N-terminal pro-B-type natriuretic peptide and pulmonary echography are predictors of acute heart failure needing early mechanical ventilation in acute coronary syndrome.

AIM: The aim of this study was to determine the best clinical predictors of acute heart failure needing mechanical ventilation (MV) in the first 48 h of evolution of patients admitted because of acute coronary syndrome (ACS). METHODS: We analyzed a cohort of patients admitted for ACS between February 2017 and February 2018. A pulmonary ultrasound was performed on admission and was considered positive (PE+) when there were three or more B-lines in two quadrants or more of each hemithorax. It was compared with N-terminal pro-B-type natriuretic peptide (NT-proBNP), peak troponin T-us value GRACE (Global Registry of Acute Coronary Events), CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology and American Heart Association guidelines - Bleeding Score), CACS (Canada Acute Coronary Syndrome risk score), and HAMIOT (Heart Failure after Acute Myocardial Infarction with Optimal Treatment score) scores, shock index, ejection fraction, chest X-ray, and Killip class at admission as predictors of MV in the first 48 h of admission. RESULTS: A total of 119 patients were included: 54.6% with ST elevation and 45.4% without ST elevation. Twelve patients (10.1%) required MV in the first 48 h of evolution. The sensitivity of PE+ was 100% (73.5-100%), specificity 91.6% (84.6-96.1%), and area under the curve was 0.96 (0.93-0.96). The sensitivity of an NT-proBNP value more than 3647 was 88.9% (51.9-99.7%), specificity 92.1% (84.5-96.8%), and area under the curve was 0.905 (0.793-1). The κ statistic between both predictors was 0.579. All the other scores were significantly worse than PE + . CONCLUSION: Lung ultrasound and a high NT-proBNP (3647 ng/L in our series) on admission are the best predictors of acute heart failure needing MV in the first 48 h of ACS. The agreement between both tests was only moderate.

Pro-inflammatory T cells-derived cytokines enhance the maturation of the human fetal intestinal epithelial barrier.

Small intestine (SI) maturation during early life is pivotal in preventing the onset of gut diseases. In this study we interrogated the milestones of SI development by gene expression profiling and ingenuity pathway analyses. We identified a set of cytokines as main regulators of changes observed across different developmental stages. Upon cytokines stimulation, with IFNγ as the most contributing factor, human fetal organoids (HFOs) increase brush border gene expression and enzyme activity as well as trans-epithelial electrical resistance. Electron microscopy revealed developed brush border and loss of fetal cell characteristics in HFOs upon cytokine stimulation. We identified T cells as major source of IFNγ production in the fetal SI lamina propria. Co-culture of HFOs with T cells recapitulated the major effects of cytokine stimulation. Our findings underline pro-inflammatory cytokines derived from T cells as pivotal factors inducing functional SI maturation in vivo and capable of modulating the barrier maturation of HFOs in vitro.

Delays in diagnosis and surgery of sarcoma patients during the COVID-19 outbreak in Spain.

Background and objectives: Social distancing and quarantine implanted during the COVID-19 outbreak could have delayed the accession of oncologic patients to hospitals and treatments. This study analysed the management of sarcoma patients during this period in five Spanish hospitals. Design and methods: Clinical data from adult sarcoma patients, soft tissue and bone sarcomas, managed during the COVID-19 outbreak, from 15 March to 14 September 2020 (Covid cohort), were retrospectively collected and time for diagnosis, surgery and active treatments were compared with sarcoma patients managed during the same pre-pandemic period in 2018 (Control cohort). Results: A total of 126 and 182 new sarcoma patients were enrolled in the Covid and Control cohorts, respectively, who were mainly diagnosed as soft tissue sarcomas (81.0% and 80.8%) and at localized stage (80.2% and 79.1%). A diagnostic delay was observed in the Covid cohort with a median time for the diagnosis of 102.5 days (range 6-355) versus 83 days (range 5-328) in the Control cohort (p = 0.034). Moreover, a delay in surgery was observed in cases with localized disease from the Covid cohort with a median time of 96.0 days (range 11-265) versus 54.5 days (range 2-331) in the Control cohort (p = 0.034). However, a lower delay for neoadjuvant radiotherapy was observed in the Covid cohort with a median time from the diagnosis to the neoadjuvant radiotherapy of 47 days (range 27-105) versus 91 days (range 27-294) in the Control cohort (p = 0.039). No significant differences for adjuvant radiotherapy, neoadjuvant/adjuvant chemotherapy and neoadjuvant/adjuvant palliative chemotherapy were observed between both cohorts. Neither progression-free survival (PFS) nor overall survival (OS) was significantly different. Conclusion: Delays in diagnosis and surgery were retrospectively observed in sarcoma patients during the COVID-19 outbreak in Spain, while the time for neoadjuvant radiotherapy was reduced. However, no impact on the PFS and OS was observed.

