Hemorrhagic Cholecystitis in a Patient Under Anticoagulant and Antiplatelet Therapy: A Case Report.

Hemorrhagic cholecystitis is an uncommon presentation of acute cholecystitis. Due to its etiology and unspecific clinical data, it is an entity that represents a diagnostic challenge. We present a case of a 70-year-old male with diabetes type 2, hypertension, and chronic kidney disease with hemodialysis, who attended the emergency department with sudden-onset abdominal pain in the epigastrium. The patient presented no additional symptoms, a normal electrocardiogram, but due to the characteristics of the pain and elevated troponin I, emergency medicine specialists considered an acute coronary syndrome and initiated antiplatelet and anticoagulant therapy. Due to persistent abdominal pain, a decrease in hemoglobin, and the onset of arterial hypotension, a computed tomography (CT) scan was performed, which revealed perforation of the gallbladder, apparent hemorrhagic cholecystitis, and hemoperitoneum. The patient underwent emergent surgery, where CT findings were confirmed. In our case, the suspicion of hemorrhagic cholecystitis arose until the clinical case was advanced, after receiving anticoagulant and antiplatelet therapy, and it was confirmed during surgery and with histopathology. This concludes that hemorrhagic cholecystitis is a rare disease and difficult to diagnose. Therefore, studies should focus on clinical presentation and risk factors (e.g., trauma, malignancy, renal failure, cirrhosis, and anticoagulation therapy) to promote early diagnosis and avoid complications.

In vivo screening for toxicity-modulating drug interactions identifies antagonism that protects against ototoxicity in zebrafish.

Introduction: Ototoxicity is a debilitating side effect of over 150 medications with diverse mechanisms of action, many of which could be taken concurrently to treat multiple conditions. Approaches for preclinical evaluation of drug-drug interactions that might impact ototoxicity would facilitate design of safer multi-drug regimens and mitigate unsafe polypharmacy by flagging combinations that potentially cause adverse interactions for monitoring. They may also identify protective agents that antagonize ototoxic injury. Methods: To address this need, we have developed a novel workflow that we call Parallelized Evaluation of Protection and Injury for Toxicity Assessment (PEPITA), which empowers high-throughput, semi-automated quantification of ototoxicity and otoprotection in zebrafish larvae via microscopy. We used PEPITA and confocal microscopy to characterize in vivo the consequences of drug-drug interactions on ototoxic drug uptake and cellular damage of zebrafish lateral line hair cells. Results and discussion: By applying PEPITA to measure ototoxic drug interaction outcomes, we discovered antagonistic interactions between macrolide and aminoglycoside antibiotics that confer protection against aminoglycoside-induced damage to lateral line hair cells in zebrafish larvae. Co-administration of either azithromycin or erythromycin in zebrafish protected against damage from a broad panel of aminoglycosides, at least in part via inhibiting drug uptake into hair cells via a mechanism independent from hair cell mechanotransduction. Conversely, combining macrolides with aminoglycosides in bacterial inhibition assays does not show antagonism of antimicrobial efficacy. The proof-of-concept otoprotective antagonism suggests that combinatorial interventions can potentially be developed to protect against other forms of toxicity without hindering on-target drug efficacy.

Identification of the native Torpedo californica nicotinic acetylcholine receptor's glycan composition after a multi-step sequential purification method using MALDI-ToF MS.

The Cys-loop pentameric ligand-gated ion channels comprise a dynamic group of proteins that have been extensively studied for decades, yielding a wealth of findings at both the structural and functional levels. The nicotinic acetylcholine receptor (nAChR) is no exception, as it is part of this large protein family involved in proper organismal function. Our efforts have successfully produced a highly pure nAChR in detergent complex (nAChR-DC), enabling more robust studies to be conducted on it, including beginning to experiment with high-throughput crystallization. Our homogeneous product has been identified and extensively characterized with 100% identity using Nano Lc MS/MS and MALDI ToF/ToF for each nAChR subunit. Additionally, the N-linked glycans in the Torpedo californica-nAChR (Tc-nAChR) subunits have been identified. To study this, the Tc-nAChR subunits were digested with PNGase F and the released glycans were analyzed by MALDI-ToF. The MS results showed the presence of high-mannose N-glycan in all native Tc-nAChR subunits. Specifically, the oligommanose population Man8-9GlcNac2 with peaks at m/z 1742 and 1904 ([M + Na]+ ions) were observed.

