Entrenamiento para el desarrollo de competencias en evaluación de impacto social a gestores de proyectos

Introducción: El contexto tecnocientífico cubano actual promueve proyectos de ciencia, tecnología e innovación, que tributan al progreso del modelo de desarrollo económico social socialista que propone el país. Pero, en la práctica, estos proyectos evidencian poca sistematicidad en la evaluación de impacto social, lo que da al traste con la transformación social que se pretende. Debido a esto, se considera necesaria la superación de los profesionales que, desde las universidades cubanas, gestionan proyectos. Objetivo: Proponer un entrenamiento para el desarrollo de competencias en evaluación de impacto social para gestores de proyectos de las universidades cubanas. Materiales y métodos: El diagnóstico realizado con métodos científicos teóricos y con la aplicación de encuestas y entrevistas a gestores de proyectos, y el análisis documental a proyectos en ejecución y a sus resultados, así como a los documentos rectores del posgrado en Cuba, permitieron conformar la propuesta de entrenamiento que se presenta. Resultados: Se identificó un nivel bajo de conocimientos y habilidades en evaluación de impacto social de los proyectos, y una alta disposición hacia la superación profesional en el tema. Esto conduce a la propuesta de un entrenamiento que consta de acciones para el desarrollo de competencias en los gestores de proyecto. Conclusiones: El entrenamiento que se propone resulta una vía esencial para atender demandas y necesidades de superación profesional en torno a conocimientos, habilidades y valores, para la evaluación de impacto social por gestores de proyectos de las universidades cubanas.

Introduction: The current Cuban techno-scientific context promotes projects of science, technology and innovation, which contribute to the progress of the model of socialist social economic development the country proposes. But, in practice, these projects show little systematicity in the social impact assessment, which ruins the social transformation that is pretended. Due to this, it is considered necessary the upgrading of the professionals who manage projects of Cuban universities. Objective: To propose training for the development of skills in social impact assessment for project managers of Cuban universities. Materials and methods: The diagnosis, carried out with scientific-theoretical methods, and with the application of inquiries and interviews to project managers, and the documentary analysis of projects in execution and their results, as well as of leading documents of post-graduate studies in Cuba, allowed to elaborate the training proposal presented. Results: A low level of knowledge and skills in the social impact assessment of the projects and a high disposition towards professional upgrading on the topic were identified. This leads to the proposal of a training that consists on actions for the development of skills in project managers. Conclusions: The training proposed results an essential way to meet demands and needs of professional upgrading regarding knowledge, skills and values, for the assessment of the social impact by project managers of Cuban universities.

Evolución clínica, cognitiva y calidad de vida posquirúrgica en un caso con síndrome de Lennox Gastaut / Clinical and Cognitive Evolution and Postoperative Quality of Life in a Case with Lennox Gastaut Syndrome

Introducción: El síndrome de Lennox Gastaut se considera una encefalopatía epiléptica. Las anomalías epileptiformes en este síndrome contribuyen a la discapacidad intelectual gradual, a las comorbilidades psiquiátricas y alteraciones conductuales. En la práctica clínica aparecen atipicidades del síndrome, con focalización funcional cuyo tratamiento constituye un desafío. Objetivo: Describir la evolución clínica, cognitiva y calidad de vida en un caso con síndrome de Lennox Gastaut antes, y después del tratamiento quirúrgico. Presentación del caso: Paciente masculino de 16 años con síndrome de Lennox Gastaut. Se revisó la historia clínica y se tomaron en consideración, los resultados del video-electroencefalograma, de la resonancia magnética nuclear y de la tomografía computarizada por emisión de fotón único. Se evaluó, además, el proceder quirúrgico, la evaluación clínica y neuropsicológica. Se realizó una descripción cualitativa de la evolución del paciente a los 6 meses y al año de la intervención quirúrgica. Conclusiones: el paciente con síndrome de Lennox Gastaut presentó una evolución favorable después del tratamiento quirúrgico, lo cual se reflejó en una disminución en la frecuencia de las crisis. mejoría cognitiva, conductual y mejor calidad de vida(AU)

Introduction: Lennox Gastaut syndrome is considered an epileptic encephalopathy. Epileptiform abnormalities in this syndrome contribute to gradual intellectual disability, psychiatric comorbidities and behavioral disturbances. In clinical practice, atypicalities of the syndrome appear with functional focalization whose treatment constitutes a challenge. Objective: To describe the clinical and cognitive evolution and quality of life in a case with Lennox Gastaut syndrome before and after surgical treatment. Case presentation: A 16-year-old male patient with Lennox Gastaut syndrome. The clinical history was reviewed and the results of the video-electroencephalogram, nuclear magnetic resonance and single photon emission computed tomography were taken into consideration. The surgical procedure, clinical and neuropsychological evaluation were also evaluated. A qualitative description of the patient's evolution past 6 months and one year after surgery was prepared. Conclusions: the patient with Lennox Gastaut syndrome has a favorable evolution after surgical treatment, which is reflected in a decrease in seizure frequency, cognitive and behavioral improvement and better quality of life(AU)

Relation of Brain Perfusion Patterns to Sudden Unexpected Death Risk Stratification: A Study in Drug Resistant Focal Epilepsy.

