Assessment of Blood Prostaglandin E2 Metabolite Levels among Infants Born Preterm with Patent Ductus Arteriosus: A Prospective Study.

OBJECTIVE: To assess the role of prostaglandin E2 by measuring blood prostaglandin E2 metabolite (PGEM) concentrations in preterm infants with patent ductus arteriosus (PDA). STUDY DESIGN: A prospective observational study of preterm infants born before 32 weeks of gestational age (GA) was performed in a single tertiary hospital in Japan. Blood samples were collected to measure serum concentrations of PGEM, ibuprofen (IBU), and cytokines. Multiple regression analyses assessed associations between blood PGEM levels and perinatal factors, development of hemodynamically significant PDA (hsPDA), and IBU treatment response of hsPDA. RESULTS: Seventy-nine infants (median GA 28 weeks) were enrolled in this study. Forty-seven received IBU for hsPDA treatment 1 d after birth in median. PDA closure occurred in 25 infants after a single IBU treatment. Serum PGEM concentrations were associated with histologic chorioamnionitis (P < .01), but not with GA, respiratory distress syndrome, or serum IL-6 concentrations. Serum PGEM concentrations decreased after initial IBU treatment; however, they were not associated with hsPDA development (P = .39). IBU concentrations correlated with IBU treatment response (aOR 1.29, P < .01). However, pre-IBU serum PGEM levels and PGEM reduction ratio did not (P = .13, .15, respectively). CONCLUSIONS: Serum PGEM concentrations in preterm infants were associated with maternal histologic chorioamnionitis, but not hsPDA development. IBU treatment response was associated with higher blood IBU concentrations, but not PGEM concentrations.

Haptic experience to significantly motivate anatomy learning in medical students.

BACKGROUND: Currently, multiple tools exist to teach and learn anatomy, but finding an adequate activity is challenging. However, it can be achieved through haptic experiences, where motivation is the means of a significant learning process. This study aimed to evaluate a haptic experience to determine if a tactile and painting with color marker interactive experience, established a better learning process in comparison to the traditional 2D workshop on printed paper with photographs. METHODS: Plaster bone models of the scapulae, humerus and clavicle were elaborated from a computerized scan tomography. Second year undergraduate medical students were invited to participate, where subjects were randomly assigned to the traditional 2D method or the 3D plaster bone model. A third group decided not to join any workshop. Following, all three groups were evaluated on bone landmarks and view, laterality, muscle insertions and functions. 2D and 3D workshop students were asked their opinion in a focus group and answered a survey regarding the overall perception and learning experience. Evaluation grades are presented as mean ± standard deviation, and answers from the survey are presented as percentages. RESULTS: The survey demonstrated the students in the 3D model graded the experience as outstanding, and in five out of the six questions, answers were very good or excellent. In contrast, for students participating in the 2D workshop the most common answers were fair or good. The exception was the answer regarding the quiz, where both groups considered it good, despite the average among all groups not being a passing grade. CONCLUSIONS: To learn the anatomy of the shoulder, the conventional methodology was compared with a haptic experience, where plaster bone models were used, enabling students to touch and paint on them. Based on the focus group and survey this study revealed the 3D workshop was an interactive experience where, the sense of touch and painting greatly contributed to their learning process. Even though this activity was useful in terms of learning bone landmarks, view muscle insertions, and establish relations, further activities must be developed to increase their understanding regarding their function, and its relevance in a clinical setting.

Optimized swarming motility assay to identify anti-virulence products against Vibrio parahaemolyticus, a pathogen of farmed shrimp.

Swarming motility is a type of movement used by pathogenic flagellated bacteria as virulence factor to colonize surfaces and cause damage to the host. Vibrio parahaemolyticus is a pathogenic flagellated bacterium that increases its virulence by switching from swimmer to swarming cells. The hosts of pathogenic V. parahaemolyticus include farmed shrimp. Therefore, methods to detect and quantify this movement are important to control shrimp diseases caused by pathogenic V. parahaemolyticus strains. We developed an optimized swarming motility assay by identifying the most optimal type of agar, and drying time of the culture medium, agar concentration and volume of the bacterial culture to achieve the fastest swarming motility during the migration of V. parahaemolyticus on Petri dishes during a 24-hour incubation period. The method includes data analysis that could be used as a tool to identify potential anti-virulence products by comparing the slopes of the linearized diameters of the swarming halos of bacteria treated with the products, as they migrate on Petri dishes over a 24-hour incubation period. Here we report:•A simple method for detection and quantification of swarming motility halos of V. parahaemolyticus bacteria.•A method that could be used as a tool to identify potential anti-virulence products.

Evolving portal hypertension through Baveno VII recommendations.

The Baveno VII consensus workshop has provided several novel recommendations regarding the management of patients with clinically significant portal hypertension (CSPH). The expert panel summarized the existing data into simple clinical rules to aid clinicians in their clinical practice. The use of non-invasive tests (NITs), especially liver stiffness measurement (LSM), have gain an important role in daily practice. The use of LSM alone or in combination with platelet count can be used to rule-in and rule-out compensated advanced chronic liver disease (cACLD) and CSPH. Further decompensation events were defined as a prognostic stage associated with an even higher mortality than that associated with first decompensation. Moreover, the term hepatic recompensation was introduced in Baveno VII consensus implying a partial or complete regression of the functional and structural changes of cirrhosis after the removal of the underlying etiology. This review will summarize the reader main aspects of Baveno VII consensus regarding the use of NITs in cACLD, analyze further decompensation events, and evaluate recent recommendations for prophylaxis and management of liver decompensation events.

