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Chronic hyperglycemia increases the risk of developing severe COVID-19 symptoms, but the related mechanisms are unclear. A mean glucose level upon hospital admission >166 mg/dl correlates positively with acute respiratory distress syndrome in patients with hyperglycemia. The objective of this study was to evaluate the relationship between sustained hyperglycemia and the outcome of hospitalized patients with severe COVID-19. We also evaluated the effect of high glucose concentrations on the expression of angiotensin-converting enzyme 2 (ACE2). We carried out a case-control study with hospitalized patients with severe COVID-19 with and without sustained hyperglycemia. In a second stage, we performed in vitro assays evaluating the effects of high glucose concentrations on ACE2 gene expression. Fifty hospitalized patients with severe COVID-19 were included, of which 28 (56%) died and 22 (44%) recovered. Patients who died due to COVID-19 and COVID-19 survivors had a high prevalence of hyperglycemia (96.4% versus 90.9%), with elevated central glucose upon admission (197.7 mg/dl versus 155.9 mg/dl, p = 0.089) and at discharge (185.2 mg/dl versus 134 mg/dl, p = 0.038). The mean hypoxemia level upon hospital admission was 81% in patients who died due to COVID-19 complications and 88% in patients who survived (p = 0.026); at the time of discharge, hypoxemia levels were also different between the groups (68% versus 92%, p ≤ 0.001). In vitro assays showed that the viability of A549 cells decreased (76.41%) as the glucose concentration increased, and the ACE2 gene was overexpressed 9.91-fold after 72 h (p ≤ 0.001). The relationship between hyperglycemia and COVID-19 in hospitalized patients with COVID-19 plays an important role in COVID-19-related complications and the outcome for these patients. In patients with chronic and/or sustained hyperglycemia, the upregulation of ACE2, and its potential glycation and malfunction, could be related to complications observed in patients with COVID-19.
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Background and Objectives. The importance of mitochondria in inflammatory pathologies, besides providing energy, is associated with the release of mitochondrial damage products, such as mitochondrial DNA (mt-DNA), which may perpetuate inflammation. In this review, we aimed to show the importance of mitochondria, as organelles that produce energy and intervene in multiple pathologies, focusing mainly in COVID-19 and using multiple molecular mechanisms that allow for the replication and maintenance of the viral genome, leading to the exacerbation and spread of the inflammatory response. The evidence suggests that mitochondria are implicated in the replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which forms double-membrane vesicles and evades detection by the cell defense system. These mitochondrion-hijacking vesicles damage the integrity of the mitochondrion's membrane, releasing mt-DNA into circulation and triggering the activation of innate immunity, which may contribute to an exacerbation of the pro-inflammatory state. Conclusions. While mitochondrial dysfunction in COVID-19 continues to be studied, the use of mt-DNA as an indicator of prognosis and severity is a potential area yet to be explored.
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COVID-19 , ADN Mitocondrial , ADN Mitocondrial/genética , Humanos , Inmunidad Innata , Mitocondrias/genética , SARS-CoV-2RESUMEN
Since the appearance of the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003 in China, diabetes mellitus (DM) and hyperglycemia in patients infected with SARS-CoV, represent independent predictors of mortality. Therefore, metabolic control has played a major role in the prognosis of these patients. In the current pandemic of coronavirus disease 19 (COVID-19), multiple studies have shown that DM is one of the main comorbidities associated with COVID-19 and higher risk of complications and death. The incidence and prevalence of COVID-19 complications and death related with hyperglycemia in patients with or without DM are high. There are many hypotheses related with worse prognosis and death related to COVID-19 and/or hyperglycemia. However, the information about the interplay between hyperglycemia and angiotensin-converting enzyme 2 (ACE2), the critical receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in the context of SARS-CoV-2 infection, is almost null, but there is enough information to consider the possible participation of hyperglycemia in the glycation of this protein, unleashing a pool of reactions leading to acute respiratory distress syndrome and death in patients with COVID-19. In this document we investigated the current evidence related with ACE2 as a key element within the pathophysiological mechanism related with hyperglycemia extrapolating it to context of SARS-CoV-2 infection and its relationship with worse prognosis and death for COVID-19.
