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Abstract Clavicle fracture represents 5% of the fractures in adults. However, segmental clavicle fractures are infrequent and have been understudied in the current literature. Cases have been reported showing adequate results with both surgical and conservative management, and yet, it has not been possible to reach a consensus regarding diagnosis or management of such condition. A patient with a middle and lateral segmental clavicle fracture is reported, after presenting multiple trauma in a road traffic accident, also suffering trauma to the right hemi body, multiple rib segmental fractures and hemothorax. After stabilization, he was taken to surgery for open reduction and internal fixation of the clavicle using a double plate technique, as it has been rarely described in the literature. The functional result was shown to be adequate and satisfactory in the postoperative follow-up. Despite the limited evidence available on the management of this type of pathology, surgical management is a valid option given the risk of non-union. The foregoing is concluded by the potential harm in patient functionality.

Resumo A fratura de clavícula representa 5% das fraturas em adultos. No entanto, as fraturas segmentares da clavícula são infrequentes e pouco estudadas na literatura atual. Há relatos de casos com bons resultados após o tratamento cirúrgico ou conservador, mas não existe consenso quanto ao diagnóstico ou manejo dessas lesões. Relata-se um paciente com fratura segmentar média e lateral da clavícula após politraumatismo em acidente de trânsito. O paciente também apresentava traumatismo em hemicorpo direito, múltiplas fraturas segmentares da costela e do hemotórax. Após estabilização, ele foi encaminhado à cirurgia para redução aberta e fixação interna da clavícula pela técnica de placa dupla, raramente descrita na literatura. O resultado funcional foi considerado satisfatório e adequado no acompanhamento pós-operatório. Apesar das poucas evidências sobre o manejo desse tipo de patologia, o tratamento cirúrgico é uma opção válida devido ao risco de não união, apesar da possível diminuição da funcionalidade do paciente.

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Introducción: Las enfermedades bucales se encuentran entre las cinco de mayor demanda de atención en los servicios de salud a nivel mundial. Materiales y métodos: Se realizó una investigación observacional analítica retrospectiva de casos y controles, con el objetivo de determinar el grado de asociación entre la caries dental y los factores de riesgo en la población infantil de 5 a 12 años del Consultorio del Médico de la Familia no. 3, pertenecientes al Policlínico Docente Belkis Sotomayor Álvarez, del municipio Ciego de Ávila, durante el período de octubre de 2021 a marzo de 2022. El grupo de casos estuvo integrado por 62 niños, al igual que el grupo control. Se utilizó la técnica de independencia basada en la distribución de Chi-cuadrado, para determinar la presencia de asociación estadística entre variables cualitativas, y se realizó el cálculo del Odd ratio para la cuantificación de riesgo. Resultados: El grupo de 5 a 8 años fue el de mayor número de niños con caries dental, para un 59,7 %. El 62,9 % solo se cepillaban los dientes con una frecuencia de dos o menos veces al día. El antecedente de caries dental, la enfermedad gingival y la ingestión de alimentos azucarados, estuvieron relacionados con la aparición de caries dental. Conclusiones: La dieta cariogénica resultó ser el factor de riesgo con mayor puntaje en la incidencia de la caries dental en la muestra estudiada.

Introduction: Oral diseases are among the five diseases demanding more care in health services worldwide. Materials and methods: A descriptive, analytic, observational research of cases and controls was carried out, with the objective of determining the association degree between dental caries and risk factors in the child population aged from 5 to 12 years from the Family Physician Consultation Nr. 3, belonging to the Teaching Polyclinic Belkis Sotomayor Alvarez, in the municipality Ciego de Avila, during the period from October 2021 to March 2022. The case group consisted of 62 children, the same as the control group. The independence technique based on the Chi-square distribution was used to determine the presence of statistical association between qualitative variables, and the Odd ratio was calculated for risk quantification. Results: The group from 5 to 8 years was the one with higher number of children with dental caries, for 59.7%. 62.9% only brushed their teeth with a frequency of two or less times a day. History of dental caries, gingival disease and sugary food ingestion were related to the appearance of dental caries. Conclusions: The cariogenic diet proved to be the risk factor with the higher score in the incidence of dental caries in the sample studied.

