Revista Ciencias de la Salud y Educación Médica
La Revista Ciencias de la Salud y Educación Médica (RCSEM) del Área de Conocimiento Ciencias de la Salud, es una revista electrónica que tiene como objetivo divulgar y difundir la producción científica, innovadora y académica, que se genera en el quehacer de la formación de grado y posgrado de las carreras de la salud, así como un espacio para todos los profesionales de la salud nacionales o extranjeros que deseen publicar sus resultados de investigaciones y avances científicos.
Development of the Link with the Environment in the Faculty of Medicine and Dentistry of the University of Antofagasta, Chile
The University of Antofagasta has a Policy and Model that defines the linkage agents and areas of action that must consider the extension and linkage activities carried out by the different Faculties and Departments. This essay addresses the genesis of the Environment and Extension Linkage Program of the Faculty of Medicine and Dentistry of the University of Antofagasta and its fulfillment, through its activities, in line with the guidelines of the Development Plan of the academic unit. 2021 – 2030, as well as the importance of reportability mechanisms and the role of the actors involved. Its main strengths, weaknesses, opportunities for improvement and actors involved are described. The methodology consisted of a reflective analysis of the development of the connection with the environment and extension in the Faculty based on what was established in its work program. The results indicate that the activities are carried out regularly, although some must be strengthened. It is concluded that the above contributes to the indicators of the Faculty and the University of Antofagasta, thanks to the reportability exercised by Liaison Secretaries, academics and students, contributing to compliance with the Quality Assurance Law of Higher Education of Chile ; the standards defined by the National Accreditation Commission and the third university mission, leaving as pending challenges the measurement of the impact of the activities carried out and their curricular correlation, through the Service Learning methodology.
Copyright (c) 2025 Revista Ciencias de la Salud y Educación Médica
Tubo gástrico como alternativa quirúrgica para el reemplazo de esófago en niños
La pérdida del esófago es un problema no tan frecuente, pero de gran sufrimiento para el niño, angustia a la familia y un desafío técnico para el cirujano pediatra. Este trabajo evaluó la viabilidad y eficacia del reemplazo esofágico utilizando un tubo gástrico como alternativa en niños del Hospital Infantil Manuel de Jesús Rivera “La Mascota” entre noviembre del 2011 a noviembre del 2018. Se llevó a cabo un análisis observacional descriptivo que abordó las características sociodemográficas, las indicaciones, los resultados de la técnica quirúrgica y las complicaciones asociadas. Un total de 19 casos de reemplazos esofágicos (14 niños y 5 niñas), con edades entre 10 meses y 18 años (media 4 años), y un seguimiento promedio de 2.7 años, se identificaron 9 pacientes con complicaciones posquirúrgicas, siendo la fístula de la anastomosis la más frecuente (6 pacientes). Se llevó a cabo modificación en los momentos de la técnica quirúrgica, que pareciera influir en una disminución del índice de complicaciones. Es importante mencionar que un paciente falleció por una complicación no vinculada al procedimiento de reemplazo esofágico, los 18 pacientes restantes lograron recuperar con éxito la alimentación oral total. En consecuencia, se concluye que el reemplazo esofágico utilizando un tubo gástrico transhiatal retromediastinal es una técnica factible, reproducible y segura para restablecer la alimentación oral en niños. Además, se observó que al realizar el reemplazo esofágico comenzando por la etapa cervical seguido de la abdominal parece proporcionar una mayor seguridad y un menor número de complicaciones.
Development of the Link with the Environment Knowledge, attitudes and risky sexual practices in first-year students of Basic Sciences and Technology, UNAN–Managua, 2023
The objective of this research was to analyze the knowledge, attitudes and risky sexual practices in first-year students of Basic Sciences and Technology at UNAN – Managua, 2023. This study is observational with a quantitative, descriptive, cross-sectional approach, and had a sample of 190 students, who came from different careers. To collect the information, an online questionnaire was applied through Google Form. The main results obtained were the following: the age of 18-19 years prevailed with 63.2%, being more frequent the female sex with 72.1%, 66.8% come from the urban area. Regarding the CAP results, they presented good knowledge and favorable attitudes, but with sexual practices of medium risk for both sexes. In conclusion, having knowledge reflects a good attitude, but it is not always synonymous with good practice and in matters that involve sexual health it can lead to unfavorable consequences, mainly in adolescents, because they are considered vulnerable for not being prepared to lead a healthy sexual life.
