[Extremity soft tissue sarcoma: does surgical margin impact survival?] / Sarcomas de tejidos blandos en las extremidades: ¿el margen quirúrgico impacta la sobrevida?

Objective: To define the impact of surgical margins on local recurrence (LR), distant recurrence (DR) and overall survival (OS) in patients with soft tissue sarcomas of the extremities (eSTS). Method: Patients treated for a primary eSTS from 2006 to 2010 were analyzed. Rates of local recurrence, distant recurrence, and overall survival were estimated using the Kaplan-Meier method. The association of possible prognostic factors such as local recurrence, metastasis, and survival was performed using the Cox proportional hazards model. Results: 128 patients were analyzed. The surgical margins were positive (R1 resection) in 22.7% and negative in 77.3%. The LR was 27%, the DR was 13% (70% of the population was free of disease at 5 years) and OS at 5 years was 84%. The prognostic factors for OS at 5 years were clinical stage, type and histological grade. The surgical margin had no impact on OS. Conclusions: Although an adequate oncological resection cannot be underestimated, this should be considered in the decision of the optimal treatment of eSTS when amputation or significant functional impairment of the limb is required to obtain negative surgical margins.

Objetivo: Definir el impacto de los márgenes quirúrgicos sobre la recurrencia local (RL), la recurrencia a distancia (RD) y la supervivencia global (SG) en pacientes con sarcomas de tejidos blandos de las extremidades (STBe). Método: Se analizaron pacientes tratados por un STBe primario desde 2006 hasta 2010. Las tasas de recurrencia local, recurrencia a distancia y sobrevida global se estimaron mediante el método de Kaplan-Meier. La asociación de posibles factores pronósticos como recidiva local, metástasis y supervivencia se realizó mediante el modelo de riesgos proporcionales de Cox. Resultados: Se analizaron 128 pacientes. Los márgenes quirúrgicos fueron positivos (resección R1) en el 22.7% y negativos en el 77.3%. La RL fue del 27% y la RD fue del 13% (el 70% de la población está libre de enfermedad a 5 años) y la SG a 5 años fue del 84%. Los factores pronósticos para la SG a 5 años fueron el estadio clínico, el tipo y el grado histológico. El margen quirúrgico no tuvo impacto en la SG. Conclusiones: Aunque no se puede subestimar una resección oncológica adecuada, esto se debe considerar en la decisión del tratamiento óptimo de los STBe cuando se requiere una amputación o un deterioro funcional significativo de la extremidad para obtener márgenes quirúrgicos negativos.

La dipeptidil peptidasa 4 y su función frente a la COVID-19 / Dipeptidyl peptidase 4 and its function against COVID-19

Ante la aparición de un nuevo virus en la ciudad de Wuhan-China, llamado SARS-CoV-2, causante del conocido síndrome agudo respiratorio severo (COVID-19), muchos de científicos tratan de hallar una solución contra el virus que ha ocasionado una pandemia. En esta búsqueda, se encontró a una glicoproteína de transmembrana llamada dipeptidil peptidasa 4 o DPP-4 presente en la superficie de diferentes tipos de células y diana en la infección por el MERS-Co-V que abre una esperanza al sospechar que la DPP-4 puede ser un blanco en diferentes coronavirus al servir como estrategia terapéutica. A ello se suman resultados que encuentran la DPP-4 elevada en pacientes con complicaciones graves ante COVID-19, lo que puede ser un posible marcador de gravedad. Sin embargo, aún existe poco énfasis en la identificación y asociación de esta glicoproteína a la COVID-19. Para ello, se realizó una revisión bibliográfica sobre los aspectos más significativos de la Dipeptidil Peptidasa 4 y su función frente a la COVID-19(AU)

Given the appearance of a new virus in the of Wuhan city, China, called SARS-CoV-2, which causes the well-known severe acute respiratory syndrome (COVID-19), many scientists are trying to find a solution against the virus that has caused a pandemic. In this search, a transmembrane glycoprotein called dipeptidyl peptidase 4 or DPP-4 was found present on the surface of different types of cells and a target in MERS-Co-V infection, which opens hope by suspecting that DPP- 4 can be a target in different coronaviruses by serving as a therapeutic strategy. Added to this, there are results that find elevated DPP-4 in patients with severe complications from COVID-19, which may be a possible marker of severity. However, there is still little emphasis on the identification and association of this glycoprotein with COVID-19. To this effect, a bibliographic review was carried out on the most significant aspects of Dipeptidyl Peptidase 4 and its function against COVID-19(AU)

Giant liver teratoma with gliosis peritonei treated by right extended hepatectomy: Overview and case report.

Germ cell tumors (GCTs) are considered as extragonadal if there is no evidence of a primary tumor in the testes or ovaries. GCTs can be classified as seminomas, non-seminomatous, mature teratomas, and immature teratomas based upon histology. Mature teratomas are generally found in prepuberal children. Less than 1% of them have been reported in the gastrointestinal tract and liver. Liver teratomas are extremely rare. There are only 11 cases reported in adults up to 2018. Isolated liver metastasis of ovarian teratoma is also very rare. We present a case of a late metachronous recurrence of liver cystic teratoma with gliosis peritonei in a female adult treated by a right extended hepatectomy along with a literature review.

[Morbimortalidad de la pancreatoduodenectomía en pacientes con cáncer de páncreas y tumores periampulares en el Hospital de Oncología del Centro Médico Nacional Siglo XXI de 2008 a 2013]. / Morbimortality of pancreatoduenectomy in patients with cancer of pancreas and periampular tumors in the Oncology Hospital of Centro Médico Nacional Siglo XXI from 2008 to 2013.

