Resultados de "Tomando Control de su Salud" online, en personas con enfermedades no transmisibles de México y Perú durante COVID-19 / Results of "Tomando Control de su Salud" online, in people with non-communicable diseases in Mexico and Peru during COVID-19

Las enfermedades no transmisibles (ENT) son una creciente preocupación global que afecta tanto a la atención médica como a la calidad de vida. Los programas de automanejo de enfermedades crónicas como el denominado "Tomando Control de su Salud" (TCS), se han vuelto estrategias efectivas para abordar este problema. OBJETIVO: Evaluar el resultado del programa TCS, versión en línea, en las variables automanejo y autoeficacia, en muestras de personas con ENT de México y Perú, durante la pandemia por COVID-19. METODOLOGÍA: El diseño del estudio fue cuasiexperimental con mediciones independientes (intervenidos y controles) y mediciones en línea, al inicio y término de la intervención; evaluadas con Partners in Health Scale y la Escala de Autoeficacia. Los cambios en el tiempo se examinaron mediante la prueba de Wilcoxon. RESULTADOS: De los 114 participantes, la mayoría eran mujeres (83.3%) con una edad promedio de 58.8 años. Antes de la intervención, los grupos fueron iguales en las variables de estudio. No se encontró ningún aumento significativo en las variables de estudio en el grupo control, sin embargo, hubo un aumento estadísticamente significativo en la autoeficacia y automanejo en el grupo intervenido. CONCLUSIONES: El programa TCS en línea contribuyó al aumento de la autoeficacia, el automanejo, el conocimiento de la enfermedad, la adherencia al tratamiento y el manejo de síntomas en participantes con ENT de México y Perú durante la pandemia de COVID-19. Esto respalda la evidencia de que el programa mejora la salud y la calidad de vida de quienes viven con estas enfermedades.

Non-communicable diseases (NCD) are a growing global concern that affects both healthcare and quality of life. Chronic disease self-management programs, such as "Tomando Control de su Salud" (TCS), have become effective strategies to address this problem. PURPOSE: To evaluate the results of the TCS program, online version, in the self-management and self-efficacy variables, in samples of people with NCD from Mexico and Peru, during the COVID-19 pandemic. METHODOLOGY: The study design was quasi-experimental with independent measurements (interventions and controls) and online measurements, at the beginning and end of the intervention; evaluated with the Partners in Health Scale and the Self-Efficacy Scale. Changes over time were examined using the Wilcoxon test. RESULTS: Out of the 114 participants, most were women (83.3%) with an average age of 58.8 years. Before the intervention, the groups were equal in the study variables. No significant increase in the study variables was found in the control group; however, there was a statistically significant increase in self-efficacy and self-management in the intervention group. CONCLUSIONS: The online TCS program contributed to increased self-efficacy, self-management, disease knowledge, treatment adherence, and symptom management in participants with NCD from Mexico and Peru during the COVID-19 pandemic. This supports evidence that the program improves the health and quality of life of those living with these illnesses.

Programa de superación profesional para angiólogos sobre tratamiento de enfermedades vasculares periféricas con técnicas novedosas

Introducción: La superación profesional es un conjunto de acciones de carácter educativo vinculadas con la actualización de conocimientos y el desarrollo de habilidades y actitudes profesionales en correspondencia con la identificación de problemas profesionales. En Ciego de Ávila, Cuba, los especialistas de Angiología y Cirugía Vascular carecen de actividades de superación profesional de forma general, sistemática y de participación colectiva, dirigidas u orientadas desde la Universidad de Ciencias Médicas. Objetivo: Elaborar un programa de superación profesional del especialista en Angiología y Cirugía Vascular para el tratamiento de las enfermedades vasculares periféricas con técnicas novedosas, a partir de insuficiencias identificadas. Método: Se realizó una investigación cualitativa con un estudio descriptivo en especialistas de Angiología y Cirugía Vascular de la provincia de Ciego de Ávila, vinculada directamente con la atención a pacientes, en el año 2020. Se trabajó con toda la población compuesta por 19 especialistas. Fue aplicada una encuesta y se utilizó la estadística descriptiva para organizar y clasificar los indicadores cuantitativos obtenidos. Resultados: La preparación para la aplicación de tratamiento con técnicas novedosas en las enfermedades vasculares periféricas se encontró como insuficiencia en nivel de Poco adecuado y No adecuado en más del 90 % de los especialistas. Conclusiones: Se aporta un programa de superación profesional como sistema abierto, de carácter flexible, que facilita su rediseño constante para adaptarse a condiciones específicas de los contextos de aplicación.

Introduction: Professional development is a set of educational actions linked to update knowledge and professional skills and attitudes in correspondence with the professional problems met. In Ciego de Avila, Cuba, specialists in Angiology and Vascular Surgery lack professional improvement activities in general, systematic and collective participation way, straightly performed or oriented from the University of Medical Sciences. Objective: To design a professional development program for specialists in Angiology and Vascular Surgery on the treatment of peripheral vascular diseases with the use of novel techniques based on the professional problems met. Method: A qualitative research with descriptive study was carried out in Angiology and Vascular Surgery specialists linked directly to the patient care service in 2020. It worked with the whole population comprised of 19 specialists. A survey was applied and descriptive statistics were used to organize and classify the quantitative indicators obtained. Results: Knowledge on how to use the novel techniques in peripheral vascular diseases treatment proved to be inadequate at a pointed level of Less adequate and Inadequate in more than 90% of studied specialists. Conclusions: The professional development program is provided with characteristics of an open system and flexibility, which facilitates its constant redesign to adapt to the specific conditions of the contexts required.

