Screening de cardiopatías en niños y adolescentes (Prevencar Program) / Screening for heart disease in kids and adolescents (Prevencar Program)

Objetivo: El objetivo fue desarrollar un cribado de detección de cardiopatías en atención primaria, para identificar alteraciones electrocardiográficas patológicas y cardiopatías subyacentes en adolescentes. Diseño: Durante un año se realizó el estudio mediante muestreo polietápico. Lugar: Se seleccionaron los centros asistenciales de atención primaria en un área de salud, que dispusieran de equipo de electrocardiograma (ECG) digital (12 centros). Participantes: Inicialmente, se reclutó a 718 (16,6%) adolescentes de 14 años y se excluyeron a los que tenían un diagnóstico de cardiopatía previo. Intervención: El cribado consistió en incluir en la revisión obligatoria de los 14 años un cuestionario de salud y un ECG. Principales medidas: Para el cribado se realizó cuestionario, auscultación cardíaca, ECG y ecocardiografía. Se establecieron criterios de anormalidad para remitir a una segunda valoración por un cardiólogo. Resultados: Finalmente la muestra la componen 698 adolescentes, con una edad media de 13,7± 0,5 años, de los cuales 354 (50,7%) fueron chicos. Fueron seleccionados 149 (21,3%) para la segunda revisión por cardiología: 88 (12,6%) por cuestionario positivo, 11 (2,2%) por auscultación cardíaca anormal y 66 (9,5%) por hallazgos en ECG. Los adolescentes con evidencia de cardiopatía fueron 24 (3,4%). De ellos, 14 (2,0%) tuvieron alteraciones sugestivas y se les recomendó seguimiento, 6 (0,9%) tuvieron diagnóstico definitivo de cardiopatía y 4 (0,6%) tenían otros hallazgos patológicos relacionados con el sistema cardiovascular. Conclusiones: El cribado permitió identificar un 1% de adolescentes con cardiopatía y otro 2% permanecerá en seguimiento. El ECG detectó más casos patológicos que el cuestionario.(AU)

Objective: The objective was to develop a screening for heart disease detection in primary care, to identify pathological electrocardiographic changes and underlying heart disease in adolescents. Design: The study was carried out for one year using multistage sampling. Site: Primary care centers in a health area that had digital ECG equipment (12 centers) were selected. Participants: Initially, 718 (16.6%) 14-year-old adolescents were recruited and those with a previous diagnosis of heart disease were excluded. Interventions: Screening consisted of including a health questionnaire in the mandatory 14-year-old check-up. Main measurements: Screening included a questionnaire, cardiac auscultation, ECG and echocardiography. Abnormality criteria were established to refer for a second evaluation by a cardiologist. Results: Finally, the sample was made up of 698 adolescents, with a mean age of 13.7±0.5 years, and 354 (50.7%) were boys. A total of 149 (21.3%) were selected for a second review by cardiology: 88 (12.6%) due to a positive questionnaire, 11 (2.2%) due to abnormal cardiac auscultation, and 66 (9.5%) due to ECG findings. Adolescents with evidence of heart disease were 24 (3.4%). Of these, 14 (2.0%) had suggestive alterations and follow-up was recommended, 6 (0.9%) had a definitive diagnosis of heart disease, and 4 (0.6%) had other pathological findings related to the cardiovascular system. Conclusions: The screening allowed us to identify 1% of adolescents with heart disease and another 2% will remain in follow-up. The ECG detected more pathological cases than the questionnaire.(AU)

[Screening for heart disease in kids and adolescents (Prevencar Program)]. / Screening de cardiopatías en niños y adolescentes (Prevencar Program).

