Método de aula invertida para la formación en gerontogeritría de estudiantes de la carrera de Medicina

Fundamento: e l aula invertida es una modalidad de enseñanza semipresencial, donde los alumnos aprenden los conceptos por sí mismos, usando normalmente videos educativos, archivos de audio y otras tecnologías, mediante la colaboración entre los compañeros en comunidades en línea. Objetivo: proponer un método de aula invertida para la formación en gerontogeriatría de estudiantes de la carrera de Medicina. Métodos: se realizó un estudio de tipo observacional de corte transversal mediante el empleo de métodos científicos: revisión de documentos, observación directa en el terreno, análisis, síntesis, inducción, deducción, sistémico y de estadística descriptiva. Resultados: se aporta un método de aula invertida para la formación gerontogeriátrica de los estudiantes de la carrea de Medicina que combina las modalidades de presencialidad y virtualidad desde la interacción entre las formas de organización de la docencia médica y de la educación en el trabajo en la Atención Primaria en Salud: consulta y visita de terreno domiciliaria. Conclusiones: el aula invertida es un contexto que favorece la formación gerontogeriátrica del estudiante de la carrera de Medicina ya que dinamiza y transforma las concepciones y enfoques tradicionales de la enseñanza - aprendizaje, al lograr un mayor protagonismo estudiantil, aumento de la autonomía, la instantaneidad, interconexión, multimedialidad y la creatividad e innovación del estudiante en la solución de problemas de salud del adulto mayor, así como el aprovechamiento de las potencialidades de los recursos y entornos virtuales de aprendizaje que posee, combinando modalidades de enseñanza presencial y virtual.

Background: the inverted classroom is a blended learning modality, where students learn the concepts by themselves, usually using educational videos, audio files and other technologies, through collaboration among peers in online communities. Objective: to propose an inverted classroom method for gerontogeriatric training in Medicine students. Methods: a cross-sectional observational study was carried out using scientific methods: document review, direct observation in the field, analysis, synthesis, induction, deduction, systemic and descriptive statistics. Results: an inverted classroom method is provided for the gerontogeriatric training of Medicine students that combines face-to-face and virtual modalities from the interaction between the forms of organization of medical teaching and education at work in the Primary Health Care: consultation and home field visit. Conclusions: the inverted classroom is a context that favors the gerontogeriatric training of the Medicine student since it revitalizes and transforms the traditional conceptions and approaches of teaching-learning, by achieving a greater student role, increased autonomy, instantaneous, interconnection, multimedia and the creativity and innovation of the student in the solution of health problems of the elderly, as well as the use of the resources and virtual learning environments' potential that it possesses, combining face-to-face and virtual teaching modalities.

Modelo de evaluación de la competencia investigativa del licenciado en Imagenología / Model for evaluating the researching competence of the graduate in Imaging

Fundamento: la evaluación del desempeño profesional y la competencia constituye el eje fundamental del modelo cubano para el análisis y evaluación de la calidad en la educación y práctica médicas. Objetivo: diseñar un modelo de evaluación de la competencia investigativa del licenciado en Imagenología. Métodos: se realizó una investigación de desarrollo en los centros de atención secundaria del municipio Holguín desde 2021 a 2022. Se emplearon métodos teóricos: histórico-lógico, análisis-síntesis, sistémico-estructural-funcional y modelación; y empíricos: análisis documental y cuestionario a licenciados en Imagenología. Para la valoración del modelo se empleó el criterio de 10 especialistas con reconocido prestigio en los centros de atención. Los indicadores fueron la pertinencia, utilidad, factibilidad. Resultados: se constataron insuficiencias en la competencia investigativa evidenciadas en el desempeño profesional. Se elaboró un modelo de evaluación compuesto por dos subsistemas: teórico funcional y contextualización; de sus relaciones deviene una nueva cualidad que se enuncia en la mejora del desempeño profesional investigativo para la solución de problemas tecnológicos y biomédicos. Conclusiones: los dos subsistemas que componen el modelo de evaluación de la competencia investigativa tienen una relación de coordinación. Los especialistas lo valoraron como pertinente, útil y factible de ser aplicado.

Background: the evaluation of professional performance and competence constitutes the fundamental axis of the Cuban model for the analysis and evaluation of quality in medical education and practice. Objective: to design a model for evaluating the research competence of the graduate in Imaging. Methods: a development investigation was carried out in the secondary care centers of the Holguín municipality from 2021 to 2022. Theoretical methods were used: historical-logical, analysis-synthesis, systemic-structural-functional and modeling; and empirical: documentary analysis and questionnaire to graduates in Imaging. To evaluate the model, the criteria of 10 specialists with recognized prestige in care centers were used. The indicators were relevance, usefulness, feasibility. Results: insufficiencies in the researching competence were found, evidenced in professional performance. An evaluation model composed of two subsystems was developed: functional theory and contextualization; from their relationships becomes a new quality that is expressed in the improvement of professional researching performance for the solution of technological and biomedical problems. Conclusions: the two subsystems that make up the research competence evaluation model have a coordination relationship. The specialists valued it as pertinent, useful and feasible to be applied.

