How has research on the effectiveness and safety of COVID-19 vaccination been evaluated: a scope review with emphasis on CoronaVac.

Introduction: The control of the COVID-19 epidemic has been focused on the development of vaccines against SARS-CoV-2. All developed vaccines have reported safety and efficacy results in preventing infection and its consequences, although the quality of evidence varies depending on the vaccine considered. Different methodological designs have been used for their evaluation, which can influence our understanding of the effects of these interventions. CoronaVac is an inactivated vaccine, and it has been assessed in various studies, including clinical trials and observational studies. Given these differences, our objective was to explore the published information to answer the question: how has the efficacy/effectiveness and safety of CoronaVac been evaluated in different studies? This is to identify potential gaps and challenges to be addressed in understanding its effect. Methods: A scoping review was carried out following the methodology proposed by the Joanna Briggs Institute, which included studies carried out in humans as of 2020, corresponding to systematic reviews, clinical trials, analytical or descriptive observational studies, in which the effectiveness and/or safety of vaccines for COVID19 were evaluated or described. There were no age restrictions for the study participants. Results: The efficacy/effectiveness and safety of this vaccine was assessed through 113 studies. Nineteen corresponded to experimental studies, 7 of Phase II, 5 of Phase IV, and 4 were clinical trials with random assignment. Although some clinical trials with random assignment have been carried out, these have limitations in terms of feasibility, follow-up times, and with this, the possibility of evaluating safety outcomes that occur with low frequencies. Not all studies have used homogeneous methods of analysis. Both the prevention of infection, and the prevention of outcomes such as hospitalization or death, have been valued through similar outcomes, but some through multivariate analysis of dependencies, and others through analysis that try to infer causally through different control methods of confounding. Conclusion: Published information on the evaluation of the efficacy/effectiveness and safety of the CoronaVac is abundant. However, there are differences in terms of vaccine application schedules, population definition, outcomes evaluated, follow-up times, and safety assessment, as well as non-standardization in the reporting of results, which may hinder the generalizability of the findings. It is important to generate meetings and consensus strategies for the methods and reporting of this type of studies, which will allow to reduce the heterogeneity in their presentation and a better understanding of the effect of these vaccines.

Recomendaciones de terapia Antihipertensiva: la importancia de las combinaciones Avalado por la Sociedad Centroamericana y del Caribe de Cardiología / Antihypertensive therapy recommendations: the importance of combinations Endorsed by the Central American and Caribbean Society of Cardiology

RESUMEN El presente trabajo es el resultado de una iniciativa para analizar, resumir y mostrar la evidencia científica más reciente sobre el tema de la hipertensión y la implementación de las mejores terapéuticas disponibles. Este documento fue creado con la colaboración conjunta de médicos especialistas para dar una perspectiva local a la gestión basada en la mejor evi- dencia científica y en el contexto de la región de Centroamérica y el Caribe. Este artículo cuenta con el respaldo científico y académico de la Sociedad Centroamericana y del Caribe de Cardiología y es el primero de su tipo en abordar el problema y tema de la hipertensión. Se desarrolló a partir de una revisión detallada de la evidencia científica utilizando los principales buscadores médicos, seleccionando los estudios pivotales y poblacionales con mayor nivel de evidencia disponible. La in- tención es brindar información sencilla, con recomendaciones fáciles de implementar en el manejo diario de los pacientes con hipertensión arterial. Este documento contó con el apoyo logístico del Laboratorio Servier, tanto con los autores como en su edición; sin embargo, la información clínica presentada no estuvo condicionada por el laboratorio. Este material es responsabilidad de los autores.

ABSTRACT Antihypertensive therapy recommendations: the importance of combinations Endorsed by the Central American and Caribbean Society of Cardiology The present work is the result of an initiative to analyze, summarize, and show the latest scientific evidence on the subject of hypertension and the implementation of the best available therapeutics. This document was created with the joint collaboration of medical specialists to give a local perspective to the management based on the best scientific evidence and in the context of the Central American and Caribbean region. This paper has the scientific and academic support of the Central American and Caribbean Society of Cardiology and is the first of its kind to address the problem and topic of hypertension. It was developed from a detailed review of the scientific evidence using the main medical search engines, selecting the pivotal and population-based studies with the highest level of evidence available. The intention is to provide simple information, with easy-to-implement recommendations to implement in the daily management of patients with arterial hypertension. This document had the logistic support of Servier Laboratory, both with the authors as well as its editing; however, the clinical information presented was not conditioned by the laboratory. This material is the responsibility of the authors.

Cardiac Involvement Due to COVID-19: Insights from Imaging and Histopathology.

