Delays in diagnosis and surgery of sarcoma patients during the COVID-19 outbreak in Spain.

Background and objectives: Social distancing and quarantine implanted during the COVID-19 outbreak could have delayed the accession of oncologic patients to hospitals and treatments. This study analysed the management of sarcoma patients during this period in five Spanish hospitals. Design and methods: Clinical data from adult sarcoma patients, soft tissue and bone sarcomas, managed during the COVID-19 outbreak, from 15 March to 14 September 2020 (Covid cohort), were retrospectively collected and time for diagnosis, surgery and active treatments were compared with sarcoma patients managed during the same pre-pandemic period in 2018 (Control cohort). Results: A total of 126 and 182 new sarcoma patients were enrolled in the Covid and Control cohorts, respectively, who were mainly diagnosed as soft tissue sarcomas (81.0% and 80.8%) and at localized stage (80.2% and 79.1%). A diagnostic delay was observed in the Covid cohort with a median time for the diagnosis of 102.5 days (range 6-355) versus 83 days (range 5-328) in the Control cohort (p = 0.034). Moreover, a delay in surgery was observed in cases with localized disease from the Covid cohort with a median time of 96.0 days (range 11-265) versus 54.5 days (range 2-331) in the Control cohort (p = 0.034). However, a lower delay for neoadjuvant radiotherapy was observed in the Covid cohort with a median time from the diagnosis to the neoadjuvant radiotherapy of 47 days (range 27-105) versus 91 days (range 27-294) in the Control cohort (p = 0.039). No significant differences for adjuvant radiotherapy, neoadjuvant/adjuvant chemotherapy and neoadjuvant/adjuvant palliative chemotherapy were observed between both cohorts. Neither progression-free survival (PFS) nor overall survival (OS) was significantly different. Conclusion: Delays in diagnosis and surgery were retrospectively observed in sarcoma patients during the COVID-19 outbreak in Spain, while the time for neoadjuvant radiotherapy was reduced. However, no impact on the PFS and OS was observed.

Evaluación de la profesionalización de los docentes de Enfermería y Tecnología de la Salud / Evaluation of Nursing and Health Technology teachers' professionalization i: en

Introducción: La profesionalización docente es una entidad de la esfera educativa que ha ganado un fuerte protagonismo entre los investigadores de esta área del conocimiento desde finales del siglo XX. Objetivo: Valorar el estado actual de la evaluación de la profesionalización de los docentes de las carreras de Enfermería y Tecnología de la Salud. Métodos: Se efectuó una investigación observacional y descriptiva, durante el año 2021, de los 144 docentes de la Facultad de Enfermería-Tecnología de la Salud de Santiago de Cuba, para lo cual se analizaron 6 variables: actividad docente, actividad científico-investigativa, actividad asistencial, actividad gerencial, actividad bioética y actuación profesional; y un total de 21 indicadores, en correspondencia con las exigencias actuales de la educación médica. Resultados: La triangulación metodológica de los instrumentos aplicados fue de 6,7, estimado como un nivel bajo de desarrollo, lo que permitió corroborar que la evaluación de la profesionalización de los docentes en el período evaluado se encontraba afectada. Conclusiones: Los problemas y las potencialidades identificados refrendan la necesidad de desarrollar la evaluación de la profesionalización de los docentes de esta Facultad.

Introduction: Teaching professionalization is an entity of educational sphere which has gained a strong role among researchers in this area of knowledge from the end of the 20th century. Objective: To assess the current state of evaluation of Nursing and Health Technology careers teachers' professionalization. Methods: An observational and descriptive investigation was carried out, during the year 2021, of the 144 teachers of Faculty of Nursing and Health Technology from Santiago de Cuba province, for which 6 variables were analyzed: teaching activity, scientific-investigative activity, care activity, management activity, bioethical activity and professional performance; as well as a total of 21 indicators, in correspondence with the current demands in medical education. Results: The methodological triangulation of the applied instruments was 6.7, estimated as a low level of development, which allowed corroborating that the evaluation of the teachers' professionalization was affected in that period. Conclusions: The problems and potentialities identified endorse the need to develop the evaluation of the teachers' professionalization in this Faculty.

