Enfermería de Práctica Avanzada en el Sistema de Salud: evolución, aceptación y reconocimiento / Advanced Practice Nursing in the Health System: evolution, acceptance and recognition

Introducción: se estima escasez de 5.9 millones de profesionistas de la salud a nivel mundial. La Enfermería de Práctica Avanzada (EPA), cuenta con conocimientos, competencias y habilidades clínicas específicas para actuar en situaciones de déficit de personal médico, tratando desde enfermedades agudas hasta crónico degenerativas, preservando tanto la salud mental como física. Objetivo: Determinar el desempeño de la Enfermería de Práctica Avanzada en el Sector Salud. Metodología: revisión sistemática sobre la EPA, que incluyó revisiones y artículos originales del periodo 2013-2022 en español e inglés, acerca de su desempeño: evolución, aceptación y reconocimiento. Para la identificación, cribado e inclusión de los artículos se utilizó el modelo PRISMA 2020. Resultados: de un total de 838 artículos identificados, se incluyeron 20 artículos y 7 de otras fuentes como citas y otros sitios web, obteniendo un total de 27 artículos de revisión, que abordan la evolución, la aceptación y reconocimiento. Se realizó análisis cualitativo. Conclusiones: el desempeño de EPA surge por las demandas poblacionales de atención primaria a la salud, diversos países ya cuentan con EPA, asistiendo a sus habitantes desde sus especialidades. La EPA es diversa y extensa, su profesionalización debe ser continua y permanente. En México falta camino para tomar la EPA como parte del equipo multidisciplinario

Abstract Introduction: About 5.9 millions healthcare professionals lack across the world. The Advanced Practice Nursing (APN), has specific knowledge, competences, and clinical abilities to act in medical absence, taking care from acute illness until chronic diseases, preserving both mental and physical health. Objective: To determine the Advanced Practice Nursing (APN) performance in the Health Sector. Methods: A systematic review about APN, including reviews and original articles from the period 2013-2022 in Spanish and English, about performance: evolution, acceptance and recognition. For the identification, screening, and inclusion of the articles the PRISMA 2020 model was used. Results: Of 838 total identified articles, 20 articles were included from the search and 7 from other sources such as citations and other websites, obtaining 27 total articles to be reviewed, which regard the evolution, acceptance and recognition. A qualitative analysis was performed. Conclusions: The APN performance arose because of demands for primary health care; several countries already have APN, providing care to inhabitants through their different specialties. APN is diverse and extensive, its professionalization must be continuous and permanent. In Mexico there is still some way to go to APN to take part in the multidisciplinary team.

Prevalencia de cardiopatías congénitas en un hospital de segundo nivel que ameritaron tratamiento quirúrgico / Prevalence of surgical treatment in congenital heart disease

Resumen Objetivo: Determinar la prevalencia de cardiopatías congénitas (CC) en un hospital de segundo nivel que ameritaron tratamiento quirúrgico. Material y métodos: Estudio descriptivo, realizado en pacientes con diagnóstico de CC en una unidad de segundo nivel de atención del Instituto Mexicano del Seguro Social (IMSS) en Puebla, México durante el periodo de 2016-2017, se incluyeron expedientes de recién nacidos (RN) a término hasta los 14 años, analizando variables sociodemográficas, tipo de CC y corto circuito, presencia de anomalías asociadas y envío a un tercer nivel de atención para tratamiento quirúrgico. La información fue recolectada y analizada mediante el programa SPSS Statistics v25. Resultados: La prevalencia hospitalaria de CC que requirieron envío a tercer nivel de atención para tratamiento quirúrgico fue 6.8% en 2016 y 6.6% en 2017, la mediana de edad fue 1 año. El 77.2% de las CC fueron acianógenas, la persistencia del conducto arterioso (PCA) fue el corto circuito más frecuente y 19.2% presentó síndrome de Down como anomalía congénita asociada. Conclusión: Obtuvimos una prevalencia similar a otras regiones de México, siendo las CC acianógenas la causa más frecuente de los tratamientos quirúrgicos. La detección y referencia oportuna mejorara la atención y calidad de vida en estos pacientes.

Abstract Objective: To determine the prevalence of congenital heart disease (CHD) in a second level hospital that required surgical treatment. Material and methods: Descriptive study carried out in patients diagnosed with CHD in a second level hospital of the Mexican Social Security Institute (IMSS) in Puebla, Mexico during the period 2016-2017. Records of full-term newborns (NB) up to 14 years of age analyzing sociodemographic variables, type of CHD and short-circuit, presence of associated anomalies, and referral to a third level hospital for surgical treatment were included. Data were collected and analyzed using the SPSS Statistics v25 program. Results: The hospital prevalence of CHD that required referral to the third level hospital for surgical treatment was 6.8% in 2016 and 6.6% in 2017; the median age was 1 year. The 77.2% of CHDs were non-cyanotic, patent ductus arteriosus (PDA) was the most common shunt, and 19.2% had Down syndrome as an associated congenital anomaly. Conclusion: We obtained a similar prevalence to other regions of Mexico, with acyanotic CHD being the most frequent cause of surgical treatments. Timely detection and referral will improve care and quality of life in these patients.

