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

Introduction: The presence of a stroke causes motor sequelae that affect gait and balance. Rehabilitation is a therapeutic tool in which the use of virtual reality promotes the recovery of general health. Objective: To update existing information related to the use of virtual reality as a rehabilitation treatment for balance and gait following stroke. Method: A bibliographic review was conducted of documents published between 2020 and 2024 in regional and high-impact databases (Redalyc, Scopus, PubMed, Dialnet, SciELO, and Web of Science). Initially, 71 documents were identified, of which 30 met the inclusion criteria and contributed information to the study. Duplicate texts, those not fully available, and those with research bias were excluded. The search was optimized through the use of health descriptors in English, Spanish, and Portuguese, and Boolean operators (AND, OR, NOT), which allowed for efficient expansion and filtering of results. Development: The main results include a summary of the key elements related to balance and gait characteristics following stroke, and the advantages of using virtual reality in restoring balance and gait in these patients. Conclusions: Virtual reality, whether as a sole or combined therapy, is established as an effective therapeutic approach that promotes improvements in postural control, balance, and gait patterns in stroke patients.

Currently, university life is shaped by a logic of scientific productivity that has turned the phrase “publish or perish” into a structural requirement. This academic culture prioritizes the quantity of publications over a comprehensive evaluation of teaching activities, which has led to a series of adverse consequences, such as the deterioration of faculty mental health. The pressure to meet quantifiable metrics—often without adequate resources or conditions—forces faculty members to sacrifice their personal time, increasing their workload and negatively impacting their well-being. Most concerning is the normalization of these conditions, which obscures the distress experienced and reinforces harmful institutional models. Therefore, a critical review of current evaluation systems is needed, along with the development of university policies that foster healthy work environments, where academic development is balanced with respect for faculty mental health and well-being.

Introduction: Euthanasia is a complex procedure in which a person gives their consent for a healthcare professional to end their life at a specific time. It includes a series of medico legal implications that are difficult to understand. Objective: To analyze the medico legal implications of euthanasia in Ecuador. Development: This article analyzes the elements related to the existing legal bases in Ecuador for the practice of euthanasia. The medico legal implications of this procedure are presented and analyzed, emphasizing ethical and cultural elements. Finally, the future challenges the country faces in implementing euthanasia are discussed. Conclusions: The practice of euthanasia in Ecuador entails a series of medical and legal implications, including a lack of legal basis, poor training of medical personnel, the absence of an approving legal framework, and a cultural framework that hinders its approval and implementation.

Introduction: Numerous factors are associated with major adverse cardiac events in patients with dilated cardiomyopathy. Identifying these factors allows for improved risk stratification. Objective: Determine the prognostic factors of major adverse cardiac events in the follow-up of patients with dilated cardiomyopathy. Methodology: Observational, descriptive, longitudinal, prospective study in 50 patients with dilated cardiomyopathy in the cardiology service of Dr. Carlos J. Finlay Hospital between 2021 and 2024, follow-up was carried out for one year after discharge and cardiac death, readmissions for heart failure, malignant ventricular arrhythmias and all combined were monitored. Survival curves were created using the Kaplan-Meier method and prognostic factors for adverse events were determined using Cox regression (Sex, Age ≥ 65 years, Obesity, LVEF ≤ 32%, LVDD ≥ 68 mm, atrial fibrillation, advanced functional class). Results: The mean follow-up was 11.8 ± 1.6 months, 58% of patients experienced events, with survival free of cardiac death (76%), readmission for heart failure (78%) and malignant ventricular arrhythmias (94%). Multivariate predictors were left ventricular ejection fraction ≤ 32% (p-0.042; 95% CI: 2,122-2,445), left ventricular diastolic diameter ≥ 68 mm (p-0.001; 95% CI: 2,421-5,500), advanced functional class (p-0.048; 95% CI: 2,140-2,556) and atrial fibrillation (p-0.035; 95% CI: 10,914-22,154). Conclusions: In patients with dilated cardiomyopathy, cardiac death was the most frequently reported event. Left ventricular anatomical and functional variables and the presence of atrial fibrillation were associated with worse clinical outcome at one-year follow-up.

Objective: This systematic review aimed to evaluate the coronal and apical sealing ability of Resilon, a thermoplastic synthetic root canal filling material, compared to gutta-percha under in vitro conditions. Methods: Following PRISMA-2020 guidelines, a comprehensive search was conducted across four databases (PubMed, Scopus, Web of Science, and Cochrane Library) without restrictions on language or publication date. Although both clinical and in vitro studies were deemed eligible, no clinical studies meeting the inclusion criteria were identified during the literature search. As a result, the final synthesis included exclusively in vitro investigations. Twenty-seven in vitro studies were included after duplicate removal, screening, and eligibility assessment. Two reviewers performed data extraction and risk of bias appraisal independently. Results: Findings showed that Resilon exhibited superior sealing ability in 17 studies, particularly in terms of reduced microleakage and better adaptation to canal walls, especially when used with methacrylate-based sealers. However, seven studies reported no significant differences between Resilon and gutta-percha, and three studies showed inferior sealing with Resilon, especially in long-term storage or under adverse conditions. Risk of bias analysis revealed methodological concerns in several studies, particularly regarding confounding and outcome measurement. The results suggest that while Resilon may offers short-term advantages in controlled settings, its sealing capacity may decline over time, raising questions about its long-term reliability. Conclusion: Overall, the evidence supports the potential use of Resilon in specific scenarios where immediate sealing is critical, but further standardized research and clinical trials are necessary to validate its long-term effectiveness and biocompatibility.

