Burnout syndrome and depression in students of a Colombian medical school, 2018.

INTRODUCTION AND OBJECTIVES: Burnout syndrome (BS) has been evaluated in few populations of medical students, and its relationship with depression is even less studied. The objective was to determine the frequency of BS in medical students of the Universidad Pedagógica y Tecnológica de Colombia (UPTC), in Tunja, Colombia, as well as its association with depression and other social, economic, demographic, and academic factors. METHODS: An observational, analytical, cross-sectional study was carried out on 182 UPTC medical students during 2018. The Maslach Burnout Inventory-Student Survey (MBI-SS) was applied, with which 3 components were obtained to determine positive SB. This was crossed in the Stata 15 program for depression and other social, economic, demographic, and academic covariates with the Generalised Linear Model (GLM). RESULTS: Of 182 respondents, 51.4% were women. The median age was 21 years (20-23 years). 14% had BS, of which 48% had depression. In the multiple regression, BS was significantly associated with a higher frequency of depression (RPa = 5.54; IC95%, 2.36-13.02; P < 0.001) and the feeling of insufficient money (RPa = 4.37; IC95%, 1.95-9.83; P < 0.001), in contrast to a negative association with smoking (RPa = 0.13; IC95%, 0.06-0.30; P < 0.001) and being a woman (RPa = 0.32; IC95%, 0.12-0.82; P = 0.018). The age of onset of marijuana use was not significant. CONCLUSIONS: BS shows a high association with increased depression and a feeling that the money is not enough at the end of the month, but it showed a negative association with tobacco consumption and being a woman. Such students should be detected to provide them with adequate academic support.

Deficiencia de butirilcolinesterasa: Una revisión narrativa de la literatura / Butirilcholinesterase Deficiency: A Narrative Review of Literature

RESUMEN La butirilcolinesterasa es una enzima que metaboliza relajantes neuromusculares despolarizantes como la succinilcolina, fármaco de elección para procedimientos que requieran parálisis muscular a corto plazo como facilitar la intubación endotraqueal en pacientes sometidos a procedimientos de emergencia. La deficiencia de butirilcolinesterasa se define como la reducción cuantitativa de dicha enzima y su actividad para hidrolizar moléculas, constituyéndose en la principal causa de bloqueo neuromuscular prolongado tras la administración de relajantes neuromusculares como la succinilcolina. Es una condición patológica que puede ser de origen hereditario o adquirido; siendo más común la deficiencia enzimática de origen genético y de carácter autosómico recesivo, la cual se presenta aproximadamente en una de cada 3200 a 5000 personas en todo el mundo. Su manifestación clínica se caracteriza por relajación muscular persistente, la cual puede producir insuficiencia respiratoria aguda. El diagnóstico debe estar orientado a la identificación de sus características clínicas, la cuantificación serológica y el monitoreo neuromuscular. Debido a que no existe cura para esta deficiencia, el manejo debe estar orientado a realizar ventilación mecánica del paciente hasta que el medicamento empleado se metabolice por completo. Este artículo tiene como objetivo realizar una revisión del estado del arte, describiendo su epidemiología, etiología, fisiopatología, manifestaciones clínicas y actualidades en su diagnóstico y tratamiento.

ABSTRACT Butyrylcholinesterase is an enzyme that metabolizes depolarizing neuromuscular relaxants, such as succinylcholine, a chosen medication for procedures that require short-term muscular paralysis, to facilitate endotracheal intubation in patients undergoing emergency procedures, for example. Butyrylcholinesterase deficiency can be defined as a quantitative reduction of the enzyme and its activity to hydrolyze molecules, becoming the main cause of prolonged neuromuscular blockade after the administration of neuromuscular relaxants such as succinylcholine. It is a pathological condition that can be of either hereditary or acquired origin; being more common the enzymatic deficiency of genetic origin and of auto-somal recessive character, occurring in approximately one in 3,200 to 5,000 people worldwide. Its clinical manifestation is characterized by persistent muscle relaxation which can lead to acute respiratory failure. The diagnosis must be oriented to the identification of its clinical characteristics, serological quantification, and neuromuscular monitoring. Because a cure does not exist for this deficiency, management should be directed to mechanical ventilation of the patient, until the used drug is fully metabolized. This article aims to review the state of the art, describing its epidemiology, etiology, pathophysiology, clinical manifestations, and updates in its diagnosis and treatment.

