Supplementation with a Symbiotic Induced Neuroprotection and Improved Memory in Rats with Ischemic Stroke.

After an ischemic stroke, various harmful mechanisms contribute to tissue damage, including the inflammatory response. The increase in pro-inflammatory cytokines has been related to greater damage to the neural tissue and the promotion of neurological alterations, including cognitive impairment. Recent research has shown that the use of prebiotics and/or probiotics counteracts inflammation and improves cognitive function through the production of growth factors, such as brain-derived neurotrophic factor (BDNF), by reducing inflammatory molecules. Therefore, in this study, the effect of the symbiotic inulin and Enterococcus faecium on neuroprotection and memory improvement was evaluated in a rat model of transient middle cerebral artery occlusion (tMCAO). In order to accomplish this, the animals were subjected to ischemia; the experimental group was supplemented with the symbiotic and the control group with the vehicle. The neurological deficit as well as spatial and working memory were evaluated using the Zea Longa scale, Morris water maze, and the eight-arm maze tests, respectively. Infarct size, the levels of BDNF, and tumor necrosis factor-alpha (TNF-α) were also assessed. The results show that supplementation with the symbiotic significantly diminished the neurological deficit and infarct size, improved memory and learning, increased BDNF expression, and reduced TNF-α production. These findings provide new evidence about the therapeutic use of symbiotics for ischemic stroke and open up the possibilities for the design of further studies.

Memory improvement in senile rats after prebiotic and probiotic supplementation is not induced by GLP-1.

INTRODUCTION: The mechanism underlying the memory improvement induced by prebiotic and probiotic supplementation remains unclear. Glucagon-like peptide type 1 (GLP-1) could play an important role since it is induced by prebiotics and enhances memory and learning. AIMS: We correlated the levels of GLP-1 with spatial memory in senile animals to determine its role in memory improvement after prebiotic and probiotic supplementation. METHODS: Senile rats were randomly assigned to four groups: (1) water (control); (2) Enterococcus faecium (probiotic); (3) agave inulin (prebiotic); and (4) E. faecium + agave inulin (symbiotic). Each supplement was administered by an orogastric cannula for 5 weeks. In the fifth week, spatial memory was assessed using the Morris Water Maze test (MWM). We extracted the hippocampus, intestine, and serum. GLP-1 levels were quantified by enzyme-linked immunosorbent assay. RESULTS: A significant decrease in escape latency time in the MWM was observed in all groups treated with supplements. The symbiotic group achieved the highest reduction (15.13 s ± 6.40) (p < 0.01). We did not find a significant increase in GLP-1 levels nor a direct correlation of its levels with spatial memory improvement (p > 0.05). CONCLUSION: Prebiotic and probiotic supplementation improved spatial memory in senile animals. However, this beneficial effect did not correlate with GLP-1 levels.

Habilidades Sociales y Aprendizaje Cooperativo el la Inclusión de Estudiantes con Necesidades Educativas Específicas / Social Skills and Cooperative Learning in the Inclusion of Students with Specific Educational Needs

RESUMEN Este estudio analiza cómo al trabajar con la metodología del aprendizaje cooperativo en el aula, los alumnos con necesidades educativas especiales pueden mejorar en sus habilidades sociales obteniendo mejores aprendizajes. Se realiza en el contexto del programa de formación docente universitaria del Experto en Aprendizaje Cooperativo online de la Universidad de Alcalá, en España. La metodología utilizada es de corte cualitativo en base a un diseño de estudio de casos desarrollado durante 6 años (2011 al 2017). Los participantes fueron 176 profesores de centros educativos españoles que cumplían los requisitos. Las acciones realizadas implicaron a un total de 3.964 estudiantes, de los cuales, 406 presentaban algún tipo de necesidad específica. Los resultados reflejan la influencia en las habilidades sociales de los alumnos con necesidades al trabajar con la metodología del aprendizaje cooperativo. Se concluye que para la mejora de las habilidades sociales del alumnado con necesidades es necesario que el docente potencie acciones que promuevan las habilidades sociales de estos alumnos a través del aprendizaje cooperativo y de las propuestas diversificadas, planificadas y ajustadas a sus necesidades concretas, dándoles la oportunidad de trabajar de forma conjunta con sus compañeros.

