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In this research we evaluated the use of recycled fine mortar aggregate (RFMA) as a fine aggregate for new masonry mortar creation. The pre-wetting effect on the aggregate before creating the mixture was analyzed as a method to reduce its absorption potential. A control mixture of conventional mortar and two groups of recycled mortars were designed with a partial replacement of natural sand by RFMA (pre-wetted and not pre-wetted) performed in different proportions. The results established that the pre-wetting process allows a reduction in the amount of water required during the creation of new mixtures, regulating the water/cement (W/C) ratio and improving the properties of recycled mortars such as air content, fresh and hardened densities, and compressive and adhesive strength for all substitution levels. Mortar made with a 20% substitution and pre-wetted until it was at 67% of its absorption capacity displayed adhesive values higher than the ones shown by the reference mortar. The pre-wetting process proves to be an easy performance technique; it is inexpensive, environmentally friendly, and the most valuable fact is that specialized equipment is not necessarily needed. This process is the most profitable option for improving RFMA exploitation and reuse.

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La progresivas preocupación de los países para optimizar el acceso, la eficiencia y la calidad de la salud, han impulsado la utilización más apropiada de las intervenciones en salud. Por ende, el interés tanto de profesionales sanitarios como de tomadores de decisiones en salud, ha sido orientado hacia la medicina basada en la evidencia, la eficacia comparativa y la Evaluación de Tecnologías Sanitarias (ETESA). Aunque los conceptos anteriormente señalados son convergentes en sus características, no son sinónimos. Sin embargo, todos estos, se basan en la orientación sistemática de pruebas y el enfoque en resultados relevantes para el paciente entre otras. Como consecuencia de todo esto, el interés no sólo implica los conceptos de eficacia, efectividad y eficiencia; sino que también en práctica clínica, costes y transparencia. En este artículo se resumen los conceptos de economía de la salud, evaluación económica, tecnología sanitaria (TS) y ETESA. Luego, se comenta el ciclo de vida de una TS, razones para implementar un programa de ETESA; para finalizar con algunos ejemplos de TS emergentes, comentarios respecto de la evidencia científica en la ETESA; y algunos ejemplos de estudios de ETESA en la práctica clínica cotidiana.

The progressive concern of countries to optimize access, efficiency and quality of health have led to the most appropriate use of health interventions. Therefore, the interest of both health professionals and health decision makers has been oriented towards evidence-based policy, comparative efficacy and Health Technologies Assessment (HTA). Although the aforementioned concepts are converging in their characteristics, they are not synonymous. However, all these are based on systematic testing orientation and focus on relevant patient outcomes among others. As a consequence of all this, interest does not only imply the concepts of effectiveness, effectiveness and efficiency, but also in clinical practice, costs and transparency.This manuscript summarizes concepts of health economics, economic evaluation, health technology and HTA. Then, the life cycle of a health technology and the reasons for implementing an HTA program are discussed. Concluding with some examples of emerging health technologies, comments on the scientific evidence in HTA, and some examples of HTA studies in daily clinical practice.

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Introducción: Las troponinas y el péptido natriurético cerebral son biomarcadores asociados a lesión miocárdica e insuficiencia cardíaca, respectivamente. Sus niveles séricos se modifican en relación inversa a la tasa del filtrado glomerular. Varias publicaciones evalúan su valor predictivo de mortalidad tanto en la población general como en pacientes con insuficiencia renal. Materiales y Métodos: Estudio prospectivo que incluyó 98 pacientes con enfermedad renal crónica en tratamiento dialítico. El objetivo fue establecer el punto de corte de las concentraciones séricas de troponina y péptido natriurético en falla renal. Pacientes con antecedentes de cardiopatía isquémica e insuficiencia cardíaca fueron excluidos del estudio. Se realizó análisis bivariado, multivariado con regresión logística y aplicación de curvas ROC. Un valor p<0.05 fue aceptado como significativo. Resultados: El promedio de edad de los pacientes fue 50.7±27.2 años; rango 20-87 años. El promedio de la troponina sérica I (TnI us) fue 59±64,9 ng/mL y del péptido natriurético cerebral (NT-proBNP) 507,3 ±633,2 pg/mL. En el modelo de regresión logística troponina y edad fueron las únicas variables que alcanzaron significancia como predictores de mortalidad (p<0,01). Las curvas ROC permitieron establecer los puntos de corte de los biomarcadores asociados a mortalidad. Discusión: La edad y el nivel sérico de troponina parecen útiles predictores de mortalidad en pacientes con insuficiencia renal crónica.

