Pan American League of Associations for Rheumatology Recommendations for the Treatment of Psoriatic Arthritis.

OBJECTIVE: Psoriatic arthritis (PsA) is chronic disease that compromises multiple domains and might be associated with progressive joint damage, increased mortality, functional limitation, and considerably impaired quality of life. Our objective was to generate evidence-based recommendations on the management of PsA in Pan American League of Associations for Rheumatology (PANLAR) countries. METHODS: We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to adapt the 2019 recommendations of the European Alliance of Associations for Rheumatology. A working group consisting of rheumatologists from various countries in Latin America identified relevant topics for the treatment of PsA in the region. The methodology team updated the evidence and synthesized the information used to generate the final recommendations. These were then discussed and defined by a panel of 31 rheumatologists from 15 countries. RESULTS: Theses guidelines report 15 recommendations addressing therapeutic targets, use of antiinflammatory agents and corticosteroids, treatment with disease-modifying antirheumatic drugs (conventional synthetic, biologic, and targeted synthetic), therapeutic failure, optimization of biologic therapy, nonpharmacological interventions, assessment tools, and follow-up of patients with PsA. CONCLUSION: Here we present a set of recommendations to guide decision making in the treatment of PsA in Latin America, based on the best evidence available, considering resources, medical expertise, and the patient's values and preferences. The successful implementation of these recommendations should be based on clinical practice conditions, healthcare settings in each country, and a tailored evaluation of patients.

Pan American League of Associations for Rheumatology recommendations for the management of axial spondyloarthritis.

Axial spondyloarthritis (axSpA) comprises a spectrum of chronic inflammatory manifestations affecting the axial skeleton and represents a challenge for diagnosis and treatment. Our objective was to generate a set of evidence-based recommendations for the management of axSpA for physicians, health professionals, rheumatologists and policy decision makers in Pan American League of Associations for Rheumatology (PANLAR) countries. Grading of Recommendations, Assessment, Development and Evaluation-ADOLOPMENT methodology was used to adapt existing recommendations after performing an independent systematic search and synthesis of the literature to update the evidence. A working group consisting of rheumatologists, epidemiologists and patient representatives from countries within the Americas prioritized 13 topics relevant to the context of these countries for the management of axSpA. This Evidence-Based Guideline article reports 13 recommendations addressing therapeutic targets, the use of NSAIDs and glucocorticoids, treatment with DMARDs (including conventional synthetic, biologic and targeted synthetic DMARDs), therapeutic failure, optimization of the use of biologic DMARDs, the use of drugs for extra-musculoskeletal manifestations of axSpA, non-pharmacological interventions and the follow-up of patients with axSpA.

The spread of agriculture in Iberia through Approximate Bayesian Computation and Neolithic projectile tools.

In the present article we use geometric microliths (a specific type of arrowhead) and Approximate Bayesian Computation (ABC) in order to evaluate possible origin points and expansion routes for the Neolithic in the Iberian Peninsula. In order to do so, we divide the Iberian Peninsula in four areas (Ebro river, Catalan shores, Xúquer river and Guadalquivir river) and we sample the geometric microliths existing in the sites with the oldest radiocarbon dates for each zone. On this data, we perform a partial Mantel test with three matrices: geographic distance matrix, cultural distance matrix and chronological distance matrix. After this is done, we simulate a series of partial Mantel tests where we alter the chronological matrix by using an expansion model with randomised origin points, and using the distribution of the observed partial Mantel test's results as a summary statistic within an Approximate Bayesian Computation-Sequential Monte-Carlo (ABC-SMC) algorithm framework. Our results point clearly to a Neolithic expansion route following the Northern Mediterranean, whilst the Southern Mediterranean route could also find support and should be further discussed. The most probable origin points focus on the Xúquer river area.

