Late gadolinium enhancement and the risk of ventricular arrhythmias and sudden death in NYHA class I patients with non-ischaemic cardiomyopathy.

AIM: To compare the risk of ventricular arrhythmias (VA) and sudden death (SD) between New York Heart Association (NYHA) class I and NYHA class II-III patients with non-ischaemic cardiomyopathy (NICM). METHODS AND RESULTS: Observational retrospective cohort study including patients with NICM who underwent cardiac magnetic resonance at two hospitals. The primary endpoint included appropriate implantable cardioverter defibrillator (ICD) therapies, sustained ventricular tachycardia, resuscitated cardiac arrest and SD. The secondary endpoint included heart failure (HF) hospitalizations, heart transplant, left ventricular assist device implant or HF death. Overall, 698 patients were included, 33% in NYHA class I. During a median follow-up of 31 months, the primary endpoint occurred in 57 patients (8%), with no differences between NYHA class I and NYHA class II-III cases (7% vs. 9%, p = 0.62). Late gadolinium enhancement (LGE) was the only independent predictor of the primary outcome both in NYHA class I and NYHA class II-III patients. LGE+ NYHA class I patients had a similar cumulative incidence of the primary endpoint as compared to LGE+ NYHA class II-III (p = 0.92) and a significantly higher risk as compared to LGE- NYHA class II-III cases (p < 0.001). The risk of the secondary endpoint was significantly higher in patients in NYHA class II-III as compared to those in NYHA class I (hazard ratio 3.2, p = 0.001). CONCLUSIONS: Patients with NICM in NYHA class I are not necessarily at low risk of VA and SD. Actually, LGE+ NYHA class I patients have a high risk. NYHA class I patients with high-risk factors, such as LGE, could benefit from primary prevention ICD at least as much as those in NYHA class II-III with the same risk factors.

Heterotopías sexuales, una localización epistemológica / Sexual heterotopies, an epistemological localization / Heterotopias sexuais, uma localização epistemológica

Resumen El presente ensayo analiza el concepto de «heterotopía¼ propuesto por Michel Foucault como una localización epistemológica a propósito de las imbricaciones existentes entre las dimensiones espaciales y sexuales. Así, el objetivo de este ensayo es trazar una asociación entre la vida urbana y aquellas libertades singulares que se pretender obtener en el imaginario de una ciudad. Para tales cometidos el texto reúne una serie de entrevistas etnográficas que engloban, por un lado, la caracterización de un desplazamiento localizado por varones homosexuales y, por el otro, un recurso epistemológico para pensar dichos movimientos espaciales.

Abstract The present essay analyzes the concept of "heterotopía" proposed by Michel Foucault as an epistemological location with regard to the imbrications existing between the spatial and sexual dimensions. Thus, the aim of this essay is to draw an association between urban life and those singular freedoms that are intended to obtain in the imaginary of a city. For such tasks the text brings together a series of ethnographic interviews that include, on the one hand, the characterization of a displacement located by homosexual men and, on the other, an epistemological resource to think about these spatial movements.

Resumo O presente ensaio analisa o conceito de "heterotopia" proposto por Michel Foucault como uma localização epistemológica em relação às imbricações existentes entre as dimensões espacial e sexual. Assim, o objetivo deste ensaio é traçar uma associação entre a vida urbana e as liberdades singulares que se pretende obter no imaginário de uma cidade. Para tais tarefas, o texto reúne uma série de entrevistas etnográficas que incluem, por um lado, a caracterização de um deslocamento localizado por homens homossexuais e, por outro, um recurso epistemológico para pensar sobre esses movimentos espaciais.

Reassimilation of ammonium in Lotus japonicus.

This review summarizes the most recent results obtained in the analysis of two important metabolic pathways involved in the release of internal sources of ammonium in the model legume Lotus japonicus: photorespiratory metabolism and asparagine breakdown mediated by aparaginase (NSE). The use of photorespiratory mutants deficient in plastidic glutamine synthetase (GS2) enabled us to investigate the transcriptomics and metabolomic changes associated with photorespiratory ammonium accumulation in this plant. The results obtained indicate the existence of a coordinate regulation of genes involved in photorespiratory metabolism. Other types of evidence illustrate the multiple interconnections existing among the photorespiratory pathway and other processes such as intermediate metabolism, nodule function, and secondary metabolism in this plant, all of which are substantially affected in GS2-deficient mutants because of the impairment of the photorespiratory cycle. Finally, the importance of asparagine metabolism in L. japonicus is highlighted because of the fact that asparagine constitutes the vast majority of the reduced nitrogen translocated between different organs of this plant. The different types of NSE enzymes and genes which are present in L. japonicus are described. There is a particular focus on the most abundant K(+)-dependent LjNSE1 isoform and how TILLING mutants were used to demonstrate by reverse genetics the importance of this particular isoform in plant growth and seed production.

