Aortic stenosis. Gender influence on left ventricular geometry and function in patients under 70 years of age

OBJECTIVE: To verify if adaptive left ventricle (LV) characteristics are also present in individuals under 70 years of age with severe aortic stenosis (AS). METHODS: The study comprised 40 consecutive patients under 70 years of age with AS and no associated coronary artery disease, referred for valve surgery. Out of the 40 patients, 22 were men and 18 women, and the mean age was 49.8±14.3 years. Cardiac symptoms, presence of systemic hypertension (SH), functional class according to the New York Heart Association (NYHA), and valve lesion etiology were considered. LV cavity dimensions, ejection fraction (EF), fractional shortening (FS), mass (MS), and relative diastolic thickness (RDT) were examined by Doppler echocardiography. RESULTS: Fourteen (63.6%) men and 11 (61.6%) women were classified as NYHA class III/IV (p=0.70). There was no difference in the frequency of angina, syncope or dyspnea between genders. The incidence of SH was greater in women than in men (10 versus 2, p=0.0044). Women had a smaller LV end-diastolic diameter index (32.1±6.5 x 36.5±5.3mm/m², p=0.027), LV end-systolic diameter index (19.9±5.9 x 26.5±6.4mm/m², p=0.0022) and LV mass index (MS) (211.4±71.1 x 270.9±74.9g/m², p=0.017) when compared with men. EF (66.2±13.4 x 52.0±14.6%, p=0.0032), FS (37.6±10.7 x 27.9±9.6%, p=0.0046) and RDT (0.58±0.22 x 0.44±0.09, p=0.0095) were significantly greater in women than in men. CONCLUSION: It is the patient gender rather than age that influences left ventricular adaptive response to AS.

Common variants in the ATP2B1 gene are associated with susceptibility to hypertension: the Japanese Millennium Genome Project.

Hypertension is one of the most common complex genetic disorders. We have described previously 38 single nucleotide polymorphisms (SNPs) with suggestive association with hypertension in Japanese individuals. In this study we extend our previous findings by analyzing a large sample of Japanese individuals (n=14 105) for the most associated SNPs. We also conducted replication analyses in Japanese of susceptibility loci for hypertension identified recently from genome-wide association studies of European ancestries. Association analysis revealed significant association of the ATP2B1 rs2070759 polymorphism with hypertension (P=5.3×10(-5); allelic odds ratio: 1.17 [95% CI: 1.09 to 1.26]). Additional SNPs in ATP2B1 were subsequently genotyped, and the most significant association was with rs11105378 (odds ratio: 1.31 [95% CI: 1.21 to 1.42]; P=4.1×10(-11)). Association of rs11105378 with hypertension was cross-validated by replication analysis with the Global Blood Pressure Genetics consortium data set (odds ratio: 1.13 [95% CI: 1.05 to 1.21]; P=5.9×10(-4)). Mean adjusted systolic blood pressure was highly significantly associated with the same SNP in a meta-analysis with individuals of European descent (P=1.4×10(-18)). ATP2B1 mRNA expression levels in umbilical artery smooth muscle cells were found to be significantly different among rs11105378 genotypes. Seven SNPs discovered in published genome-wide association studies were also genotyped in the Japanese population. In the combined analysis with replicated 3 genes, FGF5 rs1458038, CYP17A1, rs1004467, and CSK rs1378942, odds ratio of the highest risk group was 2.27 (95% CI: 1.65 to 3.12; P=4.6×10(-7)) compared with the lower risk group. In summary, this study confirmed common genetic variation in ATP2B1, as well as FGF5, CYP17A1, and CSK, to be associated with blood pressure levels and risk of hypertension.

Características de las facultades de medicina de Colombia después de la ley 30 de 1992, año 2006.

En 1992 se promulgóla Ley 30 que regula la educación superior en Colombia. Esta Ley propicióun incremento significativo de la oferta educativa en todas las áreas, incluyendo ciencias de la salud. Las facultades de medicina se incrementaron en casi un 150%, pasando de 21 a 52 en este momento; la calidad de esta oferta educativa es motivo de preocupación por parte de la comunidad médica.

Proyecto de aplicación práctica estructuración de la oficina de educación médicas del Hospital de Occidente de Kennedy

Quiero con esta propuesta colocar en su verdadera dimensión a la oficina de educación médica del HOK, que sirva de apoyo a todo lo que tiene que ver con los procesos de formación y educación médicas y a sus áreas afines

¿Impactó el programa de Tutores Pares a sus tutores?