ABSTRACT This study analyzes how students with special educational needs can improve their social skills through better learning when working with the cooperative learning methodology in the classroom. The research was carried out as part of the Online Cooperative Learning Expert training program at the University of Alcalá, in Spain. The methodology used was qualitative based on a case study design developed over 6 years (2011 to 2017). The participants were 176 teachers from Spanish educational centers who met the requirements. The actions carried out involved a total of 3,964 students, of which 406 had some type of specific need. The results reflect the influence on the social skills of the students with needs when working with the cooperative learning methodology. It is concluded that for the improvement of the social skills of students with needs, it is necessary for the teacher to make use of actions that promote the social skills of these students through cooperative learning and diversified proposals, planned and adjusted to their specific needs, giving them the opportunity to work together with their peers.

Development of a Survivorship Care Plan (SCP) Program for Rural Latina Breast Cancer Patients: Proyecto Mariposa-Application of Intervention Mapping.

Latina breast cancer survivors are less likely to receive a comprehensive Survivorship Care Plan (SCP) than non-Latina Whites. Evidence-based and theory driven interventions are needed to promote a culturally and linguistically responsive SCP. This paper describes the application of Intervention Mapping (IM) in the development of Proyecto Mariposa, a comprehensive SCP program targeting Latina breast cancer survivors living in a rural U.S.-Mexico border region. We conducted a needs assessment using focus groups (n = 40) and individual interviews (n = 4) with stakeholders to elicit their needs and preferences relating to SCPs and SCP aid (Step1). Content analysis of transcripts was conducted using Atlas.ti. The findings informed the development of a matrix of change objectives where we selected specific behavioral theories to ground the practical application of the SCP program (Step 2). We identified behavioral theories and the practical application of behavioral change (Step 3) and designed and developed a comprehensive SCP program which consisted of a culturally-and linguistically-adapted SCP document and animated video as an SCP aid (Step 4). The systematic application of the IM framework resulted in the development of a comprehensive and culturally tailored SCP intervention. Stakeholder active involvement in the cultural tailoring of the program was imperative and strengthens the SCP intervention.

Evaluation of the expression of the oncogen C-ERBB-2/HER2 in advanced gastric cancer cases from Costa Rica.

JUSTIFICATION: The prevalence of gastric cancer (GC) with increased expression of the HER2 oncoprotein shows important variations worldwide. Incidence and mortality rates of GC in Costa Rica are among the highest in Latin America and the world; however, the prevalence of HER2-positive cases in this country is unknown. Evaluation of this parameter is important to decide the therapeutic approach for GC patients. The aim of this study was to provide an estimation of the prevalence of GC patients overexpressing the HER2 oncogene in Costa Rica. METHODS: The investigation was carried out in two phases. The first one consisted of a retrospective review of 331 clinical records of patients diagnosed with advanced or metastatic GC from January 2010 to January 2012 in four hospitals in Costa Rica. In the second phase, immunohistochemistry (IHC) and fluorescent in situ hybridisation (FISH) analyses were performed in formalin-fixed and paraffin-embedded (FFPE) surgical samples from 50 patients diagnosed with GC between 2012 and 2015. RESULTS: Of the 331 clinical files reviewed, the assessment of HER2 status was carried out in 62 patients (18.7%), of which only five (8%) were HER2-positive. In the 50 surgical specimens in which IHC and FISH analyses were performed, two of them (4%) presented overexpression and amplification of the HER2 oncogene. CONCLUSION: This study suggests that the prevalence of GC cases overexpressing the HER2 oncogene in Costa Rica is less than 8%. This is the first attempt ever undertaken to estimate the prevalence of HER2-positivity in GC in Costa Rica.

Prototype of a computerized scale for the active search for potential organ donors.

