Estrés académico en estudiantes de Medicina diagnosticados en la Unidad de Orientación Estudiantil / Academic stress in Medicine students diagnosed in the Student Direction Unit i: en

Introducción: La educación universitaria constituye un proceso generador de muchas tensiones para los estudiantes de todo el mundo, que se ha asociado a altos niveles de estrés, ansiedad y depresión. Objetivo: Describir las manifestaciones de estrés académico en estudiantes del tercer año de la carrera de Medicina. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo de 10 estudiantes de la Facultad de Medicina No. 1 de Santiago de Cuba, diagnosticados con estrés académico en la Unidad de Orientación Estudiantil, desde enero hasta junio de 2022. Resultados: Predominó el estrés moderado en 70,0 % de los alumnos, con una primacía del sexo femenino (50,0 %). La frecuencia de intensidad de la preocupación fue expresada en el valor categorial mucho (70,0 %). Entre los principales factores estresores identificados figuraron: sobrecarga de tareas y trabajos, evaluaciones de los profesores y participación en clase, que en su totalidad forman parte de la dinámica del proceso formativo de la carrera. También prevaleció la diversidad de estrategias de afrontamiento a dicho estrés. Conclusiones: El estrés académico se presentó mayormente en las esferas afectiva y conductual de los estudiantes y se asoció a sucesos vivenciales como factores estresores.

Introduction: University education constitutes a process that generates many tensions for the students from all over the world, which has been associated with high stress levels, anxiety and depression. Objective: To describe the manifestations of academic stress in students from the third year of Medicine. Methods: A descriptive, cross-sectional and retrospective study of 10 students from the Medicine Faculty No. 1 was carried out in Santiago de Cuba, diagnosed with academic stress in the Student Direction Unit, from January to June, 2022. Results: The moderated stress prevailed in 70.0 % of the students, with a primacy of female sex (50.0 %). The frequency of intensity of the concern was expressed in the categorical value (70.0 %) as many. Among the main identified factors that cause stress we can mention: excess of tasks and works, professors evaluations and participation in class that are part of the dynamics in the training process of the career. Also, the diversity of strategies to face this stress prevailed. Conclusions: The academic stress was mostly present in the affective and behavioral spheres of the students and was associated with events experienced as factors that cause stress.

Satisfacción y calidad percibida en cirugía mayor ambulatoria

Fundamento: la calidad es uno de los temas que ha suscitado mayor interés en los investigadores de las más disimiles ramas de la producción, los servicios y las ciencias en los últimos años. Se ha demostrado la necesidad del estudio de la calidad percibida en el ámbito sanitario y, particularmente, en cirugía mayor ambulatoria. Objetivo: evaluar la satisfacción y calidad percibida por pacientes y familiares usuarios de cirugía mayor ambulatoria; determinar la existencia de diferencias en los criterios de pacientes y familiares. Métodos: estudio observacional descriptivo desde enero de 2018 a marzo de 2020 en el Servicio de Cirugía General del Hospital Provincial Arnaldo Milián Castro, de Santa Clara. Se aplicaron entrevistas por vía telefónica a 50 pacientes (intervenidos por cirugía mayor ambulatoria) y a un familiar que lo hubiese acompañado durante el proceso de atención. Resultados: se obtuvieron resultados favorables en la satisfacción y percepción de la calidad en los pacientes y familiares sin evidenciarse diferencias estadísticas significativas entre estos grupos. Conclusiones: la cirugía mayor ambulatoria es una modalidad asistencial bien aceptada por los pacientes y sus familiares acompañantes.

Background quality is one of the issues that has aroused the greatest interest in researchers from the most dissimilar branches of production, services and science in recent years. The need to study the perceived quality in the health field and, particularly, in major outpatient surgery has been demonstrated. Objective: to evaluate the satisfaction and quality perceived by patients and relatives who use major outpatient surgery; to determine the existence of differences in the patients and relatives' criteria. Methods: descriptive observational study from January 2018 to March 2020 at the General Surgery Service of the Arnaldo Milián Castro Provincial Hospital, in Santa Clara. Telephone interviews were applied to 50 patients (operated for major outpatient surgery) and a family member who had accompanied them during the care process. Results: favorable results were obtained in satisfaction and quality perception in patients and relatives without showing significant statistical differences between these groups. Conclusions: major ambulatory surgery is a care modality well accepted by patients and their accompanying families.

