Correlation between nasal anatomical characteristics in newborns and short binasal prong dimensions

Abstract Objective: To correlate the nasal anatomical characteristics of newborns with the dimensions of short binasal prongs. Method: Observational, cross-sectional study carried out in two hospitals in southern Brazil. The authors evaluated 1620 newborns with neonatal data and nasal dimensions. To measure the dimensions of the nasal region, the authors considered the width of the medial columella, the right nostril diameter, and the left nostril diameter. These data were correlated with the dimensions of two models of short binasal prongs. Results: Of the total newborns evaluated, 807 were female (49.8%), and 813 were male (50.2%). The majority were white (96.2%). The mean gestational age was 37.4 ± 2.9 weeks, ranging from 22 to 42 weeks. The birth weight was 2946.8 ± 699.3 g, ranging from 490.0 to 4740.0 g. Most of the nasal measures were significantly larger than both prong model measurements. Conclusion: The sizes of short binasal prongs available on the Brazilian market do not match the nasal anatomical characteristics of newborns.

Curso de posgrado para estomatólogos sobre urgencias médicas durante la práctica profesional

Introducción: Durante la práctica estomatológica pueden presentarse urgencias médicas relacionadas con los procederes realizados o las enfermedades de base de los pacientes; sin embargo, existen deficiencias en la atención a estos afectados. Objetivo: Exponer las generalidades del curso de posgrado para estomatólogos sobre urgencias médicas durante la práctica profesional y los criterios emitidos por sus participantes. Métodos: Se realizó una investigación descriptiva de corte pedagógico, donde participaron 62 estudiantes de la Facultad de Estomatología de la Universidad de Ciencias Médicas de La Habana, desde noviembre del 2018 hasta diciembre del 2022. Se analizaron las siguientes variables: temas, objetivos y sistema de conocimientos y habilidades. Además, se utilizó la técnica de positivo, negativo e interesante. Resultados: Este curso contó con 5 temas: el primero, dedicado a las generalidades de las urgencias médicas más frecuentes durante la atención estomatológica y las características particulares en la confección de historia clínica; el segundo y el tercero, a los factores de riesgo y a la atención a estas urgencias; el cuarto, al uso de medicamentos y las posibles interacciones y, el quinto, a experiencias clínicas. Los educandos aportaron criterios positivos, negativos e interesantes. Conclusiones: El curso diseñado ofreció conocimientos y habilidades al educando, que no se proporcionan en las asignaturas de pregrado y posgrado de las especialidades, lo cual contribuyó a mejorar la atención estomatológica integral de los pacientes. Los participantes aportaron criterios favorables sobre la estructura, la pertinencia y el valor científico de dicho curso.

Introduction: During stomatological practice, medical emergencies can be presented related to the procedures carried out or the patients' underlying diseases; however, there are deficiencies in the care to them. Objective: To expose the generalities of the postgraduate course for stomatologists about medical emergencies during the professional practice and the criteria emitted by their participants. Methods: A descriptive pedagogic investigation was carried out, where 62 students from the Faculty of Stomatology of the University of Medical Sciences in Havana participated, since November, 2018 to December, 2022. The following variables were analyzed: topics, objectives and system of knowledge and abilities. Also, the technique of positive, negative and interesting was used. Results: This course had 5 topics: the first one, dedicated to the most frequent medical emergencies generalities during dental care and the particular characteristics when making the medical record; the second and third topics were dedicated to the risk factors and care to these emergencies; the fourth, to the use of medications and possible interactions and, the fifth, to clinical experiences. The students contributed positive, negative and interesting criteria. Conclusions: The designed course offered knowledge and abilities to the student that are not provided in undergraduate and postgraduate subjects of the specialties, which contributed to improve the comprehensive dental care of patients. The participants offered favorable criteria about the structure, relevance and scientific value of this course.

Sistema de acciones para la mejora continua en el funcionamiento de colectivos de disciplina

Fundamento: la estructura y organización de los planes de estudio de la Educción Superior en Cuba demandan la búsqueda constante de alternativas que posibiliten perfeccionar el trabajo metodológico. Objetivo: elaborar un sistema de acciones que contribuya a mejorar el funcionamiento de los colectivos de disciplina. Métodos investigación de desarrollo con enfoque dialéctico materialista, realizada en la Universidad de Ciencias Médicas de Cienfuegos en el año 2022. Se aplicaron métodos en los niveles empíricos, teóricos y estadísticos matemáticos que en su conjunto permitieron dar salida al objetivo previsto. La propuesta se organizó en las etapas de diagnóstico, diseño y validación. Resultados identificadas potencialidades y limitaciones en el funcionamiento de los colectivos de disciplina en la institución, aspectos considerados al proponer acciones de planificación, organización, ejecución y control para la mejora continua, que particularizan aspectos para aquellos colectivos que se centran en la práctica laboral por constituir la educación en el trabajo principio y forma organizativa fundamental en la Educación Médica cubana. La validación de la propuesta realizada confirmó su valor, de manera que implementarla es el reto para continuar apostando por la calidad de los procesos en la universidad. Conclusiones las acciones propuestas se derivan del diagnóstico realizado y de manera integrada contribuyen a lograr mayor efectividad en la dirección de ese nivel organizativo para el trabajo metodológico en la institución y por tanto a su funcionamiento.

