Síndrome post COVID-19. Gravedad y evolución en 4673 trabajadores sanitarios / Post COVID-19 syndrome. Severity and evolution in 4673 health care workers

Resumen Introducción : La evolución del síndrome post COVID ha sido variable y carecemos de información sobre su impacto en los profesionales de la salud. Métodos : Realizamos una encuesta a través de una red social en profesionales de la salud sobre casos de síndrome post COVID-19 confirmados con PCR. En un cuestionario web, preguntamos sobre 21 síntomas, su gravedad, duración, grado de afectación de la actividad y reincorporación al trabajo. Resultados : Respondieron 4673 profesionales sanita rios de 21 países, edad media de 47 años, 64% mujeres. El curso inicial fue asintomático en el 9%, síntomas leves en el 36%, síntomas moderados sin hospitalización en el 40% o con hospitalización en el 11%, y síntomas graves en el 1%. Los síntomas más prevalentes fueron fatiga (67%), insomnio (44%), ansiedad (42%), mialgia (41%) y anosmia (41%). La prevalencia se redujo a la mitad en los primeros 5 cinco meses, pero en muchos casos se prolongó durante más de un año. En el análisis multi variado los síntomas tendieron a agruparse en clusters (cognitivos, neuropsiquiátricos, cardiorrespiratorios, digestivos, otros). La necesidad de cambiar de área de trabajo fue del 16% y la falta de reincorporación al tra bajo del 7%, relacionadas con la mayor edad, el número de síntomas y la gravedad del curso inicial. Conclusión : En muchos casos la persistencia de los síntomas post COVID-19 puede ser prolongada y te ner un impacto laboral en los profesionales sanitarios, requiriendo la adopción de políticas específicas para reducir el daño.

Abstract Background : The evolution of post COVID-19 syn drome has been variable and we lack information on its impact on healthcare professionals. Methods : We conducted a survey through a social network in health professionals on post COVID-19 syn drome cases confirmed with PCR. In a web-based ques tionnaire, we asked about 21 symptoms, their severity, duration, degree of activity impairment and return to work. Results : 4673 health professionals from 21 countries responded, mean age of 47 years, 64% women. The initial course was asymptomatic in 9%, mild symptoms 36%, moderate symptoms without hospitalization 40% or with hospitalization 11%, and severe symptoms 1%. The most prevalent symptoms were fatigue (67%), insomnia (44%), anxiety (42%), myalgia (41%) and anosmia (41%). Prevalence dropped by half in the first 5 five months, but in many cases, it lasted for more than a year. In the mul 670 tivariate analysis, symptoms tended to be grouped into clusters (cognitive, neuropsychiatric, cardiorespiratory, digestive, others). The need to change the work area was 16% and lack of return to work 7%, related to older age, number of symptoms and severity of the initial course. Conclusion : in many cases the persistence of post- COVID symptoms can be prolonged and have an occu pational impact on healthcare professionals, requiring the adoption of specific policies to reduce harm.

Post COVID-19 syndrome. Severity and evolution in 4673 health care workers.

BACKGROUND: The evolution of post COVID syndrome has been variable and we lack information on its impact on healthcare professionals, particularly in Latin America. METHODS: We conducted a survey through a social network in health professionals on post COVID-19 syndrome cases confirmed with PCR. In a web-based questionnaire, we asked about 21 symptoms, their severity, duration, degree of activity impairment and return to work. RESULTS: 4673 health professionals from 21 countries responded, mean age of 47.8 years, 64.2% women. The initial course was asymptomatic in 9.1%, mild symptoms 36.8%, moderate symptoms without hospitalization 40.8% or with hospitalization 11.7%, and severe symptoms with respiratory assistance 1.6%. The most prevalent symptoms were fatigue (67%), insomnia (44.2%), anxiety (42.3%), myalgia (41.9%) and anosmia (41.2%). Considering only severe symptoms (grades 3-4 on a subjective index from 1 to 4), the most prevalent were slowness (36.3%), impaired concentration (33.1%), anosmia (20.4%), fatigue (19.1%), impaired memory (18.1%) and dyspnea (15.9%). Prevalence dropped by half in the first 5 five months, but in many cases, it lasted for more than a year. In the multivariate analysis, symptoms tended to be grouped into clusters (cognitive, neuropsychiatric, cardiorespiratory, digestive, others). The need to change the work area was 16% and lack of return to work 7.8%, related to older age, number of symptoms and severity of the initial course. CONCLUSION: In conclusion, in many cases the persistence of post-COVID symptoms can be prolonged and have an occupational impact on healthcare professionals, requiring the adoption of specific policies to reduce harm.