To explore the role of the interictal and ictal SPECT to identity functional neuroimaging biomarkers for SUDEP risk stratification in patients with drug-resistant focal epilepsy (DRFE). Twenty-nine interictal-ictal Single photon emission computed tomography (SPECT) scans were obtained from nine DRFE patients. A methodology for the relative quantification of cerebral blood flow of 74 cortical and sub-cortical structures was employed. The optimal number of clusters (K) was estimated using a modified v-fold cross-validation for the use of K means algorithm. The two regions of interest (ROIs) that represent the hypoperfused and hyperperfused areas were identified. To select the structures related to the SUDEP-7 inventory score, a data mining method that computes an automatic feature selection was used. During the interictal and ictal state, the hyperperfused ROIs in the largest part of patients were the bilateral rectus gyrus, putamen as well as globus pallidus ipsilateral to the seizure onset zone. The hypoperfused ROIs included the red nucleus, substantia nigra, medulla, and entorhinal area. The findings indicated that the nearly invariability in the perfusion pattern during the interictal to ictal transition observed in the ipsi-lateral putamen F = 12.60, p = 0.03, entorhinal area F = 25.80, p = 0.01, and temporal middle gyrus F = 12.60, p = 0.03 is a potential biomarker of SUDEP risk. The results presented in this paper allowed identifying hypo- and hyperperfused brain regions during the ictal and interictal state potentially related to SUDEP risk stratification.

Common Ictal and Interictal Perfusion Patterns: A Window into the Epileptogenic Network and SUDEP Mechanism in Drug-Resistant Focal Epilepsy.

BACKGROUND: Focal epilepsies have been described as a network disease. Noninvasive investigative techniques have been used to characterize epileptogenic networks. OBJECTIVE: This study aimed to describe ictal and interictal cortical and subcortical perfusion patterns using single- photon emission computed tomography (SPECT) in patients with drug-resistant epilepsy (DRE). METHODS: Thirty-five interictal-ictal SPECT scans were obtained from 15 patients with DRE. A methodology was developed to get a relative perfusion index (PI) of 74 cortical and sub-cortical brain structures. K-means algorithm, together with modified v-fold cross-validation, was used to identify the two regions of interest (ROIs) that represent hypoperfused and hyperperfused areas. RESULTS: In common with the individual analysis, the statistical analysis evidenced that the hyperperfusion ROIs resulting from group analysis during interictal and ictal involved mainly the cingulate gyrus, cuneus, lingual gyrus, and gyrus rectus as well as the putamen. ROIs hypoperfused included the red nucleus, the substantia nigra, and the medulla. The medians of the group analysis of the hypoperfusion and hyperperfusion ROIs were 0.601-0.565 and 1.133-1.119 for the ictal and interictal states, correspondingly. A group of mostly cortical structures involved in the hyperperfused ROIs in both interictal and ictal states showed no change or negative change in the transition from interictal to ictal state (mean change of -0.002). On the other hand, the brain stem, basal ganglia, red nucleus, and thalamus revealed a mean global change of 0.19, indicating a mild increase in the PI. However, some of these structures (red nucleus, substantia nigra, and medulla oblongata) remained hypoperfused during the interictal to ictal transition. CONCLUSION: The methodology employed made it possible to identify common cortical and subcortical perfusion patterns not directly linked to epileptogenicity, for a better epileptogenic network and sudden unexpected death (SUDEP) mechanism in DRE.

Caracterización clínica y electroneuromiográfica de los pacientes con síndrome del túnel carpiano / Clinical and electroneuromyographic characterization of patients with carpal tunnel syndrome

Introducción:El síndrome del túnel carpiano, es una neuropatía compresiva del nervio mediano, provocada por un incremento de la presión, en el túnel del carpo que propicia su lesión y disfunción. Presenta manifestaciones sensitivas, motoras y tróficas que afectan la vida.Objetivo:Caracterizar clínica y electroneuromiográfica a los pacientes con diagnóstico de síndrome del túnel carpiano.Métodos:Se realizó un estudio descriptivo transversal. La población fue de 75 pacientes atendidos, en la consulta de Fisiología Médica, del Hospital General Docente Leopoldito Martínez, de diciembre de 2017 a marzo de 2019. Se estudiaron variables sociodemográficas, clínicas y neurofisiológicas.Resultados:El síndrome del túnel carpiano, se presentó en el 80 por ciento de las mujeres y el promedio de edades fue de 52.16 años. Las comorbilidades que predominaron fueron la hipertensión arterial en el 53.3 por ciento y la diabetes mellitus en el 20 por ciento. El síntoma más frecuente fue la parestesia nocturna en el 64 por cientoy el signo el de Tinnel en el 56 por ciento. Sobresalió el grado 4, en el 48 por cientode las manos derechas y el 42.6 por ciento de las manos izquierdas.Conclusiones:El síndrome del túnel carpiano predomina, en féminas, en la quinta década de la vida. La hipertensión arterial y la diabetes mellitus son las comorbilidades más frecuentes. La ausencia de potenciales de acción sensitivos y la prolongación de las latencias motoras distales, determinan el diagnóstico neurofisiológico. Los pacientes acuden al servicio, con alto grado de compromiso nervioso.(AU)

