Acciones metodológicas para implementar la estrategia curricular de Inglés con fines profesionales en Medicina / Methodological actions to implement the English language curricular strategy in English for specific purposes in medicine

Fundamento: la finalidad de la estrategia curricular Dominio del Idioma Inglés, propuesta por la subcomisión de estrategias curriculares de la Universidad de Ciencias Médicas de la Habana desde el 2009, es la competitividad idiomática de los profesionales de la salud. Objetivo: diseñar acciones metodológicas para la implementación de la estrategia curricular Dominio del Idioma Inglés en la carrera de Medicina de la Filial Universitaria Municipal de Santo Domingo. Métodos: se realizó una investigación de desarrollo con enfoque mixto entre enero de 2011 y diciembre de 2013; se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción y empíricos: análisis documental de la Resolución 210/2007, planes de trabajo metodológico y actas en los diferentes niveles organizativos, modelo del profesional y planes de clase; y la encuesta en forma de entrevista a directivos, y de cuestionario a docentes para identificar las principales insuficiencias en la preparación idiomática y metodológica. Resultados: se constató que las principales insuficiencias están relacionadas con la dirección y ejecución del trabajo metodológico interdisciplinar y con el pobre desarrollo de habilidades para la gestión de la información médica en idioma inglés, por lo que se diseñaron acciones metodológicas para lograr una mayor objetividad en la implementación interdisciplinar de esta estrategia que tribute al actual modelo del profesional de la salud. Conclusiones: las acciones fueron valoradas como pertinentes por criterios de especialistas, porque contribuyeron a transformar progresivamente la realización del trabajo metodológico para desarrollar una competencia idiomática interdisciplinar y profesional como garantía de un desempeño competente en contextos de habla inglesa.

Background: the purpose of the curricular strategy of the English Language command, proposed by the subcommittee of curricular strategies of Havana University of Medical Sciences since 2009 is the idiomatic competence of health professionals. Objective: to design methodological actions for the implementation of the curricular strategy of the English Language command in the Medicine career of Santo Domingo's Municipality Health University Site. Methods: it was carried out a development investigation with a combined approach from January 2011 to December 2013; theoretical methods were used: analysis-synthesis and induction-deduction and empiric ones: documental analysis of the 210/2007 Regulation from the Ministry of Higher Education , methodological plans and meeting records at different organizational levels, model of the professional and lesson plans; and the survey in interview form was applied to administrative leaders and a questionnaire was applied to the professors to identify the main inadequacies in the idiomatic and methodological preparation. Results: it was verified that the main inadequacies are related with the management and execution of the interdisciplinary methodological work and with the poor development of abilities for the medical information management in the English language, that's why methodological actions were designed to achieve a bigger objectivity in the interdisciplinary implementation of this strategy that contributes with the current model of health professionals. Conclusions: the actions were valued as pertinent by the specialists' criteria, because they contributed to transform the work with the methodological activity progressively to develop an interdisciplinary and professional idiomatic competence as guarantee of a competent performance in English-speaking contexts.

Fitoplancton del río Tehuantepec, Oaxaca, México y algunas relaciones biogeográficas / Phytoplankton from Tehuantepec River, Oaxaca, Mexico and some biogeographical relationships

Phytoplankton species collected from the limnetic to euryhaline sections of Tehuantepec River were identified, classified and compared with regional information from Mexico and South America. We collected 15 samples every three months from July 1997 through August 1998 with a 20 microm net and a Van Dorn bottle. Indicator values and a code checklist are included. A total of 58 families, 121 genera, 273 species, one subspecies, 75 varieties, 13 forms and one morphotype were identified in the taxa Bacillariophyta (42.0 %), Chlorophyta (29.0 %), Cyanoprocaryota (18.0 %), Euglenophyta (5.0 %), Dinophyta (3.0 %), Cryptophyta (2.0 %) and Chrysophyta (1.0 %). The predominant families were Scenedesmaceae (24 species), Oocystaceae (22), Bacillariophyceae (21), Chaetocerotaceae (15) and Euglenaceae (14). Five families, eight genera, 72 species, 45 varieties and eight forms are first records for Mexico. The species Chroococcus turgidus, Microcystis flosaquae and Pseudanabaena limnetica (which produce massive blooms or red tides) are important in this river of moderate water quality.