Quality in management of surgical samples sent to the Pathology laboratory
The aim of this research was to identify the main problems in the handling of surgical samples received in the Pathology Department of the Oscar Danilo Rosales Argüello Teaching Hospital (HEODRA), as well as to establish the level of knowledge of the handling of samples in the personnel who perform it. The study consisted of three phases: initial diagnosis of the samples and knowledge surveys of those who handle surgical samples; intervention with the personnel involved, through talks and printed educational material and, at the end, a new diagnosis of the handling of the samples and knowledge surveys after the intervention. The results showed deficiencies in the handling of samples such as: inadequate volume of fixative liquid, lack of information on the biopsy request forms and their clinical data, bottles with inadequate capacity, mouth and lid closure, as well as limitations in the knowledge of the personnel for the adequate handling of surgical samples. All the limitations found decreased considerably after intervention through talks and delivery of educational material.
Hemoglobin variants in patients with anemia at the Carlos Centeno hospital, Siuna, Nicaragua
Human hemoglobin can present alterations known as hemoglobinopathies, caused by autosomal hereditary disorders. Hemoglobin variants can be of two types: qualitative or structural and quantitative, these are increasingly common in the population as a result of the increase in human migration flows. High-performance liquid chromatography (HPLC) is the method used for the separation of hemoglobins in this study, since it has the ability to detect some hemoglobin variants, among the main ones are HbE, HbD, HbS, and HbC. The aim of this research is to focus on the ethnic group and the detection of hemoglobin variants in patients with anemia, which is a topic of great interest in healthcare since the health of ethnic groups must be maintained and cared for. The study area was the Carlos Centeno Hospital in Siuna, located on the North Caribbean Coast, 318 km from the capital of Nicaragua, Managua. The study was conducted with 67 patients with anemia, of all ages and both sexes. The results showed that the predominant sex was female with 63%, the most prominent age range was 11-15 years with 12%, 75% of the patients were of Mestizo ethnicity, 12% of Mayangna ethnicity, 7% of Miskitu ethnicity and 6% of Creole ethnicity. 81% of the patients with anemia have not been diagnosed with any hemoglobinopathy S and 19% of the patients diagnosed with anemia are due to the presence of hemoglobinopathies by HPLC.
Knowledge, attitudes and practices regarding the use of Levonorgestrel in basic sciences and technology students, UNAN-Managua, 2023
The main objective of the research was to analyze the knowledge, attitudes, and practices regarding Emergency Oral Contraception (Levonorgestrel) in first-year students of basic sciences and technology at UNAN-Managua. The study has a quantitative, prospective, descriptive, observational, cross-sectional approach. The total universe of students from basic sciences and technology areas was 329 with a total population of 130 women, where the inclusion and exclusion criteria were applied, obtaining a total of 108 females in the study, with a heterogeneous level of education and socioeconomic stratum, the technique used was the survey and the instrument used was the questionnaire applied in Google Form online self-administered. In the results obtained, the knowledge variable was identified with 55.9%, having a classification margin of 8 questions answered regularly, in the attitude variable an average score of 38 points was obtained, classified as favorable attitudes and in the practices variable 60.8% have inadequate practices, evidencing the misuse of the oral emergency method by adolescents and young people. We can conclude that in the variables investigated, it was possible to identify regular knowledge, favorable attitudes and inadequate practices, showing that, although young people have information available and know the basic aspects of the use of EOC, at the time of sexual intercourse, they let themselves be carried away by their impulses, omitting all the knowledge they possess, maintaining the same margin of risk in their daily sexual practice, whether or not they have the information, with young people being the most vulnerable group.
