Design and implementation of the Comprehensive model for the humanization of health care of the Faculty of Medicine at the Universidad Nacional de Colombia / Diseño e implementation del Modelo de humanización integral en salud de la Facultad de Medicina de la Universidad Nacional de Colombia

Abstract The aim of this article is to describe the bases and general aspects of the design and implementation process of the Comprehensive model for the humanization of health care of the Faculty of Medicine at the Universidad Nacional de Colombia, which began to be developed in 2016 and is also being implemented at the Hospital Universitario Nacional (HUN). Through this model, the Humanizing Health Care Research Group of the Faculty of Medicine seeks to produce a cultural change, from a biopsychosocial approach, in the perception of the humanization of health care in the country, the training of health care professionals, the provision of health care, and the working conditions of health care personnel. The model is based on three axes: humanization of health care, focused on the patient, their family and caregivers; humanization of health sciences education processes, with an emphasis on students; and humanization of the quality of life and working conditions of health professionals. Likewise, the model considers humanistic education, music and sports as means to achieve such cultural change in the Faculty of Medicine of the Universidad Nacional de Colombia.

Resumen El objetivo de este artículo fue describir las bases y generalidades del proceso de diseño e implemen-tación del Modelo de humanización integral en salud de la Facultad de Medicina de la Universidad Nacional de Colombia, el cual empezó a desarrollarse en 2016 y en la actualidad también se ha implementado en el Hospital Universitario Nacional (HUN). Con este modelo, el Grupo de Investigación en Humanización en Salud de la Facultad de Medicina de la Universidad Nacional de Colombia busca generar un cambio cultural en la percepción de la humanización de la salud en el país, de la formación de los profesionales de la salud, de la prestación de atención en salud y de las condiciones laborales del personal de salud, a partir de una aproximación biopsicosocial. El modelo se fundamenta en tres ejes: la humanización en la atención en salud, enfocada en el paciente, la familia y los cuidadores; la humanización en los procesos de educación en ciencias de la salud, con énfasis en los estudiantes, y la humanización en la calidad de vida y las condiciones laborales de los profesionales de la salud. Asimismo, el modelo considera la formación humanística, la música y el deporte como medios para lograr dicho cambio cultural en la Facultad de Medicina de la Universidad Nacional de Colombia.

Arginine for the Treatment of Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes: A Systematic Review.

Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a mitochondrial disease that lacks a definitive treatment. Lately, there has been an increased interest in the scientific community about the role of arginine in the short and long-term settings of the disease. We aim to conduct a systematic review of the clinical use of arginine in the management of MELAS and explore the role of arginine in the pathophysiology of the disease. We used PubMed advanced-strategy searches and only included full-text clinical trials on humans written in the English language. After applying the inclusion/exclusion criteria, four clinical trials were reviewed. We used the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol for this systematic review. We used the Cochrane Collaboration risk-of-bias tool to assess the bias encountered in each study. Overall, IV arginine seems to be effective in improving symptoms during acute attacks of MELAS, while oral arginine supplementation increases endothelial function, preventing further stroke-like episodes.

Ad honorem exhaustion: Burnout prevalence in residents from a Colombian university / Agotamiento ad honorem: prevalencia de burnout en residentes de una universidad colombiana

Abstract Introduction: The number of health professionals diagnosed with burnout syndrome is constantly increasing. Currently, in Colombia, health care institutions are not obliged to pay residents for their work during their training. Besides their living expenses, residents must also pay tuition fees, which constitutes a stressor that may contribute to the development of burnout syndrome. Objective: To measure burnout syndrome prevalence and to identify its possible association with several socioeconomic factors in residents enrolled in 2019 in the residency programs offered by the school of medicine of a public university. Materials and methods: Cross-sectional study conducted in 269 residents that had been enrolled for at least 6 months, and who were classified into two groups according to their residency program: clinical and surgical specialties. Participants were administered a survey to collect their demographic and socioeconomic data, and the Spanish version of the Maslach Burnout Inventory - Human Services Survey for Medical Personnel instrument to determine whether they had burnout syndrome or not. Data were analyzed using descriptive statistics, and associations between socioeconomic data and MBI scores were determined using the chi-squared test. Results: Burnout prevalence was 39.78%. Likewise, the presence of burnout was positively associated with lacking enough funds to pay medical specialty training associated costs (OR: 3.45, CI:2.04-5.82); having experienced recent life changing events in the last 6 months (OR: 1.84, CI: 1.07-3.14); and having had any health issue in the last 6 months (OR: 1.81, CI:1.09-3.01). Conclusion: Burnout is a prevalent condition in the study population. So, until the obligation to pay residents for their work comes fully into force in Colombia, residency programs should be aware of burnout in residents and undergo several modifications aimed at ensuring their well-being.

