Third National Registry of Cardiac Rehabilitation Programs in Mexico (RENAPREC III-2022) / Tercer Registro Nacional de Programas de Rehabilitación Cardiaca en México (RENAPREC III-2022)

Abstract Introduction: In Mexico, cardiac rehabilitation (CR) as an interdisciplinary intervention with therapeutic impact in patients with heart disease is growing. There is the need to know actual conditions of CR in our country. Objectives: The objective of this National Registry is to follow-up those existing and new CR units in Mexico through the comparison between the two previous registries, RENAPREC-2009 and RENAPREC II-2015 studies. This is a descriptive study focused on diverse CR activities such as assistance training, and certification of health professionals, barriers, reference, population attended, interdisciplinarity, permanence over time, growth prospects, regulations, post-pandemic condition, integrative characteristics, and scientific research. Results: Data were collected from 45 CR centers in the 32 states, 75.5% are private practice units, 67% are new, 33% were part of RENAPREC II-2015, and 17 have continued since 2009. With a better distribution of CR units along the territory, the median reference of candidates for CR programs is 9% with a significant reduction into tiempo of enrollment to Phase II admission (19 ± 11 days). Regarding to previous registries, the coverance of Phases I, II, and III is 71%, 100%, and 93%, respectively; and a coverance increases in evaluation, risk stratification, and prescription, more comprehensive attendance and prevention strategies. Conclusions: CR in Mexico has grown in the past 7 years. Even there is still low reference and heterogeneity in specific processes, there are strengths such as interdisciplinarity, scientific professionalization of specialists, national diversification, and an official society that are consolidated over time.

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Proyecto de Ley 339 de 2023. Cámara / Bill 339 of 2023. Chamber

"Por medio del cual se transforma el Sistema de Salud y se dictan otras disposiciones". Presentado el texto del proyecto de reforma del sistema de salud se empiezan a despejar algunas dudas y desde ya se vislumbran apuestas muy proactivas que coinciden con los Acuerdos Fundamentales expuestos por 14 organizaciones médicas y de profesiones de la salud, tales como: El artículo 1 del proyecto de ley 339 de 2023 Cámara (PL) define el objeto y establece que la ley de ser aprobada, de conformidad con la Ley Estatutaria en Salud 1751 de 2015 (LES), restructura el Sistema General de Seguridad Social en Salud (SGSSS), establece el Sistema de Salud como lo define el artículo 4 de la LES, desarrolla sus principios, enfoque, estructura organizativa y competencias. No obstante, omite incluir a los regímenes exceptuados por el artículo 279 de la Ley 100 de 1993, los cuales en nuestro criterio forman parte del Sistema de Salud, en la medida en que este "incluye todo lo que el Estado disponga para la garantía del derecho humano fundamental a la salud". La atención primaria en salud (APS) y las acciones positivas para los determinantes sociales de la salud que toman alta importancia en el Sistema de Salud con la constitución de la Comisión Intersectorial Nacional de Determinantes Sociales de la Salud, con participación del presidente y de todos los ministros (Art. 9 LES). La constitución de los equipos médicos interdisciplinarios territoriales (EMIT), empezando por las zonas de población más dispersas y vulnerables. El fortalecimiento de la red pública de servicios de salud. Los regímenes diferenciados en las zonas de población dispersa con subsidios de oferta (Art. 24 LES). La constitución del Consejo Nacional de Salud. La creación y puesta en marcha del Sistema Público Único Integrado de Información en Salud (Art. 19 de la LES). El fortalecimiento de la participación ciudadana (Art. 12 de la LES). La autonomía de los profesionales de la salud con la consecuente eliminación de las autorizaciones administrativas (Art. 17 de la LES). La eliminación parcial de las cuotas moderadoras y los copagos. El Fortalecimiento de la Superintendencia de Salud. El desarrollo de políticas públicas para la formación del talento humano, procurando su formalización laboral y la mejora en las condiciones de vida y de trabajo en el sector (Art. 18 de la LES), entre otros aspectos.

Prevalencia del tubérculo de Carabelli en una población infantil / Prevalência do tubérculo de Carabelli em uma população infantil / Prevalence of Carabelli tubercle in a child population

Introducción: Las anomalías de la forma, en niños y niñas, son en gran medida frecuentes, por ello su estudio es importante para precisar diagnósticos, dado que pueden tener diferentes implicancias odontológicas. A la altura de la cúspide mesiopalatina de los segundos molares superiores temporarios, primeros molares superiores permanentes, y con menor frecuencia en los segundos molares superiores permanentes, es posible reconocer una cúspide accesoria o tubérculo denominada de Carabelli (TC).Objetivos: Determinar la prevalencia del TC en pacientes del Hospital de Odontología Infantil (HOI) "Don Benito Quinquela Martín" de Buenos Aires, Argentina. Asimismo, comprender, con respecto a su etiología, si existe alguna relación con el origen étnico de la familia. Para ello se incorporó la variable nacionalidad de los padres para examinar el posible vínculo entre la presencia del TC y la procedencia étnica del paciente.Materiales y Métodos: Se evaluó una muestra de 363 niños que ingresaron por primera vez al Servicio de Clínica y Orientación del HOI durante el período comprendido entre agosto 2019 y marzo 2020.Resultados: La prevalencia del TC observada fue del 34 %, por lo menos en alguna de las piezas dentarias, con una mayor tendencia en el sexo masculino en un 55%, y un 45% en el sexo femenino.Conclusiones: La hipótesis propuesta fue que la prevalencia del TC en los pacientes que acuden al del HOI es inferior al 50 % y fue validada debido a que el 34% de los pacientes presentan el TC.

