Mortalidad infantil y condiciones de vida socioeconómicamente adversas: el caso de dos distritos poblacionales en Santiago de Cuba

Introducción: La mortalidad infantil es un fenómeno sanitario relacionado directamente con las condiciones de vida deletéreas, tanto del hogar del infante como de factores socioeconómicos e higiénico-sanitarios adversos. Objetivo: Caracterizar las desigualdades de la mortalidad infantil, según condiciones diferenciales de vida en dos distritos poblacionales de Santiago de Cuba. Métodos: Se llevó a cabo un estudio descriptivo, de tipo ecológico exploratorio, en el municipio Santiago de Cuba, en el trienio 1995-1997. Las unidades de análisis estuvieron constituidas por las áreas de salud enmarcadas en dos distritos poblacionales de la ciudad. Resultados: Se estratificaron ambos distritos poblacionales, según sus condiciones de vida, en asentamientos con condiciones de vida menos desfavorables y más desfavorables. Se estimó mayor mortalidad infantil en el asentamiento con condiciones de vida más desfavorables (8,7 fallecidos por 1000 nacidos vivos), donde predominaron como causas clínicas de muerte las asfixias, la anoxia e hipoxias y causas clínicas reducibles por buena atención en el parto. Conclusiones: Se identificó un perfil diferencial de mortalidad infantil, según las condiciones de vida, al interior de los asentamientos poblacionales de los distritos urbanos de Santiago de Cuba. Los riesgos distintivos de muerte infantil fueron a expensas del componente neonatal, en lo fundamental por causas clínicas reducibles por buena atención en el parto.

Introduction: Infant mortality is a health phenomenon directly related to the deleterious living conditions of both the infant's home and adverse socioeconomic and sanitary factors. Objective: To characterize inequalities in infant mortality according to differential living conditions in two populations districts of Santiago de Cuba. Methods: A descriptive, exploratory ecological study was carried out in the municipality of Santiago de Cuba in 1995-1997. The units of analysis were constituted by the areas framed in two populations districts of the city. Results: Bothe population districts were stratified, according to their living conditions, in settlements with less unfavorable and more unfavorable living conditions. Higher infant mortality was estimated in the settlement with more unfavorable living conditions (8.7 deaths per 1000 live births), where asphyxia, anoxia and hypoxia predominated as clinical causes of death and clinical causes reducible for good care at birth. Conclusions: A differential profile of infant mortality, according to living conditions, was identified within the population settlements of the urban districts of Santiago de Cuba. The distinctive risks of infant death were at the expense of the neonatal component, mainly for clinical causes reducible by good care at birth.

Validación de constructo de un algoritmo hipnoterapéutico para niños con enuresis nocturna monosintomática

Introducción: La enuresis nocturna es un motivo frecuente de consulta en pediatría, psiquiatría infantil, psicología y medicina familiar, con mayor porcentaje en los niños de 5 años de edad, seguidos por los de 7 y 9, en ese orden. Objetivo: Determinar la validez de constructo del algoritmo hipnoterapéutico para pacientes con enuresis nocturna monosintomática. Métodos: Se realizó una investigación compleja de 97 pacientes, atendidos en la Clínica de Hipnosis Terapéutica de la Universidad de Ciencias Médicas de Santiago de Cuba, desde febrero del 2021 hasta julio del 2022, la cual estuvo estructurada en 3 etapas metodológicas de validación de constructo para dar continuidad a la etapa IV de la validación de contenido del algoritmo hipnoterapéutico, sobre la base de 2 cuasi-experimentos sin grupo de control y un estudio cuasiexperimental con grupo de control no equivalente de la segunda etapa de dicha investigación. Resultados: El análisis factorial sobre el estudio de componentes principales fue factible, pues los factores 1, 2 y 3 debían mantenerse, lo cual se expresó en el gráfico de sedimentación y en la varianza total explicada, a través de los porcentajes acumulados en los autovalores iniciales y la suma de las saturaciones al cuadrado de la extracción y la rotación con 64,24 %. Conclusiones: La validación de constructo del algoritmo diseñado mostró pertinencia, dada por la idoneidad del análisis factorial y la prueba de esfericidad de Bartlett.

Introduction: Bedwetting is a frequent reason to visit pediatric, infant psychiatry, psychology and family medicine services, with more percentage in 5 years children, followed by 7 and 9 years children, in that order. Objective: To determine the construct validity of the hypnotherapeutic algorithm for patients with monosymptomatic bedwetting. Methods: A complex investigation of 97 patients was carried out, who were assisted in the Therapeutic Hypnosis Clinic of the University of Medical Sciences in Santiago de Cuba, from February, 2021, to July, 2022 which was structured in 3 methodological phases of construct validation to continue the phase IV of hypnotherapeutic algorithm content validation, on the base of 2 quasi-experiments without control group and a quasi-experiment with non equivalent control group of the second phase of this investigation. Results: The factorial analysis on the study of main components was possible, because the factors 1, 2 and 3 should stay, which was expressed in the sedimentation graph and in the explained total variance, through the percentages accumulated in the initial auto values and the sum of saturations to the square of extraction and rotation with 64.24%. Conclusions: The construct validation of the designed algorithm showed relevancy, given by the suitability of the factorial analysis and the Bartlett test of spherical form.

Ocular surface changes following computer use in post-LASIK patients.

