Escorpionismo en la población amazónica del cantón Taisha en Ecuador / Scorpion stings in the Amazonian population from Taisha Canton in Ecuador

Introducción: En el Ecuador se desconoce la frecuencia, los factores de riesgo, el efecto preciso de las picaduras de escorpión, sus toxinas, la fisiopatología e interacción con la población. Objetivo: Registrar la incidencia de las picaduras de escorpión, el cuadro clínico, su manejo y las limitaciones para la obtención del antídoto en Ecuador. Métodos: Se realizó un estudio de cohorte retrospectivo, en el cual se recolectaron datos como edad, sexo, residencia, sitio corporal de picadura, cuadro clínico, tratamiento, estancia médica, referencia a unidad de mayor complejidad, morbilidad y mortalidad, durante el periodo entre enero de 2016 y noviembre de 2018 en la población amazónica del cantón Taisha, provincia de Morona Santiago, Ecuador. Resultados: Se evaluaron 134 picaduras de escorpión, las cuales predominaron en personas adultas (70,9 %). La región corporal más frecuente de picadura fue en las extremidades superiores e inferiores (92,5 %) y el nivel de intoxicación grave correspondió al 12,7 %. La estacionalidad de las picaduras de escorpión predominó en los meses de octubre, abril, diciembre y marzo. La presentación de la morbilidad anual fue mayor en el año 2017 (52,9 %). Conclusiones: Existe una alta incidencia de picaduras de escorpión en la zona de estudio. En el Ecuador la accesibilidad al antídoto es limitada, por lo que es necesario realizar más investigaciones en el tema, incluyendo intervenciones preventivas y curativas.

Introduction: In Ecuador, the frequency, risk factors, precise effects, toxins, pathophysiology and interaction with the population of scorpion stings are unknown. Objective: To report on the incidence of scorpion stings, its clinical picture and management, and the limitations for obtaining an antidote in Ecuador. Methods: A retrospective cohort study was conducted and data was collected on the age, gender, place of residence, site of sting, clinical picture, treatment, hospital stay, referral to higher complexity unit, morbidity, and mortality from January 2016 to November 2018 in the Amazonian population from Taisha canton, Morona-Santiago province in Ecuador. Results: 134 scorpion stings were evaluated. Most cases were adults (70.9%). The most frequent region stung by scorpions were the upper and lower extremities (92.5%) and severe intoxication level accounted for 12.7% of cases. The highest incidence of scorpion stings occurred in October, April, December and March. Annual morbidity was higher in 2017 (52.9%). Conclusions: There is a high incidence of scorpion Sting in the area under study. Accessibility to an antidote is limited in Ecuador; therefore, further research on this topic and on preventive and curative interventions are necessary.

Identificación oportuna del sangrado anormal postparto: método gravimétrico para cuantificar sangrado. Proyecto de mejora / Timely detection of abnormal postpartum bleeding: use of the gravimetric method to quantify bleeding. Improvement project

Resumen: Introducción: La hemorragia postparto es una entidad que no se detecta oportunamente con la estimación visual del sangrado. Material y métodos: Se implementó un protocolo estandarizado de cuantificación gravimétrica del sangrado postparto en pacientes sometidas a cesárea. Un estudio prospectivo, comparativo, no aleatorizado determinó el cumplimiento del protocolo, frecuencia proporcional del sangrado postparto anormal, basal y postintervención de mejora; y asociación entre metodologías de evaluación del sangrado y clasificación del sangrado. Pruebas z, Fisher, p < 0.05 significativa. Resultados: El cumplimiento del protocolo estandarizado fue 53% (± 0.18). En el grupo postintervención de mejora, la frecuencia del sangrado anormal postparto se incrementó en 30% con respecto al grupo basal (p < 0.05). Se demostró asociación significativa entre la cuantificación gravimétrica del sangrado postparto, y el sangrado postparto anormal. Conclusión: La implementación del protocolo de cuantificación gravimétrica del sangrado postparto fue posible, permitió mejorar la capacidad de identificación del sangrado postparto anormal en pacientes sometidas a cesárea.

