Use of Quetiapine as a Coadjuvant to Benzodiazepines in General Anxiety Disorder in Patients Aged Over 20 Years at Hospital Naval Guayaquil

Generalized anxiety disorder is the most prevalent mental disorder worldwide. The use of quetiapine + benzodiazepines has been shown to reduce symptoms in patients with generalized anxiety disorder who do not respond adequately to the exclusive use of benzodiazepines. Despite the benefits shown in Ecuador, there are no published studies about its effectiveness. This is a prevalent, retrospective, cross-sectional, descriptive, and analytical study carried out at the Hospital Naval de Guayaquil, in patients aged over 20 years diagnosed with generalized anxiety disorder and had undergone treatment with quetiapine, benzodiazepines, or both during the years 2017–2020. The average age of diagnosis of generalized anxiety disorder is 45.12 years. It prevails in married male patients diagnosed at 39.95 years. Benzodiazepine is the drug that produces clinical improvement in 38% of patients. However, it does not present great variation before quetiapine + benzodiazepine, which produced an improvement in 27% of patients. The treatment time according to the type of drug used is shorter with quetiapine, lasting 4.32 months. However, the Kruskal-Wallis test established that the treatment time is shorter using the combination of quetiapine as a coadjuvant to benzodiazepine with a significance of >0.05. The improvement of the sleep disorder stood out with the use of benzodiazepine in 38.57%. The benzodiazepine produces clinical improvement in 38% and in turn improves the sleep disorder in 38.57%. The use of quetiapine as a coadjuvant to benzodiazepines decreases the treatment time. Keywords: Ecuador, anxiety disorder, benzodiazepines, quetiapine. Resumen El trastorno de ansiedad generalizada es el desorden mental más prevalente a nivel mundial. El uso de quetiapina + benzodiacepinas, ha demostrado disminuir la sintomatología en pacientes sin mejoría con el uso exclusivo de benzodiacepinas. Sin embargo, pese al beneficio demostrado en Ecuador, no existen estudios publicados sobre su efectividad. Materiales y métodos. Estudio de prevalencia, retrospectivo, transversal, descriptivo y analítico realizado en el Hospital Naval de Guayaquil, en pacientes mayores de 20 años que acudieron con diagnóstico de trastorno de ansiedad generalizada y que fueron sometidos a tratamiento con quetiapina , benzodiacepinas o ambas durante los años 2017-2020. Resultados. El trastorno de ansiedad generalizada se diagnostica a la edad promedio 45,12 años. Prevalece en los pacientes casados de sexo masculino diagnosticados a los 39,95 años. La benzodiacepina es el fármaco que produce mejoría clínica en un 38% de los pacientes. Sin embargo, no presenta gran variación ante la quetiapina + benzodiacepina que produjo la mejoría de 27% de los pacientes. El tiempo de tratamiento de acuerdo al tipo de fármaco utilizado es menor con quetiapina durando 4,32 meses. Sin embargo, el test de Kruskal-Wallis estableció que el tiempo de tratamiento es menor utilizando la combinacion de quetiapina mas benzodiacepina con una significacia menor que 0.05. La mejoría del trastorno del sueño destacó con el uso de benzodiacepina en 38,57%. Conclusión. La benzodiacepina produce mejoría clínica en un 38%, mejorando además el trastorno del sueño en un 38,57%. El uso de quetiapina más benzodiacepina disminye el tiempo de tratamiento. Palabras Clave: Ecuador,trastorno de ansiedad, benzodiacepinas, quetiapina

