La integración de la inteligencia artificial en la educación médica y su impacto en la práctica clínica / The integration of artificial intelligence in medical education and its impact on clinical practice

Introducción: La integración de la inteligencia artificial (IA) en la educación médica redefine paradigmas, optimiza méto-dos y forja una simbiosis tecnológica. Desarrollo: La IA potencia simulaciones clínicas, mejora evaluaciones y desarrolla habilidades blandas, redefiniendo lainteracción médico-paciente. Conclusiones: Aunque persisten desafíos éticos, la colaboración interdisciplinaria y la adaptabilidad son cruciales. La IA marca un hito en la evolución médica al elevar la calidad asistencial y establecer estándares para una colaboración armoniosa entre tecnología y compasión.(AU)

Introduction: The incorporation of artificial intelligence (AI) into medical education redefines paradigms, optimisesmethods and forges a technological symbiosis. Development: AI enhances clinical simulations, improves assessments and develops soft skills, thereby redefining doctor-patient interaction. Conclusions: Although ethical challenges remain, interdisciplinary collaboration and adaptability are crucial. AI marks a milestone in the evolution of medicine by raising the quality of care and setting standards for harmonious collaboration between technology and compassion.(AU)

El verdadero origen histórico del trauma cardíaco penetrante / The true historical origin of penetrating cardiac trauma

Introducción. Los traumatismos cardíacos son lesiones graves y con elevado índice de letalidad, aspecto que influye en el interés mostrado por los lectores cada vez que aparecen reportados en publicaciones científicas. En ocasiones existe cierto grado de incongruencia a la hora de establecer el origen histórico de sucesos o eventos ocurridos y relacionados con la historia de la medicina. En el caso del trauma cardíaco penetrante han sido descritos diversos orígenes en algunos de los artículos científicos publicados, lo cual puede generar un grado de duda en los lectores. Métodos. Se realizó una revisión de la literatura, médica y no médica, para buscar información que ayudara a esclarecer el verdadero origen histórico de esta entidad. Resultados. El trauma cardíaco penetrante fue descrito por primera vez en la obra griega titulada La Ilíada, escrita por Homero en el siglo VIII A.C., y no en El papiro quirúrgico de Edwin Smith, como varios autores mencionan. Conclusiones. De todos los eventos de trauma cardíaco penetrante descritos, el más irrefutable es el narrado en el canto XIII, donde se cuenta la muerte de Alcátoo, producto de una herida cardíaca ocasionada por una lanza arrojada por Idomeneo durante una batalla

Introduction. Cardiac traumatic injuries are serious injuries with a high lethality rate, an aspect that influences the interest shown by readers each time they appear reported in scientific publications. Sometimes there is a certain degree of inconsistency when it comes to establishing the historical origin of occurrences or events related to the history of medicine. In the case of penetrating cardiac trauma, different origins have been described in some of the published scientific articles, which may generate a degree of doubt in the readers. Methods. A review of the medical and non-medical literature was carried out to seek information that would help to clarify the true historical origin of this entity. Results. Penetrating cardiac trauma was first described in a Greek work entitled The Iliad, written by Homer in the 8th century B.C., and not in The Surgical Papyrus of Edwin Smith as several authors mention. Conclusions. Of all the events of penetrating cardiac trauma described, the most irrefutable is the one narrated in canto XIII, where it recounts the death of Alcathous product of a cardiac wound caused by a spear thrown by Idomeneo during a battle.

Infarto cerebral embólico como complicación perioperatoria de un mixoma auricular.

Perioperative stroke is one of the complications that can occur during the surgical procedure and up to 30 days after it. A 52-year-old woman with no neurological symptoms and a diagnosis of intracardiac mass. She underwent cardiac surgery with resection of the tumor that was compatible with atrial myxoma. In the immediate postoperative, she presented neurological symptoms and was diagnosed with basal ganglia infarction of embolic etiology. Perioperative stroke appears most frequently in cardiovascular surgery but is rarely reported in heart tumor resection surgery.