Consecuencias psicológicas del sexting y relación con el estrés académico / Psychological consequences of sexting and relationship with the academic stress

Se presenta el caso de una estudiante de segundo año medicina, atendida en la Unidad de Orientación Estudiantil de la Facultad de Medicina No. 1 de la Universidad de Ciencias Médicas de Santiago de Cuba, entre septiembre y diciembre de 2021, por presentar problemas académicos y manifestaciones de estrés debido a que fue víctima de acoso verbal y psicológico por parte de sus compañeros de grupo a partir de un acto de sexting por parte de su pareja. Teniendo en cuenta lo anterior se le dio seguimiento para un mejor estudio y se comparten los hallazgos con la comunidad científica en general.

The case of a second year medicine student is presented, assisted in the Student Orientation Unit of Medicine Faculty No. 1 in the University of Medical Sciences from Santiago de Cuba, between September and December, 2021, due to academic problems and stress manifestations because she was victim of verbal and psychological harassment by her groupmates as a result of an act of sexting by her couple. Taking into account the above-mentioned she was followed up for a better study and findings are shared with the scientific community in general.

Alternative language paradigms for functional magnetic resonance imaging as presurgical tools for inducing crossed cerebro-cerebellar language activations in brain tumor patients.

OBJECTIVES: Crossed cerebro-cerebellar BOLD activations have recently come to light as additional diagnostic features for patients with brain tumors. The covert verb generation (VG) task is a widely used language paradigm to determine these language-related crossed activations. Here we demonstrate these crossed activations in two additional language paradigms, the semantic and phonological association tasks. We propose the merit of these tasks to language lateralization determination in the clinic as they are easy to monitor and suitable for patients with aphasia. METHODS: Patients with brain tumors localized at different cortical sites (n = 71) performed three language paradigms, namely the VG task as well as the semantic (SA) and phonological (PA) association tasks with button-press responses. Respective language activations in disparate cortical regions and the cerebellum were assigned laterality. Agreements in laterality between the two new tasks and the verb generation task were tested using Cohen's kappa. RESULTS: Both tasks significantly agreed in cortical and cerebellar lateralization with the verb generation task in patients. Additionally, a McNemar test confirmed the presence of crossed activations in the cortex and the cerebellum in the entire subject population. CONCLUSION: We demonstrated that the semantic and phonological association tasks resulted in crossed cerebro-cerebellar language lateralization activations as those observed due to the covert verb generation task. This may suggest the possibility of these tasks being used conjointly with the traditional verb generation task, especially for subjects that may be unable to perform the latter. KEY POINTS: • The semantic and phonological association tasks can be useful as additional presurgical fMRI language lateralization paradigms for brain tumor patients along with the standard verb generation task. • All three tasks also confirm the presence of crossed cerebro-cerebellar language activations in the current subject population.

A case-control study of a combination of single nucleotide polymorphisms and clinical parameters to predict clinically relevant toxicity associated with fluoropyrimidine and platinum-based chemotherapy in gastric cancer.

BACKGROUND: Fluoropyrimidine plus platinum chemotherapy remains the standard first line treatment for gastric cancer (GC). Guidelines exist for the clinical interpretation of four DPYD genotypes related to severe fluoropyrimidine toxicity within European populations. However, the frequency of these single nucleotide polymorphisms (SNPs) in the Latin American population is low (< 0.7%). No guidelines have been development for platinum. Herein, we present association between clinical factors and common SNPs in the development of grade 3-4 toxicity. METHODS: Retrospectively, 224 clinical records of GC patient were screened, of which 93 patients were incorporated into the study. Eleven SNPs with minor allelic frequency above 5% in GSTP1, ERCC2, ERCC1, TP53, UMPS, SHMT1, MTHFR, ABCC2 and DPYD were assessed. Association between patient clinical characteristics and toxicity was estimated using logistic regression models and classification algorithms. RESULTS: Reported grade ≤ 2 and 3-4 toxicities were 64.6% (61/93) and 34.4% (32/93) respectively. Selected DPYD SNPs were associated with higher toxicity (rs1801265; OR = 4.20; 95% CI = 1.70-10.95, p = 0.002), while others displayed a trend towards lower toxicity (rs1801159; OR = 0.45; 95% CI = 0.19-1.08; p = 0.071). Combination of paired SNPs demonstrated significant associations in DPYD (rs1801265), UMPS (rs1801019), ABCC2 (rs717620) and SHMT1 (rs1979277). Using multivariate logistic regression that combined age, sex, peri-operative chemotherapy, 5-FU regimen, the binary combination of the SNPs DPYD (rs1801265) + ABCC2 (rs717620), and DPYD (rs1801159) displayed the best predictive performance. A nomogram was constructed to assess the risk of developing overall toxicity. CONCLUSION: Pending further validation, this model could predict chemotherapy associated toxicity and improve GC patient quality of life.

