Pertinencia de la superación posgraduada en correspondencia con los problemas de salud en Villa Clara / Relevance of postgraduate improvement in correspondence with health problems in Villa Clara

Fundamento: en la Universidad de Ciencias Médicas de Villa Clara se ha diseñado e implementado una estrategia metodológica para lograr mayor relación de la superación profesional con el cuadro de salud. Objetivo: exponer los resultados de la superación profesional en correspondencia con los principales problemas de salud en Villa Clara. Métodos: se realizó un estudio descriptivo con diseño transversal de la superación profesional vinculada al posgrado en el periodo 2017-2021. Se aplicaron métodos teóricos, empíricos y matemático-estadísticos; la información obtenida se presentó en tablas con valores absolutos y relativos. Resultados: del total de actividades planificadas, el 83,01 % respondieron a los problemas de salud de la provincia. Relacionado con las enfermedades crónicas no transmisibles se efectuaron 542; tumores malignos, 179; Programa de Atención Materno Infantil, 1762; y Programa de Atención al Adulto Mayor, 198. Sobre otras enfermedades transmisibles, su mayor número estuvo en el 2019. En el 2020 predominaron las vinculadas a las arbovirosis y la pandemia de la COVID-19 cuando se capacitaron un total de 325 880 profesionales en el 2020 y 5839 en el 2021. Conclusiones: la superación posgraduada de los profesionales de la salud en Villa Clara se ha correspondido con los principales problemas de la salud del territorio en los años del 2017 al 2021 lo cual evidencia pertinencia y progreso en la continuidad de la formación académica del capital humano.

Background: at Villa Clara University of Medical Sciences, a methodological strategy has been designed and implemented to achieve a greater relationship between professional improvement and health status. Objective: to present the results of professional improvement in correspondence with the main health problems in Villa Clara. Methods: a descriptive study was carried out with a cross-sectional design of professional improvement linked to postgraduate studies from 2017 to 2021. Theoretical, empirical and mathematical-statistical methods were applied; the information obtained was presented in tables with absolute and relative values. Results: out of the whole activities, 83.01% responded to the health problems of the province. Related to chronic non-transmissible diseases, 542 were carried out; malignant tumors, 179; Maternal and Child Care Program, 1762; and the Elderly Care Program, 198. Regarding other transmissible diseases, the highest number was in 2019. In 2020, those linked to arboviruses and the COVID-19 pandemic predominated when a total of 325,880 professionals were trained in 2020 and 5839 in 2021. Conclusions: the postgraduate improvement of health professionals in Villa Clara has corresponded to the main health problems of the territory in the years from 2017 to 2021, which shows relevance and progress in the continuity of the academic training of human capital.

Intracranial leptomeningeal CNS ganglioneuroblastoma. First report and review of the literature.

BACKGROUND: CNS ganglioneuroblastoma in an extremely rare embryonal tumour, specifically in the pediatric population. Bad prognosis is documented due to aggressiveness and absence of protocolized treatment at the moment. CLINICAL DESCRIPTION: We present the case of a 5-year-old boy who presented with sudden loss of consciousness. CT scan was performed showing a large posterior fossa lesion with several intraventricular focal lesions, suggesting metastases, the largest one located inside the III ventricle. The patient underwent a posterior fossa resection of the lesion and a subtotal resection of the III ventricle lesion, with adjuvant chemotherapy. The evolution was poor and the patient finally died 3 months after diagnosis. CONCLUSION: Ganglioneuroblastoma is extremely likely to recur quickly and extensively. There is little knowledge about treatment options but is documented that gross total resection followed by adjuvant radiotherapy and chemotherapy is the best management in these patients.

Palbociclib releases the latent differentiation capacity of neuroblastoma cells.

Neuroblastoma is the most common extracranial solid tumor in infants, arising from developmentally stalled neural crest-derived cells. Driving tumor differentiation is a promising therapeutic approach for this devastating disease. Here, we show that the CDK4/6 inhibitor palbociclib not only inhibits proliferation but induces extensive neuronal differentiation of adrenergic neuroblastoma cells. Palbociclib-mediated differentiation is manifested by extensive phenotypic and transcriptional changes accompanied by the establishment of an epigenetic program driving expression of mature neuronal features. In vivo palbociclib significantly inhibits tumor growth in mouse neuroblastoma models. Furthermore, dual treatment with retinoic acid resets the oncogenic adrenergic core regulatory circuit of neuroblastoma cells, further suppresses proliferation, and can enhance differentiation, altering gene expression in ways that significantly correlate with improved patient survival. We therefore identify palbociclib as a therapeutic approach to dramatically enhance neuroblastoma differentiation efficacy that could be used in combination with retinoic acid to improve patient outcomes.

