Power of Light: Raman Spectroscopy and Machine Learning for the Detection of Lung Cancer.

Lung cancer is the leading cause of cancer-related deaths worldwide, emphasizing the urgent need for reliable and efficient diagnostic methods. Conventional approaches often involve invasive procedures and can be time-consuming and costly, thereby delaying the effective treatment. The current study explores the potential of Raman spectroscopy, as a promising noninvasive technique, by analyzing human blood plasma samples from lung cancer patients and healthy controls. In a benchmark study, 16 machine learning models were evaluated by employing four strategies: the combination of dimensionality reduction with classifiers; application of feature selection prior to classification; stand-alone classifiers; and a unified predictive model. The models showed different performances due to the inherent complexity of the data, achieving accuracies from 0.77 to 0.85 and areas under the curve for receiver operating characteristics from 0.85 to 0.94. Hybrid methods incorporating dimensionality reduction and feature selection algorithms present the highest figures of merit. Nevertheless, all machine learning models deliver creditable scores and demonstrate that Raman spectroscopy represents a powerful method for future in vitro diagnostics of lung cancer.

Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial.

BACKGROUND: Functional motor disorder-the motor variant of functional neurological disorder-is a disabling condition that is commonly associated with poor health outcomes. Pathophysiological models have inspired new treatment approaches such as specialist physiotherapy, although evidence from large randomised controlled trials is absent. We aimed to assess the clinical effectiveness of a specialist physiotherapy intervention for functional motor disorder compared with treatment as usual. METHODS: In this pragmatic, multicentre, phase 3 randomised controlled trial at 11 hospitals in England and Scotland, adults with a clinically definite diagnosis of functional motor disorder, diagnosed by a neurologist, were included. Participants were randomly assigned (1:1, stratified by site) using a remote web-based application to either specialist physiotherapy (a protocolised intervention of nine sessions plus follow-up) or treatment as usual (referral to local community neurological physiotherapy). Individuals working on data collection and analysis were masked to treatment allocation. The primary outcome was the physical functioning domain of the 36-item short form health questionnaire (SF36) at 12 months after randomisation. The primary analysis followed a modified intention-to-treat principle, using a complete case approach; participants who were unable to receive their randomised treatment due to the suspension of health-care services during the COVID-19 pandemic were excluded from the primary analysis. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN56136713, and is completed. FINDINGS: Recruitment occurred between Oct 19, 2018, and March 11, 2020, pausing during the COVID-19 lockdown, and resuming from Aug 3, 2021, to Jan 31, 2022. Of 355 participants who were enrolled, 179 were randomly assigned to specialist physiotherapy and 176 to treatment as usual. 89 participants were excluded from the primary analysis due to COVID-19 interruption to treatment (27 were assigned to specialist physiotherapy and 62 to treatment as usual). After accounting for withdrawals (n=11) and loss to follow-up (n=14), the primary analysis included data from 241 participants (138 [91%] assigned specialist physiotherapy and 103 [90%] assigned treatment as usual). Physical functioning, as assessed by SF36, did not differ significantly between groups (adjusted mean difference 3·5, 95% CI -2·3 to 9·3; p=0·23). There were no serious adverse events related to the trial interventions. 35 serious adverse events were recorded in the specialist physiotherapy group by 24 participants (17·0%), and 24 serious adverse events were recorded in the treatment as usual group by 18 participants (17·0%); one death occurred in the specialist physiotherapy group (cause of death was recorded as suicide). All were considered unrelated to specialist physiotherapy. INTERPRETATION: Although more participants who were assigned specialist physiotherapy self-rated their motor symptoms as improved and had better scores on subjective measures of mental health, the intervention did not result in better self-reported physical functioning at 12 months. Both the specialist and community neurological physiotherapy appeared to be a safe and a valued treatment for selected patients with functional motor disorder. Future research should continue to refine interventions for people with functional motor disorder and develop evidence-based methods to guide treatment triage decisions. FUNDING: National Institute for Health and Care Research and Health Technology Assessment Programme.

The use of metaphors by service users with diverse long-term conditions: a secondary qualitative data analysis.