Significant Increase in Cytomegalovirus (CMV) Infection in Solid Organ Transplants Associated With Increased Use of Thymoglobulin as Induction Therapy?

BACKGROUND: Cytomegalovirus (CMV) infection remains one of the most common viral pathogens affecting solid organ transplants (SOT). In 10 years of following the outcome of transplants, we noticed an increased incidence of CMV infection, along with increased use of rabbit anti-thymocyte globulin (rATG). The study aims to assess the incidence of active CMV infection and disease, response to treatment, and recurrence in a cohort of SOT. Furthermore, we look for correlating the CMV incidence with the type of induction therapy: r-ATG or interleukin 2 receptor-blocking antibody (basiliximab). METHODS: This was a single-center, retrospective 10-year study in patients submitted to kidney, kidney-liver, and kidney-pancreas transplants who used a preemptive therapy protocol for CMV. RESULTS: Among the 476 enrolled transplant recipients, 306 (64.2 %) had at least one episode of CMV infection (replication), and 71/306 patients (23.2 %) presented CMV-related disease. The most frequent clinical conditions associated with CMV disease were gastrointestinal. Among the 476 transplant patients, 333 received immunosuppressive induction with rATG (69.9 %); 140 (29.4 %) received induction with interleukin 2 receptor-blocking antibody (basiliximab). The initial maintenance immunosuppressive therapy in the patients who presented CMV infection was primarily performed with prednisone, tacrolimus, and sodium mycophenolate (91.7 %). The induction with rATG increased from 35.2%-94.6% in 10 years. The incidence of CMV infection was 20.7 % in the first year of observation and gradually increased to 87.3 % in the last year. CONCLUSIONS: The data suggest that the increase in the use of rATG in recent years could be responsible for the very expressive increase in the incidence of CMV infection/disease.

Escalera de superación académica con enfoque interdisciplinario en la Facultad de Tecnología de la Salud de La Habana / Steps of academic training with interdisciplinary approach in the Health Technology Faculty of Havana city i: en

Introducción: A la Universidad del siglo XXI le corresponde ser consecuente con los procesos derivados del desarrollo social, lo cual debe ser atendido desde la formación de posgrado. A tales efectos, se diseñó y ejecutó una estrategia de superación en la Facultad de Tecnología de la Salud de La Habana, según las necesidades de aprendizaje de los profesionales. Objetivo: Describir los principales resultados de la generalización de la escalera de superación académica con enfoque interdisciplinario. Métodos: Se realizó un estudio descriptivo, longitudinal y retrospectivo, en el periodo 2017-2022, en la Facultad de Tecnología de la Salud de La Habana. Las 5 variables identificadas fueron la superación por tipo de actividad de posgrado según año, los artículos científicos publicados por año en la Revista Cubana de Tecnología de la Salud, la formación de doctores en educación médica, los doctores en educación médica graduados según universidades y centros de salud, así como la promoción de profesores a la categoría docente superior. Resultados: Se apreció un incremento de las formas de superación desarrolladas. En el 2019 la cifra de autores y coautores con publicaciones en la revista de la Facultad ascendió a 219; asimismo, en la formación de grado científico hubo considerables resultados, tanto en profesores como en otros profesionales de la salud, y aumentó el número de docentes que ascendieron a la categoría superior. Conclusiones: Como resultado de la superación académica escalonada se destacó la elaboración de 5 maestrías para el área de las tecnologías de la salud y se apreció un incremento sostenido en la promoción de profesionales de la educación médica a categorías docentes superiores.

