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Exercise increases the cost of breathing (COB) due to increased lung ventilation (V˙E), inducing respiratory muscles deoxygenation (∇SmO2), while the increase in workload implies ∇SmO2 in locomotor muscles. This phenomenon has been proposed as a leading cause of exercise intolerance, especially in clinical contexts. The use of high-flow nasal cannula (HFNC) during exercise routines in rehabilitation programs has gained significant interest because it is proposed as a therapeutic intervention for reducing symptoms associated with exercise intolerance, such as fatigue and dyspnea, assuming that HFNC could reduce exercise-induced ∇SmO2. SmO2 can be detected using optical wearable devices provided by near-infrared spectroscopy (NIRS) technology, which measures the changes in the amount of oxygen bound to chromophores (e.g., hemoglobin, myoglobin, cytochrome oxidase) at the target tissue level. We tested in a study with a cross-over design whether the muscular desaturation of m.vastus lateralis and m.intercostales during a high-intensity constant-load exercise can be reduced when it was supported with HFNC in non-physically active adults. Eighteen participants (nine women; age: 22 ± 2 years, weight: 65.1 ± 11.2 kg, height: 173.0 ± 5.8 cm, BMI: 21.6 ± 2.8 kg·m-2) were evaluated in a cycle ergometer (15 min, 70% maximum watts achieved in ergospirometry (V˙O2-peak)) breathing spontaneously (control, CTRL) or with HFNC support (HFNC; 50 L·min-1, fiO2: 21%, 30 °C), separated by seven days in randomized order. Two-way ANOVA tests analyzed the ∇SmO2 (m.intercostales and m.vastus lateralis), and changes in V˙E and ∇SmO2·V˙E-1. Dyspnea, leg fatigue, and effort level (RPE) were compared between trials by the Wilcoxon matched-paired signed rank test. We found that the interaction of factors (trial × exercise-time) was significant in ∇SmO2-m.intercostales, V˙E, and (∇SmO2-m.intercostales)/V˙E (p < 0.05, all) but not in ∇SmO2-m.vastus lateralis. ∇SmO2-m.intercostales was more pronounced in CTRL during exercise since 5' (p < 0.05). Hyperventilation was higher in CTRL since 10' (p < 0.05). The ∇SmO2·V˙E-1 decreased during exercise, being lowest in CTRL since 5'. Lower dyspnea was reported in HFNC, with no differences in leg fatigue and RPE. We concluded that wearable optical biosensors documented the beneficial effect of HFNC in COB due to lower respiratory ∇SmO2 induced by exercise. We suggest incorporating NIRS devices in rehabilitation programs to monitor physiological changes that can support the clinical impact of the therapeutic intervention implemented.

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Se realizó una revisión bibliográfica con el objetivo de exponer cuestiones deontológicas inherentes a la práctica de la Medicina Legal y el estado de la temática en el contexto nacional. Se abordan los principales conflictos éticos derivados de la práctica pericial, las recomendaciones para las actuaciones de los peritos, el desarrollo de la especialidad en el país y la situación actual respecto a las normativas deontológicas. La escuela cubana de Medicina Legal asienta su práctica en las normas jurídicas y éticas del país, con un fuerte compromiso humanista. Se concluye que, las particularidades propias de la actividad pericial, demandan la creación de un código deontológico propio.

A bibliographical review was carried out with the objective of exposing deontological issues inherent to the practice of Legal Medicine and the state of the issue in the national context. The main ethical conflicts derived from the expert practice, the recommendations for the actions of the experts, the development of the specialty in the country and the current situation regarding the deontological regulations. The Cuban School of Legal Medicine established its practice in the legal and ethical norms of the country, with a strong humanist commitment. It is concluded that the particularities of expert activity, demand the creation of its own code of ethics.

