Labdanum Resin from Cistus ladanifer L. as a Source of Compounds with Anti-Diabetic, Neuroprotective and Anti-Proliferative Activity.

Labdanum resin or "gum" can be obtained from Cistus ladanifer L. by two different extraction methods: the Zamorean and the Andalusian processes. Although its main use is in the fragrance and perfumery sectors, ethnobotanical reports describe its use for medicinal purposes in managing hyperglycemia and mental illnesses. However, data concerning the bioactivities and pharmacological applications are scarce. In this work, it was found that the yield of labdanum resin extracted by the Andalusian process was 25-fold higher than the Zamorean one. Both resins were purified as absolutes, and the Andalusian absolute was purified into diterpenoid and flavonoid fractions. GC-EI-MS analysis confirmed the presence of phenylpropanoids, labdane-type diterpenoids, and methylated flavonoids, which are already described in the literature, but revealed other compounds, and showed that the different extracts presented distinct chemical profile. The potential antidiabetic activity, by inhibition of α-amylase and α-glucosidase, and the potential neuroprotective activity, by inhibition of acetylcholinesterase, were investigated. Diterpenoid fraction produced the higher α-amylase inhibitory effect (~30% and ~40% at 0.5 and 1 mg/mL, respectively). Zamorean absolute showed the highest α-glucosidase inhibitory effect (~14% and ~24%, at 0.5 and 1 mg/mL, respectively). Andalusian absolute showed the highest acetylcholinesterase inhibitory effect (~70% and ~75%, at 0.5 and 1 mg/mL, respectively). Using Caco-2 and HepG2 cell lines, Andalusian absolute and its purified fractions showed moderate cytotoxic/anti-proliferative activity at 24 h exposure (IC50 = 45-70 µg/mL, for Caco-2; IC50 = 60-80 µg/mL, for HepG2), whereas Zamorean absolute did not produce cytotoxicity (IC50 ≥ 200.00 µg/mL). Here we show, for the first time, that labdanum resin obtained by the Andalusian process, and its fractions, are composed of phytochemicals with anti-diabetic, neuroprotective and anti-proliferative potential, which are worth investigating for the pharmaceutical industry. However, toxic side-effects must also be addressed when using these products by ingestion, as done traditionally.

[Human resources in the National Health System. Medical education. SESPAS Report 2024]. / Recursos humanos del Sistema Nacional de Salud. Formación. Informe SESPAS 2024.

The problems posed by medical education in Spain are diverse. This paper analyzes the system currently used to select candidates who will be admitted to a public faculty of medicine in Spain and some issues arising from the unprecedented increase in both public and private medical schools in our country. The importance of generic competencies in today's medicine and the need to return to a core design in specialist training are other aspects that are discussed. The degree of development of advanced accreditation diplomas and areas of specific competence is also subject to analysis. Finally, the authors emphasize the importance of continuous professional development and the idea of professional recertification as a system that guarantees patients the quality of the care they receive.

Real-Life Effectiveness of Mepolizumab in Refractory Chronic Rhinosinusitis with Nasal Polyps.

The aim of this study was to evaluate the efficacy of mepolizumab in patients affected by chronic rhinosinusitis with nasal polyps (CRSwNP) in real-life. A single-center retrospective observational study was conducted on severe CRSwNP patients treated with mepolizumab. Nasal endoscopic polyp score (NPS), visual analogue scale (VAS) symptom score, sinonasal outcome test (SNOT-22), asthma control test (ACT) score, fractional exhaled nitric oxide (FeNO), eosinophils blood cells and prednisone intake were assessed at baseline and after 6 months. A total of 55 patients were included; 49 patients (89%) presented with asthma; aspirin exacerbated respiratory disease (AERD) in 28 patients (51%). A statistically significant decrease in the SNOT-22 score was observed (median difference -63; 95% CI: -68; -58; p < 0.001) with median t0 76 and IQR (61;90) to t6 10 (5;15). A reduction in NPS, median t0 NPS 4; (IQR:4;6), median t6 NPS 1; (IQR:0;1) p < 0.001, was greater in patients with AERD. The median baseline VAS score was 6 (IQR:6;7) and the differences between t0 and t6 were statistically significant p < 0.001. Significant changes in blood eosinophils cells, median t0 500 cell/mcl (IQR:340;830), median t6 97 cell/mcl (IQR:60;160) p < 0.001, were greater in patients with AERD. Mepolizumab treatment effects have been demonstrated with significantly reduced symptoms, polyp scores, blood eosinophils and systemic corticosteroid use, resulting in an increased health-related quality of life in patients with severe CRSwNP, regardless of the presence or absence of asthma or AERD.

