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La acreditación y la necesaria integración entre las universidades médicas y las instituciones de salud
Get PDFThe process of accreditation of specialties is necessary, and actions between universities and health institutions must be directed and integrated towards it. Since it mediates medical practice as an essential articulating axis in the training of residents. These elements are based on the precepts of Valcárcel-Izquierdo and Díaz-Díaz,(1) who place medical practice as a dominant factor, with education at work and teaching, care and research integration as its guiding principles; that deepen and penetrate the articulation of medical education and practice in the social structure, in response to the health needs of the individual, the family and the community in relation to the environment that surrounds them.El proceso de acreditación de especialidades es necesario, y hacia él deben dirigirse e integrarse el accionar entre universidades e instituciones de salud. Puesto que media la práctica médica como eje articulador esencial en la formación de los residentes. Estos elementos se sustentan en los preceptos de Valcárcel-Izquierdo y Díaz-Díaz,(1) quienes sitúan a la práctica médica como un factor dominante, con la educación en el trabajo y la integración docente, atencional e investigativa como sus principios rectores; que profundizan y penetran en la articulación de la educación y práctica médica en la estructura social, en respuesta a las necesidades de salud del individuo, la familia y la comunidad en relación con el medio ambiente que les rodea
Una mirada actualizada sobre la tuberculosis
Get PDFIntroduction: tuberculosis is one of the most widely distributed infectious diseases in the world. A quarter of the world population is infected by the tuberculosis bacillus, Cuba is not exempt from this and the province of Ciego de Ávila has the highest incidence in the country.
Objective: to analyze the current state of the theory related to tuberculosis and from this perspective contribute to the updating of health professionals.
Methods: a bibliographic review was carried out where searches were carried out in the databases MEDLINE, SciELO, Dialnet and the Google Scholar search engine, between the years 2018 and 2022, in Spanish and English. The review focuses on pathogenesis, diagnosis, risk factors, treatment, prevention and control, and research on new vaccines.
Development: tuberculosis is caused by Mycobacterium tuberculosis, a bacterium that almost always affects the lungs. It is a disease transmitted from person to person through the air. There are hopes deposited on the development of new diagnostics, therapies and vaccines. Numerous resources have been allocated to identify its virulence and the epidemiological chain. The current situation is a faithful reflection of the socio-economic inequalities between developed and underdeveloped countries.
Conclusions: the search for aspects associated with tuberculosis, such as pathogenesis, diagnosis, research, risk factors and treatment, allows us to offer specialists the most recent studies carried out on the subject and thereby contribute to their updating.Introducción: la tuberculosis es una de las enfermedades infecciosas con más amplia distribución en el mundo. La cuarta parte de la población mundial está infectada por el bacilo de la tuberculosis, Cuba no queda exenta de esto y la provincia de Ciego de Ávila presenta la mayor incidencia de todo el país.
Objetivo: analizar el estado actual de la teoría relacionada con la tuberculosis y desde esta perspectiva contribuir a la actualización de los profesionales de la salud.
Métodos: se realizó una revisión bibliográfica donde se efectuaron búsquedas en las bases de datos MEDLINE, SciELO, Dialnet y el buscador Google Académico, entre los años 2018 y 2022, en idioma español e inglés. La revisión se centra en la patogénesis, diagnóstico, factores de riesgo, tratamiento, prevención y control e investigaciones sobre nuevas vacunas.
Desarrollo: la tuberculosis es causada por el Mycobacterium tuberculosis, una bacteria que casi siempre afecta a los pulmones. Es una enfermedad se transmite de persona a persona a través del aire. Existen esperanzas depositadas en el desarrollo de nuevos diagnósticos, terapias y vacunas. Se han destinado numerosos recursos para identificar su virulencia y la cadena epidemiológica. La situación actual es un fiel reflejo de las desigualdades socio económicas entre países desarrollados y subdesarrollados.
