Actualización en fibrosis quística estándares de atención para pacientes con diagnóstico de fibrosis quística con terapia moduladora: informe de la Sociedad Europea de Fibrosis Quística 2023 / Standards of care for patients with a diagnosis of cystic fibrosis who are on modulator therapy: report of the European Fibrosis Cystic Society 2023

La fibrosis quística ha entrado en la era de la terapia específica con los moduladores, útiles en variantes genéticas definidas por estudio molecular, con resultados clínicos exitosos. Este es un resumen de la publicación reciente de la Sociedad Respiratoria Europea que establece los estándares de cuidado para los pacientes que reciben este tratamiento.

Cystic fibrosis has entered the era of specific therapy called modulators, useful in genetic variants defined by molecular study, with successful clinical results. This is a summary of the recent publication of the European Respiratory Society that establishes the standards of care for patients receiving this treatment.

Índices fisiológicos não hiperêmicos ­ base teórica, aplicações clínicas e limitações / Non-hyperemic pressure ratios ­ theoretical basis, clinical applications, and limitations

A fisiologia coronariana tornou-se o padrão de tratamento para avaliar o significado funcional da doença aterosclerótica coronariana. Ela permite identificar isquemia miocárdica em nível de vaso, discriminar os padrões funcionais da doença aterosclerótica e orientar a necessidade de revascularização; complementar o planejamento da intervenção coronária percutânea e confirmar o sucesso funcional dessa última. Em uma edição anterior do Journal of Transcatheter Interventions, apresentamos uma revisão abrangente sobre o fluxo fracionado de reserva do miocárdio. Apesar do robusto corpo de evidências que apoiam seu uso, a aceitação clínica do fluxo fracionado de reserva é variável e excessivamente baixa em muitas áreas do mundo. O aumento percebido no tempo do procedimento, o uso de agentes hiperêmicos com seus correspondentes custos e desconforto do paciente, e a dificuldade de interpretação dos resultados em determinadas situações anatômicas contribuíram para a adoção limitada do método. A introdução do índice de fluxo instantâneo no período livre de ondas superou a maioria dessas limitações. Apoiada por uma validação técnica sólida e dados de desfechos clínicos, o índice de fluxo instantâneo no período livre de ondas recebeu as mesmas indicações clínicas que o fluxo fracionado de reserva nas recomendações mais recentes das diretrizes. Isso foi seguido pela introdução de outros índices pressóricos não hiperêmicos, já comercialmente disponíveis. Neste artigo, revisamos as bases fisiológicas que justificam o uso de índices pressóricos não hiperêmicos, sua validação técnica e clínica e dados de desfechos clínicos, além de discutirmos suas aplicações em situações anatômicas específicas, com exemplos de casos dos autores, sempre que aplicável.

Coronary physiology has become the standard of care to assess the functional significance of coronary atherosclerotic disease. It allows for identification of myocardial ischemia on a vessel level, discrimination of the functional patterns of atherosclerotic disease, guidance for the need of revascularization, complements the planning of percutaneous coronary intervention and verification of the functional success of percutaneous coronary intervention. On a previous issue of the Journal of Transcatheter Interventions, we presented a comprehensive review about fractional flow reserve. Despite the robust body of evidence supporting its use, the clinical use of fractional flow reserve is variable, and unreasonably low in many areas around the globe. The perceived increase in procedure time, the use of hyperemic agents with its related costs and patient discomfort, and difficulty in interpreting results in certain anatomical scenarios have contributed to the limited adoption of fractional flow reserve. The introduction of instantaneous wave-free ratio overcame most of these limitations. Supported by sound technical validation, and clinical outcomes data, instantaneous wave-free ratio received the same clinical indications as fractional flow reserve in the most recent guidelines recommendations. This was followed by the introduction of other non- hyperemic pressure ratios for commercial use. In the current manuscript we review the physiological basis that supports the use of non-hyperemic pressure ratios, their technical and clinical validation, clinical outcomes data, and discuss its applications on specific anatomic scenarios, with examples of cases from the authors, whenever applicable.

