Thresholds of Identification and Aesthetic Perception of Simulated Alar Base Widening Among Oral and Maxillofacial Surgeons: an Online Questionnaire-Based International Study / Limiares de Identificação e Percepção Estética do Alargamento Simulado da Base Alar Entre Cirurgiões Buco-Maxilo-Faciais: um Levantamento Internacional

This study aimed to compare the thresholds of identification and aesthetic perception of simulated alar base widening among oral and maxillofacial (OMF) surgeons from Brazil and other countries through an online data collection form. Photographs of one male and one female model were digitally manipulated to obtain aesthetically acceptable, symmetrical faces and to gradually widen the alar base to produce six different images from each original photograph. The online questionnaire was sent to OMF surgeons of different nationalities. The results mshowed that the majority of Brazilian (88%) and international (89%) evaluators considered the female faces with 0 to 2 mm of alar base widening as being more pleasant. In turn, Brazilian (93%) and international (94%) respondents agreed that faces with the greatest widening (8 and 10 mm) were less pleasant. As for the male model, Brazilian (93%) and international (85%) OMF surgeons agreed that faces with none or small widening (0 and 2 mm) were more pleasant. The male face with the greatest widening (10 mm) was considered the least attractive by the respondents (93% in both groups). The findings of this study suggest that alar base widening up to the limit of 2 mm did not alter the perception of facial attractiveness. Thus, faces without alar base widening were considered the most attractive, while those with significant alterations were considered less attractive. Most importantly, despite the limitations of this study design, it seems that different cultural and professional contexts have minor influence on aesthetics analysis performed by OMF surgeons. (AU)

Este estudo teve como objetivo comparar os limiares de identificação e percepção estética do alargamento simulado da base alar entre cirurgiões bucomaxilofaciais (BMF) do Brasil e de outros países por meio de um formulário de coleta de dados online. Fotografias de um modelo masculino e de uma modelo feminina foram manipuladas digitalmente para obter faces esteticamente aceitáveis e simétricas e para ampliar gradualmente a base alar produzindo seis imagens diferentes de cada fotografia original. O questionário online foi enviado aos cirurgiões BMF de diferentes nacionalidades. Os resultados mostraram que a maioria dos avaliadores brasileiros (88%) e internacionais (89%) consideraram as faces femininas com 0 a 2 mm de alargamento da base alar como mais agradáveis. Por sua vez, os entrevistados brasileiros (93%) e internacionais (94%) concordaram que os rostos com maior alargamento (8 e 10 mm) foram os menos agradáveis. Quanto ao modelo masculino, os cirurgiões brasileiros (93%) e internacionais (85%) da OMF concordaram que faces com nenhum ou pequeno alargamento (0 e 2 mm) eram mais agradáveis. A face masculina com maior alargamento (10 mm) foi considerada a menos atraente pelos entrevistados (93% em ambos os grupos). Nossos achados sugerem que o alargamento da base alar até o limite de 2 mm não alterou a percepção da atratividade facial. Assim, rostos sem alargamento da base alar foram considerados os mais atraentes, enquanto aqueles com alterações significativas foram considerados menos atraentes. Mais importante ainda, apesar das limitações, parece que diferentes contextos culturais e profissionais têm pouca influência na análise estética realizada pelos cirurgiões da OMF. (AU)

Violência mental: ansiedade e depressão durante a pandemia de COVID-19 no Brasil / Mental violence: anxiety and depression during COVID-19 pandemic in Brazil

Buscou-se avaliar a frequência de ansiedade e depressão e seus fatores associados ao longo da pandemia de COVID-19. Estudo transversal exploratório envolvendo 1.057 participantes, sendo aplicados os questionários GAD-7 e PHQ-9, através de Plataforma Google Forms, com amostragem bola de neve. A média de idade foi de 38 ± 14 anos, sendo 78% mulheres, provindos de 21 Estados brasileiros. Quarenta e dois por cento dos participantes tiveram escore GAD-7 ≥ 10, cerca de 53% teve escore PHQ-9 ≥ 10. Principais fatores de risco incluíram: gênero feminino, ser jovem, casado ou com companheiro, consumir bebidas alcoólicas, problemas psiquiátricos prévios, utilizar medicação para dormir, dormir menos de 8 horas, percepção negativa sobre COVID-19, estar em isolamento social, pesadelos frequentes e ideação suicida. O Brasil mantém-se com altos níveis de ansiedade e depressão durante a pandemia em associação com ideação suicida.

Anxiety and depression disorders are associated with professional and academic impairment and reduced life quality. Frequency of symptoms of anxiety and depression, and their association with health risk behaviors during the COVID-19 pandemic are evaluated. Cross-sectional study comprised 1,057 participants, 78% females, mean age 38±14 years, from 21 different Brazilian states. GAD-7 and PHQ-9 inventories were applied by Google Forms, with snowball sampling. Forty-two percent of the participants had a GAD-7 score ≥ 10, while 53% had a PHQ-9 score ≥ 10. Main risk factors comprised: being female, young, married or with partner, consuming alcoholic beverages, having previous psychiatric problems, taking sleeping pills, sleeping less than 8 hours, having a negative perception about COVID-19, staying isolated, having frequent nightmares and suicide thoughts. Brazil is a country featuring high levels of symptoms of anxiety and depression, significantly associated with suicide thoughts.