Introdução: O aperfeiçoamento profissional é um conjunto de ações educativas vinculadas à atualização de conhecimentos e desenvolvimento de habilidades e atitudes profissionais em correspondência com a identificação de problemas profissionais. No Ciego de Ávila, Cuba, os especialistas em Angiologia e Cirurgia Vascular carecem de atividades de aperfeiçoamento profissional de forma geral, sistemática e de participação coletiva, dirigidas ou orientadas pela Universidade de Ciências Médicas. Objetivo: Desenvolver um programa de aperfeiçoamento profissional do especialista em Angiologia e Cirurgia Vascular para tratamento de doenças vasculares periféricas com técnicas inovadoras, a partir das insuficiências identificadas. Método: Foi realizada uma investigação qualitativa com estudo descritivo em especialistas de Angiologia e Cirurgia Vascular na província de Ciego de Ávila, diretamente vinculados ao atendimento ao paciente, no ano de 2020. Trabalhamos com toda a população composta por 19 especialistas. Aplicou-se um survey e utilizou-se estatística descritiva para organizar e classificar os indicadores quantitativos obtidos. Resultados: A preparação para a aplicação do tratamento com novas técnicas nas doenças vasculares periféricas revelou-se insuficiente ao nível de Pouco adequado e Pouco adequado em mais de 90% dos especialistas. Conclusões: Um programa de aperfeiçoamento profissional é fornecido como um sistema aberto, de natureza flexível, o que facilita seu redesenho constante para se adaptar às condições específicas dos contextos de aplicação.

Contamination assessment and potential sources of heavy metals and other elements in sediments of a basin impacted by 500 years of mining in central Mexico.

Since the middle of the 1500 s, mining has been active in central Mexico. Total estimates for low-grade piles and mine tailing materials in the Guanajuato mining district (GMD) are in the range of 150 million tons, covering an area of 15 to 20 km2. GMD is located in the Guanajuato River sub-basin (GRB), which is part of one of the largest basins in Mexico (Lerma-Santiago). Previous studies on the GRB found unusually high concentrations of heavy metals in mining tailings and sediments. Geochemical and statistical methods were used here to determine the sediment's origin, background values, degree of contamination, and toxicity through different contamination indices. This analysis shows that Cu, Co, As, Sb, and Hg are higher than they are in the upper continental crust (UCC) overbank sediments without human and mining influence, because of the ore deposits and rock weathering in GRB. Geochemistry results in stream sediments show anomalies, where Hg, Cu, Zn, As, and Pb are higher than UCC because those heavy metals and trace elements (HMT) have been influenced by human activities and mineral recovery (smelting, amalgamation, cyanidation). The distribution of high concentrations of HMTs and contamination indices occur in the main channel of the Guanajuato River and downstream of the city of Guanajuato. Statistical analyses (cluster and principal component analysis) reveal relationships between Cr, Ni, Cu, and Pb, which are primarily of natural origin, related to rocks of the upper basin. The middle and lower basins are distinctive in their associations between As, Sb, Zn, Pb, and Hg. Additionally, it is recognized that the origins of Pb, Zn, and Hg are geogenic and anthropogenic. This study demonstrates how crucial it is to understand the geochemistry of various HMT sources, with both natural and anthropogenic contributions (stream sediments and rocks), in order to calculate a more realistic background in a basin with both natural anomalies and anthropogenic contamination. The basin is a regional aquifer recharge area, so the new geochemical data are important for improving basin environmental management.

Herramienta basada en código abierto para el cálculo de blindaje en las instalaciones de Medicina Nuclear / Open Source Based Tool for Shielding Calculation in Nuclear Medicine Installations

Uno de los requerimientos indispensables en el diseño de las instalaciones donde se trabaja con radiación ionizante es la determinación del espesor adecuado de las paredes, pisos, techo y puertas de los locales, que garanticen dosis por debajo de las restricciones establecidas por la autoridad regulatoria. El objetivo del presente trabajo es desarrollar una herramienta interactiva, libre y de código abierto para calcular los blindajes requeridos en una instalación de Medicina Nuclear. En el código, desarrollado en Phyton utilizando el entorno interactivo Jupiter Notebook, se incluyó el análisis tanto para Tomografía por Emisión de Fotón Único como para Tomografía por Emisión de Positrones. La herramienta fue implementada para el cálculo de los blindajes de un departamento de Medicina Nuclear del Centro Internacional de Restauración Neurológica (CIREN). Esta herramienta libre y de código abierto facilita los cálculos de blindaje aumentando la velocidad, lo que contribuye a lograr una optimización de la protección radiológica, pero también puede usarse como herramienta pedagógica(AU)

One of the indispensable requirements in the design of the facilities where ionizing radiation is used is the determination of the adequate thickness of the walls, floors, ceiling and doors of the premises, which guarantee doses below the restrictions established by the regulatory authority. The goal of this work is to develop an interactive, free and open source tool to calculate the shields required in a Nuclear Medicine installation. Analysis for both Single Photon Emission Tomography and Positron Emission Tomography was included in the code, developed in Phyton using the interactive Jupiter Notebook environment. The tool was implemented to calculate the shields of a Nuclear Medicine department of the International Center for Neurological Restoration (CIREN). This free and open source tool facilitates shielding calculations by increasing speed, which contributes to the optimization of radiation protection, but can also be used as a pedagogical tool(AU)

[Standardized mortality with PIM2 score in a pediatric intensive care unit in Morelos, Mexico]. / Mortalidad estandarizada mediante la escala PIM2 en una unidad de cuidados intensivos pediátricos en Morelos, México.