Introduction: Troponins and brain natriuretic peptide are specific biomarkers linked to myocardial injury and heart failure. Biomarkers blood levels are inversely related to glomerular filtration rate. Previous publications have assessed their predictive role to mortality in renal failure patients. Materials and Methods: Prospective study that followed 98 patients with chronic kidney disease on dialysis treatment during four years. The main goal was establishing blood levels of both biomarkers in renal failure. Patients with a past history of ischemic heart disease and heart failure were excluded. Bivariate, multivariate analysis and ROC curves were applied. A p-value <0.05 was accepted as significant. Results: Patients´mean age was 50.7 ± 27.2 yearsold; range 20-87 y.o. Mean serum troponins I (TnI-us) blood level was 59 ± 64,9 ng/mL and brain natriuretic peptide 507.3 ± 633.3 pg/mL. In the logistic regression model, troponin and age were significant predictors of mortality (p <0.01). ROC curves let us to obtain cutoff biomarker levels. Discussion: Age and troponin blood levels seemed to be useful indicators to predict mortality in our chronic renal failure patients.

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BACKGROUND: Individuals with stroke have a high risk of falling, and their fall predictors may differ from those of other populations. PURPOSE: To estimate fall frequency and identify factors related to fall occurrence in a sample of patients with stroke residing in the community. METHODS: Clinical data were collected from 150 consecutive stroke patients with independent gait, and the following scales were applied: modified Barthel Index (mBI), Timed Up & Go Test (TUG), and National Institutes of Health Stroke Scale (NIHSS). Univariate analysis was performed; variables with possible association (P < .1) were included in a logistic regression model. Receiver operating characteristic curves were used to identify the best cutoff point for TUG. RESULTS: Falls occurred in 37% of patients. In multivariate analysis, right hemisphere injury (odds ratio [OR], 2.621; 95% CI, 1.196-5.740; P = .016), time in TUG (OR, 1.035 for every increase in 1 second; 95% CI, 1.003-1.069; P = .034), and longer time since stroke onset (OR, 1.012 for every month increase; 95% CI, 1.002-1.021; P = .015) remained predictors. When we grouped individuals according to affected cerebral hemisphere, both hemispheres had similar accuracy, but TUG cutoff point was lower in individuals with right- versus left-hemisphere lesions. CONCLUSIONS: Patients with poor TUG performance, longer times since stroke onset, and right-hemisphere injury have particularly high fall rates, and TUG cutoff points for fall prediction vary according to cerebral hemisphere.