PURPOSE: To assess the impact of computer use on the ocular surface of individuals after laser in situ keratomileusis (LASIK). METHODS: The dry eye symptoms and ocular surface of 18 post-LASIK young individuals and 18 controls were evaluated before and after performing a 30-min task on a computer without (Visit 1) and with (Visit 2) initial instillation of artificial tears. Symptoms were assessed using the Ocular Surface Disease Index (OSDI), Symptom Assessment in Dry Eye questionnaire version two (SANDE II) and Computer Vision Syndrome Questionnaire (CVS-Q). The ocular surface was assessed by measuring corneal higher order aberrations, tear meniscus height (TMH), conjunctival redness, blink rate and incomplete blinking, lipid layer thickness (LLT) and non-invasive keratograph break-up time (NIKBUT). RESULTS: SANDE II scores were >0 after the computer task in both groups (p ≤ 0.01). SANDE II and CVS-Q scores did not differ between LASIK and controls (p ≥ 0.43). Greater bulbar-temporal conjunctival redness, TMH and LLT and shorter NIKBUT were found after computer use in the LASIK group (p ≤ 0.04), whereas no changes were observed in the controls (p ≥ 0.20). Lower SANDE II and CVS-Q scores were reported at Visit 2 compared with Visit 1 in both groups (p ≤ 0.01). Likewise, no worsening of dry eye signs was observed at Visit 2 (p ≥ 0.11). CONCLUSIONS: Ocular symptoms reported during computer use were comparable between the groups. However, a worsening of dry eye signs was mostly observed in post-LASIK individuals. The instillation of artificial tears was effective in preventing the effects of computer use on the ocular surface in post-LASIK patients.

Caracterización de internos con sífilis de una institución penitenciaria / Characterization of inmates with syphilis of a penitentiary institution i: en

Introducción: Las infecciones de transmisión sexual, entre ellas la sífilis, constituyen una grave amenaza a la salud de la población penal en diferentes países. Objetivo: Caracterizar desde el punto de vista clínico-epidemiológico a los pacientes reclusos diagnosticados con sífilis. Métodos: Se realizó un estudio observacional, descriptivo y transversal, desde enero del 2016 hasta diciembre del 2022, de 147 internos diagnosticados con sífilis en el Centro Penitenciario de Aguadores de Santiago de Cuba. Se analizaron las variables cualitativas y se calcularon las distribuciones de frecuencias y, en cuanto a la edad, la media y la desviación estándar. Se utilizó la prueba de independencia de la Χ2 para identificar alguna asociación significativa entre las variables de interés. Resultados: En la casuística predominaron el diagnóstico de sífilis latente (98,6 %), el grupo etario de 25 a 34 años (36,0 %) y el nivel escolar de secundaria básica (55,8 %). La mayoría de los internos habían contraído la infección bacteriana en el exterior del penal (93,9 %), presentaban antecedentes penales por primera vez (45,6 %) y no disfrutaban de visitas conyugales (74,2 %). Conclusiones: La detección de sífilis en los internos de la prisión de Aguadores ha permitido que estos conozcan de su estado de salud, lo cual evita la propagación de esa enfermedad en el interior del penal.

Introduction: Sexually transmitted infections, among them syphilis, constitute a serious threat to health for the penal population in different countries. Objective: To characterize the inmate patients diagnosed with syphilis from the clinical-epidemiologic point of view. Methods: An observational, descriptive and cross-sectional study was carried out from January, 2016 to December, 2022, of 147 inmates diagnosed with syphilis in Aguadores Penitentiary Center of Santiago de Cuba. The qualitative variables were analyzed and the distributions of frequencies and, as for the age, the mean and standard deviation were calculated. The chi-square test of independence was used to identify some significant association between the variables of interest. Results: In the case material there was a prevalence of the diagnosis of latent syphilis (98.6%), the 25 to 34 age group (36.0%) and the secondary school level (55.8%). Most of the inmates had acquired the bacterial infection in the exterior of the prison (93.9%), had criminal record for the first time (45-6%) and didn't enjoy marital visits (74.2%). Conclusions: Syphilis detection in the inmates of Aguadores prison has allowed that they know of their health state, which avoids the propagation of that disease inside the prison.

Germenectomía de los terceros molares con cefalometría predictiva de brote / Germenectomy of third molars with predictive cephalometry of abnormal eruption

Introducción: Las complicaciones, asociadas al brote anormal de los terceros molares, es posible evitarlas con la germenectomía de estos dientes. Objetivo: Caracterizar la evolución de la germenectomía de terceros molares en pacientes con diagnóstico cefalométrico de brote anormal. Métodos: Se realizó un estudio observacional, descriptivo y transversal en el Servicio de Cirugía Maxilofacial del Hospital Provincial "Saturnino Lora Torres", desde febrero de 2019 hasta marzo de 2021. Se estudiaron 32 pacientes de 13 a 15 años de edad, interviniéndose quirúrgicamente 78 terceros molares. Las variables fueron edad, sexo, color de la piel, localización y posición del tercer molar; así como las complicaciones trans y posoperatorias y la evolución. Resultados: Entre los 32 pacientes incluidos en el estudio predominó el sexo femenino (62,5 por ciento) y la edad de 14 años (40,6 por ciento). Las complicaciones ocurridas durante la germenectomía fueron más frecuentes en la arcada inferior. Aunque no fueron detectadas diferencias estadísticamente significativas según localización (valor de p>0,05); con 30 transoperatorias para un 38,4 por ciento y 75 posoperatorias para un 96,2 por ciento. Conclusiones: Se evidencia una evolución marcadamente favorable posterior a la germenectomía de terceros molares en la población de pacientes con diagnóstico cefalométrico de brote anormal. En ellos el sangrado transoperatorio y el dolor posoperatorio constituyen las complicaciones a considerar en este tipo de procedimiento quirúrgico(AU)

Introduction: Complications associated with the abnormal eruption of third molars can be avoided with germenectomy of these teeth. Objective: To characterize the evolution of third molar germenectomy in patients with a cephalometric diagnosis of abnormal bud. Methods: An observational, descriptive and cross-sectional study was carried out in the Maxillofacial Surgery Service at Saturnino Lora Torres Provincial Hospital, from February 2019 to March 2021. Thirty two patients aged 13 to 15 years were studied, with 78 third molars undergoing surgery. The variables were age, sex, skin color, location and position of the third molar; as well as trans and postoperative complications and evolution. Results: Among the 32 patients included in the study, the female sex (62.5 percent) and the age of 14 years (40.6 percent) predominated. Complications that occurred during germenectomy were more frequent in the lower arch. Although no statistically significant differences were perceived according to location (p value > 0.05); with 30 intraoperative for 38.4 percent and 75 postoperative for 96.2 percent. Conclusions: There is evidence of a markedly favorable evolution after germenectomy of third molars in the population of patients with cephalometric diagnosis of abnormal bud. In them, transoperative bleeding and postoperative pain are the complications to consider in this type of surgical procedure(AU)