Foundation: The conformation and organization of the Higher Education study plans in Cuba demand the constant search for alternatives that make it possible to perfect the methodological work. Objective: develop a system of actions that contributes to improve the function of disciplinary groups. Methods: development research with a materialist dialectical approach, carried out at the Cienfuegos Medical Sciences University in 2022. Methods were applied at the empirical, theoretical and mathematical statistical levels that together allowed the intended objective to be achieved. The proposal was organized into the diagnosis, design and validation stages. Results: identified potentialities and limitations in the functioning of the disciplinary groups in the institution, aspects considered when proposing planning, organization, execution and control actions for continuous improvement, which particularize aspects for those groups that focus on work practice by constitute education at work as a fundamental principle and organizational form in Cuban Medical Education. The validation of the proposal confirmed its value, so implementing it is the challenge to continue betting on the quality of the processes at the university. Conclusions: the proposed actions are derived from the diagnosis carried out and in an integrated manner contribute to achieving greater effectiveness in the direction of that organizational level for the methodological work in the institution and therefore its operat.

Multiple basal infusion rates in open-loop insulin delivery systems: is there a metabolic benefit?

ABSTRACT Objective: To evaluate glycemic control according to the number of daily basal rates (BRs) in type 1 diabetes patients using continuous subcutaneous insulin infusion (CSII). Subjects and methods: Cross-sectional study of patients treated with an open-loop CSII for at least 6 months and using a flash glucose monitoring system. Patients were divided into 2 groups: group 1 (G1) and group 2 (G2), with ≤4 and >4 BRs/24h, respectively. The groups were compared regarding HbA1c, time in range (TIR), time above range (TAR), time below range (TBR), glucose management indicator (GMI), glucose variability and data related to hypoglycemia. Regression models were performed. Results: The study included 99 patients (n = 55 in G1; n = 44 in G2). Median (Interquartile range) overall age was 30 (17) years, with 19.5 (48) and 51 (77) months of CSII use, respectively. The median number of different BRs was 3 (2) for G1 and 6 (2) for G2. There were no differences concerning age, sex, educational stage, weight, and insulin analog used. G2 had longer disease duration, longer CSII use, and higher total basal daily dose/kg. No significant differences regarding HbA1c, median glucose, GMI, TIR, TAR, and CV were found. G2 patients had more hypoglycemia, more asymptomatic hypoglycemia, and higher TBR. After adjusting for potential confounders, G1 maintained a lower risk of asymptomatic hypoglycemia. Conclusion: Programming open-loop CSII devices with more than 4 BRs does not improve metabolic control. Additionally, it seems to be a risk factor for hypoglycemia and was an independent predictor for asymptomatic hypoglycemia.

Centros de Atenção Psicossocial e formação profissional para oferta das Práticas Integrativas e Complementares: estudo com profissionais ofertantes dos serviços / Psychosocial care centers and professional training for the provision of integrative and complementary practices: a study with professionals offering these services / Centros de Atención Psicosocial y formación profesional para oferta de las Prácticas Integradoras y Complementarias: estudio con profesionales ofertantes de los servicios

Estudos sobre a formação em Práticas Integrativas e Complementares têm se concentrado na análise curricular dos cursos da Saúde e as pesquisas abrangendo as percepções dos profissionais a respeito dos processos formativos devem ser mais elucidadas. O estudo objetiva identificar os processos de formação e capacitação dos profissionais ofertantes de Práticas Integrativas e Complementares nos Centros de Atenção Psicossocial de uma região metropolitana. Trata-se de um estudo descritivo, exploratório, de abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 45 profissionais, as quais foram posteriormente analisadas segundo a Análise de Conteúdo Temática. As pós-graduações, graduação, formações em serviço e o ensino privado foram as trajetórias adotadas pelos profissionais, revelando a existência de uma formação difusa para a oferta no cenário investigado. Esses resultados podem subsidiar o planejamento de estratégias educacionais para a ordenação dos recursos humanos em Práticas Integrativas e Complementares.

Studies of training in integrative and complementary practices have concentrated on the analysis of the curriculums of health courses and further more in-depth research into professionals' perceptions about training processes is needed. This study aimed to identify training processes and capacity building for professionals who offer integrative and complementary practices in psychosocial care centers in a metropolitan region. We conducted an exploratory descriptive study involving semi-structured interviews with 45 professionals. The interview transcripts were analyzed using content analysis. The most common routes taken by the professionals were post-graduate qualifications, degrees, in-service training and private education. The results reveal that training in this area was diffuse. Our results can inform the development of educational strategies for the organization of human resources in the area of integrative and complementary practices.

Los estudios sobre la formación en Prácticas Integradoras y Complementarias se han concentrado en el análisis curricular de los cursos de la salud y las investigaciones que incluyen las percepciones de los profesionales con relación a los procesos de formación deben elucidarse más. El objetivo del estudio es identificar los procesos de formación y capacitación de los profesionales ofertantes de Prácticas Integradoras y Complementarias en los Centros de Atención Psicosocial de una región metropolitana. Se trata de un estudio descriptivo, exploratorio, de abordaje cualitativo. Se realizaron entrevistas semiestructuradas con 45 profesionales que fueron posteriormente analizadas según el Análisis de Contenido Temático. Los postgrados, graduación, formaciones en servicio y la enseñanza privada fueron las trayectorias adoptadas por los profesionales, revelando la existencia de una formación difusa para la oferta en el escenario investigado. Esos resultados pueden subsidiar la planificación de estrategias educativas para la ordenación de los recursos humanos en las Prácticas Integradoras y Complementarias.

