Utility of Remote Monitoring in Patients on Automated Peritoneal Dialysis

ABSTRACT Home hemodialysis (HD) and automated peritoneal dialysis (APD) have advantages over HD in hospitals or HD centers. Home therapies are generally less expensive and give patients greater mobility and freedom for work, school, family, and recreational activities. Technological advances have made it possible to complement APD with devices for remote monitoring (RM) of the patient. With them, objective information generated in the APD device is collected and sent to repositories "in the cloud" for analysis or at the time decided by the health team. With APD+RM, it is possible to monitor therapeutic compliance, effective dialysis time, ultrafiltration volumes, inflow and outflow patterns of dialysis fluid, and patient actions to respond to alarms that indicate deviations from the parameters set by the nephrologist. The results of APD+RM show good acceptance by the patient, nephrologists, and nurses, treatment adherence has improved, hospitalizations and technique failure have decreased, and some aspects of quality of life have improved. However, there is a lack of controlled clinical trials that reliably demonstrate lower mortality and comorbidity due to specific causes.

Utility of remote monitoring in patients on automated peritoneal dialysis.

Home hemodialysis (HD) and automated peritoneal dialysis (APD) have advantages over HD in hospitals or HD centers. Home therapies are generally less expensive and give patients greater mobility and freedom for work, school, family, and recreational activities. Technological advances have made it possible to complement APD with devices for remote monitoring (RM) of the patient. With them, objective information generated in the APD device is collected and sent to repositories "in the cloud" for analysis or at the time decided by the health team. With APD+RM, it is possible to monitor therapeutic compliance, effective dialysis time, ultrafiltration volumes, inflow and outflow patterns of dialysis fluid, and patient actions to respond to alarms that indicate deviations from the parameters set by the nephrologist. The results of APD+RM show good acceptance by the patient, nephrologists, and nurses, treatment adherence has improved, hospitalizations and technique failure have decreased, and some aspects of quality of life have improved. However, there is a lack of controlled clinical trials that reliably demonstrate lower mortality and comorbidity due to specific causes.

La pedagogía de la inclusión aplicada a la clase de Educación Física / The pedagogy of inclusion applied to the Physical Education class

La pedagogía de la inclusión persigue formar personas desde la perspectiva de su individualidad, teniendo en cuenta su interacción social. Para la escuela cubana es un reto porque requiere cambios en la forma de interactuar, investigar y ofrece oportunidades de aprendizaje considerando la diversidad de necesidades y las diferencias de contextos, como alternativa más viable para proporcionar una respuesta educativa individualizada, comprensiva y diversificada. La Educación Física es una de las materias del currículo que tiene una alta responsabilidad de educar desde la diversidad, pero para ello los docentes deben capacitarse en las exigencias educativas a satisfacer. Los autores proponen algunas acciones metodológicas ya aplicadas a fin de que constituyan experiencias compartidas entre los docentes de la especialidad en sus clases.

The pedagogy of inclusion seeks to train people from the perspective of their individuality, taking into account their social interaction. For the Cuban school it is a challenge because it requires changes in the way of interacting, investigating and offering learning opportunities considering the diversity of needs and the differences in contexts, as a more viable alternative to provide an individualized, comprehensive and diversified educational response. Physical Education is one of the subjects in the curriculum that has a high responsibility to educate from diversity, but for this, teachers must be trained in the educational demands to be met. The authors propose some methodological actions already applied so that they constitute shared experiences among the teachers of the specialty in their classes.

Peritoneal dialysis modality transition and impact on phosphate and potassium serum levels.

Peritoneal dialysis (PD) modalities affect solute removal differently. However, the impacts of switching PD modalities on serum levels of biomarkers of different sizes are not known. Our objective was to analyze whether a change in the PD modality associates with the levels of two routine biochemical laboratories. In this multicentric prospective cohort study. we selected all patients who remained on a PD modality for at least 6 months and switched PD modality. Patients were also required to be treated with the same PD modality for at least 3 months before and after the modality change. The primary outcome was change in potassium and phosphate serum levels. We identified 737 eligible patients who switched their PD modality during the study. We found mean serum phosphate levels increased during the 3 months after switching from CAPD to APD and conversely decreased after switching to from APD to CAPD. In contrast, for potassium the difference in the mean serum levels was comparable between groups switching from CAPD to APD, and vice versa. In conclusion, CAPD seems to be as efficient as APD for the control of potassium serum levels, but more effective for the control of phosphate serum levels. The effect of a higher removal of middle size molecules as result of PD modalities in terms of clinical and patient-reported outcomes should be further explored.

