Fatal case of HBV-liver failure after withdrawal of antiviral treatment.

We report a case of fatal HBV reactivation in a patient with chronic hepatitis B infection HBeAg-, who was withdrawn from antiviral therapy.. We think that it may be a warning of risks that this clinical decision may entail.

Características del trauma ocular en pacientes diagnosticados con catarata traumática / Characteristics of Ocular Trauma in Patients Diagnosed with Traumatic Cataract

Objetivo: Determinar las características del trauma ocular en pacientes diagnosticados con catarata traumática. Métodos: Se realizó un estudio observacional descriptivo de corte transversal con 335 pacientes diagnosticados con catarata traumática. Las variables incluyeron edad, sexo, ojo afectado, lugar de ocurrencia del trauma, uso de protección en el entorno laboral, tipo de trauma ocular, daños asociados, morfología de la catarata y zona de lesión. Resultados: La edad promedio de los pacientes fue de 52,2 ± 14,8 años. Se observó un predominio del sexo masculino (75,5 por ciento) y la mayoría de los casos presentaron un trauma ocular cerrado (70,4 por ciento). El ojo derecho fue más afectado (64,8 por ciento). En cuanto al lugar de ocurrencia del traumatismo ocular, el 49,9 por ciento de los casos se produjo en el contexto laboral, y la mayoría de los pacientes que experimentaron un trauma ocular abierto no utilizaban protección ocular. Las lesiones asociadas más comunes fueron el aumento de la presión intraocular, la ruptura de la cápsula y las sinequias, la diálisis del iris. En cuanto a la morfología de las cataratas, se observó que predominaba la opacidad total. Conclusiones: Este estudio subraya la importancia de estrategias preventivas, especialmente en entornos laborales propensos a lesiones oculares. La falta de protección ocular en casos de trauma ocular abierto enfatiza la necesidad de concienciar a la población sobre la importancia de medidas de seguridad adecuadas. Estos hallazgos pueden guiar intervenciones clínicas y políticas de salud pública para reducir la incidencia y las secuelas de la catarata traumática(AU)

Objective: Determine the characteristics of ocular trauma in patients diagnosed with traumatic cataract. Methods: A cross-sectional descriptive observational study was carried out with 335 patients diagnosed with traumatic cataract. The variables included age, sex, affected eye, location of trauma occurrence, use of protection in the work environment, type of ocular trauma, associated damage, cataract morphology and area of injury. Results: The average age of the patients was 52.2 ± 14.8 years. A predominance of males was observed (75.5 percent) and the majority of cases presented blunt ocular trauma (70.4 percent). The right eye was more affected (64.8 percent). Regarding the place of occurrence of ocular trauma, 49.9 percent of cases occurred in the work context, and the majority of patients who experienced open ocular trauma did not use eye protection. The most common associated injuries were increased intraocular pressure, capsule rupture and synechiae, iris dialysis. Regarding the morphology of the cataracts, it was observed that total opacity predominated. Conclusions: This study highlights the importance of preventive strategies, especially in work environments prone to eye injuries. The lack of eye protection in cases of open eye trauma emphasizes the need to raise public awareness about the importance of adequate safety measures. These findings may guide clinical interventions and public health policies to reduce the incidence and sequelae of traumatic cataract(AU)

Transforming food systems: a gendered perspective on local agricultural innovation in Cuba.

Compared to many countries, Cuba has made significant progress in advancing women's rights and gender equity; however, disparities remain. In the country's rural communities and agricultural sector, women continue to face barriers to equal participation and recognition for the value of their work. This case study shares the story of gender equity efforts that have been conducted within the framework of a broader development project-the Project to Strengthen a System of Innovation in Local Agricultural Development (PIAL, for its initials in Spanish). PIAL began in 2001 as a participatory plant-breeding initiative aimed at increasing the genetic diversity of key crops such as maize and beans. Over the course of two decades, the project's goals expanded to include an emphasis on increasing women's participation. In the beginning, those efforts focused on including women in the participatory plant-breeding activities, which enabled them to prioritize traits they cared about such as grain texture, cooking speed, and taste in the selection process. Over time, the participatory nature of the PIAL methodology empowered women to identify and pursue capacity-building in other areas of local agricultural innovation. While PPB remained central to PIAL, women also chose to pursue opportunities in seed bank management, leadership training, and small-scale farm-based entrepreneurship. The results of the PIAL work on gender have included not just more inclusive plant breeding, but also important economic improvements for rural women as they have been able to diversify their livelihoods, and social change as they have gained confidence and recognition as leaders in their households, communities, and beyond.