Management Model of Ecological Tourism for the City of Francisco de Orellana

The purpose of the present study is to design a management model of ecological tourism for the city of Francisco de Orellana. Through the compilation of information and tourist offers, and the analysis of biophysical, sociocultural and economic areas, and plants, superstructures and attractions that appeal to tourists, 4 natural and 5 cultural places were identified. With the application of the environmental impact matrix, it was determined that tourist attractions present a high level of contamination due to the presence of the industrial sector and the inadequate handling of dirty water and solid waste. The most affected tourist attractions are: Napo and Payamino rivers, the Yacu eco-park and the boardwalk; throughout the environmental impact matrix they establish obstacles to environmental remediation. With the results obtained, a sustainable tourism management model was designed based on the objectives of Plan Nacional del Buen Vivir and PLANDETUR 2020. The study concludes that the management model will provide a starting point for the development of sustainable tourism activity in the city. Keywords: sustainable tourism, management model, environmental sustainability, government policies, environmental impact, strategic plan. Resumen El objetivo de la presente investigación es diseñar un modelo de gestión del turismo ecológico para la ciudad de Francisco de Orellana. A través de la recopilación de información, oferta turística y el análisis de áreas biofísicas, socioculturales, económicas, planta turística, superestructura turística y el atractivo turístico donde se identificaron 4 lugares naturales y 5 culturales. Con la aplicación de la matriz de impacto ambiental se determinó que los atractivos turísticos presentan un alto nivel de contaminación debido a la presencia del sector industrial y al manejo inadecuado del agua sucia y los residuos sólidos. Los atractivos turísticos más afectados son: Ríos Napo y Payamino, Payamino El eco parque Yacu y el malecón, a lo largo de la matriz de soluciones, establecen alternativas de remediación ambiental. Con los resultados obtenidos, se diseña un modelo de gestión del turismo sostenible basado en los objetivos del Plan Nacional del Buen Vivir y PLANDETUR 2020. Se concluye que el modelo de gestión proporcionará el comienzo para desarrollar una actividad turística sostenible en la ciudad. Palabras clave: turismo sostenible, modelo de gestión, sostenibilidad ambiental, políticas gubernamentales, impacto ambiental, plan estratégico

Learning Strategies and Innovations among Medical Students in the Philippines during the COVID-19 Pandemic

This paper highlights the experience of graduating medical students or clinical clerks in the Philippines during the COVID-19 pandemic. For instance, clinical clerks are supposed to be having their actual face-to-face patient encounters in the hospital setting. It is during the clinical clerkship, the final year of a four-year medical degree program, that a medical student applies his or her theoretical knowledge in practice. However, due to the pandemic, changes needed to be done in order to ensure continuous learning despite having to have little to no contact with actual patients. Hence, in this paper, various learning strategies and innovations have been presented to give examples of how Filipino medical students or clinical clerks tried to cope and adapt with the changes in the mode of learning in the medical field

Thermal and current flow effects of a capacitive–resistive electric transfer application protocol on chronic elbow tendinopathy. A cadaveric study

Lateral elbow tendinopathy, or “tennis elbow”, is a pathology that affects around 1.3% of the general population. Capacitive–resistive electric transfer therapy aims to provoke temperature and current flow changes in superficial and deep tissues. The aim of this in vitro study was to analyze the thermal behavior and transmission of electric current on the superficial and deep tissues of the elbow during the application of different modalities of a capacitive–resistive electric transfer treatment protocol for chronic elbow tendinopathy. A cross-sectional study was designed; five fresh cryopreserved cadavers (10 elbows) were included in this study. A 30 min intervention was performed based on a protocol commonly used in clinics for the treatment of chronic lateral elbow tendinopathy by diathermy using the “T-Plus.” Common extensor tendon, radiohumeral capsule, and superficial temperatures were registered after each application for the duration of the 30 min treatment protocol. During all applications, we observed a current flow of over 0.03 A. The protocol showed a statistically significant increase in superficial temperature by 24% (5.02¿) (p < 0.005), the common extensor tendon by 19.7% (4.36¿) (p < 0.007), and the radiohumeral joint capsule by 17.5% (3.41¿) (p < 0.005) at the end of the 30 min protocol compared with the baseline temperature. The different applications of the protocol showed specific effects on the temperature and current flow in the common extensor tendon and radiohumeral capsule. All applications of the protocol produced a current flow that is associated with the generation of cell proliferation. These results strengthen the hypothesis of cell proliferation and thermal changes in deep and distal structures. More studies are needed to confirm these results

Linking Student Performance in Massachusetts Elementary Schools with the “Greenness” of School Surroundings Using Remote Sensing

