The structure of Leptospira interrogans GAPDH sheds light into an immunoevasion factor that can target the anaphylatoxin C5a of innate immunity.

Leptospirosis is a neglected worldwide zoonosis involving farm animals and domestic pets caused by the Gram-negative spirochete Leptospira interrogans. This bacterium deploys a variety of immune evasive mechanisms, some of them targeted at the complement system of the host's innate immunity. In this work, we have solved the X-ray crystallographic structure of L. interrogans glyceraldehyde-3-phosphate dehydrogenase (GAPDH) to 2.37-Å resolution, a glycolytic enzyme that has been shown to exhibit moonlighting functions that potentiate infectivity and immune evasion in various pathogenic organisms. Besides, we have characterized the enzyme's kinetic parameters toward the cognate substrates and have proven that the two natural products anacardic acid and curcumin are able to inhibit L. interrogans GAPDH at micromolar concentration through a noncompetitive inhibition modality. Furthermore, we have established that L. interrogans GAPDH can interact with the anaphylatoxin C5a of human innate immunity in vitro using bio-layer interferometry and a short-range cross-linking reagent that tethers free thiol groups in protein complexes. To shed light into the interaction between L. interrogans GAPDH and C5a, we have also carried out cross-link guided protein-protein docking. These results suggest that L. interrogans could be placed in the growing list of bacterial pathogens that exploit glycolytic enzymes as extracellular immune evasive factors. Analysis of the docking results indicates a low affinity interaction that is consistent with previous evidence, including known binding modes of other α-helical proteins with GAPDH. These findings allow us to propose L. interrogans GAPDH as a potential immune evasive factor targeting the complement system.

Characterization of methicillin-resistant Staphylococcus aureus strains colonizing the nostrils of Spanish children.

OBJECTIVE: To characterize the Staphylococcus aureus strains colonizing healthy Spanish children. METHODS: Between March and July 2018, 1876 Spanish children younger than 14 years attending primary healthcare centers were recruited from rural and urban areas. Staphylococcus aureus colonization of the anterior nostrils was analyzed. MecA and mecC genes, antibiotic susceptibility, and genotyping according to the spa were determined in all strains, and the following toxins were examined: Panton-Valentine leucocidin (pvl), toxic shock syndrome toxin (tst), and exfoliative toxins (eta, etb, etd). Multilocus sequence typing (MLST) and staphylococcal cassette chromosome (SCCmec) typing were performed on methicillin-resistant Staphylococcus aureus (MRSA) strains, as well as pulsed-field gel electrophoresis (PFGE). RESULTS: 619 strains were isolated in 1876 children (33%), and 92% of them were sent for characterization to the Spanish National Centre of Microbiology (n = 572). Twenty (3.5%) of these strains were mecA-positive. Several spa types were detected among MRSA, being t002 the most frequently observed (30%), associating with SCCmec IVc. Among MSSA, 33% were positive for tst, while only 0.73% were positive for pvl. The 20 MRSA strains were negative for pvl, and 6 (30%) harbored the tst gene. CONCLUSIONS: methicillin-resistant Staphylococcus aureus nasal colonization in Spanish children is rare, with t002 being the most observed spa type, associated with SCCmec IVc. None of the MRSA strains produced pvl, but up to 30% of S. aureus strains were positive for tst.

Low sensitivity of conventional fungal agars in fungemia by Rhodotorula mucilaginosa: description of two cases.

BACKGROUND: Although most bloodstream yeast infections are caused by Candida spp., infections by rare or less common species have increased in recent years. Diagnosis of infections caused by these species is difficult due to the lack of specific symptoms and adequate diagnostic tools. CASES PRESENTATION: We describe two cases of fungemia by Rhodotorula mucilaginosa within a few months of each other, in a secondary Spanish hospital. In both cases, diagnosis was challenging. Blood subcultures in conventional fungal media were persistently negatives and the use of non-conventional fungal media was essential for isolating the yeasts and achieving a correct diagnosis. 1-3 beta-D-glucan detection and a panfungal PCR assay were helpful techniques to confirm the diagnosis CONCLUSION: It is highly important to establish an early diagnosis for fungemia. The process is challenging because often non-specific symptoms are presents. When yeasts grow in blood cultures other genera than Candida spp. could be the cause of infection. Patient risk factors should be assessed to incorporate alternative culture media and the available rapid diagnostic test, in order to provide an early recognition of the pathogen.