Evaluación de resultados en una serie de pacientes con trasplante cardiaco: experiencia en el Instituto Nacional de Cardiología

Exponemos la experiencia del Instituto Nacional de Cardiología de una serie de casos de pacientes sometidos a trasplante cardiaco entre mayo de 2016 y junio 2022. Se realizaron 14 trasplantes, 13 fueron del sexo masculino. La edad osciló entre 19 y 62 años. Las etiologías fueron cardiopatías de tipo idiopática en 57% y valvular en 21%. El 50% se trasplantó en INTERMACS 4 (Interagency Registry for Mechanically Assisted Circulatory Support), 21% INTERMACS 3 y solo 28% en INTERMACS 2. Tres pacientes se trasplantaron con asistencia circulatoria tipo membrana circulación extracorpórea. Las complicaciones más frecuentes fueron las infecciosas. La mortalidad hospitalaria fue 35,7%. Hubo un fallecido en el seguimiento tras 5 años de trasplante.

We present the experience of the National Institute of Cardiology of a series of cases of patients undergoing heart transplantation between May 2016 and June 2022. Fourteen transplants were performed, 13 of the patients were male. The age ranged between 19 and 62 years. The etiologies were idiopathic heart disease in 57% and valvular heart disease in 21%. Fifty percent was transplanted in INTERMACS 4 (Interagency Registry for Mechanically Assisted Circulatory Support), 21% in INTERMACS 3 and only 28% in INTERMACS 2. Three patients were transplanted with membrane type extracorporeal circulation circulatory support. The most frequent complications were infectious. Hospital mortality was 35.7%. There was one patient who died during follow-up after 5 years of transplantation.

Safety of upadacitinib in Latin American patients with rheumatoid arthritis: an integrated safety analysis of the SELECT phase 3 clinical program.

INTRODUCTION/OBJECTIVES: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by ongoing inflammation and degradation of synovial joints. The oral JAK inhibitor, upadacitinib, is approved for RA. We conducted an integrated safety analysis of upadacitinib 15 mg once daily (QD) in patients from Latin America (LATAM) versus the rest of the world (RoW). METHODS: Treatment-emergent adverse events (AEs) and laboratory data from six phase 3, randomized controlled trials, adjusted for upadacitinib 15 mg QD use in RA, were analyzed. RESULTS: Overall, 3209 patients received upadacitinib 15 mg QD for 7024 patient-years (PY). LATAM patients (n = 725) had a mean upadacitinib exposure of 1518 PY. Baseline characteristics were generally similar between LATAM and RoW populations. AE rates (including serious/opportunistic infections, tuberculosis, and herpes zoster) and deaths were comparable between populations. LATAM patients had lower serious AE rates per 100 PY (9.4 vs 14.0 E/100 PY) and discontinuation-related AEs (3.9 vs 6.0 E/100 PY) versus RoW. Rates of cardiovascular events were low (≤ 0.5 E/100 PY) and similar between populations. Malignancies, excluding non-melanoma skin cancer, were less common in the LATAM population versus RoW (0.2 vs 1.0 E/100 PY). Laboratory abnormalities were similar between populations, with decreases in hemoglobin, lymphocyte, and neutrophil counts, and elevations in liver enzymes and creatine phosphokinase. Mean change from baseline in low- and high-density lipoprotein cholesterol was generally comparable between LATAM and RoW populations. CONCLUSION: Upadacitinib 15 mg QD demonstrated a consistent safety profile across LATAM and RoW patient populations, with no new safety risks observed. TRIAL REGISTRATION NUMBERS: SELECT-EARLY, NCT02706873; SELECT-NEXT, NCT02675426; SELECT-COMPARE, NCT02629159; SELECT-MONOTHERAPY, NCT02706951; SELECT-BEYOND, NCT02706847; SELECT-CHOICE, NCT03086343.

Double ventriculo-gallbladder shunt in the treatment of giant suprasellar arachnoid cyst with secondary hydrocephalus.

Ventriculo-gallbladder shunt is described as an effective alternative procedure in the treatment of hydrocephalus. We present the case of a 19-year-old patient diagnosed with suprasellar arachnoid cyst since his childhood and hydrocephalus, with a double shunt; ventriculo peritoneal and peritoneal cyst shunt. After several replacements due to peritoneal failure, he underwent ventriculoatrial shunt, with associated complications and subsequent repositioning to the peritoneum. After new valve dysfunction due to peritoneal complications, ventriculo-gallbladder shunt was proposed as an alternative treatment for this patient, which was safe and effective in resolving the patient's symptoms, and the patient was discharged, maintaining clinical stability in the follow-up more than 2 years later.

