Measuring visual acuity and spherical refraction with smartphone screens emitting blue light

Introduction A periodical self-monitoring of spherical refraction using smartphones may potentially allow a quicker intervention by eye care professionals to reduce myopia progression. Unfortunately, at low levels of myopia, the far point (FP) can be located far away from the eye which can make interactions with the device difficult. To partially remedy this issue, a novel method is proposed and tested wherein the longitudinal chromatic aberration (LCA) of blue light is leveraged to optically bring the FP closer to the eye. Methods Firstly, LCA was obtained by measuring spherical refraction subjectively using blue pixels in stimuli shown on organic light-emitting diode (OLED) screens and also grey stimuli with matching luminance. Secondly, the visual acuity (VA) measured with a smartphone located at 1.0 m and 1.5 m and displaying blue optotypes was compared with that obtained clinically standard measurements. Finally, the spherical over refraction obtained in blue light with a smartphone was compared with clinical over-refraction with black and white (B&W) optotypes placed at 6 m. Results Mean LCA of blue OLED smartphone screens was −0.67 ± 0.11 D. No significant differences (p > 0.05) were found between the VA measured with blue optotypes on a smartphone screen and an eye chart. Mean difference between spherical over-refraction measured subjectively by experienced subjects with smartphones and the one obtained clinically was 0.08 ± 0.34 D. Conclusions Smartphones using blue light can be used as a tool to detect changes in visual acuity and spherical refraction and facilitate monitoring of myopia progression. (AU)

Prediction of Sjögren's disease diagnosis using matched electronic dental-health record data.

BACKGROUND: Sjögren's disease (SD) is an autoimmune disease that is difficult to diagnose early due to its wide spectrum of clinical symptoms and overlap with other autoimmune diseases. SD potentially presents through early oral manifestations prior to showing symptoms of clinically significant dry eyes or dry mouth. We examined the feasibility of utilizing a linked electronic dental record (EDR) and electronic health record (EHR) dataset to identify factors that could be used to improve early diagnosis prediction of SD in a matched case-control study population. METHODS: EHR data, including demographics, medical diagnoses, medication history, serological test history, and clinical notes, were retrieved from the Indiana Network for Patient Care database and dental procedure data were retrieved from the Indiana University School of Dentistry EDR. We examined EHR and EDR history in the three years prior to SD diagnosis for SD cases and the corresponding period in matched non-SD controls. Two conditional logistic regression (CLR) models were built using Least Absolute Shrinkage and Selection Operator regression. One used only EHR data and the other used both EHR and EDR data. The ability of these models to predict SD diagnosis was assessed using a concordance index designed for CLR. RESULTS: We identified a sample population of 129 cases and 371 controls with linked EDR-EHR data. EHR factors associated with an increased risk of SD diagnosis were the usage of lubricating throat drugs with an odds ratio (OR) of 14.97 (2.70-83.06), dry mouth (OR = 6.19, 2.14-17.89), pain in joints (OR = 2.54, 1.34-4.76), tear film insufficiency (OR = 27.04, 5.37-136.), and rheumatoid factor testing (OR = 6.97, 1.94-25.12). The addition of EDR data slightly improved model concordance compared to the EHR only model (0.834 versus 0.811). Surgical dental procedures (OR = 2.33, 1.14-4.78) were found to be associated with an increased risk of SD diagnosis while dental diagnostic procedures (OR = 0.45, 0.20-1.01) were associated with decreased risk. CONCLUSION: Utilizing EDR data alongside EHR data has the potential to improve prediction models for SD. This could improve the early diagnosis of SD, which is beneficial to slowing or preventing complications of SD.

Longevity of dental restorations in Sjogren's disease patients using electronic dental and health record data.

