Valor ético de la incorporación del estudiante de Medicina al sistema de garantía de la calidad hospitalaria / Ethical value of incorporating medical student system of hospital quality assurance

Se realizó una propuesta metodológica en el Hospital Militar Clínico Quirúrgico Docente Doctor Octavio de la Concepción y la Pedraja de Camagüey durante el año 2014 con el objetivo de argumentar el valor ético que tiene para el estudiante de Medicina ser insertado al sistema de garantía de la calidad hospitalaria. Se emplearon métodos de nivel teórico como análisis y síntesis, histórico-lógico, inducción-deducción. La vinculación del estudiante universitario al sistema de garantía de calidad en un centro asistencial docente permite elevar la utilización correcta del método clínico y provee al discente de conocimiento para que al egresar desempeñe un servicio de excelencia y alcance a reducir los errores e insatisfacciones de la población y con ello los costos innecesarios.

In order to increase the ethical value integrating medical students into a hospital quality guarantee system has, a methodological proposal was put forward in the Doctor Octavio de la Concepcion y la Pedraja Teaching Clinical-Surgical Military Hospital of Camaguey during 2014. Theoretical methods such as analysis and synthesis, historical-logical methods and induction-deduction were used. Linking college students to the quality guarantee system allows increasing the proper use of the clinician and it provides the learner with the knowledge he needs to carry out an excellent service and to reduce errors making and people dissatisfactions, therefore cutting on unnecessary costs.

Intervención educativa sobre lactancia materna / Educational intervention on breast-feeding

Fundamento: la lactancia materna constituye el alimento natural de la especie humana, por ello debemos agotar todos nuestros esfuerzos en garantizar que el niño sea alimentado exclusivamente a pecho al menos hasta los primeros seis meses después de nacido. Objetivo: demostrar la eficacia de un programa sobre lactancia materna en un grupo de madres. Método: se realizó un estudio de intervención educativa para demostrar la eficacia de un programa sobre lactancia materna en un grupo de madres de diez consultorios del Policlínico Este, Municipio Camagüey desde enero de 2007 a mayo de 2008. Constituyeron el universo cincuenta y cinco madres con fechas probables de parto entre el primero de junio y el treinta y uno de agosto de 2007, a las que se les aplicó un formulario con diferentes variables y una encuesta de conocimientos antes y después de la intervención. Resultados: predominó el grupo de treinta a treinta y cuatro años. El 83,3 por ciento de las encuestadas no conocían adecuadamente de lactancia materna, y sólo el 9,72 por ciento la alcanzó en forma exclusiva hasta más de seis meses. Conclusiones: los niños que no recibieron lactancia materna exclusiva hasta el sexto mes se enfermaron con mayor frecuencia, la intervención resultó satisfactoria pues se elevó el nivel de conocimientos de las participantes y se logró que un mayor número de mujeres lactara hasta después del sexto mes.

Background: breast-feeding constitutes the natural food of human species, that is why we should exhaust all our efforts in guaranteeing the boy is exclusively fed at least to breast until the first six months after born. Objective: to demonstrate the effectiveness of a breast-feeding program in a group of mothers. Method: an educational intervention study to demonstrate the effectiveness of a breast-feeding program in a group of mothers of ten doctor's offices of the East Polyclinic, Camagüey Municipality was performed from January 2007 to May 2008. The universe was constituted by 55 mothers with probable childbirth dates among June 1st and August 31 2007, to those were applied a form with different variables and a knowledge survey before and after the intervention. Results: the group from 30 to 34 years prevailed. The 83,3 percent of those interviewed didn't know appropriately of breast-feeding, and 9,72 percent only reached it in exclusive way until more than six months. Conclusions: children didn't receive exclusive breast-feeding until the sixth month got sick with more frequency, the intervention was satisfactory because the level of the participants' knowledge rose and it was achieved a bigger number of women suckled until after the sixth month.

Anticlusterin treatment of breast cancer cells increases the sensitivities of chemotherapy and tamoxifen and counteracts the inhibitory action of dexamethasone on chemotherapy-induced cytotoxicity.

INTRODUCTION: Overexpression of the apoptosis-related protein clusterin is associated with breast cancer development and tumor progression. We describe the use of clusterin-specific antisense oligonucleotides and antibodies to sensitize breast carcinoma cells to anticancer drugs routinely used in breast cancer therapy. METHODS: MCF-7 and MDA-MB-231 cells were treated with the oligonucleotide or antibody, chemotherapeutic agents (doxorubicin or paclitaxel), tamoxifen, or with combinations of these. RESULTS: Treatments that include antisense clusterin oligonucleotide or antibody to clusterin have been shown to reduce the number of viable cells more effectively than treatment with the drugs alone. We also demonstrate that dexamethasone pretreatment of breast cancer cell lines inhibits chemotherapy-induced cytotoxicity and is associated with the transcriptional induction of clusterin. However, anticlusterin treatment increases chemotherapy-induced cytotoxicity, even in the presence of glucocorticoids, suggesting a possible role for these proteins in glucocorticoid-mediated survival. CONCLUSION: These data suggest that combined treatment with antibodies to clusterin or antisense clusterin oligodeoxynucleotides and paclitaxel, doxorubicin, or tamoxifen could be a novel and attractive strategy to inhibit the progression of breast carcinoma by regulation of the clusterin function. Moreover, glucocorticoid activation in breast cancer cells regulates survival signaling by the direct transactivation of genes like clusterin which encode proteins that decrease susceptibility to apoptosis. Given the widespread clinical administration of dexamethasone before chemotherapy, understanding glucocorticoid-induced survival mechanisms is essential for achieving optimal therapeutic responses.