Staphylococcus aureus Nasal Colonization in Spanish Children. The COSACO Nationwide Surveillance Study.

OBJECTIVE: To assess the prevalence and risk factors for S. aureus and methicillin-resistant S. aureus (MRSA) nasal colonization in Spanish children. METHODS: Cross-sectional study of patients <14 years from primary care centers all over Spain. Clinical data and nasal aspirates were collected from March to July 2018. RESULTS: A total of 1876 patients were enrolled. Prevalence of S. aureus and MRSA colonization were 33% (95% CI 30.9-35.1) and 1.44% (95% CI 0.9-2), respectively. Thirty-three percent of the children (633/1876) presented chronic conditions, mainly atopic dermatitis, asthma and/or allergy (524/633). Factors associated with S. aureus colonization were age ≥5 years (OR 1.10, 95% CI 1.07-1.12), male sex (OR 1.43, 95% CI 1.17-1.76), urban setting (OR 1.46, 95% CI 1.08-1.97) and the presence of asthma, atopic dermatitis or allergies (OR 1.25; 95% CI: 1.093-1.43). Rural residence was the only factor associated with MRSA colonization (OR 3.62, 95% CI 1.57-8.36). MRSA was more frequently resistant than methicillin-susceptible S. aureus to ciprofloxacin [41.2% vs 2.6%; p<0.0001], clindamycin [26% vs 16.9%; p=0.39], and mupirocin [14.3% vs 6.7%; p=0.18]. None of the MRSA strains was resistant to tetracycline, fosfomycin, vancomycin or daptomycin. CONCLUSIONS: The main risk factors for S. aureus colonization in Spanish children are being above five years of age, male gender, atopic dermatitis, asthma or allergy, and residence in urban areas. MRSA colonization is low, but higher than in other European countries and is associated with rural settings.

Effect of vitamin E administered to men in infertile couples on sperm and assisted reproduction outcomes: a double-blind randomized study.

OBJECTIVE: To evaluate the influence on sperm parameters and in vitro fertilization (IVF) outcomes of the administration of 400 mg/day of vitamin E for 3 months to men from infertile couples who are undergoing IVF. DESIGN: Double-blind, placebo-controlled, randomized study. SETTING: Human reproduction unit of a university hospital. PATIENTS: A total of 101 couples, 50 in the vitamin E group and 51 in the placebo group, undergoing IVF, among whom 64.4% of cases had an abnormal spermiogram according to World Health Organization (WHO) criteria. INTERVENTIONS: Vitamin E (α-tocopherol), 400 mg daily by mouth for 3 months, with sperm analysis performed immediately before starting the treatment and 3 months later on the day of IVF. MAIN OUTCOME MEASURES: WHO sperm parameters and IVF outcomes. RESULTS: Although there was a statistically significant increase in progressive motility in the vitamin E group compared with before-treatment values, a similar increase occurred in the placebo group. Normal morphology was even better in the placebo group. Regarding IVF outcomes, better fertilization rates were observed in the placebo group, but the live-birth rate per transfer was statistically significantly higher in the vitamin E group: 17 (41.46%) of 41 versus 9 (20.46%) of 44 in the placebo group. Although the clinical pregnancy rates (both per transfer and per cycle started) and the implantation rate were somewhat higher in the vitamin E group (43.9% and 25%; 36.0% and 22.0%; and 24.7% and 14.1%, respectively), the increase was not statistically significant. CONCLUSIONS: The effect of vitamin E on classic sperm parameters was not an improvement over placebo. Nonetheless, vitamin E administration was associated with a statistically significantly higher live-birth rate, and there was a trend toward better results in other IVF parameters. CLINICAL TRIAL REGISTRATION NUMBER: Eudra CT 2007-000960-25.

Estrategia de enfrentamiento a la COVID-19 en la Universidad de Ciencias Médicas Guantánamo / Strategy to face COVID-19 at the Universidad de Ciencias Médicas Guantánamo