Acute Lymphoblastic Leukemia Following Incomplete Kawasaki Disease.

Kawasaki disease (KD) is a multisystemic vasculitis of unknown etiology, typically affecting children younger than 5 years of age. A direct relationship between KD and the development of malignant tumors has not been demonstrated, however, the immunological alterations of KD could be associated with its development. An 11-month-old male was diagnosed with incomplete KD. No coronary abnormalities were detected. He was treated with intravenous immunoglobulin (IVIG) and aspirin. Four weeks later, he developed fever, otitis media, bullous pharyngitis, irritability, anemia and hyperleukocytosis, and neutropenia. Blasts forms were observed in peripheral blood. Bone marrow smear demonstrated acute lymphoblastic leukemia (ALL). KD has diverse clinical presentations, atypical manifestations, and several complications such as macrophage activation syndrome. As our case highlights, lymphoid neoplasms may follow KD.

Validation of the Latin American Spanish version of the face-name associative memory exam in a Colombian Sample.

OBJECTIVE: The Face-Name Associative Memory Exam (FNAME) has been used to detect subtle cognitive changes in clinically normal older adults at increased risk for Alzheimer's disease. FNAME assesses learning and delayed recall for face-name pairs. The aim of this study is to introduce a Latin American Spanish version of the FNAME (LAS-FNAME), examine its psychometric properties, and provide preliminary normative data in a sample of clinically normal, Spanish-speaking individuals from Antioquia, Colombia. METHOD: 59 clinically-normal individuals (71% females) were recruited by the Grupo de Neurociencias in Antioquia (Colombia). Age ranged from 27 to 82 years (M = 50.31, SD = 15.32) and years of education ranged from 2 to 17 years (M = 9.02, SD = 4.11). All participants completed the LAS-FNAME and a brief neuropsychological evaluation. We examined associations between age, education, and sex and performance on the LAS-FNAME. Internal consistency, convergent and discriminant validity were also assessed. Test-restest reliability was computed for a subset of participants (n = 32). RESULTS: LAS-FNAME exhibited moderate convergent validity with other memory measures (Free and Cued Selective Reminding Scale, rs=.465, p<.01; Wechsler Memory Scale III - Logical Memory Delayed Recall, rs=.479, p<.01). The subscales of the LAS-FNAME exhibited adequate internal consistency (α=.825). Test-retest reliability analyses demonstrated consistency of scores over time. Normative data was stratified by age (<50, 50-65, >65) and low and high educational attainment (≤8 and >8 years of education, respectively). CONCLUSIONS: The LAS-FNAME is a valid and reliable measure to assess memory in clinically normal, Spanish-speaking individuals from Colombia for clinical and research purposes.

Comparison between the body mass index and the Controlling Nutritional status to determine the severity in patients with abdominal sepsis.

BACKGROUND: The systemic response of the organism, in defense against the aggressor agent, generates acute catabolic response, which leads to deterioration of the nutritional status. OBJECTIVE: Compare the usefulness of the body mass index (BMI) and the CONUT scale to determine the severity in abdominal sepsis. METHODS: Retrospective, descriptive, cross-sectional study in patients with diagnosis of abdominal sepsis, from April 2016 to February 2017. RESULTS: We included 153 cases (61 female and 92 male); mean age of 47.44 years, the main organ causing abdominal sepsis was the appendix 43%. Mortality of 15%. An average BMI of 27.31, CONUT score of 5.5, was obtained. The findings, subjected to the Mann-Whitney u test, showed statistical significance when evaluating BMI against SOFA (p = 0.025); no significance was found when evaluating the BMI against APACHE II (p = 0.322), nor against mortality (p = 0.646). Regarding CONUT, significance was found when comparing against APACHE II, SOFA and mortality (p = 0.002, p = 0.001 and p = 0.007, respectively). CONCLUSIONS: The level of malnutrition determined by CONUT is related to the severity determined by APACHE II, SOFA and mortality. BMI is not related to severity by APACHE II or mortality; although it does seem to relate to the severity evaluated by the SOFA scale.