Structure and Function of Rhizomicrobes Recruited by Acteoside in Root Exudates of Rehmannia glutinosa / 中国实验方剂学杂志

ObjectiveTo reveal the correlation of Rehmannia glutinosa-soil feedback process with the formation of its continuous cropping obstacles through the identification of the root exudates of R. glutinosa and analysis of the specific rhizomicrobes recruited by the root exudate. MethodThe root exudates of R. glutinosa seedlings germinated under sterilized condition and those enriched in the rhizosphere of R. glutinosa cultivated in the field were collected and analyzed using the ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry（UPLC-Q-TOF-MS）. The highly abundant compounds identified in the root exudates were added into blank soil， and the soil microbial community was profiled using Illumina Miseq sequencing. The bacterial and fungal functions were predicted by PICRUSt and FUNGuild， respectively. ResultThe identification results showed that seven phenylethanoid glycosides were found in R. glutinosa root exudates， and acteoside possessed the highest abundance. In the soil enriched with acteoside， the bacterial genera such as Agromyces， Pseudomonas， Lysobacter， Sphingobium， Pseudoxanthomonas and Sphingomonas were enriched. For the fungi， the genera Neocosmospora， Plectosphaerella and Dactylonectria， and the species such as Neocosmospora rubicola， Plectosphaerella cucumerina， Dactylonectria alcacerensis and Fusarium solani showed higher abundance. The functional analysis indicated the above-mentioned bacterial genera may realize rapid proliferation by utilizing， biodegrading and transforming phenylethanoid glycosides， and some potential fungal pathogens were colonized. ConclusionThe R. glutinsoa-soil feedbacks were likely generated by the phenylethanoid glycosides in the root exudates together with the specific rhizomicrobes. The investigations of R. glutinsoa-soil feedbacks under continuous cropping system are critical to the further understanding of the underlying mechanisms related to its continuous cropping obstacles.

Clinical efficacy of double plasma molecular absorption system and sequential plasma exchange combined with continuous renal replacement therapy in treatment of acute-on-chronic liver failure with acute kidney injury / 临床肝胆病杂志

ObjectiveTo investigate the clinical efficacy of double plasma molecular adsorption system （DPMAS） and sequential plasma exchange （PE） combined with continuous renal replacement therapy （CRRT） in the treatment of patients with acute-on-chronic liver failure （ACLF） and acute kidney injury （AKI）. MethodsA retrospective analysis was performed for the clinical data of 90 patients with ACLF and AKI who were hospitalized in The Affiliated Hospital of Guizhou Medical University from January 2019 to December 2022， and according to the method for blood purification， they were divided into DPMAS sequential PE+CRRT group （observation group with 31 patients） and DPMAS sequential PE group （control group with 59 patients）. General data on admission and laboratory markers before and after blood purification were collected from all patients， including hepatic and renal function， coagulation function， and inflammation markers， and estimated glomerular filtration rate （eGFR） and MELD combined with serum sodium concentration （MELD-Na） score were calculated. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data within each group before and after treatment， and the Mann-Whitney U test was used for comparison between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsThe observation group had a significantly higher response rate than the control group ［48.4% （15/31） vs 27.1% （16/59）， χ2=4.071， P=0.044］. The methods for blood purification in both groups could effectively improve total bilirubin， alanine aminotransferase， aspartate aminotransferase （AST）， prothrombin time activity， serum creatinine （Scr）， procalcitonin （PCT）， C-reactive protein， eGFR， and MELD-Na score （all P<0.05）， and both groups had significant reductions in platelet count （PLT） and hemoglobin （Hb） after treatment （all P<0.05）， while there were no significant changes in blood urea nitrogen， albumin， and international normalized ratio after treatment （all P>0.05）. There were significant differences between the two groups in the changes in AST， Scr， PCT， eGFR， MELD-Na score， Hb， and PLT after treatment （all P<0.05）. ConclusionDPMAS sequential PE combined with CRRT can effectively remove inflammatory mediators， improve renal function， stabilize the internal environment of human body， and achieve a relatively good clinical efficacy.