OBJECTIVE: The objective was to develop a screening for heart disease detection in primary care, to identify pathological electrocardiographic changes and underlying heart disease in adolescents. DESIGN: The study was carried out for one year using multistage sampling. SITE: Primary care centers in a health area that had digital ECG equipment (12 centers) were selected. PARTICIPANTS: Initially, 718 (16.6%) 14-year-old adolescents were recruited and those with a previous diagnosis of heart disease were excluded. INTERVENTIONS: Screening consisted of including a health questionnaire in the mandatory 14-year-old check-up. MAIN MEASUREMENTS: Screening included a questionnaire, cardiac auscultation, ECG and echocardiography. Abnormality criteria were established to refer for a second evaluation by a cardiologist. RESULTS: Finally, the sample was made up of 698 adolescents, with a mean age of 13.7±0.5 years, and 354 (50.7%) were boys. A total of 149 (21.3%) were selected for a second review by cardiology: 88 (12.6%) due to a positive questionnaire, 11 (2.2%) due to abnormal cardiac auscultation, and 66 (9.5%) due to ECG findings. Adolescents with evidence of heart disease were 24 (3.4%). Of these, 14 (2.0%) had suggestive alterations and follow-up was recommended, 6 (0.9%) had a definitive diagnosis of heart disease, and 4 (0.6%) had other pathological findings related to the cardiovascular system. CONCLUSIONS: The screening allowed us to identify 1% of adolescents with heart disease and another 2% will remain in follow-up. The ECG detected more pathological cases than the questionnaire.

A taxonomic revision of the genus Tentyria Latreille, 1802 in the Peninsula and Balearic (Coleoptera: Tenebrionidae).

In this work entomological material and nomenclatural types of the Ibero-Balearic species of Tentyria Latreille, 1802 genus are revised. A reordination in groups of species and a new classification of valid species are proposed. Thirteen groups of species including 31 species and six subspecies have been established. Seven new species of Iberian Tentyria are described and figured, including two from Portugal: Tentyria stupefacta sp. nov. and Tentyria faroensis sp. nov.; and five species from Spain: Tentyria espanoli sp. nov., Tentyria kochi sp. nov., Tentyria striatorugosa sp. nov., Tentyria castrotovari sp. nov. and Tentyria pseudogaditana sp. nov. Three new subspecies: Tentyria sinuatocollis ssp. escalerai nov., Tentyria velox ssp. serrana nov., Tentyria sublaevis ssp. cognata nov., are also described. The true identity of 14 species historically confused is argued: Tentyria curculionoides (Herbst, 1799); Tentyria peiroleri Solier, 1835; Tentyria incerta Solier, 1835; Tentyria levis Solier, 1835; Tentyria sinuatocollis Rosenhauer, 1856; Tentyria prolixa Rosenhauer, 1856; Tentyria rugosostriata Kraatz, 1865; Tentyria corrugata Rosenhauer, 1856; Tentyria velox Chevrolat, 1865; Tentyria sublaevis Kraatz, 1865; Tentyria heydeni Haag-Rutenberg, 1870; Tentyria lateritia Reitter, 1900; Tentyria castiliana Koch, 1944; and Tentyria aragonica Koch, 1944. The taxonomic status and the name Tentyria subrugosa Solier, 1835 have been modified because it is a primary homonym of Tentyria subrugosa Besser, 1832. Tentyria elongata Waltl, 1835 is a primary homonym of Tentyria elongata Gebler, 1829 (= Anatolica angustata (Steven, 1828)). The taxonomic status of Tentyria grossa ssp. basalis Schaufuss, 1869 is also re-established. Lectotypes of 14 species are designated; seven synonymies are established (one of them from the Italian fauna). The distribution of species is indicated and, agreeing with the new taxonomical classification, a key of species is also provided.

Indicadores de calidad de la enteroscopia Procedimiento de la enteroscopia / No disponible

Enmarcado dentro del proyecto "Indicadores de calidad en endoscopia digestiva", liderado por la Sociedad Española de Patología Digestiva (SEPD), el objetivo es proponer los procedimientos e indicadores de estructura, proceso y resultado necesarios para aplicar y evaluar la calidad en la enteroscopia. Para ello, se ha realizado una búsqueda de indicadores de calidad en enteroscopias. La calidad de la evidencia se ha analizado aplicando la escala de clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation) definiéndola como de calidad alta, moderada, baja y muy baja. Se ha identificado para enteroscopia un total de 10 indicadores de procesos (uno de preprocedimiento, ocho de procedimiento y uno de resultado), siendo los más importantes la indicación adecuada y la elección de una vía de acceso idónea

No disponible

Quality indicators in enteroscopy. Enteroscopy procedure.

