Diagnóstico del proceso de reafirmación profesional, en la carrera de Cultura Física, en Granma

La formación de profesionales, con elevada calidad, es tarea esencial de la Educación Superior, por lo que de manera permanente se demanda de graduados comprometidos con los procesos de desarrollo, donde quedan evidenciados los conocimientos, habilidades y valores en los que se han formado. El diagnóstico tuvo como objetivo caracterizar la situación de la orientación y reafirmación profesional (consolidación de los motivos e intenciones profesionales) en el proceso de estudio de la carrera Licenciatura en Cultura Física, en Granma; a partir de tres dimensiones: pedagógica, psicológica y sociológica. Se aplicaron métodos teóricos y empíricos que mostraron insuficiencias en las acciones planificadas en las estrategias educativas y en el plan de trabajo metodológico de las diferentes disciplinas, un limitado aprovechamiento de las potencialidades del contenido y las actividades extensionistas y bajos niveles de satisfacción por el estudio de la Carrera; lo que se manifestó en la no selección de una esfera de actuación para el futuro desempeño profesional, y en los elevados niveles de deserción de los estudiantes, en los dos primeros años de formación.

A formação de profissionais, com elevada qualidade, é uma tarefa essencial do Ensino Superior, razão pela qual existe uma procura permanente de licenciados comprometidos com processos de desenvolvimento, onde se evidenciam os conhecimentos, competências e valores em que foram formados. O objetivo do diagnóstico foi caracterizar a situação de orientação e reafirmação profissional (consolidação de motivos e intenções profissionais) no processo de estudo do Bacharelado em Cultura Física, no Granma; a partir de três dimensões: pedagógica, psicológica e sociológica. a corrida; o que se manifestou na não seleção de uma esfera de atuação para futura atuação profissional, e nos elevados índices de evasão estudantil, nos dois primeiros anos de formação.

The training of professionals, with high quality, is an essential task of Higher Education, which is why there is a permanent demand for graduates committed to development processes, where the knowledge, skills and values in which they have been trained are evidenced. The objective of the diagnosis was to characterize the situation of professional guidance and reaffirmation (consolidation of professional motives and intentions) in the process of studying the Bachelor's degree in Physical Culture, in Granma; from three dimensions: pedagogical, psychological and sociological. Theoretical and empirical methods were applied that showed insufficiencies in the planned actions in the educational strategies and in the methodological work plan of the different disciplines, a limited use of the potential of the content and extension activities and low levels of satisfaction with the study of the career; which was manifested in the non-selection of a sphere of action for future professional performance, and in the high levels of student dropout, in the first two years of training.

Percepción de dirigentes deportivos locales y funcionarios municipales sobre políticas públicas deportivas locales de la comuna de Linares / Perception of local sports leaders and municipal officials on local public sports policies in the commune of Linares / Percepção dos líderes esportivos locais e das autoridades municipais sobre as políticas esportivas públicas locais na comuna de Linares

La aplicación de las políticas públicas deportivas locales (PPDL) de la comuna de Linares se han visualizado gracias a la aplicación del Plan de Desarrollo Comunal de Actividad Física y Deportes (PDC AFyD) en el período 2018 - 2022 en la comunidad y las organizaciones deportivas locales (OODD), así como de funcionarios del propio municipio. Para conocer la percepción sobre la aplicación de PPDL se aplica una entrevista semiestructurada y confeccionada para tales efectos, a 28 dirigentes deportivos y 18 funcionarios municipales, de un universo muestral total de 127 posibles. Los individuos indican que, pese a ver cambios favorables en el período desconocen el proceso y, por ende, el mecanismo aplicado para el cambio, lo que despotencia la comprensión de la PPDL y el desarrollo de ésta por medio de las propias OODD y el municipio. La aplicación de las PPDL por medio de sus distintas herramientas e instrumentos requiere que se desarrolle bajo un proceso de consulta, pertinencia y complementación entre municipio, OODD, mundo educativo y vecinos beneficiarios; todo dentro de un marco de comunicación e información concreta y permanente que logre involucrar a todos los actores, brindando con ello una cuota de responsabilidad en su ejecución, control y evaluación.