INTRODUCTION: Pancreatic tumors and periampullary tumors have a similar clinical presentation; pancreatoduodenectomy represents the only possibility of cure or of increasing survival; with an average mortality of 5-10% and a morbidity of 20-40%. OBJECTIVE: To determine the morbidity and mortality secondary to the pancreatoduodenectomy intervention in patients with pancreatic cancer or periampullary tumors in the Oncology Hospital of Centro Médico Nacional Siglo XXI (Mexico City) from 2008 to 2013. METHOD: Historical, observational and descriptive cohort carried out in the department of sarcomas and tumors of the upper digestive tube of the Oncology Hospital of Centro Médico Nacional Siglo XXI, postoperative pancreatoduodenectomy from 2008 to 2013. RESULTS: We included 71 patients who underwent pancreatoduodenectomy, 47 (66.2%) were female and 24 (33.8%) were male. The average age was 60.3 years. The most common histology was cancer of the Vater's ampulla (66.2%). The resections were R0 in 95.8% of the cases. Mortality was 4.22% and morbidity was 69%. The most frequent complication was pancreatic fistula (23.9%). In the statistical analysis, perioperative transfusion was associated with surgical complications (p < 0.007). CONCLUSIONS: The morbidity of pancreatoduodenectomy is greater than that reported in the literature, however, it does not influence mortality that is similar to that reported in other centers. The number of lymph nodes resected; as well as the percentage of negative margins are those accepted worldwide; It is concluded that this is derived from the experience of the center where these procedures are performed. No factor with statistical significance was found, only the transfusion that increased the complications.

INTRODUCCIÓN: Los tumores de páncreas y los tumores periampulares tienen una presentación clínica similar. La pancreatoduodenectomía representa la única posibilidad de curación o de aumentar la sobrevida, con una mortalidad promedio del 5-10% y una morbilidad del 20-40%. OBJETIVO: Determinar la morbilidad y la mortalidad secundarias a la intervención de pancreatoduodenectomía en pacientes con cáncer de páncreas o tumores periampulares en el Hospital de Oncología del Centro Médico Nacional SXXI de 2008 a 2013. MÉTODO: Cohorte histórica, observacional y descriptiva, realizada en el departamento de sarcomas y tumores de tubo digestivo alto del Hospital de Oncología del Centro Médico Nacional Siglo XXI, operados de pancreatoduodenectomía entre 2008 y 2013. RESULTADOS: Se incluyeron 71 pacientes que se sometieron a pancreatoduodenectomía; 47 (66.2%) eran de sexo femenino y 24 (33.8%) de sexo masculino. La edad promedio fue de 60.3 años. La histología más común fue cáncer de ámpula de Vater (66.2%). Las resecciones fueron R0 en el 95.8% de los casos. La mortalidad fue del 4.22% y la morbilidad fue del 69%. La complicación más frecuente fue la fístula pancreática (23.9%). En el análisis estadístico, la transfusión perioperatoria se asoció a complicaciones quirúrgicas (p < 0.007). CONCLUSIONES: La morbilidad de la pancreatoduodenectomía es mayor que lo reportado en la literatura; sin embargo, no influye en la mortalidad, que es similar a lo reportado en otros centros. El número de ganglios resecados, así como el porcentaje de márgenes negativos, son los aceptados internacionalmente. Se concluye que esto se deriva de la experiencia del centro donde se realizan estos procedimientos. No se encontró ningún factor con relevancia estadística, excepto la transfusión, que incrementaba las complicaciones.

Análisis de algunos indicadores bibliométricos de la Revista Información Científica de la Universidad Médica de Guantánamo / Analysis of some bibliometric indicators of the Revista Información Científica of the Medical University of Guantánamo

Introducción: la bibliometría se utiliza para evaluar áreas científicas, y resulta un método confiable y universal para medir la productividad de un sector. De la misma manera, determina que los estudios bibliométricos sean cada vez más requeridos y utilizados, hecho que se generaliza en los países científicamente con mayor desarrollo. Objetivo: evaluar la actividad científica y la producción de información de la Revista Información Científica durante el año 2011. Método: se realizó un estudio bibliométrico y descriptivo, de los artículos publicados en la RIC de la universidad médica de Guantánamo durante el año 2011, a través de la red, entre el 15 de enero y el 5 de febrero de 2012. Se revisaron desde la red los 149 artículos publicados en el período mencionado. Las variables estudiadas fueron: tipo de documentos, sexo, número de autores por artículos, municipios e instituciones donde se realizaron las investigaciones, cantidad de referencias bibliográficas utilizadas y grado de actualización. Resultados: los artículos originales fueron los más publicados, con predominio de autores del sexo femenino y autoría grupal de cuatro y cinco investigadores por artículo. Guantánamo es el municipio que más contribuyó con trabajos; la Universidad Médica y el Hospital General Docente provincial son las instituciones de mayor aporte. Hubo predominio en el uso de las referencias bibliográficas actualizadas, lo que refuerza la credibilidad, validez y rigor científico de esta revista guantanamera. Conclusiones: la RIC en sus 18 años de existencia ha sabido consolidarse. Los elementos novedosos aportados por este estudio, y que no habían sido investigados hasta ahora, constituyen datos valiosos para la política de información de la institución y lograr que el órgano oficial de los profesionales de la salud en Guantánamo gane en prestigio y calidad(AU)

