La gestión para la evaluación de las competencias en la formación del profesional de Cultura Física

La evaluación, como categoría didáctica en el proceso de enseñanza-aprendizaje de la carrera Licenciatura en Cultura Física y Deporte, enfrenta desafíos que obligan a los diferentes colectivos pedagógicos a proyectar acciones que le permitan una visión contextualizada e integral de la misma. La unidad del sistema de influencias educativas es una necesidad para la evaluación formativa, compartida, personalizada, centrada en evidencias de conocimiento, de producto y de desempeño en la formación y desarrollo de competencias en esta Carrera. El objetivo del trabajo es valorar el proceso evaluativo integrador de las competencias, en los estudiantes de la Práctica Laboral Investigativa de tercer año, de la Carrera de licenciatura en Cultura Física y Deporte, a través de la disciplina principal integradora Formación Laboral Investigativa. Para ello, se aplicaron métodos de investigación empíricos, como el análisis de documentos, la entrevista y la observación. Los resultados permitieron fundamentar una propuesta metodológica que potencie la evaluación integradora, sobre la base el enfoque integral físico-educativo, en el proceso de estudio. El diseño de los resultados fue de tipo experimental, en su variante pre-experimento. La aplicación parcial de la propuesta validó su pertinencia y contribuyó de forma favorable al mejoramiento del desempeño profesional y humano de los que participan.

A avaliação, como categoria didática no processo de ensino-aprendizagem do curso de Bacharelado em Cultura Física e Esporte, enfrenta desafios que obrigam os diferentes coletivos pedagógicos a planejar ações que permitam uma visão contextualizada e integral da mesma. A unidade do sistema de influências educacionais é uma necessidade para a avaliação formativa, compartilhada e personalizada, focada na evidência de conhecimento, produto e desempenho na formação e no desenvolvimento de competências nesse curso de graduação. O objetivo do estudo é avaliar o processo de avaliação integrativa das competências dos alunos do terceiro ano do Estágio de Pesquisa no Bacharelado em Cultura Física e Esporte, por meio da principal disciplina integrativa do Estágio de Pesquisa. Para isso, foram aplicados métodos de pesquisa empírica, como análise de documentos, entrevista e observação. Os resultados permitiram fundamentar uma proposta metodológica que aprimora a avaliação integrativa, com base na abordagem físico-educacional integral, no processo de estudo. O desenho dos resultados foi experimental, em sua variante pré-experimental. A aplicação parcial da proposta validou sua relevância e contribuiu favoravelmente para a melhoria do desempenho profissional e humano dos envolvidos.

Evaluation, as a didactic category in the teaching-learning process of the Bachelor's Degree in Physical Culture and Sports, faces challenges that force the different pedagogical groups to project actions that allow a contextualized and comprehensive vision of it. The unity of the system of educational influences is a necessity for formative, shared, personalized evaluation, focused on evidence of knowledge, product and performance in the training and development of competencies in this Career. The objective of the work is to assess the integrative evaluative process of the competencies, in the students of the third-year Investigative Work Practice, of the Bachelor's Degree in Physical Culture and Sports, through the main integrative discipline Investigative Work Training. To achieve this, empirical research methods were applied, such as document analysis, interviews and observation. The results allowed to base a methodological proposal that enhances the integrative evaluation, based on the comprehensive physical-educational approach, in the study process. The design of the results was experimental, in its pre-experiment variant. The partial application of the proposal validated its relevance and contributed favorably to the improvement of the professional and human performance of those who participate.

Modelación de los flujos de pacientes de alto riesgo con COVID-19 en Matanzas con enfoque Lean

Introducción: En el contexto de la pandemia, la gestión eficiente de los flujos de pacientes con enfoque en su trayectoria es crucial. En este sentido, el enfoque Lean permite aumentar el rendimiento del sistema sanitario, al eliminar actividades que no generan valor al paciente. Objetivo: Realizar un análisis integral de los flujos de pacientes de alto riesgo con COVID-19 en Matanzas, utilizando el enfoque Lean. Materiales y métodos: Se implementó una metodología de tipo cuantitativa, estructurada en cuatro etapas, para la gestión integrada de los flujos de pacientes de alto riesgo con COVID-19, mediante el enfoque Lean. Esta metodología integra herramientas para la selección de expertos, representación de procesos, análisis estructural y mapas de flujos de valor. Se aplicó durante del período de mayor incidencia de la pandemia en Matanzas (1 de mayo al 1 de agosto de 2021). Resultados: Se identificaron deficiencias relacionadas con los flujos de pacientes de alto riesgo con COVID-19 en Matanzas. Se realizó un análisis integral de los flujos, con el fin de realizar una propuesta de mejoras con enfoque Lean. La propuesta garantizó una optimización de 1510 minutos por ciclos de atención, con una eficiencia del 85,86 % del tiempo total de cada ciclo (etapa del tratamiento), y del 59,38 % de los tiempos de espera entre ellos. Conclusiones: Las herramientas Lean permiten realizar un análisis integral de los flujos de pacientes, además de mostrar una vía para su gestión, centrada en la trayectoria y no en la ocupación del recurso.