INTRODUCCIÓN: La respuesta sistémica del organismo, en defensa ante el agente agresor, genera una respuesta catabólica aguda que conduce a deterioro del estado nutricional. OBJETIVO: Comparar la utilidad del índice de masa corporal (IMC) y del índice de Control Nutricional (CONUT) para determinar la gravedad en pacientes con sepsis abdominal. MÉTODO: Estudio retrospectivo, descriptivo, transversal, en pacientes con diagnóstico de sepsis abdominal, de abril de 2016 a febrero de 2017. RESULTADOS: Se incluyeron 153 casos (61 mujeres y 92 hombres). El principal órgano causante de sepsis abdominal fue el apéndice (43%). La mortalidad fue del 15%. El IMC promedio fue de 27.31. El CONUT promedio fue de 5.5, Los hallazgos, sometidos a la prueba U de Mann-Whitney, mostraron al evaluar el IMC contra la escala SOFA (Sequential Organ Failure Assessment Score) una p = 0.025; no se encontró significancia al evaluar el IMC contra APACHE II (Acute Physiology and Chronic Health Evaluation) (p = 0.322) ni contra la mortalidad (p = 0.646). En cuanto a CONUT, se encontró significancia al compararla contra APACHE II, SOFA y la mortalidad (p = 0.002, p = 0.001 y p = 0.007, respectivamente). CONCLUSIÓN: El grado de malnutrición determinado por CONUT se relaciona con la gravedad determinada mediante APACHE II y SOFA, y con la mortalidad. El IMC no se relaciona con la gravedad por APACHE II ni con la mortalidad, aunque sí parece relacionarse con la gravedad evaluada mediante SOFA.

Ulcerative colitis: epidemiology, clinical features and associated factors with surgical treatment in a tertiary hospital in Mexico.

BACKGROUND: An increase incidence of ulcerative colitis (UC) has been reported in Mexico. It is important to know the clinical features of patients with UC, their clinical course, need for surgical treatment and outcomes. OBJECTIVE: To describe the demographic and clinical features of patients with UC, emphasizing the factors associated with the need for surgical treatment. METHOD: A retrospective, cross-sectional, analytical study was made which included 60 patients with diagnosis of UC confirmed by histopathology. The demographic, clinical and biochemical data of each patient will be collected. The severity was measured based on the Truelove and Witts scale, endoscopic Mayo score and Riley histological index. RESULTS: Of the patients included, the proportion was equal between men and women. The mean age of presentation was 40.6 ± 13.3 years. The extent of the disease at the time of diagnosis was proctitis in the majority of patients (61.7%). Nineteen patients (31.8%) presented extraintestinal manifestations. 55% of the patients had as sole treatment 5-aminosalicylates. Fourteen patients (23.3%) required surgical treatment mainly due to lack of response to medical treatment. CONCLUSIONS: The clinical features of UC are useful to identify patients who may present a torpid evolution of the disease and who may require surgical treatment.

ANTECEDENTES: Se tiene evidencia de un aumento en la incidencia de la colitis ulcerosa crónica idiopática (CUCI) en México, pero varía según el Estado e incluso entre hospitales de una misma región. Es importante conocer las características clínicas de los pacientes con CUCI, su curso clínico, necesidad de tratamiento quirúrgico y desenlaces. OBJETIVO: Describir las características demográficas y clínicas de los pacientes con CUCI, enfatizando en los factores asociados a la necesidad de tratamiento quirúrgico. MÉTODO: Estudio retrospectivo que incluyó 60 pacientes con diagnóstico de CUCI confirmado por histopatología. Se colectaron los datos demográficos, clínicos y bioquímicos de cada paciente. La gravedad se midió con la escala de Truelove y Witts, la escala endoscópica de Mayo y el índice histológico de Riley. RESULTADOS: Se incluyeron 30 hombres y 30 mujeres. La media de edad fue de 40.6 ± 13.3 años. La extensión de la enfermedad fue proctitis en el 61.7%. Diecinueve pacientes (31.8%) presentaron manifestaciones extraintestinales. El 55% tenían como tratamiento único ácido 5-aminosalicílico. Catorce pacientes (23.3%) requirieron tratamiento quirúrgico, principalmente por falta de respuesta al tratamiento médico. CONCLUSIONES: Las características clínicas de la CUCI son útiles para identificar a los pacientes que pudieran presentar una evolución tórpida de la enfermedad y requerir tratamiento quirúrgico.

