Endometriosis MRI: Atypical cases, pitfalls and mimics.

Endometriosis is a common but often underdiagnosed chronic gynaecological disease. Endometriosis mimics other diagnoses both clinically and radiographically, presenting a diagnostic challenge. Endometriosis can be categorised as superficial pelvic endometriosis, deep invasive endometriosis (DIE) or endometrioma. Endometrioma and DIE, including polypoid endometriosis, can masquerade as invasive neoplasms. Endometriosis can be misdiagnosed in less common locations or during pregnancy. Ultrasound is the initial investigation for endometriosis; however, MRI is advantageous in providing a larger field of view for increased detection of nodules as well as distinguishing malignancy with greater certainty. This review highlights endometriosis mimics, pitfalls and atypical cases on MRI.

A Novel Pathogenic Variant in the MN1 Gene in a Patient Presenting with Rhombencephalosynapsis and Craniofacial Anomalies, Expanding MN1 C-terminal Truncation Syndrome.

Meningioma-1 is a transcription activator that regulates mammalian palate development and is required for appropriate osteoblast proliferation, motility, differentiation, and function. Microdeletions involving the MN1 gene have been linked to syndromes including craniofacial anomalies, such as Toriello-Carey syndrome. Recently, truncating variants in the C-terminal portion of the MN1 transcriptional factor have been linked to a characteristic and distinct phenotype presenting with craniofacial anomalies and partial rhombencephalosynapsis, a rare brain malformation characterized by midline fusion of the cerebellar hemispheres with partial or complete loss of the cerebellar vermis. It has been called MN1 C-terminal truncation (MCTT) syndrome or CEBALID (Craniofacial defects, dysmorphic Ears, Brain Abnormalities, Language delay, and Intellectual Disability) and suggested to be caused by dominantly acting truncated protein MN1 instead of haploinsufficiency. As a proto-oncogene, MN1 is also involved in familial meningioma. In this study, we present a novel case of MCTT syndrome in a female patient presenting with craniofacial anomalies and rhombencephalosynapsis, harboring a de novo pathogenic variant in the MN1 gene: c.3686_3698del, p.(Met1229Argfs*87).

Thermoplastic starch/polyvinyl alcohol blends modification by citric acid-glycerol polyesters.

Thermoplastic starch/polyvinyl alcohol (TPS/PVA) films have limitations for being used in long-term applications due to starch retrogradation. This leads to plasticizer migration, especially when low molecular weight plasticizers such as glycerol, are used. In this work, we employed mixtures of oligomers based on glycerol citrates with higher molecular weight than glycerol as plasticizers for potato-based TPS/PVA blends obtained by melt-mixing. This constitutes an alternative to reduce plasticizer migration while keeping high swelling degree, and to provide high mechanical performance. The novelty lies in the usage of these oligomers by melt-mixing technique, aspect not deeply explored previously and that represents the first step towards industrial scalability. Prior to the blending process, oligomers mixtures were prepared with different molar ratios of citric acid (0-40 mol%) and added them. This minimizes the undesirable hydrolysis effect of free carboxylic groups on starch chains. The results demonstrated that the migration of plasticizers in TPS/PVA blends decreased by up to 70 % when the citric acid content increased. This reduction was attributed to the higher molecular weight (the majority in the range 764-2060 Da) and the 3D structure of the oligomers compared to using raw glycerol. Furthermore, the films exhibited a 150 % increase in Young's modulus and tensile strength without a reduction in elongation at break, while maintaining a high gel content, due to a moderate crosslinking.

Study of the Plasticization Effect of 1-Ethyl-3-methylimidazolium Acetate in TPS/PVA Biodegradable Blends Produced by Melt-Mixing.

The first step towards the production and marketing of bioplastics based on renewable and sustainable materials is to know their behavior at a semi-industrial scale. For this reason, in this work, the properties of thermoplastic starch (TPS)/polyvinyl alcohol (PVA) films plasticized by a green solvent, as the 1-ethyl-3-methylimidazolium acetate ([Emim+][Ac-]) ionic liquid, produced by melt-mixing were studied. These blends were prepared with a different content of [Emim+][Ac-] (27.5-42.5 %wt.) as a unique plasticizer. According to the results, this ionic liquid is an excellent plasticizer due to the transformation of the crystalline structure of the starch to an amorphous state, the increase in flexibility, and the drop in Tg, as the [Emim+][Ac-] amount increases. These findings show that the properties of these biomaterials could be modified in the function of [Emim+][Ac-] content in the formulations of TPS, depending on their final use, thus becoming a functional alternative to conventional polymers.

Endometriosis: A multimodal imaging review.

Endometriosis is a chronic inflammatory disorder characterized endometrial-like tissue present outside of the uterus, affecting approximately 10% of reproductive age women. It is associated with abdomino-pelvic pain, infertility and other non - gynecologic symptoms, making it a challenging diagnosis. Several guidelines have been developed by different international societies to diagnose and classify endometriosis, yet areas of controversy and uncertainty remains. Transvaginal ultrasound (TV-US) is the first-line imaging modality used to identify endometriosis due to its accessibility and cost-efficacy. Enhanced sonographic techniques are emerging as a dedicated technique to evaluate deep infiltrating endometriosis (DIE), depending on the expertise of the sonographer as well as the location of the lesions. MRI is an ideal complementary modality to ultrasonography for pre-operative planning as it allows for a larger field-of-view when required and it has high levels of reproducibility and tolerability. Typically, endometriotic lesions appear hypoechoic on ultrasonography. On MRI, classical features include DIE T2 hypointensity, endometrioma T2 hypointensity and T1 hyperintensity, while superficial peritoneal endometriosis (SPE) is described as a small focus of T1 hyperintensity. Imaging has become a critical tool in the diagnosis, surveillance and surgical planning of endometriosis. This literature review is based mostly on studies from the last two decades and aims to provide a detailed overview of the imaging features of endometriosis as well as the advances and usefulness of different imaging modalities for this condition.