Life-threatening idiopathic intracranial hypertension: the role of venous sinus stenting.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is a clinical syndrome characterised by raised intracranial pressure with no discernible aetiology. It is relatively rare in children and its demographic features may differ from those of adults. The relationship between IIH and venous sinus stenosis (VSS) is well known. As VSS plays an important role in the pathophysiology, treatments have been developed aimed at improving venous blood outflow in refractory IIH. In the last two decades, venous sinus stenting has emerged as a treatment option in cases where stenosis is documented. METHODS AND RESULTS: The scientific literature on paediatric cases of IIH and its treatment with venous sinus stenting was analysed. We present the case of a 6-year-old girl with a life-threatening presentation of IIH, who was treated with transverse sinus stenting and a lumboperitoneal shunt. We summarise the characteristic of paediatric stenting cases reported and review the literature focusing on the main aspects of venous sinus stenting. CONCLUSION: VSS stenting could be a treatment tool for the acute presentation of IIH with severe symptoms and VSS plus an elevated trans-stenotic pressure gradient. However, in some cases, additional surgical treatment may be necessary.

O Impacto da COVID-19 no Diagnóstico de Doenças Cardíacas na América Latina Uma Subanálise do INCAPS COVID / The Impact of COVID-19 on Diagnosis of Heart Disease in Latin America an INCAPS COVID Sub-analysis

Resumo Fundamento A pandemia de COVID-19 interferiu na prestação de atendimento a doenças cardiovasculares na América Latina. No entanto, o efeito da pandemia nos volumes de procedimentos cardíacos diagnósticos ainda não foi quantificado. Objetivo Avaliar (1) o impacto de COVID-19 nos volumes de diagnóstico cardíaco na América Latina e (2) determinar sua relação com a incidência de casos de COVID-19 e as medidas de distanciamento social. Métodos A International Atomic Energy Agency realizou uma pesquisa mundial avaliando mudanças nos volumes diagnósticos cardíacos decorrentes da COVID-19. Foram obtidos os volumes diagnósticos cardíacos dos locais participantes para março e abril de 2020 e comparados com março de 2019. Foram coletados dados de distanciamento social a partir dos Relatórios de mobilidade da comunidade de Google e a incidência de COVID-19 por país a partir de Our World in Data. Resultados Foram realizadas pesquisas em 194 centros que realizam procedimentos diagnósticos cardíacos, em 19 países da América Latina. Em comparação com o mês de março de 2019, os volumes dos procedimentos diagnósticos cardíacos diminuíram 36% em março de 2020 e 82% em abril de 2020.As maiores reduções ocorreram em relação aos testes de estresse ecocardiográfico (91%), testes ergométricos de esteira (88%) e escore de cálcio por tomografia computadorizada (87%), com pequenas variações entre as sub-regiões da América Latina. As mudanças em padrões de distanciamento social (p < 0,001) estavam mais fortemente associadas com a redução do volume do que a incidência de COVID-19 (p = 0,003). Conclusões A COVID-19 foi associada a uma redução significativa de procedimentos diagnósticos cardíacos na América Latina, a qual foi mais relacionada ao distanciamento social do que ao aumento da incidência da COVID-19. São necessários melhor equilíbrio e timing de medidas de distanciamento social e planejamento para manter o acesso ao atendimento médico durante um surto pandêmico, especialmente em regiões com alta mortalidade cardiovascular.

Abstract Background The COVID-19 pandemic has disrupted the delivery of care for cardiovascular diseases in Latin America. However, the effect of the pandemic on the cardiac diagnostic procedure volumes has not been quantified. Objective To assess (1) the impact of COVID-19 on cardiac diagnostic volumes in Latin America and (2) determine its relationship with COVID-19 case incidence and social distancing measures. Methods The International Atomic Energy Agency conducted a worldwide survey assessing changes in cardiac diagnostic volumes resulting from COVID-19. Cardiac diagnostic volumes were obtained from participating sites for March and April 2020 and compared to March 2019. Social distancing data were collected from Google COVID-19 community mobility reports and COVID-19 incidence per country from the Our World in Data. Results Surveys were conducted in 194 centers performing cardiac diagnostic procedures, in 19 countries in Latin America. Procedure volumes decreased 36% from March 2019 to March 2020, and 82% from March 2019 to April 2020. The greatest decreases occurred in echocardiogram stress tests (91%), exercise treadmill tests (88%), and computed tomography calcium scores (87%), with slight variations between sub-regions of Latin America. Changes in social distancing patterns (p < 0.001) were more strongly associated with volume reduction than COVID-19 incidence (p = 0.003). Conclusions COVID-19 was associated with a significant reduction in cardiac diagnostic procedures in Latin America, which was more related to social distancing than to the COVID-19 incidence. Better balance and timing of social distancing measures and planning to maintain access to medical care is warranted during a pandemic surge, especially in regions with high cardiovascular mortality.

MRI Evaluation of Patients Before and After Interventions for Benign Prostatic Hyperplasia: An Update.

Transurethral resection of the prostate is the most commonly performed procedure for the management of patients with lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). However, in recent years, various minimally invasive surgical therapies have been introduced to treat BPH. These include laser-based procedures such as holmium laser enucleation of the prostate and photoselective vaporization of the prostate as well as thermal ablation procedures such as water vapor thermal therapy (Rezum), all of which result in volume reduction of periurethral prostatic tissue. In comparison, a permanent metallic device (UroLift) can be implanted to pull open the prostatic urethra without an associated decrease in prostate size, and selective catheter-directed prostate artery embolization results in a global decrease in prostate size. The goal of this article is to familiarize radiologists with the underlying anatomic changes that occur in BPH as visualized on MRI and to describe the appearance of the prostate on MRI performed after these procedures. Complications encountered on imaging after these procedures are also discussed. Although MRI is not currently used in the routine preprocedural evaluation of BPH, emerging data support a role for MRI in predicting postprocedure outcomes.

