Desarrollo de categorías del modo de actuación creativo en estudiantes universitarios

Introducción: Es importante la relación entre el desarrollo de las categorías originalidad, flexibilidad, autonomía y motivación del modo de actuación creativo. El objetivo del artículo consistió en elaborar un sistema de indicaciones para el desarrollo de categorías del modo de actuación creativo en estudiantes universitarios. Métodos: Se realizó una investigación mixta, donde el universo lo constituyeron estudiantes de la carrera de Pedagogía-Sicología de la Universidad de Sancti Spíritus "José Martí Pérez" en el curso 2021-2022 y se tomó una muestra aleatoria intencional de 24 educandos del tercer año. Resultados: El procesamiento estadístico de los instrumentos aplicados permitió ubicar al 75 % de la muestra entre un nivel medio y bajo en el desarrollo de categorías del modo de actuación creativo, por carencias en su expresión. Discusión: Desde fundamentos teóricos referenciados se analizó una propuesta de indicaciones que permiten la sistematización de contenidos de aprendizaje y facilitan el desarrollo de acciones autónomas y motivadoras para solucionar problemáticas en el contexto laboral. Conclusiones: La elaboración de indicaciones, desde la disciplina principal integradora y en estrecha relación con las categorías declaradas del modo de actuación creativo, facilitaron su desarrollo y demostraron pertinencia y factibilidad en el contexto de la práctica laboral.

Introduction: The relationship between the development of the categories of originality, flexibility, autonomy and motivation of the creative mode of action is important. The objective of the article was to develop a system of indications for the development of categories of the creative mode of action in university students. Methods: A mixed investigation was carried out, where the universe was made up of students of the Pedagogy-Psychology degree at the University of Sancti Spíritus "José Martí Pérez" in the 2021-2022 academic year and an intentional random sample of 24 students from the third year was taken. In the research, actions were designed to solve problems in work practice and a self-assessment scale about the development of the categories of the creative mode of action. Results: The statistical processing of the applied instruments allowed 75 % of the sample to be placed between a medium and low level in the development of categories of the creative mode of action, due to deficiencies in its expression. Discussion: From referenced theoretical foundations, a proposal of indications was analyzed that allow the systematization of learning content and facilitate the development of autonomous and motivating actions to solve problems in the work context. Conclusions: The development of indications, from the main integrative discipline and in close relationship with the declared categories of the creative mode of action, facilitated its development and demonstrated relevance and feasibility in the context of work practice.

Ecografía digestiva de la enfermedad inflamatoria intestinal en pediatría

La enfermedad inflamatoria intestinal es un problema de salud que actualmente genera alta morbilidad en el paciente pediátrico. Existen múltiples métodos diagnósticos que permiten su evaluación, entre los cuales y de creciente uso, está la ecografía digestiva. El objetivo de la presente investigación fue mostrar una panorámica actualizada de la utilidad e idoneidad de esta técnica en el seguimiento de la enfermedad inflamatoria intestinal en pacientes pediátricos. Se hizo una recopilación y revisión de la literatura nacional e internacional de mayor novedad y profundidad en el tratamiento del tema, en un período de 4 meses (febrero de 2022 a mayo de 2022). La estrategia de búsqueda adoptada fue el uso de las palabras clave o descriptores en español e inglés como: enfermedad inflamatoria intestinal, pediatría, enfermedad de Crohn, colitis ulcerosa, ultrasonido, ecografía digestiva. En total se utilizaron 50 artículos, de diferentes bases de datos como:Scielo, PubMed/Medline, Ebesco, Clinical Key y Springer. Se escogieron 30 citas para realizar la revisión, donde se analizó la importancia de la técnica en la descripción de las características ecográficas intestinales en pacientes pediátricos, confirmándose el papel que tiene en la identificación e intervención temprana de la enfermedad inflamatoria intestinal.

Inflammatory bowel disease is a health problem that currently causes high morbidity in pediatric patients. There are several diagnostic methods that allow its evaluation, among which gastrointestinal ultrasound is increasingly used. The aim of this research was to provide an updated review of the usefulness and suitability of this technique in the follow-up of inflammatory bowel disease in pediatric patients. A compilation and review of the national and international literature of greater novelty and depth in the treatment of the subject was made over a period of 4 months (February 2022 to May 2022). The search strategy adopted was the use of keywords or descriptors in Spanish and English such as: inflammatory bowel disease; pediatrics; Crohn's disease; ulcerative colitis; ultrasound; digestive ultrasound. A total of 50 articles were used from different databases such as: Scielo, PubMed/Medline, Ebesco, Clinical Key and Springer. Thirty citations were selected for review, analyzing the importance of the technique in the description of intestinal ultrasound characteristics in pediatric patients, confirming its role in the identification and early intervention of inflammatory bowel disease.