Introducción: La evolución del síndrome post COVID ha sido variable y carecemos de información sobre su impacto en los profesionales de la salud. Métodos: Realizamos una encuesta a través de una red social en profesionales de la salud sobre casos de síndrome post COVID-19 confirmados con PCR. En un cuestionario web, preguntamos sobre 21 síntomas, su gravedad, duración, grado de afectación de la actividad y reincorporación al trabajo. Resultados: Respondieron 4673 profesionales sanitarios de 21 países, edad media de 47 años, 64% mujeres. El curso inicial fue asintomático en el 9%, síntomas leves en el 36%, síntomas moderados sin hospitalización en el 40% o con hospitalización en el 11%, y síntomas graves en el 1%. Los síntomas más prevalentes fueron fatiga (67%), insomnio (44%), ansiedad (42%), mialgia (41%) y anosmia (41%). La prevalencia se redujo a la mitad en los primeros 5 cinco meses, pero en muchos casos se prolongó durante más de un año. En el análisis multivariado los síntomas tendieron a agruparse en clusters (cognitivos, neuropsiquiátricos, cardiorrespiratorios, digestivos, otros). La necesidad de cambiar de área de trabajo fue del 16% y la falta de reincorporación al trabajo del 7%, relacionadas con la mayor edad, el número de síntomas y la gravedad del curso inicial. Conclusión: En muchos casos la persistencia de los síntomas post-COVID puede ser prolongada y tener un impacto laboral en los profesionales sanitarios, requiriendo la adopción de políticas específicas para reducir el daño.

Circulating microRNAs as biomarkers of Chagas cardiomyopathy.

Background: Chagas cardiomyopathy (CHCM) is the most important clinical manifestation of Chagas disease. The analysis of cardiac miRNAs may contribute to predicting the progression to CHCM in Chagas indeterminate phase and/or to the differential diagnosis for cardiomyopathy. Methods: We carried out a case-control study to identify circulating miRNAs associated with CHCM. We assigned 104 participants to four groups: healthy controls (HC), Chagas non-cardiomyopathy controls, CHCM cases, and ischemic cardiomyopathy controls. We performed a clinical, echocardiographic, and laboratory evaluation and profiled circulating miRNA in the serum samples. Results: Differences between groups were observed in clinical variables and in the analysis of miRNAs. Compared to HC, CHCM participants had 4 over-expressed and 6 under-expressed miRNAs; miR-95-3p and miR-130b-3p were upregulated in CHCM compared with controls, Chagas non-cardiomyopathy and ischemic cardiomyopathy participants, suggesting that might be a hallmark of CHCM. Analysis of gene targets associated with cardiac injury yielded results of genes involved in arrhythmia generation, cardiomegaly, and hypertrophy. Conclusions: Our data suggest that the expression of circulating miRNAs identified by deep sequencing in CHCM could be associated with different cardiac phenotypes in CHCM subjects, compared with Chagas non-CHCM, ischemic cardiomyopathy controls, and healthy controls.

Resección vascular mayor por adenocarcinoma pancreático ductal: reporte del primer caso registrado en Paraguay / Major vascular resection for pancreatic ductal adenocarcinoma: case report, of first case reported in Paraguay

El adenocarcinoma pancreático ductal (APD) es la cuarta causa de muerte por cáncer y se proyecta que para el 2030 ocupe el segundo lugar. El pronóstico es sombrío, siendo la sobrevida menor a 9% en 5 años. Se consideró durante mucho tiempo a la resección quirúrgica como el único tratamiento curativo, sin embargo, sólo el 15 a 20% de los pacientes pueden ser beneficiados con la misma. La clasificación pre terapéutica más utilizada es la del National Comprehensive Cáncer Network (NCCN), basada en la relación del tumor con estructuras vasculares, clasificándolos en tumores "resecables", de resección límite "Borderlines" y "localmente avanzados". Se presenta el primer caso registrado en Paraguay de APD con infiltración de la Vena Mesentérica Superior (VMS) tratado con duodenopancreatectomía cefálica (DPC) asociada a resección vascular mayor.

Pancreatic ductal adenocarcinoma (PDA) is the fourth leading cause of cancer death and is projected to rank second by 2030. The prognosis is bleak, with survival being less than 9% in 5 years. For a long time, surgical resection was considered the only curative treatment, however, only 15 to 20% of patients can benefit from it. The most widely used pre-therapeutic classification is that of the National Comprehensive Cancer Network (NCCN), based on the relationship of the tumor with vascular structures, classifying them into "resectable", "borderline" and "locally advanced" tumors. We present the first registered case in Paraguay of PDA with infiltration of the Superior Mesenteric Vein (SMV) treated with cephalic duodenopancreatectomy (CPD) associated with major vascular resection.

High-dose vitamin D versus placebo to prevent complications in COVID-19 patients: Multicentre randomized controlled clinical trial.