Tratamiento farmacológico del estrabismo / Pharmacological treatment of strabismus

La cirugía de la musculatura extraocular ha sido el estándar de atención para tratamiento quirúrgico del estrabismo por más de un siglo. A pesar del gran desarrollo técnico de la cirugía de estrabismo en la actualidad, la utilización de microscopio quirúrgico, el diseño novedoso del instrumental quirúrgico, la calidad de la sutura no reabsorbible; los avances en equipamiento y fármacos anestésicos, la misma no está exenta de complicaciones quirúrgicas, además del tiempo de recuperación que necesita el paciente para reincorporarse a sus actividades sociales, han propiciado una búsqueda permanente del tratamiento farmacológico para el estrabismo. El objetivo de esta revisión bibliográfica es analizar las distintas alternativas farmacológicas disponibles como tratamiento del estrabismo. Para su confección se consultó textos completos y artículos en idiomas español e inglés, disponible en algunas bases de datos. Concluimos que aunque se han estudiado numerosos fármacos, la toxina botulínica que es la más conocida y utilizada mundialmente, seguida de la bupivacaína. Encontramos otros como la IGF I y II (Insuline Growing Factor), capaces de generar un efecto de reforzamiento de la actividad muscular. Y otros que "debilitan" la musculatura extraocular, incluyen la mAb35-Rubicina, BMP4 (Proteína morfogénica ósea). Se continúa su investigación en la actualidad(AU)

Extraocular musculature surgery has been the standard of care for surgical treatment of strabismus for more than a century. Despite the great technical development of strabismus surgery today, the use of a surgical microscope, the novel design of surgical instruments, the quality of the non-absorbable suture; Advances in anesthetic equipment and drugs, it is not exempt from surgical complications, in addition to the recovery time that the patient needs to return to their social activities, have led to a permanent search for pharmacological treatment for strabismus. The objective of this bibliographic review is to analyze the different pharmacological alternatives available as a treatment for strabismus. For its preparation, full texts and articles in Spanish and English languages were consulted, available in some databases. We conclude that although numerous drugs have been studied, botulinum toxin, which is the best known and used worldwide, followed by bupivacaine. We find others such as IGF I and II (Insuline Growing Factor), capable of generating an effect of reinforcing muscle activity. And others that "weaken" MOE include mAb35-Rubicin, BMP4 (Bone Morphogenic Protein). His research is continuing today(AU)

Manual de procedimientos clínicos odontológicos / Manual of clinical procedures dental

El manual de procedimientos orienta los procesos a ejecutar en el desarrollo de las actividades que el profesional de odontología debe realizar, esto permite delimitar la responsabilidad de ejecución en los diferentes procedimientos de acuerdo al nivel de atención en salud, facilitar la realización de los mismos y consecuentemente contribuir a mejorar la calidad de la atención

The procedures manual guides the processes to be carried out in the development of the activities that the dental professional must carry out, this allows defining the responsibility of execution in the different procedures according to the level of health care, facilitating the realization of the same and consequently contribute to improving the quality of care

Cuidado emancipador / Emancipating care

Resumo A humanização do cuidado tem sido um desafio presente no campo da saúde em geral e no Sistema Único de Saúde brasileiro. O objetivo deste artigo é discutir o constructo sociológico de cuidado emancipador. Enquanto o cuidado tem forte identificação com o senso comum e com os conhecimentos tácitos, a prática clínica biomédica associou-se ao conhecimento científico resultante de uma ruptura epistemológica racionalista. O cuidado emancipador é uma hibridização entre senso comum e conhecimento científico, ou cuidado e clínica, sustentado pelo posicionamento ético-político do profissional, para a substituição da heteronomia pela autonomia no processo de saúde-doença-cuidado. A intencionalidade deste artigo é apresentar uma perspectiva inovadora sobre a discussão do cuidado, que não é nova, trazendo algumas referências históricas, não com o propósito de desenvolver uma análise epocalista ou cronológica. O objetivo é alargar o espaço de reflexões sobre os cuidados heterônomos como um evento hegemônico da cultura contemporânea, bem como ampliar os debates sobre as possibilidades de construção de práticas de cuidado que privilegiem a autonomia das pessoas e apontem para a sua emancipação. Conclui-se que o conceito de cuidado emancipador pode fazer avançar uma segunda ruptura epistemológica com o desenvolvimento de práticas emancipadoras no processo saúde-doença-cuidado.

Abstract The humanization of care has been a present challenge in the field of health in general and in the Brazilian Unified Health System. The purpose of this article is to discuss the sociological construct of emancipating care. While care is strongly identified with common sense and tacit knowledge, biomedical clinical practice has been associated with scientific knowledge resulting from a rationalist epistemological rupture. Emancipatory care is a hybridization between common sense and scientific knowledge, or care and clinic, supported by the professional's ethical-political position, to replace heteronomy with autonomy in the health-disease-care process. The purpose of this article is to present an innovative perspective on the discussion of care, which is not new, bringing some historical references, not with the purpose of developing an epochalist or chronological analysis. The objective is to expand the space for reflections on heteronomous care as a hegemonic event in contemporary culture, as well as to expand the debates on the possibilities of building care practices that privilege people's autonomy and point to their emancipation. It is concluded that the concept of emancipating care can advance a second epistemological rupture with the development of emancipating practices in the health-disease-care process.