Identificación de procesos de salud por maestrantes de la Escuela Nacional de Salud Pública / Identification of health processes by teachers of the National School of Public Health

Introducción: En los programas académicos de las especialidades, maestrías y cursos que se imparten en la Escuela Nacional de Salud Pública se inserta el estudio de los procesos y la gestión por procesos, tecnología que puede ser implementada para la mejora de la calidad en los servicios de salud en Cuba. Objetivo: Identificar los procesos vinculados al desempeño de los maestrantes en las instituciones de salud. Métodos: Investigación descriptiva de corte transversal entre enero y marzo de 2020, centrada en la búsqueda del conocimiento acerca del tema de procesos en los estudiantes de las maestrías de Atención Primaria de Salud y de Promoción y Educación para la Salud. Se solicitó la identificación de cinco procesos vinculados a su labor según la definición de la variable procesos y la selección de un proceso para la construcción colectiva de un diagrama de flujos y una ficha de procesos. Resultados: Se identificaron errores gramaticales y en la identificación de procesos en 13 maestrantes, se eliminaron aquellos que se repetían. Los procesos se agruparon y clasificaron en operativos, de apoyo y estratégicos. Se confeccionó un diagrama de flujos y una ficha del proceso más identificado por los maestrantes. Conclusiones: Los procesos operativos se identificaron con más frecuencia que los de apoyo y los estratégicos. La construcción de un diagrama de flujos y una ficha de proceso permitió una mayor visibilidad de las actividades y tareas que se desarrollan durante el proceso de atención médica por el equipo básico de salud en el consultorio médico de la familia(AU)

Introduction: The academic programs of specialties, master's degrees and courses taught at the National School of Public Health include the study of processes and process management, a technology that can be implemented to improve the quality of health services in Cuba. Objective: To identify the processes linked to the performance of master's courses students in health institutions. Methods: Cross-sectional and descriptive research carried out between January and March 2020, focused on the search for knowledge about the topic of processes in students of the master's degree courses of Primary Health Care and Health Promotion and Education. The identification of five processes linked to their work was requested according to the definition of the variable process and the selection of a process for the collective construction of a flow diagram and a process file. Results: Grammatical errors and errors in the identification of processes were observed in thirteen master's degree students, while those repeated were eliminated. The processes were grouped and classified into operational, supportive and strategic. A flow chart and a file of the process most identified by the master's degree students were made. Conclusions: Operational processes were identified more frequently than supportive and strategic ones. The construction of a flow chart and a process sheet allowed greater visibility of the activities and tasks developed during the medical care process by the basic health team in the family medical office(AU)

Miocarditis como forma de presentación de dengue: Informe de un caso / Myocarditis as a presentation form of dengue: A case report

RESUMEN El dengue es una enfermedad viral febril aguda produci da por el virus del dengue, trasmitido, principalmente, por la picadura de mosquitos del género Aedes. Puede cursar con o sin síntomas, hasta ocasionar cuadros clínicos graves. Se presenta el caso de un hombre de 47 años de edad, que ingresó por fiebre de tres días de evolución, erupción cutánea (rash), náuseas, tos seca y lipotimias. Dos días después empeoró la erupción y apareció bradicardia extrema. El ecocardiograma demostró disfunción del ventrículo izquierdo, con fracción de eyección de 38%. El paciente fue egresado a 14 días con el diagnóstico de dengue complicado con miocarditis. Es evidente que fue una miocarditis viral desde el comienzo de los síntomas, descrita como inusual en la literatura; la tos y las lipotimias fueron la expresión del bajo gasto cardíaco, que unidas a la bradicardia y las alteraciones electro y ecocardiográficas, ayudaron a establecer el diagnóstico.

ABSTRACT Dengue is an acute febrile viral disease produced by the dengue virus, mainly transmitted by the bite of mosquitoes of the genus Aedes. It can take place with or without symptoms and it can cause serious clinical conditions. The case of a 47-year-old man is presented, who was admitted due to fever of three days of evolution, skin rash, nauseas, dry cough and lipothymias. Two days later, the rash worsened and extreme bradycardia appeared. The echocardiogram showed left ventricular dysfunction, with an ejection fraction of 38%. The patient was discharged after 14 days with the diagnosis of dengue complicated by myocarditis. It is evident that it was a viral myocarditis from the beginning of symptoms, which is described as unusual in the bibliography; cough and lipothymias were the expression of the low cardiac output, that together with the bradycardia, and the electro- and echocardiographic alterations, helped to establish the diagnosis.

Polyphasic identification of Penicillium spp. isolated from Spanish semi-hard ripened cheeses.