El fitoplancton recolectado en el río Tehuantepec con características limnéticas a eurihalinas se determinó, clasificó y comparó con información regional de México y Suramérica. Se incluyen valores indicadores y un código del listado florístico para facilitar el manejo de estas algas. Se determinó un total de 58 familias, 121 géneros, 273 especies, una subespecie, 75 variedades, 13 formas y un morfotipo, pertenecientes a las divisiones Bacillariophyta (42.0 %), Chlorophyta (29.0 %), Cyanoprocaryota (18.0 %), Euglenophyta (5.0 %), Dinophyta (3.0 %), Cryptophyta (2.0 %) y Chrysophyta (1.0 %). Las familias mejor representadas fueron Scenedesmaceae (24 especies), Oocystaceae (22), Bacillariophyceae (21), Chaetocerotaceae (15) y Euglenaceae (14). Se establecen nuevos registros para México: cinco familias, ocho géneros, 72 especies, 45 variedades y ocho formas. En este río, que presenta una moderada calidad del agua, sobresalieron las especies Chroococcus turgidus, Microcystis flosaquae y Pseudanabaena limnetica (como productoras de mareas rojas).

[Prevalence of hepatitis G virus among Tunisian blood donors]

Prevalence of hepatitis G virus among Tunisian blood donors Hepatitis G virus [GBV-C/HGV] is a recently identified virus which occurs worldwide. The prevalence of GBV-C/HGV in Tunisia has not been previously studied. We aimed to assess the prevalence of GBV-C/HGV infection in Tunisian blood donors. A total of 912 blood donors were tested for anti-E2 antibodies of GBV-C/HGV by enzyme-linked immunosorbent assay and 600 were tested by reverse transcriptase polymerase chain reaction. GBV-C/HGV RNA was found in 5.3% of the sample and HGV antibodies occurred in 4.9%. A correlation was noticed between GBV-C/HGV infection and hepatitis C virus [P = 0.006]. The prevalence of GBV-C/HGV is similar to that reported worldwide

[Work injuries in building construction, metal shaping, and food production sectors in Jericho District in the Palestinian Territory]

Work injuries and accidents have a considerable impact on public and community health. This study targeted three work sectors: metal shaping, food production and building construction. Work injuries that occurred in these sectors were compared for the years 1999 and 2000 in Jericho District in the West Bank of Palestine. One hundred three injuries were examined and information recorded about the nature of the injury, site of injury in the body, direct cause of injury and some personal information about the injured worker. The most vulnerable group were young people in their twenties, and mostly those working in the metal shaping and building construction sectors. The kinds and sites of injuries varied. The data were compared with data from 1997, 1998 and 2001-2003, although only loosley as the available data about work injuries for these years were limited and inaccurate

[Analysis of the appropriateness of hospitalizations in Monastir, Tunisia]

We aimed to measure the extent of inappropriate hospital admissions and to identify factors associated with inappropriate hospital use. A descriptive study was carried out on a r and omized sample of 411 hospitalizations in 3 regional hospitals. The appropriateness of admissions was assessed using the Appropriateness Evaluation Protocol [AEP]. We found 21% [95% CI: 17%-25%] of the admissions were avoidable according to the AEP. Inappropriate admissions were associated with the hospital [P = 0.005], patient age [P = 0.003], length of stay and diagnosis [P < 0.001]. The most frequent reasons for appropriate admissions were parenteral therapy, an acute or progressive sensory motor circulatory or respiratory condition sufficient to incapacitate the patient and severe electrolyte or blood gas abnormality. Our study highlights the need to improve hospital management and to develop alternatives to hospitalization

[Water problems in the Eastern Mediterranean Region]

The Eastern Mediterranean Region of the World Health Organization is confronted with formidable water problems due to: increased water dem and both for consumption and for irrigation in agriculture that is becoming more productive and more polluting; scarce water resources; drought, erosion and pollution; inappropriate management; inadequate policies; and institutional and legal considerations. Added to these problems are the risks of regional conflicts because of the lack of "shared" management of cross-border waters which are an object of contention between neighbouring countries. This report analyses the issues relating to water availability, health and development on the basis of the distribution of water resources, and their use by industry and the huge proportion for agricultural use. It raises the question whether countries in the Region are ready to review their strategies on water priorities, particularly in the areas of health, agriculture and food self-sufficiency

