Promotion of Toilet Construction and Usage in Rural Tamil Nadu: A Mixed-Methods Evaluation Study

Background: Open defecation is the leading cause for malnutrition and diarrhoeal deaths in low- and middle-income countries. The negative public health impacts of open defecation could be neutralized by toilet usage. However, the usage of improved sanitation facilities is unsatisfactory in rural India. Objectives: The study was carried out to find the psycho?social barriers among households for not having toilets and for not using the owned toilets and to develop and find out the effect of Behaviour Change Communication (BCC) strategy on toilet construction and usage. Methods: A community?based Embedded Experimental Mixed Methods study was undertaken in the four field practice villages of Urban Health Training Centre, Villupuram. For baseline and end?line surveys, 422 independent sample households who were not having or not using the toilets were selected by Simple Random Sampling. After IEC clearance, interviews and direct observation of the toilets were undertaken. Context?specific multi?faceted BCC strategy was employed through community participation. The data were analyzed in SPSS software. Chi?square test was used to determine the significance of difference and effect size was calculated to estimate the size of the difference between the baseline and end-line data. Results: Toilet ownership and utilization improved by 21.3% and 23.3% points, respectively. There was a significant reduction in households’ perceived psychosocial barriers in toilet adoption. Conclusion: Our intervention demonstrated considerable improvements in both toilet construction and usage surpassing the psycho-social barriers. Future sanitation promotion interventions should focus more on community participation and the key messages should be reinforced multiple times using different channels.

Why Villagers Use Toilets Only During Specific Time and Season? A Mixed-Methods Study in Rural Tamil Nadu

Background: Due to the efforts of sanitation promotion interventions in India, majority of the villagers started using toilets. But there is an inconsistency in toilet usage with regard to time and season. Objectives: The objectives were to determine the time and seasonal variations in toilet usage among vil-lagers who use toilets and to identify the reasons for time and seasonal variations in toilet usage. Methodology: A community-based mixed-methods study was executed in the four field practice villages of UHTC, Villupuram. After IEC clearance, 405 individuals who were using an owned toilet were selected by Simple Random Sampling. Qualitative component (free listing) was used for questionnaire develop-ment and quantitative component (survey + observation) was used for data collection. Results: Majority, 52% villagers used toilets only in the night and 64% villagers used toilets during rainy season. Fear of darkness and snakes, emergency and large family size were the common reasons for night time toilet usage. While, non-availability of open space, illness on exposure to rain and quick filling of toilet pit contributed to toilet usage in the rainy season.Conclusion: The study findings would help in the development of culturally-sensitive and socially-acceptable key messages for future sanitation promotion interventions

Post-operative analgesia of 2% lignocaine with or without magnesium sulfate for inferior alveolar nerve block in symptomatic mandibular molars - a randomized double blind controlled clinical trial

Background@#Single inferior alveolar nerve block is ineffective in achieving adequate pulpal anesthesia in 30-80% of patients due to anatomical variations, local tissue pH, central sensitization, and several factors. Various supplementary techniques and combination of adjuvants with lignocaine are used to overcome these failures. Magnesium sulfate (MgSO4), one such adjuvant, acts at the N-methyl-D-aspartate glutamate receptor resulting in effective anesthesia. The aim of this prospective, randomized, double-blind, clinical controlled trial was to evaluate the onset, anesthetic efficacy, duration and post-operative analgesia of 2% lignocaine with and without the addition of MgSO4 in patients with symptomatic irreversible pulpitis and apical periodontitis. @*Methods@#Fourty-two patients were randomly divided into three groups: 2% lignocaine (group 1) and 2% lignocaine with MgSO4 (75 mg) and (150 mg) in groups 2 and 3, respectively. Pre-operative vitals and Heft Parker–Visual Analogue Scale (HP-VAS) pain scores were recorded. The onset of anesthesia, anesthetic efficacy, and duration of anesthesia were evaluated post administration of the local anesthetic solution. The post-operative analgesia was examined at intervals of 2, 6, 12, 24, and 48 h. @*Results@#Administration of 150 mg MgSO4 hastens the onset of anesthesia (1.29 min) and produces better anesthetic efficacy (3.29 HP-VAS) compared to group 2 (2.07 min and 9.14 HP-VAS) and group 1 (3.29 min and 35.79 HP-VAS), respectively. The duration of anesthesia was significantly higher in group 3 (247.07 min) compared to that of groups 2 and 1 (190 min and 110.21 min) with P < 0.05. @*Conclusion@#Combining 75 mg or 150 mg of MgSO4 with lignocaine is more effective than 2% lignocaine and 75 mg of MgSO4 is adequate for endodontic procedures.

