Effect of EGCG-based paste as intracanal dressing, in MMPs 2 and 9 expression in dog's periapical lesions

Abstract High expression of MMP-2 and MMP-9 in periapical lesions plays an important role in the degradation of the extracellular matrix. This study aimed to investigate the effect of epigallocatechin-3-gallate (EGCG)-based endodontic paste as an intracanal dressing on the expression of MMP-2 and MMP-9 in periapical lesions. Periapical lesions were experimentally induced in 35 mature beagle dog premolars randomly divided into healthy teeth, untreated periapical lesions, periapical lesions treated in a single session (control groups), and periapical lesions treated in two sessions with EGCG or calcium hydroxide-based pastes (experimental groups). After 120 days, specimens were obtained for histopathologic and immunofluorescence analyses to assess the expression of MMP-2 and MMP-9. The statistical analysis was performed using a p-value of 0.05. Endodontic treatment in two sessions using medication with EGCG and calcium hydroxide-based pastes provided similar repair of the apical and periapical tissues and neoformation of periodontal ligament fibers, cementum, and alveolar bone (p>0.05). The experimental groups treated in two sessions with both medications presented expression of MMP-2 and MMP-9 similar to that in healthy teeth (p>0.05), and significantly lower than teeth treated in a single session or untreated periapical lesions (p <0.001). Expression of MMP-2 and MMP-9 was observed in the cytoplasm of fibroblasts, osteoblasts, cementoblasts, cementocytes, and vascular endothelium. The use of EGCG-based endodontic paste reduced the expression of MMP-2 and MMP-9 and allowed repair of periapical lesions, similar to calcium hydroxide-based paste, and superior to treatment performed in a single session.

Resumo A alta expressão de MMP-2 e MMP-9 em lesões periapicais desempenha um papel importante na degradação da matriz extracelular. Este estudo teve como objetivo investigar o efeito de uma pasta à base de epigalocatequina-3-galato (EGCG) como curativo intracanal na expressão de MMP-2 e MMP-9 em lesões periapicais. Lesões periapicais foram induzidas experimentalmente em 35 pré-molares de cães da raça beagle, maduros, divididos aleatoriamente em dentes saudáveis, lesões periapicais não tratadas, lesões periapicais tratadas em uma única sessão e lesões periapicais tratadas em duas sessões com a pasta de EGCG ou pasta à base de hidróxido de cálcio. O operador monitorou os animais e realizou a eutanásia após 120 dias para análises histopatológicas e de imunofluorescência para avaliar a expressão de MMP-2 e MMP-9. A análise estatística foi realizada utilizando p=0,05. O tratamento endodôntico em duas sessões com pasta à base de EGCG e pasta à base de hidróxido de cálcio proporcionou níveis semelhantes de reparação dos tecidos apicais e periapicais e neoformação de fibras do ligamento periodontal, cemento e osso alveolar. Em ambos os grupos, a expressão de MMP-2 e MMP-9 foi mínima, sendo observada no citoplasma de fibroblastos, osteoblastos, cementoblastos, cementócitos e endotélio vascular. Em ambos os grupos tratados em duas sessões, a expressão de MMP-2 e MMP-9 foi semelhante à dos dentes hígidos e significativamente menor do que nas lesões periapicais tratadas em sessão única ou não tratadas (p < 0,001). O uso da pasta à base de EGCG reduziu a expressão de MMP-2 e MMP-9 e permitiu o reparo de lesões periapicais, semelhante à pasta à base de hidróxido de cálcio, e foi superior ao tratamento realizado em sessão única.

Ozonoterapia como apoyo en el tratamiento de la úlcera del pie diabético. Presentación de un caso

Una de las complicaciones más comunes de la diabetes mellitus es la úlcera del pie diabético, como una fuente importante de morbilidad y mortalidad. Se presenta el caso de una paciente de 43 años, con diagnóstico de diabetes mellitus tipo 2, de siete años de evolución, remitida desde el Cuerpo de Guardia del Policlínico Universitario Dr. Mario Muñoz Monroy, de Abreus, con el diagnóstico de pie diabético neuroinfeccioso complicado con un absceso. Se realizó drenaje del absceso, modificación del tratamiento con insulina y desbridamiento de la lesión. Además, se indicó antibiótico y Heberprot-P®. Ante la ausencia de evolución satisfactoria, se realizó nuevo desbridamiento, con amputación de tercer y cuarto dedos del pie izquierdo; se retomó el tratamiento inicial, eta vez combinado con ozonoterapia vía local y rectal. A partir de la semana 18 la paciente evolucionó favorablemente, con presencia de buena granulación, desaparición gradual del dolor y aceleración del proceso de cicatrización completa de la lesión, además de conseguir un control metabólico eficiente. El caso descrito confirma la eficacia y seguridad del uso combinado del Heberprot-P® y la terapia con ozono.

One of the most common complications of diabetes mellitus is diabetic foot ulcer, as an important source of morbidity and mortality. The case of a 43-years-old patient with a diagnosis of type 2 diabetes mellitus, of seven years of evolution, referred from the Emergency Department of the Dr. Mario Muñoz Monroy University Polyclinic, Abreus, with the diagnosis of neuroinfectious diabetic foot complicated with an abscess is presented. Drainage of the abscess, modification of insulin treatment, and debridement of the lesion were performed. In addition, antibiotics and Heberprot-P® were indicated. In the absence of satisfactory evolution, new debridement was performed, with amputation of the third and fourth toes of the left foot; the initial treatment was resumed, this time combined with local and rectal ozone therapy. From week 18 on, the patient progressed favorably, with the presence of good granulation, gradual disappearance of pain and acceleration of the complete healing process of the lesion, in addition to achieving efficient metabolic control. The described case confirms the efficacy and safety of the Heberprot-P® combined use and ozone therapy.

