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Introduction: This study aimed to characterize immune and endothelial cells, myofibroblasts and pericytes, and positive cells for hedgehog proteins in late tissue repair of rats skin wounds treated with 670 nm photobiomodulation therapy (PBMT). Methods: A blind experimental study was conducted, in order to assess the effect of PBMT in later stages of healing, with emphasis on neoangiogenesis, immune cells and Hedgehog signaling. Forty Wistar rats were allocated randomly in two groups; control and treated with a diode GaAlAs laser (9 mW, 670 nm, 0.031 W/cm2, spot size of 0.28 cm2, fluence of 4 J/ cm2 applied every other day, until a total dose of 16 J/cm2 was achieved). Standardized skin wounds were performed and the animals were euthanized at 14, 21, 28 and 35 days. Tissue sections were subjected to hematoxylin-eosin and immunohistochemistry for CD31, NG2, smooth muscle alpha actin, CD8, CD68, Ptch, Gli-2 and Ihh. All histomorphometric data were statistically analyzed and significance level was at P<0.05. Results: At late stages of wound healing, neoangiogenesis persisted as revealed for the number of CD31+ cells (P = 0.016) and NG2+ and smooth muscle alpha actin positive pericytes (P = 0.025), for both experimental groups. By day 21, laser-treated group had decreased CD68+ cells (P = 0.032) and increased CD8+ (P = 0.038). At remodeling stage, there were positive cells for the hedgehog signaling pathway family which seemed to be activated. Conclusion: These data suggest that photobiomodulation therapy was able to modulate extracellular matrix remodelling even at the later stages of wound healing.

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This study aimed to investigate the effects of gallium-aluminum-arsenium (GaAlAs) (670 nm) laser therapy on neoangiogenesis and fibroplasia during tissue remodelling. Forty male Wistar rats underwent cutaneous surgery and were divided into 2 experimental groups: the Control and Laser group (9 mW, 670 nm, 0.031 W/cm2 , 4 J/cm2 ). After 14, 21, 28, and 35 days, the animals were euthanised. Descriptive and quantitative analyses were performed in sections stained with haematoxylin-eosin and Sirius Red, respectively. The amounts of VEGF+ and CD31+ cells were evaluated by immunohistochemistry and histomorphometric analysis, respectively. Statistical analysis was performed using the Mann-Whitney, Friedman, and Spearman correlation test, P < 0.05. The collagen expression was significantly higher in the laser group compared with the control group on days 14 and 21 after the creation of the skin wound (P = 0.008; P = 0.016) and in the control group between 14 and 28 and 14 and 35 days (P = 0.001; P = 0.007). There were more blood vessels in three periods of the study only in the (Laser) treated group, with statistical significance at day 14 (P = 0.016). There was no statistically significant difference in VEGF+ cell count in the different experimental groups throughout the study, although a positive correlation was shown with the area of collagen on days 14 and 28 (P = 0.037). Laser treatment had a positive effect in the late course of healing, particularly with regards to collagen expression and the number of newly formed vessels. VEGF+ cells were present in both experimental groups, and VEGF appeared to influence fibroplasia in the treated group.

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Introducción: las infecciones asociadas a la atención de salud constituyen un problema mundial por sus implicaciones económicas, legales, éticas y médicas. Objetivos: determinar el comportamiento de las infecciones asociadas a la atención de salud. Métodos: estudio descriptivo, retrospectivo y transversal de 105 pacientes con las infecciones asociadas a la atención de salud, quienes ingresaron en el servicio de medicina interna del Hospital Clínico Quirúrgico Manuel Fajardo, desde enero de 2013 hasta diciembre hasta 2015. Se utilizó la estadística descriptiva y se relacionó la información nacional e internacional con los resultados. Resultados: los pacientes afectados fueron principalmente de 60 o más años de edad, sin diferencias en el sexo. El diagnóstico más común fue la bronconeumonía (55,2 por ciento). Las principales comorbilidades resultaron ser la hipertensión arterial (52,4 por ciento), el accidente vascular encefálico (37,1 por ciento), diabetes mellitus (35,2 por ciento) y cardiopatía isquémica (35,2 por ciento). La biterapia antibiótica fue la modalidad más habitual y en la mayoría de los casos se utilizó un ciclo de antibioticoterapia, pero con frecuencia fue necesario hacer dos o más ciclos de tratamiento antibiótico. La mortalidad mostró relación significativa con la edad y predominó en pacientes de 60 o más años de edad y en los pacientes con bronconeumonía (40,3 por ciento). Conclusiones: las infecciones asociadas a la atención de salud predominaron en una población envejecida, frecuentemente asociada a comorbilidad y la mortalidad se agrupó principalmente en pacientes de la tercera edad y con bronconeumonía(AU)

