Actualización del consenso chileno SOCHINEP-SER para el manejo de las sibilancias recurrentes del preescolar / Update of the chilean consensus SOCHINEP-SER for the management of recurrent wheezing in preschool children

Las sibilancias recurrentes del preescolar son un problema prevalente. 50% de todos los niños tiene al menos un episodio de sibilancias en los primeros 6 años. Sin embargo, solo 4% de los menores de 4 años tiene diagnóstico de asma. Por este motivo es fundamental realizar una adecuada anamnesis y examen físico tendientes a descartar causas secundarias, lo que debe ser complementado con exámenes de laboratorio de acuerdo con la orientación clínica. En la actualidad se recomienda indicar tratamiento de mantención con corticoides inhalados en aquellos niños que tengan episodios repetidos de obstrucción bronquial y que tengan una alta probabilidad de respuesta favorable a esta terapia. Se ha demostrado que aquellos pacientes que tienen un recuento de eosinófilos en sangre > 300 células por mm3 o aquellos que presentan una prueba cutánea positiva o IgE específicas positivas para alergenos inhalados responderán adecuadamente al tratamiento con esteroides inhalados.

Recurrent wheezing in preschoolers has a high prevalence. 50% of all children have at least one wheezing episode in the first six years of life. However, only 4% of children under four years of age are diagnosed with asthma. Therefore it is essential to carry out an adequate medical history and physical examination to rule out secondary causes, which must be complemented with laboratory tests in accordance with clinical guidance. It is recommended to indicate maintenance treatment with inhaled corticosteroids to those children who have repeated episodes of wheezing and who have a high probability of a good response to this therapy. It has been demonstrated that those patients who have blood eosinophil count > 300 cells per mm3 or those who have a positive skin test or positive specific IgE for inhaled allergens will have a good response to inhaled corticosteroids.

Actualización del consenso chileno SOCHINEP-SER para el manejo de las sibilancias recurrentes del preescolar / Update of the chilean consensus SOCHINEP-SER for the management of recurrent wheezing in preschool children

Las sibilancias recurrentes del preescolar son un problema prevalente. 50% de todos los niños tiene al menos un episodio de sibilancias en los primeros 6 años. Sin embargo, solo 4 % de los menores de 4 años tiene diagnóstico de asma. Por este motivo es fundamental realizar una adecuada anamnesis y examen físico tendientes a descartar causas secundarias, lo que debe ser complementado con exámenes de laboratorio de acuerdo con la orientación clínica. En la actualidad se recomienda indicar tratamiento de mantención con corticoides inhalados en aquellos niños que tengan episodios repetidos de obstrucción bronquial y que tengan una alta probabilidad de respuesta favorable a esta terapia. Se ha demostrado que aquellos pacientes que tienen un recuento de eosinófilos en sangre > 300 células por mm3 o aquellos que presentan una prueba cutánea positiva o IgE específicas positivas para alérgenos inhalados, responderán adecuadamente al tratamiento con esteroides inhalados.

Recurrent wheezing in preschoolers has a high prevalence. 50% of all children have at least one wheezing episode in the first six years of life. However, only 4% of children under four years of age are diagnosed with asthma. Therefore, it is essential to carry out an adequate medical history and physical examination to rule out secondary causes, which must be complemented with laboratory tests in accordance with clinical guidance. It is recommended to indicate maintenance treatment with inhaled corticosteroids to those children who have repeated episodes of wheezing and who have a high probability of a good response to this therapy. It has been demonstrated that those patients who have blood eosinophil count > 300 cells per mm3 or those who have a positive skin test or positive specific IgE for inhaled allergens will have a good response to inhaled corticosteroids.

Consenso chileno SOCHINEP-SER para el diagnóstico y tratamiento del asma en el escolar / Chilean SOCHINEP-SER consensus for asthma diagnosis and treatment in school age children

Bronchial asthma is the most prevalent chronic condition among children, however, in Chile, it is underdiagnosed. This may be due to medical professionals failing to recognize the disease. It is essential to be aware of the symptoms and signs that are suggestive of the disease in order to begin an appropriate treatment to achieve disease control. Asthma must be suspected in school age children who present repeated episodes of bronchial obstruction. The diagnosis should be confirmed with lung function tests that demonstrate variable airflow obstruction with a positive bronchodilator response. Treatment is based on two fundamental pillars: education and pharmacological treatment. Educational activities must include: information about the disease and its treatment, regular monitoring of treatment adherence, teaching and reviewing the correct inhalation technique at every checkup, developing a personalized written action plan and scheduling regular follow-up appointments. The gold standard for treatment is maintenance inhaled corticosteroids, in the lowest possible dose that enables disease control. The goal of the treatment is to eliminate daily symptoms and asthma crisis. Therapy should be increased if control is not achieved, but before starting it, adherence to maintenance treatment, inhalation technique, presence of associated comorbidities and environmental exposure should be evaluated. In the mild patient, who is not receiving maintenance therapy, rescue treatment should be done with bronchodilators, always associated with inhaled corticosteroids. This consensus is a guide to improve the diagnosis, treatment and control of asthma in schoolchildren.

El asma bronquial es la enfermedad crónica más frecuente en la infancia. Sin embargo en Chile existe un importante subdiagnóstico. Es fundamental estar atentos a los síntomas y signos que nos hacen sospechar el diagnóstico para iniciar un tratamiento oportuno, que asegure un buen control de la enfermedad. Debemos sospechar asma en todo escolar que presente cuadros repetidos de obstrucción bronquial. El diagnóstico debe confirmarse con pruebas de función pulmonar que demuestren obstrucción variable al flujo aéreo y respuesta broncodilatadora positiva. El tratamiento se basa en dos pilares fundamentales: la educación y el tratamiento farmacológico. Las actividades educativas deben incluir contenidos acerca de la enfermedad y su tratamiento, se debe monitorizar constantemente la adherencia al tratamiento de mantención, enseñar la técnica inhalatoria correcta y revisar en cada control, entregar un plan de acción escrito personalizado frente al inicio de una crisis y realizar controles médicos periódicos. Con respecto al tratamiento farmacológico, el estándar de oro es el uso de corticoides inhalados permanentes, en la mínima dosis posible que logre el control de la enfermedad. El objetivo del tratamiento es la supresión de los síntomas diarios y de las crisis. El tratamiento se irá incrementando en la medida que no haya una respuesta adecuada, pero antes de aquello se debe evaluar la adherencia al tratamiento de mantención, la técnica inhalatoria, presencia de comorbilidades asociadas y exposición ambiental. En el paciente leve, que esté sin tratamiento permanente, el rescate debe realizarse con broncodilatadores asociados siempre a un corticoide inhalado. Este consenso es una guía de apoyo para mejorar el diagnóstico oportuno, tratamiento y control del asma en el escolar.