A doença inflamatória intestinal é um problema de saúde que atualmente causa elevada morbilidade no doente pediátrico. Existem vários métodos de diagnóstico que permitem a sua avaliação, entre os quais a ecografia gastrointestinal é cada vez mais utilizada. O objetivo deste trabalho foi fazer uma revisão actualizada da utilidade e adequação desta técnica no seguimento da doença inflamatória intestinal em idade pediátrica. Foi feita uma compilação e revisão da literatura nacional e internacional de maior novidade e profundidade no tratamento do tema, durante um período de 4 meses (fevereiro de 2022 a maio de 2022). A estratégia de busca adotada foi o uso de palavras-chave ou descritores em espanhol e inglês, tais como: doença inflamatória intestinal; pediatria; doença de Crohn; colite ulcerativa; ultrassom; ultrassom digestivo. Foram utilizados 50 artigos de diferentes bases de dados, como: Scielo, PubMed/Medline, Ebesco, Clinical Key e Springer. Foram selecionadas 30 citações para revisão, analisando a importância da técnica na descrição das características ultra-sonográficas intestinais em pacientes pediátricos, confirmando seu papel na identificação e intervenção precoce da doença inflamatória intestinal.

Persistencia del cavum septum pellucidum y cavum vergae asociado a retraso psicomotor. Informe de caso

Fundamento: Dos de las tres formas en que se presentan los quistes intracraneales de la línea media anterior son: cavum septum pellucidum y cavum vergae; estos normalmente desaparecen después del nacimiento, de persistir suelen ser asintomáticos, pero también pueden estar asociados a manifestaciones obstructivas, trastornos psicóticos o alteraciones del neurodesarrollo que demandan de un seguimiento clínico. Objetivo: Reportar el caso de un paciente de 6 meses con persistencia de estructuras del periodo embrionario en posible asociación con retraso del desarrollo psicomotor. Presentación de caso: Por lo infrecuente que resulta en la práctica, se informa el caso de un paciente de 6 meses con una persistencia del cavum septum pellucidum y cavum vergae en el que se destaca la posible asociación del retraso del neurodesarrollo a la persistencia de estas estructuras. El diagnóstico se realizó de forma precoz y se intervino oportunamente. Conclusiones: La presentación del caso aportó evidencias epidemiológicas que favorecen la posible asociación entre la persistencia de estas estructuras embrionarias y el retraso del desarrollo psicomotor.

Background: Two out of the three forms in which intracranial anterior midline cysts present are: These usually disappear after birth; if they persist, they are often asymptomatic, but may also be associated with obstructive manifestations, psychotic disorders or neurodevelopmental disorders that require clinical follow up. Objective: To report a case of a 6-month-old patient with persistence of embryonic period structures in possible association with psychomotor developmental retardation. Case presentation: Because of how infrequent it is in practice, a case of a 6-month-old patient with a persistent cavum septum pellucidum and cavum vergae is reported in which the possible association of neurodevelopmental delay with the persistence of these structures is pointed out. The diagnosis was made in an early manner and it was timely intervened. Conclusions: The case presentation provided epidemiological evidences that encourage the possible association among the persistence of these embryonic structures and psychomotor developmental retardation.

Aprendizaje creativo en estudiantes de Medicina desde la Genética Médica

Fundamento: En la carrera de Medicina es necesario formar profesionales con pensamiento creativo que permita la solución de problemas vinculados con el ejercicio de su profesión. La Genética Médica aporta la posibilidad de reflexionar y crear soluciones creativas. Objetivo: Proponer actividades que posibiliten el aprendizaje creativo en estudiantes de Medicina desde la Genética Médica. Metodología: Se emplearon métodos teóricos, empíricos y matemático-estadístico, con una muestra de 34 estudiantes y 3 profesores que imparten la asignatura. Resultados: Los docentes reconocen que, a pesar de hacer intentos para alcanzar el aprendizaje creativo, desconocen algunas vías y manifiestan no contar con el tiempo suficiente para su logro. El accionar didáctico no favorece el conocimiento, aplicación y disposición de estudiantes para un aprendizaje creativo. Se propusieron actividades sustentadas en procederes en Genética Médica, como parte de la estrategia didáctica de los docentes, asimismo contribuir al perfeccionamiento del aprendizaje creativo en los estudiantes. Las mismas centradas en métodos problémicos y el uso de recursos tecnológicos. Conclusiones: La formación de los médicos necesita expresar un aprendizaje creativo vinculado a un desempeño eficiente en la solución de problemas de la comunidad, lo cual se puede facilitar mediante la utilización de actividades en la asignatura Genética Médica.

