Resumen Objetivo. Realizar una descripción de las características clínicas, los factores asociados y el desenlace de las traqueostomías realizadas en pacientes con COVID-19. Método. Estudio retrospectivo observacional de 14 pacientes a quienes se realizó traqueostomía. Diez de ellos se encontraban diagnosticados con COVID-19, confirmada con prueba RT-PCR de exudado nasofaríngeo y hallazgos tomográficos compatibles. Resultados. De los 10 pacientes, cinco fueron dados de alta y cinco fallecieron. La edad promedio de los pacientes que fallecieron fue de 66.6 años, y la de los que fueron dados de alta fue de 60.4 años. De los parámetros ventilatorios, se tomó como corte una FiO2 ≤ 40% y una PEEP ≤ 8; entre los pacientes dados de alta, cuatro cumplían con ambos criterios. En cambio, de los pacientes que fallecieron, ninguno los cumplió. En estos últimos se documentó un promedio de APACHE II de 16.4 y un SOFA de 7.4, mientras que en los pacientes dados de alta se observó un promedio de 12.6 y 4.6, respectivamente. Conclusiones. La traqueostomía realizada en pacientes con criterios específicos, como parámetros ventilatorios bajos, edad o puntuación baja en las escalas de gravedad, pueden llegar a tener mejor pronóstico.

Abstract Objective. Provide a description of clinical characteristics, associated factors and outcome of tracheostomies performed in COVID-19 patients. Method. Observational prospective study of 14 patients who underwent tracheostomy. 10 of them were diagnosed with COVID 19, confirmed with RT-PCR test of nasopharyngeal exudate and compatible tomographic findings. Results. Of the 10 patients, five were discharged and five died. The average age of patients who died was 66.6 years; of those who were discharged, it was 60.4 years. Ventilatory parameters cut was taken as FiO2 ≤ 40% and PEEP ≤ 8; of the patients discharged, four met both criteria. On the other hand, of the patients who died, neither met both. Of the latter, an average of APACHE II of 16.4 and SOFA 7.4 were documented, while in discharged patients an average of 12.6 and 4.6 were observed, respectively. Conclusions. Tracheostomy performed in patients with specific criteria, such as low ventilatory parameters, age, or low score in severity scales, may have a better prognosis.

With the objective of validating research instruments for the evaluation of the curriculum effectiveness in terms of the special functions of the general physician (preparation for defense and disaster medicine), two theoretical exercises were designed and applied to a sample of 6th year students, both Cubans and foreigners, from a medical school, who answered a survey about this topic. The professors acted as a counterpart in implementing the said exercises and gave their final assessment in an interview. The results obtained by the students in answering the instruments, those related to the opinion of students and professors about their use and finally their application were all processed. The final results show that the suggested instruments are adequate to assess the knowledge about the special functions of the general physicians and can be recommended for the assessment of the functions for which they were designed.

Con el propósito de validar instrumentos de investigación orientados a evaluar la efectividad del currículo en relación con las funciones especiales del Médico General (Preparación para la Defensa y Medicina de Desastres), se realizó el diseño de sendos ejercicios teóricos y aplicación a una muestra de estudiantes de sexto curso, cubanos y extranjeros, de una facultad de Ciencias Médicas, quienes respondieron una encuesta acerca de estos. Profesores de la facultad actuaron como contraparte en la aplicación de dichos ejercicios teóricos y dieron su valoración en una entrevista. Se procesaron los resultados obtenidos por los estudiantes al responder los instrumentos, los relativos a las opiniones estudiantiles y las profesorales sobre estos y su aplicación. Los resultados indican que los instrumentos propuestos son adecuados para valorar el conocimiento acerca de las funciones especiales de los médicos generales y recomendables para la evaluación de las funciones para las cuales fueron diseñados.

Introduction: current medical training in Cuba responds to the health needs of the population of our country and others in need around the world. The Department of Teaching and Research of the Ministry of Health created a research group, which designed the project Curriculum Effectiveness of Medicine. One of the cuts curriculum assessments evaluates the correspondence between the professional model declared for the five functions described in the curriculum and professional training. One of the five functions described in the model is the role of research. Objective: to design an instrument to assess the correspondence between the professional models for the function declared in curriculum research and professional training. Material and methods: a technological development research was conducted in three stages: first: design of the assessment instrument; second: implementation of the theoretical and practical exercises; Third, assessment of instrument. Results: using the designed instrument showed that the current curriculum with the research function is fulfilled by 80.8%. All the teachers and most students are projected correctly, to focus their views on the aspects required for validation. Conclusions: a tool for assessing the correspondence between the professional models for the function declared in curriculum research and professional training is designed. Shares applied validation support the validity of the instrument in terms of content and functionality in practice.

