Dysphagia lusoria in a young patient with a concomitant aortic arch anomaly, successfully treated with surgery: a case report.

Dysphagia is a common condition in clinical practice; however, an unusual type of dysphagia due to compression of the esophagus by an abnormal right subclavian artery may be discovered in a rare subset of patients. The prognosis and treatment will depend on the severity of the symptoms and the compromise of surrounding structures. We present the case of an 18-year-old female who presented with gradually progressive dysphagia. At first, it was treated as gastroesophageal reflux disease; nonetheless, the dysphagia became severe, and after a thorough evaluation, an aberrant right subclavian artery that compressed the esophagus was discovered along with a truncus bicaroticus. She was successfully treated with surgery without any complications. On follow-ups, she's doing well.

Genetic variants of PON1, GSTM1, GSTT1, and locus 9p21.3, and the risk for premature coronary artery disease in Yucatan, Mexico.

OBJECTIVE: Genetic variants of PON1, rs70587, rs662, rs854560, GSTM1, and GSTT1 and two single nucleotide polymorphisms (SNP) at 9p21.3 locus, rs1333049, and rs2383207; were evaluated in association with the risk for premature coronary artery disease (CAD) in a population of Yucatan, Mexico. These genes are involved in the inactivation of pro-oxidants and pro-inflammatory mediators, lipid and xenobiotic metabolism, detoxification of reactive oxygen species, and regulation of cellular proliferation playing key roles in the pathogenesis of atherosclerosis. METHODS: We conducted a matched case-control study with 98 CAD cases and 101 healthy controls. Genotyping of PON1 and 9p21.2 SNP was performed by real time-PCR and for GSTM1 and GSTT1 with multiplex-PCR. Odds ratios (OR) were calculated to estimate association and generalized multifactor dimensionality reduction (GMDR) algorithm to identify gene-gene and gene-environment interactions. RESULTS: The distribution of all allele/genotype frequencies in controls was within Hardy-Weinberg expectations (p > .05) except for GSTM1. The allele/genotype frequencies of the GSTT1 null were significantly higher in CAD cases than in controls, suggesting association with higher risk for developing CAD. The other SNPs did not show any significant independent association with premature CAD. GMDR revealed a significant interaction between GSTT1 and LL55 genotype. Likewise, the body mass index (BMI) and smoking also showed an interaction with GSTT1. CONCLUSION: The GSTT1 null allele/genotype is associated with an increased risk of developing premature CAD, the effect of which is not modified by cardiovascular risk factors in the population of Yucatan.

Formación profesional del especialista en Medicina General Integral y su competencia para prevenir el suicidio / Professional training of the specialist in Comprehensive General Medicine and his competence to prevent suicide

Fundamento: una de las especialidades de posgrado que más ha impactado en el sistema nacional de salud es Medicina General Integral sustentada en el enfoque social de la medicina. Objetivo: determinar las tendencias históricas del proceso de formación profesional del especialista en Medicina General Integral y su influencia en el desarrollo de la competencia específica para prevenir el intento de suicidio. Métodos: se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de documentos, se consideraron tesis de doctorado, maestría, artículos originales y de revisión publicados entre 2005 y 2021 en español e inglés. La búsqueda fue realizada en las bases de datos SciELO y Google académico de enero 2021 a marzo de 2022. Desarrollo: a pesar del desarrollo alcanzado por la especialidad aún es insuficiente la preparación de ese capital humano como verdadero promotor de salud, porque no ha sido estructurado pensando en tales idoneidades y subyacen debilidades en su actuar preventivo donde la especialización de modos de actuación para prevenir el intento de suicidio como daño a la salud se ubica en vínculo indisoluble con la práctica asistencial de este galeno y necesita ser empoderado de conocimientos para elevar su competencia y desempeño exitoso. Conclusiones: el tratamiento de los indicadores en las etapas analizadas permite revelar las principales tendencias históricas del proceso de formación profesional del especialista en Medicina General Integral por lo que el desarrollo de una competencia preventivo-suicidológica emerge como una necesidad en su superación profesional.

Intoduction: one of the postgraduate specialties that has had the most impact on the national health system is Comprehensive General Medicine based on the social approach to medicine. Objective: to determine the historical trends of the professional training process of the Comprehensive General Medicine specialist and its influence on the development of the specific competence to prevent suicidal attempt. Methods: a systematic bibliographic review was carried out to develop a reflexive critical analysis of the content of documents, considering doctoral and master's theses, original and review articles published from 2005 to 2021 in Spanish and English. The search was carried out in the SciELO and academic Google databases from January 2021 to March 2022. Development: despite the development achieved by the specialty, the preparation of this human capital as a true health promoter is still insufficient, because it has not been structured with such qualifications in mind and there are underlying weaknesses in its preventive action where the specialization of modes of action to prevent The suicidal attempt as damage to health is inextricably linked with the care practice of this doctor and needs to be empowered with knowledge to increase his competence and successful performance. Conclusions: the treatment of the indicators in the stages analyzed allows revealing the main historical trends of the professional training process of the specialist in Comprehensive General Medicine, so the development of a preventive-suicidal competence emerges as a necessity in their professional improvement.

Satisfacción estudiantil sobre el manual "Prevención de la Conducta Suicida" en Medicina General Integral / Student satisfaction with the manual "Prevention of Suicidal Behavior" in Comprehensive General Medicine

RESUMEN Fundamento: crear manuales que complementen y faciliten el aprendizaje del estudiante permite cumplir con el encargo social de los docentes como formadores de los futuros profesionales de la salud. Objetivo: valorar el nivel de satisfacción de los estudiantes de Medicina sobre el manual digital "Prevención de la Conducta Suicida" como recurso bibliográfico para facilitar el aprendizaje del referido tema en la disciplina integradora Medicina General Integral. Métodos: se realizó un estudio observacional descriptivo en en la Facultad de Ciencias Médicas de Manzanillo, Granma, en el curso 2018-2019. Se utilizaron métodos teóricos: análisis-síntesis, hipotético-deductivo y hermenéutico-dialéctico; empíricos: cuestionario a estudiantes como usuarios del manual, y para procesar la información se utilizó la estadística descriptiva. Resultados: el uso del manual facilitó la comprensión del contenido teórico y el desarrollo de habilidades para detectar riesgos en pacientes con este tipo de conducta, desde la educación en el trabajo en el consultorio médico de familia y otros escenarios docentes por donde los alumnos cumplen su rotación. Conclusiones: los estudiantes expresaron un nivel adecuado de satisfacción en sus respuestas sobre el uso del manual diseñado para los temas de la disciplina Medicina General Integral.