Seguimiento a los egresados de la Maestría en Nutrición Humana / Follow-up of the graduates of the Master´s degree in Human Nutrition

Introducción: Diferentes estudios de seguimiento de egresados hablan del valor de obtener información sobre las actividades profesionales que ejercen y determinar el impacto de la formación recibida y la percepción de la misma. Objetivos: Determinar el desempeño de los egresados de la Maestría en Nutrición Humana FCM- UNA de las promociones del 2007 al 2020. Materiales y métodos: Estudio descriptivo de diseño observacional con enfoque cuantitativo que obtuvo la participación de 83 de los 91 egresados que completaron la encuesta enviada a través del Formulario Google. Resultados: Entre los más resaltantes se tiene que las egresadas entre los encuestados sobresalen las mujeres (90,4 %). El área laboral ejercida; mayor cantidad en el área clínica (61,4 %), consultorio (24,1 %), salud pública en un 6%. El 55,4 % respondió que tuvo más oportunidades laborales; solo el 28,9 % realiza tutoría de tesis. El 79,1 % ha mejorado sus actividades docentes o asistenciales y el 55,4 % ha respondido que no desempeña actividad docente. El 71,1 % ha colaborado en trabajos de investigación siendo magister, en área clínica (47%), en Salud Pública (14,5 %), en área de alimentación, (6%), otros (3.6%); el 64,9 % no ha publicado el trabajo de investigación de la maestría realizada. El 95,2 % no ha hecho aún el Doctorado en Nutrición y al 89,2 % le gustaría hacerlo. Un 87,9 % califica la Maestría de Nutrición Humana FCM-UNA de Excelente o Muy Bueno. Conclusión: Se identifica una mayor cantidad de egresadas mujeres, en cuanto al campo laboral de desempeño, existe una mayor cantidad en el área clínica, más de la mitad de los egresados ha participado en un trabajo de investigación siendo magister en el área clínica, la tesis de maestría no ha sido publicada por la mayoría. Casi el total no ha realizado un Doctorado en Nutrición. Se presenta por primera vez, a nivel nacional, un estudio sobre el desarrollo profesional de los egresados de la Maestría en Nutrición Humana que podría ser útil para futuros trabajos de investigación y toma de decisiones en formación continua.

Introduction: Different graduate follow -up studies speak of the value of obtaining information about the professional activities they exercise and determining the impact of the training received and the perception of the same. Objectives: Determine the performance of graduates of the Master in Human Nutrition FCM One of the promotions from 2007 to 2020. Materials and methods: Descriptive study with observational design and quantitative approach that obtained the participation of 83 of the 91 graduates who completed the survey sent through the Google form. Results: Graduates women (90.4 %). The work area exercised; greater amount in the clinical area (61.4 %), office (24.1 %), public health at 6 %. 55.4 % replied that they had more work chances, only 28.9 % perform thesis tutoring. 79.1 % have improved their teaching or care activities and 55.4 % have responded that they do not perform teaching activity. 71.1%have collaborated in research papers being Master, in clinical area (47%), in public health (14.5%), in food area, (6%), others (3.6%); 64.9 % have not published the research work of the master's degree. 95.2 % have not yet done the doctorate in nutrition and at 89.2 % they would like to do it. 87.9 % describe the mastery of human nutrition FCM an excellent or very good one. Conclusion: A greater number of women graduates is identified, in terms of the performance field, there is a greater amount in the clinical area, more than half of the graduates have participated in a research work being a magister in the clinical area, the work of Master's research has not been published by the majority. Almost the total has not done a doctorate in nutrition. It is presented for the first time, at the national level, a study on the professional development of graduates of the Master in Human Nutrition that could be useful for future research works.

Correlación entre tiempo en rango y hemoglobina glicosilada en personas con diabetes mellitus: revisión sistemática / Correlation between time on target and glycated hemoglobin in people with diabetes mellitus: systematic review / Correlação entre tempo no alvo e hemoglobina glicada de pessoas com diabetes mellitus: revisão sistemática

Objetivo: analizar la correlación entre el tiempo en rango y la hemoglobina glicosilada de personas que viven con diabetes mellitus y realizan la monitorización continua de la glucemia o el automonitoreo de la glucemia capilar Método: revisión sistemática de etiología y riesgo basada en las directrices del JBI e informada según los Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abarcando seis bases de datos y la literatura gris. La muestra incluyó 16 estudios y la calidad metodológica fue evaluada utilizando las herramientas del JBI. Protocolo registrado en Open Science Framework, disponible en https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tiempo en rango (70-180 mg/dl) mostró una correlación negativa con la hemoglobina glicosilada, mientras que el tiempo por encima del rango (>180 mg/dl) mostró una correlación positiva. Los coeficientes de correlación variaron entre -0,310 y -0,869 para el tiempo en rango, y entre 0,66 y 0,934 para el tiempo por encima del rango. Un estudio se realizó en una población que hacía el automonitoreo. Conclusión: hay una correlación estadísticamente significativa entre el tiempo en rango y el tiempo por encima del rango con la hemoglobina glicosilada. Cuanto mayor sea la proporción en el rango glucémico adecuado, más cerca o por debajo del 7% estará la hemoglobina glicosilada. Se necesitan más estudios que evalúen esta métrica con datos del automonitoreo de la glucemia.

Objective: to analyze the correlation between time on target and glycated hemoglobin in people living with diabetes mellitus and carrying out continuous blood glucose monitoring or self-monitoring of capillary blood glucose. Method: systematic review of etiology and risk based on JBI guidelines and reported according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses, covering six databases and grey literature. The sample included 16 studies and methodological quality was assessed using JBI tools. Protocol registered in the Open Science Framework, available at https://doi.org/10.17605/OSF.IO/NKMZB. Results: time on target (70-180 mg/dl) showed a negative correlation with glycated hemoglobin, while time above target (>180 mg/dl) showed a positive correlation. Correlation coefficients ranged between -0.310 and -0.869 for time on target, and between 0.66 and 0.934 for time above target. A study was carried out on a population that performed self-monitoring. Conclusion: there is a statistically significant correlation between time on target and time above target with glycated hemoglobin. The higher the proportion in the adequate glycemic range, the closer to or less than 7% the glycated hemoglobin will be. More studies are needed to evaluate this metric with data from self-monitoring of blood glucose.

