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ABSTRACT Drug repositioning seeks to discover new applications for a drug that has already been approved in the market, resulting in faster and lower cost solutions, generally used for diseases that receive little investment, such as cutaneous leishmaniasis. In this context, hesperidin, commercially approved as Daflon®, is a flavonoid that belongs to the chalcones group, a class that has antileishmanial potential. The present study evaluated the in vitro and in vivo antileishmanial activity of commercial hesperidin. Hesperidin (9 to 0.56 mg mL-1) was tested against promastigote and amastigote forms of four dermotropic species of Leishmania, namely L. (L.) amazonensis, L. (V.) guyanensis, L. (V.) braziliensis and L. (V.) naiffi. For the in vivo tests, hamsters were infected in the snout and the lesions were treated with intralesional hesperidin. The treatment effectiveness was assessed by measuring the total volume of the lesion on the snout and determining the parasitic load. The in vitro results showed moderate toxicity in murine macrophages, with higher efficacy in L. (L.) amazonensis when compared to the other species tested. The in vivo results showed that hesperidin was able to gradually reduce the size of lesions by L. (L.) amazonensis, although it did not induce clinical and parasitological cure. Thus, hesperidin showed potential in in vitro tests against L. (L.) amazonensis and further studies with new formulations and experimental treatment schemes should be carried out.

RESUMO O reposicionamento de medicamentos busca descobrir novas aplicações para um medicamento já aprovado no mercado, resultando em soluções mais rápidas e de menor custo, geralmente utilizadas para doenças que recebem pouco investimento, como a leishmaniose tegumentar. Nesse contexto, a hesperidina, aprovada comercialmente como Daflon®, tem despertado interesse científico por ser um flavonoide pertencente ao grupo das chalconas, classe que possui potencial antileishmania. O presente estudo avaliou a atividade antileishmania in vitro e in vivo da hesperidina comercial. A hesperidina (9 a 0,56 mg mL-1) foi testada contra as formas promastigota e amastigota de quatro espécies dermotrópicas de Leishmania, sendo elas L. (L.) amazonensis, L. (V.) guyanensis, L. (V.) braziliensis e L. (V.) naiffi. Para os testes, os hamsters foram infectados no focinho e as lesões tratadas com hesperidina intralesional, cuja eficácia foi avaliada através da aferição do volume total da lesão no focinho e a determinação da carga parasitária. Os resultados in vitro demonstraram toxicidade moderada em macrófagos murinos e melhor eficácia em Leishmania (L.) amazonensis quando comparados às demais espécies testadas. Os resultados in vivo mostraram que a hesperidina foi capaz de reduzir gradativamente o tamanho das lesões causadas por L. (L.) amazonensis, embora não tenha induzido a cura clínica e parasitológica. Assim, a hesperidina mostrou-se promissora em estudos in vitro contra Leishmania (L.) amazonensis e novos estudos com novas formulações e esquemas de tratamento experimental devem ser realizados.

https://doi.org/10.1590/1809-4392202203181

Third National Registry of Cardiac Rehabilitation Programs in Mexico (RENAPREC III-2022)
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Lara-Vargas, Jorge A.

; Ilarraza-Lomelí, Hermes

; García-Saldivia, Marianna

; Pineda-García, Alfredo D.

; Leyva-Valadez, Eduardo A.

; Justiniano-Cordero, Samuel

; Sahagún-Olmos, Roberto

; Zavala-Ramírez, Juana

; Cassaigne-Guasco, María E.

; Sánchez-Limón, Edgar-F

; Castañeda-López, Javier

; Cerón-Enríquez, Norma

; Ku-González, Andrés

; Arteaga-Martínez, Rodolfo

; Hinojosa-López, Tania

; Vergara-Guzmán, Jéssica

; Pérez-Vázquez, Daniel I.

; Gasca-Zamudio, Pedro D.

; Aranda-Ayala, Zulema L.

; Vacío-Reyes, Martha E.

; Reza-Orozco, Marco

; Alcocer-Gamboa, Miguel A.

; Hernández-González, Pedro A.

; Pérez-Reyes, Angélica A.

; Núñez-Urquiza, Juan P.

; Alonso-Sánchez, Jesús

; Franco-Valles, Sarahí

; Romo-Escamilla, Ricardo E.

; Nuriulú-Escobar, Patricia

; Serna-Santamaría, Iván

; Avilés-González, Jorge

; Salgado-Solorio, María C.

; Muñoz-Gutiérrez, Luz M.

; Mendoza-Díaz, Pedro M.

; Ávila-Estrada, Ángel

; Morales-Medina, Carlos

; Lara-Vázquez, Eduardo

; Rodríguez-Herrera, Paulina

; Galván-López, María

; Segoviano-Mendoza, Georgina

; De-la-Torre-Cruz, Fabiola

; Jiménez-Campos, Cecilia

; Ramírez-Meléndez, Alejandra

; Almaraz-Ríos, Alejandro

; González-Bonilla, Mezthly

; Rojano-Castillo, Jessica

; Rius-Suarez, María D.