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Introduction: During severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the virus hijacks the mitochondria causing damage of its membrane and release of mt-DNA into the circulation which can trigger innate immunity and generate an inflammatory state. In this study, we explored the importance of peripheral blood mt-DNA as an early predictor of evolution in patients with COVID-19 and to evaluate the association between the concentration of mt-DNA and the severity of the disease and the patient's outcome. Methods: A total 102 patients (51 COVID-19 cases and 51 controls) were included in the study. mt-DNA obtained from peripheral blood was quantified by qRT-PCR using the NADH mitochondrial gene. Results: There were differences in peripheral blood mt-DNA between patients with COVID-19 (4.25 ng/µl ± 0.30) and controls (3.3 ng/µl ± 0.16) (p = 0.007). Lower mt-DNA concentrations were observed in patients with severe COVID-19 when compared with mild (p= 0.005) and moderate (p= 0.011) cases of COVID-19. In comparison with patients with severe COVID-19 who survived (3.74 ± 0.26 ng/µl) decreased levels of mt-DNA in patients with severe COVID-19 who died (2.4 ± 0.65 ng/µl) were also observed (p = 0.037). Conclusion: High levels of mt-DNA were associated with COVID-19 and its decrease could be used as a potential biomarker to establish a prognosis of severity and mortality of patients with COVID-19.
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COVID-19 , ADN Mitocondrial/genética , Humanos , Inmunidad Innata , Mitocondrias/genética , SARS-CoV-2RESUMEN
OBJECTIVES: To determine the percentage of positivity of close contacts of coronavirus disease 19 (COVID-19) patients to depict the importance of asymptomatic infections in the patient-to-patient transmission of COVID-19. METHODS: One hundred subjects were included. Nineteen index COVID-19 cases and 81 traced close contacts were screened for coronavirus 2 of severe acute respiratory syndrome (SARS-CoV-2) using real-time reverse transcription-polymerase chain reaction. Immunoglobulin M and G against SARS-CoV-2 were evaluated by rapid test. RESULTS: Thirty-four (42%) contacts in the study were positive for SARS-CoV-2. Twenty-three (67.6%) manifested less than 2 respiratory symptoms, and 5 (14.7%) remained asymptomatic. The average of positive contacts by index COVID-19 case (R0) was 4.3 and the mean of time of positive COVID-19 test at sampling time was 18.9 days. Positive antibody test against SARS-CoV-2 was observed in 16% of the participants. CONCLUSION: The proportion of close contacts of COVID-19 patients infected with SARS-CoV-2 (42%) and with less than 2 or with no respiratory symptoms (82.4%) was high in the study population. A low proportion of COVID-19 patients had a positive test for antibodies against SARS-CoV-2. The screening for SARS-CoV-2 in close contacts of COVID-19 positive patients should be encouraged to avoid spreading the infection and the expansion of the disease.