The OxyR and SoxR transcriptional regulators are involved in a broad oxidative stress response in Paraburkholderia xenovorans LB400

BACKGROUND: Aerobic metabolism generates reactive oxygen species that may cause critical harm to the cell. The aim of this study is the characterization of the stress responses in the model aromatic degrading bacterium Paraburkholderia xenovorans LB400 to the oxidizing agents paraquat and H 2 O2. METHODS: Antioxidant genes were identified by bioinformatic methods in the genome of P. xenovorans LB400, and the phylogeny of its OxyR and SoxR transcriptional regulators were studied. Functionality of the transcriptional regulators from strain LB400 was assessed by complementation with LB400 SoxR of null mutant P. aeruginosa ΔsoxR, and the construction of P. xenovorans pIZ oxyR that overexpresses OxyR. The effects of oxidizing agents on P. xenovorans were studied measuring bacterial susceptibility, survival and ROS formation after exposure to paraquat and H 2 O2. The effects of these oxidants on gene expression (qRT PCR) and the proteome (LC-MS/MS) were quantified. RESULTS: P. xenovorans LB400 possesses a wide repertoire of genes for the antioxidant defense including the oxyR , ahpC , ahpF , kat , trxB , dpsA and gorA genes, whose orthologous genes are regulated by the transcriptional regulator OxyR in E. coli . The LB400 genome also harbors the soxR, fumC , acnA , sodB , fpr and fldX genes, whose orthologous genes are regulated by the transcriptional regulator SoxR in E. coli . The functionality of the LB400 soxR gene was confirmed by complementation of null mutant P. aeruginosa Δ soxR . Growth, susceptibility, and ROS formation assays revealed that LB400 cells were more susceptible to paraquat than H2O2. Transcriptional analyses indicated the upregulation of the oxyR , ahpC1 , katE and ohrB genes in LB400 cells after exposure to H2O2, whereas the oxyR , fumC , ahpC1 , sodB1 and ohrB genes were induced in presence of paraquat. Proteome analysis revealed that paraquat induced the oxidative stress response proteins AhpCF and DpsA, the universal stress protein UspA and the RNA chaperone CspA. Both oxidizing agents induced the Ohr protein, which is involved in organic peroxide resistance. Notably, the overexpression of the LB400 oxyR gene in P. xenovorans significantly decreased the ROS formation and the susceptibility to paraquat, suggesting a broad OxyR regulated antioxidant response. CONCLUSIONS: This study showed that P. xenovorans LB400 possess a broad range oxidative stress response, which explain the high resistance of this strain to the oxidizing compounds paraquat and H2O2.

Avaliação dos Serviços de Alimentação de uma Universidade Pública do Rio de Janeiro na Pandemia de COVID-19 / Evaluation of the Food Services of a Public University in Rio de Janeiro during the COVID-19 Pandemic

Com o aparecimento da COVID-19, os Serviços de Alimentação (SA) precisaram se adequar aos protocolos de funcionamento dos órgãos de saúde, a fim de evitar a transmissão do vírus SARS-CoV-2. Embora não existam evidências da transmissão do vírus através dos alimentos, o contágio pode ocorrer entre manipuladores de alimentos e comensais. Neste estudo, objetivou-se avaliar as medidas implementadas em SA com o intuito de prevenir a transmissão e o contágio de COVID-19. A metodologia utilizada foi descritiva e quantitativa. A coleta de dados ocorreu no período de julho a outubro de 2021, por meio da aplicação de uma lista de checagem baseada nas normas sanitárias para a prevenção da transmissão da COVID-19. Os resultados demonstraram que os SA apresentaram inconformidades em alguns itens (28,9%), muito embora as mudanças realizadas estivessem de acordo com as orientações dos órgãos sanitários. As mudanças se referem, principalmente, à recomendação da existência de protocolos sanitários para prevenção da COVID-19, ventilação natural, reforço de limpeza, uso do Equipamento de Proteção Individual (EPI) - máscara, cartazes informativos e distanciamento físico. Conclui-se que é necessário colocar em prática as regulamentações vigentes e corrigir as possíveis falhas para que os SA alcancem todos os requisitos exigidos pela legislação na prevenção da transmissão da COVID-19.

With the emergence of COVID-19, Food Services (FS) needed to adapt to the protocols established by health agencies to avoid the transmission of the SARS-CoV-2 virus. Although there is no evidence of transmission of the virus through food, contagion can occur between food handlers and customers. In this study, the objective was to evaluate the measures implemented in a university FS in order to prevent the transmission and contagion of COVID-19. The methodology used was descriptive and quantitative. Data collection took place from July to October 2021, through the application of a checklist based on health standards for the prevention of transmission of COVID-19. The results showed that the FS demonstrated non-conformities in some items (28.9%), even though the changes made were in accordance with the guidelines of health agencies. The changes mainly refer to the recommendations of health protocols for the prevention of COVID-19 such as natural ventilation, reinforced cleaning, use of Personal Protective Equipment (PPE) - mask, informative posters, and physical distancing. It is concluded that it is necessary to put into practice the current regulations and correct the possible flaws so that the FS reach all the requirements required by the legislation in the prevention of the transmission of COVID-19.

Caracterización clínica y de gravedad de adultos con COVID-19 hospitalizados / Clinical and severity characterization of hospitalized adults with COVID-19

Se realizó una investigación de tipo cuantitativa, observacional, descriptiva y transversal en adultos ingresados en el Hospital General Alfredo Noboa Montenegro, de Guaranda, Ecuador, desde el 1ro. de julio al 30 de septiembre del 2020. Se realizó una caracterización clínica y de gravedad de adultos con COVID-19 hospitalizada. Se encontró que en el caso de presentar enfermedad cardiometabólica se aumenta la probabilidad de presentar los indicadores de gravedad (p<0,05). Presentar otras enfermedades asociadas (no cardiometabólicas) también incrementó la probabilidad de presentar indicadores de gravedad con un nivel de significación del 5%, al igual que padecer de asma bronquial (p<0,05 para ambas características); en el caso del tabaquismo solo fue estadísticamente significativo el aumento de la probabilidad de ingreso en el hospital, de presentar neumonía y de fallecer (p<0,05 para las tres variables). Los resultados de este estudio pueden usarse para identificar los factores de riesgo asociados con un mal pronóstico en pacientes con COVID-19 en Ecuador y ayudar a desarrollar medidas preventivas para disminuir la carga de la enfermedad y trazar estrategias para el manejo de los casos(AU)