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Introducción: El envejecimiento poblacional impone complejos retos a la familia cubana. Uno de ellos es el maltrato financiero a los adultos mayores, tema insuficientemente abordado. Objetivos: Determinar la presencia de maltrato financiero en los adultos mayores, así como sus características. Material y Métodos: Se llevó a cabo un estudio descriptivo transversal que incluyó a 175 adultos mayores de 60 años del policlínico Carlos Manuel Portuondo, entre enero y diciembre de 2018. Resultados: Se identificó maltrato financiero en 53.1 por ciento de los adultos mayores. Entre estos, predominó el sexo femenino, las edades entre 70 y 79 años, el padecer al menos una enfermedad crónica no transmisible, los viudos y jubilados. Las principales manifestaciones de maltrato reportadas fueron los préstamos sin devolución, las compras no autorizadas, negación de acceso al dinero propio y la presión para realizar trámites legales. Fueron los hijos los señalados como maltratadores con más frecuencia. Imperó además el sexo femenino, las edades entre 40 y 59 años, el nivel secundario de escolarización, los divorciados, las amas de casa. La mayoría tenía más de una persona a su cargo, no recibe ayuda económica externa y refirió antecedentes de atención por Salud Mental, mayormente debido a trastornos depresivo-ansiosos. Conclusiones: Se identificó la presencia de maltrato financiero en las personas mayores estudiadas, sus características, así como las de los presuntos maltratadores. Esta forma de violencia, a pesar de ser una de las menos abordadas, afecta a la población anciana y puede constituir un problema de salud(AU)

Introduction: Population aging imposes complex challenges to the Cuban family. One of them is financial abuse of the elderly, an issue that has been insufficiently addressed. Objectives: To determine the presence of financial abuse of the elderly as well as its characteristics. Material and Methods: A cross-sectional descriptive study that included 175 adults older than 60 years attended at Carlos Manuel Portuondo polyclinic was carried out between January and December 2018. Results: Financial abuse was identified in 53.1percent of the elderly. Female sex, ages between 70 and 79 years, having at least one chronic non-communicable disease, widows and retirees predominated among them. The main manifestations of mistreatment reported were loans without refund, unauthorized purchases, denial of access to their own money and pressure to perform legal proceedings. The progenies were identified as the most frequent abusers. There was a prevalence of the female sex, ages between 40 and 59 years old, secondary level of education, divorced people, and housewives. Most of them had more than one person under their care, received no external financial help and reported a history of mental health care mainly due to depressive/anxious disorders. Conclusions: Financial abuse was identified in the elderly studied. This form of violence, despite being one of the least addressed, affects the elderly population and constitutes a health problem(AU)

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Carbapenemase production in Enterobacterales clinical isolates is a global threat. Multi-drug resistant Klebsiella pneumoniae harboring carbapenemases are a major concern among the hospital settings in Latin America. Aim: The aim of this study was to analyze the genetic relatedness between three isolates of K. pneumoniae recovered from one patient in the same bacteriological round on the same day, which exhibited different susceptibility profiles to carbapenems (CP) and to colistin (Col). Isolates' profiles were as follows (susceptible-S/resistant-R): CPS/ColR, CPR/ColR, and CPR/ColS. Pulse-field gel electrophoresis, multilocus sequence typing, and whole genome sequencing were performed. Conjugation assays were carried out and PCR determination in transconjugants (Tcs) was made for: blaCTX-M-groups, blaNDM, blaKPC, blaTEM, qnr alleles, aac(6')Ib-cr, ermB, and plasmid incompatibility groups (Inc). Results: All isolates belonged to the same clone, to ST258 and harbored blaCTX-M-14, blaCTX-M-15, qnrA1, qnrB1, aac(6')Ib-cr, and wzi154 (capsule-locus KL107). One isolate had additional wzi gene, wzi109 (capsule-locus KL36). In CPR isolates, the pattern was explained for blaNDM-1 or blaNDM-1/blaKPC-2 presence, and in ColR for IS5-like element insertion in mgrB at different positions. Co-mobilization of blaNDM-1/qnrA1 was associated to a different plasmid Inc (A/C-FII) in both blaNDM-1 donors. Mobilization of blaCTX-M-14 was related to IncI1 in one donor. Conclusion: These findings highlight the potential plasticity of ST258 K. pneumoniae clone. To the best of our knowledge, this is the first description of blaNDM-1/blaKPC-2-producing K. pneumoniae ST258 in Latin America.

