Etapa subaguda de pos-COVID-19 grave o crítico. Rehabilitación musculoesquelética, respiratoria y uso de corticoides. Experiencia de la Unidad de Rehabilitación del Hospital del Banco de Seguros del Estado (URHBSE)

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Introduction: In patients with severe or critical COVID-19, the use of prednisone and musculoskeletal and respiratory rehabilitation has been described. The role of these interventions and the optimal time for their initiation are not clearly established. This study presents the results of the Rehabilitation Unit of the Banco de Seguro del Estado Hospital, which implemented a comprehensive rehabilitation program and the use of corticosteroids in the subacute stage of patients with severe or critical post-COVID-19, with a systematic approach, working interdisciplinary and centered on the person being treated. Findings at admission, oxygen requirement, Barthel scale, tomographic patterns, use of corticosteroids, their response, and complications are reported. The results of this approach on clinical, respiratory, and functional variables are described. Method: Descriptive, retrospective study of post-COVID-19 patients who completed rehabilitation at the Rehabilitation Unit of the Banco de Seguros del Estado Hospital (URHBSE) in the period April-August 2021. Data obtained from review of medical records, statistical analysis with PRISM (v8.2.1). Results: Eighty-four patients completed the rehabilitation program. Upon admission to the URHBSE, 55% had total or severe dependence on the Barthel scale. Forty-eight percent were unable to walk. Eighty-nine-point two percent required oxygen, with a mean saturation of 90.3 ± 4.8. Twenty-five percent of patients were admitted requiring a reservoir mask. All patients who entered the program were in the subacute phase of the disease (4 to 12 weeks) and received a comprehensive and individualized rehabilitation plan. The objective was to achieve a functional situation similar to what they had before COVID-19. The length of stay at the URHBSE was 23.5 ± 13.8 days. A total of 76 patients (90.5%) underwent high-resolution chest tomography (HRCT), which was pathological in 96.1% of cases. The predominant findings were ground-glass opacity in 49.3% of cases, consolidation in 8.23%, and a fibrosis-like pattern in 30.13%. "Non-typical" post-COVID damage tomographic alterations were detected (pleural effusion, cavitary nodules, apical cavities, etc.) in 11.8% of the tomographies. In 2 patients (2.6%), pulmonary aspergillosis was found, and in 6.6%, pulmonary thromboembolism. Forty-four patients (52.3%) received prednisone. In 63.4% of cases, oxygen supplementation was discontinued within the first 15 days from the start of prednisone. We found an association between the ground-glass opacity tomographic pattern and early discontinuation of oxygen supplementation from the start of prednisone (p = 0.047). Despite the high degree of colonization, we did not observe infections by colonizing microorganisms, even in those who used prednisone. Comparing admission and discharge, statistically significant differences were found in the following parameters: degree of dyspnea, oxygen requirement (only one patient was discharged with oxygen), saturation, degree of instrumentation (tracheostomy, nasogastric tube, etc.), and the Barthel dependency scale. Regarding respiratory variables, we only have data on the presence of dyspnea in the first 35 patients. Of these, 83% had dyspnea at admission, while only 17% had it at discharge (p < 0.0001). There were also significant differences in the oxygen requirement between admission and discharge (p < 0.0001) and in the degree of dependency measured on the Barthel scale. Fifty-five percent of patients had total or severe dependence at admission, compared to only 3.4% at discharge. Conclusions: The interventions carried out in the subacute stage of the disease were associated with significant improvements in clinical variables of interest. More studies are needed to define the role and the exact timing of the initiation of corticosteroids and rehabilitation in this group of patients.

