Efficacy of Continuous vs. Intermittent Administration of Cefepime in Adult ICU Patients with Gram-Negative Bacilli Bacteremia: A Randomized Double-Blind Clinical Study.

INTRODUCTION: The objective of this study was to compare the continuous infusion of cefepime with the intermittent infusion in patients with sepsis caused by Gram-negative bacilli (GNB). METHODS: Randomized 1:1 multicenter double-blinded placebo-controlled study with allocation concealment; multicenter study in the intensive care units of Colombia. Patients with sepsis, severe sepsis or septic shock, and GNB-suspected bacteremia. Cefepime was administered for 7 to 14 days over 30 m intermittently every 8 h over 24 h plus continuous saline solution (0.9%) (G1) or 3 g administered continuously plus saline solution every 8 h (0.9%) (G2). The percentage of clinical response at 3, 7, and 14 days, relapse at 28 days, and mortality at discharge were measured. RESULTS: The recruitment was stopped at the suggestion of the Institutional Review Board (IRB) following an FDA alert about cefepime. Thirty-two patients were randomized; 25 received the intervention, and GNB bacteremia was confirmed in 16 (9 G1 and 7 G2). Favorable clinical response in days 3, 7, and 14 was 88.8%, 88.8%, and 77.8% (G1) and was similar for G2 (85.7%). There were no relapses or deaths in G2, while in G1, one relapse and two deaths were observed. CONCLUSIONS: The results of this study support the use of cefepime for the treatment of Gram-negative infections in critically ill patients, but we could not demonstrate differences between continuous or intermittent administration because of the small sample size, given the early suspension of the study.

Neumonía de organización como causa de hipoxemia persistente a la tercera semana de infección por SARS-CoV-2. Reporte de caso / Organization pneumonia as a cause of persistent hypoxemia in the third week of SARS CoV-2 infection, case report

El Coronavirus 2 es un betacoronavirus de ARN responsable de la enfermedad por coronavirus 2019 (COVID-19). Fue detectado por primera vez en Wuhan, China y se propagó rápidamente a nivel mundial, llevando a la OMS a declarar una pandemia en marzo de 2020. Para julio de 2021, se habían registrado casi 196 millones de casos confirmados de COVID-19, siendo responsable de más de cuatro millones de muertes en todo el mundo. En la mayoría de los casos, los pacientes presentan síntomas respiratorios que van desde leves hasta graves, pudiendo desencadenar lesiones pulmonares agudas y disfunción multiorgánica; incluso se han reportado casos de hipoxemia refractaria, lo que implica una elevada morbimortalidad. Las posibles causas incluyen infecciones secundarias, enfermedad tromboembólica pulmonar, fibrosis pulmonar y reinfección por SARS-CoV-2. En pacientes con COVID-19 se ha observado la neumonía de organización como una complicación en la fase subaguda y tardía de la enfermedad, desencadenando un deterioro clínico y radiológico significativo. El tratamiento con glucocorticoides ha mostrado una respuesta favorable en estos casos. Presentamos un caso de neumonía de organización relacionado con la infección por SARS-CoV-2 que, aunque no contó con confirmación histológica, la integración de la presentación clínica, la evolución y los hallazgos radiológicos permitieron realizar la aproximación diagnóstica, destacando la importancia del manejo adecuado con glucocorticoides en estos casos. Sin embargo, se necesitan más estudios para evaluar el desarrollo de esta complicación en una población más amplia.

Coronavirus 2 is an RNA beta coronavirus responsible for coronavirus disease 2019 (COVID-19). It was first detected in Wuhan, China, and spread rapidly globally, leading the WHO to declare a pandemic in March 2020. By July 2021, there had been nearly 196 million confirmed cases, being responsible for more than four million deaths worldwide. In most cases, patients present with respiratory symptoms ranging from mild to severe, which can lead to acute lung lesions and multi-organ dysfunction; cases of refractory hypoxemia have even been reported, which implies high morbidity and mortality. Possible causes include secondary infections, pulmonary thromboembolic disease, pulmonary fibrosis, and SARS-CoV-2 reinfection. Most COVID-19 patients exhibit respiratory symptoms, ranging from mild to severe, with the potential for acute lung injuries and multiorgan dysfunction leading to high mortality. Cases of refractory hypoxemia in COVID-19 patients have been reported, indicating significant morbidity and mortality. Possible causes include secondary infections, pulmonary thromboembolism, pulmonary fibrosis, and reinfection by SARS-CoV-2. In patients with COVID-19, organization pneumonia has been observed as a complication in the subacute and late phase of the disease, triggering significant clinical and radiological deterioration. Treatment with glucocorticoids has shown a favorable response in these cases. We present a case of organizing pneumonia in relation SARS-CoV-2 infection that, although it did not have histological confirmation, the clinical presentation, evolution and radiological findings allowed a diagnostic approach, highlighting the importance of proper management with glucocorticoids in these cases. However, more studies are needed to evaluate the development of this complication in a larger population.