Conclusiones: la búsqueda de los aspectos asociados a la tuberculosis, como la patogénesis, el diagnóstico, la investigación, los factores de riesgo y el tratamiento, permite ofrecer a los especialistas los estudios más recientes efectuados en la temática y con ello contribuir a su actualización
Infección por VIH/sida y múltiples enfermedades oportunistas concomitantes. Informe de caso
Get PDFIntroduction: despite the existence of different therapeutic modalities and the use of antiretroviral treatment, in patients with infection caused by HIV/AIDS, the management of simultaneous opportunistic diseases that appear during the course of the disease is still complex. Imaging studies such as computed axial tomography, magnetic resonance imaging and the use of nuclear medicine contribute to clarifying the differential diagnosis of these complications.
Objective: to present the clinical-imaging characteristics of multiple concomitant diseases in an adult male with HIV/AIDS infection.
Clinical case: mixed-race patient, 44-year-old male with advanced HIV/AIDS infection, with general syndrome, convulsion, cough with hemoptoic expectoration, intermittent abdominal pain, lasting four months, with positive COVID-19 test. Abdominal ultrasound, chest X-ray, simple abdominal computed tomography with intravenous contrast, magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography were carried out. Complications such as neurotoxoplasmosis, cytomegalovirus meningitis, pulmonary tuberculosis, COVID-19, splenic lymphoma, diarrheal syndrome caused by Cryptosporidium, and osteolytic lesions in the lumbosacral spine were found.
Conclusions: the case presented confirms that the use of different diagnostic imaging modalities constitutes a valuable tool in the diagnosis, evolution and monitoring of opportunistic diseases of infectious and non-infectious cause, which increase the overall mortality rate in patients with HIV/AIDS infection.Introducción: a pesar de la existencia de diferentes modalidades terapéuticas y del empleo del tratamiento antirretroviral, en pacientes con infección causada por el VIH/sida, el manejo de las enfermedades oportunistas simultáneas que aparecen en el transcurso de la enfermedad es aún complejo. Los estudios imagenológicos como la tomografía axial computarizada, la resonancia magnética por imágenes y el empleo de la medicina nuclear, contribuyen a clarificar el diagnóstico diferencial de dichas complicaciones.
Objetivo: presentar las características clínico-imagenológicas de las múltiples enfermedades concomitantes en un adulto masculino con infección por VIH/sida.
Caso clínico: paciente mestizo, masculino de 44 años de edad con infección avanzada por VIH/sida, con síndrome general, convulsiones, tos con expectoración hemoptoica, dolor abdominal intermitente, de cuatro meses de evolución, con test de COVID-19 positivo. Se le realiza ultrasonido abdominal, rayos X de tórax, tomografía axial computarizada de abdomen simple y con contraste endovenoso, resonancia magnética por imágenes y tomografía por emisión de positrones con 18F-fluorodeoxiglucosa. Se encontraron complicaciones como neurotoxoplasmosis, meningitis por citomegalovirus, tuberculosis pulmonar, COVID-19, linfoma esplénico, síndrome diarreico causado por Cryptosporidium y lesiones osteolíticas en la columna lumbosacra.
Conclusiones: el caso presentado confirma que el empleo de las diferentes modalidades imagenológicas de diagnóstico, constituyen una valiosa herramienta en el diagnóstico, evolución y seguimiento de las enfermedades oportunistas de causa infecciosa y no infecciosa, que incrementan la tasa de mortalidad global en pacientes con infección por VIH/sida
Herida por arma de fuego con lesión de corazón y pulmón izquierdo. Informe de caso
Get PDFIntroduction: chest injuries were described for the first time around 1600 BC in the Edwin Smith Papyrus. The most frequent causes are traffic accidents and the use of firearms; less than 15% of those affected require definitive surgical treatment.Objective: to present the case of a person injured by self-harm with a firearm, with danger to life.Case presentation: white male patient, 25 years old, with a health history. He went to the Morón hospital emergency service after making a suicide attempt with a firearm, which caused a precordial injury. He arrived in a state of shock; chest x-rays showed the projectile and a concomitant left hemothorax. It was decided to perform an emergency anterolateral thoracotomy. Two holes were found; one in the left ventricle and one in the basal segments of the lower lobe of the left lung.After repairing the injuries and putting drainage in the thoracic cavity, the patient was transferred to intensive care, his condition evolved favorably, and he was discharged on the ninth day.Conclusions: the prognosis of cardiac injuries due to accidents with firearms and knives is serious. Whether it is not, depends on the combination