Various studies have reported the physical and mental health benefits from exposure to “green” neighborhoods, such as proximity to neighborhoods with trees and vegetation. However, no studies have explicitly assessed the association between exposure to “green” surroundings and cognitive function in terms of student academic performance. This study investigated the association between the “greenness” of the area surrounding a Massachusetts public elementary school and the academic achievement of the school’s student body based on standardized tests with an ecological setting. Researchers used the composite school-based performance scores generated by the Massachusetts Comprehensive Assessment System (MCAS) to measure the percentage of 3rd-grade students (the first year of standardized testing for 8–9 years-old children in public school), who scored “Above Proficient” (AP) in English and Mathematics tests (Note: Individual student scores are not publically available). The MCAS results are comparable year to year thanks to an equating process. Researchers included test results from 2006 through 2012 in 905 public schools and adjusted for differences between schools in the final analysis according to race, gender, English as a second language (proxy for ethnicity and language facility), parent income, student-teacher ratio, and school attendance. Surrounding greenness of each school was measured using satellite images converted into the Normalized Difference Vegetation Index (NDVI) in March, July and October of each year according to a 250-meter, 500-meter, 1,000-meter, and 2000-meter circular buffer around each school. Spatial Generalized Linear Mixed Models (GLMMs) estimated the impacts of surrounding greenness on school-based performance. Overall the study results supported a relationship between the “greenness” of the school area and the school-wide academic performance. Interestingly, the results showed a consistently positive significant association between the greenness of the school in the Spring (when most Massachusetts students take the MCAS tests) and school-wide performance on both English and Math tests, even after adjustment for socio-economic factors and urban residency

Monomeric Germanium(II) Amides Bearing β-Diketiminato Ligands: Synthesis, Structural Characterization, and Thermal Properties

Germanium(II) compounds featuring β-diketiminate-type ligands are attractive for applications as nanoparticle precursors, imaging agents, and components of electronic devices. In this work, we report the synthesis of β-diketiminatogermanium(II) amides LGe(NHPh) [1, L = {HC(CMeN–2,4,6-Me3C6H2)2} – ], LGe(4-NHPy) (2), LGe(2-NHPy) (3), and LGe(2-NHPy) (4), L = {HC(CMeN–2,6-iPr2C6H3)2} – ], which were obtained by the reaction of a low-valent organogermanium halide (LGeCl or LGeCl) with a lithium salt of the respective aromatic amine (LiNHPh) or aminopyridine [Li(4-NHPy) and Li(2-NHPy)]. Compounds 1–4 were characterized with several techniques such as melting point, FTIR, 1H and 13C NMR spectroscopy, elemental analysis, X-ray diffraction, and thermogravimetric analysis (TGA). Compounds 1–3 and 4 crystallized in the orthorhombic (space group Pnma) and monoclinic (space group P21/c) crystal systems, respectively. In all cases, the geometry around the central germanium atom was highly tetrahedrally distorted. According to TGA data, 1–4 do not sublime intact but rather exhibit thermal decomposition.Universidad de Costa Rica/[804-B2-A59]/UCR/Costa RicaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Básicas::Centro de Investigación en Electroquímica y Energía Química (CELEQ)UCR::Vicerrectoría de Docencia::Ciencias Básicas::Facultad de Ciencias::Escuela de Químic

Fundamentos teóricos del constructivismo y el enfoque reflexivo y su aporte en el perfeccionamiento del proceso de las prácticas pre profesionales