[Medical school's experience with Arabization 1993-2003: Gezira University]

This paper examines the importance of teaching in the mother tongue and looks at the political decisions taken in this respect. The preparations for Arabization in the Faculty of Medicine, Gezira University [in 1993] are reviewed and the experience of implementation from 1994 to 2002 is analysed by questioning the students and professors. The successes, failures, problems and obstacles are discussed in detail. The paper concludes with discussion and recommendations on how to boost success in Arabization based on previous experience

Robotics and Gastrointestinal Surgery / 대한소화기학회지

Robotics are now being used in all surgical fields. Because of increased intra-abdominal articulations while operating through small incisions, robotics are increasingly being used in a large number of visceral and solid organ operations including surgery on the gallbladder, esophagus, stomach, intestines, colon, and rectum as well as for the endocrine organs. As a speciality, robotics should continue to grow. As the robotic era invades the field of general surgeon, more and more complex procedures would be able to be approached through small incision. As technology catches up with our imagination, robotic instruments and 3D monitoring will become routine, and continue to improve patient care by providing surgeons with most precise, least traumatic ways of treating surgical disease.

Comparison of Helicobacter pylori Eradication Rate according to Different PPI-based Triple Therapy : Omeprazole, Rabeprazole, Esomeprazole and Lansoprazole / 대한소화기학회지

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) is an important cause of various gastrointestinal diseases. H. pylori eradication is essential for the cure and prevention of associated diseases. Nowdays, proton pump inhibitor (PPI)-based triple therapy is the standard eradication regimen. The aims of this study were to compare the H. pylori eradication rate of different PPI-based triple therapies and to find out the factors influencing the eradication rate. METHODS: From May 2002 through Febraury 2004, H. pylori infected patients were treated with the eradication regimen based on one of the four PPIs (omeprazole, rabeprazole, esomeprazole and lansoprazole) for 1 or 2 weeks. After two weeks, drug compliance, adverse effects, and smoking history during the eradication therapy were obtained. The follow-up H. pylori test was performed 4 weeks after the completion of therapy. The data were analyzed by Chi-square test and multiple logistic regression analysis. RESULTS: Overall eradication rate was 83.5%. There was no significant difference in eradication rate among four PPIs (p=0.379). Odds ratio (OR) for omeprazole and rabeprazole was 1.15 (95% CI 0.50-2.68); for omeprazole and esomeprazole, OR 1.63 (95% CI 0.68-3.89); and for omeprazole and lansoprazole, OR 1.13 (95% CI 0.50-2.56). Smoking habit, site of ulcer, and the duration of therapy affected the eradication rate significantly. CONCLUSIONS: The efficacy of four different PPIs for H. pylori eradication is similar to each other. Smoking, site of ulcer, and the duration of treatment have significant effects on eradication rates.

Effects of TNF-alpha on Angiogenesis in CT-26 Mouse Colon Carcinoma Homograft Model / 대한소화기학회지

BACKGROUND/AIMS: Tumor necrosis factor-alpha (TNF-alpha) exerts its anti-tumor effect through direct cytotoxicity on tumor cells and damage to the tumor vasculature. However, its role in tumor angiogenesis is controversial. We evaluated the angiogenic effect of TNF-alpha on BALB/c mouse colon carcinoma homograft model. METHODS: Ten BALB/c mice were inoculated intraperitoneally with CT-26 mouse colon carcinoma cells. After a week, recombinant mouse TNF-alpha (2microgram/mL) were given four times on every other day to five animals and the same volume of phosphate buffered saline was given at the same interval to five animals as control. Harvested tumor tissues were stained by immunohistochemistry with CD31 and VEGF antibodies. Number of microvessels and VEGF expression were counted by light microscope. RESULTS: The mean microvessel counts per 200x field of TNF-alpha treated animals were 70.2+/-7.8 and those of nontreated animals were 83.8+/-8.3 (p<0.05). The VEGF score of both groups were 3. CONCLUSIONS: TNF-alpha treated animals showed decreased microvessel counts in tumor tissue but VEGF expression in both groups showed no difference. Therefore, TNF-alpha showed antiangiogenic effects on colon carcinoma homograft model.

