Introducción. El mecanismo de como los virus atraviesan las estructuras intracelulares son el modelo que ejemplifica el tránsito intracelular por el sistema de endomembranas, el mismo que es utilizado en la enseñanza y descripción de los diferentes aparatos y organelas intracelulares. Objetivo. Desarrollar un método didáctico que explique un mecanismo de la biología molecular, como lo es la tira cómica en el tránsito y la señalización intracelular de los virus. Metodología. Se diseñó una historia cómica-ilustrativa donde una estructura viral es personificada por un espía encubierto, el eje fundamental de la trama es la obtención de las moléculas de información genética a nivel del núcleo, para ello tiene que pasar por los varios departamentos de la célula que representan las organelas intracelulares e intracitoplasmáticas con sus características funcionales, la secuencia obedece a la comunicación que tienen las diferentes organelas desde la membrana celular hasta el núcleo. Resultados. La elaboración de comics o historietas pueden recrear eventos y fenómenos estudiados en las ciencias médicas como la biología, teniendo los siguientes resultados: aumentar el interés, la comprensión, la creatividad, la necesidad de conocimientos y generación de nuevas ideas en los estudiantes. Conclusión. El cómic es una herramienta didáctica útil en la enseñanza del tránsito intracelular a partir de la narración gráfica de un modelo viral que se transporta al interior de la célula.

Introduction: Facial lipoatrophy is a rare condition described by the anomalous loss of subcutaneous fat that mainly affects the middle third of the face without compromising bone or muscle tissue. Lipoatrophy is not associated with exudative reactions or appreciable fibrosis. The etiology of lipoatrophy can be congenital or acquired, even traumatic, iatrogenic, or idiopathic. Generalized lipoatrophy is a rare disorder characterized by an almost complete absence of fat. Both congenital and acquired. Objective: this report is to present a rare case of idiopathic facial lipoatrophy in a young patient without associated pathologies. Methodology: the research design was descriptive, it has only been previously identified in four case reports, among which the demographics of the patient vary considerably. Results: a case with the anatomical and paraclinical demographic characteristics of a rare case of Facial Lipodystrophy was described. Conclusion: it was concluded that idiopathic facial lipoatrophy that presents with a generalized absence of fat followed by a series of abnormalities such as insulin resistance and acanthosis nigricans before adolescence.

Introduction. It is widely known that Coronavirus Disease 2019 (COVID 19) can cause a Severe Acute Respiratory Syndrome, however there are certain extrapulmonary complications that can occur in the context of these patients such as pneumothorax, which despite having a reduced incidence, some case studies have reported high mortality. Pneumothorax in patients with COVID 19 can present spontaneously or induced by barotrauma by invasive and non-invasive mechanical ventilation. Objective. To determine the clinical, laboratory and imaging characteristics of a group of patients who were hospitalized for pneumonia due to COVID 19 and who in turn presented as a complication of pneumothorax, within the period February to July 2021 at the Ambato Regional Hospital. Methodology. We check the clinical reports of the patients with COVID 19 admitted to the Ambato Regional Hospital for the period of time established previously, who had a diagnosis of pneumothorax, those with a traumatic origin were excluded, obtaining 3 cases; in addition to conducting a current review of the bibliography in relation to the subject. Results. A total of 6 patients had a diagnosis of pneumothorax plus COVID 19, of which two patients were excluded because the cause of their pneumothorax was considered traumatic (traffic accidents), 1 of the patients was discarded due to insufficient data on the outcome its clinical evolution; of the rest of the three presented in the article: 2 presented spontaneous pneumothorax in a late stage of the disease, one of whom died; 1 showed a pneumothorax associated with barotrauma due to invasive mechanical ventilation with a favorable clinical course. Conclusion. Pneumothorax, despite being an infrequent complication in the spectrum of COVID-19 disease, must be addressed within the differential diagnosis when a patient presents sudden respiratory decompensation; further studies are required to determine whether pneumothorax in these patients leads to higher mortality, since the reports in the current literature are based on a series of isolated cases.

