Intra-operative pyloric BOTOX injection versus pyloric surgery for prevention of delayed gastric emptying after esophagectomy.

BACKGROUND: Delayed gastric emptying (DGE) is a common complication after esophagectomy. BOTOX injections and pyloric surgeries (PS), including pyloroplasty (PP) and pyloromyotomy (PM), are performed intraoperatively as prophylaxis against DGE. This study compares the effects of pyloric BOTOX injection and PS for preventing DGE post-esophagectomy. METHODS: We retrospectively reviewed Moffitt's IRB-approved database of 1364 esophagectomies, identifying 475 patients receiving BOTOX or PS during esophageal resection. PS was further divided into PP and PM. Demographics, clinical characteristics, and postoperative outcomes were compared using Chi-Square, Fisher's exact test, Wilcoxon rank-sum, and ANOVA. Propensity-score matching was performed between BOTOX and PP cohorts. RESULTS: 238 patients received BOTOX, 108 received PP, and 129 received PM. Most BOTOX patients underwent fully minimally invasive robotic Ivor-Lewis esophagectomy (81.1% vs 1.7%) while most PS patients underwent hybrid open/Robotic Ivor-Lewis esophagectomy (95.7% vs 13.0%). Anastomotic leak (p = 0.57) and pneumonia (p = 0.75) were comparable between groups. However, PS experienced lower DGE rates (15.9% vs 9.3%; p = 0.04) while BOTOX patients had less postoperative weight loss (9.7 vs 11.45 kg; p = 0.02). After separating PP from PM, leak (p = 0.72) and pneumonia (p = 0.07) rates remained similar. However, PP patients had the lowest DGE incidence (1.9% vs 15.7% vs 15.9%; p = < 0.001) and the highest bile reflux rates (2.8% vs 0% vs 0.4%; p = 0.04). Between matched cohorts of 91 patients, PP had lower DGE rates (18.7% vs 1.1%; p = < 0.001) and less weight loss (9.8 vs 11.4 kg; p = < 0.001). Other complications were comparable (all p > 0.05). BOTOX was consistently associated with shorter LOS compared to PS (all p = < 0.001). CONCLUSION: PP demonstrates lower rates of DGE in unmatched and matched analyses. Compared to BOTOX, PS is linked to reduced DGE rates. While BOTOX is associated with more favorable LOS, this may be attributable to difference in operative approach. PP improves DGE rates after esophagectomy without improving other postoperative complications.

Rationale for Hepatitis C Virus Treatment During Hematopoietic Stem Cell Transplant in the Era of Novel Direct-Acting Antivirals.

BACKGROUND AND AIMS: Untreated hepatitis C (HCV) infection in patients undergoing hematopoietic stem cell transplantation (HSCT) can lead to worse outcomes. Traditionally, HSCT patients infected with HCV would wait until after immune reconstitution to receive HCV therapy, as the oncologic urgency of transplant would not allow time for a full preceding treatment course of HCV therapy. However, in the era of newer direct-acting antivirals (DAAs), we propose that concomitant treatment of HCV while undergoing HSCT is safe and feasible, while keeping in mind potential drug-drug interactions. METHODS: A literature review was performed to summarize the available data on the impact of HCV on patients undergoing HSCT. Drug-drug interactions for DAA's and pertinent HSCT drugs were evaluated using Lexicomp online® and http://hep-druginteractions.org . RESULTS: During HSCT, HCV appears to be a conditional risk factor for sinusoidal obstruction syndrome and a potential risk factor for graft versus host disease, both of which are associated with increased mortality. HCV reactivation and exacerbation may impact the use of chemotherapeutics, but available studies haven't shown impact specifically on HSCT. Limited case reports exist but demonstrate safe and effective use DAAs during HSCT. These, along with a drug-drug interaction review demonstrate agents such as sofosbuvir/velpatasvir and glecaprevir/pibrentasvir are promising DAAs for use in HSCT. CONCLUSION: HCV infection may worsen outcomes for patients undergoing HSCT. Concomitant treatment of HCV during HSCT using newer DAAs appears feasible and may improve patient morbidity and mortality, however large-scale studies are needed to further support this practice.

Towards Sustainable Temperature Sensor Production through CO2-Derived Polycarbonate-Based Composites.

The steep increase in carbon dioxide (CO2) emissions has created great concern due to its role in the greenhouse effect and global warming. One approach to mitigate CO2 levels involves its application in specific technologies. In this context, CO2 can be used for a more sustainable synthesis of polycarbonates (CO2-PCs). In this research, CO2-PC films and composites with multiwalled carbon nanotubes (MWCNTs, ranging from 0.2 to 7.0 wt.%) have been prepared to achieve more sustainable multifunctional sensing devices. The inclusion of the carbonaceous fillers allows for the electrical conductivity to be enhanced, reaching the percolation threshold (Pc) at 0.1 wt.% MWCNTs and a maximum electrical conductivity of 0.107 S·m-1 for the composite containing 1.5 wt.% MWCNTs. The composite containing 3.0 wt.% MWCNTs was also studied, showing a stable and linear response under temperature variations from 40 to 100 °C and from 30 to 45 °C, with a sensitivity of 1.3 × 10-4 °C-1. Thus, this investigation demonstrates the possibility of employing CO2-derived PC/MWCNT composites as thermoresistive sensing materials, allowing for the transition towards sustainable polymer-based electronics.

Ventilator-associated pneumonia by Weeksella virosa: case report.

