Contribution of Digital Technology to the Surgical Technique of Miniscrew Insertion: a Literature Review

Orthodontic miniscrews are used to achieve absolute anchorage. Their insertion technique is simple but must be precise to avoid intra- and postoperative complications. This study aimed to review the literature on the role of digital technology in the precise placement of miniscrews and to describe the different stages of the insertion guide manufacturing chain. The databases used were PubMed, Science Direct, and Google Scholar, including the following English descriptors: "Orthodontic Anchorage Procedures," "Cone Beam Computed Tomography." Digital technology improves the accuracy of miniscrew placement by using 3D imaging to assess the quantity and quality of bone and the proximity of anatomical structures in the area to be implanted. By combining 3D imaging with the new techniques of 3D printing and virtual planning, the orthodontist can obtain a personalized placement guide for the patient using computer-aided design and manufacturing techniques. A digitally-assisted miniscrew insertion system is a promising technique for precise and safe miniscrew insertion but cannot be used routinely. Therefore, large-scale studies are needed to map miniscrew insertion in different areas, considering ethnicity, gender, and different anatomical characteristics.

Experiencias de madres adolescentes en un programa de maternidad segura de Cartagena, Colombia / Experiences of Adolescents Mothers from a Safe Maternity Program in Cartagena, Colombia

Introducción: La atención prenatal es esencial para proveer cuidado obstétrico que permita un parto seguro, buscando minimizar riesgos para madre e hijo. Objetivo: Analizar las experiencias de madres adolescentes en relación con la importancia de control prenatal en el Programa de Maternidad Segura del Hospital Canapote, Cartagena, haciendo énfasis en la primera etapa del embarazo. Métodos: Estudio cualitativo, fenomenológico en el Hospital Canapote en Cartagena, Colombia, durante el período comprendido entre diciembre del 2019 y diciembre del 2020, basado en grupos focales de 14 madres adolescentes. La entrevista contó con aspectos sociodemográficos y experiencias en los controles prenatales, de las que emergieron los conceptos que se organizaron en categorías y subcategorías de análisis. Resultados: Las adolescentes tenían como promedio entre 16 y 17 años, solteras, de familias nucleares, bachilleres, del régimen subsidiado. Las experiencias fueron favorables, sobre todo en relación a la atención del médico y el trato empático de las enfermeras, esto ha transfigurado sentimientos negativos a positivos. Conclusiones: La experiencia de las madres adolescentes se caracterizó por la percepción positiva, lo que aportó un sentimiento de temor hasta llegar a la alegría y tranquilidad al final de los controles durante el embarazo(AU)

Introduction: Prenatal care is essential to provide obstetric care that allows a safe delivery, seeking to minimize risks for the mother and her child. Objective: To analyze the experiences of adolescent mothers regarding the importance of prenatal care in the safe motherhood program of Canapote Hospital, Cartagena. Methods: A qualitative and phenomenological study was carried out at Canapote Hospital in Cartagena, Colombia, during the period from December 2019 to December 2020, based on focus groups of fourteen adolescent mothers. Sociodemographic aspects and experiences regarding prenatal checkups were included in the interview, from which concepts emerged that were organized into categories and subcategories of analysis. Results: The adolescents were 16-17 years old on average, single, from nuclear families, senior high school graduates, under subsidized regime. The experiences were favorable, especially in relation to the doctor's care and the nurses' kind treatment, which has turned negative feelings into positive ones. Conclusions: The experience of adolescent mothers was characterized by positive perception, which brought a feeling of fear until reaching joy and tranquility at the end of the checkups during pregnancy(AU)

A description of sodium valproate, lamotrigine and levetiracetam consumption in the Western Cape public sector

The rational use of medicine is fundamental to ensure effective and safe patient medicine treatment, and hence, should be monitored. Undisputable evidence exists for the teratogenic risk factors associated with sodium valproate. Consequently, the Western Cape Department of Health introduced a policy (2019) recommending alternatives for valproate in women of childbearing age, including lamotrigine or levetiracetam as alternatives for patients on antiretrovirals. This study aimed to describe the change in the consumption of valproate, lamotrigine and levetiracetam after a policy implementation in public sector health facilities of the Western Cape, South Africa. Methods: This observational study followed a quasi-experimental design. Consumption data from the Cape Medical Depot over the period 01 April 2018 to 31 March 2020 were analysed retrospectively. Consumption was presented as a defined daily dose (DDD) per 1000 population per quarter for sodium valproate, levetiracetam and lamotrigine for the Western Cape province, urban and rural areas. Consumption 12 months before was compared with consumption 12 months after policy implementation. Results: Post-policy implementation, valproate consumption remained unchanged provincially (3.3%; p = 0.255), in urban (7.8%; p = 0.255) and rural (1.5%; p = 0.701) areas. Lamotrigine consumption increased significantly provincially (30.7%; p = 0.020) and in urban areas (54.5%; p = 0.002); however, rural (26.1%; p = 0.108) areas did not show significant change. Provincially, valproate consumption remained substantially higher (209 DDDs/1000 population per quarter) compared with lamotrigine consumption (32.22 DDDs/1000 population per quarter). Conclusion: In the Western Cape public sector, the consumption of sodium valproate remained unchanged 12 months after policy implementation. Although there were significant increases in lamotrigine and levetiracetam consumption, the consumption was considerably less compared with sodium valproate consumption.