Mecanismos de coordinación en la red de salud municipal de Rosario: conocimiento y uso, estudio comparativo 2015-201 / Coordination mechanisms in Rosario´s municipal health network: knowledge and use. Comparative study 2015-2017

INTRODUCCIÓN: En Argentina, como en el resto de Latinoamérica, el sistema de salud está fragmentado; los mecanismos de coordinación (MC) entre niveles de atención son un insumo para su mejora. El objetivo fue analizar, como parte del proyecto EQUITY LA II, el conocimiento y uso de MC entre niveles de atención en médicos de atención primaria (AP) y especializada (AE) en la red de Salud Municipal de Rosario, y sus cambios entre 2015 y 2017. MÉTODOS: Se realizó un estudio transversal con aplicación del cuestionario COORDENA Argentina a médicos de AP y AE. Se encuestó a 350 médicos en 2015 y a 352 en 2017. Las variables fueron nivel de conocimiento, frecuencia, finalidad y dificultades en el uso de los MC de información (MCI): hoja de referencia/contrarreferencia-interconsulta (HR/CR), informe de alta hospitalaria, teléfono; y los MC de gestión clínica (MCGC): guías de práctica clínica (GPC) y reuniones conjuntas. Se efectuó un análisis comparativo entre años y niveles. RESULTADOS: En 2015 la mayoría conocía MCI, aunque hubo diferentes porcentajes de uso según niveles de atención. Los MCGC eran menos conocidos, pero muy usados entre quienes los conocían. Hubo cambios significativos en 2017: disminuyó el envío de CR y el uso del teléfono en AP, y aumentó el conocimiento de reuniones conjuntas y de GPC (solo entre AP). DISCUSIÓN: Existen diferencias en la implementación de MC entre niveles. La adecuación al contexto local es clave para lograr una efectiva y eficiente implementación.

Percepción de funcionarios sobre la gestión del Sistema de Salud de Chone, ante el terremoto de Pedernales / Perception of officials on the management of the Chone Health System, in the face of the Pedernales earthquake

INTRODUCCIÓN. En abril de 2016 ocurrió en la provincia de Manabí-Ecuador un terremoto de 7,6 grados, escala de Richter. Afectó la gestión de entidades de salud de dicha provincia. El país viene implementando políticas para alcanzar acceso universal de atención de salud, pero, el sistema mantiene debilidades en el modelo de atención primaria. OBJETIVO. Describir los efectos del terremoto en la gestión del sistema de salud en el Distrito de Chone, en base a las percepciones de los funcionarios de salud. MATERIALES Y MÉTODOS. Estudio cualitativo. Se describió el evento desde la perspectiva de 11 funcionarios seleccionados de diferentes niveles de gestión técnica en el sistema de salud, que laboraron durante el terremoto. Datos obtenidos por una encuesta semiestructurada sobre las tres funciones del sistema de salud: Rectoría, Provisión de Servicios y Financiamiento. RESULTADOS. El terremoto profundizó las debilidades que ya existían, afectó la ejecución de los programas de salud. La gestión del nivel central del Ministerio de Salud Pública sobrecargó el trabajo del personal local y la asignación de recursos fue insuficiente. DISCUSIÓN. A pesar que la evidencia demostró que una adecuada atención primaria con suficiente personal de salud, mejora la respuesta ante desastres, sin embargo, esto no se dio y los efectos negativos del desastre se mantienen años después. CONCLUSIÓN. Las deficiencias en la atención primaria de salud, así como insuficiente preparación para la gestión adecuada ante un desastre natural, influyeron en la calidad de la respuesta del sistema de salud.