Publicaciones científicas de profesionales villaclareños de la salud del municipio Sagua la Grande. (2019-2020) / Scientific publications of health professionals from Villa Clara in the municipality of Sagua la Grande. (2019-2020)

RESUMEN Fundamento: de conjunto con la formación de profesionales, las universidades de ciencias médicas cubanas tienen como misión generar y divulgar conocimientos, lo cual se logra mediante la investigación y su difusión a través de publicaciones. Objetivo: caracterizar las publicaciones científicas de los autores villaclareños de la salud del municipio de Sagua la Grande durante el periodo 2019-2020. Métodos: se realizó un estudio descriptivo longitudinal retrospectivo sobre la producción científica de los profesionales de la salud del municipio. Se aplicaron métodos teóricos y empíricos. Para la recogida de la información se revisó una base de datos sobre la producción científica, especificando en el indicador publicaciones científicas, diseñada y actualizada por miembros del departamento de posgrado e investigación de la Facultad de Ciencias Médicas de Sagua la Grande. Resultados: se constató que las unidades donde más profesionales han publicado fueron el Hospital Docente "Mártires del 9 de Abril" y la Facultad de Ciencias Médicas. Predominaron los autores con categorías docentes de Profesor Asistente y Profesor Auxiliar, médicos y enfermeros, y escasas cifras de profesionales con categorías investigativas. Los que menos han publicado son los que laboran en las unidades de la atención primaria de salud y los que no son médicos o enfermeros. Conclusiones: la caracterización realizada a los profesionales de la salud del municipio permitió constatar que son insuficientes las publicaciones científicas en el territorio; a pesar de que existen varias revistas científicas donde publicar, algunos aún no divulgan sus resultados científicos.

ABSTRACT Background: together with the training of professionals, Cuban universities of medical sciences have the mission of generating and disseminating knowledge, which is achieved through research and its dissemination through publications. Objective: to characterize the scientific publications of the Villa Clara health authors of the municipality of Sagua la Grande during the 2019-2020 period. Methods: a retrospective longitudinal descriptive study was carried out on the scientific production of health professionals in the municipality. Theoretical and empirical methods were applied. To collect the information, a database on scientific production was reviewed, specifying scientific publications in the indicator, designed and updated by members of the postgraduate and research department of the Faculty of Medical Sciences of Sagua la Grande. Results: it was found that the institutions where more professionals have published were the "Mártires del 9 de Abril" Teaching Hospital and the Faculty of Medical Sciences. Authors with teaching ranks of Assistant Professor and Associate Professor, M.Ds and nurses predominated, and few figures of professionals with researching ranks. Those who have published the least are those who work in primary health care units and those who are not doctors or nurses. Conclusions: the characterization to the health professionals of the municipality allowed to verify that the scientific publications in the territory are insufficient; Although there are several scientific journals to publish, some still do not disclose their scientific results.

Autoevaluación de habilidades investigativas en alumnos ayudantes de una universidad médica de Cuba / Self-evaluation of investigative skills in assistant students of a medical university in Cuba

INTRODUCCIÓN: La formación y desarrollo de habilidades investigativas constituye una necesidad debido a que la investigación no solo es uno de los procesos sustantivos de la universidad, sino que representa una función específica de la labor profesional que prepara al egresado para enfrentar con éxito las exigencias del desarrollo científico-técnico contemporáneo. OBJETIVO: Describir el nivel de autoevaluación de las habilidades investigativas en los alumnos ayudantes por año académico. MÉTODO: Estudio observacional, descriptivo, de corte transversal, realizado en alumnos ayudantes de la Facultad de Medicina de la Universidad de Ciencias Médicas de Villa Clara, Cuba, en el período comprendido entre los meses de abril y mayo de 2017. La selección de la muestra se realizó a través de un muestreo probabilístico estratificado: 62 de tercer año, 46 de cuarto año y 40 de quinto año. RESULTADOS: Los alumnos ayudantes de tercer año tuvieron un predominio del nivel medianamente adecuado para un 52%, los de cuarto y quinto año se autoevaluaron mayormente de adecuado para un 53,2% y 64,7%, respectivamente. CONCLUSIONES: El nivel de autoevaluación de las habilidades investigativas por parte de los alumnos ayudantes se comportó en orden creciente del tercer al quinto año de la carrera, resultando en niveles adecuados y medianamente adecuados de desarrollo

