Vulnerabilidad y cuidado desde la perspectiva de enfermería: Una revisión integrada de la literatura

La vulnerabilidad es un concepto ampliamente utilizado en la literatura de las ciencias sociales, e incorporado al ámbito sanitario con el desarrollo de la bioética y el modelo de determinantes sociales de la salud. Ha sido descrito por expertos como un concepto complejo y de gran utilidad para abordar poblaciones susceptibles de enfermar. Esto obliga a enfermería a identificar estos grupos y responder a sus necesidades de cuidado. Objetivo. Revisar la literatura para analizar las intersecciones en la relación conceptual entre vulnerabilidad y cuidado, desde una perspectiva de enfermería. Metodología. Se realizó una revisión integradora de la literatura basada en la sistematización propuesta por Whittemore y Knafl. Se consideró la literatura de los últimos cinco años disponible en las bases de datos Wos®, Scopus® y PubMed®. En la estrategia de búsqueda se utilizaron las palabras claves "vulnerability" and "care". Resultados. Se seleccionaron 18 artículos, coincidente con países que han desarrollado modelos sanitarios con enfoque social, como Canadá y Brasil. En el análisis se identificaron y describieron cinco temas en que se interceptan vulnerabilidad y cuidado; paradigma ontológico, epidemiológico, social y bioético, y la asociación entre vulnerabilidad y necesidades de cuidado. Conclusiones. La literatura da cuenta de la estrecha relación entre vulnerabilidad y cuidado, dado que la naturaleza de los cuidados profesionales de enfermería es la respuesta organizada socialmente a la vulnerabilidad humana.

Vulnerability is a concept widely used in the social sciences literature, and incorporated into the health field with the development of bioethics, and the model of social determinants of health. It has been described by experts as a complex concept, and very useful for addressing populations susceptible to illness. This ethically obliges nursing to identify these groups and respond to their care needs. Goal. To review the literature to analyze the intersections in the conceptual relationship between vulnerability and care, from a nursing perspective. Methodology. An integrative review of the literature was carried out based on the systematization proposed by Whittemore and Knafl. Literature from the last five years available in the Wos®, Scopus® and PubMed® databases was considered. The keywords "vulnerability" and "care" were used in the search strategy. Results. 18 articles were selected, coinciding with countries with health models with a social focus, such as Canada and Brazil. In the analysis, five themes were identified and described in which vulnerability and care intersect; ontological, epidemiological, social and bioethical paradigm, and the association between vulnerability and care needs. conclusions. The literature reports the close relationship between vulnerability and care, given that the nature of professional nursing care is the socially organized response to human vulnerability.

A vulnerabilidade é um conceito amplamente utilizado na literatura das ciências sociais, incorporado ao âmbito sanitário com o desenvolvimento da bioética e o modelo de determinantes sociais da saúde. Foi descrito por especialistas como um conceito complexo e de grande utilidade para abordar populações suscetíveis a adoecer. Isto obriga eticamente a enfermagem a identificar estes grupos e responder a suas necessidades de cuidado. Objetivo. Revisar a literatura para analizar as intersecções na relação conceitual entre vulnerabilidade e cuidado, a partir de uma perspectiva da enfermagem. Metodologia. Realizou-se uma revisão integradora da literatura baseada na sistematização proposta por Whittemore e Knafl. Considerou-se a literatura dos últimos cinco anos disponíveis nas bases de dados Wos®, Scopus® e PubMed®. Na estratégia de busca utilizou-se as palavras chaves "vulnerability" and "care". Resultados. Foram selecionados 18 artigos, coincidentes com países que desenvolveram modelos sanitários com enfoque social, como o Canadá e o Brasil. Na análise identificaram-se e descreveram-se cinco temas em que se interceptam vulnerabilidade e cuidado: paradigma ontológico, epidemiológico, social e bioético, e a associação entre vulnerabilidade e necessidades de cuidado. Conclusões. A literatura dá conta da estreita relação entre vulnerabilidade e cuidado, dado que a natureza dos cuidados profissionais de enfermagem é a resposta organizada socialmente à vulnerabilidade humana.

Rendimiento de los índices predictores de gravedad en pacientes adultos hospitalizados por neumonía adquirida en la comunidad por coronavirus SARS-CoV-2 / Performance of severity indexes for the prediction of adverse events among patients hospitalized for SARS-CoV-2

BACKGROUND: Severity assessment in adult patients with community-acquired pneumonia (CAP) allows to guide the site of care (ambulatory or hospitalization), diagnostic workup and treatment. AIM: To examine the performance of twelve severity predictive indexes (CRB65, CURB65, PSI, SCAP, SMART-COP, REA-ICU, ATS minor criteria, qSOFA, CALL, COVID GRAM, 4C, STSS) in adult patients hospitalized for CAP associated with SARS-CoV-2. MATERIAL AND METHODS: Prospective clinical study conducted between April 1 and September 30, 2020 in adult patients hospitalized for CAP associated with COVID-19 in a clinical hospital. The recorded adverse events were admission to the critical care unit, use of mechanical ventilation (MV), prolonged length of stay, and hospital mortality. The predictive rules were compared based on their sensitivity, specificity, predictive values, and area under the receiver operator characteristic (ROC) curve. RESULTS: Adverse events were more common and hospital stay longer in the high-risk categories of the different prognostic indices. CURB-65, PSI, SCAP, COVID GRAM, 4 C and STSS predicted the risk of death accurately. PSI, SCAP, ATS minor criteria, CALL and 4 C criteria were sensitive in predicting the risk of hospital mortality with high negative predictive value. The performance of different prognostic indices decreased significantly for the prediction of ICU admission, use of mechanical ventilation, and prolonged hospital length of stay. CONCLUSIONS: The performance of the prognostic indices differs significantly for the prediction of adverse events in immunocompetent adult patients hospitalized for community-acquired pneumonia associated with COVID-19.