OBJECTIVE:: to develop a prototype of a computerized scale for the active search for potential organ and tissue donors. METHOD:: methodological study, with the analysis of 377 electronic medical records of patients who died due to encephalic death or cardiorespiratory arrest in the intensive care units of a tertiary hospital. Among the deaths due to cardiorespiratory arrest, the study aimed to identify factors indicating underreported encephalic death cases. The Acute Physiology and Chronic Health Evaluation II and Sepsis Related Organ Failure Assessment severity indexes were applied in the protocols. Based on this, a scale was built and sent to five experts for assessment of the scale content, and subsequently, it was computerized by using a prototyping model. RESULTS:: 34 underreported encephalic death cases were identified in the medical records of patients with cardiorespiratory arrest. Statistically significant differences were found in the Wilcoxon test between the scores of hospital admissions in the intensive care unit and the opening of the encephalic death protocol for both severity indexes. CONCLUSION:: the prototype was effective for identifying potential organ donors, as well as for the identification of the degree of organ dysfunction in patients with encephalic death. OBJETIVO:: desenvolver protótipo de escala informatizada para busca ativa de potenciais doadores de órgãos e tecidos. MÉTODO:: pesquisa metodológica, com análise de 377 prontuários eletrônicos de pacientes que evoluíram a óbito, por morte encefálica, ou parada cardiorrespiratória, nas unidades de terapia intensiva de hospital terciário. Nos óbitos por parada cardiorrespiratória, buscou-se identificar fatores que indicassem subnotificação de morte encefálica. Nos protocolos, foram aplicados os índices de gravidade Acute Physiology and Chronic Health Evaluation II e Sepsis Related Organ Failure Assessment. A partir disso, construiu-se a escala que foi encaminhada a cinco especialistas, para avaliação de conteúdo, e, posteriormente, foi informatizada por modelo de prototipação. RESULTADOS:: foram identificadas 34 subnotificações de morte encefálica nos prontuários dos casos de parada cardiorrespiratória. O teste de Wilcoxon demonstrou diferença estatisticamente significativa entre os escores de admissão em unidade de terapia intensiva e abertura do protocolo de morte encefálica, para ambos os índices de gravidade. CONCLUSÃO:: o protótipo foi efetivo para identificação de potenciais doadores, bem como o grau de disfunção orgânica de pacientes em morte encefálica. OBJETIVO:: desarrollar un prototipo de escala informatizada para la búsqueda activa de potenciales donantes de órganos y tejidos. MÉTODO:: investigación metodológica, con el análisis de 377 registros médicos electrónicos de pacientes, que fallecieron por muerte encefálica o paro cardiorrespiratorio, en las unidades de cuidados intensivos de un hospital terciario. Entre las muertes por paro cardiorrespiratorio, se buscó identificar los factores que indicasen subnotificación de muerte encefálica. Las puntuaciones de los índices de gravedad Acute Physiology and Chronic Health Evaluation II y Sepsis Related Organ Failure Assessment se aplicaron en los protocolos. A partir de eso, la escala fue construida y enviada a cinco expertos para la evaluación del contenido, y posteriormente, fue informatizada mediante un modelo de prototipación. RESULTADOS:: se identificaron 34 casos de subnotificación de muerte encefálica en los registros médicos de los casos de paro cardiorrespiratorio. Se encontraron diferencias estadísticamente significativas en la prueba de Wilcoxon, entre las puntuaciones de los ingresos hospitalarios en unidad de cuidados intensivos y apertura del protocolo de muerte encefálica para ambos índices de gravedad. CONCLUSIÓN:: el prototipo fue eficaz para la identificación de potenciales donantes, así como para la identificación del grado de disfunción orgánica en pacientes con muerte encefálica.

Prototype of a computerized scale for the active search for potential organ donors / Protótipo de escala informatizada para busca ativa de potenciais doadores de órgãos / Prototipo de escala informatizada para la búsqueda activa de potenciales donantes de órganos

ABSTRACT Objective: to develop a prototype of a computerized scale for the active search for potential organ and tissue donors. Method: methodological study, with the analysis of 377 electronic medical records of patients who died due to encephalic death or cardiorespiratory arrest in the intensive care units of a tertiary hospital. Among the deaths due to cardiorespiratory arrest, the study aimed to identify factors indicating underreported encephalic death cases. The Acute Physiology and Chronic Health Evaluation II and Sepsis Related Organ Failure Assessment severity indexes were applied in the protocols. Based on this, a scale was built and sent to five experts for assessment of the scale content, and subsequently, it was computerized by using a prototyping model. Results: 34 underreported encephalic death cases were identified in the medical records of patients with cardiorespiratory arrest. Statistically significant differences were found in the Wilcoxon test between the scores of hospital admissions in the intensive care unit and the opening of the encephalic death protocol for both severity indexes. Conclusion: the prototype was effective for identifying potential organ donors, as well as for the identification of the degree of organ dysfunction in patients with encephalic death.