Síndrome de realimentación: el diagnóstico pendiente / Refeeding syndrome: the pending diagnosis

Introducción: El síndrome de realimentación (SR) puede definirse como el conjunto de alteraciones metabólicas desencadenadas tras la rápida reintroducción del soporte nutricional en pacientes severamente desnutridos o con ayuno prolongado. Puede tener repercusiones clínicas, neurológicas y cardiológicas. La hipofosfatemia es el fenómeno predominantemente asociado con el SR. Paciente masculino de 68 años con antecedentes de tabaquismo, EPOC y depresión. Ingresa a UTI por sepsis a foco respiratorio severamente desnutrido (por Valoración Global Subjetiva), con IMC 14.6 kg/m². Inicia nutrición enteral (NE) al 30% de sus requerimientos por riesgo de SR con P sérico basal de 3,9 mg/dl. Al 2do día no se dosa P ni Mg séricos, pero sí se observa K dentro de parámetros normales. Se progresa NE al 50%, y se observa al 3ro°día una disminución significativa del P a 2,1 mg/dl, llegando a 1,9 mg/dl el 4to°día, sin haber progresado aportes (K y Mg en descenso pero dentro de parámetros normales). Se carga al 4to°día con una ampolla de fosfato de potasio, evolucionando favorablemente. Objetivo: Destacar la importancia de prevenir el SR. Discusión: Se observó la repercusión bioquímica característica del SR. El momento de detección de la hipofosfatemia significativa (3ro°día) coincide con el promedio general visto en otros estudios. No hubieron signos clínicos, probablemente porque el P no tuvo un valor crítico. Como terapéutica, se utilizó la lenta progresión de aportes y la corrección de P fue tardía. Podría haber sido adecuada la suplementación de tiamina previo inicio de NE

Introduction: The refeeding syndrome (SR) can be defined as the metabolic alterations developed after a rapid nutrition repletion (oral, enteral, as well as parenteral feeding) of severely malnourished patients. It can have clinical, neurological and cardiological effects. Hypophosphatemia is the predominantl phenomenon associated with SR. A 68-year-old male patient with a history of smoking, COPD, and depression, who is admitted in ICU severely malnourished (Subjetive Global Assesment) due to sepsis at a respiratory focus, with a BMI of 14.6 kg / m². The patient initiates enteral nutrition (NE) at 30% of its requirements due to risk of SR, with baseline serum P value of 3.9 mg/dl. At day 2, no serum P or Mg is given, but K is observed within normal parameters. NE is progressed up to 50%, and a significant decrease of P at 2.1 mg/dl is observed at day 3, reaching 1.9 mg/dl at day 4, with no progress (K and Mg in decline but within normal parameters). He is loaded at day 4 with a potassium phosphate ampoule, evolving favorably. Objective: Highlighting the importance of preventing SR. Discussion: The characteristic biochemical repercussion of SR was observed. The moment of detection of significant hypophosphatemia (day 3) coincides with the general average seen in other studies. There were no clinical signs, probably because P didn´t have a critical value. As therapy, the slow progression of caloric contributions was used, and the correction of P was late. Thiamine supplementation may have been adequate prior to initiation of NE.