Objetivo: analisar a correlação entre o tempo no alvo e a hemoglobina glicada de pessoas que vivem com diabetes mellitus e realizam a monitorização contínua da glicemia ou a automonitorização da glicemia capilar. Método: revisão sistemática de etiologia e de risco pautada nas diretrizes do JBI e reportada conforme Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abrangendo seis bases de dados e a literatura cinzenta. A amostra incluiu 16 estudos e a qualidade metodológica foi avaliada utilizando as ferramentas do JBI. Registrado protocolo no Open Science Framework, disponível em https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tempo no alvo (70-180 mg/dl) apresentou correlação negativa com a hemoglobina glicada, enquanto o tempo acima do alvo (>180 mg/dl) mostrou correlação positiva. Os coeficientes de correlação variaram entre -0,310 e -0,869 para o tempo no alvo, e entre 0,66 e 0,934 para o tempo acima do alvo. Um estudo foi efetuado com população que realizava a automonitorização. Conclusão: há correlação estatisticamente significativa entre o tempo no alvo e o tempo acima do alvo com a hemoglobina glicada. Quanto maior a proporção na faixa glicêmica adequada, mais próxima ou inferior a 7% estará a hemoglobina glicada. São necessários mais estudos que avaliem essa métrica com dados da automonitorização da glicemia.

Continuous Renal Replacement Therapy: What Have We Learned And What Are Key Milestones For The Years To Come?

ABSTRACT Continuous renal replacement therapy (CRRT) is the main extracorporeal kidney support therapy used in critical ill patients in the intensive care unit (ICU). Since its conceptualization ~50 years ago, there have been major improvements in its technology and utilization. The last decade, and particularly since the COVID-19 pandemic, has been marked by a growing interest and demand of CRRT in worldwide ICUs. This has underpinned the need for improvements in nomenclature and process standardization, optimization of CRRT deliverables, and the development and validation of key performance indicators. Further, how to leverage digital health technologies to build clinical decision support for CRRT and improve personalized bedside decisions is a subject of intense investigation. Herein, we summarize notable advancements in the provision of CRRT and propose areas in need of further development.

PCorteSoft - Sistema para la determinación del punto de corte óptimo en escalas predictivas y la categorización de variables continuas

Al desarrollar modelos de predicción para su aplicación en la práctica clínica, los profesionales de la salud suelen categorizar las variables clínicas que son de naturaleza continua. En muchas ocasiones estos modelos constituyen la base para la confección de escalas predictivas, a partir de las cuales se estratifica a los pacientes en varias categorías atendiendo al fenómeno estudiado. En estos casos se requiere la determinación de uno o varios puntos de cortes que permitan dividir el recorrido de la variable, variables continuas o puntuaciones de una escala, en dos o más categorías. El presente trabajo tiene como objetivo la automatización de diferentes métodos para dicotomizar variables continuas en modelos de predicción clínica, donde la variable respuesta es dicotómica, y determinar el punto de corte óptimo en la estratificación de pacientes en dos categorías, a partir de escalas de predicción. Para ello se elaboró un software en el lenguaje de programación R, que implementa diferentes métodos para la determinación del punto de corte óptimo, lo cual agiliza el trabajo investigativo de los especialistas de salud en el proceso de elaboración de modelos predictivos y/o escalas de predicción.

When developing predictive models for application in clinical practice, health professionals often categorize clinical variables that are continuous in nature. In many cases, these models are the basis for the development of predictive scales from which patients are stratified into various categories according to the phenomenon under study. In both cases, it is necessary to determine one or more cut-off points that allow dividing the path of the variable, continuous variables, or scores of a scale into two or more categories. The aim of the present work is to automate different existing methods for dichotomizing continuous variables in clinical prediction models where the response variable is dichotomous, as well as to determine the optimal cut-off point for stratifying patients into two categories, based on prediction scales. For this purpose, a software was developed in the R programming language, which implements different existing methods for the determination of the optimal cut-off point, speeding up the research work of health specialists in the process of developing predictive models and/or prediction scales.

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

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

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

The Ganesh朑rewal cystitome maker � A step in standardizing cataract surgery

A well-centered, adequately sized continuous curvilinear capsulorhexis (CCC) is a prerequisite for successful cataract surgery. A perfect capsulorhexis ensures safe and effective performance of various steps of surgery as well as a correctly positioned intraocular lens (IOL) with optimal rotational stability. Ganesh and Grewal (GG) cystitome maker is a step toward standardizing the creation of a cystitome to reduce variations and complications associated with the crucial step of CCC in cataract surgery. We conducted a study to measure the repeatability and precision of cystitomes made by the GG cystitome maker versus those made manually with a needle holder. The results showed that the cystitomes made with GG cystitome maker had a lesser degree of variation. This indicates a more repeatable cystitome, which will inadvertently help in reducing the error caused by the instrument in making a good CCC during cataract surgery.