Introducción: La pandemia de la COVID-19, al igual que en otras esferas de la vida social, ha tenido impacto en la educación médica. Objetivo: Exponer las experiencias de la aplicación de la estrategia de enfrentamiento a la COVID-19 en el proceso formativo de pregrado en la Universidad de Ciencias Médicas Guantánamo. Método: Se realizó un estudio descriptivo con recolección retrospectiva de la información, mediante la revisión documental de las resoluciones dictadas por el Ministerio de Salud Pública de Cuba y las que emergieron desde estas en la Universidad de Ciencias Médicas Guantánamo para la reorganización del proceso formativo de pregrado durante la pandemia. Resultados: En el proceso formativo de pregrado en la Universidad de Ciencias Médicas Guantánamo, la estrategia de enfrentamiento a esta pandemia se sustentó en cuatro pilares básicos: capacitación de los estudiantes, profesores y trabajadores en temas de bioseguridad y protocolos de enfrentamiento, ajustes curriculares en cada una de las carreras de las ciencias médicas, utilización de la educación a distancia mediante el uso de plataformas virtuales y la incorporación de los estudiantes y profesores a la pesquisa activa. Se explicitaron los contenidos de cada uno de ellos. Conclusiones: La estrategia de enfrentamiento a esta pandemia determinó modificaciones en el proceso formativo de pregrado en la Universidad de Ciencias Médicas Guantánamo, acordes a las exigencias sociales del país, lo que asegura la continuidad del proceso de enseñanza aprendizaje(AU)

Introduction: COVID-19 pandemic as well as other spheres of social life have had great impact in medical education. Objective: To promote the experiences acquired during the application of the strategy to confront the COVID-19 pandemic within the undergraduate training process at the Universidad de Ciencias Médicas Guantánamo. Method: A descriptive study collecting historical information of the topic was carried out, making a documental analysis of the Ministerio de Salud Pública de Cuba decisions issued, and the ones issued by the Universidad de Ciencias Médicas Guantánamo to reorganize the undergraduate training process during the pandemic. Results: The undergraduate training process at the Universidad de Ciencias Médicas Guantánamo used a strategy to confront the pandemic formed by 4 main basis: students, professors and workers training in biosafety requirements and confrontational protocols, curricular adjustments in each medical science major, the use of a distance learning program based on the virtual platforms, and the active epidemiologic inquiries made by students and professors. All details were explicitly informed. Conclusions: The strategy used to confront the pandemic caused some modifications in the undergraduate training process at the Universidad de Ciencias Médicas Guantánamo, following to the social demands in Cuba, which ensure the continuity of the teaching-learning process(AU)

Estrategia de enfrentamiento a la COVID-19 en la Universidad de Ciencias Médicas Guantánamo / Strategy to face COVID-19 at the Universidad de Ciencias Médicas Guantánamo

RESUMEN Introducción: La pandemia de la COVID-19, al igual que en otras esferas de la vida social, ha tenido impacto en la educación médica. Objetivo: Exponer las experiencias de la aplicación de la estrategia de enfrentamiento a la COVID-19 en el proceso formativo de pregrado en la Universidad de Ciencias Médicas Guantánamo. Método: Se realizó un estudio descriptivo con recolección retrospectiva de la información, mediante la revisión documental de las resoluciones dictadas por el Ministerio de Salud Pública de Cuba y las que emergieron desde estas en la Universidad de Ciencias Médicas Guantánamo para la reorganización del proceso formativo de pregrado durante la pandemia. Resultados: En el proceso formativo de pregrado en la Universidad de Ciencias Médicas Guantánamo, la estrategia de enfrentamiento a esta pandemia se sustentó en cuatro pilares básicos: capacitación de los estudiantes, profesores y trabajadores en temas de bioseguridad y protocolos de enfrentamiento, ajustes curriculares en cada una de las carreras de las ciencias médicas, utilización de la educación a distancia mediante el uso de plataformas virtuales y la incorporación de los estudiantes y profesores a la pesquisa activa. Se explicitaron los contenidos de cada uno de ellos. Conclusiones: La estrategia de enfrentamiento a esta pandemia determinó modificaciones en el proceso formativo de pregrado en la Universidad de Ciencias Médicas Guantánamo, acordes a las exigencias sociales del país, lo que asegura la continuidad del proceso de enseñanza aprendizaje.

ABSTRACT Introduction: COVID-19 pandemic as well as other spheres of social life have had great impact in medical education. Objective: To promote the experiences acquired during the application of the strategy to confront the COVID-19 pandemic within the undergraduate training process at the Universidad de Ciencias Médicas Guantánamo. Method: A descriptive study collecting historical information of the topic was carried out, making a documental analysis of the Ministerio de Salud Pública de Cuba decisions issued, and the ones issued by the Universidad de Ciencias Médicas Guantánamo to reorganize the undergraduate training process during the pandemic. Results: The undergraduate training process at the Universidad de Ciencias Médicas Guantánamo used a strategy to confront the pandemic formed by 4 main basis: students, professors and workers training in biosafety requirements and confrontational protocols, curricular adjustments in each medical science major, the use of a distance learning program based on the virtual platforms, and the active epidemiologic inquiries made by students and professors. All details were explicitly informed. Conclusions: The strategy used to confront the pandemic caused some modifications in the undergraduate training process at the Universidad de Ciencias Médicas Guantánamo, following to the social demands in Cuba, which ensure the continuity of the teaching-learning process.

