Centro especializado ambulatorio de Cienfuegos: una mirada desde la gestión hospitalaria en su primera década / Specialized ambulatory center of Cienfuegos province: a view to hospital management in its first decade

La celebración en el 2019 de una década de trabajo ininterrumpido del primer hospital ligero diseñado en Cuba fue motivo para la realización de este trabajo, que tuvo como objetivo describir los principales resultados en los aspectos de meso y microgestión hospitalaria del Centro Especializado Ambulatorio Héroes de Playa Girón de Cienfuegos, desde el 2009 hasta el 2019. Múltiples investigaciones mostraron la utilidad de la gestión por procesos para garantizar la calidad de la atención médica y la integración de los programas de seguridad institucional y del paciente en las funciones gerenciales y asistenciales. La primera gestión hospitalaria del Centro Especializado Ambulatorio, sobre la base de las mejores experiencias nacionales e internacionales, cumplió con los objetivos del diseño para el cual fue creado al integrar calidad, racionalidad y eficiencia. Esta experiencia puede ser ejemplo para otras instituciones que precisen de un centro de atención ambulatoria y muy corta estadía en la concepción de un hospital universitario(AU)

The celebration in 2019 of a decade of continuous work of the first ambulatory hospital designed in Cuba motivated the production of this work, that had as an objective to describe the main results in the aspects of hospital meso and micro-management of Héroes de Playa Girón Specialized Ambulatory Center of Cienfuegos province, from 2009 to 2019. Several research works showed the usefulness of management by processes to guarantee the quality of medical care and the integration of institutional and patients safety programs in management and care functions. The first hospital management of the Specialized Ambulatory Center, based on the best national and international experiences, accomplished the objectives for what it was design to by integrating quality, rationality and efficiency. This experience would be an example for other institutions that need an ambulatory care center and a short time in the creation of a university hospital(AU)

Las concepciones morales de José Martí acerca de la Educación Física, el Deporte y la Recreación / The moral conceptions of José Martí about Physical Education, Sports and Recreation / As concepções morais de José Martí sobre Educação Física, Esportes e Recreação

RESUMEN Introducción: José Martí, héroe nacional de Cuba, ha legado con el paso del tiempo, diversas ópticas progresistas, inclusive en el deporte, una faceta menos conocida en su fecunda labor periodística y literaria. Se conoce que practicó una sola especialidad: el ajedrez; pero en sus crónicas demostró conocimientos sobre carreras de fondo, fútbol americano, billar, boxeo, equitación, esgrima, caza, corridas de toros y patinaje, entre otros. Objetivo: Profundizar en las concepciones morales del Héroe Nacional de Cuba acerca del deporte y la Educación Física. Materiales y métodos: Para llevar a cabo este estudio se desarrolló una revisión bibliográfica de las obras completas de José Martí, referidas a las escenas norteamericanas donde se recoge en mayor medida las crónicas martianas acerca del deporte y la Educación Física. Resultados: El tema que se aborda por su interés trasciende las fronteras de su época y se inserta en el proyecto de las ideas que sustentan a la revolución cubana, de que el deporte es un derecho del pueblo; a ello va dedicado el presente artículo, a resaltar las opiniones que vertió José Martí sobre el deporte, la Educación Física y la Recreación, siendo un crítico de estos desde el punto de vista moral. Conclusiones: José Martí elaboró un arsenal de ideas que constituyen un alto aporte al desarrollo del deporte y la Educación Física. En el periodismo el maestro tuvo una de las visiones más certeras sobre la práctica del deporte.

SÍNTESE Introdução: José Martí, o herói nacional de Cuba, legou com o passar do tempo, várias visões progressistas, inclusive no esporte, uma faceta menos conhecida de sua prolífica obra jornalística e literária. Sabe-se que ele praticou apenas uma especialidade: xadrez; mas em suas crônicas ele demonstrou seus conhecimentos de corrida de longa distância, futebol americano, bilhar, boxe, equitação, esgrima, caça, toureio e patinação, entre outros. Objetivo: Estudar em profundidade as concepções morais do Herói Nacional de Cuba sobre esporte e Educação Física. Método: a fim de realizar este estudo, foi realizada uma revisão bibliográfica dos trabalhos completos de José Martí, referindo-se às cenas norte-americanas onde as crônicas de Marti sobre esporte e Educação Física são coletadas em maior escala. Resultados: O assunto tratado por seu interesse transcende as fronteiras de seu tempo e está inserido no projeto das idéias que sustentam a revolução cubana, que o esporte é um direito do povo; é a isso que este artigo é dedicado, para destacar as opiniões que José Martí expressou sobre esporte, Educação Física e Recreação, sendo um crítico destes do ponto de vista moral. Conclusões: José Martí elaborou um arsenal de idéias que constituem uma grande contribuição para o desenvolvimento do esporte e da Educação Física. No jornalismo, o professor tinha uma das visões mais precisas sobre a prática do esporte.

