ABSTRACT Introduction: Three-dimensional printing is one of the technologies that promote change at an economic and social level, and one of the fundamental elements of industry 4.0. It has enormous potential for the future of medicine, establishing itself as a new paradigm. Despite its advantages, its use in our environment is incipient. Objective: To design and develop solutions based on three-dimensional technologies for the teaching and practice of biomedical sciences. Materials and methods: A technological development investigation was carried out between the Center for Assisted and Sustainable Manufacturing of the University of Matanzas and Matanzas University of Medical Sciences, between September 2019 and July 2022. The designs and fabrications were made from the acquisition of computed tomography images, or from a surface scanner, which were then processed, converted into Standard Tessellation Language format, printed, and post-processed. Virtual designs were developed using computer-aided design software. Results: Various solutions were developed including prototypes: biomodels for craniosynostosis repair and anatomical figures, custom cranial prosthesis mold, hand prosthesis, O2 line splitters, tissue scaffolds, syringe gun, face shields, breast prosthesis; autologous restoration mold and tissue expander. Conclusions: In all areas of application of this technology in medicine―except the printing of medicines, in the current context―, it is feasible to obtain solutions in the territory of Matanzas. It is therefore imperative that managers and the medical community in general, begin to acquire awareness, knowledge, and experience to ensure the optimal use of this technology.

RESUMEN Introducción: La impresión tridimensional es una de las tecnologías que promueve el cambio a nivel económico y social, y uno de los elementos fundamentales de la industria 4.0. Asimismo, constituye un enorme potencial para el futuro de la medicina, estableciéndose como un nuevo paradigma. A pesar de sus ventajas, su explotación en nuestro medio es incipiente. Objetivos: Diseñar y desarrollar soluciones basadas en tecnologías tridimensionales para la enseñanza y la práctica de las ciencias biomédicas. Materiales y métodos: Se realizó una investigación colaborativa, de desarrollo tecnológico entre el Centro de Fabricación Asistida y Sostenible de la Universidad de Matanzas y la Universidad de Ciencias Médicas de Matanzas, entre septiembre de 2019 y julio de 2022. Los diseños y fabricaciones se realizaron a partir de la adquisición de imágenes de tomografía computarizada, o desde un escáner de superficie, las que luego se procesaron, se convirtieron en formato Standard Tessellation Language, se imprimieron y posprocesaron. Los diseños virtuales se desarrollaron empleando un software de diseño asistido por computadora. Resultados: Se desarrollaron varias soluciones que incluyen varios prototipos: biomodelos para reparación de craneosinostosis y figuras anatómicas, molde de prótesis craneal personalizada, prótesis de mano, divisores de líneas de O2, andamios tisulares, pistola portajeringas, protectores faciales, prótesis de mama, molde para restauración autóloga y expansor tisular. Conclusiones: En todas las áreas de aplicación de esta tecnología en medicina―salvo en la impresión de medicamentos, en el contexto actual―, es factible obtener soluciones en el territorio de Matanzas. Es un imperativo, pues, que directivos y la comunidad médica en general, comiencen a adquirir conciencia, conocimientos y experiencias para garantizar la utilización óptima de esta tecnología.

Abstract In the Bajío, bean halo blight [Pseudomonas syringae pv. phaseolicola (Psph)] causes severe damage to varieties of the Azufrado and Cacahuate Bola types. To identify resistant genotypes, various bean materials were inoculated with two isolates, races 2 and 6. Likewise, readings of the reaction to natural infection by Psph in the field were recorded in two sets of Azufrado-type lines evaluated under rainfed conditions in Celaya, Guanajuato, in 2018, one with 10 and another with 16 lines established in June and July, respectively. In the marker laboratory, primers B10, W13, and T8, associated with genes of resistance against the bacterium in various bean genotypes, were used to determine the association between the presence of the markers and resistance to Psph. The Azufrado-type genotypes established in June were severely damaged (reaction from 5 to 8 on a scale of 1 to 9) by Psph, while those of July were damaged to a lesser degree. In the first trial, environmental conditions favored the attack of the bacterium, conditions that did not occur in the second trial. Most of the genotypes inoculated with race 6 in the greenhouse were susceptible. Genotypes positive for the presence of the three markers used were susceptible to races 2 and 6; that is, the marked resistance factors do not provide resistance to those races. All evaluated genotypes of the Azufrado-type of Nueva Granada race were susceptible to Psph races 2 and 6. Among the inoculation-resistant genotypes are Flor de Mayo M38, San Rafael, Pinto Laguna 80, and Pinto Saltillo.

Resumen En el Bajío el tizón de halo del frijol [(Pseudomonas syringae pv. phaseolicola (Psph)] causa severo daño a variedades de los tipos Azufrado y Cacahuate Bola. Para identificar genotipos resistentes se inocularon diversos materiales de frijol con dos aislados, razas 2 y 6. Asimismo, se registraron lecturas de la reacción a la infección natural por Psph en campo en dos juegos de líneas de tipo Azufrado evaluadas bajo temporal en Celaya, Guanajuato en 2018, uno con 10 y otro con 16 líneas establecidas en junio y julio, respectivamente. En el laboratorio de marcadores se usaron los iniciadores B10, W13 y T8 asociados a genes de resistencia contra la bacteria en diversos genotipos de frijol para determinar la asociación entre la presencia de los marcadores y la resistencia a Psph. Los genotipos de tipo azufrado establecidos en junio fueron severamente dañados (reacción de 5 a 8 en escala de 1 a 9) por Psph, mientras que los de julio lo fueron en menor grado. En el primer ensayo las condiciones ambientales favorecieron el ataque de la bacteria, condiciones que no se registraron en el segundo ensayo. La mayoría de los genotipos inoculados con la raza 6 en invernadero, resultaron susceptibles. Genotipos positivos para la presencia de los tres marcadores utilizados fueron susceptibles a las razas 2 y 6; es decir, los factores de resistencia marcados no proporcionan resistencia a esas razas. Todos los genotipos evaluados del tipo azufrado de raza Nueva Granada, fueron susceptibles a Psph razas 2 y 6. Entre los genotipos resistentes a la inoculación se encuentran, Flor de Mayo M38, San Rafael, Pinto Laguna 80 y Pinto Saltillo.

