Estrés académico en estudiantes de Enfermería durante la pandemia: retos, afrontamientos, perspectivas inmediatas / Academic stress in Nursing students during the pandemic: challenges, coping, immediate perspectives

Introducción: la COVID-19 ha sido un reto considerable para obtener una formación de elevada calidad para los discentes del área de Enfermería porque las universidades continuaban con normas, estrategias anticuadas que no respondían a los cambios. Objetivo: exponer los elementos teóricos relacionados con el estrés académico en los estudiantes de Enfermería, el afrontamiento durante el proceso enseñanza aprendizaje en tiempos de pandemia de COVID-19 y cuáles han sido las estrategias llevadas a cabo por las instituciones de educación superior. Métodos: se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo sobre el contenido de las bibliografías, con una búsqueda documental basada en los 32 artículos científicos originales previamente seleccionados, publicaciones en idioma inglés, español y portugués en las bases de datos Scopus, Pubmed, Dialnet, Scielo, Elsevier, Latindex y Web of Science. Las palabras claves utilizadas fueron: estrés, academia, resiliencia, pandemia y enseñanza virtual. Desarrollo: el cambio del entorno presencial al virtual provocó un viraje significativo en el desarrollo del modo de enseñanza aprendizaje generando estrés, por lo que se deben manejar protocolos de atención para los estudiantes. Conclusiones: la academia fue sorprendida por la pandemia, como sucedió con la población en general. No se articularon suficientes estrategias para poder enfrentar las diferentes situaciones que generaron el estrés académico. Es necesario abordar la resiliencia para todas las eventualidades de salud.

Introduction: COVID-19 has been a considerable challenge to obtain high-quality training for students in the Nursing area because universities continued with norms, outdated strategies that did not respond to changes. Objective: to analyse the characteristics of academic stress in Nursing students during the teaching-learning process in times of the COVID-19 pandemic. Methods: a systematic bibliographic review was carried out to develop a reflective critical analysis on the content of the bibliographies, with a documentary search based on the 32 previously selected original scientific articles, publications in English, Spanish and Portuguese in the Scopus databases, Pubmed, Dialnet, Scielo, Elsevier, Latindex, and Web of Science. The keywords used were stress, academy, resilience, pandemic, and virtual teaching. Development: the change from the face-to-face to the virtual environment caused a significant shift in the development of the teaching-learning mode, generating stress, for which reason care protocols for students must be managed. Conclusions: the academy was surprised by the pandemic, as it happened with the general population. Not enough strategies were articulated to be able to face the different situations that generated academic stress. Resilience needs to be addressed for all health eventualities.

El profesional de enfermería especializado. ¿hace el mejor uso de la tecnología en el cuidado? / Compliance with the recommendations for physical activity set by the WHO by public bicycle users in a Spanish municipality

Introducción: La percepción de la integralidad del cuidado se logra cuando el profesional de enfermería integra con elevado nivel las competencias científicas, sociales, éticas y el uso de herramientas tecnológicas con la finalidad de conservar y recuperar la salud, a la medida de las necesidades y expectativas del ser cuidado. Objetivo: Analizar el desarrollo de evidencias científicas sobre el modo en que el profesional de enfermería especialista hace uso de la tecnología en el proceso de cuidado de la persona. Material y Métodos: Se realizó una búsqueda bibliográfica en las bases de datos Scielo, Lilacs, Medline, Redalyc, Scopus y Google Académico, en español, inglés y portugués. La información se consultó durante el periodo de 2019-2020, se utilizó un total de 25 referencias para su desarrollo. Resultados: El profesional de enfermería especialista utiliza los recursos tecnológicos en el proceso de cuidado y en otros pilares de su ejercicio laboral con ello se logra el cuidado integral al ser humano. Conclusiones: el profesional de enfermería especialista realiza dos grandes usos de los recursos tecnológicos en el proceso de cuidados: durante la asistencia del paciente para restaurar, mantener la salud, conservando la interacción con la familia y en los grandes pilares del ejercicio profesional: la gestión de los procesos de tratamiento y continuidad del cuidado; la docencia que asegura la excelencia de futuros profesionales y la investigación, de esta manera se aproxima a la oferta del cuidado humanizado, que constituye el ideal moral de la profesión(AU)

Introduction: The perception of the integrality of care is achieved when the nursing professional integrates, at a high level, the scientific, social, and ethical competencies and the use of technological tools to preserve and recover health, tailored to the needs and expectations of the being cared for. Objective: To analyze the development of scientific evidence on how the specialized nursing professional makes use of technology in the process of caring for the person. Material and Methods: A bibliographic search was carried out in the Scielo, Lilacs, Medline, Redalyc, Scopus, and Google Scholar databases in Spanish, English, and Portuguese. The information was consulted during the 2019-2020 period; a total of 25 references were used for its development. Results: The specialized nursing professional uses technological resources in the care process and other pillars of the work practice that contribute to providing comprehensive care to human beings. Conclusions: The specialized nursing professional makes two major uses of technological resources in the care process: during patient care itself to restore and maintain health, preserving interaction with the family; and in the great pillars of professional practice: management of treatment processes and continuity of care, teaching that ensures the excellence of future professionals, and research, thus approaching the offer of humanized care which is the moral ideal of the profession(AU)

El éxito de las Prácticas pre-profesionales: ¿De qué depende? / Success of pre-professional practices: ¿What does it depend on?

