Wiki educativa para la Clínica Virtual de Salud de Santiago de Cuba

El programa de las tecnologías de la información y las comunicaciones se ha implementado en todas las instituciones pertenecientes al sector de la salud en Cuba, pues favorece la formación a través de los entornos de enseñanza y aprendizaje en función del desarrollo y las perspectivas académicas, mediante plataformas tecnológicas para facilitar el intercambio de información. En el presente artículo se destaca la necesidad de incrementar el uso de la wiki como herramienta educativa, que favorece el aprendizaje colaborativo como un proceso de creación de conocimiento a través de la web 2.0, donde no solo se publican contenidos sino que contribuye a desarrollar habilidades de cooperación en los procesos formativos de la salud pública.

The program of information and communications technologies has been implemented in all the institutions belonging to the health sector in Cuba, because it favors the training through the teaching and learning environments in function of development and academic perspectives, by means of technological platforms to facilitate the exchange of information. In this work the necessity to increase the wiki use as educational tool in enhanced, that favors the collaborative learning as a process of knowledge creation through the web 2.0, where contents are not only published but also contributes to develop cooperation abilities in the training processes of public health.

Desarrollo del repositorio de recursos educativos abiertos para la Universidad Virtual de Salud de Santiago de Cuba

La utilización de herramientas tecnológicas en la docencia condiciona el desarrollo de nuevas destrezas intelectuales en los estudiantes, lo que les facilita la aplicación de estrategias de investigación, mejora sus capacidades de una forma integral, les ayuda a enfrentar las dificultades y exigencias del mundo y les permite adquirir un aprendizaje más significativo para poder desenvolverse en el ámbito socioeducativo. Con vistas a cumplir lo anterior, se desarrolló un repositorio institucional de recursos educativos abiertos para la Universidad Virtual de Salud, a partir del empleo de herramientas tecnológicas libres y de código abierto que permiten la estandarización e interoperabilidad entre cada uno de los repositorios establecidos en el Sistema Nacional de Salud, con lo cual se garantizará una lógica de organización académica.

The use of digital technologies in teaching determines the development of new intellectual skills in students, which facilitates the application of investigation strategies, improves their capabilities in an integral way, helps them face the difficulties and demands of the current world and allows them to acquire more significant learning to have a good performance in the socio-educational environment. With a view to fulfilling the above, an institutional repository of open educational resources was developed for the Virtual Health University, based on the use of free and open-source technology tools that allow the standardization and interoperability among each of the repositories established in the National Health System, which will guarantee logic of academic organization.

Diagnostic agreement of quantitative flow ratio with fractional flow reserve in a Latin-American population.

Quantitative flow ratio (QFR) is a recently proposed angiographic index that allows to assess the pressure loss in coronary arteries in a similar fashion as the fractional flow reserve (FFR). The purpose of this study was to evaluate the diagnostic performance of QFR as compared to FFR, in a Latin-American population of patients with suspected ischaemic heart disease. QFR was retrospectively derived from coronary angiograms. The association, diagnostic performance, and continuous agreement of fixed-flow QFR (fQFR) and contrast-flow QFR (cQFR) with FFR was assessed by continuous and dichotomous methods. 90 vessels form 66 patients were finally included. The study comprised coronary stenoses of intermediate severity, both angiographically (diameter stenosis: 46.6 ± 12.8%) and physiologically [median FFR = 0.83 (quartile 1-3, 0.76-0.89)]. The correlation of FFR with both fQFR [ρ = 0.841, (95% CI 0.767 to 0.893), p < 0.001] and cQFR [ρ = 0.833, (95% CI 0.755 to 0.887), p < 0.001] was strong. The diagnostic performance of cQFR was good [area under the ROC curve of 0.92 (95% CI 0.86 to 0.97, p < 0.001)], with 0.80 as the optimal cQFR cut-off against FFR ≤ 0.80. This 0.80 cQFR cut-off classified correctly 83.3% of total stenoses, with a sensitivity of 85.2% and specificity of 80.6%. QFR was strongly associated with FFR and exhibited a high diagnostic performance in this Latin-American population.