The proneural transcription factor ASCL1 regulates cell proliferation and primes for differentiation in neuroblastoma.

Neuroblastoma is believed to arise from sympathetic neuroblast precursors that fail to engage the neuronal differentiation programme, but instead become locked in a pro-proliferative developmental state. Achaete-scute homolog 1 (ASCL1) is a proneural master regulator of transcription which modulates both proliferation and differentiation of sympathetic neuroblast precursor cells during development, while its expression has been implicated in the maintenance of an oncogenic programme in MYCN-amplified neuroblastoma. However, the role of ASCL1 expression in neuroblastoma is not clear, especially as its levels vary considerably in different neuroblastoma cell lines. Here, we have investigated the role of ASCL1 in maintaining proliferation and controlling differentiation in both MYCN amplified and Anaplastic Lymphoma Kinase (ALK)-driven neuroblastoma cells. Using CRISPR deletion, we generated neuroblastoma cell lines lacking ASCL1 expression, and these grew more slowly than parental cells, indicating that ASCL1 contributes to rapid proliferation of MYCN amplified and non-amplified neuroblastoma cells. Genome-wide analysis after ASCL1 deletion revealed reduced expression of genes associated with neuronal differentiation, while chromatin accessibility at regulatory regions associated with differentiation genes was also attenuated by ASCL1 knock-out. In neuroblastoma, ASCL1 has been described as part of a core regulatory circuit of developmental regulators whose high expression is maintained by mutual cross-activation of a network of super enhancers and is further augmented by the activity of MYC/MYCN. Surprisingly, ASCL1 deletion had little effect on the transcription of CRC gene transcripts in these neuroblastoma cell lines, but the ability of MYC/MYCN and CRC component proteins, PHOX2B and GATA3, to bind to chromatin was compromised. Taken together, our results demonstrate several roles for endogenous ASCL1 in neuroblastoma cells: maintaining a highly proliferative phenotype, regulating DNA binding of the core regulatory circuit genes to chromatin, while also controlling accessibility and transcription of differentiation targets. Thus, we propose a model where ASCL1, a key developmental regulator of sympathetic neurogenesis, plays a pivotal role in maintaining proliferation while simultaneously priming cells for differentiation in neuroblastoma.

Elevated ASCL1 activity creates de novo regulatory elements associated with neuronal differentiation.

BACKGROUND: The pro-neural transcription factor ASCL1 is a master regulator of neurogenesis and a key factor necessary for the reprogramming of permissive cell types to neurons. Endogenously, ASCL1 expression is often associated with neuroblast stem-ness. Moreover, ASCL1-mediated reprogramming of fibroblasts to differentiated neurons is commonly achieved using artificially high levels of ASCL1 protein, where ASCL1 acts as an "on-target" pioneer factor. However, the genome-wide effects of enhancing ASCL1 activity in a permissive neurogenic environment has not been thoroughly investigated. Here, we overexpressed ASCL1 in the neuronally-permissive context of neuroblastoma (NB) cells where modest endogenous ASCL1 supports the neuroblast programme. RESULTS: Increasing ASCL1 in neuroblastoma cells both enhances binding at existing ASCL1 sites and also leads to creation of numerous additional, lower affinity binding sites. These extensive genome-wide changes in ASCL1 binding result in significant reprogramming of the NB transcriptome, redirecting it from a proliferative neuroblastic state towards one favouring neuronal differentiation. Mechanistically, ASCL1-mediated cell cycle exit and differentiation can be increased further by preventing its multi-site phosphorylation, which is associated with additional changes in genome-wide binding and gene activation profiles. CONCLUSIONS: Our findings show that enhancing ASCL1 activity in a neurogenic environment both increases binding at endogenous ASCL1 sites and also results in additional binding to new low affinity sites that favours neuronal differentiation over the proliferating neuroblast programme supported by the endogenous protein. These findings have important implications for controlling processes of neurogenesis in cancer and cellular reprogramming.

