ACCIONES PARA DESARROLLAR LA INTERDISCIPLINARIEDAD DESDELA ASIGNATURA ANATOMÍA PATOLÓGICA

RESUMEN:El artículo es el resultado de una investigación efectuada con el objetivo de realizar una propuesta de acciones para contribuir al enfoque interdisciplinario en el proceso docente educativo de la asignatura Anatomía Patológica. La población estuvo conformada por el claustro de profesores de esta asignatura de la Universidad de Ciencias Médicas de Sancti Spíritus y un total de 217 estudiantes del segundo año de la carrera de Medicina, con una muestra intencional de 27 de estudiantes. Se aplicaron encuestas a docentes y estudiantes, se analizaron documentos y se propusieron varias acciones que fueron evaluadas por el comité de expertos las que fueron validadas.[AU]

BIOPSIA ASPIRATIVA CON AGUJA FINA Y SU CORRELACIÓN CON LAHISTOLOGÍA EN LAS PATOLOGÍAS TIROIDEAS

Introducción: La biopsia aspirativa con aguja fina (BAF) del tiroides es sugerida en la actualidad para la valoración inicial del nódulo tiroideo y de otras afecciones de la glándula tiroides. Objetivo: Determinar la efectividad de la biopsia aspirativa con aguja fina al relacionarla con el diagnóstico histológico del nódulo tiroideo en el Hospital Provincial Camilo Cienfuegos de Sancti Spíritus en el período enero 2011-diciembre 2014. Métodos: Se realizó un estudio descriptivo bajo un diseño no experimental de tipo transversal donde se revisaron citologías tiroideas. Resultados: Los resultados citológicos fueron comparados con los de las piezas quirúrgicas correspondientes. Se revisaron 164 citologías correspondientes a 164 pacientes. El 79.3porciento eran mujeres. Del total, el 1.2porciento fue informada como no útil, el 76.8porciento, como benigna, el 1.2porciento, como maligna y el 7.3porciento, como sospechosa. Los 164 pacientes fueron tiroidectomizados, confirmándose el diagnóstico de benignidad en el 89.1porciento de los casos y el de sospechoso para malignidad y malignidad en el 77.8porciento, todas las citologías insatisfactorias arrojaron resultados negativos en la pieza quirúrgica. Los falsos positivos fueron un 10.9porciento. Conclusiones: Se demostró que la BAAF es un procedimiento útil, efectivo y confiable en la evaluación preoperatoria de las patologías tiroideas.[AU]

RESULTADOS DEL MANEJO TERAPÉUTICO DE LAS LESIONESTRAUMÁTICAS DE LOS TENDONES FLEXORES DE LA MANO

Introducción: La lesión de los tendones flexores de la mano debe considerarse una verdadera urgencia quirúrgica. Se realizó un estudio observacional descriptivo de corte transversal.Objetivo: Evaluar los resultados y evolución de las lesiones traumáticas de los tendones flexores de la mano a las que se aplicó el manejo terapéutico propuesto por el autor en el Hospital General Provincial Camilo Cienfuegos desde enero 2013 a diciembre 2015.Métodos: La muestra quedó constituida por pacientes mayores de15 años con lesiones traumáticas de los tendones flexores de la mano a los que se aplicó el manejo terapéutico y fueron seguidos por el autor de la investigación durante el período analizado. Se utilizaron variables demográficas, tipo de lesión,localización de la lesión, lesiones asociadas, respuesta al tratamiento y complicaciones postoperatorias. Resultados: Con los datos obtenidos se confeccionó una base de datos lacual se analizó mediante el software estadístico SPSS.Conclusiones: Se concluyó que prevalecieron las heridas nítidas, con afectación de la Zona II, las cuales se asocian a lesiones de más de un dedo, existió una relación directa en cuanto al tipo de reparación según el tiempo y los resultados obtenidos dela misma.[AU]

[Some considerations about the possible pathological mechanisms at work in antiphospholipid syndrome and stroke]. / Algunas consideraciones acerca de los posibles mecanismos patológicos en el síndrome antifosfolípidos e ictus.

