RESUMO

The placenta plays an essential role in pregnancy, leading to proper fetal development and growth. As an organ with multiple physiological functions for both mother and fetus, it is a highly energetic and metabolically demanding tissue. Mitochondrial physiology plays a crucial role in the metabolism of this organ and thus any alteration leading to mitochondrial dysfunction has a severe outcome in the development of the fetus. Pregnancy-related pathological states with a mitochondrial dysfunction outcome include preeclampsia and gestational diabetes mellitus. In this review, we address the role of mitochondrial morphology, metabolism and physiology of the placenta during pregnancy, highlighting the roles of the cytotrophoblast and syncytiotrophoblast. We also describe the relationship between preeclampsia, gestational diabetes, gestational diabesity and pre-pregnancy maternal obesity with mitochondrial dysfunction.

RESUMO

Background/Objectives: Preterm birth (PTB) remains a significant global health challenge. Previous attempts to predict preterm birth in the first trimester using cervical length have been contradictory. The cervical consistency index (CCI) was introduced to quantify early cervical changes and has shown promise across various clinical scenarios in the mid-trimester, though testing in the first trimester is lacking. This study aims to assess the cervical consistency index performance in predicting preterm birth during the first trimester of pregnancy. Methods: In this prospective cohort study, focused exclusively on research, women with singleton pregnancies, both with and without a history of spontaneous preterm birth (sPTB), were included. The primary outcome was sPTB before 37 weeks, with a secondary outcome of sPTB before 34 weeks. CCI measurements were taken between 11+0 to 13+6 weeks of gestation. Receiver operating characteristic (ROC) curves were generated, and sensitivity and specificity were calculated for the optimal cut-off and for the 5th, 10th, and 15th percentile. Intraobserver and interobserver agreements were assessed using the intraclass correlation coefficient (ICC). Results: Among the 667 patients analyzed, the rates of sPTB before 37 and 34 weeks were 9.2% (61/667) and 1.8% (12/667), respectively. The detection rates (DRs) for CCI predicting PTB before 37 and 34 weeks were 19.7% (12/61) and 33.3% (4/12). Negative predictive values were 91.8% (546/595) and 98.7% (588/596), while the areas under the curve (AUC) for sPTB before 37 and 34 weeks were 0.62 (95% CI: 0.54-0.69) and 0.80 (95% CI: 0.71-0.89), respectively. Of the 61 patients with preterm birth, 13 (21.3%) had a preterm birth history; in this group, the CCI percentile 10th identified 39% (5/13). Intraobserver ICC was 0.862 (95% CI: 0.769-0.920), and interobserver ICC was 0.833 (95% CI: 0.722-0.902). Conclusions: This study suggests that utilizing CCI in the first trimester of pregnancy could serve as a valuable tool for predicting preterm birth before 34 weeks of gestation, demonstrating robust intraobserver and interobserver reliability.

RESUMO

La operacionalización de las variables constituye una acción investigativa de gran importancia metodológica. En este artículo se repasan, someramente, aspectos teóricos acerca de las variables de estudio, con el propósito de fundamentar la mayor utilidad y conveniencia de declarar, en el proyecto de investigación, el tipo de escala que será empleada para la agrupación de los datos provenientes de las unidades de análisis, en lugar del tipo de variable, como suele hacerse. Esta idea adquiere un evidente sentido práctico cuando se trabaja con variables cuantitativas.

The variables' operationalization constitutes a research action of great methodological importance. This article briefly reviews theoretical aspects about the study variables, to substantiate the greatest usefulness and convenience of declaring, in the research project, the type of scale that will be used to group the data coming from of the units of analysis, instead of the type of variable, as is usually done. This idea takes on an obvious practical meaning when working with quantitative variables.