Gerontogeriatría en el curso propio "Envejecimiento". Plan de estudios "D" de la carrera de Medicina / Gerontogeriatrics in the own course "Aging". Study plan "D" of the Medicine career

Fundamento: el sector cubano de salud, además de garantizar una atención médico-social al adulto mayor, tiene la misión de formar los recursos humanos especializados en esta área del conocimiento, desde el pregrado en las carreras de las ciencias médicas, y de forma continua y sostenida hasta el posgrado; por lo que se precisa observar el tratamiento de los contenidos relacionados con la Gerontogeriatría en los planes de estudio. Objetivo: caracterizar la representación de la Gerontogeriatría en el curso propio "Envejecimiento" del Plan de estudios "D" de la carrera de Medicina en Cuba. Métodos: se realizó una investigación educativa observacional, descriptiva. Se desarrolló una amplia revisión documental de los planes de estudio y el diseño del curso propio "Envejecimiento" del Plan de estudios "D", precisando el análisis de sus contenidos y su aporte a la Gerontogeriatría. Resultados: se constató que el curso permite la enseñanza de la Gerontología y Geriatría, diseñado con tres objetivos y cinco temas, y contenidos que favorecen la formación gerontogeriátrica en el desempeño de la función de atención médica integral al particular proceso salud enfermedad que se expresa en el adulto mayor. Conclusiones: la Gerontogeriatría está presente en el curso propio "Envejecimiento", representada fundamentalmente con este diseño académico en todo el vigente Plan de estudios "D".

Background: the Cuban health branch, in addition to guaranteeing medical-social care for the elderly, has the mission of training specialized human resources in this area of knowledge, from undergraduate in medical sciences careers, and continuously and sustained until postgraduate; Therefore, it is necessary to observe the treatment of the contents related to Gerontogeriatrics in the study plans. Objective: to characterize the representation of Gerontogeriatrics in the own course "Aging" of the Study Plan "D" of the Medicine career in Cuba. Methods: an observational, descriptive educational research was carried out. An extensive documentary review of the study plans and the design of the own course "Aging" of the Study Plan "D" was carried out, specifying the analysis of its contents and its contribution to Gerontogeriatrics. Results: it was verified that the course allows the teaching of Gerontology and Geriatrics, designed with three objectives and five topics, and contents that favor gerontology and geriatric training in the performance of the function of comprehensive medical attention to the particular health-disease process that is expressed in the elderly. Conclusions: Gerontogeriatrics is present in the own course "Aging", fundamentally represented with this academic design throughout the current Curriculum "D".

Epstein-Barr Virus and multiple sclerosis in a Spanish cohort: A two-years longitudinal study.

Objectives: 1. To analyze the prevalence and levels of anti-EBNA-1 and anti-VCA IgG antibodies of Epstein-Barr virus (EBV) in a Spanish cohort of multiple sclerosis (MS) patients and their interactions with other environmental and genetic risk factors. 2. To analyze the association of the evolution of these antibodies with the clinical response to different disease modifying therapies (DMTs) after two-years of follow-up. 3. To assess their possible correlation with the class II HLA alleles as well as with several SNPs identified in GWAS related to disease susceptibility. Materials and methods: We recruited 325 MS patients without DMT (serum samples were collected 1-3 months before starting a therapy) and 295 healthy controls (HC). For each patient we also collected serum samples 6, 12, 18 and 24 months after starting the DMT. EBNA-1 and VCA IgG titers were analyzed by ELISA; 25(OH)D levels were analyzed by immunoassay; HLA DRB1*15:01 allelic variant was analyzed by Taqman technology. Results: 1. 97.8% (318/325) vs. 87.1% (257/295) positives for EBNA-1 in MS patients and HC, respectively (p<0.0001; O.R. = 6.7); 99.7% (324/325) vs. 94.6% (279/295) for VCA in MS patients and HC, respectively (p=0.0001; O.R. = 18.6). All MS patients were positive for EBNA-1 and/or VCA IgG antibodies vs. 280/295 (94.9%) HC (p<0.0001). IgG titers were also significantly higher in MS patients than in HC. 2. We did not find any statistical correlation in the variation of the EBNA-1 and VCA IgG titers between baseline and 24 month visits with the number of relapses, progression, clinical response, NEDA-3 condition or therapeutic failure. 3. When we compared different epidemiological and clinical variables between those with genetic factors associated with lower EBNA-1 IgG titers and all other MS patients, we found MS started 3.5 years later among the first. Conclusions: These results confirm that MS occurs rarely in absence of EBV. An intriguing association between genetic burden and lower EBNA-1 IgG titers was associated with an earlier age of disease onset. Similar studies with B-cell-targeted therapies should be performed.

