Anterior lamellar corneoscleral keratoplasty for the management of corneal thinning following treatment with mitomycin-C and interferon to treat highly suspected ocular surface squamous neoplasia: a case report

ABSTRACT A patient presented with corneoscleral thinning five months after the treatment of suspected ocular squamous surface neoplasia with mitomycin-C and interferon. For tectonic and aesthetic purposes, we decided to perform lamellar corneoscleral transplantation. The approach used established new tectonic support and corneal homeostasis. This technique might be an option in similar cases.

Evaluation of perioperative pachymetry of thin corneas during corneal crosslinking using hypo-osmolar riboflavin and hydroxypropyl methylcellulose

ABSTRACT Purpose: This study aimed to analyze variations in intraoperative corneal thickness during corneal cross-linking in patients with keratoconus and to investigate its possible correlation with presurgical maximal keratometry (Kmax) and pachymetry. Methods: This was a prospective case series. We used a method similar to the Dresden protocol, with the application of hydroxypropyl methylcellulose 0.1% hypo-osmolar riboflavin in corneas between 330 and 400 µm after epithelium removal. Corneal thickness was measured using portable calipers before and immediately after epithelium removal, and 30 and 60 min after the procedure. Results: The 30 patients in this study were followed up for one year. A statistically significant difference was observed in pachymetry values during the intraoperative period (p<0.0001) and an increase of 3.05 µm (95%C1: 0.56-5.54) for each diopter was seen after epithelium removal (p0.019). We found an average Kmax difference of —2.12 D between men and women (p0.013). One year after treatment, there was a statistically significant reduction in pachymetry (p<0.0001) and Kmax (p0.0170) values. Conclusions: A significant increase in pachymetry measurements was seen during the procedure, and most patients showed a regression in Kmax and pachymetry values one year after surgery.

Hipotermia terapéutica: estudio descriptivo de una cohorte de 10 años en un hospital público de alta complejidad / Therapeutic hypothermia: A descriptive, cohort study conducted over 10 years at a tertiary care public hospital

Introducción. La hipotermia terapéutica (HT) reduce el riesgo de muerte o discapacidad en niños con encefalopatía hipóxico-isquémica (EHI) moderada-grave. Objetivo. Describir una población de pacientes con EHI que requirió HT y su evolución hasta el alta hospitalaria. Población y métodos. Estudio descriptivo de cohorte retrospectivo. Se analizaron todos los pacientes que ingresaron a HT entre 2013 y 2022. Se evaluaron datos epidemiológicos, clínicos, de monitoreo, tratamiento, estudios complementarios y condición al alta. Se compararon los factores de riesgo entre pacientes fallecidos y sobrevivientes, y de estos, los que requirieron necesidades especiales al alta (NEAS). Resultados. Se incluyeron 247 pacientes. Mortalidad: 11 %. Evento centinela más frecuente: período expulsivo prolongado (39 %). Inicio del tratamiento: mediana 5 horas de vida. Convulsiones: 57 %. Eritropoyetina intravenosa: 66,7 %. Patrón anormal de monitoreo de función cerebral: 52 %. Normalización del monitoreo: mediana 24 horas. Resonancia magnética patológica: 42 %. Variables predictoras de mortalidad: Sarnat y Sarnat grave, y ecografía patológica al ingreso. Conclusión. La mortalidad global fue del 11 %. Las derivaciones aumentaron en forma más evidente a partir del año 2018. El horario de inicio de HT fue más tardío que en reportes anteriores. Los signos neurológicos de gravedad según la escala de Sarnat y Sarnat y la ecografía cerebral basal patológica fueron predictores independientes de mortalidad al alta. Los pacientes con NEAS presentaron normalización del trazado del electroencefalograma de amplitud integrada más tardío. El hallazgo más frecuente en la resonancia fue la afectación de los ganglios basales. No se encontraron diferencias clínicas ni de complicaciones estadísticamente significativas entre los pacientes que recibieron eritropoyetina.

Introduction. Therapeutic hypothermia (TH) reduces the risk of death or disability in children with moderate to severe hypoxic ischemic encephalopathy (HIE). Objective. To describe a population of patients with HIE that required TH and their course until discharge. Population and methods. Retrospective, descriptive, cohort study. All patients admitted to TH between 2013 and 2022 were studied. Epidemiological, clinical, monitoring, and treatment data were assessed, together with supplementary tests and condition at discharge. Risk factors were compared between deceased patients and survivors; and, among the latter, those requiring special healthcare needs (SHCN) at discharge. Results. A total of 247 patients were included. Mortality: 11%. Most common sentinel event: prolonged second stage of labor (39%). Treatment initiation: median of 5 hours of life. Seizures: 57%. Intravenous erythropoietin: 66.7%. Abnormal pattern in brain function monitoring: 52%. Normalization of monitoring: median of 24 hours. Pathological magnetic resonance imaging: 42%. Predictor variables of mortality: severe Sarnat and Sarnat staging and pathological ultrasound upon admission. Conclusion. The overall mortality rate was 11%. Referrals increased more markedly since 2018. The time of TH initiation was later than in previous reports. Severe neurological signs as per the Sarnat and Sarnat staging and a pathological baseline cranial ultrasound were independent predictors of mortality at discharge. Patients with SHCN at discharge showed a normalized tracing in the amplitude-integrated electroencephalography performed later. The most common finding in the magnetic resonance imaging was basal ganglia involvement. No statistically significant differences were observed in terms of clinical characteristics or complications among patients who received erythropoietin.