Estrategias para el control de los riesgos biológicos y accidentabilidad en el personal asistencial y administrativo en una clínica de tercer nivel de Santa Marta (Colombia) / Strategies for the Control of Biological Risks and Accident Rates in Healthcare and Administrative Personnel in a Third-Level Clinic in Santa Marta (Colombia)

RESUMEN Objetivo: Diseñar estrategias para el control de los riesgos biológicos y accidentabilidad en el personal asistencial y administrativo en una clínica de tercer nivel en la ciudad de Santa Marta (Colombia). Metodología: El diseño de la investigación corresponde a un enfoque descriptivo de corte transversal propositivo. La población objeto de estudio fue de 150 personas, y una muestra poblacional de 39 casos de personas con riesgos biológicos, las cuales cumplieron criterios de inclusión representados en el talento humano del área asistencial administrativa que labora en la clínica. Resultados: Se evidenció que en el periodo de enero-diciembre de 2017 y 2018, el área asistencial es la población más afectada, con una participación de 59 % para las auxiliares de enfermería y un 7,7 % para médicos y enfermeras simultáneamente, y las manos son la parte del cuerpo con mayor afectación (82,1%). Conclusión: Los resultados demuestran la necesidad de implementación de estrategias de prevención, enfocadas en fortalecer el conocimiento de las buenas prácticas asistenciales que mitiguen la exposición a riesgos biológicos y accidentabilidad en el personal con mayor vulnerabilidad.

ABSTRACT Objective: To apply strategies for the control of biological risks and accident rates in the healthcare and administrative staff of a third level clinic in the city of Santa Marta, Colombia. Methodology: The research design corresponds to a descriptive, cross-sectional approach. The population under study is comprised of 150 people, and the sample is made of 39 cases of persons with biological risks, who met inclusion criteria represented in the human talent of the administrative assistance area that works in the clinic. Results: It was evident that in the January-December period of the years 2017 and 2018, the healthcare area is the most affected population, with a participation of 59% for the nursing auxiliaries, and 7.7% for doctors and nurses simultaneously. The hands are the most affected part of the body, at 82.1%. Conclusion: The results demonstrate the need to implement prevention strategies, focused on strengthening the knowledge of good healthcare practices that mitigate exposure to biological risks and accident rates in the most vulnerable personnel.

La técnica de modelamiento y el tratamiento penitenciario: el caso de los internos extranjeros de difícil readaptación por tráfico ilícito de drogas en el establecimiento penitenciario Ancón II, Lima, Perú / The Modeling Technique and Penitentiary Treatment: the Case of Foreign Inmates Imprisoned due to Illegal Drug Trafficking with Rehabilitation Difficulties in the Ancón II Detention Facility, Lima, Peru / Técnica de modelagem e tratamento penitenciário: o caso do presidiários estrangeiros de difícil readaptação devido ao tráfico de drogas na penitenciária Ancón II, Lima, Peru

Resumen El establecimiento penitenciario Ancón II fue designado como "modelo" para reorientar el tratamiento penitenciario basado en técnicas modernas; por ello, recibió internos por tráfico ilícito de drogas de difícil readaptación que llegaron desde el establecimiento penitenciario del Callao. En el diagnóstico criminológico se observó renuencia a participar en las acciones psicológicas, desinterés por actividades laborales o educativas, e inadecuado arreglo personal. La investigación aplicada tuvo como objetivo proporcionar el tratamiento penitenciario. Usó como metodología la técnica de reforzamiento positivo y modelamiento. La población estuvo conformada por 67 internos, quienes decidieron participar voluntariamente en el proyecto. Los resultados muestran que el 91% de los internos alcanzó un cambio conductual significativo durante y después de participar en el proyecto Programa Integral de Tratamiento para Extranjeros en Reclusión (P.I.T.E.R.). Se concluyó que la aplicación de las técnicas conductuales facilita la participación en el tratamiento penitenciario por parte de internos extranjeros de difícil readaptación por tráfico ilícito de drogas.

Abstract The Ancón II detention facility was designated as the "model" for redirecting penitentiary treatment based on modern techniques: for this reason, it received inmates imprisoned due to illegal drug trafficking with Rehabilitation Difficulties from the Callao detention facility. Reluctance to participate in psychological actions, a lack of interest in work or educational activities and inadequate personal grooming were observed in the criminological diagnosis. The objective of the applied research was to provide penitentiary treatment. It used the positive reinforcement and modeling techniques as its methodology. The population was 67 inmates, who voluntarily decided to participate in the project. The results showed that 91% of inmates achieved a significant behavioral change while and after participating in the Comprehensive Treatment for Imprisoned Foreigners Program (P.I.T.E.R.) project. It was concluded that applying behavioral techniques facilitates the participation of foreign inmates imprisoned due to illegal drug trafficking with rehabilitation difficulties in penitentiary treatment.

Resumo A penitenciária Ancón II foi designada como "modelo" para reorientar o tratamento penitenciário com base em técnicas modernas; por isso, recebeu presos por tráfico ilícito de drogas de difícil readaptação que chegaram da penitenciária de Callao. No diagnóstico criminológico observou-se relutância em participar nas ações psicológicas, desinteresse pelas atividades de trabalho ou educacionais e cuidados pessoais inadequados. A pesquisa aplicada teve como objetivo proporcionar o tratamento penitenciário. Usou como metodologia a técnica de reforço positivo e a técnica de modelagem. A população esteve composta por 67 presidiários que decidiram participar voluntariamente do projeto. Os resultados mostram que 91% dos reclusos conseguiram uma mudança comportamental significativa durante e após a participação no projeto Programa Integral de Tratamento para Estrangeiros em Reclusão (P.I.T.E.R.). Concluiuse que a aplicação de técnicas comportamentais facilita a participação em tratamento penitenciário de presidiários estrangeiros de difícil readaptação pelo tráfico ilícito de drogas.

