A Rare Case of Septic Ovarian Thrombophlebitis Caused by Tissierella praeacuta.

We report a case of Tissierella praeacuta bacteremia and septic thrombophlebitis of the ovarian vein as a rare puerperal complication in a young patient. She was successfully managed with subcutaneous low molecular weight heparin (LMWH) and intravenous (IV) antibiotics before transitioning to a prolonged course of oral antibiotics at discharge.

Tabaco y tabaquismo en Cuba: de la economía agrícola a la economía de la salud

El consumo de cigarrillos y tabacos crea una externalidad que tiene mayor relevancia en el detrimento de la calidad de vida y de la expectativa de vida que experimenta el individuo fumador con relación a los que no consumen cigarrillos o tabacos. el costo psicosocial no cuantificado de forma financiera supera con creces cualquier expectativa de beneficio económico. El presente artículo versa en torno al impacto socioeconómico del tabaquismo en Cuba. La distribución económica inducida por el tabaquismo conlleva a la persistencia de una inequidad socioeconómica tal, que se agudiza con el número de fumadores y la intensidad del consumo de cigarrillos y tabáquico. Este fenómeno contradice el principio socialista de distribución con arreglo al trabajo, donde los no fumadores no deberían cargar con las consecuencias del tabaquismo y los propios fumadores no deberían ser inducidos a persistir en el consumo tabáquico. La sutileza de los costos sociales atribuibles al tabaquismo y el impacto de los beneficios del comercio interior y exterior, no permiten valorar en su completa dimensión los principales efectos del tabaquismo desde el aspecto socioeconómico.

The cigarettes and tobacco consumption creates an externality that is more relevant in the detriment of the life quality and life expectancy experienced by the individual smoker, in relation to those who do not consume cigarettes or tobacco. The psychosocial cost not financially quantified far exceeds any expectation of economic benefit. This article deals with the socioeconomic impact of smoking in Cuba. The economic distribution induced by smoking leads to the persistence of such socioeconomic inequity, which worsens with the number of smokers and the intensity of cigarette and tobacco consumption. This phenomenon contradicts the socialist principle of distribution according to work, where non-smokers should not bear the consequences of smoking and smokers themselves should not be induced to persist in smoking. The subtlety of the social costs attributable to smoking and the impact of the benefits of domestic and foreign trade do not allow a full assessment of the main effects of smoking from the socioeconomic aspect.

Physicians' attitudes and perceived barriers to adherence to the national breast cancer clinical practice guidelines in Mexico: a survey study.

BACKGROUND: Adherence to clinical practice guidelines improves outcomes for patients with breast cancer. However, their implementation may not be feasible in low- and middle-income countries. This study aimed to evaluate physicians' adherence, attitudes, and barriers towards the Colima Consensus, which is the Mexican national breast cancer clinical practice guideline. METHODS: A cross-sectional, 31-item survey was e-mailed to Consensus attendees and members of the Mexican Society of Oncology and Mexican Mastology Association. Descriptive statistics, univariate, and multivariate analysis were used to analyze the associations between participants' characteristics, adherence, attitudes, and barriers. RESULTS: Of 439 respondents, 78% percent adhered to Consensus recommendations and 94% believed it was applicable to their clinical practice. Forty percent reported using the Consensus as their sole breast cancer guideline. This was associated with being a surgical oncologist (OR 3.3, 95% CI 2.0-5.3) and practicing at a public hospital (OR 2.1, 95% CI 1.2-3.7). The most common barriers to adherence were lack of resources and logistical problems. Regarding attitudes towards the Consensus, 90% considered it a good educational tool, 89% considered it a reliable source of information, and 90% thought it improved quality of care. CONCLUSIONS: We showed high levels of adherence and positive attitudes towards the Colima Consensus, with a significant proportion of physicians using it as their only guideline. Lack of resources and logistical issues were the main barriers to adherence. Our results highlight the relevance of local breast cancer guidelines and suggest a need for the creation of resource-stratified guidelines.

[Direct medical costs in a cohort of patients with breast cancer]. / Costos médicos directos de la atención médica de pacientes con cáncer de mama.