Influencia de la obesidad en los resultados del tratamiento quirúrgico de la estenosis lumbar degenerativa / Obesity Influence on the Surgical Treatment Results of Degenerative Lumbar Stenosis

Introducción: La estenosis lumbar degenerativa altera la calidad de vida y disminuye la capacidad funcional en adultos mayores. La obesidad representa un problema de la salud mundial actual. Objetivo: Detallar los efectos de la obesidad sobre el riesgo quirúrgico, los índices de complicaciones posoperatorias y los resultados funcionales en pacientes adultos mayores sometidos a cirugía electiva por estenosis lumbar degenerativa. Métodos: Estudio prospectivo-descriptivo, con pacientes adultos mayores intervenidos quirúrgicamente por diagnóstico de estenosis lumbar degenerativa y valorados un año después. Resultados: 55 pacientes, 23 obesos, 32 no obesos; relación de sexos 1,5:1 masculino-femenino, mayor cantidad de espacios intervenidos, tiempo quirúrgico y pérdida de sangre en obesos. Los obesos presentaron un mayor número de complicaciones postquirúrgicas y resultados funcionales menos buenos. Conclusiones: La obesidad constituye un mayor riesgo quirúrgico, que, aunque la diferencia en los resultados clínicos no sea muy importante, provoca intervenciones más prolongadas y mayor incidencia de complicaciones quirúrgicas(AU)

Introduction: Degenerative lumbar stenosis alters quality of life and decreases functional capacity in older adults. Obesity represents a current global health problem. Objective: To detail the effects of obesity on surgical risk, postoperative complication rates, and functional outcomes in older patients undergoing elective surgery for degenerative lumbar stenosis. Methods: Prospective-descriptive study with elderly patients who underwent surgery for a diagnosis of degenerative lumbar stenosis, who were evaluated one year later. Results: Fifty-five patients, 23 obese, 32 non-obese; sex ratio 1.5:1 male-female, higher number of intervened spaces, surgical time and blood loss in obese subjects. The obese patients showed higher number of post-surgical complications and less good functional results. Conclusions: Obesity constitutes a higher surgical risk, even when the difference in clinical results is not very important, it causes longer interventions and higher incidence of surgical complications(AU)

Occupational accidents in healthcare workers: a bibliometric analysis in Scopus database 2010-2019.

Scientific publications in the occupational area have a growing trend towards management of safety in the workplace, despite lack of knowledge on the distribution and characteristics of scientific evidence on occupational accidents in healthcare professionals. This study aims to determine the characteristics and collaboration networks of publications, the co-occurrence of terms, and the main journals on occupational accidents in healthcare professionals among publications indexed in Scopus from 2010 to 2019. This is an observational, cross-sectional, bibliometric study based on publications indexed in the Scopus database. The indicators were number of publications per year, main journals of publication and its quality index, collaboration networks between authors, and co-occurrence of terms. The predominant language of publication was English, the main type of study was the observational one, and nursing professionals represent the main group of interest (31.14% of the articles), contrary to radiologists and/or physical therapists (4% each). The main source of publication about occupational accidents was Workplace Health and Safety, and the main themes of investigation were related to puncture injuries and infection by hepatitis B and C. There is a growing trend towards research on occupational accidents of independent authorship, despite the creation of collaboration networks in the last years. Furthermore, nurses and surgeons are the target group of greatest interest, and the main topics cover infectious diseases.

Las publicaciones científicas en el área ocupacional tienen una creciente tendencia en el manejo de la seguridad en el entorno laboral; no obstante, se desconocen la distribución y las características de la evidencia científica sobre accidentes laborales en los profesionales de salud. Este estudio tiene como objetivo determinar las características, redes de colaboración, la co-ocurrencia de términos, y las principales revistas científicas de publicación en accidentes ocupacionales en personal de salud indizadas en Scopus desde 2010 a 2019. Este es un estudio observacional, transversal, bibliométrico a partir de publicaciones indizadas en la base de datos Scopus. Los indicadores fueron número de publicaciones por año, principales revistas de publicación y su índice de calidad, redes de colaboración de autores y co-ocurrencia de palabras. El idioma de publicación predominante fue el inglés, el principal tipo de estudio fue el observacional, y los enfermeros representaron el principal grupo de interés (31,14% de los artículos), al contrario de los radiólogos y/o terapeutas físicos (4% cada uno). La principal fuente de publicación sobre accidentes ocupacionales fue la revista Workplace Health and Safety, y los principales temas de investigación se relacionan a lesiones punzocortantes y contagios por hepatitis B y C. Se muestra una creciente tendencia en investigación sobre accidentes ocupacionales de autoría independiente, a pesar de la formación de redes en los últimos años. Además, enfermeras y médicos cirujanos son el grupo objetivo de mayor interés, y los tópicos principales abarcan enfermedades infecciosas.

Exogenous application of stress-related signaling molecules affect growth and cannabinoid accumulation in medical cannabis (Cannabis sativa L.).