Abstract: Introduction: Postpartum hemorrhage is a complication, that is not timely detected with the visual estimation of bleeding. Material and methods: A standardized protocol for the gravimetric quantification of postpartum bleeding was implemented to improve the ability to identify abnormal bleeding in patients undergoing caesarean section. A prospective, comparative, non-randomized study evaluated the improvement intervention. Compliance with the protocol, classification of postpartum bleeding before and after intervention; and the association between methodologies for assessing bleeding and postpartum bleeding classification were determined. Fisher z tests, p < 0.05 significant. Results: Compliance with the standardized protocol was 53% (± 0.18). In the post-intervention group, the frequency of abnormal postpartum bleeding increased by 30% with respect to the baseline group (p < 0.05). A significant association was demonstrated between gravimetric quantification of postpartum bleeding and abnormal postpartum bleeding. Conclusion: The implementation of the protocol for the gravimetric quantification of postpartum bleeding was possible. It improved the ability to identify abnormal postpartum bleeding in patients undergoing cesarean section.

Fast surveillance response reveals the introduction of a new yellow fever virus sub-lineage in 2021, in Minas Gerais, Brazil

BACKGROUND In Brazil, the yellow fever virus (YFV) is maintained in a sylvatic cycle involving wild mosquitoes and non-human primates (NHPs). The virus is endemic to the Amazon region; however, waves of epidemic expansion reaching other Brazilian states sporadically occur, eventually causing spillovers to humans. OBJECTIVES To report a surveillance effort that led to the first confirmation of YFV in NHPs in the state of Minas Gerais (MG), Southeast region, in 2021. METHODS A surveillance network was created, encompassing the technology of smartphone applications and coordinated actions of several research institutions and health services to monitor and investigate NHP epizootics. FINDINGS When alerts were spread through the network, samples from NHPs were collected and YFV infection confirmed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and genome sequencing at an interval of only 10 days. Near-complete genomes were generated using the Nanopore MinION sequencer. Phylogenetic analysis indicated that viral genomes were related to the South American genotype I, clustering with a genome detected in the Amazon region (state of Pará) in 2017, named YFVPA/MG sub-lineage. Fast YFV confirmation potentialised vaccination campaigns. MAIN CONCLUSIONS A new YFV introduction was detected in MG 6 years after the beginning of the major outbreak reported in the state (2015-2018). The YFV strain was not related to the sub-lineages previously reported in MG. No human cases have been reported, suggesting the importance of coordinated surveillance of NHPs using available technologies and supporting laboratories to ensure a quick response and implementation of contingency measures to avoid YFV spillover to humans.

Presentación y manejo de las cardiopatías congénitas en el primer año de edad / Presentation and management of congenital heart disease in the first year of age

Resumen Las cardiopatías congénitas (CC) se definen como una anomalía estructural del corazón o de los grandes vasos intratorácicos. Constituyen la malformación congénita más frecuente al nacimiento. Al menos un tercio de los pacientes requieren algún tipo de intervención antes del año de edad. Las manifestaciones clínicas de las cardiopatías en la etapa neonatal se presentan con un amplio contexto clínico y se pueden confundir con problemas a nivel pulmonar o infeccioso, lo que dificulta su diagnóstico y con ello contribuyendo de forma importante a la mortalidad y morbilidad de estos pacientes, ya que se retrasa el diagnóstico y manejo oportuno. El monitoreo por oximetría de pulso en el periodo neonatal se utiliza actualmente como método diagnóstico para la detección de cardiopatías congénitas críticas; a pesar de que las detecta en forma temprana, en muchos países aún no se lleva a cabo. El objetivo de este artículo es ofrecer un panorama general de la presentación clínica, aspectos diagnósticos y manejo inicial de las CC en el primer año de edad que pueda ser de utilidad a los médicos de primer contacto para mejorar la atención en este grupo de pacientes.