Introduction:Carpal tunnel syndrome, is a compressive neuropathy of the medium nerve caused by an increasing of pressure on the carpal tunnel that provides its lesion and dysfunction. It presents sensitive motor and trophic manifestations that affect life.Objective:To characterize patients with diagnosis of carpal tunnel syndrome electroneuromyographic and clinically.Methods:A descriptive cross-sectional was carried out. The population was formed by 75 patients assisted at the Medical Physiology consultation, at Leopoldito Martínez General Teaching Hospital, from December, 2017 to March, 2019. Socio-myographic, clinical and neurophysiological variables were studied.Results:Carpal tunnel syndrome, was presented in the 80 per cent of women and the average age was 52.16. The comorbidities which prevailed were hypertension in the 53.3 per cent and diabetes mellitus in the 20 per cent. The most frequent symptom was nocturnal paresthesia in the 64 per cent and Tinnel sign in the 56 per cent. Grade 4 prevailed, in the 48 per cent of right hands and the 42.6 per cent of left hands.Conclusions:Carpal tunnel syndrome prevailed, in female patients, in the fifth decade of life. Hypertension and diabetes mellitus are the most common co-morbidities. Absence of sensitive action potentials and extension of motor distal latencies, determine the neurophysiologic diagnosis. Patients go to the service, with a high degree of nervous involvement.(AU)

Surgical Outcome in Extratemporal Epilepsies Based on Multimodal Pre-Surgical Evaluation and Sequential Intraoperative Electrocorticography.

OBJECTIVE: to present the postsurgical outcome of extratemporal epilepsy (ExTLE) patients submitted to preoperative multimodal evaluation and intraoperative sequential electrocorticography (ECoG). SUBJECTS AND METHODS: thirty-four pharmaco-resistant patients with lesional and non-lesional ExTLE underwent comprehensive pre-surgical evaluation including multimodal neuroimaging such as ictal and interictal perfusion single photon emission computed tomography (SPECT) scans, subtraction of ictal and interictal SPECT co-registered with magnetic resonance imaging (SISCOM) and electroencephalography (EEG) source imaging (ESI) of ictal epileptic activity. Surgical procedures were tailored by sequential intraoperative ECoG, and absolute spike frequency (ASF) was calculated in the pre- and post-resection ECoG. Postoperative clinical outcome assessment for each patient was carried out one year after surgery using Engel scores. RESULTS: frontal and occipital resection were the most common surgical techniques applied. In addition, surgical resection encroaching upon eloquent cortex was accomplished in 41% of the ExTLE patients. Pre-surgical magnetic resonance imaging (MRI) did not indicate a distinct lesion in 47% of the cases. In the latter number of subjects, SISCOM and ESI of ictal epileptic activity made it possible to estimate the epileptogenic zone. After one- year follow up, 55.8% of the patients was categorized as Engel class I-II. In this study, there was no difference in the clinical outcome between lesional and non lesional ExTLE patients. About 43.7% of patients without lesion were also seizure- free, p = 0.15 (Fischer exact test). Patients with satisfactory seizure outcome showed lower absolute spike frequency in the pre-resection intraoperative ECoG than those with unsatisfactory seizure outcome, (Mann- Whitney U test, p = 0.005). CONCLUSIONS: this study has shown that multimodal pre-surgical evaluation based, particularly, on data from SISCOM and ESI alongside sequential intraoperative ECoG, allow seizure control to be achieved in patients with pharmacoresistant ExTLE epilepsy.

Functional Connectivity Derived From Electroencephalogram in Pharmacoresistant Epileptic Encephalopathy Using Cannabidiol as Adjunctive Antiepileptic Therapy.