Introdução: O uso de prednisona e reabilitação musculoesquelética e respiratória foi descrito no tratamento de pacientes com COVID-19 grave ou crítico. O papel destas intervenções e o momento ideal para o seu início não estão claramente estabelecidos. Este trabalho mostra os resultados da Unidade de Reabilitação Hospitalar do Banco de Seguro del Estado que implementou um programa abrangente de reabilitação e uso de corticosteroides na fase subaguda de pacientes graves ou críticos pós-COVID-19, com uma abordagem sistematizada, trabalhando de forma interdisciplinar e centrada no paciente. São relatados os achados na admissão, a necessidade de oxigênio, a escala de Barthel, os padrões tomográficos, o uso de corticosteroides, a resposta ao tratamento e as complicações. Os resultados desta abordagem sobre variáveis clínicas, respiratórias e funcionais são descritos. Material e métodos: Estudo descritivo e retrospectivo de pacientes pós-COVID-19 que completaram reabilitação na Unidade de Reabilitação do Hospital Banco de Seguros del Estado (URHBSE) no período de abril a agosto de 2021. Os dados foram obtidos dos prontuários de pacientes com posterior análise estatísticas usando PRISM (v8.2.1). Resultados: 84 pacientes completaram o programa de reabilitação. No momento da admissão na URHBSE, 55% apresentavam dependência total ou grave da escala de Barthel. 48% não conseguiam se mover. 89,2% necessitaram oxigênio com saturação média de 90,3 ± 4,8. 25% dos pacientes foram internados necessitando máscara com reservatório. Todos os pacientes que ingressaram no programa estavam na fase subaguda da doença (4 a 12 semanas) e receberam um plano de reabilitação abrangente e individualizado. O objetivo era alcançar uma situação funcional semelhante à que apresentavam antes da COVID-19. O tempo de permanência na URHBSE foi de 23,5±13,8 dias. A tomografia de tórax de alta resolução (TCAR) foi realizada em 76 pacientes (90,5%); os resultados foram patológicos em 96,1%. O vidro fosco predominou em 49,3% deles, a consolidação em 8,23% e o padrão fibroso em 30,13%. Alterações tomográficas "atípicas" de danos pós-COVID (derrame pleural, nódulos cavitados, cavidades apicais, etc.) foram detectadas em 11,8% dos exames tomográficos. Aspergilose pulmonar foi encontrada em 2,6% dos pacientes e tromboembolismo pulmonar em 6,6%. 44 pacientes (52,3%) receberam prednisona. Em 63,4% a oferta de oxigênio foi suspensa nos primeiros 15 dias após o início da mesma. Encontramos associação entre o padrão tomográfico em vidro fosco e a suspensão precoce da oferta de oxigênio desde o início da administração da prednisona (p = 0,047). Apesar do alto grau de colonização, mesmo naqueles que usaram prednisona, não observamos infecções. Em relação às variáveis respiratórias, só temos dados sobre a presença de dispneia nos primeiros 35 pacientes; destes, 83% apresentavam dispneia na admissão, enquanto apenas 17% a apresentavam na alta (p< 0,0001). Observou-se também diferenças significativas na necessidade de O2 entre a admissão e a alta (p< 0,0001) e no grau de dependência medido pela escala de Barthel, com 55% dos pacientes apresentando dependência total ou grave na admissão e apenas 3,4% na alta. Conclusões: As intervenções realizadas na fase subaguda da doença foram associadas a melhorias significativas nas variáveis de interesse clínico. São necessários mais estudos para definir o papel e o momento exato do início dos corticosteroides e da reabilitação neste grupo de pacientes.

Arsenic, lead and cadmium concentration in food and estimated daily intake in the Cuban population and the health risks using a Total Diet Study.

This study estimates the intake of arsenic, lead and cadmium by the adult population (aged 18-91) of Cuba. The food consumption indices were obtained through 24-h dietary recall surveys applied to 450 people between October 2020 and March 2021. The Estimated Dietary Intake (EDI) of t-As (54.6 µg/day), Pb (118.5 µg/day) and Cd (35.1 µg/day) complied with Cuban legislation but was higher than the EDI for Cd established by the CONTAM Panel. The Target Hazard Quotients for the three contaminants were: iAs (0.220), Pb (0.409) and Cd (0.424), making the value of the Total Target Hazard Quotient 1.05, which indicates potential health risks for the population. Additionally, associated carcinogenic risks were: iAs (1.0·10-4), Pb (7.2·10-4) and Cd (25.9·10-4). Therefore, 10, 72 and 259 persons per 100,000 inhabitants are likely prone to developing cancer due to the ingestion of iAs, Pb and Cd, respectively.

Dynamic Fracture and Crack Arrest Toughness Evaluation of High-Performance Steel Used in Highway Bridges.

Impact energy tests are an efficient method of verifying adequate toughness of steel prior to it being put into service. Based on a multitude of historical correlations between impact energy and fracture toughness, minimum impact energy requirements that correspond to desired levels of fracture toughness are prescribed by steel bridge design specifications. Research characterizing the fracture behavior of grade 485 and 690 (70 and 100) high-performance steel utilized impact, fracture toughness, and crack arrest testing to verify adequate performance for bridge applications. Fracture toughness results from both quasi-static and dynamic stress intensity rate tests were analyzed using the most recently adopted master curve methodology. Both impact and fracture toughness tests indicated performance significantly greater than the minimum required by material specifications. Even at the AASHTO Zone III service temperature, which is significantly colder than prescribed test temperatures, minimum average impact energy requirements were greatly exceeded. All master curve reference temperatures, both for quasi-static and dynamic loading rates, were found to be colder than the Zone III minimum service temperature. Three correlations between impact energy and fracture toughness were evaluated and found to estimate reference temperatures that are conservative by 12 to 50 °C (22 to 90 °F) on average for the grades and specimen types tested. The evaluation of two reference temperature shifts intended to account for the loading rate was also performed and the results are discussed.

Variation in youth and young adult homicide rates and their association with city characteristics in Latin America: the SALURBAL study.