El accidente cerebrovascular perioperatorio es una de las complicaciones que pueden presentarse durante el proceder quirúrgico y hasta los 30 días posteriores al mismo. Se presenta el caso de una mujer de 52 años, sin síntomas neurológicos y con diagnóstico de masa intracardiaca. Se le realizó cirugía cardiaca con resección del tumor, que resultó compatible con mixoma auricular. En el posoperatorio inmediato presentó sintomatología neurológica y se diagnosticó infarto de ganglios basales de etiología embólica. El accidente cerebrovascular perioperatorio aparece con mayor frecuencia en las cirugías cardiovasculares, pero rara vez es reportado en cirugías de exéresis de tumores cardiacos.

Mobile element insertion detection in 89,874 clinical exomes.

PURPOSE: Exome sequencing (ES) is increasingly used for the diagnosis of rare genetic disease. However, some pathogenic sequence variants within the exome go undetected due to the technical difficulty of identifying them. Mobile element insertions (MEIs) are a known cause of genetic disease in humans but have been historically difficult to detect via ES and similar targeted sequencing methods. METHODS: We developed and applied a novel MEI detection method prospectively to samples received for clinical ES beginning in November 2017. Positive MEI findings were confirmed by an orthogonal method and reported back to the ordering provider. In this study, we examined 89,874 samples from 38,871 cases. RESULTS: Diagnostic MEIs were present in 0.03% (95% binomial test confidence interval: 0.02-0.06%) of all cases and account for 0.15% (95% binomial test confidence interval: 0.08-0.25%) of cases with a molecular diagnosis. One diagnostic MEI was a novel founder event. Most patients with pathogenic MEIs had prior genetic testing, three of whom had previous negative DNA sequencing analysis of the diagnostic gene. CONCLUSION: MEI detection from ES is a valuable diagnostic tool, reveals molecular findings that may be undetected by other sequencing assays, and increases diagnostic yield by 0.15%.

High-throughput SuperSAGE for gene expression analysis of Nicotiana tabacum-Rhizoctonia solani interaction.

OBJECTIVE: The ubiquitous soil pathogen Rhizoctonia solani causes serious diseases in different plant species. Despite the importance of this disease, little is known regarding the molecular basis of susceptibility. SuperSAGE technology and next-generation sequencing were used to generate transcript libraries during the compatible Nicotiana tabacum-R. solani interaction. Also, we used the post-transcriptional silencing to evaluate the function of a group of important genes. RESULTS: A total of 8960 and 8221 unique Tag sequences identified as differentially up- and down-regulated were obtained. Based on gene ontology classification, several annotated UniTags corresponded to defense response, metabolism and signal transduction. Analysis of the N. tabacum transcriptome during infection identified regulatory genes implicated in a number of hormone pathways. Silencing of an mRNA induced by salicylic acid reduced the susceptibility of N. tabacum to R. solani. We provide evidence that the salicylic acid pathway was involved in disease development. This is important for further development of disease management strategies caused by this pathogen.

Endoscopic evacuation of spontaneous supratentorial intracerebral hemorrhage

Introduction: Spontaneous intracerebral hemorrhage (SICH) constitutes a major public health problem worldwide, despite active research it is still a leading cause of morbidity, disability, and death. In Cuba cerebrovascular disease represents the 3rd cause of death and in the last decade, the number of deaths for this cause has increased and the mortality rate is about 41/100,000/year. Method: We have carried out a descriptive study of 14 patients admitted in the intensive care unit of Moron General Hospital in Ciego de Avila, Cuba, with diagnosis of Spontaneous Supratentorial Intracerebral Hemorrhage (SSICH), who were treated with endoscopic surgical evacuation in the period from January of 2013 to December of 2014. Results: All patients underwent surgery within 12 hours of ictus and 10 (71.43 percent) underwent surgery within 6 hours. The mean time from SSICH onset to surgery was 7.6 hours. The mean operative time was 90 minutes. Endoscopy was successfully completed in all cases and the hematoma evacuation rate was 97 percent- 100 percent in all patients. The mortality rate was 5 patients (35.71 percent). Six months after clot endoscopic evacuation, six cases (42.86 percent) had poor results (Grade IV-VI) and 8 (57.14 percent) had goodrecovery (Grade 0-III). Conclusions: Early endoscope-assisted SSICH evacuation is safe, effective and feasible method in hematoma evacuation.