Introduction: The University of the XXI century is in charge of being consequent with the processes derived from the social development, which should be assisted from the posdegree education. To such effects, a training strategy was designed and implemented in the Health Technology Faculty of Havana city, according to the learning necessities of professionals. Objective: To describe the main results of generalization of the academic training steps with interdisciplinary approach. Methods: A descriptive, longitudinal and retrospective study was carried out in 2017-2022 in the Health Technology Faculty of Havana city. The 5 variables identified were training by type of posdegree activity according to year, the scientific works published per year in the Cuban Journal of Health Technology, training of doctors in Medical Education, doctors in Medical Education graduated according to universities and health centers, as well as the promotion of professors to the superior teaching category. Results: An increment in the developed ways of training was appreciated. In 2019, the number of authors and joint authors with publications in the Faculty's journal has reached 219; also, there were considerable results in the scientific degree education, either in professors or in other health professionals, and there was a higher number of professors that reached the superior category. Conclusions: As a result of the staged academic training, the elaboration of 5 masters՚ degree for health technologies area was notable and a sustained increment was appreciated in the promotion of professionals from the medical education to superior educational categories.

Evaluación de la profesionalización de los docentes de Enfermería y Tecnología de la Salud / Evaluation of Nursing and Health Technology teachers' professionalization i: en

Introducción: La profesionalización docente es una entidad de la esfera educativa que ha ganado un fuerte protagonismo entre los investigadores de esta área del conocimiento desde finales del siglo XX. Objetivo: Valorar el estado actual de la evaluación de la profesionalización de los docentes de las carreras de Enfermería y Tecnología de la Salud. Métodos: Se efectuó una investigación observacional y descriptiva, durante el año 2021, de los 144 docentes de la Facultad de Enfermería-Tecnología de la Salud de Santiago de Cuba, para lo cual se analizaron 6 variables: actividad docente, actividad científico-investigativa, actividad asistencial, actividad gerencial, actividad bioética y actuación profesional; y un total de 21 indicadores, en correspondencia con las exigencias actuales de la educación médica. Resultados: La triangulación metodológica de los instrumentos aplicados fue de 6,7, estimado como un nivel bajo de desarrollo, lo que permitió corroborar que la evaluación de la profesionalización de los docentes en el período evaluado se encontraba afectada. Conclusiones: Los problemas y las potencialidades identificados refrendan la necesidad de desarrollar la evaluación de la profesionalización de los docentes de esta Facultad.

Introduction: Teaching professionalization is an entity of educational sphere which has gained a strong role among researchers in this area of knowledge from the end of the 20th century. Objective: To assess the current state of evaluation of Nursing and Health Technology careers teachers' professionalization. Methods: An observational and descriptive investigation was carried out, during the year 2021, of the 144 teachers of Faculty of Nursing and Health Technology from Santiago de Cuba province, for which 6 variables were analyzed: teaching activity, scientific-investigative activity, care activity, management activity, bioethical activity and professional performance; as well as a total of 21 indicators, in correspondence with the current demands in medical education. Results: The methodological triangulation of the applied instruments was 6.7, estimated as a low level of development, which allowed corroborating that the evaluation of the teachers' professionalization was affected in that period. Conclusions: The problems and potentialities identified endorse the need to develop the evaluation of the teachers' professionalization in this Faculty.

Estrategia de gestión académica para la integración de los procesos sustantivos en la formación del estudiante de Medicina / Academic management strategy for the integration of fundamental processes in the medical student training i: en

Partiendo de las limitaciones identificadas en el accionar del especialista en medicina general integral para la integración de los procesos sustantivos en la formación del estudiante de Medicina, se determinó diseñar una estrategia de gestión académica, la cual connota los referentes epistémicos que la sustentan, sus propósitos y etapas. En este artículo se exponen los métodos teóricos empleados para la concepción de dicha estrategia, así como las técnicas usadas para su ejecución y las etapas en que se estructuró. Asimismo, se confirma su validez y pertinencia luego de aplicada y el grado de satisfacción de los docentes con ella. Finalmente, se identifican los principales impactos revelados de su implementación, en los órdenes social, científico y educativo.

Based on the limitations identified in the actions of the specialist in comprehensive general medicine for the integration of fundamental processes in the medical student training, it was determined to design an academic management strategy, which connotes the epistemic referents that support it, as well as its purposes and stages. The theoretical methods used for the conception of such a strategy, as well as the techniques used for its implementation and the stages in which it was structured are presented in this work. Likewise, its validity and relevance after its application and the degree of professors' satisfaction with it are confirmed. Finally, the main revealed impacts of its implementation are identified, in social, scientific and educational orders.

