Introduction: Mental disorders are very frequent in older adults, during the COVID 19 pandemic, this disease has been exacerbated and increasing the vulnerability of this group by modifying their lifestyles. Objective: The objective of this review is to establish and summarize the existing information related to mental health in the elderly during the COVID 19 pandemic. Materials and methods: A systematic review of indexed journals, PubMed, PMC, Elsevier, SciELO was conducted to select scientific articles with relevant content. Results: It has been identified that a significant percentage of older adults suffer from mental health problems. More than 20% of people over 60 years of age suffer from a mental or neural disorder (not counting those manifested by headache) and 6.6% of disability in this age group is attributed to mental disorders and of the nervous system. In short, the crisis because of the pandemic has generated anxiety, depressive, adaptation disorders, whose cognitive and emotional symptoms demand attention, which is why it is necessary to develop strategies to promote personal and community mental health. Conclusions: when human beings reach old age, they present many health problems, which makes it difficult to respond positively to stressors with grave consequences in the bio-psycho-social field. Dementia and depression are the most common neuro-psychiatric disorders at this age, all these factors increase the mortality rate.

Introduction: Urinary incontinence is the involuntary loss of urine and represents a common medical condition in the elderly, although it can also affect younger adult men and women. In addition, it is considered one of the most common public health problems among women. mainly affecting those who are in the postmenopausal period, so it is important to determine an effective treatment for this disorder. Objective: To evaluate the efficacy of urinary continence re-education in postmenopausal women. Methodology: A qualitative bibliographic review based on studies found in Cochrane, academic Google, Medline, Scielo and Blogs on issues related to urinary incontinence, especially that which occurs as a consequence of menopause in women, as well as techniques and methods of reeducation to minimize the negative effects of this condition. Results: The main objective of urinary continence re-education is to strengthen the pelvic floor to improve function and to reinforce surgical procedures to prevent relapses, applying techniques such as bladder control training, Kegel exercises, biofeedback, vaginal cones and electrostimulation, forming a comprehensive rehabilitation training that also includes physiotherapy and behavioral therapy, in order to reduce this condition and improve the quality of life of affected patients. Conclusions: The re-education of urinary continence through the various techniques analyzed is considered the most effective treatment for the control of this condition, especially as a therapeutic alternative in postmenopause, by significantly reducing urinary losses and, consequently, promoting the improvement of self-esteem and quality of life.

Introduction: Pregnancy constitutes a period of great physiological changes in the body, which can lead to the appearance of disorders in the state of oral health. Objectives: Describe the state of periodontal health in pregnant women in the Colón Oeste health area. Methodology: An observational, descriptive, cross-sectional, retrospective study was carried out in the period from January 2019 to March 2020. The universe was studied in its entirety and consisted of 291 pregnant women belonging to the Colón Oeste health area, which were visited to obtain informed consent to participate in research. The results were presented in statistical tables and the percentage was used as a summary measure. Results: The age with the most patients was the age group 25 to 34 years with 37.5%. Healthy patients predominated for 70.2%, followed by patients with chronic gingivitis with 28.5%. Inadequate oral hygiene was the most significant with 52.3%, among the risk factors the history of dental caries had a greater significance with 61.8%, gingival inflation prevailed in 100% of periodontally ill patients. Conclusions: The age of 25 to 34 years was the one that contributed more patients, healthy patients predominated followed by patients with chronic gingivitis. Inadequate oral hygiene was the most significant, the prevailing risk factors were a history of dental caries followed by dental crowding. The most representative sign was gingival inflation.