Anti-Human Herpesvirus 6 A/B Antibodies Titers Correlate With Multiple Sclerosis-Associated Retrovirus Envelope Expression.

Human endogenous retrovirus W family envelope proteins (pHERV-W ENV/syncytin-1) have been repeatedly associated with multiple sclerosis (MS). Here, we have focused on the study of pHERV-W ENV/syncytin-1 expression levels in MS patients (relapsing and progressive forms) and in healthy donors (HD) and on exploring their possible relationship with Epstein-Barr virus (EBV) and human herpesvirus-6A/B (HHV-6A/B). We included blood samples from 101 MS patients and 37 HD to analyze antiviral antibody titers by ELISA and pHERV-W ENV/syncytin-1 expression levels by flow cytometry as well as by qPCR. Patients with relapsing MS forms showed significantly higher pHERV-W ENV/syncytin-1 protein and gene expression levels than HD. Progressive MS patients also showed significantly higher protein and gene expression levels than both HD and relapsing MS patients. Regarding antiviral antibodies titers, anti-HHV-6A/B IgM levels were positively correlated with pHERV-W ENV/syncytin-1 protein expression levels in patients with relapsing MS, while in the progressive forms patients this correlation was found with anti-HHVA/B IgG levels. Therefore, pHERV-W ENV could be involved in MS pathogenesis, playing a role in relapsing and progressive forms. Besides, anti-HHV-6A/B antibodies positively correlated with pHERV-W ENV expression. Further studies are needed to better understand this possible relationship.

Software educativo de matemática para estudiantes de Vigilancia y Lucha Antivectorial / Mathematics educational software for Surveillance and Vector Control students

RESUMEN Introducción: el software educativo juega un rol importante en el proceso enseñanza aprendizaje en la Educación Médica Superior en Cuba. Es una valiosa herramienta que contribuirá de manera significativa al desarrollo del auto aprendizaje de la matemática. Objetivo: proponer un software educativo como recurso didáctico para el desarrollo del proceso de enseñanza aprendizaje de la asignatura matemática en la carrera de Vigilancia y Lucha Antivectorial. Métodos: se realizó un estudio de desarrollo tecnológico en el área de recursos para el aprendizaje en la Filial de Ciencias Médicas ¨Lidia Doce Sánchez¨ de Mayarí, en el período de enero del 2018 a junio del 2019. El universo estuvo constituido por 39 estudiantes de las carreras de Tecnología de la Salud y 18 profesores que les imparten docencia a estos estudiantes. La muestra fue de 27 estudiantes y cinco profesores que imparten la asignatura matemática, escogidos de forma intencional, se utilizaron métodos teóricos y dentro de los empíricos, el cuestionario, la técnica de lluvia de ideas y la observación. Se utilizó escala de actitud Likert. Resultados: se identificó la necesidad de la elaboración del recurso de aprendizaje para la asignatura matemática. Se diseñó un software educativo para el aprendizaje de los cuatro temas de la asignatura matemática con orientaciones metodológicas para su uso en las clases. Conclusión: el software educativo motiva el aprendizaje, eleva la calidad del proceso docente y estimulan la participación creadora de los estudiantes. Se recomienda la utilización del mismo y continuar su actualización y perfeccionamiento.

ABSTRACT Introduction: educational software plays an important role in the teaching-learning process in Higher Medical Education in Cuba. It is a valuable tool that will contribute significantly to the development of mathematics self-learning. Objective: to propose educational software as a didactic resource for the development of the teaching-learning process of the subject of mathematics in the profession of Surveillance and Vector Control. Methods: a technological development study was conducted in the area of learning resources at Lidia Doce Sánchez Medical Science Affiliate Institution of Mayarí, in the period from January 2018 to June 2019. The target group comprised 39 students of Health Technology Studies and 18 professors of these students and the sample included 27 students and 5 professors who teach the subject of mathematics, chosen intentionally. Theoretical methods were used, and among the empirical methods, the questionnaire, the brainstorming technique and observation. Likert Attitude Scale was used. Results: the need for the development of a learning resource for the subject of mathematics was identified. The educational software was designed for learning the four topics of the subject with methodological guidelines for its application in the program of study. Conclusion: the educational software motivates learning, raises the quality of the teaching process and stimulates the creative participation of students. It is recommended to use it and to continue its update and improvement.