Guía para la confección del informe de tesis de especialistas de primer grado / Guide for preparing the thesis report of first-degree specialists i: en

Contar con una guía que establezca un formato único para la elaboración del informe correspondiente a las tesis de las especialidades de las ciencias médicas ha sido, hasta el momento, una necesidad de los tribunales y residentes. Por ello, en la Universidad de Ciencias Médicas de Santiago de Cuba se propuso confeccionar una guía a tal efecto, en la cual se mantienen los aspectos formales y científicos establecidos previamente, pero se añaden elementos en el formato en cuanto a la escritura y la extensión general y por secciones. En este artículo se expone dicha guía, que se constituye en un instrumento de utilidad tanto para los especialistas de primer grado, al facilitar y perfeccionar la confección del trabajo de tesis, como para los tribunales estatales que tienen a su cargo la evaluación de estos informes.

Having a guide that establishes a single format for preparing the report corresponding to theses in medical science specialties has been, until now, a need for courts and residents. For this reason, at the University of Medical Sciences from Santiago de Cuba it was proposed to prepare a guide for this purpose, in which the formal and scientific aspects previously established are maintained, but elements are added in the format in terms of writing and general extension and by parts. This article presents this guide, which constitutes a useful instrument both for first-degree specialists, by facilitating and perfecting the preparation of the thesis work, and for the state courts that are in charge of evaluating these reports.

Dengue grave en fémina con infección previa por SARS-CoV-2 / Serious dengue in a woman with previous infection due to SARS-CoV-2 i: en

Se presenta el caso clínico de una paciente de 30 años de edad, con antecedentes de asma bronquial, úlcera gastroduodenal y virus C de la hepatitis, quien fue ingresada en el Hospital Universitario Clínico-Quirúrgico Dr. Ambrosio Grillo Portuondo de la provincia de Santiago de Cuba en 2 ocasiones: primero por presentar infección del virus SARS-CoV-2 y luego, el virus del dengue, con formas graves de la enfermedad en ambos momentos, por lo que se deduce que el daño vascular producido por el SARS-CoV-2 puede ser un factor de riesgo para que se desarrolle un dengue con signos de alarma.

The case report of a 30 years patient with history of bronchial asthma, gastroduodenal ulcer and hepatitis C virus is presented. She was admitted to Dr. Ambrosio Grillo Portuondo Clinical-Surgical University Hospital in Santiago de Cuba in 2 occasions: first for presenting SARS-CoV-2 infection and then, dengue virus, with serious forms of the disease in both moments, reason why it is deduced that the vascular damage caused by SARS-CoV-2 can be a risk factor so that dengue with warning signs is developed.

Condiciones de vida en situaciones excepcionales y su influencia en la mortalidad infantil: hallazgos de referencia / Life conditions in exceptional circumstances and their influence on infant mortality: reference findings i: en

Introducción: La mortalidad infantil se ve afectada por condiciones de vida socioeconómicas y ambientales deletéreas, las cuales se agravan en situaciones excepcionales. Objetivo: Describir la mortalidad infantil en el municipio habanero de La Lisa durante un trienio, según la estratificación diferencial de las condiciones de vida del territorio. Métodos: Se llevó a cabo un estudio observacional, descriptivo y transversal (de tipo ecológico exploratorio) en el municipio capitalino de La Lisa en el trienio 1991-1993, donde las unidades de análisis fueron las áreas de salud estratificadas mediante clasificación automática. Las variables fundamentales fueron las condiciones de vida, según diferentes dimensiones y sus variables, y las tasas centrales de mortalidad infantil en el periodo, considerando sus componentes y la causa básica de muerte. Resultados: Se logró estratificar el municipio según sus condiciones de vida en asentamientos favorables y desfavorables. La mortalidad infantil fue superior en el asentamiento con condiciones de vida desfavorables (10,3 fallecidos por 1000 nacidos vivos), donde predominaron como causas de muerte el traumatismo obstétrico, la muerte idiopática y la sepsis. Conclusiones: Se alcanzó la estratificación según condiciones de vida en el municipio de La Lisa. El asentamiento poblacional con condiciones de vida desfavorables evidenció riesgo de mortalidad infantil diferencial sustantivo, probablemente asociado a factores higiénico-sanitarios y socioeconómicos deletéreos, según las causas de muerte registradas.

Introduction: Infant mortality is affected by deleterious, socioeconomic and environmental living conditions, which are aggravated in exceptional situations. Objective: To describe infant mortality in the Havana municipality of La Lisa during the three-year period 1991-1993, according to the differential stratification of living conditions in the territory. Methods: An observational, descriptive and transversal study (of exploratory ecological type) was carried out in the capital municipality of La Lisa, in the triennium 1991-1993, where the units of analysis were the health areas stratified by automatic classification. The fundamental variables were living conditions, according to different dimensions and their variables, and the central infant mortality rates in the period, considering its components and the basic cause of death. Results: The municipality was stratified according to its living conditions in favorable and unfavorable settlements. Infant mortality was higher in the settlement with unfavorable living conditions (10.3 deaths per 1000 live births), where obstetric trauma, idiopathic death and sepsis predominated as causes of death. Conclusions: Stratification according to living conditions in the municipality of La Lisa was achieved. The population settlement with unfavorable living conditions showed a substantial differential infant mortality risk, probably associated with hygienic-sanitary and socioeconomic factors, according to the causes of death recorded.