En el ámbito universitario, es imprescindible que el talento humano, es decir, el talento docente, esté en permanente actualización científica y en constante ejecución de investigaciones, ya que ésta genera conocimiento, el cual es transferido a los estudiantes tanto de grado como de posgrado a través de diversas estrategias y formas de enseñanza y a la sociedad a través de artículos científicas publicados en Revistas, como la Revista Ciencias de la Salud y Educación Médica.
Cervical cancer prevention, an educational nursing intervention
This research study aimed to analyze the relationship between nursing educational interventions and cervical cancer prevention knowledge of patients attending the “Early Lesions Clinic” of the “Carlos Marx” Nicaraguan German Hospital. The study is descriptive and cross-sectional, with a population of 80 women, all part of the early lesions program, who were interviewed pre and post-intervention. The results obtained were the following: the age that predominated was 45 years (41%), evangelical religion (73%), complete primary (34%), housewives (68%), single (34%) from rural area (79%). General knowledge about the prevention of cervical cancer went from intermediate to high (100%), in the modifiable risk factors remained in high or advanced learning (100%), but increased from intermediate to high in contraceptive methods that decrease probabilities of the disease and why the PAP should be performed (96%), in relation to when taking PAP should be started, maintained a low knowledge with (29%). The factors related to reproduction reached a high level of knowledge in its majority (97%), except for the number of sexual partners (25%) number of pregnancies (27%) and the number of vaginal births that predispose the disease (20%) being lower in the post intervention (5% and 8% respectively). Concluding, that nursing educational interventions improve knowledge about cervical cancer prevention. Keywords: Cervical cancer, educational interventions, Prevention, Students.
Copyright (c) 2024 Revista Ciencias de la Salud y Educación Médica
Risk factors associated with gynecology surgical site infections
Surgical site infections (SSIs) are a persistent challenge in medicine, significantly impacting morbidity, costs, and patients' quality of life despite advancements in techniques and preventive measures. SSIs, which occur in the operated area and are uncommon, it can have serious health consequences and a high economic burden. These infections generally originate during surgery, due to microorganisms introduced into the wound, although they can also be acquired postoperatively if the wound does not close properly or if there are predisposing factors. They represent a considerable economic problem due to prolonged hospitalizations and additional treatments. Up to 60% of SSIs are preventable with evidence-based measures, highlighting the importance of identifying specific risk factors. This study at Bertha Calderón Roque Hospital, Managua, analyzes these factors in gynecological surgeries performed between January 2013 and December 2015. The findings show that age, origin, educational level, occupation, and personal pathological history are significant factors. It is also observed that prolonged preoperative stays and diagnoses such as pelvic tumors increase the risk of SSIs. The study aims not only to reduce infections and costs, but also to prevent unnecessary suffering, emphasizing the importance of prevention to improve the safety and quality of life of patients. Keywords: infection, risk, gynecology, prevention
Effectiveness of Tranexamic Acid as a fibrinolysis inhibitor in patients with postpartum hemorrhage treated in a Hospital in Nicaragua
Postpartum Hemorrhage (PPH) is defined as blood loss of 500 mL or more within 24 hours after delivery, which can be classified according to the time of occurrence, as early or late; according to the WHO, this is the main cause of maternal mortality in Latin America and worldwide. The purpose of the study was to identify the effectiveness of tranexamic acid as a treatment in patients with postpartum hemorrhage, which will open the doors to the possible use of this drug by public and private health institutions to reduce the risk of bleeding and maternal death. This descriptive, cross-sectional and retrospective study, developed at Hospital Alemán Nicaraguense Managua-Nicaragua, the national reference hospital, in which a non-randomized sample of 40 patients was taken, who were treated between 2021 and 2022 was taken. The mean age of the study population was 22 years (SD ±8); the main cause of hemorrhage was uterine atony (42.5%); Tranexamic acid showed its effectiveness by inhibiting fibrinolysis in 88% of the sample studied, although this sample size does not allow making a statistical inference, it opens the doors to continue investigating this field with a larger sample that confirms or rejects our results. Keywords: Postpartum hemorrhage, tranexamic acid, effectiveness