ABSTRACT Background: creating manuals that complement and facilitate student learning allows fulfilling the social mission of teachers as trainers of future health professionals. Objective: to assess the level of satisfaction of medical students on the electronic manual "Prevention of Suicidal Behavior" as a bibliographic resource to facilitate learning of the aforementioned subject in the integrative discipline General Comprehensive Medicine. Methods: a descriptive observational study was carried out in the Faculty of Medical Sciences of Manzanillo, Granma, in the 2018-2019 academic year. Theoretical methods were used: analysis-synthesis, hypothetical-deductive and hermeneutical-dialectical; empirical: questionnaire to students as users of the manual and descriptive statistics were used to process the information. Results: the use of the manual facilitated the understanding of the theoretical content and the development of skills to detect risks in patients with this type of behavior, from the in-service training in the GP's office and other teaching institutions where students fulfill their rotation. Conclusions: the students expressed an adequate level of satisfaction in their answers about the use of the manual designed for the subjects of the comprehensive General Medicine discipline.

Un acercamiento al conocimiento de la presencia de marcadores neurobiológicos en la génesis del suicidio / An approach to the knowledge of the presence of neurobiological markers in the genesis of suicide / Uma abordagem para o conhecimento da presença de marcadores neurobiológicos nagênese do suicídio

RESUMEN El suicidio ha constituido desde siempre uno de los grandes enigmas de la humanidad. El presente trabajo tiene como objetivo abordar los elementos más actuales de la génesis neurobiológica de la conducta suicida que puedan contribuir a su prevención. Se realizaron diversas búsquedas en materiales impresos y digitales a partir de las consultas del catálogo online de la biblioteca virtual de Infomed, en bases de datos multidisciplinarias así como las revistas digitales certificadas. Entre los marcadores neurobiológicos descritos en la actualidad más destacados están bajos niveles del 5-HIAA en el líquido cefalorraquídeo (LCR), aumento de la densidad de los receptores 5-HT1A en la corteza pre- frontal, disminución de los sitios de unión del receptor serotoninérgico en la misma región, modificación del sistema GABA-érgico y los receptores benzodiazepínicos entre otros. A modo de conclusión se puede decir que los marcadores neurobiológicos y los factores psicopatológicos- de interacción familiar- de stress psicosocial descritos buscan identificar aquellos individuos con potencial riesgo de suicidio para establecer medidas de prevención, lo cual exige su detección e intervención a tiempo buscando evitar la ocurrencia del primer intento y a su vez la repetición del acto que conlleve al desenlace fatal.

ABSTRACT Suicide has always been one of the great enigmas of humanity. The present work aims to address the most current elements of the neurobiological genesis of suicidal behavior that can contribute to its prevention. Various searches were made of printed and digital materials based on queries in the online catalog of the Infomed virtual library, in multidisciplinary databases as well as certified digital journals. Among the most prominent neurobiological markers currently described are low levels of 5-HIAA in cerebrospinal fluid (CSF), increased density of 5-HT1A receptors in the prefrontal cortex, decreased receptor binding sites serotonergic in the same region, decrease in platelet serotonin receptors, modification of the GABA-ergic system and benzodiazepine receptors, among others. Suicide has multidimensional qualities and a multifactorial etiopathogenesis, therefore, in the consummation of the suicidal act, genetic factors -neurobiological - psychopathological - family interaction - psychosocial stress should be considered. By way of conclusion, the neurobiological and psychosocial markers described seek to identify those individuals with a potential risk of suicide to establish a prevention measure, which requires their detection and intervention in time, seeking to avoid the occurrence of the first attempt and, in turn, the repetition of the act that entails to the fatal outcome.

RESUMO O suicídios em prefoium dos grandes enigmas da humanidade. O presente trabalho visa abordar os elementos maisatuais da gênese neurobiológica do comportamento suicida que podem contribuir para sua prevenção. Foram realizadas várias pesquisas em materiais impressos e digitais do catálogo online da biblioteca virtual Infomed, em bases de dados multidisciplinares e também em revistas digitais certificadas. Entre os marcadores neurobiológicos mais proeminentes atualmente descritos estão baixos níveis de 5-HIAA no líquido cefalorraquidiano (LCR), aumento da densidade de receptores 5-HT1A no córtex pré-frontal, diminuição dos sítios de ligação do receptor serotonérgicona mesma região, modificação do GABA- sistema ergico e receptores de benzodiazepina, entre outros. A título de conclusão, pode-se dizer que os marcadores neurobiológicos e fatores psicopatológicos - de interação familiar - do estresse psicossocial descritos buscam identificar aqueles indivíduos com potencial risco de suicídio para estabelecer medidas de prevenção, o que requer sua detecção e intervenção em tempo, visando evitar a ocorrência da primeira tentativa e, por sua vez, a repetição do ato que leva ao resultado fatal.

Un acercamiento al conocimiento de la presencia de marcadores neurobiológicos en la génesis del suicidio / An approach to the knowledge of the presence of neurobiological markers in the genesis of suicide

El suicidio ha constituido desde siempre uno de los grandes enigmas de la humanidad. El presente trabajo tiene como objetivo abordar los elementos más actuales de la génesis neurobiológica de la conducta suicida que puedan contribuir a su prevención. Se realizaron diversas búsquedas en materiales impresos y digitales a partir de las consultas del catálogo online de la biblioteca virtual de Infomed, en bases de datos multidisciplinarias así como las revistas digitales certificadas. Entre los marcadores neurobiológicos descritos en la actualidad más destacados están bajos niveles del 5-HIAA en el líquido cefalorraquídeo (LCR), aumento de la densidad de los receptores 5-HT1A en la corteza pre-frontal, disminución de los sitios de unión del receptor serotoninérgico en la misma región, modificación del sistema GABA-érgico y los receptores benzodiazepínicos entre otros. A modo de conclusión se puede decir que los marcadores neurobiológicos y los factores psicopatológicos-de interacción familiar- de stress psicosocial descritos buscan identificar aquellos individuos con potencial riesgo de suicidio para establecer medidas de prevención, lo cual exige su detección e intervención a tiempo buscando evitar la ocurrencia del primer intento y a su vez la repetición del acto que conlleve al desenlace fatal(AU)