BACKGROUND: Mortality in pediatric intensive care units (PICUs) is elevated, with limited information generated from Mexico. OBJECTIVE: To identify the standardized mortality (SM) at the Hospital del Niño Morelense's (HNM) (Child from Morelos' Hospital) PICU. MATERIAL AND METHODS: Electronic records of seriously ill patients admitted at the HNM's PICU during 2014 (n = 130) were used. SM was calculated using the observed mortality and the probability of death by PIM2. The area under the ROC curve (AUC) was used to identify the discriminatory capacity of PIM2, and the Hosmer Lemeshow (HL) test to calibrate it. By using odds ratios (OR) and 95% confidence intervals (95% CI), risk factors of mortality were identified. RESULTS: There were no differences between observed mortality and expected mortality with PIM2 (17.7%; HL p = 0.17), resulting in a SM of 1. The AUC of PIM2 was 0.76 (95% CI, 0.68 0.83). Risk factors associated to mortality were: admission due to medical diagnosis (OR 3.22; 95% CI, 1.08 10.76), absence of pupillary light reflex (OR 7.36; 95% CI, 1.81 29.68), high risk diagnosis according to PIM2 (OR 3.85; 95% CI, 1.16 12.03), and coming from the Emergency Room showed a borderline result (OR 2.80; 95% CI, 0.98 8.69; chi-squared, p = 0.04). CONCLUSIONS: Mortality observed in the HNM's PICU during 2014 was elevated, but similar to predicted mortality by PIM2 score, with a SM of 1. PIM2 is a validated score used all over the world, which is useful to predict the expected mortality in PICUs.

INTRODUCCIÓN: la mortalidad en las unidades de cuidados intensivos pediátricos (UCIP) es elevada, con escasa información generada en México. OBJETIVO: identificar la mortalidad estandarizada (ME) en la UCIP del Hospital del Niño Morelense (HNM). MATERIAL Y MÉTODOS: se usaron los expedientes electrónicos de enfermos críticos admitidos en la UCIP del HNM durante 2014 (n = 130). Se calculó la ME empleando la mortalidad observada y la probabilidad de muerte mediante PIM2. Se empleó el área bajo la curva ROC (ABC ROC) para identificar la capacidad discriminatoria de PIM2, y la prueba de Hosmer Lemeshow (HL) para calibrarla. Mediante razón de momios (RM) e intervalo de confianza al 95% (IC 95%) se identificaron los factores de riesgo de mortalidad. RESULTADOS: no hubo diferencias entre la mortalidad observada y la esperada con PIM2 (17.7%; HL p = 0.17), lo cual generó una ME de 1. El ABC ROC de PIM2 fue 0.76 (IC 95% 0.68 0.83). Los factores de riesgo asociados a mortalidad fueron: ingreso por diagnóstico médico (RM 3.22; IC 95% 1.08 10.76), ausencia de reflejo pupilar (RM 7.36; IC 95% 1.81 29.68), diagnóstico de alto riesgo según PIM2 (RM 3.85; IC 95% 1.16 12.03) y proceder de Urgencias fue limítrofe (RM 2.80; IC 95% 0.98 8.69; chi cuadrada p = 0.03). CONCLUSIONES: la mortalidad observada en la UCIP del HNM durante 2014 fue elevada, pero igual que la predicha por la escala PIM2, con ME de 1. La escala PIM2 es una escala internacional validada que es útil para predecir la posibilidad de muerte en las UCIP.

Impact of pectus excavatum on cardiac morphology and function according to the site of maximum compression: effect of physical exertion and respiratory cycle.

AIMS: Previous studies have demonstrated diverse cardiac manifestations in patients with pectus excavatum (PEX), although mostly addressing morphological or physiological impact as separate findings. Using multimodality imaging, we evaluated the impact of PEX on cardiac morphology and function according to the site of maximum compression, and the effect of exertion and breathing. METHODS AND RESULTS: All patients underwent chest computed tomography, cardiac magnetic resonance (CMR), and stress echocardiography (echo) in order to establish surgical candidacy. We evaluated diastolic function and trans-tricuspid gradient during stress (echo); and systolic function and respiratory-related septal wall motion abnormalities (CMR). Patients were classified according to the site of cardiac compression as type 0 (without cardiac compression); type 1 (right ventricle); and type 2 [right ventricle and atrioventricular (AV) groove]. Fifty-nine patients underwent multimodality imaging, with a mean age of 19.5 ± 5.9 years. Compared with a sex and age matched control group, peak exercise capacity was lower in patients with PEX (8.4 ± 2.0 METs vs. 15.1 ± 4.6 METs, P < 0.0001). At stress, significant differences were found between groups regarding left ventricular E/A (P = 0.004) and e/a ratio (P = 0.005), right ventricular E/A ratio (P = 0.03), and trans-tricuspid gradient (P = 0.001). At CMR, only 9 (15%) patients with PEX had normal septal motion, whereas 17 (29%) had septal flattening during inspiration. Septal motion abnormalities were significantly related to the cardiac compression classification (P < 0.0001). CONCLUSIONS: The present study demonstrated that patients with PEX, particularly those with compression affecting the right ventricle and AV groove, manifest diverse cardiac abnormalities that are mostly related to exertion, inspiration, and diastolic function.

Sternal torsion in pectus excavatum is related to cardiac compression and chest malformation indexes.