Introdução: As anomalias de forma em meninos e meninas são bastante frequentes, por isso seu estudo é importante para especificar diagnósticos, pois podem ter diferentes implicações odontológicas. Na altura da cúspide mesiopalatina dos segundos molares superiores temporários, primeiros molares superiores permanentes e, menos frequentemente, nos segundos molares superiores permanentes, é possível reconhecer uma cúspide ou tubérculo acessório, denominado Carabelli (TC). Objetivos: Determinar a prevalência de TC em pacientes do Hospital de Odontologia Infantil "Don Benito Quinquela Martín" (HOI) de Buenos Aires, Argentina. Materiais e métodos: Uma amostra de 363 crianças entre dois e quinze anos de idade foi avaliada por inspeção visual direta ­realizada com instrumentos de exploração­, considerando admissões, na Clínica HOI e Serviço de Orientação durante o período abrangido. agosto de 2019 e março de 2020. Resultados: 34% dos pacientes apresentaram TC em um dos dentes, com maior tendência para o sexo masculino em 55%. Conclusões: Embora a prevalência de DC nos pacientes que compareceram ao HOI tenha sido inferior a 50%, ter observado o traço em 34% sugere a importância de sua detecção precoce, pois é fundamental informar ao paciente que o traço o acompanhará durante todo o sua vida e exige maior higiene bucal. Além disso, avise ao paciente que a cúspide não está relacionada a uma doença, mas corresponde à herança genética

Introduction: Shape abnormalities in children are recurrent, so their study is important to make an accurate diagnosis because they can have several dental implications. This anatomical structure is generally found on the mesial palatal side of the tooth, just below the mesial palatal cusp, specifically on the upper first deciduous molars, less frequently in the upper second permanent molars, it is possible to recognize an accessory cusp or a tubercle identified as Carabelli. Aim: To determine the prevalence of the Carabelli ́s tubercle (CT) in patients of the Clinical Service and Orientation from the Quinquela Martín Hospital of Pediatric dentistry (HOI) Government of Buenos Aires City- Aires, Argentina. Materials and methods: A sample of 363 children, between two and fifteen years of age, was evaluated by direct visual inspection ­carried out with exploration instruments­, taking into account admissions and readmissions, to the HOI Clinic and Orientation Service during the period covered between August 2019 and March 2020. Results: The prevalence of CT observed was 34% in at least some teeth, with a greater tendency in the male gender of 55% and 45% in the female. Conclusions: Although the prevalence of CT in patients who attended the HOI was less than 50%, having observed the trait in 34% suggests the importance of its early detection, since it is essential to inform the patient that the trait it will accompany you throughout his life and requires effective oral hygiene. Also, warn the patient that the cusp is not related to a disease, but corresponds to genetic inheritance.

Implicações bioéticas do uso terapêutico da Cannabis sativa L. no Brasil / Bioethical implications of the therapeutic use of Cannabis sativa L. in Brazil

A utilização medicinal da Cannabis sativa L., usualmente chamada de maconha, é conhecida desde tempos remotos devido a suas elevadas propriedades terapêuticas. As discussões acerca de seu uso medicinal no Brasil são urgentes, notadamente porque já há comprovação científica dos benefícios relacionados ao tratamento de diversas enfermidades. Este artigo teve como foco demonstrar que os argumentos apresentados para criminalizar a C. sativa, além de concorrerem para uma conjuntura racista e criminalizadora de classes sociais baixas, violam os princípios bioéticos da beneficência, autonomia e justiça, ao impedir que o sujeito tenha acesso a prescrições médicas adequadas e menos onerosas, a fim de proporcionar o alívio de suas dores físicas e psíquicas. Para tanto, utilizou-se da metodologia qualitativa, por meio da qual se realizou revisão bibliográfica de artigos científicos publicados em português, entre os anos de 2015 e 2020, nas bases de dados Google Scholar e Scientific Electronic Library Online, juntamente com pesquisa de resoluções da Agência Nacional de Vigilância Sanitária e do Conselho Federal de Medicina. De posse desses dados, constatou-se a necessidade de democratização no acesso à C. sativa medicinal, sendo imprescindível o fornecimento gratuito de canabidiol pelo Sistema Único de Saúde, bem como uma normatização que permita o cultivo da C. sativa para fins medicinais para a produção de medicamentos no país.

The medicinal use of Cannabis sativa L., usually called marijuana, has been known since ancient times, due to its enhanced therapeutic properties. Discussions about its medicinal use in Brazil are urgent, especially because there is already scientific proof of the benefits that it can produce in treatment of various diseases. Therefore, it is essential that there is support from the State so that access to C. sativa for medicinal purposes is universal, considering the right to health treatments as a fundamental right, provided for in the Constitution. However, the use and possession for own consumption are still criminalized. Thus, the article seeks to demonstrate that the justifications presented to criminalize this plant, in addition to contributing to a racist marginalization of low social classes, violate Bioethical precepts, by preventing patients from accessing medical prescriptions that are adequate and less costly, to provide relief from their physical and mental pain. For that, we used a qualitative methodology. A bibliographic review of scientific articles published in Portuguese, between the years 2015 and 2020, was carried out in the Google Scholar and Scientific Electronic Library Online databases. Resolutions of the Brazilian Health Regulatory Agency, as well as of the Federal Council of Medicine were also considered. With these data, this article concludes that the need for democratization in access to medicinal C. sativa is imperative, by supplying patients with CBD compounds through the Brazilian National Public Health System, and by enacting legislation that allows for the cultivation of C. sativa for medicinal purposes and for medicine production in Brazil.

Retrospective histopathology audit of thymectomy specimens: A clinicopathological study of 303 cases spanning the non-neoplastic, benign and malignant spectrum