Algunas especificidades concernientes a las complicaciones quirúrgicas infecciosas en adultos mayores tras cirugía abdominal de urgencia / Specificities Concerning Infectious Surgical Complications in Older Adults after Emergency Abdominal Surgery

Introducción: El manejo del paciente geriátrico en cirugía siempre ha representado un gran desafío por considerarse de "alto riesgo". Objetivo: Describir las características clínicas, terapéuticas y epidemiológicas concernientes a las complicaciones quirúrgicas infecciosas en adultos mayores tras cirugía abdominal de urgencia. Métodos: Se realizó un estudio observacional analítico de casos y controles en pacientes adultos mayores que presentaron complicaciones quirúrgicas tras cirugía abdominal de urgencia en el período comprendido de 2019 hasta 2021 en el Servicio de Cirugía General del Hospital Provincial Saturnino Lora de Santiago de Cuba. Se trabajó con una muestra de casos complicados y otra de controles, representada por aquellos que no sufrieron complicaciones. Las variables analizadas fueron: edad, sexo, comorbilidades gérmenes aislados y tratamiento requerido. Resultados: Las complicaciones quirúrgicas en la cirugía abdominal urgente afectan fundamentalmente a pacientes adultos mayores en edades tempranas de ambos sexos con antecedentes de enfermedades endocrinas y/o cardiovasculares. La infección superficial y profunda del sitio quirúrgico es la complicación predominante. Los gérmenes más frecuentemente aislados fueron: Escherichia coli, Pseudomona aureoginosa y Klebsiella. El tratamiento farmacológico seguido del quirúrgico se utilizó en la mayoría de los enfermos para la solución de sus complicaciones. Conclusiones: Las comorbilidades constituyen el factor de riesgo principal para la aparición de complicaciones quirúrgicas infecciosas en adultos mayores, tras cirugía abdominal de urgencia con primacía de la infección superficial y profunda del sitio quirúrgico. Los gérmenes causales están en relación con la microbiota de la piel, donde se realiza la incisión, y la microbiota de los órganos donde se efectúa la intervención quirúrgica(AU)

Introduction: The surgical management of the geriatric patient has always represented a great challenge because such is considered as "high risk." Objective: To describe the clinical, therapeutic and epidemiological characteristics concerning infectious surgical complications in older adults after emergency abdominal surgery. Methods: An analytical observational study of cases and controls was carried out with older adult patients who presented surgical complications after emergency abdominal surgery, in the period from 2019 to 2021, at the general surgery service of Hospital Provincial Saturnino Lora, of Santiago de Cuba. The study work was conducted with a sample of complicated cases and another sample of controls, the latter represented by those who did not suffer complications. The analyzed variables were age, sex, comorbidity, isolated germs and required treatment. Results: Surgical complications in emergency abdominal surgery affect mainly older adult patients at early ages, from both sexes and with a history of endocrine or cardiovascular diseases. Superficial and deep surgical-site infection is the predominant complication. The most frequently isolated germs were Escherichia coli, Pseudomona aureoginosa and Klebsiella. Pharmacological treatment followed by surgical treatment was used in most of the patients, with the aim of giving a solution to their complications. Conclusions: Comorbidity is the main risk factor for the appearance of infectious surgical complications in older adults after emergency abdominal surgery, primarily for superficial and deep surgical-site infection. The causal germs are related to the skin microbiota, according to the site where the incision is made, as well as the microbiota of the organs where the surgical intervention is performed(AU)

Changes in visual function and optical and tear film quality in computer users.

PURPOSE: To assess changes in visual function and optical and tear film quality in computer users. METHODS: Forty computer workers and 40 controls were evaluated at the beginning and end of a working day. Symptoms were assessed using the Quality of Vision questionnaire (QoV), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment in Dry Eye version II (SANDE II). Tear film quality was evaluated using the Medmont E300 dynamic corneal topography tool to measure the tear film surface quality (TFSQ), TFSQ area and auto tear break-up time (TBUT). Optical quality was assessed by measuring high, low and total ocular aberrations with a Hartmann-Shack wavefront sensor. Visual performance was assessed by measuring photopic and mesopic visual acuity, photopic and mesopic contrast sensitivity and light disturbance. RESULTS: Poorer DEQ-5, QoV and SANDE II scores were obtained in computer workers at the end of the working day compared with controls (p ≤ 0.02). Computer workers exhibited a higher (worse) TFSQ and TFSQ area at visit 2 compared with visit 1 (p ≤ 0.04), while no significant differences in TBUT (p = 0.19) or ocular aberrations were observed (p ≥ 0.09). Additionally, both light disturbance (p ≤ 0.04) and mesopic and photopic contrast sensitivity worsened at several spatial frequencies (p ≤ 0.04) throughout the working day in computer workers, while visual acuity remained unchanged (p ≥ 0.07). In contrast, control subjects exhibited no decrease in any variable during the day. CONCLUSIONS: While visual acuity remained unchanged, several aspects of visual function and quality of vision decreased over a day of computer use. These changes were accompanied by greater dry eye symptoms and tear film changes, which are likely to have played a fundamental role. The present study provides insight into new metrics to assess digital eye strain.

American Society of Hematology, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panamena de Hematología, Sociedad Peruana de Hematología, and SVH 2023 guidelines for diagnosis of venous thromboembolism and for its management in special populations in Latin America.

Implementation of international guidelines in Latin American settings requires additional considerations (ie, values and preferences, resources, accessibility, feasibility, and impact on health equity). The purpose of this guideline is to provide evidence-based recommendations about the diagnosis of venous thromboembolism (VTE) and its management in children and during pregnancy. We used the GRADE ADOLOPMENT method to adapt recommendations from 3 American Society of Hematology (ASH) VTE guidelines (diagnosis of VTE, VTE in pregnancy, and VTE in the pediatric population). ASH and 12 local hematology societies formed a guideline panel comprising medical professionals from 10 countries in Latin America. Panelists prioritized 10 questions about the diagnosis of VTE and 18 questions about its management in special populations that were relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context. In comparison with the original guideline, there were significant changes in 2 of 10 diagnostic recommendations (changes in the diagnostic algorithms) and in 9 of 18 management recommendations (4 changed direction and 5 changed strength). This guideline ADOLOPMENT project highlighted the importance of contextualizing recommendations in other settings based on differences in values, resources, feasibility, and health equity impact.