Desarrollo de la Clínica Virtual Docente en la universidad médica de Santiago de Cuba / Development of the Teaching Virtual Clinic in the medical university of Santiago de Cuba

Entre los entornos virtuales de enseñanza-aprendizaje figura la Clínica Virtual Docente, que es un espacio educativo de gran trascendencia en el contexto universitario de las ciencias médicas, el cual contiene situaciones de salud agrupadas en diferentes especialidades y secciones con características específicas en cuanto a objetivos y organización, lo que favorece la integración de actividades docentes, presenciales o no, y el intercambio social entre personas que comparten problemas e intereses afines, con la perspectiva de la construcción permanente de saberes, a partir de principios rectores bien definidos, como crear, compartir y colaborar.

Among the teaching-learning virtual environments figures the Teaching Virtual Clinic that is an educational space of great transcendency in the university context of medical sciences, which contains health situations grouped in different specialties and sections with specific characteristics as for objectives and organization, what favors the integration of teaching activities with or without physical presence, and the social exchange between people that share common problems and interests, with the perspective of the permanent construction of knowledge, starting from very well defined rectors principles, as creating, sharing and collaborating.

Return to exercise after COVID-19. Statement of the Mexican Society of Cardiology / Retorno al ejercicio después de COVID-19. Posicionamiento de la Sociedad Mexicana de Cardiología

The coronavirus disease 2019 (COVID-19) was declared a pandemic on March 11, 2020; one consequence has been the increase in sedentary lifestyle and reduction of sports activity. Exercise benefits the immune defense system especially in older adults; it is recommended to keep a distance of 1.5 meters between people, and if walking or jogging is carried out, the space must be up to 5 and 10 meters respectively. The reported cases are mostly mild up to 80% and can be critical in up to 4.7%; the risk factors are well known, hypertension, diabetes and previous heart disease. Severe or critical cases present as symptoms of acute respiratory distress syndrome, and in the case of cardiovascular disease, they mainly occur as myopericarditis, acute coronary syndromes, cardiogenic shock, thrombotic events, among others. Returning to exercise after recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is always recommended, however it will depend on the clinical picture what measures should be taken prior to its onset, and it is in moderate cases and especially in the severe ones where the evaluation and prescription prior to returning to exercise or sport should be guided by medical personnel experts in cardiopulmonary rehabilitation, especially in athletes.

La enfermedad por coronavirus 2019 (COVID-19) fue declarada pandemia el 11 de marzo de 2020; una consecuencia ha sido el incremento en el sedentarismo y la reducción de la actividad deportiva. El ejercicio beneficia el sistema inmunitario de defensa, especialmente en adultos mayores. Se recomienda guardar distancia de 1.5 metros entre personas, y si se realiza caminata o trote, el espacio debe ser de hasta 5 y 10 metros respectivamente. Los casos reportados son en su mayoría leves hasta en un 80%, y pueden ser críticos hasta en 4.7%; los factores de riesgo son bien conocidos: hipertensión, diabetes y enfermedad cardiaca previa. Los casos graves o críticos se presentan como cuadros de síndrome de distrés respiratorio agudo y ante afección cardiovascular cursan principalmente como miopericarditis, síndromes coronarios agudos, choque cardiogénico y eventos trombóticos, entre otros. El ejercicio después de la recuperación de infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) siempre está recomendado, sin embargo, dependerá del cuadro clínico qué medidas se deben tomar previo a su inicio, y es en casos moderados y especialmente en los graves donde la evaluación y prescripción previa al retorno al ejercicio o deporte debe ser guiada por personal médico experto en rehabilitación cardiopulmonar, en especial en deportistas.