External evaluation of the quality of Hematology laboratories in Nicaragua
In Nicaragua, automated analyzers have been implemented in Hematology laboratories since 2008, with the aim of improving the quality of the processes. In addition, the laboratories participate in an external quality assessment program called "RANDOX International Quality Assessment Scheme" (RIQAS). The research focuses on analyzing the performance indicators of the external quality assessment program in the hematology laboratories of the Ministry of Health of Nicaragua in 2022. A retrospective approach was used, and data were collected from external controls sent by the laboratories. The sample consisted of 7 laboratories of the Ministry of Health participating in the program, distributed across different levels of care. The results of the external quality assessment program were generally acceptable, some with excellent performances for the parameters evaluated, although some discrepancies were observed in the measurements of RDW and platelet count. This does not represent a weakness, but rather an opportunity to improve the consistency and precision of the results. It is advisable to review and adjust the procedures in the mentioned analyses. Continuing with these efforts will ensure that laboratories continue to offer first-class service and precision in their measurements, which will contribute substantially to public health in Nicaragua. Keywords: Performance indicators, PEEC, MINSA, Nicaragua, Hematology, Quality.
Biological and cognitive factors that influence the academic performance of medical students in the subject of Physiology I
The study aims to determine the biological and cognitive factors that influence the academic performance of medical students in the subject of Physiology I at UNAN-Managua, 2020. Methodology: The study is descriptive, observational, cross-sectional, retrospective, and quantitative in approach. The universe was made up of 142 students and the sample was 105 active students, who took the subject of Physiology I. The sampling was simple random probabilistic. The ethical aspects were based on the Declaration of Helsinki. The source of information was primary, and the information was processed in SPSS 23. Results: The main factors influencing academic performance were evaluation overload, insufficient time for self-study, poor organization of study time, distracting agents and inappropriate study techniques. Students present anxiety in 80.1%. When evaluating students with the CEE test, it was found that 53.3% of students have above-average stress and 17.1% show high stress. On the other hand, the SISCO questionnaire showed that 98.1% of students have some degree of stress (56.2% moderate stress). The degree of excessive daytime sleepiness was evident in 79.0% of students. The average number of hours that students sleep is 5.4 hours. The learning style is reflective. Keywords: Medicine, Drowsiness, Stress, learning, Academic performance.
Knowledge, attitudes and practices about contraceptive Methods in adolescents.
The sexual and reproductive health of adolescence marks a very important concept in the subsequent development of the human being, and having a healthy life depends greatly on it, achieving stability in your life, your family and society itself. The objective of the present study was to evaluate the level of knowledge, attitudes and practices about contraceptive methods in adolescents from first to fifth year of the Ladislao Chwalbinsky Public Institute of the municipality of Altagracia-Rivas, period 2020 -2021. The research was descriptive, cross-sectional, observational, CAP type, with a quantitative approach, the sampling was probabilistic for convenience corresponding to 264 high school adolescents. The instruments were a survey and interview guide for key actors. The majority of the adolescents were between 15 and 19 years old, female, Catholic, and from an urban area. Knowledge about contraceptive methods was regular; adolescents indicated having received information about contraceptive methods in schools from their teachers, through educational talks. The attitude level is unfavorable. Regarding practice, it was determined that the majority have not yet started an active sexual life and the adolescents who started their active sexual life in a small proportion, use condoms as a contraceptive method, they obtain contraceptive methods in pharmacies. We can conclude by saying that the level of knowledge about MACs by adolescents is regular, they have an unfavorable attitude towards MACs and they have a regular practice in using contraceptives. Key Words: Contraception, Pregnancy in adolescence, Sex education