RESUMO Objetivo: desenvolver protótipo de escala informatizada para busca ativa de potenciais doadores de órgãos e tecidos. Método: pesquisa metodológica, com análise de 377 prontuários eletrônicos de pacientes que evoluíram a óbito, por morte encefálica, ou parada cardiorrespiratória, nas unidades de terapia intensiva de hospital terciário. Nos óbitos por parada cardiorrespiratória, buscou-se identificar fatores que indicassem subnotificação de morte encefálica. Nos protocolos, foram aplicados os índices de gravidade Acute Physiology and Chronic Health Evaluation II e Sepsis Related Organ Failure Assessment. A partir disso, construiu-se a escala que foi encaminhada a cinco especialistas, para avaliação de conteúdo, e, posteriormente, foi informatizada por modelo de prototipação. Resultados: foram identificadas 34 subnotificações de morte encefálica nos prontuários dos casos de parada cardiorrespiratória. O teste de Wilcoxon demonstrou diferença estatisticamente significativa entre os escores de admissão em unidade de terapia intensiva e abertura do protocolo de morte encefálica, para ambos os índices de gravidade. Conclusão: o protótipo foi efetivo para identificação de potenciais doadores, bem como o grau de disfunção orgânica de pacientes em morte encefálica.

RESUMEN Objetivo: desarrollar un prototipo de escala informatizada para la búsqueda activa de potenciales donantes de órganos y tejidos. Método: investigación metodológica, con el análisis de 377 registros médicos electrónicos de pacientes, que fallecieron por muerte encefálica o paro cardiorrespiratorio, en las unidades de cuidados intensivos de un hospital terciario. Entre las muertes por paro cardiorrespiratorio, se buscó identificar los factores que indicasen subnotificación de muerte encefálica. Las puntuaciones de los índices de gravedad Acute Physiology and Chronic Health Evaluation II y Sepsis Related Organ Failure Assessment se aplicaron en los protocolos. A partir de eso, la escala fue construida y enviada a cinco expertos para la evaluación del contenido, y posteriormente, fue informatizada mediante un modelo de prototipación. Resultados: se identificaron 34 casos de subnotificación de muerte encefálica en los registros médicos de los casos de paro cardiorrespiratorio. Se encontraron diferencias estadísticamente significativas en la prueba de Wilcoxon, entre las puntuaciones de los ingresos hospitalarios en unidad de cuidados intensivos y apertura del protocolo de muerte encefálica para ambos índices de gravedad. Conclusión: el prototipo fue eficaz para la identificación de potenciales donantes, así como para la identificación del grado de disfunción orgánica en pacientes con muerte encefálica.

The individual contribution and relative importance of self-management and quality of care on glycaemic control in type 2 diabetes.

OBJECTIVE: To evaluate the relative importance of selfmanagement (SM) and quality of care (QoC) inpredicting glycaemic control in patients with type 2 diabetes. MATERIALS AND METHODS: A longitudinal cohort study was conducted in 204 adults diagnosed with type 2 diabetes. Self-management and quality of care were measured at baseline. HbA1c was measured at baseline and at six-month follow-up. RESULTS: None of the measures of self-management were significantly associated with HbA1c.Treatment intensification (TI) (a proxy for quality of care) resulted in lower HbA1c at follow-up. Other variables were associated with HbA1c at follow-up: HbA1c at baseline, age, diabetes duration, and combination of oral glucose-lowering medications. An exploratory analysis showed that patients who did not receive treatment intensification but performed more self-management behaviours had lower HbA1c levels at follow-up. CONCLUSION: Treatment intensification might be more important for glycaemic control than self-management but the interaction between treatment intensification and self-management needs further research.

The individual contribution and relative importance of self-management and quality of care on glycaemic control in type 2 diabetes / Contribución individual e importancia relativa del auto-cuidado y la calidad de la atención en el control glucémico de la diabetes tipo 2

Abstract: Objective: To evaluate the relative importance of selfmanagement (SM) and quality of care (QoC) inpredicting glycaemic control in patients with type 2 diabetes. Materials and methods: A longitudinal cohort study was conducted in 204 adults diagnosed with type 2 diabetes. Self-management and quality of care were measured at baseline. HbA1c was measured at baseline and at six-month follow-up. Results: None of the measures of self-management were significantly associated with HbA1c.Treatment intensification (TI) (a proxy for quality of care) resulted in lower HbA1c at follow-up. Other variables were associated with HbA1c at follow-up: HbA1c at baseline, age, diabetes duration, and combination of oral glucose-lowering medications. An exploratory analysis showed that patients who did not receive treatment intensification but performed more self-management behaviours had lower HbA1c levels at follow-up. Conclusion: Treatment intensification might be more important for glycaemic control than self-management but the interaction between treatment intensification and self-management needs further research.