Internacionalización en el desarrollo de Recursos Humanos a Nivel de Posgrado en Salud Pública en Meso América / Internacionalization of Human Resources development at Posdegree level on Public Health in Meso American Region

Desde 1982 hasta 2017, el CIESUNAN Managua ha entregado a la Región Meso Americana um aproximado de 1532 Profesionales Graduados de Posgrado, donde el 64% son mujeres, y el resto varones. 930 son nicaragüenses (60.7%), y el resto son graduados de otros países de la Región Mesoamericana. Estos Graduados han aprobado uno o más de los cinco programas de Maestrías (Administración de la Salud y Epidemiología desde 1982, Salud Pública desde 1990, Economía de la Salud desde 2005 y Salud Ocupacional desde 2010). En el 2015 es abierto el Programa de Doctorado en Ciencias de la Salud. La Gestión Institucional basada en la Extensión Universitaria y la Internacionalización se constituyen en las bases imprescindibles de la Formación de Recursos Humanos en ambientes complejos y a veces hasta conflictivos. Es posible identificar diferentes momentos o kayros en los 35 años del CIES, y deducir las lecciones aprendidas en este proceso, condición necesaria para comprender y emprender los retos del futuro de la Educación de Posgrado en Salud Pública en función del impacto tecnológico y epistemológico que caracteriza a la determinación social de la Salud y la necesaria Intersectorialidad a construir en el marco de la Iniciativa Salud en Todas las Políticas y de los Objetivos de Desarrollo Sostenibles. Se exploran los diferentes períodos (kayros) de desarrollo y las lecciones aprendidas en cada uno de ellos, especialmente en los aspectos relacionados con la internacionalización de estos procesos, las relaciones establecidas con los actores surgidos y los espacios abiertos en estos processos.

From 1982 to 2017, CIESUNAN Managua has delivered to the Mesoamerican Region approximately 1532 Graduate Graduates, where 64% are women. Among those graduates, 930 are Nicaraguans (60.7%), and the rest are graduates coming from other countries of the Mesoamerican Region. These Graduates have approved one or more of the five Master's programs (Health Administration and Epidemiology since 1982, Public Health since 1990, Health Economics since 2005 and Occupational Health since 2010). In 2015 the Doctorate Program in Health Sciences is opened. Institutional Management based on University Extensionand Internationalization constitute the essential bases of Human Resource Training in complex and sometimes even conflicting environments. It is possible to identify different moments or kayros in the 35 years of the CIES, and to deduce the lessons learned in this process, a necessary condition to understand and undertake the future challenges of Postgraduate Education in Public Health according to the technological and epistemological impact that characterizes to the social determination of Health and the necessary intersectorality to be built within the framework of the Health Initiative in All Policies and the Sustainable Development Goals. It explores the different development periods and lessons learned in each one of them, especially in the aspects related to the internationalization of these processes, the established relationships with the actors that have emerged and the open spaces in these processes

Centro de Investigaciones y Estudios de la Salud: 37 años fortaleciendo la salud pública em Centroamérica / Centro de Pesquisas e Estudos da Saúde: 37 anos fortalecendo a saúde pública na América Central / Center for Research and Studies of the Health: 37 years strengthening public health in Central America

Este libro es el resultado de una alianza institucional del Centro de Investigación y Estudios en Salud (CIES), de la Universidad Nacional Autónoma de Nicaragua, Managua (UNAN Managua), con la Associação Brasileira da Rede Unida, a través de su Editorial. Fue organizado, editado, diseñado y lanzado en el contexto del 37 Aniversario del CIES UNAN Managua, una institución académica siempre comprometida con el desarrollo de recursos humanos a través de la capacitación de profesionales y líderes comunitarios en salud para Nicaragua y Centro América, y con el intercambio de conocimientos y tecnología para fortalecer la salud como un derecho humano. La producción de este libro ha sido posible gracias al apoyo fundamental de la Organización Panamericana de la Salud, Organización Mundial de la Salud a través de su Representación en Nicaragua, lo cual agradezco profundamente. El presente libro llega a las manos de los lectores con los resultados del análisis y evaluaciones producidas y compartidas por diferentes actores de esta historia, permitiendo ver un poco más allá en el futuro. A medida que las políticas públicas y la salud de las personas y las comunidades se enfrentan a desafíos cada vez más complejos en el planeta, así también nos esforzamos cada vez más por desarrollar y proporcionar nuevos niveles de pensamiento y capacidades humanas para el trabajo dentro de los sistemas y servicios de salud.

Consumo de alimentos funcionales por estudiantes universitarios ecuatorianos / Consumption of functional foods by Ecuadorian university students

El consumo de alimentos funcionales durante la etapa de estudiantes universitarios es crucial para asegurar un consumo adecuado de nutrientes, por esta razón, el objetivo de esta investigación fue determinar el consumo de alimentos funcionales en estudiantes universitarios ecuatorianos. El marco poblacional estuvo constituido por todos los estudiantes del primer nivel (111) y del décimo año (59) de la carrera de medicina periodo 2018-2019. Los resultados muestran que el 51,1% de los estudiantes ecuatorianos declararon consumir siempre o casi siempre vegetales con compuestos bioactivos. Al comparar su consumo entre el primero y décimo nivel no se observaron diferencias significativas (P> 0,05). El vegetal de mayor consumo fue la zanahoria seguido por brócoli y productos a base de tomate. El 78,2% de los estudiantes manifestó consumir siempre o casi siempre frutas; entre las frutas de mayor consumo está la manzana (89,4%), seguida de los frutos rojos, duraznos, mango y kiwi. El consumo de manzana entre los estudiantes del primero y décimo nivel mostró diferencias significativas (P< 0,05). Solo un pequeño porcentaje de estudiantes manifestó consumir semillas oleaginosas como linaza y chía. Las lentejas, el frijol y los garbanzos son las legumbres consumidas con más frecuencia. Los estudiantes casi nunca o nunca consumen frutos secos. La mayoría (72,0%) de los estudiantes manifestó que siempre consumían yogurt con probióticos. Un elevado porcentaje de estudiantes universitarios consume alimentos con propiedades funcionales debido a sus compuestos bioactivos como fitoquímicos, polifenoles, carotenoides y vitaminas que pueden prevenir o reducir el riego de enfermedades importantes(AU)