The application of local public policies on sports (LPSP) of the commune of Linares has been visualized thanks to the application of the Communal Development Plan for Physical Activity and Sports (CDP PA&S) in the period 2018 - 2022 in the community and local sports organizations (LSO), as well as officials of the municipality itself. To know the perception of the implementation of LPSP, a semi-structured interview was applied to 28 sports leaders and 18 municipal officials out of a total sample universe of 127 possible. The individuals indicate that, despite seeing favorable changes in the period, they are unaware of the process and, therefore, the mechanism applied for change, which undermines the understanding of the LPSP and its development through the LSOO and the municipality. The application of the LPSP through its different tools and instruments requires that it be developed under a process of consultation, relevance, and complementarity between the municipality, LSOO, the educational world and beneficiary neighbors; all under a framework of communication and concrete and permanent information that manages to involve all the actors, thus providing a share of responsibility in its execution, control, and evaluation.

A implementação das políticas esportivas públicas locais (PEPL) na comuna de Linares foi visualizada graças à implementação do Plano de Desenvolvimento Comunitário para Atividade Física e Esporte (PDC AFyE) no período 2018 - 2022 na comunidade e organizações esportivas locais (OOEE), bem como funcionários do próprio município. Foi realizada uma entrevista semi-estruturada com 28 líderes esportivos e 18 funcionários municipais de um universo de amostra total de 127. Os indivíduos indicam que, apesar de verem mudanças favoráveis no período, não conhecem o processo e, portanto, o mecanismo aplicado para a mudança, o que prejudica a compreensão do PEPL e seu desenvolvimento através do OOEE e do próprio município. A implementação do PEPL através de suas diferentes ferramentas e instrumentos requer um processo de consulta, relevância e complementaridade entre o município, o OOEE, o mundo educacional e os vizinhos beneficiários; tudo isso dentro de uma estrutura de comunicação e informação concreta e permanente que envolva todos os atores, proporcionando assim uma parcela de responsabilidade em sua implementação, controle e avaliação.

Co-existence of peripheral fatigue of the knee extensors and jump potentiation after an incremental running test to exhaustion in endurance trained male runners.

The aim of the present study was to investigate the effect of an incremental running exercise until exhaustion on twitch responses and jump capacity in endurance trained runners. For this purpose, 8 experienced endurance male runners were required to perform neuromuscular function tests before and after a submaximal running bout (control condition -CTR-) or an incremental running test to volitional exhaustion (experimental conditions -EXP-). The twitch interpolation technique was used to assess voluntary activation and muscle contractile properties before and after each condition (CTR and EXP). Countermovement jump was also used to assess the stretch-shortening cycle function before and after both conditions. In addition, rating of perceived exertion, heart rate, blood lactate and skin temperature were also recorded. Only EXP improved jump performance, however, it was also accompanied by a reduction in maximal voluntary contraction and the peak twitch force of the knee extensors evoked by electrical stimulation at 10 Hz (Db10). It is likely that reductions in maximal voluntary contraction may be related to an excitation-contraction coupling failure (i.e. low-frequency fatigue) as suggest the reduction in the Db10. The current results confirm that acute changes in jump performance may not be appropriate to evaluate acute fatigue in endurance trained runners.

Cardiothoracic surgery and peripheral endovascular intervention in cardiovascular damage from a cohort of orphan rheumatological diseases-epidemiological and survival analysis.

Background: Aortic diseases in some orphan rheumatological diseases require medical, surgical or peripheral endovascular intervention because they can be catastrophic. Objectives: to analyze the main clinical and epidemiological characteristics of patients with Takayasu arteritis (TA), Marfan syndrome (MS) and similar conditions that were treated with cardiothoracic surgery and peripheral endovascular intervention. Methods: Retrospective and descriptive cohort study that included patients of any age and gender with TA (as per the criteria of the American College of Rheumatology and EULAR/PRINTO), MS (according to Ghent criteria), and similar conditions who underwent cardiothoracic surgery or peripheral endovascular intervention. Data were collected from electronic charts. Results: A total of 77 patients with TA and 135 patients with MS and similar conditions were included. The frequency of surgical or interventional requirements in patients with TA and MS/similar conditions was 77/364 (21.2%) and 135/300 (45%), respectively; such patients were followed for a median of 6 [2-12] and 3.29 (0.42-6.62) years, with (maximum follow-up range of 47 and 21.37 years, respectively). Aneurysms were present in 11 (14.3%) and 66 (48.9%) in patients with TA and MS/similar conditions, respectively. Aortic, mitral and tricuspid valve damage occurred in 8 (10.4%) patients, 4 (5.2%) patients and 1 (1.3%) patient with TA, respectively; corresponding frequencies in patients with MS/similar conditions were 98 (72.6%), 50 (37.0%) and 20 (14.8%). We identified that 20% of patients with TA died after 5.08 years (95% CI: 0.23-25.42 years) and 20 % of the patients with MS and other similar conditions died after 7.52 years (95% CI: 1.10-9.02 years). Conclusions: The frequency of surgical intervention was low in this study. Long-term prognosis is good if surgery is performed in a timely manner. Epidemiological studies provide relevant information for public health decisions related to the management of orphan rheumatological diseases.