[Revista Médica del IMSS: Institutional heritage and Important reference]. / Revista Médica del IMSS: patrimonio institucional e importante referente formativo.

In a context that has tended towards globalization, in which obtaining economic resources is usually the driving force of societies, information resources have frequently been treated as private goods for which one must pay. A strategy for the above has been open and free access to information, a factor of great importance for the construction of more open media.

En un contexto que ha tendido a lo globalizado, en el que la obtención de recursos económicos suele ser el motor de las sociedades, los recursos de información han sido tratados con frecuencia como bienes privados por los que hay que pagar. Una estrategia a lo anterior ha sido el acceso abierto y gratuito a la información, un factor de gran importancia para la construcción de medios más abiertos.

Application of artificial neural networks in assigned leadership and academic success in medical graduates.

OBJECTIVE: To apply an artificial neural networks analysis (ANN) model to identify variables that predict assigned leadership and academic success in graduates of six generations of medical school. METHOD: Analytical, retrospective, comparative study. A total of 1434 graduates participated. A questionnaire was sent to them by e-mail including a voluntary participation consent. A multivariate statistical analysis using multi-layer perceptron ANN, decision trees and driver analysis was performed. RESULTS: The ANN identified seven independent variables that predicted professional success and eight for leadership in medical graduates. The decision trees identified significant differences in the variables professional performance (p = 0.000), age (p = 0.005) and continuing education activities (p = 0.034) related to professional success, and for leadership the variables gender (p = 0.000), high school grades (p = 0.042), performing clinical practice during the social service year (p = 0.002) and continuing education activities (p = 0.011). CONCLUSIONS: The ANN identified the main independent predictor variables of professional success and leadership of the graduates. This study opens up two new lines of research little studied with the techniques of in the area of medicine.

OBJETIVO: Aplicar un modelo de análisis de redes neuronales artificiales (RNA) para identificar las variables que predicen el liderazgo asignado y el éxito académico en egresados de seis generaciones de la carrera de Medicina. MÉTODO: Estudio analítico, retrospectivo y comparativo. Participaron 1434 egresados. Se envió un cuestionario por correo electrónico que incluyó el consentimiento de participación voluntaria. Se realizó análisis estadístico multivariado mediante RNA del tipo perceptrón multicapa, árboles de decisión y análisis de impulsores. RESULTADOS: Las RNA identificaron siete variables independientes que predijeron el éxito profesional y ocho para el liderazgo en los médicos egresados. Los árboles de decisión identificaron diferencias significativas en las variables desempeño profesional (p = 0.000), edad (p = 0.005) y actividades de educación continua (p = 0.034) relacionadas con el éxito profesional, y para el liderazgo las variables sexo (p = 0.000), promedio en el bachillerato (p = 0.042), realizar práctica clínica en el servicio social (p = 0.002) y actividades de educación continua (p = 0.011). ­. CONCLUSIONES: Las RNA identificaron las principales variables independientes predictoras del éxito profesional y el liderazgo de los egresados. El estudio abre dos líneas de investigación poco estudiadas con las técnicas de RNA en el área de la medicina.

[Farewell to a great doctor and extraordinary believer, creator of Quality of Care: Dr. Héctor Aguirre Gas]. / Despedida a un gran médico y extraordinario creyente, creador de la Calidad de la Atención: Dr. Héctor Aguirre Gas.

From these lines a farewell is expressed to Dr. Héctor Gerardo Aguirre Gas, excellent doctor and great exponent of the Quality of Medical Care and Patient Safety, trained and servant in the medical services of the Instituto Mexicano del Seguro Social (IMSS), noble companion and friend. A man with universal ethical values and a straight and humble figure, active and bold behavior, committed to serving others.