Gestión de riesgos aplicado al diseño de un nuevo proceso productivo de un inmunoterapéutico del Centro de Ingeniería Genética y Biotecnología / Risk management applied to the design of a new production process for an immunotherapeutic from the Center for Genetic Engineering and Biotechnology

El estudio expone las acciones dirigidas a la reducción de los riesgos en el diseño de un nuevo proceso de producción del ingrediente farmacéutico activo de un inmunoterapéutico producido en el Centro de Ingeniería Genética y Biotecnología. El análisis modal de fallas y efectos fue conducido por un equipo multidisciplinario del referido centro. La administración de riesgos a la calidad se aplicó a la tecnología de obtención de una proteína recombinante con uso diagnóstico que se proponía transferir a la Dirección de Desarrollo Tecnológico. El riesgo en el diseño de un nuevo proceso de producción evaluó las fallas de mayor influencia en el bajo recobrado y el incumplimiento de las especificaciones de calidad del inmunoterapéutico. Las causas potenciales de estos fallas fueron: la insuficiente cantidad de viales de los bancos de células, el medio de cultivo complejo con componentes de origen bovino, la incorrecta manipulación de las muestras por los operarios, el uso de equipamiento no adecuado, los parámetros de operación (agitación, pH y conductividad) fuera de límites de especificación con efecto sobre la pureza por el alto porcentaje de contaminantes del hospedero; así como, un medio filtrante inadecuado unido a una incorrecta preparación del sistema de filtración redundantes en un producto no estéril. Las acciones llevaron a modificaciones en la tecnología propuesta por la Dirección de Investigaciones Biomédicas que permitió el diseño de un nuevo proceso productivo para un biofarmacéutico destinado al tratamiento de enfermedades virales crónicas(AU)

The study aimed at reducing risks in the design of a new production process for the active pharmaceutical ingredient of an immunotherapeutic produced at the Center for Genetic Engineering and Biotechnology. The failure mode and effects analysis were conducted by a multidisciplinary team from the center. Quality risk management was applied to the technology for obtaining a recombinant protein for diagnostic use that was proposed to be transferred to Technological Development Division. The risk analyses evaluated the greatest influence on low recovery and non-compliance with the immunotherapeutic quality specifications. The potential causes of the failures were: the insufficient number of vials in cell banks, the complex culture medium with components of bovine origin, the samples handling errors by the operators, the use of inappropriate equipment, the parameters of operation (agitation, pH and conductivity) outside specification limits affecting purity due to the high percentage of contaminants from the host; as well as, the inadequate filtering medium together with an incorrect preparation of the redundant filtration system in a non-sterile product. The actions could modify the technology proposed by Biomedical Research Division that allowed the design of a new production process of a biopharmaceutical product for the treatment of chronic viral diseases(AU)

Actualización de resultados demográficos y terapéuticos de pacientes con Leucemia Mieloide Aguda no promielocítica en el Hospital Clínico de la Pontificia Universidad Católica de Chile / Acute myeloid leukemia. Analysis of 114 patients

BACKGROUND: Acute myeloid leukemia (AML) is the most common leukemia in adults. Aim: To Describe our population of patients with AML and report the outcomes of our treatments. MATERIAL AND METHODS: Review of electronic clinical records of 114 patients with AML with a median age of 57 years (59% men). Results: Seventeen percent of patients were classified as low risk, 38% as intermediate risk and 33% as high risk. Seventy-six percent of patients were treated with intensive chemotherapy. Five years overall survival according to cytogenetic risk was 59, 41, and 12% in low, intermediate, and high-risk patients, respectively. The outcomes were better in patients under 60 years. The median survival of patients treated with intensive chemotherapy aged less than 60 years and 60 years and above was 3.4 and 1 year, respectively. CONCLUSIONS: Our results are comparable to those reported in developed countries. Improving the survival of patients 60 years and older is our main challenge.

Evaluación de los predictores clínicos de infección respiratoria aguda por coronavirus SARS-CoV-2 en población adulta / Clinical features of COVID-19 infection among patients consulting at an emergency service

Background: COVID-19 is a serious public health problem worldwide. Aim: To describe the clinical features of COVID-19 infection in adult patients consulting at an Emergency Service. Material and Methods: Descriptive prospective study of adult patients with suspected COVID-19 consulting between April 1 and July 31, 2020, at the Emergency Service of a clinical hospital. Clinical features, chronic comorbidities and demographic data were recorded. Results: We assessed 2,958 adult patients aged 42 ± 15 years (46% males). In 54% of them, COVID-19 infection was confirmed, 40% had preexisting diseases, especially hypertension (15%), hypothyroidism (6%), diabetes (6%), asthma (5%) and obesity (6%). The main clinical manifestations associated with COVID-19 were general malaise (79%), anorexia (38%), myalgia (64%), fever (52%), headache (70%), anosmia/dysgeusia (60%), cough (56%), dyspnea (54%) and diarrhea (36%). In the multivariate analysis, the main clinical predictors of COVID-19 infection were malaise, anorexia, fever, myalgia, headache, nasal congestion, cough, expectoration, anosmia/dysgeusia, and history of close contact with a SARS-CoV-2 patient. Odynophagia and chest discomfort were negative predictors of the disease. The history of fever associated with anorexia, cough, and dyspnea or anosmia/dysgeusia and close contact with a SARS-CoV-2 patient had high specificity and positive predictive value for COVID-19 infection. Conclusions: Clinical features of COVID-19 infection were highly unspecific in these patients. Clinical diagnostic prediction models could be useful to support healthcare decision making at primary care setting.

Modelos matemáticos aplicados a la Epidemiología / Mathematical models applied to Epidemiology / Modelos matemáticos aplicados à Epidemiologia

RESUMEN Un modelo matemático es una descripción matemática (a menudo por medio de una función o una ecuación) de un fenómeno del mundo real, como el tamaño de una población, la expectativa de vida de una persona al nacer o la propagación de una epidemia. Para ver la importancia de estos en las Ciencias de la Salud, específicamente en la especialidad de Higiene y Epidemiología mostramos dos de ellos para predecir el comportamiento de epidemias. El primero lo exponemos mediante una ecuación diferencial de 1er orden y el segundo mediante un sistema de ecuaciones diferenciales.