Suicide has always been one of the great enigmas of humanity. The present work aims to address the most current elements of the neurobiological genesis of suicidal behavior that can contribute to its prevention. Various searches were made of printed and digital materials based on queries in the online catalog of the Infomed virtual library, in multidisciplinary databases as well as certified digital journals. Among the most prominent neurobiological markers currently described are low levels of 5-HIAA in cerebrospinal fluid (CSF), increased density of 5-HT1A receptors in the prefrontal cortex, decreased receptor binding sites serotonergic in the same region, decrease in platelet serotonin receptors, modification of the GABA-ergic system and benzodiazepine receptors, among others. Suicide has multidimensional qualities and a multifactorial etiopathogenesis, therefore, in the consummation of the suicidal act, genetic factors-neurobiological-psychopathological -family interaction-psychosocial stress should be considered. By way of conclusion, the neurobiological and psychosocial markers described seek to identify those individuals with a potential risk of suicide to establish a prevention measure, which requires their detection and intervention in time, see king to avoid the occurrence of the first attempt and, in turn, the repetition of the act that entails to the fatal outcome(EU)

Competencia y desempeño del médico de la familia en la prevención de la conducta suicida a nivel comunitario / Competence and performance of the family doctor in the prevention of suicidal behavior at the community level

La investigación tiene como objetivo evaluar la competencia profesional y el desempeño del médico de familia en la prevención y control de la conducta suicida. Se realizó un estudio descriptivo, el universo fueron 33 médicos (residentes y especialistas) distribuidos en las 18 áreas de salud del Policlínico No. 2 de Manzanillo. La información se obtuvo de una encuesta que permitió determinar el nivel de competencia específica para la prevención del intento y/o suicidio, una guía para evaluar el desempeño profesional y una entrevista focalizada buscando la triangulación metodológica. La mayoría de los médicos obtienen una competencia inadecuada 81.8 por ciento, la razón expresa que por cada 6 médicos evaluados con una competencia inadecuada hay solo 1 con una competencia adecuada, el 75.8 por ciento fueron evaluados con un desempeño profesional inadecuado, la razón expresa que por cada 5 médicos evaluados con un desempeño inadecuado hay solo 1 con un desempeño adecuado. Con la aplicación de los instrumentos validados se comprobó insuficientes conocimientos en los médicos de familia para el manejo de este daño a la salud a nivel comunitario lo que limita su actuación en la práctica asistencial y denota la necesidad de la superación postgraduada para resolver las insuficiencias detectadas(AU)

The research aims to evaluate the professional competence and performance of the family doctor in the prevention and control of suicidal behavior. A descriptive study was carried out, the universe was 33 doctors (residents and specialists) distributed in the 18 health areas of the Polyclinic No. 2 of Manzanillo. The information was obtained from a survey that made it possible to determine the level of specific competence for the prevention of attempt and/or suicide, a guide to evaluate professional performance and a focused interview seeking methodological triangulation. Most of the doctors obtain an inadequate competence 81.8 percent, the reason expresses that for every 6 doctors evaluated with an inadequate competence there is only 1 with an adequate competence, 75.8 percent were evaluated with an inadequate professional performance, the reason expresses that for each 5 doctors evaluated with an inadequate performance there is only 1 with an adequate performance. With the application of the validated instruments, insufficient knowledge was found in family physicians for the management of this damage to health at the community level, which limits their performance in healthcare practice and denotes the need for postgraduate improvement to resolve the deficiencies detected(EU)

Competencia y desempeño del médico de la familia en la prevención de la conducta suicida a nivel comunitario / Competence and performance of the family doctor in the prevention of suicidal behavior at the community level / Competência e atuação do médico de família na prevenção do comportamento suicida na comunidade

RESUMEN La investigación tiene como objetivo evaluar la competencia profesional y el desempeño del médico de familia en la prevención y control de la conducta suicida. Se realizó un estudio descriptivo, el universo fueron33médicos (residentes y especialistas) distribuidos en las 18 áreas de salud del Policlínico No.2 de Manzanillo. La información se obtuvo de una encuesta que permitió determinar el nivel de competencia específica para la prevención del intento y/o suicidio, una guía para evaluar el desempeño profesional y una entrevista focalizada buscando la triangulación metodológica. La mayoría de los médicos obtienen una competencia inadecuada 81.8%, la razón expresa que por cada 6 médicos evaluados con una competencia inadecuada hay solo 1 con una competencia adecuada, el 75.8%fueron evaluados con un desempeño profesional inadecuado, la razón expresa que por cada 5 médicos evaluados con un desempeño inadecuado hay solo 1 con un desempeño adecuado. Con la aplicación de los instrumentos validados se comprobó insuficientes conocimientos en los médicos de familia para el manejo de este daño a la salud a nivel comunitario lo que limita su actuación en la práctica asistencial y denota la necesidad de la superación postgraduada para resolver las insuficiencias detectadas.

ABSTRACT The research aims to evaluate the professional competence and performance of the family doctor in the prevention and control of suicidal behavior. A descriptive study was carried out, the universe was 33 doctors (residents and specialists) distributed in the 18 health areas of the Polyclinic No.2 of Manzanillo. The information was obtained from a survey that made it possible to determine the level of specific competence for the prevention of attempt and / or suicide, a guide to evaluate professional performance and a focused interview seeking methodological triangulation. Most of the doctors obtain an inadequate competence 81.8%, the reason expresses that for every 6 doctors evaluated with an inadequate competence there is only 1 with an adequate competence, 75.8% were evaluated with an inadequate professional performance, the reason expresses that for each 5 doctors evaluated with an inadequate performance there is only 1 with an adequate performance. With the application of the validated instruments, insufficient knowledge was found in family physicians for the management of this damage to health at the community level, which limits their performance in healthcare practice and denotes the need for postgraduate improvement to resolve the deficiencies detected.

RESUMO A pesquisa tem como objetivo avaliar a competência profissional e a atuação do médico de família na prevenção e controle do comportamento suicida. Foi realizado um estudo descritivo, o universo foi de 33 médicos (residentes e especialistas) distribuídos nas 18 áreas de saúde da Policlínica nº 2 de Manzanillo. As informações foram obtidas por meio de questionário que possibilitou determinar o nível de competência específica para a prevenção de tentativa e / ou suicídio, guia de avaliação do desempenho profissional e entrevista focada buscando triangulação metodológica. A maioria dos médicos obtém uma competência inadequada 81,8%, o motivo expressa que para cada 6 médicos avaliados com competência inadequada há apenas 1 com competência adequada, 75,8% foram avaliados com desempenho profissional inadequado, o motivo expressa que para cada 5 médicos avaliados com desempenho inadequado restando apenas 1 com desempenho adequado. Com a aplicação dos instrumentos validados, foi constatado conhecimento insuficiente dos médicos de família para o manejo desses agravos à saúde na comunidade, o que limita sua atuação na prática assistencial e denota a necessidade de aprimoramento da pós-graduação para sanar as deficiências detectadas.