Peloideterapia en adultos mayores con osteoartrosis de rodilla. Yaguaramas, 2021

Fundamento el incremento de la esperanza de vida viene aparejado con la necesidad del adulto mayor de desenvolverse en su medio y garantizar una longevidad plena. Objetivo determinar la efectividad de la peloideterapia en adultos mayores con osteoartrosis de rodilla. Métodos se realizó un estudio de intervención, cuasi experimental, en 30 pacientes con osteoartrosis de rodilla, seleccionados mediante aleatorización simple, quienes fueron atendidos en el área de salud de Yaguaramas (Abreus, Cienfuegos), en el período comprendido entre marzo y junio de 2021. Se realizó una encuesta general. La evolución del dolor se determinó mediante la escala de Likert, y la limitación articular se analizó mediante la medición del arco articular de la rodilla con el goniómetro. Resultados predominaron los pacientes del grupo de edades de 66-70 años y del sexo femenino; con tiempo de evolución entre 5-10 años (60 %); y con ambas rodillas afectadas (56,7%). Los principales signos y síntomas fueron el dolor (100 %) y la limitación del movimiento articular (93,3 %), los cuales disminuyeron tras el tratamiento. El 53,3 % refirió dolor ligero antes del tratamiento; después del tratamiento el 83,3 % describió ausencia de dolor. El 76,7 % de los pacientes manifestó limitación en la flexión de la rodilla, que después del tratamiento disminuyó a 13,3 %. Conclusiones la peloideterapia influye positivamente en los adultos mayores con osteoartrosis de rodilla, al mejorar su estado funcional e independencia personal, además de reducir las demandas de servicios médicos.

Background the increase in life expectancy is coupled with the elderly's need to function in its media and guarantee full longevity. Objective to determine the effectiveness of peloidtherapy in older adults with osteoarthritis of the knee. Method a quasi-experimental intervention study was carried out in 30 patients with osteoarthritis of the knee, selected by simple randomization, who were treated in the health area of Yaguaramas (Abreus, Cienfuegos), between March and June of 2021. A general survey was carried out. The evolution of pain was determined using the Likert scale, and joint limitation was analyzed by measuring the knee joint arc with the goniometer. Results there was a predominance of patients in the age group of 66-70 years old and of the female sex; with evolution time between 5-10 years (60%); and with both knees affected (56.7%). The main signs and symptoms were pain (100%) and limitation of joint movement (93.3%), which decreased after treatment. 53.3% reported light pain before treatment; after treatment, 83.3% described absence of pain. 76.7% of the patients manifested limitation in knee flexion, which after treatment decreased to 13.3%. Conclusions peloidtherapy has a positive influence on older adults with osteoarthritis of the knee, by improving their functional status and personal independence, as well as reducing the demands for medical services.

Caracterización de los focos de mosquitos Aedes aegypti en el municipio de Abreus. 2016-2022

Fundamento el conocimiento acerca de la focalidad por mosquitos motiva a pobladores y decisores a trabajar sobre las cuestiones que inciden en la proliferación de estos vectores; así como a una participación comunitaria eficaz, y el éxito en la prevención y control de las arbovirosis. Objetivo caracterizar los focos de mosquitos Aedes aegypti. Métodos se realizó un estudio observacional, retrospectivo, y de corte transversal, acerca de los focos de Aedes aegypti detectados en el municipio de Abreus, provincia de Cienfuegos, en el período 2016-2022. El universo fue de 390 focos, para los cuales se describieron las variables: semana estadística, mes y año de diagnóstico, consejo popular, tipo de depósito, lugar de la vivienda donde se encontró y fase del mosquito al diagnóstico. Se utilizaron datos de las encuestas entomológicas y los registros del laboratorio de Entomología Médica de la Unidad Municipal de Higiene y Epidemiología. Resultados la mediana del número de focos de Aedes aegypti correspondió a la semana estadística 32 de cada año. La mayor cantidad de focos se detectó en los consejos populares de Abreus (165) y Juraguá (102); hallados sobre todo en patios (85,5 %) y tanques bajos (55,5 %). Predominó la fase larvaria en IV estadio (82,3 %). Conclusiones en el municipio de Abreus la focalidad por mosquitos Aedes aegypti se caracterizó por su mayor incidencia en los meses de junio a septiembre, con predominio en el consejo popular de Abreus, sobre todo en tanques bajos y patios. El mayor número fue diagnosticado en la IV fase.

Background knowledge about the mosquito's breeding grounds motivates residents and decision makers to work on the issues that affect the mosquito proliferation; as well as effective community participation, and success in the prevention and control of arboviral diseases. Objective to characterize the Aedes aegypti mosquito's breeding grounds. Methods an observational, retrospective, and cross-sectional study was carried out on Aedes aegypti's breeding grounds detected in the Abreus municipality, Cienfuegos province, from 2016 to 2022. 390 breeding grounds were the universe, for which the described variables were: statistical week, month and year of diagnosis, neighborhood, type of deposit, place of residence where it was found, and phase of the mosquito at diagnosis. Data from entomological surveys and records from the Municipal Hygiene and Epidemiology Unit's Medical Entomology laboratory were used. Results the median number of Aedes aegypti breeding grounds corresponded to statistical week 32 of each year. The largest number of outbreaks was detected in the Abreus' neighborhood (165) and Juraguá (102); found mainly in yards (85.5 %) and low tanks (55.5 %). The larval phase in IV stage predominated (82.3 %). Conclusions in the municipality of Abreus, the focality of Aedes aegypti mosquitoes was characterized by its highest incidence in the months of June to September, with predominance in the popular council of Abreus, especially in low tanks and yards. The largest number was diagnosed in the IV phase.