BACKGROUND: The role of oral vitamin D3 supplementation for hospitalized patients with COVID-19 remains to be determined. The study was aimed to evaluate whether vitamin D3 supplementation could prevent respiratory worsening among hospitalized patients with COVID-19. METHODS AND FINDINGS: We designed a multicentre, randomized, double-blind, sequential, placebo-controlled clinical trial. The study was conducted in 17 second and third level hospitals, located in four provinces of Argentina, from 14 August 2020 to 22 June 2021. We enrolled 218 adult patients, hospitalized in general wards with SARS-CoV-2 confirmed infection, mild-to-moderate COVID-19 and risk factors for disease progression. Participants were randomized to a single oral dose of 500 000 IU of vitamin D3 or matching placebo. Randomization ratio was 1:1, with permuted blocks and stratified for study site, diabetes and age (≤60 vs >60 years). The primary outcome was the change in the respiratory Sepsis related Organ Failure Assessment score between baseline and the highest value recorded up to day 7. Secondary outcomes included the length of hospital stay; intensive care unit admission; and in-hospital mortality. Overall, 115 participants were assigned to vitamin D3 and 105 to placebo (mean [SD] age, 59.1 [10.7] years; 103 [47.2%] women). There were no significant differences in the primary outcome between groups (median [IQR] 0.0 [0.0-1.0] vs 0.0 [0.0-1.0], for vitamin D3 and placebo, respectively; p = 0.925). Median [IQR] length of hospital stay was not significantly different between vitamin D3 group (6.0 [4.0-9.0] days) and placebo group (6.0 [4.0-10.0] days; p = 0.632). There were no significant differences for intensive care unit admissions (7.8% vs 10.7%; RR 0.73; 95% CI 0.32 to 1.70; p = 0.622), or in-hospital mortality (4.3% vs 1.9%; RR 2.24; 95% CI 0.44 to 11.29; p = 0.451). There were no significant differences in serious adverse events (vitamin D3 = 14.8%, placebo = 11.7%). CONCLUSIONS: Among hospitalized patients with mild-to-moderate COVID-19 and risk factors, a single high oral dose of vitamin D3 as compared with placebo, did not prevent the respiratory worsening. TRIAL REGISTRATION: ClincicalTrials.gov Identifier: NCT04411446.

The ATP synthase inhibition induces an AMPK-dependent glycolytic switch of mesenchymal stem cells that enhances their immunotherapeutic potential.

Objectives: Mesenchymal Stem/Stromal Cells (MSC) are promising therapeutic tools for inflammatory diseases due to their potent immunoregulatory capacities. Their suppressive activity mainly depends on inflammatory cues that have been recently associated with changes in MSC bioenergetic status towards a glycolytic metabolism. However, the molecular mechanisms behind this metabolic reprogramming and its impact on MSC therapeutic properties have not been investigated. Methods: Human and murine-derived MSC were metabolically reprogramed using pro-inflammatory cytokines, an inhibitor of ATP synthase (oligomycin), or 2-deoxy-D-glucose (2DG). The immunosuppressive activity of these cells was tested in vitro using co-culture experiments with pro-inflammatory T cells and in vivo with the Delayed-Type Hypersensitivity (DTH) and the Graph versus Host Disease (GVHD) murine models. Results: We found that the oligomycin-mediated pro-glycolytic switch of MSC significantly enhanced their immunosuppressive properties in vitro. Conversely, glycolysis inhibition using 2DG significantly reduced MSC immunoregulatory effects. Moreover, in vivo, MSC glycolytic reprogramming significantly increased their therapeutic benefit in the DTH and GVHD mouse models. Finally, we demonstrated that the MSC glycolytic switch effect partly depends on the activation of the AMPK signaling pathway. Conclusion: Altogether, our findings show that AMPK-dependent glycolytic reprogramming of MSC using an ATP synthase inhibitor contributes to their immunosuppressive and therapeutic functions, and suggest that pro-glycolytic drugs might be used to improve MSC-based therapy.

Medicamentos modificadores en esclerosis múltiple: esquemas terapéuticos actuales / Disease-Modifying drugs in multiple sclerosis: current therapeutic schemes

La esclerosis múltiple (EM) es una enfermedad crónica, autoinmune y neurodegenerativa; que tiene como principal característica la desmielinización de los axones en el sistema nervioso. Los medicamentos modificadores de la enfermedad (MME) logran retrasar la aparición de los síntomas y modificar parcialmente el progreso de la desmielinización y daño neuronal, resultando cada vez más complejo determinar un esquema terapéutico estandarizado según la condición particular de cada paciente. En este artículo se presenta una revisión actualizada de la evidencia clínica que ha llevado al uso de los esquemas terapéuticos en EM. La mayoría de los medicamentos aprobados actualmente son utilizados para la EM remitente-recurrente y se pueden dividir de acuerdo a la eficacia y seguridad. Los medicamentos de primera línea han mostrado una baja o moderada eficacia y alta seguridad; después de usar estos fármacos sin lograr una buena respuesta o ante una enfermedad avanzada se usan medicamentos de segunda y tercera línea que tienen una alta eficacia, pero son menos seguros, presentando mayores efectos secundarios y riesgos asociados para los pacientes. El ocrelizumab es el único fármaco aceptado para la EM primaria progresiva y el siponimod fue aprobado como una alternativa para la EM secundaria progresiva. El desarrollo de nuevos medicamentos y el seguimiento clínico de los ya aprobados permitirá establecer un mejor abordaje terapéutico logrando así mejorar la calidad de vida de cada paciente.