Conocimientos sobre la COVID 19 en pacientes del CMF No. 12 y acciones preventivas del trío de pesquisa / Knowledge about COVID 19 in CMF No. 12 patients and preventive actions of the research trio

Introducción: los grandes asesinos de la historia son las bacterias y los virus, a mediados de diciembre la humanidad comenzó a ser azotada por un nuevo virus SARS-CoV-2, originando una enfermedad llamada COVID 19. Objetivo: evaluar el nivel de conocimientos y el cumplimiento de las medidas preventivas sobre la COVID-19 en los pacientes antes y después de tener la presencia en el área de salud de un caso positivo a la Covid-19. Método: se realizó un estudio descriptivo con fase de intervención a los pacientes de tres Manzanas del consultorio # 12 del policlínico Ángel Ortíz Vázquez del municipio Manzanillo, de la provincia Granma. Resultados: los resultados obtenidos fueron de 583 pacientes un 55,5 por ciento presentan factores de riesgo, antes de la intervención un 34,8 por ciento desconocen vías de trasmisión, además un 44.0 por ciento usan el nasobuco de forma inadecuado, lo cual aumentó después de la pesquisa fortalecida aumento a un 97.7 por ciento, al igual que el nivel de conocimientos que aumentó a un 91.0 por ciento y satisfacción de la comunidad con las acciones educativas a un 100 por ciento. Conclusiones: se observó después de las acciones educativas un aumento en el conocimiento de la enfermedad empoderando a la población de conocimientos y prácticas necesarias, los pacientes cumplieron adecuadamente las medidas preventivas y la satisfacción de la comunidad con el trabajo de los tríos participantes fue favorable(AU)

Introduction: the greatest killers in history are bacteria and viruses, in mid-December humanity began to be hit by a new SARS-CoV-2 virus, causing a disease called COVID 19. Objective: to assess the level of knowledge and compliance with preventive measures on COVID-19 in patients before and after having the presence in the health area of a positive case for Covid-19. Method: a descriptive study with intervention phase was carried out on the patients of three apples from office # 12 of the Ángel Ortiz Vázquez polyclinic in the Manzanillo municipality, Granma province. Results: the results obtained were from 583 patients, 55.5 percent presented risk factors, before the intervention 34.8 percent were unaware of transmission routes, and 44.0 percent used the nasobuco improperly, which increased after the strengthened research increased to 97.7 percent, as did the level of knowledge that increased to 91.0 percent and satisfaction of the community with the educational actions to 100 percent. Conclusions: after the educational actions, an increase in the knowledge of the disease was observed, empowering the population with the necessary knowledge and practices, the patients adequately complied with the preventive measures and the satisfaction of the community with the work of the participating trios was favorable(EU)

Conocimientos sobre la COVID 19 en pacientes del CMF No. 12 y acciones preventivas del trío de pesquisa / Knowledge about COVID 19 in CMF No. 12 patients and preventive actions of the research trio / Conhecimento sobre COVID 19 em pacientes com CMF nº 12 e ações preventivas do trio de pesquisa

RESUMEN Introducción: los grandes asesinos de la historia son las bacterias y los virus, a mediados de diciembre la humanidad comenzó a ser azotada por un nuevo virus SARS-CoV-2, originando una enfermedad llamada COVID 19. Objetivo: evaluar el nivel de conocimientos y el cumplimiento de las medidas preventivas sobre la COVID-19 en los pacientes antes y después de tener la presencia en el área de salud de un caso positivo a la Covid-19. Método: se realizó un estudio descriptivo con fase de intervención a los pacientes de tres Manzanas del consultorio # 12 del policlínico Ángel Ortiz Vázquez del municipio Manzanillo, de la provincia Granma. Resultados: los resultados obtenidos fueron de 583 pacientes un 55,5 por ciento presentan factores de riesgo, antes de la intervención un 34,8% desconocen vías de trasmisión, además un 44.0 % usan el nasobuco de forma inadecuado, lo cual aumento después de la pesquisa fortalecida aumento a un 97.7%, al igual que el nivel de conocimientos que aumento a un 91.0% y satisfacción de la comunidad con las acciones educativas a un 100%. Conclusiones: se observó después de las acciones educativas un aumento en el conocimiento de la enfermedad empoderando a la población de conocimientos y prácticas necesarias, los pacientes cumplieron adecuadamente las medidas preventivas y la satisfacción de la comunidad con el trabajo de los tríos participantes fue favorable.

ABSTRACT Introduction: the greatest killers in history are bacteria and viruses, in mid-December humanity began to be hit by a new SARS-CoV-2 virus, causing a disease called COVID 19. Objective: to assess the level of knowledge and compliance with preventive measures on COVID-19 in patients before and after having the presence in the health area of ​​a positive case for Covid-19. Method: a descriptive study with intervention phase was carried out on the patients of three apples from office # 12 of the Ángel Ortiz Vázquez polyclinic in the Manzanillo municipality, Granma province. Results: the results obtained were from 583 patients, 55.5 percent presented risk factors, before the intervention 34.8% were unaware of transmission routes, and 44.0% used the nasobuco improperly, which increased after the strengthened research increased to 97.7%, as did the level of knowledge that increased to 91.0% and satisfaction of the community with the educational actions to 100%. Conclusions: after the educational actions, an increase in the knowledge of the disease was observed, empowering the population with the necessary knowledge and practices, the patients adequately complied with the preventive measures and the satisfaction of the community with the work of the participating trios was favorable.

RESUMO Introdução: os maiores assassinos da história são bactérias e vírus. Em meados de dezembro, a humanidade começou a ser atingida por um novo vírus SARS-CoV-2, causando uma doença chamada COVID 19. Objetivo: avaliar o nível de conhecimento e a adesão às medidas preventivas do COVID-19 em pacientes antes e depois da presença na área da saúde de um caso positivo para o Covid-19. Método: foi realizado um estudo descritivo com uma fase de intervenção em pacientes de três maçãs do consultório nº 12 da policlínica Ángel Ortiz Vázquez no município de Manzanillo, província de Granma. Resultados: os resultados obtidos foram de 583 pacientes, 55,5 por cento apresentavam fatores de risco, antes da intervenção 34,8% desconheciam as vias de transmissão e 44,0% usavam indevidamente o nasobuco, que aumentava após a pesquisa reforçada aumentou para 97,7%, assim como o nível de conhecimento que aumentou para 91,0% e a satisfação da comunidade com as ações educativas para 100%. Conclusões: após as ações educativas, observou-se um aumento no conhecimento da doença, capacitando a população com os conhecimentos e práticas necessários, os pacientes cumpriram adequadamente as medidas preventivas e a satisfação da comunidade com o trabalho dos trios participantes foi favorável.