Abstract: The main objective of this research study is to determine whether perceived behavioral control has a moderating role in the influence of attitude toward entrepreneurship and subjective norms on entrepreneurial intention. The sample consists of 159 master of business administration (MBA) students from four Colombian universities. The methodological design is cross-sectional and explanatory and applies the partial least squares structural equation modeling (PLS-SEM). The results show that there is no evidence to suggest that perceived behavioral control moderates the relationship between attitude toward entrepreneurship and entrepreneurial intention. In addition, there is no evidence to infer that perceived behavioral control moderates the relationship between subjective norms and entrepreneurial intention. In conclusion, the current model of the theory of planned behavior provides no empirical support for explaining the entrepreneurial intention of MBA students from four different Colombian universities.

Resumen: El objetivo de esta investigación es determinar si el control del comportamiento percibido tiene un rol moderador en la influencia de la actitud hacia el emprendimiento y las normas subjetivas sobre la intención emprendedora. La muestra consiste en 159 estudiantes de maestría en administración de empresas (MBA) de cuatro universidades privadas colombianas en Bogotá. El diseño metodológico es explicativo-transversal y utiliza el modelo de ecuaciones estructurales con mínimos cuadrados parciales (PLS-SEM). Los resultados muestran que no hay evidencia para afirmar que el control del comportamiento percibido modera la relación entre la actitud hacia el emprendimiento y la intención emprendedora. Tampoco hay evidencia de que el control del comportamiento percibido modera la relación entre las normas subjetivas y la intención emprendedora. En conclusión, el modelo actual de la teoría de la conducta planeada no tiene respaldo empírico en la explicación de la intención emprendedora de estudiantes de cuatro programas de MBA de universidades colombianas.

ABSTRACT Introduction: The doctor Francois-Sigismond Jaccoud, described in 1869 in a young patient with rheumatic fever (RF), some joint deformities that consisted of classic deformations observed in rheumatoid arthritis (RA), such as the swan neck, the thumb subluxation, ulnar deviation, but that the main difference had the characteristic that they were reducible to passive movement, for which they were called Jaccoud‘s arthropathy (JA). Clinical Case: First case: 23-year-old female patient, by profession a housewife, with a history of deformity in the hands and feet since she was approximately 6 years old, without treatment. He denied systemic manifestations, arthralgia. Second case: A 61-year-old female patient, housewife by profession, from a rural area, diagnosed with Systemic Lupus Erythematosus (SLE) since she was 23 years old, with a history of deformity in the hands and feet since approximately the same age, currently with treatment with hydroxychloroquine and prednisone. He referred joint manifestations such as occasional arthralgia in the hands with significant edema in the fingers. Conclusion: Jaccoud‘s arthropathy (JA) is a reversible chronic nonerosive joint disorder that can occur after repeated episodes of arthritis.

RESUMEN Introducción: El médico Francois-Sigismond Jaccoud, describió en 1869 en un paciente joven con fiebre reumática (FR), algunas deformidades articulares que las mismas consistían en deformaciones clásicas observadas en la artritis reumatoide (AR), tales como el cuello de cisne, la subluxación del pulgar, la desviación cubital, pero que la principal diferencia tenían la característica de que las mismas eran reductibles al movimiento pasivo, por lo cual se las denominó con el nombre de artropatía de Jaccoud (AJ). Caso Clínico: Primer caso: Paciente femenino de 23 años, de profesión ama de casa, con antecedente de deformidad en manos y pies desde los 6 años aproximadamente, sin tratamiento. Niega manifestaciones sistémicas, artralgias. Segundo caso: Paciente femenino de 61 años, de profesión ama de casa, procedente del área rural, con diagnóstico de Lupus Eritematoso Sistémico (LES) desde los 23 años, con antecedente de deformidad en manos y pies desde esa misma edad aproximadamente, actualmente con tratamiento con hidroxicloroquina y prednisona. Refiere manifestaciones articulares como artralgias ocasionales en manos con edema importante en los dedos. Conclusión: La artropatía de Jaccoud (AJ) es un transtorno articular reversible crónico no erosivo que puede ocurrir después de episodios repetidos de artritis.

Resumen Introducción: La insuficiencia cardiaca en pacientes con fibrilación auricular no valvular (FANV) es de dos a tres veces más frecuente que en individuos sin FANV. Objetivo: Identificar los factores de riesgo cardiometabólico (FRCM) y el tratamiento antitrombótico de pacientes con FANV e insuficiencia cardiaca con fracción de expulsión reducida (IC-FEr), y determinar si existen diferencias conforme al sexo. Métodos: En forma global y de acuerdo con el sexo se analizaron FRCM, riesgo protrombótico, riesgo de sangrado y terapia antitrombótica. Resultados: De 1423 pacientes con FANV, 336 tuvieron IC-FEr. Las mujeres promediaron mayor edad que los hombres. No hubo diferencia entre los sexos respecto al tipo de FANV o uso de anticoagulantes orales directos. La hipertensión arterial sistémica fue más frecuente en mujeres. Un 3.6 % de los pacientes reportó antecedente de ataque isquémico transitorio y 10 % de evento vascular cerebral, sin diferencias en cuanto al sexo. El porcentaje de hombres con riesgo embólico elevado fue mayor, pero sin tratamiento antitrombótico, en comparación con las mujeres. Conclusiones: Se encontraron diferencias significativas de acuerdo con el sexo en pacientes con FANV e IC-FEr, tanto en FRCM y algunas comorbilidades, como en el tratamiento antitrombótico de acuerdo con el riesgo embólico y de sangrado.

Abstract Introduction: Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF. Objective: To identify cardiometabolic risk factors (CMRF) and antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender. Methods: CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender. Results: Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women. Conclusions: Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.