New obstetric systemic inflammatory response syndrome criteria for early identification of high-risk of sepsis in obstetric patients.

OBJECTIVES: We aimed to establish new cut-off values for SIRS (Systemic Inflammatory Response Syndrome) variables in the obstetric population. METHODS: A prospective cohort study in pregnant and postpartum women admitted with systemic infections between December 2017 and January 2019. Patients were divided into three cohorts: Group A, patients with infection but without severe maternal outcomes (SMO); Group B, patients with infection and SMO or admission to the intensive care unit (ICU); and Group C, a control group. Outcome measures were ICU admission and SMO. The relationship between SIRS criteria and SMO was expressed as the area under the receiver operating characteristics curve (AUROC), selecting the best cut-off for each SIRS criterion. RESULTS: A total of 541 obstetric patients were enrolled, including 341 with infections and 200 enrolled as the reference group (Group C). The patients with infections included 313 (91.7%) in Group A and 28 (8.2%) in Group B. There were significant differences for all SIRS variables in Group B, compared with Groups A and C, but there were no significant differences between Groups A and C. The best cut-off values were the following: temperature 38.2 °C, OR 4.1 (1.8-9.0); heart rate 120 bpm, OR 2.9 (1.2-7.4); respiratory rate 22 bpm, OR 4.1 (1.6-10.1); and leukocyte count 16,100 per mcl, OR 3.5 (1.6-7.6). CONCLUSIONS: The cut-off values for SIRS variables did not differ between healthy and infected obstetric patients. However, a higher cut-off may help predict the population with a higher risk of severe maternal outcomes.

La evaluación de riesgos en la prevención de enfermedades profesionales, incidentes y accidentes laborales en el cultivo intensivo de tilapia / The evaluation of risks in the disease prevention professional, incidental and occupational accidents in the intensive farming of tilapia

RESUMEN Introducción: el cuidado y preservación de la salud en los trabajadores es un factor clave para el incremento de la productividad, la sostenibilidad del trabajo realizado y el bienestar de todos sus empleados. El cultivo intensivo de la tilapia en Cuba es un proceso clave en la producción de alimentos saludables. Sin embargo, en esta actividad existen un conjunto de factores de riesgo que pueden provocar incidentes/accidentes laborales en las diferentes fases de su cultivo y que además pueden provocar enfermedades profesionales o comunes en los trabajadores involucrados. Objetivo: evaluar los factores de riesgos presentes en la actividad de cultivo intensivo de tilapia, desarrollada en una empresa pesquera. Materiales y métodos: e stán referidos a los tipos de investigación utilizados: exploratorios, descriptivos y explicativos. En cuanto a los métodos empíricos aplicados se incluyen la revisión bibliográfica, el método científico inductivo-deductivo y el análisis y la síntesis. Además de las herramientas propias del campo de investigación implicado (herramienta mapa del cuerpo y método binario de evaluación de riesgo). Resultados: s e identifican y evalúan los riesgos para la seguridad y salud de los trabajadores que laboran en el cultivo intensivo de la tilapia. Además, se identifican las principales dolencias en el cuerpo por la incidencia de las condiciones de trabajo y las tareas a desarrollar, considerando tres momentos: inicio, mediado y final de la jornada laboral. Se proponen las acciones preventivas a considerar para evitar problemas de salud, incidentes o accidentes laborales en función de las evaluaciones realizadas. Conclusiones: se destaca que el procedimiento utilizado y los resultados obtenidos constituyen una guía útil para las diferentes organizaciones que deseen conocer la incidencia que tienen los factores de riesgo encontrados en la salud de sus trabajadores, proponiendo un conjunto de medidas preventivas y correctivas para atenuar las situaciones desfavorables (AU).

ABSTRACT Introduction: care and preservation of the health in the workers is a key factor for the productivity improvement, the sustainability of the realized work and the well-being of all its employees. The intensive farming of the Tilapia in Cuba is a key process in the production of wholesome foods. However; In this activity there are a set of risk factors that incidents can provoke occupational accidents in the different phases of their cultivation and that besides they can provoke professional or common diseases in the implicated workers. Objective: evaluating the factors of present risks in the activity of intensive farming of Tilapia, developed in a fishing company. Materials and methods: they are referred to the types of investigation used: Exploratory, descriptive and explanatory. As to the empiric applied methods they include the bibliographic revision, the inductive deductive scientific method and the analysis and the synthesis. In addition to the own tools of the implicated line of research (tool map of the body and binary method of risk assessment). Results: they provide evidence of their identity and they evaluate security risks and health of the workers that labor in the intensive farming of the tilapia. Furthermore, provide evidence of their identity the main illnesses in the body for the incidence of the working conditions and the tasks to develop, considering three moments: Start, mediated and final of the workday. Actions for provisional remedy intend to consider to avoid health problems, incidents or occupational accidents in terms of the realized evaluations. Conclusions: he stands out that the used procedure and the obtained results constitute an useful guideline for the different organizations that they desire knowing the incidence that have the risk factors found in the health of their workers, proposing a set of measures preventive and corrective to attenuate the unfavorable situations (AU).