Violencia doméstica en niños y adolescentes de la Comuna Tala Hady / The domestic violence of children and adolescents in the neighborhood Tala Hady

Fundamento: la violencia o abuso de niños y adolescentes ha sido reconocida por diversos autores como un problema complejo y creciente en los últimos años. Objetivo: describir los factores personales y familiares presentes en las víctimas sometidas a violencia doméstica en el Barrio Tala Hady, municipio de Cazenga. Métodos: la población en estudio fueron los casos denunciados y atendidos por violencia doméstica en la Delegación de la Policía en el segundo trimestre del año 2015 para un total de 31 casos. Se utilizó un cuestionario creado por los autores y el test de percepción del funcionamiento familiar (FF-SIL), fueron cumplidos los procedimientos éticos para la investigación.Resultados: predominó el sexo masculino, se destacó el grupo de 12-14 años y de 9-11 años, la mayoría tenían entre seis y ocho hermanos, lo que indicó que las familias estudiadas eran muy numerosas, referente a los tipos de violencia se encontró violencia física, violencia sexual y violencia psicológica , pero una buena parte de los casos sufrían más de un tipo de violencia, o sea, estaban expuestos a varios tipos de abuso y de agresión por padres, padrastos y madrastas, sobresalían las familias disfuncionales, donde los problemas más relevantes el abuso de alcohol u otras sustancias psicoactivas, problemas económicos y malas condiciones de vida, los factores descritos constituyen riesgo en los niños y adolescentes lo que compromete su desarrollo integral. Conclusiones: fue posible detectar la presencia de diversos tiposde violencia doméstica en la población infantil estudiada, con marcada presencia de daños físicos y psicológicos, lo que media en la problemática estudiada la disfuncionabilidad familiar, lo que da cuentas de la influencia negativa que pueden tener estas situaciones en la salud física y mental de los infantes(AU)

Background: the violence or abuse of children and adolescents has been recognized by various authors as a complex and growing problem in recent years. Objective:to describe the personal and family factors present in the victims subjected to domestic violence in the neighborhood Tala Hady, municipality of Cazenga. Methods: the study populations were cases reported and attended due to domestic violence in the Police Delegation in the second quarter of 2015, a total of 31.A questionnaire created by the authors and the family test (FF-SIL) were used, the ethical procedures for the research were fulfilled. Results: the male sex was predominant, the group of 12-14 years old and 9-11 years old stood out, the majority had between 6-8 siblings, indicating that the families studied were very numerous. Referring to the types of violence, physical violence, sexual violence and psychological violence were found, but a good part of the cases suffer more than one type of violence, that is, they were exposed to various types of abuse and aggression by parents, stepfathers or stepmothers, dysfunctional families stand out, being the most relevant problems the abuse of alcohol or other psychoactive substances, economic problems and bad living conditions. The described factors constitute risk in children and adolescents compromising their integral development. Conclusions: it was possible to detect the presence of different types of domestic violence in the child population studied, with a marked presence of physical and psychological damage, mediating the dysfunctional family in the studied problem, which accounts for the negative influence that these situations can have on the physical and mental health of infants(AU)

Violencia doméstica en niños y adolescentes de la Comuna Tala Hady / The domestic violence of children and adolescents in the neighborhood Tala Hady

RESUMEN Fundamento: la violencia o abuso de niños y adolescentes ha sido reconocida por diversos autores como un problema complejo y creciente en los últimos años. Objetivo: describir los factores personales y familiares presentes en las víctimas sometidas a violencia doméstica en el Barrio Tala Hady, municipio de Cazenga. Métodos: la población en estudio fueron los casos denunciados y atendidos por violencia doméstica en la Delegación de la Policía en el segundo trimestre del año 2015 para un total de 31 casos. Se utilizó un cuestionario creado por los autores y el test de percepción del funcionamiento familiar (FF-SIL), fueron cumplidos los procedimientos éticos para la investigación. Resultados: predominó el sexo masculino, se destacó el grupo de 12-14 años y de 9-11 años, la mayoría tenían entre seis y ocho hermanos, lo que indicó que las familias estudiadas eran muy numerosas, referente a los tipos de violencia se encontró violencia física, violencia sexual y violencia psicológica , pero una buena parte de los casos sufrían más de un tipo de violencia, o sea, estaban expuestos a varios tipos de abuso y de agresión por padres, padrastos y madrastas, sobresalían las familias disfuncionales, donde los problemas más relevantes el abuso de alcohol u otras sustancias psicoactivas, problemas económicos y malas condiciones de vida, los factores descritos constituyen riesgo en los niños y adolescentes lo que compromete su desarrollo integral. Conclusiones: fue posible detectar la presencia de diversos tipos de violencia doméstica en la población infantil estudiada, con marcada presencia de daños físicos y psicológicos, lo que media en la problemática estudiada la disfuncionabilidad familiar, lo que da cuentas de la influencia negativa que pueden tener estas situaciones en la salud física y mental de los infantes.

ABSTRACT Background: the violence or abuse of children and adolescents has been recognized by various authors as a complex and growing problem in recent years. Objective: to describe the personal and family factors present in the victims subjected to domestic violence in the neighborhood Tala Hady, municipality of Cazenga. Methods: the study populations were cases reported and attended due to domestic violence in the Police Delegation in the second quarter of 2015, a total of 31.A questionnaire created by the authors and the family test (FF-SIL) were used, the ethical procedures for the research were fulfilled. Results: the male sex was predominant, the group of 12-14 years old and 9-11 years old stood out, the majority had between 6-8 siblings, indicating that the families studied were very numerous. Referring to the types of violence, physical violence, sexual violence and psychological violence were found, but a good part of the cases suffer more than one type of violence, that is, they were exposed to various types of abuse and aggression by parents, stepfathers or stepmothers, dysfunctional families stand out, being the most relevant problems the abuse of alcohol or other psychoactive substances, economic problems and bad living conditions. The described factors constitute risk in children and adolescents compromising their integral development. Conclusions: it was possible to detect the presence of different types of domestic violence in the child population studied, with a marked presence of physical and psychological damage, mediating the dysfunctional family in the studied problem, which accounts for the negative influence that these situations can have on the physical and mental health of infants.