A Produção do Cuidado em um Contexto Formativo com Visitadoras do Programa Primeira Infância Melhor / The Production of Care in a Training Course Context with Visitors of the Programa Primeira Infância Melhor / La Producción de Cuidado en un Contexto de Formación con Visitadoras del Primeira Infância Melhor

A partir de uma experiência de encontros de formação com visitadoras do Programa Primeira Infância Melhor, este trabalho se propõe a refletir sobre a inserção da psicanálise nas políticas públicas. Foram utilizadas vinhetas dos encontros e de entrevistas individuais com as visitadoras para pensar na importância de espaços onde a circulação da palavra e, com ela, ressignificações sobre o trabalho realizado nos territórios, seja possível. Ganham destaque três elementos que se articulam e produzem reverberações no contexto de trabalho com o Primeira Infância Melhor: as bases legais e normativas da política pública, as famílias e crianças visitadas e o sujeito-visitador. Pensa-se que esses três aspectos, quando trazidos à tona pelo processo de enunciação em um espaço de formação, geram a circulação de lugares e posições discursivas. Tais movimentações, por sua vez, contribuem para a sustentação de uma prática pautada na produção de cuidado no contexto das políticas públicas de saúde.

Based on the experience of training meetings with visitors of the Programa Primeira Infância Melhor (Better Early Childhood Program), this work aims to discuss the presence of psychoanalysis on public policies. Small excerpts from the meetings and personal interviews with the visitors have been taken to think about the importance of spaces where the circulation of the word take place, as well as to reframe the work done in the territories. We highlight here three elements that articulate and echo the context of work at Programa Primeira Infância Melhor: the legal and normative basis of public policy, the families and children visited, and the subject-visitor. We believe that these three aspects when brought to light by the process of enunciation in a training space build up the circulation of places and discursive positions. Therefore, such movements lead towards keeping a practice guided by the production of care in the context of public health policies.

Este trabajo se propone pensar a respecto de la inserción del psicoanálisis en las políticas públicas a partir de una experiencia de encuentros de formación con visitadoras del Programa Primeira Infância Melhor. Utilizamos fragmentos de reuniones y entrevistas individuales con las visitadoras para pensar sobre la importancia de espacios de circulación de palabras y, a partir de ella, posibilidades de resignificar el trabajo realizado en los territorios. Se destaca la articulación de tres elementos que producen reverberaciones en el contexto de trabajo en el Primeira Infância Melhor: las bases legales y normativas de las políticas públicas, las familias y los niños visitados, y el sujeto-visitador. Pensamos que los tres aspectos, cuando son planteados por el proceso de enunciación en un espacio de formación, generan una circulación de lugares y posiciones discursivas. Estos movimientos, por su turno, contribuyen para sostener una práctica pautada en la producción de cuidado en el contexto de las políticas públicas de salud.

Flash glucose monitoring system in patients with type 1 diabetes in healthcare center in Brazil: real world data from a short-term prospective study

ABSTRACT Objectives: To evaluate the alternate use of flash glucose monitoring (FGM) with self-monitoring blood glucose (SMBG), in patients with type 1 diabetes (T1D). Materials and methods: Two weeks of open FGM (P2), both preceded (P1) and followed by 2 weeks (P3) of SMBG with a blinded FGM system. Mean absolute relative difference (MARD) was calculated by (-FGMi − SMBGi-) / SMBGi, where it was a paired data sample. Results: In total, 34 patients were evaluated. Time in range (TIR) did not change between P1 and P2. In 12 patients (35.3%), TIR increased from 40% at P1 to 52% at P2 (p = 0.002) and in 22 (64.7%), TIR decreased or did not change. FGM use resulted in decreased % time spent in hypoglycemia (<70 mg/dL) (6.5% vs. 5.0%; p = 0.005), increased % time spent in hyperglycemia (>180 mg/dL) (44.5% to 51%; p = 0.046) with no significant change in % TIR. The proportion of patients who reached sensor-estimated glycated hemoglobin (eA1c) < 7% decreased from 23.5% at P1 to 12.9% at P2, p = 0.028. For the whole sample, the MARD between the two methods was 15.5% (95% CI 14.5-16.6%). For normal glucose range, hyperglycemic levels and hypoglycemic levels MARD were 16.0% (95% CI 15.0-17.0%), 13.3% (95% CI 11.5-15.2%) and 23.4% [95% CI 20.5-26.3%)], respectively. Conclusion: FGM after usual SMBG decreased the % time spent in hypoglycemia concomitant with an undesired increase in % time spent in hyperglycemia. Lower accuracy of FGM regarding hypoglycemia levels could result in overcorrection of hypoglycemia.