Efficacy of an information system addressed to nursing staff for diminishing contaminated blood cultures: a blind clinical trial / Eficacia de un sistema de información dirigido al personal de enfermería para disminuir la contaminación de los hemocultivos: un ensayo clínico ciego

Introduction: Evaluate the efficacy of an information system addressed to nursing staff to lower the blood culture contamination rate. Methods: A blind clinical trial was conducted at Internal Medicine and Emergency Departments during 2011. After following a reeducation program in BC extraction, participants were randomly selected in a 1:1 ratio. Every participant of the experimental group was informed of each worker's individual performance; whereas the control group was only informed of the global results. Results: A total of 977 blood extractions were performed in 12 months. Blood culture contamination rate was 7.5%. This rate was higher in the Emergency Department than in Internal Medicine (10% vs. 3.8%; p=0.001). Factors associated with the higher risk of contamination were, in the univariate analysis, the extraction through a recently implanted blood route and the time of professional experience, while those associated with a lower risk were the extraction in Internal Medicine and through a butterfly needle. On multivariate analysis, extraction through a recently placed access was an independent risk factor for an increased contamination rate (OR 2.29; 95%CI 1.18-4.44, p=0.014), while individual information about the blood culture results (OR 0.11; 95%CI 0.023-0.57; p=0.008), and more than 9 years of professional experience were asso-ciated with fewer contaminations (OR 0.30; 95%CI 0.12-0.77; p=0.012). In the intervention group the contamination rate diminished by a 26 %. Conclusions: Drawing blood cultures through a recently taken peripheral venous access increased their risk of contamination. The intervention informing the nurse staff of the contamination rate is effective to decrease it

Objetivos: Evaluar la eficacia de un sistema de información dirigido al personal de enfermería, en la reducción de la tasa de contaminación de los hemocultivos. Métodos: Durante el año 2011, se realizó un ensayo clínico en los servicios de Medicina Interna y de Urgencias. Después de seguir un programa de reeducación en la extracción de los hemocultivos, los participantes, fueron aleatorizados en una proporción de 1:1. En el grupo de intervención se informó del porcentaje de hemocultivos contaminados de cada profesional y en el grupo control se aportaba la información del porcentaje global de contaminaciones. Resultados: Durante un periodo de 12 meses se realizaron 977 extracciones. La tasa de contaminación de los hemocultivos fue del 7,5%. Esta tasa fue mayor en Urgencias que en Medicina Interna (10% versus 3,8%, p=0,001). Los factores asociados con mayor riesgo de contaminación fueron, en el análisis univariable: la extracción a través de una vía sanguínea recientemente implantada y el tiempo de experiencia profesional; mientras que los que se asociaron con menor riesgo fueron la extracción en Medicina Interna (versus en Urgencias) y a través de una palomilla. En el análisis multivariable, la extracción de los hemocultivos de una vía recientemente implantada se relacionó de forma independiente con un incremento de las contaminaciones (OR 2,29, IC 95% 1,18-4,44, p=0,014),mientras que la información individual sobre los resultados de los hemocultivos (OR 0.11; IC 95% 0,023-0,57; p=0,008) y la experiencia profesional mayor de 9 años, lo hizo con menos contaminaciones (OR 0,30, IC 95% 0,12-0,77, p=0,012). En el grupo de intervención la tasa de contaminaciones se redujo en un 26%. Conclusión: La extracción de hemocultivos a través de una vena periférica recientemente implantada aumentó el riesgo de contaminación de los mismos. La intervención informativa a los enfermeros de la tasa de contaminación de los hemocultivos, es eficaz para disminuirla

Enfermedad de Alzheimer, algunos factores de riesgo modificables / Alzheimer's disease, some modifiable risk factors

