Crisis neonatales: evaluacion, diagnostico y tratamiento / Neonatal seizures: evaluation, diagnosis, and treatment

Resumen Las crisis convulsivas tienen una alta incidencia en la etapa neonatal, representando la principal manifes tación de disfunción neurológica. Ciertas condiciones fisiológicas del cerebro neonatal facilitan su aparición. Su diagnóstico puede ser un reto debido a que su semio logía no es tan clara comparado con niños mayores, y además, es necesario la confirmación por medio de EEG continuo o aEEG. Su reconocimiento oportuno es muy importante para un adecuado tratamiento y así evitar un impacto negative en el pronóstico a largo plazo. En la siguiente revisión, recapitulamos la fisiopatología, las causas y la clasificación de las crisis convulsivas neo natales, además de su correcto abordaje y las mejores opciones terapéuticas para su tratamiento dependiendo de la causa.

Abstract Seizures have a high incidence in the neonatal stage, being the main manifestation of neurological dysfunc tion. Certain physiological conditions of the neonatal brain facilitate its appearance. Its diagnosis can be a challenging because its semiology is not as clear as in older children, furthermore, confirmation by either EEG or aEEG is necessary. Its timely recognition is very im portant for adequate treatment and thus avoid a nega tive impact on the long-term outcome. In the following review, we recapitulate the pathophysiology, causes, and classification of neonatal seizures, as well as their correct approach and the best therapeutic options for their treatment depending on the cause.

When in Rome, do as the Romans do: a case study of Odebrecht and the continuum of destructiveness / Cuando estés en Roma, haz como los romanos: un estudio de caso de Odebrecht y el continuo de destructividad / Quando em Roma, faça como os romanos: um estudo de caso da Odebrecht e o contínuo da destrutividade

Abstract This research conducts a case study on Odebrecht, a heavy construction company, to answer the question of how an individual rationalizes crime in a corrupt organization? The study is based on the concepts of a corrupt organization, the continuum of destructiveness, moral disengagement, and rationalization. We analyze four books, artifacts on Odebrecht's culture and videos on 49 executives that collaborated in the Car Wash corruption probe. The results describe the paths employees undertake in the organization by acquiring its internal set of values, beliefs, and assumptions. These paths lead to the rationalization of corruption. This case study shows that the continuum of destructiveness starts when employees encounter unethical behavior in the organization and that their rationalization mechanism changes with time in the corrupt culture. At any point, executives can quit or blow the whistle; however, with time, it becomes more challenging to exercise either of the options. By applying and refining the continuum, this research provides an understanding of how moral disengagement and rationalization to help employees to progress in the continuum in a corrupt culture.

Resumen Esta investigación realiza un estudio de caso de la empresa de construcción pesada Odebrecht para responder a la pregunta: ¿Cómo un individuo racionaliza el crimen en una organización corrupta? Este estudio se basa en los conceptos de organización corrupta, continuo de destructividad, desvinculación moral y racionalización. Analizamos cuatro libros que son artefactos de la cultura Odebrecht y videos de 49 ejecutivos que colaboraron en la investigación "Lava Jato". Los resultados describen los caminos que toman los empleados dentro de la organización, adquiriendo sus sistemas de valores, creencias y suposiciones. Estos caminos conducen a la racionalización de la corrupción. Este estudio de caso muestra que el continuo de destructividad comienza cuando los empleados encuentran un comportamiento poco ético dentro de la organización y que los mecanismos de racionalización cambian con el tiempo dentro de la cultura corrupta. Los ejecutivos pueden renunciar o denunciar en cualquier momento, sin embargo, con el tiempo se vuelve difícil ejercer cualquiera de estas opciones. Al aplicar y refinar el continuo, esta investigación proporciona una idea de cómo la desconexión moral y la racionalización alientan a los empleados a ascender en el continuo.

Resumo Esta pesquisa conduz um estudo de caso de uma empresa de construção pesada Odebrecht para responder à questão: Como um indivíduo racionaliza o crime em uma organização corrupta? Este estudo é baseado nos conceitos de organização corrupta, contínuo da destrutividade, desengajamento moral e racionalização. Nós analisamos quatro livros que são artefatos da cultura da Odebrecht e vídeos de 49 executivos que colaboraram na investigação da Lava Jato. Os resultados descrevem os caminhos que os funcionários trilham dentro da organização, adquirindo seus sistemas de valores, crenças e pressupostos. Estes caminhos levam a racionalização da corrupção. Este estudo de caso mostra que o contínuo da destrutividade começa quando empregados encontram comportamentos antiéticos dentro da organização e que os mecanismos de racionalização se modificam com o tempo dentro da cultura corrupta. A qualquer momento executivos podem pedir demissão ou denunciar; no entanto, com o tempo se torna difícil exercer qualquer uma dessas opções. Ao aplicar e refinar o contínuo, esta pesquisa prove um entendimento sobre como desengajamento moral e racionalização incentivam funcionários a seguir adiante no contínuo.

The butterflies (Lepidoptera, Papilionoidea) of the Parque Estadual Intervales and surroundings, São Paulo, Brazil / As borboletas (Lepidoptera, Papilionoidea) do Parque Estadual Intervales e arredores, São Paulo, Brasil

Abstract The Global South has witnessed increasing sampling of its immense biological diversity during the past century. However, the diversity of many regions remains unknown, even at pristine and highly threatened places, such as in the Atlantic Forest; and for bioindicator, umbrella, and flagship groups. The present study reports the first butterfly list of the Parque Estadual Intervales, São Paulo, Brazil and surroundings, a key protected area in the last massive continuous of the Atlantic Forest. We compiled data from museums and four years of field work, under three sampling methods. We also aimed at providing resources to support conservation efforts by analyzing 27 years of climatic data (detailed in the Supplementary Material, in English and in Portuguese), discussing our results also for non-academics, and producing scientific outreach and educational material. A companion article dealt with the experiences of science outreach and capacity development, and illustrated the butterfly catalogue of the species sampled in the park. We found 312 species that sum to 2,139 records. The museum had 229 species (432 records), and we sampled 142 species (1,682 individuals), in a total effort of 36,679 sampling hours (36,432 trap and 247 net and observation hours). The richest families were Nymphalidae (148 species) and Hesperiidae (100 species). Most species were sampled exclusively by active methods (79.8%), but other sources (passive sampling, citizen science, etc.) also found unique records. We found the highest diversity metrics from January to May, and we demonstrated that winter months had less richness and abundance. We illustrated the 20 species common to all regions, and listed those that were found more than seven months in the year, as well as the most abundant species in trap sampling, with forest dwellers as well as species common to open and fragmented areas. The dominant species in our trap datasets was the iridescent white morpho, Morpho epistrophus (Fabricius, 1796), and we suggest it to become the park butterfly mascot.

Resumo O Sul Global testemunhou crescente amostragem de sua imensa diversidade biológica durante o século passado. Entretanto, a diversidade de muitas regiões permanece desconhecida, mesmo em locais pristinos e altamente ameaçados, como na Mata Atlântica; e para grupos bioindicadores, guarda-chuva e emblemáticos. O presente estudo reporta a primeira lista de borboletas do Parque Estadual Intervales, São Paulo, Brasil e arredores, uma unidade de conservação chave no último maciço contínuo de Mata Atlântica. Compilamos dados de museus e quatro anos de campo, sob três métodos de amostragem. Também visamos oferecer recursos para apoiar os esforços de conservação, analisando 27 anos de dados climáticos (detalhados no Material Suplementar, em inglês e em português), discutindo nossos resultados numa linguagem também para não acadêmicos, e produzindo material de divulgação científica e educativos. Um artigo irmão tratou das experiências de divulgação científica e capacitação, e ilustrou o catálogo de borboletas das espécies amostradas no parque. Encontramos 312 espécies em 2.139 registros. O museu tinha 229 espécies (432 registros), e amostramos 142 espécies (1.682 indivíduos), em um esforço total de 36.679 horas de amostragem (36.432 armadilhas e 247 horas de rede e observação). As famílias mais ricas foram Nymphalidae (148 espécies) e Hesperiidae (100 espécies). A maioria das espécies foi amostrada exclusivamente por métodos ativos (79,8%), mas outras fontes (passiva, ciência cidadã, etc.) também encontraram registros únicos. Encontramos as maiores métricas de diversidade de janeiro a maio, e demonstramos que os meses de inverno tiveram menos riqueza e abundância. Ilustramos as 20 espécies comuns a todas as regiões, e listamos aquelas que foram encontradas em mais de sete meses no ano, bem como as espécies mais abundantes em armadilhas, com espécies florestais e também comuns em áreas abertas e fragmentadas. A espécie dominante em nossas armadilhas foi a morfo branca iridescente, Morpho epistrophus (Fabricius, 1796), e sugerimos que se torne a borboleta mascote do parque.