Resumen Introducción. El número de profesionales de la salud diagnosticados con síndrome de burnout es cada día mayor. En la actualidad, en Colombia las instituciones de salud no están obligadas a pagarles salarios durante su entrenamiento. Además, aparte de sus gastos de manutención, los residentes deben pagar matrícula, lo que puede constituir un factor de estrés que contribuye al desarrollo de burnout. Objetivo. Medir la prevalencia de síndrome de burnout e identificar su posible asociación con diversos factores socioeconómicos en residentes matriculados en programas de residencia ofrecidos por la facultad de medicina de una universidad pública en 2019. Materiales y métodos. Estudio transversal realizado en 269 residentes con un tiempo mínimo de matrícula de 6 meses, y que, según su residencia, fueron clasificados en dos grupos: especialidades clínicas y quirúrgicas. Los datos demográficos y socioeconómicos se recolectaron mediante un cuestionario diseñado para tal fin; además, para el diagnóstico de burnout se utilizó la versión en español del instrumento Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS MP). Los datos se analizaron mediante estadística descriptiva y las asociaciones entre los datos socioeconómicos y los puntajes obtenidos en el MBI se determinaron con la prueba de chi-cuadrado. Resultados. La prevalencia de burnout fue de 39.78%. De igual forma, se observó que su ocurrencia se asoció positivamente con no tener fondos suficientes para costear los gastos asociados con la formación médica de la residencia (OR: 3.45, IC:2.04-5.82), y con haber experimentado eventos de gran importancia o haber presentado problemas de salud en los últimos seis meses (OR: 1.84, IC:1.07-3.14; y OR: 1.81, IC:1.09-3.01, respectivamente). Conclusión. El síndrome de burnout es una condición prevalente en la población estudiada. De esta forma, hasta que la obligación de pagar un salario a los residentes entre en vigencia en Colombia, los programas de residencia deben estar al tanto de este problema y realizar varias modificaciones dirigidas a asegurar su bienestar.

Producción científica en las facultades de Medicina en Colombia en el periodo 2001-2015 / Scientific production in Colombian medical schools during the last 15 years

Resumen Introducción. El crecimiento en el número de facultades de Medicina en Colombia ha sido acelerado y sin un estricto control por parte del Estado, por lo que existen muchos aspectos cuestionados, incluyendo su capacidad para generar investigación y nuevo conocimiento. Objetivo. Describir la producción científica generada desde el año 2001 hasta el 2015 en el área de medicina por las universidades colombianas. Materiales y métodos. Se realizó un estudio de corte transversal revisando la producción científica de los últimos 15 años en la base de datos SCOPUS para las 62 facultades de Medicina registradas ante el Ministerio de Educación Nacional. Resultados. El total de publicaciones científicas en el periodo de observación fue 14 167. Las cinco instituciones con el mayor número de publicaciones fueron Universidad de Antioquia, Universidad Nacional de Colombia, Universidad del Valle, Pontificia Universidad Javeriana y Colegio Mayor de Nuestra Señora del Rosario. Las 10 primeras facultades generaron el 78.5% del total de publicaciones. Conclusiones. El volumen de producción científica identificada se concentra en unas pocas facultades de Medicina. Los resultados de este estudio pueden tomarse como un acercamiento a la forma en la que se mide la calidad actual de las instituciones de educación superior en Colombia, en especial en Medicina.

Abstract Introduction: The growth of medical schools in Colombia has been rapid, although State control is not strict; therefore, many questionable aspects can be found, among them, the ability to generate research and new knowledge. Objective: To describe scientific production related to Medicine between 2001 and 2015 in Colombian universities. Materials and methods: Cross-sectional study in which scientific production incorporated in the SCOPUS database in the last 15 years was reviewed, including all work done by the 62 medical schools registered before the Ministry of National Education. Results: The total number of scientific publications made during the observation period was 14 167. The five institutions with the highest number of publications were Universidad de Antioquia, Universidad Nacional de Colombia, Universidad del Valle, Pontificia Universidad Javeriana and Colegio Mayor de Nuestra Señora del Rosario. The first 10 faculties generated 78.5% of the total publications. Conclusions: The volume of identified scientific production is produced by a few medical schools. The results of this study can be taken as an approach to the way how quality in Colombian higher education institutions is currently measured, especially in medicine schools.

