Experiencia docente en un programa de formación de Medicina Familiar y General a distancia / Teaching experience in a distance learning program for Family and General Medicine

La distribución inequitativa del talento humano en salud afecta la capacidad de los sistemas de ofrecer servicios esenciales. En la provincia de Córdoba, el primer nivel de atención es responsabilidad de los municipios, pero el nivel provincial procura sostener la rectoría y ser garante del derecho a la salud. En ese marco, se desarrolló un programa para reducir las brechas en la distribución de médicos: el Plan Cordobés de Médicos del Interior. Acompañando ese plan se ejecutó un convenio específico con la Universidad Nacional de Córdoba para garantizar la formación en la especialidad de Medicina Familiar y General. Ingresaron al programa 170 personas, y hoy contamos con 98 médicos en formación o seguimiento. En este artículo damos cuenta de la experiencia docente, los desafíos y dificultades que supuso afrontar una formación en lugares de práctica variados, y con el aporte de las tecnologías de la información y comunicación. Esperamos que la experiencia sirva para transmitir los aprendizajes de nuestra práctica (AU)

The inequitable distribution of human talent in health affects the capacity of systems to offer essential services. In the province of Córdoba, the primary level of care is the responsibility of municipalities, but the provincial level aims to maintain leadership and guarantee the right to health. Within this framework, a program was developed to reduce gaps in the distribution of physicians: the Cordobés Plan for Interior Physicians. Accompanying this plan, a specific agreement was executed with the National University of Córdoba to ensure training in the specialty of Family and General Medicine. 170 individuals entered the program, and today we have 98 physicians in training or under supervision. In this article, we give an account of the teaching experience, the challenges, and difficulties involved in facing training in various practice settings, along with the contribution of information and communication technologies. We hope that this experience serves to transmit the lessons learned from our practice (AU)

Resultados de "Tomando Control de su Salud" online, en personas con enfermedades no transmisibles de México y Perú durante COVID-19 / Results of "Tomando Control de su Salud" online, in people with non-communicable diseases in Mexico and Peru during COVID-19

Las enfermedades no transmisibles (ENT) son una creciente preocupación global que afecta tanto a la atención médica como a la calidad de vida. Los programas de automanejo de enfermedades crónicas como el denominado "Tomando Control de su Salud" (TCS), se han vuelto estrategias efectivas para abordar este problema. OBJETIVO: Evaluar el resultado del programa TCS, versión en línea, en las variables automanejo y autoeficacia, en muestras de personas con ENT de México y Perú, durante la pandemia por COVID-19. METODOLOGÍA: El diseño del estudio fue cuasiexperimental con mediciones independientes (intervenidos y controles) y mediciones en línea, al inicio y término de la intervención; evaluadas con Partners in Health Scale y la Escala de Autoeficacia. Los cambios en el tiempo se examinaron mediante la prueba de Wilcoxon. RESULTADOS: De los 114 participantes, la mayoría eran mujeres (83.3%) con una edad promedio de 58.8 años. Antes de la intervención, los grupos fueron iguales en las variables de estudio. No se encontró ningún aumento significativo en las variables de estudio en el grupo control, sin embargo, hubo un aumento estadísticamente significativo en la autoeficacia y automanejo en el grupo intervenido. CONCLUSIONES: El programa TCS en línea contribuyó al aumento de la autoeficacia, el automanejo, el conocimiento de la enfermedad, la adherencia al tratamiento y el manejo de síntomas en participantes con ENT de México y Perú durante la pandemia de COVID-19. Esto respalda la evidencia de que el programa mejora la salud y la calidad de vida de quienes viven con estas enfermedades.

Non-communicable diseases (NCD) are a growing global concern that affects both healthcare and quality of life. Chronic disease self-management programs, such as "Tomando Control de su Salud" (TCS), have become effective strategies to address this problem. PURPOSE: To evaluate the results of the TCS program, online version, in the self-management and self-efficacy variables, in samples of people with NCD from Mexico and Peru, during the COVID-19 pandemic. METHODOLOGY: The study design was quasi-experimental with independent measurements (interventions and controls) and online measurements, at the beginning and end of the intervention; evaluated with the Partners in Health Scale and the Self-Efficacy Scale. Changes over time were examined using the Wilcoxon test. RESULTS: Out of the 114 participants, most were women (83.3%) with an average age of 58.8 years. Before the intervention, the groups were equal in the study variables. No significant increase in the study variables was found in the control group; however, there was a statistically significant increase in self-efficacy and self-management in the intervention group. CONCLUSIONS: The online TCS program contributed to increased self-efficacy, self-management, disease knowledge, treatment adherence, and symptom management in participants with NCD from Mexico and Peru during the COVID-19 pandemic. This supports evidence that the program improves the health and quality of life of those living with these illnesses.