BACKGROUND: Weeksella virosa pneumonia is an infection that has been described as a healthcare-associated infection. This is a rare gram-negative anaerobic bacterium associated with the use of mechanical ventilation for a long period of time and is more frequent in immunosuppressed patients. This is the first case reported in the state of Veracruz and the second in Mexico. CASE PRESENTATION: We present the case of a 64-year-old female from Veracruz, Mexico who developed an infectious process in the right pelvic limb after a transcatheter aortic valve replacement procedure and subsequently developed sudden cardiorespiratory arrest requiring mechanical ventilation, with subsequent imaging studies demonstrating a pneumonic process associated with a nosocomial infection. DISCUSSION AND CONCLUSIONS: We should take into consideration that this pathogen affects not only adults with multiple comorbidities but also children with renal, hepatic, or oncological pathologies, as well as immunocompromised patients, who should be considered high-risk populations for W. virosa infection.

ATF4 expression in thermogenic adipocytes is required for cold-induced thermogenesis in mice via FGF21-independent mechanisms.

In brown adipose tissue (BAT), short-term cold exposure induces the activating transcription factor 4 (ATF4), and its downstream target fibroblast growth factor 21 (FGF21). Induction of ATF4 in BAT in response to mitochondrial stress is required for thermoregulation, partially by increasing FGF21 expression. In the present study, we tested the hypothesis that Atf4 and Fgf21 induction in BAT are both required for BAT thermogenesis under physiological stress by generating mice selectively lacking either Atf4 (ATF4 BKO) or Fgf21 (FGF21 BKO) in UCP1-expressing adipocytes. After 3 days of cold exposure, core body temperature was significantly reduced in ad-libitum-fed ATF4 BKO mice, which correlated with Fgf21 downregulation in brown and beige adipocytes, and impaired browning of white adipose tissue. Conversely, despite having reduced browning, FGF21 BKO mice had preserved core body temperature after cold exposure. Mechanistically, ATF4, but not FGF21, regulates amino acid import and metabolism in response to cold, likely contributing to BAT thermogenic capacity under ad libitum-fed conditions. Importantly, under fasting conditions, both ATF4 and FGF21 were required for thermogenesis in cold-exposed mice. Thus, ATF4 regulates BAT thermogenesis under fed conditions likely in a FGF21-independent manner, in part via increased amino acid uptake and metabolism.

Mitochondrial Dynamics, Diabetes, and Cardiovascular Disease.

Mitochondria undergo repeated cycles of fusion and fission that regulate their size and shape by a process known as mitochondrial dynamics. Numerous studies have revealed the importance of this process in maintaining mitochondrial health and cellular homeostasis, particularly in highly metabolically active tissues such as skeletal muscle and the heart. Here, we review the literature on the relationship between mitochondrial dynamics and the pathophysiology of type 2 diabetes and cardiovascular disease (CVD). Importantly, we emphasize divergent outcomes resulting from downregulating distinct mitochondrial dynamics proteins in various tissues. This review underscores compensatory mechanisms and adaptive pathways that offset potentially detrimental effects, resulting instead in improved metabolic health. Finally, we offer a perspective on potential therapeutic implications of modulating mitochondrial dynamics proteins for treatment of diabetes and CVD.

Primer Consenso Chileno de Grupo de Estudio de Tuberculosis Ocular / First Chilean Consensus Document of the Ocular Tuberculosis Study Group

INTRODUCCIÓN: El tratamiento de la tuberculosis (TB) ocular es un tema que genera controversia en el mundo. Para el correcto manejo de estos pacientes, es necesario el desarrollo de guías que consideren la epidemiología de la TB ocular en cada nación. El objetivo de este consenso fue discutir de forma interdisciplinaria la epidemiología, fisiopatología, clínica, diagnóstico, estudio y tratamiento de los pacientes con TB ocular, para establecer un algoritmo de tratamiento y proponer qué pacientes deben ser tratados en Chile y con qué tratamiento. Además, se establecieron acuerdos para efectuar quimioprofilaxis de los pacientes con TB latente que tienen indicación de tratamiento inmunosupresor por enfermedades inflamatorias oculares.

The treatment of ocular tuberculosis (TB) remains controversial worldwide. The development of guidelines for ocular TB can facilitate the approach and management of these patients. These guidelines should be developed regionally, considering the local TB epidemiology. The objectives of this consensus are: to initiate an interdisciplinary discussion about the epidemiology, pathophysiology, clinical presentation, diagnosis, workup and treatment of patients with ocular TB, to establish a treatment algorithm and define which patients should be treated in Chile and how and, to analyze and discuss the published data regarding chemoprophylaxis for patients with latent TB who need to start immunosuppressive treatment due to inflammatory ocular conditions.

Intelligent digital tools for screening of brain connectivity and dementia risk estimation in people affected by mild cognitive impairment: the AI-Mind clinical study protocol.

More than 10 million Europeans show signs of mild cognitive impairment (MCI), a transitional stage between normal brain aging and dementia stage memory disorder. The path MCI takes can be divergent; while some maintain stability or even revert to cognitive norms, alarmingly, up to half of the cases progress to dementia within 5 years. Current diagnostic practice lacks the necessary screening tools to identify those at risk of progression. The European patient experience often involves a long journey from the initial signs of MCI to the eventual diagnosis of dementia. The trajectory is far from ideal. Here, we introduce the AI-Mind project, a pioneering initiative with an innovative approach to early risk assessment through the implementation of advanced artificial intelligence (AI) on multimodal data. The cutting-edge AI-based tools developed in the project aim not only to accelerate the diagnostic process but also to deliver highly accurate predictions regarding an individual's risk of developing dementia when prevention and intervention may still be possible. AI-Mind is a European Research and Innovation Action (RIA H2020-SC1-BHC-06-2020, No. 964220) financed between 2021 and 2026. First, the AI-Mind Connector identifies dysfunctional brain networks based on high-density magneto- and electroencephalography (M/EEG) recordings. Second, the AI-Mind Predictor predicts dementia risk using data from the Connector, enriched with computerized cognitive tests, genetic and protein biomarkers, as well as sociodemographic and clinical variables. AI-Mind is integrated within a network of major European initiatives, including The Virtual Brain, The Virtual Epileptic Patient, and EBRAINS AISBL service for sensitive data, HealthDataCloud, where big patient data are generated for advancing digital and virtual twin technology development. AI-Mind's innovation lies not only in its early prediction of dementia risk, but it also enables a virtual laboratory scenario for hypothesis-driven personalized intervention research. This article introduces the background of the AI-Mind project and its clinical study protocol, setting the stage for future scientific contributions.