La Clínica Virtual Docente en el contexto educativo de las ciencias médicas / Teaching Virtual Clinic in the educational context of medical sciences

La Clínica Virtual Docente ha ocupado un lugar primordial como entorno virtual de enseñanza-aprendizaje, puesto que supone un cambio esencial en la didáctica universitaria de las ciencias médicas, la que demanda un proceso docente más dinámico, interactivo y activo en el tratamiento de situaciones de salud, basado en el intercambio social entre personas que comparten problemas e intereses afines, y con la perspectiva de la construcción permanente de saberes, a partir de principios rectores bien definidos, como son el de crear, compartir y colaborar.

Teaching Virtual Clinic has occupied an essential place as virtual environment of the teaching-learning process, since it supposes an essential change in the university didactics of medical sciences, that demands a more dynamic, interactive and active teaching process in the treatment of health situations, based on the social exchange between people that share similar problems and interests, and with the perspective of the permanent construction of knowledge, starting from well defined guiding principles, as creating, sharing and collaborating.

Extractos de los documentos de posicionamientos y recomendaciones mexicanas en enfermedades cardiovasculares y COVID-19 / Excerpts from the documents of Mexican positions and recommendations in cardiovascular diseases and COVID-19

Resumen Se presentan las recomendaciones en las cuales la Sociedad Mexicana de Cardiología (SMC) en conjunto con la Asociación Nacional de Cardiólogos de México (ANCAM), así como diferentes asociaciones médicas mexicanas vinculadas con la cardiología, después de una revisión y análisis exhaustivo y consensuado sobre los tópicos relacionados con las enfermedades cardiovasculares en la pandemia de COVID-19, se analizan posturas científicas y se dan recomendaciones responsables sobre medidas generales a los pacientes, con cuidados personales, alimentación saludable, actividad física regular, acciones en caso de paro cardiorrespiratorio, la protección del paciente y del personal de salud así como las indicaciones precisas en el uso de la imagen cardiovascular no invasiva, la prescripción de medicamentos, cuidados en tópicos específicos como en la hipertensión arterial sistémica, insuficiencia cardiaca, arritmias y síndromes coronarios agudos, además de hacer énfasis en los procedimientos de electrofisiología, intervencionismo, cirugía cardiaca y en la rehabilitación cardiaca. El interés principal es brindar a la comunidad médica una orientación general sobre el quehacer en la práctica cotidiana y pacientes con enfermedades cardiovasculares en el escenario esta crisis epidemiológica sin precedentes de COVID-19.

Abstract The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.

La gestión de información estadística relacionada con las actividades formativas en la Universidad Virtual de Salud / Statistical information management related to the training activities in the Health Virtual University

Introducción: Las tecnologías de la información y las comunicaciones han originado cambios imprevisibles y vertiginosos en las distintas esferas de la vida. Objetivo: Caracterizar el estado actual de la gestión de información estadística relacionada con las actividades formativas en la Universidad Virtual de Salud de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y longitudinal de evaluación durante el curso escolar 2016-2017 en la Universidad de Ciencias Médicas de Santiago de Cuba. Resultados: Los gestores poseían pocos años de experiencia como activistas de UNIVERS; se aprovechaban variadas fuentes de información primaria para recolectar la información; no existía uniformidad en los modelos de registros primarios y era limitado el empleo de aplicaciones informáticas que contribuyeran a organizar, procesar, archivar, controlar, recuperar y agilizar la información estadística. De igual modo, el proceso de gestión de edición y emisión de certificados manuales resultaba moroso y difícil. Conclusiones: Se determinó que no siempre los gestores de UNIVERS percibían las potencialidades de las tecnologías para obtener la información estadística y que, a pesar de que se realizaban actividades de alfabetización utilizando las herramientas que brinda esta plataforma de teleformación, existía escaso aprovechamiento de estas para garantizar un adecuado análisis, control y emisión de la información estadística de las actividades formativas y los recursos educativos abiertos en la Universidad Virtual de Salud.

