Fault injection on a mixed-signal programmable SoC with design diversity mitigation

This paper presents an approach for runtime software-based fault injection, applied to a commercial mixed-signal programmable system-on-chip (PSoC). The fault-injection scheme is based on a pseudo-random sequence gen erator and software interruption. A fault tolerant data acquisition system, based on a design diversity redundant scheme, is considered as case study. The fault injection is performed by intensively inserting bit flips in the peripherals control registers of the mixed-signal PSoC blocks, as well as in the SRAM memory of the device. Results allow to evaluate the applied fault tolerance technique, indicating that the system is able to tolerate most of the generated errors. Additionally, a high fault masking effect is observed, and different criticality levels are observed for faults injected into the SRAM memory and in the peripherals control registers

Prognostic value of clinical, humoral and tomographic abnormalities in patients with severe traumatic brain injury

Se realizó un estudio observacional, analítico, de cohortes con el objetivo de identificar el valor pronóstico de las alteraciones clínicas, humorales y tomográficas en pacientes con traumatismo craneoencefálico grave (TCEG). Se seleccionaron 100 enfermos ingresados en la unidad de cuidados intensivos (UCI), del Hospital general universitario “Carlos Manuel de Céspedes” de Bayamo, Granma, Cuba, en el periodo comprendido desde 1º de enero del 2007 hasta el 31 de diciembre del 2011 y que tuvieron escala de coma de Glasgow (ECG) menor de 8 puntos. Las variables estudiadas fueron: la edad, el sexo, los hábitos tóxicos (alcoholismo y tabaquismo), la comorbilidad, los traumas asociados, la temperatura, el valor de los leucocitos, la presión arterial media (PAM), la ECG, la presencia de infección nosocomial, los valores de hemoglobina y los hallazgos tomográficos (desplazamiento  de la línea media y signos de herniación cerebral). La variable pronóstica fue la muerte en la UCI. El análisis estadístico multivariado, a través de la regresión logística, demostró que la hipoxemia (OR ajustado 23 IC 95% 2,5-208,6), la escala de coma del Glasgow (OR ajustado 4,9 IC 95% 1,7-11,8), el desplazamiento de la línea media (OR ajustado 2,4-68,9) y los signos de herniación cerebral (OR ajustado 6,7 IC 95% 1,6-70,1) tuvieron una relación significativa con la muerte, de ahí su valor pronóstico.It was performed an observational, analytical, cohort study with the aim of identifying the prognostic value of the clinical, humoral and tomographic abnormalities in patients with severe craniocerebral trauma (SCCT). There were selected 100 patients admitted to the Intensive Care Unit (ICU) at "Carlos Manuel de Céspedes" General University Hospital in Bayamo, Granma, Cuba, since January 1rst, 2007 to December 31rst, 2011 and they had Glasgow Coma Scale (GCS) under 8 points. The variables studied were: age, sex, toxic habits (alcohol and tobacco), comorbidity, associated trauma, the temperature, the value of leukocytes, mean blood pressure (MBP), the ECG, nosocomial infection, hemoglobin values and tomographic findings (displacement of the midline) and signs of brain herniation. The prognostic variable was the death in the ICU. The multivariate statistical analysis through logistic regression showed that hypoxemia (OR set 23; 95% CI 2, 5-208, 6), the Glasgow Coma Scale (OR adjusted 4.9; 95% CI 1, 7-11, 8), the displacement of the middle line (set OR 2, 4-68, 9 and signs of brain herniation (6.7 set OR 95% CI 6-70, 1, 1) had a significant relationship with death, favouring its prognostic value

Propuesta didáctica para el desarrollo del sistema de clases de electrocardiografía en la asignatura Propedéutica Clínica