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O tumor de Wilms (TW) é uma neoplasia renal infantil, de histologia trifásica, composta pelos componentes epitelial, estromal e blastematoso, que recapitula o rim fetal. Pode ser uni ou bilateral, desenvolvendo-se a partir de células do blastema metanéfrico que são incapacitadas de completar sua diferenciação durante a diferenciação do rim. A maioria dos TWs é esporádico, resultado de mutações somáticas, restritas ao tecido tumoral. Aproximadamente 30% dos TWs apresentam mutações nos genes WT1, WTX e CTNNB1. Porém, 70% dos casos de TW ainda continuam sem nenhuma alteração associada. Neste sentido, este projeto tem por objetivo a validação de alterações somáticas e de novo associadas ao desenvolvimento de TW, previamente identificadas por nosso grupo de pesquisa através do sequenciamento de exoma. O sequenciamento de exoma partiu de 4 amostras associadas a um caso de TW esporádico de histologia favorável: amostras tumoral e sanguínea do probando e amostras sanguíneas dos progenitores. Para este estudo, inicialmente, as variantes identificadas foram filtradas daquelas presentes no dbSNP. Para seleção das candidatas a variantes, foram estabelecidos os seguintes critérios: a base deveria ter sido representada pelo menos 10 reads e a base variante estar presente em pelo menos 20%, e não estar localizada em regiões de alta similaridade ou repetitivas do genoma. Para seleção dos candidatos a variantes de novo nenhum read da base variante poderia estar presente no sangue dos progenitores). Para as variantes que ocorreram dentro da região codificadora do gene, foram selecionadas as alterações missenses (alteração de aminoácido) classificadas como patogênicas em pelo menos um programa de predição (SIFT e/ou Polyphen2), variantes nonsense (sem sentido - que codifica um códon de parada), deleções e inserções. Para as variantes que ocorrem fora da região codificadora foram selecionados as alterações em sítios de splice. Das 84 alterações de novo encontradas, selecionamos 11 variantes para a validação por sequenciamento capilar, duas que levavam a códon de parada prematuro na proteína, uma em sítio de splice, além de 8 variantes missenses (que levavam a alteração de amino acido na proteína).Destas 11 variantes, 4 não foram confirmadas, 6 apresentaram a variante em pelo menos um dos progenitores (alteração herdada) e apenas 1 alteração foi confirmada como sendo uma variação de novo. A variante missense resultante da alteração (A>G) que leva a mudança de aminoácido (Asn>Asp), foi encontrada no gene PARD6B que codifica uma proteína citoplasmática envolvida na divisão celular e em processos de polarização celular, sendo importante para o desenvolvimento embrionário e remodelação tecidual. Com relação às alterações somáticas, 8 mutações missense foram selecionadas para validação. Após o sequenciamento capilar, 6 alterações não foram confirmadas na amostra tumoral. Para as duas alterações restantes, confirmadas em tecido tumoral, apenas uma foi confirmada como sendo uma alteração somática. A variação (G>A) com troca de aminoácido (Glu>Lys) foi encontrada no gene DROSHA, que apresenta um papel central na via de biogênese de microRNAs. Essa alteração ocorre exatamente no códon que abrange um dos sítios de ligação do cofator magnésio que é essencial para o funcionamento da proteína codificada por este gene. Esta alteração foi identificada em 9,3% das 97 amostras de TW avaliadas, mostrando tratar-se de uma mutação recorrente neste tumor.

Wilms Tumor (WT) is a childhood kidney neoplasia that presents a triphasic histology, formed by epithelial, stromal and blastemal components that recapitulates the fetal kidney. It can be uni or bilateral, familial or sporadic, and is developed from metanephric blastemal cells that are unable to complete their differentiation during the kidney development. The majority of WTs is sporadic, resulting from somatic mutations that are restricted to the tumor tissue. About of 30% of cases presents mutations in WT1, WTX and CTNNB1 genes. However, 70% of WTs remain without any associated alteration. In this sense, the aim of this project was the validation of somatic and de novo alterations possibly associated with WT onset that were previously identified by our group through exome sequencing. The exome sequencing was performed in 4 samples related to a favorable histology WT patient: patient's blood and tumor samples, in addition to mother's and father's blood samples. For this study, initially, the variants identified were filtered if present on dbSNP. For the selection of variant candidates, some criteria were established: the variant base should be represented by at least 10 reads and the variant should be presented in at least 20%, and not be located at higly similar or repetitive genome regions. For the selection of de novo variant any read of variant base could not be presented on proband's blood and absent at parents samples. For variations that occurred within the coding region of the gene, we selected the missense alterations (amino acid changes) classified as pathogenic in at least one of the prediction programs (SIFT and/or Polyphen2), nonsense alterations (that create a stop codon), deletions and insertions. For variations that occur outside of the coding region we selected changes in splice sites. From 84 de novo alterations identified, we selected 11 variants for validation by capillary sequencing, two that lead to a stop codon in the protein, one at splice site and 8 missense that lead to amino acid change in the protein. From the 11 genes, 4 were not confirmed, 6 showed the variant at least in one of the parents (inherited alterations) and only 1 alteration was confirmed to be a de novo variation. The missense variant resulting from the alteration (A>G) that results in an amino acid change (Asn>Asp), was found in PARD6B gene, that encodes a citoplasmatic protein involved in cellular division and polarization processes, been important for the embrionic development and tissue remodalation. Regarding somatic alterations, 8 were selected for validation. After capillary sequencing, 6 alterations were not confirmed in the tumor. From the remaining 2 alterations that were validated in the tumor sample, only one was confirmed as an acquired variation. The variation (G>A) with aminoacid change (Glu>Lys) was fond yhe DROSHA gene, which has a central role in the microRNA processing pathway. This alteration occurs exactly at a codon that represents one of the binding sites for a magnesium cofactor, which is essential for the proper function of this protein. This mutation was found in 9.3% of 97 additional WT samples, suggesting it to be a recurrent somatic mutation in this tumor.