Background: Latin America and the Caribbean (LAC) is one of the most urbanized and violent regions worldwide. Homicides in youth (15-24 years old, yo) and young adults (25-39yo) are an especially pressing public health problem. Yet there is little research on how city characteristics relate to homicide rates in youth and young adults. We aimed to describe homicide rates among youth and young adults, as well as their association with socioeconomic and built environment factors across 315 cities in eight LAC countries. Methods: This is an ecological study. We estimated homicide rates in youth and young adults for the period 2010-2016. We investigated associations of homicide rates with sub-city education and GDP, Gini, density, landscape isolation, population and population growth using sex-stratified negative binomial models with city and sub-city level random intercepts, and country-level fixed effects. Findings: The mean sub-city homicide rate per 100,000 in persons aged 15-24 was 76.9 (SD = 95.9) in male and 6.7 (SD = 8.5) in female, and in persons aged 25-39 was 69.4 (SD = 68.9) in male and 6.0 (SD = 6.7) in female. Rates were higher in Brazil, Colombia, Mexico and El Salvador than in Argentina, Chile, Panama and Peru. There was significant variation in rates across cities and sub-cities, even after accounting for the country. In fully adjusted models, higher sub-city education scores and higher city GDP were associated with a lower homicide rate among male and female (rate ratios (RR) per SD higher value in male and female, respectively, 0.87 (CI 0.84-0.90) and 0.90 (CI 0.86-0.93) for education and 0.87 (CI 0.81-0.92) and 0.92 (CI 0.87-0.97) for GDP). A higher city Gini index was associated with higher homicide rates (RR 1.28 (CI 1.10-1.48) and 1.21 (CI 1.07-1.36) in male and female, respectively). Greater isolation da was also associated with higher homicide rates (RR 1.13 (CI 1.07-1.21) and 1.07 (CI 1.02-1.12) in male and female, respectively). Interpretation: City and sub-city factors are associated with homicide rates. Improvements to education, social conditions and inequality and physical integration of cities may contribute to the reduction of homicides in the region. Funding: The Wellcome Trust [205177/Z/16/Z].

Quiste mesentérico gigante, un hallazgo incidental: reporte de caso / Giant mesenteric cyst, an incidental finding: case report / Cisto mesentérico gigante, um achado incidental: relatório de caso

Se presenta el caso de un hombre de 58 años de edad, sin antecedentes de importancia para la presencia de hepatopatía, quien presentó distensión abdominal progresiva que no respondió al manejo a base de diuréticos, diagnosticado incidentalmente a través de estudios de imagen con un quiste mesentérico gigante, el cual constituye un tumor raro, con pocos reportes de caso en la literatura, según lo referido es más frecuente en el sexo femenino, su etiología aun es desconocida, su diagnóstico generalmente se realiza a través de estudios de imagen y el tratamiento consiste en la escisión quirúrgica completa ya que su drenaje constituye un medio ineficaz por el alto riesgo de recurrencia.

We present the case of a 58-year-old man, with no history of significant hepatopathy, who presented progressive abdominal distension that did not respond to diuretics, diagnosed incidentally through imaging studies with a giant mesenteric cyst, which is a rare tumor, Its etiology is still unknown, its diagnosis is generally made through imaging studies and the treatment consists of complete surgical excision since its drainage is an ineffective means due to the high risk of recurrence.

Apresentamos o caso de um homem de 58 anos, sem historial de hepatopatia significativa, que apresentava uma distensão abdominal progressiva que não respondia a uma gestão baseada em diuréticos, diagnosticada incidentalmente através de estudos de imagem com um cisto mesentérico gigante, que é um tumor raro, A sua etiologia é ainda desconhecida, o seu diagnóstico é geralmente feito através de estudos de imagem e o tratamento consiste na excisão cirúrgica completa, uma vez que a drenagem é um meio ineficaz devido ao elevado risco de recidiva.

Herd culture and herd immunity. / Cultura de rebaño e inmunidad de rebaño.

Although communicable diseases affect our bodies, they occur in a society that interprets and gives them meaning. Herd immunity provides the body protection; however, long-term protection requires shifts in the way people interpret and respond to disease, cultural transformation that enables the development of the knowledge, habits and skills that make herd immunity feasible and sustainable. Herd culture allows individuals to protect themselves and restrict their liberty in order to protect others; it is a form of exercising positive liberty and a necessary complement to herd immunity in a democratic society.

Aunque las enfermedades transmisibles afectan nuestros cuerpos, ocurren en una sociedad que las interpreta y dota de significado, y cuyos individuos causan o evitan. La inmunidad de rebaño permite lograr una protección del cuerpo, sin embargo, para su sustentabilidad, se requiere de cambios en la manera cómo las personas interpretan y responden a la enfermedad, de transformaciones culturales que permitan desarrollar conocimientos, hábitos y destrezas que hagan factible y sostenible la inmunidad de rebaño. La cultura de rebaño permite a los individuos protegerse y restringir su libertad para proteger a los demás, es una forma de ejercicio de la libertad positiva y el complemento necesario de la inmunidad del rebaño en la sociedad democrática.

Cultura de rebaño e inmunidad de rebaño / Herd culture and herd immunity

Resumen Aunque las enfermedades transmisibles afectan nuestros cuerpos, ocurren en una sociedad que las interpreta y dota de significado, y cuyos individuos causan o evitan. La inmunidad de rebaño permite lograr una protección del cuerpo, sin embargo, para su sustentabilidad, se requiere de cambios en la manera cómo las personas interpretan y responden a la enfermedad, de transformaciones culturales que permitan desarrollar conocimientos, hábitos y destrezas que hagan factible y sostenible la inmunidad de rebaño. La cultura de rebaño permite a los individuos protegerse y restringir su libertad para proteger a los demás, es una forma de ejercicio de la libertad positiva y el complemento necesario de la inmunidad del rebaño en la sociedad democrática.