Utility of pulmonary echography with a handheld ultrasound device in patients with acute coronary syndrome.

The objectives of this study are to establish the usefulness of lung ultrasound with a handheld device to predict the risk of developing heart failure with the need for mechanical ventilation (MV) in acute coronary syndrome (ACS). This is a prospective study of consecutive patients admitted because of ACS-type myocardial infarction, without data of HF at admission in a tertiary hospital, between February 2017 and February 2018. Lung ultrasounds were performed with a handheld cardiologic device in the first 24 h, and defined as echo-positive (PE+) when exams revealed 3 or more B-lines in 2 or more bilateral quadrants. We related this finding to the need for MV during admission. We included 119 patients (65.1 ± 12.8 year; 75.6% male, 24.4% female; 87.4% in Killip class I, 12.6% in Killip class II). Pulmonary echography was positive (PE+) in 21 patients (17.6%). The sensitivity of PE+ to predict MV was 93.3%, the specificity 93.3%, and the area under the curve 0.93. In Cox regression analysis adjusted by CRUSADE score and Killip class, PE+ patients had a hazard ratio of 64.55 (CI 7.87; 529.25, p < 0.001) of needing MV. PE+ was associated with more frequent use of inotropes and mortality. Pulmonary ultrasonography with a handheld echocardiograph was predictive of severe heart failure and the need for mechanical ventilation in ACS with high specificity and sensitivity.

El aprendizaje basado en problemas como herramienta didáctica para mejoras del desempeño en peritonitis posoperatoria / Problem-based learning as a didactic tool for performance improvements in postoperative peritonitis

Fundamento: el aprendizaje basado en problemas es una herramienta didáctica de la superación profesional a distancia poco utilizada en Cirugía. Objetivo: analizar el aprendizaje basado en problemas como herramienta didáctica virtual pertinente para el desarrollo de habilidades clínicas y quirúrgicas en la peritonitis posoperatoria. Método: se realizó una investigación cualitativa descriptiva en el Hospital "Dr. Ambrosio Grillo" de Santiago de Cuba, en el trimestre mayo-julio 2022. Se emplearon métodos del nivel teórico para la fundamentación de la investigación, empírico (prueba de desempeño con la aplicación de 20 problemas de salud (14 en español y 6 en inglés) para la evaluación final teórico-práctica de un entrenamiento virtual en peritonitis posoperatoria; y matemáticos. Resultados: se constató que el aprendizaje basado en problemas en la superación profesional a distancia en Cirugía representa una herramienta didáctica motivacional para el desarrollo de habilidades clínicas y quirúrgicas en la peritonitis posoperatoria y soluciona insuficiencias en el desempeño de los profesionales que tratan esta complicación. El empleo de las TIC en el aprendizaje contemporáneo facilita la autopreparación mediante el diseño de simuladas problemáticas de salud. Conclusiones: el aprendizaje basado en problemas es una pertinente herramienta que contribuye a mejoras del desempeño profesional frente a complicaciones quirúrgicas graves como la peritonitis posoperatoria, desde la superación profesional a distancia.

Background: problem-based learning is a didactic tool for distance professional improvement that is rarely used in Surgery. Objective: to analyze problem-based learning as a relevant virtual didactic tool for the development of clinical and surgical skills in postoperative peritonitis. Method: a descriptive qualitative research was carried out at the Hospital "Dr. Ambrosio Grillo" of Santiago de Cuba, from May to July 2022. Methods of the theoretical level were used for the foundation of the research, empirical (performance test with the application of 20 health problems (14 in Spanish and 6 in English) for the theoretical-practical final evaluation of a virtual training in postoperative peritonitis; and mathematics. Results: it was found that problem-based learning in distance professional improvement in Surgery represents a motivational didactic tool for the development of clinical and surgical skills in postoperative peritonitis and solves deficiencies in the performance of professionals who treat this complication. The use of ICT in contemporary learning facilitates self-preparation through the design of simulated health problems. Conclusions: problem-based learning is a pertinent tool that contributes to improvements in professional performance when facing serious surgical complications such as postoperative peritonitis, from distance professional improvement.