Archivos de cardiología de México

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dec 2023, Volume 93 N. 4 Pages 405 - 416

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

resumen está disponible en el texto completo

Abstract Introduction: In Mexico, cardiac rehabilitation (CR) as an interdisciplinary intervention with therapeutic impact in patients with heart disease is growing. There is the need to know actual conditions of CR in our country. Objectives: The objective of this National Registry is to follow-up those existing and new CR units in Mexico through the comparison between the two previous registries, RENAPREC-2009 and RENAPREC II-2015 studies. This is a descriptive study focused on diverse CR activities such as assistance training, and certification of health professionals, barriers, reference, population attended, interdisciplinarity, permanence over time, growth prospects, regulations, post-pandemic condition, integrative characteristics, and scientific research. Results: Data were collected from 45 CR centers in the 32 states, 75.5% are private practice units, 67% are new, 33% were part of RENAPREC II-2015, and 17 have continued since 2009. With a better distribution of CR units along the territory, the median reference of candidates for CR programs is 9% with a significant reduction into tiempo of enrollment to Phase II admission (19 ± 11 days). Regarding to previous registries, the coverance of Phases I, II, and III is 71%, 100%, and 93%, respectively; and a coverance increases in evaluation, risk stratification, and prescription, more comprehensive attendance and prevention strategies. Conclusions: CR in Mexico has grown in the past 7 years. Even there is still low reference and heterogeneity in specific processes, there are strengths such as interdisciplinarity, scientific professionalization of specialists, national diversification, and an official society that are consolidated over time.

https://doi.org/10.24875/acm.22000235

El pensamiento neoliberal y la producción del sujeto neoliberal: Reflexiones desde la política pública para Costa Rica y El Salvador
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Vargas Vargas, Bryan Roberto

; Aguilar, Jeannette

Revista Rupturas

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dec 2023, Volume 13 N. 2 Pages 21 - 50

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Se ofrece una discusión sobre cómo se produce una subjetividad neoliberal bajo un idealismo economicista, del mercado y de la libertad individual. Se desarrollan premisas que muestran que el neoliberalismo no solo es acción en el campo económico, sino también una pérdida de un proyecto común de sociedad y una individualización en el plano psicológico, que exige a cada persona afrontar la realidad de forma aislada y donde cada una puede alcanzar/comprar individualmente lo necesario. Se explica la idea del emprendimiento laboral como una de las estrategias neoliberales para individualizar y deslegitimar la necesidad de los Estados. Es una reflexión teórica que analiza para su desarrollo datos contextuales principalmente de Costa Rica y El Salvador, planes de gobierno, políticas públicas, proyectos de ley, discusiones públicas y notas periodísticas.

Abstract A discussion is offered on how neoliberal subjectivity is produced under an economic idealism, of the market and of individual freedom. Premises show that neoliberalism is not only a practice in the economic field but also a loss of a social project and individualization in the psychological plane that requires each person to face reality in isolation and where each one can reach/buy individually what is necessary. The idea of entrepreneurship is explained as one of the neoliberal strategies to individualize and delegitimize the need for States. It is a theoretical reflection that analyzes historical contextual data from Costa Rica and El Salvador, government plans, policies already applied, bills, public discussions and journalistic notes.

https://doi.org/10.22458/rr.v13i2.4894

Los inicios de la enseñanza de pediatría en Chile y la fundación de hospitales de niños
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Schonhaut Berman, Luisa

; Chávez Zúftiga, Pablo

; Vargas Catalán, Nelson A.

Andes pediatrica

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jan 2023, Volume 94 N. 1 Pages 112 - 118

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen: El objetivo del presente manuscrito es revisar antecedentes históricos previos a la creación de la Sociedad Chilena de Pediatría (SOCHIPE) en el año 1922, con el propósito de reflexionar sobre su impacto en la profesionalización de la pediatría nacional, especialmente en la salud y sobrevida de los niños. Se revisaron documentos de la Junta de Beneficencia, libros y estudios especializados de la época. Hasta principios del siglo XX, el país ostentaba una de las tasas de mortalidad infantil más elevadas del mundo, y contaba con precarias instalaciones para enfrentarlas. En aquellos años, el único establecimiento cerrado para la atención de infantes era la Casa de Huérfanos, que estaba al cuidado de religiosas con apoyo de médicos; es ahí donde se desarrollaron los primeros cursos teórico-prácticos de la especialidad. Presionados por la alta mortalidad infantil y las mortíferas epidemias, la Junta de Beneficencia vio la urgencia de mejorar las condiciones higiénicas y crear instalaciones para el cuidado de los niños. El manuscrito aborda el surgimiento de espacios encargados del resguardo de la salud de los menores de cinco años, desde la creación de la cátedra de pediatría y del primer hospital de niños, el Hospital Roberto del Río, lo que marcó el inicio de las políticas de salud pública infantiles.

