Implementation of the Versius robotic surgical system for thoracic surgery: first clinical evaluation of feasibility and performance.

OBJECTIVES: The aim of this study is to demonstrate the ability of the Versius surgical system to successfully and safely complete a range of thoracic procedures aligned with Stage 2a (Development) of the Idea, Development, Exploration, Assessment and Long-term follow-up framework for surgical innovation. METHODS: This prospective study included the first 30 consecutive patients who underwent robotic surgery with Versius by 2 surgeons without prior robotic experience between 1 April 2023 and 30 December 2023 [25 lung resections (wedge, segmentectomy and lobectomy) and 5 thymectomies]. There were no specific predetermined selection criteria for each case. The primary outcome was safe completion of the procedure without unplanned conversion. Secondary outcomes included intraoperative and postoperative complications, intraoperative device-related outcomes and pathology results. RESULTS: Twenty-eight (93.3%) cases were completed without conversion. Both conversions were to thoracoscopy, one due to a 'console alarm' and the other due to pulmonary artery bleeding. In lung resections, median console time was 103 (90-129) min. Five (20%) patients experienced postoperative complications, most frequent was persistent air leak (16%). Median length-of-stay was 3 (2-4) days. Neither readmissions nor mortality was observed. In thymectomies, no intraoperative or postoperative complications, readmissions, reinterventions or mortality were observed. Median console time was 77 (75-89) min and median length of stay was 1 (1-1) day. CONCLUSIONS: This phase 2a IDEAL-D study confirms lung resections and thymectomies are feasible with the use of Versius system, laying the foundation for larger phase 2b and 3 clinical studies within the IDEAL-D framework.

Predicting changes in brain metabolism and progression from mild cognitive impairment to dementia using multitask Deep Learning models and explainable AI.

BACKGROUND: The prediction of Alzheimer's disease (AD) progression from its early stages is a research priority. In this context, the use of Artificial Intelligence (AI) in AD has experienced a notable surge in recent years. However, existing investigations predominantly concentrate on distinguishing clinical phenotypes through cross-sectional approaches. This study aims to investigate the potential of modeling additional dimensions of the disease, such as variations in brain metabolism assessed via [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET), and utilize this information to identify patients with mild cognitive impairment (MCI) who will progress to dementia (pMCI). METHODS: We analyzed data from 1,617 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) who had undergone at least one FDG-PET scan. We identified the brain regions with the most significant hypometabolism in AD and used Deep Learning (DL) models to predict future changes in brain metabolism. The best-performing model was then adapted under a multi-task learning framework to identify pMCI individuals. Finally, this model underwent further analysis using eXplainable AI (XAI) techniques. RESULTS: Our results confirm a strong association between hypometabolism, disease progression, and cognitive decline. Furthermore, we demonstrated that integrating data on changes in brain metabolism during training enhanced the models' ability to detect pMCI individuals (sensitivity=88.4%, specificity=86.9%). Lastly, the application of XAI techniques enabled us to delve into the brain regions with the most significant impact on model predictions, highlighting the importance of the hippocampus, cingulate cortex, and some subcortical structures. CONCLUSION: This study introduces a novel dimension to predictive modeling in AD, emphasizing the importance of projecting variations in brain metabolism under a multi-task learning paradigm.

Genetic-based patient stratification in Alzheimer's disease.

Alzheimer's disease (AD) shows a high pathological and symptomatological heterogeneity. To study this heterogeneity, we have developed a patient stratification technique based on one of the most significant risk factors for the development of AD: genetics. We addressed this challenge by including network biology concepts, mapping genetic variants data into a brain-specific protein-protein interaction (PPI) network, and obtaining individualized PPI scores that we then used as input for a clustering technique. We then phenotyped each obtained cluster regarding genetics, sociodemographics, biomarkers, fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging, and neurocognitive assessments. We found three clusters defined mainly by genetic variants found in MAPT, APP, and APOE, considering known variants associated with AD and other neurodegenerative disease genetic architectures. Profiling of these clusters revealed minimal variation in AD symptoms and pathology, suggesting different biological mechanisms may activate the neurodegeneration and pathobiological patterns behind AD and result in similar clinical and pathological presentations, even a shared disease diagnosis. Lastly, our research highlighted MAPT, APP, and APOE as key genes where these genetic distinctions manifest, suggesting them as potential targets for personalized drug development strategies to address each AD subgroup individually.