A quantitative, observational, descriptive and cross-sectional investigation was carried out in adults admitted to the Alfredo Noboa Montenegro General Hospital, in Guaranda, Ecuador, from the 1st. from July to September 30, 2020. A clinical and severity characterization of hospitalized adults with COVID-19 was carried out. It was found that in the case of presenting cardiometabolic disease, the probability of presenting severity indicators is increased (p<0.05). Presenting other associated diseases (not cardiometabolic) also increased the probability of presenting severity indicators with a significance level of 5%, as well as suffering from bronchial asthma (p<0.05 for both characteristics); In the case of smoking, only the increase in the probability of hospital admission, pneumonia and death was statistically significant (p<0.05 for the three variables). The results of this study can be used to identify risk factors associated with a poor prognosis in patients with COVID-19 in Ecuador and help develop preventive measures to reduce the burden of the disease and devise strategies for case management(AU)

It is time to adapt the definition of chronic kidney disease according to age

Abstract Chronic kidney disease is a condition with high morbidity, mortality and healthcare costs which affects all population groups, having a significant impact on their quality of life. Its classification has been modified over time and there is still no universal consensus to differentiate a physiological change in kidney clearance from a pathological change. Below, we will discuss the importance of reconsidering the definition and classification in the general population according to age, including children and adults. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2080).

Diversidad de Perifiton como indicador de calidad de agua en Caño Barandas: Reserva Natural El Diamante de las Aguas, Guaviare-Colombia / Diversity of Periphyton as an indicator of water quality in Caño Barandas: El Diamante de las Aguas Nature Reserve, Guaviare-Colombia

Introducción. El perifiton se entiende como una comunidad compleja de microorganismos entre los cuales se encuentran principalmente organismos fotosintéticos y zooplancton adheridos a sustratos, su estudio permite conocer el funcionamiento de los ecosistemas acuáticos, así como el estado y ecología de las comunidades presentes. Objetivo. Evaluar la calidad de agua a partir de la diversidad de perifiton del caño Barandas en la Reserva Natural El Diamante de Las Aguas, en el departamento de Guaviare. Metodología. se midieron las variables fisicoquímicas pH, oxígeno disuelto y temperatura en 5 estaciones a lo largo de 200 metros del cuerpo de agua, se tomaron muestras de perifiton sobrepuesto en superficies de roca, tronco y hojarasca, por medio de un raspado en el interior de un marco de 2x2 cm con 3 repeticiones; para la identificación de los organismos se observaron 25 alícuotas durante 5 minutos por alicuota; para evaluar la calidad de agua, se realizaron índices de diversidad de Shannon-Wiener, Simpson, Menhinick, análisis de correspondencia canónica y el índice biológico de contaminación (IBC). Resultados. Se obtuvieron 465 registros, distribuidos en 82 géneros, los más representativos fueron Campylodiscus (5.81%), Tribonema (8.60%), Ophyoctium (10.75%) y Microspora (11.40%). El BCI arrojó como resultado 11,7 lo cual indica que es una zona de agua limpia. Conclusión. Las variables evaluadas presentaron una relación directa con las comunidades de perifiton encontradas en las estaciones. Los índices de diversidad mostraron que en este caño hay una alta diversidad en las comunidades de perifiton, lo cual indica una buena calidad de agua.

Introduction. The periphyton is understood as a complex community of microorganisms among which are mainly photosynthetic organisms and zooplankton adhered to substrates, its study allows to know the functioning of aquatic ecosystems, as well as the state and ecology of the communities present. Objetive. To evaluate the water quality from the diversity of periphyton of Caño Barandas in the El Diamante de Las Aguas, Natural Reserve in the department of Guaviare. Methodology. The physicochemical variables pH, dissolved oxygen and temperature were measured in 5 stations along 200 meters in the water-body, followed by samples of the periphyton superimposed on rock surfaces, trunk and litter, by means of a scraping inside a 2x2 cm frame, with 3 repetitions, subsequently, for the identification of the organisms, 25 aliquots were observed for 5 minutes per aliquot. to evaluate the water quality. Shannon-Wiener, Simpson, Menhinick diversity indices, canonical correspondence analysis and the biological contamination index, Results. A total of 465 records were obtained, distributed in 82 genera, the most representative were Campylodiscus (5.81%), Tribonema (8.60%), Ophyoctium (10.75%) and Microspora (11.40%). The latter gave 11.7 as a result, which indicates that it is a clean water area. Conclusion. The evaluated variables presented a direct relationship with the periphyton communities found in the stations. The diversity indices showed that in this area there is a high diversity in the periphyton communities, which indicates a good water quality.

Ascaris lumbricoides, causa de la colecistitis aguda en el servicio de emergencia del Hospital "Alfredo Noboa Montenegro", 2018 / Ascaris lumbricoides, cause of acute cholecystitis in the emergency service of the "Alfredo Noboa Montenegro" Hospital, 2018

Ascaris lumbricoides provoca una de las helmintiasis más frecuentes en los países tropicales, pudiendo producir efectos patológicos en cualquier parte del organismo, siendo los conductos biliales uno de los sitios recurrentes provocando una colecistitis aguda. La CA es una de las principales causas de ingreso al servicio de Emergencia, es una inflamación de la vesícula cuyo diagnóstico oportuno es de vital importancia para la prevención de complicaciones. Por tal razón, determinar la frecuencia de las variables clínicas, de laboratorio y ecográficas, su relación con las comorbilidades asociadas a las características demográficas de los pacientes y el nivel de severidad de la colecistitis aguda causada por la A. lumbricoides de las Guías de Tokio 2018 del Servicio de Emergencia del Hospital Alfredo Noboa Montenegro durante el periodo junio - diciembre 2018, para la elaboración de un esquema diagnóstico. La metodología de investigación fue cuantitativa descriptiva de corte transversal. Dentro de los principales hallazgos, el CA aparece con prevalencia en el género femenino en un 69,41%, promedio de edad de 32 a 45 años, el 10% de 170 pacientes presentaron en su ecografía una forma parasitaria compatible con A. Lumbricoides, los resultados clínicos arrojaron presencia de dolor (67,34%), fiebre (68,65%), náuseas (45,93%); en los laboratorio la Proteína C Reactiva estuvo aumenta en el 94,18% de los casos, en imagenología se refleja presencia de líquido pericolecistico en un 78,82% y un engrosamiento de pared vesicular en un 34,12%. El nivel de severidad registrado según los criterios de las guías de Tokio 2018 fue grado I 35,3%, grado II 47,1% y grado III 17,6%. Se recomienda la estructuración de un esquema diagnóstico oportuno de colecistitis aguda causada por A. Lumbricoides(AU)