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COVID-19/transmisión , Portador Sano/transmisión , Adulto , Anciano , COVID-19/epidemiología , COVID-19/fisiopatología , Prueba de Ácido Nucleico para COVID-19 , Prueba Serológica para COVID-19 , Portador Sano/epidemiología , Trazado de Contacto , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , SARS-CoV-2 , Enfermedades no Diagnosticadas , Adulto JovenRESUMEN
RESUMEN: Objetivo: Conocer mediante el análisis del estado del conocimiento, el impacto de polifarmacia en calidad de vida de adultos mayores y cuál ha sido el rol de enfermería frente a esta problemática de salud. Métodos: Revisión descriptiva de 62 artículos originales de diversos diseños metodológicos, en bases de datos: EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS y Dialnet. Resultados: La polifarmacia en adultos mayores se presenta con mayor frecuencia en el sexo femenino, en personas con bajo nivel de escolaridad, sumados a factores socioeconómico. Un gran porcentaje de adultos mayores presenta efecto cascada en consumo de fármacos, por cantidad de medicamentos consumidos y número de médicos consultados, produciendo interacciones farmacológicas, afectando funcionalidad y calidad de vida. Conclusiones: Es necesario mayor control de medicamentos consumidos por adultos mayores, para evitar efectos nocivos. Los profesionales de enfermería deben tener un rol educativo en este grupo etario, para disminuir polifarmacia e impulsar estilos de vida que fomenten el envejecimiento saludable.(AU)
ABSTRACT: Objective: To know, by analyzing the state of knowledge, the impact of the polypharmacy on the quality of life of older adults and the role of nursing when dealing with this health problem. Materials and Methods: Descriptive review of 62 original articles with multiple methodological designs, in the databases EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS and Dialnet. Results: Polypharmacy in older adults is more frequent in the female sex and people with low level of education, and is associated with socioeconomic factors. A large percentage of older adults present with prescription cascade due to the amount of drugs consumed and the number of doctors consulted, leading to pharmacological interactions that affect functionality and quality of life. Conclusions: More control of drugs consumed by older adults is needed to avoid harmful effects. Nursing professionals should have an educational role in this age group to reduce polypharmacy and promote lifestyles that foster healthy ageing.(AU)
RESUMO: Objetivo: Conhecer, através da análise do estado do conhecimento, o impacto da polifarmácia na qualidade de vida do idoso e qual o papel da enfermagem diante desse problema de saúde. Métodos: Revisão descritiva de 62 artigos originais de vários desenhos metodológicos, nas bases de dados: EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS e Dialnet. Resultados: A polifarmácia em idosos ocorre mais frequentemente no sexo feminino, em pessoas com baixa escolaridade, somada a fatores socioeconômicos. Uma grande porcentagem de idosos apresenta efeito cascata no consumo de medicamentos, pela quantidade de medicamentos consumidos e número de médicos consultados, produzindo interações farmacológicas, afetando a funcionalidade e a qualidade de vida. Conclusões: É necessário um maior controle dos medicamentos consumidos por idosos para evitar efeitos nocivos. Os profissionais de enfermagem devem ter papel educativo nessa faixa etária, para diminuir a polifarmácia e promover estilos de vida que promovam o envelhecimento saudável.(AU)
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Salud del Anciano , Polifarmacia , Esperanza de Vida Ajustada a la Calidad de Vida , Atención de Enfermería/organización & administración , Mal Uso de Medicamentos de Venta con Receta/efectos adversosRESUMEN
OBJECTIVE: To know, by analyzing the state of knowledge, the impact of the polypharmacy on the quality of life of older adults and the role of nursing when dealing with this health problem. MATERIALS AND METHODS: Descriptive review of 62 original articles with multiple methodological designs, in the databases EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS and Dialnet. RESULTS: Polypharmacy in older adults is more frequent in the female sex and people with low level of education, and is associated with socioeconomic factors. A large percentage of older adults present with prescription cascade due to the amount of drugs consumed and the number of doctors consulted, leading to pharmacological interactions that affect functionality and quality of life. CONCLUSIONS: More control of drugs consumed by older adults is needed to avoid harmful effects. Nursing professionals should have an educational role in this age group to reduce polypharmacy and promote lifestyles that foster healthy ageing.
OBJETIVO: Conocer mediante el análisis del estado del conocimiento, el impacto de polifarmacia en calidad de vida de adultos mayores y cuál ha sido el rol de enfermería frente a esta problemática de salud. MÉTODOS: Revisión descriptiva de 62 artículos originales de diversos diseños metodológicos, en bases de datos: EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS y Dialnet. RESULTADOS: La polifarmacia en adultos mayores se presenta con mayor frecuencia en el sexo femenino, en personas con bajo nivel de escolaridad, sumados a factores socioeconómico. Un gran porcentaje de adultos mayores presenta efecto cascada en consumo de fármacos, por cantidad de medicamentos consumidos y número de médicos consultados, produciendo interacciones farmacológicas, afectando funcionalidad y calidad de vida. CONCLUSIONES: Es necesario mayor control de medicamentos consumidos por adultos mayores, para evitar efectos nocivos. Los profesionales de enfermería deben tener un rol educativo en este grupo etario, para disminuir polifarmacia e impulsar estilos de vida que fomenten el envejecimiento saludable.