Expression of the antiapoptotic proteins clusterin and bcl-2 in laryngeal squamous cell carcinomas.

Bcl-2 and clusterin genes have been related to the inhibition of apoptosis, an event that plays a key role in malignant transformation and in invasive disease. In this work, we determine the significance of clusterin and bcl-2 expression in a large series of laryngeal carcinomas. We used immunohistochemical methods and in situ hybridization to examine the expression of these proteins. Nontumoral epithelial laryngeal tissues did not express clusterin and bcl-2 proteins. However, 9% (14 out of 154) and 25% of these tumors (39 of 154) had positive clusterin and bcl-2 staining, respectively. Clusterin expression was significantly related to the degree of local invasion and higher bcl-2 expression was found in these clusterin-positive tumors (p < 0.05). Bcl-2 expression was significantly correlated with supraglottic localization, nodal metastases, invasion in depth, and poorly differentiated tumors. However, by multivariate analysis, bcl-2 was shown to be an independent predictor of good prognosis in these tumors (OR = 0.12, 95% CI = 0.02-0.91). These findings indicate that clusterin and bcl-2 are upregulated in laryngeal carcinomas and their expression is related to the invasiveness of these tumors.

[Collagen synthesis and heart failure]. / Síntesis de colágeno e insuficiencia cardíaca.

Little is known about collagen metabolism in heart failure, with or without left ventricular systolic dysfunction. We studied serum concentrations of the carboxy-terminal propeptide of procollagen type I (PIP), a marker of collagen type-I synthesis, and of the carboxy-terminal telopeptide of collagen type I (ICTP), a marker of collagen type-I degradation, in 70 patients admitted for heart failure (35 with depressed left ventricular systolic function and 35 with preserved left ventricular systolic function) and in 30 control subjects. Patients with kidney failure, liver disease, metabolic bone disease, rheumatic disease, recent (within 3 months) major trauma or surgery, or serious wounds were excluded. The concentration of the collagen synthesis marker, PIP, was higher in heart failure patients than control subjects, at 140+/-56.38 mg/L vs 113.66+/-36.6 microg/L, respectively (P=.01). However, there was no difference in the concentration of the collagen degradation marker, ICTP, between heart failure patients and control subjects, at 2.89+/-2.37 mg/L vs 2.26+/-1.7 microg/l, respectively. In heart failure patients, left ventricular systolic function had nonsignificant effect on the PIP or ICTP concentration.

Major histocompatibility complex status in breast carcinogenesis and relationship to apoptosis.

Major histocompatibility complex (MHC) molecules are of central importance in regulating the immune response against tumors. In this study we used immunohistochemistry to study human leukocyte antigen (HLA) class I and II antigen expression in normal breast tissues and benign, preneoplastic, primary, and metastatic breast lesions using antibodies against beta-2-microglobulin (beta2-m), heavy-chain, and HLA-DR antigens. Whereas all normal tissues and benign lesions were positive for beta2-m and HLA-A, -B, and -C antigens, total loss of HLA class I antigens was found in 37% (11 of 30) of in situ carcinomas, in 43% (56 of 131) of the primary tumors, and in 70% (31 of 45) of the lymph node metastases. HLA-DR was also underexpressed in breast cancer cells; thus 20% (6 of 30) of in situ carcinomas, 15% of invasive carcinomas (20 of 131), and only 1 metastatic case were positive for this antigen. Both HLA class I and II antigen expression were more frequently down-regulated in metastatic lesions than in primary breast lesions (P <0.05), and a tendency toward a simultaneous defective expression of HLA class I and II antigens was observed in primary carcinomas (P = 0.07). However, no correlation was found between the expression of any of the aforementioned molecules and pathological parameters or survival. Interestingly, HLA class I expression was expressed more frequently in tissues with high apoptotic activity and was significantly associated with the expression of the proapoptotic bax gene (P = 0.02), and was inversely associated with expression of the antiapoptotic bcl-2 gene (P = 0.03). We conclude that alterations in HLA class I and II antigen expression are early events in breast carcinogenesis and play significant roles in metastatic progression. In addition, their expression is correlated with apoptosis-regulating proteins, which may influence the cytotoxicity of T cells against HLA class I-specific tumor antigens.