Clinical simulation in health education: a systematic review / La simulación clínica en la enseñanza sanitaria: una revisión sistemática / Simulação clínica na educação em saúde: uma revisão sistemática

Objective. To summarize the most recent scientific evidence on the usefulness and implementation of simulation training programs for health science students. Methods. A search and systematic review were conducted of the literature through the use of the PRISMA guidelines using the terms MESH Simulation AND healthcare AND Professional Training, including 42 articles. Results. The bibliometric analysis revealed that most of the studies were local in nature, that is, conducted in a single center, or in a few centers in the same region, from the English-speaking world, and using a mixed methodology with pre/post-test measurements. As for the educational aspects, most of the studies were conducted at universities or in the area of continuous education, used multidisciplinary teams as the student target, and used role-playing games as the simulation method. Also, these programs were especially successful in the acquisition of competencies, such as teamwork, communication, and trust. Conclusion. Clinical simulation is a teaching methodology implemented in the last twenty years, mainly in English-speaking countries; it utilizes techniques for its execution and assessment that have been validated in contrasted in many scientific studies, and lastly, it was also observed that it is useful for providing training on general competencies for multidisciplinary groups.

Objetivo. Resumir la evidencia científica más reciente sobre la utilidad e implementación de programas de formación mediante simulación en estudiantes de ciencias de la salud. Métodos. Se ha desarrollado una búsqueda y revisión sistemática de la literatura mediante la guía PRISMA empleando los términos MESH Simulation AND healthcare AND Professional Training, incluyéndose 42 artículos. Resultados. El análisis bibliométrico reveló que la mayoría de estudios eran de ámbito local, es decir, desarrollados en un único centro o en unos pocos centros de una misma localidad, procedentes del mundo anglosajón, y utilizaban una metodología mixta con pre/post-test. En cuanto a los aspectos educativos, la mayoría de estudios se desarrollaron a nivel universitario o en el ámbito de la formación continua, tuvieron como alumnado objetivo equipos multidisciplinares y utilizaron el juego de rol como método de simulación. Además, estos programas fueron especialmente exitosos en la adquisición de competencias como el trabajo en equipo, la comunicación y la confianza. Conclusión. La simulación clínica es una metodología docente que se ha ido implantando progresivamente durante las últimas dos décadas, mayoritariamente en países anglosajones, que utiliza técnicas para su ejecución y evaluación validadas y contrastadas en múltiples estudios científicos, y que resulta útil para el entrenamiento de competencias genéricas y equipos multidisciplinares.

Objetivo. Resumir as evidências científicas mais recentes sobre a utilidade e implementação de programas de treinamento de simulação em estudantes de ciências da saúde. Métodos. Uma busca sistemática e revisão da literatura foi realizada usando o guia PRISMA usando os termos MESH Simulation AND Healthcare AND Professional Training, incluindo 42 artigos. Resultados. A análise bibliométrica revelou que a maioria dos estudos foram locais, ou seja, desenvolvidos num único centro ou em alguns centros de uma mesma cidade, do mundo anglo-saxão, e utilizaram uma metodologia mista com pré/pós- teste. Quanto aos aspectos educacionais, a maioria dos estudos foi realizada no nível universitário ou no campo da formação contínua, os alunos-alvo eram equipes multidisciplinares e usaram a dramatização como método de simulação. Além disso, esses programas foram especialmente bem-sucedidos na aquisição de habilidades como trabalho em equipe, comunicação e confiança. Conclusão. A simulação clínica é uma metodologia de ensino que tem vindo a ser progressivamente implementada ao longo das duas últimas décadas, maioritariamente em países anglo-saxões, que utiliza técnicas para a sua execução e avaliação validadas e contrastadas em múltiplos estudos científicos, e que é útil para o treino de competências genéricas. equipes multidisciplinares.

Psychological adjustment of children with cancer: relapse and survival perspectives / Ajustamento psicológico de crianças com câncer: perspectivas da recidiva e da remissão / Ajuste psicológico de niños con cáncer: perspectivas de recaída y supervivencia

In Brazil, few studies have investigated the psychological aspects of childhood cancer. The aim of this article was to compare the psychological adjustment of children with cancer from different survival perspectives with that of children without cancer, besides examining potential risk factors. The sample consisted of 179 participants (6-14 years-old) recruited in two Brazilian public hospitals and three schools, and divided in three groups (relapsed, survivors and control). Children answered orally the self-reported Behavior Assessment Scale for Children, the Revised Children's Manifest Anxiety Scale and Piers-Harris' Self-Concept Scale. No differences were found between groups regarding school and clinical maladjustment, personal adjustment, emotional symptoms and self-concept. Findings also showed positive associations between psychological maladjustment and gender, younger age, lower household income, single parenthood and lower levels of parental education. Conclusions indicate that children with cancer adapt well to the disease and do not present more psychological problems than controls (AU).

No Brasil, poucos estudos investigaram os aspectos psicológicos do câncer infantil. O objetivo deste artigo foi comparar o ajustamento psicológico de crianças com câncer com diferentes perspectivas de sobrevivência com o de crianças sem câncer, além de examinar potenciais fatores de risco. A amostra consistiu em 179 participantes (6-14 anos de idade) recrutados em dois hospitais públicos e três escolas brasileiras. As crianças responderam oralmente à Escala de Avaliação Comportamental para Crianças, à Escala de Ansiedade Manifesta para Crianças Revisada e à Escala de Autoconceito Piers-Harris. Não foram constatadas diferenças entre os grupos com relação ao desajustamento clínico e escolar, ajustamento pessoal, sintomas emocionais e autoconceito. Os resultados também mostraram associações positivas entre o desajustamento psicológico e gênero, menor idade, menor renda, famílias monoparentais e menor nível educacional parental. As conclusões indicam que crianças com câncer se adaptam bem à doença e não apresentam mais problemas psicológicos que as do grupo controle (AU).

