Influência da terapia neoadjuvante na razão de linfonodos / Influence of neoadjuvant therapy on the ratio of lymph nodes

ABSTRACT Background: To evaluate the relationship between the ratio of affected lymph nodes (LNR) and clinical and anatomopathological variables in patients with rectal adenocarcinoma submitted or not to neoadjuvant chemoradiotherapy. Methods: The LNR was determined by dividing the number of compromised LNR by the total number of LNR dissected in the surgical specimen. Patients were divided into two groups: with QRT and without QRT. In each group, the relationship between LNR and the following variables was evaluated: degree of cell differentiation, depth of invasion in the rectal wall, angiolymphatic /perineural invasion, degree of tumor regression and occurrence of metastases. The LNR was evaluated in patients with more than 1, LNR (LNR >12) or less (LNR<12) in the surgical specimen with overall survival (OS) and disease-free survival (DFS). The results were expressed as the mean with the respective standard deviation. Qualitative variables were analyzed using Fisher's exact test, while quantitative variables were analyzed using the Kruskal -Wallis and Mann-Whitney tests. The significance level was 5%. Results: We evaluated 282 patients with QRT and 114 without QRT, between 1995-2011. In the QRT Group, LNR showed a significant association with mucinous tumors (P=0.007) and degree of tumor regression (P=0.003). In both groups, LNR was associated with poorly differentiated tumors (P=0.001, P=0.02), presence of angiolymphatic invasion (P<0.0001 and P=0.01), perineural (P=0.0007, P=0.02), degree of rectal wall invasion (T3>T2; P<0.0001, P=0.02); Compromised LNR (P<0.0001, P<0.01), metastases (P<0.0001, P<0.01). In patients with QRT, LNR<12 was associated with DFS (5.889; 95%CI1.935-19.687; P=0.018) and LNR>12 with DFS and OS (17.984; 95%CI5.931-54.351; P<0.001 and 10.286; 95%CI 2.654-39.854; P=0.007, respectively). Conclusion: LNR was associated with histological aspects of poor prognosis, regardless of the use of QRT. In the occurrence of less than 12 evaluated LNR, the LNR was associated only with the DFS.

RESUMO Contexto: Avaliar a relação entre a razão de linfonodos (RLA) acometidos e variáveis clínicas e anatomopatológicas em portadores de adenocarcinoma de reto submetidos ou não à quimiorradioterapia neoadjuvante. Métodos: A RLA foi determinada dividindo-se o número total de linfonodos (LFNs) dissecados no espécime cirúrgico pelo número de comprometidos. Os doentes foram divididos em dois grupos: com QRT e sem QRT. Em cada grupo foi avaliada a relação entre a RLA e as seguintes variáveis: grau de diferenciação celular, profundidade de invasão na parede retal, invasão angiolinfática/perineural, grau de regressão tumoral e ocorrência de metástases. Avaliou-se a RLA em pacientes com mais do que 12 LFNs (RLA>12) ou menos (RLA<12) na peça cirúrgica com a sobrevida global (SG) e sobrevida livre de doença (SLD). Os resultados foram expressos pela média com o respectivo desvio padrão. As variáveis qualitativas foram analisadas utilizando-se o teste exato de Fisher, enquanto as quantitativas pelos testes de Kruskal-Wallis e Mann-Whitney. O nível de significância foi de 5%. Resultados: Foram avaliados 282 pacientes com QRT e 114 sem QRT, entre 1995-2011. No Grupo QRT, RLA mostrou associação significativa com os tumores mucinosos (P=0,007) e grau de regressão tumoral (P=0,003). Nos dois grupos, a RLA associou-se com tumores pouco diferenciados (P=0,001 e P=0,02), presença de invasão angiolinfática (P<0,0001 e P=0,01), perineural (P=0,0007 e P=0,02), grau de invasão da parede retal (T3>T2; P<0,0001 e P=0,02); LFNs comprometidos (P<0,0001 e P<0,01), metástases (P<0,0001 e P<0,01). Nos pacientes com QRT, a RLA <12 associou-se com a SLD (5,889; IC95%1,935-19,687; P=0,018) e a RLA >12 com SLD e SG (17,984; IC95%5,931-54,351; P<0,001 e 10,286; IC95%2,654-39,854; P=0,007, respectivamente). Conclusão: A RLA associou-se a aspectos histológicos de mau prognóstico, independentemente do emprego de QRT. Na ocorrência de menos de 12 LFNs avaliados, a RLA associou-se apenas com a SLD.

A review to honor the historical contributions of pauline gross, aldred warthin, and henry lynch in the description and recognition of inheritance in colorectal cancer / Uma revisão para honrar as contribuições históricas de pauline gross, aldred warthin e henry lynch na descrição e reconhecimento da hereditariedade no câncer colorretal

ABSTRACT The present manuscript aimed to review the historical development and most important contributions regarding Lynch Syndrome since its first description, more than a century ago. In 1895, a reputed pathologist from Michigan University, Dr. Aldred Scott Warthin, got intrigued by the family history of a local seamstress called Pauline Gross. According to her prevision, she would present an early death due to cancer, which actually happened (from the uterus). Historically, her family was designated "Family G", comprising a group recognized as the longest and most detailed cancer genealogy that has ever been studied. Warthin concluded that its members had genetic susceptibility for cancer, and they are, nowadays, considered the first reported Lynch Syndrome family. At that time, however, the medical cancer community was far less receptive to the association between heredity and cancer, despite the description of other families with similar heredograms. Unfortunately, this historical fact remained somewhat dormant until another investigator inaugurated a new era in the understanding of family cancer clusters. After reports and studies from this family and many others, the condition initially called Cancer Family Syndrome was changed to the eponym Lynch Syndrome. This was a recognition of the extensive and dedicated work developed by Dr. Henry Lynch in describing various characteristics of the disease, and his efforts to establish the correct recommendations for its diagnosis and treatment. Although the future announces there is still far to go for a complete understanding of Lynch Syndrome, the remarkable contributions of Pauline's intuition, Warthin's perseverance, and Lynch's work consistency must never be forgotten by those who already have or will still benefit from this knowledge.

RESUMO O objetivo do presente manuscrito foi fazer uma revisão histórica do desenvolvimento e das mais importantes contribuições em relação à Síndrome de Lynch, desde sua primeira descrição há mais de um século atrás. Em 1895, o reputado patologista Dr. Aldred Scott Warthin ficou intrigado com a história familiar de uma costureira local, chamada Pauline Gross. De acordo com a sua previsão, ela morreria precocemente devido a um câncer, o que realmente aconteceu (do útero). Historicamente, sua família foi designada como Família "G", caracterizando um grupo reconhecido como a maior e mais longa árvore genealógica relacionada ao câncer familiar jamais estudada. Warthin concluiu que os membros dessa família tinham susceptibilidade genética para câncer, e ainda hoje são considerados a primeira família com Síndrome de Lynch reportada na literatura. Entretanto, naquela época a comunidade médica oncológica não era receptiva à associação entre hereditariedade e câncer, a despeito da descrição de outras famílias com heredogramas similares. Infelizmente, esse fato histórico permaneceu esquecido até que outro investigador inaugurou uma nova era para a melhor compreensão da agregação familiar do câncer. Após diversas descrições dessa mesma agregação de casos de câncer em outras famílias, essa condição inicialmente denominada Síndrome de Câncer Familial foi mudada para o epônimo Síndrome de Lynch. Esse foi um reconhecimento ao extenso e dedicado trabalho desenvolvido pelo Dr. Henry Lynch na descrição de diversas características da doença e seus esforços para estabelecer as recomendações corretas para o seu diagnóstico e tratamento. Embora o futuro anuncie que ainda teremos um longo caminho a percorrer para a completa compreensão da Síndrome de Lynch, as contribuições extraordinárias da intuição de Pauline, da perseverança de Warthin e da consistência do trabalho de Lynch nunca devem ser esquecidas por àqueles que já se beneficiaram, bem como os que ainda irão se beneficiar de todo esse conhecimento.

