Introduction: Cranioencephalic trauma includes any physical injury or functional deterioration of the cranial content, secondary to a sudden exchange of mechanical energy. According to severity in relation to its Glasgow Scale, it is classified as Mild, Moderate and Severe. It frequently causes cerebral contusion, lacerations, direct damage to the cranial nerves and hemorrhages located at the cortical and subcortical levels, its resolution is surgical through Decompressive Craniectomy, its complications include cerebral edema, intracranial hypertension and secondary cerebral injuries of systemic cause. The onslaught of the coronavirus has taken over the world, being on January 7, 2020, when the Chinese authorities identified as the causative agent of the new outbreak of viral pneumonia a new type of virus of the Coronaviridae family that has subsequently been called SARS-CoV2-2019 . Objective: To socialize the different clinical manifestations and complications that occur in patients with TBI associated with Covid-19. Results: Cranioencephalic Trauma requires the immediate detection and correction of secondary complications of systemic origin that aggravate the primary injury in which currently it is necessary to rule out covid-19 since the uncertainty of the diagnosis of Covid-19 that is associated with another pathology could lead To an erroneous count of COVID-19 deaths, especially because it presents nonspecific symptoms, the different prognostic scales to predict its severity are moderately suggestive that they can guide our treatment, but they do not present good sensitivity and their use is controversial as well. Established drug therapy holds great promise when applied early in the course of the disease, but its utility in advanced stages may be questionable. It can occur in any individual without a common base pattern, so we cannot rule it out in any patient who comes to our emergency service since it can be linked and aggravate any clinical or surgical disease as exhibited in the present case. Conclusiones: In TBI, immediate access to brain tomography is vital for immediate and timely management, since it depends on the access time to surgical resolution, which impacts the patient's prognosis. Despite the pandemic plus the demand for patients, it has been shown that serious head trauma can be adequately managed as long as coordination is maintained with the pre and intrahospital health system.

Introduction: The term pulmonary-renal syndrome (PRS) is defined as pulmonary and renal failure caused by diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis. Its pathogenesis is due to a variety of immune-mediated mechanisms which is related to the deposition of antiglomerular basement membrane antibodies, antineutrophil cytoplasmic antibodies, immune complexes, and thrombotic microangiopathy. Since the syndrome is characterized by a fulminant course if left untreated, early diagnosis, exclusion of infection, close monitoring, and timely initiation of treatment are crucial for patient outcome. Treatment consists of ventilatory support, replacement of renal function, high-dose corticosteroids, and cytotoxic agents. Kidney transplantation is the only alternative in end-stage renal disease. The association of Systemic Lupus Erythematosus (SLE) with results of Antibody Neutrophil Cytoplasm (ANCA) does not necessarily indicate that it is also a Vasculitis if criteria for the latter are lacking, but if they confer a worse prognosis. Objective: To present the case of a patient with SPR due to SLE plus the presence of Anca p from Hospital Regional Ambato. Methodology: Data were collected by direct interview and supplemented with review of the patient's physical medical history with the due informed consent. Results: Updated review of the pathogenesis, diagnostic approach and treatment of PRS.

Introduction: The term pulmonary-renal syndrome (PRS) is defined as pulmonary and renal failure caused by diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis. Its pathogenesis is due to a variety of immune-mediated mechanisms which is related to the deposition of antiglomerular basement membrane antibodies, antineutrophil cytoplasmic antibodies, immune complexes, and thrombotic microangiopathy. Since the syndrome is characterized by a fulminant course if left untreated, early diagnosis, exclusion of infection, close monitoring, and timely initiation of treatment are crucial for patient outcome. Treatment consists of ventilatory support, replacement of renal function, high-dose corticosteroids, and cytotoxic agents. Kidney transplantation is the only alternative in end-stage renal disease. The association of Systemic Lupus Erythematosus (SLE) with results of Antibody Neutrophil Cytoplasm (ANCA) does not necessarily indicate that it is also a Vasculitis if criteria for the latter are lacking, but if they confer a worse prognosis. Objective: To present the case of a patient with SPR due to SLE plus the presence of Anca p from Hospital Regional Ambato. Methodology: Data were collected by direct interview and supplemented with review of the patient's physical medical history with the due informed consent. Results: Updated review of the pathogenesis, diagnostic approach and treatment of PRS.

