Artículos FCS INSIS

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    El enfoque curricular centrado en competencias: sus beneficios en educación en ciencias de la salud
    (2023-09-06) Olga Jape Collins
    Se presenta una revisión bibliográfica determinando beneficios fundamentales de la implementación del enfoque basado en competencias en la educación en Ciencias de la Salud. El objetivo primordial fue analizar cómo este enfoque fomenta habilidades interpersonales, comunicación efectiva, adaptabilidad, integración teoría-práctica y evaluación precisa del rendimiento estudiantil en este campo crucial. El método de revisión se basó en una búsqueda exhaustiva y un análisis crítico de investigaciones, artículos y libros relacionados con la educación en salud y el desarrollo de competencias en este contexto, para respaldar y enriquecer las afirmaciones realizadas. Los resultados de esta revisión en progreso demuestran que la perspectiva basada en competencias fortalece significativamente la formación de profesionales altamente competentes en Ciencias de la Salud, preparándolos para enfrentar los desafíos complejos de la atención en salud contemporánea. La relevancia de este enfoque curricular metodología radica en su capacidad para alinear la educación con las demandas de un mundo cambiante. Además, la integración de la evaluación precisa del rendimiento estudiantil en este enfoque garantiza que los egresados estén realmente preparados para ejercer en un entorno profesional exigente y para contribuir de manera significativa a la mejora de la atención clínica individual y la salud colectiva. En conclusión, la inclusión del enfoque basado en competencias en la educación en Ciencias de la Salud proporciona a los estudiantes una sólida base para abordar las diversas situaciones en el entorno de la salud y les dota de habilidades esenciales para trabajar en equipos interdisciplinarios y comunicarse eficientemente con pacientes y colegas.
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    Evaluation of the short-term response in refractory trigeminal neuralgia treated with CyberKnife
    (2023-11-06) Maricely Ámbar Pérez Fernández
    Objectives. Stereotactic radiosurgery combined with pharmacological treatment is currently one of the most acceptable alternatives for the treatment of trigeminal neuralgia (TN). Our primary endpoint was to report the short-term response (one month) outcomes of 10 patients with refractory TN after CyberKnife® (CK) radiosurgery; secondary endpoints were to assess early side effects and complications. Methods. Ten female patients with TN refractory to pharmacological and/or nonpharmacological treatment received a single dose of 90 Gy with CyberKnife® radiosurgery. Clinical and demographic characteristics were obtained from medical records. The visual analog scale (VAS) was used to assess facial pain before as well as seven, 15, and 30 days after treatment. Friedman test was performed to evaluate pain relief in treated patients. Results. All patients responded well to the CK and experienced initial adequate pain relief during the first 30 days (p<0.001). No significant differences (p=0.661) were found between six patients who received CK radiosurgery as the first treatment option and those who underwent other non-pharmacological treatments. One patient was re-irradiated with 75 Gy. Transient facial paresthesia was observed in 3/10 patients without any other complications. Conclusion. High-tech CK treatment is safe, non-invasive, fast, with minimal side effects, and effective in achieving short-term pain relief in patients with refractory TN, even in those with multiple previous interventions. Given these results, we recommend evaluating CK radiosurgery as the first-line treatment of choice for trigeminal neuralgia refractory to pharmacological treatment.
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    Exploring feasibility and acceptability of an integrated urban gardens and peer nutritional couseling intervention for people with HIV in the Dominican Republic
    (2023-10-31) Amarilis Then Paulino
    Objective. Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up. Design. Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants (n 45) and qualitative data from a purposive sample of participants (n 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively. Setting. An HIV clinic in the northwest-central part of the Dominican Republic. Results. The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93–96 %) rated the gardening as ‘helpful’ or ‘very helpful’ for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89–97 %) rated the nutrition counselling ‘helpful’ or ‘very helpful’ for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants’ households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation. Conclusion. An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit.
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    Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic
    (2023-08-24) Amarilis Then Paulino
    HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men’s experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women’s experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to “move on” and “look ahead.” Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.