Functional foods during the stage of university study is crucial to ensure an adequate intake of nutrients for this reason, the objective of this research was to determine the consumption of functional food in Ecuadorian students. The population frame was constituted by all the students of the first and tenth level of medical career period 2018-2019. The results show that the 51.1% of Ecuadorian surveyed students stated that always or almost always consume vegetables with bioactive compounds. When comparing their consumption between the first and the tenth level no significant differences (P> 0.05) were observed. The vegetable with the highest consumption was carrots, followed by broccoli and tomato- based products. The 78.2% of the students stated that always or almost always consume fruits. Among the fruits with the highest consumption is the apple (89.4) followed by red fruits, peaches and nectarines, mango, and kiwi. Apple consumption among first and tenth level students showed significant differences (P< 0.05). Only a small percentage of students reported consuming oilseeds as flaxseed and chía. Lentils, beans and chickpeas are the most commonly consumed legumes. Students almost never or never consume nuts. A high percentage (72.0%) student stated that they always consumed yogurt with probiotics. Most of students consume foods with functional properties due to its bioactive compounds such as phytochemicals, polyphenols, carotenoids and vitamins that can reduce the risk of major diseases(AU)

Chemical composition of propolis extract and its effects on epirubicin-induced hepatotoxicity in rats

ABSTRACT Propolis is a natural substance, produced by honeybees from the resin of various plants. The purpose of this study was to determine the chemical composition and evaluate the hepatoprotective effect of ethyl acetate extract of propolis from Tigzirt, against the toxicity induced by epirubicin which is a anticancer agent, and belongs to the family of antracyclines. The study included thirty male Wistar albino rats divided into five groups. The rats received the extraction of propolis or the quercetin orally for 15 days. The hepatotoxicity was promoted by injection epirubicin (i.v.) with a cumulative dose of 9 mg/kg. Several biological parameters were measured. Oxidative status was also assessed by evaluating antioxidant enzyme and histological study of some organs. Epirubicin caused oxidative stress by a significant decrease in hepatic antioxidant enzymes (gluthation peroxidase, catalase, superoxide dismutase), increased malondialdehyde and liver parameters (ASAT, ALAT, γGT, ALP) compared to the control. The histological study revealed major damage to the liver. Perturbations in this liver function, antioxidant status and damage to the liver by epirubicin have been repaired by the administration of propolis. Furthermore, epirubicin showed inflammatory effects induced by an increase in TNF-α and PGE2. Pretreatment with propolis to rats restored these inflammatory parameters. The chemical identification of extract of propolis by HPLC/UV shows the presence of polyphenolic compounds and many flavonoids. The propolis extract showed a significant reduction in oxidative damage from oxidative stress and a very important protective effect against epirubicin-induced hepatotoxicity.

La virtualización en programas de postgrado: experiencia del CIES UNAN MANAGUA 2010-2017 / Virtualization in postgraduate programs: experience of CIES UNAN MANAGUA 2010-2017

El CIES-UNAN Managua ha desarrollado una tendencia hacia la virtualización de los Programas de Estudios de Postgrado en Salud Pública (5 programas de Maestría -Salud Pública, Administración de la Salud, Epidemiología, Salud Ocupacional, Economía de la Salud- y uno de Doctorado en Ciencias de la Salud) en el último decenio de sus 35 años de servicio. Motivado en las necesidades de sus usuarios (Profesionales de la Salud de la Región Meso Americana, especialmente de Nicaragua, Honduras y El Salvador), surgidas de factores que impulsan un cambio permanente en sus necesidades, ha ido incorporando la Tecnología y la Metodología necesaria para que esta evolución sea siempre en función de las necesidades de los usuarios. Esto ha sido mediado a través de Modalidades mixtas. Los avances evidenciados en este estudio parten del diagnóstico sobre el uso de la tecnología de los estudiantes activos en los programas académicos de Postgrado, llegando a una valoración de los espacios virtuales de aprendizaje a partir de criterios presentes en la literatura existente sobre el tema. Se evidencia la satisfacción de los Estudiantes específicamente en los elementos de virtualización que han sido implementados. El conocimiento previo de la tecnología por su parte permite una mejor utilización de las Plataformas. También es notoria la Evolución satisfactoria de los hábitos de búsqueda de Información de los Estudiantes en Internet, acompañado con el desarrollo de competencias con el aprovechamiento de la Tecnología, lo que les ha permitido emigrar hacia Plataformas y Sitios más reconocidos y más confiables

The CIES-UNAN Managua has developed a trend towards the virtualization of the Postgraduate Studies Programs in Public Health (5 Master's programs - Public Health, Health Administration, Epidemiology, Occupational Health, Health Economics - and one Doctorate in Health Sciences) in the last decade of his 35 years of service. Motivated in the needs of its users (Health Professionals of the Meso-American Region, especially in Nicaragua, Honduras and El Salvador), arising from factors that drive a permanent change in their needs, it has incorporated the Technology and Methodology necessary to that this evolution is always based on the needs of users. This has been mediated through mixed Modalities. The advances evidenced in this study are based on the diagnosis of the use of technology by active students in postgraduate academic programs, reaching an assessment of virtual learning spaces based on criteria present in the existing literature on the subject. The satisfaction of the Students is evidenced specifically in the elements of virtualization that have been implemented. The prior knowledge of the technology allows a better use of the Platforms. It is also notorious the satisfactory evolution of student's information search habits on Internet, accompanied by the development of skills on the use of technology, which has allowed them to migrate to more recognized and reliable platforms and sites.

