Revista Información Científica (RIC) is the Open Access Journal, official scientific body of the Universidad de Ciencias Médicas de Guantánamo, Cuba. It publishes serial numbers bimonthly, besides news, supplements and special numbers dedicated to different scientific topics of interest of the medical sciences. It is addressed to all health professionals (or related to this sector) of the country and abroad with the need to communicate the results of their research, cooperate, exchange and manage scientific health information.
Introduction: advanced esophageal cancer is one of the most aggressive neoplasms with high morbid... more Introduction: advanced esophageal cancer is one of the most aggressive neoplasms with high morbidity and mortality. Botswana ranks 14th in the world for deaths from this disease. Objective: to determine the clinicopathological characteristics of patients with advanced esophageal cancer at the Princess Marina Hospital in Gaborone, Botswana. Method: a prospective-descriptive study was carried out, where 45 patients with endoscopic and histological diagnosis of advanced esophageal cancer were characterized clinically and pathologically, from January to September 2019. Results: males predominated (86.7%), and also patients older than 60 years (60.0%). Dysphagia, anorexia and weight loss were the most frequent symptoms, and prevailed patients with three to six months between the appearance of symptoms and endoscopic diagnosis; inadequate diet, chronic alcoholism, and smoking were the predominant risk factors. The most frequent anatomical location was the middle third (51.1%), the predomi...
Giant phyllodes tumors are one of the rarest breast tumors. This tumor typically presents itself ... more Giant phyllodes tumors are one of the rarest breast tumors. This tumor typically presents itself as a firm and painless mass, mobile and generally located in one of the breasts. An HIV-positive 17 years old female patient presented a left breast swelling with a history of fast growing pace in the previous 6 months. Physical examination showed an ulcerated painless giant phyllodes tumor on the left breast, with multilobed firm characteristics and considerable blood vessel network. The tumor, with a 33cm circumference, took most of the left breast volume. No lymphadenopathies were detected. After radiographic tests, surgical procedure was performed. The anatomopathological report confirmed the presence of a high grade phyllodes tumor. The patient evolved favorably after surgery and was discharged in good general condition, with no fever. The study and management of this pathology was reviewed, as well as the importance of a correct differential diagnosis.
It was reported a case of a 73 years old patient with a history of an unknown outcomes surgical p... more It was reported a case of a 73 years old patient with a history of an unknown outcomes surgical procedure 5 years ago at the Hospital Clínico Quirúrgico Docente “Amalia Simoni” in Camaguey, Cuba. He presented pain and functional limitation of the right lower limb, which led to the resection of a tumor in the ipsilateral femur; five years later the tumor present signs of recurrence, this time with invasion of the bony pelvis and rectum and resulting in urinary disorders and constipation. Pelvis bone radiology, computed tomography scan and magnetic resonance imaging of the pelvis showed a mixed tumor with lytic lesions that invaded and displaced the organs in the pelvic cavity. The patient underwent excision of the tumor, which was 173×156 mm, weighing approximately 1.380 g. Histopathological analysis of the surgical resection specimen revealed a pelvic malignant mesenchymoma.
Introduction: childhood obesity globally is an unresolved health problem, becoming increasingly p... more Introduction: childhood obesity globally is an unresolved health problem, becoming increasingly present in all countries with not appropriate standard treatment strategies. Objective: to describe the relationship between breastfeeding, complementary feeding and formula milk in childhood obesity. Method: an observational cross-sectional study was conducted in 126 children, aged of 6 months to 2 years, treated at the Hospital General Docente Ambato, Ecuador, in 2019. The variables studied were as follow: age, sex, nutritional status, exclusive breastfeeding duration, time of initiation in complementary feeding and duration providing formula milk. Descriptive statistics and the nonparametric Mann-Whitney U test were applied. Results: infants between the age of 6 to 12 months (50.8%) and female sex (55.2%) predominated. Of the total of children, 62.1% apply in obese profile, 70.6 % were exclusively breastfed in their early 6 months (2 months less than obese patients). The same behavior was observed in those who received complementary feeding and in those who consumed formula milk for 2.5 months. Conclusions: most children in the study were classified as obese. Obese children had a short frequency of exclusive breastfeeding and consumed complementary feeding and formula milk for a longer period of time rather than children with normal weight.
Introduction: perioperative hypertension represents one of the leading alterations detected perfo... more Introduction: perioperative hypertension represents one of the leading alterations detected performing endoscopic cholecystectomy. It is presumed that atenolol has a protective effect able to reduce this morbid condition, likely due to its beta-blocking action. Objective: to assess the efficacy of atenolol on preventing perioperative hypertension performing laparoscopic cholecystectomy in the surgical unit of the Hospital Clínico Quirúrgico "Lucía Íñiguez Landín" of Holguín. Method: an observational, analytical, longitudinal and prospective cohort study was conducted with two study groups at the same time, experimental group and control group, from January to December, 2018. A total of 697 patients (N=697) evaluated in the preoperative consultation were involved in the study, the sample included 183 hypertensive patients (n=183) who underwent endoscopic surgery for gallbladder lithiasis, of whom 95 were randomized to the atenolol treatment group and 88 to the control group. Patients in the treatment group were administered atenolol at 25 mg daily for 15 days before surgery. Leading variables used were systolic, diastolic and mean arterial pressures, and specific indicators were used to evaluate treatment effectiveness. Results: preoperative arterial pressures decreased significantly with the use of atenolol in the treatment group. Perioperative hypertension was more frequent in the control group. Atenolol is a selective beta 1 receptor blocker, who causes a hypertensive effects in the central level, depressing the bulbar vasomotor center. Conclusion: the results of this investigation show that the use of atenolol in treatment was an effective alternative, thus effectiveness reduce perioperative hypertension rate.
