La anatomía comparada del corazón, una necesidad de práctica de laboratorio en la carrera de medicina / The comparative anatomy of the heart, a need for laboratory practice in the medical career

Introducción: en este curso inició el Plan D para la carrera Medicina, y estando inmersos en la preparación de las nuevas asignaturas rectoras que incluidas anteriormente en Morfofisiología, se propone una práctica de laboratorio con métodos de anatomía comparada. Objetivo: proponer la implementación de una práctica de laboratorio sobre la Anatomía del corazón para el segundo año de medicina, basada en métodos de anatomía comparada. Método: se realizó un estudio cuasiexperimental en la Filial de Ciencias Médicas Manuel Piti Fajardo durante los cursos 2015-16 y 2016-17. Donde se impartió la actividad propuesta al total de estudiantes (104) realizándose la observación de un corazón real de cerdo en comparación con el humano, mostrando aspectos de la anatomía externa e interna, y usando la guía de estudio de la anatomía cardiaca mediante la disección de un corazón porcino. Se aplicaron métodos teóricos: histórico lógico, analítico-sintético, inductivo-deductivo; de los empíricos se aplicó la observación, el análisis de documentos y la técnica del PNI. Resultados: los resultados de la evaluación sistemática fueron comparados con los alcanzados por los 128 estudiantes del curso anterior, encontrándose diferencias significativas entre ellas, se amplió el porcentaje de calificaciones con calidad, se disminuyó ligeramente el porcentaje de calificados de regular y disminuyó el porcentaje de suspensos. Conclusiones: los resultados han sido superiores con la introducción de esta práctica por lo que se propone como parte del programa de la asignatura "Sistemas cardiovascular, respiratorio, digestivo y renal", Plan D, segundo año, Medicina

Introduction: A Lab Practice is proposed to give an answer to methodological problems dealing with a new Curriculum of the Medical Career called Plan D in Medicine Career. It took place in Manuel Piti Fajardo Medical School in San Cristóbal during 2015-2016 and 2016-2017academic courses, is related to a new subject called Cardiovascular, Respiratory, Digestive and Renal systems which were taught before with the name of Morph-physiology. Objective: to offer a suggestion for a lab practice where students have to get familiar to the cardiovascular system using a pig's heart to observe its internal and external characteristics comparing it with a human heart. Methods: it consists of a quasi-experimental study based on a Lab Practice where students have to use a pig's heart to observe its internal and external characteristics comparing it with a human heart. Theoretical methods such us Inductive-Deductive method, Analytic- Synthetic method, Historical - Logical method were used and some empirical methods like observation, documentary analysis and P.N.I. were applied too. The methodology used for carrying out the study is similar to the one used by Biology students in the University of Havana. Results: Systematic evaluation results are presented comparing them, with the ones done before. The initial and final diagnoses are shown. Conclusion: the suggestion is made to work with the plan D curriculum, improving medical students' knowledge, related to a new subjecting Medicine Career called Cardiovascular, Respiratory, Digestive and Renal systems which were taught before with the name of Morph-physiology(AU)

Factores de crecimiento aportados por el lisado plaquetario en el tratamiento tópico de úlceras posflebíticas / Platelet lysate-derived growth factors for topical treatment of postphlebitis ulcers