Resumen: Objetivo: Evaluar la importancia relativa del autocuidado (AU) y calidad de la atención (CA) para predecir control glucémico en diabetes mellitus tipo 2 (DM2). Material y métodos: Estudio longitudinal en 204 adultos con DM2. AU y CA evaluados en la medición basal. HbA1c evaluada en la medición basal y a los seis meses. Resultados: A los seis meses, ninguna de las mediciones de AU se asoció significativamente con HbA1c. La intensificación en el tratamiento (IT) (proxy de CA) se asoció con disminución de HbA1c. Otras variables asociadas con HbA1c: HbA1c en medición basal, edad, duración de diabetes, y combinación de anti-hiperglucemiantes. En un análisis exploratorio, los participantes que no recibieron IT pero desempeñaron más conductas de AU tuvieron niveles más bajos de HbA1c. Conclusión: IT parece ser más importante para el control glucémico que AU, pero la interacción entre IT y conductas de AU se deben estudiar con más profundidad.

Acolhimento com classificação de risco: avaliação da estrutura, processo e resultado / User embracement with risk rating: evaluation of the structure, process, and result / Acogida con clasificación de riesgo: evaluación de la estructura, del proceso y de los resultados

Estudo descritivo-exploratório, com abordagem quantitativa, realizado entre agosto e novembro/2011, com o objetivo de avaliar sob a ótica dostrabalhadores a estrutura, o processo e o resultado da implantação do acolhimento com classificação de risco (ACCR). Participaram 314 profissionaisde quatro serviços hospitalares de emergência (SHE) de diferentes categorias profissionais. Para a coleta de dados foi usado o “Instrumento paraAvaliação do Acolhimento com Classificação de Risco”. Entre os sujeitos, a maioria era mulher (63,7%); da área de Enfermagem (56,7%); comexperiência média de 7,2±7,6 anos no setor. Apesar de haver priorização dos casos graves; atendimento aos casos não graves; informação sobre otempo provável de espera; e acolhimento do usuário pelos profissionais que atuam nesse sistema, constatou-se que no cômputo geral o acolhimentocom classificação de risco foi avaliado como precário. Como principais agravantes detectaram-se: falta de espaço físico; problemas no relacionamentoda equipe multiprofissional; e dificuldade na operacionalização das condutas estabelecidas. Concluiu-se que, apesar de nos serviços de emergênciainvestigados as condutas fundamentais propostas pelo ACCR serem realizadas, há necessidade da operacionalização integral desse sistema.

The present work is a descriptive and exploratory study, with a quantitative approach, conducted between August and November 2011, aimed at, from theworkers’ perspective, assessing the Structure, Process, and Result of implementing the Reception with Risk Rating (RRR) instrument. This study included 314professionals of different professional categories from four Emergency Hospital Services (EHS). The “Instrument to Assess Reception with Risk Rating” was usedfor data collection. Among the subjects, most were women (63.7 %), from the Nursing field (56.7 %), with an average experience of 7.2±7.6 years in the sector.Although there is a prioritizing of serious cases, care for mild cases, information about the probable waiting time, and user reception by the professionals whowork in this system, it was found that, overall, the RRR was considered precarious. The main aggravating factors included: lack of physical space, problemsin relationships within the multidisciplinary staff, and difficulty in putting the defined conduct into effect. It could therefore be concluded that, although theessential conduct proposed by RRR was in fact implemented in the investigated emergency services, there is still a need to make this system fully operational.

Estudio exploratorio descriptivo con enfoque cuantitativo realizado entre agosto y noviembre/2011 con el objetivo de evaluar la estructura, el proceso y el resultadode la implantación de la Acogida con Clasificación de Riesgos (ACCR) desde la perspectiva de los trabajadores. Participaron 314 profesionales de cuatro serviciosde urgencias hospitalarias (SUH) de diferentes categorías profesionales. Para la recogida de datos se utilizó el “Instrumento para Evaluación de la Acogida conClasificación de Riesgos”. La mayoría eran mujeres (63,7%); del área de enfermería (56,7 %); con experiencia media de 7.2±7.6 años en dicho sector. A pesar de haberprioridad para los casos graves; atención de casos no graves; información sobre el tiempo probable de espera y acogida del usuario por los profesionales que trabajanen este sistema, se constató que, en general, la Acogida con Clasificación de Riesgos fue evaluada como Precaria. Los principales agravantes detectados fueron: faltade espacio físico, problemas en la relación entre el equipo multidisciplinario y dificultad para poner en práctica las conductas establecidas. Se concluye que, aunqueen los Servicios de Urgencia investigados se cumplan las conductas fundamentales propuestas por la ACCR, este sistema debe ponerse en práctica de forma integral.