Consenso chileno SOCHINEP-SER para el diagnóstico y tratamiento del asma en el escolar / Chilean SOCHINEP-SER consensus for asthma diagnosis and treatment in school age children

El asma bronquial es la enfermedad crónica más frecuente en la infancia. Sin embargo, en Chile existe un importante subdiagnóstico. Es fundamental estar atentos a los síntomas y signos que nos hacen sospechar el diagnóstico para iniciar un tratamiento oportuno, que asegure un buen control de la enfermedad. Debemos sospechar asma en todo escolar que presente cuadros repetidos de obstrucción bronquial. El diagnóstico debe confirmarse con pruebas de función pulmonar que demuestren obstrucción variable al flujo aéreo y respuesta broncodilatadora positiva. El tratamiento se basa en dos pilares fundamentales: la educación y el tratamiento farmacológico. Las actividades educativas deben incluir contenidos acerca de la enfermedad y su tratamiento, se debe monitorizar constantemente la adherencia al tratamiento de mantención, enseñar la técnica inhalatoria correcta y revisar en cada control, entregar un plan de acción escrito personalizado frente al inicio de una crisis y realizar controles médicos periódicos. Con respecto al tratamiento farmacológico, el estándar de oro es el uso de corticoides inhalados permanentes, en la mínima dosis posible que logre el control de la enfermedad. El objetivo del tratamiento es la supresión de los síntomas diarios y de las crisis. El tratamiento se irá incrementando en la medida que no haya una respuesta adecuada, pero antes de aquello se debe evaluar la adherencia al tratamiento de mantención, la técnica inhalatoria, presencia de comorbilidades asociadas y exposición ambiental. En el paciente leve, que esté sin tratamiento permanente, el rescate debe realizarse con broncodilatadores asociados siempre a un corticoide inhalado. Este consenso es una guía de apoyo para mejorar el diagnóstico oportuno, tratamiento y control del asma en el escolar.

Bronchial asthma is the most prevalent chronic condition among children, however, in Chile, it is underdiagnosed. This may be due to medical professionals failing to recognize the disease. It is essential to be aware of the symptoms and signs that are suggestive of the disease in order to begin an appropriate treatment to achieve disease control. Asthma must be suspected in school age children who present repeated episodes of bronchial obstruction. The diagnosis should be confirmed with lung function tests that demonstrate variable airflow obstruction with a positive bronchodilator response. Treatment is based on two fundamental pillars: education and pharmacological treatment. Educational activities must include: information about the disease and its treatment, regular monitoring of treatment adherence, teaching and reviewing the correct inhalation technique at every checkup, developing a personalized written action plan and scheduling regular follow-up appointments. The gold standard for treatment is maintenance inhaled corticosteroids, in the lowest possible dose that enables disease control. The goal of the treatment is to eliminate daily symptoms and asthma crisis. Therapy should be increased if control is not achieved, but before starting it, adherence to maintenance treatment, inhalation technique, presence of associated comorbidities and environmental exposure should be evaluated. In the mild patient, who is not receiving maintenance therapy, rescue treatment should be done with bronchodilators, always associated with inhaled corticosteroids. This consensus is a guide to improve the diagnosis, treatment and control of asthma in schoolchildren

El acto médico en la era de la telemedicina / The medical act in the era of telemedicine

Telemedicine partially resolved inequalities in access to health care, especially in geographical areas with a low number of doctors and in places with absent or insufficient specialists. Currently, Chile has a National Telehealth Program, but there are no specific laws on digital medicine that recognize remote medical acts and it is uncertain if they really are medical acts. The goal of a medical act is the well-being of a patient, requiring a therapeutic alliance based on the doctor's knowledge of the needs, expectations and fears of such a patient. This article tries to determine if patient care by telemedicine can be considered a medical act. For this purpose, the conception of a medical act defined by P. Laín Entralgo, M. Besio and the main medical and professional associations is analyzed in depth. It is concluded that although direct physical contact between doctor and patient largely supports the therapeutic alliance, telemedicine has been successful, particularly in its synchronous modality. Taking the necessary precautions, in most cases distant medical acts can be carried out allowing a humanized and respectful care of people.

Predições da espectroscopia no infravermelho próximo podem determinar a digestibilidade e o consumo alimentar de cordeiros confinados / Near-IR spectroscopy predictions can determine the digestibility and feed intake from feedlot lambs

O presente trabalho teve como objetivo validar a eficácia do método de espectroscopia de reflectância do infravermelho proximal (NIRS) em predizer o consumo e a digestibilidade da MS e nutrientes de dietas para cordeiros confinados, em comparação ao método convencional de laboratório. Amostras das dietas fornecidas, sobras e fezes de 40 cordeiros Santa Inês foram submetidas a ambos os métodos e analisadas quanto aos teores de MS, MM, FDN, FDA, PB e EE, para futuros cálculos do consumo e da digestibilidade. A maioria dos coeficientes de correlação do modelo ficou na faixa de 0,66 a 0,81, mostrando-se adequados para a predição quantitativa. Os maiores coeficientes foram observados para teores de PB das dietas (0,85) e sobras (0,87). Foram encontradas altas correlações entre os métodos na predição do consumo (média de 0,93) e digestibilidade (média de 0,90) das dietas. As correlações entre as variáveis obtidas pela predição do NIRS e pelo método convencional foram adequadas, demonstrando que, independentemente do método, os teores nutricionais das dietas, das sobras e das fezes podem ser utilizados para calcular o consumo e a digestibilidade da MS e dos nutrientes das dietas para cordeiros confinados, sendo recomendado o método NIRS pela precisão, pela rapidez e pelo baixo custo em relação ao método convencional.(AU)