Fortaleciendo la educación para la prevención en salud
Prolactinomas: Clinical behavior in the adult population
Prolactinomas are the most common type of secretory pituitary tumors in the adult population. The clinical presentation of this pathology is variable and can present with non-specific symptoms and signs, which can represent a challenge for the diagnostic approach. A descriptive cross-sectional study was carried out in patients treated at the Antonio Lenin Fonseca Hospital, during 2017 to 2020, with the aim of characterizing the clinical behavior of prolactinomas in the adult population, through the review of the records of 69 patients. The results were: The tumor predominated in the female sex 76.8%, the average age was 35.17 years ± 13.03 years, the age group of 28-37 years 36.2% was the most affected. The most frequent reasons for consultation were headache 42%, changes in menstruation 36.2% and loss of vision 14.4%. Headache was the most frequent clinical manifestation 78.3%. The predominant manifestation of sexual and reproductive dysfunction in the female sex were amenorrhea 66%and galactorrhea 60.4%; while in the male sex there was decreased libido 87.5% and gynecomastia 18.8%. Campimetry was altered in 62.4% of patients. Macroprolactinoma was the most frequent of the tumors 45% and the majority were functioning prolactinomas 78.3%. 98.6% of the patients had an excess of prolactin. Prolactinomas are more frequent in reproductive age, the presence of larger prolactinomas causes the clinical manifestations of mass effect to be more frequent. Key words: prolactinomas, pituitary tumors, clinical behaviour.
Febrile Neutropenia: clinical and therapeutic characterization of patients treated in a national reference hospital.
Febrile neutropenia (NF) is an oncological and infectious emergency secondary to chemotherapy that causes interruptions in treatment, increased morbidity, mortality and health costs in the management of cancer patients. Timely diagnosis and treatment is key to avoiding complications and death from NF. A descriptive cross sectional case series study was carried out in patients at the Manolo Morales Peralta Hospital, Nicaragua, during 2017-2021, with the objective of clinically and therapeutically characterizing 93 episodes of NF. The episodes mainly affect male patients 53.8%, with a mean age of 44 years and with the most frequent oncological diagnosis of Acute Lymphoid Leukemia. In 100% of the episodes, risk stratification was performed with the MASCC index (55.9% low risk) and the CISNE scale (77.4% intermediate risk). The classification of clinically documented infection 72% and skin/tissue focus 16.1% predominated. Culture was not performed in 71% of cases. The most frequent treatment was empirical 97.8%, ciprofloxacin was the most used drug. Targeted treatment was only applied to 7.5%, with Meropenem and Imipenem plus vancomycin being the most used therapeutic regimen. 68.8% of patients did not present complications, deaths associated with NF were recorded in 16.1% of patients. Keywords: Febrile neutropenia, infections, haematology, cancer
Evaluation of social e-learning based on learning analytics and applied in medical education
This work describes and proposes the social e-learning evaluation process based on a learning analytics approach, to supervise student training through their participation and interaction on a virtual learning platform, in medical education. The aim is to design a measurement system represented with categories, variables and indicators of social e-learning; plus the visual representation of a dashboard, as an instrument operated from learning analytics. The methodology of this research has been defined as: a first activity associated with the analytics generation process based on social e-learning; a second activity refers to the work of the students, collaboration and cooperation, in the instructional design planned by the teacher; and the third activity refers to the assembly of the dashboard for monitoring and supervising the student's participation and its degree of relevance, in the scope of the academic course. Then, the teacher and other educational actors who participates in decision-making in the institution, will be able to have information to achieve strategic objectives in relation to the approval of the course, and on curricular and didactic aspects of the university degree in medical sciences. Key words: social e-learning, learning analytics, dashboard, medical education.