Event-related potential correlates of recognition memory in asymptomatic individuals with CADASIL.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common form of hereditary stroke disorder and is caused by mutations of the NOTCH3 gene. Cognitive decline in CADASIL is characterized by early impairments of attention, memory, and executive functions. Studying asymptomatic individuals with CADASIL offers a unique genetic model to understand preclinical vascular cognitive impairment and dementia. This study aimed at examine whether early preclinical physiological changes could be observed in asymptomatic individuals with CADASIL, who will go on to develop vascular cognitive impairment and dementia later in life. Twenty-nine individuals (mean age: 54.1 years old) were included in the study; five CADASIL NOTCH3 mutation carriers and twenty-five age-matched non-carriers. Participants underwent a comprehensive clinical evaluation and neuropsychological testing. Event-related potentials (ERPs) were recorded during a picture recognition memory task. Analyses focused on the early frontal effect and parietal effect ERP components associated with familiarity and recollection memory. There were no differences between groups in behavioral performance during recognition memory discrimination or cognitive performance. Compared to non-carriers, CADASIL carriers had decreased amplitudes in both ERP components for hits and correct rejections. Among mutation carriers, lower amplitude at 500-600 ms in the left parietal region of interest for correct rejections was correlated with worse performance on measures of semantic fluency and inhibitory control. We conclude that cognitively unimpaired CADASIL carriers showed abnormalities in the neural correlates of recognition memory, years before clinical onset. Early disruptions of fronto-subcortical networks may explain preclinical changes in brain function during recognition memory. This work also demonstrates the potential usefulness of ERP brain correlates as preclinical markers of vascular dementia.

Valoración de la variabilidad de la frecuencia cardiaca en pacientes con hipertensión arterial sistémica tratados mediante ablación renal por radiofrecuencia. Serie de casos / Assessment of the variability of the cardiac frequency in patients with systemic arterial hypertension treated through renal ablation by radio frequency. Series of cases

Resumen Introducción La hipertensión arterial sistémica refractaria es la presión arterial en el consultorio por encima de la meta apropiada a pesar del uso de tres o más antihipertensivos, uno de los cuales es un diurético; la denervación renal por ablación por radiofrecuencia es un tratamiento para este padecimiento, el cual es efectivo y seguro. Consideramos que la denervación disminuye el tono del sistema nervioso autónomo a nivel renal (eje renina angiotensina aldosterona), por lo que el resultado será la disminución de la presión arterial sin afectar la variabilidad de la frecuencia cardiaca. Objetivo Determinar si existe modificación en la variabilidad de la frecuencia cardiaca en pacientes con hipertensión arterial sistémica refractaria que son tratados mediante denervación renal por radiofrecuencia con catéter. Material y métodos Estudio observacional, descriptivo y analítico de pacientes con hipertensión arterial sistémica refractaria que fueron tratados mediante ablación renal por radiofrecuencia con catéter. Se midió la variabilidad de la frecuencia cardiaca en el dominio temporal y frecuencial, antes y dos meses después del procedimiento. El análisis estadístico de resultados se hizo con la prueba t de Student para muestras relacionadas. Resultados Fueron elegibles nueve pacientes, sólo se incluyeron seis pacientes con hipertensión arterial sistémica refractaria tratados mediante ablación renal por radiofrecuencia en el dominio temporal para la desviación estándar de los intervalos NN (SDNN), se observó un incremento estadísticamente no significativo (7 ms, p = 0.58). Conclusión En los seis pacientes con hipertensión arterial sistémica refractaria tratados mediante ablación renal por radiofrecuencia se observó, dos meses posteriores al procedimiento, que la variabilidad de la frecuencia cardiaca en el dominio temporal para la desviación estándar de los intervalos NN (SDNN) se incrementó 7 ms, siendo estadísticamente no significativo (p = 0.58).

Abstract Introduction Refractory systemic arterial hypertension is the blood pressure above the appropriate goal despite the use of three or more antihypertensive drugs, one of which is a diuretic; renal denervation by radiofrequency ablation, is a treatment for this condition, which is effective and safe. We consider that denervation decreases the tone of the autonomic nervous system at the renal level (renin angiotensin aldosterone axis), so that the result will be a decrease in blood pressure without affecting the variability of the heart rate. Objective To determine if there is a change in the variability of heart rate in patients with refractory systemic arterial hypertension who are treated by radiofrequency renal denervation with catheter. Material and methods Observational, descriptive and analytical study of patients with refractory systemic arterial hypertension who were treated by radiofrequency renal ablation with catheter. The variability of the heart rate in the temporal and frequency domain was measured before and two months after the procedure. The statistical analysis of results was by Student's t-test for related samples. Results Nine patients were eligible, only six patients with refractory systemic arterial hypertension treated by radiofrequency renal ablation were included, in the domain temporal domain for the standard deviation of the NN intervals (SDNN), a statistically non-significant increase was observed (7 ms, p = 0.58). Conclusion In the six patients with refractory systemic arterial hypertension treated by radiofrequency renal ablation, it was observed two months after the procedure, that the variability of the heart rate in the time domain for the standard deviation of the NN intervals (SDNN), it increased 7 ms, being statistically non-significant (p = 0.58).