Abstract: The objective of this manuscript is to review the historical background before the creation of the Chilean Society of Pediatrics (SOCHIPE) in 1922 and reflect on its impact on the professionalization of national pediatrics, especially on children’s health and survival. For this purpose, we review documents from the Charity Board, books, and specialized studies. Until the beginning of the 20th century, the country had one of the highest infant mortality rates in the world and precarious facilities to deal with it. In those years, the only closed establishment for infant care was the House of Orphans, which was cared for by nuns with doctors’ support; they developed the first theoretical-practical courses of the specialty. Pressured by high infant mortality and deadly epidemics, the Charity board cared about the urgency of improving hygienic conditions and creating childcare facilities. The manuscript addresses the emergence of spaces responsible for safeguarding the health of children under five years of age since the creation of the chair of pediatrics and the first children’s hospital, the Roberto del Río Hospital, which set the beginning of the policies for children’s public health.

https://doi.org/10.32641/andespediatr.v94i1.4618

Differentially methylated regions identified in bovine embryos are not observed in adulthood
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Vargas, Luna Nascimento

; Nochi, Allice Rodrigues Ferreira

; Castro, Paloma Soares de

; Cunha, Andrielle Thainar Mendes

; Silva, Thainara Christie Ferreira

; Togawa, Roberto Coiti

; Silveira, Márcia Marques

; Caetano, Alexandre Rodrigues

; Franco, Maurício Machaim

Animal Reproduction

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2023, Volume 20 N. 1 elocation e20220076

Abstract: En | Text: En | PDF: En

Abstract The establishment of epigenetic marks during the reprogramming window is susceptible to environmental influences, and stimuli during this critical stage can cause altered DNA methylation in offspring. In a previous study, we found that low levels of sulphur and cobalt (low S/Co) in the diet offered to oocyte donors altered the DNA methylome of bovine embryos. However, due to the extensive epigenetic reprogramming that occurs during embryogenesis, we hypothesized that the different methylation regions (DMRs) identified in the blastocysts may not maintain in adulthood. Here, we aimed to characterize DMRs previously identified in embryos, in the blood and sperm of adult progenies of two groups of heifers (low S/Co and control). We used six bulls and characterized the DNA methylation levels of KDM2A, KDM5A, KMT2D, and DOT1L genes. Our results showed that all DMRs analysed in both groups and tissues were hypermethylated unlike that noticed in the embryonic methylome profiles. These results suggest that embryo DMRs were reprogrammed during the final stages of de novo methylation during embryogenesis or later in development. Therefore, due to the highly dynamic epigenetic state during early embryonic development, we suggest that is essential to validate the DMRs found in embryos in adult individuals.

https://doi.org/10.1590/1984-3143-ar2022-0076

Modelos didácticos mediados por TIC en la enseñanza universitaria: una revisión sistemática
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Becerra, Isabel Jiménez

; Reyes, Roberto Canales

; Marín, Alejandra Agudelo

; Vargas, Lucy Deyanira Andrade

Educação e Pesquisa

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2023, Volume 49 elocation e251276

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract The interest in understanding the role of the university teacher in today’s society implies analyzing the didactic decisions that guide their work for the development of professional, social and technological skills. In this framework, the present study aimed to identify the scientific production related to the application of didactic models, mediated by Information and Communication Technologies (ICT), in the context of university education. Through a mixed analysis, with the application of qualitative and quantitative methodologies, a search was carried out from the five moments of the systematic review process, where a total of eighty-nine articles published in different high-impact journals were obtained. The results show the effort of teachers to implement some models based on the use of ICT resources and tools, compared to the poor command of didactic and technological skills for the construction of this type of strategy. Within a pragmatic perspective of education, this article proposes the challenges assumed by teachers to reformulate their practices, amid the dynamics of a transhumanist world located in the new ecology of knowledge. In this way, the different sociocultural contexts would facilitate the transformation and solution of problems applied in the classroom.