Introduction: ovarian cancer is one of the most common and lethal tumor in women. This happens as... more Introduction: ovarian cancer is one of the most common and lethal tumor in women. This happens as a result of late-stage cancer detention and an increased chemoresistance to standard therapy. The current development in therapies to kill the cancer cells and its spread tendencies has emerged as a key alternative to treat tumors. Objective: to describe the current therapeutic strategies lead to confront different capabilities of tumor cells found in the ovarian cancer treatment. Method: a search of literuture was carried out in the following databases ScienceDirect, Redalyc, Latindex, ResearchGate, PubMed, Elsevier, ClinicalTrials.gov, SpringerLink, LARVOL's CLIN, Cuban Public Registry of Clinical Trials, from January to April 2023. A total of 50 text concerning ovarian cancer subject and alternative for treatment were selected. Development: the driving factors that promoted the use of ovarian cancer therapies were pointed out. The current therapeutic targets used in the treatment of this neoplasia were described, as well as the use of multiple approved drugs or in process of approval, including the synergistic drug combinations. Final considerations: there are a lot of options currently being implemented in ovarian cancer treatment. Despite clinical efficacy of targeted therapy, it´s presented still restricted to specific molecular subtypes and none of the assays illustrated survival benefit in general; the results obtained in the process of drugs development specifically targeting genome instability and sustained angiogenesis have been remarkable.
Introduction: commercial plastic products has transformed the modern era in such a way that curre... more Introduction: commercial plastic products has transformed the modern era in such a way that current life without plastic would not be possible, so at the same time with this development, plastics contamination is present, becoming one of the most urgent environmental problems nowadays. Objective: to gather available information published on the last five years concerning the microplastics as a source of environmental contamination in Ecuador and in order to reinforce the local interest on plastic pollution. Development: an unstructured review of the literature was performed. Databases used, PubMed and Google Scholar. The inclusion criteria used were as follow: articles in English and Spanish published on the last 5 years, no other language; study selections have been done by convenience. It was chronologically organized and analyzed the evidence published in PubMed and Google Scholar on the last five years concerning the microplastics behavior in Ecuador. Final considerations: the information collected chronologically shows the advancing pollution caused by microplastics both globally and in Ecuador, in addition, the presence of microplastics in oceans, fresh water, terrestrial ecosystems, air, foods and even in the human body is evident. Therefore, contamination caused by microplastics is a topic of a great importance today, which requires a speedy control action.
Introduction: currently there are very few published studies concerning the effect of implantatio... more Introduction: currently there are very few published studies concerning the effect of implantations with stem cells in post-surgical aseptic pseudoarthrosis. In addition, the traditional methods of adjuvant treatment in order to improve efficacy (anabolic steroids and bisphosphonates) represent high risks, rejection and even treatment abandonment by patients. Objective: hierarchalising the most influential variables for treatment with stem cells in post-surgical aseptic pseudoarthrosis in the Orthopedics and Traumatology service of the Hospital General Docente “Dr. Agostinho Neto”, Guantánamo, from January 2022 to January 2023, with the application of the TOPSIS fuzzy method. Method: a descriptive study was applied, with the application of Fuzzy Analytical Hierarchy process methods (Fuzzy AHP) and the Technique for Order of Preference by Similarity to Ideal Solution (fuzzy TOPSIS), with information gathered from the Orthopedics and Traumatology department of the aforementioned hospital. The universe of study consisted of 50 patients. The study sample included n꓿44. Results: it was possible to obtain the main variables involved in the stem cell treatment for pseudarthrosis, variables with great contribution in the success of implementation of such treatment, which were as follow: fracture trace, cause of pseudarthrosis, type of therapy used, time of bone consolidation and degree in bone consolidation. Conclusions: the hierarchization of the variables obtained will constitute a guide where the Orthopedics and Traumatology services of the Hospital General Docente “Dr. Agostinho Neto”, in Guantánamo municipality, will be able to influence in the efficacy of stem cell treatment for pseudarthrosis.
Introduction: legal and criminal liability of the health professionals, regardless its antiquity,... more Introduction: legal and criminal liability of the health professionals, regardless its antiquity, at present has becoming more and more theoretical and practical relevance in which an excessive judicialization of medical activity is revealed as a mechanism for the protection of patient rights. Objective: systematization of the different theoretical positions that are currently identified around the judicialization process of medical activity and the likely causes that stimulate it. Method: a documentary study was carried out through an exhaustive bibliographic review in bibliographic search engines such as Scopus, SciELO, Google Scholar and PubMed. The argumentative and exploratory research was conducted on March 16, 2023 and of the 30 articles found concerning medical malpractice, only 11 were chosen for the study with strict selection criteria. Development: the theoretical positions on the judicialization of medical activity and the causes that stimulate it were systematized; in addition, the correct interpretation of the lex artis was presented as a mechanism of normative heterointegration of the duty of care by the medical personnel, in order to avoid excesses in the application of the criminal law in this area of professional activity. Final considerations: a much greater intervention of criminal law in the practice of medicine is not the most efficient policy to protect the life and integrity of the patient in the face up to the medical malpractice.
Introduction: currently, there is a lack of information in the national literature concerning joi... more Introduction: currently, there is a lack of information in the national literature concerning joint loose bodies in the knee joint. These occur as a consequence of traumatic, degenerative, inflammatory and ischemic injuries. Objective: to update knowledge on the most general aspects concerning joint loose bodies in the knee and the use of the arthroscopy procedure on its treatment. Method: search and analysis of the information was performed on 59 days (January 1 to February 28, 2023) and the following keywords were used: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. Based on the information obtained, a bibliographic review was made of a total of 211 articles published in the PubMed, Hinari, SciELO and Medline databases. The EndNote search manager and reference manager was used. Of the total of articles, 33 contributions selected for the review were used, 32 were published the last five years. Development: it was refered in the study on the positive diagnosis based on the history, clinical picture and imaging. In relation to the differential diagnosis of this entity, special emphasis is made up with all the conditions that produce joint blockage. Specifically, meniscal lesions are reviewed, as well as the most commonly used classifications according to size, origin, quantity and mobility. In relation to the arthroscopic treatment, the following four stages were described: identification, trapping, extraction and revision. Final considerations: the arthroscopic approach, due to its multiple advantages, represents the most effective surgical modality for the diagnosis and treatment of patients with joint loose bodies in the knee.