Leucemia linfocítica crônica associada a melanoma metastático em homem de 53 anos / Metastatic melanoma in a 53-year-old male with relapsed chronic lymphocytic leukemia

Introdução: A associação de leucemia linfocítica crônica (LLC) e melanoma tem sido estudada nos últimos anos. Acredita-se que a imunossupressão causada pelo tratamento da doença seja o fator de risco mais importante para o aumento da susceptibilidade ao desenvolvimento e disseminação do câncer de pele. Relato de Caso: Este relato de caso descreve homem de 53 anos, em tratamento de leucemia linfocítica crônica desde 2018, já submetido a diversos ciclos de quimioterapia com fludarabina. Apresentou histórico de exérese de melanoma nodular epitelioide no couro cabeludo em 2019, removido com margens livres. Um ano após a cirurgia, paciente evoluiu com piora do estado geral com necessidade de hospitalização. Investigação adicional revelou focos de metástase em pulmões, fígado, rins, estômago, sistema nervoso central e linfonodos. Análise histopatológica foi positiva para melanoma. A possibilidade de tratamento foi descartada pela equipe de oncologia, que sugeriu cuidados paliativos. Discussão: Um dos mecanismos mais discutidos para explicar esta associação de neoplasias é a imunossupressão resultante do tratamento da LLC, que deixa o paciente suscetível ao desenvolvimento e à disseminação do melanoma. Além disso, a fludarabina, quimioterápico geralmente usado para remissão da LLC, é conhecida por depletar células T-helper e tem sido descrita como cofator deste processo. A associação de leucemia e melanoma cutâneo têm sido descrita nos últimos anos, porém não há nenhum protocolo de tratamento para esta condição.

BACKGROUND: The association of Chronic Lymphocytic Leukemia (CLL) and melanoma have been studied in the last years. The immunosuppression caused by the treatment of CLL seems to be the major factor of increasing patients' susceptibility to the development and spread of skin cancer. CASE REPORT: This case report describes a 53-year-old male patient, in CLL treatment since 2018, already submitted to many cycles of chemotherapy with fludarabine. History of an exeresis of epithelioid nodular melanoma of the scalp in 2019, which was removed with a clear margin. One year later, he presented with a poor general condition with hospitalization indication. Additional investigation revealed metastatic lesions in lungs, liver, kidneys, stomach, central nervous system, and lymph nodes. Histopathologic analysis positive for melanoma. The possibility of treatment was discarded by the Oncology team, which suggested palliative care. DISCUSSION: One of the most discussed mechanisms to explain this cancer association is the immunosuppression developed during the treatment of CLL, increasing patients' susceptibility to the development and spread of melanoma. In addition, the use of fludarabine, a chemotherapy commonly used in relapsed CLL, is known to deplete T-helper cells and has been described as a cofactor of this process. The association of leukemia and cutaneous melanoma has been reported in the last years, yet there is no surveillance protocol.

Breviario de guías y metas del paciente crítico hospitalizado en Medicina Interna / Breviary of guidelines and goals of critical hospitalized patients in Internal Medicine

Los pacientes en estado crítico presentan disfunción fisiológica que provoca inestabilidad en órganos y sistemas del cuerpo, con desenlaces fatales y lesiones irreversibles o incluso la muerte. En los servicios de Medicina Interna de los hospitales de México, en especial en los públicos, hay pacientes críticos con múltiples patologías que requieren vigilancia en el cumplimiento de diversas metas de su tratamiento. Se presenta un compendio de las guías y metas de patologías críticas con mayor prevalencia en los servicios de Medicina Interna, las cuales son necesarias para guiar el tratamiento.

Patients with critical illness develop physiological dysfunction which provokes multi-organ system failure and triggers fatal outcomes and irreversible injuries or even death. Inside Internal Medicine services of Mexican hospitals, especially in public hospitals, there is a considerable number of critically ill patients with multiple pathologies who require surveillance to reach clinical goals of their treatment. We present a summary of guidelines and goals of the most prevalent critical diseases inside Internal Medicine services, which are necessary to guide treatments.

Trastornos Alimentarios y Terapia de la Conciencia Corporal Basal: un enfoque de "Fisioterapia en Salud Mental" / Eating Disorders and Basic Body Awareness Therapy: A "Physiotherapy in Mental Health" approach

La Terapia de la Conciencia Corporal Basal intenta lograr la calidad del movimiento corporal a través de patrones motores musculares libres de presión y tensión, con el objetivo de promover la conciencia corporal y optimizar el esquema corporal de la persona. El objetivo de esta revisión narrativa de la literatura es determinar los beneficios que la Terapia de la Conciencia Corporal Basal puede brindar en el tratamiento de los trastornos alimentarios. Los estudios incluidos en esta revisión de la literatura respaldaron la eficacia de la Terapia de la Conciencia Corporal Basal como terapia adyuvante de los Trastornos Alimentarios, aunque muchos estudios tienen importantes limitaciones con respecto a su metodología. El papel del fisioterapeuta está ganando protagonismo en el tratamiento de pacientes con Trastornos Alimentarios, ya que las técnicas fisioterapéuticas como la Terapia de la Conciencia Corporal Basal proporcionan una mejora significativa en la calidad de vida, los síntomas psiquiátricos y la salud física de los pacientes afectados.