Estrategia de actualización en búsqueda y recuperación de información científica para desarrollar habilidades informáticas / Update strategy in search and retrieval of scientific information to develop computer skills

RESUMEN Fundamento: la utilización de las tecnologías de la información y las comunicaciones en el primer año de la carrera de Medicina constituye una herramienta para desarrollar habilidades informáticas en cuanto a la búsqueda y recuperación de la información en salud. Objetivo: diseñar una estrategia de actualización en búsqueda y recuperación de información científica para desarrollar habilidades informáticas en el primer año de la carrera de Medicina. Métodos: se realizó un estudio de desarrollo en la Facultad de Ciencias Médicas de Holguín, se diseñó una estrategia con tres etapas: planificación, ejecución y evaluación. Para el estudio se seleccionó 220 estudiantes por muestreo aleatorio simple y de forma intencionada, a los profesores principales de las diferentes asignaturas que se imparten en el primer año de la carrera y los profesores de la disciplina Metodología de la Investigación en Salud. Resultados: se diseñó una estrategia de actualización en búsqueda y recuperación de información científica para desarrollar habilidades informáticas, en el primer año de la carrera de Medicina. La planificación para transmitir conocimientos básicos en la utilización del portal de Infomed y sus recursos. La ejecución se materializa con actividades teórico-prácticas referentes a la búsqueda y recuperación de información científica. En la tercera etapa se evalúo la actualización en búsqueda y recuperación de la información científica de forma integral. Conclusiones: con la estrategia se prepara a los estudiantes en la búsqueda y recuperación de la información científica, la cual desarrolla conocimientos y habilidades informáticas, según las exigencias del plan de estudio E en la carrera de Medicina.

ABSTRACT Background: the use of information and communication technologies in the first year of the Medicine career constitutes a tool to develop computer skills in search and retrieval of health information. Objective: to design an update strategy in search and retrieval of scientific information to develop computer skills in the first year of the Medicine degree. Methods: a development study was carried out at the Faculty of Medical Sciences of Holguín; a strategy was designed with three stages: planning, execution and evaluation. A sample of 220 students was selected by simple random sampling and intentionally, to the main teachers of the different subjects taught in the first year of the career and teachers of the discipline Health Research Methodology. Results: an update strategy was designed in search and retrieval of scientific information to develop computer skills in the first year of the Medicine degree. With three stages: Planning, execution and evaluation. Planning to transmit basic knowledge in the use of the Infomed portal and its resources. The execution is materialized with theoretical-practical activities related to the search and retrieval of scientific information. In the third stage, the updating in search and recovery of scientific information is evaluated in a comprehensive way. Conclusions: the strategy prepares students in the search and retrieval of scientific information, which develops computer knowledge and skills, according to the demands of study plan E in the Medicine degree.

Evolution of antibody titres against Epstein-Barr virus and human herpesvirus 6A/B and expression of multiple sclerosis-associated retrovirus in the serum of pregnant multiple sclerosis patients.

Epstein-Barr virus (EBV), human herpesvirus 6A/B (HHV-6A/B) and multiple sclerosis (MS)-associated retrovirus (MSRV) have been described as possible MS triggers. We analysed antibody titres against EBV and HHV-6, and MSRV envelope (env) mRNA expression, in the serum of pregnant multiple sclerosis patients (P-MS) to study their possible link to the clinical activity of MS during pregnancy and postpartum and their possible role as relapse predictors. For that purpose, serum samples were collected from 71 pregnant women (50 pregnant MS and 21 pregnant healthy controls-P-HC) during pregnancy and postpartum. Relating to antibody titres, IgM antibody titres against HHV-6A/B were significantly higher in P-MS than in P-HC both in each pregnancy trimester and in the postpartum period. Moreover, IgM antibody titres against HHV-6A/B were higher in P-MS who suffered a relapse during the postpartum. Regarding MSRV env mRNA expression, the prevalence in the first trimester of pregnancy was significantly higher in P-MS who suffered relapses during pregnancy. Summing it up, high IgM antibody titres against HHV-6A/B and MSRV env mRNA expression during the first trimester of pregnancy could act as relapse predictors for the gestation/postpartum periods.

Propuesta de guía para la evaluación conjunta del trabajo de curso en Metodología de la Investigación y Prevención en Salud / Guide proposal for the combined evaluation of the term paper in Methodology of investigation and Health prevention

Uno de los cambios más importantes en el perfeccionamiento de los planes de estudio es lograr una evaluación final más cualitativa e integradora en todas las disciplinas, donde se proyecten trabajos de curso interdisciplinarios. Por tanto, en la Facultad de Ciencias Médicas de Holguín se consideró oportuno unificar el trabajo de curso de las asignaturas Metodología de la Investigación y Prevención en Salud, lo que impone que los profesores de ambas materias actúen del mismo modo en la orientación, seguimiento y evaluación de esta actividad, motivo por el cual se elaboró una guía que facilita la orientación para el desarrollo del trabajo a los estudiantes y la uniformidad de criterios de los docentes para evaluar y disminuir la subjetividad al otorgar una calificación.

