La Economía Circular desde la perspectiva de la empresa estatal cubana: ¿ oportunidad o necesidad en la condiciones actuales? / The Circular Economy from the perspective of the Cuban state enterprise: ¿opportunity o necessity in current condition?

La Economía Circular (EC) se ha posicionado como una alternativa viable ante la insostenibilidad del modelo económico lineal. Hoy este constituye una temática que está en el centro del debate y de todas las agendas de gobierno y Cuba no puede ser la excepción. El presente artículo persigue como objetivo principal diagnosticar el estado de la economía circular en Cuba desde la perspectiva de las empresas estatales. En este sentido se parte de sistematizar las ventajas de la aplicación de modelos circulares en el país. Se particulariza en el estudio por sectores que han avanzado en la aplicación del paradigma circular y se concluye con una propuesta de acciones estratégicas a seguir para expandir las prácticas circulares en el país, las cuales son validadas según criterio de los principales usuarios responsables de su implementación a través de la técnica de IADOV

The Circular Economy (CE) has positioned itself as aviable alternative to the unsustainability of the linear economic model. Today this is an issue that is at the center of the debate and of all government agendas, and Cuba cannot be the exception. The main objective of this article is to diagnose the state of the circular economy in Cuba from the perspective of public enterprises. e study is particularized to analyze separately the advance of the different sectors in the application of the circular paradigm. It concludes with a proposal of strategic actions to be followed to expand circular practices in the country, which are validated according to the criteria of the main users responsible for their implementation through the IADOV technique

Nonsurgical Management of Shoulder Pain in Rotator Cuff Tears: Ultrasound-Guided Biceps Tenotomy Combined With Corticosteroid Injection.

Traditionally, the management of rotator cuff tears in elderly individuals has involved surgical intervention, specifically biceps tenotomy. However, surgical procedures come with inherent medical risks and significant financial costs. As an alternative, ultrasound-guided biceps tenotomy combined with corticosteroid has emerged as a highly effective, well-tolerated, and cost-efficient option. This article aims to describe the procedural technique of nonsurgical management using ultrasound-guided biceps tenotomy combined with corticosteroid injection.

Ultrasound-Guided Hydraulic Release Associated With Corticosteroids in Radial Tunnel Syndrome: Description of Technique and Preliminary Clinical Results.

The aim of this study was to describe a perineural ultrasound-guided infiltration technique for management of radial tunnel syndrome and to report its preliminary results in 54 patients. A mixture of a saline solution, a local anesthetic, and a corticosteroid solution was infiltrated in the perineural region at the arcade of Frohse. Pain was reported in 100% of patients before the procedure versus 1.9% after the procedure. Scratch collapse and Cozen test results were positive in 98.1% and 66.7% of patients before infiltration, respectively, versus 5.6% and 9.2% after infiltration. All variables had statistically significant differences between preprocedure and postprocedure evaluations (P < .01).

Intra-articular administration of peripheral blood stem cells with platelet-rich plasma regenerated articular cartilage and improved clinical outcomes for knee chondral lesions.

PURPOSE: To determine whether intra-articular injections of peripheral blood stem cells improved the regeneration of articular cartilage in patients with osteochondral knee injuries. METHODS: This prospective study included 20 patients with grade 3b knee osteochondral lesions who underwent knee arthroscopies. All were white, and all had performed physical activity at least five times a week. International Knee Documentation Committee (IKDC) and visual analog scale scores were recorded before surgery, six months and one year after surgery, and then yearly until five years after surgery. Magnetic resonance imaging scans were obtained six months preoperatively and then yearly and were evaluated by musculoskeletal radiologists blinded to the patient data. Tissue repair was quantified using the International Cartilage Repair Society morphologic score system. Unpaired t-tests were used for comparisons between the time points. RESULTS: The mean preoperative IKDC score was 50.5 (42-61). At the six-month follow-up, the mean values were 60.79 (P = 0.32) and 90.97. At the six-month follow-up, the mean values were 70.8 (P = 0.043). At the end of the five-year follow-up, the IKDC was 82.2 (P = 0.024). At five-year follow-up, the visual analog scale score was 1.1 (P = 0.0018). The main morphologic score system score was 3.2 preoperatively and 9.7 ±â€¯1.6 at five-year follow-up (P = 0.0021). No infection, tumors, or synovitis were reported at the end of the follow-up. CONCLUSIONS: Intra-articular peripheral blood stem cells with platelet-rich plasma regenerated articular cartilage and improved clinical outcomes for knee chondral lesions at five years of follow-up.