Irritable bowel syndrome and role of pinaverium bromide: pharmacological profile and clinical efficacy

Irritable bowel syndrome (IBS) is a common gut brain interaction disorder that is diagnosed via patient-reported symptoms and various diagnostic criteria. Multiple factors, such as visceral hypersensitivity, gut dysbiosis, dysmotility, gut-brain dysregulation, lifestyle, and dietary habits, are involved in the development of IBS and manifestation of its symptoms of abdominal pain, bloating, and abnormal bowel movements. Lifestyle modifications and dietary changes, behavioral therapy, and pharmacological treatments, namely antispasmodics and antianxiety drugs, are commonly prescribed for IBS management. Pinaverium bromide is a selective calcium channel blocker that acts locally in the gastrointestinal tract and relieves spasms making it an effective agent for the treatment of IBS. This review provides a background on the diagnostic criteria and pathogenic mechanisms of IBS from an Indian clinician standpoint and provides an in-depth overview on clinical studies of pinaverium emphasizing its role in IBS treatment.

Balancing act: navigating the intricacies of proteostasis

Proteostasis, the intricate balance of protein synthesis, folding, trafficking, and degradation, is a fundamental cellular process crucial for maintaining cellular health and homeostasis. Imbalances in proteostasis are implicated in various diseases, including neurodegenerative disorders, cancer, aging, type 2 diabetes mellitus, cataract, huntington's disease, heart disease, sarcopenia, ischemic disorders, diabetic neuropathy and other metabolic conditions. We delve in to the proteostasis mechanisms and highlight the significance of proteostasis in the context of protein misfolding diseases that have broadened our understanding of proteostasis network. Further, we explore the relevance of proteostasis in cancer, shedding light on the interplay between the ubiquitin-proteasome system and oncoproteins. Furthermore, we also address therapeutic approaches aimed at modulating proteostasis to combat protein misfolding diseases. The mysteries of protein balance continue to captivate researchers, and the evolving landscape of proteostasis research promises insights into novel therapeutic strategies and a deeper understanding of its role in human health. This review offers a comprehensive perspective on the ever-expanding frontiers of proteostasis research, with the hope of inspiring further exploration and innovation in this dynamic field.

Representaciones sociales sobre diabetes tipo 2 en pacientes del área Metropolitana de Buenos Aires, Argentina

Introducción: Las características y complejidad de la diabetes mellitus tipo 2 motivan la necesidad de un abordaje multi e interdisciplinario. El estudio persigue caracterizar las representaciones sociales de la diabetes mellitus tipo 2 que posee un grupo de pacientes adultos, residentes en Área Metropolitana de Buenos Aires, Argentina Método: Estudio cuantitativo, descriptivo, corte transversal. Se aplicó cuestionario sociodemográfico elaborado ad hoc y técnica de palabras asociadas. Participaron 90 pacientes adultos, reclutados principalmente del servicio de diabetológica del Hospital de Clínicas "José de San Martin" dependiente de la Universidad de Buenos Aires. Resultados: El núcleo de la representación social estuvo integrado por palabras referidas al impacto y malestar emocional que causa esta patología; la identidad de la enfermedad y la necesidad de cuidado de la salud. La periferia contuvo los siguientes temas, de mayor a menor importancia: obesidad, complicaciones de la diabetes, plan alimentario, tratamiento médico y medicación. En menor medida, se mencionaron elementos como actividad física y sedentarismo. De manera tangencial, surgieron los elementos de desinformación y sexualidad. Discusión: La representación social de la diabetes mellitus tipo 2 en pacientes se caracteriza por reflejar, en su núcleo, el temor, impacto y malestar que causa esta enfermedad. La reproducción del discurso médico mediante los temas referidos a factores de riesgo, complicaciones y tratamiento, conforman el sistema periférico de la representación. Elementos importantes tales como actividad física, sedentarismo, desinformación y sexualidad, son poco mencionados. Se destaca la importancia de la salud mental, como una problemática central a abordar en este tipo de patologías. También se sugiere implementación de educación terapéutica.

Introduction: Characteristics and complexity of type 2 diabetes generates the need for a multi and interdisciplinary approach. The aim of the study is to characterize social representations of type 2 diabetes in a group of adult patients, living in the Metropolitan Area of Buenos Aires, Argentina. Method: Descriptive and cross-sectional design. An ad-hoc sociodemographic questionnaire and the associated words technique were applied. 90 adult patients participated, recruited mainly from a diabetes service of a public hospital. Results: The core of the social representation was made up of words referring to the impact and emotional discomfort caused by this pathology, the identity of the disease and the need for health care. The periphery contained the following topics, from most to least important: obesity, diabetes complications, eating plan, medical treatment, and medication. Elements such as physical activity and sedentary lifestyle were mentioned to a lesser extent. Also, misinformation and sexuality were mentioned tangentially. Discussion: Social representation of type 2 diabetes in patients is characterized by reflecting at its core, the fear, impact and discomfort that this disease causes. The reproduction of medical discourse, through topics related to risk factors, complications and treatment, make up the peripheral system of representation. Important elements such as physical activity, sedentary lifestyle, misinformation and sexuality are rarely mentioned. The importance of mental health is highlighted as a central problem to be addressed in this type of pathology. Also, it's suggested the implementation of therapeutic education.