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Fundamento la salud bucal es un componente de la salud general de las personas, desarrollar acciones de promoción y prevención desde temprana edad, garantiza estilos de vida saludables. Objetivo determinar la efectividad de una estrategia de intervención educativa para mejorar el nivel de conocimientos sobre salud bucal en escolares de quinto grado. Métodos estudio pre-experimental, de intervención, del tipo antes y después, en 43 escolares del municipio de Venezuela, Ciego de Ávila, Cuba, en el período septiembre de 2018 a enero de 2019. Mediante una encuesta se identificaron las necesidades de aprendizaje. Luego se confeccionó y ejecutó la estrategia de intervención educativa con actividades teórico-prácticas y técnicas afectivo- participativas acordes con la edad d os participantes. Se utilizó como unidad de resumen el por ciento; y para el análisis estadístico, la prueba de McNemar. Resultados antes de la intervención existían conocimientos insuficientes acerca de temas como la caries dental, higiene bucal y dieta cariogénica; después de aplicada la estrategia se modificaron favorablemente los conocimientos acerca de salud bucal en general (65,1 %). La información relacionada con el tiempo de cambio del cepillo, y otros medios auxiliares para realizar la higiene bucal, resultaron los tópicos mejor asimilados (93,0 % y 90,7 % cada uno) por los infantes. Conclusiones la intervención educativa fue eficaz, lo cual se evidenció al elevarse el nivel de conocimientos sobre salud bucal en la población estudiada, como resultado de las acciones educativas realizadas.

Foundation oral health is a component of people's general health, developing promotion and prevention actions from an early age to guarantee healthy lifestyles. Objective to determine the effectiveness of an educational intervention strategy to improve the oral health knowledge level in fifth grade students. Methods pre-experimental, intervention study, of the before and after type, in 43 schoolchildren from the Venezuela municipality, Ciego de Ávila, Cuba, from September 2018 to January 2019. Learning needs were identified through a survey. The educational intervention strategy was prepared and executed with theoretical-practical activities and affective-participatory techniques according to the participants' age. The percent was used as the summary unit; and for statistical analysis, the McNemar test. Results before the intervention there was insufficient knowledge about topics such as dental caries, oral hygiene and cariogenic diet; after applying the strategy, knowledge about oral health in general was modified favorably (65.1%). The information related to the time to change the toothbrush, and other auxiliary means to perform oral hygiene, were the best assimilated topics (93.0 % and 90.7 % each) by the infants. Conclusions the educational intervention was effective; it was evidenced by raising the oral health knowledge level in the studied population, as a result of the educational actions carried out.

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Introducción: el enclavijamiento endomedular (EE) es una opción terapéutica para fracturas de la diáfisis humeral; sin embargo, algunos pacientes tratados con EE desarrollan signos de pinzamiento subacromial y disminución de la fuerza en movimientos de flexión y abducción.Objetivo: evaluar el impacto en el hombro del uso del EE anterógrado para el tratamiento de fracturas de la diáfisis humeral en términos de dolor, funcionalidad y signos de pinzamiento subacromial.Metodología: estudio observacional retrospectivo realizado en 25 pacientes adultos con fracturas de la diáfisis humeral tratadas con EE anterógrado. Se realizó seguimiento entre 6 y 12 meses después del procedimiento, valorando la funcionalidad (arcos de movimiento y escala QuickDASH) y la presencia de dolor (escala visual análoga [EVA]) y signos de pinzamiento subacromial (según Yocum, Neer y Hawkins-Kennedy). Los datos se describen utilizando frecuencias absolutas y relativas para las variables cualitativas, y medias y desviaciones estándar para las cuantitativas.Resultados: las medias de la flexión anterior, puntaje en la escala QuickDASH y escala EVA fueron 145° (±31,6), 6,1 (±8,5) y 2,32 (±2,06), respectivamente. El 32% de los pacientes presentó uno o más signos de pinzamiento subacromial. Además, la consolidación completa de la fractura ocurrió en todos los casos.Conclusiones: dado que no se evidenció un impacto significativo en el hombro en términos de movilidad, dolor o signos de pinzamiento subacromial y que la consolidación de la fractura ocurrió en todos los casos, el EE fue adecuado para el tratamiento de fracturas de la diáfisis humeral