RESUMO

El artículo ha tenido como objetivo reseñar, de forma cronológica, los acontecimientos más relevantes relacionados con la utilización de simulaciones computarizadas en el proceso docente, en el contexto particular de la Facultad de Ciencias Médicas de Cienfuegos durante el periodo 1990-2007. Entre los acontecimientos identificados se encuentran los siguientes: la elaboración e introducción de simulaciones en la asignatura Medicina Interna correspondiente al tercer año de la carrera (curso 1990-1991); la introducción de la simulación, con fines evaluativos, en el internado de Medicina Interna (1997-2000); el desarrollo de un nuevo software para la elaboración de simulaciones (2002); y la extensión del uso de simulaciones a los seminarios de actualización terapéutica correspondientes al internado de Pediatría (2007). Se evidenció que la contribución realizada por la institución docente al tema abordado, no solo consistió en la elaboración de ejercicios de simulación y su introducción en la práctica formativa, sino también en la ejecución de acciones dirigidas a la capacitación de profesores, el perfeccionamiento de las herramientas utilizadas (programas, metodologías) y la socialización de las experiencias; todo lo cual se acompañó de una amplia actividad investigativa que mereció reconocimientos a diferentes niveles.

The objective of this article is to review chronologically, the most relevant events related to the use of computerized simulations in the teaching process, in the particular context of the Cienfuegos Medical Sciences Faculty from 1990 to 2007. Among the identified events are: the development and introduction of simulations in the Internal Medicine subject corresponding to the third year of the degree (course 1990-1991); the introduction of simulation, for evaluation purposes, in the Internal Medicine internship (1997-2000); the development of a new software for the elaboration of simulations (2002); and the extension of the use of simulations to therapeutic update seminars corresponding to the Pediatrics internship (2007). It was evidenced that the contribution made by the educational institution to the topic addressed, not only consisted in the preparation of simulation exercises and their introduction in the training practice, but also in the teacher training, the improvement of the tools used (programs, methodologies) and the sharing of experiences; all of which was accompanied by extensive research activity that deserved recognition at different levels.

RESUMO

Uno de los aspectos metodológicos esenciales de una investigación es la delimitación de los sujetos a estudiar. Este artìculo aborda la tendencia actual a una excesiva e injustificada declaración de los criterios de inclusión y de exclusión en todo tipo de investigación. Se defiende la idea de que una adecuada utilización de las categorías universo y muestra hace innecesaria la declaración de criterios de inclusión y de exclusión en el diseño metodológico de la mayoría de los proyectos de trabajo de terminación de la especialidad que presentan nuestros residentes.

One of the essential methodological aspects of an investigation is the delimitation of the subjects to be studied. This article addresses the current trend towards an excessive and unjustified statement of inclusion and exclusion criteria in all types of research. The idea is defended that an adequate use of the universe and sample categories makes it unnecessary to declare inclusion and exclusion criteria in the methodological design of most of the specialty completion work projects presented by our residents.

RESUMO

La clasificación de los estudios en transversales o longitudinales constituye uno de los aspectos metodológicos que se declaran en los proyectos de investigación correspondientes a los trabajos de terminación de la especialidad. En este artículo se ofrecen elementos esclarecedores para la distinción entre ambos tipos de estudios; en este sentido, se considera que la esencia definitoria del estudio longitudinal radica en el interés del investigador por los cambios en el tiempo del fenómeno investigado.

The studies' classification as cross-sectional or longitudinal constitutes one of the methodological aspects that are declared in the research projects corresponding to the specialty's completion works. This article offers clarifying elements for the distinction between both types of studies; In this sense, it is considered that the longitudinal study's defining essence lies in the researcher's interest in the changes over time of the investigated phenomenon.

RESUMO

ATP hydrolysis is required for the synthesis, transport and polymerization of monomers for macromolecules as well as for the assembly of the latter into cellular structures. Other cellular processes not directly related to synthesis of biomass, such as maintenance of membrane potential and cellular shape, also require ATP. The unicellular flagellated parasite Trypanosoma brucei has a complex digenetic life cycle. The primary energy source for this parasite in its bloodstream form (BSF) is glucose, which is abundant in the host's bloodstream. Here, we made a detailed estimation of the energy budget during the BSF cell cycle. As glycolysis is the source of most produced ATP, we calculated that a single parasite produces 6.0 x 1011 molecules of ATP/cell cycle. Total biomass production (which involves biomass maintenance and duplication) accounts for ~63% of the total energy budget, while the total biomass duplication accounts for the remaining ~37% of the ATP consumption, with in both cases translation being the most expensive process. These values allowed us to estimate a theoretical YATP of 10.1 (g biomass)/mole ATP and a theoretical [Formula: see text] of 28.6 (g biomass)/mole ATP. Flagellar motility, variant surface glycoprotein recycling, transport and maintenance of transmembrane potential account for less than 30% of the consumed ATP. Finally, there is still ~5.5% available in the budget that is being used for other cellular processes of as yet unknown cost. These data put a new perspective on the assumptions about the relative energetic weight of the processes a BSF trypanosome undergoes during its cell cycle.

