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Perales A, Lipsker D, Cribier B, Lenormand C. Non-scarring alopecia of lupus erythematosus: A comprehensive review. Ann Dermatol Venereol 2023; 150:260-269. [PMID: 37598015 DOI: 10.1016/j.annder.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/05/2023] [Accepted: 04/04/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Although non-scarring alopecia (NSA) is a frequent clinical finding in patients with systemic lupus erythematosus (SLE), it has been poorly described in the literature. It is considered a nonspecific sign in the current classification of skin lesions of LE. The aim of this study was to give an updated overview of the spectrum of NSA in LE patients, with emphasis on the clinical significance thereof. METHOD We conducted a review of the English literature using the PubMed-Medline database using the keywords "Alopecia" + "Lupus erythematosus". Publications describing LE patients with NSA were included. RESULTS Data for 237 patients from 27 publications were analyzed. Ninety-one patients had diffuse NSA, 43 had patchy NSA, 83 had lupus hair, 3 had alopecia of dermal cutaneous LE, and 17 had alopecia of linear and annular lupus panniculitis of the scalp. Patients with diffuse/patchy NSA and lupus hair shared the following features: strong association with systemic activity of LE, subtle clinical/trichoscopic signs of inflammation, histological aspect consistent with lesions specific to cutaneous LE, high likelihood of response to SLE therapy, and absence of progression to scarring alopecia. Association with SLE was rare in patients with dermal cutaneous LE or linear and annular lupus panniculitis of the scalp, and skin-directed therapies were most often effective. One patient of each subtype progressed to scarring alopecia. DISCUSSION Diffuse/patchy NSA and lupus hair may represent a topographic variation of a single entity specific for LE. Prospective studies are warranted to further document the clinical significance of this manifestation.
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Affiliation(s)
- A Perales
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - D Lipsker
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - B Cribier
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - C Lenormand
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France.
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Romero R, Conde-Agudelo A, Rehal A, Da Fonseca E, Brizot ML, Rode L, Serra V, Cetingoz E, Syngelaki A, Tabor A, Perales A, Hassan SS, Nicolaides KH. Vaginal progesterone for the prevention of preterm birth and adverse perinatal outcomes in twin gestations with a short cervix: an updated individual patient data meta-analysis. Ultrasound Obstet Gynecol 2022; 59:263-266. [PMID: 34941003 PMCID: PMC9333094 DOI: 10.1002/uog.24839] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 05/27/2023]
Affiliation(s)
- R Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
| | - A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
| | - A Rehal
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - E Da Fonseca
- Departamento de Obstetrícia e Ginecologia, Hospital do Servidor Publico Estadual 'Francisco Morato de Oliveira' and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - M L Brizot
- Department of Obstetrics and Gynecology, Pontifical Catholic University of São Paulo School of Medical and Health Sciences, São Paulo, Brazil
| | - L Rode
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Juliane Marie Centre, Department of Obstetrics, Copenhagen, Denmark
| | - V Serra
- Maternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of Valencia, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - E Cetingoz
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Uskudar, Istanbul, Turkey
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - A Perales
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
- Department of Obstetrics, University Hospital La Fe, Valencia, Spain
| | - S S Hassan
- Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Aguilar-Redondo P, Viñals A, Cabello P, Delgado J, Azcona D, Polo R, Perales A, Zucca D. SPR stoichiometric calibration of a single energy CT and validation using fresh tissue samples. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Romero R, Conde-Agudelo A, Rode L, Brizot ML, Cetingoz E, Serra V, Da Fonseca E, Tabor A, Perales A, Hassan SS, Nicolaides KH. Vaginal progesterone in twin gestation with a short cervix: revisiting an individual patient data systematic review and meta-analysis. Ultrasound Obstet Gynecol 2021; 58:943-945. [PMID: 34516022 PMCID: PMC9335349 DOI: 10.1002/uog.24765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 06/01/2023]
Affiliation(s)
- R Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National, Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
| | - A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National, Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
| | - L Rode
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Juliane Marie Centre, Department of Obstetrics, Copenhagen, Denmark
| | - M L Brizot
- Department of Obstetrics and Gynecology, Pontifical Catholic University of São Paulo School of Medical and Health Sciences, São Paulo, Brazil
| | - E Cetingoz
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Uskudar, Istanbul, Turkey
| | - V Serra
- Maternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of Valencia, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - E Da Fonseca
- Departamento de Obstetrícia e Ginecologia, Hospital do Servidor Publico Estadual 'Francisco Morato de Oliveira' and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - A Perales
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
- Department of Obstetrics, University Hospital La Fe, Valencia, Spain
| | - S S Hassan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Azcona J, Aguilar B, Irazola L, Viñals A, Cabello P, Zucca D, Perales A, Polo R, Delgado J, Burguete J. PO-1696 Clinical commissioning a synchrotron-based proton therapy system. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arce P, Bolst D, Bordage MC, Brown JMC, Cirrone P, Cortés-Giraldo MA, Cutajar D, Cuttone G, Desorgher L, Dondero P, Dotti A, Faddegon B, Fedon C, Guatelli S, Incerti S, Ivanchenko V, Konstantinov D, Kyriakou I, Latyshev G, Le A, Mancini-Terracciano C, Maire M, Mantero A, Novak M, Omachi C, Pandola L, Perales A, Perrot Y, Petringa G, Quesada JM, Ramos-Méndez J, Romano F, Rosenfeld AB, Sarmiento LG, Sakata D, Sasaki T, Sechopoulos I, Simpson EC, Toshito T, Wright DH. Report on G4-Med, a Geant4 benchmarking system for medical physics applications developed by the Geant4 Medical Simulation Benchmarking Group. Med Phys 2021; 48:19-56. [PMID: 32392626 PMCID: PMC8054528 DOI: 10.1002/mp.14226] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 04/26/2020] [Accepted: 04/30/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Geant4 is a Monte Carlo code extensively used in medical physics for a wide range of applications, such as dosimetry, micro- and nanodosimetry, imaging, radiation protection, and nuclear medicine. Geant4 is continuously evolving, so it is crucial to have a system that benchmarks this Monte Carlo code for medical physics against reference data and to perform regression testing. AIMS To respond to these needs, we developed G4-Med, a benchmarking and regression testing system of Geant4 for medical physics. MATERIALS AND METHODS G4-Med currently includes 18 tests. They range from the benchmarking of fundamental physics quantities to the testing of Monte Carlo simulation setups typical of medical physics applications. Both electromagnetic and hadronic physics processes and models within the prebuilt Geant4 physics lists are tested. The tests included in G4-Med are executed on the CERN computing infrastructure via the use of the geant-val web application, developed at CERN for Geant4 testing. The physical observables can be compared to reference data for benchmarking and to results of previous Geant4 versions for regression testing purposes. RESULTS This paper describes the tests included in G4-Med and shows the results derived from the benchmarking of Geant4 10.5 against reference data. DISCUSSION Our results indicate that the Geant4 electromagnetic physics constructor G4EmStandardPhysics_option4 gives a good agreement with the reference data for all the tests. The QGSP_BIC_HP physics list provided an overall adequate description of the physics involved in hadron therapy, including proton and carbon ion therapy. New tests should be included in the next stage of the project to extend the benchmarking to other physical quantities and application scenarios of interest for medical physics. CONCLUSION The results presented and discussed in this paper will aid users in tailoring physics lists to their particular application.