Characterization of patients with acutely decompensated cirrhosis who received care in different highly complex emergency services of Medellín, Colombia

Introduction. Cirrhosis is one of the ten leading causes of death in the Western hemisphere and entails a significant cost of health care. Objective. To describe the sociodemographic, clinical, and laboratory characteristics of patients older than 18 years who received care for acute decompensation of cirrhosis in the emergency services of three highly complex centers in Medellín, Colombia. Materials and methods. This was an observational retrospective cohort study from clinical records. The results were analyzed by frequency measures and represented in tables and graphics. Results. In total, 576 clinical records met the inclusion criteria; 287 were included for analysis, and 58.9% were men, with an average age of 64 (± 13.5) years. The most frequent causes of cirrhosis were alcohol intake (47.7%), cryptogenic or unspecified etiology (29.6%), and non-alcoholic fatty liver disease (9.1%). The main reasons for visiting the emergency department were the presence of edema and/or ascites (34.1%), suspicion of gastrointestinal bleeding (26.5%), abdominal pain (14.3%) and altered mental status (13.9%). The most frequent clinical manifestations of an acute decompensation of cirrhosis were ascites (45.6%), variceal hemorrhage (25.4%), hepatic encephalopathy (23.0%), and spontaneous bacterial peritonitis (5.2%). During their treatment, 56.1% of the patients received intravenous antibiotics; 24.0%, human albumin; 24.0%, vasoactive support, and 27.5%, blood products; 21.3% required management in an intensive or intermediate care unit, registering 53 deceased patients for a mortality of 18.5%. Conclusion. Patients who consult the emergency services due to acute decompensation of cirrhosis demand a high amount of health resources, frequently present associated complications, and a high percentage requires management in critical care units and shows a high in-hospital mortality rate.

Introducción. La cirrosis hace parte de las diez primeras causas de muerte en el hemisferio occidental y acarrea un importante costo en salud. Objetivo. Describir las características sociodemográficas, clínicas y de laboratorio, de los pacientes mayores de 18 años que recibieron atención por descompensación aguda de la cirrosis en los servicios de urgencias de tres centros de alta complejidad en Medellín, Colombia. Materiales y métodos. Se trata de un estudio observacional de cohorte. Los resultados se analizaron mediante medidas de frecuencia, y se representaron en tablas y gráficas. Resultados. En total, en 576 registros clínicos se cumplieron los criterios de inclusión; se incluyeron 287 para el análisis. El 58,9 % fueron hombres, con edad promedio de 64 (± 13,5) años. Las causas más frecuentes de cirrosis fueron: ingestión de alcohol (47,7 %), criptogénica o inespecífica (29,6 %) y enfermedad por hígado graso no alcohólico (9,1 %). Los principales motivos de consulta fueron: presencia de edemas, ascitis o ambas (34,1 %), sospecha de hemorragia digestiva (26,5 %), dolor abdominal (14,3 %) y alteración del estado mental (13,9 %). Los diagnósticos de complicación aguda más frecuentes fueron ascitis (45,6 %), hemorragia digestiva por várices esofágicas (25,4 %), encefalopatía hepática (23,0 %) y peritonitis bacteriana espontánea (5,2 %). El 56,1 % de los pacientes recibió antibióticos; el 24,0 %, albúmina humana; el 24,0 % medicamentos, y el 27,5 % hemoderivados. En el 21,3 % de los casos, se requirió hospitalización en la unidad de cuidados intensivos o en la de cuidados intermedios. Se registraron 53 decesos, para una mortalidad del 18,5 %. Conclusiones. Los pacientes que consultan a los servicios de urgencias por una descompensación aguda de la cirrosis demandan una gran cantidad de recursos, frecuentemente presentan complicaciones asociadas, requieren manejo en unidades de cuidado crítico y evidencian una alta tasa de mortalidad.

Addiction to Tobacco Smoking and Vaping

ABSTRACT The tobacco epidemic has been one of the biggest public health threats, and smoking is one of the world's largest preventable causes of premature death. An estimated 15.4% of all deaths in the world are attributable to tobacco smoking. The present review aims to describe addiction to tobacco smoking and vaping. Tobacco and vaping devices contain nicotine, a highly addictive drug, which explains why smoking is so prevalent and persistent. Electronic cigarettes are a group of novel nicotine or tobacco products that have rapidly gained popularity in recent years. Electronic cigarette devices allow for the use of other drugs, including THC, while the lax regulation may allow for the introduction of toxic compounds that can lead to acute or subacute toxicity, such as the e-cigarette- or vaping-associated lung injury that has been linked to vitamin E acetate. In addition, regular vapers and heated tobacco devices emit toxins, although at lower concentrations than burned tobacco. However, more and more side effects have been identified. No new effective treatment for nicotine addiction has been developed recently, despite its huge adverse impact on overall health and other outcomes. As for the primary line of medications, the last one started in 2006, the varenicline, demonstrating a low interest in developing new medications against smoking, an unacceptable state of affairs, given the huge impact of smoking on morbidity and mortality.