Cambios en el EEG en reposo de exparticipantes en el conflicto armado colombiano con trastorno de personalidad antisocial / Changes in Resting EEG in Colombian Ex-combatants ith Antisocial Personality Disorder

RESUMEN Introducción: El conflicto armado colombiano, además de secuelas sociales y económicas en la población civil, ha implicado otras consecuencias. Los excombatientes, como la otra cara del conflicto, han sido objeto de interrogación sobre su estructura de personalidad y predisposición a conductas violentas. Se ha encontrado en parte de la población asociada al conflicto armado rasgos característicos del trastorno de personalidad antisocial (TPA) que se relacionarían con los comportamientos en contra de las convenciones sociales. Métodos: Mediante registros electrocardiográficos cuantitativos (qEEG), se evaluaron las diferencias en los patrones de actividad cortical entre un grupo de excombatientes, algunos de ellos con diagnóstico de TPA, y un grupo de control ajeno al conflicto armado y sin alteraciones psiquiátricas. Se empleó la Lista de Chequeo de Psicopatía Revisada (PCL-R) para determinar la presencia de criterios diagnósticos de TPA, así como la entrevista diagnóstica para estudios genéticos (DIGS) para clasificar la presencia de otros trastornos mentales incluidos en el CIE-10. Resultados: Se encontraron diferencias significativas en los niveles de psicopatía evaluados mediante la PCL-R. Con respecto al análisis de la potencia espectral, se observaron diferencias entre grupos en las ondas alfa-2 y beta, en regiones frontal y temporal izquierda y temporocentral izquierda respectivamente. Conclusiones: La técnica de qEEG permite evidenciarlas diferencias entre grupos en el potencial espectral en reposo, las cuales se relacionan con comportamientos desadaptativos característicos del TPA.

ABSTRACT Introduction: Although the social and economic consequences of Colombian internal conflicts mainly affected the civilian population, they also had other implications. The ex-combatants, the other side of the conflict, have been the subject of many studies that question their personality structures and antisocial features. Results suggest that ex-combatants usually have characteristics of an antisocial personality disorder (ASPD) that is related with their behavior. Methods: Quantitative EEG (qEEG) was used to evaluate differences in cortical activity patterns between an ex-combatants group and a control group. The Psychopathy Checklist-Revised (PCL-R) was used to assess the presence of ASPD in the ex-combatants group, as well as the Diagnostic Interview for Genetic Studies (DIGS) for other mental disorders classified in the DCI-10. Results: There are significant differences in psychopathy levels between groups, as well as in alpha-2 and beta waves, especially in left temporal and frontal areas for alpha-2 waves and left temporal-central regions for beta waves. Conclusions: qEEG measurements allow spectral resting potential to be differentiated between groups that are related with features typically involved in antisocial personality disorder, and to correlate them with patterns in the questionnaires and clinical interview.

Changes in Resting EEG in Colombian Ex-combatants ith Antisocial Personality Disorder. / Cambios en el EEG en reposo de exparticipantes en el conflicto armado colombiano con trastorno de personalidad antisocial.

INTRODUCTION: Although the social and economic consequences of Colombian internal conflicts mainly affected the civilian population, they also had other implications. The ex-combatants, the other side of the conflict, have been the subject of many studies that question their personality structures and antisocial features. Results suggest that ex-combatants usually have characteristics of an antisocial personality disorder (ASPD) that is related with their behaviour. METHODS: Quantitative EEG (qEEG) was used to evaluate differences in cortical activity patterns between an ex-combatants group and a control group. The Psychopathy Checklist-Revised (PCL-R) was used to assess the presence of ASPD in the ex-combatants group, as well as the Diagnostic Interview for Genetic Studies (DIGS) for other mental disorders classified in the DCI-10. RESULTS: There are significant differences in psychopathy levels between groups, as well as in alpha-2 and beta waves, especially in left temporal and frontal areas for alpha-2 waves and left temporal-central regions for beta waves. CONCLUSIONS: qEEG measurements allow spectral resting potential to be differentiated between groups that are related with features typically involved in antisocial personality disorder, and to correlate them with patterns in the questionnaires and clinical interview.