Riesgo de aerolización como limitante para el uso de cánulas de alto flujo en pacientes con insuficiencia respiratoria por Covid-19 de hospitales de recursos limitados / Risk of aerolization as a limitation for the use of high flow cannulas in patients with respiratory insufficiency due to Covid-19 in limited resource hospitals

Señor Editor: Ha pasado más de un año desde la aparición de la COVID-19, se han desarrollado diferentes tipos de vacunas sin embargo a pesar de ello, debido a las demoras logísticas del proceso de vacunación y las mutaciones del virus, esta continúa propagándose. Ahora que está terminando la segunda ola, los sistemas de salud de hospitales públicos y privados de países subdesarrollados están colapsando nuevamente y agotando el uso de los ventiladores mecánicos invasivos en las Unidades de Cuidados Intensivos (UCI)

Mr. Editor: It has been more than a year since the appearance of COVID-19, different types of vaccines have been developed however despite this, due to logistical delays in the vaccination process and mutations of the virus, it continues to spread. Now that the second wave is ending, public and private hospital health systems in underdeveloped countries are again collapsing and exhausting the use of invasive mechanical ventilators in Intensive Care Units (ICUs).

Caracterización sociodemográfica, clínica y terapéutica de pacientes con falla cardiaca con fracción de eyección intermedia: cohorte MED-ICAi / Sociodemographic, clinical and therapeutic characteristics of patients with heart failure with mid-range ejection fraction: MED-ICAi cohort

Resumen Antecedentes: Clásicamente, la falla cardiaca se ha clasificado en dos grupos, según tengan fracción de eyección preservada o reducida; no obstante, en fecha reciente se ha añadido el grupo de fracción intermedia, y aún existe gran desconocimiento sobre sus características fisiopatológicas y clínicas. Objetivo: Caracterizar el grupo de pacientes con fracción intermedia en cuanto a sus variables sociodemográficas, clínicas y de tratamiento. Método: Se realizó un estudio descriptivo, retrospectivo, en el que se analizaron historias clínicas de pacientes con falla cardiaca hospitalizados por agudización en el periodo comprendido entre enero de 2015 y diciembre de 2017. Resultados: Se revisaron 1536 historias clínicas, de las cuales 864 cumplían los criterios de inclusión. El grupo con fracción intermedia correspondió a 83 (9.6%) pacientes, en quienes se encontró predominio del sexo femenino (53%) y una edad mediana de 77 años. La coronariopatía fue la etiología más frecuente (26.5%), mientras que la falta de adherencia a los medicamentos fue la causa principal de descompensación (14.5%). Los medicamentos más usados fueron los betabloqueadores y la furosemida, tanto al ingreso como al egreso. El grupo con mayor mortalidad fue el de fracción de eyección reducida (4.1%). La estancia hospitalaria, el ingreso y la estancia en la unidad de cuidados intensivos fueron similares en todos los grupos, independientemente de la fracción de eyección. Conclusiones: Los hallazgos son similares a los descritos en otras poblaciones internacionales y en algunas nacionales, y avalan la hipótesis de un fenotipo intermedio con un comportamiento etiológico semejante al de la fracción de eyección reducida.

Abstract Background: Classically, heart failure has been classified in two groups, depending on a preserved or reduced ejection fraction, but a mid-range ejection fraction group has been introduced recently, and there is still great ignorance about its physiopathological and clinical characteristics. Objective: To characterize this group of patients as for their sociodemographic, clinical and treatment variables. Method: We carried out a descriptive, retrospective study, by analyzing medical records from patients hospitalized with acute heart failure between January 2015 and December 2017. Results: We reviewed 1536 medical records of which 864 met the inclusion criteria. The mid-range ejection fraction group corresponded to 83 (9.6%) of patients, of which the majority were women (53%), with a median age of 77 years, coronary heart disease as the most frequent etiology (26.5%) and lack of adherence to medications as the main cause of decompensation (14.5%). The most frequently used drugs were betablockers and furosemide, both upon admission and discharge. Mortality was higher between patients with reduced ejection fraction (4.1%). Hospital stay, admission to and length of stay in an ICU, were similar between all groups regardless of ejection fraction. Conclusions: Our findings are similar to those described in previous international and national cohorts, and support the hypothesis of an intermediate phenotype with an etiology similar to that seen with a reduced ejection fraction.

Pandemia por el SARS-CoV-2: aspectos biológicos, epidemiológicos y clínicos / SARS-CoV-2 Pandemic. Biological, epidemiological, clinical aspects

El objetivo principal de este trabajo es describir los principales aspectos biológicos, epidemiológicos y clínicos,con especial énfasis en la fisiopatología, ocasionado por el SARS-CoV-2.El Coronavirus 2 del Síndrome Agudo Respiratorio Severo,es un orthocoronavirinae, del grupoI V, pertenecientes al género betacoronavirus,que causa la actual enfermedad pandémica definida por la Organización Mundial de la Salud (OMS)(2020), como COVID-19.Esta es considerada por los expertos mundiales como una infección viral emergente. Su origenes veterinario y su transmisión zoonótica, a partir de virus que tienen como reservorios a murciélagos y como hospedador intermediario al pangolín, desde el cual se infiere que pudo adaptarse al ser humano, para transmitirse de persona a persona,mediante gotitas respiratorias y secreciones nasales contaminadas con partículas altamente infecciosas. No se descarta la transmisión fecal-oral. La enfermedad posee un periodo de incubación de 2 a 14 días (promedio:5,2 días) y hasta ahora las medidas de prevención y control más eficientes son la cuarentena social obligatoria, el uso de tapabocas, lavado de manos con agua y jabón por al menos 20 segundos,o con productos en gel con alcohol al 70%, mantener una distancia mínima entre las personas de 2 metros. Lo aprendido de los otros dos betacoronavirus humanos relacionados, causantes de las epidemias previas: SARS-CoVen 2002-2003 y el MERSen 2012 ,permiten encarar de mejor forma la actual pandemia(AU)