Resumen El interés por comprender el rol del docente universitario en la sociedad actual implica analizar las decisiones didácticas que orientan su quehacer para el desarrollo de competencias profesionales, sociales y tecnológicas. En este marco, el presente estudio tuvo como objetivo identificar la producción científica relacionada con la aplicación de modelos didácticos, mediados por las Tecnologías de la Información y la Comunicación (TIC), en el contexto de la enseñanza universitaria. A través de un análisis mixto, con la aplicación de metodologías cualitativas y cuantitativas, se realizó una búsqueda desde los cinco momentos del proceso de revisión sistemática, donde se obtuvo un total de ochenta y nueve artículos publicados en diferentes revistas de alto impacto. Los resultados evidencian el esfuerzo del profesorado por implementar algunos modelos basados en el uso de recursos y herramientas TIC, frente al escaso dominio de las competencias didácticas y tecnológicas para la construcción de este tipo de estrategias. Dentro de una perspectiva pragmática de la educación, en este artículo se proponen los desafíos asumidos por los docentes para reformular sus prácticas, en medio de las dinámicas de un mundo transhumanista ubicado en la nueva ecología del conocimiento. De esta forma, los diferentes contextos socioculturales facilitarían la transformación y solución de problemas aplicados en el aula de clase.

https://doi.org/10.1590/s1678-4634202349251276es

Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19
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Barbosa, Hannah Cardoso

; Martins, Maria Auxiliadora Parreiras

; Jesus, Jordana Cristina de

; Meira, Karina Cardoso

; Passaglia, Luiz Guilherme

; Sacioto, Manuela Furtado

; Bezerra, Adriana Falangola Benjamin

; Schwarzbold, Alexandre Vargas

; Maurílio, Amanda de Oliveira

; Farace, Barbara Lopes

; Silva, Carla Thais Cândida Alves da

; Cimini, Christiane Corrêa Rodrigues

; Silveira, Daniel Vitorio

; Carazai, Daniela do Reis

; Ponce, Daniela

; Costa, Emanuel Victor Alves

; Manenti, Euler Roberto Fernandes

; Cenci, Evelin Paola de Almeida

; Bartolazzi, Frederico

; Madeira, Glícia Cristina de Castro

; Nascimento, Guilherme Fagundes

; Velloso, Isabela Vasconcellos Pires

; Batista, Joanna d’Arc Lyra

; Morais, Júlia Drumond Parreiras de

; Carvalho, Juliana da Silva Nogueira

; Ruschel, Karen Brasil

; Martins, Karina Paula Medeiros Prado

; Zandoná, Liege Barella

; Menezes, Luanna Silva Monteiro

; Kopittke, Luciane

; Castro, Luís César de

; Nasi, Luiz Antônio

; Floriani, Maiara Anschau

; Souza, Maíra Dias

; Carneiro, Marcelo

; Bicalho, Maria Aparecida Camargos

; Lima, Maria Clara Pontello Barbosa

; Godoy, Mariana Frizzo de

; Guimarães-Júnior, Milton Henriques

; Mendes, Paulo Mascarenhas

; Delfino-Pereira, Polianna

; Ribeiro, Raquel Jaqueline Eder

; Finger, Renan Goulart

; Menezes, Rochele Mosmann

; Francisco, Saionara Cristina

; Araújo, Silvia Ferreira

; Oliveira, Talita Fischer

; Oliveira, Thainara Conceição de

; Polanczyk, Carisi Anne

; Marcolino, Milena Soriano

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 2 elocation e20220151

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease’s pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

https://doi.org/10.36660/abc.20220151

Immune thrombocytopenia associated with lymph node tuberculosis: a case report
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Vargas, Juliano Córdova

; Bezerra, Patrícia Nunes

; Sequeira, Murilo

; Oliveira, Gabriella Haydée de

; Pegolo, Carlos Eduardo

; Fiore, Lucas

; Hamerschlak, Nelson

; Ferreira, Paulo Roberto Abrão

Revista da Sociedade Brasileira de Medicina Tropical

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2023, Volume 56 elocation e0072-2023

Abstract: En | Text: En | PDF: En

ABSTRACT Extrapulmonary tuberculosis associated with immune thrombocytopenia (ITP) is extremely rare. A likely association between ITP and pulmonary and lymph node tuberculosis was reported in a 29-year-old male patient. His platelet count decreased to 4,000/µL. Chest tomography revealed mediastinal adenomegaly, lymph node clusters in the aorta, and consolidation in the left upper lung lobe. Immunoglobulin and methylprednisolone were administered intravenously. The histopathology of the left upper lung lobe confirmed tuberculosis. The rifampicin/isoniazid/pyrazinamide/ethambutol regimen was initiated, and the corticosteroids were tapered off. This case suggests an association of tuberculosis with ITP, since the platelet count effectively normalized after tuberculosis treatment.

https://doi.org/10.1590/0037-8682-0072-2023

Effects of mechanical in-exsufflation in preventing postextubation acute respiratory failure in intensive care acquired weakness patients: a randomized controlled trial
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Wibart, Philippe

; Réginault, Thomas

; Garcia-Fontan, Margarita

; Barbrel, Bérangère

; Bader, Clement

; Benard, Antoine

; Parreira, Verônica Franco

; Gonzalez-Antón, Daniel

; Bui, Nam H.