Multiple sclerosis (MS) is a chronic, autoimmune and neurodegenerative disease; whose main characteristic is the demyelination of axons in the nervous system. Disease-modifying drugs (DMD) can delay the onset of symptoms and partially modify the progression of demyelination and neuronal damage, making it increasingly complex to determine a standardized therapeutic scheme that is individualized to each patient. This article presents an updated review on the clinical evidence that has led to the use of current therapeutic schemes in MS with focus on DMD. Current medications in treating relapsing-remitting MS can be divided according to efficacy and safety. First-line drugs have shown low or moderate efficacy and high safety. Second- and third-line drugs are used after a poor response or in cases of advanced disease. These drugs are highly effective, but less safe, presenting greater side effects and associated risks for patients. Ocrelizumab is the only accepted drug for primary progressive MS and siponimod is accepted as an alternative for secondary progressive MS. The development of new medications and the clinical follow-up of those already approved will allow establishing a better therapeutic approach, thus improving the quality of life of each patient.

Carcinoma endometrioide sincrónico de ovario y endometrio / Ovarian and endometrial synchronous endometrioid carcinoma

ANTECEDENTES: existe una asociación demostrada entre endometriosis y algunas histologías del carcinoma epitelial de ovario. Por otra parte, se ha observado que hasta un 30% de las neoplasias de ovario se presentan de forma concomitante a neoplasias del endometrio. Para considerar la sincronicidad entre estos tumores, estos deben cumplir criterios anatomopatológicos estrictos como los descritos por scully. OBJETIVO: presentar un caso clínico de carcinoma endometrioide sincrónico de ovario y endometrio sobre focos de endometriosis, así como su diagnóstico y manejo. CASO CLÍNICO: paciente de 27 años que consulta por spotting intermenstrual. En la ecografía endocavitaria se observa un pólipo endometrial. Además, se describe un tumor anexial izquierdo de 42mm, trilobulado, con un polo sólido de 17×15mm. Se somete a una polipectomía histeroscópica y quistectomía ovárica laparoscópica. Asimismo, se reseca implante sospechoso en el fondo de saco posterior. El resultado anatomopatológico de las piezas quirúrgicas fue: pólipo endometrial con hiperplasia compleja con atipias y focos de adenocarcinoma endometrioide grado I; el tumor quístico ovárico izquierdo consistente con quiste endometriósico con focos de adenocarcinoma endometrioide. La lesión peritoneal corresponde a un implante de adenocarcinoma endometrioide grado I. El estudio de las características anatomopatológicas y la presencia del implante peritoneal sugieren el diagnóstico de un carcinoma endometrioide ovárico con origen en una lesión endometriósica sincrónico con un carcinoma endometrioide endometrial. CONCLUSIÓN: el diagnóstico diferencial entre la sincronicidad o diseminación de los tumores de ovario y endometrio de estirpe endometrioide supone un reto para el clínico y es fundamental para el correcto manejo de estas neoplasias.

BACKGROUND: there is a demonstrated association between endometriosis and some epithelial ovarian carcinoma histologies. On the other hand, it has been observed that up to 30% of ovarian neoplasms present concomitantly with endometrial neoplasms. To consider synchronicity between these neoplasms, they must meet strict pathological criteria such as those described by scully. OBJECTIVE: to introduce a case of an ovarian and endometrial synchronous endometrioid carcinoma implanted on endometriosis sites, as well as its diagnosis and management. CLINICAL CASE: a 27-year-old patient who consulted because of an intermenstrual spotting. The ultrasound image showed an endometrial polyp. Furthermore, a 42 mm left adnexal trilobal tumor with a 17×15mm solid pole was described. She underwent a hysteroscopic polypectomy and laparoscopic ovarian cystectomy. Likewise, resection of a suspicious implant in the posterior vaginal fornix was done. The pathological result of the surgical pieces was: endometrial polyp with complex hyperplasia with atypia and focal points of grade I endometrioid adenocarcinoma; the left ovarian cystectomy: endometriotic cyst with focal points of endometrioid adenocarcinoma. The peritoneal lesion corresponded to a grade I endometrioid adenocarcinoma implant. The study of the pathological characteristics and the presence of the peritoneal implant suggest the diagnosis of endometrioid ovarian carcinoma originated in a synchronous endometriotic lesion with endometrial endometrioid carcinoma. CONCLUSION: differential diagnosis between the synchronicity or spread of ovarian and endometrial endometrioid cell line carcinomas, is a great challenge and it is essential for the correct management of these neoplasms

Adjusted linguistic validation and psychometric properties of the Colombian version of KIDSCREEN-52.

In health and clinical studies, health-related quality of life is often assessed using the well-established KIDSCREEN-52 questionnaires as well as the Vécu et Santé Perçue de l'Adolescent (VSP-A). The purpose of this study was twofold: to perform an adjusted linguistic validation of the Colombian version of the KIDSCREEN-52 and to assess its psychometric properties in children and adolescents. A total of 146 children and adolescents completed the KIDSCREEN-52, adolescents ( n = 48) additionally completed the VSP-A. Psychometric analyses focused on the internal consistency as well as the convergent and discriminant validity of the KIDSCREEN-52 Colombian version. Syntactic and semantic modifications were made to 19 items in the adapted version of the KIDSCREEN-52. Cronbach's α ranged from .74 to .89 for eight dimensions, while α < .70 was obtained for self-perception and social acceptance. We found evidence of good convergent validity with the VSP-A dimensions. Regarding known-groups validity, children aged between 8 and 10=years, male, with a high socioeconomic level and no chronic health condition obtained higher scores compared to the other categories. The developed Colombian version of the KIDSCREEN-52 showed acceptable reliability and validity. This study provides a cultural adaptation of the Spanish version of the KIDSCREEN-52 for Colombian children and adolescents.