Within the project "Quality Indicators in Gastrointestinal Endoscopy," under the leadership of the Sociedad Española de Patología Digestiva (SEPD), our goal is to propose the procedures and the structure, process, and outcome indicators required for the application and assessment of quality in enteroscopy. To this end a search was performed for quality indicators in enteroscopy. Quality of evidence was measured by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system, and classified as high, moderate, low, and very low. A total of 10 process indicators (one preprocedure, eight procedure, one postprocedure) were identified for enteroscopy, with appropriate indication and choice of most efficient route being most significant.

Aging and Erectile Dysfunction.

INTRODUCTION: Erectile dysfunction (ED) has been identified as the most common sexual problem that affects mainly men older than 40 years. According to this, there is a strong evidence linking ED with a number of medical conditions and related risk factors that had been described in the literature, yet there is limited information about the specific mechanism involved in the establishment of ED among healthy older men. AIM: The purpose of this study is to review the literature and mainly focus on the basic physiologic and vascular alterations and morphologic changes related to aging and its related risk factors, summarizing the main and the latest findings in basic research of tissue remodeling process involved in ED pathophysiology. METHODS: Data from the pertinent literature were examined to inform our conclusions. MAIN OUTCOME MEASURE: This article defines the morphologic and physiologic mechanisms involved in the process of aging, which play a key role in the development of sexual dysfunction. RESULTS: ED has been considered as a nonlife-threatening condition, but the recognition of its multiple comorbid conditions, the importance of aging process over the male sexual performance among them its relation with vascular and nitric oxide content alteration, as well as penile morphologic changes, and the fact that it is a widespread under-reported disease, have established the need of an early diagnosis and treatment of this common sexual problem within the general male population. CONCLUSION: In this case, morphologic and physiologic mechanisms that are involved in the aging process play a key role in the development of sexual dysfunction in the absence of any other clinical or medical condition.

Evaluación y mejora de la comprensión de los documentos de consentimiento informado / Evaluation and improvement of the comprehension of informed consent documents

INTRODUCCIÓN: Contar con documentos de consentimiento informado (DCI) de calidad implica que la información pueda ser comprendida y asimilada por el paciente. El propósito de este estudio es evaluar y mejorar la facilidad de comprensión de los DCI presentados para su acreditación en un hospital de tercer nivel. MÉTODOS: Estudio de evaluación y mejora de la calidad de 132 DCI provenientes de 2 servicios de un hospital público de tercer nivel, estructurado en 3 fases: evaluación inicial, intervención y reevaluación. Se utilizaron 2 criterios: extensión (deseable inferior a 490 palabras) e índice de legibilidad INFLESZ (adecuado si >55 puntos), tanto del DCI completo como de cada uno de sus apartados. Los contenidos propuestos por los servicios fueron adaptados por una persona entrenada no sanitaria, cuyas dudas sobre términos médicos fueron resueltas por los autores. Para comparar los resultados entre evaluaciones se calcularon mejoras relativas en extensión e INFLESZ, y su significación estadística. RESULTADOS: Antes de la intervención, el 78,8% de los DCI eran de extensión deseable (IC 95%: 86,5-71,1) con un INFLESZ medio de 44,1 puntos (3,8% > 55 puntos) (IC 95%: 6,0-1,6). Tras ella, el INFLESZ fue de 61,9 puntos (mejora relativa 40,3%, p < 0,001), con el 100% > 55. Los DCI resultantes dedican una mayor extensión a describir la naturaleza del procedimiento (p < 0,0001) y menor a consecuencias, riesgos (p < 0,0001) y alternativas (p < 0,05). CONCLUSIONES: Introducir dinámicas de mejora en el diseño de DCI es posible y necesario, ya que produce DCI de mayor calidad y más fáciles de comprender por los pacientes