Abstract Congenital heart disease (CHD) is defined as a structural abnormality of the heart or large intrathoracic vessels. They constitute the most frequent congenital malformation at birth. At least one third of patients require some type of intervention before the year of age. The clinical manifestations of heart disease in the neonatal stage are presented with a wide clinical context and can be confused with problems at the pulmonary or infectious level making difficult to diagnose them and thereby contributing significantly to the mortality and morbility of these patients since the diagnosis is delayed and timely handling. Pulse oximetry monitoring in the neonatal period is currently used as a diagnostic method for the detection of critical congenital heart disease. Although it detects them early, in many countries it is not yet carried out. The objective of this article is to offer an overview of the clinical presentation, diagnostic aspect and initial management of CHD in the first year of age that may be useful to first contact physicians to improve the management of this group of patients.

Risk of cardiovascular disease according to the Framingham score in patients with high blood pressure from Píllaro, Ecuador. 2017-2018 / Riesgo cardiovascular según la escala de Framingham en pacientes hipertensos de Píllaro, Ecuador. 2017-2018

Abstract Introduction: Cardiovascular disease (CVD) is the main cause of morbidity and mortality worldwide. The use of the Framingham Risk Score is of great importance for predicting CVD risk. Objective: To estimate the 10-year CVD risk in adult patients diagnosed high blood pressure (HBP) who visited the outpatient service of the San Miguelito de Píllaro Health Center, in Tungura-hua, Ecuador, using the Framingham Risk Score (2008). Materials and methods: Cross-sectional, observational, prospective and descriptive study conducted in 120 HBP patients aged 30 to 74 years who visited the outpatient service between January and October 2017. Data were obtained from the review of medical records, which were in turn updated during the execution of the study. The Framingham risk score was used to calculate the 10-year CVD risk. A descriptive analysis of the data was performed in Epi Info 7, using absolute frequencies and percentages. Results: Of the 120 patients, 59.17% were women. Furthermore, 15% of the participants had been diagnosed with type 2 diabetes mellitus, 13.33% had a history of smoking, 47.50% had elevated systolic blood pressure, and 39.17% had hypercholesterolemia. CVD risk was low (≤ 1% Framingham score), intermediate (10-19%), and high (≥ 20%) in 15%, 29.16%, and 59.16% of participants, respectively. None of them had a very low CVD risk (≤1%). Conclusion: The Framingham risk score was useful to estimate CVD risk in the study population treated in the primary health care setting. Consequently, more extensive use of this instrument in different health units is recommended to obtain better estimates of CVD risk and, as a result, achieve the implementation of health prevention and health care actions that improve the prognosis in the medium and long term, and thus the quality of life of these patients.

Resumen Introducción. Las enfermedades cardiovasculares (ECV) son la principal casusa de morbimortalidades a nivel mundial; el uso de la escala de Framingham es de gran importancia para predecir el riesgo de ECV. Objetivo. Determinar el riesgo de ECV a 10 años en pacientes adultos con diagnóstico de hipertensión arterial (HTA) que asistieron al servicio de consulta externa del Centro de Salud de San Miguelito de Píllaro, Tungurahua, Ecuador, utilizando la escala de riesgo de Framingham (2008). Materiales y métodos. Estudio transversal, observacional, prospectivo y descriptivo realizado en 120 pacientes con edades entre 30 y 74 años y con diagnóstico de HTA que asistieron al servicio de consulta externa entre enero y octubre de 2017. Los datos se obtuvieron a partir de la revisión de las historias clínicas, las cuales, a su vez, fueron actualizadas durante la ejecución del estudio. El riesgo de ECV a 10 años se determinó según el puntaje obtenido en la escala Framingham. Se realizó un análisis descriptivo de los datos en el programa Epi Info 7 utilizando frecuencias absolutas y porcentajes. Resultados. De los 120 pacientes, 59.17% eran mujeres. Además, 15% de los participantes había sido diagnosticado con diabetes mellitus tipo 2, 13.33% tenía antecedentes de tabaquismo, 47.50% tenía presión arterial sistólica elevada y 39.17% tenía hipercolesterolemia. El riesgo cardiovascular fue bajo (≤1% puntaje Framingham), intermedio (10-19%) y alto (≥20%) en 15%, 29.16% y 59.16% de los participantes, respectivamente. Ninguno tuvo riesgo muy bajo (≤1%). Conclusión. La escala Framingham fue útil para estimar el riesgo cardiovascular de los participantes en el contexto de la atención primaria de salud, por lo que se recomienda un uso más amplio de este instrumento en las diferentes unidades de salud con el fin de obtener una mejor estimación del riesgo de ECV y así lograr la implementación de acciones de prevención y atención en salud que mejoren su pronóstico en el mediano y largo plazo, y, por tanto, la calidad de vida de estos pacientes.