In spite of the multiple strategies designed for the teaching of the contents about the Electrocardiographic Propedeutic program, the students do not get properly the knowledge and they do not apply them systematically. Besides, the subject program does not have methodological guidelines for the topic. This situation has brought about insufficiencies in the development of the skills in third year medical students, for the diagnostic of the main electrocardiographic alterations, we propose to elaborate a didactic proposal for the development of the system of electrocardiographic lessons in the Clinical Propedeutic Subject. This proposal is based on the application of the didactic principles to the teaching learning process, in the solution of the difficulties identified by the teachers during the development of this system of lessons and in the different problems to be solved in the Primary Health Care. It is proposed the system of objectives, knowledge and skills for the different electrocardiographic lessons. It was established like a general objective, the diagnostic of the main electrocardiographic alterations. The proposal emphasizes in the education at work like an ideal way to develop the skills and form the values in the students.  The proposal can be useful for the teachers in order to develop the system of electrocardiographic lessons and to obtain in the students the necessary skills for the diagnostic of the main electrocardiographic alterations.A pesar de las múltiples estrategias diseñadas para la impartición de los contenidos sobre electrocardiografía del programa de Propedéutica, los estudiantes no siempre se apropian de los conocimientos ni los aplican sistemáticamente. Además, el programa de la asignatura no cuenta con orientaciones metodológicas para el desarrollo tema. Esta situación ha propiciado insuficiencias en el desarrollo de habilidades en los estudiantes del tercer año de la carrera de Medicina, para el diagnóstico de las principales alteraciones electrocardiográficas Objetivo: elaborar una propuesta didáctica para el desarrollo del sistema de clases de electrocardiografía en la asignatura de Propedéutica Clínica.  Método: Dicha propuesta se basa en la aplicación de los principios didácticos al proceso docente educativo, en la solución de las   dificultades identificadas por los docentes durante el desarrollo de este sistema de clases y en los diferentes problemas a resolver en la Atención Primaria de Salud. Resultados: Se propone el sistema de objetivos, de conocimientos y habilidades para las diferentes de clases de electrocardiografía. Se establece como objetivo general a lograr, el diagnóstico de las principales alteraciones electrocardiográficas. La propuesta enfatiza en la educación en el trabajo como vía idónea para desarrollar las habilidades y formar los valores en los estudiantes.  Conclusiones: La propuesta puede ser de utilidad para que los docentes desarrollen el sistema de clase de electrocardiografía y logren en los estudiantes habilidades en el diagnóstico de las principales alteraciones electrocardiográficas

Prognosis of diffuse peritonitis acording to the nutritional conditions.

Introducción: Entre los factores que influyen en la evolución de enfermos con infecciones intraabdominales se encuentra el estado nutricional. Existen diferencias en el pronóstico de los pacientes desnutridos, pudiendo producirse en ellos la Disfunción Múltiple de Órganos (DMO) y muerte. Objetivo: Identificar y cuantificar la influencia del estado nutricional sobre el pronóstico de pacientes con peritonitis difusa. Material y Método: Se realizó un estudio de cohortes en 219 pacientes atendidos en la Unidad de Cuidados Intensivos. Se evaluó cada indicador y el estado nutricional en las primeras 24 horas del ingreso. Como variable marcadora del pronóstico se consideraron la aparición o no de disfunción de múltiples órganos (D.M.O) y muerte. Resultado: Se encontró que el riesgo de D.M.O se incrementó significativamente en pacientes desnutridos (RR 9,17 IC 95% 5,58-15,07) y el de muerte se duplicó en comparación con los nutridos (RR 2,0 IC 95% 1,4-2,8). El valor promedio (desviación estándar) de albúmina en fallecidos fue de 29,30 (6,04); significativamente menor que en vivos (35,22; DS 4,31). Ni el estado nutricional ni la albúmina fueron variables independientes en el modelo de regresión logística multivariado. Discusión: Se comprueba la hipótesis del rol del estado nutricional en el pronóstico de las peritonitis. Su valor como factor pronóstico  aislado es incuestionable. Conclusiones: El estado nutricional influye en la aparición de D.M.O y muerte, pero su influencia está mediada por otros factores que caracterizan la gravedad del  paciente.Among the factors that influence upon the evolution of sick people with intra-abdominal infections it can be found the nutritional conditions. There are differences in the prognosis of the undernourished patients, producing Organs Multiple Disfunction. (O.M.D) and death in these patients. The main objective of the research is to identify and quantify the influence of thenutritional conditions about the prognosis of patients with diffuse peritonitis. In regard to the methods, it was applied a cohort study in 219 patients assisted in The Intensive Care Unit. It was evaluated each indicator and the nutritional conditions during the first 24 hours of hospitalization. As the prognosis marker variable it was considered the presence or lack of O.M.D and death. As the final result it was found that the O.M.D risk outstandingly increased in undernourished patients (RR.9.17 IC 95% 5, 58-15, 07) and death risk exceeded according to the nourished patients (RR. 2,0 IC 95% 1,4-2,8)The average(standard deviation) of albumin in deceased persons was about 29,30 (6,04) significatively inferior than alive patients ( 35,22, DS 4,31) Neither the nutritional conditions nor than albumin were the independent variables in the pattern of multivaried logistic regression. It was verified the hypothesis of roll of the nutritional conditions in the prognosis of the peritonitis. Its value as isolated prognosis factor is unquestionable. As the conclusion, the nutritional conditions influence in the apparition of O.M.D and death, but its influence is measured by others factors that characterized the patients seriousness

Prognosis of diffuse peritonitis acording to the nutritional conditions.