Na Brasil, pocos estudios han investigado los aspectos psicológicos del cáncer infantil. El objetivo de este artículo fue comparar el ajuste psicológico de niños na cáncer na diferentes perspectivas de supervivencia na el de niños sin cáncer, además de examinar los posibles factores de riesgo. La muestra consistió en 179 participantes (6-14 años de edad) reclutados en dos hospitales públicos y tres escuelas brasileñas. Los niños contestaron oralmente a la Escala de Evaluación del Comportamiento del Niño, la Escala Revisada de Ansiedad Manifiesta en Niños y la Escala de Autoconcepto de Piers-Harris. No se constataron diferencias entre los grupos con respeto al desajuste clínico y escolar, el ajuste personal, los síntomas emocionales y el autoconcepto. Los resultados también mostraron asociaciones positivas entre el desajuste psicológico y el género, la menor edad, la menor renta, las familias monoparentales y el nivel educativo parental más bajo. Las conclusiones señalan que niños con cáncer se adaptan bien a la enfermedad y no presentan más problemas psicológicos que los del grupo de control (AU).

Psychological Adjustment of Parents of Children with Different Cancer Prognoses / Ajustamento Psicológico de Pais de Crianças com Diferentes Prognósticos de Câncer / Ajuste Psicológico de Padres de Niños con Distintos Pronósticos de Cáncer

Abstract Little is known about the psychological adjustment of parents of children with cancer relapse or remission. This study investigated differences in the psychological adjustment of caregivers of children with different cancer prognosis, by comparing them with a control group. In total, 183 caregivers participated in this study: those with children in relapse/on treatment (n = 32), remission/off treatment (n = 75), and "healthy" (n = 76). The Beck Depression and Anxiety Inventories, the Symptom Check list-90-R, the Norbeck Social Support Questionnaire-Reviewed and the Family Environment Scale were analyzed with Variance Analysis, Student's t-test, Chi-square and Pearson correlations. The results showed that parents of children with cancer relapse presented less psychological adjustment. Furthermore, a protective effect of family cohesion and possible risk factors related to sociodemographic variables were observed. Conclusions highlight the convenience of developing specific interventions for parents of children with cancer relapse.

Resumo Pouco se sabe sobre o ajustamento psicológico de pais de crianças em recidiva de câncer e em remissão. Este estudo investigou diferenças no ajustamento psicológico de cuidadores de crianças com diferentes prognósticos de câncer, comparando-os com um grupo controle. Os participantes foram 183 cuidadores de crianças em recidiva/tratamento (n = 32), remissão/fora de tratamento (n = 75) e "saudáveis" (n = 76). Os Inventários Beck de Depressão e Ansiedade, a Escala de Avaliação de Sintomas 90-R, o Questionário Norbeck de apoio social-revisado e a Family Environment Scale foram analisados com análises de variância, t de Student, Qui-quadrado e correlações de Pearson. Os resultados mostraram que os pais de crianças em recidiva apresentaram menos ajustamento psicológico. Além disto, observou-se um efeito protetor da coesão familiar e possíveis fatores de risco relacionados a variáveis sociodemográficas. Discute-se a conveniência de desenvolver intervenções psicológicas para pais de crianças em recidiva de câncer.

Resumen Poco se conoce sobre el ajuste psicológico de padres de niños en recidiva de cáncer y en remisión. Este estudio investigó las diferencias en el ajuste psicológico de cuidadores de niños con distintos pronósticos de cáncer, comparándolos con un grupo control. Participaron 183 cuidadores de niños en recidiva/en tratamiento (n = 32), remisión/sin tratamiento (n = 75) y "sanos" (n = 76). Se analizaron los Inventarios de Depresión y Ansiedad de Beck, la Escala de Síntomas 90-R, el Cuestionario Norbeck de Apoyo Social Revisado y la Family Environment Scale mediante análisis de varianza, prueba t de Student, test de chi-cuadrado y correlaciones de Pearson. Los resultados mostraron que los padres de niños en recidiva presentaban menos ajuste psicológico. Además, se observó un efecto protector de la cohesión familiar y posibles factores de riesgo relacionados a variables sociodemográficas. Se discute la conveniencia de desarrollar intervenciones psicológicas para padres de niños en recidiva de cáncer.

Niveles de actividad física en estudiantes de enfermería / Levels of Physical Activity in Nursing Students

RESUMEN Fundamento los beneficios del ejercicio físico son bien conocidos e incluyen un menor riesgo de padecer enfermedades cardiovasculares, obesidad, insulino-resistencia y ciertos tipos de cáncer como el de colon y mama. La actividad física reduce el riesgo de obesidad y se asocia con la salud mental, el bienestar emocional y una mayor longevidad. Objetivo determinar el nivel de actividad física desarrollada por estudiantes de enfermería de la Universidad de Ciencias Médicas de Cienfuegos. Métodos: se realizó una investigación cuantitativa de tipo descriptiva de corte transversal. El instrumento empleado para determinar la actividad física fue el International Physical Activity Questionnaire de versión larga, dicho instrumento mide el nivel de actividad física en: nivel bajo, nivel moderado y nivel vigoroso. Resultados respecto al nivel de actividad física, se encontró que el 22,38 % de los estudiantes de la carrera de enfermería presentaron un nivel moderado, el 8,95 % actividad física de nivel vigoroso y el 68,65 % actividad física de nivel bajo; pero los de sexo masculino son más activos que los de sexo femenino. Conclusiones: se determinó por primera vez una evaluación del nivel de actividad física establecido por el cuestionario internacional siendo estos resultados negativos porque los estudiantes llevan una vida sedentaria la cual es perjudicial para la salud, lo que puede incidir en la aparición de enfermedades no trasmisibles como la diabetes y la hipertensión arterial.