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Affiliation(s)
| | - D Bolst
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - M-C Bordage
- CRCT (INSERM and Paul Sabatier University), Toulouse, France
| | - J M C Brown
- Department of Radiation Science and Technology, Delft University of Technology, Delft, The Netherlands
| | | | | | - D Cutajar
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | | | - L Desorgher
- Institute of Radiation Physics (IRA), Lausanne University Hospital, Lausanne, Switzerland
| | | | - A Dotti
- SLAC National Accelerator Laboratory, Stanford, CA, USA
| | - B Faddegon
- University of California, San Francisco, CA, USA
| | - C Fedon
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Guatelli
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - S Incerti
- Université de Bordeaux, CNRS/IN2P3, UMR5797, Centre d'Études Nucléaires de Bordeaux Gradignan, Gradignan, France
| | - V Ivanchenko
- Tomsk State University, Tomsk, Russian Federation
- CERN, Geneva, Switzerland
| | - D Konstantinov
- NRC "Kurchatov Institute" - IHEP, Protvino, Russian Federation
| | - I Kyriakou
- Medical Physics Laboratory, University of Ioannina, Ioannina, Greece
| | - G Latyshev
- NRC "Kurchatov Institute" - IHEP, Protvino, Russian Federation
| | - A Le
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | | | | | | | | | - C Omachi
- Nagoya Proton Therapy Center, Nagoya, Japan
| | | | - A Perales
- Medical Physics Department of Clínica Universidad de Navarra, Pamplona, Spain
| | - Y Perrot
- IRSN, Fontenay-aux-Roses, France
| | | | | | | | - F Romano
- INFN Catania Section, Catania, Italy
- Medical Physics Department, National Physical Laboratory, Teddington, UK
| | - A B Rosenfeld
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | | | - D Sakata
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | | | - I Sechopoulos
- Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Center for Screening (LRCB), Nijmegen, The Netherlands
| | - E C Simpson
- Department of Nuclear Physics, Research School of Physics, Australian National University, Canberra, Australia
| | - T Toshito
- Nagoya Proton Therapy Center, Nagoya, Japan
| | - D H Wright
- SLAC National Accelerator Laboratory, Stanford, CA, USA
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Valle R, Perales A. Enseñanza de psicoterapia en la profesión médica en el Perú. An Fac med 2020. [DOI: 10.15381/anales.v81i3.18039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
La psicoterapia busca modificar la conducta anormal y promover conductas normales por medios psicológicos y actitudinales, así como de experiencias correctivas. Su utilidad está plasmada en guías de práctica clínica que la ubican dentro de las primeras líneas de tratamiento de los trastornos mentales. En Perú, los médicos son capacitados en psicoterapia en el pregrado de medicina y en el residentado de psiquiatría. Sin embargo, se reportan algunos problemas en su enseñanza. En el pregrado, solo algunas escuelas de medicina brindan clases de psicoterapia, y aquellas que lo hacen, invierten pocas horas de enseñanza. En el residentado de psiquiatría, algunos residentes reportan no llevar clases teóricas o prácticas que le permitan aplicar psicoterapia de soporte. Adicionalmente, los programas de postgrado en psicoterapia, aparte del residentado de psiquiatría, son escasos. El manuscrito analiza la capacitación en psicoterapia en la profesión médica, y propone una estructura de enseñanza según etapas de estudios.
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Valle R, Perales A. Enseñanza de psicoterapia en el pregrado de escuelas de medicina del Perú. An Fac med 2020. [DOI: 10.15381/anales.v81i2.17680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
La psicoterapia es una herramienta terapéutica basada en la relación empática entre el paciente y su terapeuta, que utiliza técnicas actitudinales y verbales para lograr la recuperación de la salud. Los estudios evidencian su eficacia, y guías de práctica clínica la recomiendan en el tratamiento de problemas específicos de salud mental en el primer nivel de atención de salud. Esto significa que los médicos que trabajan en este nivel debieran conocer las indicaciones y uso de esta valiosa herramienta terapéutica. En el Perú, un gran porcentaje de médicos que trabajan en este primer nivel son médicos recién egresados que realizan el Servicio Rural Urbano Marginal. Estos profesionales atenderán problemas prevalentes de salud mental, tales como depresión, ansiedad y problemas de violencia en su primera experiencia como profesionales de salud (4). Por ello, resulta importante que las facultades de medicina capaciten adecuadamente a los estudiantes de medicina en psicoterapia.
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Mas-Cabo J, Prats-Boluda G, Garcia-Casado J, Alberola-Rubio J, Monfort-Ortiz R, Martinez-Saez C, Perales A, Ye-Lin Y. Electrohysterogram for ANN-Based Prediction of Imminent Labor in Women with Threatened Preterm Labor Undergoing Tocolytic Therapy. Sensors (Basel) 2020; 20:s20092681. [PMID: 32397177 PMCID: PMC7248811 DOI: 10.3390/s20092681] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 12/22/2022]
Abstract
Threatened preterm labor (TPL) is the most common cause of hospitalization in the second half of pregnancy and entails high costs for health systems. Currently, no reliable labor proximity prediction techniques are available for clinical use. Regular checks by uterine electrohysterogram (EHG) for predicting preterm labor have been widely studied. The aim of the present study was to assess the feasibility of predicting labor with a 7- and 14-day time horizon in TPL women, who may be under tocolytic treatment, using EHG and/or obstetric data. Based on 140 EHG recordings, artificial neural networks were used to develop prediction models. Non-linear EHG parameters were found to be more reliable than linear for differentiating labor in under and over 7/14 days. Using EHG and obstetric data, the <7- and <14-day labor prediction models achieved an AUC in the test group of 87.1 ± 4.3% and 76.2 ± 5.8%, respectively. These results suggest that EHG can be reliable for predicting imminent labor in TPL women, regardless of the tocolytic therapy stage. This paves the way for the development of diagnostic tools to help obstetricians make better decisions on treatments, hospital stays and admitting TPL women, and can therefore reduce costs and improve maternal and fetal wellbeing.
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Affiliation(s)
- J Mas-Cabo
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
| | - G Prats-Boluda
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
| | - J Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
| | | | - R Monfort-Ortiz
- Servicio de Obstetricia, H.U. P. La Fe, 46026 Valencia, Spain
| | - C Martinez-Saez
- Servicio de Obstetricia, H.U. P. La Fe, 46026 Valencia, Spain
| | - A Perales
- Servicio de Obstetricia, H.U. P. La Fe, 46026 Valencia, Spain
| | - Y Ye-Lin
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
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Perales A, Izaguirre M, Sánchez E, Barahona L, Martina M, Amemiya I, Delgado A, Domínguez I, Pinto M, Cuadros R, Padilla A. Salud mental en estudiantes de pregrado de la Facultad de Medicina de la Universidad Nacional Mayor de San Marcos. An Fac med 2019. [DOI: 10.15381/anales.v80i4.17142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introducción. Estudios previos evidencian problemas de salud mental en estudiantes de pre-grado de la Facultad de Medicina de la Universidad Nacional Mayor de San Marcos (UNMSM). Objetivo. Evaluar si existen diferencias entre la frecuencia de problemas de salud mental entre los estudiantes de primer año, y el resto de años de estudio, en alumnos de las cinco escuelas profesionales de la Facultad de Medicina de la UNMSM. Métodos. Estudio transversal. Se utilizaron instrumentos validados para evaluar problemas de salud mental: intento suicida, pensamiento homicida, conducta disocial, problemas con el alcohol, depresión y angustia. Adicionalmente, se midieron niveles de resiliencia. Se incluyeron estudiantes de todas las escuelas profesionales de la Facultad de Medicina, en dos grupos de análisis: estudiantes de primer año y estudiantes de los otros años. Resultados. Se evidenció que en alumnos de primer año se encontró un 7,5% de intento suicida, 18,9% de conducta disocial y 21,9% de pensamiento homicida. Asimismo, se encontró un 4,8% de problemas con el alcohol, 8,5% de depresión y 3,2% de angustia. La frecuencia de problemas de salud mental fue mayor según transcurren los años de estudio, con diferencias estadísticamente significativas sólo en depresión, angustia y problemas con el alcohol. El 29,3% de encuestados tuvo bajo nivel de resiliencia. Conclusión. Se encontró frecuencias preocupantes de problemas de salud mental en los estudiantes de pregrado de la Facultad de Medicina de la UNMSM, aunque un porcentaje de alumnos ingresa a la universidad con problemas de salud mental. El entorno universitario sería factor agravante en depresión, ansiedad y problemas con el alcohol.
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Valle R, Perales A. Self-disorders in Early Stages of the Schizophrenia Spectrum. Rev Colomb Psiquiatr (Engl Ed) 2019; 48:244-251. [PMID: 31779875 DOI: 10.1016/j.rcp.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/04/2018] [Accepted: 02/08/2018] [Indexed: 06/10/2023]
Abstract
The pathogenic nucleus of schizophrenia has varied according to the different eras and influences of distinguished clinical researchers. Self-disorders have also been recognised to be at the heart of this disorder, although they have seldom been studied due to their subjective nature. Recently, due to the growing interest in the study of the early stages of schizophrenia, the study of self-disorders has been resumed. The self-disorders in schizophrenia model, developed by Sass and Parnas, proposes that in this disorder the person suffers loss of the first-person perspective and experiences hyperreflexibility, diminished self-affection and disturbance of the field of awareness. Therefore, the person experiences feelings of strangeness about him/herself, difficulty in understanding the common sense of things and difficulty interacting with his/her environment. Based on this model, self-disorder evaluation instruments have been developed and empirical studies have been conducted to evaluate people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in prepsychotic stages and that their manifestation may predict the transition to schizophrenia spectrum disorders. These results have important clinical implications as they enable people in the early stages of the disorder to be identified and create the opportunity to apply early therapeutic interventions.