ABSTRACT A mathematical model is a mathematical description (often by means of a function or an equation) of a real-world phenomenon, such as the size of a population, the life expectancy of a person at birth, or the spread of an epidemic. To see the importance of these in Health Sciences, specifically in the specialty of Hygiene and Epidemiology, we show two of them to predict the behavior of epidemics. We expose the first through a 1st order differential equation and the second through a system of differential equations.

RESUMO Um modelo matemático é uma descrição matemática (frequentemente por meio de uma função ouequação) de um fenômeno do mundo real, como o tamanho de uma população, a expectativa de vida de uma pessoaao nascer ou a propagação de uma epidemia. Para perceber a importância destesnas Ciências da Saúde, especificamente na especialidade Higiene e Epidemiologia, mostramos dois deles para prever o comportamento de epidemias. Expomos o primeiro por meio de uma equação diferencial de 1ª ordem e o segundo por meio de um sistema de equaçõ es diferenciais.

Eficacia de la movilización de células madre en pacientes con Polineuropatía Desmielinizante Inflamatoria Crónica refractaria / Efficacy of mobilization of stem cells in patients with Refractory Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

Introducción: La polineuropatía desmielinizante inflamatoria crónica (CIDP) es una enfermedad desmielinizante e inflamatoria de mediación autoinmune. El tratamiento convencional es basado en la inmunomodulación e inmunosupresión. El uso de células madre es una terapia novedosa en los trastornos autoinmune, siendo incluida como terapia. Objetivo: Determinar la eficacia de la movilización de células madre mediante la aplicación del factor estimulador de colonias granulocíticas (F-ECG) en pacientes con CIDP que han recibido otras líneas de tratamiento. Material y Métodos: Se realizó un estudio aleatorizado, doble ciego sobre una cohorte de 45 pacientes con CIDP, donde se administró el (F-ECG) en 25 pacientes y 20 continuaron con el tratamiento habitual, tratados anteriormente con otras variantes terapéuticas por más de tres años, sin respuesta satisfactoria. Resultados: Predominio de los hombres para 64,4 por ciento, la Diabetes Mellitus tuvo mayor asociación y la medicación más usada fueron los esteroides. Los síntomas y signos clínicos mejoraron significativamente tras el tratamiento. Los valores de la puntuación del TCSS al mes y 3 meses después del tratamiento disminuyeron significativamente; pero este decremento no se mantuvo al final del estudio. La velocidad de conducción y el potencial de acción de los nervios sensoriales y motores mejoraron considerablemente después del tratamiento. Conclusiones: La efectividad de la aplicación del (F-ECG) para la mejoría de los síntomas clínicos y resultados de estudios neurofisiológicos evolutivamente son mayores que otras variantes terapéuticas en los primeros meses, con buena seguridad y tolerabilidad, por lo que se puede incluir en la terapéutica convencional para la CIDP(AU)

Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune demyelinating disease. Conventional treatment is based on immunomodulation and immunosuppression. The use of stem cells is a novel therapy in autoimmune disorders, so it is included as therapy. Objective: To determine the efficacy of mobilization of stem cells by applying granulocyte colony-stimulating factor (G-CSF) in patients with CIDP who have followed other lines of treatment. Material and Methods: A randomized, double-blind study was carried out on a cohort of 45 patients with CIDP. G-CSF was administered to 25 patients and 20 of them continued with the usual treatment. These patients were previously treated with other therapeutic variants for more than three years without satisfactory response. Results: There was a prevalence of men (64.4 percent), Diabetes Mellitus had a greater association, and the most used medications were steroids. Clinical symptoms and signs improved significantly after treatment. TCSS scores significantly decreased at one and three months after treatment, but this decrease was not maintained at the end of the study. The conduction velocity and action potential of sensory and motor nerves improved considerably after treatment. Conclusions: The effectiveness of the use of G-CSF shows an improvement of clinical symptoms. The results of neurophysiological studies have a better course than other therapeutic variants during the first months, with good safety and tolerability, so it can be included in the conventional therapy for the CIDP(AU)

Gestión de riesgos relativo al cambio de campaña productiva durante la etapa de desarrollo tecnológico en una instalación multiproducto / Risk-management related to the productive campaign change during technological development stage in a multi-product facility

Los nuevos paradigmas de la industria farmacéutica en el siglo XXI incorporan el uso de las técnicas de gestión de la calidad, necesarias en el cumplimiento de las buenas prácticas de fabricación en el sector biotecnológico. En este caso de estudio, se aplicó la gestión de riesgo en el cambio de campaña entre los ingredientes farmacéuticos activos de futuros candidatos inmunoterapeúticos contra el cáncer, en la etapa de desarrollo tecnológico en una instalación multiproducto certificada. Las causas potenciales de mayor influencia en las fallas son: la calificación del personal de la Dirección de Desarrollo Tecnológico en los procedimientos patrones de operación de la planta, la mezcla entre los componentes y materiales no dedicados utilizados en el proceso de purificación cromatográfica, la documentación en elaboración o aprobación y el establecimiento de las técnicas analíticas en función de la etapa del proyecto. Como resultado se proponen acciones que minimizan los riesgos de la contaminación cruzada y hacen viable un adecuado cambio de campaña entre la fabricación de los inmunoterapéuticos, durante el desarrollo tecnológico en una instalación multiproducto de la industria biotecnológica(AU)

The new paradigms of the pharmaceutical industry in the 21st century introduce the use of modern quality management techniques to comply with good manufacturing practices in the biotechnological area. In this paper, it was applied the risk management for the campaign change among the process for obtaining the active pharmaceutical ingredients to future immunotherapeutic candidates at the technological development stage in a certified multi-product facility. Particularly, the training for the development personnel in the standard operating procedures of the facility, the mixture between the components and non-dedicated materials used in the chromatographic purification process, the documentation in the preparation or approval, and the establishment of analytical techniques depending on the stage of the project are the potential causes of greater influence. As a result, actions are proposed to minimize risks and carry out an adequate campaign change feasible between the manufacture of immunotherapeutics during the technological development stage in a biotechnological multi-product facility(AU)