La evaluación de riesgos en la prevención de enfermedades profesionales, incidentes y accidentes laborales en el cultivo intensivo de tilapia / The evaluation of risks in the disease prevention professional, incidental and occupational accidents in the intensive farming of tilapia

RESUMEN Introducción: el cuidado y preservación de la salud en los trabajadores es un factor clave para el incremento de la productividad, la sostenibilidad del trabajo realizado y el bienestar de todos sus empleados. El cultivo intensivo de la tilapia en Cuba es un proceso clave en la producción de alimentos saludables. Sin embargo, en esta actividad existen un conjunto de factores de riesgo que pueden provocar incidentes/accidentes laborales en las diferentes fases de su cultivo y que además pueden provocar enfermedades profesionales o comunes en los trabajadores involucrados. Objetivo: evaluar los factores de riesgos presentes en la actividad de cultivo intensivo de tilapia, desarrollada en una empresa pesquera. Materiales y métodos: e stán referidos a los tipos de investigación utilizados: exploratorios, descriptivos y explicativos. En cuanto a los métodos empíricos aplicados se incluyen la revisión bibliográfica, el método científico inductivo-deductivo y el análisis y la síntesis. Además de las herramientas propias del campo de investigación implicado (herramienta mapa del cuerpo y método binario de evaluación de riesgo). Resultados: s e identifican y evalúan los riesgos para la seguridad y salud de los trabajadores que laboran en el cultivo intensivo de la tilapia. Además, se identifican las principales dolencias en el cuerpo por la incidencia de las condiciones de trabajo y las tareas a desarrollar, considerando tres momentos: inicio, mediado y final de la jornada laboral. Se proponen las acciones preventivas a considerar para evitar problemas de salud, incidentes o accidentes laborales en función de las evaluaciones realizadas. Conclusiones: se destaca que el procedimiento utilizado y los resultados obtenidos constituyen una guía útil para las diferentes organizaciones que deseen conocer la incidencia que tienen los factores de riesgo encontrados en la salud de sus trabajadores, proponiendo un conjunto de medidas preventivas y correctivas para atenuar las situaciones desfavorables (AU).

ABSTRACT Introduction: care and preservation of the health in the workers is a key factor for the productivity improvement, the sustainability of the realized work and the well-being of all its employees. The intensive farming of the Tilapia in Cuba is a key process in the production of wholesome foods. However; In this activity there are a set of risk factors that incidents can provoke occupational accidents in the different phases of their cultivation and that besides they can provoke professional or common diseases in the implicated workers. Objective: evaluating the factors of present risks in the activity of intensive farming of Tilapia, developed in a fishing company. Materials and methods: they are referred to the types of investigation used: Exploratory, descriptive and explanatory. As to the empiric applied methods they include the bibliographic revision, the inductive deductive scientific method and the analysis and the synthesis. In addition to the own tools of the implicated line of research (tool map of the body and binary method of risk assessment). Results: they provide evidence of their identity and they evaluate security risks and health of the workers that labor in the intensive farming of the tilapia. Furthermore, provide evidence of their identity the main illnesses in the body for the incidence of the working conditions and the tasks to develop, considering three moments: Start, mediated and final of the workday. Actions for provisional remedy intend to consider to avoid health problems, incidents or occupational accidents in terms of the realized evaluations. Conclusions: he stands out that the used procedure and the obtained results constitute an useful guideline for the different organizations that they desire knowing the incidence that have the risk factors found in the health of their workers, proposing a set of measures preventive and corrective to attenuate the unfavorable situations (AU).