One of the most important changes in the syllabus improvement is to achieve a more qualitative and comprehensive final evaluation in all disciplines, where interdisciplinary term papers are projected. Therefore, it was considered opportune to unify the term papers of Methodology of Investigation and Health Prevention subjects in the Medical Sciencies Faculty of Holguín, what imposes that professors of both matters act in the same way towards the orientation, follow-up and evaluation of this activity, reason why a guide that facilitates the orientation for work development to the students and criteria uniformity in the teaching staff to evaluate and diminish the subjectivity when granting a qualification was elaborated.

Herpesvirus Antibodies, Vitamin D and Short-Chain Fatty Acids: Their Correlation with Cell Subsets in Multiple Sclerosis Patients and Healthy Controls.

Although the etiology of multiple sclerosis (MS) is still unknown, it is commonly accepted that environmental factors could contribute to the disease. The objective of this study was to analyze the humoral response to Epstein-Barr virus, human herpesvirus 6A/B and cytomegalovirus, and the levels of 25-hydroxyvitamin D (25(OH)D) and the three main short-chain fatty acids (SCFA), propionate (PA), butyrate (BA) and acetate (AA), in MS patients and healthy controls (HC) to understand how they could contribute to the pathogenesis of the disease. With this purpose, we analyzed the correlations among them and with different clinical variables and a wide panel of cell subsets. We found statistically significant differences for most of the environmental factors analyzed when we compared MS patients and HC, supporting their possible involvement in the disease. The strongest correlations with the clinical variables and the cell subsets analyzed were found for 25(OH)D and SCFAs levels. A correlation was also found between 25(OH)D and PA/AA ratio, and the interaction between these factors negatively correlated with interleukin 17 (IL-17)-producing CD4+ and CD8+ T cells in untreated MS patients. Therapies that simultaneously increase vitamin D levels and modify the proportion of SCFA could be evaluated in the future.

Predictive factors and early biomarkers of response in multiple sclerosis patients treated with natalizumab.

There are an increasing number of treatments available for multiple sclerosis (MS). The early identification of optimal responders to individual treatments is important to achieve individualized therapy. With this aim, we performed a multicenter retrospective longitudinal study including 186 MS patients treated with natalizumab who were followed for 2 years. We analyzed the following variables at recruitment: sex, current age, age at disease onset, disease duration, EDSS, number of T2 and Gd + lesions, IgG and IgM oligoclonal bands, HLA class II (DR, DRB, DQA, DQB, and DRB1*15:01), IgG and IgM antibody titers against human herpesvirus 6 (HHV-6) and the antibody response to Epstein-Barr virus (EBV) through the measurement of the anti-EBNA-1 and anti-VCA IgG titers, in relation to clinical response (no relapses or disability progression), and to NEDA-3 (no evidence of disease activity in terms of clinical response and no changes in MRI scans either) after 2-years follow-up. Baseline EDSS score, baseline EBNA-1 IgG titers and percentage change of HHV6 IgG titers between baseline and 6 month visits were significantly different in clinical responders and in NEDA-3 status (all of them remained significant in the multivariate analysis). We identified three variables for the early identification of natalizumab optimal responders in a rapid and cost-effective approach.

Utilización de la plataforma Moodle en la disciplina Informática Médica de la carrera de Medicina / Use of the Moodle platform in the Medical Computing discipline of the Medical degree

RESUMEN Fundamento: la plataforma Moodle es un software libre que permite organizar y gestionar el proceso enseñanza aprendizaje. Objetivo: describir el uso de la plataforma Moodle en la disciplina Informática Médica en la Facultad de Medicina "Mariana Grajales Coello" de Holguín. Métodos: se realizó un estudio descriptivo durante el curso 2018-2019. Se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción para los referentes teóricos del tema y la conformación del informe final de la investigación; empíricos: análisis documental y encuesta en forma de cuestionario a estudiantes de segundo año y profesores de la disciplina. Resultados: la utilización de la plataforma Moodle ha sido aprovechada por la mayoría de los profesores y estudiantes para organizar contenidos y actualizar bibliografía, se constató que existe un limitado conocimiento por los docentes de las herramientas que ofrece para la evaluación individual de forma interactiva. El poco equipamiento de medios informáticos en los laboratorios para alumnos, atenta contra su mejor aprovechamiento, aunque pueden utilizar sus tabletas y celulares para acceder a la mencionada plataforma. Conclusiones: la disciplina Informática Médica aprovecha las opciones que ofrece la plataforma Moodle para contribuir al perfeccionamiento del proceso enseñanza aprendizaje por las numerosas ventajas de su aplicación.