BACKGROUND: Decreased salivary secretion is not only a risk factor for carious lesions in Sjögren's disease (SD) but also an indicator of deterioration of teeth with every restorative replacement. This study determined the longevity of direct dental restorations placed in patients with SD using matched electronic dental record (EDR) and electronic health record (EHR) data. METHODS: We conducted a retrospective cohort study using EDR and EHR data of Indiana University School of Dentistry patients who have a SD diagnosis in their EHR. Treatment history of patients during 15 years with SD (cases) and their matched controls with at least one direct dental restoration were retrieved from the EDR. Descriptive statistics summarized the study population characteristics. Cox regression models with random effects analyzed differences between cases and controls for time to direct restoration failure. Further the model explored the effect of covariates such as age, sex, race, dental insurance, medical insurance, medical diagnosis, medication use, preventive dental visits per year, and the number of tooth surfaces on time to restoration failure. RESULTS: At least one completed direct restoration was present for 102 cases and 42 controls resulting in a cohort of 144 patients' EDR and EHR data. The cases were distributed as 21 positives, 57 negatives, and 24 uncertain cases based on clinical findings. The average age was 56, about 93% were females, 54% were White, 74% had no dental insurance, 61% had public medical insurance, < 1 preventive dental visit per year, 94% used medications and 93% had a medical diagnosis that potentially causes dry mouth within the overall study cohort. About 529 direct dental restorations were present in cases with SD and 140 restorations in corresponding controls. Hazard ratios of 2.99 (1.48-6.03; p = 0.002) and 3.30 (1.49-7.31, p-value: 0.003) showed significantly decreased time to restoration failure among cases and positive for SD cases compared to controls, respectively. Except for the number of tooth surfaces, no other covariates had a significant influence on the survival time. CONCLUSION: Considering the rapid failure of dental restorations, appropriate post-treatment assessment, management, and evaluation should be implemented while planning restorative dental procedures among cases with SD. Since survival time is decreased with an increase in the number of surfaces, guidelines for restorative procedures should be formulated specifically for patients with SD.

Measuring visual acuity and spherical refraction with smartphone screens emitting blue light.

INTRODUCTION: A periodical self-monitoring of spherical refraction using smartphones may potentially allow a quicker intervention by eye care professionals to reduce myopia progression. Unfortunately, at low levels of myopia, the far point (FP) can be located far away from the eye which can make interactions with the device difficult. To partially remedy this issue, a novel method is proposed and tested wherein the longitudinal chromatic aberration (LCA) of blue light is leveraged to optically bring the FP closer to the eye. METHODS: Firstly, LCA was obtained by measuring spherical refraction subjectively using blue pixels in stimuli shown on organic light-emitting diode (OLED) screens and also grey stimuli with matching luminance. Secondly, the visual acuity (VA) measured with a smartphone located at 1.0 m and 1.5 m and displaying blue optotypes was compared with that obtained clinically standard measurements. Finally, the spherical over refraction obtained in blue light with a smartphone was compared with clinical over-refraction with black and white (B&W) optotypes placed at 6 m. RESULTS: Mean LCA of blue OLED smartphone screens was -0.67 ± 0.11 D. No significant differences (p > 0.05) were found between the VA measured with blue optotypes on a smartphone screen and an eye chart. Mean difference between spherical over-refraction measured subjectively by experienced subjects with smartphones and the one obtained clinically was 0.08 ± 0.34 D. CONCLUSIONS: Smartphones using blue light can be used as a tool to detect changes in visual acuity and spherical refraction and facilitate monitoring of myopia progression.

Photosynthesis and biochemical characterization of the green alga Chlamydopodium fusiforme (Chlorophyta) grown in a thin-layer cascade.

Photosynthesis, growth and biochemical composition of the biomass of the freshwater microalga Chlamydopodium fusiforme cultures outdoors in a thin-layer cascade were investigated. Gross oxygen production measured off-line in samples taken from the outdoor cultures was correlated with the electron transport rate estimated from chlorophyll a fluorescence measurements. According to photosynthesis measurements, a mean of 38.9 ± 10.3 mol of photons were required to release one mole of O2, which is 4.86 times higher than the theoretical value (8 photons per 1 O2). In contrast, according to the fluorescence measurements, a mean of 11.7 ± 0.74 mol of photons were required to release 1 mol of O2. These findings indicate that fluorescence-based photosynthesis rates may not be fully replace oxygen measurements to evaluate the performance of an outdoor culture. Daily gross biomass productivity was 0.3 g DW L-1 day-1 consistently for 4 days. Biomass productivity was strongly affected by the suboptimal concentration at which the culture was operated and by the respiration rate, as the substantial volume of culture was kept in the dark (about 45% of the total volume). As the cells were exposed to excessive light, the photosynthetic activity was mainly directed to the synthesis of carbohydrates in the biomass. In the morning, carbohydrate content decreased because of the dark respiration. Per contra, protein content in the biomass was lower at the end of the day and higher in the morning due to carbohydrate consumption by respiration. The data gathered in these trials are important for the future exploitation of Chlamydopodium fusiforme as a potential novel species in the field of microalgae for the production of bio-based compounds.