[BK and JC polyomavirus detection in leukocyte extracts of peripheral blood samples of HIV+ patients from the north area of Santiago]. / Detección de polyomavirus BK y JC en extractos leucocitarios de sangre periférica de pacientes con infección por VIH del área norte de Santiago.

INTRODUCTION: Polyomavirus BK (BKPyV) and JC (JCPyV) are persistent pathogens able to reactivate in im-munocompromised patients, involving mostly urinary and central nervous system. There are no Chilean studies in HIV positive patients. OBJECTIVE: To detect BKPyV and JCPyV in blood of Chilean HIV positive adult patients and to correlate these results with clinical-related variables. MATERIALS AND METHODS: 96 stored blood samples from HIV patients belonging to the north area of Santiago were analyzed. Viral genomes of both viruses were detected by real-time PCR. For statistical analysis, chi-square (Pearson) and Mann-Whitney tests were used and p-values < 0.05 were considered significant. RESULTS: 33% of the samples were positive for BKPyV and a significant correlation was found between the presence of BKPyV genome and the absence of detectable HIV viral load. We demonstrated the need to consider more than one amplification target to detect the BKPyV genome. All the samples were negative for JCPyV genome. DISCUSSION: BKPyV prevalence in Chilean HIV patients is higher than most of international studies. New studies regarding the interaction between both viruses are required. These patients should undergo periodic evaluations by urologist and nephrologist.

Detección de polyomavirus BK y JC en extractos leucocitarios de sangre periférica de pacientes con infección por VIH del área norte de Santiago / BK and JC polyomavirus detection in leukocyte extracts of peripheral blood samples of HIV+ patients from the north area of Santiago

Introducción: Polyomavirus BK (BKPyV) y JC (JCPyV) son patógenos persistentes con capacidad de reactivación en inmunocomprometidos, afectando principalmente el sistema urinario y el sistema nervioso central, respectivamente. No existen estudios chilenos en población infectada por VIH. Objetivo: Detectar la presencia de BKPyV y JCPyV en muestras de sangre de pacientes adultos, chilenos, con infección por VIH y correlacionar los resultados con variables clínicas. Materiales y Métodos: Analizamos 96 muestras de extractos leucocitarios de pacientes del área norte de Santiago. El genoma viral se detectó mediante RPC en tiempo real. Para el análisis estadístico se utilizó las pruebas chi-cuadrado de Pearson y Mann-Whitney, considerando significativo un valor de p < 0,05. Resultados: 33% de las muestras resultaron positivas para BKPyV y se encontró una correlación significativa entre la presencia de genoma de BKPyV y la ausencia de carga viral de VIH. Se evidenció la necesidad de considerar más de un blanco de amplificación del genoma de BKPyV. Todas las muestras fueron negativas para JCPyV. Discusión: La prevalencia de BKPyV en pacientes chilenos con infección por VIH es superior a la informada en la mayoría de los reportes internacionales. Se requiere estudios que evalúen la interacción entre ambos virus. Estos pacientes deberían ser sometidos a controles urológicos y nefrológicos periódicos.

Introduction: Polyomavirus BK (BKPyV) and JC (JCPyV) are persistent pathogens able to reactivate in im-munocompromised patients, involving mostly urinary and central nervous system. There are no Chilean studies in HIV positive patients. Objective: To detect BKPyV and JCPyV in blood of Chilean HIV positive adult patients and to correlate these results with clinical-related variables. Materials and Methods: 96 stored blood samples from HIV patients belonging to the north area of Santiago were analyzed. Viral genomes of both viruses were detected by real-time PCR. For statistical analysis, chi-square (Pearson) and Mann-Whitney tests were used and p-values < 0.05 were considered significant. Results: 33% of the samples were positive for BKPyV and a significant correlation was found between the presence of BKPyV genome and the absence of detectable HIV viral load. We demonstrated the need to consider more than one amplification target to detect the BKPyV genome. All the samples were negative for JCPyV genome. Discussion: BKPyV prevalence in Chilean HIV patients is higher than most of international studies. New studies regarding the interaction between both viruses are required. These patients should undergo periodic evaluations by urologist and nephrologist.

Antidepresivos en pacientes con depresión post-infarto: meta-análisis de la evidencia / Antidepressants in patients with post-infarct depression: meta-analysis of the evidence

El presente meta-análisis se propone como objetivo analizar los efectos sobre la morbi-mortalidad de los anti-depresivos en pacientes con depresión tras un infarto. Entre un 17-27% de los pacientes con un evento coronario reciente tienen asociado un trastorno depresivo mayor, encontrándose síntomas depresivos en hasta un 65%. Nueve estudios incluyeron los criterios de inclusión. Se incluyeron 3330 pacientes, 1236 a un grupo de intervención (GI) que recibió tratamiento con antidepresivos y 2094 pacientes a un grupo control (GC). Los resultados del meta-análisis sugieren que el tratamiento anti-depresivo podría ser beneficioso entre pacientes con diagnóstico de depresión después de un infarto, a expensas de la disminución de la mortalidad y del re-infarto de miocardio.