Clinical-epidemiological behavior of Hansen’s disease in patients treated at the Francisco Soto Calderon National Dermatology Center
To know the clinical and epidemiological characteristics of Hansen’s disease is important for its control, along with the commitment of different institutions and governments to eradicate this disease. The aim of the study was to describe the clinical-epidemiological behavior of Hansen’s disease in patients who attended the National Dermatology Center "Francisco Soto Calderon" during 2018-2022. The study is a descriptive case series, with a cross-sectional and quantitative approach, where 38 patients diagnosed with Hansen's disease were included. The source of information was secondary, so, a data collection form was filled out from the patients' medical records. The majority of cases occurred in ages over 34 years (68.4%), with a slight predominance of the male sex at 55.30%. Regarding to the risk factors for infection, overcrowding was present in 84%, this being a means of transmission in the family environment, most of the patients come from rural areas with 55.30%. The most frequent clinical diagnosis was multibacillary (81.6%). In relation to the clinical forms, tuberculoid leprosy with dimorphic leprosy predominated (66%), the aspects of the lesions that predominated were infiltrations in 28.9%, also finding a statistically significant association between the clinical diagnosis and the therapeutic management p =0.002. Finally, the scheme used was multibacillary treatment with 95% and 100% cure success for patients with Hansen's disease. Key words: clinical, epidemiology, Hansen’s disease, leprosy.
FRASER syndrome: first case reported in Nicaragua
Fraser síndrome is a genetic syndrome with autosomal recessive inheritance. It present with many congenital anomalies, but predominantly includes the presence of uni or bilateral cryptophthalmos, cutaneous syndactyly and genitourinary anomalies. A number of abnormalities in other organs and systems have been reported. We present a patient with a clinical diagnosis of Fraser syndrome with many congenital anomalies, including some that have been reported very rarely in the international literature, it is also the first case of Fraser syndrome reported in Nicaragua. Key words: Fraser syndrome, Cryptophthalmos, persistent cloaca
Early-onset breast cancer: A look from molecular biology
Breast cancer is the most common invasive cancer in women, affecting one in 8 women throughout their lives, furthermore, it represents the leading cause of cancer death in women worldwide. Young women represent only 3% of all diagnosed cases; however, these patients have larger tumors and a higher proliferation index compared to older women. Similarly, in early-onset breast cancer, more aggressive histological and molecular subtypes with a worse prognosis are overexpressed. In general, breast cancer in young women is related to a more aggressive tumor biology and worse clinical evolution. Basal-type and HER2-positive tumors are more frequently diagnosed in young women with breast cancer in 34.3% and 22% respectively, lymph node metastasis, multifocal disease and high tumor grade are described more frequently, compared to older population. They are generally diagnosed in an advanced stage. All of these characteristics act as poor prognostic factors, increasing the mortality rate up to 1.5 times and a higher recurrence rate compared to older patients. In studies that analyze the gene expression of tumors in the group of young patients, identifying up to 63 genes that specifically appear altered, through which the molecular pathways that are affected can be studied, being specific oncogenic alterations and different from those that promote tumorigenesis in older patients. Keywords: Early onset cancer, Genetic mutations, Molecular pathways
Las normas éticas como requisito en la investigación y la publicación científica
Pharmacotherapy: attention must be paid to the situation of clarithromycin and its role in Helicobacter pylori eradication schemes.
The virulence and extreme adaptability of Helicobacter Pylori as well as its direct relationship with gastric cancer, acid peptic diseases, as well as other gastrointestinal disorders with a great impact on world public health, particularly in Latin America, determine the development of research that allows improving the efficacy of eradication programs, where antimicrobial treatment schemes represent the most widely used strategy. However, resistance to antimicrobials, especially to clarithromycin, has become very relevant as a decisive factor for therapy failure, since this antibiotic is usually one of the most important recommendations in various schemes that allow the eradication of this bacterium, for Therefore, the search for strategies that reduce the possibility of failure in the pharmacological therapy to be used is a priority task. Methodology: An exhaustive search was carried out in various bibliographic sources available with open access in the Research 4 life metabase, the Chrocane collaborations database and the Pubmed NCBI metabase were consulted, Google Scholar was also consulted. Conclusions: The detection of resistance to Clarithromycin is a high-performance strategy to predict which pharmacological therapy is the most appropriate to use, since usually and empirically the task of prescribing or guiding eradication therapies is undertaken. Therefore, research and development aimed at the early detection of resistance to clarithromycin is a valuable opportunity to dramatically improve clinical outcomes. Key words: H. pylori, clarithromycin, antibiotic resistance, acid peptic disease.