Desde estas líneas se expresa una despedida al Dr. Héctor Gerardo Aguirre Gas, excelente médico y gran exponente de la Calidad de la Atención Médica y Seguridad del Paciente, formado y servidor en los servicios médicos del Instituto Mexicano del Seguro Social (IMSS), noble compañero y amigo. Un hombre con valores éticos universales y una figura recta y sencilla, proceder activo y audaz, empeñado en servir al prójimo.

[First steps of medical administration at the IMSS]. / Primeros pasos de la administración médica en el IMSS.

The creation of an institution as large as the Instituto Mexicano del Seguro Social (IMSS) required a lot of planning to manage all the benefits provided to the population. Thus, it is necessary to have health personnel with knowledge and experience in health services administration. This manuscript is an acknowledgment to doctors Manuel Barquín Calderón, Antonio Ríos Vargas and Carlos Zamarripa Torres, pioneers and recognized protagonists in the planning and organization (administration) of the IMSS medical services between 1945 and 1955, who also had rational initiatives and constructive, doing their duty. On the other hand, the Institute exposed and projected that medical-administrative activities were a complex task, and that its practice required specialized knowledge that could not be left to chance, empiricism, good will, beliefs or nonobjective imagination.

La creación de una organización tan grande como el Instituto Mexicano del Seguro Social (IMSS) requirió de mucha planeación para lograr administrar todas las prestaciones que se brindan a la población. Siendo así una necesidad contar con personal de salud con conocimientos y experiencia en administración en servicios de salud. El presente manuscrito es un reconocimiento a los doctores Manuel Barquín Calderón, Antonio Ríos Vargas y Carlos Zamarripa Torres, pioneros y protagonistas reconocidos en la planeación y organización (administración) de los servicios médicos del IMSS entre 1945 y 1955, quienes además tuvieron iniciativas racionales y constructivas, cumpliendo con su deber. Por otro lado, el Instituto expuso y proyectó que las actividades médico-administrativas eran una tarea compleja, y que su práctica necesitaba conocimientos especializados que no podían dejarse al azahar, al empirismo, a la buena voluntad, a las creencias o a la imaginación no objetiva.

Primeros pasos de la administración médica en el IMSS / First steps of medical administration at the IMSS

La creación de una organización tan grande como el Instituto Mexicano del Seguro Social (IMSS) requirió de mucha planeación para lograr administrar todas las prestaciones que se brindan a la población. Siendo así una necesidad contar con personal de salud con conocimientos y experiencia en administración en servicios de salud. El presente manuscrito es un reconocimiento a los doctores Manuel Barquín Calderón, Antonio Ríos Vargas y Carlos Zamarripa Torres, pioneros y protagonistas reconocidos en la planeación y organización (administración) de los servicios médicos del IMSS entre 1945 y 1955, quienes además tuvieron iniciativas racionales y constructivas, cumpliendo con su deber. Por otro lado, el Instituto expuso y proyectó que las actividades médico-administrativas eran una tarea compleja, y que su práctica necesitaba conocimientos especializados que no podían dejarse al azahar, al empirismo, a la buena voluntad, a las creencias o a la imaginación no objetiva.

The creation of an institution as large as the Instituto Mexicano del Seguro Social (IMSS) required a lot of planning to manage all the benefits provided to the population. Thus, it is necessary to have health personnel with knowledge and experience in health services administration. This manuscript is an acknowledgment to doctors Manuel Barquín Calderón, Antonio Ríos Vargas and Carlos Zamarripa Torres, pioneers and recognized protagonists in the planning and organization (administration) of the IMSS medical services between 1945 and 1955, who also had rational initiatives and constructive, doing their duty. On the other hand, the Institute exposed and projected that medical-administrative activities were a complex task, and that its practice required specialized knowledge that could not be left to chance, empiricism, good will, beliefs or nonobjective imagination.

Clinical characteristics, systemic complications, and in-hospital outcomes for patients with COVID-19 in Latin America. LIVEN-Covid-19 study: A prospective, multicenter, multinational, cohort study.