Fanconi Anemia Patients from an Indigenous Community in Mexico Carry a New Founder Pathogenic Variant in FANCG.

Fanconi anemia (FA) is a rare genetic disorder caused by pathogenic variants (PV) in at least 22 genes, which cooperate in the Fanconi anemia/Breast Cancer (FA/BRCA) pathway to maintain genome stability. PV in FANCA, FANCC, and FANCG account for most cases (~90%). This study evaluated the chromosomal, molecular, and physical phenotypic findings of a novel founder FANCG PV, identified in three patients with FA from the Mixe community of Oaxaca, Mexico. All patients presented chromosomal instability and a homozygous PV, FANCG: c.511-3_511-2delCA, identified by next-generation sequencing analysis. Bioinformatic predictions suggest that this deletion disrupts a splice acceptor site promoting the exon 5 skipping. Analysis of Cytoscan 750 K arrays for haplotyping and global ancestry supported the Mexican origin and founder effect of the variant, reaffirming the high frequency of founder PV in FANCG. The degree of bone marrow failure and physical findings (described through the acronyms VACTERL-H and PHENOS) were used to depict the phenotype of the patients. Despite having a similar frequency of chromosomal aberrations and genetic constitution, the phenotype showed a wide spectrum of severity. The identification of a founder PV could help for a systematic and accurate genetic screening of patients with FA suspicion in this population.

Effectiveness of a Fibromyalgia Online Nursing Consultation in the Quality of Life: A Randomized Controlled Trial.

BACKGROUND: Aim: To evaluate the effectiveness of an online nursing consultation through the Internet platform Red Sinapsis (RS) in improving the perceived quality of life of patients with fibromyalgia (FM). METHOD: Eighty patients with FM were randomized to an intervention group (n = 40) or control group (n= 40). The intervention group (IG) was monitored by a nursing specialist through the online platform RS while the control group (CG) received standard follow-up at the clinic. The Fibromyalgia Impact Questionnaire (FIQ) and 36-item Short-Form Health Survey (SF-36) were used at baseline, 6-month, and 12-month follow-up. RESULTS: The IG showed a 65% improvement in the perception of their general state of health at 12 months into the study, compared with an improvement of 5.6% in the CG (p < .001). The IG also achieved better results for emotional status, with a maintained improvement throughout the study of more than 2 points in the anxiety variable (from 7.64 to 5.36), that remained constant in the CG. The depression variable also showed constant improvement over the 12 months of the study in the IG, rising from an average of 7.72 (standard deviation [SD] = 2.05) to 5.33 (SD = 1.65), while in the CG a slight deterioration was observed. In both cases, the difference in mood evolution was significant (p < .001). CONCLUSIONS: Online nursing follow-up for people with fibromyalgia improves patients' perceived quality of life related to their welfare and emotional state. Fibromyalgia (FM) is among the diseases causing the highest rate of occupational disability in Spain. Fibromyalgia (FM) is a complex condition that causes pain, fatigue, non-refreshed sleep, mood disturbance and cognitive impairment.

Estudio morfométrico del radio proximal en una población chilena / Morphometric study of the proximal radius in a Chilean population

RESUMEN: El objetivo de esta investigación fue determinar la morfometría del extremo proximal del radio, mediante mediciones efectuadas en la cabeza, cuello y tuberosidad del radio, en una población chilena y compararlas según sexo. Se efectuó un estudio transversal analizando exámenes de Tomografía Computarizada (TC) de codo, realizados entre enero de 2014 y diciembre de 2018. Se incluyó 32 TC, correspondientes a 16 hombres y 16 mujeres. Se transfirió las imágenes formateadas al software RadiAnt, para efectuar las mediciones en el radio proximal. El análisis estadístico de los resultados se realizó mediante el software SPSS 22. El diámetro de la cabeza del radio en hombres osciló entre 22,8±1,3 y 25,0±1,7 mm; en mujeres osciló entre 19,4±1,4 y 20,7±1,4 mm. El diámetro del cuello del radio proximal en hombres osciló entre 14,0±0,8 y 15,6±0,7 mm; en mujeres osciló entre 11,7±0,8 y 13,3±1,3 mm. El diámetro del cuello del radio distal en hombres osciló entre 14,4±1,0 y 16,0±1,2 mm; en mujeres osciló entre 12,5±1,0 y 13,8±1,5 mm. El diámetro de la tuberosidad radial en hombres osciló entre 15,1±1,5 y 17,7±1,8 mm; en mujeres osciló entre 13,2±1,1 y 15,5±1,8 mm. El promedio de altura de la cabeza del radio fue de 11,2±1,2 mm en hombres y de 9,5+0,8 mm en mujeres. El análisis comparativo entre sexos mostró diferencias estadísticamente significativas en todas las mediciones precedentes. El promedio de altura del cuello del radio fue de 11,2±1,2 mm en hombres y 10,1±1,6 mm en mujeres, sin diferencia significativa (p= 0,15). Los valores promedios de la morfometría del radio proximal de la población chilena difieren de los descritos para la población europea y presentan algunas similitudes con la población china. Nuestros resultados pueden ser de utilidad para el diseño de implantes y prótesis para el extremo proximal del radio y para una correcta planificación quirúrgica en ortopedia y traumatología.