ABSTRACT Background: the Moodle platform is a free software that allows to organize and manage the teaching-learning process. Objective: to describe the use of the Moodle platform in the Medical Computing discipline at Mariana Grajales Coello School of Medicine of the Holguín province. Methods: a descriptive study was carried out during the 2018-2019 academic year. Theoretical methods were used: analysis-synthesis and induction-deduction for the theoretical references of the subject and the conformation of the final research report; Empirical ones: documentary analysis and survey in questionnaire form for second-year students and professors of the discipline. Results: the use of the Moodle platform has been used by the majority of professors and students to organize content and update bibliography, it was found that there is limited knowledge of the tools offered for individual interactive assessment by professors. The little equipment of computer media in laboratories for students, it affects its best use although they can use their tablets and cell phones to access to the aforementioned platform. Conclusions: the Medical Computing discipline takes advantage of the options offered by the Moodle platform to contribute to the improvement of the teaching-learning process due to the numerous advantages of its application.

A Polymorphism Within the MBP Gene Is Associated With a Higher Relapse Number in Male Patients of Multiple Sclerosis.

Myelin basic protein (MBP) is thought to be one of the key autoantigens in multiple sclerosis (MS) development. A recent study described the association of the single nucleotide polymorphism (SNP) rs12959006, within the MBP gene, with a higher risk of relapse and worse prognosis. We aim at studying potential associations of this SNP to MS in an independent population. Clinical data of the first 5 years of the disease were collected retrospectively from 291 MS confirmed patients. MBP polymorphism rs12959006 was genotyped in all patients. Associations with EDSS, number of relapses and serology for Herpesvirus 6 (HHV-6) and Epstein Barr (EBV) viruses were studied. Lymphocyte activation measured by CD69 expression was also analyzed according to sex and rs12959006 genotype. The rs12959006 polymorphism contributed significantly to a higher number of relapses at 5 years after onset only in male patients (rs12959006∗TT ß = 0.74 [0.36-1.09]; p = 7 × 10-5). Titers of anti-HHV6 IgG antibodies showed also a mild association with relapses, both in male and female patients (ß = 0.01 [0.01-0.02]; p = 3.7 × 10-8). Both the genetic variation in MBP and HHV-6 infection aid in predicting a higher number of relapses during the first years of MS. The association described in MBP rs12959006∗T is exclusive to male patients.

Alternativa didáctica para estimular el pensamiento creativo de los profesores y estudiantes / Didactic alternative to stimulate the creative thinking of teachers and students

RESUMEN Fundamento: actualizar de forma constante los métodos, procedimientos y vías para resolver problemas, cuyas soluciones constituyen estereotipos de la estadística inferencial, los cuales no estimulan el pensamiento creador de profesores y estudiantes. Objetivo: ilustrar a través de la resolución de problemas de la estadística inferencial como estimular el pensamiento creador de los profesores de Bioestadística y los estudiantes de la carrera de Medicina. Métodos: se emplean los métodos teóricos: análisis-síntesis, inducción-deducción y abstracción-concreción. Construcción de curvas de la distribución normal, procesos de comprensión, explicación e interpretación. Se aplican métodos, procedimientos y algoritmos matemáticos y estadísticos. Resultados: se elabora una alternativa didáctica para estimular el pensamiento creativo de los profesores y estudiantes de la carrera de Medicina, la cual ilustra la importancia del tema: Introducción a la inferencia estadística. Se integran y se sistematizan conceptos de variable aleatoria, distribución normal, probabilidad, dominio de aceptación, dominio de rechazo, estimaciones puntuales, entre otras. Conclusiones: mediante situaciones de salud a enfrentar por el Médico General en su quehacer profesional, en las cuales se evidencien las necesidades de interpretar los errores de primero y segundo género: α y β. Se consolidan los conocimientos y habilidades relacionadas con los conceptos abordados en el tema: introducción a la estadística inferencial, mediante programas informáticos profesionales se visualizan los resultados alcanzados, según la modelación y la simulación matemática.

ABSTRACT Background: constantly update the methods, procedures and ways to solve problems, whose solutions constitute stereotypes of the inferential statistics, which do not stimulate the creative thinking of teachers and students in general. Objective: to illustrate, through the resolution of problems of inferential statistics, how to stimulate the creative thinking of the Biostatistics professors and the students of the Medicine degree. Methods: the theoretical methods used are analysis-synthesis, induction-deduction and abstraction-concretion. Construction of curves of the normal distribution, comprehension processes, explanation and interpretation. Mathematical and statistical methods, procedures and algorithms are applied. Results: a didactic alternative is elaborated to stimulate the creative thought of the professors and students of the Medicine degree, which illustrates the importance of the topic: Introduction to the statistical inference. Concepts of random variable, normal distribution, probability, acceptance domain, rejection domain, point estimates, among others, are integrated and systematized. Conclusions: health situations are created to be faced by the General Practitioner in his professional work that evidences the needs to interpret the errors of first and second gender: α and β. The knowledge and skills related to the concepts addressed in the subject are consolidated: Introduction to Inferential Statistics, through professional computer programs visualize the results achieved, according to modeling and mathematical simulation.