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    Influencia de la maestría en Salud Pública en el contexto laboral de sus egresados
    (2023-07-30) Olga Jape Collins
    La maestría en Salud Pública persigue calificar a sus egresados para la conducción, análisis y negociación, así como forjar cambios y un ejercicio de la salud pública apoyado en nuevos conocimientos teóricos y prácticos y que esto les insertarse favorablemente en los sistemas sanitarios. Con el objetivo de determinar la influencia de la Maestría en Salud Pública en el contexto laboral de sus egresados, se realizó una investigación no experimental, transversal, descriptiva y retrospectiva, sustentada en la selección de una muestra por conveniencia de 46 de los 99 egresados de las 7 cohortes desarrolladas entre los años 1983 y 2000. Se exploraron 8 aspectos del contexto laboral, a través de la técnica encuesta, con la aplicación de un cuestionario en línea. Los datos cualitativos se analizaron con la técnica triangulación de contenido, los cuantitativos a partir de las técnicas de estadística descriptiva con medidas de tendencia central, frecuencia relativa y valoración media. Los resultados arrojan que la adquisición o cambio de condición magisterial o categoría docente fue conseguida por el 58 por ciento de los egresados. En 92% hubo mejoras de la posición laboral en comparación a la que tenía antes de cursar la maestría. El aspecto “ocupación de puesto laboral de salud pública” fue de los que recibió mayor influencia, siendo esta reflejada en el 83% de la muestra. El estudio evidenció el cambio de situación laboral y mejora de los ingresos económicos, promoción en el puesto. En todos los aspectos abordados hubo algún tipo de influencia demostrando la validez de esta formación para la mejora de la reputación y prestigio.
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    Las prácticas alimentarias: una mirada reflexiva a partir del culto al cuerpo
    (2023-07-30) Ysabel Noemí Tejeda
    La ingesta de alimentos corresponde a una de las necesidades básicas para el mantenimiento de la vida. Esta acción permite el desarrollo de diversas prácticas impregnadas de significados y subjetividades que responden a las demandas del contexto sobre algunos patrones idealizados de la imagen corporal. El alcance de un ideal físico involucra una gran presión social en la obtención de un cuerpo estandarizado. En la ejecución de éstas acciones pueden existir alteraciones en el equilibrio de los procesos bioquímicos del organismo, así como en las interacciones sociales de los sujetos. El propósito del estudio es inferir los significados de cómo algunos sujetos que adoptan un patrón de vida a partir del culto al cuerpo se apropian y asignan sentido a las prácticas alimentarias. La presente investigación se enmarca dentro del paradigma cualitativo, bajo un enfoque naturalista interpretativo vivencial, el cual supone, por un lado, la construcción de sentido del consumo de los alimentos y por el otro, los distintos modos de construir ese sentido. El diseño metodológico correspondió al método fenomenológico - hermenéutico, el cual estuvo orientado a la descripción e interpretación de las estructuras fundamentales de la experiencia vivida y al reconocimiento del significado del valor de esta experiencia. La técnica de investigación seleccionada fue la entrevista a profundidad o abierta. La unidad de análisis estuvo representada por los discursos emanados de los sujetos claves recogidos en dichas entrevistas, lo cual permitió dar cuenta de los significados construidos a partir de la comprensión, apropiación y asignación de sentido a las prácticas alimentarias de algunos sujetos que adoptan un patrón de vida a partir del culto al cuerpo. El sentido que tiene para estos sujetos corresponde al sentido de construcción y pertenencia, así como la manifestación de poder, de acuerdo a lo establecido en la sociedad contemporánea como “salud, bienestar y belleza”. Las experiencias vividas por los sujetos en el desarrollo de las prácticas alimentarias presentes en este fenómeno social, corresponden a la aceptaciónrechazo de algunos grupos de alimentos, el predominio de ingestas, la selección de métodos de cocción y la utilización de suplementos nutricionales.