Introducción: la demencia es un trastorno de la cognición que interfiere en el funcionamiento de la vida diaria y produce una pérdida de la independencia. Su prevalencia e incidencia se incrementan con la edad avanzada. Se realizó una revisión bibliográfica actualizada que consistió en una búsqueda en revistas especializadas en el tema, se revisaron trabajos en idioma español e inglés y fueron incluidas investigaciones de diverso diseño de autores prestigiosos en el tema. Objetivo: actualizar la evidencia disponible sobre los factores de riesgo modificables que se asocian a la enfermedad de Alzheimer (EA). Desarrollo: en las últimas décadas, los estudios epidemiológicos revelan varios factores de riesgo para el desarrollo de esta entidad, entre los que aparecen los factores relacionados con el estilo de vida. Estrategias poblacionales de modificación de estos factores podrían potencialmente evitar algunos casos de Alzheimer. Conclusiones: las estrategias poblacionales deben comprender un esfuerzo global que involucre población supuestamente saludable, profesionales de la salud, y la comunidad, para modificar el modo y estilo de vida dirigida a los factores modificables, de manera que contribuyan al conocimiento de la enfermedad a su manejo y al retardo de su aparición(AU)

Introduction: dementia is a disorder of cognition that interferes with the functioning of daily life and produces a loss of independence. Its prevalence and incidence increase with advanced age. An updated bibliographical review was carried out, which consisted of a search of specialized journals on the subject, works in Spanish and English were reviewed, and investigations of diverse design by prestigious authors on the subject were included. Objective: to update the available evidence on the modifiable risk factors associated with Alzheimer's disease (AD). Development: in recent decades, epidemiological studies reveal several risk factors for the development of this entity, among which appear the factors related to lifestyle. Population strategies for modifying these factors could potentially prevent some cases of Alzheimer's. Conclusions: Population strategies must include a global effort involving the supposedly healthy population, health professionals, and the community, to modify the way and style of life directed to the modifiable factors, so that they contribute to the knowledge of the disease to its management and the delay of its appearance(AU)

Introdução: a demência é um distúrbio da cognição que interfere no funcionamento da vida cotidiana e produz uma perda de independência. Sua prevalência e incidência aumentam com a idade avançada. Realizou-se uma revisão bibliográfica atualizada, que consistiu na busca de periódicos especializados sobre o tema, trabalhos em espanhol e inglês, além de investigações de desenho diversificado por prestigiados autores sobre o assunto. Objetivo: atualizar as evidências disponíveis sobre os fatores de risco modificáveis associados à doença de Alzheimer (DA). Desenvolvimento: nas últimas décadas, estudos epidemiológicos revelam vários fatores de risco para o desenvolvimento dessa entidade, dentre os quais aparecem os fatores relacionados ao estilo de vida. Estratégias populacionais para modificar esses fatores poderiam potencialmente prevenir alguns casos de Alzheimer. Conclusões: As estratégias populacionais devem incluir um esforço global envolvendo a população supostamente saudável, os profissionais de saúde e a comunidade, para modificar o modo e o estilo de vida direcionados aos fatores modificáveis, de modo que contribuam para o conhecimento da doença até o seu desenvolvimento. gestão e o atraso do seu aparecimento(AU)

Proteomic pattern of implantative human endometrial fluid in in vitro fertilization cycles.

PURPOSE: To assess whether there are proteins in endometrial fluid aspirate (EFA) that predict implantation. METHODS: The population under study consisted of 285 women undergoing embryo transfer (ET). Endometrial fluid aspiration was performed immediately before ET. Results of proteomic analysis of EFA were compared between 33 cases who achieved pregnancy and 33 who did not. Samples were analysed by 2D electrophoresis and mass spectrometry. Blood samples were studied by ELISA Pregnancy rates and maternal complications were compared to those in women refusing aspiration. RESULTS: We found 23 proteins differentially expressed in the EFA in conception cycles: 4 up-regulated proteins and 19 down-regulated (FC = 0.31 0.78) (among others, arginase-1, actin B, PARK-7, cofilin-1, stathmin, annexin-2 and CAPZB). Among the five studied proteins that were differentially expressed in EFA, none was differentially expressed in serum. The aspiration procedure had no impact on pregnancy rate. No maternal complications were reported. CONCLUSIONS: We found a very different protein profile in implantative cycles, the majority of proteins being down-regulated. This probably reflects a different endometrial functional status, more favourable to implantation. EFA proteomic analysis could be a useful tool in the planning ET strategies.