Introducción: El programa de Tutores Pares-TP es una iniciativa creada en la EMCS de la Universidad del Rosario que brinda acompañamiento académico a través de estudiantes-tutores a pares menos avanzados. Éste entrega a sus Tutores sistemáticamente, herramientas para desempeñarse armónicamente en el ejercicio de guía y provee habilidades para el manejo del saber. Este estudio busca explorar posibles ´impactos´ generados tras la participación de estudiantes de medicina como TPs dentro de un programa estructurado. Materiales y métodos: Estudio cualitativo que involucró la construcción y aplicación de encuestas a grupos focales –TPs, Docentes y Familiares- creadas a partir de seis ejes/categorías que enmarcan al médico ideal. Las respuestas obtenidas de preguntas cerradas –en escala valorativa- y de naturaleza abierta fueron sometidas a análisis descriptivo –modas- y triangulación. Resultados: 41 tutores, agrupados en 4 grupos de análisis, evidenciaron un impacto general positivo con predominio en habilidades interpersonales (60%,65%,66%,45%, respectivamente), funciones/actividades basadas en la práctica y mejoramiento (57%,67%,60%,45%) y la forma como se emplean los conocimientos (47%,70%,67%,48%). Ocho docentes encuestados consideraron relevante el impacto del programa en habilidades interpersonales-(49%), conocimientos-(42%) y la interacción con colegas-(38%). En los padres de familia hay consenso en el cambio en habilidades interpersonales, funciones basadas en la práctica y mejoramiento y en actitudes-valores ético/morales. Dichos resultados están en paralelo con las observaciones plasmadas en las preguntas abiertas. Conclusiones: Se evidenció un impacto general positivo en la formación y desempeño profesional tras la participación como TPs dentro del programa; hallazgo que soporta aquellos publicados de experiencias académicas similares.

Percepción de residentes de medicina de urgencias en Colombia del ambiente educativo en los servicios de urgencias

Introducción: La atención de calidad en urgencias sólo es posible si los médicos han recibido una enseñanza de alta calidad. La escala PHEEM (Postgraduate Hospital Educational Environment Measure) es un instrumento válido y fiable, utilizado internacionalmente para medir el entorno educativo, en la formación médica de posgrado. Materiales y métodos: Estudio de corte trasversal que utilizó la escala PHEEM versión en español para conocer el entorno educativo de los programas de urgencias. El coeficiente alfa de Cronbach se calculó para determinar la consistencia interna. Se aplicó estadística descriptiva a nivel global, por categorías e ítems de la escala PHEEM y se compararon resultados por sexo, año de residencia y programa. Resultados: 94 (94%) residentes llenaron el cuestionario. La puntuación media de la escala PHEEM fue 93,91 ± 23,71 (58,1% de la puntuación máxima) que se considera un ambiente educativo más positivo que negativo, pero con margen de mejora. Hubo una diferencia estadísticamente significativa en la percepción del ambiente educativo entre los programas de residencia (p =0,01). El instrumento es altamente confiable (alfa de Cronbach = 0,952). La barrera más frecuente en la enseñanza fue el hacinamiento y la evaluación fue percibida con el propósito de cumplir normas. Discusión: Los resultados de este estudio aportaron evidencia sobre la validez interna de la escala PHEEM en el contexto colombiano. Este estudio demostró cómo la medición del ambiente educativo en una especialidad médico-quirúrgica, con el uso de una herramienta cuantitativa, puede proporcionar información en relación a las fortalezas y debilidades de los programas.

Occupational therapy and its relevance in social projects. relationships, learning and opportunities: collection of experiences of University of Alberta Mscot students in Bogotá, Colombia