Eficacia y seguridad del cierre quirúrgico del conducto arterioso permeable por el cirujano pediatra general: ensayo clínico / Effectiveness and safety of the surgical closure of permeable arteriosus conduct by the general pediatric surgeon: clinical trial

Resumen Antecedentes: El conducto arterioso permeable (CAP) es un defecto cardiaco congénito y se considera un problema de salud pública. Se presenta en un alto porcentaje de recién nacidos y en algunos mayores de 1 mes. El cierre farmacológico es el tratamiento inicial preferido, ya que ha tenido excelentes resultados; sin embargo, en aquellos casos en los que no es posible, está indicado el cierre quirúrgico. Objetivo: Evaluar la eficacia y la seguridad del cierre quirúrgico del CAP por cirujanos pediatras sin especialidad en cirugía cardiovascular. Método: Ensayo clínico realizado en pacientes del Hospital General de Occidente, centro hospitalario público de segundo nivel, con diagnóstico de CAP, que requirieron corrección quirúrgica. Se revisaron en forma retrospectiva los expedientes de enero de 2001 a diciembre de 2018. Resultados: Se incluyeron 224 pacientes divididos en dos grupos: grupo I, con 184 (82%) recién nacidos, y grupo II, con 40 (18%) niños grandes de 2 meses a 8 años de edad. A todos se les realizó cierre quirúrgico: 3 por toracoscopía y 221 por toracotomía posterolateral izquierda. Presentaron complicaciones 36 pacientes, lo que representa el 16% del total; solo el 5.3% fueron complicaciones mayores. Fallecieron 24 pacientes en el posoperatorio, lo que representa una mortalidad del 10.7%; ninguno falleció por complicaciones transquirúrgicas. El CAP es un defecto cardíaco congénito que se presenta en alto porcentaje en pacientes prematuros. El cierre farmacológico es el principal tratamiento por tener excelentes resultados en recién nacidos; sin embargo, en aquellos casos en los que no sea posible está indicado el cierre quirúrgico. Todos los pacientes fueron operados por cirujanos pediatras generales, con una sobrevida global del 92%. Conclusiones: En los hospitales donde no hay cirujano cardiovascular pediátrico ni cardiólogo intervencionista, la corrección quirúrgica del CAP puede ser llevada a cabo por un cirujano pediatra. La técnica es reproducible, fácil de realizar y con mínimas complicaciones.