Válvula aórtica bicúspide: ¿qué debo conocer? Revisión actualizada de sus aspectos clínicos y fisiopatológicos / Bicuspid aortic valve: what should I know? Updated review of its clinical and pathophysiological aspects

Resumen La válvula aórtica bicúspide es la cardiopatía congénita más frecuente en la población general. Lejos de ser solo una malformación valvular inocua, supone una enfermedad compleja y heterogénea. A menudo es identificada como un hallazgo incidental en personas sanas, cursando de manera asintomática. Sin embargo, en un alto porcentaje de pacientes conduce a lo largo de su vida a complicaciones valvulares (estenosis, insuficiencia, endocarditis) o aórticas (dilatación o disección). Con frecuencia estas manifestaciones suceden a una edad temprana y causan una elevada morbimortalidad. A pesar de que en los últimos años se ha producido una intensa investigación en este campo, la fisiopatogenia de la enfermedad no es del todo conocida y muchas preguntas siguen abiertas. En este artículo se revisan de forma actualizada los aspectos clínicos y fisiopatológicos más novedosos y relevantes sobre esta cardiopatía congénita.

Abstract The most common congenital heart disease in the general population is the bicuspid aortic valve. Far from being just a harmless valve malformation, it is a complex and heterogeneous disease. It is often identified as an incidental finding in healthy people. However, in a high percentage of patients it leads throughout their life towards valvular (stenosis, insufficiency, endocarditis) or aortic (dilatation or dissection) complications. Frequently, manifestations occur at an early age, being responsible for high morbidity and mortality. Even though in recent years intense research has been carried out in this field, the pathophysiogenesis of the disease is not fully known and many questions remain open. In this article, we review the most innovative and relevant clinical and pathophysiological aspects of this congenital heart disease.

Longitudinal relationships between job satisfaction and creative performance: a three-wave cross-lagged panel design / Relações longitudinais entre satisfação no trabalho e desempenho criativo: um projeto de painel com três ondas cruzadas / Relaciones longitudinales entre la satisfacción laboral y el desempeño creativo: diseño de panel de correlaciones cruzadas, con tres momentos temporales

Despite the assumption about the positive relationship between wellbeing and performance within the happy and productive worker thesis (HPWT), the matter is still under discussion due to inconclusive results. To better understand the link between wellbeing and performance and delineate their possible causal relationships, it is necessary to conduct longitudinal studies with data collection at different moments, as well as broaden the focus by considering different types of wellbeing and performance. To achieve this, the authors of this study analyzed the relationship between intrinsic (IJS) and extrinsic job satisfaction (EJS) with creative performance. The design consisted of a three-time cross-lagged panel design since it permits analyzation of the reciprocal and longitudinal relationship between two or more variables. Our sample was composed of 209 employees from nine different organizations in Spain. The results demonstrated that only IJS predicted creative performance at one of the time intervals. The conclusions were: 1) the relationship between IJS and creative performance might be spurious, 2) it is important to consider IJS and EJS separately because they yield differential results, 3) the relationship between IJS and creative performance is not reciprocal, and 4) it is necessary to increase longitudinal studies in the field.

Apesar do pressuposto sobre a relação positiva entre bem-estar e desempenho dentro da Tese do Trabalhador Feliz e Produtivo (happy and productive worker thesis - HPWT), o assunto ainda está em discussão devido aos resultados inconclusivos. Para melhor compreender a relação entre bem-estar e desempenho e delinear suas possíveis relações causais, é necessário realizar estudos longitudinais com coleta de dados em diferentes momentos, bem como ampliar o foco considerando diferentes tipos de bem-estar e desempenho. Para alcançar este objetivo, os autores deste estudo analisaram a relação entre satisfação intrínseca (intrinsic job satisfaction - IJS) e extrínseca no trabalho (extrinsic job satisfaction - EJS) com o desempenho criativo. O desenho consistiu em um projeto de painel com retardo cruzado de três ondas, uma vez que permite a análise da relação recíproca e longitudinal entre duas ou mais variáveis. Nossa amostra foi composta por 209 funcionários de nove organizações diferentes na Espanha. Os resultados demonstraram que apenas IJS previu desempenho criativo em um dos intervalos de tempo. As conclusões foram: 1) a relação entre IJS e desempenho criativo pode ser espuria, 2) é importante considerar IJS e EJS separadamente porque eles produzem resultados diferenciais, 3) a relação entre IJS e desempenho criativo não é recíproca e 4) é necessário aumentar os estudos longitudinais na área.

A pesar de la suposición sobre la relación positiva entre el bienestar y el desempeño dentro de la tesis del trabajador feliz y productivo (happy and productive worker thesis - HPWT), el tema aún está en discusión debido a resultados no concluyentes. Para comprender mejor el vínculo entre bienestar y desempeño y delinear sus posibles relaciones causales, es necesario realizar estudios longitudinales con recolección de datos en diferentes momentos, así como ampliar el enfoque considerando diferentes tipos de bienestar y desempeño. Para lograrlo, los autores de este estudio analizaron la relación entre la satisfacción laboral intrínseca (intrinsic job satisfaction - IJS) y extrínseca (extrinsic job satisfaction - EJS) con el desempeño creativo. Se utilizó un diseño de panel de correlaciones cruzadas, con tres momentos temporales, ya que permite el análisis de la relación recíproca y longitudinal entre dos o más variables. Nuestra muestra estuvo compuesta por 209 empleados de nueve organizaciones diferentes en España. Los resultados demostraron que solo IJS predijo el rendimiento creativo en uno de los intervalos de tiempo. Las conclusiones fueron: 1) la relación entre IJS y el desempeño creativo podría ser espuria, 2) es importante considerar IJS y EJS por separado porque producen resultados diferenciales, 3) la relación entre IJS y el desempeño creativo no es recíproca, y 4) es necesario incrementar los estudios longitudinales en el campo.