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Affiliation(s)
- Rubén Valle
- Centro de Investigación en Epidemiología Clínica y Medicina Basada en Evidencias, Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Perú; Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú; DEIDAE de Adultos y Adultos Mayores, Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi, Lima, Perú.
| | - Alberto Perales
- Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú; Instituto de Ética en Salud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
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Sarasqueta C, Perales A, Escobar A, Baré M, Redondo M, Fernández de Larrea N, Briones E, Piera JM, Zunzunegui MV, Quintana JM. Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer. BMC Cancer 2019; 19:735. [PMID: 31345187 PMCID: PMC6659283 DOI: 10.1186/s12885-019-5910-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Many older patients don’t receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer. Methods A prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics. Results In colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ2trends < 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ2trends < 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1–0.6) and 0.04 (0.02–0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6–1.4) and 0.5 (0.3–0.8) compared with those under 65 years of age. Conclusions The probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors’ attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies. Electronic supplementary material The online version of this article (10.1186/s12885-019-5910-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Sarasqueta
- Biodonostia Health Research Institute - Donostia University Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Paseo Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Gipuzkoa, Spain.
| | - A Perales
- Biodonostia Health Research Institute - Donostia University Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Paseo Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Gipuzkoa, Spain
| | - A Escobar
- Research Unit, Hospital Basurto / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Avda Montevideo, 18, 48013, Bilbao, Bizkaia, Spain
| | - M Baré
- Clinical Epidemiology and Cancer Screening, Corporació Sanitaria Parc Taulí / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - M Redondo
- Research Unit, Costa del Sol Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Autovía A-7, Km 187, 29603, Marbella, Málaga, Spain
| | - N Fernández de Larrea
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III / Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avda de Monforte de Lemos, 5, 28029, Madrid, Spain
| | - E Briones
- Epidemiology Unit, Seville Health District, Andalusian Health Service / Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avda de la Constitución, 18, 41071, Seville, Spain
| | - J M Piera
- Medical Oncology Unit, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014, Donostia-San Sebastián, Gipuzkoa, Spain
| | - M V Zunzunegui
- Departement de médecine sociale et préventive Institut de recherche en santé publique (IRSPUM), University of Montréal, Pavillon 7101, salle 3111 7101, Avenue du Parc Montréal, Montréal, Québec, H3N 1X9, Canada
| | - J M Quintana
- Research Unit, Galdakao-Usansolo Hospital / REDISSEC, Labeaga Auzoa, 48960, Galdakao, Bizkaia, Spain
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Perales A. [Ethical training as a support for the moral development of students in health sciences programs: towards a teaching focused on the needs of the student as a person]. ACTA ACUST UNITED AC 2019; 36:100-105. [PMID: 31116322 DOI: 10.17843/rpmesp.2019.361.4314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 11/06/2022]
Abstract
Based on the epidemiological surveys on mental health applied to Health Science students of the School of Medicine (Medicine, Nursing, Obstetrics, Nutrition, and Medical Technology) of Universidad Nacional Mayor de San Marcos, the author postulates that there are two ways to understand the teaching needs of ethics: 1) as a curricular strategy, with theoretical information through specific courses; and, 2) as a support to the moral development of the personality with diverse innovative methods. Based on the results of the surveys mentioned, which show lifetime prevalence of suicide attempts and dissocial behaviors greater than in the general population, it is proposed that such teaching shall be planned for two groups of students with different needs: 1) those without a mental health pathology and who can benefit from the regular curricular strategy; and, 2) those who, with mental health problems and indicators of difficulties in their social behavior, shall also be helped with techniques aimed at offering them support in their moral development. And that this educational challenge must be the responsibility of the university of the 21st century, under the question: What does our country need, health professionals who know ethics or who behave ethically?
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Affiliation(s)
- Alberto Perales
- Instituto de Ética en Salud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú
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Perales A, Sánchez E, Barahona L, Oliveros M, Bravo E, Aguilar W, Ocampo JC, Pinto M, Orellana I, Padilla A. Prevalencia y factores asociados a conducta suicida en estudiantes de la Universidad Nacional Mayor de San Marcos, Lima-Perú. An Fac med 2019. [DOI: 10.15381/anales.v80i1.15865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introducción. La Organización Mundial de la Salud ha señalado el incremento de riesgo suicida en personas de 15 a 44 años, grupo etario en el que se ubican los estudiantes universitarios. Objetivo. Determinar prevalencias de conducta suicida y variables asociadas en estudiantes de pregrado de la Universidad Nacional Mayor de San Marcos (UNMSM), Lima-Perú. Métodos. Estudio analítico, transversal. La población objetivo fue de 24 118 estudiantes matriculados en 2015. Se aplicaron los instrumentos de conducta suicida de la Encuesta Nacional de Salud Mental en el Perú 2002 y 2012, las escalas de ansiedad y depresión de Zung y el cuestionario CAGE para problemas de alcohol, a una muestra de 1819 estudiantes obtenida mediante muestreo bietápico. Se estimaron prevalencias y se empleó regresión logística para determinar factores asociados. Resultados. Las prevalencias de vida, último año, últimos seis meses y último mes de los componentes de la conducta suicida fueron: deseos de morir (35%; 13,9%; 11% y 5,6%); ideación suicida (22,4%; 8,2%; 6% y 3,3%); plan suicida (17,7%; 4,4%; 3,5% y 1,6%); e intento suicida (11,1%; 3,7%; 2,8% y 1,4%). Los factores de riesgo en términos de odds ratio (OR) ajustados y sus IC 95% fueron: condición de mujer 1,48 (IC 95%: 1,03-2,12), depresión 2,46 (IC 95%: 1,49-4,06), angustia 2,5 (IC 95%: 1,38-4,6), y vivir en hogar no nuclear 2,51 (IC 95%: 1,70-3,72). De los estudiantes que intentaron suicidarse sólo 16% buscó ayuda profesional y 21% pensó repetir el intento. Conclusiones. Los estudiantes de la UNMSM tienen mayor riesgo de conducta suicida que los de la población en general, tanto por razones científicas como por responsabilidad moral se recomienda implementar estrategias de intervención para revertir esta tendencia y proteger a este valioso recurso humano.
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Perales A. ¿Por qué está la corrupción tan extendida en el carácter y la conducta de tantos peruanos? An Fac med 2018. [DOI: 10.15381/anales.v79i3.15310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Cuando en las décadas del 80 y 90, publiqué varios artículos que identificaban los tres problemas principales de salud mental en el Perú: 1°) la pobreza y el subdesarrollo, 2°) la corrupción generalizada y 3°) la violencia1,2,3, no imaginé la profundidad con la que la segunda de ellas, la corrupción, carcomía la estructura institucional del Estado, el sistema democrático y el tejido social de nuestro país. Al respecto, no necesito aportar evidencias porque fluyen sin freno por todos los niveles observables de nuestra sociedad, desde los más altos hasta los más humildes, como si los peruanos, por primera vez, hubiéramos logrado ponernos de acuerdo en algo, en decirle a Manuel Gonzales Prada que tenía razón: “En el Perú, donde pones el dedo salta el pus”.