Introduction: Health-care associated infections are a global problem due to their economic, legal, ethical, and medical implications. Objectives: To determine the behavior of health-care associated infections in the internal medicine service at Manuel Fajardo Hospital. Methods: Descriptive, retrospective and cross-sectional study of 105 patients with health-care associated infections was conducted. These patients were admitted to the Internal Medicine Service at Manuel Fajardo Hospital, from January 2013 to December 2015. Descriptive statistics and national and international information were related to the results. Results: The affected patients were mainly 60 or older, without differences in sex. The most common diagnosis was bronchopneumonia (55.2 percent). The main comorbidities were hypertension (52.4 percent), cerebrovascular accident (37.1 percent), diabetes mellitus (35.2 percent) and ischemic heart disease (35.2 percent). Antibiotic biotherapy was the most common modality. In most cases an antibiotic therapy cycle was used, but it was often necessary to do two or more cycles of antibiotic treatment. Mortality showed a significant relationship with age and predominated in patients who were 60 or older and in patients with bronchopneumonia (40.3 percent). Conclusions: Health-care associated infections prevailed in an aging population, frequently associated with comorbidity, and mortality was mainly grouped in elderly patients with bronchopneumonia(AU)

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Introducción: Las infecciones asociadas a la atención de salud (IAAS) son uno de los principales problemas que afecta a los pacientes en las unidades hospitalarias, tanto en países desarrollados como carentes de recursos. Objetivo: Identificar los tipos de IAAS reportadas, microorganismo causal y susceptibilidad antimicrobiana en el Servicio de Medicina Interna del Hospital Clínico-Quirúrgico "Manuel Fajardo". Material y método: Estudio descriptivo, retrospectivo y transversal de 105 pacientes con IAAS, quienes ingresaron en el Servicio de Medicina Interna del Hospital Clínico-Quirúrgico Manuel Fajardo, desde enero 2013 hasta diciembre 2015. Se analizaron distintas variables. Se utilizó la estadística descriptiva y se relacionó la información nacional e internacional con los resultados obtenidos. Resultados: Predominaron los pacientes con edad superior a los 60 años. El diagnóstico más común fue la bronconeumonía en 58 pacientes (55.2 por ciento). El principal microorganismo causal para la bronconeumonía, la traqueobronquitis y las úlceras de presión fue Pseudomona spp.; mientras que para la infección del tracto urinario y flebitis-celulitis y absceso fueron E. coli y S. aureus respectivamente. Pseudomona spp. y E. coli mostraron alta resistencia a las cefalosporinas de primera, segunda y tercera generaciones testadas y a otros tipos de antibióticos; sin embargo, para los aminoglucósidos y Cefepime la sensibilidad fue favorable. La susceptibilidad de S. aureus mostró resultados muy adversos, pues solo para la Amikacina y Vancomicina tuvo aceptable sensibilidad. Conclusiones: Las IAAS predominaron en una población envejecida y fueron ocasionadas por una diversidad de microorganismos, principalmente Pseudomona spp., E. coli y S. aureus, los cuales mostraron elevada resistencia antimicrobiana(AU)

Introduction: The health care associated infections (HCAI) are one of the major problems which affect the patients in the hospital units, both in developed countries and in countries with low resources. Objective: To identify what kind of HCAI were reported, causal microorganism and antimicrobial susceptibility in the Internal Medicine Service at the "Manuel Fajardo" clinical-surgical hospital. Material and method: Descriptive, retrospective and transversal study of 105 patients with HCAI, who were admitted in the Internal Medicine Service at the Manuel Fajardo clinical-surgical hospital, from January 2013 to December 2015. It was analyzed different variables. It was used descriptive statistics and it was related the national and international information with the obtained results. Results: It were predominated the patients with age over 60 years. The more common diagnosis was broncho-pneumonia in 58 patients (55.2 percent). The principal causal microorganism for broncho-pneumonia, the tracheo-bronchitis and the pressure ulcers was Pseudomona spp.; while for urinary tract infection and flebitis-cellulitis and abscess were E. coli and S. aureus respectively. Pseudomona spp. and E. coli showed high resistance to cephalosporins of the first, second and third generation tested and other kinds of antibiotics; however, for the amynoglucosides and for Cefepime the sensibility was favourable. The susceptibility of S. aureus showed very adverse results, because only for Amikacin and Vancomicin had acceptable sensibility. Conclusions: The HCAI predominated in an aged population and were caused by a diversity of microorganisms, principally Pseudomona spp., E. coli and S. aureus, which showed high antimicrobial resistance(AU)

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Regeneration and tissue repair processes consist of a sequence of molecular and cellular events which occur after the onset of a tissue lesion in order to restore the damaged tissue. The exsudative, proliferative, and extracellular matrix remodeling phases are sequential events that occur through the integration of dynamic processes involving soluble mediators, blood cells, and parenchymal cells. Exsudative phenomena that take place after injury contribute to the development of tissue edema. The proliferative stage seeks to reduce the area of tissue injury by contracting myofibroblasts and fibroplasia. At this stage, angiogenesis and reepithelialization processes can still be observed. Endothelial cells are able to differentiate into mesenchymal components, and this difference appears to be finely orchestrated by a set of signaling proteins that have been studied in the literature. This pathway is known as Hedgehog. The purpose of this review is to describe the various cellular and molecular aspects involved in the skin healing process.