INTRODUCTION AND DEVELOPMENT: Over the last two decades antiphospholipid syndrome (APS) has started to be recognized from the association of apparently anionic phospholipid-specific antibodies with thrombosis, thrombocytopenia and recurrent foetal losses. This syndrome affects patients with systemic lupus erythematosus and is considered to be an important cause of thromboembolic disease. Antiphospholipid antibodies are serum immunoglobulins that react with negatively charged phospholipids, albeit directly or by means of a cofactor, affect the coagulation system, and promote thrombosis. Recent research has been directed towards gaining an understanding of the mechanisms by which these antibodies are able to play a direct role in the pathophysiology of thrombosis, and the extent to which certain risk factors, such as smoking, high blood pressure, lipid disorders and so on, exert an influence over the expression of phospholipids in the cerebral endothelium. CONCLUSION: These antibodies have no single mechanism of action; different authors have described different pathological mechanisms, which help us to understand the heterogeneous clinical manifestations of APS.

Algunas consideraciones acerca de los posibles mecanismos patológicos en el síndrome antifosfolípidos e ictus / Some considerations about the possible pathological mechanisms at work in antiphospholipid syndrome and stroke

Introducción y desarrollo. En las dos últimas décadas ha comenzado a reconocerse el síndrome antifosfolípidos (SAP) por la asociación de anticuerpos con una aparente especificidad por fosfolípidos aniónicos con trombosis, trombocitopenia y pérdidas fetales recurrentes. Este síndrome afecta a pacientes con lupus eritematoso sistémico y se considera una causa importante de enfermedad tromboembólica. Los anticuerpos antifosfolípidos son inmunoglobulinas del suero que reaccionan con fosfolípidos cargados negativamente, ya sea directamente o a través de un cofactor, afectan el sistema de la coagulación y promueven la trombosis. Algunas investigaciones recientes se han encaminado a comprender los mecanismos por los que estos anticuerpos pueden desempeñar un papel directo en la fisiopatología de la trombosis, y cómo pueden influir determinados factores de riesgo como el tabaquismo, la hipertensión arterial, la hiperlipidemia, etc., sobre la expresión de los fosfolípidos en el endotelio cerebral. Conclusión. No existe un mecanismo único de acción de estos anticuerpos; diversos autores han descrito diferentes mecanismos patológicos, los cuales ayudan a comprender las heterogéneas manifestaciones clínicas del SAP (AU)

Introduction and development. Over the last two decades antiphospholipid syndrome (APS) has started to be recognized from the association of apparently anionic phospholipid-specific antibodies with thrombosis, thrombocytopenia and recurrent foetal losses. This syndrome affects patients with systemic lupus erythematosus and is considered to be an important cause of thromboembolic disease. Antiphospholipid antibodies are serum immunoglobulins that react with negatively charged phospholipids, albeit directly or by means of a cofactor, affect the coagulation system, and promote thrombosis. Recent research has been directed towards gaining an understanding of the mechanisms by which these antibodies are able to play a direct role in the pathophysiology of thrombosis, and the extent to which certain risk factors, such as smoking, high blood pressure, lipid disorders and so on, exert an influence over the expression of phospholipids in the cerebral endothelium. Conclusion. These antibodies have no single mechanism of action; different authors have described different pathological mechanisms, which help us to understand the heterogeneous clinical manifestations of APS (AU)

[Activation of T cells in experimental autoimmune encephalomyelitis and multiple sclerosis]. / Activación de la célula T en la encefalomielitis autoinmune experimental y esclerosis múltiple.

AIMS: In this study we describe the main findings from research into the autoreactive process triggered by activated T lymphocytes, which are generated in the peripheral compartment and then migrate towards the central nervous system (CNS) in multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE) its animal model. METHOD: The different strategies that have been developed to date for the immunological treatment of MS have been designed to intervene in the pathogenic process of the disease by blocking the activation of T cells and B cells with specific antigens, interfering with immunological effector mechanisms and inhibiting the migration of lymphocytes towards the CNS. The cause of the inflammatory response in MS has still not been defined, but the findings from EAE studies and in patients with MS suggest that the disease has an autoimmune aetiology involving autoreactive T cells which are specific for antigens in the myelin membrane. To activate these cells at least two cues are needed during antigen recognition and later the T CD4+ lymphocytes are differentiated in two subpopulations, Th1 and Th2, which differ in the pattern of secretion of cytosines depending on the stage of the disease process. The progressions of EAE and MS give rise to changes in the primary and secondary self reactive responses of the T cells during the progression of the disease. CONCLUSION: The pathological immune mechanisms mediated by activated myelin specific T lymphocytes play a key role in the progression and recuperation, as well as the mediation, of tissue damage during the course of MS and EAE.