Introduction: In the context of the pandemic, the efficient management of the patients flow with a focus on their trajectory is crucial. In this sense, the Lean approach allows to increase the performance of the health care system, eliminating activities that do not generate value for the patient. Objective: To carry out an integral analysis of the high risk patients flow with COVID-19 in Matanzas, using the Lean approach. Materials and methods: A quantitative methodology, structured in four stages was implemented for the integrated management of the flow of high risk patients with COVID-19, using the Lean approach. This methodology integrates tools for the selection of experts, process representation, structural analysis and value flow maps. It was applied during the period of highest incidence of the pandemic in Matanzas (May 1st to August 1st 2021). Results: Deficiencies related to the flows of high risks patients with COVID-19 in Matanzas were identified. A comprehensive analysis of the flows was carried out in order to make a proposal for improvements with a Lean approach. The proposal guaranteed an optimization of 1 500 minutes per service cycle, with an efficiency of 85.86% of the total time of each cycle (treatment stage), and 59.38% of the waiting times between them. Conclusions: Lean tools allow a comprehensive analysis of the patients' flow, in addition to showing a route for their management, focused on the trajectory and not on the occupation of the resource.

Implications of the Circular Economy in the Context of Plastic Recycling: The Case Study of Opaque PET.

The use of recycled opaque PET (r-O-PET, with TiO2) as a reinforcement for the recycled polypropylene matrix (r-PP) was evaluated through the life cycle assessment according to different scenarios corresponding to two different recycled blends and considered two virgin raw plastic material as reference materials when comparing the environmental performance of the proposed treatments. The results indicate that the environmental performance was quite different for each blend, since the additional extrusion process required in scenario 2 (blend with TiO2) causes all impact categories analysed to report higher values when compared with scenario 1 (blend without TiO2). The stage that contributes the most corresponds to the different extrusion processes included in both recycling blends, representing at least 80% of the total for global warming. Compared with virgin raw materials, the blend with TiO2 showed better performance in all the impact categories analysed in comparison with virgin PA66, while the blend without TiO2 showed the opposite trend when compared to PP. Furthermore, the fact that the upcycling treatment was carried out on a pilot scale provides room for improvement when implemented on a full scale. It is worth noting the high energy consumption of the treatment processes and their associated cost, in addition to the market cost of virgin raw materials, however, when considering the environmental cost of raw materials, it is observed that when substituting virgin materials PP and PA66 for the blends evaluated in this study results in a reduction of the environmental price of up to 2.5 times.

Extruded-Calendered Sheets of Fully Recycled PP/Opaque PET Blends: Mechanical and Fracture Behaviour.

This work presents the experimental results of the mechanical and fracture behaviour of three polymeric blends prepared from two recycled plastics, namely polypropylene and opaque poly (ethylene terephthalate), where the second one acted as a reinforcement phase. The raw materials were two commercial degrees of recycled post-consumer waste, i.e., rPP and rPET-O. Sheets were manufactured by a semi-industrial extrusion-calendering process. The mechanical and fracture behaviours of manufactured sheets were analyzed via tensile tests and the essential work of fracture approach. SEM micrographics of cryofractured sheets revelated the development of in situ rPP/rPET-O microfibrillar composites when 30 wt.% of rPET-O was added. It was observed that the yield stress was not affected with the addition of rPET-O. However, the microfibrillar structure increased the Young's modulus by more than a third compared with rPP, fulfilling the longitudinal value predicted by the additive rule of mixtures. Regarding the EWF analysis, the resistance to crack initiation was highly influenced by the resistance to its propagation owing to morphology-related instabilities during tearing. To analyze the initiation stage, a partition energy method was successfully applied by splitting the total work of fracture into two specific energetic contributions, namely initiation and propagation. The results revelated that the specific essential initiation-related work of fracture was mainly affected by rPET-O phase. Remarkably, its value was significantly improved by a factor of three with the microfibrillar structure of rPET-O phase. The results allowed the exploration of the potential ability of manufacturing in situ MFCs without a "precursor" morphology, providing an economical way to promote the recycling rate of PET-O, as this material is being discarded from current recycling processes.

Insight Into the Ontogeny of GnRH Neurons From Patients Born Without a Nose.

CONTEXT: The reproductive axis is controlled by a network of gonadotropin-releasing hormone (GnRH) neurons born in the primitive nose that migrate to the hypothalamus alongside axons of the olfactory system. The observation that congenital anosmia (inability to smell) is often associated with GnRH deficiency in humans led to the prevailing view that GnRH neurons depend on olfactory structures to reach the brain, but this hypothesis has not been confirmed. OBJECTIVE: The objective of this work is to determine the potential for normal reproductive function in the setting of completely absent internal and external olfactory structures. METHODS: We conducted comprehensive phenotyping studies in 11 patients with congenital arhinia. These studies were augmented by review of medical records and study questionnaires in another 40 international patients. RESULTS: All male patients demonstrated clinical and/or biochemical signs of GnRH deficiency, and the 5 men studied in person had no luteinizing hormone (LH) pulses, suggesting absent GnRH activity. The 6 women studied in person also had apulsatile LH profiles, yet 3 had spontaneous breast development and 2 women (studied from afar) had normal breast development and menstrual cycles, suggesting a fully intact reproductive axis. Administration of pulsatile GnRH to 2 GnRH-deficient patients revealed normal pituitary responsiveness but gonadal failure in the male patient. CONCLUSIONS: Patients with arhinia teach us that the GnRH neuron, a key gatekeeper of the reproductive axis, is associated with but may not depend on olfactory structures for normal migration and function, and more broadly, illustrate the power of extreme human phenotypes in answering fundamental questions about human embryology.