Abstract Background: The Patent Ductus Arteriosus (PDA) is congenital heart defect and is considered a public health problem. It occurs in a high percentage of newborns and in some older than 1 month. Pharmacological closure is the preferred initial treatment, as it has had excellent results; however, in those cases where it is not possible, surgical closure is indicated. Objective: The objective is to evaluate the efficacy and safety of the surgical closure of the patent PDA when it is carried out by pediatric surgeons without specialization in cardiovascular surgery. Methods: This study was conducted at the West General Hospital, a 2nd level public hospital, with the diagnosis of patent ductus arteriosus that required surgical correction. For the collection of the information, the files from January 2001 to December 2018 were retrospectively reviewed. Results: 224 patients were included; divided into two groups: Group I: 184 (82%) "newborns" and Group II: 40 (18%) "big children" with ages from 2 months to 8 years. All had a surgical closure; 3 by thoracoscopy and 221 by left posterolateral thoracotomy. 36 patients presented complications representing 16% of the total of patients, only 5.3% were major complications. 24 patients died in the postoperative period, representing a mortality of 10.7%, none died due to trans-surgical complications. PDA is a congenital heart defect that occurs in a high percentage of premature patients. The pharmacological closure is the principal treatment because it has had excellent results in newborns; however, in those cases where it is not possible, surgical closure it´s indicated. All patients were operated by general pediatric surgeons, with a global survival of 92%. Conclusions: We conclude that in hospitals where there is no pediatric cardiovascular surgeon or interventional cardiologist, the surgical correction of the PDA can be carried out by a general pediatric surgeon. The technique is reproducible, easy to perform and with minimal complications.

Inequidad de la atención de las cardiopatías congénitas en los hospitales públicos de México. El falso derecho a la salud / Inequity of congenital heart disease care in the public hospitals of Mexico. The false right to health

Resumen La cardiología pediátrica y la cirugía cardiovascular han tenido avances importantes en los últimos años; las cardiopatías congénitas (CC) son una de las principales causas de mortalidad en niños. Muchos de los factores que determinan la evolución final de estos pacientes incluyen el tipo de cardiopatía y el tiempo del diagnóstico y tratamiento; infortunadamente, dos de los que presentan mayores efectos son el estado socioeconómico y el área geográfica de atención en México. El objetivo de este estudio es conocer el tipo de atención para los pacientes con CC en hospitales públicos del país.

Abstract Pediatric cardiology and cardiovascular surgery have made significant advances in recent years, congenital heart diseases (CHD) are one of the leading causes of mortality in children. Many of the factors that determine the final evolution of these patients include the type of heart disease, the time of diagnosis and treatment; unfortunately, in our country, two of those greatest impact area the socioeconomic status and the geographic area of attention. The objective of this study is to know the type of care for patients with CHD in public hospitals in the country.

Current situation of congenital heart diseases in two public hospitals in the state of Jalisco / Situación real de las cardiopatías congénitas en dos hospitales públicos del estado de Jalisco

Abstract Introduction: Congenital heart disease represents a public health issue worldwide. Objective: To know the number of patients with heart disease treated in two public hospitals of the State of Jalisco, as well as the mortality and resources available to participating hospitals for the care of these patients in the period from 2015 to 2018; the information was requested to the National Transparency Platform, and the database of pediatric cardiology services and pediatric cardiovascular surgery of the participating hospitals were also reviewed. Results: The second level hospital has human resources, but not the material to attend to these patients; so it is not possible to offer any type of palliative or corrective treatment. A total of 624 patients were evaluated, of which 92.2% corresponded to non-critical heart disease; overall mortality was 12% but in critical heart disease it was 79.5%. The third level hospital has human and material resources to care for these patients. During the study period, 289 operations were performed and the overall mortality was 20.4%. Conclusion: Congenital heart disease in the State of Jalisco is an important cause of mortality, with a high incidence and a very limited resolution capacity since the health services in the State of Jalisco for the care of these patients are insufficient and inadequate. It is essential to strengthen the health system for the care for these patients.

