Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Introduction: Diagnosis of sinus fungal ball (SFB) remains a challenge in clinical practice. However, the use of corticosteroids in patients with autoimmune diseases may increase the risk of occurrence. Objective: To report the occurrence of sinus fungal ball after long-term treatment with hydrocortisone in an autoimmune patient. Case report: A 57-year-old patient, diagnosed with Addison's disease (AD) at age 21 and on continuous hydrocortisone therapy since then, presented to the healthcare facility. Initially, bacterial sinusitis was suspected, and he underwent multiple antibiotic courses over six months. On computed tomography, pseudopneumatization with an oval image compatible with a fungal ball was observed. Finally, SFB was removed nine months after the initial medical care. The level of causality between sinus fungal ball and hydrocortisone was "possible" and had a "moderate" severity level. Conclusions: Healthcare professionals should consider the diagnosis of sinus fungal ball in immunocompromised patients during clinical practice and should remain alert to the possibility of fungal infections as side effects of long-term corticosteroid therapy.

Introduction: Kounis syndrome is a complex and potentially serious clinical entity characterized by the concurrent occurrence of an acute coronary syndrome and an allergic or hypersensitivity reaction. Objective: To collect the clinical, electrocardiographic and imaging manifestations of Kounis syndrome in the context of an allergic reaction to amoxicillin. Clinical Case: A 45-year-old male patient with a known history of penicillin allergy. The electrocardiogram revealed ST-segment elevation greater than 2 mm in leads II, III, and aVF, along with ST-segment depression in leads aVL and V2. Conclusion: Kounis syndrome can present at any age and combines allergic reactions with cardiac involvement. Its management requires a careful balance between treating hypersensitivity and ensuring cardiovascular stability.

Introduction: Lung cancer frequently occurs in older adults. It causes variable respiratory distress, and breathing exercises may be a therapeutic alternative to minimize respiratory distress. Objective: To analyze the available scientific evidence on the efficacy and applicability of breathing exercises in older adults with lung cancer. Method: A literature review was conducted to obtain updated information available in the databases Redalyc, Latindex, Scielo, Scopus, PubMed, Dialnet, and Web of Science. Google Scholar was used as the search engine. To expand the volume of information and optimize results, health descriptors in English, Spanish, and Portuguese were used, along with Boolean operators (AND, OR, and NOT). 79 documents were identified, of which 21 provided relevant information for the study. Development: The main results include an analysis of the effect of breathing exercises on improving lung function and dyspnea; their impact on perceived quality of life; as well as factors affecting adherence to breathing exercises and clinical considerations and future directions as a complementary therapy in patients with this disease. Conclusions: Breathing exercises constitute an effective intervention for improving lung function and reducing dyspnea in older adults with lung cancer. Integrating these exercises into multidisciplinary pulmonary rehabilitation programs may be key to optimizing their effectiveness in clinical practice.

Introduction: Modern hospital management faces the challenge of continuously introducing changes in which digital transformation and process management ensure quality in medical care and decision-making. Objective: To delve deeper into the development of digital transformation and hospital process management. Methods: A documentary review was conducted, including articles from journals indexed in SciElo, Scopus, PubMed/Medline, and the Google Scholar search engine, from June 2024 to February 2025, related to digital transformation and hospital process management. Thirty-four original articles were reviewed from 2010 to 2024, in Spanish and English, and 27 were referenced. Search terms included digital transformation and hospital process management; excluded articles included other forms of quality management. Development: Digital transformation brings competitiveness to management and quality, enables synergy and harmonization of processes in a systematic manner, improves the effectiveness of medical care, and ensures timely decision-making. The use of integrative tools achieves continuous improvement, facilitated by technological advances. Conclusions: The digital transformation process responds to institutional priorities and needs; it enhances process management and refinement, with the use of tools that continuously improve healthcare, administrative, educational, and research processes.

The commendable work of the reviewers and the new challenges

Introduction: The rise in bacterial resistance to synthetic antimicrobials has driven research into the therapeutic potential of phytocompounds for managing urinary tract infections (UTIs). Current scientific evidence demonstrates that secondary metabolites from plant species exhibit selective antimicrobial activity, positioning them as pharmacological alternatives with mechanisms of action distinct from conventional antibiotics. Objective: To describe the antimicrobial potential of medicinal plant extracts against common uropathogens, with the aim of proposing therapeutic alternatives to synthetic antibiotics for UTIs. Development: A narrative literature review of recent scientific publications (2019–2024) was conducted using PubMed, Scopus, Web of Science, and SciELO. The review focused on evaluating the antimicrobial activity of medicinal plants against key Gram-negative uropathogens (Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa) and Gram-positive pathogens (Staphylococcus saprophyticus, Enterococcus faecalis). Experimental studies reporting efficacy parameters (MIC/MBC), mechanisms of action, and phytochemical composition were analyzed to identify promising plant species as therapeutic alternatives for UTIs. Results: The review revealed that diverse plant extracts exhibit significant antimicrobial activity against major uropathogens, with MIC values ranging from 32–256 µg/mL for resistant strains. The most effective compounds belonged to phytochemical groups such as alkaloids and polyphenols, which demonstrated mechanisms of action including biofilm inhibition and bacterial membrane disruption. However, fewer than 20% of the studies assessed safety parameters or synergistic effects with conventional antimicrobials. Conclusions: Plant extracts represent a promising therapeutic alternative against resistant uropathogens, though further preclinical studies are needed to validate their clinical safety and efficacy.