Medical cannabis (Cannabis sativa L.) is a source of bioactive phytochemicals with promising pharmacological and therapeutic applications. Enhancing the accumulation of valuable bioactive compounds is potentially a way of increasing the economic importance of this crop. Signaling molecules like salicylic acid (SA), jasmonic acid (JA), and γ-aminobutyric acid (GABA) are involved in the regulation of plant development and responses to biotic and abiotic stresses. Moreover, several phytohormones regulate plant trichome formation and elicit the synthesis of secondary metabolites in many plant species in both in vitro and in vivo systems. Therefore, exogenously delivered plant signaling molecules have the potential to modify the chemical profiles of medical cannabis. In this study, we found that the foliar application of SA, methyl jasmonate (MeJA), and GABA produces changes in the accumulation of the two major cannabinoids, cannabidiolic acid (CBDA) and Δ9- tetrahydrocannabinolic acid (THCA), in leaves and inflorescences of a medical cannabis variety. MeJA at 0.1 mM increased the CBDA content in inflorescences by 15.6%, while SA and MeJA at 0.1 mM increased CBDA and THCA accumulation in leaves by up to 57.3%. Treatments did not change the expression of genes participating in the final steps of the biosynthetic pathway of cannabinoids: olivetolic acid cyclase (CsOAC-1 and CsOAC-2), 2-acylphloroglucinol 4-prenyltransferase (CsPT4), cannabidiolic acid synthase (CsCBDAS), and tetrahydrocannabinolic acid synthase (CsTHCAS). Trichome density was not significantly different from the control plants in any treatment. Besides, we found strong correlations between several plant growth parameters and cannabinoid yields, showing a direct link between plant fitness and the production of cannabinoids.

Manejo de fracturas abiertas de tibia en Cuba / Management of Open Tibial Fractures in Cuba

Introducción: Las fracturas abiertas de tibia son un subconjunto de la carga de traumatismos en América Latina. Se examinaron cuestiones relacionadas con el tratamiento potencialmente críticas en Cuba, país con recursos limitados, pero con un programa nacional de salud estandarizado, coherencia en educación y similitudes de programas de posgrado. Objetivos: Describir los patrones de tratamiento de la fractura abierta de tibia en Cuba, y comparar las características del manejo agudo y tardío en siete provincias del país. Métodos: Se encuestaron 67 cirujanos ortopédicos para evaluar cuatro aspectos en el tratamiento de la fractura abierta: profilaxis antibiótica, irrigación y desbridamiento, estabilización y tratamiento de heridas. Se utilizó el método de muestreo por conveniencia para identificar a los cirujanos y el análisis se realizó mediante la prueba exacta de Fisher (p < 0,05). Resultados: Se administraron antibióticos posoperatorios durante más de 72 horas para las fracturas GA-I/II (49 por ciento) y las fracturas GA-III (70 por ciento). Los cirujanos de La Habana (n= 32) utilizaron con más frecuencia la fijación interna primaria para las fracturas GA-I/II, que los cirujanos en las restantes provincias (n= 35) (64,3 porciento vs. 30,3 por ciento, p= 0,008). Los cirujanos de otras provincias realizaron cierre primario en el momento de la fijación definitiva de fracturas GA-I /II con más frecuencia que los de La Habana (62,9 por ciento vs. 32,3 por ciento, p= 0,013). Para fracturas GA-III, la mayoría de los cirujanos habaneros (88,6 %), al igual que los de las restantes provincias (96,8 por ciento) prefirieron realizar cierre diferido.Conclusiones: El tratamiento de fracturas abiertas de tibia en Cuba es generalmente consistente con otros países de América Latina. Se describen las características del manejo de fracturas abiertas de tibia en Cuba y se comparan las diferencias en los métodos de estabilización y tratamiento de heridas entre provincias, lo cual resulta útil para evaluar si son resultado de diferencias en la práctica quirúrgica, o en la disponibilidad de recursos. Esto representa una ayuda al abordar las formas de optimizar la atención al paciente, a través de la capacitación especializada y la asignación de los recursos(AU)

Introduction: Open tibia fractures are a significant subset of the overall trauma burden in Latin America. Latin American countries vary in their access to orthopaedic care resources, and country-specific orthopaedic recommendations are necessary. Cuba, a country with limited resources, has a standardized national health program, consistencies in education, and similarities across post-graduate training programs. This study aimed to identify management preferences for open tibia factures in Cuba. Objectives: To describe the treatment of open tibial fractures in Cuba, and to compare the characteristics of acute and delayed management across seven Cuban provinces. Methods: Sixty-seven orthopaedic surgeons were surveyed to evaluate four aspects of open fracture management, regarding antibiotic prophylaxis, irrigation and debridement, stabilization, and wound management. The convenience sampling method was used to identify surgeons and the analysis was performed using Fisher's exact test (p <0.05). Results: Postoperative antibiotics were administered for more than 72 hours for GA-I / II fractures (49 pecent) and GA-III fractures (70 percent). Surgeons in Havana (n = 32) used primary internal fixation for GA-I / II fractures more frequently than surgeons in the remaining provinces (n = 35) (64.3 pecent vs. 30.3 percent p = 0.008). Surgeons from other provinces performed primary closure at the time of definitive fixation of GA-I / II fractures more frequently than those from Havana (62.9 percent vs. 32.3 percent, p = 0.013). For GA-III fractures, the majority of Havana surgeons (88.6 percent), as well as those of the remaining provinces (96.8 percent) preferred to perform deferred closure. Conclusions: The treatment of open tibial fractures in Cuba is generally consistent with other Latin American countries. The characteristics of the management of open tibial fractures in Cuba are described and differences in wound stabilization and treatment methods between provinces are compared, which is useful to assess whether they are the result of differences in surgical practice, or in availability of resources. This is helpful in addressing ways to optimize patient care through specialized training and resource allocation(AU)