ABSTRACT Background: the benefits of physical exercise are well known and include a lower risk of cardiovascular diseases, obesity, insulin resistance and certain types of cancer such as colon and breast cancer. Physical activity reduces the risk of obesity and is associated with mental health, emotional well-being, and increased longevity. Objective: to determine the level of physical activity developed by nursing students from the Cienfuegos University of Medical Sciences. Methods: a descriptive, cross-sectional quantitative research was carried out. The instrument used to determine physical activity was the International Physical Activity Questionnaire the long version, this instrument measures the level of physical activity in low level, moderate level and vigorous level. Results: regarding the level of physical activity, it was found that the 22.38 % of the nursing students presented a moderate level, the 8.95 % vigorous level physical activity and the 68.65 % low-level physical activity, but males are more active than females. Conclusions: an evaluation of the level of physical activity established by the international questionnaire was determined for the first time, these results being negative since the students lead a sedentary life which is detrimental to health and may affect the appearance of non-communicable diseases such as diabetes and arterial hypertension

Anal PAP, HPV tests and magnifying chromoendoscopy with biopsies in the diagnosis of anal intraephitelial neoplasia / Papanicolau anal, testes de HPV e cromoendoscopia de ampliação com biópsias no diagnóstico de neoplasia intraepitelial anal

Abstract Introduction: Anal intraepithelial neoplasia (AIN) is the most likely precursor of squamous cells cancer which represents 90% of anal cancers. The use of biomolecular tests as a screening method has been extended by gynecology. Given the similarities that exist between the HPV disease in the lower genital tract and anorectal sectors, it is expected that HPV tests can provide information for the diagnosis, treatment and follow-up for AIN-affected patients. Objectives: Comparing the performance of anal cytology, PAP and HPV tests (Hybrid Capture and Papillocheck) against the histology of the diagnosis of low- and high-grade AIN in risk groups. Material and methods: A cross-sectional study was carried out to evaluate diagnostic methods for low- and high-grade AIN in 73 patients. Samples for anal PAP, Papillocheck and Hybrid Capture were taken from all patients who then, regardless of the results, underwent magnifying chromoendoscopy (MCE) along with biopsy. Diagnostic test performances and their 95% confidence intervals (CI: 95%) were calculated as well as the likelihood ratio for each test. Results: Of the 73 patients, 49 (67%) were women. The average age of the patients was 38 years. In 38 patients (52%), the histology was positive with 10 (14%) grade II AIN or higher. There were no statistically significant differences in sensitivity nor in specificity for low- and high-grade AINs between any of the tests. Conclusion: Anal PAP, the Hybrid Capture test (HC2, Qiagen) and PapilloCheck (Greiner Bio One) were highly sensitive but not specific for low- and high-grade AINs. Therefore, a biopsy should be conducted against a positive result of any of the tests to confirm AIN and the degree of dysplasia. The screening method selection depend on the availability but also costs of the test should be considered, since all the diagnostic tests have similar performance.

Resumo Introdução: A neoplasia intraepitelial anal é o precursor mais provável do câncer de células escamosas, que representa 90% dos tumores anais. O uso de exames biomoleculares como método de triagem foi ampliado pela ginecologia. Considerando-se as semelhanças entre as apresentações de HPV no trato genital inferior e anorretal, espera-se que os exames de HPV possam fornecer informações para o diagnóstico, tratamento e acompanhamento dos pacientes com neoplasia intraepitelial anal. Objetivo: Comparar o desempenho da citologia anal, Papanicolau, exames para HPV (teste de captura híbrida e Papillocheck) e histologia no diagnóstico de neoplasia intraepitelial anal de baixo e alto grau em grupos de risco. Material e métodos: Foi realizado um estudo transversal para avaliar métodos de diagnóstico de neoplasia intraepitelial anal de baixo e alto grau em 73 pacientes. Amostras para Papanicolau anal, Papillocheck e captura híbrida foram coletadas de todos os pacientes; independentemente dos resultados desses exames, todos foram submetidos a cromoendoscopia de ampliação (CEA) e biópsia. O desempenho dos exames e seus intervalos de confiança de 95% (95% CI) foram calculados, bem como a razão de verossimilhança para cada teste. Resultados: Dos 73 pacientes, 49 (67%) eram mulheres. A idade média dos pacientes foi de 38 anos. A histologia foi positiva em 38 pacientes (52%), dos quais dez (14%) apresentaram neoplasia intraepitelial anal grau II ou superior. Não foram observadas diferenças estatisticamente significativas na sensibilidade ou especificidade para as neoplasias intraepiteliais anal de baixo e alto grau entre qualquer um dos exames. Conclusão: O Papanicolau anal, o teste de captura híbrida (HC2, Qiagen) e o Papillocheck (Greiner Bio One) foram altamente sensíveis, mas não específicos para neoplasia intraepitelial anal de baixo e alto grau. Portanto, uma biópsia deve ser realizada após um resultado positivo em qualquer um dos testes para confirmar o diagnóstico de neoplasia intraepitelial anal e seu grau. A seleção do método de triagem depende da disponibilidade, mas os custos devem ser considerados, uma vez que todos os testes apresentam desempenho semelhante.

