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BACKGROUND: One of the population groups at higher risk of suicide is that of people who attend mental health institutions. OBJECTIVE: To know the demographic and clinical characteristics of people admitted for suicidal ideation and suicide attempt to the observation area of a psychiatric hospital in a period of 10 non-consecutive months. MATERIAL AND METHODS: Retrospective, descriptive, correlational study. A total of 439 medical records were collected, out of which 62.9% (n = 276) corresponded to women, 36.7% (n = 161) to men and 0.5% (n = 2) to transgender people; age ranged from 17 to 74 years. RESULTS: The highest incidence of cases was observed between 18 and 25 years of age; the most frequent diagnosis was depressive disorder, and 45.5% (n = 200) of the cases had a suicide attempt. The main method for committing a suicidal act was poisoning by taking various medications, followed by self-inflicted injuries with sharp objects. A positive correlation was found between suicide attempt and self-harm (c² = 1.965, p < 0.05). CONCLUSIONS: The findings highlight the importance of early identification of risk factors that may contribute to an increase in suicidal behaviors.

ANTECEDENTES: Uno de los grupos poblacionales en mayor riesgo de suicidio lo constituyen las personas que asisten a instituciones de salud mental. OBJETIVO: Conocer las características demográficas y clínicas de las personas ingresadas por ideación e intento suicida al área de observación de un hospital psiquiátrico en un periodo de 10 meses no consecutivos. MATERIAL Y MÉTODOS: Estudio retrospectivo, descriptivo y correlacional. Se recabaron 439 expedientes, de los cuales las mujeres representaron 62.9 % (n = 276), los hombres 36.7 % (n = 161) y las personas transgénero 0.5 % (n = 2); el rango de edad varió de 17 a 74 años. RESULTADOS: La mayor incidencia de casos se observó entre los 18 y 25 años, el diagnóstico más frecuente fue el trastorno depresivo y 45.5 % (n = 200) de los casos presentó una tentativa suicida. El principal método para cometer un acto suicida fue el envenenamiento por diversos medicamentos seguido por las lesiones autoinflingidas con objeto punzocortante. Se encontró correlación positiva entre intento suicida y autolesiones (c² = 1.965, p < 0.05). CONCLUSIONES: Los hallazgos resaltan la importancia de la identificación temprana de los factores de riesgo que pueden contribuir al incremento del comportamiento suicida.

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Introducción. El dolor neuropático afecta al 2 % de la población y 15 de cada 100 pacientes que acuden a consulta médica, sufren de dolor neuropático. Este tipo de dolor es muy común en pacientes con cáncer. Objetivo. Determinar si el uso de lidocaína en infusión endovenosa disminuye el dolor neuropático en los cuidados paliativos con tratamiento opioide. Metodología. Serie de casos de tres pacientes en cuidados paliativos que presentaron dolor neuropático y se les administraron múltiples infusiones de lidocaína intravenosa como coadyuvante para el manejo del dolor, se describieron las dosis utilizadas, el número de infusiones, se evaluó la mejoría del dolor a través de la escala visual análoga y se monitorizaron los posibles efectos secundarios. Resultados. Caso 1: escala visual análoga al ingreso 9/10; 24 horas posinfusión de lidocaína: 4/10. Caso 2: escala visual análoga al ingreso 6/10; 24 horas posinfusión de lidocaína 2/10. Caso 3: escala visual análoga al ingreso 8/10; 24 horas posinfusión 2/10. Conclusión. La infusión intravenosa de lidocaína al 2 % disminuyó el dolor neuropático en los tres pacientes del estudio, sin embargo, el alivio fue transitorio y el efecto positivo se perdió con el paso del tiempo

Introduction. Neuropathic pain affects 2 % of the population and 15 out of 100 patients who go to a physician suffer from neuropathic pain. This type of pain is common in cancer patients. Objective. To determine if the use of lidocaine in intravenous infusion reduces neuropathic pain in palliative care with opioid treatment. Methodology. Case series of three patients in palliative care who presented neuropathic pain and underwent multiple infusions of intravenous lidocaine as an adjuvant for pain management; the doses used and the number of infusions were described, pain improvement was evaluated through the visual analog scale and possible side effects were monitored. Results. Case 1: visual analogue scale on admission 9/10; 24 hours post lidocaine infusion: 4/10. Case 2: visual analogue scale on admission 6/10; 24 hours post lidocaine infusion 2/10. Case 3: visual analogue scale on admission 8/10; 24 hours post-infusion 2/10. Conclusion.Intravenous infusion of 2 % lidocaine reduced neuropathic pain in the three patients of the study, however, the relief is transitory, and the positive effect is lost over time.