PURPOSE: The COVID-19 pandemic has spread worldwide, and almost 396 million people have been infected around the globe. Latin American countries have been deeply affected, and there is a lack of data in this regard. This study aims to identify the clinical characteristics, in-hospital outcomes, and factors associated with ICU admission due to COVID-19. Furthermore, to describe the functional status of patients at hospital discharge after the acute episode of COVID-19. MATERIAL AND METHODS: This was a prospective, multicenter, multinational observational cohort study of subjects admitted to 22 hospitals within Latin America. Data were collected prospectively. Descriptive statistics were used to characterize patients, and multivariate regression was carried out to identify factors associated with severe COVID-19. RESULTS: A total of 3008 patients were included in the study. A total of 64.3% of patients had severe COVID-19 and were admitted to the ICU. Patients admitted to the ICU had a higher mean (SD) 4C score (10 [3] vs. 7 [3)], p<0.001). The risk factors independently associated with progression to ICU admission were age, shortness of breath, and obesity. In-hospital mortality was 24.1%, whereas the ICU mortality rate was 35.1%. Most patients had equal self-care ability at discharge 43.8%; however, ICU patients had worse self-care ability at hospital discharge (25.7% [497/1934] vs. 3.7% [40/1074], p<0.001). CONCLUSIONS: This study confirms that patients with SARS CoV-2 in the Latin American population had a lower mortality rate than previously reported. Systemic complications are frequent in patients admitted to the ICU due to COVID-19, as previously described in high-income countries.

Recommendations for the diagnosis and management of persons with suspected vaccine-induced immune thrombotic thrombocytopenia (VITT) / Recomendaciones para diagnostico y manejo de personas con trombocitopenia trombotica inmune inducida por vacunas (VITT)

Abstract In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.

Resumen En meses recientes se han reportado casos raros de trombocitopenia y trombosis en sitios inusuales, que ocurren dentro de una ventana de riesgo típica ( por ejemplo de 4 a 28 días) luego de recibir vacunas de SARS CoV 2. Los profesionales de la salud deben estar preparados para detectar estos casos a tiempo. Un panel de expertos y una red de transferencia de conocimiento realizó una búsqueda libre de literatura seleccionada. Con la información disponible y la experticia clínica del grupo de trabajo revisamos y dimos recomendaciones para la sospecha temprana, el diagnostico (definición de caso, el uso de pruebas de laboratorio especificas y de imágenes diagnósticas) para le manejo de estas condiciones tromboticas. Este documento es considerado un documento vivo que debe ser actualizado a medida que surja nueva evidencia y las recomendaciones vayan cambiando con el tiempo

[In memory of the first editor of the Revista Médica del IMSS]. / En recuerdo del primer editor de la Revista Médica del IMSS.

This article is dedicated to the memory of doctor Francisco Olvera Esnaurrizar (1929-2019), first editor of the Revista Médica del Instituto Mexicano del Seguro Social -Medical Journal of the Mexican Institute for Social Security- (1962-1973).

El presente artículo está dedicado a la memoria del doctor Francisco Olvera Esnaurrizar (1929-2019), primer editor de la Revista Médica del Instituto Mexicano del Seguro Social (1962-1973).

Treatment with IgM-enriched immunoglobulin in sepsis: a matched case-control analysis.

The therapeutic potential of IgM-enriched immunoglobulin preparations (IgGAM) in sepsis remains a field of debate. The use of polyclonal immunoglobulins as adjuvant therapy (Esen & Tugrul, 2009; Kaukonen et al., 2014; Molnár et al., 2013; Taccone et al., 2009) has been shown to improve clinical outcomes in terms of mortality. This study analyze the impact of IgM-enriched IgG (IgGM) as additional immunomodulation. Patients and methods: This is a retrospective registry of 1196 patients with severe sepsis and septic shock from nine Intensive Care Units in Colombia, from routine clinical practice; 220 patients treated with IgGAM were registered. Fully matched comparators for severity and type of infection selected among patients non-treated with IgGAM. Mortality after 28 days was 30.5% among IgGAM-treated patients and 40.5% among matched comparators. Results: Multivariate Cox regression analysis showed IgGAM treatment to be the only variable protective from death after 28 days (hazard ratio 0.62; 0.45-0.86; p: 0.004). Results reinforce the importance of IgGAM treatment for favorable outcome after septic shock and are in line with recent published meta-analyses. This study showed that treatment with IgGM in patients with sepsis was an independent modulator of the 28-day associated with a lower mortality.