Escalera de superación académica con enfoque interdisciplinario en la Facultad de Tecnología de la Salud de La Habana / Steps of academic training with interdisciplinary approach in the Health Technology Faculty of Havana city i: en

Introducción: A la Universidad del siglo XXI le corresponde ser consecuente con los procesos derivados del desarrollo social, lo cual debe ser atendido desde la formación de posgrado. A tales efectos, se diseñó y ejecutó una estrategia de superación en la Facultad de Tecnología de la Salud de La Habana, según las necesidades de aprendizaje de los profesionales. Objetivo: Describir los principales resultados de la generalización de la escalera de superación académica con enfoque interdisciplinario. Métodos: Se realizó un estudio descriptivo, longitudinal y retrospectivo, en el periodo 2017-2022, en la Facultad de Tecnología de la Salud de La Habana. Las 5 variables identificadas fueron la superación por tipo de actividad de posgrado según año, los artículos científicos publicados por año en la Revista Cubana de Tecnología de la Salud, la formación de doctores en educación médica, los doctores en educación médica graduados según universidades y centros de salud, así como la promoción de profesores a la categoría docente superior. Resultados: Se apreció un incremento de las formas de superación desarrolladas. En el 2019 la cifra de autores y coautores con publicaciones en la revista de la Facultad ascendió a 219; asimismo, en la formación de grado científico hubo considerables resultados, tanto en profesores como en otros profesionales de la salud, y aumentó el número de docentes que ascendieron a la categoría superior. Conclusiones: Como resultado de la superación académica escalonada se destacó la elaboración de 5 maestrías para el área de las tecnologías de la salud y se apreció un incremento sostenido en la promoción de profesionales de la educación médica a categorías docentes superiores.

Introduction: The University of the XXI century is in charge of being consequent with the processes derived from the social development, which should be assisted from the posdegree education. To such effects, a training strategy was designed and implemented in the Health Technology Faculty of Havana city, according to the learning necessities of professionals. Objective: To describe the main results of generalization of the academic training steps with interdisciplinary approach. Methods: A descriptive, longitudinal and retrospective study was carried out in 2017-2022 in the Health Technology Faculty of Havana city. The 5 variables identified were training by type of posdegree activity according to year, the scientific works published per year in the Cuban Journal of Health Technology, training of doctors in Medical Education, doctors in Medical Education graduated according to universities and health centers, as well as the promotion of professors to the superior teaching category. Results: An increment in the developed ways of training was appreciated. In 2019, the number of authors and joint authors with publications in the Faculty's journal has reached 219; also, there were considerable results in the scientific degree education, either in professors or in other health professionals, and there was a higher number of professors that reached the superior category. Conclusions: As a result of the staged academic training, the elaboration of 5 masters՚ degree for health technologies area was notable and a sustained increment was appreciated in the promotion of professionals from the medical education to superior educational categories.

Estrategia de gestión académica para la integración de los procesos sustantivos en la formación del estudiante de Medicina / Academic management strategy for the integration of fundamental processes in the medical student training i: en

Partiendo de las limitaciones identificadas en el accionar del especialista en medicina general integral para la integración de los procesos sustantivos en la formación del estudiante de Medicina, se determinó diseñar una estrategia de gestión académica, la cual connota los referentes epistémicos que la sustentan, sus propósitos y etapas. En este artículo se exponen los métodos teóricos empleados para la concepción de dicha estrategia, así como las técnicas usadas para su ejecución y las etapas en que se estructuró. Asimismo, se confirma su validez y pertinencia luego de aplicada y el grado de satisfacción de los docentes con ella. Finalmente, se identifican los principales impactos revelados de su implementación, en los órdenes social, científico y educativo.

Based on the limitations identified in the actions of the specialist in comprehensive general medicine for the integration of fundamental processes in the medical student training, it was determined to design an academic management strategy, which connotes the epistemic referents that support it, as well as its purposes and stages. The theoretical methods used for the conception of such a strategy, as well as the techniques used for its implementation and the stages in which it was structured are presented in this work. Likewise, its validity and relevance after its application and the degree of professors' satisfaction with it are confirmed. Finally, the main revealed impacts of its implementation are identified, in social, scientific and educational orders.

El aprendizaje basado en problemas como herramienta didáctica para mejoras del desempeño en peritonitis posoperatoria / Problem-based learning as a didactic tool for performance improvements in postoperative peritonitis