Dimensiones de la motivación desde la perspectiva del alumnado: 20 ãnos investigación / Dimensions of motivation towards learning, students´s perspective: 20 years of research / Dimensões da motivação na aprendizagem a partir da perspectiva dos alunos: 20 anos de pesquisa

Este artículo tiene como objetivo identificar y analizar qué dimensiones se constituyen como factores de motivación o desmotivación hacia el aprendizaje, en la materia de Historia de segundo curso de Bachillerato, desde el punto de vista de los estudiantes. La información para responder a estas cuestiones surge de una línea de investigación iniciada hace más de dos décadas, desde cuyo marco se han realizado diversas recogidas de datos a través de cuestionarios a 1523 estudiantes de la Región de Murcia y entrevistas a 200 estudiantes de diferentes titulaciones universitarias, repartidos por las provincias de Alicante, Almería, Barcelona, Murcia y Sevilla.Los resultados indican una constancia a lo largo de los cursos y ponen de manifiesto una dimensión ligada a aspectos relacionales que contribuyen, en gran medida, a la motivación del alumnado hacia el aprendizaje de la Historia. Así, el clima del aula y el profesor se consideran agentes de motivación, sugiriendo que un profesor capaz de planificar, organizar y proponer tareas lejos de la metodología tradicional y más próximo a crear ambientes dinámicos, a través de actividades cooperativas en un clima de confianza, puede contribuir a fomentar el interés, enganchar y despertar el gusto por la Historia, así como aumentar la calidad académica.

This article aims to identify and analyze dimensions that can be seen as motivating or demotivating factors for the learning of History in the 2nd year of “Bachillerato” (Spanish post-compulsory secondary education stage) according to the students’ views. The information necessary to answer these questions arises from a line of research started more than two decades ago. For such a purpose, several questionnaires for information collection were handed out to 1,523 students from the Region of Murcia, and interviews were conducted with 200 students attending different undergraduate courses from Alicante,Almeria, Barcelona, Murcia and Seville. Results indicate a certain level of perseverance along school years and show a dimension linked to relational aspects which, to a great extent, contribute to boosting the students’ motivation to learn History. In this way, the atmosphere of the classroom and the teacher can be considered as motivating agents; it is worth pointing out that a teacher able to plan, organize and propose tasks that can overcome the traditional methodology and a teacher capable of creatinga dynamic space by using cooperative activities in an environment of trust can promote the interest of students and make them acquire a taste for History, while raising academic quality.

Este artigo tem como objetivo identificar e analisar que dimensões se constituem como fatores de motivação ou desmotivação para a aprendizagem, na matéria de História, do ponto de vista dos estudantes do segundo ano de bacharelado. A informação para responder a estas questões surge de uma linha de investigação iniciadahá mais de duas décadas; desde a então foram realizadas diversas coletas de dados por meiode questionários aplicados a 1523 estudantes da Região de Múrcia e entrevistas a 200 estudantes de diferentes cursos universitários, pertencentes às províncias de Alicante, Almería, Barcelona, Múrcia e Sevilla. Os resultados mostram uma constância ao longo dos anos e põem em evidência uma dimensão unida a aspectos relacionais que contribuem, em grande parte, à motivação do alunado para a aprendizagem da História. Assim, o clima da sala e o professor consideram-se como agentes de motivação, sugerindo que um professor capaz de planificar, organizar e propor tarefas longe da metodologia tradicional e mais próximo de criar ambientes dinâmicos, a partir de atividades cooperativas em um clima de confiança, pode contribuir parafomentar o interesse, captar e fazer acordar o gosto pela História, bem como aumentar a qualidade acadêmica.

Dimensiones de la motivación desde la perspectiva del alumnado: 20 ãnos investigación / Dimensions of motivation towards learning, students´s perspective: 20 years of research

Este artículo tiene como objetivo identificar y analizar qué dimensiones se constituyen como factores de motivación o desmotivación hacia el aprendizaje, en la materia de Historia de segundo curso de Bachillerato, desde el punto de vista de los estudiantes. La información para responder a estas cuestiones surge de una línea de investigación iniciada hace más de dos décadas, desde cuyo marco se han realizado diversas recogidas de datos a través de cuestionarios a 1523 estudiantes de la Región de Murcia y entrevistas a 200 estudiantes de diferentes titulaciones universitarias, repartidos por las provincias de Alicante, Almería, Barcelona, Murcia y Sevilla.Los resultados indican una constancia a lo largo de los cursos y ponen de manifiesto una dimensión ligada a aspectos relacionales que contribuyen, en gran medida, a la motivación del alumnado hacia el aprendizaje de la Historia. Así, el clima del aula y el profesor se consideran agentes de motivación, sugiriendo que un profesor capaz de planificar, organizar y proponer tareas lejos de la metodología tradicional y más próximo a crear ambientes dinámicos, a través de actividades cooperativas en un clima de confianza, puede contribuir a fomentar el interés, enganchar y despertar el gusto por la Historia, así como aumentar la calidad académica