Coagulación intravascular diseminada / Disseminated intravascular coagulation

Resumen La coagulación intravascular diseminada es un estado alterado de la coagulación secundario a cuadros inflamatorios locales o sistémicos. Se caracteriza por un aumento de la coagulación y una inadecuada fibrinólisis endógena que da como resultado la formación de fibrina intravascular, trombosis microvascular multiorgánica y un excesivo consumo de los factores de coagulación sanguínea, esto desencadena sangrados severos y trombosis, los cuales conducen a falla orgánica y circulatoria como principal manifestación clínica. Este artículo tiene como objetivo realizar una revisión del estado del arte describiendo su definición, etiología, fisiopatología, manifestaciones clínicas y actualidades en su diagnóstico y tratamiento. Para esto, se realizó una búsqueda bibliográfica en PubMed utilizando el término MeSH "Disseminated Intravascular Coagulation", seleccionándose 63 artículos por la relevancia y pertinencia de su información al objetivo de la investigación. De esta manera, se espera brindar al clínico las herramientas necesarias para responder adecuadamente frente a esta patología. MÉD.UIS.2020;33(2):75-84.

Abstract Disseminated Intravascular Coagulation is an altered state of coagulation secondary to local or systemic inflammatory symptoms. It is characterized by increased coagulation and inadequate endogenous fibrinolysis resulting in intravascular fibrin formation, multi-organ microvascular thrombosis, and excessive consumption of blood coagulation factors, this triggers severe bleeding and thrombosis, which lead to organic and circulatory failure as the main clinical manifestation.This article aims to review the state of the art describing its definition, etiology, pathophysiology, clinical manifestations and news in its diagnosis and treatment. Accordingly, a bibliographic search was carried out in PubMed using the MeSH term "Disseminated Intravascular Coagulation", selecting 63 articles for the relevance and pertinence of their information to the objective of the investigation. Therefore, it is expected to provide the clinician with the necessary tools to adequately respond to this pathology. MÉD.UIS.2020;33(2):75-84.

Evolución de las recomendaciones para la prevención de la infección quirúrgica en cirugía de colon / Evolution of the Recommendations for Preventing Surgical Site Infection After Colon Surgery

RESUMEN Las infecciones del sitio quirúrgico constituyen un problema de calidad de los cuidados a la salud, las cuales son potencialmente prevenibles mediante la aplicación de guías de prevención basadas en evidencias. Se pretendedescribir la evolución histórica de las prácticas de uso profiláctico de antibióticos en cirugía de colon desde el siglo pasado. Se analizó literatura publicada en las últimas cinco décadas en MEDLINE, Infomed y otras fuentes secundarias. Se destaca la evolución del uso combinado de antimicrobianos (aminoglucósidos, penicilina, cefalosporinas y nitroimidazoles) asociados a la preparación enérgica del colon en la década de los 70 del pasado siglo. Numerosos antimicrobianos y prácticas han sido ensayados para demostrar que el uso de antibióticos para el control de las bacterias aerobias y anaerobias, administrados por vía oral e intravenosa, logra la prevención de hasta el 75 por ciento de las infecciones del sitio quirúrgico en cirugía de colon. Las evidencias científicas orientan hacia la necesidad del uso de profilaxis antibióticos orales más intravenosas asociados a la preparación mecánica del colon(AU)

ABSTRACT Surgical site infections are a concern with respect to quality of health care. Surgical site infections are potentially preventable through the application of evidence-based prevention guidelines. The aim is to describe the historical evolution of practicing prophylactic use of antibiotics in colon surgery since the last century. We analyzed the literature published in the last five decades in MEDLINE, Infomed and other secondary sources. The evolution is highlighted of the combined use of antimicrobials (aminoglycosides, penicillin, cephalosporins, and nitroimidazoles) associated with the vigorous preparation of the colon in the 1970s of the last century. Numerous antimicrobials and practices have been tested to demonstrate that the use of antibiotics to control aerobic and anaerobic bacteria, administered orally and intravenously, achieves the prevention of up to 75 percent of surgical site infections in colon surgery. Scientific evidence points to the need for the use of more intravenous oral antibiotic prophylaxis associated with mechanical preparation of the colon(AU)

