Universidad de Especialidades Espíritu Santo

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia. A less studied presentation of AF is intraoperative atrial fibrillation (IOAF), which is defined as AF occurring during surgery. IOAF has important clinical implications, as this condition is associated with increased morbidity and mortality, even in non-cardiac surgical procedures. A narrative review of studies published between 1990 and 2025 was conducted using PubMed, ScienceDirect, and the Cochrane Library to evaluate the risk factors and management of IOAF in non-cardiac surgery. Reported IOAF prevalence varies by procedure type, ranging from 1% to 5% in most non-cardiac surgeries. Across non-cardiac surgical procedures, three IOAF risk domains emerge: patient profile, including age, prior AF, and structural heart disease; the invasiveness of the procedure; acute triggers, including hypotension and electrolyte imbalance. Management of IOAF begins with rapid assessment of hemodynamic stability and identification of surgical triggers. In hemodynamically unstable patients, particularly those with myocardial ischemia or pulmonary edema, immediate synchronized direct-current cardioversion (DCCV) is indicated. Conversely, in hemodynamically stable patients, the “3As” management framework is usually followed: first, acute triggers are addressed; then, the AF rate or rhythm is controlled; finally, anticoagulation is considered using the CHA2DS2-VASc score. Across the spectrum of surgical procedures, IOAF is best documented in cardiac surgery, where guidelines for the associated management and prevention are readily available. To further investigate IOAF in non-cardiac surgery, adopting standardized definitions is critical to advancing research and improving management.

Robotic Process Automation (RPA) is increasingly adopted to streamline back-office operations, reduce human error, and enhance efficiency. Yet, a critical challenge is employees’ reluctance to accept automation, particularly in emerging economies where psychological and contextual factors remain underexplored. This study proposes and tests an enriched Unified Theory of Acceptance and Use of Technology (UTAUT) model—extended with perceived risk, technology fear, and self-efficacy—to examine RPA acceptance among office employees in Ecuador’s cosmetics manufacturing and distribution industry. Using a seven-point Likert-scale survey with theoretically established constructs, data were collected from 210 employees at an organization undergoing RPA implementation. Analysis via PLS-SEM and confirmatory factor analysis showed that the extended model explained 58.2

Quadriceps tendon ruptures are relatively uncommon injuries, typically resulting from trauma or associated with degenerative conditions related to overuse, aging, or underlying comorbidities. Early treatment is recommended, as delayed management may negatively impact functional outcomes. We present two cases evaluated one year after sustaining a traumatic quadriceps tendon rupture. Imaging studies confirmed the diagnosis and defined the extent of the injury. Open surgical repair was performed, with satisfactory clinical outcomes observed at one-year follow-up. Objective To describe the surgical technique used in the management of two cases of chronic complete quadriceps tendon rupture, employing different operative strategies, and to report their medium-term outcomes.

ObjectivesTo compare the treatments used for the first episode of lupus nephritis (LN) in two Latin American cohorts (historical and contemporary) over a 25-year period, and their associations with clinical outcomes.MethodsPatients with biopsy-confirmed first LN episode were classified as non-proliferative (class V) or proliferative (classes III/IV). Sociodemographic, clinical, and treatment variables were described. Propensity score matching was used to examine the associations with four outcomes: mortality, damage accrual (SDI), hospitalization, and end-stage renal disease (ESRD).ResultsA total of 532 SLE patients were included: 362 from GLADEL 1.0 (historical cohort) and 170 from GLADEL 2.0. (contemporary). Compared to GLADEL 1.0, patients in GLADEL 2.0 received lower doses of oral glucocorticoids (GC), more frequently GC pulses and antimalarials but less frequently cyclophosphamide. An increase in the use of mycophenolate mofetil and other immunosuppressants was also observed. In the logistic regression models, SDI was associated with baseline SDI and GC pulses, whereas belonging to the GLADEL 2.0 was a protective factor. Mortality was associated with Mestizo ethnicity and partial health coverage; antimalarial was identified as a protective factor. Hospitalizations were associated with baseline SLEDAI and SDI, follow-up time, and lower educational level. Belonging to the GLADEL 2.0 cohort was protective against the occurrence of ESRD.ConclusionsPatients in the contemporary cohort benefited from advances in treatment strategies, with less cumulative damage and progression to ESRD, although mortality remained unchanged. These improvements likely reflect the increased use of newer therapies, more targeted approaches, in line with current treatment guidelines, and better access to specialized care.

El presente artículo examina la paradoja que plantea la inteligencia artificial generativa (IAG) en los entornos educativos contemporáneos: la misma herramienta capaz de personalizar el aprendizaje y ampliar el acceso al conocimiento puede, si se incorpora sin mediación crítica, sustituir los procesos cognitivos que la educación tiene por misión desarrollar. A partir de una revisión narrativa de 22 publicaciones especializadas del periodo 2020-2025, el estudio identifica tres tensiones estructurales que condicionan el impacto de la IAG sobre el aprendizaje: autonomía versus dependencia tecnológica, eficiencia versus profundidad de procesamiento, y acceso versus equidad algorítmica. Los resultados muestran que la efectividad de la IAG como catalizador del aprendizaje depende, en mayor medida, del diseño instruccional que del potencial técnico de la herramienta. Se propone un marco de integración didáctica orientado al fortalecimiento de las competencias cognitivas del estudiante, sustentado en cuatro estrategias pedagógicas convergentes: tareas de segundo orden, uso socrático de la IAG, integración metacognitiva y rediseño evaluativo. El estudio concluye que una integración pedagógicamente responsable exige revisar los fines de la educación antes de decidir el rol de los medios tecnológicos, con especial atención al contexto latinoamericano.