Pensamiento de Fidel vigente en el estudiantado de ciencias médicas

El pensamiento de Fidel ha sido guía estratégica para el desarrollo de la educación médica cubana. Su estudio permanente constituye premisa inexcusable para el logro de una formación de Recursos Humanos en Salud con calidad y pertinencia. Se realizó un estudio socio histórico del pensamiento de Fidel sobre el proceso docente educativo en el área de la educación médica por la vía del análisis de contenido de discursos e intervenciones de Fidel Castro Ruz realizadas entre 1959 y el 2006, con el objetivo de analizar el pensamiento de Fidel como referente para el desarrollo de la educación médica y del capital humano en el Sistema Nacional de Salud cubano. Se tomó como referencia un trabajo realizado por un grupo de profesores expertos del comité académico de la Maestría en Educación Médica de la Escuela Nacional de Salud Pública. Se presentaron los pronunciamientos seleccionados en los 12 discursos e intervenciones de Fidel relacionados con el proceso docente educativo en la Educación Médica, así como las ideas básicas, a partir de las cuales se elaboró la idea integradora y se establecieron las acciones necesarias para garantizar su cumplimiento en la práctica educativa. El pensamiento de Fidel vinculado al desarrollo del proceso docente educativo en la educación médica superior, contribuyó al incremento de la calidad y la pertinencia de los procesos formativos en la Educación Médica Cubana.

Fidel's thinking has been a strategic guide for the development of Cuban medical education. Its permanent study constitutes an inexcusable premise for the achievement of a Human Resources in Health training with quality and relevance. A socio-historical study of Fidel's thinking on the educational teaching process in the area of ​​medical education was conducted through the analysis of the content of speeches and interventions by Fidel Castro Ruz made between 1959 and 2006, with the aim of analyzing the Fidel thought as a reference for the development of medical education and human capital in the Cuban National Health System. A work carried out by a group of expert professors from the academic committee of the Master in Medical Education of the National School of Public Health was taken as a reference. The pronouncements selected in the 12 speeches and interventions of Fidel related to the educational teaching process in Medical Education were presented, as well as the basic ideas, from which the integrative idea was elaborated and the necessary actions were established to ensure compliance In educational practice. Fidel's thinking, linked to the development of the educational teaching process in higher medical education, contributed to the increase in the quality and relevance of the training processes in Cuban Medical Education.

O pensamento de Fidel tem sido um guia estratégico para o desenvolvimento da educação médica cubana. Seu estudo permanente constitui uma premissa indesculpável para a realização de um treinamento de Recursos Humanos em Saúde com qualidade e relevância. Um estudo sócio-histórico do pensamento de Fidel sobre o processo de ensino educacional na área da educação médica foi realizado através da análise do conteúdo dos discursos e intervenções de Fidel Castro Ruz, realizados entre 1959 e 2006, com o objetivo de analisar a Fidel pensou como uma referência para o desenvolvimento da educação médica e do capital humano no Sistema Nacional de Saúde de Cuba. Um trabalho realizado por um grupo de professores especialistas do comitê acadêmico do Mestrado em Educação Médica da Escola Nacional de Saúde Pública foi tomado como referência. Foram apresentados os pronunciamentos selecionados nos 12 discursos e intervenções de Fidel relacionados ao processo de ensino educacional em Educação Médica, bem como as idéias básicas, a partir das quais a ideia integradora foi elaborada e as ações necessárias para garantir a conformidade Na prática educacional. O pensamento de Fidel, vinculado ao desenvolvimento do processo de ensino educacional no ensino superior médico, contribuiu para o aumento da qualidade e relevância dos processos de treinamento no ensino médico cubano.

Factores de riesgo coronario modificables en el servicio de enfermería del Hospital General Universitario V. I. Lenin. Noviembre 2016- Noviembre 2018 / Modifiable coronary risk factors in the nursing service of the University General Hospital V. I. Lenin. November 2016- November 2018 / Fatores de risco coronariano modificáveis no serviço de enfermagem do Hospital Geral da Universidade V. I. Lenin. Novembro de 2016 - novembro de 2018