INTRODUCTION: The training and development of research skills is a necessity because research is not only one of the substantive processes of the university, but represents a specific function of the professional work that prepares the graduate to successfully face the demands of the university contemporary scientific-technical development. OBJECTIVE: To describe the level of self-assessment of research skills in the student assistants by academic year. METHOD: Observational, descriptive, cross-sectional study, of Student assistants of the medical degree of the Villa Clara Medical University, during the period from April to May 2017. After the stratification of the sample, there were 62 from the third year, 46 from the fourth, and 40 from the fifth. RESULTS: The student assistants of the third year had a predominance (52%) of a moderately adequate level, with those of the fourth and fifth self-evaluated as mostly adequate for 53.2% and 64.7%, respectively. CONCLUSIONS: The level of self-evaluation of the research skills by the assistant student assistants was in an increasing order from the third to fifth year of the degree, resulting in the three years of the degree studied at adequate and moderately adequate levels

Design of an algorithm for the diagnostic approach of patients with joint pain.

BACKGROUND: Rheumatic diseases are a reason for frequent consultation with primary care doctors. Unfortunately, there is a high percentage of misdiagnosis. OBJECTIVE: To design an algorithm to be used by primary care physicians to improve the diagnostic approach of the patient with joint pain, and thus improve the diagnostic capacity in four rheumatic diseases. METHODS: Based on the information obtained from a literature review, we identified the main symptoms, signs, and paraclinical tests related to the diagnosis of rheumatoid arthritis, spondyloarthritis with peripheral involvement, systemic lupus erythematosus with joint involvement, and osteoarthritis. We conducted 3 consultations with a group of expert rheumatologists, using the Delphi technique, to design a diagnostic algorithm that has as a starting point "joint pain" as a common symptom for the four diseases. RESULTS: Thirty-nine rheumatologists from 18 countries of Ibero-America participated in the Delphi exercise. In the first consultation, we presented 94 items to the experts (35 symptoms, 31 signs, and 28 paraclinical tests) candidates to be part of the algorithm; 74 items (25 symptoms, 27 signs, and 22 paraclinical tests) were chosen. In the second consultation, the decision nodes of the algorithm were chosen, and in the third, its final structure was defined. The Delphi exercise lasted 8 months; 100% of the experts participated in the three consultations. CONCLUSION: We present an algorithm designed through an international consensus of experts, in which Delphi methodology was used, to support primary care physicians in the clinical approach to patients with joint pain. Key Points • We developed an algorithm with the participation of rheumatologists from 18 countries of Ibero-America, which gives a global vision of the clinical context of the patient with joint pain. • We integrated four rheumatic diseases into one tool with one common symptom: joint pain. It is a novel tool, as it is the first algorithm that will support the primary care physician in the consideration of four different rheumatic diseases. • It will improve the correct diagnosis and reduce the number of paraclinical tests requested by primary care physicians, in the management of patients with joint pain. This point was verified in a recently published study in the journal Rheumatology International (reference number 31).

The exceptional finding of Locus 2 at Dehesilla Cave and the Middle Neolithic ritual funerary practices of the Iberian Peninsula.

There is a significant number of funerary contexts for the Early Neolithic in the Iberian Peninsula, and the body of information is much larger for the Late Neolithic. In contrast, the archaeological information available for the period in between (ca. 4800-4400/4200 cal BC) is scarce. This period, generally called Middle Neolithic, is the least well-known of the peninsular Neolithic sequence, and at present there is no specific synthesis on this topic at the peninsular scale. In 2017, an exceptional funerary context was discovered at Dehesilla Cave (Sierra de Cádiz, Southern Iberian Peninsula), providing radiocarbon dates which place it at the beginning of this little-known Middle Neolithic period, specifically between ca. 4800-4550 cal BC. Locus 2 is a deposition constituted by two adult human skulls and the skeleton of a very young sheep/goat, associated with stone structures and a hearth, and a number of pots, stone and bone tools and charred plant remains. The objectives of this paper are, firstly, to present the new archaeological context documented at Dehesilla Cave, supported by a wide range of data provided by interdisciplinary methods. The dataset is diverse in nature: stratigraphic, osteological, isotopic, zoological, artifactual, botanical and radiocarbon results are presented together. Secondly, to place this finding within the general context of the contemporaneous sites known in the Iberian Peninsula through a systematic review of the available evidence. This enables not only the formulation of explanations of the singular new context, but also to infer the possible ritual funerary behaviours and practices in the 5th millennium cal BC in the Iberian Peninsula.