Resumen Introducción: Las cardiopatías congénitas representan un problema de salud pública a nivel mundial. Objetivo: Conocer la cantidad de pacientes cardiópatas atendidos en dos hospitales públicos del estado de Jalisco, así como la mortalidad y los recursos con que cuentan los hospitales participantes para la atención de estos pacientes en el período del 2015 al 2018. Se solicitó la información a la Plataforma Nacional de Transparencia y además se revisaron las bases de datos de los servicios de cardiología pediátrica y cirugía cardiovascular pediátrica de los hospitales participantes. Resultados: El hospital de segundo nivel cuenta con los recursos humanos, pero no con el material para atender a estos pacientes, por lo que no es posible ofrecer ningún tipo de tratamiento paliativo o correctivo (sólo se cierran algunos conductos arteriosos en la etapa neonatal). Se valoró a un total de 624 pacientes, de los cuales el 92.2% correspondió a cardiopatías no críticas; la mortalidad global fue del 12% pero en las cardiopatías críticas fue del 79.5%. El hospital de tercer nivel cuenta con recursos humanos y material para atender a estos pacientes; en el período de estudio se realizaron 289 operaciones y la mortalidad global fue del 20.4%. Conclusión: Las cardiopatías congénitas en el estado de Jalisco son una causa importante de mortalidad, con una incidencia elevada y una capacidad de resolución sumamente limitada, ya que los servicios de salud de Jalisco para la atención de estos pacientes son insuficientes e inadecuados. Es esencial fortalecer el sistema de salud para atender a estos pacientes.

Comparación de oxómetros para detección de cardiopatías congénitas críticas / Comparison of oximeters for the detection of critical congenital heart diseases

Resumen Introducción y objetivos: En algunos centros el tamiz cardíaco no se realiza con la justificación de no tener el oxímetro adecuado. Comparamos la efectividad de dos marcas de oxímetros para realizarlo. Métodos: En los neonatos a término del Servicio de alojamiento conjunto del Hospital General de Occidente en Zapopan Jalisco México de mayo a noviembre del 2018 se realizó tamiz cardíaco según las guías de la Academia Americana de Pediatría con dos oxímetros, el Masimo SET (aprobado por la FDA) y el ChoiceMMed, comparando su efectividad para la detección de cardiopatías congénitas críticas, el tiempo de toma y los falsos positivos. Resultados: En cada grupo se analizaron 1,022 pacientes; con el oxímetro Massimo SET se obtuvieron 83 pruebas positivas (8.12%) de las cuales 22 casos presentaron alguna cardiopatía (26.5%), lo que representa una sensibilidad del 100%, una especificidad del 93.9%, un valor predictivo positivo del 26.5% y un valor predictivo negativo del 100% (Odd Ratio [OR]: 0.73; IC 95%: 0.6-0.8). Con el oxímetro ChoiceMMed se obtuvieron 168 pruebas positivas (16.4%), de las cuales 22 casos presentaron alguna cardiopatía (13.09%), con una sensibilidad del 100%, una especificidad del 85.4%, un valor predictivo positivo del 13.09% y un valor predictivo negativo del 100% (OR: 0.86; IC 95%: 0.8-0.92). En cuanto al tiempo para realizar el tamiz cardíaco, la media en minutos del oxímetro Masimo SET fue 5.38 y del oxímetro ChoiceMMed fue 9.7 minutos. Conclusiones: El oxímetro ChoiceMMed presentó mayor cantidad de falsos positivos y mayor tiempo de realización del tamiz cardíaco en comparación al Masimo SET, sin embargo, ambos presentan un valor predictivo negativo del 100%, siendo igualmente útiles como método de detección de cardiopatías críticas.

