Perineural Infiltration: A Comprehensive Review of Diagnostic, Prognostic, and Therapeutic Implications.

ABSTRACT: Perineural infiltration refers to a neoplastic cell involvement in, around, and through the nerves. It is considered as one of the neoplastic dissemination pathways. Thus, its identification is crucial to establish the prognosis of some malignant skin neoplasms, such as squamous cell carcinoma, and explains the locally aggressive behavior of cutaneous neoplasms, such as microcystic adnexal carcinoma. We have conducted a review of malignant and benign skin tumors in which perineural infiltration has been described, and we also discuss some histopathological findings that may simulate perineural infiltration.

Clinical, histopathologic, immunohistochemical, and electron microscopic findings in cutaneous monkeypox: A multicenter retrospective case series in Spain.

BACKGROUND: The worldwide outbreak of monkeypox has evidenced the usefulness of the dermatologic manifestations for its diagnosis. OBJECTIVE: To describe the histopathologic and immunohistochemical findings of monkeypox cutaneous lesions. METHODS: This is a retrospective histopathologic and immunohistochemical study of 20 patients with positive Monkeypox virus DNA polymerase chain reaction and immunohistochemical positivity for Vaccinia virus in cutaneous lesions. Four cases were also examined by electron microscopy. RESULTS: The most characteristic histopathologic findings consisted of full-thickness epidermal necrosis with hyperplasia and keratinocytic ballooning at the edges. In some cases, the outer root sheath of the hair follicle and the sebaceous gland epithelium were affected. Intraepithelial cytoplasmic inclusion bodies and scattered multinucleated keratinocytes were occasionally found. Immunohistochemically, strong positivity with anti-Vaccinia virus antibody was seen in the cytoplasm of ballooned keratinocytes. Electron microscopy study demonstrated numerous viral particles of monkeypox in affected keratinocytes. LIMITATIONS: Small sample size. Electron microscopic study was only performed in 4 cases. CONCLUSION: Epidermal necrosis and keratinocytic ballooning are the most constant histopathologic findings. Immunohistochemical positivity for Vaccinia virus was mostly detected in the cytoplasm of the ballooned keratinocytes. These findings support the usefulness of histopathologic and immunohistochemical studies of cutaneous lesions for diagnosis of monkeypox.

Histopathology of Dermatologic Complications of Tattoos.

ABSTRACT: Tattoos are characterized by the introduction of exogenous pigments into the dermis. Tattoos usually serve cosmetic purposes, although they may have other causes, such as traumatic pigment implants in accidents or medical-related tattoos in the context of radiotherapy. Dermatologic adverse reactions are relatively uncommon, and they include infections, immune-mediated reactions, cutaneous lesions secondary to the Koebner phenomenon, exacerbation of preexisting dermatosis, benign and malignant neoplasms, and a miscellaneous group of dermatologic conditions that may appear in a preexisting tattoo. The aim of this study is to review the types of histopathologic reactions that may appear in a preexisting permanent tattoo.

Immunophenotypic Differences in Tumor-Infiltrating Lymphocytes and Neovascularization Between Primary Cutaneous Melanoma With and Without Metastasis: An Immunohistochemical Study of 80 Cases.

ABSTRACT: The prognostic implications of the immunophenotype of the tumor-infiltrating lymphocytes (TILs) in primary cutaneous melanoma are well known. In recent years, the study of this immunophenotype has also resulted in immunotherapeutic consequences. The aims of this study were to characterize the subpopulations of TILs in primary cutaneous melanoma, in cases with and without metastasis, as well as the neovascularization associated with the primary neoplasm, and its influence on the development of metastasis. To this end, the immunophenotype of TILs and the neovascularization of 80 patients with primary cutaneous melanoma (40 each with metastatic and non-metastatic melanoma) were analyzed by immunohistochemistry for CD3, CD4, CD8, FOXP3, PD-1, CD31, and D2-40 antibodies. We found that higher frequencies of TILs with brisk pattern, and CD4+, CD8+, and CD20+ cells in TILs, and a lower frequency of CD31+ vessels were histopathological features associated with better prognosis in primary cutaneous melanoma. Our results support the notion that the immunohistochemical study of TILs and neovascularization in primary cutaneous melanoma may be helpful tools for identifying patients at increased risk of metastasis development.