To explore brain function using functional connectivity and network topology derived from electroencephalogram (EEG) in patients with pharmacoresistant epileptic encephalopathy with cannabidiol as adjunctive antiepileptic treatment. Sixteen epileptic patients participated in the study, six of whom had epileptic encephalopathy with a stable dose of cannabidiol Epidiolex (CBD) as adjunctive therapy. Functional connectivity derived from EEG was analyzed based on the synchronization likelihood (SL). The analysis also included reconstructing graph-theoretic measures from the synchronization matrix. Comparison of functional connectivity data between each pathological group with the control group was carried out using a nonparametric permutation test applied to SL values between pairs of electrodes for each frequency band. To compare the association patterns between graph-theoretical properties of each pathological group with the control group, Z Crawford was calculated as a measure of distance. There were differences between pairs of electrodes in all frequency bands evaluated in encephalopathy epileptic patients with CBD adjunctive therapy compared with the control (p < 0.05, permutation test). In the epileptic encephalopathy group without CBD therapy, the SL values were higher than in the control group for the beta, theta, and delta EEG frequency bands, and lower for the alpha frequency band. Interestingly, patients who had CBD as adjunctive therapy demonstrated greater synchronization for all frequency bands, showing less spatial distribution for alpha frequency compared with the control. When comparing both epileptic groups, those patients who had adjunctive CBD treatment also showed increased synchronization for all frequency bands. In epileptic encephalopathy with adjunctive CBD therapy, the pattern of differences for graph-theoretical measures according to Z Crawford indicated less segregation and greater integration suggesting a trend towards the random organization of the network principally for alpha and beta EEG bands. This exploratory study revealed a tendency to an overconnectivity with a random network topology mainly for fast EEG bands in epileptic encephalopathy patients using CBD adjunctive therapy. It can therefore be assumed that the CBD treatment could be related to inhibition of the transition of the interictal to ictal state and/or to the improvement of EEG organization and brain function.

Funcionamiento familiar y esfuerzo percibido por el cuidador primario de niños con enfermedades neurológicas / Family functioning and perceived effort by the primary caregiver of children with neurological diseases

RESUMEN Fundamento: Las investigaciones que intentan relacionar el funcionamiento familiar y el esfuerzo percibido por el cuidador primario de niños con enfermedades neurológicas, documentan resultados divergentes e insuficientes. Objetivo: identificar la relación entre el funcionamiento familiar y el esfuerzo percibido por el cuidador primario de niños con enfermedades neurológicas. Métodos: estudio de serie de casos, realizado en el Servicio de Neuropsicología, del Centro Internacional de Restauración Neurológica, en el segundo semestre de 2018. Los participantes fueron 12 cuidadores de niños entre uno y seis años de edad. Se aplicó entrevista estructurada, índice de esfuerzo del cuidador, escala de funcionamiento familiar/FF-SIL, inventario de características familiares de riesgo y análisis documental. Se utilizó estadística descriptiva, comparación de medias y correlación de Spearman. Resultados: el 92 % de los cuidadores no había recibido información de cómo cuidarse, ni de cómo cuidar a su hijo. El índice de esfuerzo del cuidador manifestó iguales proporciones para los niveles elevado y bajo (50 % respectivamente). Se observó relación entre edad de los cuidadores y edad de desarrollo de los niños y el funcionamiento familiar (r=0,71, r=0,67); así como entre el índice de esfuerzo del cuidador y el inventario de riesgos familiares (r=0,72). Conclusión: Los cuidadores primarios estudiados carecen de información de autocuidado y del cuidado de su hijo; una criticidad elevada y un índice de esfuerzo del cuidador heterogéneo, lo cual se relaciona con los riesgos familiares. La edad de los cuidadores y la edad de desarrollo de los niños influyen en el funcionamiento familiar.

ABSTRACT Foundation: Research that attempts to relate family functioning and the effort perceived by the primary caregiver of children with neurological diseases, documents divergent and insufficient results. Objective: to identify the relationship between family functioning and the effort perceived by the primary caregiver of children with neurological diseases. Methods: case series study, conducted at the Neuropsychology Service, of the International Center for Neurological Restoration, in the second half of 2018. The participants were 12 children caregivers between one and six years old. Structured interview, caregiver effort index, family functioning scale / FF-SIL, inventory of family risk characteristics and documentary analysis were applied. Descriptive statistics, comparison of means and Spearman correlation were used. Results: 92% of caregivers had not received information on how to take care of themselves, or how to care for their child. The caregiver effort index showed equal proportions for the high and low levels (50% respectively). The relationship between caregivers´ age, children´s development age and family functioning was observed (r = 0.71, r = 0.67); as well as between the caregiver's effort index and the family risk inventory (r = 0.72). Conclusion: The primary caregivers studied lack self-care information and care of their child; a high criticality and an effort index of the heterogeneous caregiver, which is related to family risks. The age of caregivers and the age of children´s development influence family functioning.

Alteraciones electroneuromiográficas en la polineuropatía infecciosa secundaria a la Enfermedad de Hansen. Presentación de un paciente. / Electroneuromiographic alterations in infectuous polineuropathy secondary to Hansen disease. Presentation of a patient

La lepra o enfermedad de Hansen es una enfermedad infecciosa, granulo­matosa crónica, causada por Mycobacterium leprae. Se caracteriza por lesiones cutáneas, en mucosa y nervios periféricos que provocan consecuentemente anestesia, debilidad muscular y parálisis. Tiene la capacidad de invadir y afectar los nervios periféricos de manera asimétrica. El estudio se realiza con el objetivo de presentar las alteraciones electroneuromiográficas en un paciente con diagnóstico de lepra teniendo en cuenta la infrecuencia de esta enfermedad en Mayabeque. Se trata de un caso clínico atendido en la consulta especializada de Neurofisiología en el Hospital General Docente Leopoldito Martínez, San José de las Lajas. El paciente presentó daño en las fibras motoras de tipo axonomielínico de menor intensidad que en las fibras sensitivas y con mayor severidad en miembros inferiores. Se concluye que a través de la electroneuromiografía se determina intensidad, topografía y mecanismo fisiopatológico de la neuropatía leprótica, aspectos de gran interés pronóstico (AU).

