An Update on Phytochemicals and Pharmacological Activities of the Genus Persicaria and Polygonum.

The discovery of new pharmaceutical identities, particularly anti-infective agents, represents an urgent need due to the increase in immunocompromised patients and the ineffectiveness/toxicity of the drugs currently used. The scientific community has recognized in the last decades the importance of the plant kingdom as a huge source of novel molecules which could act against different type of infections or illness. However, the great diversity of plant species makes it difficult to select them with probabilities of success, adding to the fact that existing information is difficult to find, it is atomized or disordered. Persicaria and Polygonum constitute two of the main representatives of the Polygonaceae family, which have been extensively used in traditional medicine worldwide. Important and structurally diverse bioactive compounds have been isolated from these genera of wild plants; among them, sesquiterpenes and flavonoids should be remarked. In this article, we firstly mention all the species reported with pharmacological use and their geographical distribution. Moreover, a number of tables which summarize an update detailing the type of natural product (extract or isolated compound), applied doses, displayed bioassays and the results obtained for the main bioactivities of these genera cited in the literature during the past 40 years. Antimicrobial, antioxidant, analgesic and anti-inflammatory, antinociceptive, anticancer, antiviral, antiparasitic, anti-diabetic, antipyretic, hepatoprotective, diuretic, gastroprotective and neuropharmacological activities were explored and reviewed in this work, concluding that both genera could be the source for upcoming molecules to treat different human diseases.

Path to health asthma study: A survey of pediatric asthma in an urban community.

OBJECTIVE: Minority children with asthma who live in low-income urban communities bear a disproportionate burden of the disease. This study explores the perceived health care needs related to asthma care, identifies asthma triggers, potential barriers to care, and assesses the need for additional community resources. METHODS: We conducted a cross-sectional survey of Hispanic and African American adults (n = 53) who take care of a child with asthma and live in an urban community of North Philadelphia. Input from community leaders was obtained in the development the survey tool resulting in a unique 'community-centric' questionnaire. The survey was also available in Spanish. All surveys were conducted in the community setting. RESULTS: Variables were used to measure asthma severity and triggers. Children were categorized with intermittent (n = 24, 45.3%), mild persistent (n = 13, 24.5%), or moderate-to-severe persistent asthma (n = 16, 30.2%). Most children with persistent asthma were enrolled under Medicaid or CHIP (n = 24, p = 0.011) and reflected a low-income socioeconomic status. Persistent asthma was found to be associated with most triggers: pets, dust mites, mice, mold, and cockroaches. There was no significant association between environmental tobacco smoke and persistent asthma. Children with persistent asthma and 2 or more triggers were more likely to be hospitalized and go to the Emergency Department. CONCLUSION: Urban minority children living in low-income communities face neighborhood-specific asthma triggers and challenges to care. Studies conducted in urban neighborhoods, with collaboration from community members, will highlight the need of comprehensive services to account for community-centric social determinants.

Impacting Health Disparities in Urban Communities: Preparing Future Healthcare Providers for "Neighborhood-Engaged Care" Through a Community Engagement Course Intervention.

It is well known that health disparities exist and that a significant majority of patients who suffer disproportionately from them are lower income, non-white residents of dense, and diverse urban neighborhoods. It is our belief that factors hindering the reduction of health disparities in these neighborhoods are a lack of a framework and preparation needed to engage these communities in identifying specific health care needs. This paper describes one curricular intervention, a graduate level community engagement course, developed within an academic medical center located in an urban setting, that demonstrates promise in effecting change in the extent to which clinicians are able to engage communities and practice "neighborhood-engaged care" with the central goal of mitigating disparities.

A review of barriers to effective asthma management in Puerto Ricans: cultural, healthcare system and pharmacogenomic issues.