Necesidades de formación de las personas editoras de la Universidad de Costa Rica

El crecimiento de la necesidad de información veraz ha llevado a que las revistas científicas se posicionen como medios de información confiables; lo cual hace que se requiera una necesidad de la profesionalización de esta labor que garantice la confiablidad y rigurosidad de las mismas. El objetivo de este manuscrito fue identificar las necesidades de formación de profesionales a cargo de la gestión editorial de las revistas científicas de la Universidad de Costa Rica. La investigación se realizó desde enero del 2019 hasta junio del 2020, por medio de un enfoque cualitativo de tipo descriptivo, con técnicas de recolección de este mismo enfoque. Se entrevistaron a las personas editoras y directoras de las principales revistas posicionadas en los primeros diez lugares del ranking UCR índex (a la fecha 4 de noviembre del 2019), se utilizó una entrevista semiestructurada con preguntas relacionadas a la identificación de actitudes, habilidades, conocimientos, necesidades de formación y el contexto en el que se desarrollan, estas representan las categorías de análisis utilizadas para el procesamiento de información. Entre los resultados se destacaron necesidades de formación en temáticas afines a los procesos administrativos relacionados con revistas, fundamentos de la gestión editorial, herramientas tecnológicas y el posicionamiento de las revistas; además se evidenciaron las cortas jornadas laborales que poseen los editores de revistas UCR. Se concluye que es imperativo que la UCR atienda estas necesidades de formación, además de fortalecer estos medios de divulgación del conocimiento y que se analice la oportunidad de ofrecer un programa de formación continua o bien una especialidad en gestión editorial.

The growth of the need for reliable information has led scientific journals to position themselves as reliable information media, which entails a need for the professionalization of this work that guarantees the reliability and rigor of this. The objective of this manuscript was to identify the training needs of the professionals in charge of the editorial management of the scientific journals of the University of Costa Rica. The research was carried out from January 2019 to June 2020, through a descriptive qualitative approach, with qualitative collection techniques. The editors and directors of the main journals positioned in the first ten places of the UCR index ranking (November 4th, 2019) were interviewed, a semi-structured interview was used with questions related to the identification of attitudes, skills, knowledge, training needs and the context in which they are developed, these represent the categories of analysis used for the processing of information. The main results shows that, training needs in topics related to the processes were highlighted, administrative issues related to journals, fundamentals of editorial management, technological tools and the positioning of journals; in addition, the short working hours that the editors of UCR magazines have were evidenced. It is concluded that it is imperative that the UCR meets these training needs, in addition to strengthening these means of disseminating knowledge and that the opportunity to offer a continuous training program or a specialty in editorial management be analyzed.

30G needle aspiration - A modified technique of capsulorhexis in pediatric cataract with high intra-lenticular pressure

This surgical technique describes a modification of the continuous curvilinear capsulorhexis (CCC) to achieve an adequate-sized capsulorhexis in pediatric cataracts with high intralenticular pressure. Performing CCC in pediatric cataracts is challenging, especially when the intralenticular pressure is high. This technique involves 30 G needle decompression of the lens to reduce positive intralenticular pressure and subsequent flattening of the anterior capsule. This minimizes the chances of extension of CCC without using any special equipment. This technique was used in two eyes of two patients (age 8 and 10 years) with unilateral developmental cataracts. Both surgeries were performed by a single surgeon (PKM). In both eyes, a well-centered CCC was achieved with no extension, and a posterior chamber intraocular lens (IOL) was placed in the capsular bag. Thus, our technique of 30 G needle aspiration could be extremely useful to achieve an adequately sized CCC in pediatric cataracts with high intralenticular pressure, especially for beginner surgeons.

Effectiveness of synchronous vs asynchronous faculty aid in learning how to diagnose, plan and perform a 44C ankle fracture osteosynthesis in a synthetic bone model / Eficacia de la ayuda docente sincrónica frente a la asincrónica en el aprendizaje del diagnóstico, la planificación y el desempeño de una osteosíntesis de fractura de tobillo 44C en un modelo de hueso sintético

Abstract: Introduction: COVID-19 pandemic has disrupted educational activities since 2020. AO Trauma Latin American courses took place in a blended modality during 2021 and participant's feedback was positive. In this study, we aim to identify if there was any difference in learning, planning, and executing an osteosynthesis on a bone model with synchronous or asynchronous faculty support during an online asynchronous learning program. Material and methods: we designed an online asynchronous course designed for teaching about trimalleolar ankle fractures. We randomized twenty participants into two groups: the control group had synchronous faculty support and the intervention group had asynchronous faculty support. Participants were evaluated with initial and final quizzes, preoperative planning, and execution of an osteosynthesis on a bone model. Comparisons of scores between CG and IG were performed using the Mann-Whitney U test for non-parametric variables. A two-tailed p < 0.05 was considered statistically significant. Results: we did not find a significant difference between synchronous or asynchronous faculty support during our asynchronous learning program in quiz results, preoperative planning, global rating scale or the result of the osteosynthesis as compared to the preoperative plan. Conclusion: there appears to be no difference in participant learning with synchronous or asynchronous faculty support during an online, asynchronous course. Asynchronous activities appear to be effective teaching methods and should be considered in continuous medical education in orthopedics. Larger studies are needed to identify differences in participant learning outcomes between synchronous and asynchronous faculty support models.