Sistema de acciones de orientación educativa para la familia de niño con discapacidad físico-motora

Fundamento: la orientación educativa a las familias de niños con discapacidad físico-motora es esencial para su correcta rehabilitación e inserción en la sociedad. Objetivo: aplicar un sistema de acciones de orientación educativa a la familia de un niño con discapacidad físico-motora. Métodos: se realizó un estudio cualitativo de investigación acción práctica a la familia de un niño con diagnóstico de una parálisis cerebral percibida como una discapacidad físico-motora en el período julio 2021-diciembre 2022, perteneciente al área de salud del Policlínico Docente "Marta Abreu". Los métodos teóricos utilizados fueron: analítico-sintético; inductivo-deductivo y la modelación. Entre los métodos empíricos se aplicaron: la observación participante; entrevista en profundidad; análisis de documentos; diario del investigador y estudio de casos. Resultados: el diagnóstico realizado demostró la necesidad de la preparación de la familia de un niño con discapacidad fisico-motora para afrontar con calidad esta nueva etapa de sus vidas, por lo que se diseñó y aplicó un sistema de acciones el cual fue estructurado en tres subsistemas: primero, acciones para el manejo de las técnicas de aseo; segundo, para las técnicas de alimentación; y tercero, los cuidados posturales y las transferencias. Fue valorado por especialistas vinculados con esta temática, quienes lo consideraron muy pertinente y viable. Conclusiones: el sistema de acciones de orientación a las familias de niños con discapacidad fisico-motora resultó efectivo pues se evidenciaron cambios importantes en cuanto al manejo de este niño por la familia.

Background: educational guidance for families of children with physical-motor disabilities is essential for their correct rehabilitation and insertion into society. Objective: apply a system of educational guidance actions to the family of a child with physical-motor disability. Methods: a qualitative practical action research study was carried out on the family of a child with a diagnosis of cerebral palsy perceived as a physical-motor disability from July 2021 to December 2022, from "Marta Abreu" University Polyclinic health area theoretical methods used were: analytical-synthetic; inductive-deductive and modeling: empirical ones: participant observation; depth interview; document analysis; researcher diary and case study. Results: the diagnosis carried out demonstrated the need to prepare the family of the child with a physical-motor disability to face this new stage of their lives with quality, so a system of actions was designed and applied which was structured in three subsystems: first, actions to manage grooming techniques; second, for feeding techniques; and third, postural care and transfers. It was evaluated by specialists linked to this topic, who considered it very pertinent and viable. Conclusions: the system of guidance actions for the family of a child with a physical-motor disability was effective as important changes were evident in terms of the management of this child by the family.

Estrategia metodológica para la prevención de los problemas de salud bucal en la educación primaria

Introducción: Las transformaciones que se evidencian en la sociedad, hace que surjan, en las instituciones educativas, exigencias referidas a la preparación de los profesionales para enfrentar los nuevos desafíos y lograr ciudadanos con una formación integral y responsables con el cuidado de su salud. Ahí es donde ocupan un lugar privilegiado los aspectos relacionados con la prevención de los problemas de salud bucal en la educación primaria. Objetivo: Diseñar una estrategia metodológica para la prevención de los problemas de salud bucal en la educación primaria. Materiales y métodos: La estrategia fue diseñada en cuatro etapas: diagnóstico, planeación, instrumentación, y control y evaluación. Para su elaboración se consideró el diagnóstico realizado en el curso escolar 2021-2022 a tres escuelas primarias pertenecientes al municipio Matanzas. Se definió la variable fundamental de la investigación y, a partir de su operacionalización, se establecieron las dimensiones e indicadores. Se aplicaron métodos del nivel teórico y empírico del conocimiento, así como métodos estadísticos. Resultados: Se evidencian limitadas acciones de preparación metodológica que inciden en el tratamiento a la prevención de los problemas de salud bucal desde el contexto escolar. Para transformar los resultados obtenidos se diseñó la estrategia metodológica. Conclusiones: El diseño de la estrategia metodológica revela una manera novedosa de organizar y realizar actividades en el sistema de trabajo metodológico de la escuela primaria, para contribuir a la preparación metodológica del maestro primario en la temática.

Introduction: The transformations that are evident in society cause to arise, in educational institutions, demands regarding to the training of professionals to face the new challenges and achieve citizens with comprehensive training and responsible with the care of their health. That is where aspects related to the prevention of oral health problems in primary education occupy a privileged place. Objective: To design a methodological strategy for the prevention of oral health problems in primary education. Materials and methods: The strategy was designed in four stages: diagnosis, planning, implementation; and evaluation and control. For its elaboration, the diagnosis carried out during the 2021-2022 school year in three primary schools belonging to the municipality of Matanzas was considered. The fundamental variable of the research was defined and the dimensions and indicators were established, on the basis of its operationalization. Methods of the theoretical and empirical level of knowledge were applied, as well as statistical methods. Results: It is evidenced that methodological preparation actions that have repercussion on the prevention of oral health problems from the school context are not enough. To transform the results obtained, the methodological strategy was designed. Conclusions: The design of the methodological strategy reveals a new way of organizing and carrying out activities in the methodological work system of the primary school, to contribute to the methodological preparation of primary teacher on the topic.

Anatomía de la cámara pulpar y sistema de conductos radiculares: Estrategias pedagógicas unarevisión de literatura / Anatomy of the pulp chamber and the root canal system: Pedagogical strategiesAliterature review

Antecedentes: El conocimiento anatómico de la cámara pulpar y del sistema de conductos radiculareses fundamental para el correcto diagnóstico y planificación del tratamiento en endodoncia. Las herramientas pedagógicasdirigidasa los estudiantes de odontologíacomo apoyo en los procesos formativosde la asignatura de endodoncia favorecen la apropiación del conocimiento e identificación de las variantes morfológicas del sistema de conductos radiculares, que permiten al estudiantela integración del conocimiento. Objetivo:Identificar mediante una revisión de la literatura las estrategias pedagógicas que se utilizan para la enseñanza de morfología del sistema de conductos radiculares en endodoncia. Materiales y métodos: Se realizó una búsqueda bibliográfica de estudios originales en las bases de datos Medline (Pubmed), SciELO, Lilacs, Medline (Ovid), Web of science, Scopus, Embase, Google académico, eligiendo estudios publicadosa partir del año 2010 al 2022, para la selección de los artículos definitivos se seleccionaron estudios concernientes a procesos pedagógicos en endodoncia, excluyendo así otros tipos de enfoques en el área de odontología. Resultados: Se identificaron un total de 63 referencias, los cuales fueron analizados y seleccionados16, siendo excluidos 47 por no cumplir los criterios de inclusión. Conclusión: El uso de herramientas pedagógicas virtuales, didácticas y tecnológicas propician un efecto positivo en el estudiante de pregrado de odontología durante el aprendizaje de anatomía de sistemas de conductos radiculares que aumentan la confianza y seguridad al momento de realizar un tratamiento endodóntico en pacientes