Educación Meditativa, una metodología para el autocuidado de académicos universitarios

Introducción: Dentro de la cultura organizacional, el profesor universitario es un agente clave para el logro de los aprendizajes, coordinando diariamente las solicitudes de las asignaturas y carrera, junto a las necesidades estudiantiles. Por esto, la docencia es una de las profesiones con mayor riesgo de padecer estrés, así como ansiedad y depresión. Con el objetivo de disminuir dichos factores se han creado programas para docentes con diversas actividades que promueven el autocuidado. Objetivo: Demostrar la efectividad del Programa de Educación Meditativa del Sistema Isha Judd en la disminución de los niveles de estrés, depresión y ansiedad de docentes de la Facultad de Ciencias de la Salud de la Universidad Autónoma de Chile. Métodos: Se desarrollaron 10 talleres presenciales dirigidos por facilitadores del Sistema ISHA Judd. Los inscritos se dividieron en tres grupos que sesionaron los lunes, en horarios diferidos (n = 22). Las reuniones fueron cada 15 días, cada sesión se dividió en seis momentos. En la primera y última sesión se realizaron Test Depresión y Ansiedad de Beck, Escala de Autoestima de Rossemberg, Escala de Estrés Percibido y encuesta de bienestar del Sistema Isha Judd. Resultados: El nivel de estrés del grupo bajó en 7,2 puntos pasando de moderado a bajo, el nivel de depresión bajó significativamente, al igual que los valores de ansiedad, llegando a leve y mínimo. El nivel de autoestima inicialmente estaba en el rango alto y al finalizar se mantuvo en el mismo rango, pero mejorando el puntaje promedio en 1,88. Conclusión: En aquellos docentes que cumplieron con los requerimientos mínimos del programa, esta metodología impactó positivamente en su satisfacción, mejorando en promedio sus niveles de estrés, ansiedad, depresión y autoestima. Este estudio presenta limitaciones por el número y tipo de muestra por lo que se sugiere realizar una segunda etapa(AU)

Introduction: Within the organizational culture, the university professor is a key agent for the achievement of learning, coordinating daily the requests of the subjects and majors, together with the students' needs. For this reason, teaching is one of the professions with the highest risk of experiencing stress, as well as anxiety and depression. In order to reduce these factors, programs have been created for teachers with various activities that promote self-care. Objective: To demonstrate the effectiveness of the Meditative Education Program of the Isha Judd System in reducing the levels of stress, depression and anxiety in teachers of the School of Health Sciences of the Universidad Autónoma de Chile. Methods: Ten face-to-face workshops were conducted by facilitators of the Isha Judd System. The participants were divided into three groups that met on Mondays, at different times (n = 22). The meetings were held every 15 days, each session was divided into six moments. In the first and last session, Beck's Depression and Anxiety Test, Rossemberg's Self-Esteem Scale, Perceived Stress Scale and the Isha Judd System wellbeing survey were applied. Results: The stress level of the group decreased by 7.2 points, going from moderate to low, the depression level decreased significantly, as did the anxiety values, reaching mild and minimal. The level of self-esteem was initially in the high range and at the end it remained in the same range, but the average score improved by 1.88 points. Conclusion: In those teachers who met the minimum requirements of the program, this methodology had a positive impact on their satisfaction, improving on average their levels of stress, anxiety, depression and self-esteem. This study has limitations due to the number and type of sample, so a second stage is suggested(AU)

Siderosis idiopática del sistema nervioso central y asociación con atrofia óptica e infarto cerebral. Caso clínico / Superficial siderosis of the central nervous system. Report of one case

Superficial siderosis of the central nervous system is produced by the deposit of hemosiderin within the subpial layers of the central nervous system and central parts of the cranial nerves, leading to progressive degeneration. We report a 55-year-old male who consulted for hearing loss and long-standing progressive decrease in visual acuity, associated with sudden onset of left hemiparesis. A brain CAT scan showed subacute ischemic lesions in the territory of the right posterior cerebral artery (thalamus and right subcortical temporal regions), old ischemic lesions in the right subcortical occipital regions and cerebellar atrophy. A magnetic resonance confirmed the lesions and the presence of superficial diffuse siderosis. A cerebrospinal fluid analysis showed slight xanthochromia, 26 leukocytes/mm3, glucose 51 mg/dL and proteins 1.23 g/L. He was managed with aspirin in low doses and statins. His motor function improved and was discharged two weeks after admission.

