ACERCAMIENTO A LA MEDICINA MORTAL DEL NAZISMO

Any discussion of the events that occurred in Germany during the period between 1933 and 1945, includes a debate about the role that German medicine played in them. A bibliographic review was carried out with the objective of arguing the importance that medicine had for the establishment and development of the Nazi Regime, for which 15 bibliographies were consulted. The Nazi doctors participated in the development and application of methods of mass extermination, being responsible for the murder and sterilization of thousands of people. In the concentration camps they conducted experiments on humans and selected individuals who would die. German medical research and education institutes benefited from the corpses of the deceased. The study of the role of medicine in Nazism can be a means that contributes to the training of health professionals and thus avoid the repetition of these events

In-hospital mortality prognostic factors in patients with cerebrovascular hemorrhagic disease

Introducción: Las enfermedades cerebrovasculares son afecciones por pérdida funcional transitoria o permanente de una parte del sistema nervioso central, generalmente de instalación súbita, por oclusiones arteriales, trombos, émbolos o por rotura de una arteria encefálica. Son un problema de salud mundial, constituyen la tercera causa de muerte, la primera de discapacidad en el adulto y la segunda de demencia en el planeta. De todos los ictus, la hemorragia cerebral es la que presenta mayor mortalidad. Objetivo: Determinar los factores pronósticos de mortalidad intrahospitalaria. Métodos: Se realizó estudio observacional analítico de tipo casos y controles en pacientes con enfermedad cerebrovascular hemorrágica atendidos en el Hospital “Arnaldo Milián Castro” entre enero y diciembre del año 2016. El universo estuvo constituido por N=122, grupo caso por los fallecidos(n=45) y grupo control por los egresados vivos (n=77). Las variables estudiadas fueron: edad, sexo, color de la piel, antecedentes patológicos personales, estado de conciencia, resultados de la Tomografía Axial Computarizada, complicaciones, estado final al egreso y estadía hospitalaria. Realizamos análisis univariado y multivariado; y Regresión Logística Binaria para determinar las variables pronósticas. Resultados: La estadía hospitalaria mostró una media de 9,25 días, el sexo y color de la piel no mostraron diferencias significativas, existió un mayor porciento (66,7) de pacientes con APP de HTA, el estar conciente y el coma tuvieron diferencias significativas entre los dos grupos, fué mayor el número de casos con HIP (88,5%), la bronconeumonia fué la complicación más frecuente, el análisis multivariado de regresión logística identificó como factores pronósticos de mortalidad a las variables: conciente, coma y bronconeumonia. Conclusiones: El estar conciente, el coma y la bronconeumonia constituyeron los factores pronósticos de mortalidad intrahospitalaria.Introduction: Cerebrovascular diseases are conditions of transient or permanent functional loss of a part of the central nervous system, usually of sudden onset, by arterial occlusions, thrombi, emboli or by rupture of an encephalic artery. Objective: to determine the in-hospital mortality prognostic factors. Methods: an observational, analytical, case-control study was conducted in patients with hemorrhagic cerebrovascular disease treated at the Arnaldo Milián Castro Hospital between January and December of 2016. The population consisted of 122 patients: case group for the deceased ( 45) and control group for those discharged alive (77). The studied variables were: age, sex, skin color, personal pathological history, state of consciousness, computerized axial tomography results, complications, final status at discharge and hospital stay. Univariate and multivariate analyzes and binary logistic regression were performed to determine the prognostic variables. Results: the hospital stay showed an average of 9.25 days, sex and skin color did not show significant differences, there was a higher percentage (66.7) of patients with personal hypertension pathological history, being aware and the coma had significant differences between the two groups, the number of cases with intraparenchymal hemorrhage was greater (88.5%), bronchopneumonia was the most frequent complication, and the multivariate logistic regression analysis identified mortality prognostic factors variables as. :aware, coma and bronchopneumonia. Conclusions: being aware, coma and bronchopneumonia were the prognostic factors of mortality

Factores asociados a las neoplasias quísticas del páncreas en pacientes atendidos en el Hospital “Arnaldo Milián Castro”. 2004-2014