This research was carried out to validate the effectiveness of the Near-IR spectroscopy method in predicting intake and digestibility of DM and nutrients of diets for feedlot lambs, in order to compare with the conventional laboratory method. Samples of diets, ort,s and feces of forty Santa Ines lambs were subjected to both methods and analyzed for DM, MM, NDF, ADF, CP, and EE for future calculations for intake and digestibility. Most of the model's correlation coefficient was in the range of 0.66 to 0.81, being suitable for quantitative prediction. Highest values for CP content of 0.85 (diets) and 0.87 (orts) were observed. There were high correlations between the methods to predicting intake (average values of 0.93) and digestibility (average values of 0.93). Correlations between the variables obtained by the prediction of NIRS and the conventional method were adequate, showing that regardless of the method, the nutritional content of diets, orts and feces can be used to calculate the intake and digestibility of DM and nutrients of lambs' diets. The Near-IR spectroscopy method is recommended for accuracy, speed and low cost compared to conventional method.(AU)

Glicerina na alimentação de cordeiros terminados em confinamento: características quantitativas da carcaça e qualitativas da carne / Glycerin in feeding of lambs finished in feedlot: quantitative characteristics of carcass and qualitative characteristics of meat

O presente trabalho foi conduzido com o objetivo de avaliar a ausência e a inclusão de glicerina na dieta de cordeiros terminados em confinamento, sobre as características da carcaça e a qualidade da carne no músculo semimembranosus. Foram utilizados 40 cordeiros machos, não castrados, da raça ½ Dorper ½ Santa Inês, desmamados com idade média de 90 dias e peso médio inicial de 21+2,3kg. Os tratamentos constituíram-se de duas dietas: G0 - ausência de glicerina e G10 - inclusão de 10% de glicerina na MS. O delineamento experimental utilizado foi o inteiramente ao acaso, com dois tratamentos e 20 repetições. Observou-se efeito para peso de abate (P=0,041) e rendimento de carcaça fria (P=0,019) entre os tratamentos. Conclui-se que os cordeiros alimentados com a inclusão de glicerina (inclusão de 10% de glicerina na MS) apresentaram melhor rendimento de carcaça fria e menor peso de abate, sem que fossem alteradas as demais características estudadas.(AU)

This study was conducted to evaluate absence and the inclusion of glycerin in the diet of feedlot finished lambs on carcass characteristics and meat quality in the semimembranosus muscle. Forty males of the breed ½ Dorper ½ Santa Inês weaned with average age of 90 days and average weight of 21+2.3kg were included. The treatments consisted of two diets: G0 - absence of glycerin and G10 - inclusion of 10% glycerol. The experimental design was completely randomized, with two treatments and 20 repetitions. There was effect to slaughter weight (P=0.041) and cold carcass yield (P=0.019) between treatments. We conclude that the lambs fed the inclusion of glycerin (10%) showed better cold carcass yield and lower slaughter weight without changing the other characteristics studied.(AU)

Análisis estadístico de los espectros de frecuencia de las regiones reguladoras del ENCODE / Statistical analysis of the Fourier Spectra of the ENCODE regulatory regions

RESUMEN En la actualidad, nuevas bases de datos genómicos (secuencias de ADN) son puestas al alcance del dominio público para su análisis. La bioinformática ha desarrollado algoritmos para extraer información y características de dichas secuencias. Sin embargo, estos algoritmos bioinformáticos tienen limitaciones. Una alternativa es utilizar herramientas propias del procesamiento digital de señales (DSP) adaptadas a secuencias genómicas (procesamiento de señales genómicas - GSP). El presente trabajo versa sobre el análisis de los cuatro primeros momentos centrales (media, desviación estándar, asimetría y curtosis) y dos momentos estadísticos (mediana y varianza) de los espectros frecuenciales de las 15 Regiones Reguladoras (RRs) de la base de datos ENCODE con el objetivo de estudiar diferencias estadísticas y frecuencias características. La base de datos seleccionada es "mapeada". Luego, la FFT es calculada a estas señales genómicas y finalmente los momentos estadísticos son implementados. Los resultados mues tran la existencia de 3 grupos de RRs utilizando la media, mediana y curtosis. La desviación estándar y la varianza, parecen no resaltar información importante. Finalmente, la asimetría revela un comportamiento homogéneo ante la presencia de valores atípicos en algunas RRs. Estas observaciones permiten inferir que la periodicidad dentro de la secuencia está relacionada o podría determinar la función biológica que desempeña la misma secuencia.

ABSTRACT Nowadays, new genomic databases (DNA sequences) are available to the whole scientist community for its analysis. The bioinformatics has developed algorithms to extract information and features of the sequences. However, the bioinformatics algorithms have restrictions. An alternative is the use of digital signal processing (DSP) tools adapted to genomic sequences (genomic signal processing - GSP). This work analyzes the first four statistics moments (mean, standard deviation, skewness and kurtosis) and other two moments (median and variance) of the frequency spectra of 15 regulatory regions (RRs) in ENCODE database with the main objective of studying the statistics di fferences and frequency features. The selected database is mapped. Then, the FFT is calculated to these genomic signals and finally the statistic moments implemented. The results show a three-group behavior in the RRs with the mean, median and kurtosis. The deviations standard and the variance do not show important behavior. Finally, the skewness shows a homogeneous behavior with the lack of atypical values in some RRs. These observations support the idea of the presence of periodicities in a sequence that may be related or may determine the biological function that a sequence may perform.