Abstract Although communicable diseases affect our bodies, they occur in a society that interprets and gives them meaning. Herd immunity provides the body protection; however, long-term protection requires shifts in the way people interpret and respond to disease, cultural transformation that enables the development of the knowledge, habits and skills that make herd immunity feasible and sustainable. Herd culture allows individuals to protect themselves and restrict their liberty in order to protect others; it is a form of exercising positive liberty and a necessary complement to herd immunity in a democratic society.

An Efficient Multi-Level Convolutional Neural Network Approach for White Blood Cells Classification.

The evaluation of white blood cells is essential to assess the quality of the human immune system; however, the assessment of the blood smear depends on the pathologist's expertise. Most machine learning tools make a one-level classification for white blood cell classification. This work presents a two-stage hybrid multi-level scheme that efficiently classifies four cell groups: lymphocytes and monocytes (mononuclear) and segmented neutrophils and eosinophils (polymorphonuclear). At the first level, a Faster R-CNN network is applied for the identification of the region of interest of white blood cells, together with the separation of mononuclear cells from polymorphonuclear cells. Once separated, two parallel convolutional neural networks with the MobileNet structure are used to recognize the subclasses in the second level. The results obtained using Monte Carlo cross-validation show that the proposed model has a performance metric of around 98.4% (accuracy, recall, precision, and F1-score). The proposed model represents a good alternative for computer-aided diagnosis (CAD) tools for supporting the pathologist in the clinical laboratory in assessing white blood cells from blood smear images.

Development of Computational Approaches with a Fragment-Based Drug Design Strategy: In Silico Hsp90 Inhibitors Discovery.

A semi-exhaustive approach and a heuristic search algorithm use a fragment-based drug design (FBDD) strategy for designing new inhibitors in an in silico process. A deconstruction reconstruction process uses a set of known Hsp90 ligands for generating new ones. The deconstruction process consists of cutting off a known ligand in fragments. The reconstruction process consists of coupling fragments to develop a new set of ligands. For evaluating the approaches, we compare the binding energy of the new ligands with the known ligands.

Delphi Project on the trends in Implant Dentistry in the COVID-19 era: Perspectives from Latin America.

AIM: To establish trends in Implant Dentistry in Latin America in the COVID-19 pandemic. MATERIAL AND METHODS: A steering committee and an advisory group of experts in Implant Dentistry were selected among eighteen countries. An open-ended questionnaire by Delphi methodology was validated including 64 questions, divided in 7 topics, concerning the various trends in dental implantology. The survey was conducted in two rounds, which provided the participants in the second round with the results of the first. The questionnaires were completed on August 2020, and the online meeting conference was held on September 2020. The final prediction was developed through consensus by a selected group of experts. RESULTS: A total of 197 experts from Latin America answered the first and second questionnaire. In the first round, the established threshold for consensus (65%) was achieved in 30 questions (46.87%). In the second round, performed on average 45 days later, this level was achieved in 47 questions (73.43%). Consensus was completely reached on the item "Diagnostic" (100%), the field with the lowest consensus was "Demand for treatment with dental implants" (37.5%). CONCLUSIONS: The present study in Latin America has provided relevant and useful information on the predictions in the education and practice of Implant Dentistry in the COVID-19 era. The consensus points toward a great confidence of clinicians in the biosecurity protocols used to minimize the risk of SARS-CoV-2 transmission. It is foreseen as an important change in education, with introduction of virtual reality and other simulation technologies in implant training.

Identification of the naphthoquinone derivative inhibitors binding site in heat shock protein 90: an induced-fit docking, molecular dynamics and 3D-QSAR study.

The combination of molecular modeling methods to identify the putative binding site of inhibitors constitutes an important tool in drug discovery. In this work, we used these analyses to understand the potent inhibitory effect of naphthoquinone derivatives on heat shock protein 90 (Hsp90), one of the proteins involved in many types of cancer. Molecular docking results indicated that some favorable interactions of key amino acid residues at the binding site of Hsp90 with these quinones would be responsible for the inhibition of Hsp90 activity. Molecular docking and molecular dynamics simulation were carried out to further understand the binding modes and the interactions between the protein and these inhibitors. The main residues of the internal cavity were Val136, Phe138, Tyr139, Val150, Trp162 and Val186. The high concordance between the docking results and 3D-QSAR contour maps gives us helpful information about the environment of the binding site. Our results provide the bases for a rational modification of new molecules based in quinone scaffold, in order to design more potent Hsp90 inhibitors, which would exhibit highly potent antitumor activity.Communicated by Ramaswamy H. Sarma.

Estado nutricional y factores relacionados con la desnutrición en una residencia de ancianos / Nutritional state and desnutrition related factors in a nursing home