Introduction: Non-small cell lung cancer (NSCLC) is one of the leading causes of death in the world, however, the application of immunotherapy has improved the quality of life and overall survival. Objective: To characterize the current health status of patients with long-survival NSCLC treated with active Cuban immunotherapy in the province of Matanzas. Methodology: A descriptive, retrospective study was conducted in 24 patients with a cytohistological diagnosis of NSCLC treated with active Cuban immunotherapy, in the Provincial Oncology Service of Matanzas, from January 2010 to July 2021. The data were obtained through the medical records and reports of the Department of Pathological Anatomy of the "Faustino Pérez" Hospital. Results and discussion: Patients with long-survival NSCLC were mostly men, with a white complexion, older than 60 years, with a diagnosis of squamous cell carcinoma, stage IIIB-IV, with first-line treatment with chemotherapy and radiotherapy, followed by active immunotherapy with Vaxira and CIMAvax-EGF, associated with a survival of 5 to 15 years and low lethality. Conclusions: Patients treated with active immunotherapy presented long survival associated with a better quality of life.

Introduction: Breast primary non-Hodgkin lymphoma is an infrequent entity, is less than the 0,5% of all the malignancies of the breast. Due the lack of specific characteristics, clinics or by image (mammogram and ultrasound), it is difficult to stablished a pre surgical diagnoses, confused it with breast carcinoma, that could even occur with the cytological and histologic diagnosis using any of the current pathology methods. Immunohistochemistry is required to corroborate the diagnosis, type its cell of origin and select and adequate and more precise treatments. Objective: To explain the clinical and pathological characteristics of the primary extranodal NHL of the breast through the presentation of a case. Methodology: A review of the literature related to the subject was carried out and this review was prepared, the exposed case was diagnosed and treated at the Faustino Pérez Hospital in Matanzas, Cuba. Results: We present a case of a Breast primary extranodal non-Hodgkin lymphoma in a patient of 66 years old that shows a bad outcome, being deceased at the time of this report. Conclusions: it is a rare entity, with an unfavorable prognosis. There is a lack of clinical, diagnostic or therapeutic guidelines that allow optimizing the diagnosis and immunohistochemistry is essential to filiate the type of lymphoma and to be able to propose a treatment with immunotherapy.

Introduction Damage control surgery has constituted an orderly step strategy that allows a severely traumatized patient to be given a second chance, with the purpose of preventing the deadly triad (coagulopathy, acidosis, hypothermia), in this paper the surgery is compared Conventional with damage control surgery Objective: To analyze the effectiveness of damage control surgery (CCD) versus conventional surgery (CC) in patients with severe abdominal trauma. Methodology: Patients with severe abdominal trauma undergoing damage control surgery and conventional surgery were included in the Surgery Service of the Abel Gilbert Pontón Hospital from January 2016 to December 2018. For which data from the computer system, medical records were reviewed. and operating records. Results: Of the studied population represented by fifty-eight patients, 79% underwent damage control surgery and 21% conventional surgery, with severe hemodynamic alterations assessed by ISS scales, RTS, Shock index. The most frequent type of trauma in the CCD was the penetrating in 59%, while in the CC the closed trauma represented by 58% was more frequent. Within the study it was observed that there was an alteration of coagulopathy in a greater percentage in patients undergoing damage control surgery with 61%. In both groups the most frequent surgical time is given between the ranges of 61 to 120 min. And the days of stay in the ICU were greater than 7 days with a totalization in their hospitalization days were greater than 15 days for both surgical strategies. Of the group studied, the one with the lowest mortality was in CCD with 33%, and the one with the highest mortality was in patients with mixed lesions 60% in CCD and in a minority 36% in CC. According to the RTS scale, there was a better survival in patients with CCD with 72%, it was also established in the mortality adjusted to the ISS that there are better results in the CCD since increasing their index does not increase their mortality. Conclusions: Damage Control surgery has a better outcome in the scenario of patients with severe penetrating abdominal trauma. Keywords: damage control, abdominal trauma, conventional surgery.