Desarrollo de una herramienta computacional para el análisis de conductancia galvánica de la piel, ECG y frecuencia respiratoria por arritmia sinusal respiratoria (SCRATER) / Development of a computational tool for the analysis of galvanic skin conductance, EKG and respiratory rate due to respiratory sinus arrhythmia (SCRATER)

Resumen: La existencia de una correlación entre la frecuencia cardíaca (FC), la frecuencia respiratoria (FR) y las respuestas electrodérmicas de la piel (Skin Conductance Response, SCR) ha sido reportada en la literatura, así como también el uso de estos parámetros como medida del nivel de activación del sistema nervioso autónomo. Objetivo: Este trabajo presenta una herramienta (SCRATER) para el análisis conjunto de SCR, FC y FR, las dos últimas, calculadas a partir del análisis del registro de electrocardiograma (ECG). Metodología: En esta investigación, se realizó una descripción detallada de cada algoritmo desarrollado, asi como una una descripción de la interfaz para utilizarlos. En la validación de los algoritmos empleados, se analizaron 192 registros de ECG y 231 registros de actividad electrodérmica (Electro-Dermal Activity, EDA) de 40 participantes masculinos sanos, de los cuales se calculó el número de complejos QRS y FC en cada registro de ECG y el número de SCRs de cada registro de EDA. Resultados: Los datos obtenidos fueron comparados con otras herramientas que analizan SCR y FC pero de manera independiente, obteniendo resultados equiparables mediante coeficientes de correlación. Limitaciones: El ruido y los artefactos presentes en los registros no permiten una correcta estimación de los parámetros y afectan los resultados de todas las herramientas empleadas en el desarrollo de este trabajo. Valor: SCRATER ofrece tres ventajas principales sobre las otras herramientas: 1) libre acceso, 2) código abierto y no utiliza formatos codificados o exclusivos. Conclusión: Este trabajo proporciona una herramienta computacional gratuita que permite analizar simultáneamente SCRs, FC y FR.

Abstract: The existence of a correlation between heart rate (HR), respiratory rate (RR) and skin conductance response (SCR) has been reported in the literature, as well as the use of these parameters as a measure of the activation level of the autonomous nervous system. Objective: This paper introduces a computational tool (SCRATER) developed with the aim to analyze simultaneous recordings of SCR, and heart and respiratory rates, which were calculated from the electrocardiogram recording (ECG) analysis. Methodology: In this research, a detailed description of each developed algorithm was made, as well as a description of the interface to be used. In the validation of the algorithms used, 192 ECG records and 231 Electro-Dermal Activity (EDA) registers of 40 healthy male participants were analyzed, from which the number of QRS complexes and HR in each ECG record and the number of SCRs of each EDA record are calculated. Results: The data obtained were compared with other tools that analyze SCR and HR separately, obtaining comparable results using correlation coefficients. Limitations: The noise and artifacts present in the records do not allow a correct estimation of the parameters and affect the results of all the tools used in the development of this work. Value: SCRATER offers three main advantages over other tools: 1) free access, 2) open source and 3) does not use coded or exclusive formats. Conclusion: This work provides a free computational tool that allows simultaneous analysis of SCRs, FC and FR.

Glicerina bruta associada à ureia na terminação de bovinos: consumo, desempenho e características da carne / Glycerin associated with urea in finishing beef cattle: performance and meat characteristics

Objetivou-se nesta pesquisa avaliar os efeitos da combinação de glicerina bruta e ureia sobre o consumo, o desempenho produtivo e as características da carne de bovinos da raça Nelore. O estudo foi conduzido no confinamento do Setor de Digestibilidade, pertencente à Faculdade de Ciências Agrárias e Veterinárias-FCAV/Unesp, Câmpus de Jaboticabal. Para tal, 28 novilhas, da raça Nelore (n=28, com aproximadamente 20 meses de idade, 278±5,6kg), foram aleatoriamente distribuídas em quatro tratamentos utilizando-se de delineamento inteiramente ao acaso. Quatro dietas com energia metabolizável e proteína bruta semelhantes foram formuladas utilizando-se a proporção volumoso:concentrado de 30:70. O volumoso empregado foi silagem de milho, e os concentrados foram compostos por milho grão moído, casca de soja, farelo de girassol, e a utilização ou não de acordo com o tratamento de glicerina e ureia. A introdução da glicerina e da ureia na dieta foi fixada, respectivamente, em 10 e 1% de inclusão na matéria seca da dieta. Os tratamentos foram: C = controle sem glicerina e ureia; U= 1% de ureia na matéria seca; G10= 10% de glicerina na matéria seca; GU10= 10% de glicerina e 1% de ureia na matéria seca. A introdução de 10% de glicerina bruta, com ou sem a presença de ureia, não modificou o consumo, tampouco nenhuma variável do desempenho produtivo (P>0,05). As características físico-químicas da carne, bem como o perfil de ácidos graxos, também não foram modificadas. O desempenho dos animais e as características da carne foram satisfatórios e dentro dos padrões esperados encontrados na literatura. Assim, a associação de glicerina com ureia pode ser uma estratégia viável em sistemas de produção de bovinos confinados.(AU)

The aim of this research was to investigate the effect of glycerol with urea, on the consumption and nutritional performance of Nelore cattle. The work was conducted within the confines of the digestibility sector, belonging to the Faculdade de Ciências Agrárias e Veterinária - FCAV/Unesp campus Jaboticabal. Heifers, Nellore, with approximately 20 months of age with an average body weight of 278kg were allotted to four treatments using a completely randomized design. Four diets with similar metabolizable energy and crude protein were formulated using the forage: concentrate ratio of 30:70. The roughage used was corn silage. The concentrates used were composed of corn, soybean hulls, sunflower meal, and the use or not of glycerin and urea in accordance with the treatment. The introduction of glycerin and urea in the diet was fixed respectively at 10 and 1% inclusion in the diet dry matter, based on recommendations found in the literature for cattle confinados. The treatments were: C = control without glycerin and urea, U = 1 % urea in dry matter; G10 = 10% glycerin dry matter; GU10 = 10% glycerin and 1 % urea in dry matter. The diets were not different ( P>0.05 ) in regards to performance of animals or meat characteristics, so the use of glycerin or glycerine association with urea did not alter the growth traits of Nelore heifers finished in confinement. Thus the association of glycerol with urea may be a viable strategy in the production of cattle feedlot systems.(AU)

Aspectos éticos en la donación de órganos, más allá de sólo generosidad / Ethical aspects in organ donation, beyond generosity

Organ donation for transplantation raises ethical dilemmas which demand a response from an anthropological vision respectful of the human person and his dignity. The ethical principles that should be respected primarily are: the defense of physical life, self-determination and non-instrumentalization of human beings. The act of donation is essentially altruistic and, as such, cannot be mandatory; consent process shall be ethically valid if it contains sufficient information and if is signed by a competent person, free of coercion. In the case of living donors, the act shall be lawful if there is an adequate relationship between the risks for the donor and the expected benefits for the recipient. Deceased organ donation occurs in two circumstances, when death is certified by neurological criteria (brain death) or by cardiovascular criterion (circulatory death); the latter usually occurs in critically ill patients in whom it has been decided to limit the therapeutic effort withdrawing life support measures. In decision-making at the end of life, physicians should always pursue the good of the patient, regardless of their status as potential donor; also, the medical team must have reasonable certainty that death has occurred when removing the organs. The person must always be treated as an end in itself and never as a mere means for obtaining other purposes, however laudable they may be.