of immediate transport, the resuscitation measures adopted in emergencies, and the severity of the anatomical damage to the organ found in the perioperative period. The work provided evidence on the importance of timely diagnosis and treatment as guarantees for a prognosis of survival with minimal complicationsIntroduction: chest injuries were described for the first time around 1600 BC in the Edwin Smith Papyrus. The most frequent causes are traffic accidents and the use of firearms; less than 15% of those affected require definitive surgical treatment.Objective: to present the case of a person injured by self-harm with a firearm, with danger to life.Case presentation: white male patient, 25 years old, with a health history. He went to the Morón hospital emergency service after making a suicide attempt with a firearm, which caused a precordial injury. He arrived in a state of shock; chest x-rays showed the projectile and a concomitant left hemothorax. It was decided to perform an emergency anterolateral thoracotomy. Two holes were found; one in the left ventricle and one in the basal segments of the lower lobe of the left lung.After repairing the injuries and putting drainage in the thoracic cavity, the patient was transferred to intensive care, his condition evolved favorably, and he was discharged on the ninth day.Conclusions: the prognosis of cardiac injuries due to accidents with firearms and knives is serious. Whether it is not, depends on the combination of immediate transport, the resuscitation measures adopted in emergencies, and the severity of the anatomical damage to the organ found in the perioperative period. The work provided evidence on the importance of timely diagnosis and treatment as guarantees for a prognosis of survival with minimal complication
Trauma fisario en la edad pediátrica, una descripción histórica de su clasificación
Get PDFIntroduction: the classification of physeal lesions in the history of traumatology goes through many tendencies and authors. At present they still constitute a source of controversy among specialists.
Objective: to describe the historical development of the classifications for traumatic injury of the physis.
Methods: a systematic bibliographic review of the classifications related to traumatic epiphysiolysis in the immature skeleton was carried out. The analytical-synthetic, historical-logical and inductive-deductive theoretical methods were used. Articles published in PubMed, in Spanish and English, were consulted and articles accessible freely or through ClinicalKey and Hinari were examined. Some that exceed five years old were taken into account, but that were key in the historical evolution of the subject.
Development: Immature bone fractures account for 15 % of all injuries during childhood. The essential anatomophysiological, epidemiological, biomechanical, clinical and surgical details that supported the classifications and typologies that have transcended to the present are described. It was in the middle of the 20th century the stage of greatest boom with three classifications. However, the Salter and Harris classification of 1963, which included approximately a third of skeletal injuries in children, continues to be valid in the world and in Cuba, as it provides an excellent guide for the treatment and prognosis of the patient.
Conclusions: there are multiple classifications and typologies of traumatic physeal injury, in Cuba the most used is that of Salter and Harris.Introduction: the classification of physeal lesions in the history of traumatology goes through many tendencies and authors. At present they still constitute a source of controversy among specialists.
Objective: to describe the historical development of the classifications for traumatic injury of the physis.
Methods: a systematic bibliographic review of the classifications related to traumatic epiphysiolysis in the immature skeleton was carried out. The analytical-synthetic, historical-logical and inductive-deductive theoretical methods were used. Articles published in PubMed, in Spanish and English, were consulted and articles accessible freely or through ClinicalKey and Hinari were examined. Some that exceed five years old were taken into account, but that were key in the historical evolution of the subject.
Development: Immature bone fractures account for 15 % of all injuries during childhood. The essential anatomophysiological, epidemiological, biomechanical, clinical and surgical details that supported the classifications and typologies that have transcended to the present are described. It was in the middle of the 20th century the stage of greatest boom with three classifications. However, the Salter and Harris classification of 1963, which included approximately a third of skeletal injuries in children, continues to be valid in the world and in Cuba, as it provides an excellent guide for the treatment and prognosis of the patient.