Unveiling an oral hemangiolymphangioma

ABSTRACT Hemangiolymphangioma is a very rare vascular malformation that develops as a combination of dilated venous and lymphatic vessels. We describe an unusual case of hemangiolymphangioma of the tongue affecting an adult man who complained of an uncomfortable, slowly progressing exophytic irregular dark red-violaceous nodular mass on his tongue that impaired speech and swallowing for two weeks. The clinical differential diagnoses were Kaposi's sarcoma and a COVID-19-related lesion. A complete blood count and serology for HIV-1 and 2 and RT-PCR for COVID-19 were requested and results were negative. An incisional biopsy was performed. Microscopically, the lesion exhibited several dilated vessels lined by normal-appearing endothelial cells, some filled with prominent intravascular erythrocytes and others containing proteinaceous eosinophilic material resembling lymphatic vessels, in close association with hyperkeratosis, papillomatosis, and acanthosis. From immunohistochemical analysis, most vessels were found to be CD34 positive, some highlighted by α-SMA, whereas D2-40 was focal. Positive staining for some lymphatic and blood vessel markers, i.e., D2-40 and CD34, respectively, indicates a mixed derivation of the lesion. HHV-8 was negative. Clinical features, the congested blood vessels with ectasia in intimate association with hyperplastic epithelium, and the immunohistochemical profile supported the final diagnosis of oral hemangiolymphangioma. The patient underwent minimally invasive surgical excision with no intercurrences. After 18 months of follow-up, there were no signs of relapse.

Intraoral lipoma with degenerative changes mimicking atypical lipomatous tumor: an immunohistochemical study

ABSTRACT Lipomas are mesenchymal neoplasms relatively uncommon in the oral cavity. Lipomas can exhibit histopathological features mimicking atypical lipomatous tumors (ALT) or dysplastic lipoma (DL) in the presence of degenerative changes. Relevantly, immunohistochemistry assists in the correct diagnosis. Herein, we present the case of a 54-year-old male with a sessile nodule located on the dorsum of the tongue. The histopathological analysis showed a diffuse, non-circumscribed adipocytic proliferation constituted by cells of variable size containing cytoplasmic vacuoles and displaced nuclei, some resembling lipoblasts supported by fibrous connective tissue stroma. By immunohistochemistry, tumor cells were positive for vimentin, S100, FASN, CD10, and p16. Rb expression was intact. Moreover, CD34, p53, MDM2, and CDK4 were negative. After 2-year of follow-up, no alteration or recurrence was observed. In conclusion, MDM2, CDK4, p53, and Rb immunomarkers can be used reliably to differentiate benign lipoma with degenerative changes from ALT and DL.

Conocimientos de los residentes de Medicina General Integral sobre prevención y control de las arbovirosis / Comprehensive General Medicine residents: their knowledge about prevention and control of arboviruses

Fundamento: las arbovirosis son enfermedades víricas transmitidas por mosquitos, las que han propagado rápidamente en todas las regiones del mundo en los últimos años, con alta incidencia en la salud de las personas y en la economía de los países. Objetivo: identificar el nivel de conocimientos de los residentes de Medicina General Integral del municipio Abreus, sobre la prevención y control de las arbovirosis. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal, en la Dirección Municipal de Salud Abreus, en octubre de 2021. Se utilizaron métodos teóricos y empíricos para fundamentar la investigación, y estadísticos para el análisis de los datos encontrados. Resultados: la mayoría de los residentes manifestaron que han tenido preparación sobre la prevención y control de las arbovirosis, fundamentalmente, durante la educación en el trabajo, todos han adquirido experiencia previa en la pesquisa activa, y algunos señalaron haber atendido a enfermos; sin embargo, la mayoría presentaron dificultades para identificar las formas clínicas y el cuadro clínico de las arbovirosis. Conclusiones: se identificó el nivel de conocimientos alcanzados por los residentes de Medicina General Integral del municipio Abreus, sobre la prevención y control de las arbovirosis, el diagnóstico realizado mostró la necesidad de asumir nuevas metodologías en la educación en el trabajo a fin de lograr correctos modos de actuación y actualización sobre su prevención y control.

Background: arboviruses are viral diseases transmitted by mosquitoes, which have spread rapidly in all regions of the world in recent years, with a high impact on people's health and the economies of countries. Objective: to identify the level of knowledge of Comprehensive General Medicine residents from the Abreus municipality, about the prevention and control of arboviruses. Methods: an observational, descriptive, cross-sectional study was carried out at the Abreus Municipal Health Directorate, in October 2021. Theoretical and empirical methods were used to support the research, and statistical methods were used to analyze the data found. Results: most residents stated that they have had training on the prevention and control of arboviruses, mainly, during on-the-job education, all have acquired previous experience in active search, and some of them indicated had taken care for sick people; however, most of them had difficulties in identifying the clinical forms and clinical profile of arboviruses. Conclusions: the level of knowledge achieved by Comprehensive General Medicine residents from Abreus municipality was identified, regarding the prevention and control of arboviruses, the diagnosis made by them showed the need to conceive new methodologies in education at work in order to achieve adequate modes of action and updating their knowledge about the prevention and control of it.