Fifteen samples of semi-hard ripened cheeses, both spoiled (10) and unspoiled (5), and obtained from cheese factories located in Northwest of Spain, were analysed by a dilution plating technique and direct sampling. A total of 32 isolates were identified at species level by a polyphasic approach (phenotypic characterization, partial extrolite analysis and molecular identification). Most isolates (65.6%) belonged to the species P. commune; other species found were P. solitum, P. chrysogenum, P. nordicum, P. expansum and P. cvjetkovicii. All of the P. commune isolates were able to produce cyclopiazonic acid, while the P. nordicum and the P. expansum isolates were producers of ochratoxin A and patulin respectively. Despite this, the role of P. commune as beneficial fungi in cheese ripening should be investigated. Molecular identification based on BenA sequence analysis was able to identify the majority of isolates. The three mycotoxins investigated can be considered key for identification. The polyphasic approach seems to be a very valuable tool for identification of isolates of this complex genus.

Caracterización clínico epidemiológica de pacientes con ébola en un centro de tratamiento de Sierra Leona / Clinical-epidemiological characterization of Ebola disease in patients at a treatment center in Sierra Leone

Introducción: La enfermedad del ébola se dio a conocer por primera vez en 1976, con una letalidad muy elevada en todos los brotes detectados. Objetivo: Caracterizar clínica y epidemiológicamente a los pacientes portadores de la enfermedad por el virus del Ébola. Métodos: Se realizó un estudio observacional, descriptivo y transversal en 424 pacientes ingresados en un centro de tratamiento de ébola en la República de Sierra Leona, África occidental, con el diagnóstico confirmado mediante la técnica de reacción en cadena de la polimerasa para virus Ébola, durante el período de noviembre de 2014 hasta marzo de 2015. Resultados: Se muestra que el grupo etario más afectado fue el de 25 a 34 con un 25,9 por ciento. La mayor letalidad se presentó en los pacientes con más de 65 años de edad con un 44,4 por ciento. El síntoma que prevaleció fue la fiebre para un 61,8 por ciento, y el hipo se presentó en el 88,8 por ciento de los fallecidos. Conclusión: Se concluye que la enfermedad no tuvo distinción significativa con el sexo. La mayor letalidad se presentó en las edades geriátricas. Los síntomas más frecuentes fueron la fiebre, diarrea y el decaimiento. El hipo fue el signo que más se presentó en los pacientes que fallecieron(AU)

Introduction: Ebola disease was first reported in 1976 with a very high lethality in all outbreaks. Objective: To clinically and epidemiologically characterize the patients carriers of Ebola virus disease. Methods: we conducted an observational, descriptive and cross-sectional study in 424 patients admitted to an Ebola Treatment Center in the Republic of Sierra Leone, West Africa from November 2014 to March 2015. The polymerase chain reaction technique for Ebola virus confirmed the diagnosis. Medical records provided all data. Results: The age group most affected was 25 to 34 (25.9 percent). The highest lethality occurred in those over 65 years of age (44.4 percent ). Fever was the prevailing symptom (61.8 percent) and hiccups occurred in 88.8 percent of the deceased. Conclusion: Clinical manifestations were variable, although fever was the main symptom. Hiccup was a sign of poor prognosis when associated with a higher percentage of mortality. Lethality was high(AU)

Análisis del programa Propedéutica Clínica y Semiología Médica. Una metodología estructurada por pasos / Analysis of the Syllabus of Semiology and Clinical Propedeutics. Steps-structured methodology

Introducción: Los diseños establecidos en planes y programas de estudios deben ir al unísono de los cambios que la sociedad genera; esto implica su análisis con el propósito de perfeccionarlos de manera permanente. Objetivo: Determinar el alcance y limitaciones que puede tener el plan de estudio de la asignatura Propedéutica Clínica y Semiología Médica. Material y métodos: Se realizó un estudio cualitativo de corte pedagógico entre el 1 de abril y el 31 de junio de 2017, que asume el método dialéctico-materialista con enfoque de sistema como rector del proceso de investigación, para efectuar el análisis crítico a un programa de estudio; la metodología utilizada para ello consta de cinco pasos fundamentales que incluye, entre otros elementos, la pertinencia y la revisión de los componentes del proceso enseñanza-aprendizaje. Resultados y Discusión: Se realizó el análisis crítico del programa, se identifican puntos de mejora y una contradicción didáctica relacionada con el desarrollo del razonamiento clínico en los estudiantes de la carrera de Medicina, al reconocerse una discordancia entre el contenido de la asignatura y la forma ideal de impartirlo, por lo que los autores consideran que es un problema metodológico. Conclusiones: El programa de estudio satisface la idea integradora del comandante Fidel en relación con el proceso docente-educativo en la formación de médicos en Cuba, al orientar integralidad, presencia de la educación en el trabajo, aumento del protagonismo del alumno, con la garantía de su calidad humana, científica y técnica, comprometida con el pueblo. El uso de esta metodología puede generalizarse(AU)