ABSTRACT Introduction: José Martí, Cuba's national hero, has bequeathed various progressive perspectives over time, including in sports, a lesser-known facet of his prolific journalistic and literary work. It is known that he practiced a single specialty: chess; but in his chronicles he demonstrated knowledge of long-distance running, American football, billiards, boxing, horse riding, fencing, hunting, bullfighting and skating, among others. Objective: To deepen the moral conceptions of the National Hero of Cuba about sports and Physical Education. Materials and methods: to carry out this study, a bibliographic review of the complete works of José Martí was developed, referring to the North American scenes where Martí's chronicles about sports and Physical Education are collected to a greater extent. Results: the topic that is addressed by his interest transcends the borders of his time and is inserted in the project of the ideas that sustain the Cuban revolution, that sport is a right of the people; This article is dedicated to this, to highlight the opinions expressed by José Martí on sports, Physical Education and Recreation, being a critic of these from the moral point of view. Conclusions: José Martí developed an arsenal of ideas that constitute a high contribution to the development of sport and Physical Education. In journalism, the teacher had one of the most accurate views on the practice of sport.

La exitosa respuesta de los consolareños a la COVID-19 en la comunidad Camilo Cienfuegos / The successful response of Consolacion del Sur inhabitants to COVID-19 in Camilo Cienfuegos community

RESUMEN Introducción: la aparición de la pandemia de la COVID-19 trajo como resultado que más de 180 países estén afectados. Cuba no ha estado ajena a esta situación. El primer evento epidemiológico registrado en la comunidad Camilo Cienfuegos, municipio Consolación del Sur, provincia Pinar del Río, que puso a prueba la capacidad de movilización del personal médico, y de los sectores que de una u otra forma colaboraron en la puesta en cuarentena entre el 31 de marzo y el 1º de mayo, para evitar la propagación. Objetivo: caracterizar el comportamiento de la comunidad Camilo Cienfuegos durante la cuarentena por la COVID-19. Métodos: se utilizaron métodos empíricos, la observación, revisión documental, entrevistas a miembros del equipo médico y a dirigentes de la comunidad. Desarrollo: se logró una caracterización de la comunidad en el proceso de la cuarentena a partir de su indicación por el Consejo de Defensa Municipal, para el enfrentamiento y la prevención del surgimiento de nuevos casos de la enfermedad. Conclusiones: la caracterización histórica de la comunidad Camilo Cienfuegos permitió al Consejo de Defensa Municipal disponer de una herramienta testimonial sobre el tratamiento de la COVID-19, lo que facilitó su aplicación o consulta a posteriores situaciones episódicas de la enfermedad en la provincia y el país. Así como su importancia para la toma de decisiones en el enfrentamiento a la pandemia.

ABSTRACT Introduction: the emergence of Covid-19 pandemic resulted in more than 180 countries being affected today. Cuba has not been exempt from this situation and its first epidemiological event took place in Camilo Cienfuegos community, Consolacion del Sur municipality, Pinar del Río province, which tested the mobilization capacity of the medical personnel, and of the sectors that in one way or another collaborated in the period of quarantine between March 31 and May 1, in order to avoid the spread and the onset of new cases. Objective: to characterize the behavior of Camilo Cienfuegos community during Covid-19 period of quarantine. Methods: empirical methods such as observation, documentary review and interviews with members of the medical team and community leaders were applied. Development: a characterization of the community in the quarantine process was accomplished complying with the indications of the Municipal Defense Council to cope with and prevent the onset of Covid-19 new cases. Conclusions: the historical characterization of Camilo Cienfuegos community allowed the Municipal Defense Council to have a testimonial tool on the treatment of Covid-19, which facilitated the further requests or enquiries of posterior episodic situations of this disease in the province and the country, as well as its importance for decision making in coping with this pandemic.