Entre los factores que influyen en la evolución de enfermos con infecciones intraabdominales se encuentra el estado nutricional. Existen diferencias en el pronóstico de los pacientes desnutridos, pudiendo producirse en ellos la Disfunción Múltiple de Órganos (DMO) y muerte. Objetivo: Identificar y cuantificar la influencia del estado nutricional sobre el pronóstico de pacientes con peritonitis difusa. Material y Método: Se realizó un estudio de cohortes en 219 pacientes atendidos en la Unidad de Cuidados Intensivos. Se evaluó cada indicador y el estado nutricional en las primeras 24 horas del ingreso. Como variable marcadora del pronóstico se consideraron la aparición o no de disfunción de múltiples órganos (D.M.O) y muerte. Resultado: Se encontró que el riesgo de D.M.O se incrementó significativamente en pacientes desnutridos (RR 9,17 IC 95% 5,58-15,07) y el de muerte se duplicó en comparación con los nutridos (RR 2,0 IC 95% 1,4-2,8). El valor promedio (desviación estándar) de albúmina en fallecidos fue de 29,30 (6,04); significativamente menor que en vivos (35,22; DS 4,31). Ni el estado nutricional ni la albúmina fueron variables independientes en el modelo de regresión logística multivariado. Discusión: Se comprueba la hipótesis del rol del estado nutricional en el pronóstico de las peritonitis. Su valor como factor pronóstico  aislado es incuestionable. Conclusiones: El estado nutricional influye en la aparición de D.M.O y muerte, pero su influencia está mediada por otros factores que caracterizan la gravedad del  paciente.Among the factors that influence upon the evolution of sick people with intra-abdominal infections it can be found the nutritional conditions. There are differences in the prognosis of the undernourished patients, producing Organs Multiple Disfunction. (O.M.D) and death in these patients. The main objective of the research is to identify and quantify the influence of thenutritional conditions about the prognosis of patients with diffuse peritonitis. In regard to the methods, it was applied a cohort study in 219 patients assisted in The Intensive Care Unit. It was evaluated each indicator and the nutritional conditions during the first 24 hours of hospitalization. As the prognosis marker variable it was considered the presence or lack of O.M.D and death. As the final result it was found that the O.M.D risk outstandingly increased in undernourished patients (RR.9.17 IC 95% 5, 58-15, 07) and death risk exceeded according to the nourished patients (RR. 2,0 IC 95% 1,4-2,8)The average(standard deviation) of albumin in deceased persons was about 29,30 (6,04) significatively inferior than alive patients ( 35,22, DS 4,31) Neither the nutritional conditions nor than albumin were the independent variables in the pattern of multivaried logistic regression. It was verified the hypothesis of roll of the nutritional conditions in the prognosis of the peritonitis. Its value as isolated prognosis factor is unquestionable. As the conclusion, the nutritional conditions influence in the apparition of O.M.D and death, but its influence is measured by others factors that characterized the patients seriousness

Infection related to health care in the Intensive Care Unit

Se realizó un estudio descriptivo y retrospectivo con el objetivo de describir las características clínicas y epidemiológicas de los pacientes con infección relacionada con los cuidados sanitarios en la unidad de cuidados intensivos del Hospital provincial general docente “Carlos Manuel de Céspedes”, de Bayamo, Granma, Cuba en el período comprendido desde el 1ero de enero de 2011 hasta el 31 de diciembre de 2011. De  556 pacientes ingresados, 47 (8.6%) cumplieron los criterios de infección asociada a cuidados sanitarios. Se seleccionaron variables como: edad, sexo, tipo de paciente, evolución final, localización de la infección, gérmenes aislados, cultivos indicados, factores de riesgos relacionados y tiempo de aparición de la enfermedad. Para el análisis estadístico se utilizaron como medidas de resumen el porcentaje, la razón, la proporción; la media aritmética y la desviación estándar. La infección se desarrolló con mayor frecuencia en enfermos entre los 66 y 75 años (23.4 %). Hubo ligero predominio del sexo femenino (51.1%). El paciente quirúrgico fue el más afectado (66,0%). La neumonía asociada a ventilación (46.8%) fue la localización más frecuente. Existió predominio de los gérmenes gramnegativos, entre ellos el Enterobácter sp. (28%). Se indicaron 67 cultivos, 54 de ellos fueron positivos. La sonda vesical (80.9%) constituyó el factor de riesgo fundamental. El mayor número de infecciones apareció entre el primer y el quinto día de ingreso (42.6%). Fallecieron seis pacientes (12,8%).It was performed a descriptive and retrospective study with the aim of describing the clinical and epidemiological features of patients with infections related to health care in the Intensive Care Unit at "Carlos Manuel de Céspedes" General Teaching Province Hospital in Bayamo, Granma, during the period  January 1rst, 2011 to  December 31rst, 2011. From the 556 patients admitted, 47 (8.6%) fullfiled the criteria of infection associated with health care. There were selected variables such as: age, sex, type of patient, final evolution, location of the infection, isolated germs, indicated cultures, time of the appearance of the disease and related risk factors. For the statistical analysis there were used as summary measures the percentage, reason, proportion; the arithmetic mean and deviation standard. The infection was most frequently developed in patients between 66 and 75 years (23.4%). There was a slight female predominance (51.1%). The surgical patient was the most affected (66,0%). The pneumonia associated to ventilation (46.8%) was the most common location. There was a predominance of the gram-negative bacteria, including Enterobacter sp. (28%). There were indicated 67 cultures, 54 of them were positive. The urinary catheter (80.9%) constituted the main risk factor. The largest number of infections appeared between the first and the fifth day of hospitalizations (42.6%). Six patients died (12.8%)