Intususcepción intestinal debido a un pólipo fibroide inflamatorio (tumor de vanek) / Intestinal intussusception due to an inflammatory fibroid polyp (tumor vanek)

Presentamos el caso de un hombre de 58 años, quien consultó por cuadro de dolor abdominal de tres meses de evolución. En un periodo de 8 días previo a dicha consulta el dolor se intensificó y asoció vómitos incontables de contenido biliar y fecaloides. Se manejó como un abdomen agudo y se le realizó una laparotomía exploratoria, en la cual se evidenció una masa en yeyuno, con obstrucción distal completa e intosuscepción. El análisis histopatológico de la lesión confirmó un pólipo fibroide inflamatorio (Tumor de Vanek) del yeyuno. En este artículo se discuten las características clínicas e histopatológicas.

We report the case of a man aged 58, who consulted for abdominal pain of three months duration. In a period of 8 days prior to such consultation pain intensified and countless associated vomiting bile and fecaloid content. Was handled as an acute abdomen and was made an exploratory laparotomy, in which a jejunal mass with complete distal obstruction and intosuscepción evidenced. Histological examination of the lesion confirmed an inflammatory fibroid polyp (Vanek tumor) of the jejunum. In this article, the clinical and histopathologic features are discussed.

The relationship between quality of care and self-management in patients with type 2 diabetes: a cross-sectional survey in primary care in Mexico.

BACKGROUND: Achieving glycaemic control in diabetes reduces complications and improves outcomes. Glycaemic control requires both good quality clinical care and effective self-management support. However, the relationship between these factors in routine clinical practice is unclear. AIMS: To evaluate baseline levels of self-management and clinical quality of care in patients with type 2 diabetes in primary care in Mexico and to explore relationships between measures of self-management and clinical quality of care. METHODS: The sample consisted of adults (N=205) diagnosed with type 2 diabetes for over a year and registered at one of five practices in the Mexican Institute of Social Security in Aguascalientes. Self-management and quality of care were measured using medical record review and interviews, including validated measures of diabetes knowledge, self-care behaviours, self-efficacy, treatment intensification, continuity of care, doctor-patient communication, and patient satisfaction with diabetes care. HbA1c and cholesterol tests were taken. RESULTS: There were few associations between measures of self-management, and between measures of the quality of clinical care. 'Strong' knowledge about medical prescription was associated with higher diabetes knowledge (OR = 1.2, 95% CI 1.08 to 1.32). Diabetes self-efficacy was associated with self-care behaviours (OR = 1.51, 95% CI 1.26 to 1.81). Patient-doctor communication was associated with continuity of care (Chi-squared = 11.03, P <0.05), with patient satisfaction (ß = 6.17, 95% CI 4.47 to 7.93) and with diabetes self-efficacy (ß = 0.70, 95% CI 0.19 to 1.20, P <0.01). Patient satisfaction was associated with continuity of care (F = 7.82, P <0.001). CONCLUSION: The associations between measures of self-management and quality of care were modest. Patients who were achieving high levels of one aspect of care were not necessarily receiving high levels of the other. This indicates that different factors are likely to be driving each aspect of care and highlights the importance of measuring their relative importance.

El sistema de salud y el médico que el Perú necesita en la reforma del sector salud. Propuesta final / The health system and physician that Peru needs in the health sector reform. Final proposal

El presente documento describe el análisis de la situación de los sistemas de salud del país, mediante la búsqueda del consenso de todos los médicos loaycinos para su elaboración de la propuesta final como Cuerpo Médico, y luego ser socializado a los demás estamentos del Hospital Nacional Arzobispo Loayza, así como al Consejo Nacional de Salud y a las instancias pertinentes del sector, simultáneamente, por la urgencia que demanda la situación actual de la Reforma del sector Salud(AU)

El sistema de salud y el médico que el Perú necesita en la reforma del sector salud. Propuesta final / The health system and physician that Peru needs in the health sector reform. Final proposal