Experiencias en la implementación de la disciplina Bases Biológicas de la Medicina en el plan de estudio D / Experiences in the implementation of the discipline Biological Bases of Medicine in the study plan

Se realizó este trabajo con el objetivo de describir las experiencias en la implementación de la disciplina Bases Biológicas de la Medicina (BBM) en el plan D del primer año de la carrera de Medicina en la Universidad de Ciencias Médicas de Guantánamo, identificar las deficiencias en la ejecución del mismo y generar soluciones adecuadas para el mejoramiento de la calidad del proceso formativo. Se utilizaron métodos descriptivos para reflejar las características de esos procesos y resultados. Se partió de un análisis histórico lógico del contexto local. Se estudiaron documentos y se realizaron entrevistas grupales y criterios de expertos. Se identificaron fortalezas, debilidades y se realizaron propuestas de soluciones para cada una de las deficiencias identificadas(AU)

This work aims to describe the experiences in the implementation of the discipline Biological Bases of Medicine in plan "D" of the first year of the medical course at the University of Medical Sciences of Guantanamo, identify deficiencies in the execution of the same and generate Adequate solutions for the improvement of the quality of the training process. Descriptive methods were used to reflect the characteristics of those processes and results. It was based on a logical historical analysis of the local context. Documents were studied and group interviews and expert criteria were carried out. Strengths and weaknesses were identified and solutions were proposed for each of the identified deficiencies(AU)

Enfermedad de Alzheimer, algunos factores de riesgo modificables / Doença de Alzheimer, alguns fatores de risco modificáveis / Alzheimer's disease, some modifiable risk factors

Introducción: la demencia es un trastorno de la cognición que interfiere en el funcionamiento de la vida diaria y produce una pérdida de la independencia. Su prevalencia e incidencia se incrementan con la edad avanzada. Se realizó una revisión bibliográfica actualizada que consistió en una búsqueda en revistas especializadas en el tema, se revisaron trabajos en idioma español e inglés y fueron incluidas investigaciones de diverso diseño de autores prestigiosos en el tema. Objetivo: actualizar la evidencia disponible sobre los factores de riesgo modificables que se asocian a la enfermedad de Alzheimer (EA). Desarrollo: en las últimas décadas, los estudios epidemiológicos revelan varios factores de riesgo para el desarrollo de esta entidad, entre los que aparecen los factores relacionados con el estilo de vida. Estrategias poblacionales de modificación de estos factores podrían potencialmente evitar algunos casos de Alzheimer. Conclusiones: las estrategias poblacionales deben comprender un esfuerzo global que involucre población supuestamente saludable, profesionales de la salud, y la comunidad, para modificar el modo y estilo de vida dirigida a los factores modificables, de manera que contribuyan al conocimiento de la enfermedad a su manejo y al retardo de su aparición(AU)

Introduction: dementia is a disorder of cognition that interferes with the functioning of daily life and produces a loss of independence. Its prevalence and incidence increase with advanced age. An updated bibliographical review was carried out, which consisted of a search of specialized journals on the subject, works in Spanish and English were reviewed, and investigations of diverse design by prestigious authors on the subject were included. Objective: to update the available evidence on the modifiable risk factors associated with Alzheimer's disease (AD). Development: in recent decades, epidemiological studies reveal several risk factors for the development of this entity, among which appear the factors related to lifestyle. Population strategies for modifying these factors could potentially prevent some cases of Alzheimer's. Conclusions: Population strategies must include a global effort involving the supposedly healthy population, health professionals, and the community, to modify the way and style of life directed to the modifiable factors, so that they contribute to the knowledge of the disease to its management and the delay of its appearance(AU)

Introdução: a demência é um distúrbio da cognição que interfere no funcionamento da vida cotidiana e produz uma perda de independência. Sua prevalência e incidência aumentam com a idade avançada. Realizou-se uma revisão bibliográfica atualizada, que consistiu na busca de periódicos especializados sobre o tema, trabalhos em espanhol e inglês, além de investigações de desenho diversificado por prestigiados autores sobre o assunto. Objetivo: atualizar as evidências disponíveis sobre os fatores de risco modificáveis associados à doença de Alzheimer (DA). Desenvolvimento: nas últimas décadas, estudos epidemiológicos revelam vários fatores de risco para o desenvolvimento dessa entidade, dentre os quais aparecem os fatores relacionados ao estilo de vida. Estratégias populacionais para modificar esses fatores poderiam potencialmente prevenir alguns casos de Alzheimer. Conclusões: As estratégias populacionais devem incluir um esforço global envolvendo a população supostamente saudável, os profissionais de saúde e a comunidade, para modificar o modo e o estilo de vida direcionados aos fatores modificáveis, de modo que contribuam para o conhecimento da doença até o seu desenvolvimento. gestão e o atraso do seu aparecimento(AU)