Incidencia de la insatisfacción laboral en la eficiencia de la gestión. Caso Clínica Estomatológica / Incidence of the occupational dissatisfaction in the efficiency of management. Case Dental Clinic

Introducción: la calidad en la gestión de los servicios asistenciales, es una exigencia que produce beneficios tanto para la población como para las instituciones de salud, máxime en Cuba, donde "Los servicios de salud son gratuitos, pero cuestan". Los costos de calidad son indicadores de eficiencia, particularmente en las partidas asociadas a fallos que evalúan los recursos malgastados por una deficiente gestión y sobre lo cual deberán enfocarse las acciones para la mejora. Objetivo: identificar los costos por fallos, en estrecha relación con el análisis de sus causas y la satisfacción de los trabajadores. Materiales y métodos: se realizó un estudio descriptivo. La metódica radicó en la investigación de campo en base a encuestas aplicadas a los trabajadores, revisión de documentos, evaluación de partidas de costos por extensión del sistema contable o estimación, según el caso, así como el análisis causal desarrollado por un grupo de expertos de la organización, con representación de las diferentes áreas de la clínica objeto de estudio. Resultados: se evalúan monetariamente fallos incurridos durante el año 2014, ascendiendo a $ 12260,49, los mayores montos estuvieron asociados a reelaboraciones y desperdicios. El análisis causal mostró una fuerte incidencia de los trabajadores en la ocurrencia de dichas ineficiencias, predominando las negligencias. La insatisfacción de los trabajadores, fue de una media general de 2,94 (por debajo de 3), lo que se puede interpretar como que estos reciben menos de lo que esperan, esencialmente, en cuanto a salario, condiciones laborales y participación en la toma de decisiones. Conclusiones: se establecen los montos de los costos asociados a fallos en la gestión de los servicios de la Clínica Estomatológica III Congreso del PCC, en línea con el análisis de la satisfacción de los trabajadores como elemento causal fundamental que incide en la calidad de los servicios en dicha organización, la cual debe establecer plan de mejoras en su gestión (AU).

Introduction: the quality of management in health care services is an exigency producing benefits both for the population and for health institutions, especially in Cuba, where "health services are free, but they cost." The quality costs are indicators of efficiency, particularly in the items associated to failures assessing resources misspent for a deficient management, and on which the actions should be focused for getting improvement. Objective: to identify the costs by failures, in tight relation with the analysis of their causes and workers´ satisfaction. Materials and methods: a descriptive study was carried out. Methodologically, it was a field research on the bases of surveys applied to workers, documental reviewing, and evaluation of cost items by extension of the accounting system or estimation, according to the case, and also the causal analyses performed by an expert group of the organization, with representatives of the different areas of the clinic being studied. Results: the failures that occurred during 2014 are monetarily evaluated, coming to $ 12 260.49. The highest amounts were associated to re-elaborations and wastes. The causal analysis showed a strong incidence of the workers in the occurrence of those inefficiencies, predominating negligence. The workers´ dissatisfaction was in general average 2.94 (under 3), what may be interpreted like if they receive less than they expect, essentially as for salary, working conditions and participation in decision-making. Conclusions: the amount of the cost associated to failures in the management of the services in the Dental Clinic "III Congreso del PCC" is established, aligned with the analysis of the workers´ satisfaction as main causal element striking in the quality of the services in that institution; they should elaborate and carried out a plan for the improvement of their management (AU).

Incidencia de la insatisfacción laboral en la eficiencia de la gestión. Caso Clínica Estomatológica / Incidence of the occupational dissatisfaction in the efficiency of management. Case Dental Clinic

Introducción: la calidad en la gestión de los servicios asistenciales, es una exigencia que produce beneficios tanto para la población como para las instituciones de salud, máxime en Cuba, donde "Los servicios de salud son gratuitos, pero cuestan". Los costos de calidad son indicadores de eficiencia, particularmente en las partidas asociadas a fallos que evalúan los recursos malgastados por una deficiente gestión y sobre lo cual deberán enfocarse las acciones para la mejora. Objetivo: identificar los costos por fallos, en estrecha relación con el análisis de sus causas y la satisfacción de los trabajadores. Materiales y métodos: se realizó un estudio descriptivo. La metódica radicó en la investigación de campo en base a encuestas aplicadas a los trabajadores, revisión de documentos, evaluación de partidas de costos por extensión del sistema contable o estimación, según el caso, así como el análisis causal desarrollado por un grupo de expertos de la organización, con representación de las diferentes áreas de la clínica objeto de estudio. Resultados: se evalúan monetariamente fallos incurridos durante el año 2014, ascendiendo a $ 12260,49, los mayores montos estuvieron asociados a reelaboraciones y desperdicios. El análisis causal mostró una fuerte incidencia de los trabajadores en la ocurrencia de dichas ineficiencias, predominando las negligencias. La insatisfacción de los trabajadores, fue de una media general de 2,94 (por debajo de 3), lo que se puede interpretar como que estos reciben menos de lo que esperan, esencialmente, en cuanto a salario, condiciones laborales y participación en la toma de decisiones. Conclusiones: se establecen los montos de los costos asociados a fallos en la gestión de los servicios de la Clínica Estomatológica III Congreso del PCC, en línea con el análisis de la satisfacción de los trabajadores como elemento causal fundamental que incide en la calidad de los servicios en dicha organización, la cual debe establecer plan de mejoras en su gestión (AU).