Long-term conditions and accompanied co-morbidities now affect about a quarter of the UK population. Enabling patients and caregivers to communicate their experience of illness in their own words is vital to developing a shared understanding of the condition and its impact on patients' and caregivers' lives and in delivering person-centred care. Studies of patient language show how metaphors provide insight into the physical and emotional world of the patient, but such studies are often limited by their focus on a single illness. The authors of this study undertook a secondary qualitative data analysis of 25 interviews, comparing the metaphors used by patients and parents of patients with five longterm conditions. Analysis shows how similar metaphors can be used in empowering and disempowering ways as patients strive to accept illness in their daily lives and how metaphor use depends on the manifestation, diagnosis, and treatment of individual conditions. The study concludes with implications for how metaphorical expressions can be attended to by healthcare professionals as part of shared care planning.

Socialización de experiencias y logros en la salud pública y la Colaboración Médica Cubana desde las redes sociales. Venezuela 2021-2022

Introducción: Las redes sociales son formas de interacción social, que fomentan un intercambio dinámico entre personas, grupos e instituciones en contextos disímiles. Objetivo: Socializar la experiencia y los logros de la salud pública y la Colaboración Médica Cubana desde las redes sociales en Venezuela desde enero de 2021 hasta octubre de 2022. Métodos: Se realiza una investigación de tipo observacional descriptiva en el periodo comprendido desde enero de 2021 hasta octubre de 2022 y aplicado en la Misión Médica Cubana en Venezuela con una población de 14 213 profesionales de la salud dividida en 24 estados. Resultados: En el año 2021 se realizaron 21 tuitazos con un millón 876 898 tuits. Para el año 2022 Facebook se comportó con 32 489 seguidores, Twiter con 16 832, Instagram Cubacooperave, 3 905, Yotube.com/c/cubacooperave 2 830, Tiktok 890 y Telegram 371 suscriptores. Se realizaron 26 actividades nacionales, 11 Tuitazos y 15 Jornadas en las Redes, 144 en TV, 200 en Radio y 100 en la Prensa escrita. Conclusiones: El reto es utilizar la posibilidad que ofrece la tecnología para ampliar los horizontes del uso de las redes sociales, realizar acciones de alfabetización informacional dirigidas a los gestores y usuarios de las mismas en pos de una divulgación adecuada del trabajo en la Misión Médica Cubana en Venezuela.

Introduction: Social networks are forms of social interaction that foster a dynamic exchange among people, groups, and institutions in dissimilar contexts. Objective: To socialize the experience and achievements of public health and the Cuban Medical Collaboration in social networks in Venezuela from January 2021 to October 2022. Method: An observational descriptive research was conducted from January 2021 to October 2022 and applied to the Cuban Medical Mission in Venezuela in a population of 14 213 health professionals divided into 24 states. Results: In the year 2021, there was a total of 21 tweets with 1 876 898 tweets published. In 2022, the Facebook network had 32 489 followers; Twitter, 16 832; Instragram Cubacooperave, 3 905; the Yotube.com/c/Cubacooperave channel, 2 830; Tik Tok, 890; and Telegram had 371 subscribers. A total of 26 national activities such as 11 Tuits, 15 Network Events; 144 TV, 200 Radio, and 100 written Press activities were performed. Conclusions: The challenge is to use the possibility offered by technology to broaden the horizons of the use of social networks, as well as to establish information literacy actions directed towards the managers and users of these networks for the sake of an adequate dissemination of the work carried out by the Cuban Medical Mission in Venezuela.

Caracterización de pacientes con enfermedades genéticas / Characterization of Patients with Genetic Diseases

Introducción: Las enfermedades genéticas se corresponden con variaciones genéticas del desarrollo que precisan ayuda médica, educativa, social o combinaciones de estas. Objetivo: Caracterizar clínica y epidemiológicamente a los pacientes con enfermedades genéticas. Método: Estudio descriptivo transversal. El universo estuvo constituido por los 521 pacientes evaluados en la consulta de asesoramiento genético del municipio Mayarí y la muestra estuvo representada por los 216 pacientes portadores de enfermedades genéticas pertenecientes al Policlínico Universitario 26 de Julio; del Área de Salud de Mayarí, durante el año 2018. Resultados: Predominó el sexo femenino (53,24 por ciento), el grupo de edades de 41 a 50 años (18,06 por ciento), las enfermedades monogénicas (58,8 por ciento), los pacientes con síndrome de Down (20,37 por ciento), los pacientes que no cuentan con antecedentes familiares (54,63por ciento). Conclusiones: Prevalecieron los pacientes con discapacidad mental, con diagnóstico posnatal y con más de 20 años de diagnóstico. El mayor número no realizaba tratamiento. Los pacientes vinculados integralmente a la sociedad resultaron minoría, así como los que tenían antecedentes familiares de enfermedad genética(AU)