Aims: Thymectomy specimens are uncommon in routine histopathology practice. However, awareness of various pathologic entities and definite reporting of these specimens is paramount to optimal patient management. Our objective was to determine the histomorphologic spectrum of thymectomy specimens spanning the non-neoplastic, benign to malignant spectrum. Methods and Results: Thymectomies received over an 8-year period were retrospectively analyzed by reviewing clinical details and histologic findings in detail, incorporating the latest World Health Organization (WHO) 2015 histologic classification. A total of 303 thymectomy specimens (179 males/124 females, mean age 45.3 years [3–84 years]) were included. Around 51.2% (n = 155) patients had associated myasthenia gravis (MG), while 17.5% (n = 53) had incidentally detected anterior mediastinal mass (AMM). Non-neoplastic and benign pathologies comprised 31% (n = 94) cases and showed stronger association with MG (P = 0.009). Thymic follicular hyperplasia (TFH) was the commonest non-neoplastic pathology (n = 32), while the benign tumor group included thymic hemangioma/lymphangioma, thymolipoma, and ectopic parathyroid adenoma. Thymic epithelial tumors (TETs) comprised 64.7% cases, with majority being thymomas (185/303; 61.1%). Thymoma type B2 was the commonest histologic subtype and Stage I/T1 was the most frequent stage. Type A and AB thymomas affected older patients (P = 0.005) and were in lower stage (both Masaoka and American Joint Committee on Cancer [AJCC]) than type B thymomas (P = 0.007). No significant association between MG and thymoma subtype, patient sex or Masaoka stage was seen (P > 0.05). Thymic carcinomas comprised 11 cases and showed no association with MG (0/11, P < 0.001); squamous cell carcinoma was the commonest histologic type (8/11; 72.7%). Conclusion: TETs are the commonest thymic lesions; however, a diverse spectrum of pathologic processes can affect the thymus.

Floración algal nociva del dinoflagelado Blixaea quinquecornis en el Perú / Harmful algal bloom of dinoflagellate Blixaea quinquecornis in Peru

Resumen En el presente trabajo, se registra por primera vez floraciones algales nocivas del dinoflagelado Blixaea quinquecornis (Abé) Gottschling, 2017 para aguas costeras del mar peruano. La determinación taxonómica de esta especie se realizó mediante microscopia de luz, electrónica de barrido y contraste interferencial diferencial (DIC). La fórmula tecal encontrada fue: pp, 3', 2a, 7'',5c, 5"' y 2''' 4s. Blixaea quinquecornis fue registrada en las bahías Sechura, Miraflores y Paracas entre el 2014 y 2017, usualmente con altas densidades de 3.2 x105 cel.L-1 (Miraflores) y 2.11x105 cel.L-1 (Paracas) en verano y 4.11 x104 (Paracas) en otoño 2016. Blixaea quinquecornis estuvo alternando con floraciones algales del dinoflagelado atecado Akashiwo sanguinea. El florecimiento de B. quinquecornis se observó con TSM entre 18.5 a 26.6 °C, salinidades entre 34.70 y 35.32 ups, pH entre 7.32 y 8.82 y oxígeno disuelto entre 3.8 y 12.5 mL/L. En Bahía Miraflores, la floración de B. quinquecornis fue asociado positivamente con el incremento de la TSM, salinidad y negativamente con la concentración de nitratos, mientras que las floraciones algales de A. sanguinea se correlacionó positivamente con la concentración de fosfatos y oxígeno disuelto. El registro de la floración de B. quinquecornis en las bahías de Miraflores y Paracas, coincidió con eventos de inusual calentamiento del mar asociado con el evento cálido El Niño 2015-2016.

Abstract In the present work, harmful algal blooms of the dinoflagellate Blixaea quinquecornis (Abé) Gottschling, 2017 are recorded for the first time for coastal waters of the Peruvian sea. The taxonomic determination of this species was done with light microscopy, Scanning Electron Microscopy (SEM), and Differential Interference Contrast (DIC) microscopy. The thecal formula is: pp, 3', 2a, 7'', 5c, 5"' and 2''' 4s. Blixaea quinquecornis was recorded in Sechura, Miraflores and Paracas bays between 2014 - 2016, mainly with algal blooms of 3.2 x105 cel.L-1 (Miraflores) and 2.11x105 cel.L-1 (Paracas) and 4.11 x104 cel.L-1 (Paracas) in autumn of 2016. Blixaea quinquecornis was found alternating with algal bloom produced by the athecate dinoflagellate Akashiwo sanguinea. The physicochemical variables associated with the bloom of B. quinquecornis were SST (18.5 to 26.6° C), salinities (34.7 to 35.325), pH (7.32 to 12.5), and dissolved oxygen (3.8 to 12.5 mL/L). The bloom of B. quinquecornis in Miraflores Bay was positively associated with the increase in SST, salinity and negatively with the concentration of nitrates, whereas the algal blooms of A. sanguinea were positively correlated with the concentration of phosphates and oxygen. The record of the bloom of B. quinquecornis in the 3 bays coincided with unusual sea warming event associated with the El Niño phenomenon 2015-2016.

Clinical Analysis of Pediatric Acute Myeloid Leukemia with CCLG-AML 2015 Regimen / 中国实验血液学杂志

OBJECTIVE@#To analyze the clinical effects of CCLG-AML-2015 protocol on newly diagnosed children with acute myeloid leukemia (AML).@*METHODS@#The clinical data of 60 newly diagnosed AML children in the Department of Hematology and Oncology, Wuhan Children's Hospital from August 2015 to September 2019 were summarized, the effect of chemotherapy using the CCLG-AML-2015 regimen (hereinafter referred to as the 2015 regimen) were retrospectively analyzed. 42 children with AML treated by the AML-2006 regimen (hereinafter referred to as the 2006 regimen) from February 2010 to July 2015 were used as control group.@*RESULTS@#There were no statistical differences between the 2015 regimen group and the 2006 regimen group in sex, age at first diagnosis, and risk stratification (P>0.05). The complete remission rate of bone marrow cytology after induction of 1 course of chemotherapy (84.7% vs 73.1%, P=0.155), and minimal residual disease detection (MRD) negative (42.3% vs 41.4%, P=0.928) in the 2015 regimen group were not statistically different than those in the 2006 regimen group. The bone marrow cytology CR (98.1% vs 80.6%, P=0.004) and MRD negative (83.3% vs 52.8%, P=0.002) in the 2015 regimen group after 2 courses of induction were higher than those in the 2006 regimen group. The 5-year overall survival (OS) rate in the 2015 regimen group (62.3%±6.4% vs 20.6%±6.4%, P=0.001), the 5-year disease-free survival (EFS) rate (61.0%±6.4% vs 21.0% ±6.4% , P=0.001) were better than those in the 2006 regimen group. The 5-year OS and EFS of high-risk transplant patients in the 2015 regimen group were significantly better than those of high-risk non-transplant patients (OS: 86.6%±9.0% vs 26.7%±11.4%, P=0.000; EFS: 86.6%±9% vs 26.7%±11.4%, P=0.000).@*CONCLUSION@#The 2015 regimen can increase the CR rate after 2 courses of induction compared with the 2006 regimen. High-risk children receiving hematopoietic stem cell transplantation can significantly improve the prognosis.