Perioperative Kounis syndrome in an older adult

Introduction: Kounis syndrome (KS) is myocardial ischemia secondary to the release of inflam matory mediators (mastocyte degranulation) during an allergic reaction. Adult anaphylaxis is often triggered by medications, of which antibiotics are the most frequently reported. Objective: to study the presentation of and clinical approach to a patient with Kounis syndrome and increase the diagnostic suspicion of a disease which does not have a standardized treatment and is not supported by clinical practice guidelines. Case presentation: we present the case of a 62-year-old adult patient with chest pain and anginal equivalents following perioperative anaphylactic shock during a scheduled open cholecystectomy for gallstones, with subsequent acute myocardial infarction without ST elevation, and coronary artery lesions or atheromatous disease ruled out by arteriography. Conclusions: Kounis syndrome is an underdiagnosed entity with a variable clinical presenta tion and no concrete or standardized treatment. This therefore encourages the development of a greater case history and the structuring of widely disseminated guidelines for its treatment. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2289).

Introducción: el síndrome de Kounis (SDK) corresponde a una isquemia miocárdica secundaria a la liberación de mediadores inflamatorios (degranulación de mastocitos) durante una reacción alérgica. La anafilaxia en adultos comúnmente es desencadenada por medicamentos, de los cuales los antibióticos son los más frecuentemente informados. Objetivo: estudiar la forma de presentación y abordaje clínico de un paciente con síndrome de Kounis y aumentar la sospecha diagnóstica de una patología que no tiene un tratamiento estanda rizado o respaldado por guías de práctica clínica. Presentación de caso: se presenta el caso de una paciente adulta de 62 años con dolor pre cordial y equivalentes anginosos posterior a un choque anafiláctico perioperatorio durante una colecistectomía abierta realizada de forma programada por colelitiasis, con posterior infarto agudo de miocardio sin elevación del ST, con arteriografía que descartó lesiones en arterias coronarias o enfermedad ateromatosa. Conclusiones: el síndrome de Kounis es una entidad subdiagnosticada, con presentación clínica variable y sin un tratamiento concreto o estandarizado, lo que motiva a realizar una mayor casuística y estructurar recomendaciones de amplia difusión respecto a su tratamiento. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2289).

Pharmacological blockade of protease-Activated Receptor 2 improves airway remodeling and lung inflammation in experimental allergic asthma

Abstract Protease-activated receptors (PARs) are metabotropic G-protein-coupled receptors that are activated via proteolytic cleavage of a specific sequence of amino acids in their N-terminal region. PAR2 has been implicated in mediating allergic airway inflammation. This study aims to study the effect of PAR2 antagonist ENMD1068in lung inflammation and airway remodeling in experimental asthma. Allergic lung inflammation was induced in sensitized BALB/c mice through intranasal instillations of ovalbumin (OVA), and mice were pretreated with ENMD1068 1 hour before each OVA challenge. Bronchoalveolar lavage fluid (BALF) was collected, and the lungs were removed at different time intervals after OVA challenge to analyze inflammation, airway remodeling and airway hyperresponsiveness. Ovalbumin promoted leukocyte infiltration into BALF in a PAR2-dependent manner. ENMD1068 impaired eosinophil peroxidase (EPO) and myeloperoxidase (MPO) activity in the lung parenchyma into BALF and reduced the loss of dynamic pulmonary compliance, lung resistance in response to methacholine, mucus production, collagen deposition and chemokine (C-C motif) ligand 5 expression compared to those in OVA-challenged mice. We propose that proteases released after an allergen challenge may be crucial to the development of allergic asthma in mice, and PAR2 blockade may be useful as a new pharmacological approach for the treatment of airway allergic diseases.

Associated risks of smoking and possible benefits of cessation in Covid-19: a rapid narrative review / Riesgos asociados con tabaquismo y posibles beneficios de cesación en Covid-19: una revisión narrativa rápida

Abstract: Objective: To describe the possible risks associated to smoking in the spread and complications of Covid-19, emphasizing in the benefits of quitting smoking. Materials and methods: The narrative review methodology and the established process for Cochrane rapid reviews were used. Results: The scientific evidence related to smoking and Covid-19 remains limited. However, there is an already documented trend in cross-sectional, clinical studies and meta-analyses on the increased risk of adverse outcomes with Covid-19 associated with tobacco use. Conclusions: It is necessary to issue a warning that persons who smoke would have greater risks in the Covid-19 pandemic, which add to the many already known risks of tobacco use. Thus, quitting smoking becomes a relevant preventive measure to better confront SARS-CoV-2.