Tay-Sachs disease / Enfermedad de Tay-Sachs

Abstract Introduction: Lysosomal storage disease is caused by the deficiency of a single hydrolase (lysosomal enzymes). GM2 gangliosidoses are autosomal recessive disorders caused by deficiency of β-hexosaminidase and Tay-Sachs disease (TSD) is one of its three forms. Objective: To perform a review of the state of the art on TSD and describe its definition, epidemiology, etiology, physiopathology, clinical manifestations, as well as advances regarding its diagnosis and treatment. Materials and methods: A literature search was carried out in PubMed using the MeSH terms "Tay-Sachs Disease". Results: after the initial search was conducted, 1 233 results were retrieved, of which 53 articles were finally selected. TSD is caused by the deficiency of the lysosomal enzyme β-hexosaminidase A (HexA), and is characterized by neurodevelopmental regression, hypotonia, hyperacusis and cherry-red spots in the macula. Research on molecular pathogenesis and the development of possible treatments has been limited, consequently there is no treatment established to date. Conclusion: TSD is an autosomal recessive neurodegenerative disorder. Death usually occurs before the age of five. More research and studies on this type of gangliosidosis are needed in order to find an adequate treatment.

Resumen Introducción. La deficiencia de una sola hidrolasa (enzimas lisosomales) da como resultado una enfermedad de almacenamiento lisosomal. Las gangliosidosis GM2 son trastornos autosómicos recesivos causados por la deficiencia de β-hexosaminidasa. La enfermedad de Tay-Sachs (TSD, por sus siglas en inglés) es una de las tres presentaciones de este tipo de gangliosidosis. Objetivo. Realizar una revisión del estado del arte de la TSD describiendo su definición, epidemiología, etiología, fisiopatología, manifestaciones clínicas y actualidades en su diagnóstico y tratamiento. Materiales y métodos. Se realizó una búsqueda bibliográfica en PubMed utilizando como único término MeSH "Tay-Sachs Disease". Resultados. Se encontraron 1 233 publicaciones y se seleccionaron 53 artículos. La TSD es originada por la deficiencia de la enzima lisosomal β-hexosaminidasa A (HexA) y se caracteriza por regresión del neurodesarrollo, hipotonía, hiperacusia y manchas maculares rojo cereza. La investigación de la patogenia molecular y el desarrollo de posibles tratamientos han sido limitados y en la actualidad no se cuenta con uno plenamente establecido. Conclusiones. La TSD es un trastorno neurodegenerativo autosómico recesivo y por lo general la muerte se produce antes de los 5 años de edad. Son necesarias más investigaciones y estudios sobre este tipo de gangliosidosis con el fin de encontrar un tratamiento adecuado.

Deficiencia de butirilcolinesterasa identificada después de la administración de succinilcolina. Reporte del caso / Butyrylcholinesterase deficiency identified after succinylcholine administration. Case report

RESUMEN La función principal de la enzima butirilcolinesterasa es hidrolizar ésteres exógenos como los que están presentes en el relajante neuromuscular succinilcolina, que se utiliza con frecuencia en procedimientos quirúrgicos de corta duración. Se considera que la herencia de butirilcolinesterasa atípica o deficiencia de butirilcolinesterasa es un rasgo autosómico recesivo que se presenta aproximadamente en una de cada 3200 a 5000 personas. Dicha deficiencia puede tener consecuencias graves en pacientes anestesiados con dicho relajante porque en ocasiones causa prolongación de la parálisis o apnea posoperatoria. Se presenta el caso de una paciente de 73 años admitida al servicio de cirugía para una tiroidectomía subtotal. Finalizada la intervención, no emergió espontáneamente del anestésico, presentó signos de relajación con mal esfuerzo inspiratorio y sin recuperar la respuesta neuromuscular; por ello se procedió a revertir con neostigmina, previa aplicación de atropina. La reversión falló por lo que fue trasladada a la unidad de cuidados intensivos. En los exámenes se halló reducido el nivel de colinesterasa sérica, lo que indicó una deficiencia de butirilcolinesterasa compatible con sus síntomas. Tal situación está descrita en la literatura médica.