The Basic Body Awareness Therapy attempts to achieve the quality of body movement through muscular motor patterns free of pressure and tension with the aim of promoting body awareness and optimizing the person's body scheme. The aim of this narrative review of the literature is to determine the benefits that Basic Body Awareness Therapy can provide as a treatment for Eating Disorders. The studies including in this review of the literature supported the efficacy of Basic Body Awareness Therapy as an adjunctive therapy of Eating Disorders, but many studies have important limitations regarding their methodology. The role of the Physiotherapist is gaining prominence in the treatment of patients with Eating Disorders, as physiotherapeutic technics such as Basic Body Awareness Therapy provide significant improvement in the quality of life, psychiatric symptoms, and physical health of the affected patients.

Dephosphorylation of the Proneural Transcription Factor ASCL1 Re-Engages a Latent Post-Mitotic Differentiation Program in Neuroblastoma.

Pediatric cancers often resemble trapped developmental intermediate states that fail to engage the normal differentiation program, typified by high-risk neuroblastoma arising from the developing sympathetic nervous system. Neuroblastoma cells resemble arrested neuroblasts trapped by a stable but aberrant epigenetic program controlled by sustained expression of a core transcriptional circuit of developmental regulators in conjunction with elevated MYCN or MYC (MYC). The transcription factor ASCL1 is a key master regulator in neuroblastoma and has oncogenic and tumor-suppressive activities in several other tumor types. Using functional mutational approaches, we find that preventing CDK-dependent phosphorylation of ASCL1 in neuroblastoma cells drives coordinated suppression of the MYC-driven core circuit supporting neuroblast identity and proliferation, while simultaneously activating an enduring gene program driving mitotic exit and neuronal differentiation. IMPLICATIONS: These findings indicate that targeting phosphorylation of ASCL1 may offer a new approach to development of differentiation therapies in neuroblastoma. VISUAL OVERVIEW: http://mcr.aacrjournals.org/content/molcanres/18/12/1759/F1.large.jpg.

Teaching geriatrics during the COVID-19 pandemic: experience of a brazilian medical school / Ensino de Geriatria durante a Pandemia de COVID-19: Experiência de uma Faculdade de Medicina Brasileira

INTRODUCTION: During the COVID-19 pandemic, the discipline of geriatrics at the Santa Casa de Sao Paulo School of Medical Sciences of São Paulo was adapted to a web-based learning environment due to social distancing measures. OBJECTIVE: To describe the full adaptation of the discipline of geriatrics to a web-based learning tool, of two activities that were developed including the current COVID-19 to illustrate some of the main concepts of geriatric medicine. METHODS: The course was fully adapted to the open-source course management system called MOODLE. The first activity was a COVID-19 clinical case discussion, whose main objective was to include COVID-19 in the content of our course, illustrating some of the main concepts of geriatrics. The second activity was a Comprehensive Geriatric Assessment (CGA) experience, done via videoconference, which also assessed the impact of social distancing measures on the health of older adults. RESULTS: A total of 43 medical students performed both activities, and 95% of the students considered the inclusion of the COVID-19 into the discipline of geriatrics useful, 88% approved the practical experience of CGA, and 84% felt that they contributed to the health of the interviewees after contact. CONCLUSION: Adapting our discipline to a web-based learning tool, while including the current COVID-19 in our course content and a practical experience of CGA via videoconference was possible and approved by students. The adoption of this initiative may not only be an academic strategy, but also a possible way to improve the quality of life of older people during the COVID-19 pandemic

Durante a pandemia de COVID-19, a disciplina de geriatria da Faculdade de Ciências Médicas da Santa Casa de São Paulo foi adaptada a um plataforma de aprendizagem a distância devido a medidas de distanciamento social. OBJETIVO: Descrever a adaptação completa da disciplina de geriatria a uma plataforma de aprendizagem a distância de duas atividades desenvolvidas que abordaram o atual tema COVID-19 para ilustrar alguns dos principais conceitos em medicina geriátrica. METODOLOGIA: O curso foi totalmente adaptado à plataforma de aprendizagem a distância chamada MOODLE. A primeira atividade foi uma discussão de caso clínico de COVID-19, cujo objetivo principal foi incluir o tema no conteúdo de nosso curso, ilustrando alguns dos principais conceitos em geriatria. A segunda atividade foi a experiência prática da Avaliação Geriátrica Ampla (AGA), realizada por videoconferência, que também avaliou o impacto das medidas de distanciamento social na saúde de idosos. RESULTADOS: 43 estudantes de medicina realizaram as duas atividades e 95% consideraram útil a inclusão do tema COVID-19 na disciplina de geriatria, 88% aprovaram a experiência prática da AGA e 84% consideraram que contribuíam para a saúde dos entrevistados após o contato. CONCLUSÃO: A adaptação de nossa disciplina a uma plataforma de aprendizagem a distância, incluindo o tema COVID-19 no conteúdo do curso e uma experiência prática da AGA por videoconferência, foi possível e aprovada pelos alunos. A adoção dessa iniciativa pode ser não apenas uma estratégia acadêmica, mas também uma maneira possível de melhorar a qualidade de vida dos idosos durante a pandemia de COVID-19.