  El interés particular  de los autores se centra en el perfeccionamiento del proceso de las Prácticas Pre Profesionales y su aporte a la formación universitaria de los futuros docentes, de esta forma es ineludible el análisis de cómo se realiza su formación. Por tal motivo el objetivo principal de este trabajo se ajusta en cómo los fundamentos teóricos del constructivismo y el enfoque reflexivo aportan a tan importante proceso de formación académica. Se realizó un análisis teórico exhaustivo para extraer dentro de estas teorías aportes significativos que puedan orientar de una manera más adecuada el proceso de las Prácticas Pre Profesionales, previamente se realizó un estudio a los documentos normativos que rigen el proceso de práctica en la Facultad de Filosofía Letras y Ciencias de la Educación, de Filosofía, Letras y Ciencias de la Educación de la Universidad Técnica de Manabí específicamente en la carrera de Pedagogía de los Idiomas Nacionales y Extranjeros (Idiomas). Como resultado del análisis teórico se recogió valiosa información que corrobora la importancia que tienen estas dos teorías dentro del proceso de PPP, esencialmente en el carácter activo del estudiante como ente y principal actor de su formación así también la reflexión como principal vía de interiorización de conocimientos hacia el aprendizaje significativo, elementos importantes dentro del proceso de prácticas los cuales hay que fortalecer y mantener.   Palabras clave  —  Teoría  constructivista,  enfoque reflexivo, Proceso de Prácticas Pre Profesionales.   Abstract ─ The authors' particular interest is focused on the improvement of the Pre-Professional Practices process and their contribution to the university training of future teachers, thus the analysis of how their training is carried out is inescapable. For this reason, the main objective of this work is adjusted in how the theoretical foundations of constructivism and the reflective approach contribute to such an important process of academic formation. An exhaustive theoretical analysis was carried out to extract within these theories significant contributions that can guide the process of Pre-Professional Practices in a more adequate way, previously a study was made of the normative documents that govern the practice process in the Faculty of Philosophy. Letters and Sciences of Education, Philosophy, Letters and Sciences of Education of the Technical University of Manabí specifically in the career of Pedagogy of National and Foreign Languages (Languages). As a result of the theoretical analysis, valuable information was collected that corroborates the importance of these two theories in the PPP process, essentially in the active character of the student as the entity and main actor in their training, as well as reflection as the main way of internalizing knowledge. towards meaningful learning, important elements within the internship process which must be strengthened and maintained.   Keywords— Constructivist theory, reflective approach, Pre- Professional Practices Process

An inhibitory circuit from central amygdala to zona incerta drives pain-related behaviors in mice

Central amygdala neurons expressing protein kinase C-delta (CeA-PKCδ) are sensitized following nerve injury and promote pain-related responses in mice. The neural circuits underlying modulation of pain-related behaviors by CeA-PKCδ neurons, however, remain unknown. In this study, we identified a neural circuit that originates in CeA-PKCδ neurons and terminates in the ventral region of the zona incerta (ZI), a subthalamic structure previously linked to pain processing. Behavioral experiments show that chemogenetic inhibition of GABAergic ZI neurons induced bilateral hypersensitivity in uninjured mice and contralateral hypersensitivity after nerve injury. In contrast, chemogenetic activation of GABAergic ZI neurons reversed nerve injury-induced hyper-sensitivity. Optogenetic manipulations of CeA-PKCδ axonal terminals in the ZI further showed that inhibition of this pathway reduces nerve injury-induced hypersensitivity whereas activation of the pathway produces hypersensitivity in the uninjured paws. Altogether, our results identify a novel nociceptive inhibitory efferent pathway from CeA-PKCδ neurons to the ZI that bidirectionally modulates pain-related behaviors in mice.Fil: Singh, Sudhuman. National Center For Complementary And Integrative Health; Estados UnidosFil: Wilson, Torri D.. National Center For Complementary And Integrative Health; Estados UnidosFil: Valdivia Torres, Lesly Spring. National Center For Complementary And Integrative Health; Estados Unidos. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Benowitz, Barbara. National Center For Complementary And Integrative Health; Estados UnidosFil: Chaudhry, Sarah. National Center For Complementary And Integrative Health; Estados UnidosFil: Ma, Jun. National Center For Complementary And Integrative Health; Estados UnidosFil: Adke, Anisha P.. National Center For Complementary And Integrative Health; Estados UnidosFil: Soler Cedeño, Omar. National Center For Complementary And Integrative Health; Estados UnidosFil: Velasquez, Daniela. National Center For Complementary And Integrative Health; Estados UnidosFil: Penzo, Mario A.. National Center For Complementary And Integrative Health; Estados UnidosFil: Carrasquillo, Yarimar. National Center For Complementary And Integrative Health; Estados Unido

Are some brain injury patients improving more than ohers?

Predicting the evolution of individuals is a rather new mining task with applications in medicine. Medical researchers are interested in the progress of a disease and in the evolution of individuals subjected to treatment. We investigate the evolution of patients on the basis of medical tests before and during treatment after brain trauma: we want to understand how similar patients can become to healthy participants. We face two challenges. First, we have less information on healthy participants than on the patients. Second, the values of the medical tests for patients, even after treatment started, remain well-separated from those of healthy people; this is typical for neurodegenerative diseases, but also for further brain impairments. Our approach encompasses methods for modelling patient evolution and for predicting the health improvement of different patient subpopulations, dealing with the above challenges. We test our approach on a cohort of patients treated after brain trauma and a corresponding cohort of controls