Activación de la célula T en la encefalomielitis autoinmune experimental y esclerosis múltiple / Activation of T cells in experimental autoimmune encephalomyelitis and multiple sclerosis

Objetivo. En el presente trabajo se describen los principales hallazgos encontrados en las investigaciones acerca del proceso autorreactivo iniciado por linfocitos T activados, que se generan en el compartimento periférico y posteriormente migran hacia el sistema nervioso central (SNC) en la esclerosis múltiple (EM) y la encefalomielitis autoinmune experimental (EAE), su modelo animal. Desarrollo. Las diversas estrategias desarrolladas hasta la fecha para el tratamiento inmunológico de la EM se han diseñado para intervenir en el proceso patogénico de la enfermedad mediante el bloqueo de la activación de células T y células B por antígenos específicos, la interferencia con mecanismos efectores inmunológicos y la inhibición de la migración linfocítica hacia el SNC. La causa de la respuesta inflamatoria en la EM todavía no se ha podido definir, pero los hallazgos encontrados en EAE y en pacientes con EM han sugerido que la enfermedad presenta una etiología autoinmune mediada por células T autorreactivas específicas para antígenos de la membrana mielínica. Para la activación de dichas células se requieren al menos dos señales durante el reconocimiento antigénico y, posteriormente, los linfocitos T CD4+ se diferencian en dos subpoblaciones, Th1 o Th2, que difieren en el patrón de secreción de citocinas que dependen del estadio de la enfermedad. La progresión de la EAE y EM involucra cambios en las respuestas autorreactivas primaria y secundaria de las células T durante la progresión de la enfermedad. Conclusión. Los mecanismos patológicos inmunes mediados por linfocitos T activados específicos de la mielina desempeñan un papel importante en la progresión y recuperación, así como en la mediación del daño tisular durante la EM y la EAE (AU)

Aims. In this study we describe the main findings from research into the autoreactive process triggered by activated T lymphocytes, which are generated in the peripheral compartment and then migrate towards the central nervous system (CNS) in multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE) –its animal model. Method. The different strategies that have been developed to date for the immunological treatment of MS have been designed to intervene in the pathogenic process of the disease by blocking the activation of T cells and B cells with specific antigens, interfering with immunological effector mechanisms and inhibiting the migration of lymphocytes towards the CNS. The cause of the inflammatory response in MS has still not been defined, but the findings from EAE studies and in patients with MS suggest that the disease has an autoimmune aetiology involving autoreactive T cells which are specific for antigens in the myelin membrane. To activate these cells at least two cues are needed during antigen recognition and later the T CD4+ lymphocytes are differentiated in two subpopulations, Th1 and Th2, which differ in the pattern of secretion of cytosines depending on the stage of the disease process. The progressions of EAE and MS give rise to changes in the primary and secondary self-reactive responses of the T cells during the progression of the disease. Conclusion. The pathological immune mechanisms mediated by activated myelin-specific T lymphocytes play a key role in the progression and recuperation, as well as the mediation, of tissue damage during the course of MS and EAE (AU)

[The importance of antiphospholipid antibodies in strokes]. / Importancia de los anticuerpos antifosfolípidos en el ictus.

INTRODUCTION AND METHOD: The study of antiphospholipid antibodies has aroused a great deal of interest among researchers, as some of them are related to neurological diseases and in particular with cerebral ischemia. Cases of strokes in which the aetiology is unknown have been reported in young patients. Until now anticardiolipin antibodies and lupus anticoagulant have received the most attention in studies, but recently descriptions have been published of anticardiolipin antibodies with other particularities that can act as more specific immunity markers for strokes of undetermined origin in young adults. Recent research has been directed towards gaining an understanding of the mechanisms that allow these antibodies to play a direct role in the physiopathology of thrombosis and how certain risk factors smoking, high blood pressure, lipid disorders can exert an influence on the expression of phospholipids in the cerebral endothelium. Several authors have described different pathological mechanisms that help to understand the heterogeneous clinical manifestations of antiphospholipid syndrome. CONCLUSION: There is a need to study the different possible antigens of the antiphospholipid antibodies, as well as their specificities and pathological mechanisms, in greater depth in order to obtain a phospholipid immunity marker that is useful in the diagnosis of young stroke patients who are positive for these antibodies.