Introduction: Information and communications technologies have originated unforeseeable and vertiginous changes in the different spheres of life. Objective: To characterize the current state of the statistical information management related to the training activities in the Health Virtual University in Santiago de Cuba. Methods: A descriptive and longitudinal study of evaluation during the school course 2016-2017 was carried out in the Medical Sciences University in Santiago de Cuba. Results: The managers had few years of experience as activists of UNIVERS; they took advantage from varied primary information sources to gather the information; there was no uniformity in the models of primary records and the use of computer tools was limited which contributed to organize, to process, to file, to control, to recover and to make faster the statistical information. Likewise, edition and emission of manual certificates was a doubtful and difficult process. Conclusions: It was determined that UNIVERS managers not always perceived the potentialities of technologies for obtaining statistical information and that, although there were literacy activities carried out using the tools offered by this training platform, there was scarce use of them to guarantee an appropriate analysis, control and emission of the statistical information of training activities and the teaching open resources emerging in the Health Virtual University.

IL15 Infusion of Cancer Patients Expands the Subpopulation of Cytotoxic CD56bright NK Cells and Increases NK-Cell Cytokine Release Capabilities.

The cytokine IL15 is required for survival and activation of natural killer (NK) cells as well as expansion of NK-cell populations. Here, we compare the effects of continuous IL15 infusions on NK-cell subpopulations in cancer patients. Infusions affected the CD56bright NK-cell subpopulation in that the expansion rates exceeded those of CD56dim NK-cell populations with a 350-fold increase in their total cell numbers compared with 20-fold expansion for the CD56dim subset. CD56bright NK cells responded with increased cytokine release to various stimuli, as expected given their immunoregulatory functions. Moreover, CD56bright NK cells gained the ability to kill various target cells at levels that are typical for CD56dim NK cells. Some increased cytotoxic activities were also observed for CD56dim NK cells. IL15 infusions induced expression changes on the surface of both NK-cell subsets, resulting in a previously undescribed and similar phenotype. These data suggest that IL15 infusions expand and arm CD56bright NK cells that alone or in combination with tumor-targeting antibodies may be useful in the treatment of cancer. Cancer Immunol Res; 5(10); 929-38. ©2017 AACR.

Clínica virtual docente: un espacio formativo para la enseñanza de las ciencias médicas / Teaching virtual clinic: a training space for teaching medical sciences

La Clínica virtual es un espacio con fines docentes en las ciencias médicas, donde predomina la aplicación del método científico en los aspectos clínico, epidemiológico y diagnóstico; sin embargo, se han evidenciado insuficiencias en el empleo de esta herramienta tecnológica para abordar y solucionar situaciones profesionales en los procesos formativos de pregrado y posgrado. Por ello, se decidió elaborar una estrategia didáctica que propiciara el desarrollo de actividades formativas en las carreras y especialidades de las ciencias médicas mediante el apoyo de la Clínica virtual como expresión de la telemedicina, y que puede ser adaptada según las características particulares del grupo de estudiantes, de las asignaturas y las especificidades de cada tema en cuestión.

Virtual Clinic is a space with teaching aims in medical sciences, where the implementation of the scientific method prevails in the clinical, epidemiological and diagnostic aspects; however, inadequacies in the use of this technological tool to approach and solve professional situations in predegree and postdegree training processes have been evidenced. That is why, it was decided to elaborate a didactic strategy that propitiated the development of training activities in the careers and specialties of medical sciences with the support of virtual Clinic as expression of Telemedicine, and that can be adapted according to the peculiar characteristics of the group of students, subjects and specificities of each topic.

