre la implicación del alumnado y su satisfacción con este modelo de evaluación y su rendimiento académico se evaluó mediante modelos de regresión lineal múltiple. Resultados. El 40,8% de los estudiantes indicó un 'muy elevado grado de satisfacción' con el sistema de evaluación continua. Se observó que, a mayor asistencia a clases de teoría, mayor fue la calificación obtenida en el examen final (p < 0,05 y p < 0,001, respectivamente). La implicación del alumnado en las actividades docentes programadas se asoció positivamente con la calificación obtenida en el examen final (p < 0,001). Conclusión. La inclusión de un sistema de evaluación basado en la evaluación continuada favoreció un mayor rendimiento académico del alumnado.

This paper proposes a new reading of the poem "Ballad of Paul Rokha" of moans (1922) Paul Rokha. The goal is to find traces (characters) of the presence and referentiality of the subject of enunciation within the discourse which he produces, that is, evidence that these textual markers provide insights into ways in "Ballad" emerges a subject of enunciation that when he says "I" becomes unstable boundaries of the first person singular.

Este artículo propone en una relectura del poema "Balada de Pablo de Rokha" de Los gemidos (1922) de Pablo de Rokha. El objetivo es encontrar huellas (signos) de la presencia y referencialidad del sujeto de la enunciación al interior del discurso que él mismo produce, es decir, evidenciar aquellas marcas textuales que permiten comprender cómo en Balada emerge un sujeto de la enunciación que, cuando dice "yo", torna inestables los límites de la primera persona singular.

La UCV es uno de los principales actores del Sistema Nacional de Ciencia, Tecnología e Innovación (SNCTI) de Venezuela. El propósito del presente estudio es determinar el peso histórico que tiene esta institución en cuanto a la producción de artículos científicos en el Web of Science (WoS) con respecto al país. Como fuente de información se utilizó una base de datos obtenida de la búsqueda en el WoS utilizando como criterio a "Venezuela" como país de origen de la publicación. El período del estudio abarcó tres décadas (1981-2007) y los registros correspondientes al área de "Salud y Calidad de Vida" fueron segmentados en base al sistema de clasificación de disciplinas científicas utilizado por la UNESCO, que es una de las características del programa de manejo de la base de datos utilizado en esta investigación (Programa BIBLIOS). Los resultados encontrados demuestran la importancia primigenia en investigación que tiene la UCV en esa área fundamental para la sociedad venezolana

The UCV is a major player within the Sistema Nacional de Ciencia, Tecnología e Innovación (National System of Science, Technology and Innovation) in Venezuela. This paper aims to establish the historical weight that this institution represents regarding its production of scientific publications as registered in the Web of Science (WoS), relative to the whole country. The WoS was queried by using the term "Venezuela" as "Country of Origin for the Publication" in order to generate a database, which in turn was used as the source for the current study and for a time frame ranging from 1981 to 2007. Entries corresponding to Health and Quality of Life were segmented based on the UNESCO taxonomy using a functionality offered by the software BIBLIOS. These findings show the importance that research developed by the UCV in these fields of knowledge has for Venezuelan society

L’UCV est un des principaux acteurs du Système National de Science, Technologie et Innovation (SNCTI) du Vénézuela. Le but de la présente étude est de déterminer le poids historique qu´a cette institution quant à la production d´articles scientifiques dans le Web of Science (WoS) á l´égard du pays. Comme source d’information on a utilisé une base de données obtenue de la recherche dans le WoS en utilisant comme critère le Vénézuela comme pays d’origine de la publication. La période d’étude a compris trois décennies (1981-2007) et les registres correspondant au secteur «Santé et Qualité de Vie» ont été segmentés sur la base du système de classification de disciplines scientifiques utilisé par l’UNESCO, qui est une des caractéristiques du programme de maniement de la base de données utilisé dans cette recherche (Programme BIBLIOS). Les résultats trouvés démontrent l’importance en recherche que l’UCV a dans ce secteur fondamental pour la société vénézuélienne

In 1993 the NIH (National Institute of Health) Consensus Conference on Impotence defined erectile dysfunction as the permanent incompetence to start or maintain an erection enough to enable satisfactory sexual intercourse. Erectile dysfunction (ED) is a frequent disorder that affects negatively quality of life of males suffering it. Its prevalence varies between different countries, cultures and races. The first population studies published date from early 90's and still keep their validity. All of them show the influence of age on prevalence of ED, as well as its close relationship with cardiovascular diseases. Depending on the definition used and study design prevalence varies from 10 to 52%, mainly in men between 40-70 years, with an incidence in western countries between 25-30 new cases per 1000 inhabitants year.

En 1993, la conferencia de consenso sobre la impotencia del NIH (Nacional Institute of Health), define la Disfunción Eréctil (DE) como "la incapacidad permanente para iniciar o mantener una erección suficiente como para permitir una relación sexual satisfactoria". La Disfunción Eréctil (DE), es un trastorno frecuente que afecta negativamente a la calidad de vida de los varones que la padecen. Su prevalencia varía entre diferentes países, culturas y razas. Los primeros estudios poblaciones publicados, datan de principios de los 90 y conservan aún su vigencia. Todos reflejan la influencia que la edad tiene sobre la prevalencia de esta patología, así como su estrecha relación con las enfermedades cardiovasculares. Dependiendo de la definición utilizada y del diseño del estudio, la prevalencia varía entre el 10 y el 52%, en particular en hombres entre 40 y 70 años, con una incidencia en occidente de 25-30 nuevos casos por 1000 habitantes y año.