The Gender Violence - Implicit Association Test to measure attitudes toward intimate partner violence against women

Attitudes play a central role in intimate partner violence against women and are related to its origin, to the responses of women who suffer violence, and to the settings where it occurs. In fact, these attitudes are recognized as one of the risk factors linked to violent perpetration and to public, professional, and victim responses to this type of violence. However, even though available research generally shows a broad rejection of this violence, it remains a serious social and health problem that has reached epidemic proportions. This suggests that the information available about these attitudes (obtained through explicit and direct measures, i.e., self-reports) may be distorted or influenced by factors such as social desirability. In this context, the overall objective of our research project is to provide multi-method measures (explicit and implicit) of attitudes toward intimate partner violence against women, and the main goal of this paper is to propose an instrument for the implicit measurement of these attitudes. In this regard, the Implicit Association Test (IAT) is the most common procedure used, providing a superior predictive validity compared to explicit measures for socially sensitive topics. We will present an exploratory study that describes its adaptation for our purposes, and the development of the Gender Violence - Implicit Association Test (GV-IAT) to use among Spanish-speaking populations, and discuss the strengths and limitations of this proposal.

Criterios de severidad de la enfermedad hipertensiva del embarazo / Severity criteria for hypertensive pregnancy disease

Introducción: los trastornos hipertensivos del embarazo siguen siendo una causa de morbimortalidad materna. La pre eclampsia es una enfermedad con afectación multisistemica con disfunción de órganos. Objetivos: estudiar la frecuencia de criterios de severidad en las pacientes con trastornos hipertensivos durante el embarazo o puerperio que acuden al Hospital Nacional de Itauguá durante los años (2012-2013) y (2016-2017). Metodología: estudio observacional descriptivo, transversal. La muestra estuvo formada por gestantes o puérperas con trastornos hipertensivos del embarazo admitidas en el Hospital Nacional de Itauguá los años (2012-2013) y (2016-2017). Muestreo no probabilístico de casos consecutivos. Las principales variables estudiadas fueron las formas de presentación de la enfermedad hipertensiva grave, los criterios clínicos o laboratoriales de disfunción de órganos. Resultados: se estudió 317 pacientes con trastornos hipertensivos severos. La media de edad fue 28±7 años, la mayor proporción procedían del interior del país, presentaron pre eclampsia severa con criterios clínicos de disfunción deórganos: neurológico, renal, hepático y pulmonar; por criterios de estudios de laboratorio el más afectado fue el hígado. Ingresaron a Unidad de cuidados intensivos 11 pacientes por hemorragia cerebral, coma, insuficiencia renal aguda. Conclusión: la forma clínica más frecuente de presentación fue la disfunción neurológica. En cuanto a las anomalías de laboratorio, el órgano más afectado fue el hígado

Introduction: hypertensive disorders of pregnancy are still a cause of maternal morbidity and mortality, preeclampsia is a disease with multisystemic affectation with organ dysfunction. Objectives: To identify the frequency of criteria of severity in patients with hypertensive disorders during pregnancy or puerperium who attend the National Hospital of Itauguá during the years (2012-2013), (2016-2017). Methodology: descriptive, cross-sectional, observational study. The population consisted of pregnant or puerperal women with hypertensive disorders of pregnancy treated in Hospital Nacional de Itauguá years (2012-2013), (2016-2017). Probabilistic sampling of consecutive cases, the main variables studied are clinical or laboratory criteria of organ dysfunction. Results: 317 patients with severe hypertensive disorders were studied The average age was 28 ± 7.3 years, they come from the interior of the country, they presented severe preeclampsia with clinical criteria of organ failure renal, hepatic pulmonary and brain dysfunction; by laboratory studies the most affected was the liver and kidneys. A total of 11 patients were admitted to the intensive care unit. Conclusion: the most frequent clinical form of presentation was neurological dysfunction. In terms of laboratorial abnormalities the most affected organ was the liver

Dipyridamole potentiated the trypanocidal effect of nifurtimox and improved the cardiac function in NMRI mice with acute chagasic myocarditis

BACKGROUND As chronic Chagas disease does not have a definitive treatment, the development of alternative therapeutic protocols is a priority. Dipyridamole (DPY) is an alternative to counteract the pathophysiological phenomena involved in Chagas cardiomyopathy. OBJECTIVE To evaluate the therapeutic efficacy of DPY associated with nifurtimox (Nfx) in epimastigote axenic cultures and in mice with acute Chagas disease. METHODS NMRI adult male mice were divided into nine groups: three healthy and six Trypanosoma cruzi-infected groups. Mice received vehicle, Nfx or DPY, alone or combined. The doses assayed were Nfx 10 and 40 mg/kg and DPY 30 mg/kg. The treatment efficacy was evaluated by clinical, electrocardiographic, parasitological, biochemical and histopathological methods. FINDINGS In vitro, DPY and Nfx had a trypanocidal effect with IC50 values of 372 ± 52 and 21.53 ± 2.13 µM, respectively; DPY potentiated the Nfx effect. In vivo, Nfx (40 mg/kg) with or without DPY had a therapeutic effect, which was reflected in the 84-92% survival rate and elimination of parasitaemia and heart tissue amastigotes. Nfx (10 mg/kg) had a subtherapeutic effect with no survival and persistence of amastigotes, inflammation and fibrosis in heart tissue; adding DPY increased the survival rate to 85%, and all tested parameters were significantly improved. MAIN CONCLUSION DPY has a trypanocidal effect in vitro and enhances the Nfx therapeutic effect in an in vivo murine model.