Estrategias para mitigar hipoglucemias y variabilidad glucémica / Strategies to mitigate hypoglycemia and glycemic variability

La última década se ha destacado por los importantes avances en el desarrollo de nuevas tecnologías para pacientes que viven con diabetes mellitus (DM). Las innovaciones han estado orientadas principalmente a: mejorar la calidad de vida, reducir el impacto que genera la ocurrencia de hipoglucemias y reducir la carga de la enfermedad colaborando en la toma diaria de decisiones1. El monitoreo continuo de glucosa (MCG) es una herramienta que ha experimentado un importante avance al aportar información dinámica del estado metabólico en los pacientes y permitir la toma de decisiones, demostrado por un control metabólico estable, menores excursiones glucémicas, y una reducción significativa en la aparición y gravedad de las hipoglucemias2-5. Las presentes recomendaciones tienen como objetivo brindar herramientas rápidas para la interpretación de datos metabólicos y la consiguiente toma de decisiones terapéuticas. A tal fin se realizó una exhaustiva revisión de las principales guías y recomendaciones vigentes; posteriormente, el Grupo de Trabajo adaptó esa información según una serie de preguntas con criterio clínico práctico. El avance de los MCG es innegable, no solo en el desarrollo tecnológico, sino que se han convertido en una herramienta educativa para las personas con DM, su entorno y el equipo de salud al posibilitar un ajuste dinámico del tratamiento, prevenir complicaciones agudas y mejorar la calidad de vida. En esta ecuación enfatizamos la importancia de la educación diabetológica continua de la persona con DM y su entorno, participando activamente en la toma de decisiones para, de esta manera, cumplir con los objetivos propuestos: mejorar la calidad de vida, reducir la carga de la enfermedad y disminuir las excursiones glucémicas agudas.

The last decade has been highlighted by important advances in the development of new technologies for patients living with diabetes. The innovations have been oriented above all to improve the quality of life, reduce the impact generated by the occurrence of hypoglycemia and reduce the burden of the disease by collaborating in daily decision-making1. Continuous glucose monitoring (CGM) is a tool that has undergone significant progress, providing dynamic information on the metabolic status of patients, allowing decision making, demonstrated by stable metabolic control, lower glycemic excursions and a significant reduction in the occurrence and severity of hypoglycemia2-5. The purpose of these recommendations, developed by members of the Innovation Committee of the Argentine Society of Diabetes, is to provide rapid tools for the interpretation of metabolic data and the subsequent therapeutic decisionmaking. To this end, an exhaustive review of the main current guidelines and recommendations has been carried out, later the working group adapted this information according to a series of questions with practical clinical criteria. The progress of CGMs is undeniable, not only in technological development, but it has become an educational tool for people with diabetes, their environment, and the health team, offering the possibility of a dynamic adjustment of treatment, prevention of acute complications and improving quality of life. In this equation, we emphasize the importance of continuous diabetes education for the person with diabetes and their environment, actively participating in decision-making, and in this way, meeting the proposed objectives: improving quality of life, reducing the burden of disease, and decreasing acute glycemic excursions.

Utilidad del monitoreo continuo del electroencefalograma en el paciente crítico / Utility of continuous electroencephalogram monitoring in the critical patients

Introducción: El monitoreo continuo del Electroencefalograma, es la recogida simultánea de la actividad cerebral y la conducta clínica por un período de horas a días. Por el alto costo de la técnica aún no está muy difundida. Objetivos: Evaluar la utilidad del monitoreo electroencefalográfico continuo en el paciente crítico. Métodos: Se realizó un estudio descriptivo, retrospectivo y longitudinal en 118 sujetos mayores de 19 años ingresados en las unidades de terapia del Hospital Clínico Quirúrgico Hermanos Ameijeiras; entre noviembre 2016 a octubre 2018 con indicación de un Electroencefalograma continuo. Se consideraron variables clínicas y electroencefalográficas: escala de Glasgow, ocurrencia de crisis, diagnóstico, estado al egreso, anormalidad del Electroencefalograma, descargas epileptiformes, sospecha de estatus epiléptico no convulsivo por electroencefalograma entre otras. Los datos se procesaron con test de Chi cuadrado, test de Mc Nemar y test t de student, se empleó un nivel de significación de p≤0.05. Resultados: 60 de los pacientes pertenecían al sexo femenino, la mediana de las edades fue 67,5 años. La escala de Glasgow mostró asociación significativa con el grado de anormalidad del electroencefalograma (p=0,001), es la arreactividad y la discontinuidad de la actividad de base predictores de pobre pronóstico. Se observaron descargas epileptiformes periódicas en 100 pacientes. Se definió estatus epiléptico no convulsivo en 56 sujetos (37,28 por ciento) y en 81 sujetos (68,64 por ciento) el resultado del electroencefalograma motivó una conducta médica. Conclusiones: El monitoreo continuo del electroencefalograma es útil en el diagnóstico y manejo del paciente con episodios no convulsivos, permite formular un pronóstico neurológico y orientó la conducta médica(AU)

Introduction: The continuous monitoring of the electroencephalogram is the simultaneous collection of brain activity and clinical behavior for a period of hours to days. Due to the high cost of the technique, it is not yet widely used. Objectives: To evaluate the usefulness of continuous electroencephalographic monitoring in critically ill patients. Methods: A descriptive, retrospective and longitudinal study was carried out in 118 subjects over 19 years of age admitted to the therapy units at Hermanos Ameijeiras Surgical Clinical Hospital; from November 2016 to October 2018. They were indicated a continuous electroencephalogram. Clinical and electroencephalographic variables were considered, such as Glasgow scale, seizure occurrence, diagnosis, discharge status, electroencephalogram abnormality, epileptiform discharges, suspicion of nonconvulsive status epilepticus by electroencephalogram, among others. The data was processed with the Chi square test, the Mc Nemar test and the student's t test, using significance level of p≤0.05. Results: Sixty patients were female, the median age was 67.5 years. The Glasgow scale showed significant association with the degree of electroencephalogram abnormality (p=0.001). A reactivity and discontinuity of baseline activity are predictors of poor prognosis. Periodic epileptiform discharges were observed in 100 patients. Non-convulsive status epilepticus was defined in 56 subjects (37.28 percent) and in 81 subjects (68.64 percent) the result of the electroencephalogram motivated a medical procedure. Conclusions: The continuous monitoring of the electroencephalogram is useful in the diagnosis and management of patients with non-convulsive episodes, it allows formulating a neurological prognosis and guided medical conduct(AU)

Consensus for the use of flash glucose monitoring in the Colombian adult population with type 1 and 2 diabetes mellitus / Consenso para el uso de monitoreo de glucosa flash en la población adulta colombiana con diabetes mellitus tipo 1 y 2

Abstract Introduction: in Colombia, the Clinical Practice Guidelines for the treatment of patients with type 1 (DM1) and type 2 (DM2) diabetes do not mention the use of flash glucose monitoring, as this system was not available. The objective of this study was to establish a set of recommendations for the use of intermittent flash monitoring in Colombia. Methods: the group of experts consisted of eight Colombian physicians from different cities within Colombia, with expertise in the management of patients with DM1 and DM2; a certified diabetes nurse educator; a patient with DM1; and a methodological expert. Using the Zoom Enterprise video conferencing application (Zoom Video Communications, San Jose, California), the group generated questions through the Metaplan method, then carried out a systematic literature search and evidence review. The recommendations were made according to the degree of evidence and strength of the recommendation, following the GRADE method. Results: clinical recommendations were made for: a) patients with DM1 and hypoglycemia; b) patients with DM1 and poor metabolic control; c) patients with insulin-treated DM2; d) pregestational diabetes; e) quality of life; and f) inpatient use. Conclusions: this consensus's clinical recommendations guide clinical decision making with regard to the use of intermittent flash monitoring in patients with diabetes in various clinical settings. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2239).