This article aims to identify and analyze dimensions that can be seen as motivating or demotivating factors for the learning of History in the 2nd year of “Bachillerato” (Spanish post-compulsory secondary education stage) according to the students’ views. The information necessary to answer these questions arises from a line of research started more than two decades ago. For such a purpose, several questionnaires for information collection were handed out to 1,523 students from the Region of Murcia, and interviews were conducted with 200 students attending different undergraduate courses from Alicante,Almeria, Barcelona, Murcia and Seville. Results indicate a certain level of perseverance along school years and show a dimension linked to relational aspects which, to a great extent, contribute to boosting the students’ motivation to learn History. In this way, the atmosphere of the classroom and the teacher can be considered as motivating agents; it is worth pointing out that a teacher able to plan, organize and propose tasks that can overcome the traditional methodology and a teacher capable of creatinga dynamic space by using cooperative activities in an environment of trust can promote the interest of students and make them acquire a taste for History, while raising academic quality.

Este artigo tem como objetivo identificar e analisar que dimensões se constituem como fatores de motivação ou desmotivação para a aprendizagem, na matéria de História, do ponto de vista dos estudantes do segundo ano de bacharelado. A informação para responder a estas questões surge de uma linha de investigação iniciadahá mais de duas décadas; desde a então foram realizadas diversas coletas de dados por meiode questionários aplicados a 1523 estudantes da Região de Múrcia e entrevistas a 200 estudantes de diferentes cursos universitários, pertencentes às províncias de Alicante, Almería, Barcelona, Múrcia e Sevilla. Os resultados mostram uma constância ao longo dos anos e põem em evidência uma dimensão unida a aspectos relacionais que contribuem, em grande parte, à motivação do alunado para a aprendizagem da História. Assim, o clima da sala e o professor consideram-se como agentes de motivação, sugerindo que um professor capaz de planificar, organizar e propor tarefas longe da metodologia tradicional e mais próximo de criar ambientes dinâmicos, a partir de atividades cooperativas em um clima de confiança, pode contribuir parafomentar o interesse, captar e fazer acordar o gosto pela História, bem como aumentar a qualidade acadêmica

Síndrome de Bickerstaff: Caso clínico / Bickerstaff syndrome: Case report

El síndrome de Guillain-Barré se define como una polirradiculoneuropatía aguda, de inicio súbito y cuyo origen es, en la mayor parte de los casos, autoinmune. Se manifiesta como un cuadro de parálisis motora fláccida, de tipo ascendente, acompañada de arreflexia, con alteraciones sensitivas o sin ellas. Es la causa más frecuente de parálisis fláccida aguda en niños previamente sanos. Presenta distintas variantes que forman parte de un mismo espectro. Una de ellas es el síndrome de Bickerstaff, caracterizado por ataxia, oftalmoplejía externa asociada a encefalopatía o hiperreflexia. Es importante el diagnóstico precoz a fin de poder instaurar rápidamente medidas de sostén y tratamiento que beneficiarán a aquellos pacientes que progresan hacia un cuadro de mayor gravedad. Presentamos el caso de un niño de 4 años de edad, previamente sano, que presenta cuadro compatible con síndrome de Bickerstaff.

Guillain-Barré syndrome is defined as an acute polyradiculoneuropathy, with sudden onset and its origin being mostly autoimmune. It is characterized by flaccid paralysis, symmetrical and ascending, together with areflexia, with or without sensory disturbances. It is the primary cause of acute flaccid paralysis in previously healthy children. Guillain-Barré syndrome presents different variants as part of the same spectrum. One of this is the Bickerstaff syndrome, characterized by ataxia, encephalopathy, hyperreflexia and external ophthalmoplegia. Early diagnosis is important with the view to establishing an early treatment that will be beneficial for those patients that progress to a more serious illness. We report the case of a 4-year-old boy who was previously healthy, and then presented symptoms that are compatible with Bickerstaff syndrome.

Síndrome de Bickerstaff: Caso clínico / Bickerstaff syndrome: Case report

El síndrome de Guillain-Barré se define como una polirradiculoneuropatía aguda, de inicio súbito y cuyo origen es, en la mayor parte de los casos, autoinmune. Se manifiesta como un cuadro de parálisis motora fláccida, de tipo ascendente, acompañada de arreflexia, con alteraciones sensitivas o sin ellas. Es la causa más frecuente de parálisis fláccida aguda en niños previamente sanos. Presenta distintas variantes que forman parte de un mismo espectro. Una de ellas es el síndrome de Bickerstaff, caracterizado por ataxia, oftalmoplejía externa asociada a encefalopatía o hiperreflexia. Es importante el diagnóstico precoz a fin de poder instaurar rápidamente medidas de sostén y tratamiento que beneficiarán a aquellos pacientes que progresan hacia un cuadro de mayor gravedad. Presentamos el caso de un niño de 4 años de edad, previamente sano, que presenta cuadro compatible con síndrome de Bickerstaff.(AU)