SUMMARY The main function of the enzyme butyrylcholinesterase is to hydrolyze exogenous esters such as those present in the neuromuscular blocking agent succinylcholine, which is frequently used in short surgical procedures. Inheritance of atypical butyrylcholinesterase or butyrylcholinesterase deficiency is considered an autosomal recessive characteristic and occurs worldwide in approximately one out of 3200 to 5000 people. Such deficiency may have serious consequences for patients anesthetized with that relaxant because sometimes it causes an extension of paralysis or postoperative apnea. We report the case of a 73-year-old woman submitted to subtotal thyroidectomy. After surgery, she did not spontaneously emerge from anesthesia, had signs of relaxation with poor inspiratory effort, and no recovery of neuromuscular response. After application of atropine, reversal was attempted with neostigmine, but it failed, and she was transferred to the ICU. Laboratory results revealed a reduced level of serum cholinesterase indicating a deficiency in butyrylcholinesterase consistent with her symptoms. Such situation has been described in medical literature.

Immunohistochemical evaluation of MMP-2 and TIMP-2 in canine mammary tumours: a survival study.

Canine mammary tumours (CMTs) are a very heterogeneous group of neoplasms with variable prognosis. Their aggressiveness is mainly due to their ability to invade locally and to metastasize. The degradation of extracellular matrix components is an important determinant of the invasive phenotype. The aims of this study were to analyse by immunohistochemistry and double immunofluorescence the expression of metalloproteinase 2 (MMP-2) and tissue inhibitor of metalloproteinase 2 (TIMP-2) in eight normal canine mammary glands and 118 CMTs (24 benign, 94 malignant) and to investigate relationships with metastatic disease and survival. MMP-2 and TIMP-2 expression was higher in malignant tumours than in normal canine mammary tissue and benign tumours. The main difference between benign and malignant CMTs was the pattern of expression of both molecules: benign tumours presented TIMP-2 and MMP-2 immunoreactivity in the myoepithelial cells lining the basement membrane of tubuloalveolar structures, while malignant tumours showed mainly diffuse expression in neoplastic cells. In malignant tumours, increased TIMP-2 expression was significantly associated with the development of distant metastases, lower overall survival and lower disease-free survival. MMP-2 expression was not significantly associated to any of these parameters. These results suggest that the immunohistochemical expression of TIMP-2 is a useful prognostic factor in CMTs.

Immunohistochemical analysis of urokinase plasminogen activator and its prognostic value in canine mammary tumours.

Urokinase plasminogen activator (uPA) has been associated with aggressive behaviour and poor prognosis in human breast cancer, but there is no information on its expression in canine mammary tumours (CMT). uPA immunohistochemical expression was studied in 119 CMT (24 benign, 95 malignant) to investigate its relationship with clinical and histopathological parameters. Dogs with malignant mammary tumours (MMT) underwent a 2-year follow-up evaluation. MMT expressed significantly more uPA than benign tumours. In MMT, high uPA stromal expression was significantly associated with larger tumour size, high Ki-67 expression, invasive growth, high histological grade, regional lymph node metastases, development of distant metastases, and lower overall survival (OS) and disease-free survival (DFS). On the basis of these results, uPA could be considered a useful prognostic factor in dogs with MMT.

A comparison of transcutaneous and total serum bilirubin in newborn Hispanic infants at 35 or more weeks of gestation.

INTRODUCTION: Transcutaneous bilirubin (TcB) measurement in newborns has been studied extensively in the non-Hispanic population, but its usefulness in the Hispanic population remains unclear. We evaluate the accuracy of TcB measurements in assessing jaundice in Hispanic neonates by using total serum bilirubin (TSB) measurements as the reference standard and determine the TcB level that can be used to identify neonates at risk for clinically significant jaundice (above the 95th percentile). METHODS: A total of 192 Hispanic neonates were enrolled. TcB measurements were performed within 30 minutes of obtaining the TSB measurement. The linear relationship between TcB and TSB was measured by using the Pearson correlation coefficient (r). We calculated sensitivity, specificity, and positive and negative predictive values by using a TcB level above the 75th percentile to identify neonates with a TSB level above the 95th percentile. RESULTS: TSB ranged from 1.7 to 13.9 mg/dL, with 62% falling below the 75th percentile. TcB correlated well with TSB in Hispanic neonates (r = 0.87). A TcB level above the 75th percentile detected all infants with a TSB level above the 95th percentile, sensitivity 100%, and specificity 66%. CONCLUSIONS: In Hispanic newborns, the TcB level correlated well with the TSB level. TcB monitoring is a useful clinical screening tool to evaluate for the risk of clinically significant jaundice.