Yoga: beneficios para la salud. Una revisión de la literatura / Yoga: health benefits. A literature review

El Yoga es una forma de ejercicio físico no convencional, es una técnica milenaria que posee tres componentes esenciales: elongaciones musculares, ejercicios para el control de la respiración y meditación para una intervención mente-cuerpo. Esta modalidad de ejercicio físico tiene una particularidad, que, por su mirada holística, hace interesante y llamativa. El objetivo de esta revisión fue buscar evidencia que apoye al Yoga para su utilidad en beneficio de la salud de las personas. Esta fue una revisión narrativa, no sistemática, centrada en literatura primaria, seleccionada de una búsqueda en las bases de datos PubMed y SciELO. Los términos clave que se utilizaron para la búsqueda y selección fueron: "Yoga y ejercicio físico", "Yoga y salud física", "Yoga y salud mental". Se extrajo literatura secundaria (libros y capitulo de libros, hecho por expertos) para complementar a la literatura primaria y contribuir aún más para la investigación. Todos los autores participaron de la investigación y revisión de la literatura. Concluyeron que existe evidencia que apoya la utilidad del Yoga para el beneficio de la salud de las personas, aunque aún es limitada, debido a paradigmas aún existentes sobre conceptos de salud que limitan el diseño metodológico de muchos estudios referentes al tema.

Yoga is an unconventional form of physical exercise, it is an ancient technique that has three essential components: muscle stretching, exercises to control breathing and meditation for a mind-body intervention. This type of physical exercise has a particularity for its holistic look which makes it interesting and striking. The objective of this review was to search for evidence that supports Yoga for its usefulness for the benefit of people's health. This was a narrative, non-systematic review, focused on primary literature, selected from a search of the PubMed and SciELO databases. The key terms used for the search and selection were: "Yoga and physical exercise", "Yoga and physical health", "Yoga and mental health". Secondary literature (books and book chapter, made by experts) was extracted to complement the primary literature and further contribute to the research. All authors participated in the research and literature review. They concluded that there is evidence that supports the usefulness of Yoga for the benefit of people's health, although it is still limited, due to still existing paradigms on health concepts that limit the methodological design of many studies on the subject.

Anaesthetic Approach for Patient with Hereditary Angioedema.

Hereditary Angioedema (HEA), a disease caused by a mutation in the gene that encodes for the production of the fraction C1 in the complement (C1-INH), is a rare pathology (1/50.000) that causes swelling of the skin and submucosa in various organs, either naturally triggered or provoked by physical and psychological traumas, infections, or by the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and angiotensin-converting enzyme inhibitors (ACEIs). Surgical trauma may spur the HEA crisis, leading to complications such as the swelling of the respiratory tracts and hemodynamic instability. Thus, the pre-surgical approach to HEA patients requires a specific plan that ensures short term prophylaxis, careful intra-operative management, rescue therapy and intensive post-surgery care. We present a report on a video-laparoscopic cholecystectomy approach for a 28-year-old woman diagnosed with asthma and HEA with symptomatic choledocholithiasis. We opted for short-term prophylaxis and immunology with the intravenous application of C1-INH. Ultrasonography imaging showed arterial wall oedema, which could correspond to a manifestation of C1-INH deficiency in the wall of the manipulated arteries during ultrasonography-guided puncture. Once the patient recovered consciousness, she was transferred to the intensive care unit and was discharged on the 6th day of hospitalisation.