Percepción del diagnóstico laparoscópico desde la perspectiva de habilidad profesional para el médico gastroenterólogo / Percepção do diagnóstico por laparoscopia na perspectiva da habilidade profissional do gastroenterologista / Perception of laparoscopic diagnosis from the perspective of professional skill for the gastroenterologist

Introducción: la calidad de la formación del residente es una exigencia social. Objetivo: diseñar una vía para favorecer la apropiación del diagnóstico laparoscópico (DL) por el residente de Gastroenterología (RG) desde la perspectiva de habilidad profesional. Método: se realizó un estudio con enfoque cualitativo en la Facultad de Medicina de Guantánamo durante el curso 2018-2019. Se emplearon métodos teóricos (analíticosintético e inductivo-deductivo, modelación); empíricos (análisis documental, la encuesta, criterio de especialistas) y matemáticos estadísticos (cálculo de porcentajes). Resultados: el 100 por ciento de los profesores encuestados reconocieron que se manifiestan insuficiencias en la preparación del RG para la realización del DL, en lo que influyó la limitada percepción del DL como habilidad para el gastroenterólogo. Se modeló teóricamente el desarrollo de la habilidad diagnóstico laparoscópico y el 100 por ciento de los profesores consultados consideraron que podría ser instrumentado en la práctica pedagógica. Conclusiones: se modeló didácticamente la preparación del residente para la realización del diagnóstico laparoscópico, lo que puede contribuir a un cambio didácticometodológico cualitativamente superior en el proceso de enseñanza aprendizaje en la especialización en Gastroenterología(AU)

Introduction: the quality of the resident's education is a social requirement. Objective: to design a way to favor the appropriation of laparoscopic diagnosis (DL) by the resident of gastroenterology (RG) from the perspective of professional skill. Method: a qualitative study was conducted at the Faculty of Medicine of Guantánamo during the 2018- 2019 academic year. Theoretical methods were used (analytic-synthetic and inductive-deductive, modeling); empirical (documentary analysis, the survey, criteria of specialists) and statistical mathematicians (calculation of percentages). Results: 100 per cent of the professors surveyed acknowledged that insufficiencies were manifested in the preparation of the GR for the realization of DL, which was influenced by the limited perception of laparoscopic diagnosis (DL) as a skill for the gastroenterologist. The development of the laparoscopic diagnostic skill was theoretically modeled and 100 per cent of the professors consulted considered that it could be instrumented in the pedagogical practice. Conclusions: the preparation of the resident was modeled didactically for laparoscopic diagnosis, which can contribute to a qualitatively superior didactic-methodological change in the teaching-learning process in the specialization in Gastroenterology(AU)

Introdução: a qualidade da educação do residente é uma exigência social. Objetivo: conceber uma forma de favorecer a apropriação do diagnóstico laparoscópico (DL) pelo residente de gastroenterologia (GP) na perspectiva da habilidade profissional. Método: um estudo qualitativo foi realizado na Faculdade de Medicina de Guantánamo durante o ano letivo de 2018-2019. Métodos teóricos foram utilizados (analítico-sintético e indutivo-dedutivo, modelagem); empírica (análise documental, a pesquisa, critérios de especialistas) e matemáticos estatísticos (cálculo de porcentagens). Resultados: 100 por cento dos professores pesquisados reconheceram que as inadequações se manifestaram no preparo do GR para a realização do DL, no qual a limitada percepção do diagnóstico laparoscópico (DL) como habilidade do gastroenterologista influenciou. O desenvolvimento da habilidade diagnóstica laparoscópica foi modelado teoricamente e 100 por cento dos professores consultados consideraram que ela poderia ser instrumentada na prática pedagógica. Conclusões: a preparação do morador foi modelada didaticamente para o diagnóstico laparoscópico, o que pode contribuir para uma mudança didáticometodológica qualitativamente superior no processo de ensinoaprendizagem na especialização em Gastroenterologia(AU)

Health Related Quality of Life, Disability, and Pain in Alpha Mannosidosis: Long-Term Data of Enzyme Replacement Therapy With Velmanase Alfa (Human Recombinant Alpha Mannosidase)

Abstract Alpha-mannosidosis, a rare lysosomal storage disorder caused by deficiency of the lysosomal enzyme alpha-mannosidase, results in accumulation of mannose-rich glycoproteins in the tissues and sequelae leading to intellectual disability, ataxia, impaired hearing and speech, recurrent infections, skeletal abnormalities, muscular pain, and weakness. This study aimed to investigate disability, pain, and overall health using the Childhood Health Assessment Questionnaire (CHAQ) and the EuroQol 5 Dimension-5 Level Questionnaire (EQ-5D-5L) in patients with alpha-mannosidosis participating in rhLAMAN-10, a phase III open-label, clinical trial of velmanase alfa, a recombinanthumanlysosomalalpha-mannosidase. Long-termprognosesformost patients withuntreatedalpha-mannosidosisarepoor due to progressive neuromuscular, skeletal, and intellectual deterioration, leading to increased dependence in mobility and activities of daily living and increased caregiver and health-care burden. Long-term CHAQ and EQ-5D-5L data highlight improvement trends in health-related quality of life and a reduction in disability and pain in patients receiving up to 48 months of velmanase alfa treatment.