Safety and efficacy of treatment with pegylated interferon alpha-2a with ribavirin in chronic hepatitis C genotype 4.

The hepatitis C virus (HCV) genotype is an important predictive outcome parameter for pegylated interferon plus ribavirin therapy. Most published therapeutic trials to date have enrolled mainly patients with HCV genotypes 1, 2 and 3. Limited studies have focused on genotype 4 patients, who have had a poor representation in pivotal trials. Our aim was to evaluate the efficacy and safety of treatment with standard dose pegylated interferon alfa-2a in combination with weight-based ribavirin in patients with chronic hepatitis C genotype 4. In this prospective observational study, 198 patients with HCV-4 were included in this study from February 2004 to August 2005,188 patients who received at least 1 dose of drugs were included in the ITT analysis and they were treated with pegylated interferon alfa-2a and ribavirin for 48 weeks. Baseline and demographic characteristics, response to treatment at weeks 12, 48 and 72, and the nature and frequency of adverse effects were analyzed. Virological response at week 12 was achieved in 144 patients (76.6%). Virological response at the end of treatment was present in 110 patients (58.5%). At week 72, 99 patients presented SVR (52.7%). The reported adverse events were similar to those found in the literature for treatments of similar dose and duration. In conclusion, combined treatment with pegylated interferon alfa-2a and ribavirin was well tolerated and effective in chronic hepatitis C genotype 4, yielding response rates between those reported for genotype 1 and those of genotypes 2-3.

Peginterferon alpha-2a and ribavirin in patients with hepatitis C virus genotype 1 infection with persistently normal alanine aminotransferase levels.

BACKGROUND AND AIM: To evaluate the efficacy and safety of peginterferon α-2a plus ribavirin at standard doses in patients with hepatitis C virus (HVC) genotype 1 infection with persistently normal alanine aminotransferase (ALT) levels. METHODS: Patients aged 18 to 65 years were included in this observational, prospective study if they had evidence of a HCV genotype 1 infection. The serum HCV RNA concentration was determined at baseline and week 12. A qualitative HCV RNA test was performed at baseline and at weeks 48 and 72. Liver function tests were performed at each study visit. The primary efficacy measure was the sustained virological response in the intention-to-treat population. Logistic regression analyses were also performed to explore predictors of virological response. RESULTS: A sustained virological response was observed in 100 of the 175 patients (57%). An early virological response and end-of-treatment response were seen in 159 patients (91%) and 133 patients (76%), respectively. Thirty-seven of the 122 evaluable patients for this outcome (30%) showed a rapid virological response. A higher viral load was a significant predictor for a lack of rapid virological response and lack of sustained virological response. There were not any unexpected safety or tolerability findings. CONCLUSIONS: Our study suggests that the efficacy of the combination of peginterferon α-2a and ribavirin in patients with HCV genotype 1 infection and normal ALT levels is at least similar to that reported in patients with elevated ALT levels.

Implication of polycomb members Bmi-1, Mel-18, and Hpc-2 in the regulation of p16INK4a, p14ARF, h-TERT, and c-Myc expression in primary breast carcinomas.

