Abstract INTRODUCTION Immunity in cancer patients is modified both by the cancer itself and by oncospecific treatments. Whether a patient’s adaptive immunity is impaired depends on their levels of naive lymphocytes and other cell populations. During the COVID-19 pandemic, cancer patients are at greater risk of progressing to severe forms of the disease and have higher mortality rates than individuals without cancer, particularly while they are receiving cancer-specific therapies. An individual’s protection against infection, their response to vaccines, and even the tests that determine the humoral immune response to SARS-CoV-2, depend on lymphocyte populations, meriting their study. OBJECTIVE Estimate blood concentrations of lymphocytes involved in the immune response to new pathogens in cancer patients. METHODS We carried out an analytical study of 218 cancer patients; 124 women and 94 men, 26–93 years of age, who were treated at the National Oncology and Radiobiology Institute in Havana, Cuba, March–June, 2020. Patients were divided into five groups: (1) those with controlled disease who were not undergoing cancer-specific treatment; (2) those undergoing debulking surgery; (3) patients undergoing chemotherapy; (4) patients undergoing radiation therapy and (5) patients currently battling infection. We evaluated the following peripheral blood lymphocyte subsets via flow cytometry: B lymphocytes (total, naive, transitional, memory, plasmablasts and plasma cells); T lymphocytes (total, helper, cytotoxic and their respective naive, activated, central memory and effector memory subsets); and total, secretory and cytotoxic natural killer cells and T natural killer cells. We also estimated neutrophil/lymphocyte ratios. Lymphocyte concentrations were associated with controlled disease and standard cancer therapy. For variables that did not fall within a normal distribution, ranges were set by medians and 2.5–97.5 percentiles. The two-tailed Mann–Whitney U test was used to measure the effect of sex and to compare lymphocyte populations. We calculated odds ratios to estimate lymphopenia risk. RESULTS All cancer patients had lower values of naive helper and cytotoxic T lymphocyte populations, naive B lymphocytes, and natural killer cells than normal reference medians. Naive helper T cells were the most affected subpopulation. Memory B cells, plasmablasts, plasma cells, activated T helper cells, and cytotoxic central memory T cells were increased. Patients undergoing treatment had lower levels of naive lymphocytes than untreated patients, particularly during radiation therapy. The risk of B lymphopenia was higher in patients in treatment. The odds ratio for B lymphopenia was 8.0 in patients who underwent surgery, 12.9 in those undergoing chemotherapy, and 13.9 in patients in radiotherapy. CONCLUSIONS Cancer and conventional cancer therapies significantly affect peripheral blood B lymphocyte levels, particularly transitional T helper lymphocytes, reducing the immune system’s ability to trigger primary immune responses against new antigens.

ABSTRACT Introduction: Formative evaluation is a continuous activity developed throughout the educational teaching process in order to regulate it; but, in its broadest conception, its purpose is for the student to build a personal system for lifelong learning. Objective: To promote self-regulation of learning through formative evaluation in medical education. Development: During formative evaluation, the professor, as a mediator, has the responsibility of training professionals who are given the appropriate tools for managing lifelong learning, which is specified in self-regulation learning competencies. Thorough systematization of different publications, the stages of this process are specified according to Zimmerman’s and Moylan’s (2009) Cyclical Phases model -one of the most widespread in the scientific literature-; and it is explained how, through formative evaluation in medical education, the professor can guide the process towards self-regulation of learning. Conclusions: The elements that characterize self-regulation of learning are presented, highlighting its importance throughout life. The attributes of formative evaluation to manage learning are justified, as well as how to guide it towards the promotion of self-regulated actions through the development of metacognitive capacities that encourage the student to improve the processes that allow them to learn, the strategies to regulate learning, and such projection in an adequate domain of the modes of action that characterize the professional activity.

RESUMEN Introducción: La evaluación formativa constituye una actividad continua que se desarrolla durante todo el proceso docente educativo con la finalidad de regularlo; pero, en su concepción más amplia, su propósito es que el estudiante construya un sistema personal para el aprendizaje permanente. Objetivo: Promover la autorregulación del aprendizaje desde la evaluación formativa en la educación médica. Desarrollo: Durante la evaluación formativa, el profesor como mediador tiene la responsabilidad de formar profesionales que estén dotados de las herramientas apropiadas para este aprendizaje a lo largo de la vida, que se concreta en competencias de autorregulación del aprendizaje. En una sistematización de diferentes publicaciones se puntualizan las etapas de este proceso según el modelo cíclico de fases de Zimmerman y Moylan (2009) -uno de los más difundidos en la literatura científica-, y se explica cómo desde la evaluación formativa en la educación médica el profesor puede orientar el proceso hacia la autorregulación del aprendizaje. Conclusiones: Se exponen los elementos que caracterizan la autorregulación del aprendizaje y se destaca su importancia a lo largo de la vida. Se justifican los atributos de la evaluación formativa para gestionar el aprendizaje y cómo orientarla hacia la promoción de actuaciones autorreguladas a través del desarrollo de las capacidades metacognitivas que propicien en el estudiante perfeccionar los procesos que le permitan aprender, las estrategias para regular el aprendizaje y su proyección en un adecuado dominio de los modos de actuación que caracterizan la actividad profesional.