INTRODUCTION: The information contained in a good informed consent form (ICF) must be understood by the patients. The aim of this study is to assess and improve the readability of the ICF submitted for accreditation in a tertiary hospital. METHODS: Study of assessment and improvement of the quality of 132 ICF from 2 departments of a public tertiary hospital, divided into 3 phases: Initial assessment, intervention and reassessment. Both length and readability are assessed. Length is measured in words (adequate to 470, excessive over 940), and readability in INFLESZ points (suitable if over 55). The ICF contents initially proposed by departments were adapted by non-health-related trained persons, whose doubts about medical terms were resolved by the authors. To compare results between evaluations, relative improvement (in both length and INFLESZ) and statistical significances were calculated. RESULTS: Baseline data: 78.8% of the ICFs showed a desired length (CI95% 86,5-71,1) and a mean of 44.1 INFLESZ points (3.8% >55 points, CI95% 6,0-1,6). After the intervention, INFLESZ raised to 61.9 points (improvement 40.3%, P<.001), all ICF showing >55 points. The resulting ICFs had a longer description of the nature of the procedure (P<.0001) and a shorter description of their consequences, risks (P <.0001) and alternatives (P <.05). CONCLUSIONS: The introduction of improvement dynamics in the design of ICFs is possible and necessary because it produces more effective and easily readable ICFs

[Identification of the factors conditioning times and indicators of quality in the intrahospital care of acute stroke]. / Identificación de los factores condicionantes de tiempos e indicadores de calidad en la atención intrahospitalaria al ictus agudo.

INTRODUCTION: Stroke is a serious but potentially reversible entity. Reducing the time of care in the acute phase is essential to limit morbidity and mortality. The evaluation of the performances in stroke care is essential because it allows identify opportunities for improvement. AIM: To understand and analyze the determinants of the delay in the time of hospital care for the subsequent implementation of a cycle of improvement. PATIENTS AND METHODS: Retrospective study of patients with acute ischemic stroke treated with intravenous thrombolysis (IVT) and/or intra-arterial mechanical thrombectomy (IAMT) in a tertiary hospital between 2009-2014. In-hospital times, quality indicators and associated factors were analyzed. RESULTS: 337 patients with acute ischemic stroke were treated with IVT (66.2%) and/or IAMT (54.1%). In-hospital times (95% confidence interval): door-to-needle time, 75.88 min (71.67-80.16 min); door-to-imaging, 43.27 min (40.17-46.37 min), imaging-to-needle, 38.01 min (34.08-41.93 min); IVT-IAMT time, 127.44 min (108.7-146.18 min); door-to-groin puncture, 155.22 min (140.03-170.40 min). 36.6% treated in less than 60 min, neuroimaging in less than 25 min in 19.9% and IVT-IAMT time in less than 90 minutes in 28.8%. Age, onset-to-door time, non-ambulance transport and the learning period were identified as determinants. CONCLUSIONS: Knowledge of the current situation of the times and quality indicators and their determinants are essential to provide the motivation to start an initiative to improve the quality of care in patients with acute stroke.

TITLE: Identificacion de los factores condicionantes de tiempos e indicadores de calidad en la atencion intrahospitalaria al ictus agudo.Introduccion. El ictus es una entidad grave, pero potencialmente reversible. La reduccion del tiempo de atencion en el momento agudo es fundamental para limitar la morbimortalidad. La evaluacion de las actuaciones en la atencion al ictus es esencial, porque permite identificar oportunidades de mejora. Objetivo. Conocer y analizar los factores condicionantes de la demora en los tiempos de atencion intrahospitalaria para la posterior implementacion de un ciclo de mejora. Pacientes y metodos. Estudio retrospectivo de pacientes con ictus isquemico agudo tratados con trombolisis intravenosa (TLIV) y/o trombectomia intraarterial mecanica (TIAM) en un hospital terciario entre 2009-2014. Se analizaron los tiempos intrahospitalarios, los indicadores de calidad y sus factores condicionantes. Resultados. Un total de 337 pacientes fueron tratados con TLIV (66,2%) y/o TIAM (54,1%). Tiempos medios de actuacion (intervalo de confianza al 95%): puerta-TLIV, 75,88 min (71,67-80,16 min); puerta-TC, 43,27 min (40,17-46,37 min); TC-TLIV, 38,01 min (34,08-41,93 min); TLIV-TIAM, 127,44 min (108,7-146,18 min); puerta-TIAM, 155,22 min (140,03-170,4 min). El 36,6% fue tratado en menos de 60 min, la neuroimagen se realizo en menos de 25 min en un 19,9% y el tiempo TLIV-TIAM fue menor de 90 min en un 28,8%. La edad, el tiempo inicio-puerta, la procedencia de otro hospital y el periodo de aprendizaje se identificaron como factores condicionantes. Conclusiones. El conocimiento de la situacion actual de los tiempos e indicadores intrahospitalarios y sus factores condicionantes son el punto de partida y proporcionan la motivacion necesaria para impulsar una iniciativa para la mejora de la calidad asistencial en el paciente con ictus agudo.