Introduction: bibliometrics is used to evaluate scientific areas, and is a reliable and universal method to measure the productivity of a sector. In the same way, it determines that bibliometric studies are increasingly required and used, a fact that is generalized in scientifically developed countries. Objective: to evaluate the scientific activity and the information production of the Scientific Information Magazine during the year 2011. Method: a bibliometric and descriptive study was carried out of the articles published in the RIC of the medical university of Guantánamo during the year 2011, through the network, between January 15 and February 5, 2012. The 149 articles published in the aforementioned period were reviewed from the network. The variables studied were: type of documents, sex, number of authors per article, municipalities and institutions where the research was carried out, number of bibliographic references used and degree of update. Results: the original articles were the most published, with a predominance of female authors and group authorship of four and five researchers per article. Guantanamo is the municipality that contributed most with jobs; the Medical University and the Provincial Teaching General Hospital are the institutions with the greatest contribution. There was a predominance in the use of updated bibliographical references, which reinforces the credibility, validity and scientific rigor of this Guantanamera magazine. Conclusions: the RIC in its 18 years of existence has been able to consolidate. The novel elements contributed by this study, which had not been investigated until now, are valuable data for the information policy of the institution and ensure that the official organ of health professionals in Guantanamo gain in prestige and quality(AU)

Introdução: a bibliometria é usada para avaliar áreas científicas e é um método confiável e universal para medir a produtividade de um setor. Da mesma forma, determina que os estudos bibliométricos sejam cada vez mais necessários e utilizados, fato generalizado nos países cientificamente desenvolvidos. Objetivo: avaliar a atividade científica e a produção de informação da revista Scientific Information durante o ano de 2011. Método: foi realizado um estudo bibliométrico e descritivo dos artigos publicados na RIC da universidade médica de Guantánamo durante o ano de 2011, através da rede, entre 15 de janeiro e 5 de fevereiro de 2012. Os 149 artigos publicados no período supracitado foram revisados da rede. As variáveis estudadas foram: tipo de documentos, sexo, número de autores por artigo, municípios e instituições onde a pesquisa foi realizada, número de referências bibliográficas utilizadas e grau de atualização. Resultados: os artigos originais foram os mais publicados, com predominância de autores femininos e autoria de grupo de quatro e cinco pesquisadores por artigo. Guantánamo é o município que mais contribuiu com empregos; a Universidade Médica e o Hospital Geral Provincial de Ensino são as instituições com maior contribuição. Houve predomínio no uso de referências bibliográficas atualizadas, o que reforça a credibilidade, validade e rigor científico desta revista Guantanamera. Conclusões: o RIC em seus 18 anos de existência conseguiu consolidar. Os elementos novos contribuídos por este estudo, que não haviam sido investigados até agora, são dados valiosos para a política de informação da instituição e garantem que o órgão oficial dos profissionais de saúde em Guantánamo ganhe em prestígio e qualidade(AU)

Análisis de algunos indicadores bibliométricos de la Revista Información Científica de la Universidad Médica de Guantánamo / Análise de alguns indicadores bibliométricos da Revista Informaçión Científica da Universidade Médica de Guantánamo / Analysis of some bibliometric indicators of the Revista Información Científica of the Medical University of Guantánamo

Introducción: la bibliometría se utiliza para evaluar áreas científicas, y resulta un método confiable y universal para medir la productividad de un sector. De la misma manera, determina que los estudios bibliométricos sean cada vez más requeridos y utilizados, hecho que se generaliza en los países científicamente con mayor desarrollo. Objetivo: evaluar la actividad científica y la producción de información de la Revista Información Científica durante el año 2011. Método: se realizó un estudio bibliométrico y descriptivo, de los artículos publicados en la RIC de la universidad médica de Guantánamo durante el año 2011, a través de la red, entre el 15 de enero y el 5 de febrero de 2012. Se revisaron desde la red los 149 artículos publicados en el período mencionado. Las variables estudiadas fueron: tipo de documentos, sexo, número de autores por artículos, municipios e instituciones donde se realizaron las investigaciones, cantidad de referencias bibliográficas utilizadas y grado de actualización. Resultados: los artículos originales fueron los más publicados, con predominio de autores del sexo femenino y autoría grupal de cuatro y cinco investigadores por artículo. Guantánamo es el municipio que más contribuyó con trabajos; la Universidad Médica y el Hospital General Docente provincial son las instituciones de mayor aporte. Hubo predominio en el uso de las referencias bibliográficas actualizadas, lo que refuerza la credibilidad, validez y rigor científico de esta revista guantanamera. Conclusiones: la RIC en sus 18 años de existencia ha sabido consolidarse. Los elementos novedosos aportados por este estudio, y que no habían sido investigados hasta ahora, constituyen datos valiosos para la política de información de la institución y lograr que el órgano oficial de los profesionales de la salud en Guantánamo gane en prestigio y calidad(AU)

Introduction: bibliometrics is used to evaluate scientific areas, and is a reliable and universal method to measure the productivity of a sector. In the same way, it determines that bibliometric studies are increasingly required and used, a fact that is generalized in scientifically developed countries. Objective: to evaluate the scientific activity and the information production of the Scientific Information Magazine during the year 2011. Method: a bibliometric and descriptive study was carried out of the articles published in the RIC of the medical university of Guantánamo during the year 2011, through the network, between January 15 and February 5, 2012. The 149 articles published in the aforementioned period were reviewed from the network. The variables studied were: type of documents, sex, number of authors per article, municipalities and institutions where the research was carried out, number of bibliographic references used and degree of update. Results: the original articles were the most published, with a predominance of female authors and group authorship of four and five researchers per article. Guantanamo is the municipality that contributed most with jobs; the Medical University and the Provincial Teaching General Hospital are the institutions with the greatest contribution. There was a predominance in the use of updated bibliographical references, which reinforces the credibility, validity and scientific rigor of this Guantanamera magazine. Conclusions: the RIC in its 18 years of existence has been able to consolidate. The novel elements contributed by this study, which had not been investigated until now, are valuable data for the information policy of the institution and ensure that the official organ of health professionals in Guantanamo gain in prestige and quality(AU)