The additional benefit of residual spraying and insecticide-treated curtains for dengue control over current best practice in Cuba: Evaluation of disease incidence in a cluster randomized trial in a low burden setting with intensive routine control.

BACKGROUND: Aedes control interventions are considered the cornerstone of dengue control programmes, but there is scarce evidence on their effect on disease. We set-up a cluster randomized controlled trial in Santiago de Cuba to evaluate the entomological and epidemiological effectiveness of periodical intra- and peri-domiciliary residual insecticide (deltamethrin) treatment (RIT) and long lasting insecticide treated curtains (ITC). METHODOLOGY/PRINCIPAL FINDINGS: Sixty three clusters (around 250 households each) were randomly allocated to two intervention (RIT and ITC) and one control arm. Routine Aedes control activities (entomological surveillance, source reduction, selective adulticiding, health education) were applied in the whole study area. The outcome measures were clinical dengue case incidence and immature Aedes infestation. Effectiveness of tools was evaluated using a generalized linear regression model with a negative binomial link function. Despite significant reduction in Aedes indices (Rate Ratio (RR) 0.54 (95%CI 0.32-0.89) in the first month after RIT, the effect faded out over time and dengue incidence was not reduced. Overall, in this setting there was no protective effect of RIT or ITC over routine in the 17months intervention period, with for house index RR of 1.16 (95%CI 0.96-1.40) and 1.25 (95%CI 1.03-1.50) and for dengue incidence RR of 1.43 (95%CI 1.08-1.90) and 0.96 (95%CI 0.72-1.28) respectively. The monthly dengue incidence rate (IR) at cluster level was best explained by epidemic periods (Incidence Rate Ratio (IRR) 5.50 (95%CI 4.14-7.31)), the IR in bordering houseblocks (IRR 1.03 (95%CI 1.02-1.04)) and the IR pre-intervention (IRR 1.02 (95%CI 1.00-1.04)). CONCLUSIONS: Adding RIT to an intensive routine Aedes control programme has a transient effect on the already moderate low entomological infestation levels, while ITC did not have any effect. For both interventions, we didn't evidence impact on disease incidence. Further studies are needed to evaluate impact in settings with high Aedes infestation and arbovirus case load.

Perisciatic Ultrasound-Guided Infiltration for Treatment of Deep Gluteal Syndrome: Description of Technique and Preliminary Results.

The objective of this study was to describe a perisciatic ultrasound-guided infiltration technique for treatment of deep gluteal syndrome and to report its preliminary clinical results. A mixture of saline (20 mL), a local anesthetic (4 mL), and a corticosteroid solution (1 mL) was infiltrated in the perisciatic region between the gluteus maximus and pelvitrochanteric muscles. Relative pain relief was achieved in 73.7% of the patients, with average preprocedural and postprocedural visual analog scale scores of 8.3 and 2.8, respectively. Fifty percent of patients reported recurrence of discomfort, and the average duration of the therapeutic effect in these patients was 5.3 weeks.

Platelet-Rich Plasma Augmentation of Arthroscopic Hip Surgery for Femoroacetabular Impingement: A Prospective Study With 24-Month Follow-up.

PURPOSE: The objective of this study is to evaluate the clinical and immunologic effects of intra-articular doses of platelet-rich plasma (PRP) in arthroscopic hip surgery for femoroacetabular impingement. METHODS: Preoperatively, patients were randomized either to receive an intra-articular injection of PRP (group I, n = 30) or not to receive PRP (group II, n = 27) at the end of hip arthroscopic surgery. To evaluate the clinical outcome and follow-up, we used the modified Harris Hip Score (mHHS) 3, 6, and 24 months after surgery. Pain was evaluated using a visual analog scale 24 hours, 48 hours, 3 months, and 6 months after surgery. The radiologic outcome was analyzed using radiographs and magnetic resonance imaging (MRI) obtained before surgery and 6 months after surgery. Labral integration and joint effusion were evaluated with MRI at 6 months. For statistical analysis, an independent t test and the Wilcoxon rank sum test were used (P < .05 was considered statistically significant). RESULTS: The visual analog scale score 48 hours after surgery was 3.04 in group I compared with 5.28 in group II (P < .05). At the 3-month follow-up, the mHHS was 91.79 in group I versus 90.97 in group II (P = .65). At the 24-month follow-up, the mHHS was 93.41 in group I (P = .56) versus 92.32 in group II (P = .52). At the 6-month follow-up, MRI showed no effusion in 36.7% of patients in group I versus 21.1% of patients in group II (P = .013). Regarding labral integration, no statistical differences were observed between the groups (P = .76). CONCLUSIONS: In this randomized study, PRP resulted in lower postoperative pain scores at 48 hours and fewer joint effusions at 6 months. These findings suggest that PRP may have a benefit regarding postoperative inflammation; however, the long-term clinical benefit is unclear. LEVEL OF EVIDENCE: Level II, lesser-quality randomized controlled trial.