Resumen: Objetivo: Describir los posibles riesgos asociados de tabaquismo con contagio y complicaciones por Covid-19, haciendo hincapié en los beneficios de dejar de fumar. Material y métodos: Se utilizó la metodología de revisión narrativa y el proceso establecido para las revisiones rápidas Cochrane. Resultados: La evidencia científica relacionada con el tabaquismo y Covid-19 todavía es limitada. Existe una tendencia ya documentada en estudios clínicos transversales y metaanálisis del aumento del riesgo de resultados adversos para Covid-19 asociados con el consumo de tabaco. Conclusiones: Es necesario advertir que las personas que fuman tendrán mayores riesgos en la pandemia de Covid-19, los cuales se suman a los muchos ya conocidos del consumo de tabaco, de modo que dejar de fumar se convierte en una medida preventiva relevante para enfrentar mejor el SARS-CoV-2.

Parto gemelar diferido: a propósito de un caso / Delayed twin birth: case report

INTRODUCCIÓN: Se presenta el caso de un parto diferido en una gestación gemelar en la que se consigue retrasar el parto del segundo gemelo 45 días con manejo conservador. CASO CLÍNICO: Mujer de 25 años, gestación gemelar bicorial biamniótica, con diagnóstico de muerte fetal del primer gemelo en semana 24+3 y parto del mismo tras una semana de evolución. Se decide la opción de tratamiento conservador expectante, con reposo absoluto, manteniendo tocolisis intravenosa, controles analíticos seriados, controles cardiotocográficos diarios, profilaxis antibiótica y antitrombótica. Con ello se consigue diferir el parto un total de 45 días. CONCLUSIÓN: El parto diferido en gestaciones gemelares es una práctica poco habitual, por lo que se carece de protocolos y actuaciones específicas. La bibliografía disponible difiere en cuanto al manejo de dichos casos y en el total de días que se consigue diferir el parto, pero en todos los estudios se reporta el beneficio en términos de resultados perinatales al conseguir aumentar la edad gestacional del segundo gemelo. En nuestro caso se consiguió una mejora sustancial del resultado perinatal asociado a la prematuridad sin importantes efectos adversos maternos y tras el periodo de latencia indicado.

INTRODUCTION: We report a delayed delivery of a dichorionic diamniotic twin pregnancy, in which the birth of the second twin was postponed 45 days. CASE REPORT: At 24+3 weeks of gestation, a 25-year-old woman with dichorionic diamniotic twin pregnancy presented with preterm premature rupture of membranes and intrauterine dead of the first fetus. Spontaneous delivery of the first death twin, occurred al 25+2 weeks. Tocolysis, antibiotic, antithrombotic prophylaxis, absolute rest, serial blood tests and fetal cardiotocography controls, were performed. The second twin was delivered at 31+5 weeks, after a the preterm premature rupture of membranes triggered the labor. The interval between the first and second birth was 45 days. CONCLUSION: Delayed delivery in twin pregnancies, is an uncommon clinical situation, so there are not validated medical protocols. Available bibliography offers different practices related to its management. Most studies confirm the better survival rate and perinatal outcomes of the postponed birth twin.

Presencia de Pseudomonas aeruginosas, cepas BLEE y resistencia en Salas del Hospital Solomon Klein, Cochabamba / Presence of Pseudomonas aeruginosas, BLEE strains and resistance in Rooms of the Solomon Klein Hospital, Cochabamba

Las infecciones causadas por Pseudomona aeruginosa y cepas BLEE junto con la resistencia bacteriana, producto del uso exagerado e inapropiado de los antibióticos, han favorecido al aumento importante de microorganismos resistentes a múltiples fármacos por lo que se ha convertido en un problema importante de salud de difícil manejo. OBJETIVO: conocer la presencia de Pseudomona aeruginosa y cepas BLEE junto con su resistencia en la Sala de Maternidad y Neonatología del Hospital Solomon Klein el año 2019. MATERIALES Y MÉTODOS: estudio de tipo descriptivo y transversal, se incluyó porta-sueros, agarrador de las camas, bandeja del material de curación, llave de los sueros, mangueras de los sueros e incubadoras para tomar muestras de estos. RESULTADOS: se tomaron 25 muestras de la sala de maternidad y neonatología de las que 3 (12%) resultaron positivos a Pseudomona aeruginosa en superficies de porta sueros, agarrador de camilla y bandeja de material de curación del servicio de Enfermería de la Sala de Maternidad. En las 21 (84%) muestras restantes prevaleció la presencia de la enterobacteria Hafnia alvei, en el análisis de resistencia resultaron sensibles a Cefotaxima descartando la existencia de cepas BLEE en el hospital. DISCUSIÓN: las infecciones asociadas a servicios de salud ocurren principalmente durante el ingreso y estancia hospitalaria y es por eso que la vigilancia de estos patrones facilita conocer los mecanismos de acción predominantes de los servicios, lo cual, es muy importante al momento de tomar decisiones terapéuticas. (AU)