Mejoría de la supervivencia con la intervención de un equipo multidisciplinario en el programa de implante de válvula aórtica transcatéter (TAVI) / Improved survival with multidisciplinary team intervention in the transcatheter aortic valve implant (TAVI) program

Resumen Introducción El implante de la válvula aórtica transcatéter (TAVI) es un tratamiento de mínima invasión e innovador con buenos resultados, para pacientes con estenosis aórtica de riesgo quirúrgico intermedio o alto; sin embargo, la gran mayoría de los pacientes son de edad avanzada y con múltiples comorbilidades que condicionan un aumento de la mortalidad y en muchos casos de las complicaciones. Un punto crucial y determinante para una buena evolución es el papel del equipo de corazón de una institución, ya que un equipo incompleto o con poca experiencia conlleva a una mala selección de pacientes. En nuestra institución el equipo de corazón pasó a ser un equipo multidisciplinario integrado por varias especialidades para la valoración integral de los pacientes. Material y Métodos Se llevó a cabo una cohorte de 36 pacientes en el Hospital Central Militar desde septiembre del 2013 a octubre del 2017. Se reunieron 36 pacientes con estenosis aórtica y tratados con TAVI; los primeros 17 pacientes fueron evaluados por un cirujano cardiovascular, dos cardiólogos intervencionistas, y dos cardiólogos clínicos. Posteriormente se evaluaron 19 pacientes en donde se incluyó en el equipo multidisciplinario a una geriatra, neumólogo, neurólogo, entre otras especialidades. Resultados De los 36 pacientes en total que fueron llevados a TAVI, los primeros 17 pacientes fueron seleccionados por el equipo de corazón desde el inicio del programa hasta el 2015 (47.2%) y los últimos 19 pacientes (del 2015 a la fecha) valorados por el equipo multidisciplinario (52.7%). En el primer grupo fallecieron durante el seguimiento a un año, por muerte de causa no cardiaca, ocho de 17 pacientes (47%) y en el segundo grupo, dos pacientes de 19 (10.5%), una muerte cardiaca y otra no cardiaca. Conclusiones Los resultados de un programa para TAVI están basados en tres puntos fuertes: las instalaciones, la formación del equipo de corazón y la experiencia del equipo implantador de válvulas; sin embargo, nosotros formamos un equipo multidisciplinario integrado por el equipo de corazón y otro personal de salud trascendental en la selección y seguimiento de los pacientes con mejores resultados a corto y largo plazo.

Abstract Introduction The implantation of the transcatheter aortic valve (TAVI) is a minimally invasive and innovative treatment with good results for patients with aortic stenosis of intermediate or high surgical risk; However, the vast majority of patients are elderly and have multiple co-morbidities that lead to increased mortality and in many cases to complications. A crucial and determining point for a good evolution is the role of the heart team of an institution, since an incomplete team or with little experience leads to a poor selection of patients. In our institution, the heart team became a multidisciplinary team composed of several specialties for the comprehensive assessment of patients. Material and Methods A cohort of 36 patients was carried out at the Central Military Hospital from September 2013 to October 2017. Thirty-six patients with aortic stenosis and treated with TAVI were met; The first 17 patients were evaluated by a cardiovascular surgeon, two interventional cardiologists, and two clinical cardiologists. Subsequently, a geriatrician, a pulmonologist, and a neurologist were included in the multidisciplinary team, among other specialties. Results Of the 36 patients in total who were taken to TAVI, the first 17 patients selected by the heart team from the beginning of the program until 2015 (47.2%) and the last 19 patients (from 2015 to date) valued by the multidisciplinary team (52.7%). In the first group, they died during the follow-up at one year, 8 of 17 patients (47%) and in the second group, 2 patients of 19 (10.5%). Conclusions The results of a program for TAVI are based on three strengths, the facilities, the training of the heart team and the experience of the valve implantation team, however, we form a multidisciplinary team composed of the heart team and another transcendental health personnel in the selection and follow-up of patients.

Atypical Modulations of N170 Component during Emotional Processing and Their Links to Social Behaviors in Ex-combatants.

Emotional processing (EP) is crucial for the elaboration and implementation of adaptive social strategies. EP is also necessary for the expression of social cognition and behavior (SCB) patterns. It is well-known that war contexts induce socio-emotional atypical functioning, in particular for those who participate in combats. Thus, ex-combatants represent an ideal non-clinical population to explore EP modulation and to evaluate its relation with SCB. The aim of this study was to explore EP and its relation with SCB dimensions such as empathy, theory of mind and social skills in a sample of 50 subjects, of which 30 were ex-combatants from illegally armed groups in Colombia, and 20 controls without combat experience. We adapted an Emotional Recognition Task for faces and words and synchronized it with electroencephalographic recording. Ex-combatants presented with higher assertion skills and showed more pronounced brain responses to faces than Controls. They did not show the bias toward anger observed in control participants whereby the latter group was more likely to misclassify neutral faces as angry. However, ex-combatants showed an atypical word valence processing. That is, words with different emotions yielded no differences in N170 modulations. SCB variables were successfully predicted by neurocognitive variables. Our results suggest that in ex-combatants the links between EP and SCB functions are reorganized. This may reflect neurocognitive modulations associated to chronic exposure to war experiences.

Social Cognitive Training Improves Emotional Processing and Reduces Aggressive Attitudes in Ex-combatants.