Occupational therapists are equipped to promote wellbeing through occupation and to enable participation and meaningful engagement of people in their social and physical environments (WFOT, 2012). As such, the role of the occupational therapists is profoundly linked to the social, cultural and environmental characteristics of the contexts in which occupations take place. The central role that context plays in occupational performance creates an interesting dichotomy for the occupational therapist: on one hand, a profound understanding of cultural and social factors is required from the Occupational Therapy (OT) in order to develop a meaningful and successful collaboration with the person; on the other hand, the ability of the occupational therapists to recognize and explore the contextual factor of an occupation-person dyad transcends cultural and spatial barriers. As a result, occupational therapists are equipped to engage in international collaboration and practice, and as such face unique and enriching challenges. International fieldwork experiences have become a tool through which occupational therapists in training can develop the critical skills for understanding the impact of cultural and social factors on occupation. An OT student in an international fieldwork experience faces numerous challenges in leading a process that is both relevant and respectful to the characteristics of the local context: language, cultural perceptions of occupation and personhood, religious backgrounds, health care access, etc. These challenges stand out as ethical considerations that must be considered when navigating an international fieldwork experience (AOTA, 2009). For more than five years now, the Faculty of Rehabilitation Medicine (FRM) of the University of Alberta (UoFA) and the School of Medicine and Health Sciences at the Universidad del Rosario (UR), Bogota, Colombia, have sustained a productive and meaningful international collaboration. This collaboration includes a visit by Dr. Albert Cook, professor of the FRM and former dean, to the UR as the main guest speaker in the International Congress of Technologies for Disability Support (IBERDISCAP) in 2008. Furthermore, Dr. Cook was a speaker in the research seminar of the Assistive Technology Research Group of the Universidad del Rosario. Following Dr. Cook’s visit, Professors Liliana Álvarez and Adriana Ríos travelled to Edmonton and initiated collaboration with the FRM, resulting in the signing of an agreement between the FRM and the UR in 2009, agreement that has been maintained to this day. The main goal of this agreement is to increase academic and cultural cooperation between the UR and the UofA. Other activities have included the cooperation between Dr. Kim Adams (who has largely maintained interest and effort in supporting the capacity building of the UR rehabilitation programs in coordinating the provision of research placement opportunities for UR students at the UofA), an Assistive Technology course for clinicians and students led by Dr. Adams, and a research project that researched the use of basic cell phones to provide social interaction and health information access for people with disabilities in a low-income community in Colombia (led by Tim Barlott, OT, MSc, under the supervision of Dr. Adams). Since the beginning, the occupational therapy programs of the Universidad del Rosario and the University of Alberta have promoted this collaboration and have strived to engage in interactions that provide further development opportunities for students and staff. As part of this process, the international placement experience of UofA OT students was born under the leadership of: Claudia Rozo, OT program director at UR, placement and academic leadership of Elvis Castro and Angélica Monsalve, professors of the occupational therapy program at UR; and Dr. Lili Liu, OT department director at UofA, Cori Schmitz, Academic coordinator of clinical education at the UofA; and Tim Barlott and Liliana Álvarez leading the international and cross-cultural aspect of this collaboration.This publication summarizes and illustrates the process of international placement in community settings in Colombia, undertaken by occupational therapy students of the University of Alberta. It is our hope that this document can provide and document the ethical considerations of international fieldwork experience, the special characteristics of communities and the ways in which cultural and social competences are developed and help international students navigate the international setting. We also hope that this document will stimulate discussion among professional and academic communities about the importance and richness of international placement experiences and encourage staff and students to articulate their daily efforts with the global occupational therapy agenda.

Curva de aprendizaje para ventana ecográfica de la vena cava inferior, en residentes de medicina de emergencias

INTRODUCCIÓN. El ultrasonido es fundamental en la medicina de emergencias, no se conoce cual debería ser la curva de aprendizaje para obtener las competencias técnicas y operativas; ACEP recomienda por cada ventana ecográfica realizar 25 repeticiones. No existe una curva de aprendizaje para ventana de VCI en la población de residentes colombianos. OBJETIVO: Determinar la curva de aprendizaje necesaria para obtener una proporción mayor al 80% de éxitos en la toma de la ventana ecográfica de la VCI, usando la escala de calificación para el aseguramiento de la calidad sugerida por ACEP, en residentes de I a III año de medicina de emergencias. METODOLOGÍA: Estudio experimental no comparativo, que evaluó la proporción de éxito en función del las tomas repetidas de la VCI por ultrasonido, mediciones que se tomaron luego de participar en una capacitación teórica y demostrativa de la técnica propuesta; se calificaron los videos según la escala publicada por ACEP. El análisis estadístico se realizó con un modelo logístico multinivel para la proporción del éxito, agrupado por repetición y agrupado por sujeto. RESULTADOS: Se obtuvo información de 8 residentes, cada uno realizo 25 repeticiones a 3 modelos sanos con asignación aleatoria. Se realizó la curva de aprendizaje obteniendo en 11 repeticiones una proporción de 0.80 (rango 0.54 a 0.92) y en 21 repeticiones una proporción de 0.9 (rango 0.75 a 0.96), datos ajustados por numero de repetición y residente. CONCLUSIÓN: La curva de aprendizaje para la ventana ecográfica de la VCI es de 11 y 21 repeticiones para obtener el 80% y 90% de éxito en residentes de medicina de emergencias de I a III año de la universidad del rosario.