OBJETIVO: Las personas de la tercera edad frágiles son un colectivo en riesgo de sufrir desnutrición. El objetivo de este estudio fue describir el estado nutricional de una residencia asistida de 136 plazas y analizar su relación con otras variables. MÉTODOS: Estudio observacional descriptivo transversal sobre una muestra de 113 personas. Se recogieron las variables composición corporal del residente, estado de deterioro cognitivo, nutricional, tipo de desnutrición y alimentación (tipo de dieta, tratamiento nutricional, disfagia, anorexia y dependencia en la alimentación). Se realizaron comparaciones de medias mediante la prueba de la t de Student y comparación de proporciones mediante c2 de Pearson. RESULTADOS: El riesgo de desnutrición encontrada fue del 31% (n = 35); de ellos, el 22% (n = 25) presentaba desnutrición según Gasull. El 92% (104) de los participantes del estudio presentaban algún síntoma o patología y solamente 18 (15,9%) personas no padecían deterioro cognitivo. El 65,5% (74) seguía una dieta basal/diabética y el 35,4% (48) necesitaba ayuda para comer. El deterioro cognitivo moderado-elevado y las dietas terapéuticas obtuvieron mayor proporción de casos de desnutrición según Gasull. CONCLUSIÓN: El estado nutricional de la residencia se puede relacionar con la mayor complejidad que presentan los residentes (alto porcentaje de ellos con deterioro cognitivo moderado y grave y/u otras patologías) y con la calidad en la asistencia. La falta de asociación de desnutrición con el resto de las variables analizadas nos lleva a apoyar la hipótesis de que son múltiples factores los que interfieren en el estado nutricional de los adultos mayores

OBJECTIVE: elderly fragile people are a group at risk for malnutrition. Because of this, the study aimed to describe the nutritional status of an assisted residence of 136 beds and analyze the relationship between malnutrition and other variables. METHODS: descriptive, observational, cross-sectional study on a sample of 113 people. Variables collected were body composition of resident, nutritional and cognitive impairment, type of malnutrition and feeding (type of diet, nutritional therapy, dysphagia, anorexia, and eating dependence). Comparison of means using the Student T test and compared proportions using Chi-square of Pearson were made. RESULTS: The risk of malnutrition found was 31% (n = 35), of them, 22% (n = 25) of total residents were classified as Gasull malnutrition. 92% (104) of the participants of the study showed some symptoms or disease and only 18 (15.9%) were not suffering from cognitive impairment. The 65.5% (74) was at basal/diabetic diet and the 35.4% (48) needed help to eat. Moderate-high cognitive impairment and therapeutic diets showed a positive correlation with malnutrition according to Gasull cases. CONCLUSION: Nutritional state of the residence may be related with greater resident complexity (high percentage of them with moderate and severe cognitive impairment and/or other illnesses) and with the quality of assistance. The lack of association of malnutrition with the rest of the variables analyzed, leads us to support the hypothesis that multiple factors interfere in the nutritional status of elder adults

Utilización de la plataforma Moodle en la disciplina Informática Médica de la carrera de Medicina / Use of the Moodle platform in the Medical Computing discipline of the Medical degree

RESUMEN Fundamento: la plataforma Moodle es un software libre que permite organizar y gestionar el proceso enseñanza aprendizaje. Objetivo: describir el uso de la plataforma Moodle en la disciplina Informática Médica en la Facultad de Medicina "Mariana Grajales Coello" de Holguín. Métodos: se realizó un estudio descriptivo durante el curso 2018-2019. Se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción para los referentes teóricos del tema y la conformación del informe final de la investigación; empíricos: análisis documental y encuesta en forma de cuestionario a estudiantes de segundo año y profesores de la disciplina. Resultados: la utilización de la plataforma Moodle ha sido aprovechada por la mayoría de los profesores y estudiantes para organizar contenidos y actualizar bibliografía, se constató que existe un limitado conocimiento por los docentes de las herramientas que ofrece para la evaluación individual de forma interactiva. El poco equipamiento de medios informáticos en los laboratorios para alumnos, atenta contra su mejor aprovechamiento, aunque pueden utilizar sus tabletas y celulares para acceder a la mencionada plataforma. Conclusiones: la disciplina Informática Médica aprovecha las opciones que ofrece la plataforma Moodle para contribuir al perfeccionamiento del proceso enseñanza aprendizaje por las numerosas ventajas de su aplicación.

ABSTRACT Background: the Moodle platform is a free software that allows to organize and manage the teaching-learning process. Objective: to describe the use of the Moodle platform in the Medical Computing discipline at Mariana Grajales Coello School of Medicine of the Holguín province. Methods: a descriptive study was carried out during the 2018-2019 academic year. Theoretical methods were used: analysis-synthesis and induction-deduction for the theoretical references of the subject and the conformation of the final research report; Empirical ones: documentary analysis and survey in questionnaire form for second-year students and professors of the discipline. Results: the use of the Moodle platform has been used by the majority of professors and students to organize content and update bibliography, it was found that there is limited knowledge of the tools offered for individual interactive assessment by professors. The little equipment of computer media in laboratories for students, it affects its best use although they can use their tablets and cell phones to access to the aforementioned platform. Conclusions: the Medical Computing discipline takes advantage of the options offered by the Moodle platform to contribute to the improvement of the teaching-learning process due to the numerous advantages of its application.