Resumen Introducción: en Colombia las Guías de Práctica Clínica para el manejo del paciente con diabetes tipo 1 (DM1) y tipo 2 (DM2) no mencionan el uso del monitoreo de glucosa flash dado que dicho sistema no estaba disponible. El objetivo del presente trabajo fue establecer un grupo de recomendaciones sobre el uso del monitoreo intermitente flash en Colombia. Métodos: el grupo de expertos estuvo conformado por ocho médicos colombianos expertos en el manejo de pacientes con DM1 y DM2 de diversas ciudades de Colombia, una enfermera licenciada educadora en diabetes, una paciente con diagnóstico de DM1 y un experto metodológico. A través de Zoom Enterprise versión de la aplicación de videoconferencia Zoom (Zoom Video Communications, San Jose, California) el grupo generó las preguntas con metodología Metaplan. Posteriormente, se realizó una búsqueda sistemática de la literatura y análisis de la evidencia. Las recomendaciones se generaron mediante grupo nominal según el grado de evidencia y la formaleza de la recomendación siguiendo la metodología GRADE. Resultados: se generaron recomendaciones clínicas enfocadas a: a) paciente con diagnóstico de DM1 e hipoglucemia; b) paciente con diagnóstico de DM1 y mal control metabólico, c) paciente con diagnóstico de DM tipo 2 tratado con insulina, d) diabetes pregestacional, e) calidad de vida y f) uso intrahospitalario. Conclusiones: las recomendaciones clínicas del presente consenso orientan la toma de decisiones clínicas con respecto al uso de monitoreo intermitente flash en el paciente con diagnóstico de diabetes en diferentes escenarios clínicos. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2239).

Hemodiálisis vs Hemodiafiltración en línea / Hemodialysis vs Hemodiafiltration online

INTRODUCCIÓN. La incorporación de nuevas tecnologías como la hemodiafiltración en línea, han mejorado parámetros metabólicos/nutricionales en los pacientes que se encontraban en hemodiálisis convencional; en la actualidad no existen datos registrados en la población ecuatoriana que se encuentra sometida a esta clase de tecnologías. OBJETIVO. Comparar la evolución clínico-metabólica de pacientes que estaban en hemodiálisis convencional y cambiaron a hemodiafiltración en línea, determinar si es favorable la migración de la terapia hemodialítica difusiva a convectiva y establecer si el cambio de terapia dialítica ocasionó resultados favorables. MATERIALES Y MÉTODOS. Estudio analítico retrospectivo. Población y muestra de 38 pacientes enfermos renales crónicos en terapia de sustitución renal modalidad hemodiálisis convencional que cambiaron a hemodiafiltración en línea, independientemente del tiempo de diagnóstico y tratamiento en la unidad de hemodiálisis del Hospital de Especialidades Carlos Andrade Marín, Quito-Ecuador, durante el periodo marzo 2016 a marzo 2017. RESULTADOS. Los efectos nutricionales y metabólicos pudieron denotar mayor ponderación de resultados favorables en la modalidad de hemodiafiltración. En la estabilidad hemodinámica y la dosis de diálisis se evidenció una leve superioridad en la modalidad de hemodiafiltración en comparación a la Hemodiálisis. En las dosis administradas de Calcio, Hierro, Eritropoyetina y Calcitriol no existieron diferencias significativas entre las dos modalidades de tratamientos. CONCLUSIÓN. El cambio de modalidad de Hemodiálisis convencional a Hemodiafiltración en línea fue favorable, y mejoró los parámetros clínicos/metabólicos de los pacientes que requieren terapia de sustitución renal.

INTRODUCTION. The incorporation of new technologies such as online haemodiafiltration have improved metabolic/nutritional parameters in patients who were on conventional haemodialysis; At present, there are no registered data on the Ecuadorian population that is subjected to this kind of technology. OBJECTIVE. To compare the clinical-metabolic evolution of patients who were on conventional hemodialysis and changed to online hemodiafiltration, to determine if the migration from diffusive to convective hemodialysis therapy is favorable and to establish if the change in dialysis therapy caused favorable results. MATERIALS AND METHODS. Retrospective analytical study. Population and sample of 38 patients with chronic kidney disease in conventional hemodialysis modality renal replacement therapy who changed to online hemodiafiltration, regardless of the time of diagnosis and treatment in the hemodialysis unit of the Hospital de Especialidades Carlos Andrade Marín, Quito-Ecuador, during the period March 2016 to March 2017. RESULTS. The nutritional and metabolic effects could denote a greater weighting of favorable results in the hemodiafiltration modality. In hemodynamic stability and dialysis dose, a slight superiority was evidenced in the hemodiafiltration modality compared to hemodialysis. In the administered doses of Calcium, Iron, Erythropoietin and Calcitriol there were no significant differences between the two treatment modalities. CONCLUSION. The change of modality from conventional hemodialysis to online hemodiafiltration was favorable, and improved the clinical/metabolic parameters of patients requiring renal replacement therapy.

Estrategias para mitigar hipoglucemias y variabilidad glucémica / Strategies to mitigate hypoglycemia and glycemic variability

Resumen La última década se ha destacado por los importantes avances en el desarrollo de nuevas tecnologías para pacientes que viven con diabetes mellitus (DM). Las innovaciones han estado orientadas principalmente a: mejorar la calidad de vida, reducir el impacto que genera la ocurrencia de hipoglucemias y reducir la carga de la enfermedad colaborando en la toma diaria de decisiones1. El monitoreo continuo de glucosa (MCG) es una herramienta que ha experimentado un importante avance al aportar información dinámica del estado metabólico en los pacientes y permitir la toma de decisiones, demostrado por un control metabólico estable, menores excursiones glucémicas, y una reducción significativa en la aparición y gravedad de las hipoglucemias2-5. Las presentes recomendaciones tienen como objetivo brindar herramientas rápidas para la interpretación de datos metabólicos y la consiguiente toma de decisiones terapéuticas. A tal fin se realizó una exhaustiva revisión de las principales guías y recomendaciones vigentes; posteriormente, el Grupo de Trabajo adaptó esa información según una serie de preguntas con criterio clínico práctico. El avance de los MCG es innegable, no solo en el desarrollo tecnológico, sino que se han convertido en una herramienta educativa para las personas con DM, su entorno y el equipo de salud al posibilitar un ajuste dinámico del tratamiento, prevenir complicaciones agudas y mejorar la calidad de vida. En esta ecuación enfatizamos la importancia de la educación diabetológica continua de la persona con DM y su entorno, participando activamente en la toma de decisiones para, de esta manera, cumplir con los objetivos propuestos: mejorar la calidad de vida, reducir la carga de la enfermedad y disminuir las excursiones glucémicas agudas.

Abstract The last decade has been highlighted by important advances in the development of new technologies for patients living with diabetes. The innovations have been oriented above all to improve the quality of life, reduce the impact generated by the occurrence of hypoglycemia and reduce the burden of the disease by collaborating in daily decision-making1. Continuous glucose monitoring (CGM) is a tool that has undergone significant progress, providing dynamic information on the metabolic status of patients, allowing decision making, demonstrated by stable metabolic control, lower glycemic excursions and a significant reduction in the occurrence and severity of hypoglycemia2-5. The purpose of these recommendations, developed by members of the Innovation Committee of the Argentine Society of Diabetes, is to provide rapid tools for the interpretation of metabolic data and the subsequent therapeutic decisionmaking. To this end, an exhaustive review of the main current guidelines and recommendations has been carried out, later the working group adapted this information according to a series of questions with practical clinical criteria. The progress of CGMs is undeniable, not only in technological development, but it has become an educational tool for people with diabetes, their environment, and the health team, offering the possibility of a dynamic adjustment of treatment, prevention of acute complications and improving quality of life. In this equation, we emphasize the importance of continuous diabetes education for the person with diabetes and their environment, actively participating in decision-making, and in this way, meeting the proposed objectives: improving quality of life, reducing the burden of disease, and decreasing acute glycemic excursions.