Conmemorando los cincuenta años de Leche Purita: importancia de la leche en la erradicación de la desnutrición infantil en Chile

La desnutrición ocurre cuando hay una ingesta o asimilación deficiente de la energía y los nutrientes. Si esta se produce dentro de los primeros años de vida, las consecuencias para la salud son devastadoras. El tratamiento temprano de la desnutrición es clave para reducir estas consecuencias y en este proceso la leche tiene una participación destacada. La leche es un excelente alimento debido al contenido y calidad de sus macro- y micronutrientes, lo que ha llevado a que la investigación y el uso de la leche en el tratamiento de la desnutrición hayan aumentado sostenidamente desde comienzos del siglo XX. En Chile, la desnutrición infantil fue prácticamente erradicada entre los años 1960 y 1980 debido a la aplicación exitosa de una serie de políticas públicas materno-infantiles, dentro de las cuales la Leche Purita fue fundamental. Sin embargo, la historia de la leche como parte de las políticas nutricionales en Chile comenzó mucho antes. Conmemorando los cincuenta años desde el nacimiento de Leche Purita, el objetivo de este trabajo es realizar un breve repaso acerca de la importancia histórica de la leche en las políticas nutricionales en Chile, enfatizando la contribución realizada por la Leche Purita a la erradicación de la desnutrición infantil y a la disminución de la anemia en niños.

Undernutrition occurs when there is poor intake or assimilation of energy and nutrients. If undernutrition is established within the first years of life, the health consequences are devastating. Early treatment of undernutrition is critical to reduce these consequences and milk plays an important role in this treatment. Cow's milk is an excellent food due to the content and quality of its macro- and micronutrients. This has led to a steady increase in research and the use of milk in treating undernutrition since the beginning of the 20th century. In Chile, child undernutrition was practically eradicated between the decades of 1960 and 1980 due to the successful application of maternal and child public policies, within which the product Leche Purita was fundamental. However, the history of milk as part of nutritional policies in Chile began much earlier. Commemorating fifty years since the introduction of Leche Purita, we aim to summarize the historical importance of milk in Chile's nutritional policies. We emphasize Leche Purita's role in eradicating child undernutrition and reducing anemia among children.

Monitoring differences in the function of the autonomic nervous system in patients with chronic insomnia using a wearable device.

STUDY OBJECTIVES: to characterize possible differences in the function of the ANS in patients with chronic insomnia compared to a control group, using a wearable device, in order to determine whether those findings allow diagnosing this medical entity. METHODS: Thirty-two patients with chronic insomnia and nineteen patients without any sleep disorder, as a control group, were recruited prospectively. Both groups of patients underwent an in-patient night with simultaneous polysomnography and wearable device recording Empatica E4 a diverse array of physiological signals, including electrodermal activity, temperature, accelerometry, and photoplethysmography, providing a comprehensive resource for in-depth sleep analysis. RESULTS: In polysomnography, patients suffering from insomnia showed a significant decrease in sleep efficiency and total sleep time, prolonged sleep latency, and increased wakefulness after sleep onset. Accelerometry results were statistically significant differences in the three axis (x, y, z) just in stage N3, no differences were observed between both groups in REM sleep. The lowest temperature was reached in REM sleep in both groups. Peripheral temperature did not decrease during the different sleep phases compared to wakefulness in insomnia, unlike in the control group. Heart rate was higher in patients with insomnia than in controls during wakefulness and sleep stage. Heart rate variability was lower in stage N3 and higher in REM sleep compared to wakefulness in both groups. Sweating was significantly higher in patients with insomnia compared to the control group, as indicated by Skin Conductance Variability values and Sudomotor Nerve. CONCLUSIONS: Our study suggests that patients with insomnia have increased sympathetic activity during sleep, showing a higher heart rate. Temperature and sweating significantly influence the different sleep phases.

30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study.

OBJECTIVE: This study aimed to assess 30-day morbidity and mortality rates following cholecystectomy for benign gallbladder disease and identify the factors associated with complications. SUMMARY BACKGROUND DATA: Although cholecystectomy is common for benign gallbladder disease, there is a gap in the knowledge of the current practice and variations on a global level. METHODS: A prospective, international, observational collaborative cohort study of consecutive patients undergoing cholecystectomy for benign gallbladder disease from participating hospitals in 57 countries between January 1 and June 30, 2022, was performed. Univariate and multivariate logistic regression models were used to identify preoperative and operative variables associated with 30-day postoperative outcomes. RESULTS: Data of 21,706 surgical patients from 57 countries were included in the analysis. A total of 10,821 (49.9%), 4,263 (19.7%), and 6,622 (30.5%) cholecystectomies were performed in the elective, emergency, and delayed settings, respectively. Thirty-day postoperative complications were observed in 1,738 patients (8.0%), including mortality in 83 patients (0.4%). Bile leaks (Strasberg grade A) were reported in 278 (1.3%) patients and severe bile duct injuries (Strasberg grades B-E) were reported in 48 (0.2%) patients. Patient age, ASA physical status class, surgical setting, operative approach and Nassar operative difficulty grade were identified as the five predictors demonstrating the highest relative importance in predicting postoperative complications. CONCLUSION: This multinational observational collaborative cohort study presents a comprehensive report of the current practices and outcomes of cholecystectomy for benign gallbladder disease. Ongoing global collaborative evaluations and initiatives are needed to promote quality assurance and improvement in cholecystectomy.