Assuntos

RESUMO

Las series de casos constituyen un tipo particular de estudio de uso muy frecuente en la investigación clínica. En este artículo se pretende resaltar la utilidad y plena vigencia de estos estudios como propuestas de proyectos de terminación de la especialidad, así como abordar sus particularidades más importantes en la delimitación de sus unidades de análisis. Cuando son bien realizadas, estas investigaciones constituyen una excelente fuente de actualización del conocimiento médico y una magnífica oportunidad para que los investigadores jóvenes se entrenen en el campo de la investigación científica.

Case series are a particular type of study that is very frequently used in clinical research. This article intends to highlight the usefulness and full validity of these studies as proposals for completion projects of the specialty, as well as to address their most important particularities in the delimitation of their analysis units. When they are well carried out, these researches constitute an excellent source of updating medical knowledge and a magnificent opportunity for young researchers to train in the scientific research field.

RESUMO

The outbreak of the COVID-19 pandemic had an immediate and severe impact on the economy. However, we do not know whether the disease may have a longer-term effect on people's employment opportunities. In this study, we focus on the effects of COVID-19 infection on labor market outcomes 12 months after diagnosis. We use a unique dataset that includes all formal private sector workers in the Mexican social security system and that links health outcomes with administrative records. We implement two alternative identification strategies to estimate the impact: matching estimators and individual fixed effects models. Our study finds that COVID-19 infection does not harm employment probabilities or wages. On the contrary, we find that workers who had tested positive for COVID had a higher likelihood of keeping their formal sector jobs and higher wages than those who did not. Moreover, our results describe mostly low-income workers.

RESUMO

La utilización de hipótesis en los proyectos de trabajo de terminación de la especialidad constituye uno de los aspectos metodológicos que amerita un análisis. El artículo pretende esclarecer a los investigadores jóvenes cuándo en una investigación debe ser declarada esta categoría. Se sugiere utilizar el alcance de la investigación (exploratorio, descriptivo, correlacional o explicativo) para la decisión de empleo o no de hipótesis en un proyecto investigativo. Se detallan condiciones que determinan el uso de hipótesis específicamente en los estudios descriptivos, los más frecuentemente realizados por los residentes.

The use of hypotheses in the specialty finishing projects constitutes one of the methodological aspects that deserves an analysis. The article aims to clarify for young researchers when this category should be declared in a research. It is suggested to use the scope of the research (exploratory, descriptive, correlational or explanatory) for the decision of whether or not to use hypotheses in a research project. Conditions that determine the use of hypotheses specifically in descriptive studies, the most frequently carried out by residents are detailed.

RESUMO

RESUMEN Las investigaciones relacionadas con factores de riesgo para las enfermedades, así como sobre factores pronósticos de diversos problemas de salud, constituyen propuestas frecuentes de proyectos de trabajos de terminación de la especialidad. En este artículo se ejemplifica, a través de diferentes variantes para la realización de estas investigaciones, la consecución de la imprescindible relación entre el problema de investigación, el objetivo y el diseño metodológico del estudio.

ABSTRACT Research related to risk factors for diseases, as well as prognostic factors for various health problems, are frequent proposals for completion projects in the specialty. This article exemplifies, through different variants for carrying out these investigations, the achievement of the essential relationship between the research problem, the objective and the methodological design of the study.