Lingering cardiac symptoms are increasingly recognised complications of severe acute respiratory syndrome coronavirus 2 infection, now referred to as post-acute cardiovascular sequelae of COVID-19 (PASC). In the acute phase, cardiac injury is driven by cytokine release and stems from ischaemic and thrombotic complications, resulting in myocardial necrosis. Patients with pre-existing cardiac conditions are particularly vulnerable. Myocarditis due to a direct viral infection is rare. Chronic symptoms relate to either worsening of pre-existing heart disease (PASC - cardiovascular disease) or delayed chronic inflammatory condition due to heterogenous immune dysregulation (PASC - cardiovascular syndrome), the latter affecting a broad segment of previously well people. Both PASC presentations are associated with increased cardiovascular risk, long-term disability and reduced quality of life. The recognition and management of PASC in clinical settings remains a considerable challenge. Sensitive diagnostic methods are needed to detect subtler inflammatory changes that underlie the persistent symptoms in PASC - cardiovascular syndrome, alongside considerable clinical experience in inflammatory cardiac conditions.

Adoption of Sustainable Agriculture Practices through Participatory Research: A Case Study on Galapagos Islands Farmers Using Water-Saving Technologies.

Agriculture in the populated islands of the Galapagos Archipelago, a protected area due to its unique biodiversity, has been detrimental to its conservation but highly required to meet food necessities. A potential solution to make agricultural farming more sustainable is adopting water-saving technologies (WSTs). Therefore, this study aimed to test the effectiveness of using WSTs such as Groasis Waterboxx® in three of the most valuable crops in the islands through participatory research with the involvement of a group of farmers from the Floreana and Santa Cruz islands and explore a possible transition to more sustainable agricultural practices. Capsicum annuum, Cucumis sativus and Solanum lycopersicum were cultivated using Groasis Waterboxx® and compared to conventional irrigation practices (drip-irrigated controls) to assess the variability of productivity, the number of fruits and individual fruit weight (IFW). In addition, differences in plant traits were analyzed by crop, and island. Results suggested that WSTs such as Groasis Waterboxx® may provide on-farm benefits regarding the yields of the studied traits. From this study, it is difficult to determine whether participation in such a research study will permanently change irrigation practices. However, the participant's responses to the study suggest an increase in their understanding of the use and benefits of WST.

Genome editing in animals with minimal PAM CRISPR-Cas9 enzymes.

The requirement for Cas nucleases to recognize a specific PAM is a major restriction for genome editing. SpCas9 variants SpG and SpRY, recognizing NGN and NRN PAMs, respectively, have contributed to increase the number of editable genomic sites in cell cultures and plants. However, their use has not been demonstrated in animals. Here we study the nuclease activity of SpG and SpRY by targeting 40 sites in zebrafish and C. elegans. Delivered as mRNA-gRNA or ribonucleoprotein (RNP) complexes, SpG and SpRY were able to induce mutations in vivo, albeit at a lower rate than SpCas9 in equivalent formulations. This lower activity was overcome by optimizing mRNA-gRNA or RNP concentration, leading to mutagenesis at regions inaccessible to SpCas9. We also found that the CRISPRscan algorithm could help to predict SpG and SpRY targets with high activity in vivo. Finally, we applied SpG and SpRY to generate knock-ins by homology-directed repair. Altogether, our results expand the CRISPR-Cas targeting genomic landscape in animals.

[MIA 2021, Comprehensive Asthma Management. Guidelines for Mexico]. / MIA 2021, Manejo Integral del Asma. Lineamientos para México.

BACKGROUND: Asthma continues to be one of the most frequent chronic respiratory diseases in our country. New methods for diagnosis and treatment have been described; accordingly, the international guidelines were renewed. OBJECTIVE: To create a national platform for the development of updated guidelines, solidly based on evidence: Comprehensive Asthma Management (Spanish acronym: MIA). METHODS: MIA uses the ADAPTE method. The MIA development group consists of experts in pulmonology-allergology-methodology and representatives of 13 institutions and societies of specialties that manage asthma. The international reference guidelines (selected with AGREE-II): GINA 2020, GEMA 5.0, BTS/SIGN 2019 and ATS/ERS consensus document 2014-2019 on severe asthma. MIA covers suspected asthma, diagnosis, treatment, and special groups. Key clinical questions were formulated on treatment steps 1-3, biomarkers and severe asthma. RESULTS: Based on evidence, safety, cost and local reality, the core group developed responses. Through a Delphi process the broad MIA development group suggested adjustments until consensus was reached. CONCLUSION: A document was generated with multiple figures and algorithms, solidly based on evidence about asthma management, adjusted for Mexico with a broad base among different societies that participated in its development. It does not include guidelines for acute asthma.

Antecedentes: El asma sigue siendo una patología respiratoria crónica frecuente en México. Se han descrito nuevos métodos para el diagnóstico y tratamiento conforme se renuevan las guías internacionales. Objetivo: Crear la plataforma nacional Manejo Integral del Asma (MIA), para el desarrollo de lineamientos actualizados con base en evidencia. Métodos: Se utilizó el método ADAPTE. El grupo de desarrollo de MIA estuvo integrado por expertos en neumología, alergología y metodología y representantes de 13 instituciones y sociedades de especialidades que manejan asma. Las guías internacionales de referencia (seleccionadas con AGREE-II) fueron GINA 2020, GEMA 5.0, BTS/SIGN 2019 y consenso ATS/ERS 2014-2019. En MIA se aborda sospecha de asma, diagnóstico, tratamiento y grupos especiales. Se formularon preguntas clínicas clave sobre tratamiento en los pasos 1 a 3, biomarcadores y asma grave. Resultados: Con base en evidencia, seguridad, costo y realidad local, el grupo nuclear desarrolló respuestas. Mediante proceso Delphi, el grupo amplio de desarrollo sugirió ajustes hasta que se logró el consenso. Conclusión: El documento generado contiene múltiples figuras y algoritmos, está sólidamente basado en evidencia acerca del manejo del asma y fue ajustado para México con participación de diferentes sociedades para su desarrollo; no se incluyeron lineamientos para la crisis asmática.