PURPOSE: Deregulation of mammalian Polycomb group (PcG) members may contribute to human carcinogenesis. p16INK4a and p14ARF tumor suppressors, human telomerase reverse transcriptase (h-TERT), and oncoprotein c-Myc have been implicated in the regulation of the cell cycle and proliferation mediated by PcG proteins, mainly Bmi-1, in mice and in cell culture experiments. Here, we examine whether these in vitro findings can be extrapolated to the in vivo situation. EXPERIMENTAL DESIGN: We measure the expression of PcG members Bmi-1, Mel-18, and Hpc-2 and their potential targets by reverse transcription-PCR, immunostaining, and Western blotting in a series of 134 breast carcinomas and correlate the data with several clinical-pathologic variables of the tumors. RESULTS: Expression of PcG genes was variably detected, but overexpression of Bmi-1 was the most frequent PcG alteration observed. In addition, statistical direct correlation in expression level of the three PcG members was detected. A correlation between c-Myc and Bmi-1 expression levels was observed; however, there was no correlation between expression of Bmi-1 and p16INK4a, p14ARF, or h-TERT. However, expression of the other PcG members Mel-18 and Hpc-2 correlated with the cell cycle regulators. Moreover, PcG mRNA-altered expression correlated significantly with certain clinical-pathologic variables associated with poor prognosis. CONCLUSIONS: Our data suggest that the oncogenic role of Bmi-1 in human primary breast carcinomas is not determined by its capacity to inhibit INK4a/ARF proteins or to induce telomerase activity.

Incidence of human papillomavirus-related oropharyngeal cancer and outcomes after chemoradiation in a population of heavy smokers.

BACKGROUND: Incidence of human papillomavirus (HPV)-related oropharyngeal carcinomas is increasing worldwide. The purpose of this study was to report the incidence in our region, and to determine the influence of HPV status on survival among a heavy smoking population. METHODS: p16 expression was analyzed in 102 patients with stage II to IV treated with chemoradiation. Overall survival (OS), locoregional control, and disease-free survival (DFS) were compared for HPV+ and HPV- status. RESULTS: The majority of patients were smokers (86%). p16 positivity was found in 26.7%. Patients who were HPV+ were younger (56 vs 59 years old; p = .052). No differences were observed regarding tumor stage, sex, or smoking between HPV+ and HPV-. Three-year OS was 67.4% for patients who were HPV+ versus 49.7% for HPV- (hazard ratio [HR], 0.55; p = .095). CONCLUSION: Incidence of HPV-related oropharyngeal carcinoma in Spain is similar to that reported in other European countries. In this sample of heavy smokers, we observed a nonsignificant trend for better outcomes in patients who were HPV+.

Factors associated with early virological response to peginterferon-α-2a/ribavirin in chronic hepatitis C.