Introduction: The designs established in the different syllabuses should be in complete agreement with the demands of society. Therefore, an analysis should be carried out in order to improve them permanently. Objective: To determine the scope and limitations of the syllabus of the subject Semiology and Clinical Propedeutics. Material and Methods: A qualitative study from a pedagogical perspective was conducted from April 1st to June 31st, 2017, which assumes the materialistic dialectic method with an approach on the system as the main action of the research process in order to carry out a critical syllabus analysis. The methodology used for this consists of five main steps which include, among other elements, the appropriateness and the review of the components of the teaching-learning process. Results and discussion: A critical syllabus analysis was carried out, and aspects for the improvement and a didactic unit of contradiction related to the clinical discussion in the medical students were identified at recognizing a disagreement between the subject contents and the ideal way to teach them, thus considering it a methodological problem. Conclusions: The curriculum satisfies the integrative idea of Commander Fidel in relation to the teaching-learning process for the formation of doctors in Cuba at advising a comprehensive formation, implementing the in-service training, and increasing the students´ leading role that guarantees a human, scientific, and technical quality, directed to give a better care to the people. The use of this methodology can be generalized(AU)

Características clínicas del alcoholismo en hombres de la tercera edad / Clinical characteristics of alcoholism in old-aged men

RESUMEN Introducción: el alcoholismo en adultos mayores suscita gran interés por las implicaciones del mismo a la salud de este vulnerable grupo poblacional. Objetivo: determinar el comportamiento del alcoholismo en adultos mayores. Métodos: estudio analítico, de casos-control, realizado en el Hospital José Ramón López Tabrane, de Matanzas, durante el año 2012. Se trabajó directamente con un universo de 88 ancianos varones, dividiéndolo en dos grupos (estudio y control) acorde a si eran o no alcohólicos. La aplicación del Test de Cage, encuestas y análisis de historias clínicas permitieron la obtención de información que dio salida a las variables estudiadas. Se respetó la médica. Resultados: predominaron los ancianos del grupo etáreo 60-69 años, a la vez que lo hicieron las cardiopatías y la hipertensión arterial en el grupo de estudio, por las infecciones respiratorias en el grupo control, siendo superior el porcentaje de pacientes con cirrosis hepática, en el primero de los grupos. Por su parte, a excepción de la polineuritis, las restantes afecciones asociadas al alcoholismo mostraron porcentajes superiores en el grupo estudio. La mortalidad en el grupo control fue mayor, a expensas de las infecciones respiratorias, mostrando las muertes por cirrosis hepática, neoplasia de pulmón e infarto cerebral porcentajes mayores en el grupo de estudio. Conclusiones: amén del bajo porcentaje de ancianos alcohólicos, se reportaron porcentajes superiores de morbimortalidad en este grupo, identificando esta enfermedad como uno de los pilares a tratar, con vistas a mejorar la cantidad y calidad en este grupo tan susceptible.

ABSTRACT Introduction: alcoholism in old people gives rise to a great interest due its implications in the health of this vulnerable group of population. Objective: to determine the behavior of alcoholism in old people at José Ramón López Tabrane Hospital in Matanzas province. Methods: an analytical case-control study was conducted at José Ramón López Tabrane Hospital in Matanzas province during 2012. The total of the target group included 88 old-aged men; dividing them into two groups (study and control), considering whether they were alcoholics or non-alcoholics. The application of Cage Test, surveys and the analysis of medical histories allowed obtaining the information that responded to the variables studied. Clinical criterion was respected Results: the age group from 60 to 69 years old predominated, at the same time as heart diseases and hypertension in the study group, and respiratory infections in the control group, being higher the percentage of old-aged men with hepatic cirrhosis, in the first groups. On the other hand, with the exception of polyneuritis, the remaining conditions associated with alcoholism showed higher percentages in the study group. Mortality rate in the control group was higher, as a consequence of respiratory infections, deaths due to hepatic cirrhosis, lung neoplasia and cerebral infarction showed higher percentages in the study group. Conclusions: in addition to the low percentage of alcoholic old-aged men, higher percentages of morbidity and mortality were reported in this group, identifying this disease as one of the pillars to be treated, in order to improve the quantity and the quality of life of this very vulnerable group.

Larva migrans visceral. Presentación de un caso / Visceral larva migrans. Report of a case

RESUMEN La larva migrans visceral es una enfermedad que se produce al ingerir huevos infectantes de nematodos parásitos de gatos y perros (Toxocaracanis y Toxocaracati); los cuales eclosionan en el intestino del hombre y las larvas se distribuyen en todo el organismo, principalmente hígado, pulmón, corazón y cerebro. Las larvas en su migración dejan trazos de hemorragias, necrosis y células inflamatorias; algunas son destruidas por la respuesta inmune del huésped y otras forman granulomas eosinofílicos. Los síntomas dependen del tejido u órgano afectado, de la intensidad de la infección y del grado de la respuesta inmunológica inducida. Se presenta un caso del sexo masculino de 72 años que ingresa en el Servicio de Medicina del Hospital Militar Docente “Dr. Mario Muñoz Monroy”, de Matanzas, por cuadro de fiebre, diarreas, tos seca, astenia, anorexia y pérdida de peso al que se le diagnosticó larva migrans visceral. Por lo atípico de la edad del paciente y la complejidad del diagnóstico decidimos presentar este caso (AU).