Correction: Garcia-Gonzalez, D.; Rivero, D.; Fernandez-Blanco, E.; Luaces, M.R. A Public Domain Dataset for Real-Life Human Activity Recognition Using Smartphone Sensors. Sensors 2020, 20, 2200.

The authors wish to make the following corrections to this paper [...].

Conocimientos sobre el diagnóstico del dolor torácico agudo: una necesidad en los internos de Medicina / Knowledge on the diagnosis of acute chest pain: a necessity in medical interns

RESUMEN Fundamento: el dominio y la aplicación del método clínico en el contexto del dolor torácico agudo son fundamentales, pues resulta uno de los síntomas más frecuentes en las consultas de servicios médicos de urgencia hospitalaria. Objetivo: evaluar el nivel de conocimientos sobre el diagnóstico de dolor torácico agudo en internos de Medicina. Métodos: se realizó un estudio descriptivo, transversal en estudiantes internos que cursaban su rotación por Medicina Interna en el Hospital Universitario "Mártires del 9 de Abril" en la provincia Villa Clara, Cuba durante el año 2018. Se aplicaron métodos teóricos: análisis-síntesis, inducción-deducción e histórico-lógico; y empíricos: la encuesta en forma de cuestionario. Resultados: la mayoría de los estudiantes obtuvieron evaluación de Regular en cuanto a las habilidades para la identificación etiológica del dolor torácico a través de la anamnesis. De igual forma se comportó el resultado en la evaluación en cuanto a la exploración física. Por su parte la identificación del examen complementario de elección ante cada situación arrojó mejores resultados, al obtener calificaciones de Excelente 20 internos. Conclusiones: el nivel de conocimientos sobre diagnóstico del dolor torácico agudo en internos de Medicina resultó insuficiente, preferentemente en la interpretación los datos aportados por la anamnesis y la exploración física.

ABSTRACT Background: mastery and application of the clinical method in the context of acute chest pain are essential, as it is one of the most frequent symptoms in hospital emergency medical services. Objective: to assess the level of knowledge on the diagnosis of acute chest pain in medical interns. Methods: a descriptive, cross-sectional study was carried out in internal students who were studying Internal Medicine at the "Mártires del 9 de Abril" University Hospital in Villa Clara province, Cuba during 2018. Theoretical methods were applied: analysis-synthesis, induction-deduction and historical-logical; and empirical ones: the survey in questionnaire form. Results: the majority of the students obtained a so-so mark in the evaluation regarding the abilities for the etiological identification of chest pain through the history-taking pain. In the same way behaved the result in the assessment in terms of physical examination. On the other hand, the identification of the complementary examination of choice in each situation yielded better results, 20 interns got excellent qualifications. Conclusions: the level of knowledge about the diagnosis of acute chest pain in medical interns was insufficient, preferably in the interpretation of the data provided by the history-taking pain and physical examination.

A Public Domain Dataset for Real-Life Human Activity Recognition Using Smartphone Sensors.

In recent years, human activity recognition has become a hot topic inside the scientific community. The reason to be under the spotlight is its direct application in multiple domains, like healthcare or fitness. Additionally, the current worldwide use of smartphones makes it particularly easy to get this kind of data from people in a non-intrusive and cheaper way, without the need for other wearables. In this paper, we introduce our orientation-independent, placement-independent and subject-independent human activity recognition dataset. The information in this dataset is the measurements from the accelerometer, gyroscope, magnetometer, and GPS of the smartphone. Additionally, each measure is associated with one of the four possible registered activities: inactive, active, walking and driving. This work also proposes asupport vector machine (SVM) model to perform some preliminary experiments on the dataset. Considering that this dataset was taken from smartphones in their actual use, unlike other datasets, the development of a good model on such data is an open problem and a challenge for researchers. By doing so, we would be able to close the gap between the model and a real-life application.