In vivo screening for toxicity-modulating drug interactions identifies antagonism that protects against ototoxicity in zebrafish.

Ototoxicity is a debilitating side effect of over 150 medications with diverse mechanisms of action, many of which could be taken concurrently to treat multiple conditions. Approaches for preclinical evaluation of drug interactions that might impact ototoxicity would facilitate design of safer multi-drug regimens and mitigate unsafe polypharmacy by flagging combinations that potentially cause adverse interactions for monitoring. They may also identify protective agents that antagonize ototoxic injury. To address this need, we have developed a novel workflow that we call Parallelized Evaluation of Protection and Injury for Toxicity Assessment (PEPITA), which empowers high-throughput, semi-automated quantification of ototoxicity and otoprotection in zebrafish larvae. By applying PEPITA to characterize ototoxic drug interaction outcomes, we have discovered antagonistic interactions between macrolide and aminoglycoside antibiotics that confer protection against aminoglycoside-induced damage to lateral line hair cells in zebrafish larvae. Co-administration of either azithromycin or erythromycin in zebrafish protected against damage from a broad panel of aminoglycosides, at least in part via inhibiting drug uptake into hair cells via a mechanism independent from hair cell mechanotransduction. Conversely, combining macrolides with aminoglycosides in bacterial inhibition assays does not show antagonism of antimicrobial efficacy. The proof-of-concept otoprotective antagonism suggests that combinatorial interventions can potentially be developed to protect against other forms of toxicity without hindering on-target drug efficacy.

Seroprevalence and clinical characteristics of SARS-CoV-2 infection in children with cystic fibrosis.

BACKGROUND: People with cystic fibrosis (PwCF) have chronic lung disease and may be at increased risk of coronavirus disease 2019 (COVID-19)-related morbidity and mortality. This study aimed to determine seroprevalence and clinical characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with cystic fibrosis (CF), and to assess antibody responses following SARS-CoV-2 infection or vaccination. METHODS: Children and adolescents with CF followed at Seattle Children's Hospital were enrolled between July 20, 2020 and February 28, 2021. SARS-CoV-2 serostatus was determined on enrollment at 6 and 11 months (±2 months) for nucleocapsid and spike IgG. Participants completed intake and weekly surveys inquiring about SARS-CoV-2 exposures, viral/respiratory illnesses, and symptoms. RESULTS: Of 125 PwCF enrolled, 14 (11%) had positive SARS-CoV-2 antibodies consistent with recent or past infection. Seropositive participants were more likely to identify as Hispanic (29% vs. 8%, p = 0.04) and have pulmonary exacerbations requiring oral antibiotics in the year prior (71% vs. 41%, p = 0.04). Five seropositive individuals (35.7%) were asymptomatic, while six (42.9%) reported mild symptoms, primarily cough and nasal congestion. Antispike protein IgG levels were approximately 10-fold higher in participants following vaccination compared with participants who had natural infection alone (p < 0.0001) and resembled levels previously reported in the general population. CONCLUSIONS: A majority of PwCF have mild or no symptoms of SARS-CoV-2 making it difficult to distinguish from baseline respiratory symptoms. Hispanic PwCF may be disproportionately impacted, consistent with racial and ethnic COVID-19 disparities among the general US population. Vaccination in PwCF generated antibody responses similar to those previously reported in the general population.

Juan Nicolás Dávalos y Betancourt, eminente bacteriólogo cubano

Entre las figuras cimeras de la microbiología en Cuba, se encuentra el Dr. Juan Nicolás Dávalos y Betancourt, conocido en su época como "el sabio que sueña con las bacterias", quien fue el primer médico cubano, dedicado a tiempo completo a la práctica de esta ciencia, en específico a la bacteriología. A pesar de esto, su vida y su obra no están suficientemente difundidas, por lo que este trabajo tiene como objetivo dar a conocer su legado, en un contexto histórico, social y científico, para que se conocido y valorado por las actuales y futuras generaciones de microbiólogos cubanos. Se realizó una investigación biográfica y se adicionan testimonios gráficos. La figura del Dr. Juan Nicolás Dávalos es destacada, no solo para la microbiología, como también para la ciencia en Cuba.