Fundamento: el aprendizaje basado en problemas es una herramienta didáctica de la superación profesional a distancia poco utilizada en Cirugía. Objetivo: analizar el aprendizaje basado en problemas como herramienta didáctica virtual pertinente para el desarrollo de habilidades clínicas y quirúrgicas en la peritonitis posoperatoria. Método: se realizó una investigación cualitativa descriptiva en el Hospital "Dr. Ambrosio Grillo" de Santiago de Cuba, en el trimestre mayo-julio 2022. Se emplearon métodos del nivel teórico para la fundamentación de la investigación, empírico (prueba de desempeño con la aplicación de 20 problemas de salud (14 en español y 6 en inglés) para la evaluación final teórico-práctica de un entrenamiento virtual en peritonitis posoperatoria; y matemáticos. Resultados: se constató que el aprendizaje basado en problemas en la superación profesional a distancia en Cirugía representa una herramienta didáctica motivacional para el desarrollo de habilidades clínicas y quirúrgicas en la peritonitis posoperatoria y soluciona insuficiencias en el desempeño de los profesionales que tratan esta complicación. El empleo de las TIC en el aprendizaje contemporáneo facilita la autopreparación mediante el diseño de simuladas problemáticas de salud. Conclusiones: el aprendizaje basado en problemas es una pertinente herramienta que contribuye a mejoras del desempeño profesional frente a complicaciones quirúrgicas graves como la peritonitis posoperatoria, desde la superación profesional a distancia.

Background: problem-based learning is a didactic tool for distance professional improvement that is rarely used in Surgery. Objective: to analyze problem-based learning as a relevant virtual didactic tool for the development of clinical and surgical skills in postoperative peritonitis. Method: a descriptive qualitative research was carried out at the Hospital "Dr. Ambrosio Grillo" of Santiago de Cuba, from May to July 2022. Methods of the theoretical level were used for the foundation of the research, empirical (performance test with the application of 20 health problems (14 in Spanish and 6 in English) for the theoretical-practical final evaluation of a virtual training in postoperative peritonitis; and mathematics. Results: it was found that problem-based learning in distance professional improvement in Surgery represents a motivational didactic tool for the development of clinical and surgical skills in postoperative peritonitis and solves deficiencies in the performance of professionals who treat this complication. The use of ICT in contemporary learning facilitates self-preparation through the design of simulated health problems. Conclusions: problem-based learning is a pertinent tool that contributes to improvements in professional performance when facing serious surgical complications such as postoperative peritonitis, from distance professional improvement.

Habilidades procedimentales invariantes para el diagnóstico y el tratamiento de la peritonitis posoperatoria

Introducción: Las habilidades procedimentales invariantes en las peritonitis posoperatorias, les permite a los cirujanos el diagnóstico temprano y la reoperación abdominal urgente. Objetivo: Diseñar las habilidades procedimentales invariantes de atención diagnóstica y terapéutica a la peritonitis posoperatoria dirigida a los cirujanos. Método: Se realizó una investigación cualitativa en el Hospital Clínico Quirúrgico "Ambrosio Grillo" de Santiago de Cuba en el trimestre mayo-julio de 2022. La población de estudio estuvo constituida por 33 profesionales tratantes de la peritonitis posoperatoria: 22 médicos (12 cirujanos y 10 intensivistas) y 11 licenciadas en Enfermería. Se utilizó la sistematización como método teórico y como método empírico la revisión documental con la revisión de las historias clínicas y la observación con la práctica atencional-docente de la autora principal. Resultados: Se diseñaron las habilidades procedimentales invariantes para el diagnóstico temprano y la terapéutica de la peritonitis posoperatoria dirigida a los cirujanos con especial importancia en el método clínico. La autopreparación del tema en cuestión posibilita la complementación de conocimientos y habilidades aprendidas, así como la actualización de saberes que garantiza la atención clínica quirúrgica a este complejo enfermo. Conclusiones: El diseño de las habilidades procedimentales invariantes para el diagnóstico temprano y la terapéutica de la peritonitis posoperatoria en la necesaria superación permanente y continuada de los cirujanos representa una herramienta asistencial-docente que contribuye al mejoramiento del desempeño profesional ante este tipo de enfermo.

Introduction: Invariant procedural skills in postoperative peritonitis allow surgeons an early diagnosis and the performance of urgent abdominal resurgery. Objective: To design invariant procedural skills to be implemented for surgeons on the diagnostic and therapeutic care of postoperative peritonitis. Method: A qualitative research was conducted at the Hospital Clínico Quirúrgico "Ambrosio Grillo" of Santiago de Cuba in the quarter period of May-July 2022. The study population consisted of 33 specialists on postoperative peritonitis: 22 physicians (12 surgeons and 10 intensivists) and 11 graduated bachelor in nursing. Systematization was used as the theoretical method and the empirical methods used were the document analysis supported with the review of clinical histories and the observation with the main author's attentional-teaching practice. Results: It was designed an invariant procedural skills for the early diagnosis and therapy of postoperative peritonitis with special emphasis on the clinical method. The self-preparation on the subject makes possible the complementation of both knowledge and skills learned, as well as an update of knowledge that guarantees the surgical clinical care of these complex patients. Conclusions: The design of invariant procedural skills for the early diagnosis and therapy of postoperative peritonitis in the necessary permanent and continuous knowledge improvement of surgeons represents a care-teaching tool that contributes to improve the professional performance at the time to attend to this type of patient.