Emotional processing (EP) is a complex cognitive function necessary to successfully adjust to social environments where we need to interpret and respond to cues that convey threat or reward signals. Ex-combatants have consistently shown atypical EP as well as poor social interactions. Available reintegration programs aim to facilitate the re-adaptation of ex-combatants to their communities. However, they do not incorporate actions to improve EP and to enhance cognitive-emotional regulation. The present study was aimed at evaluating the usefulness of an intervention focused on Social Cognitive Training (SCT), which was designed to equip ex-combatants enrolled in the Social Reintegration Route with EP and social cognition skills. A group of 31 ex-combatants (mean age of 37.2, 29 men) from Colombian illegal armed groups were recruited into this study. Of these, 16 were invited to take part in a SCT and the other continued with the conventional reintegration intervention. Both groups underwent 12 training sessions in a period 12-14 weeks. They were assessed with a comprehensive protocol which included Psychosocial, Behavioral, and Emotion Processing instruments. The scores on these instruments prior to and after the intervention were compared within and between groups. Both groups were matched at baseline. Ex-combatants receiving the SCT experienced significant improvements in EP and a reduction in aggressive attitudes, effects not observed in those continuing the conventional reintegration intervention. This is the first study that achieves such outcomes in such a population using SCT intervention. We discuss the implications of such results toward better social reintegration strategies.

[Turnbull-cutait technique in low rectal cancer: Case report]. / Técnica de Turnbull-Cutait en cáncer de recto inferior: reporte de un caso.

BACKGROUND: The surgical treatment for low rectal cancer involves an ultra-low anterior resection with complete mesorectal resection and coloanal anastomosis. Two-stage coloanal anastomosis such as the Turnbull-Cutait technique represents an option for patients with low rectal cancer. CLINICAL CASE: A 69 year-old female patient with a diagnosis of adenocarcinoma (T2N1), located 4 cm from the anal margin. She received neoadjuvant radiotherapy. An ultra-low anterior resection and total resection of the mesorectum were performed. The intestinal transit was reconstructed by coloanal anastomosis using the Turnbull-Cutait technique. CONCLUSION: Coloanal anastomosis with the Turnbull-Cutait technique represents a primary option for patients with low rectal cancer, avoiding a loop ileostomy, its economic impact and on their quality of life.

Association of the interleukin 15 (IL-15) gene polymorphisms with the risk of developing ulcerative colitis in Mexican individuals.

Interleukin 15 (IL-15) is a Th1-related cytokine that triggers inflammatory cell recruitment with implications for pathogenesis in ulcerative colitis. The IL-15 gene is located within a 35 kb region of the q28-31 locus of chromosome 4. In the present work, the role of IL-15 gene polymorphisms as susceptibility markers for UC was evaluated. Seven polymorphisms of IL-15 (rs3806798, rs10833, rs4956403, rs2254514, rs2857261, rs10519613, and rs1057972) were genotyped by 5' exonuclease TaqMan genotyping assays in a group of 199 Mexican patients with UC and 698 Mexican Mestizo healthy unrelated individuals. UC patients and healthy controls showed similar distribution of the rs3806798, rs10833, rs4956403, rs2857261, rs10519613, and rs1057972 polymorphisms. The rs2254514 polymorphism was significantly associated with decreased risk of UC as compared to controls under both dominant and additive models (OR 0.62, Pdom = 0.014 and OR 0.65, Padd = 0.02). The rs2254514 CC genotype was associated with young age at diagnosis <40 years (P = 0.03; OR 3.67). Five polymorphisms (rs1051613, rs2254514, rs2857261, rs1057972, and rs10833) were in strong linkage disequilibrium and were included in six haplotypes: H1 (ACAAC), H2 (CCGTC), H3 (CTAAT), H4 (CCAAT), H5 (CTAAC), and H6 (CCAAC). UC patients showed an increased frequency of the H6 haplotype (P = 0.005; OR 3.2) and a decreased frequency of the H5 haplotype (P = 0.031; OR 0.40). These results suggest that the IL-15 rs2254514 polymorphism might have an important role in the development of UC in the Mexican population. We were able to distinguish one risk and one protective uncommon haplotype for the development of UC.

Genetic polymorphisms of interleukin 20 (IL-20) in patients with ulcerative colitis.