Apego Adulto y Soltería: Validación de una Escala / Adult Attachment and Singleness: Validation of a Scale

Resumen El apego es un vínculo afectivo que caracteriza y moldea las relaciones interpersonales cercanas. Los estilos de apego son el conjunto de conocimientos, expectativas e inseguridades que se sostienen sobre el sí mismo y los demás. El objetivo de la presente investigación fue elaborar una escala que evalúe el apego adulto no solo en el contexto romántico, sino con otros significativos, lo que permitirá el estudio de las personas sin pareja. Se realizaron tres estudios: en el estudio uno se realizó un análisis factorial exploratorio (n=400); en el estudio dos un análisis factorial confirmatorio (n=700). Se obtuvo una escala compuesta por 16 reactivos distribuidos en cuatro factores: preocupado, temeroso, evitante y seguro. La varianza explicada fue del 38.09%, con un índice de fiabilidad con un rango de 0.46 a 0.82 en los distintos factores. En el estudio tres se analizó la validez concurrente (n=201). En los tres estudios se encontraron diferencias entre las personas con pareja y sin pareja, puntuando más alto en seguridad las primeras y más alto en apego ansioso aquellas sin pareja. Se obtuvo una escala válida, confiable, culturalmente relevante que evalúa el apego adulto no solo en el ámbito romántico, sino con otros significativos.

Abstract The attachment is an affective bond that characterizes and shapes close interpersonal relationships. Attachment styles are the set of knowledge, expectations and insecurities about oneself and others. The aim of this research was to develop a scale with adequate psychometric properties, that allows to assess adult attachment not only in a romantic context, but with significant others in general. It will allow the study of groups such as single people. To address that aim, three studies were conducted in which men and women form Mexico City participated voluntarily. In study one an exploratory factor analysis was performed (n=400), in study two a confirmatory factor analysis was performed (n=700). As a result of these studies, it was obtained a scale compounded by 16 items distributed in four factors: preoccupied, fearful, dismissing, and secure. The explained variance was 38.09%, with a reliability index of 0.46 to 0.82 in the different factors. In study three concurrent validity was analyzed (n=201). Differences between people with a partner and single were found in the three studies, scoring higher in security the first and single people scoring higher in preoccupied attachment. It was obtained a valid, reliable, and culturally relevant scale to assess adult attachment not only in the romantic ambit, but also in relation to significant others like family and friends.

Inpatient Hepatology Consultation: A Practical Approach for Clinicians.

Cirrhosis is the end-stage of chronic liver disease and constitutes a leading cause of potential years of working life lost, especially in the Americas and Europe. Its natural history is characterized by an asymptomatic phase called compensated cirrhosis, followed by a rapidly progressive phase characterized by liver-related complications termed decompensated cirrhosis. Complications could be related to portal hypertension and/or liver dysfunction, including ascites, portal hypertensive gastrointestinal bleeding, encephalopathy, and jaundice. This review will discuss some of the most important precipitants of hepatic decompensation, including acute variceal bleeding, spontaneous bacterial peritonitis, and hepatic encephalopathy.

Urine-derived exosomal PSMA is a promising diagnostic biomarker for the detection of prostate cancer on initial biopsy.

PURPOSE: It is well-established that the lack of accurate diagnostic modalities for prostate cancer (PCa) leads to overdiagnosis and overtreatments. Accordingly, this study aimed to assess the value of urine-derived exosomal prostate-specific membrane antigen (PSMA) as a biomarker for the diagnosis of PCa and clinically significant prostate cancer (csPCa). METHODS: A total of 284 urine samples were collected from patients after the digital rectal examination (DRE). Urinary exosomes were extracted using commercial kits, and urine-derived exosomal PSMA was determined via enzyme-linked immunosorbent assay (ELISA). Evaluation of diagnostic accuracy of PSMA was performed via receiver operating characteristic (ROC) analysis, decision curve analysis (DCA), and waterfall plots. RESULTS: We found that urine-derived exosomal PSMA was significantly higher in PCa and csPCa than in benign prostatic hyperplasia (BPH) and BPH + non-aggressive prostate cancer (naPCa) groups (P < 0.001). Furthermore, the urine-derived exosome PSMA yielded area under the ROC curve (AUC) values of 0.876 and 0.826 for detecting PCa and csPCa, respectively, suggesting better performance than traditional clinical biomarkers. Besides, when the cutoff value used corresponded to a sensitivity of 95%, urine-derived exosomal PSMA could avoid unnecessary biopsies in 41.2% of cases and missed only 0.7% of csPCa cases. CONCLUSIONS: Urine-derived exosomal PSMA exhibits a good diagnostic yield for detecting PCa and csPCa. Findings of the present study provide the foothold for future studies on cancer management and research in this patient population.

O Um e a função do sexo segundo a psicanálise / El Uno y la función del sexo según el psicoanálisis / The One and the function of sex according to psychoanalysis

RESUMO Segundo a ambiguidade constitutiva do Um que Lacan promove a partir da lógica e da matemática nos seminários O saber do psicanalista e ... ou pior, entre 1971 e 1972, o artigo busca fundamentar a teoria da sexuação desenvolvida nesse período e esclarecer que tal conceituação retoma a subversão freudiana do polimorfismo pulsional. Se a pulsão não tem qualquer determinação instintual quanto a seu objeto, constata-se que esse mesmo equívoco se deslinda como impossibilidade de proporção e relação sexual [rapport sexuel] para o ser falante, que se posiciona gramaticalmente na estrutura da linguagem a partir desse impasse. Nesse sentido, a bifididade do Um, entre conjunto e elemento, mesmidade e diferença, particularidade e universalidade, ex-sistência e relatividade, real e simbólico, reescreve a diferença (sexual) conforme a psicanálise. O sexo, portanto, é a própria ausência de qualquer referência que não seja a opacidade de princípio do significante, é a evasão fundamental do ser à verdade.