Introduction: Intramedullary nailing (IN) is a common therapeutic option for humeral shaft fractures. However, some patients treated with IN develop signs of subacromial impingement and decreased strength in flexion and abduction movements. Objective: To evaluate the clinical impact of the use of antegrade IN on the shoulder for the treatment of humeral shaft fractures in terms of pain, functionality, and subacromial impingement symptoms.Methodology: Retrospective observational study carried out in 25 adult patients with humeral shaft fractures treated with antegrade IN. Follow-up was performed 6 to 12 months after the procedure, assessing functionality (arcs of motion and QuickDASH scale), as well as the presence of pain (visual analog scale [VAS]) and signs of subacromial impingement (according to Yocum, Neer and Hawkins-Kennedy). Data are described using absolute and relative frequencies for qualitative variables and means and standard deviations for quantitative variables.Results: The mean anterior flexion, QuickDASH score, and VAS score were 145° (±31.6), 6.1 (±8.5), and 2.32 (±2.06), respectively. One or more signs of subacromial impingement were observed in 32% of the patients. In addition, complete fracture healing occurred in all cases.Conclusion: Given that no significant impact on the shoulder was evidenced in terms of mobility, pain or signs of subacromial impingement and that fracture healing occurred in all cases, IN was adequate for the treatment of humeral shaft fractures.

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Medial tibial stress syndrome (MTSS) is characterized by the presence of diffuse pain in the posteromedial portion of the medial border of the tibia. Current evidence from the literature has not established an effective treatment and has not been able to demonstrate effectiveness of numerous modalities commonly used to treat MTSS pain. CASE DESCRIPTION: This report describes an 18-year-old male collegiate soccer player who presented with pain along the distal medial tibial border bilaterally consistent with the diagnosis of medial tibial stress syndrome (MTSS). Treatment focused on correcting clinical and kinesiological findings likely contributing to the patient's condition including fascial mobilization, interferential currents (IFC), strengthening and stretching exercises. After 10 sessions over 10 weeks the patient was able to return to training and competition without pain.

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Scene analysis in video sequences is a complex task for a computer vision system. Several schemes have been addressed in this analysis, such as deep learning networks or traditional image processing methods. However, these methods require thorough training or manual adjustment of parameters to achieve accurate results. Therefore, it is necessary to develop novel methods to analyze the scenario information in video sequences. For this reason, this paper proposes a method for object segmentation in video sequences inspired by the structural layers of the visual cortex. The method is called Neuro-Inspired Object Segmentation, SegNI. SegNI has a hierarchical architecture that analyzes object features such as edges, color, and motion to generate regions that represent the objects in the scenario. The results obtained with the Video Segmentation Benchmark VSB100 dataset demonstrate that SegNI can adapt automatically to videos with scenarios that have different nature, composition, and different types of objects. Also, SegNI adapts its processing to new scenario conditions without training, which is a significant advantage over deep learning networks.

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Lecithin-cholesterol acyltransferase (LCAT) deficiency is a rare autosomal recessive condition affecting lipid metabolism with a prevalence of less than 1:1,000,000. Described here is the case of a 29-year-old pregnant woman with a diagnosis of LCAT deficiency (c.140G>A in exon 4), who had three episodes of hypertriglyceridemia-induced pancreatitis and nephrotic-range proteinuria throughout the pregnancy. Furthermore, fetal ultrasounds carried out during the second and third trimester revealed a steady reduction in fetal growth rate, and fetal growth restriction (FGR) was diagnosed. The woman underwent an elective caesarean section at 33 weeks of gestation and delivered a healthy neonate. This case report adds knowledge of the natural history of LCAT deficiency during pregnancy and will be useful in future patient management.