Glutamine synthetase in legumes: recent advances in enzyme structure and functional genomics.

Glutamine synthetase (GS) is the key enzyme involved in the assimilation of ammonia derived either from nitrate reduction, N(2) fixation, photorespiration or asparagine breakdown. A small gene family is encoding for different cytosolic (GS1) or plastidic (GS2) isoforms in legumes. We summarize here the recent advances carried out concerning the quaternary structure of GS, as well as the functional relationship existing between GS2 and processes such as nodulation, photorespiration and water stress, in this latter case by means of proline production. Functional genomic analysis using GS2-minus mutant reveals the key role of GS2 in the metabolic control of the plants and, more particularly, in carbon metabolism.

Teorías y modelos de enfermería. Una aproximación a la lectura crítica / Nursing theories and models. An approach to critical reading

Resumen

Introducción: la educación en enfermería a través del tiempo ha sido rutinaria y pasiva lo que requiere desarrollar aptitudes de tipo reflexivo, que reflejen una actuación profesional de calidad para la atención del paciente, para ello demanda tener habilidades como la lectura crítica que al desarrollarla permite el florecimiento de una actitud crítica la cual lleva implícito el desarrollo de la autocrítica.

Objetivo: comparar el nivel de desarrollo para la habilidad de lectura crítica de textos de teorías y modelos de enfermería alcanzada mediante dos estrategias educativas diferenciadas.

Metodología: estudio cuasiexperimental, con un grupo experimental (GE) integrado por 12 alumnos del 7° semestre de Licenciatura de Enfermería y un grupo control (GC) conformado por 11 alumnos del mismo semestre. Para estimar el grado de desarrollo de habilidad para la lectura crítica de textos teóricos se utilizó un instrumento cuyo índice de confiabilidad fue de 0.96. El GE fue sometido a una estrategia que promueve ambientes propicios para la reflexión y crítica, el grupo control fue continuo con la enseñanza habitual.

Resultados: en la medición basal no se encontraron diferencias significativas entre ambos grupos. Al comparar los grupos posterior a la intervención, encontramos diferencia estadísticamente significativa para el GE.

Conclusiones: un ambiente propicio para confrontar la experiencia con la literatura científica y someterla a la crítica en este caso sobre teorías y modelos de enfermería favorece el desarrollo de la aptitud para la lectura crítica de textos teórico.

Summary

Introduction: through the years nursing education has been monotonous and passive so it requires to develop reflexive skills that reflect a professional performance and quality patient care, thus it is necessary to apply abilities such as critical reading that allows the development of a critical attitude which implies the evolution to self-criticism.

Objective: in order to compare the level of skill development for critical reading of texts, in nursing theories and models, achieved by two different educational strategies.

Methodology: a quasi-experimental study was conducted with an experimental group (GE) composed of 12 students of 7th semester of Bachelor in Nursing and a control group (GC) composed of 11 students in the same semester. To estimate the degree of skill development for critical reading of theoretical texts an instrument of which reliability index was 0.96 was used. The GE was subjected to a strategy that fosters reflective and critical environments, the GC kept regular education.

Results: in the baseline measurement there were no significant differences between groups. When comparing post-intervention groups, we found statistically significant difference for the GE.

Conclusions: a conducive environment to confront the experience with scientific literature and to subject it to criticism, in this case on nursing theories and models, favors the development of skills for critical reading of theoretical texts.

[Development of critical reading on theoretical papers. Criticism of the teaching performance]. / Desarrollo de lectura crítica de textos teóricos. Crítica a la actuación docente.