Desenvolvimento de rota sintética da Rosiglitazona em processo batelada e microrreator capilar / Rosiglitazone synthetic route development in batch process and capillary microreactor

Para que os fármacos possam ser comercializados economicamente, a sua escala de produção deve ser aumentada para atender à demanda do mercado. Atualmente, a maior parte dos fármacos são sintetizados em processos batelada que possuem limitações quanto à eficiência de mistura, temperatura e pressão. O uso de microrreatores surge como alternativa na indústria químico-farmacêutica, aumentando a eficiência dos processos de maneira segura. Ferramentas utilizadas no segmento computacional multidisciplinar teórico, como o DFT (Density Functional Theory), podem prever e compreender o comportamento das reações químicas, podendo ter grande utilidade na síntese de novos fármacos economizando tempo, investimento e reduzindo a geração de resíduos. A diabetes mellitus é uma doença de caráter epidêmico, que a cada ano vem aumentando o número de casos. O emprego de fármacos derivados das glitazonas no tratamento de diabetes mellitus tipo 2 é recomendado devido ao excelente controle glicêmico que esta classe de fármacos oferece. Neste trabalho, foi sintetizada a Rosiglitazona, um fármaco derivado das glitazonas, que auxilia no tratamento da diabetes mellitus tipo 2, sendo estudadas duas rotas de síntese distintas, que foram otimizadas com o intuito de maximizar o rendimento de seus intermediários, obtendo a Rosiglitazona com pureza de cerca de 94%. Foi realizada, para os intermediários, aqui denominados, 1R, 2R2 e 3R2 a síntese one-pot e para os intermediários 1R, 2R1 e 3R2 foi realizada a transposição do processo usual em batelada para fluxo contínuo no microrreator, com rendimentos de até 93%. Com o auxílio da química quântica computacional, a reação de síntese do intermediário 1R, foi elucidada teoricamente e determinadas as grandezas termodinâmicas (ΔH‡, ΔG‡ e ΔS‡) no estado de transição, que foram comparadas com os valores experimentais, sendo constatada uma boa concordância, com desvio máximo de 14%

In order for drugs to be commercialized economically, their production scale must be increased to meet market demand. Currently, most drugs are synthesized in batch processes that have limitations in terms of mixing efficiency, temperature and pressure. The use of microreactors appears as an alternative in the chemical-pharmaceutical industry, increasing the efficiency of the synthesis processes in a safe way. Tools used in the theoretical multidisciplinary computational segment, such as DFT (Density Functional Theory), can predict and understand the behavior of chemical reactions, and can be very useful in the synthesis of new drugs, saving time, investment and reducing waste generation. Diabetes mellitus is an epidemic disease that has been increasing the number of cases every year. The use of drugs derived from glitazones in the treatment of type 2 diabetes mellitus is recommended due to the excellent glycemic control that this class of drugs offers. In this work, Rosiglitazone, a drug derived from glitazones, which helps in the treatment of type 2 diabetes mellitus, was synthesized. Two different synthetic routes were studied and optimized in order to maximize the yield of its intermediates, obtaining Rosiglitazone with purity of about 94%. One-pot synthesis was performed to 1R, 2R2 and 3R2 intermediates, and the transposition from the usual batch process to continuous flow in microreactor was performed to 1R, 2R1 and 3R2 intermediates, with yields of up to 93%. With the aid of computational quantum chemistry, the intermediate 1R synthesis reaction was theoretically elucidated and the thermodynamic properties were determined (ΔH‡, ΔG‡ and ΔS‡) in the transition state, which were compared with the experimental results, obtaining good agreement, with a maximum deviation of 14%

Recomendaciones para el monitoreo continuo de la glucosa en pacientes embarazadas con diabetes mellitus tipos 1, 2 y gestacional / Recommendations for continuous glucose monitoring in pregnant patients with type 1, 2 and gestational diabetes mellitus

Resumen OBJETIVO: Emitir recomendaciones para la vigilancia y seguimiento de pacientes embarazadas con diabetes mellitus tipos 1, 2 y gestacional con base en la experiencia de un grupo de especialistas y en lo reportado en la bibliografía, desde la perspectiva del sistema de salud mexicano. MATERIALES Y MÉTODOS: Se utilizó la metodología del panel Delphi modificado, mediante la unanimidad de criterios de un grupo de especialistas en Ginecoobstetricia, Biología de la Reproducción y Medicina Materno Fetal mexicanos, tomando en cuenta un nivel de unanimidad del 80% de los participantes. RESULTADOS: Con base en un ejercicio de consenso se recomienda el monitoreo continuo de la glucosa en todas las pacientes embarazadas con diabetes mellitus tipos 1 y 2 a partir del primer trimestre de la gestación. En pacientes con diabetes gestacional considerar, a partir del segundo o tercer trimestre, el monitoreo continuo de la glucosa en usuarias de insulina o en descontrol glucémico, dependiendo del momento en que se diagnostique la diabetes gestacional, del descontrol glucémico y de la necesidad de insulina. La hemoglobina glucosilada y el tiempo en las concentraciones límite también son métricas de control glucémico. CONCLUSIONES: El monitoreo continuo de la glucosa tiene ventajas en: menos complicaciones perinatales, detección oportuna y reducción de eventos de hiper o hipoglucemia, menor descontrol, ajuste de dosis respecto del tratamiento con insulina y mejora en los hábitos para controlar las concentraciones de glucosa.

Abstract OBJECTIVE: To issue recommendations for the surveillance and follow-up of pregnant patients with types 1, 2 and gestational diabetes mellitus based on the experience of a group of experts and on what is reported in the literature, from the perspective of the Mexican health system. MATERIALS AND METHODS: A modified Delphi Panel methodology was performed, through consensus among gynecology, reproductive biologist, and fetal-maternal specialists, and an 80% consensus of all participants. RESULTS: Based on the consensus exercise, we recommend continuous glucose monitoring in all pregnant patients with type I and II diabetes starting on the first trimester; meanwhile in patients with gestational diabetes, continuous monitoring should be considered in patients treated with insulin or uncontrolled glycemia, starting in the second or third trimester, depending on the moment of diagnosis, glycemic levels and insulin requirements, taking into account HbA1c levels and time in range as well as glycemic control metrics. CONCLUSIONS: Continuous glucose monitoring has advantages including the reduction of perinatal complications, timely detection, reduction in the number of hyper/hypoglycemia events, fewer uncontrolled patients, and the capacity for insulin dosage adjustments and improvement of habits for glucose control.

¡Bienvenido 2022! ¡La transición ha sido concretada! / Bem vindo 2022!! A Transição está concretizada! / Welcome 2022! The transition has been completed!

La Revista de Odontopediatría Latinoamericana ha pasado a adoptar la tendencia de las publicaciones científicas y, a partir de este momento, es de flujo continuo. Es así como todas las ediciones del año en curso permanecerán abiertas (In progress). El logro de este sueño solo ha sido posible con la ayuda de todos los colegas, colaboradores, autores y revisores quienes, sin escatimar esfuerzos, trabajaron para concretarlo en la edición de 2022. Por lo tanto, esta edición estará compuesta por todos los trabajos aprobados y editados hasta el final del semestre, cuando el equipo editorial también publicará su archivo y editorial, procediendo al cierre de la edición.

O Latin American Journal of Paediatric Dentistry adotou a tendência das publicações científicas e, de agora em diante, está em fluxo contínuo. Assim, todas as edições do ano corrente permanecerão abertas (Em andamento). A realização deste sonho só foi possível com a ajuda de todos os colegas, colaboradores, autores e revisores que, sem poupar esforços, trabalharam para que este sonho se tornasse realidade na edição de 2022. Portanto, esta edição será composta por todos os trabalhos aprovados e editados até o final do semestre, quando a equipe editorial também publicará seu arquivo e editorial, procedendo ao encerramento da edição.

The Journal of Latin American Pediatric Dentistry has adopted the trend of scientific publications and, from now on, it is in continuous flow. Thus, all editions of the current year will remain open (In progress). The achievement of this dream has only been possible with the help of all colleagues, collaborators, authors and reviewers who, sparing no effort, worked to realize it in the 2022 edition. Therefore, this edition will be composed of all the papers approved and edited until the end of the semester, when the editorial team will also publish its archive and editorial, proceeding to the closing of the edition.

Public policy coverage and access to medicines in Brazil / Cobertura de políticas públicas e acesso a medicamentos no Brasil

ABSTRACT OBJECTIVE Describe consumption patterns for monetary and non-monetary acquisition of medicines according to age and income groups, highlighting pharmaceuticals associated with health programs with specific access guarantees. METHODS Descriptive observational study using microdata from the 2017-2018 Pesquisa de Orçamentos Familiares (Household Budget Survey, POF/IBGE). We initially reviewed programs/policies with specific guarantees of access to medicines in the SUS. Using the pharmaceutical product list of POF-4 (chart 29 of the questionnaire on individual expenditures), we selected the medicines related to these programs. We then described frequencies and percentages for not reporting medicine consumption and for reporting consumption (either through monetary or non-monetary acquisition) according to age and income groups. For medicines with distinctive access guarantees, we compared average monthly values of acquisitions and consumption patterns by age and income. RESULTS 63% of those in the ≤ 2 minimum wage (MW) household income group did not report consuming medicines in the last month. Among those earning > 25 MW, 44.3% did not report consumption. Non-monetary acquisitions of medicines were mainly reported for the < 10 MW group and for the elderly and accounted for 20.5% of the total consumption of medicines (in value). For policies with specific access guarantees, non-monetary acquisitions reached 33.6% of total consumption. This percentage varied for the various selected medicines: vaccines, 83.3%; cancer drugs, 70.3%; diabetes, 47.9%; hypertension, 35.9%; asthma and bronchitis, 29.2%; eye problems, 14%; prostate and urinary tract, 10.7%; gynecological, 11.6%; and contraceptives, 9.7%. CONCLUSION Shares for non-monetary acquisitions of medicines are still low but benefit mainly lower-income and older age groups. Policies and programs with specific access guarantees to medicines have increased access. Results suggest the need to strengthen and expand pharmaceutical care policies.