Introduction: the quality of management in health care services is an exigency producing benefits both for the population and for health institutions, especially in Cuba, where "health services are free, but they cost." The quality costs are indicators of efficiency, particularly in the items associated to failures assessing resources misspent for a deficient management, and on which the actions should be focused for getting improvement. Objective: to identify the costs by failures, in tight relation with the analysis of their causes and workers´ satisfaction. Materials and methods: a descriptive study was carried out. Methodologically, it was a field research on the bases of surveys applied to workers, documental reviewing, and evaluation of cost items by extension of the accounting system or estimation, according to the case, and also the causal analyses performed by an expert group of the organization, with representatives of the different areas of the clinic being studied. Results: the failures that occurred during 2014 are monetarily evaluated, coming to $ 12 260.49. The highest amounts were associated to re-elaborations and wastes. The causal analysis showed a strong incidence of the workers in the occurrence of those inefficiencies, predominating negligence. The workers´ dissatisfaction was in general average 2.94 (under 3), what may be interpreted like if they receive less than they expect, essentially as for salary, working conditions and participation in decision-making. Conclusions: the amount of the cost associated to failures in the management of the services in the Dental Clinic "III Congreso del PCC" is established, aligned with the analysis of the workers´ satisfaction as main causal element striking in the quality of the services in that institution; they should elaborate and carried out a plan for the improvement of their management (AU).

Paciente con tumor de cuerpo carotideo / Patient with carotid body tumor

Los tumores de cuerpo carotideo (paragangliomas) son neoplasias altamente vascularizadas, muy poco frecuentes y generalmente benignas, originadas en los quimiorreceptores del cuerpo carotideo. Se presenta el caso de un paciente de 54 años, con aumento de volumen cervical derecho, asintomático, con estudio preoperatorio y angiografía realizados por tomografía axial computarizada, que resultan compatibles con tumor de cuerpo carotideo. Se realiza disección subadventicial, informando la biopsia paraganglioma. El tumor fue completamente resecado, sin evidencia de recurrencia y sin complicaciones(AU)

Carotid body tumors (paragangliomas) are highly vascularized, infrequent and generally benign neoplasms that emerge in the carotid body chemoreceptors. This is a male patient aged 54 years with increased right cervical volume, preoperative study and angiography by computerized tomography; the result was carotid body tumor. Subadventitial dissection was made for biopsy which yielded the diagnosis of paraganglioma. The tumor was completely excised, with no evidence of recurrence or complication(AU)

Paciente con tumor de cuerpo carotideo / Patient with carotid body tumor

Los tumores de cuerpo carotideo (paragangliomas) son neoplasias altamente vascularizadas, muy poco frecuentes y generalmente benignas, originadas en los quimiorreceptores del cuerpo carotideo. Se presenta el caso de un paciente de 54 años, con aumento de volumen cervical derecho, asintomático, con estudio preoperatorio y angiografía realizados por tomografía axial computarizada, que resultan compatibles con tumor de cuerpo carotideo. Se realiza disección subadventicial, informando la biopsia paraganglioma. El tumor fue completamente resecado, sin evidencia de recurrencia y sin complicaciones(AU)

Carotid body tumors (paragangliomas) are highly vascularized, infrequent and generally benign neoplasms that emerge in the carotid body chemoreceptors. This is a male patient aged 54 years with increased right cervical volume, preoperative study and angiography by computerized tomography; the result was carotid body tumor. Subadventitial dissection was made for biopsy which yielded the diagnosis of paraganglioma. The tumor was completely excised, with no evidence of recurrence or complication(AU)

Tumor de Krukenberg secundario a carcinoma de colon durante el embarazo / Krukenberg tumor secondary to carcinoma of the colon during pregnancy