Infections caused by Pseudomona aeruginosa and BLEE strains together with the bacterial resistance due to exaggerated and incorrect use of antibiotics have favored the increase in the importance of microorganisms resistant to multiple drugs, which has become an important health problem for difficult handling OBJECTIVE: to know the presence of Pseudomona aeruginosa and BLEE strains together with their resistance in the Maternity and Neonatology Room of the Solomon Klein Hospital in 2019. MATERIALS AND METHODS: descriptive study and cross-sectional type include serum-holder, grabber the beds, tray of the healing material, key of the sera, hoses of the sera and incubators to take samples of these. RESULTS: we took 25 samples from the maternity and neonatology ward of which 3 (12%) were positive for Pseudomona aeruginosa on serum carrier surfaces, stretcher gripper and Cure Material Tray of the Nursing Service of the Maternity ward. In the 21 (84%) remaining samples, the presence of Hafnia alvei enterobacteria prevailed, in the resistance analysis they were sensitive to Cefotaxime, ruling out the existence of BLEE strains in the hospital. DISCUSSION: infections associated with health services occur mainly during hospital admission and hospital stay and that is why monitoring these patterns makes it easier to know the predominant mechanisms of action of the services, which is very important at the moment.of making therapeutic decisions.(AU)

Aportes de Medicina Familiar en el desarrollo de las competencias profesionales de la carrera de Medicina de la Facultad de Ciencias Médicas de la Universidad Nacional de Córdoba / Contributions of Family Medicine in the development of professional competences of the medical career of the Faculty of Medicine of the National University of Córdoba

Medicina Familiar constituye un espacio de integración curricular en la Práctica Final de Medicina de la Universidad Nacional de Córdoba. Objetivo: identificar aportes de la asignatura para adquisición de competencias según resolución CONEAU N° 1314. Material y método: Estudio descriptivo cualicuantitativo, transversal. Período 2016 ­ 2017. Encuesta de autoevaluación y test de observación directa al inicio y al final del cursado. Se realizó análisis de contenido. Resultados: Autoevaluación inicial y final: competencias de alto impacto (investigación de la dolencia, búsqueda de opinión y acuerdo en tratamientos, investigación contexto). Competencias de bajo impacto (identificación motivo de consulta, explicación al paciente que se lo va a examinar, uso racional de métodos complementarios). Análisis cualitativo competencia "Búsqueda de acuerdo y consenso", categorías: explicar el problema, diagnóstico, alternativas de tratamiento; consultar comprensión del problema, dudas, preferencias. Competencia "Investigación contexto social, categorías: estructura familiar; condiciones laborales; contexto. Evaluación competencias pre y pos cursado (observación directa): impacto intermedio, valoraciones satisfactorias sin modificaciones significativas pre y post. Comparación percepción de los alumnos/ nivel de desarrollo de competencias: mayor divergencia ("organización de entrevista", "claridad para realizar examen físico", "precisión para definir los problemas", "selección de tratamientos según efectividad"). Conclusión: se logró el afianzamiento de competencias relacionadas con la entrevista y el abordaje integral (AU)

Family medicine constitutes a space of curricular integration in the final practice of the career of medicine of the National University of Córdoba.Objectives: to identify the contributions of the subject in the acquirement of competence according to CONEAU ́s resolution N° 1314.Material and methods: transversal descriptive cuali-cuantitative study. During the period of the years 2016-2017. Self-evaluation survey and a direct observation test in the begging and the end of the classes. Analysis of the data: SPSS statistics and analysis of the content.Results: Initial and final self- evaluation: High impact competences (inquiry of the disease, search for opinions and agreements about the treatments, investigation of the social and family context and support network). Low impact competences (identifying reason of the consultation, explaining to the patient that they were going to be examined, rational use of complementary methods). Qualitative competence analysis "Search for agreements and consensus", categories: to explain the problem, diagnosis, treatment alternatives; consultation about (consult of) the comprehension of the problem, doubts and preferences. Competence "Investigation of the social context", categories: family structure, working conditions, neighborhood context, family relationships. Evaluation of the competences pre and post taking classes (direct observation): intermediate impact: satisfactory evaluations without significant modification pre and post. Student perception and level of competence development comparison: grater divergence (" organization of the interview", "clarity to do a physical exam", "precision to define problems", "chose of treatments according to effectiveness"). Conclusion: Family medicine managed to secure professional ́s competences related to clinical interview and integral approach of the person (AU)

