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BACKGROUND: The COVID-19 pandemic has prompted a transformation of medical training. Although there were obvious medical education and social interaction challenges, e-learning presented some advantages, which may have generated medical curricula innovation and adjustments to novel technological methodologies. This study aims to generate consensuses among medical students regarding medical education provided during the pandemic in the resource-limited context of a Global South university. METHODS: The implementation of a participatory Delphi method included a recruitment campaign, training, constitution of Delphi panels and questions, and development of the Delphi exercises. Students from the second to the sixth year of medicine of a university in Quito, Ecuador, constituted two Delphi panels, developed questions about the education received during the pandemic, and answered them over 3.5 rounds. FINDINGS: Twenty-two medical students participated in the Delphi exercises about their perception of medical education during the COVID-19 pandemic. The analysis consisted of a total of 22 Delphi questions divided into five distinct categories: adaptations and innovations, curriculum and assessment changes, virtual clinical practice, time management, and mental health. The authors established high, medium, and low consensuses for analysis. CONCLUSIONS: Consensuses were reached based on students' academic year and focused on the changes in lecture delivery, the usage of new technologies, patient care skills, the impact of the educational routine, and the mental health of the COVID-19 pandemic. The way the pandemic affected medical education in the Global South set the stage for the need for a comprehensive review of tools, skills, and curricula for students from culturally diverse backgrounds. This study offers a highly replicable methodology to generate consensuses and introduce students to academic research.
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COVID-19 , Currículo , Técnica Delphi , Educação Médica , Estudantes de Medicina , COVID-19/epidemiologia , Humanos , Estudantes de Medicina/psicologia , Educação Médica/métodos , SARS-CoV-2/isolamento & purificação , Pandemias , Feminino , Masculino , Equador/epidemiologia , Educação a Distância/métodos , AdultoRESUMO
Introducción: la flujometría de la arteria pulmonar en fetos sanos puede ser un estudio predictor de la madurez pulmonar, lo que conlleva a un impacto en la disminución de la mortalidad perinatal.Objetivo: establecer el índice de tiempo de aceleración/tiempo de eyección de la arteria pulmonar (TA/TE) como un indicador de madurez pulmonar fetal en gestantes entre 26 y 40 semanas de gestación (SG), usuarias del Hospital Especializado Fundación Humanitaria Pablo Jaramillo Crespo, periodo 2017.Métodos: estudio de validación de prueba diagnóstica. Se evaluó la flujometría de la arteria pulmonar por ecografía doppler en 300 fetos sanos de gestantes entre 15 y 45 años de edad. Para la recolección de datos se utilizó encuestas y para la determinación de la validez se usó los estadísticos sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Resultados: el valor del índice TA/TE de la arteria pulmonar fue 0.216 para las gestantes entre 26-28 SG; de 0.253 entre 29-31 SG; de 0.279 entre 32-34 SG; de 0.315 para las gestantes entre 35-37 SG y de 0.349 entre 38-40 SG. Las 37 SG en punto de corte fue de 0.320; el área ROC fue 0.98 con una S: 95.2%, E: 97.2%. VPP 93.0% y VPN 98.1%.Conclusiones: el índice TA/TE de la arteria pulmonar demostró correlación con la edad gestacional. Un índice TA/TE de 0.320, como punto de corte, predice madurez pulmonar fetal (AU);
Introduction: pulmonary artery flow metric in healthy fetuses can be a predictive study of lung maturity, which leads to an impact on the decrease in perinatal mortality.Objective: to establish the ratio of pulmonary artery acceleration time to ejection time (AT/ET) as an indicator of fetal lung maturity in pregnant women from 26 to 40 weeks of gestation (WG), users of the "Hospital Especializado Fundación Humanitaria Pablo Jaramillo Crespo", period 2017.Methods: A validity study of diagnostic tests was carried out. Pulmonary artery flow metric was evaluated by Doppler ultrasound in 300 healthy fetuses of pregnant women between 15 to 45 years old. Surveys were used to collect data. Sensitivity (S), specificity (E), positive predictive value (PPV) and negative predictive value (NPV) were used to determine validity.Results: the value of the TA / TE index of the pulmonary artery was 0.216 for pregnant women between 26-28 WG; of 0.253 between 29-31 WG; 0.279 between 32-34 WG; 0.315 for pregnant women between 35-37 WG and 0.349 between 38-40 WG. The 37 WG at the cut-off point was 0.320; the ROC area was 0.98 with a S: 95.2%, E: 97.2%. The PPV 93.0% and NPV 98.1%.Conclusions: the AT/ET ratio of pulmonary artery showed correlation with gestational age. An AT/ET ratio of 0.320, as a cut-off point, predicts fetal lung maturity (AU);