INTRODUCTION. In april 2016, an earthquake of 7.6 degrees, on the Richter scale, occurred in the province of Manabí-Ecuador. It affected the management of health entities in said province. The country has been implementing policies to achieve universal access to health care, but the system maintains weaknesses in the primary care model. OBJECTIVE. Describe the effects of the earthquake on the management of the health system in the Chone District, based on the perceptions of health officials. MATERIALS AND METHODS. Qualitative study. The event was described from the perspective of 11 officials selected from different levels of technical management in the health system, who worked during the earthquake. Data obtained by a semi-structured survey on the three functions of the health system: Stewardship, Provision of Services and Financing. RESULTS. The earthquake deepened the weaknesses that already existed, affected the execution of health programs. Management at the central level of the Ministry of Public Health overloaded the work of local staff and the allocation of resources was insufficient. DISCUSSION. Although the evidence showed that adequate primary care with sufficient health personnel improves the response to disasters, however, this did not occur and the negative effects of the disaster continue years later. CONCLUSION. Deficiencies in primary health care, as well as insufficient preparation to properly manage a natural disaster, influenced the quality of the health system response.

Efetividade de uma intervenção baseada em Mindfulness para redução de estresse e melhora da qualidade de vida em estudantes de enfermagem: Effects on stress and quality of life / Mindfulness based intervention for nursing students / Efectividad de una intervencion basada en Mindfulness para reduccion de estres y mejora de la calidad de vida en estudiantes de enfermeria

OBJETIVO: avaliar a efetividade de uma intervenção para redução de estresse baseada em Mindfulness em aspectos relacionados à Qualidade de Vida, Atenção Plena e Estresse Percebido, em estudantes de graduação e pós-graduação em enfermagem. MÉTODO: aplicados instrumentos de avaliação para a construção de uma linha basal e posteriormente a amostra foi submetida a um Programa de Redução de Estresse e aumento da Qualidade de Vida baseado em Mindfulness, formatado em encontros semanais por oito semanas. RESULTADOS: após a intervenção, houve diminuição do nível de Estresse Percebido, aumento do nível de Atenção Plena e melhora da Qualidade de Vida em âmbito psicológico. CONCLUSÃO: intervenções baseadas em Mindfulness se mostram efetivas e podem constituir um importante recurso para o gerenciamento do estresse e melhora na Qualidade de Vida dos estudantes.

OBJECTIVE: to evaluate the effectiveness of an intervention to reduce stress based on Mindfulness in aspects related to Quality of Life, Mindfulness and Perceived Stress in undergraduate and postgraduate students of Nursing. METHOD: evaluation instruments were applied to establish baseline data, and the sample was subsequently submitted to a Mindfulness Based Stress Reduction and Quality of Life, formatted eight consecutive weeks. RESULTS: after the intervention, there was a decrease in the level of Perceived Stress, increase in the level of Mindfulness and improvement of the Quality of Life in the psychological area. CONCLUSION: interventions based in Mindfulness are effective and can offer important resources for managing stress and improving the Quality of Life of students.

OBJETIVO: evaluar la efectividad de una intervención para reducción de estrés basada en Mindfulness en relación a la Calidad de Vida, Atención Plena y Estrés Percibido, en universitarios y estudiantes de postgrado de Enfermería. MÉTODO: previamente se aplicaron instrumentos de evaluación para la construcción de una línea basal y posteriormente la muestra fue sometida a un Programa de Reducción de Estrés y aumento de la Calidad de Vida basado en Mindfulness, constituído de encuentros semanales, durante ocho semanas consecutivas. RESULTADOS: se observó que después de la intervención, hubo disminución del nivel de Estrés Percibido, aumento del nivel de Atención Plena y mejora de la Calidad de Vida en ámbito psicológico. CONCLUSIÓN: intervencones basadas en Mindfulness se muestran efectivas y pueden constituir un importante recurso para manejar el estrés y mejorar la Calidad de Vida de los estudiantes.

Características de pacientes adultos con cáncer y su atención en el Hospital Universitario San José de Popayán, Colombia / Characteristics of adult cancer patients and their care at the San José University Hospital, Popayán, Colombia