Introducción: La formación profesional sigue siendo uno de los factores críticos al momento de analizar la relación entre calidad de la educación y el desempeño profesional de los maestros, las prácticas preprofesionales son un eslabón fundamental en dicha relación. Objetivo: Analizar cómo se lleva a cabo el proceso de gestión y desarrollo de las prácticas preprofesionales por las instituciones educativas y con ello se constate la posibilidad de existencia o no de algún modelo que establezca la especificidad de tan relevante actividad. Material y Métodos: Se realizó una búsqueda documental/bibliográfica en relación con nuestra variable de estudio "prácticas preprofesionales" de un total de 70 artículos, pertenecientes a las bases de datos: Scopus, Scielo, Dialnet y ERIHPLUS, que fueron analizados de manera inductiva, tras la aplicación de los criterios de inclusión y exclusión se abordó el estudio con de 26. Resultados: Se establece una descripción de datos de revistas indexadas donde se explican las principales características de las prácticas preprofesionales en el ámbito educativo general y en la Educación Médica superior, desde la concepción, organización hasta su evaluación. Se explica el papel generador de esta importante actividad en el proceso de formación de los futuros profesionales; así como de sus falencias y limitaciones. Cuestión que urge resolver por parte de las instituciones de educación superior con la consecuente y necesaria creación de modelos administrativos que pauten tan loable tarea. Conclusiones: La educación médica debe replantearse nuevas formas de enseñanza aprendizaje que mejoren el desarrollo del internado rotativo, una pandemia lo ha evidenciado. No constatamos modelos administrativos, gerenciales, entre otros, únicos que reúnan los criterios para ejecutar tan valioso programa o que pauten dicha actividad(AU)

Introduction : Professional training continues to be one of the critical factors for the analysis of the relationship between the quality of education and the teachers' professional performance, including pre-professional practices as an essential link in this relationship. Objective : To analyze how the process of management and development of pre-professional practices is carried out by educational institutions in an attempt to prove the possibility of the existence of a model that establishes the specificity of such relevant activity. Material and Methods : A bibliographic and documentary search that included "pre-professional practices" as our study variable was carried out on 70 articles belonging to Scopus, Scielo, Dialnet and ERIHPLUS databases. All the articles were inductively analyzed. After applying the inclusion and exclusion criteria, the study was undertaken to address the topic in a total of 26 articles. Results : A description of data is established among indexed journals that explain the main characteristics of pre-professional practices in the general educational field and the higher medical education which go from their conception and organization until their evaluation. The generating role of this important activity in the training process of future professionals, as well as its shortcomings and limitations are explained. This is an urgent issue to be solved by the centers of higher education with the consequent and necessary creation of administrative models aimed at guiding such a praiseworthy task. Conclusions : The medical education should consider new forms of teaching and learning aimed at improving the rotating internship, which has been evidenced during the course of the pandemic. Administrative, management, unique models, as well as others that meet the criteria to implement such a valuable program or guide the above-mentioned activity have not been observed in our analysis(AU)

Mental health problems among healthcare workers involved with the COVID-19 outbreak

Objective: The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers' mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems. Methods: A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19. Results: The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001). Conclusion: The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.

Effect of physical and sexual violence during childhood and/or adolescence on the development of menstrual related mood disorders: A systematic review and meta-analysis / Efecto de la violencia física y sexual durante la infancia y/o la adolescencia en el desarrollo de trastornos del estado de ánimo relacionados con la menstruación: Una revisión sistemática y metaanálisis

Abstract Background Abuse in early life stages has been proposed as an etiological risk factor for developing menstrually-related mood disorders (MRMDs). Objetive To evaluate whether there is a relation between the occurrence of physical and/or sexual violence in childhood and/or adolescence and the development of MRMDs in adulthood. Method A systematic search was conducted in PubMed, Web of Science, and ScienceDirect, with the route ("Premenstrual Syndrome"[Mesh]) OR ("Premenstrual Dysphoric Disorder"[MeSH]) AND ("Violence"[Mesh]) / ("menstrually-related mood disorders" AND "abuse"). Fifty-four articles were initially reviewed and 32 were excluded based on the criteria. Twenty-two articles were thoroughly reviewed. Finally, five articles (publication years 2014, 2013, 2012, 2007, and 2003) were included in the systematic review and submitted to a meta-analysis. Results Results indicate that having been exposed to physical and/or sexual violence in childhood and/or adolescence increases 1.99 times the risk of experiencing MRMDs in adulthood in comparison with women who did not experience that type of violence (odds ratio [OR] = 1.99; 95% confidence interval [1.58, 2.51]). Discussion and conclusion The present work provides evidence that a woman who experienced violence through physical and/or sexual abuse during childhood and/or adolescence has a greater risk of developing MRMDs in adulthood.

Resumen Antecedentes El abuso en las etapas tempranas de la vida se ha propuesto como un factor de riesgo etiológico para desarrollar trastornos del estado de ánimo relacionados con la menstruación (TEARM). Objetivo Evaluar si existe una relación entre la ocurrencia de violencia física y/o sexual en la infancia y/o la adolescencia y el desarrollo de MRMD en la edad adulta. Método Se realizó una búsqueda sistemática en PubMed, Web of Science y ScienceDirect con la ruta ("Premenstrual Syndrome"[Mesh]) OR ("Premenstrual Dysphoric Disorder"[MeSH]) AND ("Violence"[Mesh]) / ("menstrually-related mood disorders" AND "abuse"). Cincuenta y cuatro artículos fueron revisados inicialmente y 32 fueron excluidos con base en los criterios establecidos. Veintidós artículos fueron revisados exhaustivamente. Por último, se incluyeron cinco artículos (años de publicación 2014, 2013, 2012, 2007 y 2003) en la revisión sistemática, y cinco de ellos fueron sometidos a un metaanálisis. Resultados Los resultados indican que haber estado expuesta a violencia física y/o sexual en la niñez y/o la adolescencia aumenta 1.99 veces el riesgo de experimentar TEARM en la edad adulta en comparación con las mujeres que no experimentaron ese tipo de violencia (odds ratio [OR] = 1.99; intervalo de confianza del 95% [1.58-2.51]). Discusión y conclusión El presente trabajo aporta evidencia de que una mujer que experimentó violencia por abuso físico y/o sexual durante la niñez y/o la adolescencia tiene un mayor riesgo de desarrollar TEARM en la edad adulta.

Formación del docente de Enfermería en metodologías activas de aprendizajes: ¿Es necesario en los saberes? / Nursing teacher training in active learning methodologies: ¿Is it necessary for knowledge?