Conocimientos sobre prevención del intento de suicidio en estudiantes de Medicina y médicos de familia / Knowledge about the prevention of suicide attempts in medical students and general practitioners

RESUMEN Fundamento: una práctica laboral efectiva requiere de un enfoque de competencia que muestre la relación entre aprendizaje y trabajo. Objetivo: evaluar el nivel de conocimientos que tienen los estudiantes de Medicina y médicos de familia sobre la prevención del intento de suicidio. Método: se realizó un estudio descriptivo de corte transversal en el periodo de enero 2017-2018 en el Policlínico Docente 1. "Dra. Francisca Rivero Arocha" del municipio Manzanillo, Granma. Se utilizaron métodos teóricos: histórico-lógico, análisis-síntesis e inducción-deducción; empíricos: encuesta en forma de cuestionario; y estadísticos para el procesamiento de los datos en números absolutos y el análisis porcentual. Resultados: los encuestados mostraron desconocimiento en la identificación y atención de individuos y grupos de riesgo para cometer un intento suicida; la mayoría de los estudiantes estuvieron incluidos en la categoría de Mal, en los residentes y especialistas de Medicina General Integral sobresalen las categorías de Regular, en lo fundamental. Se constataron, además insuficiencias relacionadas con el desconocimiento de los objetivos que persigue el Programa Nacional para la Prevención y Control de la Conducta Suicida. Conclusión: el diagnóstico realizado evidenció notables insuficiencias en el conocimiento acerca de la prevención del intento suicida, los autores consideran que es un problema a resolver desde la academia en el proceso de formación y superación del profesional de la Atención Primaria de Salud.

ABSTRACT Background: an effective work practice requires a competency approach that shows the relationship between learning and work. Objective: to assess the level of knowledge that medical students and General practitioners have about the prevention of suicide attempts. Method: a descriptive cross-sectional study was carried out in the period from January 2017 to 2018 in "Dr. Francisca Rivero Arocha "Teaching Polyclinic 1" from the municipality of Manzanillo, Granma province. Theoretical methods were used: historical-logical, analysis-synthesis and induction-deduction; empirical ones: survey in the form of a questionnaire; and statistics for data processing of absolute numbers and the percentage analysis. Results: the respondents showed ignorance in the identification and attention of individuals and groups at risk to commit a suicide attempt; the majority of the students were included in the category of Bad, in the residents and specialists of comprehensive General Medicine the categories of average stand out, in the fundamental thing. There were also shortcomings related to the ignorance of the objectives pursued by the National Program for the Prevention and Control of Suicidal Behavior. Conclusion: the diagnosis made evidenced notable insufficiencies in the knowledge about the prevention of the suicidal attempt; the authors consider that it is a problem to solve from the academy in the process of formation and improvement of the professional of the Primary Health Care.

Análisis de epistasia de polimorfismos de genes metabólicos asociados a cardiopatía isquémica en Yucatán / Epistasis analysis of metabolic genes polymorphisms associated with ischemic heart disease in Yucatan

Objetivo: La epistasia es un tipo de interacción genética que podría explicar gran parte de la variabilidad fenotípica que muestran las enfermedades complejas. En este trabajo se determinó el efecto de la epistasia de genes metabólicos y los factores de riesgo cardiovascular en la susceptibilidad al desarrollo de cardiopatía isquémica en Yucatán. Métodos: Estudio de casos y controles en 79 pacientes yucatecos con cardiopatía isquémica y 101 controles sanos pareados por edad y origen con los casos. Se genotipificaron los polimorfismos -108CT, Q192R, L55M (paraoxonasa 1, PON1), C677T, A1298C (5,10 metilentetrahidrofolato reductasa, MTHFR) y la presencia/ausencia del gen glutatión S-transferasa T1 (GSTT1). El análisis de epistasia se realizó con el método de reducción dimensional multifactorial (MDR). El mejor modelo de predicción de riesgo se seleccionó con base en la precisión (%), la significación estadística (p < 0,05) y la consistencia de la validación cruzada. Resultados: Se encontró asociación independiente del genotipo nulo GSTT1*0/0 (OR = 3,39; IC: 1,29-8,87; p = 0,017) y el alelo nulo (OR = 1,86; IC: 1,19-2,91; p = 0,007) con la cardiopatía isquémica. La deleción GSTT1*0 y el genotipo 677TT (MTHFR) se identificaron de alto riesgo cardiovascular, mientras que el genotipo silvestre GSTT1*1 y la variante CC677 se clasificaron de bajo riesgo. La interacción gen-ambiente identificó al gen GSTT1, al polimorfismo C677T (MTHFR) y a la hipertensión arterial como los factores que mejor explican la cardiopatía isquémica en la población estudiada. Conclusiones: La interacción de los genes GSTT1 y MTHFR conjuntamente con la hipertensión arterial puede constituir un modelo de predicción de riesgo para el inicio temprano de cardiopatía isquémica en la población de Yucatán

Objective: Epistasis is a type of genetic interaction that could explain much of the phenotypic variability of complex diseases. In this work, the effect of epistasis of metabolic genes and cardiovascular risk on the susceptibility to the development of ischemic heart disease in Yucatan was determined. Methods: Case-control study in 79 Yucatecan patients with ischemic heart disease and 101 healthy controls matched by age and origin with cases. The polymorphisms -108CT, Q192R, L55M (paraoxonase 1; PON1), C677T, A1298C (methylenetetrahydrofolate reductase; MTHFR), and the presence/absence of the glutathione S-transferase T1 (GSTT1) gene were genotyped. Epistasis analysis was performed using the multifactorial dimensional reduction method. The best risk prediction model was selected based on precision (%), statistical significance (P<0.05), and cross-validation consistency. Results: We found an independent association of the null genotype GSTT1*0/0 (OR=3.39, CI: 1.29-8.87, P=0.017) and the null allele (OR=1.86, CI: 1.19-2.91, P=0.007) with ischemic heart disease. The GSTT1*0 deletion and the 677TT genotype (MTHFR) were identified as being at a high cardiovascular risk, whereas the GSTT1*1 wild type genotype and the CC677 variant were at low risk. The gene-environment interaction identified the GSTT1 gene, C677T polymorphism (MTHFR), and hypertension as the factors that best explain ischemic heart disease in the study population. Conclusions: The interaction of the MTHFR, GSTT1 and hypertension may constitute a predictive model of risk for early onset ischemic heart disease in the population of Yucatan

Epistasis analysis of metabolic genes polymorphisms associated with ischemic heart disease in Yucatan. / Análisis de epistasia de polimorfismos de genes metabólicos asociados a cardiopatía isquémica en Yucatán.