Leprosy or Hansen disease is an infectious, chronic, granulomatous disease caused by Mycobacterium leprae. It is characterized by cutaneous lesions, in mucosa and peripheral nerves that consequently cause anesthesia, muscular weakness and paralysis. It has the capacity to invade and affect the peripheral nerves in an asymmetric way. The study was performed with the objective of presenting the electroneuromiographic alterations in a patient with diagnosis of leprosy, taking into account the infrequency of this disease in Mayabeque. It is about a clinical case assisted in the specialized consultation of Neurophysiology at Leopoldito Martínez Teaching General Hospital in San José de las Lajas. The patient presented damage in the axonomielinic motor fibers of less intensity than in the sensitive fibers and with higher severity in lower limbs. It can be concluded that the electroneuromiography determines intensity, topography and physiopathology mechanism of the leprosy neuropathy, aspects of a great prognosis interest (AU).

Relation of Structural and Functional Changes in Auditory and Visual Pathways after Temporal Lobe Epilepsy Surgery.

Auditory and visual pathways may be affected as a consequence of temporal lobe epilepsy surgery because of their anatomical relationships with this structure. The purpose of this paper is to correlate the results of the auditory and visual evoked responses with the parameters of tractography of the visual pathway, and with the state of connectivity between respective thalamic nuclei and primary cortices in both systems after the surgical resection of the epileptogenic zone in drug-resistant epileptic patients. Tractography of visual pathway and anatomical connectivity of auditory and visual thalamus-cortical radiations were evaluated in a sample of eight patients. In general, there was a positive relationship of middle latency response (MLR) latency and length of resection, while a negative correlation was found between MLR latency and the anatomical connection strength and anatomical connection probability of the auditory radiations. In the visual pathway, significant differences between sides were found with respect to the number and length of tracts, which was lower in the operated one. Anatomical connectivity variables and perimetry (visual field defect index) were particularly correlated with the latency of P100 wave which was obtained by quadrant stimulation. These results demonstrate an indirect functional modification of the auditory pathway and a direct traumatic lesion of the visual pathway after anterior temporal lobectomy in patients with drug resistant epilepsy.

Long-Term Electroclinical and Employment Follow up in Temporal Lobe Epilepsy Surgery. A Cuban Comprehensive Epilepsy Surgery Program.

The purpose of this paper is to present a long- term electroclinical and employment follow up in temporal lobe epilepsy (TLE) patients in a comprehensive epilepsy surgery program. Forty adult patients with pharmacoresistant TLE underwent detailed presurgical evaluation. Electroencephalogram (EEG) and clinical follow up assessment for each patient were carried out. The occurrence of interictal epileptiform activity (IEA) and absolute spike frequency (ASF) were tabulated before and after 1, 6, 12, 24 and 72 months surgical treatment. Employment status pre- to post-surgery at the last evaluated period was also examined. Engel scores follow-up was described as follows: at 12 months 70% (28) class I, 10% (4) class II and 19% (8) class III-IV; at 24 months after surgery 55.2% (21) of the patients were class I, 28.9% (11) class II and 15.1% (6) class III-IV. After one- year follow up 23 (57.7%) patients were seizure and aura-free (Engel class IA). These figures changed to 47.3%, and 48.6% respectively two and five years following surgery whereas 50% maintained this condition in the last follow up period. A decline in the ASF was observed from the first year until the sixth year after surgery in relation to the preoperative EEG. The ASF one year after surgery allowed to distinguish "satisfactory" from "unsatisfactory" seizure relief outcome at the last follow up. An adequate social functioning in terms of education and employment in more than 50% of the patients was also found. Results revealed the feasibility of conducting a successful epilepsy surgery program with favorable long term electroclinical and psychosocial functioning outcomes in a developing country as well.

Fascitis necrotizante. Presentación de un paciente / Necrotizing fascitis. Presentationof a patient

La fascitis necrotizante es una enfermedad infecciosa grave y poco frecuente de piel y partes blandas, asociada a una alta mortalidad. Generalmente es de etiología polimicrobiana, su manejo es difícil y representa un desafío para todo el personal de salud implicado en el tratamiento. Se presenta un paciente con ese diagnóstico atendido en el servicio de Cirugía General del Hospital General Docente Leopoldito Martínez, de San José de las Lajas, provincia Mayabeque, El mismo se presentó con un absceso perianal que evolucionó hacia una fascitis necrotizante afectando al escroto derecho, la región inguinal y toda la pared anterolateral del abdomen, evolucionando al shock séptico. En el paciente que se presenta, el diagnóstico fue clínico, la conducta terapéutica estuvo sustentada en el tratamiento quirúrgico, el uso de antimicrobianos sistémicos y del oleozón tópico. La evolución fue satisfactoria(AU)