La donación de órganos para trasplantes plantea dilemas éticos cuya respuesta demanda una visión antropológica respetuosa de la persona humana y su dignidad. Los principios éticos que deberían respetarse primariamente son: la defensa de la vida física, la autodeterminación y la no-instrumentalización del ser humano. El acto de donación es esencialmente altruista y, como tal, no puede ser obligatorio; el proceso de consentimiento será éticamente válido si es informado, suscrito por una persona competente y libre de coacción o coerción. En el caso del donante vivo, el acto será lícito en la medida que exista una relación adecuada entre los riesgos a que se somete el donante y los beneficios esperados para el receptor. La donación de órganos por alguien ya fallecido ocurre en dos circunstancias, según si la muerte se certifica mediante criterio neurológico (muerte encefálica) o por criterio cardiovascular (muerte circulatoria o en asistolía); este último caso ocurre habitualmente en pacientes críticos en quienes se ha decidido limitar el esfuerzo terapéutico suspendiendo medidas de soporte vital. Un correcto actuar médico siempre debe privilegiar el bien del paciente en la toma de decisiones al final de la vida, con independencia de su condición de potencial donante; asimismo, el equipo médico debe tener razonable certeza que la muerte ya ha ocurrido al momento de extraer los órganos. La persona debe ser tratada siempre como un fin en sí misma y nunca como mero medio para la obtención de otros fines, por muy loables que éstos sean.

Percepción de examen oral estandarizado vs no estandarizado en el internado de medicina interna / Students’ perceptions comparing standardized and non-standardized oral exams in internal medicine

Background: Oral examinations are a useful tool to appraise certain medical skills compared to other examinations. However, they have some disadvantages that might be reduced with standardization. Aim: To compare students’ perception comparing a standardized oral exam (SOE) versus a traditional, non-standardized oral exam (NSOE). Material and Methods: During the first semester of 2013 a NSOE was applied to internal medicine undergraduate students. During the second semester, a SOE was applied. An anonymous and voluntary perception questionnaire, consisting in 10 questions based on a 5-level Likert scale, was answered by these students. Statistical analysis was done using the Mann-Whitney U test. Results: Among the 118 students, 50.8% were evaluated using NSOE and 49.2% using SOE. Questionnaire response rate was 84%. Among respondents, 52% took the SOE and 48%, the NSOE. Students evaluated using SOE perceived that the degree of complexity of clinical cases was similar for all examinees (p < 0.05), that exam duration was standardized (p < 0.05), and that grades obtained were less influenced by the clinical site where the exam was taken (p < 0.05). However, anxiety level remained high in both groups, as well as the overall satisfaction experience. Conclusions: Standardization of an oral examination improves the perception of medical students about levels of difficulty, duration and external influences on the final grade.

Trastornos músculo-esqueléticos y psíquicos en población trabajadora, maquila de la confección, Departamento de Cortés, Honduras / Musculoskeletal and psychological disorders in garment maquila workers in Honduras

El objetivo general fue identificar la frecuencia de trastornos músculo-esqueléticos y psíquicos asociados a las condiciones y medio ambiente de trabajo en la población trabajadora de la industria maquiladora de ropa en el Departamento de Cortés, Honduras, con la finalidad de fundamentar estrategias para la prevención. El diseño fue transversal, observacional y descriptivo. Se realizó un muestreo por conveniencia habiendo participado 526 trabajadoras y trabajadores de la maquila de la confección de San Pedro Sula, Choloma, Villanueva y La Lima, del Departamento de Cortés, Honduras. Se aplicó una encuesta de uso epidemiológico. Se indagó sobre: datos generales, condiciones de trabajo, riesgos y exigencias laborales y sobre trastornos músculo-esqueléticos, depresión, ansiedad y estrés. Se definieron criterios de inclusión y de eliminación. El nivel de significancia fue establecido a p<0.05 y el estimador de los parámetros de interés fue reportado con su intervalo de confianza de 95%. El análisis de datos se realizó con el JMP8 de SAS Institute, Inc. Los trastornos músculoesqueléticos presentaron una tasa de 62 por cada 100 trabajadoras. La ansiedad, el distrés y la depresión se presentaron en 4 de cada 10 participantes. Las exigencias disergonómicas, los movimientos de fuerza con algunas partes del cuerpo, el no tomar agua para no ir al baño o disminuir el tiempo del almuerzo para alcanzar la meta de producción, se asociaron con los daños a la salud con valores de p<0.0001 y con prevalencias duplicadas. Se proponen medidas que impactan a la organización del trabajo.

The overall objective was to identify the frequency of musculoskeletal disorders and psychological conditions associated with working conditions and workplace environment in a population of garment assembly workers in the Department of Cortés, Honduras, as a basis for proposing prevention strategies. The study design was cross-sectional, observational, and descriptive. The study population consisted of a convenience sample of 526 garment workers in Honduran maquila plants in San Pedro Sula, Choloma, Villanueva and La Lima, Department of Cortés. An epidemiological survey was administered to participants, which asked about general information, working conditions, hazards and work demands; and musculoskeletal disorders, depression, anxiety and stress. Inclusion and exclusion criteria were defined, the significance level was set at p<0.05 and the estimates of the parameters of interest were reported with confidence intervals of 95%. Data analysis was carried out using JMP8 by SAS Institute, Inc. The prevalence of musculoskeletal disorders was 62 per 100 workers. Anxiety, stress, or depression were reported by 4 out of 10 participants. Work requirements or conditions associated with adverse health were awkward postures, forceful movements, refraining from drinking water in order to not have to go to the bathroom, and reducing lunch breaks to reach production targets. The associations had significance p <0.0001 and these factors doubled the prevalence of health damage. Measures impacting work organization are proposed.