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Resumen Antecedentes: Uno de los grupos poblacionales en mayor riesgo de suicidio lo constituyen las personas que asisten a instituciones de salud mental. Objetivo: Conocer las características demográficas y clínicas de las personas ingresadas por ideación e intento suicida al área de observación de un hospital psiquiátrico en un periodo de 10 meses no consecutivos. Material y métodos: Estudio retrospectivo, descriptivo y correlacional. Se recabaron 439 expedientes, de los cuales las mujeres representaron 62.9 % (n = 276), los hombres 36.7 % (n = 161) y las personas transgénero 0.5 % (n = 2); el rango de edad varió de 17 a 74 años. Resultados: La mayor incidencia de casos se observó entre los 18 y 25 años, el diagnóstico más frecuente fue el trastorno depresivo y 45.5 % (n = 200) de los casos presentó una tentativa suicida. El principal método para cometer un acto suicida fue el envenenamiento por diversos medicamentos seguido por las lesiones autoinflingidas con objeto punzocortante. Se encontró correlación positiva entre intento suicida y autolesiones (χ2 = 1.965, p < 0.05). Conclusiones: Los hallazgos resaltan la importancia de la identificación temprana de los factores de riesgo que pueden contribuir al incremento del comportamiento suicida.

Abstract Background: One of the population groups at higher risk of suicide is that of people who attend mental health institutions. Objective: To know the demographic and clinical characteristics of people admitted for suicidal ideation and suicide attempt to the observation area of a psychiatric hospital in a period of 10 non-consecutive months. Material and methods: Retrospective, descriptive, correlational study. A total of 439 medical records were collected, out of which 62.9% (n = 276) corresponded to women, 36.7% (n = 161) to men and 0.5% (n = 2) to transgender people; age ranged from 17 to 74 years. Results: The highest incidence of cases was observed between 18 and 25 years of age; the most frequent diagnosis was depressive disorder, and 45.5% (n = 200) of the cases had a suicide attempt. The main method for committing a suicidal act was poisoning by taking various medications, followed by self-inflicted injuries with sharp objects. A positive correlation was found between suicide attempt and self-harm (χ2 = 1.965, p < 0.05). Conclusions: The findings highlight the importance of early identification of risk factors that may contribute to an increase in suicidal behaviors.

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SUMMARY: It has been demonstrated that the teaching and learning process of human anatomy is influenced by different external factors that can affect, in the short and long term, the academic and professional performance of medical students. In this sense, the present work aims to determine the relationship between sociodemographic factors and the academic performance of students belonging to the program of Medicine and Surgery of the Universidad del Valle, in Cali-Colombia, who were enrolled in the course of Human Gross Anatomy. Based on the organization of the course plan, the average grades obtained by the students in the different exams taken in the course were compared. Through a survey, sociodemographic data that have been reported as influential factors in academic performance were asked. The first stage of the analysis consisted of identifying the characteristics of the variables, then the correlation of the sociodemographic variables with the students' academic performance, and finally, a multiple linear regression model was implemented. Although the results did not show statistically significant correlations between the variables analyzed, a close relationship was observed with the sex and place of origin of the students, obtaining that women and students from other towns and cities presented lower academic performance compared to their peers. This highlights the importance of including activities to strengthen the learning process, as well as guiding support programs to maintain academic performance and reduce the inequality gap.