Etiquetado nutricional de alimentos procesados (semáforo nutri-cional) y su relación con factores socioeconómicos, culturales, demográficos y publicitarios, según padres de niños entre 5-11 años de dos colegios de Quito / Nutritional labeling of processed foods (nutritional stoplight) and its relationship with socioeconomic, cultural, demographic and advertising factors, according to parents of children between 5-11 years of age from two schools in Quito

Introducción: El etiquetado nutricional es una herramienta gráfica para notificar al consumidor sobre las propiedades nutricionales de un alimento lo que facilita su selección. El objetivo del presente estudio fue determinar la influencia del etiquetado nutricional y los factores socioeconómicos, culturales, demográficos, publicitarios en la selección de alimentos en un grupo de padres de niños entre 5-11 años en dos unidades educativas públicas y privadas de Quito. Métodos: Con diseño mixto, cuantitativo- transversal y cualitativa interpretativa se analizó una muestra de opiniones de 240 padres en las Unidades Educativas (UE) Nueva Aurora (Privada) y 235 padres en la UE Julio María Matovelle (Pública) de Quito. Se realizaron tres grupos focales, grabados y transcriptos de forma textual y se aplicó un cuestionario. El paquete esta-dístico usado fue SPSS v24.0. Resultados: Hubo mayor consumo de alimentos procesados en la UE Privada n=79/240 (32.9%). Selección por fácil preparación (39.2% UE Privada y 46.4% UE Pública). El 54.2 % y 57 % de los padres ven publicidad en la televisión. El conocimiento del etiquetado fue superior en la UE privada (94.9%; n=223). Asociación entre edad [OR: 2.3; IC 95%: 1.08-5.04] instrucción [OR: 3.95; IC 95%: 2.12-7.37], exposición a la publicidad [OR: 0.62; IC 95%: 0.36-1.05] y conocimientos (P<0.05). La actitud se asoció con el nivel de instrucción [OR: 2.57; IC 95%: 1.62-4.09] e ingresos (P<0.05). Análisis cualitativo: grado de conocimiento y publicidad elevados, con un impacto importante en la selección de los alimentos. Conclusiones: El conocimiento sobre el etiquetado nutricional fue elevado; pero no fue el principal factor para seleccionar alimentos. El tiempo de preparación y el sabor fueron más importantes que las especificaciones nutricionales

Introduction: Nutrition labeling is a graphic tool to notify consumers about the nutritional properties of a food, which facilitates their selection. The objective of this study was to determine the influence of nutri-tional labeling and socioeconomic, cultural, demographic, and advertising factors on food selection in a group of parents of children between 5-11 years old in two public and private educational units in Quito. Methods: With a mixed, quantitative-transversal and qualitative interpretative design, a sample of opin-ions of 240 parents in the Educational Units (EU) Nueva Aurora (Fiscal) and 235 parents in the EU Julio María Matovelle (Private) of Quito was analyzed. Three focus groups were carried out, recorded and transcribed textually, and a questionnaire was administered. The statistical package used was SPSS v24.0. Results: There was a higher consumption of processed foods in the private EU n = 79/240 (32.9%). Selection for easy preparation (39.2% Private EU and 46.4% Public EU). 54.2% and 57% of parents see advertising on television. Knowledge of labeling was higher in the private EU (94.9%; n = 223). Association between age [OR: 2.3; 95% CI: 1.08-5.04] instruction [OR: 3.95; 95% CI: 2.12-7.37], exposure to advertising [OR: 0.62; 95% CI: 0.36-1.05] and knowledge (P <0.05). Attitude was associated with educational level [OR: 2.57; 95% CI: 1.62-4.09] and admissions (P <0.05). Qualitative analysis: high degree of knowledge and publicity, with a significant impact on food selection. Conclusions: Knowledge about nutritional labeling was high, but it was not the main factor in selecting food. Prep time and flavor were more important than nutritional specifications.

Infección por uncinarias en un lactante menor: Reporte de caso / Infantile hookworm infection: Clinical case report

La uncinariasis es endémica en zonas tropicales. Es común en preescolares y escolares pero infrecuente en lactantes antes de los 6 meses debido al mecanismo de transmisión que implica contacto de la piel con el suelo contaminado. La infección se caracteriza por anemia ferropénica secundaria a sangrado digestivo crónico. Una forma inusual de presentación es el sangrado digestivo masivo que causa anemia severa. Presentación del caso: Niña shuar de 4 meses sin antecedentes patológicos, referida del Hospital General Puyo por un cuadro de melenas de 3 meses de evolución. Al mes de edad inició con deposiciones melénicas ocasionales y palidez que empeoraron dos semanas antes del ingreso. Se apreció palidez generalizada, hipoactividad y edema en miembros inferiores. Presentó hemoglobina 2,8 g/dL, hematocrito 9%, volumen corpuscular medio 73 fl, ancho de distribución de eritrocitos 18%, reticulocitos 1% y eosinófilos 4%. El coprológico y coproparasitario reportaron heces alquitranosas, sangre positiva y huevos de uncinarias más Kato-Katz compatible con intensidad de infección moderada. Se diagnosticó anemia severa por sangrado digestivo secundario a uncinarias. Se trató con Albendazol 400 mg vía oral en una toma más transfusión sanguínea. A los 5 días mejoró la hemoglobina y disminuyó el edema. Las melenas cesaron. Se dió el alta para control ambulatorio. Conclusión: La uncinariasis es una enfermedad endémica cuya presencia e impacto en lactantes se ha subestimado pues no es considerada como causa de sangrado digestivo. Debe pensarse en esta parasitosis en contextos de zonas endémicas en niños que cumplan un perfil clínico similar al descrito