Background: Anatomical knowledge of the pulp chamber and the root canal system is essential for correct diagnosis and treatment planning in endodontics. The pedagogical tools aimed at dental students as support in the training processes of the endodontics subject favor the appropriation of knowledge and identification of the morphological variants of the root canal system, which allow the student the integration of knowledge. Objective: To identify, through a review of the literature, the pedagogical strategies used to teach morphology of the root canal system in endodontics. Materials and methods: A bibliographic search of original studies was carried out in the Medline (Pubmed), SciELO, Lilacs, Medline (Ovid), Web of Science, Scopus, Embase, and Google academic databases, choosing studies published from 2010 to 2022. , for the selection of the definitive articles, studies concerning pedagogical processes in endodontics were selected, thus excluding other types of approaches in the area of dentistry. Results: A total of 63 references were identified, 16 of which were analyzed and selected, 47 being excluded for not meeting the inclusion criteria. Conclusion: The use of virtual, didactic and technological pedagogical tools favor a positive effect on the dentistry undergraduate student while learning the anatomy of root canal systems that increase confidence and security when performing endodontic treatment in patients.

Descripción de analgesia de parto con lidocaína o bupivacaina y Apgar al nacer. Estudio observacional descriptivo retrospectivo

El trabajo de parto lleva con este la experiencia que causa uno de los dolores más intensos que se han descrito. En el Instituto de Seguridad Social de El Salvador (ISSS) se registran aproximadamente 600 a 700 partos vaginales por mes y de estos aproximadamente 10-20% solicitan analgesia para trabajo de parto, la cual el servicio de anestesia provee a través del abordaje epidural. Es conocido que se considera que el medicamento ideal para la analgesia de trabajo de parto es la bupivacaína o lidocaína 3, sin embargo, es de especial importancia describir el puntaje de APGAR de los recién nacidos de madres que recibieron cualquiera de estos dos fármacos por la vía ya mencionada. Objetivo: Determinar cómo influye el uso de lidocaína y bupivacaína como anestésico epidural sobre el puntaje APGAR posterior al nacimiento en mujeres embarazadas en fase activa del trabajo de parto con necesidad de analgesia epidural. Métodos: El presente es un estudio observacional descriptivo retrospectivo de fuentes primarias. El servicio de anestesiología del Hospital Materno Infantil Primero de Mayo cuenta con un registro sobre cuántos y a cuáles pacientes se les administra analgesia epidural por lo que el equipo investigador realizó una revisión de la técnica anestésica y se describe el Apgar al final del parto por vía vaginal en aquellas pacientes que recibieron analgesia epidural con lidocaína o bupivacaína. Se realizó el filtrado con la base de datos de Excel utilizando criterios de inclusión y exclusión, logrando incluir finalmente 81 pacientes en el análisis de los datos. Se encontró durante el escrutinio de estos que a 25 de estas se les realizó cesárea de emergencia y en 6 de estos mismos expedientes no se consignó de manera completa todos los datos necesarios para el análisis de ello, por lo que se utilizaron finalmente 51 expedientes clínicos para la realización de la presente investigación. Resultados: El APGAR promedio de los pacientes que recibieron analgesia de trabajo de parto con bupivacaína es de 8.75 y 8.9 al minuto y cinco minutos respectivamente y el promedio de APGAR alcanzado por los recién nacidos de pacientes que recibieron analgesia de trabajo de parto con lidocaína es de 9 puntos al minuto y cinco minutos. Conclusión: El promedio de APGAR en pacientes que recibieron bupivacaína es de 8.75 y el de lidocaína es de 9. (provisto por Infomedic International)

Labor brings with it the experience that causes one of the most intense pains ever described. At the Social Security Institute of El Salvador (ISSS) approximately 600 to 700 vaginal deliveries are registered per month and of these approximately 10-20% request labor analgesia, which the anesthesia service provides through the epidural approach. It is known that the ideal drug for labor analgesia is considered to be bupivacaine or lidocaine 3, however, it is of special importance to describe the APGAR score of newborns born to mothers who received either of these two drugs by the aforementioned route. Objective: To determine how the use of lidocaine and bupivacaine as epidural anesthetic influences the post-birth APGAR score in pregnant women in the active phase of labor requiring epidural analgesia. Methods: The present is a retrospective descriptive observational observational study from primary sources. The anesthesiology service of the Hospital Materno Infantil Primero de Mayo has a record of how many and to which patients epidural analgesia is administered, so the research team conducted a review of the anesthetic technique and described the Apgar at the end of vaginal delivery in those patients who received epidural analgesia with lidocaine or bupivacaine. Filtering was performed with the Excel database using inclusion and exclusion criteria, finally including 81 patients in the data analysis. It was found during the scrutiny of these that 25 of them had undergone emergency cesarean section and in 6 of these same records not all the data necessary for the analysis were completely recorded, so that 51 clinical records were finally used for the present investigation. Results: The average APGAR of the patients who received labor analgesia with bupivacaine was 8.75 and 8.9 at one minute and five minutes respectively, and the average APGAR achieved by the newborns of patients who received labor analgesia with lidocaine was 9 points at one minute and five minutes. Conclusion: The average APGAR in patients who received bupivacaine is 8.75 and that of lidocaine is 9. (provided by Infomedic International)

Tratamiento psicológico inclusivo como modalidad terapéutica en el estado cognitivo-emocional-conductual en las personas prejubilables / Inclusive psychological treatment as a therapeutic modality for cognitive, emotional and behavioural state in pre-retired people

Introducción: La prejubilación se define como una etapa de la vida donde convergen factores biológicos, psicológicos, sociales, culturales, espirituales y ambientales que preparan al individuo para un cambio global y profundo. Objetivo: Precisar mediante el tratamiento psicológico inclusivo los cambios ocurridos en el proceso cognoscitivo del pensamiento y las modificaciones obtenidas en la esfera emocional en el grupo intervenido. Métodos: Se realizó un estudio cuasi-experimental en el Policlínico Docente «Marta Abreu», de Santa Clara, Villa Clara, en el período de enero de 2017 a febrero de 2019. Se emplearon procedimientos, métodos y técnicas con la aplicación de esta modalidad terapéutica en un grupo estudio de 200 personas prejubilables, de 55 a 65 años de edad. Se utilizaron métodos teóricos, empíricos y estadísticos-matemáticos. Se aplicaron técnicas psicológicas antes del tratamiento psicológico inclusivo, y después de este, en el grupo estudio y en el grupo control. Resultados: Fueron muy reveladores en el grupo estudio, y se registraron cambios muy significativos en los procesos intelectuales, en el pensamiento lógico verbal, práctico constructivo y rumiativo; además estados emocionales ansioso bajo y depresivo leve, autoestima alta, y notable mejoría en la vulnerabilidad al estrés. En el grupo control no se reflejaron cambios favorables. Conclusiones: El tratamiento psicológico inclusivo resultó efectivo por el logro de cambios positivos en el estado cognitivo-emocional-conductual en personas prejubilables del grupo estudio. La aplicación de las estrategias de desactivación fisiológica, cognitivas, reflexivo vivenciales, informativas, así como las habilidades de conductas de afrontamiento, las acciones de mantenimiento y generalización y las ayudas paliativas y moderadoras de estrés en la atención a personas prejubilables, constituyó un novedoso recurso terapéutico.