Interleukin (IL)-20 belongs to the IL-10 family and is a potent immunomodulatory cytokine with implications for pathogenesis in the inflammatory bowel disease (IBD). The interleukin 20 gene is located within a 200kb region of q31-32 locus of chromosome 1. No previous studies have reported this novel association between ulcerative colitis (UC) and IL-20 polymorphisms. In the present work, we evaluated the role of IL-20 gene polymorphisms as susceptibility markers for UC. Three polymorphisms of IL-20 gene (rs2981573, rs2232360, rs1518108) were genotyped by 5' exonuclease TaqMan genotyping assays on an ABI Prism 7900 HT Fast Real-Time PCR system in a group of 198 Mexican Mestizo patients with UC and 698 ethnically matched healthy unrelated individuals with no family history of UC. We found significant decreased frequencies of two IL-20 genotypes: GG (rs2981573) [10.6% vs. 17.6%, p=0.017, OR=0.55, 95% CI: 0.33-0.93] and GG (rs2232360) [10.6% vs. 17.6%, p=0.017, OR=0.55, 95% CI: 0.33-0.93] in UC patients as compared to healthy controls. No significant differences of gene frequencies were found between UC patients and healthy controls in the rs1518108 polymorphism. In the subgroup analysis, no differences were found between the IL-20 genotypes and the clinical characteristics of UC. The results suggest that the GG genotypes of the IL-20 polymorphisms (rs2981573 and rs2232360) might have an important role in the development of UC in the Mexican population.

Small microcapsules of crystal proteins and spores of Bacillus thuringiensis by an emulsification/internal gelation method.

This paper describes a microencapsulation process of a spore crystal aggregate produced by Bacillus thuringiensis var. kurstaki HD-1. The methodology is based on the emulsification/internal gelation method, and was implemented to produce microcapsules of small diameter (< 10 µm) with the capacity to protect the spore crystal aggregate from extreme ultraviolet radiation. The diameter of microcapsules was in the range of 3.1 ± 0.2-6.8 ± 0.4 µm, which is considered adequate for biological control purposes. The protective effect of the alginate coat was verified by the remaining 60 ± 2% and 40 ± 1% of spore viability and protein activity, respectively, after UV-B radiation of 236 J, and with bioassays with Spodoptera frugiperda. It is expected that the protective effect of the alginate coat will improve the effectiveness of the Bt-HD1 formulated as small diameter microcapsules, and their yield, once they are released into the environment, will also be improved.

Breast cancer care in developing countries.

BACKGROUND: Breast cancer is the commonest cancer of women the world over, and its incidence is rising, especially in developing countries, where the disease poses a major health care challenge. This growing incidence in developing countries reflects the advanced stage at diagnosis, low levels of public awareness of the risk for the disease, and poor medical infrastructure and expertise, with the resultant poor treatment outcomes. METHODS: This article provides a collective edited summary of the presentations at the symposium titled "Breast Cancer Care in Developing Countries," held as part of the Breast Surgery International program at the International Surgical week 2007, Montreal, Canada, August 2007. The aim of the presentations was to bring out the diverse clinical pathological and outcomes-related facts of breast cancer care available to women in several countries. As the incidence of breast cancer continues to rise steadily in the developing world, the lack of awareness of this disease and the absence of breast cancer screening programs make it almost certain that the majority of breast cancers are diagnosed at an advanced stage. In addition, the quality of care available for breast cancer patients varies widely according to where the patient is treated. RESULTS: Though there are some centers of excellence providing multimodality protocol-based treatment on a par with the best anywhere in the world, most breast cancer patients receive inadequate and inappropriate treatment because of a lack of high-quality infrastructure-and sometimes skills-and, above all, because of limited financial resources. CONCLUSIONS: In countries where these limitations are present, there is a need to emphasize public health education, promoting early diagnosis. In addition, resources must be directed toward the creation of more public facilities for cancer treatment. As these goals are met, it is likely that there will be a much-needed improvement in breast cancer care in developing countries.

[Infection of the surgical site. Experience of two years in the gynecology and obstetric service of Mexican General Hospital]. / Infección del sitio quirúrgico. Experiencia de dos años en el servicio de ginecología y obstetricia del Hospital General de México.

OBJECTIVE: To know the incidence and causal agents of the surgical site infection at the Gynecology and Obstetrics Service of the Hospital General de Mexico. MATERIAL AND METHOD: A retrospective, descriptive and analytical study was performed on patients with surgical site infection at the Gynecology and Obstetrics Service of the Hospital General de Mexico during January 1st, 2000 to December 31st, 2001. RESULTS: A global low rate of surgical site infection was observed, with predominance on the third life decade patients and on obstetrics events (69.5%). The initial treatment consisting of 600 mg intravenous clindamycin every eight hours and 500 mg intravenous amikacin every 12 hours showed high efficacy. The mean time of hospital stay was nine days; 97% of the discharges were due to improvement, with a minimum rate of mortality. CONCLUSIONS: The index of surgical site infections for gynecological and obstetric procedures is lower than the accepted percentage, but it is more frequent in patients submitted to total abdominal hysterectomy.