Medical curricula have historically been designed in a top-down approach, usually excluding students. While Delphi panels have been used as a tool for medical education curricula design, none have ...been conducted in Ecuador. In addition, no such approach has ever included students both as panelists and researchers.
Four Delphi panels were developed and conducted using a participatory approach that allowed medical students to take part both as expert panelists and researchers: specifically, students developed the questionnaire and conducted a qualitative synthesis. Questionnaire responses were anonymized and dispatched online to panelists. The information was organized and collected to develop the qualitative syntheses and prepare the final statements.
Thirty-two medical students participated between February and May 2018. A total of 32 questions were developed, corresponding to five different categories. For some questions, consensus was reached; for other questions, general statements were obtained.
Discussion and conclusion: Developing the questionnaire, responding to it and analyzing the answers allowed students to raise significant concerns regarding medical education topics proposing relevant policy and curricula change. Participatory Delphi panels can be an efficient tool to obtain organized feedback, improve student class involvement, and promote research skills.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The effect of oxidation time on the surface chemical and morphological properties of carbon nanofibers (CNFs) and their suitability for use as a reinforcement agent in the development of bone ...scaffolds was assessed. The CNFs were modified using a 3:1 v/v mixture of concentrated sulfuric (H
2
SO
4
) and nitric acid (HNO
3
) for different periods of time. Several analytical techniques were used to characterize the oxidized CNF surface properties. Photoacoustic Fourier transform infrared spectroscopy (PAS-FTIR) showed the creation of carboxylic groups due to the acid treatments. Scanning electron microscopy images revealed differences in the nanofibers before and after acid treatment. The relationship between the CNF crystals and their defects when varying the oxidation time were determined by Raman spectroscopy. The CNF FTIR results, contact angle measurements, and dispersion tests showed the formation of carboxylic groups due to the oxidative treatment. The results confirmed the presence of microstructures with defects, as well as chemically active functional surface groups, such as carboxyls and hydroxyls. Furthermore, a composite was prepared using polycaprolactone (PCL) as a matrix and the CNF as the reinforcement. The storage module of the oxidized CNFs was improved with respect to the nonoxidized CNFs. Furthermore, the scaffolds of PCL with oxidized CNFs enhanced the cell proliferation.
This paper investigates the seismic behavior of a steel beam-to-concrete-filled steel tubular column connection with external diaphragms. In addition to the multiple advantages observed for ...manufacturing and assembly, this type of connection is expected to provide an adequate plasticizing mechanism based on its ductility, energy dissipation and moment resistance capacity. However, guidelines have not been provided for this type of connection within the AISC 358 standard, which makes experimental studies under cyclic loads necessary. This work presents such a study, which was carried out in accordance with the FEMA 350 standard for earthquake-resistant structures. The results for the failure modes, hysteretic performance, strength and stiffness degradation, rigidity classification and energy dissipation are provided and analyzed. The results indicate that this connection exhibits large hysteretic loops and develops ductility and dissipation capacity, as expected. More importantly, the maximum rotation of the beam was 0.07 rad with a resistant moment above 80% of the beam capacity measured from the face of the column. Thus, the ductility design requirements for earthquake resistance are met according to the current regulations. Consequently, the proposed connection is suitable for use in special moment frame structures located in areas of high seismic threat.
Glioblastoma (GBM) is one of the most aggressive and vascularized brain tumors in adults, with a median survival of 20.9 months. In newly diagnosed and recurrent GBM, bevacizumab demonstrated an ...increase in progression-free survival, but not in overall survival.
We conducted an in silico analysis of VEGF expression, in a cohort of 1082 glioma patients. Then, to determine whether appropriate bevacizumab dose adjustment could increase the anti-angiogenic response, we used in vitro and in vivo GBM models. Additionally, we analyzed VEGFA expression in tissue, serum, and plasma in a cohort of GBM patients before and during bevacizumab treatment.
We identified that 20% of primary GBM did not express VEGFA suggesting that these patients would probably not respond to bevacizumab therapy as we proved in vitro and in vivo. We found that a specific dose of bevacizumab calculated based on VEGFA expression levels increases the response to treatment in cell culture and serum samples from mice bearing GBM tumors. Additionally, in a cohort of GBM patients, we observed a correlation of VEGFA levels in serum, but not in plasma, with bevacizumab treatment performance.
Our data suggest that bevacizumab dose adjustment could improve clinical outcomes in Glioblastoma treatment.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cardiorespiratory arrest's unpredictability poses a global health challenge, with gaps in physicians' life support knowledge potentially leading to poor patient outcomes, a factor yet unstudied among ...Ecuadorian physicians. This study aims to elucidate the state of physicians' theoretical knowledge in Ecuador based on Basic Life Support (BLS) and Advanced Life Support (ALS) guidelines.