Comparación de resultados entre el abordaje anterior y posterior en la artroplastia total de cadera / Comparing Results between the Anterior and Posterior Approach in Total Hip Arthroplasty

Introducción: Existe una gran controversia con respecto a la existencia de un abordaje quirúrgico óptimo para artroplastia de cadera. El énfasis actual en la investigación ha sido examinar las posibles diferencias en los resultados funcionales entre el abordaje anterior y el abordaje posterior. Objetivo: Comparar las medidas de resultado informadas por los pacientes sometidos a artroplastia total de cadera, mediante abordajes anterior y posterior. Métodos: Se realiza una búsqueda sobre el tema en la base de datos PubMed entre los años 2010-2020 en inglés con los términos: comparación entre abordaje anterior y abordaje posterior de la cadera, abordaje anterior directo de la cadera, abordaje posterior de la cadera, y resultados de artroplastia de la cadera mediante abordajes anterior y posterior. Análisis y síntesis de la información: El abordaje anterior muestra una mayor mejora en la velocidad de la marcha, la longitud del paso y la simetría de la marcha, en comparación con el abordaje posterior para artroplastia de cadera al mes después de la operación. A los cuatro meses estas características de la marcha no fueron diferentes, pero los resultados de algunas pruebas funcionales fueron superiores en los pacientes intervenidos por abordaje anterior. Conclusiones: La elección del abordaje quirúrgico para artroplastia de cadera debe basarse en los factores del paciente, la preferencia del cirujano y su experiencia(AU)

Introduction: There is great controversy regarding the existence of an optimal surgical approach for hip arthroplasty. The current research emphasis has been to examine the possible differences in functional outcomes between anterior and posterior approaches. Objective: To compare the outcome measures reported by patients undergoing total hip arthroplasty, using anterior and posterior approaches. Methods: A search is carried out on the subject in the PubMed database during the years 2010-2020, in English, with the terms comparison between anterior approach and posterior approach to the hip, direct anterior approach to the hip, posterior approach to the hip, and results of hip arthroplasty using anterior and posterior approaches. Analysis and synthesis of the information: The anterior approach showed greater improvement in gait speed, stride length and gait symmetry, compared to the posterior approach for hip arthroplasty one month after the operation. At four months, these gait characteristics were not different, but the results of some functional tests were superior in patients operated on by anterior approach. Conclusions: The choice of the surgical approach for hip arthroplasty should be based on the patient´s factors, preference of the surgeons and their experience(AU)

An unusual case of acute otitis media resulting in Gradenigo syndrome: CT and MRI findings.

With the widespread use of antibiotics, Gradenigo syndrome is a rare complication of acute otitis media (AOM) and acute mastoiditis. It is an uncommon form of petrous apicitis and can be life-threatening. We report the case of a 14-year-old female with unresolved AOM, who developed otorrhea, ipsilateral headaches, diplopia and raised inflammatory markers. Magnetic Resonance Imaging (MRI) demonstrated features of petrous apicitis and confirmed the suspicion of Gradenigo syndrome. The objective of this clinical case report is to highlight this unusual syndrome together with its radiological appearance to improve its diagnosis and management.

Fracturas trocántereas inestables. ¿Fijación extramedular o intramedular? / Unstable trochanteric fractures. Extramedullary or intramedullary fixation?

Introducción: Las fracturas trocantéreas inestables presentan dificultad para lograr la osteosíntesis estable, el apoyo precoz y la rápida reintegración social. Se tratan mediante osteosíntesis extra o intramedular. La osteosíntesis extramedular mediante placa atornillada estática o dinámica. Los implantes intramedulares poseen clavos o tornillos deslizantes. Objetivo: Revisar la literatura publicada entre 2015 y 2020 que comparen los diferentes métodos de fijación quirúrgica de las fracturas trocantéreas inestables. Estrategia de búsqueda: En PubMed de publicaciones entre los años 2010-2020 en ingles con los términos: fracturas trocantéreas inestables, tratamiento de las fracturas extracapsulares de fémur proximal, osteosíntesis en fracturas trocantéreas femorales inestables. Conclusiones: Las fracturas trocantéreas inestables poseen tendencia al desplazamiento en varo con medialización de la diáfisis. El clavo-placa estático muestra elevados índices de fallo, superiores al del clavo-placa deslizante (DHS), pero la placa estabilizadora trocantérea (TSP) parece ser el mejor implante para osteosíntesis extramedular muy semejante a lo reportado con los implantes intramedulares(AU)

Introduction: Unstable trochanteric fractures show difficulty in achieving stable osteosynthesis, early support and rapid social reintegration. They are treated by intra or extramedullary osteosynthesis, the later, by using a static or dynamic screw plate. Intramedullary implants have sliding nails or screws. Objective: To review the literature published from 2015 and 2020 that compares the different methods of surgical fixation of unstable trochanteric fractures. Search strategy: We searched in PubMed for publications from 2010 to 2020 in English with the terms unstable trochanteric fractures, treatment of extracapsular fractures of the proximal femur, osteosynthesis in unstable femoral trochanteric fractures. Conclusions: Unstable trochanteric fractures have a tendency to varus displacement with medialization of the diaphysis. The static nail-plate shows high failure rates, higher than that of the sliding nail-plate (DHS), but the trochanteric stabilizing plate (TSP) seems to be the best implant for extramedullary osteosynthesis, which is very similar to that reported with intramedullary implants(AU)