Smoking cessation treatments: current psychological and pharmacological options

Abstract Background Smoking is considered an epidemic, indeed, one of the most important public health problems worldwide. It is also the most significant preventable cause of death, of a high number of premature deaths, and avoidable chronic diseases. It is considered an enormous economic burden for the world. Objective To provide an overview of smoking-cessation treatments, including pharmacological and psychological options, and to gather current scientific evidence available on them. Methods Research included reviewing publications from 2007-2018 in four databases using algorithms related to bupropion, varenicline, nicotine replacement therapy, smoking cessation, psychological treatment, motivational interview, cognitive-behavioral therapy and clinical guidelines for smoking treatment. Meta-analyses or systematic reviews and randomized or quasi-randomized trials were selected. We also included clinical guidelines for smoking treatment from Mexico and other countries. Results After refining the search, 37 articles met the criteria and were included in the review. The results were grouped by type of intervention. Conclusions It is necessary to conduct research on combinations of both kinds of treatment with an integral, multidisciplinary vision. Current standard for smoking cessation is a combined psychological and pharmacological treatment.

Pharmacological potential of Maytenus species and isolated constituents, especially tingenone, for treatment of painful inflammatory diseases

ABSTRACT Uses of medicinal plants by people around the world significantly contribute and guide biologically active compounds research that can be useful in the combat against various diseases. Due to a great chemical and structural variety found in their vegetal structures it consolidates ethnopharmacology as an important science for the pharmaceutical section. Inserted in the diversity of medicinal plants, is the Maytenus genus, whose research has already revealed lots of isolated substances which are responsible for a great variety of biological activities, among which we cite analgesic and anti-inflammatory, for the treatment of inflammatory diseases such as rheumatoid arthritis, gastritis, ulcers and gastrointestinal disorders. The aim of this review article is to make a compendium of the Maytenus genus and its isolated chemical compounds, among them tingenone. The elucidation of its mechanism of action reveals promising sources for the development of new drugs specially targeted for the treatment of painful inflammatory diseases.

Los cuerpos de la Guerra. Análisis de los procesos de construcción corporal y subjetiva en los militantes / The Bodies of War. Analysis of the Processes of Corporal and Subjective Construction in Activists

En los procesos de construcción corporal y subjetiva en el contexto del conflicto interno colombiano y, específicamente, entre los militantes del grupo guerrillero del Ejército de Liberación Nacional (ELN), se destaca el sentido de lo colectivo en la construcción de la corporalidad en este grupo guerrillero, estructurada en función del "cuerpo social" como ideal de su proyecto de lucha, derivado de la configuración de una subjetividad fundada en el "nosotros".

In the corporal and subjective construction in the context of the Colombian conflict, and specifically, among the militants of the guerrilla group of the National Liberation Army (ELN), the sense of the collective in the construction of the corporality in this guerrilla group stands out. Such a construction is structured on the basis of the "social body" as an ideal of their project of fight, which is derived from the configuration of subjectivity and founded in "us."

Relación entre depresión y práctica religiosa: un estudio exploratorio / Relationship between and religious practice: An exploratory study

La relación entre la depresión y la práctica religiosa ha sido hasta ahora poco estudiada en el mundo en general. Para explorar esta relación, este estudio evaluó una muestra bogotana constituida por 340 mujeres y 279 hombres trabajadores, a quienes se les aplicó la escala de depresión de Derogatis y un inventario de apoyo social religioso. Se encontró que el nivel de depresión en las mujeres es significativamente mayor que en los hombres, así como que la práctica religiosa como forma de apoyo social también es significativamente más usada por las mujeres. Se encontró una correlación negativa significativa entre el nivel de depresión y pertenecer activamente a un grupo religioso o espiritual, tanto en la muestra de hombres como en la de mujeres.

The relationship between depression and religious practice has not been studied in great detail throughout the world. In order to explore the nature of this relationship, this study evaluated a sample of 340 women and 279 workmen currently living in Bogotá, who answered a Derogatis depression scale and a religious social support. It was found that the level of depression was significantly higher for women than for men. It was also found that religious practice as a way of social support is also significantly more used by women. There was also a significant negative correlation between participating actively in a religious or a spiritual group and the level of depression, both for men and women.