Background: The economic cost of breast cancer (BC) treatment and the increase in incidence and prevalence challenges the financial stability of any healthcare system. Objective: To determine direct medical costs (DMC) of BC treatment and factors associated with DMC. Material and methods: Partial economic evaluation in a retrospective cohort of 160 patients with a confirmed diagnosis of BC. DMC was considered from the IMSS perspective. Bootstrapping analysis was used to deal with uncertainty and generalized linear model to identify factors associated with DCM. Results: The total average annual cost of BC treatment was $251,018 mexican pesos. In clinical stage I was $116,123, stage II $242,132, stage III $287,946, and stage IV $358,792 pesos. In progression disease, DMC were more elevate ($380,117) vs. without progression ($172,897), (p < 0.0001). In patients who died, DMC were $357,579 mexican pesos compared to those who survived ($218,699) (p < 0.0001). Conclusions: The average annual cost of CM treatment was $251,018 pesos. DMCs increase significantly as patients present more advanced stages of the disease. Factors associated with costs were age, stages II, III and the progression of BC.

Introducción: el costo económico del tratamiento de cáncer de mama (CM) y el aumento en su incidencia y prevalencia desafía la estabilidad financiera de cualquier sistema de salud. Objetivo: determinar los costos médicos directos (CMD) del tratamiento de CM y los factores asociados a estos costos. Material y métodos: evaluación económica parcial en una cohorte retrospectiva de 160 pacientes con diagnóstico confirmado de CM. Se consideraron CMD desde la perspectiva del IMSS. Se utilizó análisis de bootstrapping para tratar incertidumbre y el modelo lineal generalizado para identificar factores asociados a costos. Resultados: el costo promedio anual (CPA) del tratamiento de CM fue de $ 251,018 pesos. En estadio 1, $ 116,123; estadio II, $ 242,132; estadio III, $ 287,946, y estadio IV, $ 358,792 pesos. El CPA fue mayor en progresión del CM ($ 380,117 frente a no progresión $ 172,897), y en pacientes que fallecieron durante el seguimiento ($ 357,579) frente a aquellas que sobrevivieron ($ 218,699). Conclusiones: el CPA del tratamiento de CM fue de $ 251,018 pesos. Los CMD aumentan significativamente conforme las pacientes presentan estadios más avanzados de la enfermedad. Los factores asociados al CMD fueron edad, estadios II, III y la progresión del CM.

Costos médicos directos de la atención médica de pacientes con cáncer de mama / Direct medical costs in a cohort of patients with breast cancer

Introducción: el costo económico del tratamiento de cáncer de mama (CM) y el aumento en su incidencia y prevalencia desafía la estabilidad financiera de cualquier sistema de salud. Objetivo: determinar los costos médicos directos (CMD) del tratamiento de CM y los factores asociados a estos costos. Material y métodos: evaluación económica parcial en una cohorte retrospectiva de 160 pacientes con diagnóstico conf irmado de CM. Se consideraron CMD desde la perspectiva del IMSS. Se utilizó análisis de bootstrapping para tratar incertidumbre y el modelo lineal generalizado para identificar factores asociados a costos. Resultados: el costo promedio anual (CPA) del tratamiento de CM fue de $ 251,018 pesos. En estadio 1, $ 116,123; estadio II, $ 242,132; estadio III, $ 287,946, y estadio IV, $ 358,792 pesos. El CPA fue mayor en progresión del CM ($ 380,117 frente a no progresión $ 172,897), y en pacientes que fallecieron durante el seguimiento ($ 357,579) frente a aquellas que sobrevivieron ($ 218,699). Conclusiones: el CPA del tratamiento de CM fue de $ 251,018 pesos. Los CMD aumentan significativamente conforme las pacientes presentan estadios más avanzados de la enfermedad. Los factores asociados al CMD fueron edad, estadios II, III y la progresión del CM.