Hookworms are endemic nematodes from tropical regions. Infection is more common in preschool and school children, but it is less frequent in infants under 6 months, because of the transmission mechanism that implies contact between contaminated soil and skin. The clinical disease is characterized by manifestations related to iron-deficiency anemia, secondary to a chronic digestive blood loss. An unusual way of presentation is the massive digestive bleeding that causes severe anemia. Case report: A four month shuar girl with no significant medical history, referred from General Puyo hospital, presented upper digestive bleeding of 3 months duration. At month of age, the girl presented self-limited melenas and skin pallor that worsen two weeks before the admission. The girl was hypo active, with a pale complexion, and had edema of feet. Her blood count showed hemoglobin 2.8 g/dl, hematocrit 9%, mean corpuscular volume 73 fl, red cell distribution width 18%, reticulocyte count 1%, eosinophils 4%. Coprological analysis reported tarry stools, positive fecal occult blood test, and hookworm eggs determined by Kato ­ Katz as a moderate infection. It was diagnosed iron-deficiency anemia secondary to an upper digestive bleeding caused by hookworms. The infection was treated with a single oral dose of albendazole 400mg plus blood transfusion. After 5 days of treatment, hemoglobin increased and edema was reduced. Melenas disappeared completely. Finally the discharge was indicated for outdoor control. Conclusion: Hookworm infestation is an endemic disease whose presence and impact in infants has been underestimated because it is not necessary as a cause of digestive bleeding. This disease should be considered in contexts of endemic areas in children who meet a clinical profile similar to that described

Comparación de la utilidad clínica de datos antropométricos de recién nacidos prematuros empleando las gráficas Fenton e Intergrowth-21st / Comparison of the clinical utility of anthropometric data of preterm infants using Fenton and Intergrowth -21 st charts

Introducción: no existe consenso sobre la gráfica idónea para monitorizar el crecimiento de prematuros, sin embargo, Fenton es la más difundida. Desde el aparecimiento de INTERGROWTH-21st ésta se perfila como una herramienta eficaz. Nuestro objetivo fue comparar INTERGROWTH-21st y Fenton en la valoración antropométrica de prematuros. Población y Métodos: estudio transversal que analizó datos antropométricos de prematuros entre enero de 2014 a diciembre de 2016 mediante la revisión de registros. La clasificación se realizó por edad gestacional y sexo usando Fenton y se compararon con INTERGROWTH-21st categorizando los percentiles 10, 50 y 90. Se realizaron pruebas de correlación y concordancia (p < 0.05, intervalo de confianza 95%). Se mantuvieron los respectivos lineamientos éticos. Resultados: en 232 prematuros la prevalencia de peso bajo fue de 13.7% con Fenton y 15.9% con INTERGROWTH-21st y para peso elevado 2.5% y 6% respectivamente. Presentaron una concordancia de 0.7 peso y perímetro cefálico. De 194 prematuros adecuados para la edad gestacional por Fenton, INTERGROWTH-21st clasificó al 4% como bajos y altos y el resto como adecuados. Existió correlación positiva en los tres parámetros antropométricos. Tomando como estándar a INTERGROWTH-21st y como criterio a evaluar a Fenton, la especificidad fue mayor que la sensibilidad en la antropometría baja (98.4 y 78.3 peso, 98.3 y 62.5 longitud y 100 y 64.2 perímetro cefálico) y elevada (100 y 42.8 peso, 97.5 y 22.2 longitud y 96.3 y 70 perímetro cefálico). Conclusión: Fenton clasifica con menor frecuencia pesos bajos y elevados para la edad gestacional en relación a INTERGROWTH-21st.