Spatial and spatiotemporal clustering of the COVID-19 pandemic in Ecuador / Aglomeración espacial y espaciotemporal de la pandemia por COVID-19 en Ecuador

Abstract Introduction: In Ecuador, the first COVID-19 case, the disease caused by the SARS-CoV-2 virus, was officially reported on February 29, 2020. As of April 2, the officially confirmed numbers of COVID-19 cases and deaths from it were 3 163 and 120, respectively, that is, a mortality rate of 3.8%. Objective: To identify spatial and spatiotemporal clusters of COVID-19 cases officially confirmed in Ecuador. Materials and methods: Case series study. An analysis of all COVID-19 cases officially confirmed in Ecuador from March 13, 2020 to April 2, 2020 was performed. Relative Risk (RR) of COVID-19 contagion was determined using the discrete Poisson distribution model in the SaTScan software. Clusters were generated using purely spatial and spatiotemporal scan statistics. Significance of each cluster was obtained through 999 iterations using the Monte Carlo simulation, obtaining the most probable random model. Results: As of April 2, spatiotemporal clustering allowed identifying two clusters in Ecuador, a main cluster in the Guayas province (area: 15 430 km2; population: 3.6 million inhabitants; RR: 7.08; p<0.000001; calculated annual incidence 1700 cases / 100 000 people) and a secondary cluster in the Pichincha province (area: 88 904 km2; population: 7.1 million; RR: 0.38; p<0.000001; calculated annual incidence 737 cases / 100 000 people.) Conclusions: The implementation of COVID-19 mitigation strategies should be focused on areas of high transmission risk; therefore, spatial, and spatiotemporal clustering with SaTScan can be extremely useful for the early detection and surveillance of COVID-19 outbreaks.

Resumen Introducción. En Ecuador el primer caso de COVID-19, la enfermedad causada por el virus SARS-CoV-2, fue reportado oficialmente el 29 de febrero del 2020, y para el 2 de abril, las cifras oficiales de casos confirmados y de muertes ascendían a 3 163 y 120, respectivamente, con una tasa de mortalidad del 3.8% Objetivo. Identificar aglomerados espaciales y espaciotemporales de los casos de COVID-19 confirmados oficialmente en Ecuador. Materiales y métodos. Estudio de series de casos. Se analizaron todos los casos de COVID-19 confirmados oficialmente en Ecuador entre el 13 de marzo y el 2 de abril de 2020. El riesgo relativo (RR) de contagio se determinó en el programa SaTScan de acuerdo con el modelo de probabilidad discreta de Poisson, las aglomeraciones espaciales y espaciotemporales se detectaron con la estadística de rastreo espacial y la significancia estadística de cada aglomerado se determinó mediante 999 iteraciones usando la simulación Monte Carlo, obteniéndose el modelo aleatorio más probable. Resultados. Al 2 de abril, mediante la aglomeración espaciotemporal, fue posible identificar dos aglomerados en Ecuador, uno principal centrado en la provincia de Guayas (superficie: 15 430 km2, población: 3,6 millones de habitantes, RR: 7.08; p<0.000001 e incidencia anual calculada: 1 700 casos/100 000 habitantes) y uno secundario centrado en la provincia de Pichincha (superficie: 88 904 km2, población: 7.1 millones de habitantes, RR: 0.38, p<0.000001 e incidencia anual calculada: 737 casos/100 000 habitantes). Conclusiones. La implementación de las estrategias de mitigación del COVID-19 se debe enfocar en áreas de alto riesgo de transmisión; por tanto, los datos sobre aglomerados espaciales y espaciotemporales obtenidos con el programa SatScan pueden ser de gran utilidad en la detección temprana y vigilancia sanitaria de focos de COVID-19.

El sistema de salud colombiano, reflexiones sobre su influencia en la salud de la población / The Colombian health system: Reflections on its influence on the health of the population / O sistema de saúde colombiano, reflexões sobre sua influência na saúde da população

Los sistemas de salud son una respuesta social que se modifica y adapta según el momento y lugar en la historia; en la medida que las sociedades se complejizan, estos encuentran nuevos desafíos. Conocer este panorama facilita su interpretación. Este artículo presenta una reflexión que parte de reconocer los principales avances y limitaciones del sistema de salud colombiano, para ampliar el panorama frente a sus posibilidades y necesidades de configuración. Se analizan elementos sociopolíticos y económicos de contexto y se examinan los principales indicadores de salud usados para reflejar la manera como los sistemas de salud responden a la protección de la población. El Sistema General de Seguridad Social en Salud, creado a través de la Ley 100 de 1993, nació en el contexto del desmonte de los Estados de bienestar y el fortalecimiento del neoliberalismo. Con este se han logrando avances en el acceso a los servicios de salud de la población en mayores condiciones de pobreza, sin embargo, se continúan presentando brechas e inequidades. La Terapia Ocupacional no es ajena a estas cuestiones, sus acciones deben propender por el cierre de tales brechas e inequidades sociales.