RESUMEN Basado en la ambigüedad constitutiva del Uno que Lacan promueve desde la lógica y de la matemática en los seminarios O saber do psicanalista e ...ou pior, entre 1971 y 1972, el artículo busca apoyar la teoría de la sexuación desarrollada en ese período y aclarar que tal conceptualización reanuda la subversión freudiana del polimorfismo de la pulsión. Si la pulsión no tiene ninguna determinación instintiva en cuanto a su objeto, parece que este mismo malentendido se revela como la imposibilidad de la proporción y la relación sexual [rapport sexuel] para el ser hablante, que se posiciona gramaticalmente en la estructura del lenguaje desde esta cuestión. Así, la bifidez del Uno, entre conjunto y elemento, igualdad y diferencia, particularidad y universalidad, ex-sistencia y relatividad, real y simbólico, reescribe la diferencia (sexual) según el psicoanálisis. El sexo, por lo tanto, es la ausencia misma de cualquier referencia que no sea la opacidad de principio del significante, es la evasión fundamental del ser de la verdad.

ABSTRACT Based on the constitutive ambiguity of the One that Lacan promotes from logic and mathematics in the seminaries O saber do psicanalista e ...ou pior, between 1971 and 1972, the article seeks to support the theory of sexuation developed in that period and clarify that such conceptualization resumes the Freudian subversion of the drive polymorphism. If the drive does not have any instinctual determination as to its object, it appears that this same misunderstanding is revealed as the impossibility of proportion and sexual relationship [rapport sexuel] for the speaking being, who grammatically positions themselves in the structure of language from this impasse. Thus, the bifidity of the One, between set and element, sameness and difference, particularity and universality, ex-sistence and relativity, real and symbolic, rewrites the (sexual) difference according to psychoanalysis. Sex, therefore, is the very absence of any reference other than the constitutive opacity of the signifier, it is the fundamental evasion of the being from the truth.

Ausencia de diferencias relacionadas con el sexo en los valores de los cambios mínimos significativos para composición corporal por DXA en sujetos adultos / Absence of sex-related differences in the values of minimum significant changes for body composition by DXA in adult subjects

Para la evaluación longitudinal de la composición corporal por DXA se deben calcular los cambios mínimos significativos (CMS). No está claro si hay diferencias de género para los CMS de adultos. Con consentimiento informado se realizaron 2 escaneos DXA de cuerpo completo consecutivos, con reposicionamiento entre ellos, en 40 varones y 40 mujeres (rango de edad de 22 a 85 años), con un equipo GE Lunar Prodigy Advance®, siguiendo las pautas de la International Society for Clinical Densitometry (ISCD). Todos los escaneos fueron obtenidos por la misma técnica experta. Los CMS se calcularon de acuerdo con el método propuesto por la ISCD. Los resultados se analizaron con GraphPad® para Windows 6.0, con una significancia fijada en p < 0,05. No hubo diferencias de género para la edad (p = 0,846) o el índice de masa corporal (p = 0,802). La altura, la masa corporal, la masa magra y el contenido mineral óseo (CMO) fueron mayores en los varones (todos p < 0,0001), mientras que la masa grasa fue mayor en las mujeres (p = 0,0036). No hubo diferencias significativas entre géneros para los coeficientes de variación de masa grasa (p = 0,0698), masa magra (p = 0,1483) o CMO (p = 0,5254). Los CMS (para IC de 95%) para la masa grasa fueron 1,780 kg (varones), 1,671 kg (mujeres) y 1,727 kg (ambos sexos); para masa magra, 1,658 kg (varones), 1,644 kg (mujeres) y 1,651 (ambos sexos); y para CMO, 112,2 g (varones), 109,4 (mujeres) y 110,8 g (ambos sexos). Los resultados sugieren que los CMS para la composición corporal de su-jetos adultos pueden calcularse a partir de una muestra de cualquier género o una que incluya sujetos de ambos sexos. (AU)

Lack of gender-related differences in least significant changes for DXA body composition analysis in adult subjectsFor longitudinal assessment of body composition by DXA, least significant changes (LSCs) should be calculated. It is unclear if there are gender differences for adult LSCs. With informed consent, 2 consecutive total-body DXA scans, with repositioning between them, were performed on 40 males and 40 females (age range 22 to 85 years) with a GE Lunar Prodigy Advance scanner, following the guidelines of the International Society for Clinical Densitometry (ISCD). All scans were obtained by the same skilled technologist. The LSCs were calculated according to the method proposed by the ISCD. Results were analyzed with GraphPad for Windows 6.0, with significance set at p < 0.05. There were no gender differences for age (p = 0.846) or body mass index (p = 0.802). Height, body mass, lean mass, and bone mineral content (BMC) were higher in males (all p < 0.0001), whereas fat mass was higher in females (p = 0.0036). There was no significant difference between genders for the coefficients of variation of fat mass (p = 0.0698), lean mass (p = 0.1483), or BMC (p = 0.5254). The LSCs (for a 95% CI) for fat mass were 1.780 kg (men), 1.671 kg (women), and 1.727 kg (both genders); for lean mass, 1.658 kg (men), 1.644 kg (women) and 1,651 (both genders); and for BMC, 112.2 g (men), 109.4 (women), and 110.8 g (both genders). These results suggest that LSCs for body composition of adult subjects can be calculated from either a sample of each gender or one that includes subjects of both genders. (AU)

The most significant change for Colombian medical trainees going transformative learning on cultural safety: qualitative results from a randomised controlled trial.