Introduction: there is no consensus on the ideal graph to monitor the growth of premature infants; however, the Fenton graph is the most widespread. Since the appearance of the INTERGROWTH-21st chart, this is emerging as an effective tool. Our objective was to compare INTERGROWTH-21st and Fenton in the anthropometric assessment of premature infants. Population and methods: a cross-sectional study that analyzed anthropometric data of premature infants between January 2014 and December 2016 by reviewing records. The classification was made by gestational age and sex using Fenton and was compared with INTERGROWTH-21st by categorizing the 10th, 50th and 90th percentiles. Correlation and concordance tests were performed (p <0.005, 95% confidence interval). The respective ethical guidelines were maintained. Results: in 232 preterm infants the prevalence of low weight was 13.7% with Fenton and 15.9% with INTERGROWTH-21st and for high weight 2.5% and 6% respectively. Weight and cephalic perimeter presented a concordance of 0.7. Of 194 premature babies suitable for gestational age by Fenton, INTERGROWTH-21st classified 4% as low and high, the rest as adequate. There was positive correlation in the three anthropometric parameters. Taking as standard INTERGROWTH-21st and as a criterion to evaluate Fenton, the specificity was greater than the sensitivity in low anthropometry (98.4 and 78.3 weight, 98.3 and 62.5 length, 100 and 64.2 cephalic perimeter) and high (100 and 42.8 weight, 97.5 and 22.2 length, 96.3 and 70 cephalic perimeter). Conclusion: Fenton classified less frequently low and high weights for gestational age in relation to INTERGROWTH-21st.

La simulación clínica como estrategia de enseñanza-aprendizaje en ciencias de la salud / Clinical simulation as a teaching-learning strategy in health sciences

Las estrategias de enseñanza-aprendizaje en Salud han evolucionado sustancialmente, ubicando a la simulación clínica como parte esencial de los procesos curriculares y de acreditación; sin embargo, debido al tiempo e inversión que requiere, puede verse relegada de incorporarla de forma eficiente y temprana en los procesos educativos. Se expone una panorámica sobre su importancia en la docencia y cómo influye en las competencias clínicas para la atención de salud.

Health teaching-learning strategies have evolved substantially, locating clinical simulation as an essential part of curricular and accreditation processes; however, due to the time and the investment required, it can be relegated to incorporate efficiently and early to education processes. A panoramic view of its importance with teaching a

Galería de imágenes morfológicas para el estudio del sistema respiratorio en Estomatología / Morphological images set for the study of the respiratory system in Dentistry

Fundamento: los medios de enseñanza tecnológicos constituyen un recurso del aprendizaje muy utilizado actualmente en las ciencias médicas. Objetivo: elaborar una galería de imágenes morfológicas sobre el tema sistema respiratorio que contribuya al desarrollo de habilidades en los estudiantes de Estomatología. Métodos: se realizó una investigación de desarrollo en el campo de los recursos del aprendizaje, en la Facultad de Estomatología de la Universidad de Ciencias Médicas de Villa Clara, durante el periodo comprendido de septiembre 2015 hasta mayo 2016. Se utilizaron métodos teóricos, entre ellos: histórico-lógico, tránsito de lo concreto a lo abstracto, inductivo-deductivo, analítico-sintético, entre otros; y empíricos: análisis documental, la observación a actividades docentes y la encuesta en forma de entrevista a informantes clave. Resultados: se constató un déficit de imágenes anatómicas referente a los diferentes sistemas, entre ellos, el respiratorio, que atenta contra la calidad de las actividades docentes, por lo que fue diseñado un producto informático fundamentado en el programa docente de la asignatura Morfofisiología IV, el cual fue valorado por criterio de especialistas. Conclusiones: resultó ser una herramienta sencilla, atractiva y de fácil manejo por la cientificidad de su contenido, la calidad de sus imágenes y las posibilidades de interacción que ofrece, además facilita el logro de habilidades prácticas en la formación académica de los estudiantes de Estomatología; fue valorado por especialistas como pertinente, útil y factible en su utilización.

Background: technological teaching aids constitute a learning resource widely used at present in the medical sciences. Objective: to develop a morphological image set on the subject respiratory system that contributes to the development of skills in Dentistry students. Methods: a developmental research was carried out in the field of learning resources, at Villa Clara University of Medical Sciences Dentistry Faculty, from September 2015 to May 2016. Theoretical methods were used: Historical-logical, from concrete to abstract, inductive-deductive, analytic-synthetic, etc. And empirical ones: documentary analysis, observation of teaching activities and the survey in interview form to key informants. Results: a deficit of anatomical images was observed regarding different systems, including the respiratory one, which undermines the quality of teaching activities, so a computing product was designed based on the teaching program of the subject Morphology-physiology IV, which was assessed by specialists´ criteria. Conclusions: it turned out to be a simple, attractive and easy-to-use tool due to the scientific nature of its content, the quality of its images and the possibilities of interaction that it offers, besides facilitating the achievement of practical skills in the academic training of Dentistry students; it was assessed by specialists as relevant, useful and feasible in its usage.