Prevalencia de dislipidemias en pacientes obesos / Dylispidemia prevalence in obese patients

Introducción: Las dislipidemias asociadas a la obesidad constituyen factores de riesgo de varias enfermedades especialmente del sistema cardiovascular. Objetivo: Determinar la prevalencia de dislipidemias en pacientes obesos. Métodos: Se realizó un estudio correlacional, retrospectivo y transversal de150 pacientes obesos, quienes acudieron a la consulta externa de la Clínica Medina del Hospital Básico de Guayaquil, desde el 2018 hasta el 2019. Las variables analizadas fueron edad, sexo, índice de masa corporal y resultados de laboratorio, tales como colesterol total, triglicéridos, colesterol LDL y dislipidemia mixta (colesterol HDL y VLDL). Resultados: En la serie predominaron el sexo masculino (62,6%), los pacientes con más de 65 años de edad (42,0 %), los niveles entre rango crítico y alto riesgo (66 pacientes); 16,0 % se clasificaron de alto riesgo con niveles de colesterol superior a 240 mg/dL. Mostraron resultados anormales en cuanto a los triglicéridos 62 afectados, en un rango mayor de 150 con niveles y limítrofe altos. Conclusiones: Se observó una correspondencia entre las dislipidemias y la obesidad, pues todos los pacientes presentaron algún tipo de alteración en los lípidos.

Introduction: Dyslipidemias associated to obesity constitute risk factors of several diseases specially from the cardiovascular system. Objective: To determine the prevalence of dyslipidemias in obese patients Methods: A correlational restrospective and cross-sectional study of 150 obese patients, who visited the outpatients department of Medina Clinic from Hospital Básico in Guayaquil, from 2018 to 2019. Variables used were age, sex, body mass index and laboratory results such as total cholesterol, triglycerids. LDL colesterol and mixed dyslipidemias (cholesterol HDL and VLDL). Results: In the serie, male sex (62.6 %), patients over 65 years (42.0 %), levels between critical and high risk (66 patients) prevailed, 16.0 % were classified as high risk patients with cholesterol level over 240 mg/dL. Sixty two patients showed subnormal results regarding triglycerids, in a rank higher than 150 with high limits and levels. Conclusions: A correspondance between dyslipidemias and obesity was observed, as all patients presented some type of change in lipids.

Repercusión de factores socioculturales en la salud reproductiva de las mujeres de la Universidad de Guayaquil / Impact of sociocultural factors in the reproductive health of women in Guayaquil University

Introducción: La salud sexual y reproductiva es importante para el bienestar general de las mujeres y la toma de decisiones sobre la planificación familiar; sin embargo, existen factores socioculturales que condicionan desfavorablemente los aspectos antes mencionados. Objetivo: Determinar los factores socioculturales que condicionaron desfavorablemente la salud reproductiva de estudiantes de la Universidad de Guayaquil. Métodos: Se realizó una investigación descriptiva y observacional de 120 estudiantes, quienes asistieron a la consulta de ginecoobstetricia de la Universidad de Guayaquil, Ecuador, durante el 2019. Resultados: La edad de los encuestados osciló entre los 18 y 29 años (82,0 %); 55% no recibió o desconocía la existencia de los servicios de orientación sexual que se brindaban a los adolescentes de dicha universidad. Asimismo, 60,0 % de las féminas dejaron de acudir a centros de salud para prepararse sobre temas de salud sexual y reproductiva y abandonaron la protección al tener relaciones sexuales por falta de medios económicos. Conclusiones: Los factores socioculturales influyeron significativamente en el acceso a los servicios de salud sexual y reproductiva que se brindaron a los adolescentes en la universidad con énfasis en la ausencia de medios económicos.

Introduction: The sexual and reproductive health is important for the general well-being of women and decisions making on the family planning; however, there are sociocultural factors that condition unfavorably the abovementioned aspects. Objective: To determine the sociocultural factors that conditioned unfavorably the reproductive health of students at Guayaquil University. Methods: A descriptive and observational investigation of 120 students was carried out, they attended the gynecoobstetrics service of Guayaquil University, Ecuador, during 2019. Results: The interviewed aged 18 and 29 (82.0 %); 55 % didn't receive or ignored the existence of sexual orientation services that were offered to the adolescents of this university. Also, 60.0 % of women stopped going to health centers to get ready on topics of sexual and reproductive health and they abandoned the protection when having sexual relationships due to lack of economic means. Conclusions: The sociocultural factors influenced significantly in the access to the services of sexual and reproductive health that were offered to the adolescents in the university with emphasis in the absence of economic means.

Chemoprotective and antiobesity effects of tocols from seed oil of Maqui-berry: Their antioxidative and digestive enzyme inhibition potential.

Maqui-berry (Aristotelia chilensis) is the emerging Chilean superfruit with high nutraceutical value. Until now, the research on this commodity was focused on the formulations enriched with polyphenols from the pulp. Herein, contents of tocols were compared in the seed oil of Maqui-berry obtained through three different extraction methods followed by determining their antioxidative and enzyme inhibitions in-vitro. Firstly, oilseed was extracted with n-hexane (Soxhlet method), chloroform/methanol/water (Bligh and Dyer method) and pressing (industrial). These samples were used to access their effects against DPPH, HORAC, ORAC, FRAP, Lipid-peroxidation (TBARS), α-amylase, α-glucosidase, and pancreatic lipase. All the isomers of tocopherol and tocotrienol were identified, and ß-sitosterol was the only sterol found in higher amounts than other vegetable oils. The Bligh and Dyer method could lead to the highest antioxidative capacity compared to Soxhlet and press methods likely because the latter have a higher amount of tocopherols. Further, seed oil from Maqui berry and their tocols (α, ß, γ, δ-tocopherols, tocotrienols, and ß-sitosterol) warrant clinical investigation for their antioxidative and antiobesity potential. Taken together, these findings provide relevant and suitable conditions for the industrial processing of Maqui-berry.

