Introduction: Carpal tunnel syndrome (CTS), also called median wrist mononeuropathy, is the most frequent nerve compression syndrome reaching up to 90%. Objective: To detail the current information related to carpal tunnel syndrome and its management, as well as to analyze the conservative and surgical treatment of this disease. Methodology: A total of 27 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 18 bibliographies were used because the other 9 articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: túnel carpiano, síndrome do túnel do carpo e AINEs, carpal tunnel syndrome, treatment in patients with carpal tunnel syndrome and corticoids in carpal tunnel. Results: Wrist flexion and extension increase pressure in the carpal canal, leading to the following symptoms: pain, numbness and paresthesia. Corticosteroid injections are recommended in mild to moderate carpal tunnel syndrome. Endoscopic carpal tunnel release has less postoperative pain, earlier recovery in grip and pinch strength, compared to open release. Postoperative complications are infrequent and most are minimal and transient. Conclusions: Carpal tunnel syndrome is the oppression of the median nerve at the level of the wrist joint, which may be accompanied with limitation in epineural and axoplasmic blood flow, leading to nerve dysfunction, edema, and scarring. The diagnosis of carpal tunnel syndrome has been made through a mixture of clinical history and physical examination maneuvers, however, the use of ultrasound and electrodiagnostic tests is now being supported. There are conservative and surgical treatments, among which evidence shows that steroid injection and carpal tunnel release are effective and present good treatment results. KEY WORDS: Syndrome, tunnel, carpal, mononeuropathy

Vitamin C is a substance that has been the subject of debate over the years because of its numerous documented uses. Benefits have been shown in some cases, from use as prevention and shortening the duration of colds to reviewing vitamin C and its effects on diseases such as cancer. Therefore, vitamin C has been studied to evaluate the different mechanisms of action of vitamin C in relation to cancer; even vitamin C has been used as monotherapy or in combination with chemotherapy to demonstrate or eliminate its role in cancer. The aim of this review is to show whether the effects of vitamin C are effective and whether it makes sense to use it as monotherapy or in combination with chemotherapy; and even more to confirm or deny its positive effect in cancer.

Introduction: Depression is a global health problem that has been increasing in recent years, but it is still underdiagnosed and it’s not taken seriously enough. For this reason, it is vital for health workers to know their correct diagnosis and treatment to prevent patients from reaching their worst outcome, which is suicide. Objective: To examine how these patients have been approached and managed, and the effectiveness of both pharmacological and non-pharmacological therapies, based on review articles from the last five years. Methodology: a total of 43 original and review articles, collected from the Cochrane Library, PubMed and Google Scholar databases, were searched for the term Depression. The documents were found in Spanish and English. Some articles were excluded due to lack of updated information and lack of relevance for our literature review. Results: there is a fundamental pillar for the treatment of depression, based on psychological therapies (primary and fundamental element), pharmacotherapy and, as a last line, electroconvulsive therapy. The drugs generally used are serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors. There are other therapies such as acupuncture, music therapy, which have shown some benefit. Conclusions: throughout this time, it has been determined that current diagnostic modalities have made it possible to diagnose early and a greater number of people suffering from depression, starting with psychotherapy, and administering antidepressant drugs in the absence of response to psychotherapy. KEY WORDS: depression, dysthymia, psychotherapy, Serotonin Uptake Inhibitors, Serotonin and Norepinephrine Reuptake Inhibitors.

INTRODUCTION Pleural effusion is a pathology resulting from overproduction of pleural fluid and decreased absorption. Transudative pleural effusions are caused by general alterations in formation and absorption, as in the case of cirrhosis or heart failure. Exudative pleural effusions are usually caused by local alterations that affect physiology, such as pneumonia, neoplasms or pulmonary embolisms. The origin of the fluid in the present clinical case comes from the presence of an infectious process located in the sub-mandibular region, due to poor hygiene and oral care of the patient, which leads to bacterial pneumonia, which evolves into empyema. CLINICAL CASE The clinical case is presented of a 43 year old male patient, attended in a hospital in the Amazon, belonging to the province of Morona Santiago-Ecuador, with a personal history of chronic alcoholism; and the presentation of a picture of pain in the oral cavity of moderate intensity, associated with purulent secretion of moderate quantity, which evolves unfavourably with non-productive cough and pleuritic pain. Complementary studies were carried out which revealed the presence of pleural empyema and submandibular abscess. EVOLUTION The patient was treated with broad-spectrum antibiotic therapy, vasoactive support management due to the presence of septic shock and management of his dental problems. In addition, radiographic and tomographic images were taken to confirm the patients critical clinical condition. Subsequently, the patient decided to request medical discharge to go to another private health unit of greater complexity. CONCLUSIONS Neck abscesses are the result of dental disorders which, if not treated immediately, are a strong predisposing factor for infections in other regions of the body through dissemination, such as the lung, mediastinum and pericardium. The different causes of empyema are of vital importance, because diagnosing the possible aetiologies of empyema can lead to a correct and more targeted management and treatment of the cause. KEY WORDS: Empyema, Submandibular abscess, Pleural effusion

INTRODUCTION: IgG subclass deficiency was described by William Terry in a patient with recurrent infections. Selective IgG subclass is defined as a significant decrease in serum concentration of 1 or more IgG subclasses with normal total IgG, IgA and IgM levels. Persistent low serum levels of one or more immunoglobulin G (IgG) subclasses may be found in a high proportion of adult patients with increased susceptibility to infections (17). This deficiency has been described in association with other primary immunodeficiencies, including: selective IgA deficiency, selective IgM deficiency and Ataxia-Telangiectasia, growth hormone deficiency, Down syndrome, cystic fibrosis, among others (1). CLINICAL CASE:We present the clinical case of a 28-year-old female patient with a history of selective immunodeficiency to IgG immunoglobulin, repeated urinary tract infections, repeated vaginal infections and herpes simplex II infection, all of which have been treated, She went to a hospital in Morona Santiago three days ago for presenting, as the apparent cause, administration of immunoglobulin for a basic illness, a mild holocranial headache that evolved into a severe headache, accompanied by nausea that led to vomiting on one occasion, for which she was admitted to the hospital for pain management. Complementary examinations showed that there was no metabolic alteration or neurological deterioration, which is why she was classified as an adverse effect of the administration of immunoglobulin 3 days earlier. EVOLUTION:The patient was admitted for pain management due to severe headaches, multiple analgesics were administered without adequate response, so it was decided to start a tramadol infusion pump. During the following hours of hospitalization she remained with a feeling of nausea and weakness, however, the headache gradually subsided and it was decided to discontinue analgesic medication to assess the response of the clinical picture, and she was discharged 24 hours after admission with a favorable evolution. CONCLUSIONS: IgG subclass deficiency is a pathology characterized by the fact that it occurs in women over 16 years of age, with a very low prevalence; the presence of respiratory pathologies gives rise to the suspicion of this disease. The treatment of this pathology is based solely on the intravenous or subcutaneous administration of Immunoglobulin G, together with the concomitant treatment of the infections that the patient presents. Adverse effects should always be taken into account, as they are temporary, but quite disabling. KEYWORDS: Headache, Immunoglobulin G, Urinary Tract Infections, Herpes Simplex