Resumen Objetivo: Determinar la prevalencia y factores de riesgo cardiovascular de los pacientes con infarto agudo de miocardio sin evidencia de lesiones coronarias obstructivas en la arteriografía coronaria, en una institución de salud con servicios de mediana y alta complejidad en la ciudad de Valledupar (Cesar), Colombia. Materiales y métodos: Estudio descriptivo, de corte transversal, único centro, en el que se incluyeron pacientes mayores de 18 años, atendidos en un centro hospitalario en la ciudad de Valledupar con síndrome coronario agudo, a quienes se les realizó arteriografía coronaria y cumplían con los criterios para MINOCA según la cuarta definición universal de infarto de miocardio, desde enero de 2016 hasta diciembre de 2019. Se calculó la prevalencia de MINOCA y descripción por sexo, edad, factores de riesgo cardiovascular y tipo de presentación del SCA. Resultados: De un total de 3.022 pacientes de la población estudiada con diagnóstico de infarto agudo de miocardio, 215 no tenían lesiones coronarias obstructivas, lo cual arrojó una prevalencia del 7.11% (IC 95%: 6.20-8.03%). La mayoría fueron mujeres (53.02%) con una edad promedio de 56,6 años. El 75.8% de los pacientes tenía al menos un factor de riesgo cardiovascular, con predominio de hipertensión arterial (67.4 %). La mayoría presentó síndrome coronario agudo sin elevación del segmento ST (93.5%). Conclusión: La prevalencia de MINOCA en nuestra institución se encuentra en el rango descrito en la literatura médica y tiene características clínicas similares en reportes publicados. Se plantea la necesidad de realizar estudios posteriores para la determinación de la causa en este tipo de pacientes.

Abstract Objective: To determine the prevalence and cardiovascular risk factors in patients with acute myocardial infarction with non-obstructive coronary lesions in coronary arteriography in a health institution with intermediate and specialized care in the city of Valledupar (Cesar), Colombia. Materials and methods: This was a descriptive, cross-sectional, single-center study. All patients included were over 18 years of age. They presented an acute coronary syndrome and were treated in a health center in Valledupar, Colombia. Coronary arteriography was completed, and patients met the criteria for MINOCA according to the fourth universal definition of myocardial infarction. The prevalence of MINOCA and description by sex, age, cardiovascular risk factors, and type of ACS presentation were calculated. The study was carried out between January 2016 and December 2019. Results: Of the 3.022 patients diagnosed with acute myocardial infarction, 215 did not have non-obstructive coronary lesions, with a prevalence of 7.11% (CI 95%: 6.20-8.03%). Most subjects were women (53.02 %), and the mean age was 56.6 years. 75.8% of participants had at least one cardiovascular risk factor, predominantly arterial hypertension (67.4%). Most patients had non-ST-segment elevation acute coronary syndrome (93.5%). Conclusion: The prevalence of MINOCA in our institution is within the range described in the medical literature. The clinical characteristics found were similar to those reported in the literature. Further studies need to be conducted to determine the cause in this type of patient.