Monitor of water quality using the grey mullet [mugil cephalus] as bioindicator in two egyptian lakes

Background-Burullus Lake has brackish water and agricultural, industrial and sewage drainage water represent the major inflows and it represents one of the most subjected lakes to serious pollutants at the delta's coastline. Mugil cephalus is one of the most important food fish species for the Egyptian people. This study was conducted to explain the effect of water pollution of both Qarun and Burullus Lakes on some biochemical and histological characteristics of mullet collected from both Lakes. Our results showed that water collected from Burullus Lake has higher levels of lead and cadmium than Qarun Lake. The liver function analysis showed that there were no significant differences between levels of GGT in M. cephalus livers collected from both Lakes. ALT and AST were significantly increased in livers of fishes collected from Qarun Lake than Burullus Lake, cholesterol, triglycerides, RF1, RF2, high density lipoproteins [HDL], low density lipoproteins [LDL] and very low density lipoproteins [VLDL] in muscles of the mullet collected from Burullus Lake were highly significant increase, while total proteins were significantly decreased in comparison with mullet of Qarun Lake. Histopathological investigations revealed that livers of mullet cached from both Lakes were suffered from marked area of hemorrhage, aggregates of hemosiderin granules and vacuolated hepatocytes. Ultrastructural observation showed degenerated and swelled cylindrical mitochondria in liver obtained from Burullus Lake with accumulation of lipid droplets and degenerated cytoplasmic organoids. Hepatocyte from Qarun Lake showed apoptotic nuclei, degenerated, swelled and cylindrical mitochondria, lipid droplets and dilated rough endoplasmic reticulum. Von Kupffer cells in liver of both lakes contained abundant lysosomes with corrugated walls and numerous cytoplasmic vacuoles. The kidney sections of mullet of both Lakes showed necrosis in the tubular epithelial lining with scattered apoptotic cells and interstitial inflammatory infiltrate

Efectividad de láser en el tratamiento de pacientes con síndrome dolor disfunción de la articulación temporomandibular / Eficácia do laser no tratamento de pacientes com síndrome da dor disfunção temporomandibular / Effectiveness of laser in the treatment of patients with pain syndrome temporomandibular joint dysfunction

Introducción: el síndrome de disfunción temporomandibular, es una alteración que comprende un conjunto de signos y síntomas relacionados con las estructuras del sistema estomatognático. Objetivo: determinar la efectividad del tratamiento conjunto de láser y terapia de apoyo medicamentosa, aplicadas a los pacientes con el síndrome dolor disfunción de la articulación temporomandibular. Método: se realizó una intervención terapéutica en 84 pacientes que asistieron a la consulta de prótesis de la Clínica Estomatológica "Julio Antonio Mella" de Guantánamo, en el período comprendido entre septiembre de 2014 al mismo mes de 2015. Se conformaron dos grupos terapéuticos: uno recibió láser y terapia de apoyo medicamentosa y, el otro, terapia de apoyo medicamentosa, cada grupo con 42 pacientes que fueron evaluados a los 5, 10 y 15 días. Se tomaron en cuenta variables generales y clínicas: edad, grado de severidad, comportamiento del dolor y criterios de evaluación. Resultados: la terapia combinada de láser y terapia medicamentosa resultó ser más efectivo que la terapia medicamentosa, al desaparecer la sintomatología en un período de tiempo menor. Conclusiones: se validó que el tratamiento combinado de láser y terapia de apoyo medicamentosa resultó más efectivo al desaparecer progresivamente la sintomatología en un periodo de tiempo menor, en relación a los que se les aplicó el tratamiento convencional y por tanto es factible su aplicación(AU)

Introduction: temporomandibular dysfunction syndrome is an alteration that includes a set of signs and symptoms related to the structures of the stomatognathic system. Objective: to determine the effectiveness of the joint treatment of laser and drug support therapy, applied to patients with pain syndrome temporomandibular joint dysfunction. Method: a therapeutic intervention was carried out in 84 patients who attended the prosthesis consultation of the "Julio Antonio Mella" Stomatology Clinic in Guantánamo, in the period from September 2014 to the same month of 2015. Two therapeutic groups were formed: one received laser and drug support therapy and, the other, drug support therapy, each group with 42 patients who were evaluated at 5, 10 and 15 days. General and clinical variables were taken into account: age, degree of severity, pain behavior and evaluation criteria. Results: the combination therapy of laser and drug therapy proved to be more effective than drug therapy, as the symptoms disappear in a shorter period of time. Conclusions: it was validated that the combined treatment of laser and drug support therapy was more effective as the symptomatology progressively disappeared in a shorter period of time, in relation to those that were treated with conventional treatment and therefore its application is feasible(AU)