Introducción: los factores de crecimiento plaquetario son proteínas bioactivas que se sintetizan y almacenan en las plaquetas. Objetivo: evaluar la efectividad de los factores de crecimiento aportados por el lisado plaquetario alogénico en el tratamiento tópico de úlceras posflebíticas Métodos: se realizó un estudio cuasi-experimental con control simultáneo en la consulta de medicina regenerativa, Hospital General Docente "Comandante Pinares", entre enero de 2008 y diciembre de 2012. Se evaluaron 135 pacientes con el diagnóstico de úlceras posflebíticas con inadecuada respuesta al tratamiento convencional y ausencia de otras enfermedades de base que impidieran una respuesta a la terapia regenerativa. Los pacientes se dividieron en dos grupos: 90 recibieron tratamiento con la aplicación local del lisado plaquetario obtenido de las plaquetas alogénicas ABO compatibles y 45 mantuvieron el tratamiento convencional (grupo control). El tiempo de respuesta fue la característica distintiva para medir la eficacia entre ambos tratamientos. Resultados: predominó el sexo femenino y edad de más de 50 años. Los síntomas cardinales del síndrome posflebítico, estuvieron presentes en un mayor número de pacientes del grupo tratado con el lisado plaquetario, sin embargo, a los 30 días, se constató una mejoría de los mismos así como una disminución significativa del área promedio de las úlceras. En el grupo tratado con lisado, 86 pacientes remitieron sus síntomas en menos de seis semanas, frente a solo ocho en el mismo tiempo en el grupo convencional. Conclusiones: el uso de factores de crecimiento aportados por el lisado plaquetario alogénico fue efectivo en el tratamiento tópico de úlceras posflebíticas(AU)

Introduction: platelet-derived growth factors are bio-active proteins that are synthesized and stored in the platelets. Objective: to evaluate the effectiveness of allogenic platelet lysate-derived growth factors in the topical treatment of postphlebitis ulcers. Methods: a quasi-experimental study with simultaneous control was conducted from January 2008 through December 2012 in the regenerative medicine service of "Comandante Pinares" general teaching hospital located in San Cristobal, Artemisa province, Cuba. One hundred and thirty five patients with diagnosis of postphlebitis ulcers, inadequate response to the conventional treatment and absence of other illnesses that could hinder such response to regenerative therapy were evaluated. The patients were divided into two groups: 90 treated with local use of compatible ABO allogenic platelet-derived platelet lysate and 45 kept under the conventional treatment (control group). The reaction time was the distinctive characteristic to measure the effectiveness of both treatments. Results: females and over 50 years-old age predominated. The main symptoms of the posphlebitic syndrome were present in a high number of patients in the group treated with the platelet lysate. Thirty days later, these symptoms significantly improved and the average ulcer area dramatically decreased. There was observed symptoms remission in eighty six patients in less than six weeks in contrast with only eight in the conventional group during this period. Conclusions: the use of allogenic platelet lysate-derived growth factors was effective in the topical treatment of postphlebitis ulcers(AU)

Factores de crecimiento aportados por el lisado plaquetario en el tratamiento tópico de úlceras posflebíticas / Platelet lysate-derived growth factors for topical treatment of postphlebitis ulcers

Introducción: los factores de crecimiento plaquetario son proteínas bioactivas que se sintetizan y almacenan en las plaquetas.Objetivo: evaluar la efectividad de los factores de crecimiento aportados por el lisado plaquetario alogénico en el tratamiento tópico de úlceras posflebíticasMétodos: se realizó un estudio cuasi-experimental con control simultáneo en la consulta de medicina regenerativa, Hospital General Docente Comandante Pinares, entre enero de 2008 y diciembre de 2012. Se evaluaron 135 pacientes con el diagnóstico de úlceras posflebíticas con inadecuada respuesta al tratamiento convencional y ausencia de otras enfermedades de base que impidieran una respuesta a la terapia regenerativa. Los pacientes se dividieron en dos grupos: 90 recibieron tratamiento con la aplicación local del lisado plaquetario obtenido de las plaquetas alogénicas ABO compatibles y 45 mantuvieron el tratamiento convencional (grupo control). El tiempo de respuesta fue la característica distintiva para medir la eficacia entre ambos tratamientos.Resultados: predominó el sexo femenino y edad de más de 50 años. Los síntomas cardinales del síndrome posflebítico, estuvieron presentes en un mayor número de pacientes del grupo tratado con el lisado plaquetario, sin embargo, a los 30 días, se constató una mejoría de los mismos así como una disminución significativa del área promedio de las úlceras. En el grupo tratado con lisado, 86 pacientes remitieron sus síntomas en menos de seis semanas, frente a solo ocho en el mismo tiempo en el grupo convencional.Conclusiones: el uso de factores de crecimiento aportados por el lisado plaquetario alogénico fue efectivo en el tratamiento tópico de úlceras posflebíticas(AU)