Empiric antibiotics for community-acquired pneumonia in adult patients: a systematic review and a network meta-analysis.

OBJECTIVE: The main aim of this network meta-analysis is to identify the empiric antibiotic (Em-ATB) with the highest probability of being the best (HPBB) in terms of (1) cure rate and (2) mortality rate in hospitalised patients with community acquired pneumonia (CAP) . METHOD: Inclusion criteria: (1) adult patients (>16 years old) diagnosed with CAP that required hospitalisation; (2) randomised to at least two different Em-ATBs, (3) that report cure rate and (4) are written in English or Spanish. EXCLUSION CRITERIA: (1) ambiguous antibiotics protocol and (2) published exclusively in abstract or letter format. DATA SOURCES: Medline, Embase, Cochrane and citation reviews from 1 January 2000 to 31 December 2018. Risk of bias: Cochrane's tool. Quality of the systematic review (SR): A MeaSurement Tool to Assess systematic Reviews-2. Certainity of the evidence: Grading of Recommendations Assessment, Development and Evaluation. STATISTICAL ANALYSES: frequentist method performed with the 'netmeta' library, R package. RESULTS: 27 randomised controlled trials (RCTs) from the initial 41 307 screened citations were included. Regarding the risk of bias, more than one quarter of the studies presented low risk and no study presented high risk in all domains. The SR quality is moderate. For cure, two networks were constructed. Thus, two Em-ATBs have the HPBB: cetaroline 600 mg (two times a day) and piperacillin 2000 mg (two times a day). For mortality, three networks were constructed. Thus, three Em-ATBs have the HPBB: ceftriaxone 2000 mg (once a day) plus levofloxacin 500 (two times a day), ertapenem 1000 mg (two times a day) and amikacin 250 mg (two times a day) plus clarithromycin 500 mg (two times a day). The certainity of evidence for each results is moderate. CONCLUSION: For cure rate, ceftaroline and piperaciline are the options with the HPBB. However, for mortality rate, the options are ceftriaxone plus levofloxacin, ertapenem and amikacin plus clarithromycin. It seems necessary to conduct an RCT that compares treatments with the HPBB for each event (cure or mortality) (CRD42017060692).

Characteristics among six generations of medicine graduates.

BACKGROUND: Medical graduates follow-up programs allow the improvement of the curriculum of the Medicine career. Through identifying opportunity areas and strengthening points, institutions become increasingly competitive. OBJECTIVE: Identify the socio-demographic, formative, labor insertion and satisfaction characteristics among six generations of graduates of the Medical School of the Faculty of Medicine of the National Autonomous University of Mexico (2004-2009). METHOD: It is a descriptive, cross-sectional, retrospective, comparative study integrating the answers of mailed electronic questionnaires to 5295 graduates who concluded studies between 2004 and 2009. Descriptive and inferential techniques were used for analysis. RESULTS: An upward trend in the number of years to conclude the career was identified and an increase in failed assignments in the last three generations. Noticeable was also that, as time went by, the incorporation of physicians into the labor market was slower. Although the percentage of general unemployment was very low (2.9%). CONCLUSIONS: There are no major changes in the characteristics of the Medicine graduates. Although it is necessary to identify the reason for the increased in failed assignments which affects the length of completion. Further improvement in Research and Social Medicine programs are to be considered.

ANTECEDENTES: Los programas de seguimiento de egresados permiten mejorar los programas y el currículo de la carrera de Medicina, identificando las áreas de oportunidad y haciendo más competitivas a las instituciones educativas. OBJETIVO: Identificar las características sociodemográficas, formativas, de inserción laboral y de satisfacción, en seis generaciones de egresados de la carrera de Medicina de la Universidad Nacional Autónoma de México (2004-2009). MÉTODO: Estudio descriptivo, transversal, retrospectivo y comparativo, con 5295 egresados de la carrera de Medicina que concluyeron entre 2004 y 2009. Se envió un cuestionario por correo electrónico a cada uno de los egresados y se analizaron los resultados mediante técnicas descriptivas e inferenciales. RESULTADOS: Se observó un incremento en el número de años para concluir la carrera y un aumento en el número de materias reprobadas en las últimas tres generaciones. Además, hubo mayor lentitud en la inserción laboral en el mismo periodo, aunque el porcentaje de desempleo general fue muy bajo (2.9%). CONCLUSIONES: No hay cambios en la caracterización de los egresados respecto a generaciones anteriores; no obstante, será fundamental identificar las causas del incremento en el número de materias reprobadas que está afectando la eficiencia terminal, además de mejorar los programas de investigación epidemiológica y socio-médica.