Among the leading figures of microbiology in Cuba, is Dr. Juan Nicolás Dávalos y Betancourt, known in his time as "the wise man who dreams of bacteria", who was the first Cuban doctor dedicated full-time to the practice of this science, specifically bacteriology. Despite this, his life and his work are not sufficiently disseminated, so this work aims to make his legacy known, in a historical, social and scientific context, so that it is known and valued by current and future generations. of Cuban microbiologists. A biographical investigation was carried out and graphic testimonies are added. Dr. Juan Nicolás Dávalos is outstanding, not only for microbiology, but also for science in Cuba.

Important advances in regenerative medicine. A vision to the future of ophthalmology / Avances importantes en medicina regenerativa. Una visión al futuro de la oftalmología

The treatment of corneal lesions continues to be a topic of great interest. However, despite the development of new technologies and due to the slow evolution and uncertain healing of corneal lesions, they still represent a public health problem since patients can be affected for life, affecting the family and the health system due to the costly and uncertain response to treatment. For this reason, the need arises to seek therapeutic alternatives to treat these patients.

El tratamiento de lesiones corneales sigue siendo un tema de gran interés. Pese al desarrollo de nuevas tecnologías y debido a la evolución lenta, e incierta cicatrización que tienen las lesiones corneales, estas todavía representan un problema de salud pública, ya que los pacientes pueden verse afectados de por vida afectando a la familia y al sistema de salud por lo costoso e incierta respuesta al tratamiento. Por esta razón, surge la necesidad de buscar alternativas terapéuticas para tratar a estos pacientes.

Impairment in inflammasome signaling by the chronic Pseudomonas aeruginosa isolates from cystic fibrosis patients results in an increase in inflammatory response.

Pseudomonas aeruginosa is a common respiratory pathogen in cystic fibrosis (CF) patients which undergoes adaptations during chronic infection towards reduced virulence, which can facilitate bacterial evasion of killing by host cells. However, inflammatory cytokines are often found to be elevated in CF patients, and it is unknown how chronic P. aeruginosa infection can be paradoxically associated with both diminished virulence in vitro and increased inflammation and disease progression. Thus, we investigated the relationship between the stimulation of inflammatory cell death pathways by CF P. aeruginosa respiratory isolates and the expression of key inflammatory cytokines. We show that early respiratory isolates of P. aeruginosa from CF patients potently induce inflammasome signaling, cell death, and expression of IL-1ß by macrophages, yet little expression of other inflammatory cytokines (TNF, IL-6 and IL-8). In contrast, chronic P. aeruginosa isolates induce relatively poor macrophage inflammasome signaling, cell death, and IL-1ß expression but paradoxically excessive production of TNF, IL-6 and IL-8 compared to early P. aeruginosa isolates. Using various mutants of P. aeruginosa, we show that the premature cell death of macrophages caused by virulent bacteria compromises their ability to express cytokines. Contrary to the belief that chronic P. aeruginosa isolates are less pathogenic, we reveal that infections with chronic P. aeruginosa isolates result in increased cytokine induction due to their failure to induce immune cell death, which results in a relatively intense inflammation compared with early isolates.

May Measurement Month 2019: an analysis of blood pressure screening results from Venezuela, Latin America.

Cardiovascular diseases are the main cause of death in Venezuela. Raised blood pressure (BP) accompanied by diabetes mellitus, obesity, lipid abnormalities, and tobacco usage are the biggest contributors to mortality. The May Measurement Month (MMM) campaign is a global initiative aimed to raising awareness of hypertension, which has been conducted in Venezuela since 2017. MMM2019 included 24 672 subjects (mean age: 54.7 years, SD 25.2, 63.1% female). The proportion with hypertension was 48.9%; 14.3% were unknown hypertensives, 35.5% of those who receiving treatment had uncontrolled hypertension (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg); when considering all hypertensives, 53.3% were controlled. Sixty per cent of those on anti-hypertensive medication were on monotherapy, 27.7% were on two, and 7.7% were on three or more drugs. Body mass index, calculated for the total population, was on average 25.6 (SD: 4.8) kg/m2. 16.2% of participants were classified as obese, 34.0% as overweight, and 4.0% were classified as underweight. Diabetes mellitus was reported by 9.4%, smoking by 7.3%, and 10.5% reported drinking alcohol regularly. Conditions associated with higher BP levels were obesity, diabetes mellitus, and women with a history of hypertension during a previous pregnancy. These results are consistent with the two previous MMM campaigns and indicate that repeated screening can routinely identify hypertension. There is an urgent need for Venezuela to implement programmes of detection, treatment, and control not only for hypertension but also for other common cardiovascular risk factors.