Characteristics of Colon Cancer Diagnosed in Patients Taking Aspirin or Warfarin / 대한소화기학회지

BACKGROUND/AIMS: Warfarin and aspirin are commonly used to prevent cardiovascular diseases. Aspirin was recently found to have chemopreventive effects on colon cancer and polyps by inhibiting cyclooxygenase-2. Therefore, we evaluated whether the symptoms of bleeding related with aspirin or warfarin could be a clue in early detection of colon cancer. We also assessed the effect of aspirin on the development of synchronous polyps. METHODS: A total of forty-one and 16 patients diagnosed as colon cancer, taking aspirin or warfarin respectively were enrolled. In addition, 171 patients with colon cancers were age and gender matched as a control group. We investigated the difference of clinical features and laboratory findings among three groups. RESULTS: The incidence of bleeding was 81.3% (warfarin), 53.7% (aspirin), 40.4% (control). Among three groups, location and size of cancer, number of lymph nodes involvement and stages were not different, but the number of patients in Duke stage D in warfarin group (n=1, 6.3%) were less than that of the control (n=44, 25.7%) (p=0.049). The extent of circumferencial involvement by cancer was lower in aspirin group (67%) than in the control group (80%) (p=0.035). The percentage of patients with synchronous polyps and mean number of synchronous polyps in aspirin group (34.1%, 0.68, respectively) was lower than that of control group (53.6%, 1.69, respectively) (p=0.029, 0.008, respectively). CONCLUSIONS: Bleeding related with aspirin or warfarin usage had no effect on the early diagnosis of colon cancer. However, lower incidence of Duke stage D in warfarin group might be related to anti-metastatic effect of warfarin. In addition, aspirin may have a role in suppressing the development of synchronous polyps.

The Outcome of Endoscopic Treatment in Bile Duct Injury after Cholecystectomy / 대한소화기학회지

BACKGROUND/AIMS: Bile duct injury is the most serious complication of cholecystectomy. The aim of this study was to evaluate the outcome of endoscopic treatment in bile duct injury after cholecystectomy. METHODS: We reviewed the results of endoscopic treatments in the patients diagnosed as bile duct injury after cholecystectomy on cholangiographic examinations, retrospectively. Endoscopic treatment included insertion of nasobiliary drainage catheter or plastic stent after endoscopic sphicterotomy. RESULTS: A total of twenty-two patients (9 male, 13 female; median age of 59 years) with bile duct injury were included. Endoscopic treatment was successfully performed in 12 of 13 patients with bile leak only. In patients with both bile leak and stricture, endoscopic treatment was successful in 2 of 3 patients. In 6 patients with complete obstruction of bile duct, endoscopic treatment failed and surgical approach was needed. In our series, transpapillary endoscopic treatment was not successful when proximal bile duct above the injured site was not visualized by endoscopic retrograde cholangiopancreatography (ERCP) and surgery was performed in all cases. Overall success rate of endoscopic treatment in 22 patients with bile duct injury was 64% (14/22). There was no complication associated with endoscopic treatment. CONCLUSIONS: ERCP is useful for the treatment of bile leakage after cholecystectomy and can be used for the treatment prior to surgery. Surgical intervention is needed in case of endoscopic treatment failure.

A Case of Subphrenic Abscess with Ileal Fistula Caused by Metastatic Adenocarcinoma of Unknown Origin / 대한소화기학회지

Usual sources of subphrenic abscess with intestinal fistula are previous abdominal operation, inflammatory bowel disease and malignancy. Reported cases of intestinal fistula caused by adenocarcinoma were complicated by direct invasion. In this report, a 70-year-old male had a subphrenic abscess with intestinal fistula and the cause was a metastatic adenocarcinoma of unknown origin. As far as we know, this has not been reported previously in the literatures. The abscess went on chronic course for six months because intermittent administration of antibiotics modified its clinical presentation. The fistulous tract between the abscess and ileum was demonstrated by tubogram via the drainage catheter in abscess. The patient underwent surgical treatment because the cause of fistula was obscure. Invasion of the ileum by metastatic adenocarcinoma was diagnosed by the histologic examination of surgical specimen. Therefore, when a fistula develops without any apparent cause, there is a possibility of malignancy, and surgical approach must be considered. An early surgical approach will prevent the delay in treatment and reduce the mortality.

