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Estatinas para el Síndrome Coronario Agudo Medicina basada en evidencia sobre la administración temprana con dosis de carga
Fonseca-Gamboa,Carlos; Sáenz-Campos,Desiree;
Acta Médica Costarricense , 2011,
Abstract: aim: it has been observed that in some emergency services it has become a common practice to prescribe a high but variable loading dose of statins to patients with acute myocardial infarction within the first few hours from the onset of symptoms, under the premise that this will help reduce inflammatory mediators and have a positive effect over the endothelium, and by doing so reduce the risk of recurrent ischemic events. to review the scientific evidence that could support this practice and help clarify the optimum dosage. methods: for the process of documenting the evidence, we searched through scientific information databases to find sources of primary information, giving emphasis on randomized clinical trials that evaluated the efficacy of statins. we also searched through tertiary sources of information specifically looking for systematic reviews and recommendations made by internationally referenced technology evaluating institutes. results: four random clinical trials (rct) were found controlled with placebo, neither of them found any significant differences for their primary end point: mayor cardiac event, death, fatal acute myocardial infarction, fatal stroke or other cause of cardiovascular death. none of the rct used the statin at a loading dose or within the first 24 h from the onset of symptoms. conclusion: due to the lack of evidence that would let us project with clarity a beneficial role for therapy with statins in the initial management of acute coronary syndrome, it’s considered that the risk/benefit ratio moves away from the rational use of medicines and the application of the evidence based medicine paradigm.
Estatinas para el Síndrome Coronario Agudo Medicina basada en evidencia sobre la administración temprana con dosis de carga Statins in Acute Coronary Syndrome Use of an Early Loading Dose
Carlos Fonseca-Gamboa,Desiree Sáenz-Campos
Acta Médica Costarricense , 2011,
Abstract: Objetivo: En algunos Servicios de Emergencias de la CCSS, a los pacientes con infarto agudo de miocardio se les administra una dosis alta -aunque variable- de lovastatina en las primeras horas de evolución de los síndromes coronarios agudos, con la expectativa de lograr efectos pleiotrópicos, un resultado positivo sobre el endotelio y la disminución de mediadores inflamatorios. Analizar la evidencia científica que sustenta el beneficio de esta intervención farmacológica y clarificar la posible dosis oral y el potencial intervalo idóneo. Búsqueda vía electrónica en sistemas secundarios de información científica y análisis de fuentes primarias, con énfasis en ensayos clínicos aleatorizados que evalúen la eficacia de las estatinas en los eventos coronarios agudos; también de fuentes terciarias, específicamente revisiones sistemáticas y guías de consenso para práctica clínica basadas en evidencia y revisiones por instancias evaluadoras de tecnologías con reconocimiento internacional. Resultados: Cuatro ensayos clínicos aleatorizados controlados con placebo, no demostraron diferencias significativas ni clínicamente relevantes en la variable primaria combinada: evento cardiaco mayor, muerte, IAM recurrente fatal, AVC fatal u otra causa de muerte cardiovascular, ninguno usó dosis de carga, ni se inició la administración en las 24 hs del inicio de la sintomatología. Conclusión: Ante la falta de evidencia que permita proyectar con claridad un papel beneficioso para las estatinas en el manejo inicial del síndrome coronario agudo, esta práctica desequilibra la relación beneficio/riesgo y se aleja de los principios del uso racional de medicamentos y la aplicación del paradigma de la medicina basada en evidencia. Aim: It has been observed that in some emergency services it has become a common practice to prescribe a high but variable loading dose of statins to patients with acute myocardial infarction within the first few hours from the onset of symptoms, under the premise that this will help reduce inflammatory mediators and have a positive effect over the endothelium, and by doing so reduce the risk of recurrent ischemic events. To review the scientific evidence that could support this practice and help clarify the optimum dosage. Methods: For the process of documenting the evidence, we searched through scientific information databases to find sources of primary information, giving emphasis on randomized clinical trials that evaluated the efficacy of statins. We also searched through tertiary sources of information specifically looking for systematic reviews and r
