Oral health status in Cienfuegos population

Background: The creation of reliable epidemiological profiles in different populations is a helpful practice that offers a general vision of how community health can be affected and it assess health systems interventions and provides information to guide the policy making process. Objective: To assess the population´s oral health condition of through the determining of the appropriate markers. Methods: Descriptive study in five health areas of Cienfuegos province including people selected by age group and through randomized sampling. The oral health condition of this population was analyzed, and the results were compared with the previous measurement dating from 1998. Results: The percentage of this population between 5-18 years of age without malocclusions or gingival and periodontal affectation was 72,6% and 38,6% respectively; the percentage of children with DMF-index at the age of five was 1,96, while the 88,2% of 18 years-old surveyed people have all their teeth. The mean of lost teeth in the age groups 35-44 and 60-74 was 7,6 and 24,7 respectively. Conclusions: Most of oral health markers improved compared with the previous measurements, except for the age group 5-18 without malocclusions and the percentage of people without gingival or periodontal affectations, which was slightly reduced. </span

Rhinoplasty by relocation of autografts in patients with nasal deformities. Cienfuegos, 2009-2019

Background: In modern rhinoplasty there are new concepts aimed at achieving the ideal model of a nose. Many techniques have become old, but new, less invasive ones have emerged.Objective: to describe the results of rhinoplasty using the autograft relocation technique in patients with nasal deformities.Methods: a descriptive case series study conducted at the Dr. Gustavo Aldereguía Lima General University Hospital, in Cienfuegos. 25 patients were included in the research, who attended the Maxillofacial Surgery consultation due to nasal deformities, between 2009 and 2019, to whom the rhinoplasty surgical technique (the modified Joseph technique) was applied. Age, sex, skin color, type of graft, technique used (endonasal, open) and type of anesthesia were analyzed.Results: female sex and white skin color predominated. The most used surgical technique was endonasal (20 patients). All were operated under local anesthesia. The largest age group was 15-30 years old. The osteocartilaginous hump was the graft used in 72% of the cases.Conclusion: with the autograft relocation technique, favorable results were obtained in the case series described. This is one of the most advanced in the context of nasal cosmetic surgery.</p

Impact of the Revolution´s Programs in Cienfuegos Dental Services

Background: Revolution´s Programs in Stomatology are part of a strategy to improve oral health of the population and the quality of the dental services. Objective: To asses the impact of Revolution´s Programs in the primary dental services in Cienfuegos. Methods: Retrospective, longitudinal study evaluating the tendencies of dental services markers of municipalities of Cienfuegos before and after the intervention between 2000 and 2007. Results: The effectiveness in Stomatology services improved in more than 100% in 2007 compared with 2005; the good use of prosthesis increased in 100%; the assistance covering and resolution index for persons over 60 years and bellow 19 increased lineally, reaching values similar to those of the first years of the studied period. Conclusions: The impact of the Revolution’s Programs was positive since the performance of the studied markers was superior after the intervention

Reconstructive surgery in the Maxillofacial Surgery service. Cienfuegos, 2015-2019

Background: Reconstructive surgery of the different parts of the face is a challenge for the surgeons who perform it. Despite its current rise, studies of series of patients treated by these procedures are few.Objective: to characterize the face repair surgery in patients seen in a repair surgery consulting room.Methods: descriptive study, of a series of cases, at the Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos. Patients who received reconstructive surgery of different facial structures, in the period January 2015 to December 2019 (N = 21) attended in the repair surgery consultation were studied. For this series, age, sex, skin color, diagnosis, cause, type of anesthesia and surgical technique were analyzed.Results: men and white skin color predominated. The auricle was the most frequently affected structure; consequently, the most commonly used techniques were the Filatov tube and Dieffenbach retroauricular, combined. Local anesthesia was used in almost all cases. The largest age group was 18-35 years (13 patients), with more than 50% of the total. Patients aged 60 and over were affected by lesions derived from carcinomas.Conclusion: The series presented shows that reconstructive surgery can solve different health and aesthetic situations, sometimes both in the same patient, with techniques of minimal surgical risk, a short time and favorable results.</p

Dental health state in the 20 year-old population and more in Cienfuegos province.

<strong>Background:</strong> The absence of consice data of some indicators in the stomatological subsystem of our province difficults the knowledge of the real situation of the dental health in our province population. <strong><br />Objetive:</strong> to determine some epidemiological indicators related to dental health in the 20 year-old population and more in Cienfuegos province. <strong><br />Method:</strong> a descriptive epidemiologcal study. Methods: 253 621 patients in a range of 20 years old and more. All health areas including municipalities were taken into consideration from May to June 2004. <strong><br />Results:</strong> The kind of denture more demanded for its rehabilitation by the population was the upper and the lower one. The highest indicators of cavities and exodonties were found in the 35 to 59 year-old group of patient as well as in the rural areas. The anatomic localization of cavity lesions were predominant in the posterior dental sector with a relation between sectors of 1:1,7. The lowest percetange in the covering range of stomatological attention was found in the 35 to 59 year-old group with 5 and 18 % in the majority of the municipalities. <strong><br />Conclusions:</strong> Through this investigation the behaviour of proposed indicators were evaluated as well as the necesities of treatment to establish future strategies of work in order to improve the dental health in the population.<strong><br /></strong

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research