The "peel-away" technique for a ventriculoatrial shunt in a 6-month-old patient: A case report.

Background: A ventriculoatrial shunt (VAS) proves to be an excellent alternative in the treatment of hydrocephalus. Its usage is a viable option when ventriculoperitoneal shunt (VPS) is contraindicated in any age of patients. Case Description: This report highlights a successful case involving a 6-month-old patient who underwent VAS catheter positioning. The child presented with hydrocephalus and biliary atresia, making him a candidate for a liver transplant. Notably, a VPS was considered a relative contraindication in this scenario. Conclusion: The VAS emerges as a viable option for patients in whom a VPS might be contraindicated. This case demonstrates the successful application of a VAS in a pediatric patient.

Algunas consideraciones relevantes de la COVID-19 en el adulto mayor

La COVID-19 puede afectar a cualquier persona, sin distinción de edad, sexo o raza; pero numerosos estudios se han enfocado en caracterizar su heterogeneidad en términos demográficos, con una clara evidencia de alta mortalidad en hombres y adultos mayores. El objetivo de este trabajo es realizar algunas consideraciones sobre la covid-19 y su repercusión en el adulto mayor. Para ello se realizó una búsqueda bibliográfica teniendo en cuenta algunas consideraciones relevantes de la enfermedad, presentes en el adulto mayor, tales como su susceptibilidad ante la covid-19, elementos clínicos, complicaciones y tratamiento. Se pudo constatar, según publicaciones analizadas, que el adulto mayor es considerado el de mayor susceptibilidad ante la COVID-19, la morbimortalidad se incrementa con la edad y por la menor respuesta de defensa inmunológica ante la presencia de comorbilidades; la clínica es muy variable y atípica con la aparición de múltiples complicaciones extrapulmonares y la prevención es la conducta más efectiva. Los adultos mayores continúan considerándose una población vulnerable y se precisa de la prevención y un diagnóstico oportuno, para poder minimizar los daños a la salud.

COVID-19 can affect anyone regardless of age, sex or race; but numerous studies have focused on characterizing its heterogeneity in demographic terms, with clear evidence of high mortality in men and older adults. The objective of this work is to make some considerations about covid-19 and its impact on the elderly. A bibliographic search was carried out taking into account some relevant considerations of the disease, present in the elderly, such as their susceptibility to covid-19, clinical elements, complications and treatment. It was possible to verify, according to the analyzed publications, that the elderly is considered the most susceptible to COVID-19, morbidity and mortality increases with age and due to the lower immune defense response in the presence of comorbidities; the symptoms are highly variable and atypical with the appearance of multiple extrapulmonary complications and prevention, is the most effective course of action. Older adults continue to be considered a vulnerable population and prevention and timely diagnosis are required in order to minimize damage to health.

Theoretical and applied study of the psychological and educational effects of lockdown in primary school students in Argentina.

Emotions are complex states, which have a fundamental role for children's mental health and learning. The proper self-regulation of emotions allows to tolerate frustrations, improves social skills and healthy bonds with peers and adults in the environment (Bisquerra, 2003, p. 12). The lack of regulation causes discomfort that leads to a decrease in academic performance (Graziano, Reavis, Keanes & Calkins, 2006) and particularly in reading comprehension, because this competence requires motivation and cognitive processes that will allow to process the linguistic code, interpret it and represent it symbolically (Alonso-Tapia, 2005, p. 64). In this work, we show the essential relationship between emotional regulation and reading comprehension in primary school students. After that, we study the effect of lockdown on these two processes. The aim is to have preliminary information about the challenges and effects of the current situation. To do this, a semi-structured survey has been conducted of parents and teachers in order to assess the psychological and educational effects of the current health situation. The results of 40 semi-structured telephone surveys are analyzed, 20 of parents of children with learning disorders and 20 of their classroom teachers in Traslasierra, Córdoba-Argentina. The results inform that the students and their parents have difficulties to regulate their emotions and this emotional struggle has a negative impact on comprehension of texts. The problems that previously presented in these two areas have increased due to the lack of adaptation of activities by teachers, the lack of knowledge of their parents to help them and the difficulty in accessing digital technologies. Both parents and teachers express that lockdown affects learning processes, although parents are also concerned about the effects on social life.