AIM: To evaluate the impact of sociodemographic/clinical factors on early virological response (EVR) to peginterferon/ribavirin for chronic hepatitis C (CHC) in clinical practice. METHODS: We conducted a multicenter, cross-sectional, observational study in Hepatology Units of 91 Spanish hospitals. CHC patients treated with peginterferon α-2a plus ribavirin were included. EVR was defined as undetectable hepatitis C virus (HCV)-ribonucleic acid (RNA) or ≥ 2 log HCV-RNA decrease after 12 wk of treatment. A bivariate analysis of sociodemographic and clinical variables associated with EVR was carried out. Independent factors associated with an EVR were analyzed using a multiple regression analysis that included the following baseline demographic and clinical variables: age (≤ 40 years vs > 40 years), gender, race, educational level, marital status and family status, weight, alcohol and tobacco consumption, source of HCV infection, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, and gamma glutamyl transpeptidase (GGT) (≤ 85 IU/mL vs > 85 IU/mL), serum ferritin, serum HCV-RNA concentration (< 400,000 vs ≥ 400,000), genotype (1/4 vs 3/4), cirrhotic status and ribavirin dose (800/1000/1200 mg/d). RESULTS: A total of 1014 patients were included in the study. Mean age of the patients was 44.3 ± 9.8 years, 70% were male, and 97% were Caucasian. The main sources of HCV infection were intravenous drug abuse (25%) and blood transfusion (23%). Seventy-eight percent were infected with HCV genotype 1/4 (68% had genotype 1) and 22% with genotypes 2/3. The HCV-RNA level was > 400 000 IU/mL in 74% of patients. The mean ALT and AST levels were 88.4 ± 69.7 IU/mL and 73.9 ± 64.4 IU/mL, respectively, and mean GGT level was 82 ± 91.6 IU/mL. The mean ferritin level was 266 ± 284.8 µg/L. Only 6.2% of patients presented with cirrhosis. All patients received 180 mg of peginterferon α-2a. The most frequently used ribavirin doses were 1000 mg/d (41%) and 1200 mg/d (41%). The planned treatment duration was 48 wk for 92% of patients with genotype 2/3 and 24 wk for 97% of those with genotype 1/4 (P < 0.001). Seven percent of patients experienced at least one reduction in ribavirin or peginterferon α-2a dose, respectively. Only 2% of patients required a dose reduction of both drugs. Treatment was continued until week 12 in 99% of patients. Treatment compliance was ≥ 80% in 98% of patients. EVR was achieved in 87% of cases (96% vs 83% of patients with genotype 2/3 and 1/4, respectively; P < 0.001). The bivariate analysis showed that patients who failed to achieve EVR were older (P < 0.005), had higher ALT (P < 0.05), AST (P < 0.05), GGT (P < 0.001) and ferritin levels (P < 0.001), a diagnosis of cirrhosis (P < 0.001), and a higher baseline viral load (P < 0.05) than patients reaching an EVR. Age < 40 years [odds ratios (OR): 0.543, 95%CI: 0.373-0.790, P < 0.01], GGT < 85 IU/mL (OR: 3.301, 95%CI: 0.192-0.471, P < 0.001), low ferritin levels (OR: 0.999, 95%CI: 0.998-0.999, P < 0.01) and genotype other than 1/4 (OR: 4.716, 95%CI: 2.010-11.063, P < 0.001) were identified as independent predictors for EVR in the multivariate analysis. CONCLUSION: CHC patients treated with peginterferon-α-2a/ribavirin in clinical practice show high EVR. Older age, genotype 1/4, and high GGT were associated with lack of EVR.

Mortalidad por causas violentas en hombres de la provincia de Santiago de Cuba durante 2011 / Mortality from violence in men of Santiago de Cuba province during 2011

Se realizó un estudio descriptivo y transversal en la provincia de Santiago de Cuba, con vistas a determinar la mortalidad masculina por causas violentas, según algunas conductas (accidentes, suicidios y homicidios), durante el año 2011, para lo cual se obtuvo la información del Departamento Provincial de Estadísticas y de los registros computarizados de mortalidad por tales causas. Entre los resultados sobresalió el incremento de las muertes violentas por la accidentabilidad, con predominio de los varones y las edades tempranas de la vida; de igual forma, el sexo masculino conformó el grupo de mayor riesgo, por ser el más vulnerable a estas muertes, en las que se emplearon métodos cada vez más duros, con un marcado aumento de la mortalidad prematura y los años de vida potencialmente perdidos. Finalmente, se recomendó trazar estrategias de intervención en grupos de varones con riesgo de incurrir en los mencionados procederes, fundamentalmente en edades jóvenes, a fin de reducir en ellos el peligro de morir y extender sus años de vida socialmente útiles.

A descriptive and cross-sectional study was carried out in Santiago de Cuba province in order to determine the male mortality from violence according to some behaviors (accidents, suicides and homicides) during 2011, for which the information was obtained from the Provincial Statistical Department and computerized records of mortality due to such causes. Among the results the increment of violent deaths by accidents, with a predominance of males and the early ages of life, was remarkable; also, male sex constituted the highest risk group, being the most vulnerable to these deaths, in which increasingly aggressive methods were used, with a marked increase of premature mortality and years of life potentially lost. Finally, it was recommended to devise intervention strategies in groups of men with risk for these behaviors, mainly at younger ages, in order to reduce the risk of dying and to extend their socially useful years of life.