ABSTRACT Introduction: One of the trends of postgraduate medical education in the academic setting worldwide is the need to develop an evaluation process with a focus on performance, which requires the preparation of teachers. Objective: To present the characteristics of the performance evaluation process in medical specialties and the procedures used with the greatest impact on its assessment at the international level. Development: Teachers need theoretical-methodological and practical references as the basis to implement a performance-oriented evaluation process, in correspondence with the professional profile of the specialist model projected and the contemporary trends in medical education postgraduate. The attributes of the performance evaluation process are justified as a tool to manage lifelong learning, by promoting the development and empowerment of capabilities for self-regulation of learning and its projection in self-regulation of performance. Conclusions: In a process of systematization of various publications, the characteristics of the performance evaluation process in medical specialties are established, and the procedures and instruments described in the literature are exposed as having the greatest impact on their development.

RESUMEN Introducción: Una de las tendencias del posgrado en la educación médica en el ámbito académico a nivel mundial es la necesidad de desarrollar un proceso de evaluación con enfoque en el desempeño y esto requiere de la preparación de los profesores. Objetivo: Exponer las características del proceso de evaluación del desempeño en las especialidades médicas y de los procedimientos empleados con mayor impacto en su valoración a nivel internacional. Desarrollo: Los profesores necesitan de referentes teórico-metodológicos y prácticos como fundamento para implementar un proceso de evaluación orientado al desempeño, en correspondencia con el perfil profesional del modelo del especialista previsto y las tendencias contemporáneas del posgrado en la educación médica. Se justifican los atributos del proceso de evaluación del desempeño como herramienta para gestionar el aprendizaje a lo largo de la vida, al promover el desarrollo y la potenciación de capacidades para la autorregulación del aprendizaje y su proyección en la autorregulación del desempeño. Conclusiones: En un proceso de sistematización de diversas publicaciones se establecen las características del proceso de evaluación del desempeño en las especialidades médicas, y se exponen los procedimientos e instrumentos descritos en la literatura como de mayor impacto en su desarrollo.

17 patients that underwent surgery at Comandante Manuel Fajardo Teaching Hospital, from 1996 to 2000, with big incisional hernias reproduced in more than one ocassion, and with repair by polypropylene or polyester meshes in prefascial or supraaponeurotic position, were presented. In our series, all the patients had undergone at least 2 previous operations. 5 cases had been operated on 4 times and 1,7 ocassions. In all cases, a careful preoperative arrangement was made that included the local preparation of the skin and the reestablishment of the thoracoabdominal capacity by pneumoperitonea, which made possible the fascia to fascia facing without tension. The hernial rings measured more than 10 cm, with an average of 16. Cefazolin was used as a prophylactic antibiotic in all cases. There was no wound sepsis. No hernial relapse was observed with an average follow-up of 39.6 months. There have been no manifestations of rejection to the prosthetic material up to now. No immediate complications as seroma or hematoma of the surgical wound were reported, since a drainage was placed in the surgical zone in all cases

Se presentan 17 enfermos intervenidos en el Hospital Universitario "Comandante Manuel Fajardo" durante 1996 al 2000, con hernias incisionales grandes reproducidas en más de una ocasión, con reparación mediante mallas de polipropileno o poliéster en posición prefascial o supraaponeurótica. En nuestra serie todos los enfermos habían sufrido al menos 2 intervenciones anteriores, 5 casos habían sido operados 4 veces y 1 en 7 ocasiones. En todos los casos se realizó una cuidadosa preparación preoperatoria que incluyó la preparación local de la piel y el restablecimiento de la capacidad toracoabdominal mediante neumoperitoneos, lo que hizo posible el afrontamiento fascia a fascia sin tensión. Los anillos herniarios midieron más de 10 cm, con promedio de 16. En todos los casos se utilizó la cefasolina como antibiótico profiláctico y no se produjo sepsis de la herida. No ocurrió recidiva herniaria, con un seguimiento promedio de 39,6 meses. No existieron hasta el momento manifestaciones de rechazo atribuibles al material protésico. No se reportaron complicaciones inmediatas como seroma o hematoma de la herida quirúrgica, al haberse colocado en todos los casos drenaje de la zona quirúrgica