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RESUMEN La Wicca, considerada una nueva corriente religiosa, se ha hecho presente entre grupos de adolescentes y jóvenes cubanos. Sin embargo, resulta desconocida para la mayoría de los profesionales sanitarios. Se realizó una revisión bibliográfica, con el objetivo de analizarla como fenómeno religioso-cultural a nivel mundial y en Cuba.

ABSTRACT Wicca, considered a new religious trend, has become present among groups of cuban adolescents and youth. However, it is unknown to most healthcare professionals. A bibliographic review was carried out, with the aim of analyzing it as a religious-cultural phenomenon worldwide and in Cuba.

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Introducción: El mundo vive una situación excepcional por el avance de la pandemia producida por el coronavirus 2 del síndrome respiratorio agudo grave y la inédita medida de aislamiento social preventivo y obligatorio utilizada por varios países. Esta situación genera un impacto psicosocial que ha sido insuficientemente abordado. Objetivo: Analizar la repercusión que sobre la salud mental pudiera provocar la COVID-19 y las medidas para su prevención y control, así como las estrategias para favorecerla. Material y Métodos: Se realizó una revisión bibliográfica en el período comprendido entre marzo y abril de 2020. Se consultaron fuentes de información disponibles en la Biblioteca Virtual de Salud de la red telemática infomed, entre ellas, las bases de datos SciELO, Pubmed/Medline, Cumed, Lilacs. Se usó además el buscador Google académico. Se utilizaron los buscadores propios de las diferentes fuentes y se diseñó una estrategia de búsqueda a través de palabras claves, en español e inglés. Se recuperaron 7 citas bibliográficas en materiales cubanos y se seleccionaron para nuestro estudio un total de 21 referencias. Desarrollo: Se describen elementos que integran la salud mental como constructo multidisciplinario y los principales efectos que sobre la misma producen las epidemias. Se presentan estrategias para potenciar conductas que tributen a la salud mental en el contexto actual. Conclusiones: A la par de las medidas sanitarias, urge potenciar la resiliencia, el crecimiento personal, las relaciones intrafamiliares y la atención especial a los grupos vulnerables para así minimizar el impacto psicosocial de la epidemia en la población(AU)

Introduction: The world is experiencing an exceptional situation due to the advance of the pandemic caused by the severe acute respiratory syndrome coronavirus 2 and the unprecedented preventive and mandatory measure of social isolation used by various countries. This situation generates a psychosocial impact that has been insufficiently addressed. Objective: To analyze the repercussion that COVID-19 could cause on mental health and the measures for its prevention and control, as well as the strategies to favor it. Material and Methods: A bibliographic review was performed in the period between March and April 2020. Information sources available in the Virtual Health Library on the Cuban National Health Care Network and Portal (INFOMED) were consulted, including the SciELO, Pubmed / Medline, Cumed, and Lilacs databases. Google Scholar search engine was also used. The search engines of the different sources were used and a search strategy using keywords in Spanish and English was designed. Seven bibliographic citations were retrieved from Cuban materials and a total of 21 references were selected for our study. Development: Elements that integrate mental health as a multidisciplinary construct and the main effects that the epidemics produce on it are described. Strategies to promote behaviors that contribute to mental health in the current context are presented. Conclusions: Along with health measures, there is an urgent need to strengthen resilience, personal growth, intra-family relationships and special attention to vulnerable groups in order to minimize the psychosocial impact of the epidemic on the population(AU)