Guillain-Barré syndrome is defined as an acute polyradiculoneuropathy, with sudden onset and its origin being mostly autoimmune. It is characterized by flaccid paralysis, symmetrical and ascending, together with areflexia, with or without sensory disturbances. It is the primary cause of acute flaccid paralysis in previously healthy children. Guillain-Barré syndrome presents different variants as part of the same spectrum. One of this is the Bickerstaff syndrome, characterized by ataxia, encephalopathy, hyperreflexia and external ophthalmoplegia. Early diagnosis is important with the view to establishing an early treatment that will be beneficial for those patients that progress to a more serious illness. We report the case of a 4-year-old boy who was previously healthy, and then presented symptoms that are compatible with Bickerstaff syndrome.(AU)

[Bickerstaff syndrome: Case report]. / Síndrome de Bickerstaff: Caso clínico.

Guillain-Barré syndrome is defined as an acute polyradiculoneuropathy, with sudden onset and its origin being mostly autoimmune. It is characterized by flaccid paralysis, symmetrical and ascending, together with areflexia, with or without sensory disturbances. It is the primary cause of acute flaccid paralysis in previously healthy children. Guillain-Barré syndrome presents different variants as part of the same spectrum. One of this is the Bickerstaff syndrome, characterized by ataxia, encephalopathy, hyperreflexia and external ophthalmoplegia. Early diagnosis is important with the view to establishing an early treatment that will be beneficial for those patients that progress to a more serious illness. We report the case of a 4-year-old boy who was previously healthy, and then presented symptoms that are compatible with Bickerstaff syndrome.

Ansiedad y depresión en la espondilitisanquilosante: una visión histórica / Anxiety and depression in ankylosing spondylitis: A historical view

Analizar la prevalencia de alteraciones psicológicas (síntomas de ansiedad y depresión)y evaluar su asociación con variables sociodemográficas, clínicas, capacidad funcionaly dolor, en un grupo de pacientes con diagnóstico de espondilitis anquilosante revisadosentre enero de 1995 y diciembre de 1997.Pacientes y métodos: Estudio transversal en 115 pacientes con espondilitis anquilosante revisadosambulatoriamente. A todos los enfermos se les realizó una historia clínica y se valoróla capacidad funcional mediante el cuestionario Health Assessment Questionnaire validadopara la espondilitis anquilosante (HAQEA), depresión mediante el cuestionario GeriatricDepression Scale (GDS) y ansiedad por el cuestionario State Trait Anxiety Inventory (STAI).Además, se realizaron determinaciones analíticas y de imagen (radiología).Resultados: La edad media de los pacientes era de 40 anos ˜ y el 84% eran varones. La puntuaciónmedia del HAQEA fue de 1 ± 0,7 (0-3 puntos). El 22% presentó síntomas de depresión y el30% de ansiedad. Las variables que mejor explicaban la varianza de los síntomas de ansiedady depresión fueron la capacidad funcional, el nivel de estudios y el índice de entesis.Conclusiones: Los síntomas de depresión y ansiedad están presentes en 1/3 de nuestrospacientes con espondilitis anquilosante y están influidos, principalmente, por la limitaciónfuncional, entesis dolorosas y nivel de educación...

Evaluación del efecto antiinflamatorio de un extracto orgánico de Allophylus cominia (L) Sw. sobre la actividad de COX-2 y FLA-2s / Evaluation of the antiinflammatory effect of an organic extract of Allophylus cominia (L) Sw. on COX-2 and sPLA-2 activity

Allophylus cominia (L) Sw (Sapindaceae), is one of the most popular Cuban medicinal plant. The aimed of this study was to explore, if the antidiabetic organic extract has also anti-inflammatory effect, considering that inflammation is correlationated with diabetes. It was evaluated in vitro inhibitory activity of chloroform extract of leaves on cyclooxygenase-2 (COX-2) and secreted phospholipase A2 (sPLA-2), which are important cellular mediators in the signaling cascade of the inflammatory process. The extract studied shown inhibitory activity on COX-2, while not shown on FLA-2s. This study provides direct evidence of the activity of A. cominia on mechanisms related to anti-inflammatory effects involving the eicosanoid cascade.

Allophylus cominia (L) Sw (Sapindáceas) es una de las plantas medicinales más afamadas de la medicina tradicional en Cuba. El objetivo de este estudio fue explorar si el extracto orgánico con actividad antidiabética tenía también efecto de tipo antiinflamatorio, considerando que la inflamación es un evento relacionado con la diabetes. En tal sentido se evaluó in vitro la actividad inhibitoria del extracto clorofórmico de las hojas de Allophylus cominia (L) Sw sobre cicloxigenasa-2 (COX-2) y fosofolipasa A2 secretada (FLA-2s), las cuales constituyen importantes mediadores celulares en la cascada de señalización del proceso inflamatorio. El extracto estudiado exhibió actividad inhibitoria sobre COX-2, mientras que no la mostró sobre FLA-2s. Este trabajo brinda evidencias directas de la actividad de A. cominia sobre mecanismos vinculados al efecto antinflamatorio que involucran la cascada de eicosanoides.