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Humanos , Feminino , Gravidez , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Artéria Pulmonar/diagnóstico por imagem , Idade Gestacional , Ultrassonografia Doppler , Maturidade dos Órgãos Fetais , Pulmão/embriologia , Sensibilidade e Especificidade , Fluxometria por Laser-DopplerRESUMO
The aim of this research was to determine the prevalence of cervical intraepithelial lesions in indigenous women of Ecuador 2017. A descriptive study was performed. Population was formed by 2489 indigenous women aged 15 to 64 years old, of which 396 users were chosen by spontaneous demand. Frequency values and percentages were taken from qualitative variables, while mean and standard deviation were taken from quantitative variables. Prevalence of intraepithelial lesions was 13,8%. Average age was 31 years old. Uncertain importance's squamous atypical cells were higher in 30-to-39-year-old group (46,7%). Non-specific atypical glandular cells were observed in 66,7% of 30-to-39-year-old group. Low-grade intraepithelial lesions were majorly found in 20-to-29-year-old group (43,8%). High-grade intraepithelial lesions were also seen in 20-to-29-year-old group. Conclusions were: prevalence of intraepithelial lesions in indigenous women of Ecuador was higher than 10% of reported in other studies, and more frequent in those aged 20 and 39 years old
El objetivo de esta investigación fue determinar la prevalencia de lesiones intraepiteliales cervicales en mujeres indígenas del Ecuador 2017. Se realizó un estudio descriptivo. La población estuvo compuesta por 2489 mujeres indígenas de 15 a 64 años, de las cuales 396 usuarias fueron elegidas por demanda espontánea. De las variables cualitativas se obtuvieron los valores de frecuencia y porcentajes, y de las cuantitativas la media y la desviación estándar. La prevalencia de las lesiones intraepiteliales fue del 13,8%. La edad promedio fue 31 años. Las células escamosas atípicas de importancia incierta fueron mayores en el grupo de edad de 30 a 39 años (46,7%). Se observaron células atípicas glandulares no específicas en el 66,7% en el grupo de 30 y 39 años de edad. Las lesiones intraepiteliales de bajo grado se presentaron más en el grupo de 20 y 29 años (43,8%). Las lesiones intraepiteliales de alto grado se identificaron también en el grupo de 20 a 29 años de edad. Las conclusiones fueron: la prevalencia de lesiones intraepiteliales en las mujeres indígenas del Ecuador fue superior al 10% de las reportadas en otros estudios, y más frecuente en aquellas de 20 y 39 años de edad
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INTRODUCTION: Only a few scales have been validated in Spanish for the assessment of suicide risk, and none of them have achieved predictive validity. OBJECTIVE: To determine the validity and reliability of the Beck Hopelessness Scale in patients with suicide risk attending the specialist clinic. METHODS: The Beck Hopelessness Scale, reasons for living inventory, and the suicide behaviour questionnaire were applied in patients with suicide risk attending the psychiatric clinic and the emergency department. A new assessment was made 30 days later to determine the predictive validity of suicide or suicide attempt. RESULTS: The evaluation included a total of 244 patients, with a mean age of 30.7±13.2 years, and the majority were women. The internal consistency was .9 (Kuder-Richardson formula 20). Four dimensions were found which accounted for 50% of the variance. It was positively correlated with the suicidal behaviour questionnaire (Spearman .48, P<.001), number of suicide attempts (Spearman .25, P<.001), severity of suicide risk (Spearman .23, P<.001). The correlation with the reasons for living inventory was negative (Spearman -.52, P<.001). With a cut-off ≥12, the negative predictive value was 98.4% (95% CI: 94.2-99.8), and the positive predictive value was 14.8% (95% CI: 6.6-27.1). CONCLUSION: The Beck Hopelessness Scale in Colombian patients with suicidality shows results similar to the original version, with adequate reliability and moderate concurrent and predictive validity.