Loperamida en el manejo de ileostomía de alto débito. A propósito de un caso / Loperamide in the management of high-debit ileostomy. About a case

Introducción: La Ostomía de Alto Débito es una complicación frecuente y poco identificada. Se recomienda la utilización de loperamida. Sin embargo, es una indicación off label.Paciente femenino de 78 años con antecedente de una ileostomía por cáncer de colon derecho, internada por sepsis en terapia intensiva. Presenta abundante débito por ileostomía permeable.Se acuerda con médico tratante y equipo de soporte nutricional iniciar nutrición enteral y loperamida. La paciente evoluciona favorablemente y normaliza el débito.Algunos profesionales, deciden suspender la loperamida y otros disminuir la frecuencia. La paciente aumenta nuevamente la producción del débito.Se justifica el propósito de la intervención con evidencia científica y se optimiza la comunicación interdisciplinaria para asegurar la dosificación que optimiza el tratamiento. Evoluciona de forma favorable y es dada de alta. Objetivo: Destacar la importancia del trabajo interdisciplinario para el abordaje de complicaciones, dando a conocer un tratamiento efectivo en ileostomías de alto débito.Discusión:La información publicada en relación con el uso de loperamida para esta indicación es escasa. El tratamiento sigue siendo basado en la observación y la experiencia de los expertos en los centros especializados.En cuanto a la seguridad de instaurar el tratamiento, evaluando que los efectos adversos cardíacos no han sido reportados en éstos pacientes, y que éstos presentan mayor riesgo de tener eventos cardíacos secundarios a los trastornos hidroelectrolíticos concomitantes de la misma patología de base, se decidió avalar laconducta de la indicación de loperamida que mostró mejor riesgo-beneficio con respecto a la no indicación. La comunicación interdisciplinaria impacta en la mejoría clínica del paciente y en la calidad de atención brindada

ntroduction: High-output Ostomy is a frequent and poorly identified complication. The use of loperamide is recommended. However, it is an off label indication.A 78-year-old female patient with a history of an ileostomy due to right colon cancer hospitalized for sepsis in intensive care. It has an abundant flow rate due to permeable ileostomy.It is agreed with treating physician and nutritional support team to initiate enteral nutrition and loperamide. The patient progresses favorably and normalizes th flow rate.Some professionals, decide to suspend loperamide and others decrease the frequency. The patient again increases the output of the flow.The purpose of the intervention with scientific evidence is justified and the interdisciplinary communication is optimized to ensure the dosage that optimizes the treatment. Evolves favorably and is discharged.Objective: Highlight the importance of interdisciplinary work in the management of complications, revealing an effective treatment in high-output ileostomies.Discussion: The published information regarding the use of loperamide for this indication is scarce. Treatment is still based on the observation and experience of experts in specialized centers.As regard the safety of establishing the treatment, evaluating that cardiac adverse effects have not been reported in these patients, and that they are at increased risk of having cardiac events secondary to the concomitant hydroelectrolytic disorders of the same underlying disease, it was decided to endorse The behavior of the indication of loperamide that showed better risk-benefit with respect to no indication.Interdisciplinary communication impacts on the clinical improvement of the patient and on the quality of care provided

Resignificación y comprensión de la lactancia en sus actores / Redefinition and understanding of breastfeeding in its actors / Redefinição e compreensão da amamentação materna em seus atores