Ascaris lumbricoides causes one of the most frequent helminthiases in tropical countries, being able to produce pathological effects in any part of the body, being the bile ducts one of the recurrent sites causing acute cholecystitis. AC is one of the main causes of admission to the Emergency service, it is an inflammation of the gallbladder whose timely diagnosis is of vital importance for the prevention of complications. signs and symptoms, the timely diagnosis is of vital importance for the prevention of complications. For this reason, determine the frequency of clinical, laboratory and ultrasound variables, their relationship with the comorbidities associated with the demographic characteristics of the patients and the level of severity of acute cholecystitis cause of A. lumbricoides of the Tokyo Guidelines 2018 of the Hospital Emergency Service Alfredo Noboa Montenegro during the period June - December 2018, for the elaboration of a diagnostic scheme. The research methodology was quantitative cross-sectional descriptive. Among the main findings that were prevailed in the female gender in 69,41%, average age from 32 to 45 years, 10% of 170 patients presented in their ultrasound a parasitic form compatible with A. lumbricoides, clinical results that prevailed was presence of pain (67.34%), fever (68.65%), nausea (45.93%); in the laboratory findings the C Reactive Protein was increased in 94,18% of cases, in imaging the presence of pericolecist fluid is reflected in 78,82% and a thickening of the vesicular wall in 34,12%. The severity level recorded according to the criteria of the Tokyo 2018 guidelines was grade I 43,53%, grade II 48,24% and grade III 8,24%. The structuring of a timely diagnostic scheme for acute cholecystitis cause of A. lumbricoides is recommended(AU)

Sublingual and oral zolpidem for insomnia disorder: a 3-month randomized trial

Objective: To evaluate the safety and efficacy of a 5 mg sublingual dose of zolpidem, compared to a 10 mg oral dose, at bedtime and "as needed" following middle-of-the-night awakenings. Methods: Participants were randomized into an oral group (oral zolpidem 10 mg and sublingual placebo at bedtime and "as-needed") and a sublingual group (oral placebo and sublingual zolpidem 5 mg at bedtime and "as-needed"). Participants underwent medical evaluation, polysomnography, the psychomotor vigilance test, and completed questionnaires. Results: Of 85 patients, 67 met the criteria for insomnia (48±10 years; 79% women) and were randomized. Of these, 46 completed 92±5 days of treatment. Mild-to-moderate adverse events were reported by 25% of the participants, including headache, sleepiness, and dizziness. Both treatments decreased middle-of-the-night awakenings by an average of -3.1±2.3 days/week and increased total sleep time by 1.5 hours. Changes in sleep quality and insomnia severity scores were also favorable and comparable between groups: variation depended on continuation of treatment. Regarding PSG findings, sleep latency decreased more in the sublingual group than the oral group (-14±42 vs. 10±29 min; p = 0.03). The psychomotor vigilance test showed minor residual effects 30 minutes after awakening, which reversed after 2 hours. Conclusions: The safety and efficacy of both zolpidem formulations are comparable. The sublingual 5 mg dose induced sleep more rapidly. Clinical trial registration: NCT01896336

Síndrome de burnout y la satisfacción laboral en profesionales de la salud / Burnout syndrome and job satisfaction in health professionals

Objetivo: Determinar las relaciones funcionales entre el burnout y la satisfacción laboral de los profesionales de la salud de dos hospitales del Perú. Materiales y métodos: Estudio cuantitativo, observacional, correlacional de corte transversal. De una población de 620 profesionales de la salud se encuestaron a 177 profesionales (médicos, odontólogos, químicos farmacéuticos, psicólogos, enfermeros, obstetras, tecnólogos médicos, nutricionistas y trabajadores sociales). Los instrumentos de medición utilizados fueron el inventario de burnout de Maslach (MBI) y la escala de satisfacción laboral (SL-SPC), cuyas propiedades psicométricas fueron adecuadas. Resultados: La tasa de prevalencia (TP) para el burnout alto fue 33,3 %. Mediante el análisis de ecuaciones estructurales, se encontró que existe relación significativa (AGFI = 0,946) y negativa (coeficiente estructural = -0,62) entre el burnout y la satisfacción laboral en los profesionales de la salud. La dimensión predominante del burnout fue la despersonalización (37 %=0,72/ (0,56+0,72+0,65); y el factor predominante de la satisfacción laboral fueron los beneficios económicos (35 %=0,99/ (0,67+0,99+0,48+0,66). Conclusiones: Existe relación funcional significativa y negativa entre el síndrome de burnout y la satisfacción laboral; el burnout es predictor de la satisfacción laboral. No se han encontrado diferencias significativas al comparar la tasa de prevalencia del burnout alto, según las variables sociodemográficas y laborales.