Crónica de una muerte anunciada: El valor del análisis crítico de la información científica, caso de la “Proteína C Activada”
Carlos Fonseca-Gamboa,Desirée Sáenz-Campos
Acta Médica Costarricense , 2012,
Abstract:
Estudio de utilización de fenazopiridina en la atención médica ambulatoria en la seguridad social: A drug utilization research in the Costa Rican Social Security Phenazopyridine
Hugo Marín-Piva,Carlos Fonseca-Gamboa,Desirée Sáenz-Campos
Acta Médica Costarricense , 2012,
Abstract: Justificación: fenazopiridina es un medicamento analgésico urinario oral; cuenta con una amplia experiencia histórica de uso y, bajo el paradigma de medicina basada en evidencia, tiene poco fundamento de alta calidad para sustentar su valor terapéutico. Objetivo: analizar el perfil de la utilización de la fenazopiridina en la práctica clínica habitual dentro de la Seguridad Social, a nivel de consulta ambulatoria, en los tres niveles de atención y por un periodo de 30 días. Procedimientos: en enero de 2011, en una unidad de cada nivel de atención: área de Salud de Santa Bárbara, Clínica Dr. Carlos Durán y Hospital Dr. Calderón Guardia, se analizó el reporte de despacho por farmacia de la fenazopiridina, con el fin de preparar un perfil cuantitativo. En el análisis cualitativo de la prescripción, se revisó una muestra al azar de 30 expedientes de pacientes atendidos durante ese periodo en cada unidad, con un formulario predise ado para el efecto. Resultados: durante 1 mes, tres unidades despacharon 381 prescripciones a los pacientes, mayormente mujeres. La prescripción varió entre 3 y 90 tabletas; la mayoría (60,43%) con solo 10 tabletas para tratamiento. Se documentó la anotación del medicamento y la dosis en un 54,55% de los expedientes. La dosis diaria prescrita (DDP) fue 100 mg TID, equivalente a 300 mg/d, en la mitad de los pacientes, y en las unidades del primer y segundo nivel de atención; seguida de 100 mg BID (33,33%). Un 54,55% de los pacientes tenían diagnóstico de infección del tracto urinario (89% mujeres); de estos, un 89,89% recibió también antibióticos. La duración varió entre 1 y 30 días, y se prolongó más en unidades del segundo y tercer nivel. Conclusión: la utilización es parcial y razonablemente adecuada, apoya el supuesto de efectividad seguridad, sobre todo en el contexto de la atención médica en el primero y segundo niveles de atención. La diversidad en los hábitos de prescripción requiere mejorar su empleo y desarrollar acciones para favorecer una prescripción más racional, en procura de maximizar el beneficio a los pacientes Background: Phenazopiridine is an oral urinary tract analgesic; an extensive historical experience of use and, under the paradigm of evidence-based medicine, its therapeutic value is not supported by high quality explanations. Aim: To analyze the use of phenazopiridine in everyday clinical practice, at an ambulatory level, in the three different levels of attention in the Costa Rican social security during a period of 30 days. Methods: In January 2011, electronic pharmacy records from a first, second and thir
THE TEACHING OF GEOMETRY SUPPORTED BY COMPUTERS: A NEW REALITY IN JUNIOR HIGH SCHOOL / LA ENSE ANZA DE LA GEOMETRíA ASISTIDA POR COMPUTADORAS: UNA NUEVA REALIDAD EN LA SECUNDARIA BáSICA
Juan José Fonseca Pérez,Michel Enrique Gamboa Grau
Didasc@lia : Didáctica y Educación , 2010,
Abstract: With the third revolution in the educational system in Cuba, schools are provided with new technologies, among them: computers, constituting a challenge for its usage in the teaching-learning process. Being aware that the learning of Geometry presents difficulties proved in different moments and by different people, this work offers methodological words of advice for teachers and it shows some activities designed where it is used a computer′ program of application as it is Geometry, which eases to reveal its potentialities and transform the teaching-learning process of Geometry and takes into account the levels of development of the geometric thought, the formation of stages in the mental actions and the didactic for a developing process. In its implementation, in the referential provincial center, are shown significant changes in the learners.