Experiencias en la implementación de la disciplina Bases Biológicas de la Medicina en el plan de estudio D / Experiences in the implementation of the discipline Biological Bases of Medicine in the study plan D

Se realizó este trabajo con el objetivo de describir las experiencias en la implementación de la disciplina Bases Biológicas de la Medicina (BBM) en el plan "D" del primer año de la carrera de Medicina en la Universidad de Ciencias Médicas de Guantánamo, identificar las deficiencias en la ejecución del mismo y generar soluciones adecuadas para el mejoramiento de la calidad del proceso formativo. Se utilizaron métodos descriptivos para reflejar las características de esos procesos y resultados. Se partió de un análisis histórico lógico del contexto local. Se estudiaron documentos y se realizaron entrevistas grupales y criterios de expertos. Se identificaron fortalezas, debilidades y se realizaron propuestas de soluciones para cada una de las deficiencias identificadas(AU)

This work aims to describe the experiences in the implementation of the discipline Biological Bases of Medicine in plan "D" of the first year of the medical course at the University of Medical Sciences of Guantanamo, identify deficiencies in the execution of the same and generate Adequate solutions for the improvement of the quality of the training process. Descriptive methods were used to reflect the characteristics of those processes and results. It was based on a logical historical analysis of the local context. Documents were studied and group interviews and expert criteria were carried out. Strengths and weaknesses were identified and solutions were proposed for each of the identified deficiencies(AU)

XV Aniversario Cátedra "Prevención de Drogodependencias" / 15th Anniversary "Prevention of Drug Addiction" Chair

La Cátedra "Prevención de Drogodependencias", de la Universidad de Ciencias Médicas de Guantánamo, fue la primera creada sobre el tema de prevención de drogas en las universidades médicas ubanas, el 11 de noviembre de 2001. El presente trabajo recrea el accionar de esta cátedra durante 15 años, da a conocer los principales objetivos, funciones, composición de la misma y los resultados obtenidos por los grupos de trabajo en la labor realizada con y por los estudiantes de diferentes carreras y años de estudios, de todas las universidades guantanameras. Se expone la participación intersectorial, con la participación de profesionales de la salud, educación, justicia, MININT y organizaciones de masas, además de la participación comunitaria en los Consejos Populares Pastorita, San Justo y Sur Isleta del municipio Guantánamo

The "Prevention of Drug Addiction" Chair of the University of Medical Sciences of Guantanamo as the first one created on the subject of drug prevention at Cuban medical universities, on November 11, 2001. The present work compiles the actions of this chair over 15 years and reveals the main objectives, functions, composition and results obtained by the working groups in the work carried out with and by students of different courses and years of studies of all the Guantanamo universities. Intersectoral participation is described, with the participation of healthcare, education, justice professionals, MININT and mass organizations, in addition to community participation in the Pastorita, San Justo and Sur Isleta Popular Councils of Guantanamo municipality

Enfermedad de Alzheimer, algunos factores de riesgo modificables / Alzheimer's disease, some modifiable risk factors

Se realizó una revisión con el objetivo de actualizar la evidencia disponible sobre los factores de riesgo modificables que se asocian a la enfermedad de Alzheimer (EA). En las últimas décadas, los estudios epidemiológicos revelan varios factores de riesgo para el desarrollo de esta entidad, entre los que aparecen los factores relacionados con el estilo de vida. Estrategias poblacionales de modificación de estos factores podrían potencialmente evitar algunos casos de Alzheimer. El estudio realizado consistió en una búsqueda en revistas especializadas en el tema, se revisaron trabajos en idioma español e inglés y fueron incluidas investigaciones de diverso diseño de autores prestigiosos en el tema(AU)

A review was performed to update available evidence on modifiable risk factors associated with Alzheimer's disease (AD). In the last decades, epidemiological studies revealed several risk factors for the development of this entity, appearing the factors related to the lifestyle. Population strategies for modifying these factors could prevent some cases of Alzheimer's. The study consisted of a search in specialized journal in the subject, was reviewed works in Spanish and English language and included investigations of diverse design of prestigious authors in the subject(AU)

Modelo para la dirección de la estrategia educativa de la carrera de Medicina / Model for the direction of the educational strategy of the medical career

