Contralateral orbicularis oculi muscle transposition in facial paralysis: functional, aesthetic and electromyographic outcomes. A case report and literature update.

PURPOSE: Many surgical approaches have been described for achieving satisfactory functionality in patients with facial paralysis, to ensure the protection of the cornea and the highest degree of physiological blinking. Out of all those available, dynamic techniques are indicated when motion recovery and synchrony are the goals pursued. Orbicularis oculi transposition (OOT) allows a genuine restoration of blinking by means of contralateral reinnervation, with minimal insult for the donor site. METHODS: We present the case of a 64-year-old man with unilateral facial paralysis. A physical examination revealed a lagophthalmos of more than 5 mm. A neurophysiological study showed a mild-to-moderate axonal injury of the left facial nerve. Contralateral OOT was indicated as the first therapy option since it can restore involuntary blinking. The orbicularis muscle flap was not divided into branches, as described previously by other authors; the whole flap was transposed to the paralysed upper eyelid to achieve the highest level of potential reinnervation. RESULTS: Lagophthalmos was fully corrected after the surgery. The patient reported subjective improvement of symptoms, less frequent instillation of artificial tear drops and, especially, synchronous blinking with significant improvement in involuntarity. These improvements were maintained after 1 year of follow-up. Postoperative electromyographic studies confirmed the improvement in neural function. CONCLUSIONS: OOT can be a safe and effective option for the treatment of patients with peripheral facial paralysis, as it achieves a good restoration of blinking function with minimal morbidity in the healthy donor eye.

Aproximaciones interdisciplinarias entre las asignaturas Vigilancia y Lucha Antivectorial e Historia de América / Interdisciplinary approaches among the subjects Surveillance and Vector Control and History of America

El establecimiento de la interdisciplinariedad representa una imperiosa llamada en el presente, por lo que nuestro sistema educativo lo ha incorporado al proceso de enseñanza aprendizaje. El objetivo de este trabajo es describir las relaciones interdisciplinarias que se pueden establecer entre las asignaturas Historia de América y Vigilancia y Lucha Antivectorial en la carrera de este mismo nombre, de la enseñanza Técnica Profesional insertada en la Universidad de Ciencias Médicas de Cienfuegos. Se expresa la forma de llevar a cabo esta relación mediante el análisis histórico concreto de civilizaciones y gestas independentistas, incluyendo no solo asentamientos, cultura, sino situaciones epidemiológicas y de salud propias de las condiciones de dichas civilizaciones. De esta forma se potencia la formación interdisciplinar de los futuros profesionales que trabajarán la vigilancia y la lucha antivectorial.

Establishing interdisciplinary relations represents a current vital need, reason for which it has been incorporated into the teaching-learning process in our education system. This work is aimed at describing the interdisciplinary approach that can be established among the History of America and Surveillance and Vector Control subjects in the career of the same name, at the Technical Professional education inserted at the Cienfuegos University of Medical Sciences. The way to carry out this relationship through the concrete civilization historical analysis and independence development is explained, including not only settlements, culture, but epidemiological and typical health situations of these civilizations as well. In this way, the interdisciplinary training of these future professionals, who will work on surveillance and vector control, is strengthened.

Using public health data systems to understand and eliminate cancer disparities.

Identifying and eliminating social disparities in cancer depend upon the availability and ready use of public health surveillance data at the national, state and local levels. As an example of advancing a statewide research agenda in cancer disparities, we present descriptive statistics from major public health surveillance data systems in Massachusetts. Disparities highlighted include higher breast cancer mortality rates among African-American women than women of other racial groups, lower rates of colorectal and cervical cancer screening among Asian-American residents, and striking gradients in cancer risk factor prevalence and screening by income and education. Challenges in utilizing public health surveillance data include lack of information in many domains of social inequity beyond race/ethnicity, uneven quality, and lack of stable, reportable data for smaller populations. Opportunities to maximize the usefulness of cancer registry data include application of geographic information systems and linkage with other data systems tracking information on health services outcomes and clinical trial participation. Analyses of surveillance data can spark advances not only in community-based participatory research but also in programs and policies that may ultimately eliminate disparities along the cancer continuum.

A community approach to addressing excess breast and cervical cancer mortality among women of African descent in Boston.

In 2000, the REACH Boston 2010 Breast and Cervical Cancer Coalition conducted a community needs assessment and found several factors that may have contributed to disproportionately high breast and cervical cancer mortality among black women: (a) Focus group participants reported that many women in their communities had limited awareness about risk factors for cancer as well as about screening. (b) Black women experienced barriers to care related to the cultural competence of providers and of institutions. (c) Black women were not receiving adequate follow-up for abnormal mammograms and Pap smears. The Coalition's Community Action Plan to address disparities includes a model primary care service for black women; scholarships to increase the number of black mammogram technologists; primary care provider and radiology technologist training about disparities and cultural competence; and education to increase awareness among black women and to increase leadership and advocacy skills.