Severe COVID-19 initially presenting as mesenteric adenopathy.

Coronavirus disease 2019 (COVID-19) can present with abdominal pain in children and adults. Most imaging findings have been limited to characteristic lung findings, as well as one report of bowel-ischemia-related findings in adults. We report a case of COVID-19 in a healthy teenager who initially presented with isolated mesenteric adenopathy, typically a self-limited illness, which progressed to severe illness requiring intensive care before complete recovery. The boy tested negative for COVID-19 twice by polymerase chain reaction (PCR) from upper respiratory swabs before sputum PCR resulted positive. A high index of suspicion should be maintained for COVID-19 given the continued emergence of new manifestations of the disease.

Algunas consideraciones sobre la escritura de artículos científicos / Some considerations on the writing of scientific papers

En estos meses de pandemia por la COVID-19, provocada por la diseminación del nuevo coronavirus SARS-CoV-2, he tenido la oportunidad y el placer de revisar artículos enviados para su posible publicación en la Revista Cubana de Medicina Militar. Esta revista, gana cada vez más espacio entre los autores nacionales y también de otras latitudes, sobre todo de países latinoamericanos. El espectro de temas tratados, también se ha ampliado significativamente, de manera que en cada número, el lector puede actualizarse en diferentes materias. Renglón aparte merecen los cada vez más frecuentes trabajos realizados sobre la COVID-19 y las inestimables experiencias acumuladas por el personal médico, incluido el de las Fuerzas Armadas Revolucionarias, que deben servir de guía práctica para el enfrentamiento a esta enfermedad. Después de haber revisado más de un centenar de artículos, me he percatado, que a pesar de que la revista orienta una serie de instrucciones que los autores deben cumplir, una buena parte de los trabajos, presentan importantes deficiencias formales, aunque desde el punto de vista científico pudieran resultar valiosos. A mi modo de ver, parece haber dos factores causantes: premura por realizar el envío por parte del autor, que hace obviar detalles importantes, y falta de enmienda oportuna, que evite errores. Un trabajo científico, debe tener dos atributos: valor científico y un texto, escrito de forma tal que sea capaz de llevar al lector a reconocerlo como tal. La redacción del texto es un elemento vital. Esta no incluye solo elementos tan primarios como la ortografía y los signos de puntuación. Tiene que exponer las ideas de forma que se entiendan, con un lenguaje científico, no coloquial como a veces ocurre. El autor no escribe "para él", sino para la comunidad científica, destinataria de su artículo. La revista, en su página web, instruye a los autores en la confección del trabajo, pero hay detalles que a veces pasan por alto y que el revisor señala. Patología no es lo mismo que enfermedad, severo no es igual que grave, ni injuria es herida o daño a un tejido. Se exponen unas pautas que pudieran ser de ayuda a los autores, a la hora de escribir el fruto de su investigación. Título: conciso, no sobrepasar aproximadamente 15 palabras. No poner punto final a ningún título o subtítulo. Resumen: estructurar de acuerdo con el tipo de artículo. Los objetivos tienen que quedar bien definidos, evitar el uso de siglas o acrónimos y no puede exceder de 250 palabras. Palabras clave: como mínimo tres términos o frases, separados mediante punto y coma. Es importante considerar que esta será una de las formas para indexar y localizar al artículo, lo