Utilidad de la educación en asma bronquial infantil: experiencia piloto / Importance of education in pediatric bronchial asthma: pilot experience

Introduction: Even though asthmatic children in Chile have a guaranteed access to treatment, an important number of them have a severe adverse evolution, requiring hospitalization. Education in bronchial asthma is fundamental in the management of these patients, just as pharmacological therapy, as yet most Health Centers in our country do not hold educational activities. Patients and Methods: A pilot prospective study was carried out to evaluate the usefulness of bronchial asthma education, in a group of 12 patients hospitalized for asthma crisis in Clínica Santa María, Santiago de Chile. Patients were randomized in 2 groups, 7 patients receiving formal educational activities and 5 patients receiving the standard information given by their physician. Patients were followed 2, 6 and 12 months after discharge. Results: All studied patients exhibited an improvement in asthma control measured by Asthma Control Test -ACT-, as well as an improvement in quality of life, measured by a questionnaire (PaQLQ). Nonetheless, patients that received the educational activities did attend the Emergency Room less frequently and required less systemic corticosteroid treatments during the study than the patients that did not undergo formal education on asthma. Conclusions: This pilot study suggests that asthma education is a useful tool for patients, in order to achieve a better control of the disease.

Introducción: A pesar que hoy en día, en Chile, todos los niños asmáticos tienen acceso garantizado al tratamiento, un número importante de ellos evoluciona en forma severa requiriendo hospitalización. La educación en asma bronquial es un pilar fundamental en el manejo de estos pacientes, al igual que el tratamiento farmacológico. Sin embargo, la mayoría de los centros asistenciales de nuestro país no contemplan actividades educativas. Pacientes y Método: Se realizó un estudio piloto, prospectivo para evaluar la utilidad de la educación en asma bronquial en un grupo de 12 pacientes hospitalizados por crisis de asma en Clínica Santa María. Los pacientes fueron distribuidos en forma aleatoria en 2 grupos, 7 pacientes recibieron una actividad educativa formal y 5 la información habitual que entrega el médico tratante al momento del alta. Los pacientes fueron seguidos a los 2, 6 y 12 meses post alta. Resultados: Ambos grupos mejoraron el grado de control de la enfermedad medido por el Asthma Control Test (ACT) y la calidad de vida medida por cuestionario PaQLQ. Los pacientes que recibieron la actividad educativa consultaron menos al servicio de urgencia y requirieron menos curas con corticoides sistémicos durante el año de seguimiento en comparación con el grupo que no la recibió. Conclusiones: La educación parece ser una herramienta útil para lograr una mejor evolución en los pacientes asmáticos.

Consenso chileno SER-SOCHINEP para el manejo del asma en el preescolar / Chilean consensus on management of asthma in preschool children

Preschool wheezing is one of the most common presenting symptoms in pediatric practice. The vast majority of these patients present wheeze triggered by viral respiratory infections and only a minority of them will have asthma in school age. The evaluation of these children begin with a detailed clinical history and physical examination and standard laboratory tests to rule out secondary causes of wheezing. The decision for controlling therapy will depend on the frequency and severity of the wheezing episodes, but should always be considered as a treatment trial, avoiding prolonged periods of time. It is recommended to start with low doses of inhaled corticosteroids, evaluating treatment effect with a close follow up. Inhaled bronchodilators remain the treatment of choice in acute exacerbations of wheezing, systemic corticosteroids should be reserved for severe exacerbations in hospitalized patients.

Las sibilancias recurrentes del preescolar es una condición frecuente a la que se ve enfrentado el pediatra. La gran mayoría de estos pacientes presentan sibilancias en relación a infecciones respiratorias virales y sólo una minoría de ellos tendrá diagnóstico de asma en la edad escolar. El enfrentamiento adecuado de estos niños se inicia con una detallada anamnesis y examen físico para descartar causas secundarias, lo que se complementa con algunos exámenes de laboratorio. La decisión de iniciar tratamiento de mantención dependerá principalmente de la frecuencia y gravedad de los episodios de sibilancias. Este tratamiento debe ser considerado como una prueba terapéutica, evitando su mantención por tiempos prolongados. Se recomienda el uso de corticoides inhalados en dosis bajas y realizar un seguimiento estrecho del paciente para objetivar la respuesta. En el caso de los episodios agudos los broncodilatadores son el tratamiento de elección, mientras que los corticoides sistémicos debieran reservarse sólo para los casos severos o que requieren hospitalización.

Caracterización de un modelo de diabetes tipo 2 en ratas Wistar hembra / Characterization of a type 2 diabetes model in female Wistar rats

Objetivo. Caracterizar un modelo de diabetes mellitus tipo 2 (DM2) en ratas hembra. Materiales y métodos. Se utilizaron 20 ratas Wistar hembra de 48 horas de edad; a 10 se les administró estreptozotocina (STZ), [135 mg/kg de peso corporal] en 50 µl de amortiguador de citratos a pH de 4.5, vía intraperitoneal (inducidos) y a 10 se les administró 50 µl del amortiguador (testigo). Resultados. Los animales inducidos presentaron glicemias de 7.8±2 mmol/L (52.9% más que el testigo; p<0.005) y un peso de 334.4±12 g (51.6 g menor que el testigo; p<0.05) al final del estudio. La concentración de colesterol fue del doble en el grupo inducido. La concentración de triglicéridos no presentó diferencia entre grupos al primer mes de edad, pero al segundo fue 50% mayor en los animales inducidos (p<0.05). La concentración de hemoglobina glicada fue de 4.3% en los testigos y de 5.9% en animales inducidos (p<0.05). La curva de tolerancia mostró alteración en el grupo inducido con glicemias superiores a 7.4 mmol/L hasta los 240 min. Conclusiones. De acuerdo con los parámetros de las pruebas comúnmente utilizadas para el diagnóstico y control de la diabetes en humanos, los valores obtenidos en el presente estudio convalidan el desarrollo de un modelo de DM2 en ratas hembras mediante el uso de STZ.