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Mas-Cabo J, Ye-Lin Y, Garcia-Casado J, Alberola-Rubio J, Perales A, Prats-Boluda G. Uterine contractile efficiency indexes for labor prediction: A bivariate approach from multichannel electrohysterographic records. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2018.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Garrido-Gomez T, Amadoz A, Jimenez Almazan J, Mateos P, Blesa D, Rubert L, Perales A, Simon C. Global transcriptional profiling corroborates an endometrial defective decidualization pattern in severe preeclampsia. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Perales A, Sánchez E, Barahona L, Oliveros M, Bravo E, Mendoza A, Aguilar W, Ocampo JC, Pinto M, Orellana I. Conducta y personalidad disociales en estudiantes de medicina: implicancias para la educación médica peruana. An Fac med 2018. [DOI: 10.15381/anales.v79i3.15018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Investigaciones previas sobre conducta suicida realizadas en estudiantes de medicina hallaron, como variable asociada, una alta prevalencia de vida (PV) de indicadores de conducta disocial. Tal resultado obliga a sospechar presencia de personalidad de este tipo en dicha población. Con el objetivo de aportar nuevos elementos que complementen los estudios previos, el presente artículo analiza el concepto de personalidad disocial y discute los resultados de un estudio piloto que evaluó su presencia en una muestra de alumnos recién ingresados a la Escuela de Medicina de la Universidad Nacional Mayor de San Marcos. Se encontró que de 175 estudiantes, 33 resultaron positivos a indicadores de conducta disocial (19% de PV) durante una primera evaluación; de este grupo, 30 se presentaron a una segunda evaluación diagnóstica, de los cuales cinco superaron el punto de corte para personalidad disocial, y 11 obtuvieron puntaje de sospecha de tal desarrollo. Sobre estos resultados sugerimos que la universidad debiera aceptar la responsabilidad de continuar investigando esta área, crear intervenciones preventivo-terapéuticas tempranas e innovaciones curriculares para reducir el riesgo de producir profesionales tecnicamente bien entrenados pero con minusvalías morales.
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Garcia-Casado J, Ye-Lin Y, Prats-Boluda G, Mas-Cabo J, Alberola-Rubio J, Perales A. Electrohysterography in the diagnosis of preterm birth: a review. Physiol Meas 2018; 39:02TR01. [PMID: 29406317 DOI: 10.1088/1361-6579/aaad56] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Preterm birth (PTB) is one of the most common and serious complications in pregnancy. About 15 million preterm neonates are born every year, with ratios of 10-15% of total births. In industrialized countries, preterm delivery is responsible for 70% of mortality and 75% of morbidity in the neonatal period. Diagnostic means for its timely risk assessment are lacking and the underlying physiological mechanisms are unclear. Surface recording of the uterine myoelectrical activity (electrohysterogram, EHG) has emerged as a better uterine dynamics monitoring technique than traditional surface pressure recordings and provides information on the condition of uterine muscle in different obstetrical scenarios with emphasis on predicting preterm deliveries. OBJECTIVE A comprehensive review of the literature was performed on studies related to the use of the electrohysterogram in the PTB context. APPROACH This review presents and discusses the results according to the different types of parameter (temporal and spectral, non-linear and bivariate) used for EHG characterization. MAIN RESULTS Electrohysterogram analysis reveals that the uterine electrophysiological changes that precede spontaneous preterm labor are associated with contractions of more intensity, higher frequency content, faster and more organized propagated activity and stronger coupling of different uterine areas. Temporal, spectral, non-linear and bivariate EHG analyses therefore provide useful and complementary information. Classificatory techniques of different types and varying complexity have been developed to diagnose PTB. The information derived from these different types of EHG parameters, either individually or in combination, is able to provide more accurate predictions of PTB than current clinical methods. However, in order to extend EHG to clinical applications, the recording set-up should be simplified, be less intrusive and more robust-and signal analysis should be automated without requiring much supervision and yield physiologically interpretable results. SIGNIFICANCE This review provides a general background to PTB and describes how EHG can be used to better understand its underlying physiological mechanisms and improve its prediction. The findings will help future research workers to decide the most appropriate EHG features to be used in their analyses and facilitate future clinical EHG applications in order to improve PTB prediction.
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Affiliation(s)
- J Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería (CI2B), Universitat Politècnica de València (UPV), Camino de Vera SN, 46022, Valencia, Spain
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Perales A, Delgado JL, de la Calle M, García‐Hernández JA, Escudero AI, Campillos JM, Sarabia MD, Laíz B, Duque M, Navarro M, Calmarza P, Hund M, Álvarez FV. sFlt-1/PlGF for prediction of early-onset pre-eclampsia: STEPS (Study of Early Pre-eclampsia in Spain). Ultrasound Obstet Gynecol 2017; 50:373-382. [PMID: 27883242 PMCID: PMC5836987 DOI: 10.1002/uog.17373] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/08/2016] [Accepted: 11/11/2016] [Indexed: 05/31/2023]
Abstract
OBJECTIVE A high ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) has been linked to pre-eclampsia (PE). We evaluated the sFlt-1/PlGF ratio as a predictive marker for early-onset PE in women at risk of PE. METHODS This prospective, Spanish, multicenter study included pregnant women with a risk factor for PE, including intrauterine growth restriction, PE, eclampsia or hemolysis, elevated liver enzymes and low platelet count syndrome in previous pregnancy, pregestational diabetes or abnormal uterine artery Doppler. The primary objective was to show that the sFlt-1/PlGF ratio at 20, 24 and 28 weeks' gestation was predictive of early-onset PE (< 34 + 0 weeks). Serum sFlt-1 and PlGF were measured at 20, 24 and 28 weeks. Multivariate logistic regression was used to develop a predictive model. RESULTS A total of 819 women were enrolled, of which 729 were suitable for analysis. Of these, 78 (10.7%) women developed PE (24 early onset and 54 late onset). Median sFlt-1/PlGF ratio at 20, 24 and 28 weeks was 6.3 (interquartile range (IQR), 4.1-9.3), 4.0 (IQR, 2.6-6.3) and 3.3 (IQR, 2.0-5.9), respectively, for women who did not develop PE (controls); 14.5 (IQR, 5.5-43.7), 18.4 (IQR, 8.2-57.9) and 51.9 (IQR, 11.5-145.6) for women with early-onset PE; and 6.7 (IQR, 4.6-9.9), 4.7 (IQR, 2.8-7.2) and 6.0 (IQR, 3.8-10.5) for women with late-onset PE. Compared with early-onset PE, the sFlt-1/PlGF ratio was significantly lower in controls (P < 0.001 at each timepoint) and in women with chronic hypertension (P < 0.001 at each timepoint), gestational hypertension (P < 0.001 at each timepoint) and late-onset PE (P < 0.001 at each timepoint). A prediction model for early-onset PE was developed, which included the sFlt-1/PlGF ratio plus mean arterial pressure, being parous and previous PE, with areas under the receiver-operating characteristics curves of 0.86 (95% CI, 0.77-0.95), 0.91 (95% CI, 0.85-0.97) and 0.93 (95% CI, 0.86-0.99) at 20, 24 and 28 weeks, respectively, and was superior to models using the sFlt-1/PlGF ratio alone or uterine artery mean pulsatility index. CONCLUSIONS The sFlt-1/PlGF ratio can improve prediction of early-onset PE for women at risk of this condition. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A. Perales
- Hospital Universitario y Politécnico La FeValenciaSpain
| | | | | | | | | | | | | | - B. Laíz
- Hospital Universitario y Politécnico La FeValenciaSpain
| | - M. Duque
- Hospital Universitario La PazMadridSpain
| | - M. Navarro
- Hospital Universitario Materno Infantil de CanariasGran CanariaSpain
| | - P. Calmarza
- Hospital Universitario Miguel ServetZaragozaSpain
| | - M. Hund
- Roche Diagnostics International LtdRotkreuzSwitzerland
| | - F. V. Álvarez
- Hospital Universitario Central de AsturiasOviedoSpain
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Rodriguez E, Zamora J, Monfort I, Rubert L, Fuster S, Diago V, Perales A. Unusual twin pregnancy: complete hydatidiform mole with coexistent normal fetus. CLIN EXP OBSTET GYN 2017. [DOI: 10.12891/ceog3571.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Perales A, Cortés-Giraldo M, Schardt D, Pavón J, Quesada J, Gallardo M. PO-0791: Determination of water mean ionization potential for Geant4 simulations of therapeutical ion beams. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31228-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Romero R, Conde‐Agudelo A, El‐Refaie W, Rode L, Brizot ML, Cetingoz E, Serra V, Da Fonseca E, Abdelhafez MS, Tabor A, Perales A, Hassan SS, Nicolaides KH. Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data. Ultrasound Obstet Gynecol 2017; 49:303-314. [PMID: 28067007 PMCID: PMC5396280 DOI: 10.1002/uog.17397] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the efficacy of vaginal progesterone for the prevention of preterm birth and neonatal morbidity and mortality in asymptomatic women with a twin gestation and a sonographic short cervix (cervical length ≤ 25 mm) in the mid-trimester. METHODS This was an updated systematic review and meta-analysis of individual patient data (IPD) from randomized controlled trials comparing vaginal progesterone with placebo/no treatment in women with a twin gestation and a mid-trimester sonographic cervical length ≤ 25 mm. MEDLINE, EMBASE, POPLINE, CINAHL and LILACS (all from inception to 31 December 2016), the Cochrane Central Register of Controlled Trials, Research Registers of ongoing trials, Google Scholar, conference proceedings and reference lists of identified studies were searched. The primary outcome measure was preterm birth < 33 weeks' gestation. Two reviewers independently selected studies, assessed the risk of bias and extracted the data. Pooled relative risks (RRs) with 95% confidence intervals (CI) were calculated. RESULTS IPD were available for 303 women (159 assigned to vaginal progesterone and 144 assigned to placebo/no treatment) and their 606 fetuses/infants from six randomized controlled trials. One study, which included women with a cervical length between 20 and 25 mm, provided 74% of the total sample size of the IPD meta-analysis. Vaginal progesterone, compared with placebo/no treatment, was associated with a statistically significant reduction in the risk of preterm birth < 33 weeks' gestation (31.4% vs 43.1%; RR, 0.69 (95% CI, 0.51-0.93); moderate-quality evidence). Moreover, vaginal progesterone administration was associated with a significant decrease in the risk of preterm birth < 35, < 34, < 32 and < 30 weeks' gestation (RRs ranging from 0.47 to 0.83), neonatal death (RR, 0.53 (95% CI, 0.35-0.81)), respiratory distress syndrome (RR, 0.70 (95% CI, 0.56-0.89)), composite neonatal morbidity and mortality (RR, 0.61 (95% CI, 0.34-0.98)), use of mechanical ventilation (RR, 0.54 (95% CI, 0.36-0.81)) and birth weight < 1500 g (RR, 0.53 (95% CI, 0.35-0.80)) (all moderate-quality evidence). There were no significant differences in neurodevelopmental outcomes at 4-5 years of age between the vaginal progesterone and placebo groups. CONCLUSION Administration of vaginal progesterone to asymptomatic women with a twin gestation and a sonographic short cervix in the mid-trimester reduces the risk of preterm birth occurring at < 30 to < 35 gestational weeks, neonatal mortality and some measures of neonatal morbidity, without any demonstrable deleterious effects on childhood neurodevelopment. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- R. Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of Health, Department of Health and Human ServicesBethesda, MD and DetroitMIUSA
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMIUSA
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMIUSA
- Center for Molecular Medicine and GeneticsWayne State UniversityDetroitMIUSA
| | - A. Conde‐Agudelo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of Health, Department of Health and Human ServicesBethesda, MD and DetroitMIUSA
- Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitMIUSA
| | - W. El‐Refaie
- Department of Obstetrics and Gynecology, Mansoura University HospitalsMansoura UniversityMansouraEgypt
| | - L. Rode
- Center of Fetal Medicine and Pregnancy, Department of ObstetricsCopenhagen University HospitalRigshospitaletCopenhagenDenmark
- Department of Clinical BiochemistryHerlev and Gentofte HospitalHerlevDenmark
| | - M. L. Brizot
- Department of Obstetrics and GynecologySão Paulo University Medical SchoolSão PauloBrazil
| | - E. Cetingoz
- Department of Obstetrics and GynecologyZeynep Kamil Women and Children Diseases Education and Research HospitalUskudarIstanbulTurkey
| | - V. Serra
- Maternal‐Fetal Medicine Unit, Instituto Valenciano de InfertilidadUniversity of ValenciaValenciaSpain
- Department of Pediatrics, Obstetrics and GynecologyUniversity of ValenciaValenciaSpain
| | - E. Da Fonseca
- Departamento de Obstetrícia e Ginecologia, Hospital do Servidor Publico Estadual ‘Francisco Morato de Oliveira’ and School of MedicineUniversity of São PauloSão PauloBrazil
| | - M. S. Abdelhafez
- Department of Obstetrics and Gynecology, Mansoura University HospitalsMansoura UniversityMansouraEgypt
| | - A. Tabor
- Center of Fetal Medicine and Pregnancy, Department of ObstetricsCopenhagen University HospitalRigshospitaletCopenhagenDenmark
- University of CopenhagenFaculty of Health SciencesCopenhagenDenmark
| | - A. Perales
- Department of Pediatrics, Obstetrics and GynecologyUniversity of ValenciaValenciaSpain
- Department of ObstetricsUniversity Hospital La FeValenciaSpain
| | - S. S. Hassan
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of Health, Department of Health and Human ServicesBethesda, MD and DetroitMIUSA
- Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitMIUSA
| | - K. H. Nicolaides
- Harris Birthright Research Centre for Fetal MedicineKing's College HospitalLondonUK
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Rodriguez E, Zamora JO, Monfort IR, Rubert L, Fuster S, Diago V, Perales A. Unusual twin pregnancy: complete hydatidiform mole with coexistent normal fetus. CLIN EXP OBSTET GYN 2017; 44:492-493. [PMID: 29949305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The authors present a case of complete hydatidiform mole and coexisting fetus (CHMCF) in which mole gestation caused a placenta previa; with a posterior preterm premature rupture of membranes (PPROM) and ending in the 28h week of gestation due to acute chorioamnionitis, obtaining a live preterm newborn.
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Perales A. Medicina centrada en la persona: del concepto a la acción. Rev Peru Med Exp Salud Publica 2016; 33:605-606. [DOI: 10.17843/rpmesp.2016.334.2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/23/2016] [Indexed: 11/06/2022] Open
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26
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Valle R, Perales A. [New rules for medical residency qualification in Peru: problems and perspectives]. Rev Peru Med Exp Salud Publica 2016; 33:357-361. [PMID: 27656938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/06/2016] [Indexed: 06/06/2023] Open
Abstract
On May 11, 2015, amendment RS 017-2015-SA to the Regulation of the National System of Medical Residency (RS 002-2006-SA) was published in the Peruvian official newspaper "El Peruano". This amendment establishes that the submission of a thesis or scholarly work is not necessary to obtain the title of medical specialist (article 28), but when a "work project" is performed in a specialty area, it must be presented at the conclusion of the second year of medical residency (article 27). This news has been welcomed by one sector of medical residents, while others believe that the measure conflicts with their training as specialists. This article aims to analyze the new rules for medical residency qualification in Peru and its implications for research developed during this formative stage for specialist physicians.
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27
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Perales A. Ethics, psychiatry and mental health. ACTA BIOETH 2016. [DOI: 10.4067/s1726-569x2016000100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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28
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Valle R, Perales A. Nueva normativa de titulación en el residentado médico en el Perú: problemas y perspectivas. Rev Peru Med Exp Salud Publica 2016. [DOI: 10.17843/rpmesp.2016.332.2142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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29
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Pamplona Bueno L, Ferri Folch B, Juárez Pallarés I, Akhoundova F, Desantes Real D, Pérez Martínez G, Diago Almela VJ, Perales A. Haemoperitoneum after spontaneous vaginal delivery due to uterine artery pseudoaneurysm rupture. J OBSTET GYNAECOL 2016; 36:670-1. [PMID: 26790042 DOI: 10.3109/01443615.2015.1134457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- L Pamplona Bueno
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - B Ferri Folch
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - I Juárez Pallarés
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - F Akhoundova
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - D Desantes Real
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - G Pérez Martínez
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - V J Diago Almela
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - A Perales
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
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Affiliation(s)
- Rubén Valle
- Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi. Lima, Perú.,Facultad de Medicina. Universidad Nacional Mayor de San Marcos. Lima, Perú
| | - Alberto Perales
- Facultad de Medicina. Universidad Nacional Mayor de San Marcos. Lima, Perú.,Instituto de Ética en Salud, Universidad Nacional Mayor de San Marcos. Lima, Perú
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Mezzich JE, Perales A. [Person centered clinical care: principles and strategies]. ACTA ACUST UNITED AC 2016; 33:794-800. [PMID: 28327852 DOI: 10.17843/rpmesp.2016.334.2567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/23/2016] [Indexed: 11/06/2022]
Abstract
The development of person-centered clinical care is inscribed within an international programmatic movement towards a medicine focused on the totality of the person. This movement, with broad historical bases, has been maturing since 2008 through conferences among global health institutions, research projects and academic publications. This paper is aimed at elucidating the conceptual principles of person-centered medicine (PCM) and to delineate strategies for the practical application of such principles in clinical care services. The above objectives have been approached through literature reviews, international consultations, and reflections on the patterns and indications obtained. The principles identified for person-centered medicine are the following: Ethical commitment, holistic framework, cultural awareness and responsiveness, communication and relational focus, individualized clinical care, common ground among clinicians, patient and family for joint diagnostic understanding and shared decision making, person- and community-centered organization of integrated services, and person-centered medical education and research. Additionally, pertinent strategies have been delineated for the implementation of such principles in clinical care. The authors conclude that the presented principles and strategies are consistent with suggestions offered in the literature and may serve as bases for the design of indices and scales. Their continuous refinement is proposed through future international and local studies. to clarify the key concepts of the movement as well as strategies for their practical clinical application.