Introdução: As habilidades processuais invariantes na peritonite pós-operatória permitem aos cirurgiões o diagnóstico precoce e a reoperação abdominal urgente. Objetivo: Projetar as habilidades processuais invariantes de atenção diagnóstica e terapêutica para peritonite pós-operatória destinadas a cirurgiões. Método: Uma pesquisa qualitativa foi realizada no Hospital Clínico Cirúrgico "Ambrosio Grillo" em Santiago de Cuba no trimestre maio-julho de 2022. A população do estudo consistiu em 33 profissionais que tratam de peritonite pós-operatória: 22 médicos (12 cirurgiões e 10 intensivistas) e 11 graduados em enfermagem. Utilizou-se como método teórico a sistematização e como métodos empíricos a revição documental com revisão de histórias clínicas e a observação com a prática docente-atencional da autora principal. Resultados: Desenharam-se competências processuais invariantes para o diagnóstico precoce e terapêutica da peritonite pós-operatória dirigidas a cirurgiões com especial importância no método clínico. O autopreparo do sujeito em questão possibilita a complementação dos conhecimentos e habilidades aprendidas, bem como a atualização de conhecimentos que garantem o cuidado clínico cirúrgico desta complexa doença. Conclusões: O desenho de habilidades processuais invariantes para o diagnóstico precoce e tratamento da peritonite pós-operatória no necessário aperfeiçoamento permanente e contínuo dos cirurgiões representa uma ferramenta cuidado-ensino que contribui para o aperfeiçoamento da atuação profissional frente a este tipo de paciente.

La investigación científica: un reto en electromedicina

RESUMEN En Cuba se fomenta el desarrollo de investigaciones en el campo de las ciencias médicas, con el fin de introducir sus resultados a favor del progreso económico y social. El objetivo de este trabajo fue reflexionar sobre el papel de la ciencia en la gestión de equipos médicos, su aplicación en los departamentos de electromedicina de las instituciones sanitarias, y su impacto social. Todo ello a partir de la presentación de los aspectos teóricos fundamentales de las relaciones entre ciencia, gestión de equipos médicos y función social de la electromedicina, a partir de su situación actual. La investigación científica en electromedicina, permitiría formular nuevas teorías o modificar las existentes e incrementar los conocimientos, lo que posibilitaría el enriquecimiento de las ciencias médicas. Resulta necesaria como proceso, a fin de obtener información relevante para la verificación, corrección y aplicación del conocimiento, en aras de solucionar los problemas de las tecnologías sanitarias y su impacto socioeconómico.

ABSTRACT In Cuba, the development of research in the field of the medical sciences is promoted in order to introduce its results to favor the social and economic progress. The aim of this work was to reflect on the role of science in the management of medical devices, its application in the electromedicine departments of health facilities, and its social impact, all this from the presentation of the main theoretical aspects of the relations between science, medical devices management and electromedicine social function in its current situation. Scientific research in electromedicine would allow to formulate new theories or to modify the existent ones and to increase knowledge, what would make possible the enrichment of the medical sciences. As a process, scientific research is necessary in order to obtain relevant information for the validation, correction and application of the knowledge, for the sake of solving the problems of health technologies and its socioeconomic impact.

Retrospective analysis of the clinical presentation and imaging of eight primary benign mediastinal schwannomas.

OBJECTIVE: Mediastinal schwannomas are sometimes confused with other neoplasms during initial radiological studies, especially when there is a history of cancer in another area. In these cases, a more accurate analysis using computed tomography (CT) or even magnetic resonance (MRI) is required. Our study aimed to perform a retrospective analysis of the clinical and imaging features for a series of patients with mediastinal schwannomas that were confirmed by histology and immunohistochemistry. RESULTS: We found eight patients, five men and three women, with an average age of 51 years for this study. The main signs and symptoms at diagnosis were chest pain, dyspnea, cough, and dysphagia. CT showed that the tumor was located in the posterior compartment of the chest in 7/8 cases. Tumors > 10 cm were more heterogeneous and showed cystic changes. All patients underwent posterolateral thoracotomy, and radiological follow-up showed no evidence of recurrence. Histological analysis was considered the gold standard to confirm diagnosis, along with at least one neurogenic IHC marker. In conclusion, mediastinal schwannomas are benign encapsulated tumors. According to CT, schwannomas > 10 cm show cystic degeneration more frequently. Posterolateral thoracotomy allows complete resection and is considered the surgical approach of choice.

