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Presentación del caso. Se trata de una mujer de 26 años de edad, en seguimiento por la especialidad de reumatología desde los 17 años, cuando consultó con historia de un año de evolución de síndrome poliarticular de grandes y pequeñas articulaciones, aditivo, simétrico acompañado de fatiga, rigidez matutina mayor de una hora. Se reportó además factor reumatoide positivo. La radiografía de ambas manos presentó erosiones, que confirmó el diagnóstico de artritis reumatoide. Adicionalmente, la paciente tenía el antecedente de procesos sinobronquiales a repetición desde su infancia. En la evaluación médica se identificó dolor en los senos paranasales, dextrocardia y bronquiectasias, confirmados por los estudios de imágenes, que permitió concluir en el diagnóstico de síndrome de Kartagener. Intervención terapéutica. La paciente presentaba actividad clínica severa de la artritis reumatoide, se inició el tratamiento con metotrexato 10 mg vía oral un día a la semana, prednisona 5 mg al día y ácido fólico 5 mg a la semana y citas periódicas, controlando los datos de actividad y efectos adversos de los medicamentos, con pruebas hepáticas, hemograma y transaminasas. La especialidad de neumología recomendó la inclusión de la paciente en un programa de rehabilitación respiratoria, así como el uso de azitromicina 500 mg cada día por tres días en los períodos de agudización. Evolución clínica. El tratamiento logró mantener una actividad leve de la artritis reumatoide y sin exacerbación de los síntomas respiratorios

Case presentation. A 26-year-old woman, under follow-up by the rheumatology specialty since she was 17 years old, when she consulted with a history of one year of evolution of polyarticular disease of large and small joints, additive, symmetrical, accompanied by fatigue and morning stiffness for more than one hour. Positive rheumatoid factor was also reported. Additionally, the patient had a history of repeated sinobronchial processes since childhood. Medical examination revealed sinus pain in the paranasal sinuses, dextrocardia, and bronchiectasis, confirmed by imaging studies, which led to the diagnosis of Kartagener's syndrome. Treatment. The patient presented the severe clinical activity of rheumatoid arthritis. The treatment was started with methotrexate 10 mg orally one day a week, prednisone 5 mg a day, and folic acid 5 mg a week and periodic appointments, controlling the activity data and adverse effects of the drugs, with liver tests, hemogram, and transaminases. The pneumology department recommended the inclusion of the patient in a respiratory rehabilitation program as well as the use of azithromycin 500 mg every day for three days during periods of exacerbation. Outcome. The treatment was successful in maintaining a mild activity of the rheumatoid arthritis and without exacerbation of respiratory symptoms

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INTRODUCTION AND IMPORTANCE: Incisional hernias are among the most frequent complications of abdominal surgery, with an incidence of 4-10 % of patients [1]. The multidisciplinary approach according to the patient's needs and their comorbidities has been shown to improve postoperative outcomes. This case report highlights the importance of a multidisciplinary approach including cardiology, general surgery, plastic surgery anesthesiology and intensive care unit for abdominal wall reconstruction in a patient with heart failure and reduced ejection fraction. CLINICAL PRESENTATION: We present a case of a 61-year-old patient with long-standing incisional hernia, without surgical correction due to the patient's condition and multiple comorbidities, advanced heart failure with reduced left ejection fraction (10-15 %) who underwent a multidisciplinary approach by cardiology, plastic surgery, anesthesiology, intensive care unit, and general surgery. DISCUSSION: The patient underwent abdominal wall reconstruction without complications. Due to multiple comorbidities, the patient was admitted in the ICU in the immediate postoperative period. He was discharged 9 days after surgery. The patient did not report long-term complications. CONCLUSION: Heart failure is associated with an increased risk of cardiovascular complications during surgical hospitalization. In patients with multiple comorbidities, the multidisciplinary approach represents an essential strategy in order to improve the surgical outcome, reduce costs to the health care system, and improve the patient's quality of life.

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Reinke's edema is one of the most prevalent laryngeal pathologies. Its detection can be addressed by using computer-aided diagnosis systems based on features extracted from speech recordings. When extracting acoustic features from different voice recordings of a particular subject at a concrete moment, imperfections in technology and the very biological variability result in values that are close, but they are not identical. This suggests that the within-subject variability must be properly addressed in the statistical methodology. Regularization-based regression approaches can be used to reduce the classification errors by favoring the best predictors and penalizing the worst ones. Three replication-based regularization approaches for variable selection and classification have been specifically designed and implemented to take into account the underlying within-subject variability. In order to illustrate the applicability of these approaches, an experiment has been specifically conducted to discriminate Reinke's edema patients (30 subjects) from healthy people (30 subjects) in a hospital environment. The features have been extracted from four phonations of the sustained vowel /a/ recorded for each subject, leading to a database that has fed the proposed machine learning approaches. The proposed replication-based approaches have been proved to be reliable in terms of selected features and predictive ability, leading to a stable accuracy rate of 0.89 under a cross-validation framework. Also, a comparison with traditional independence-based regularization methods reports a great variability of the latter in terms of selected features and accuracy metrics. Therefore, the proposed approaches contribute to fill a gap in the scientific literature on statistical approaches considering within-subject variability and can be used to build a robust expert system.

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Motivated by a study tracking the progression of Parkinson's disease (PD) based on features extracted from voice recordings, an inhomogeneous hidden Markov model with continuous state-space is proposed. The approach addresses the measurement error in the response, the within-subject variability of the replicated covariates and presumed nondecreasing response. A Bayesian framework is described and an efficient Markov chain Monte Carlo method is developed. The model performance is evaluated through a simulation-based example and the analysis of a PD tracking progression dataset is presented. Although the approach was motivated by a PD tracking progression problem, it can be applied to any monotonic nondecreasing process whose continuous response variable is subject to measurement errors and where replicated covariates play a key role.

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El Infarto Miocardio Agudo (IMA), se ha mantenido año tras año en la cumbre de las causas de muerte de los países desarrollados y en vías de desarrollo, por lo anterior expuesto nos motivamos a realizar este trabajo para valorar la morbilidad por IMA en pacientes mayores de 60 años en la Unidad de Cuidados Coronarios del Hospital Abel Santamaría en el año 2004. Para ello de un universo de 347 pacientes se tomó una muestra de 219 y se revisaron las historias clínicas donde las principales variables a medir fueron edad, sexo, cara del corazón afectada y las complicaciones más frecuentes, utilizando el método porcentual aritmético, concluyendo que la edad más frecuente osciló entre 60 y 65 años de edad, la cara del corazón afectada fue la anterior, el sexo el masculino y las complicaciones eléctricas fueron las más frecuentes.

Acute myocardial infarction (AMI) has maintained the pinnacle of the causes of death in developed and developing countries year after year, this was the motivation to conduct this research paper that was aimed at assessing the morbidity due to AMI in patients older than 60 years old in the Coronary Intensive Care Unit at “Abel Santamaria Cuadrado” University Hospital in 2004. The target group was comprised of 347 patients and the sample 219, clinical histories were examined and the main variables analyzed were age, sex, most affected face of the heart and frequent complications using arithmetic percentage methods. Conclusion: Ages most affected oscillated between 60 and 65, the affected face of the heart was the anterior, male sex prevailed and electric complications were the most frequent.

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