Background: In the Medicine career it is necessary to form professionals with creative thoughts that allow the solution of problems linked to their professional practice. Medical Genetics provides the possibility to reflect and create creative solutions. Objective: To propose activities that allow creative learning in Medical students from the Medical Genetics perspective. Methodology: Theoretical, empirical and mathematical-statistical methods were applied, with a sample of 34 students and 3 teachers who teach the subject. Results: Teachers recognize that, despite making attempts to achieve creative learning, they are unaware of some ways and declare that they do not have enough time to achieve it. The didactic action does not favor the knowledge, application and disposition of students for creative learning. Activities supported by procedures in Medical Genetics were proposed as part of the didactic strategy of the teachers, likewise contribute to the improvement of creative learning in students. The same ones are focused on problem-solving methods and the use of technological resources. Conclusions: Physician education needs to express creative learning coupled with efficient performance in solving community problems, which may be facilitated through the use of activities in Medical Genetics Medical subject.

Carcinoma basocelular de la piel cabelluda tratado con HeberFERON. Seguimiento clínico, ecográfico e histopatológico

Fundamento: El carcinoma basocelular es infrecuente en la piel cabelluda. Es un tumor de invasión local y crecimiento lento, puede ser agresivo, destruir tejidos vecinos, causar ulceración e invadir en profundidad cartílago y hueso. Objetivo: Evaluar los resultados de la aplicación del HeberFERON y el seguimiento con ecografía cutánea en pacientes con carcinoma basocelular en la piel cabelluda. Metodología: Se realizó un estudio observacional, descriptivo y longitudinal en una serie de casos con diagnóstico de carcinoma basocelular de la piel cabelluda en el Policlínico Centro de la ciudad Sancti Spíritus, durante el período de 10 de julio del 2018 a 29 de julio del 2022. Se incluyeron 6 casos. Las variables estudiadas fueron la respuesta al tratamiento mediante la clínica, la ecografía cutánea e histopatología y presencia de eventos adversos. Resultados: Predominó el sexo masculino, subtipo histológico sólido, subtipo clínico nódulo ulcerativo, tamaño del tumor mayor de 30 mm y tiempo de evolución de más de 12 meses; la respuesta al tratamiento en la mayoría de los casos fue parcial. Los eventos adversos fueron dolor y ardor en el sitio de inyección, fiebre, edema y eritema perilesional. Conclusiones: El HeberFERON resultó de utilidad en los pacientes con carcinoma basocelular del cuero cabelludo ya que redujo el tumor en unos casos y en otros lo eliminó. La ecografía permitió la evaluación en tiempo real de la neoplasia; los eventos adversos más frecuentes fueron la fiebre y el dolor en el sitio de inyección, a pesar de ello ningún paciente abandonó el tratamiento.

Background: Basal cell carcinoma is uncommon in the scalp. It is a slow-growing locally invasive tumor, it can be aggressive in destroying neighboring tissues, cause ulceration and invade deep into the cartilage and bone. Objective: To evaluate the results of HeberFERON application and follow-up with cutaneous echographical in patients with scalp basal cell carcinoma. Methodology: An observational, descriptive and longitudinal study was conducted in a series of cases diagnosed with scalp basal cell carcinoma at the Center Polyclinic in Sancti Spíritus city during the period from July 10, 2018 to July 29, 2022. Six clinical cases were included. The studied variables were the answer to the treatment by clinical, cutaneous echographical and histopathology and the presence of adverse events. Results: Male sex predominated, solid histologic subtype, clinical subtype ulcerative nodule, tumor size greater than 30 mm and evolution time of over 12 months; the treatment response in most cases was partial; adverse events were pain and burning at the injection site, fever, edema and perilesional erythema. Conclusion: It was observed that in patients with scalp basal cell carcinoma, the HeberFERON treatment reduced in some cases and eliminated the tumor in others. Echography allowed real-time evaluation of the neoplasm, fever and pain at the injection site were the most frequent adverse events. In spite of this, none of the patients abandoned the therapy.

Características clínico epidemiológicas de pacientes con enfermedad por hígado graso no alcohólico: Serie de casos / Clinical-epidemiologic characteristics of patients with non-alcoholic fatty liver disease: Case series