El documento describe el análisis de la situación de los sistemas de salud del país, mediante la búsqueda del consenso de todos los médicos loaycinos para su elaboración de la propuesta final como Cuerpo Médico, y luego ser socializado a los demás estamentos del Hospital Nacional Arzobispo Loayza, así como al Consejo Nacional de Salud y a las instancias pertinentes del sector, simultáneamente, por la urgencia que demanda la situación actual de la Reforma del sector Salud

Tabaquismo y aterosclerosis / Smoking and aterosclerosis

Las personas subestiman el gran riesgo que produce el tabaquismo para la salud. Existen varias clasificaciones relacionadas con los factores de riesgo que este hábito implica; una de ellas lo sitúa como factor de riesgo principal junto a la hiperlipidemia, la hipertensión arterial y la diabetes mellitus; otra lo clasifica como factor de riesgo potencialmente modificable de enfermedad vascular coronaria, cerebral y periférica. Si se considera el riesgo de desarrollar una enfermedad cardiovascular de una persona del sexo masculino de 40 años en relación al tabaco, el colesterol sérico y la hipertensión arterial, la presencia simultánea de los tres factores da un riesgo tres veces mayor que la suma de los efectos individuales. El tabaquismo es una causa importante de enfermedad cerebro vascular y ésta es responsable de 57 muertes x 100,000 habitantes. El fumar aumenta la probabilidad de hemorragia subaracnoidea en fumadores y asociado a anticonceptivos orales aumenta este riesgo. La situación actual del problema del tabaquismo en Cuba es su asociación como factor de riesgo a las primeras causas de muerte prematura. Encuestas nacionales de factores de riesgo realizadas en 1995 arrojaron un 37 por ciento de prevalencia de tabaquismo (AU)

Tabaquismo y aterosclerosis / Smoking and aterosclerosis

Las personas subestiman el gran riesgo que produce el tabaquismo para la salud. Existen varias clasificaciones relacionadas con los factores de riesgo que este hábito implica; una de ellas lo sitúa como factor de riesgo principal junto a la hiperlipidemia, la hipertensión arterial y la diabetes mellitus; otra lo clasifica como factor de riesgo potencialmente modificable de enfermedad vascular coronaria, cerebral y periférica. Si se considera el riesgo de desarrollar una enfermedad cardiovascular de una persona del sexo masculino de 40 años en relación al tabaco, el colesterol sérico y la hipertensión arterial, la presencia simultánea de los tres factores da un riesgo tres veces mayor que la suma de los efectos individuales. El tabaquismo es una causa importante de enfermedad cerebro vascular y ésta es responsable de 57 muertes x 100,000 habitantes. El fumar aumenta la probabilidad de hemorragia subaracnoidea en fumadores y asociado a anticonceptivos orales aumenta este riesgo. La situación actual del problema del tabaquismo en Cuba es su asociación como factor de riesgo a las primeras causas de muerte prematura. Encuestas nacionales de factores de riesgo realizadas en 1995 arrojaron un 37 por ciento de prevalencia de tabaquismo.

Sarcoma vesical: presentación de un caso / Bladder Sarcoma: case Presentation

Paciente femenina de 50 años de edad, quien presenta hematuria y pérdida de peso. Se le realizaron varios exámenes, incluyendo ultrasonido abdominal, donde se observa masa tumoral en región vesical. No se pudo intervenir, posteriormente, por la evolución tórpida con deceso, que presentara la misma. Se toma muestra para biopsia y se envía el especimen quirúrgico a Anatomía Patológica; resultó un tumor vesical infrecuente con poca incidencia en la literatura. Lo fundamental es señalar la importancia de poner en práctica y descubrir, a tiempo, las herramientas necesarias para evidenciar y diagnosticar estos tipos de tumores(AU)

50 years old ,female who suffrered haematuria and lost weight is presented. Several tests are perfomed including abdominal ultrasonographic test in which a tumoral mass in vesical region are noted . The patient was not surgered due to bad evolution and fast death. Surgical specimen for biopsy was sent to Anatomy pathology deparment. The diagnosis was an infrecuent vesical tumor as well as the lower incidence in the literature. I think that the most important goal is finding as soon as possible the necessary tools that just may us to diagnose them at time(AU)

Sarcoma vesical: presentación de un caso / Bladder Sarcoma: case presentation

Paciente femenina de 50 años de edad, quien presenta hematuria y pérdida de peso. Se le realizaron varios exámenes, incluyendo ultrasonido abdominal, donde se observa masa tumoral en región vesical. No se pudo intervenir, posteriormente, por la evolución tórpida con deceso, que presentara la misma. Se toma muestra para biopsia y se envía el especimen quirúrgico a Anatomía Patológica; resultó un tumor vesical infrecuente con poca incidencia en la literatura. Lo fundamental es señalar la importancia de poner en práctica y descubrir, a tiempo, las herramientas necesarias para evidenciar y diagnosticar estos tipos de tumores(AU)