BACKGROUND: Among the Hispanic community, Puerto Ricans have the highest prevalence of asthma and manifest the worst outcomes. The expected growth of the Hispanic population in the USA in the next several decades make elimination of disparate care in Puerto Rican asthmatics a matter of national importance. The purpose of this review of the literature (ROL) is to examine a variety of health system, genetic and cultural barriers in the Puerto Rican community which have created disparities in asthma care and outcomes among adult and pediatric Hispanic populations. In addition, this ROL describes several culturally sensitive, community-based educational interventions which can be used as a framework for future projects to improved asthma outcomes. METHODS: Databases searched included Medline, PubMED, EBSCOhost, PsycINFO, CINAHL, Google Scholar and ERIC. Papers published in English from January 1990 to January 2012 were reviewed. RESULTS: Health system policies, insurer compensation patterns, clinician attitudes and cultural values/folk remedies in the Puerto Rican community represent barriers to effective asthma management, the use of controller medication and the implementation of educational interventions. In addition, genetic factors involving the beta-2 adrenergic receptor gene, which impair the response to albuterol, appear to contribute to poorer outcomes in Puerto Rican asthmatics. In contrast, several comprehensive, community-based, culturally sensitive educational interventions such as Controlling Asthma in American Cities Project (CAACP), the Racial and Ethnic Approach to Community Health in the US Program and Healthy Hoops programs (REACH) have been described. CONCLUSIONS: We believe that culturally sensitive community-based asthma education programs can serve as models for programs targeted toward Puerto Ricans to help decrease asthma morbidity. Moreover, greater sensitivity to Puerto Rican mores and folk remedies on the part of healthcare providers may improve the patient-clinician rapport and, hence, asthma outcomes. Finally, given ethnically based differences in pharmacogenomics, clinical trials targeting the Puerto Rican population may help to better define optimal asthma medication regimens in this ethnic group.

Genome sequence analysis of the Vibrio parahaemolyticus lytic bacteriophage VPMS1.

VPMS1 is a Vibrio parahaemolyticus lytic phage isolated from a marine clam. The 42.3-kb genome was predicted to encode 53 proteins. Comparison of the VPMS1 DNA genome with known phage genomes revealed no similarity; hence, it represents a new VP phage, organized into three differently oriented modules. The module for packaging covers 12 % of the genome, the module for structure covers 31 %, and the module for replication and regulation covers 48 %. The G + C content was 44.67 %. The coding region corresponds to 91 % of the genome, and 9 % apparently does not encode any protein. Thirty genes, constituting 57 % of the genome, had significant similarity to some reported proteins in the protein database; 23 genes, constituting 43 % of the genome, showed no significant homology to any reported protein, and these could be new proteins whose hypothetical functions can be deduced from their position in the genome.

In Vitro Antifungal Screening of Argentine Native or Naturalized Plants against the Phytopathogen Monilinia fructicola.

BACKGROUND: One of the main problems that fruit health has gone through in recent years is the problematic eradication of their fungal pathogens during crops or the post-harvest stage. This concerns the whole world because it represents huge production losses, fruit export restrictions, and consumer distrust. Consequently, new alternatives are sought to avoid the increasing use of fungicides that cause important damage to fruit consumers and the environment. One of the alternatives to solve this problem could be exploring plants and their active compounds applied to the treatment of fruit health. MATERIALS AND METHODS: This article describes peach production worldwide and particularly in Argentina, in addition to the main fungal rot that causes the greatest economic losses. Furthermore, experimental in-vitro studies of 69 extracts obtained from 18 plants growing in the central region of Argentina were displayed against the devastating fungus Monilinia fructicola, which greatly affects stone fruits. A simple and effective method developed in agar plate was applied to evaluate a large number of samples in a short time. RESULTS: The results showed that approximately 36% of the samples tested were strongly active against this pathogen, 12% were moderately active, and 52% demonstrated to be inactive. CONCLUSION: These findings support the possible use of natural products for fruit health and the importance of deepening in this field of science.

Decrease in Cell Viability of Breast Cancer Cells by a Di-Hydroxylated Derivative of N-(2-hydroxyphenyl)-2-Propylpentanamide.