cual contribuye a su visibilidad. La introducción tiene que situar al lector en los elementos que sirven de génesis a la investigación. Los métodos, entre otras cosas, deben definir qué tipo de investigación es. Los resultados, si se expresan mediante tablas (no cuadros) y figuras (no gráficos) deben estar numerados y titulados. El título de la tabla debe estar sobre esta, mientras que el de la figura debe ir al pie, o sea, debajo. En las tablas no usar las abreviaturas No, no. como número, que crean confusión, poner n. La discusión no puede ser una repetición de los resultados. Las conclusiones tienen que responder el objetivo planteado. También es importante la extensión del artículo, la cual está limitada por las normas editoriales según el tipo de artículo (incluye todo el contenido). Ejemplos: presentaciones de casos, 2000 palabras; artículos de investigación, 4500; revisiones bibliográficas, 6000. Se recomienda que los nombres de autores que se mencionan en el texto, se escriban en letra cursiva, al igual que los textos en otro idioma. De igual modo, los microorganismos, cuya nomenclatura es binomial: género (mayúscula) y especie (minúscula); ejemplo: Escherichia coli. Las acotaciones (citas) se colocarán en números arábigos, en superíndice, entre paréntesis y después del signo de puntuación, sin espacio desde el carácter precedente: Ejemplo:(1) Cuando son varias citas consecutivas, se escriben todas (ejemplo:(1,2,3,4)), separadas por comas. No deben ser más de 5 - 6 referencias por acotación, por lo cual deben seleccionarse las fundamentales. Se recomienda usar coma para los números decimales en el texto en español (23,6), dejar siempre un espacio entre el número y el signo que le sucede. (17 por ciento). Debe usarse correctamente el gerundio. Otra de las grandes dificultades de los autores es con la forma de presentar las referencias bibliográficas. Se deben seguir las instrucciones que da la revista para este acápite, que están en consonancia con lo establecido por el Comité Internacional de Editores de Revistas Médicas, las llamadas normas de Vancouver. Las citas se enumeran en orden consecutivo según el orden de citación en el desarrollo de todo el trabajo. En el listado no se usan viñetas, serán enumeradas manualmente. No se puede utilizar la opción de "lista numérica" automática del editor de texto. En la era digital, se deben proporcionar las direcciones URL para las referencias, siempre que sea posible, lo cual aparece como requisito en la lista de chequeo que debe marcar el autor que realiza el envío. Ejemplo: 16. Hanley B, Lucas SB, Youd E, Swift B, Osborn M. Autopsy in suspected COVID-19 cases. J Clin Pathol. 2020 (acceso: 15/06/2020(; 73(5):239-42. Disponible en: https://jcp.bmj.com/content/73/5/239.full Por último, se considera útil recordar a los autores que escriben artículos sobre la pandemia, que el nombre correcto del agente etiológico, el nuevo coronavirus, es el SARS-CoV-2 y la enfermedad que provoca es la COVID-19 (en femenino). La prueba diagnóstica, conocida como RT-PCR, en inglés significa reverse transcriptase-polimerase chain reaction (reacción en cadena de la polimerasa- transcriptasa inversa). Sin entrar en disquisiciones técnicas, lo común es que RT se traduzca por "real time" (en tiempo real), aunque hay criterios de que ambos términos no son lo mismo. Lo importante es que cuando se hable de la prueba, se escoja uno de los dos, porque ambos no deben ponerse a la vez. Espero que estas consideraciones sean de alguna utilidad y ayuden a que los artículos publicados gocen de la calidad que demanda y tiene la revista(AU)