Tratamientos terapéuticos para afrontar la ruptura amorosa: Una revisión sistemática / Therapeutic treatments to cope with a love breakup: a systematic review

Abstract The study aimed to conduct a systematic review of therapeutic treatments to cope with a love breakup from 1992 to 2023 in Spanish, English and Portuguese in EBSCO, PsycINFO, PubMed, Scopus, and Web of Science (WOS). Two independent researchers performed the searches and data extraction. Out of 156 records, 13 articles are included addressing treatments to cope with love breakups. Most of the studies found were in the United States and Iran and aimed to women. The studies showed a significant decrease in symptoms of depression and anxiety during the love breakup. Empirical evaluation of the efficacy of future interventions to deal with breakups is recommended, based on experimental designs in adolescents and young people of both sexes.

Resumen El objetivo del estudio fue llevar a cabo una revisión sistemática acerca de los tratamientos terapéuticos para afrontar la ruptura amorosa de 1992 a 2023 en español, inglés y portugués en EBSCO, PsycINFO, PubMed, Scopus y Web of Science (WOS). Dos investigadores independientes realizaron las búsquedas y extracción de datos. De 156 registros, se incluyeron 13 artículos que abordaron tratamientos terapéuticos para afrontar la ruptura amorosa. La mayor parte de los estudios que se encontraron fue en Estados Unidos e Irán y fueron dirigidos a mujeres. Los estudios mostraron una disminución significativa en los síntomas de depresión y ansiedad por la ruptura amorosa. Se recomienda la evaluación empírica de la eficacia de las futuras intervenciones para afrontar la ruptura amorosa a partir de diseños experimentales en población adolescente y joven jóvenes de ambos sexos.

Itinerários terapêuticos de pessoas hospitalizadas por covid-19 no SUS: um estudo quantiqualitativo no Distrito Federal / Therapeutic itineraries of people hospitalized for COVID-19 in the SUS: quantitative and qualitative study in the Federal District

RESUMO Os estudos sobre itinerários terapêuticos revelam modelos de cuidado e decisões tomadas pelas pessoas em situações de adoecimento e podem contribuir para o planejamento de políticas e serviços de saúde mais efetivos, especialmente em emergências como a pandemia de covid-19. O objetivo desta pesquisa foi descrever os itinerários terapêuticos de pacientes hospitalizados por covid-19 em um hospital público do Distrito Federal e explorar associações com determinantes sociais da saúde. Trata-se de um estudo de caso integrado, com triangulação de evidências quantitativas e qualitativas obtidas a partir da análise do banco de dados de um estudo observacional transversal com 233 adultos internados entre maio/2020 e dezembro/2021. A maioria homens, idosos, pretos ou pardos, com baixo nível de renda e escolaridade e múltiplas comorbidades, que procuraram atendimento na atenção especializada e conseguiram acesso rápido ao sistema de saúde. Os fatores que influenciaram a escolha do primeiro serviço foram: ocupação, região de moradia, classe econômica e escolaridade. Já os determinantes da facilidade de acesso foram: tipo de serviço buscado primeiro, gravidade do caso e contexto socioeconômico. Os resultados confirmam a influência de determinantes sociais nas experiências de adoecimento e podem subsidiar reflexões relacionadas à organização do acesso ao SUS em emergências sanitárias.

ABSTRACT Studies on therapeutic itineraries reveal models of care and decisions taken by people in situations of illness and can contribute to the planning of effective health policies and services, especially in emergencies such as the COVID-19 pandemic. The aim of this research was to describe the itineraries of patients hospitalized for COVID-19 in a public hospital in the Federal District and explore associations with social determinants of health. This is an integrated case study, with triangulation of quantitative and qualitative evidence obtained from the analysis of raw data from a cross-sectional observational study with 233 adults hospitalized between May/2020 and December/2021. The majority were men, elderly, black or brown, with low income and education levels and multiple comorbidities, who sought care in specialized care and obtained quick access to the health system. The factors that influenced the choice of the first service sought were: occupation, region of residence, economic class and education. The determinants of ease of access were: type of service first sought, severity of the case and socioeconomic context. The results confirm the influence of social determinants on illness experiences and can support reflections related to the organization of access to the SUS in health emergencies.