INTRODUCCIÓN: Las neoplasias quísticas del páncreas son tumores cuya incidencia ha ido incrementándose en las últimas décadas. No abundan las investigaciones enfocadas en identificar factores que permitan distinguir entre las neoplasias quísticas del páncreas y lesiones quísticas pancreáticas no neoplásicas.OBJETIVO: Identificar los factores asociados a las neoplasias quísticas del páncreas en los pacientes atendidos en el Hospital “Arnaldo Milián Castro”.MÉTODOS: Se realizó un estudio analítico de tipo casos y controles en el Hospital “Arnaldo Milián Castro” en el período 2004-2014. Conformaron el grupo caso 15 pacientes con neoplasias quísticas pancreáticas y el grupo control 30 pacientes con lesiones quísticas pancreáticas no neoplásicas.RESULTADOS: Predominó el sexo femenino (93.3%) y el color de piel blanca (66.7%), la edad promedio en el grupo caso fue de 38.9 años; en ellos fue significativamente mayor la presencia de hábito de fumar (OR=2.471;IC=1.068-5.717), diabetes mellitus (OR=2.333;IC=1.094-4.975), pérdida de peso (OR=5.250;IC=2.462-11.193), anorexia (OR=3.532;IC=1.664-7.499), ausencia de síntomas (OR=2.909;IC=1.493-5.670) y la localización de la lesión en la cola del páncreas (OR=3.692;IC=1.647-8.277). Se presentó con mayor frecuencia en el grupo caso el cistoadenoma mucinoso (53.3%). Se identificaron como factores de riesgo para el desarrollo de neoplasias quísticas pancreáticas a la edad entre 20 y 40 años (OR=1.21; IC=1.256-3.995), el sexo femenino (OR=1.81; IC=1.658-5.009) y el hábito de fumar (OR=1.95; IC=1.336-9.455).CONCLUSIONES: Fueron identificados los factores que con mayor fuerza se asociaron a la presencia de neoplasias quísticas pancreáticas. Su reconocimiento en la práctica clínica diaria podría contribuir a distinguir entre lesiones quísticas pancreáticas neoplásicas y no neoplásicas.

COVID-19 in Older Patients: Assessment of Post-COVID-19 Sarcopenia

(1) Background: Acute COVID-19 infections produce alterations in the skeletal muscle, leading to acute sarcopenia, but the medium- and long-term consequences are still unknown. The aim of this study was to evaluate: (1) body composition; (2) muscle strength and the prevalence of sarcopenia; and (3) the relationship between muscle strength with symptomatic and functional evolution in older patients affected by/recovered from COVID-19; (2) Methods: A prospective, longitudinal study of patients aged ≥65 years who had suffered from COVID-19 infection between 1 March and 31 May 2020, as confirmed by PCR or subsequent seroconversion. Persistent symptoms, as well as anthropometric, clinical, and analytical characteristics, were analyzed at 3 and 12 months after infection. The degree of sarcopenia was determined by dynamometry and with SARC-F; (3) Results: 106 participants, aged 76.8 ± 7 years, were included. At 3 months postinfection, a high percentage of sarcopenic patients was found, especially among women and in those with hospitalization. At 12 months postinfection, this percentage had decreased, coinciding with a functional and symptomatic recovery, and the normalization of inflammatory parameters, especially interleukin-6 (4.7 ± 11.6 pg/mL vs. 1.5 ± 2.4 pg/mL, p < 0.05). The improvement in muscle strength was accompanied by significant weight gain (71.9 ± 12.1 kg vs. 74.7 ± 12.7 kg, p < 0.001), but not by an increase in lean mass (49.6 ± 10 vs. 49.9 ± 10, p 0.29); (4) Conclusions: Older COVID-19 survivors presented a functional, clinical, and muscular recovery 12 months postinfection. Even so, it is necessary to carry out comprehensive follow-ups and assessments that include aspects of nutrition and physical activity.Funding for open access charge: Universidad de Málag

Study protocol for a randomised, double-blinded, placebo-controlled phase III trial examining the add-on efficacy, cost-utility and neurobiological effects of low-dose naltrexone (LDN) in patients with fibromyalgia (INNOVA study)

Introduction There is evidence that low-dose naltrexone (LDN; <5.0 mg/day) reduces pain and improves the quality of life of people with fibromyalgia syndrome (FMS). However, no randomised controlled trials with long-term follow-ups have been carried out. The INNOVA study will evaluate the add-on efficacy, safety, cost-utility and neurobiological effects of LDN for reducing pain in patients with FMS, with a 1-year follow-up. Methods and analysis A single-site, prospective, randomised, double-blinded, placebo-controlled, parallel design phase III trial will be performed. Eligibility criteria include being adult, having a diagnosis of FMS and experiencing pain of 4 or higher on a 10-point numerical rating scale. Participants will be randomised to a LDN intervention group (4.5 mg/day) or to a placebo control group. Clinical assessments will be performed at baseline (T0), 3 months (T1), 6 months (T2) and 12 months (T3). The primary endpoint will be pain intensity. A sample size of 60 patients per study arm (120 in total), as calculated prior to recruitment for sufficient power, will be monitored between January 2022 and August 2024. Assessment will also include daily ecological momentary evaluations of FMS-related symptoms (eg, pain intensity, fatigue and sleep disturbance), and side effects via ecological momentary assessment through the Pain Monitor app during the first 3 months. Costs and quality-adjusted life years will be also calculated. Half of the participants in each arm will be scanned with MRI at T0 and T1 for changes in brain metabolites related to neuroinflammation and central sensitisation. Inflammatory biomarkers in serum will also be measured. Ethics and dissemination This study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and community engagement activities. Trial registration number NCT04739995