Introduction: administrative personnel with a vision on Science, Technology and Society can influ... more Introduction: administrative personnel with a vision on Science, Technology and Society can influence universities functions through a social approach, the training, research and, extension process. Objective: to diagnose the level of knowledge on the Science, Technology and Society perspective of the administrative teaching personnel of the Universidad de Ciencias Médicas de Ciego de Ávila, Cuba. Method: a descriptive observational study was carried out in 2022 at the aforementioned university, where the population study consisted of 52 administrative personnel in teaching functions (N=52). A sample of 34 was selected by simple random sampling (n=34). A validated questionnaire was applied as an empirical method for data collection. Measurement scales were established for quantitative variables. Results: the diagnosis revealed a low level of knowledge on Science, Technology and Innovation definitions (85%, 69% and 44%, respectively). Most of the teaching and administrative personnel (53%) did not recognize the models that revealed the relationships between Science, Technology and Society and have in consideration that the University of Medicine is not positioned as a relevant actor in the local development. Forty-one percent reported that the Science, Technology and Society perspective almost always appears in the normative documents of the Ministerios de Educación Superior y de Salud Pública. Conclusions: there is evidence of insufficient knowledge on Science, Technology and Society and its use in the process management at universities. It is recommended to design related improvement actions on the subject.
Introduction: while a number of research studies have shown that mindfulness influences perceived... more Introduction: while a number of research studies have shown that mindfulness influences perceived stress, there is a lack of research that have tested the relationship between emotional regulation, mindfulness and perceived stress, specifically in those health workers who work in intensive care units. Objective: test relationship between mindfulness and perceived stress in health workers of public and private hospitals in Santo Domingo de los Colorados, Ecuador, in order to identify whether this relationship is mediated by emotional regulation. Method: a quantitative study of descriptive correlational scope and cross-sectional design was carried out, where a questionnaire consisting of 39 questions taken from three psychosomatic scales was applied to 382 health care workers in intensive care units of the aforementioned institutions. Variables used were as follow: mindfulness, emotional regulation and perceived stress. Statistical analyses were structured using two specialized softwares Excel and Statistical Package for Social Sciences 21. Results: statistical analyses showed that mindfulness influenced perceived stress (β=0.428**), and also emotional regulation (β=0.488**), at the same time, emotional regulation influenced perceived stress (β=0.417**). Conclusions: it was corroborated that emotional regulation played a mediating effect between mindfulness and perceived stress felt by the health care workers who work in intensive care units. Frequently, these personnel develop activities without mindfulness, however, they have control over their work activities and are able to regulate and hide emotions that may arise in their work environment and, in this way, reduce the risks of suffering stress.
Introduction: in Cuba, there is an insufficient disclosure of studies in intellectual disability ... more Introduction: in Cuba, there is an insufficient disclosure of studies in intellectual disability and its impact on family health, despite the fact that the current rate of people with intellectual desability registered is 3.26 per 100 inhabitants, with the highest incidence in Guantánamo province. Objective: to assess the impact of intellectual disability on family functioning, studied period January 2020 to January 2022, at the Hospital Psiquiátrico Provincial "Luis Ramírez López" de Guantánamo. Method: a descriptive qualitative study was carried out. A total of 25 families (N꓿25) were involved in the study, families with one of their members diagnosed with intellectual disability. Variables used: socioeconomic factors, psychological factors, family functioning, social adaptation, level of repercussion. Absolute and relative frequency distributions were performed in contingency tables. Results: among the socioeconomic factors, families with structural problems in their houses (64%) and overcrowding (56 %) predominated. Psychologically, planning of tasks and family life projects as a whole was severely affected (64%). Family functioning was affected by two aspects, the lack of practical actions to face problems head on (76%) and loss of intra-family communication (72%). The needs of an specialized support (100% of families) was the most affected social adaptation. Conclusions: intellectual disability in one of the family members denotes a lack of acceptance by the community, alienation from friends and relatives; the lack of social support prevents the patients from being included in the community and, on many occasions, one of the parents has to quit his or her job to assume the patient´s care, decisions which has deep impact on family incomes.
Introduction: atherosclerosis, its risk factors and associated diseases have been reviewed for de... more Introduction: atherosclerosis, its risk factors and associated diseases have been reviewed for decades. So, its multifactorial origin becomes it a continuing interest of study. Objective: characterization of the risk factors for atherosclerosis in the older smokers from the Hogar de Ancianos Pedro Vázquez Hidalgo, Holguín, in 2019. Method: a cross-sectional descriptive study was carried out, in which a total of 104 older smokers of 60 years old or older and both sex were involved. All variables studied were obtained from the medical records: age, sex, toxic habits associated with smoking (alcohol and/or coffee), nutritional evaluation, laboratory tests (blood glucose, uric acid, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol) and cardiovascular diseases associated to the atherosclerosis (arterial hypertension, diabetes mellitus, obesity, ischemic heart disease, chronic kidney disease, peripheral vascular disease, cerebrovascular disease). Results: male sex predominated in the age group of 75 years old or older (56.6%), while the consumption of coffee and alcohol linked with smoking predominated in the female sex (61.9%). There was adequate nutrition in both sexes (29%). The HDL-cholesterol tests were elevated in 80.9% of the female sex and 94% of the male sex, in addition to an increasing triglycerides in 37.3% of the latter. Both hypertension (90.5%) and ischemic heart disease (66.6%) were most common risk factors observed in women. Conclusions: the study of risk factors for atherosclerosis in older smokers such as toxic habits, nutritional evaluation, among others, are very important for preventing related disease complications in in this population group.
Introduction: the impact of chronic opioid use has been related to a wide range of cognitive diso... more Introduction: the impact of chronic opioid use has been related to a wide range of cognitive disorders, ranging from minor deficiencies in cognitive abilities to problems in abilities such as attention, learning, memory, and executive functions. Objective: to carry out a systematic review to research the cognitive impact in patients who use opioids chronically and to assess the severity of this impact. Method: randomized clinical trials, case-control studies, prospective and retrospective cohorts were evaluated in two databases: PubMed and Cochrane Central, using the following search terms: "analgesic opioids", "cognitive dysfunction", "cognition impairments", "chronic disease" and "abuse, substance". The search was in English, Spanish, and Portuguese for studies conducted in adult humans with chronic opioid use and its cognitive impact. Results: 7 studies were selected, 5 of which the patients used tramadol and the negative cognitive impact was verified, a study with the use of tapentadol with a positive impact on cognition and a study with the use of hydrocodone with a positive impact on neurocognition of patients. Conclusions: despite the limitations found, as a conclusion it is considered that tramadol has a negative impact on neurocognition, which does not occur in relation to tapentadol and hydrocodone, which will present an improvement in the quality of life and cognition of patients.