BACKGROUND/PURPOSE: The role of sternal torsion (ST) in patients with pectus excavatum (PEX) is unknown. We evaluated the relationship between ST and both chest malformation and cardiac compression (CC) indexes. METHODS: We included consecutive patients with PEX who underwent chest computed tomography and cardiac magnetic resonance (CMR) to define surgical candidacy. Malformation indexes included the Haller index (HI), correction index (CI), and ST. CC and the tricuspid to mitral annulus width ratio were evaluated using CMR. RESULTS: One-hundred and sixteen patients were included, with a mean HI of 5.8 ±â€¯3.6 and a mean CI of 35.8 ±â€¯18.0%. ST was significantly related to malformation indexes, being patients with absence of ST those showing the lowest HI (p = 0.048) and CI (p = 0.002). Right-sided ST was significantly related to the CC classification (p = 0.0001), and the tricuspid/mitral annulus width ratio was significantly lower among these patients (absence 0.98 ±â€¯0.15, left-sided 0.91 ±â€¯0.10, right-sided 0.80 ±â€¯0.15, p < 0.0001). A significant inverse relationship between ST degrees and the tricuspid/mitral ratio was also identified (r = -0.47, p < 0.0001). CONCLUSIONS: We identified a significant relationship between ST and both chest malformation and CC indexes; the absence of ST being identified as a marker of an overall more benign phenotype. TYPE OF STUDY: Study of diagnostic test. LEVEL OF EVIDENCE: Level II.

Design of a preamplifier card for the photomultiplier tubes of a gamma camera / Diseño de una tarjeta preamplificadora para los tubos fotomultiplicadores de una cámara gamma

Abstract The service provided by Gamma Cameras (GC) in Nuclear Medicine departments fails because of their breakdown, generally due to the associated electronics and not to the physical detection components. Therefore, it was decided to develop an electronic system that allows the recovery and optimization of disused GC, starting with the design of the preamplifier for each photomultiplier tube (PMT). The circuit was designed and simulated and the list of components necessary for the construction of the preamplifier was generated, as well as the printed circuit board was designed for its assembly. By simulating the preamplifier, this worked in linear mode. This determines that the amplitude of the output signal is proportional to the amount of charge delivered by the detector. This card allows an automatic adjustment of the signals of the PMTs as modern GC do. Besides, the circuit was designed and simulated for 37 and 75 PMTs, and the printed circuit board was designed for both cases.

Resumen El servicio que prestan las Cámaras Gamma (CG) en los departamentos de Medicina Nuclear falla por roturas de las mismas, generalmente debido a la electrónica asociada y no a los componentes físicos de detección. Por tal razón, se decidió desarrollar un sistema electrónico que permita la recuperación y optimización de las CG en desuso, comenzando con el diseño del preamplificador para cada tubo fotomultiplicador (TFM). Se diseñó y simuló el circuito y se generó la lista de componentes necesarios para la construcción del preamplificador, así como se diseñó la placa de circuitos impresos para su montaje. Al simular el preamplificador este trabajó en modo lineal. Esto determina que la amplitud de la señal de salida sea proporcional a la cantidad de carga entregada por el detector. Esta tarjeta permite un ajuste automático de las señales de los TFMs como lo hacen las CG modernas. Además, se diseñó y simuló el circuito para 37 y 75 TFMs, así como se diseñó la placa de circuitos impreso para ambos casos.

La infertilidad por Mioma Submucoso. Caso clínico / Infertility by Submucous Myoma. Case report

Los miomas pueden causar infertilidad. Provocan una marcada deformación del útero por deformación u obstrucción de los segmentos uterinos de las trompas de Falopio, cavidad y cuello uterino anormales. Este caso se trata de una paciente de 27 años de edad, de la raza negra, con menstruaciones abundantes y antecedentes de infertilidad, atendida en el Servicio de Ginecología del Hospital Provincial de Luanda del Norte, Angola. En el examen físico se encontró una tumoración en el hipogastrio. La ecografía transvaginal mostró un mioma uterino submucoso, que ocupaba y deformaba toda la cavidad endometrial. Todo esto se consideró como la causa de su infertilidad y se le realizó una miomectomía con evolución satisfactoria.

Myomas can cause infertility. They create alterations of uterus and cervix, marked by deformations of the fallopian tubes uterine segments for an abnormal uterine cavity. This case refers to a 27-year-old black patient, with heavy menstruation and infertility background, attended at the Gynecology Service of the Provincial Hospital of North Luanda, Angola. A tumor in the hypogastrium was found during physical examination. Transvaginal ultrasound revealed a submucosal uterine fibroid affecting endometrial cavity, which was considered the cause of her infertility. Myomectomy was performed with a positive evolution.

Modeling and Characterization of Traffic Flows in Urban Environments.

Currently, one of the main challenges faced in large metropolitan areas is traffic congestion. To address this problem, adequate traffic control could produce many benefits, including reduced pollutant emissions and reduced travel times. If it were possible to characterize the state of traffic by predicting future traffic conditions for optimizing the route of automated vehicles, and if these measures could be taken to preventively mitigate the effects of congestion with its related problems, the overall traffic flow could be improved. This paper performs an experimental study of the traffic distribution in the city of Valencia, Spain, characterizing the different streets of the city in terms of vehicle load with respect to the travel time during rush hour traffic conditions. Experimental results based on realistic vehicular traffic traces from the city of Valencia show that only some street segments fall under the general theory of vehicular flow, offering a good fit using quadratic regression, while a great number of street segments fall under other categories. Although in some cases such discrepancies are related to lack of traffic, injecting additional vehicles shows that significant mismatches still persist. Thus, in this paper we propose an equation to characterize travel times over a segment belonging to the sigmoid family; specifically, we apply logistic regression, being able to significantly improve the curve fitting results for most of the street segments under analysis. Based on our regression results, we performed a clustering analysis of the different street segments, showing that they can be classified into three well-defined categories, which evidences a predictable traffic distribution using the logistic regression throughout the city during rush hours, and allows optimizing the traffic for automated vehicles.

Towards Realistic Urban Traffic Experiments Using DFROUTER: Heuristic, Validation and Extensions.