Introduction: pre-retirement is defined as a stage of life where biological, psychological, social, cultural, spiritual and environmental factors converge to prepare the individual for a global and profound change. Objective: to determine, through the inclusive psychological treatment, the changes occurred in the cognitive process of thinking and the modifications obtained in the emotional sphere in the intervened group. Methods: a quasi-experimental study was carried out at "Marta Abreu" Teaching Polyclinic in Santa Clara, Villa Clara from January 2017 to February 2019. Procedures, methods and techniques were used with the application of this therapeutic modality in a study group of 200 pre-retired people aged 55 to 65 years old. Theoretical, empirical, statistical and mathematical methods were used. Psychological techniques were applied before and after the inclusive psychological treatment in the study and control groups. Results: they very revealing in the study group, and very significant changes were registered in intellectual processes as well as in verbal-logical, practical-constructive and ruminative thinking; also low anxious and mild depressive emotional states, high self-esteem, and notable improvement in vulnerability to stress. No favorable changes were reflected in the control group. Conclusions: the inclusive psychological treatment was effective in achieving positive changes in the cognitive, emotional and behavioural state in pre-retired people from the study group. The application of physiological deactivation, cognitive, experiential, reflective, and informative strategies, as well as coping behavioural skills, maintenance and generalization actions and palliative and moderating stress aids in the care of pre-retired people constituted a novel therapeutic resource.

Recommendations for modernizing infant vaccination schedules with combination vaccines in Colombia and Peru / Recomendaciones para modernizar los calendarios de vacunación infantil con vacunas combinadas en Colombia y Perú / Recomendações para modernizar os esquemas de vacinação infantil com vacinas combinadas na Colômbia e no Peru

ABSTRACT The objective of this article was to consider the vaccination challenges in Colombia and Peru and the role of pediatric combination vaccines in overcoming these challenges. Barriers to including new vaccines with more antigens remain apparent in parts of these countries, where vaccine-preventable diseases in infants continue to be a major problem. The challenges include the heterogeneity of vaccine coverage within each country and in neighboring countries, which can contribute to poor rates of vaccination coverage; the adverse impact of the inward migration of unvaccinated individuals, which has favored the re-emergence of vaccine-preventable diseases; vaccine shortages; and the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the associated shifts in health care resources. To improve the coverage of pediatric vaccines in Colombia and Peru, it will be necessary to ensure the widespread integration into vaccine schedules of combination vaccines containing diphtheria, tetanus, acellular pertussis, inactivated poliovirus, Haemophilus influenzae type b and hepatitis B antigens with a three-dose primary series delivered at 2, 4 and 6 months of age followed by a booster at 18 months of age. Such vaccines play important roles in preventing diphtheria, tetanus and pertussis; eradicating polio; and providing boosting against H. influenzae type b.

RESUMEN El objetivo de este artículo es considerar los desafíos que se enfrentan en Colombia y Perú con respecto a la vacunación y el papel de las vacunas combinadas pediátricas para superar estos desafíos. Los obstáculos para incluir vacunas nuevas con más antígenos siguen siendo evidentes en algunos lugares de estos países, donde las enfermedades prevenibles por vacunación en menores de 1 año continúan siendo un grave problema. Entre los desafíos se incluye la heterogeneidad de la cobertura de vacunación en cada país y en los países vecinos, lo que puede contribuir con que se registren tasas bajas de cobertura de vacunación; el impacto adverso de la migración interna de personas no vacunadas, lo que ha favorecido la reaparición de enfermedades prevenibles por vacunación; la escasez de vacunas, y el impacto de la pandemia del coronavirus de tipo 2 causante del síndrome respiratorio agudo grave (SARS-CoV-2) y los consiguientes cambios en los recursos de atención médica. Para mejorar la cobertura de las vacunas pediátricas en Colombia y Perú será necesario integrar de manera generalizada en los calendarios de vacunación vacunas combinadas con antígenos de difteria, tétanos, tos ferina acelular, poliovirus inactivados, Haemophilus influenzae tipo b y hepatitis B con una serie primaria de tres dosis administradas a los 2, 4 y 6 meses de edad, seguida de un refuerzo a los 18 meses de edad. Esas vacunas desempeñan un papel esencial en la prevención de la difteria, el tétanos y la tos ferina; la erradicación de la polio; y el refuerzo contra H. influenzae tipo b.

RESUMO O objetivo deste artigo foi avaliar os desafios da vacinação na Colômbia e no Peru e o papel das vacinas pediátricas combinadas na superação de tais desafios. Os obstáculos para incluir novas vacinas com mais antígenos permanecem visíveis em partes desses países, onde doenças imunopreveníveis em lactentes continuam a ser um grande problema. Os desafios incluem a heterogeneidade da cobertura vacinal dentro de cada país e nos países vizinhos, o que pode contribuir para baixas taxas de cobertura vacinal; o impacto adverso da migração interna de pessoas não vacinadas, o que favoreceu o ressurgimento de doenças imunopreveníveis; a escassez de vacinas; e o impacto da pandemia de síndrome respiratória aguda grave do coronavírus 2 (SARS-CoV-2) e mudanças relacionadas nos recursos de atenção à saúde. Para melhorar a cobertura das vacinas pediátricas na Colômbia e no Peru, será necessário assegurar sua integração generalizada em esquemas de vacinas combinadas contendo antígenos de difteria, tétano, pertussis acelular, poliovírus inativado, Haemophilus influenzae tipo B e hepatite B, com uma série primária de três doses aplicadas aos 2, 4 e 6 meses de idade seguidas de um reforço aos 18 meses de idade. Tais vacinas desempenham papéis importantes na prevenção da difteria, tétano e coqueluche; na erradicação da poliomielite; e no reforço contra H. influenzae tipo b.

Intra-abdominal desmoid tumors in familial adenomatous polyposis: How much do clinical and surgical variables interfere with their development?

Abstract Objective: Familial Adenomatous Polyposis is a complex hereditary disease that exposes the carrier to a great risk of Colorectal Cancer (CRC). After prophylactic surgery, intra-abdominal desmoid tumors are known to be one the most important cause of death. Therefore, recognition of increased-risk patients and modification of operative strategy may be crucial. Aim: The objective of this study was to estimate the desmoid tumor risk in relation to various surgical and clinical variables. Methods: Patients who had undergone polyposis since 1958 were included in the study. After exclusion criteria were met, those who had developed desmoid tumors were selected to undergo further evaluation. Results: The study revealed that the risk of developing desmoid tumors was associated with various factors such as sex ratio, colectomy, and reoperations. On the other hand, the type of surgery, family history, and surgical approach did not affect the risk of developing desmoid tumors. The data collected from 146 polyposis patients revealed that 16% had desmoid polyps. The sex ratio was 7:1, and the median age at colectomy was 28.6 years. Family history, multiple abdominal operations, and reoperations were some of the characteristics that were common in desmoid patients. Conclusion: Recognition of clinical (female sex) and surgical (timing of surgery and previous reoperations) data as unfavorable variables associated with greater risk may be useful during the decision-making process.