SUMMARY: The aim of this research was to determine the morphometry of the proximal radius in a Chilean population, by means of measurements made in head of radius, neck of radius and radial tuberosity, and to compare them according to sex. A cross-sectional study was conducted analyzing Computed Tomography scans (CT) of elbows, performed between January 2014 and December 2018. Thirty-two CT corresponding to 16 men and 16 women were included. The formatted images were transferred to the RadiAnt software in order to perform measurements in the proximal radius. The statistical analysis of the results was performed using the SPSS 22 software. The diameter of the head of radius in men ranged between 22.8±1.3 and 25.0±1.7 mm; in women it ranged between 19.4±1.4 and 20.7±1.4 mm. The diameter of the proximal neck of radius in men ranged between 14.0±0.8 and 15.6±0.7 mm; in women, it ranged between 11.7±0.8 and 13.3±1.3 mm. The diameter of the distal neck of radius in men ranged between 14.4±1.0 and 16.0±1.2 mm; in women, it ranged between 12.5±1.0 and 13.8±1.5 mm. The diameter of radial tuberosty in men ranged between 15.1±1.5 and 17.7±1.8 mm; in women, it ranged between 13.2±1.1 and 15.5±1.8 mm. The mean height of the head of radius was 11.2±1.2 mm in men and 9.5±0.8 mm in women. Statistically significant sex differences were revealed in all the preceding measurements. The mean height of the neck of radius was 11.2±1.2 mm in men and 10.1±1.6 mm in women, with no significant difference (p= 0.15). The average values of morphometry of the proximal radius of the Chilean population differ from those describing the European population, and show some similarities with the Chinese population. Our results may be useful to design of implants and prostheses for the proximal radius, and to correct surgical planning in orthopedics and traumatology.

Obesity, Thrombotic Risk, and Inflammation in Cancer.

Neoplasms exhibits a high incidence and mortality rates due to their complex and commonly overlapping clinical, biochemical, and morphologic profiles influenced by acquired or inherited molecular abnormalities, cell of origin, and level of differentiation. Obesity appears related to ~20% of cancers including endometrial, esophageal, colorectal, postmenopausal breast, prostate, and renal. Several factors other than obesity, i.e., insulin, insulin-like growth factor, sexual hormones, and adipokines may play a potential role in neoplasia. Cancer-associated hypercoagulable and thrombotic states are influenced by abnormalities in the vascular wall and susceptibility to invasion, interference in blood flow and increase in circulating tissue factor and thrombin, activation of cell growth factors, the presence of a central catheter, chemotherapies, neoplasm type, and surgery. In cancer, thromboembolic complications are the second most frequent cause of death with pulmonary thromboembolism in ~50% of cases postmortem. Thrombosis worsens prognosis as demonstrated with a survival rate as low as 12% per year vs 36% in nonthrombic patients. Deep vein thrombosis is the most frequent thromboembolic complication in cancer. It is usually detected at diagnosis and within the first 3 months of chemotherapy. The underlining mechanisms of this association should be further studied to identify patients at higher risk and develop adequate prevention, diagnostic, and treatment measures. The D-dimer test can be successfully used to assess the fibrinolytic phase of coagulation and as such is routinely used in suspected cases of deep vein thrombosis and pulmonary thromboembolism. In addition, significant advances have been made in understanding the composition and functional capabilities of the gut microbiota in the inflammatory process, obesity, and its roles in cancer; however, the intricate balance that exists within the microbiota may not only affect the host directly, it can also disrupt the entire microbial community. CONCLUSIONS: Cancer is a prothrombotic and inflammatory state in which the activation of coagulation is related to tumor growth, angiogenesis, and metastasis. It is important to identify the relationship between body mass index with these processes and clarify their importance in cancer prognosis. Future research should answer the question if manipulation of resident microbial communities could potentially improve prognosis and treatment outcome.