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Esperança , Escalas de Graduação Psiquiátrica , Suicídio , Adolescente , Adulto , Idoso , Criança , Colômbia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Medição de Risco , Traduções , Adulto JovemRESUMO
Dengue is the most prevalent human arbovirus disease worldwide. Dengue virus (DENV) infection causes syndromes varying from self-limiting febrile illness to severe dengue. Although dengue pathophysiology is not completely understood, it is widely accepted that increased inflammation plays important roles in dengue pathogenesis. Platelets are blood cells classically known as effectors of hemostasis which have been increasingly recognized to have major immune and inflammatory activities. Nevertheless, the phenotype and effector functions of platelets in dengue pathogenesis are not completely understood. Here we used quantitative proteomics to investigate the protein content of platelets in clinical samples from patients with dengue compared to platelets from healthy donors. Our assays revealed a set of 252 differentially abundant proteins. In silico analyses associated these proteins with key molecular events including platelet activation and inflammatory responses, and with events not previously attributed to platelets during dengue infection including antigen processing and presentation, proteasome activity, and expression of histones. From these results, we conducted functional assays using samples from a larger cohort of patients and demonstrated evidence for platelet activation indicated by P-selectin (CD62P) translocation and secretion of granule-stored chemokines by platelets. In addition, we found evidence that DENV infection triggers HLA class I synthesis and surface expression by a mechanism depending on functional proteasome activity. Furthermore, we demonstrate that cell-free histone H2A released during dengue infection binds to platelets, increasing platelet activation. These findings are consistent with functional importance of HLA class I, proteasome subunits, and histones that we found exclusively in proteome analysis of platelets in samples from dengue patients. Our study provides the first in-depth characterization of the platelet proteome in dengue, and sheds light on new mechanisms of platelet activation and platelet-mediated immune and inflammatory responses.
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Plaquetas/imunologia , Vírus da Dengue/fisiologia , Dengue/imunologia , Proteoma/imunologia , Adulto , Plaquetas/química , Estudos de Coortes , Dengue/sangue , Dengue/genética , Dengue/virologia , Vírus da Dengue/imunologia , Feminino , Humanos , Masculino , Ativação Plaquetária , Proteoma/genéticaRESUMO
Determinar los factores epidemiológicos y la profilaxis antirretroviral utilizada en embarazadas seropositivas al virus de inmunodeficiencia humana. El siguiente es un estudio descriptivo, se revisaron 80 historias clínicas (82 embarazos con 83 recién nacidos), que fueron evaluadas en el HUC entre el año 1999 y 2004, se analizaron variables epidemiológicas que se recogieron en un protocolo de recolección de datos que incluían: edad, diagnóstico de virus de inmunodeficiencia humana, modo de adquisición del virus de inmunodeficiencia humana, inicio y tipo de profalaxis antirretroviral utilizada en la madre y el recién nacido, modo de culminación del embarazo, carga viral, linfocitos TCD4+, infecciones oportunistas y/o neoplasias, transmisión vertical del virus de inmunodeficiencia humana y malformaciones congénitas, entre otros. Las variables se recogieron en un protocolo de recolección de datos. Para el análisis y descripción de los datos se utilizó el programa Epi Info 5. La mayoría de las pacientes se encontraban en las edades de 20-29 años edad: 52 (63 por ciento). El diagnóstico de virus de inmunodeficiencia humana se realizó durante el embarazo en el 62 por ciento de los casos, 69,5 por ciento de las pacientes eran amas de casa, el promedio del contaje de linfocitos TCD4+ al finalizar la profilaxis antirretroviral fue de 527,6 células/mm3 y el de la carga viral fue de 150.24 copias por mm3. En el 91,5 por ciento (75/82) de los casos se indicó profilaxis antirretroviral en la etapa prenatal, en la culminación del embarazo y en el recién nacido, 12,5 por ciento casos no lo recibieron. El esquema de ZDV, LMV NFV, 57 (76 por ciento) fue el más utilizado.
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Humanos , Adolescente , Adulto , Feminino , Gravidez , Recém-Nascido , Antibioticoprofilaxia , Infecções por HIV/diagnóstico , Infecções por HIV/patologia , Infecções por HIV/prevenção & controle , Soropositividade para HIV/imunologia , Cuidado Pré-Natal/métodos , Infectologia , Transaminases/análiseRESUMO
Lograr la inducción del trabajo de parto en embarazo a término, mediante el uso de análogo sintético de prostanglandina E1 intravaginal y E2 intracervical, comparando la eficacia, seguridad y costos de ambos. Estudio prospectivo, descriptivo, comparativo en 60 pacientes distribuidas al azar en dos grupos, uno de 29 y otro de 31 pacientes para recibir 50 µg de misoprostol intravaginal cada tres horas por seis dosis y 0,5 mg de dinoprostona intracervical cada 6 horas por tres dosis, respectivamente, desde abril de 1996 hasta octubre del mismo año. Hospital Universitario de Caracas, Venezuela. El grupo que recibió misoprostol requirió menor número de dósis, utilizados con mayor frecuencia una sola dosis (73 por ciento vs 43 por ciento), no requirió uso adicional de oxitocina y los costos fueron menores en comparación con el grupo que recibió dinoprostona, estas diferencias fueron estadísticamente significativas (p<0,10). El microprostol intravaginal es más efectivo, económico e igualmente seguro que la dinoprostona intracervical