Mucin levels in glands of the colonic mucosa of rats with diversion colitis subjected to enemas containing sucralfate and n-acetylcysteine alone or in combination

Purpose: To evaluate the tissue content of neutral and acidic mucins, sulfomucins and sialomucins in colonic glands devoid of intestinal transit after enemas containing sucralfate and n-acetylcysteine alone or in combination. Methods: Sixty-four rats underwent intestinal transit bypass. A colonic segment was collected to compose the white group (without intervention). After derivation, the animals were divided into two groups according to whether enemas were performed daily for two or four weeks. Each group was subdivided into four subgroups according to the substance used: control group: saline 0.9%; sucralfate group (SCF): SCF 2 g/kg/day; n-acetylcysteine group (NAC): NAC 100 mg/kg/day; and SCF+NAC group: SCF 2 g/kg/day + NAC 100 mg/kg/day.Neutral and acidic mucins were stained by periodic acid-Schiff and alcian-blue techniques, respectively. The distinction between sulfomucins and sialomucin was made by the high alcian-blue iron diamine technique. The content of mucins in the colonic glands was measured by computerized morphometry. The inflammatory score was assessed using a validated scale. The results between the groups were compared by the Mann-Whitney's test, while the variation according to time by the Kruskal-Wallis' test (Dunn's post-test). A significance level of 5% was adopted. Results: There was reduction in the inflammatory score regardless of the application of isolated or associated substances. Intervention with SCF+NAC increased the content of all mucin subtypes regardless of intervention time. Conclusions: The application of SCF+NAC reduced the inflammatory process of the colonic mucosa and increased the content of different types of mucins in the colonic glands of segments excluded from fecal transit.

Impact of the covid-19 pandemic on the emergency surgical treatment of colorectal cancer / Impacto da pandemia da covid-19 no tratamento cirúrgico emergencial do câncer colorretal

ABSTRACT BACKGROUND: Colorectal cancer (CRC) is the most common malignancy of the gastrointestinal tract and the third most common type of cancer worldwide. The COVID-19 pandemic, during the years 2020 and 2022, increased the difficulties in offering adequate early diagnosis and treatment to CRC patients worldwide. During this period, it was only possible to treat patients who evolved with complications, mainly intestinal obstruction and perforation. AIMS: To assess the impact of the COVID-19 pandemic on the treatment of patients with CRC. METHODS: A review of data from a total of 112 patients undergoing emergency surgical treatment due to complications of CRC was carried out. Of these, 78 patients underwent emergency surgery during the COVID-19 pandemic (2020/2021), and 34 were treated before the pandemic (2018/2019). Ethnic aspects, clinical symptoms, laboratory tests, histopathological variables, intra and postoperative complications, and 90-day postoperative follow-up were compared between the two groups. RESULTS: Between the years 2018 and 2019, 79.4% (27/34) of patients had intestinal obstruction, while 20.6% (7/34) had intestinal perforation. During the period of the COVID-19 pandemic (2020/2021), 1.3% (1/78) of patients underwent surgery due to gastrointestinal bleeding, 6.4% (5/78) due to intestinal perforation, and 92.3% (72/78) due to intestinal obstruction. No statistically significant differences were recorded between the two groups in ethnic aspects, laboratory tests, type of complications, number of lymph nodes resected, compromised lymph nodes, TNM staging, pre or intraoperative complications, length of stay, readmission, or mortality rate. When considering postoperative tumor staging, among patients operated on in 2018/2019, 44.1% were classified as stage III and 38.2% as stage IV, while during the pandemic period, 28.2% presented stage III and 51.3% stage IV, also without a statistically significant difference between the two periods. Patients operated on during the pandemic had higher rates of vascular, lymphatic and perineural invasion. CONCLUSIONS: The COVID-19 pandemic increased the rate of complications related to CRC when comparing patients treated before and during the pandemic. Furthermore, it had a negative impact on histopathological variables, causing worse oncological prognoses in patients undergoing emergency surgery.

RESUMO RACIONAL: O câncer colorretal (CCR) é a doença maligna mais comum do trato gastrointestinal sendo o terceiro tipo de câncer mais comum em todo o mundo. A pandemia de COVID-19 durante os anos de 2020 e 2022 aumentou as dificuldades em se oferecer diagnóstico e tratamento precoce adequado aos pacientes com CCR em todo o mundo. Nesse período, só foi possível tratar os pacientes que evoluíram com complicações representadas, principalmente, pela obstrução e perfuração intestinal. OBJETIVOS: Avaliar o impacto da pandemia de COVID-19 no tratamento de pacientes com CCR. MÉTODOS: Foi realizada uma revisão dos dados de um total de 112 pacientes submetidos ao tratamento cirúrgico de urgência devido complicações do CCR. Destes, 78 pacientes foram submetidos a cirurgia de emergência durante o período da pandemia de COVID-19 (2020/2021), e 34 pacientes foram operados no período anterior à pandemia (2018/2019). Aspectos étnicos, sintomas clínicos, exames laboratoriais, variáveis histopatológicas, complicações intra e pós-operatórias e acompanhamento pós-operatório de 90 dias foram analisados comparando os dois grupos. RESULTADOS: Entre os anos 2018 e 2019, 79,4% (27/34) dos pacientes apresentaram obstrução intestinal enquanto 20,6% (7/34) perfuração intestinal. Durante o período da pandemia de COVID-19 (2020/2021) 1,3% (1/78) dos pacientes foram operados por hemorragia digestiva baixa, 6,4% (5/78) por perfuração intestinal e 92,3% (72/78) por obstrução intestinal. Não foram registradas diferenças estatisticamente significativas entre os dois grupos nos aspectos étnicos, exames laboratoriais, tipo de complicações, número de linfonodos ressecados, linfonodos comprometidos, estadiamento TNM, complicações pré ou intraoperatórias, tempo de internação, readmissão e taxa de mortalidade. Ao considerar o estadiamento tumoral pós-operatório, entre os pacientes operados em 2018/19, 44,1% foram classificados como estágio III e 38,2% como estágio IV, enquanto no período pandêmico, 28,2% apresentaram estágio III e 51,3% estágio IV, também sem diferença estatisticamente significativa entre os dois períodos. Doentes operados durante a pandemia apresentaram maiores índices de invasão vascular, linfática e perineural. CONCLUSÕES: A pandemia de COVID-19 aumentou as taxas de complicações relacionadas ao CCR, comparando pacientes tratados antes e durante a pandemia. Além disso, teve impacto negativo nas variáveis histopatológicas, causando piores prognósticos oncológicos em pacientes submetidos a cirurgias de emergência.