50 years old female who suffrered haematuria and lost weight is presented. Several tests are perfomed including abdominal ultrasonographic test in which a tumoral mass in vesical region are noted. The patient was not surgered due to bad evolution and fast death. Surgical specimen for biopsy was sent to Anatomy pathology deparment. The diagnosis was an infrecuent vesical tumor as well as the lower incidence in the literature. I think that the most important goal is finding as soon as possible the necessary tools that just may us to diagnose them at time(AU)

Performance of two questionnaires to measure treatment adherence in patients with Type-2 diabetes.

BACKGROUND: Most valid methods to measure treatment adherence require time and resources, and they are not easily applied in highly demanding Primary Health Care Clinics (PHCC). The objective of this study was to determine sensitivity, specificity, predictive values, likelihood ratios, and post-test probabilities of two novel questionnaires as proxy measurements of treatment adherence in Type-2 diabetic patients. METHODS: Two questionnaires were developed by a group of experts to identify the patient's medical prescription knowledge (knowledge) and their attitudes toward treatment adherence (attitudes) as proxy measurements of adherence. The questionnaires were completed by patients receiving care in PHCC pertaining to the Mexican Institute of Social Security in Aguascalientes (Mexico). Pill count was used as gold standard. Participants were selected randomly, and their oral hypoglycemic prescriptions were studied. The main outcome measures for each questionnaire were sensitivity, specificity, predictive values, likelihood ratios, and post-test probabilities, all as an independent questionnaire test and in a serial analysis. RESULTS: Adherence prevalence was 27.0% using pill count. Knowledge questionnaire showed the highest sensitivity (68.1%) and negative predictive value (82.2%), the lowest negative likelihood ratio (0.58) and post-test probability for a negative result (0.16). Serial analysis showed the highest specificity (77.4%) and positive predictive value (40.1%) as well as the highest positive likelihood ratio (1.8) and post-test probability for a positive result (0.39). CONCLUSION: Medical Prescription Knowledge questionnaire showed the best performance as proxy measurement to identify non-adherence in type 2 diabetic patients regarding negative predictive value, negative likelihood ratio, and post-test probability for a negative result. However, Medical Prescription Knowledge questionnaire performance may change in contexts with higher adherence prevalence. Therefore, more research is needed before using this method in other contexts.

Disfagia en paciente con enfermedad cerebrovascular: actualización / Dysphagia in patients with cerebrovascular disease: update

Gran número de pacientes con enfermedadcerebrovascular padecen de disfagia, por lesiones dehemisferios o del tronco cerebral, lo que, además decontribuir a un mal pronóstico en términos de morbilidady recuperación funcional, por las complicaciones queacarrea, es causa importante de afectación del estadonutricional, con incremento de la desnutriciónintrahospitalaria, de la estadía y de los costos porenfermo. Uno de los propósitos del Grupo de ApoyoNutricional del Instituto de Neurología y Neurocirugía esminimizar las causas de desnutrición en los enfermoscon trastornos neurológicos. Se realizó una ampliarevisión del tema y se consultaron expertos del país,procedentes de las instituciones mencionadas antes, conel objetivo de conformar un informe actualizadorelacionado con la importancia del diagnóstico precoz dela disfagia en el paciente con ictus y la aplicaciónoportuna y adecuada de medidas terapéuticas quedisminuyan el riesgo de complicaciones(AU)

An important number of patients with cerebrovasculardisease also present dysphagia as a result of damage incerebral hemispheres or brainstem, which contributes tonegative morbility and functional rehabilitation prognosisdue to the complications liked with this condition. It is asignificant cause of nutritional dysfunctions, includingincreased in-hospital undernourishment, increased perpatient expenditure and longer in-hospital stay. One ofthe objectives of the Nutritional Support Team of theNeuroscience and Neurology Institute is to reduceundernourishment causes in patients with neurologicaldiseases. A wide review of the subject was performedincluding experts´ opinions, from the above mentionedinstitutions, in order to gather an updated report relatedwith the significance of early diagnosis of dysphagia inpatients with ictus and the opportune and correct use oftherapeutic measures to reduce complication risk(AU)