BACKGROUND: The critical reading development requires the reader get involved with author idea, systematizing, arguing and debating the information sources. Our objective was to evaluate the development of the skill to critical reading of theoretical text in education with an educational strategies aimed to promote active participation. METHODS: A study of intervention, comparative, multicentre and prospective with five groups of students was designed An instrument was refined and validated to measure the critical reading ability of theoretical text before and after the educational strategies, that had in common the aim to favor development critical reading from the participative approach of the education. RESULTS: Before the educational intervention the D group and E group had higher median score showing statistical difference (p = 0.02) than the other control groups. After educational intervention the skill for critical reading was similar (p = 0.20). CONCLUSIONS: Teaching performance during the development of educational strategy promotes the participation that favors in a similar way the critical reading of theoretical texts.

Aproximación a la lectura crítica de textos teóricos de enfermería. Elaboración y validación de un instrumento / Approaching to critical reading of theoretical nursing texts. Elaboration and validation of an instrument

Introducción: Desarrollar aptitudes que faciliten el camino para el aprendizaje y la elaboración del conocimiento a los alumnos de la licenciatura de enfermería es básico para su formación, entre ellas la lectura crítica de textos teóricos. Considerar estos atributos en el proceso educativo requiere de poner énfasis a la forma en que se construyen instrumentos que se aproximen a la realidad objetiva de la evaluación. Objetivo: Construir y validar un instrumento que permita identificar la forma en que los alumnos de licenciatura de enfermería se aproximan a las fuentes de información de textos teóricos durante su proceso formativo. Metodología: Se construyó y validó un instrumento de lectura crítica de textos teóricos en enfermería, posterior a la revisión y análisis por un grupo de expertos en lectura crítica, el instrumento quedó conformado por 86 items y se aplicó a un grupo piloto (estudiantes del 7º semestre de la licenciatura en enfermería). Resultados: La consistencia interna se determinó mediante la prueba de Kuder-Richardson No. 21, resultando un índice de 0.96. Discusión: El proceso de construcción y validación de un instrumento requiere de una vigilancia epistemológica del desarrollo y fortalecimiento de una postura que dé coherencia, pertinencia y congruencia a la educación como parte del acto educativo.

Introduction: Developing aptitudes to facilitate the pathway toward the learning process and the elaboration of knowledge in students of baccalaureate in nursing is basic for their formation, among those, the critical reading of theoretical texts. In order to consider these attributes in the learning process, a special emphasis on the way in which the instruments of evaluation are built is required. These instruments need to be close to the objective reality of the evaluation. Objetive: To construct and validate an instrument that allows identifying the way how baccalaureates in nursing students approach to theoretical sources of information during their formation process. Methodology: An instrument of critical reading of theoretical texts was constructed and validated, after a reviewing and analysis by a group of experts in critical reading. The instrument was integrated by 86 items and was applied to a pilot group (students in the level of the seventh semester of baccalaureate in nursing). Results: The internal consistency was determined through the Kuder-Richardson test, number 21, and coming out score of 0.96. Discussion: Construction and validity process for an instrument need to be survillace on its epistemology development and reinforcement in order to get a posture with coherence, pertinence and congruence as a part of evaluation on the educative process.

Evaluación de la aptitud clínica en diabetes mellitus de los médicos internos de pregrado / Evaluation of clinical interns for their clinical aptitude in diabetes mellitus

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Aspectos legales de la relación médico-paciente / Legal aspect of the relationship physician-patient

Tradicionalmente los aspectos legales relacionados con la profesión médica han sido soslayados por quienes la ejercen; un tanto porque los consideran desvinculados de su actividad y porque, hasta hace poco, el modelo de atención prevaleciente transcurría de tal manera que los pacientes rara vez se inconformaban y acudían a instancias judiciales. Al estar los pacientes más enterados de los derechos que les asiste y al notar transgresiones en su atención, entablan cada vez más demandas de orden civil o penal en contra de quienes los atienden. Por ello, es necesario que los médicos recuerden la necesidad de allegarse a los conocimientos legales básicos que rigen su profesión

Diabetes mellitus insulino requiriente: una proposición nueva respecto a la clasificación actual / Insulin-requerent diabetes mellitus: the purpose new to current classification

El objetivo de la presente comunicación es introducir el término de diabetes mellitus insulino requiriente dentro de la clasificación actual de la Diabetes Mellitus, la razón para proponer dicha modificación es que de esta forma se contemplarían a todos aquellos pacientes que son tratados con hipoglucemiantes orales y que por determinadas circunstancias son candidatos a utilizar insulina en forma temporal, por estrés emocional, quirúrgico o infecciones, para continuar posteriormente con su tratamiento a base de hipoglucemiantes orales