Captación de adolescentes gestantes e interrupción del embarazo durante un quinquenio en la provincia de Santiago de Cuba / Prenatal visit of pregnant teenagers and interruption of pregnancy during a five year period in Santiago de Cuba province

Se realizó un estudio descriptivo y transversal de las adolescentes con captación de embarazo o interrupción de este, o ambos, en la provincia de Santiago de Cuba, durante el quinquenio 2007-2011, con vistas a caracterizarles según grupos etarios, métodos y procedimientos de interrupción de la gestación, y además determinar la razón captación e interrupción de embarazo, así como captación de embarazo y aborto provocado. Los resultados mostraron que el método más utilizado para interrumpir la gestación fue la regulación menstrual, con una tendencia descendente a emplearlo; en tanto se observó un ascenso del aborto provocado y el número de embarazos, con una cifra superior de interrupciones respecto a las captaciones. Se recomendó incrementar la labor educativa sobre salud sexual y reproductiva en los jóvenes y sus familiares, para así lograr disminuir la cantidad de embarazos en las adolescentes y las interrupciones de estos, de manera que mejore la calidad de vida de dicha población de féminas.

A descriptive and cross-sectional study of the adolescents under prenatal screening visits, and/or interruption of pregnancy, was carried out in Santiago de Cuba, during the five year period 2007-2011, aimed at characterizing them according to age groups, methods and interruption procedures for pregnancy, and also to determine the reason why the prenatal visit and pregnancy interruption occurred, as well as why prenatal visit and artificial abortion took place. The results showed that the most used method to interrupt pregnancy was the menstrual regulation, with a declining tendency to use it; meanwhile an increase of the artificial abortion and the number of pregnancies was observed, with a higher number of interruptions compared to the prenatal visits. It was recommended to increase the educational work on sexual and reproductive health in the youth and their relatives, so as to decrease the quantity of pregnancies in the adolescents and their interruptions, so that the life quality of this female population improves.

Eficacia de la lidocaína para el control de la respuesta refleja durante la ejecución de laringoscopia e intubación endotraqueal / Effectiveness of the lidocaine for control of the reflex response during laryngoscopy and endotracheal intubation

Se realizó un estudio de intervención farmacológica, de corte transversal, con vistas a evaluar la eficacia de la lidocaína para el control de la respuesta refleja asociada a la ejecución de laringoscopia e intubación endotraqueal en una muestra de 100 pacientes operados con anestesia general en el Hospital Clinicoquirúrgico Docente Dr Ambrosio Grillo Portuondo de Santiago de Cuba, desde julio de 2010 hasta mayo de 2011, previo a lo cual fueron asignados a los grupos 1 y 2, con 50 integrantes cada uno: a los primeros se administró lidocaína en bolo (1,5 mg/kg), 2 minutos antes de iniciar la laringoscopia y a los segundos no. Si bien los resultados en cuanto al control de las cifras tensionales durante el examen de la laringe y la intubación endotraqueal fueron mejores cuando se usó el mencionado anestésico, en cambio la elevación de la frecuencia cardíaca y las imágenes de alteraciones electrocardiográficas se presentaron más comúnmente en quienes no se empleó ese fármaco.

A cross-sectional study of pharmacological intervention was carried out in order to evaluate the effectiveness of the lidocaine for control of the reflex response associated with the laryngoscopy and endotracheal intubation in a sample of 100 patients operated under general anesthesia in Dr Ambrosio Grillo Portuondo Teaching Clinical and Surgical Hospital in Santiago de Cuba from July 2010 to May 2011, prior to which they were assigned to groups 1 and 2 with 50 patients each: the former were administered a lidocaine bolus (1,5 mg/kg) 2 minutes before beginning the laryngoscopy, but the latter were not. While the results of blood pressure control during the examination of the larynx and endotracheal intubation were better when using this anesthetic, whereas the elevated heart rate and abnormal electrocardiographic images were more common in whom this drug was not used.