Impact of comorbidities in mexican SARS-COV-2-positive patients: a retrospective analysis in a national cohort

ABSTRACT Background: The coronavirus disease 2019 outbreak is a significant challenge for health-care systems around the world. Objective: The objective of the study was to assess the impact of comorbidities on the case fatality rate (CFR) and the development of adverse events in patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Mexican population. Materials and methods: We analyzed the data from 13,842 laboratory-confirmed SARS-CoV-2 patients in Mexico between January 1, 2020, and April 25, 2020. We investigated the risk of death and the development of adverse events (hospitalization, pneumonia, orotracheal intubation, and intensive care unit [ICU] admission), comparing the number of comorbidities of each patient. Results: The patient mean age was 46.6 ± 15.6 years, 42.3% (n = 5853) of the cases were women, 38.8% of patients were hospitalized, 4.4% were intubated, 29.6% developed pneumonia, and 4.4% had critical illness. The CFR was 9.4%. The risk of hospitalization (odds ratio [OR] = 3.1, 95% confidence interval [CI]: 2.7-3.7), pneumonia (OR = 3.02, 95% CI: 2.6-3.5), ICU admission (OR = 2, 95% CI: 1.5-2.7), and CFR (hazard ratio = 3.5, 95% CI: 2.9-4.2) was higher in patients with three or more comorbidities than in patients with 1, 2, or with no comorbidities. Conclusions: The number of comorbidities may be a determining factor in the clinical course and its outcomes in SARS-CoV-2-positive patients.

Factores de riesgo cardiovascular en mujeres obesas menopáusicas y premenopáusicas de Lima Metropolitana / Cardiovascular risk factors in obese menopausal and premenopausal women from Metropolitan Lima, Peru

Objective: To determine the frequency of cardiovascular risk factors (CVRF) in obese menopausal and premenopausal women aged 30 to 75 from Metropolitan Lima, Peru. Methods: We conducted a descriptive, analytical, transversal study in 95 obese women aged 30 to 75 from Metropolitan Lima from 2015 to 2017, where 48 were menopausal (MENO) and 47, premenopausal (PREMENO). Obesity grade was determined using the World Health Organization criteria. Conventional methods were used for anthropometry, blood pressure (BP), fasting blood glucose (G), total cholesterol (TC), triglycerides, HDL cholesterol, insulin (I) and transaminases values; VLDL, LDL and non-HDL (cNoHDL), and HOMA coefficient were calculated. We used the program SPSS v. 23 for statistical analysis. We considered obesity, dyslipoproteinemia, high blood pressure, insulin resistance and high transaminases values as CVRF. Results: From a total of 95 obese women, 45.3% had grade I obesity, 28.4% had grade II, and 26.3% had grade III. Compared to premenopausal women, menopausal women were older and had a greater height and higher BP, cNoHDL, insulin and HOMA values. Conclusion: Obese menopausal women presented a higher cardiovascular risk than obese premenopausal women.

Objetivos. Establecer la frecuencia de factores de riesgo cardiovascular (FRCV) en mujeres obesas menopáusicas y premenopáusicas de 30 a 70 años de Lima Metropolitana. Métodos. Estudio analítico, observacional, transversal en 95 pacientes obesas de 30 a 75 años de edad, de Lima Metropolitana, cuyo grado de obesidad se catalogó de acuerdo a los criterios del Organización Mundial de la Salud; 48 fueron menopáusicas (MENO) y un grupo control de 47 premenopáusicas (PREMENO). Se determinó las medidas antropométricas, presión arterial (PA) y, en una muestra de sangre en ayunas, glucosa (G), colesterol total (CT), triglicéridos (Tg), colesterol HDL, insulina (I), y transaminasas; se calculó las fracciones VLDL, LDL, No-HDL (cNoHDL) e índice HOMA, los cálculos estadísticos mediante el programa SPSS v.23. Se consideró FRCV a la obesidad, dislipoproteinemia, hipertensión arterial (HTA), resistencia a la insulina (RI), transaminasas elevadas. Resultados. De las 95 mujeres, 45,3% tenía obesidad grado I, 28,4% grado II y 26,3% grado III. Las MENO tuvieron mayor edad, talla, PA, cNoHDL, I y HOMA que las PREMENO. Conclusiones. Las mujeres obesas menopáusicas tienen mayor riesgo cardiovascular que las mujeres premenopáusicas obesas.