Introduction: Genetic diseases are due to developmental genetic variations that require medical, educational and social help, or combinations of these. Objective: To characterize, clinically and epidemiologically, patients with genetic diseases. Method: Descriptive and cross-sectional study. The universe was made up of the 521 patients assessed in the genetic counseling consultation of Mayarí Municipality and the sample was represented by the 216 patients with genetic diseases belonging to 26 de Julio University Polyclinic of the health area of Mayarí, during the year 2018. Results: The female sex predominated (53.24 percent), together with the age group 41-50 years (18.06 percent), monogenic diseases (58.8 percent), patients with Down syndrome (20.37 percent), and patients with no family history of diseases (54.63 percent). Conclusions: Patients with mental disabilities, with postnatal diagnosis and with more than twenty years of diagnosis prevailed. The largest number did not undergo treatment. Patients fully linked to society were a minority, as well as those with a family history of genetic disease(AU)

Orientación diagnóstica del dolor torácico en el niño / Diagnostic orientation of the chest pain in the child

INTRODUCCIÓN: el dolor torácico es una molestia que siente el niño en la parte superior de la zona del tórax o pecho, que puede ser una sensación física o emocional desagradable, y diferente para cada niño. OBJETIVO: identificar las características del dolor torácico en el niño que dificultan el diagnóstico, y que a la vez, permitan una mejor orientación y conducta hacia esta manifestación, por parte de los médicos de asistencia en el área de salud de Guatemala. MÉTODOS: se realizó un estudio descriptivo retrospectivo en 54 pacientes con diagnóstico de dolor torácico atendidos en el policlínico con servicios de hospitalización "Roberto Escudero Díaz", y sus consultorios del área de salud de Guatemala, de 2012 a 2014. RESULTADOS: el dolor torácico se presentó en una población infantil de 1 a 14 años, con edad media general de 12 años, y predominio del sexo masculino. Entre los factores predisponentes prevaleció el esfuerzo físico mantenido. En la mayoría de los casos el dolor torácico se presentó sin otras manifestaciones clínicas. El signo positivo al examen físico que más se destacó fue la taquicardia. Predominó la causa musculoesquelética. Entre las enfermedades cardiovasculares asociadas se encontró el prolapso de válvula mitral y la pericarditis. Los principales exámenes realizados para el diagnóstico fueron las radiografías de tórax y el electrocardiograma. CONCLUSIONES: el dolor torácico en el niño rara vez tiene origen cardiaco, y la anamnesis -más un examen físico exhaustivo- permite llegar al diagnóstico para brindar adecuada atención a estos pacientes.

INTRODUCTION: chest pain is some discomfort that a child may feel at the upper part of his/her thoracic area or chest and that creates unpleasant physical or emotional sensation which is different in each child. OBJECTIVE: to identify the characteristics of the chest pain in a child that makes diagnosis difficult but at the same time, allows better orientation and behavior before this manifestation by the health professionals in the health area of Guatemala. METHODS: a retrospective descriptive study was conducted in 54 patients with chest pain diagnosis seen at the admission service of "Roberto Escudero Diaz" polyclinics and its physician's offices located in the health area of Guatemala municipality from 2012 to 2014. RESULTS: chest pain was detected in an infant population aged 1 to 14 years; with general average age of 12 years and predominance of males. Sustained physical effort was a prevalent predisposing factor. Chest pain appeared with no other clinical symptom in most of cases. On the physical examination, tachycardia was the fundamental positive sign. Muscular-skeletal causes predominated. Mitral valve prolapse and pericarditis were found to be associated cardiovascular diseases. The main tests for diagnosis were chest x-rays and electrocardiogram. CONCLUSIONS: chest pain in the child is rarely of cardiac origin, so anamnesis plus comprehensive physical exam are needed to reach adequate diagnosis and provide better care for these patients.