Introducción: La formación del docente de Enfermería tiene ante sí el reto de su profesionalización, en un mundo caracterizado por la globalización, un acelerado desarrollo de la ciencia, las tecnologías y complejos procesos de cambios que requieren de nuevas transformaciones del conocimiento; es una necesidad la actualización de saberes más avanzados en metodologías activas en el docente de enfermería como un proceso continuo y simultáneo para alcanzar multihabilidades y valores. Objetivo: Describir los aspectos fundamentales que conforman el proceso de formación del docente de Enfermería en metodologías activas de aprendizajes en las instituciones de educación superior. Material y Métodos: El presente estudio es de diseño descriptivo, con un análisis de la información de manera inductiva, se examinaron 76 textos en las bases de datos Scopus, Scielo, Eric, empleadas como fuentes de investigación. Tras aplicar los criterios de inclusión y exclusión se abordó el estudio con un total de 27 artículos. Conclusiones: Todas las profesiones, oficios se verán afectados de una manera u otra en esta crucial avanzada por lo que es imprescindible el papel de las instituciones de educación superior en la emergente implementación y enseñanza de las metodologías activas que hoy anhelan ser aplicadas de manera insoslayable en los diferentes saberes; la profesión y ciencia de Enfermería no está exenta de ello; lo que busca un proceso transformador de profesionales competentes hacia una sociedad laboral competitiva(AU)

Introduction: Nursing teacher training is a professional challenge in a world characterized by globalization, accelerated development of science and technologies and complex processes of change that require new transformations of knowledge; an updating of the most advanced knowledge in active methodologies for nursing professors as a continuous and simultaneous process to promote multi-abilities and values is a must. Objective: To describe the main aspects that make up the Nursing teacher training process in active learning methodologies in higher education centers. Material and Methods: Descriptive study with an inductive content analysis. A total of 76 bibliographies were examined in the Scopus, Scielo, and Eric databases, which were used as research sources. After applying the inclusion and exclusion criteria, the study was approached with a total of 27 articles. Conclusions: All professions and experiences will be affected in one way or another in this crucial advance, so the role of higher education centers is essential in the emerging implementation and teaching of active methodologies that today yearn to be applied in an unavoidable way in the different fields of knowledge. The profession and Nursing science is not exempt from this trend and looks for a transforming process of competent professionals towards a competitive society of labor(AU)

Cognitive and clinic profile of volatile substance users / Perfil cognitivo y clínico de usuarios de sustancias volátiles

Abstract Introduction Inhalant use disorder has increased in spite of its adverse medical consequences. Due to the inherent difficulties of working with this population, so far there has been no quantifiable clinical evidence of the cognitive characteristics of inhalants users in early withdrawal and the clinic effect of consumption time. Objective To evaluate the clinical and cognitive performance of inhalant users and the clinic effects of consumption time. Method A cross-sectional study in which 28 adult users of inhalants were included, divided in two groups according to their consumption time: less than or greater than seven years. They were all evaluated in terms of clinical and neuropsychological values. Results Consumers of inhalant showed presence of craving (M = 479.14, SD = 213.51), altered frontal behavior before (M = 119.18, SD = 29.53) and now (M = 130, SD = 33.03), sleeping problems (M = 8.93, SD = 3.4), and cognitive difficulties (inhibitory control, planning, decision-making, working memory, verbal fluency, and cognitive flexibility); all these tasks were statistically significant (p = < .05). Discussion and conclusion Executive functioning is impaired with inhalant use disorder; these alterations increase with withdrawal and craving and changes remain independent from the use time.

Resumen Introducción El trastorno por uso de inhalables ha aumentado a pesar de las consecuencias médicas adversas. Debido a las dificultades que entraña trabajar con estas poblaciones, hasta hace poco no había evidencia clínica cuantificable de las características cognitivas de los usuarios de inhalables en la abstinencia temprana y de los efectos clínicos del tiempo de consumo. Objetivo Se analizó el rendimiento clínico y cognitivo de usuarios de inhalables y los efectos clínicos del tiempo de consumo. Método Estudio transversal en el que se incluyeron 28 adultos usuarios de inhalables, divididos en dos grupos dependiendo del tiempo de consumo, menor o mayor a siete años. Todos fueron evaluados en términos de valores clínicos y neuropsicológicos. Resultados Los consumidores de inhalables mostraron presencia de craving (M = 479.14, SD = 213.51), comportamiento frontal alterado antes (M = 119.18, SD = 29.53) y actualmente (M = 130, SD = 33.03), problemas para dormir (M = 8.93, SD = 3.4) y dificultades cognitivas (control inhibitorio, planificación, toma de decisiones, memoria de trabajo, fluidez verbal y flexibilidad cognitiva); todas estas tareas fueron estadísticamente significativas (p = < .05). Discusión y conclusión El funcionamiento ejecutivo se ve afectado en el trastorno por uso de inhalables. Estas alteraciones aumentan en la abstinencia y en la apetencia, y los cambios se mantienen independientes del tiempo de uso.

Clinical improvement in patients with borderline personality disorder after treatment with repetitive transcranial magnetic stimulation: preliminary results

Objective: Current treatment of borderline personality disorder (BPD) consists of psychotherapy and pharmacological interventions. However, the use of repetitive transcranial magnetic stimulation (rTMS) could be beneficial to improve some BPD symptoms. The objective of this study was to evaluate clinical improvement in patients with BPD after application of rTMS over the right or left dorsolateral prefrontal cortex (DLPFC). Method: Twenty-nine patients with BPD from the National Institute of Psychiatry, Mexico, were randomized in two groups to receive 15 sessions of rTMS applied over the right (1 Hz, n=15) or left (5 Hz, n=14) DLPFC. Improvement was measured by the Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity Over Time (BEST), Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), and Barratt Impulsiveness Scale (BIS). Results: Intragroup comparison showed significant (p < 0.05) reductions in every psychopathologic domain of the CGI-BPD and in the total scores of all scales in both groups. Conclusions: Both protocols produced global improvement in severity and symptoms of BPD, particularly in impulsiveness, affective instability, and anger. Further studies are warranted to explore the therapeutic effect of rTMS in BPD. Clinical trial registration: NCT02273674.