Introduction: platelet-derived growth factors are bio-active proteins that are synthesized and stored in the platelets.Objective: to evaluate the effectiveness of allogenic platelet lysate-derived growth factors in the topical treatment of postphlebitis ulcers.Methods: a quasi-experimental study with simultaneous control was conducted from January 2008 through December 2012 in the regenerative medicine service of "Comandante Pinares" general teaching hospital located in San Cristobal, Artemisa province, Cuba. One hundred and thirty five patients with diagnosis of postphlebitis ulcers, inadequate response to the conventional treatment and absence of other illnesses that could hinder such response to regenerative therapy were evaluated. The patients were divided into two groups: 90 treated with local use of compatible ABO allogenic platelet-derived platelet lysate and 45 kept under the conventional treatment (control group). The reaction time was the distinctive characteristic to measure the effectiveness of both treatments.Results: females and over 50 years-old age predominated. The main symptoms of the posphlebitic syndrome were present in a high number of patients in the group treated with the platelet lysate. Thirty days later, these symptoms significantly improved and the average ulcer area dramatically decreased. There was observed symptoms remission in eighty six patients in less than six weeks in contrast with only eight in the conventional group during this period.Conclusions: the use of allogenic platelet lysate-derived growth factors was effective in the topical treatment of postphlebitis ulcers(AU)

Effect of an educational intervention to improve adverse drug reaction reporting in physicians: a cluster randomized controlled trial.

BACKGROUND: The yellow-card scheme continues to be one of the principal methods for signal generation in pharmacovigilance. Nevertheless, under-reporting, one of its disadvantages, delays alert signals and has a negative influence on public health. Educational interventions in pharmacovigilance may have a positive impact on the spontaneous reporting of adverse drug reactions (ADRs). OBJECTIVES: To assess the duration of the effect and effectiveness of an educational intervention in pharmacovigilance designed to improve ADR reporting in a robust pharmacovigilance system. METHODS: A spatial, cluster randomized controlled trial was conducted covering all National Health System physicians in the northwest of Spain and targeting those who were actively engaged in clinical practice (n = 7,498). Of these, 2,120 were assigned in three spatial clusters to the intervention group (six hospitals and 138 primary care centers) and 3,614 in four clusters to the control group (seven hospitals and 267 primary care centers). The educational intervention consisted of two complementary approaches--one active (group sessions), the other passive (educational material, reporting form)-implemented from November 2007 to December 2008, with a follow-up period of 8 months. RESULTS: Intervention participation was 53.7 % in a hospital setting and 60.5 % in primary care settings. ADR reporting in the intervention group increased by 65.4 % (95 % confidence interval [CI]: 8.2-153.4) across the follow-up. The ADR reporting rate per 1,000 physicians/year in the intervention group rose from 28.1 to 39.6 following the intervention (51.7 and 27.4 in the first and second 4-month period, respectively). For the intervention group, relative risk (RR) was 2.31 (95 % CI: 1.46-3.68) and 1.04 (95 % CI: 0.61-1.77) in the first and second 4-month period, respectively adjusted to baseline values. There was an increase in unexpected ADR reporting (RR 2.06, 95 % CI 1.19-3.55). CONCLUSIONS: Pharmacovigilance educational interventions that have proved effective can be successfully applied in different geographical areas. A high baseline notification rate could account for the educational program having a moderate effect.