Aplicación de propuestas para el perfeccionamiento de la atención en cirugía mayor ambulatoria y de corta estadía / Application of proposals for the ambulatory and short-stay major surgery improvement of care

RESUMEN Fundamento: se han evidenciado dificultades en la coordinación entre los niveles primario y secundario de salud en el proceso de atención a pacientes en la cirugía mayor ambulatoria y la cirugía de corta estadía. En respuesta a esta situación se diseñaron propuestas asistenciales (un modelo teórico-asistencial, un manual para la organización procedimental y un modelo de historia clínica) en etapas investigativas anteriores. Objetivo: evaluar la satisfacción y calidad percibida por pacientes y familiares con la aplicación de un modelo asistencial, un manual de procedimientos y un modelo de historia clínica para el perfeccionamiento asistencial en cirugía mayor ambulatoria y cirugía de corta estadía. Métodos: desde el 4 de enero de 2016 hasta el 28 de diciembre de 2017 se efectuó un estudio cuasi-experimental para evaluar la satisfacción y calidad percibida por pacientes sin experiencia en cirugía mayor ambulatoria o de corta estadía y un familiar acompañante en cada caso. Se aplicó un diseño con un grupo experimental y otro de control solo con post-prueba para pacientes y familiares. Los grupos experimentales estuvieron constituidos por 50 pacientes y 50 familiares respectivamente y los grupos de control por 67 pacientes y 67 familiares. La satisfacción y calidad percibida fueron evaluadas mediante escalas ascendentes de 1 hasta 5 puntos. Resultados: se obtuvieron niveles más favorables en la satisfacción y percepción de la calidad en los pacientes y familiares de los grupos experimentales. Conclusiones: la aplicación de las propuestas asistenciales contribuyó al logro de elevados niveles de satisfacción y calidad percibida en los usuarios.

ABSTRACT Background: difficulties have been evidenced in the coordination between the primary and secondary health levels in the process of caring for patients in major outpatient surgery and short-stay surgery. In answer to this situation, healthcare proposals (a theoretical-healthcare model, a manual for procedural organization and a clinical history model) were designed in previous research stages. Objective: to evaluate the satisfaction and quality perceived by patients and relatives with the application of a care model, a procedure manual and a clinical history model for major outpatient surgery and short-stay surgery improvement of care. Methods: from January the 4th, 2016 to December the 28th, 2017, a quasi-experimental study was carried out to evaluate the satisfaction and quality perceived by patients with no experience in major outpatient or short-stay surgery and a companion relative in each case. A design was applied with an experimental group and a control group only with post-test for patients and relatives. The experimental groups consisted of 50 patients and 50 relatives respectively and the control groups of 67 patients and 67 relatives. Satisfaction and perceived quality were evaluated using ascending scales from 1 to 5 points. Results: more favorable levels of satisfaction and perception of quality were obtained in patients and relatives of the experimental groups. Conclusions: the application of the healthcare proposals contributed to the achievement of high levels of satisfaction and perceived quality in the users.

Protein quantification by bicinchoninic acid (BCA) assay follows complex kinetics and can be performed at short incubation times.