El uso de la aplicación WhatsApp como herramienta educativa en tiempos de COVID-19 / The use of WhatsApp as an educational tool in times of COVID-19

Fundamento: WhatsApp es una aplicación que permite la continuidad del proceso docente educativo en tiempos de pandemia. Objetivo: valorar el uso de la aplicación WhatsApp como herramienta educativa en tiempos de COVID-19, en el municipio Abreus, provincia Cienfuegos, Cuba. Métodos: se realizó una investigación con predominio de una metodología cualitativa, en el municipio Abreus, entre septiembre-diciembre 2021. Se utilizaron métodos teóricos (analítico sintético, histórico-lógico y sistémico) y empíricos (análisis de documentos, y la valoración mediante una encuesta a través de la aplicación WhatsApp de docentes y residentes). Resultados: el uso de WhatsApp como herramienta educativa fue la forma principal de comunicación virtual entre los residentes y docentes. La posibilidad de integrar contactos y armar grupos lo hizo muy popular, simulando una pequeña red social, interactiva y mucho más rápida. Además, se constató que es necesaria, con ventajas y desventajas en el proceso docente educativo. Conclusiones: la valoración de docentes y residentes fue positiva; WhatsApp puede incidir en la mejora del dinamismo de los procesos enseñanza aprendizaje a distancia, por sus posibilidades de conectarse en cualquier momento y desde cualquier lugar, dentro o fuera de los contextos de aprendizaje formal, y con estrategias bien diseñadas puede generar un cambio radical y favorable en el proceso educativo.

Background: WhatsApp is an application that allows us the continuity of the educational teaching process in times of pandemic. Objective: to assess the use of WhatsApp as an educational tool in times of COVID-19, in Abreus municipality, Cienfuegos province, Cuba. Methods: a research with a predominance of a qualitative methodology was carried out in Abreus municipality from September to December 2021. Analytical-synthetic, historical-logical and systemic approaches were applied as theoretical methods; document analysis and assessment through a survey by means of the WhatsApp application of teachers and residents were used as empirical ones. Results: the use of WhatsApp as an educational tool was the main way of virtual communication between residents and teachers. The possibility of integrating contacts and creating groups made it very popular, simulating a small, interactive and much faster social network. In addition, we found that it is necessary, with its advantages and disadvantages in the educational process. Conclusions: the evaluation of teachers and residents was positive; WhatsApp can influence the improvement of the dynamism of the distance learning teaching processes, due to its possibilities of connecting at any time and from any place, inside or outside the formal learning contexts, and it can generate a radical and favourable change in the educational process with well-designed strategies.

Toward a Possible Reassessment of Causes and Protecting Strategies Underlying the Dynamic of Parental Burnout in Costa Rica / Acerca de una posible reevaluación de las causas y estrategias de protección subyacentes a la dinámica del desgaste parental en Costa Rica

Objective. This study aims to reach an initial understanding of some specific cultural characteristics of parental burnout in Costa Rica. The findings stem from analyzing specific family configurations of parental burnout during parenting. Method. An intentional sample of 146 mothers and 102 fathers (n= 248, mean age 37) was selected. They completed a questionnaire regarding socio-demographics, Parental burnout assessment, Gender roles, Independent-interdependent Self, Involvement in parental function and duties, and the Parental goals and values. Results. there is a low prevalence of parental burnout and an average level of individualism in parenting. Although the study failed to identify high degrees of parental burnout in the Costa Rican sampled parents, which tend to be rather moderate or low in comparison with other countries, there seems to be an initial tendency of some type of family toward increasing burnout as well as noteworthy traits of familial dynamics that might function as mitigating or even protective factors against parental burnout.

Objetivo. Avanzar en la comprensión de las características culturales específicas del agotamiento parental en Costa Rica al analizar configuraciones familiares específicas del agotamiento parental durante la crianza. Método. Se seleccionó una muestra intencional de 146 madres y 102 padres con una media de edad de 37 años. Los participantes completaron un cuestionario que indagó en variables sociodemográficas y las medidas parental burnout assessment, Gender Roles, Independent-interdependent Self, Involvement in parental Function and Duties y Parental Goals and Values. Resultados. Una baja prevalencia de agotamiento parental y un rol importante del individualismo moderado en la crianza. Se concluye que, aunque no se logró detectar un alto grado de agotamiento parental en la muestra de padres y madres, quienes mostraron moderados y bajos niveles de agotamiento en comparación con otros países. Se halló una tendencia inicial hacia un aumento del agotamiento en algunos tipos de familia, además de dinámicas familiares que parecen funcionar como factores atenuantes e incluso protectores contra al agotamiento parental.