Lisado plaquetario alogénico en la necrosis del colgajo / Alogenic platelet lysate in necrosis of the torn piece

La utilización de lisado plaquetario alogénico abre otra posibilidad terapéutica en ortopedia. Se presenta su uso en una paciente femenina de 40 años de edad, con antecedentes de asma bronquial y tratamiento con esteroides, que como consecuencia de una caída sufrió herida avulsiva extensa en el tercio inferior de la pierna derecha con desgarro de piel de aproximadamente 11 cm con vértice distal y base proximal estrecha, que solamente tomó piel; y otra herida similar, aledaña a esta lesión, de aproximadamente 6 cm de diámetro. Se le realizó toilette y necreptomía de los bordes que tenían signos de necrosis, fundamentalmente los vértices. Se le realizaron puntos de afrontamiento donde se observó extrema fragilidad de la piel, se inició tratamiento con antibióticoterapia. A las 48 horas se observó necrosis de dos tercios del colgajo de piel, el cual se decidió mantener hasta pasados 10 días. Cuando se le retiró se comenzó a usar lisado plaquetario local en curaciones en días alternos. Se observó mejoría de la granulación, no así de la piel aledaña a la lesión. Posteriormente se le realizó infiltración perilesional con lisado plaquetario alogénico, con cuyo proceder mejoró el aspecto de la lesión y la cicatrización en un período de solo 7 días...

The use of allogenic platelet lysate opens another therapeutic possibility in orthopedics. Its use is presented in a 40 year-old patient with previous history of bronchial asthma and treated with steroids who, as a result a fall, suffered an extensive avulsive wound in her right foot of approximately 11 cm with skin laceration and necrosis of the torn piece, with vertex distal and proximal base that only took skin, with another torn piece of similar bodering and a diameter of approximatety 6 cm. A toilette and necrectomy of the cyanotic edge was made, mainly in the vertexes. Confrontation stitches were taken and an extreme fragility of the skin was observed when carrying this procedure. Treatment with antibiotics was started and after 48 hours necrosis of two third of the skin of the torn piece was observed which was not removed for ten days. After removal local therapy with alogenic platelet lysate was applied on alternate days. Improving of granulation was observed, but not in the surrounding skin lesion. Then, a perilessional infiltration with allogenic platelet lysate was made which improved the lesion appearance and its healing in a period of only 7 days...

Lisado plaquetario alogénico en la necrosis del colgajo / Alogenic platelet lysate in necrosis of the torn piece

La utilización de lisado plaquetario alogénico abre otra posibilidad terapéutica en ortopedia. Se presenta su uso en una paciente femenina de 40 años de edad, con antecedentes de asma bronquial y tratamiento con esteroides, que como consecuencia de una caída sufrió herida avulsiva extensa en el tercio inferior de la pierna derecha con desgarro de piel de aproximadamente 11 cm con vértice distal y base proximal estrecha, que solamente tomó piel; y otra herida similar, aledaña a esta lesión, de aproximadamente 6 cm de diámetro. Se le realizó toilette y necreptomía de los bordes que tenían signos de necrosis, fundamentalmente los vértices. Se le realizaron puntos de afrontamiento donde se observó extrema fragilidad de la piel, se inició tratamiento con antibióticoterapia. A las 48 horas se observó necrosis de dos tercios del colgajo de piel, el cual se decidió mantener hasta pasados 10 días. Cuando se le retiró se comenzó a usar lisado plaquetario local en curaciones en días alternos. Se observó mejoría de la granulación, no así de la piel aledaña a la lesión. Posteriormente se le realizó infiltración perilesional con lisado plaquetario alogénico, con cuyo proceder mejoró el aspecto de la lesión y la cicatrización en un período de solo 7 días(AU)