RESUMEN La cardiopatía isquémica es la enfermedad más común, grave y de mayor riesgo en términos de mortalidad, morbilidad en gran parte del mundo, contribuyendo una serie de factores, que se relacionan con un riesgo aumentado de padecer dicha enfermedad. Se realizó un estudio transversal durante el período comprendido entre el 1ro de noviembre del 2016 al 1ro de noviembre del 2018 con el objetivo de contribuir al conocimiento de los factores de riesgo coronario modificables en enfermeros(as) del Hospital General Universitario "V. I. Lenin". Se trabajaron con variables principales: el tabaquismo, la obesidad, la hipertensión arterial, la diabetes mellitus, la dieta rica en grasas saturadas, la dislipidemia, el sedentarismo y la tensión emocional mantenida. El dato primario se obtuvo a través de la entrevista, el examen físico, y la determinación de lípidos en sangre. Se estudiaron variables sociodemográficas y biomédicas generales. Dentro de los factores de riesgo prevalecieron la tensión emocional mantenida 88,5 %, la dieta rica en grasa saturada 86,0 % y el sedentarismo para 82,0 %. En un porcentaje menor se mostraron la obesidad 49,0 % y la dislipidemia para 44,0 %. Se destaca que en una importante proporción de casos coexistían dos y tres factores de riesgo a la vez. Es elevado el riesgo cardiovascular como consecuencia de la alta prevalencia de los factores de riesgo coronario encontrados.

ABSTRACT Ischemic heart disease is the most common disease, serious and most at risk in terms of mortality, morbidity in much of the world, contributing a number of factors, which are related to an increased risk of suffering from such disease. A cross-sectional study was conducted during the period from November 1, 2016 to November 1, 2018 with the objective of contributing to the knowledge of the modifiable coronary risk factors in nurses of the General University Hospital "V. I. Lenin" They worked with main variables: smoking, obesity, high blood pressure, diabetes mellitus, diet high in saturated fat, dyslipidemia, sedentary lifestyle and sustained emotional tension. The primary data was obtained through the interview, physical examination, and blood lipid determination. General sociodemographic and biomedical variables were studied. Among the risk factors, the emotional tension maintained 88.5%, the diet rich in saturated fat 86.0% and the sedentary lifestyle prevailed for 82.0%. In a smaller percentage, obesity was 49.0% and dyslipidemia for 44.0%. It is emphasized that in a significant proportion of cases two and three risk factors coexisted at the same time. The cardiovascular risk is high as a consequence of the high prevalence of the coronary risk factors found.

RESUMO A cardiopatia isquêmica é a doença mais comum, mais grave e de maior risco em termos de mortalidade, morbidade em grande parte do mundo, contribuindo com vários fatores relacionados ao aumento do risco de sofrer dessa doença. Foi realizado um estudo transversal no período de 1º de novembro de 2016 a 1º de novembro de 2018, com o objetivo de contribuir para o conhecimento dos fatores de risco coronariano modificáveis ​​em enfermeiros do Hospital Universitário Geral "V. I. Lenin. " Eles trabalharam com as principais variáveis: tabagismo, obesidade, pressão alta, diabetes mellitus, dieta rica em gordura saturada, dislipidemia, estilo de vida sedentário e tensão emocional sustentada. Os dados primários foram obtidos através da entrevista, exame físico e determinação de lipídios no sangue. Foram estudadas variáveis ​​sociodemográficas e biomédicas gerais. Entre os fatores de risco, a tensão emocional manteve 88,5%, a dieta rica em gordura saturada 86,0% e o sedentarismo prevaleceu em 82,0%. Em porcentagem menor, a obesidade foi de 49,0% e a dislipidemia, 44,0%. Enfatiza-se que em uma proporção significativa de casos, dois e três fatores de risco coexistem ao mesmo tempo. O risco cardiovascular é alto como consequência da alta prevalência dos fatores de risco coronariano encontrados.

Equilibrio Ácido Base en el Adulto Mayor / Acid-Base Balance in the Elderly

Resumen El envejecimiento es un proceso fisiológico caracterizado por el deterioro progresivo de las funciones orgánicas, en el que la capacidad de adaptación y la respuesta a una situación de estrés se encuentra reducida. Las alteraciones en el equilibrio ácido-base representan un hito poco comprendido en el adulto mayor, los efectos per se a edad avanzada en órganos como el hígado, pulmón y riñón, asociados al consumo de polifarmacia, representan la causa de estas alteraciones. Se realizó una revisión no sistemática de la literatura por medio de las bases de datos PubMed y los portales SciELO y SpringerLink. Para integrar la presente revisión y análisis, se identificaron aquellos estudios científicos que proponían explicar los cambios renales y pulmonares asociados a la edad, y con efecto en la homeostasis ácido-base.

Abstract Aging is a physiological process characterized by progressive deterioration of organ functions, where the ability to adapt and respond to a stressful situation is reduced. Acid-base disorders represent a milestone little understood in the elderly. Being associated with polypharmacy, the effects per se of advanced age in organs such as liver, lung and kidney are the cause of these alterations. A non-systematic review of literature was carried out through the PubMed database and the SciELO and SpringerLink portals. To integrate these review and analysis, we identified those scientific studies that proposed an explanation of renal and pulmonary changes associated with age and having an effect on acid-base homeostasis.