Resumen Objetivo: Describir las características sociodemográficas y clínicas de los pacientes adultos con diagnóstico de cáncer atendidos en el Hospital Universitario San José (HUSJ) de Popayán, Colombia. Métodos: Estudio observacional con datos rutinarios de cáncer que incluyó pacientes mayores de 18 años atendidos entre 2012 y 2017 en los servicios de urgencias y hospitalización con diagnóstico de cáncer, según el Manual CIE 10 (Clasificación Internacional de Enfermedades, décima versión) en el HUSJ. Se aplicó una estrategia de muestreo aleatorio simple con afijación proporcional por años y se analizaron de forma descriptiva y gráfica. Resultados: Se incluyeron 245 pacientes. El 51% de los cuales correspondió al género femenino y la mediana de edad fue de 64 años. El cáncer más frecuente en ambos sexos fue el de estómago, seguido por el cáncer de ovario y cérvix en mujeres y por el cáncer de próstata, de tejido sanguíneo y de médula ósea en hombres. Los tipos histológicos de cáncer registrados en la mayoría de los pacientes fueron los carcinomas y adenocarcinomas. En el 36,7% de los pacientes se documentó la presencia de metástasis. La mortalidad durante la última hospitalización fue del 20% y el 12% de los pacientes requirieron remisión a otro nivel de atención superior. Conclusión: Los resultados de este estudio muestran similitudes con el comportamiento de la enfermedad en el país, con excepción del cáncer ginecológico. Adicionalmente, aporta información valiosa tanto a nivel regional como a la institución y crea conciencia de la necesidad de la implementación y mantenimiento de registros hospitalarios de cáncer.

Abstract Objective: To describe the socio-demographic and clinical characteristics of adult cancer patients who received treatment at the San José University Hospital (HUSJ) in Popayán, Colombia. Methods: Observational study with routine cancer data, which included patients aged over 18 years, who received treatment between 2012 and 2017 in the emergency and hospitalization departments, with cancer diagnosis according to the ICD Manual 10 (International Statistical Classification of Diseases, tenth revision) in the HUSJ. It was applied a simple random sampling strategy, with proportional allocation by years, and they were analyzed descriptively and graphically. Results: 245 patients were included, 51% of which corresponded to female gender; median age, 64 years. The most frequent cancer in both sexes was stomach cancer, followed by ovary cancer and cervix cancer in women; and cancer of the prostate, blood tissue, and bone marrow in men. The histological types of cancer registered in most of the patients were carcinomas and adenocarcinomas. The presence of metastases was documented in 36.7% of the patients. The mortality during the last hospitalization was 20%; and 12% of patients required referral to another higher level of care. Conclusion: The results of this study show similarities with the behavior of the disease in the country, with the exception of gynecological cancer. Additionally, it provides valuable information both regionally and at institution level, as well as it raises awareness of the need for the implementation and maintenance of hospital cancer records.

Uso de substâncias em adultos em situação de rua e associação com mindfulness / Substance use among adults living on the streets and association with mindfulness / Uso de sustancias en adultos en situación de calle y asociación con mindfulness

OBJETIVO: analisar a relação entre o nível de atenção plena e o uso problemático de álcool e drogas em pessoas em situação de rua. MÉTODO: foi realizado um estudo de corte transversal com 40 usuários de um serviço de convivência de adultos em situação de rua ou de abrigamento. Eles foram entrevistados utilizando-se as escalas MAAS (Mindful Attention Awareness Scale ou Escala de Consciência e Atenção Mindfulness, em português), CAGE (acrônimo referente às suas quatro perguntas em inglês: Cut down, Annoyde by criticims, Guilty e Eye-opener) e AUDIT (Alcohol Use Disorders Identification Test), além de um questionário sociodemográfico. RESULTADOS: evidenciam alta prevalência de abuso de substâncias nessa amostra e mostraram correlação negativa entre o uso problemático de álcool e drogas e o nível de atenção plena, o que indica que baixos níveis de mindfulness podem ser um fator de risco para a população adicta. CONCLUSÃO: o uso de meditação em intervenções com essa população é sugerido.

OBJECTIVE: to analyze the relationship between mindfulness traits and problematic use of alcohol and other drugs. METHODS: a cross-sectional study was conducted with 40 users of a coexistence service for adults living in the streets or shelters. They answered, during an interview, the MAAS scale (Mindful Attention Awareness Scale), CAGE (Cut down, Annoyde by criticims, Guilty and Eye-opener) and AUDIT (Alcohol Use Disorders Identification Test), as well as a sociodemographic questionnaire. RESULTS: high prevalence of substance abuse in this sample, and a negative correlation between the problematic use of alcohol and drugs and the level of mindfulness, which may indicate that low levels of mindfulness may be a risk factor for the addicted population. CONCLUSION: the use of meditation in interventions with this population is suggested.