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Summary: The new Coronavirus SARS CoV-2 pandemic was declared at the beginning of March 2020 when the Uruguayan government appointed the National Contingency Plan for the COVID-19 disease caused by this virus. This plan included non-pharmacological preventive measures such as: hand hygiene, physical distancing, use of different types of masks according to the risk of who should wear them, in some periods, restrictions to mobility, educational activities or public shows, and movement by land, air or sea. Responsible freedom was strongly called for. In December 2020, the Vaccination Strategy was included as a primary prevention mechanism. On 3/1/2021, the COVID-19 2021 Vaccination Campaign began, it was non-mandatory, population-based, initially for people over 19 years of age, and for adolescents between 12 and 17 years of age and pregnant women since June. The National Honorary Scientific Advisory Group (GACH) together with the National Vaccine Advisory Committee (CNAV) of the Ministry of Public Health (MSP) that has vast experience in advising health authorities in scientific decisions on the introduction of vaccines, and an ad-Hoc Commission created for COVID-19 vaccines, brought together experts to advise on the vaccination strategy. The Honorary Commission for the Fight Against Tuberculosis and Prevalent Diseases (CHLA-EP), as the operational branch of the MSP’s Department of Immunizations, has participated with all stakeholders since December to implement the COVID-19 Population Vaccination Campaign without neglecting their tasks regarding the vaccination to prevent other infectious diseases. Methodology: a descriptive, retrospective study was carried out regarding the strategies implemented by the Immunization Operational Department (operational branch of the Ministry of Health’s Immunization Department), A. Calmette Laboratory, Honorary Commission, General Coordination and Administrative Departments between November, 2020 and July 2021. Data source: reports were issued or provided specially for this work by the Immunization Operational Department, A. Calmette Laboratory, by the Ministry of Public Health’s immunization Department, Human Resources, Material Resources, Support, Communication and Design Service, Peripheral Centers, Executive Board and General secretariat. Results: the results of the 4 periods are as follows: 1- Planning (Period November - December 2020), 2- Training, hiring of human resources and advice for the acquisition of qualitative and quantitative material resources (January - February 2021), 3- Opening of COVID-19 vaccination centers (Hubs), posts and launch of the COVID-19 Campaign (March 2021), 4- Overlap of the 2021 flu campaign (April-June) and maintenance of vaccine coverage (National Immunization Programme - PNI). 1- Planning: The characteristics of the different vaccines (dead virus vaccines, vector vaccines and in particular mRNA vaccines, with storage requirements of -70ºC, transfer and distribution requirements of -25ºC, and reconstitution and use of +2 + 8ºC) were taken into account in the different scenarios. Risk and costs analysis were performed. We interchanged data with different companies that provided this service, we participated in training activities with some of them, mainly in the design of a solid cold chain without failures (e.g. a Vac-Q-tec training activity). The transfer of vaccines to hubs, tertiary vaccination centers or peripheral vaccination centers was designed. The different destination site of the vaccines, the different possible scenarios were taken into account, both at local central level (Montevideo - Carrasco International Airport), but also at National level using the different air terminals. Similarly, strategies for the distribution of vaccines by land were planned involving different public or private actors based on the institutions’ experience, both regarding the vaccination campaign and in the PNI maintenance. We made a supply acquisition plan for the vaccine’s storage and distribution, for the vaccination itself, and for the purchase of supplies jointly with the Procurement Department of the Ministry of Economy and Executive Secretariat of the MSP. Six-people vaccination teams were created with clear roles and with the slogan of rapid, universal, free and safe vaccination for all. 2- Training: Courses and materials were organized for the staff to acquire updated knowledge about SARS CoV 2 and COVID-19, transmission mechanisms, use and planning of use of personal protective equipment (PPE) and of course, a detailed monitoring of the vaccines being developed. We carried out a thorough analysis of the vaccine companies to arrive in Uruguay, we focused on 3 of them (Pfizer BioNtech, CoronaVac, Oxford AZ). Training was carried out by roles (vaccinators, preppers, administrators, position referents, backups). Special emphasis was placed on the training of the care of the person to be vaccinated, registration of the vaccination act, end-to-end cold chain, disposal of used materials and filing out inspection forms. All the contents and materials were available on the Institution’s webpage. Human resources: human resources were allocated for the creation, signature and registration of the paperwork for 1,463 new contracts for teams across the country. These resources were allocated not only to vaccination itself, but also to actively participate in each of the vaccination posts. This meant that the work was multiplied by 6 for the tasks required during this period. The Department of Material Resources, went from packaging and distributing from 7 to 15 packages a month to 80 packages a month for each Peripheral/Vaccination Center. Material shipment quadrupled at the beginning of the campaign and it eventually grew by five and sixfold. Some of the key figures to highlight are: 3, 300,000 needle syringes, 8,800 liters of Eucalyptus Alcohol, 852,000 latex and nitrile gloves and 141,000 isolation gowns. 3. COVID-19 Vaccination Hubs, Posts and Campaigns. We gradually opened maximum response mass vaccination Hubs in Montevideo (8), Canelones (1) and Maldonado (1). Since it was had been decided to vaccinate 3 to 5 people every 15 minutes, the primary results at the Hospital de Clínicas Hub were 211,153 doses administered in 32 vaccination posts, and at Antel Arena Hub 615,637 doses were administered in its 15 vaccination posts. As of July 31, there were 144 COVID 19 vaccination posts throughout the national territory. The distribution was made nationwide: 3,229,320 Sinovac vaccine doses, 97,790 Oxford-Astra Zeneca vaccine doses, and 1,585,452 Pfizer-BioNtech vaccine doses. We devised 60 teams including a referent (identification, registration, control), a trainer, 2 vaccinators and vaccination driver for Homes for the Elderly at ELEPEM and people needing special care. They actively participated in the vaccination at ELEPEM, Shelters and Schools for Children with Special Needs and visited a total of 1679 Institutions and overall, 35,006 people were vaccinated. 4- Overlap of the 2021 flu campaign (April-June) and the maintenance of the COVID vaccine coverage (National Immunization Programme - PNI). Since 04/24/2021, the Anti-Flu Campaign began, and it overlapped the COVID-19 campaign described above, which meant reinforcing strategies and expanding actions to be able to carry out both campaigns simultaneously, always with the objective of maintaining the National Immunization Program. Vaccination was carried out at the ELEPEM, as it is performed annually by the commission and vaccination of COVID-19, influenza and PNI was performed on the territory. According to the data received on July 17 in the Ministry of Public Health Immunization Unit Report (week 12), there were 605,802 registered doses, of which at least 87,802 had been administered by the Institution. This difference regarding previous campaigns could have been caused by the intense work carried out during the COVID19 Vaccination Campaign. Within the framework of the inter-institutional activity “Barrio a Barrio” (Vaccination in all Neighborhoods), 7,225 people were vaccinated with the influenza vaccine at the CHLA-EP mobile vaccination bus in Montevideo. The CHLA-EP has contributed with logistics and vaccination with a 2-dose schedule for the 3 platforms and a booster dose for those who received virus vaccines. The CHLA-EP has contributed to achieving the target of the COVID-19 Vaccination Campaign between 1/3 and 8/29/21: 5,487,181 doses were applied, 2,065,269 people received 1 dose of vaccine and 2,496,290 of them received 2 doses and 333,662 have received booster doses. Conclusion: the planning, training, provision of human and material resources has enabled us to successfully carry out two historical simultaneous vaccination campaigns in hubs, vaccination centers, ELEPEM and all along the territory.