Medicina baseada em evidências: breve aporte histórico sobre marcos conceituais e objetivos práticos do cuidado / Evidence-based medicine: a brief historical analysis of conceptual landmarks and practical goals for care

Resumo A medicina baseada em evidências (MBE) pretende aumentar a eficiência e qualidade dos serviços de saúde prestados à população e diminuir os custos operacionais dos processos de prevenção, tratamento e reabilitação. Busca identificar problemas relevantes do paciente e promover a aplicabilidade social das conclusões. O artigo ressalta a importância da MBE para o ensino e para as práticas clínicas sociais da atualidade a partir da contribuição de Archibald Cochrane e David Sackett no desenvolvimento e na difusão desse paradigma assistencial e pedagógico durante o século XX. A MBE tem contribuído para ampliar a discussão sobre as relações entre ensino e prática da medicina, assumindo papel de destaque em reformas curriculares e modelos de formação no cuidado e práticas em saúde.

Abstract Evidence-based medicine (EBM) is intended to improve the efficiency and quality of health services provided to the population and reduce the operational costs of prevention, treatment, and rehabilitation; the objective of EBM is to identify relevant issues and promote the social applicability of conclusions. This article underscores the importance of EBM in modern clinical teaching and social practices from the contributions of Archibald Cochrane and David Sackett to the development and dissemination of this paradigm in care and education during the twentieth century. EBM has helped broaden discussions on the relationships between teaching and medical practice, and has taken on an important role in curriculum reforms and training models and practices in health care.

Prognostic significance of measurable residual disease based on multiparameter flow cytometry in childhood acute myeloid leukemia / 中国当代儿科杂志

OBJECTIVES@#To study the prognostic value of measurable residual disease (MRD) for childhood acute myeloid leukemia (AML) by analyzing MRD-guided risk stratification therapy.@*METHODS@#A total of 93 children with AML were prospectively enrolled in this study. Chemotherapy with the 2015-AML-03 regimen was completed according to the risk stratification determined by genetic abnormality at initial diagnosis and MRD and bone marrow cytology after induction therapy I. Multiparameter flow cytometry was used to dynamically monitor MRD and analyze the prognostic effect of MRD on 3-year cumulative incidence of recurrence (CIR) rate, event-free survival (EFS) rate, and overall survival (OS) rate.@*RESULTS@#The 93 children with AML had a 3-year CIR rate of 48%±6%, a median time to recurrence of 11 months (range 2-32 months), a 3-year OS rate of 65%±6%, and a 3-year EFS rate of 50%±5%. After induction therapy I and intensive therapy I, the MRD-positive children had a significantly higher 3-year CIR rate and significantly lower 3-year EFS and OS rates than the MRD-negative children (@*CONCLUSIONS@#MRD has predictive value for the prognosis of children with AML. Based on the MRD-guided risk stratification therapy, reasonable application of chemotherapy may improve the overall prognosis of children with AML.

Contribuições técnicas e socioculturais da prevenção quaternária para a atenção primária à saúde: caminhos e desafios / Technical and socio-cultural contributions of quaternary prevention for primary health care: paths and challenges / Contribuciones técnicas y socioculturales de prevención cuaternaria para la atención primaria de salud: caminos y desafíos

Introdução: No contexto do Sistema Único de Saúde, o conceito da prevenção quaternária adentra timidamente os níveis de atenção à saúde, no entanto, sofre expansão significativa no âmbito da atenção primária à saúde. Objetivo: Identificar por meio da sistematização de evidências científicas, as contribuições técnicas e socioculturais da prevenção quaternária no âmbito da atenção primária à saúde no Brasil. Métodos: Trata-se de uma revisão integrativa de estudos presentes nas bases de dados científicas da Scientific Electronic Library Online, Biblioteca Virtual em Saúde, biblioteca virtual da Comissão de Aperfeiçoamento de Pessoal do Nível Superior e MEDLINE via PubMed com a utilização dos descritores "prevenção quaternária" e "atenção primária à saúde", em inglês e português. Resultados: O corpus de análise foi composto por 22 artigos, sendo que a produção científica sobre o tema se deu de forma mais intensa a partir do ano de 2015 e, em sua maioria, possuíam como abordagem metodológica ensaios teóricos. Dentre as contribuições técnicas destacaram-se a introdução do ensino da prevenção quaternária de modo continuado aos graduandos e profissionais; a construção de protocolos e documentos de amparo profissional; a utilização de modelos explicativos dinâmicos na socialização do quadro clínico; a conduta profissional com os usuários e as contribuições socioculturais envolvendo mudanças na percepção profissional e comunitária sobre o fenômeno saúde-doença, assim como o incentivo a práticas de desmedicalização sociocultural em relação à dor, incapacidade, desconforto, envelhecimento, nascimento e morte. Conclusão: Apesar do reconhecimento das potencialidades da prevenção quaternária, faz-se necessário fortalecer estratégias que possibilitem o desenvolvimento de políticas públicas para fomentar e gerenciar alianças estratégicas com tomadores de decisão, profissionais de saúde e cidadãos, para fomentar a redução de diagnósticos e tratamentos excessivos, contribuindo com a qualidade do cuidado.