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Resumen Objetivo: Presentar una serie de reconstrucciones con colgajos perforantes en pacientes con casos severos de hidradenitis supurativa y sus resultados. Pacientes y métodos: Se realizaron 7 reconstrucciones axilares y un caso de reconstrucción esternal en 5 pacientes. Todos los pacientes correspondieron a la clasificación II o III de Hurley, y fueron derivados a nuestro servicio después de por lo menos un año de tratamiento médico sin obtener resultados. El equipo de cirugía plástica realizó tanto la resección como la reconstrucción en todos los casos. Los vasos perforantes fueron marcados con un dispositivo Doppler sonido. Resultados: Se obtuvo cobertura en todos los casos, con solo una pérdida parcial de colgajo que fue resuelta con curaciones. Tras un seguimiento de 26 meses, no hubo recidiva de hidradenitis supurativa. Todas las reconstrucciones evolucionaron con resultados funcionales óptimos. Conclusión: Los colgajos perforantes son una buena alternativa para el tratamiento de casos severos de hidradenitis supurativa, tanto esternal como axilar. Por esta razón, debe ser considerado en el armamento de cirujanos plásticos que traten esta enfermedad, una vez que el tratamiento médico haya fallado.
Abstract Aim: To present a brief series of reconstructions with perforator flaps in severe cases of hidradenitis suppurativa patients and results. Patients and methods: Seven axillary and one sternal case in five patients were operated on. All patients were in stage II or III according to Hurley classification, and were referred after at least one year of medical treatment with no satisfactory result. The plastic surgery team performed both, resection and reconstruction in all cases. Perforator vessels were marked using a handheld Doppler device. Results: One partial flap failure occurred, which healed with standard wound care. After a median follow up of 26 months, no relapse of hidradenitis suppurativa occurred. All reconstructions evolved with full functional results. Conclusion: Perforator flaps are a good choice in the treatment of severe cases of hidradenitis suppurativa, both sternal and axillary. It should be considered in the armamentarium of any plastic surgeon treating patients with this condition, once the medical treatment has failed.
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Humanos , Masculino , Femenino , Adulto , Axila/cirugía , Hidradenitis Supurativa/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajo Perforante , Esternón/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model. METHODS: Postgraduate year-3 general surgery residents were assessed in a 17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using validated global and specific scales (objective structured assessment of technical skills) and a validated checklist. Operating times and patency rates were assessed. Hand-motion analysis was used to measure economy of movements. After training, residents performed an arterial and venous end-to-end anastomosis on live rats. Results were compared to six experienced surgeons in the same models. Values of p < 0.05 were considered statistically significant. RESULTS: Learning curves were achieved. Ten residents improved their median global and specific objective structured assessment of technical skills scores for artery [10 (range, 8 to 10) versus 28 (range, 27 to 29), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 28), p < 0.05] and vein [8 (range, 8 to 11) versus 28 (range, 27 to 28), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 29), p < 0.05]. Checklist scores also improved for both procedures (p < 0.05). Trainees were slower and less efficient than experienced surgeons (p < 0.05). In the living rat, patency rates at 30 minutes were 100 percent and 50 percent for artery and vein, respectively. CONCLUSIONS: Significant acquisition of microsurgical skills was achieved by trainees to a level similar to that of experienced surgeons. Acquired skills were transferred to a more complex live model.