EVALUATION OF PRESCRIBING PATTERN IN ORTHOPEDICS DEPARTMENT IN A TERTIARY CARE HOSPITAL: A PROSPECTIVE OBSERVATIONAL STUDY

Objective: To study the demographic profile and prescription pattern in Orthopedics department in a tertiary care hospital.Methods: A prospective, observational and cross-sectional study design was adopted for this study. A total of 144 patients were enrolled and their prescriptions were analyzed for three months. The data was analyzed by using a Microsoft Excel Worksheet. The Anatomical Therapeutic Chemical classification system and defined daily dose were used to classify the prescribed drugs.Results: Out of 144 patients enrolled, 105 (72.92%) were male and 39 (27.08%) were female. Maximum patients were between 21-40 y of age. The mean age of the patients was 35.04±18.53. The average number of drugs per prescription was 4.84. Fracture of limbs (58.33%) was the most common diagnosis. Analgesics were the most commonly prescribed drugs. Diabetes was the most common comorbidity. The percentage of drugs prescribed by generic names was 48.06, and that from the essential drug list was 47.78. The percentage of fixed-dose combinations used was 28.55.Conclusion: Although we found that a good percentage of drugs were prescribed from essential drug list but, this practice has to be increased in future. It is also seen that average number of drugs per prescription was high and percentage of drugs prescribed by generic names was less than that by brand names. So, there is immense scope of improvement for prescribing in the hospital.

Impact of therapeutic hypothermia (whole body cooling) on severely asphyxiated term neonates: a prospective non-randomized comparative study in an Indian tertiary care setting

Background: Early application of Therapeutic Hypothermia within 6 hours of birth is neuroprotective. We aimed at examining whether therapeutic hypothermia alongside standard optimal intensive care improves immediate survival outcome and reduces neuro-disability.Methods: This was a prospective non-randomized study involving inborn and out born newborns admitted at NICU, carried out from March 2022 to December 2022. Eligible candidates were enrolled as cases and therapeutic hypothermia was offered while rest were included as a control group and monitored likewise for the overall survival and neurological outcome. These babies were followed up till 1 month and 3 months of age to assess neurological outcome.Results: In this study, a total of 47 patients were enrolled both from extramural and intramural NICU set ups. Of them, 22 patients were offered Therapeutic Hypothermia and 25 patients were given standard post asphyxia care. 7 out of 9 inborn patients and 3 out of 13 out born neonates who were offered therapeutic hypothermia survived whereas 5 out of 11 inborn and 4 out of 14 out born neonates who were offered standard post asphyxia care survived.Conclusions: Therapeutic hypothermia cannot be attributed to significant increase or decrease in mortality when compared with standard care group. No inference could be made about hypothermic neuroprotection in the follow up study. Overall survival outcome was better in inborn patients than that of outborn. Inborn neonates subjected to therapeutic hypothermia, showed a trend towards better survival than those given standard post asphyxia care.

Evaluation of orphan drug therapies and associated monitoring guidelines

Orphan drugs, designed for the treatment and prevention of rare medical conditions known as orphan diseases, are infrequently accessible due to their high costs and limited research. The prevalence of rare diseases varies across countries based on population demographics. The Food and Drug Administration (FDA) has approved over 770 drugs with 77 designations for orphan status. Some of these drugs, often discovered by the pharmaceutical industry, are both highly valuable and expensive. When using orphan drugs, specific parameters need to be monitored. Therapeutic monitoring should align with the patient's physical condition and the severity of the disease. This article aims to comprehensively examine the development of orphan drugs and their monitoring protocols.

Intervenções terapêuticas não farmacológicas para o tratamento de úlceras no pé diabético: revisão integrativa / Intervenciones terapéuticas no farmacológicas para el tratamiento de las úlceras diabéticas: revisión integral de la literatura / Non-pharmacological therapeutic interventions for the treatment of diabetic foot ulcers: an integrative literature review

Introdução: As úlceras no pé diabético surgem da interação complexa entreneuropatia periférica e doença arterial periférica, comprometendo a cicatrização após traumas. Objetivo: Explorar a diversidade de intervenções terapêuticas não farmacológicas que têm sido estudadas e avaliadas quanto à sua eficácia e segurança no tratamento de úlceras no pé diabético. Metodologia: Pesquisa do tipo revisão integrativa da literatura. Para obtenção dos resultados foi realizado um levantamento nas plataformas PubMed e Biblioteca Virtual em Saúde. Para elaboração dos resultados foram selecionados 21 artigos. Resultados: As intervenções encontradas foram oxigenoterapia hiperbárica, terapia de feridas por pressão negativa, uso de matriz dérmica, plasma rico em plaquetas, plasma atmosférico frio, tratamentos com curativos especiais e uso de solas rígidas, entre outros. Mostraram uma variabilidade na taxa de cicatrização e no tempo de fechamento da ferida, bem como na melhoria da regeneração tecidual. Conclusão: As pesquisas mostram uma diversidade de intervenções terapêuticas não farmacológicas utilizadas no tratamento de úlceras no pé diabético, ressaltando a necessidade de abordagens individualizadas e mais estudos para determinar a eficácia e segurança de cada intervenção (AU).

Introduction:Diabetic foot ulcers arise from the complex interaction between peripheral neuropathy and peripheral arterial disease, compromising wound healing after traumas. Objective:To explore the diversity of non-pharmacological therapeutic interventions that have been studied and evaluated for their effectiveness and safety in the treatment of diabetic foot ulcers. Methodology: An integrative literature review was conducted. The search for results was performed on the PubMed and Virtual Health Library platforms. Twenty-one articles were selected for result elaboration.Results:The identified interventions included hyperbaric oxygen therapy, negative pressure wound therapy, use of dermal matrix, platelet-rich plasma, cold atmospheric plasma, treatments with special dressings, and the use of rigid soles, among others. They exhibited variability in the healing rate and wound closure time, as well as improvement in tissue regeneration.Conclusion:The research demonstrates a diversity of non-pharmacological therapeutic interventions used in the treatment of diabetic foot ulcers, emphasizing the need for individualized approaches and further studies to determine the effectiveness and safety of each intervention (AU).