The Influence of Non-steroidal Anti-inflammatory Drugs on Clinical Outcome in Patients with Bleeding Peptic Ulcers / 대한소화기학회지

BACKGROUND/AIMS: We conducted this study to find the clinical characteristics of ulcer bleeding that occurred in patients who had been taking non-steroidal anti-inflammatory drugs (NSAIDs) and to evaluate the influences of NSAIDs on clinical outcomes. METHODS: Between January 2000 and December 2002, a total of 310 patients with ulcer bleeding were analyzed. Study group composed of 49 patients who had taken NSAIDs regularly for at least 4 weeks before the admission. Other 261 patients who had not taken NSAIDs were classified as control group. Relevant informations were obtained from the medical records. RESULTS: Of the NSAIDs group, aspirin was the most common medication. The mean age and the proportion of females in the NSAIDs group were significantly higher than those of the control group. Prevalence of co-morbid illness was significantly higher in the NSAIDs group than in the control group (85.7% vs 30.7%, p<0.001). The severity of bleeding which was assessed by hemoglobin level at presentation, amount of transfusion, and duration of admission, was not different between two groups. There were no significant differences in frequency of re-bleeding, urgent surgery, and mortality. CONCLUSIONS: Ulcer bleeding among patients taking NSAIDs occurred more frequently in older females with co- morbid illness. However, NSAIDs is not associated with higher morbidity and mortality.

Colonoscopic Surveillance after Curative Resection for Colorectal Cancer with Synchronous Adenoma / 대한소화기학회지

BACKGROUND/AIMS: Guidelines for current postoperative colonoscopic surveillance are not specified in colorectal cancer (CRC) patients with synchronous adenoma (SA). We performed this retrospective study to determine the postoperative colonoscopic surveillance interval for the CRC patients with SA. METHODS: One hundred and twenty-four CRC patients with SA (SA-group) and the same number of patients without SA (NSA-group) were selected from our database. Two groups were matched by the stage of CRC. Median colonoscopic surveillance period was 55 (12-99) months. The colonoscopic surveillance frequency and interval were similar between the two groups. RESULTS: Mean age was higher and male was more frequent in SA-group than NSA-group (p= 0.0001). The incidence of missed adenoma, advanced missed adenoma and metachronous adenoma (MA) were higher in SA-group (30.8% vs. 5.8% at 1st yr., p=0.0001; 4.4% vs. 0%, p=0.0001; 31.1% vs. 9.1% at 2nd yr., p=0.016) during the first consecutive two years of surveillance. The MA- and advanced-MA-free survival rate were lower in SA-group (24.6% vs. 6.6%, p=0.0001; 4.1% vs. 0%, p=0.02) during three years after surgery. Dysplasia of the SA (p=0.04; OR, 110.3; 95% CI, 1.13-10742.6) and presence of missed adenoma (p=0.036; OR, 43.6; 95% CI, 1.28-1490.1) were risk factors for the advanced MA on a multivariate analysis in SA-group. CONCLUSIONS: Postoperative colonoscopic surveillance at first year after surgery is warranted in CRC patients with SA.

Effects of Tamoxifen on the Voltage-dependent Ionic Currents in Mouse Colonic Smooth Muscle Cells / 대한소화기학회지

BACKGROUND/AIMS: Tamoxifen is a widely used anticancer drug for breast cancer with frequent gastrointestinal side effects. Changes in gastrointestinal motility is associated with altered activities of membrane ion channels. Ion channels have important role in regulating membrane potential and cell excitability. This study was performed to investigate the effects of tamoxifen on the membrane ionic currents in colonic smooth muscle cells. METHODS: Murine colonic smooth muscle cells were isolated from the proximal colon using collagenase, and the membrane currents were recorded using a whole-cell patch clamp technique. RESULTS: Two types of voltage-dependent K+ currents were recorded (A-type and delayed rectifier K+ currents). Tamoxifen inhibited both types of voltage-dependent K+ currents in a dose-dependent manner. However, tamoxifen did not change the half-inactivation potential and the recovery time of voltage-dependent K+ currents. Chelerythrine, a protein kinase C inhibitor or phorbol 12, 13-dibutyrate, a protein kinase C activator did not affect the voltage-dependent K+ currents. Guanosine 5'-O-(2-thio-diphosphate) did not affect the tamoxifen-induced inhibition of voltage-dependent K+ currents. Tamoxifen inhibited voltage-dependent Ca2+ currents completely in whole-test ranges. CONCLUSIONS: These results suggest that tamoxifen can alter various membrane ionic currents in smooth muscle cells and cause some adverse effects on the gastrointestinal motility.