Caracterización del autoaprendizaje en estudiantes de reciente ingreso a la educación médica superior / Characterization of self-learning in recently enrolled students in higher medical education

RESUMEN Fundamento: conocer las características del autoaprendizaje en los estudiantes de Medicina de reciente ingreso es pertinente para potenciar el desarrollo de habilidades que les permitan enfrentarse a las exigencias del plan de estudio en cada escenario docente. Objetivo: caracterizar el autoaprendizaje en los estudiantes de Medicina de reciente ingreso en la Facultad No. 1 de Santiago de Cuba. Métodos: se realizó un estudio descriptivo transversal durante el período académico 2016-2017. Se utilizaron métodos teóricos: analítico-sintético, inductivo-deductivo, histórico-lógico y el tránsito de lo abstracto a lo concreto; y empíricos: encuesta en forma de cuestionario a los estudiantes para obtener la información necesaria. Los datos se analizaron utilizando la estadística descriptiva y fueron presentados en tablas con números absolutos y porcentajes. Resultados: la mayoría de los alumnos planificaron el tiempo para el texto escrito orientado en forma de trabajo independiente; sin embargo, solo el menor porciento lo realizó con un orden lógico y adecuadas ortografía y sintaxis. Se constataron carencias en el uso de las tecnologías de la información y las comunicaciones y hubo predominio de la memoria a corto plazo, lo cual no garantiza la sostenibilidad del conocimiento. Conclusiones: algunos estudiantes ingresaron a la carrera de Medicina sin las habilidades necesarias para asumir su autoaprendizaje, tan necesario en esta etapa universitaria.

ABSTRACT Background: knowing the characteristics of self-learning in recently enrolled medical students is relevant to enhance the development of skills that allow them to face the demands of the curriculum in each classroom. Objective: to characterize self-learning in recently enrolled medical students in the Faculty No. 1 of Santiago de Cuba. Methods: a cross-sectional descriptive study was carried out during the 2016-2017 academic year. Theoretical methods were used: analytic-synthetic, inductive-deductive, historical-logical and the transition from the abstract to the concrete; and empirical ones: survey in the form of questionnaire to the students to obtain the necessary information. The data were analyzed using descriptive statistics and presented in tables with absolute numbers and percentages. Results: most of the students planned the time for the written text oriented in the form of independent work; however, only the smallest percentage did it with a logical order and adequate spelling and syntax. There were shortcomings in the use of information and communication technologies and there was a predominance of short-term memory, which does not guarantee the sustainability of knowledge. Conclusions: some students entered the Medicine degree without the necessary skills to assume their self-learning, so necessary in this university stage.

Impact of a Basal-Bolus Insulin Regimen on Metabolic Control and Risk of Hypoglycemia in Patients With Diabetes Undergoing Peritoneal Dialysis.

INTRODUCTION: Clinical interventional studies in diabetes mellitus usually exclude patients undergoing peritoneal dialysis (PD). This study evaluates the impact of an educational program and a basal-bolus insulin regimen on the blood glucose level control and risk of hypoglycemia in this population. METHODS: A before-and-after study was conducted in type 1 and type 2 DM patients undergoing PD at the Renal Therapy Services (RTS) clinic network, Bogota, Colombia. An intervention was instituted consisting of a three-month educational program and a basal-bolus detemir (Levemir, NovoNordisk) and aspart (Novorapid, NovoNordisk) insulin regimen. Prior to the intervention and at the end of treatment were conducted measures of HbA1c levels and continuous glucose monitoring (CGM). RESULTS: Forty-seven patients were recruited. Mean HbA1c level decreased from 8.41% ± 0.83 to 7.68% ± 1.32 (mean difference -0.739, 95% CI -0.419, -1.059; P < .0001). Of subjects, 52% achieved HbA1c levels <7.5% at the end of study. Mean blood glucose level reduced from 194.0 ± 42.5 to 172.9 ± 31.8 mg/dl ( P = .0015) measured by CGM. Significant differences were not observed in incidence of overall ( P = .7739), diurnal ( P = .3701), or nocturnal ( P = .5724) hypoglycemia episodes nor in area under the curve (AUC) <54 mg/dl ( P = .9528), but a reduction in AUC >180 ( P < .01) and AUC >250 ( P = .01) was evidenced for total, diurnal, and nocturnal episodes. CONCLUSIONS: An intervention consisting of an educational program and a basal-bolus insulin regimen in type 1 and type 2 diabetes mellitus patients undergoing PD caused a decrease in HbA1c levels, and mean blood glucose levels as measured from CGM with no significant increases in hypoglycemia episodes.

Effects of performing morning versus afternoon exercise on glycemic control and hypoglycemia frequency in type 1 diabetes patients on sensor-augmented insulin pump therapy.