RESUMO OBJETIVO Descrever padrões de consumo de medicamentos com e sem desembolso direto de recursos, segundo faixas de idade e de renda, destacando os fármacos associados a programas de saúde com garantias específicas de acesso. MÉTODOS Estudo descritivo observacional usando microdados da Pesquisa de Orçamentos Familiares (POF/IBGE) 2017-2018. Inicialmente, foram definidas as garantias específicas de acesso a medicamentos do SUS pela sistematização de programas/políticas com essa previsão. A partir dos medicamentos do quadro 29 do questionário de despesas individuais (POF-4), foram selecionados tipos de medicamentos associados a essas garantias. Foram descritas as frequências e os percentuais de pessoas sem consumo e com consumo (aquisição com e sem desembolso direto de recursos), segundo faixas de idade e de renda. Para medicamentos vinculados a garantias específicas, comparou-se valores médios mensais de aquisições e padrões de consumo por faixa etária e renda. RESULTADOS Entre as pessoas com renda domiciliar até dois salários mínimos, 63% não declararam consumo de medicamentos no mês. Entre as acima de 25 salários mínimos, foram 44,3%. Aquisições sem desembolso direto foram feitas principalmente por pessoas na faixa com até 10 salários mínimos e entre os mais idosos. O consumo sem desembolso direto representou 20,5% do consumo total de medicamentos (em valor). Para políticas com garantias específicas de acesso, o consumo sem desembolso foi de 33,6% com variações desse percentual entre os medicamentos selecionados no estudo: vacinas, 83,3%; medicamentos para câncer, 70,3%; diabetes, 47,9%; hipertensão, 35,9%; asma e bronquite, 29,2%; problemas oftalmológicos, 14%; medicamentos para próstata e vias urinárias, 10,7%; para problemas ginecológicos, 11,6%; e anticoncepcionais, 9,7%. CONCLUSÃO O consumo sem desembolso ainda é baixo, mas beneficia principalmente pessoas de menor renda e idosos. Políticas e programas com garantias específicas de acesso a medicamentos têm aumentado esse acesso. Os resultados sugerem a necessidade de fortalecer e ampliar as políticas de assistência farmacêutica.

Desenvolvimento de rota sintética da Rosiglitazona em processo batelada e microrreator capilar / Rosiglitazone synthetic route development in batch process and capillary microreactor

Para que os fármacos possam ser comercializados economicamente, a sua escala de produção deve ser aumentada para atender à demanda do mercado. Atualmente, a maior parte dos fármacos são sintetizados em processos batelada que possuem limitações quanto à eficiência de mistura, temperatura e pressão. O uso de microrreatores surge como alternativa na indústria químico-farmacêutica, aumentando a eficiência dos processos de maneira segura. Ferramentas utilizadas no segmento computacional multidisciplinar teórico, como o DFT (Density Functional Theory), podem prever e compreender o comportamento das reações químicas, podendo ter grande utilidade na síntese de novos fármacos economizando tempo, investimento e reduzindo a geração de resíduos. A diabetes mellitus é uma doença de caráter epidêmico, que a cada ano vem aumentando o número de casos. O emprego de fármacos derivados das glitazonas no tratamento de diabetes mellitus tipo 2 é recomendado devido ao excelente controle glicêmico que esta classe de fármacos oferece. Neste trabalho, foi sintetizada a Rosiglitazona, um fármaco derivado das glitazonas, que auxilia no tratamento da diabetes mellitus tipo 2, sendo estudadas duas rotas de síntese distintas, que foram otimizadas com o intuito de maximizar o rendimento de seus intermediários, obtendo a Rosiglitazona com pureza de cerca de 94%. Foi realizada, para os intermediários, aqui denominados, 1R, 2R2 e 3R2 a síntese one-pot e para os intermediários 1R, 2R1 e 3R2 foi realizada a transposição do processo usual em batelada para fluxo contínuo no microrreator, com rendimentos de até 93%. Com o auxílio da química quântica computacional, a reação de síntese do intermediário 1R, foi elucidada teoricamente e determinadas as grandezas termodinâmicas (ΔH‡, ΔG‡ e ΔS‡) no estado de transição, que foram comparadas com os valores experimentais, sendo constatada uma boa concordância, com desvio máximo de 14%

In order for drugs to be commercialized economically, their production scale must be increased to meet market demand. Currently, most drugs are synthesized in batch processes that have limitations in terms of mixing efficiency, temperature and pressure. The use of microreactors appears as an alternative in the chemical-pharmaceutical industry, increasing the efficiency of the synthesis processes in a safe way. Tools used in the theoretical multidisciplinary computational segment, such as DFT (Density Functional Theory), can predict and understand the behavior of chemical reactions, and can be very useful in the synthesis of new drugs, saving time, investment and reducing waste generation. Diabetes mellitus is an epidemic disease that has been increasing the number of cases every year. The use of drugs derived from glitazones in the treatment of type 2 diabetes mellitus is recommended due to the excellent glycemic control that this class of drugs offers. In this work, Rosiglitazone, a drug derived from glitazones, which helps in the treatment of type 2 diabetes mellitus, was synthesized. Two different synthetic routes were studied and optimized in order to maximize the yield of its intermediates, obtaining Rosiglitazone with purity of about 94%. One-pot synthesis was performed to 1R, 2R2 and 3R2 intermediates, and the transposition from the usual batch process to continuous flow in microreactor was performed to 1R, 2R1 and 3R2 intermediates, with yields of up to 93%. With the aid of computational quantum chemistry, the intermediate 1R synthesis reaction was theoretically elucidated and the thermodynamic properties were determined (ΔH‡, ΔG‡ and ΔS‡) in the transition state, which were compared with the experimental results, obtaining good agreement, with a maximum deviation of 14%.

El continuo de salud mental durante la pandemia por COVID-19 en población general de adultos argentinos / The Mental Health Continuum During the Covid-19 Pandemic in a General Population of Argentine Adults

Resumen El análisis de la salud mental de las personas en contexto de pandemia por SARS-Cov-2 constituye un reto de gran relevancia para la psicología actual. La presente investigación se propuso dos objetivos. En primer lugar, analizar las asociaciones entre el continuo de salud mental y los síntomas de ansiedad, depresión e intolerancia a la incertidumbre en adultos argentinos en pandemia por COVID-19 y, en segundo lugar, comparar los niveles de bienestar emocional, psicológico y social según asistencia psicológica en contexto de pandemia por COVID-19. El tipo de estudio fue descriptivo, correlacional y de diferencia de grupos bajo un diseño no experimental de corte transversal. Se utilizó una muestra de 1120 adultos de entre 18 y 84 años (MEdad 37.32, DE = 14.81), 60.1% mujeres y 39.9% varones. Los resultados informaron que las asociaciones entre los niveles de bienestar emocional, psicológico, social y total y los síntomas de depresión e intolerancia a la incertidumbre fueron negativas y significativas. Sin embargo, las correlaciones con los síntomas de ansiedad fueron positivas y significativas. Se hallaron diferencias significativas en los niveles de bienestar emocional, psicológico, social y total según asistencia a tratamiento psicoterapéutico. En todos los casos, las personas que asistieron a tratamiento psicoterapéutico demostraron mayores niveles de bienestar en comparación a quienes no lo realizaron. Se concluye que las personas que se encontraban en la categoría de salud mental floreciente y realizaban tratamiento psicoterapéutico presentaron menores indicadores de depresión e intolerancia a la incertidumbre.