Relación entre la presencia de colifagos en agua para consumo humano, las lluvias y las diarreas agudas en Costa Rica / Relation between coliphages presence in drinking water, rain and acute diarrhea in Costa Rica

ResumenLa calidad del agua de consumo es una de las preocupaciones más grandes a las que se enfrentan los entes de salud. En Costa Rica, a pesar de la buena calidad de las fuentes de agua y del agua de consumo, se siguen registrando numerosos casos de diarrea anualmente. En este estudio se realizó un análisis de indicadores de contaminación virales y bacterianos, en dos comunidades del Valle Central con acueducto propio. Se analizaron en total 24 muestras de agua por cada comunidad, durante un año, 12 en la fuente de agua y 12 en el agua tratada. La frecuencia de diarreas en cada comunidad fue comparada con la calidad microbiológica del agua consumida, encontrándose ausencia de indicadores bacterianos en muestras de agua tratada, mientras que la presencia de indicadores virales en el agua de consumo (con cloro residual) se relaciona con un incremento en el número de casos de diarreas, adicionalmente se analizó el comportamiento de las diarreas de acuerdo a la precipitación promedio con el fin de observar posibles patrones de estacionalidad. Estos hallazgos respaldan la necesidad de ampliar el monitoreo de calidad microbiológica del agua con otro tipo de indicadores de contaminación que correlacionen mejor con otros agentes patógenos de transmisión hídrica, principalmente en época seca, periodo en que se observan más casos de diarrea.

AbstractThe quality of potable water is one of the most important issues of public health. In Costa Rica, in spite of having good sources of water and good quality of water for consumption, there continues to be a significant number of diarrhea cases annually. In this investigation, viral and bacterial analyses of indicators of contamination were conducted in two rural communities with their own aqueducts in the Central Valley of Costa Rica. Twenty-four samples were taken from each community during the year; 12 from the water sources and 12 from the treated waters. The frequency of diarrhea in each community was compared to the microbiological quality of the water being consumed, noting an absence of bacterial indicators in samples of treated water, while the presence of viral indicators in the water (with residual chlorine) were associated with an incremental increase in the number of cases of diarrhea. The analysis also included measurements of average monthly rainfall with the aim of observing possible associations between seasonal conditions and the incidence of diarrhea cases. These findings indicate the need to increase the monitoring of the microbiological quality of the water with other types of indicators of contamination that correlate better with other pathogens transmitted by water, especially in the dry seasons when a greater number of cases of diarrhea are observed.

Hijo de madre con síndrome de HELLP: características y papel de la prematuridad, bajo peso y leucopenia en su evolución / Newborn of mother with HELLP syndrome: characteristics and role of prematurity, low birth-weight and leukopenia in evolution

ResumenIntroducción: El síndrome de HELLP es un grave trastorno hipertensivo del embarazo con importantes problemas neonatales en los hijos de las madres afectadas. El objetivo de este trabajo fue conocer las características de estos neonatos y su evolución.Métodos: Se llevó a cabo un estudio observacional descriptivo y retrospectivo de los neonatos hijos de madre con síndrome de HELLP, nacidos en un hospital universitario entre el 1° de enero de 2008 y el 31 de diciembre de 2013. Se estudiaron 33 neonatos procedentes de 28 gestaciones (cinco gemelares). Se realizó un análisis descriptivo y comparativo entre grupos, y posteriormente un análisis de multivarianza de factores asociados con la mortalidad dentro de la serie.Resultados: De 33 recién nacidos estudiados (2.2/1,000 recién nacidos totales), dos fueron mortinatos (6.1% del total) y cuatro fallecieron tras el nacimiento (12.9% de los neonatos vivos), con una mortalidad perinatal total del 18.2%; 28 neonatos terminaron la gestación antes de la semana 37 (84.8%) y 11 antes de la semana 32 (33.3%); siete neonatos pesaron menos de 1,500 g (cuatro de ellos menos de 1,000 g). De los 31 recién nacidos vivos, 13 neonatos tenían peso menor al percentil 10 para su edad gestacional (41.9%), 20 precisaron reanimación neonatal (64.5%) y 14 presentaban leucopenia neonatal (45.2%). En la regresión logística final, la mortalidad neonatal se asoció con la gran prematuridad, independientemente del bajo peso, leucopenia o necesidad de reanimación neonatal.Conclusiones: Los hijos de madre con síndrome de HELLP presentan elevada mortalidad asociada con la alta prematuridad, independientemente de la presencia de leucopenia, bajo peso para edad gestacional o necesidad de reanimación neonatal.

AbstractBackground: HELLP syndrome is a serious hypertensive disorder of pregnancy with important neonatal problems in the newborn. The objective of this work was to determine the characteristics of these infants and its neonatal evolution.Methods: A retrospective observational study of all newborns of mothers with HELLP syndrome born in a university hospital between January 1, 2008 and December 31, 2013 was carried out. Thirty-three infants from 28 pregnancies (five twin gestations) were studied. A descriptive and comparative analysis between groups and a multivariate analysis of factors associated with mortality in the series took place.Results: Of 33 newborns studied (2.2 newborns/1,000 infants total), two were stillbirths (6.1% of the total) and four died after birth (12.9% of live neonates) with overall perinatal mortality of 18.2%. Pregnancies in 28 infants ended before 37 weeks (84.8%) and 11 pregnancies ended before week 32 (33.3%). Seven infants weighed < 1500 g (four weighed <1000 g). Of the 31 live births, 13 infants were in a <10th percentile weight for gestational age (41.9%), 20 needed neonatal resuscitation (64.5%) and 14 had leukopenia at birth (45.2%). In the final logistic regression, neonatal mortality was associated with extreme prematurity regardless of underweight, leukopenia and/or need for neonatal resuscitation.Conclusions: Children of mothers with HELLP syndrome have a high mortality associated with extreme prematurity, independent of the presence of leukopenia, low weight for gestational age and need for neonatal resuscitation.