[Evaluation and improvement of the comprehension of informed consent documents]. / Evaluación y mejora de la comprensión de los documentos de consentimiento informado.

INTRODUCTION: The information contained in a good informed consent form (ICF) must be understood by the patients. The aim of this study is to assess and improve the readability of the ICF submitted for accreditation in a tertiary hospital. METHODS: Study of assessment and improvement of the quality of 132 ICF from 2 departments of a public tertiary hospital, divided into 3 phases: Initial assessment, intervention and reassessment. Both length and readability are assessed. Length is measured in words (adequate to 470, excessive over 940), and readability in INFLESZ points (suitable if over 55). The ICF contents initially proposed by departments were adapted by non-health-related trained persons, whose doubts about medical terms were resolved by the authors. To compare results between evaluations, relative improvement (in both length and INFLESZ) and statistical significances were calculated. BASELINE DATA: 78.8% of the ICFs showed a desired length (CI95% 86,5-71,1) and a mean of 44.1 INFLESZ points (3.8% >55 points, CI95% 6,0-1,6). After the intervention, INFLESZ raised to 61.9 points (improvement 40.3%, P<.001), all ICF showing >55 points. The resulting ICFs had a longer description of the nature of the procedure (P<.0001) and a shorter description of their consequences, risks (P <.0001) and alternatives (P <.05). CONCLUSIONS: The introduction of improvement dynamics in the design of ICFs is possible and necessary because it produces more effective and easily readable ICFs.

Identificación de los factores condicionantes de tiempos e indicadores de calidad en la atención intrahospitalaria al ictus agudo / Identification of the factors conditioning times and indicators of quality in the intrahospital care of acute stroke

Introducción. El ictus es una entidad grave, pero potencialmente reversible. La reducción del tiempo de atención en el momento agudo es fundamental para limitar la morbimortalidad. La evaluación de las actuaciones en la atención al ictus es esencial, porque permite identificar oportunidades de mejora. Objetivo. Conocer y analizar los factores condicionantes de la demora en los tiempos de atención intrahospitalaria para la posterior implementación de un ciclo de mejora. Pacientes y métodos. Estudio retrospectivo de pacientes con ictus isquémico agudo tratados con trombólisis intravenosa (TLIV) y/o trombectomía intraarterial mecánica (TIAM) en un hospital terciario entre 2009-2014. Se analizaron los tiempos intrahospitalarios, los indicadores de calidad y sus factores condicionantes. Resultados. Un total de 337 pacientes fueron tratados con TLIV (66,2%) y/o TIAM (54,1%). Tiempos medios de actuación (intervalo de confianza al 95%): puerta-TLIV, 75,88 min (71,67-80,16 min); puerta-TC, 43,27 min (40,17-46,37 min); TC-TLIV, 38,01 min (34,08-41,93 min); TLIV-TIAM, 127,44 min (108,7-146,18 min); puerta-TIAM, 155,22 min (140,03-170,4 min). El 36,6% fue tratado en menos de 60 min, la neuroimagen se realizó en menos de 25 min en un 19,9% y el tiempo TLIVTIAM fue menor de 90 min en un 28,8%. La edad, el tiempo inicio-puerta, la procedencia de otro hospital y el período de aprendizaje se identificaron como factores condicionantes. Conclusiones. El conocimiento de la situación actual de los tiempos e indicadores intrahospitalarios y sus factores condicionantes son el punto de partida y proporcionan la motivación necesaria para impulsar una iniciativa para la mejora de la calidad asistencial en el paciente con ictus agudo (AU)