Health systems are a social response modified and adapted according to the time and place in history. As societies become more complex, health systems face new challenges. Knowing this overview facilitates its interpretation. This article presents a reflection that starts from recognizing the main improvements and limitations of the Colombian health system to broaden the perspective regarding its configuration possibilities and needs. Elements of the socio-political and economic context are analyzed, and the primary health indicators used to reflect how health systems respond to the protection of the population are examined. The Sistema General de Seguridad Social en Salud (general system for social security in health), created by the Law 100 of 1993, was born in the context of dismantling the welfare states and the strengthening of neoliberalism. The system has enabled progress in the access to health services for the population in more critical poverty conditions. However, gaps and inequities are still present. Occupational Therapy is not alien to these issues; its actions should tend to close such gaps and social inequities.

Os sistemas de saúde são uma resposta social que se modifica e se adapta de acordo com o tempo e o lugar na história; À medida que as sociedades se tornam mais complexas, elas encontram novos desafios. Conhecer esse panorama facilita sua interpretação. Este artigo apresenta uma reflexão que parte do reconhecimento dos principais avanços e limitações do sistema de saúde colombiano, a fim de ampliar o panorama sobre suas possibilidades e necessidades de configuração. São analisados os elementos sociopolíticos e econômicos do contexto e examinados os principais indicadores de saúde que refletem a forma como os sistemas de saúde respondem à proteção da população. O Regime Geral de Previdência Social em Saúde, criado pela Lei nº 100 de 1993, nasceu no contexto de desmantelamento dos Estados de bem-estar e do fortalecimento do neoliberalismo. Com isso, houve avanços no acesso aos serviços de saúde para a população em maior condição de pobreza, porém, lacunas e iniquidades continuam aparecendo. A Terapia Ocupacional não é alheia a essas questões, suas ações devem tender a fechar tais lacunas e iniquidades sociais.

Insuficiencia Mitral Severa secundaria a "Cleft" Mitral Aislado: revisión a partir de un caso clínico / Severe Mitral Insufficiency secondary to Isolated Mitral Cleft: Review from a clinical case

Resumen El "cleft" mitral es un defecto congénito raro que se encuentra comúnmente asociado a otras patologías no obstante, en raras ocasiones puede encontrarse como un defecto aislado. Dicho hallazgo es de suma importancia desde el punto de vista clínico ya que es una causa reparable de insuficiencia mitral, sin necesidad de someterse a reemplazo valvular. Su diagnóstico es primariamente mediante ecocardiografía, en la que el uso del 3D como técnica permite la correcta delimitación de la extensión de la lesión, así como la valoración a detalle del resto del aparato valvular mitral. Presentamos un caso de Insuficiencia Mitral severa en la infancia de causa no clara en un inicio, en la cual, por medio de ecocardiografía transtorácica 3D se logró identificar una hendidura aislada de la valva anterior como etiología y descartar otras posibles etiologías y/o mecanismos.

Abstract Severe Mitral Insufficiency secondary to Isolated Mitral Cleft: Review from a clinical case Severe mitral valve reguritacion secondary to an Isolated cleft of the mitral valve: a review based on a clinical case Mitral Cleft is a rare congenital defect that is commonly associated with others pathologies; nevertheless, in rare occasions it can be found as an isolated defect. This finding is paramount from clinical perspective as it is a reparable defect and not necessarily ends in valvular replacement. Its assessment is primarily by transthoracic echocardiography with the addition of 3D technology that provides a more detailed delimitation of the extent of the lesion, as well as detailed assessment of the whole mitral valve apparatus. In this article, we present a case of severe mitral regurgitation without a clear ethiology at glance, but posteriorly identified with the aid of transthoracic 3D echocardiography, as an isolated mitral cleft and also, allowed to rule out other possible etiologies and mechanisms.