El presente trabajo se realiza en el marco de la investigación "Resignificación y comprensión de la lactancia en sus actores". El \r\npropósito fue identificar y describir la resignificación de la práctica de la lactancia alrededor de experiencias significativas, que \r\npermitan comprender y observar la transformación de las relaciones involucradas con la lactancia en distintas situaciones. Se \r\nrealizó un estudio cualitativo de tipo investigación/intervención, donde se hizo una aproximación a las problemáticas sociales \r\npara entender sus transformaciones en la actualidad. Se incluyeron pacientes de la consulta prenatal y pediátrica de las institu\r\n-\r\nciones prestadoras de salud: Javesalud y Colsubsidio. La información se recolectó mediante entrevistas con grupos mixtos, las cuales fueron custodiadas y agrupadas en unidades hermenéuticas asegurando su contenido; posteriormente se clasificaron en \r\ncategorías para análisis por parte de todos los investigadores, procedimiento denominado triangulación, el cual permitió la clasifi\r\n-\r\ncación final de la información en tres categorías: desnaturalización, familia, y nutrición vs. nutrir, que dan cuenta de las vicisitudes \r\nque las madres experimentan durante la lactancia y el poco acompañamiento que reciben para enfrentarlas. Se propone una \r\nreflexión alrededor de las consecuencias de dichas dificultades, tanto en el escenario de lo natural como en la desnaturalización \r\nde la lactancia: el apoyo de la pareja o la familia, las capacitaciones y el acompañamiento que los profesionales de la salud deben \r\nbrindar hacia aspectos de diferente índole para asegurar el vínculo madre-hijo. Se sugiriere modificar la metodología de los cursos \r\npsicoprofilácticos y profundizar en temas psicosociales durante el acompañamiento en la lactancia.

Introduction. This work originates in the research denomi\r\n-\r\nnated "Redefinition and Understanding of breastfeeding in its \r\nActors". Its purpose is to identify and describe the redefining of \r\nthe practice of breastfeeding through meaningful experiences \r\nthat allow the understanding and observation of the transfor\r\n-\r\nmations of the relationships among those persons involved \r\nwith breastfeeding in different situations and contexts.\r\nMethodology. A qualitative research / intervention study was \r\ncarried out, where social problems were examined in order \r\nto understand their transformations across time. Prenatal and \r\npediatric consultation patients from the health providing insti\r\n-\r\ntutions Javesalud and Colsubsidio were included. Information \r\nwas collected through mixed groups given interviews that \r\nwere guarded and grouped in hermeneutical units to ensure \r\ntheir content. Credibility was given through confirmation of \r\nfindings with participants after data collection and analysis.\r\nResults. The interviews were classified in categories for analysis \r\nby the investigators, a procedure denominated "triangulation", \r\nwhich permitted the final classification of the information into \r\nthree categories: denaturation, family, and nutrition vs. nurture \r\nwhich give an account of the vicissitudes that mothers expe\r\n-\r\nrience during breastfeeding and the little accompaniment \r\nthey receive in order to face them. Conclusions. A reflection on \r\nthe consequences generated by breastfeeding related vicis\r\n-\r\nsitudes, both at the natural scenarios of breastfeeding and at \r\nthe denaturation stage, is proposed to examine issues such \r\nas the support of breastfeeding by the partner or the family \r\nand the training and support that healthcare professionals \r\nshould provide in different aspects to safeguard the moth\r\n-\r\ner-child bond. The psycho-prophylactic courses must change \r\ntheir current methodology and deepen psychosocial aspects \r\nduring the accompaniment of lactation.

Este trabalho tem lugar no âmbito da investigação: "Rede\r\n-\r\nfinição e compreensão da amamentação materna em seus \r\natores". O objetivo foi identificar e gerar a redefinição da prática \r\nde amamentação materna por meio de técnicas significativas \r\nque permitem compreender e observar a transformação da \r\nrelação com a amamentação materna, em situações diferentes.\r\nRealizou-se um estudo qualitativo do tipo investigação/inter\r\n-\r\nvenção, onde foi realizado uma abordagem às questões sociais \r\nna busca de entendimento de suas transformações na atuali\r\n-\r\ndade. Incluíram-se pacientes da consulta pré-natal e pediátrica \r\ndas instituições de saúde Javesalud e Colsubsidio. As informa\r\n-\r\nções foram coletadas por meio de entrevistas com grupos \r\nmistos, as quais foram custodiadas e agrupadas em unidades \r\nhermenêuticas para garantir seu conteúdo. Posteriormente, \r\nforam classificadas por parte de todos os investigadores em \r\ncategorias para análise, procedimento denominado triangu\r\n-\r\nlação, o qual permitiu a classificação final da informação em \r\ntrês categorias: desnaturalização, família e nutrição vs. nutrir, \r\nque tratam das vicissitudes que as mães experimentam \r\ndurante a amamentação e o pouco de acompanhamento que \r\nrecebem para lidar com elas.\r\nPropõe-se uma reflexão sobre as consequências de tais dificul\r\n-\r\ntades, tanto no cenário natural quanto na desnaturalização da \r\namamentação: o apoio do parceiro ou da família, a formação \r\ne o acompanhamento que os profissionais de saúde devem \r\nfornecer aos diferentes aspectos para garantir o vínculo mãe-\r\nfilho. Sugere-se que os cursos psicoprofiláticos alterem a sua \r\nmetodologia atual e aprofundem questões psicossociais \r\ndurante a amamentação.