Introduction. Stroke is a serious but potentially reversible entity. Reducing the time of care in the acute phase is essential to limit morbidity and mortality. The evaluation of the performances in stroke care is essential because it allows identify opportunities for improvement. Aim. To understand and analyze the determinants of the delay in the time of hospital care for the subsequent implementation of a cycle of improvement. Patients and methods. Retrospective study of patients with acute ischemic stroke treated with intravenous thrombolysis (IVT) and/or intra-arterial mechanical thrombectomy (IAMT) in a tertiary hospital between 2009-2014. In-hospital times, quality indicators and associated factors were analyzed. Results. 337 patients with acute ischemic stroke were treated with IVT (66.2%) and/or IAMT (54.1%). In-hospital times (95% confidence interval): door-to-needle time, 75.88 min (71.67-80.16 min); door-to-imaging, 43.27 min (40.17-46.37 min), imaging-to-needle, 38.01 min (34.08-41.93 min); IVT-IAMT time, 127.44 min (108.7-146.18 min); door-to-groin puncture, 155.22 min (140.03-170.40 min). 36.6% treated in less than 60 min, neuroimaging in less than 25 min in a 19.9% and IVT-IAMT time in less than 90 minutes in 28.8%. Age, onset-to-door time, non-ambulance transport and the learning period were identified as determinants. Conclusions. Knowledge of the current situation of the times and quality indicators and their determinants are essential to provide the motivation to start an initiative to improve the quality of care in patients with acute stroke (AU)

Hiperentorno de aprendizaje para el tratamiento de los contenidos de las biomoléculas en las carreras de Tecnología de la Salud / Learning hyperrange for biomolecules themes in the Health Technologies careers

El aprendizaje de las biomoléculas en los programas de Química y su dirección metodológica requieren de una constante actualización en correspondencia con las exigencias de la formación de los tecnólogos de la salud. Un acercamiento al proceso de enseñanza-aprendizaje de la Química en la filial de Ciencias Médicas permitió corroborar la existencia de insuficiencias que limitan el aprendizaje de los contenidos sobre biomoléculas en vinculación con sus aplicaciones prácticas en el ámbito de la salud, haciéndose necesario aportar un medio didáctico para la dirección de este proceso, en el cual se concibe una nueva visión metodológica. Como resultado de esta investigación, el Hiperentorno Educativo de Aprendizaje (HEA) para el aprendizaje de las biomoléculas, concebido desde la organización de la actividad cognoscitiva y la sistematización metodológica, integra coherentemente situaciones de aprendizaje, sistemas de ejercicios y preguntas a partir de las aplicaciones prácticas de las biomoléculas en el ámbito de la salud(AU)

The biomolecules learning in the chemistry subjects and its methodological direction require a constant updating in correspondence with the demands of the health technologists. An approaching to teaching-learning process of the chemistry in the medical sciences college allowed to corroborate the existence of insufficiencies that limit the learning over the contents dealing with biomolecules linked to their practical applications in the health issues, making it necessary to contribute with a didactical mean for the process direction in which a new methodological vision is conceived. As a result in this investigation, the Learning Educative Hyperrange for the directions of the biomolecules teaching-learning process, conceived since the cognitive activity organization and methodological systematization which integrates coherently, learning situations, exercises systems and questions to deport of the practical applications on the biomolecules in the health issues(AU)

Respuesta de los autores: Interacciones farmacológicas en atención primaria y seguridad del paciente / Author's reply: Drug interactions in primary care and patient safety

No disponible

Hipermedia de enseñanza-aprendizaje química orgánica / Hypermedia of organic chemistry teaching

La Investigación está encaminada a favorecer el aprendizaje de los compuestos orgánicos oxigenados y nitrogenados con aplicación terapéutica en los estudiantes de primer año de las carreras de Tecnología de la Salud en la Filial de Ciencias Médicas de Manzanillo. La investigación se orientó hacia el objetivo siguiente: Elaboración de una hipermedia para el aprendizaje de los compuestos orgánicos oxigenados y nitrogenados con aplicación terapéutica en los procederes profesionales de los estudiantes de las carreras de Tecnología de la Salud. La hipermedia propuesta tiene como núcleo la relación compuestos orgánicos- potencialidad-aplicación terapéutica de los compuestos oxigenados y nitrogenados. Una vez elaborada la hipermedia, fue sometida a su valoración mediante el enjuiciamiento de los especialistas seleccionados como expertos y aplicada en la práctica educativa mediante un experimento pedagógico, cuyos resultados evidenciaron la factibilidad e impacto positivo en el proceso de enseñanza-aprendizaje de la Química(AU)