Metamorfosis y emergencia de Aedes aegypti fuera del medio acuático y nuevo reporte de importancia entomológica y epidemiológica en Santiago de Cuba / Metamorphosis and emergence of Aedes aegypti mosquitoes outside the aquatic environment and a new report of entomologic and epidemiologic significance in Santiago de Cuba

INTRODUCCIÓN: Una medida para reducir la aparición de brotes epidémicos de dengue y mejorar la eficacia en función del costo de las campañas contra Aedes aegypti consiste en identificar los factores ambientales locales que facilitan la reinfestación. OBJETIVOS: Determinar el nivel de emergencia de adultos Aedes aegypti partiendo de pupas depositadas fuera del medio acuático, así como precisar la eficacia de los rayos solares como método físico para la destrucción de los focos. MÉTODOS: Se realizó un ensayo experimental de campo controlado, aleatorizado en dos ramas. El grupo experimental correspondió a las pupas extraídas del medio acuático colocadas en tierra. Las pupas que se mantuvieron en el agua integraron el grupo control, Y todas fueron seleccionadas según sus edades en horas. Por otra parte, se ensayó el efecto de los rayos solares como método físico para la destrucción de las pupas extraídas del agua. RESULTADOS: La metamorfosis de pupas sobrevivientes fuera del agua se completó entre 48 y 72 horas, similar al comportamiento en el medio acuático. El nivel de emergencia de mosquitos adultos en el grupo experimental fue de 34,3 por ciento. La reducción del riesgo relativo aportó que la extracción de pupas del agua hacia la tierra reduce el riesgo de generar nuevos mosquitos en solo 65 por ciento, y queda el 35 por ciento de probabilidad de generar nuevos focos. El riesgo relativo en el grupo expuesto a las radiaciones solares en relación con los no expuestos fue de cero. CONCLUSIONES: Las pupas de Aedes aegypti extraídas de su medio acuático pueden permanecer con vida varias horas en tierra, completar su metamorfosis y emerger hasta mosquitos adultos. Se evidenció además que los rayos solares como método físico reducen a cero el nivel de emergencia del vector.

INTRODUCTION: A measure to reduce the appearance of epidemic outbreaks of dengue and to improve effectiveness depending on the cost of campaigns against the Aedes aegypti is to identify the local environmental factors leading to reinfestation. OBJECTIVES: To determine the level of emergence of Aedes aegypti adult mosquitoes from the pupa placed outside the aquatic environment, as well as to specify exactly the effectiveness of the sunbeams as a physical method for elimination of foci. METHODS: A randomized field controlled experimental trial was carried out in two branches. The experimental group corresponded to extracted pupas of aquatic environment placed in land. Pupas remained in the water were the control group and all of them were selected according its ages in hours. On the other hand, the effect of sunbeams as physical method was assayed for elimination of pupas extracted from water. RESULTS: The metamorphosis of pupas surviving outside water was finished between 48 and 72 hours, similar to behavior in the aquatic environment. The emergence level of adult mosquitoes in the experimental group was of 34.3 percent. The reduction of relative risk showed that pupa's extraction from the water towards land, to reduce the risk to generate new mosquitoes in only the 65 percent and remains the 35 percent of probability of to generate new foci. The relative risk in the group exposed to sun radiations in relation to those non-exposed was of zero. CONCLUSIONS: The pups of Aedes aegypti extracted of its aquatic environment may to live for some hours in land, to complete its metamorphosis and to emerge until adult mosquitoes. Also, it was evidenced that sunbeams as a physical method to reduce to zero the emergence level of vector.