Habilidades procedimentales invariantes para el diagnóstico y el tratamiento de la peritonitis posoperatoria

Introducción: Las habilidades procedimentales invariantes en las peritonitis posoperatorias, les permite a los cirujanos el diagnóstico temprano y la reoperación abdominal urgente. Objetivo: Diseñar las habilidades procedimentales invariantes de atención diagnóstica y terapéutica a la peritonitis posoperatoria dirigida a los cirujanos. Método: Se realizó una investigación cualitativa en el Hospital Clínico Quirúrgico "Ambrosio Grillo" de Santiago de Cuba en el trimestre mayo-julio de 2022. La población de estudio estuvo constituida por 33 profesionales tratantes de la peritonitis posoperatoria: 22 médicos (12 cirujanos y 10 intensivistas) y 11 licenciadas en Enfermería. Se utilizó la sistematización como método teórico y como método empírico la revisión documental con la revisión de las historias clínicas y la observación con la práctica atencional-docente de la autora principal. Resultados: Se diseñaron las habilidades procedimentales invariantes para el diagnóstico temprano y la terapéutica de la peritonitis posoperatoria dirigida a los cirujanos con especial importancia en el método clínico. La autopreparación del tema en cuestión posibilita la complementación de conocimientos y habilidades aprendidas, así como la actualización de saberes que garantiza la atención clínica quirúrgica a este complejo enfermo. Conclusiones: El diseño de las habilidades procedimentales invariantes para el diagnóstico temprano y la terapéutica de la peritonitis posoperatoria en la necesaria superación permanente y continuada de los cirujanos representa una herramienta asistencial-docente que contribuye al mejoramiento del desempeño profesional ante este tipo de enfermo.

Introduction: Invariant procedural skills in postoperative peritonitis allow surgeons an early diagnosis and the performance of urgent abdominal resurgery. Objective: To design invariant procedural skills to be implemented for surgeons on the diagnostic and therapeutic care of postoperative peritonitis. Method: A qualitative research was conducted at the Hospital Clínico Quirúrgico "Ambrosio Grillo" of Santiago de Cuba in the quarter period of May-July 2022. The study population consisted of 33 specialists on postoperative peritonitis: 22 physicians (12 surgeons and 10 intensivists) and 11 graduated bachelor in nursing. Systematization was used as the theoretical method and the empirical methods used were the document analysis supported with the review of clinical histories and the observation with the main author's attentional-teaching practice. Results: It was designed an invariant procedural skills for the early diagnosis and therapy of postoperative peritonitis with special emphasis on the clinical method. The self-preparation on the subject makes possible the complementation of both knowledge and skills learned, as well as an update of knowledge that guarantees the surgical clinical care of these complex patients. Conclusions: The design of invariant procedural skills for the early diagnosis and therapy of postoperative peritonitis in the necessary permanent and continuous knowledge improvement of surgeons represents a care-teaching tool that contributes to improve the professional performance at the time to attend to this type of patient.

Introdução: As habilidades processuais invariantes na peritonite pós-operatória permitem aos cirurgiões o diagnóstico precoce e a reoperação abdominal urgente. Objetivo: Projetar as habilidades processuais invariantes de atenção diagnóstica e terapêutica para peritonite pós-operatória destinadas a cirurgiões. Método: Uma pesquisa qualitativa foi realizada no Hospital Clínico Cirúrgico "Ambrosio Grillo" em Santiago de Cuba no trimestre maio-julho de 2022. A população do estudo consistiu em 33 profissionais que tratam de peritonite pós-operatória: 22 médicos (12 cirurgiões e 10 intensivistas) e 11 graduados em enfermagem. Utilizou-se como método teórico a sistematização e como métodos empíricos a revição documental com revisão de histórias clínicas e a observação com a prática docente-atencional da autora principal. Resultados: Desenharam-se competências processuais invariantes para o diagnóstico precoce e terapêutica da peritonite pós-operatória dirigidas a cirurgiões com especial importância no método clínico. O autopreparo do sujeito em questão possibilita a complementação dos conhecimentos e habilidades aprendidas, bem como a atualização de conhecimentos que garantem o cuidado clínico cirúrgico desta complexa doença. Conclusões: O desenho de habilidades processuais invariantes para o diagnóstico precoce e tratamento da peritonite pós-operatória no necessário aperfeiçoamento permanente e contínuo dos cirurgiões representa uma ferramenta cuidado-ensino que contribui para o aperfeiçoamento da atuação profissional frente a este tipo de paciente.