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Introducción: La arteria femoral común y sus ramas suministran la mayor parte del flujo sanguíneo al muslo, así como a la totalidad de la pierna y el pie, lo que da lugar a la mayor rama del triángulo femoral: la arteria femoral profunda. Objetivo: Exponer la efectividad de la profundaplastia femoral en la "era endovascular". Reporte del caso: Se presenta un caso de enfermedad arterial periférica de múltiples sectores, sin criterio de cirugía revascularizadora (derivación protésica aorto bifemoral). El paciente manifestaba claudicación intermitente a menos de 30 metros, localizada en pantorrilla derecha. En el estudio hemodinámico se apreciaron los índices de presiones tobillo/brazo disminuidos en arteria tibial posterior (0,46) y pedia derecha (0,33). La ecografía doppler del sector femoral derecho evidenció una estenosis de la arteria femoral profunda en su origen, que producía aumento de las velocidades picos sistólicos (479 cm/s), con flujo desorganizado, dilatación posestenótica y oclusión de la arteria femoral superficial en su origen. Se realizó endarterectomía femoral común y profunda con colocación de parche de politetrafloroetileno. El paciente evolucionó sin complicaciones posoperatorias. En el seguimiento se observó mejoría clínica en relación con la distancia de claudicación y un aumento de los índices de presiones tobillo/brazo en arteria tibial posterior y pedia derecha (0,50), respectivamente. Conclusiones: La profundaplastia femoral, aún en la "era endovascular", permanece como un proceder eficaz que resulta alternativa de tratamiento revascularizador en la enfermedad arterial periférica de localización infrainguinal(AU)

Introduction: The normal femoral artery and its branches supply most of the blood flow to the thigh, as well as to the whole leg and foot, which forms the largest branch of the femoral triangle: the deep femoral artery. Objective: Show the effectiveness of femoral deep plasty in the "endovascular era". Case report: It is presented a case of peripheral artery disease in multiple sectors, without surgical criteria of revascularization (derivación protésica aortobifemoral). The patient presented intermittent claudication in less than 30 meters, and it was located in the right calf. In the hemodynamic study, the ankle-arm pressure indexes were dicreased in the posterior tibial artery (0,46) and right dorsalis pedis artery (0,33). The doppler echocardiography of the right femoral sector confirmed a stenosis in the deep femoral artery in its origin, which produced an increase in the peak systolic velocity (479 cm/s), unorganized flows, poststenotic dilatation and occlusion of the superficial femoral artery in its origin. It was performed a common and deep femoral endarterectomy with colocation of polytetrafluoroethylene patch. The patient evolved without post-surgical complications. In the follow-up, it was observed a clinical improvement in relation with the claudication distance and the increase of the ankle-arm pressure indexes in the posterior tibial artery and right dorsalis pedis artery (0,50), respectively. Conclusions: The femoral deep plasty, still in the ´´endovascular era´´, is an efficient procedure that is an alternative to the revascularization treatment in the peripheral artery disease with infrainguinal location(AU)

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INTRODUCTION: Diabetic macular edema is a frequent pathology that causes gradual deterioration of visual acuity, which does not have a standardized treatment. The anti-vascular endothelial growth factor (anti-VEGF) drugs and corticosteroids are widely used, especially aflibercept and dexamethasone, respectively, but it is unclear which one is best. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: No evidence that compared the interventions directly in the population of interest was found, so systematic reviews that provide an estimate of the effect indirectly using network meta-analysis were selected. We identified two systematic reviews that together included four primary studies, all randomized trials. We concluded that we are uncertain whether aflibercept compared to dexamethasone improves visual acuity or is safer, as the certainty of the evidence has been assessed as very low.

INTRODUCCIÓN: El edema macular diabético es una patología frecuente, causante de deterioro gradual de la agudeza visual, que no tiene un tratamiento estandarizado. Los fármacos anti factor del crecimiento vascular endotelial (anti-VEGF) y los corticoides se encuentran entre los tratamientos más ampliamente utilizados, destacando aflibercept y dexametasona, respectivamente, sin haber una clara superioridad entre ambas terapias. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: No se encontró evidencia que compare las intervenciones directamente en la población de interés, por lo que se seleccionaron revisiones sistemáticas que entregan una estimación del efecto de manera indirecta, mediante la técnica de metanálisis de comparaciones múltiples (metanálisis en red). Identificamos dos revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, todos ensayos aleatorizados. Concluimos que no es posible establecer con claridad si usar aflibercept comparado con dexametasona aumenta la agudeza visual o es más seguro, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.

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