In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kantian and communitarian foundations. If one considers the nature and core functions of public health, which are focused on a population perspective, utilitarianism seems still more applicable to public health ethics. Nevertheless, faulting additional protections towards the human person, utilitarianism doesn't offer appropriate solutions when conflicts among values do arise. Further criteria must be applied to protect the fundamental principles of respect for human life. Personalism offers similar advantages to utilitarianism but warrants more protection to the human person. We suggest a possible adaptation of personalism in the specific field of public health by means of four principles: absolute respect for life or principle of inviolability; subsidiarity and the "minimum" mandatory principle; solidarity; justice and non discrimination.

Nell'etica della sanità pubblica, come in bioetica, spesso prevale un approccio utilitarista, seguito dall'etica kantiana e comunitarista. Se si considerano la natura e le funzioni chiave della sanità pubblica, incentrate su una prospettiva collettivista o di popolazione, l'utilitarismo sembra maggiormente applicabile all'etica della sanità pubblica. Eppure, in caso di conflitto tra valori, l'utilitarismo spesso non offre soluzioni appropriate, poiché non fornisce protezioni aggiuntive alla persona umana. Dunque, per proteggere i principi fondamentali del rispetto per la vita umana, si devono applicare ulteriori criteri. Nell'analisi dei problemi etici nella sanità pubblica il personalismo offre vantaggi simili all'utilitarismo, garantendo maggiore protezione alla persona umana. In questo lavoro si propone un adattamento del personalismo all'ambito specifico della sanità pubblica con l'adozione di quattro principi: rispetto assoluto della vita o principio di inviolabilità; sussidiarietà e principio del "minimo" obbligatorio; solidarietà; giustizia e non discriminazione.

En los últimos años ha crecido una cierta oposición al criterio neurológico para la determinación de la muerte, conocido generalmente como muerte cerebral. Esta controversia tiene una base médica, pero se mueve fundamentalmente en el ámbito filosófico. En este artículo presento lo que me parece ser una correcta comprensión de la muerte cerebral como procedimiento diagnóstico, y no como intento de cambiar el concepto de muerte, que ciertamente conlleva dificultades serias en el contexto de una antropología cristiana. Por el hecho de que haya evidencias clínicas que sugieren una profundización en el modo de realizar este diagnóstico no parece, al menos teniendo en cuenta los datos que se poseen actualmente, que se deba abandonar un criterio de determinación de la muerte, que si se realiza con rigor técnico resulta más fiable que el cardiopulmonar. Este criterio, por tanto, podría seguir empleándose para la certificación de la muerte en el ámbito de los trasplantes de órganos.

Recent years have seen the emergence of a certain opposition to the neurological criteria used to determine death, generally known as cerebral death. There is a medical basis to the controversy, but it is played out fundamentally in the philosophical arena. The article presents what the author believes is a correct understanding of cerebral death as a diagnostic procedure, and not as an attempt to alter the concept of death, which certainly would lead to serious difficulties in the context of a Christian anthropology. The fact that there might be clinical evidence to suggest more depth in the way this diagnosis is conducted does not imply, at least with the data at hand, that a criterion for determining death, which if applied with technical exactitude is more viable than the cardiopulmonary criterion, should be abandoned. Hence, this criterion could continue to be used to certify death in cases involving organ transplants.

Nos últimos anos tem aumentado a oposição ao critério neurológico para determinar a morte, geralmente conhecido como morte cerebral. Mesmo que esta controvérsia tem um fundamento médico, se desenvolve principalmente no campo da filosofia. Neste artigo, apresento o que me parece uma compreensão correta da morte cerebral como um procedimento de diagnóstico, e não para tentar mudar o conceito de morte, o que certamente leva a sérias dificuldades no contexto de uma antropologia cristã. As evidências clínicas sugerindo um aprofundamento na maneira de fazer este diagnóstico para determinar a morte não conduzem a abandoná-lo -ao menos tendo em conta os dados atuais-, já que se faz com rigor técnico e tem mais confiabilidade do que diagnóstico cardiopulmonar. Portanto, este critério poderia continuar a ser usado para a certificação de morte no campo dos transplantes de órgãos.

Incidence of renal carcinoma, one of the most fatal solid neoplasms, has steadily increased in Western society. Moreover, these tumors are being increasingly detected in their early stages. As with most cancers, the underlying causes of the disease remain unknown. However, understanding of pathogenesis of this tumor is rapidly advancing, and will allow for new treatments for advanced disease. Understanding of the influence of easily avoidable risk factors may allow for prevention of thousands of deaths caused by renal cancer.

El carcinoma renal constituye una de las neoplasias sólidas más letales. En la sociedad occidental se ha producido un constante aumento de la incidencia de este tumor, además de un incremento en la detección de tumores en estadíos precoces. Como ocurre en la mayoría de los cánceres, las causas de la enfermedad permanecen en gran medida desconocidas. Sin embargo, el conocimiento sobre la patogenia última de este tumor avanza rápidamente, permitiendo nuevos tratamientos para la enfermedad avanzada. El conocimiento de la influencia de factores de riesgo fácilmente evitables puede permitir evitar miles de muertes causadas por el cáncer renal.