Traffic congestion is an important problem faced by Intelligent Transportation Systems (ITS), requiring models that allow predicting the impact of different solutions on urban traffic flow. Such an approach typically requires the use of simulations, which should be as realistic as possible. However, achieving high degrees of realism can be complex when the actual traffic patterns, defined through an Origin/Destination (O-D) matrix for the vehicles in a city, remain unknown. Thus, the main contribution of this paper is a heuristic for improving traffic congestion modeling. In particular, we propose a procedure that, starting from real induction loop measurements made available by traffic authorities, iteratively refines the output of DFROUTER, which is a module provided by the SUMO (Simulation of Urban MObility) tool. This way, it is able to generate an O-D matrix for traffic that resembles the real traffic distribution and that can be directly imported by SUMO. We apply our technique to the city of Valencia, and we then compare the obtained results against other existing traffic mobility data for the cities of Cologne (Germany) and Bologna (Italy), thereby validating our approach. We also use our technique to determine what degree of congestion is expectable if certain conditions cause additional traffic to circulate in the city, adopting both a uniform pattern and a hotspot-based pattern for traffic injection to demonstrate how to regulate the overall number of vehicles in the city. This study allows evaluating the impact of vehicle flow changes on the overall traffic congestion levels.

Derivación aorto-bifemoral. Presentación de caso / Bypass aorto-bifemoral. Case presentation

Introducción: durante la última década se han perfeccionado e introducido nuevas tecnologías percutáneas que, por su baja morbilidad –comparada con la de la alternativa quirúrgica tradicionalson muy utilizadas; sin embargo la operación revascularizadora derivativa basada en las técnicas de DeBakey y colaboradores, con el principio de injerto-puente o derivación en forma de ramas colaterales artificiales con injertos vasculares homeoplásticos o aloplásticos, es el tratamiento de elección para los pacientes clasificados como TASC-D por la Trans-Atlantic Inter-Society Consensus.Objetivo: presentar el primer caso operado mediante la técnica de derivación aorto-bifemoral en la provincia Ciego de Ávila.Presentación del caso: el paciente, atendido en el Servicio de Angiología y Cirugía Vascular del Hospital Provincial General Docente Dr. Antonio Luaces Iraola de Ciego de Ávila, presentó dolor intenso en la región glútea luego de la marcha y calambres en los muslos y piernas, que lo obligaban al descanso. Se le diagnosticó enfermedad esteno-oclusiva aorto-ilíaca y, con posterioridad a una angiotomografía aorto-ílio-femoro-poplítea, se le realizaron una operación revascularizadora derivativa anatómica con injerto protésico (mediante la técnica convencional de derivación aorto-bifemoral por vía transperitoneal) y una segunda operación con la técnica convencional de derivación femoro-poplítea izquierda, con prótesis de politetrafluoroetileno. Al año de operado, el paciente presenta buen estado general.Conclusiones: no obstante los avances en las técnicas quirúrgicas endovasculares, existen lesiones no accesibles con ellas, que pueden ser tratadas mediante la derivación aorto-bifemoral; la selección adecuada de los pacientes y una técnica bien realizada, posibilitan buenos resultados a pesar del riesgo quirúrgico(AU)

Introduction: during the last decade have perfected and introduced new percutaneous technologies which by its low morbidity –compared with traditional surgical alternativeare widely used; however the derivatively revascularization surgery-based on DeBakey techniques and collaborators, with the principle of graft-bypass or artificial collateral branches with homeoplastic or alloplastic vascular grafts, is the treatment of choice for patients classified as TASC-D by the Trans-Atlantic Inter-Society Consensus.Objective: to present the first case operated by the bypass aorto-bifemoral technique in Ciego de Ávila province.Case presentation: the patient, treated at the Service of Angiology and Vascular Surgery in the Provincial General Teaching Hospital Dr. Antonio Luaces Iraola of Ciego de Ávila, presented severe pain in the gluteal region –after walkingand cramps in the thighs and legs, which forced him to rest. He was diagnosed with steno-occlusive aortoiliac disease and after an angiotomography aorto-ilio-femoro-popliteal, was carried out an anatomical derivative revascularization surgery with prosthetic graft (through the conventional technique of bypass aorto-bifemoral for transperitoneal route) and a second operation with the conventional technique of left femoral-popliteal bypass with polytetrafluoroethylene prosthesis. A year after surgery, the patient has good general condition.Conclusions: however advances in endovascular surgical techniques, there are no visible injuries with them, which can be treated through bypass aorto-bifemoral; the proper selection of patients and a well done technique allow good results despite of the surgical risk(AU)

Comportamiento de la cesárea en pacientes del Hospital Vladimir Ilich Lenin de Holguín / Incidence of Cesarean Section in Patients of Vladimir Ilich Lenin Hospital of Holguín

Introducción: el aumento de las tasas de cesárea constituye un problema a escala mundial. En Cuba, desde principios del siglo XXI los datos institucionales, así como, las encuestas demográficas y de salud señalan un porcentaje de ejecución de cesáreas superior a 20%, tendencia que se acentúa en los últimos años. Objetivo: determinar el comportamiento del parto por cesárea en pacientes del Hospital Lenin. Método: se realizó un estudio descriptivo, retrospectivo, cuyo universo de trabajo estuvo constituido por 29 299 partos, en el Servicio de la Maternidad del Hospital General Universitario Vladimir Ilich Lenin, provincia Holguín, en el periodo comprendido de enero de 2010 a diciembre de 2013. La muestra fue 11 726 partos por cesárea. Se excluyeron los partos eutócico/instrumentado y las cesáreas que se realizaron antes de las 28 semanas con feto no viable. Resultados: la frecuencia de cesáreas predominó en el año 2013 con un total de 3 034 casos, a expensas de las cesáreas primitivas 2 148 (70,8%). La incidencia de cesárea mostró una tendencia lineal creciente con respecto al año 2010, debido al incremento de las cesáreas primitivas. La indicación principal de cesárea fue el sufrimiento fetal agudo con 3 009 casos (36,09%). La edad gestacional que predominó fue de 37-41 semanas con 72,30%. La morbilidad general materna fue de 4,65%, con predominio de gestantes con infecciones para el 54,95%. Conclusiones: la tasa de incidencia de cesárea mostró un aumento en el periodo de estudio, sin embargo, la morbilidad materna fue baja. El mayor número de cesáreas se realizó entre las 37 y 41 semanas de edad gestacional.