BACKGROUND: Cultural safety training is not yet standard in Colombian medical education. If incorporated, it could address currently adversarial interactions between health professionals and the 40% of people who use traditional medicine practices. In 2019, a randomised controlled trial tested the impact of cultural safety training for medical students using participatory serious game design. The quantitative evaluation showed improved cultural safety intentions of Colombian medical trainees. We report here a qualitative evaluation of the most significant change perceived by trial participants. METHODS: This qualitative descriptive study used the most significant change technique. We invited the trial participants engaged in clinical settings to describe stories of change in their supervised clinical practice that they attributed to the intervention. Using a deductive thematic analysis based on a modified theory of planned behaviour, two independent reviewers coded the stories and, by consensus, created themes and sub-themes. RESULTS: From 27 stories of change, we identified seven themes and 15 subthemes: (a) Conscious knowledge: benefits of cultural safety training, consequences of culturally unsafe behaviour, cultural diversity and cultural practices; (b) Attitudes: respect and appreciation for cultural diversity, openness, and self-awareness; (c) Subjective norms: positive perception of cultural practices and less ethnocentrism; (d) Intention to Change; (e) Agency to accept cultural diversity and to prevent culturally unsafe actions; (f) Discussion; and (g) Action: better communication and relationship with patients and peers, improved outcomes for patients, physicians, and society, investigation about cultural health practices, and efforts to integrate modern medicine and cultural health practices. CONCLUSION: The narratives illustrated the transformative impact of cultural safety training on a results chain from conscious knowledge through to action. Our results encourage medical educators to report other cultural safety training experiences, ideally using patient-related outcomes or direct observation of medical trainees in clinical practice. TRIAL REGISTRATION: Registered on ISRCTN registry on 18/07/2019. REGISTRATION NUMBER: ISRCTN14261595.

Secure Exchange of Medical Images Via Extended Visual Cryptography / Intercambio Seguro de Imágenes Médicas Mediante Criptografía Visual Extendida

ABSTRACT Medical image security is acquiring its importance to preserve the integrity and confidentiality of information (medical data) from malicious users given its importance in timely and successful diagnosis. In this context, several techniques have been developed to protect medical images, such as encryption, data hiding, image tagging, application of Hash algorithms, etc. This paper proposes a technique to cipher medical images by adding the metadata inside a cover image, based on extended visual cryptography as well as the inclusion of a Hash-like function to verify the integrity of the image and the metadata once they are recovered. The method proposed in this work is implemented using medical images with a grayscale resolution of [0,4095] that is a depth of 12 bits/pixel and color images with 24 bits/pixel depth. Experimental results prove the effectiveness of the proposed method in the task of secure exchange of medical images by allowing higher hiding capability, lower distortion in the visual quality of the image with the hidden medical data, as well as a means to verify the integrity of the sent data, compared to state-of-the-art.

RESUMEN La seguridad de imágenes médicas está incrementando su importancia para preservar la integridad y la confidencialidad de la información (datos médicos), frente a usuarios malintencionados dada su importancia en el diagnóstico oportuno y acertado. En este contexto, se han desarrollado varias técnicas para proteger las imágenes médicas, como el cifrado, la ocultación de datos, el etiquetado de imágenes, la aplicación de algoritmos Hash, etc. Este trabajo propone una técnica para cifrar imágenes médicas añadiendo los metadatos dentro de una imagen de cubierta, basada en la criptografía visual extendida, así como la inclusión de una función tipo Hash para comprobar la integridad de la imagen y los metadatos una vez estos sean recuperados. El método propuesto en este trabajo se implementa utilizando imágenes médicas con una resolución en escala de grises de [0,4095] es decir una profundidad de 12 bits/ píxel e imágenes en color con 24 bits/píxel de profundidad. Los resultados experimentales demuestran la eficacia del método propuesto en la tarea de transmisión segura de imágenes médicas permitiendo una mayor capacidad de ocultamiento, una menor distorsión en la calidad visual de la imagen con los datos médicos ocultos, así como un medio para comprobar la integridad de los datos enviados, en comparación con los artículos publicados.

Educação permanente na atenção secundária: elaboração de protocolo de atendimento de urgência / Permanent education in secondary care: elaboration of an emergency care protocol