BACKGROUND: A preliminary study of the biotransformation by cytochrome P450 enzymes (CYP) of N-(2- hydroxyphenyl)-2-propylpentanamide (HO-AAVPA), an HDAC inhibitor, led to the synthesis of two hydroxylated derivatives: N-(2,4-dihydroxyphenyl)-2-propylpentanamide (5a) and N-(2,5-dihydroxyphenyl)-2-propylpentanamide (5b). OBJECTIVE: The study aims to evaluate the anti-proliferative activity of these di-hydroxylated derivatives in breast cancer cell lines. METHODS: MTT assays were conducted in MCF-7 and MDA-MB-231 cell lines. Additionally, in silico studies were carried out to evaluate the affinity of these derivatives with the HDAC1 enzyme. RESULTS: Results showed that only 5b possess an enhanced anti-proliferative effect in breast cancer cell lines MCF-7 and MDA-MB-231. Docking studies revealed that the presence of hydroxyl groups, as well as the position of the additional hydroxyl groups, could have an impact on HDAC1 affinity and could explain the lack of activity of compound 5a. CONCLUSION: A priori, these results hypothesize that anti-proliferative activity of 5b could be related to HDAC1 inhibition and thus anti-proliferative activity in breast cancer cells.

Exploring the biotransformation of N-(2-hydroxyphenyl)-2-propylpentanamide (an aryl valproic acid derivative) by CYP2C11, using in silico predictions and in vitro studies.

OBJECTIVES: N-(2-hydroxyphenyl)-2-propylpentanamide (HO-AAVPA), a derivative of valproic acid (VPA), has been proposed as a potential anticancer agent due to its improved antiproliferative effects in some cancer cell lines. Although there is evidence that VPA is metabolized by cytochrome P450 2C11 rat isoform, HO-AAVPA CYP-mediated metabolism has not yet been fully explored. Therefore, in this work, the biotransformation of HO-AAVPA by CYP2C11 was investigated. METHODS: Kinetic parameters and spectral interaction between HO-AAVPA and CYP were evaluated using rat liver microsomes. The participation of CYP2C11 in metabolism of HO-AAVPA was confirmed by cimetidine (CIM) inhibition assay. Docking and molecular dynamics simulations coupled to MMGBSA methods were used in theoretical study. KEY FINDINGS: HO-AAVPA is metabolized by CYP enzymes (KM  = 38.94 µm), yielding a hydroxylated metabolite according to its HPLC retention time (5.4 min) and MS analysis (252.2 m/z). In addition, CIM inhibition in rat liver microsomes (Ki  = 59.23 µm) confirmed that CYP2C11 is mainly involved in HO-AAVPA metabolism. Furthermore, HO-AAVPA interacts with CYP2C11 as a type I ligand. HO-AAVPA is stabilized at the CYP2C11 ligand recognition site through a map of interactions similar to other typical CYP2C11 substrates. CONCLUSION: Therefore, rat liver CYP2C11 isoform is able to metabolize HO-AAVPA.

Surgical Resection of a Parotid Gland Hemangioma in Teenager Managed with External Carotid Artery Ligation.

Parotid gland hemangiomas represent <0.6% of the total tumors of the gland and there are <50 tumors reported during adult age, so there is no standard treatment. A 18-year-old female presents with a mass in the right parotid gland of 18 months of a slow progressive asymptomatic growth; on physical examination, only the mass was detected. An angiography was performed, and it reported a possible hemangioma that depends on the right internal maxillary artery and right facial artery and was not suitable for embolization. Total parotidectomy was performed with prior ligation of the right external carotid artery, complete resection was achieved and preservation of the facial nerve and all branches with minimal loss of blood (150 cc). External carotid artery ligation is a safe technique that can be considered in carefully selected patients with vascular tumors that affect the head and neck to achieve a clean and safe surgery with minimal sequels.

[Identification of risk factors in relatives of type-2 diabetics]. / Identificación de factores de riesgo en familiares de enfermos diabéticos tipo 2.

OBJECTIVE: To identify risk factors and warning signs in a sample of first-degree relatives of type-2 diabetics at the Family Medicine Unit 2 of the General Hospital in Irapuato, Guanajuato, Mexico. MATERIAL AND METHODS: In a non-probabilistic sample of 360 relatives, a 14-item questionnaire was applied to measure abdominal perimeter and body mass index (obesity and overweight), eating habits, addictions and sedentarism. The questionnaire was made by general consent of experts, by applying Cronbach's alpha reliability coefficient. Specific rates of prevalence by sex and age groups were estimated. RESULTS: 233 (65%) relatives were females. As part of their family history background, arterial hypertension was recorded in 263 (73%) and acute myocardial infarction in 97 (27%). Among the dangerous food for health consumed by the relatives of diabetics are cola drinks in 94.7%, red meat in 83%, candies in 74.7% and chips in 65.8%; only half of them consumed fresh fruits and vegetables; a quarter of them ate prickly pears or whole wheat bread. There were 163 (45.3%) persons with high-risk abdominal perimeter, and sedentarism was present in 267 (74.2%). However, obesity was 3 times more frequent in females, but excessive drinking or smoking habits were 7 times more prevailing in males. CONCLUSIONS: A high-risk behavior was demonstrated among relativies of diabetic patients. Therefore, a public-health educational program is required to modify risky habits. A change towards prevention rather than cure is much needed in health staff.