Factores asociados con malignidad en pacientes con nódulos de tiroides / Factors associated with malignancy in patients with thyroid nodules

RESUMEN Introducción: la enfermedad nodular tiroidea es uno de los problemas endocrinos más frecuentes; constituye un reto para cirujanos, endocrinólogos y oncólogos por su asociación con el cáncer de la glándula tiroidea. Objetivos: determinar los factores asociados con malignidad en pacientes con nódulos de tiroides que han recibido tratamiento quirúrgico. Métodos: se realizó un estudio observacional-analítico de tipo casos y controles, en pacientes que ingresaron con diagnóstico de nódulo de tiroides y recibieron tratamiento quirúrgico en el Hospital «Mártires del 9 de Abril¼, del municipio Sagua la Grande, en el período de enero de 2015 a abril de 2018. La muestra quedó conformada por un total de 80 pacientes (n=80), de los cuales, el grupo caso tuvo un total de 20 (n1 = 20), y el grupo control 60 (n2 = 60). Resultados: entre los tipos histológicos de tumores malignos más frecuentes se encontró el carcinoma papilar en 16 pacientes (80 %) y 4 fueron diagnosticados con carcinoma folicular (20 %). Entre los predictores más fuertemente asociados con malignidad se pueden mencionar las adenopatías (VPP: 88,89, IC: 62,80-100,00) y la consistencia pétrea (VPP: 85,71, IC: 52,65-100,00) como variables clínicas, seguidas por el sexo masculino como variable sociodemográfica (VPP: 72,73, IC: 41,86-100,00). Conclusiones: las características clínicas, sociodemográficas y ultrasonográficas de los pacientes con nódulo tiroideo son útiles para identificar el riesgo de malignidad. Los predictores más fuertemente asociados con malignidad fueron las adenopatías, la consistencia pétrea y el sexo masculino.

ABSTRACT Introduction: thyroid nodular disease is one of the most common endocrine problems; it constitutes a challenge for surgeons, endocrinologists and oncologists because of its association with thyroid gland cancer. Objectives: to determine factors associated with malignancy in patients with thyroid nodules who have received surgical treatment. Methods: an observational, analytical, case-control study was carried out in patients who were admitted with a diagnosis of a thyroid nodule and received surgical treatment at "Mártires del 9 de Abril" Hospital, in Sagua la Grande municipality, from January 2015 to April 2018. The sample consisted of a total of 80 patients (n = 80), of which, case group 20 (n1= 20), and control group 60 (n2= 60). Results: papillary carcinoma was found among the most frequent histological types of malignant tumors in 16 patients (80%), and 4 were diagnosed with follicular carcinoma (20%). Adenopathies were among the predictors most strongly associated with malignancy, (PPV: 88.89, CI: 62.80-100.00) and stony consistency (PPV: 85.71, CI: 52.65-100.00) as clinical variables, followed by male gender as a socio-demographic variable (PPV: 72.73, CI: 41.86-100.00). Conclusions: clinical, socio-demographic and ultrasonographic characteristics of patients with thyroid nodule are useful to identify the risk of malignancy. The predictors most strongly associated with malignancy were adenopathies, stony consistency and male gender.

Medición de la actividad lúpica y daño acumulado en pacientes con lupus eritematoso sistémico / Measurement of lupus activity and cumulative damage in patients with systemic lupus erythematosus