[Occupational health and safety: educational intervention for cleaning workers in research sectors]. / Salud y seguridad laboral: intervención educativa en trabajadores de limpieza en áreas de investigación.

OBJECTIVE: To evaluate the results of educational interven- tion on health and safety regarding principles of biosafety in cleaning workers of a health institution. MATERIALS AND METHODS: Using concurrent mixed methods, we evaluated a total of 31 workers on their knowledge, attitudes, and practices of biosafety and risk perception. We conducted baseline measurements and two follow-ups. Fractional logistic regression models were fitted with study stage as covariate. Additional models included interactions of study stage with key workers characteristics. Thematic qualitative analysis and triangulation was developed. RESULTS: The knowledge (+33.3 points, scale 0-100), attitudes (+10.6), and practices (+23.5) increased significantly in the first follow-up; knowledge de- creased in the second follow-up (p<0.001). The qualitative findings revealed an improvement in risk prevention attitudes and practices, framed by experiences of vulnerability, stigma, and discrimination. CONCLUSIONS: The study provides key elements for biosafety research related to vulnerable groups and it is effective in promoting the health of a disadvantaged and invisible sector.

OBJETIVO: Evaluar los resultados de una intervención educativa sobre salud y seguridad laboral bajo principios de bioseguridad en trabajadores y trabajadoras de limpieza de una institución de salud. MATERIAL Y MÉTODOS: Evaluación con métodos mixtos concurrentes sobre conocimientos, actitudes y prácticas en bioseguridad y percepción de riesgos, con medición basal y dos seguimientos, en 31 trabajadores y trabajadoras. Se realizaron modelos fraccionales separados para estimar interacciones de las mediciones. Se hizo análisis cualitativo temático y triangulación metodológica. RESULTADOS: Los conocimientos (+33.3 puntos, escala 0 - 100), actitudes (+10.6) y prácticas (+23.5) incrementaron signifi- cativamente en el primer seguimiento; los conocimientos disminuyeron en el segundo seguimiento (p<0.001). Los ha- llazgos cualitativos revelaron mejora en actitudes y prácticas de prevención frente al riesgo, enmarcados por experiencias de vulnerabilidad, estigma y discriminación. CONCLUSIONES: El estudio aporta elementos clave para la investigación en bioseguridad relacionada con grupos vulnerables y es efectivo para la promoción de la salud de un sector desfavorecido e invisibilizado.

Salud y seguridad laboral: intervención educativa en trabajadores de limpieza en áreas de investigación / Occupational health and safety: educational intervention for cleaning workers in research sectors

Resumen: Objetivo: Evaluar los resultados de una intervención educativa sobre salud y seguridad laboral bajo principios de bioseguridad en trabajadores y trabajadoras de limpieza de una institución de salud. Material y métodos: Evaluación con métodos mixtos concurrentes sobre conocimientos, actitudes y prácticas en bioseguridad y percepción de riesgos, con medición basal y dos seguimientos, en 31 trabajadores y trabajadoras. Se realizaron modelos fraccionales separados para estimar interacciones de las mediciones. Se hizo análisis cualitativo temático y triangulación metodológica. Resultados: Los conocimientos (+33.3 puntos, escala 0-100), actitudes (+10.6) y prácticas (+23.5) incrementaron significativamente en el primer seguimiento; los conocimientos disminuyeron en el segundo seguimiento (p<0.001). Los hallazgos cualitativos revelaron mejora en actitudes y prácticas de prevención frente al riesgo, enmarcados por experiencias de vulnerabilidad, estigma y discriminación. Conclusiones: El estudio aporta elementos clave para la investigación en bioseguridad relacionada con grupos vulnerables y es efectivo para la promoción de la salud de un sector desfavorecido e invisibilizado.