Os centros de especialidades, não somente médicas, são apontados como fundamentais na retaguarda à Atenção Primária e desempenham importante papel em Redes Regionalizadas de Saúde, não só no Brasil, sendo representado pela Atenção Secundária. O processo de trabalho no SUS, para ser constituído de forma a permitir a melhor interação interprofissional, requer o exercício cotidiano da Educação Permanente em nossas Unidades de Saúde. Objetivo geral: Elaborar um procedimento operacional padrão para a organização do processo de trabalho comum grupo de funcionários que atua direta e indiretamente no ambulatório de cardiologia da atenção secundária de um município de médio porte da região serrana do estado do Rio de Janeiro. Objetivos especificos: 1.Identificar os entraves encontrados pelos trabalhadores do ambulatório de atenção secundária para o atendimento ao paciente com diminuição do nível de consciência. 2.Descrever as dificuldades no processo de trabalho quanto à necessidade da implementação da Educação Permanente 3.Propor estratégias que poderão ser vivenciadas e experimentadas através da Educação Permanente, para a solução ou enfrentamento desses entraves. Método: Trata-se de uma pesquisa qualitativa,tendo como referencial político-pedagógico a Política Nacional de Educação Permanente. O tipo de pesquisa é a análise intencional de pesquisa-ação de Thiollent (1997), referencial teórico, sendo utilizado como referencial filosófico, o educador Paulo Freire. A técnica e instrumento para coleta e análise de dados mediante grupo focal e/ou Questionário Semiestruturado, sob análise temática em Bardin e Turato (2011). O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universidade Federal Fluminense sob nº 4.428.883Resultados: Os resultados apontam para melhorias no processo de trabalho cotidiano, calcado em premissas da Educação Permanente como uma prática transformadora. Propõe uma reflexão sobre a prática individual do profissional e, mais do que sua interação multiprofissional no processo de trabalho, apresenta uma experiência positiva originada da atuação em processo de Educação Permanente na Atenção Secundária da região serrana do estado do Rio de Janeiro. Conclusão: Esse estudo trouxe contribuições significativas para a prática, mediante elaboração de um protocolo de atendimento a pacientes com nível de consciência reduzido, em Posto de Saúde da Atenção Secundária, adequado à realidade local, produto da demanda do grupo de trabalho.

Specialty centers, not only medical, are seen as fundamental in the rear of Primary Care, and play an important role in Regionalized Health Networks, not only in Brazil, being represented by Secondary Care. The work process in the SUS, to be constituted in a way that allows the best interprofessional interaction, requires the daily exercise of Continuing Education in our Health Units. General objective: To develop a standard operating procedure for the organization of the work process with a group of employees who work directly and indirectly in the secondary care cardiology outpatient clinic of a medium-sized city in the mountainous region of the state of Rio de Janeiro. Specific Objectives: 1. Identify the obstacles encountered by workers at the secondary care clinic for patient care with a decreased level of consciousness. 2.Describe the difficulties in the work process regarding the need to implement Continuing Education. 3.Propose strategies that can be experienced and tried out, through Continuing Education, for the solution or confrontation of these obstacles. Method: This is a qualitative research, using the National Policy for Continuing Education as a political-pedagogical framework. The type of research is the intentional analysis of action research by Thiollent (1997), theoretical framework, being used as a philosophical framework, the educator Paulo Freire. The technique and instrument for data collection and analysis through focus group and/or Semi-structured Questionnaire, under thematic analysis in Bardin and Turato (2011). The project was approved by the Research Ethics Committee of the Faculty of Medicine of Universidade Federal Fluminense under nº 4.428.883Results: The results point to improvements in the daily work process, based on premises of Continuing Education as a transforming practice. It proposes a reflection on the professional's individual practice, and more than its multidisciplinary interaction in the work process, it presents a positive experience originating from the performance in the Permanent Education process in Secondary Care in the mountainous region of the state of Rio de Janeiro. Conclusion: This study brought significant contributions to the practice, through the elaboration of a care protocol for patients with reduced level of consciousness, in a Secondary Care Health Center, adequate to the local reality, product of the demand of the work group.

Psicanálise e linguística: intersecções e cortes / Psychoanalysis and linguistics: intersections and cuts

Este trabalho faz parte do projeto de pesquisa "A pesquisa clínica em transferência". Neste artigo, revisitamos alguns conceitos linguísticos - linguagem, língua, discurso, signo linguístico, significante, entre outros - e suas articulações com o campo lacaniano no que diz respeito, principalmente, à lógica do significante. Serão analisadas referências da linguística em Saussure, Jakobson e Benveniste, além de textos de Lacan e leituras contemporâneas afins, com o objetivo de mostrar alguns pontos do caminho teórico percorrido por Lacan sob a influência da linguística, mas considerando também seu modo singular de apreender e utilizar esses conhecimentos. Apresentaremos, igualmente, alguns comentários sobre elementos discordantes entre essas duas disciplinas, o que, ao longo do seu ensino, levou Lacan a um afastamento conceitual da linguística. Tal distanciamento foi justificado pela ideia de que a psicanálise se ocupa do sujeito do inconsciente e do que fica fora da linguagem, diferentemente da linguística, que evidencia as funções de comunicação e expressão da linguagem no nível da consciência.(AU)

This work was created as part of the studies of a research entitled "The clinical research in transference". In this article, we reexamine some of linguistics concepts such as language, tongue, discourse, linguistic sign, significant, among others, and its articulations with de lacanian field in special the the significant logic. We will analyze linguistics references in Saussure, Jakobson and Benvenist's works, beyond Lacan'texts and contemporaneous readings about the issue aiming to show some matters from the lacanian trajectory since the linguistic influence, but also considering their unique way of apprehending and using such knowledge. We will also present some comments on discordant elements between these two disciplines, which, throughout his teaching, led Lacan to a conceptual separation from linguistics. Such distancing was justified by the idea that psychoanalysis deals with the subject of the unconscious and what lies outside of language, differently from the linguistic that demonstrates the communicative and expressive functions of the language in the conscious mind.(AU)