Introducción: Las úlceras en el pie diabético surgen de la interacción compleja entre neuropatía periférica y enfermedad arterial periférica, comprometiendo la cicatrización después de traumas.Objetivo: Explorar la diversidad de intervenciones terapéuticas no farmacológicas que han sido estudiadas y evaluadas en cuanto a su eficacia y seguridad en el tratamiento de úlceras en el pie diabético.Metodología: Investigación del tipo revisión integrativa de la literatura. Para obtener los resultados se realizó un estudio en las plataformas PubMed y Biblioteca Virtual en Salud. Para la elaboración de los resultados se seleccionaron 21 artículos. Resultados: Las intervenciones encontradas fueron oxigenoterapia hiperbárica, terapia de heridas por presión negativa, uso de matriz dérmica, plasma rico en plaquetas, plasma atmosférico frío, tratamientos con curativos especiales y uso de suelas rígidas, entre otros. Mostraron una variabilidad en la tasa de cicatrización y en el tiempo de cierre de la herida, así como en la mejora de la regeneración tisular. Conclusión: Las investigaciones muestran una diversidad de intervenciones terapéuticas no farmacológicas utilizadas en el tratamiento de úlceras en el pie diabético, resaltando la necesidad de enfoques individualizados y más estudios para determinar la eficacia y seguridad de cada intervención (AU).

Diagnóstico de colapso maxilar de acuerdo con el análisis de Penn y la decisión terapéutica / Diagnosis of maxillary collapse according to the Penn analysis and therapeutic decision

Introducción: el colapso trasversal maxilar se define como el desarrollo insuficiente del maxilar en sentido trasversal. Es uno de los problemas más perjudiciales en el crecimiento facial y la integridad de las estructuras dentoalveolares. Objetivo: identificar la cantidad colapsos transversales del maxilar en tomografía computarizada de haz cónico (CBCT) y la decisión terapéutica propuesta. Material y métodos: se examinó un total de 52 expedientes con CBCT del Postgrado de Ortodoncia de la Universidad Autónoma de Sinaloa determinándose los casos de colapso trasversal maxilar a través del análisis de Penn. La información recolectada fue capturada en una base de datos, utilizando el programa Excel, y se analizó con un modelo de regresión logística. Resultados: se encontraron 32 pacientes con colapso trasversal maxilar de un total 44 pacientes atendidos. El modelo de regresión logística no mostró asociación entre la presencia de colapso maxilar y el uso de tratamientos con el que resolvieran el colapso maxilar. Conclusión: existe gran cantidad de pacientes con colapso maxilar; sin embargo, el plan de tratamiento no muestra tratar de resolver estos colapsos maxilares (AU)

Introduction: transverse maxillary collapse is defined as insufficient development of the maxilla in a transverse direction. It is one of the most harmful problems in facial growth and the integrity of the dentoalveolar structures. Objective: identify the number of transverse collapses of the maxilla in cone beam computed tomography (CBCT) and the proposed therapeutic decision. Material and methods: a total of 52 records with CBCT of the orthodontics postgraduate course of the Autonomous University of Sinaloa UAS were examined, determining the cases of transverse maxillary collapse through the Pen analysis. The information collected was captured in a database using the Excel program and analyzed with a logistic regression model. Results: 32 patients with maxillary transverse collapse were found out of a total of 44 patients attended. The logistic regression model did not show an association between the presence of maxillary collapse and the use of treatments that resolved maxillary collapse. Conclusion: there is a large number of patients with maxillary collapse, however, the treatment plan does not show trying to resolve these maxillary collapses (AU)

Efectos de la marihuana en la salud bucal / Effects of marijuana on oral health

Aun cuando las autoridades del Sector Salud en México no se han declarado respecto al uso medicinal de la marihuana, con el objetivo de conocer el estado actual internacional sobre sus riesgos y usos terapéuticos, investigamos los avances reportados en la actualidad, así como las comunidades que han despenalizado su uso. Se presenta su origen como elemento terapéutico, pueblos involucrados, diversas denominaciones, historicidad, las diversas preparaciones, farmacodinamia, sus efectos nocivos a la salud en general y particularmente en boca, sus posibles usos en odontología tomando en cuenta sus propiedades terapéuticas. ampliamente reseñadas en relación a otros lugares del organismo. Finalmente, la propuesta de investigación en odontología con especial énfasis en aquellas especialidades donde la inflamación y el dolor agudo estén presentes de manera significativa (AU)

Although health authorities in Mexico have not officially declared their stance on the medicinal use of marijuana, our research aims to explore the current international status regarding its risks and therapeutic uses. We have investigated the latest reported advancements and examined communities that have decriminalized its usage. This presentation encompasses its therapeutic origin, involved communities, various designations, historical context, diverse preparations, pharmacodynamics, its adverse effects on overall health and particularly oral health, as well as its potential applications in dentistry, considering its widely documented therapeutic properties in comparison to other areas of the body. Finally, our research proposal in dentistry places special emphasis on specialties where inflammation and acute pain are significantly present (AU)