Manifestaciones clínicas y predictores de gravedad en pacientes adultos con infección respiratoria aguda por coronavirus SARS-CoV-2

Background: In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan city and spread rapidly throughout China and the world. Aim: To describe the clinical features, risk factors, and predictors of hospitalization in adult patients treated for acute respiratory infections associated with coronavirus SARS-CoV-2. Material and Methods: Descriptive prospective study of ambulatory and hospitalized adult patients with confirmed COVID-19 attended between April 1 and May 31, 2020. Clinical features, chronic comorbidities and demographic data were recorded, and patients were followed for two months as outpatients. Results: We assessed 1,022 adults aged 41 ± 14 years (50% men) with laboratory-confirmed COVID-19. One-third had comorbidities, specially hypertension (12.5%), hypothyroidism (6.6%), asthma (5.4%) and diabetes (4.5%). Hospital admission was required in 11%, 5.2% were admitted to critical care unit and 0.9% were connected to mechanical ventilation. Common symptoms included fatigue (55.4%), fever (52.5%), headache (68.6%), anosmia/dysgeusia (53.2%), dry cough (53.4%), dyspnea (27.4%) and diarrhea (35.5%). One third of patients reported persistence of symptoms at one-month follow-up, specially fatigue, cough and dyspnea. In the multivariate analysis, age, fever, cough, dyspnea and immunosuppression were associated with hospitalization and ICU admission. Age, male sex and moderate-severe dyspnea were associated with requirement of mechanical ventilation. The main predictors of prolonged clinical course were female sex, presence of comorbidities, history of dyspnea, cough, myalgia and abdominal pain. Conclusions: Clinical features of COVID-19 were highly unspecific. Prediction models for severity, will help medical decision making at the primary care setting.

Estudio de prevalencia de síndrome de apneas obstructivas del sueño en la población adulta chilena. Subestudio de la Encuesta Nacional de Salud, 2016/17 / Prevalence of obstructive sleep apnea syndrome in Chilean adults. A sub-study of the national health survey, 2016/17

Background: Obstructive sleep apnea syndrome (OSAS) affects approximately 10%-20% of adults and is associated with obesity, hypertension and metabolic syndrome. Aim: To assess the prevalence and risk factors associated with OSAS in Chilean adults. Material and Methods: A standardized sleep questionnaire and respiratory polygraphy at home were conducted on adults aged 18 years or more, residing in the Metropolitan Region and enrolled in the 2016/17 National Health Survey. Results: Two-hundred and five people between 18 and 84 years old (46% men, mean age 50 years) underwent overnight respiratory polygraphy at home. The estimated obstructive sleep apnea prevalence was 49% (62% men, 31% women) considering an apnea-hypopnea index ≥ 5 respiratory events/hour, and 16% (21% men, 13% women) considering an apnea-hypopnea index ≥ 15 respiratory events/hour. The prevalence of obstructive sleep apnea continuously increased along with age for men and women, with a later onset for women. Age, gender, body mass index, cervical and waist circumference, snoring, reporting of apnea by proxies, self-reported cardiovascular and metabolic diseases such as hypertension, diabetes and dyslipidemia, were significantly associated with OSAS. No association was found with insomnia and daytime sleepiness. Conclusions: The prevalence and risk factors associated to obstructive sleep apnea syndrome were high among these adults.

Haploidentical transplantation outcomes are comparable with those obtained with identical human leukocyte antigen allogeneic transplantation in Chilean patients with benign and malignant hemopathies

Abstract Introduction Patients with benign or malignant blood disorders, who require allogeneic stem cell transplantation and lack an identical human leukocyte antigen HLA identicalHL sibling donor, could be transplanted with hematopoietic stem cells from unrelated adult or umbilical cord donors. However, in our country, both approaches are costly and time-consuming options. Methods Over the last few years, haploidentical modalities have been investigated as an alternative donor source, showing similar results to those obtained with identical HLA donors. We started using T-cell-replete haploidentical with post-transplant cyclophosphamide in 2012 and we presented our experience with patients undergoing haploidentical ransplantation compared to SIB. Results Since January 2012 to date, 91 allogeneic transplants have been performed, of which 49 were haploidentical and 42 were HLA identical. The mean age of the patients was 35 years (range: 17-62). The mean CD34/kg × 106 infused per group was 5.93 and 5.89, respectively. Time to granulocyte and platelet engraftment was 11 and 15 days, respectively, for haploidentical, and 12 and 14 days, respectively, for HLA identical (p = 0.10). The 100-day cumulative incidence of global acute GVHD was 34% for haploidentical and 29% for SIHLA identical (p = 0.9). The 2-year overall global graft-versus-host disease was 43% for haploidentical and 41% for HLA identical (p = 0.8). Overall survival, relapse, and transplant and relapse-related mortality were similar between both groups. Conclusion Our experience showed that haploidentical has similar outcomes to those obtained with HLA idential and can be performed in our country safely.

Chemical constituents of leaves of Persea americana (avocado) and their protective effects against neomycin-induced hair cell damage

ABSTRACT Persea americana Mill., Lauraceae, commonly known as the avocado, is native to tropical and subtropical regions, including Brazil. From the leaves of P. americana, one previously undescribed flavonol glycoside (1) together with ten known flavonoids (2-11), four megastigmane glycosides (12-15) and two lignans (16-17) were isolated. Their structures were determined by extensive spectroscopic methods including 1D- and 2D-nuclear magnetic resonance and mass spectrometry data. This is the first investigation that reports megastigmane glycoside and lignan classes within the genus Persea. All the isolated compounds have been assessed through the cell survival of larval zebrafish following neomycin-induced damage and the cell viability of a House Ear Institute-Organ of Corti 1 mouse auditory cell line. Among the tested compounds, juglanin (2) and (+)-lyoniresinol (16) showed significant cell regeneration in neomycin-damaged hair cell without cellular toxicity.