Remodelado estructural y riesgo de recurrencia en la fibrilación auricular / Structural remodeling and risk of recurrence in atrial fibrillation / Remodelação estrutural e risco de recidiva na fibrilação atrial

RESUMEN La fibrilación auricular es la disrritmia sostenida más frecuente del pasado siglo; con el fin de caracterizar el riesgo de recurrencia de la fibrilación auricular y su relación con el remodelado estructural cardiaco, se realizó un estudio descriptivo de serie de casos, en el Hospital Vladimir Ilich Lenin, en el año 2017. El análisis de la información referida a 100 pacientes con diagnóstico de fibrilación auricular identificó los resultados siguientes: de los pacientes estudiados 41 (54.7%) fueron del sexo femenino y mayor de 55 años; los indicadores del índice pronóstico prevalecieron en el riesgo elevado de recurrencia; el riesgo de recurrencia elevado en válvulopatas mitrales con predominio de la estenosis mitral alcanzo el 40.7% de los pacientes, así como la dilatación de la aurícula izquierda en este mismo grupo, con un total de 22 pacientes (81.4%). Un total de 15 pacientes, que representó el 55.6 %, tuvieron una fracción de eyección del ventrículo izquierdo disminuida con un riesgo de recurrencia elevado. El mayor por ciento de los pacientes presentaron un valor de p significativo y muy significativo; y por último el 22 % de los pacientes con riesgo elevado de recurrencia presentaron remodelado estructural cardiaco. Se concluyó que la afección estudiada predominó en pacientes mayores de 55 años, del sexo femenino, con riesgo elevado de recurrencia en relación con los indicadores del índice pronostico y predictores del remodelado estructural, lo que justifica la hipótesis alternativa, con un elevado valor clínico y estadístico.

ABSTRACT Atrial fibrillation is the most frequent sustained dysrhythmia of the past century; In order to characterize the risk of recurrence of atrial fibrillation and its relationship with cardiac structural remodeling, a descriptive study of a series of cases was conducted at the Vladimir Ilich Lenin Hospital in 2017. The analysis of the referred information 100 patients diagnosed with atrial fibrillation identified the following results: of the patients studied, 41 (54.7%) were female and over 55 years old; the indicators of the prognostic index prevailed in the high risk of recurrence; the risk of high recurrence in mitral valvelets with predominance of mitral stenosis reached 40.7% of patients, as well as dilation of the left atrium in this same group, with a total of 22 patients (81.4%). A total of 15 patients, who represented 55.6%, had a decreased left ventricular ejection fraction with a high risk of recurrence. The highest percent of patients presented a significant and very significant p value; and finally, 22% of the patients with high risk of recurrence presented structural cardiac remodeling. It was concluded that the studied condition predominated in patients over 55 years old, female, with a high risk of recurrence in relation to the indicators of the prognostic index and predictors of structural remodeling, which justifies the alternative hypothesis, with a high clinical value and statistical.

RESUMO A fibrilação atrial é a arritmia sustentada mais comum século passado; a fim de caracterizar o risco de recorrência de fibrilação atrial e a sua relação com a remodelação cardíaca estrutural, uma série de casos descritiva foi realizado no Hospital Lênin Vladimir Ilich em 2017. A análise das informações referidas 100 pacientes diagnosticados com fibrilação atrial identificados os seguintes resultados: 41 dos pacientes (54,7%) eram do sexo feminino e 55 do sexo mais; os indicadores do índice prognóstico prevaleceram no alto risco de recidiva; o alto risco de recorrência em válvulopatas mitral lojas atingiu estenose mitral com 40,7% dos pacientes e dilatação do átrio esquerdo do mesmo grupo, com um total de 22 pacientes (81,4%). Um total de 15 doentes, correspondendo a 55,6%, tinha uma fracção de ejecção do ventrículo esquerdo diminuída com um risco elevado de recidiva. O maior percentual de pacientes apresentou valor p significativo e muito significativo; e, finalmente, 22% dos pacientes com alto risco de recorrência mostrou remodelação cardíaca estrutural. Concluiu-se que a condição estudada predominaram em pacientes com mais de 55 anos de idade, do sexo feminino, com alto risco de recorrência em relação ao índice de indicadores de prognóstico e preditores de remodelação estrutural, o que justifica a hipótese alternativa, com um valor clínico de alta e estatística.

Fluidoterapia intravenosa guiada por metas / Intravenous fluid therapy guided by goals

Resumen La fluidoterapia es la primera maniobra realizada por el médico al estar en contacto con un paciente al que se pretende incrementar la volemia, la administración del tipo de solución parenteral, la cantidad y la duración en su aplicación es el reto del intensivista. En la actualidad el monitoreo hemodinámico ha tenido un importante avance tecnológico, al ser mínimamente invasivo y con constantes no sólo estáticas sino dinámicas, lo que ha permitido mejorar la toma de decisiones médicas en el paciente críticamente enfermo. Esta revisión no sistemática tiene como objetivo proporcionar una actualización de las mediciones que son consideradas nuevas herramientas ante viejos paradigmas en el monitoreo hemodinámico.