Physical and Chemical Properties Characterization of 3D-Printed Substrates Loaded with Copper-Nickel Nanowires.

This study deals with the laser stereolithography manufacturing feasibility of copper-nickel nanowire-loaded photosensitive resins. The addition of nanowires resulted in a novel resin suitable for additive manufacturing technologies based on layer-by-layer photopolymerization. The pure and nanowire-loaded resin samples were 3D printed in a similar way. Their morphological, mechanical, thermal, and chemical properties were characterized. X-ray computed tomography revealed that 0.06 vol % of the composite resin was filled with nanowires forming randomly distributed aggregates. The increase of 57% in the storage modulus and 50% in the hardness when loading the resin with nanowire was attributed to the load transfer. Moreover, the decrease in the glass transition temperature from 57.9 °C to 52.8 °C in the polymeric matrix with nanowires evidenced a decrease in the cross-linking density, leading to a higher mobility of the polymer chains during glass transition. Consequently, this research demonstrates the successful dispersion and use of copper-nickel nanowires as a reinforcement material in a commercial resin for laser stereolithography.

Carbapenems drive the collateral resistance to ceftaroline in cystic fibrosis patients with MRSA.

Chronic airways infection with methicillin-resistant Staphylococcus aureus (MRSA) is associated with worse respiratory disease cystic fibrosis (CF) patients. Ceftaroline is a cephalosporin that inhibits the penicillin-binding protein (PBP2a) uniquely produced by MRSA. We analyzed 335 S. aureus isolates from CF sputum samples collected at three US centers between 2015-2018. Molecular relationships demonstrated that high-level resistance of preceding isolates to carbapenems were associated with subsequent isolation of ceftaroline resistant CF MRSA. In vitro evolution experiments showed that pre-exposure of CF MRSA to meropenem with further selection with ceftaroline implied mutations in mecA and additional mutations in pbp1 and pbp2, targets of carbapenems; no effects were achieved by other ß-lactams. An in vivo pneumonia mouse model showed the potential therapeutic efficacy of ceftaroline/meropenem combination against ceftaroline-resistant CF MRSA infections. Thus, the present findings highlight risk factors and potential therapeutic strategies offering an opportunity to both prevent and address antibiotic resistance in this patient population.

Antimicrobial Polymer-Peptide Conjugates Based on Maximin H5 and PEG to Prevent Biofouling of E. coli and P. aeruginosa.

Many pathogens, such as Pseudomonas aeruginosa and Escherichia coli bacteria can easily attach to surfaces and form stable biofilms. The formation of such biofilms in surfaces presents a problem in environmental, biomedical, and industrial processes, among many others. Aiming to provide a plausible solution to this issue, the anionic and hydrophobic peptide Maximin H5 C-terminally deaminated isoform (MH5C) has been modified with a cysteine in the C-terminal (MH5C-Cys) and coupled to polyethylene glycol (PEG) polymers of varying sizes (i.e., 2 kDa and 5 kDa) to serve as a surface protective coating. Briefly, the MH5C-Cys was bioconjugated to PEG and purified by size exclusion chromatography while the reaction was confirmed via SDS-PAGE and MALDI ToF. Moreover, the preventive antimicrobial activity of the MH5C-Cys-PEG conjugates was performed via the growth curves method, showing inhibition of bacterial growth after 24 h. The efficacy of these peptide-polymer conjugates was extensively characterized via scanning electron microscopy (SEM), minimum inhibition concentration (MIC), minimum biofilm inhibition concentration (MBIC), and minimum biofilm eradication concentration (MBEC) assays to evaluate their ability to eradicate and prevent the biofilms. Interestingly, this work demonstrated a critical PEG polymer weight of 5 kDa as ideal when coupled to the peptide to achieve inhibition and eradication of the biofilm formation in both bacteria strains. According to the MICs (40 µM) and MBICs (300 µM), we can conclude that this conjugate (MH5C-Cys-5 kDa) has an action that prevents/inhibits the formation of biofilms and the eradication of biofilms (MBEC 500 µM). In contrast, the MH5C-Cys peptide with PEG polymer of 2 kDa did not show inhibition or eradication of the biofilms.

A Rare Case of Uterine Leiomyosarcoma with Metastasis to the Thyroid Gland.

Uterine leiomyosarcomas are aggressive tumors associated with a poor prognosis. These neoplasms have high metastatic potential, more frequently affecting the lungs, liver, and peritoneum. There are very few cases of metastasis to the thyroid described in the literature. We present the case of a 47-year-old female diagnosed with uterine leiomyosarcoma metastatic to the thyroid gland. In this case report, we want to emphasize the utility of ancillary studies to help differentiate a leiomyosarcoma from anaplastic thyroid carcinoma since cytologic evaluation alone can be challenging.

May measurement month 2017: Latin America.

OBJECTIVES: To raise awareness of blood pressure, measured by number of countries involved, number of people screened, and number of people who have untreated or inadequately treated hypertension. METHODS: An opportunistic cross-sectional survey of volunteers aged at least 18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard May measurement month protocol. Eighteen countries in Latin America and the Caribbean participated in the campaign, providing us with a wide sample for characterization. RESULTS: During May measurement month 2017 in Latin America and the Caribbean, 105 246 individuals were screened. Participants who had cardiovascular disease, 2245 (2.3%) had a prior myocardial infarction, and 1711 (1.6%) a previous stroke, additionally 6760 (6.4%) individuals were diabetic, 7014 (6.7%) current smokers and 9262 (8.8%) reported alcohol intake once or more per week. Mean SBP was 122.7 mmHg and DBP was 75.6 mmHg. After imputation, 42 328 participants (40,4%) were found to be hypertensive. CONCLUSION: The high numbers of participants detected with hypertension and the relatively large proportion of participants on antihypertensive treatment but with uncontrolled hypertension reinforces the importance of this annual event in our continent, to raise awareness of the prevention of cardiovascular events.