Talleres "Actitud creativa del adulto mayor": opción para la cooperación desde la atención primaria / Workshops "Creative attitude of the elderly": option for cooperation from primary care

RESUMEN Fundamento: el trabajo conjunto entre la Universidad Central "Marta Abreu" de Las Villas y el Ministerio de Salud Pública en Cuba constituye una alternativa para atender las necesidades de las personas de la tercera edad para un envejecimiento saludable y feliz. Objetivo: diseñar talleres para la recreación centrados en el trabajo de grupo, que desarrolle la actitud creativa en los adultos de la tercera edad. Métodos: se realizó una investigación acción en el "Consejo Popular Hospital de Santa Clara" desde noviembre 2018 a mayo 2019. Se emplearon métodos teóricos y como empírico: el experimento. La propuesta de talleres fue valorada por criterio de expertos. Resultados: se realizaron varios talleres para el desarrollo de la actitud creativa de personas de la tercera edad fundamentados en exigencias, estructura y etapas, y mediatizados por el trabajo de grupo y la recreación. Se comprobaron cambios favorables manifestados por el incremento de conductas positivas en los participantes. Conclusiones: los talleres desarrollados conformaron la base para la educación de la actitud creativa en los adultos mayores y aportaron conocimientos necesarios para los profesionales de la salud y la cultura física. La propuesta es válida, al constituir una unidad de orientaciones y procedimientos planteados para dar solución al problema científico y la superación de los profesionales de la salud en la atención primaria. Los talleres fueron validados satisfactoriamente por los expertos consultados.

ABSTRACT Background: the joint work of "Marta Abreu" Central University of Las Villas and the Ministry of Public Health in Cuba constitute an alternative to meet the needs of the elderly for a healthy and happy aging. Objective: to design workshops for recreation focused on group works, which develop the creative attitude in the elderly. Methods: an action research was carried out in the "Hospital Consejo Popular in Santa Clara" from November 2018 to May 2019. Theoretical and empirical methods were used: the experiment. The workshops proposal was evaluated by expert´s criteria. Results: several workshops were held for the development of the creative attitude of the elderly based on demands, structure and stages, and mediated by group work and recreation. Favorable changes manifested by the increase of positive behaviors in the participants were verified. Conclusions: the workshops developed formed the basis for the education of creative attitude in the elderly and provided the necessary knowledge for health professionals and physical culture. The proposal is valid, as it constitutes a unit of orientations and procedures proposed to solve the scientific problem and the improvement of health professionals in primary health care. The workshops were successfully validated by the experts consulted.

Coffee-derived activated carbon from second biowaste for supercapacitor applications.

The electrochemical energy storage performance of activated carbons (ACs) obtained from coffee-derived biowastes was assessed. ACs were obtained from spent coffee ground second waste, after polyphenol extraction, by means of a hydrothermal process followed by physical or chemical activation. The resulting materials exhibited microporous structures with a total specific area between 585 and 2330 m2·g-1. Scanning electron microscopy (SEM) revealed a highly porous microstructure in the case of the chemically activated carbons, while physical activation led to a cracked micro-sized morphology. The electrochemical properties of the materials for supercapacitor applications were investigated in 1 M Na2SO4. After chemical activation, the coffee-derived material displayed a capacitance of 84 F·g-1 at 1 A·g-1 in a 1.9 V voltage window, with 70% capacitance retention at 10 A·g-1 and 85% retention after 5000 cycles of continuous charge-discharge. This work demonstrates how coffee secondary biowaste can be conveniently activated to perform as electrochemical energy storage material, contributing to its revalorization and reinsertion in a circular economy.