Introdução: a bibliometria é usada para avaliar áreas científicas e é um método confiável e universal para medir a produtividade de um setor. Da mesma forma, determina que os estudos bibliométricos sejam cada vez mais necessários e utilizados, fato generalizado nos países cientificamente desenvolvidos. Objetivo: avaliar a atividade científica e a produção de informação da revista Scientific Information durante o ano de 2011. Método: foi realizado um estudo bibliométrico e descritivo dos artigos publicados na RIC da universidade médica de Guantánamo durante o ano de 2011, através da rede, entre 15 de janeiro e 5 de fevereiro de 2012. Os 149 artigos publicados no período supracitado foram revisados da rede. As variáveis estudadas foram: tipo de documentos, sexo, número de autores por artigo, municípios e instituições onde a pesquisa foi realizada, número de referências bibliográficas utilizadas e grau de atualização. Resultados: os artigos originais foram os mais publicados, com predominância de autores femininos e autoria de grupo de quatro e cinco pesquisadores por artigo. Guantánamo é o município que mais contribuiu com empregos; a Universidade Médica e o Hospital Geral Provincial de Ensino são as instituições com maior contribuição. Houve predomínio no uso de referências bibliográficas atualizadas, o que reforça a credibilidade, validade e rigor científico desta revista Guantanamera. Conclusões: o RIC em seus 18 anos de existência conseguiu consolidar. Os elementos novos contribuídos por este estudo, que não haviam sido investigados até agora, são dados valiosos para a política de informação da instituição e garantem que o órgão oficial dos profissionais de saúde em Guantánamo ganhe em prestígio e qualidade(AU)

[Prognostic factors for survival in patients with resectable advanced gastric adenocarcinoma]. / Factores pronóstico de sobrevida en adenocarcinoma gástrico avanzado resecable.

BACKGROUND: Patients under 45 years with gastric cancer are associated with a poor prognosis. Recent studies report that the 5-year survival is better in younger patients after curative resection. OBJECTIVE: To determine if prognostic factors such as age under 45 years old, anaemia, weight loss, tumour differentiation, histological sub-type, depth of invasion, and lymph node involvement, reduce the survival of patients with resectable advanced gastric adenocarcinoma undergoing gastrectomy with limited and extended lymphadenectomy. MATERIALS AND METHODS: This study included a cohort of consecutive cases treated in the Sarcomas Department of the Oncology Hospital of the Centro Médico Nacional Siglo XXI, of the Instituto Mexicano del Seguro Social, during the period between January 2000 and December 2006. RESULTS: Of the total of 588 patients evaluated, 112 (19%) were under 45 years, 43% classified as Borrmann IV, and 36% as Borrmann III. Metastatic disease was present in 39.3%, localised diffuse in 12.5%; lower resectability 52.7 vs. 61.3% in older than 45 years. At the end of the study 29.5% of patients under 45 years were alive; no recurrence in 26.8%, with an overall survival of 58.6±4.3 months, compared with 18.3% of patients alive over 45 years, 17.9% disease-free, and with overall survival 35.2±4.3 months resectable disease. CONCLUSIONS: Patients under 45 years have a better survival after a two-year disease-free period.

Folleto complementario para la docencia de Física I en las residencias en ciencias básicas biomédicas / Complementary booklet for the teaching of Physics I in the biomedical basic sciences residences

Fundamento: la Física Médica utiliza sus fundamentos en múltiples técnicas terapéuticas y proporciona las bases para la compresión de modernas tecnologías médicas con criterios de utilización en el área de la salud. Objetivo: elaborar un folleto complementario como material de apoyo a Física I en las especialidades de las ciencias básicas biomédicas. Métodos: se realizó una investigación descriptiva longitudinal en la Universidad de Ciencias Médicas de Villa Clara, durante 2012-2013. Se emplearon métodos teóricos: histórico-lógico, analítico-sintético, inductivo-deductivo y sistémico-estructural; y empíricos: análisis documental del programa Física I y de las residencias Anatomía Humana y Fisiología para corroborar la vinculación intermaterias y determinar los núcleos esenciales del contenido; la encuesta a los residentes para comprobar su nivel de conocimientos sobre Física I, y a los docentes para conocer cuáles contenidos de sus asignaturas se vinculan con la Física. Resultados: se evidenció desactualización bibliográfica sobre los contenidos de Física en las especialidades. El cuestionario a los residentes corroboró las temáticas con mayores dificultades: leyes de Newton, oscilaciones y ondas, y movimiento circular; plantearon la necesidad de vincular Física I con los procesos fisiológicos y anatómicos del cuerpo humano. Los profesores expresaron que las temáticas de sus asignaturas se relacionan con Física, y que resultaría beneficioso un tratamiento metodológico interdisciplinario. Se elaboró un Folleto Complementario de apoyo para la docencia con contenidos de la asignatura y un sistema de ejercicios. Conclusiones: el material confeccionado fue valorado por los especialistas como útil y pertinente, por la actualización de sus contenidos y tratamiento metodológico.