The extracellular matrix controls stem cell specification and crypt morphology in the developing and adult mouse gut.

The rapid renewal of the epithelial gut lining is fuelled by stem cells that reside at the base of intestinal crypts. The signal transduction pathways and morphogens that regulate intestinal stem cell self-renewal and differentiation have been extensively characterised. In contrast, although extracellular matrix (ECM) components form an integral part of the intestinal stem cell niche, their direct influence on the cellular composition is less well understood. We set out to systematically compare the effect of two ECM classes, the interstitial matrix and the basement membrane, on the intestinal epithelium. We found that both collagen I and laminin-containing cultures allow growth of small intestinal epithelial cells with all cell types present in both cultures, albeit at different ratios. The collagen cultures contained a subset of cells enriched in fetal-like markers. In contrast, laminin increased Lgr5+ stem cells and Paneth cells, and induced crypt-like morphology changes. The transition from a collagen culture to a laminin culture resembled gut development in vivo. The dramatic ECM remodelling was accompanied by a local expression of the laminin receptor ITGA6 in the crypt-forming epithelium. Importantly, deletion of laminin in the adult mouse resulted in a marked reduction of adult intestinal stem cells. Overall, our data support the hypothesis that the formation of intestinal crypts is induced by an increased laminin concentration in the ECM.

N-antigenemia detection by a rapid lateral flow test predicts 90-day mortality in COVID-19: A prospective cohort study.

OBJECTIVES: To evaluate if the detection of N antigen of SARS-CoV-2 in plasma by a rapid lateral flow test predicts 90-day mortality in COVID-19 patients hospitalized at the wards. METHODS: The presence of N-antigenemia was evaluated in the first 36 hours after hospitalization in 600 unvaccinated COVID-19 patients, by using the Panbio COVID-19 Ag Rapid Test Device from Abbott (Abbott Laboratories Inc., Chicago, IL, USA). The impact of N-antigenemia on 90-day mortality was assessed by multivariable Cox regression analysis. RESULTS: Prevalence of N-antigenemia at hospitalization was higher in nonsurvivors (69% (82/118) vs. 52% (250/482); p < 0.001). The patients with N-antigenemia showed more frequently RNAemia (45.7% (148/324) vs. 19.8% (51/257); p < 0.001), absence of anti-SARS-CoV-2 N antibodies (80.7% (264/327) vs. 26.6% (69/259); p < 0.001) and absence of S1 antibodies (73.4% (240/327) vs. 23.6% (61/259); p < 0.001). The patients with antigenemia showed more frequently acute respiratory distress syndrome (30.1% (100/332) vs. 18.7% (50/268); p = 0.001) and nosocomial infections (13.6% (45/331) vs. 7.9% (21/267); p = 0.026). N-antigenemia was a risk factor for increased 90-day mortality in the multivariable analysis (HR, 1.99 (95% CI,1.09-3.61), whereas the presence of anti-SARS-CoV-2 N-antibodies represented a protective factor (HR, 0.47 (95% CI, 0.26-0.85). DISCUSSION: The presence of N-antigenemia or the absence of anti-SARS-CoV-2 N-antibodies after hospitalization is associated to increased 90-day mortality in unvaccinated COVID-19 patients. Detection of N-antigenemia by using lateral flow tests is a quick, widely available tool that could contribute to early identify those COVID-19 patients at risk of deterioration.

La investigación científica: un reto en electromedicina

RESUMEN En Cuba se fomenta el desarrollo de investigaciones en el campo de las ciencias médicas, con el fin de introducir sus resultados a favor del progreso económico y social. El objetivo de este trabajo fue reflexionar sobre el papel de la ciencia en la gestión de equipos médicos, su aplicación en los departamentos de electromedicina de las instituciones sanitarias, y su impacto social. Todo ello a partir de la presentación de los aspectos teóricos fundamentales de las relaciones entre ciencia, gestión de equipos médicos y función social de la electromedicina, a partir de su situación actual. La investigación científica en electromedicina, permitiría formular nuevas teorías o modificar las existentes e incrementar los conocimientos, lo que posibilitaría el enriquecimiento de las ciencias médicas. Resulta necesaria como proceso, a fin de obtener información relevante para la verificación, corrección y aplicación del conocimiento, en aras de solucionar los problemas de las tecnologías sanitarias y su impacto socioeconómico.