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Considerando que el 2 por ciento de los embarazos son ectópicos, por ocurrir la fecundación en la trompa de Falopio, y pudiendo originar graves alteraciones con riesgo de muerte materna, cuya prevalencia se multiplica mundialmente, en Cuba y en el Hospital Docente Ginecoobstétrico de Matanzas Dr. Julio Alfonso Medina, reportándose un estudio prospectivo descriptivo comenzado en dicho centro desde el 2004 hasta el 2006 de las pacientes ingresadas con sospecha de Embarazo Ectópico, con el objetivo de evaluar el comportamiento de la entidad en estas pacientes, así como su incidencia, edad y los principales factores de riesgo, se estableció la correlación entre el diagnóstico clínico y los hallazgos histopatológicos en las pacientes que cumplían con los criterios de inclusión, entre otras variables. Los datos se recopilaron en una planilla confeccionada para ello, con el consentimiento escrito de las pacientes. Esta información obtenida permitió confeccionar una base de datos, procesada por el paquete estadístico SPSS para Windows Versión 10.0. La mayor frecuencia del embarazo ectópico fue de 37,4 por ciento durante el 2005, siendo más alta en el grupo de 25-34 años en los tres años (54.3 por ciento). El mayor número de las pacientes usaban DIU (44.5 por ciento) y/o se habían interrumpido algún embarazo previamente (44.1 por ciento). Existió una alta correlación clínica histopatológica (más del 86 por ciento) en los Embarazos Ectópicos (EE) no complicados. Concluimos que existe una alta frecuencia de Embarazo Ectópico que se desplaza al grupo de edades de las adolescentes y recomendamos educar a la población para prevenir los factores de riesgo y acudir precozmente al médico.

Considering that 2 % of the pregnancies are ectopic, by fecundation occurring at the Fallopian Tube, and being able to originate serious alterations with maternal death risk, and that its prevalence increases around the world, in Cuba and at the Gynecoobstetric Teaching Hospital of Matanzas, “Dr. Julio Alfonso Medina”, we report a prospective, descriptive study of the patients treated for suspected ectopic pregnancy, carried out in that hospital from 2004 to 2006. The objective was evaluating the entity behaviour in these patients, and also, its incidence, age and main risk facts. We established a correlation between the clinical diagnosis and the histopathologic findings in patients fulfilling the inclusion parameters, among other variables. Data were recorded in a form designed for that, with the written consent of the patients. The obtained information allowed making a database, processed by the statistic packet SPSS for Windows Version 10.0. The highest frequency of the ectopic pregnancy was 37, 4 % during 2005, being higher in the 25- 34 years-old group for the three years (54.3%). The biggest number of the patients used intra-uterine devices (44, 5 %) and/or have had interrupted a pregnancy before (44.1%). There was a high histopathologic clinical correlation (more than 86 %) in the non-complicated ectopic pregnancies. We concluded that there is a high frequency of the ectopic pregnancy, moving to the teenagers' age group, and we recommend educating the population in order to prevent the risk facts and to early visit the doctor.