ABSTRACT Visceral larva migrans is a disease produced after the ingestion of infectant eggs of cat´s and dog´s nematode parasites (Toxocara canis and Toxocara cati). These parasites harch in the men´s intestines and the larvas are distributed around the organism, mainly in the following organs: liver, lungs, hearth and brain. In their migration, the larvas leave traces of hemorrhage, necrosis and inflammatory cells; several of them are destroyed by the host´s immune answer and others form eosinophilic granulomas. The symptoms depend on the affected tissue or organ, on the infection intensity and on the level of induced immunologic answer. The case of a male patient, aged 72 years-old is presented. He entered the Medicine Service of the Teaching Military Hospital “Dr. Mario Muñoz Monroy”, of Matanzas with fever, diarrhea, dry cought, asthenia, anorexia and weight loss.Visceral larva migrans was diagnosed. The presentation of the case was decided because of the atypical patient´s age and the complexity of the diagnosis (AU).

Endocarditis infecciosa en válvula nativa mitral por Hafnia alvei / Infective endocarditis in native mitral valve by Hafnia alvei

We report the case of a 40-year-old male patient with no prior personal pathological history, who had a prolonged febrile syndrome without being associated with other important clinical features. He was diagnosed with subacute bacterial endocarditis in the native mitral valve by an atypical pathogen: Hafnia Alvei. After an exhaustive review of the bibliography of the last 20 years corresponding to the Cuban medical journals, we conclude that we are facing the first clinical case of this type published in Cuba(AU)

Se presenta el caso clínico de un paciente masculino de 40 años de edad, sin antecedentes patológicos personales, portador de un síndrome febril prolongado sin asociarse a otros elementos clínicos de importancia. Se le diagnosticó una endocarditis bacteriana subaguda en válvula mitral nativa por un germen patógeno atípico: Hafnia alvei. Tras realizar una exhaustiva revisión de la bibliografía de los últimos 20 años correspondiente a las revistas médicas cubanas, se concluye que estamos frente al primer caso clínico de este tipo publicado en Cuba(AU)

El Programa del médico y enfermera de la familia: desarrollo del modelo de atención médica en Cuba / The Family Doctor and Nurse Program: development of the health care model in Cuba / O Programa de Médicos e Enfermeiras da Família: desenvolvimento do modelo de saúde em Cuba

RESUMEN El modelo de medicina familiar cubano se desarrolla, desde hace más de tres décadas, como el tercer modelo de atención médica del período revolucionario en Cuba. Es la expresión más acabada de la aplicación de la estrategia de atención primaria de salud. Aún muestra potencial para la mejora en la organización, la calidad y la eficiencia de los servicios de salud en el primer nivel de atención de salud. El objetivo esencial de este trabajo es describir el modelo, sus singularidades, sus elementos distintivos, y sus principales logros, retos y desafíos. Se realizó una revisión documental en artículos de revistas, libros y documentos oficiales del Ministerio de Salud Pública de Cuba sobre la creación y desarrollo del modelo, seleccionados y analizados por expertos para la elaboración del presente informe. Se presentan elementos conceptuales del modelo, así como indicadores que sustentan la información. En este trabajo se identificaron las principales características de la medicina familiar en Cuba, sus logros fundamentales, retos y desafíos. Con base en sus resultados, se concluye que el modelo de medicina familiar de Cuba es un referente para la Región de las Américas. Es aún un modelo en desarrollo, perfectible y susceptible de transformaciones para enfrentar nuevos retos, el mayor de los cuales será renovar el modelo manteniendo y fortaleciendo las ideas fundacionales del programa.

ABSTRACT The Cuban family medicine model has been developed, for more than three decades, as the third model of medical care of the revolutionary period in Cuba. It is the complete expression of the application of the primary health care strategy. However, it is still possible to improve the organization, quality and efficiency of health services in the first level of health care. The objective of this article is to describe the model, its singularities, distinctive elements, main achievements, and challenges. A documentary review was made from journal articles, books and official documents of the Ministry of Public Health of Cuba on the creation and development of the model; documents were selected and analyzed by experts for the preparation of this report. Conceptual elements of the model are presented, as well as indicators supporting the information. The main characteristics of family medicine in Cuba, its fundamental achievements, and challenges are presented. Based on its results, Cuba's family medicine model is a reference for the Region of the Americas. It is still a model in development, however, perfectible and susceptible to transformations to face new challenges, more importantly to renew the model keeping and strengthening the foundational ideas of the program.