El tumor de Krukenberg (TK) es un tumor metastásico en el ovario, y el carcinoma primario más frecuente es el de origen gástrico. Su incidencia es muy baja en la población general, y excepcional su asociación al embarazo. Se presenta el caso de una paciente de 17 años con diagnóstico de tumor de Krukenberg en las 20 semanas de gestación, como tumor primario se encontró un adenocarcinoma de colon(AU)

Krukenberg tumor (KT) is a metastatic tumor in the ovary, and the most common primary carcinoma is the gastric origin. Its incidence is very low in general population, and its association with pregnancy is exceptional. A 17 year-old patient is presented here with diagnosis of Krukenbergen tumor at the 20th weeks of gestation, as primary tumor a colon adenocarcinoma was found(AU)

Tumor de Krukenberg secundario a carcinoma de colon durante el embarazo / Krukenberg tumor secondary to carcinoma of the colon during pregnancy

El tumor de Krukenberg (TK) es un tumor metastásico en el ovario, y el carcinoma primario más frecuente es el de origen gástrico. Su incidencia es muy baja en la población general, y excepcional su asociación al embarazo. Se presenta el caso de una paciente de 17 años con diagnóstico de tumor de Krukenberg en las 20 semanas de gestación, como tumor primario se encontró un adenocarcinoma de colon.

Krukenberg tumor (KT) is a metastatic tumor in the ovary, and the most common primary carcinoma is the gastric origin. Its incidence is very low in general population, and its association with pregnancy is exceptional. A 17 year-old patient is presented here with diagnosis of Krukenbergen tumor at the 20th weeks of gestation, as primary tumor a colon adenocarcinoma was found.

Sarcoma del estroma endometrial de grado alto / High degree endometrial stromal sarcoma

El sarcoma del estroma endometrial es un tumor infrecuente, que comprende menos del 1 por ciento de los tumores malignos ginecológicos. Presentamos el caso de una adolescente de 16 años con hemorragia uterina anormal a la que se le realizó histerectomía subtotal. Microscópicamente, la neoplasia estaba constituida por una proliferación maligna de células estromales del endometrio. El estudio inmuno-histoquímico mostró positividad para vimentina, desmina, CD10, CD117.El CD10 es un marcador inmuno-histoquímico del estroma endometrial normal y de los tumores del estroma endometrial, y es útil para el diagnóstico diferencial entre el sarcoma del estroma endometrial y el leiomioma celular o el leiomiosarcoma uterino. Las mejores opciones de tratamiento se obtienen con un enfoque multidisciplinario y en centros especializados(AU)

Endometrial stromal sarcoma is a rare tumor comprising less than 1 percent of gynecological malignancies. We report the case of a 16 year-old adolescent with abnormal uterine bleeding who underwent hysterectomy subtotal. At microscopy the neoplasm was composed of malignant proliferation of endometrial stromal cells. Immunohistochemical studies were positive for vimentin, desmin, CD10 and CD117. CD10 is an immunohistochemical marker of normal endometrial stroma and of endometrial stromal neoplasms. This marker is useful in the differential diagnosis of endometrial stromal sarcoma versus uterine cellular leiomyoma or uterine leiomyosarcoma. The best treatment options are obtained with a focus multidisciplinary, in specialized centers(AU)

Sarcoma del estroma endometrial de grado alto / High degree endometrial stromal sarcoma

El sarcoma del estroma endometrial es un tumor infrecuente, que comprende menos del 1 % de los tumores malignos ginecológicos. Presentamos el caso de una adolescente de 16 años con hemorragia uterina anormal a la que se le realizó histerectomía subtotal. Microscópicamente, la neoplasia estaba constituida por una proliferación maligna de células estromales del endometrio. El estudio inmuno-histoquímico mostró positividad para vimentina, desmina, CD10, CD117. El CD10 es un marcador inmuno-histoquímico del estroma endometrial normal y de los tumores del estroma endometrial, y es útil para el diagnóstico diferencial entre el sarcoma del estroma endometrial y el leiomioma celular o el leiomiosarcoma uterino. Las mejores opciones de tratamiento se obtienen con un enfoque multidisciplinario y en centros especializados.

Endometrial stromal sarcoma is a rare tumor comprising less than 1 % of gynecological malignancies. We report the case of a 16 year-old adolescent with abnormal uterine bleeding who underwent hysterectomy subtotal. At microscopy the neoplasm was composed of malignant proliferation of endometrial stromal cells. Immunohistochemical studies were positive for vimentin, desmin, CD10 and CD117. CD10 is an immunohistochemical marker of normal endometrial stroma and of endometrial stromal neoplasms. This marker is useful in the differential diagnosis of endometrial stromal sarcoma versus uterine cellular leiomyoma or uterine leiomyosarcoma. The best treatment options are obtained with a focus multidisciplinary, in specialized centers.