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Curriculum , Cirugía General/educación , Internado y Residencia/métodos , Microcirugia/educación , Modelos Anatómicos , Modelos Educacionales , Entrenamiento Simulado/métodos , Anastomosis Quirúrgica/educación , Animales , Arterias/cirugía , Pollos , Chile , Competencia Clínica , Masculino , Modelos Animales , Ratas , Ratas Sprague-Dawley , Método Simple Ciego , Venas/cirugíaRESUMEN
INTRODUCTION: Living animal models are frequently used for perforator flap dissection training, but no ex vivo models have been described. The aim of this study is to present a novel nonliving model for perforator flap training based on a constant perforator in the chicken leg. METHODS: A total of 15 chicken legs were used in this study. Anatomical dissection of the perforator was performed after its identification using ink injection, and in four of these specimens a perforator-based flap was raised. RESULTS: The anatomical dissection revealed a constant intramuscular perforator with a median length of 5.7 cm. Median proximal and distal vessel diameters were 0.93 and 0.4 mm, respectively. The median dissection time was 77.5 minutes. CONCLUSION: This study introduces a novel, affordable, and reproducible model for the intramuscular dissection of a perforator-based flap using an ex vivo animal model. Its consistent perforator and appropriate-sized vessels make it useful for training.
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Background Supermicrosurgery is a technique used for dissection and anastomosis of submillimeter diameter vessels. This technique requires precise hand movements and superb eye-hand coordination, making continuous training necessary. Biological in vivo and ex vivo models have been described for this purpose, the latter being more accessible and cost-effective. The aim of this study is to present a new ex vivo training model using a chicken leg. Methods In 28 chicken legs, an anatomical study was performed. An intramuscular perforator vessel was identified and dissected. Arterial diameters of 0.7, 0.5, and 0.3 mm were identified and consistency of the perforator was assessed. In additional 10 chicken legs, 25 submillimeter arteries were anastomosed using this perforator vessel. Five arteries of 0.3 and 10 of 0.5 mm were anastomosed with nylon 11-0 and 12-0 sutures. Intravascular stent (IVaS) technique and open guide (OG) technique were used in 0.5-mm arteries. A total of 10 arteries of 0.7 mm were anastomosed using 10-0 sutures in a conventional fashion. Dissection and anastomosis time were recorded and patency was tested. Results We were able to identify 0.7 to 0.3 mm diameter arteries in all the specimens and confirm the consistency of the perforator. The median time for dissection was 13.4 minutes. The median time for anastomosis was 32.3 minutes for 0.3-mm arteries, 24.3 minutes for 0.5-mm arteries using IVaS, 29.5 minutes for the OG technique, and 20.9 minutes for the 0.7 mm diameter arteries. All the anastomoses were permeable. Conclusion Due to its consistent and adequate diameter vessels, this model is adequate for training supermicrosurgical skills.