Análisis de fuentes del EEG en pacientes tratados con estimulación magnética transcraneal a 5 Hz como tratamiento antidepresivo / Electroencephalographic source analysis in patients receiving 5-Hz transcranial magnetic stimulation as antidepressant treatment

Transcranial Magnetic Stimulation (rTMS) is a technique that allows noninvasive electrical stimulation of the cortex with few side effects. An antidepressant effect has been proposed when rTMS is delivered over prefrontal dorsolateral cortex (DLPFC) ≥5Hz. Quantitative EEG studies have shown increases in alpha and theta power bands as well as frontal interhemispheric asymmetries in most recordings from depressed patients. rTMS over left DLPFC at 5Hz involve a safer and more tolerable procedure, and its neurophysiological correlates has not been explored using EEG source analysis. The aim of this research was to study changes in EEG sources using VARTERA method in a group of patients with major depressive disorder (MDD) treated with 5Hz rTMS over left DLPFC as single or combined treatment with escitalopram. Methods 18 patients with DSM-IV MDD diagnosis without treatment for the current episode were included. Subjects were randomly assigned to one of two groups: A) rTMS+escitalopram 10mg, n=9; B) rTMS+placebo, n=9. Subjects received 15 sessions of rTMS on a daily basis. In order to compare changes in EEG sources two recordings were obtained, prior and after treatment. HDRS, BDI and HARD were used for clinical assessments. Results All patients of group A and eight patients of group B showed response to treatment (considered as a reduction of 50% in HDRS score). An increase in absolute power at 9.37Hz and 10.17Hz in temporal and postcentral gyrus on the left hemisphere was found in group B. Absolute power in those frequencies was decreased in the same regions for group A. In addition, an increased power in beta band frequencies was observed in both hemispheres for group A. Conclusion Increases in alpha band could be the hallmark of the 5Hz rTMS, but it could be reduced by escitalopram. Besides, increases observed in beta band for group A could be related to escitalopram effect.

La estimulación magnética transcraneal repetitiva (EMTr) es una técnica que permite estimular eléctricamente la corteza cerebral de manera no invasiva y con pocos efectos secundarios. Se ha propuesto que la EMTr aplicada sobre la corteza prefrontal dorsolateral (CPFDL) izquierda con frecuencias ≥5Hz tiene efectos antidepresivos. Se ha encontrado que en el electroencefalograma cuantitativo (QEEG por sus siglas en inglés) la mayoría de pacientes deprimidos presentan incrementos en las bandas theta y alfa, así como asimetrías interhemisféricas en la actividad alfa en regiones anteriores. La EMTr sobre la CPFDL izquierda a 5Hz ofrece ventajas considerables en seguridad y tolerabilidad; sin embargo, sus correlatos neurofisiológicos no han sido explorados por el análisis de fuentes del EEG. Objetivo Estudiar los cambios en las fuentes del EEG según el método VARETA en un grupo de pacientes con trastorno depresivo mayor que recibieron EMTr a 5Hz sobre la corteza prefrontal dorsolateral izquierda como tratamiento único o en combinación con escitalopram. Material y métodos Se estudiaron 18 pacientes con diagnóstico de trastorno depresivo mayor de acuerdo con los criterios del DSM-IV sin tratamiento para el episodio en curso. Los sujetos habían sido aleatoriamente asignados a uno de los siguientes grupos de tratamiento: A) EMTr+escitalopram 10mg, n=9; B) EMTr+placebo, n=9. Se aplicó EMTr, a 5Hz en una sesión diaria durante 15 días. Se obtuvieron dos registros electroencefalográficos, uno basal y otro final, con el fin de comparar los cambios en las fuentes de actividad eléctrica cerebral, pretratamiento y post-tratamiento. Se realizaron evaluaciones clinimétricas con las escalas de Hamilton para Depresión y Ansiedad y el Inventario de Depresión de Beck. Resultados Todos los pacientes en el grupo A y ocho pacientes en el grupo B respondieron al tratamiento, con una reducción de 50% o más en la escala HDRS. En el análisis de fuentes se encontró un efecto en el grupo B caracterizado por incremento en la PA de 9.37 a 10.17Hz, en regiones temporales y giro poscentral izquierdos, mismo que se encontró disminuido en el grupo A, Además se encontró un incremento en fracuencias correspondientes a la banda beta en regiones frontales de ambos hemisferios en el grupo A. Conclusiones Podría considerarse que el incremento en la banda alfa es característico de la EMTr a 5Hz, mismo que se ve reducido por efecto del escitalopram. Por otro lado, se observó que el grupo A mostró incrementos en fuentes correspondientes a la banda beta como posible efecto relacionado del fármaco antidepresivo.

Clinical and electrophysiological effect of right and left repetitive transcranial magnetic stimulation in patients with major depressive disorder / Efecto clínico y electrofisiológico de la estimulación magnética transcraneal repetitiva derecha e izquierda en pacientes con transtorno depresivo mayor