Estrategia de superación para el mejoramiento del desempeño profesional de oftalmólogos de la Atención Primaria de Salud en Santiago de Cuba / Training strategy for improving the professional performance in primary health care ophthalmologists in Santiago de Cuba

El vertiginoso desarrollo científico - tecnológico de la oftalmología requiere de una actualización sistemática desde el punto de vista teórico - práctico. A tales efectos, se diseñó una estrategia de superación para el mejoramiento del desempeño profesional de los oftalmólogos de la Atención Primaria de Salud dirigida a la atención integral de los pacientes con oclusiones vasculares retinianas. Se emplearon métodos de los niveles teórico y empírico. Fue diseñada en 4 etapas y se utilizó el ciclo Deming como referente metodológico. Se establecieron relaciones esenciales que ofrecen coherencia lógica interna a la educación médica en su concepción como ciencia en construcción, en particular en el área de la formación permanente y continuada de los profesionales de la salud, al profundizar en el orden conceptual, metodológico y epistemológico en los procesos de desempeño profesional y superación.

The fast scientific and technological development of Ophthalmology requires a systematic updating from the theoretical and practical points of view. To such effects, a training strategy was designed for the improvement of professional performance of the primary care ophthalmologists directed to the comprehensive care of patients with retinal vascular occlusions. Empiric and theoretical level methods were used. The strategy was designed in 4 stages and the Deming cycle was implemented as methodological referent. Essential relationships were established which offer internal logical coherence to the Medical Education in its conception as science, particularly in the area of permanent and continued training of the health professionals, as there is a deepening in the conceptual, methodological and epistemological order in the processes of professional and training performance.

Evolución histórica del proceso de superación de los oftalmólogos en Cuba / Historical evolution of the ophthalmologists training process in Cuba

En Cuba, el proceso de superación en oftalmología comienza en el período colonial y republicano, con un carácter elitista, lo cual se modifica al triunfar la revolución. En esa época la actividad social más importante fue extender los servicios oftalmológicos hasta los lugares recónditos para facilitar la atención a la población. Considerando lo anterior se realizó el presente estudio con el objetivo de caracterizar las diferentes etapas del proceso de superación de los oftalmólogos cubanos. Se presentan algunos fundamentos teóricos que justifican la necesidad de la superación permanente y continuada de los oftalmólogos, tomando en cuenta sus peculiaridades formativas. Se concluye que en la oftalmología cubana la superación profesional constituye una vía importante para brindar servicios de excelencia en todos los niveles de atención de salud.

In Cuba, the training process in ophthalmology begins in the colonial and republican period, with an elitist character, that is modified after the triumph of the revolution. In that time the most important social activity was to extend the ophthalmological services up to the most isolated places to facilitate population care. Considering the above-mentioned the present study, aimed at characterizing the different stages of the Cuban ophthalmologists training process, was carried out. Some theoretical foundations that justify the necessity of the permanent and continuous training of the ophthalmologists are presented, taking into account their training peculiarities. It is concluded that in Cuban ophthalmology the professional training constitutes an important way to offer excellence services in all health care levels.

Morbilidad y mortalidad de pacientes de la cuarta edad en la unidad de cuidados intensivos / Morbidity and mortality of fourth age patietns at the intensive care unit

Introducción: El ingreso de pacientes de la cuarta edad en unidades de cuidados intensivos se incrementó en los últimos años. Objetivo: Determinar la morbilidad y mortalidad de pacientes de la cuarta edad en la unidad de cuidados intensivos. Métodos: Estudio descriptivo, retrospectivo. Serie constituida por 703 pacientes. Variables: edad, sexo, causas de ingreso, estadía, APACHE II, ventilación mecánica, estado al egreso y causa directa de muerte. Estadísticos: distribuciones de frecuencia absoluta y relativa, medidas de tendencia central, pruebas de Chi-cuadrado y t de Student. Nivel de significación 5 por ciento. esultados: La edad media fue de 84,2 ± 3,2 años. Predominaron el sexo femenino (57,7 por ciento) y el grupo de edad de 75 - 79 años (46,8 por ciento). La proporción del sexo femenino/masculino fue de 1,09:1,0. Más de la mitad de los pacientes egresaron fallecidos (60,7 por ciento). No hubo diferencias significativas entre las medias de la edad de los fallecidos y de los egresados vivos (80,7 vs 80,4 años). El ingreso clínico tuvo el mayor número de pacientes (69,7 por ciento). La media del valor de la escala APACHE II al ingreso fue de 20,1; en los fallecidos fue superior (23,0 vs 15,5). La estadía media fue de 5,7 días, más prolongada en los fallecidos (6,7 vs 4,3). El 61,5 por ciento de los pacientes recibieron ventilación mecánica. La principal causa directa de muerte fue la bronconeumonía bacteriana (36,9 por ciento). Conclusiones: Los pacientes de la cuarta edad tuvieron mortalidad elevada, asociada principalmente a la bronconeumonía bacteriana y un porcentaje alto requirió ventilación mecánica(AU)