Estudio de la calidad asistencial prestada en consultas externas a pacientes con cirrosis hepática / No disponible

INTRODUCCIÓN: la calidad de la asistencia prestada a los pacientes cirróticos se puede medir analizando una serie de indicadores. Los estudios publicados hasta la actualidad muestran una tasa de adherencia a las indicaciones de las guías clínicas del 40-80 %. OBJETIVO: valorar la calidad de la asistencia prestada en un hospital docente de tercer nivel. MÉTODOS: estudio observacional retrospectivo en pacientes cirróticos controlados durante un semestre en consultas externas. Se han revisado 324 historias clínicas recogiendo 14 indicadores de calidad de cinco dominios diferentes y se ha estudiado la adherencia global y en relación a la experiencia del médico responsable. RESULTADOS: excelentes (más del 90 % de adherencia) en indicadores relacionados con documentación de la etiología de la cirrosis y profilaxis de la hemorragia digestiva por varices; aceptables (60-90 %) en despistaje del carcinoma hepatocelular y valoración de la gravedad de la enfermedad; y malos (menos del 50 %) en vacunaciones. Los residentes obtuvieron significativamente mejores resultados que los adjuntos en etiología, valoración de la gravedad y dos indicadores de profilaxis de hemorragia digestiva. Por su parte, los adjuntos presentaron mejores resultados en el despistaje de carcinoma hepatocelular. CONCLUSIONES: a pesar de haber obtenido excelentes resultados en algunos indicadores, muchos deben ser mejorados, especialmente las vacunaciones. La calidad asistencial prestada por los residentes es igual o incluso mejor que la prestada por los adjuntos. Analizar la calidad asistencial es esencial para medir y mejorar la atención prestada a los pacientes cirróticos, y puede ser una herramienta muy eficaz para supervisar a los especialistas en formación

No disponible

Quality of care provided to outpatients with hepatic cirrhosis in a teaching hospital.

INTRODUCTION: a set of indicators to measure the quality of care of cirrhotic patients has been established and previously published studies report an adherence rate to clinical guide indications of 40-80 %. OBJECTIVE: to assess the adherence to quality indicators in a tertiary teaching hospital. METHODS: a retrospective observational study was performed of all cirrhotic outpatients seen during one semester in 2017. The charts were studied of 324 patients and quality indicators related to five domains were collected. An overall adherence to 14 quality indicators was recorded and analyzed based on the attending physician's experience. RESULTS: the results were excellent (more than 90 % adherence) for quality indicators related to prophylaxis of variceal bleeding and documentation of cirrhosis etiology, acceptable (60-90 % adherence) for hepatocellular carcinoma screening and disease severity assessment, and poor (less than 50 %) for vaccinations. Residents had significantly better results than experienced physicians in etiology, disease severity assessment and two indicators of prophylaxis of bleeding. Experienced physicians only presented a better adherence to hepatocellular carcinoma screening. CONCLUSIONS: despite excellent results for some quality indicators, most required improvement, especially vaccinations. The quality of care achieved by residents is equal to and even better than that of experienced physicians. Measuring quality of care is essential to analyze and improve the health care of cirrhotic outpatients and may be a useful tool for supervising specialists in training.

Criterios campesinos para la selección de maíz (Zea mays L.) en Villaflores y Villa Corzo, Chiapas, México / Farmers' criteria for maize (Zea maysL.) selection in Villaflores and Villa Corzo, Chiapas, Mexico

RESUMEN La producción de maíz en Chiapas implica la decisión de cultivar maíces locales o híbridos. Estos últimos, tienen rendimientos más altos, pero requieren mayor cantidad de insumos, asociados con la degradación de suelos, contaminación del agua, pérdida de diversidad genética y del conocimiento sobre las variedades locales. El objetivo de esta investigación fue identificar los criterios que usan los pequeños productores, en la selección del material genético, para la siembra de maíz en los municipios de Villaflores y Villa Corzo, Chiapas. Se realizaron entrevistas semi-estructuradas a productores participantes del programa ASERCA. El maíz híbrido presentó mayor preferencia en ambos municipios, aunque algunos productores prefirieron los maíces locales o cultivaron ambos, por razones de usos y costumbres. La selección de maíces híbridos en los dos municipios se hizo principalmente con base en el rendimiento, seguido de la mayor resistencia a plagas y enfermedades. Otros criterios empleados para elegir semillas híbridas fueron: mayor resistencia al acame, mayor resistencia a la humedad, menor altura a la planta, menor pudrición de semillas y mayor tolerancia a la sequía. En maíces locales, el rendimiento fue un parámetro de importancia en ambos municipios, pero la mayor resistencia a plagas y enfermedades fue solo considerada en Villa Corzo. Y el mejor precio de venta del grano no se consideró en ninguno de los dos municipios. Otros criterios empleados para seleccionar las semillas locales fueron: mayor tolerancia a la sequía, menor costo de la semilla, mayor tamaño de la mazorca, interés por conservar dicho material, mejor sabor y permitir la rotación de variedades locales. Las seis características deseables a mejorar en el maíz local fueron: una menor altura de planta, un mayor rendimiento, una mayor resistencia a la humedad y al acame, un mayor peso del grano, un mayor tamaño de mazorca y de granos.

ABSTRACT The maize production in Chiapas implies the decision to grow local or hybrid maize. The latter present higher yields characteristics, but demand more inputs, particularly those related to soil degradation, water pollution, genetic diversity and knowledge losses over local maize varieties. The objective of this research was to identify the criteria used by small maize farmers in the election of seed for sowing in the Villaflores and Villa Corzo municipalities (Chiapas). The data were gathered through semi-structured interviews with farmers' participating in the ASERCA program and analyzed by percentages and frequencies. The hybrid maize is the most preferred variety by the small farmers in both municipalities, although some still prefer local maize (native) or bet on the cultivation of both due to use and customs reasons. The selectionof hybrid maizeseeds in both municipalities is based mainly on better yield characteristics, although in Villa Corzo, the selection of local varieties is due to their better resistance against pests and diseases. Additional criteria used to select the local seeds were: better lodging resistance, better moisture resistance, lower plant height, less seed rot and better drought tolerance. In local maize varieties, seed yield was considered an important factor in both municipalities, but a greater resistance against pests and diseases was only considered in Villa Corzo. The highest sale price was not an important consideration in neither of the two municipalities. Other criteria used to select the local seeds were better drought tolerance, seed lower cost, greater ear size, personal interest in conserving the local resource, better flavor and the possibility for the rotation of local varieties. The six wished characteristics of local maize varieties to be improved were: a lower plant height, a better yield, a better resistance to humidity and lodging, a greater grain weight, and a bigger size of ears and grains.

[Teaching Bioethics to Students of Medicine with Problem-Based Learning (PBL)]. / Enseñar Bioética a Estudiantes de Medicina Mediante el Aprendizaje Basado en Problemas (ABP).

We present the experience of the introduction of the subject of bioethics in a medical school in order to give to the 73 students of 5th degree skills to handle ethical conflicts in their practice. The main teaching method used was problem-based learning (PBL). Skills objectives are described. The course was structured with a theoretical seminar (2 hours of duration), a workshop (2 hours of duration), 4 cases of PBL (24 hours of duration in total) and a role playing workshop (2 hours of duration). The seminar was aimed at the acquisition of theoretical knowledge. The PBL cases provided critical appraisal, obtaining knowledge, and application. The Role Playing set out for the practical demonstration of skills acquired in a simulated environment. A continuous assessment of students was performed throughout their practice on the PBL cases (40% of the final score) and also a final evaluation of the course was carried out via exam (60% of the final score). Students completed a course and faculty evaluation anonymously, which came out with positive results (median score of 8.5/10).