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Affiliation(s)
- Juan Enrique Mezzich
- Icahn School of Medicine at Mount Sinai. New York, EE.UU.,Colegio Internacional de Medicina Centrada en la Persona. New York, EE.UU
| | - Alberto Perales
- Instituto de Ética en Salud. Lima, Perú.,Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú
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Perales A, Mendoza J, Armas R, Cluzet O. [Latin American perspectives on person-centered medicine]. Rev Peru Med Exp Salud Publica 2016; 33:801-810. [PMID: 28327853 DOI: 10.17843/rpmesp.2016.334.2568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/23/2016] [Indexed: 11/06/2022] Open
Abstract
Person-centered medicine (PCM) is a programmatic global initiative led by the International College of Person-Centered Medicine. It has recently emerged in Latin America. It requires the use of scientific research as an instrument to generate the best clinical evidence, and humanism as the essence of medicine to help mankind. It is focused on not only combatting disease but also promoting the display of healthy human being potentials towards achieving well-being and comprehensive growth. Although the humanism of medicine in Latin America has been a distinctive characteristic of its practice, now, there is a worrying decline in its impact on healthcare. This article summarizes the Latin American perspective from four countries. Needs and experiences are compared and responses that arise in view of the dehumanizing influence of technology and health management as a consumption good are described.
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Affiliation(s)
- Alberto Perales
- Facultad de Medicina, Instituto de Ética en Salud, Universidad Nacional Mayor de San Marcos. Lima, Perú
| | - Juan Mendoza
- Universidad Nacional de Colombia. Colombia.,Academia Nacional de Medicina de Colombia. Colombia.,Facultad de Medicina, Colegio Mayor de Nuestra Señora del Rosario. Bogotá, Colombia
| | | | - Oscar Cluzet
- Academia Nacional de Medicina de Uruguay. Uruguay
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Rubert L, Lozoya T, Monfort R, Domingo S, Diago V, Perales A. Obstetric outcomes after a radical trachelectomy complicated with haematometra: A case report. J OBSTET GYNAECOL 2015; 36:424-5. [PMID: 26466847 DOI: 10.3109/01443615.2015.1086987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- L Rubert
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
| | - T Lozoya
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
| | - R Monfort
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
| | - S Domingo
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
| | - V Diago
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
| | - A Perales
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
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Kindinger LM, Poon LC, Cacciatore S, MacIntyre DA, Fox NS, Schuit E, Mol BW, Liem S, Lim AC, Serra V, Perales A, Hermans F, Darzi A, Bennett P, Nicolaides KH, Teoh TG. The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis. BJOG 2015; 123:877-84. [PMID: 26333191 DOI: 10.1111/1471-0528.13575] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the effect of gestational age (GA) and cervical length (CL) measurements at transvaginal ultrasound (TVUS) in the prediction of preterm birth in twin pregnancy. DESIGN Individual patient data (IPD) meta-analysis. SETTING International multicentre study. POPULATION Asymptomatic twin pregnancy. METHODS MEDLINE and EMBASE searches were performed and IPD obtained from authors of relevant studies. Multinomial logistic regression analysis determined probabilities for birth at ≤28(+0) , 28(+1) to 32(+0) , 32(+1) to 36(+0) , and ≥36(+1) weeks as a function of GA at screening and CL measurements. MAIN OUTCOME MEASURES Predicted probabilities for preterm birth at ≤28(+0) , 28(+1) to 32(+0) , and 32(+1) to 36(+0) . RESULTS A total of 6188 CL measurements were performed on 4409 twin pregnancies in 12 studies. Both GA at screening and CL had a significant and non-linear effect on GA at birth. The best prediction of birth at ≤28(+0) weeks was provided by screening at ≤18(+0) weeks (P < 0.001), whereas the best prediction of birth between 28(+1) and 36(+0) weeks was provided by screening at ≥24(+0) weeks (P < 0.001). Negative prediction value of 100% for birth at ≤28(+0) weeks is achieved at CL 65 mm and 43 mm at ultrasound GA at ≤18(+0) weeks and at 22(+1) to 24(+0) weeks, respectively. CONCLUSION In twin pregnancies, prediction of preterm birth depends on both CL and the GA at screening. When CL is <30 mm, screening at ≤18(+0) weeks is most predictive for birth at ≤28(+0) weeks. Later screening at >22(+0) weeks is most predictive of delivery at 28(+1) to 36(+0) weeks. In twins, we recommend CL screening in twins to commence from ≤18(+0) weeks. TWEETABLE ABSTRACT An individual patient meta-analysis assessing gestation and CL in the prediction of preterm birth in twins.
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Affiliation(s)
- L M Kindinger
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK.,Fetal Medicine Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - L C Poon
- Fetal Medicine Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.,Harris Birthright Research Centre for Fetal Medicine, Kings College Hospital, London, UK
| | - S Cacciatore
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - D A MacIntyre
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - N S Fox
- Maternal Fetal Medicine Associates, PLLC, New York, NY, USA
| | - E Schuit
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - B W Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia
| | - S Liem
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - A C Lim
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - V Serra
- Maternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of Valencia, Valencia, Spain
| | - A Perales
- Department of Paediatrics, Obstetrics and Gynaecology, La FE, University and Polytechnic Hospital, University of Valencia, Valencia, Spain
| | - F Hermans
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - A Darzi
- Department of Academic Surgery, St Marys Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - P Bennett
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Kings College Hospital, London, UK
| | - T G Teoh
- Fetal Medicine Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Wagner P, Perales A, Armas R, Codas O, De los Santos R, Elio Calvo D, Mendoza Vega J, Arce M, Calderón JL, Llosa L, Saavedra J, Ugarte O, Vildózola H, Mezzich JE. Bases y Perspectivas Latinoamericanas sobre Medicina y Salud Centradas en la Persona. An Fac med 2015. [DOI: 10.15381/anales.v76i1.11077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Antecedentes: Este artículo emerge como parte de un proceso liderado por la Academia Nacional de Medicina del Perú en estrecha colaboración con otras Academias de Medicina Latinoamericanas, e importantes instituciones universitarias y profesionales relacionadas con la salud. Objetivo: Describir y fundamentar la importancia de la Medicina Centrada en la Persona (MCP) en el contexto latinoamericano. Metodología: Revisión de artículos y experiencias latinoamericanas sobre el tema, realización de reuniones académicas para deliberar sobre contenidos afines, dos preliminares en Lima en diciembre 2013 y enero 2014, una tercera en Buenos Aires, a propósito del 2° Congreso Internacional de Medicina Centrada en la Persona, con la presencia de las Academias de Medicina de Argentina, Bolivia, Chile y Perú (noviembre 2014) y una cuarta en Lima, Reunión de las Academias de Medicina de Bolivia, Colombia, Chile, Paraguay y Perú (diciembre 2014). Resultados: Se puntualizan los precedentes históricos y contemporáneos, universales y locales, pertinentes a la gestación y desarrollo de una re-priorización de la medicina en torno a la persona y su contexto, articulando para el efecto ciencia y humanismo. Se discute el nivel filosófico del concepto Persona en medicina, incluyendo bases terminológicas, históricas, y derechos humanos. Sobre estas bases se examina la evolución de los conceptos centrales de la MCP, resaltando su pertinencia tanto en la medicina clínica como en la salud pública, la atención, educación e investigación y las políticas en salud. Con respecto a la práctica y educación clínicas, se plantea la noción de MCP como principio estratégico fundamental, sus aplicaciones educacionales programáticas, y su posible institucionalización a nivel de facultades de medicina. Se resalta la importancia de la formación en ética y comunicación clínica y del apropiado uso de la tecnología y la evidencia científica al servicio de la persona. Se incluyen posibilidades institucionales disponibles para la educación inter-disciplinaria de los profesionales de la salud así como perspectivas educacionales latinoamericanas. Se destaca la importancia de la investigación científica sobre la MCP, abarcando estudios sobre conceptualización, medición y diagnóstico incluyendo la necesidad de elaborar instrumentos narrativos complementarios. Finalmente, se consideran perspectivas sobre políticas de salud centradas en la persona y la comunidad así como aportes y recomendaciones derivados de la experiencia latinoamericana en este tema. Conclusiones: La Medicina Centrada en la Persona valora los avances biológicos, psicológicos y socio-culturales y los procesa dentro del marco de la totalidad de la persona, articulando la ciencia como instrumento esencial y el humanismo como la esencia de la medicina. Frente a formulaciones epistemológicas reduccionistas, la MCP propone una medicina informada por la evidencia y la experiencia y orientada a la persona en su totalidad.