Objective. Characterization of a type 2 diabetes mellitus (DM2) model in female rats. Materials and methods. 20, 48 hour-old wistar female rats were used; 10 were intraperitoneally injected with streptozotocin (STZ) [135 mg/kg body weight] in 50 µl citrate buffer pH 4.5 (induced group) and 10 were injected with 50 µl of citrate buffer (control group). Results. The induced group had average glycemias of 7.8±2 mmol/L (52.9%; p<0.005) and a body weight of 334.4±12 g (51.6 g lower than the control group; p<0.05) at the end of the treatment. The cholesterol concentration was two-fold higher in the induced group. Triglyceride concentration was not different during the first month, but it was 50% higher on the second month for the induced group (p<0.05). The concentration of glycated hemoglobin was 4.3% for the control group and 5.9% for the induced group (p<0.05). The glucose tolerance curve was altered in the induced group with blood glucose concentrations in diabetic animals over 7.4 mmol/L until 240 min. Conclusions. According to the parameters currently used for diagnostic and control of diabetes in humans, the results displayed in this study support the development of a DM2 model in female rats through the use of STZ.

Infecciones del tracto urinario bajo en adultos y embarazadas: consenso para el manejo empírico / Lower Urinary Tract Infections in Adults and Pregnant Women: A Consensus for Empirical Treatment

Introducción: La infección no complicada del tracto urinario bajo y la bacteriuria asintomática son causas frecuentes de consulta médica ambulatoria y en el servicio de urgencias en Colombia y el mundo. La falta de pautas y consenso para el manejo, así como la emergencia de resistencia a las múltiples opciones terapéuticas disponibles en los uropatógenos provenientes de la comunidad, hacen necesario elaborar unas recomendaciones que orienten al clínico sobre el abordaje óptimo de estas entidades. Objetivo: Definir un consenso sobre el manejo empírico de la bacteriuria asintomática y la infección del tracto urinario (ITU) bajo en adultos y mujeres embarazadas en Colombia. Metodología: Se lleva a cabo una metodología de consenso con expertos en urología, infectología, medicina interna, ginecología y microbiología basada en la revisión de las referencias bibliográficas disponibles en los términos de búsqueda relacionados, haciendo énfasis en estudios locales. Resultados: Se elaboró un algoritmo de manejo para el tratamiento empírico de la ITU baja no complicada en adultos con antisépticos urinarios como nitrofurantoína y fosfomicina trometamol como primera línea, con recomendaciones terapéuticas específicas para el tratamiento de la bacteriuria asintomática en mujeres embarazadas. Adicionalmente, se formuló un algoritmo de decisión para el procesamiento de cultivos de orina. La recurrencia o recaída frecuente justifica remisión a urología e infectología. Conclusiones: Se generan recomendaciones prácticas de fácil implementación en el diagnóstico y manejo de la ITU bajo en adultos y embarazadas, y de los casos donde es necesario tratar la bacteriuria asintomática, con opciones terapéuticas efectivas y de espectro reducido.

Background: Uncomplicated infection of the lower urinary tract and asymptomatic bacteriuria are frequent causes of visits to outpatient clinics and emergency departments in Colombia and worldwide. The lack of guidelines and a consensus for their management, and the emergence of resistance of community-based uropathogens to the available therapeutic options, make it necessary to develop recommendations to guide clinicians on the optimal approach to these entities. Objective: Define a consensus for the empiric management of asymptomatic bacteriuria and Urinary Tract Infection (UTI) in adults and pregnant women in Colombia. Methods: We carried out a consensus methodology with experts in urology, infectious diseases, internal medicine, gynecology and clinical microbiology; based on reviewing the available literature on the related terms, and emphasizing local studies. Results: We developed a management algorithm for the empirical treatment of uncomplicated lower UTI in adults with urinary antiseptics such as nitrofurantoin and fosfomycin trometamol as first line, with specific therapeutic recommendations for the treatment of asymptomatic bacteriuria in pregnant women. Additionally, we created a decision algorithm for processing urine cultures. Frequent recurrence or relapse justifies referral to urology and infectious disease professionals. Conclusions: We generated straightforward and easy-to-implement recommendations for the diagnosis and management of UTI in adults and pregnant women, and in cases where it is necessary to treat asymptomatic bacteriuria, with effective therapeutic and narrow spectrum options.

Primer consenso venezolanode enfermedad por reflujo gastroesofágico / Venezuelan consensus on gastroesophageal reflux diseases

El Consenso Venezolano de Enfermedad por Reflujo Gastroesófágico (ERGE) se realizó con el objeto de proveer guías para mejorar la identificación, el diagnóstico y el tratamiento de este trastorno en el país. Los coordinadores establecieron las líneas de consenso, basado en una revisión sistemática de la literatura médica de los últimos 15 años a partir de 1995. Participaron 55 miembros con el aval de sus respectivas cátedras y sociedades locales de gastroenterología. Éstos revisaron y presentaron los temas con sus niveles de evidencia y grados de recomendación para discutirlos y votarlos en una reunión plenaria. Tras un informe final de los miembros, los coordinadores prepararon las declaraciones finales. El consenso concluyó que la enfermedad por reflujo gastroesofágico tiene una prevalencia estimada del 11,54% en Venezuela, a predominio del sexo femenino (Grado B). El diagnóstico es fundamentalmente clínico, basado en la presencia de síntomas típicos y/o atípicos, e incluso síntomas de alarma que sugieren alguna complicación (Grado B). La endoscopia es importante en la investigación de la presencia de esofagitis de reflujo y laringitis de reflujo (Grado B). Las otras pruebas diagnósticas como lo son la pHmetría esofágica de 24 horas con o sin impedancia intraluminal multicanal son importantes en los pacientes que no tienen esofagitis, tienen síntomas atípicos o cuando hay falla en la respuesta al tratamiento médico (Grado B). La radiología, manometría esofágica y el ultrasonido endoscópico no están indicados en el diagnóstico de la ERGE (Grado B). El objetivo del tratamiento es reducir la exposición ácida en el esófago y con esto: aliviar los síntomas, cicatrizar las lesiones en la mucosa esofágica, prevenir la recurrencia y las complicaciones. Los inhibidores de bomba de protones deberían ser la primera opción en el tratamiento en el síndrome de ERGE y en la esofagitis por reflujo tanto en la fase aguda como durante el mantenimiento...