OBJETIVO: analizar la relación entre el nivel de atención plena y el uso problemático de alcohol y drogas en personas en situación de calle. MÉTODO: estudio de corte transversal con 40 usuarios de un servicio de convivencia de adultos en situación de calle o de refugio. Contestaron, durante una entrevista, las escalas MAAS (Mindful Attention Awareness Scale), CAGE (Cut down, Annoyde by criticims, Guilty and Eye-opener) y AUDIT (Alcohol Use Disorders Identification Test), así como un cuestionario sociodemográfico. RESULTADOS: alta prevalencia de abuso de sustancias en esta muestra y mostraron una correlación negativa entre el uso problemático de alcohol y drogas y el nivel de atención plena, lo que indica que bajos niveles de mindfulness pueden ser un factor de riesgo para la población adicta. CONCLUSION: se sugiere el uso de meditación en intervenciones con esa población.

Completion hysterectomy after chemoradiotherapy for locally advanced adeno-type cervical carcinoma: updated survival outcomes and experience in post radiation surgery / 부인종양

OBJECTIVE: To compare patient survival outcomes between completion hysterectomy and conventional surveillance in locally advanced adenocarcinoma of the cervix after concurrent chemoradiotherapy (CCRT).METHODS: Patients with adenocarcinoma of the cervix after CCRT were identified in a tertiary academic center database from 2004 to 2018. Patients received completion hysterectomy or surveillance after CCRT. We compared the progression-free survival (PFS) and overall survival (OS) between the patients with or without adjuvant hysterectomy. Surgery features, operative complications, and pathologic characteristics were documented. Patient outcomes were also analyzed according to clinicopathologic factors.RESULTS: A total of 78 patients were assigned to completion surgery and 97 to surveillance after CCRT. The PFS was better in the surgery group compared to the CCRT only group, at 3 years the PFS rates were 68.1% and 45.2%, respectively (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.282–0.749; p=0.002). Adjuvant surgery was also associated with a higher rate of OS (HR=0.361; 95% CI=0.189–0.689; p=0.002), at 3 years, 87.9% and 67%, respectively. Tumor stage, size, lymph-vascular space invasion (LVSI), lymphadenopathy were associated with PFS but not with OS. Hysterectomy specimens revealed 64.1% (50/78) of the patients had pathologic residual tumor. Patients age less than 60, tumor size over 4 cm, stage IIB and persistent residual disease after CCRT were most likely to benefit from hysterectomy. Hysterectomy was associated with a lower rate of locoregional recurrence but did not reach statistical significance (5.13% vs. 13.5%, p=0.067).CONCLUSION: Completion hysterectomy after CCRT was associated with better survival outcome compared with the current standard of care.

Penile Reconstructive Surgery in Peyronie Disease: Challenges in Restoring Normal Penis Size, Shape, and Function

Abordagem ao período pós-operatório inicial no transplante de fígado: um ponto de vista institucional / Approach to the liver transplant early postoperative period: an institutional standpoint

RESUMO O programa de transplante de fígado teve início em nosso centro em 1992, e pacientes em pós-operatório de transplante hepático ainda são admitidos à unidade de terapia intensiva. Uma curva de aprendizado do médico intensivista teve então início, com aquisição de habilidades e estabelecimento de uma prática específica. Contudo, muitos dos conceitos se modificaram com o tempo, o que conduziu a uma melhora nos cuidados proporcionados a esses pacientes. A abordagem prática varia entre diferentes centros de transplante de fígado, segundo especificidades locais. Assim, ensejamos apresentar nossa prática para estimular o debate entre diferentes equipes dedicadas, o que tem potencial de permitir a introdução de novas ideias e, possivelmente, melhorar o padrão de cuidados em cada instituição.

ABSTRACT The liver transplant program in our center started in 1992, and post-liver transplant patients are still admitted to the intensive care unit. For the intensive care physician, a learning curve started then, skills were acquired, and a specific practice was established. Throughout this time, several concepts changed, improving the care of these patients. The practical approach varies between liver transplant centers, according to local specificities. Hence, we wanted to present our routine practice to stimulate the debate between dedicated teams, which can allow the introduction of new ideas and potentially improve each local standard of care.

Factores asociados con somnolencia diurna excesiva en estudiantes de Medicina de una institución de educación superior de Bucaramanga / Factors Associated with Excessive Daytime Sleepiness in Medical Students of a Higher Education Institution of Bucaramanga