Metodología de gestión de la propiedad intelectual en los proyectos de ciencia, tecnología e innovación / Methodology of Intellectual Property Management in science, technology and innovation projects

RESUMEN Introducción: en Pinar del Río, Cuba, durante la ejecución de proyectos de ciencia, tecnología e innovación, se identifica la obtención de resultados de la ciencia con alto valor agregado, sin embargo, no se dispone de un proceder organizativo, que permita gestionar la propiedad intelectual en cada una las fases que componen su ciclo de vida. Objetivo: exponer una metodología de gestión de la propiedad intelectual en los proyectos de ciencia, tecnología e innovación en Pinar del Río. Métodos: histórico - lógico para conocer los fundamentos y tendencias sobre la gestión de la propiedad intelectual y su articulación con el Sistema de Ciencia, Tecnología e Innovación, el análisis documental a fin de contextualizar valoraciones emitidas, la entrevista y encuesta en función de validar aportes y obtener razonamientos en el proceso del diseño de la metodología. Resultados: la metodología permitió que los proyectos fueran valorados desde la perspectiva de la propiedad intelectual en su proceso de gestión, asegurando acciones relacionadas con la adquisición, conservación, mantenimiento y defensa de los derechos de la propiedad intelectual que tienen su salida en actividades de investigación - desarrollo e innovación. Conclusiones: la metodología contribuye a gestionar la propiedad intelectual en las fases del ciclo de vida de los proyectos de ciencia, tecnología e innovación en Pinar del Río, favoreciendo la práctica de nuevas conductas, modos de planificar y decidir, de manera que se correspondan, integren y armonicen coherentemente con la Política Nacional de Ciencia, Tecnología e Innovación y de la Propiedad Intelectual.

ABSTRACT Introduction: in Pinar del Río, Cuba, during the implementation of science, technology and innovation projects, the achievement of scientific results with high-added value is identified; however, there is no organizational procedure available to manage the intellectual property in each of the phases that make up its life cycle. Objective: to present a methodology of Intellectual Property Management in science, technology and innovation projects in Pinar del Río. Methods: historical - logical to know of the foundations and trends on the Intellectual Property Management and its articulation with the System of Science, Technology and Innovation, the documentary analysis in order to contextualize the assessments issued, the interview and survey in function of validating contributions and get reasoning in the process of designing the methodology. Results: the methodology allowed the projects to be valued from the perspective of intellectual property in their management process, ensuring actions related to the acquisition, conservation, maintenance and defense of intellectual property rights that have their way out in research activities, development and innovation. Conclusions: the methodology contributes to Intellectual Property Management in the phases of the life cycle of science, technology and innovation projects in Pinar del Río, favoring the practice of new behaviors, ways of planning and deciding, in order to correspond, integrate and harmonize coherently with the National Policy on Science Technology and Innovation along with the Intellectual Property Management.

Implementación de la terapia miofuncional orofacial en una clínica de posgrado de Ortodoncia / Implementation of orofacial myofunctional therapy in a graduate education dental clinic

Introducción: la terapia miofuncional orofacial es el conjunto de técnicas que intervienen en los desórdenes miofuncionales que afectan el comportamiento de la dinámica del sistema estomatognático, su equilibrio y su funcionamiento integrando sus acciones durante un tratamiento de ortopedia maxilar y ortodoncia. Objetivo: desarrollar la implementación del servicio de terapia miofuncional en una Clínica de Ortodoncia y Ortopedia Maxilar como una estrategia de intervención ante la presencia de desórdenes miofuncionales. Métodos: se consideraron dos momentos metodológicos. En el primer momento, se estableció el diagnóstico situacional asistencial con una investigación descriptiva transversal a una muestra de 68 informes fonoaudiológicos de pacientes. Igualmente, para el establecimiento del diagnóstico académico y profesional se realizó una encuesta a 35 personas, 83 por ciento estudiantes de posgrado y 17 por ciento docentes. En el segundo momento, se realizó una revisión documental como soporte teórico de las guías de manejo. Resultados: las fases de diagnóstico situacional confirman la pertinencia de implementar un servicio de terapia miofuncional dado que el 100 por ciento de los pacientes presentaron un diagnóstico de desorden miofuncional, deglución atípica completa en el 60 por ciento y la deglución atípica anterior en el 29 por ciento. En lo referente al diagnóstico profesional, el 91 por ciento de los encuestados presentó una experiencia positiva con la terapia miofuncional tanto en la fase evaluativa como terapéutica. Se consolidaron las guías de manejo que rigen el servicio tanto en acciones evaluativas, diagnósticas y terapéuticas. Conclusiones: se justifica la pertinencia de la implementación de la terapia miofuncional no solo desde los efectos bucofaciales, sino desde la prevención de estos. El desarrollo de programas de intervención clínico educativo en el marco legal de promoción y prevención deben ser contundentes en las clínicas de Ortodoncia y Ortopedia Maxilar, donde se ejecuten actividades de protección específica, detección temprana y atención oportuna en la salud bucal(AU)

Introduction: orofacial myofunctional therapy is the set of techniques used to treat myofunctional disorders affecting the dynamics of the stomatognathic system, its balance and operation, integrating their actions during maxillary orthopedics and orthodontics treatment. Objective: implement the myofunctional therapy service in a maxillary orthopedic / orthodontic clinic as an intervention strategy for myofunctional disorders. Methods: Methodologically, the study was structured into two stages. In the first stage situational care diagnostics was established via a cross-sectional descriptive study of a sample of 68 phonoaudiological reports about patients. Academic and professional diagnostics was based on a survey applied to 35 people, 83 percent of whom were post-graduate students and 17 percent were teachers. The second stage consisted in a document review to provide theoretical foundation to the management guides. Results: the situational diagnostics stages confirm the relevance of implementing a myofunctional therapy service, since 100 percent of the patients were diagnosed with myofunctional disorder, with total atypical deglutition in 60 percent and anterior atypical deglutition in 29 percent. Professional diagnostics showed that 91 percent of respondents had had a positive experience with myofunctional therapy in either its evaluative or therapeutic stage. Consolidation was conducted of the management guides governing the service in terms of evaluative, diagnostic and therapeutic actions. Conclusions: pertinence of the implementation of myofunctional therapy is justified, not only by orofacial effects, but also by their prevention. Development of clinical educational intervention programs within the legal framework for promotion and prevention should be forcefully conducted in maxillary orthopedic / orthodontic clinics, where actions will be performed aimed at specific protection, early detection and timely care in dental practice(AU)