Alteraciones renales en la drepanocitosis / Renal disorders in sickle cell disease

La drepanocitosis está asociada con un amplio espectro de alteraciones renales que tienen su base en la falciformación de los eritrocitos en los vasos de la médula renal, que conduce a fenómenos de isquemia, microinfartos y anomalías de la función tubular. Se producen también alteraciones glomerulares funcionales reversibles de la autorregulación renal (hiperfiltración), que pueden conducir a cambios anatómicos irreversibles con glomeruloesclerosis segmentaria focal. Estas anomalías se expresan tempranamente como microalbuminuria, proteinuria y de forma mas tardía, como síndrome nefrótico e insuficiencia renal crónica. Medidas terapéuticas como el uso de inhibidores de la enzima convertidora de la angiotensina II, de los bloqueadores del receptor de la angiotensina II, asociados o no con la hidroxiurea, pueden prevenir o retardar el daño glomerular. En el presente trabajo se exponen de forma resumida aspectos relacionados con la fisiopatología del daño renal en la drepanocitosis y su tratamiento

Sickle cell disease is associated with a wide range of renal disorders resulting from the falciformation of erythrocytes in vessels of the renal medulla, leading to ischemia, microinfarctions and tubular function abnormalities. Reversible glomerular functional renal self-regulation disorders (hyperfiltration) also occur, which may lead to irreversible anatomical changes with focal segmental glomerular sclerosis. These anomalies are expressed at an early stage as microalbuminuria and proteinuria, and at a later stage as nephrotic syndrome and chronic renal failure. Therapeutic measures such as the use of angiotensin-II converting enzyme inhibitors and angiotensin-II receptor blockers, associated or not with hydroxyurea, may either prevent or delay glomerular damage. The paper succinctly presents the physiopathology of renal damage in drepanocytosis and its treatment

Comportamiento de la colestasis del recién nacido y del lactante en el Hospital Pediátrico William Soler / Behavior of newborn and infant cholestasis in the William Soler Children Hospital

INTRODUCCIÓN. Los recién nacidos y lactantes pequeños tienen una inmadurez funcional y anatómica que justifica que las enfermedades hepáticas que se manifiestan en estas edades tengan a la ictericia como signo principal. La lista de procesos que causan colestasis en este período es muy extensa e incluye anomalías estructurales, extrahepáticas e intrahepáticas, y procesos que alteran los mecanismos de síntesis y excreción de las sales biliares. El objetivo del estudio fue describir el comportamiento de los casos de colestasis del lactante atendidos en el Servicio de Hepatología del Hospital Pediátrico William Soler, evaluados de forma protocolizada entre enero del 2004 y diciembre del 2006. MÉTODOS. Se realizó un estudio descriptivo y retrospectivo. La muestra estuvo constituida por 76 lactantes con diagnóstico de colestasis, que fueron evaluados de forma protocolizada en el período referido. Se analizaron las variables sexo, edad gestacional y peso al nacer, antecedentes peri y posnatales, presencia o ausencia de signos de insuficiencia hepática, así como localización regional y causas de la colestasis. Se elaboró una base de datos en SPSS (versión 12) y las variables fueron analizadas de forma porcentual. RESULTADOS. Se encontró predominio de recién nacidos del sexo masculino (45; 59,2 por ciento), a término (63; 82,9 por ciento), de peso normal (50; 65,7 por ciento) y sin antecedentes peri y posnatales. Solo en el 9,2 por ciento de los casos la colestasis se asoció a insuficiencia hepática. La frecuencia de colestasis intrahepática y extrahepática fue similar. Las principales causas de colestasis encontradas fueron atresia de las vías biliares (24; 31,5 por ciento), hepatitis neonatal idiopática (15; 19,8 por ciento), infección por citomegalovirus (14; 18,5 por ciento) y síndrome de espesamiento de la bilis (9; 11,9 por ciento). CONCLUSIONES. El comportamiento de las diferentes causas de colestasis es heterogéneo…