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Ye-Lin Y, Alberola-Rubio J, Prats-Boluda G, Bueno Barrachina JM, Perales A, Valero J, Desantes D, Garcia-Casado J. Non-invasive electrohysterogram recording using flexible concentric ring electrode. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:4050-3. [PMID: 25570881 DOI: 10.1109/embc.2014.6944513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Non-invasive electrohysterogram (EHG) recording could provide valuable information about uterine dynamics. Bipolar EHG has usually been performed using monopolar disposable electrodes. Recently concentric ring electrodes have been used for EHG recordings so as to acquire more localized electrical activity which may be helpful for deducing uterine contraction efficiency. Nevertheless concentric ring electrodes have commonly been implemented in rigid substrates. Therefore they do not adapt to the body surface curvature which may cause discomfort for patients and a poor contact between electrode and skin. The aim of this paper is to examine the feasibility of picking up EHG signals (BC-EHG) using a new flexible tripolar concentric ring (TCR) electrode placed on the abdominal surface, and to compare it with the conventional bipolar recordings. For this purpose, a total of 7 recording sessions were carried out in 7 pregnant women. Each recording implied simultaneous acquisition of one bipolar EHG signal and of two bipolar concentric EHG (BC-EHG) signals using the flexible TCR electrode. Then a set of temporal and spectral parameters was computed from both bipolar EHG and BC-EHG bursts. Experimental results show no noticeable difference in duration and in dominant frequency in Fast Wave High frequency range. Nonetheless, the low frequency content (0.1-0.2 Hz) of BC-EHG records is smaller than that of bipolar record. These results suggest that the new flexible TCR electrode permits to pick up uterine electrical activity and may provide additional information for deducing uterine efficiency.
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Ye-Lin Y, Alberola-Rubio J, Prats-Boluda G, Perales A, Desantes D, Garcia-Casado J. Feasibility and analysis of bipolar concentric recording of electrohysterogram with flexible active electrode. Ann Biomed Eng 2014; 43:968-76. [PMID: 25274161 DOI: 10.1007/s10439-014-1130-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/19/2014] [Indexed: 11/25/2022]
Abstract
The conduction velocity and propagation patterns of the electrohysterogram (EHG) provide fundamental information on the electrophysiological condition of the uterus. However, the accuracy of these measurements can be impaired by both the poor spatial selectivity and sensitivity to the relative direction of the contraction propagation associated with conventional disc electrodes. Concentric ring electrodes could overcome these limitations. The aim of this study was to examine the feasibility of picking up surface EHG signals using a new flexible tripolar concentric ring electrode (TCRE), and to compare these signals with conventional bipolar recordings. Simultaneous recording of conventional bipolar signals and bipolar concentric EHG (BC-EHG) were carried out on 22 pregnant women. Signal bursts were characterized and compared. No significant differences were found between the channels in either duration or dominant frequency in the Fast Wave High frequency range. Nonetheless, the high pass filtering effect of the BC-EHG recordings gave lower frequency content between 0.1 and 0.2 Hz. Although the BC-EHG signal amplitude was about 5-7 times smaller than that of bipolar recordings, a similar signal-to-noise ratio was obtained. These results suggest that the flexible TCRE is able to pick up uterine electrical activity and could provide additional information for deducing the uterine electrophysiological condition.
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Affiliation(s)
- Y Ye-Lin
- Institute of Research and Innovation in Bioengineering, Universidad Politécnica de Valencia, Camino de Vera s/n Ed.7F, 46022, Valencia, Spain,
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Schuit E, Stock S, Rode L, Rouse DJ, Lim AC, Norman JE, Nassar AH, Serra V, Combs CA, Vayssiere C, Aboulghar MM, Wood S, Çetingöz E, Briery CM, Fonseca EB, Worda K, Tabor A, Thom EA, Caritis SN, Awwad J, Usta IM, Perales A, Meseguer J, Maurel K, Garite T, Aboulghar MA, Amin YM, Ross S, Cam C, Karateke A, Morrison JC, Magann EF, Nicolaides KH, Zuithoff NPA, Groenwold RHH, Moons KGM, Kwee A, Mol BWJ. Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis. BJOG 2014; 122:27-37. [PMID: 25145491 DOI: 10.1111/1471-0528.13032] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). OBJECTIVES To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies using individual participant data meta-analysis (IPDMA). SEARCH STRATEGY We searched international scientific databases, trial registration websites, and references of identified articles. SELECTION CRITERIA Randomised clinical trials (RCTs) of 17-hydroxyprogesterone caproate (17Pc) or vaginally administered natural progesterone, compared with placebo or no treatment. DATA COLLECTION AND ANALYSIS Investigators of identified RCTs were asked to share their IPD. The primary outcome was a composite of perinatal mortality and severe neonatal morbidity. Prespecified subgroup analyses were performed for chorionicity, cervical length, and prior spontaneous PTB. MAIN RESULTS Thirteen trials included 3768 women and their 7536 babies. Neither 17Pc nor vaginal progesterone reduced the incidence of adverse perinatal outcome (17Pc relative risk, RR 1.1; 95% confidence interval, 95% CI 0.97-1.4, vaginal progesterone RR 0.97; 95% CI 0.77-1.2). In a subgroup of women with a cervical length of ≤25 mm, vaginal progesterone reduced adverse perinatal outcome when cervical length was measured at randomisation (15/56 versus 22/60; RR 0.57; 95% CI 0.47-0.70) or before 24 weeks of gestation (14/52 versus 21/56; RR 0.56; 95% CI 0.42-0.75). AUTHOR'S CONCLUSIONS In unselected women with an uncomplicated twin gestation, treatment with progestogens (intramuscular 17Pc or vaginal natural progesterone) does not improve perinatal outcome. Vaginal progesterone may be effective in the reduction of adverse perinatal outcome in women with a cervical length of ≤25 mm; however, further research is warranted to confirm this finding.
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Affiliation(s)
- E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands
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Abstract
Propósito: Estudiar la vocación médica desde una perspectiva científica. Objetivos: Analizar la vocación médica respecto a sus orígenes yfactores asociados a su desarrollo en médicos considerados ejemplos de conducta profesional y vocación médica. Diseño: Investigación cualitativa,con muestreo de caso típico y entrevistas en profundidad. Institución: Instituto de Ética en Salud, Facultad de Medicina, Universidad NacionalMayor de San Marcos, Lima, Perú. Participantes: Médicos. Metodología: La muestra estuvo conformada por 76 médicos seleccionados enbase a criterios pre-establecidos, miembros de las cuatro instituciones médicas más prestigiadas del país: Academia Nacional de Medicina,Academia Peruana de Cirugía y Facultades de Medicina de la Universidad Nacional Mayor de San Marcos y Universidad Peruana CayetanoHeredia. Se obtuvo su consentimiento informado. Principales medidas de resultados: Orígenes y factores asociados a vocación médica.Resultados: El 82% correspondió al sexo masculino; edad promedio 71,6 años, con rango de edad 49 a 88 años; 8% era hijo/a de médicoy 14% tenía otro familiar médico; 30% era el/la mayor de los hijos. La vocación médica no siguió un patrón único, pudiendo iniciarseen diferentes momentos del ciclo vital, incluso después de que el alumno hubo ingresado a la Facultad de Medicina. Entre los factoresexplicativos más frecuentemente asociados destacaron una dinámica personal y la influencia familiar, aunque hubo dos casos en los que nose encontró factor explicativo alguno. A base de los resultados se presenta definiciones de vocación y vocación médica. Conclusiones: Elanálisis de la información permite entender la vocación médica como un proceso que se genera en un ser humano en virtud de dos factores:uno individual y otro social (entorno que estimula su desarrollo). Su inicio puede ocurrir a edades y en formas variadas constituyéndose,finalmente, en parte del ‘proyecto de ser’ (se dan ejemplos específicos).