Resumen: Introducción: la pandemia de COVID-19 ha interrumpido las actividades educativas desde 2020. Los cursos de AO Trauma Latinoamérica se realizaron en modalidad semipresencial durante 2021 y la retroalimentación de los participantes fue positiva. En este estudio, nuestro objetivo es identificar si hubo alguna diferencia en el aprendizaje, la planificación y la ejecución de una osteosíntesis en un modelo óseo con el apoyo sincrónico o asincrónico de la facultad durante un programa de aprendizaje asincrónico en línea. Material y métodos: diseñamos un curso asíncrono en línea para la enseñanza de las fracturas trimaleolares de tobillo. Se distribuyó aleatoriamente a 20 participantes en dos grupos: el grupo de control tuvo apoyo docente sincrónico y el grupo de intervención tuvo apoyo docente asincrónico. Se evaluó a los participantes con cuestionarios iniciales y finales, planificación preoperatoria y ejecución de una osteosíntesis en un modelo óseo. Las comparaciones de las puntuaciones entre GC e GI se realizaron mediante la prueba U de Mann-Whitney para variables no paramétricas. Una p de dos colas < 0.05 se consideró estadísticamente significativa. Resultados: no encontramos diferencia significativa entre el apoyo del profesorado síncrono o asíncrono durante nuestro programa de aprendizaje asíncrono en los resultados de los cuestionarios, la planificación preoperatoria, la escala de valoración global o el resultado de la osteosíntesis en comparación con el plan preoperatorio. Conclusión: no parece haber diferencias en el aprendizaje de los participantes con el apoyo sincrónico o asincrónico del profesorado durante un curso en línea asincrónico. Las actividades asíncronas parecen ser métodos de enseñanza eficaces y deberían tenerse en cuenta en la formación médica continua en ortopedia. Se necesitan estudios más amplios para identificar las diferencias en los resultados de aprendizaje de los participantes entre los modelos de apoyo docente síncrono y asíncrono.

Impact of different automated peritoneal dialysis modalities on the inflammatory profile of elderly patients with chronic kidney disease / Impacto das diferentes modalidades de diálise peritoneal automatizada sobre o perfil inflamatório de idosos portadores de doença renal crônica

Abstract Introduction: Chronic kidney disease, more prevalent in the elderly, is considered a public health issue worldwide. Objective: To evaluate the impact of automated, peritoneal dialysis modalities, intermittent and continuous, on the inflammatory profile of elderly people with chronic kidney disease. Methods: Prospective, cross-sectional and analytical study carried out in a dialysis clinic in Brasília - Brazil, with 74 elderly people aged 60 years or older. The patients underwent rapid Peritoneal Equilibration Test, clinical assessment, blood collection for biochemical and cytokine assessments, interleukin 6 and transforming growth factor beta 1, and answered a quality-of-life questionnaire (KDQOL-SF36). We used a 5% significance level for data analysis, associations and correlations. Results: Patients in the continuous modality had higher serum values of transforming growth factor beta 1 than those in the intermittent modality, which had higher peritoneal transforming growth factor beta 1, age and residual renal function than those in continuous mode. Interleukin 6 dosage in the peritoneum was associated with age, while serum IL-6 was associated with IL-6 in the peritoneum, time on dialysis and age. There was no association between the modality and the presence of diabetes, blood volume or nutritional status. Both modalities enable good adaptation to the dialysis treatment. Conclusion: Inflammation in automated peritoneal dialysis is mainly associated with low residual renal function, advanced age and longer time on therapy, and not to the type of dialysis performed.

Resumo Introdução: A doença renal crônica, mais prevalente em idosos, é considerada um problema de saúde pública em todo o mundo. Objetivo: Avaliar o impacto das modalidades de diálise peritoneal automatizada, intermitente e contínua, no perfil inflamatório de idosos renais crônicos. Métodos: Estudo prospectivo, transversal e analítico realizado em uma clínica de diálise em Brasília, com 74 idosos com idade igual ou maior que 60 anos. Os pacientes foram submetidos ao Teste de Equilíbrio Peritoneal rápido, avaliação clínica, coleta de sangue para avaliações bioquímicas e de citocinas, interleucina 6 e fator de crescimento transformador beta 1, e questionário de qualidade de vida (KDQOL-SF36). Foram utilizadas para análise dos dados, associações e correlações com nível de significância de 5%. Resultados: Pacientes na modalidade contínua apresentaram valores séricos do fator de crescimento transformador beta 1 maiores do que os em modalidade intermitente. Estes apresentaram fator de crescimento transformador beta 1 no peritônio, idade e função renal residual maiores do que os em modalidade contínua. A dosagem da interleucina 6 no peritônio foi associada à idade, enquanto a IL-6 sérica foi associada à IL-6 no peritônio, ao tempo em diálise e à idade. Não houve associação entre a modalidade e a presença de diabetes, volemia ou estado nutricional. Ambas as modalidades permitem boa adequação à terapia dialítica. Conclusão: A inflamação na diálise peritoneal automatizada está associada principalmente à baixa função renal residual, à idade avançada e ao maior tempo em terapia, e não à modalidade de diálise realizada.

Health Technology Use in Noncommunicable Disorders: Challenges and Opportunities in India

Health care in India is undergoing a rapid change from its historical focus on acute disease management to a focus more on chronic and continuous care-based model for noncommunicable disorders. Health technology could be a game changer as it has a potential to optimize costs and effectively manage such operations. IT solutions are likely to become an integral part of process management, patient care and the hospital management information system in future. This brief communication describes the key enablers and limitations of using health technology in chronic diseases in developing countries like India.