Background: the Medical Physics uses its background in multiple therapeutic techniques and it provides the bases for the compression of modern medical technologies with usage criteria in the health area. Objective: to elaborate a complementary booklet as a material aid to Physics I in the specialties of the biomedical basic sciences. Methods: it was carried out a longitudinal descriptive research work in Villa Clara University of Medical Sciences, from 2012 to 2013. Theoretical methods were used: historical-logical, analytic-synthetic, inductive-deductive and systemic-structural; and empiric ones: documental analysis of the program Physics I and Human Anatomy and Physiology in the residences to corroborate the subjects interrelation and to determine the essential content cores; the survey to the residents to check their knowledge level on Physics I, and to the professors to know which contents of their subjects are linked with Physics. Results: it was evidenced a lack of bibliographical updating on the Physics contents in the specialties. The questionnaire to the residents corroborated the topics with more difficulties: Newton´s laws, oscillations and waves, and circular movement; they outlined the necessity to link Physics I with the physiologic and anatomical processes of the human body. The professors expressed that the topics of their subjects are related with Physics, and that it would be beneficial an interdisciplinary methodological treatment. A Complementary material aid booklet was elaborated for teaching with contents of the subject and a system of exercises. Conclusions: the elaborated material was valued by the specialists as useful and pertinent, for the updating of its contents and methodological treatment.

Folleto complementario para la docencia de Física I en las residencias en ciencias básicas biomédicas / Complementary booklet for the teaching of Physics I in the biomedical basic sciences residences

Fundamento: la Física Médica utiliza sus fundamentos en múltiples técnicas terapéuticas y proporciona las bases para la compresión de modernas tecnologías médicas con criterios de utilización en el área de la salud.Objetivo: elaborar un folleto complementario como material de apoyo a Física I en las especialidades de las ciencias básicas biomédicas.Métodos: se realizó una investigación descriptiva longitudinal en la Universidad de Ciencias Médicas de Villa Clara, durante 2012-2013. Se emplearon métodos teóricos: histórico-lógico, analítico-sintético, inductivo-deductivo y sistémico-estructural; y empíricos: análisis documental del programa Física I y de las residencias Anatomía Humana y Fisiología para corroborar la vinculación intermaterias y determinar los núcleos esenciales del contenido; la encuesta a los residentes para comprobar su nivel de conocimientos sobre Física I, y a los docentes para conocer cuáles contenidos de sus asignaturas se vinculan con la Física. Resultados: se evidenció desactualización bibliográfica sobre los contenidos de Física en las especialidades. El cuestionario a los residentes corroboró las temáticas con mayores dificultades: leyes de Newton, oscilaciones y ondas, y movimiento circular; plantearon la necesidad de vincular Física I con los procesos fisiológicos y anatómicos del cuerpo humano. Los profesores expresaron que las temáticas de sus asignaturas se relacionan con Física, y que resultaría beneficioso un tratamiento metodológico interdisciplinario. Se elaboró un Folleto Complementario de apoyo para la docencia con contenidos de la asignatura y un sistema de ejercicios. Conclusiones: el material confeccionado fue valorado por los especialistas como útil y pertinente, por la actualización de sus contenidos y tratamiento metodológico(AU)

Efecto del índice enfermera-paciente en la calidad de atención: estudio realizado en pacientes con enfermedades crónicodegenerativas en el servicio de medicina Interna / effect of contents nurse-patient quality of care: study in patients with chronic degenerative in internal medicine diseases

Los indicadores para determinar el número de personal de enfermería necesario deben responder a la demanda epidemiológica que caracteriza a nuestro país, dominada por enfermedades crónico-degenerativas que requieren un cuidado complejo que garantice la calidad de atención en salud y reduzca el riesgo de lesiones, maximizando la salud de los pacientes. La demanda de atención exige a las instituciones realizar la asignación del personal sin considerar la gravedad de la enfermedad, lo que puede alterar la calidad de atención. El objetivo de este trabajo fue evaluar, en un hospital de segundo nivel, la calidad de atención brindada a los pacientes con enfermedades crónico-degenerativas en relación al índice enfermera-paciente en medicina interna de atención. La metodología utilizada fue cuantitativa, longitudinal, prospectiva, no experimental, analítica y correlacional, en 47 pacientes por muestra probabilística. Por día se registró el índice real enfermera-paciente, se aplicó una cédula para valorar el estado integral del paciente a su ingreso y egreso, así como los cuidados de enfermería, utilizando los indicadores de calidad. El análisis se realizó con el Programa SPSS v20.0, e interpretación correlacional de Pearson y Spearman. Resultados: No se encontró ninguna asociación significativa (Rho Spearman = 0.00) entre la calidad de atención y los pacientes recibidos en el servicio, ni entre la calidad de atención y el personal promedio que labora en el Servicio de Medicina Interna. Conclusiones: Los indicadores establecidos por la Comisión Interinstitucional de Enfermería están basados en datos epidemiológicos de 1997, los cuales no responden al estándar de cuidado actualmente requerido

Indicators to determine the number of nurses needed, must respond to the epidemiological demand that characterizes our country that is dominated by chronic degenerative diseases requiring complex care, to ensure the quality of health care, reduce the risk of injuries, maximizing the health of patients. The demand for care requires institutions make the assignment of staff regardless of disease severity, such a situation may alter the quality of care provided to patients. The objective was to evaluate the quality of care provided to patients with chronic degenerative diseases relating to nurse patient ratio of internal medicine at a hospital in secondary care. The methodology used was quantitative, longitudinal, prospective, non-experimental, analytical and correlational, in 47 patients by probabilistic sample. By day the actual nurse-patient ratio were recorded,a charter was applied to assess the overall condition of the patient at admission and discharge, as well as nursing care, using quality indicators. The analysis was performed using SPSS v20.0 program, interpretation and correlation of Pearson and Spearman. Results: No significant association (Spearman Rho = 0.00) was not found between the quality of patient care and service received, or between quality of care and the average staff working in the Department of Internal Medicine. Conclusions: The indicators established by the Inter Nursing Facility, are based on epidemiological data from 1997, which do not respond to standard of care currently required

Changes in bacterial population of gastrointestinal tract of weaned pigs fed with different additives.