Escorpionismo en la población amazónica del cantón Taisha en Ecuador / Scorpion stings in the Amazonian population from Taisha Canton in Ecuador

Introducción: En el Ecuador se desconoce la frecuencia, los factores de riesgo, el efecto preciso de las picaduras de escorpión, sus toxinas, la fisiopatología e interacción con la población. Objetivo: Registrar la incidencia de las picaduras de escorpión, el cuadro clínico, su manejo y las limitaciones para la obtención del antídoto en Ecuador. Métodos: Se realizó un estudio de cohorte retrospectivo, en el cual se recolectaron datos como edad, sexo, residencia, sitio corporal de picadura, cuadro clínico, tratamiento, estancia médica, referencia a unidad de mayor complejidad, morbilidad y mortalidad, durante el periodo entre enero de 2016 y noviembre de 2018 en la población amazónica del cantón Taisha, provincia de Morona Santiago, Ecuador. Resultados: Se evaluaron 134 picaduras de escorpión, las cuales predominaron en personas adultas (70,9 %). La región corporal más frecuente de picadura fue en las extremidades superiores e inferiores (92,5 %) y el nivel de intoxicación grave correspondió al 12,7 %. La estacionalidad de las picaduras de escorpión predominó en los meses de octubre, abril, diciembre y marzo. La presentación de la morbilidad anual fue mayor en el año 2017 (52,9 %). Conclusiones: Existe una alta incidencia de picaduras de escorpión en la zona de estudio. En el Ecuador la accesibilidad al antídoto es limitada, por lo que es necesario realizar más investigaciones en el tema, incluyendo intervenciones preventivas y curativas.

Introduction: In Ecuador, the frequency, risk factors, precise effects, toxins, pathophysiology and interaction with the population of scorpion stings are unknown. Objective: To report on the incidence of scorpion stings, its clinical picture and management, and the limitations for obtaining an antidote in Ecuador. Methods: A retrospective cohort study was conducted and data was collected on the age, gender, place of residence, site of sting, clinical picture, treatment, hospital stay, referral to higher complexity unit, morbidity, and mortality from January 2016 to November 2018 in the Amazonian population from Taisha canton, Morona-Santiago province in Ecuador. Results: 134 scorpion stings were evaluated. Most cases were adults (70.9%). The most frequent region stung by scorpions were the upper and lower extremities (92.5%) and severe intoxication level accounted for 12.7% of cases. The highest incidence of scorpion stings occurred in October, April, December and March. Annual morbidity was higher in 2017 (52.9%). Conclusions: There is a high incidence of scorpion Sting in the area under study. Accessibility to an antidote is limited in Ecuador; therefore, further research on this topic and on preventive and curative interventions are necessary.

Transmisión de la COVID-19 en el Municipio Abreus, entre las semanas 29 y 41 del año 2021 / Transmission of COVID-19 in the Abreus Municipality, between weeks 29 and 41 of the year 2021

RESUMEN Fundamento: el siglo XXI se ha caracterizado desde sus inicios por una problemática de salud que ha afectado al mundo y a Cuba, que va desde un incremento de la resistencia microbiana hasta la aparición de nuevas enfermedades infecciosas, como la COVID-19. Objetivo: describir la transmisión de la COVID-19 en el municipio Abreus, provincia Cienfuegos, entre las semanas 29 y 41 del año 2021. Métodos: estudio observacional, descriptivo, retrospectivo de corte transversal que incluye desde la semana 29 hasta la 41. El universo estuvo constituido por 3421 pacientes diagnosticados con COVID-19, confirmados por prueba diagnóstica de reacción en cadena de polimerasa en tiempo real (PCR-RT). Resultados: se observó una alta magnitud de transmisión con 3421 casos, 122 como promedio en la semana 33. Tendencia al incremento del reporte de casos y de la velocidad de transmisión desde la semana estadística 29 a la 35 (385 a 3421 casos). El pico máximo se observó en la semana estadística 33, con disminución a partir de dicha semana; además, hubo una dispersión en todos los consejos populares, con mayor concentración en los consejos populares Abreus (1035) y Horquita (725). La circulación viral estuvo por encima del 20 % en todas las semanas y la mayor ocurrió en la semana estadística 37. Conclusiones: la COVID-19 en el municipio Abreus tuvo una gran transmisión en el período estudiado. Se aportó información útil para la toma de decisiones durante el desarrollo de la enfermedad y base para la comprensión evolutiva ante futuros eventos análogos.

ABSTRACT Background: The 21st century has been characterized from the beginning by a health problem that has affected the world and Cuba, ranging from an increase in microbial resistance to the appearance of new infectious diseases, such as COVID-19. Objective: To describe the transmission of COVID-19 in the Abreus municipality, Cienfuegos province, between weeks 29 and 41 of the year 2021. Methods: An observational, descriptive, retrospective cross-sectional study was carried out from week 29-41. The universe consisted of 3,421 patients diagnosed with COVID-19, confirmed by a real-time polymerase chain reaction (RT-PCR) diagnostic test. Results: A high magnitude of transmission was observed with 3,421 cases, 122 on average in week 33. Trend of increased case reporting and transmission speed from statistical week 29 to 35 (385 to 3,421 cases). The maximum peak was observed at statistical week 33, with a decrease from that week; In addition, there was a dispersion in all the popular councils, with a greater concentration in the Abreus (1035) and Horquita (725) popular councils. Viral circulation was above 20% in all weeks and the highest occurred in statistical week 37. Conclusions: COVID-19 in the Abreus municipality had a great impact in the period studied. Useful information was provided for decision-making during the development of the disease and a basis for the evolutionary understanding of future analogous events.