RESUMO O modelo cubano de medicina familiar foi desenvolvido, há mais de três décadas, como o terceiro modelo de assistência médica do período revolucionário em Cuba. É a expressão mais completa da aplicação da estratégia de atenção primária à saúde. Ainda mostra potencial de melhoria na organização, qualidade e eficiência dos serviços de saúde no primeiro nível de cuidados de saúde. O objetivo essencial deste trabalho é descrever o modelo, suas singularidades, elementos distintivos, principais conquistas, e desafios. Para isso, foi feita uma revisão documental em artigos de revistas, livros e documentos oficiais do Ministério da Saúde Pública de Cuba sobre a criação e desenvolvimento do modelo, selecionados e analisados por especialistas para a elaboração deste relatório. Os elementos conceituais do modelo são apresentados, bem como indicadores que suportam a informação. Identificamos as principais características da medicina familiar em Cuba, suas conquistas fundamentais, e desafios. Com base em seus resultados, conclui-se que o modelo de medicina familiar de Cuba é uma referência para a Região das Américas. Ainda é um modelo em desenvolvimento, perfeitável e susceptível a transformações para enfrentar novos desafios, o maior dos quais será renovar o modelo com a manutenção e fortalecimento das idéias fundamentais do programa.

Antioxidant effects of extra virgin olive oil enriched by myrtle phenolic extracts on iron-mediated lipid peroxidation under intestinal conditions model.

Chelating and free radicals scavenging activities of extra virgin olive oil (EVOO) enriched by Myrtus communis phenolic compounds (McPCs), α-tocopherol and Butylated hydroxytoluene (BHT) were evaluated using chemical assays, 2,2-diphenyl-1-picrylhydrazyl (DPPH) and Oxygen radical absorbance capacity (ORAC), and biological model as 2,2'-azobis (2-aminopropane) dihydrochloride (AAPH) or Fe+3/Ascorbic acid (Fe+3/AsA) system mediated peroxidation of l-α-phosphatidylcholine aqueous dispersions stabilized by bile salts (BS) under simulated intestinal conditions (pH 7.4). McPC-EEVOO increased significantly the neutralization of DPPH radical and AAPH-derived radicals in ORAC assay more than α-tocopherol and BHT. The phospholipid stability increased by a factor of 33.6%, 34.8%, 19.3% and 10.7% for myrtle microwave assisted extraction (MAE) and conventional extraction (CE) extracts, α-tocopherol and BHT, respectively, as compared to the control (EVOO without enrichment) in Fe+3/AsA system. But a slightly additive effect was observed when AAPH system was used. Our observation showed that McPCs may interact positively with EVOO to inhibit phospholipid peroxidation, and thus, McPC-EEVOO could be a potential functional food.

Diabetes mellitus vs diabetes insípida y un factor común: la poliuria. Presentación de un caso / Diabetes mellitus versus diabetes insipidus and a common factor: polyuria. Case presentation

La diabetes mellitus es una enfermedad crónica no trasmisible muy frecuente en la ciudad de Matanzas, se presenta en cualquier grupo etáreo, siendo tipo I o tipo II. En la diabetes tipo I, el cuerpo no produce insulina. En la diabetes tipo II, la más común, el cuerpo no produce o no usa la insulina adecuadamente. Sin suficiente insulina, la glucosa permanece en la sangre, provocando múltiples complicaciones tanto agudas como crónicas. La diabetes insípida es un trastorno poco común del metabolismo del agua. Esto quiere decir que el balance entre la cantidad de agua o líquido que usted toma no corresponde con el volumen de excreción urinaria. Es causada por una falta de respuesta o una respuesta deficiente a la hormona antidiurética vasopresina. Esta hormona controla el balance hídrico mediante la concentración de orina. Los pacientes con diabetes insípida orinan mucho, por lo cual necesitan beber bastantes líquidos para reemplazar los que pierden. Se presenta un paciente de 45 años con antecedentes de salud que debutó con una diabetes insípida y un año más tarde con una diabetes mellitus tipo II concomitando ambas, corroborándose por los complementarios correspondientes y mejorando con tratamiento (AU).

Diabetes mellitus is a non-transmissible chronic disease, very frequent in the city of Matanzas, which is present in any age group, and is classified as type I and type II. In the type I diabetes, the body does not produce insulin. In the type II diabetes, the most common one, the body does not produce or does not use it effectively. Without enough insulin, glucose remains in the blood, causing several complications, both acute and chronic. The diabetes insipidus is a few common disorder of the water metabolism. That means that the balance between the quantity of water or any other fluid someone drinks does not coincide with the volume of the urinary excretion. It is due to a lack of answer or a deficient answer to the anti-diuretic hormone vasopressin. This hormone controls the water balance through the urine concentration. The patients with diabetes insipidus urinate a lot, so they need to drink many liquids to replace those they lose. It is presented the case of a patient aged 45 years, with health antecedents, that debuted with diabetes insipidus and a year later with a concomitant type II diabetes mellitus. The complementary tests confirmed that and the patient got better with the treatment (AU).