Necrotizing fascitis is a critical and non-frequent infectious disease of the skin and soft tissues, associatedto a high mortality. Generallyit has a poli-microbial etiology, its management is difficult and it represents a challenge for all the health personnel involved in the treatment. A patient comes with that diagnosis assisted in General Surgery Service at LeopolditoMartínez General Teaching Hospital in San José de lasLajas, Mayabequeprovince, the patient went to the hospital complaining of a perianal abscess that developed to a necrotizing fascitis affecting the right scrotumin the inguinal site and all the anterolateral abdomen wall , developing asepticshock. In this patient it was a clinical diagnosisthe therapeutic management was a surgical treatment,the use of systemic antimicrobials and topicoleozon. The evolution was good(AU)

Caracterización de pacientes sometidos a cirugía ortopédica con infección del sitio quirúrgico / Characterization of patients with orthopedic surgery with infection of the surgical site

Introducción: se considera infección del sitio quirúrgico a la que se produce en relación con el procedimiento operatorio propiamente dicho, hasta un mes después de la cirugía. En los casos de implantes de prótesis el período se extiende a un año. Objetivo: caracterizar a los pacientes sometidos a cirugía ortopédica con infección del sitio quirúrgico, atendidos en el Hospital Leopoldito Martínez, en el período comprendido de enero de 2014 a diciembre de 2014. Métodos: se realizó un estudio observacional, descriptivo, longitudinal y retrospectivo. La población estuvo constituida por 23 pacientes. Fueron distribuidos en tres grupos etarios de 20-39 años, de 40-59 años y de ≥60 años de edad. Se describieron las variables edad, sexo, diagnóstico preoperatorio, estado al egreso, estadía hospitalaria, antecedentes patológicos personales, antibióticos utilizados y estudios de laboratorio.Resultados: el sexo masculino predominó y representó el 61 por ciento 14 pacientes. El grupo que predominó fue el de ≥ 60 años. El diagnóstico preoperatorio que prevaleció fue el de fractura de cadera derecha, todos los pacientes egresaron vivos. Los estudios de laboratorio estuvieron en cifras fisiológicas en la generalidad de los pacientes. Conclusiones: los pacientes que más padecieron la infección del sitio quirúrgico fueron los adultos mayores y del sexo masculino. Todos los pacientes egresaron vivos, según la escala utilizada para describir la estadía hospitalaria, la generalidad de los pacientes estuvo en el mínimo de la misma. La mayoría de los pacientes tuvieron antecedentes patológicos personales (AU)

Introduction: infection of the surgical site is considered to the one that is produced in relation to the proper operatory procedure, until a month after surgery. In the cases of prostheses implants the period of time is extended till a year.Objective: to characterize the patients who received orthopedic surgery with infection of the surgical site, assisted at Leopoldito Martínez Hospital, from January, 2014 to December 2014. Methods: a retrospective, longitudinal, descriptive, observational study was carried out. The population was constituted by 23 patients. They were distributed in three age groups 20-39, 40-59 and ≥60 years old. The variables age, sex, pre-operative diagnosis, status at the moment of the discharge, hospital staying, personal history, used antibiotics and laboratory tets were described. Results: the male sex prevailed and it represented a 61 per cent 14 patients. The age group that prevailed was ≥ 60 years old. The pre-operative diagnosis that prevailed was right hip fracture, all the patients were discharged alive. The laboratory tests showed physiologic figures in most of the patients. Conclusions: the patients who most suffered from infection in the surgical site were male elderly adults. All the patients were discharged alive, according to the used scale to describe hospital staying, most of the patients were in the minimum of it. Most of the patients had positive personal history (AU)

Caracterización del estado nutricional en ancianos con hernias de la pared abdominal / Characterization of nutritional status in elderly patients with abdominal wall hernias

Introducción: en Cuba existe un grado de envejecimiento importante de la población.Objetivo: describir las características generales del estado nutricional de los ancianos con diagnóstico de hernia de la pared abdominal, atendidos en una consulta de cirugía general del Hospital General Docente Leopoldito Martínez. Métodos: se realizó un estudio descriptivo, exploratorio y analítico de corte transversal. La población estuvo constituida por 69 ancianos todos entre 70 a 99 años de edad, que no se encontraban institucionalizados. Fueron distribuidos en tres grupos etarios, de 70-79 años, de 80-89 años y de 90-99 años de edad. Se caracterizó el estado nutricional mediante la aplicación de la encuesta nutricional, la medición de los parámetros antropométricos y de las variables hemoquímicas. Resultados: el sexo masculino predominó, representaron el 68,11 por ciento 47. El grupo que predominó fue el de 70-79 años de edad. La correlación de Pearson entre el índice de masa corporal y la circunferencia del brazo fue de 0,88; y entre el primero y el área grasa del brazo de 0,83. Según el índice masa corporal el mayor número de ancianos estuvo sobrepeso. Las variables hemoquímicas estuvieron en cifras fisiológicas en la generalidad de los ancianos. La encuesta nutricional clasificó a la mayoría en riesgo de malnutrición.Conclusiones: las variables antropométricas se asociaron significativamente y muestran que la población presenta elevada reserva energética. El mini-examen del estado nutricional detecta el riesgo de mal nutrición antes de que se establezcan cambios en los compartimentos corporales, detectables por las técnicas antropométricas (AU)