The use of allogenic platelet lysate opens another therapeutic possibility in orthopedics. Its use is presented in a 40 year-old patient with previous history of bronchial asthma and treated with steroids who, as a result a fall, suffered an extensive avulsive wound in her right foot of approximately 11 cm with skin laceration and necrosis of the torn piece, with vertex distal and proximal base that only took skin, with another torn piece of similar bodering and a diameter of approximatety 6 cm. A toilette and necrectomy of the cyanotic edge was made, mainly in the vertexes. Confrontation stitches were taken and an extreme fragility of the skin was observed when carrying this procedure. Treatment with antibiotics was started and after 48 hours necrosis of two third of the skin of the torn piece was observed which was not removed for ten days. After removal local therapy with alogenic platelet lysate was applied on alternate days. Improving of granulation was observed, but not in the surrounding skin lesion. Then, a perilessional infiltration with allogenic platelet lysate was made which improved the lesion appearance and its healing in a period of only 7 days(AU)

Impacto del tratamiento con células madre adultas en la osteoartrosis de la rodilla / Impact of the treatment with adult stem cells in knee osteoarthrosis

Introducción: la osteoartrosis de la rodilla (OAR) es la causa más frecuente de artritis en la población por encima de los 55 años de edad. A menudo se asocia con discapacidad y deterioro variable de la calidad de vida. En la actualidad, el tratamiento con células madre ha abierto una alternativa más dentro del arsenal terapéutico con que se cuenta. Objetivo: evaluar la eficacia y seguridad del autotrasplante de células madre adultas en el tratamiento de la osteoartrosis de rodilla. Métodos: se realizó un estudio desde mayo 2009 hasta diciembre 2011, en el que se incluyeron 123 pacientes adultos con OAR atendidos en la consulta de medicina regenerativa, que no respondían a los tratamientos convencionales. Se les realizó el implante intrarticular de células mononucleares de sangre periférica (CMN-SP) autólogas, movilizadas mediante el factor estimulante de colonias granulocíticas. En todos los casos prevalecía el dolor y la dificultad a la marcha al inicio del tratamiento. Resultados: a los seis meses se observó mejoría clínica y radiológica en 117 pacientes (95,1 por ciento) y solo en seis enfermos (4,9 por ciento) no hubo la respuesta deseada, coincidiendo estos con los que presentaron trastornos de alineación marcados, en los cuales el dolor no desapareció, pero sí existió modificación de la intensidad. Conclusiones: el implante de CMN-SP es un método factible, simple, seguro y menos costoso para el tratamiento de OAR. Se recomienda que si existe deformidad angular acentuada marcada, esta debe corregirse antes del implante para que el proceder sea exitoso

Introduction: osteoarthrosis an every day more frequent degenerative disease affecting the quality of life of people over 55 years old and its treatment is a great challenge. The use of stem cells has open a new alternative in the available therapeutic arsenal. Objective: to assess the efficacy and safety of autologous adult stem cell transplantation in the treatment of knee osteoarthrosis. Methods: the study took place from May 2009 to December 2011 in 123 adult patients with OAR from the regenerative medicine outpatient service who had no response to conventional treatments. Intra-articular implantation of autologous peripheral blood mononuclear cells (MNC-SP) mobilized by granulocyte colony stimulating factor was performed. In all cases pain and gait difficulty at baseline prevailed. Results: after six months, clinical and radiological improvement in 117 patients (95,1 percent) were observed and only in six patients (4,9 percent) the expected response was not obtained. These last patients presented marked alignment disorders and the pain did not disappear, but there was a positive change in its intensity. Conclusions: the CMN-SP implant is a feasible, simple, safe and less expensive method for the treatment of knee osteoarthrosis. It is recommended that in cases with marked angular deformity, this disorder should be corrected prior to MNC-SP implantation so the procedure be successful

Impacto del tratamiento con células madre adultas en la osteoartrosis de la rodilla / Impact of the treatment with adult stem cells in knee osteoarthrosis