Background: The economic cost of breast cancer (BC) treatment and the increase in incidence and prevalence challenges the financial stability of any healthcare system. Objective: To determine direct medical costs (DMC) of BC treatment and factors associated with DMC. Material and methods: Partial economic evaluation in a retrospective cohort of 160 patients with a confirmed diagnosis of BC. DMC was considered from the IMSS perspective. Bootstrapping analysis was used to deal with uncertainty and generalized linear model to identify factors associated with DCM Results: The total average annual cost of BC treatment was $251,018 mexican pesos. In clinical stage I was $116,123, stage II $242,132, stage III $287,946, and stage IV $358,792 pesos. In progression disease, DMC were more elevate ($380,117) vs. without progression ($172,897), (p < 0.0001). In patients who died, DMC were $357,579 mexican pesos compared to those who survived ($218,699) (p < 0.0001). Conclusions: The average annual cost of CM treatment was $251,018 pesos. DMCs increase significantly as patients present more advanced stages of the disease. Factors associated with costs were age, stages II, III and the progression of BC.

Capacitación pedagógica en entorno virtual de los entrenadores de Djibouti

Las diferentes formas de capacitación de los entrenadores deportivos están dirigidas a satisfacer las necesidades de movilizar los conocimientos, las técnicas y la reflexión dirigida a la resolución de problemas en la preparación de los atletas. Debido a esto, la investigación se trazó como objetivo diseñar la concepción teórica para la capacitación pedagógica en entorno virtual de los entrenadores de Djibouti sobre la iniciación del niño al futbol. A partir de un enfoque dialéctico materialista de interpretación de los fenómenos, se emplearon como principales métodos de investigación el análisis de documentos, la observación, la encuesta la modelación y la comparación. Fue así, que se constató que eran insuficientes los conocimientos teórico-metodológicos relacionados con la iniciación de los niños al futbol y las limitaciones organizativas y metodológicas en las formas de capacitación. Los elementos epistemológicos modelados fueron comparados con otras propuestas, que demostró la novedad teórica argumentativa de la propuesta.

As diferentes formas de treinamento de treinadores esportivos visam atender às necessidades de mobilização de conhecimentos, técnicas e reflexão voltadas para a solução de problemas na preparação dos atletas. Por isso, a pesquisa teve como objetivo elaborar a concepção teórica para a formação pedagógica dos treinadores djibutianos em um ambiente virtual sobre a iniciação das crianças no futebol. Com base em uma abordagem materialista dialética para a interpretação dos fenômenos, os principais métodos de pesquisa utilizados foram a análise, observação, levantamento, modelagem e comparação de documentos. Assim, verificou-se que os conhecimentos teóricos e metodológicos relacionados com a iniciação das crianças ao futebol e as limitações organizacionais e metodológicas nas formas de treinamento eram insuficientes. Os elementos epistemológicos modelados foram comparados com outras propostas, o que demonstrou a novidade teórica argumentativa da proposta.

The different forms of training of sports coaches are aimed at satisfying the needs of mobilizing knowledge, techniques and reflection aimed at solving problems in the preparation of athletes. Due to this, the research was set as an objective: to design the theoretical conception for the pedagogical training in a virtual environment of the Djiboutian coaches on the initiation of the child to soccer. From a materialist dialectical approach to the interpretation of phenomena, document analysis, observation, survey, modeling and comparison were used as the main research methods. Thus, it was found that the theoretical-methodological knowledge related to the initiation of children to soccer and the organizational and methodological limitations in the forms of training were insufficient. The epistemological elements modeled were compared with other proposals, which demonstrated the argumentative theoretical novelty of the proposal.

A Rare Case of Parvovirus B19 Infection Manifesting as Chronic Aplastic Anemia and Neutropenia in a Human Immunodeficiency Virus-Infected Patient.