Introduction: interprofessional education is included in the third major health education reform.... more Introduction: interprofessional education is included in the third major health education reform. It consists of health systems-based teaching, focused on local and global competencies. It is the base of an interprofessional collaborative practice that guarantees a comprehensive health care service for patients, families and the community. Objective: to demonstrate the need for interprofessional education process in undergraduate and postgraduate Health Sciences education as a guarantee of an effective interprofessional collaborative practice that contributes to a sustainable and inclusive comprehensive health care. Method: a documentary research, in English and Spanish, was carried out in several databases: Scopus, SciELO, PubMed/MedLine, Redalyc, Google Scholar and the Infomed portal. The information was systematized and authors gave their critical evaluations. Development: collaborative interprofessional practice has been increasing in different scenarios and has become an essential condition for quality care service as demanded by society and healthcare systems worldwide in recent years and it is a necessary requirement for quality and health care safety. Collaborative interprofessional education improves coordination, integration and the merging of useful knowledge among different health and social care professionals. A close relationship between ministries of health and training institutions is required for interprofessional education from undergraduate, postgraduate and continuing education. Final considerations: collaborative interprofessional education in health care education contributes to sustainable interprofessional collaborative practice.
Introduction: one of the challenges facing universities of health sciences today is the implement... more Introduction: one of the challenges facing universities of health sciences today is the implementation and validation of effective tools for evaluation. Objective: to evaluate the quality of the partial exams of an in-house course in Morphofunctional bases of the most common hemorrhagic diathesis in Stomatology, Facultad de Estomatología, Universidad de Ciencias Médicas de Santiago de Cuba, course 2022. Method: an analytical and transversal observational study was carried out. For the study, it was selected 30 of the partial exams implemented in the in-house Morphofunctional bases of the most common hemorrhagic diathesis in Stomatology course, type (E) course syllabus, Stomatology career, Facultad de Estomatología, Universidad de Ciencias Médicas de Santiago de Cuba, course 2022. Correspondence between scheduled time and the number of items used in the test was assessed, and also, difficulty index and discrimination index for items and questions, point-biserial item discrimination coefficient and internal consistency coefficient were calculated. Results: there was an adequate correspondence between the time scheduled for the topics and the number of items used in the exam. Items with a moderate difficulty index and high degree of discrimination index predominated. The internal consistency of the individual questions was excellent, but the exam in general was low. Conclusions: the quality of the partial exam of the in-house course Morphofunctional bases of the main hemorrhagic diathesis treated in Stomatology, giving in the Faculty of Stomatology, University of Medical Sciences of Santiago de Cuba, course 2022, was inadequate.
Introduction: self-medication can generate adverse reactions, drug interactions, delay and failur... more Introduction: self-medication can generate adverse reactions, drug interactions, delay and failure in the diagnosis of the disease, resistance to antibiotics and loss of health resources. During the COVID-19 pandemic, it is reported that the frequency of adverse reactions due to self-medication has doubled. Objective: to identify the various causes and factors that affect self-medication by COVID-19 in rotating Nursing interns at the Hospital General "Luis Gabriel Dávila" in Tulcán, Ecuador. Method: a descriptive-analytical-correlational cross-sectional study was carried out on self-medication in 64 rotating Nursing interns of said institution in the period 2020-2021. Methods were used: empirical, analytical-synthetic, inductive-deductive, historical-logical level. The questionnaire was the technique applied to characterize the current state. The collected data was exported to Microsoft Excel v.2013. Results: 50.3% of Nursing inmates took frequent medication, 60.9% self-medicated with analgesics in the presence of symptoms due to COVID-19. 29.7% presented sore throat as a symptom of COVID-19, followed by fever with 26.5%. 78.1% used the oral route. 55.0% of these inmates always had free access to medications in their rotations; which prompted 42.2% to self-medication. Conclusions: the results obtained serve to characterize the problem of self-medication by COVID-19 in university students and provide information for the formulation of strategies that reduce its negative impact. The university and health authorities must dedicate efforts to the problem of self-medication by COVID-19, since it is a public health problem worldwide.
Introduction: valproic acid is a drug used in the treatment of various diseases, including epilep... more Introduction: valproic acid is a drug used in the treatment of various diseases, including epilepsy. Although it is considered a safe drug, it presents different adverse effects, among them the most common is the considerable increase in body weight. Objective: to identify the relationship between the use of valproic acid in patients with antiepileptic treatment and weight gain. Method: systematic review carried out at the Universidad Abierta Interamericana, Argentina, in which an exhaustive search of studies was carried out in the PubMed database with MeSH terms on Valproic acid AND weight gain. Once the articles were selected after applying the inclusion and exclusion criteria, 17 remained, which were useful to carry out this research. Results: the information from the articles found reveals that the mechanisms through which valproic acid can generate this increase in body weight are still not fully clarified. Several hypotheses have been proposed; the most frequent in the literature are: hyperinsulinemia and insulin resistance, as well as hyperleptinemia and leptin resistance, among others. Patients who present weight gain have important health consequences, particularly the development of obesity and the association with dyslipidemia, arterial hypertension, type 2 diabetes mellitus, and atherosclerosis. In addition, by generating changes in body image, it can bring depression, decreased self-esteem and self-confidence, which causes non-compliance and abandonment of treatment. Conclusion: the causal relationship of valproic acid on weight gain in patients with epilepsy is observed.
Introduction: adequate nutrition in pregnancy depends not only on a healthy diet, but also on the... more Introduction: adequate nutrition in pregnancy depends not only on a healthy diet, but also on the most effective way of taking vitamins, minerals and other nutrient supplementation. Objective: to describe aspects related to supplementation with folic acid, iron, iodine, calcium, vitamin B12 and omega-3 in pregnancy. Method: a systematic review was conducted between May 2022 and March 2023, concerning supplementation intake of vitamins and minerals in pregnancy. Electronic databases of biomedical scientific literature were reviewed such as: UpToDate, Science Direct, SciELO and PUBMED, LILACS. Searching was on articles published from 2016 to 2022. The key terms for searching in databases were as follow: supplements "Vitamins", "Micronutrients", "Minerals", and "Pregnancy", in English and Spanish. Results: a vitamin, minerals and different nutrients intake requirements has increased in pregnancy. An appropriate diet and the consumption of micronutrients in the form of supplements are the basic support for an adequate health status of the mother and the development the fetus; on the other hand, an adequate nutrition reduces the risk of congenital malformations, obstetric, fetal and perinatal complications. Not all pregnant women need the same amount of supplements, so it is necessary to identify those with a highest risk of presenting deficiency. Conclusions: supplementation of vitamins, minerals and other micronutrients in pregnancy is very important to reduce the risk of obstetric complications and fetal or perinatal anomalies.