La evaluación formativa en el proceso enseñanza aprendizaje / Formative evaluation in the teaching-learning process

El proceso de perfeccionamiento de la educación superior cubana se fundamenta en la necesidad de formar un tipo de profesional capaz de dar respuesta a las exigencias de las demandas sociales con una sólida formación teórico-práctica. Al realizar un diagnóstico en el claustro del Departamento de Ciencias Básicas Biomédicas, se apreció que presentaba dificultades relativas a la didáctica de la evaluación, unido a la tendencia de aplicar la evaluación calificativa sin tener lo suficientemente en cuenta la formativa. Se realizó una revisión bibliográfica con el objetivo de reflexionar sobre cómo aplicarla correctamente en el proceso enseñanza aprendizaje. En los aspectos abordados se muestra la coincidencia de numerosos autores de diferentes países y enfoques teóricos en el reconocimiento y constatación de sus problemas actuales, tales como su reduccionismo conceptual y metodológico, su subordinación a necesidades y demandas externas al proceso pedagógico, y sus efectos y consecuencias.

The process of perfecting Cuban higher e ducation is based on the need to train a type of professional capable of responding to the demands of social demands with a solid theoretical and practical training. When making a diagnosis in the teaching staff of the Basic Biomedical Sciences Department, difficulties related to the didactics of evaluation were presented, there is a tendency to apply the qualifying assessment without taking into account the formative assessment. A bibliographical review was carried out with the objective of reflecting on how to correctly apply the formative evaluation in the teaching learning process. In the aspects covered, it shows the coincidence of numerous authors from different countries and theoretical approaches, in the recognition and verification of their current problems, such as their conceptual and methodological reductionism, their subordination to external needs and demands to the pedagogical process, and their effects and consequences.

Factores de riesgo asociados con hemorragia pulmonar neonatal / Risk factors associated with neonatal pulmonary haemorrhage

Objetivo: determinar la prevalencia de la hemorragia pulmonar en pacientes ingresados en Cuidado Intensivo Neonatal e identificar los factores de riesgo asociados. Metodología: estudio de casos y controles en pacientes en soporte ventilatorio con diagnóstico confirmado de hemorragia pulmonar con criterios de inclusión previamente definidos. Los controles fueron pareados por sexo y se seleccionaron en relación con el siguiente ingreso a la sala de Neonatología después de un caso con una diferencia de peso de ±200 gramos y una edad gestacional de ±1 semana. Se identificaron características asociadas con el cuadro sintomático divididas en factores prenatales y postnatales. La recolección de datos se hizo mediante el paquete estadístico SPSS; se usó estadística descriptiva y para el análisis se usó tablas cruzadas y evaluación de odds ratio. Se calculó la prevalencia del problema. Resultados: un total de 1.039 pacientes fueron atendidos en la sala de Neonatología. Se registraron 17 casos de hemorragia pulmonar. Con los criterios de inclusión planteados, solamente se tomaron en cuenta 12 y se parearon con 24 controles. La prevalencia de la hemorragia pulmonar fue de 1.15% con una mortalidad del 66.7%. Del total de casos, la hemorragia pulmonar se presentó en 33.3% en pacientes menores de 1.500 g y en 83.3% de prematuros, particularmente menores de 32 semanas. Factores de riesgo identificados: no uso de corticoides para maduración pulmonar en la madre gestante (OR 1.73 IC 1.40-7.36 p 0.45), hipertensión pulmonar persistente (OR 1.73 IC 1.40-7.36 p 0.45), enfermedad de membrana hialina (OR 2.0 IC 1.47-8.46 p 0.34) y uso de surfactante exógeno para el manejo de esta última (OR 3.40 IC 1.80-14.41 p 0.09). De forma independiente, la coagulopatía presentó significancia estadística relevante como causa (OR 35.0 IC 5.02-93.85 p 0.01). Conclusión: la hemorragia pulmonar es una complicación poco prevalente pero de alta mortalidad en la cual la edad gestacional y los factores asociados al manejo inmediato de las complicaciones de la prematurez son fundamentales para mejorar el pronóstico. (AU)

Objective: to determine the prevalence of pulmonary bleeding in patients admitted to neonatal intensive care and identify associated risk factors. Methodology: case-control study in patients with ventilatory support and a confirmed pulmonary hemorrhage diagnosis, with predefined inclusion criteria. Controls were matched by sex and selected in relation to the following entry in the Neonatology Intensive Care Unit after a case with a weight difference of ± 200 g and a gestational age of ± 1 week. Associated characteristics to the clinical features were identified and divided into prenatal and postnatal factors. The selection and analysis of data were made with the SPSS statistical basis; descriptive statistics were used and crossing variables with odds ratio evaluation were performed for the analysis. The problem's prevalence was also calculated. Results: a total of 1039 patients were treated at the Neonatal ICU, where we recorded 17 cases of pulmonary hemorrhage, with inclusion criteria defined, there were taken 12 that matched with 24 controls. The prevalence of pulmonary hemorrhage was 1.15% with a mortality of 66.7%. From all the cases, pulmonary hemorrhage occurred in 33.3%, in patients with less than 1500 g and in 83.3% of preterm infants, particularly in those under 32 weeks. They were identified as risk factors not to use steroids for lung maturity during the pregnancy (OR 1.73 CI 1.40 to 7.36 p 0.45), persistent pulmonary hypertension (OR 1.73 CI 1.40-7.36 p 0.45), hyaline membrane disease (OR 2.0 CI 1.47 to 8.46 p 0.34) and the use of exogenous surfactant therapy for the management of it (OR 3 40 CI 1.80 to 14.41 p 0.09). Independently, disseminated intravascular coagulopathy, had more relevant statistical significance as a cause (OR 35.0 CI 5.02 to 93.85 p 0.01). Conclusion: pulmonary hemorrhage is a poor prevalent complication with a high mortality, in which gestational age and associated factors to the immediate management of prematurity complications are essential to improve the prognosis. (AU)