Introduction: Les fractures trochantériennes instables présentent des difficultés pour obtenir une ostéosynthèse stable, un soutien précoce et une réinsertion sociale rapide. Ils sont traités par ostéosynthèse extra ou intramédullaire. Ostéosynthèse extramédullaire à l'aide d'une plaque vissée statique ou dynamique. Les implants intramédullaires ont des clous ou des vis coulissants. Objectif: Bilan des travaux 2015-2020 comparant les différentes méthodes de fixation chirurgicale des fractures trochantériennes instables. Stratégie de recherche: Dans PubMed des publications 2010-2020 en anglais avec les termes: instable trochanteric fractures, treatment of extracapsular fractures of the proximal fémur, Ostéosynthesis in instable fémoral trochantic fractures. Conclusions: Les fractures trochantériennes instables ont tendance à se déplacer en varus avec médialisation de la diaphyse. La plaque à clous statique présente des taux d'échec élevés, supérieurs à ceux de la plaque à clous coulissante (DHS), mais la plaque de stabilisation du trochanter (TSP) semble être le meilleur implant pour l'ostéosynthèse extramédullaire très similaire à celle rapportée avec les implants intramédullaires(AU)

Caracterización clínico-epidemiológica de los pacientes confirmados con la COVID-19 en Pinar del Río / Clinical-epidemiological characterization of confirmed COVID-19 patients in Pinar del Río

RESUMEN Introducción: el estudio de las características de los pacientes con la COVID-19 permite determinar grupos de riesgo en poblaciones específicas y trazar estrategias por las instituciones para enfrentar dicha situación. Objetivo: caracterizar clínico-epidemiológicamente a pacientes confirmados con la COVID-19 en Pinar del Río. Métodos: se realizó un estudio observacional, descriptivo, longitudinal y prospectivo en los 52 casos con diagnóstico confirmado a la COVID-19 entre marzo y mayo de 2020. Los datos fueron recogidos de las historias clínicas y las encuestas epidemiológicas. Se empleó estadística descriptiva. Resultados: predominó el grupo etario entre 40 y 59 años (tasa de 8,2 por cada 10 mil habitantes), con predominio del sexo masculino (tasa de 0,8 por cada 10 mil habitantes). El 94,2 % de los pacientes presentaron fuente de infección precisada al momento del ingreso. Los síntomas más frecuentes fueron la fiebre (51,9 %), tos (40,4 %) y rinorrea (21,1 %). La hipertensión arterial se presentó en el 11,11 % de los pacientes, donde el 35,7 % de los pacientes hipertensos desarrollaron neumopatía aguda inflamatoria. En el 86,5 % de los pacientes se realizó alta clínica a los 14 días y el 96,2 % alta epidemiológica a los 28 días. Conclusiones: la transmisión fue mayormente autóctona, menormente asintomática, donde la fiebre y la tos fueron los principales síntomas. Los pacientes con comorbilidades desarrollaron en mayor cuantía, complicaciones. Se encontró una respuesta positiva al tratamiento con altos porcentajes de alta clínica y epidemiológica a los 14 y 28 días respectivamente.

ABSTRACT Introduction: the study of the characteristics of COVID-19 patients allows the determination of risk groups and specific populations and the strategies designed by the institutions to deal with this situation. Objective: to characterize clinical and epidemiologically the confirmed COVID-19 patients in Pinar del Río. Methods: an observational, descriptive, longitudinal and prospective study including the 52 confirmed cases of COVID-19 between March and May 2020 was conducted. Data were collected from clinical records and epidemiological surveys. Descriptive statistics was used. Results: the age group between 40 and 59 years old predominated (rate of 8,2 per 10 thousand inhabitants), with predominance of male sex (rate of 0,8 per 10 thousand inhabitants). The 94,2 % of the patients presented a precise source of infection at the time of admission. The most frequent symptoms were fever (51,9 %), cough (40,4 %) and rhinorrhea (21,1 %). High blood pressure was present in 11,11 % of the patients, where 35,7 % of hypertensive patients developed acute inflammatory pneumopathy; 86,5 % of the patients were discharged from hospital after 14 days and 96,2 % were epidemiologically discharged after 28 days. Conclusions: transmission was mostly autochthonous, less asymptomatic, where fever and cough were the main symptoms. Patients with comorbidities developed more complications. A positive response to treatment was found, achieving high percentages of clinical and epidemiological discharge at 14 and 28 days respectively.

Fracturas de tobillo en adultos mayores / Ankle Fracture Treatment in Aged Adults

RESUMEN Introducción: El tratamiento de las fracturas del tobillo tiene importancia en la recuperación de la movilidad e independencia del paciente geriátrico. Objetivo: Evaluar el resultado obtenido al transcurrir un año del tratamiento quirúrgico mediante reducción y fijación de las fracturas inestables en pacientes mayores de 65 años. Métodos: Estudio descriptivo y prospectivo; pacientes mayores de 65 años, atendidos entre enero de 2017 y diciembre de 2018 por fractura de tobillo desplazada, en el Hospital Universitario General Calixto García Íñiguez y el Centro de Investigaciones en Longevidad, Envejecimiento y Salud, que fueron evaluados un año después. Resultados: De un total de 31 pacientes, 6 hombres y 25 mujeres con una edad media de 73,4 ± 3,5 años, 12 presentaban deterioro cognitivo, 18 llevaban terapia anticoagulante y 14 ingerían más de cuatro medicamentos diariamente. Predominaron los grupos con 3 y 4 puntos del índice de Charlson, la mayoría se ubicó en ASA III de riesgo anestésico y fracturas Dannis-Weber tipo C, 29 fracturas fueron cerradas. Las complicaciones fueron escasas; 27 de 31 pacientes se ubicaron como excelente o bueno según la escala AOFAS; 3 ± 2 en la escala visual de dolor; 86 por ciento podían realizar sus actividades de la vida diaria, Conclusiones: El resultado del tratamiento quirúrgico de las fracturas de tobillo en mayores de 65 años fue bueno y con baja incidencia de complicaciones que pueden relacionarse con condiciones mórbidas previas(AU)