Major Depressive Disorder (MDD) is a common psychiatric disorder that represents one of the main public health problems worldwide. It has been projected that for 2020 it will be the second cause of disability-adjusted life years just below ischemic heart disease. Quantitative electroencephalogram provides the opportunity to study cortical oscillatory activity across the different frequency bands. It constitutes an accessible tool to explore the clinical and neurophysiologic correlates underlying psychiatric disorders as well as the effect of diverse therapeutic options and the performance through cognitive tasks. Repetitive transcranial magnetic stimulation is a technique that allows the stimulation of the cerebral cortex noninvasively, relatively painlessly and with fairly few side effects. The vast majority of rTMS studies target left dorsolateral prefrontal cortex (DLPFC) based on imaging studies showing that left prefrontal cortex dysfunction is pathophysiologically linked to depression. However, there is some evidence implicating right PFC in the pathophysiology of depression. Comparison of antidepressant efficacy of diverse stimulation frequencies is relevant since a main concern around rTMS is its potential to induce seizures; hence we consider that frequency of stimulation is an important aspect to be studied. For this study we aimed to elucidate the clinical efficacy of rTMS comparing two groups of depressed patients stimulated over DLPFC, one over the left (at 5 Hz) and other over the right (at 1 Hz). We also meant to know if there were clinical and electroencephalographic differential long-term after-effects between those groups of treatment. We included twenty right-handed patients with a DSM-IVR diagnosis of MDD. They were assigned into two groups of treatment. Group 1 received 5Hz rTMS over the left DLPFC. Group 2 received 1Hz rTMS over the right DLPFC. We obtained two EEG measurements in order to analyze Z score of broad-band spectral parameters and cross-spectral. No statistical differences among groups were found in response to treatment after weekly comparisons of clinimetric scores and significant differences between baseline and final assessment by HDRS, MADRS, BDI and HARS. The major rTMS effect on EEG was observed in the group that received 1 Hz over the right DLPFC and no significant effects were observed for the group that received 5 Hz over the left DLPFC. Our results propose that administration of 15 sessions on either left (5 Hz) or right (1 Hz) rTMS over DLPFC is sufficient to reach response to treatment, assessed by HDRS, MADRS, BDI and HARS in subjects with MDD. Moreover, in both cases rTMS was able to induce an equivalent antidepressant effect. The major effect of rTMS on EEG was observed in the right 1 Hz rTMS group where changes were elicited mainly over frontal, central and temporal regions on alpha and particularly beta frequency bands. In a lesser extent for left 5 Hz rTMS group the main effect was observed on anterior regions for beta and particularly alpha frequency bands. We believe it is pertinent to continue exploring the therapeutic potential of lower stimulation frequencies, for what further research including larger samples is still necessary to confirm these trends.

El trastorno depresivo mayor es una entidad psiquiátrica que representa uno de los principales problemas de salud pública a nivel mundial. Se ha proyectado que para el año 2020 será la segunda causa de discapacidad únicamente por debajo de la cardiopatía isquémica. La utilización del electroencefalograma cuantitativo ofrece la oportunidad de estudiar la actividad oscilatoria cortical a través de las diferentes bandas de frecuencias. Éste constituye una herramienta para explorar las características clínicas y neurofisiológicas que subyacen a los trastornos psiquiátricos, así como un instrumento para evaluar el efecto de diversas opciones terapéuticas y el desempeño de los sujetos durante la realización de tareas cognitivas. La estimulación magnética transcraneal repetitiva (EMTr) es una técnica que permite la estimulación de la corteza cerebral de manera no invasiva, relativamente sin dolor y con pocos efectos secundarios. Con base en los estudios de neuroimagen que vinculan la fisiopatología de la depresión con disfunción en la corteza prefrontal dorsolateral (CPFDL), la mayoría de las investigaciones se han enfocado en estimular dicha corteza en el hemisferio izquierdo. No obstante, existen pruebas que implican a la corteza prefrontal derecha con la fisiopatología de la depresión. La relevancia de comparar la eficacia antidepresiva de diversas frecuencias radica en el hecho de que un tema de interés particular alrededor de la EMTr es su potencial para inducir convulsiones, por ello consideramos que la exploración de las diversas frecuencias de estimulación con efecto terapéutico constituye un aspecto importante de estudio. Para este trabajo nos propusimos determinar la eficacia antidepresiva de la EMTr comparando dos grupos de pacientes que fueron estimulados en la CPFDL derecha a 1 Hz o en la izquierda a 5 Hz. También buscamos dilucidar si existen diferencias clínicas y electroencefalográficas a largo plazo entre grupos de tratamiento. Para este estudio se incluyeron 20 pacientes con diagnóstico de trastorno depresivo mayor de acuerdo con los criterios del DSM-I V. Los sujetos fueron asignados aleatoriamente a uno de dos grupos de tratamiento. Un grupo recibió EMTr sobre la CPFDL izquierda a 5Hz; el otro recibió estimulación a 1 Hz sobre la corteza contralateral. Se obtuvieron dos registros electroencefalográficos, uno basal y otro final, con el fin de comparar las medidas espectrales de banda ancha y estrecha, pretratamiento y postratamiento. Se realizaron evaluaciones clinimétricas con las escalas de Hamilton para Depresión y Ansiedad, la escala de Depresión de Montgomery-Asberg y el Inventario de Beck. No encontramos diferencias significativas al comparar la respuesta a la EMTr entre ambos grupos. Los pacientes de ambos grupos presentaron respuesta a tratamiento (disminución de ≥50% de la sintomatología depresiva) medida por clinimetría. El efecto más importante de la EMTr sobre el EEG se observó en el grupo de estimulación derecha a 1 Hz donde encontramos disminución postratamiento en los valores Z de banda estrecha alfa y beta, principalmente en regiones fronto-centro-temporales. Aunque en menor proporción, en el grupo de estimulación izquierda a 5 Hz encontramos incrementos significativos post EMTr, predominantemente en las bandas beta y alfa sobre todo en regiones anteriores. No se encontraron resultados significativos en el análisis de banda ancha. Nuestros resultados sugieren que la administración de 15 sesiones de EMTr ya sea sobre la CPFDL derecha (1 Hz) o izquierda (5 Hz) es capaz de lograr respuesta antidepresiva. Nuestros hallazgos electrofisiológicos sugieren que uno de los efectos a largo plazo de la EMTr es la reorganización de los circuitos neuronales implicados en la depresión.