Abstract: The people's mental health analysis in SARS-Cov-2 pandemic context constitutes a highly relevant challenge for current psychology. The present research had two goals, firstly to analyze the associations between the mental health continuum and symptoms of anxiety, depression and intolerance to uncertainty in Argentine adults in the COVID-19 pandemic, and secondly to compare the levels of emotional, psychological and social well-being according to psychological assistance in the context of the COVID-19 pandemic. The study included a sample of 1120 adults between 18 and 84 years of age (Mage 37.32, SD = 14.81), 60.1% women and 39.9% men. The results reported that the associations between levels of emotional, psychological, social and total well-being and symptoms of depression and intolerance of uncertainty were negative and significant. However, the correlations with anxiety symptoms were positive and significant. Significant differences were found in the levels of emotional, psychological, social and total well-being according to attendance to psychotherapeutic treatment. In all cases, people who attended psychotherapeutic treatment showed higher levels of well-being compared to those who did not. It is concluded that people who were in the flourishing mental health category and underwent psychotherapeutic treatment showed lower indicators of depression and intolerance to uncertainty.

Resumo: A análise da saúde mental das pessoas no contexto de uma pandemia de SARS-Cov-2 é um desafio altamente relevante para a psicologia actual. A presente investigação tinha dois objectivos, primeiro para analisar as associações entre a continuidade da saúde mental e os sintomas de ansiedade, depressão e intolerância à incerteza em adultos argentinos numa pandemia COVID-19, e segundo para comparar os níveis de bem-estar emocional, psicológico e social de acordo com a assistência psicológica no contexto de uma pandemia COVID-19. O tipo de estudo foi descritivo, correlacional e de diferença de grupo, sob um desenho transversal não experimental. Foi utilizada uma amostra de 1120 adultos de 18-84 anos (Midade 37.32, DP = 14.81), 60.1% feminino e 39.9% masculino. Os resultados relataram que as associações entre os níveis de bem-estar emocional, psicológico, social e total e os sintomas de depressão e de intolerância à incerteza eram negativas e significativas. No entanto, as correlações com sintomas de ansiedade foram positivas e significativas. Foram encontradas diferenças significativas nos níveis de bem-estar emocional, psicológico, social e total de acordo com a assistência ao tratamento psicoterapêutico. Em todos os casos, as pessoas que assistiram ao tratamento psicoterapêutico mostraram níveis mais elevados de bem-estar em comparação com as que não o fizeram. Concluise que as pessoas que se encontravam na próspera categoria de saúde mental e foram submetidas a tratamento psicoterapêutico mostraram indicadores mais baixos de depressão e intolerância à incerteza.

Rol de enfermería en terapia de reemplazo renal continuo en una Unidad de Cuidados Intensivos Quirúrgicos / Nursing Involvement in Continuous Renal Replacement Therapy in a Surgical Intensive Care Unit

Introducción: La disfunción renal aguda es una complicación grave y frecuente en Unidades de Cuidados Intensivos, que se asocia al empleo de terapias continuas de reemplazo renal, donde la actuación de enfermería es determinante para su aplicación exitosa. Objetivo: Describir el rol de enfermería en el uso de terapias de reemplazo renal continuo en una Unidad de Cuidados Intensivos Quirúrgicos. Métodos: Estudio cuantitativo, descriptivo de corte transversal, en la Unidad de Cuidados Intensivos del Centro Nacional de Cirugía de Mínimo Acceso, La Habana, Cuba, desde 2016 hasta 2019. Universo de 10 pacientes con terapias de reemplazo renal continuo, se revisaron en historias clínicas las variables edad, sexo, duración del hemofiltro, duración de la terapia, acceso venoso, valores de creatinina y urea. Se utilizó el programa IBM SPSS para Windows para calcular distribuciones de frecuencias absolutas, porcentajes, media, mediana, desviación típica, valor mínimo y máximo. Resultados: La mediana de edad fue 73 años, el hemofiltro con duración media de 14,70 horas, tiempo medio de terapia 77 horas, valores medios de creatinina 206,9 É¥mol/l y urea 22,4 mmol/l. Se utilizó anticoagulación sistémica. Conclusiones: El rol de enfermería fue decisivo en el uso exitoso de terapias de reemplazo renal continuo en la Unidad de Cuidados Intensivos Quirúrgicos estudiada. La insuficiencia renal aguda fue la causa de inicio de las terapias, predominaron los pacientes adultos mayores sin diferencias en relación al sexo. Se mantuvo la terapia por más de 72 horas en varios pacientes, se debe lograr una mayor longevidad de los filtros(AU)

Introduction: Acute renal dysfunction is a serious and frequent complication in Intensive Care Units, associated with the use of continuous renal replacement therapies, where nursing action is decisive for successful application. Objective: To describe the involvement of nursing in the use of continuous renal replacement therapies in a Surgical Intensive Care Unit. Methods: A quantitative, descriptive, cross-sectional study of 10 patients with continuous renal replacement therapies in the Intensive Care Unit was carried out at the National Center for Minimal Invasive Surgery, Havana, Cuba, from 2016 to 2019. The medical records were reviewed for the variables age, sex, hemofilter duration, duration of therapy, venous access, creatinine and urea values. The IBM SPSS program for Windows was used to calculate absolute frequency distributions, mean, percentages, median, standard deviation, minimum and maximum value. Results: The median age was 73 years, hemofilter had a mean duration of 14.70 hours, mean therapy time 77 hours, mean creatinine values 206.9 µmol /l and urea 22.4 mmol /l. Systemic anticoagulation was used. Conclusions: The nursing involvement was decisive in the successful use of continuous renal replacement therapies in the Surgical Intensive Care Unit studied. Acute renal failure was the cause of initiation of therapies; older patients predominated with no differences in relation to sex. The therapy was kept for more than 72 hours in several patients; a greater longevity of the filters should be achieved(AU)

Sobrecarga hídrica de pacientes con complicaciones obstétricas que requieren terapia de reemplazo renal continua / Fluid overload of patients with obstetric complications requiring continuous kidney replacement therapy / Sobrecarga hidrica de pacientes com complicações obstétricas que requerem terapia de substituição renal contínua

Resumen: Introducción: La sobrecarga hídrica es un fenómeno frecuente cuyo manejo es un elemento clave, ya que se ha relacionado con disfunción orgánica y mayor mortalidad. A la fecha no existe un consenso sobre el manejo óptimo de fluidos para pacientes con lesión renal aguda asociada con complicaciones obstétricas (PR-AKI). Objetivo: Evaluar la sobrecarga hídrica en las pacientes con PR-AKI que requieren terapia de reemplazo renal continua (TRRC). Material y métodos: Se llevó a cabo un estudio observacional, retrospectivo, transversal, comparativo. Se realizó una revisión de expedientes de pacientes con PR-AKI y que requirieron TRRC durante el periodo de enero de 2013-diciembre de 2019 en el Hospital de la Mujer de Morelia. Resultados: Ingresaron a la UCI del Hospital de la Mujer 15 pacientes de 2013-2019. La edad promedio fue de 26.15 años. El peso promedio a su ingreso fue de 75.71 kg con un porcentaje de sobrecarga hídrica de 13.7%. La gravedad de las pacientes según la clasificación APACHE II fue de 23.6 puntos. El promedio de la estancia intrahospitalaria dentro de la UCI fue de 13.1 días, mientras que el promedio de ventilación mecánica asistida fue de 7.5 días. Conclusiones: La sobrecarga hídrica de las pacientes con PR-AKI fue de 13.7%; se asocia a mayores días de estancia dentro de la unidad de cuidados intensivos y más días de ventilación mecánica asistida; sin embargo, no es un factor que indique progresión a enfermedad renal crónica o a la muerte en este grupo de pacientes.

Abstract: Introduction: Water overload is a frequent phenomenon whose management is a key element since it has been related to organ dysfunction and higher mortality. To date, there is no consensus on the optimal fluid management for patients with acute kidney injury associated with obstetric complications (PR-AKI). Objective: To evaluate fluid overload in patients with PR-AKI who require continuous renal replacement therapy (CRRT). Material and methods: An observational, retrospective, cross-sectional, comparative study was carried out. A review of the records of patients with PR-AKI and who required CRRT was carried out during the period of January 2013-December 2019 at the Hospital de la Mujer de Morelia. Results: 15 patients from 2013-2019 were admitted to the ICU of the Women's Hospital. The average age of the patients was 26.15 years. The average weight of the patients upon admission was 75.71 kg with a percentage of fluid overload of 13.7%. The severity of the patients according to the APACHE II classification was 23.6 points. The average hospital stay within the ICU was 13.1 days, while the average assisted mechanical ventilation was 7.5 days. Conclusions: The fluid overload of the patients with PR-AKI was 13.7%; It is associated with longer days of stay within the Intensive Care Unit and more days of assisted mechanical ventilation, however, it is not a factor that indicates progression to chronic kidney disease or death in this group of patients.