Amongst the available methodologies for protein determination, the bicinchoninic acid (BCA) assay highlights for its simplicity, sensitivity, repeatability and reproducibility. Nevertheless, in spite that the general principle behind this methodology is known, there are still unanswered questions regarding the chemistry behind the assay and the experimental conditions commonly employed. The present work explored the kinetics, and the analytical response of the assay to free amino acids, peptides (containing tryptophan and tyrosine), and proteins. Results revealed kinetic profiles characterized by the absence of plateaus, with behaviors depending on the type of the sample. The latter, along with contribution to the BCA index elicited by oxidation products generated at the side chain of tryptophan and tyrosine, as well as pre-oxidized ß-casein, evidenced the presence of complex reaction mechanisms. In spite of such complexity, our results showed that the BCA index is not modulated by the incubation time. This applies for responses producing absorbance intensities (at 562 nm) higher than 0.1. Therefore, we propose that the assay can be applied at shorter incubation times (15 min) than those indicated in manufactures specifications, and usually used by researches and industry (30 min at 37 °C).

Assessment of the Economic and Health-Care Impact of COVID-19 (SARS-CoV-2) on Public and Private Dental Surgeries in Spain: A Pilot Study.

OBJECTIVES: The COVID-19 (SARS-CoV-2) pandemic is an ongoing public health challenge, also for the dentistry community. The main objective of this paper was to determine the economic and health-care impact of COVID-19 on dentists in the Autonomous Region of Galicia (Spain). METHODS: This was a descriptive observational study in which the data was collected by means of a self-administered survey (from 1 April 2020 to 30 April 2020). RESULTS: A total of 400 dentists from Galicia responded to the survey. Only 12.3% of the participants could obtain personal protective equipment (PPE) including FFP2 masks. Of the male respondents, 33.1% suffered losses >€15,000 compared to 19.4% of female respondents (OR = 3.121, p < 0.001). Economic losses seem to have contributed to the applications for economic help as 29.5% of the respondents who applied for this measure recorded losses in excess of €15,000 (p = 0.03). Patients complained more about the fact that only emergency care was available during the State of Alarm, in dental surgeries that do not work with insurance companies or franchises. Only 4 professionals tested positive, 50% of whom worked exclusively in private practice and the other 50% who practised in both private and public surgeries. Dentists who practise in the public sector saw more urgent patients per week than those practising in private surgeries (p = 0.013). CONCLUSIONS: The COVID-19 pandemic has had economic repercussions in dentistry as only urgent treatment was available during the State of Alarm. These repercussions seem to be higher in male participants, as the majority of the participants have revealed higher economic losses than females. The level of assistance has also been affected, reducing the number of treated patients, although this quantity has been different in private and public surgeries. By presenting these findings we look to highlight the role that dentists play in society in treating dental emergencies in our surgeries, and this must be recognised and addressed by the relevant authorities, who must provide PPEs as a priority to this group as well as providing special economic aid in accordance with the losses incurred by the sector.

Multi-Objective Optimization for Personalized Prediction of Venous Thromboembolism in Ovarian Cancer Patients.

Thrombotic events are one of the leading causes of mortality and morbidity related to cancer, with ovarian cancer having one of the highest incidence rates. The need to prevent these events through the prescription of adequate schemes of antithrombotic prophylaxis has motivated the development of models that aid the identification of patients at higher risk of thrombotic events with lethal consequences. However, antithrombotic prophylaxis increases the risk of bleeding and this risk depends on the class and intensity of the chosen antithrombotic prophylactic scheme, the clinical and personal condition of the patient and the disease characteristics. Moreover, the datasets used to obtain current models are imbalanced, i.e., they incorporate more patients who did not suffer thrombotic events than patients who experienced them what can lead to wrong predictions, especially for the clinically relevant patient group at high risk of thrombosis. Herein, predictive models based on machine learning were developed utilizing 121 high-grade serous ovarian carcinoma patients, considering the clinical variables of the patients and those typical of the disease. To properly manage the data imbalance, cost-sensitive classification together with multi-objective optimization was performed considering different combinations of metrics. In this way, five Pareto fronts and a series of optimal models with different false positive and false negative rates were obtained. With this novel approach to the development of clinical predictive models, personalized models can be developed, helping the clinician to achieve a better balance between the risk of bleeding and the risk of thrombosis.