Se ha demostrado que en el proceso de enseñanza y aprendizaje de la anatomía humana inciden diferentes factores externos que pueden afectar, a corto y largo plazo, el desempeño académico y profesional de los estudiantes de Medicina. En este sentido, el presente trabajo tiene como objetivo determinar la relación existente entre los factores sociodemográficos y el rendimiento académico de los estudiantes que pertenecen al programa de Medicina y Cirugía de la Universidad del Valle, en Cali-Colombia, matriculados en la asignatura de Anatomía Macroscópica Humana. A partir de la organización del plan del curso, se comparó el promedio de las notas obtenidas por los estudiantes en los diferentes exámenes realizados en la asignatura. A través de una encuesta, se preguntaron algunos datos sociodemográficos que han sido reportados como factores influyentes en el rendimiento académico. La primera etapa del análisis consistió en identificar las características de las variables, a continuación, la correlación de las variables sociodemográficas con el desempeño académico de los estudiantes y, finalmente, se implementó un modelo de regresión lineal múltiple. Si bien los resultados no arrojaron correlaciones estadísticamente significativas entre las variables analizadas, sí se observó una estrecha relación con el sexo y el lugar de procedencia de los estudiantes, obteniendo que las mujeres y los estudiantes foráneos presentaron menor rendimiento académico en comparación con los demás compañeros. Esto resalta la importancia de incluir actividades que permitan fortalecer el proceso de aprendizaje, así como guiar programas de apoyo para mantener el rendimiento académico y disminuir la brecha de desigualdad.

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Spiritual care is an essential part of quality palliative care. However, the literature regarding spiritual care competencies in Latin America is limited. Herein we propose the basic quality standards for spiritual care in palliative care according to best professional practices and provide a common vocabulary and required competencies for quality clinical spiritual care. Both elements, quality standards and a common vocabulary, are part of an essential step implementing continuous educational initiatives among interdisciplinary palliative care teams in Latin America. Members of the Spirituality Commission of the Latin American Association for Palliative Care and three members of independent professional palliative care organizations identified and reviewed our proposed spiritual care competencies and created a consensus document describing the competencies for general spiritual care. In the context of palliative care in Latin America, general spiritual care is provided by members of interdisciplinary teams. We proposed six competencies for high-quality general spiritual care and their observable behaviors that every member of an interdisciplinary palliative care team should have to provide quality clinical spiritual care in their daily practice: (I) personal, spiritual, and professional development; (II) ethics of spiritual care; (III) assessment of spiritual needs and spiritual care interventions; (IV) empathic and compassionate communication; (V) supportive and collaborative relationships among the interdisciplinary team; and (VI) inclusivity and diversity.

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Resumen: La historia de la transfusión sanguínea es apasionante. En México, esta práctica se inició en el siglo XIX y a partir de entonces los avances y contribuciones de investigadores y clínicos fueron decisivos para su desarrollo e implementación en la práctica clínica. El objetivo de este trabajo es hacer una breve revisión histórica de la transfusión sanguínea en México.

Abstract: The history of blood transfusions is exciting. In Mexico this practice began in the XIX century and from this time the advances and contributions of researchers and clinicians were decisive for its development and implementation in the clinical practice. The aim of this paper is to make a brief review of the history of blood transfusion in Mexico.

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Due to the COVID-19 pandemic, changes and improvements regarding the organization have been made to adapt quickly at the Emergency Department (ED) of the Hospital Italiano de Buenos Aires, Argentina. This article describes the design, implementation, and use of an electronic dashboard which provided monitoring of patients discharged home, during follow-up with telehealth. It was useful to access essential information to organize and coordinate professional work and patients' surveillance, providing highly relevant data in real-time as proxy variables for quality and safety during home isolation. The implemented tool innovated in the integration of technologies within a real context. The information management was crucial to optimize services and decision-making, as well to guarantee safety for healthcare workers and patients.

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Since Argentina's government declared a national emergency to combat the COVID-19 pandemic with a lockdown status, it has produced consequences on the healthcare system. We aimed to quantify the effect on the Emergency Department (ED) visits at Hospital Italiano de Buenos Aires. Our electronic health data showed that ED in-person visits declined 46% during the COVID-19 pandemic, from an overall of 176,370 visits during 2019 to 95,421 visits during 2020. Simultaneously, there was a telehealth visits boom when mandatory quarantine began (March 20, 2020): from a median of 12 daily in February 2020 to a median of 338 daily in April 2020; reaching a maximum daily peak of 1,132 on March 26 2020. For a while, teleconsultations replaced ED visits. Then, when face-to-face visits began to increase, teleconsultations began to decrease slowly, as the phenomenon reversed.