A national cross-sectional online 35-questions survey was conducted between February and March 2023 using a self-administered, expert-validated questionnaire. Participants' responses were obtained through official social media groups (WhatsApp and Facebook). The survey evaluated the theoretical knowledge of BLS and ALS, with scores based on the number of correct answers out of a maximum of 10.0 points. For descriptive analysis, frequencies, percentages, means, and standard deviations (SD) were used. The
-test and one-way ANOVA were utilized to analyze the associations between knowledge levels and demographic and academic training variables of Ecuadorian doctors. Values of p < 0.05 were considered statistically significant for all analyses.
The survey garnered responses from 385 physicians, with a majority being female (56.6%) and possessing less than 3 years of work experience (75.1%). Of these, 71.7% and 51.9% held BLS and ALS certifications, respectively. Knowledge scores for BLS (5.8/10 ± 1.6) surpassed those for ALS (4.7/10 ± 1.8) (p < 0.001). Physicians with less than 3 years of work experience exhibited higher knowledge scores in both BLS and ALS tests (p < 0.05).
This study revealed a notable deficiency in the theoretical knowledge of BLS and ALS among surveyed Ecuadorian physicians. Factors such as prior certification and years of work experience appeared to influence knowledge levels. Continual training and updates in life support protocols at universities and healthcare institutions are key to enhancing physicians' skills and patient outcomes.
Abstract
Background
The prevalence of overweight in childhood is 26% and obesity is 12.6% in Spain. Diastolic function assessed with echocardiography shows significant worsening in obese adults ...compared to non-obese adults. However, few studies describe the association between obesity and diastolic function in the pediatric population.
Aim
To investigate the relationship between obesity and diastolic function in a Mediterranean pediatric population.
Methods
A random sample of children and adolescents of primary and secondary education was selected, stratifying by age, gender and educational centers in a rural town of 2864 inhabitants of southern Spain. Children between 6 and 17 years old were included. A transthoracic echocardiogram was performed to evaluate diastolic function.
Results
A total of 212 children were studied (10.9 ± 3.0 years old and 51.9% males): 163 (76.9%) were not obese and 49 (23.1%) were obese. Age and sex were similar in both groups. Results are shown in the table. Obesity was related to a larger left atrial volume, a higher A-wave velocity, a lower lateral e "wave velocity, a higher average E/e ratio, and a higher pressure gradient between the atrium and the right ventricle.
Conclusions
Obesity in childhood is associated to worsening of diastolic function parameters commonly measured in echocardiography.
Obese Vs non-Obese non-obese obese p Age 10,8 ± 3,0 11,0 ± 2,8 0,63 Male (%) 50,1% 57,1% 0,4 A-wave velocity (cm/s) 58,7 ± 13,1 64,8 ± 13,8 0,005 E/A 1,89 ± 0,45 1,75 ± 0,41 0,05 lateral e" velocity (cm/s) 21,26 ± 4,61 19,58 ± 3,97 0,02 average E/e" 6,4 ± 1,1 7,0 ± 1,2 0,001 left atrial volume (mL) 20,8 ± 6,8 27,9 ± 7,4 <0,0005 pressure gradient (mmHg) 15,5 ± 4,5 18,0 ± 4,9 0,02
Abstract
Introduction
Childhood obesity is currently a mayor public health problem. There is a direct relationship between a high body mass index with a higher cardiovascular morbimortality. Among ...child population 4 out of 10 individuals are overweight, the prevalence of overweight is 26 per cent and the prevalence of obesity is 12,6 per cent. The epicardial fat is a heart visceral adiposity index, may play a role in the coronary atherosclerosis pathogenesis, a chronic inflammatory disease and in heart disease. The rise in the epicardial fat is considered as a target organ injure in child population.
Aims
To know the relationship between childhood obesity and echocardiographic parameters of epicardial fat, as a target organ injure among the child Mediterranean population.
Methods
Randomly, we selected a sample of children and adolescents of primary and secondary education, in a rural town of 2864 inhabitants of southern Spain. We include children between 6-17 years. We performed transthoracic echocardiography, with measurements of 2D epicardial fat, in systole in parasternal long axis (PLA) and parasternal short axis (PSA), taking the measure as the average of 3 measurements in consecutive beats.
Results
We studied a total of 212 children (10.9 ± 3.0 years and 51.9% males), 45 (21.3% were obese), of which 7.2% were diagnosed with hypertension (HBP), 5.1% with metabolic syndrome and 5.3% as prediabetic. The thickness of the epicardial fat in PLA was related to Obesity 2.2 ± 0.7 mm vs 1.75 ± 0.5 mm p (<0.001); HBP 2.16 ± 0.9 mm vs. 1.86 ± 0.5 mm (P <0.05); Metabolic syndrome 2.23 ± 0.8 mm vs 1.81 ± 0.5 mm (P <0.05), in PSA: Obesity 2.36 ± 0.7 mm vs 1.78 ± 0.6 mm p (<0.001); HBP 2.31 ± 0.6 mm vs 1.88 ± 0.6 mm (P <0.05); Metabolic syndrome 2.43 ± 0.8 mm vs 1.87 ± 0.6 mm (P <0.01) and overall combining PLA and PSA views: Obesity 2.27 ± 0.7 mm vs 1.76 ± 0.5 mm p (<0.001); HBP 2.23 ± 0.7 mm vs 1.85 ± 0.5 mm (P <0.05); Metabolic syndrome 2.23 ± 0.7 mm vs 1.84 ± 0.5 mm (P <0.01).