Artropatía de jaccoud en el lupus eritematoso sistémico. Revisión de la literatura a propósito de un caso / Jaccoud arthropathy in Systemic Lupus Erythematosus. Literature review on a case

El Lupus eritematoso sistémico es una colagenosis de etiología aún desconocida, que muestra una patogenia de carácter multifactorial, aunque con marcada referencia autoinmune; ocasiona afectación multisistémica y presenta un curso clínico variable. Es más frecuente en las mujeres que en los hombres en proporción 8:1 y en determinadas razas; su pico de incidencia se sitúa entre los 15 y 40 años de edad. La mayoría de los autores describen la afectación articular del lupus como una artritis no erosiva ni deformante y resulta muy infrecuente que afecte las articulaciones interfalángicas distales. Sin embargo, algunos pacientes pueden presentar erosiones y deformaciones articulares que logran hacerse permanentes, ocasionando una pérdida importante de la función articular. Se presenta el caso de una paciente con dicha complicación por la importancia que reviste su diagnóstico oportuno para evitar el deterioro articular irreversible.

Systemic lupus erythematosus is a collagenous of still unknown etiology, showing a multifactorial pathogenesis, although with marked autoimmune reference; It causes multisystemic involvement and presents a variable clinical course. It is more common in women than in males in proportion 8:1 and in certain races; Its peak incidence is between 15 and 40 years old. Most authors describe the joint involvement of Lupus as a non-erosive or deforming arthritis and is very rare to affect distal interphalangeal joints. However, some patients may have articular erosions and deformations that manage to become permanent, causing a significant loss of joint function. The case of a patient with this complication is presented because of the importance of its timely diagnosis in order to avoid irreversible articular deterioration.

Frecuencia y características de obesos con y sin riesgo cardiometabólico / Frecuency and characteristics of obese subjects with and without cardiometabolic risk

Objetivo. Determinar la frecuencia y características de una población de pacientes obesos con y sin riesgo cardiometabólico (RCM) y revisar el concepto de obeso cardiometabólico normal (OCMN). Materiales y Métodos. Estudio analítico, transversal, de 105 pacientes obesos, de 30 a 75 años, de ambos géneros. Recolectados de un programa preventivo promocional de mayo de 2015 a abril del año 2016. Previo consentimiento informado, se registró la edad, género, medidas antropométricas, presión arterial (PA), antecedentes personales y familiares de factores de riesgo cardiovascular (FRCV). En ayunas, se determinó en sangre glucosa (G), colesterol total (CT), colesterol HDL, triglicéridos (Tg), creatinina, proteínas plasmáticas, bilirrubinas, transaminasas (AST,ALT), fosfatasa alcalina (FA) y gamaglutamiltranspeptidasa (GGTP), por métodos convencionales; las fracciones VLDL, LDL y NoHDL fueron calculados. Se empleó el programa SPSS.23 para el análisis estadístico Resultados. El 77,4% fueron mujeres, edad promedio 51±0,86 años. El 45,7% tuvo obesidad grado I, 24,7% grado II y 29,5% grado III. Las mujeres tuvieron menor talla, peso y circunferencia abdominal (CA) y cifras más altas de HDL que los varones, no hubo diferencias en otros parámetros. El 89,2 % de mujeres y 87% de varones tuvieron dislipoproteinemia; hipertensión arterial (HTA): mujeres 20,7% y varones 21,4%; tabaquismo: mujeres 5,5% y varones 42,3%; hiperglicemia: mujeres 14,2% y varones 14,2%; macrosomía/bajo peso al nacer: mujeres 6,9%, varones 0; enzimas hepáticas elevadas: mujeres 29,8%, varones 32,1%. El 9,5% fueron OCMN por tener PA, G, cHDL, Tg, cLDL cNoHDL normales. Conclusiones: La mayoría de los pacientes obesos tuvieron RCM, solo 10 (9,5%) fueron OCMN.