La enseñanza problémica y el desarrollo del razonamiento en la disciplina Informática Médica / The problem teaching method and the development of reasoning in the Medical Informatics Discipline

Introducción: En el proceso de enseñanza aprendizaje de la disciplina Informática Médica es necesario utilizar métodos de enseñanza dirigidos a la comprensión consciente de los diferentes contenidos y al desarrollo del razonamiento en los estudiantes. Los métodos de la enseñanza problémica estén dirigidos a estimular y desarrollar los procesos lógicos del pensamiento, por lo que se requiere la utilización de los mismos. Objetivo: Diseñar acciones para la utilización de la enseñanza problémica en el proceso de enseñanza aprendizaje de la disciplina Informática Médica. Método: Se realizó una investigación de desarrollo en la Facultad de Ciencias Médicas de Holguín, de septiembre a diciembre del 2017. Se aplicaron métodos teóricos para fundamentar el problema. Se utilizaron métodos del nivel teórico, así como el análisis de documentos de diferentes informes. Dentro de los métodos empíricos se utilizó la observación y la encuesta. Resultados: Se expone la esencia de los métodos problémicos: la exposición problémica, la búsqueda parcial, la conversación heurística y el método investigativo. Se propone un conjunto de acciones para utilizar los métodos de la enseñanza problémica en el proceso de enseñanza aprendizaje de la disciplina Informática Médica. Conclusiones: Para lograr que los estudiantes adquieran formas adecuadas de razonamiento en la solución de situaciones de salud se requiere el empleo de métodos activos de apropiación del conocimiento, que permitan que el estudiante alcance niveles de asimilación productivos(AU)

Introduction: In the teaching-learning process of the Medical Computer discipline it is necessary to use teaching methods aimed at the conscious understanding of the different contents and the development of reasoning in the students. The methods of problem teaching are aimed at stimulating and developing the logical processes of thought, so the use of them is required. Objective: Design actions for the use of problem teaching in the teaching-learning process of the Medical Informatics discipline. Method: A development research was carried out in the Faculty of Medical Sciences of Holguin, from September to December 2017. Theoretical methods were applied to support the problem. Methods of the theoretical level were used, as well as the analysis of documents from different reports. Within the empirical methods, observation and survey were used. Results: The essence of the method is exposed: the exposition, the partial search, the heuristic conversation and the investigative method. A set of actions is proposed to use the methods of problem teaching in the teaching-learning process of the Medical Informatics discipline. Conclusions: In order to achieve adequate forms of reasoning in the solution of health situations, the use of active methods of appropriation of knowledge is required, which allows the student to achieve productive assimilation levels(AU)

Study of the anti-JCV antibody levels in a Spanish multiple sclerosis cohort.

BACKGROUND: One of the risk factor to develop progressive multifocal leukoencephalopathy (PML) among natalizumab-treated patients is the presence and high levels of anti-JCV antibodies. Our purpose was to test the association of different clinical and demographic variables with the presence and levels of anti-JCV antibodies in a Spanish cohort of patients with multiple sclerosis (MS) during natalizumab treatment. MATERIALS AND METHODS: All patients with MS from two hospitals with at least one measure of the anti-JCV antibodies levels (2011-2014) were recruited, among them were two PML cases. Anti-JCV antibody levels were assessed using two-step ELISA. RESULTS: A total of 1061 patients (16·3% natalizumab-treated) participated in this study. The seropositivity rate of anti-JCV antibodies was 58·2%. It increased with age (Pcorrected = 0·00005) and was lower among HLA-DRB1*15:01 carriers (Pcorrected = 0·049). The two patients with PML were HLA-DRB1*15:01 carriers. We had at least three quarterly anti-JCV antibody measurements (index value) from 137 patients, whose levels did not increase during natalizumab treatment. However, 5·8% of these patients had an increase of the index value higher of one point in a maximum of 6 months, something that was more frequently observed (P = 0·054) among patients treated with immunosuppressant prior to natalizumab onset. CONCLUSIONS: Old age and HLA-DRB1*15:01 were the factors that influence positively and negatively, respectively, our anti-JCV antibody prevalence, although our both PML cases were HLA-DRB1*15:01carriers. Most of our patients showed a stable anti-JCV antibody index values during natalizumab treatment.