Effects of UV Radiation on Photosynthesis, Antioxidant Capacity and the Accumulation of Bioactive Compounds in Gracilariopsis longissima, Hydropuntia cornea and Halopithys incurva (Rhodophyta).

The red macroalgae Hydropuntia cornea, Gracilariopsis longissima and Halopithys incurva were cultured for 14 d under laboratory conditions, in enriched seawater with a high nutrient content (N-NH4+ and P-PO43- ) and two radiation regimes: PAR (400-700 nm) and PAB (280-700 nm). The UV radiation effects under high availability of nutrients on growth, photosynthetic pigments (chlorophyll a, carotenoids and phycobiliproteins), photosynthetic activity and biochemical composition were studied. Maximum quantum yield (Fv /Fm ) was not significantly different among the PAR and PAB treatments during the experiment. However, the maximum electronic transport rate (ETRmax ) increased over time, showing the highest values in PAR for H. incurva and H. cornea, whereas for G. longissima it was found in PAB. Photosynthetic efficiency (αETR ) decreased over time in the first two species, but increased in G. longissima. Saturation irradiance (EkETR ) and maximum nonphotochemical quenching (NPQmax ) increased in PAB with time up to 80% and 30%, respectively, indicating a photosynthetic acclimatization like that of sun-type algae. Five MAAs were identified in all species using high performance liquid chromatography (HPLC). The total content of MAAs increased over time, being 30% higher in H. incurva, 40% in G. longissima and 50% in H. cornea in PAB than in the PAR treatment. Finally, the antioxidant activity was also higher in the PAB treatment. All of the species presented an effective mechanism of photoprotection based on the accumulation of photoprotective compounds with antioxidant activity, as well as a high dissipation of excitation energy (high NPQmax ).

Effects of Ultraviolet Radiation (UV-A+UV-B) on the Antioxidant Metabolism of the Red Macroalga Species Acanthophora spicifera (Rhodophyta, Ceramiales) From Different Salinity and Nutrient Conditions.

Acanthophora spicifera (M.Vahl) Børgesen is a macroalga of great economic importance. This study evaluated the antioxidant responses of two algal populations of A. spicifera adapted to different abiotic conditions when exposed to ultraviolet-A+ultraviolet-B radiation (UV-A+UV-B). Experiments were performed using the water at two collection points for 7 days of acclimatization and 7 days of exposure to UVR (3 h per day), followed by metabolic analyses. At point 1, water of 30 ± 1 practical salinity unit (psu) had concentrations of 1.06 ± 0.27 mm NH 4 + , 8.47 ± 0.01 mm NO 3 - , 0.17 ± 0.01 mm PO 4 - 3 and pH 7.88. At point 2, water of 35 ± 1 psu had concentrations of 1.13 ± 0.05 mm NH 4 + , 3.73 ± 0.01 mm NO 3 - , 0.52 ± 0.01 mm PO 4 - 3 and pH 8.55. Chlorophyll a, phycobiliproteins, carotenoids, mycosporins, polyphenolics and antioxidant enzymes (catalase, superoxide dismutase and guaiacol peroxidase) were evaluated. The present study demonstrates that ultraviolet radiation triggers antioxidant activity in the A. spicifera. However, such activation resulted in greater responses in samples of the point 1, with lower salinity and highest concentration of nutrients.

UVA and UVB Photoprotective Capabilities of Topical Formulations Containing Mycosporine-like Amino Acids (MAAs) through Different Biological Effective Protection Factors (BEPFs).