Introduction. This article is carried out in order to publicize how the hospital library affects the emotional state of the caregivers of children, taking into account that they are important when it comes to taking care of them when they are isolated in said home health, being necessary to carry out an analysis to see what these people do while the children are in this state. Objectives: The general objective of this research is to analyze the incidence that the hospital library has on the emotional state of the caregivers of children at the Hospital Verdi Cevallos Balda 2020, this purpose brings with it the specific objectives of diagnosing through the observation guide with the Likert scale the emotional state of the caregivers of the children, in addition to encouraging reading as entertainment in the caregivers of the children through reading therapy and the use of the hospital library and finally examining the impact caused by reading strategies and the use of the hospital library in the emotional state of the caregivers of the children. Methodology. The methodology implemented was descriptive, with a qualitative-quantitative approach. At the same time, the observation and survey sheet technique was used. The population was 25 people, there was no sample since 100% of the community was used. Results. The results were important since they let the hospital community know how necessary it is to read to have a better emotional state when their patients are afflicted in a hospital bed, since reading is a therapy. Conclution. It was concluded that the reading strategies implemented in the hospital favored the emotional state of the hospital community.

The study aims to carry out a structured exploratory systematic review based on the results found around the terms Wheelchair Rugby, Performance and Acceleration. To carry out the search for the documents, the following keywords were used: "Wheelchair Rugby", "Performance" and "Acceleration". To do this, the documents were searched in different databases: Scopus, Web of Science and SPORTDiscus. To focus the search on relation to the study objective, a series of inclusion criteria were established: i) Mention at least some of the characteristics of performance in wheelchair rugby (minimum 20 words), ii) Select documents related to Wheelchair Rugby, iii) Be available in full text or with summary, and (iiii) Be written in Spanish, English or Portuguese. Articles published until June 2021 are eligible. In conclusion, the papers on performance in wheelchair rugby address different research topics that report the main performance factors in this sport.

A descriptive, cross-sectional observational study was carried out in the stomatological clinic of the Güines municipality, Mayabeque province, from September-2018 to May-2020 to determine the prevalence and severity of chronic periodontitis in patients with Diabetes Mellitus. The study population consisted of 126 patients over 16 who attended the dental clinic with the disease. The information was collected through a spreadsheet prepared for this purpose and processed through a database in electronic format, using descriptive statistics techniques. It was concluded that more than half of the examined population was between 16 and 30 years old (57.1), belonged to the female sex (61.9%), the majority suffered from periodontitis (40.5%), from Type II Diabetes Mellitus (83.3%) with more than 5 years of evolution (76.2%) and little stability in glycemic values ​​(66.7%).

The injuries to the buccal mucous membrane in the geriatric patients constitute a problem of buccal health between the rehabilitated with removables   dental prosthesis. With the objective of determinate the clinical forms of the protesicases aggressions to the buccal mucous membrane, your localization and irregularity associated as well as identifying protesicoses inadequate and noxious habits in these patients an observational, descriptive and transversal study was carried out in the dental clinical “Andres Ortiz Junco”, of the Guines municipality Mayabeque from October 2019 to October 2021. The universe 360 patient and the sample 80 selected for a sampling not probabilistico, deliberate and opportunistic. Signed two similar groups numerically, one with acute injuries and other with injuries cronicases. The variables in study went: form acute and cronicases of the protesica aggressions to the mucous membrane, localization areas, protesica irregularity and inadequated and noxious protesicoses habits. Carried out a cross-examination, the buccal examination and of the prosthesis in use. The statistical analysis carried out through the docima X2 y Duncan. As a result it are obtained that the 38, 75 % of the diagnosed injuries were subprotesises stomatitis and a 28,75 % were traumatic ulcers.The 37, 40 % with affectation of the palate. The 39,02 5 of the protesises it had as protesica irregularity the compresion evelope.The 48,75 of the patients were accustomed  the protesises in na endless way,the 41,25 % with a faulty hygiene and a 53,75 % were smoking. Of which it is concluded that the chronic more frequente lesion went the suprotesises stomatitis and of the acute the traumatic ulcer,the more affected are the plate.