Abstract Fluid therapy is the first maneuver performed by the physician to be in contact with a patient who is intended to increase the volemia, the administration of parenteral solution type, the amount and duration in its application is the challenge of the intensivist. Currently the hemodynamic monitoring has undergone an important technological advance, being minimally invasive and with not only static but also dynamic constants, they have allowed to improve the medical decision making in the critically ill patient. The present non-systematic review aims to provide an update on measurements that are considered new tools before old paradigms in hemodynamic monitoring.

[Nevus lipomatosus cutaneous superficialis. Report of four cases including an unusual presentation associated with massive lipomas and diffuse lipomatosis]. / Nevo lipomatoso cutáneo superficial. Comunicación de 4 casos incluyendo una presentación inusual asociada a lipoma gigante y lipomatosis difusa.

Nevus lipomatosus cutaneus superficialis is a rare, hamartomatous disorder, characterized by the presence of ectopic mature adipose tissue within the superficial dermis. Lesions occur within the first three decades of life. We report four new cases, including a patient with the most extensive affectation reported to date, which was associated with massive lipomas in the subcutaneous cell tissue and diffuse lipomatosis. To our knowledge, it is the first report of this disorder in Cuba.

Lesiones más comunes en pescadores deportivos y la aplicación de Medicina Natural y Tradicional / Most common injuries in sports fishermen and the application of Natural and Traditional Medicine

La pesca deportiva es una actividad que implica riesgos. El objetivo de este trabajo estuvo referido a identificar las lesiones más comunes en los pescadores cubanos que participaron en eventos deportivos y su tratamiento con Medicina Natural y Tradicional. Se realizó un estudio observacional descriptivo y longitudinal, donde se aplicó una encuesta a 150 participantes que conformaron el universo de estudio y la muestra estuvo representada por los 95 pescadores que sufrieron algún tipo de lesión o accidente en los eventos nacionales de la Federación Cubana de Pesca Deportiva, en las modalidades de Spinning Marítimo, que tuvieron lugar entre los años 2015 y 2016. Durante el proceso investigativo se utilizaron métodos teóricos, empíricos y estadísticos, que permitieron corroborar la existencia real del problema, así como la valoración de su pertinencia. El estudio realizado demostró que las lesiones más comunes ocurridas en los pescadores deportivos durante el desempeño de sus actividades son las lesiones musculo esqueléticas (54,7 %) y las lesiones de la piel (43,1 %). Se reconoció que el uso de la Medicina Natural y tradicional, in situ, puede no solo aliviar y mejorar los síntomas producidos por estas afecciones, sino además prevenir complicaciones a corto, mediano y largo plazo.

Genetic Variations in the TP53 Pathway in Native Americans Strongly Suggest Adaptation to the High Altitudes of the Andes.

The diversity of the five single nucleotide polymorphisms located in genes of the TP53 pathway (TP53, rs1042522; MDM2, rs2279744; MDM4, rs1563828; USP7, rs1529916; and LIF, rs929271) were studied in a total of 282 individuals belonging to Quechua, Aymara, Chivay, Cabanaconde, Yanke, Taquile, Amantani, Anapia, Uros, Guarani Ñandeva, and Guarani Kaiowá populations, characterized as Native American or as having a high level (> 90%) of Native American ancestry. In addition, published data pertaining to 100 persons from five other Native American populations (Surui, Karitiana, Maya, Pima, and Piapoco) were analyzed. The populations were classified as living in high altitude (≥ 2,500 m) or in lowlands (< 2,500 m). Our analyses revealed that alleles USP7-G, LIF-T, and MDM2-T showed significant evidence that they were selected for in relation to harsh environmental variables related to high altitudes. Our results show for the first time that alleles of classical TP53 network genes have been evolutionary co-opted for the successful human colonization of the Andes.

Spatiotemporal Phylogenetic Analysis and Molecular Characterisation of Infectious Bursal Disease Viruses Based on the VP2 Hyper-Variable Region.

BACKGROUND: Infectious bursal disease is a highly contagious and acute viral disease caused by the infectious bursal disease virus (IBDV); it affects all major poultry producing areas of the world. The current study was designed to rigorously measure the global phylogeographic dynamics of IBDV strains to gain insight into viral population expansion as well as the emergence, spread and pattern of the geographical structure of very virulent IBDV (vvIBDV) strains. METHODOLOGY/PRINCIPAL FINDINGS: Sequences of the hyper-variable region of the VP2 (HVR-VP2) gene from IBDV strains isolated from diverse geographic locations were obtained from the GenBank database; Cuban sequences were obtained in the current work. All sequences were analysed by Bayesian phylogeographic analysis, implemented in the Bayesian Evolutionary Analysis Sampling Trees (BEAST), Bayesian Tip-association Significance testing (BaTS) and Spatial Phylogenetic Reconstruction of Evolutionary Dynamics (SPREAD) software packages. Selection pressure on the HVR-VP2 was also assessed. The phylogeographic association-trait analysis showed that viruses sampled from individual countries tend to cluster together, suggesting a geographic pattern for IBDV strains. Spatial analysis from this study revealed that strains carrying sequences that were linked to increased virulence of IBDV appeared in Iran in 1981 and spread to Western Europe (Belgium) in 1987, Africa (Egypt) around 1990, East Asia (China and Japan) in 1993, the Caribbean Region (Cuba) by 1995 and South America (Brazil) around 2000. Selection pressure analysis showed that several codons in the HVR-VP2 region were under purifying selection. CONCLUSIONS/SIGNIFICANCE: To our knowledge, this work is the first study applying the Bayesian phylogeographic reconstruction approach to analyse the emergence and spread of vvIBDV strains worldwide.