Introducción: medir la actividad de la enfermedad y el daño irreversible en pacientes con lupus eritematoso sistémico es de vital importancia para evaluar las medidas de desenlace del paciente y su pronóstico, las diferencias entre grupos de pacientes y las respuestas a nuevos tratamientos. Objetivo: determinar el grado de actividad lúpica y daño acumulado en un grupo de pacientes con lupus eritematoso sistémico. Método: se realizó un estudio observacional, descriptivo, de corte transversal, en el Hospital Universitario Mártires del 9 de Abril de Sagua la Grande, provincia Villa Clara, en el periodo comprendido de enero de 2013 a septiembre de 2018. La muestra, seleccionada de manera no probabilística por criterios, quedó conformada por 53 pacientes con diagnóstico de lupus eritematoso sistémico. Resultados: la media de puntajes de la escala MEX-SLEDAI fue de 5.8±3.7 puntos (rango 1-17 puntos). El 37.7 por ciento de los pacientes presentó actividad leve, sólo el 1.9 por ciento presentó actividad muy severa y el 17 por ciento se encontraba en remisión o sin actividad. Los dominios del índice SLICC/ACR más afectados fueron el musculoesquelético (17.0 por ciento), el cardiovascular (17.0 por ciento) y el cutáneo (15.1 por ciento). Conclusiones: los pacientes estudiados mostraron un predominio de actividad leve a moderada de la enfermedad según MEX-SLEDAI. La presencia de daño cardiovascular fue superior a la reportada por otros estudios. Se encontró correlación significativa entre la presencia de actividad lúpica y daño acumulado(AU)

Introduction: measuring the activity of the disease and the irreversible damage in patients with systemic lupus erythematosus is of vital importance to evaluate the outcome measures of the patient and their prognosis, the differences between groups of patients and the responses to new treatments. Objective: to determine the degree of lupus activity and accumulated damage in a group of patients with systemic lupus erythematosus. Method: an observational, descriptive, cross-sectional study was conducted at the Mártires del 9 de Abril University Hospital in Sagua la Grande, Villa Clara province, in the period from January 2013 to September 2018. The sample, selected in a non-probabilistic manner by criteria, was composed of 53 patients with a diagnosis of systemic lupus erythematosus. Results: the mean score of the MEX-SLEDAI scale was 5.8 ± 3.7 points (range 1-17 points). 37.7 percent of the patients presented mild activity, only 1.9 percent presented very severe activity and 17 percent were in remission or without activity. The most affected areas of the SLICC / ACR index were musculoskeletal (17.0 percent), cardiovascular (17.0 percent) and cutaneous (15.1 percent. Conclusions: the patients studied showed a predominance of mild to moderate disease activity according to MEX-SLEDAI. The presence of cardiovascular damage was higher than that reported by other studies. A significant correlation was found between the presence of lupus activity and accumulated damage(AU)

Habilidades, motivaciones e interés por la investigación en alumnos ayudantes en Villa Clara / Researching skills, motivation and interest in teaching students in Villa Clara

RESUMEN Fundamento: la investigación científica estudiantil es considerada uno de los pilares de la educación médica superior. Objetivo: describir las habilidades, motivaciones e interés por la investigación en los alumnos ayudantes de la Universidad de Ciencias Médicas de Villa Clara. Métodos: se realizó un estudio descriptivo de corte transversal en la Universidad de Ciencias Médicas de Villa Clara, en el período de abril a mayo de 2017. Se utilizaron como métodos teóricos: analítico-sintético, inductivo-deductivo e histórico-lógico, del nivel empírico: encuesta en forma de cuestionario a los estudiantes. Resultados: la mayoría de los estudiantes refirió motivaciones por la investigación, les interesa ejercitarla una vez egresado transversal a la carrera, pero reconocieron como barreras tener carencias relacionadas con el dominio de algunas habilidades investigativas y la no existencia de grupos de investigación, solo una minoría consideró esta actividad como medianamente importante o poco importante. Conclusiones: los alumnos ayudantes de la Universidad de Ciencias Médicas de Villa Clara tienen interés por dedicarse a la investigación una vez egresados de la carrera, pero es aún insuficiente la preparación por lo que es necesario continuar su superación aprovechando las diferentes formas.