Introduction: The admission of patients of fourth age in intensive care units has increased in the last years. Objectives: To determinate the mortality and morbidity of the patients of the fourth age. Methods: A retrospective and descriptive study. The series consisted of 703 patients. Variables: age, sex, cause of admitted, stay, APACHE II, mechanical ventilation, status of issue, direct cause of death. The statistical methods used were the absolute and relative frequency distributions, measures of central tendency, as well as the Chi-square and Student´s t tests. A significant level of 5 percent was considered. Results: The average age was 84.2 ± 3.2 years. Females (57. 7 percent) and the 75-79 years age group (46, 8 percent) predominated. The ratio of women/men was 1. 09/1. 0. Over half of the patients died on discharge (60. 7 percent). There were not significant differences between average ages of deceased and the living patients (80. 7 vs 80. 4 years). The clinical admission showed the highest number of patients (69. 7 percent). The mean of APACHE II was 20. 1, being higher in patients dead that in the ones alive (23. 0 vs 15. 5). The average stay was 5.7 days, longer in the deceased patients (6. 7 vs 4. 3). 71.5 percent of patients received mechanical ventilation. The main direct cause of death was bacterial bronchial pneumonia (36. 9 percent). Conclusions: the patient of fourth age admitted to the intensive care unit has higher mortality and high percentage require mechanical ventilationAU

Driver mutations of the adenoma-carcinoma sequence govern the intestinal epithelial global translational capacity.

Deregulated global mRNA translation is an emerging feature of cancer cells. Oncogenic transformation in colorectal cancer (CRC) is driven by mutations in APC, KRAS, SMAD4, and TP53, known as the adenoma-carcinoma sequence (ACS). Here we introduce each of these driver mutations into intestinal organoids to show that they are modulators of global translational capacity in intestinal epithelial cells. Increased global translation resulting from loss of Apc expression was potentiated by the presence of oncogenic KrasG12D Knockdown of Smad4 further enhanced global translation efficiency and was associated with a lower 4E-BP1-to-eIF4E ratio. Quadruple mutant cells with additional P53 loss displayed the highest global translational capacity, paralleled by high proliferation and growth rates, indicating that the proteome is heavily geared toward cell division. Transcriptional reprogramming facilitating global translation included elevated ribogenesis and activation of mTORC1 signaling. Accordingly, interfering with the mTORC1/4E-BP/eIF4E axis inhibited the growth potential endowed by accumulation of multiple drivers. In conclusion, the ACS is characterized by a strongly altered global translational landscape in epithelial cells, exposing a therapeutic potential for direct targeting of the translational apparatus.

La profesionalización en los docentes de Enfermería y Tecnología de la Salud / Professionalization in the Nursing and Health Technology teaching staff

La profesionalización en los docentes de las carreras de Enfermería y Tecnología de la Salud es el proceso de formación continua compuesto por las dimensiones docente, investigativa, asistencial, gerencial, bioética y de actuación profesional, que posibilitan la conjugación armónica entre el "saber", "saber hacer" y "saber ser". Dicha profesionalización constituye una herramienta que puede proveer un modo de hacer y un lenguaje común para el desarrollo de estos profesionales. Por ello, en el presente artículo se exponen algunos aspectos de interés sobre el tema y se ofrecen los principales resultados de una evaluación realizada a este proceso de formación.

The professionalization in the teaching staff of Nursing and Health Technology careers is the process of continuous training composed by the educational, investigative, assistance, management, bioethics and professional performance dimensions that facilitate the harmonic conjugation between "knowledge", "know how to do" and "know how to be". This professionalization constitutes a tool that can provide a way of making and a common language for the development of these professionals. That is the reason why, in this work some aspects of interest on the topic are exposed and the main results of an evaluation carried out to this training process are offered.

Recapitulating Suckling-to-Weaning Transition In Vitro using Fetal Intestinal Organoids.

