Complementario para la asignatura Servicios de Información

A study was done at the Medical Sciences faculty of Guantánamo, with the objective of developing teaching materials that provide students with basic knowledges and skills in implementing and designing services of excellence that made from the needs and requirements of potential users of different institutions. Through observation, it was found insufficient literatures in libraries and information centers CITMA, Guantanamo Pedagogical Institute and bibliographical searching related to Internet. Se realiza un estudio en la Filial de Ciencias Médicas de Guantánamo, con el objetivo de elaborar un material didáctico que proporcione a los estudiantes los conocimientos básicos y el desarrollo de habilidades en la implementación y diseño de servicios de excelencia, que realizan a partir de las necesidades y requerimientos de los usuarios potenciales de su institución. A través de la observación se pudo constatar la insuficiente y dispersa bibliografía en Centros de Información y bibliotecas del CITMA, Instituto Superior Pedagógico de Guantánamo y búsquedas bibliográficas en Internet

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Guambía, somos de Pishimisak. Cuando el patrimonio cultural nos habla para dar vida

Título del número: Un legado difícil de asumir. Relaciones entre el patrimonio cultural, la violencia y el posconflictoEl presente texto reflexiona en torno a la relación de las luchas por la recuperación del territorio, la historia y la cultura del pueblo Misak. Atentos a la continuidad y cauce que ha llevado este proceso que sigue su principio "recuperar el territorio para recuperarlo todo"; se enfatiza en la función primordial del patrimonio cultural como elemento de cohesión social y en el fortalecimiento de la identidad y vida guambiana. Interesa resaltar cómo a pesar del constante clima de violencia en la llamada zona roja, diversas generaciones han contribuido de manera distinta en el trabajo colectivo por la continuidad histórica de los hijos del Pishimisak, un pueblo que vive su territorio y se proyecta a futuro a partir de la carga histórica de sus antepasado

Turismo creativo y la ancestralidad mercantilizada - la falsa relación entre el patrimonio cultural y las comunidades

Título del número: A propósito del "Turismo Creativo": Nuevas relaciones entre el patrimonio cultural y el turismoEl modelo económico mundial de desarrollo sostenible se ha insertado en diversos proyectos comunitarios al punto de considerarse eslabón de ayuda económica para las poblaciones asociadas al patrimonio cultural. La exaltación de valores y del patrimonio cultural como recurso se canaliza hacia la ejecución de proyectos turísticos comunitarios enfocados en turismo creativo. Aunque inicialmente esta empresa contribuye a la economía de las poblaciones promotoras, no garantiza su éxito y permanencia como centros turísticos, y a la postre resulta en más problemas que beneficios para las comunidades. Tales proyectos favorecen la cooptación de algunos dirigentes de pueblos y naciones originarias, lo cual produce el fenómeno que se conoce como el indio permitido, cuyo fin es la comercialización de la ancestralidad originaria y la desestructuración del modo de vida comunitario. Los proyectos comunitarios multiculturales relacionados al turismo creativo y el patrimonio cultural ponen en evidencia el problem

Arqueología social y Arqueología Antropológica. Aproximación a la Praxis de la arqueología Latinoamericana

A continuación se presenta una breve disertación sobre los puntos medulares de dos formas de hacer arqueología en Latinamérica que son La Arqueología Social Latinakericana y la Arqueología Antropológica, nos enfocaremos en el área valorativa de cada una, y hasta donde sea posible, en la praxis que han desarrolado a través de su producción científica, Para lograra lo anterior, se consideró partir de dos elementos fundamentales : el primero lo constituye la propuesta de análisis de "posición teórica" formulada por el arqueólogo Manuel Gándara y la segunda, "Filosofía y parxis" dels filósofo Adolfo Sánchez Vázquez

Arqueología social y Arqueología Antropológica. Aproximación a la Praxis de la arqueología Latinoamericana