Clínica virtual docente: un espacio formativo para la enseñanza de las ciencias médicas / Teaching virtual clinic: a training space for teaching medical sciences

La Clínica virtual es un espacio con fines docentes en las ciencias médicas, donde predomina la aplicación del método científico en los aspectos clínico, epidemiológico y diagnóstico; sin embargo, se han evidenciado insuficiencias en el empleo de esta herramienta tecnológica para abordar y solucionar situaciones profesionales en los procesos formativos de pregrado y posgrado. Por ello, se decidió elaborar una estrategia didáctica que propiciara el desarrollo de actividades formativas en las carreras y especialidades de las ciencias médicas mediante el apoyo de la Clínica virtual como expresión de la telemedicina, y que puede ser adaptada según las características particulares del grupo de estudiantes, de las asignaturas y las especificidades de cada tema en cuestión(AU)

Virtual Clinic is a space with teaching aims in medical sciences, where the implementation of the scientific method prevails in the clinical, epidemiological and diagnostic aspects; however, inadequacies in the use of this technological tool to approach and solve professional situations in predegree and postdegree training processes have been evidenced. That is why, it was decided to elaborate a didactic strategy that propitiated the development of training activities in the careers and specialties of medical sciences with the support of virtual Clinic as expression of Telemedicine, and that can be adapted according to the peculiar characteristics of the group of students, subjects and specificities of each topic(AU)

Impacto social de la telemedicina en la formación profesional de los estudiantes de ciencias médicas / Social impact of telemedicine on the professional training of the medical sciences students

La educación médica y la medicina son prácticas sociales cuyos fines y medios tienen que definirse históricamente, considerando las necesidades de cada país al respecto y la reorientación didáctica que exige su desarrollo científico para que puedan determinarse, con precisión, los conocimientos requeridos para afrontar situaciones sanitarias epidemiológica y socialmente prioritarias. En este artículo se analizan algunas de las consecuencias generales relacionadas con el empleo de las tecnologías de la información y las comunicaciones, particularmente en la educación superior, y cómo devienen retos que deben asumir las universidades, específicamente de ciencias médicas, en la formación de sus profesionales.

Medical education and medical career are social practices whose aims and resources have to be historically defined, considering the needs of each country on this respect and the didactic reorientation that demands their scientific development so that the knowledge required to face epidemiologically and socially high-priority health situations can be accurately determined. Some of the general consequences related to the use of the information and communications technologies are analyzed in this work, particularly in the higher education, and how they become challenges that should be assumed by the universities, specifically of medical sciences, in the training of their professionals.

Impacto social de la telemedicina en la formación profesional de los estudiantes de ciencias médicas / Social impact of telemedicine on the professional training of the medical sciences students

La educación médica y la medicina son prácticas sociales cuyos fines y medios tienen que definirse históricamente, considerando las necesidades de cada país al respecto y la reorientación didáctica que exige su desarrollo científico para que puedan determinarse, con precisión, los conocimientos requeridos para afrontar situaciones sanitarias epidemiológica y socialmente prioritarias. En este artículo se analizan algunas de las consecuencias generales relacionadas con el empleo de las tecnologías de la información y las comunicaciones, particularmente en la educación superior, y cómo devienen retos que deben asumir las universidades, específicamente de ciencias médicas, en la formación de sus profesionales(AU)

Medical education and medical career are social practices whose aims and resources have to be historically defined, considering the needs of each country on this respect and the didactic reorientation that demands their scientific development so that the knowledge required to face epidemiologically and socially high-priority health situations can be accurately determined. Some of the general consequences related to the use of the information and communications technologies are analyzed in this work, particularly in the higher education, and how they become challenges that should be assumed by the universities, specifically of medical sciences, in the training of their professionals(AU)

[National Registry of Cardiac Rehabilitation Programs in México]. / Registro Nacional sobre Programas de Rehabilitación Cardíaca en México (RENAPREC).