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Appropriate antibiotic prescription contributes to reducing bacterial resistance; therefore, it is critical to provide training regarding this challenge. The objective of this study was to develop a virtual learning environment for antibiotic prescription and to determine its impact on dentists' awareness, attitudes, and intention to practice. First, the learning content on multimedia resources was developed and distributed into three challenges that participants had to overcome. Then, a quasi-experimental study was performed in which the virtual learning environment was implemented on dentists from seven Colombian cities. The median of correct answers and the levels of awareness, attitudes, and intention to practice were compared before, immediately after, and 6-months post-intervention. Wilcoxon signed-rank and McNemar's tests were used to determine the differences. A total of 206 participants who finished the virtual learning environment activities exhibited a favorable and statistically significant impact on the median of correct answers of awareness (p < 0.001), attitudes (p < 0.001), and intention to practice (p = 0.042). A significant increase occurred in the number of participants with a high level of awareness (p < 0.001) and a non-significant increase in participants with high levels of attitudes (p = 0.230) and intention to practice (p = 0.286). At 6 months, the positive effect on the median of correct answers on awareness and intention to practice persisted (p < 0.001); however, this was not evident for attitudes (p = 0.105). Moreover, there was a significant decrease in the number of participants who showed low levels of awareness (p = 0.019) and a slight increase in those with high levels of the same component (p = 0.161). The use of a virtual learning environment designed for dentists contributed to a rapid improvement in awareness and intention to practice antibiotic prescription; however, their attitudes and information retention need reinforcement.

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Poliomyelitis emerged in Europe as an epidemic disease at the end of the 19th century. During the thirties of the twentieth century it reached great intensity in the United States and Canada, but it was after the Second World War when the disease became a serious world public health problem, which punished several countries of the world, including Mexico. Poliomyelitis is a very contagious viral disease that invades the central nervous system (destroys motor neurons) that frightened the Mexican population in the first half of the twentieth century, not so much by high mortality and morbidity figures but by its paralytic sequels, like the disability, and by the fact that it affected one of the most vulnerable population groups: children. The disease mainly affected children under five years of age, being rare in the first months of life of the newborn due to the protective effect of immunity that the mother transfers to the son through breast milk; After eight months, at the end of the feed, the infant could be infected by poliovirus by invading the spinal cord and producing paralysis, most commonly of the legs or trunk. Likewise, it caused a paralysis in the respiratory muscles (diaphragm) of children, who had to help them to breathe since, if not, they were suffocated, so they were introduced in machines commonly known as steel lungs or lungs of Emerson type (machine that allows a person to breathe when he lost control of his respiratory muscles, such as the diaphragm, invented in 1928 by the American engineer Philip Drinker).

La poliomielitis emergió en Europa como enfermedad epidémica a finales del siglo XIX. Durante los años treinta del siglo XX alcanzó gran intensidad en los Estados Unidos y Canadá, pero fue tras la Segunda Guerra Mundial cuando la enfermedad se convirtió en un grave problema de salud pública mundial que castigó terriblemente a varios países del mundo, incluyendo a México. La poliomielitis es una enfermedad viral muy contagiosa que invade el sistema nervioso central (destruye las neuronas motoras) que atemorizó a la población mexicana en la primera mitad del siglo XX, no tanto por las altas cifras de mortalidad y morbilidad sino por sus secuelas paralíticas, como la invalidez, y por el hecho de que afectó a uno de los grupos poblacionales más vulnerables: los niños. La enfermedad afectaba principalmente a los niños menores de cinco años, siendo poco frecuente en los primeros meses de vida del recién nacido debido al efecto protector de la inmunidad que le transfiere la madre al hijo a través de la leche materna; después de ocho meses, al término de la alimentación, el infante podía ser infectado por el poliovirus invadiendo la medula espinal y produciendo la parálisis, más comúnmente de las piernas o tronco. Asimismo, ocasionaba una parálisis en los músculos respiratorios (diafragma) de los niños, a quienes había que auxiliarlos a respirar ya que, si no, se asfixiaban, por lo que se les introducía en unas máquinas conocidas comúnmente como pulmones de acero o pulmotores de tipo Emerson (máquina que permite a una persona respirar cuando esta perdió el control de sus músculos respiratorios, como el diafragma, inventada en 1928 por el ingeniero estadounidense Philip Drinker).