Biodegradación anaerobia de las aguas generadas en el despulpado del café / Anaerobic biodegradation of wastewater generated in the pulping of coffee

El cultivo y procesado del café es una de las actividades agroindustriales más importantes en varios países de Latinoamérica; sin embargo, dicha actividad conlleva grandes impactos ambientales, ya que genera aguas residuales con alta carga contaminante. La peligrosidad ecológica de estos vertidos ha potenciado la búsqueda de alternativas para su tratamiento y disposición final. En este trabajo se empleó una comunidad microbiana proveniente del fluido ruminal vacuno, para investigar la factibilidad de su empleo en la depuración de aguas residuales provenientes del despulpado del café, mediante la disminución de la carga orgánica expresada como DQO, además del volumen de metano generado. La cinética de degradación fue seguida en un reactor por lotes, anaerobio y mesofílico de dos litros de capacidad, bajo diferentes condiciones de temperatura (28 y 36 ºC) y pH (4,6; 7 y 8,5). Los resultados mostraron un índice volumétrico de lodos de 0,44 mL/g y actividad metanogénica específica de 0,0076 gDQO/gSST*d. En la mayoría de los casos, los resultados de remoción de DQO fueron superiores a la mitad del contenido orgánico inicial, llegando a 91,2% con pH de 4,6 y 28 ºC en 16 días. Los resultados muestran que el consorcio bajo estudio es capaz de adaptarse al sustrato y degradar la mayor parte de su carga orgánica, lo cual lo convierte en una interesante opción biotecnológica para el tratamiento de vertidos del despulpado de café.

The cultivation and processed of coffee, is one of the agro-industrial activities more important in several countries in Latin America; however this activity involves high environmental impacts, because generate wastewater with high pollution load. The danger ecological these discharges, has maximized the search for alternatives of treatment and disposal. In this work, was used a microbial community from fluid ruminal of cow, to investigate the feasibility of your employment in the depuration of wastewater generated in the pulping of the coffee, through the reduction of organic matter expressed as COD, in addition of volume of methane generated. The kinetic of degradation was followed in a reactor batch, anaerobic and mesophilic of two liters of capacity, under different conditions of temperature (28 and 36ºC) and pH (4.6, 7 and 8.5). The results showed a volume index of sludge of 0.44 ml/g and activity specific methanogenic of 0.0076 gDQO/gSST*d. In most cases, the results of removal of COD was more than half of the initial organic content, reaching 91.2% with pH of 4.6 and 28 ºC in 16 days. The results show that the consortium under study is able to adapt to the substrate and degrade greater part of organic load, which makes it an interesting option biotechnology for the treatment of wastewater of pulping of coffee.

Estimulación magnética transcraneal para síntomas negativos en la esquizofrenia: una revisión / The transcraneal magnetic stimulation for the negative symptoms in schizofrenia: a review

Schizophrenia is one of the most studied diseases in psychiatry and different dysfunctions of thinking, emotions, perception, movement, and behavior converge in it. These dysfunctions affect the quality of life of the patients in different ways. It is a disease that has been observed in the whole world, with a 0.5 to 1.5% prevalence among adults. Although the biological basis of schizophrenia is not clear enough, the dopaminergic hypothesis is preponderant in our understanding of the symptoms of the disease. A mesolimbic pathway hyperactivity is related to a positive symptomathology, while a prefrontal dopaminergic hypofunction relates to negative symptoms. It has been observed that using serotoninergic antagonists, which promote dopaminergic activity in the prefrontal cortex, translates in to a reduction of the intensity of negative symptoms. This negative syndrome includes a difficulty to initiate new activities (apathy), speech and creativity impoverishment (alogia), alterations in emotional expression, and a lack of capacity to experiment joy. Patients with negative symptoms present gray and white matter loss in left-sided cerebral structures, including temporal lobe, anterior cingulated, and medial frontal cortex. Such a loss seems to be more evident in prefrontal regions, such as the dorsolateral prefrontal region, which connects with anterior temporal structures. Persistent negative symptomathology is a concept proposed by Buchanan, which must fulfill the following criteria: symptoms are primary to the disease or secondary but have not responded to current treatment; interfere with the patient's capacity to accomplish normal functioning; persist during periods of clinical stability, and represent an unresolved therapeutic need. They must be measurable by clinical scales and persist, at least, six months. The Food and Drug Administration has recently considered negative symptoms as an investigation target or new treatments due to their prevalence and high negative impact in the life of the schizophrenic population. Nowadays, the current treatments available for such an entity are second generation antipshycotics and glutamatergic agents -such as d-cycloserine and glicine-, amisulpiride and seleginine, even though their efficacy is limited. Dysfunction of the human prefrontal cortex is considered to be implicated in the pathophisiology of negative symptoms. This cerebral region is essential in the regulation of emotions and cognition. Multiple neural networks begin in the prefrontal cortex and go towards other cortical association areas, to insular region, thalamic structures, basal ganglia and limbic system. It regulates dopaminergic mesencephalic activity through activating and inhibitory pathways, allowing a precise regulation of dopaminergic activity. This double modulation model of dopaminergic pathways has been recently sustained by studies which prove that extracellular dopaminergic concentration in nucleus accumbens increases or reduces after a high or low frequency stimulation of the prefrontal cortex, respectively. A prefrontal cortex lesion causes a syndrome similar to the negative symptomathology in schizophrenia. Transcraneal magnetic stimulation (TMS) could be effective in the treatment of negative symptoms by activating the prefrontal cortex, maybe by stimulating the liberation of dopamine in the mesolimbic and mesoestriatal pathways which have a crucial role in the pathogenesis of negative symptoms such as apathy and anhedonia. TMS was introduced in 1985 and since the early 90's its potential as a treatment has been tested in numerous neurological and psychiatric conditions. It is a noninvasive means of stimulating nervous cells in superficial areas of the brain. During a TMS procedure, an electrical current passes through a wire coil placed over the scalp. This induces a magnetic field that can produce a substantive electrical field in the brain. This electrical field produces in turn a depolarization of nervous cells resulting in the stimulation or disruption of brain activity. TMS may be applied as a single stimulus or repeated many times per second (repetitive TMS), with variations in the intensity, site, and orientation of the magnetic field. Most research and interest has focused on the potential application of repetitive TMS (rTMS) in the treatment of depression. In addition, in recent years an increasing number of open and double-blinded studies of rTMS were conducted in patients with schizophrenia. Most investigators have chosen to focus on the treatment of specific refractory symptoms or syndromes within the disorder such as refractory auditory hallucinations or persistent negative symptoms. TMS has become widely used in research, especially as a method to probe normal and abnormal brain function, motor cortical physiology, and cognition. Regarding negative symptoms in schizophrenia, eleven studies using TMS were carried out until 2006, with a total of 172 patients studied. These studies are difficult to compare because they used different stimulation parameters and the symptoms described were heterogenic. Six studies were blind and five were open, using high frequency TMS in all of them (frequencies above 1 Hz), which is the type of stimulation most commonly used in treatment studies. Six of these studies found a reduction in the severity of the symptoms, but the reduction was not significant in two of them. Ten were the maximum number of sessions included in every study, except for one, in which 20 sessions of TMS were given. In this study, the score of negative subscale of the PANSS was reduced in 33%, which is considered a significant response, and this result was sustained within the next month. In one of these studies, researchers compared 3- and 20-Hz stimulation with sham stimulation and stimulation provided at the patient's individual alpha frequency. Alpha-frequency stimulation was calculated as the patient's peak alpha frequency from five frontal EEG leads. Stimulation of alpha frequency resulted in a significantly greater reduction in negative symptoms than the other conditions. This finding could suggest that negative symptoms may specifically relate to alpha EEG oscillations, which is interesting and requires further exploration and confirmation. Another two studies were conducted in 2007; in the first one, no improvement in negative, positive of affective symptoms was found. The second one, which was a double-blinded clinical trial, found a significant reduction in the intensity of negative, positive, and general symptoms with the active TMS. We should remark that TMS produces changes in the cortical activity in ventral and dorsoestratial regions, but other cerebral regions could be stimulated too, since some activation abnormalities in the left globus palidus, bilateral caudate nucleus, prefrontal, and temporal right cortex have been found and are associated with the etiology of the negative syndrome. In addition, it will be interesting to see whether changes in subcortical dopamine release, which were shown with rTMS in normal volunteers, can be demonstrated in clinical populations, such as patients with schizophrenia, and how this may relate to response to treatment. There is still a need for a larger number of controlled studies, with larger samples, longer periods of evaluation, and constant stimulation parameters, so they can be compared between them and the exact efficacy of TMS as a treatment for negative symptoms can be established.