Analysis of the university extension at UNAN-Managua
The National Autonomous University of Nicaragua, UNAN Managua incorporated the University Extension function in the nineties, its initial implementation being bumpy, identifying itself as one of the functions least developed by the university community. In 2019, it is incorporated into the Statutes and the Extension Policy is created, which identifies eleven areas of interaction of the University with society: scholarships, continuing education, physical education and sports, art and culture, research, innovation and entrepreneurship, practices, programs and projects, healthy university, state - company and society and social volunteering, which, in this Essay, are analyzed and grouped considering the individual, professional training and society scope, evidencing that the Extension and Social Projection it flows from the particular to the general, transcending from the individual to society Key words: University extension, Social projection
Nicaraguan recommendations on the identification of treatment failure in patients with relapsing-remitting Multiple Sclerosis
Introduction: The definition of treatment failure in Multiple Sclerosis (MS) is a central aspect of patient care, since its rapid identification and approach will prevent the progression of the disease in affected patients. The objective of the following consensus is to provide recommendations on the identification of treatment failure in patients with relapsing-remitting (RR) MS phenotype in Nicaragua. Methods: Remote survey round, carried out by a group of 5 Nicaraguan neurologists through a link that allowed access to the form to answer the statements, the degree of agreement being based on their knowledge, experience and the additional bibliography sent for your review. The assertions were made in three sections: 1) General aspects of the follow-up of patients with multiple sclerosis and identification of disease activity. 2) Importance of identifying MS activity and 3) Definition of treatment failure. The score of each statement was established in the following categories: inappropriate, doubtful and appropriate. Results: A total of 59 statements were made, which were divided into three sections; first with 28 affirmations, second with 20 affirmations and third with 11 affirmations. Of the total number of statements, 40 (67.7%) obtained the appropriate response category, 17 (28.8%) doubtful response, and 2 (3.38%) inappropriate. Conclusion: The recommendations were established based on the published evidence and the criteria of the experts who participated. The recommendations address general aspects of management, as well as the definition of patients using sustained therapies (maintenance) such as pulse therapies (reconstitution therapies) in patients with RRMS. Although there is no universally accepted definition of treatment failure, having local recommendations will allow us to optimize patient care in our setting. These recommendations seek to help the neurologist in the follow-up of patients with RRMS who do not respond to the implemented treatments. Keywords: Multiple sclerosis, treatment failure, consensus, Nicaragua
Single photon emission computed tomography to assess myocardial perfusion in suspected ischemic heart disease
The objective of the study is to analyze the usefulness of single photon emission computed tomography (tomogammagraphy) to assess myocardial perfusion in patients with suspected ischemic heart disease, at the Lenin Fonseca School Hospital, between February 2018 and July 2021. Material and method: Observational, descriptive, correlational, retrospective, cross-sectional study. The study population was 52 patients, selected according to the census criteria. The Kappa-Cohen concordance index statistical test was applied, between electrocardiography and tomogammagraphy in the detection of myocardial ischemia. Results: The age group of 40-59 years was the most frequent with 29 (56%). There were 27 women (52%). Chronic arterial hypertension was the most common comorbidity with 31 (60%). Chest pain was the most common indication with 48 (92%). Complete block of the left bundle branch of His was the most frequent baseline electrocardiographic finding with 7 (13%). Pharmacological stress was the most used technique in 29 patients (56%), with an average time of 6-9 minutes in 49 (94%). Six patients (11%) presented ischemia by electrocardiography and 12 (23%) by tomography. The Kappa-Cohen concordance index between electrocardiography and tomogammagraphy was 0.343 (low concordance), (p=0,007). Conclusions: Tomogammagraphy detected a higher proportion of ischemia than electrocardiography, especially in pre-existing bundle branch block, in whom it was not possible to detect ischemia by electrocardiography, so the low concordance between both diagnostic tests was statistically significant. Therefore, the research hypothesis is confirmed and the null hypothesis is rejected. Keywords: Scintigraphy, cardiac ischemia, cardiac tomogammagraphy, single photon emission computed tomography.