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La poliomielitis emergió en Europa como enfermedad epidémica a finales del siglo XIX. Durante los años treinta del siglo XX alcanzó gran intensidad en los Estados Unidos y Canadá, pero fue tras la Segunda Guerra Mundial cuando la enfermedad se convirtió en un grave problema de salud pública mundial que castigó terriblemente a varios países del mundo, incluyendo a México. La poliomielitis es una enfermedad viral muy contagiosa que invade el sistema nervioso central (destruye las neuronas motoras) que atemorizó a la población mexicana en la primera mitad del siglo XX, no tanto por las altas cifras de mortalidad y morbilidad sino por sus secuelas paralíticas, como la invalidez, y por el hecho de que afectó a uno de los grupos poblacionales más vulnerables: los niños. La enfermedad afectaba principalmente a los niños menores de cinco años, siendo poco frecuente en los primeros meses de vida del recién nacido debido al efecto protector de la inmunidad que le transfiere la madre al hijo a través de la leche materna; después de ocho meses, al término de la alimentación, el infante podía ser infectado por el poliovirus invadiendo la medula espinal y produciendo la parálisis, más comúnmente de las piernas o tronco. Asimismo, ocasionaba una parálisis en los músculos respiratorios (diafragma) de los niños, a quienes había que auxiliarlos a respirar ya que, si no, se asfixiaban, por lo que se les introducía en unas máquinas conocidas comúnmente como pulmones de acero o pulmotores de tipo Emerson (máquina que permite a una persona respirar cuando esta perdió el control de sus músculos respiratorios, como el diafragma, inventada en 1928 por el ingeniero estadounidense Philip Drinker).

Poliomyelitis emerged in Europe as an epidemic disease at the end of the 19th century. During the thirties of the twentieth century it reached great intensity in the United States and Canada, but it was after the Second World War when the disease became a serious world public health problem, which punished several countries of the world, including Mexico. Poliomyelitis is a very contagious viral disease that invades the central nervous system (destroys motor neurons) that frightened the Mexican population in the first half of the twentieth century, not so much by high mortality and morbidity figures but by its paralytic sequels, like the disability, and by the fact that it affected one of the most vulnerable population groups: children. The disease mainly affected children under five years of age, being rare in the first months of life of the newborn due to the protective effect of immunity that the mother transfers to the son through breast milk; After eight months, at the end of the feed, the infant could be infected by poliovirus by invading the spinal cord and producing paralysis, most commonly of the legs or trunk. Likewise, it caused a paralysis in the respiratory muscles (diaphragm) of children, who had to help them to breathe since, if not, they were suffocated, so they were introduced in machines commonly known as steel lungs or lungs of Emerson type (machine that allows a person to breathe when he lost control of his respiratory muscles, such as the diaphragm, invented in 1928 by the American engineer Philip Drinker).

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Introduction: To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Methods: We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until ED-readmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression. Results: We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID-19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31-3.34, p0 .002), fever (aOR 1.56, 95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009). Conclusion: The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety.

Introducción: Describir las características de los pacientes COVID-19 con síntomas leves dados de alta desde la Central de Emergencias de Adultos (CEA) y seguidos en forma ambulatoria mediante telemedicina. Estimar las tasas de re-consulta a CEA y hospitalización, y explorar los factores asociados a estos desenlaces. Métodos: Cohorte retrospectiva de Junio a Agosto 2020 en el Hospital Italiano de Buenos Aires, que incluyó personas COVID-19 con síntomas leves. Se siguieron durante 14 días hasta la ocurrencia de re-consulta en CEA y/o hospitalización. Se utilizaron modelos de Kaplan-Meier y regresión logística. Resultados: De un total de 1.239 pacientes, con una mediana de 41 años y 53,82% varones, 167 pacientes re-consultaron a CEA, con una tasa de incidencia global a los 14 días del 13,08% (IC del 95% 11,32 a 15,08). De estos, 83 requirieron hospitalización (media de 4,98 días), el 6% no se relaciona con COVID-19 y 5 pacientes fallecieron. Después del ajuste por factores confundidores (edad ≥65, sexo, diabetes, hipertensión, ex tabaquismo, tabaquismo activo, fiebre, diarrea y saturación de oxígeno), encontramos asociaciones significativas: tabaquismo anterior (ORa 2,09, IC95% 1,31-3,34, p0=0,002), fiebre (ORa 1,56, IC95% 1,07-2,28, p=0,002) y saturación de oxígeno (ORa 0,82, IC95% 0,71-0,95, p=0,009). Conclusión: La tasa del 13% de re-consulta a CEA durante 14 días de seguimiento resultó muy significativa para la gestión hospitalaria, la calidad del desempeño y la seguridad del paciente.