Conclusions: there are multiple classifications and typologies of traumatic physeal injury, in Cuba the most used is that of Salter and Harris
A propósito del artículo “Enseñanzas de la COVID-19”
Get PDFThe publication in MediCiego Magazine, Volume 26, Number 3 (2020) of the article “Lessons from COVID-19” is very interesting, not only because of its importance for Cuba from an economic and social point of view, precisely when it is intended to meet the development projections in the face of the pressures represented by the continuously strengthened measures that increase the systematic blockade, but also because of the firm response of the people to maintain hygienic-sanitary measures to counteract the presence of the coronavirus. In addition to constituting an element of important value for all scientists who day after day are engaged in the search for a solution to counteract the epidemiological situation caused by COVID-19.Muy interesante resulta la publicación en la Revista MediCiego, Volumen 26, Número 3 (2020) del artículo “Enseñanzas de la COVID-19”, no solo por la importancia que reviste para Cuba desde el punto de vista económico y social, precisamente cuando se pretende cumplir con las proyecciones de desarrollo ante las presiones que representan las medidas continuamente fortalecidas que aumentan el bloqueo sistemático, sino también por la respuesta firma del pueblo de mantener las medidas higiénicosanitarias para contrarrestar la presencia del coronavirus. Además de constituir un elemento de importante valor para todos los científicos que día a día se enfrascan en la búsqueda de una solución para contrarrestar la situación epidemiológica causada por la COVID-1
Características clínicas y epidemiológicas de los traumatismos oculares en tiempos de la COVID-19
Get PDFIntroduction: ocular trauma is one of the most common causes of blindness in young people.
Objective: to describe some clinical and epidemiological characteristics in patients with ocular trauma in the context of the COVID-19 pandemic.
Methods: a cross-sectional descriptive study was carried out on the universe of 2 534 patients with ocular trauma from the Ciego de Ávila province who attended the ophthalmology emergency room of Ciego de Ávila Hospital during the first seven months of the pandemic (from April to October 2020). The variables studied were: age group, sex, health areas of origin, types of trauma and injuries. The data was obtained from the charge sheets. Ethical aspects were met.
Results: male patients (75,14 %), from the age group between 40 and 49 years (25,18 %), from the northern health area of Ciego de Ávila (33,27 %) and blunt traumatisms prevailed. (87,61 %), and of them, the corneal foreign body (44,86 %). Among the palpebral traumas, the wound without section of the canaliculus was more frequent (31,17 %) and among the open injuries, the penetrating corneal wound (62,50 %).
Conclusions: during the first seven months of the pandemic, ocular traumatisms occurred with high frequency in male patients. There was a slight increase in their ages. The presence of a corneal foreign body was the most frequent diagnosis.Introducción: los traumatismos oculares constituyen una de las causas más comunes de ceguera en personas jóvenes.
Objetivo: describir algunas características clínicas y epidemiológicas en pacientes con traumatismos oculares en el contexto de la pandemia de COVID-19.
Métodos: se realizó un estudio descriptivo transversal al universo de 2 534 pacientes con traumas oculares de la provincia Ciego de Ávila que acudieron al cuerpo de guardia de oftalmología del Hospital de Ciego de Ávila durante los primeros siete meses de pandemia (desde abril a octubre de 2020). Las variables estudiadas fueron: grupo de edades, sexo, áreas de salud de procedencia, tipos de traumatismos y lesiones. Los datos se obtuvieron de las hojas de cargo. Se cumplieron los aspectos éticos.
Resultados: predominaron los pacientes de sexo masculino (75,14 %), del grupo de edades entre 40 y 49 años (25,18 %), del área de salud norte de Ciego de Ávila (33,27 %) y los traumatismos cerrados (87,61 %), y de ellos, el cuerpo extraño corneal (44,86 %). Entre los traumatismos palpebrales fue más frecuente la herida sin sección de canalículo (31,17 %) y entre los traumatismos abiertos, la herida penetrante corneal (62,50 %).