The main objective of this work is to describe the main biological, epidemiological and clinical aspects, with special emphasis on pathophysiology, caused by SARS-CoV-2. Coronavirus 2 of Severe Acute Respiratory Syndrome is a member of group IV orthocoronavirinae, belonging to the betacoronavirus genus, which causes the current pandemic disease defined by the World Health Organization as COVID-19. This is considered by world experts as an emerging viral infection. Its origin is veterinary and its zoonotic transmission, from viruses that have bats as reservoirs to pangolin an as an intermediate host, from which it is inferred that it could have adapted to the human being, transmitted from person to person by means of respiratory droplets, and highly infectious contaminated nasal secretions Fecal-oral transmission is not ruled out. The disease has an incubation period of 2 to 14 days (5.2 days in mean), and until now the most efficient prevention and control measures are the obligatory social quarantine, the use of face masks, hand washing with soap and water for at least 20 seconds, or with products in gel with 70 alcohol, keeping a minimum distance between people of 2 meters. What has been learned from the other two related human betacoronaviruses that caused the previous epidemics: SARS-CoV in 2002-2003 and MERS in 2012, allow us to better face the current pandemic(AU)

Frecuencia de contaminación por enteroparásitos en pasamanos de autobuses de Barquisimeto, Venezuela / Enteric Parasite Contamination Frequency on Bus Handrails in Barquisimeto, Venezuela / Frequência da contaminação por enteroparasitos em corrimãos de ônibus em Barquisimeto, Venezuela

Introducción. La contaminación enteroparasitaria en autobuses por parte de usuarios infectados con malas conductas sanitarias potencia el riesgo de infección del resto de los pasajeros con el subsecuente peligro del desarrollo de patologías gastrointestinales. Por esto se evaluó la frecuencia de contaminación de autobuses con el fin de aportar datos que son desconocidos en Venezuela e inexistentes en Latinoamérica. Metodología. El trabajo fue descriptivo, transversal, con muestra no probabilística y accidental, donde la obtención de la muestra consistió en frotar el pasamanos de cada autobús (100 vehículos examinados) tres veces con un hisopo impregnado en solución salina isotónica 0.85%, resuspendiendolo en un tubo de ensayo con 10 ml de solución salina. La muestra se centrifugó a 3000 rpm por diez minutos para luego observar el sedimento al microscopio. Resultados. El 16% de las muestras presentaron contaminación, encontrándose solo dos especies de enteroparásitos, Blastocystis spp. (14% del total de muestras examinadas) y Endolimax nana (5%). Discusión. La abundancia del potencial patógeno Blastocystis sp., se relaciona con lo descrito en exámenes de heces de habitantes de Barquisimeto y del estado Lara, demostrando que los usuarios enfermos con malas conductas higiénicas convierten a los autobuses en un foco de infección que debe ser controlado. Conclusión. La falta de aseo constante en unidades de transporte público y la ausencia de conciencia sanitaria de algunos pasajeros infectados facilitan la transmisión de enteroparásitos endémicos potencialmente productores de enfermedades gastrointestinales. Cómo citar: Traviezo, L. Frecuencia de contaminación por enteroparásitos en pasamanos de autobuses de Barquisimeto, Venezuela. MedUNAB. 2020;23(3):434-440 doi: doi.org/10.29375/01237047.3913

Introduction. Enteroparasite contamination by infected users with poor sanitary habits in buses increases other passengers' risk of infection, with the subsequent danger of developing gastrointestinal pathologies. For this reason, bus contamination frequency was evaluated in order to provide data that is unknown in Venezuela and non-existent in Latin America. Methodology. The work was descriptive and cross-sectional, with non-probability and accidental sampling. The sample was obtained by rubbing each bus' handrail (100 examined vehicles) three times with a swab permeated with a 0.85% isotonic saline solution, resuspending it in a test tube with 10 ml of saline solution. The sample was centrifuged at 3,000 rpm for ten minutes to then observe the sediment under a microscope. Results. Sixteen percent of samples were contaminated, observing only two species of enteroparasites, Blastocystis sp. (14% of total examined samples) and Endolimax nana (5%). Discussion. The abundance of the potential pathogen, Blastocystis sp. is related to what has been described in feces exams on the inhabitants of Barquisimeto and the state of Lara, demonstrating that sick users with poor hygiene habits make buses a point of infection that must be controlled. Conclusion. The lack of constant cleaning in public transportation units and the absence of some infected passengers' sanitary awareness facilitates transmitting endemic enteroparasites that could potentially produce gastrointestinal diseases. Cómo citar: Traviezo, L. Frecuencia de contaminación por enteroparásitos en pasamanos de autobuses de Barquisimeto, Venezuela. MedUNAB. 2020;23(3):434-440 doi: doi.org/10.29375/01237047.3913