Caracterización epidemiológica, clínica y cefalométrica del brote anormal de los terceros molares / Epidemiological, clinical and cephalometric characterization of the abnormal eruption of third molars

Introducción: El brote de los terceros molares es un proceso que no está del todo explicado, pero durante su erupción puede provocar diferentes accidentes o complicaciones. Objetivo: Caracterizar el brote anormal de los terceros molares según variables epidemiológicas, clínicas y cefalométricas. Método: Se realizó un estudio observacional, descriptivo y transversal en la Clínica Estomatológica Provincial Docente «Mártires del Moncada», de Santiago de Cuba, desde noviembre de 2019 a febrero de 2020. La población estuvo conformada por jóvenes de 18 a 25 años de edad; la muestra fue seleccionada por muestreo aleatorio simple. Se tuvieron en cuenta las siguientes variables: sexo, color de la piel, brote anormal y otras variables cefalométricas. Resultados: De los 84 dientes incluidos en el estudio, se detectaron 66 terceros molares con brote anormal (78,6 %). El promedio asociado al brote de estos molares de espacio óseo superior insuficiente fue igual para los superiores con medias de 25,9 mm; el de angulación inadecuada resultó obtuso en el superior izquierdo con 128,3º y agudo en los inferiores derechos con 58,8º; asimismo el mayor diámetro mesiodistal inadecuado fue el de los inferiores derechos con 15,7 mm. Conclusiones: El brote anormal de los terceros molares se caracteriza por afectar, de forma importante, a féminas y a individuos mestizos. Su observación se singulariza, fundamentalmente, en molares inferiores con espacios óseos posteriores reducidos, mesioangulaciones y diámetros mesiodistales considerables.

Introduction: eruption of the third molars is a process that is not fully explained in the literature; however it is known that their eruption can cause different complications. Objective: to characterize the abnormal eruption of third molars according to epidemiological, clinical and cephalometric variables. Methods: an observational, descriptive and cross-sectional study was carried out at "Mártires del Moncada" Provincial Teaching Dental Clinic, in Santiago de Cuba, from November 2019 to February 2020. The population consisted of young people aged 18-25 years; the sample was selected by simple random sampling. Gender, skin color, abnormal eruption and other cephalometric variables were taken into account. Results: sixty-six third molars with abnormal eruption were detected from the 84 teeth included in the study (78.6%). The average associated with the eruption of these molars with insufficient upper bone space was the same for the upper ones with means of 25.9 mm; the average with inadequate angulation was obtuse in the upper left third molar with 128.3º and the acute one in the lower right third molars with 58.8º; the lower right third molars likewise had the largest inadequate mesiodistal diameter with 15.7 mm. Conclusions: the abnormal eruption of third molars is characterized by significantly affecting females and mixed-race individuals. Its observation is singled out, fundamentally, in lower molars with reduced posterior bone spaces, mesioangulations and considerable mesiodistal diameters.

Morbilidad y mortalidad de pacientes operados de cáncer de esófago / Morbidity and Mortality of Patients Operated on for Esophageal Cancer

Introducción: El tratamiento principal del cáncer esofágico es la esofagectomía. Objetivo: Determinar la morbilidad y mortalidad de los pacientes operados de cáncer esofágico. Métodos: Se realizó un estudio observacional, descriptivo y transversal en 87 pacientes operados de cáncer esofágico en el Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba durante el período comprendido de 2014 a 2018. Resultados: Dos pacientes en estadio II (100,0 por ciento) recibieron tratamiento quirúrgico curativo y 12 en estadio III (17,9 por ciento). Recibieron tratamiento quirúrgico paliativo 55 (82,1 por ciento) enfermos en estadio III y 18 (100,0 por ciento) en estadio IV. Predominó la técnica transhiatal de Denk-Sloan-Orringer aplicada en 10 (71,4 por ciento) pacientes. La gastrostomía predominó como proceder paliativo para alimentación en 53 (76,2 por ciento) pacientes. Se reportaron 45 complicaciones; el 53,3 por ciento de tipo médica, en las que prevalecieron las respiratorias: bronconeumonía (13,3 por ciento) y distrés respiratorio (11,1 por ciento). En cambio, el 46,7 por ciento de las complicaciones fueron de tipo quirúrgicas: infección del sitio operatorio (20,0 por ciento), seguida de la fuga anastomótica (15,6 por ciento). Fallecieron 16 (18,4 por ciento) pacientes del total de la serie. Las causas de muerte predominantes fueron el distrés respiratorio (31,3 por ciento) y la disfunción múltiple de órganos (25,0 por ciento). Conclusiones: La esofagectomía abierta o mínimamente invasiva se erige como el tratamiento quirúrgico de elección para el tratamiento del cáncer esofágico con intención curativa, proceder con elevada morbilidad y mortalidad a escala mundial. Los resultados de esta investigación coinciden con los reportados en la literatura médica nacional y extranjera(AU)