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Anastomosis Quirúrgica/educación , Disección/educación , Extremidad Inferior/cirugía , Microcirugia/educación , Microvasos/cirugía , Modelos Animales , Procedimientos Quirúrgicos Vasculares/educación , Anastomosis Quirúrgica/métodos , Animales , Pollos , Competencia Clínica , Disección/métodos , Educación de Postgrado en Medicina , Extremidad Inferior/anatomía & histología , Microvasos/anatomía & histología , Tempo OperativoRESUMEN
Fundamento: las posibilidades de perfeccionamiento de los programas docentes de las asignaturas relacionadas con la disciplina Estomatología Integral en el Plan D, fue la motivación principal para realizar la presente investigación. Objetivo: validar el contenido de un instrumento para el perfeccionamiento de los programas docentes de la disciplina Estomatología Integral del Plan D.Métodos: se realizó una investigación esencialmente cualitativa, en el periodo marzo 2011 a enero 2012 en la Clínica Universitaria de Especialidades Estomatológicas General Manuel Cedeño de Bayamo. Se utilizaron métodos teóricos: análisis-síntesis, histórico_lógico e hipotético_deductivo; y empíricos: análisis documental, cuestionario y criterio de expertos; y matemáticos estadísticos para las frecuencias absolutas y porcientos los cuales permitieron la fundamentación de los resultados obtenidos. Resultados: la información aportada permitió la construcción de la propuesta valorada según los criterios de Moriyama, los que obtuvieron más del 70 % en la categoría de "mucho" en todas las propiedades, la validación del contenido de la propuesta fue considerada a partir de los indicadores: razonable, justificable, claramente definida, discrimina variaciones y sus datos son factibles de obtener.Conclusiones: la propuesta diseñada ofrece un instrumento metodológico sencillo, adecuado para orientar la ejecución de procesos de mejora, que permite evaluar de manera rápida y sencilla el diseño estructural de los programas docentes de las asignaturas relacionadas con la disciplina Estomatología Integral para el Plan D. Fue validado por los expertos los cuales consideraron que la formulación de sus variables e indicadores cumplieron los criterios de Moriyama(AU)
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Educación en OdontologíaRESUMEN
Introducción el bruxismo se define como el acto parafuncional de apretar los dientes, relacionado con factores locales, sistémicos, psíquicos y ocupacionales, generadores de una morbilidad que puede llegar a ser muy alta.Objetivo: determinar la asociación del bruxismo con factores bio-sociales.Método se realizó una investigación analítica de casos-controles, de enero a junio de 2012, en la Clínica Estomatológica de Bayamo, Provincia Granma. El universo fue de 435 pacientes de 35-54 años ingresados durante el período, la muestra de 80 pacientes, 40 para cada grupo. Las variables estudiadas fueron: bruxismo, nivel de escolaridad, vínculo laboral, interferencias oclusales, necesidad de rehabilitación protésica por desdentamiento y trastornos en la articulación temporomandibular, que clasificaron como cualitativa nominal dicotómica. A partir de sus frecuencias absolutas se determinó la asociación entre estas por la prueba X2 cuando p<0,05 y el Odds Ratio (OR), con intervalos de confianza del 95 por ciento (IC).Resultados mostraron la relación causal entre el bruxismo y el alto nivel de escolaridad (OR=6,40; IC=2,35-17,15), el vínculo laboral (OR=10,50; IC=3,3932,52), las interferencias oclusales (OR=7,86; IC=2,7922,16), la necesidad de rehabilitación protésica (OR=16,24; IC=5,3948,91) y los trastornos de la articulación temporomandibular (OR=4,27; IC=1,5311,88).Conclusiones: el vínculo laboral como elemento generador de estrés, la necesidad de rehabilitación protésica y los trastornos sobre la articulación temporomandibular por su influencia en la relación de oclusión fueron los factores causales que más influyeron(AU)
Introduction: bruxism is defined as the functional act of pressing the teeth, which is related with local, systemic, psychic and occupation factors that may cause a very high morbidity.Objective: to determine the bruxism association with biosocial factors.Method: an analytic control cases research was carried out, from January to June of 2012, at Dental Clinic of Bayamo, Granma Province. The universe comprised 435 patients between 35-54 years admitted during the period, and the sample was represented by 80 patients (40 for each group). The studied variables were: bruxism, education level, labor bond, occlusal interferences, necessity of rehabilitation denture for toothless and dysfunctions in the temporomandibular joint, classified as nominal qualitative dichotomy, considering the absolute frequencies, the association was determined among them by the test X2 when p < 0.05 and Odds Ratio (OR), with confidence intervals of 95 percent.Results: the results showed the causal relationship between bruxism with education level (OR = 6.40) IC [2,35 - 17,15], labor bond (OR = 10,50) IC [3,39-32,52], occlusal interferences (OR = 7,86) IC [2,79-22,16], the necessity of denture rehabilitation (OR=16 ,24) IC [5,39. 48,91] and the temporomandibular joint dysfunctions (OR=4 ,27) IC [1,53. 11,88].Conclusions: the labor bond as factor that causes stress, the necessity of rehabilitation denture were the causal factors of most influence due to its influence on the occlusion relationship(AU)