BACKGROUND: Although physical exercise (PE) is recommended for individuals with type 1 diabetes (DM1), participation in exercise is challenging because it increases the risk of severe hypoglycemia and the available therapeutic options to prevent it frequently result in hyperglycemia. There is no clear recommendation about the best timing for exercise. The aim of this study was to compare the risk of hypoglycemia after morning or afternoon exercise sessions up to 36 hours postworkout. METHODS: This randomized crossover study enrolled subjects with DM1, older than 18 years of age, on sensor-augmented insulin pump (SAP) therapy. Participants underwent 2 moderate-intensity exercise sessions; 1 in the morning and 1 in the afternoon, separated by a 7 to 14 day wash-out period. Continuous glucose monitoring (CGM) data were collected 24 hours before, during and 36 hours after each session. RESULTS: Thirty-five subjects (mean age 30.31 ± 12.66 years) participated in the study. The rate of hypoglycemia was significantly lower following morning versus afternoon exercise sessions (5.6 vs 10.7 events per patient, incidence rate ratio, 0.52; 95% CI, 0.43-0.63; P < .0001). Most hypoglycemic events occurred 15-24 hours after the session. On days following morning exercise sessions, there were 20% more CGM readings in near-euglycemic range (70-200 mg/dL) than on days prior to morning exercise (P = .003). CONCLUSIONS: Morning exercise confers a lower risk of late-onset hypoglycemia than afternoon exercise and improves metabolic control on the subsequent day.

Cambios en el cuerpo calloso posteriores a derivación ventricular: Descripción de dos casos y revisión del tema / Imaging changes in the corpus callosum after ventricular shunting: Case reports and literature review

Se presentan dos pacientes sometidos a derivación ventricular por hidrocefalia idiopática y cisticercosis del cuarto ventrículo, respectivamente. En la resonancia magnética (RM) de control se encontró un aumento en el tamaño del cuerpo calloso con zonas de prolongación de los tiempos de relajación sin restricción en la secuencia de difusión. Las teorías fisiopatológicas mencionan: efectos mecánicos directos tras la colocación de la derivación, efecto compresivo crónico sobre el cuerpo calloso contra la hoz cerebral por la hidrocefalia, tracción de ramas perforantes de las arterias pericallosas que conduce a isquemia (probablemente ausente en estudios prequirúrgicos por el adelgazamiento del cuerpo calloso) y descompresión, luego de la derivación, que produce reexpansión del cuerpo calloso y edema intersticial del mismo. Los hallazgos pueden explicarse por el antecedente de derivación e hidrocefalia sin repercusión clínica aparente.(AU)

We report the cases of two patients with ventricular drainage due to idiopathic hydrocephalus and fourth ventricle cysticercosis, respectively. A follow-up MRI demonstrated increased volume of the corpus callosum with areas of prolonged relaxation without restriction on water diffusion sequences. Pathophysiologic theories include direct mechanical effects after the catheter insertion, chronic compression of the corpus callosum against the falx due to hydrocephalus, ischemia due to elongation of perforating pericallosal arteries not detected before shunting due to thinning of the corpus callosum, and decompressive changes leading to corpus callosum expansion and interstitial edema. These findings might be related to the history of ventricular shunt and hydrocephalus with no apparent clinical significance.(AU)

Cambios en el cuerpo calloso posteriores a derivación ventricular. Descripción de dos casos y revisión del tema / Imaging changes in the corpus callosum after ventricular shunting. Case reports and literature review

Se presentan dos pacientes sometidos a derivación ventricular por hidrocefalia idiopática y cisticercosis del cuarto ventrículo, respectivamente. En la resonancia magnética (RM) de control se encontró un aumento en el tamaño del cuerpo calloso con zonas de prolongación de los tiempos de relajación sin restricción en la secuencia de difusión. Las teorías fisiopatológicas mencionan: efectos mecánicos directos tras la colocación de la derivación, efecto compresivo crónico sobre el cuerpo calloso contra la hoz cerebral por la hidrocefalia, tracción de ramas perforantes de las arterias pericallosas que conduce a isquemia (probablemente ausente en estudios prequirúrgicos por el adelgazamiento del cuerpo calloso) y descompresión, luego de la derivación, que produce reexpansión del cuerpo calloso y edema intersticial del mismo. Los hallazgos pueden explicarse por el antecedente de derivación e hidrocefalia sin repercusión clínica aparente...

Drug-induced lupus in anti-TNF-alpha therapy and its treatment with rituximab.

We report three patients with rheumatoid arthritis (RA) who were treated with anti-TNF-α agents and who developed drug-induced lupus (DIL). Two of them received etanercept and the remainder adalimumab. We also present the favorable response observed with the withdrawal of the anti-TNF-alpha agents and the introduction of rituximab. Through this intervention, we observed a very good control of the activity of both DIL and RA without additional adverse reactions.