Metamorfosis y emergencia de Aedes aegypti fuera del medio acuático y nuevo reporte de importancia entomológica y epidemiológica en Santiago de Cuba / Metamorphosis and emergence of Aedes aegypti mosquitoes outside the aquatic environment and a new report of entomologic and epidemiologic significance in Santiago de Cuba

INTRODUCCIÓN: Una medida para reducir la aparición de brotes epidémicos de dengue y mejorar la eficacia en función del costo de las campañas contra Aedes aegypti consiste en identificar los factores ambientales locales que facilitan la reinfestación. OBJETIVOS: Determinar el nivel de emergencia de adultos Aedes aegypti partiendo de pupas depositadas fuera del medio acuático, así como precisar la eficacia de los rayos solares como método físico para la destrucción de los focos. MÉTODOS: Se realizó un ensayo experimental de campo controlado, aleatorizado en dos ramas. El grupo experimental correspondió a las pupas extraídas del medio acuático colocadas en tierra. Las pupas que se mantuvieron en el agua integraron el grupo control, Y todas fueron seleccionadas según sus edades en horas. Por otra parte, se ensayó el efecto de los rayos solares como método físico para la destrucción de las pupas extraídas del agua. RESULTADOS: La metamorfosis de pupas sobrevivientes fuera del agua se completó entre 48 y 72 horas, similar al comportamiento en el medio acuático. El nivel de emergencia de mosquitos adultos en el grupo experimental fue de 34,3 por ciento. La reducción del riesgo relativo aportó que la extracción de pupas del agua hacia la tierra reduce el riesgo de generar nuevos mosquitos en solo 65 por ciento, y queda el 35 por ciento de probabilidad de generar nuevos focos. El riesgo relativo en el grupo expuesto a las radiaciones solares en relación con los no expuestos fue de cero. CONCLUSIONES: Las pupas de Aedes aegypti extraídas de su medio acuático pueden permanecer con vida varias horas en tierra, completar su metamorfosis y emerger hasta mosquitos adultos. Se evidenció además que los rayos solares como método físico reducen a cero el nivel de emergencia del vector(AU)

INTRODUCTION: A measure to reduce the appearance of epidemic outbreaks of dengue and to improve effectiveness depending on the cost of campaigns against the Aedes aegypti is to identify the local environmental factors leading to reinfestation. OBJECTIVES: To determine the level of emergence of Aedes aegypti adult mosquitoes from the pupa placed outside the aquatic environment, as well as to specify exactly the effectiveness of the sunbeams as a physical method for elimination of foci. METHODS: A randomized field controlled experimental trial was carried out in two branches. The experimental group corresponded to extracted pupas of aquatic environment placed in land. Pupas remained in the water were the control group and all of them were selected according its ages in hours. On the other hand, the effect of sunbeams as physical method was assayed for elimination of pupas extracted from water. RESULTS: The metamorphosis of pupas surviving outside water was finished between 48 and 72 hours, similar to behavior in the aquatic environment. The emergence level of adult mosquitoes in the experimental group was of 34.3 percent. The reduction of relative risk showed that pupa's extraction from the water towards land, to reduce the risk to generate new mosquitoes in only the 65 percent and remains the 35 percent of probability of to generate new foci. The relative risk in the group exposed to sun radiations in relation to those non-exposed was of zero. CONCLUSIONS: The pups of Aedes aegypti extracted of its aquatic environment may to live for some hours in land, to complete its metamorphosis and to emerge until adult mosquitoes. Also, it was evidenced that sunbeams as a physical method to reduce to zero the emergence level of vector(AU)

Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors.

PURPOSE: To determine whether the use of platelet-rich plasma gel (PRPG) affects magnetic resonance imaging (MRI) findings in the anterior cruciate ligament (ACL) graft during the first year after reconstruction. METHODS: A prospective single-blinded study of 50 ACL reconstructions in 50 patients was performed. In group A (study group) PRPG was added to the graft with a standardized technique, and in group B (control group) no PRPG was added. An MRI study was performed postoperatively between 3 and 9 months in group A and between 3 and 12 months in group B. The imaging analysis was performed in a blind protocol by the same radiologist. RESULTS: The mean heterogeneity score value at the time of MRI, assigned by the radiologist, was 1.14 in group A and 3.25 in group B. Both groups were comparable in terms of sex and age (P < .05). The mean time to obtain a completely homogeneous intra-articular segment in group A (PRPG added) was 177 days after surgery, and it was 369 days in group B. Using the quadratic predictive model, these findings show that group A (PRPG added) needed only 48% of the time group B required to achieve the same MRI image (P < .001). CONCLUSIONS: ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI, in 179 days compared with 369 days for ACL reconstruction without PRPG. This represents a time shortening of 48% with respect to ACL reconstruction without PRPG.