A continuación se presenta una breve disertación sobre los puntos medulares de dos formas de hacer arqueología en Latinamérica que son La Arqueología Social Latinakericana y la Arqueología Antropológica, nos enfocaremos en el área valorativa de cada una, y hasta donde sea posible, en la praxis que han desarrolado a través de su producción científica, Para lograra lo anterior, se consideró partir de dos elementos fundamentales : el primero lo constituye la propuesta de análisis de "posición teórica" formulada por el arqueólogo Manuel Gándara y la segunda, "Filosofía y parxis" dels filósofo Adolfo Sánchez Vázquez

Clinical phenotypes and quality of life to define post-COVID-19 syndrome: a cluster analysis of the multinational, prospective ORCHESTRA cohort

Background: Lack of specific definitions of clinical characteristics, disease severity, and risk and preventive factors of post-COVID-19 syndrome (PCS) severely impacts research and discovery of new preventive and therapeutics drugs. Methods: This prospective multicenter cohort study was conducted from February 2020 to June 2022 in 5 countries, enrolling SARS-CoV-2 out- and in-patients followed at 3-, 6-, and 12-month from diagnosis, with assessment of clinical and biochemical features, antibody (Ab) response, Variant of Concern (VoC), and physical and mental quality of life (QoL). Outcome of interest was identification of risk and protective factors of PCS by clinical phenotype, setting, severity of disease, treatment, and vaccination status. We used SF-36 questionnaire to assess evolution in QoL index during follow-up and unsupervised machine learning algorithms (principal component analysis, PCA) to explore symptom clusters. Severity of PCS was defined by clinical phenotype and QoL. We also used generalized linear models to analyse the impact of PCS on QoL and associated risk and preventive factors. CT registration number: NCT05097677. Findings: Among 1796 patients enrolled, 1030 (57%) suffered from at least one symptom at 12-month. PCA identified 4 clinical phenotypes: chronic fatigue-like syndrome (CFs: fatigue, headache and memory loss, 757 patients, 42%), respiratory syndrome (REs: cough and dyspnoea, 502, 23%); chronic pain syndrome (CPs: arthralgia and myalgia, 399, 22%); and neurosensorial syndrome (NSs: alteration in taste and smell, 197, 11%). Determinants of clinical phenotypes were different (all comparisons p < 0.05): being female increased risk of CPs, NSs, and CFs; chronic pulmonary diseases of REs; neurological symptoms at SARS-CoV-2 diagnosis of REs, NSs, and CFs; oxygen therapy of CFs and REs; and gastrointestinal symptoms at SARS-CoV-2 diagnosis of CFs. Early treatment of SARS-CoV-2 infection with monoclonal Ab (all clinical phenotypes), corticosteroids therapy for mild/severe cases (NSs), and SARS-CoV-2 vaccination (CPs) were less likely to be associated to PCS (all comparisons p < 0.05). Highest reduction in QoL was detected in REs and CPs (43.57 and 43.86 vs 57.32 in PCS-negative controls, p < 0.001). Female sex (p < 0.001), gastrointestinal symptoms (p = 0.034) and renal complications (p = 0.002) during the acute infection were likely to increase risk of severe PCS (QoL <50). Vaccination and early treatment with monoclonal Ab reduced the risk of severe PCS (p = 0.01 and p = 0.03, respectively). Interpretation: Our study provides new evidence suggesting that PCS can be classified by clinical phenotypes with different impact on QoL, underlying possible different pathogenic mechanisms. We identified factors associated to each clinical phenotype and to severe PCS. These results might help in designing pathogenesis studies and in selecting high-risk patients for inclusion in therapeutic and management clinical trials. Funding: The study received funding from the Horizon 2020 ORCHESTRA project, grant 101016167; from the Netherlands Organisation for Health Research and Development (ZonMw), grant 10430012010023; from Inserm, REACTing (REsearch & ACtion emergING infectious diseases) consortium and the French Ministry of Health, grant PHRC 20-0424