Aplicación de un modelo asistencial para perfeccionar la atención en cirugía mayor ambulatoria y en la de corta estadía / Application of an assisting model to improve care in ambulatory major surgery and short stay

RESUMEN Fundamento: Se han evidenciado dificultades en la coordinación entre los niveles primario y secundario de salud en el proceso de atención a pacientes en la cirugía mayor ambulatoria y la cirugía de corta estadía. Objetivo: evaluar la satisfacción y calidad percibida por pacientes y familiares con la aplicación de un modelo asistencial, una guía de procedimientos y un modelo de historia clínica para el perfeccionamiento asistencial en la cirugía mayor ambulatoria y la cirugía de corta estadía. Métodos: se efectuó un estudio cuasi-experimental para evaluar la satisfacción y calidad percibida por pacientes con experiencia en cirugía mayor electiva ambulatoria o de corta estadía, y por sus familiares. El grupo experimental quedó conformado por 22 pacientes y 22 familiares, y el de control por 28 pacientes y 28 familiares. La satisfacción fue evaluada mediante una escala Likert. Para las comparaciones entre los grupos experimental y de control, se aplicó la Dócima U de Mann-Whitney para dos muestras independientes. Resultados: existió correspondencia entre ambos grupos de pacientes, el experimental y el control, con un comportamiento similar entre la satisfacción y los indicadores de calidad percibida. En los pacientes del grupo experimental, la satisfacción y los indicadores de calidad percibidos mostraron mejores resultados en la postprueba, con excepción del indicador accesibilidad. Conclusión: la aplicación de las propuestas asistenciales contribuyó al logro de elevados niveles de satisfacción y calidad percibida en pacientes y familiares.

ABSTRACT Foundation: Difficulties have been evidenced in the coordination between primary and secondary health levels in the process of patient care in ambulatory major surgery and short stay surgery. Objective: to evaluate the satisfaction and quality perceived by patients and family members with the application of an assisting model, a procedure guide and a clinical history model for care improvement in ambulatory major surgery and short stay surgery. Methods: a quasi-experimental study was conducted to evaluate the satisfaction and perceived quality of patients with their experience in ambulatory or short-stay elective major surgery, and by their relatives. The experimental group was constituted of 22 patients and 22 relatives, and the control group was composed of 28 patients and 28 relatives. Satisfaction was assessed using a Likert scale. The Mann-Whitney U-score was applied for comparisons between the experimental and control groups and for two independent samples. Results: there was correspondence between both groups of patients, experimental and control, with a similar behavior between satisfaction and indicators of perceived quality. In the patients of the experimental group, satisfaction and perceived quality indicators showed better results in the post-test, with the exception of the indicator accessibility. Conclusion: the application of assisting proposals contributed to the achievement of high levels of satisfaction and perceived quality in patients and relatives.

Differences by Resistotyping Between C. albicans Strains Isolated from the Oral Cavity of HIV+ and Seronegative Patients / Diferencias por resistotipificación entre cepas de C. albicans aisladas de la cavidad oral de pacientes VIH+ y seronegativos

Abstract Candida albicans is the etiological agent most frequently associated with oral candidiasis in human immunodeficiency virus (HIV) carriers. Strain typification is important to disease epidemiology, particularly with simple, low-cost methodologies such as resistotyping. The present study was designed to use resistotyping to identify possible phenotypic differences between C. albicans strains isolated from the oral cavity of HIV+ and HIV-seronegative patients. Analyses were run using resistotyping (boric acid, cetrimide, sodium periodate, sodium selenite and silver nitrate) to identify phenotypical differences between C. albicans. Descriptive statistics was performed. Of the 149 clones isolated from HIV+ patients the most frequent (47.0%) resistotype was ABCDE. The most frequent resistotype (64.8%) in the 74 clones from HIV-seronegative patients was --CDE. Phenotypic differences were identified between the strains isolated from each group. HIV+ patients exhibited greater strain diversity. Although it has limitations, resistotyping effectively identified differences between C. albicans strains.