LOAD THAT MAXIMIZES POWER OUTPUT IN COUNTERMOVEMENT JUMP / CARGA QUE MAXIMIZA A POTÊNCIA DE SAÍDA NO SALTO COM CONTRAMOVIMENTO / CARGA CON LA QUE SE ALCANZA LA MÁXIMA POTENCIA EN EL SALTO CON CONTRAMOVIMIENTO

ABSTRACT Introduction: One of the main problems faced by strength and conditioning coaches is the issue of how to objectively quantify and monitor the actual training load undertaken by athletes in order to maximize performance. It is well known that performance of explosive sports activities is largely determined by mechanical power. Objective: This study analysed the height at which maximal power output is generated and the corresponding load with which is achieved in a group of male-trained track and field athletes in the test of countermovement jump (CMJ) with extra loads (CMJEL). Methods: Fifty national level male athletes in sprinting and jumping performed a CMJ test with increasing loads up to a height of 16 cm. The relative load that maximized the mechanical power output (Pmax) was determined using a force platform and lineal encoder synchronization and estimating the power by peak power, average power and flight time in CMJ. Results: The load at which the power output no longer existed was at a height of 19.9 ± 2.35, referring to a 99.1 ± 1% of the maximum power output. The load that maximizes power output in all cases has been the load with which an athlete jump a height of approximately 20 cm. Conclusion: These results highlight the importance of considering the height achieved in CMJ with extra load instead of power because maximum power is always attained with the same height. We advise for the preferential use of the height achieved in CMJEL test, since it seems to be a valid indicative of an individual's actual neuromuscular potential providing a valid information for coaches and trainers when assessing the performance status of our athletes and to quantify and monitor training loads, measuring only the height of the jump in the exercise of CMJEL.

RESUMO Introdução: Um dos principais problemas enfrentados pelos treinadores de força e condicionamento físico é como quantificar e monitorar objetivamente a carga real de treinamento realizada pelos atletas para maximizar o desempenho. Sabe-se que o desempenho de atividades esportivas explosivas é grandemente determinado pela potência mecânica. Objetivo: Este estudo analisou a altura em que a potência de saída máxima é gerada e a carga correspondente em que é atingida em um grupo de esportistas do sexo masculino que praticam atletismo no teste de salto com contramovimento (SCM) com cargas adicionais (SCMc). Métodos: Cinquenta atletas de nível nacional de corrida de velocidade e salto realizaram o teste SCM com cargas crescentes até a altura de 16 cm. A carga relativa que maximizou a potência de saída (Pmax) foi determinada usando uma plataforma de força e um codificador linear de sincronização e estimada por potência máxima, média e tempo de vôo no SCM. Resultados: A carga em que a potência de saída já não existia foi na altura de 19,9 ± 2,35, com relação a 99,1 ± 1% da potência de saída máxima. A carga que maximiza a potência de saída em todos os casos foi aquela em que o atleta salta em altura de aproximadamente 20 cm. Conclusão: Esses resultados salientam a importância de considerar a altura atingida no SCM com carga adicional, em vez de com potência, porque a potência máxima sempre é obtida com a mesma altura. Aconselhamos o uso preferencial da altura atingida no teste SCMc, uma vez que parece ser um indicador válido da potência neuromuscular real do indivíduo, fornecendo informação para treinadores e preparadores físicos ao avaliar o desempenho de nossos atletas e quantificar e monitorar as cargas do treinamento, medindo a altura do salto no exercício de SCMc.