Fundamento: El hígado graso no alcohólico es la enfermedad hepática por depósito de grasa en ausencia de un consumo significativo de alcohol. La mayoría de los pacientes tienen un nexo epidemiológico común asociado a factores de riesgo metabólico. Objetivo: Describir características clínico epidemiológicas de pacientes con enfermedad por hígado graso no alcohólico. Metodología: Se realizó un estudio descriptivo de una serie de casos en la consulta de Gastroenterología del Hospital General Provincial "Camilo Cienfuegos" de Sancti Spíritus, durante el período 6 de mayo de 2019 al 6 de mayo de 2020. Se consideró un total de 1167 pacientes pertenecientes a la provincia Sancti Spíritus; a 346 pacientes se le diagnosticó esteatosis hepática por ultrasonido; la muestra se conformó por 114 pacientes que cumplieron con los criterios de inclusión. Resultados: La mayoría de los pacientes con la enfermedad eran sintomáticos, hombres y tenían comorbilidad como la hipertensión arterial y obesidad, el índice de masa corporal y el índice de cintura abdominal/cadera estaban elevados en el sexo femenino, las alteraciones en la química sanguínea fueron colesterol y triacilglicéridos. Conclusiones: Predominó en el sexo masculino y la comorbilidad con la HTA y la obesidad, y la dislipidemia, además los hábitos alimenticios inadecuados y el sedentarismo; las medidas antropométricas resultaron elevadas en el sexo femenino.

Background: Nonalcoholic fatty liver disease is a resulting from fat accumulation in the absence of significant alcohol consumption. Most patients have a common epidemiologic link associated with metabolic risk factors. Objective: To describe the clinical and epidemiologic characteristics of patients with nonalcoholic fatty liver disease. Methodology: A descriptive study of a series of cases was carried out in the Gastroenterology consultation of the "Camilo Cienfuegos" Provincial General Hospital of Sancti Spíritus, during the period from May 6, 2019 through May 6, 2020. A total of 1167 patients belonging to the province of Sancti Spiritus were included in the study; 346 patients were diagnosed with hepatic steatosis by means of ultrasound; the sample consisted of 114 patients who fulfilled the inclusion criteria. Results: Most patients with the disease were symptomatic, men, and had comorbidities including hypertension and obesity, the body mass index and the waist-to-hip ratio of the abdomen were increased in women., the blood chemistry changes were cholesterol and triacylglycerides. Conclusions: It predominated in the male sex and comorbidity with HBP and obesity and dyslipidemia, in addition to inadequate dietary habits and sedentary lifestyle; in women, the anthropometric measurements were high.

mRNA-1273 boost after BNT162b2 vaccination generates comparable SARS-CoV-2-specific functional responses in naïve and COVID-19-recovered individuals.

Introduction: COVID-19 vaccines based on mRNA have represented a revolution in the biomedical research field. The initial two-dose vaccination schedule generates potent humoral and cellular responses, with a massive protective effect against severe COVID-19 and death. Months after this vaccination, levels of antibodies against SARS-CoV-2 waned, and this promoted the recommendation of a third vaccination dose. Methods: We have performed an integral and longitudinal study of the immunological responses triggered by the booster mRNA-1273 vaccination, in a cohort of health workers previously vaccinated with two doses of the BNT162b2 vaccine at University Hospital La Paz located in Madrid, Spain. Circulating humoral responses and SARS-CoV-2-specific cellular reactions, after ex vivo restimulation of both T and B cells (cytokines production, proliferation, class switching), have been analyzed. Importantly, all along these studies, the analyses have been performed comparing naïve and subjects recovered from COVID-19, addressing the influence of a previous infection by SARS-CoV-2. Furthermore, as the injection of the third vaccination dose was contemporary to the rise of the Omicron BA.1 variant of concern, T- and B-cell-mediated cellular responses have been comparatively analyzed in response to this variant. Results: All these analyses indicated that differential responses to vaccination due to a previous SARS-CoV-2 infection were balanced following the boost. The increase in circulating humoral responses due to this booster dropped after 6 months, whereas T-cell-mediated responses were more stable along the time. Finally, all the analyzed immunological features were dampened in response to the Omicron variant of concern, particularly late after the booster vaccination. Conclusion: This work represents a follow-up longitudinal study for almost 1.5 years, analyzing in an integral manner the immunological responses triggered by the prime-boost mRNA-based vaccination schedule against COVID-19.

Formación docente en los médicos de la atención primaria de salud / Teaching training in primary health care physicians

Fundamento: el nivel académico superior en la atención primaria de salud tiene importante repercusión en la formación de los futuros profesionales, por lo que es necesario atender las necesidades de superación pedagógica con vistas a perfeccionar la competencia y desempeño en esta tarea. Objetivo: diagnosticar las necesidades de superación pedagógica en médicos de la atención primaria de salud pertenecientes al Policlínico Universitario "Juana Naranjo León" de Sancti Spíritus, Cuba. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal. Su contexto fueron los escenarios docentes asistenciales del Policlínico Universitario "Juana Naranjo León" de Sancti Spíritus, en el período comprendido de 2020-2021. Para fundamentar la investigación se utilizaron métodos teóricos (análisis-síntesis e inducción-deducción) y empíricos (revisión documental y cuestionario). Se emplearon procedimientos de estadística descriptiva (frecuencia absoluta y relativa), para el análisis e interpretación de los resultados. Resultados: se evidenció limitada preparación docente e insuficiente desempeño en la formación educativa para garantizar la calidad del proceso enseñanza aprendizaje, a partir de la baja categorización y el escaso número de actividades e investigaciones de corte académico. Conclusiones: el estudio realizado permitió conocer el estado actual de los conocimientos y preparación docente-metodológica del claustro de la institución en el primer nivel de atención médica. Estos profesionales requieren atención prioritaria para el desempeño formativo, y alcanzar con ello la excelencia en el proceso docente-educativo.