La formación de valores en tecnólogos de la salud / Values formation in health technologists

El artículo trata sobre la formación de valores en los estudiantes de todos los perfiles de segundo año de la Facultad de Tecnología de la Salud, del Instituto Superior de Ciencias Médicas de Santiago de Cuba, mediante un plan de acciones y actividades docentes, que les permitan estar en mejores condiciones de asumir con responsabilidad los nuevos valores personales que se impone incorporar, formar y perfeccionar.

The article deals on the values formation in the students from all specialities of second year studying in the Health Technology Faculty, of the Medical University in Santiago de Cuba, by means of an action plan and teaching activities that allow them to be under conditions of facing with responsibility the new personal values that they should incorporate, create and improve, to become better people in their social condition.

Libros y monografías en el portal Infomed de Santiago de Cuba / Books and monographs in Infomed portal from Santiago de Cuba

En el artículo científico, además de mencionarse los autores y títulos de los 29 libros y monografías disponibles en el portal Infomed de Santiago de Cuba, estos se identifican gráficamente por medio de sus cubiertas y con las direcciones electrónicas para acceder a la consulta de cada ejemplar. Su procedimiento en pdf data de 2004 y todas las obras se refieren a determinado tema sobre prevención de enfermedades, medidas sanitarias y calidad de vida en sentido general. Puede accederse libremente a su contenido a través del sitio http://www.scu.sld.cu/_libros.php.

In this scientific work, besides mentioning the authors and titles of the 29 books and monographs available in Infomed portal from Santiago de Cuba, they are graphically identified by means of their covers, and through their electronic mail addresses access may be obtained for each of them. Its processing in pdf dates from 2004 and all the works refer to certain topic on prevention of illnesses, sanitary measures and life quality in a general sense. It can be freely acceded through: http://www.scu.sld.cu/_libros.php(.

Anaquel: un boletín informativo utilitario de la Biblioteca Médica Provincial / Anaquel: a news bulletin compact car of the Provincial Medical Library

Se presenta el diseño del Boletín informativo Anaquel, publicación bimensual de la Biblioteca Médica Provincial de Santiago de Cuba, como una herramienta necesaria para divulgar los documentos recibidos en esta, así como los servicios tradicionales que en ella se brindan y otros que se han incorporado sobre la base de las nuevas tecnologías de la información y el conocimiento, entre los cuales figuran el servicio SCAD y SeCimed. Se recomienda que todas las bibliotecas de la red que cuenten con técnicas y equipos de avanzada, confeccionen su boletín informativo, pues esto ayudaría a la diseminación virtual de sus últimas adquisiciones.

The design of the Bulletin Anaquel, a bimonthly publication of the Provincial Medical Library of Santiago de Cuba, is showed as a necessary tool to spread documents received as well as traditional services offered in this library, and other services that have been incorporated on the basis of the new information technologies and knowledge, among which are the SCAD and SeCimed services. It is recommended that all the libraries of the net that have advanced techniques and equipment produce their own bulletin, because this would contribute to the virtual dissemination of their most recent acquisitions.

Greenstone: una valiosa herramienta para la creación de la biblioteca digital de salud en Santiago de Cuba / Greenstone: a valuable tool for creating the digital library in Santiago de Cuba

Se realizó el diseño de la biblioteca digital del Centro Provincial de Información de Ciencias Médicas de Santiago de Cuba para dar respuesta a la demanda de información pertinente sobre problemas de salud que afectan a la provincia. El diseño de esta base de datos se inició con la creación de 3 colecciones sobre temas de gran interés para la comunidad científica del territorio: dengue, diabetes mellitus e hipertensión arterial y su procesamiento abarcó de septiembre a diciembre del 2007. La herramienta utilizada para ello fue Greenstone, teniendo en cuenta los campos y botones más factibles para que los usuarios interactúen con su contenido. Se concluyó que las bibliotecas digitales pueden satisfacer las necesidades de información sanitaria y relacionadas con esta, que las bases de datos médicas devienen el sitio ideal para recuperar valiosos conocimientos del saber humano y que el Greenstone constituye una herramienta ideal para la creación de las colecciones digitales, por lo cual se aconseja impartir cursos que propicien el uso de este programa en la red de bibliotecas de la provincia.