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    New option for reliable fast indirect volumetry: the XYZ geo method
    (2023-03-03) Santiago Valenzuela Sosa
    Objectives: present a simple, fast and reliable method to determine the volume of brain pathologies by applying the formula of the geometric figure that best fits the lesion studied. Material and method: retrospective study on 403 tumor lesions of different histology found in 172 patients treated by radiosurgery at the Dominican Gamma Knife Center (CGKD), using 1.5 and 3.0 Tesla MRI images with thin cuts for three-dimensional reconstruction. The volume of each of them was determined following the voxel method (planimetry) in which the edges of the lesion are painted in each slice. We immediately proceeded to determine if the lesion was Ellipsoidal, Cubic, Cuboid or other. More than 98% of the lesions were ellipsoid-shaped, about 1% were cubic. Applying the formula of the figure in question in each case and starting from the center of the structure, the XYZ diameters used internationally to define the stereotactic dimensions of the space were drawn. Thus, the Theoretical Volume was determined, which was compared to the Real Volume of each lesion using the Student’s T Test to establish the Mean between two measurements, then they were correlated using the Wilcoxon Test and the Spearman’s Rang Test. Results: If the lesion was ellipsoidal and we used the correct formula, the result was close to 93% of the Real Volume. If the Ellipsoid formula was applied to a cubic lesion, we obtained 178% of the Real Volume. If a Cubic lesion was measured with the corresponding formula, the result only exceeded the Real Volume by 12%. Conclusion: the XYZ Geo Method offers an option for rapid indirect volumetry very close to the real volume of the intracranial lesion if the geometric formula that best defines the lesion studied is applied, respecting the principles established for measuring its diameters on an imaging platform with option to calculate the three dimensions of stereotactic space (XYZ).
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    Preliminary Effects of an urban gardens and peer nutritional counseling intervention on HIV treatment adherence and detectable viral load among people with HIV and food insecurity: Evidence from a pilot cluster randomized controlled trial in the Dominican Republic
    (2022-09-06) Amarilis Then Paulino
    A pilot cluster randomized controlled trial involving two HIV clinics in the Dominican Republic assessed preliminary efficacy of an urban garden and peer nutritional counseling intervention. A total of 115 participants (52 intervention, 63 control) with moderate or severe food insecurity and sub-optimal antiretroviral therapy (ART) adherence and/or detectable viral load were assessed at baseline, 6- and 12-months. Longitudinal multivariate regression analysis controlling for socio-demographics and accounting for serial cluster correlation found that the intervention: reduced the prevalence of detectable viral load by 20 percentage points at 12 months; reduced any missed clinic appointments by 34 and 16 percentage points at 6 and 12 months; increased the probability of “perfect” ART adherence by 24 and 20 percentage points at 6 and 12 months; and decreased food insecurity at 6 and 12 months. Results are promising and warrant a larger controlled trial to establish intervention efficacy for improving HIV clinical outcomes.
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    Rapid indirect hippocampal volumetry using the XYZ geo method: A useful tool in the diagnosis of cognitive impairment
    (2024-01-10) Santiago Valenzuela Sosa
    Objectives: to compare and validate the doses determined according to the novel method for calculating doses in radiosurgery called the Sosa Model (MS) with the dose protocols of national and international institutions. Material and Method: retrospective study on 403 tumor lesions of different histology found in 172 patients treated by radiosurgery at the Gamma Knife Dominican Center (CGKD), using MRI images of 1.5 and 3.0 Tesla with protocol for neuronavigation. In MS, the Sosa Score (SS) is obtained by adding 3 scores to a constant of 10Gy: Volume Score (VS), Radioresistance Score (RS), Eloquence Score (ES) of the lesion, complying with the formula that supports it. : SS= VS+RS+ES+10. Using the Wilcoxon Signed-Rank Test, it was compared with the conventional doses used in the CGKD, which are similar to those used internationally. Results: most lesions received between 12 and 24 Gy, calculated by both methods. Of the meningiomas treated in the CGKD, 65% received a dose of 12 to 14 Gy. Most of the doses suggested by the MS were between 15 and 18 Gy. On average, metastases treated in CGKD received between 16 and 24 Gy (220 of 247, 89%). The doses recommended by the MS were very close, ranging between 15 and 21 Gy (232 of 247, 93.9%). In