Este trabajo fue creado como parte de los estudios de una investigación titulada "La investigación clínica em la transferencia". En este artículo reexaminamos algunos conceptos lingüísticos como lenguaje, lengua, discurso, signo lingüístico, significante, entre otros, y sus articulaciones con el campo lacaniano en particular la lógica significante. Analizaremos los referentes lingüísticos em las obras de Saussure, Jakobson y Benveniste, más allá de los textos de Lacan y las lecturas contemporáneas sobre el tema, con el objetivo de mostrar algunas cuestiones de la trayectoria lacaniana desde la influencia linguística, pero también considerando su forma única de aprehender y utilizar dicho conocimiento. También presentaremos algunos comentarios sobre elementos discordantes entre estas dos disciplinas que, a lo largo de su enseñanza, llevaron a Lacan a una separación conceptual de la lingüística. Tal distanciamiento fue justificado por la idea de que el psicoanálisis trata el tema del inconsciente y lo que está fuera del lenguaje, a diferencia del lingüístico que demuestra las funciones comunicativas y expresivas del lenguaje em lamente consciente.(AU)

El reciclaje: Hecho significativo del valor ambiental desde el entorno educativo y su influencia en la salud / Recycling: a significant fact of environmental value from the educational environment and its influence on health

El reciclaje, la reutilización y la reducción en el consumo, es la demostración más concreta de una toma de conciencia en el ser y su papel protagonista en los procesos transformadores de nuestra realidad como especie. En este sentido, vemos que inculcar conocimientos en el área, desde las más jóvenes generaciones, hasta nuestros ancianos, puede lograr positivos cambios para la salud general, tanto del planeta, como del ser humano, siendo el propósito de la investigación conocer la importancia del reciclaje como un hecho significativo para exaltar el valor ambiental en los estudiantes. En cuanto al apartado epistemo­metodológico, se trabajó bajo el paradigma interpretativo, con un método fenomenológico­hermenéutico, usando la observación participante y la entrevista en profundidad, como técnicas de recolección de información, las cuales se aplicaron a un sujeto informante del aula de 4to año, siendo éste seleccionado por ser el más adecuado para el estudio. La técnica de análisis fue reducciones fenomenológicas a los extractos más importantes de la información, la cual fue proporcionada por el sujeto informante durante la entrevista, donde surgieron las categorías que se desglosaron en un cierre eidético que dio a conocer las ideas de la esencia verdadera del pensamiento del informante, así como también se hizo un giro hermenéutico, el cual logró proporcionar sentido a lo que se expresó en la investigación, como un aporte del investigador para dar visión a todo aquello en lo que se puede ir más allá del proceso investigativo(AU)

Recycling, reuse and reduction in consumption is the most concrete demonstration of an awareness of being and its leading role in the transforming processes of our reality as a species. In this sense, we see that instilling knowledge in the area, from the youngest generations, to our elders, can achieve positive changes for the general health, both of the planet and of the human being, the purpose of the research being to know the importance of recycling as a significant fact to exalt the environmental value in students. As for the epistemological-methodological section, we worked under the interpretive paradigm, with a phenomenological-hermeneutic method, using participant observation and in-depth interview, as information collection techniques, which were applied to an informant subject from the classroom of 4th year, this being selected for being the most suitable for the study. The analysis technique was phenomenological reductions to the most important extracts of the information, which was provided by the informant subject during the interview, where the categories emerged that were broken down into an eidetic closure that revealed the ideas of the true essence of the informant's thought, as well as a hermeneutical turn, which managed to provide meaning to what was expressed in the investigation, as a contribution of the researcher to give vision to everything in which one can go beyond the investigative process(AU)

The Evolutionary Landscape of SARS-CoV-2 Variant B.1.1.519 and Its Clinical Impact in Mexico City.

The SARS-CoV-2 pandemic is one of the most concerning health problems around the globe. We reported the emergence of SARS-CoV-2 variant B.1.1.519 in Mexico City. We reported the effective reproduction number (Rt) of B.1.1.519 and presented evidence of its geographical origin based on phylogenetic analysis. We also studied its evolution via haplotype analysis and identified the most recurrent haplotypes. Finally, we studied the clinical impact of B.1.1.519. The B.1.1.519 variant was predominant between November 2020 and May 2021, reaching 90% of all cases sequenced in February 2021. It is characterized by three amino acid changes in the spike protein: T478K, P681H, and T732A. Its Rt varies between 0.5 and 2.9. Its geographical origin remain to be investigated. Patients infected with variant B.1.1.519 showed a highly significant adjusted odds ratio (aOR) increase of 1.85 over non-B.1.1.519 patients for developing a severe/critical outcome (p = 0.000296, 1.33-2.6 95% CI) and a 2.35-fold increase for hospitalization (p = 0.005, 1.32-4.34 95% CI). The continuous monitoring of this and other variants will be required to control the ongoing pandemic as it evolves.

Peer teaching, a didactic strategy for learning basic electrocardiography / La enseñanza por pares, una estrategia didáctica para el aprendizaje de la electrocardiografía básica

Abstract Teaching electrocardiography is a very important area in undergraduate student training. A constant concern of professors is for physicians in training to acquire competence in reading and interpreting electrocardiograms (EKGs). This study describes and explores how the didactic strat egy of peer teaching improves learning processes for second-year medical students. Evidence was found that peer teaching fosters significant learning of cardiac physiology and electrocardiograms, in particular, because it allows students to acquire abilities and skills in EKG reading, and improves the understanding and interpretation of this test. In addition, it promotes horizontal peer relationships which facilitate the development of autonomy, self-learning and teamwork. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.1971).