The research was directed to facilitate the learning of oxygenated and nitrogenous organic compounds with the therapeutic application in first year students of Health Technologic Careers in the Filial Subsidiary of Medical Sciences in Manzanillo. The research was directed towards the following objective: ellaboration of a hypermedia for the learning of the oxygenated and nitrogenous organic compounds with therapeutic application in the professional behavior of the students of Health Technologies. The hypermedia proposed has as the main core the relation organic compounds –therapeutic -potentiality –application of the oxygenated and nitrogenous compounds. After the hipermedia was done it was valued through selected specialists like experts and applied in the educational practice through a pedagogical experiment which results evidenced the feasibility and positive impact in the teaching learning process of Chemistry(EU)

Age-related morphological changes in smooth muscle and collagen content in human corpus cavernosum.

INTRODUCTION: Aging process has been related to erectile dysfunction (ED) possibly due to morphological changes in corpus cavernosum among many other causes. AIM: To evaluate smooth muscle and collagen content in human corpus cavernosum and to correlate it to age. METHODS: Cadaveric human cavernosal tissue was collected during the period of 1 year. Morphological analysis of a whole corpus cavernosum was performed in tissue sections stained with Masson's trichromic method to differentiate smooth muscle (red) from collagen (blue) content. MAIN OUTCOME MEASURES: Analysis was performed with specialized micrographs image analysis software. Pearson's correlation test was used to establish correlation between corpus cavernosum morphology (smooth muscle and collagen content) and age. RESULTS: A total sample of 89 tissues from different male cadavers were analyzed. The average age of the sample was 49.2 ± 19.1 years, with a range between 14 and 90 years. There was a statistically significant inverse correlation between age and the percentage of smooth muscle content (P = 0.012), direct correlation between age and percentage of collagen content (P = 0.019), and inverse correlation between age and the ratio of smooth muscle : collagen content (P = 0.007). CONCLUSIONS: Age-related morphological changes in terms of smooth muscle and collagen content are observed in human corpus cavernosum as a possible contributing factor to the development of ED.

Laparoscopia diagnóstica de urgencia en el traumatismo abdominal: un estudio en 41 pacientes / Emergency diagnostic laparoscopy in abdominal trauma: a study of 41 patients

Fundamento: la laparoscopia es una prueba utilizada en pacientes con trauma abdominal que enfrentan la sospecha de lesión orgánica intra-abdominal para lo cual se requiere una conducta quirúrgica inminente. Objetivo: exponer los resultados de la laparoscopia diagnóstica de urgencia en traumatismos abdominales. Métodos: estudio descriptivo y retrospectivo en pacientes con diagnóstico de trauma abdominal a los cuales se les realizó laparoscopia de urgencia en el Servicio de Gastroenterología del Hospital Dr Gustavo Aldereguía Lima de Cienfuegos, entre los meses de enero del 2001 a diciembre del 2008. Se aplicaron criterios de inclusión y exclusión. Resultados: se estudian a 41 pacientes con una edad promedio de 39,2 ± 7,7 años. La mayor parte de los pacientes estudiados se encontraban en el rango de edad entre los 31 a 40 años, 21 pacientes (51,2 por ciento), predominó el traumatismo abdominal abierto con 26 pacientes (63,4 por ciento). El sexo masculino predominó con 38 pacientes (92,7 por ciento), tanto el trauma abierto como el cerrado fueron más frecuentes en este sexo con 25 (96,2 por ciento) y 13 pacientes (86,7 por ciento) respectivamente. No mostraron lesión visceral durante la laparoscopia 93,3 por ciento de los pacientes con trauma abdominal cerrado por lo que se evitó el tratamiento quirúrgico al igual que en los pacientes con traumatismos abdominales abiertos que tenían una lesión no penetrante en la cavidad abdominal (80,8 por ciento). Conclusiones: la laparoscopia diagnóstica es una prueba útil en pacientes con trauma abdominal y evita un número considerable de laparotomías exploradoras innecesarias(AU)