RESUMEN Introducción: La somnolencia diurna excesiva (SDE) puede llegar a interferir en el desempeño académico y profesional, debido a que las personas afectadas tienden a quedarse dormidas en situaciones que exigen un alto nivel de atención. Los estudiantes de Medicina representan una población en riesgo de SDE, dada la exigencia académica de numerosas horas de estudio, debido al gran número de créditos por asignatura contenidos en el plan de estudios del programa académico, las prácticas docentes asistenciales y los turnos nocturnos, que pueden generar privación o déficit acumulado del sueño. Por esta razón, es importante estimar la prevalencia de SDE y los factores asociados en estudiantes de Medicina de una institución de educación superior (IES) de Bucaramanga, con el objetivo de implementar estrategias de prevención primaria que disminuyan la presentación de este problema y mejoren la calidad de vida y el desempeño académico de los estudiantes. Material y métodos: Estudio transversal analítico observacional, con una muestra poblacional de 458 estudiantes de Medicina matriculados en el segundo semestre de 2015 en la Universidad Autónoma de Bucaramanga (UNAB), quienes respondieron a 4 cuestionarios: variables sociodemográficas, escala de somnolencia de Epworth, índice de calidad del sueño de Pittsburg (ICSP) e índice de higiene del sueño (IHS). Se realizó el análisis bivariable y multivariable en busca de asociación con SDE. Resultados: Los estudiantes tenían una media de edad de 20,3 arios; de los 458 encuestados, el 62,88% eran mujeres. Se estableció que el 80,75% de los participantes tenían SDE y el 80,55%, una percepción negativa de la calidad del sueño (OR = 1,91;IC95%, 1,11-3,29; p = 0,019). En el análisis multivariable, se encontró que el hecho de estar cursando ciencias clínicas disminuye el riesgo de SDE respecto a quienes estaban cursando el ciclo básico. Además, se observó que una puntuación > 15 en el IHS aumenta de manera significativa el riesgo de padecer SDE. Conclusiones: Aunque es frecuente encontrar SDE en los estudiantes de Medicina, solo un pequeño porcentaje de ellos sufren la forma severa de este trastorno del sueño. Estar cursando asignaturas del ciclo básico se asocia con mayor riesgo de SDE, por lo cual es importante que los comités curriculares de las IES evalúen regularmente la cantidad de horas de trabajo supervisado e independiente que realizan los estudiantes de Medicina. Finalmente, es importante emprender campañas orientadas a mejorar la percepción de riesgo sobre el uso de bebidas energizantes de los estudiantes universitarios y realizar, desde el ingreso al programa académico, recomendaciones sobre los hábitos de higiene del sueño.

ABSTRACT Introduction: Excessive daytime sleepiness (EDS) can interfere with academic and professional performance, as affected individuals tend to fall asleep in situations that demand a high level of alertness. Medical students are often a population at risk of suffering from EDS due to the demanding number of study hours, the significant number of credits per subject in the academic curriculum, practical teaching sessions and hospital night shifts, which can lead to sleep deprivation or sleep debt. It is for these reasons that it is important to estimate the prevalence of EDS and its associated factors in medical students of a Higher Education Institution (HEI) in Bucaramanga, in order to implement early prevention strategies to reduce the occurrence of this problem and to improve the students' quality of life and academic performance. Material and methods: An observational, cross-sectional analytical study with a population sample of 458 medical students enrolled in the second semester of 2015 at the Universidad Autonomade Bucaramanga (UNAB), who completed four questionnaires: Sociodemographic Variables, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and Sleep Hygiene Index (SHI). A bivariate and multivariate analysis was performed to identify any correlations with EDS. Results: Mean student age was 20.3 years and 62.88% of the 458 respondents were women. We were able to establish that 80.75% of participants suffered from EDS and 80.55% had a negative perception of their sleep quality (OR=1.91; 95% CI, 1.11-3.29; p =0.019). In the multivariate analysis, it was found that the risk of EDS is lower in the clinical sciences than in the basic cycle. Furthermore, it was noted that a score higher than 15 in the Sleep Hygiene Index significantly increases the risk of suffering from EDS. Conclusions: Although EDS is very common in medical students, only a small percentage present the most severe form of this sleep disorder. Being enrolled in basic cycle subjects is associated with a higher risk of suffering EDS, so it is important for the curriculum committees of higher education institutions to regularly evaluate the number of hours of supervised and independent work performed by medical students. Finally, it is important to implement campaigns aimed at improving university students' perception of the risk of taking energy drinks and to establish sleep hygiene recommendations from the start of the academic programme.