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Introducción: El estigma es un constructo social que incluye actitudes, sentimientos, creencias y comportamiento que está configurado como prejuicio y trae como consecuencias discriminatorias hacia la persona estigmatizada. Las personas que padecen algún trastorno mental son uno de los grupos más estigmatizados de nuestra sociedad, especialmente las que padecen esquizofrenia. Objetivo: Fundamentar cómo el estigma social influye de manera negativa en la rehabilitación y reinserción social de las personas que padecen Esquizofrenia. Material y Métodos: Se realizó una revisión bibliográfica en fuentes de información disponibles en la Biblioteca Virtual de Salud de la red telemática Infomed, entre ellas, las bases de datos SciELO, Pubmed/Medline, Cumed, Lilacs, así como el Google académico. Finalmente se seleccionaron para nuestro estudio un total de 38 referencias. Desarrollo: El estigma se considera un constructo social y está asociado a numerosos factores psicológicos, sociológicos, históricos, así como a la representación social que se tenga de la causa de la estigmatización. Puede clasificarse de varias maneras y su abordaje resulta sumamente complejo, especialmente en lo relacionado con la Esquizofrenia. Conclusiones: El estigma social, unido a la representación que sobre la Esquizofrenia persiste en nuestro medio, son fenómenos que impiden una adecuada reinserción social en este tipo de pacientes. Urge el desarrollo de estrategias que modifiquen los falsos conceptos que sobre a enfermedad mental, persisten en nuestra sociedad(AU)

Introduction: Stigma is a social construct that includes attitudes, feelings, beliefs, and behavior that is configured as prejudice and brings about discriminatory consequences toward the stigmatized person. People who suffer from a mental disorder are recognized as one of the most stigmatized groups in our society, especially those who suffer from Schizophrenia. Objective: To establish how social stigma has a negative influence on the rehabilitation and social reintegration of people suffering from Schizophrenia. Material and Methods: A bibliographic review was made through the search of information in sources available from the Cuban National Health Care Network and Portal (INFOMED), among them, databases such as SciELO, Pubmed / Medline, Cumed, Lilacs, as well as Google Scholar. Finally, a total of 38 references were selected for our study. Development: Stigma is considered a social construct and is associated with many psychological, sociological, and historical factors, as well as the social representation of the cause of stigmatization. It can be classified in several ways. Its approach is extremely complex, especially when it is related to Schizophrenia. Conclusions: The social stigma, together with the representation in Schizophrenia that persists in our environment, are phenomena that prevent an adequate social reintegration in these patients. The development of strategies that modify the false concepts that persist over mental illness in our society is an urgent concern(AU)

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Introducción: El trastorno esquizotípico se manifiesta desde edades tempranas como un patrón general de déficit social e interpersonal, comportamiento excéntrico, capacidad reducida para las relaciones personales y distorsiones cognoscitivas, incomprensibles psicológicamente. Objetivo: Fundamentar la responsabilidad médico-legal de un caso de trastorno esquizotípico que cometió homicidio. Presentación de caso: Individuo de 22 años, soltero, sin hijos, técnico medio, sin historia de trastornos mentales que es peritado por psiquiatría forense debido a que agredió a su abuelo materno con un arma blanca, y causó la muerte. Se le realizó examen psiquiátrico, se aplicó la Escala de Valoración de Impulsividad, se realizó electroencefalograma y valoración psicológica, que incluyó la aplicación de las pruebas proyectivas Bender, Machover y Rorschach. El diagnóstico propuesto por el equipo evaluador fue trastorno esquizotípico, sin enajenación mental. Conclusiones: El trastorno esquizotípico no es un diagnóstico frecuente en Psiquiatría. Cuando se involucra en conductas delictivas, estas ocurren en solitario y suelen estar relacionadas con agresiones hacia otras personas. Es determinante de semi-imputatibilidad o imputabilidad y no se recomienda su permanencia en régimen penitenciario(AU)