Introduction: The main treatment for esophageal cancer is esophagectomy. Objective: To determine the morbidity and mortality of patients operated on for esophageal cancer. Methods: An observational, descriptive and cross-sectional study was carried out with 87 patients operated on for esophageal cancer in the general surgery service of Hospital Provincial Docente Saturnino Lora, of Santiago de Cuba, during the period from 2014 to 2018. Results: Curative surgical treatment was received by 2 patients (100.0 percent) in stage II and 12 patients (17.9 percent) in stage III. Palliative surgical treatment was received by 55 ill patients (82.1 percent) in stage III and 18 ill patients (100.0 percent) in stage IV. There was a predominance of the Denk-Sloan-Orringer transhiatal technique, applied in 10 (71.4 percent) patients. Gastrostomy predominated in 53 (76.2 percent) patients as a palliative procedure for feeding. Forty-five complications were reported, 53.3 percent of which were medical, with respiratory complications prevailing: bronchopneumonia (13.3 percent) and respiratory distress (11.1 percent). On the other hand, 46.7 percent of the complications were surgical: surgical site infection (20.0 percent), followed by anastomotic leak (15.6 percent). Out of the total series, 16 (18.4 percent) patients died. The predominant causes of death were respiratory distress (31.3 percent) and multiple organ dysfunction (25.0 percent). Conclusions: Open or minimally invasive esophagectomy stands out as the surgical treatment of choice for esophageal cancer with curative purposes, being a procedure with high morbidity and mortality worldwide. The results of this research coincide with those reported in the national and foreign medical literature(AU)

La atrofia cerebral como hallazgo o factor predictor del deterioro cognitivo en el envejecimiento normal / Cerebral Atrophy as a Finding of Predictive Factor for Cognitive Impairment in Normal Aging

Introducción: En el curso del envejecimiento es conocida la existencia de un patrón complejo de cambios estructurales cerebrales, conductuales y cognitivos, en ocasiones relacionados con enfermedades neurológicas y psiquiátricas. Objetivo: Determinar la posible relación de causalidad de la atrofia cerebral en la aparición del deterioro cognitivo en el curso del envejecimiento normal. Métodos: Se desarrolló un estudio retrospectivo, transversal, descriptivo y observacional. El universo estuvo conformado por el total de los pacientes de ambos sexos con edades comprendidas entre 35-74 años de edad, con indicaciones previas de tomografía computarizada de cráneo y cuyos resultados fueron informados con signos de atrofia cerebral, cuya cifra ascendió a 733. Resultados: El grupo de edad que predomino fue el de 45-54 años (35,3 por ciento), así como las pacientes del sexo femenino (66,3 por ciento). El 27,7 por ciento tenía como nivel de escolaridad el técnico medio superior y 36,2 por ciento fueron pacientes amas de casa. El 99,7 por ciento fueron diestros. Un total de 368 voluntarios presentaron deterioro cognitivo y 365 sujetos no evidenciaron declive en las funciones exploradas. Las funciones de atención y cálculo y retención verbal a corto plazo fueron las que se vieron más afectadas, seguidas de orientación espacial y memoria verbal de fijación. Conclusiones: No se logró establecer una relación de causalidad significativa entre el diagnóstico radiológico de atrofia cerebral y la presencia de deterioro cognitivo(AU)

Introduction: In the course of aging, the existence of a complex pattern of behavioral, cognitive and cerebral structural changes is known, sometimes related to neurological and psychiatric diseases. Objective: To determine the possible causal relationship of cerebral atrophy with the onset of cognitive impairment in the course of normal aging. Methods: A retrospective, cross-sectional, descriptive and observational study was carried out. The study universe consisted of all patients of both sexes aged 35-74 years, with previous indications for cranial computed tomography and whose results were reported with signs of cerebral atrophy, which numbered 733. Results: The predominant age group was 45-54 years old (35.3percent), as well as female patients (66.3percent). The educational level of 27.7percent of the patients was technical high school and 36.2percent were housewife patients. A total of 99.7percent were right-handed. A total of 368 volunteers showed cognitive impairment and 365 subjects showed no decline in the tested functions. The functions of attention and calculation, as well as short-term verbal retention, were the most affected, followed by spatial orientation and speech retention memory. Conclusions: No significant causal relationship was established between the radiological diagnosis of cerebral atrophy and the presence of cognitive impairment(AU)

Morbilidad y mortalidad de la duodenopancreatectomía cefálica convencional en pacientes con enfermedad del confluente biliopancreático

Introducción: La duodenopancreatectomía cefálica es una operación cada vez más frecuente en pacientes seleccionados. Objetivo: Identificar la morbilidad y la mortalidad concerniente a la duodenopancreatectomía cefálica convencional. Métodos: Se realizó un estudio observacional, descriptivo de una serie de 15 casos operados de duodenopancreatectomía cefálica. Se investigaron las variables: estadificación según clasificación tumor, linfonódulo, metástasis (TNM), diagnóstico anatomopatológico, complicaciones, tiempo quirúrgico y estado al egreso. Se utilizaron el número absoluto y el porcentaje como medidas de resumen para las variables estadificación y diagnóstico; la media, la mediana y el rango para el tiempo quirúrgico y el intervalo de confianza para el estado al egreso. Resultados: El diagnóstico anatomopatológico principal fue adenocarcinoma de páncreas con 9 pacientes (60,1 %) y de duodeno con 2 (13,3 %). El estadio posoperatorio IIA fue el que prevaleció con 5 (45,5 %). El retraso del vaciamiento gástrico fue la complicación quirúrgica que prevaleció, con 7 (46,7 %) enfermos, seguida de la fístula biliar con 3 (20,0 %). La fístula pancreática, la lesión de la vena mesentérica superior y la hemorragia posoperatoria se presentaron una sola vez (6,7 %), respectivamente. Estas 2 últimas, provocaron la muerte del enfermo en las primeras 48 horas del posoperatorio. Fallecieron 4 (26,7 %) pacientes de la serie. Conclusiones: Las complicaciones posquirúrgicas se observan principalmente a expensas del retardo del vaciamiento gástrico, la fístula biliar y pancreática. La mortalidad puede estar relacionada con la prolongación del tiempo quirúrgico igual o mayor de 5 horas, con el consiguiente aumento de las pérdidas hemáticas.