Introduction: advanced esophageal cancer is one of the most aggressive neoplasms with high morbid... more Introduction: advanced esophageal cancer is one of the most aggressive neoplasms with high morbidity and mortality. Botswana ranks 14th in the world for deaths from this disease. Objective: to determine the clinicopathological characteristics of patients with advanced esophageal cancer at the Princess Marina Hospital in Gaborone, Botswana. Method: a prospective-descriptive study was carried out, where 45 patients with endoscopic and histological diagnosis of advanced esophageal cancer were characterized clinically and pathologically, from January to September 2019. Results: males predominated (86.7%), and also patients older than 60 years (60.0%). Dysphagia, anorexia and weight loss were the most frequent symptoms, and prevailed patients with three to six months between the appearance of symptoms and endoscopic diagnosis; inadequate diet, chronic alcoholism, and smoking were the predominant risk factors. The most frequent anatomical location was the middle third (51.1%), the predomi...
Giant phyllodes tumors are one of the rarest breast tumors. This tumor typically presents itself ... more Giant phyllodes tumors are one of the rarest breast tumors. This tumor typically presents itself as a firm and painless mass, mobile and generally located in one of the breasts. An HIV-positive 17 years old female patient presented a left breast swelling with a history of fast growing pace in the previous 6 months. Physical examination showed an ulcerated painless giant phyllodes tumor on the left breast, with multilobed firm characteristics and considerable blood vessel network. The tumor, with a 33cm circumference, took most of the left breast volume. No lymphadenopathies were detected. After radiographic tests, surgical procedure was performed. The anatomopathological report confirmed the presence of a high grade phyllodes tumor. The patient evolved favorably after surgery and was discharged in good general condition, with no fever. The study and management of this pathology was reviewed, as well as the importance of a correct differential diagnosis.
It was reported a case of a 73 years old patient with a history of an unknown outcomes surgical p... more It was reported a case of a 73 years old patient with a history of an unknown outcomes surgical procedure 5 years ago at the Hospital Clínico Quirúrgico Docente “Amalia Simoni” in Camaguey, Cuba. He presented pain and functional limitation of the right lower limb, which led to the resection of a tumor in the ipsilateral femur; five years later the tumor present signs of recurrence, this time with invasion of the bony pelvis and rectum and resulting in urinary disorders and constipation. Pelvis bone radiology, computed tomography scan and magnetic resonance imaging of the pelvis showed a mixed tumor with lytic lesions that invaded and displaced the organs in the pelvic cavity. The patient underwent excision of the tumor, which was 173×156 mm, weighing approximately 1.380 g. Histopathological analysis of the surgical resection specimen revealed a pelvic malignant mesenchymoma.
Introduction: childhood obesity globally is an unresolved health problem, becoming increasingly p... more Introduction: childhood obesity globally is an unresolved health problem, becoming increasingly present in all countries with not appropriate standard treatment strategies. Objective: to describe the relationship between breastfeeding, complementary feeding and formula milk in childhood obesity. Method: an observational cross-sectional study was conducted in 126 children, aged of 6 months to 2 years, treated at the Hospital General Docente Ambato, Ecuador, in 2019. The variables studied were as follow: age, sex, nutritional status, exclusive breastfeeding duration, time of initiation in complementary feeding and duration providing formula milk. Descriptive statistics and the nonparametric Mann-Whitney U test were applied. Results: infants between the age of 6 to 12 months (50.8%) and female sex (55.2%) predominated. Of the total of children, 62.1% apply in obese profile, 70.6 % were exclusively breastfed in their early 6 months (2 months less than obese patients). The same behavior was observed in those who received complementary feeding and in those who consumed formula milk for 2.5 months. Conclusions: most children in the study were classified as obese. Obese children had a short frequency of exclusive breastfeeding and consumed complementary feeding and formula milk for a longer period of time rather than children with normal weight.
Introduction: perioperative hypertension represents one of the leading alterations detected perfo... more Introduction: perioperative hypertension represents one of the leading alterations detected performing endoscopic cholecystectomy. It is presumed that atenolol has a protective effect able to reduce this morbid condition, likely due to its beta-blocking action. Objective: to assess the efficacy of atenolol on preventing perioperative hypertension performing laparoscopic cholecystectomy in the surgical unit of the Hospital Clínico Quirúrgico "Lucía Íñiguez Landín" of Holguín. Method: an observational, analytical, longitudinal and prospective cohort study was conducted with two study groups at the same time, experimental group and control group, from January to December, 2018. A total of 697 patients (N=697) evaluated in the preoperative consultation were involved in the study, the sample included 183 hypertensive patients (n=183) who underwent endoscopic surgery for gallbladder lithiasis, of whom 95 were randomized to the atenolol treatment group and 88 to the control group. Patients in the treatment group were administered atenolol at 25 mg daily for 15 days before surgery. Leading variables used were systolic, diastolic and mean arterial pressures, and specific indicators were used to evaluate treatment effectiveness. Results: preoperative arterial pressures decreased significantly with the use of atenolol in the treatment group. Perioperative hypertension was more frequent in the control group. Atenolol is a selective beta 1 receptor blocker, who causes a hypertensive effects in the central level, depressing the bulbar vasomotor center. Conclusion: the results of this investigation show that the use of atenolol in treatment was an effective alternative, thus effectiveness reduce perioperative hypertension rate.
Introduction: ovarian cancer is one of the most common and lethal tumor in women. This happens as... more Introduction: ovarian cancer is one of the most common and lethal tumor in women. This happens as a result of late-stage cancer detention and an increased chemoresistance to standard therapy. The current development in therapies to kill the cancer cells and its spread tendencies has emerged as a key alternative to treat tumors. Objective: to describe the current therapeutic strategies lead to confront different capabilities of tumor cells found in the ovarian cancer treatment. Method: a search of literuture was carried out in the following databases ScienceDirect, Redalyc, Latindex, ResearchGate, PubMed, Elsevier, ClinicalTrials.gov, SpringerLink, LARVOL's CLIN, Cuban Public Registry of Clinical Trials, from January to April 2023. A total of 50 text concerning ovarian cancer subject and alternative for treatment were selected. Development: the driving factors that promoted the use of ovarian cancer therapies were pointed out. The current therapeutic targets used in the treatment of this neoplasia were described, as well as the use of multiple approved drugs or in process of approval, including the synergistic drug combinations. Final considerations: there are a lot of options currently being implemented in ovarian cancer treatment. Despite clinical efficacy of targeted therapy, it´s presented still restricted to specific molecular subtypes and none of the assays illustrated survival benefit in general; the results obtained in the process of drugs development specifically targeting genome instability and sustained angiogenesis have been remarkable.