; Gruson, Didier

; Hilbert, Gilles

; Martinez-Alejos, Roberto

; Vargas, Frédéric

Critical Care Science

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2023, Volume 35 N. 2 Pages 168 - 176

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Objective: We hypothesized that the use of mechanical insufflation-exsufflation can reduce the incidence of acute respiratory failure within the 48-hour post-extubation period in intensive care unit-acquired weakness patients. Methods: This was a prospective randomized controlled open-label trial. Patients diagnosed with intensive care unit-acquired weakness were consecutively enrolled based on a Medical Research Council score ≤ 48/60. The patients randomly received two daily sessions; in the control group, conventional chest physiotherapy was performed, while in the intervention group, chest physiotherapy was associated with mechanical insufflation-exsufflation. The incidence of acute respiratory failure within 48 hours of extubation was evaluated. Similarly, the reintubation rate, intensive care unit length of stay, mortality at 28 days, and survival probability at 90 days were assessed. The study was stopped after futility results in the interim analysis. Results: We included 122 consecutive patients (n = 61 per group). There was no significant difference in the incidence of acute respiratory failure between treatments (11.5% control group versus 16.4%, intervention group; p = 0.60), the need for reintubation (3.6% versus 10.7%; p = 0.27), mean length of stay (3 versus 4 days; p = 0.33), mortality at Day 28 (9.8% versus 15.0%; p = 0.42), or survival probability at Day 90 (21.3% versus 28.3%; p = 0.41). Conclusion: Mechanical insufflation-exsufflation combined with chest physiotherapy seems to have no impact in preventing postextubation acute respiratory failure in intensive care unit-acquired weakness patients. Similarly, mortality and survival probability were similar in both groups. Nevertheless, given the early termination of the trial, further clinical investigation is strongly recommended. Clinical Trials Register: NCT 01931228

RESUMO Objetivo: Verificar se o uso de insuflação-exsuflação mecânica pode reduzir a incidência da insuficiência respiratória aguda no período de 48 horas pós-extubação em pacientes com fraqueza adquirida em unidades de terapia intensiva. Métodos: Estudo prospectivo, randomizado, controlado e aberto. Os pacientes diagnosticados com fraqueza adquirida em unidade de terapia intensiva foram incluídos consecutivamente, com base em uma pontuação do Medical Research Council ≤ 48/60. Os pacientes receberam aleatoriamente duas sessões diárias; no grupo controle, realizou-se fisioterapia torácica convencional, enquanto no grupo intervenção, combinou-se fisioterapia torácica com insuflação-exsuflação mecânica. Avaliou-se a incidência de insuficiência respiratória aguda dentro de 48 horas após a extubação. Da mesma forma, avaliaram-se a taxa de reintubação, o tempo de permanência na unidade de terapia intensiva, a mortalidade aos 28 dias e a probabilidade de sobrevida aos 90 dias. O estudo foi interrompido após resultados de futilidade na análise intermediária. Resultados: Incluímos 122 pacientes consecutivos (n = 61 por grupo). Não houve diferença significativa na incidência de insuficiência respiratória aguda entre os tratamentos (11,5% no grupo controle versus 16,4% no grupo intervenção; p = 0,60), na necessidade de reintubação (3,6% versus 10,7%; p = 0,27), no tempo médio de internação (3 versus 4 dias; p = 0,33), na mortalidade aos 28 dias (9,8% versus 15,0%; p = 0,42) ou na probabilidade de sobrevida aos 90 dias (21,3% versus 28,3%; p = 0,41). Conclusão: A insuflação-exsuflação mecânica associada à fisioterapia torácica parece não ter impacto na prevenção da insuficiência respiratória aguda pós-extubação em pacientes com fraqueza adquirida na unidade de terapia intensiva. Da mesma forma, a mortalidade e a probabilidade de sobrevida foram semelhantes em ambos os grupos. No entanto, devido ao término precoce do estudo, recomenda-se enfaticamente uma investigação clínica mais aprofundada. Registro Clinical Trials: NCT 01931228

https://doi.org/10.5935/2965-2774.20230410-en

10.

Dados de Vida Real sobre o Uso da Hidroxicloroquina ou da Cloroquina Combinadas ou Não à Azitromicina em Pacientes com Covid-19: Uma Análise Retrospectiva no Brasil
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Souza-Silva, Maíra Viana Rego