Importancia de los anticuerpos antifosfolípidos en el ictus / The importance of antiphospholipid antibodies in strokes

Introducción y desarrollo. El estudio de los anticuerpos antifosfolípidos ha despertado gran interés, pues algunos de ellos se relacionan con enfermedades neurológicas, fundamentalmente con la isquemia cerebral. Existen descripciones de pacientes jóvenes con ictus de etiología no definida con presencia de estos anticuerpos. Los anticuerpos anticardiolipina y el anticoagulante lúpico han sido hasta ahora los más estudiados, pero han comenzado a describirse anticuerpos antifosfolípidos con otras especificidades que pueden constituir marcadores inmunes más específicos para el ictus de causa no determinada en adultos jóvenes. Las investigaciones recientes se han encaminado a comprender los mecanismos por los cuales estos anticuerpos pueden desempeñar un papel directo en la fisiopatología de la trombosis y cómo determinados factores de riesgo -el tabaquismo, la hipertensión arterial, la hiperlipidemia- pueden influir sobre la expresión de los fosfolípidos en el endotelio cerebral. Diversos autores han descrito diferentes mecanismos patológicos, que ayudan a comprender las heterogéneas manifestaciones clínicas del síndrome antifosfolípido. Conclusión. Es necesario profundizar en el estudio de los diferentes posibles antígenos de los anticuerpos antifosfolípidos, sus especificidades y mecanismos patológicos, con el fin de contar con un marcador inmunitario fosfolipídico útil para el diagnóstico de pacientes jóvenes con ictus con positividad para estos anticuerpos (AU)

Introduction and method. The study of antiphospholipid antibodies has aroused a great deal of interest among researchers, as some of them are related to neurological diseases and in particular with cerebral ischemia. Cases of strokes in which the aetiology is unknown have been reported in young patients. Until now anticardiolipin antibodies and lupus anticoagulant have received the most attention in studies, but recently descriptions have been published of anticardiolipin antibodies with other particularities that can act as more specific immunity markers for strokes of undetermined origin in young adults. Recent research has been directed towards gaining an understanding of the mechanisms that allow these antibodies to play a direct role in the physiopathology of thrombosis and how certain risk factors –smoking, high blood pressure, lipid disorders– can exert an influence on the expression of phospholipids in the cerebral endothelium. Several authors have described different pathological mechanisms that help to understand the heterogeneous clinical manifestations of antiphospholipid syndrome. Conclusion. There is a need to study the different possible antigens of the antiphospholipid antibodies, as well as their specificities and pathological mechanisms, in greater depth in order to obtain a phospholipid immunity marker that is useful in the diagnosis of young stroke patients who are positive for these antibodies (AU)

[Immunological study of cerebrospinal fluid using a human IgM antiserum produced in Cuba. A preliminary evaluation]. / Estudio inmunológico del líquido cefalorraquídeo con el empleo de un antisuero de IgG humano producido en Cuba. Evaluación preliminar.

INTRODUCTION: The immunological study of cerebrospinal fluid (CSF) is an essential diagnostic tool for evaluating patients with neurological diseases. The quantitative determination of the albumen and immunoglobulin G (IgG) in blood serum and in CSF by single radial immunodiffusion (SRID), together with the calculation of the IgG index to evaluate the presence of intrathecal synthesis of IgG and of the albumen quotient in order to evaluate the state of functioning of the blood brain barrier are essential elements to be evaluated for diagnosis and research in neurological clinical practice, as well as in the follow up of certain neurological diseases such as multiple sclerosis. Specific antiserums from commercial firms such as Boehring, SIGMA, etc. are used for the quantitative determination of IgG and albumen both in blood serum and in CSF by SRID. The high cost and the difficulty in acquiring these immunodiagnostic kits have had an important effect on the diagnostic and research opportunities throughout the country. MATERIALS AND METHODS: In this work we present the preliminary findings of the evaluation of the human IgG antiserum obtained from a ram, by Labex laboratories, for the quantitative determination of IgG in CSF by SRID, in order to find out whether this antiserum is efficient in the quantitative determination of IgG in CSF. RESULTS AND CONCLUSIONS: The studies conducted so far show that this antiserum may be a good candidate for use in immunological studies of CSF. Further work needs to be carried out on its validation in order to resolve the problems involved in immunological studies of CSF that we highlighted above. This would be achieved with an antiserum that is cheaper than those used up to now.

[Nursing research on epidural analgesia for chronic cancer pain]. / Papel de la enfermera en la analgesia epidural para el dolor cronico por cancer.

A retrospective study was made on 9 cases with pains due to advanced head and neck cancer, attended to at the Pain Clinic of the National Institute of Oncology and Radiobiology between 1988 and 1991. An epidural catheter was implanted to these patients at the CNS level for the administration of a morphine solution. 7 patients (77.8%) showed total pain relief; and 2 cases showed easily-controlled slight pains. The most frequent complications were; fever (3 cases) and alterations of the level of consciousness (2 cases). No infections were reported. The importance of an adequate preparation of the patient and a strict follow up, where oncology nursing personnel play an important role, is pointed out.