Comportamiento de la preeclampsia con agravamiento en gestantes o puérperas en Mayarí / Incidence of Severe Worsening Preeclampsia in Pregnant or Postpartum Women in Mayarí

Introducción: la preeclampsia representa un riesgo para la madre y el producto de la concepción. Objetivo: determinar el comportamiento de la preeclampsia con agravamiento en la sala de cuidados perinatales de la maternidad municipal. Métodos: durante enero-diciembre de 2013 en el Hospital General Universitario Mártires de Mayarí de la provincia Holguín se realizó un estudio de serie de casos en 44 pacientes que ingresaron en la Sala de Cuidados Perinatales con diagnóstico de preeclampsia con agravamiento. Se utilizaron estadígrafos como el porcentaje, la media y la desviación estándar; el Chi cuadrado para probar hipótesis de independencia. Resultados: los pacientes con diagnóstico de preeclampsia con agravamiento entre los 20 y 25 años representaron el 43,18%. El tiempo de gestación que predominó fue de 37 semanas y más con el 50%; el parto distócico representó el 90,9%; los recién nacidos pretérminos representaron el 43,47%. Conclusiones: el mayor número de casos con preeclampsia con agravamiento estuvo en pacientes entre 20 y 25 años. La vía del parto abdominal (cesárea) fue la predominante relacionándose con un número importante de embarazos pretérminos; en los resultados perinatales el indicador más afectado fue la prematuridad y el bajo peso al nacer con sus complicaciones.

Introduction: preeclampsia is a risk for the mother and the result of the conception. Objective: determinate the behavior of severe preeclampsia in the Perinatal Care Unit of the municipality. Method: a case series study was performed in 44 patients admitted to the Perinatal Care Ward with a diagnosis of worsening preeclampsia, during January to December 2013 at General University Hospital of Mayarí Holguin province. They used stadigraphs as the percentage, the mean and standard deviation as well as Chi square for testing hypothesis of independence. Results: patients diagnosed with worsening preeclampsia between 20 and 25 accounted for 43.18%. The gestation period that prevailed was 37 weeks and more with 50%; the dystocia accounted for 90.9%; preterm infants accounted for 43.47%. Conclusions: the highest number of cases with worsening preeclampsia was in patients between 20 and 25 years. The way of abdominal delivery (C-section) was the predominant interacting with a large number of preterm pregnancies; in perinatal outcomes, prematurity and low birth weight infants with complications represented the most affected indicator.

Report of cases in patients with acute herpetic neuralgia using a Mangifera indica extract

It has been accepted that neuroinflammation, oxidative stress and glial activation are involved in the central sensitization underlying neuropathic and inflammatory pain. Vimang® is the brand name of an aqueous extract of Mangifera indica L., Anacardiaceae, traditionally used in Cuba for its antioxidant, antiinflammatory, analgesic, and immunomodulatory properties. In the present study, we determined the possible effects of Vimang formulations in acute herpes zoster (n=12) patients, that received a daily dose of 1800 mg of extract (two coated Vimang tablets, 300 mg each, three times daily before meals) associated to low doses of amitriptyline (10-25 mg/d). In addition to the tablets, they utilized compresses containing Vimang dissolution at 2 percent on skin lesions for thirty days. The average daily pain score using a Likert scale and variations in concomitant drug daily dosage were determined. The analgesic effect was observed from week 1 (p<0.001) with respect to baseline data and none showed post-herpetic neuralgia. Significant reduction of antidepressant medication (p<0.01) and analgesic rescue dosages (p=0.0035) with respect to the initial daily dosage were showed. No adverse events were reported. The results obtained in this report of cases suggest that Vimang supplementation might be beneficial to prevent and treat neuropathic pain.