Cryptogenic organizational pneumonia

Paciente masculino de 74 años de edad, con antecedentes patológicos personales de obesidad, hipertensión arterial, diabetes mellitus y bloqueo de rama izquierda del haz de His. Comenzó con disnea y tos seca que no mejoró con el tratamiento impuesto por el médico de familia. Acudió al Cardiocentro “Ernesto Che Guevara” -se le realizaron complementarios: hemoglobina (cifras bajas), creatinina y acido úrico (elevados)-, desde donde fue remitido al Cuerpo de Guardia del Hospital “Arnaldo Milián Castro”: se le auscultaron crepitantes bibasales en el aparato respiratorio, soplo sistólico II/VI en focos aórticos y pulmonar y edema de miembros inferiores; una radiografía de torax arrojó moteado algodonoso en ambas  bases pulmonares y un  ecocardiograma signos de hipertensión pulmonar severa. Fue ingresado con diagnósticos de enfermedad renal crónica por nefropatía diabética e hipertensión arterial; evolucionó mal, no respondió a los tratamientos y falleció por insuficiencia respiratoria a los 18 días de admitido. Los hallazgos en la necropsia permitieron el diagnóstico de cor pulmonale crónico descompensado en paciente que padece hipertensión pulmonar severa por neumonía organizativa criptógena como causa básica de muerte.Male patient of 74 years old, with personal pathological histories of obesity, hypertension, diabetes mellitus and left branch block of the bundle of His. He began with dyspnea and dry cough that did not improve with the treatment imposed by the family doctor. He went to the Cardiocentro “Ernesto Che Guevara” and carried out complementary tests: hemoglobin (low figures), creatinine and uric acid (elevated), from where he was referred to “Arnaldo Milián Castro” Hospital Guardhouse: bibasal crackles were heard in the respiratory system, systolic murmur II/VI in aortic and pulmonary focus and edema of the lower limbs; a chest x-ray showed cottony speckling on both lung bases and an echocardiogram signs of severe pulmonary hypertension. He was admitted with diagnoses of chronic kidney disease due to diabetic nephropathy and arterial hypertension; he evolved poorly, he did not respond to the treatments and died of respiratory failure 18 days after admission. The findings at necropsy allowed the diagnosis of decompensated chronic cor pulmonale in a patient suffering from severe pulmonary hypertension due to cryptogenic organizing pneumonia as a basic cause of death

¿Son las “arritmias” un predictor de mortalidad en pacientes holguineros con esclerosis sistémica?

Señor Editor:He leído detenidamente el artículo titulado Supervivencia en pacientes con esclerosis sistémica en la provincia de Holguín, de los autores Remedios Batista SE et al.1 publicado en la Revista Cubana de Reumatología.Felicito a los autores por abordar un tema tan interesante, necesario y además novedoso en la literatura médica cubana. Sin embargo considero que la investigación presenta varias limitaciones que ensombrecen sus resultados

Movimiento de alumnos ayudantes: experiencia de una institución cubana

Resumen: El movimiento de alumnos ayudantes surge como una necesidad ante el éxodo masivo de profesionales al comienzo de la revolución cubana. A más de 5 décadas de creado conserva total vigencia al perfeccionarse y adecuarse continuamente a los dinámicos requerimientos sociales del país. En este artículo se describe la experiencia del Hospital Universitario Arnaldo Milián Castro en el trabajo con los alumnos ayudantes en el período entre 2011 y 2016, enfatizando sus logros y desafíos en el cumplimiento de sus principales objetivos en la educación médica superior cubana: apoyar el desarrollo del proceso docente educativo, dirigir la orientación profesional hacia especialidades que se encuentran en déficit y adquirir de forma acelerada habilidades como docente, investigativas y propias de la especialidad. Abstract: The teaching-support student movement arose out of the necessity to cover the lack of teachers caused by the massive exodus of professionals at the beginning of the Cuban Revolution. Five decades later it is still alive and continuously perfects and adjusts itself according to the dynamic social requirements of the country. This article intends to describe the experience acquired at the University Hospital “Arnaldo Milián Castro” based on the work of teaching-support students in the period from 2011 to 2016, emphasising its achievements and challenges in the fulfilment of its main objectives in Cuban higher medical education such as: to support the development of the instructional and educational process, to address the professional orientation towards specialities deficient in professionals and to quickly acquire skills for teaching, research, and those related to specialities. Palabras clave: Educación médica, Recursos humanos en salud, Internado y residencia, Especialización, Cuba, Keywords: Medical education, Health manpower, Internship and residency, Specialisation, Cub