Análisis regional de zonas homogéneas de precipitación en Carabobo, Venezuela / Regional analysis of homogeneous precipitation areas in Carabobo, Venezuela / Análise regional de áreas de precipitação homogênea em Carabobo, Venezuela

Resumen Introducción. La utilidad primordial de los datos sobre el clima para planificar el desarrollo sostenible en áreas agrícolas y hacer frente a todas las consecuencias del cambio climático ya ha quedado firmemente establecida en diferentes programas y políticas a nivel mundial. Objetivo. Analizar la variabilidad espacio temporal de la precipitación e identificar las zonas homogéneas a partir de datos mensuales y anuales (1969-1999) provenientes de las estaciones climatológicas en Carabobo, Venezuela. Materiales y métodos. Para definir subgrupos de estaciones pluviométricas que caractericen zonas homogéneas se aplicaron técnicas multivariadas (análisis de componentes principales y análisis de conglomerados) basadas en la similitud del comportamiento de las series de datos de lluvia anual precipitada. Finalmente se elaboró el mapa de distribución espacial de la precipitación mediante la interpolación kriging. Resultados. Se lograron identificar cuatro grupos de estaciones con comportamiento similar en lo que se refiere a los procesos pluviométricos. Esta investigación permitió conocer el comportamiento espacial y temporal de la precipitación, caracterizada por la marcada estacionalidad producto de la influencia directa de la Zona de Convergencia Intertropical. La tendencia mostró un patrón de distribución espacial con una gradación que va de menor a mayor en sentido noreste a sureste. Conclusiones. Este estudio permitió estimar la regularidad espacial del comportamiento de la lluvia y del grado de heterogeneidad de este elemento climático año tras año, que a su vez representa el inicio de la planificación estratégica a nivel regional.

Abstract Introduction: The primary utility of climate data for planning sustainable development in agricultural areas and addressing all the consequences of climate change has already been firmly established in different programs and policies worldwide. Objective: Analyze the temporal space variability of precipitation and identify homogeneous areas based on monthly and annual data from weather stations in Carabobo, Venezuela, during the period 1969-1999. Materials and methods: To define subgroups of rainfall stations that characterize homogeneous zones, multivariate techniques (principal component analysis and cluster analysis) were applied based on the similarity of the behavior of the data series of precipitated annual rainfall. Finally, the spatial distribution map of the precipitation was prepared by means of kriging interpolation. Results: It was possible to identify four groups of stations with similar behavior in terms of rainfall processes. This investigation allowed to know the spatial and temporal behavior of precipitation, characterized by the marked seasonality resulting from the direct influence of the Intertropical Convergence Zone. The trend showed a pattern of spatial distribution with a gradation that goes from minor to major in the northeast to southeast direction. Conclusion: In addition, this study allowed estimating the spatial regularity of rainfall behavior and the degree of heterogeneity of this climatic element year after year, which in turn represents the beginning of strategic planning at the regional level.

Resumo Introdução. A utilidade primordial dos dados climáticos para planejar o desenvolvimento sustentável em áreas agrícolas e abordar todas as consequências da alteração climática já ficou firmemente estabelecida nos diferentes programas e políticas ao nível mundial. Objetivo. Analisar a variabilidade do espaço temporal da precipitação e identificar as zonas homogêneas a partir de dados mensais e anais (1969-1999) provenientes das estações climatológicas em Carabobo, Venezuela. Materiais e métodos. Para definir subgrupos de estações pluviométricas que posam caracterizar as zonas homogêneas aplicaram-se técnicas multivariadas (análise de componentes principais e análise de conglomerados) baseadas na similitude do comportamento das series de dados de chuva anual precipitada. Finalmente elaborou-se o mapa de distribuição espacial da precipitação mediante a interpolação kriging. Resultados. Conseguiu-se identificar quatro grupos de estações com comportamento similar no que se refere aos processos pluviométricos. Esta pesquisa permitiu conhecer o comportamento espacial e temporal da precipitação, caracterizada pela marcada sazonalidade, produto da influência direta da Zona de Convergência Intertropical. A tendência mostrou um padrão de distribuição espacial com uma gradação que vai de menor à maior no sentido nordeste à sudeste. Conclusões. Este estudo permitiu estimar a regularidade espacial do comportamento da chuva e do grau da heterogeneidade deste elemento climático ano após ano, que ao mesmo tempo representa o início do planejamento estratégico ao nível regional.