Lesiones iatrogénicas del nervio radial en la osteosíntesis de la diáfisis humeral / Intraoperative iatrogenic injury of the radial nerve in humerus osteosynthesis

Introducción: Los objetivos de este estudio fueron determinar la incidencia de lesión iatrogénica intraquirúrgica del nervio radial durante la osteosíntesis de la diáfisis y el extremo distal del húmero, distinguir factores de riesgos asociados y reconocer elementos pronósticos que participan de su recuperación. Materiales y Métodos: Se evaluó, en forma retrospectiva, a 82 pacientes con osteosíntesis de húmero entre 2005 y 2021, sin parálisis radial preoperatoria. Se consideraron los sistemas de fijación utilizados, y se compararon las cirugías primarias con las reoperaciones y el tiempo transcurrido entre estas. El diagnóstico de parálisis radial posoperatorio fue clínico. Todos los pacientes fueron tratados con férula en extensión de muñeca, electroestimulación, kinesiología y vitaminas B1, B6, B12. La electromiografía se solicitó a los fines del pronóstico. Resultados: Nueve pacientes tuvieron déficit motor del nervio radial en el posoperatorio inmediato. El sistema de fijación era una placa (7 casos), sistema de cable-placa (1 caso) y clavo endomedular acerrojado anterógrado (1 caso). Siete ocurrieron en cirugías primarias y dos en reoperaciones. El 88% recuperó su función motora completamente antes de los 6 meses después de la parálisis. La electromiografía reveló un nervio radial no excitable en el 22% restante con parálisis definitiva. Conclusiones: El uso de placa de osteosíntesis, la disección intraoperatoria del nervio radial y las reoperaciones aumentan la incidencia de parálisis. Un nervio radial no excitable se relaciona con un peor pronóstico de recuperación espontánea. Nivel de Evidencia: IV

Introduction: The purpose of this study is to determine the incidence of intraoperative iatrogenic radial nerve injury after osteosynthesis of the diaphysis and distal end of the humerus, identify associated risk factors, and determine the prognostic factors involved in its recovery. Materials and Methods: We retrospectively assessed 82 humerus osteosynthesis cases between 2005 and 2021 who had normal radial nerve function before surgery. We evaluated the fixation systems used, the type of surgery (primary versus revision), and the intervals between surgeries. The diagnosis of postoperative radial palsy was made by clinical examination. All patients were treated with wrist extension splint, physiotherapy, and vitamins B1, B6, and B12. Results: After humerus fixation, 9 patients developed motor palsy. Seven cases were fixed with plates, one with a cable-plate system, and one with an anterograde locking intramedullary nail. Seven cases (22%) occurred after primary procedures, while two occurred during revisions. Within 6 months, 88% had regained full motor function. In the remaining 22% of patients with definite palsy, electromyography revealed no excitability of the radial nerve. Conclusions: The use of an osteosynthesis plate, as well as intraoperative dissection and neurolysis of the radial nerve, were identified as risk factors for the development of radial palsy. Reoperations on the humerus, on the other hand, are a risk factor that increases the likelihood of postoperative radial nerve palsy. A radial nerve with no excitability on the postoperative electromyogram has a poor prognosis of spontaneous radial nerve function recovery. Level of Evidence: IV

Cáncer colorrectal. Variantes génicas en la vía de señalización BMP y ancestría en población mexicana / Colorectal cancer. Genetic variants in BMP signaling pathway and ancestry in the Mexican population

Resumen Introducción: Variantes génicas relacionadas con la vía de señalización de las proteínas morfogenéticas óseas (BMP2, BMP4, GREM1, SMAD7) se han asociado a cáncer colorrectal, principalmente en poblaciones caucásicas. Objetivo: Describir la asociación de variantes en miembros de la vía BMP en población mexicana, caracterizada por su ancestría indoamericana y caucásica. Métodos: Se realizó el genotipado de 1000 casos de cáncer colorrectal y 1043 individuos de control reclutados en la Ciudad de México, Monterrey y Torreón mediante la plataforma Sequenom. Con análisis univariados y multivariados se estudiaron las asociaciones entre cáncer colorrectal y variantes. Resultados: Las variantes rs4444235, rs12953717 y rs4939827 replicaron la asociación con la neoplasia (p ≤ 0.05). La ascendencia caucásica mostró asociación con el tumor. Conclusiones: El estudio mostró las asociaciones entre cáncer colorrectal y las variantes SMAD7 y BMP4, así como con el componente caucásico de la mezcla étnica.

Abstract Introduction: Genetic variants related to bone morphogenetic proteins (BMP2, BMP4, GREM1, SMAD7) signaling pathway have been associated with colorectal cancer, mainly in Caucasian populations. Objective: To describe the association of variants in members of the BMP signaling pathway in a Mexican population, characterized by its indigenous American and Caucasian ancestry. Methods: Genotyping of 1,000 colorectal cancer cases and 1,043 control individuals recruited in Mexico City, Monterrey, and Torreón was carried out using the Sequenom platform. Associations between colorectal cancer and variants were studied with univariate and multivariate analyses. Results: Variants rs4444235, rs12953717 and rs4939827 replicated the association with the neoplasm (p ≤ 0.05). Caucasian ancestry showed association with the tumor. Conclusions: The study replicated the associations between colorectal cancer and SMAD7 and BMP4 variants, with an association being observed with the Caucasian component of the ethnic mix.

Diagnóstico nutricional y neurológico según antigüedad, nivel neurológico y tipo de lesión en paciente raquimedular

Introducción: La lesión medular (LM) es un problema médico contemporáneo caracterizado por datos insuficientes sobre prevalencia y debilidad de modelización en metodología. Objetivo: Establecer las interrelaciones del estado nutricional y la condición neurológica-funcional con signos clínicos: tiempo y tipo de lesión, nivel de lesión y severidad del trauma raquimedular dorso lumbar. Material y Métodos: Estudio descriptivo transversal de 102 pacientes con trauma raquimedular al ingreso, 85 hombres y 17 mujeres (febrero 2016 - enero de 2020, CIREN) La Habana, Cuba. Se realizó evaluación nutricional, neurológica (nivel, grado y severidad de lesión) mediante escalas ASIA, Independencia SCIM-III e índice de Barthel. Se obtienen medias, desviación estándar, error estándar y análisis de varianza para distribuciones normales. Se utilizó SPSS versión 26. Resultados: La edad promedio fue 29,7 ± 8,1 años. La antigüedad del trauma fue 3,1 ± 1,4 años. La lesión raquimedular ocurrió en 50,6 % del segmento T7- L3 en pacientes con lesión completa. Hubo deficiencia energética crónica (4,9 %), según Índice de Masa Corporal; el 50,6 % fueron ≥ 22 kg/m2, según criterio de riesgo de Nash. El 73,5 % clasificaban en escala A de ASIA. La correlación entre Catz y Barthel demostró asociación significativa (p< 0,01). La disminución de masa muscular, área muscular del brazo, reflectividad y sensibilidad es significativa según antigüedad, tipo, nivel y severidad de lesiones (p< 0,05). Se discute debilidad metodológica de estimaciones para masa muscular esquelética. Conclusiones: Se caracterizan antigüedad de lesión, tono muscular y nivel neurológico de lesión medular como condicionantes interactivos del diagnóstico.