Fósforo sérico en niños con desnutrición grave y su relación con el síndrome de realimentación / Serum phosphorus in malnourished children and its relationship with the syndrome of feedback

El síndrome de realimentación ocurre como consecuencia de la reintroducción de alimentos en pacientes malnutridos. Se realizó estudio de tipo observacional, prospectivo, no experimental y comparativo. Se midieron los niveles de fósforo en niños desnutridos graves y eutróficos al ingreso y al día 7 después de iniciada la alimentación con el objetivo de relacionar los niveles séricos de fósforo con el síndrome de realimentación en niños desnutridos graves atendidos en el Servicio de Emergencia de Pediatría Hospital Universitario de Maracaibo. Venezuela, desde junio 2010 hasta junio 2011. Se incluyeron 60 niños, entre 1 mes y 4 años, de ambos sexos, divididos en 2 grupos: Grupo A n=30 niños desnutridos graves y Grupo B n=30 niños eutróficos. En ambos grupos predominaron los lactantes de 1 a 23 meses con el 86,7% y el 60% respectivamente. Fueron del sexo masculino el 70% y 73% en cada grupo. El fósforo sérico en el grupo A al ingreso fue de 3,17 ± 0,98 mg/dl y a los siete días 2,48 ± 1,01 mg/dl, estadísticamente significativo p = 0,002; sin manifestaciones clínicas. En el grupo B no hubo significancia estadística con p=0,569 al comparar los valores del fósforo sérico al ingreso y al día 7. Tres niños del grupo A murieron. Se observo en el presente estudio que los niños desnutridos graves presentaron disminución del fósforo sérico al ser realimentados. Nuevas líneas de investigación deben hacerse para aumentar los conocimientos actuales sobre ésta condición(AU)

Refeeding syndrome occurs as a result of the reintroduction of food in malnourished patients. Observational, prospective, non experimental and comparative study was performed. Phosphorus levels in severely malnourished children and healthy children was measured at admission and at 7 days after initiation of feeding in order to associate the concentration of serum phosphorus with refeeding syndrome in severely malnourished children hospitalized at the Pediatric Emergency Service University Hospital of Maracaibo, Venezuela, from June 2010 to June 2011. We included 60 children between 1 month and 4 years and both sexes, divided into 2 groups: Group A n = 30 serious malnourished children and Group B (control) n = 30 eutrophic children. In both groups predominated the infants 1 to 23 months with 86.7% and 60% respectively. 70% and 73% were male both group. In Group A, there was statistical significance betwee the serum phosphorus at the beginning (3.17 ± 0.98 mg/dl) and at seven days of hospitalization 2.48 ± 1.01 mg/dl, p = 0.002; without clinical manifestations. In Group B there was no statistical significance with p=0,569 to compare values of serum phosphorus income and day 7. Three children of the group A died. It was observed in this study that serious malnourished children presented the serum phosphorus decreased to be refueled. New lines of research should be expanded in this area to increase current knowledge about this condition(AU)

Comparación entre los niveles de prolactina de madres en relactancia y madres con lactancia materna exclusiva / Comparison between levels of prolactin of mother in relactation and exclusive breast feeding mothers

Estudio no experimental, prospectivo, comparativo y longitudinal, realizado con el objetivo de comparar los niveles de prolactina en 15 madres (Grupo estudio) con más de dos semanas de haber suspendido la lactancia materna y entrenadas para relactar según método recomendado por Organización Mundial de la Salud: Estimulación del pezón y del pecho, Técnica de chorrear y gotear y Extracción mecánica y manual y en 25 madres (grupo control) que lactaban en forma exclusiva, cuyos hijos menores de seis meses, fueron hospitalizados por diversas patologías, en la División Pediátrica del Servicio Autónomo Hospital Universitario de Maracaibo, desde noviembre 2010 a octubre 2011. Las madres tuvieron entre 15 y 25 años de edad en ambos grupos (p=0,58); la causa principal del abandono de la lactancia fue escasa producción láctea (46,67%).El tiempo de aparición de la secreción láctea fue de 6+1,60 días.Los niveles de prolactina de madres del grupo estudio en las primeras 24 horas del ingreso del lactante fue 35,58+18,04 ng/ml y en el grupo control 129,83+35,01 ng/ml, estadísticamente significativo (p=0,01). Iniciada la secreción láctea fue de 121,20+16,90 ng/ml, estadísticamente significativo (p=0,01) comparado con el valor inicial del grupo estudio, pero al comparar con el grupo control fue estadísticamente no significativo (p=0,13).Se concluye que en este grupo de madres que abandonaron la lactancia, una vez iniciada la relactación presentaron un aumento significativo de los niveles de prolactina, similares a los niveles en madres lactando en forma exclusiva.

Not experimental, prospective, comparative, and longitudinal study conducted in order to compare the levels of prolactin in 15 mothers (study group) with more than two weeks of having suspended the breastfeeding, and trained to relactate according to the method recommended by World Health Organization: nipple and breast stimulation, technique of dripping and drip and mechanical and manual removal, and 25mothers (control group) that breastfeeding exclusively, whose children less than six months, were hospitalized with various diseases, in the Division of Pediatric of University Hospital in Maracaibo, from November 2010 to October 2011. The mothers had between 15 and 25 years of age in both groups (p =0.58), the main cause of the abandonment of breastfeeding was insufficient milk production (46.67%). The time of occurrence of milk secretion was 6+1.60 days. Prolactin levels in the study group mothers in the first 24 hours of admission was 35.58+18.04 ng/ml, and in the control group 129.83+ 35.01 ng/ml, statistically significant (p=0.01). Initiated the milk secretion was 121.20+16.90 ng/ml, statistically significant (p =0.01 compared to base line study group, but when was compared to the control group was not statistically significant (p =0.13). It concludes that in this group of mothers who left nursing, once started relactation had significantly higher prolactin levels, similar to the levels in mothers exclusively breastfeeding.