The Venezuelan Gastroesophageal Reflux Disease (GERD) Consensus was carried out in order to provide guidelines to improve the identification, diagnosis and treatment of this illness in Venezuela.  The coordinators established the consensuslines, based on a systematic revision of the medical literature of the last 15 years starting from 1995. 55 physicians participated with the support of their respective medical schools and local societies. They revised and presented the topics with their respective evidence levels and recommendation grades to discuss and vote them in a plenary meeting. After a final report of the members, the coordinators prepared the definitive declarations. The consensus concluded that GERD prevalence in Venezuela is 11,54%, higher in women than men (Grade B). The diagnosis is mainly clinical, based on the presence of typical and/or atypical symptoms and alarm symptoms that may suggest the presence of complications (Grade B). Endoscopy is important when reflux esophagitis and laryngitis are present (Grade B). Other diagnostic tests as ambulatory 24 hours pH monitoring with or without multichannel intraluminal impedance are important in patients without esophagitis, with atypical symptoms or when there is flaw in the answer to the medical treatment (Grade B). Radiology, esophageal manometry and endoscopic ultrasonography are not indicated in the diagnosis of GERD (Grade B). The objective of the treatment is to reduce the presence of acid in the esophagus and consequently: alleviate the symptoms and heal lesions in the esophagus mucosa to prevent recurrence and complications. Proton pump inhibitors should be the first option drug in the treatment of GERD syndrome andin esophagitis during the acute and the maintenance phase using standard or half dose (Grade A). So far, pokinetics are drugs with a limited use in GERD patients; they stimulate the esophagus/gastric motility...

Densidad neuronal en la corteza visual primaria (área 17), en ratas sometidas a estrés crónico / Density in primary visual cortex (17 visual area) from rats subjected to chronic stress

El estrés puede ser definido como una amenaza a la integridad psicológica o fisiológica de un individuo. Por otro lado, se ha verificado que el estrés tiene efecto sobre la morfología y función de diversas estructuras del Sistema Nervioso Central, relacionadas con el aprendizaje, memoria y respuestas emocionales, tales como el hipocampo, amígdala y corteza prefrontal. Es por lo anterior, que el objetivo del presente trabajo fue realizar un estudio de la anatomía de la corteza visual primaria (área 17), en ratas machos (n=9), de la cepa Sprague-Dawley, de 3 meses de edad (250-350g.), sometidas a estrés crónico por inmovilización. Es así como se observó que el grupo estrés (n=3) presentó una menor densidad neuronal que el grupo control (n=3) y una significativa menor densidad neuronal (p<0,05) que el grupo post estrés (n=3) el cual presentó la más alta densidad neuronal observada. Estableciendo una relación inversa entre densidad neuronal y tamaño de los somas neuronales y sus respectivas conexiones y ramificaciones dendríticas. Lo anterior podría tener incidencia en el procesamiento de la información visual.

Stress can be understood as a threat to psychological or physiological integrity of the individual. Stress has previously shown to alter morphology and function of diverse structures of the Central Nervous System related to learning, memory and emotional response, such as hippocampus, amygdala and prefrontal cortex. In the current work we assessed the effect of chronic stress for immobilization on structure of primary visual cortex (area 17) in male adult Sprague-Dawley rats (n=9), of 3 months of age (250-350g.). Stressed rats (n=3) tended to show lower neuronal densities than control rats (n=3) and were significantly lower (p<0.05) than recovered post-stress rats (n=3), which showed the highest neuronal densities observed. Since an inverse correlation between neuronal density and size of neuronal bodies and their respective dendrite branches, these changes might impact processing of visual information.

Rendimentos de carcaça, composição tecidual e musculosidade da perna de cordeiros alimentados com silagem de milho ou cana-de-açúcar em dois níveis de concentrado / Carcass yield, tissue composition, and leg muscularity of lambs fed corn silage or sugar cane in two levels of concentrate

Avaliou-se o efeito da relação volumoso:concentrado e do tipo de volumoso nos rendimentos de carcaça e dos cortes comerciais, e sobre a composição dos tecidos e musculosidade da perna de 32 cordeiros Ile de France, terminados em confinamento, alimentados com silagem de milho ou cana-de-açúcar, em duas relações volumoso:concentrado: de 60:40 ou 40:60. Os cordeiros foram abatidos aos 32kg de peso corporal; calcularam-se o peso e o rendimento da carcaça quente (PCQ e RCQ). Após 24 horas de refrigeração, obtiveram-se o peso e o rendimento da carcaça fria (PCF e RCF), o rendimento verdadeiro e as perdas por resfriamento. As carcaças foram divididas em cinco cortes comerciais, paleta, lombo, perna, costelas e pescoço, e a perna foi dissecada em músculo, osso e gordura, calculando-se as relações músculo:osso e músculo:gordura, além do índice de musculosidade da perna. Os cordeiros alimentados com silagem de milho apresentaram maiores PCQ (16,05kg), PCF (15,61kg), RCQ (50,4 por cento) e RCF (49,0 por cento). O rendimento de lombo foi menor nos cordeiros alimentados com cana-de-açúcar (9,1 por cento). A cana-de-açúcar e a silagem de milho nas duas relações volumoso:concentrado estudadas não afetaram as proporções de osso, músculo e gordura e musculosidade da perna, e podem constituir a dieta desses animais sem diminuir as proporções desses tecidos, responsáveis pela qualidade da carne.

The effects of roughage:concentrate ratio and type of roughage were evaluated on the carcass yield and commercial cuts, and tissue composition and leg muscularity of 32 Ile de France lambs finished in feedlot and fed corn silage or sugar cane in two roughage:concentrate ratios: 60:40 or 40:60. The lambs were slaughtered with 32kg of body weight and the weight and yield of hot carcass (WHC and YHC) were determined. After refrigerated for 24h in cold camera, the weight and yield of cold carcass (WCC and YCC), real yield, and weight loss for cooling were obtained. The carcass was divided in five commercial cuts (shoulder, loin, leg, ribs, and neck), and the leg was dissected on muscle, bone, and fat, and the relations muscle:bone and muscle:fat and also the leg muscularity index were calculated. The lambs fed corn silage showed higher WHC (16.05kg), WCC (15.61kg), YHC (50.42 percent), and YCC (49.03 percent). The loin yield was lower in lambs fed sugar cane (9.11 percent). The sugar cane and corn silage in this two roughage:concentrate ratios did not affect the proportions of muscle, bone, and fat, and leg muscularity. Therefore, they can be used in diets for animals without reducing the proportions of these tissues, that are related to meat quality.