At the end of the suckling period, many mammalian species undergo major changes in the intestinal epithelium that are associated with the capability to digest solid food. This process is termed suckling-to-weaning transition and results in the replacement of neonatal epithelium with adult epithelium which goes hand in hand with metabolic and morphological adjustments. These complex developmental changes are the result of a genetic program that is intrinsic to the intestinal epithelial cells but can, to some extent, be modulated by extrinsic factors. Prolonged culture of mouse primary intestinal epithelial cells from late fetal period, recapitulates suckling-to-weaning transition in vitro. Here, we describe a detailed protocol for mouse fetal intestinal organoid culture best suited to model this process in vitro. We describe several useful assays designed to monitor the change of intestinal functions associated with suckling-to-weaning transition over time. Additionally, we include an example of an extrinsic factor that is capable to affect suckling-to-weaning transition in vivo, as a representation of modulating the timing of suckling-to-weaning transition in vitro. This in vitro approach can be used to study molecular mechanisms of the suckling-to-weaning transition as well as modulators of this process. Importantly, with respect to animal ethics in research, replacing in vivo models by this in vitro model contributes to refinement of animal experiments and possibly to a reduction in the use of animals to study gut maturation processes.

Oxidative stress in testes of rats exposed to n-butylparaben.

This study was aimed at determining if oxidative stress imbalance in testes of rats occurs after n-butylparaben (n-ButP) exposure. Young male Sprague-Dawley rats were subcutaneously treated with n-ButP during one spermatogenic cycle (57 days) at 0 (control-oil), 150, 300 and 600 mg/kg/d with peanut oil as vehicle. A non-vehicle control group was also included. Antioxidant enzyme activities (superoxide dismutase, catalase, glutathione reductase, and glutathione peroxidase) and levels of reduced and oxidized glutathione were measured in testes. Lipid peroxidation and H2O2 concentrations were also assessed. Results showed an increase of oxidative stress in oil-treated groups, excepting 600 mg/kg/d, suggesting oxidative stress due to peanut oil. A possible antioxidant effect due to n-ButP and its metabolites was suggested at 600 mg/kg/d, the only group not showing oxidative stress. An increase of calcium concentration in testes was also observed. On the other hand, a physiologically-based pharmacokinetic (PBPK) model was developed and the concentrations of n-ButP and its metabolites were simulated in plasma and testes. The peak concentration (Cmax) in testes was found slightly higher than that in plasma. The current results indicate that peanut oil can cause oxidative stress while high doses of n-ButP can act as antioxidant agent in testes.

Mouse fetal intestinal organoids: new model to study epithelial maturation from suckling to weaning.

During the suckling-to-weaning transition, the intestinal epithelium matures, allowing digestion of solid food. Transplantation experiments with rodent fetal epithelium into subcutaneous tissue of adult animals suggest that this transition is intrinsically programmed and occurs in the absence of dietary or hormonal signals. Here, we show that organoids derived from mouse primary fetal intestinal epithelial cells express markers of late fetal and neonatal development. In a stable culture medium, these fetal epithelium-derived organoids lose all markers of neonatal epithelium and start expressing hallmarks of adult epithelium in a time frame that mirrors epithelial maturation in vivoIn vitro postnatal development of the fetal-derived organoids accelerates by dexamethasone, a drug used to accelerate intestinal maturation in vivo Together, our data show that organoids derived from fetal epithelium undergo suckling-to-weaning transition, that the speed of maturation can be modulated, and that fetal organoids can be used to model the molecular mechanisms of postnatal epithelial maturation.

Oral exposure to silver nanoparticles increases oxidative stress markers in the liver of male rats and deregulates the insulin signalling pathway and p53 and cleaved caspase 3 protein expression.

The present study was aimed at assessing the impact of AgNPs on the liver of male rats orally exposed to 0, 50, 100 and 200 mg/kg/day of polyvinyl pyrrolidone coated AgNPs (PVP-AgNPs) for 90 days. The induction of apoptotic cell death -by measuring the protein levels of the active form of caspase 3- and the levels of the microtubule-associated protein 1A/1B-light chain (LC3) protein were measured as a marker of the induction of autophagy. PVP-AgNPs caused an increase of the activity of superoxide dismutase (SOD) and catalase (CAT) in the liver of male rats. However, the activity decreased after exposure to high amounts of PVP-AgNPs. Increased protein levels of IRS-1, AKT, GSK3ß and mTOR proteins were observed in a dose-dependent manner. However, these proteins showed a decrease at 200 mg/kg/day. The same pattern was observed for the p53, p21 and cleaved caspase 3 protein levels. The current results suggest that the increase of ROS production by PVP-AgNPs stimulated SOD and CAT activity, as well as IRS-1, AKT, mTOR, p53, p21 and caspase 3 as protective mechanisms of cell survival and preserve DNA fidelity. However, cellular damage by excessive ROS production might induce the depletion of these survival mechanisms at 200 mg/kg/day.