Nodular fasciitis on the zygomatic region: immunohistochemical analysis and literature review / Fascitis nodular en la región cigomática: análisis inmunohistoquímico y revisión de la literatura

Background: Nodular Fasciitis (NF) is characterized as a benign, fast-growing lesion with proliferation of fibroblasts and myofibroblasts. The use of immunohistochemistry is important for the diagnostic definition and if its findings are not clear, the differential diagnosis will be challenging, even more when the clinical findings do not correspond with the histopathological characteristics. Objective:Here, we reported a case of dermal Nodular Fasciitis affecting zygomatic region of a 64 years old male who complained of swelling in the right side of the face for 3 months, which appeared after an ox-horn trauma. Literature review: We reviewed the literature for all Nodular Fasciitis cases in the zygomatic region. Furthermore, we discussed the relationship of trauma as an etiological factor, main differential diagnoses and immunohistochemical markers for Nodular Fasciitis. Case report: Incisional biopsy was done which revealed benign neoplasm of mesenchymal origin characterized by the fusocellular proliferation. Immunohistochemistry revealed positivity for VIM and SMA, being negative for S-100, CKs, CD34, and p53. The Ki-67 index was low. Due to the clinical, histopathological and immunohistochemical findings, the diagnosis of dermal NF was established. Conclusion: This case consists of Nodular Fasciitis, which must be microscopically differentiated from dermatofibroma, solitary fibrous tumor, low-grade myofibroblastic sarcoma and atypical fibroxanthoma. Immunohistochemistry should always be performed to elucidate the nature of tumor cells and thus contribute to the correct diagnosis and treatment. Nodular Fasciitis appears to be uncommon in the zygomatic region.

Introdução: A Fasciíte Nodular (FN) é caracterizada como uma lesão benigna, de crescimento rápido, com proliferação de fibroblastos e miofibroblastos. O uso da imunoistoquímica é importante para a definição diagnóstica e se seus achados não forem claros, odiagnóstico diferencial será desafiador, ainda mais quando os achados clínicos não corresponderem às características histopatológicas. Objetivo: Relatar um caso de Fasciíte Nodular dérmica acometendo a região zigomática de um homem de 64 anos que se queixava de inchaço no lado direito da face há 3 meses, que surgiu após trauma ocasionado por chifre de boi. Revisão da literatura: A literatura foi revisada para todos os casos de Fasciíte Nodular na região zigomática. Além disso, discutiu-se a relação do trauma como fator etiológico, principais diagnósticos diferenciais e marcadores imunoistoquímicos para Fasciíte Nodular. Relato de caso: Foi realizada biópsia incisional que revelou neoplasia benigna de origem mesenquimal caracterizada pela proliferação fusocelular. A imunoistoquímica revelou positividade para VIM e AML, sendo negativa para S-100, CKs, CD34 e p53. O índice Ki-67 foi baixo. Devido aos achados clínicos, histopatológicos e imunoistoquímicos, foi estabelecido o diagnóstico de Fasciíte Nodular dérmica. Conclusão:Este caso consiste em Fasciíte Nodular, que deve ser diferenciada microscopicamente de dermatofibroma, tumor fibroso solitário, sarcoma miofibroblástico de baixo grau e fibroxantoma atípico. A imunoistoquímica deve sempre ser realizada para elucidar a natureza das células tumorais e assim contribuir para o correto diagnóstico e tratamento. A Fasciíte Nodular parece ser incomum na região zigomática

Suppurative minor salivary gland sialolithiasis

ABSTRACT Sialolithiasis is a common nonneoplastic disease of the major salivary glands that often affects the submandibular glands. Minor salivary gland involvement by sialolithiasis is uncommon, with only 273 cases reported. A long clinical history, acute symptoms, and mucopurulent discharge are unusual features of these cases. Herein, we report the case of a 63-year-old woman who complained of symptomatic nodular swelling of the buccal mucosa associated with purulent discharge for several days. The clinical history lasted 15 years, with episodes of asymptomatic non-suppurative swelling in the same area. The patient underwent surgical excision. The microscopic examination revealed chronic nonspecific sialadenitis associated with psammomatous calcifications, confirming minor salivary gland sialolithiasis. After 3 years of follow-up, the patient was free of symptoms. Patients with sialolithiasis are usually asymptomatic; however, swelling, pain, and fistula may be present in rare cases. The presence of purulent exudate should lead to the differential diagnosis of stomatitis glandularis, a rare inflammatory condition affecting the minor salivary glands. Sialolithiasis and stomatitis glandularis should be considered in the clinical differential diagnosis of symptomatic suppurative nodular swelling affecting the oral mucosa, and histopathological analysis is necessary for the diagnosis.

El papel de la publicación tradicional de pruebas clínicas en la era de las modernas plataformas mediáticas / Theroleoftraditionalpublishingofclinicalevidenceintheageofmodernsocialmediaplatforms

Las redes sociales han revolucionado el uso de Internet. Según el Informe Digital de Estadísticas Globales de abril de 2022, hay unos 4.650 millones de usuarios de redes sociales en todo el mundo. 1 Este número equivale al 58,7 % de la población mundial, muchos de los cuales utilizan las redes sociales como principal fuente de información. ), youtube (2,2 mil millones), WhatsApp (2 mil millones), Instagram (2 mil millones), TikTok (1 mil millones), Snapchat (538 millones ), Pinterest (444 millones), Reddit (430 millones), Linkedin (250 millones) y Twitter (217 millones). Los cirujanos que están subiendo de rango son usuarios ávidos de las plataformas modernas de redes sociales o, al menos, son conscientes de ellos.