Effects of platelet concentrate and a bone plug on the healing of hamstring tendons in a bone tunnel.

PURPOSE: The purpose of this study was to determine if the use of platelet concentrate (PC) and bone plug (BP) does accelerate the healing process in anterior cruciate ligament (ACL) reconstruction. METHODS: One hundred and eight patients requiring ACL reconstruction were prospectively randomized into 4 groups: control (27 patients), PC (26 patients), BP (28 patients), and a combination of PC and BP (27 patients). Magnetic resonance imaging (MRI) studies were carried out at both 3 and 6 months postsurgery. Maturation of the graft was evaluated at the femoral tunnel using MRI maturation criteria defined by a low-intensity signal, absence of osteoligamentous interface, and no widening of the femoral tunnel. RESULTS: Three months after surgery, no differences were found among the groups regarding MRI maturation criteria. Six months postsurgery, 78% of the patients in the control group had a low-intensity signal, while in the PC group the low-intensity signal was present in 100% of the patients (P = .036). No statistical differences were observed regarding the osteoligamentous interface between the various groups. Finally, tunnel widening was seen in 11% of the patients of the BP group versus 41% of the patients in the control group (P = .047), but no statistical difference was seen with the other groups. CONCLUSIONS: The use of PC had an enhancing effect on the graft maturation process evaluated only by MRI signal intensity, without showing any significant effect in the osteoligamentous interface or tunnel widening evolution. The use of a BP effectively prevented tunnel widening. The BP and PC combination did not show a synergic effect as compared to PC or BP individually. LEVEL OF EVIDENCE: Level II, lesser quality randomized controlled trial.

Uso de concentrado autologo rico en factores de crecimiento en la reconstruccion del ligamento cruzado anterior / Using AutoLogo concentrate rich in growth factors in the reconstruction of the anterior cruciate ligament

Hipotesis: La aplicación de factores de crecimiento obtenidos de concentrado plaquetario autólogo al injerto al efectuar la reeconstrucción de ligamento. cruzado anterior en deportistas, afecta positivamente el proceso de remodelación del injerto utilizado. Objetivo: Determinar el efecto que tiene en el proceso de remodelación del injerto, la aplicación de factores de crecimiento obtenidos de concentrado plaquetario autólogo al efectuar la reconstrucción de ligamento cruzado anterior en deportistas. Diseño del estudio: Prospectivo, clínico randomizado, con grupo control y ciego simple. Método: Se realiza en forma prospectiva el análisis de 50 reconstrucciones de LCA en 50 pacientes, todas ellas realizadas por el mismo equipo quirúrgico. Al grupo A , además de efectuar la reconstrucción de LCA, se adiciona Concentrado Plaquetario Autólogo, desarrollando una técnica de aplicación que permite estandarizar la dosis de concentrado empleada y evitar la pérdida de este en el paso del injerto a través de los túneles óseos. Los pacientes del grupo A se sometieron a estudio de resonancia magnética en forma seriada a los 3,4, 5, 6, 7, 8 Y 9 meses postoperatorio. El grupo control el estudio se realizó a los 3, 4, 6, 7,9,10 ,11 ,12 meses. La evaluación de las placas obtenidas fue realizada por un solo radiólogo en forma ciega, ya que desconocía: tiempo de evolución, técnica quirúrgica empleada o si se aplicó AGE analisis estadístico: Comparación de Grupos: T-Student (p-value <5%) Y Prueba F (p-value <5%). Modelo cuadrático predictivo de tiempo de maduración (homogeneidad) para determinar el tiempo de remodelación y maduración en cada grupo. Resultados: El puntaje promedio de maduración al momento de la resonancia magnética, entregado por el radiólogo en el grupo A fue de 1,14 y en el grupo B (control) fue de 3,25. Ambos grupos son comparables según sexo y edad (p-value <5%). El tiempo de maduración del segmento intraarticular, en el grupo A (co...