Introduction: Cephalic duodenopancreatectomy is an increasingly frequent operation in selected patients. Objective: To identify the morbidity and mortality related to conventional cephalic duodenopancreatectomy. Methods: An observational, descriptive study of a series of 15 cases operated on cephalic duodenopancreatectomy. The variables were investigated: staging according to the Tumor, Linphonod, Metastasis (TNM) classification, pathological diagnosis, complications, surgical time and discharge status. Absolute number and percentage were used as summary measures for the variables staging and diagnosis; mean, median and range for surgical time and confidence interval for discharge status. Results: The main pathological diagnosis was adenocarcinoma of the pancreas with 9 patients (60.1%) and of the duodenum with 2 (13.3%). Postoperative stage IIA was the one that prevailed with 5 (45.5%) patients. Delayed gastric emptying was the prevailing surgical complication, with 7 (46.7%) patients, followed by biliary fistula with 3 (20.0%). Pancreatic fistula, superior mesenteric vein injury, and postoperative hemorrhage occurred only once (6.7%), respectively. These last 2, caused the death of the patient in the first 48 hours of the postoperative period. Four (26.7%) patients in the series died. Conclusions: Postoperative complications are mainly observed at the expense of delayed gastric emptying and biliary and pancreatic fistula. Mortality may be related to the prolongation of surgical time equal to or greater than 5 hours with the consequent increase of blood loss.

Complicaciones hemorrágicas y trombóticas del embarazo: diagnóstico, prevención y tratamiento

Las hemorragias y la enfermedad tromboembólica venosa (ETEV) figuran entre las cinco causas más frecuentes de morbilidad y mortalidad materna en el mundo. Revisamos la evaluación y el manejo actualizado de las causas obstétricas de la hemorragia posparto (HPP), así como el diagnóstico y manejo de condiciones hematológicas que pueden causar o agravar la HPP, por ejemplo: coagulación intravascular diseminada, enfermedad de von Willebrand, trombocitopenia autoinmune y las microangiopatías trombóticas. Revisamos el rol del síndrome antifosfolípido y las trombofilias hereditarias como factores predisponentes a pérdidas fetales recurrentes y la ETEV en el embarazo y las recomendaciones actuales para la prevención de ambas complicaciones. Asimismo, repasamos el abordaje diagnóstico y líneas de manejo de la ETEV. Un objetivo adicional fue enfatizar la importancia del trabajo colaborativo multidisciplinario para lograr el manejo exitoso de las gestantes con las complicaciones obstétricas y hematológicas descritas.

Bleeding and venous thromboembolism (VTE) are among the five most common causes of morbidity and mortality in pregnant women worldwide. This review describes the current evaluation and management of the obstetric causes of postpartum hemorrhage (PPH), as well as the diagnosis and management of hematologic conditions which can cause or worsen PPH, such as disseminated intravascular coagulation, von Willebrand disease, autoimmune thrombocytopenia and the thrombotic microangiopathies. It also describes the role of the antiphospholipid syndrome and inherited thrombophilia as predisposing factors for recurrent pregnancy loses and VTE, and the current recommendations for the prevention of both complications. As well, the current diagnostic approach and management of ETEV are described. An additional objective of this Review is to emphasize the importance of a collaborative multidisciplinary approach for the successful management of the obstetric and hematologic complications herein described.

Treatment efficacy of 0.9% saline and mepivacaine infiltration with Dermojet® in eliminating plantar warts.

BACKGROUND: Plantar warts are benign, epidermal neoformations, viral, and easily transmitted. Although 30% of these warts disappear spontaneously, the American Association of Dermatology recommends treatment if they cause pain or bleeding. OBJECTIVES: The aim of this study was to determine the efficacy of Dermojet® infiltration using a solution composed of equal parts of 0.9% saline and 2% mepivacaine in the treatment of plantar warts, and to identify the type of necrosis achieved at 7-10 days after the infiltration (M1 sample) and at 15-17 days (M2 sample). METHOD: In this analytical prospective observational study, 102 histories were reviewed by the same researcher. The patients were treated with this technique at four private podiatry clinics. RESULTS: A total of 61.8% of the patients were male. The patients' mean age was 26.6 ± 14.10 years. A total percentage of 78.4% of the patients achieved complete elimination of the lesion by the second evaluation and after a single infiltration. Bivariate analysis revealed a significant inverse relationship between treatment efficacy and a history of previous disease (p < 0.001) and the period of evolution of the lesion (p < 0.001; 95% CI [0.78-7.91]). Multivariate linear regression analysis revealed an association with the number of evaluation sessions (p < 0.001) and with previous illnesses (p = 0.014). A total percentage of 82.35% presented partial necrosis in the M1 sample and 76.92% had complete necrosis in the M2 sample. CONCLUSIONS: In 78.4% of the patients considered, the plantar warts treated disappeared after a single infiltration. The variables associated with treatment efficacy were the number of follow-up visits and the existence of associated diseases.

Ventilación mecánica no invasiva en pacientes con enfermedad pulmonar obstructiva crónica agudizada en cuidados intensivos: diez años de experiencia / Non invasive mechanic ventilation in patients with acute chronic obstructive lung disease in intensive cares: ten years of experience:en