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Valle R, Sánchez E, Perales A. [Depressive symptomatology and alcohol-related problems during the academic training of medical students]. Rev Peru Med Exp Salud Publica 2014; 30:54-7. [PMID: 23612813 DOI: 10.1590/s1726-46342013000100011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 01/23/2013] [Indexed: 11/22/2022] Open
Abstract
In order to evaluate the frequency of depressive symptomatology (DS) and alcohol-related problems (ARP) during the academic training of medical students from Universidad Nacional Mayor de San Marcos, a cross-sectional study was conducted among students from first to sixth year of career. The Zung Self-Rating depression scale was used to evaluate DS and the CAGE questionnaire to evaluate ARP. 23.3% of participants had DS, and 7.3% had ARP. We found that the frequency of DS and ARP was higher among students in the first years of career. We recommend it is necessary to take action in the prevention and detection of these disorders from the first years of training of medical students.
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Affiliation(s)
- Rubén Valle
- Facultad de Medicina Humana San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú.
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Abstract
Objetivo: Evaluar las percepciones y desarrollo de la vocación médica en estudiantes de medicina de una universidad peruana. Diseño: Estudio cualitativo. Institución: Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Participantes: Estudiantes de medicina. Métodos: Se realizó entrevistas semiestructuradas a 50 estudiantes de medicina, de primero a quinto año. Se indagó sobre: 1) definición de vocación, 2) definición de vocación médica, y 3) el desarrollo de su propia vocación médica. Principales medidas de resultados: Comparación de vocación médica entre los alumnos actuales y la de médicos ya realizados. Resultados: La mitad de los entrevistados fue de sexo femenino, edad promedio 21,7 años; 8% era hijo/a de médico; 82% era natural de Lima Metropolitana. Los estudiantes identificaron que la vocación médica tiene tres características: aspiración a ayudar, voluntad de servicio y espíritu de sacrificio. Sobre el desarrollo de su propia vocación, la decisión para estudiar medicina puede forjarse en la niñez temprana o en la adolescencia y, aún, ser incipiente al momento de ingresar a la Facultad de Medicina, siendo influenciada por diversas vivencias, dentro de las que destacan contactos con familiares médicos o con médicos en el curso de alguna enfermedad que los estudiantes padecieron. También existe influencia familiar e interés en relación al prestigio social. Conclusiones: Comparativamente, la vocación médica de los alumnos actuales y la de médicos ya realizados, muestran similitudes y diferencias. Entre los aspectos similares, un patrón de aspirante a médico altruista con motivaciones espirituales, económicas y sociales. En las diferencias, las motivaciones externas son más influyentes en los estudiantes actuales para iniciarse en la medicina así como una fascinación por el desarrollo tecnológico. Al respecto, se dan recomendaciones a los centros formadores.
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Perales A, Sánchez E, Parhuana A, Carrera R, Torres H. Conducta suicida en estudiantes de la escuela de nutrición de una universidad pública peruana. Rev Neuropsiquiatr 2014. [DOI: 10.20453/rnp.v76i4.1172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objetivos: Estimar la prevalencia de vida de la conducta suicida y variables asociadas en estudiantes de nutrición de una universidad pública peruana. Material y métodos: Estudio descriptivo y analítico, de corte transversal. Del universo de 322 alumnos, los estudiantes del 5º año, no pudieron participar, lo cual redujo la población total a 269 (de 1º. a 4º. años). De estos, 131 (49 %) aceptaron la encuesta voluntariamente. Se aplicaron cuestionarios previamente validados sobre conducta suicida y pensamiento homicida, escalas de Ansiedad y Depresión de Zung, indicadores de conducta antisocial y CAGE (problemas relacionados con uso de alcohol). Para la búsqueda de asociaciones se realizaron análisis bivariados, considerándose estadísticamente significativo un p<0,05. Resultados: La prevalencia de vida de la conducta suicida global fue de 39,5%: (deseos de morir, 35,2%; pensamiento suicida, 20%; plan suicida, 8,1% e intento suicida, 9,4%); de ideación homicida, 13,9% y de indicadores de conducta antisocial, 27,5%. prevalencia puntual de depresión 4,6%; de ansiedad 3,1%; y CAGE positivo, 5,2%. En el análisis bivariado la conducta suicida global se asoció en forma significativa a ideación homicida, OR 9,07, (IC 95% 2,41-34,10) p<0,001 y al tipo de familia: vivir con familia nuclear constituye un factor protector: OR 0,38, (IC 95% 0,15-0,97) p<0,039. El intento suicida estuvo asociado a indicadores de conducta antisocial, OR: 4,93, (IC 95% 2,09-11,65) p<0,001. Conclusión: Uno de cada 11 estudiantes de la Escuela materia de este estudio ha intentado suicidarse, por lo menos una vez durante su vida. Este tipo de conducta se halla generalmente asociado a otros problemas de salud mental.
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Perales A. Acerca del estudio de la psicopatología general y transcultural. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2013.301.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Valle R, Sánchez E, Perales A. Sintomatología depresiva y problemas relacionados al consumo de alcohol durante la formación académica de estudiantes de medicina. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2013.301.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Borras D, Perales-Puchalt A, Ruiz Sacedón N, Perales A. Angiogenic growth factors in maternal and fetal serum in pregnancies complicated with intrauterine growth restriction. J OBSTET GYNAECOL 2014; 34:218-20. [DOI: 10.3109/01443615.2013.834304] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Perales A. Ética, bioética y medicina. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2011.284.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Perales A, Chue H, Padilla A, Barahona L. Estrés, ansiedad y depresión en magistrados de Lima, Perú. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2011.284.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Gonzalez-Coloma A, Hernandez MG, Perales A, Fraga BM. Chemical ecology of canarian laurel forest: Toxic diterpenes fromPersea indica (Lauraceae). J Chem Ecol 2013; 16:2723-33. [PMID: 24264325 DOI: 10.1007/bf00988081] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/1989] [Accepted: 03/29/1990] [Indexed: 11/25/2022]
Abstract
The tree speciesP. indica (Lauraceae) is an important endemism in the Canary Islands laurel forest and can readily be distinguished by its defoliated appearance due to the seasonal action of wild rats (Rattus rattus), which eat the plant and become intoxicated. These observations and the phytochemical interest of this plant species led us to study the potentially toxic chemicals responsible for such action. We found that an ethanolic extract ofP. indica and its water fraction were toxic when injected into laboratory mice. The mice also died after ingestion of the stems and showed a significant preference for those extracted and rehydrated with an 8% aqueous extract solution when compared with the water control. Two compounds that have been isolated from the toxic fraction and identified by spectroscopic methods are the polyhydroxy pentacyclic diterpenes ryanodol and cinnceylanol. Possible ecological implications are discussed.
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Affiliation(s)
- A Gonzalez-Coloma
- Instituto de Productos Naturales Orgánicos, C. S. I. C., Ave. Astrofísico F. Sanchez, 2. La Laguna, 38206, Tenerife, Canary Islands, Spain
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Pérez-Sancho M, García-Seco T, Arrogante L, García N, Martínez I, Diez-Guerrier A, Perales A, Goyache J, Domínguez L, Álvarez J. Development and evaluation of an IS711-based loop mediated isothermal amplification method (LAMP) for detection of Brucella spp. on clinical samples. Res Vet Sci 2013; 95:489-94. [DOI: 10.1016/j.rvsc.2013.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/14/2013] [Accepted: 05/04/2013] [Indexed: 11/16/2022]
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Abstract
Objetivos: Delimitar la vocación médica como objeto de investigación y plantear hipótesis para permitir su estudio científico. Métodos: Revisión de la literatura internacional y nacional pertinentes, elaborando preguntas de investigación. Resultados: La literatura revisada muestra una insuficiente delimitación del problema, pobre presencia del método científico para su estudio y abundancia de reflexiones de médicos paradigmáticos sobre su esencia. Conclusiones: Frente al riesgo actual de la deshumanización del ejercicio de la medicina y de los sistemas de atención de salud de someterse a la presión económica de las leyes del mercado, urge crear conocimiento válido sobre la vocación médica, para que las Facultades de Medicina puedan aplicarlo, tanto en los exámenes de selección de candidatos cuanto en el proceso de formación profesional.
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