Background: the higher academic level in primary health care has an important impact on the training of future professionals, so it is necessary to meet the needs of pedagogical improvement with a view to improving competence and performance in this task. Objective: to diagnose the needs for pedagogical improvement in PHC doctors belonging to the "Juana Naranjo León" University Polyclinic in Sancti Spíritus, Cuba. Methods: an observational, descriptive, cross-sectional study was carried out. Its context was the teaching assistance scenarios of the "Juana Naranjo León" University Polyclinic in Sancti Spíritus, from 2020 to 2021. Theoretical methods were used to support the research: (analysis-synthesis and induction-deduction) and empirical ones (documentary review and questionnaire). Descriptive statistical procedures (absolute and relative frequency) were used for the analysis and interpretation of the results. Results: limited teaching preparation and insufficient performance in educational training were evidenced to guarantee the quality of the teaching-learning process, taking into account the low categorization and the small number of activities and academic research. Conclusions: the study allowed us to know the current state of knowledge and teaching-methodological preparation of the teaching staff of the institution at the first level of medical care, which require priority attention for training performance, and thereby achieve excellence in the teaching-learning process.

Imagenología digital como recurso didáctico en el aprendizaje significativo de las Ciencias Médicas

RESUMEN La especialidad de Imagenología comprende áreas del conocimiento médico que utilizan diferentes tecnologías en creciente desarrollo y métodos que exteriorizan partes del cuerpo humano, por tal motivo, educar a través del diagnóstico por imágenes informatizadas constituye un desafío en la actualidad. El presente artículo plantea describir las características principales de los medios de enseñanza y el interés que brinda especialmente la imagen radiológica digital como recurso didáctico. Se recopiló y revisó bibliografía de mayor novedad y profundidad en el tratamiento del tema. La estrategia de búsqueda adoptada fue la utilización de las palabras clave o descriptores en español e inglés. En la Universidad de Ciencias Médicas las tecnologías modernas traen diversidad de herramientas didácticas en el marco de escenarios docentes que impulsan y motivan el desarrollo rápido de habilidades perceptivas, la utilización cada vez más frecuente de imágenes digitales como medio de enseñanza la convierten en un recurso muy utilizado actualmente que exige habilidades y manejo eficaz. Las imágenes digitales con fines docentes son una alternativa importante, pues reflejan la modernidad e incorporan el conocimiento, debido a que se transforman en un nuevo recurso destinado a comunicar.

ABSTRACT The specialty of Imaging includes areas of medical knowledge that use different technologies in growing development and methods that externalize parts of the human body, for this reason, educating through computerized imaging diagnosis is a challenge today. This article proposes to describe the main characteristics of the teaching aids and the interest that the digital radiological image offers especially as a didactic resource. Bibliography of greater novelty and depth in the treatment of the subject was collected and reviewed. The search strategy adopted was the use of keywords or descriptors in Spanish and English. In the University of Medical Sciences, modern technologies bring diversity of didactic tools within the framework of teaching scenarios that promote and motivate the rapid development of perceptual skills, the increasingly frequent use of digital images as a means of teaching make it a very useful resource. Currently used that requires skills and effective handling. Digital images for teaching purposes are an important alternative, as they reflect modernity and incorporate knowledge, because they become a new resource for communicating.

Rejuvenecimiento facial con plasma rico en plaquetas autólogo / Facial rejuvenation with autologous platelet rich plasma

Introducción: La creciente necesidad de una piel de aspecto juvenil impulsa innovaciones continuas con procedimientos mínimamente invasivos. El plasma rico en plaquetas autólogo representa una terapéutica regenerativa incluida en el novedoso arsenal de intervenciones que buscan este efecto. Objetivo: Evaluar los resultados de la terapéutica con plasma rico en plaquetas autólogo en pacientes con envejecimiento facial. Métodos: La muestra estuvo constituida por 68 pacientes valorados con la escala para valoración clínica de fotoenvejecimiento cutáneo al inicio del tratamiento. Se sometieron a cuatro sesiones de plasma rico en plaquetas cada 15 días y una sesión adicional a los 3 meses de concluir el tratamiento inicial. Los pacientes fueron seguidos durante 6 meses al cabo de los cuales se volvieron a evaluar con el mismo instrumento. Resultados: Las edades estuvieron comprendidas entre 21 y 73 años con una media de 46,80 años, predominó el sexo femenino (89,9 %). Los resultados significativos en el tratamiento de las arrugas, los surcos, la textura de la piel y las lesiones cutáneas estuvieron relacionados con la mesoterapia con plasma rico en plaquetas. El procedimiento produjo una mejoría valorada a través de la escala para valoración clínica de fotoenvejecimiento cutáneo. Conclusiones: La terapia con plasma rico en plaquetas tiene buenos resultados en el tratamiento de pacientes con envejecimiento facial.