Introducción: la formación actual de médicos en Cuba responde a las necesidades de salud de la población del nuestro país y de otros lugares necesitados del mundo. El Área de Docencia e Investigación del Ministerio de Salud Pública creó un grupo de investigación, el cual diseñó el proyecto Efectividad del Currículo de Medicina. Uno de los cortes de valoración del currículo evalúa la correspondencia entre el modelo del profesional declarado para las cinco funciones descritas en el currículo y el profesional en formación. Una de las cinco funciones que se describe en el modelo es la función de investigación. Objetivo: diseñar un instrumento para evaluar la correspondencia entre el modelo del profesional declarado para la función de investigación en el currículo y el profesional en formación. Material y métodos: se realizó una investigación de desarrollo tecnológico en tres etapas: primera: diseño del instrumento evaluativo; segunda: ejecución de los ejercicios teóricos y prácticos; tercera: valoración del instrumento. Resultados: mediante el instrumento diseñado se demostró que con el actual currículo la función de investigación se cumple en 80.8%. La totalidad de los profesores y la mayor parte de los estudiantes se proyectaron correctamente, al focalizar sus opiniones en los aspectos requeridos para la validación. Conclusiones: se diseñó un instrumento que permite evaluar la correspondencia entre el modelo del profesional declarado para la función de investigación en el currículo y el profesional en formación. Las acciones de validación aplicadas apoyan la validez del instrumento en cuanto a su contenido y operatividad en la práctica.

Introduction: in order to appraisal in what measure the students achieve the final objectives of the Clinic Propedeutic subject is required to create an instrument based in a theoretic and practice Test for assessing the abilities achieved. Objective: design an evaluative instrument for a theoretic and practical exercise that aloud a valid and reliable assessment of the fulfillment of subject at the end of the fifth semester of Medicine's career. Material and methods: an investigation of technological development in three stages; First: Design of the evaluative instrument; Second: Execution of the theoretic practice exercises; Third: Assessment of the instrument. Results: it was designed an instrument of theoretic practical evaluation that allow to appraisal the quality of the learning in Clinic Propedeutic, the main integrative subject of the fifth semester of Medicine's career. The actions of validation applied back up his contents validity and imperativeness in practice. Conclusions: the instrument elaborated responds to the bio psychosocial paradigm, the patient centered style of medical attention and it makes sense with the problem based teaching.

Introducción: para valorar en qué medida los estudiantes logran cumplir los objetivos a final de la asignatura Propedéutica Clínica se requiere crear un instrumento basado en un examen teórico y práctico que aborde las habilidades a lograr. Objetivo: diseñar un instrumento evaluativo para un ejercicio teórico-práctico que permita una valoración válida y confiable del cumplimiento de los objetivo de la asignatura al final del quinto semestre de la carrera de Medicina. Material y métodos: se realizó una investigación de desarrollo tecnológico en tres etapas: primera: diseño del instrumento evaluativo; segunda: ejecución de los ejercicios teóricos y prácticos; tercera: valoración del instrumento. Resultados: se logró diseñar un instrumento de evaluación teórico-práctico que permite valorar la calidad del aprendizaje en la asignatura Propedéutica Clínica, principal integradora del quinto semestre de la carrera de Medicina. Las acciones de validación aplicadas apoyan su validez en cuanto a su contenido y operatividad en la práctica. Conclusiones: el instrumento elaborado responde al paradigma biosicosocial, al estilo de atención médica centrada en el paciente y es coherente con la enseñanza basada en problemas

Hypsiboas punctatus (Schneider 1799) has a wide distribution in South America, throughout a latitudinal and environmental gradient (tropical/temperate), thus, supporting significantly different pressures among populations. Until now, only tropical populations’ reproductive parameters have been recorded. Then, our goal was to study reproductive parameters on a population inhabiting a temperate climate region to evaluate differences with those inhabiting tropical regions. Studied frogs were smaller than those from tropical regions. There was no correlation between weight and size of males and their testicles volume. Conversely, females’ weight and size was positively correlated to their fertility. Fat bodies were developed in males but absent in females. When compared with other studies, our results showed the variability in reproductive parameters of H. punctatus between tropical and temperate regions. This variability could be the result of phenotypic plasticity and/or genetic differentiation between distant populations. This variability may be one of the keys that allow H. punctatus to thrive in diverse ecosystems with different characteristics and environmental pressures.