In vitro activity of the essential oil from Hesperozygis myrtoides on Rhipicephalus (Boophilus) microplus and Haemonchus contortus

ABSTRACT Commercial antiparasitics have been the main tool to control parasites, but due to the resistance development, plant extracts have been widely investigated to find new molecules. The present study aimed to investigate the in vitro acaricide and anthelmintic activities of the essential oil from the aerial parts of Hesperozygis myrtoides (A.St.-Hil. ex Benth.) Epling, Lamiaceae. The essential oil was obtained by hydrodistillation analyzed by GC-FID and GC-MS. Four tests were conducted in vitro to screen the antiparasitic action of the essential oil. The evaluation on Rhipicephalus (Boophilus) microplus was performed with the adult immersion test at concentrations ranging from 0.391 to 25 mg/ml and the larval packet test from 3.125 to 100 mg/ml. For Haemonchus contortus the egg hatch test was performed from 0.012 to 25 mg/ml and the larval development test from 0.003 to 0.4 mg/ml. The LC50 and LC90 values were calculated by Probit. The main components identified in the essential oil were isomenthone (47.7%), pulegone (21.4%), limonene (7.7%), isomenthyl acetate (6.8%) and neoisomenthol (3.9%). In the larval packet test the LC50 and LC90 were 13.5 and 21.8 mg/ml, respectively. In egg hatch test, the LC50 and LC90 were 0.249 and 0.797 mg/ml, respectively, while in the larval development test were 0.072 and 0.167 mg/ml, respectively. This is the first report of the H. myrtoides evaluation against those parasites. The anthelmintic results proved its efficacy on H. contortus encouraging new research with a focus on their main bioactives.

Demencia en pacientes adultos con síndrome de inmunodeficiencia adquirida, atendidos en el Hospital Mario Catarino Rivas / Dementia in adult patients with acquired immunodeficiency syndrome treated at Hospital Mario Catarino Rivas

Introducción: La demencia asociada al virus de inmunodeficiencia humana (D-VIH) es un tipo de demencia subcortical debido a infecciones crónicas por VIH; y combina alteraciones cognitivas, motoras y conductuales, afectando del 20 al 30% de los pacientes adultos que sufren esta enfermedad. La Escala de Demencia por VIH (EDV) es una herramienta sensible que se utiliza para tamizaje de pacientes infectados por VIH y con riesgo de desarrollar demencia. Objetivos. Aplicar la EDV en pacientes con infección avanzada por VIH que asistían al Centro de Atención Integral (CAI) del Hospital Mario Catarino Rivas (HMCR) y analizar su relación con el conteo de células TCD4 <200. Metodología. Se trata de un estudio cuantitativo, descriptivo, de corte transversal con un muestreo intencionado. En el estudio se incluyó pacientes mayores de 18 años con VIH confirmado, quienes asisten al CAI, alfabetos, con conteo reciente de linfocitos CD4 menor de 200 células y que consintieron participar en el estudio. Se les aplicó la EDV como tamizaje para evaluar su función mental. Resultados. El 81% de los pacientes entrevistados presentaron riesgo de D-VIH con un rango de edad de mayor prevalencia entre 38 y 57 años, siendo el género femenino el de mayor riesgo. Conclusión de acuerdo a los resultados obtenidos, la EDV es una herramienta costo-efectiva para determinar la función cognitiva en los pacientes...(AU)

Effectiveness of diode laser trans-scleral cyclophotocoagulation in patients following silicone oil-induced ocular hypertension in Chinese eyes.