Introduction: the increasing cesarean section rates constitute a health problem to a worldwide scale. In Cuba, the institutional data coming from demographic and health surveys point out to a percentage of cesarean sections superior to 20%, since the beginnings of the XXI century. This tendency has been accentuated during the last years. Objective: to determine the incidence of cesarean sections in the Vladimir Ilich Lenin General Teaching Hospital of Holguín. Method: a descriptive, retrospective study whose universe was made up of 29 299 deliveries at the maternity service of Vladimir Ilich Lenin General Teaching Hospital was conducted from January to December 2013 aimed at determining the incidence of delivery through cesarean section (C-section). The sample comprised 11 726 deliveries by C-section. The eutocic /instrumental deliveries and the C-sections performed before the 28 weeks of gestation with nonviable fetuses were excluded from the sample. Results: the frequency of C-sections predominated in 2013 with a total of 3 034 cases, at the expense of 2148 primitive C-sections (70.8 %). The incidence of C-sections showed a linear growing trend comparing to 2010, due to the increase of primitive C-sections. The main indication for C-section was acute fetal distress with 3 009 cases (36.09%). The gestational age that predominated was 37-41. There was a greater number of pregnant women with infections accounting for 300 cases (54.95%). Conclusions: the rate of cesarean section incidence showed an increase in the period under study; however, maternal morbidity was low. The greater number of C-sections was performed between 37 and 41 weeks of gestational age.

Comportamiento de la cesárea en pacientes del Hospital Vladimir Ilich Lenin de Holguín / Incidence of Cesarean Section in Patients of Vladimir Ilich Lenin Hospital of Holguín

Introducción: el aumento de las tasas de cesárea constituye un problema a escala mundial. En Cuba, desde principios del siglo XXI los datos institucionales, así como, las encuestas demográficas y de salud señalan un porcentaje de ejecución de cesáreas superior a 20%, tendencia que se acentúa en los últimos años.Objetivo: determinar el comportamiento del parto por cesárea en pacientes del Hospital Lenin.Método: se realizó un estudio descriptivo, retrospectivo, cuyo universo de trabajo estuvo constituido por 29 299 partos, en el Servicio de la Maternidad del Hospital General Universitario Vladimir Ilich Lenin, provincia Holguín, en el periodo comprendido de enero de 2010 a diciembre de 2013. La muestra fue 11 726 partos por cesárea. Se excluyeron los partos eutócico/instrumentado y las cesáreas que se realizaron antes de las 28 semanas con feto no viable.Resultados: la frecuencia de cesáreas predominó en el año 2013 con un total de 3 034 casos, a expensas de las cesáreas primitivas 2 148 (70,8%). La incidencia de cesárea mostró una tendencia lineal creciente con respecto al año 2010, debido al incremento de las cesáreas primitivas. La indicación principal de cesárea fue el sufrimiento fetal agudo con 3 009 casos (36,09%). La edad gestacional que predominó fue de 37-41 semanas con 72,30%. La morbilidad general materna fue de 4,65%, con predominio de gestantes con infecciones para el 54,95%.Conclusiones: la tasa de incidencia de cesárea mostró un aumento en el periodo de estudio, sin embargo, la morbilidad materna fue baja. El mayor número de cesáreas se realizó entre las 37 y 41 semanas de edad gestacional.(AU)

Introduction: the increasing cesarean section rates constitute a health problem to a worldwide scale. In Cuba, the institutional data coming from demographic and health surveys point out to a percentage of cesarean sections superior to 20%, since the beginnings of the XXI century. This tendency has been accentuated during the last years.Objective: to determine the incidence of cesarean sections in the Vladimir Ilich Lenin General Teaching Hospital of Holguín. Method: a descriptive, retrospective study whose universe was made up of 29 299 deliveries at the maternity service of Vladimir Ilich Lenin General Teaching Hospital was conducted from January to December 2013 aimed at determining the incidence of delivery through cesarean section (C-section). The sample comprised 11 726 deliveries by C-section. The eutocic /instrumental deliveries and the C-sections performed before the 28 weeks of gestation with nonviable fetuses were excluded from the sample.Results: the frequency of C-sections predominated in 2013 with a total of 3 034 cases, at the expense of 2148 primitive C-sections (70.8 %). The incidence of C-sections showed a linear growing trend comparing to 2010, due to the increase of primitive C-sections. The main indication for C-section was acute fetal distress with 3 009 cases (36.09%). The gestational age that predominated was 37-41. There was a greater number of pregnant women with infections accounting for 300 cases (54.95%).Conclusions: the rate of cesarean section incidence showed an increase in the period under study; however, maternal morbidity was low. The greater number of C-sections was performed between 37 and 41 weeks of gestational age.(AU)

Presentación de una paciente con mioma gigante del útero / Report of a Patient with Giant Uterine Myoma

Se presentó una paciente de 32 años de edad, de la raza negra, con historia obstétrica de dos abortos espontáneos en el primer trimestre del embarazo, nulípara, que acudió a la Consulta de Ginecología en enero de 2010 en el Hospital de Kabgayi, Rwanda, África, y refirió aumento de volumen del abdomen y además, constipación, tenesmo vesical y sangrados abundantes, que le causaban anemia severa. Después del interrogatorio y examen físico se encontró una tumoración gigante de la cavidad abdominal que ocupaba todo el hemiabdomen inferior y sobrepasaba la cicatriz umbilical que parecía ser un mioma uterino, diagnóstico que se corroboró posteriormente con la ultrasonografía abdominal. Se decidió tratamiento quirúrgico con histerectomía total, y se obtuvo una pieza correspondiente a un mioma uterino con un peso de 4,7 kg.