Introdução. A contaminação enteroparasitária em ônibus por usuários infectados com comportamentos sanitários inadequados aumenta o risco de infecção do resto dos passageiros com o consequente perigo de desenvolvimento de patologias gastrointestinais. Por isso, avaliou-se a frequência de contaminação de ônibus, a fim de fornecer dados até agora desconhecidos na Venezuela e inexistentes na América Latina. Metodologia. O trabalho foi descritivo, transversal, com amostra não-probabilística e acidental, em que a obtenção da amostra consistiu em esfregar o corrimão de cada ônibus (100 veículos examinados) três vezes com um cotonete impregnado em solução salina isotônica 0.85%, ressuspendendo-o em um tubo de ensaio com 10 ml de solução salina. A amostra foi centrifugada a 3,000 rpm por dez minutos para posteriormente observar o sedimento ao microscópio. Resultados. 16% das amostras apresentaram contaminação, sendo encontradas apenas duas espécies de enteroparasitas, Blastocystis sp. (14% do total das amostras examinadas) e Endolimax nana (5%). Discussão. A abundância do potencial patógeno Blastocystis sp., está relacionada ao que foi descrito em exames de fezes de moradores dos estados de Barquisimeto e Lara, mostrando que usuários doentes e com comportamentos sanitários inadequados fazem do ônibus um foco de infecção que deve ser controlado. Conclusão. A falta de limpeza constante nas unidades de transporte público e a falta de conscientização sobre a saúde de alguns passageiros infectados facilitam a transmissão de enteroparasitos endêmicos potencialmente produtoras de doenças gastrointestinais. Cómo citar: Traviezo, L. Frecuencia de contaminación por enteroparásitos en pasamanos de autobuses de Barquisimeto, Venezuela. MedUNAB. 2020;23(3):434-440 doi: doi.org/10.29375/01237047.3913

Auriculoterapia y tratamiento habitual en niños con tartamudez en Municipio Matanzas. Año 2017 / Auriculotherapy and habitual treatment in children with stuttering in the municipality of Matanzas. 2017

RESUMEN Introducción: se realizó un estudio experimental, longitudinal, prospectivo sobre el tratamiento de los niños con tartamudez con el tratamiento habitual y la adición de auriculoterapia en el Centro Auditivo Provincial en Matanzas entre enero y diciembre del 2017. Objetivo: comparar la evolución clínica de los pacientes con el tratamiento habitual y con la adición de auriculoterapia. Materiales y métodos: el universo del estudio fue de 14 pacientes con tartamudez. Según la llegada de los pacientes a consulta los mismos fueron ubicados alternativamente en dos grupos, uno control que se trató con tratamiento habitual y otro experimental, donde se aplicó el tratamiento habitual más la auriculoterapia. Fue elaborada la historia clínica con una evaluación logofoniátrica antes y después del tratamiento. Resultados: el 64,3% de los pacientes correspondió al grupo etáreo de 6-9 años, predominó el sexo masculino con 57,1 % y raza blanca con 64,3%. Los síntomas y signos más frecuente antes del tratamiento fueron la conciencia de sus dificultades en el 100 % de los pacientes y la ansiedad en 92,8%. Después del tratamiento en el grupo experimental hubo mayor disminución de la ansiedad con 28,6% y el 71,4% de este grupo consideró su evolución satisfactoria. Conclusión: en ambos grupos de estudio predominó la edad entre 6 y 9 años, el sexo masculino, la raza blanca y los síntomas y signos más frecuentes fueron: la conciencia de sus dificultades y la ansiedad. En pacientes del grupo experimental la evolución fue más satisfactoria y hubo una mayor reducción de la ansiedad (AU).

SUMMARY Introduction: a prospective, longitudinal experimental study on the treatment of children with stuttering using the habitual treatment and the addition of Auriculotherapy in the Provincial Auditory Center in Matanzas, from January to December 2017. Objective: to compare the clinical evolution of the patients with the habitual treatment and with the addition of auriculotherapy. Materials and methods: the universe of study was 14 patients with stuttering. According to the arrival of the patients to the consultation they were alternatively located in two groups, a control one treated with the customary treatment, and an experimental one treated with the usual treatment plus auriculotherapy. The clinical records were elaborated with a logo-phoniatric assessment before and after treatment. Results: 64.3 % of patients were in the 6-9 years-old age group; male sex and white race predominated, with 57.1 % and 64.3 % respectively. The most frequent symptoms and signs before treatment were the consciousness of their difficulties in 100 % of patients, and anxiety in 92.8 % of them. After treatment, there it was a higher diminution of anxiety for 28.6 % in the experimental group, and 71.4 % of them considered satisfactory their evolution. Conclusion: age between 6 and 9 years, male sex and white race predominated in both groups; the most frequent symptoms and signs were the consciousness of their difficulties and anxiety. In the experimental group the evolution was satisfactory and the reduction of anxiety was higher (AU).

Caracterización clínica de la hemorragia intracerebral en pacientes ingresados en Hospital Faustino Pérez. 2012-2013 / Clinical characterization of the intracerebral hemorrhage in patients admitted in the Hospital Faustino Perez. 2012-2013

RESUMEN Introducción: las enfermedades cerebrovasculares son un problema de salud mundial, constituyen la tercera causa de muerte, la primera de discapacidad en el adulto y la segunda de demencia en el planeta Objetivo: caracterizar la hemorragia intracerebral en estos pacientes en relación con edad y sexo, factores de riesgo, letalidad según localización y extensión de la hemorragia. Materiales y métodos: se realizó un estudio observacional retrospectivo en pacientes ingresados con hemorragia intracerebral en el Hospital Faustino Pérez en los años 2012 y 2013. El universo del estudio fue de 86 pacientes ingresados con hemorragia intracerebral. Resultados: predominó el sexo masculino y el grupo de edades de 70-79 años con 54,65% y 34,88% respectivamente, la raza negra con 40,7% y el factor de riesgo más frecuente fue la hipertensión arterial con 82,55% seguido de la diabetes mellitus con 23.25. La letalidad fue más elevada en los pacientes mayores de 80 años con 41,66%. Según la localización la subcortical fue más frecuente con 34,88% y la más letal el tallo encefálico con 100%. Según la extensión predominó la intraparenquimatosa pura con 69,76% y fue más letal intraventricular con 55%. Conclusión: la hemorragia intracerebral fue más frecuente en pacientes del sexo masculino, del grupo de edades de 70-79 años y de raza negra. El factor de riesgo más frecuente fue la hipertensión arterial, la localización más frecuente fue la subcortical y la extensión la intraparenquimatosa pura. La letalidad fue más alta en pacientes mayores de 80 años, con localización en tronco encefálico y extensión intraventricular.