ABSTRACT Introduction: The ankle fracture treatment is important in the recovery of mobility and independence of geriatric patients. Objective: To evaluate the results after one year of surgical treatment by reduction and fixation of unstable fractures in patients older than 65 years. Methods: A descriptive and prospective study was carried out in patients older than 65 years, treated from January 2017 to December 2018 due to displaced ankle fracture, at General Calixto García Íñiguez University Hospital and the Research Center for Health, Longevity and Aging. These patients were assessed a year later. Results: Out of a total of 31 patients, 6 men and 25 women with a mean age of 73.4 ± 3.5 years, 12 had cognitive impairment, 18 were on anticoagulant therapy and 14 were taking more than four medications daily. Groups with 3 and 4 points of Charlson index predominated, the majority were located in ASA III of anesthetic risk and Dannis-Weber type C fractures, 29 fractures were closed. Complications were rare and 27 out of 31 patients ranked as excellent or good according to the AOFAS scale, 3 ± 2 on the visual pain scale, 86 percent of performing activities of their daily life. Conclusions: The result of the surgical treatment of ankle fractures in people older than 65 years was good and with a low incidence of complications that may be related to previous morbid conditions(AU)

The economic benefits of increasing breastfeeding rates in Spain.

BACKGROUND: Interventions aimed at promoting breastfeeding rates are among the most effective possible health policies available, with an estimated return of US$35 per dollar invested. Indeed, some authors found that a 10% increase in exclusive breastfeeding rates in the first two years of life led to a reduction in treatment costs of US$312 million in the US, US$7.8 million in the UK, US$30 million in China, and US$1.8 million in Brazil. Among high-income countries, Spain stands out for its low breastfeeding rate. METHODS: We calculated the savings that the Spanish National Health System would have benefited from had breastfeeding rates been higher in Spain, both from the time of hospital discharge and at 6 months postpartum. We followed the methods used in similar studies carried out in the US, Italy, Australia, the Netherlands, and the UK, to conservatively estimate these potential savings by considering only the lower thresholds in all our estimates. Here we approximated the benefits of having increased exclusive breastfeeding rates based on the lower incidence of infantile pathologies among exclusively breastfed infants. Robust evidence indicates that among breastfed infants there is a lower prevalence of otitis media, gastroenteritis, respiratory infections, and necrotising enterocolitis. We obtained the estimated monetary cost of these diseases by combining their prevalences with data about their economic costs for diagnosis-related groups. RESULTS: The estimated effects we calculated imply that the Spanish National Health System could have saved more than €5.6 million for every percentage point increase in exclusive breastfeeding rates in Spain during 2014. CONCLUSIONS: Breastfeeding is essential both for the health of mothers and the health and development of newborns but is rarely considered as an economic issue and remains economically invisible. In addition to the improved wellbeing of mothers and their infants, breastfeeding can positively impact society as a whole and should therefore be better defined in public policies. Thus, strategies aimed at increasing exclusive breastfeeding rates would likely contribute to lowering the fiscal burden of the Spanish National Health System. Moreover, the magnitude of these potential benefits suggests that such policies would likely be socially cost-effective.

Características epidemiológicas de los pacientes portadores de COVID-19 en Pinar del Río, Cuba

RESUMEN Introducción: Comprender la evolución epidemiológica de la enfermedad COVID-19 proporcionará información oportuna para guiar la política de intervención con mayor eficiencia. Objetivo: Determinar las características epidemiológicas de los pacientes portadores de COVID-19. Métodos: Investigación epidemiológica, descriptiva, longitudinal realizada en la provincia de Pinar del Rio, Cuba, del 20 marzo-20 junio de 2020. El universo de estudio lo constituyeron los 52 casos portadores de COVID-19. Variables analizadas: edad, sexo, modos de contagio, afectados por municipios, número reproductivo básico y eventos de trasmisión local ocurridos. Para el análisis se empleó el paquete estadístico SPSS versión 21.0. Resultados: La enfermedad predominó en el sexo femenino 29 (55,77 %), en edades de 30 a 39 años 10 (19,24 %), el contacto directo fue el modo de contagio principal 47 (90,38 %), el municipio más afectado es Guane 19 (39,54 %), el índice de reproducción más alto, mes de abril (2,57); hubo dos eventos de trasmisión local en la provincia. Conclusiones: La enfermedad COVID-19 por su desarrollo, desde el punto de vista epidemiológico tuvo una evolución favorable en la provincia de Pinar del Río, lo que permitió su erradicación.

ABSTRACT Introduction: To understand the epidemiological evolution of COVID-19 disease will provide appropriate information for guiding the interventions policy with higher efficiency. Objective: To determine the epidemiological characteristics of COVID-19 carriers. Methods: Epidemiological, descriptive, longitudinal study conducted in Pinar del Río province from March 20 to June 20, 2020. The study sample was formed by 53 COVID-19 carrier's cases. The variables analysed were: age, sex, way of contagion, patients per municipalities and events of local transmission occurred. For this analysis, it was used the statistics package called SPSS version 21.0 Results: The disease was predominant in the female sex (29 patients representing 55.7%), in ages from 30 to 39 years (10 patients representing 19.24%), the direct contact was the main contagion way (47 patients representing 90.38%); the most affected municipality was Guane with 19 patients (39.54%), the highest reproduction rate was in April (2,57), and there were two events of local transmission in the province. Conclusions: COVID-19 due to its behaviour and from the epidemiological point of view had a favourable evolution which allowed its eradication.