RESUMEN Introducción: Uno de los principales problemas que los preparadores físicos enfrentan es el hecho de cómo objetivamente cuantificar y monitorear la carga de entrenamiento real utilizada por los atletas con el fin de optimizar el rendimiento. Es bien conocido que el rendimiento en actividades deportivas de carácter explosivo está determinado en gran medida por la potencia mecánica. Objetivo: Este estudio analizó la altura en la que se genera la máxima potencia y la carga correspondiente con la que se consigue, en un grupo de deportistas de atletismo del sexo masculino entrenados en el test de salto con contramovimiento (SCM) con cargas progresivas (SCMc). Métodos: Cincuenta atletas hombres velocistas y saltadores de nivel nacional realizaron el test de SCM, incrementando las cargas hasta la altura de 16 cm. La carga relativa con la que se alcanzó la máxima potencia (Pmax) se determinó utilizando una plataforma de fuerza sincronizada con un codificador lineal y estimando la potencia mediante la potencia pico, la potencia media y el tiempo de vuelo en el SCM. Resultados: La carga con la que la potencia máxima no más existía fue en la altura de 19,9 ± 2,35, con referencia al 99,1 ± 1% de la potencia máxima. La carga con la que se alcanza la potencia máxima en todos los casos ha sido con aquella con la que el atleta salta una altura de aproximadamente 20 cm. Conclusión: Estos resultados destacan la importancia de considerar la altura alcanzada en SCM con carga extra en lugar de la potencia, puesto que la potencia máxima siempre se alcanza a la misma altura. Es muy recomendable priorizar el empleo de la altura alcanzada en el test SCMc, ya que parece ser un indicador válido del potencial neuromuscular real de un individuo proporcionando una información válida para entrenadores y preparadores físicos para evaluar la condición de rendimiento de nuestros atletas y cuantificar y monitorear las cargas de entrenamiento, solamente midiendo la altura del salto en el ejercicio de SCMc.

Determinación de arsénico y mercurio en agua superficial del lago de Atitlán / Determination of arsenic and mercury levels in superfitial water of Atitlán lake

El lago de Atitlán, considerado uno de los lagos más bellos del mundo, tiene una superficie de 125.7 km2, una profundidad máxima de aproximadamente 350 m, y se encuentra en el departamento de Sololá, en el occidente de Guatemala. Desde 2009 se han observado floraciones extensivas de cianobacterias en el lago, reflejando la contaminación del agua en la cuenca. Se determinaron los niveles dearsénico (As) y mercurio (Hg) en agua superficial del lago de Atitlán, por espectrofotometría de absorción atómica (EAA), en cuatro muestreos realizados en marzo, mayo, agosto y octubre de 2014 en 14 sitios. Diez sitios se encuentran localizados en el lago, habiendo sido definidos en estudios anteriores con base en su cercanía a poblaciones asentadas en la orillas del lago. Dos sitios corresponden a los principales ríos tributarios, y los restantes dos sitios a la entrada y salida de la planta de tratamiento Los Cebollales, ubicada en Panajachel. Los niveles de As encontrados en el lago de Atitlán, tributarios y en la planta de tratamiento, fueron superiores a 20 μg/L. Los resultados indican que la contaminación del lago de Atitlán por As se debe principalmente a la geología de la cuenca, al localizarse en una zona volcánica. Los niveles cuantificables de As, son superiores al nivel máximo permitido para agua potable en la Norma de Agua Potable (NGO 29001:99) de la Comisión Guatemalteca de Normas (COGUANOR), por lo que el agua del lago de Atitlán no se considera apta para el consumo humano.

Lake Atitlan is considered one of the most beautiful lakes in the world. It has 125.7 km2 and 350 m maximum depth. It is located at the western province Sololá in the Guatemalan highlands. Since 2009 several cyanobacterial blooms have occurred at the lake, as consequence of the environmental degradation caused by water contamination into the basin. In this study pollution levels by arsenic (As) and mercury (Hg) in Lake Atitlan, were investigated in collaboration with the Authority for the Sustainable Management of Lake Atitlan and its Surroundings (AMSCLAE). Four samplings were conducted in March, May, August and October 2014, collecting samples of water at 14 sampling sites, including the Wastewater Treatment Plant located at Panajachel. As and Hg in water samples of Lake Atitlan were analyzed by atomic absorption spectrophotometry. Presence of arsenic above 20 μg/L was found in the water of Lake Atitlan, rivers and the wastewater treatment plant. The results indicate that contamination of Lake Atitlan regarding metals, is due majorly to the Basin geology located in a volcanic region. The levels of As are higher than recommended levels for drinking water in different regulations.

Impact of immunohistochemistry-based molecular subtype on chemosensitivity and survival in Hispanic breast cancer patients following neoadjuvant chemotherapy.