Caracterización y hallazgos endoscópicos e histopatológicos de enfermedad inflamatoria intestinal en el Instituto Salvadoreño del Seguro Social / Characterization of endoscopic and histopathological findings of inflammatory bowel disease at the "Instituto Salvadoreño del Seguro Social"

Enfermedad inflamatoria intestinal (EII) comprende 2 entidades a saber: colitis ulcerativa (CU) y la enfermedad de Crohn (EC). La prevalencia e incidencia de estas entidades clínicas varían ampliamente en función de la etnia, localización geográfica y otros factores. En América Latina existen pocos informes sobre la epidemiología de EII, en nuestro país no existen datos reales de la existencia de esta patología, si bien es cierto de acuerdo con los registros del Instituto Salvadoreño del Seguro Social (ISSS) al mes de mayo del 2012, se está cubriendo cerca del 1.6 millones de asegurados en general, con un crecimiento esperado del 2.8% para el último año. Aunque se ha sugerido una menor incidencia y una evolución más benigna de la enfermedad en América Latina. El objetivo principal es "determinar la concordancia de los hallazgos endoscópicos e histopatológicos de la enfermedad inflamatoria intestinal del servicio de Gastroenterología y el departamento de patología del ISSS, en el período del 2008 al 2013." Mejorando en conjunto el trabajo del servicio de gastroenterología y patología para optimizar la concordancia de los resultados endoscópicos e histopatológicos con los cuales se puedan implementar una mejor categorización de los pacientes con EII y de esta manera poder dar un tratamiento oportuno y específico, además de mantener un registro actualizado. Dicha información se obtendrá a través de los estudios colonoscópicos realizados a los pacientes, comparando los resultados histopatológicos y macroscópicos se caracterizará y se establecerá así una base de datos confiable y actualizado de los pacientes con EII

Tuberculosis de aorta ascendente con enfermedad de poncet / Aortic tuberculosis and poncet´disease

La tuberculosis cardiovascular constituye entre 1-3% de los casos de tuberculosis extrapulmonar. En países en vías de desarrollo es causante de 38-83% de los casos de pericarditis constrictiva crónica, mientras que en los países desarrollados, el porcentaje es del 1%. Es más frecuente en hombres entre 30-50 años de edad. Caso: paciente masculino de 36 años de edad quien 2 meses previos a su ingreso, refiere tos con expectoración verdosa y disnea de 15 días de evolución. Se asocia proptosis indolora, limitación para la motilidad ocular, artritis simétrica, aditiva, ascendente desde tobillos hasta rodillas, luego muñecas y codos. Durante hospitalización requiere múltiples pericardiocentesis, por lo cual, se realiza pericardiectomía anterior con hallazgo en biopsia de aorta ascendente: inflamación crónica granulomatosa, BAAR positiva. Se plantea diagnóstico de TBC extrapulmonar: TBC de aorta ascendente complicada con derrame pericárdico, TBC ocular derecha y artritis reactiva por tuberculosis (Enfermedad de Poncet). La tuberculosis cardiovascular constituye una enfermedad poco común, de difícil diagnóstico que conlleva a consecuencias graves si no se trata oportunamente(AU)

Cardiovascular tuberculosis occurs in 1-3% of cases of extrapulmonary tuberculosis. In developing countries causes 38-83% of cases of chronic constrictive pericarditis, while in developed countries it represents 1%. It is more common in men between 30-50 years of age. We present a 36 year old male patient, who two months prior admission, referred productive cough and dyspnea during 15 days. Painless proptosis, limitation of ocular motility, symmetric, additive, ascending arthritis from ankles to knees, wrists and elbows were then associated. During his hospitalization multiple pericardiocentesis were performed, requiring pericardiectomy. The findings in ascending aorta biopsy were: anulomatous chronic inflammation, positive for alcohol resistant bacillus. Final diagnosis: tuberculosis of ascending aorta complicated with pericardial effusion, right eye tuberculosis and ceactive arthritis tuberculosis (Poncet´s disease) .Cardiovascular tuberculosis is a rare disease difficult to diagnose which leads to serious consequences without timely treatment(AU)