Resumen Candida albicans es el agente etiológico más frecuentemente asociado con la candidiasis oral en portadores del virus de la inmunodeficiencia humana (VIH). La tipificación de la cepas es importante para conocer la epidemiología de la enfermedad, particularmente con metodologías simples y de bajo costo, como la resistotipificación. El presente estudio fue diseñado para identificar posibles diferencias fenotípicas por el método de resistotipificación entre cepas de C. albicans aisladas de la cavidad oral de pacientes VIH+ y seronegativos. Se realizó estadística descriptiva. Los análisis se realizaron utilizando resistotipificación (ácido bórico, cetrimida, peryodato de sodio, selenito de sodio y nitrato de plata) para identificar diferencias fenotípicas entre C. albicans. De las 149 clonas aisladas de pacientes VIH+, el resistotipo más frecuente (47.0%) fue ABCDE. El resistotipo más frecuente (64.8%) en las 74 clonas de pacientes seronegativos al VIH fue --CDE. Se identificaron diferencias fenotípicas entre las cepas aisladas de cada grupo. Los pacientes VIH + exhibieron una mayor diversidad de cepas. Aunque tiene limitaciones, la resistotipificación identificó de manera efectiva las diferencias entre las cepas de C. albicans.

Treatment characteristics, efficacy and safety of thrombopoietin analogues in routine management of primary immune thrombocytopenia.

: Thrombopoietin receptor agonist (TPO-RAs) have demonstrated good efficacy and tolerance in clinical trials in refractory chronic primary immune thrombocytopenia (ITP) or chronic ITP with contraindication for splenectomy. No head-to-head study is available, and differences in trials design do not allow comparisons. Information on the use of TPO-RAs in nonchronic ITP is scant. We described our experience with TPO-RAs in ITP (chronic, persistent and newly diagnosed ITP) in routine clinical practice. Retrospective series of 100 adult ITP patients was analysed; 41 treated with eltrombopag, 37 with romiplostim and 22 with both. Response-related and safety variables were evaluated. With a median follow-up of 86.5 weeks (interquartile range, 34.3-128 weeks), no differences were found in response rate, time to response, stability of response or response duration based on the type of TPO-RA used. Of all, 25% of patients with newly diagnosed or persistent ITP and 7.2% with chronic responded and maintained their response when TPO-RAs were stopped. Regarding safety, two developed bone marrow fibrosis grade 3, with loss of response to both drugs. Incidence of vascular events was 7%. Both TPO-RAs may be useful in all types of ITP, not only chronic but also persistent and newly diagnosed. Similar results were noted in efficacy and safety variables for both drugs.

Chilean Gastric Cancer Task Force: A study protocol to obtain a clinical and molecular classification of a cohort of gastric cancer patients.

Gastric cancer (GC) is the world's second-leading cause of neoplastic mortality. Genetic alterations, response to treatments, and mortality rates are highly heterogeneous across different regions. Within Latin America, GC is the leading cause of cancer death in Chile, affecting 17.6 per 100,000 people and causing >3000 deaths/y. Clinical outcomes and response to "one size fits all" therapies are highly heterogeneous and thus a better stratification of patients may aid cancer treatment and response.The Gastric Cancer Task Force is a Chilean collaborative, noninterventional study that seeks to stratify gastric adenocarcinomas using clinical outcomes and genomic, epigenomic, and protein alterations in a cohort of 200 patients. Tumor samples from the Pathology Department and the Cancer Center at UC-Christus healthcare network, Pontificia Universidad Católica de Chile will be analyzed using a panel of 143 known cancer genes (Oncomine Comprehensive Assay) at the Center of Excellence in Precision Medicine in Santiago, Chile. In addition, promoter methylation for selected genes will be performed along with tissue microarray for clinically relevant proteins (e.g., PD-L1, Erb-2, VEGFR2, among others) and Helicobacter pylori and Epstein-Barr virus status. Obtained data will be correlated to 120 clinical parameters retrieve from medical records, including general patient information, cancer history, laboratory studies, comorbidity index, chemotherapy, targeted therapies, efficacy, and follow-up.The development of a clinically meaningful classification that encompasses comprehensive clinical and molecular parameters may improve patient treatment, predict clinical outcomes, aid patient selection/stratification for clinical trials and may offer insights into future preventive and/or therapeutic strategies in patients from Latin America region. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03158571, Registered on May 18, 2017.