Impacto de los instrumentos evaluativos en el nuevo modelo de formación en la asignatura Morfofisiología / Impact of evaluative instruments on the new education model in the Morphophysiology subject

Se efectuó el examen práctico estructurado, por objetivos, de la asignatura de Morfofisiología a 12 estudiantes de segundo año de medicina en el nuevo modelo de formación pedagógica, pertenecientes al Policlínico Docente Frank País García de Santiago de Cuba en el 2008. El método utilizado para desarrollar habilidades y evaluar los resultados de ese proceso educativo a través de la observación del desempeño de los educandos, además de confiable, permitió elevar la calidad de las calificaciones sobre la base de la buena aceptación por parte de los alumnos(AU)

The structured practical exam by objectives of the Morphophysiology subject was taken in 12 second year-medical students for the new pedagogic education model, who belonged to Frank País García Teaching Polyclinic of Santiago de Cuba in 2008. The method used to develop abilities and to evaluate the results of that educational process through the observation of students, besides reliable, allowed to elevate the quality of marks on the basis of the good acceptance by the students(AU)

Impacto de los instrumentos evaluativos en el nuevo modelo de formación en la asignatura Morfofisiología / Impact of evaluative instruments on the new education model in the Morphophysiology subject

Se efectuó el examen práctico estructurado, por objetivos, de la asignatura de Morfofisiología a 12 estudiantes de segundo año de medicina en el nuevo modelo de formación pedagógica, pertenecientes al Policlínico Docente Frank País García de Santiago de Cuba en el 2008. El método utilizado para desarrollar habilidades y evaluar los resultados de ese proceso educativo a través de la observación del desempeño de los educandos, además de confiable, permitió elevar la calidad de las calificaciones sobre la base de la buena aceptación por parte de los alumnos.

The structured practical exam by objectives of the Morphophysiology subject was taken in 12 second year-medical students for the new pedagogic education model, who belonged to Frank País García Teaching Polyclinic of Santiago de Cuba in 2008. The method used to develop abilities and to evaluate the results of that educational process through the observation of students, besides reliable, allowed to elevate the quality of marks on the basis of the good acceptance by the students.

Regulación menstrual y adolescencia / Menstrual regulation and adolescence

Se realizó un estudio descriptivo comparativo para determinar los conocimientos de 64 adolescentes (48 hembras y 16 varones) sobre la Regulación Menstrual, correspondientes a 4 consultorios de un grupo básico de trabajo del policlínico Frank País García de Santiago de Cuba en el período de enero-agosto del año 2003. La información se obtuvo a través de un modelo de encuesta elaborado al efecto que luego fue procesado manualmente y se utilizó el porcentaje como medida de resumen. De la investigación realizada se derivó que el descenso de la Regulación Menstrual con relación al año anterior fue a expensas de las pacientes no adolescentes, además casi la totalidad de los adolescentes presentaban vida sexual activa desde la adolescencia intermedia cuando ya piensan en la Regulación Menstrual como método anticonceptivo a lo que se le une el no uso del condón como medio de protección en algo más de la mitad de los casos, por lo cual se impone continuar ampliando y enriqueciendo los conocimientos de modo general sobre educación sexual y en particular sobre Regulación Menstrual en los adolescentes del área ya mencionada(AU)

Gadolinium-enhanced MRI in the evaluation of minimally invasive treatments of the prostate: correlation with histopathologic findings.

OBJECTIVES: To explore the use of magnetic resonance imaging (MRI) with gadolinium enhancement as a noninvasive method to image the extent of ablation after minimally invasive treatment. Minimally invasive methods for ablating prostatic tissue have emerged as a viable option in the treatment of prostate disease. As these devices enter the mainstream of patient care, imaging methods that verify the exact location, extent, and pattern of the ablation are needed. METHODS: Nineteen patients with prostate cancer were evaluated. All received some type of minimally invasive treatment, post-treatment gadolinium-enhanced MRI sequences, and radical retropubic prostatectomy for histopathologic evaluation. Visual comparisons of gadolinium defects and areas of coagulation necrosis as seen on histopathologic evaluation were made by us. Volumetric and two-dimensional area measurements of the ablation lesions were also compared for correlation between the MRI and histopathologic results. RESULTS: Gadolinium-enhanced MRI could be matched to histopathologic findings by visual comparison in 17 of the 19 cases. Surgically distorted histopathologic specimens and a small periurethral lesion caused 2 patients to have MRI and histopathologic results that could not be matched. Complete volumetric measurements were available for 16 of the 19 patients and correlated strongly (r = 0.924). The two-dimensional area data for all patients also showed significant correlation (r = 0.886). CONCLUSIONS: Correlation with histopathologic findings showed gadolinium-enhanced MRI to be useful for determining the location, pattern, and extent of necrosis caused within the prostate by minimally invasive techniques. Gadolinium-enhanced MRI gives the urologist a useful tool to evaluate the effectiveness of new minimally invasive therapies.