Detección precoz de pacientes con riesgo de diabetes mellitus en la atención secundaria de salud / Early detection of patients at risk of diabetes mellitus in secondary health care

Introducción: los pacientes prediabéticos poseen riesgo de desarrollo de diabetes mellitus. Su diagnóstico precoz puede prevenir la aparición de esta condición metabólica. Objetivo: identificar la prevalencia de pacientes con prediabetes durante el chequeo médico y la caracterización de algunos aspectos clínicos y epidemiológicos. Métodos: se realizó un estudio observacional, descriptivo y transversal en el Hospital Militar Docente Dr. Mario Muñoz Monroyde Matanzas. La muestra estuvo constituida por 434 individuos a los que se les diagnosticó prediabetes. Resultados: predominó el sexo masculino (88 por ciento), siendo más frecuente para ambos sexos el grupo de edad de 45 a 54 años. En la categoría de glicemia en ayunas alterada hubo 234 pacientes (54 por ciento), 139 (32 por ciento) con tolerancia a la glucosa alterada y 61 (14 por ciento) portadores de prediabetes doble. El factor de riesgo más frecuente fue la dislipidemia, seguido del índice de masa corporal mayor e igual de 25 y la edad mayor de 45 años. En las enfermedades concomitantes predominó la hipertensión arterial esencial (68 por ciento) y la cardiopatía isquémica (25 por ciento). En el estado nutricional predominaron los sobrepesos y obesos con el 54 y 47 por ciento, respectivamente. Conclusiones: en la atención secundaria de salud fue detectada precozmente una elevada prevalencia de pacientes con riesgo de desarrollo de diabetes mellitus tipo 2 que desconocían su condición(AU)

Introduction: Pre-diabetic patients are at risk of developing diabetes mellitus. Early diagnosis can prevent the onset of this metabolic condition. Objective: To identify the prevalence of patients with prediabetes during the medical check-up, and at the same time to characterize some clinical and epidemiological aspects. Methods: An observational, descriptive and cross-sectional study was conducted at the Military Teaching Hospital Dr. Mario Muñoz Monroy from Matanzas. The sample consisted of 434 individuals who were diagnosed with prediabetes. Results: The male sex predominated (88 percent), being more frequent for both sexes the age group of 45 to 54 years. In the altered fasting glycemia category, there were 234 patients (54 percent), 139 (32 percent) with impaired glucose tolerance and 61 (14 percent) patients with double prediabetes. The most frequent risk factor was dyslipidemia, followed by a greater and equal body mass index of 25 and age over 45 years. In the concomitant diseases, essential hypertension predominated (68 percent) and ischemic heart disease (25 percent). In the nutritional status, overweight and obese were predominant with 54 and 47 percent, respectively. Conclusions: At secondary health care, a high prevalence of patients with risk of developing type 2 diabetes mellitus who did not know their condition was detected early(AU)

Evaluación de la formación de profesionales de la especialidad de Medicina General Integral / Assessment of the profesional training in the specialty of family medicine

Introducción: la evaluación de la formación de los residentes de la especialidad de Medicina General Integral se realiza mediante las visitas de control a los procesos formativos que realizan las Facultades de Ciencias Médicas, por los elementos que aportan los educandos en el proceso de evaluación profesoral y mediante la reacreditación docente de los policlínicos docentes. Objetivo: caracterizar el estado actual de la evaluación de la formación de la especialidad de Medicina General Integral. Métodos: se realizó un estudio descriptivo, de corte transversal, durante el primer semestre del año 2015, en los policlínicos docentes de la Facultad de Ciencias Médicas "Dr. Miguel Enríquez", el universo de estudio estuvo conformado por 100 residentes de MGI y los 13 jefes de los departamentos docentes de los policlínicos de los municipios de Regla, Guanabacoa, San Miguel del Padrón y el Cotorro, se utilizaron métodos teóricos y empíricos, así como cuantitativos y cualitativos. Resultados: la totalidad de los jefes de departamento docentes de los policlínicos le conceden importancia a la evaluación de la formación de la especialidad por su parte, los residentes consideran que estos procesos evaluativos garantizan mayor calidad de la formación y mejora la infraestructura y el funcionamiento de los servicios en los policlínicos. Conclusiones: la evaluación de la formación de la especialidad de Medicina General Integral está respaldado por los documentos normativos emanados por el Ministerio de Salud Pública(AU)

Introduction: The assessment of the residents training in the specialty of family medicine is carried out through visits to control the training processes carried out by the School of Medical Sciences, considering the elements provided by the students in the process of teacher evaluation and through the teacher re-accreditation of the polyclinic teachers. Objective: To characterize the present state of the assessment to the training in the specialty of family medicine. Methods: A cross-sectional, descriptive study was carried out during the first semester of 2015, in the School Polyclinic of Dr. Miguel Enríquez School of Medical Sciences. The universe of study consisted of 100 family medicine residents and the 13 heads of the Polyclinic teaching Departments of the municipalities of Regla, Guanabacoa, San Miguel del Padrón, and Cotorro, using theoretical and empirical methods whether quantitative and qualitative. Results: All the heads of teaching Departments of the Polyclinics gave importance to the assessment of the training in the specialty. On the other hand, the residents consider that these evaluative processes guarantee better quality of the training and improve the infrastructure and the operation of services in polyclinics. Conclusions: The assessment of the training in the specialty of family medicine is supported by the regulative documents issued by the Ministry of Public Health(AU)