The design of the digital library of the Provincial Medical Information Center of Santiago de Cuba was made to meet requirements of relevant information on health problems affecting the province. The design of this database was initiated with the creation of 3 collections on topics of great interest for the scientific community of the territory: dengue, diabetes mellitus and hypertension, and their creation ranged from September to December, 2007. Greenstone was the tool used, taking into account more feasible fields and buttons so that the users interact with their content. It is concluded that the digital libraries can meet requirements of health information and those related, medical databases become an ideal site to retrieve valuable information on the human knowledge and Greenstone constitutes an appropriate tool for the creation of digital collections. Therefore, it is recommended to give courses propitiating the use of this program in the province library network.

MEDISAN: órgano de publicación periódica oficial de los profesionales y técnicos de la Salud de Santiago de Cuba / MEDISAN: organ of periodical publication for Health professionals and technicians in Santiago de Cuba

En sus 40 números editados desde 1997 hasta el 2006, la revista MEDISAN ha sido la vía más utilizada por los profesionales y técnicos de la Salud de la provincia de Santiago de Cuba para publicar artículos originales, defender criterios sobre aspectos de interés biomédico en general, compartir experiencias de carácter docente y divulgar resultados expuestos por autores nacionales y extranjeros en importantes actividades científicas desarrolladas en el territorio. Los logros obtenidos, el prestigio alcanzado y la demanda de publicaciones, cada vez más creciente, obliga a ampliar la cobertura en esta dirección, a incrementar la periodicidad de salida, así como a evaluar con rigor el contenido de la producción científica difundida para ganar nuevos espacios en la sociedad de la información y el conocimiento

La toma de decisiones: una experiencia en el Consultorio del Médico de la Familia para el tratamiento de la hipertensión arterial / The Decision-Making: An Experience of the Doctor''''s Office in the Treatment of Hipertensive Patients

Se hizo un estudio descriptivo y transversal para evaluar la aplicación de los conocimientos sobre el método de dirección Toma de decisiones, dirigido a lograr el aprovechamiento de los conceptos de las técnicas de dirección en función de la atención médica, en particular de la brindada por el médico de la familia, para lo cual se escogió una muestra simple aleatoria de 103 pacientes con hipertensión arterial, mayores de 15 años y atendidos por esa causa en el consultorio médico nr 56, perteneciente al área de salud del Policlínico Docente “José Martí” de Santiago de Cuba, durante el período comprendido del 2001 al 2002. En virtud de lo anterior se analizaron variables como: sexo, edad, antecedentes familiares de la enfermedad, valores de la tensión arterial (sistólica y diastólica) según grupos etarios, tratamiento antihipertensivo, control de la hipertensión arterial, hallazgos electrocardiográficos más importantes y efecto terapéutico en los pacientes que cumplían las medidas indicadas por el médico de la familia. El uso del método de dirección fue válido para lograr una gestión con calidad y eficiencia en la toma de decisiones, así como en la ejecución de algunas acciones y medidas de control que pueden contribuir a mejorar la salud comunitaria.

Complicaciones neurológicas en la hemofilia / Neurologic complications in hemophilia

Se estudiaron 25 hemofílicos que presentaron manifestaciones neurológicas por sangramiento del sistema nervioso, durante los años 1980-1981. La incidencia de estas complicaciones fue similar a lo informado en la literatura. La lesión de nervios periféricos fue la afección más frecuente. La hemorragia intracraneal fue más común en los hemofílicos B y el antecedente de traumatismo sólo se recogió en el 20% de los casos. La baja mortalidad y la escasa aparición de secuelas en los pacientes de nuestra casuística se atribuyeron fundamentalmente al diagnóstico precoz de la complicación neurológica