The safety and stability of synthetic UV-filters and the procedures for evaluating the photoprotective capability of commercial sunscreens are under continuous review. The influence of pH and temperature stressors on the stability of certain Mycosporine-like amino acids (MAAs) isolated at high purity levels was examined. MAAs were highly stable at room temperature during 24 h at pH 4.5⁻8.5. At 50 °C, MAAs showed instability at pH 10.5 while at 85 °C, progressive disappearances were observed for MAAs through the studied pH range. In alkaline conditions, their degradation was much faster. Mycosporine-serinol and porphyra-334 (+shinorine) were the most stable MAAs under the conditions tested. They were included in four cosmetically stable topical sunscreens, of which the Sun Protection Factor (SPF) and other Biological Effective Protection Factors (BEPFs) were calculated. The formulation containing these MAAs showed similar SPF and UVB-BEPFs values as those of the reference sunscreen, composed of synthetic UV absorbing filters in similar percentages, while UVA-BEPFs values were slightly lower. Current in vitro data strongly suggest that MAAs, as natural and safe UV-absorbing and antioxidant compounds, have high potential for protection against the diverse harmful effects of solar UV radiation. In addition, novel complementary in vitro tests for evaluation of commercial sunscreens efficacy are proposed.

UV Photoprotection, Cytotoxicity and Immunology Capacity of Red Algae Extracts.

This study was designed to evaluate the potential use of algal extracts in cosmeceuticals, including factors related to biosecurity. The aqueous crude extracts of Hydropuntia cornea and Gracilariopsis longissima showed a good photoprotective capacity (Sun Protection Factor, SPF) due to, among other reasons, the presence of five types of mycosporine-like amino acids (MAAs) detected by high pressure liquid chromatography-photodiode array detector (HPLC-PDA) and electrospray ionization mass spectrometry (ESI-MS) (Palythine, Asterina-330, Shinorine, Porphyra-334, and Palythinol). The toxicity of the extracts was evaluated by the MTT assay, which is based on the metabolic reduction of MTT [3-(4,5-dimethylthiazol-2yl)-diphenyl tetrazolium bromide] by the action of the mitochondrial enzyme succinate dehydrogenase. This assay was carried out in vitro in three cell lines: one related to the immune system (murine macrophages of the immune system: RAW264.7) and two human cell lines related to the skin (gingival fibroblasts: HGF, and immortalized human keratinocytes: HaCaT). Both extracts showed no cytotoxic activity in both types of human cells, whereas they showed cytotoxicity in murine tumor cells of the immune system (macrophages: RAW264.7). On the other hand, the immunological activity in the murine macrophage RAW264.7 was studied at a concentration lower than 100 µg mL-1 and lower than the EC50, and evaluated by the production of pro-inflammatory compounds through an immunosorbent assay linked to enzymes such as tumor necrosis factor-α (TNF-α) or anti-inflammatory/proinflammatory enzymes such as interleukin-6 (IL-6). Both algae extracts induced the biosynthesis of TNF-α and IL-6. The production of TNF-α was much higher than that observed in the control (at a concentration of the aqueous extract higher than 5 µg mL-1). These results support the theory that the extracts of H. cornea and G. longissima actively induce the production of cytokines. In summary, the extracts of these species did not show cytotoxicity in human cells, and they present with immunomodulatory and photoprotection capacity.

Production of Mycosporine-Like Amino Acids from Gracilaria vermiculophylla (Rhodophyta) Cultured Through One Year in an Integrated Multi-trophic Aquaculture (IMTA) System.

This study evaluates the production of biomass and mycosporine-like amino acids (MAAs) throughout the year in Gracilaria vermiculophylla (Rhodophyta) collected in Ria de Aveiro (Portugal). The algae were grown in outdoor tanks in seawater with the addition of fishpond effluents under two different water flows (100 and 200 L h-1) in an integrated multi-trophic aquaculture (IMTA) system (tanks 1200 L; 1.5 m2) and different algal densities (3, 5, and 7 kg m-2). MAA content in IMTA seaweeds was significantly affected by the interaction of time and stocking density, but not by the water flow. The highest MAA content was observed in April (about 3.13 mg g-1 DW) followed by May (1.79 mg g-1 DW). Seaweed biomass productivity was higher in May (372.06 g DW m-2 week-1) than in April (353.40 g DW m-2 week-1). Four MAAs were identified by HPLC and electrospray ionization mass spectrometry (ESI-MS) in G. vermiculophylla: Porphyra-334, Shinorine, Palythine and Asterina-330. The highest levels of Porphyra-334 and Shinorine were reached from November to January and the Palythine + Asterina-330 from April to August. Taking into account the average biomass and MAA production of G. vermiculophylla growing in this IMTA system (8.56 g of MAA in 18 m2 culture along 8 months; 35.5% produced in April), a total amount of 71.33 g MAA year-1 could be produced in this system by scaling up to 100 m2. MAAs could be further used as photoprotector and antioxidant compounds in cosmetic products.