Introducción: la osteoartrosis de la rodilla (OAR) es la causa más frecuente de artritis en la población por encima de los 55 años de edad. A menudo se asocia con discapacidad y deterioro variable de la calidad de vida. En la actualidad, el tratamiento con células madre ha abierto una alternativa más dentro del arsenal terapéutico con que se cuenta. Objetivo: evaluar la eficacia y seguridad del autotrasplante de células madre adultas en el tratamiento de la osteoartrosis de rodilla. Métodos: se realizó un estudio desde mayo 2009 hasta diciembre 2011, en el que se incluyeron 123 pacientes adultos con OAR atendidos en la consulta de medicina regenerativa, que no respondían a los tratamientos convencionales. Se les realizó el implante intrarticular de células mononucleares de sangre periférica (CMN-SP) autólogas, movilizadas mediante el factor estimulante de colonias granulocíticas. En todos los casos prevalecía el dolor y la dificultad a la marcha al inicio del tratamiento. Resultados: a los seis meses se observó mejoría clínica y radiológica en 117 pacientes (95,1 por ciento) y solo en seis enfermos (4,9 por ciento) no hubo la respuesta deseada, coincidiendo estos con los que presentaron trastornos de alineación marcados, en los cuales el dolor no desapareció, pero sí existió modificación de la intensidad. Conclusiones: el implante de CMN-SP es un método factible, simple, seguro y menos costoso para el tratamiento de OAR. Se recomienda que si existe deformidad angular acentuada marcada, esta debe corregirse antes del implante para que el proceder sea exitoso(AU)

Introduction: osteoarthrosis an every day more frequent degenerative disease affecting the quality of life of people over 55 years old and its treatment is a great challenge. The use of stem cells has open a new alternative in the available therapeutic arsenal. Objective: to assess the efficacy and safety of autologous adult stem cell transplantation in the treatment of knee osteoarthrosis. Methods: the study took place from May 2009 to December 2011 in 123 adult patients with OAR from the regenerative medicine outpatient service who had no response to conventional treatments. Intra-articular implantation of autologous peripheral blood mononuclear cells (MNC-SP) mobilized by granulocyte colony stimulating factor was performed. In all cases pain and gait difficulty at baseline prevailed. Results: after six months, clinical and radiological improvement in 117 patients (95,1 percent) were observed and only in six patients (4,9 percent) the expected response was not obtained. These last patients presented marked alignment disorders and the pain did not disappear, but there was a positive change in its intensity. Conclusions: the CMN-SP implant is a feasible, simple, safe and less expensive method for the treatment of knee osteoarthrosis. It is recommended that in cases with marked angular deformity, this disorder should be corrected prior to MNC-SP implantation so the procedure be successful(AU)

Strategies to improve adverse drug reaction reporting: a critical and systematic review.

BACKGROUND: Underreporting is the major limitation of a voluntary adverse drug reaction (ADR) reporting system. Many studies have assessed the effectiveness of different interventions designed to reduce underreporting. OBJECTIVE: We aimed to conduct a critical review of papers that assessed the effectiveness of different strategies to increase ADR reporting, regardless of the health professionals or patients included. DATA SOURCES: Scientific papers were selected after a search of the MEDLINE-PubMed and EMBASE scientific databases up to 7 December 2010. STUDY SELECTION: We included papers in English, French or Spanish that analysed an intervention aimed at increasing the number of reported ADRs, and quantify the results of the intervention in terms of number of reports. DATA EXTRACTION: The abstracts retrieved in both computerized searches were reviewed independently by two of the authors. Initially selected papers were thoroughly read to evaluate if they met inclusion and exclusion criteria. Data in finally selected papers were independently extracted by both authors and set in pre-designed tables. A third author took the final decision in case of disagreement. For each study, we analysed study design, type of intervention, assessment period, and results of the intervention. RESULTS: Of the 4,221 papers located that fulfilled the search criteria, 43 met the selection criteria. With the exception of one study, the interventions assessed were deemed to be effective. The vast majority of papers displayed methodological and formal limitations that lowered the grade of evidence. Multiple interventions seem to have had more impact than did single interventions. There were very few cases in which interventions were designed on the basis of inappropriate attitudes and mistaken beliefs about ADRs. CONCLUSIONS: In general, there is a need for studies of better methodological quality in this topic, so that more evidence of the effectiveness of the respective strategies can be collected for the purpose of improving ADR reporting by health professionals. It is probable that multiple interventions cause greater increases in the ADR reporting rates than single.