Parvovirus B19 (PVB19) is a deoxyribonucleic acid (DNA) virus, the only member of the Parvoviridae, which has a direct cytopathic effect on erythroid progenitor cells, resulting in an arrest of hematopoiesis and subsequent anemia. Less frequently, neutropenia and thrombocytopenia have been reported with the PVB19 infection. We report a rare case of chronic neutropenia due to PVB19 in a human immunodeficiency virus (HIV) patient. A 51-year-old male with a medical history of HIV presented to the Emergency Department (ED) with complaints of generalized weakness. His laboratory tests were significant for severe anemia and new neutropenia. PVB19 DNA by polymerase chain reaction (PCR) was positive. PVB19 immunoglobulin M (IgM) and IgG were reported negative. He was diagnosed with aplastic anemia from PVB19 and neutropenia. From June 2013 to January 2019, the patient was admitted 23 times with severe neutropenia and anemia, and on each occasion, PVB19 DNA by PCR was positive. During these multiple admissions, he was treated with antibiotics for neutropenic fever, methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, and methicillin-sensitive Staphylococcus aureus (MSSA) skin abscesses. On each occasion, he required multiple blood transfusions, and he received intravenous immunoglobulin (IVIG) that resulted in significant improvement of absolute neutrophil count (ANC) count. He had bone biopsy twice, which showed normal maturation of the myeloid series and reduced erythroid progenitor cells consistent with PVB19 infection. PVB19 DNA by PCR remains positive to date. Immunocompromised individuals usually develop a chronic infection from PVB19, and rarely infection with PVB19 can cause severe neutropenia that can be long-lasting and life-threatening. Early recognition and treatment with IVIG are the key to improve the clinical outcome.

A Rare Case of DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) Syndrome with Cholecystitis in a Patient on Levetiracetam.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare idiosyncratic drug reaction with a mortality of up to 10%. As the name suggests, it is characterized by skin rash, eosinophilia, and systemic symptoms resulting from the involvement of visceral organs. We present a case of DRESS in a patient who was on both lamotrigine and levetiracetam, where levetiracetam turned out to be the inciting agent. The interesting features of the case include the onset of symptoms about 70 days after the initiation of levetiracetam, the lack of prominent eosinophilia and the involvement of the gall bladder, which was previously unknown with Levetiracetam. It also reinforces the importance of using the RegiSCAR score in the diagnosis of DRESS. The symptoms resolved over the next few months after drug withdrawal.

Erratum to: Causal Inference Network of Genes Related with Bone Metastasis of Breast Cancer and Osteoblasts Using Causal Bayesian Networks.

[This corrects the article on p. 251 in vol. 25, PMID: 30574470.].

Causal Inference Network of Genes Related with Bone Metastasis of Breast Cancer and Osteoblasts Using Causal Bayesian Networks.

BACKGROUND: The causal networks among genes that are commonly expressed in osteoblasts and during bone metastasis (BM) of breast cancer (BC) are not well understood. Here, we developed a machine learning method to obtain a plausible causal network of genes that are commonly expressed during BM and in osteoblasts in BC. METHODS: We selected BC genes that are commonly expressed during BM and in osteoblasts from the Gene Expression Omnibus database. Bayesian Network Inference with Java Objects (Banjo) was used to obtain the Bayesian network. Genes registered as BC related genes were included as candidate genes in the implementation of Banjo. Next, we obtained the Bayesian structure and assessed the prediction rate for BM, conditional independence among nodes, and causality among nodes. Furthermore, we reported the maximum relative risks (RRs) of combined gene expression of the genes in the model. RESULTS: We mechanistically identified 33 significantly related and plausibly involved genes in the development of BC BM. Further model evaluations showed that 16 genes were enough for a model to be statistically significant in terms of maximum likelihood of the causal Bayesian networks (CBNs) and for correct prediction of BM of BC. Maximum RRs of combined gene expression patterns showed that the expression levels of UBIAD1, HEBP1, BTNL8, TSPO, PSAT1, and ZFP36L2 significantly affected development of BM from BC. CONCLUSIONS: The CBN structure can be used as a reasonable inference network for accurately predicting BM in BC.