La estimulación magnética transcraneal (EMT) es un método no invasivo que utiliza campos magnéticos alternantes para inducir corrientes eléctricas en el tejido cortical en diferentes áreas cerebrales. Se considera una forma de tratamiento para diferentes trastornos psiquiátricos, especialmente en la depresión, adicciones y esquizofrenia. Está técnica terapéutica ofrece una vía innovadora para estudiar la excitabilidad de la corteza, la conectividad regional cortical, la plasticidad de las respuestas cerebrales y las funciones cognitivas en el estado del enfermo. Aunque se han documentado resultados positivos en la estimulación de la CPF izquierda y en la CPF derecha, se sugiere que puede ejercer su acción beneficiosa a través de diversos mecanismos de acción aún no comprendidos en su totalidad. La corteza prefrontal humana es esencial en el control e integración de las emociones, la cognición y la regulación del Sistema Nervioso Autónomo. Numerosas conexiones neuronales bidireccionales se originan en la CPF y se extienden al resto de las áreas de asociación cortical, región insular, sistema límbico y los ganglios basales. La CPF modula la actividad dopaminérgica mesencefálica mediante una vía activadora y otra inhibidora, lo que permite una regulación sumamente fina de la actividad dopaminérgica. La vía activadora funciona por medio de proyecciones glutamatérgicas directas e indirectas a las células dopaminérgicas. La vía inhibitoria hace lo propio mediante eferencias glutamatérgicas prefrontales a las interneuronas GABAérgicas mesencefálicas y a las neuronas GABAérgicas estriatomesencefálicas. El modelo de la doble modulación del sistema dopaminérgico mesolímbico demuestra que la concentración dopaminérgica extracelular en el núcleo accumbens disminuye o aumenta después de la estimulación de la corteza prefrontal a baja o alta frecuencia, respectivamente. Dentro de los estudios que utilizan la EMT en la esquizofrenia, se ha encontrado que, tras una EMT de alta frecuencia (>1Hz) o repetititiva (EMTr), hay un aumento de la excitabilidad en varias áreas cerebrales, mientras que la excitabilidad cortical disminuye tras una EMT de baja frecuencia (<1Hz). La excitabilidad cortical también depende de la intensidad y duración de la estimulación, lo que quiere decir que a intensidades más altas habrá mayor actividad cortical y a trenes prolongados habrá cambios duraderos en la excitabilidad cortical. Una gama de síntomas de difícil tratamiento en la esquizofrenia son los síntomas negativos persistentes, donde se ha demostrado una disminución de la actividad en la CPF, por lo que la EMT se ha utilizado para revertir dicha hipoactividad y disminuir los síntomas. De forma contraria, los síntomas positivos, como las alucinaciones, se asocian con una hiperactividad de las áreas témporo-parietales y por tanto debería resultar beneficiosa la aplicación de EMT de baja frecuencia en dichas áreas. La EMT de alta frecuencia también se ha utilizado para tratar a sujetos con síntomas catatónicos prominentes y se ha logrado una mejoría con el tratamiento. El objetivo de esta revisión es que se comprendan mejor la EMT y el uso que se le puede dar para tratar diversos síntomas en la esquizofrenia.