Introduction: The growing need for youthful looking skin drives continued innovations with minimally invasive procedures. Autologous platelet-rich plasma represents a regenerative therapeutic included in the new arsenal of interventions that seek this effect. Objective: Assess the results of platelet-rich plasma therapy in patients with facial aging. Methods: The sample consisted of 68 patients assessed with the scale for the clinical assessment of cutaneous photoaging (SCACPH). They underwent four PRP sessions every 15 days and an additional session 3 months after completing the initial treatment. The patients were followed up for 6 months, after which they were reevaluated which the same instrument. Results: The ages of the patients were between 21 and 73 years with a mean of 46.80 years, the female sex predominated (89.9%). Significant results in the treatment of wrinkles, furrows, and skin texture and skin lesions were related to PRP mesotherapy. The procedure produced an improvement assessed with the SCACPH. Conclusions: Autologous PRP therapy has good results in the treatment of patients with facial aging.

Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children.

BACKGROUND: Knee examination guidelines in minors are intended to aid decision-making in the management of knee instability. CLINICAL QUESTION: A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence. A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children. KEY FINDINGS: there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary. Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed. CLINICAL APPLICATION: In the absence of a strong evidence base, these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible. Following this expert consensus, surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test ++, and may include an anterior drawer test + and a Lachman test +. If these conditions are not present, the conservative approach should be chosen, as the anatomical and functional development of children, together with a physiotherapy programme, may improve the evolution of the injury.

Early programming of reproductive health and fertility: novel neuroendocrine mechanisms and implications in reproductive medicine.

BACKGROUND: According to the Developmental Origins of Health and Disease (DOHaD) hypothesis, environmental changes taking place during early maturational periods may alter normal development and predispose to the occurrence of diverse pathologies later in life. Indeed, adverse conditions during these critical developmental windows of high plasticity have been reported to alter the offspring developmental trajectory, causing permanent functional and structural perturbations that in the long term may enhance disease susceptibility. However, while solid evidence has documented that fluctuations in environmental factors, ranging from nutrient availability to chemicals, in early developmental stages (including the peri-conceptional period) have discernible programming effects that increase vulnerability to develop metabolic perturbations, the impact and eventual mechanisms involved, of such developmental alterations on the reproductive phenotype of offspring have received less attention. OBJECTIVE AND RATIONALE: This review will summarize recent advances in basic and clinical research that support the concept of DOHaD in the context of the impact of nutritional and hormonal perturbations, occurring during the periconceptional, fetal and early postnatal stages, on different aspects of reproductive function in both sexes. Special emphasis will be given to the effects of early nutritional stress on the timing of puberty and adult gonadotropic function, and to address the underlying neuroendocrine pathways, with particular attention to involvement of the Kiss1 system in these reproductive perturbations. The implications of such phenomena in terms of reproductive medicine will also be considered. SEARCH METHODS: A comprehensive MEDLINE search, using PubMed as main interface, of research articles and reviews, published mainly between 2006 and 2021, has been carried out. Search was implemented using multiple terms, focusing on clinical and preclinical data from DOHaD studies, addressing periconceptional, gestational and perinatal programming of reproduction. Selected studies addressing early programming of metabolic function have also been considered, when relevant. OUTCOMES: A solid body of evidence, from clinical and preclinical studies, has documented the impact of nutritional and hormonal fluctuations during the periconceptional, prenatal and early postnatal periods on pubertal maturation, as well as adult gonadotropic function and fertility. Furthermore, exposure to environmental chemicals, such as bisphenol A, and maternal stress has been shown to negatively influence pubertal development and gonadotropic function in adulthood. The underlying neuroendocrine pathways and mechanisms involved have been also addressed, mainly by preclinical studies, which have identified an, as yet incomplete, array of molecular and neurohormonal effectors. These include, prominently, epigenetic regulatory mechanisms and the hypothalamic Kiss1 system, which likely contribute to the generation of reproductive alterations in conditions of early nutritional and/or metabolic stress. In addition to the Kiss1 system, other major hypothalamic regulators of GnRH neurosecretion, such as γ-aminobutyric acid and glutamate, may be targets of developmental programming. WIDER IMPLICATIONS: This review addresses an underdeveloped area of reproductive biology and medicine that may help to improve our understanding of human reproductive disorders and stresses the importance, and eventual pathogenic impact, of early determinants of puberty, adult reproductive function and fertility.