Perspectiva holística en salud: la contribución de la Homeopatía / Holistic Perspective in Health: The Contribution of Homeopathy

En el panorama de la salud, el cuerpo humano, en su estado natural, se revela como una intrincada unidad que opera en armonía para mantener el equilibrio dinámico. Sin embargo, esta homeostasis puede verse afectada, dando lugar a la dualidad y a trastornos que comprometen la estabilidad vital. Este artículo propone una reflexión sobre la perspectiva homeopática, destacando su enfoque único en comparación con la medicina convencional. Diferenciándose al tratar al individuo como un todo integrado, la Homeopatía reconoce la transitoriedad de la dualidad representada por las enfermedades y enfatiza la importancia de la armonía entre el cuerpo y la mente en la búsqueda de la homeostasis. Inspirada en las ideas de Hahnemann, la Homeopatía se destaca por su visión holística, rechazando el dualismo estricto y proponiendo intervenciones que van más allá de la supresión de los síntomas. Anclada en la ley de los similares, busca sustancias que reproduzcan los síntomas del paciente en un estado saludable, buscando una cura profunda y la restauración de la unidad dinámica del organismo. A pesar de los desafíos, como la resistencia y la falta de métodos de investigación universalmente aceptados, la Homeopatía persiste a nivel mundial, sugiriendo un valor único. Este artículo promueve una reflexión sobre el enfoque homeopático, enfatizando su contribución a la comprensión de la salud y su papel en el panorama terapéutico.

n the landscape of health, the human body, in its natural state, reveals itself as an intricate unity, operating harmoniously to maintain dynamic balance. However, this homeostasis can be disrupted, leading to duality and disturbances that compromise vital stability. This article reflects on the homeopathic perspective, highlighting its unique approach compared to conventional medicine. Distinguishing itself by treating the individual as an integrated whole, homeopathy recognizes the transience of duality represented by diseases and emphasizes the importance of harmony between body and mind in the pursuit of homeostasis.Inspired by Hahnemann's ideas, homeopathy stands out for its holistic view, rejecting strict dualism and proposing interventions that go beyond symptom suppression. Anchored in the Law of Similars, it seeks substances that would reproduce the patient's symptoms in a healthy state, aiming for a profound cure and the restoration of the dynamic unity of the organism. Despite challenges, such as resistance and a lack of universally accepted research methods, homeopathy persists globally, suggesting unique value. This article encourages reflection on the homeopathic approach, emphasizing

Empleo de laser terapéutico versus corrientes TENS para manejo de dolor en pacientes posoperados de artroscopia de rodilla en etapa posoperatoria / Use of therapeutic laser vs TENS currents for pain management in postoperative knee arthroscopy patients in the postoperative stage

Resumen Objetivo: Comprar el dolor en pacientes posoperados de artroscopia de rodilla después de ser sometidos a tratamiento con láser terapéutico versus corrientes TENS. Materiales y método: Se realizó un estudio de tipo experimental, longitudinal, prospectivo, y comparativo que incluyó a 14 pacientes que acudieron al área de Medicina Física y Rehabilitación del Hospital Central Militar, identificados con el diagnóstico de posoperados de artroscopia de rodilla, mediante aleatorización simple, por sorteo, para incluir a los pacientes en los grupos de trabajo: tratamiento con láser terapéutico versus tratamiento con corrientes TENS. Se aplicó la escala visual análoga en la evaluación, y se realizó la medición de ambas rodillas por circometria, pre y postratamiento para medir el edema. El análisis se realizó con el programa estadístico SPSS versión 26 y se utilizó la prueba T de student. Nivel de significancia p<0.05. Resultados: Ingresaron al estudio un total de 14 pacientes, a 7 se les dio en tratamiento con láser terapéutico y a 7 con corrientes TENS. El 50% (7 pacientes) fueron mujeres y el 50% (7 pacientes) fueron hombres. La edad promedio fue de 44.85 años. Al analizar la escala visual análoga, en la evaluación pre y postratamiento ambos grupos disminuyeron su intensidad de dolor con diferencias estadísticamente significativas, (con una desviación típica de 1.15 para TENS y una desviación típica de 1.35) al comparar ambos resultados, se observó una diferencia estadisticamente significativa a favor de las corrientes TENS sobre el láser terapeutico p<0.0001. Conclusiones: En ambos tratamientos, se observaron mejorías en el dolor percibido por los pacientes. Teniendo mayor disminución del dolor con las corrientes TENS. Por lo tanto, en este estudio se llega a la conclusión que este tratamiento es más efectivo que el láser terapéutico en el manejo del dolor en pacientes posoperados de artroscopia de rodilla. No se observó mejoría en el edema en ninguno de los tratamientos.