Disintegration of Pancreatic Duct Stones with Extracorporeal Shockwave Lithotripsy / 대한소화기학회지

BACKGROUND/AIMS: Treatment of pancreatic duct stones by extracorporeal shockwave lithotripsy (ESWL) serves as a nonsurgical treatment modality in patients with stones that are located in upstream of the strictures or in patients with impacted stones. We present the results of ESWL in endoscopically unretrievable pancreatic duct stones in the past 2 years. METHODS: Between January 2002 and December 2003, 58 patients with chronic pancreatitis were treated by ESWL for pancreatic duct stones. ESWL was performed with an electrohydraulic lithotripter ultrasound focusing system. RESULTS: The mean number of shockwave treatments was 2.5, and the patients received 4,578 (1,527-10,155) shockwave discharges with a mean energy of 15.8 kV. Fragmentations of the stones were achieved in 54 patients (93.2%), and complete clearance of the stones were noticed in 27 patients (46.6%). Fragmentation of stones equal or less than 3 mm in diameter was associated with successful removal of stones (p<0.05). Complete relief of pain occurred in 32 patients (55.2%). The procedures were well tolerated and no patient had significant complications such as acute pancreatitis. CONCLUSIONS: ESWL is an effective and a safe procedure for endoscopically unretrievable main pancreatic duct stones. ESWL combined with endoscopic therapy can increase the success rate of nonsurgical removal of pancreatic duct stones in patients with chronic pancreatitis.

A Case of Primary Angiosarcoma of Small Intestine Presenting as Recurrent Gastrointestinal Bleeding / 대한소화기학회지

Angiosarcoma is a rare malignant tumor which occurs frequently in the skin and soft subcutis. Moreover, primary gastrointestinal angiosarcomas are very rare. This tumor manifests as non-specific symptoms such as gastrointestinal bleeding, abdominal pain and nausea. The diagnosis is often made at an advanced stage. Surgery, chemotherapy and radiotherapy are the mainstay of treatment. However, the prognosis is very poor. We report a case of primary angiosarcoma of the small intestine presenting as recurrent gastrointestinal bleeding. A 54-year-old man was admitted with recurrent gastrointestinal bleeding. An abdominal CT scan revealed an ileo-ileal intussusception. Segmental resection was performed with ileo-ileal anastomosis. The ileal mass was diagnosed as angiosarcoma on immunohistochemical stain. He received 3 cycles of chemotherapy, but died 5 months after the diagnosis.

A Case of Metastasis-induced Acute Pancreatitis Improved by Chemotherap / 대한소화기학회지

Pancreatic metastases are found in up to 40% of patients with small cell lung cancer, but metastasis-induced acute pancreatitis is rare. Treatment of metastasis-induced acute pancreatitis is initially supportive, but failure of conservative management are common. There are few reports on aggressive treatment with chemotherapy which lead to rapid clinical improvement and prolongation of survival in patients with metastasis-induced acute pancreatitis. We experienced a case of metastasis-induced acute pancreatitis in a patient with small cell lung cancer. Despite conservative treatment with dietary restriction and intravenous fluid supply, serum amylase levels increased persistently with severe abdominal pain. After chemotherapy with irinotecan and carboplatin, abdominal pain and serum amylase levels resolved dramatically.

Endoscopic Injection Treatment for Gastric Dieulafoy Lesion in Two Newborn Infants / 대한소화기학회지

Dieulafoy lesion is an abnormally large calibered submucosal artery associated with a minute mucosal defect in the gastrointestinal mucosa. It is a rare cause of profuse, but intermittent gastrointestinal bleeding. The lesion is usually located in the stomach, although it may occur anywhere in the gastrointestinal tract. Dieulafoy lesion is extremely rare in the neonates. We report two newborn infants with a gastric Dieulafoy lesion which was treated by endoscopic epinephrine injection therapy without complication and recurrence.