ABSTRACT Introduction: cerebrovascular diseases are a health problem around the world, being the third cause of death, the first one of disability in adults, and the second cause of dementia in the world. Objective: to characterize intracerebral hemorrhage in these patients in relation to age and sex, risk factors, lethality according to its location and hemorrhage extension. Materials and methods: an observational, retrospective study was carried out in patients admitted in the Hospital Faustino Perez with intracerebral hemorrhage in 2012 and 2013. The universe of the study was 86 patients admitted due to intracerebral hemorrhage. Results: male sex (54.65 %), 70-79-years-old age group (34.88 %) and black race (49.7 %) predominated. The most frequent risk factor was arterial hypertension (82.55 %), followed by diabetes mellitus (23.25 %). Lethality was higher in patients elder than 80 years old (41.66 %). According to location, the subcortical one was the most frequent (34.88 %), and the most lethal was the one of the brainstem (100 %). According for the extension, the pure intraparenchimatous one predominated (69.76 %), and the intraventricular one was the most lethal (55 %). Conclusion: the intracerebral hemorrhage was more frequent in male sex, 70-79-years-old age group and black race. The most frequent risk factor was arterial hypertension; the most frequent location was the subcortical one, and the one with larger extension was the pure intraparenchimatous one. Lethality was higher in patients aged more than 80 years, located in the brainstem and with intraventricular extension.

Films as an Educational Resource in the Teaching of Humanistic Attitudes to Medicine Students / O Cinema como Recurso Educacional no Ensino de Atitudes Humanísticas a Estudantes de Medicina

ABSTRACT Introduction Contemporary medical education prioritizes the development of scientific knowledge and technical skills, associated with professional attitudes. Attitudes are components of affective ability and influence medical practice, so they should be taught systematically during undergraduate training. The use of films as a pedagogical resource in medical training allows reflection on the biopsychosocial context in which the patient is inserted, contributing to the development of humanistic attitudes among students and future physicians. Objective To evaluate the effectiveness of cinema as an educational resource in teaching humanistic attitudes to medical students. Material and Methods A cross-sectional, quasi-experimental, qualitative and quantitative study was carried out with 107 students from the first to sixth year of the medical course of the Federal University of Amapá. The Medical Students Attitude Scale (validated by the author Maria de Fátima Colares, 2002) was used before and after the exhibition of films related to relevant themes in the medical area. This psychometric scale is composed of multiple-choice Likert-type responses and aims to assess the attitudes of medical students regarding the following factors: primary health care; psychological and emotional aspects involved in diseases; ethical aspects in professional practice; mental illness, death-related situations; scientific research. The Wilcoxon Rank Test was used to compare data from paired samples. Results All the factors evaluated by the medical students attitudes scale related to relevant aspects of medical practice showed a significant increase in the frequency of positive attitudes (p < 0.05) among the first- to fourth-year students following the cinema sessions. The fifth- and sixth-year students did not present significant changes in attitudes related to death, mental illness and contribution to the scientific advancement of medicine. Conclusion Cinema is an effective pedagogical tool in teaching humanistic attitudes in the preclinical series of the medical course.

RESUMO Introdução A educação médica contemporânea prioriza o desenvolvimento de conhecimento científico e habilidades técnicas, associados a atitudes profissionais. Atitudes são componentes da habilidade afetiva e influenciam a prática médica, por isso devem ser ensinadas sistematicamente durante a graduação. A utilização de filmes como recurso pedagógico na graduação médica possibilita uma reflexão no contexto biopsicossocial em que o paciente está inserido, contribuindo para desenvolver atitudes humanísticas entre estudantes de Medicina e futuros médicos. Objetivo Avaliar a eficácia do cinema como recurso educacional no ensino de atitudes humanísticas aos discentes do curso de Medicina. Material e Métodos Foi realizado um estudo transversal, exploratório, quantitativo, com 107 estudantes do primeiro ao sexto ano do curso de Medicina da Universidade Federal do Amapá. Foi utilizada a Escala de Atitude de Estudantes de Medicina (validada por Colares et al.1 ) antes e depois da exibição de filmes relacionados a temáticas relevantes na área médica. Esta escala psicométrica é composta de respostas de múltipla escolha do tipo Likert e visa aferir atitudes de estudantes de Medicina em relação aos seguintes fatores: assistência primária à saúde; aspectos psicológicos e emocionais envolvidos nas doenças; aspectos éticos no exercício profissional; doença mental, situações relacionadas à morte; pesquisa científica. Foi empregado o Teste de Wilcoxon (Wilcoxon Rank Test) para comparar dados de amostras pareadas. Resultados Todos os fatores avaliados pela escala de atitudes dos estudantes de Medicina frente a aspectos relevantes da prática médica apresentaram aumento significativo na frequência de atitudes positivas (p < 0,05) após as sessões de cinema entre os alunos do primeiro ao quarto ano da graduação. Os alunos do quinto e sexto ano não apresentaram mudança significativa de atitudes nos fatores relacionados à morte, à doença mental e à contribuição com o avanço científico da medicina. Conclusão O cinema é uma ferramenta pedagógica eficaz no ensino de atitudes humanísticas a estudantes do curso médico.