; Pereira, Daniella Nunes

; Pires, Magda Carvalho

; Vasconcelos, Isabela Muzzi

; Schwarzbold, Alexandre Vargas

; Vasconcelos, Diego Henrique de

; Pereira, Elayne Crestani

; Manenti, Euler Roberto Fernandes

; Costa, Felício Roberto

; Aguiar, Filipe Carrilho de

; Anschau, Fernando

; Bartolazzi, Frederico

; Nascimento, Guilherme Fagundes

; Vianna, Heloisa Reniers

; Batista, Joanna d’Arc Lyra

; Machado-Rugolo, Juliana

; Ruschel, Karen Brasil

; Ferreira, Maria Angélica Pires

; Oliveira, Leonardo Seixas de

; Menezes, Luanna Silva Monteiro

; Ziegelmann, Patricia Klarmann

; Tofani, Marcela Gonçalves Trindade

; Bicalho, Maria Aparecida Camargos

; Nogueira, Matheus Carvalho Alves

; Guimarães-Júnior, Milton Henriques

; Aguiar, Rúbia Laura Oliveira

; Rios, Danyelle Romana Alves

; Polanczyk, Carisi Anne

; Marcolino, Milena Soriano

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 9 elocation e20220935

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background Despite no evidence showing benefits of hydroxychloroquine and chloroquine with or without azithromycin for COVID-19 treatment, these medications have been largely prescribed in Brazil. Objectives To assess outcomes, including in-hospital mortality, electrocardiographic abnormalities, hospital length-of-stay, admission to the intensive care unit, and need for dialysis and mechanical ventilation, in hospitalized COVID-19 patients who received chloroquine or hydroxychloroquine, and to compare outcomes between those patients and their matched controls. Methods A retrospective multicenter cohort study that included consecutive laboratory-confirmed COVID-19 patients from 37 Brazilian hospitals from March to September 2020. Propensity score was used to select matching controls by age, sex, cardiovascular comorbidities, and in-hospital use of corticosteroid. A p-value <0.05 was considered statistically significant. Results From 7,850 COVID-19 patients, 673 (8.6%) received hydroxychloroquine and 67 (0.9%) chloroquine. The median age in the study group was 60 years (46 - 71) and 59.1% were women. During hospitalization, 3.2% of patients presented side effects and 2.2% required therapy discontinuation. Electrocardiographic abnormalities were more prevalent in the chloroquine/hydroxychloroquine group (13.2% vs. 8.2%, p=0.01), and the long corrected QT interval was the main difference (3.6% vs. 0.4%, p<0.001). The median hospital length of stay was longer in the HCQ/CQ + AZT group than in controls (9.0 [5.0, 18.0] vs. 8.0 [4.0, 14.0] days). There was no statistical differences between groups in intensive care unit admission (35.1% vs. 32.0%; p=0.282), invasive mechanical ventilation support (27.0% vs. 22.3%; p=0.074) or mortality (18.9% vs. 18.0%; p=0.682). Conclusion COVID-19 patients treated with chloroquine or hydroxychloroquine had a longer hospital length of stay, when compared to matched controls. Intensive care unit admission, invasive mechanical ventilation, dialysis and in-hospital mortality were similar.

Resumo Fundamento Apesar da ausência de evidência mostrando benefícios da hidroxicloroquina e da cloroquina combinadas ou não à azitromicina no tratamento da covid-19, esses medicamentos têm sido amplamente prescritos no Brasil. Objetivos Avaliar desfechos, incluindo moralidade hospitalar, alterações eletrocardiográficas, tempo de internação, admissão na unidade de terapia intensiva, e necessidade de diálise e de ventilação mecânica em pacientes hospitalizados com covid-19 que receberam cloroquina ou hidroxicloroquina, e comparar os desfechos entre aqueles pacientes e seus controles pareados. Métodos Estudo multicêntrico retrospectivo do tipo coorte que incluiu pacientes com diagnóstico laboratorial de covid-19 de 37 hospitais no Brasil de março a setembro de 2020. Escore de propensão foi usado para selecionar controles pareados quanto a idade, sexo, comorbidades cardiovasculares, e uso de corticosteroides durante a internação. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados Dos 7850 pacientes com covid-19, 673 (8,6%) receberam hidroxicloroquina e 67 (0,9%) cloroquina. A idade mediana no grupo de estudo foi 60 (46-71) anos e 59,1% eram mulheres. Durante a internação, 3,2% dos pacientes apresentaram efeitos adversos e 2,2% necessitaram de interromper o tratamento. Alterações eletrocardiográficas foram mais prevalentes no grupo hidroxicloroquina/cloroquina (13,2% vs. 8,2%, p=0,01), e o prolongamento do intervalo QT corrigido foi a principal diferença (3,6% vs. 0,4%, p<0,001). O tempo mediano de internação hospitalar foi maior no grupo usando CQ/HCQ em relação aos controles (9,0 [5,0-18,0] vs. 8,0 [4,0-14,0] dias). Não houve diferenças estatisticamente significativas entre os grupos quanto a admissão na unidade de terapia intensiva (35,1% vs. 32,0%; p=0,282), ventilação mecânica invasiva (27,0% vs. 22,3%; p=0,074) ou mortalidade (18,9% vs. 18,0%; p=0,682). Conclusão Pacientes com covid-19 tratados com cloroquina ou hidroxicloroquina apresentaram maior tempo de internação hospitalar, em comparação aos controles. Não houve diferença em relação a admissão em unidade de terapia intensiva, necessidade de ventilação mecânica e mortalidade hospitalar.

https://doi.org/10.36660/abc.20220935

11.