Objetive. To study the frequency and characteristics of an obese population with and without cardiometabolic risk (CMR) and, to revise the concept of cardiometabolically healthy obese CMHO subjects. Material and methods. A total of 105 obese subjects, 30 to 75 years old, were recluted from a preventive-promotional program from may 2015 to april 2016. Previous informed consent, age, gender, anthropometric measures, blood pressure (BP), personal and family history of cardiovascular risk factors (CVRF) were registered. At fasting glucose (G), total cholesterol (TC), HDL cholesterol (cHDL), triglycerides (Tg), creatinine, plasma proteins, bilirrubins, transaminases (AST,ALT), alkaline fosfatase (FA) and gamaglutamyltranspeptidase (GGTP) were measured in blood by conventional methods. VLDL, LDL, Non-HDL fractions were calculated. Statistics were calculated with SPSS.23 program. Results. 77,4% were women, mean age 51±0,86 years. Women had lower height, weight and abdominal circumference than male but higher HDL concentration, other parameters were similar. Obesity grade I was found in 45,7%, grade II in 24,7% and grade III in 29,5%. Dislipoproteinemia had 89,2% of women and 87% of men; high blood pressure (HBP): women 20,7%, men 21,4%; tobaccoism women 5,5%, male 42,3%; hyperglycemia: women 14,2%, men 14,2%; macrosomia/low birthweight: women 6,94%, men 0%; elevated hepatic enzymes: women 29,8%, male 32,1%. 9,52% were CMHO since they had normal BP, G. HDLc, Tg, LDLc and Non-HDL . Conclusions. The majority of obese patients had CMR, only 10 (9,5%) were CMHO.

Implicaciones bioéticas en el tratamiento integral al paciente afectado por enfermedades reumáticas / Bioethical implications in the integral treatment given to patients suffering from rheumatic diseases

La Ética es la parte de la filosofía práctica que se ocupa del hecho moral y de los problemas filosóficos que nacen de la conducta humana, la bioética resulta la rama de la ética que se dedica a proveer los principios para la correcta conducta humana; respecto a la vida. En el proceso de atención a los pacientes con enfermedades reumáticas se emplean variados procedimientos. Las nuevas tecnologías han mejorado notablemente su tratamiento integral; estos adelantos científicos deben ser empleados con la intención fundamental de no producir daño y previo consentimiento informado; por lo que resulta necesario argumentar acerca de las implicaciones bioéticas que resultan del empleo de los avances científico-tecnológicos en el tratamiento a los pacientes con enfermedades reumáticas.

Ethics is the part of Practical Philosophy that deals with moral facts and philosophical problems that have their roots in human behavior. Bioethics is the branch of Ethics devoted to providing the principles for correct human behavior, with respect to life. Various procedures are used when treating patients with rheumatic diseases. New technologies have considerably improved their integral treatment; these scientific advances must be used with the main purpose of causing no harm and with prior informed consent. Therefore, it is necessary to argue on the bioethical implications that turn out from the use of scientific-technological advances in the treatment of patients with rheumatic diseases.

Guía clínica para la rehabilitación de los pacientes con enfermedades reumáticas / Clinical guideline for the rehabilitation of patients with rheumatic diseases

Se presenta la guía clínica para el manejo de los pacientes con enfermedades reumáticas con recomendaciones de procedimientos terapéuticos aplicables en atención secundaria. Se construyó con base en la búsqueda metódica de literatura respecto al tema, y el consenso entre los especialistas en Medicina Tradicional y Natural y en Medicina Física y Rehabilitación del Centro Especializado Ambulatorio del Hospital Dr. Gustavo Aldereguía Lima de Cienfuegos. Se hace énfasis en el manejo individualizado de estos pacientes con diagnóstico previo de enfermedad reumática y la fase en que se consultan, la evaluación consecuente del mismo, la evolución y el manejo oportuno; se aborda el tratamiento farmacológico, la acupuntura y sus técnicas afines, ozonoterapia, homeopatía así como los agentes físicos artificiales, las medidas de prevención y los ejercicios terapéuticos.

The clinical guideline for the management of patients with rheumatic diseases is presented with recommendations of therapeutic procedures applicable in secondary health care level. It was designed based on a methodical search in the bibliography related to the topic, and on the agreement of Natural and Traditional Medicine and Physical Medicine and Rehabilitation specialists of the Specialized Ambulatory Center of the General University Hospital Dr. Gustavo Aldereguía Lima. Cienfuegos. It emphasizes in the individualized patient management with previous diagnosis of rheumatic disease and the phase in which they are consulted, its consequent evaluation, the evolution and the timely management; it also approaches the pharmacological treatment, acupuncture and similar techniques, ozone therapy, homeopathy so as artificial physical agents, preventive measures and therapeutic exercises.