Introduction: in Cuba there is a significant degree of population aging.Objective: to describe the general characteristics of the nutritional status of elderly people diagnosed with hernia of the abdominal wall, who were assisted in a General Surgery consult of Leopoldito Martínez Hospital.Methods: a descriptive, exploratory, analytical and cross-sectional study was performed. The population consisted of 69 elders all between 70-99 years of age who were not institutionalized. They were divided into three age groups, 70-79 years, 80-89 years and 90-99 years of age. The nutritional status was characterized by applying the nutritional survey, measuring of anthropometric parameters and hemochemical variables.Results: the male sex predominated, accounting for 68,11 por ciento 47. The predominant group was 70-79 years old. The Pearson's correlation between the body mass index and arm circumference was 0,88; and between the first and the arm fat area of 0,83. According to the body mass index the greater number of elderly was overweight. The hemochemical variables were in physiological numbers in most of the elderly. The nutritional survey ranked the most at risk of malnutrition.Conclusions: the anthropometric variables were significantly associated and show that the population has an elevated energetic reserve. The Mini Nutritional Assessment detects the risk of malnutrition before changes in body compartments are established, detectable by anthropometric techniques (AU)

Evaluación del índice de MANTRELS en el diagnóstico de la apendicitis aguda

el índice de MANTRELS, fue creado como un instrumento diagnóstico para contribuir a identificar de forma precoz a los pacientes con apendicitis aguda.Objetivo: evaluar el índice de MANTRELS en el diagnóstico de la apendicitis aguda en los pacientes admitidos en el Hospital General Docente Leopoldito Martínez, de San José de las Lajas, provincia Mayabeque.Métodos: se realizó un estudio prospectivo y descriptivo en el servicio de Cirugía General, del Hospital General Docente Leopoldito Martínez, en el período comprendido desde enero de 2012 hasta diciembre de 2012. El universo estuvo constituido por 135 pacientes que ingresaron en la institución con diagnóstico presuntivo de apendicitis aguda, a quienes se les aplicó el índice de MANTRELS. Las determinaciones de la escala se hicieron al ingreso y hasta establecer el diagnóstico.Resultados: la edad promedio fue de 29 años. El sexo masculino predominó sobre el femenino. El dolor espontáneo en la fosa ilíaca derecha y a la descompresión en dicha zona, se identificaron en el 100 por ciento de los pacientes En el 85 por ciento de los pacientes se constató una relación directa entre el Índice de MANTRELS positivo y los hallazgos histológicos del apéndice cecal. El Índice de MANTRELS presentó una sensibilidad y especificidad de 98 por ciento y 83 por ciento respectivamente. La eficacia general de la escala fue de un 96 por ciento.Conclusiones: el Índice de MANTRELS es un instrumento efectivo, de aplicación rápida, simple, económica, no invasiva, de elevada sensibilidad y eficacia. Permite el diagnóstico precoz de la apendicitis aguda (AU)

Introduction: the MANTRELS score was created as a diagnostic instrument to contribute in the early identification of patients with acute appendicitis.Objective: tTo assess the MANTRELS score in the diagnosis of acute appendicitis in patients admitted to Leopoldito Martínez General Teaching Hospital, of San José de las Lajas, Mayabeque province.Methods: a prospective, descriptive study was conducted at the General Surgical Services of Leopoldito Martínez General Teaching Hospital in the period from January 2012 to December 2012. The universe consisted of 135 patients admitted to the institution with a presumptive diagnosis of acute appendicitis, to whom it was applied the MANTRELS score. The determinations of the score were made on admission level and unti the diagnosis was established.Results: the mean age was 29 years. Males predominated over females. Spontaneous pain in the right iliac fossa and decompression in that area, were identified in 100 per cent of patients. In 85 per cent of patients it was confirmed a direct relationship between positive MANTRELS score and histological findings of the cecal appendix. MANTRELS score had a sensitivity and specificity of 98 per cent and 83 per cent respectively. The overall effectiveness of the score was 96 per cent.Conclusions: MANTRELS scoring system is an effective, rapid-application, simple, economical, non-invasive, high sensitivity and efficiency instrument. It allows early diagnosis of acute appendicitis (AU)