Avaliação dos níveis de intensidade de esforço durante o jogo de rugby em cadeiras de rodas / Effort intensity levels during a wheelchair rugby game

O Rugby em cadeira de rodas (RCR) é um esporte paralímpico praticado por homens e mulheres com tetraplegia decorrente de lesão na medula espinhal (LME). Nos esportes de alto rendimento o desempenho do atleta depende de preparo físico, aspectos tático e técnico. Dentre as variáveis fisiológicas importantes no controle do treinamento e na resposta aos treinos encontra-se a frequência cardíaca (FC). O presente estudo teve como objetivo verificar a intensidade da FC durante jogos de RCR. Para isso, utilizou-se do frequencímetro FIRTSBEAT modelo SPORTS Team 4.6®, para o monitoramento da FC dos atletas de RCR durante os jogos. A amostra foi composta por nove atletas homens de RCR com LME com nível de lesão acima da vértebra T6. Os resultados obtidos demonstraram que a média das FC máximas foi de 138,55 ± 17,5 bpm. A intensidade variou cerca de 77% do tempo entre Zona aeróbia 1, Zona aeróbia 2 e Zona de limiar anaeróbio, indicando uma grande oscilação, o que é esperado por se tratar de um esporte que possui características de intermitência. Conclui-se que os atletas de RCR apresentaram uma FC máxima reduzida, correspondente às encontradas na literatura, e que esses apresentaram uma variação da intensidade da FC, com predominância entre 60% a 90% da FC máxima.

Wheelchair Rugby (WR) is a Paralympic sport modality practiced by men and women with spinal cord injury (SCI). In high performance sports, the performance of the athlete depends on his physical fitness, as well as tactical and technical aspects. Heart rate (HR) features among the several essential physiological variables in the control of the training and in response to training. This study aimed to determine the HR intensity during WR matches. In order to do so, FIRSTBEAT SPORTS Team 4.6® heart rate monitors were used to monitor the HR of the WR athletes during the games. The sample consisted of nine male WR athletes with SCI with impairment level above T6. The results showed that the average maximum HR was 138 ± 17.5 bpm. Intensity varied in approximately 77% of the time between the Aerobic Zone 1, Aerobic Zone 2 and the Anaerobic Threshold Zone, presenting great oscillation. This is expected, since rugby is a sport with intermittent characteristics. It was concluded that WR athletes showed reduced HR (max), similar to the results found in literature, and presented variation in the HR intensity, with a predominance between 60% to 90% of the HR(max).

Caracterización clínico-epidemiológica de los pacientes ancianos diabéticos con discapacidad funcional / Clinical epidemiologic characteristics of diabetic elder people with functional disability

Introducción: la diabetes mellitus es una de las enfermedades crónicas más frecuentes en el senescente. Se ha notado un gran incremento en los últimos años debido al aumento de la sobrevida de la población mundial, no hay correspondencia entre la atención que se presta en las unidades de salud a los ancianos diabéticos y la alta repercusión que tiene en su funcionabilidad, lo cual atenta contra su calidad de vida. Objetivo: determinar la relación existente entre la diabetes y la discapacidad en los ancianos, así como entre la funcionalidad y tiempo de evolución de la enfermedad, enfermedades asociadas y alteraciones en la esfera psicoafectiva. Materiales y métodos: se realizó un estudio observacional descriptivo de corte transversal que incluyo 141 pacientes diabéticos mayores de 60 años pertenecientes al área de salud de Ceiba Mocha que cumplían los criterios de inclusión, en el período comprendido de octubre del 2013, hasta diciembre del 2014. Resultados: más de la mitad de los pacientes evidenciaron alteración de la funcionabilidad. La obesidad y la hipertensión fueron las enfermedades asociadas que predominaron en los diabéticos con alteración funcional. Se evidenció un mayor número de pacientes con alteración funcional en aquellos de 10 a 15 años de evolución de la enfermedad. Un alto por ciento de los pacientes con alteración funcional evidencio depresión y deterioro cognitivo leve. Conclusiones: de los pacientes diabéticos estudiados el grupo de edad más afectado fue el de 70 a 79 años, seguido del de 60 a 69. El sexo femenino fue el que más predominó. Más de la mitad de los pacientes estudiados evidenciaron alteración funcional predominando en aquellos pacientes con mayor tiempo de evolución de la enfermedad (AU).

Introduction: diabetes mellitus is one of the most frequent chronic diseases in elder people. A great increase of this disease has been noted during the last years due to the growth of population´s survival. There is not correspondence between the health care given to diabetic elder people in the health care institutions and the high repercussion the disease has on their functionality, a fact attempting against their life quality. Objective:to determine the relationship existing between diabetes and disability in elder people, and also between functionality and disease evolution time, associated diseases and disorders in the psycho-affective sphere. Material and methods: a cross-sectional, observational, descriptive study was carried out on 141 diabetic patients, older than 60 years old, belonging to the health area Ceiba Mocha, who fulfilled the inclusion criteria, in the period from October 2013 to December 2014. Results: more than half of the patients evidenced functionality disorders. Obesity and hypertension were the predominating associated diseases in diabetic patients with functional disorders. It was evidenced a higher number of patients with functional disorders among those with 10-15 years of disease´s evolution. A high percent of the patients with functional disorders showed depression and mild cognitive impairment. Conclusions: among the studied patients, the most affected age group was the 70-79-years-old group, followed by the 60-69-years-old one. The female sex predominated. More than half of the studied patients had functional disorders, predominating in those patients with a higher time of disease´s evolution. (AU)

Caracterización clínica de la tuberculosis en el municipio de Matanzas. Año 2010-2014 / Clinical characterization of tuberculosis in the municipality of Matanzas. 2010-2014 years