OBJECTIVE: Epistasis is a type of genetic interaction that could explain much of the phenotypic variability of complex diseases. In this work, the effect of epistasis of metabolic genes and cardiovascular risk on the susceptibility to the development of ischemic heart disease in Yucatan was determined. METHODS: Case-control study in 79 Yucatecan patients with ischemic heart disease and 101 healthy controls matched by age and origin with cases. The polymorphisms -108CT, Q192R, L55M (paraoxonase 1; PON1), C677T, A1298C (methylenetetrahydrofolate reductase; MTHFR), and the presence/absence of the glutathione S-transferase T1 (GSTT1) gene were genotyped. Epistasis analysis was performed using the multifactorial dimensional reduction method. The best risk prediction model was selected based on precision (%), statistical significance (P<0.05), and cross-validation consistency. RESULTS: We found an independent association of the null genotype GSTT1*0/0 (OR=3.39, CI: 1.29-8.87, P=0.017) and the null allele (OR=1.86, CI: 1.19-2.91, P=0.007) with ischemic heart disease. The GSTT1*0 deletion and the 677TT genotype (MTHFR) were identified as being at a high cardiovascular risk, whereas the GSTT1*1 wild type genotype and the CC677 variant were at low risk. The gene-environment interaction identified the GSTT1 gene, C677T polymorphism (MTHFR), and hypertension as the factors that best explain ischemic heart disease in the study population. CONCLUSIONS: The interaction of the MTHFR, GSTT1 and hypertension may constitute a predictive model of risk for early onset ischemic heart disease in the population of Yucatan.

Usefulness of Drug-Eluting Balloons for Bare-Metal and Drug-Eluting In-Stent Restenosis (from the RIBS IV and V Randomized Trials).

Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) is particularly challenging. We sought to compare results of drug-eluting balloons in patients with DES-ISR with those in patients with bare-metal stent (BMS) ISR. A pooled analysis of the Restenosis Intra-Stent: Drug-Eluting Balloon versus Everolimus-Eluting Stent IV and V randomized trials was performed. Both trials had identical inclusion and exclusion criteria. Results of drug-eluting balloons in 95 patients with BMS-ISR and 154 patients with DES-ISR were compared. Patients with DES-ISR were more frequently diabetics, presented more often as an acute coronary syndrome and had more severe lesions and more frequently a focal pattern, including edge-ISR. Late angiographic findings (92% of eligible patients), including minimal lumen diameter (1.80 ± 0.6 vs 2.01 ± 0.6 mm, p = 0.001; absolute mean difference 0.21 mm; 95% confidence interval 0.04 to 0.38; p = 0.014) and restenosis rate (19% vs 9.5%, p <0.05) were poorer in DES-ISR. Results were consistent across 10 prespecified subgroups. Moreover, on multiple linear regression analysis, minimal lumen diameter at follow-up remained significantly smaller in patients with DES-ISR after adjusting for potential confounders (adjusted absolute mean difference 0.17 mm; 95% confidence interval 0.04 to 0.41; p = 0.019). Finally, at 1-year clinical follow-up (100% of patients), rates of target vessel revascularization (16% vs 6%, p = 0.02) and of the main combined clinical end point (18% vs 8%, p = 0.03) were significantly higher in patients treated for DES-ISR. In conclusion, this study confirms the efficacy of DEB for patients with ISR. However, the long-term clinical and angiographic results of DEB are poorer in patients with DES-ISR than in those with BMS-ISR. (ClinicalTrials.govIdentifier:NCT01239953&NCT01239940).

Disfunción sexual eréctil en pacientes diabéticos atendidos en la consulta multidisciplinaria de Terapia y Orientación Sexual. Manzanillo / Erectile sexual dysfunction in diabetic patients treated at therapy and sexual orientation multidiscipline consultation. Manzanillo

La impotencia asociada a la diabetes puede aparecer a cualquier edad. Se realizó una investigación descriptiva para describir la morbilidad de disfunción sexual eréctil en pacientes diabéticos. El universo de trabajo lo conformaron todos los pacientes diabéticos atendidos en la consulta multidisciplinaria municipal de Orientación y Terapia Sexual (n=18; 100 por ciento) en el periodo de febrero 2016-febrero 2017. Se exploraron las variables edad, tipo de diabetes mellitus, tiempo de evolución de la diabetes, causa de la disfunción (psicógena u orgánica), intensidad de la disfunción eréctil y niveles de ansiedad como estado y como rasgo, se aplicaron varios instrumentos para la recolección de los datos como entrevista clínica psicológica, cuestionario para la salud sexual masculina (IIFE) y el inventario de ansiedad rasgo-estado (IDARE). Los datos se expresaron en números absolutos y porcentajes. Se encontró predominio de pacientes diabéticos tipo II con más de 50 años de edad y más de 10 años de padecer la enfermedad e incluidos en la etapa de la vida de adulto medio y mayor, la causa de la disfunción es mayormente de tipo orgánica, la intensidad de la disfunción sexual eréctil en los pacientes fue grave y moderada, en su mayoría con el diagnóstico de diabetes tipo II y al evaluar el tipo de ansiedad predominó la ansiedad a niveles medio y alto. Se concluye que se encontró alta morbilidad de disfunción eréctil de mantenimiento en los pacientes diabéticos atendidos en la consulta especializada de orientación y terapia sexual(AU)

The impotence associated with diabetes can appear at any age. A descriptive investigation was carried out to describe the morbidity of erectile sexual dysfunction in diabetic patients. The universe of work was made up of all the diabetic patients seen in the multidisciplinary municipal consultation of Sexual Orientation and Therapy (n = 18, 100 percent) in the period of February 2016-February 2017. The variables age, type of diabetes mellitus, were explored, time of evolution of diabetes, cause of dysfunction (psychogenic or organic), intensity of erectile dysfunction and levels of anxiety as a state and as a trait, several instruments were applied for the collection of data as psychological clinical interview, questionnaire for the Male Sexual Health (IIFE) and Trait-State Anxiety Inventory (IDARE). The data were expressed in absolute numbers and percentages. We found predominance of type II diabetic patients over 50 years of age and more than 10 years of suffering from the disease and included in the stage of life of middle and older adult, the cause of the dysfunction is mostly organic, the intensity of erectile sexual dysfunction in the patients was severe and moderate, mostly with the diagnosis of type II diabetes and when anxiety type was assessed, anxiety at medium and high levels prevailed. It is concluded that high morbidity of maintenance erectile dysfunction was found in diabetic patients attended in the specialized consultation of orientation and sexual therapy(EU)

Riesgos psicosociales de salud mental en niños de 0-10 años asistidos en el consultorio del Hospital Provincial de Bengo. Angola / Psychosocial mental health risks in children aged 0-10 years old assisted in the Bengo Provincial Hospital practice. Angola

