Contribución de las tecnologías de la información y la comunicación (TIC) a los procesos lecto-escriturales en el grado tercero de básica primaria

Reconocer el uso de las tecnologías de la información y la comunicación “TIC” como herramienta fundamental en los procesos de lecto-escritura, de los estudiantes del grado tercero de primaria del Centro Educativo Hogar Jesús Redentor.Este proyecto destaca la importancia del Aporte De Las Tecnologías De La Información Y La Comunicación (Tic) A Los Procesos Lecto-Escriturales En El Grado Tercero como una estrategia para mejorar la educación de niños y niñas en edad escolar, teniendo siempre en cuenta sus conocimientos previos, sus gustos y su edad. Durante el desarrollo de la investigación se hallaron diversas herramientas que permitieron encontrar la fundamentación teórica pertinente para el desarrollo de la misma y la ejecución de la propuesta de intervención, que se plantea para dar solución a las inquietudes de los niños y niñas, de sus familias, y en especial de los hallazgos que arrojaron las observaciones previas. Se desarrollo en esté una propuesta de intervención donde el niño y la niña tienen la posibilidad de acercarse a las Tecnologías De La Información Y La Comunicación (Tic) A Los Procesos Lecto-Escriturales

Contribución de las tecnologías de la información y la comunicación (TIC) a los procesos lecto-escriturales en el grado tercero de básica primaria

Reconocer el uso de las tecnologías de la información y la comunicación “TIC” como herramienta fundamental en los procesos de lecto-escritura, de los estudiantes del grado tercero de primaria del Centro Educativo Hogar Jesús Redentor.Este proyecto destaca la importancia del Aporte De Las Tecnologías De La Información Y La Comunicación (Tic) A Los Procesos Lecto-Escriturales En El Grado Tercero como una estrategia para mejorar la educación de niños y niñas en edad escolar, teniendo siempre en cuenta sus conocimientos previos, sus gustos y su edad. Durante el desarrollo de la investigación se hallaron diversas herramientas que permitieron encontrar la fundamentación teórica pertinente para el desarrollo de la misma y la ejecución de la propuesta de intervención, que se plantea para dar solución a las inquietudes de los niños y niñas, de sus familias, y en especial de los hallazgos que arrojaron las observaciones previas. Se desarrollo en esté una propuesta de intervención donde el niño y la niña tienen la posibilidad de acercarse a las Tecnologías De La Información Y La Comunicación (Tic) A Los Procesos Lecto-Escriturales

The forgiveness: a condition for the peace. Nursing and Public Health students University of Antioquia

Colombia está viviendo un momento histórico con la firma de los acuerdos de paz que dan fin a una violencia de más de 50 años. Importa saber qué significa para las personas la paz, en especial para los estudiantes de Salud Pública y Enfermería quienes son parte del futuro y la transformación del país. Objetivo: comprender el significado que le dan a la paz los estudiantes de Salud Pública y Enfermería. Metodología: investigación cualitativa ‐ etnográfica, realizada en Medellín, Colombia. Se entrevistaron 16 estudiantes. Para el análisis de la información se codificaron y categorizaron las entrevistas. Ética: El principio de confidencialidad y el respeto mutuo fueron los criterios que primaron durante la investigación. Resultados: Los estudiantes consideran la paz como derecho y deber, por lo tanto tienen que comprender a las personas que han participado en el conflicto armado en Colombia, para lograr tranquilidad en la población; para algunos la paz significa un imposible, para otros puede ser viable. El perdón es ambiguo porque está condicionado a los sentimientos que les generó el conflicto armado; los estudiantes que tuvieron experiencias directas perdonan, si los excombatientes sufren y los de experiencias indirectas, perdonan si estos pagan por los delitos. Conclusión: Hay dos miradas sobre la paz y una es que la paz es un imposible, por lo tanto ni entienden ni perdonan; la otra mirada es que la paz es posible y se perdona.Colombia is experiencing a historic moment after the signing of the peace agreements that ended over 50 years of violence. It is important to know the meaning of peace for people, especially for nursing and Public Health students because they are part of the future and the transformation of the country. Objective: to understand the meaning that Nursing and Public Health students give to peace. Methodology: qualitative - ethnographic research, carried out in Medellín, Colombia. 16 students were interviewed. For the analysis of the information, the interviews were codified and categorized. Ethics: Confidentiality and mutual respect were the criteria that prevailed during the investigation. Results: Students consider peace as a right and a duty. To achieve tranquility in the population it is necessary to understand the people who have been part in the armed conflict in Colombia. For some people peace means an impossible, for others it can be viable. Forgiveness is ambiguous because it is conditioned by the feelings generated during the armed conflict; for the students that report direct experiences forgiveness is conditioned to the suffering of the excombatants, and for those with indirect experiences, forgiveness can happened if they pay for the crimes. Conclusion: There are two views about peace, for some students peace is impossible, therefore people do not understand and they will not forgive; for others peace is possible, and people can forgive

Estudio epidemiológico, morfológico y microbiológico de la isquemia crónica de miembros inferiores estadio IV