Abstract Objective: To measure pain in postoperative knee arthroscopy patients after undergoing treatment with therapeutic laser vs. TENS currents. Materials and method: An experimental, longitudinal, prospective, and comparative study was carried out that included 14 patients who attended the Physical Medicine and Rehabilitation area of the Hospital Central Militar, identified with the diagnosis of postoperative knee arthroscopy, through randomization. simple, by lottery, to include patients in the work groups: treatment with therapeutic laser vs treatment with TENS currents. The visual analogue scale was applied in the evaluation, and measurement of both knees was carried out by circometry, pre- and post-treatment to measure edema. The analysis was carried out with the statistical program SPSS version 26 and the student's T test was used. Significance level p<0.05. Results: A total of 14 patients entered the study, 7 were treated with therapeutic laser and 7 with TENS currents. 50% (7 patients) were women and 50% (7 patients) were men. The average age was 44.85 years. When analyzing the visual analog scale, in the pre- and post-treatment evaluation, both groups decreased their pain intensity with statistically significant differences (with a standard deviation of 1.15 for TENS and a standard deviation of 1.35). When comparing both results, a difference was observed. statistically significant difference in favor of TENS Currents over therapeutic laser p<0.0001. Conclusions: In both treatments, both the therapeutic laser and the TENS currents, improvements were observed in the pain perceived by the patients. Having a greater reduction in pain with TENS currents. Therefore, in this study we conclude that treatment with TENS currents is more effective than therapeutic laser in pain management in post-knee arthroscopy patients. No improvement in edema was observed in any of the treatments.

Adherencia terapéutica de pacientes con diabetes mellitus tipo 2 en cuatro áreas de salud del país

Fundamento: El incumplimiento del tratamiento por las personas diabéticas, no solo empeora el pronóstico, sino su calidad de vida. Objetivo: Caracterizar la adherencia terapéutica en pacientes diabéticos tipo 2 pertenecientes a cuatro áreas de salud, de dos municipios de Cuba. Métodos: Se realizó un estudio descriptivo y transversal en dos áreas de salud de los municipios de Cárdenas y Santiago de Cuba, en el periodo enero - agosto de 2019. El universo estuvo representado por 1091 personas diabéticas que se recuperaron de un estudio previo efectuado entre el 2015 y 2016 en las mismas áreas de salud. A estas se les realizó mediciones antropométricas, de la presión arterial, hemoglobina glicada y se aplicó un cuestionario. Se estudiaron variables: sociodemográficas (edad, sexo, color de la piel, ocupación, nivel de escolaridad, convivencia), factores de riesgo y comorbilidades, tratamiento farmacológico y no farmacológico y su relación con la adherencia. Las variables categóricas fueron presentadas como frecuencias y porcentajes. Resultados: La adherencia fue de 70,7 %, relacionada estadísticamente con color de piel blanca, nivel de escolaridad alto, control de la hemoglobina glicada según edad y valor inferior a 7 %, así como, el no padecimiento de comorbilidades como enfermedades cardiovasculares, respiratorias crónicas, dislipidemia, no consumo de bebidas alcohólicas, ni azucaradas. Conclusiones: La no disponibilidad de medicamentos en farmacia, el olvido en tomarlos y en los horarios establecidos resultaron las principales barreras referidas por los pacientes, esto debe tenerse en cuenta para incidir de forma favorable en el control de la diabetes mellitus.

Foundation: Non-compliance with treatment by diabetic people not only worsens the prognosis, but also their quality of life. Objective: To characterize therapeutic adherence in type 2 diabetic patients belonging to four health areas, from two municipalities in Cuba. Methods: A descriptive and cross-sectional study was carried out in two health areas of the municipalities of Cárdenas and Santiago de Cuba, in the period January - August 2019. The universe was represented by 1091 diabetic people who recovered from a previous study carried out between 2015 and 2016 in the same health areas. They underwent anthropometric measurements, blood pressure, glycated hemoglobin and a questionnaire was applied. Variables were studied: sociodemographic (age, sex, skin color, occupation, level of education, cohabitation), risk factors and comorbidities, pharmacological and non-pharmacological treatment and their relationship with adherence. Categorical variables were presented as frequencies and percentages. Results: Adherence was 70.7 %, statistically related to white skin color, high level of education, control of glycated hemoglobin according to age and value less than 7 %, as well as not suffering from comorbidities such as cardiovascular diseases, chronic respiratory diseases, dyslipidemia, no consumption of alcoholic or sugary beverages. Conclusions: The non-availability of medications in the pharmacy, forgetting to take them and at the established times were the main barriers reported by patients, this must be taken into account to have a favorable impact on the control of diabetes mellitus.

Utilização da toxina botulínica para o tratamento de cicatriz queloide: revisão de escopo / Use of botulinum toxin for the treatment of keloid scars: scoping review