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En los ámbitos científico e institucional existe controversia sobre el manejo idóneo de la bron- quiolitis en pacientes pediátricos. El objetivo de este trabajo es valorar el nivel de evidencia cientí- fica que existe sobre el manejo de la bronquiolitis para determinar si las recomendaciones actuales son o no adecuadas. Se realizó una revisión sis- temática de artículos científicos consultando di- versas bases de datos, sin restricción de fecha, en los idiomas español e inglés. Se incluyó literatura gris mediante búsqueda manual. No se hicieron restricciones respecto al tipo de estudio. Se re- visaron los resúmenes y en los casos necesarios los artículos completos, teniéndose en cuenta fi- nalmente todos los artículos que incluían apor- tes sobre el manejo adecuado de la bronquiolitis. Como resultado la mayoría de las recomenda- ciones realizadas por las sociedades fueron a tra- vés de guías de práctica clínica o artículos de opinión, concluyendo que no se cuenta con un esquema de tratamiento adecuado para tratar la bronquiolitis aguda, existiendo un manejo erróneo con el uso de esteroides y antibióticos, mientras que uno de los tratamiento más viables y costo efectivos queda en el olvido como es la solución hipertónica al 3%, la cual ha demostra- do reducción de la estancia hospitalaria...(AU)

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Resumen: Felipe Alfonso Aceves Zubieta (1899-1960) fue un médico mexicano del siglo XX, profesor de varias asignaturas quirúrgicas en la Escuela Nacional de Medicina, y fundador de las Asambleas Nacionales de Cirujanos (1934), de la Revista de Cirugía del Hospital Juárez y de la Academia Mexicana de Cirugía.

Abstract: Felipe Alfonso Aceves-Zubieta (1899-1960), was a Mexican physician, who teached several surgical subjects at National School of Medicine, in Mexico City, and was the founder of Asambleas Nacionales de Cirujanos (1934), Revista de Cirugía del Hospital Juárez and Academia Mexicana de Cirugía.

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OBJECTIVES: Inappropriate prescription of antibiotics contributes to antibiotic resistance. Therefore, the objective of this study was to determine the awareness, attitudes, and intention to practice of dentists prescribing antibiotics in Colombia in order to design a virtual learning environment on this subject. METHODS: In a descriptive study across seven cities, 700 dentists from different Colombian cities were requested to complete a validated questionnaire containing five sections: general information, awareness on antibiotic effectiveness and antibiotic resistance, attitudes regarding prescription decision, intention to practice concerning clinical cases, and complementary information. The level of awareness, attitudes, and intention to practice was determined and Chi-square test was used to determine the existence of significant differences among cities. RESULTS: The majority of dentists showed a medium level regarding the number of correct answers on awareness (62.4 percent) and attitudes (88.7 percent) and a high level on intention to practice (91.7 percent). Common errors within the awareness section included the meaning of the term "antibiotic resistance" (35 percent) and most dentists were not convinced that such resistance could be derived from prescription of antibiotics (51.2 percent). In the attitudes section, only 45 percent declared that they prescribe antibiotics based mainly on symptoms, and the intention to practice section showed a significant percentage of unnecessary prescription (51 percent for pacemaker users) or absence of prescription (53.9 percent for ventricular septal defect) in antibiotic prophylaxis for infectious endocarditis (IE). CONCLUSION: The dentists interviewed should be trained and made aware of antibiotic resistance, microbiological and clinical foundations, and current antibiotic prophylaxis guidelines.