Barreras y facilitadores en la implementación de la estrategia de atención primaria en salud en Palmira, Colombia / Barriers and facilitators in the implementation of the primary health care strategy in Palmira, Colombia

RESUMEN Objetivo Conocer las barreras y facilitadores para la continuidad en la implementación de la estrategia de Atención Primaria en Salud en Palmira. Métodos Se tomó la experiencia de Atención Primaria en Salud (APS) del ente territorial de salud del Municipio de Palmira, Colombia, un territorio de aproximadamente 283 431 habitantes. Se usó el enfoque metodológico cualitativo mediante el análisis de contenido temático. La población objeto fueron los informantes clave, individuos con un papel potencialmente significativo en la formulación y desarrollo de la estrategia de APS, elegidos con un enfoque no probabilístico por conveniencia. La información se obtuvo de fuentes primarias y secundarias y se utilizó el software informático de análisis cualitativo Atlas Ti V7, como herramienta de apoyo para el manejo de datos. Resultados El análisis de barreras y facilitadores para la continuidad de la estrategia de APS identificó las principales características de la estrategia y una serie de temas recurrentes al momento de analizar las posibles barreras y facilitadores en los componentes de proceso, actores, contenido y contexto. Cada uno de estos temas presentó comportamientos diversos según la percepción de los participantes. Algunos temas fueron percibidos como facilitadores, barreras o como ambos. Conclusión Al comparar las barreras y facilitadores, se encontró que, a nivel global, son mayores las barreras que los facilitadores, comportamiento reflejado en la teoría, que indica que la población con algún tipo de vulnerabilidad presenta mayor cantidad de barreras frente a los servicios de salud y que la estrategia de APS hace especial énfasis en este tipo de población.

ABSTRACT Objective To know the barriers and facilitators for the continuity in the implementation of the Primary Health Care strategy in Palmira. Methods The Primary Health Care (PHC) experience was taken from the territorial health entity of the Municipality of Palmira, Colombia, which is a territory approximately with 283,431 habitants. The qualitative methodological approach was used through thematic content analysis. The target population was the key informants, individuals with a potentially significant role in the formulation and development of the PHC strategy, chosen with a non-probabilistic approach for convenience. The information was obtained from primary and secondary sources and the qualitative analysis computer software Atlas Ti V7 was used as a support tool for data management. Results The analysis of barriers and facilitators for the continuity of the PHC strategy, identified the main characteristics of the strategy and a series of recurring themes when analyzing the possible barriers and facilitators in the process components, actors, content, and context. Each of these themes presented different behaviors according to the perception of the participants, where some themes were perceived as facilitators, barriers, or both. Conclusión When comparing barriers and facilitators, it was found that globally the barriers are greater than facilitators, a behavior reflected in the theory since it indicates that the vulnerable population presents a greater number of barriers compared to health services and the strategy of APS places special emphasis on this type of population.

Amiloidosis cardiaca: estudio de caso y revisión bibliográfica / Cardiac amyloidosis: Case study and bibliographic review

Resumen La amiloidosis es una enfermedad multisistémica, originada por un plegamiento proteico anormal el cual a su vez genera su depósito y acumulación en diferentes tejidos. A nivel cardiovascular, el amiloide se deposita en el tejido miocárdico generando las manifestaciones típicas de la enfermedad. Presenta hallazgos electrocardiográficos y ecocardiográficos distintivos que proporcionan una ayuda invaluable en el diagnóstico de la amiloidosis cardiaca. En el presente artículo se expone un caso de un paciente portador de amiloidosis AL, quien exhibe síntomas de falla cardiaca y en el cual se documenta posteriormente severo compromiso cardiovascular. Además, se presenta una revisión de las manifestaciones cardiovasculares y el diagnóstico de dicha patología.

Abstract Amyloidosis is a multisystemic disease, originated by an abnormal protein folding which in turn generates its deposit and accumulation in different tissues. At a cardiovascular level, amyloid is deposited in the myocardial tissue and thus generating the typical manifestations of the disease. It presents distinctive electrocardiographic and echocardiographic findings that provide invaluable help in the diagnosis of cardiac amyloidosis. In this article, a case of a patient with AL amyloidosis is presented. Said patient developed symptoms of heart failure, which later progressed into severe cardiovascular compromise. Furthermore, a review of the cardiovascular manifestations and the diagnosis of said pathology is presented.

Análisis del Ventrículo derecho / Analysis of the right ventricle

Resumen El ventrículo derecho, históricamente, ha sido en gran medida olvidado e y la gran mayoría de las técnicas diagnósticas,los abordajes terapéuticos y las investigaciones clínicas están dirigidas al ventrículo izquierdo. Con una anatomía y fisiologíamuy diferente a su contraparte izquierda, el ventrículo derecho dispone de limitadas opciones terapéuticas cuando éste falla, lo cual empeora enormemente el pronóstico del paciente. La presente revisión pretende hacer un análisis de la anatomía, fisiología, fisiopatología, estudios de imagen y tratamiento de la falla ventricular derecha con el fin de retomar su importancia en la cardiología actual.

Abstract The right ventricle has been, historically, largely forgotten and the vast majority of diagnostic techniques, therapeutic approaches and clinical research are directed to the left ventricle. With a very different anatomy and physiology from its left counterpart, the right ventricle has limited therapeutic options when it fails, which greatly worsens the patient's prognosis. The present review intends to analyze the anatomy, physiology, physiopathology, imaging studies and treatment of right ventricular failure in order to resume its importance in current cardiology.