ABSTRACT Background: student´s scientific research is considered one of the pillars of higher medical education. Objective: to describe the researching skills, motivations and interests in the teaching students of Villa Clara University of Medical Sciences. Methods: a descriptive cross-sectional study was carried out at Villa Clara University of Medical Sciences, from April to May 2017. The following theoretical methods were used: analytical-synthetic, inductive-deductive and historical-logical, empirical methods: survey in the form of a questionnaire to students. Results: the majority of the students referred researching motivations, they are interested in exercising it once they graduate from their studies, but they recognized as barriers to have deficiencies related to the mastery of some researching skills and the non-existence of researching groups, only a minority considered this activity as moderately important or unimportant. Conclusions: the teaching students of Villa Clara University of Medical Sciences have interests to dedicate themselves to researching once graduated from the degree, but the preparation is still insufficient, reason why it is necessary to continue its overcoming taking advantage of the different forms.

Características de los pacientes con disección aórtica aguda en Villa Clara: Estudio multicéntrico / Characteristics of patients with acute aortic dissection in Villa Clara: Multicentric study

RESUMEN Introducción: La disección aórtica aguda es considerada como una de las enfermedades cardiovasculares más catastróficas que ocurren en el ser humano, tiene una alta mortalidad que obliga a un diagnóstico y tratamiento precoces. Objetivo: Describir las características de los pacientes con disección aórtica atendidos en 4 instituciones hospitalarias de la provincia de Villa Clara. Método: Se realizó un estudio observacional, descriptivo, de corte transversal, multicéntrico, en 25 pacientes que fueron atendidos con el diagnóstico de disección aórtica en el período comprendido entre enero de 2012 y diciembre de 2017, en 4 centros hospitalarios de nivel secundario de la provincia de Villa Clara, Cuba. Resultados: La media de la edad de los pacientes fue 60,48 ± 13,99 años, 21 fueron del sexo masculino lo que representó el 84,0%. Según la clasificación de Stanford, predominó el tipo A, en 17 pacientes (68,0%). El síntoma más referido fue el dolor torácico anterior y el taponamiento cardíaco fue la complicación más frecuente (28,0%). Conclusiones: Las características de los pacientes con disección aórtica en Villa Clara fueron similares a lo que acontece en el ámbito nacional e internacional, con una elevada mortalidad y una mayor incidencia en hombres, hipertensos y mayores de 65 años de edad. El dolor torácico fue el síntoma cardinal y el taponamiento cardíaco la complicación más temida. La disección aórtica requiere un alto nivel de sospecha por parte del médico para un diagnóstico y un tratamiento tempranos.

ABSTRACT Introduction: Acute aortic dissection is considered one of the most tragic cardiovascular diseases that occur in humans; with high mortality which requires early diagnosis and treatment. Objective: To describe the characteristics of patients with aortic dissection treated in 4 hospital institutions in the province of Villa Clara. Method: An observational, descriptive, cross-sectional, multicenter study was conducted in 25 patients who were treated under the diagnosis of aortic dissection in the period between January 2012 and December 2017, in 4 secondary-level hospital centers in Villa Clara province, Cuba. Results: The mean age of the patients was 60.48 ± 13.99 years, 21 were male, which represented 84.0%. According to the Stanford classification, type A predominated in 17 patients (68.0%). The most common symptom was anterior chest pain while the most frequent complication was cardiac tamponade (28.0%). Conclusions: The characteristics of patients with aortic dissection in the Villa Clara setting manifested in a similar way to those in the national and international sphere. A high level of suspicion is required by the doctor to achieve a timely diagnosis and treatment.

Gas-Phase Photolysis of Hg(I) Radical Species: A New Atmospheric Mercury Reduction Process.

The efficient gas-phase photoreduction of Hg(II) has recently been shown to change mercury cycling significantly in the atmosphere and its deposition to the Earth's surface. However, the photolysis of key Hg(I) species within that cycle is currently not considered. Here we present ultraviolet-visible absorption spectra and cross-sections of HgCl, HgBr, HgI, and HgOH radicals, computed by high-level quantum-chemical methods, and show for the first time that gas-phase Hg(I) photoreduction can occur at time scales that eventually would influence the mercury chemistry in the atmosphere. These results provide new fundamental understanding of the photobehavior of Hg(I) radicals and show that the photolysis of HgBr increases atmospheric mercury lifetime, contributing to its global distribution in a significant way.