Unusual record of the Burrowing Owl (Athene cunicularia) in Costa Rica after 120 years
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Alfaro-Rojas, Danny

; Alpízar-Trejos, Kattia

; Guido, Beto

; Vargas-Masís, Roberto

Huitzil

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dec 2022, Volume 23 N. 2 elocation e637

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen La lechuza llanera (Athene cunicularia) se considera una especie er rante y migratoria en América Central con muy pocos informes en Honduras, El Salvador, Guatemala, Panamá, Nicaragua y Costa Rica. El 28 de noviembre de 2020 observamos un individuo de Lechu za llanera en La Ceiba, Orotina, provincia de Alajuela, Costa Rica. Este fue un registro inusual para el país, y es importante ya que no ha habido registros confirmados de la especie en Costa Rica durante 120 años. Este avistamiento también enfatiza la importancia del área como hábitat adecuado para aves migratorias y residentes, por lo que su conservación y manejo adecuado es fundamental para preservar la biodiversidad.

Abstarct The Burrowing Owl (Athene cunicularia) is considered a vagrant as well as a migratory species in Central America with very few reports in Honduras, El Salvador, Guatemala, Panama, Nicaragua, and Costa Rica. On 28 November 2020 we observed an individual Burrowing Owl at La Ceiba, Orotina, Alajuela province, Costa Rica. This was an unusual record for the country, and is of importance as there have been no confirmed records of the species in Costa Rica for 120 years. This sighting also emphasizes the importance of the area as a suitable habitat for migratory and resident birds, so its conservation and pro per management is essential to preserve biodiversity.

https://doi.org/10.28947/hrmo.2022.23.2.586

12.

Competencias culturales en estudiantes de Enfermería del sur de Chile
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Álvarez-San Martín, Roberto

; Moll-Contreras, Josefa Malini

; Vargas-Santander, Alejandra Nataly

Revista Internacional de Investigación en Ciencias Sociales

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dec 2022, Volume 18 N. 2 Pages 329 - 342

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

RESUMEN En el actual contexto de diversidad cultural, la atención de salud requiere de profesionales con competencias culturales, habilitados para otorgar una atención de calidad y culturalmente pertinente. En este artículo se presentan los resultados de un estudio sobre el desarrollo de competencias culturales en estudiantes de Enfermería en una universidad chilena, para lo cual se aplicó la Escala de Medición de Competencia Cultural, versión chilena, midiendo las competencias en tres subáreas: conocimientos, sensibilidad y habilidades culturales. Los resultados indican que los estudiantes presentan un alto desarrollo de competencias en la dimensión conocimientos culturales, en tanto que la sensibilidad cultural es la menos desarrollada. Se concluye que los estudiantes de Enfermería son culturalmente competentes para otorgar una atención de salud a pacientes de diversos orígenes culturales y capaces de adaptarse a contextos multiculturales en el área de los cuidados de la salud.

ABSTRACT In the current context of cultural diversity, health care requires professionals with cultural competencies who are able to provide quality and culturally relevant care. This article presents the results of a study on the development of cultural competencies in nursing students at a Chilean university, for which the Chilean version of the Cultural Competency Measurement Scale was applied, measuring competencies in three sub-areas: cultural knowledge, sensitivity and skills. The results indicate that students show a high level of competence development in the cultural knowledge dimension, while cultural sensitivity is the least developed. It is concluded that nursing students are culturally competent to provide health care to patients from diverse cultural backgrounds and able to adapt to multicultural contexts in the area of health care.

https://doi.org/10.18004/riics.2022.diciembre.329

13.

Entablando diálogos con Freire: sobre el espacio pedagógico y otras reflexiones compartidas
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Gutiérrez Slon, Juan Antonio

; Vargas Vargas, Bryan Roberto

Revista Innovaciones Educativas

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dec 2022, Volume 24 N. 37 Pages 231 - 243

Abstract: Es Pt En | Text: Es Pt En | PDF: Es | PDF: Pt | PDF: En

Resumen: El ensayo hace énfasis en algunas reflexiones de Paulo Freire que se sustentan en el análisis de la ''educación como práctica de la libertad'' realizado a la luz de tres de sus obras: una teórica, una de aproximación empírica y otra de síntesis. Hace énfasis sobre la condición de opresión enmarcada en los procesos educativos a la vez que indaga sobre la perspectiva metodológica del espacio pedagógico y las posibilidades que éste tiene para superar la relación opresor-oprimido desde una propuesta de problematización desde voces sin discriminación incluidas en los procesos educativos del mundo sociopolítico.