Colombia y Uruguay ante la COVID-19: datos epidemiológicos, medidas generales y en la práctica odontológica / Colombia and Uruguay in the face of COVID-19: epidemiological data, general and dental practice measures

Objetivo: analizar los datos epidemiológicos y las medidas generales en la práctica odontológica tomadas por Colombia y Uruguay durante la pandemia por la COVID-19. Métodos: este trabajo es una revisión de la literatura. Se consultaron las bases de datos "PubMed", "Scielo" y el motor de búsqueda "Google Scholar". También se consultaron bases de datos de libre acceso como google, our world in data y las páginas oficiales de la Organización Mundial de la Salud, el Ministerio de Salud de Colombia, el Instituto Nacional de Salud y el Ministerio de Salud Pública de Uruguay. Se realizó un análisis descriptivo del comportamiento epidemiológico y de las medidas tomadas en la práctica odontológica en los dos países. Resultados: en Colombia, a diario, se presentan más de 3.000 casos nuevos y más de 100 muertes. Lo contrario ocurre en Uruguay, que ha logrado disminuir las tasas de contagio y de muertes, presentando menos de 10 casos y ninguna muerte diaria. Los profesionales de la salud han incrementado su lucha; los odontólogos se encuentran expuestos por su proximidad al momento de la atención, en el contacto con saliva, sangre y la generación de aerosoles, por lo que han modificado los protocolos de bioseguridad buscando prevenir los contagios asociados a la prestación de servicio. Conclusiones: Uruguay ha tenido un comportamiento ejemplar ante la pandemia; en Colombia los resultados son preocupantes dado el crecimiento exponencial. En ambos países la práctica odontológica se ha visto afectada y se han implementado nuevos protocolos para proteger a profesionales y pacientes.

Objective: Analyze the epidemiological data, general and dental practice measures taken by Colombia and Uruguay in the face of the COVID-19 pandemic. Methods: This study is a review. We search in the databases "PubMed", "Scielo" and in the search engine "Google Scholar". Also, were consulted the free databases like google, our world in data and the official pages of the World Health Organization, Ministry of Health of Colombia, The National institute of health and the Ministry of public Health of Uruguay. A descriptive analysis of the epidemiological behavior and the measures taken of dental practice in both countries was done. Results: Colombia had more than 3,000 new cases and more than 100 deaths daily. The opposite occurs in Uruguay, which has managed to decrease the infection and death rates, presenting less than 10 cases and no daily deaths. The struggles experienced by health professionals has increased, dentists are exposed, by their proximity at the time of care, to contact with saliva, blood and the generation of aerosols, therefore, they have modified the biosafety protocols, seeking to prevent infections associated with the practice. Conclusions: Uruguay has an exemplary behavior; in Colombia these results are worrying with an exponential growth. In both countries, dental practice has been affected and new protocols have been implemented that seek to protect the professionals and patients.

Co-production of ethanol and biodiesel from sweet sorghum juice in two consecutive fermentation steps

Background: Sugars from sweet sorghum stalks can be used to produce ethanol and also to grow oleaginous yeasts. Instead of two separate processes, in this paper we propose a different route producing ethanol and microbial oil in two consecutive fermentation steps. Results: Three yeasts were compared in the first ethanol producing step. In the second step four different oleaginous yeasts were tested. Sweet sorghum juice was first clarified and concentrated. High gravity ethanol fermentation was carried out with concentrated juice with 23.7 g/100 mL of total sugars and without added nutrients. Total sugars were 2.5 times more than the original clarified juice. One yeast gave the best overall response over the two other tested; relative high ethanol productivity, 1.44 g ethanol/L•h−1 , and 90% of sugar consumption. Aeration by flask agitation produced superior results than static flasks for all yeasts. Microbial oil production was done employing the residual liquid left after ethanol separation. The pooled residual liquid from the ethanol distillation contained 7.08 g/mL of total carbohydrates, rich in reducing sugars. Trichosporon oleaginosus and Lipomyces starkeyi produced higher dry biomass, total sugar consumption and oil productivity than the other two oleaginous yeasts tested; with values around 25 g/L, 80%, and 0.55 g oil/L•h−1 respectively. However, the biomass oil content in all yeasts was relatively low in the range of 14 to 16%. Conclusion: The two step process is viable and could be considered an integral part of a consolidated biorefinery from sweet sorghum.

Violence against indigenous children and adolescents in Venezuela.

Research on violence in indigenous communities refers to traditional practices of competition for scarce goods and clashes with other populations over their territories. Violence against children is not described, and authors of some studies state a tradition of good treatment towards them. In our study we shows that the situation has changed and new forms of violence are affecting 725,000 inhabitants from 51 indigenous groups of Venezuela, especially those composed of children and adolescents. The method used was interviews with key informants and for secondary census, civil society data and journalists' reports. Results describe the existence of four types of violence: (a) structural violence, derived from the shortage of food and medicines that have caused deaths due to malnutrition and lack of medical attention, prostitution, girl trafficking and forced emigration; (b) violence of organized crime, which exercise control of illegal mining and affect the Yanomami and Pemón peoples, as workforce for the production of coca and drug trafficking with the Yupka people; and contraband of gasoline in the Wayúu people; (c) domestic violence due to cultural changes derived from new patterns of alcohol consumption or the use of physical punishment of children between Piaroa and Yekuana peoples; and (d) the illegal violence of the State for the imposition of mining with the Pemón people or the repression for the protests with the Warao and Inga peoples. In the article we show the great difference between the official discourse of protection of indigenous peoples and the realities of violence, criminal exploitation and violation of rights suffered by indigenous children and adolescents.