Carrier Screening is a Deficient Strategy for Determining Sperm Donor Eligibility and Reducing Risk of Disease in Recipient Children.

AIMS: DNA-based carrier screening is a standard component of donor eligibility protocols practiced by U.S. sperm banks. Applicants who test positive for carrying a recessive disease mutation are typically disqualified. The aim of our study was to examine the utility of a range of screening panels adopted by the industry and the effectiveness of the screening paradigm in reducing a future child's risk of inheriting disease. METHODS: A cohort of 27 donor applicants, who tested negative on an initial cystic fibrosis carrier test, was further screened with three expanded commercial carrier testing panels. These results were then compared to a systematic analysis of the applicants' DNA using next-generation sequencing (NGS) data. RESULTS: The carrier panels detected serious pediatric disease mutations in one, four, or six donor applicants. Because each panel screens distinct regions of the genome, no single donor was uniformly identified as carrier positive by all three panels. In contrast, systematic NGS analysis identified all donors as carriers of one or more mutations associated with severe monogenic pediatric disease. These included 30 variants classified as "pathogenic" based on clinical observation and 66 with a high likelihood of causing gene dysfunction. CONCLUSION: Despite tremendous advances in variant identification, understanding, and analysis, the vast majority of disease-causing mutation combinations remain undetected by commercial carrier screening panels, which cover a narrow, and often distinct, subset of genes and mutations. The biological reality is that all donors and recipients carry serious recessive disease mutations. This challenges the utility of any screening protocol that anchors donor eligibility to carrier status. A more effective approach to reducing recessive disease risk would consider joint comprehensive analysis of both donor and recipient disease mutations. This type of high-resolution recessive disease risk analysis is now available and affordable, but industry practice must be modified to incorporate its use.

'Candidatus Liberibacter asiaticus', Causal Agent of Citrus Huanglongbing, Is Reduced by Treatment with Brassinosteroids.

Huanglongbing (HLB) constitutes the most destructive disease of citrus worldwide, yet no established efficient management measures exist for it. Brassinosteroids, a family of plant steroidal compounds, are essential for plant growth, development and stress tolerance. As a possible control strategy for HLB, epibrassinolide was applied to as a foliar spray to citrus plants infected with the causal agent of HLB, 'Candidatus Liberibacter asiaticus'. The bacterial titers were reduced after treatment with epibrassinolide under both greenhouse and field conditions but were stronger in the greenhouse. Known defense genes were induced in leaves by epibrassinolide. With the SuperSAGE technology combined with next generation sequencing, induction of genes known to be associated with defense response to bacteria and hormone transduction pathways were identified. The results demonstrate that epibrassinolide may provide a useful tool for the management of HLB.

Targeted mutation screening panels expose systematic population bias in detection of cystic fibrosis risk.

PURPOSE: Carrier screening for mutations contributing to cystic fibrosis (CF) is typically accomplished with panels composed of variants that are clinically validated primarily in patients of European descent. This approach has created a static genetic and phenotypic profile for CF. An opportunity now exists to reevaluate the disease profile of CFTR at a global population level. METHODS: CFTR allele and genotype frequencies were obtained from a nonpatient cohort with more than 60,000 unrelated personal genomes collected by the Exome Aggregation Consortium. Likely disease-contributing mutations were identified with the use of public database annotations and computational tools. RESULTS: We identified 131 previously described and likely pathogenic variants and another 210 untested variants with a high probability of causing protein damage. None of the current genetic screening panels or existing CFTR mutation databases covered a majority of deleterious variants in any geographical population outside of Europe. CONCLUSIONS: Both clinical annotation and mutation coverage by commercially available targeted screening panels for CF are strongly biased toward detection of reproductive risk in persons of European descent. South and East Asian populations are severely underrepresented, in part because of a definition of disease that preferences the phenotype associated with European-typical CFTR alleles.