Resumo: A pandemia causada pela infecção pelo novo Coronavírus SARS CoV-2 determinou que no Uruguai no início de março de 2020 o governo elaborasse o Plano Nacional de Contingência para a doença COVID-19 causada por este vírus. Este plano incluía medidas preventivas não farmacológicas como: higiene das mãos, distanciamento físico, uso de diferentes tipos de máscaras dependendo do risco de quem as deve usar, em alguns períodos várias restrições à circulação de pessoas, atividades educativas ou espetáculos públicos e a trânsito por terra, ar ou mar). Foi feito um forte apelo à liberdade responsável. A partir de dezembro de 2020, decidiu-se incorporar uma Estratégia de Vacinação à prevenção primária. Em 01/03/2021 teve início a Campanha de Vacinação COVID-19 2021, não obrigatória, de base populacional, inicialmente para maiores de 18 anos e a partir de junho contempla adolescentes entre 12 e 17 anos e gestantes. O Grupo Honorário de Assessoramento Científico do Governo Nacional juntamente com a Comissão Nacional de Assessoramento de Vacinas (CNAV) do Ministério da Saúde Pública (MSP), que assessora autoridades de saúde em decisões científicas sobre a introdução de vacinas, e uma Comissão ad hoc criada para vacinas contra a COVID-19 reuniu especialistas do país para aconselhar sobre a estratégia de vacinação. A Comissão Honorária de Luta contra a Tuberculose e Doenças Prevalentes (CHLA-EP) como braço operacional do Departamento de Vacinação do MSP envolveu-se desde dezembro com todos os intervenientes na implementação da Campanha de Vacinação da População COVID-19, aliás de realizar as tarefas de vacinação para prevenir outras doenças infecciosas. Metodologia: foi realizado um estudo descritivo e retrospectivo das estratégias implementadas pelo Departamento Operacional de Imunizações (braço operacional do Departamento de Imunizações do MSP), Laboratório A. Calmette, Comissão Honorária, Coordenação Geral e departamentos administrativos: entre os meses de novembro de 2020 a julho de 2021. Fonte de dados: relatórios divulgados ou oferecidos especialmente para este trabalho pelo Departamento Operacional de Imunizações, Laboratório A. Calmette, Departamento de Imunizações do Ministério da Saúde Pública, Recursos Humanos, Recursos Materiais, Serviço de Apoio, Comunicação e Design, Centros Periféricos, Direção Executiva e Secretaria Geral. Resultados: são apresentados os resultados de 4 períodos: 1- Planejamento (novembro - dezembro de 2020), 2- Capacitação, contratação de recursos humanos e assessoria para aquisição de recursos materiais em qualidade e quantidade (janeiro - fevereiro de 2021), 3- Abertura de centros (Hubs), postos de vacinação COVID-19 e implementação da Campanha COVID-19 (março 2021), 4- Sobreposição da campanha da gripe 2021 (abril-junho 2021) e manutenção da cobertura vacinal (PNI) 1- Planejamento: As características das vacinas a receber eram vacinas de vírus mortos, vacinas vetoriais e em particular mRNA com requisitos de armazenamento de temperaturas de -70ºC, transferência e distribuição de -25ºC, e reconstituição e uso de +2 +8ºC nos diferentes cenários. Análise de risco e análise de custo foram realizadas. Realizaram-se intercâmbios com diferentes empresas que prestam este serviço, participando em ações de formação com algumas delas, essenciais na criação de uma cadeia de frio sólida e sem falhas (ex. ação de formação com Vac-Q-tec). Foi projetada a transferência de vacinas para os hubs, centros de vacinação terciários ou periféricos. Tendo em conta o local de chegada das vacinas, foram considerados os diferentes cenários possíveis, não só a nível central (Montevidéu - Aeroporto Internacional de Carrasco), mas também a nível nacional utilizando os diferentes terminais aéreas. Da mesma forma, foram planejadas estratégias de distribuição de vacinas por via terrestre envolvendo diferentes atores (públicos ou privados), com base na experiência da instituição, tanto na campanha de vacinação quanto na manutenção do PNI. A previsão de compra de insumos foi feita tanto para o armazenamento e distribuição da vacina, quanto para a própria vacinação, como também na tomada de decisão na compra de insumos, atuando em conjunto com o Departamento de Compras do Ministério da Economia e Gestão Secretário do MSP. Eles participaram da formação de equipes de 6 pessoas com funções especificas de vacinação com o slogan de vacinação rápida, universal, gratuita e segura. 2- Capacitação, contratação de recursos humanos e assessoria para aquisição de recursos materiais em qualidade e quantidade. Foram organizados cursos e materiais para que os funcionários adquirissem conhecimento atualizado sobre SARS CoV2 e COVID-19, mecanismos de transmissão, uso e planejamento de uso de equipamentos de proteção individual (EPI) e também para o acompanhamento minucioso das vacinas em desenvolvimento. Fizemos a análise minuciosa das possíveis vacinas candidatas para chegar ao Uruguai, e focamos em 3 delas (Pfizer BioNtech, CoronaVac, Oxford AZ). O treinamento foi realizado por funções (vacinadores, treinadores, administradores, posição de referência, backup). Foi dado especial destaque à formação no cuidado da pessoa a vacinar, registo do ato vacinal, rede de frio em todos os seus pontos, eliminação de materiais utilizados e preenchimento de fichas de controlo. Todos os conteúdos e materiais foram disponibilizados na página web da Instituição. Recursos humanos: funcionários foram alocados para a preparação, assinatura e registro de 1.463 novos contratos para complementar as equipes em todo o país, estes recursos humanos estiveram dedicados não apenas à vacinação em si, mas a participar ativamente de cada um dos postos de vacinação. Isso significou que o trabalho se multiplicou por 6 para as tarefas exigidas durante esse período. O Departamento de Recursos Materiais, passou de embalar e distribuir de 7 para 15 embalagens por mês, passando para 80 embalagens para cada Periférico/Centro de Vacinação. A remessa habitual de materiais se quadruplicou e no início da campanha aumentou cinco e seis vezes. Alguns dos números a destacar são: 3.300.000 seringas com agulha, 8.800 litros de álcool de eucalipto, 852.000 luvas de látex e nitrílica e 141.000 túnicas. 3. Abertura de centros e postos de vacinação COVID-19 e lançamento da Campanha COVID-19. Isso gerou progressivamente o estabelecimento de centros de resposta máxima (Hubs) (vacinação em massa) 8 em Montevidéu, um em Canelones e um em Maldonado. Já que decidiu-se vacinar de 3 a 5 pessoas a cada 15 minutos, no Hub. O Hospital de Clínicas administrou 211.153 doses em seus 32 postos de vacinação e na Arena Hub Antel foram administradas 615.637 doses em seus 15 postos de vacinação. Até 31 de julho, havia 144 postos de vacinação contra a COVID 19 habilitados em todo o território nacional. A distribuição foi realizada, 3.229 foram distribuídos em todo o país, 320 doses de vacina Sinovac, 97.790 doses de vacinas AstraZeneca e 1.585452 de vacina Pfizer. Participaram no treinamento de 60 equipes de referência (identificação, registo, controle), treinador, 2 vacinadores e motorista para vacinação em estabelecimentos de longa permanência para idosos (ELEPEM) e pessoas com situações especiais em albergues e escolas especiais, visitando um total de 1.679 Instituições e vacinando a 35.006 pessoas. 4- Sobreposição da campanha de gripe de 2021 (abril a junho de 2021) e manutenção da cobertura vacinal (PNI). A partir de 24/04/2021 teve início a Campanha da Gripe 2021, sobrepondo-se à campanha COVID-19 descrita, o que implicou o reforço de estratégias e ampliação das ações para poder cumprir ambas campanhas em paralelo, sempre com o objetivo de não descurar o Programa Nacional de Imunizações. Foi realizada a vacinação no ELEPEM, conforme anualmente realizada pela comissão e a vacinação no território das vacinas COVID-19, influenza e PNI. De acordo com os dados recebidos até 17 de julho no relatório da Unidade de Imunizações dos Ministérios da Saúde Pública (semana 12), foram registradas 605.802 doses, das quais pelo menos 87.802 doses foram administradas pela Instituição. Essa diferença em relação às campanhas anteriores pode ser atribuída ao intenso trabalho realizado na estratégia de Vacinação COVID19. No âmbito da atividade interinstitucional Bairro a Bairro, 7.225 pessoas foram vacinadas com a vacina contra gripe no celular do CHLAEP de Montevidéu. O CHLA-EP tem contribuído desde a logística e vacinação com um esquema de 2 doses para as 3 plataformas e uma dose de reforço para quem recebeu vacinas de vírus mortos. O CHLA-EP contribuiu para atingir os números da Campanha de Vacinação COVID-19 entre 1/3 e 29/8/21: 5.487.181 doses aplicadas, 2.065.269 pessoas que receberam 1 dose de vacina e delas 2.496.290 têm 2 doses e 333.662 receberam doses de reforço. Conclusões: O planejamento, capacitação, disponibilização de recursos humanos e materiais permitiram a realização de duas campanhas de vacinação coexistentes nos hubs, vacinatórios, ELEPEM e no território, o que pode ser considerado um processo bem sucedido e histórico.