Introduction: commercial plastic products has transformed the modern era in such a way that curre... more Introduction: commercial plastic products has transformed the modern era in such a way that current life without plastic would not be possible, so at the same time with this development, plastics contamination is present, becoming one of the most urgent environmental problems nowadays. Objective: to gather available information published on the last five years concerning the microplastics as a source of environmental contamination in Ecuador and in order to reinforce the local interest on plastic pollution. Development: an unstructured review of the literature was performed. Databases used, PubMed and Google Scholar. The inclusion criteria used were as follow: articles in English and Spanish published on the last 5 years, no other language; study selections have been done by convenience. It was chronologically organized and analyzed the evidence published in PubMed and Google Scholar on the last five years concerning the microplastics behavior in Ecuador. Final considerations: the information collected chronologically shows the advancing pollution caused by microplastics both globally and in Ecuador, in addition, the presence of microplastics in oceans, fresh water, terrestrial ecosystems, air, foods and even in the human body is evident. Therefore, contamination caused by microplastics is a topic of a great importance today, which requires a speedy control action.
Introduction: currently there are very few published studies concerning the effect of implantatio... more Introduction: currently there are very few published studies concerning the effect of implantations with stem cells in post-surgical aseptic pseudoarthrosis. In addition, the traditional methods of adjuvant treatment in order to improve efficacy (anabolic steroids and bisphosphonates) represent high risks, rejection and even treatment abandonment by patients. Objective: hierarchalising the most influential variables for treatment with stem cells in post-surgical aseptic pseudoarthrosis in the Orthopedics and Traumatology service of the Hospital General Docente “Dr. Agostinho Neto”, Guantánamo, from January 2022 to January 2023, with the application of the TOPSIS fuzzy method. Method: a descriptive study was applied, with the application of Fuzzy Analytical Hierarchy process methods (Fuzzy AHP) and the Technique for Order of Preference by Similarity to Ideal Solution (fuzzy TOPSIS), with information gathered from the Orthopedics and Traumatology department of the aforementioned hospital. The universe of study consisted of 50 patients. The study sample included n꓿44. Results: it was possible to obtain the main variables involved in the stem cell treatment for pseudarthrosis, variables with great contribution in the success of implementation of such treatment, which were as follow: fracture trace, cause of pseudarthrosis, type of therapy used, time of bone consolidation and degree in bone consolidation. Conclusions: the hierarchization of the variables obtained will constitute a guide where the Orthopedics and Traumatology services of the Hospital General Docente “Dr. Agostinho Neto”, in Guantánamo municipality, will be able to influence in the efficacy of stem cell treatment for pseudarthrosis.
Introduction: legal and criminal liability of the health professionals, regardless its antiquity,... more Introduction: legal and criminal liability of the health professionals, regardless its antiquity, at present has becoming more and more theoretical and practical relevance in which an excessive judicialization of medical activity is revealed as a mechanism for the protection of patient rights. Objective: systematization of the different theoretical positions that are currently identified around the judicialization process of medical activity and the likely causes that stimulate it. Method: a documentary study was carried out through an exhaustive bibliographic review in bibliographic search engines such as Scopus, SciELO, Google Scholar and PubMed. The argumentative and exploratory research was conducted on March 16, 2023 and of the 30 articles found concerning medical malpractice, only 11 were chosen for the study with strict selection criteria. Development: the theoretical positions on the judicialization of medical activity and the causes that stimulate it were systematized; in addition, the correct interpretation of the lex artis was presented as a mechanism of normative heterointegration of the duty of care by the medical personnel, in order to avoid excesses in the application of the criminal law in this area of professional activity. Final considerations: a much greater intervention of criminal law in the practice of medicine is not the most efficient policy to protect the life and integrity of the patient in the face up to the medical malpractice.
Introduction: currently, there is a lack of information in the national literature concerning joi... more Introduction: currently, there is a lack of information in the national literature concerning joint loose bodies in the knee joint. These occur as a consequence of traumatic, degenerative, inflammatory and ischemic injuries. Objective: to update knowledge on the most general aspects concerning joint loose bodies in the knee and the use of the arthroscopy procedure on its treatment. Method: search and analysis of the information was performed on 59 days (January 1 to February 28, 2023) and the following keywords were used: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. Based on the information obtained, a bibliographic review was made of a total of 211 articles published in the PubMed, Hinari, SciELO and Medline databases. The EndNote search manager and reference manager was used. Of the total of articles, 33 contributions selected for the review were used, 32 were published the last five years. Development: it was refered in the study on the positive diagnosis based on the history, clinical picture and imaging. In relation to the differential diagnosis of this entity, special emphasis is made up with all the conditions that produce joint blockage. Specifically, meniscal lesions are reviewed, as well as the most commonly used classifications according to size, origin, quantity and mobility. In relation to the arthroscopic treatment, the following four stages were described: identification, trapping, extraction and revision. Final considerations: the arthroscopic approach, due to its multiple advantages, represents the most effective surgical modality for the diagnosis and treatment of patients with joint loose bodies in the knee.
Introduction: administrative personnel with a vision on Science, Technology and Society can influ... more Introduction: administrative personnel with a vision on Science, Technology and Society can influence universities functions through a social approach, the training, research and, extension process. Objective: to diagnose the level of knowledge on the Science, Technology and Society perspective of the administrative teaching personnel of the Universidad de Ciencias Médicas de Ciego de Ávila, Cuba. Method: a descriptive observational study was carried out in 2022 at the aforementioned university, where the population study consisted of 52 administrative personnel in teaching functions (N=52). A sample of 34 was selected by simple random sampling (n=34). A validated questionnaire was applied as an empirical method for data collection. Measurement scales were established for quantitative variables. Results: the diagnosis revealed a low level of knowledge on Science, Technology and Innovation definitions (85%, 69% and 44%, respectively). Most of the teaching and administrative personnel (53%) did not recognize the models that revealed the relationships between Science, Technology and Society and have in consideration that the University of Medicine is not positioned as a relevant actor in the local development. Forty-one percent reported that the Science, Technology and Society perspective almost always appears in the normative documents of the Ministerios de Educación Superior y de Salud Pública. Conclusions: there is evidence of insufficient knowledge on Science, Technology and Society and its use in the process management at universities. It is recommended to design related improvement actions on the subject.