Expression of a Nicotiana tabacum pathogen-induced gene is involved in the susceptibility to black shank.

Many host genes induced during compatible plant-pathogen interactions constitute targets of pathogen virulence factors that act to suppress host defenses. In order to identify Nicotiana tabacum L. genes for pathogen-induced proteins involved in susceptibility to the oomycete Phytophthora parasitica var. nicotianae, we used SuperSAGE technology combined with next-generation sequencing to identify transcripts that were differentially upregulated during a compatible interaction. We identified a pathogen-induced gene (NtPIP) that was rapidly induced only during the compatible interaction. Virus-induced gene silencing of NtPIP reduced the susceptibility of N. tabacum to P. parasitica var. nicotianae. Additionally, transient expression of NtPIP in the resistant species Nicotiana megalosiphon Van Heurck & Mull. Arg. compromised the resistance to P. parasitica var. nicotianae. This pathogen-induced protein is therefore a positive regulator of the susceptibility response against an oomycete pathogen in tobacco.

Validation of a high resolution NGS method for detecting spinal muscular atrophy carriers among phase 3 participants in the 1000 Genomes Project.

BACKGROUND: Spinal muscular atrophy (SMA) is the most common pan-ethnic cause of early childhood death due to mutations in a single gene, SMN1. Most chromosome 5 homologs have a functional gene and dysfunctional copy, SMN2, with a single synonymous base substitution that results in faulty RNA splicing. However, the copy number of SMN1 and SMN2 is highly variable, and one in 60 adults worldwide are SMA carriers. Although population-wide screening is recommended, current SMA carrier tests have not been incorporated into targeted gene panels. METHODS: Here we describe a novel computational protocol for determining SMA carrier status based solely on individual exome data. Our method utilizes a Bayesian hierarchical model to quantify an individual's carrier probability given only his or her SMN1 and SMN2 reads at six loci of interest. RESULTS: We find complete concordance with results obtained with the current qPCR-based testing standard in known SMA carriers and affecteds. We applied our protocol to the phase 3 cohort of the 1,000 Genomes Project and found carrier frequencies in multiple populations consistent with the present literature. CONCLUSION: Our process is a convenient, robust alternative to qPCR, which can easily be integrated into the analysis of large multi-gene NGS carrier screens.

High efficacy of a 20 amino acid peptide of the acidic ribosomal protein P0 against the cattle tick, Rhipicephalus microplus.

Current strategies to control cattle ticks use integrated control programs (ICP) that include vaccination. Reduction in the use of chemicals and in the cost of tick control, the delay or elimination of acaricide resistance and the decreasing of environmental pollution are the advantages of using these programs. This integrated program is potentially applicable to all genotypes of chemical resistant ticks. However, the problem here is to improve the efficacy of anti-tick vaccines. The P0 protein is a structural component of the ribosome of all organisms. We have identified an immunogenic region of ribosomal protein P0 from Rhipicephalus spp. ticks that is not very conserved compared to the orthologous protein in their hosts. A synthetic 20 amino acid peptide from this sequence was effective as a vaccine against Rhipicephalus sanguineus infestations in an immunization and challenge experiment using rabbits. In this paper, the same peptide used as vaccine against the cattle tick Rhipicephalus Boophilus microplus shows a significant diminution in the number of engorged females recovered, in the weight of females and the weight of egg masses. The number of eggs hatched was also significantly reduced for the vaccinated group, with an overall effectivity for the antigen pP0 of 96%. These results, together with the conserved sequence of the P0 peptide among ticks, suggest that this antigen could be a good broad spectrum vaccine candidate. It would be expected to be active against many species of ticks and thus has promise in an ICP for effective control of ticks and thereby to improve the efficiency and productivity of the livestock industry.