Abstract The need to analyze the relationship between procrastination, self-efficacy and emotional state lies on its impact on productivity, academic performance, and mental health. This research examined the role of academic procrastination as a mediator between self-efficacy and emotional state. A total of 531 university students (59.1% female) participated, with an average age of 21.69 years. The results identified that self-efficacy has a negative influence on procrastination. Likewise, the model was able to corroborate that self-efficacy decreases procrastination and produces a positive affective state. At the same time, a person with high self-efficacy can decrease their negative feelings; however, when procrastinating their negative feelings increase. Furthermore, this model did not vary between gender and academic semester groups, which shows that the results can be interpreted equivalently between these groups.

Resumen La necesidad de analizar la relación entre procrastinación, autoeficacia y estado emocional radica en su impacto en la productividad, rendimiento académico y salud mental. Esta investigación examinó el rol de la procrastinación académica como elemento mediador entre la autoeficacia y el estado emocional. Participaron 531 estudiantes universitarios (59.1% mujeres), con edad promedio de 21.69 años. En los resultados se identificó que la autoeficacia influye negativamente en la procrastinación. Asimismo, el modelo pudo corroborar que la autoeficacia disminuye la conducta procrastinadora y produce un estado afectivo positivo. Al mismo tiempo, una persona con alta autoeficacia puede disminuir su emocionalidad negativa, no obstante, cuando procrastina su estado emocional negativo incrementa. Además, este modelo fue invariante entre grupos de sexo y semestres académicos, lo que demuestra que se puede interpretar los resultados de forma equivalente entre estos grupos.

Resumo A necessidade de analisar a relação entre a procrastinação, a autoeficácia e o estado emocional está no seu impacto sobre a produtividade, o desempenho acadêmico e a saúde mental. Esta pesquisa teve como objetivo examinar o papel da procrastinação acadêmica como mediadora entre a autoeficácia e o estado emocional. Participaram 531 estudantes universitários (59,1% do sexo feminino), com idade média de 21,69 anos. Os resultados identificaram que a autoeficácia tem uma influência negativa sobre a procrastinação. Da mesma forma, o modelo foi capaz de corroborar que a autoeficácia diminui o comportamento procrastinador e produz um estado afetivo positivo. Ao mesmo tempo, uma pessoa com alta autoeficácia pode diminuir seu estado emocional negativo, porém, ao procrastinar, seu estado emocional negativo aumenta. Além disso, esse modelo foi invariável entre os grupos de gênero e semestre acadêmico, o que mostra que os resultados podem ser interpretados de forma equivalente entre esses grupos.

RESUMEN INTRODUCCIÓN: Paciente de 71 años con diagnóstico de fibrilación auricular y ataques cerebrovasculares recurrentes, tratada con varios anticoagulantes. El costo del tratamiento del ictus en Colombia para el año 2008 fue de $450.000 millones de pesos colombianos. OBJETIVO: Estimar el costo hospitalario de la atención de un paciente con ictus a repetición secundario a fibrilación auricular. MÉTODOS: Estudio económico parcial de microcosteo de la atención intrahospitalaria para un caso de espectro severo recurrente, que no necesariamente refleja el caso promedio. El consumo de recursos se valoró mediante el uso de tarifas de referencia nacionales. Los resultados se presentan en precios actuales del 2019 (peso colombiano y dólar americano). RESULTADOS: Paciente con 3 eventos hospitalarios, que estuvo 31 días hospitalizada. Las hospitalizaciones tuvieron unos costos de: $53.883.490 (USD 16.141,1), $6.343.096 (USD 1.900,1) y $15.719.443 (USD 4.708,9) respectivamente, con un precio promedio por cada hospitalización de $25.315.343 (USD 7.583,4), costo total de $75.946.029 (USD 22.750,1) costo día de $2.449.872 (USD 729,5). El rubro que aumentó consistentemente los costos fueron los procedimientos (35,7 %). CONCLUSIONES: El ictus recurrente causado por fibrilación auricular no valvular se asocia con un incremento significativo de los costos directos, con un impacto de casi dos veces el PIB per cápita. Un diagnóstico oportuno y una selección adecuada pueden reducirlo.

ABSTRACT INTRODUCTION: A 71-year-old patient with a diagnosis of atrial fibrillation and recurrent strokes, treated with various anticoagulants, the stroke treatment in Colombia for 2008 was $ 450 billion Colombian pesos. OBJECTIVE: To estimate the hospital cost of caring for a patient with recurrent stroke secondary to atrial fibrillation. METHODS: Partial economic study of micro costing of in-hospital care for a case of recurrent severe spectrum stroke, which does not necessarily reflect the average case. Resource consumption was valued using national reference rates. The results are presented in current 2019 prices (Colombian pesos and US dollars). RESULTS: Patient with 3 hospital events, who was hospitalized for 31 days. Hospitalizations had costs of $ 53,883,490 (USD 16,141.1), $ 6,343,096 (USD 1,900.1) and $ 15,719,443 (USD 4,708.9) respectively, with an average price for each hospitalization of $ 25,315,343 (USD 7,583.4), total cost of $ 75,946,029 (USD 22,750.1) daily cost of $ 2,449,872 (USD 729.5). The item that consistently increased costs was procedures (35.7 %). CONCLUSIONS: Recurrent stroke caused by nonvalvular atrial fibrillation is associated with a significant increase in direct costs, with an impact of almost twice the GDP per capita. A timely diagnosis and proper selection can reduce it.