Resumen La enseñanza de la electrocardiografía es un área de gran importancia en la formación de los estudiantes de pregrado, para los docentes es una preocupación constante que los médicos en for mación adquieran las competencias para la lectura e interpretación del electrocardiograma (ECG). El presente estudio describe e indaga sobre cómo la estrategia didáctica de la enseñanza por pares mejora los procesos de aprendizaje de los estudiantes de segundo año de formación médica. Se halló evidencia de que la enseñanza por pares favorece el aprendizaje significativo de la fisiología cardiaca y del electrocardiograma, en particular, porque permite la adquisición de habilidades y destrezas a los estudiantes en la lectura del ECG y mejora la comprensión e interpretación de dicho examen; además, propicia relaciones horizontales entre pares que facilitan el desarrollo de la autonomía, el autoaprendizaje y el trabajo en equipo. (Acta Med Colomb 2021; 46. DOI:doi.org/10.36104/amc.2021.1971).

Hepamet Fibrosis Score in Nonalcoholic Fatty Liver Disease Patients in Mexico: Lower than Expected Positive Predictive Value.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has been associated with different negative outcomes in the presence of advanced fibrosis. The Hepamet Fibrosis Score (HFS), a recently described noninvasive score, has shown excellent performance for the detection of advanced fibrosis. The aim of this study was to assess its performance in a Mexican population with NAFLD. METHODS: This was a retrospective cross-sectional study performed in 222 patients with biopsy-proven NAFLD, of whom 33(14%) had advanced fibrosis. We retrieved clinical data from each patient's medical record to compute the HFS, the NAFLD Fibrosis Score (NFS), and the Fibrosis-4 (FIB-4), and assess their performance. RESULTS: When considering the models as continuous variables, the area under the receiving operating characteristics curve of the HFS(0.758) was not different from that of the NFS(0.669, p = 0.09) or FIB-4(0.796, p = 0.1). The HFS had a sensitivity, specificity, positive and negative predictive values of 76.7% (95% CI 57.7-90.1), 90.1% (95% CI 85-93.9), 36.7% (95% CI 19.9-56.1), and 94.3% (95% CI 88.5-97.7), respectively. Indeterminate results (i.e., gray area) were more common with FIB-4 and HFS when compared with NFS [139(63%) and 122(55%) vs 80(36%), p < 0.001]. The variables that were associated with misclassification using the HFS were diabetes [OR 3.40 (95% CI 1.42-8.10), p = 0.006] and age [OR 1.06 (95% CI 1.01-1.11), p = 0.01]. CONCLUSION: The HFS showed sensitivity and specificity similar to that reported in the original publication; however, the positive predictive value was 36.7% at a pretest probability of 14%. The role of the HFS in prospective studies and in combination with other methods should be further explored.

Genetic data improves niche model discrimination and alters the direction and magnitude of climate change forecasts.

Ecological niche models (ENMs) have classically operated under the simplifying assumptions that there are no barriers to gene flow, species are genetically homogeneous (i.e., no population-specific local adaptation), and all individuals share the same niche. Yet, these assumptions are violated for most broadly distributed species. Here, we incorporate genetic data from the widespread riparian tree species narrowleaf cottonwood (Populus angustifolia) to examine whether including intraspecific genetic variation can alter model performance and predictions of climate change impacts. We found that (1) P. angustifolia is differentiated into six genetic groups across its range from México to Canada and (2) different populations occupy distinct climate niches representing unique ecotypes. Comparing model discriminatory power, (3) all genetically informed ecological niche models (gENMs) outperformed the standard species-level ENM (3-14% increase in AUC; 1-23% increase in pROC). Furthermore, (4) gENMs predicted large differences among ecotypes in both the direction and magnitude of responses to climate change and (5) revealed evidence of niche divergence, particularly for the Eastern Rocky Mountain ecotype. (6) Models also predicted progressively increasing fragmentation and decreasing overlap between ecotypes. Contact zones are often hotspots of diversity that are critical for supporting species' capacity to respond to present and future climate change, thus predicted reductions in connectivity among ecotypes is of conservation concern. We further examined the generality of our findings by comparing our model developed for a higher elevation Rocky Mountain species with a related desert riparian cottonwood, P. fremontii. Together our results suggest that incorporating intraspecific genetic information can improve model performance by addressing this important source of variance. gENMs bring an evolutionary perspective to niche modeling and provide a truly "adaptive management" approach to support conservation genetic management of species facing global change.

Leucocituria significativa como indicador de probable infección del tracto urinario sin cultivo positivo / Significant leukocyturia as an indicator of probable urinary tract infection without positive culture