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Humanos , Persona de Mediana Edad , Bruxismo/psicología , Estrés Psicológico/complicaciones , Factores Socioeconómicos , Factores SociológicosRESUMEN
Fundamento: El perfeccionamiento del currículo es una estrategia priorizada del sistema educacional. Métodos: Se realizó una investigación descriptiva transversal, dirigida a caracterizar la implementación de la asignatura Estomatología Integral VI de la carrera en la Clínica Universitaria de Especialidades Estomatológicas de Bayamo. El estudio comprendió el período de marzo de 2011 a enero de 2012, y participaron 6 profesores y 87 estudiantes de tercer año. Se emplearon métodos teóricos, empíricos y estadísticos. Resultados: Se identificaron los principales problemas que atentaron contra el adecuado desarrollo del proceso formativo, entre los que se encuentran: criterios de satisfacción diferentes desde la visión de estudiantes y profesores, problemas con la accesibilidad a la bibliografía, planteamiento de objetivos y el nexo con otras asignaturas. Conclusiones: Todo ello puede ser de importancia durante la puesta en marcha del Plan de Estudios D de Estomatología, donde los contenidos de esta asignatura pasarán a formar parte de otras unidades curriculares con nueva nomenclatura y estructura diferente; no obstante, servirán de referente para emprender una acertada gestión docente del currículo(AU)
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Medicina Oral , Estudiantes de Odontología , CurriculumRESUMEN
Se realizó un estudio descriptivo de corte transversal de pacientes ingresados en unidades de atención al grave del Hospital General Docente Dr.Ernesto Guevara de la Serna, con afecciones quirúrgicas digestivas que comprometían su vida. Se recogieron los datos de los pacientes operados en el período comprendido de enero de 2007 a diciembre de 2009 para evaluar el comportamiento de estas enfermedades. La pancreatitis aguda aportó el mayor número de casos. En los pacientes reintervenidos predominó la relaparotomía a demanda. La principal causa de muerte la constituyó la pancreatitis aguda. A medida que aumentó el número de operaciones, aumentó la mortalidad (AU)
A descriptive, cross-sectional study was carried out at the seriously-ill-patient attention units of Dr Ernesto Guevara de la Serna General Teaching Hospital, on patients admitted with digestive surgical complaints that compromised their life. The data of the patients was gathered in the period from January, 2007 to December, 2009 to evaluate the behavior of these illnesses. Acute pancreatitis contributed with the biggest number of cases and in most of the patients who had to be re-operated was used the laparotomy on demand. Acute pancreatitis was the main cause of death and as the number of operations increased, so did mortality (AU)
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Humanos , Pancreatitis Aguda Necrotizante , Colecistitis Aguda , Colangitis , Úlcera Péptica PerforadaRESUMEN
Soldier suicide rates, unfortunately, continue to rise in our military services. It is well known that military personnel are highly vulnerable to multiple psychopathologies due to a lack of social support system, traumatizing life events and deprived sense of control. Serious psychopathologies such as post-traumatic stress disorders, other anxiety disorders (i.e., generalized anxiety disorder) and depression may increase the risk of suicide. In addition, malingering may be a serious problem that can affect valid treatment due to an intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentive such as avoiding military duty or obtaining financial compensation. Moreover, Hispanic soldiers may be at a higher risk for such psychopathologies due to extreme marginalization conditions by military peers, lack of bilingual language management and discrimination that can severely affect their quality of life. Thus, it is important to recognize those problems in order to prevent them. Literature demonstrate that Primary Preventive Interventions (PPI) can help to reduce the incidence of psychiatric disorders due to an early identification of the mental conditions associate to serious outcome, such as suicide. Taking the previous factors into consideration, the relevant literature pertaining suicidality in service members and the mental disorders associated with it is reviewed. Furthermore, emphasis is made in the importance to develop and validate a battery of screening instruments that address the previous conditions in the military personnel, especially in the Hispanic/Latino soldier and/or veteran as future plans of interventions. This implies the creation, adaptation and administration of a Psychological Battery that will be culturally sensitive for Hispanic/Latino soldiers in which the screening of the previously mentioned pathologies and conditions can be identified. This may help to prevent serious psychological situations and extreme irreversible damage, such as suicide.