Introdução: Cicatrizes visíveis podem acarretar agravos, sejam estéticos, psicológicos, funcionais ou sociais, principalmente de grande extensão e volume, como os queloides. A descoberta de novos tratamentos de queloides não é fácil, visto a presença de alguns entraves metodológicos e éticos, sendo uma área pouco explorada. A toxina botulínica tem sido apresentada como alternativa terapêutica em estudos nacionais e internacionais, sendo necessária uma compilação e destaque dos principais estudos que possam subsidiar a prática clínica. Assim, o objetivo foi apresentar uma revisão de escopo sobre a utilização terapêutica da toxina botulínica para o tratamento de cicatrizes queloides. Método: A revisão foi realizada através da estratégia PICO e utilizando o Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Foi realizada nas bases de dados PubMed/ Medline, Biblioteca Virtual em Saúde e SciELO, considerando estudos do período de 2016 até setembro de 2021. Resultados: Foram encontrados 34 artigos no geral relacionados ao tema. Após filtragem e seleção, a revisão foi construída com apoio de 5 artigos. Os estudos variaram entre coorte, relatos de caso, ensaio clínico randomizado e caso-controle. Foi possível observar como principais resultados a ação a curto prazo da toxina botulínica na redução de queloides, maior efetividade na redução dos sintomas e possibilidades de utilização clínica para diferentes populações e manifestações clínicas. Conclusão: O mecanismo de ação da toxina botulínica pode facilitar o tratamento de queloides e redução de sintomas, sendo necessários estudos mais robustos para definição de protocolos cínicos de gestão de cicatrizes.

Introduction: Visible scars can cause problems, whether aesthetic, psychological, functional, or social, mainly of great extension and volume, such as keloids. The discovery of new treatments for keloids is not easy, given the presence of some methodological and ethical obstacles, and it is an area that is little explored. Botulinum toxin has been presented as a therapeutic alternative in national and international studies, requiring a compilation and highlighting of the main studies that can support clinical practice. Thus, the objective was to present a scoping review on the therapeutic use of botulinum toxin for the treatment of keloid scars. Method: The review was carried out using the PICO strategy and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. It was carried out in the PubMed/ Medline, Virtual Health Library, and SciELO databases, considering studies from 2016 to September 2021. Results: Overall, 34 articles related to the topic were found. After filtering and selection, the review was constructed with the support of 5 articles. The studies varied between cohorts, case reports, randomized clinical trials, and casecontrol. It was possible to observe as main results of the short-term action of botulinum toxin in reducing keloids, greater effectiveness in reducing symptoms, and possibilities of clinical use for different populations and clinical manifestations. Conclusion: The mechanism of action of botulinum toxin can facilitate the treatment of keloids and reduce symptoms, requiring more robust studies to define effective scar management protocols.

¿Ensayos clínicos de superioridad, equivalencia o no inferioridad? / ¿Clinical trials of superiority, non-inferiority or equivalence?

La eficacia de una nueva intervención se establece generalmente a través de ensayos clínicos (EC) con asignación aleatoria (AA). Sin embargo, entre otros tantos desafíos metodológicos, el especificar la hipótesis de un EC con AA, sigue siendo un problema complejo de resolver para los investigadores clínicos. En este manuscrito discutimos las características de tres variantes de los EC con AA: EC de superioridad (ECS), EC de no-inferioridad (ECNI), y EC de equivalencia (ECE). Estos tres tipos de EC tienen supuestos diferentes sobre los efectos de una intervención, por lo que plantear hipótesis y definir objetivos requiere conocer algunos supuestos subyacentes a estos EC, incluso hasta elementos relacionados con la estimación del tamaño de muestra para cada cual. El objetivo de este manuscrito fue describir las diferencias metodológicas entre ECS, ECNI y ECE.

Efficacy and effectivity of new interventions are generally established through randomized clinical trials (RCTs). However, among many other methodological challenges, specifying the hypothesis of a RCT remains complex problem for clinical researchers. In this manuscript we discuss the characteristics of three variants of RCTs: superiority RCT (SRCT), non-inferiority RCT (NIRCT), and equivalence RCT (ERCT). These three types of RCT have different assumptions about the effects of an intervention, so setting hypotheses and defining objectives requires knowing some assumptions underlying these RCTs, including elements related to the estimation of the sample size for each one. The aim of this manuscript was to describe methodological differences between SRCT, NIRCT and ERCT.

Mass spectrometry in clinical laboratory: applications and future prospects

Innovations in laboratory medicine face additional challenges due to the unmet need for extremely precise methods of disease diagnosis. Developments in mass spectrometry-based disease biomarker identification are constantly expanding the field of clinical diagnosis. More mass spectrometry-based in vitro diagnostics are anticipated to move from the bench to the bedside shortly, although several are currently incorporated into standard clinical procedures. The molecular detection by mass spectrometry technique is very effective in diagnosis of the disease and therapeutic monitoring because of its extremely high sensitivity, specificity, and short turnaround time. Mass spectrometry is a potent analytical instrument that may be used to analyse a variety of materials and matrices; its use in clinical laboratory medicine applications is rising. For clinical prognostics and diagnostic purposes, mass spectrometry imaging has been widely utilized to distinguish between healthy and diseased tissues. Modern single-cell studies will benefit from its cutting-edge applications, which will offer comprehensive cellular biochemical data for mechanistic comprehension and, eventually, the development of therapeutic interventions. Within the field of laboratory medicine, the application of mass spectrometry is crucial, especially in terms of diagnostics and therapeutic drug monitoring. This review on the clinical application of mass spectrometry and its future prospects promises an insightful exploration of the evolving landscape of mass spectrometry in clinical settings, delving into its current applications and shedding light on its potential future advancements, for which a comprehensive search in the PubMed, ScienceDirect, and Web of Science databases was conducted.