Cutaneous and articular tuberculosis in a renal transplant recipient.

Seven months after undergoing kidney transplantation, a 56-year-old woman presented with papules and ulcers in her right forearm. The patient received antibiotics for 8 months with limited improvement. Eleven months after symptom onset, she presented with acute arthritis in her left knee. Asynovial fluid culture yielded Mycobacterium tuberculosis, and a forearm ulcer biopsy showed granulomatous inflammation. After surgical fistulectomy and 12 months of tuberculosis treatment, she was cured. Chronic cutaneous ulcers and articular manifestations in TB are rare, but they should always be considered in the differential diagnosis for immunosuppressed patients. Surgical intervention and prolonged treatment might be necessary.

Caracterización de pacientes con paludismo grave por Plasmodium falciparum en una unidad de cuidados intensivos / Characterization of patients with severe Plasmodium falciparum malaria in an intensive care unit

Introducción: el paludismo es la enfermedad parasitaria más importante del ser humano, causa anualmente entre uno y tres millones de muertes. Objetivos: caracterizar a los pacientes con paludismo grave por Plasmodium falciparum ingresados en una unidad de cuidados intensivos. Métodos: se realizó un estudio observacional, descriptivo en una Unidad de Cuidados Intensivos en Angola, de julio de 2014 hasta julio de 2016. La serie quedó constituida por 485 pacientes. Resultados: la serie representó el 99,6 por ciento de los ingresos. La edad media fue de 23,4 ± 11,2 años. Predominaron el sexo masculino (66,4 por ciento) y los grupos de edades de 30 años o menos (83,6 por ciento). La proporción del sexo masculino/femenino fue de 1,97:1. La mortalidad fue de 43,1 por ciento. El sexo femenino tuvo mayor proporción de fallecidos (61 por ciento). Fue más alto el por ciento de fallecidos en los que presentaron parasitemia >= 50000 x mm3. La media del valor del Acute Physiology, Age, Chronic Health Evaluation II fue de 14,8 ± 5,4; en los fallecidos fue superior que en los vivos (17,6 vs 12,3). Las complicaciones más frecuentes fueron de tipo neurológicas (90,1 por ciento), hematológicas (77 por ciento), respiratorias (61,8 por ciento), hepáticas (58,7 por ciento), y renales (40,3 por ciento). El 51,6 por ciento de los pacientes recibieron ventilación mecánica. Conclusiones: los jóvenes representaron la mayor parte de los ingresos por malaria en la unidad de cuidados intensivos, un porcentaje alto requirió ventilación mecánica, la mortalidad en las mujeres fue mayor y la global elevada(AU)

Introduction: Malaria is the most important parasitic disease of the human being, causes between one and three million deaths annually. Objectives: To characterize patients with severe malaria due to plasmodium falciparum admitted to an intensive care unit. Methods: An observational, descriptive study was carried out in an Intensive Care Unit in Luanda, from July 2014 to July 2016. The series consisted of 485 patients. Results: The series represented 99.6 percent of admissions. The mean age was 23.4 ± 11.2 years. The male sex predominated (66.4 percent) and the age groups were 30 years old or younger (83.6 percent). The male / female ratio was 1.97: 1. The mortality was 43.1 percent. The female sex had a higher proportion of deaths (61 percent). The percentage of deaths in those with blood parasites count >= 500003 x mm was higher. The mean value of Acute Physiology, Age, Chronic Health Evaluation II was 14.8 ± 5.4; in the deceased it was higher than in the living (17.6 vs. 12.3). The most frequent complications were neurological (90.1 percent), hematological (77 percent), respiratory (61.8 percent), hepatic (58.7 percent), and renal (40.3 percent). 51.6 percent of the patients received mechanical ventilation. Conclusions: Young people accounted for most of the admissions for malaria in the intensive care unit, a high percentage required mechanical ventilation, and mortality in women was higher and overall high(AU)

Cutaneous and articular tuberculosis in a renal transplant recipient

Abstract Seven months after undergoing kidney transplantation, a 56-year-old woman presented with papules and ulcers in her right forearm. The patient received antibiotics for 8 months with limited improvement. Eleven months after symptom onset, she presented with acute arthritis in her left knee. Asynovial fluid culture yielded Mycobacterium tuberculosis, and a forearm ulcer biopsy showed granulomatous inflammation. After surgical fistulectomy and 12 months of tuberculosis treatment, she was cured. Chronic cutaneous ulcers and articular manifestations in TB are rare, but they should always be considered in the differential diagnosis for immunosuppressed patients. Surgical intervention and prolonged treatment might be necessary.