Incidencia de infección relacionada con el cuidado sanitario en la Unidad de Cuidados Intensivos de Adultos del Hospital Morón. Año 2012 / Incidence of infection associated with health care in the Adult Intensive Care Unit from Moron Hospital. 2012

Introducción: Las infecciones relacionadas con los cuidados sanitarios son causas principales de morbilidad y mortalidad en las unidades de cuidados intensivos. Método: Se realizó un estudio observacional descriptivo, prospectivo y transversal, que incluyó a 84 pacientes de la Unidad de Cuidados Intensivos de Morón durante tres meses del año 2012. Se recogieron variables generales, relacionadas con la presencia de factores de riesgo extrínseco e intrínseco, diagnósticos de infecciones relacionadas con los cuidados sanitarios y gérmenes causales. Resultados: Los principales factores de riesgo fueron el uso de antibióticos y dispositivos invasivos. Al menos una infección durante su ingreso se diagnosticó en 20,1 por ciento de la muestra. Las localizaciones más frecuentes fueron la respiratoria, a predominio de la neumonía asociada a ventilación mecánica, 26,3 por ciento, las bacteriemias primarias y asociadas a catéter (21,0 por ciento/10,5 por ciento). La densidad de incidencia de neumonía asociada a ventilación mecánica fue 14,49 por ciento días de factor de riesgo. Los microorganismos más frecuentes aislados fueron el grupo de los Staphylococcus spp., Acinetobacter spp. y Klebsiellas spp. La estadía media de los pacientes con infección relacionada con el cuidado sanitario fue 10,37 días vs 4,12 días en pacientes sin ellas (p<0,001).Conclusiones: Las tasas y densidades de incidencia de infecciones relacionadas con los cuidados sanitarios son altas y ocasionan un aumento de la estadía y mortalidad; los resultados mostrados reflejan la magnitud del problema de las IRCS en las UCIs(AU)

The healthcare-related infections are the main causes of morbidity and mortality in intensive care units. A descriptive, prospective and cross-sectional study involving 84 patients in the Intensive Care Unit of Moron, for three months was carried out. General variables, such as the presence of extrinsic and intrinsic risk factors, infection diagnostics related to causal germs and health care were collected. The main risk factors were the use of antibiotics and invasive devices. At least one infection during hospitalization was diagnosed in 20.1percent of the sample. The most common sites were respiratory, prevalence of ventilator-associated pneumonia, 26.3 percent, primary and catheter- related bacteremia (21.0 percent/10.5 percent). The incidence density of ventilator-associated pneumonia was a 14.49 percent of risk factor days. The most common isolated microorganisms were the groups of Staphylococcus spp., Acinetobacter spp. and Klebsiellas spp. The average stay of patients with this condition was 10.37 days 4.12 in other patients (p <0.001). The rates and incidence density of health care related infections are high and cause an increase of stay and mortality(AU)

Esteroides en sepsis grave y shock séptico. Aspectos polémicos / Steroids in severe sepsis and septic shock. Controversial aspects

En lo que respecta a la terapéutica de pacientes en cuidados intensivos varias son las novedades reportadas hasta el momento que han logrado mejorar las tasas de mortalidad, entre las que se encuentran las estrategias ventilatorias protectivas, el control glucémico estricto con insulina intravenosa y el resurgimiento de la terapia corticoidea a dosis fisiológicas. Respecto a este último pilar, el tratamiento con esteroides en la sepsis posee un gran atractivo en aquellas situaciones en las que la respuesta inflamatoria del organismo séptico es responsable de la gravedad de la misma, las indicaciones potenciales del tratamiento esteroideo son muchas; sin embargo, la evidencia científica es escasa y de calidad insuficiente. Por último, el papel de los corticoides en el tratamiento de la sepsis grave y el shock séptico ha sido y es un episodio controvertido y polémico y si bien se ha demostrado que el uso de pautas no prolongadas de esteroides a bajas dosis mejoran la hemodinámica y reducen la duración del tratamiento vasopresor se sospecha que su empleo está generalizado gracias al gran éxito que han tenido las medidas propugnadas por la campaña Sobrevivir a la sepsis. Por todo esto, se realizó en el servicio de Cuidados Intensivos Adulto del Hospital General Docente de Morón Capitán Roberto Rodríguez Fernández una revisión sobre el tema (AU)