Fiebre y bloqueo cardíaco / Fever and heart block

Los trastornos de la conducción son un fenómeno poco frecuente de la endocarditis infecciosa y se asocia a un aumento de la mortalidad. Presentamos el caso de un paciente con bloqueo cardiaco completo como debut de una endocarditis infecciosa...

Conduction abnormalities are a rare phenomenon in Infective Endocarditis; and they are usually associated with an increase in mortality. We present the case of a patient with complete heart block as the debut of Infective Endocarditis...

Analysis of a suppressive subtractive hybridization library of Alternaria alternata resistant to 2-propenyl isothiocyanate

Background Isothiocyanates (ITCs) are natural products obtained from plants of the Brassicas family. They represent an environmentally friendly alternative for the control of phytopathogenic fungi. However, as it has been observed with synthetic fungicides, the possibility of inducing ITC-resistant strains is a major concern. It is, therefore, essential to understanding the molecular mechanisms of fungal resistance to ITCs. We analyzed a subtractive library containing 180 clones of an Alternaria alternata strain resistant to 2-propenyl ITC (2-pITC). After their sequencing, 141 expressed sequence tags (ESTs) were identified using the BlastX algorithm. The sequence assembly was carried out using CAP3 software; the functional annotation and metabolic pathways identification were performed using the Blast2GO program. Results The bioinformatics analysis revealed 124 reads with similarities to proteins involved in transcriptional control, defense and stress pathways, cell wall integrity maintenance, detoxification, organization and cytoskeleton destabilization; exocytosis, transport, DNA damage control, ribosome maintenance, and RNA processing. In addition, transcripts corresponding to enzymes as oxidoreductases, transferases, hydrolases, lyases, and ligases, were detected. Degradation pathways for styrene, aminobenzoate, and toluene were induced, as well as the biosynthesis of phenylpropanoid and several types of N-glycan. Conclusions The fungal response showed that natural compounds could induce tolerance/resistance mechanisms in organisms in the same manner as synthetic chemical products. The response of A. alternata to the toxicity of 2-pITC is a sophisticated phenomenon including the induction of signaling cascades targeting a broad set of cellular processes. Whole-transcriptome approaches are needed to elucidate completely the fungal response to 2-pITC.

Induction of the expression of defence genes in Carica papaya fruit by methyl jasmonate and low temperature treatments

The defence mechanisms that are activated by methyl jasmonate (MJ) in fruits are not well understood. In this work, we studied the expression of defence genes in papaya fruit that are induced by the exposure to MJ and/or low temperatures. The papaya fruits ‘Maradol’ were randomly divided into two groups: one group was the untreated control and the other was treated with 10-4 M of MJ. Half of the fruits from each of the two groups were stored after treatment for 5 days at 5ºC and 2 days at 20ºC. We studied the expression levels of the pdf1.1 and pdf1.2 genes by amplification from expression libraries created from the pulp and skin tissues of the papaya fruit. As a reference, the mRNA level of the 18s ribosomal gene was used. In the skin tissue, the expression levels of the pdf1.1 and pdf1.2 genes were higher immediately after MJ treatment compared to the control. Furthermore, the expression of pdf1.2 remained high after MJ treatment and subsequent storage compared to the control. It was therefore concluded that the activation of the pdf1.1 and pdf1.2 genes forms part of the molecular defence mechanism in fruits that is activated by exposure to MJ. To our knowledge, this is the first study that analyzes the gene expression in papaya fruit that is induced by the exogenous application of methyl jasmonate and cold treatment.

Neuropatía óptica traumática / Traumatic optic neuropathy

La neuropatía óptica traumática, en sus múltiples variantes, constituye una entidad poco frecuente. Se puede definir como aquella lesión del nervio óptico que aparece tras un episodio traumático. Puede clasificarse según su topografía y mecanismos productores. A pesar de un mejor entendimiento en los últimos años de sus mecanismos productores, su tratamiento continúa siendo un tema extremadamente controversial.

Traumatic optic neuropathy, in its different modalities, is a rare entity. It is the damage of the optic nerve resulting from a traumatic episode. The classification depends on its topography and causative mechanisms. Although there has been better understanding of the causative mechanisms in the last few years, the management is still an extremely controversial topic.