Quality Requirements for Multimedia Interactive Informative Systems  [PDF]
Sylviane Levy, Fernando Gamboa
Journal of Software Engineering and Applications (JSEA) , 2013, DOI: 10.4236/jsea.2013.68051
Abstract:

Multimedia Interactive Informative Systems (MIIS) are software applications resulting from the convergence of multiples technologies such as audiovisual, computing and communication. They aim to transmit information to a large, diverse and dispersed public. As with other mass media, the fulfillment of MIIS goals depends largely on the quality of communication between the system and end users. Therefore, those systems should be developed in order to ensure that this quality requirement is satisfied. If MIIS are constructed according to usual software engineering practices, the analysis discipline of the development process includes requirements identification and specification; however, these techniques are focused on functional requirements, and they do not give much importance to non-functional requirements. In this paper, we propose a development process based on the production of videogames which has two different phases: preproduction and production. The first phase, corresponding to requirements identification, derives into the concept of system. In order to translate this concept into a specification, we propose the use of new communicational attributes and a MIIS metamodel. The establishment of MIIS non-functional specification is the result of analyzing class diagrams through quality attributes. In order to evaluate if the specifications are responding to communicational attributes, a functional prototype is built and evaluated with end users. The proposed methodology is applied to a real case study.

Guillermo de Ockham y el desafío escéptico en los Quodlibeta Septem
Gamboa, Deni;
Diánoia , 2009,
Abstract: after analyzing the quodlibeta septem it is possible to state that ockham's epistemology leads to skeptical conclusions. this statement is grounded on my interpretation of the way in which any cognition process of singular entities develops. my interpretation might be expressed in two propositions: 1) the intuitive and abstractive cognitions are different forms of a simple assent, and 2) within his own espistemological system, ockham tries to avoid skeptical conclusions by way of reflexive cognitions. nevertheless, the idea of reflexive cognitions would not let us justify which thoughts are true. in ockham's epistemology, the idea of reflexive cognitions does not solve the skeptical challenge.
Estado poblacional del orden Plecoptera (Insecta) en el Parque Nacional Sierra Nevada en Venezuela y sus implicaciones para planes de conservación
Gamboa,Maribet;
Revista de Biología Tropical , 2010,
Abstract: population status of insects of plecoptera order in sierra nevada national park in venezuela and its implications for conservation planning. longitudinal distribution of plecoptera species were examined along the sierra nevada national park in the andean region of merida state, venezuela. pnsn is one of the largest protected areas and consists of two major sub-basins. quantitative samples were collected in 7 river tributaries along the pnsn from february to may of 2009, and a total of 135 individuals and 4 species of the genus anacroneuria were collected. only three rivers (nuestra se?ora, la picón y corcovada) found the presence of stoneflies, the principal component analysis show that the characterization of habitat, current velocity, dissolved oxygen and the absence of human disturbance sources of influence in a suitable habitat for populations. stoneflies are endangered or have become extinct throughout much of its range due to human activities. conservation plans must be implemented urgently, in order to avoid recreational areas and/or economic in vicinity thereof. rev. biol. trop. 58 (4): 1299-1310. epub 2010 december 01
La neurotomía del obturador en la contractura en Aducción en las paraplegias espásticas
MARCELO GAMBOA
Revista chilena de pediatría , 1942,
Abstract:
Correa Sutil, Sofía. 2005: Con las riendas del poder. La derecha chilena en el siglo xx. Santiago: Editorial Sudamericana, 313 pp.
Ricardo Gamboa
Revista de Ciencia Política , 2005,
Abstract:
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