Introduction: Spinal cord injury (SCI) is a contemporary medical problem characterized by insufficient data on prevalence and weak modelling methodology. Objective: To establish nutritional status and neurological-functional condition interrelationships with clinical signs: time and type of injury, level of injury and severity of dorsal lumbar spinal cord injury. Material and Methods: A cross-sectional descriptive study of 102 patients with spinal cord trauma on admission (85 men and 17 women) was conducted from February 2016 to January 2020, in CIREN, Havana, Cuba. Nutritional and neurological assessment (level, degree and severity of injury) was performed using ASIA scales, SCIM-III Independence, and Barthel index. Means, standard deviation, standard error and analysis of variance for normal distributions were obtained. SPSS version 26 was used. Results: The mean age was 29.7 ± 8.1 years. The age of trauma was 3.1 ± 1.4 years. Spinal cord injury occurred in 50.6 % of the T7- L3 segment in patients with complete injury. There was chronic energy deficiency (4.9 %), according to Body Mass Index; 50.6 % were ≥22 kg/m2, according to Nash risk criteria. In addition, 73.5 % were classified on the ASIA A scale. The correlation between Catz and Barthel showed a significant association (p< 0.01). The decrease in muscle mass, arm muscle area, reflectivity and sensitivity were significant according to age, type, level and severity of injury (p< 0.05). Methodological weakness of estimates for skeletal muscle mass is discussed. Conclusions: Time of injury, muscle tone and neurological level of spinal cord injury are characterized as interactive determinants of the diagnosis.

Estudo da fisiologia anorretal pré e pós terapia neoadjuvante para câncer de reto por manometria anorretal e escore de Jorge-Wexner / Study of anorectal physiology pre and pos neoadjuvant therapy for rectal cancer by anorectal manometry and jorge-wexner score

ABSTRACT Background: The treatment of distal rectal cancer may be accompanied by evacuation disorders of multifactorial etiology. Neoadjuvant chemoradiotherapy (NCRT) is part of the standard treatment for patients with locally advanced extraperitoneal rectal cancer. The assessment of anorectal function after long-term NCRT in patients with cancer of the extraperitoneal rectum has been poorly evaluated. Objective: The aim of the present study was to evaluate the effects of NCRT on anorectal function and continence in patients with extraperitoneal rectal cancer. Methods: Rectal adenocarcinoma patients undergoing neoadjuvant therapy were submitted to functional evaluation by anorectal manometry and the degree of fecal incontinence using the Jorge-Wexner score, before and eight weeks after NCRT. The manometric parameters evaluated were mean resting anal pressure (ARp), maximum voluntary contraction anal pressure (MaxSp) and average voluntary contraction anal pressure (ASp). All patients underwent the same NCRT protocol based on the application of fluoropyrimidine (5-FU) at a dosage of 350 mg/m2 associated with folic acid at a dosage of 20 mg/m2, intravenously, in the first and last week of treatment, concomitantly with conformational radiotherapy with a total dose of 50.4Gy, divided into 28 daily fractions of 1.8Gy. For statistical analysis of the quantitative variables with normal distribution, the mean, standard deviation, median and interquartile range were calculated. For comparison of two related samples (before and eight weeks after NCRT), Wilcoxon's non-parametric test was used. Results: Forty-eight patients with rectal cancer were included in the study, with a mean age of 62.8 (39-81) years, 36 (75%) of whom were male. The use of NCRT was associated with a decrease in the values of ARp (55.0 mmHg vs 39.1 mmHg, P<0.05) and ASp (161.9 mmHg vs 141.9 mmHg, P<0.05) without changing MaxSp values (185,5 mmHg vs 173 mmHg, P=0.05). There was no worsening of the incontinence score eight weeks after the use of NCRT (3.0 vs 3.3; P>0.05). Conclusion: NCRT was associated with a reduction in the values of ARp and the ASp. There was no change in MaxSp, as well as in the degree of fecal continence by the Jorge-Wexner score.

RESUMO Contexto: O tratamento do câncer retal distal pode ser acompanhado por distúrbios evacuatórios de etiologia multifatorial. A quimiorradioterapia neoadjuvante faz parte do tratamento padrão para pacientes com câncer retal extraperitoneal localmente avançado. A avaliação da função anorretal após neoadjuvância de longa duração em pacientes com câncer de reto extraperitoneal tem sido pouco estudada. Objetivo: O objetivo do presente estudo foi avaliar os efeitos da neoadjuvância na função anorretal e na incontinência em pacientes com câncer retal extraperitoneal. Métodos: Pacientes com adenocarcinoma de reto candidatos à terapia neoadjuvante foram submetidos a avaliação funcional por manometria anorretal e avaliação do grau de incontinência fecal pelo escore de Jorge-Wexner, pré e oito semanas após a neoadjuvância. Os parâmetros manométricos avaliados foram pressão anal média de repouso, pressão anal de contração voluntária máxima e pressão anal média de contração voluntária. Todos os pacientes foram submetidos ao mesmo protocolo de neoadjuvância baseado na aplicação de fluoropirimidina (5-FU) na dosagem de 350 mg/m2 associada ao ácido fólico na dosagem de 20 mg/m2, por via intravenosa, na primeira e última semana de tratamento, concomitantemente à radioterapia conformacional com dose total de 50,4Gy, dividida em 28 frações diárias de 1,8Gy. Para análise estatística das variáveis quantitativas com distribuição normal, foram calculados a média, desvio padrão, mediana e intervalo interquartil. Para comparação de duas amostras relacionadas (antes e oito semanas após a neoadjuvância, foi utilizado o teste não paramétrico de Wilcoxon. Resultados: Quarenta e oito pacientes com câncer retal foram incluídos no estudo, com média de idade de 62,8 (39-81) anos, sendo 36 (75%) do sexo masculino. O uso de neoadjuvância foi associado à diminuição dos valores de média de pressão de repouso (55,0 mmHg vs 39,1 mmHg, P<0,05) e média de pressão de contração voluntária (161,9 mmHg vs 141,9 mmHg, P<0,05) sem alterar os valores de pressão de contração voluntária máxima ((185,5 mmHg vs 173 mmHg, P=0.05)). Não houve piora do escore de incontinência oito semanas após o uso da quimiorradioterapia neoadjuvante (3,0 vs 3,3; P>0,05). Conclusão: A neoadjuvância associou-se à redução dos valores de média de pressão de repouso e média dos valores contração voluntária. Não houve alteração nos valores de contração voluntária máxima, bem como no grau de continência fecal pelo escore de Jorge-Wexner.

Práctica de Enfermería para control emocional en personas con antecedentes de infarto agudo de miocardio / Nursing practice for emotional control in people with a history of acute myocardial infarction

RESUMEN El ejercicio de la Enfermería tiene un alto componente de responsabilidad y comportamiento ético para el control emocional de las personas con antecedentes de infarto agudo de miocardio. Este sustento le da significado a la práctica de la Enfermería para ser aplicada de forma sistemática y organizada. Se realizó una investigación descriptiva con el objetivo de proponer acciones, desde la Enfermería, que contribuyan al mejoramiento del control emocional en las personas con antecedentes de infarto agudo de miocardio pertenecientes al Policlínico Docente Universitario «Martha Abreu de Estévez¼, de Santa Clara, Villa Clara, en el período de enero de 2017 a febrero de 2019. En las personas estudiadas se constató un predominio de: autoestima baja, alta vulnerabilidad al estrés y la ansiedad. Por otro lado, se evidenciaron dificultades en el conocimiento de sus estados emocionales, incapacidad para clarificar y reparar sus emociones, así como una satisfacción vital no satisfactoria.