INTRODUCTION. The small newborns and infants have a functional and anatomical immaturity justifying that the liver diseases present in these ages have the jaundice as the main sign. The list of processes causing cholestasis during this period is very large including structural, extrahepatic, intrahepatic anomalies and also processes altering the mechanisms synthesis and the excretion of bile salts. The aim of present study was to describe the behavior of the cases of infants presenting with cholestasis seen in the Hepatology Service of the William Soler Children General Hospital, assessed in a programmed way between January, 2004 and December, 2006. METHODS. A retrospective and descriptive study was conducted. Sample included 76 patients diagnosed with cholestasis, assessed in a programmed way during this period. Variables analyzed were: sex, gestational age and birth weight, perinatal and postnatal backgrounds, presence or absence of cholestasis. A database was designed in SPSS (version 12) and the variables were analyzed in percentage way. RESULTS. There was predominance of male newborns (45, 59,2 percent), term (63, 82,9 percent) of normal weight (50,65,7 percent) and without perinatal and postnatal backgrounds. Only in the 9,2 percent of cases the cholestasis was associated with a liver failure. Frequency of intrahepatic and extrahepatic cholestasis was similar. The major causes of cholestasis present were: biliary tracts atresia (24, 31,5 percent), idiopathic neonatal hepatitis(15, 19,8 percent), cytomegalovirus infection (14, 18,5 percent) and bile thickening (9,11,9 percent). CONCLUSIONS. Behavior of different causes of cholestasis is heterogeneous and the differences as regards the frequencies of cholestasis causes is in some extent a reflection of the differences in the composition of the group of series

Colestasis del recién nacido y del lactante / Cholestasis of newborn and infant

Los recién nacidos y lactantes pequeños tienen una inmadurez funcional y anatómica que justifica que las enfermedades hepáticas que se manifiestan en estas edades tengan la ictericia como signo principal y que otros procesos extrahepáticos o sistémicos puedan condicionar colestasis. La colestasis del lactante es un síndrome clínico caracterizado por ictericia, acolia o hipocolia, y coluria, que evoluciona con elevación de la bilirrubina directa y de los ácidos biliares séricos. La evaluación diagnóstica del lactante con colestasis, realizada por un equipo multidisciplinario, debe minimizar la realización de pruebas innecesarias para lograr un diagnóstico correcto en el menor tiempo posible, diferenciar entre colestasis intrahepática o extrahepática y lograr un diagnóstico etiológico, que incluya aquellos procesos que ponen en peligro la vida o requieren un tratamiento específico médico o quirúrgico. El presente trabajo pretende revisar las principales causas, procedimientos diagnósticos y el enfoque terapéutico de la colestasis del recién nacido y del lactante en aras de contribuir a su diagnóstico temprano y su tratamiento adecuado

The small newborns and infants have a functional anatomical immaturity justifying that liver diseases present at these ages have the jaundice as leading sign and that other extra-hepatic or systemic processes may conditioning the Cholestasis. Infant Cholestasis is a clinical syndrome characterized by jaundice, acholia or hypoacholia and choluria evolving with a rise of direct bilirubin and of serum biliary acids. The diagnostic assessment of infant presenting with Cholestasis made by a multidisciplinary staff must to minimize the carrying out of unnecessary tests to obtain an appropriate diagnosis in less time, to differentiate among the intrahepatic or extrahepatic cholestasis and to achieve an etiologic diagnosis including the processes threatening the life or that requiring a medical or surgical specific treatment. The aim of present paper is to review the leading causes, diagnostic procedures and the therapeutical approach of cholestasis en the newborn and in the infant to contribute to its early diagnosis and its appropriate treatment

Uso del factor VII activado recombinante en pacientes no hemofílicos en Cuba / Use of the recombinant activated factor VII in non-hemophilic patients in Cuba