Objective: To estimate the functional relationships between burnout and job satisfaction in health professionals of two hospitals in Peru.Materials and methods: A quantitative, observational, correlational and cross-sectional research was carried out. Out of a study population of 620 health professionals, 177 (physicians, odontologists, pharmacists, psychologists, nurses, obstetricians, medical technologists, nutritionists and social workers) were interviewed. The Maslach Burnout Inventory (MBI) and the Job Satisfaction Scale (SL-SPC) were used as measuring instruments, showing adequate psychometric properties.Results: The high-burnout prevalence rate (TP) was 33.3 %. Using a structural equation analysis, a significant (AGFI = 0.946) and negative (structural coefficient = -0.62) relationship was found between burnout and job satisfaction in health professionals. The predominant dimension of burnout was depersonalization (37 % = 0.72 / (0.56 + 0.72 + 0.65)) and the predominant factor of job satisfaction was profits (35 % = 0.99 / (0.67 + 0.99 + 0.48 + 0.66)). Conclusions: There is a significant and negative functional relationship between burnout syndrome and job satisfaction. Burnout is a predictor of job satisfaction. No significant differences were found when comparing the high-burnout prevalence rate regarding the sociodemographic and work-related variables.

Percepción estudiantil sobre formación bioética en pregrado, en tres escuelas de la Facultad de Medicina de la Universidad de Chile / Student perceptions of bioethics education in three University of Chile allied health departments

Objetivos: describir la percepción estudiantil en las carreras de Fonoaudiología, Obstetricia y Terapia Ocupacional respecto a la formación bioética en pregrado y su aplicabilidad al inicio de su experiencia práctica profesional. Método: estudio descriptivo transversal; se diseñó y aplicó una encuesta a 147 estudiantes, correspondiendo un 29,9% a la Escuela de Fonoaudiología, 42,2% a la Escuela de Obstetricia y 18,4% a la Escuela de Terapia Ocupacional. Las aseveraciones fueron dirigidas a indagar sobre: conocimientos, actitudes y aplicabilidad de los conocimientos en el ámbito clínico asistencial. Se realizó análisis estadístico simple de frecuencia. Resultados: 99,3% de los estudiantes encuestados refiere que está muy de acuerdo y de acuerdo con la relevancia de esta formación bioética, 85% reconoce estar muy de acuerdo y de acuerdo en utilizar regularmente sus conocimientos de bioética en la práctica clínica. Conclusiones: los estudiantes de las tres carreras, perciben muy relevante la formación en bioética durante el pregrado y de alta aplicabilidad en el contexto clínico. En el actual proceso de innovación curricular se sugiere que la enseñanza bioética de futuros profesionales de la salud, tenga un enfoque más práctico orientado a lo clínico.

Objectives: we intend to describe how undergraduates majoring in Speech & Language Therapy, Obstetrics and Occupational Therapy, appreciate their Bioethics courses. Methodology: descriptive, cross-sectional, study; a survey was designed and applied to 147 students from Schools of: 29,9% Speech & Language Therapy, 42,2% from Obstetrics, and 18,4% from Occupational Therapy. Items inspected topics such as students' attitudes and perception of their learning process outcomes after completing Bioethics courses, as well as Bioethics' relevance for professional practice. Results: data were analyzed descriptively. 99,3% of surveyed students strongly agree or agree in considering Bioethics as useful. 85% of surveyed students reported regularly using Bioethics guidelines in their clinical practice. Conclusions: Students from the three surveyed majors perceive Bioethics courses as useful and highly relevant within clinical contexts. Curricular-design processes should consider a more practical approach when implementing Bioethics courses for to-be health professionals.

Comparación de aspectos de seguridad radiológica en odontopediatras con profesionales de distintas especialidades odontológicas de Lima ­ Perú

Objetivo: En los últimos años se viene realizando una labor de control y certificación de calidad en los temas relacionados a la radiación ionizante para obtener diversos objetivos; entre ellos, optimizar tratamientos, promover la salud ocupacional, etc. La presente investigación analiza el cumplimiento -por parte de profesionales en odontología- del uso de un protocolo de seguridad radiológica, creado a partir de leyes peruanas y recomendaciones internacionales. Metodología: Se elaboró una escala denominada "Protocolo de Seguridad Radiológica", integrada por 15 afirmaciones, cada uno con tres posibles respuestas y un puntaje, cuya suma representa el índice de cumplimiento de las normas de protección radiológica. Las afirmaciones y el protocolo en su conjunto pasaron por un análisis estadístico, con la finalidad de establecer la validez de confiabilidad de los mismos. La población de estudio abarcó profesionales de odontología de las especialidades de Endodoncia, Periodoncia, Odontopediatría; Rehabilitación Oral, Estética y Ortodoncia, de la Universidad Científica del Sur de Lima-Perú. De ella se seleccionó una muestra no probabilística de tipo intencional, integrada por 108 personas (34 hombres y 74 mujeres). Resultados: Se halló que los endodoncistas (puntaje promedio en la escala: 15.89, que representa el 52.97% del puntaje total de la misma) y odontopediatras (promedio 16.68, que representa el 55.6% del puntaje total) son los profesionales de las especialidades que menos se rigen en el "Protocolo de Seguridad Radiológica". Conclusiones: Se determinó que las prácticas o comportamientos de los diversos especialistas odontólogos, relacionados al cumplimiento del uso del "Protocolo de Seguridad Radiológica", no garantizan calidad en relación al mismo.

Síndrome de interrupción del tallo pituitario: Relaciones clínicas, bioquímicas y neurorradiológicas / Pituitary stalk interruption syndrome: Clinical, biochemical and neuroradiological relationships