Attitudes of Portuguese health professionals toward adverse drug reaction reporting.

BACKGROUND: Adverse drug reactions are a major public health problem. Underreporting is an important limitation of all reporting systems, partially due to attitudes of health professionals. OBJECTIVE: This study sought: (1) to evaluate the reproducibility of a questionnaire on attitudes to and knowledge of adverse drug reaction (ADR) reporting among physicians, nurses and pharmacists: and (2) to compare the attitudes and knowledge of these three groups of health professionals. METHODS: This study targeted a sample of physicians (n = 30), nurses (n = 30) and pharmacists (n = 20) in the central region of Portugal. A structured questionnaire was administered to each health professional twice, at an interval of 2-4 weeks. Most attitudes were based on Inman's 'seven deadly sins' and measured using a continuous visual analog scale (VAS), with answers scored from 0 (total disagreement) to 10 (total agreement). Questionnaire reproducibility was determined using the intraclass correlation coefficient (ICC). RESULTS: The response rate was 100 %. Attitudes that registered the highest ICCs were Complacency (the belief that really serious ADRs are well documented by the time a drug is marketed) (physicians, ICC 0.84; nurses, ICC 0.70; pharmacists, ICC 0.99), and Diffidence (the belief that one would only report an ADR if one were sure that it was related to the use of a particular drug) (physicians, ICC 0.73; nurses, ICC 0.65; pharmacists, ICC 0.98). In most cases, there were no differences among the three groups of professionals in terms of attitudes and knowledge. CONCLUSIONS: The Horizontal continuous VAS is reliable to detect the knowledge and attitudes about ADRs.

Terapia celular en fractura del fémur / Cell therapy in femur fractures

La medicina regenerativa ha abierto una posibilidad más para la consolidación efectiva y la recuperación rápida de los pacientes con lesiones traumáticas. Se presenta un paciente masculino, blanco, de 46 años de edad con antecedentes de accidente de tránsito. Se diagnosticó fractura del tercio medio del fémur izquierdo y las radiografías simples evidenciaron conminución Grado IV. Egresó después de 20 días de internamiento con persistencia del dolor a pesar de habérsele administrado analgésicos cada 4-6 horas. Se indicó terapia celular que se realizó en régimen ambulatorio. A partir de las primeras 48 horas la mejoría se incrementó progresivamente, logró estabilidad y desapareció el dolor en el foco de fractura, síntoma que mantenía desde el accidente. A las 8 semanas después de la terapia celular se observó mejoría radiológica. En general, su evolución se consideró satisfactoria por la pronta mejoría y su incorporación a la vida social. Este es el primer paciente en la provincia de Artemisa en que se ha realizado este nuevo tipo de terapia y hasta donde conocemos en el momento de la redacción de este trabajo, también el primero informado en la literatura científica en Cuba

Regenerative medicine has opened another opportunity for effective consolidation and rapid recovery of patients with traumatic injuries. We present a 46 year- old white male patient with a history of traffic accident. A middle third left femur fracture was diagnosed and plain radiographs showed IV grade comminution. He was released after 20 days of hospitalization with persistent pain despite of pain medication every 4-6 hours. Cell therapy was prescribed and it was performed on outpatient basis. After 48 hours the improvement was increased progressively, stability was achieved and pain disappeared in the fracture site, this was a symptom present since the accident. 8 weeks after cell therapy, radiological improvement was observed. In general, his eveolution was considered satisfactory for the fast recovery and its incorporation into social life. This is the first patient in Artemisa province who underwent this new type of therapy and as far as we know at the time of this writing, it is also the first reported in the scientific literature in Cuba