La investigación se desarrolló en el hospital provincial de Bengo con el objetivo general de describir los principales riesgos psicosociales que pueden influir en la salud mental de los niños de 0-10 años. Se realizó un estudio descriptivo, en los niños atendidos en el hospital en la consulta de pediatría con una frecuencia de tres veces por semana de octubre-noviembre 2014 donde asistieron 319 niños, se seleccionó una muestra probabilística aleatoria de 50 niños. Se utilizó un cuestionario realizado por los autores y el test de la familia para evaluar la percepción de funcionamento familiar (FF-SIL), se cumplieron los procedimientos éticos en toda la investigación. Entre los resultados principales se observó que hay un predominio de los hábitos de consumo de alcohol (56 por ciento) de las madres que en su mayoría son adolescentes y el 40 por ciento son víctimas de violencia doméstica, la mayoría de las mujeres tienen más de tres hijos y no tienen vinculo laboral, los principales riesgos psicosociales en los niños fueron la desnutrición, trastornos del sueño y la discapacidad auditiva, con énfasis en el grupo de la primera infancia (menores de 4 años), se destacan familias disfuncionales y altamente disfuncionales (50 por ciento y 60 por ciento, respectivamente) con problemas económicos. A pesar de ser un estudio descriptivo se usa el enfoque de riesgo en el análisis de sus resultados y advierte la necesidad de proteger los niños más vulnerables para prevenir diversos trastornos psicopatológicos a corto y largo plazo(AU)

The research was developed at the provincial hospital of Bengo with the general objective of describing the main psychosocial risks that can influence the mental health of children 0-10 years old. A descriptive study was carried out in children treated at the pediatric clinic with a frequency of three times a week from October to November 2014, attended by 319 children. A random probability sample of 50 children was selected. We used a questionnaire made by the authors and the family test to evaluate the perception of family functioning (FF-SIL); the ethical procedures were fulfilled throughout the investigation. Among the main results it was observed that there is a predominance of alcohol consumption habits (56 percent) of mothers who are mostly adolescents and 40 percent are victims of domestic violence, most of the women have more than three children and no employment relationship, the main psychosocial risks in children were malnutrition, sleep disorders and hearing impairment, with an emphasis on the early childhood group (under 4 years), dysfunctional and highly dysfunctional families (50 percent and 60 percent, respectively) with economic problems. Despite being a descriptive study, the risk approach is used in the analysis of its results and warns of the need to protect the most vulnerable children to prevent various psychopathological disorders in the short and long term(EU)

Everolimus-Eluting Stents in Patients With Bare-Metal and Drug-Eluting In-Stent Restenosis: Results From a Patient-Level Pooled Analysis of the RIBS IV and V Trials.

BACKGROUND: Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) is more challenging than that of patients with bare-metal stent ISR. However, the results of everolimus-eluting stents (EES) in these distinct scenarios remain unsettled. METHODS AND RESULTS: A pooled analysis of the RIBS IV (Restenosis Intra-Stent of Drug-Eluting Stents: Paclitaxel-Eluting Balloon vs Everolimus-Eluting Stent) and RIBS V (Restenosis Intra-Stent of Bare Metal Stents: Paclitaxel-Eluting Balloon vs Everolimus-Eluting Stent) randomized trials was performed using patient-level data to compare the efficacy of EES in bare-metal stent ISR and DES-ISR. Inclusion and exclusion criteria were identical in both trials. Results of 94 patients treated with EES for bare-metal stent ISR were compared with those of 155 patients treated with EES for DES-ISR. Baseline characteristics were more adverse in patients with DES-ISR, although they presented later and more frequently with a focal pattern. After intervention, minimal lumen diameter (2.22±0.5 versus 2.38±0.5 mm, P=0.01) was smaller in the DES-ISR group. Late angiographic findings (89.3% of eligible patients), including minimal lumen diameter (2.03±0.7 versus 2.36±0.6 mm, P<0.001) and diameter stenosis (23±22 versus 13±17%, P<0.001) were poorer in patients with DES-ISR. Results were consistent in the in-segment and in-lesion analyses. On multiple linear regression analysis, minimal lumen diameter at follow-up remained significantly smaller in patients with DES-ISR. Finally, at 1-year clinical follow-up (100% of patients), mortality (2.6 versus 0%, P<0.01) and need for target vessel revascularization (8 versus 2%, P=0.03) were higher in the DES-ISR group. CONCLUSIONS: This patient-level pooled analysis of the RIBS IV and RIBS V randomized clinical trials suggests that EES provide favorable outcomes in patients with ISR. However, the results of EES are less satisfactory in patients with DES-ISR than in those with bare-metal stent ISR. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01239953 and NCT01239940.

Long-Term Results of Everolimus-Eluting Stents Versus Drug-Eluting Balloons in Patients With Bare-Metal In-Stent Restenosis: 3-Year Follow-Up of the RIBS V Clinical Trial.

OBJECTIVES: The aim of this study was to compare the long-term efficacy of everolimus-eluting stents (EES) and drug-eluting balloons (DEB) in patients with bare-metal stent in-stent restenosis (ISR). BACKGROUND: The relative long-term clinical efficacy of current therapeutic modalities in patients with ISR remains unknown. METHODS: The 3-year clinical follow-up (pre-specified endpoint) of patients included in the RIBS V (Restenosis Intra-Stent of Bare-Metal Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent Implantation) randomized clinical trial was analyzed. All patients were followed yearly using a pre-defined structured questionnaire. RESULTS: A total of 189 patients with bare-metal stent ISR were allocated to either EES (n = 94) or DEB (n = 95). Clinical follow-up at 1, 2, and 3 years was obtained in all patients (100%). Compared with patients treated with DEB, those treated with EES obtained better angiographic results, including larger minimal luminal diameter at follow-up (primary study endpoint; 2.36 ± 0.6 mm vs. 2.01 ± 0.6 mm; p < 0.001). At 3 years, the rates of cardiac death (2% vs. 1%), myocardial infarction (4% vs. 5%) and target vessel revascularization (9% vs. 5%) were similar in the DEB and EES arms. Importantly, however, at 3 years, the rate of target lesion revascularization was significantly lower in the EES arm (2% vs. 8%; p = 0.04; hazard ratio: 0.23; 95% confidence interval: 0.06 to 0.93). The need for "late" (>1 year) target vessel (3 [3.2%] vs. 3 [3.2%]; p = 0.95) and target lesion (1 [1%] vs. 2 [2.1%]; p = 0.54) revascularization was low and similar in the 2 arms. Rates of definite or probable stent thrombosis (1% vs. 0%) were also similar in the 2 arms. CONCLUSIONS: The 3-year clinical follow-up of the RIBS V clinical trial confirms the sustained safety and efficacy of EES and DEB in patients treated for bare-metal stent ISR. In this setting, EES reduce the need for target lesion revascularization at very long-term follow-up. (RIBS V [Restenosis Intra-Stent of Bare Metal Stents: Paclitaxel-Eluting Balloon vs Everolimus-Eluting Stent] [RIBS V]; NCT01239953).