Violence against indigenous children and adolescents in Venezuela / Violencia contra niños y adolescentes indígenas en Venezuela / Violência contra crianças e adolescentes indígenas na Venezuela

Abstract: Research on violence in indigenous communities refers to traditional practices of competition for scarce goods and clashes with other populations over their territories. Violence against children is not described, and authors of some studies state a tradition of good treatment towards them. In our study we shows that the situation has changed and new forms of violence are affecting 725,000 inhabitants from 51 indigenous groups of Venezuela, especially those composed of children and adolescents. The method used was interviews with key informants and for secondary census, civil society data and journalists' reports. Results describe the existence of four types of violence: (a) structural violence, derived from the shortage of food and medicines that have caused deaths due to malnutrition and lack of medical attention, prostitution, girl trafficking and forced emigration; (b) violence of organized crime, which exercise control of illegal mining and affect the Yanomami and Pemón peoples, as workforce for the production of coca and drug trafficking with the Yupka people; and contraband of gasoline in the Wayúu people; (c) domestic violence due to cultural changes derived from new patterns of alcohol consumption or the use of physical punishment of children between Piaroa and Yekuana peoples; and (d) the illegal violence of the State for the imposition of mining with the Pemón people or the repression for the protests with the Warao and Inga peoples. In the article we show the great difference between the official discourse of protection of indigenous peoples and the realities of violence, criminal exploitation and violation of rights suffered by indigenous children and adolescents.

Resumen: La investigación sobre la violencia en las comunidades indígenas se refiere a las prácticas tradicionales de competencia por los bienes escasos y enfrentamientos con otras poblaciones por sus territorios. La violencia contra los niños no se ha conocido, y algunos estudios afirman la existencia de una tradición de buen trato hacia ellos. Este estudio muestra que la situación cambió y que nuevas formas de violencia están afectando a 725.000 habitantes de los 51 grupos indígenas de Venezuela, especialmente niños y adolescentes. El método utilizado fue entrevistas con informantes clave, un censo secundario, así como datos de la sociedad civil e informes de periodistas. Los resultados describen la existencia de cuatro tipos de violencia: (a) violencia estructural, derivada de la escasez de comida y medicinas, que ha causado muertes debido a la malnutrición y falta de atención médica; prostitución, tráfico de niñas y emigración forzosa; (b) la violencia del crimen organizado, que ejerce el control de la minería ilegal y afecta a los Yanomami y Pemón, como fuerza de trabajo para la producción de coca y tráfico de drogas en el caso de los Yupka; además de contrabando de gasolina con los Wayúu; (c) la violencia doméstica, debido a los cambios culturales, derivada de nuevos patrones de consumo de alcohol o la aplicación del castigo físico de niños entre los Piaroa y Yekuana; y (d) la violencia ilegal del estado para la imposición de la minería con los Pemón o la represión de las protestas con los Warao e Inga. El artículo expone la gran diferencia entre el discurso oficial de protección a los indígenas y las realidades de violencia, explotación criminal y violación de los derechos sufridos por los niños y adolescentes indígenas.

Resumo: A pesquisa sobre violência em comunidades indígenas se refere a práticas tradicionais de disputa por bens escassos e confrontos com outras populações pela posse de seus territórios. A violência contra crianças ainda não foi descrita, e alguns estudos afirmam uma tradição de bom tratamento em relação a elas. O estudo mostra que a situação já mudou, e que novas formas de violência estão afetando 725.000 habitantes de 51 grupos indígenas na Venezuela, especialmente contra crianças e adolescentes. O método utilizado teve como base entrevistas com informantes-chave e acesso a dados censitários e de fontes da sociedade civil, além de relatos de jornalistas. Os resultados descrevem a existência de quatro tipos violência: (a) violência estrutural, derivada da escassez de alimentos e medicamentos, que provoca mortes devido à desnutrição e à falta de atendimento médico; prostituição e tráfico de meninas, além de emigração forçada; (b) violência praticada pelo crime organizado, com o controle da mineração ilegal e que afeta os povos Yanomami e Pemón, como força de trabalho na produção de coca e no tráfico de drogas no povo Yupka e o contrabando de gasolina no povo Wayúu; (c) violência doméstica em função de mudanças culturais derivadas dos novos padrões de consumo de álcool ou do uso de castigo físico de crianças, entre os povos Piaroa e Yekuana; e (d) violência ilegal praticada pelo estado pela imposição da mineração no povo Pemón ou com a repressão de protestos pelos povos Warao e Inga. O artigo mostra a grande diferença entre o discurso oficial da proteção dos indígenas e a realidade de violência, exploração criminosa e violação dos direitos das crianças e adolescentes indígenas na Venezuela.