Resistência de união de primers/silanos em superfície de cêramica vítrea / Novel silane/primers bond strength in glass ceramics surface

Objetivo: investigar a resistência de união por cisalhamento de diferentes soluções contendo silano e primer na superfície de Dissilicato de Lítio (IPS e.maxCAD, Ivoclar-Vivadent). Metodologia: 78 blocos cerâmicos foram incluídos em resina acrílica, polidos e lavados em ultra-som por 10 minutos. Os espécimes foram divididos em dois grupos de acordo com tratamento de superfície: Superfície Polida (PS); Ácido Hidro-Fluorídrico 9,5% - 20s (HF). Cada grupo foi dividido em três subgrupos (n = 13), de acordo com o tipo de silano: silano tradicional (Porcelain Prime, Inc. Bisco); mistura de silano e resina (KerrSilane, Kerr); mistura de silano e adesivo universal (Single-bond Universal, 3M Espe). Os espécimes foram montados em um dispositivo padrão para teste de cisalhamento (UltradentBonding Assembly), cimentados com cimento resinoso dual (Duolink Universal™, Bisco Inc.) e foto-polimerizados por 20s. As amostras foram testadas após 24 horas e 90 dias de armazenamento em água destilada a 47°C. Os dados foram analisados por 2-Way Anova e Teste de Tukey (α=5%). Resultados: em geral, os valores de resistência adesiva do silano tradicional foram, estatisticamente, mais elevados do que os outros tipos de silanos. O armazenamento afetou, significativamente, a força de adesão para a maioria dos grupos (p <0,001). O grupo PS apresentou menores valores de resistência adesiva, independentemente da variável (silano vs armazenamento). Conclusões: adequada resistência adesiva pode ser obtida com silanos tradicionais após o pré-tratamento de superfície com ácido HF

Objective: To investigate the efficacy of "new silanes / primer" in the Lithium Disilicate surface (IPS e.maxCAD, IvoclarVivadent-) by means of adhesive shear bond strength test. Methodology: A total of 78 ceramic blocks were embedded in acrylic resin, polished and washed in ultrasound for 10 minutes. The specimens were divided into two groups according to surface treatment: Polished Surface (PS); Hydrofluoric acid 9,5% - 20s (HF). Each group was divided into three sub-groups (n = 13) according to the type of silane used: traditional silane (Porcelain Prime Bisco, Inc.); mixture of silane and resin (Kerr Silane, Kerr); mixture of silane and universal adhesive (Single-bond Universal, 3M Espe). The specimens were mounted on a standard device for shear test (Ultradent Bonding Assembly), cemented with dual resin cement (Duolink Universal ™, Bisco Inc.) and photo-polymerised for 20s. The samples were tested after 24 hours and 90 days of storage in distilled water at 47°C. Data were analyzed by 2-way ANOVA and Tukey Test (α = 5%). Results: In general, the adhesive strength value of traditional silanewas significantly higher than other types of silanes. The storage significantly affects the bond strength (bond) for most groups (p <0.001). The PS group showed lower bond strength values, independent of the variable (silane vs. storage). Conclusions: Suitable adhesive strength can be obtained with traditional silanes, combined with the pre-treatment surface with HF acid.

Different bonding agents effect on adhesive bond strength: lithium disilicate glass ceramic / Efeito de diferentes agentes de união na cimentação adesiva em superfície cerâmica de dissilicato de lítio

Introduction: The silanization of the ceramic surface prior to applying the adhesive and/or resinous materials plays an important role in bond strength. Nowadays, a new family of adhesive systems has been introduced into the market, aiming to simplify the technique of adhesive procedures during cementation. Objective: To investigate the effectiveness of different bonding agents containing silane and primer on Lithium Disilicate Glass Ceramic (LD) surface by shear bond strength tests. Material and method: 130 LD ceramic blocks were included in acrylic resin, polished and washed in ultrasound for 10 minutes. The specimens were divided into 2 groups according to surface treatment: Polished Surface (PS); Hydrofluoric Acid 9.5% - 20s (HF). Each group was divided into 5 subgroups (n = 13) according to bonding agent type: metallic primer containing MDP (ZPrimePlus, Bisco Inc); two traditional silanes (MonobondPlus, IvoclarVivadent / Porcelain Prime, Bisco Inc.); mixture of silane and resin (Kerr Silane, Kerr); mixture of silane and universal adhesive (Single-bond Universal, 3M Espe). The specimens were mounted in a standard device for shear testing (UltradentBonding Assembly), cemented with dual resin cement (RelyX UltimateTM, 3M Espe.) and photo-polymerized for 20s. The samples were tested after 24 hours and 3 months of storage in distilled water at ±36 °C. The data were analyzed by 3-Way Anova and Tukey's test (α = 5%). Result: Shear bond strength (SBS) was significantly influenced by surface treatment, bonding agent used and storage (p <0.001). Conclusion: Adequate adhesive bond strength to Lithium Disilicate Glass Ceramic can be obtained with traditional silanes, combined with HF acid pretreatment surface.