Efecto gastroprotector del jugo de zanahoria (Daucus carota), col (Brassica oleracea ) y papa (Solanum tuberosum) / Effects of carrot (Daucus carota), cabbage (Brassica oleracea) and potato (Solanum tuberosum) juices as gastric mucosal protections

INTRODUCCIÓN: a muchos vegetales se les reconocen acciones beneficiosas sobre el aparato digestivo. A la zanahoria (Daucus carota), la col (Brassica oleracea) y la papa (Solanum tuberosum) la población les atribuye acciones gastroprotectoras. Objetivo: Comprobar experimentalmente la acción gastroprotectora de los jugos de zanahoria, col y papa. MÉTODOS: se utilizaron ratas Sprague-Dawley machos de 190 ± 10 g como modelo biológico; las úlceras gástricas se produjeron con 1 mL de etanol absoluto por cada animal. Los 40 animales fueron distribuidos en cinco grupos de ocho. El grupo 1 fue el control, el 2, el control positivo (atropina 20 mg/Kg), el 3 fue tratado con el jugo de col, el 4 con el de zanahoria y el 5 con el de papa. Media hora antes de la inducción de la úlcera, se administraron los jugos a una dosis de 400 mg/Kg sobre la base de los sólidos totales. Los animales se sacrificaron una hora después de la inducción de las úlceras, las cuales fueron cuantificadas, y se midió el área dañada. RESULTADOS: con todos los jugos empleados, se observó una disminución significativa del área afectada cuando se comparó con el control; sin embargo, solo en el grupo al que se administró el jugo de col, la disminución no presentó significación estadística con relación al grupo control positivo, por lo que el efecto gastroprotector fue similar a él. CONCLUSIONES: los jugos de zanahoria y papa presentaron un moderado efecto gastroprotector, el cual resultó alto en el grupo tratado con jugo de col.

INTRODUCTION: many vegetables are known for their beneficial effects on digestive system. Population attributed the benefits of carrot (Daucus carota), cabbage (Brassica oleracea) and potato (Solanum tuberosum) as gastric mucosal protections. OBJECTIVE: to prove experimentally the action of carrot (Daucus carota), cabbage (Brassica oleracea) and potato (Solanum tuberosum) juices as gastric mucosal protections. METHODS: sprague-Dawley male rats of 190 ± 10 g were used as biological models; ulcers were induced with 1 mL of absolute ethanol for each animal. Forty animals were distributed in five groups of eight. Group 1 was selected as control group, 2 as positive control (atropine 20 mg/Kg), 3 was treated with cabbage juice, 4 with carrot juice and 5 with potato juice. A half hour before the ulcer induction, all juices were administrated at a dose of 400 mg/Kg on the basis of total solids. Animals were sacrificed an hour after the ulcer inductions, ulcers were quantified, as well as, the damage area was measured. Results: a significant decrease of the affected area after using the juices was observed comparing to the control group; however, group which was given cabbage juice, did not show a significant statistical decrease in relation to the positive control group, that is why the effect as gastric mucosal protection was similar to it. CONCLUSIONS: carrot and potato juices had a moderated effect as gastric mucosal protections; on the other hand, group treated with cabbage did show a high effect on the digestive system.

Propiedades psicométricas del modelo bifactorial del BDI-II (versión española) en muestras mexicanas de población general y estudiantes universitarios / Psychometric Properties of the BDI-II Bifactorial Model on Mexican General Population and University Students

En este trabajo, se analizan las propiedades psicométricas de la versión española (Sanz, Navarro, & Vázquez, 2003) del Inventario para la Depresión de Beck ([BDI-II]; Beck, Steer, & Brown, 1996) en muestras mexicanas no clínicas: 474 estudiantes universitarios y 478 personas de población general. La consistencia interna resultó satisfactoria en ambas muestras siendo alfa de Cronbach 0.901 para la muestra total. Los resultados coinciden con los reportados en estudios previos españoles (Sanz, Navarro & Vázquez, 2003; Sanz, Perdigón & Vazquez, 2003) acerca de las propiedades psicométricas del instrumento, así como otros estudios internacionales revisados. El análisis factorial confirmatorio muestra buenos índices de ajuste al modelo bifactorial de la escala. Se encontraron diferencias significativas en las puntuaciones en función del sexo, pero no se observan efectos significativos de la edad. Se concluye que la versión española del BDI-II puede ser un instrumento válido y fiable para evaluar la sintomatología depresiva en la población general adulta mexicana y en estudiantes universitarios.

The purpose of this study was to test the Spanish version (Sanz, Navarro, & Vazquez, 2003) of the Beck Depression Inventory-II ([BDI-II]; Beck, Steer, & Brown, 1996) in the Mexican general population and undergraduate university students on non clinical samples. The reliability and construct validity obtained in a sample of 474 university students and 478 people from the general population, confirmed good psychometric properties: Cronbach alpha of 0.901 and Confirmatory factor analysis, showed good adjustment indices to two-factor model scale. These results agree with those reported in previous studies both international and Spanish studies on the psychometric properties of the instrument (Sanz, Navarro, & Vázquez, 2003; Sanz, Perdigón & Vázquez, 2003). Confirmatory factor analysis showed a good fit of the Mexican population data, the two-factor model reported in the Spanish population. Finally, the distributions of scores were similar to those found in Spanish studies. There were significant differences in scores by gender, but there are no significant effects of age. It is concluded that the Spanish version of the BDI-II may be a valid and reliable instrument to assess depressive symptoms in college students and the general population of Mexican adults.