Non-Functional Pituitary Adenomas, the MS (17-18 Gy) yields doses above those of the CGKD (12-16 Gy) since it does not include adaptations to protect the visual pathway. In Functional Pituitary Adenomas, MS falls below the particularly high doses (25 to 35 Gy) internationally recommended. The Acoustic Neuromas all received between 12 and 13 Gy in the CGKD and most of the doses recommended by the MS were between 14 and 15 Gy. Conclusions: Comparing the doses used by CGKD and those recommended by MS, there is a close proximity when it comes to Acoustic Neuromas and Metastases, but an important difference when it comes to Adenomas and Meningiomas. When applying the Wilcoxon Signed Rank Test to the 403 lesions studied, the mean difference between the two dose calculation systems was 0.23 Gy (95% CI: -0.127-0.60)
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    Real World KINDLE-Latin America Subset data on treatment patterns and clinical outcomes in patients with stage III Non-Small-Cell Lung Cancer
    (2022-07-04) Adrián Puello
    Introduction: Stage III non- small- cell lung cancer (NSCLC) management is challenging given the heterogeneous nature of the disease. The LATAM subset of the real- world, global KINDLE study reported the treatment patterns and clinical outcomes for LATAM from the pre- immuno- oncology era.Methods: The study was conducted in seven countries (Argentina, Chile, Colombia, Dominican Republic, Mexico, Peru and Uruguay) in stage III NSCLC (American Joint Committee on Cancer, 7th edition) diagnosed between January 2013 and December 2017. Retrospective data from patients’ medical records (index date to the end of follow- up) were collected. Summary statistics, Kaplan– Meier sur-vival estimates and a two- sided 95% confidence interval (CI) were provided. Cox proportional hazard model was used for univariate and multi- variateanalyses.Results: A total of 231 patients was enrolled, the median age was 65.0 years (range 21.0– 89.0), 60.6% were males, 76.6% had smoking history, 64.0% had ad-enocarcinoma and 28.7% underwent curative resection. Multiple treatment regi-mens (>25) were used; chemotherapy alone was the most common (24.8%). The overall median progression- free survival (mPFS) and median overall survival (mOS) were 14.8 months (95% CI, 12.1– 18.6) and 48.6 months (95% CI, 34.7 to not calculable). Significantly better mPFS and mOS were observed for stage IIIA with curative surgery and resectabletumours and stage IIIB with an Eastern Cooperative Oncology Group score of 0/1, female gender, resectabletumours, ad-enocarcinoma and curative surgery (p < 0.05).Conclusion: Results show diversity in treatment practices and the correspond-ing clinical outcomes in stage III NSCLC. There is a need to streamline treatment selection and sequencing to decrease relapse rates after initial therapy.
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    The ability of the yeast Wickerhamomyces anomalus to hydrolyze immunogenic wheat gliadin proteins
    (2022-12-19) Paula Xiomara Méndez
    Gliadins proteins make up around 30% of total wheat flour proteins. They are involved in many immune disorders affecting an increasing number of people who eat foods made with wheat flour. The triggering factor is the accumulation in the gut of immunogenic peptides derived from incomplete degradation of gliadins by gastric proteases. Previous research has revealed the effectiveness of sourdough-fermentation technology or related lactic acid bacteria in reducing wheat flour allergenic proteins. However, there are no single yeast cultures for producing reduced allergenicity wheat products. This study evaluated sourdough-related yeast Wickerhamomycesanomalus strains for their ability to hydrolyze gliadin proteins. All yeast strains were able to degrade gliadins and use them as carbon and nitrogen sources. The proliferation of the yeast strains depended on the gliadin addition; complete hydrolysis was observed after 24 h. The strain showing higher proteolytic activity fermented, acceptably wheat flour dough. The gliadin content of the leavened dough was reduced by 50%. Bread made from the W. anomalus-fermented dough showed a 78% reduction in immunogenic α-gliadins. 50% of the decrease was attributed to the proteolytic activity of the yeast cells, and the other 35% to the baking process. These results show the potential of the yeast W. anomalus as a starter for reducing immunogenicity wheat products.
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    The co-management of HIV and chronic non-communicable diseases in the Dominican Republic: A qualitative study.
    (2023-07-13) Amarilis Then Paulino
    HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men’s experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women’s experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to “move on” and “look ahead.” Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.