Papel de la Informática Médica en el desarrollo de las formas lógicas del pensamiento / Medical Informatics role in the development of logical forms of thinking

El desarrollo de las formas lógicas es un elemento fundamental a tener en cuenta en el proceso de enseñanza aprendizaje de la disciplina Informática Médica en la formación del médico general. Esta disciplina, compuesta por dos asignaturas Informática y Metodología de la Investigación y Estadística brinda un conjunto de métodos y procedimientos que permiten el análisis y la interpretación de los datos derivados en las investigaciones médicas, por lo que contribuye a desarrollar las formas lógicas del pensamiento: conceptos, juicios y razonamientos. Desde una concepción desarrolladora, el proceso de enseñanza aprendizaje de la Informática Médica, requiere el empleo de métodos de enseñanza problémicos, así como un enfoque interdisciplinario en la impartición del contenido. Se precisa además, determinar la significación de los contenidos en la práctica médica y la utilización de las etapas del método clínico epidemiológico debido a la analogía que presenta con el método científico, para contribuir al desarrollo de las habilidades en la solución de los problemas de salud del individuo, la familia y la comunidad(AU)

The development of logical forms of thinking is a key element to consider in the process of learning of the discipline Medical Informatics in the formation of the general practitioner. This discipline, consisting of two subjects: Computer and Research Methodology and Statistics provides a set of methods and procedures for the analysis and interpretation of data derived in medical research, which helps develop logical forms of thought: concepts, judgments and reasoning. From a concept developer, the process of learning of Medical Informatics requires the use of problem teaching methods and an interdisciplinary approach in the delivery of content. It is also necessary to determine the significance of the contents in the medical practice and the utilization of the stages of clinical epidemiological method because of the analogy that comes with the scientific method, to help develop skills in solving health problems the individual, family and community(AU)

Dificultad y discriminación de los ítems del examen de Metodología de la Investigación y Estadística / Difficulty and discrimination of the items of the exams of Research Methodology and Statistics

Fundamento: la evaluación del aprendizaje es un proceso consustancial al desarrollo del proceso docente educativo que permite su regulación y retroalimentación. Objetivo: valorar el comportamiento del índice de dificultad y del coeficiente de discriminación en los ítems del examen final de la asignatura Metodología de la Investigación y Estadística. Métodos: se realizó una investigación descriptiva en la Universidad de Ciencias Médicas de Holguín durante el curso 2010-2011. El universo de estudio estuvo constituido por el total de exámenes finales ordinarios de la asignatura Metodología de la Investigación y Estadística del cual se seleccionó una muestra intencionada de 276 exámenes. Se utilizaron como método teóricos: análisis-síntesis e inducción-deducción, y empíricos: análisis documental y encuesta en forma de entrevista a seis informantes clave. Se analizó la correspondencia del fondo de tiempo y la cantidad de ítems explorados en el examen, se calculó el índice de dificultad y el coeficiente de correlación del punto biserial de los ítems del examen. Resultados: se evidenció la no correspondencia entre el tiempo dedicado a cada tema y la cantidad de ítems explorados, la cantidad de ítems fáciles superó ligeramente el porciento esperado, discriminaron de forma excelente la mayoría de los ítems. Conclusiones: la valoración de los indicadores aplicados demostró predominio de los ítems de dificultad media y de excelente poder discriminativo. Los ítems que no discriminaron de forma adecuada coincidieron en ser clasificados como fáciles, con dificultades en su elaboración y nivel de asimilación reproductivo.

Background: the evaluation of learning is an inherent process of the development of the educational-teaching process that allows its regulation and feedback. Objective: to value the behavior of the index of difficulty and the discrimination coefficient in the items of the final exam of the subject Research Methodology and Statistics. Methods: it was carried out an educational research work in Holguín University of Medical Sciences during the academic year 2010-2011. The study universe was constituted by the total of ordinary final exams of the subject Research Methodology and Statistics, on purposive sampling 276 exams were selected. There were used as theoretical method: analysis-synthesis and induction-deduction, and empiric ones: documental analysis, the survey in interview form was applied to six key informants. The correspondence between the duration of the exam and the quantity of items explored in the exam was analyzed, it was calculated the index of difficulty and the coefficient of correlation of the difficulty level of the items exam. Results: it was evidenced the non correspondence between the time dedicated to each topic and the quantity of explored items, the quantity of easy items overcame the expected percent lightly. There were discriminated in an excellent way most of the items. Conclusions: the valuation of the applied indicators demonstrated prevalence of the items of average difficulty and excellent discriminatory power. The items that were not discriminated in an appropriate way coincided with those classified as easy, with difficulties in their elaboration and reproductive level of assimilation.