Conclusiones: durante los primeros siete meses de la pandemia los traumatismos oculares se presentaron con alta frecuencia en pacientes de sexo masculino. Hubo un ligero aumento en sus edades. La presencia de cuerpo extraño corneal fue el diagnóstico más frecuente
Obstrucción de vías biliares por tumor estromal gastrointestinal en duodeno. Informe de caso
Get PDFIntroduction: Gastrointestinal stromal tumors generally have a long silent period until clinical manifestation and expansive growth that displaces neighboring structures without invading them.Objective: to present a case with bile duct obstruction due to extrinsic compression caused by a gastrointestinal stromal tumor of the duodenum.Presentation of the case: a 63-year-old male patient, with a history of complicated acid-peptic disease, who by chance was detected an image in the projection of the head of the pancreas that suggested the existence of a gastrointestinal stromal tumor, confirmed by histological and immunohistochemistry analysis. The multidisciplinary care team considered the tumor unresectable due to vascular compromise and high morbidity due to advanced disease, for which neoadjuvant therapy with imatinib was instituted. Months later, a secondary biliary obstructive condition to extrinsic tumor compression led to the death of the patient.Conclusions: Gastrointestinal stromal tumors constitute a diagnostic challenge for primary care professionals, requiring early and rapid management of affected patients, both from a clinical and imaging point of view. A clinical case is contributed to the literature that reveals the deleterious effects of late diagnosis in advanced stages of these tumors, which prevents the implementation of therapeutic options that allow greater survival of patients affected by cancer.Introducción: los tumores de estroma gastrointestinal tienen generalmente un largo período silente hasta manifestarse clínicamente y un crecimiento expansivo que desplaza las estructuras vecinas sin invadirlas.Objetivo: presentar un caso con obstrucción de vías biliares por compresión extrínseca causada por un tumor de estroma gastrointestinal de duodeno.Presentación del caso: paciente masculino de 63 años, con antecedentes de enfermedad ácido-péptica complicada, al que fortuitamente se le detectó una imagen en la proyección de la cabeza del páncreas que sugería la existencia de un tumor de estroma gastrointestinal, confirmado mediante análisis histológico e inmunohistoquímico. El equipo multidisciplinario de asistencia consideró irresecable la tumoración, debido a compromiso vascular y alta morbilidad por enfermedad avanzada, por lo cual se instituyó terapéutica neoadyuvante con imatinib. Meses después un cuadro obstructivo biliar secundario a la compresión tumoral extrínseca, condujo al fallecimiento del paciente.Conclusiones: los tumores de estroma gastrointestinal constituyen un reto diagnóstico para los profesionales de la atención primaria, requieren el manejo temprano y rápido de los pacientes afectados, tanto desde el punto de vista clínico como imagenológico. Se aporta a la literatura un caso clínico que revela los efectos deletéreos del diagnóstico tardío en estadios avanzados de estos tumores, lo cual impide implementar opciones terapéuticas que permitan una mayor supervivencia de los pacientes afectados por cáncer
Úlceras corneales infecciosas en el contexto de la COVID-19
Get PDFIntroduction: Corneal ulcers cause preventable monocular blindness in developing countries. The COVID-19 pandemic has imposed atypical living and working conditions, with a global impact on health services.Objective: to characterize the clinical-epidemiological behavior of infectious corneal ulcers in the cornea service of the Ciego de Ávila Ophthalmological Center in the context of the COVID-19 pandemic.Methods: an observational, longitudinal, prospective study was carried out in 48 patients with infectious corneal ulcer, treated from April 2020 to March 2021. The variables analyzed were: age, sex, pre-treatment evolution time, characteristics of the infiltrate, complications, clinical severity, hospital admission and final corneal status.Results: the male sex and the group from 18 to 39 years old predominated. Infiltrates of 5 mm or less, paracentral, with deepening to the middle stroma, prevailed. Most of the complicated or serious cases and all those who underwent surgery had more than 72 hours of pre-treatment evolution. Admission criteria were modified to increase bed availability and minimize the number of hospitalized patients. The final degree of opacity was greater in patients with a prolonged pre-treatment evolution time. Conjunctival resurfacing was the most performed surgery, due to the impact of the pandemic on the availability of amniotic membranes and donor corneas.Conclusions: the COVID-19 pandemic had a negative impact, both on the delay in people's presentation to ophthalmological services, as well as on the treatment and performance of medical personnel