Intervención sobre las representaciones sociales del envejecimiento para potenciar la salud del adulto mayor / Intervention on social representations of aging to promote the health of the elderly

Introducción: el envejecimiento como fenómeno social es resultado de los avances alcanzados en la ciencia y la tecnología, que contribuyen a prolongar la esperanza de vida, proceso característico de los países desarrollados del cual no escapa Cuba como uno de los más envejecidos de América Latina. Objetivo: elaborar acciones para favorecer las representaciones sociales del envejecimiento en los adultos mayores de la comunidad Latinoamericano. Método: se empleó la metodología cualitativa, se reconocieron las funciones, misiones y objetivos de los implicados en el proceso de integración y su condicionamiento por el contexto en que actúan, así como la relación horizontal que se establece entre los sujetos participantes, elementos que permitió aplicar la investigación - acción participativa. Resultados: se elaboró una intervención que modificó la visión de los sujetos investigados, se realizaron acciones intersectoriales que desde la comunidad promueve una nueva visión: continuidad de la vida y no fin de la vida. Conclusiones: se aplicaron técnicas para la recogida de información que permitieron conocer necesidades sentidas y la creación de un imaginario instituyente como expresión de cambio(AU)

Introduction: aging as a social phenomenon is a result of the advances made in science and technology, which contributes to prolong life expectancy, a characteristic process of developed countries from which Cuba does not escape as one of the oldest in Latin America. Objective: to develop actions to promote social representations of aging in the elderly in the Latin merican community. Method: the qualitative methodology was used, the functions, missions and objectives of those involved in the integration process were acknowledged and their conditioning by the context in which they operate, as well as the horizontal relationship established among the participants, elements that allowed applying participatory research - action. Results: an intervention was elaborated that modified the vision of the investigated subjects, intersectorial actions were carried out that from the community promotes a new vision: continuity of life and not end of life. Conclusions: techniques were applied for the collection of information that allowed knowing felt needs and the creation of an institutional imaginary as an expression of change(EU)

Conocimientos sobre prevención del embarazo en estudiantes adolescentes con retraso mental ligero / Knowledge about preventing pregnancy among adolescent students with mild mental retardation

La sexualidad de las personas con discapacidad mental, su educación y orientación ha de basarse en los mismos principios de una persona normal. Se realizó un estudio descriptivo, con el objetivo de explorar el nivel de conocimientos sobre la prevención del embarazo en adolescentes con retraso mental ligero, para lo cual se trabajó con estudiantes y profesores de la Escuela Especial Jorge Aleaga Peña del municipio de Las Tunas, durante el primer trimestre de 2010. La población de estudio estuvo integrada por 66 adolescentes retrasados mentales leves y cinco profesores. En opinión de los estudiantes, la edad de inicio de las relaciones sexuales es 15-17 años (28,7 por ciento), seguido de 18-20 (18,1 por ciento); coincidiendo con la edad para procrear, que refieren puede ser de 15-17 (37,8 por ciento) y 18-20 (36,4 por ciento). El método anticonceptivo que prefieren es el condón. Existen deficiencias en la preparación que tienen los adolescentes con retraso mental ligero para asumir una relación sexual sana y prevenir las consecuencias de un embarazo (AU)