Editor's Highlight: Differential Effects of Exposure to Single Versus a Mixture of Endocrine-Disrupting Chemicals on Steroidogenesis Pathway in Mouse Testes.

Endocrine-disrupting chemicals (EDCs) generate reproductive dysfunctions affecting the biosynthesis of steroid hormones and genes of the steroidogenic pathway. EDCs effects are mainly reported as a result of exposure to single compounds. However, humans are environmentally exposed to a mixture of EDCs. Herein, we assess chronic exposure to single alkylphenols and phthalates versus a mixture in mouse testes histology and steroidogenesis. Pregnant mice were exposed through drinking water to: 0.3 mg/kg-body weight (BW)/d of each phthalate (bis (2-ethylhexyl) phthalate, dibutyl phthalate, benzyl butyl phthalate), 0.05 mg/kg-BW/d of each alkylphenol (4-nonylphenol, 4-tert-octylphenol), or their mixture, covering from 0.5 postcoital day to weaning, continuing in the male offspring each exposure until adulthood (60-days old). Body and relative testis weight were increased in mixture-exposed mice along with histological alterations. Intratesticular testosterone (T) changed only in mice exposed to DBP, whereas estradiol (E2) levels were altered in all groups (except benzyl butyl phthalate). mRNA levels of genes encoding hormones of the steroid pathway (Cyp11a1, Hsd3b1, Cyp17a1, and Cyp19a1), cholesterol transporters (Star), and transcriptional factors (Sp1) showed that mice exposed to single or mixed compounds had alterations in at least 2 transcripts. However, none of the different types of exposure induced changes in all transcripts. In addition, changes at the mRNA or protein levels with single compounds were not always the same as those with a mixture. In conclusion, the effects of a chronic exposure to a mixture of EDCs on the expression of genes and proteins of the steroidogenic pathway and hormonal status were different from those exposed to single EDC.

Influencia de la aparatología ortodóntica sobre la ocurrencia de Candida spp. en la cavidad oral / Influence of orthodontic appliances on the occurrence of Candida spp. in the oral cavity

Introducción: El uso de aparatología ortodóntica crea condiciones favorables para el incremento de la placa bacteriana. Objetivo: Evaluar si el uso de aparatología ortodóntica influye en la presencia de especies de Candida en la cavidad oral, en un grupo de pacientes pediátricos. Material y Métodos: Se estudiaron 60 pacientes entre 4 y 10 años de edad, que requirieron tratamiento con aparatología ortodóntica. Se tomaron muestras de la cavidad oral al inicio del tratamiento ortodóntico y a los seis meses de uso. Las muestras fueron sembradas en Agar Dextrosa Sabouraud y CHROMagar® Candida. Las especies de Candida se confirmaron por RPC múltiple. Los resultados se analizaron con la prueba estadística de chi cuadrada. Resultados: La presencia de Candida fue mayor en las muestras tomadas a los seis meses de iniciado el tratamiento (p < 0,001). La especie más frecuente antes del tratamiento fue C. albicans (8,3%) y después del tratamiento fue C. tropicalis (20,0%). Conclusiones: El uso de aparatología ortodóntica influye en la presencia de especies de Candida, por lo que deben tomarse medidas preventivas para evitar su conversión en candidiasis oral, en especial, en pacientes inmunodeprimidos.

Introduction: Use of orthodontic appliances creates favorable conditions for growth of dental bacterial plaque. Aim: To establish if use of orthodontic appliance affects the presence of Candida species in the oral cavity in a group of pediatric patients. Materials and Methods: We studied 60 patients between 4 and 10 years old, requiring treatment with orthodontic appliances. Samples were taken of the oral cavity before orthodontic treatment and six months after use began. Samples were inoculated in Sabouraud Dextrose Agar and Candida CHROMagar®. Candida species confirmation and identification was done by multiple PCR, and results analyzed with a chi-squared test. Results: Candida presence was greater (p < 0,001) in the samples taken six months after use began than in the initial samples. Before treatment, the most frequently found species (percentage of studied patients) was C. albicans (8.3%), while after treatment it was C. tropicalis (20.0%). Conclusions: Use of orthodontic appliances in children increases Candida species presence in the oral cavity. Preventative measures should be taken to avoid oral candidiasis, particularly in immunosuppressed patients.