Objetivos: Evaluar en pacientes con diagnóstico de isquemia crónica de miembros inferiores estadio IV las características epidemiológicas, los factores pronósticos que influyen en el desarrollo de la enfermedad y en el resultado final del proceso (amputación menor, amputación mayor e isquemia crónica no revascularizable). Comparar su evolución, en función del tipo de lesión isquémica y determinar qué factores han influido en el desarrollo de la enfermedad y las complicaciones durante su estancia en el hospital y su repercusión en la tasa de amputación. Material y métodos: Se ha realizado un estudio retrospectivo a partir de una base de datos completada de forma prospectiva con los datos de 267 pacientes ingresados en 388 ocasiones durante el periodo del 1 de enero de 2006 al 31 de diciembre de 2010 en el Servicio de Angiología, Cirugía Vascular y Endovascular del Hospital Universitario Miguel Servet de Zaragoza con el diagnóstico principal de isquemia crónica de miembros inferiores estadio IV. Para clasificar las complicaciones quirúrgicas hemos utilizado la clasificación de Clavien-Dindo. Posteriormente se ha realizado el análisis estadístico descriptivo (media, mediana, frecuencia), bivariante (Chi cuadrado, T de Student, Kruskal-Wallis), multivariante (regresión logística binaria) y de supervivencia (Curvas de Kaplan-Meier). Resultados: La edad media de los pacientes fue de 74 años y una proporción de ingresos por paciente de 1.3. El 64% padecían diabetes, el 75% hipertensión arterial y el 65% eran fumadores. Un 40% tenían antecedentes de enfermedad cardiológica y un 22% de enfermedad renal. El 48% de los pacientes eran dependientes para las actividades básicas de la vida diaria. Respecto a su enfermedad vascular, el 60% presentaba dolor de reposo y el 45% tenía antecedentes de claudicación. En el análisis multivariante los factores de riesgo asociados a la amputación mayor han sido el ingreso prolongado (p=0.001), el reingreso (p=0.002, OR=3.4), la dislipemia (p=0.028, OR=2.4), la cirugía de revascularización (p=0.038, OR=2.3), el cultivo positivo de la lesión primaria (p=0.029, OR=3) y la necesidad de opiáceos mayores para la analgesia (p=0.004, OR=3.1) En el análisis multivariante los factores de riesgo asociados a la presencia de complicaciones han sido el ingreso prolongado (p<0.001), la HTA (p=0.040, OR=2.3), la EPOC (p=0.049, OR=2.2), la IRC (p=0.012, OR=2.4), el ASA IV (p=0.018, OR=3.4), la amputación menor (p=0.015, OR=2.4), la amputación mayor (p=0.001, OR=4.7) y la cirugía de revascularización (p<0.001, OR=3.9). Hemos observado como los pacientes con isquemia crónica de miembros inferiores estadio IV presentan una edad avanzada y múltiples comorbilidades. Su manejo perioperatorio es complejo y están expuesto a padecer complicaciones, sobre todo de causa cardiovascular (amputación mayor, infarto agudo de miocardio, isquemia cerebrovascular)

Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study

Purpose: Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19. Methods: Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated. Results: Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65–0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58–0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14–1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61–0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia. Conclusion: Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful.15 página

Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis

Objectives: To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. Methods: A secondary analysis from a prospective, multicentre, observational study (2009-2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the binominal distributions of the true (+) and true (−) results. Results: Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT <0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT <0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. Conclusion: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock

Vaccinated Patients Admitted in ICU with Severe Pneumonia Due to SARS-CoV-2: A Multicenter Pilot Study

Background: The aim of this study was to analyze the percentage of patients admitted to the ICU having received the vaccine against COVID-19, to describe the clinical profile of vaccinated patients admitted to the ICU, and to assess the humoral immune response to vaccination. Methods: In this multicenter prospective descriptive cohort study, consecutive critically ill patients with confirmed SARS-CoV-2 pneumonia who received at least one dose of the SARS-CoV-2 vaccine were included. The time of study was from 1 July to 10 August of 2021. Results: Of the 94 consecutive patients from seven Andalusian ICUs admitted during the time of study, 50 (53.2%) received at least one dose of anti SARS-CoV-2 vaccine. No patient was admitted having previously had SARS-CoV-2 infection. The B.1.617.2 (Delta) variant was the most frequently identified, in 80.76% of cases. Patients with a complete vaccination with non-optimal antibody levels were immunocompromised. Fifteen patients were admitted to the ICU with Acute Respiratory Distress Syndrome (ARDS) without having completed their vaccination; the clinical profile was younger and with less comorbidities compared to patients with full vaccination. There were no differences in severity of ARDS. Conclusions: Most of the patients who were admitted to the ICU having received a dose of the vaccine were not optimally vaccinated; fully vaccinated patients who did not obtain optimal serum antibody levels were patients considered immunocompromise

Ten Issues for Updating in Community-Acquired Pneumonia: An Expert Review

Community-acquired pneumonia represents the third-highest cause of mortality in industrialized countries and the first due to infection. Although guidelines for the approach to this infection model are widely implemented in international health schemes, information continually emerges that generates controversy or requires updating its management. This paper reviews the most important issues in the approach to this process, such as an aetiologic update using new molecular platforms or imaging techniques, including the diagnostic stewardship in different clinical settings. It also reviews both the Intensive Care Unit admission criteria and those of clinical stability to discharge. An update in antibiotic, in oxygen, or steroidal therapy is presented. It also analyzes the management out-of-hospital in CAP requiring hospitalization, the main factors for readmission, and an approach to therapeutic failure or rescue. Finally, the main strategies for prevention and vaccination in both immunocompetent and immunocompromised hosts are reviewed

Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19:a multinational, multicentre study, prospective, observational study

Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40-2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98-1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes. Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable