RESUMO

While the Internet has brought convenience and speed to human life, it has also led to frequent privacy violations. In the context of epidemiological investigations and information disclosure regarding confirmed Covid-19 patients, many individuals have utilized the Internet as a means to disseminate information and engage in cyber manhunts, resulting in breaches of privacy for those involved. This phenomenon is particularly prevalent within the realm of the Internet, where the boundaries of privacy invasion become blurred. Various types of privacy infringements, both active and passive negligence, are evident on social networking platforms. The juxtaposition of the virtual world of the Internet with real-life scenarios presents novel challenges in the realm of privacy violations. The Internet era, coupled with the widespread use and integration of big data, has diminished the absolute right to privacy on the Internet. This paper examines the challenge of safeguarding the identity information of infectious patients through the lens of two theoretical frameworks -Kantianism and Utilitarianism- in an effort to address this ethical dilemma.

Aunque Internet ha aportado comodidad y rapidez a la vida humana, también ha dado lugar a frecuentes violaciones de la intimidad. En el contexto de las investigaciones epidemiológicas y la divulgación de información relativa a pacientes confirmados de covid-19, muchas personas han utilizado Internet como medio para difundir información y participar en cibercacerías, lo que ha dado lugar a violaciones en la intimidad de los implicados. Este fenómeno prevalece en el ámbito de Internet, donde los límites de la invasión de la intimidad se vuelven vagos. En las redes sociales, se manifiestan diversos tipos de violaciones de la intimidad, tanto por negligencia activa como pasiva. La yuxtaposición entre el mundo virtual de Internet con escenarios de la vida real plantea nuevos retos en el ámbito de las violaciones de la intimidad. La era de Internet, junto con el uso generalizado y la integración del bigdata, han mermado el derecho absoluto a la privacidad. Este artículo examina el reto de salvaguardar la información sobre la identidad de los pacientes infecciosos a través de la lente de dos marcos teóricos -el kantianismo y el utilitarismo- en un esfuerzo por abordar este dilema ético.

Enquanto a Internet trouxe conveniência e velocidade à vida humana, ela também levou a frequentes violações da privacidade. No contexto de investigações epidemiológicas e divulgação de informações em relação a pacientes confirmados de Covid-19, muitos indivíduos utilizaram a Internet como um meio para disseminar informação e participar de uma caçada cibernética, resultando em violações da privacidade para aqueles envolvidos. Esse fenômeno é particularmente prevalente no âmbito da Internet, onde os limites de invasão da privacidade se tornaram borrados. Vários tipos de infrações da privacidade, tanto negligências ativa como passiva, são evidentes em plataformas de redes sociais. A justaposição do mundo virtual da Internet com cenários da vida real apresenta novos desafios no âmbito das violações da privacidade. A era da Internet, juntamente com o amplo uso e integração de megadados (big data), diminuiu o direito absoluto à privacidade na Internet. Esse artigo examina o desafio de proteger a informação de identidade de pacientes infectantes através das lentes de dois enquadres teóricos -Kantianismo e Utilitarismo- em um esforço para abordar esse dilema ético.

RESUMO

Introducción: El infarto cerebral isquémico (ICI) en adultos jóvenes ha emergido como un relevante problema de salud debido al incremento de su incidencia, alta mortalidad, larga duración del tiempo de la discapacidad y consecuencias sociales. Objetivo: Describir una aproximación al diagnóstico del infarto cerebral isquémico en adultos jóvenes sobre la base de la clasificación etiopatogénica, historia e investigaciones complementarias. Método: Se realizó una extensa revisión bibliográfica con el buscador Google Académico, en las bases de datos bibliográficas PubMed, SciELO y Medline, y con la búsqueda de palabras claves; siendo escogidos 32 artículos cuyo título y resumen se relacionaron con el tema de la presente revisión. Desarrollo: Los subtipos etiopatogénicos del infarto cerebral isquémico en adultos jóvenes difieren al compararlo con adultos mayores, y sus causas etiológicas son más variadas y heterogéneas. Los factores de riesgo, antecedentes patológicos personales y familiares, manifestaciones clínicas no neurológicas y neurológicas, permiten un acercamiento al diagnóstico, mientras que las investigaciones complementarias facilitan la confirmación del diagnóstico, la localización y tamaño del infarto isquémico, el establecimiento de la causa etiológica y el sustento de las decisiones terapéuticas. Consideraciones finales: La historia y manifestaciones clínicas obtenidas mediante el interrogatorio y examen físico, unido a las investigaciones complementarias, posibilita la aproximación al diagnóstico del subtipo etiopatogénico y a la causa del infarto cerebral isquémico en adultos jóvenes, lo que mejora las posibilidades de tratamiento del mismo.(AU)

Introduction: Ischemic stroke in young adults has emerged as a relevant health problem today due to its increased incidence, high mortality, the duration of the disability and social consequences. Objective: To describe an approach in diagnosis of ischemic stroke in young adults based on etiopathogenic classification, history and complementary investigations. Method: A wide-ranging bibliographic review was carried out using Google Scholar, searching in bibliographic databases like PubMed, SciELO and Medline, and searching different keywords; 32 articles were chosen in the process with title and abstract were linked with the subject of this review. Development: The etiopathogenic subtypes of ischemic stroke in young adults differ with regard to older adults, and its etiologic causes are more diverse and heterogeneous. Risk factors, personal and family pathological history, non-neurological and neurological clinical manifestations, allow an approach to diagnosis, while complementary investigations facilitate the confirmation of diagnosis, the location and size of the ischemic infarction, definition of the etiological cause and the support of therapeutic decisions. Final considerations: The history and clinical manifestations obtained through interrogation and physical examination, in association with complementary investigations, made it possible an approach to diagnosis of etiopathogenic subtype and the cause of ischemic brain infarction in young adults improving treatment possibilities.(AU)

Introdução: O acidente vascular cerebral (AVC) isquêmico em adultos jovens emergiu como um problema de saúde relevante devido à sua crescente incidência, elevada mortalidade, longa duração da incapacidade e consequências sociais. Objetivo: Descrever uma abordagem ao diagnóstico do AVC isquêmico em adultos jovens baseada na classificação etiopatogénica, na história e em exames complementares. Método: Foi realizado uma extensa revisão bibliográfica utilizando o motor de busca Google Scholar, as bases de dados bibliográficas PubMed, SciELO e Medline, e uma pesquisa por palavras-chave; foram selecionados 32 artigos cujo título e resumo estavam relacionados com o tema desta revisão. Desenvolvimento: Os subtipos etiopatogênicos do AVC isquêmico em adultos jovens diferem quando comparados aos adultos mais velhos, e suas causas etiológicas são mais variadas e heterogêneas. Os fatores de risco, os antecedentes patológicos pessoais e familiares, as manifestações clínicas não neurológicas e neurológicas permitem uma aproximação ao diagnóstico, enquanto as investigações complementares facilitam a confirmação do diagnóstico, a localização e o tamanho do infarto isquêmico, o estabelecimento da causa etiológica e o apoio às decisões terapêuticas. Considerações finais: A história e as manifestações clínicas obtidas por meio de questionamento e exame físico, juntamente com investigações complementares, permitem abordar o diagnóstico do subtipo etiopatogênico e a causa do AVC isquêmico em adultos jovens, melhorando as possibilidades de seu tratamento.(AU)

Assuntos

RESUMO

Resumo Este ensaio objetiva discutir as investigações de surtos e epidemias, desde os primeiros relatos disponíveis na literatura científica do século XVIII até o momento atual, utilizando para sua construção artigos científicos e livros sobre a temática. O principal argumento desenvolvido é a passagem de abordagens qualitativas da epidemiologia, predominantes nos períodos iniciais, para a abordagem quantitativa, que inicialmente convive com a qualitativa, mas se torna dominante a partir da segunda metade do século XIX. Conclui-se com uma breve reflexão sobre o momento atual de enfrentamento da epidemia da covid-19.

Abstract This essay aims to discuss the investigation of outbreaks and epidemics, from the first reports available in scientific literature from the 18th century to the present time, using scientific articles and books on the subject for its construction. The main argument developed is the transition from qualitative approaches of epidemiology, which predominated in the early periods, to the quantitative approach, which initially coexists with the qualitative one but became dominant from the second half of the 19th century. It concludes with a brief reflection on the current moment of confronting the COVID-19 epidemic.

Assuntos

RESUMO

In the 2020s, understanding disaster risk requires a strong and clear recognition of values and goals that influence the use of political and economic power and social authority to guide growth and development. This configuration of values, goals, power and authority may also lead to concrete drivers of risk at any one time. Building on previous disaster risk frameworks and experiences from practice, since 2010, the 'Forensic Investigations of Disasters (FORIN)' approach has been developed to support transdisciplinary research on the transformational pathways societies may follow to recognise and address root causes and drivers of disaster risk. This article explores and assesses the achievements and failures of the FORIN approach. It also focuses on shedding light upon key requirements for new approaches and understandings of disaster risk research. The new requirements stem not only from the uncompleted ambitions of FORIN and the forensic approach but also from dramatic and ongoing transformational changes characterised by climate change, the coronavirus disease 2019 (COVID-19) pandemic and the threat of global international confrontation, among other potential crises, both those that can be identified and those not yet identified or unknown. Contribution: Disasters associated with extreme natural events cannot be treated in isolation. A comprehensive "all risks" or "all disasters" approach is essential for a global transformation, which could lead to a better world order. To achieve this, an Intergovernmental Panel for Disaster Risk is suggested to assess risk science periodically and work towards sustainability, human rights, and accountability, within a development and human security frame and on a systemic basis and integrated perspective.

RESUMO

Introducción: Varios miembros del Departamento de Investigaciones en Adicciones de la Universidad de Ciencias Médicas de La Habana participaron en el 2020 y 2021 como docentes, asesores y directores de tesis en dos programas de formación académica de estudiantes ecuatorianos: especialización en Medicina Familiar y Comunitaria y maestría en Psicología Clínica (mención en Salud Mental Comunitaria). Objetivo: Describir los resultados del estudio y las investigaciones concluidas en ambos programas de formación académica. Método: Se realizó un estudio descriptivo de corte transversal basado en el análisis de los 69 proyectos de investigación desarrollados. Para la descripción de los resultados se realizó el análisis de contenido del 20 por ciento de las investigaciones. Resultados: El 63,8 `por ciento de los estudios fueron investigaciones biomédicas, y el 36,1 por ciento fueron estudios psicosociales. En ambos casos, el contexto social en las comunidades fue de (84,7 por ciento). Entre las investigaciones médicas predominaron las dirigidas al paciente con hipertensión arterial (39,1 por ciento) centradas en la adherencia terapéutica (32,6 por ciento). En los estudios psicológicos predominaron los dirigidos a niños y adolescentes (23,0 por ciento) y a profesionales sanitarios (23,0 por ciento) centradas en las afecciones mentales (19,2 por ciento). Conclusiones: Los proyectos desarrollados concluyeron resultados satisfactorios, se describió con mayor sistematicidad el enfoque comunitario en las investigaciones biomédicas. Se abordaron contenidos relativos a la adherencia terapéutica y las afectaciones a la salud mental. El impacto de la COVID-19 fue valorado como generador de dificultades en niños y adolescentes, profesionales sanitarios y en la población(AU)

Introduction: In 2020 and 2021, the Department of Research on Addiction of Havana University of Medical Sciences participated as teachers, advisors and thesis directors in two academic training programs for Ecuadorian students: specialization in Family and Community Medicine and master's degree in Clinical Psychology with a mention in Community Mental Health. Objective: To describe the results of the study and the research concluded in both academic training programs. Methods: A descriptive cross-sectional study was carried out based on the analysis of the sixty nine research projects established. The content analysis of 20 percent of the investigations was carried out to describe the results. Results: 63.8percent of the studies were biomedical research and 36.1 percent were psychosocial studies. In both cases, communities was the social context (84.7percent). Among the medical investigations, those aimed at the patient with hypertension (39.1percent) focused on therapeutic adherence (32.6percent) predominated. In the psychological studies, those intended at children and adolescents (23.0percent) and health professionals (23.0percent) focused on mental disorders (19.2percent) prevailed. Conclusions: These projects yielded satisfactory results. The community approach in biomedical research was more systematically described. Contents related to therapeutic adherence and the effects on mental health were addressed. The impact of COVID-19 was assessed as generator of difficulties in children and adolescents, health professionals, and in the population(AU)

Assuntos

RESUMO

Since 2013, the Brazilian National Bank of Genetic Profiles (BNPG) of the Integrated Network of Genetic Profiles Bank (RIBPG) has been used to aid investigations, identifying who committed a crime based on biological samples found at crime scenes or on victims, which may be substantial evidence in a criminal case. This research evaluates the extent to which the types of genetic profiles and the number of hits influence the number of investigations aided. The study used data from institutions of the RIBPG adopting the period from 2016 to 2020 and organized them in a stacked panel with 98 observations. A regression mediation model was built to estimate the influence of the independent variables "forensic unknown profiles," "profiles of convicted offenders," and "profiles of suspected perpetrators or legal profiles" when mediated by the "hits" variable, influence the increase of the dependent variable "investigations aided," identified as a measure of the effectiveness of the forensic DNA banks. The results showed that the 1% increase in the variables "forensic unknown profiles" and "profiles of suspected perpetrators or legal profiles," mediated by "hits," was significant to produce "investigations aided." As for the variable "profiles of convicted offenders," there was no evidence that it contributed significantly to the increase in "hits" and "investigations aided." The study demonstrated that the increase in "forensic unknown profiles" by 126 and "profiles of suspected perpetrators or legal profiles" by 14 led to 12 "hits" in the RIBPG, offering support to 4 cases. The variable "profiles of convicted offenders" did not show significant results in terms of "hits" and "investigations aided."

Assuntos

RESUMO

Achenbach's syndrome describes the sudden occurrence of bruising, pain and swelling of one or more digits of the hand involving the volar aspect of the proximal and middle phalanges. Also known as the paroxysmal finger hematoma, it presents in dramatic fashion, sometimes with a prodrome of tingling, itching or numbness but despite its dramatic presentation, all investigations are normal. Routine blood investigations, as well as coagulation and thrombophilia screens are all negative as are vascular imaging and echocardiography. The diagnosis is solely clinical. Due to the nature of its presentation, almost all patients are referred for an urgent vascular consultation but the condition resolves spontaneously usually within 2-3 days, although the discoloration may persist for longer. Its appearance usually leads clinicians to start anticoagulation in the belief that it may progress but, in fact, it settles as quickly as it appears. Though there are episodic cases which recur years later, it is generally self-resolving with no complications nor residual morbidity. Although the etiology was previously unknown, there is now a recognized genetic link. Genes related to the acute phase reactive proteins and the coagulation and complement cascades appear to be linked to Achenbach's syndrome. This evidence may explain why only certain individuals seem prone to this acutely painful, bruising disorder. We review this interesting disorder and compare patients from the tropical Caribbean region with similar cases from the temperate United Kingdom and discuss whether there are climatic variations in presentations.

Assuntos

RESUMO

ABSTRACT BACKGROUND: In plastic surgery, a lack of ethical and moral behavior by professionals can result in unfortunate circumstances and can justify ethical-disciplinary procedures. OBJECTIVE: To review 421 plastic surgery professional-misconduct cases filed before the São Paulo State Medical Board (CREMESP) between 2008 and 2017. DESIGN AND SETTING: Cross-sectional study conducted in a medical council. METHODS: The cases were categorized according to sex, age, medical specialty (plastic surgery, other field or none), medical ethics code chapter(s) involved, ethics code articles violated and board ruling/outcome. RESULTS: Most of the defendants were men over 40 years of age who were experienced in their professional practice and who graduated from public and private universities all over Brazil; 47.74% had a specialist title in plastic surgery. Violation of professional responsibility (medical malpractice, recklessness or negligence) was the commonest complaint (28.43%), followed by medical advertising (24.19%) and poor doctor-patient relationship (10.39%), in violation of articles 18, 51, 75 and 1. Among the 233 cases adjudicated over this period, 133 resulted in disciplinary sanction, 80 were ruled in the physician's favor and 20 were dismissed. CONCLUSION: Classification of plastic surgery professional-misconduct cases creates possibilities for adopting preventive measures for good practice in this specialty, which would consequently reduce the number of complaints to the regional medical boards.

Assuntos

RESUMO

Las universidades son uno de los ejes principales del desarrollo científico de un país y su misión ha variado a lo largo del tiempo. Estas instituciones nacieron con una primera misión que es la docencia, pero actualmente sus actividades son mucho más amplias. Al respecto, se realizó el presente estudio con el objetivo de reflexionar en torno a la producción científica en la Universidad de Ciencias Médicas en Santiago de Cuba; asimismo, se indagó acerca de la colaboración e impacto alcanzados en la última edición del Ranking Iberoamericano de Instituciones de Educación Superior, 2020. Se evidenció que el uso de indicadores bibliométricos es una alternativa para medir y evaluar la producción científica de los profesionales de la salud, así como ampliar la productividad y la visibilidad a través de estrategias y políticas trazadas, a partir de la toma de decisiones oportunas.

The universities are one of the main focal points in the scientific development of a country and its mission has varied as time goes by. These institutions were born with a first mission that is teaching, but at the moment their activities are much wider. In this respect, the present study was carried out aimed at meditating around the scientific production in the University of Medical Sciences in Santiago de Cuba; also, there was an investigation about the collaboration and impact reached in the last edition of the Ibero-American Ranking of Higher Education Institutions, 2020. It was evidenced that the use of bibliometric indicatives is an alternative to measure and evaluate the scientific production of the health professionals, as well as to enlarge the productivity and visibility through strategies and politics drawn up, taking the opportune decisions making as a starting point.

Assuntos

RESUMO

OBJETIVE: We followed our previously reported algorithm based on intra and postoperative parathyroid hormone (PTH) levels to predict postthyroidectomy hypoparathyroid hypocalcemia. The objective of the study was to assess if this strategy is useful and safe to reduce hypocalcemia, hospitalisation length and postsurgery calcium sampling. DESIGN, PATIENTS, MEASSUREMENTS: We classified our series of 66 patients according to their risk of hypoparathyroidism based on PTH determinations. We treated high-risk patients with calcium and vitamin D1-25 supplementation and obtained routine daily calcium samples to control low-risk patients until 48 h postsurgery. We compared the outcomes and overall results of this new approach with those of a historical control group of patients with equivalent PTH measurements who were treated only if they presented hypocalcemia. RESULTS: In the high-risk subgroup (n = 30), five patients had hypocalcemia within the first 24 h. Compared with the high-risk control subgroup, the incidence of hypocalcemia fell from 100% to 17% (p < .001), and the median hospitalisation length from 6 to 3 days (p < .001). In the low-risk subgroup (n = 36), 28 patients remained normocalcemic with significantly less calcium sampling (p < .001). Eight patients had hypocalcemia; seven of them required neck dissection, which was the only risk factor related to postsurgical hypoparathyroidism (RR: 2.1 [confidence interval 95%: 1.4-3.1]; p < .001). The overall incidence of hypocalcemia decreased by 58% in our patients compared to the control group. CONCLUSIONS: Assessing PTH levels to classify the risk of hypoparathyroidism and to initiate preventive therapy was an effective approach that improved the safety of our paediatric patients by reducing the incidence of hypocalcemia and the length of hospitalisation after thyroidectomy in paediatric patients.

Assuntos

RESUMO

OBJECTIVE: Describe the secretion and profile of adrenal steroids in patients with adrenal incidentalomas compared to control subjects. DESIGN, SETTING AND PARTICIPANTS: A prospective study, 73 patients with adrenal incidentalomas, 21 bilateral and 52 unilateral and 34 matched controls in University Hospital. METHODS: Collect fasting blood sample before and 60 min after ACTH test (250 µg IV). One week later, perform overnight 1 mg dexamethasone test. The following steroids were measured by liquid chromatography-mass spectrometry (LC-MS): pregnenolone, 17-OH pregnenolone, 17-OH progesterone, 11-deoxycorticosterone, 11-deoxyortisol, 21-deoxycortisol, corticosterone, cortisol, androstenedione and aldosterone. RESULTS: Mean baseline serum cortisol was higher in incidentalomas, bilateral 361 ± 124, (range 143-665) nmol/L,(p < .0001), unilateral 268 ± 89 3.2 (range 98-507) nmol/L (p < .019) compared to controls 207 ± 100 (range 72-502) nmol/L. ACTH stimulation showed significantly higher levels in bilateral and unilateral cases compared to controls. After dexamethasone, mean serum cortisol levels suppressed in bilaterals 89 ± 69 (range 30-3) nmol/L (p < .0001), 58 ± 52 (range 16-323) nmol/L in unilateral (p < .01) compared to 26 ± 9 (range 7-46) nmol/L in controls. Mean baseline serum corticosterone was higher in bilateral 9.3 ± 4.8 (range 2.4-18.4) nmol/L (p < .005) and unilateral 7.3 ± 5.7 (range 0.1-30.3) nmol/L (p < .01) compared to controls 4.2 ± 2.4 (range 1.1-10.2) nmol/L, after ACTH stimulation significantly increased to higher levels in bilateral (p < .0002) and unilateral cases (p < .044) compared to controls. After dexamethasone, mean levels were 2.5 ± 2.6 (range 0.5-12.5) nmol/L in bilateral (p < .0006), 1.5 ± 1.6 (range 0.3-9.3) nmol/L in unilateral (p < .09) and 0.75 ± 0.46 (range 0.1-2.1) nmol/L in controls. Mean baseline serum 11-deoxycorticosterone (DOC) was higher in bilaterals 0.32 ± 0.23 (range 0.08-1.1) nmol/L (p < .03) compared to controls 0.15 ± 0.21 (range 0.08-1.1) nmol/L. ACTH stimulation increased levels to 3.27 ± 1.72 (range 0.5-7.4) nmol/L in bilateral cases compared to controls 1.369 ± 1.53 (range 0.1-7.1) nmol/L (p < .0001). Dexamethasone decreased levels to baseline (p ns). There were significant differences in serum 21-deoxycortisol (p < .0002) and serum pregnenolone (p < .004) only after ACTH stimulation. CONCLUSIONS: There is increased activity in several steroid biosynthesis pathways and higher steroid levels in bilateral compared to unilateral cases and evidence of hypercortisolism in 30% unilateral and 62% of bilateral incidentalomas.

Assuntos

RESUMO

En esta investigación documental se presentan alternativas viables para utilizar cabezas de pescado, subproductos de la acuicultura, para elaborar harina que sirva como materia prima para la fortificación de productos alimenticios nutritivos. La harina de cabeza de pescado propuesta en esta investigación puede ser integrada exitosamente a alimentos para consumo humano, y usadas en las proporciones adecuadas no causa interferencias en las propiedades sensoriales de los productos formulados. Para masificar la producción de los alimentos fortificados con harina de cabeza de pescado propuestos en este estudio, es indispensable practicarle además una serie de pruebas denominadas "vida de anaquel".

In this documentary research, viable alternatives are presented to use fish heads, by-products of aquaculture, to make flour that serve as raw material for the fortification of nutritious food products. The fish head meal proposed in this research can be successfully integrated into food for human consumption, and used in the appropriate proportions does not cause interference in the sensory properties of the formulated products. To massify the production of foods fortified with fish head meal proposed in this study, it is essential to also perform a series of tests called "shelf life".

Assuntos

RESUMO

ABSTRACT BACKGROUND: Nowadays, there is an ethical and moral necessity to establish rules that govern professional attitudes and conduct. In the medical field, these rules are multifaceted, given the health consequences inherent to medical procedures. Ethics is an even more delicate subject when it comes to plastic surgery, since one of the aims of this particular medical specialty is esthetic improvement of the body. OBJECTIVE: To survey and classify São Paulo State Medical Board investigations of plastic-surgery complaints that were treated as professional-misconduct cases between 2007 and 2016. DESIGN AND SETTING: Cross-sectional study conducted in a medical council. METHODS: A total of 360 cases were reviewed. Among these, 8 (2.23%) were dismissed, 1 (0.27%) became an administrative lawsuit and 351 (97.50%) were treated as professional-misconduct cases. RESULTS: A breakdown of the complaints filed over the nine-year period showed that complaints concerning malpractice were the most common (28.43%), followed by those regarding medical advertising (24.19%) and poor doctor-patient relationships (10.39%). CONCLUSION: Overall, the number of complaints lodged decreased over the last two years reviewed, although complaints regarding malpractice and poor doctor-patient relationships increased by 10% over the same period. In order to further reduce the number of medical board investigations, the medical establishment needs to carefully review the medical training of students and doctors at every stage of their careers.

Assuntos

RESUMO

BACKGROUND: The growing international movement legislating medical marijuana has brought renewed interest to the role of marijuana smoking on fertility potential. Although studies have identified that sperm quality can be compromised by marijuana use, little focus has been placed specifically on those trying to conceive. In this study, we aimed to clarify the impact of marijuana use in semen quality in men being investigated for assisted reproduction. MATERIALS AND METHODS: We conducted a cross-sectional study at a university-based facility in Jamaica. Routine semen analyses were performed on 229 men ages 23-72 years who were new clients. Logistic regression analyses were performed in order to independently predict quantifiable measures of the impact of marijuana use. The main outcome measures were sperm motility, total motile spermatozoa and morphology. RESULTS: Overall, 47% of the participants reported marijuana use with 21% of these men reporting recent use. Regression analyses showed that recent use and users of large quantities of marijuana were 2.6 times (aOR = 2.6; 95% CI, 1.0-6.8, p = 0.044) and 4.3 times (aOR = 4.3; 95% CI, 1.1-15.9, p = 0.030) at greater risk of being diagnosed with abnormal motility (asthenozoospermia). Additionally, moderate quantity users were 3.4 times (aOR = 3.4; 95% CI, 1.5-7.9, p = 0.004) more likely to be diagnosed with abnormal morphology (teratozoospermia). DISCUSSION AND CONCLUSION: Recent use of marijuana as well as moderate to large quantities had an impact on sperm motility and morphology in men being investigated for infertility. We recommend therefore that men undergoing fertility investigations be routinely asked about their recreational use of marijuana and in particular recent and heavy users counselled to stop.

Assuntos

RESUMO

Introducción: Los retos de la educación superior en el área de las ciencias médicas precisan de un nuevo enfoque, fundamentado en los principios de excelencia, calidad y pertinencia; de ahí la importancia de las investigaciones pedagógicas para el perfeccionamiento continuo del proceso docente-educativo en la educación médica. Objetivos: Determinar los principales aportes de las investigaciones pedagógicas en la educación médica cubana. Métodos: Se realizó una investigación descriptiva, de corte pedagógico, de 80 tesis, obtenidas del repositorio de tesis doctorales del sitio Infomed, en el período de enero a diciembre del 2017. Resultados: En la investigación predominaron las tesis de obtención del grado científico de Doctor en Ciencias Pedagógicas, con 65 de ellas, y 50,0 % correspondieron a la didáctica de la educación superior. Igualmente, se destacaron los aportes teóricos y prácticos que desarrollan potencialidades metodológicas y, a la vez, contribuyen a la formación lógica de los profesionales, con lo cual se reveló su esencia pedagógica. Conclusiones: Se proyectó una visión de futuro en la formación de los profesionales, con las potencialidades necesarias para su desempeño y un carácter humanista, así como el marco ético pertinente para satisfacer las necesidades de la salud en Cuba y en otros pueblos.

Introduction: The challenges of higher education in the area of the medical sciences need a new approach, based on the principles of excellence, quality and pertinence; so the importance of the pedagogical investigations for the continuous improvement of the teaching-educational process in the medical education. Objectives: To determine the main contributions of the pedagogical investigations in the Cuban medical education. Methods: A descriptive and pedagogical investigation of 80 theses, obtained from the Infomed doctoral thesis repository, was carried out from January to December, 2017. Results: In the study, theses to obtain the scientific degree of Doctor in Pedagogical Sciences prevailed, with 65 of them, and 50.0% of the dissertations corresponded to the didactics of higher education. Likewise, the theoretical and practical contributions that develop methodological potentialities were remarkable and, at the same time, they contribute to the logical training of professionals, with which their pedagogical essence was revealed. Conclusions: A future vision in training the professionals was projected, with the necessary potentialities for their performance, a humanist character and the pertinent ethical framework to satisfy health necessities in Cuba and in other countries.

Assuntos

RESUMO

Abstract Inquiring into the impact of DNA technology on Brazilian family law,, through the consultation of legislation, jurisprudence and specific legal briefs concerning paternity disputes, we map out trends over the past thirty years. We show how, after a moment of original skepticism, genetic evidence appears to dominate the legal scene, rendering personal testimony irrelevant. However, with growing concern about men who use a negative test result to disclaim their paternal status, this testimony is once again needed to clarify whether or not the man originally believed the child was his blood-related offspring. Finally, we look at a recent period, showing how reactions against the "real biological truth" have spawned a new juridical category-socio-affective paternity-that, spreading well beyond paternity tests, is altering some basic tenets of family law.

Resumo Enfocando o impacto da tecnologia do DNA no direito de família brasileiro, pela análise de leis, jurisprudência e processos particulares lidando com disputas de paternidade, mapeamos tendências de mudança ao longo dos últimos trinta anos. Mostramos como, após um momento de ceticismo inicial, a evidência genética parece dominar o cenário legal, tornando os depoimentos pessoais irrelevantes. Entretanto, com a atenção crescente dirigida para homens que usam um resultado negativo para refutar seu status paterno, a importância de depoimentos volta para esclarecer se o pai registral originalmente acreditava ou não que tinha um vínculo consanguíneo com seu filho. Finalmente, olhamos para um período recente, rastreando como reações contra a "verdade real" da biologia geram uma nova categoria jurídica - paternidade socioafetiva - que, estendendo-se muito além dos testes de paternidade, está alterando alguns princípios básicos do direito da família.

Resumen Centrándonos en el impacto de la tecnología del ADN en el derecho de familia brasileño, analizando las leyes, la jurisprudencia y las demandas particulares relacionadas con disputas de paternidad, trazando tendencias cambiantes en los últimos treinta años. Mostramos como, después de un momento de escepticismo inicial, la evidencia genética parece dominar el panorama legal, haciendo irrelevantes los testimonios personales. Sin embargo, con la atención cada vez mayor dirigida a los hombres que usan un resultado negativo para refutar su paternidad, la importancia de los testimonios vuelve a aclarar si el padre de registro originalmente creía o no, tener un vínculo consanguíneo con su hijo. Finalmente, observamos un período reciente, rastreando como las reacciones contra la "verdad real" de la biología, generan una nueva categoría legal, paternidad socioafectiva, que, más allá de las pruebas de paternidad, está alterando algunos principios básicos del derecho de familia.

Assuntos

RESUMO

Introducción: La adolescencia es un periodo de desarrollo y crecimiento durante el cual las personas establecen su sentido de identidad individual, adaptación a capacidades intelectuales más maduras, a las exigencias de la sociedad en lo que respecta a la conducta, internalización de un sistema de valores personales y la preparación para roles de adultos. En este periodo acontecen transformaciones biológicas, psicológicas y sociales que requieren de atención especializada. Los resultados de la investigación científica que se traducen en producción científica pueden contribuir al perfeccionamiento de la atención integral a los adolescentes. Objetivo: Caracterizar el comportamiento de la producción científica relacionada con la adolescencia. Métodos: Se realizó un estudio descriptivo bibliométrico, se definieron las producciones científicas e investigaciones que abordan los principales problemas de salud de los adolescentes cubanos. Para el estudio se tomó el universo de la producción científica de la Revista Cubana de Salud Pública, Revista Cubana de Pediatría y Revista Cubana de Medicina Familiar en el periodo 2011-2015. Resultados: Se identificaron de forma armónica la correspondencia entre los principales problemas de salud de los adolescentes y las temáticas abordadas en las revistas seleccionadas. Conclusiones: La generalización de la comunicación científica favorece la solución de los principales problemas de salud identificados en los adolescentes cubanos(AU)

Introduction: The adolescence is a period of development and growth during which the persons establish its sense of individual identity, adaptation to more mature intellectual capacities, to the requirements of the society as for the conduct, internalization of a system of personal values and the preparation for adults' rolls. In this period there happen biological, psychological and social transformations that need of specializing attention. The results of the scientific investigation that are translated in scientific production can contribute to the improving of the integral attention to and the adolescents. Objective: To characterize the behavior of the scientific production related to the adolescence, bibliométricos realized a descriptive study, defining the scientific productions and investigations that tackle the main problems of health of and the Cuban adolescents. Methods: For the study there took the universe of the scientific production of the Cuban Magazine of Public health, Cuban Magazine of Paediatrics and Cuban Magazine of Familiar Medicine in the period 2011-2015. Results: The present investigation allowed to identify of harmonic form the mail between the main problems of health of and the adolescents and the subject-matters tackled in the chosen magazines. Conclusions: The generalization of the scientific communication favors the solution of the main problems of health identified in and the Cuban adolescents(AU)

Assuntos

RESUMO

INTRODUCTION: Microbes such as Salmonella, Campylobacter and S. aureus have been implicated in Foodborne disease outbreaks (FBDOs) worldwide, yet information on their occurrence in Barbados is scanty. The purpose of this study was to determine the aetiological agents, food vehicles, locations and peak seasons of FBDOs in Barbados; assess the quality of epidemiological investigations; and identify deficiencies in food production practices and laboratory detection. METHODOLOGY: A search of FBDOs occurring in Barbados between 1998-2009 was conducted among published and unpublished literature sources and reports. The search terms included the keywords "foodborne disease," "outbreaks" and "Barbados". RESULTS: During the period 1998 to 2009, there were 24 foodborne outbreaks, 215 cases of illness, one hospitalisation and no deaths. Overall, 37.5% of outbreaks were associated with hotels/resorts. Salmonella Enteritidis phage type 8 was most commonly implicated with eggs and poultry being the primary vehicles. Three outbreak reports were available for assessment and revealed that there were deficiencies in the outbreak investigations. These reports also recorded high levels of food contamination with indicator organisms, suggesting that improvements in food hygiene and production practices were required. CONCLUSIONS: The number of FBDOs is low in comparison to developed countries. However, the data was likely affected by under-reporting and inadequacies in the outbreak investigations and laboratory detection. Improvements in these areas would lead to not only better detection and characterisation of FBDOs in Barbados but improved food safety control measures.

Assuntos

RESUMO

Infective endocarditis (IE) remains a severe and potentially fatal disease demanding sophisticated diagnostic strategies for detection of the causative microorganisms. The aim of the present study was to develop a broad-range 16S ribosomal RNA gene polymerase chain reaction in the routine diagnostic of IE for the early diagnosis of fatal disease. A broad-range PCR technique was selected and evaluated in terms of its efficiency in the diagnosis of endocarditis using 19 heart valves from patients undergoing cardiovascular surgeries at the Habib Bourguiba Hospital of Sfax, Tunisia, on the grounds of suspected IE. The results demonstrated the efficiency of this technique particularly in cases involving a limited number of bacteria since it helped to increase detection sensitivity. The technique proved to be efficient, particularly, in the bacteriological diagnosis of IE in contexts involving negative results from conventional culture methods and other contexts involving bacterial species that were not amenable to identification by phenotypic investigations. Indeed, the sequencing of the partial 16S ribosomal RNA gene revealed the presence of Bartonella henselae, Enterobacter sp., and Streptococcus pyogenes in three heart valves with the negative culture. It should be noted that the results obtained from the polymerase chain reaction-sequencing identification applied to the heart valve and the strain isolated from the same tissue were not consistent with the ones found by the conventional microbiological methods in the case of IE caused by Gemella morbillorum. In fact, the results from the molecular identification revealed the presence of Lactobacillus jensenii. Overall, the results have revealed that the proposed method is sensitive, reliable and might open promising opportunities for the early diagnosis of IE.(AU)

Assuntos

RESUMO

Abstract Infective endocarditis (IE) remains a severe and potentially fatal disease demanding sophisticated diagnostic strategies for detection of the causative microorganisms. The aim of the present study was to develop a broad-range 16S ribosomal RNA gene polymerase chain reaction in the routine diagnostic of IE for the early diagnosis of fatal disease. A broad-range PCR technique was selected and evaluated in terms of its efficiency in the diagnosis of endocarditis using 19 heart valves from patients undergoing cardiovascular surgeries at the Habib Bourguiba Hospital of Sfax, Tunisia, on the grounds of suspected IE. The results demonstrated the efficiency of this technique particularly in cases involving a limited number of bacteria since it helped to increase detection sensitivity. The technique proved to be efficient, particularly, in the bacteriological diagnosis of IE in contexts involving negative results from conventional culture methods and other contexts involving bacterial species that were not amenable to identification by phenotypic investigations. Indeed, the sequencing of the partial 16S ribosomal RNA gene revealed the presence of Bartonella henselae, Enterobacter sp., and Streptococcus pyogenes in three heart valves with the negative culture. It should be noted that the results obtained from the polymerase chain reaction-sequencing identification applied to the heart valve and the strain isolated from the same tissue were not consistent with the ones found by the conventional microbiological methods in the case of IE caused by Gemella morbillorum. In fact, the results from the molecular identification revealed the presence of Lactobacillus jensenii. Overall, the results have revealed that the proposed method is sensitive, reliable and might open promising opportunities for the early diagnosis of IE.

Assuntos