La infección por Trypanosoma cruzi disminuye el desarrollo del melanoma maligno e incrementa la supervivencia en ratones C57BL/6 / Trypanosoma cruzi infection decreases malignant melanoma development and increases survival in C57BL/6 mice

Diversos agentes infecciosos interfieren en la progresión del cáncer. En esta investigación se estudió el efecto de la infección o inmunización con Trypanosoma cruzi (Tc) sobre el desarrollo del melanoma maligno. Se utilizaron 258 ratones machos C57BL/6 divididos en 5 grupos melanoma: melanoma control, melanoma Tc inmunizado, melanoma Tc agudo, melanoma Tc crónico y melanoma Tc infectado; 3 grupos controles: control sano, control Tc agudo, control Tc crónico. 100.000 células de melanoma B16-BL6 fueron inoculados vía intramuscular a los grupos melanoma; 3 ó 20 tripomastigotes/g de peso fueron inoculados vía intraperitoneal a los grupos Tc crónicos o Tc agudos previo a la inoculación del melanoma, respectivamente, el grupo melanoma Tc inmunizado fue inoculado con 30.000 epimastigotes fijados en formol y suspendidos en adyuvante completo de Freund, y el grupo melanoma Tc infectado fue inoculado con células de melanoma obtenidas de ratones melanoma Tc agudo. Se evaluó volumen tumoral, supervivencia, parasitemia e histopatología tumoral. Los grupos melanoma Tc: agudo, crónico y melanoma infectado, respectivamente, mostraron una disminución significativa del desarrollo tumoral y de la supervivencia al ser comparados con los grupos melanoma control e inmunizado. Los estudios histopatológicos mostraron áreas de necrosis asociadas con depósitos de melanina, degeneración citopática tumoral y amastigotes intracelulares contenidos en vacuolas parasitofóricas. En conclusión, Tc inhibe el desarrollo tumoral del melanoma maligno y aumenta la supervivencia de ratones C57BL/6, fenómeno que podría estar relacionado con la capacidad invasiva tumoral del parásito y a la respuesta inmune generada.

Some infectious pathogens have the capacity to affect cancer progression. In the present paper we studied the effect of infection or immunization with Trypanosoma cruzi (Tc) against malignant melanoma development. We worked on 258 C57BL/6 male mice divided in five melanoma groups: control melanoma, melanoma Tc acutely infected, melanoma Tc chronically infected, melanoma Tc immunized and infected melanoma; and three control groups: healthy, Tc acutely infected and Tc chronically infected. 100.000 B16-BL6 melanoma cells were inoculated in the thigh of melanoma groups; 3 or 20 trypomastigotes/g were inoculated intraperitoneally in chronic or acute Tc groups, before the melanoma injection, respectively; melanoma Tc immunized were subcutaneously inoculated with 30.000 formaldehide-fixed epimastigotes diluted in complete Freund´s adjuvant and the infected melanoma group was inoculated with melanoma cells obtained from melanoma Tc acutely infected mice. We evaluated survival, parasitemia, tumor volume and tumor histopathology. Results showed that in mice infected with Tc, the tumor development and survival were significantly lower as compared with control melanoma and melanoma Tc immunized. Histopathologically, the tumor displayed necrosis areas with melanin deposits, cytopathic degeneration and amastigotes in parasitophorous vacuoles. In conclusion, Tc inhibits the development of malignant melanoma, increasing C57BL/6 survival, a phenomena that could be related to the parasite tumoral invasive capacity, its ability to produce melanoma cell lysis and to induce a robust immune response.

Recomendaciones prácticas para la preparación del ejercicio docente de análisis del programa de asignatura / Practical recommendations for the preparation of the teaching activity of subject program analysis

Se presenta de forma estructurada y resumida, los pasos seguidos por los autores para realizar el análisis del programa de una asignatura, a partir de experiencias adquiridas en trabajos prácticos de la maestría de Docencia Superior y en la promoción de categoría docente, con la finalidad de mostrar una guía orientadora que pueda ser utilizada por profesores nóveles, optantes de titulaciones que requieran de estos ejercicios docentes

It is presented in a structured and summarized form the steps taken by the authors to conduct the analysis of a subject program based on acquired experiences in practical works of the Superior Teaching Mastery and in the promotion of educational category, in order to show an orientation guide that can be used by novice teachers, individuals opting for degrees requiring these teaching activities

Clinical and experimental approaches to knee cartilage lesion repair and mesenchymal stem cell chondrocyte differentiation

Cartilage has poor regeneration capacity due to the scarcity of endogenous stem cells, its low metabolic activity and the avascular environment. Repair strategies vary widely, including microfracture, autologous or allogenic tissue implantation, and in vitro engineered tissues of autologous origin. However, unlike the advances that have been made over more than two decades with more complex organs, including vascular, cardiac or bone tissues, similar advances in tissue engineering for cartilage repair are lacking. Although the inherent characteristics of cartilage tissue, such as the lack of vascularity and low cellular diversity, suggest that it would be one of the more simple tissues to be engineered, its functional weight-bearing role and implant viability and adaptation make this type of repair more complex. Over the last decade several therapeutic approaches and innovative techniques show promise for lasting and functional regeneration of hyaline cartilage. Here we will analyze the main strategies for cartilage regeneration and discuss our experience.

Typical and atypical stem cells in the brain, vitamin C effect and neuropathology

Stem cells are considered a valuable cellular resource for tissue replacement therapies in most brain disorders. Stem cells have the ability to self-replicate and differentiate into numerous cell types, including neurons, oligodendrocytes and astrocytes. As a result, stem cells have been considered the "holy grail" of modern medical neuroscience. Despite their tremendous therapeutic potential, little is known about the mechanisms that regulate their differentiation. In this review, we analyze stem cells in embryonic and adult brains, and illustrate the differentiation pathways that give origin to most brain cells. We also evaluate the emergent role of the well known anti-oxidant, vitamin C, in stem cell differentiation. We believe that a complete understanding of all molecular players, including vitamin C, in stem cell differentiation will positively impact on the use of stem cell transplantation for neurodegenerative diseases.