El síndrome de interrupción del tallo pituitario (PSIS) se caracteriza por la demostración neurorradiológica de un tallo pituitario ausente, interrumpido o hipoplásico, adenohipófisis aplásica/hipoplásica o neurohipófisis ectópica. Este síndrome se ha relacionado con formas severas de hipopituitarismo congénito (HPC), asociado a múltiples deficiencias de hormonas pituitarias (MPHD). Evaluamos a pacientes con HPC y PSIS, analizando los signos y los síntomas neonatales al diagnóstico, relacionándolos con las deficiencias hormonales pituitarias y signos neurorradiológicos presentes. Estudiamos retrospectivamente a 80 pacientes asistidos en el Hospital de Niños de Córdoba, con diagnóstico de HPC, de los cuales 42 (52%) presentaron PSIS; 22 mujeres y 20 varones, EC: 5 días-9,5 años. El 62% presentó MPHD y el 38% insuficiencia somatotrófica aislada (IGHD). El análisis de las variables perinatales demostró antecedentes de parto natural en el 52% (11/21) de las MPHD vs. 13% (2/15) de las IGHD. Cuatro pacientes, 2 con MPHD y 2 con IGHD presentaban antecedentes obstétricos consistentes en presentación podálica y transversa respectivamente, todos ellos resueltos mediante operación cesárea. Los signos y los síntomas perinatales fueron hipo- glucemia: 61% en MPHD vs. 19% en IGHD, p: 0,0105; ictericia: 38% en MPHD vs. 25% en IGHD; micropene: 77% en MPHD y colestasis: 19% en MPHD. Convulsiones neonatales se presentaron en el 75% de los niños con MPHD e hipoglucemia. EC media de consulta: 2,1 años en MPHD (30% en el período neonatal, 70% antes de 2 años) y 3,6 años en IGHD (44% en menores de 2 años). Los pacientes con MPHD presentaban: tallo no visible 81% (n: 21/26) vs. tallo hipoplásico: 19% (n: 5/26), p: 0,0001; en IGHD 56% (n: 9/16) vs. 44% (n: 7/16), p: 0,5067, respectivamente. El 100% de los neonatos con HPC tenían tallo pituitario ausente. Concluimos que la demostración de PSIS en niños con HPC proporciona información valiosa como predictor de la severidad fenotípica, la presencia de MPHD y de la respuesta al tratamiento. La baja frecuencia de antecedentes obstétricos posicionales potencialmente distócicos, como parte de los mecanismos fisiopatogénicos responsables de PSIS, indicaría la necesidad de analizar la importancia de posibles factores genéticos y epigenéticos involucrados. El diagnóstico precoz de HPC debe sospecharse en presencia de signos y síntomas clínicos, tales como hipoglucemia, colestasis, micropene y defectos asociados en la línea media facial. La resonancia magnética cerebral debe formar parte de los estudios complementarios en pacientes con esta presunción diagnóstica, especialmente a edades tempranas. El reconocimiento tardío de esta entidad puede aumentar la morbilidad y la mortalidad con efectos potenciales deletéreos y permanentes.

Pituitary stalk interruption syndrome (PSIS) is characterised by the combination of an interrupted or thin pituitary stalk, absent or ectopic posterior pituitary, and anterior pituitary hypoplasia. It is manifested as isolated (IGHD) or combined pituitary hormone deficiencies (CPHD) of variable degrees and timing of onset, with a wide spectrum of clinical phenotypes. PSIS may be an isolated morphological abnormality or be part of a syndrome. A retrospective evaluation is presented of clinical signs and symptoms present at early life stages, as well as an analysis of their relationship with hormone laboratory tests and diagnostic imaging in children with congenital hypopituitarism (CHP), and PSIS. This study was performed in a single centre on a sample of 42 children out of a total of 80 CHP patients, with a chronological age range between 5 days and 9.5 years from a database analysed over a period of 26 years. The study included 26/42 (62%) with CPHD and 16/42 (38%) with IGHD. The analysis of perinatal variables showed a natural delivery in 52% (11/21) of CPHD vs 13% (2/15) of IGHD. Four patients, two with CPHD and two IGHD had breech and transverse presentation respectively. All of them were resolved by caesarean section. The perinatal histories showed hypoglycaemia (61% CPHD vs 19% IGHD, P=.0105), jaundice (38% CPHDvs25% IGHD), micropenis (75%CPHD), hypoglycaemic seizures (75% CPHD), and cholestasis (19% CPHD). The mean CA of consulting for CPHD patients was 2.1 years, 30% in neonatal period and 70% before 2 years. The mean chronical age (CA) was 3.6 years in IGHD patients, with 44% of them less than 2 years. MRI showed that 81% of CPHD patients had absence of pituitary stalk vs 19% with thin pituitary stalk (P=.0001); Patients with IGHD presented 56% absence of pituitary stalk vs 44% with thin pituitary stalk (P=.5067). All (100%) of the patients diagnosed in the neonatal stage had absent pituitary stalk. The characterisation of GH deficient patients by presence and type of hypothalamic-pituitary imaging abnormality provides valuable information as a predictor of phenotypic severity, treatment response, and the potential to develop additional hormonal deficiencies. We conclude that demonstrating PSIS in children with HPC provides valuable information as a predictor of phenotypic severity, presence of MPHD, and response to treatment. The low frequency of potentially dysfunctional positional obstetric history, as part of the pathophysiological mechanisms responsible for PSIS, would indicate the need to analyse the importance of possible genetic and epigenetic factors involved. Early diagnosis of HPC should be suspected in the presence of clinical signs and symptoms, such as hypoglycaemia, cholestasis, micropenis, and associated facial midline defects. MRI should be part of complementary studies in patients with this diagnostic suspicion, especially at an early age. Late recognition of this entity may increase morbidity and mortality with potential permanent deleterious effects.

Caries dental y microbiota. Revisión / Dental caries and microbiot. Review

Cuando ocurre un desequilibrio en el balance de minerales en contacto con la superficie del esmalte dental y el balance es negativo hacia una pérdida de minerales se produce una degradación de la superficie y subsuperficie, este desequilibrio afecta al diente en su forma, función, sensibilidad y estética, esta alteración va a cambiar el status del microbioma. Investigaciones recientes sobre ADN y ARN relacionados a la lesión de caries han demostrado un ecosistema extraordinariamente diverso donde el conteo del Streptococo Mutans es sólo una muy pequeña fracción de la comunidad bacteriana hallada. Por lo tanto la dirección de prevención y/ó terapias específicas de caries dental no sólo deben estar enfocadas en el Streptococo Mutans porque se sabe que no están presentes en la primera colonización o inicio de la caries dental y se deben buscar estrategias dirigidas a la modulación de las interacciones entre microorganismos para poder tener una adecuada estrategia de prevención tomando como pilar principal a los microorganismos que inician la enfermedad. (AU)