We evaluated the effectiveness of diode laser trans-scleral cyclophotocoagulation (TSCPC) on intraocular pressure (IOP) in nine patients having raised IOP following use of silicone oil (SO) for retinal detachment (RD) surgery in a retrospective observational case series. Diode laser TSCPC was applied at a power setting of 1.75 to 2.5 watts, for two sec with a maximum of 30 applications. The patients were followed up for 40 to 312 weeks. The mean pre-laser IOP was 32.06 mm Hg (SD 7.32). The mean post-laser IOP at one month, three months and six months was 17.89 mm Hg (SD 8.23), 21.89 mm Hg (SD 8.16) and 21.67 mm Hg (SD 7.55) respectively. The final IOP (at the last follow-up) was 19.56 mm Hg (SD 7.85) (P=0.021). Seven of them had undergone SO removal. In our observation, effectiveness of TSCPC in long-term control of SO-induced ocular hypertension was limited as compared to short-term control of IOP.

Relationship of mild fatty liver, β-carotene, vitamins a and e status of periparturient Holstein cows / Relación del hígado graso leve y el estatus de β-caroteno, vitaminas A y E en vacas Holstein durante el periparto

The objectives of this study were to determine the association between mild fatty liver and β-carotene (BC), retinol (ROL), and a-tocopherol (AT) status. Multiparous Holstein cows were defined as having mild fatty liver using a threshold of 2% liver triacylglycerol (TAG, wet basis) at day (d) 2 after calving. Cows with mild fatty liver decreased dry matter intake (DMI) as a % of body weight (BW) from calving to 5th week (wk) of lactation (3.47 vs. 3.99, P = 0.02) and increased plasma nonesterified fatty acids (NEFA) concentration (345.0 vs. 266.0 µeq/dL, P = 0.10) as compared to normal cows. Fatty liver tended to lower plasma ROL (0.20 vs. 0.23 µg/mL, P = 0.10), but had no effect on plasma BC, plasma AT, liver BC, and liver ROL (P > 0.12) concentrations. However, depression in liver BC at calving was very small (8.0 vs. 68.0%) for fatty liver than for normal cows. Liver AT concentrations were greater (5.5 vs. 4.0 µg/g, P = 0.06) for cows with more than 2% liver TAG concentration. Concentration of plasma NEFA was positively correlated with plasma BC concentrations (r = 0.18, P < 0.05) and negatively correlated with concentrations of plasma ROL (r = -0.36, P < 0.0001) or AT (r = -0.35, P < 0.0001). A positive direct relationship between DMI and plasma vitamins status was found to exist only for ROL and AT, which suggests that stores of ROL or AT are less labile than stores for BC. At different times from calving, liver BC concentrations were positively correlated with liver TAG concentrations in a consistent manner but, correlations among liver ROL or liver AT concentrations and liver TAG concentrations were nonsignificants. The results suggest that the regulatory role of the liver in maintaining retinol concentrations in plasma may be compromise in cows with fatty liver.