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Resumen Introducción: el síndrome de Cushing (SC) es un grupo de signos y síntomas causados por la exposición crónica al exceso de glucocorticoides. El uso de fármacos con glucocorticoides es la causa más frecuente, pero algunos productos vendidos como suplementos nutricionales o medicamentos naturistas para el control de los dolores articulares pueden contenerlos de forma oculta, lo cual dificulta el enfoque diagnóstico Presentación del caso: paciente de 40 años con signos clínico típicos de síndrome de Cushing con resultados discordantes en las pruebas diagnósticas para identificar su origen. Finalmente se logra establecer que el paciente consumía de forma crónica un producto "naturista" conocido como artrin®, el cual fue analizado en el laboratorio de la institución con resultados positivos para cortisol. Conclusión: la exposición crónica a glucocorticoides exógenos, ya sea subrepticia, desconocida o prescrita, causa SC y debe distinguirse tempranamente de las formas endógenas para evitar la realización de pruebas diagnósticas y tratamientos inadecuados.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1500).

Abstract Introduction: Cushing's syndrome (CS) is a group of signs and symptoms caused by chronic exposure to excessive glucocorticoids. The use of medications containing glucocorticoids is the most common cause, but they may be hidden in some products sold as nutritional supplements or naturopathic medications, which makes the diagnostic approach more difficult. Case presentation: this was a 40-year-old patient with typical clinical signs of Cushing's syndrome and discordant results of diagnostic tests to identify its origin. It was ultimately determined that the patient had been chronically taking a "naturopathic" product known as artrin®, which was analyzed in the institution's lab and found to contain cortisol. Conclusion: chronic exposure to exogenous glucocorticoids, whether surreptitious, unknown or prescribed, causes CS and should be promptly distinguished from endogenous forms to avoid inappropriate diagnostic tests and treatments.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1500).

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Introducción: Para mejorar la estabilidad hemodinámica, trastornos de la coagulación, perfusión hística, capacidad de transporte de oxígeno, entre otros, en el paciente crítico se hace necesario la transfusión de sangre y derivados. Objetivo: Caracterizar la población de pacientes graves que recibieron tratamiento con sangre y hemoderivados. Métodos: Se realizó un estudio descriptivo y transversal en 199 pacientes ingresados en la unidad de cuidados intensivos del Hospital General Orlando Pantoja Tamayo del municipio Contramaestre, provincia Santiago de Cuba, desde enero de 2016 hasta abril de 2019. Las variables analizadas fueron: edad, sexo, causas de hemoterapia, tipo de componente sanguíneo empleado, frecuencia de administración, reacciones adversas y estado al egreso. Se utilizó el porcentaje para resumir la información, así como el test chi cuadrado para identificar asociación estadística. Resultados: Predominaron el sexo femenino (56,7 por ciento) y la edad comprendida entre 65 años y más, con el diagnóstico de politraumatizados, sangrado digestivo alto y sepsis. El concentrado de hematíes fue el más empleado y la frecuencia de administración, en una ocasión, fue en la categoría que más reacciones adversas se encontró (56,6 por ciento); el empleo en cuatro o más ocasiones incrementó la mortalidad. Conclusiones: El concentrado de hematíes fue el hemoderivado más administrado, la administración en una ocasión fue la que más reacciones adversas provocó y la mayoría fueron del tipo inmediatas inmunológicas(AU)

Introduction: To improve hemodynamic stability, coagulation disorders, tissue perfusion, oxygen transport capacity, among others, the transfusion of blood and plasma derivatives is necessary in the critically-ill patient. Objective: To characterize the population of seriously-ill patients who received treatment with blood and hemoderivatives. Methods: A descriptive and cross-sectional study was carried out with 199 patients admitted to the intensive care unit of Orlando Pantoja Tamayo General Hospital in Contramaestre Municipality, Santiago de Cuba Province, from January 2016 to April 2019. The variables analyzed were age, sex, causes for hemotherapy, type of blood component used, frequency of administration, adverse reactions, and discharge status. Percentage was used to summarize the information. Also, the chi-square test was used to identify statistical association. Results: There was a predominance of the female sex (56.7%) and of the age 65 years and older, with diagnosis of polytrauma, high digestive bleeding, and sepsis. The red blood cell concentrate was the most used and the frequency of administration, on one occasion, occurred in the category with the highest amount of adverse reactions (56.6%). Administration on four or more occasions increased mortality. Conclusions: The red blood cell concentrate was the most administered hemoderivative. Administration on one occasion that caused the most adverse reactions and most were immediate immunological ones(AU)