Resumo: Introdução: A sobrecarga de água é um fenômeno frequente cujo manejo é um elemento chave, uma vez que tem sido relacionado a disfunções orgânicas e maiores mortalidade. Até o momento, não há consenso sobre o manejo ideal de fluidos para pacientes com lesão renal aguda associada a complicações obstétricas (PR-AKI). Objetivo: Avaliar a sobrecarga de fluidos em pacientes com PR-AKI que requerem terapia de substituição renal contínua (CRRT). Material e métodos: Foi realizado um estudo observacional retrospectivo, transversal, comparativo. Uma revisão dos prontuários dos pacientes foi realizada com PR-AKI e que exigiu TRRC durante o período de janeiro de 2013 a dezembro 2019 no Hospital Feminino de Morelia. Resultados: 15 pacientes de 2013 foram admitidos na UTI do Hospital de la Mujer- 2019. A idade média era de 26,15 anos. O peso médio na admissão era de 75,71 kg com um percentual de sobrecarga hídrica de 13,7%. A gravidade de os pacientes pela classificação APACHE II foi de 23,6 pontos. A média de internação na UTI foi de 13,1 dias, enquanto a média de ventilação mecânica assistida foi de 7,5 dias. Conclusões: A sobrecarga hídrica dos pacientes com PR-LRA foi13.7%; está associado a dias mais longos passados ​​na unidade de cuidados ventilação mecânica intensiva e mais dias assistida; no entanto, não é um fator que indica progressão para doença renal crônica ou morte neste grupo de pacientes.

Validación de la escala de violencia obstétrica y pruebas de la invarianza factorial en una muestra de mujeres chilenas / Validation and factorial invariance test of obstetric violence scale in women from Chile

Resumen La violencia obstétrica (VO) es un problema de enorme relevancia social en nuestro contexto, ya que puede afectar psíquica y físicamente a las mujeres, al mismo tiempo que puede socavar la confianza en el sistema de salud y limitar el acceso oportuno a este por parte de las mujeres. La violencia obstétrica se ha definido como la apropiación del cuerpo de la mujer por parte del personal de salud a través de prácticas que redundan en la medicalización y patologización de sus procesos reproductivos. Esta violencia puede ser psicológica (p. e., regaños, negativa a responder a preguntas o realizar un plan de parto ajustado a sus expectativas), física (p. e., uso innecesario de la fuerza o querer causar dolor intencionalmente) y/o sexual (p. e. comentarios de naturaleza sexual referidos a su cuerpo o genitales, etc.). También se puede verificar mediante la realización de prácticas que están desaconsejadas o estrictamente prohibidas (p. e., monitorización fetal continua, uso de oxitocina sintética para agilizar el procedimiento, negación de la libertad de movimiento, maniobra de Kristeller, episiotomía de rutina, entre otros). No existen a la fecha escalas validadas que permitan detectar violencia obstétrica en la atención de salud. Método: Se analiza la fiabilidad (alfa y omega) y se aportan pruebas de la validez (análisis factorial confirmatorio) de la escala de VO. Las participantes de la muestra fueron 367 mujeres, mayores de edad, de la región de Valparaíso (Chile), que habían tenido alguna vez un parto. Los resultados apoyan la validez de la escala de VO y la estructura unifactorial propuesta muestra un buen ajuste (CFI = .94, NFI = .91, IFI = .94 y RSMEA = .067); también apoyan la idea de invarianza a través de diferentes muestras (ΔCFI < .01 y ΔRSMEA < .01), toda vez que la escala de VO demuestra ser un instrumento confiable (α = .83 y ω = .88). Por lo tanto se concluye que la escala de VO es un instrumento fiable y válido para la detección de este tipo específico de violencia contra las mujeres.

Abstract Obstetric violence is a long-standing problem of great social relevance in our context, since it can affect women psychically and physically. Similarly, obstetric violence can strongly undermine confidence in the health system and limit timely access to it by women (who could avoid conducting routine examinations associated with their pregnancy and which would explain the growing proportion women who wish to deliver at home and outside the medical system). Obstetric violence (also commonly referred to as "disrespect and abuse" during childbirth and "mistreatment" during childbirth care) has been defined as the appropriation of women's bodies by health personnel through practices that become the medicalization and pathologization of their reproductive processes. This violence can be psychological (e.g. abuse, scolding, refusal to answer your questions or carry out a birth plan adjusted to your expectations), physical (e.g. use of force or intentionally wanting to cause pain) and / or sexual (e.g. tacts of a sexual nature, comments of a sexual nature referring to your body or genitals, etc.), which can also be verified in the performance of a series of practices that are discouraged or strictly prohibited (for example, continuous fetal monitoring, use of synthetic oxytocin to speed up the procedure, impaired free movement, Kristeller's maneuver, routine episiotomy, among others). To date, there are no validated scales in our context that allow detecting obstetric violence (OV) in health care. These forms of violence can be a traumatic experience for many women. The scale has been created having as its main reference the so-called "obstetric violence test" prepared by the association El parto es nuestro, which includes the most recurrent situations of lack of respect and abuse in obstetric care. Reliability (alpha and omega) is analyzed and validity tests (confirmatory factor analysis) of the VO scale are provided. The invariance tests aim to ensure that the construct being evaluated (in this case obstetric violence) has the same meaning for women who provide care in the private and public health systems. The participants in the sample were 367 women, all of legal age, from the Valparaíso region (Chile) and who had had a child birth at some point in their lives. These women had their deliveries in both the public and private health systems. Of the total number of women who participated in the study, 58.9% declared having experienced some situation of violence during their delivery. The results support the validity of the VO scale, the proposed unifactorial structure shows a good fit (CFI = .94, NFI = .91, IFI = .94 and RSMEA = .067). The results support the idea of ​​invariance through the samples of women who attended their delivery in the private and public health system (ΔCFI < .01 and ΔRSMEA < .01), since the VO scale proves to be a reliable instrument (α = .83 and ω = .88) and with high levels of internal consistency (either based on total item correlations or factor loadings, which would be the most appropriate method for scales that use ordinal level of measurement). In conclusions, the VO scale is a reliable and valid instrument for the detection of this specific type of violence against women that can contribute to studies that detect abusive practices within the health system. Many of the women who do not report having experienced obstetric violence, do report the presence of some practices that are discouraged or prohibited: genital shaving (66.2 %), enema (45.5 %), prohibition of consuming food or water (51.7 %), indication of lying down during labor (24.5 %), induction of labor using medication (36.1 %), repeated vaginal examinations (24.3 %), compression of the abdomen (34.5 %), episiotomy (33.6 %), cesarean section (54.1 %) ) and uterine scraping without anesthesia (2 %). The previous results indicate the normalization of violent practices and their routine performance in the framework of delivery care in public and private health services, which could make us underestimate their prevalence.

Programas e intervenciones educativas ofrecidas al personal farmacéutico para mejorar la prestación de los servicios asistenciales farmacéuticos: una revisión estructurada / Educational programs and interventions offered to pharmacy staff to improve the delivery of pharmaceutical assistance services: A structured review

Resumen Objetivo: Describir los programas y las intervenciones educativas ofrecidas al personal farmacéutico, para mejorar la prestación de los servicios asistenciales farmacéuticos y los métodos utilizados para evaluar la efectividad de estos programas. Métodos: Se realizó una revisión estructurada, se utilizó la base de datos PubMed/Medline entre 2007 y 2019, sobre el desarrollo, la descripción, la evaluación del impacto, la efectividad o la comparación de una intervención educativa, un entrenamiento específico o un programa educativo dirigido al personal farmacéutico de farmacias comunitarias (ambulatorias) y/o hospitalarias. Resultados: En total, 1290 referencias bibliográficas fueron identificadas: se incluyeron 26 referencias adicionales y se seleccionaron 90 artículos para su revisión y análisis. Se encontró que el 70 % (63) de los estudios fueron realizados en países desarrollados, principalmente en Estados Unidos, Australia, Canadá e Inglaterra. El 67 % (60) de los estudios se realizaron a nivel ambulatorio, el 10 % (9) a nivel hospitalario y el 23 % (21), en ambos contextos. Las intervenciones fueron clasificadas en tres categorías: Entrenamientos Específicos (41 %), programas de Educación Continua (43 %) y de Desarrollo Profesional Continuo, (16 %). De las metodologías o métodos de provisión de la intervención, la más común fue la presencial en el 72 % (65) de los estudios, seguido de metodologías apoyadas con herramientas virtuales en el de las intervenciones educativas varió entre menos de 1 hora y 120 horas. Conclusión: Se describen los programas y las intervenciones educativas ofrecidas al personal farmacéutico, principalmente para mejorar sus competencias laborales y la prestación de los servicios asistenciales farmacéuticos, además de los métodos utilizados para evaluar la efectividad de las intervenciones educativas.