Brain potentials to mathematical syntax problems.

Anterior negativities obtained during sentence processing have never been unambiguously reported in the mathematical domain. The reason for this might be that the tasks explored in the mathematical domain have been far from resembling those typically yielding language-related anterior negativities. To test this hypothesis, we explored three mathematical aspects: Order-relevant information, a parenthesis indicating the onset of an embedded calculation, and violations of the type of symbol displayed. Results yielded parieto-occipital instead of frontal negativities. Late posterior positivities were also found, largely comparable to linguistic P600 in topography, but dissociable in functional terms. Our data suggest that language-related anterior negativities may indeed reflect language-specific resources of the human brain and support recent claims that language and mathematical domains are more independent than previously thought.

Are semantic and syntactic cues inducing the same processes in the identification of word order?

The purpose of this study was to find a common pattern of event-related potential (ERP) fluctuations regardless of the type of information (either semantic or syntactic) determining the presence of a reversed word order. ERPs were recorded while subjects read Spanish transitive sentences in which either semantic or syntactic information determined the actual word order. On the one hand (semantic condition), the order could be reversed by using an inanimate noun in the first noun phrase (NP), together with a verb representing an action that cannot correspond to an inanimate entity. On the other hand (syntactic condition), word order could be manipulated depending on the presence of a preposition preceding the second NP, which confirms the preferred word order, or a determiner, conveying a reversed word order. Interestingly, the inanimate first noun elicited a frontal negativity, which could be interpreted as the detection of an initial difficulty for using that noun as the subject of the sentence. At the point of disambiguation in either condition, a late posterior positivity was observed. The P600/SPS might, therefore, be an indicator of the syntactic processing costs incurred by the variation of word order, reflecting phrase structure reallocation processes common to this operation regardless of the cue used.

The recognition potential during sentence presentation: stimulus probability, background stimuli, and SOA.

Recognition potential (RP) is an electrical brain response that has proved its usefulness for studying semantic processing of isolated words, and appears when subjects view meaningful stimuli embedded in a stream of background images at a high rate of presentation: the rapid stream stimulation paradigm (RSS). The present technical study is aimed at testing the validity of this procedure in the study of words within sentences. For this purpose, we varied word and background probability of appearance, the number of background stimuli preceding each word, and stimulus onset asynchrony. Probability did not have significant effects on RP, but it was found that a minimum number of two background stimuli preceding each word and a high rate (250 ms) of presentation are preferable for enhancing RP amplitude. The RSS paradigm would therefore improve the visibility-and, hence, refine the analysis-of a component that can nevertheless be obtained with more standard paradigms, such as rapid serial visual presentation, devoid of interspersed background stimuli.

Electrophysiological evidence of an early effect of sentence context in reading.

Recognition Potential is an electrophysiological response of the brain that is sensitive to semantic aspects of stimuli. According to its peak values (about 250ms), Recognition Potential appears as a good candidate to reflect lexical selection processes. Consequently, Recognition Potential might be sensitive to contextual information during reading a sentence. In present study, the standard procedures to improve the visibility of Recognition Potential (Rapid Stream Stimulation paradigm) were used in a task in which sentence context was crucial. A parieto-occipital Recognition Potential was observed to peak about 264ms after stimulus onset, followed by a centro-parietal N400 peaking at about 450ms. Recognition Potential was affected by contextual information though, contrary to N400, presenting larger amplitude to contextually congruous words. These results support the assumption that Recognition Potential may reflect lexical selection processes, representing also evidence of context effects on ERP around 250ms after stimulus onset during sentence reading.

Analysis of anxiety variables in dental students.