Introduction: while a number of research studies have shown that mindfulness influences perceived... more Introduction: while a number of research studies have shown that mindfulness influences perceived stress, there is a lack of research that have tested the relationship between emotional regulation, mindfulness and perceived stress, specifically in those health workers who work in intensive care units. Objective: test relationship between mindfulness and perceived stress in health workers of public and private hospitals in Santo Domingo de los Colorados, Ecuador, in order to identify whether this relationship is mediated by emotional regulation. Method: a quantitative study of descriptive correlational scope and cross-sectional design was carried out, where a questionnaire consisting of 39 questions taken from three psychosomatic scales was applied to 382 health care workers in intensive care units of the aforementioned institutions. Variables used were as follow: mindfulness, emotional regulation and perceived stress. Statistical analyses were structured using two specialized softwares Excel and Statistical Package for Social Sciences 21. Results: statistical analyses showed that mindfulness influenced perceived stress (β=0.428**), and also emotional regulation (β=0.488**), at the same time, emotional regulation influenced perceived stress (β=0.417**). Conclusions: it was corroborated that emotional regulation played a mediating effect between mindfulness and perceived stress felt by the health care workers who work in intensive care units. Frequently, these personnel develop activities without mindfulness, however, they have control over their work activities and are able to regulate and hide emotions that may arise in their work environment and, in this way, reduce the risks of suffering stress.
Introduction: in Cuba, there is an insufficient disclosure of studies in intellectual disability ... more Introduction: in Cuba, there is an insufficient disclosure of studies in intellectual disability and its impact on family health, despite the fact that the current rate of people with intellectual desability registered is 3.26 per 100 inhabitants, with the highest incidence in Guantánamo province. Objective: to assess the impact of intellectual disability on family functioning, studied period January 2020 to January 2022, at the Hospital Psiquiátrico Provincial "Luis Ramírez López" de Guantánamo. Method: a descriptive qualitative study was carried out. A total of 25 families (N꓿25) were involved in the study, families with one of their members diagnosed with intellectual disability. Variables used: socioeconomic factors, psychological factors, family functioning, social adaptation, level of repercussion. Absolute and relative frequency distributions were performed in contingency tables. Results: among the socioeconomic factors, families with structural problems in their houses (64%) and overcrowding (56 %) predominated. Psychologically, planning of tasks and family life projects as a whole was severely affected (64%). Family functioning was affected by two aspects, the lack of practical actions to face problems head on (76%) and loss of intra-family communication (72%). The needs of an specialized support (100% of families) was the most affected social adaptation. Conclusions: intellectual disability in one of the family members denotes a lack of acceptance by the community, alienation from friends and relatives; the lack of social support prevents the patients from being included in the community and, on many occasions, one of the parents has to quit his or her job to assume the patient´s care, decisions which has deep impact on family incomes.
Introduction: atherosclerosis, its risk factors and associated diseases have been reviewed for de... more Introduction: atherosclerosis, its risk factors and associated diseases have been reviewed for decades. So, its multifactorial origin becomes it a continuing interest of study. Objective: characterization of the risk factors for atherosclerosis in the older smokers from the Hogar de Ancianos Pedro Vázquez Hidalgo, Holguín, in 2019. Method: a cross-sectional descriptive study was carried out, in which a total of 104 older smokers of 60 years old or older and both sex were involved. All variables studied were obtained from the medical records: age, sex, toxic habits associated with smoking (alcohol and/or coffee), nutritional evaluation, laboratory tests (blood glucose, uric acid, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol) and cardiovascular diseases associated to the atherosclerosis (arterial hypertension, diabetes mellitus, obesity, ischemic heart disease, chronic kidney disease, peripheral vascular disease, cerebrovascular disease). Results: male sex predominated in the age group of 75 years old or older (56.6%), while the consumption of coffee and alcohol linked with smoking predominated in the female sex (61.9%). There was adequate nutrition in both sexes (29%). The HDL-cholesterol tests were elevated in 80.9% of the female sex and 94% of the male sex, in addition to an increasing triglycerides in 37.3% of the latter. Both hypertension (90.5%) and ischemic heart disease (66.6%) were most common risk factors observed in women. Conclusions: the study of risk factors for atherosclerosis in older smokers such as toxic habits, nutritional evaluation, among others, are very important for preventing related disease complications in in this population group.
Introduction: the impact of chronic opioid use has been related to a wide range of cognitive diso... more Introduction: the impact of chronic opioid use has been related to a wide range of cognitive disorders, ranging from minor deficiencies in cognitive abilities to problems in abilities such as attention, learning, memory, and executive functions. Objective: to carry out a systematic review to research the cognitive impact in patients who use opioids chronically and to assess the severity of this impact. Method: randomized clinical trials, case-control studies, prospective and retrospective cohorts were evaluated in two databases: PubMed and Cochrane Central, using the following search terms: "analgesic opioids", "cognitive dysfunction", "cognition impairments", "chronic disease" and "abuse, substance". The search was in English, Spanish, and Portuguese for studies conducted in adult humans with chronic opioid use and its cognitive impact. Results: 7 studies were selected, 5 of which the patients used tramadol and the negative cognitive impact was verified, a study with the use of tapentadol with a positive impact on cognition and a study with the use of hydrocodone with a positive impact on neurocognition of patients. Conclusions: despite the limitations found, as a conclusion it is considered that tramadol has a negative impact on neurocognition, which does not occur in relation to tapentadol and hydrocodone, which will present an improvement in the quality of life and cognition of patients.