ABSTRACT In Cuba, the development of research in the field of the medical sciences is promoted in order to introduce its results to favor the social and economic progress. The aim of this work was to reflect on the role of science in the management of medical devices, its application in the electromedicine departments of health facilities, and its social impact, all this from the presentation of the main theoretical aspects of the relations between science, medical devices management and electromedicine social function in its current situation. Scientific research in electromedicine would allow to formulate new theories or to modify the existent ones and to increase knowledge, what would make possible the enrichment of the medical sciences. As a process, scientific research is necessary in order to obtain relevant information for the validation, correction and application of the knowledge, for the sake of solving the problems of health technologies and its socioeconomic impact.

Retrospective analysis of the clinical presentation and imaging of eight primary benign mediastinal schwannomas.

OBJECTIVE: Mediastinal schwannomas are sometimes confused with other neoplasms during initial radiological studies, especially when there is a history of cancer in another area. In these cases, a more accurate analysis using computed tomography (CT) or even magnetic resonance (MRI) is required. Our study aimed to perform a retrospective analysis of the clinical and imaging features for a series of patients with mediastinal schwannomas that were confirmed by histology and immunohistochemistry. RESULTS: We found eight patients, five men and three women, with an average age of 51 years for this study. The main signs and symptoms at diagnosis were chest pain, dyspnea, cough, and dysphagia. CT showed that the tumor was located in the posterior compartment of the chest in 7/8 cases. Tumors > 10 cm were more heterogeneous and showed cystic changes. All patients underwent posterolateral thoracotomy, and radiological follow-up showed no evidence of recurrence. Histological analysis was considered the gold standard to confirm diagnosis, along with at least one neurogenic IHC marker. In conclusion, mediastinal schwannomas are benign encapsulated tumors. According to CT, schwannomas > 10 cm show cystic degeneration more frequently. Posterolateral thoracotomy allows complete resection and is considered the surgical approach of choice.

Early Life Antibiotics Influence In Vivo and In Vitro Mouse Intestinal Epithelium Maturation and Functioning.

BACKGROUND & AIMS: The use of antibiotics (ABs) is a common practice during the first months of life. ABs can perturb the intestinal microbiota, indirectly influencing the intestinal epithelial cells (IECs), but can also directly affect IECs independent of the microbiota. Previous studies have focused mostly on the impact of AB treatment during adulthood. However, the difference between the adult and neonatal intestine warrants careful investigation of AB effects in early life. METHODS: Neonatal mice were treated with a combination of amoxicillin, vancomycin, and metronidazole from postnatal day 10 to 20. Intestinal permeability and whole-intestine gene and protein expression were analyzed. IECs were sorted by a fluorescence-activated cell sorter and their genome-wide gene expression was analyzed. Mouse fetal intestinal organoids were treated with the same AB combination and their gene and protein expression and metabolic capacity were determined. RESULTS: We found that in vivo treatment of neonatal mice led to decreased intestinal permeability and a reduced number of specialized vacuolated cells, characteristic of the neonatal period and necessary for absorption of milk macromolecules. In addition, the expression of genes typically present in the neonatal intestinal epithelium was lower, whereas the adult gene expression signature was higher. Moreover, we found altered epithelial defense and transepithelial-sensing capacity. In vitro treatment of intestinal fetal organoids with AB showed that part of the consequences observed in vivo is a result of the direct action of the ABs on IECs. Lastly, ABs reduced the metabolic capacity of intestinal fetal organoids. CONCLUSIONS: Our results show that early life AB treatment induces direct and indirect effects on IECs, influencing their maturation and functioning.

Estrategia de superación para el mejoramiento del desempeño profesional de oftalmólogos de la Atención Primaria de Salud en Santiago de Cuba / Training strategy for improving the professional performance in primary health care ophthalmologists in Santiago de Cuba

El vertiginoso desarrollo científico - tecnológico de la oftalmología requiere de una actualización sistemática desde el punto de vista teórico - práctico. A tales efectos, se diseñó una estrategia de superación para el mejoramiento del desempeño profesional de los oftalmólogos de la Atención Primaria de Salud dirigida a la atención integral de los pacientes con oclusiones vasculares retinianas. Se emplearon métodos de los niveles teórico y empírico. Fue diseñada en 4 etapas y se utilizó el ciclo Deming como referente metodológico. Se establecieron relaciones esenciales que ofrecen coherencia lógica interna a la educación médica en su concepción como ciencia en construcción, en particular en el área de la formación permanente y continuada de los profesionales de la salud, al profundizar en el orden conceptual, metodológico y epistemológico en los procesos de desempeño profesional y superación.