Recuperación de la fertilidad en una paciente estéril,mediante microcirugía de trompa uterina, y la aproximación al ovario contralateral / Fertility recovery in a sterile patient, by means of uterine tube microsurgery, and the approach to the contralateral ovary

Para que ocurra un embarazo exitoso, se requiere la integridad del tracto genital femenino, destacando como elementos importantes las trompas uterinas (TU) que transportan gametos y al óvulo fecundado a la cavidad uterina. La enfermedad de las TU por varias causas, como el embarazo ectópico, constituyen un 20% de causas de infertilidad. Gracias al desarrollo de técnicas de reproducción asistida (TRA) como la fecundación in vitro (FIV), en un alto porcentaje de pacientes que tienen un daño permanente y severo en estas estructuras, la cirugía para reparar o recanalizar las trompas uterinas ha sido desplazada por esta técnica de reproducción asistida. La reanastomosis tubárica tiene una tasa de éxito y de embarazos naturales después de la cirugía del 9% en mujeres con enfermedad tubárica severa al 69% en casos de enfermedad tubárica leve. Se presenta el caso de una paciente joven diagnosticada de infertilidad postquirúrgica por antecedentes de dos embarazos ectópicos accidentados previos que afectaron ambas trompas uterinas y ooforectomía izquierda; luego de realizado el procedimiento microquirúrgico, recuperó la posibilidad de ser madre.

For a successful pregnancy to occur, the integrity of the female genital tract is required, highlighting as important elements the uterine tubes (TU) that transport gametes and the fertilized egg into the uterine cavity. The disease of TU due to several causes, such as ectopic preg- nancy, constitute 20% of infertility causes. Thanks to the development of assisted reproduction techniques (ART) such as in vitro fertilization (IVF), in a high percentage of patients who have permanent and severe damage to these structures, surgery to repair or recanalize the uterine tubes has been displaced by This assisted reproduction technique. Tubal reanastomosis has a success rate and natural pregnancies after surgery of 9% in women with severe tubal disease at 69% in cases of mild tubal disease. We present the case of a young patient diagnosed with post-surgical infertility due to a history of two previous injured ectopic pregnancies that affec- ted both uterine tubes and left oophorectomy; After performing the micro-surgical procedure, he recovered the possibility of being a mother.

La relación entre la política tributaria y el control del tabaquismo en Cuba / Tributary policy related to smoking control in Cuba

Introducción: la aplicación de políticas tributarias para el control de la comercialización y el consumo del tabaco, ha estado vigente desde la iniciación de los gobiernos, como ejecutores de la política del Estado. Esta política económica ha sido precedida por un conjunto de otras medidas que, han creado las condiciones propicias para la aplicación de la política tributaria. Objetivo: valorar la eficacia de la aplicación de una política tributaria a la comercialización y el consumo minoristas de cigarrillos y tabacos en Cuba. Métodos: Teóricos: histórico-lógico, para el análisis intertemporal de las variables estudiadas, del año 2008 al 2013. Análisis y síntesis para el estudio, comprensión y proyección de los resultados y, consulta dialéctico-materialista como método, para la comprensión general del fenómeno estudiado. Empírico: mínimos cuadrados ordinarios, en el estudio intertemporal de las variables estudiadas. Todas las variables fueron analizadas a través de Microsoft Excel 2013. Resultados: a pesar de la disminución neta del consumo anual a 52 cigarrillos, se mantuvo una tendencia al incremento neto anual del gasto per cápita de 0,60 CUP. Conclusiones: en Cuba, existen algunas condiciones importantes que favorecen la aplicación de una política tributaria restrictiva sobre el consumo de cigarrillos, pero el nivel de incertidumbre sobre la relación de sustitución del consumo de cigarrillos cotizados en CUP, según marca comercial, no permite prever, con un grado de confianza razonable, los resultados esperados de una política tributaria para el control del tabaquismo.

Introduction: tobacco control and marketing tributaries policies had marked the policy of the State, since governments beginning. Previous to other measure packets, they have created conditions to apply tributary policies. Objective: validate tributary policy application efficiency, to minor consumption and commercialization tobacco and cigarettes, in Cuba. Methods: Theorist: historic-logical inter-time variables from 2008 to 2013. Projection and understanding study, results analysis and synthesis, and dialectic-materialist general method for studied phenomena understanding. Empiric: Lest Squared Order studied variables inter-time's study. All variables were analyzed using Microsoft Excel 2013. Results: although annual consumption decrease closes to 52 tobaccos, net expenditure by person in increases up to 0.60 CUP. Conclusions: in Cuba, conditions that favor a restrictive tributary policy over tobacco consumption are still uncertain. Tobacco CUP marketing level, has not reasonable trust grade, because of the expected smoking control policy results.