Enseñar bioética a estudiantes de medicina mediante el aprendizaje basado en problemas (ABP) / Teaching bioethics to students of medicine with problema-based learning (PBL)

Se describe la implantación de la asignatura de Bioética en una Facultad de Medicina con el objetivo de dotar a los 73 alumnos de quinto curso de competencias para manejar conflictos éticos en su práctica profesional. El método docente utilizado principalmente fue el aprendizaje basado en problemas. Se describen las competencias y objetivos docentes marcados. El diseño de la asignatura consistió en un seminario teórico (2 horas), un taller práctico (2 horas), cuatro casos de aprendizaje basado en problemas (ABP) (24 horas en total) y un taller de dramatizaciones (Role Playing) (2 horas). El seminario se orientó a la adquisición de conocimientos teóricos básicos sobre bioética. Los casos ABP facilitaron la valoración crítica, la obtención de conocimiento, y su aplicación. Los Role Playing se encaminaron a la demostración práctica de las competencias adquiridas en un entorno simulado. Se realizó una evaluación continuada de los alumnos durante su trabajo en los casos ABP (40% de la nota), y una evaluación final de la asignatura mediante un examen (60% de la nota). Los alumnos evaluaron la asignatura y al profesorado de forma anónima, siendo los resultados positivos (8,5/10)

We present the experience of the introduction of the subject of bioethics in a medical school in order to give to the 73 students of 5th degree skills to handle ethical conflicts in their practice. The main teaching method used was problem-based learning (PBL). Skills objectives are described. The course was structured with a theoretical seminar (2 hours of duration), a workshop (2 hours of duration), 4 cases of PBL (24 hours of duration in total) and a role playing workshop (2 hours of duration). The seminar was aimed at the acquisition of theoretical knowledge. The PBL cases provided critical appraisal, obtaining knowledge, and application. The Role Playing set out for the practical demonstration of skills acquired in a simulated environment. A continuous assessment of students was performed throughout their practice on the PBL cases (40% of the final score) and also a final evaluation of the course was carried out via exam (60% of the final score). Students completed a course and faculty evaluation anonymously, which came out with positive results (median score of 8.5/10)

Efficacy of granisetron in the antiemetic control of nonsurgical intestinal obstruction in advanced cancer: a phase II clinical trial.

The objective of this study was to assess antiemetic efficacy of granisetron in inoperable intestinal obstruction caused by advanced cancer. The study was open, prospective, and multi-centered. We assessed 24 patients (mean age: 61.3 years; 10 males, 14 females) with intestinal obstruction who were refractory to previous antiemetics. Obstruction involved the upper intestine in six patients, the lower intestine in three, and was at multiple levels in 15. Daily treatment included intravenous granisetron (3mg) and dexamethasone (8 mg); nasogastric drainage was not allowed. Subcutaneous haloperidol was available as rescue therapy. A numeric scale was used to evaluate nausea, pain, asthenia, and anorexia at baseline visit and every 24 hours up to the completion of four days of treatment (final visit). Treatment failure was defined as nausea >4 on the numeric scale, vomiting 2/day or more, and rescue therapy with haloperidol at 5mg/day or more. Of the 24 patients, 23 were evaluable for efficacy. Evaluation pre- vs. post-treatment indicated a significant decrease in the severity of nausea (score 6.9 vs. 0.8; P<0.001), number of episodes of vomiting (5.3 vs. 1.0; P<0.001), and abdominal pain (score 4.4 vs. 1.2; P<0.001). Nausea and vomiting control was achieved in 86.9% of patients. Although there was a trend toward greater efficacy in the lower and multiple levels of obstruction, the differences were not statistically significant owing, probably, to small sample size. We conclude that granisetron may be highly efficacious in the control of emesis resulting from intestinal obstruction caused by metastatic cancer, and can be used effectively in patients refractory to other antiemetics.