Material de apoyo para la docencia "Cuidados postoperatorios cardiovasculares en adultos y niños" / Teaching aid for teaching "Cardiovascular postoperative cares in adults and children"

RESUMEN Fundamento: el desarrollo vertiginoso de la ciencia y la técnica incorpora constantemente nuevos adelantos al quehacer diario del ejercicio médico, lo cual reclama una continua capacitación. Esta necesidad se acentúa cuando se trata de la atención a pacientes graves en el contexto del postoperatorio de cirugía cardiovascular, donde la mayoría son atendidos en unidades de terapia intensiva. Objetivos: diseñar un material docente de apoyo bibliográfico para los temas incluidos en el Módulo 25: Cuidados postoperatorios cardiovasculares en el adulto y el niño, del programa de estudio de tercer año de la residencia de Cardiología. Métodos: se realizó una investigación de desarrollo en el Cardiocentro "Ernesto Che Guevara", de Villa Clara, durante diciembre 2017-mayo 2018. Se emplearon métodos teóricos: análisis-síntesis, inducción-deducción y sistémico-estructural; empíricos: análisis documental y cuestionario a docentes médicos especialistas; y matemáticos estadísticos para los valores absolutos y relativos. Resultados: la literatura sobre los temas del módulo se encuentra dispersa, es extensa y posee acceso parcialmente limitado, el cuestionario de satisfacción sobre el material diseñado, obtuvo en todas las variables analizadas la categoría 4, lo que avala su actualización, pertinencia, integración, estructura y organización de los contenidos. Conclusiones: el material de apoyo resultó adecuado, con buena aceptación, y se tuvieron en cuenta las recomendaciones emitidas por los especialistas en su elaboración final.

ABSTRACT Background: the vertiginous development of science and technology constantly incorporates new advances to the daily task of medical practice, which calls for continuous training. This need is accentuated when dealing with the care of serious patients in the context of postoperative cardiovascular surgery, where the most of them are treated in intensive care units. Objectives: to design a teaching aid for bibliographic support for the subjects included in Module 25: Cardiovascular post-operative care in adults and children, of the third year study program of the cardiology residency. Methods: a development research was carried out in the "Ernesto Che Guevara" Cardiologic center, in Villa Clara, from December 2017 to 2018. Theoretical methods were used: analysis-synthesis, induction-deduction and systemic-structural; empirical ones: documentary analysis and questionnaire to specialized medical teachers; and statistical mathematics for absolute and relative values. Results: the literature on the subjects of the module is scattered, it is extensive and has partially limited access, the satisfaction questionnaire on the teaching aid designed, obtained in the entire variables analyzed category 4, which supports its updating, relevance, integration, structure and organization of the contents. Conclusions: the teaching aid was adequate, with good acceptance, and the recommendations issued by the specialists in its final elaboration were taken into account.

En el 65 aniversario de la graduación como médico de Ernesto Che Guevara (1953-2018) / On the 65th anniversary of graduation as doctor of Ernesto Che Guevara (1953-2018)

En su corta pero intensa existencia, el Che acumuló las más variadas experiencias personales y en todas ellas dejó su impronta, lo cual ha sido extensamente tratado. Sin embargo, de su accionar en el campo de la medicina no todo es muy conocido. El objetivo de este trabajo es reseñar, de forma sucinta, los aspectos más significativos relacionados con el quehacer del comandante Ernesto Che Guevara como profesional de la salud, en el aniversario 65 de su graduación como médico. De la reseña de los hechos expuestos, se puede concluir que aun cuando los avatares en su breve pero fructífera vida no le permitieron desarrollar su profesión tal y como hubiera querido, su ejemplo constituye el paradigma de médico revolucionario, comprometido con las causas más justas de la humanidad y la salud de los más desfavorecidos(AU)

In his short but intense existence, Che accumulated the most varied personal experiences and in all of them he left his imprint, which has been extensively treated. However, his actions in the field of medicine are not all well known. The objective of this work is to outline, in a succinct way, the most significant aspects related to the work of the commander Ernesto Che Guevara as a health professional, on the 65th anniversary of his graduation as a doctor. From the review of the facts exposed, it can be concluded that Che, even though the avatars in his brief but fruitful life did not allow him to develop his profession as he would have liked, his example constitutes the paradigm of a revolutionary doctor, committed to the causes fairer of humanity and the health of the most disadvantaged(AU)