Introducción: La presencia de leucocituria nos orienta hacia la probabilidad de infección del tracto urinario en niños. Objetivo: Determinar si la leucocituria significativa es un marcador de infección urinaria aun sin cultivo de orina positivo. Métodos: Estudio descriptivo y retrospectivo en pacientes egresados de los Servicios de Neonatología y Nefrología del Hospital Pediátrico Universitario Juan Manuel Márquez, entre enero 2018-diciembre 2019, que incluyó 124 niños de 2 años de edad; un grupo con infección del tracto urinario confirmada (clínica, leucocituria mayor 10 000 leucocitos/ml y con urocultivos positivos) y otro sospechada (clínica, con leucocituria significativa de más 100 000 leucocitos/ml, pero sin cultivo de orina positivo). Se compararon variables clínicas, de laboratorio y de radioimagen. Resultados: En 78,6 por ciento de los niños se aisló Escherichia coli. La fiebre fue un hallazgo clínico frecuente. El reactante de fase aguda con mayor variación fue la velocidad de sedimentación globular (71,0 por ciento), presentaron alteraciones del ultrasonido (79,8 por ciento) y uretrocistografía miccional (50,0 por ciento). No hubo diferencias estadísticamente significativas al comparar las variables clínicas, de laboratorio y de radioimagen entre el grupo de pacientes con infección del tracto urinario confirmada por urocultivo positivo y el grupo sospechado por la clínica, con leucocituria significativa de más 100 000 leucocitos/ml, pero sin urocultivo positivo. Conclusiones: En los niños con manifestaciones clínicas de infección, con presencia de una leucocituria significativa (más 100 000 leucocitos/ml), aunque no cuenten con un resultado positivo del urocultivo, se les debe proporcionar la atención médica establecida para un paciente con infección del tracto urinario(AU)

Introduction: The presence of leukocyturia guides towards the probability of urinary tract infection in children. Objective: Determine whether significant leukocyturia is a marker of urinary tract infection even without positive urine culture. Methods: Descriptive and retrospective study in patients discharged from the Neonatology and Nephrology Services of Juan Manuel Márquez University Pediatric Hospital, from January 2018 to December 2019, which included 124 children of 2 years of age; one group with confirmed urinary tract infection (clinical, leukocyturia of more than 10 000 leukocytes/ml and with positive urine cultures) and another group of suspected ones (clinical, with significant leukocyturia of more than 100 000 leukocytes/ml, but without positive urine culture). Clinical, laboratory and radioimaging variables were compared. Results: Escherichia coli was isolated in 78.6 percent of the children. Fever was a common clinical finding. The reactant acute phase with the greatest variation was the erythrocyte sedimentation rate (71.0 percent), there were ultrasound alterations (79.8 percent) and voiding urethrocystography (50.0 percent). There were no statistically significant differences when comparing clinical, laboratory and radioimaging variables between the group of patients with urine tract infection confirmed by positive urine culture and the group suspected by the clinic findings, with significant leukocyturia of more than 100 000 leukocytes/ml, but without positive urine culture. Conclusions: In children with clinical manifestations of infection, with the presence of significant leukocyturia (more than 100 000 leukocytes/ml), even if they do not have a positive urine culture result, they should be provided with the medical care established for a patient with urinary tract infection(AU)

Funções exercidas pelos membros das redes sociais significativas de pessoas aposentadas / Roles of members in support networks to retirees / Funciones ejercidas por los miembros de las redes sociales de personas jubiladas

Este estudo de caráter qualitativo teve como objetivo analisar as funções exercidas pelos membros das redes sociais significativas de pessoas aposentadas. Participaram da pesquisa doze aposentados com idade entre 52 e 66 anos. Os instrumentos de coleta de dados foram entrevistas semiestruturadas e mapas de redes. A organização e a análise dos dados se fundamentaram na Grounded Theory e contaram com o auxílio do software Atlas.ti versão 1.6.0. Os resultados evidenciaram que, embora os participantes sustentem vínculos em outros contextos relacionais, a família e os amigos se distinguem como os principais articuladores das interações sociais nesse período da vida. Identificou-se ainda que as redes influenciam diferentes momentos do processo de aposentadoria, sendo que as funções exercidas pelos membros foram recursos importantes que auxiliaram na tomada de decisão e no ajustamento dos idosos. Diante disso, o conjunto de resultados alcançados elucidam a relevância de considerar o universo relacional em que o aposentado se encontra participando, posto que, por meio dos intercâmbios afetivos construídos com os membros das redes sociais, consolidam-se ações que agenciam os processos de mudança atrelados à aposentadoria.(AU)

This qualitative study aims to assess the roles of members of Support Networks to Retirees. Data on 12 retirees aged between 52 and 66 years were collected by means of semi-structured interviews and Network Maps and analyzed in the light of the Grounded Theory using the 1.6.0 Atlas.ti software. Results show that families and friends are the primary source of social interaction for retirees, although they also establish relationships in other social settings. Moreover, the Support Networks exerted considerable influence on different stages of the retirement process, as members' roles functioned as vital resources in aiding their decision-making and adjustments. These findings evince the relevance of considering the relational universe in which the retiree is inserted, for affective interactions consolidate the actions of managing every retirement-related process of change.(AU)

Este estudio cualitativo tuvo como objetivo analizar las funciones ejercidas por los miembros de las redes sociales de personas jubiladas. Participaron 12 jubilados, con edades entre los 52 y los 66 años. Los instrumentos de recolección de datos fueron entrevistas semiestructuradas y mapas de red. La organización y el análisis de los datos se basaron en la teoría fundamentada y fueron realizadas con el software Atlas.ti versión 1.6.0. Los resultados mostraron que, aunque los participantes también mantuvieron lazos en otros contextos relacionales, la familia y los amigos fueron los principales articuladores de las interacciones sociales en este período de la vida. También se identificó que las redes influyeron en diferentes momentos del proceso de jubilación, y las funciones realizadas por los miembros fueron recursos importantes que les ayudaron en la toma de decisiones y el ajuste. Ante esto, los resultados evidencian la relevancia de considerar el universo relacional en el que participa el jubilado, ya que es a través de los intercambios afectivos constituidos con los miembros de las redes sociales que las acciones consolidan los procesos de cambio vinculados al retiro.(AU)