Anxiety, depression and sleep quality in medical students, UNAN-Managua, June - August, 2021
In this times, anxiety, depression and bad quality sleep, are mental health problems that affect medical students worldwide and present a risk to their personal and professional development. The objective of this work was to correlate anxiety, depression and sleep quality in medical students in 5th and 6th year, from the Medical Sciences Faculty at UNAN-Managua and determine the prevalence of these components in light of the demographics of the learning physicians. To achieve this, Pittsburgh’s sleep quality index was used, as well as Beck’s Anxiety and Depression Inventory, and a demographic questionary, 76 students participated in the study, 53% from 5th year and 47% from 6th year, 57% females and 43% males, with an average age of 22 years. The prevalence of anxiety was 92%, depressions 81% and bad sleep quality 98%. A positive moderate correlation was found between sleep quality and depression (0,515), likewise between sleep quality and anxiety (0,598), and a high positive correlation between anxiety and depression (0,709). Concluding that an important percentage of students suffer symptoms of these disorders and that the presence of one of these components affects the apparition of other. Key words: Medical student, anxiety, depression, mental health
Multiple metachronous neoplasms in a patient with resistant opportunistic infections.
Multiple Primary Cancers (MPCs) have increased as life expectancy and risk factors for cancer development increase in the population. MPCs can be synchronous or metachronous and are considered as such those in which each tumor is malignant and histologically different, and metastases are excluded. The presence of multiple resistant polymicrobial infections led to the suspicion of the presence of immunocompromise without an apparent cause in a patient who, one year before this condition, was successfully treated for early-stage breast cancer. Despite the timely initiation of antibacterial treatment, antifungal and antifimic, the patient maintained severe neutropenia requiring bone marrow aspirate (AMO) which revealed the presence of infiltration by lymphoblasts in relation to L1 acute lymphoblastic leukemia. Key Word: leukemia, breast cancer, opportunistic infections
Effectiveness of platelet rich-fibrin in third molars extractions. Systematic review
Fibrin-rich plasma (PRF) is an autologous material obtained from blood centrifugation, considered as an adjuvant in the cellular regeneration of soft tissues and bone, as it contains a high concentration of platelets, fibrin, leukocytes and growth factors that have a significant potential in tissue repair. The objective is to elaborate a systematic review of the effectiveness of fibrin-rich plasma in third molar extractions, using the PRISMA critical analysis guidelines, in Scielo, PubMed and ScienceDirect web portals by manual search. Regarding the studies reviewed, 25% concluded that no significant differences were found when using PRF, while 75% of the publications reported that the application of PRF improved and/or accelerated the tissue healing process, reduced the pain during the recovery process and decreased the incidence of infections. From the results found, it is concluded that the application of fibrin-rich plasma brings potential advantages in the post-surgical of third molar surgeries. Key words: Dentistry, Oral surgery, Platelet rich fibrin, Systematic review, Third molar.
Perception of the vaccine against COVID-19: A community study in Managua
Vaccination coverage against COVID-19 is key to its prevention and control. A descriptive, cross-sectional study was carried out in residents treated at the Yolanda Mayorga health clinic, Managua, during April and May 2021, with the objective of evaluating the community perception of the vaccines against COVID-19 and the factors associated with vaccine hesitancy, applying a semi-structured survey to 185 residents. Only 57,3% expressed an intention to be vaccinated; It was expressed by the individuals that fear, distrust and considering that the vaccine is not safe are the main causes of vaccine hesitancy. Digital platforms were the main source of information on vaccines. The lack of knowledge, misinformation, belief in myths and the lack of vaccination against influenza were factors associated with hesitancy. No statistical association was found between sociodemographic characteristics and the intention to be vaccinated. Key words: COVID-19 vaccine, myths, perception, hesitancy, vaccination refusal.