Introduction: interprofessional education is included in the third major health education reform.... more Introduction: interprofessional education is included in the third major health education reform. It consists of health systems-based teaching, focused on local and global competencies. It is the base of an interprofessional collaborative practice that guarantees a comprehensive health care service for patients, families and the community. Objective: to demonstrate the need for interprofessional education process in undergraduate and postgraduate Health Sciences education as a guarantee of an effective interprofessional collaborative practice that contributes to a sustainable and inclusive comprehensive health care. Method: a documentary research, in English and Spanish, was carried out in several databases: Scopus, SciELO, PubMed/MedLine, Redalyc, Google Scholar and the Infomed portal. The information was systematized and authors gave their critical evaluations. Development: collaborative interprofessional practice has been increasing in different scenarios and has become an essential condition for quality care service as demanded by society and healthcare systems worldwide in recent years and it is a necessary requirement for quality and health care safety. Collaborative interprofessional education improves coordination, integration and the merging of useful knowledge among different health and social care professionals. A close relationship between ministries of health and training institutions is required for interprofessional education from undergraduate, postgraduate and continuing education. Final considerations: collaborative interprofessional education in health care education contributes to sustainable interprofessional collaborative practice.
Introduction: one of the challenges facing universities of health sciences today is the implement... more Introduction: one of the challenges facing universities of health sciences today is the implementation and validation of effective tools for evaluation. Objective: to evaluate the quality of the partial exams of an in-house course in Morphofunctional bases of the most common hemorrhagic diathesis in Stomatology, Facultad de Estomatología, Universidad de Ciencias Médicas de Santiago de Cuba, course 2022. Method: an analytical and transversal observational study was carried out. For the study, it was selected 30 of the partial exams implemented in the in-house Morphofunctional bases of the most common hemorrhagic diathesis in Stomatology course, type (E) course syllabus, Stomatology career, Facultad de Estomatología, Universidad de Ciencias Médicas de Santiago de Cuba, course 2022. Correspondence between scheduled time and the number of items used in the test was assessed, and also, difficulty index and discrimination index for items and questions, point-biserial item discrimination coefficient and internal consistency coefficient were calculated. Results: there was an adequate correspondence between the time scheduled for the topics and the number of items used in the exam. Items with a moderate difficulty index and high degree of discrimination index predominated. The internal consistency of the individual questions was excellent, but the exam in general was low. Conclusions: the quality of the partial exam of the in-house course Morphofunctional bases of the main hemorrhagic diathesis treated in Stomatology, giving in the Faculty of Stomatology, University of Medical Sciences of Santiago de Cuba, course 2022, was inadequate.
Introduction: self-medication can generate adverse reactions, drug interactions, delay and failur... more Introduction: self-medication can generate adverse reactions, drug interactions, delay and failure in the diagnosis of the disease, resistance to antibiotics and loss of health resources. During the COVID-19 pandemic, it is reported that the frequency of adverse reactions due to self-medication has doubled. Objective: to identify the various causes and factors that affect self-medication by COVID-19 in rotating Nursing interns at the Hospital General "Luis Gabriel Dávila" in Tulcán, Ecuador. Method: a descriptive-analytical-correlational cross-sectional study was carried out on self-medication in 64 rotating Nursing interns of said institution in the period 2020-2021. Methods were used: empirical, analytical-synthetic, inductive-deductive, historical-logical level. The questionnaire was the technique applied to characterize the current state. The collected data was exported to Microsoft Excel v.2013. Results: 50.3% of Nursing inmates took frequent medication, 60.9% self-medicated with analgesics in the presence of symptoms due to COVID-19. 29.7% presented sore throat as a symptom of COVID-19, followed by fever with 26.5%. 78.1% used the oral route. 55.0% of these inmates always had free access to medications in their rotations; which prompted 42.2% to self-medication. Conclusions: the results obtained serve to characterize the problem of self-medication by COVID-19 in university students and provide information for the formulation of strategies that reduce its negative impact. The university and health authorities must dedicate efforts to the problem of self-medication by COVID-19, since it is a public health problem worldwide.
Introduction: valproic acid is a drug used in the treatment of various diseases, including epilep... more Introduction: valproic acid is a drug used in the treatment of various diseases, including epilepsy. Although it is considered a safe drug, it presents different adverse effects, among them the most common is the considerable increase in body weight. Objective: to identify the relationship between the use of valproic acid in patients with antiepileptic treatment and weight gain. Method: systematic review carried out at the Universidad Abierta Interamericana, Argentina, in which an exhaustive search of studies was carried out in the PubMed database with MeSH terms on Valproic acid AND weight gain. Once the articles were selected after applying the inclusion and exclusion criteria, 17 remained, which were useful to carry out this research. Results: the information from the articles found reveals that the mechanisms through which valproic acid can generate this increase in body weight are still not fully clarified. Several hypotheses have been proposed; the most frequent in the literature are: hyperinsulinemia and insulin resistance, as well as hyperleptinemia and leptin resistance, among others. Patients who present weight gain have important health consequences, particularly the development of obesity and the association with dyslipidemia, arterial hypertension, type 2 diabetes mellitus, and atherosclerosis. In addition, by generating changes in body image, it can bring depression, decreased self-esteem and self-confidence, which causes non-compliance and abandonment of treatment. Conclusion: the causal relationship of valproic acid on weight gain in patients with epilepsy is observed.
Introduction: adequate nutrition in pregnancy depends not only on a healthy diet, but also on the... more Introduction: adequate nutrition in pregnancy depends not only on a healthy diet, but also on the most effective way of taking vitamins, minerals and other nutrient supplementation. Objective: to describe aspects related to supplementation with folic acid, iron, iodine, calcium, vitamin B12 and omega-3 in pregnancy. Method: a systematic review was conducted between May 2022 and March 2023, concerning supplementation intake of vitamins and minerals in pregnancy. Electronic databases of biomedical scientific literature were reviewed such as: UpToDate, Science Direct, SciELO and PUBMED, LILACS. Searching was on articles published from 2016 to 2022. The key terms for searching in databases were as follow: supplements "Vitamins", "Micronutrients", "Minerals", and "Pregnancy", in English and Spanish. Results: a vitamin, minerals and different nutrients intake requirements has increased in pregnancy. An appropriate diet and the consumption of micronutrients in the form of supplements are the basic support for an adequate health status of the mother and the development the fetus; on the other hand, an adequate nutrition reduces the risk of congenital malformations, obstetric, fetal and perinatal complications. Not all pregnant women need the same amount of supplements, so it is necessary to identify those with a highest risk of presenting deficiency. Conclusions: supplementation of vitamins, minerals and other micronutrients in pregnancy is very important to reduce the risk of obstetric complications and fetal or perinatal anomalies.
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