Recovery of polyclonal immunoglobulins during treatment in patients ineligible for autologous stem-cell transplantation is a prognostic marker of longer progression-free survival and overall survival

Immunoparesis is the suppression of normal polyclonal immunoglobulins and is present in most patients with newly diagnosed multiple myeloma (MM). The association of immunoparesis at diagnosis, and particularly its recovery along with treatment, with survival in patients ineligible for autologous stem-cell transplantation (ASCT) has not been well established. This retrospective study evaluated the impact of immunoparesis in 431 patients diagnosed with MM, ineligible for ASCT, with a median overall survival of 36 months [95% confidence interval (CI): 31–40]. Immunoparesis was present in 81.2% of patients at diagnosis and was associated with a trend to a worse overall response rate (ORR: 84.8% vs. 74.9%; OR 1.88 (95% CI: 0.97–3.63), shorter progression-free survival (PFS) [22.0 vs. 18.2 months; hazard ratio (HR) 0.775; 95%CI: 0.590–1.018; p = 0.066], and overall survival (OS) (45.9 vs. 34.2 months; HR 0.746; 95% CI: 0.551–1.010; p = 0.057). Twenty-four per cent of patients who had immunoparesis at diagnosis recovered polyclonal immunoglobulins in the follow-up period. Interestingly, these patients had a better ORR (96.3% vs. 68.2%; OR 12.29 (95% CI: 3.77–40.06), PFS (HR 0.703; 95CI%: 0.526–0.941; p = 0.018) and OS (HR 0.678; 95 CI%: 0.503–0.913; p = 0.011) than patients who did not recover it. In summary, restoring a healthy immune system along with first-line treatment in patients with MM, not receiving ASCT, is associated with better outcomes

Testing a fault tolerant mixed-signal design under TID and heavy ions

This work presents results of three distinctradiation tests performed upon a fault tolerant data acqui-sition system comprising a design diversity redundancytechnique. The first and second experiments are Total Ion-izing Dose (TID) essays, comprising gamma and X-rayirradiations. The last experiment considers single eventeffects, in which two heavy ion irradiation campaignsare carried out. The case study system comprises threeanalog-to-digital converters and two software-based vot-ers, besides additional software and hardware resourcesused for controlling, monitoring and memory manage-ment. The applied Diversity Triple Modular Redundancy(DTMR) technique, comprises different levels of diversity(temporal and architectural). The circuit was designed ina programmable System-on-Chip (PSoC), fabricated in a130nm CMOS technology process. Results show that thetechnique may increase the lifetime of the system underTID if comparing with a non-redundant implementation.Considering the heavy ions experiments the system wasproved effective to tolerate 100% of the observed errorsoriginated in the converters, while errors in the process-ing unit present a higher criticality. Critical errors occur-ring in one of the voters were also observed. A secondheavy ion campaign was then carried out to investigatethe voters reliability, comparing the the dynamic cross sec-tion of three different software-based voter schemes im-plemented in the considered PSoC

Clinical rating scale for pantothenate kinase-associated neurodegeneration: A pilot study

Pantothenate kinase-associated neurodegeneration is a progressive neurological disorder occurring in both childhood and adulthood. The objective of this study was to design and pilot-test a disease-specific clinical rating scale for the assessment of patients with pantothenate kinase-associated neurodegeneration.info:eu-repo/semantics/publishedVersio

Cliocanarias III

Este número de Cliocanarias ofrece un conjunto de artículos de investigación y divulgación relativos a muy diversos temas y ámbitos territoriale