Colecistitis aguda asociada a ascaris lumbricoides / Acute cholecystitis associated with ascaris lumbricoides

Se presenta un caso atendido en el hospital provincial Antonio Luaces de la provincia Ciego de Ávila, Cuba, en el servicio de terapia intermedio, de aparición poco frecuente. Se trata de unpaciente masculino de 44 años de edad que acude a consulta por dolor epigastrio intenso con irradiación a ambos flancos y hacia espalda, de tipo cólico acompañado de fiebre y vómitos. Al examen físico: mucosas ligeramente ictéricas, fiebre (38 graus C), taquicardia (90 latidos por minuto),abdomen ligeramente distendido, ruidos hidroaéreos normales, reacción de defensa a la palpación del hemiabdomen superior donde la percusión es dolorosa. Se realiza ultra-son del abdomen yse arribó al diagnóstico de colecistitis aguda asociado a Ascaris lumbricoides. Se realizó cirugía (colecistectomia), durante la cual se observó la presencia del parasito dentro de la vesícula biliar.

An unusual case attended at Ciego’s provincial Hospital “Antonio Luaces”, Cuba, is described. A male patient, 44 years old, complaining of severe pain of colic type, at epigastrium, with irradiation to both flanks and to the back, accompanied with fever and vomits. On physical examination he presented: slight icteric mucosa, fever (38oC), tachycardia (90 bpm), slightly distended abdomen, normal abdominal sounds, and reaction of defence on the superior abdomen whose percussion was painful. Abdominal ultrasonography showed cholecystitis and an image of Ascaris lumbricoides inside the gallbladder. The patient underwent surgery with cholecystectomy when the presence of the parasite...

Histerectomía total abdominal frente a histerectomía mínimamente invasiva: revisión sistemática y metaanálisis / Total abdominal hysterectomy versus minimal-invasive hysterectomy: a systemic review and meta-analysis

En la actualizad se usan tres tipos de histerectomías: la histerectomía vaginal, la histerectomía abdominal y la histerectomía mínimamente invasiva. El objetivo de esta investigación fue comparar la histerectomía mínimamente invasiva (HMI) con la histerectomía total abdominal (HA) en mujeres con enfermedades uterinas benignas. Se realizó una revisión sistemática y metaanálisis a partir de las bases de datos siguientes: MEDLINE, EBSCO HOST y The Cochrane Central Register of Controlled Trials. Se seleccionaron solo estudios controlados y aleatorizados. Se combinaron los datos de todos los estudios incluidos y se utilizó el riesgo relativo (RR) con un intervalo de confianza del 95 por ciento, usando el método de Mantel-Haenszel como medida de efecto para variables dicotómicas. Para el análisis de las variables continuas se utilizó la diferencia de medias. En todas las comparaciones realizadas los resultados fueron obtenidos usando modelos de efecto fijo y aleatorios. Se registraron 53 complicaciones transoperatorias en el grupo de HMI contra 17 en el grupo de HA (RR: 1,78; IC: 1,04-3,05). Las complicaciones posoperatorias se comportaron de forma similar en ambos grupos, sin diferencias significativas desde el punto de vista estadístico. Las pérdidas sanguíneas, la estadía hospitalaria y la reincorporación de la paciente a las actividades habituales y al trabajo fueron significativamente menores en el grupo laparoscópico; sin embargo, el tiempo operatorio es mayor cuando se compara con la HA (diferencia de medias: 37,36; IC: 34,36-39,93). Ambas técnicas tienen ventajas y desventajas. La indicación de las técnicas de HMI debe ser individualizada según la situación clínica de cada paciente y éstas no deben realizarse en centros donde no exista personal quirúrgico debidamente entrenado y con experiencia en cirugía mínimamente invasiva de avanzada(AU)

At the present time three types of hysterectomies are used: the vaginal hysterectomy and the minimal-invasive hysterectomy (MIH). The objective of present research was to compare the MIH and the total abdominal hysterectomy (TAH) in women presenting with benign uterine diseases. A systemic review was made and a meta-analysis from the following databases: MEDLINE, EBSCO HOST AND The Cochrane Central Register of Controlled Trials. Only the controlled and randomized studies were selected. The data of all studies were combined and also the relative risk (RR) with a 95 percent CI was used with the Mantel-Haenszel method as an effect measure for dichotomy variables. For the analysis of continuing variables the mean difference was used. In all the comparisons performed the results were obtained with the fix effect and randomized forms. A total of 53 transoperative complications were registered in the MIH hysterectomy versus 17 in the TAH group (RR: 1,78; 95 percent CI: 1,04-3.05). Postoperative complications evolved in a similar way in both groups without significant differences from the statistical point of view. The blood losses, the hospital stay and the patient's reincorporation to usual and work activities were lesser in the laparoscopy group; however, the operative time is higher when it is compared with TAH (mean difference: 37,36; 95 percent CI: 34,36-39,93). Both techniques have advantages and disadvantages. The indication of MIH must to be individualized according to the clinical situation of each patient and these not to be performed in those centers without a properly trained surgical staff and with experience in advanced minimal invasive surgery(AU)