Algunas pautas metodológicas para la elaboración de situaciones problémicas con ejemplos en la disciplina morfofisiología / Some methodological guidelines for the preparation of problem-based situations with examples of morphophysiology discipline

La creación de condiciones óptimas para que surjan situaciones problémicas es una de las tareas más importantes de la enseñanza problémica y es, precisamente, donde radica una de las mayores limitaciones de los docentes al implementarla. Dando continuidad al propósito de estimular el uso de este sistema didáctico como una alternativa metodológica viable en la educación médica superior cubana, el presente artículo pretende proporcionar recomendaciones o pautas metodológicas en la elaboración de situaciones problémicas: se precisan los factores de los que depende esta, los requisitos que debe cumplir, sus tipos fundamentales y se proponen formas de presentación de las contradicciones del contenido de enseñanza para su creación con ejemplos en Morfofisiología. Se utilizaron principalmente metodos teóricos, tales como el enfoque histórico-lógico, análisis-síntesis e inducción-deducción y la modelación.

The creation of optimal conditions for problem-based situations is one of the most important tasks of the problem-based teaching and at the same time one of the major restrictions of the professors at the time of implementing it. As part of the objective of encouraging the use of this didactic system as a viable methodological alternative in Cuban higher education, the present article was intended to offer recommendations or to provide methodological for the preparation of problem-based situations. To this end, the paper specified the factors on which they depend, the requirements that they should fulfill the fundamental types and the forms of presentation of the contradictions in the teaching contents for the creation of these situations, with examples given in morphophysiology subject. Theoretical methods were mainly used, such as historical-logical approach, analysis-synthesis and induction-deduction, and modeling.

Proceso de diseño de un currículo por competencia profesional para los postgrados de medicina interna de la Universidad Central de Venezuela / Process design of a curriculum for professional competence for postgraduates of internal medicine at the Universidad Central de Venezuela

En el año 2003 se inicia desde el Comité Nacional de Educación Médica de la Sociedad Venezolana de Medicina Interna y el Centro de Investigación y Desarrollo de la Educación Médica de la UCV un proceso para elaboración en el marco del paradigma Socio-Cognitivo y de la Educación Basada en la Competencia Profesional, de una metodología amigable y transferible para el diseño de currículos por competencia profesional, que dió como resultado un nuevo currículo para los postgrados de Medicina Interna de la UCV. Se trata de la primera aplicación del Modelo Socio-Cognitivo en el campo de la educación médica para el diseño de currículo por competencia profesional, lo cual requiere de la comprensión por parte del profesorado de nuevos modelos educativos para el mejoramiento de la educación médica de postgrado, como alternativas al currículum tradicional. El currículo por competencia profesional para los postgrados de medicina interna de la UCV, por su concepción y fundamentos es un recurso para facilitar la transparencia en las estructuras educativas de los postgrados de esta especialidad médica en el país e impulsar la innovación educativa a través de la comunicación de experiencias y la identificación de buenas prácticas. Así como, para estimular la innovación y la calidad en educación médica mediante la reflexión y el intercambio, al desarrollar y compartir información relativa al diseño de currículos por competencia profesional y crear una estructura curricular modelo como punto de referencia. La aprobación e implementación del primer currículo por competencia profesional de los postgrados de medicina interna en la UCV, implicó la capacitación del profesorado en su diseño, los cuales serán a su vez promotores y facilitadores del cambio curricular en la propia institución. Y además, requerirá del compromiso de las autoridades universitaria y demás entes rectores de la educación universitaria, para la adecuación de la normativa que permite la innovación educativa...

In 2003, the National Committee on Medical Education of the Venezuelan Society of Internal Medicine and the Center for Research and Development of Medical Education of the Universidad Central de Venezuela (UCV) started the process of elaborating, under the Socio-Cognitive paradigm and professional competency based Education, a friendly and transferable methodology to design curricula based on professional competence. This resulted in a new curriculum for Internal Medicine postgraduates in the UCV. This is the first application of the Socio-Cognitive Model in the field of medical education on professional competency based curriculum design. It is required that teachers of the new educational model understand it fully so there is an improvement of the medical education graduate, as alternatives to the traditional curriculum. The curriculum for professional competence postgraduate in internal medicine at the UCV, in concept and fundamentals is a resource to facilitate transparency in the educational structures of the graduate in this medical specialty in the country. It also encourages educational innovation through experience sharing and good practices identification. It intends as well to stimulate innovation and quality in medical education through reflection and exchange; developing and sharing information on the design of professional competency based curricula, creating a benchmark curriculum model. The adoption and implementation of the first curriculum for professional competence postgraduate in internal medicine at the UCV, involves curricula design capacitation for teachers. They shall become promoters and facilitators of curriculum change in the institution. Besides that, the commitment of the university authorities and other higher education governing bodies will be required to adapt the rules in order to allow educational innovation and self-renewal