The fast scientific and technological development of Ophthalmology requires a systematic updating from the theoretical and practical points of view. To such effects, a training strategy was designed for the improvement of professional performance of the primary care ophthalmologists directed to the comprehensive care of patients with retinal vascular occlusions. Empiric and theoretical level methods were used. The strategy was designed in 4 stages and the Deming cycle was implemented as methodological referent. Essential relationships were established which offer internal logical coherence to the Medical Education in its conception as science, particularly in the area of permanent and continued training of the health professionals, as there is a deepening in the conceptual, methodological and epistemological order in the processes of professional and training performance.

Automatic Evaluation of Heart Condition According to the Sounds Emitted and Implementing Six Classification Methods.

The main cause of death in Mexico and the world is heart disease, and it will continue to lead the death rate in the next decade according to data from the World Health Organization (WHO) and the National Institute of Statistics and Geography (INEGI). Therefore, the objective of this work is to implement, compare and evaluate machine learning algorithms that are capable of classifying normal and abnormal heart sounds. Three different sounds were analyzed in this study; normal heart sounds, heart murmur sounds and extra systolic sounds, which were labeled as healthy sounds (normal sounds) and unhealthy sounds (murmur and extra systolic sounds). From these sounds, fifty-two features were calculated to create a numerical dataset; thirty-six statistical features, eight Linear Predictive Coding (LPC) coefficients and eight Cepstral Frequency-Mel Coefficients (MFCC). From this dataset two more were created; one normalized and one standardized. These datasets were analyzed with six classifiers: k-Nearest Neighbors, Naive Bayes, Decision Trees, Logistic Regression, Support Vector Machine and Artificial Neural Networks, all of them were evaluated with six metrics: accuracy, specificity, sensitivity, ROC curve, precision and F1-score, respectively. The performances of all the models were statistically significant, but the models that performed best for this problem were logistic regression for the standardized data set, with a specificity of 0.7500 and a ROC curve of 0.8405, logistic regression for the normalized data set, with a specificity of 0.7083 and a ROC curve of 0.8407, and Support Vector Machine with a lineal kernel for the non-normalized data; with a specificity of 0.6842 and a ROC curve of 0.7703. Both of these metrics are of utmost importance in evaluating the performance of computer-assisted diagnostic systems.

Fondaparinux versus enoxaparin in the contemporary management of non-ST-elevation acute coronary syndromes. Insights from a multicenter registry.

BACKGROUND: Fondaparinux is thought to have the most favorable risk-benefit profile among all anticoagulants in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, conflicting findings exist whether this holds true in current clinical practice. We aimed to assess the net clinical benefit of fondaparinux versus enoxaparin in the contemporary management of NSTE-ACS. METHODS: Analysis of prospective multicenter registry data of NSTE-ACS patients who received fondaparinux or enoxaparin from February 2015, through December 2017. Survival models within a competing risks framework including site-specific random effects, were used to assess the composite of clinically relevant bleedings and major adverse cardiovascular events at 30 days. RESULTS: Of 2094 patients, 1724 (82%) received enoxaparin and 370 (18%) fondaparinux. Both groups were comparable except for a lower prevalence of diabetes and renal impairment, and greater use of transradial approach in the fondaparinux group. Multivariate analysis revealed a net clinical benefit in favour of fondaparinux versus enoxaparin (Subhazard Ratio [SHR] 0.59; 95%CI 0.37-0.92), mainly driven by a reduction in bleeding (SHR 0.57; 95%CI 0.37-0.89). Exploratory analysis suggested greater reductions in bleeding with fondaparinux among patients undergoing transradial approach, revealing a significant interaction between treatment and vascular access on the multiplicative scale (Pinteraction = 0.0056), but not on an additive scale (P = 0.457). Propensity-score-matching analysis yielded similar results. CONCLUSIONS: In contemporary management of NSTE-ACS, fondaparinux seems to provide a favorable net clinical benefit compared with enoxaparin, primarily driven by a bleeding reduction. Effect modification on the safety profile of fondaparinux by the vascular access approach warrants further investigation.