RESUMO

In 2015, emergent cases of localized cutaneous leishmaniasis (LCL) were reported in Tinum, Yucatan, Mexico. As part of an eco-epidemiological study to characterize the elements that trigger Leishmania infection in that area, we conducted a field study to investigate the occurrence of Leishmania infection in wild rodents. From November 2019 to February 2020, rodents were caught from three sites located in the municipality of Tinum, Yucatan. For each specimen, clinical signs suggestive of Leishmania infection were recorded. Samples from the tail, liver, and spleen were taken for the identification of Leishmania DNA by PCR. Twenty rodents belonging to two species were caught including Heteromys gaumeri (55%, 11/20) and Ototylomys phyllotis (45%, 9/20). Fifty-five percent of the animals presented white spots on the tail, 15% had splenomegaly, and 5% had hepatomegaly. Fifty-five percent (11/20) of the animals were found infected by Leishmania. Heteromys gaumeri was caught in all trapping sites and was the most infected species (63.6%, 7/11). The percentage of infection for O. phyllotis was 44.4% (4/9). Leishmania (Leishmania) mexicana was identified as the infecting species in two H. gaumeri. This study provides, for the first time, evidence of Leishmania infection in wild rodents from the Yucatan state. Heteromys gaumeri and O. phyllotis may be involved in the transmission cycle of L. mexicana in this emergent focus; however, further longitudinal studies are needed to confirm their role as primary reservoirs.

RESUMO

BACKGROUND: Sheehan's syndrome is a hypopituitarism secondary to necrosis of the pituitary gland caused by massive postpartum bleeding. The presentation is frequently amenorrhea and agalactia; hypoglycemia as a solitary presentation is uncommon. CASE REPORT: 68-year-old female with a history of postpartum hemorrhage 35 years ago. She had two episodes of hypoglycemia. During her hospital stay, panhypopituitarism was detected and the empty sella was confirmed by magnetic resonance imaging. CONCLUSIONS: It is recommended that medical personnel suspect Sheehan´s syndrome in any woman with nonspecific hypoglycemia and no history of chronic degenerative disease.

ANTECEDENTES: El síndrome de Sheehan es un hipopituitarismo secundario a necrosis de la glándula hipófisis causado por una hemorragia posparto. La presentación frecuentemente es como amenorrea y agalactia; la hipoglucemia como presentación solitaria es infrecuente. CASO CLÍNICO: Mujer de 68 años con antecedente de hemorragia posparto hace 35 años. Cursó con dos episodios de hipoglucemia. Durante su hospitalización se detecta panhipopituitarismo y se corrobora por resonancia magnética la silla turca vacía. CONCLUSIONES: Es recomendable que el personal médico sospeche un síndrome de Sheehan ante cualquier mujer con hipoglucemia inespecífica y sin antecedente de enfermedad crónica degenerativa.

Assuntos

RESUMO

RESUMEN En este artículo se aborda la unidad dialéctica entre el objeto de estudio y los sujetos de la investigación. Debido a que usualmente, a través del universo y muestra de la investigación, son declarados los sujetos a estudiar, en este trabajo se hace énfasis en la necesidad de declarar explícitamente el objeto a investigar.

ABSTRACT This article presents the dialectical unity between the object of study and the research subjects. Because usually, through the universe and the research sample, the subjects to be studied are declared, this work emphasizes the need to explicitly declare the object to be research.

RESUMO

Transplacental transmission of Zika virus has been reported during all trimesters of pregnancy and might lead to central nervous system anomalies, including microcephaly. We report 3 cases of perinatal Zika infection identified during the epidemic in Colombia and provide detailed descriptions of clinical features, diagnosis, and neurodevelopmental outcome at 18 months of age (corrected).

Assuntos

RESUMO

BACKGROUND: The COVID-19 pandemic revealed large structural inequalities that led to disparities in health outcomes related to socioeconomic status. So far, most of the evidence is based on aggregated data or simulations with individual data, which point to various possible mechanisms behind the association. To date, there have been no studies regarding an income gradient in COVID-19 mortality based on individual-level data and adjusting for comorbidities or access to healthcare. METHODS: In this paper, we use linked employee-patient data for patients tested for COVID-19 at the Mexican Institute of Social Security. We estimate the association of the probability of dying with income centiles, using a probit estimation and adjusting for COVID-19 diagnosis, sociodemographic variables, and comorbidities. FINDINGS: After controlling for all these variables, we find that persons in the lowest income decile still had a probability of dying from COVID-19 five times greater than those at the top decile. INTERPRETATION: Our results imply that the association between income and COVID outcomes is not explained by the prevalence of comorbidities or by a lack of access to healthcare among the low-income population. FUNDING: This study was not supported by any external funding source.