Introdução: A silanização da superfície cerâmica antes da aplicação do adesivo e/ou materiais resinosos desempenha um papel importante na resistência adesiva. Atualmente, uma nova família de sistemas adesivos foi introduzida no mercado, visando simplificar a técnica dos procedimentos adesivos durante a cimentação. Objetivo: Investigar a eficácia de diferentes soluções contendo silano e primer na superfície de cerâmicas de Dissilicato de Lítio (DLT) por meio de testes de resistência adesiva por cisalhamento. Material e método: 130 blocos cerâmicos DLT foram incluídos em resina acrílica, polidos e lavados em ultra-som por 10 minutos. Os espécimes foram divididos em 2 grupos de acordo com tratamento de superfície: Superfície Polida (PS); Ácido Hidro-Fluorídrico 9,5% - 20s (HF). Cada grupo foi dividido em 5 sub-grupos (n = 13) de acordo com o tipo de primer/silano: primer metálico contendo MDP (ZprimePlus, Bisco Inc); dois silanos tradicionais (MonobondPlus, IvoclarVivadent / Porcelain Prime, Bisco Inc.); mistura de silano e resina (Kerr Silane, Kerr); mistura de silano e adesivo universal (Single-bond Universal, 3M Espe). Os espécimes foram montados em um dispositivo padrão (UltradentBonding Assembly) para teste de cisalhamento Bisco Shear Bond Tester), cimentados com cimento resinoso dual (RelyX UltimateTM, 3M Espe.) e foto-polimerizados por 20s. O teste foi realizado após o período de: 24 horas e 3 meses de armazenamento em água destilada à ±36 °C. Os dados foram analisados por 3-Way Anova e Teste de Tukey (α=5%). Resultado: A resistência adesiva ao cisalhamento (SBS) foi significativamente influenciada pelo tipo de tratamento da superfície, pelo tipo de agente de união utilizado e pelo armazenamento (p<0,001). Conclusão: Adequada resistência adesiva pode ser obtida com silanos tradicionais, combinados com o pré-tratamento de superfície com ácido HF.

Impacto del proceso de universalización de la enseñanza aplicado en un policlínico docente universitario / Impact of the process of universalization of teaching applied in a university teaching polyclinic

RESUMEN Fundamento: la universalización de la enseñanza en las ciencias médicas centró de manera particular su actividad formativa en la atención primaria de salud como principal escenario docente para los estudiantes de Medicina. Objetivo: describir las experiencias del proceso de universalización de la enseñanza del ciclo área básica en el Policlínico Docente Universitario "XX Aniversario" de Santa Clara, Villa Clara durante sus diez años de desempeño. Métodos: se realizó una investigación documental en el Policlínico Docente Universitario "XX Aniversario" de Santa Clara, Villa Clara. Se utilizaron métodos teóricos: análisis-síntesis, inducción-deducción e histórico-lógico; empíricos: análisis documental sobre informes relacionados con el decursar del proceso de universalización; y matemáticos para los valores absolutos y relativos. Resultados: con respecto a los estudiantes se constataron buenos resultados en la promoción y retención escolar y una adecuada participación en actividades políticas y eventos deportivos, culturales, científicos y en otras que contribuyeron a su formación integral. En cuanto a los profesores desarrollaron una labor meritoria, fueron preparándose pedagógicamente para acometer la docencia, dominaban los contenidos, y mostraron buena preparación política y su presencia en la universalización fue estable. Conclusiones: el análisis realizado permitió expresar la satisfacción por los resultados alcanzados en cuanto a la buena calidad del proceso enseñanza aprendizaje y la realización de las actividades políticas, educativo-formativas y otras, las cuales contribuyeron a la formación integral de los estudiantes.

ABSTRACT Background: the universalization of teaching in medical sciences focused in particular on its training activity in primary health care as the main teaching setting for medical students. Objective: to describe the experiences of the process of universalization of teaching of the basic area cycle in the "XX Anniversary" University Teaching Polyclinic of Santa Clara, Villa Clara during its 10 years of performance. Methods: a documentary research was carried out in the "XX Anniversary" University Teaching Polyclinic of Santa Clara, Villa Clara. Theoretical methods were used: analysis-synthesis, induction-deduction and historical-logical; empirical ones: documentary analysis on reports related to the progress of the universalization process; and mathematics for absolute and relative values. Results: in respect to the students, good results were found in school grading and continuance and adequate participation in political activities and sports, cultural, scientific and other events that contributed to their comprehensive training. As far as the professors developed a meritorious work, they were preparing pedagogically to undertake teaching, they dominated the contents, and they showed good political preparation and their presence in the universalization process was stable. Conclusions: the analysis made allowed expressing satisfaction with the results achieved in terms of the good quality of the teaching-learning process and the implementation of educational-training activities and others, which contributed to the comprehensive training of students.