Informe final creación y evaluación de campo de un instrumento para la medición de las competencias clínicas en Fisioterapia

La evaluación de los procesos formativos en el área clínica, basados en competencias, es fundamental para la Fisioterapia. Este proceso articula la teoría con la práctica, orienta la organización de los procesos académicos, promueve la formación integral y establece mecanismos de retroalimentación permanentes y rigurosos, basados en la evaluación del desempeño del profesional en formación ante situaciones del día a día que dan cuenta de su toma de decisiones profesional. Se espera que los estudiantes se formen y puedan actuar como profesionales competitivos a nivel nacional e internacional, de manera integral, con sólidos compromisos éticos y sociales para responder a las necesidades del entorno social en el que se desenvuelven (PEP, Universidad del Rosario). Los esfuerzos actuales en investigación de la evaluación educativa se encuentran orientados a la integración de la adquisición del conocimiento y al desarrollo de estrategias de medición y cuantificación de capacidades técnico-científicas dentro de cada disciplina. En este sentido, hasta el momento, en Colombia no se encuentra evidencia alrededor de la validación de instrumentos de medición de las competencias clínicas, ni se cuenta con estándares para la evaluación en práctica clínica en el proceso de formación del recurso humano en Fisioterapia. En el proyecto se desarrolló y fueron evaluadas las propiedades psicométricas de un instrumento que mide las competencias clínicas del estudiante de fisioterapia en la práctica clínica. Este proceso involucró a Fisioterapeutas que con experiencia en el área de docencia y clínica, contribuyen con la formación de fisioterapeutas en Colombia.

Evaluation of the effect of complementary pollination on Actinidia deliciosa 'Hayward' in northwest Portugal

The objective of this research was to study the effect of complementary pollination on kiwifruit production and quality. For 3 years, complementary application of wet or dry pollen have been done at different stages of flower opening on vines in the Portuguese regions of Entre-Douro e Minho and Beira Litoral. Commercial production data were collected and fruit quality attributes were measured at harvest. Complementary pollination did not affect fruit soluble solids content or firmness in any year, and was beneficial for fruit size and commercial production in the third year only, showing that it is important in some conditions, when natural pollination is inadequate.

The effect of calcium applications on kiwifruit quality preservation during storage

It is well known that calcium increases storage life of many fruits. This study investigated the effect of vine calcium application, as well as postharvest application on storage behaviour of 'Hayward' kiwifruit. Three applications of 0.03% CaCl2 or CaO were made in June, July and September. After harvest half of the fruit from sprayed vines were dipped in a solution of 2% CaCl2; the other fruit were untreated. All fruit were then stored at 0 degrees C and relative humidity of about 90-95%. Results for fruit of the size range 85-105 g are discussed. Kiwifruit dipped in 2% CaCl2 postharvest maintained higher firmness through storage than undipped fruit, but soluble solids content was only slightly lower after storage. This suggests that postharvest dipping of kiwifruit in 2% CaCl2 benefits storage life. The concentrations of 0.03% CaCl2 (Antistip) or 0.03% CaO (Chelal) used in vine applications seem to be too low and higher concentrations should be tried.

Evaluation of the effect of complementary pollination on Actinidia deliciosa 'Hayward' in northwest Portugal

The objective of this research was to study the effect of complementary pollination on kiwifruit production and quality. For 3 years, complementary application of wet or dry pollen have been done at different stages of flower opening on vines in the Portuguese regions of Entre-Douro e Minho and Beira Litoral. Commercial production data were collected and fruit quality attributes were measured at harvest. Complementary pollination did not affect fruit soluble solids content or firmness in any year, and was beneficial for fruit size and commercial production in the third year only, showing that it is important in some conditions, when natural pollination is inadequate.

The effect of calcium applications on kiwifruit quality preservation during storage

It is well known that calcium increases storage life of many fruits. This study investigated the effect of vine calcium application, as well as postharvest application on storage behaviour of 'Hayward' kiwifruit. Three applications of 0.03% CaCl2 or CaO were made in June, July and September. After harvest half of the fruit from sprayed vines were dipped in a solution of 2% CaCl2; the other fruit were untreated. All fruit were then stored at 0 degrees C and relative humidity of about 90-95%. Results for fruit of the size range 85-105 g are discussed. Kiwifruit dipped in 2% CaCl2 postharvest maintained higher firmness through storage than undipped fruit, but soluble solids content was only slightly lower after storage. This suggests that postharvest dipping of kiwifruit in 2% CaCl2 benefits storage life. The concentrations of 0.03% CaCl2 (Antistip) or 0.03% CaO (Chelal) used in vine applications seem to be too low and higher concentrations should be tried.

Na 1 Nachlass Max Horkheimer, 610 - Vorlesung: "Geschichte der neueren Philosophie" 3 (p. VIII 7, 2a.10 - VIII 7, 2a.14)

Vorlesungsskript, Typoskript mit eigenhändigen Korrekturen (GS 9, S.11-480);