Introduction: In the context of the Unified Health System, the concept of quaternary prevention shyly enters the levels of health care, however, undergoes significant expansion in the scope of primary health care. Objective: To identify, through the systematization of scientific evidence, the technical and socio-cultural contributions of quaternary prevention within the scope of primary health care in Brazil. Methods: This is an integrative review of studies present in the scientific databases of the Scientific Electronic Library Online, Regional Portal of the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization, virtual library of the Higher Education Personnel Improvement Commission, and MEDLINE through PubMed using the descriptors "quaternary prevention" and "primary health care", in English and Portuguese. Results: The corpus of analysis consisted of 22 articles, and the scientific production on the topic took place more intensively from the year 2015 and, for the most part, had theoretical essays as methodological approach. Among the technical contributions, we highlight the introduction of teaching on quaternary prevention in a continuous way to undergraduates and professionals; the construction of protocols and documents of professional support; the use of dynamic explanatory models in the socialization of the clinical picture and professional conduct with users and socio-cultural contributions involve changes in the professional and community perception about the phenomenon of illness and health conception, as well as the incentive to practices of socio-cultural demedicalization in relation to pain, disability, discomfort, aging, birth, and death. Conclusion: Despite the recognition of the potential of quaternary prevention, it is necessary to strengthen strategies that enable the development of public policies to foster and manage strategic alliances with decision makers, health professionals and citizens, to promote the reduction of excessive diagnoses and treatments, contributing to the quality of care.

Introducción: En el contexto del Sistema Único de Salud, el concepto de prevención cuaternaria entra tímidamente en los niveles de atención de salud, sin embargo, experimenta una expansión significativa en el alcance de la Atención Primaria de Salud. Objetivo: Identificar, a través de la sistematización de evidencia científica, las contribuciones técnicas y socioculturales de la prevención cuaternaria en el ámbito de la Atención Primaria de Salud en Brasil. Métodos: Esta es una revisión integradora de estudios presentes en las bases de datos científicas de la Biblioteca Electrónica Científica en línea, Portal Regional de la Biblioteca Virtual en Salud del Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud de la Organización Panamericana de la Salud, biblioteca virtual de la Comisión de Mejoramiento del Personal de Educación Superior y MEDLINE a través de PubMed utilizando los descriptores de prevención cuaternaria y atención primaria de salud, en inglés y portugués. Resultados: El corpus de análisis estuvo conformado por 22 artículos, siendo la producción científica sobre el tema más intensiva desde 2015 y, en su mayor parte, tuvo ensayos teóricos como abordaje metodológico. Entre los aportes técnicos, destacamos la implantación de la docencia en prevención cuaternaria de forma continua a estudiantes de pregrado y profesionales; construcción de protocolos y documentos de apoyo profesional, uso de modelos explicativos dinámicos en la socialización del cuadro clínico y conducta profesional con los usuarios y los aportes socioculturales implican cambios en la percepción profesional y comunitaria sobre el fenómeno de la enfermedad y la concepción de la salud, así como el incentivo a prácticas de desmedicalización sociocultural en relación al dolor, discapacidad, malestar, envejecimiento, nacimiento y muerte. Conclusión: A pesar del reconocimiento del potencial de la prevención cuaternaria, es necesario fortalecer estrategias que permitan el desarrollo de políticas públicas para fomentar y gestionar alianzas estratégicas con los tomadores de decisiones, profesionales de la salud y ciudadanos, para promover la reducción de diagnósticos y tratamientos excesivos, contribuyendo a la calidad de la atención.

A saúde na Agenda 2030 de Desenvolvimento Sustentável na América Latina: quem está publicando? / Health in the Sustainable Development Agenda 2030 in Latin America: who is publishing? / La salud en la Agenda 2030 de Desarrollo Sostenible en América Latina: ¿Quién está publicando?

Este artigo apresenta um trabalho que consistiu no levantamento quantitativo das publicações sobre a Agenda 2030 de Desenvolvimento Sustentável na América Latina, ou que foram escritas por autores afiliados às instituições da região, focando no tema saúde. Foram realizadas buscas em bancos de dados, para o período entre janeiro de 2009 e maio de 2017, e encontradas 127 publicações voltadas para o Objetivo de Desenvolvimento Sustentável 3 ­ Boa Saúde e Bem-Estar. A maior parcela dos resultados (92%) é constituída de artigos científicos que foram descritos segundo o ano e veículo de publicação, instituições de filiação dos autores e sua localização. Quase a metade das publicações (47%) foi feita sem a participação de organizações latino-americanas e em apenas 30% dos casos o primeiro autor pertence a uma organização latino-americana. Esse quadro se torna mais nítido quando se observa a concentração da produção latinoamericana em torno de organizações brasileiras: a produção científica sobre as resoluções da Agenda 2030 em relação à saúde ainda está ausente em grande parte do território latino-americano.

This article presents a work that consisted of a quantitative research about publications on Agenda 2030 on Sustainable Development in Latin America, or written by authors affiliated with institutions in the region, focusing on health. A search using databases on the subject for the period between January 2009 and May 2017 was made, and 127 publications focusing on Sustainable Development Goal 3 ­ Good Health and Well-Being. The majority (92%) of the publications were scientific articles and were described in relation to the year and vehicle of publication, authors' affiliation institutions and their location. Almost half of the publications (47%) were made without the participation of Latin American organizations and only 30% of cases have the first author who belongs to a Latin American organization. This picture becomes clearer when we see the concentration of Latin American production at Brazilian organizations: scientific production onAgenda 2030 regarding health is still absent in much of the Latin American territory.

Este artículo presenta un trabajo que ha consistido en el levantamiento cuantitativo de las publicaciones sobre la Agenda 2030 en América Latina o que fueron escritas por autores afiliados a instituciones de la región con el foco en salud. Se realizaron búsquedas en bancos de datos para el período entre 2009 y mayo de 2017. Se encontraron 127 publicaciones sobre el Objetivos de desarrollo sostenible 3 ­ Salud y Bienestar. Constituyen la mayoría (92%) artículos científicos que fueron descritos según el año y el vehículo de publicación, las instituciones de filiación de los autores y su ubicación. En casi la mitad de las publicaciones (47%) no hubo participación de organizaciones latinoamericanas y solamente en 30% de los casos el primer autor pertenece a una organización latinoamericana. Este cuadro es más nítido cuando observada la concentración de la producción latinoamericana en organizaciones brasileñas: La producción científica sobrela Agenda 2030 en el área de la salud todavía está ausente en gran parte de la América Latina.