Cellular and humoral functional responses after BNT162b2 mRNA vaccination differ longitudinally between naive and subjects recovered from COVID-19.

We have analyzed BNT162b2 vaccine-induced immune responses in naive subjects and individuals recovered from coronavirus disease 2019 (COVID-19), both soon after (14 days) and later after (almost 8 months) vaccination. Plasma spike (S)-specific immunoglobulins peak after one vaccine shot in individuals recovered from COVID-19, while a second dose is needed in naive subjects, although the latter group shows reduced levels all along the analyzed period. Despite how the neutralization capacity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mirrors this behavior early after vaccination, both groups show comparable neutralizing antibodies and S-specific B cell levels late post-vaccination. When studying cellular responses, naive individuals exhibit higher SARS-CoV-2-specific cytokine production, CD4+ T cell activation, and proliferation than do individuals recovered from COVID-19, with patent inverse correlations between humoral and cellular variables early post-vaccination. However, almost 8 months post-vaccination, SARS-CoV-2-specific responses are comparable between both groups. Our data indicate that a previous history of COVID-19 differentially determines the functional T and B cell-mediated responses to BNT162b2 vaccination over time.

Cirugía oncoplástica como alternativa en el tratamiento de pacientes con cáncer de mama

RESUMEN Fundamento: la cirugía plástica ayuda a la mejora de la calidad de vida de las pacientes con cáncer de mama. La reconstrucción mamaria ha evolucionado no solo en las cuestiones estéticas, sino también, a favor de lograr menor morbilidad en las pacientes afectadas. Objetivo: describir los resultados obtenidos con la aplicación de técnicas oncoplásticas en pacientes con cáncer de mama. Método: se realizó un estudio descriptivo de una serie de 41 pacientes en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus desde marzo de 2018 hasta octubre de 2020. La muestra incluyó a todas las pacientes intervenidas por cáncer de mama a las que se realizaron técnicas oncológicas conservadoras y radicales, así como, cirugía plástica. Fueron analizadas variables demográficas, clínicas y terapéuticas. Se utilizaron los procedimientos aritméticos y tabulares de la estadística descriptiva. Se mostraron las variables cuantitativas como promedios y desviación estándar, los datos cualitativos como frecuencias y porcentajes. Resultados: la edad media fue de 45 años, con una mínima de 26 años y una máxima de 67. En las pacientes sin deformidad mamaria previa se aplicaron tratamientos radicales, conservadores, reconstrucción con cirugía ahorradora de piel y mastoplastias con mínimas incisiones. En las pacientes con deformidades mayores el tratamiento que predominó fue conservador y las reconstrucciones con mastoplastias. Los estadios tumorales que prevalecieron fueron los T2N1M0 y T1N1M0. El mayor número de complicaciones se observó en las pacientes sometidas a cirugía ahorradora de piel y en aquellas con tratamientos radicales. Conclusiones: la cirugía oncoplástica es una alternativa de tratamiento quirúrgico que actualmente se emplea con más frecuencia en las pacientes con cáncer de mama. Se obtienen resultados similares a los de la cirugía convencional en cuanto a incidencia de complicaciones, recidivas y muerte.

ABSTRACT Background: plastic surgery helps to improve the quality of life of patients with breast cancer. Breast reconstruction has evolved not only in aesthetic matters, but also in favor of achieving less morbidity in each patient affected. Objective: to describe the results obtained with the application of oncoplastic techniques in patients with breast cancer. Method: a descriptive study of a series of 41 patients was carried out at the Camilo Cienfuegos Provincial General Hospital in Sancti Spíritus from March 2018 to October 2020. The sample included all the patients operated on for breast cancer in which techniques were performed. Conservative and radical oncology, as well as, plastic surgery. Demographic, clinical and therapeutic variables were analyzed. The arithmetic and tabular procedures of descriptive statistics were used. Quantitative variables were shown as means and standard deviation. Qualitative data such as frequencies and percentages. Results: the mean age was 45 years, with a minimum of 26 years and a maximum of 67. In patients without previous breast deformity, radical and conservative treatments, reconstruction with skin-sparing surgery and mastoplasties with minimal incisions were applied. In patients with major deformities, the predominant treatment was conservative and reconstructions with mastoplasties. The tumor stages that prevailed were T2N1M0 and T1N1M0. The highest number of complications was observed in patients undergoing skin-sparing surgery and in those with radical treatments. Conclusions: oncoplastic surgery is an alternative surgical treatment that is currently used more frequently in patients with breast cancer. Similar results are obtained to conventional surgery in terms of incidence of complications, recurrences and death.