Neuromodulación acupuntural y regulación nociceptiva / Acupuncture neuromodulation and nociceptive regulation

A pesar de todo lo avanzado en el campo de la neurofisiología y la farmacología, los sistemas antinociceptivos continúan siendo un enigma científico y los mecanismos de acción de las técnicas de reflexoterapia, uno de los tópicos más controvertidos. El propósito de esta revisión es vincular el estudio de las bases neurobiológicas de la Acupuntura a los eventos neuroquímicos de la nocicepción y del dolor patológico. Para ese fin transitamos la transmisión, modulación medular, supramedular y percepción; definimos sensibilización central y profundizamos en los elementos de la vía postsináptica Glutamato/NMDA/NO/GMPc comprometida en el proceso. Analizamos los posibles mecanismos de acción a los diferentes niveles del proceso que pudieran sustentarse químicamente a nivel del cuerno posterior de la ME, en la supra-regulación de receptores GABA y opiodes y la sub-regulación de receptores NMDA; con la consiguiente prevención de la Sensibilización Central

Láser en odontología / Laser in dentistry

The term Laser means light amplifed by stimulated emmiting radiation. It has been used for the last 30 years in different medical areas, including dentistry. Basically it transfers an external energy in lightning or luminic energy. There are two types of laser: surgical and therapeutic. The biological reactions of the different tissues, depend on their optical cualities. In dentistry, it has been used in endodontics to clean seal accesory canals; in operative dentistry: as analgesic antiinflamatory in surgical procedures. Taking into account the cautions recommended, it offers a good choise of treatment for our patients.

Bases neurobiologicas de la acupuntura y la electroacupuntura / Neurobiological bases of acupuncture and electroacupuncture

El mecanismo de acción de la Acupuntura y técnicas afines es controvertido, al parecer por el intento en la búsqueda de un proceso único cuando el fenómeno es multifactorial y parte del sistema más complejo y diferenciado del ser humano: el Sistema Nervioso. Las neuromodulaciones son homeostáticas per se y la comprensión del fenómeno nociceptivo es la ruta para la investigación en este campo. El propósito de esta revisión es profundizar en las bases neurofisiológicas y neuro-químicas de la Acupuntura, acorde con los avances acontecidos en la última década en el estudio del dolor. Transitamos por los procesos neurofisiológicos de la nocicepción y definimos el concepto de Sensibilización Periférica, centrando nuestra atención en la modulación periférica y el posible mecanismo de acción de la Acupuntura a ese nivel; que pudiera deberse a la inhibición del sistema Glutamato/NMDA/ONS/ON/GMPc o al estímulo de la Vía L-Arginina/NO/GMPc. Puede poseer valor en la profilaxis de la Sensibilización Central

Riesgos laborales del ejercicio profesional: una responsabilidad compartida / Labor risk: a sharing responsability

Descripción de los factores de riesgo asociados con enfermería

Actividad antihiperalgésica de la electroacupuntura y su combinación con fármacos inhibidores de la sensibilización central

La teoría de la sensibilización central intenta explicar la fisiopatología del dolor neuropático. La electroacupuntura (EA) podría insertarse en su tratamiento. El objetivo del presente estudio fue determinar la actividad antihiperalgésica de la EA a baja frecuencia y su combinación con fármacos inhibidores de la vía glutamato-N metil-D-aspartato (NMDA)-óxido nítrico (NO) en el dolor patológico. Para lo que se estudiaron las puntuaciones diarias medias de dolor (PDMD) y otras alteraciones del procesamiento nociceptivo en pacientes portadores de neuralgia post-herpética (NPH) forma nociceptor irritable tratados con EA a 10 Hz y la combinación EA-ketamina. Así como, la conducta y las concentraciones de los productos de oxidación del NO en un modelo de neuroinflamación inducida por carragenina en ratas concientes y no restringidas, pre-tratadas con EA a 10 Hz y las combinaciones EA-antagonista NMDA y EA-inhibidor de la óxido nítrico sintasa (NOS), para caracterizar su efecto antihiperalgésico térmico en estas condiciones. La EA y la combinación EA-ketamina, mostraron efectos antihiperalgésico, antialodínico mecánico y térmico en la NPH. La forma combinada fue superior a la EA. En el modelo animal se demostró la actividad antihiperalgésica térmica del pre-tratamiento con EA, que fue facilitada por el antagonista de los receptores NMDA. El pre-tratamiento agudo con EA elevó significativamente las concentraciones plasmáticas de nitritos. El inhibidor de la NOS previno el efecto antihiperalgésico de la EA y redujo significativamente las concentraciones de nitritos plasmáticos. El efecto antihiperalgésico del proceder en estas condiciones, pudiera estar mediado al menos en parte, a través de la víaL-arginina-NOS-NO-GMPc.