Abstract Objective: To describe the educational programs and interventions offered to pharmacy staff, to improve the delivery of pharmaceutical healthcare services and the methods used to evaluate the programs' effectiveness. Methods: A structured review was performed using the PubMed/Medline database from 2007 to 2019. Results: In total, 1290 bibliographic references were identified; besides, 26 references identified by other sources were included and 90 articles for review and analysis were selected. It was found that 70% (63) of the studies were made in developed countries, mainly in the United States, Australia, Canada, and England. 67% (60) of the studies were carried out at the outpatient level, 10% (9) at the hospital level, and 23% (21) in both contexts. The interventions were classified into three categories: Specific settings (41%), Continuing Education (43%), and Continuing Professional Development (16%) programs. The most common methodology or delivery methods for the intervention were face-to-face in 72% (65) of the studies, followed by methodologies supported by virtual tools in 28% (25) and 11% (10) of the studies combined face-to-face and virtual methods. The duration of the educational interventions ranged from less than 1 hour to 120 hours. Conclusion: The educational programs and interventions offered to the pharmacy staff are described, mainly to improve their labor competencies. Additionally the provision of pharmaceutical healthcare services and the methods used to evaluate the effectiveness of the educational intervention.

Cuidados continuos y estado de salud en el adulto mayor con cáncer de próstata / Continuous Cares and Health Status in the Elderly with Prostate Cancer

Introducción: El proceso de envejecimiento trae consigo cambios fisiológicos en las esferas orgánica y mental, que predisponen eventos fisiopatológicos, entre ellos el cáncer, entidad con repercusión significativa en el estado de salud del adulto mayor. Objetivo: Destacar la necesidad de los cuidados continuos para potenciar el estado de salud en el adulto mayor con cáncer de próstata. Métodos: Se confeccionó una comunicación breve a partir de un estudio preliminar con enfoque descriptivo de corte transversal, desde junio 2019 hasta febrero 2020, en el Hospital de Oncología María Curie, Camagüey, Cuba, donde se aplicó una encuesta sobre el nivel información de los cuidados continuos en oncología y los componentes de las teorías de Sor Callista Roy y Kristen M. Swanson en 16 enfermeros(as) participantes en el proyecto. Se ejecutó valoración del estado de salud, utilizando los instrumentos (Índice de Katz y escala de Lawton) en 34 adultos mayores con cáncer de próstata. Resultados: Fueron descritos niveles de información, mínimo aceptable e inaceptable en el personal encuestado. La valoración integral al adulto mayor con cáncer de próstata permitió conocer expresiones de dependencia a las actividades de la vida diaria e instrumentada. Conclusión: El estudio favoreció la preparación integral del personal de enfermería en la atención continuada del paciente oncológico. Además facilitó pautas que fortalecen la utilidad de la valoración integral para el proceso de los cuidados continuos del adulto mayor con cáncer de próstata, que permitan preservar conductas generadoras de salud biopsicosocial y potenciar su estado de salud(AU)

Introduction: The aging process brings about physiological changes, both organically and mentally, that may be the cause for pathophysiological events, including cancer, an entity with significant repercussions on the health status of the elderlies. Objective: To highlight the need for continuous care to enhance the health status of the elderlies with prostate cancer. Methods: A brief communication was made from a preliminary study with a descriptive cross-sectional approach, from June 2019 to February 2020, at María Curie Oncology Hospital, in Camagüey, Cuba, where a survey about the information level of continuous care in oncology and the components of the theories of Sister Callista Roy and Kristen M. Swanson was applied in sixteen nurses who participated in the project. Health status assessment was carried out, using the Katz index and Lawton scale in 34 older adults with prostate cancer. Results: Minimum ally acceptable and unacceptable levels of information were described in the surveyed personnel. The comprehensive assessment of the elderlies with prostate cancer allowed us to know expressions of dependence on the activities of daily and instrumented life. Conclusion: The study favored the comprehensive training of the nursing staff regarding ongoing care of cancer patients. In addition, it provided guidelines that strengthen the usefulness of comprehensive assessment for the process of continuous care of the elderlies with prostate cancer, so that these guidelines allow preserving behaviors that generate biopsychosocial health and enhance their health status(AU)

Monitoreo continuo de glucosa: indicaciones, interpretación de datos y toma de decisiones terapéuticas. Recomendaciones de expertos / Continuous glucose monitoring: indications, data interpretation and making therapeutic decisions. Expert recommendations

Las herramientas para evaluar el grado de control glucémico se modificaron últimamente. La emoglobina glicosilada (HbA1c), parámetro de referencia (gold standard), refleja el control glucémico de los últimos tres meses de manera retrospectiva, sin expresar la variabilidad glucémica. El automonitoreo glucémico capilar (AGC) brinda información inmediata y prospectiva, pero dispone de pocos datos glucémicos para generar promedios y desviaciones estándares representativas. No detecta tendencias y tiene limitaciones para obtener datos nocturnos o durante la actividad física. Es invasivo y muchas veces rechazado. Contrariamente, el monitoreo continuo de glucosa (MCG) mide la glucosa instantáneamente, y muestra sus tendencias y su variabilidad en forma continua, incorporando nuevas métricas de control. Mediante el perfil ambulatorio de glucosa (PAG) se analizan los patrones del control glucémico durante el sueño, los ayunos prolongados, la actividad física y las intercurrencias, expresándolos como curvas con sus desviaciones estándar durante períodos de horas (8 a 24 horas) o días (7, 14, 30 y 90 días). El PAG contiene las siguientes métricas: porcentaje de tiempo en rango TIR (del inglés, time in range), porcentaje de tiempo por encima del rango TAR (del inglés, time above range), porcentaje de tiempo por debajo del rango o hipoglucemia TBR (del inglés, time below range) y coeficiente de variabilidad (%CV). La información continua permite tomar decisiones inmediatas, ya sea con la ingesta de carbohidratos o con la aplicación de insulina. El MCG con terapéuticas insulínicas inyectables (TII) o bomba portable de insulina (BPI) es una herramienta muy útil y complementaria para el tratamiento de la diabetes mellitus tipo 1 (DM1) y la DM2 en la insulinoterapia. Su utilización se asoció con descensos significativos en la HbA1c, disminución de la variabilidad glucémica, reducción de las hipoglucemias totales y nocturnas, y mejoría de la calidad de vida en estos pacientes. Nuestro propósito como grupo de expertos es generar una guía práctica para regular la implementación del MCG.

The tools to assess the degree of glycemic control were modified lately. Glycosylated hemoglobin (HbA1c), the gold standard, reflects the glycemic control of the last 3 months retrospectively, without expressing glycemic variability. Selfblood glucose monitoring (SBGM) provides immediate and prospective information, but has little glycemic data to generate representative averages and standard deviations. It does not detect trends and has limitations to obtain nocturnal data or during physical activity. It is invasive and often rejected. On the contrary, continuous glucose monitoring (CGM), allows to measure glucose instantly, shows your trends and variability continuously, incorporating new control metrics. The ambulatory glucose profile (AGP) analyzes the patterns of glycemic control during sleep, prolonged fasting, physical activity and intercurrences, expressing them as curves with their standard deviations during periods of hours (8 to 24 hours) or days (7, 14, 30 and 90 days). The AGP contains the following metrics: percentage time in range (TIR), percentage time above range mg/dl (TAR), percentage time below range or hypoglycemia (TBR) and coefficient of variation (%CV). CGM with IIT or continuous subcutaneous insulin infusion (CSII), is a very useful and complementary tool for the treatment of DM1 and DM2 in insulin therapy. Its use was associated with significant decreases in HbA1c, decreased glycemic variability, reduction of total and nocturnal hypoglycemia and improvement of the quality of life in these patients. Our aim as a group of experts is to generate a practical guide to regulate the implementation of the CGM.