Introduction: Currently the world is hit by a new pandemic, the causative agent of which is a new virus, SARS-CoV-2. COVID-19 is an emerging viral infectious disease with high mortality, which has contributed to increased mortality from Chronic Non-Communicable Diseases (CNCD) in a very short time. NCDs are the leading cause of death worldwide. In this sense, the Cuban public health system is designed to face any health problem. One of the tools developed in dealing with communicable and non-communicable diseases is active research, whose actions tend to identify existing risk factors with the aim of be included in programs (dispensarization) to guarantee their follow-up and continued care. Objective: identify the dispensing of drugs in older adults who live alone, in the face of COVID-19. Methodology: For this, a descriptive cross-sectional study was carried out during the period from May to June 2020. Results: Of the total number of patients identified, 58.3% are female and 41.7% are male. Antihypertensive drugs represent the most widely used by dispensarized patients, followed by Diabetics. Conclusions: The active investigation of patients older than 60 years with CNCD favors the application of prevention and control strategies, as well as the delivery of drugs by the pharmacy to older adults who live alone in the presence of COVID-19.

Introduction: The nurse from its beginnings has been considered as a social product linked to the art of taking care, the patient's security. As sure practice it is a problem at world level. The nursing agent's professional acting, is an element to consider evaluating the quality of the attention of health that its professionals offer, it is revealed like a necessity to investigate.  Objective: to systematize the professional acting of the nursing managers/decision for the patient's security. Methodology: was carried out a revision in different databases. Infomed, Cochrane, Library, Lilac, CINHAL, Dialnet, PubMed, Scielo, Scopus, they were used for the search the articles referred describers in Spanish language, English and available Portuguese in the portals of selected data that they presented adherence to the thematic one, published among the years 2000 and 2019. The exclusion approaches were the investigations that were repeated in the databases the editorials and the letters to the editor. Results: To support the whole definition with regard to Professional performance and the patient's security they are supported the definitions of Nurse, their functional List, decision-makers / managers  sure Care and the patient's Security as a result.  Conclusion: as a result of the analysis of the definitions on acting professional facilitated the analysis with a systemic conception of the managers/agent's work in nursing in its professional acting, asì the authors gave its approach of the professional acting in relaciòn to the patient's security.

Introduction: The continuous development of today's world requires a comprehensive preparation of professionals from all spheres of society.The study programs of the different university careers, on the one hand, include the English language as a discipline and on the other, this constitutes a curricular strategy to be followed in conjunction with the other subjects or disciplines that make up the curriculum. The subject of English Language for the career of Medicine, conceives from the program the development of the four communication skills, giving priority to the ability of oral expression with emphasis on face-to-face classes, as well as the development of reading skills, listening comprehension and writing in a guided, semi-guided and productive way. The methodology used is qualitative in nature. The analytical-synthetic method was used for the study of theoretical-methodological and inductive-deductive referents, to establish generalizations from theoretical assumptions and characterize the teaching-learning process of English. For this, this work aims to link learning strategies, educational communication, educational evaluation and the production of teaching materials and their use in teaching activities, specifically in the treatment of the grammatical contents of the English language from a communicative approach.

Infectious mononucleosis is a disease caused mainly by the Epstein-Barr virus, it is widespread and it generally occurs in childhood and adolescence, cases in adulthood are rarely reported. Due to its very general characteristics such as thermal rise, pharyngitis and lymphadenopathy, being in most cases self-limited and together with a low incidence of complications in its evolution, it is usually no to diagnosed and it is confused with similar conditions such as the cold. However, there is a small percentage of these patients who can have much greater complications and can even lead to death if they are not properly diagnosed and managed, especially when they reach adulthood. Next, a clinical case of atypical mononucleosis is presented, since characteristics such as age, initial manifestations, as well as complications were not the usual ones, which is why it is proposed not to forget the existence of this pathology in differential diagnoses and the importance of an adequate assessment and management.