Eficacia de la meditación para el control del malestar psicológico en gestantes con riesgo de complicaciones inminentes / Effectiveness of meditation to control the psychological discomfort in pregnant women at risk of inminent complications

Se realizó un estudio cuasi-experimental de corte transversal en 20 gestantes con alto riesgo de complicaciones inminentes, hospitalizadas en el Hospital Ginecoobstétrico Docente "Tamara Bunke Bider" de Santiago de Cuba, de enero a mayo del 2015, y que mostraban diferentes manifestaciones de malestar psicológico, con el fin de evaluar la eficacia de la meditación para reducir los síntomas de estas alteraciones. Para ello se efectuó una evaluación inicial previa a la intervención y una final, con la aplicación de la entrevista y los tests de IDARE, Zung y Conde; también se utilizó el test de McNemar para medir el nivel de asociación entre los resultados finales del tratamiento y la meditación. Como principal resultado se obtuvo que la práctica de la meditación fuera eficaz en la mejoría de los malestares ansioso y mixto, aunque su eficacia era reducida en las pacientes que presentaban disforia. De igual modo, la técnica contribuyó a elevar el autocontrol emocional en las embarazadas.

A quasi-experimental cross-sectional study in 20 pregnant women at high risk of inminent complications, hospitalized in "Tamara Bunke Bider" Teaching Ginecoobstetric Hospital in Santiago de Cuba, was carried out from January to May, 2015, that showed different manifestations of psychological discomfort, with the purpose of evaluating the effectiveness of meditation to reduce the symptoms of these disorders. An initial and final evaluations were carried out, with the interview and the IDARE, Zung and Conde tests; the McNemar test was also used to measure the association level between the final results of the treatment and the meditation. As main result it was obtained that the practice of meditation was effective in the improvement of the anxious and mixed discomfort, although its effectiveness was reduced in the patients that presented dysphoria. In the same way, the technique contributed to elevate the emotional selfcontrol in pregnant women.

Necesidad del enfoque por competencias en la formación profesional en cirugía endoscópica / Need for a Competency-based Approach to Training in Endoscopic Surgery

Pese al desarrollo alcanzado en el país en el sector de la salud y en la educación médica, el currículo del residente de cirugía se ha mantenido estático por casi tres décadas. De manera particular, el residente de cirugía debe adquirir habilidades en cirugía endoscópica durante su formación especializada. En virtud de ello, se trae a colación el enfoque de formación basado en competencias, sustentado en los razonamientos y deducciones emanadas de los estudiosos a nivel nacional e internacional. Se concluye que es necesario el enfoque por competencias en la formación profesional en cirugía endoscópica, ya que en la estructura de estas se encuentran componentes diversos que se corresponden con las características deseables en el cirujano general que realiza este tipo de cirugía.

Despite the development achieved in the country in the field of health and medical education, the surgical residency program has remained static for nearly three decades. In particular, surgical residents must acquire skills for endoscopic surgery during their specialized training. In light of this, the competency-based training, which is the result of the analysis and deductions emanating from scholars at the national and international level, is discussed. It is concluded that the competency-based approach to training in endoscopic surgery is necessary since it includes various components that correspond with the desired characteristics of the general surgeon performing this type of procedure.

Quantity and accessibility for specific targeting of receptors in tumours.

Synaphic (ligand-directed) targeting of drugs is an important potential new approach to drug delivery, particularly in oncology. Considerable success with this approach has been achieved in the treatment of blood-borne cancers, but the advances with solid tumours have been modest. Here, we have studied the number and availability for ligand binding of the receptors for two targeting ligands. The results show that both paucity of total receptors and their poor availability are major bottlenecks in drug targeting. A tumour-penetrating peptide greatly increases the availability of receptors by promoting transport of the drug to the extravascular tumour tissue, but the number of available receptors still remains low, severely limiting the utility of the approach. Our results emphasize the importance of using drugs with high specific activity to avoid exceeding receptor capacity because any excess drug conjugate would lose the targeting advantage. The mathematical models we describe make it possible to focus on those aspects of the targeting mechanism that are most likely to have a substantial effect on the overall efficacy of the targeting.