When an imbalance occurs in the balance of minerals in contact with the surface of the dental enamel and the balance is negative towards a loss of minerals, a degradation of the surface and subsurface occurs, this imbalance affects the tooth in its shape, function, sensitivity and aesthetics, this alteration will change the status of the microbiome. Recent research on DNA and RNA related to caries lesion has demonstrated an extraordinarily diverse ecosystem where the Streptococcus Mutans count is only a very small fraction of the bacterial community found. Therefore, the prevention direction and / or specific therapies of dental caries should not only be focused on the Streptococcus Mutansbecause it is known that they are not present in the first colonization or onset of dental caries and strategies aimed at modulation should be sought of the interactions between microorganisms to be able to have an adequate prevention strategy taking as main pillar the microorganisms that initiate the disease. (AU)

Paródias no ensino de microbiologia: a música como ferramenta pedagógica / Parodies in the teaching of microbiology: music as a pedagogical tool / Parodias en la enseñanza de la microbiología: la música como herramienta pegagógica

Atividades lúdicas, como as paródias, são estratégias didáticas motivadoras para a aprendizagem e configuram-se como forma criativa e crítica de trabalhar o aprendizado. O presente artigo objetiva descrever o processo de construção e divulgação de paródias como instrumento facilitador para transmissão e assimilação de conteúdos microbianos, no âmbito do projeto de extensão ‘Musicalizando a Biologia’, vinculado ao Curso de Ciências Biológicas a distância da Universidade Estadual do Ceará/Universidade Aberta do Brasil. Trata-se de relato de experiência da produção de três paródias na qual foi possível estabelecer os critérios e os conteúdos, bem como a escolha de músicas populares que viriam a facilitar a fixação da melodia e da letra contendo as ideias que se queria transmitir. Os resultados indicam que a utilização dessa ferramenta pode oferecer contribuições significativas para o ensino e favorecer a aprendizagem dos conteúdos em microbiologia.

Fun activities, such as parodies, are among the creative teaching strategies that can motivate learning and critical analysis. This article describes the process of constructing and diffusion of parodies as aninstrument for transmission and assimilation of the technical concepts involving microbiology, in the project called ‘Musicalizando a Biologia’ (musicalization of biology), associated with the distance education undergraduate course in biology offered by University of Ceará/Open University of Brazil. It is a experience report of the production of three parodies, through which it was possible to establish the criteria, as well as the choice of popular melodies to facilitate memorization of the content and ideas. The results indicate that the use of this tool can make significant contributions to teaching and favoring the learning of concepts of microbiology.

Actividades lúdicas, como parodias, son estrategias de enseñanza motivadoras y se configuran como forma creativa y crítica para trabajar el aprendizaje. Este artículo describe el proceso de construcción y divulgación de parodias como facilitador para la transmisión y asimilación de contenido microbiano dentro del proyecto denominado ‘Musicalizando a Biologia’, vinculado a el curso de ciencias biológicas a distancia de la Universidad del Estado de Ceará/Universidad Abierta de Brasil. Se trata de un relato de experiencia de la producción de tres parodias, por la cual fue posible establecer los criterios y contenidos, así como la elección de canciones populares que facilitasen la memorización de la melodía y de la letra con las ideas que se quería transmitir. Los resultados indican que el uso de esta herramienta puede ofrecer contribuciones significativas a la enseñanza y favorecer el aprendizaje de contenidos en microbiología.

Saúde no trabalho de fumicultores do RS: não adoece somente quem fuma, mas também quem planta / Tobacco farmers' health and work in RS: both farmers and smokers grow sick / Salud en el trabajo de los productores de tabaco en RS: no sólo enferma quien fuma, sino también quien planta

Este artigo investigou as vivências de sofrimento e como os fumicultores lidam com adversidades no trabalho. Participaram do estudo 15 fumicultores de Dom Feliciano-RS. O instrumento empregado foi a técnica dos grupos focais. No exame dos dados, realizou-se a análise de conteúdo, definindo categorias a priori com base na abordagem teórica da psicodinâmica do trabalho dejouriana. O não reconhecimento, remuneração baixa e instável, condições laborais danosas e sobrecarga de trabalho foram destacados como elementos desencadeadores do sofrimento. Muitos trabalhadores, mesmo cientes da sua exploração, responsabilizam-se individualmente pela maioria dos seus atos: culpam-se por destinarem poucas horas ao descanso e lazer e por seu endividamento. Nesse cenário de precarização desencadeado pela organização do trabalho, os trabalhadores vivenciam desavenças familiares, drogadição, trabalho infantil e suicídio. Evidenciou-se que fumicultores precisam ter "voz" para que seja lançada sua crítica à sociedade e que se apropriem dessa construção reflexiva, a fim de ressignificar seu trabalho

This paper has investigated how tobacco farmers deal with the adversities experienced in work. Fifteen tobacco farmers from Dom Feliciano-RS participated in focus groups. For the results, content analysis was used, defining a priori categories based on the theoretical approach of Dejour's Work Psychodynamics. Four main causes of suffering have been pointed out: no acknowledgement, low and unstable income, dangerous work conditions and excessive workload. Despite being aware of the work conditions, many tobacco farmers consider themselves guilty for indedtedness and not dedicating enough time for rest. In this precarious environment instigated the way the work is established, workers experience: family disputes, drug addiction, child labor and suicide. It has become clear that tobacco farmers need a 'voice' so that their opinions can be heard, as well as owning this reflexive construction in order to re-determine their work