Tryptophan and serotonin in blood and platelets of depressed patients: Effect of an antidepressant treatment

Abstract: Platelets llave serotonin (5-HT) uptake and storage mechanisms similar to those from neurons. In addition, they represent nearly 99% of blood 5-HT concentration. For these characteristics, platelets are considered useful biomarkers of the serotonergic synaptic neurotransmission, particularly in psychiatric disturbances such as depression. However, most studies which have evaluated platelet 5-HT concentrations in depression have not shown similar findings. It has been suggested that changes in plasma tryptophan (TRP) concentrations might modify 5-HT concentration in the brain, as well as in platelets. Likewise, decreased plasma concentrations of TRP have been found in depressed patients, and the selective 5-HT reuptake inhibitors (SSRIs) induce changes in platelet 5-HT concentration. Considering the controversy surrounding platelet 5-HT concentrations in depressed patients, and the fact that blood 5-HT and TRP have not been studied in the Mexican population, we decided to study 5-HT and tryptophan concentrations in blood and platelets from depressed and control Mexican subjects to evaluate a possible correlation with the severity of depression. The effect of fluoxetine and citalopram treatment on blood and platelet 5-HT and TRP concentrations in depressed patients was also studied. Material and methods Depressed patients The patients of this study were carefully selected and evaluated. Scales based on semi-structured interviews were applied (MINI and SCID-II) by clinical investigators to reduce any possible bias in patient selection. The influence of the seasonal variability on the 5-HT or TRP blood concentrations was controlled by pairing depressed patients and healthy subjects according to age, gender and, in the case of women, menstrual cycle phase. Patients with a complete remission of depression symptoms (defined as a score not higher than 5 points in the Hamilton's scale, and lower than 7 points in Beck's scale) were asked for a blood sample to measure platelet and blood concentrations of 5-HT and TRP. The patients were weighted before the treatment and after their improvement. Control subjects The control group was integrated by 30 healthy subjects, 24 women and 6 men, with an average age of 32.3 ± 10.8 years. Participants were recruited from the overall Mexican population, interviewed by a psychiatrist, and evaluated with the structured interview MINI and the SCID-II, all these to discard any psychiatric diagnose. None of them had received any pharmacological treatment during the three weeks prior to the study. Control and depressed women were paired according to their menstrual cycle phase. All participants received a detailed explanation of the study, and those who voluntarily accepted the stipulations signed an informed consent document. Control and patient subjects were clinically examined and studied with routine laboratory tests (blood count, blood chemistry, urinalysis, and thyroid function test). Blood sample procedures 5-HT and TRP measurements in total blood preparation were carried out according to the method described by Anderson, and were quantified by high performance liquid chromatography (HPLC). Statistical analysis The differences were statistically determined through an analysis of variance (ANOVA), with the assistance of the SPSS 12.00 (Statistical Software by SPPS Inc.). Results Results from laboratory tests, such as blood count, blood chemistry, thyroid function (T3, T4 and TSH) and urinalysis were normal in depressed subjects, as well as in healthy volunteers. Platelet number, blood 5-HT concentration, platelet content of 5-HT, and blood tryptophan concentration showed no significant differences in depressed patients in comparison to control subjects. 5-HT values in blood and platelet were significantly lower than the initial concentrations in patients after antidepressant treatment. Discussion and conclusions Discrepancies between our study and those found in the literature can be explained with three different approaches: ethnical, physiological, and methodological, as is further discussed. The significant decrease produced by the antidepressant treatment in blood and platelet serotonin concentration may be a consequence of the action of SSRIs, due to a 5-HT diminished uptake by the platelet. Considering our results, we conclude that: Blood and platelet 5-HT concentrations were not different between depressed patients and healthy volunteers. Blood TRP concentrations were not different between depressed patients and healthy volunteers. SSRIs (fluoxetine or citalopram) used in the treatment of depressed patients induced a significant decrease in blood and platelet content of 5-HT, and had no effect in TRP concentrations. Based on these results, neither blood/platelet 5-HT nor blood tryptophan concentrations seem to be good biological markers of depressive patients status. However, 5-HT, but not tryp-tophan, might be a reference point for pharmacological treatment effect.

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El uso de las Guías Internacionales de Diagnóstico y Tratamiento del Asma (GINA) en la práctica clínica de los médicos familiares / Use of international guidelines for the diagnosis and treatment of asthmatic patients in the clinical practice of familial physicians

Objetivo: evaluar el grado de conocimiento que tienen los médicos familiares sobre las Guías Internacionales de Diagnóstico y Tratamiento del Asma (GINA). Material y método: se aplicó un cuestionario a 50 médicos familiares de las Unidades de Medicina Familiar números 1, 21 y 28. Los participantes tenían una edad promedio de 46 años y una proporción 1:1 entre el sexo masculino y el femenino. El análisis se realizó con SPSS y la prueba r de Pearson. Resultados: la correlación entre los conocimientos generales sobre el asma y las nociones sobre las GINA fue de r=0.022; la de los conocimientos generales del asma y la especialidad de medicina familiar, de r=-0.117 y la de los conocimientos sobre las Guías Internacionales del Asma y la medicina familiar, de r=0.33. Conclusiones: existe un escaso conocimiento de las guías GINA.

Proyecciones a corto plazo de la incidencia del Sida en México y análisis de los patrones de sobrevida / Short term projections of AIDS incidence in Mexico and analysis of survival patterns

Se explora la distribución real del retraso en la notificación de los casos de SIDA durante el curso de la epidemia en México. Se realizan proyecciones a corto plazo de la incidencia acumulada del SIDA en México, basadas en el ajuste de un modelo logístico lineal y considerando la distribución temporal del retraso en la notificación. La comparación de estas proyecciones a corto plazo con datos observados hasta Diciembre de 1992, resulta excelente. Se realiza un análisis estadístico de los patrones de sobrevida de los casos de SIDA entre hombres homosexuales y transfundidos. Se comparan los estimadores de máxima verosímilitud del modelo exponencial de sobrevida con los estimadores del análisis empírico de sobrevida Kaplan-Meier. Este análisis considera tanto el sesgo producido por el retraso en la notificación del diagnóstico de SIDA después de la muerte, como el producto por la distribución del retraso en la notificación durante la epidemia. Se demuestra un ligero aumento en la esperanza de vida de los casos de SIDA en hombres homosexuales y transfundidos