Resumo: O ensaio enfatiza algumas reflexões de Paulo Freire baseadas na análise da ''educação como prática de liberdade'' à luz de três de suas obras, uma teórica, uma abordagem empírica e outra de síntese. Enfatiza as discussões sobre a condição de opressão que é enquadrada nos processos educativos, ao mesmo tempo em que investiga a perspectiva metodológica do autor sobre o espaço pedagógico e as possibilidades que têm para superar a relação opressor-oprimido a partir de uma proposta de problematização situada a partir de vozes sem discriminação incluídas nos processos educativos do mundo sociopolítico.

Abstract: The essay emphasizes some of Paulo Freire's reflections based on the analysis of ''education as a practice of freedom'' in the light of three of his works: one theoretical, one empirical approach, and one of synthesis. It emphasizes discussions on the condition of oppression that is framed in the educational processes while investigating the author's methodological perspective on the pedagogical domain and the possibilities it has to overcome the oppressor-oppressed relationship with a proposal of problematization based on the actual voices without discrimination included in the educational processes of the socio-political world.

https://doi.org/10.22458/ie.v24i37.3963

14.

Diferencias de actividad electromiográfica abdominal en el entrenamiento del core
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Silhi-Vargas, Fares

; Bruneau-Chávez, José

; Rifo-Contreras, Victor

; Lagos-Hernández, Roberto

Revista de la Universidad Industrial de Santander. Salud

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dec 2022, Volume 54 elocation e600

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Introducción: La musculatura del core involucra a todos los grupos musculares ubicados en la zona media del cuerpo. La metodología clínica de elección para el registro y análisis de su actividad bioeléctrica es la electromiografía superficial (sEMG), metodología clínica para el registro y posterior análisis de las actividades bioeléctricas del músculo esquelético. Objetivo: El objetivo de esta investigación es determinar si existen diferencias de actividad electromiográfica en la musculatura del recto abdominal y oblicuo externo entre practicantes de musculación y practicantes de calistenia. Metodología: El estudio es de tipo comparativo, de diseño no experimental, transversal de enfoque cuantitativo en una muestra de 20 sujetos; 10 practicantes de calistenia y 10 que entrenan con ejercicios de musculación clásicos. Resultados: Los ejercicios que tuvieron mayor respuesta electromiográfica fueron abdominal en suspensión y abdominal inclinado. Conclusiones: La calistenia es una alternativa viable para la activación muscular a nivel del Core.

Abstract Introduction: The Core musculature involves all the muscle groups located in the middle area of the body whose activity can be measured using superficial electromyography (sEMG), a clinical methodology for recording and subsequent analysis of skeletal muscle bioelectric activities. Objectives: The objective of this research is to determine if there are differences in electromyographic activity in the muscles of the rectus abdominis and external oblique between bodybuilding practitioners and calisthenics practitioners. Methodology: A comparative study, non-experimental design, cross-sectional with a quantitative approach in a sample of 20 subjects; 10 calisthenics practitioners and 10 who train with classic bodybuilding exercises. Results: The exercises with the greatest electromyographic response were abdominal in suspension and abdominal incline. Conclusions: Calisthenics is a viable alternative for muscle activation at the Core level.

https://doi.org/10.18273/saluduis.54.e:22009 2 downloads

15.

Descomposición de la desigualdad del rendimiento escolar por condición de pobreza en estudiantes mexicanos
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Santillán Hernández, Alma Sofía

; Vargas Sánchez, Juan Roberto

Análisis económico

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aug 2022, Volume 37 N. 95 Pages 125 - 141

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract The difference in school performance according to the condition of poverty is analyzed. The scores of standardized national tests of mathematics and language and communication of Mexican students of primary and secondary education are used. The difference is decomposed in the average and by quantiles to identify the portions due to the observable characteristics and the returns. In secondary, for language and communication, most of the difference between groups is explained by the observable characteristics, for both fields of education, inequality is due to returns. At both levels of education, the gap is larger for students with higher school achievement. It is also more pronounced in language and communication than in mathematics.

Resumen Con los puntajes de pruebas nacionales estandarizadas de matemáticas y lenguaje y comunicación de estudiantes mexicanos de educación primaria y secundaria, se analiza la diferencia en el rendimiento escolar según la condición de pobreza, se usan métodos de descomposición tanto en el promedio como por cuantiles y se identifican las partes que explican las desigualdades ya sea por características observables o por retornos. En secundaria, para lenguaje y comunicación la mayor parte de la diferencia entre los grupos se explica por las características individuales observables; en matemáticas la explicación es por los retornos. En primaria, para ambos campos de formación, la desigualdad se debe a los retornos. En los dos niveles educativos la brecha es más grande para los estudiantes de mayor aprovechamiento escolar. También es más pronunciada en lenguaje y comunicación que en matemáticas.

https://doi.org/10.24275/uam/azc/dcsh/ae/2022v37n95/santillan 157 downloads

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