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Introducción: La incidencia, morbilidad y mortalidad de la sepsis la convierten en un importante problema sanitario que requiere la adopción de medidas específicas, a fin de tomar conciencia del problema. Objetivo: Caracterizar a los pacientes con sepsis según variables clínicas, epidemiológicas y microbiológicas seleccionadas. Métodos: Se realizó un estudio descriptivo y transversal de 119 pacientes con sepsis, egresados de la Unidad de Cuidados Intensivos del Hospital General Orlando Pantoja Tamayo, del municipio de Contramaestre, desde enero de 2014 hasta julio de 2017. Se aplicó la prueba de Ji al cuadrado de independencia, para identificar asociación estadísticamente significativa entre las variables, con un nivel de significación de α= 0,05. Resultados: Prevalecieron las féminas (54,6 %), el grupo etario de 66-80 años de edad para ambos sexos (33,6 %) y la neumonía asociada a la ventilación como la forma de presentación más frecuente de la sepsis (51,6 %), principalmente la producida por Enterobacter sp. (34,4 %). Conclusiones: La sepsis se presenta fundamentalmente por infecciones respiratorias producidas por gérmenes gramnegativos en pacientes que requirieren procederes invasivos como parte del tratamiento.

Introduction: The incidence, morbidity and mortality of sepsis transforms it into an important health care problem that requires the adoption of specific measures, in order to take conscience of the problem. Objectives: To characterize the patients with sepsis according to selected clinical, epidemiological and microbiological variables. Methods: A descriptive and cross-sectional study of 119 patients with sepsis, discharged from the Intensive Cares Unit of Orlando Pantoja Tamayo General Hospital, in Contramaestre was carried out, from January, 2014 to July, 2017. The chi-square test was applied, to identify association statistically significant between the variables, with a significance level of α = 0.05. Results: There was a prevalence of females (54.6 %), 66-80 years age group for both sexes (33.6 %) and pneumonia associated to ventilation as the most frequent form of presentation of sepsis (51.6 %), mainly the one produced by Enterobacter sp. (34.4 %). Conclusions: Sepsis is presented fundamentally by breathing infections produced by gramnegative germs in patients who required invasive procedures as part of the treatment.

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BACKGROUND: Nordic walking is an attractive method of endurance training. Nevertheless, the biomechanic response due to the additional contribution of using poles in relation to free walking training has been less explored in the elderly. PURPOSE: This randomized parallel controlled trial aimed to assess the effects of 8 weeks of Nordic walking and free walking training on the walking economy, mechanical work, metabolically optimal speed, and electromyographic activation in elderly. METHODS: Thirty-three sedentary elderly were randomized into Nordic walking (n = 16) and free walking group (n = 17) with equalized loads. Submaximal walking tests were performed from 1 to 5 km h-1 on the treadmill. RESULTS: Walking economy was improved in both free and Nordic walking groups (x2 4.91, p = 0.014) and the metabolically optimal speed was increased by approximately 0.5 km h-1 changing the speed-cost profile. The electromyographic activation in lower and upper limbs, pendular recovery, and total, external, and internal mechanical work remained unchanged (p > 0.05). Interestingly, the internal mechanical work associated with arm movement was higher in the Nordic walking group than in the free walking group after training, while the co-contraction from upper limb muscles was reduced similarly to both groups. CONCLUSIONS: Eight weeks of Nordic walking training effectively improved the walking economy and functionality as well as maintained the gait mechanics, similar to free walking training in elderly people. This enhancement in the metabolic economy may have been mediated by a reduction in the co-contraction from upper limb muscles. TRIAL REGISTRATION: ClinicalTrails.gov NCT03096964.