With regard to therapy of patients in ICU are several developments reported so far have succeeded in improving mortality rates, among which are: protective ventilatory strategies, strict glycemic control with intravenous insulin and the resurgence of corticosteroid therapy at physiological doses. Taking into account this last pillar, steroid therapy in sepsis has great appeal in situations where the body septic inflammatory response is responsible for the severity of it, the potential indications of therapy are many; however, the scientific evidence is scarce and poor. Finally, the role of corticosteroids in the treatment of severe sepsis and septic shock has been controversial and although it has been shown that the use of not prolonged guidelines of low-dose steroids improve hemodynamics and reduce duration of Vasoconstrictor therapy is suspected that their use is widespread due to the great success that have taken the measures advocated by the Surviving sepsis campaign. For all this, in the Intensive Care Unit from the Teaching General Hospital of Moron Capitán Roberto Rodríguez Fernández, a review about it was carried out (AU)

Downregulation of miR-23a and miR-27a following experimental traumatic brain injury induces neuronal cell death through activation of proapoptotic Bcl-2 proteins.

MicroRNAs (miRs) are small noncoding RNAs that negatively regulate gene expression at the post-transcriptional level. To identify miRs that may regulate neuronal cell death after experimental traumatic brain injury (TBI), we profiled miR expression changes during the first several days after controlled cortical impact (CCI) in mice. miR-23a and miR-27a were rapidly downregulated in the injured cortex in the first hour after TBI. These changes coincided with increased expression of the proapoptotic Bcl-2 family members Noxa, Puma, and Bax. In an etoposide-induced in vitro model of apoptosis in primary cortical neurons, miR-23a and miR-27a were markedly downregulated as early as 1 h after exposure, before the upregulation of proapoptotic Bcl-2 family molecules. Administration of miR-23a and miR-27a mimics attenuated etoposide-induced changes in Noxa, Puma, and Bax, reduced downstream markers of caspase-dependent (cytochrome c release and caspase activation) and caspase-independent (apoptosis-inducing factor release) pathways, and limited neuronal cell death. In contrast, miRs hairpin inhibitors enhanced etoposide-induced neuronal apoptosis and caspase activation. Importantly, administration of miR-23a and miR-27a mimics significantly reduced activation of Puma, Noxa, and Bax as well as attenuated markers of caspase-dependent and -independent apoptosis after TBI. Furthermore, miR-23a and miR-27a mimics significantly attenuated cortical lesion volume and neuronal cell loss in the hippocampus after TBI. These findings indicate that post-traumatic decreases in miR-23a and miR-27a contribute to neuronal cell death after TBI by upregulating proapoptotic Bcl-2 family members, thus providing a novel therapeutic target.

Strong oviposition preference for Bt over non-Bt maize in Spodoptera frugiperda and its implications for the evolution of resistance.

BACKGROUND: Transgenic crops expressing Bt toxins have substantial benefits for growers in terms of reduced synthetic insecticide inputs, area-wide pest management and yield. This valuable technology depends upon delaying the evolution of resistance. The 'high dose/refuge strategy', in which a refuge of non-Bt plants is planted in close proximity to the Bt crop, is the foundation of most existing resistance management. Most theoretical analyses of the high dose/refuge strategy assume random oviposition across refugia and Bt crops. RESULTS: In this study we examined oviposition and survival of Spodoptera frugiperda across conventional and Bt maize and explored the impact of oviposition behavior on the evolution of resistance in simulation models. Over six growing seasons oviposition rates per plant were higher in Bt crops than in refugia. The Cry1F Bt maize variety retained largely undamaged leaves, and oviposition preference was correlated with the level of feeding damage in the refuge. In simulation models, damage-avoiding oviposition accelerated the evolution of resistance and either led to requirements for larger refugia or undermined resistance management altogether. Since larval densities affected oviposition preferences, pest population dynamics affected resistance evolution: larger refugia were weakly beneficial for resistance management if they increased pest population sizes and the concomitant degree of leaf damage. CONCLUSIONS: Damaged host plants have reduced attractiveness to many insect pests, and crops expressing Bt toxins are generally less damaged than conventional counterparts. Resistance management strategies should take account of this behavior, as it has the potential to undermine the effectiveness of existing practice, especially in the tropics where many pests are polyvoltinous. Efforts to bring down total pest population sizes and/or increase the attractiveness of damaged conventional plants will have substantial benefits for slowing the evolution of resistance.