Caracterización de pacientes con síndrome cerebral perdedor de sal en afecciones en neurológicas graves / Characterization of patients presenting with salt wasting cerebral syndrome in severe neurologic affections

Introducción: La hiponatremia es un problema común y grave en la medicina clínica. Objetivo: caracterizar a los pacientes con síndrome cerebral perdedor de sal en la evolución y pronóstico de las afecciones neurológicas graves y su relación con la evolución neurológica. Métodos: se realizó un estudio observacional, analítico, longitudinal y prospectivo con un universo de 114 pacientes. Resultados: se presentó el síndrome cerebral perdedor de sal en 23 de los 114 casos para un 20,2 por ciento de pacientes afectados. Se encontró mayor incidencia en la hemorragia subaracnoidea (55,6 por ciento), tumores (36,4 por ciento) y la hemorragia intraparenquimatosa (17,6 por ciento). De los 56 pacientes con una evolución neurológica desfavorable, 16 presentaban el síndrome (28,5 por ciento) y hubo mayor porcentaje de fallecidos entre los que lo tenían (23,1 por ciento versus 17,7 por ciento que no lo tenían). La mortalidad no mostró diferencias significativas en cuanto al número total de fallecidos. Conclusiones: el síndrome cerebral perdedor de sal presenta una alta incidencia en pacientes con afecciones neurológicas agudas, asociándose más frecuentemente la hemorragia subaracnoidea, los tumores intracraneales y la enfermedad cerebrovascular isquémica. Tiene relación con la evolución neurológica y es más probable padecerlo cuando esta es desfavorable

Introduction: hyponatremia is common and severe problem in clinical medicine. Objective: to characterize the patients presenting with salt wasting cerebral syndrome in the evolution and prognosis of severe neurological lesions and its relation to the neurologic course. Methods: a prospective, longitudinal, analytical and observational study was conducted in 114 patients. Results: the salt losing cerebral syndrome was present in 23 of the 114 cases for a 20.2 percent of patients involved. There was a great incidence in subarachnoid hemorrhage (55.6 percent), tumors (36.4 percent) and the intra-parenchymatous hemorrhage (17.6 percent). From the 56 patients with a unfavourable, 16 had the above mentioned syndrome (28.5 percent) and there was a greater percentage of deceased among those with it (23.1 percent vs. 17.7 percent without it). Mortality not showed significant differences as regards the total figure of deceased. Conclusions: the salt wasting cerebral syndrome has a high incidence in patients with acute neurological affections, with a more frequent association with subarachnoid hemorrhage, the intracranial tumors and the ischemic cerebrovascular disease. It has relation to the neurologic evolution and it is more probable its suffering when it is unfavourable

Isolation and study of a ubiquitously expressed tomato pectin methylesterase regulatory region

Pectin methylesterase (PME) is an enzyme located in the plant cell wall of higher plants whose physiological role is largely unknown. We had isolated a PME gene from a tomato genomic library, including 2.59 kb of 5üL flanking region and the coding region. Both coding and promoter region were sequenced and computer analyzed. Tobacco transgenic plants were created harboring constructs in which 2.596 Kb, 1.306 Kb and 0.267 Kb sizes of the promoter were driving the expression of âÀ-Glucuronidase gene (GUS). GUS activity was studied by histochemical and fluorometric assays. Two introns of 106 and 1039 bp were found in the coding region and phylogenetic analysis placed this PME gene closer to genes from Citrus sinensis and Arabidopsis thaliana than tomato fruit-specific PME genes. In the promoter, it was found direct repeats, perfect inverted repeats and light responsive elements. GUS histochemical analysis showed activity in all plant tissues with the exception of pollen. The reduction in the promoter size induced a reduction in GUS activity in root, stem and leaf. Furthermore, root and leaf showed the highest and lowest activity, respectively. We had isolated a tomato PME gene with novel characteristics as compared with other known PME genes from tomato.

El impacto clínico de teorías recientes sobre control motor y aprendizaje motor / The clinical impact of modern theories about motor control and motor learning

Este artículo hace una revisión de conceptos y teorías sobre el control motor y aprendizaje motor, las cuales están cambiando las bases de las técnicas de evaluación y tratamiento aplicadas en pacientes con lateraciones neuromotoras