This study aimed to provide novel insights into the gastrointestinal microbial diversity from different gastrointestinal locations in weaning piglets using PCR-restriction fragment length polymorphism (PCR-RFLP). Additionally, the effect of different feed additives was analyzed. Thirty-two piglets were fed with four different diets: a control group and three enriched diets, with avilamycin, sodium butyrate, and a plant extract mixture. Digesta samples were collected from eight different gastrointestinal segments of each animal and the bacterial population was analysed by a PCR-RFLP technique that uses 16S rDNA gene sequences. Bacterial diversity was assessed by calculating the number of bands and the Shannon-Weaver index. Dendrograms were constructed to estimate the similarity of bacterial populations. A higher bacterial diversity was detected in large intestine compared to small intestine. Among diets, the most relevant microbial diversity differences were found between sodium butyrate and plant extract mixture. Proximal jejunum, ileum, and proximal colon were identified as those segments that could be representative of microbial diversity in pig gut. Results indicate that PCR-RFLP technique allowed detecting modifications on the gastrointestinal microbial ecology in pigs fed with different additives, such as increased biodiversity by sodium butyrate in feed.

Análisis de algunos indicadores bibliométricos de la Revista de Información Científica de la Universidad Médica de Guantánamo / Analysis of bibliometric indicators of the Journal of Scientific Medical information in the University, Guantanamo

Se presenta un estudio bibliométrico y descriptivo de la Revista de Información Científica (RIC) de la Universidad Médica de Guantánamo durante el año 2011, para evaluar la productividad científica de dicha publicación. Se revisan desde la red los 149 artículos publicados en el período mencionado. Las variables estudiadas son: tipo de documentos, sexo, número de autores por artículos, municipios e instituciones donde se realizaron las investigaciones, cantidad de referencias bibliográficas utilizadas y grado de actualización. Los artículos originales fueron los más publicados, con predominio de autores del sexo femenino y autoría grupal de cuatro y cinco investigadores por artículo. Guantánamo es el municipio que más contribuyó con trabajos; la Universidad Médica y el Hospital General Docente provincial son las instituciones de mayor aporte. Hubo predominio en el uso de las referencias bibliográficas actualizadas, lo que refuerza la credibilidad, validez y rigor científico de esta revista guantanamera(AU)

A descriptive and bibliometric study is presented in the Journal of Scientific Information (RIC) at the Medical University of Guantánamo in 2011 to assess the scientific productivity of such publication. Network is reviewed from the 149 articles published in this period. The variables were studied: type of documents, sex, and number of authors for articles, municipalities and institutions where researches were conducted, number of used references and degree of renovation. The original articles were the most published predominantly female authors and authoring group of four and five researchers per item. Guantánamo is a municipality that more contributed papers, the Medical University and General Teaching Hospital and provincial institutions are greatest with contribution. The use of update references was more important, reinforcing the credibility, validity and scientific rigor of this journal(AU)

Factores asociados con el cambio temprano de catéter de diálisis peritoneal en Veracruz, México / Factors associated with early peritoneal dialysis catheter replacement in Veracruz, Mexico

Antecedentes: Las complicaciones asociadas con el catéter en diálisis peritoneal causan disminución en su eficacia e interrupción de ésta, conversión a hemodiálisis, hospitalizaciones y necesidad de cirugía para cambiar el catéter. Objetivos: Determinar factores de riesgo para la disfunción temprana del catéter que hace necesario su cambio. Métodos: Se incluyeron 235 catéteres colocados con técnica quirúrgica abierta en línea media infraumbilical. Dentro de los posibles factores de riesgo se incluyó: edad, género, índice de masa corporal, área de superficie corporal, diabetes, enfermedad poliquística renal, cirugía previa, tiempo quirúrgico, omentectomía, omentopexia, infección de la herida y hernia posincisional. Resultados: El cambio del catéter por disfuncionalidad ocurrió en 47 pacientes (20%) durante el primer año. La complicación más frecuente fue: migración del catéter y peritonitis (4,3% en ambos casos), además de obstrucción por el omento (3,7%). En el análisis univariado, los pacientes que presentaron disfunción del catéter/cambio eran jóvenes con índice de masa corporal y área de superficie corporal bajos (p < 0,05). La infección de la herida y la hernia posincisional estaban asociados significativamente con el cambio de catéter. La omentectomía fue asociada a baja incidencia de disfunción de catéter/cambio en el análisis univariado y regresión logística (razón de momios: 0,275, intervalo de confianza: 95%, 0,101-0,751, p < 0,012). Conclusiones: Nuestra técnica de inserción de catéter ofrece bajas tasas de complicaciones y buenos resultados el primer año posquirúrgico. Además de la omentectomía, en nuestro estudio no se encontró un factor de riesgo para cambio de catéter en nuestra población. La omentectomía tuvo un efecto protector en términos de cambio de catéter (AU)

Introduction: Catheter-related complications in patients on peritoneal dialysis lead to decreased effectiveness and discontinuation of the technique, conversion to haemodialysis, hospitalisation, and surgical interventions to replace the catheter. Objectives: Determine risk factors for early catheter dysfunction that result in the need for replacement. Methods: We analysed 235 catheters placed by open surgery using an infra-umbilical midline incision. Possible risk factors included the following: age, sex, body mass index, body surface area, diabetes, polycystic kidney disease, previous surgery, time of surgical procedure, omentectomy, omentopexy, wound infection and postoperative incisional hernia. Results: During the first year, 47 patients (20%) required a catheter replacement due to poor function. The most common complications were catheter migration and peritonitis (4.3% in both cases), followed by obstruction from omental wrapping (3.7%). Univariate analysis showed that patients with catheter dysfunction or requiring catheter replacement were younger, with a lower body mass index and body surface area (P<.05). There was a significant association of wound infection and post-operative incisional hernia with catheter replacement. Omentectomy was associated with a low incidence rate of catheter dysfunction/replacement in the univariate and logistical regression analyses (odds ratio: 0.275; 95% confidence interval: 0.101-0.751; P<.012). Conclusions: Our catheter placement technique offers a low complication rate and good results in the first year after surgery. Except for omentectomy, we did not discover any risk factors for catheter replacement in our study population. Omentectomy had a protective effect in terms of catheter replacement (AU)

Factors associated with early peritoneal dialysis catheter replacement in Veracruz, Mexico.