Introdução: a síndrome de disfunção temporomandibular é uma alteração que inclui um conjunto de sinais e sintomas relacionados às estruturas do sistema estomatognático. Objetivo: determinar a eficácia do tratamento articular da terapia de suporte a laser e medicamentosa, aplicada a pacientes com disfunção temporomandibular da síndrome da dor. Método: intervenção terapêutica em 84 pacientes atendidos no ambulatório de prótese de Estomatologia "Julio Antonio Mella" Clinic Guantanamo no período de setembro de 2014 para 2015. mês foi realizada foram organizados dois grupos de tratamento: um receberam laser e terapia de suporte medicamentoso e, o outro, terapia de suporte medicamentoso, cada grupo com 42 pacientes que foram avaliados aos 5, 10 e 15 dias. Variáveis gerais e clínicas foram consideradas: idade, grau de severidade, comportamento de dor e critérios de avaliação. Resultados: a terapia combinada de laser e terapia medicamentosa mostrou-se mais eficaz que a terapia medicamentosa, pois os sintomas desaparecem em menor tempo. Conclusões: é validado que o laser de tratamento combinado e terapia de droga foi mais eficaz para apoiar sintomas em fases num curto período de tempo, em relação aos quais foram aplicados o tratamento convencional, e, portanto, a sua aplicação é viável(AU)

Harmful effects of water pollution on some physiological responses of the nile tilapia [oreochromis niloticus] in both Qarun and Burullus lakes

Background: Qarun and Burullus Lakes suffer from serious pollution problems owing to the enormous input of untreated agricultural, domestic and industrial effluents. This study was conducted to explain the effect of water pollution of these lakes on some physiological parameters of O. niloticus

Results: Showed clearly that water collected from both Qarun and Burullus Lakes were contaminated with high levels of lead and cadmium. The concentration of Pb and Cd in Lake Qarun [0.074 and 0.006 ppm respectively] were much lower than that of Burullus Lake [0.112 and 0.011ppm respectively]. The study showed that the rates of Pb bioaccumulations were increased significantly in the muscles of O. niloticus collected from Brurllues Lake than that of Qarun Lake. It can be seen also that there are insignificant differences of Cd concentrations in muscles of tilapians collected from both Lakes. Analysis of liver functions shwoed a highly significant increase in the level of ALT in O. niloticus liver collected from Brurllues Lake than tilapia'sb liver from Qarun Lake. Both AST and GGT levels were insignificantly changed in fishes collected from both Lakes [no change in the table]. Investigation of kidney functions of tilapias collected from Qarun and Burullus Lakes showed that urea concentration was significantly increased in kidney of Tilapia gathered from Burullus Lake [32.40 +/- 0.93 mg/dl] than those collected from Qarun Lake [28.80 +/- 0.73 mg/dl]. Creatinine concentrations were significantly increased in kidney of tilapias gathered from Burullus Lake than Qarun Lake. Cholesterol, Triglycerides, high density lipoproteins [HDL], low density lipoproteins [LDL], and very low density lipoproteins [VLDL] in the muscles of tilapians collected from Burllues Lake were highly significant increase while total proteins were significantly decreased in comparison with tilapians of Qaron Lake

Sindrome de Marshall- Smith en mujer adulta: nuevos retos en anticoncepción / Marshall-Smith syndrome in an adult woman: new challenges in contraception

Se presenta el caso de una mujer de 38 años con Síndrome de Marshall-Smith. Se trata de una enfermedad rara de etiología desconocida, cuyas características incluyen anomalías craneofaciales, maduración ósea acelerada, alteraciones en el desarrollo neurológico y en las vías respiratorias con compromiso de la vía aérea y escasa supervivencia a largo plazo debido a problemas respiratorios. Sin embargo, los avances en el soporte respiratorio han permitido que algunos pacientes lleguen a la etapa adulta. Nuestra paciente, sin retraso intelectual ni psicomotor, solicita método anticonceptivo. Los pacientes con enfermedades raras necesitan ser atendidos con especial dedicación intentando reducir al mínimo la transmisión genética de dichas entidades, y mejorando al máximo su calidad de vida. Se ofrece un método anticonceptivo reversible de larga duración, sin riesgos para la evolución de su patología respiratoria, y atendiendo a los criterios medicos de elegibilidad de método anticonceptivo de la OMS, se indica la utilización de un implante subdérmico de etonogestrel. Con un perfil de seguridad y farmacocinética equivalente a los métodos de solo gestágeno y mayor comodidad.

A 38-year-old female patient with a history of Marshall-Smith syndrome is reported. It is a rare congenital disorder of unknown aetiology, which features include craneo facial dysmorphism, accelerated bone maturation, neurodevelopmental abnormalities, and upper and lower airways compromise. Long term survival is a problem due to respiratory complications, but it has decreased since airway support has improved, and that allows survival into adulthood. Our patient has neither intelectual nor psychomotor delay, so she asks for contraception method. As a rare genetic condition it needs to be attended with special consideration in order to reduce the disorder's transmission and to increase the life's quality of patients. A secure contraception method should be offered with no risk at all, attending to medical elegibility criteria for contraception use. We considered progestogen-only options and the patient's choice was etonogestrel subcutaneous implant.

Relación clonal y detección del gen blaKPC en cepas de Klebsiella pneumoniae resistentes a carbapenémicos, en un hospital de Venezuela / Clonal relationship and detection of blaKPC gene in strains of Klebsiella pneumoniae resistant to carbapenems, at a hospital in Venezuela

In order to study the clonal relationship and blaKPC gene detection in clinical isolates of Klebsiella pneumoniae resistant to carbapenems, we analyzed 22 clinical isolates of K. pneumoniae with resistance to imipenem and/ or meropenem, isolated in the laboratory of bacteriology at the University Hospital "Antonio Patricio de Alcalá" (HUAPA) from the Cumana city, Sucre state, Venezuela, for a period of five consecutive years. Susceptibility to different antimicrobials was determined, and the presence of carbapenemases was detected by modified Hodge method, phenyl boronic acid synergy and combination discs. blaKPC gene detection was conducted by polymerase chain reaction and the clonal relationship was determined by pulsed field electrophoresis. High rates of antimicrobial resistance were found, five strains were negative, at least one phenotypic method, and all carried the blaKPC gene. Clonal spread was observed only in the intensive care unit (ICU), while in other services, polyclonality was found. We concluded that blaKPC gene is present in K. pneumoniae strains resistant to carbapenems isolated in the HUAPA and clonal spread it was only in the ICU.