Abstract: Objective: To evaluate the results of educational intervention on health and safety regarding principles of biosafety in cleaning workers of a health institution. Materials and methods: Using concurrent mixed methods, we evaluated a total of 31 workers on their knowledge, attitudes, and practices of biosafety and risk perception. We conducted baseline measurements and two follow-ups. Fractional logistic regression models were fitted with study stage as covariate. Additional models included interactions of study stage with key workers characteristics. Thematic qualitative analysis and triangulation was developed. Results: The knowledge (+33.3 points, scale 0-100), attitudes (+10.6), and practices (+23.5) increased significantly in the first follow-up; knowledge decreased in the second follow-up (p<0.001). The qualitative findings revealed an improvement in risk prevention attitudes and practices, framed by experiences of vulnerability, stigma, and discrimination. Conclusions: The study provides key elements for biosafety research related to vulnerable groups and it is effective in promoting the health of a disadvantaged and invisible sector.

Predicting the Impact of Diffuse Alveolar Damage through Open Lung Biopsy in Acute Respiratory Distress Syndrome-The PREDATOR Study.

The aim of this retrospective and international study is to identify those clinical variables associated with diffuse alveolar damage (DAD), and to explore the impact of DAD on hospital mortality risk. Inclusion criteria were: adult patients with acute respiratory distress syndrome (ARDS) undergoing open lung biopsy (OLB) during their intensive care unit (ICU) management. The main end-points were: DAD and hospital mortality. In the training (n = 193) and validation cohorts (n = 65), the respiratory rate (odd ratio (OR) 0.956; confidence interval (CI) 95% 0.918; 0.995) and coronary ischemia (OR 5.974; CI95% 1.668; 21.399) on the day of ARDS had an average area under the receiver operating characteristic curve (AUROC) of 0.660 (CI95% 0.585; 0.736) and 0.562 (0.417; 0.706), respectively. PEEP (OR 1.131; CI95% 1.051; 1.218) and coronary ischemia (OR 6.820; CI95% 1.856; 25.061) on the day of OLB had an average AUROC of 0.696 (CI95% 0.621; 0.769) and 0.534 (CI95% 0.391; 0.678), respectively, to predict DAD. DAD (OR 2.296; CI95% 1.228; 4.294), diabetes mellitus requiring insulin (OR 0.081; CI95% 0.009; 0.710) and the respiratory rate (OR 1.045; CI95% 1.001; 1.091) on the day of ARDS had an average AUROC of 0.659 (CI95% 0.583; 0.737) and 0.513 (CI95% 0.361; 0.664) to predict hospital mortality and DAD (OR 2.081; CI95% 1.053; 4.114), diabetes mellitus requiring insulin (OR 0.093; CI95% 0.009; 0.956), PaCO2 (OR 1.051; CI95% 1.019; 1.084), and platelets count (OR 0.999; CI95% 0.999; 0.999) the day of OLB had an average AUROC of 0.778 (CI95% 0.710; 0.843) and 0.634 (CI95%0.481; 0.787) to predict hospital mortalty in the training and validation cohorts, respectively. In conclusion, DAD could not to be predicted clinically and was significantly associated with hospital mortality.

Management of medical care, a fundamental tool for resident doctors.

In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly possess knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important.

En el área de la enseñanza médica, y particularmente dentro de nuestro país, las residencias médicas en hospitales son el mejor modelo para realizar un posgrado; sin embargo, cuando un médico joven inicia su residencia y arriba a un hospital, difícilmente posee los conocimientos de los servicios, tipo de pacientes y procesos que se realizan en dicho lugar, lo que repercute directamente en el cumplimiento de sus tareas, aprendizaje y, más importante, los servicios que ofrece el hospital. Por lo tanto, es imperante hacer partícipes a los médicos residentes en la gestión de la atención médica, darles a conocer que esta es la encargada de articular de forma armónica todos los procesos médico-administrativos en los que participan pacientes, recursos humanos, materiales y financieros, para alcanzar el cumplimiento de la misión y la visión hospitalaria con eficiencia operativa y sentido humano. De esta manera será posible orientarlos a realizar una correcta toma de decisiones y una gestión adecuada de los recursos, y a que su contribución en los procesos médico-administrativos brinde un servicio de calidad y seguridad para el paciente.