Eficiente administración sanitaria? Caso clínica estomatológica / Efficient sanitary administration? The Stomatologic Clinic Case

La administración en las instituciones de salud es un tema importante para el logro de la satisfacción de los pacientes y familiares, a la par de la correcta utilización de los recursos disponibles. El sistema de salud en Cuba es presupuestado, y por ello, una gestión eficiente es vital para distribuir los recursos en función de los mejores resultados. Un importante indicador a considerar en este tema lo constituyen los costos de calidad. Dentro del sistema nacional de salud, las clínicas estomatológicas son organizaciones donde resulta muy novedoso el tema de mejoramiento continuo de su gestión a partir de los costos de calidad. En el presente trabajo se realizó una evaluación de los costos de calidad en la Clínica Estomatológica Docente III Congreso del PCC, lo cual constituyó la base del programa de mejoras. El costo total de calidad fue de 22 394.15 pesos en el año 2011, siendo el 62,69 por ciento por fallos relacionados esencialmente a reelaboraciones, desperdicios, paralización parcial por poco instrumental, entre otras causas que fueron la base del programa de mejora.

The administration of health care institutions is an important theme for achieving the patients and relatives satisfaction, and the right usage of the available resources at the same time. Health Care System in Cuba is budgeted and for that, an efficient management is vital in distributing the resources for better results. Quality costs are an important indicator to consider in this theme. Inside the national Health Care System, stomatologic clinics are organizations where it is fashionable the theme of the continuous management improvement on the basis of the quality costs. In the current work we carried out an evaluation of the quality costs at the Teaching Stomatologic Clinic III Congreso del Partido, took as the basis of the improvement program. The total quality cost was 22 394.15 pesos in 2011. 62,69 percent was caused by mistakes essentially related with re-elaboration, wastes, partial paralyzing because of few instrumental, among other causes that were the base of the improvement program.

Análisis de riesgos de la calidad en un cambio de campaña. Etapa de limpieza / Quality risk analysis in a changeover. Stage of cleaning

Objetivo: identificar los riesgos generales en la etapa de limpieza de los cambios de campaña de una planta multipropósito para productos biológicos, así como proponer acciones de control para mitigarlos, garantizando enfocar la atención sobre los riesgos no aceptados identificados y sus escenarios.Métodos: se aplicó el análisis de riesgos de calidad, usando la herramienta análisis de modo y efectos de fallas, lo cual permitió la identificación de los riesgos asociados a la contaminación y sus escenarios, así como accionar de forma proactiva teniendo en cuenta los resultados del cálculo del número de prioridad de riesgo. Resultados: se demostró que los residuos de producto e higienizante comprometen la etapa de limpieza. Se propusieron acciones que deben ser documentadas en los procedimientos de limpieza de los equipos no dedicados. Conclusiones: se identificaron los riesgos generales y sus escenarios. Las acciones de control de riesgos implementadas mitigaron a más del 50 por ciento del número de prioridad de riesgo total para garantizar la efectividad de la operación de cambio de campaña como parte del cumplimiento de las Buenas Prácticas de Fabricación(AU)

Objective: to identify the general risks in the cleaning phase during changeover in a multiproduct plant for biological products and to put forward control actions to reduce them, guaranteeing to focus attention on the unacceptable identified risks and their scenarios. Methods: aquality risk analysis using the tool called Failure Mode and Effect Analysis was made, which allowed identifying pollution-associated risks and their settings, and working proactively according to the results of the risk priority number estimation. Results: it was proven that the product and the cleaning agent residues may compromise the cleaning phase. Several actions that should be documented in the cleaning procedures of non-dedicated equipment were then suggested. Conclusions: the general risks as well as their settings were identified. The implemented risk management actions reduced total risk priority number values by over 50 percent in order to assure the effectiveness of the changeover operation as part of the compliant requirements for Good Manufacturing Practices(AU)

Análisis de riesgos de la calidad en un cambio de campaña. Etapa de limpieza / Quality risk analysis in a changeover. Stage of cleaning