Influence of Starch Composition and Molecular Weight on Physicochemical Properties of Biodegradable Films.

Thermoplastic starch (TPS) films are considered one of the most promising alternatives for replacing synthetic polymers in the packaging field due to the starch biodegradability, low cost, and abundant availability. However, starch granule composition, expressed in terms of amylose content and phosphate monoesters, and molecular weight of starch clearly affects some film properties. In this contribution, biodegradable TPS films made from potato, corn, wheat, and rice starch were prepared using the casting technique. The effect of the grain structure of each starch on microstructure, transparency, hydration properties, crystallinity, and mechanical properties of the films, was evaluated. Potato starch films were the most transparent and corn starch films the most opaque. All the films had homogeneous internal structures-highly amorphous and with no pores, both of which point to a good starch gelatinization process. The maximum tensile strength (4.48-8.14 MPa), elongation at break (35.41-100.34%), and Young's modulus (116.42-294.98 MPa) of the TPS films were clearly influenced by the amylose content, molecular weight, and crystallinity of the film. In this respect, wheat and corn starch films, are the most resistant and least stretchable, while rice starch films are the most extensible but least resistant. These findings show that all the studied starches can be considered suitable for manufacturing resistant and flexible films with similar properties to those of synthetic low-density polyethylene (LDPE), by a simple and environmentally-friendly process.

Relación entre la degeneración discal y la inestabilidad lumbar / Relations between disc degeneration and lumbar instability

Introducción: La inestabilidad lumbar es una de las causas más frecuentes del dolor en la espalda. Las dificultades para el diagnóstico provocan que su incidencia sea menor de lo esperado en la práctica clínica y dificultan su tratamiento. Objetivo: Evaluar lo publicado relativo al proceso de degeneración discal, así como su influencia sobre la estabilidad de la columna lumbar. Métodos: Se revisaron los principales avances relacionados con la degeneración discal que guardan relación con la inestabilidad vertebral lumbar. Se consultaron artículos publicados en PubMed, en idioma inglés, desde 2012 hasta 2017. Se examinaron artículos accesibles de forma libre o a través de Clinical Key e Hinari. Se tuvieron en cuenta algunos artículos que sobrepasan los cinco años de antigüedad, pero que son claves en el tema. Resultados: Dos procesos afectan al disco intervertebral lumbar como consecuencia del envejecimiento y la degeneración: espondilosis deformante y osteocondrosis intervertebral. Los cambios degenerativos están relacionados con el tiempo. Se pueden diferenciar tres fases que, a manera de cascada, desencadenan trastornos del movimiento e inestabilidad. Conclusiones: Los cambios degenerativos vertebrales producen aumento de la movilidad segmentaria (posible causa de inestabilidad lumbar). La zona neutra es un parámetro solo medible in vitro. No existe una prueba que permita confirmar el diagnóstico de inestabilidad vertebral. Los hallazgos clínicos y por imágenes constituyen la mejor recomendación para llegar al diagnóstico. El concepto de inestabilidad vertebral lumbar y su tratamiento, a través de la fusión vertebral, no están suficientemente justificados(AU)

Introduction: Lumbar instability is one of the most frequent causes of back pain. Difficulties in diagnosis result its incidence to be lower than expected in clinical practice and make it difficult to treat. Objective: To characterize and evaluate what is published regarding the process of disc degeneration, as well as its influence on the stability of the lumbar spine. Methods: We reviewed the main advances related to disc degeneration that cause vertebral instability. Articles published in PubMed, in English, from 2012 to 2017 were consulted. Articles in open access or through Clinical Key and Hinari were studied. Some articles older than 5 years were taken into account, because they are relevant to the subject. Results: Two processes affect the lumbar intervertebral disc because of aging and degeneration: deforming spondylosis and intervertebral osteochondrosis. The degenerative changes occur related to time and three phases can be differentiated that cascade triggers movement disorders and instability. Conclusions: Vertebral degenerative changes produce increased segmental mobility, a possible cause of lumbar instability. The neutral zone is a parameter only measurable "in vitro". There is no evidence to confirm the diagnosis of vertebral instability. Clinical and imaging findings are the best recommendation to reach to a diagnosis. The concept of lumbar vertebral instability and its treatment through vertebral fusion are not sufficiently justified(AU)

Introduction: L'instabilité lombaire est l'une des causes les plus fréquentes du mal au dos. Son diagnostic s'avère difficile, ce qui provoque une incidence plus faible qu'attendu dans la pratique clinique, et empêche son traitement. Objectif: Évaluer tout ce qui a été publié en relation avec le processus de dégénérescence discale, ainsi que son influence sur la stabilité de la colonne lombaire. Méthodes: Une revue des principales avancées relatives à la dégénérescence distale qui sont en rapport avec l'instabilité vertébrale lombaire a été effectuée. On a consulté des articles publiés sur PubMed, en langue anglaise, depuis 2012 jusqu'à 2017. On a examiné des articles accessibles de manière libre ou à travers Clinical Key et Hinari. Si bien que certains articles surpassaient les cinq ans de publication, ils ont été pris en compte, parce qu'ils étaient essentiels pour ce thème. Résultats: Deux processus affectent le disque intervertébral lombaire comme conséquence du vieillissement et de la dégénérescence -la spondylose déformante et l'ostéochondrose intervertébrale. Les changements dégénératifs sont en relation avec le temps. On peut distinguer trois phases qui, en guise de cascade, déclenchent les troubles du mouvement et l'instabilité. Conclusion: Les changements dégénératifs vertébraux entrainent une augmentation de la mobilité segmentaire (possible cause d'instabilité lombaire). La zone neutre est un paramètre qui ne peut être mesuré qu'in vitro. Il n'existe aucune preuve permettant de confirmer le diagnostic d'instabilité vertébrale. Les constatations cliniques et par imagerie constituent la meilleure recommandation pour aboutir à un diagnostic. La notion d'instabilité vertébrale lombaire et son traitement, à travers la fusion vertébrale, ne sont pas suffisamment justifiés(AU)