Introduction: Cardiac tumors are extremely rare and are generally benign. Myxomas are the most frequent, and they commonly occur in women, adults between the third and sixth decade of life (1), the diagnosis is usually incidental or is established after the devastating consequences that it usually causes, its most frequent location is inside of the left atrium, representing a greater systemic embolization. The case of a patient with left atrial myxoma, manifested by left hemispheric ischemic stroke, is presented. Objective: To present the clinical case of a patient treated at the Ambato Regional Teaching Hospital for the diagnosis of ischemic stroke as a manifestation of left atrial myxoma. Methodology: Data were collected through a direct interview and were complemented with a review of the patient's physical medical history prior to signing the informed consent. Results: Updated review of the pathogenesis and diagnostic and surgical approach to left atrial myxoma.

Introduction: Around the world the deaths due droning has a transcendental issue due to the number of deaths that occur, becoming a public health problem, the characteristics of the victim due to submergence, they vary between countries. Ecuador has diverse geographical regions that make each one of them present specific characteristics of the fatal victims, since a characterization of them was conducted. In the sierra region, agriculture predominates as an economic activity, which is why there are multiple reservoirs, ponds, ditches, irrigation channels in the region, added to the water basins that pass through this geographical area, which constitute a risk factor for this population. Objectives: To evaluate the presentation of external and internal signs of mechanical asphyxia by submersion described in the classical literature, affecting to determine their relationship of dependence or independence among themselves, contrasting them with their pathophysiology. Results and analysis: Cyanosis appeared in 100% of the cases, petechiae in 95.5% of the cases, foam fungus 45.5%, palmar maceration 38.6%, liquid in the respiratory tract 93.2%, Niles sign in 38.6% Vargas sign 6.8% Alvarado vital injuries in 52.3%, postmortem injuries in 4.4%. Conclusions: The highest percentage of corpses presented general signs of asphyxia in their external and internal inspect in the medico-legal autopsy.

Forensic anthropology values several specific characteristics of the individual such as height, sex, racial pattern to individualize and identify corpses in rotting states or skeletal reduction phase, having as a premise a comparative study between premortem and postmortem information; The teeth, thanks to their anatomical disposition and composition, remain intact for prolonged periods of time, preserving transcendental information for identification. The objective of the research was to establish the height of a person based on the dimensions of the dental structures in the students of the third semester of the Dental Career of the National University of Chimborazo, where a quantitative cross-sectional, correlational research was conducted of hypothesis testing. Fifty study models were collected, in which the mesio-distal measurements of the lower anterior parts of both the right and left sides were determined. The data were recorded on a data collection sheet using the observation technique, applying the Carrea Method. After having performed a statistical analysis, it was concluded that there is no significant difference between the actual height and that obtained by the Carrea Method, making it a feasible formula for determining the height in the identification.

Introduction: Sexual violence can affect every human being regardless of age, sex, ethnicity, social or employment status; It affects the freedom of decision and express consent to the benefit of sexual rights and the sexual integrity of those who are being prepared and who cannot the ability to decide on sexual activities deliberately. According to the National Institute of Statistics and Censuses (2011), 25.7% of Ecuadorian women have been victims of sexual violence. Within the physical examination of the victim, it is important to detect extra-genital, para-genital and/or genital injuries; To assist in the process, application scales have been created during the forensic sexological examination, one is the Genital Injury Severity Scale (GISS) developed by Kelly D. et al. in 2013, to assess and grade the injuries in the genital area of female victims. Objective: To apply the Genital Injury Severity Scale (GISS) and relate it to the naked eye during the forensic sexological examination. Methodology: The study design was observational, cross-sectional and analytical, in women victims of alleged sexual assault who underwent a forensic sexological examination. Results: It was shown that there is a good diagnostic concordance to establish genital injuries in women victims of alleged sexual assault, between the genital injury severity scale (GISS) and the naked eye (NE) (Kappa index: 0.66; 95% CI: 0.52-0.79). Conclusions: The genital injury severity scale has a diagnostic agreement for the detection of injuries in the genital area concerning direct observation.