Con el objetivo de estudiar la relación clonal y detección del gen blaKPC en aislados clínicos de Klebsiella pneumoniae resistentes a carbapenémicos, se analizaron 22 cepas clínicas de K. pneumoniae con resistencia a imipenem y/o meropenem, aisladas en el laboratorio de bacteriología del Hospital Universitario "Antonio patricio de Alcalá" (HUAPA) de la ciudad de cumaná, Estado Sucre, Venezuela, durante un período de cinco años continuos. Se determinó la susceptibilidad a diversos antimicrobianos, y se detectó la presencia de carbapenemasas por los métodos de Hodge modificado, sinergia con ácido fenil borónico y combinación de discos. La detección del gen blaKPC se llevó a cabo mediante la técnica de reacción de polimerasa en cadena y la determinación de la relación clonal se realizó por electroforesis de campo pulsado. Se encontraron elevados porcentajes de resistencia antimicrobiana, cinco cepas resultaron negativas, al menos, a un método fenotípico y todas portaban el gen blaKPC. Se observó diseminación de clones únicamente en la Unidad de cuidados Intensivos (UCI), mientras que, en otros servicios, se halló policlonalidad. Se concluye que el gen blaKPC se encuentra presente en cepas de K. pneumoniae resistentes a carbapenémicos aisladas en el HUAPA y que hubo diseminación clonal sólo en UCI.

Respuesta inmune en la infección por el virus del Ébola / Immune Response to Ebola Virus Infection

El virus del Ébola pertenece a la familia de los filovirus y produce una fiebre hemorrágica con una elevada letalidad. Los pacientes afectados muestran una respuesta inmune deteriorada como consecuencia de los mecanismos de evasión del virus. La catepsina es una enzima presente en los gránulos de los fagocitos que escinde las glicoproteínas de la superficie viral, permitiendo al virus la entrada a la célula anfitriona. Por otro lado, este virus es resistente a los efectos antivirales del interferón tipo I, promueve la síntesis de citoquinas proinflamatorias e induce la apoptosis de los monocitos y los linfocitos. Otros efectos del mismo son: inducir una activación incompleta de las células dendríticas con lo que evita la presentación de los antígenos virales. A pesar de que después de la primera semana se producen anticuerpos específicos, estos tienen una capacidad neutralizante dudosa. El virus evade la respuesta inmune y se replica de forma incontrolada en el hospedero. Se realizó este trabajo con el propósito de resumir los principales aspectos relacionados con las particularidades de la respuesta inmune durante la infección por el virus del Ébola.

Ebola virus belongs to the family Filoviridae and causes a highly lethal hemorrhagic fever. Affected patients show an impaired immune response as a result of the evasion mechanisms employed by the virus. Cathepsin is an enzyme present in the granules of phagocytes which cleaves viral surface glycoproteins, allowing virus entry into the host cell. In addition, this virus is resistant to the antiviral effects of type I interferon, promotes the synthesis of proinflammatory cytokines and induces apoptosis of monocytes and lymphocytes. It also induces an incomplete activation of dendritic cells, thus avoiding the presentation of viral antigens. Although specific antibodies are produced after the first week, their neutralizing capacity is doubtful. The virus evades the immune response and replicates uncontrollably in the host. This paper aims to summarize the main characteristics of the immune response to Ebola virus infection.

Contribution à l'étude des manifestations buccales du lichen plan

Introduction:Le lichen plan buccal est une dermatose inflammatoire chronique, Il touche d'avantage la peau et la muqueuse orale mais les phanères et les autres muqueuses peuvent être également touchées. L'objet de notre étude est de préciser les caractéristiques cliniques de la pathologie dans sa localisation buccale. Patients et méthode Le recrutement des patients s'est fait au service de pathologie bucco-dentaire du CHU Mustapha Ont été retenus les patients présentant une lésion évoquant cliniquement un lichen plan buccal. Tous les patients ont bénéficié d'un examen clinique, complété pour certains par un examen anatomo-pathologique. La saisie des données est faite sur le logiciel Epi Info 6.0 fr. Résultats 80 patients ont été recrutés entre Janvier 2009 et Juin 2015, Le taux de prévalence estimé de la maladie est de 0,11%. La pathologie est plus fréquente chez l'adulte entre 40 et 60 ans, avec une prédominance féminine. 63,75% des patients présentent des comorbidités notamment diabète (29,41%), HTA (47,05%), et 55% prennent un traitement médical de façon permanente et chronique, Le stress et l'état psychologique du patient ont été retenus comme facteurs déclenchant la maladie et exacerbant la symptomatologie. La forme réticulée est plus fréquente (78,75%) suivie par la forme érosive (53,75%), L'atteinte est dans 84% des cas bilatérale, La localisation jugale prédomine (88,75%), Le traitement médical reste à effet palliatif, nous avons noté un cas de transformation maligne (1,44%), chez une femme après 03 ans d'évolution d'un lichen plan érosif lingual. Conclusion Le lichen plan est une pathologie auto-immune chronique, dans sa localisation buccale pose un problème de diagnostic, le traitement médical reste palliatif, l'élimination des facteurs irritatifs locaux et la prise en charge psychologique des patients permettent de mieux gérer les symptômes et les poussées aigues. Le risque de transformation maligne existe et par conséquent un suivi régulier du malade s'impose