Serotonin 2A receptor clustering in peripheral lymphocytes is altered in major depression and may be a biomarker of therapeutic efficacy.

BACKGROUND: In a previous report, we showed that the clustering of serotonin (5HT) transporter (SERT) protein on cell membranes of peripheral lymphocytes predicts responsivity to antidepressant medication in two subpopulations of naïve depression patients (Rivera-Baltanas et al., J Affect Disord, 2012, 137, 46-55). In this study, we extended this idea to 5-HT2A receptor clusters in a similar patient population. METHODS: We collected blood samples from a subset of patients from our previous study on SERT clustering (20 untreated and newly diagnosed depression patients, and 20 matched control subjects). Blood samples were collected at the time of diagnosis and after 8 weeks of pharmacological treatment and at analogous times in control subjects. We used the Hamilton scale to quantify the level of depression in patients both before and after treatment. We then used immunocytochemistry to assess 5-HT2A receptor clusters in lymphocytes at the same time points. RESULTS: We found that both the size and number of 5-HT2A receptor clusters were increased in naïve depression patients compared to control subjects. Interestingly, there were individual differences in the distribution of 5-HT2A receptor cluster size that allowed us to differentiate the depression patients into two subgroups: a D-I group and a D-II group. After 8 weeks of pharmacological treatment, patients in both groups showed an improvement of symptoms, but patients in the D-II group had a much better outcome with many of them showing remission of symptoms. Furthermore, although treatment decreased cluster number and size in both D-I and D-II groups, only the D-II patients showed an increase in the number of clusters within the modal peak. Importantly, the same patients that belonged in the D-I or D-II groups in the present report were also assigned to the same groups in our previous study on SERT clustering. LIMITATIONS: The data should be replicated within a proper clinical trial. CONCLUSIONS: 5-HT2A receptor clusters in peripheral lymphocytes are altered in major depression, partially reversed by antidepressant treatment, and may be considered a putative biomarker of therapeutic efficacy in major depression.

Serotonin transporter clustering in blood lymphocytes as a putative biomarker of therapeutic efficacy in major depressive disorder.

BACKGROUND: Serotonin transporter (SERT) binding is decreased in lymphocytes of depression patients and this decrease is partially reversed by antidepressant medication. However, recent evidence has shown that clustering of SERT on cell membranes is very important for receptor functionality. Alteration in SERT clustering on peripheral lymphocytes does not affect symptoms severity. At the most it is associated or predicts responsivity to treatment. METHODS: We collected blood samples from 38 untreated and newly diagnosed depression patients at the time of diagnosis and after 8weeks of pharmacological treatment and of 38 control subjects. We used the Hamilton Scale to quantify the level of depression in patients both before and after pharmacological treatment. We then used immunocytochemistry to assess SERT protein clusters in lymphocyte blood samples. RESULTS: We found an increase in SERT cluster size, but not the number of SERT clusters, in naïve depression patients compared to control subjects. Based on the distribution of SERT cluster size we differentiated the naïve depression patients into two groups (D-I and D-II). Naïve D-I and D-II patients initially showed similar Hamilton scores. However, after pharmacological treatment the D-II patients showed a greater decrease in Hamilton scores than did the D-I patients, and they had an increase in the number of SERT clusters. LIMITATIONS: The data should be replicated in a larger cohort of patients and with a proper clinical trial. CONCLUSIONS: We propose that SERT clustering in blood lymphocytes may be a putative biomarker for antidepressant efficacy in major depressive disorder.

Prevalência de queilite anular entre (Boqueira) em escolares de Alfenas-MG, na faixa etária de 7 a 12 anos / Prevalence of angular cheilitis in 7-12-year-old school-children of Alfenas-MG

Examinaram 42 escolares de ambos os sexos, de 7 a 12 anos, na Clínica de Odontopediatria da Escola de Farmácia e Odontologia de Alfenas. Os pacientes foram separados em dois grupos: I - aqueles com etiologia de infecção primária; II - aqueles cuja causa primária não era infecciosa. Determinou-se a relação entre sexos, idade e condição social. Formas de tratamento foram realizadas e são aqui descritas