Conclusion
In a random Spanish pediatric population correlation is found by echocardiography of the thickness of epicardial fat with obesity, HBP and metabolic syndrome. Being this a rapid test, non-invasive and without ionizing radiation.
Abstract
Background
Aims: 1) to compare persistence on adalimumab treatment over time in inflammatory bowel disease (IBD) patients who maintained adalimumab reference non-switch cohort (NC) vs. those ...who switched from adalimumab reference to adalimumab biosimilar switch cohort (SC); 2) to compare loss of effectiveness of adalimumab treatment in the NC vs. SC; 3) to identify factors associated with discontinuation of adalimumab therapy; 4) to identify the factors associated with relapse in both cohorts; and 5) to evaluate the safety of both strategies.
Methods
Retrospective, observational, multicentre study. Patients under adalimumab reference who were in clinical remission at standard dose of adalimumab reference, and in whom adalimumab was the first anti-TNF administered, were included. Clinical remission was defined as a Harvey-Bradshaw index ≤4 points in Crohn’s disease, a partial Mayo score ≤2 in ulcerative colitis, and the absence of fistula drainage despite gentle finger compression in perianal disease. The follow-up time was at least 6 months since start of study observation period. The Kaplan-Meier method with log-rank test was used to evaluate the cumulative incidence of treatment discontinuation. Cox regression model was used to investigate factors potentially associated with therapy discontinuation.
Results
A total of 505 patients were included (45% women, 87% Crohn’s disease): 229 in the SC and 276 in the NC. The median follow-up was 12 months in the SC and 23 months in the NC (p<0.01). The incidence rate of adalimumab discontinuation was 10% 95% confidence interval (95%CI)=6–14%, and 7% (95%CI=5–10%) per patient-year in the SC and in the NC, respectively (p=0.035). The probability of maintaining adalimumab was 92% at 12 months and 77% at 24 months in the SC, and 97% at 12 months and 86% at 24 months in the NC. In the multivariable analysis, the switch to adalimumab biosimilar, adjusted for the level of C-reactive protein at baseline, was not associated with therapy discontinuation. 18% of the patients relapsed in the SC vs. 21% in the NC. The incidence of relapse was 17% (95%CI=13–23%) in the SC, and 12% (95%CI=10–16%) per patient-year in the NC (p=0.04). The cumulative incidence of relapse was 11% at 12 months and 38% at 24 months in the SC, and 11% at 12 months and 22% at 24 months in the NC. In the multivariable analysis, the switch to adalimumab biosimilar (adjusted by type of IBD) was associated with a higher risk of relapse (HR=1.5, 95%CI=1.008–2.36). 4% of the patients had adverse events in the SC vs. 8% in the NC (p>0.05).
Conclusion
The incidence rate of relapse was slightly higher in the SC; however, this fact had no impact on persistence on the drug. Switching from adalimumab reference to adalimumab biosimilar was safe.
La generación e implementación de estrategias para disminuir la transmisión de SARS-CoV-2 son un reto imperante para el país. Las estrategias deben ser dinámicas y específicas para cada región ...buscando equilibrar el impacto en la salud y en la economía. Esta tarea debe abordarse desde un enfoque interdisciplinario con el fin de estudiar la problemática de manera holística. En el presente artículo se presentan algunos hallazgos y revisiones realizadas en el marco del proyecto SISCOVID, en el cual se utilizan modelos sistémicos de simulación computacional para apoyar la toma de decisiones para el control y mitigación de la pandemia en Colombia. El proyecto está conformado por investigadores de la Universidad de Los Andes, el Centro Nacional de Consultoría (CNC) y la Universidad de Ibagué, en alianza con universidades internacionales y empresas. El proyecto ha logrado apoyar a los tomadores de decisiones en formular estrategias para disminuir la transmisión de SARS-CoV-2 en contextos urbanos en las ciudades de Barranquilla, Bogotá, Cali, Cartagena y Medellín. Palabras clave: SARS-CoV-2, Epidemiología, Prevención, Modelos sistémicos, Sistemas Complejos The development and implementation of strategies to reduce SARS-CoV2 transmission is a prevailing challenge for Colombia. These strategies ought to be dynamic and specific to each region, seeking to balance health and economic impacts. This task calls for an interdisciplinary approach to ensure a holistic view of the problem. This article presents findings and results obtained from the SISCOVID project, which used simulated systemic models to support decision making and efforts to mitigate the pandemic in Colombia. The project included researchers from Universidad de Los Andes, the Centro Nacional de Consultoría (CNC) and Universidad de Ibagué, in alliance with several international universities and companies. SISCOVID helped decision makers design strategies to reduce SARS-CoV-2 transmission in urban contexts for the cities of Barranquilla, Bogotá, Cali, Cartagena, and Medellín. Key words: SARS-CoV-2, Epidemiology, Prevention, Systemic Models, Complex Systems
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