Programa de Evaluación Externa de la Calidad "Prof. Dr. Daniel Mazziotta": una nueva etapa asegurando la mejora continua de la calidad / External Quality Assessment Program "Prof. Dr. Daniel Mazziotta ": a new stage ensuring continuous quality improvement

Las determinaciones de los laboratorios clínicos tienen un papel muy importante en la evaluación, diagnóstico, tratamiento y evolución del estado de salud de las personas. La confiabilidad de sus resultados se logra a través del aseguramiento de la calidad y mejora continua. El Programa de Evaluación Externa de la Calidad "Prof. Dr. Daniel Mazziotta" acompaña a los laboratorios de análisis clínicos desde hace 31 años brindando distintas herramientas para garantizar la calidad analítica. Ofrece los servicios de evaluación externa de la calidad, suministro de material para control de calidad interno para determinaciones en Química Clínica y soluciones para control de instrumental y pruebas de suficiencia. Desde la creación del programa se establecieron objetivos estratégicos a desarrollarse en tres etapas: establecimiento, consolidación y apoyo a la gestión de la calidad. Se genera ahora una nueva etapa, cuyo objetivo final es la acreditación. Como primer paso de este ciclo, se implementó un sistema de gestión de la calidad (SGC) de acuerdo a los requisitos establecidos en la norma argentina IRAM-ISO 9001:2015. En agosto de 2019, el Instituto Argentino de Normalización y Certificación (IRAM), representante en Argentina de la International Organization for Standarization (ISO), certificó que el SGC del programa cumple lo establecido en dicha norma. Su aplicación tiene como objetivo asegurar que los servicios ofrecidos satisfagan las necesidades de los laboratorios clínicos cumpliendo los requisitos legales requeridos y asegurando la mejora continua. El objetivo de este trabajo fue describir las acciones realizadas en la implementación del SGC y la posterior certificación de IRAM-ISO 9001:2015, por el IRAM.

Clinical laboratory determinations have a very important role in the evaluation, diagnosis, treatment and evolution of the health status of people. The reliability of their results is achieved through quality assurance and continuous improvement. The External Quality Assessment Programme Prof. Dr. Daniel Mazziotta has been accompanying clinical analysis laboratories for 31 years offering different tools to ensure analytical quality. It provides the services of external quality assessment, supply of material for internal quality control for determinations in Clinical Chemistry and solutions for instrumental control and sufficiency tests. Since the creation of the program, strategic objectives have been established to be developed in three stages: establishment, consolidation and support for quality management. A new stage is now being generated, whose final objective is accreditation. As a first step of this cycle, a quality management system (QMS) was implemented according to the requirements established in the IRAM Argentina standard-ISO 9001:2015. In August 2019, the Argentine Institute for Standardization and Certification (IRAM), representative in Argentina of the International Organization for Standardization (ISO), certified that the Programme's QMS complies with the provisions of said standard. Its application aims to ensure that the services offered meet the needs of clinical laboratories by fulfilling the legal requirements and ensuring continuous improvement. The objective of this work is to describe the actions carried out in the implementation of the QMS and the subsequent IRAM-ISO 9001: 2015 certification by the IRAM.

As determinações laboratoriais clínicas têm um papel muito importante na avaliação, diagnóstico, tratamento e evolução do estado de saúde das pessoas. A confiabilidade de seus resultados é alcançada através da garantia de qualidade e melhoria contínua. O Programa de Avaliação da Qualidade Externa "Prof. Dr. Daniel Mazziotta" apoia os laboratórios de análises clínicas há 31 anos, oferecendo diferentes ferramentas para garantir a qualidade analítica. Oferece os serviços de: avaliação externa de qualidade, fornecimento de material de controle interno de qualidade para determinações em Química Clínica e soluções para controle instrumental e testes de suficiência. Desde a criação do programa, os objetivos estratégicos foram estabelecidos para serem desenvolvidos em três etapas: estabelecimento, consolidação e suporte para a gestão da qualidade. Uma nova etapa é agora gerada, cujo objetivo final é a Acreditação. Como primeira etapa desse ciclo, um sistema de gestão da qualidade (SGQ) foi implementado de acordo com os requisitos estabelecidos na norma IRAM Argentina - ISO 9001:2015. Em agosto de 2019, o Instituto Argentino de Normalização e Certificação (IRAM), representante na Argentina da Organização Internacional de Normalização (ISO), certificou que o SGC do programa está em conformidade com as disposições da referida norma. Sua aplicação visa garantir que os serviços oferecidos satisfaçam as necessidades dos laboratórios clínicos, atendendo aos requisitos legais exigidos e garantindo a melhoria contínua. O objetivo deste trabalho é descrever as ações realizadas na implementação do SGQ e a subsequente certificação da IRAM-ISO 9001:2015, pela IRAM.

Histotyping of Indian thymomas: A clinicopathologic study from north India

Background & objectives: Thymomas are rare, but most common anterior mediastinal lesions. The histomorphologic spectrum of thymic epithelial tumours (TETs) in Indian population has not been explored in depth. This study was aimed to assess the histomorphology of TETs in the Indian patients and correlate clinical parameters with pathological features. Methods: It was a retrospective study conducted in a tertiary referral hospital in north India. All morphologically confirmed cases of TETs since 2009 were included. Clinical details and histology slides were reviewed using the Modified Masaoka-Koga staging system and WHO 2015 classification. Clinicopathological correlation and survival analysis were done. A comparative review from other published Indian studies was performed. Results: A total of 219 cases of TETs (138 resections and 81 biopsies) were identified. The most common histomorphologic type was B2, and the most frequent stage was I. Types A/AB were common in older age (P<0.01). Clinically, higher stage tumours were found mostly in men (P<0.01), and these were Type B thymomas (P<0.01). Myasthenia gravis was more common in women (P<0.02) and in lower stages (P<0.05). Survival analysis revealed significant association between recurrence and tumour stage. Although thymic carcinoma was diagnosed on biopsy, no resectable case was identified. Interpretation & conclusions: Our findings showed that the thymomas in Indian patients were most commonly Stage I tumours of B2 and AB histotypes. Resected thymic carcinomas were conspicuously absent in our study. More studies need to be done to establish the frequency and biology of TETs from India.