Introduction, the emergence of a new infectious disease is always a complex situation, especially if it presents itself as an epidemic or pandemic of significant extent or severity, sarcov-2 later called covid-19 has had a significant impact on all economies. Objective: to expose the costs of the disease in its different stages of evolution and establish a clear prevention policy that makes us reflect on the emotional, psychological and economic consequences that this disease generated in its initial stages. Methodology. The research design was analytical-descriptive, cataloged as a field study, the methodology used was inductive deductive, in which information gathering techniques and surveys were selected and applied, which allowed the development of hypotheses: ¿a public policy of prevention? Of covid-19, will it allow the reduction of state spending? Is the cost of prevention lower than the cost of treating covid-19? In addition to carrying out the technical and statistical analysis of the patients in their different periods of evolution and the economic impact that these generate in each of the stages. Results. Asymptomatic and mild symptomatic: the costs represent 80.29 USD in a total of 14 days. Moderate symptomatic: cost per hospital stay per day 1465.76 USD in public hospitals and 1805.82 USD in private hospitals. Severe symptomatic: cost per hospital stay per day 1722.87 USD in public hospitals and 2122.58 USD in private hospitals. Conclusions: The limited economic capacity of the health systems exceeded the supply of both public and private hospitals with high costs that exceeded the economic capacity of the users; Strategic preventive models and inspection controls must be established as a public preventive measure for an adequate use of health resources.

Abstract

Introduction. The practice of hospital nursing requires a high demand for physical effort, which due to ignorance can cause musculoskeletal injuries. Objective,  Propose an educational plan in body mechanics for hospital nursing staff. Methodology. Based on a previous descriptive, prospective, cross-sectional research, with a non-experimental design, in a sample of 124 subjects of the nursing staff, applying an instrument on knowledge and application of body mechanics in the care of patients, in the Hospital. Alfredo Noboa Montenegro, Ecuador, from July to December 2018. Results. The theoretical and practical principles of body mechanics in the practice of hospital nursing, can and should be achieved through training activities. Conclusion. The educational program allows the updating of knowledge, prevention of musculoskeletal injuries in nursing personnel through an adequate application of body mechanics, promoting the occupational health of those who practice this profession.

In the decade of the 70s in Ecuador, 3 out of every 100 people developed rheumatic fever, of which 75% had cardiac complications and in hospitalization areas, 39% of all admitted cardiac patients were of rheumatic origin; As a result of this, thousands of secular cardiac patients remained, as is the case below, a 70-year-old adult man with dual tricuspid valve injury associated with rheumatic fever with a history of mechanical mitral valve replacement. Reason why we report this historically important and statistically rare medical finding. It is enriching to detail its debut, diagnosis and, above all, treatment.

Introduction: in December 2019, a new respiratory virus of the coronavirus family was identified in the province of Wuhan China, it rapidly spread worldwide, causing an impact on morbidity and mortality secondary to respiratory diseases. The case of spontaneous pneumothorax in a severe post-COVID 19 patient is presented, the low number of reported cases presenting this type of complications is remarkable. Objective: to describe a clinical case of spontaneous pneumothorax secondary to the formation of emphysematous bullae in a patient who presented severe respiratory infection by SARSCOV2. Materials and Methods: presentation of a clinical case, descriptive, retrospective study. Results: male patient, 66 years of age with no significant pathological history, does not report exposure to biomass fuels or tobacco, entered the respiratory isolation area of ​​one of the main container centers for COVID-19 patients in the City of Ambato - Ecuador for presenting respiratory symptoms of several days of evolution, confirming by means of RT - PCR a case of pneumonia due to COVID 19, it was classified as severe affectation after the pulmonary radiographic evaluation for which he had a prolonged stay, due to this; He was discharged with significant pulmonary sequelae of the interstitial lung disease secondary to SARSCOV2 infection, for which he required home oxygen permanent use. After more than 20 days after hospital discharge, he was readmitted for acute respiratory failure. After ruling out nosocomial respiratory infection and pulmonary thromboembolism, spontaneous pneumothorax was identified as the cause of the symptoms, evolving favorably after chest tube placement, and discharging this time without the need for supplemental oxygen. Conclusion: early and late complications secondary to COVID 19 are an issue of vital importance within the hospital setting and the general management of this type of patients. An adequate assessment and timely intervention in patients with severe disease secondary to this pathology is essential to reduce morbidity and mortality from the virus.