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Abstract: Regeneration and tissue repair processes consist of a sequence of molecular and cellular events which occur after the onset of a tissue lesion in order to restore the damaged tissue. The exsudative, proliferative, and extracellular matrix remodeling phases are sequential events that occur through the integration of dynamic processes involving soluble mediators, blood cells, and parenchymal cells. Exsudative phenomena that take place after injury contribute to the development of tissue edema. The proliferative stage seeks to reduce the area of tissue injury by contracting myofibroblasts and fibroplasia. At this stage, angiogenesis and reepithelialization processes can still be observed. Endothelial cells are able to differentiate into mesenchymal components, and this difference appears to be finely orchestrated by a set of signaling proteins that have been studied in the literature. This pathway is known as Hedgehog. The purpose of this review is to describe the various cellular and molecular aspects involved in the skin healing process.

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Precancerous lesions have been studied because of their carcinogenic potential and their association with squamous cell carcinoma (SCC) has been reported. In the tumour microenvironment, the processes of angiogenesis and tissue remodelling are regulated by a family of proteins (Hedgehog) described as being able to modulate epithelial/mesenchymal interactions. The objective of this study was to perform a comparative study of precancerous lesions and SCCs by immunohistochemistry for the presence of Sonic, Gli2, SMO and Patched proteins, members of the Hedgehog pathway. Sixteen cases diagnosed as actinic cheilitis associated with SCC were compared to normal oral mucosa. The sections were subjected to immunohistochemistry and the positively stained cells were counted by morphometric analysis. There was a significant progressive increase in expression of all proteins of the Hedgehog pathway, both in the epithelium and in the connective tissue, when sections of normal mucosa, dysplasia and carcinoma were compared (P < 0.05). Thus, one may suggest that the Hedgehog pathway in tumour transformation influences SCC, and more studies should be conducted to expand the understanding of the role of these proteins in neoplastic transformation.

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This study evaluated the influence of hypothalamic-pituitary-adrenal (HPA) axis in cutaneous wounds subjected to laser biomodulation. A total of 48 rats were divided into two groups: Group I (GI) with 24 adrenalectomized animals and Group II (GII) with 24 non-adrenalectomized animals. Each group was divided into two subgroups: the irradiated subgroup which laser was applied to four points at the edges of the wound (670 nm laser, 9 mW) and control subgroup. Rats in each subgroup were sacrificed at 24 or 72 h. Adrenal glands were only removed from GI rats. Three days after adrenalectomy, a cutaneous wound was made. An immunohistochemical analysis was performed using anti-CD45 and anti-CD8 antibodies. Flow cytometry was used to count T lymphocytes and their subpopulations in blood. Decreases in the number of CD45-positive inflammatory cells and in the total numbers of CD8- and CD45-positive cells were observed in histological sections of adrenalectomized animals subjected to laser biomodulation at 24h. Similar results were observed for distribution of total lymphocytes in blood (p<0.05). The action of 670 nm laser does not depend exclusively on HPA axis. It is believed that corticosteroid-promoting enzymes liberated in non-adrenal tissues may influence immune response under the influence of this type of phototherapy.

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Se realizó un estudio pre-experimental con la cantidad de 50 estudiantes de 2do año de la carrera de Medicina a los que se le aplicó un instrumento evaluativo para conocer los logros en la competencia comunicativa a través de la utilización de la música en las clases de Inglés. Ese instrumento fue aplicado antes y después de introducir las canciones y se obtuvo como resultado una elevación del nivel de asimilación y comprensión de conocimientos y habilidades que necesitan los estudiantes en el estudio de la Lengua Inglesa.

A pre-experimental study was conducted with 50 students from the second year of the Medicine career. We applied and evaluated an instrument to know the level of knowledge acquired by them when introducing the music in the English lessons. That instrument was applied before and after introducing the different exercises, obtaining as results an elevation of the level of assimilation and comprehension of knowledge that the students need in the study of the English language.

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This article addresses an emerging issue in health care systems: the impact of judicial rulings on public policy regarding financing and delivery of health care services, and the attendant tensions, contradictions and questions. In Colombia, HIV/AIDS patients' use of a legal instrument called tutela, or writ of protection, has produced abundant jurisprudence and prompted health authorities to respond with decisions about HIV/AIDS service coverage that do not consider epidemiologic criteria and sustainability, introducing distortions in the health care system with respect to financing, priority-setting and universality.

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