ABSTRACT Introduction: The diabetic foot is one of the most feared complications of diabetes mellitus; It is the cause of 80 % of non-traumatic amputations worldwide. For decades, different treatments have been used to heal diabetic foot; growth factors have revolutionized this therapy. The participation of a multidisciplinary team with compliance with the action protocols and the use of Heberprot-P decrease the rate of amputations in patients with this condition. Objective: To present the evolution of patients with diabetic foot ulcers, in different clinical stages, treated with Heberprot-P. Development: Three clinical cases are presented; The first is a male patient, 56 years old, diabetic, with open transmetatarsal amputation in which 16 applications of Heberprot-P were performed and a skin graft was placed, the lesion closed in 45 days. The second is a 58-year-old patient, diabetic and hypertensive, with a right foot injury, with previous vascular surgery; 19 applications of Heberprot-P were performed and the lesion healed in 49 days. The third case is a 55-year-old patient, who was admitted due to an extensive injury to his right foot, 22 applications of Heberprot-P were performed, closure of the injury was achieved in 85 days and amputation was avoided. Conclusions: The presented cases evolved favorably with Heberprot-P treatment.

RESUMEN Introducción: El pie diabético es una de las complicaciones más temible de la diabetes mellitus; es el causante del 80 % de las amputaciones no traumáticas a nivel mundial. Durante décadas se han utilizados diferentes tratamientos para la cicatrización del pie diabético; los factores de crecimiento han revolucionado esta terapéutica. La participación de un equipo multidisciplinario con el cumplimiento de los protocolos de actuación y el empleo del Heberprot-P disminuyen el índice de amputaciones en pacientes con esta afección. Objetivo: Presentar la evolución de pacientes con úlceras del pie diabético, en diferentes estadios clínicos, tratados con Heberprot-P. Desarrollo: Se presentan 3 casos clínicos; el primero es un paciente masculino, de 56 años, diabético, con amputación transmetatarsiana abierta en la cual se realizaron 16 aplicaciones del Heberprot-P y se colocó un injerto de piel, la lesión cerró en 45 días. El segundo es un paciente de 58 años, diabético e hipertenso, con lesión en el pie derecho, con una cirugía vascular previa; se realizaron 19 aplicaciones del Heberprot-P y la lesión cicatrizó en 49 días. El tercer caso es un paciente de 55 años, que ingresa por la una lesión extensa en el pie derecho, se le realizaron 22 aplicaciones de Heberprot-P, se logró el cierre de la lesión en 85 días y se evitó la amputación. Conclusiones: Los casos presentados evolucionaron de forma favorable con el tratamiento de Heberprot-P.

Abstract: The present study sought to analyze the relationship between innovation management and student satisfaction with their well-being at a higher education institution from Barranquilla (Colombia). The study followed a latent variable design. Two Likert-type scales were used to collect information. Boh were applied to a sample of 406 participants. The results showed that innovation management was composed of two dimensions: process structure and process management. Likewise, student satisfaction was composed of three factors: trust and security, tangible elements, and motivation to participate. The relationship between the study variables was corroborated based on the proposed dimensions. These findings allow concluding that applying innovation management into the well-being of university students improves student satisfaction.

Resumen: El presente estudio buscó analizar la relación entre la gestión de la innovación y la satisfacción estudiantil en el área de bienestar universitario de una institución de educación superior en Barranquilla (Colombia). El estudio siguió un diseño de variables latentes. Para la recolección de la información se emplearon dos escalas tipo Likert aplicadas a una muestra de 406 participantes. Los resultados obtenidos indicaron que la gestión de la innovación estaba compuesta por dos dimensiones: estructura de los procesos y gestión de los procesos. Asimismo, la satisfacción estudiantil estaba conformada por tres factores: confianza y seguridad, elementos tangibles y motivación para participar. Se corroboró la relación entre las variables de estudio a partir de las dimensiones propuestas. Estos hallazgos permiten concluir que la gestión de la innovación en el bienestar universitario genera una mayor satisfacción para los estudiantes universitarios.

Abstract Objective: The purpose of this study is to report epidemiological and clinical data of the patients that were admitted with spinal gunshot injuries. Methods: This was retrospective study and observational study. Patients who had a spinal injury secondary to a gunshot wound that was admitted to our hospital (level III trauma center) from July 2018 through July 2020 were included in the study. Demographic and clinical data including age, gender, civil status, occupation, level of injury (cervical, thoracic, or lumbar), degree of neurological impairment at admission, associated injuries, treatment established, length of hospital stay, and mortality rate were recorded. Results: A total of 55 patients were included in the study, of which 50 patients (90.9%) were men and five female patients (9.09%). The average age was 30.2 years. Three patients died during hospitalization representing a mortality rate of 5.45%. Conclusions: Spinal gunshot injuries are associated with significant sequelae, requiring long and costly treatments. This study obtained one of the highest incidences of gunshot injuries to the spine reported in the literature.

Resumen Objetivo: El propósito de este estudio es reportar datos epidemiológicos y clínicos de los pacientes que ingresaron con heridas por arma de fuego en columna. Métodos: Estudio retrospectivo y observacional. Se incluyeron pacientes que presentaban una lesión medular a secundaria a una herida por arma de fuego que ingresaron en nuestro hospital (centro de trauma de nivel III) desde julio de 2018 hasta julio de 2020. Se registraron datos demográficos y clínicos que incluían edad, sexo, estado civil, ocupación, grado de lesión (cervical, torácica o lumbar), grado de deterioro neurológico al ingreso, lesiones asociadas, tratamiento establecido, duración de la estancia hospitalaria y tasa de mortalidad. Resultados: Se incluyeron en el estudio un total de 55 pacientes, de los cuales 50 pacientes (90,9%) eran hombres y 5 mujeres (9,09%). La edad media fue de 30,2 años. Tres pacientes fallecieron durante la hospitalización lo que representa una tasa de mortalidad del 5,45%. Conclusiones: Las lesiones por arma de fuego en la columna están asociadas con secuelas importantes, que requieren tratamientos largos y costosos. Este estudio obtuvo una de las incidencias más altas de heridas por arma de fuego en la columna vertebral reportadas en la literatura.