Socialmediahaverevolutionizedtheuseoftheinternet.Accord-ingtotheDigital2022AprilGlobalStatshotReport,therearesome4.65billionsocialmediausersworldwide.1Thisnumberistheequivalentto58.7%oftheglobalpopulation,manyofwhomareusingsocialmediaasaprimarysourceofinformation.Accordingtotheactiveusernumbers,themostpopularsocialmediaplatformsin2022areFacebook(2.9billion),youtube(2.2billion),WhatsApp(2billion),Instagram(2billion),TikTok(1billion),Snapchat(538million),Pinterest(444million),Reddit(430million),Linkedin(250million),andTwitter(217million).1SocialmediaisnotjustaU.S.phenomenonwhere84%ofAmericanshaveatleastoneoftheabove-listedsocialmediaaccounts.Thereareover1billionsocialmediausersinChina,despite415millionofitscitizenshavingnointernetaccess.1Mostyoungergenerationsoforthopedicsur-geonscominguptheranksareeitheravidusersofmodernsocialmediaplatformsorareatleastawareofthem

Rompiendo el efecto ''techo de cristal'' en la generación de evidencia clínica de alto nivel en ortopedia y traumatología / Breaking the "glass ceiling" effect in the generation of high-level clinical evidence in orthopedics and traumatology

Introduction: In clinical studies involving common orthopedic problems and traumatic injuries, randomization methods are difficult to orchestrate. The lack of high-level clinical evidence based on prospective, randomized, double-blind studies is often cited as a major reason for rejecting proposed therapeutic advances in orthopedic surgery. Materials and methods: This opinion document summarizes the limitations of clinical trials in surgical subspecialties. A consensus is presented about how the practicing orthopedic surgeon can produce high-quality clinical evidence and thus make changes to their clinical practice protocols. Results: This literature review revealed that level of evidence classifications vary among surgical subspecialties. Research in orthopedics and traumatology is primarily directed toward diagnosis, preferred treatment, and economic decision analysis, while other prognostic classifications are preferred in other areas, such as plastic surgery. In orthopedics, double-blind controlled studies are rare and often impractical or even unethical. Crossover between randomized surgical trials of study groups is more common. Other difficulties in surgical trials range from: lack of organizational and financial support, institutional approval or ethics committee and registration requirements for clinical trials, and to insufficient time outside of an already busy clinical program to dedicate to this laborious task. uncompensated task. Conclusion: Orthopedic surgery is a subspecialty based on experience and skill. Many innovations begin with enterprising surgeons reporting opinion reports or retrospective cohort studies, many of which are biased. Prospective observational cohort studies with consistent results may offer higher grade clinical evidence than poorly executed randomized trials.

Caracterización de pacientes extranjeros confirmados con la COVID-19 en Santiago de Cuba / Characterization of foreign patients confirmed with the COVID - 19 in Santiago de Cuba

Introducción: La COVID - 19 es una enfermedad emergente, que ha afectado a todo el mundo de forma pandémica, con elevados costos sanitarios, económicos y sociales. Objetivo: Caracterizar a los pacientes extranjeros confirmados con la COVID - 19 en Santiago de Cuba, según variables clinicoepidemiológicas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 42 pacientes extranjeros, quienes visitaron la provincia de Santiago de Cuba y resultaron positivos a la COVID - 19, los cuales fueron remitidos a los centros de salud destinados para su atención desde marzo hasta diciembre del 2020. Se analizaron variables, tales como edad, sexo, municipio de residencia, país de procedencia, meses de mayor número de extranjeros que visitaron la provincia y evolución clínica. Resultados: El grupo etario de mayor frecuencia fue el de 30 - 44 años (14 pacientes para 33,3 %), seguido de los afectados de 45 - 59 (11 para 26,2 %). El municipio de Santiago de Cuba resultó el de mayor riesgo de incidencia (27 para 64,3 %). La manifestación clínica más común fue el malestar general y el país de procedencia que prevaleció, Estados Unidos (47,6 %). Todos los pacientes fueron importados. Conclusiones: Los integrantes de la casuística tuvieron una evolución favorable, lo cual permitió accionar, desde la atención primaria de salud, a fin de prevenir la enfermedad y realizar el control de foco como principal herramienta para cortar la cadena de transmisión.

Introduction: The COVID-19 is an emergent disease that has affected everybody in a pandemic way, with high sanitary, economic and social costs. Objective: To characterize foreign patients confirmed with the COVID-19 in Santiago de Cuba, according to selected clinical epidemiological variables. Methods: An observational, descriptive and cross-sectional study of 42 foreign patients who visited Santiago de Cuba province and tested positive to the COVID-19, who were referred to the health centers dedicated for their care was carried out from March to December, 2020. Some variables were analyzed, such as age, sex, residence municipality, origin country, months of more number of foreigners that visited the province and clinical course. Results: The age group of more frequency was that of 30 - 44 years (14 patients for 33.3 %), followed by those affected of 45 - 59 years (11 for 26.2 %). The municipality of Santiago de Cuba had the higher risk of incidence (27 for 64.3 %). The most common clinical sign was the diffuse discomfort and the origin country that prevailed, United States (47.6 %). All the patients were imported. Conclusions: The members of the case material had a favorable clinical course, that allowed to work, from the primary health care, in order to prevent the disease and to carry out the source of infection control as main tool to stop the transmission chain.