A 32- year- old patient of black race, with obstetrical history of two spontaneous abortions in the first trimester of pregnancy, nullipara, who was attended at Gynecology Service in January 2010, Kabgayi Hospital in Rwanda, Africa. The patient´s abdomen increased and the clinical manifestations were constipation, vesiacal tenesmus and profuse bleeding that caused severe anemia. After the patient’s interview application and the physical examination was done a giant tumor of the abdominal cavity was found that filled the lower abdomen and surpassed the umbilicus that clinically impressed: a uterine myoma that was later confirmed by abdominal ultrasonography. Surgical treatment was performed with total hysterectomy, and showed a giant tumor of 4.7 kg.

Presentación de una paciente con mioma gigante del útero / Report of a Patient with Giant Uterine Myoma

Se presentó una paciente de 32 años de edad, de la raza negra, con historia obstétrica de dos abortos espontáneos en el primer trimestre del embarazo, nulípara, que acudió a la Consulta de Ginecología en enero de 2010 en el Hospital de Kabgayi, Rwanda, África, y refirió aumento de volumen del abdomen y además, constipación, tenesmo vesical y sangrados abundantes, que le causaban anemia severa. Después del interrogatorio y examen físico se encontró una tumoración gigante de la cavidad abdominal que ocupaba todo el hemiabdomen inferior y sobrepasaba la cicatriz umbilical que parecía ser un mioma uterino, diagnóstico que se corroboró posteriormente con la ultrasonografía abdominal. Se decidió tratamiento quirúrgico con histerectomía total, y se obtuvo una pieza correspondiente a un mioma uterino con un peso de 4, 7 kg(AU)

A ,32, year old patient of black race, with obstetrical history of two spontaneous abortions in the first trimester of pregnancy , nullipara, who was attended at Gynecology Service in January ,2010, Kabgayi Hospital in Rwanda, Africa. The patient´s abdomen increased andthe clinical manifestations were constipation, vesiacal tenesmus and profuse bleeding that caused severe anemia. After the patients interview application and the physical examinationwas done a giant tumor of the abdominal cavity was found that filled the lower abdomen andsurpassed the umbilicus that clinically impressed: a uterine myoma that was later confirmed by abdominal ultrasonography. Surgical treatment was performed with total hysterectomy, and showed a giant tumor of ,4.7, kg(AU)

Caracterización de las farmacias comunitarias de Santa Clara para la implementación de la Dispensación de Medicamentos / Characterization of community pharmacies in Santa Clara city for the implementation of drug dispensing

Introducción: la inclusión del Servicio de Dispensación de Medicamentos en la Atención Farmacéutica, busca evidenciar la participación del farmacéutico en el logro de resultados positivos en los tratamientos, basado en los conocimientos farmacoterapéuticos y principios éticos que identifican esta profesión. La caracterización de las farmacias comunitarias resulta elemental para trazar acciones que permitan implementar dicho servicio. Objetivo: caracterizar las farmacias comunitarias de Santa Clara para la implementación del Servicio de Dispensación de Medicamentos. Métodos: se realizó una investigación en sistemas y servicios de salud con un enfoque sistémico (evaluación de la estructura, el proceso y los resultados). El estudio fue observacional, descriptivo y transversal. El contexto espacial lo constituyeron las farmacias comunitarias del municipio de Santa Clara, en el período comprendido entre enero y mayo de 2010. Se seleccionó el 30 por ciento del total de farmacias comunitarias del municipio de Santa Clara. Resultados: la disponibilidad de los recursos humanos fue limitada y no existieron suficientes recursos materiales para sustentar el servicio. El 95,2 por ciento de los farmacéuticos comunitarios presentaron altas necesidades de aprendizaje sobre Dispensación y no existieron Procedimientos Normalizados de Trabajo. A través de la observación directa se determinó que el servicio no se ejecutó, lo cual se corroboró con la encuesta realizada a los usuarios. Conclusiones: las farmacias comunitarias del municipio de Santa Clara se caracterizan por tener una estructura parcialmente adecuada y por ser el proceso y los resultados no adecuados para la ejecución del Servicio de Dispensación de Medicamentos.

Introduction: the drug dispensing service as part of the pharmaceutical care is aimed at showing the involvement of the pharmacist in attaining positive results of therapies, based on the pharmaco-therapeutic knowledge and the ethical principles of this profession. The characterization of community pharmacies is important to take actions to implement this service. Objectives: to characterize the community pharmacies of Santa Clara city for implementation of the drug dispensing service there. Methods: an observational, descriptive and cross-sectional research study was carried out in health systems and services with a systemic approach (assessment of structure, process and results). The universe of study was the community pharmacies of Santa Clara city, from January to May, 2010. Thirty percent of these pharmacies was selected. Results: limited availability of human resources in addition to lack of material resources to keep the service operating. Most of the pharmacists at community level (95.2 percent) presented learning requirements on dispensing and there were no standardized working methods. The direct observation allows determining that the service was inadequate, which was corroborated in a survey to users. Conclusions: the characterization of the community pharmacies in Santa Clara city yielded that their structure is not fully adequate; and neither the process nor the results are suitable for the implementation of the drug dispensing service.