Interfaz cerebro-computador multimodal para procesos de neurorrehabilitación de miembros superiores en pacientes con lesiones de médula espinal: una revisión / Multimodal Brain-Computer Interface for Supporting Upper Limb neurorehabilitation processes in spinal cord injury patients: a review / Interface multimodal Cérebro-Computador para apoiar os processos de neurona-reabilitacão dos membros superiores em pacientes com lesão da medula espinhal: uma revisão

Resumen El número de trabajos relacionados con Interfaces Cerebro-Computador (BCI, Brain-Computer Interface en inglés) directamente aplicados al proceso de rehabilitación de pacientes con lesiones de médula espinal está en aumento debido a la mejora en las técnicas de procesamiento digital de señales y reconocimiento de patrones que permiten relacionar las señales electroencefalográficas con acciones motoras. Los resultados preliminares de las pruebas de las BCI sobre sujetos reales permiten visualizar en un futuro relativamente cercano la inclusión de este tipo de herramientas en los protocolos de rehabilitación. Sin embargo, hay muchas barreras por resolver, principalmente las relacionadas con el aumento del desempeño y la generación de múltiples comandos naturales mediante interfaces cerebro-computador a partir de electroencefalografía superficial (EEG). En este trabajo se hace una revisión de los más importantes trabajos que muestran la evolución, el estado actual y las oportunidades de investigación alrededor de la temática de interfaces cerebro-computador en procesos de neurorrehabilitación de miembros superiores en pacientes con lesiones medulares.

Abstract The number of researches related to rehabilitation processes in spinal cord injury patients using Brain-Computer Interfaces is increasing due to the development of improved digital signal processing and pattern recognition techniques that allows decoding motor actions from electroencephalographic signals. Preliminary results on the application of BCI with real experimental subjects allow to envision a rehabilitation scenario using this kind of technology as part of the therapeutic protocols in a near future. Yet, some problems need to be solved: improve target detection performance and the generation of natural commands by non-invasive brain-computer interfaces based on surface electroencephalography are some of them. In this work, we make a review of the most important researches to exhibit the evolution, the current status, and the research opportunities on the use of brain-computer interfaces for upper limb neurorehabilitation in spinal cord injury patients.

Resumo O número de trabalhos relacionados com Interfaces Cérebro-Computador (BCI, Brain-Computer Interface en inglés) diretamente aplicado no processo de reabilitação de pacientes com lesões de medula espinal está no aumento e a melhoria nas técnicas de processamento digital de sinais e reconhecimento de patrones que permitam relacionar as seqüências de eletroencefalográficas com ações motoras. Os resultados preliminares das provas de BCI sobre sujeitos reais permitem visualizar em um futuro, mais perto da inclusão deste tipo de ferramentas em protocolos de reabilitação. Sin embargo, feno muitas barreras por resolver, principalmente as relacionadas com o aumento do desempenho e a geração de comandos comandos por meio de interfaces cerebro-computador a partir de electroencefalografía superficial (EEG). No presente trabalho, a empresa tem uma revisão dos mais importantes trabalhos e mostra as evoluções, o estado real e as oportunidades de pesquisa em torno da temática de interfaces cerebro-computador em processos de neurorrehabilitação de supostos superiores en pacientes com lesiones medulares.

Pediatric asthma treatment: What to do when international guideline recommendations do not agree.

BACKGROUND: There was a need for a solid asthma guideline in Mexico to update and unify asthma management. Because high-quality asthma guidelines exist worldwide, in which the latest evidence on asthma management is summarized, the ADAPTE approach allows for the development of a national asthma guideline based on evidence from already existing guidelines, adapted to national needs. OBJECTIVE: To fuse evidence from the best asthma guidelines and adapt it to local needs with the ADAPTE approach. METHODS: The Appraisal of Guidelines for Research and Evaluation (AGREE) II asthma guidelines were evaluated by a core group to select 3 primary guidelines. For each step of asthma management, clinical questions were formulated and replied according to (1) evidence in the primary guidelines, (2) safety, (3) Cost, and (4) patient preference. The Guidelines Development Group, composed of a broad range of experts from medical specialties, primary care physicians, and methodologists, adjusted the draft questions and replies in several rounds of a Delphi process and 3 face-to-face meetings, taking into account the reality of the situation in Mexico. We present the results of the pediatric asthma treatment part. RESULTS: Selected primary guidelines are from the British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN), Global Initiative for Asthma (GINA), and Spanish Guidelines on the Management of Asthma (GEMA) 2015, with 2016 updates. Recommendations or suggestions were made for asthma treatment in Mexico. In this article, the detailed analysis of the evidence present in the BTS/SIGN, GINA, and GEMA sections on the (non) pharmacologic treatment of pediatric asthma, education, and devices are presented for 2 age groups: children 5 years or younger and children 6 to 11 years old with asthma. CONCLUSION: For the pediatric treatment and patient education sections, applying the AGREE II and Delphi methods is useful to develop a scientifically sustained document, adjusted to the Mexican situation, as is the Mexican Guideline on Asthma.

[Mexican Asthma Guidelines: GUIMA 2017]. / Guía Mexicana del Asma: GUIMA 2017.