Implicaciones histórico-sociales, legales, bioéticas y religiosas de la muerte encefálica / Historical social, legal, bioethical and religious implications of brain death

La profesión médica se ha caracterizado, en cada época histórica, por determinados rasgos que han sido la expresión de la actitud que ha asumido la sociedad hacia el hombre y su cuerpo, de una parte, y la valoración que éste ha hecho de su salud y de la enfermedad, por otra. Muy vinculados a estos conceptos ha estado la forma de enfrentamiento a la muerte, ya como etapa o evento del propio proceso vital, ya como castigo o premio. En los tiempos más remotos de la humanidad el médico-sacerdote-brujo trataba al hombre enfermo como un todo, atendía al cuerpo y al alma. En la mayoría de las ocasiones no podía discernir dónde terminaba el mal de uno y comenzaba el de la otra. La materia y el espíritu del hombre formaban una sola unidad y, en esa totalidad debía ser tratado. La disolución de la unidad estaba presente con la muerte. En la Unidad de Cuidados Intensivos del Hospital General de Morón se valoran algunas consideraciones sobre las implicaciones histórico sociales de la muerte encefálica y se enuncian los criterios médicos para el diagnóstico y se analizan los aspectos legales de la definición para determinar las implicaciones bioéticas y evaluar qué interpretación hace la religión de la muerte encefálica (AU)

Medical profession has been characterized, in each historical period, by certain features that have been the expression of the attitude that has taken the company to the man and his body, and the assessment it has made of his health and disease. Closely linked to these concepts has been the way of confronting death and as a stage or event of the life process, and as a punishment or reward. In the earliest days of mankind, the doctor - priest - warlock treated the sick man as a whole; he tended to body and soul. In most cases he could not tell where ended the evil and where began the other one. Matter and spirit of man formed a single unit, in that all he should be treated. The dissolution of the unit was present at death. In the Intensive Care Unit of the General Hospital of Moron it was proposed some considerations on the historical social implications of brain death and stating the medical criteria for diagnosing , analyzing the legal aspects of defining, determining bioethical implications and assess how religion interprets the brain death (AU)

Relación de la gingivitis crónica con algunas afecciones del sistema osteomioarticular según holograma del microsistema de dientes alemán / Relationship of chronic gingivitis with some conditions of the osteomyoarticular system according to hologram of the German dental microsystem

Se realizó un estudio descriptivo y transversal de 77 pacientes de ambos sexos y edades entre 20-45 años con alguna afección del sistema osteomioarticular, atendidos en la consulta estomatológica de la parroquia Leoncio Martínez de Caracas, Venezuela, desde enero hasta Junio de 2009, a fin de relacionar la gingivitis crónica con algunas afecciones de este sistema según holograma del microsistema de dientes alemán. En la casuística, el meridiano más afectado fue pulmón-intestino grueso; predominaron las dolencias del sistema osteomioarticular en el lado izquierdo y la mayoría de campos de interferencia con la gingivitis crónica estuvieron en la parte derecha de la cavidad bucal. Asimismo, se hallaron alteraciones en la columna vertebral de los afectados con gingivitis leve, moderada y avanzada(AU)

A descriptive and cross-sectional study was conducted in 77 patients of both sexes and ages between 20-45 years with some condition of the osteomyoarticular system, attended in the dental department of the parish Leoncio Martínez from Caracas, Venezuela, from January to June 2009, in order to relate chronic gingivitis to some conditions of this system according to hologram of the German dental microsystem. In the case material the most affected meridian was lung-large intestine; osteomyoarticular system conditions prevailed on the left and most of the interference fields with chronic gingivitis were on the right side of the oral cavity. Also, abnormalities in the spine of those patients with mild, moderate and severe gingivitis were found(AU)