ABSTRACT Objective: The study aims at describing a set of activities to promote citizenship education for education and heritage culture enrichment, in order to stimulate individuals’ sustainable participation in preserving and protecting Viñales valley diversity. Methods: The authors rely on theoretical methods such as the critical analysis of documents related to heritage education and legal norm ruling the interrelation of the local society to the environment. The systemic approach, the analysis-synthesis and inductive deductive methods, and comparative studies, as well as observation and interviews make possible to characterize the geographical environment and to configure a framework viewing citizenship education as a process and educations as its object and immediate result. Results: The main finding is a theoretical framework of a set of activities promoting citizenship education favoring education and cultural heritage enrichment. This framework includes the general principles and the description of its structural components. Conclusions: The set of activities devised favor citizenship and heritage education of Viñales inhabitants. According to the assessment just completed resulting in a high level of knowledge and participants’ satisfaction, and a medium level of transformation of participants’ performance, that, naturally, demands further attention and maturation.

RESUMEN Objetivo: El estudio se centra en la descripción de una propuesta de actividades para el fomento de la educación ciudadana, en función de la formación y el desarrollo de una cultura patrimonial para lograr la participación en el cuidado y protección de la riqueza del valle de Viñales, en correspondencia con el desarrollo sostenible. Métodos: Se emplearon métodos de nivel teórico como el análisis de documentos acerca de la educación patrimonial y las normas reguladoras de la relación entre sociedad local y su entorno. El enfoque sistémico, el analítico-sintético e inductivo-deductivo; el estudio comparado y los métodos de nivel empírico como la observación participante y la entrevista posibilitaron como resultado principal el acercamiento a referentes sobre el trabajo preventivo, identificar y caracterizar el entorno geográfico, la formación de juicios valorativos a partir del estado del arte sobre la educación ciudadana como proceso, y la formación como su objeto y resultado inmediato. Resultados: El resultado fundamental del estudio es la concepción de un sistema de actividades para el fomento de la educación ciudadana en función de la formación y desarrollo de la cultura patrimonial con sus correspondientes principios y componentes estructurales. Conclusiones: El sistema de actividades propuesto, de acuerdo a las mediciones realizadas hasta el momento favorece la educación ciudadana y patrimonial de los habitantes del valle, ha proporcionado altos niveles de aprendizaje y satisfacción de los participantes, así como un nivel medio de transformación de los modos de actuación, lo que naturalmente, requiere de seguimiento y maduración.

Abstract: The purpose of this study is to analyze the mediating effect of information and communication technologies (ICTs) on the relationship between innovation capability and student satisfaction in Colombian higher education institutions (HEIs). The statistical approach applied is the variance-based structural equation model, also known as the partial least squares (PLS-SEM). The sample consists of 398 university students. Data is gathered by using a five-point Likert-type scale composed of 30 items. The results show that all the variables examined are related to each other and that ICTs moderate the relationship between innovation capability and student satisfaction. These findings highlight the importance of involving ICTs in the services provided by HEIs since they generate positive results for their end-users, the students. In conclusion, the relationship between the capacity for innovation and student satisfaction is significant and is mediated through ICTs in HEIs.

Resumen: El propósito de este estudio es analizar el efecto mediador de las tecnologías de la información y la comunicación (TIC) en la relación entre la capacidad de innovación y la satisfacción estudiantil en instituciones de educación superior (IES) colombianas. Se utiliza el modelamiento de ecuaciones estructurales basado en las varianzas, también conocido como mínimos cuadrados parciales (PLS-SEM). La muestra está conformada por 398 universitarios. Se aplica una escala tipo Likert de cinco puntos compuesta por 30 ítems. Los resultados muestran que todas las variables están relacionadas entre sí, y que las TIC moderan la relación entre la capacidad de innovación y la satisfacción estudiantil. Esto resultados señalan la importancia de involucrar las TIC en los servicios que prestan las IES, ya que generan resultados positivos para sus usuarios finales, los estudiantes. En conclusión, existe una relación significativa entre la capacidad de innovación y la satisfacción estudiantil que es mediada a través de las TIC en las IES.

Resumen El sedimento es la capa superficial del fondo en estanques o en lagunas de oxidación. Este se origina fundamentalmente por la deposición de sólidos en suspensión, nutrientes y partículas del suelo que están en contacto con el agua, y que son naturalmente producidos por la operación de las granjas. Su manejo y disposición se constituye actualmente en un imperativo técnico, dadas las implicaciones ambientales que tienen las descargas provenientes de cultivos piscícolas. Se realizó la caracterización general del sedimento en tres sectores de una granja intensiva de producción, afluente, laguna de oxidación y efluente, la cual incluyó cuatro parámetros, que fueron medidos en tres momentos diferentes. Los valores obtenidos fueron comparados mediante análisis de varianza de una vía con α = 0,05 como nivel de significancia. Además, cuando fue necesario se realizó una prueba de Tukey para precisar las diferencias. Aquello cobijó las medidas de fósforo disponible, materia orgánica, carbono orgánico y relación C: N. Las diferencias encontradas entre los sectores son una aproximación al efecto de la producción piscícola sobre la composición de los sedimentos.

Abstract Sediment is the surface layer in the bottom of ponds or oxidation pools. It is created basically due to the deposition of solids in suspension, nutrients, and soil particles that contact the water and are produced naturally in farming operations. Today, the management and arrangement are a must in technical issues due to the environmental implications generated by the discharges coming from fish cultures. The general characterization of the sediment was carried out in three sectors of an intensive production farm, affluent, oxidation pool, and effluent. It included four parameters that were measured in three different time points. Obtained values were compared using one-way variance analysis with α = 0.05 as the significance level. In addition, when necessary, a Tukey test was carried out to pin down the differences. It enabled us to find the measures of available phosphorus, organic matter, organic carbon, and the ratio C: N. the differences found between the sectors are approximate values to the effect of the fish production regarding the sediment composition.