The sexuality of people with mental disabilities, their education and orientation must be based on the same principles of a normal person. A descriptive study was carried out with the objective of exploring the level of knowledge about the prevention of pregnancy in mild mentally retarded adolescents; consequently, a research was developed with students and teachers from Jorge Aleaga Peña Special School in Las Tunas municipality during the first three-month period of 2010. The study population consisted of 66 mild mentally retarded adolescents and five teachers. According to the students opinion, the age of the first sexual intercourse is about 15 to 17 years old (28,7 percent), followed by 18 to 20 (18,1 percent), coinciding with age for childbearing, which they think it can be about 15 to 17 (37,8 percent) and 18 to 20 (36,4 percent). The contraceptive method of choice is the condom. There are deficiencies in the preparation of adolescents with mild mental retardation to take on a healthy sexual relationship and prevent the consequences of a pregnancy (AU)

Fundación para la diabetes

A Fundação Diabetes é uma entidade privada, constituída de acordo com a Lei 30/94, de 24 de novembro, como uma organização sem fins lucrativos e de interesse público fundamental. Foi registrada nas Fundações Registrar Protetorado do Ministério da Educação e Cultura no dia 9 de dezembro de 1998. A Fundação tem uma personalidade independente, património próprio e tem plena capacidade jurídica para agir.

Durability of the Liotta porcine bioprosthesis beyond two decades.

Porcine valves are generally known to have a limited durability. The case is reported of a 35-year-old male patient who underwent mitral valve replacement with a 28 mm Liotta porcine bioprosthesis. At reoperation 21 years later, the bioprosthesis was replaced (uneventfully) with a second porcine bioprosthesis. Pathological and X-radiographic examinations of the excised valve demonstrated focal calcification of the leaflets, confirming the long-term durability of the Liotta porcine bioprosthesis.

El lavado de manos: prevención de infecciones trasmisibles / Handwashing: preventing transmissible infections

Introducción: Las enfermedades trasmisibles en el entorno sanitario se encuentran entre las principales causas de muerte y de incremento de la morbilidad en pacientes hospitalizados. En la historia del control y la prevención de las infecciones, nunca antes se había desarrollado una campaña a nivel mundial sobre la higiene de las manos, la cual contribuyó a disminuir la morbimortalidad en la población hospitalaria mediante la promoción de prácticas tan básicas y a la vez tan esenciales como las del lavado de manos. Se ha podido constatar que las infecciones nosocomiales generalmente se propagan a través de las manos del personal sanitario, visitantes de la comunidad. Al realizar una adecuada higiene de las manos, se mejora la salud de millones de personas y se ofrece una atención más segura a los pacientes. Objetivo: Resumir procedimientos básicos relacionados con el lavado de las manos que demuestren su importancia en la prevención de las enfermedades trasmisibles Conclusiones: Esta acción sigue siendo la medida primordial para reducir la incidencia y la propagación de enfermedades trasmisibles(AU)

Introduction: Transmitted diseases in the sanitary environment are among the main causes of death and increased morbidity in hospitalized patients. In the history of control and prevention of infections, a campaign had never before been developed at world level on hygiene of hands, which contributed to diminish morbidity-mortality in hospital population by promoting practices so basic and so essential as handwashing. It has been confirmed that nosocomial infections generally spread through the hands of sanitary personnel, visitors of the community. When carrying out an appropriate hygiene of hands, the health of million people is improved and a safer attention is provided to patients. Objective: To summarize basic procedures related with handwashing that demonstrate its importance in preventing transmissible diseases Conclusions: This action is still the principal measure to reduce the incidence and propagation of transmissible diseases(AU)

Influenza A H1N1: Provincia Sancti Spíritus. Junio 2009 a marzo 2010 / Influenza A H1N1: Sancti Spíritus province from June of 2009 to March of 2010