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La escabiosis es una parasitosis cutánea. Los tratamientos erróneos y el mal diagnóstico contribuyen a la persistencia de esta infestación. Cuba, al igual que el resto del mundo, continúa siendo afectada con un incremento sustancial de esta dermatosis, y el municipio de Colón en la provincia de Matanzas no ha estado exento a esto. En la presente investigación se evalúa el Programa de Control y Prevención de la Escabiosis durante el período del 1ro. de enero al 31 de diciembre del 2006. Se visitaron las tres áreas de salud del municipio para obtener información sobre la estructura organizativa y los recursos con que contaban. También se aplicó una encuesta a médicos y enfermeras de la familia para conocer lo referente a capacitación. Los resultados se muestran en cuadros una vez procesados los datos y se clasifican en aceptables o no aceptables. La estructura, el proceso y el resultado se evaluaron de no aceptable. Se incrementó la tasa con respecto al año anterior debido entre otras causas a la deficiente estructura y recursos necesarios para la atención, unido a un conocimiento insuficiente por parte del Equipo Básico de Trabajo (EBT) en el manejo de la enfermedad.

The scabies is a skin parasitic disease. The erroneous treatments and bad diagnostic contribute to the persistence of this infestation. Cuba , like the rest of the world, continues being affected with a substantial increment of this dermatosis, and the municipality of Colon , in the province of Matanzas , has not been exempt to this. In the present investigation we evaluate the Scabies Control and Prevention Program during the period from January 1st to December 31st 2006 . We visited the three health areas of the municipality to obtain information on the organizational structure and the resources they counted with. A survey was also applied to the family doctors and nurses to know about their training level. The data were processed and the results are shown in tables; they were classified in acceptable or not acceptable. The structure, the process and the result were evaluated as not acceptable. The rate increased with regard to the previous year because of the deficient structure and the lack of the necessary resources for the medical care, and also because of the insufficient knowledge of the team to manage the disease, among other causes.

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Los procedimientos y técnicas quirúrgicas de las vías biliares se realizan para producir la mejoría y/o curación de los diferentes síndromes que las involucran. Sin embargo, siguen existiendo situaciones en las que el propio tratamiento quirúrgico es responsable directo de cuadros de morbilidad y mortalidad. Tipo de estudio: Descriptivo, retrospectivo, transversal, Objetivos: Conocer las complicaciones de la colecistectomía abierta; distribuir la incidencia y secuelas de las complicaciones posquirúrgicas en cada grupo etáreo. Metodología: Se realizó el estudio durante 6 meses con 223 pacientes a los que se les realizó colecistectomía abierta. Resultados: de éstos, sólo 16 pacientes se mostraron con complicaciones (7). Según el género, los pacientes masculinos fueron 10 (62) y las pacientes femeninas 6 (38). Las edades con mayor complicación fueron de 40 a 49 años (5 pacientes). Con respecto a las complicaciones, la hemorragia fue la mayor causa, con 5 pacientes. En conclusión, si bien existe una alta incidencia de pacientes, el número de casos complicados no es grande. Afortunadamente la morbilidad supera a la mortalidad y estas complicaciones pudieron ser diagnosticadas y tratadas. Conclusión: Aunque los métodos realizados en el acto quirúrgico y el cuidado postoperatorio que se lleva a cabo siguen siendo efectivos para la gran mayoría de pacientes, hay que considerar siempre la existencia de complicaciones.

Surgical procedures and techniques in bile ducts are carried out to obtain improvement and/or healing of syndromes involving bile ducts. Nevertheless, there are still situations in which the surgical treatment itself is the direct responsible of morbidity and mortality profiles. Type of study: Descriptive, retrospective, transverse. Objectives: To know the complications of open cholecystectomy, arrange the impact and after-effects of postoperative complications in each age group. Methodology: the study was made for 6 months with 223 patients to whom an open cholecystectomy was carried out. Results: only 16 patients had complications (7). Male patients: 10 (62). Female: 6 (38). Ages with greatest complications: 40 to 49 (5 patients). Among complications, Haemorrhage was the greatest cause: 5 patients. In conclusion, although there is a high incidence of patients, the amount of complicated cases is not big. Fortunately morbidity exceeds mortality and these complications were diagnosed and treated. Conclusion: Although methods used in surgery and postoperative care are still effective for most of patients, we must always regard the possibility of complications.

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