Background: laparoscopy is a test used in the patients with abdominal trauma with suspicion of intra-abdominal organic damage and an imminent surgical behavior. Objectives: to expose the results of the urgency laparoscopic diagnosis in the traumatic acute abdomen. Methods: an descriptive and retrospective study in patient with diagnosis of abdominal trauma to which were carried out urgency laparoscopy at the Hospital Dr. Gustavo Aldereguía Lima", from january 2001 to december 2008, when not being possible to define injury of intra-abdominal viscera performing other tests. Inclusion and exclusion criterion were applied. Results: we study 41 patients with average of 39, 2 ± 7, 7 years. Most of the studied patients were in the age range from 31 to 40 years with 21 patients (51, 2 percent) the open abdominal trauma with 26 patients prevailed (63, 4 percent). The masculine sex prevailed with 38 patients (92,7 percent) and as much the open trauma as the closed one were more frequent in this sex with 25 patients (96,2 percent) and 13 patients (86,7 percent) respectively. They didn't show visceral damage during the laparoscopy 93, 3 percent of the patients with closed abdominal trauma by what the surgical treatment was avoided, the same as in the patients with open abdominal trauma which had a non penetrating damage in abdominal cavity (80, 8 percent). Conclusion: laparoscopic diagnosis is a useful test in patients with abdominal trauma and it avoids a considerable number of unnecessary conventional surgical treatment(AU)

Prolonged inflation of coronary angioplasty balloon as treatment for subocclusive dissection of the coronary sinus during implantation of a coronary sinus pacing lead.

Cardiac resynchronization therapy with biventricular stimulation is an accepted treatment procedure for patients with severe heart failure (NYHA class III/IV), low left ventricle ejection fraction, and left bundle branch block, in spite of optimal medical treatment (Smith, S. C. Jr, Feldman, T. E., Hirshfeld, J. W. Jr, Jacobs, A. K., Kern, M. J., King, S. B. et al. Circulation, 113(7), e166-e286, (2006)). In the ventricular resynchronization procedure, an electrode must be implanted, via the coronary sinus (CS), in a coronary vein of the left ventricle (LV). Insertion of guide catheters and guide wires through the CS towards the target vein may produce more or less extensive dissections and staining which makes visualizing the target vein opening difficult and gives rise to deferment of the procedure. We describe a case of CS dissection, produced by the catheter guide, resulting in a venous wall flap which impeded further advancement of the lead. This was treated with prolonged inflation of a coronary angioplasty balloon, which allowed completion of the procedure in the same surgical intervention. To our knowledge, this is the first report of the successful use of a coronary angioplasty balloon to resolve this complication of electrode implantation.

Pacientes con enfermedad renal terminal bajo hemodiálisis: libido y función eréctil / Patients with terminal renal disease in hemodialysis: libido and erectile function

Introducción: Los hombres en avanzado estado de Insuficiencia Renal Crónica (IRC) tratados con hemodiálisis presentan una alta prevalencia de Disfunción Eréctil (DE). Sin embargo, ha sido poco estudiado si estos pacientes preservan o no su deseo sexual a pesar de su estado de salud. Objetivo: Evaluar la integridad del deseo sexual y la prevalencia de DE en pacientes que padecen IRC y en terapia con hemodiálisis y la frecuencia de tratamiento en ellos. Métodos: Estudio multicéntrico de corte transversal llevado a cabo en 5 diferentes unidades renales en Medellín, Colombia. Ciento treinta y dos pacientes en tratamiento con hemodiálisis fueron evaluados para DE mediante el índice Internacional de Función Eréctil (IIEF) usando dos de sus dominios: Libido y función eréctil. La asociación con otras patologías también fue investigada. Resultados: La edad media de los pacientes fue de 60 mas menos 14,5 años. 61,4 por ciento y 81 por ciento de los pacientes tenían asociadas Diabetes mellitus e Hipertensión arterial respectivamente. La DE fue severa en el 70 por ciento de los pacientes, leve en el 19 por ciento y 11 por ciento no presentaron DE; 29 por ciento de los pacientes habían buscado tratamiento para la DE y de ellos 29 por ciento recibió tratamiento farmacológico. El deseo sexual fue calificado como de frecuencia moderada o alta en el 67,4 por ciento de los pacientes y la intensidad del deseo sexual moderada a muy alta en el 60,6 por ciento de los pacientes. Conclusiones: La libido fue altamente preservada en más del 60 por ciento de los pacientes, sin embargo la prevalencia de DE es muy alta (89 por ciento). A pesar de esto solamente el 11,3 por ciento de los pacientes recibieron tratamiento médico para mejorar su desempeño sexual.(AU)