Introducción: La ventilación no invasiva es un tratamiento efectivo en pacientes con enfermedad pulmonar agudizada. Objetivo: Describir las características demográficas, clínicas, ventilatorias y hemogasométricas en pacientes tratados con ventilación no invasiva. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal y prospectivo de 234 pacientes con enfermedad pulmonar obstructiva crónica agudizada, ventilados de forma no invasiva en la Unidad de Cuidados Intensivos del Hospital Provincial Clínico-Quirúrgico Docente Saturnino Lora de Santiago de Cuba de enero de 2011 a septiembre de 2021. Resultados: En la serie predominaron el sexo masculino, la neumonía extrahospitalaria y la insuficiencia cardíaca crónica; mientras que la edad media fue de 71 años y la ventilación no invasiva fracasó en 53,8 % de los afectados. Asimismo, la frecuencia respiratoria disminuyó de 34,3 a 23,5 respiraciones por minuto en la segunda hora y se observó, además, un incremento del pH, así como de la relación presión arterial de O2/fracción inspirada de O2 y saturación de oxígeno a la pulsioximetría/fracción inspiratoria de O2. La presión arterial de CO2 tuvo valores promedio de 61,8 mmHg al inicio y de 60,7 mmHg en la segunda hora. Conclusiones: Los valores basales de las variables clínicas, hemogasométricas y ventilatorias mejoraron luego del tratamiento con ventilación no invasiva. Entre los parámetros asociados al fracaso del tratamiento figuraron: frecuencia cardiaca, frecuencia respiratoria, presión arterial de CO2, escala de coma de Glasgow, pH y presencia de fugas; igualmente, la estadía prolongada, la ventilación por más de 48 horas y la mortalidad estuvieron relacionadas con dicho fracaso.

Introduction: The non invasive ventilation is an effective treatment in patients with acute lung disease. Objective: To describe the demographic, clinical, ventilatory and hemogasometric characteristics in patients treated with non invasive ventilation. Methods: An observational, descriptive, longitudinal and prospective study of 234 patients with chronic obstructive lung disease, non-invasive ventilated in the Intensive Cares Unit of Saturnino Lora Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, was carried out, from January, 2011 to September, 2021. Results: In the series there was a prevalence of male sex, non hospital acquired pneumonia and chronic heart failure; while the mean age was 71 years and non invasive ventilation failed in 53.8 % of those affected. Also, the respiratory rate decreased from 34.3 to 23.5 breaths per minute in the second hour and an increase in pH was also observed, as well as in the relationship arterial pressure of O2/inspired fraction of O2 and oxygen saturation to the pulsioximetry/inspiratory fraction of O2. The arterial pressure of CO2 had average values of 61.8 mmHg to the beginning and of 60.7 mmHg in the second hour. Conclusions: The basal values of clinical, hemogasometric and ventilatory variables improved after treatment with non invasive ventilation. Among the parameters associated with the treatment failure there were heart frequency, respiratory frequency, arterial pressure of CO2, coma Glasgow scale, pH and leaks; equally, the long stay, the ventilation for more than 48 hours and mortality were related to this failure.

Assessment of meibomian gland drop-out and visibility through a new quantitative method in scleral lens wearers: A one-year follow-up study.

OBJECTIVES: To validate a previously developed algorithm based on the visibility of meibomian gland images obtained with Cobra fundus camera and to assess the changes in meibomian glands in scleral lens wearers over one year of lens wear. METHODS: Infrared meibography was obtained from the upper eyelid using the Cobra fundus camera in forty-three volunteers (34.2 ± 10.1 years). Meibographies were classified into 3 groups: Group 1 = good subjective gland visibility and gland drop-out < 1/3 of the total area; Group 2 = low visibility and gland drop-out < 1/3; and Group 3 = low visibility and gland drop-out > 1/3. Meibomian gland visibility metrics were then calculated using the developed algorithm from the pixel intensity values of meibographies. Repeatability of new metrics and their correlations with gland drop-out were assessed. Meibographies and ocular symptoms were also assessed after 1 year of scleral lens wear in 29 subjects. RESULTS: Gland drop-out percentage was not statistically different between groups 1 and 2 (p = 0.464). Nevertheless, group 1 showed higher grey pixel intensity values than the other groups. Statistically significant correlations were found between gland visibility metrics and gland drop-out percentage. Repeatability was acceptable for all metrics, coefficient of variation achieving values between 0.52 and 3.18. While ocular symptoms decreased with scleral lens wear (p < 0.001), no statistically significant differences were found in gland drop-out percentage (p = 0.157) and gland visibility metrics (p > 0.217). CONCLUSIONS: The proposed method can assess meibomian gland visibility in an objective and repeatable way. Scleral lens wear appears to not adversely affect meibomian gland drop-out and visibility while might improve dry eye symptoms after one year of lens wear. These preliminary results should be confirmed with a control group.

Ocular surface predisposing factors for digital display-induced dry eye.

CLINICAL RELEVANCE: The use of digital displays is recognised as a consistent risk factor for dry eye disease. BACKGROUND: To identify ocular parameters contributing to the impact of computer use on dry eye. METHODS: The ocular surface of 82 undergraduate students with a mean age of 22.8 ± 2.1 years was assessed at baseline and after reading on a computer for 30 minutes. Measurements included the ocular surface disease index (OSDI) questionnaire, 5-item dry eye questionnaire (DEQ-5), tear meniscus height, non-invasive keratograph break-up time (NIKBUT), conjunctival bulbar redness, meibomian gland dropout percentage, spontaneous blink rate and percentage of incomplete blinks. Multiple linear regressions and generalised linear mixed models were conducted to explore the associations between baseline parameters and pre-task - post-task differences and to predict the impact of computer use, respectively. RESULTS: Greater dry eye symptoms (p < 0.0005), higher tear meniscus height and conjunctival bulbar redness (p < 0.0005 and p = 0.012, respectively) and shorter NIKBUT (p = 0.03) were obtained after reading on the computer for 30 minutes. The baseline score obtained with the OSDI and DEQ-5 was positively associated with the increase in symptoms with computer use (p < 0.0005), while the change in conjunctival redness and pre-task NIKBUT were associated with the change in NIKBUT (p ≤ 0.005). No ocular surface parameter revealed an association with tear meniscus height changes. Having a positive OSDI score at baseline increased the odds of painful and sore eyes (p = 0.012), while a higher pre-task NIKBUT increased the odds of a reduction in tear stability (p = 0.038). CONCLUSIONS: Participants with greater dry eye symptoms were more likely to experience a greater increase in symptomatology with computer operation, while the participants with longer NIKBUT and greater conjunctival redness were more likely to suffer a greater reduction in tear stability.