Karyotyping and population genetics in Cold War Mexico: Armendares's and Lisker's characterization of child and indigenous populations, 1960s-1980s / Cariotipia e genética de populações no México da Guerra Fria: as caracterizações de Armendares e Lisker sobre as populações infantil e indígena, 1960-1980

Abstract This paper focuses on geneticists Salvador Armendares's and Rubén Lisker's studies from the 1960s to the 1980s, to explore how their work fits into the post-1945 human biological studies, and also how the populations they studied, child and indigenous, can be considered laboratories of knowledge production. This paper describes how populations were considered for different purposes: scientific inquiry, standardization of medical practices, and production or application of medicines. Through the narrative of the different trajectories and collaborations between Armendares and Lisker, this paper also attempts to show the contact of their scientific practices, which brought cytogenetics and population genetics together at the local and global levels from a transnational perspective.

Resumo Aborda o trabalho dos geneticistas Salvador Armendares e Rubén Lisker, entre 1960 e 1980, para analisar como se insere nos estudos biológicos humanos do pós-1945, e demonstra como as populações estudadas por eles, a infantil e a indígena, podem ser consideradas laboratórios de produção de conhecimento. O artigo revela como as populações foram consideradas para diversos propósitos: investigação científica, padronização das práticas médicas e produção ou aplicação de suas medicinas. Por meio da narrativa das diferentes trajetórias e colaborações entre Armendares e Lisker, também procura discutir o contato de suas práticas científicas, que colocaram a citogenética e a genética de populações lado a lado nos níveis local e global a partir de uma perspectiva transnacional.

Improvement of Identification Method （3）of Isatis indigotica from 2015 Edition of Chinese Pharmacopeia （PartⅠ） / 中国药房

OBJECTIVE： To investigate the rationality of TLC identification method （3） of （R，S）-epigoitrin in Isatis indigotica stated in 2015 edition of Chinese Pharmacopeia （partⅠ） （later abbreviated as pharmacopeia）， and make some improvements. METHODS： Three batches I. indigotica were collected and prepared into decoction pieces according to the processing method of I. indigotica in pharmacopoeia. TLC identification of （R，S）-goitrin in I. indigotica decoction piece and medicinal material were conducted according to identification method （3） in pharmacopeia （80％ ethanol as solvent for sample treatment， ultrasound extraction）； the rationality of pharmacopoeia method was investigated. Then the method was improved by changing the extraction solvent and pretreatment method （method one： using water as solvent， ultrasound extraction； method two： soaking in water for 1 h， then adding into methanol， ultrasound extraction； method three： the sample was wetted and then dried， using 80％ methanol as solvent， ultrasound extraction） of samples， and the optimal method was verified. According to the optimal method， the TLC identification of （R，S）-goitrin was detected by using chromatographic plates from different manufacturers， under the conditions of low temperature and low humidity （7 ℃， relative humidity 48％） and high temperature and high humidity （35 ℃， relative humidity 75％） respectively，to investigate the durability of the method. RESULTS： According to the method of pharmacopeia， in the chromatograms of decoction pieces， the same color spots appeared at the corresponding chromatographic positions of reference substance， but no corresponding spots appeared in the medicinal material chromatograms. After the samples were treated by three improvement methods， in medicinal material chromatograms， the same color spots appeared in the corresponding chromatographic positions of reference substances. There were single chromatographic spot after medicinal materials were treated with method one， and there were more spots after medicinal materials were treated with method two and three， and method two consumed less time than method three. The results of validation tests and method durability tests  showed that after the treatment of I. indigotica and its decoction pieces according to method two， the same color spots appeared in the corresponding positions of the decoction pieces and the medicinal materials chromatograms as those of the control. CONCLUSIONS： The improved TLC identification method is effective， the chromatographic spots are clear， and the repeatability is good.

Analysis of the Inclusion of Set Prescription Preparation Containing Coptis chinensis and Its Processed Product in 2015 Edition of Chinese Pharmacopeia ·Guidelines for Clinical Drug Use / 中国药房

OBJECTIVE： To provide reference for standardizing rational use of set prescription preparation containing Coptis chinensis and its processed product. METHODS： By retrieving 2015 edition of Chinese Pharmacopeia·Guidelines for Clinical Drug Use（volume of TCM set prescription）， the inclusion of set prescription preparation containing C. chinensis and its processed product were summarized and analyzed. RESULTS&CONCLUSIONS： There were 127 set prescription preparations containing C. chinensis and its processed product included in 2015 edition of Chinese Pharmacopeia·Guidelines for Clinical Drug Use（volume of TCM set prescription）， among which， there were 83， 5， 2， 8， 4， 11， 6， 5 and 3 set prescription preparations for internal medicine， surgery， gynecology， pediatrics， dermatology， ophthalmology， pharyngology， stomatology， orthopedics and traumatology， respectively. There were 120 set prescription preparations containing C. chinensis（94.49％）， 2， 4 and 1 set prescription preparations containing prepared C. chinensis with vino， prepared C. chinensis with ginger and prepared C. chinensis with Euodia rutaecarpa， respectively. There were 39， 59 and 29 kinds of set prescription preparations with C. chinensis as main symptoms medicine， assists medicine and complication medicine， which were mainly for clearing heat， drying dampness， purging fire and detoxifying（104 kinds， 81.89％）. Main types included Shexiang niuhuang pills， Gegen cenlian tablets， Kaiwei jianpi pills， etc. By comparing the efficacy of C. chinensis and its processed product， it was found that the names of processed products were not standardized， the labeling of C. chinensis and its processed products were not uniform and the application was not standardized； the related contents still needed to be further improved. It is necessary to strengthen the research on the pharmacodynamic basis and processing standard of C. chinensis and carry out the investigation and correction of relevant publications in order to help improve the rational drug use level of set prescription preparations containing C. chinensis and its processed products.