UNLABELLED: Personality, stress factors, gender and personal circumstances have been studied in dental students and a change in anxiety levels has been discovered over the different academic years that make up the degree course. OBJECTIVES: To analyse the variation in anxiety over the different years and to determine any variation between the genders, in dental students at the Madrid Complutense University. METHOD: Eight scales of the Inventory of Anxiety Situations and Responses were administered to 110 students, of both genders, from the 1st, 3rd and 5th years. RESULTS: Mean scores were obtained for the eight scales, separately by year and for gender. In general the women showed a higher anxiety level in the scales for cognitive, physiological, motor, general and assessment anxiety responses. Anxiety in the 3rd year was higher than in the 1st year. The lowest levels were found in the 5th year. DISCUSSION: High anxiety levels increase the risk of suffering illness and make it necessary to plan educational control strategies bearing in mind the factors which stress men or women and the activities carried out in each academic year.

UV index experimental values during the years 2000 and 2001 from the Spanish broadband UV-B radiometric network.

An analysis is made of experimental ultraviolet erythemal solar radiation data measured during the years 2000 and 2001 by the Spanish UV-B radiation evaluation and prediction network. This network consists of 16 Robertson-Berger type pyranometers for evaluating solar erythemal radiation and five Brewer spectroradiometers for evaluating the stratospheric ozone. On the basis of these data the Ultraviolet Index (UVI) was evaluated for the measuring stations that are located either in coastal regions or in the more densely populated regions inland on the Iberian Peninsula. It has been checked that in most cases the maximum irradiance values corresponded to solar noon, although there were exceptions that could be explained by cloudiness. The maximum experimental values of the UVI were around 9 during the summer, though frequently passing this value at the inland measurement stations. The annual accumulated dose of irradiation on a horizontal plane has also been studied, as well as the evolution through the year in units of energy, standard erythemal doses and minimum erythemal doses, according to different phototypes.

The recognition potential and repetition effects.

The recognition potential (RP) is an electrical brain response peaking at 250 ms that appears when subjects view meaningful stimuli. Previous RP research was conducted in experimental conditions in which repetition effects could not be totally ruled out as influencing the generation of the RP response. The present study aims to elucidate whether repetition effects affect the topography and waveform of this component. For this purpose semantically correct, orthographically correct, strings of random letters, control and background stimuli were presented to 20 subjects following the rapid stream stimulation procedure and without repetition of any test stimulus. As previously, the RP showed its maximal amplitude at the PO7 electrode. It showed sensitivity to all levels of lexical processing, its response being maximal for semantically correct stimuli, and its topographical distribution was similar for all types of stimulus. Direct statistical comparisons with the data of a previous study where repetition effects could not be disregarded were performed, confirming the similarity between the results obtained in both experiments. The neural generators of the RP were placed again, as in previous studies, within the lingual gyrus. Although repetition effects have been reported to affect other semantic-related components such as the N400, they do not seem to affect either the topography or the waveform of the RP.

Prevalencia, consecuencias y antecedentes de miedo, ansiedad y fobia dental / Prevalence, consequences and antecedents of dental fear, anxiety and phobia

En este trabajo de revisión se recogen las definiciones sobre los conceptos de miedo, ansiedad y fobia dental. Se recoge la prevalencia y la incidencia de estos trastornos en distintas poblaciones. Se indican las principales consecuencias en el cuidado y salud bucodental y los problemas dentales más importantes que padecen los pacientes que presentan niveles más altos de miedo, ansiedad y fobia dental. Se revisan tanto en niños como en adultos, los antecedentes de estos trastornos, el modo de adquisición y las variables que influyen en su mantenimiento. Se indican los elementos y componentes del tratamiento dental que más miedo y ansiedad producen en los pacientes

Prevalencia, consecuencias y antecedentes de miedo, ansiedad y fobia dental / Prevalence, consequences and antecedents of dental fear, anxiety and phobia

En este trabajo de revisión se recogen las definiciones sobre los conceptos de miedo, ansiedad y fobia dental. Se recoge la prevalencia y la incidencia de estos trastornos en distintas poblaciones. Se indican las principales consecuencias en el cuidado y salud bucodental y los problemas dentales más importantes que padecen los pacientes que presentan niveles más altos de miedo, ansiedad y fobia dental. Se revisan tanto en niños como en adultos, los antecedentes de estos trastornos, el modo de adquisición y las variables que influyen en su mantenimiento. Se indican los elementos y componentes del tratamiento dental que más miedo y ansiedad producen en los pacientes (AU)