Multiorgan Failure and Refractory Lactic Acidosis due to Pasteurella multocida Septicemia in a Patient with No Animal Exposure.

INTRODUCTION: Pasteurella multocida is a gram-negative coccobacillus pathogenic to animals. It can cause infection in humans by a bite, scratch, or lick from a cat or dog. P. multocida can cause a variety of infections in humans, including cellulitis, osteomyelitis, endocarditis, peritonitis, and septic shock. CASE PRESENTATION: A 56-year-old male presented to our hospital with a 2-day history of fever, abdominal pain, nausea, and vomiting. He denied exposure to cats, dogs or other pets. He had severe respiratory distress requiring ventilator support, profound septic shock requiring multiple vasopressors, severe lactic acidosis, and renal failure requiring emergent hemodialysis. Blood cultures confirmed the presence of P. multocida. The patient subsequently died of cardiopulmonary arrest due to multiorgan failure with refractory shock. CONCLUSION: P. multocida septicemia can lead to septic shock. Early identification of this organism may decrease mortality. Although our patient had no known cat or dog exposure, physicians should enquire about a history of animal exposure when a patient presents with an infection with no obvious cause.

Accelerometer-based atrioventricular synchronous pacing with a ventricular leadless pacemaker: Results from the Micra atrioventricular feasibility studies.

BACKGROUND: Micra is a leadless pacemaker that is implanted in the right ventricle and provides rate response via a 3-axis accelerometer (ACC). Custom software was developed to detect atrial contraction using the ACC enabling atrioventricular (AV) synchronous pacing. OBJECTIVE: The purpose of this study was to sense atrial contractions from the Micra ACC signal and provide AV synchronous pacing. METHODS: The Micra Accelerometer Sensor Sub-Study (MASS) and MASS2 early feasibility studies showed intracardiac accelerations related to atrial contraction can be measured via ACC in the Micra leadless pacemaker. The Micra Atrial TRacking Using A Ventricular AccELerometer (MARVEL) study was a prospective multicenter study designed to characterize the closed-loop performance of an AV synchronous algorithm downloaded into previously implanted Micra devices. Atrioventricular synchrony (AVS) was measured during 30 minutes of rest and during VVI pacing. AVS was defined as a P wave visible on surface ECG followed by a ventricular event <300 ms. RESULTS: A total of 64 patients completed the MARVEL study procedure at 12 centers in 9 countries. Patients were implanted with a Micra for a median of 6.0 months (range 0-41.4). High-degree AV block was present in 33 patients, whereas 31 had predominantly intrinsic conduction during the study. Average AVS during AV algorithm pacing was 87.0% (95% confidence interval 81.8%-90.9%), 80.0% in high-degree block patients and 94.4% in patients with intrinsic conduction. AVS was significantly greater (P <.001) during AV algorithm pacing compared to VVI in high-degree block patients, whereas AVS was maintained in patients with intrinsic conduction. CONCLUSION: Accelerometer-based atrial sensing is feasible and significantly improves AVS in patients with AV block and a single-chamber leadless pacemaker implanted in the right ventricle.

La relación entre la política tributaria y el control del tabaquismo en Cuba / Tributary policy related to smoking control in Cuba