Hypsiboas punctatus (Schneider 1799) posee una amplia distribución en Sudamérica, a lo largo de un gradiente ambiental y latitudinal (tropical/templado), por lo que las condiciones que enfrentan sus poblaciones difieren significativamente. Hasta el momento, solamente se conocen los parámetros reproductivos de esta especie en regiones tropicales, por lo que en el presente trabajo se estudió una población de una región templada para evaluar si existen diferencias. Los individuos estudiados resultaron ser de menor tamaño que los de poblaciones tropicales. El tamaño y peso de los machos no se correlacionaron con el volumen testicular. En cambio, el tamaño y el peso de las hembras se correlacionaron positivamente con su fertilidad. No se encontraron cuerpos grasos desarrollados en las hembras pero sí en los machos. Los resultados obtenidos sugieren que existe una variabilidad en los parámetros reproductivos de H. punctatus que puede estar relacionada tanto a un fenómeno de plasticidad fenotípica como de diferenciación genética entre poblaciones distantes. Esto sería una de las claves que permitiría a esta especie prosperar en diferentes ecosistemas con distintas características y presiones ambientales.

Alguns peixes de água doce da América do Sul podem melhorar o desempenho da respiração aquática superficial (RAS) desenvolvendo protuberâncias dérmicas labiais na mandíbula. Considerava-se que essa adaptação era limitada aos peixes onívoros ou herbívoros. Este trabalho apresenta os primeiros indícios de que juvenis de um caracídeo piscívoro, Salminus brasiliensis, desenvolvem protuberâncias dérmicas labiais durante períodos de hipoxia em lagoas de várzea do rio Salado, Argentina. As protuberâncias de S. brasiliensis envolvem porções dérmicas das duas mandíbulas e exibem lóbulos laterais ao lado da boca dispostas no plano vertical. Concentrações de oxigênio dissolvido na água, inferiores ou iguais a 1,05 mgl-1, foram associadas a um aumento notável no desenvolvimento das protuberâncias labiais. Nesta espécie os lóbulos laterais da protuberância podem limitar o acesso de água à porção anterior da boca, que está posicionada mais perto da superfície da água oxigenada durante a RAS. Finalmente, a RAS, complementada com o desenvolvimento de protuberâncias dérmicas labiais, pode ser considerada uma valiosa estratégia para a sobrevivência em ambientes hipóxicos, mesmo para peixes carnívoros com elevada demanda de oxigênio.

Some South American freshwater fishes can improve their capability of aquatic surface respiration (ASR) by developing dermal lip protuberances in the lower jaw. This adaptation was thought to be limited to omnivorous or herbivorous fishes. The present work provides the first evidence that juveniles of a piscivorous characid, Salminus brasiliensis, develop dermal lip protuberances during periods of hypoxia in floodplain ponds of the Salado River, in Argentina. The protuberance of S. brasiliensis involves dermal portions of both jaws exhibiting lateral lobes on the sides of the mouth arranged in the vertical plane. Water dissolved oxygen concentrations less than or equal to 1.05 mgl-1 were associated with a remarkable increase in lip protuberance. The lateral lobes of the protuberance in this species may limit the access of water to the anterior portion of the mouth which is positioned nearer to the oxygenated surface water during ASR. Finally, ASR, complemented with the development of dermal lip protuberances, can be considered a valuable strategy to survive in hypoxic environments, even for carnivorous fishes with elevated oxygen requirements.

The study of the feeding ecology of amphibians is an old issue in herpetology. Notwithstanding, the lack of food resources data in many studies of amphibians feeding has lead to partial understanding of frog feeding strategies. In this study we evaluate the trophic selectivity of a red spotted green frog (Hypsiboas punctatus) population from a Middle Paraná River floodplain pond in Argentina, and discuss the importance of prey availability data when interpreting results from diet analysis. We analyzed the gut contents of 47 H. punctatus adults and compared frog’s diet with the environmental food resources. Prey availability was estimated by systematically seep-netting the microhabitat where anurans were localized foraging. We identified 33 taxonomic categories from gastrointestinal contents. Numerically, the most important prey categories were dipterans, followed by hemipterans, homopterans and coleopterans. The diet similarity between males and females was high and no statistical differences in diet composition were found. The most abundant food resources in the environment were dipterans, coleopterans, homopterans and collembolans. In order to assess whether frogs were selecting their preys, we calculated Pianka’s niche overlap index and Jacobs’ electivity index comparing gut contents to prey availability data. Trophic niche overlap was medium but significantly higher than expected by chance. The electivity index indicated that H. punctatus foraged dipterans slightly above their environmental abundance. Among the secondary preys, hemipterans were foraged selectively, homopterans were consumed in the same proportion to their occurrence in the environment, coleopterans were foraged quite under their availability and collembolans were practically ignored by frogs. Without food resources data, H. punctatus could be classified as a specialist feeder, but dipterans also were quite abundant in the environment. Our results show that H. punctatus fit better as a generalist feeder, foraging on their main food item and some secondary preys in similar proportion to their environmental availability; even though other secondary preys are being selectively preferred or ignored by frogs. Our data illustrate the importance of including the resource availability data on diet studies to improve the understanding of amphibian feeding ecology. Rev. Biol. Trop. 57 (3): 847-857. Epub 2009 September 30.