Cardiac Rehabilitation and secondary prevention programs are a group of therapeutic maneuvers that can reduce the adverse impact of cardiovascular disease, by using the cardiovascular risk factors reduction, through secondary prevention and exercise training therapy programs. This program started in Mexico in 1944, since then, several health institutions are working on a public or private basis, mainly in an isolated way. This article presents data about fourteen cardiac rehabilitation institutions that answered the first national registry of cardiac rehabilitation programs (RENAPREC) in 2007. On this study, we observed that these centers were mainly private; nevertheless, almost all of the referred population was attended in public health institutions. The core-components for an adequate cardiac rehabilitation attention were satisfied by almost all these centers. The patients used to pay, by their own, this kind of medical practice. In our country, only the 0.58% of the population, that needed to be included on a cardiac rehabilitation program, was covered. This phenomena is due, in one hand, to the reduced number of cardiac rehabilitation centers in Mexico, but on the other hand, it happens because the primary physician do not refer all the eligible patients to this kid of programs. RENAPREC can be one first attempt to consolidate all the activities around the inter-institutional cardiac rehabilitation and secondary prevention programs in our country.

Registro Nacional sobre Programas de Rehabilitación Cardíaca en México (RENAPREC) / National Registry of Cardiac Rehabilitation Programs in México

Cardiac Rehabilitation and secondary prevention programs are a group of therapeutic maneuvers that can reduce the adverse impact of cardiovascular disease, by using the cardiovascular risk factors reduction, through secondary prevention and exercise training therapy programs. This program started in Mexico in 1944, since then, several health institutions are working on a public or private basis, mainly in an isolated way. This article presents data about fourteen cardiac rehabilitation institutions that answered the first national registry of cardiac rehabilitation programs (RENAPREC) in 2007. On this study, we observed that these centers were mainly private; nevertheless, almost all of the referred population was attended in public health institutions. The core-components for an adequate cardiac rehabilitation attention were satisfied by almost all these centers. The patients used to pay, by their own, this kind of medical practice. In our country, only the 0.58% of the population, that needed to be included on a cardiac rehabilitation program, was covered. This phenomena is due, in one hand, to the reduced number of cardiac rehabilitation centers in Mexico, but on the other hand, it happens because the primary physician do not refer all the eligible patients to this kid of programs. RENAPREC can be one first attempt to consolidate all the activities around the inter-institutional cardiac rehabilitation and secondary prevention programs in our country.

Protegiendo al recién nacido durante el puerperio la madre adolescente asegura un hijo sano y fuerte / Protecting the newborn during the alter childbirth period the adolescent mother ensures a healthy and strong child

El presente artículo es el resultado de una investigación que tuvo como propósito comprender el significado del cuidado de la adolescente puérpera con su hijo recién nacido. Para conducirlo se utilizó la etnografía focalizada y como método de recolección de la información la entrevista no estructurada. Participaron ocho adolescentes en Cali y ocho en Bogotá, entre 13 y 17 años, con igual número de recién nacidos. Para confirmar la validez de las entrevistas se llevaron a cabo tres entrevistas grupales. En Bogotá participaron tres parteras tradicionales y en Cali dos parteras y un curandero. El análisis se realizó utilizando el concepto de “análisis de Spradley”, el cual incluye los dominios, taxonomías, análisis componencial y temas. Cada vez que se realizaba una entrevista se transcribía y se leía varias veces buscando categorías nativas y relaciones semánticas, con lo cual se facilitaba el descubrimiento de los dominios. Los conceptos y prácticas de las adolescentes relacionados con el cuidado de sus hijos recién nacidos, presentaron algún contraste con aquellos promovidos por el conocimiento profesional de Enfermería. Las adolescentes realizan prácticas cotidianas con los recién nacidos para asegurar hijos sanos y fuertes.

This article is the result of a survey whose main purpose was to understand the significance of the care of the adolescent and her newborn after giving childbirth. There was used the focalized ethnography to conduct it, and as means to collect the information it was used the non structured interview. There were eight adolescents in Cali and eight in Bogotá, between the ages of 13 and 17 with the same amount of newborns. To confirm the strength of the interviews there were performed three collective interviews. In Bogotá three traditional midwives participated, and in Cali there were two, and a traditional health care giver. For the analysis it was used the concept of “Spradley analysis” which include the domains, taxonomies, componential...