Introducción: la aplicación de políticas tributarias para el control de la comercialización y el consumo del tabaco, ha estado vigente desde la iniciación de los gobiernos, como ejecutores de la política del Estado. Esta política económica ha sido precedida por un conjunto de otras medidas que, han creado las condiciones propicias para la aplicación de la política tributaria.Objetivo: valorar la eficacia de la aplicación de una política tributaria a la comercialización y el consumo minoristas de cigarrillos y tabacos en Cuba.Métodos: Teóricos: histórico-lógico, para el análisis intertemporal de las variables estudiadas, del año 2008 al 2013. Análisis y síntesis para el estudio, comprensión y proyección de los resultados y, consulta dialéctico-materialista como método, para la comprensión general del fenómeno estudiado. Empírico: mínimos cuadrados ordinarios, en el estudio intertemporal de las variables estudiadas. Todas las variables fueron analizadas a través de Microsoft Excel 2013.Resultados: a pesar de la disminución neta del consumo anual a 52 cigarrillos, se mantuvo una tendencia al incremento neto anual del gasto per cápita de 0,60 CUP.Conclusiones: en Cuba, existen algunas condiciones importantes que favorecen la aplicación de una política tributaria restrictiva sobre el consumo de cigarrillos, pero el nivel de incertidumbre sobre la relación de sustitución del consumo de cigarrillos cotizados en CUP, según marca comercial, no permite prever, con un grado de confianza razonable, los resultados esperados de una política tributaria para el control del tabaquismo.(AU)

Introduction: tobacco control and marketing tributaries policies had marked the policy of the State, since governments beginning. Previous to other measure packets, they have created conditions to apply tributary policies.Objective: validate tributary policy application efficiency, to minor consumption and commercialization tobacco and cigarettes, in Cuba.Methods: Theorist: historic-logical inter-time variables from 2008 to 2013. Projection and understanding study, results analysis and synthesis, and dialectic-materialist general method for studied phenomena understanding. Empiric: Lest Squared Order studied variables inter-times study. All variables were analyzed using Microsoft Excel 2013.Results: although annual consumption decrease closes to 52 tobaccos, net expenditure by person in increases up to 0.60 CUP.Conclusions: in Cuba, conditions that favor a restrictive tributary policy over tobacco consumption are still uncertain. Tobacco CUP marketing level, has not reasonable trust grade, because of the expected smoking control policy results.(AU)

La pérdida de productividad laboral atribuible al tabaquismo / Occupational productivity lose due to tobacco dependence

Introducción: La Organización Mundial de la Salud (OMS) destaca que una de las consecuencias del tabaquismo para la economía nacional está en la pérdida de la productividad laboral, lo cual trae apareado un círculo vicioso de adicción, falta de productividad y pobreza. La OMS también ha destacado que existe una relación muy estrecha entre desarrollo de las fuerzas productivas y consumo de cigarrillos y tabacos, donde que por lo general, los mayores consumos mundialmente se concentran en los países subdesarrollados, y no precisamente en los de mayor ingreso per cápita o desarrollo económico. De hecho, dada la fuerte dependencia que genera el consumo regular de productos manufacturados de la hoja del tabaco para fumar en sus consumidores, dicho consumo puede ir desplazando poco a poco el consumo de otros bienes y/o servicios de primera necesidad, lo cual acentúa los niveles de pobreza extrema, accesibilidad e iniquidad social. Objetivo: Identificar las características generales y fundamentales del tabaquismo como factor de riesgo en la pérdida de productividad laboral. Método: Se realizó un estudio descriptivo mediante una revisión bibliográfica que permitiera identificar las características generales y fundamentales del tabaquismo como factor de riesgo en la pérdida de productividad laboral. Resultados y discusión: Se desagregaron conceptualmente las distintas manifestaciones de la pérdida de productividad laboral atribuibles al tabaquismo como factor de riesgo. Conclusiones: El tabaquismo como factor de riesgo es un elemento clave en la pérdida de la productividad laboral. Dicha pérdida se manifiesta de diversas maneras e impactan negativamente también sobre la economía individual y social(AU)

[Clinical evaluation of patients with breast cancer and pregnancy]. / Evaluación clínica de pacientes con cáncer de mama asociado con el embarazo.