Caracterización de las farmacias comunitarias de Santa Clara para la implementación de la Dispensación de Medicamentos / Characterization of community pharmacies in Santa Clara city for the implementation of drug dispensing

Introducción: la inclusión del Servicio de Dispensación de Medicamentos en la Atención Farmacéutica, busca evidenciar la participación del farmacéutico en el logro de resultados positivos en los tratamientos, basado en los conocimientos farmacoterapéuticos y principios éticos que identifican esta profesión. La caracterización de las farmacias comunitarias resulta elemental para trazar acciones que permitan implementar dicho servicio. Objetivo: caracterizar las farmacias comunitarias de Santa Clara para la implementación del Servicio de Dispensación de Medicamentos. Métodos: se realizó una investigación en sistemas y servicios de salud con un enfoque sistémico (evaluación de la estructura, el proceso y los resultados). El estudio fue observacional, descriptivo y transversal. El contexto espacial lo constituyeron las farmacias comunitarias del municipio de Santa Clara, en el período comprendido entre enero y mayo de 2010. Se seleccionó el 30 por ciento del total de farmacias comunitarias del municipio de Santa Clara. Resultados: la disponibilidad de los recursos humanos fue limitada y no existieron suficientes recursos materiales para sustentar el servicio. El 95,2 por ciento de los farmacéuticos comunitarios presentaron altas necesidades de aprendizaje sobre Dispensación y no existieron Procedimientos Normalizados de Trabajo. A través de la observación directa se determinó que el servicio no se ejecutó, lo cual se corroboró con la encuesta realizada a los usuarios. Conclusiones: las farmacias comunitarias del municipio de Santa Clara se caracterizan por tener una estructura parcialmente adecuada y por ser el proceso y los resultados no adecuados para la ejecución del Servicio de Dispensación de Medicamentos.(AU)

Introduction: the drug dispensing service as part of the pharmaceutical care is aimed at showing the involvement of the pharmacist in attaining positive results of therapies, based on the pharmaco-therapeutic knowledge and the ethical principles of this profession. The characterization of community pharmacies is important to take actions to implement this service. Objectives: to characterize the community pharmacies of Santa Clara city for implementation of the drug dispensing service there. Methods: an observational, descriptive and cross-sectional research study was carried out in health systems and services with a systemic approach (assessment of structure, process and results). The universe of study was the community pharmacies of Santa Clara city, from January to May, 2010. Thirty percent of these pharmacies was selected. Results: limited availability of human resources in addition to lack of material resources to keep the service operating. Most of the pharmacists at community level (95.2 percent) presented learning requirements on dispensing and there were no standardized working methods. The direct observation allows determining that the service was inadequate, which was corroborated in a survey to users. Conclusions: the characterization of the community pharmacies in Santa Clara city yielded that their structure is not fully adequate; and neither the process nor the results are suitable for the implementation of the drug dispensing service.(AU)

Respiración bucal en niños de 3-5 años: parroquia Catia la Mar Vargas, enero-junio de 2008 / Mouth breathing 3-to-5-years-old children: parrish Catia la Mar, Vargas, january-june 2008

La respiración normal involucra la utilización adecuada del tracto nasal y nasofaríngeo. Un aumento de volumen de las estructuras que se encuentran dentro de esos espacios, imposibilita el paso de aire por estos conductos, y el resultado será que el niño respire por la boca, trayendo serias alteraciones en el aparato estomatognático que afectan al niño de forma estética, funcional y psíquicamente. Se realizó un estudio descriptivo transversal, con el objetivo de caracterizar clínica y epidemiológicamente la respiración bucal en niños de 3 a 5 años en la parroquia Catia La Mar, de enero a junio de 2008. El universo estuvo constituido por 350 niños, y la muestra la conformaron 100 niños que practicaban el hábito de respirador bucal. El hábito de respirador bucal se observó en los niños de menor edad con mayor frecuencia en el sexo masculino. La respiración bucal patológica predominó sobre la respiración bucal por hábito en los varones. El asma bronquial y la bronquitis asmática predominaron en las edades de 3 y 5 años; el más afectado fue el sexo masculino, mientras que en las hembras predominó la rinitis alérgica en la edad de 5 años. Los pacientes con obstrucción de las vías respiratorias fueron respiradores bucales, y predominó la hipertrofia adenoidea y/o amigdalar y la hipertrofia de cornetes para las hembras y la desviación del tabique para los varones...(AU)

Normal breathing involves the adequate usage of the nasal and nasopharyngeal tract. The volume increase of the structures inside these spaces makes impossible air passing through these ducts, resulting in children breathing through the mouth, bringing about serious alterations of the stomatognathic apparatus, affecting the child in aesthetical, functional, and psychical way. We developed a transversal, descriptive study, with the objective of characterizing, in a clinical and epidemiological way, mouth breathing in children aged 3-5 years in the parrish Catia la Mar, from January to June 2008. The universe was formed by 350 children and the sample by 100 children having the habit of mouth breathing. The mouth breathing habit was observed in younger children, more frequently male. Pathological mouth breathing prevailed over mouth breathing per habit in male children. Bronchial asthma and asthmatic bronchitis were predominant in ages between 3 and 5 years, the most affected genre was the male one, while among females acute rhinitis prevailed at the age of 5. The patients with obstructions in the respiratory ways were mouth breathers and there was a predominance of adenoidal and/or tonsillar hypertrophy, and turbinal hypertrophy for girls and septum deviation for boys...(AU)