Introducción: la tuberculosis es la más antigua de las pandemias y causa alrededor de 1,7 millones de muertes y 9 millones de casos nuevos cada año constituyendo una enfermedad remergente en cuba por lo cual se realizó un estudio observacional descriptivo retrospectivo en el municipio de Matanzas en el período comprendido entre enero 2010 a diciembre del 2014. Objetivo: determinar el comportamiento clínico de la tuberculosis. Materiales y métodos: el universo del estudio fue el total de 41 pacientes con diagnóstico de tuberculosis en el municipio de Matanzas en el periodo estudiado y los datos fueron obtenidos del departamento de estadística del Centro Municipal de Higiene y Epidemiología. Resultados: predominó el sexo masculino con el 87,8% de los pacientes y el grupo de edades de 60 y más años con el 34,15 %. El grupo vulnerable más frecuente fue el de los alcohólicos 50,09% seguidos de los pacientes con 60 o más años con el 34,14%. Predominó el diagnóstico mediante el pesquisaje pasivo con el 65,85% de los pacientes. El síntoma más frecuente fue la tos en 85,35% de los pacientes seguido por la expectoración y la disnea con 68,29% y 65,85% respectivamente. La tasa de defunción por tuberculosis en quinquenio estudiado fue 0,36 x 100000 habitantes. Conclusiones: el diagnóstico de tuberculosis fue más frecuente en el sexo masculino, en el grupo etario de 60 años y más y en alcohólicos. Los síntomas más frecuentes fueron tos, expectoración y disnea. Predominó el pesquisaje pasivo en el diagnóstico (AU).

Introduction: tuberculosis is the oldest of the pandemics and causes around 1.7 million of death and 9 million of cases every year, being a reemerging disease in Cuba. That is why a retrospective, descriptive, observational study was carried out in the municipality of Matanzas in the period between January 2010 and December 2014. Objective: to determine the clinical behavior of tuberculosis. Materials and methods: the universe of study was the total of 41 patients diagnosed with tuberculosis in the municipality of Matanzas in the studied period. Data were obtained from the Department of Statistics of the Municipal Center of Hygiene and Epidemiology. Results: male sex predominated with 87.8 % of the patients in the age group of 60 years and more (34.15 %). The most vulnerable group was the one of the alcoholics with 50.09 %, followed by the patients aged 60 years or more, with 34.14 %. The predominating diagnosis was the one obtained through passive screening, for 65.85 % of the patients. The most frequent symptom was cough in 85.35 of the patients, followed by expectoration and dyspnea, with 68.29 % and 65.85 respectively. The death rate for tuberculosis in the studied five-year period was 0.36 x 100 000 inhabitants. Conclusions: Tuberculosis diagnosis was more frequent in male sex, in the age group of 60 years-old and more and in alcoholics. The most frequent symptoms were cough, expectoration and dyspnea. Passive screening predominated in the diagnosis (AU).

Conducta antitrombótica en pacientes con fibrilación auricular e ictus isquémico. Hospital Faustino Pérez. Año 2017 / Antithrombotic behavior in patients with auricular fibrillation and ischemic stroke. Hospital ¨Faustino Pérez¨. 2017

Introducción: se realizó un estudio observacional transversal en pacientes con fibrilación auricular ingresados con ictus isquémico en la sala de neurología del Hospital Faustino Pérez el año 2017. Objetivo: describir la conducta antitrombótica en estos pacientes previa al ingreso en relación con: riesgo de embolismo y sangrado, factores de riesgo de sangrado, tratamiento antitrombótico indicado. Materiales y métodos: el universo del estudio fue de 40 pacientes con fibrilación auricular e ictus isquémico. Durante el ingreso a los pacientes y/o familiares se les aplicó una encuesta para la obtención de la información. Se determinó el riesgo de embolismo y sangrado según las escalas CHA2DS2-VASc y HAS-BLED respectivamente. Resultados: predominó el grupo de edades de 75-84 años con 50%, 95% de los pacientes presentó alto riesgo de embolismo, los factores de riesgo de sangrado más frecuente fueron la edad > 65 años y la hipertensión arterial con 95% y 85% respectivamente, 70 % presentó bajo riesgo de sangrado y en pacientes con alto riesgo de sangrado el 20% presentó puntuación de 3 puntos, 60% de los pacientes no presentó tratamiento antitrombótico antes del ingreso con ictus isquémico asociado a fibrilación auricular, 35 % fue tratado con antiagregantes plaquetario y solo 5% con tratamiento anticoagulante. Conclusiones: la mayoría de los pacientes fueron mayores de 75 años con alto riesgo de embolismo y bajo riesgo de sangrado por lo cual era recomendada la anticoagulación. Los anticoagulantes orales son poco indicados en pacientes con fibrilación auricular a pesar de asociarse a mayor supervivencia (AU).

Introduction: it was carried out a transversal observational study in the hospitalized patients with atrial fibrillation and ischemic stroke in the neurology service of Faustino Pérez Hospital in 2017. Objective: To delineate the antithrombotic management in these patients prior to be admitted in the hospital in regard to embolism risk and bleeding risk, bleeding risk factors, antithrombotic therapy indicated. Materials and methods: The universe of the study was 40 patients with AF and ischemic stroke. During the hospitalization of the patients were applied a survey to patients and/or their relatives for getting the information. The embolism risk and bleeding risk were defined according to CHA2DS2-VASc and HAS-BLED scales respectively. Results: The most prevalence ages group was of the 75-84 year-old, in 95% of the patients the embolism risk was high, the most frequent bleeding risk factors for bleeding were age over 65 years and arterial hypertension with 95% y 85% respectively, in 70% bleeding risk was low and in patients with high bleeding risk the 20% carried a score of 3 points, 60% of the patients hadn't antithrombotic therapy prior to be hospitalized with ischemic stroke, 35 % used antiplatelet Agents and only 5% used anticoagulants therapy. Conclusion: The most hospitalized patients with ischemic stroke and AF had high embolism risk and low bleeding risk and should be treated with oral anticoagulant therapy. Oral anticoagulants are underused patients with atrial fibrillation despite of being associated with more survival (AU).