BACKGROUND: Breast cancer is the second most common malignancy diagnosed in pregnancy. Breast cancer in pregnancy represents a challenge in diagnosis as well as in treatment. OBJECTIVE: To evaluate clinically patients with breast cancer in pregnancy. METERIAL AND METHODS: Retrospective, transversal, descriptive study was done in which we enrolled women with breast cancer and pregnancy from the outpatient clinic of medical oncology of a tertiary care center hospital. Statistical analysis: descriptive statistics. RESULTS: The variables of 15 clinical records were examined, median age 33.3 ± 5.5 years, tobacco use 3/15, oral contraceptives use 2/15, age at first birth 25.8 ± 7 years, breastfed 4/15. The initial medical evaluation was done 7.5 ± 7.7 months after the onset of symptoms, the diagnosis was made with trucut biopsy in 9/15 of patients, excisional biopsy 4/15 and fine needle aspiration biopsy 2/15. Clinical stage was IIA 3/15, IIIA 8/15, IIIB 3/15 and IV 1/15. Six patients were treated with chemotherapy during pregnancy in the second and third trimester and three with surgical treatment. There were no fetal deaths related to treatment. Response to treatment: 8/15 are disease-free, 5/15 progressed to death and 2/15 had bone metastasis. CONCLUSION: Even major cancer centers have limited experience with breast cancer in pregnancy. Medical and surgical treatment should not be differed. More prospective studies are needed to assess factors related to treatment and prognosis.

Representación social que los adolescentes de Jalisco, México, tienen de la detección precoz del cáncer de mama / The social representation that adolescents from Jalisco, Mexico have of early detection of breast cancer

OBJETIVO: Mostrar la representación social que tienen de la detección precoz del cáncer de mama los adolescentes de Jalisco, México. DISEÑO: Cualitativo transversal, tipo analítico-interpretativo y fundamentado en la teoría de las representaciones sociales. Muestreo no probabilístico. Emplazamiento: Contacto con escuelas de nivel educativo básico de 7 municipios del Estado de Jalisco, México, a través de diversas instituciones gubernamentales y educativas. Participantes: Ciento treinta y cinco adolescentes, hombres y mujeres, escolarizados. MÉTODO: Entrevista a 13 grupos focales: 12 de 8-12 participantes y uno de 18 participantes. Transcripción de entrevistas y análisis de tipo semiótico en programa Atlas Ti versión 4.1. para la identificación de componentes de la representación social. RESULTADOS: Se vinculó la detección precoz a la disminución de muertes por cáncer de mama, tratamientos prolongados y mastectomía, pero se percibió poca cobertura a la salud mamaria del adolescente. Se refirieron como elementos limitadores de la detección precoz los aspectos de género, psicológicos y de acceso a la información y servicios de salud; como facilitadores, se mencionó la transición de los elementos limitadores a variantes positivas. CONCLUSIONES: Se muestra un panorama favorable sobre el nivel de sensibilización de los adolescentes sobre su salud mamaria, identificándose como un sector altamente sensible a la información sobre cáncer de mama y con disposición para efectuar acciones de detección precoz. Se identifica como reto importante la generación de campañas, materiales educativos y espacios de salud enfocados al adolescente

PURPOSE: To describe the social representation that adolescents from Jalisco, Mexico, have of early detection of breast cancer. DESIGN: Qualitative cross, analytical interpretative and based on the theory of social representations. Non-probability sampling. Location: Contact schools in basic education level of 7 municipalities of the State of Jalisco, Mexico, through various government and educational institutions. Participants: A hundred thirty five schooled adolescents, men and women. METHOD: Interview with 12 focus group 8-12 participants and 1 with 18 participants. The interviews were transcribed in Atlas Ti program version 4.1 for a semiotic analysis to identify components of social representation. RESULTS: The precocious detection linked itself to the decrease of deaths for cancer of breast, long treatments and mastectomy, but little coverage was perceived to the mammary health of the teenager. They refer as limiter elements of the precocious detection the aspects of kind, psychological and of access to the information and services of health; since facilitators there was mentioned the transition of the limiter elements to facilitators. CONCLUSIONS: A favorable panorama appears on the level of awareness of the teenagers on his mammary health, identifying as a sector highly sensitive to the information about cancer of breast and with disposition to effect actions of early detection; there are identified as important challenge the generation of campaigns, educational materials and spaces of health focused on the teenager