Comportamiento del bajo peso al nacer en el Policlínico Belkys Sotomayor Álvarez de Ciego de Ávila en el cuatrienio 2007-2010 / Behavior of low birth weight in the Policlynic Belkys Sotomayor Álvarez from 2007 to 2010

Se realizó un estudio descriptivo retrospectivo sobre el comportamiento del bajo peso al nacer en el Policlínico Belkys Sotomayor Álvarez de Ciego de Ávila en el cuatrienio 2007-2010. El universo estuvo constituido por todos los nacidos con peso inferior a 2500 gr. El índice de bajo peso aumenta en el año 2009 (4.1 en 2007; 4.3 en 2008; 7.6 en 2009; 7.0 en 2010). Ocurren cuatro fallecimientos en menores de un año, de los cuales uno es producido por prematuridad y el resto por malformaciones congénitas. Se encuentra un ligero predominio del parto pretérmino sobre el bajo peso al nacer. El embarazo gemelar y la enfermedad hipertensiva gravídica son los factores de riesgo que predominan. Solo ocurre un nacimiento de peso extremo con defunción posterior

A retrospective descriptive study was carried out on behavior of low birth weight at Polyclinic Belkys Alvarez Sotomayor in Ciego de Avila between 2007and 2010. In 2009, the rate of low birthweight was increased, 4.1 (2007) and 4.3 (2008) to 7.6 (2009) and 7.0 (2010). The universe consisted of all those born weighing less than 2500 gr Four deaths occurred in children under one year one of which is produced by prematurity and the rest by congenital malformations.There is a slight predominance of the preterm on low birth weight. The twin pregnancy and gestational hypertensive disease are the predominant risk factors It only happens a birth of extreme weightwith subsequent death

Caracterización de algunas variables en las adolescentes atendidas en la consulta de Planificación Familiar del Policlínico Belkis Sotomayor Álvarez / Characterization of some variables in adolescents treated at the Family Planning Consultation from polyclinic Belkis Sotomayor Alvarez

Se realiza un estudio descriptivo transversal con las pacientes atendidas en la consulta acreditada por la Sociedad Cubana de Desarrollo Familiar en el policlínico Belkis Sotomayor de Ciego de Ávila para conocer algunos aspectos relacionados con las mismas. El universo estuvo constituido por todas las adolescentes que son atendidas en esta consulta durante el período de tiempo comprendido entre enero y diciembre del 2010. El 28.8 por ciento son menores de 20 años (185), predominando las de 14 a 17 años: 57.8 por ciento del total, el 61 por ciento son estudiantes y el 14 por ciento han tenido un hijo, 31 se han realizado regulaciones menstruales. Los métodos anticonceptivos más utilizados fueron el de hormonales inyectables (50.2 por ciento) y los anticonceptivos orales (41 por ciento)

A cross-sectional study was carried out with patients treated in the office accredited by Cuban Society for Family Development in the polyclinic Belkis Sotomayor Álvarez, Ciego de Avila for knowing some aspects of them. The universe consisted of all adolescents who are treated in this consultation between January and December 2010. 28.8 percent are under 20 years (185), predominate adolescents between 14 and 17 years: 57.8 percent from total, 61 percent are students and 14 percent have had a son, 31 menstrual regulations have been made. The methods more used were injectable hormones (50.2 percent) and oral contraceptives (41 percent)

Modelo experimental de hiperlipidemia con el empleo de caseína y grasas saturadas / Experimental model of hyperlipidaemia with the use of casein and saturated fats

En el presente trabajo se evaluó el efecto hiperlipídico de una dieta combinada de caseína y grasas saturadas, en un modelo biológico conformado por ratas Wistar. Se integraron tres grupos experimentales de seis animales cada uno: el primero (grupo control) consumió una dieta convencional; el segundo, una dieta convencional combinada con caseína y grasa de cerdo al 20 por ciento y el tercero, la dieta convencional suplementada solamente con grasa de cerdo al por ciento. Fueron cuantificados el colesterol y los triacilglicéridos por métodos enzimáticos en tres momentos diferentes: al comienzo del estudio, a los 15 días y al finalizar este. El incremento de peso corporal, una vez finalizada la investigación, no mostró diferencias significativas entre los grupos de experimentación. El grupo de la dieta combinada elevó el perfil lipídico más eficientemente que el que solo consumió grasas saturadas, lo cual confirma que el modelo experimental de hiperlipidemia inducida por dieta suplementada con caseína y grasas saturadas es el más eficaz para la elevación del perfil lipídico

In the current research it was evaluated the hyperlipidic effect of a combined diet with casein andsaturated fats, in a biological model conformed by Wistar's rats. Three experimental groups wereintegrated with six animals in each one. The first group (control group) consumed a conventionaldiet; the second group, a conventional diet combined with casein and pig fat at 20 %; and the thirdone, the same conventional diet supplemented just with pig fat at 20 %.The cholesterol andtriacylglycerols were quantified by means of enzymatic methods in three different moments: at thebeginning of the study, after 15 days and at the end of this. The increase of body weight, once itwas finished the research, didn't show significant differences among the experimental groups. Thegroup of the combined diet increased its lipidic profile more efficiently than the group that justconsumed saturated fats, which confirms that the experimental model of induced hyperlipidaemiaby supplemented diet with casein and saturated fats is the most effective for the elevation of lipidicprofile.