RESUMO

RESUMEN La pieza fresca es un tipo particular de discusión diagnóstica que permite una aproximación inicial a la concordancia clínico-patológica. Este artículo tiene como objetivo realizar un breve recordatorio de las acciones que conforman la actividad de pieza fresca. Se precisan los cuatro momentos para su ejecución: presentación del caso, discusión clínica, presentación de las piezas y conclusiones de la actividad. Se resalta la necesidad de sistematicidad en su ejecución dado el elevado número de necropsias que se realizan en nuestro contexto.

ABSTRACT The fresh piece is a particular type of diagnostic discussion that allows an initial approach to clinicopathological concordance. This article aims to provide a brief reminder of the actions that make up the fresh piece activity. The four moments are required for its execution: presentation of the case, clinical discussion, presentation of the pieces and conclusions of the activity. The need for systematicity in its execution is highlighted given the high number of autopsies that are performed in our context.

RESUMO

El desarrollo de competencias investigativas en el profesional de la Medicina es una necesidad incuestionable. En este sentido, la residencia, como forma de educación de posgrado, debe tener una función relevante. En este artículo se analizan especificidades relacionadas con la evaluación del componente trabajo de terminación de la especialidad, correspondiente a la evaluación de graduación o examen final estatal. Las acciones y modificaciones que se proponen persiguen como propósito que la presentación y defensa del trabajo de tesis constituya un verdadero exponente de actividad científica, para lo cual se requiere de un proceso formativo que las valorice, y en el cual se involucren, responsablemente, tutores y residentes(AU)

The development of investigative competences in the medical professional is an unquestionable need. In this sense, residency, as a form of postgraduate education, must have a relevant function. This article analyzes specificities related to the evaluation of the component work of completion of the specialty, corresponding to the graduation evaluation or state final exam. The actions and modifications that are proposed pursue the purpose that the presentation and defense of their thesis work constitute a true exponent of scientific activity, for which a training process is required that values them, and in which tutors and residents are responsibly involved(AU)

Assuntos

RESUMO

importancia del razonamiento diagnóstico, como competencia profesional, justifica que la discusión de la actividad evaluativa se incluya en la llamada Evaluación de Graduación de las residencias médicas. En este artículo se proponen algunos indicadores a utilizar por los profesores durante las actividades de discusión diagnóstica evaluativas; indicadores que emanan de la descomposición de la actividad en sus pasos o acciones. El empleo de estos indicadores y de algunas sugerencias realizadas puede contribuir a hacer más uniforme la evaluación y calificación de los ejercicios de discusión diagnóstica en el marco de la Evaluación de Graduación, o de los exámenes de promoción o pase de año(AU)

The importance of diagnostic reasoning, as professional competence, justifies the discussion of the evaluative activity in the so-called Graduation Assessment of medical residencies. This article proposes some indicators to be used by the professors during the diagnostic discussion evaluative activities. These indicators derive from the breakdown of the activity in steps or actions. The use of these indicators and some suggestions can contribute to making the evaluation and qualification of the diagnostic discussion exercises more uniform in the framework of the graduation assessment, or of the promotion or year exams(AU)

Assuntos

RESUMO

RESUMEN El título de un artículo científico, de un proyecto de investigación o del informe final de una tesis tiene como intención brindar una información orientadora acerca del contenido del estudio. A partir de la relación problema de investigación-objetivo-título se realiza un análisis de una de las cualidades del título más señalizada: su extensión. Derivado de este análisis se concluye que en la valoración de la calidad del título de un trabajo de investigación, la prioridad, lo verdaderamente relevante, es su precisión y no su extensión.

ABSTRACT The title of a scientific article, a research project or the thesis final report is intended to provide guiding information about the content of the study. Based on the research problem-objective-title relationship, an analysis is made of one of the title´s most marked qualities: its extension. Derived from this analysis, it is concluded that in assessing the title of a research work´s quality, the priority, what is truly relevant is its precision and not its extension.