INTRODUCTION: Catheter-related complications in patients on peritoneal dialysis lead to decreased effectiveness and discontinuation of the technique, conversion to haemodialysis, hospitalisation, and surgical interventions to replace the catheter. OBJECTIVES: Determine risk factors for early catheter dysfunction that result in the need for replacement. METHODS: We analysed 235 catheters placed by open surgery using an infra-umbilical midline incision. Possible risk factors included the following: age, sex, body mass index, body surface area, diabetes, polycystic kidney disease, previous surgery, time of surgical procedure, omentectomy, omentopexy, wound infection and postoperative incisional hernia. RESULTS: During the first year, 47 patients (20%) required a catheter replacement due to poor function. The most common complications were catheter migration and peritonitis (4.3% in both cases), followed by obstruction from omental wrapping (3.7%). Univariate analysis showed that patients with catheter dysfunction or requiring catheter replacement were younger, with a lower body mass index and body surface area (P<.05). There was a significant association of wound infection and post-operative incisional hernia with catheter replacement. Omentectomy was associated with a low incidence rate of catheter dysfunction/replacement in the univariate and logistical regression analyses (odds ratio: 0.275; 95% confidence interval: 0.101-0.751; P<.012). CONCLUSIONS: Our catheter placement technique offers a low complication rate and good results in the first year after surgery. Except for omentectomy, we did not discover any risk factors for catheter replacement in our study population. Omentectomy had a protective effect in terms of catheter replacement.

Literature review on the safety of Toyocerin, a non-toxigenic and non-pathogenic Bacillus cereus var. toyoi preparation.

Bacillus cereus var. toyoi is a naturally occurring, non-toxigenic and non-pathogenic strain of B. cereus. Safety studies were conducted on a B. toyoi preparation (Toyocerin, including but not limited to enterotoxicity, eye irritation, genotoxicity, acute, subchronic and chronic toxicity studies and human clinical trials. In rabbits, Toyocerin did not exhibit enterotoxicity and was only slightly irritating to the eyes. It was non-mutagenic in an Ames assay at up to 10,000 microg/plate and did not exhibit clastogenic activity in a chromosomal aberration test at up to 450 mg/ml. It was non-toxic in acute and repeated-dose (30 and 60 days and 1 year) toxicity studies in rats and mice at up to 3 x 10(11)spores/kg bw/day. In an eight-day human clinical trial, Toyocerin did not cause any adverse effects in healthy male and female subjects at 1 x 10(9) and 1 x 10(10)spores/kg bw/day. In feeding trials, Toyocerin not cause any adverse effects in rabbits, pigs, chickens, turkeys and cattle at doses ranging from 8.5 x 10(7) to 4 x 10(9)spores/kg bw/day for durations of 2 weeks to 18 months. Taken together, these studies demonstrate that Toyocerin is safe at the doses tested.

Una estrategia pedagógica extracurrricular para educar valores en la formación profesional de los estudiantes de la Escuela Latinoamericana de Medicina / An extracurricular pedagogic strategy for educating moral values in the students of the Latin American Medical School during their professional training

Elaborar y validar una estrategia pedagógica extracurricular para el trabajo del profesor guía que propicieel desarrollo de los valores responsabilidad, solidaridad y honestidad. Se realizó un diseño experimental en su variante de pre-experimento con prueba antes y después, al que se incorporaron elementos de investigación acción participativa para conferir flexibilidad a la estrategia implementada. Como métodos teóricos se emplearon el enfoque sistémico, la modelación y el histórico-lógico. De los métodos empíricos se emplearon la observación, el cuestionario, la entrevista grupal y los dilemas morales. Se trabajó con una muestra intencional de tres grupos de estudiantes. Se estableció una estrategia para el trabajo educativo en la ELAM como un sistema de actividades y tareas. La comparación entre el diagnóstico inicial y final mostró un incremento de los valores implicados en la estrategia. Para el componente cognoscitivo se apreciaron movimientos hacia niveles superiores. En cuanto a la intención conductual, para los tres valores se observó un cambio estadísticamente significativo, hacia categorías superiores. Se estableció una estrategia para el trabajo educativo en la ELAM a través de la que fue posible elevar el nivel de desarrollo de los valores morales responsabilidad, solidaridad y honestidad(AU)

To elaborate and to validate an extracurricular pedagogic strategy to develop the responsibility, solidarity and honesty as moral values of the students through the class teacher work. An experimental design which included pre-text and post-test was carried out. Some elements of participating action-research were integrated to the pedagogic experiment in order to make the strategy flexible in its setting in practice. As theoretic methods the systemic approach and modelling were used. As empirical methods the observation, a questionnaire, a group interview and moral dilemmas were employed, the sample was formedwith six groups of students. A system of activities and tasks was established as a strategy for the educating work in the Latin American Medical School. The comparison between the initial and final diagnostics showed an increase of the moral values considered in the strategy. Movements to higher levels were detected for the cognitive component. For the behavioural intention a meaningful statistic change toward higher categories was observed in each of the three moral values evaluated. A strategy for the educating work in the Latin American Medical School was established and it allowed to rise the development level of responsibility, solidarity and honesty as moral values of the students(AU)

Changes in caecal microbiota and mucosal morphology of weaned pigs.