Este estudio fue realizado con los objetivos de determinar la asociación entre hígado graso leve (HGL) y estatus de β-caroteno (BC), retinol (ROL) y a-tocoferol (AT). Para definir HGL en vacas Holstein multíparas se empleó como valor crítico el 2% de triacilgliceroles (TAG, base fresca) en el hígado al segundo día después del parto. El consumo de materia seca (CMS), como porcentaje del peso vivo, disminuyó (3,47 vs. 3,99; P = 0,02) mientras que la concentración de ácidos grasos no-esterificados (AGNE) incrementó (345,0 vs. 266,0 µeq/dL; P = 0,10), desde el parto hasta la 5ta semana de lactancia en las vacas con HGL en comparación con las vacas control. El hígado graso tuvo la tendencia a disminuir el ROL plasmático (0,20 vs. 0,23 µg/mL, P = 0,10), pero no afectó las concentraciones de BC y AT en plasma, ni las de BC y ROL hepático (P > 0,12). Sin embargo, en el parto, la caída del BC hepático fue muy pequeña (8,0 vs. 68,0%) en las vacas con HGL. Las concentraciones de AT hepático fueron mayores (5,5 vs. 4,0 µg/g, P = 0,06) en las vacas con más de 2% de TAG hepático. La concentración plasmática de AGNE tuvo una correlación positiva con las concentraciones plasmáticas de BC (r = 0,18; P < 0,05) pero negativa con las concentraciones de ROL (r = -0,36: P < 0,0001) o AT (r = -0,35; P < 0,0001) plasmático. Solo el estatus plasmático de ROL y AT evidenciaron una relación directa positiva con el CMS, lo que sugiere que los depósitos de ROL o AT son menos lábiles que los de BC. En días diferentes del postparto, las concentraciones hepáticas de BC fueron correlacionadas positivamente con las concentraciones hepáticas de TAG de una manera consistente, pero las correlaciones entre las concentraciones de ROL o AT hepático vs. las de TAG hepático no fueron significativas. Los resultados sugieren que la función reguladora del hígado para mantener las concentraciones plasmáticas de retinol puede estar comprometida en las vacas que sufren hígado graso.

Valoración del diseño curricular del programa de Salud Pública como disciplina / Assessment of the curricular design of the health public syllabus as a discipline

Se refleja una valoración del Diseño Curricular del programa de Salud Pública como disciplina que se imparte en el 5to. año de la carrera de Medicina, teniendo como base las experiencias de la aplicación del nuevo programa de la estancia de Salud Pública desde 1996 en la Facultad de Ciencias Médicas de Pinar del Río. Se considera que para su elaboración se tomaron los modelos de diseño curricular que más se acercan a los planes de estudio de la Educación Médica Superior Cubana. Se concluye que para su formulación se tuvo en cuenta el perfil de salida de nuestro egresado de Ciencias Médicas (Médico General Básico), y el tributo a la disciplina general integradora (Medicina General Integral), permitiendo el desarrollo de habilidades prácticas en la comunidad, con una organización modular y la utilización del método problémico como forma de enseñanza. Se sugiere que el método de evaluación del análisis de la situación de salud debe perfeccionarse para lograr un mayor desempeño creativo e investigativo del educando, lo cual puede materializarse utilizando la flexibilidad que facilita el programa. La sistematicidad en el funcionamiento de los colectivos de asignatura y los Comités Horizontales y Verticales garantizarán el cumplimiento de los objetivos propuestos.

Pim-1: A serine/threonine kinase with a role in cell survival, proliferation, differentiation and tumorigenesis

Pim-1 belongs to a family of serine/threonine protein kinases that are highly conserved through evolution in multicellular organisms. Originally identified from moloney murine leukemia virus (MuLV)-induced T-cell lymphomas in mice, Pim-1 kinase is involved in the control of cell growth, differentiation and apoptosis. Expression of Pim-1 kinase can be stimulated by a variety of growth factors and regulated at four different levels: transcriptional, post-transcriptional, translational and post-translational. Several signal transduction pathways may be associated with the regulation of Pim-1's expression; accumulating data support that the expression of Pim-1 protein is mediated through activation of JAK/STATs. Recent studies of Pim family kinases indicate that Pim-1 kinase plays important roles outside of the hematopoietic system as well.