BACKGROUND: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. METHODS: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. RESULTS: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. CONCLUSIONS: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.

Antecedentes: Con el objetivo de unificar el manejo del asma en México se estructuró una guía clínica que conjunta el conocimiento de diversas especialidades y la atención en el primer nivel de contacto. Se seleccionaron 3 guías publicadas en el ámbito internacional para su transculturación. Métodos: Conforme a la metodología ADAPTE se usó AGREE II después de la búsqueda bibliográfica de guías sobre asma publicadas entre 2007 y 2015. Se fusionó la realidad local con la evidencia de 3/40 mejores guías. El documento inicial fue sometido a la revisión de representantes de 12 sociedades médicas en varias rondas Delphi hasta llegar a la versión final. Resultados: Las guías base fueron la British Thoracic Society Asthma Guideline 2014, la Global Initiative on Asthma 2015 y la Guía Española del Manejo del Asma 2015. Después de 3 rondas Delphi se desarrolló un documento en el que se consideraron las características de los pacientes según edad, costos de los tratamientos y perfiles de seguridad de los fármacos disponibles en México. Conclusión: Con la cooperación de neumólogos, alergólogos, otorrinolaringólogos, pediatras y médicos generales se llegó a un consenso basado en evidencia, en el que se incluyeron recomendaciones sobre prevención, diagnóstico y tratamiento del asma y sus crisis.

Microbiología de lavado broncoalveolar en lactantes con neumonía bacteriana adquirida en la comunidad de mala evolución / Microbiology of bronchoalveolar lavage in infants with bacterial community-acquired pneumonia with poor outcome

ResumenIntroducción: La neumonía adquirida en la comunidad (NAC) es una de las causas infecciosas más frecuentes de morbi-mortalidad a escala mundial en niños menores de 5 años. El objetivo del estudio fue precisar el diagnóstico bacteriano etiológico en lactantes con NAC.Métodos: Se condujo un estudio prospectivo, transversal y descriptivo en 17 pacientes de 6 meses a 2 años 11 meses de edad con NAC de mala evolución, que ingresaron al servicio de Neumología pediátrica. A los pacientes se les realizó broncoscopia con lavado broncoalveolar (LBA) con las medidas pertinentes durante el procedimiento para limitar el riesgo de contaminación.Resultados: Las bacterias aerobias aisladas fueron Moraxella sp. (23%), Streptococcus mitis (23%), Streptococcus pneumoniae (18%), Haemophilus influenzae (12%), Streptococcus oralis (12%), y Streptococcus salivarius (12%).Conclusiones: En contraste con otros informes se observó que Moraxella sp. es un importante patógeno potencial bacteriano, posiblemente debido a la mejora en la detección con broncoscopia más LBA.

AbstractBackground: Community-acquired pneumonia (CAP) is one of the most common infectious causes of morbidity and mortality in children <5 years of age. The aim of the study was to clarify the bacterial etiologic diagnosis in infants with CAP.Methods:A prospective, cross-sectional and descriptive study in patients 6 months to 2 years 11 months of age with CAP with poor outcome was conducted. Patients were admitted to the Pediatric Pneumology Service and underwent bronchoscopy with bronchoalveolar lavage (BAL), taking appropriate measures during the procedure to limit the risk of contamination.Results: Aerobic bacteria isolated were Moraxella sp. 23%, Streptococcus mitis 23%, Streptococcus pneumoniae 18%, Haemophilus influenzae 12%, Streptococcus oralis 12%, and Streptococcus salivarius 12%.Conclusions: In contrast to other reports, we found Moraxella sp. to be a major bacterial pathogen, possibly because of improved detection with bronchoscopy plus BAL.

[Microbiology of bronchoalveolar lavage in infants with bacterial community-acquired pneumonia with poor outcome]. / Microbiología de lavado broncoalveolar en lactantes con neumonía bacteriana adquirida en la comunidad de mala evolución.

BACKGROUND: Community-acquired pneumonia (CAP) is one of the most common infectious causes of morbidity and mortality in children <5 years of age. The aim of the study was to clarify the bacterial etiologic diagnosis in infants with CAP. METHODS: A prospective, cross-sectional and descriptive study in patients 6 months to 2 years 11 months of age with CAP with poor outcome was conducted. Patients were admitted to the Pediatric Pneumology Service and underwent bronchoscopy with bronchoalveolar lavage (BAL), taking appropriate measures during the procedure to limit the risk of contamination. RESULTS: Aerobic bacteria isolated were Moraxella sp. 23%, Streptococcus mitis 23%, Streptococcus pneumoniae 18%, Haemophilus influenzae 12%, Streptococcus oralis 12%, and Streptococcus salivarius 12%. CONCLUSIONS: In contrast to other reports, we found Moraxella sp. to be a major bacterial pathogen, possibly because of improved detection with bronchoscopy plus BAL.

[ARIA Mexico 2014. Adaptation of the Clinical Practice Guide ARIA 2010 for Mexico. Methodology ADAPTE]. / ARIA México 2014. Adaptación de la Guía de Práctica Clínica ARIA 2010 para México. Metodología ADAPTE.