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    Validation of a new method for dose determination in radiosurgery: “The Sosa Model”
    (2024-04-04) Santiago Valenzuela Sosa
    Goals: to demonstrate the validity of the XYZ Geo Method of rapid indirect volumetry 37, 38, 39 using the simplified geometric formula of the XYZ/1910 ellipsoid, to obtain a volume of the anterior part of the hippocampus (Ammon’s Horn + Body = AA) or the complete Hippocampus, including the tail (AA + Tail = Complete Hippocampus = HarP = Harmonized Protocol 24), very close to the real volume determined by the voxel method (planimetry). Material and Method: prospective study, which took place between January 2020 and July 2022, of 100 Dominican adults, divided into a control group of 60 patients with normal cognition divided into 3 age groups (20-40, 41 to 60 and 61 to 80 years). and a case group of 40 patients complaining of cognitive problems (aged 41 to 60 and 61 to 80). The Folstein Mini Mental State Examination (MMSE) adapted to Latino patients was administered.15. All benefited from a 1.5 Tesla MRI with 1-1.5 mm slices for three- dimensional reconstruction including non-contrast T1, FLAIR, T2 and TOF sequences. The Principal Investigator (PI) performs real volumetry of the Anterior and Complete Hippocampus using voxels (planimetry), processing these Magnetic Resonance images on the Elekta Workstation Gamma Plan 10 platform of the Dominican Gamma Knife Center of CEDIMAT in the Plaza de la Salud de Santo Sunday, Dominican Republic. Next, the PI performs the indirect volumetry of these structures by applying the simplified formula of the Ellipsoid, following the guidelines of the XYZ Geo Method for rapid indirect volumetry of intracranial structures39, determining their largest diameters Axial (X), Sagittal (Y) and Vertical (Z) on the aforementioned Platform. For each of these patients, blindly with respect to the PI results, the Research Assistants (RA), using the Magnetic Resonance CD in which the RadiAnt DICOM Viewer software with capacity for millimeter measurement is encrypted, determine rapid indirect volumetry of the Anterior Hippocampus (AA) and complete Hippocampus (HarP) applying the aforementioned methodology. The data collected was processed using measures of central tendency and dispersion in the Microsoft Excel 2016 platform. Results: The indirect volumetry of the hippocampi studied carried out by the PI using the simplified geometric formula of the ellipsoid had an average approximation of 101.7% with respect to the real volume determined by voxels. The measurement carried out by the RAs approached 99.6% of the real volume of the hippocampi studied. The average time to perform the actual volumetry of the Anterior Hippocampus (AA) by the PI was more than 11 minutes, while using the formula for rapid indirect volumetry the hippocampal volume could be calculated in less than a minute. Conclusion: indirect volumetry of the hippocampus applying the guidelines of the XYZ Geo Method 39 and using the simplified geometric formula of the ellipsoid, it is a reliable and rapid alternative to determine the health and integrity of this important anatomical marker of cognitive and seizure health, even if it is used by non-neurospecialist doctors.
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    Valoración de la escala News (National Early Warning Score) como predictor de sepsis en pacientes con síndrome febril. Servicio medicina interna, Hospital Salvador Bienvenido Gautier. Agosto – diciembre 2019
    (2022-02-27) Ángel Díaz Beltré; Clevy Pérez; Mariella Cedano
    Introducción: la utilización de la escala NEWS podría construir una herramienta en el diagnóstico, pronóstico y estratificación precoz ante la sospecha de sepsis. El propósito de esta investigación fue determinar la eficacia de la escala NEWS como predictor de sepsis en pacientes ingresados por síndrome febril en el Hospital Salvador Bienvenido Gautier, en el período de octubre-diciembre 2019. Material y método: se realizó un estudio descriptivo, prospectivo y de corte transversal donde la técnica utilizada para la recolección de la información fue la evaluación directa de los 43 pacientes admitidos aplicando la escala NEWS y revisión de expedientes clínicos. Resultados: se determinó que el punto de corte ≥6 en la escala NEWS obtuvo valores de sensibilidad (91 %), especificidad (70 %), índice de Youden de 0.61, valor predictivo positivo de 78 %, valor predictivo negativo de 88 %, razón de verosimilitud positiva de 3 y negativa de 0.1. La aplicación de la escala NEWS en el sexo masculino presentó una sensibilidad de 92.9 % y especificidad de 87.5 %. En los grupos de 18-30 y 71-80 años, esta escala presentó una sensibilidad y especificidad de 100 %. Los pacientes clasificados como riesgo bajo, moderado y alto fueron diagnosticados con sepsis el 16.67 %, 63.64 % y un 70 %, respectivamente. Conclusiones: una puntuación mayor o igual a 6 en la escala NEWS se presenta como un predictor estadísticamente significativo que ayudaría en el diagnóstico temprano de sepsis, siendo más sensible que especifica. Fue mejor predictor en el sexo masculino y en los grupos etarios de 18-30 y 71-80 años.