En este artículo se investigó las experiencias de sufrimiento y cómo los productores de tabaco hacen frente a las adversidades en el trabajo. Los participantes fueron 15 productores de Dom Feliciano-RS. El instrumento utilizado fue la técnica de grupos focales. En el análisis de los datos se llevó a cabo el análisis de contenido, definiendo categorías a priori con base en el enfoque teórico de la psicodinámica del trabajo dejouriana. El no reconocimiento, remuneración baja e inestable, condiciones de trabajo perjudiciales y sobrecarga de trabajo se destacaron como factores desencadenadores del sufrimiento. Muchos trabajadores, aun conscientes de que son explotados, se responsabilizan individualmente por la mayoría de sus actos: ellos se culpabilizan por dedicar pocas horas al descanso y al ocio, y por su endeudamiento. En este escenario de precarización desencadenado por la organización del trabajo, los trabajadores vivencian desavenencias familiares, drogadicción, trabajo infantil y suicidio. Se evidenció que los productores de tabaco deben tener "voz" para que su crítica sea lanzada a la sociedad y para que ellos se apropien de esta construcción reflexiva con el fin de resignificar su trabajo

Análisis bibliométrico: la terapia de espejo como estrategia de intervención desde la terapia ocupacional en el ámbito clínico / Bibliometric Analysis: Mirror Therapy as an Occupational Therapy Intervention Strategy in the Clinical Setting / Análise bibliométrica: a terapia de espelho como estratégia de intervenção desde terapia ocupacional no âmbito clínic

Objetivo: Determinar la evidencia científica, a nivel nacional e internacional, sobre el uso de la terapia de espejo como herramienta de intervención, desde terapia ocupacional, en el área clínica; esto con el propósito de ofrecer soporte teórico para la implementación de esta estrategia en la práctica profesional. Materiales y métodos. Se realizó un estudio descriptivo donde se utilizó como estrategia de búsqueda descriptores de ciencias de la salud (DECS), tales como 'neuronas en espejo', 'terapia ocupacional', 'rehabilitación física' e 'imaginería motora'. Mediante el uso del boleano and se realizaron combinaciones en cinco bases de datos: Embase, Ebsco, OTseeker Science Direct y Medline. Los análisis fueron realizados mediante el establecimiento de frecuencias para variables como revista, país, tipo de estudio y años de publicación. Conclusiones: Dentro del análisis de la evidencia se encontró que la terapia de espejo es una modalidad de intervención, recientemente utilizada por diferentes profesiones de rehabilitación. A partir de 2004 se observa un incremento en la generación de evidencia científica de alto impacto sobre el tema, debido a la efectivde salud secundarias a la enfermedad cerebrovascular (ECV), la amputación de miembros, los síndromes dolorosos crónicos y la rehabilitación posquirúrgica. Durante el periodo analizado, se evidenció un incremento en la producción académica de alto nivel de evidencia. El 35,7 % de las publicaciones analizadas corresponden a ensayos clínicos controlados aleatorizados (ECCA) y el 42,9 % corresponden a revisiones sistemáticas. El uso de la terapia de espejo en terapia ocupacional es una modalidad de intervención que facilita procesos de rehabilitación funcional, promueve la independencia en la ejecución de actividades de la vida diaria y facilita procesos de participación social y adaptación al entorno.

Objective: To determine the national and international scientific evidence regarding the use of mirror therapy, as an occupational therapy intervention tool in the clinical setting, in order to acquire knowledge and implement this strategy in professional practice. Materials and methods: A descriptive study was conducted in which the research strategy was held through medical subject headings (MeSH), such as "mirror neuron", "occupational therapy", "physical rehabilitation" and "motor imagery". Through the use of the bolean and combinations in five different databases were performed: Embase, Ebsco, OTseeker, Science Direct and Medline. The analysis was elaborated by establishing frequencies of different variables such as journal, country, study type and publishing year. Conclusions: In the evidence analysis it was found that mirror therapy is an intervention modality recently used by different rehabilitation professionals. Since 2004, an increase in the generation of high impact scientific evidence about this subject has been recognized, due in part to the reported effectiveness in clinical practices, mainly the treatment of health conditions secondary to stroke, limb amputations, chronic pain syndromes, and post-surgical rehabilitation. During the reviewed period, an increase in high level academic evidence was observed: 35.7 % of the analyzed publications correspond to randomized controlled trials and 42.9 % are systematic reviews. The use of mirror therapy in occupational therapy is an intervention modality that facilitates functional rehabilitation processes, promotes independence in performing activities of daily living (ADL) and allows social participation and environment adaptation processes to happen.

Objetivo: Determinar a evidência científica no nível nacional e internacional sobre o uso da terapia de espelho, como ferramenta de intervenção desde terapia ocupacional na área clínica, com o propósito de oferecer suporte teórico para a implementação desta estratégia na prática profissional. Materiais e métodos: realizou-se um estudo descritivo onde se utilizou como estratégia de busca descritores de ciências da saúde (DeCS) tais como "neurônios em espelho", "terapia ocupacional", "reabilitação física" e "imagética motora". Mediante o uso do booleano and se realizaram combinações em cinco bases de dados: Embase, Ebsco, OT seeker Science Direct y Medline. As análises foram realizadas mediante o estabelecimento de frequências para variáveis como revista, país, tipo de estudo e anos de publicação. Conclusões: dentro da análise da evidência encontrou-se que a terapia de espelho é uma modalidade de intervenção recentemente utilizada por diferentes profissões de reabilitação. A partir do ano 2004 se observa um incremento a geração de evidência científica de alto impacto sobre o tema, devido à efetividade reportada na prática clínica, principalmente no tratamento de condições de saúde secundárias à doença cerebrovascular (ECV), amputação de membros, síndromes dolorosas crónicas, e reabilitação pós-cirúrgica. Durante o período analisado, evidenciou-se um incremento na produção académica de alto nível de evidência. O 35,7% das publicações analisadas correspondem a ensaios clínicos controlados aleatorizados (ECCA) e 42,9% correspondem a revisões sistemáticas. O uso da terapia de espelho em terapia ocupacional, é uma modalidade de intervenção que facilita processos de reabilitação funcional, promove a independência na execução de atividades da vida diária e facilita processos de participação social e adaptação ao entorno.