BACKGROUND: The global prevalence of allergic rhinitis is high. International Study of Asthma and Allergies in Childhood (ISAAC) Phase III reports a total estimated prevalence of 4.6% in Mexico. There is evidence based on allergic rhinitis Clinical Practice Guidelines (CPG), but its promotion, acceptance and application is not optimal or adequate in Mexico. OBJECTIVE: To generate a guideline for the treatment of allergic rhinitis and its impact on asthma by adaptating the 2010 ARIA Guideline to Mexican reality, through a transculturation process applying the ADAPTE methodology. PATIENTS AND METHOD: Using the ADAPTE Methodology, the original 2010 ARIA CPG recommendations were evaluated by the guideline development group (GDG) into which multiple medical specialities managing patients with allergic rhinitis were incoorporated. The GDG valorated the quality of 2010 ARIA, checked and translated key clinical questions. Moreover, the GDG adjusted recommendations, patient preferences and included comments in the context of the Mexican reality (safety, costs and cultural issues). To accomplish this, we ran Delphi panels with as many rounds as necessary to reach agreement. One extra question, not included in the original 2010 ARIA, on the use of Nasal Lavages for AR was created sustained by a systematic literature review. RESULTS: A total of 45 questions from the original 2010 ARIA were included and divided into six groups covering prevention, medical treatment, immunotherapy and alternative medicine to treat patients with allergic rhinitis with or without asthma. Most of the questions reached agreement in one or two rounds; one question required three rounds. CONCLUSIONS: An easy-to-use, adaptated, up-to-date and applicable allergic rhinitis guideline for Mexico is now available.

ANTECEDENTES: la prevalencia de rinitis alérgica en todo el mundo es alta. El Estudio Internacional de Asma y Alergias en la Niñez (ISAAC de International Study of Asthma and Allergies in Childhood) Fase III reporta una prevalencia estimada total en México de 4.6%. Existen guías de práctica clínica basadas en evidencia de rinitis alérgica, pero su promoción, aceptación y validez no son óptimas ni adecuadas para México. OBJETIVO: generar una guía de tratamiento de la rinitis alérgica y su repercusión en el asma adaptando la guía ARIA 2010 a la realidad mexicana mediante un proceso de transculturización, por medio de la metodología ADAPTE. MATERIAL Y MÉTODO: a través de la metodología ADAPTE un grupo de desarrollo de la guía, integrado por múltiples especialistas que tratan pacientes con rinitis alérgica, valoró la calidad de la guía ARIA 2010, revisó y tradujo las preguntas clínicas clave y ajustó las recomendaciones, preferencias del paciente y comentarios a la realidad mexicana (seguridad, costos y aspectos culturales). Para lograrlo se corrieron páneles Delphi, con tantas rondas como fuera necesario hasta lograr un acuerdo. Por medio de una revisión sistemática de la bibliografía se creó una pregunta especial no incluida en ARIA 2010 de la utilidad de realizar lavados nasales en pacientes con rinitis alérgica. RESULTADOS: se incluyeron 45 preguntas de la guía original ARIA 2010, divididas en seis bloques que abarcan prevención, tratamiento médico, inmunoterapia y terapias alternativas de pacientes con rinitis alérgica con o sin asma. La mayor parte de las preguntas alcanzaron acuerdo en una a dos rondas, sólo una requirió tres para ello. CONCLUSIONES: se cuenta ahora con una guía de rinitis alérgica de usosencillo, adaptada, actualizada y válida para México.

La enseñanza en servicios de salud caso Costa Rica / Education in health services Costa Rica case

La docencia en salud se distingue por ser una actividad de enseñanza y aprendizaje que se inicia en el aula y luego se completa en el hospital, en centros de atención primaria o secundaria, en la comunidad o en el seno familiar. Este ensayo se orienta en hacer un análisis de este tipo de docencia y su contribución en el desarrollo del personal que luego se desempeñará en diferentes espacios laborales de los servicios de salud. Se plantean algunos elementos relacionados con el enfoque de recursos humanos que se da a partir de la modernización de los servicios de salud y el vínculo entre docencia, servicios asistenciales e investigación

Dnmt3a regulates emotional behavior and spine plasticity in the nucleus accumbens.

Despite abundant expression of DNA methyltransferases (Dnmts) in brain, the regulation and behavioral role of DNA methylation remain poorly understood. We found that Dnmt3a expression was regulated in mouse nucleus accumbens (NAc) by chronic cocaine use and chronic social defeat stress. Moreover, NAc-specific manipulations that block DNA methylation potentiated cocaine reward and exerted antidepressant-like effects, whereas NAc-specific Dnmt3a overexpression attenuated cocaine reward and was pro-depressant. On a cellular level, we found that chronic cocaine use selectively increased thin dendritic spines on NAc neurons and that DNA methylation was both necessary and sufficient to mediate these effects. These data establish the importance of Dnmt3a in the NAc in regulating cellular and behavioral plasticity to emotional stimuli.