Introduction: Schizotypical disorder appears at very early ages as a general pattern of social and interpersonal deficit; eccentric behavior; reduced capacity to maintain personal relations; and cognitive distortions, which are psychologically inexplicable. Objective: To establish the medico-legal implications in a case of schizotypical personality disorder that committed homicide. Case presentation: A 22 years old individual, single, without children, technician, without history of mental disorders who is studied by Forensic Psychiatry because he attacked his maternal grandfather with a knife, which caused his death. Psychiatric examination was done; the Impulsiveness Scale was applied; and an enlectroencephalogram (EEG) and a psychological evaluation were carried out, which included Bender, Machover, and Rorschach tests. The evaluating staff made the diagnosis of Schizotypical disorder, without mental derangement. Conclusions: Schizotypical disorder is not a frequent diagnosis in Psychiatry. When it is involved in criminal behaviors, they occur in isolation and they are usually related to attacks to other persons. It is a determinant condition of semi-imputability or imputability. Prison system is not recommended(AU)

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Se realizó un estudio descriptivo de corte trasversal con el objetivo de determinar cómo evalúan su calidad de vida de las personas mayores de 60 años con diagnóstico de demencia por Enfermedad de Alzheimer. Participaron 35 personas. Se estudiaron características sociodemográficas, relacionadas con la propia enfermedad y grado de dependencia. Para evaluar calidad de vida se utilizó el instrumento Calidad de vida en la Enfermedad de Alzheimer (ADRQL) y para el grado de dependencia el Índice de Barthel. Predominó el sexo femenino (60%), las edades entre los 70 y 79 años (37.1%), para una edad media de 78,1 años con desviación estándar de ± 11,2, las personas viudas (42,9%) y divorciadas (31,4%), con nivel de escolarización primario (40%), la enfermedad demencial leve (60%) y la dependencia grave (37,1%) y leve (31,4%). La mayoría de las personas estudiadas evaluó su calidad de vida global como satisfactoria (65,7%). Los mejores resultados se obtuvieron en el área identidad personal y de personas importantes (74,3%). El área comportamiento en el lugar de residencia recibió más valoraciones negativas (57,1%).

A descriptive cross-sectional study was carried out in order to determine how they assess their quality of life for people over 60 years of age with a diagnosis of dementia due to Alzheimer's disease. 35 people participated. Sociodemographic characteristics related to the disease itself and degree of dependence were studied. To assess the quality of life, the instrument Quality of life in Alzheimer's disease (ADRQL) was used, and for the degree of dependence, the Barthel Index. Female sex predominated (60%), ages between 70 and 79 years (37.1%), for an average age of 78.1 years with standard deviation of ± 11.2, widowed (42.9%) and divorced (31.4%), with primary schooling level (40%), mild dementia (60%) and severe (37.1%) and mild (31.4%). The majority of the people studied evaluated their overall quality of life as satisfactory (65.7%). The best results were obtained in the area of personal identity and of important people (74.3%). The behavior area in the place of residence received more negative evaluations (57.1%).

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Resumen Como revisamos en la primera parte1 hay algunos conceptos que deben ser considerados para el adecuado manejo médico por parte del equipo clínico que recibe el reporte de patología, de esta misma manera existen aspectos por parte del patólogo que este debe conocer, los cuales tienen impacto terapéutico. En esta segunda parte queremos revisar algunos conceptos que son de importancia por parte del patólogo que aplican directamente sobre la interpretación del clínico, como: procesamiento macroscópico; estudio de la citología por aspiración con aguja fina (FNA) vs. biopsia trucut, utilidad de la biopsia por congelación y de la inmunohistoquímica, así como los métodos e imágenes diagnósticas.

Abstract As was reviewed in the first part, there are some concepts that should be considered for the appropriate medical management by the medical team that receives the pathology report. Similarly, there are some aspects that the pathologist should know, such as those that can have therapeutic impact. In this second part, a short review is presented on some of the concepts that are of importance to the pathologist that apply directly to the interpretation by the clinician, such as the macroscopic processing, the cytology study of the fine-needle aspirate (FNA) vs. "tru-cut" biopsy, the usefulness of the frozen biopsy, and immunohistochemistry, as well as diagnostic methods and diagnostic images.

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