Introduction: Evaluating soil fauna is key to understanding the impact of hybrid corn H-Ame15 on soil health, which is directly related to food quality and safety. Biodiversity degradation alters biogeochemical cycles, compromises crop nutrition, and can affect human health, making it essential to ensure safe food. Objective: To analyze the effect of hybrid corn H-Ame15 and the insecticidal proteins Cry1Fa and Vip3A on soil bioindicators. Methods: The assay was developed according to guideline 850.3200. Experimental groups: control (glucose), inactive and active proteins, plant residues from the hybrid and its non-transgenic counterpart, and two groups with earthworms (Eisenia andrei). The effects on the microbial community were assessed by quantifying CO2 on days 5, 28, 35, 42, and 63 (end of the assay). Earthworms were analyzed weekly for mortality and signs of toxicity. Results: Proteins did not modify CO2 emissions. Hybrid maize showed lower respiration levels than conventional maize (-0.96 mg/g on day 63). The presence of earthworms favored respiratory function: values ​​of 20.22 and 18.54 mg/g for conventional and hybrid maize, respectively. No toxicity was evident in the earthworms. Conclusion: Hybrid maize H-Ame15 and the proteins it expresses did not cause significant damage to soil health indicators, suggesting that there are no indirect risks to human health associated with its cultivation.

Introduction: Professional development is conceived as a continuous process for teachers, allowing them to update their knowledge. Objective: To assess the dimensions and indicators for teaching and scientific development of healthcare professionals. Methods: An educational research study was conducted from December 2023 to May 2024. The population consisted of healthcare professionals with teaching status from the "Dr. Joaquín Castillo Duany" Military Hospital; the sample consisted of 61 professionals and 10 development center managers, heads of departments, and academic committee coordinators. Teaching and scientific development was defined as the primary variable, which was evaluated using three dimensions (teaching development, scientific development, and bioethics) and 19 indicators. Results: The teaching development dimension had a medium impact, obtaining an impact score of 3.14; Scientific improvement showed a high level of impact, with all indicators evaluated using this category, and the bioethical dimension was assessed as having low difficulty, with a score of 4.02. The final result of the methodological triangulation was 3.35, estimated as a medium level of impact. Conclusions: A high level of impact was identified in scientific improvement and a medium level in teaching improvement, which makes it pertinent to improve these dimensions.

Introduction: Periodontal disease (PD) has been associated with the incidence of chronic systemic diseases, including breast cancer (BC). However, studies on their association have shown inconsistent results. Objective: To evaluate the risk of BC in people with PD. Methods: A systematic review and meta-analysis following the PRISMA 2020 guidelines in Scopus, PubMed, ScienceDirect, EBSCO, Wiley Online Library, and Google Scholar was performed. Any observational study evaluating BC risk in people with and without PD was included. Study quality assessment was conducted using the Newcastle-Ottawa Scale. Fixed- or random-effects model meta-analyses were used and the results were reported as relative risks (RR) and 95% confidence intervals (CI). All statistical analyses were performed using Stata version 17.0 software. Results: Fifteen observational studies involving 816,219 female participants were included. There was a 22% increased risk of BC in people with PD (RR = 1.22; 95% CI = 1.10-1.35; p = 0.0001; I2 = 89.80%). Subgroup analysis showed consistent and significant results when stratified by sample size and follow-up period. This meta-analysis was robust based on sensitivity analysis; however, it should be interpreted with caution due to its high heterogeneity. Conclusions: The risk of BC is increased in people with PD. Future studies are needed to evaluate the effect of periodontal treatment on reducing the risk of BC.

Introduction: De Morgan first described Fractures of the anterior tibial tuberosity in 1853. They constitute between 1% and 3% of knee extensor mechanism injuries. Objective: To present a case with injury to the knee extensor mechanism due to avulsion of the anterior tibial tuberosity in an elderly adult. Clinical Case: A case was presented of a 70-year-old woman who fell from standing height with her knees flexed. The injury was accompanied by swelling, ecchymosis, inability to extend the left knee, a high-riding patella, and a palpable defect over de tibial tuberosity. Radiographs revealed a discontinuity at the tibial tuberosity of the left knee. Open reduction and internal fixation were performed using compression screws and cerclage due to an extensor mechanism injury caused by avulsion of the left tibial tuberosity. Conclusions: Injuries to the knee extensor mechanism due to avulsion of the tibial tuberosity in the elderly are rare and are due to poor bone quality associated with a hyperflexion mechanism. Early diagnosis and repair are the treatment objectives for improved joint function.