De los Albores a los Albores: un recorrido por la historia de la medicina / From the Dawn to Dawn: a journey through the history of medicine

El libro aunque hace referencias frecuentes y en ocasiones de cierta amplitud a las medicinas de otras regiones, e incluso tiene varios capítulos sobre ellas, hace énfasis, fundamentalmente , en la historia de la medicina occidental. Sería demasiado extenso abarcar el estudio a profundidad de las prácticas médicas en todas las culturas. Por ello, me considero obligado a continuar la faena y ya en este momento me encuentro en fase de realización de un nuevo texto que tratará fundamentalmente sobre las medicinas no occidentales. Antes de cooncluir quiero resaltar que mi mayor deseo es que este libro sirva para interesar a los más jóvenes y a todo el que desee conocer el fascinante mundo de la historia de la ciencia, sobre todo a los que comienzan ahora sus estudios de medicina, y que los haga interesarse no solo en se profesionales altamente preparados desde el punto de vista técnico, sino en profesionales cultos y repletos de ese humanismo que solo el conocimiento es capaz de llaver a la persona y que solo puede alcanzarse con una postura de curiosidad ante todo los hechos de la vida, o, como diría el médico argentino Federico Pérgol, "asomándose a todas las ventanas del saber"...

Herida penetrante cráneo-facial por arpón: presentación de un caso / Penetrating craniofacial wound by harpoon: a case presentation

Se presenta un caso de herida penetrante en región lateral izquierda de la cara por un arpón de pesca, entrando aproximadamente a 3 centímetros por debajo del arco cigomático y saliendo por la región temporal. El paciente fué hospitalizado y llevado de manera urgente al salón de operaciones donde, bajo anestesia general endovenosa, se realizó la extracción del objeto. Los resultados de este trabajo evidencian lo infrecuente de este tipo de lesiones en nuestra provincia y la necesidad de conocer las características de su manejo.

A case of penetrating wound in left lateral region of the face by a fishing harpoon, appears approximately 3 cm below the zygomatic arc and leaving by the temporal region. The patient was hospitalized and taken in an urgent way to the operating room where, under endovenous general anesthetic, the extraction of the object was realized. The results of this work demonstrate the infrequent of this type of injuries in our province and the necessity of knowing the characteristics of their handling.

Divertículo de Meckel y oclusión intestinal: presentación de un caso / Meckel's diverticulum and intestinal occlusion: a case presentation

Se presenta un caso de un paciente de 16 años de edad que acude por un cuadro oclusivo al cuerpo de guardia y durante la intervención quirúrgica se observa divertículo de Meckel como hallazgo transoperatorio, participando en el proceso, por compresión del mismo unido a asa delgada en una hernia interna. Se ilustra el mismo con fotografía del divertículo e imágenes radiológicas.

A case of a 16-years-old patient is reported, who goes to the emergency department suffering an occlusive picture and surgery for Meckel's diverticulum is seen as transoperative finding, participating in the process, by compression of it, joined the small intestine in an internal hernia. It is illustrated with diverticulum photography and radiological images.

Hipoacusia neurosensorial en un síndrome de Noonan y secuencia Poland / Neurosensory hypoacusis in a Noonan's syndrome and Poland's sequence

Se calcula que el 50 por ciento de los casos de sordera profunda en la infancia puede ser de origen genético. Se presenta el caso de un niño de 9 años, atendido en los Servicios de Otorrinolaringología y Genética del Hospital Pediátrico Docente William Soler, por presentar hipoacusia neurosensorial grave unilateral y displasia congénita de Mondini en el oído izquierdo, del lado contrario a la hipoplasia del músculo pectoral mayor, lo cual coincide con un síndrome de Noonan y secuencia de Poland, que resulta de especial interés. Se constató la hipoacusia con audiometría tonal y potencial evocado auditivo de tallo cerebral. En la tomografía del oído se observó una hipoplasia coclear con agenesia de la espira apical. Se destacan las manifestaciones clínicas y la importancia del estudio otológico e imaginólogico en el diagnóstico de la pérdida auditiva

It is estimated that the 50 percent of cases of deep deafness during childhood may be or genetic origin. This is the case of a child aged 9 seen in Otorhinolaryngology and Genetics Services of the Wiliam Soler Teaching Children Hospital due to a unilateral severe neurosensory hypoacusis and Mondini's congenital dysplasia in left ear contralateral to the major pectoral muscle hypoplasia, an interesting situation. Hypoacusis was confirmed using tone audiometry and auditory evoked potential of brain stem. Ear tomography demonstrated a cochlear hypoplasia with agenesis of apical spiral. The clinical manifestations and the significance of the ontological and imaging study in diagnosis of auditory loss are emphasized