Introduction: Dementia and cardiovascular diseases (CVD) are prevalent conditions in the elderly population, with a complex and multifactorial relationship. Recent studies suggest that cardiovascular diseases may contribute to cognitive decline and dementia. Objective: To describe current evidence on the causal relationship between cardiovascular diseases and cognitive impairment, highlighting pathophysiological mechanisms and clinical implications. Method: A narrative review of the literature was conducted based on a structured search in Medline (via PubMed), SciELO, Cochrane Library, and Google Scholar for studies published between 2018 and 2024. The search strategy incorporated terms such as 'Dementia,' 'Cognitive Dysfunction,' 'Cardiovascular Diseases,' and their Spanish equivalents, combined with Boolean operators. The selection of studies focused on identifying the most relevant evidence discussing pathophysiological mechanisms and clinical implications. Development: Epidemiological evidence shows an association between CVD (coronary heart disease, heart failure, atrial fibrillation, and stroke) and dementia. Mechanisms such as cerebral hypoperfusion, silent microinfarcts, and endothelial dysfunction explain this relationship. Additionally, factors like hypertension and diabetes mellitus are common to both conditions. Conclusions: The evidence confirms that the relationship between cardiovascular diseases and dementia is causal, mediated by mechanisms of cerebral hypoperfusion, silent microinfarcts, and endothelial dysfunction. This knowledge supports the association of cardiovascular health as a cornerstone in the prevention of cognitive impairment. Further studies are needed to validate specific interventions targeting these mechanisms.

Introduction: Most severe cases of COVID-19 are associated with hyperinflammation. The scales developed in the context of the recent pandemic have not focused on determining its onset, but rather primarily on prognosis. Early prediction of this disorder is crucial for implementing measures to minimize complications from the disease. Objective: Design a model for the early prediction of hyperinflammation in patients with COVID‑19. Methods: An observational, analytical, cohort study was conducted from July 1 to October 31, 2021, at the “Dr. Joaquín Castillo Duany” Military Hospital in Santiago de Cuba; 472 patients were studied. A multivariate analysis was performed using binary logistic regression. Results: Male patients predominated (72.0%); 27.1% of infected patients took > 3 days to reach the hospital, and the majority were discharged alive (75.0%). In the multivariate analysis, the arterial oxygen pressure/fractional inspired oxygen ratio, phase angle, lactodehydrogenase, taking more than 3 days to reach the hospital, and age ≥ 70 years were significantly related to hyperinflammation. The constructed model showed an area under the curve of 0.930; (95% CI: 0.896–0.954), the Hosmer-Lemeshow test had a value of 0.150 and the Nagelkerke R2 was 0.713. Conclusions: The predictive model designed from clinical, humoral, hemogasometric and bioelectrical elements showed good fit and discriminatory power.

Introduction: Diabetic macular edema is a common complication of diabetic retinopathy that affects central vision. Optical coherence tomography is the gold standard diagnostic tool for following and monitoring the evolution of retinal thickness, fluid presence, and vitreomacular interface characteristics. Objective: To describe the tomographic characteristics of the vitreomacular interface and diabetic macular edema in diabetic patients. Methods: A descriptive, cross-sectional study was conducted in 93 patients (154 eyes). Variables related to the characteristics of diabetic macular edema and changes in the vitreomacular interface were studied. Summary measures were used for qualitative variables (frequencies), and the mean and standard deviation for quantitative variables. The chi-square test of independence was used to identify associations between variables. Results: Diabetic macular edema with foveal involvement was observed in 83.76% of eyes; 74.02% showed intraretinal cysts. The average central macular thickness was 474.7 microns, reflecting the severity of the edema. Some changes in the vitreomacular interface were present in 83.11% of eyes, the most common being epiretinal membrane (75.0%) and anomalous posterior vitreous detachment (47.6%). Conclusions: Diabetic macular edema is characterized by a high prevalence of vitreomacular interface abnormalities; therefore, it is essential to identify the central macular thickness, the presence of cysts, hyperreflective spots, and changes in the vitreomacular interface to establish the visual prognosis of patients.

Introduction: In 2020, a new disease became a pandemic. A safe methodology was developed in Cuba for its morphological study. Objective: To reflect on the contributions made through the study of minimally invasive autopsies of confirmed deaths during the COVID-19 pandemic. Development: Before COVID-19, the strengths were: the Cuban healthcare system, autopsies (quantity and quality), its automated system, and the confirmation of multiple organ damage. Are specific to COVID-19: minimally invasive autopsies, the organization of the special working group, the morphological alterations found in different organs, and the causes of death. Post-COVID-19 contributions included the need to monitor post-COVID patients. Other contributions included support for teaching, presentations at events and publications, encouragement of innovation, and confirmation of the hypothesis of the use of immunomodulators and supplemental oxygenation. Conclusions: Autopsies are necessary to clarify the causes of death and reorient treatments; to highlight the need for monitoring patients after COVID-19; to delve deeper into the inflammatory response and its morphological manifestations in preparation for future pandemics; and to explore effective treatment with Jusvinza, ozone, or other immunomodulators.

Coordination between educational institutions and healthcare entities for the design of oral health promotion and prevention programs is essential in areas such as physical education and sports, as they allow for prioritizing aspects related to adherence to healthy lifestyles. Therefore, it is necessary to implement preventive health education and intervention programs that address these issues. Furthermore, it is essential to allocate resources effectively, prioritizing underweight and obese populations who require dental care. Likewise, there is a need to establish specific public dental health policies with an emphasis on the rural population.