BACKGROUND: Neoadjuvant chemotherapy (NAC) is the standard treatment for patients with locally advanced breast cancer, showing improvement in disease-free survival (DFS) and overall survival (OS) rates in patients achieving pathological complete response (pCR). The relationship between immunohistochemistry-based molecular subtyping (IMS), chemo sensitivity and survival is currently a matter of interest. We explore this relationship in a Hispanic cohort of breast cancer patients treated with NAC. METHODS: A retrospective survival analysis was performed on Colombian females with breast cancer treated at Instituto de Cancerología-Clinica Las Américas between January 2009 and December 2011. Patients were classified according to immunohistochemistry-based subtyping into the following five groups: Luminal A, Luminal B, Luminal B/HER 2+, HER2-enriched, and triple-negative breast cancer. Demographic characteristics, recurrence pattern, and survival rate were reviewed by bivariate and multivariate analysis. RESULTS: A total of 328 patients fulfilled the study's inclusion parameters and the distribution of subtypes were as follows: Luminal A: 73 (22.3%), Luminal B/HER2-: 110 (33.5%), Luminal B/HER2+: 75 (22.9%), HER2-enriched: 30 (9.1%), and triple-negative: 40 (12.2%). The median follow-up was 41 months (interquartile range: 31-52). Pathological response to NAC was as follows: complete pathological response (pCR) in 28 (8.5%) patients, partial 247 (75.3%); stable disease 47 (14.3%), and progression 6 (1.8%) patients. The presence of pCR had a significant DFS and OS in the entire group (p = 0.01) but subtypes had different DFS in Luminal B (p = 0.01) and triple negative (p = 0.02) and also OS in Luminal B (p = 0.01) and triple negative (p = 0.01). CONCLUSIONS: pCR is associated with an improved overall survival and disease-free survival rates in this group of Hispanics patients. Advanced stages, Luminal B subtypes, triple-negative tumours and non-pCR showed lower DFS.

The clinical significance of coagulation and the inflammatory response in autoimmunity.

Maintenance of normal blood flow requires equilibrium between procoagulant and anticoagulant factors; occasionally, procoagulant activity predominates, leading to clot formation; frequently, tissue damage is the triggering factor. Hereditary factors, primary or acquired, play a role in the development of thrombosis. Primary thrombophilia is associated with hereditary factors, which promote hypercoagulability because natural anticoagulants are not exerting their activity. On the other hand, acquired thrombophilia may occur associated to autoimmune diseases, cancer, surgical procedures, pregnancy, postpartum period, and obesity. Activation of the coagulation system is characterized by the co-participation of inflammatory response components, factors related to the subjacent disease, and other procoagulant factors. The study of patients with thrombosis should include both inflammatory and autoimmune response markers.

Association of IL1B polymorphism with left ventricular systolic dysfunction: a relation with the release of interleukin-1ß in stress condition.

OBJECTIVE: Proinflammatory cytokines play a major role in the pathomechanisms of heart failure. Besides this, the influence of mental stress on heart failure is poorly documented despite its effects on sympathetic stimulation of interleukin-1ß (IL-1ß) secretion. We examined whether the polymorphisms of proinflammatory cytokines are predictors of left ventricular systolic dysfunction (LVSD) and if so, whether such associations are related to the secretion of these cytokines, in 572 consecutive patients under mental stress produced by coronary angiography. METHODS: We examined IL-1RN (VNTR), IL1A-889 C>T, IL1B-511 C>T, IL6-174 G>C and TNFA-308 G>A, according to LVSD (left ventricular ejection fraction, <40%). Saliva IL-1ß, serum tumour necrosis factor-α and C-reactive protein were assayed in basal (T0 and T2, before and after coronary angiography) and stress (T1) conditions. MAIN RESULTS: The 42.1% of patients with LVSD had a 1.5-fold higher frequency of IL1B T allele (P<0.001). IL1B-511TT was associated with LVSD (P=0.008) and with a decrease in IL-1ß level in saliva at T1 (P=0.013). IL-1ß was the highest at T1 (P<0.001) and was associated with left ventricular ejection fraction (P=0.002). The IL1B TT genotype and the C-reactive protein were the two independent predictors of LVSD in multivariate analysis, with an odds ratio of 2.7 (95% confidence interval: 1.3-5.5; P=0.008) and 1.1 (95% confidence interval: 1.1-1.2; P<0.001), respectively. CONCLUSION: IL1B was a predictor of LVSD and of the decreased IL-1ß response to stress. This suggests that IL1B exerts an influence on LVSD through its effect on IL-1ß secretion.

Algunos dilemas éticos en la práctica médica / Some ethical dilemmas in the medical praxis

Con la intención de prevenir conflictos en el acto médico y desde el punto de vista bioético, éste, el manejo paliativo y de la muerte digna; situaciones que pueden ser fuente de demandas entre el paciente y el médico. Sostenemos que la actitud y aptitud del médico, del paciente, su familia, amigos y representantes legales, con apertura y honestidad, pueden prevenir la gran mayoría de las causas de conflicto y evitar las consecuencias del mismo entre los profesionales de la salud y los enfermos. La prevención es posible si hay buena voluntad y conocimiento de normas, leyes, usos y sentido común.