Objetivo: identificar los riesgos generales en la etapa de limpieza de los cambios de campaña de una planta multipropósito para productos biológicos, así como proponer acciones de control para mitigarlos, garantizando enfocar la atención sobre los riesgos no aceptados identificados y sus escenarios.Métodos: se aplicó el análisis de riesgos de calidad, usando la herramienta análisis de modo y efectos de fallas, lo cual permitió la identificación de los riesgos asociados a la contaminación y sus escenarios, así como accionar de forma proactiva teniendo en cuenta los resultados del cálculo del número de prioridad de riesgo. Resultados: se demostró que los residuos de producto e higienizante comprometen la etapa de limpieza. Se propusieron acciones que deben ser documentadas en los procedimientos de limpieza de los equipos no dedicados. Conclusiones: se identificaron los riesgos generales y sus escenarios. Las acciones de control de riesgos implementadas mitigaron a más del 50 por ciento del número de prioridad de riesgo total para garantizar la efectividad de la operación de cambio de campaña como parte del cumplimiento de las Buenas Prácticas de Fabricación

Objective: to identify the general risks in the cleaning phase during changeover in a multiproduct plant for biological products and to put forward control actions to reduce them, guaranteeing to focus attention on the unacceptable identified risks and their scenarios. Methods: aquality risk analysis using the tool called Failure Mode and Effect Analysis was made, which allowed identifying pollution-associated risks and their settings, and working proactively according to the results of the risk priority number estimation. Results: it was proven that the product and the cleaning agent residues may compromise the cleaning phase. Several actions that should be documented in the cleaning procedures of non-dedicated equipment were then suggested. Conclusions: the general risks as well as their settings were identified. The implemented risk management actions reduced total risk priority number values by over 50 percent in order to assure the effectiveness of the changeover operation as part of the compliant requirements for Good Manufacturing Practices

Economic Burden of Incident Unplanned Starts on Peritoneal Dialysis in a High Specialty Health Care Facility in Mexico City.

OBJECTIVES: Few studies have examined hospitalization costs for unplanned initiation of peritoneal dialysis (PD). We used data from a health care facility in Mexico to examine first hospitalization costs associated with the unplanned initiation of PD. METHODS: Descriptive analyses focusing on initial hospitalization costs during the unplanned initiation of PD were conducted. In addition, multivariate regression models examined the association of costs with requiring urgent hemodialysis (HD) at the time of starting PD, and the association of driving distance with requiring urgent HD. RESULTS: Of 195 patients hospitalized in 2010 for PD catheter placement, 51 patients met criteria for unplanned PD initiation and 25 of them required urgent HD prior to PD initiation. Ninety-two percent of the patients received 90% or greater government subsidy of hospital costs. Average inpatient costs for the first hospitalization related to the unplanned initiation of PD were 64,174 Mexican Pesos (MXN) (US $4,657). Costs were 78,683 MXN ($5,710) per patient for those requiring urgent HD and 50,225 MXN ($3,645) for those who did not, a difference (P<0.05) of roughly 28,000 MXN ($2,032), and regression results were similar. In addition, long driving distance to the institution was significantly associated with requiring urgent HD. CONCLUSIONS: Our findings highlight potential cost savings to payers for developing better strategies to manage PD starts in Mexico and should help inform policy regarding oversight and coverage of low-income patients at risk of dialysis.

Razones para vivir en personas que se encuentran en situación de desplazamiento forzado / Reasons to live in persons who are in forcibly displaced

Este trabajo tiene como objetivo identificar las razones por las cuales algunas personas desplazadas prefieren vivir y afirman su existencia. Para ello se hizo un estudio cuantitativo descriptivo, con un diseño descriptivo transversal con una muestra de tipo intencionado de 100 personas entre los 18 y los 81 años en condición de desplazamiento forzado. Para recolectar la información se utilizó el Inventario de razones para vivir (I.R.V.) (Linehan, Goodstein, Nielsen & Chiles, 1983; Bascarán, Bobes, Bousoño, Portilla & Sáiz, 2006). Los resultados indican que las habilidades de afrontamiento (55%), la responsabilidad con la familia (16%) y el miedo al suicidio (10%) protegen las personas de cometer actos suicidas, incluso en condiciones de estrés elevado.

This work aims to identify the reasons for living in displaced persons through a descriptive quantitative research. It uses a cross-sectional design with a sample of 100 persons which ages were between 18 and 81 years. They all were in forced displacement conditions. To collect the information it was used Cuestionario de razones para vivir (reasons for living inventory) (Linehan, Goodstein, Nielsen & Chiles, 1983; Bascarán, Bobes, Bousoño, Portilla & Sáiz, 2006). Results show that coping skills (55%), responsibility with family (16%), and the fear to suicide (10%) protect people from suicide acts; even in high stress situations.