Factores de riesgo asociados a la prematuridad en recién nacidos de madres adolescentes / Risk factors associated with prematurity in preterm born to teenage mothers

OBJETIVO: determinar factores de riesgo asociados a prematuridad en neonatos hijos de 205 madres adolescentes en la Maternidad “Dr. Armando Castillo Plaza”, Maracaibo, desde enero - agosto 2012. MÉTODOS: Estudio descriptivo, prospectivo y transversal, se realizó entrevista a la madre y revisión de historias clínicas de la madre y del neonato; indicadores recopilados: factores personales, socioeconómicos, demográficos, gineco-obstétricos y del nacimiento. RESULTADOS: Hubo 15,13 % adolescentes con hijos prematuros; entre 17-19 años (67,31 %); índice de masa corporal: 18,5-24,99 kg/m2 (71,13 %); no estudiaban (41,46.%), no completaron la secundaria (78,54.%), dedicadas a oficios del hogar (68,29 %); en concubinato (55,12 %), estrato socioeconómico: nivel V (52,68 %); sin consumo de alcohol, drogas o tabaco (100 %); venezolanas (97,56 %), raza mestiza (61,46.%); residenciadas en zonas urbanas (62,44.%); viven con familia materna y padre del niño (41,95.%), familias disfuncionales (55,61 %); rechazo familiar (65,85 %); embarazos no deseados (88,29 %); sin intentos de aborto en 82,93 %. Menarquía con media de 11,81 ±1,09 años, inicio de relaciones sexuales: 14,67±1,11 años; mal control prenatal (64,39 %), primiparidad (72,68.%) nacimiento por parto (56,59 %), entre 34 y menores de 38 semanas de gestación (79,51 %); neonato hembra (58,05 %); peso entre 1 501-2.500 g (45,37 %); adecuados para la edad gestacional (79,51 %); buen Apgar al minuto (56,59 %), a los cinco (74,63 %). Presentaron patologías maternas (100 %) y del neonato (89 %). CONCLUSIONES: El bajo nivel socioeconómico y factores de riesgo familiar se relacionan con la prematuridad en el embarazo de estas adolescentes.

OBJECTIVE: to determine risk factors associated with prematurity in infants children of 205 teenagers at the Dr. Armando Castillo Plaza”, Maracaibo, maternity leave from January - August 2012. METHOD: Descriptive, prospective and transversal study was interviewing the mother and review of clinical histories, the mother and the newborn; collected indicators: personal, socio-economic, demographic, gyneco-obstetrical and birth factors. RESULTS: There were 15.13 % adolescents with premature children; between 17 and 19 years old (67.31 %); body mass index: 18, 5-24, 99 kg/m2 (71.13 %); not studied (41.46 %), have not completed high school (78.54 %), dedicated to offices of the household (68,29 %); in concubinage (55.12.%), socio-economic stratum: level V (52.68 %); no consumption of alcohol, drugs or tobacco (100.%). Venezuelans (97.56 %), mixed race (61.46 %); domiciled in urban areas (62.44 %); living with mother’s family and the father of the child (41.95 %), dysfunctional families (55.61 %); family rejection (65,85 %) and unwanted pregnancies (88.29 %); no attempts of abortion in 82.93 %. Menarche with average of 11.81 ±1, 09 years, home of intercourse: 14, 67±1, 11 years; poor prenatal care (64.39 %), primiparidad (72.68 %) birth by birth (56.59 %), between 34 and 38 weeks of gestation (79.51 %) children; female neonate (58.05 %), weight between 1 501-2 500 g (45.37 %); appropriate for gestational age (79.51 %); good Apgar score at the minute (56.59 %), five (74.63 %). They presented maternal diseases (100 %) and neonatal (89 %). CONCLUSIONS: Low socioeconomic and family risk factors is related to prematurity in these teen pregnancy.

Endoftalmitis endógena secundaria a un absceso renal / Endogenous endophthalmitis secondary to a renal abcess

La endoftalmitis endógena puede ocurrir en aquellos casos de inflamación de los tejidos oculares internos secundaria a infección intraocular, resultado de la diseminación hematógena de los microorganismos desde un foco distal al ojo. Es el grupo menos frecuente de todas las endoftalmitis (5 por ciento), es preferentemente unilateral, y en la mayoría de los pacientes se aprecia al menos un foco extraocular infeccioso. Aunque puede darse en pacientes sanos inmunocompetentes, esta enfoftalmitis afecta fundamentalmente a pacientes con uno o más factores de riesgo, entre ellos, enfermedades crónicas, procedimientos quirúrgicos, neoplasias, usuarios de drogas administradas por vía parenteral, inmunodeficiencias, catéteres intravenosos. Se presenta un caso de una paciente diabética con una endoftalmitis endógena secundaria a un tumor renal, cuyo cuadro inicial apuntaba hacia un coma diabético y en la medida que evolucionó y a través del estudio oftalmológico se logró un completo diagnóstico y tratamiento de su problema de salud

The endogenous endophthalmitis may occur in cases of internal tissue inflammation secondary to intraocular infection, as a result of the hematogenous dissemination of microorganisms from a distal focus to the eye. It is the less frequent group of all types of endophthalmitis (5 percent), preferably unilateral, and most of the cases present with an extraocular infectious focus. Although it may appear in healthy immuno competent patients, this endophthalmitis mainly affects patients with one or more risk factors such as chronic illnesses, surgical procedures, neoplasias, parenterally administered drug users, immunodeficiencies and intravenous catheters. A case of a diabetic female patient with endogenous endophthalmitis secondary to a renal tumor was presented. Her initial clinical picture pointed to diabetic coma, but as the disease evolved and based on the ophthalmological study, it was possible to reach a complete diagnosis and to apply a treatment for her health problem