El factor VII activado recombinante (rFVIIa, NovoSeven®) ha sido utilizado en el tratamiento de los sangramientos en los pacientes hemofílicos con inhibidores. También ha sido usado para el tratamiento de los sangramientos no controlados asociados con trauma o cirugía. Se describe el tratamiento con rFVIIa en 7 pacientes no hemofílicos con un amplio rango de eventos hemorrágicos: 3 a quienes se les realizó trasplante hepático y presentaron sangramiento postrasplante sin respuesta al tratamiento convencional; 1 con aplasia medular severa y hemorragia retiniana; 1 con enfermedad de Rendú-Osler-Weber, quien tuvo un sangramiento gastrointestinal severo; y 1 paciente con manifestaciones hemorrágicas cutáneas y pulmonares debido a una enfermedad viral. La dosis de rFVIIa utilizada fue entre 90_100 µg/kg de peso, tanto para el tratamiento profiláctico como terapéutico. El rFVII activado alcanzó una hemostasia efectiva en todos los casos. Consideramos que el FVII activado puede ser aplicado cuando la combinación de los hemoderivados y los avances quirúrgicos han fallado en el control de los sangramientos que ponen en peligro la vida.

The recombinant activated factor VII (rFVIIa, NovoSeven®) has been used in the treatment of bleedings in hemophilic patients with inhibitors. It has also been used for treating uncontrolled bleedings associated with trauma or surgery. The treatment with rFVIIa in 7 non-hemophilic patients with a wide range of hemorrhagic events is described: 3 that underwent liver transplant and presented posttransplant without response to the conventional treatment; 1 with severe medullary aplasia and retinal hemorrhage; 1 with Rendú-Osler-Weber's disease that had severe gastrointestinal bleeding; and 1 patient with cutaneous and pulmonary hemorrhagic manifestations due to a viral disease. The dose of rFVIIa used was between 90 and 100 µg/kg of weight, both for the prophylactic and therapeutic treatment. The activated rFVII reached an effective hemostasis in all cases. We consider that the activated FVII may be applied when the combination of hemoderivatives and the surgical advances have failed in the control of bleedings endangering life.

Histerectomía obstétrica (1984-1995) / Obstetrical hysterectomy (1984-1995)

Objetivo. Conocer la incidencia, factores relacionados y repercusiones de la histerectomía obstétrica. Método. Estudio retrospectivo, descriptivo de 60 histerectomías realizadas entre 1984 y 1995, en 52817 casos obstétricos. Ambiente. Hospital Dr."Adolfo Prince Lara", Puerto Cabello Edo. Carabobo. Resultados. La frecuencia fue de 0,10 por ciento o de 1x880. La edad materna varió entre menos de 19 años y más de 40; hubo 11 a 19 o menos años (18,33 por ciento); Doce eran primigestas y 11 grandes multiparas. La principal indicación fue la sepsis, con 26 casos (12 posaborto, 9 poscesárea y 5 posparto), seguida por la atonía uterina, 21 casos, y la rotura o dehiscencia de la cicatriz, 12. Como complicaciones figuraron: anemia (75 por ciento), infecciones de la herida (13,33 por ciento) y 6 muertes maternas(10 por ciento). Conclusión. Se necesita estrategia de ataque séptico y mejora de las condiciones de asepsia y antisepsia del acto obstétrico

Rotura uterina (1984-1995) / Uterine rupture (1984-1995)

Objetivo. Determinar las características clínicas y las complicaciones asociadas a la rotura uterina durante el embarazo. Método. Análisis retrospectivo, descriptivo de 18 roturas uterinas acaecidas entre 1983 y 1995 en 48546 partos. Ambiente. Hospital Dr."Adolfo Prince Lara", Puerto Cabello, Edo. Carabobo. Resultado. Las roturas uterinas ocurrieron con una frecuencia de 0,4 por mil 1 cada 2.697 partos. El grupo de edad más común fue el comprendido entre 20 y 34 años: 77,78 por ciento (14/18); la paridad entre 2 y 7: 83,33 por ciento (15/18); la edad de la gestación, 22 y 42 semanas, la mayoría entre 37 y 41: 66,67 por ciento (12/18). En 9 casos había cicatriz de cesárea previa, en 4 uso de ocitocina, en 2 versiones internas. En 7 casos hubo dehiscencia de la cicatriz anterior. Se hizo histerectomía en 8 e histerorrafia en 6. Hubo 3 muertes maternas (16,67 por ciento) y 10 muertes perinatales (55,56 por ciento). Conclusión. La rotura uterina está asociada a cicatriz uterina previa y al uso de ocitócicos. Se requiere mejores evaluación obstétrica y vigilancia del parto