Differentiated Thyroid Cancer and Radioactive Iodine: Past, Present and Future

Radioiodine has been known as an important and safe armamentarium in the diagnosis and treatment of differentiated thyroid cancer (DTC) for more than 70 years. The 2015 guidelines from the American Thyroid Association (ATA) for adults with thyroid nodules and DTC seem to be the most comprehensive guidelines in the thyroid cancer field. The 2015 ATA guidelines provided an advance in evidence-based management of DTC, and resulted in a significant change in the patterns of practice regarding the application of the radioiodine. However, the 2015 ATA guidelines also provoked much controversy because a substantial portion of the recommendations announced were not based on sufficiently strong evidence. While the number of radioiodine administrations in Korea in the year of 2018 has decreased to a level less than 50% of that in 2013, in this review, we address some of the current issues and controversies regarding the application of radioiodine for the diagnosis, ablation and treatment of DTC, especially related to the 2015 ATA guidelines. Possible strategies for the achievement of better quality in radioiodine imaging and improvement in treatment efficiency that can be used in the near future are also discussed here.

The application of Precede-Proceed Model on medication management training in schizophrenic inpatients / 中国实用护理杂志

Objective To evaluate the application effect of the medication management training based on Precede-Proceed Model in schizophrenic inpatients. Methods In this self-control study, 60 schizophrenic inpatients were chosen for this investigation and were undergoing the medication management training on Precede-Proceed Model with conventional nursing care. By using Insight and Treatment Attitudes Questionnaires (ITAQ), The Brief Psychiatric Rating Scale (BPRS) and Nurses′Observation Scale for Inpatient Evaluation (NOSIE) after the first 3 months and 6 months of the intervention, in order to evaluate their results with their initial readings. Results The total scores of ITAQ, the total scores of BPRS, lacking in activity factor, reaction factor, hostile-suspiciousness factor, the total scores of NOSIE, total positive and negative factors before the intervention were (183.3±15.0) points, (71.7±10.9) points and (13.6±8.8) points; three months after intervention were (189.0±15.8) points, (75.3± 11.1) points and (11.6 ± 7.2) points; six months after intervention were (193.8 months after intervention were15.2) points, (71.8 ±9.6) points and (10.1±7.0) points. There were significant differences between the total score and the total negative factor score before and after treatment (F=43.244, 23.060, P﹤0.05). Conclusion The Precede-Proceed Model on medication management training in schizophrenic inpatients plays a positive role in promoting recovery and it is worth extending in clinical practice.

EvaluationofthereportingqualityofchineseimagingdiagnosticaccuracystudiesbySTARD2015 / 实用放射学杂志

Objective ToevaluatethereportingqualityofChineseimagingdiagnosticaccuracystudiesbyStandardsforReporting DiagnosticAccuracyStudies (STARD)2015.Methods AticalspublishedinChina,whichoriginatedfrom ChinaBiology Medicine (CBM),ChinaNationalKnowledgeInfrastructure(CNKI)andWanfangDatabasefromJanuary12014toApril82016wereretrievedfor statisticalanalysis.Keywordswereasfollows:"Ultrasound","CT","MRI","X-ray"and"diagnosticstudy".Tworeviewersindependently screenedtheliteraturesandassessedtheincorporatedstudies.Excel2016wasusedtofigureouttheaccordancerateandSPSS (version 17.0)wasusedtoanalyzethedata.Results 152studieswerefinallyincluded.Thenumberandproportionofstudiesonimagingdiagnostic methodswere84 (55.26%)ultrasound,29 (19.08%)CT,16 (10.53%)MRI,and23 (15.13%)withthecombinationoftwoand moremethods.Thecoincidencerateandcorrespondingnumberofsingledocumentreportswereasfollows:0%－10%,1report;11%－20%,4reports;21%－30%,45reports;31%－40%,74reports;41%－50%,24reports;51%－60%,3reports;and61%－70%,1 report.Therewasnosignificantdifferenceofcoincidencerate (P＝0.09)betweendifferentimagingdiagnosticmethods.Also,there wasnosignificantdifferenceofcoincidenceratebetweentheoldentriesinSTARD2003andnewentriesinSTARD2015(P＝0.34). Conclusion ThisstudyprovidesareferencebaselinefortheresearchersandthecliniciansonthequalityofChinesetestreportson imagingdiagnosticaccuracy.Itisshowedthat,thereportsondiagnosticaccuracyofUltrasound,CT,MRIandX-raypublishedbetween January1,2014andApril8,2016aregenerally middleandlow level.

A Study Of Clinical Profile Of Swine Flu Patients In The Outbreak Of 2015 In Tertiary Care Centre At Jabalpur

AIM:To study the clinical profile of H1N1 positive patients admitted in Swine flu ward in NSCB Medical College, Jabalpur in outbreak of 2015. MATERIALS & METHODS: All H1N1 positive patients admitted in NSCB MCH, Jabalpur were analysed retrospectively with respect to morbidity and mortality and possible clinical conclusions were derived. RESULTS: Of 64 H1N1 positive patients, 23 died. Cough, fever & dyspnoea were main symptoms in all patients including those under mortality group. Those with a duration of stay in hospital >10 days had least mortality. Highest mortality seen in patients with duration of stay between 1-10 days. 40 (62.5%) of 64 patients had some co-existing illness of which Anemia & DM were most common. 16 (69.5%) out of 23 patients who died had some co-existing illness of which DM was associated with 9 patients, Anaemia with 8 & Hypertension with 7 patients. 25 (39%) of 64 patients developed some complications of which ARDS & encephalopathy had higher mortality as compared to Renal failure & MODS. Of 23 patients who died, 18 (78%) developed some complication. CONCLUSION: Knowing the potential of Influenza virus for genetic mutations, it is difficult to find a stereotype pattern of illness as also documented by studies done in past. Good clinical skills always carry high value in suspecting & defining H1N1 infection & its complications. Co-existing illness must be taken special care of during an outbreak of Swine flu. Community education, timely immunization of those at high risk & early referral can save many lives