Cartera de Servicios por Curso de vida y Niveles de Atención y Complejidad / Organization Manual of the Health Services within the framework of the RIISS Paraguay

La primera edición de la Cartera de Servicios de Salud del Paraguay constituye una herramienta de gestión elaborada y consensuada de manera participativa, mediante la coordinación de un equipo técnico ejecutivo y el desarrollo de tres talleres de trabajo y numerosas reuniones de revisión para la incorporación de ajustes y actualización de servicios que el MSPBS brinda en los establecimientos de salud por curso de vida y niveles de atención y complejidad. Se ha convocado a más de 100 profesionales y técnicos procedentes de escenarios gerenciales,hospitalarios, y referentes de programas prioritarios de salud pública, quienes han aportado conocimientos y experiencia para la construcción de esta guía. El enfoque de la cartera de servicios vincula dos vertientes: desde la gestión y administración (capacidad instalada) y desde la mirada clínico asistencial y preventiva, definiendo un catálogo de prestaciones, con el objetivo de organizar la oferta para garantizar capacidad de respuesta sostenible en las unidades efectoras de las redes de servicios de salud en todo el país. La cartera de servicios refleja las necesidades de la población, según grupos de edad, sujeta a modificaciones periódicas según los análisis de situación de salud y prevalencia de enfermedades, contextos que modifican los indicadores trazadores de salud y orientan hacia el comportamiento de la demanda. La disponibilidad de un listado básico de prestaciones por niveles de atención y complejidad proporciona información que respalda la actividad diaria de profesionales y personal de salud, incorporando procesos evaluativos en el curso de su implementación y lineamientos sobre calidad de atención, que contribuirá a la funcionalidad de la RIISS.

2019 Update of the Korean Clinical Practice Guidelines of Stroke for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke / 대한뇌졸중학회지

Endovascular recanalization therapy (ERT) has been a standard of care for patients with acute ischemic stroke due to large artery occlusion (LAO) within 6 hours after onset, since five landmark ERT trials conducted by 2015 demonstrated its clinical benefit. Recently, two randomized clinical trials demonstrated that ERT, even in the late time window of up to 16 hours or 24 hours after last known normal time, improved the outcome of patients who had a target mismatch, defined as either clinical-core mismatch or perfusion-core mismatch, which prompted the update of national guidelines in several countries. Accordingly, to provide evidence-based and up-to-date recommendations for ERT in patients with acute LAO in Korea, the Clinical Practice Guidelines Committee of the Korean Stroke Society decided to revise the previous Korean Clinical Practice Guidelines of Stroke for ERT. For this update, the members of the writing group were appointed by the Korean Stroke Society and the Korean Society of Interventional Neuroradiology. After thoroughly reviewing the updated evidence from two recent trials and relevant literature, the writing members revised recommendations, for which formal consensus was achieved by convening an expert panel composed of 45 experts from the participating academic societies. The current guidelines are intended to help healthcare providers, patients, and their caregivers make well-informed decisions and to improve the quality of care regarding ERT. The ultimate decision for ERT in a particular patient must be made in light of circumstances specific to that patient.

Neoadjuvant Therapy Should Be the Standard of Care for Every Node Positive Breast Cancer Patient / 한국유방암학회지

No abstract available.

Long-Term Experience of Sperm Cryopreservation in Cancer Patients in a Single Fertility Center

PURPOSE: Sperm cryopreservation before cancer treatment is the most effective method to preserve the fertility of male patients. We present our 21 years experience with sperm cryopreservation for cancer patients, including an examination of semen quality, the current status of cryopreserved sperm, and the rate of sperm use for assisted reproductive technology (ART). MATERIALS AND METHODS: A total of 721 cancer patients at Fertility Center of CHA Gangnam Medical Center successfully performed sperm cryopreservation for fertility preservation from January 1996 to December 2016. Medical chart review was used to analyze patient age, marital status, cancer type, semen volume, sperm counts and motility, length of storage, and current banking status. RESULTS: The major cancers of the 721 patients were leukemia (28.4%), lymphoma (18.3%), testis cancer (10.0%). The mean age at cryopreservation was 27.0 years, and 111 patients (15.4%) performed sperm cryopreservation during or after cancer treatment. The mean sperm concentration was 66.7±66.3 ×106/mL and the mean sperm motility was 33.8%±16.3%. During median follow-up duration of 75 months (range, 1–226 months), 44 patients (6.1%) used their banked sperm at our fertility center for ART and 9 patients (1.2%) transferred their banked sperm to another center. The median duration from cryopreservation to use was 51 months (range, 1–158 months). CONCLUSIONS: Sperm cryopreservation before gonadotoxic treatment is the most reliable method to preserve the fertility of male cancer patients. Sperm cryopreservation should be offered as a standard of care for all men planning cancer therapy.