El objetivo del trabajo fue presentar un modelo para la dirección de la estrategia educativa de la carrera de Medicina, que supere las orientaciones que al respecto ofrece el Plan de Estudios D; aunque, a la vez, las tenga en cuenta. El modelo propuesto se diseñó mediante la aplicación del método de planificación estratégica al proceso docente-educativo. De este modo, se obtiene un modelo que constituye una genuina estrategia para la dirección, planificación, control y evaluación del trabajo educativo a nivel de la carrera; la cual se caracteriza por su objetividad, integralidad y rigor científico(AU)

The objective of this work is to present a model for the direction of the educational strategy of the medical career, which surpasses the mere orientations that, in this respect, gives Curriculum D; although, at the same time, it takes them into account. The proposed model was designed through the application of the strategic planning method to the educational-educational process. In this way, a model is obtained that constitutes a genuine strategy for the direction, planning, control and evaluation of the educational work at the level of the race; Which is characterized by its objectivity, integrity and scientific rigor(AU)

Estrategia para perfeccionar el proceso de formación doctoral en las Ciencias Médicas de Cuba / Strategy to improve the process of doctoral training in the Medical Sciences of Cuba

Se realizó una investigación durante el período enero - abril de 2016 que ofreció una panorámica del desarrollo del doctorado en las ciencias médicas con el objetivo de diseñar líneas estratégicas para perfeccionar el proceso de la formación doctoral que de respuesta a las exigencias por la calidad en la formación en las Universidades de Ciencias Médicas. Fueron utilizados métodos cuantitativos y cualitativos, así como diferentes técnicas de investigación. Se identificaron seis causas fundamentales, las cuales interfieren en el proceso de formación doctoral y para lo cual se propusieron acciones a corto y largo plazos que por su integralidad dieron respuesta a la problemática planteada. Se identificó como problema que, a pesar del nivel y el prestigio alcanzado por las Especialidades Médicas Cubanas en su perfeccionamiento continuo, en la etapa actual, existe una lenta formación hacia el doctorado no correspondiente al claustro profesoral de las Universidades. Se arribó a conclusiones y recomendaciones que contribuirán al mejoramiento de la problemática objeto de la investigación(AU)

An investigation was carried out during the period January - April of 2016 that offered an overview of the development of the doctorate in the medical sciences with the objective of designing strategic lines to perfect the process of the doctoral training that in response to the demands for the quality in the Training in the Universities of Medical Sciences. Quantitative and qualitative methods were used, as well as different research techniques. Six fundamental causes were identified, which interfered in the doctoral training process and for which short-term and long-term actions were proposed that, due to their completeness, responded to the problems raised. It was identified as a problem that, despite the level and prestige reached by the Cuban Medical Specialties in their continuous improvement, at the present stage, there is a slow formation towards the doctorate not corresponding to the professorial faculty of the Universities. We reached conclusions and recommendations that will contribute to the improvement of the problem that is the object of the research(AU)

Patogenia de la enfermedad de alzheimer. Actualización / Pathogenesis of the Alzheimer disease. Update

La enfermedad de alzheimer afecta en el mundo a 25 millones de personas y es la causa más frecuente de demencia en los países occidentales. La causa o causas de la enfermedad permanecen aún desconocidas, por lo que actualmente no existe ningún tratamiento curativo. Su relación con la edad avanzada y el progresivo envejecimiento poblacional existente hacen que sea una patología de elevada prevalencia e incidencia. Existen diferentes teorías que tratan de explicar las causas moleculares de esta enfermedad. Este trabajo de revisión tiene como propósito profundizar en la fisiopatología de la enfermedad de alzheimer, así como en las estrategias terapéuticas empleadas en la actualidad (AU)

Patogenia de la aterosclerosis / Pathogeny of the arteriosclerosis

La enfermedad cardiovascular arteriosclerótica es una alteración compleja en la que participan una serie de factores moleculares, genéticos, medioambientales. Las concentraciones plasmáticas elevadas de lipoproteínas de baja densidad son un factor de riesgo para el desarrollo prematuro de la aterosclerosis y cardiopatía isquémica. Las lipoproteínas de baja densidad oxidadas por los radicales libres intervienen en prácticamente todas las etapas del proceso de formación de la placa de ateroma. En la arteriogénesis intervienen múltiples factores de crecimiento, citokinas y otras sustancias producidas por las células endoteliales, las células de músculo liso y los linfocitos T que regulan la respuesta inflamatoria y la proliferación celular. Este trabajo de revisión tiene como propósito profundizar en la fisiopatología molecular de la aterosclerosis(AU)