Apuntes históricos y cronológicos de los Planes de estudio de la Educación Médica en Cuba / History and chronology of Medical Education curriculums in Cuba

Se realiza un recorrido por la historia de los planes de estudio de la Educación Médica en Cuba, desde sus inicios que se remontan a la fundación del Seminario de San Basilio el Magno en Santiago de Cuba en 1722 hasta la actualidad. Se citan cronológicamente los planes de estudio relacionados con el contexto en que se desarrollaron cada uno de ellos, así como las influencias recibidas en su ejecución. (AU)

The history of the Medical Education curriculums in Cuba is reviewed from its beginning, back to the foundation of San Basilio el Magno seminary in Santiago de Cuba, in 1722, to the present day. Curriculums are cited chronologically in relation to the contexts they were implemented in, and also the influences under which they were put in practice. (AU)

Síndrome de Fanconi-Bickel. Presentación de un caso y revisión de la literatura / Fanconi-Bickel syndrome. Clinical case report and literature review

Se reporta un caso de Síndrome de Fanconi- Bickel, un tipo raro de enfermedad del metabolismo de los carbohidratos. La presentación clínica se da en los primeros meses de vida con retardo del crecimiento, hepatomegalia, hipoglicemia en ayuno, raquitismo y disfunción tubular renal proximal. La orientación diagnóstica se establece sobre la base de manifestaciones clínicas, hallazgos radiológicos de raquitismo y a partir de resultados característicos de las investigaciones de laboratorio que muestran disfunción tubular proximal, caracterizada por glucosuria con hipoglicemia en ayunas, acidosis metabólica, hipofosfatemia, fosfaturia, aminoaciduria. Fue descrito en 1949 por Fanconi y Bickel y es ocasionado por mutaciones en el transportador facilitado de glucosa GLUT 2.

We present a case of Fanconi- Bickel Syndrome, a rare type of carbohydrate metabolism disorder. Clinical presentation begins during the first months of life with failure to thrive, hepatomegaly, fasting hypoglycemia, rickets and renal proximal tubular dysfunction. Diagnosis is established on the basis of clinical manifestations, radiological findings of rickets, and laboratory investigations showing proximal tubular dysfunction, characterized by glucosuria with fasting hypoglycemia, metabolic acidosis, hypophosphatemia, phosphaturia and aminoaciduria. It was described in 1949 by Fanconi and Bick.

Mitotic counts in breast cancer after neoadjuvant systemic chemotherapy and development of metastatic disease.

Although pathologic complete response after neoadjuvant systemic chemotherapy (NST) is associated with an excellent prognosis, the prognosis for patients with residual disease is variable. The mitotic count (MC) is commonly used in the evaluation of histologic tumor grade, but its prognostic value relative to other factors when determined after NST has not been studied. We evaluated MC in the residual tumor after NST in order to determine whether it provided prognostic information independent of other factors, including the residual cancer burden (RCB). We retrospectively reviewed pathologic specimens from 80 patients with localized breast cancer who received standard NST, of whom 61 had residual disease evaluable for MC analysis and RCB score. The exact number of mitotic figures was counted in 10 high power (40×) fields (hpf). We classified tumors as having high (≥13 per 10 hpf) and low (<13 per 10 hpf) MC because this threshold fell at the midpoint for an intermediate MC score in the Nottingham combined histologic grade. Distant metastases developed in 2 of 32 (6.3 %) patients with a low MC compared with 18 of 29 (62.1 %) with a high MC (log-rank test, p < 0.001). When adjusted for other covariates, including age, estrogen receptor, HER2/neu expressions, and RCB score, a high MC was associated with a significantly higher risk of developing distant metastases (hazard ratio 11.21, 95 % CI [2.19, 57.37]; p = 0.004). Our findings indicated that evaluation of MC after NST warrants validation and further evaluation as a prognostic marker in breast cancer.

Lymphocytic host response to oral squamous cell carcinoma: an adaptive T-cell response at the tumor interface.

Lymphocytic host response (LHR) in the Risk Model is histologically quantified as the density of lymphocytes at the tumor interface (Brandwein-Gensler in Am J Surg Pathol, 34:676-688, 1; in, Am J Surg Pathol 29:167-178, 2). It is classified as strong, intermediate or weak, and is inversely associated with the risk of decreased time to disease progression. In this study, we test the hypothesis that strong LHR corresponds to a greater degree of adaptive cytotoxic T cell response as compared to moderate LHR. We studied resection specimens of primary oral squamous carcinoma classified as having either strong (n = 16), intermediate (n = 20) or weak (n = 4) LHR. CD20+, CD4+, & CD8+ cells were detected by immunohistochemistry and quantified at 40× with a grid; counting the 10 fields with the most lymphocytes at the tumor interface and within tumors. Mean counts/tumor were analyzed by the 2-sided T-test. Statistically significant differences were observed for interface CD8 cells with respect to strong versus moderate LHR, strong versus weak LHR, and moderate versus weak LHR, and tumor infiltrating CD8 cells with respect to strong versus weak LHR. Statistically significant differences were also observed for interface CD4 cells with respect to strong versus weak LHR, and moderate versus weak LHR. Statistically significant differences in interface B cell counts were seen with respect to strong versus weak LHR, and moderate versus weak LHR. Decreased CD8+ T cells were significantly associated with higher stage at presentation (P = 0.005); a direct, but nonsignificant correlation was seen between decreased CD8+ T cells and decreased survival time. Immune response at the tumor interface correlates with an adaptive T cell response; the degree of cytotoxic CD8+ cells infiltrate can distinguish between strong and intermediate LHR at the interface of oral carcinomas.

Toxoplasmosis congénita: aspectos a tener en cuenta / Congenital toxoplasmosis: aspects to be taken into account

Las Infecciones durante el embarazo ocupan el 3 por ciento de las causas de malformaciones en recién nacidos vivos. Entre los agentes biológicos que más se han asociado a teratogenicidad se encuentra el Toxoplasma gondii, agente causal de la toxoplasmosis. Esta infección durante la gestación ha sido asociada con pérdidas del embarazo y producción de malformaciones congénitas. La magnitud del riesgo se ha relacionado con la severidad de la enfermedad materna. Teniendo en cuenta la importancia que para nuestro sistema de salud reviste el bienestar materno y fetal y la necesidad de nuestros médicos de conocer sobre este tipo de infecciones cosmopolitas, realizamos un compendio de información actualizada sobre este tema...

Facial changes following treatment with a removable orthodontic appliance in adults.

The purpose of this study is to determine soft tissue facial changes in adults with mild Class I or Class II malocclusions, treated with a removable orthodontic appliance (Homeoblock '). Standardized intra-oral and frontal facial photographs of 25 adults were scanned and x, y coordinates of 16 maxillary arch and nine facial landmarks were digitized. Mean maxillary arch and facial configurations were subjected to finite-element analysis (FEA). Results showed that the mean pre- and post-treatment maxillary and facial configurations differed statistically (p < 0.05). Specifically, the maxillary arch showed a 30% relative size increase in the mid-palatal region with shape changes consistent with improved dental alignment and maxillary expansion in the transverse direction. For facial changes, a 10% size increase was localized in the nasomaxillary region, and the intercanthal angle changed from -4.6(0) to +4.2(0) (p < 0.05). It is concluded that dental and facial changes associated with the Homeoblock' removable orthodontic appliance are consistent with a broader smile and a more symmetrical facial appearance in non-growing adults.