Posgrado gineco-obstétrico autogestionado / Gineco-obstetric postgraduate self-agency

Se describe experiencia del desarrollo y ejecución de un posgrado basado en la autogestión, con participación de especialistas y residentes. Durante enero a septiembre de 1993 se realizó la programación curricular y concurso; se inició en octubre con 6 cursantes a 3 años, teniendo carácter experimental. Es dictado por médicos especialistas del Departamento con un Coordinador, y la participación activa de un Coordinador Residente rotante bimensual. En dos años y 6 meses de ejecutoria se ha cumplido 100 por ciento la actividad docente y pasantías, con importante récord quirúrgico. El promedio de evaluación es 18 puntos, han participado en Jornadas, Cursos y Congresos Nacionales, como expositores, con 9 trabajos de investigación. La actividad es evaluada bimensualmente con los cursantes y semestralmente por el Consejo Docente. Se tiene previsto para octubre de 1996 primera promoción. Los resultados obtenidos sugieren que la autogestión es un procedimiento válido actual en la docencia de posgrado en nuestra región

Accidentes: estudio en pacientes menores de 15 años / Accidents: a study with patients under 15

Se realizó un estudio descriptivo de los accidentes ocurridos en la población pediátrica atendida por 20 consultorios de médico de la familia pertenecientes al Policlínico Docente "19 de abril", durante el período de enero a diciembre del año 1991. Se encontró una tasa por 100 habitantes de 2,7, con un promedio en el sexo masculino. El mayor número de accidentados estuvo en la edad de 5 a 14 años. Las lesiones que más se presentaron fueron la contusión, las quemaduras y las heridas; la mayor parte de ellas ocurrio en el hogar y el resto en lugares públicos. La mayoría de los casos graves (65,5 por ciento ) estaban en lasedades de 5 a 14 años, igualmente que los 3 casos mortales. La repercusión psicológica predominante en las niñas fue la ansiedad y la fobia, mientras que en los varones predominó la fobia y la depresiónó los días de la semana en que predominaron los accidentes fueron el martes (22,2 por ciento ) y el sábado (18 por ciento )

Embarazada de 40 años y más / Pregnancy of 40 years and older

Se evaluaron retrospectivamente 370 embarazos en mujeres de 40 años de edad durante un lapso de 5 años (1987-1991) y se compararon con una muestra representativa de 642 gestantes entre 20 y 24 años de edad atendidas en ese lapso. La incidencia fue de 1,38 por ciento, lo que representa una embarazada de 40 y más años de edad por cada 72 ingresos. El 71 por ciento fueron grandes multíparas. La hipertensión inducida por el embarazo y la hipertensión arterial crónica fueron significativamente más altas que en el grupo control (p<0,01). El aborto fue significativamente más alto en el grupo de estudio (p<0,01). Los recién nacidos de bajo peso, representaron el 18,11 por ciento y el 9,22 por ciento en el grupo control. La puntuación de Apgar<7, representó el 27,56 por ciento; en el grupo control fue de 18,47 por ciento, diferencia estadísticamente significativa p<0,05. La mortalidad fetal tardia fue de 40 x 1000, el doble de la tasa habida en la maternidad durante ese lapso

Malformaciones congénitas: revisión de 20 años / Congenital malformations: review of 20 years

Se hizo una revisión de 20 años (1969-1988), sobre malformaciones congénitas en nuestro hospital, encontrándose 323 casos. Durante este lapso hubo un total de 61.471 nacimientos con una incidencia de 5,25 x 1000. La edad promedio de los pacientes fue de 25 años. El 43,03 por ciento fueron primíparas. En cuanto a las características de las malformaciones: 22,62 por ciento correspondió al sistema nervioso; 14,86 por ciento estuvieron encasilladas en el Síndrome de Down. Hubo un 15,79 por ciento de malformaciones múltiples y una incidencia de 1,54 por ciento de gemelos unidos o monstruos dobles, llamando la atención la cifra tan alta de estas malformaciones en nuestro medio, 1 por cada 12.294 nacidos vivos