and, therefore, on the evolution of patients with corneal ulcers. infectious.Introducción: las úlceras corneales causan ceguera monocular prevenible en países en desarrollo. La pandemia de COVID-19 ha impuesto condiciones de vida y trabajo atípicas, con impacto mundial en los servicios de salud.Objetivo: caracterizar el comportamiento clínico-epidemiológico de las úlceras corneales infecciosas en el servicio de córnea del Centro Oftalmológico de Ciego de Ávila en el contexto de la pandemia de COVID-19.Métodos: se realizó un estudio observacional, longitudinal, prospectivo en 48 pacientes con úlcera corneal infecciosa, atendidos desde abril de 2020 a marzo de 2021. Las variables analizadas fueron: edad, sexo, tiempo de evolución pre-tratamiento, características del infiltrado, complicaciones, gravedad clínica, ingreso hospitalario y estado final corneal.Resultados: predominó el sexo masculino y el grupo de 18 a 39 años. Prevalecieron los infiltrados de 5 mm o menos, paracentrales, con profundización hasta el estroma medio. La mayoría de los casos complicados o graves y todos los intervenidos, tenían más de 72 horas de evolución pre-tratamiento. Se modificaron los criterios de ingreso para aumentar la disponibilidad de camas y minimizar la cantidad de pacientes hospitalizados. El grado de opacidad final fue mayor en pacientes con tiempo de evolución pre-tratamiento prolongado. El recubrimiento conjuntival fue la cirugía más realizada, debido al impacto de la pandemia en la disponibilidad de membranas amnióticas y córneas donantes.Conclusiones: la pandemia de COVID-19 impactó de forma negativa, tanto en la demora de la presentación de las personas a los servicios oftalmológicos, como en el tratamiento y actuación del personal médico y, por tanto, en la evolución de los pacientes con úlceras corneales infecciosa
Autocuidado frente a la COVID-19 en enfermos psiquiátricos hospitalizados
Get PDFIntroduction: the COVID-19 pandemic has substantially modified the dynamics of care in psychiatric hospitals. One of the most effective ways to prevent this disease in hospitalized patients is self-care. Objective: to implement an educational intervention to promote self-care against COVID-19 in hospitalized psychiatric patients. Methods: an educational intervention was developed and applied between March and June 2020, with a before and after design, at the Sancti Spíritus Psychiatric Hospital. It worked with all 88 patients, who met the inclusion criteria in the study. The research covered three phases: initial (included design), implementation and evaluation. It was validated through socialization workshops, and the McNemar test was used to compare the proportions before and after. The established ethical precepts were fulfilled. Results: after the intervention, 70,45 % of the patients had minimum acceptable levels of knowledge, and 18.18% acceptable. In the majority (71,59 %) acceptable self-care prevailed, and with it the assumption of health-generating behaviors, such as proper hand washing, sanitizing inanimate objects, proper use of the mask, adequate nutrition, physical distancing and information to health personnel about the appearance of suspicious symptoms. The results were of high significance. Conclusions: the level of knowledge of hospitalized psychiatric patients about COVID-19 was raised, and thus self-care against the disease was promoted.Introducción: la pandemia de COVID-19 ha modificado sustancialmente la dinámica atencional en los hospitales psiquiátricos. Una de las formas más eficaces para evitar esta enfermedad en los pacientes ingresados es el autocuidado.Objetivo: implementar una intervención educativa para fomentar el autocuidado frente a la COVID-19 en los enfermos psiquiátricos hospitalizados.Métodos: se elaboró e implementó una intervención educativa entre marzo y junio de 2020, con diseño antes y después, en el Hospital Psiquiátrico de Sancti Spíritus. Se trabajó con la totalidad de 88 pacientes, los cuales cumplieron los criterios de inclusión en el estudio. La investigación abarcó tres fases: inicial (incluyó el diseño), implementación y evaluación. Se validó mediante talleres de socialización, y se utilizó la prueba de McNemar para comparar las proporciones antes y después. Se cumplieron los preceptos éticos establecidos.Resultados: después de la intervención, 70,45 % de los pacientes tenían niveles de conocimientos mínimos aceptables, y 18,18 % aceptables. En la mayoría (71,59 %) primó el autocuidado aceptable, y con ello la asunción de conductas generadoras de salud, como el lavado correcto de las manos, higienización de objetos inanimados, uso adecuado de la mascarilla, alimentación adecuada, distanciamiento físico y la información al personal de salud sobre la aparición de sintomatología sospechosa. Los resultados fueron de alta significación.Conclusiones: se elevó el nivel de conocimientos de los enfermos psiquiátricos hospitalizados sobre la COVID-19, y con ello se fomentó el autocuidado frente a la enfermeda