Relación entre la degeneración discal, el dolor y la estabilidad lumbar / Relationship between disc degeneration, pain and lumbar stability

Introducción: La inestabilidad lumbar es una de las causas más frecuentes del dolor en la espalda. Las dificultades para el diagnóstico provocan que su incidencia sea menor de lo esperado en la práctica clínica y dificultan su tratamiento. Objetivo: Evaluar lo publicado relativo al proceso de degeneración discal, así como su influencia sobre la estabilidad de la columna lumbar. Métodos: Se revisaron los principales avances relacionados con la degeneración discal que guardan relación con la inestabilidad vertebral lumbar. Se consultaron artículos publicados en PubMed, en idioma inglés, desde 2012 hasta 2017. Se examinaron artículos accesibles de forma libre o a través de Clinical Key e Hinari. Se tuvieron en cuenta algunos artículos que sobrepasan los cinco años de antigüedad, pero que son claves en el tema. Resultados: Dos procesos afectan al disco intervertebral lumbar como consecuencia del envejecimiento y la degeneración: espondilosis deformante y osteocondrosis intervertebral. Los cambios degenerativos están relacionados con el tiempo. Se pueden diferenciar tres fases que, a manera de cascada, desencadenan trastornos del movimiento e inestabilidad. Conclusiones: Los cambios degenerativos vertebrales producen aumento de la movilidad segmentaria (posible causa de inestabilidad lumbar). La zona neutra es un parámetro solo medible in vitro. No existe una prueba que permita confirmar el diagnóstico de inestabilidad vertebral. Los hallazgos clínicos y por imágenes constituyen la mejor recomendación para llegar al diagnóstico. El concepto de inestabilidad vertebral lumbar y su tratamiento, a través de la fusión vertebral, no están suficientemente justificados(AU)

Introduction: Lumbar instability is one of the most frequent causes of back pain. Difficulties in diagnosis result its incidence to be lower than expected in clinical practice and make it difficult to treat. Objective: To characterize and evaluate what is published regarding the process of disc degeneration, as well as its influence on the stability of the lumbar spine. Methods: We reviewed the main advances related to disc degeneration that cause vertebral instability. Articles published in PubMed, in English, from 2012 to 2017 were consulted. Articles in open access or through Clinical Key and Hinari were studied. Some articles older than 5 years were taken into account, because they are relevant to the subject. Results: Two processes affect the lumbar intervertebral disc because of aging and degeneration: deforming spondylosis and intervertebral osteochondrosis. The degenerative changes occur related to time and three phases can be differentiated that cascade triggers movement disorders and instability. Conclusions: Vertebral degenerative changes produce increased segmental mobility, a possible cause of lumbar instability. The neutral zone is a parameter only measurable "in vitro". There is no evidence to confirm the diagnosis of vertebral instability. Clinical and imaging findings are the best recommendation to reach to a diagnosis. The concept of lumbar vertebral instability and its treatment through vertebral fusion are not sufficiently justified(AU)

Introduction: L'instabilité lombaire est l'une des causes les plus fréquentes du mal au dos. Son diagnostic s'avère difficile, ce qui provoque une incidence plus faible qu'attendu dans la pratique clinique, et empêche son traitement. Objectif: Évaluer tout ce qui a été publié en relation avec le processus de dégénérescence discale, ainsi que son influence sur la stabilité de la colonne lombaire. Méthodes: Une revue des principales avancées relatives à la dégénérescence distale qui sont en rapport avec l'instabilité vertébrale lombaire a été effectuée. On a consulté des articles publiés sur PubMed, en langue anglaise, depuis 2012 jusqu'à 2017. On a examiné des articles accessibles de manière libre ou à travers Clinical Key et Hinari. Si bien que certains articles surpassaient les cinq ans de publication, ils ont été pris en compte, parce qu'ils étaient essentiels pour ce thème. Résultats: Deux processus affectent le disque intervertébral lombaire comme conséquence du vieillissement et de la dégénérescence -la spondylose déformante et l'ostéochondrose intervertébrale. Les changements dégénératifs sont en relation avec le temps. On peut distinguer trois phases qui, en guise de cascade, déclenchent les troubles du mouvement et l'instabilité. Conclusion: Les changements dégénératifs vertébraux entrainent une augmentation de la mobilité segmentaire (possible cause d'instabilité lombaire). La zone neutre est un paramètre qui ne peut être mesuré qu'in vitro. Il n'existe aucune preuve permettant de confirmer le diagnostic d'instabilité vertébrale. Les constatations cliniques et par imagerie constituent la meilleure recommandation pour aboutir à un diagnostic. La notion d'instabilité vertébrale lombaire et son traitement, à travers la fusion vertébrale, ne sont pas suffisamment justifiés(AU)