Evolución histórica de la fisioterapia en Colombia y en la Universidad Industrial de Santander / Historical development of physiotherapy in Colombia and the Industrial University of Santander

Esta revisión documenta la evolución histórica de la fisioterapia en Colombia y en la Universidad Industrial de Santander (UIS) desde su institucionalización. Se realizó recopilando los acontecimientos más importantes y los cambios sucesivos de la carrera, mediante la revisión de la bibliografía y de algunas fuentes históricas de la profesión y del programa. En Colombia la enseñanza de la fisioterapia se institucionaliza a partir del año 1952 y desde entonces ha estado en constante evolución. En la región, el Programa empezó a ofrecerse desde 1963 por parte de la Universidad Femenina de Santander, siendo incorporado cuatro años más tarde a la UIS. El dinámico cambio del contexto sociopolítico nacional ha influenciado la transformación del perfil académico y laboral del fisioterapeuta. Durante las dos últimas décadas se ha avanzado en la profundización del cuerpo de conocimiento de la fisioterapia y en la definición del objeto de estudio particular, lo cual ha permitido mejorar la identidad y autonomía profesional, con la consecuente identificación de nuevas oportunidades para el desempeño y el posicionamiento de la fisioterapia en el contexto de la salud. Salud UIS 2004;36:21-31.

This review documents the historical evolution of Physiotherapy in Colombia and at the Industrial University of Santander (UIS) since its institutionalization. The most relevant events and successive changes of the career are described after a complete bibliographical revision from historical sources of the profession and the academic program. In Colombia teaching of Physiotherapy was institutionalized since 1952 and from then on it has been in constant evolution. In the region, the Program was offered from 1963 as a part of the Feminine University of Santander, being incorporate four years later to the UIS. Teaching of Physiotherapy has been in constant evolution until now. Social and political changes on national context have influenced the transformation of the academic and professional profile. During the last two decades important advances have occurred in knowledge of physiotherapy and definition of the study matter, those advances have allowed to improve the identity and professional autonomy, with consequent identification of new opportunities for acting and positioning of physiotherapy in the context of health. Salud UIS 2004;36:21-31.

Efeito dos pontos de acupuntura VC-22 (Tiantu) e VC-23 (Linquan) na hipossalivaçäo induzida por atropina em ratos wistar / Effect of acupoints VC-22 (Tiantu) and VC-23 (Linquan) in hyposalivation induced by atropine in wistar rats

Este estudo tem por finalidade verificar o efeito da Acupuntura sobre a hipossalivação em ratos Wistar obtida com o uso da atropina. Material e Método - 24 ratos Wistar, machos, de 200 a 250g, foram divididos em quatro grupos: grupo Acupuntura, em que os animais receberam atropina e eletroacupuntura nos pontos de acupuntura VC-22 (Tiantu) e VC-23 (Linquan); grupo SHAM, em que os animais receberam a mesma quantidade de atropina, porém a eletroacupuntura em um não-ponto de acupuntura na região clavicular média, bilateralmente; grupo Atropina, em que os animais receberam apenas atropina e grupo Controle, em que os animais não receberam nem atropina nem eletroacupuntura. A salivação foi medida embebendo-se pequenas bolinhas de algodão na saliva da boca do rato e pesadas em balança de precisão. Foram realizadas sete medições de cinco em cinco minutos. Resultados - Os resultados obtidos foram submetidos à análise estatística por One Way RM ANOVA, considerando-se significantes os valores de p < 0,05. Comparando-se os três grupos em cada medição, foram encontradas diferenças significantes na primeira medição, sendo que a salivação do grupo Acupuntura foi significantemente maior que todas as demais, que a do grupo Controle foi significantemente maior que a dos grupos Atropina e Sham e que a dos grupos Atropina e Sham não apresentou diferença significante; e na quarta medição, foi observado que tanto no grupo Acupuntura quanto no grupo Controle foi significantemente maior que a dos demais, mas que não houve significância nem entre os dois, nem entre os grupos Atropina e Sham. Comparando-se a primeira e a quarta medição do grupo Acupuntura com as demais medições do Sham, Atropina e Controle, observou-se que a primeira medição foi significantemente maior que todas as medidas dos grupos Sham e Atropina. Conclusão - A eletroestimulação dos pontos VC-22 (Tiantu) e VC-23 (Linquan) mostrou-se eficiente no tratamento da hipossalivação induzida por atropina em ratos Wistar, assim como em promover o aumento de salivação.

Efeito antiinflamatório da folha de batata-doce (Ipomoea batatas) / Anti-inflammatory effects of sweet potato leaves (Ipomoea batatas)

Neste trabalho testamos os efeitos antiinflamatórios do extrato hidroalcoólico de folhas de Ipomoea batatas. O modelo experimental de inflamaçäo utilizado foi de edema de pata de ratos induzido pelo composto 48/80. Apesar de ser comumente utilizada na medicina popular, esse tipo de extrato näo apresentou nenhum efeito antiinflamatório no modelo experimental utilizado