Terapia celular en fractura del fémur / Cell therapy in femur fractures

La medicina regenerativa ha abierto una posibilidad más para la consolidación efectiva y la recuperación rápida de los pacientes con lesiones traumáticas. Se presenta un paciente masculino, blanco, de 46 años de edad con antecedentes de accidente de tránsito. Se diagnosticó fractura del tercio medio del fémur izquierdo y las radiografías simples evidenciaron conminución Grado IV. Egresó después de 20 días de internamiento con persistencia del dolor a pesar de habérsele administrado analgésicos cada 4-6 horas. Se indicó terapia celular que se realizó en régimen ambulatorio. A partir de las primeras 48 horas la mejoría se incrementó progresivamente, logró estabilidad y desapareció el dolor en el foco de fractura, síntoma que mantenía desde el accidente. A las 8 semanas después de la terapia celular se observó mejoría radiológica. En general, su evolución se consideró satisfactoria por la pronta mejoría y su incorporación a la vida social. Este es el primer paciente en la provincia de Artemisa en que se ha realizado este nuevo tipo de terapia y hasta donde conocemos en el momento de la redacción de este trabajo, también el primero informado en la literatura científica en Cuba(AU)

Regenerative medicine has opened another opportunity for effective consolidation and rapid recovery of patients with traumatic injuries. We present a 46 year- old white male patient with a history of traffic accident. A middle third left femur fracture was diagnosed and plain radiographs showed IV grade comminution. He was released after 20 days of hospitalization with persistent pain despite of pain medication every 4-6 hours. Cell therapy was prescribed and it was performed on outpatient basis. After 48 hours the improvement was increased progressively, stability was achieved and pain disappeared in the fracture site, this was a symptom present since the accident. 8 weeks after cell therapy, radiological improvement was observed. In general, his eveolution was considered satisfactory for the fast recovery and its incorporation into social life. This is the first patient in Artemisa province who underwent this new type of therapy and as far as we know at the time of this writing, it is also the first reported in the scientific literature in Cuba(AU)

Determinants of under-reporting of adverse drug reactions: a systematic review.

A voluntary reporting system of adverse drug reactions (ADRs) is fundamental to drug safety surveillance but under-reporting is its major limitation. This bibliographic review sought to assess the influence of personal and professional characteristics on ADR reporting and to identify knowledge and attitudes associated with ADR reporting. A systematic review was conducted using the MEDLINE and EMBASE databases. We included papers that were published in English, French and Spanish, and covered a study population made up of health professionals. In each case, the following data were extracted: study population; workplace; study type; sample size; type of questionnaire; type of scale for measuring knowledge; response rate; personal and professional factors; and knowledge and attitudes (based on Inman's 'seven deadly sins') associated with reporting. Based on a search of computerized databases, we identified a total of 657 papers in MEDLINE and 973 in EMBASE. In all, the review covered 45 papers that fulfilled the inclusion criteria. Medical specialty was the professional characteristic most closely associated with under-reporting in 76% of studies involving physicians. Other factors associated with under-reporting were ignorance (only severe ADRs need to be reported) in 95%; diffidence (fear of appearing ridiculous for reporting merely suspected ADRs) in 72%; lethargy (an amalgam of procrastination, lack of interest or time to find a report card, and other excuses) in 77%; indifference (the one case that an individual doctor might see could not contribute to medical knowledge) and insecurity (it is nearly impossible to determine whether or not a drug is responsible for a particular adverse reaction) in 67%; and complacency (only safe drugs are allowed on the market) in 47% of studies. While personal and professional factors display a weak influence, the knowledge and attitudes of health professionals appear to be strongly related with reporting in a high proportion of studies. This result may have important implications in terms of public health, if knowledge and attitudes are viewed as potentially modifiable factors.