Introducción: La gripe A (H1N1) surge en el año 2009 con un incremento importante en la morbilidad por enfermedades respiratorias, entidad que se ha convertido en una pandemia causada por una variante del Influenzavirus A de origen porcino (subtipo H1N1). Objetivo: Describir el comportamiento de la pandemia de Influenza A H1N1 en la provincia de Sancti Spíritus. Material y Método: Se realizó una investigación descriptiva en el período comprendido entre junio del 2009 y marzo del 2010. Resultados: Durante el período analizado se confirmó el diagnóstico en 46 pacientes. No se reportaron fallecidos por esta infección. Los grupos de edad con mayor morbilidad fueron los de 11 a 20 (32,6 porciento) y de 21 a 30 (28,20 porciento). No existió diferencia significativa entre ambos sexos. Las mujeres embarazadas con un promedio de 30,4 semanas de gestación fueron afectada en un 26.0 porciento. Los síntomas respiratorios de mayor frecuencia fueron: La fiebre alta en el 89,13 porciento, los episodios de tos persistentes con un 67,39 porciento, la congestión nasal y el malestar general con el 32,61 porciento y la rinorrea y el dolor de garganta en el 30,43 porciento. Conclusiones: El primer caso confirmado de Influenza fue importado de los Estados Unidos. La incidencia y letalidad de los casos fue baja. No se reportaron fallecidos en el período. Las embarazadas integraron uno de los grupos más vulnerables. El diagnóstico y tratamiento oportuno influyó favorablemente en la evolución de los pacientes(AU)

Introduction. Influenza A (H1N1) appears in the year 2009 with an important increment in morbidity for breathing diseases, entity that has become a pandemic caused by a variant of the Influenza virus A of a swinish origin (subtype H1N1). Objective. To describe the behavior of the Influenza A H1N1 pandemic in the province of Sancti Spíritus. Material and method: A descriptive research was made in the period from June of 2009 to March of 2010. Results. Diagnosis was confirmed in 46 patients. No deaths were reported from this infection. The age groups with the greatest morbilidy were the ones from 11 to 20 (32,6 percent) and from 21 to 30 (28,20 percent). No significant difference was found between both sexes. Pregnant women with an average of 30,4 weeks of gestation were affected in 26,0 percent. The most common breathing symptoms were: high fever in 89,13 percent, persistent episodes of cough with 67,39 percent, nasal congestion and general malaise with 32,61 percent and rhinorrea and sore throat in 30,43 percent. Conclusions: The first confirmed case of influenza was imported from the United States. The incidence and lethality of cases were low. No deaths were reported in this period. Pregnant women integrated one of the most vulnerable groups. Diagnosis and timely treatment influenced favorably the evolution of patients(AU)

Thoracoscopic pulmonary vein isolation in patients with atrial fibrillation and failed percutaneous ablation.

OBJECTIVE: Pulmonary vein isolation is indicated in patients with symptomatic isolated atrial fibrillation not controlled with antiarrhythmic therapy. We describe our surgical experience with thoracoscopic pulmonary vein isolation in patients in whom percutaneous ablation has failed. METHODS: Thirty-four adult patients with unsuccessful catheter ablations (range 1-4, mean 2 +/- 1) underwent thoracoscopic bipolar-radiofrequency pulmonary vein isolation. Seventeen patients had paroxysmal atrial fibrillation, 12 with persistent and 5 with long-standing persistent fibrillation, for a mean of 6 years (range 3-10 years), 13 years (5-25 years), and 9 years (3-15 years), respectively. RESULTS: There was no mortality during the procedure or follow-up (mean 16 +/- 11 months). Two patients needed conversion to thoracotomy owing to hemorrhage, and ablation could not be completed. Antiarrhythmic therapy was withdrawn 3 months postoperatively. Postoperative sinus rhythm was maintained in 82% of those with paroxysmal atrial fibrillation (13/15 at 6 months, 9/11 at 12 months), 60% had persistent atrial fibrillation (8/12 at 6 months and 6/10 at 12 months), and 20% had long-standing persistent atrial fibrillation (1/5 at 6 and 12 months). Preoperative left atrial diameter significantly differed between patients with paroxysmal fibrillation (mean 42 +/- 6 mm) and those with persistent and long-standing persistent fibrillation (means 50 +/- 4 and 47 +/- 2 mm). Left atrial size greater than 45 mm and atrial fibrillation type were preoperative factors that significantly influenced outcome in the univariate logistic regression analysis. CONCLUSIONS: Thoracoscopic pulmonary vein isolation in patients with previously unsuccessful catheter ablations demonstrates satisfactory sinus rhythm maintenance rates in paroxysmal and persistent atrial fibrillation, but not in long-standing persistent atrial fibrillation. As with other minimally invasive surgical techniques, there is an important learning curve.