ABSTRACT Nursing practice has a high component of responsibility and ethical behavior for the emotional control of people with a history of acute myocardial infarction. This support gives meaning to the practice of Nursing to be applied in a systematic and organized way. A descriptive research was carried out with the objective of proposing actions, from the point of view of Nursing, that contribute to the improvement of emotional control in people with a history of acute myocardial infarction belonging to "Martha Abreu de Estévez" University Teaching Polyclinic, in Santa Clara, Villa Clara, from January 2017 to February 2019. A predominance of low self-esteem, high vulnerability to stress and anxiety was found in the people studied. On the other hand, difficulties in understanding their emotional states, inability to clarify and repair their emotions, as well as unsatisfactory life satisfaction were evidenced.

Síndrome coronario agudo en el paciente joven / Acute coronary syndrome in the young patient

Resumen Las enfermedades del sistema circulatorio constituyen la primera causa de muerte en el mundo. En Colombia, la enfermedad cardíaca isquémica se ubica como la principal causa de muerte, tanto en hombres como en mujeres. En la población femenina es la causa de más de la mitad de las muertes, cercana al 53%. La enfermedad isquémica en jóvenes, definidos como aquellos menores de 45 años, se ha descrito en cohortes en hasta un 11,6%, con una menor tasa de mortalidad. La dificultad para el abordaje de estos pacientes es mayor, dado que, al consultar al servicio de urgencias, pocas veces se sospecha enfermedad cardíaca isquémica.

Abstract The diseases of the circulatory system constitute the leading cause of death in the world. In Colombia, ischemic heart disease is the main cause of death, both in men and women, being within the group of women the cause of more than half of the deaths, close to 53%. Ischemic disease in young people, defined as those under 45 years old, has been described in cohorts around to 11.6%, with a lower mortality rate. The difficulty in addressing these patients is higher, given that, when consulting the emergency department, ischemic heart disease is rarely suspected.

La prevención de los problemas de salud bucal: una visión desde la educación primaria

RESUMEN Introducción: la prevención, desde la escuela, debe facilitar una visión anticipadora que en la práctica se revierta en iniciativas en el proceso pedagógico, a partir de la participación de su colectivo, logrando modificaciones en la conducta de las personas para una mejor calidad de vida. Asimismo, propiciar la armonía entre las formas de pensar, sentir y actuar en el desarrollo del infante, y de manera activa contribuir a edificar el proyecto social deseado. Objetivo: describir el estado actual de los conocimientos, procedimientos y comportamientos, para prevenir los problemas de salud bucal en escolares de la Escuela Primaria José María Heredia de Heredia, del municipio de Matanzas. Materiales y métodos: se realizó un diagnóstico sobre los conocimientos, procedimientos y comportamientos que poseen los maestros para prever los problemas de salud bucal en escolares en la Escuela Primaria José María Heredia de Heredia, del municipio de Matanzas, entre los meses de febrero y abril de 2021. Resultados: se evidenció potencialidades e insuficiencias en la preparación del maestro primario para la prevención de los problemas de salud bucal. Conclusión: los conocimientos, procedimientos y comportamientos que poseen los maestros de esta institución educativa para precaver los problemas de salud bucal en sus escolares son insuficientes, y demuestran la necesidad de proponer acciones educativas dirigidas a solucionar esa insuficiencia.

ABSTRACT Introduction: prevention, from the school, should facilitate an anticipatory vision that in practice reverts to initiatives in the pedagogical process, based on the participation of its collective, leading to changes in the behavior of people for a better life quality. It also should propitiate harmony between the ways of thinking, feeling and behaving in the development of the child, and actively contribute to build the desired social project. Objective: to describe the current state of knowledge, procedures and behaviors to prevent oral health problems in schoolchildren at Jose Maria Heredia de Heredia Primary School, in the municipality of Matanzas. Materials and methods: a diagnostic was made on the knowledge, procedures and behaviors the teachers have to prevent oral health problems in schoolchildren at Jose Maria Heredia de Heredia Primary School, municipality of Matanzas, between the months of February and April 2021. Results: potentialities and insufficiencies were evidenced in the training of the primary teacher for the prevention of oral health problems. Conclusions: the knowledge, procedures and behaviors the teachers of this educational institution have to prevent oral health problems in their students are insufficient, and demonstrate the need of proposing educational actions aimed at solving this insufficiency.

Síndrome coqueluchoide y tosferina

RESUMEN Introducción: El síndrome coqueluchoide es una causa frecuente de ingreso y no siempre se descarta a la Bordetella pertussis como su origen. Objetivo: Identificar la etiología infecciosa en niños ingresados con síndrome coqueluchoide/coqueluche y su relación con el estado de la vacunación. Métodos: Estudio descriptivo, transversal, en 120 niños hasta 10 años de edad con diagnóstico de síndrome coqueluchoide ingresados en el Servicio de Neumología del Hospital Pediátrico "Juan Manuel Márquez", entre enero 2010 y septiembre 2012. Se evaluó la edad, sexo, evolución, resultados de reacción en cadena de la polimerasa y cultivo para virus, bacterias y micoplasmas en muestras obtenidas al ingreso, procesadas en el Instituto de Medicina Tropical, además, cumplimiento de vacunación antipertussis. Las variables cualitativas se describieron mediante frecuencias absolutas y porcentajes; para evaluar la relación tos ferina e incumplimiento de la vacunación se empleó la prueba Ji cuadrada con un nivel de significación de p≤ 0,05. Resultados: Predominaron los menores de un año (69,2 %) y el sexo femenino (55%). Bordetella pertussis se aisló en 71 casos (59,2 %); más frecuente en menores de 6 meses (59,7 %) y en niños con vacunación incompleta (80 %), pero no fue significativa la diferencia con los casos no pertussis (p=0,214).Existió coinfección con virus y micoplasmas (54-76 %). La etiología viral predominó en los restantes 49; rinovirus fue el más representado en general. Falleció una recién nacida con neumonía por B pertussis. Conclusiones: Ante un síndrome coqueluchoide debemos siempre tener presente la posibilidad de tos ferina, sobre todo en niños pequeños con vacunación incompleta.

ABSTRACT Introduction: Coqueluchoid syndrome is a frequent cause of admission and Bordetella pertussis is not always ruled out as its origin. Objective: Identify the infectious etiology in children admitted with coqueluchoid/coqueluche syndrome and its relationship with vaccination status. Methods: A descriptive, cross-sectional study was conducted in 120 children up to 10 years of age diagnosed with coqueluchoid syndrome admitted to the Pulmonology Service of "Juan Manuel Márquez" Children's Hospital between January 2010 and September 2012. Age, sex, evolution, polymerase chain reaction results and culture for viruses, bacteria and mycoplasmas were evaluated in samples obtained at admission, processed at the Institute of Tropical Medicine ; in addition to the compliance with anti-pertussis vaccination. Qualitative variables were described by absolute frequencies and percentages; to evaluate the ratio of whooping cough and non-compliance with vaccination, the Ji square test was used with a significance level of p≤ 0.05. Results: Children under one year of age (69.2%) and female sex (55%) predominated. Bordetella pertussis was isolated in 71 cases (59.2%); it was more frequent in children under 6 months (59.7%) and in children with incomplete vaccination (80%), but the difference with non-pertussis cases was not significant (p= 0.214). There was co-infection with viruses and mycoplasmas (54-76%). Viral etiology predominated in the remaining 49; rhinovirus was the most represented overall. A newborn died with B. pertussis pneumonia. Conclusions: In the face of a coqueluchoid syndrome we must always keep in mind the possibility of whooping cough, especially in young children with incomplete vaccination.