Injuries after new years celebration seen at the National Orthopedic Hospital (January 1990) (With Addendum, January 1991)

By tradition, the Filipinos combine the Western New Year with the Asian custom of exploding fireworks. To estimate the number of injuries associated with fireworks, a descriptive study was done. We reviewed clinical records of outpatient and inpatients of the National Orthopedic Hospital (NOH) who sustained injuries because of fireworks from December 1, 1989 to January 6, 1990. Between December 22, 1989 and January 6, 1990 113 cases of firework injuries were seen at the NOH. One hundred eight (96%) were males. Seventy five (66%) were between 5 and 24 years. Seventy three (65%) of the cases were seen on January 1, 1990 between 12:00 midnight to 2:00 am. One hundred seven (95%) were self inflicted. Thirty four (30%) patients were hospitalized; none died. There were 178 injuries. Fifty four (48%) had multiple injuries. The hand was the body part most commonly affected. Amputation of fingers or wrists accounted 42 (24%) of the injuries; mostly in ages 5-14 years. Fractures accounted 24 (13%) of the injuries; mostly in ages 10-19 years. Avulsions accounted 23 (13%) of the injuries; mostly in ages 15-24 years. We concluded that the use of fireworks can cause debilitating injuries - - the more serious involved the age group 5-24 years. We thereby recommend that health education and preventive measures should be directed to these age group. Existing Philippine law absolutely prohibits the use of fireworks. However, this was hard to implement and illegal manufacturers make larger fireworks than when fireworks were legal. We recommend the selective legalization of small fireworks which may be more a practical way to prevent the severe injuries we documented.

Coparison of vestibular function tests / Comparación de tres pruebas de función vestibular

Se comparan tres pruebas de función vestibular, electronistagmografía (ENG), electronistagmografía de aceleración (AENG) y posturografía (EQT) en 83 pacientes com mareo, vértigo o trastornos del equilibrio. Treinta y uno (37.4 por ciento) presentaban mareo postraumático, 18 (21.7 por ciento) vértigo postural paroxístico benigno, 11 (13.3 por ciento) fístula perilinfática, 6 (7,2 por ciento) neuronitis vestibular, 4 (4.8 por ciento) emfermedad de Menière, 4 (4.8 por ciento) se diagnosticaron como vestibulopatía de origen desconocido y 9 (10.8 por ciento) pacientes se consideraron sin anormalidad vestibular. La ENG se practicó con electrodos superficiales para registrar los movimientos oculares. Incluyó las pruebas de nistagmus espontáneo, de reojo, optoquinético y postural, así como pruebas térmicas con estímulo a 30-C y 44-C. La AENG se estudió usando un sillón rotatorio alternante montado en una plataforma motorizada, en un cuarto oscuro aislado electricamente. El reflejo vestíbulo-oculomotor (VOR) se registró en tres condiciones: rotando sinusoidalmente el sillón en la oscuridad para probar el VOR, rotando el sillón con luz, rodeado por un tambor optoquinético estacionario para probar el reflejo oculmotor optovestibular (OVOR) y rotando sinusoidalmente el sillón en la obscuridad junto con un diodo luminoso frente a los ojos abiertos, para probar la supresión visual (VS). Los resultados revelaron que la ENG fue la prueba mas sensitiva para revelar anomalías (56.6 por ciento), la AENG un poco menos sensitiva (44.6 por ciento) y la EQT la menos sensitiva. Además, solo la ENG mostró especificidad respecto al sitio y al lado de la lesión. los resultados de la ENG y de la AENG se correlacionaron mejor en pacientes con mareo postraumático, vértigo postural paroxístico benigno, neuronitis vestibular, vestibulopatía de origen desconocido y enfermedad de Meniere. Esto puede ser debido porque ambas prueban respuestas del VOR en tanto que la EQT mide las respuestas del fascículo vestíbulo-espinal. Ninguna de las pruebas fue mejor que otra en el diagnóstico de fístula perilinfática. La EQT fue útil en la documentación del componente funcinal en los pacientes estudiados por mareo.