Asunto(s)
Personal Militar , Prevención del Suicidio , Suicidio , Adolescente , Adulto , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Hispánicos o Latinos/psicología , Humanos , Simulación de Enfermedad , Tamizaje Masivo , Trastornos Mentales/epidemiología , Personal Militar/psicología , Personal Militar/estadística & datos numéricos , Prejuicio , Factores de Riesgo , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/psicología , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología , Estrés Psicológico/psicología , Suicidio/etnología , Suicidio/psicología , Suicidio/estadística & datos numéricos , Guerra , Adulto JovenRESUMEN
Se realizó un estudio de caso de una paciente que presentaba una gran hernia hiatal tipo II, con el objetivo de valorar los aspecto diagnóstico y terapéutico. La misma fue diagnosticada por radiografía contrastada de esófago, estómago y duodeno; durante el acto operatorio se empleó la vía abdominal, se observó una gran hernia hiatal tipo II formada por el fundus y cuerpo gástrico y por el epiplón. Se redujo el contenido herniario, se eliminó el saco, se cerró el hiato esofágico y se realizó un proceder antireflujo por la técnica de Toupet. Evoluciona favorablemente y egresa a los cinco días de operada. Este tipo de hernia es la menos frecuente, pero la que más complicaciones presenta(AU)
A study was done on a patient who had a large type II hiatal hernia. The objective was to analyze diagnostic and therapeutic methods aspects. The hernia was diagnosed by a barium meal which is a contrasted study of the oesophagus, stomach and duodenum. The abdomen was opened to operate the hernia which was large and formed by the fundus and body of the stomach and by the epiplon. The hernia was reduced, the sac eliminated, the oesophageal hiatus closed and an antireflux procedure using the Toupet technique was employed. The healing process was satisfactory and the patient was discharged from the hospital within five days of being operated. This kind of hernia is very infrequent but it presents many complications(AU)
Asunto(s)
Conejos , Hernia Hiatal/cirugía , Unión Esofagogástrica/cirugía , Reflujo Gastroesofágico/cirugíaRESUMEN
PURPOSE: The prevalence of diabetes mellitus in Puerto Ricans has been identified and reported as being disproportionately higher as compared to other metabolic pathologies. Recently, diabetes has been identified as the third cause of mortality in Puerto Rico (Puerto Rico Health Department, Vital Statistics Annual Report, 1999-2001). The Research Center, Education and Medical Services for Diabetes in Puerto Rico (also known as the "Centro de Diabetes para Puerto Rico" [CDPR]) is a public corporation in the island created by the government to reduce diabetes prevalence, mortality and morbidity. METHOD: The CDPR offers Diabetes Self Management Educational Training Program Schools for patients (DSMETPS) island wide. The research design was an ex-post facto. As part of the process, patients are administered an extensive sociodemographic and health information questionnaire, which also includes the CES-D (a symptomatology depressive scale). This study pretends to describe the diabetic patient profiles (n=27) using information from the DSMETPS of the CDPR and explore the association with the CES-D. Variables such as patients' needs, knowledge and understanding of the condition (i.e., pathology management, type and medications utilized and exercise and nutritional patterns), patient attitudes to diabetes and their relations with the CES-D were explored. RESULTS: Results show a negative association, controlling for age and gender, between patients diabetic education/knowledge and CES-D score. CONCLUSIONS: Diabetes educators in Puerto Rico need to identify depressive symptomatology in order to prevent mental health complications in their patients since this may affect their future treatment and prognosis. An interdisciplinary team is recommended to improve the effectivity of the intervention.