Respuesta inmunológica a varias proteínas del H. pylori en pacientes guatemaltecos / Inmune response to various H. pylori proteins in Guatemalan patients

Se determinó la respuesta inmunológica a proteínas recombinantes de Helicobacter pylori en pacientes dis-pépticos (adultos y niños), pacientes con cáncer gástrico y sus familiares asintomáticos adultos viviendo con ellos. Se utilizó la prueba recomLine® Helicobacter IgG e IgA, y con base en el reconocimiento de los factores de virulencia VacA y CagA se determinó si la cepa de H. pylori era de tipo I o II. El análisis de los datos fue descriptivo y analítico y se estimaron los intervalos de confianza de 95%, con un nivel de error de 0.05 y Odds ratio. El 58.7% (121/206) de los pacientes presentó la bacteria en tinción histológica de biopsia, positividad que disminuyó con la edad y daño histológico. La frecuencia de la respuesta a los anticuerpos IgG fue mayor que IgA, en ambos casos ésta fue menor en los niños. Las proteínas del H. pylori más reconocidas tanto por IgA como IgG fueron VacA y CagA, y la respuesta a las otras proteínas investigadas fue mayor al aumentar el daño histológi-co. La cepa tipo I fue la que predominó en la población en estudio con 66% (136/206). Se deben continuar con los estudios de prevalencia de la cepa tipo I del H. pylori y del reconocimiento de sus antígenos en la población guatemalteca a fin de determinar su utilidad en el diagnóstico y pronóstico de la infección.

The immune response to recombinant Helicobacter pylori proteins was determined in dyspeptic patients (adults and children), patients with gastric cancer and their asymptomatic adults' relatives living with them. The recomLine® Helicobacter IgG and IgA test was used and based on the recognition of the virulence factors VacA and CagA, it was determined whether the H. pylori strain was type I or II. The data analysis was descriptive and analytic, and 95% confidence intervals were estimated, with an error level of 0.05, and Odds ratio. The patients that presented the bacterium in histological biopsy were 58.7% (121/206), positivity that decreased with age and histological damage. The frecuency of response to IgG antibodies was higher than IgA, in both cases it was lower in children. VacA and CagA were the H. pylori proteins most recognized by both IgA and IgG and it was observed that the number of recognized proteins was greater with increasing histological damage. The type I strain was the one that predominated in the study population 66% (136/206). Prevalence studies of the type I strain of H. pylori ant the recognition of its antigens in the Guatemalan population should continue in order to determine its usefulness in the diagnosis and prognosis of infection.

Exuberant hypercementosis mimicking cementoblastoma / Hipercementose exuberante simulando cementoblastoma

RESUMEN La hipercementosis se clasifica como una proliferación no neoplásica que implica un depósito excesivo de cemento a lo largo del cemento radicular normal. Presentamos el caso de un paciente masculino de 77 años que acude al dentista por una lesión supurativa en la encía que evoluciona desde hace varios meses. El examen radiográfico mostró una gran área radiopaca involucrando la raíz del diente 46, que estaba completamente rodeada por un área radiolúcida, sugiriendo un cementoblastoma asociado con el proceso infeccioso. El examen histopatológico del diente afectado reveló hipercementosis extensa asociada con inflamación supurativa crónica, además de osteomielitis crónica localizada. Esta presentación es infrecuente y, debido a los hallazgos clínico-patológicos, se propone el término "hipercementitis crónica". Los dentistas, especialmente los patólogos orales y endodoncistas, deben estar tener conocimiento de esta inusual presentación para establecer el diagnóstico correcto.

Post-radiotherapy recurrence of conventional oral squamous cell carcinoma showing sarcomatoid components: an immunohistochemical study

Spindle cell squamous cell carcinoma (SpSCC) is a rare biphasic malignant neoplasm, uncommonly affecting the oral cavity. The SpSCC diagnosis is difficult, especially when it exhibits inconspicuous morphology, inadequate tissue sampling, or association with an exuberant inflammatory reaction. Post-radiotherapy recurrent SpSCC occurring at the same site of conventional SCC is a rare phenomenon. A 59-year-old man was complained of "painful injury on the tongue" with 20 days of duration. He reported smoking and alcohol consumption. Medical history revealed conventional SCC on the tongue treated with surgery and radiotherapy 10 years ago. Intraoral examination showed a polypoid lesion with ulcerated areas, measuring 3 cm in diameter, on the tongue and floor of the mouth, at the same site of previous conventional SCC. The microscopical analysis showed small foci of carcinomatous component admixed with an exuberant inflammatory reaction. Immunohistochemistry highlighted the sarcomatoid component. Both malignant components were positive for EMA, CD138, p40 (deltaNp63), p63, and p53. Moreover, CK AE1/AE3 evidenced the carcinomatous component, whereas vimentin stained the sarcomatoid component. The Ki-67 was >10%. The current case emphasizes the importance of immunohistochemistry in the differential diagnosis of SpSCC from mimics and documents a rare complication of Ionizing Radiation.

Immunohistochemistry analysis of checkpoint kinase 2 in oral squamous cell carcinoma

Background: Oral squamous cell carcinoma (OSCC) is the most frequently occurring malignant tumor of the head and neck region. Chk2 (Checkpoint kinase 2) is considered a tumor suppressor gene that acts on the cellular response to DNA damage. However, the role of Chk2 in OSCC prognosis is not yet fully understood. The objective of this study was to evaluate Chk2 immunoexpression in OSCC and to elucidate the association between its expression and clinicopathological parameters of prognostic importance, including overall survival, disease-free survival, and metastasis-free survival. Methods: Chk2 expression was analyzed in 101 samples from patients with OSCC using immunohistochemistry. We stratified the patients into high expression (> 66% of cells positive for Chk2) and low expression (< 66%) groups. Results: Chk2 showed high expression in 57.43% of OSCC. In our study, the expression of Chk2 did not correlate with any of the prognostic parameters evaluated. There was no difference between overall survival, metastasis-free survival, and disease-free survival according to Chk2 expression. Conclusion: Despite the great importance of Chk2 in the development of different types of cancer, our findings do not favor Chk2 as a prognostic marker in oral squamous cell carcinoma.