The recurrence of COVID-19 is not very well determined at present, the probabilities of viral reactivation, new infection or infection by a new strain are those studied now. The objective was to identify the recurrence of SARS CoV-2 infection, blood group and type of vaccine in patients immunized for COVID-19. A descriptive study was carried out with the results of surveys directed at the general population of a group of social networks. A database was created in Microsoft Excel 2016, it was processed with SPSS 25, frequencies and percentages of qualitative and quantitative variables were calculated. It was found that the recurrence of COVID-19 was 6.30% of the sample studied, with 3.6% frequency in people with blood type O Rh +. The protocolization of care for patients with COVID-19 for immunized patients is important to identify in a timely manner the clinical, demographic and complementary laboratory characteristics to identify recurrences of infection by SARS CoV-2.

The expertise and knowledge of abdominal pain in pediatric patients is key when characterizing acute appendicitis. In our country Ecuador, it is one of the most frequent etiologies in morbidity rates, which depending on circumstances such as time, areas of difficult access, lack of health personnel, among others, there may be complications and fatal outcomes. The objective of presenting this review was to socialize the behavior of the pathology to medical students, physicians and health personnel in general, who are in direct care of patients with abdominal pain. The highlights of this disease have been clearly and precisely written, from its origin to its treatment in pediatric patients. The purpose of presenting this review is to provide the key characteristics of acute appendicitis for effective diagnosis and treatment.

Introduction: The finding of intestinal intramural hematoma is rare, due to multiple factors, starting with its low incidence, 1 out of every 2500 patients receiving warfarin treatment. Its appearance is 90% associated with abdominal trauma, with few cases reported in relation to anticoagulant overdose. It is a highly infrequent cause of acute abdominal pain, but it becomes a differential diagnosis to be taken into account in a patient with a history of anticoagulation. In spontaneous cases, its location is more frequent in the jejunum (71.6%) followed by the duodenum (29.8%). Objective: To report this rare radiological finding. Methodology: In this article we detail the rare radiological finding by computed tomography of an intramural hematoma in the small intestine specifically in the second and third portion of the duodenum related to anticoagulation; from the report of a reported clinical case. Conclusion: The report of radiological findings of rare entities such as non-traumatic duodenal intramural hematoma is important and nutritious in terms of scientific evidence, expanding the range of options in patients with unspecified abdominal pain with suspected anticoagulation overdose.

Introduction: obesity is a chronic disease associated with increased morbidity and mortality worldwide, and the impact of the COVID-19 pandemic. The clinical manifestations of COVID-19 disease vary from asymptomatic to moderate and even severe cases, arriving with artificial airway and invasive ventilatory assistance to an Intensive Care Unit (ICU). Methodology: a retrospective study was carried out, by collecting data from the electronic medical record of the AS 400 hospital system of the Hospital de Especialidades Dr. Teodoro Maldonado Carbo in January 2021. Results: 67-year-old obese female patient with a history of hypertension and diabetes milletus Type II, chest CT showed ground-glass infiltrates in both lung fields, multilobular with peripheral distribution, COVID-19 pneumonia. Contributions: recognize possible mechanisms and implications in the clinical management of patients with morbid obesity, diagnosed with Pneumonia due to COVID 19.