We reviewed from a bioethical perspective and attempting prevention of potential conflicts derived communication failure during medical practice, palliative treatments and dignified death in the institutional practice as well as general practice; most of conflicts related to patient-doctor relationship could de prevented. We propose an attitude and aptitude plus in deep knowledge of patient, family, friends and legal representatives in terms fully honest communication to prevent most of conflicts and avoid its consequences against doctors and other health workers. Prevention is better and it depends of knowledge of norms, laws, general beliefs and common sense in this country and maybe others.

Determinación de actividad inflamatoria en pacientes con arteritis de Takayasu mediante tomografía por emisión de positrones (PET) / PET evaluation of inflammatory process in Takayasu's arteritis

Objetivos: Determinar la aplicación que tiene la tomografía por emisión de positrones en el seguimiento de pacientes con arteritis de Takayasu con actividad inflamatoria y su correlación con los criterios clínicos establecidos. Métodos: Se incluyeron 35 pacientes con diagnóstico de arteritis de Takayasu. Se determinó velocidad de sedimentación globular, proteína C reactiva, biometría hemática, así como, fibrinógeno y se aplicaron los criterios clínicos de actividad. Se realizó tomografía por emisión de positrones basal de los pacientes positivos para actividad inflamatoria, todos recibieron tratamiento farmacológico. De forma aleatoria se incluyó a 10 pacientes que posterior al tratamiento durante seis meses se les realizó un nuevo estudio clínico y una tomografía por emisión de positrones para determinar actividad inflamatoria. Se compararon los criterios clínicos con tomografía por emisión de positrones tanto del estudio basal como el de seguimiento. Resultados: Los criterios clínicos tuvieron una sensibilidad de 63% y especificidad de 90% para demostrar actividad inflamatoria en forma basal. La sensibilidad de los criterios clínicos disminuyó posterior al tratamiento hasta 27%, en donde se observó que pacientes aparentemente inactivos por clínica, continuaban activos por tomografía por emisión de positrones. Discusión: Éste es el primer estudio que compara de manera prospectiva los hallazgos de tomografía por emisión de positrones antes y después del tratamiento para actividad inflamatoria en pacientes con arteritis de Takayasu. Los criterios clínicos carecen de sensibilidad para la detección de actividad inflamatoria en el seguimiento posterior al tratamiento. Conclusiones: El tomografía por emisión de positrones es una técnica de diagnóstico con una alta sensibilidad y especificidad para el diagnóstico y seguimiento de pacientes con arteritis de Takayasu y actividad inflamatoria.

Objective: To determine the application of PET in monitoring patients with Takayasu's arteritis (TA) with inflammatory activity (IA) and its correlation with established clinical criteria. Methods: 35 patients diagnosed with TA were enrolled. Determination of erythrocyte sedimentation rate, C-reactive protein, fibrinogen and a complete blood count was performed and clinical criteria of activity were applied. A baseline PET was performed in all patients. Those who were positive for IA received drug treatment. Among the group of active patients, ten were randomized to undergo another PET scan and clinical criteria determination to evaluate inflammatory activity after 6 months of treatment. We compared clinical criteria with PET capacity to determine IA. The results between the initial and final PET were finally compared. Results: Clinical criteria had a sensitivity of 63% and a specificity of 90% to show IA. Sensitivity decreased after 6 months of treatment to 27%. Discussion: This is the first prospective study that compares the findings of PET before and after treatment for IA in patients with TA. Clinical criteria lack sensitivity for the detection of IA in the follow-up after treatment. Conclusions: PET is a diagnostic technique with high sensitivity and specificity for the diagnosis and monitoring of patients with TA and inflammatory activity.

Performance levels of four Latin American laboratories for the serodiagnosis of Chagas disease in Mexican sera samples

In nearly all of the previous multicentre studies evaluating serological tests for Trypanosoma cruzi infection, sera samples from Central or South American countries have been used preferentially. In this work we compared the reliability of the serological tests using Mexican sera samples that were evaluated in four independent laboratories. This included a reference laboratory in Brazil and three participant laboratories, including one in Central America and two in Mexico. The kappa index between Brazilian and Honduran laboratories reached 1.0 and the index for the Mexican laboratories reached 0.94. Another finding of this study was that the source of antigen did not affect the performance of the serological tests.