Phase Stability under Thermal Drifts in Photodiode-Conditioning Transimpedance Amplifiers for Distance Metrology.

Transimpedance amplifiers (TIA) are widely used for front-end signal conditioning in many optical distance measuring applications in which high accuracy is often required. Small effects due to the real characteristics of the components and the parasitic elements in the circuit board may cause the error to rise to unacceptable levels. In this work we study these effects on the TIA delay time error and deduce analytic expressions, taking into account the trade-off between the uncertainties caused by the delay time instability and by the signal-to-noise ratio. A specific continuous-wave phase-shift case study is shown to illustrate the analysis, and further compared with real measurements. General strategies and conclusions, useful for designers of this kind of system, are extracted too. The study and results show that the delay time thermal stability is a key determinant factor in the measured distance accuracy and, without an adequate design, moderate temperature variations of the TIA can cause extremely high measurement errors.

Diagnóstico imagenológico de neumonía por SARS-CoV-2 en pacientes con la Covid-19 / Imaging diagnosis of pneumonia by SARS-CoV-2 in patients with Covid-19

RESUMEN Fundamento: Los estudios imagenológicos son importantes en la evaluación del paciente con la Covid-19, las publicaciones sobre la aplicación de estos crecen y evolucionan cada día, lo cual trae consigo la inabarcable búsqueda de información verosímil. Objetivo: Analizar información actual disponible de hallazgos imagenológicos de neumonía por SARS-CoV-2, así como el papel y la idoneidad de los estudios de imagen para el mejor diagnóstico y seguimiento de pacientes en diversos contextos clínicos. Metodología: Se hizo una recopilación y revisión de la bibliografía nacional e internacional en un período de febrero a agosto de 2020. La estrategia de búsqueda adoptada fue la utilización de palabras clave o descriptores en español e inglés. Se revisaron 71 artículos de diferentes bases de datos y se utilizaron 42. Desarrollo: Se describen los signos imagenológicos en pacientes sospechosos y diagnosticados con neumonía por SARS-CoV-2, así como las ventajas y desventajas de los estudios imagenológicos más utilizados. Conclusiones: Los estudios de imagen juegan un papel relevante para la identificación e intervención temprana en pacientes de todas las edades con neumonía por SARS-CoV-2. Se propone valorar la utilización de la ecografía pulmonar en el contexto nacional a partir de las evidencias científicas encontradas.

ABSTRACT Background: Imaging studies are important in the evaluation of patient with Covid-19, publications on its application increase and evolve every day, so it results in the endless search of credible information. Objective: To analyze current available information on imaging findings of pneumonia by SARS-CoV-2, as well as the role and imaging studies suitability for the best diagnosis and monitoring of patients in several clinical contexts. Methodology: A compilation and review of the national and international bibliography from February to August 2020 was made. The search strategy was the use of keywords or descriptors in Spanish and English. 71 articles from different databases were reviewed and 42 were used. Development: Imaging signs were described in suspicious patients diagnosed with pneumonia by SARS-CoV-2, also the advantages and disadvantages of the most widely used imaging studies. Conclusions: Imaging studies play a relevant role in the early identification and intervention in patients of all ages with pneumonia by SARS-CoV-2. Based on the scientific evidence, it is proposed to assess the use of pulmonary ultrasound in the national context.

Neonatal exposure to androgens dynamically alters gut microbiota architecture.

Gonadal steroids strongly contribute to the metabolic programming that shapes the susceptibility to the manifestation of diseases later in life, and the effect is often sexually dimorphic. Microbiome signatures, together with metabolic traits and sex steroid levels, were analyzed at adulthood in neonatally androgenized female rats, and compared with those of control male and female rats. Exposure of female rats to high doses of androgens on early postnatal life resulted in persistent alterations of the sex steroid profile later on life, namely lower progesterone and higher estradiol and estrone levels, with no effect on endogenous androgens. Neonatally androgenized females were heavier (10% at early adulthood and 26% at adulthood) than controls and had impaired glucose homeostasis observed by higher AUC of glucose in GTT and ITT when subjected to obesogenic manipulations. Androgenized female displayed overt alterations in gut microbiota, indicated especially by higher Bacteroidetes and lower Firmicutes abundance at early adulthood, which disappeared when animals were concurrently overfed at adulthood. Notably, these changes in gut microbiota were related with the intestinal expression of several miRNAs, such as miR-27a-3p, miR-29a-5p, and miR-100-3p. Our results suggest that nutritional and hormonal disruption at early developmental periods not only alters the metabolic programming of the individual later in life but also perturbs the architecture of gut microbiota, which may interact with the host by a cross-talk mediated by intestinal miRNAs; phenomena that may contribute to amplify the metabolic derangement caused by obesity, as seen in neonatally androgenized female rats.