Tumor gigante de partes blandas / Giant tumor of soft tissues

Los lipomas son tumores de partes blandas asintomáticos, de crecimiento lento, consistencia elástica y superficie generalmente lobulada. Se identifican con mayor frecuencia en individuos obesos y del sexo femenino. Por su localización se distinguen dos grupos: a) cutáneos o superficiales, y b) profundos. Se presenta un caso clínico atendido en el servicio de Cirugía General del Centro de Diagnóstico Integral La Victoria, municipio Caroní, Estado Bolívar, Venezuela. El paciente se presentó con un tumor de parte blanda pediculado, en región glútea izquierda, superficie irregular, de 24 cm de longitud, con lesiones isquémicas, no doloroso. El principal dilema en el diagnóstico diferencial se establece con el liposarcoma y otros tumores malignos de partes blandas. La cirugía es el pilar fundamental en el tratamiento (AU)

Lipomas are asymptomatic, slow-growing, elastic consistency and usually lobulated surface soft tissue tumors. They are more frequently identified in obese and female individuals. Two groups are distinguished by their location: a) cutaneous or superficial, and b) deep. It is presented a clinical case treated at the General Surgery Service of La Victoria Integral Diagnostic Center, Caroni municipality, Bolivar State, Venezuela. The patient came to consultation presenting a pedunculated soft tissue tumor, in left gluteal region, uneven surface, 24 cm long with ischemic lesions, painless. The main dilemma in the differential diagnosis is established with liposarcoma and other malignant soft tissue tumors. Surgery is the mainstay in the treatment (AU)

Tumor gigante de partes blandas / Giant tumor of soft tissues

Los lipomas son tumores de partes blandas asintomáticos, de crecimiento lento, consistencia elástica y superficie generalmente lobulada. Se identifican con mayor frecuencia en individuos obesos y del sexo femenino. Por su localización se distinguen dos grupos: a) cutáneos o superficiales, y b) profundos. Se presenta un caso clínico atendido en el servicio de Cirugía General del Centro de Diagnóstico Integral La Victoria, municipio Caroní, Estado Bolívar, Venezuela. El paciente se presentó con un tumor de parte blanda pediculado, en región glútea izquierda, superficie irregular, de 24 cm de longitud, con lesiones isquémicas, no doloroso. El principal dilema en el diagnóstico diferencial se establece con el liposarcoma y otros tumores malignos de partes blandas. La cirugía es el pilar fundamental en el tratamiento

Lipomas are asymptomatic, slow-growing, elastic consistency and usually lobulated surface soft tissue tumors. They are more frequently identified in obese and female individuals. Two groups are distinguished by their location: a) cutaneous or superficial, and b) deep. It is presented a clinical case treated at the General Surgery Service of La Victoria Integral Diagnostic Center, Caroni municipality, Bolivar State, Venezuela. The patient came to consultation presenting a pedunculated soft tissue tumor, in left gluteal region, uneven surface, 24 cm long with ischemic lesions, painless. The main dilemma in the differential diagnosis is established with liposarcoma and other malignant soft tissue tumors. Surgery is the mainstay in the treatment

La ética y la calidad en la atención médica / Ethics and quality in medical care

Se realiza este trabajo sobre los antecedentes relacionados con el desarrollo de la ética y el análisis conceptual de la calidad de la atención médica, con el objetivo de analizar la trascendencia de la ética como elemento fundamental en la calidad de la atención médica. La ética médica se conoce desde la antigüedad y ha estado acorde con las circunstancias particulares, las condiciones del medio y el pensamiento filosófico dominante de cada período. Los grandes cambios de la medicina en los ámbitos científico, tecnológico, social y económico, han contribuido a la deshumanización y a engrandecer la distancia entre el médico y el paciente. Lo anterior se sustenta en que casi la mitad de los reportes de insatisfacción de los pacientes, por los servicios de salud recibidos, se deben a trastornos en la comunicación. A lo largo de la historia de la humanidad se han creado varios documentos con el objetivo de regir la conducta de los galenos, como el juramento Hipocrático, el cual constituye el código más citado que guía la conducta ética de los profesionales de la salud. Existe una relación dialéctica entre ética médica y calidad, siendo la primera un eslabón fundamental de la calidad en los servicios de salud. De esta forma el cumplimiento de los principios de la ética médica, rigen la conducta de los profesionales de la salud hacia la excelencia en los servicios. Por lo que ambas constituyen estrategias prioritarias para el desarrollo de las instituciones de salud (AU)

This work was carried out on the background related to the development of ethics and conceptual analysis of the quality of medical care, in order to analyze the importance of ethics as a key element in the quality of care. Medical ethics has been known since antiquity and has been commensurate with the particular circumstances, environmental conditions and the dominant philosophical thought of each period. The great changes in medicine in the scientific, technological, social and economic spheres, have contributed to the dehumanization and to increase the distance between doctor and patient. The foregoing is sustained in that nearly half of the reports of dissatisfaction among patients for the health services received is due to communication disorders. Throughout the history of mankind several documents have been created in order to govern the conduct of the doctors, as the Hippocratic Oath, which constitutes the most commonly cited code that guides the ethical conduct of health professionals. There is a dialectical relationship between medical ethics and quality, the first being a vital link in the quality of health services. Thus the fulfillment of the principles of medical ethics govern the conduct of health professionals towards service excellence. So both are priority strategies for the development of health institutions (AU)