An experiment was designed to monitor the changes in caecal microbiota associated with early weaning. Twelve piglets (20+/-2 days) from six different litters were selected from a commercial source. For the two experimental groups, one animal from each litter was weaned onto a post-weaning diet (W) and the other remained with the sow (S). After 1 week, animals were sacrificed and caecal samples taken. Microbial counts for total bacteria, enterobacteria and lactobacilli populations were determined by quantitative PCR using SYBR Green dye. Microbial profiles were assessed by terminal restriction fragment length polymorphism (t-RFLP). Weaning promoted an increase in the enterobacteria:lactobacilli ratio (0.27 versus 1.67 log/log 16S rRNA gene copy number, P=0.05). Total bacteria and richness of the caecal microbial ecosystem (number of peaks) were similar in both experimental groups (49.3 for S and 53.4 for W, respectively, P=0.22), although the band patterns were clearly grouped in two different clusters by dendogram analysis. Weaning was also associated with a decrease in crypt density, an increase in mytotic index and a decrease in the number of goblet cells. A reduced immunological response was also observed and was manifested by an increase in intraepithelial lymphocytes and lymphocyte density in the lamina propria. Weaning appears to be critical in the establishment of the caecal microbiota in pigs with important changes, particularly in microbial groups and in caecal mucosal architecture.

Application of 16S rRNA gene-targetted fluorescence in situ hybridization and restriction fragment length polymorphism to study porcine microbiota along the gastrointestinal tract in response to different sources of dietary fibre.

A total of 32 pigs of 15+/-0.38 kg body weight were fed for 6 weeks one of four diets differing in their source of dietary fibre. FISH was used to quantify the main bacterial groups in the pig gut using the following probes: Eub338, Bac303, Rfla729, Rbro730, Erec482, Fprau645, Prop853, Str493 and Lab158. FISH counts revealed important differences at four sites along the pig gastrointestinal tract, but we were unable to show differences related to diets. Stomach and jejunal samples gave total bacterial counts of 0.1-5.3 x 10(8) g(-1) of contents. In the stomach, streptococci and lactobacilli were predominant, and the clostridial cluster IX group was abundant (14-41% of total bacterial count). Clostridial cluster IX bacteria were present elsewhere in the gastrointestinal tract at 1-8%. The other groups were generally more abundant in the proximal colon and rectum: Bacteroides/Prevotella (5-10%), clostridial cluster XIVa (10-19%), and cluster IV relatives of Faecalibacterium prausnitzii (1-4%) and ruminococcus (4-10%). Restriction fragment length polymorphism profiles showed changes related to diet, with pigs fed wheat bran having the lowest richness of all diets (P=0.008).

Quantification of total bacteria, enterobacteria and lactobacilli populations in pig digesta by real-time PCR.

Jejunum digesta samples were taken from weaning pigs in order to evaluate real-time PCR (qPCR) as a method for quantifying pig gut bacteria. Total bacteria, lactobacilli and enterobacteria were quantified by qPCR and the results were compared with those obtained with traditional methods: 4',6-diamidino-2-phenylindole (DAPI staining) for total bacteria, selective culture for lactobacilli and enterobacteria. Real-time PCR showed higher values in terms of 16S rRNA gene copies than DAPI counts or CFU. Despite the differences, the lactobacilli:enterobacteria ratio was similar between methods (2.5 +/- 0.58 for qPCR and 3.1 +/- 0.71 for selective culture, P = 0.39). Possible reasons for the higher PCR counts are discussed considering both an overestimation with PCR by quantification of dead bacteria or free DNA and also an underestimation with conventional methods. Inherent differences in the pre-treatment of the samples could partially explain the discrepancies observed. Regardless of the numerical differences between methods, values obtained by qPCR and traditional methods showed a significant correlation for lactobacilli and total bacteria. In the light of these results, real-time PCR seems a valid method to quantify microbial shifts in the gastrointestinal tract.

Consumption of raw potato starch increases colon length and fecal excretion of purine bases in growing pigs.

Male growing pigs were fed a diet containing 250 g/kg of native corn starch (CS; 26% amylose, 74% amylopectin) or 250 g/kg of raw potato starch (RPS), as examples of digestible starch and resistant starch (Type II), respectively. Whole-tract digestibilities of organic matter, crude protein and starch were greater in pigs fed CS than in those fed RPS through at least d 23 of the study. However, the values progressively increased in the RPS-fed pigs up to d 38, at which time the groups did not differ in organic matter and starch digestibility. The digestive tract and colonic digesta were heavier and colon length longer in pigs fed the RPS diet. Digestibility of starch in the ileum on d 38 was significantly lower in RPS-fed pigs, but rose from ileum to rectum; most starch was extensively fermented in the cecum and proximal colon. Purine base (PB) and short-chain fatty acid (SCFA) concentrations in feces initially increased and then decreased beginning on d 4 for PB and on d 21 for SCFA. PB concentration in feces was greater in pigs fed RPS than in those fed CS. In the large bowel digesta, PB and SCFA concentrations increased from the ileum to the cecum and proximal colon and then fell in the distal colon. Pigs fed the RPS diet had a higher PB concentration in the middle colonic digesta and a greater SCFA concentration in the proximal colonic digesta than the CS-fed group. Adaptation of growing pigs to supplementary RPS required 5 wk, as reflected by whole-tract digestibility and PB and SCFA fecal excretion data.