Abstract Introduction and objectives: In some centers the pulse oximetry is not performed with the justification of lack of the adequate oximeter. We compared the effectiveness of two brands of oximeters to perform it. Methods: In neonates a term of the joint housing service of a Hospital General de Occidente in Zapopan Jalisco Mexico from May-November 2018, an examination of the characteristics of the American Academy of Pediatrics with both oximeters (ChoiceMMed and Masimo SET) was carried out, comparing the detection of critical congenital heart disease (CCC), time of intake and false positives. Results: In each group 1,022 patients were analyzed; with the Masimo SET oximeter 83 positive tests were obtained (8.12%), of which 22 cases had some heart disease (26.5%), which represents a sensitivity of 100%, specificity of 93.9%, positive predictive value of 26.5% and negative predictive value of 100% (OR: 0.73; 95% CI: 0.6-0.8). With the ChoiceMMed oximeter, 168 positive tests were obtained (16.4%), of which 22 cases had some heart disease (13.09%), with a sensitivity of 100%, specificity of 85.4%, positive predictive value of 13.09% and negative predictive value 100% (OR: 0.86; 95% CI: 0.8-0.92). Regarding the time to perform the cardiac sieve, the mean in minutes of the Masimo SET oximeter was 5.38 and the ChoiceMMed oximeter was 9.7 minutes. Conclusions: The ChoiceMMed oximeter contains a large number of false positives and a greater number of echocardiograms and comparatively longer cardiac screen printing with Masimo SET, however, both with a negative predictive value of 100% eliminating such excuses.

Sarcomas de Partes Blandas. Análisis de la casuística del Instituto del Cáncer de Solca-Cuenca en el período 2002-2012 / Soft part Sarcomas. Casuistry Analysis of Solca-Cuenca Cancer Intitute, period 2002-2012

Introducción: Los sarcomas de partes blandas son tumores poco comunes, se presentan en mayor prevalencia en extremidades y su base de tratamiento es la resección quirúrgica acompañada de tratamiento radio y quimioterápico. El objetivo del presente estudio es describir las características clínicas y la supervivencia de un grupo de pacientes con sarcomas de partes blandas presentados en un centro único oncológico en la ciudad de Cuenca-Ecuador. Métodos: En el servicio de Clínica del Instituto de Cáncer de Solca-Cuenca, durante el período Enero del 2002 a Diciembre 2012 se realizó un estudio descriptivo, retrospectivo. Se analizaron todos los casos de pacientes derivados del área con diagnóstico de Sarcoma de partes blandas. Se excluyeron pacientes con neoplasias de origen secundario, con historias clínicas incompletas que imposibilitaron el análisis y menores de edad. Se estudiaron las variables sexo, edad, localización del tumor, diagnostico histopatológico y supervivencia. El análisis estadístico realizado fue descriptivo. Resultados: Se analizaron 71 casos, 37 mujeres (52.1 %). Las lesiones estuvieron localizados en el miembro inferior en 38 casos (53.5%) y en el miembro superior 10 casos (14.1 %.). La edad más frecuente en los 68-77 años 16 casos (22.5%). El tipo histológico más prevalente fue el Liposarcoma en 34 casos (47.9 %) y leimiosarcoma en 15 casos (21.1 %). En los casos analizados el grado de diferenciación que con más frecuencia se presentó fue el grado III 30 casos (42.3%). El estadío clínico II fue el más prevalente con 27 casos (38 %). El tratamiento quirúrgico de resección se aplicó en 59 casos (83.1 %). En 20 casos (28.2 %) se trataron con Radioterapia Adyuvante, y en 24 casos (33.8 %) se trataron con Quimioterapia Adyuvante. La supervivencia global del grupo fue 36.5 meses, la supervivencia media libre de progresión del grupo estudiado fue de 22.7 meses. Conclusión: En este reporte el sexo, la ubicación el tipo histológico y la supervivencia son variables que coinciden con los reportados con la comunidad científica. El manejo quirúrgico se realizó en la mayoría de casos con manejo Radio y Quimio ­terápicos Adyuvantes

Introduction: Soft tissue sarcomas are uncommon tumors, they present a higher prevalence in extremities and their treatment base is surgical resection accompanied by radio and chemotherapy treatment. The aim of the present study is to describe the clinical characteristics and survival of a group of patients with soft tissue sarcomas presented in a single oncological center in the city of Cuenca-Ecuador. Methods: In the Clinical Service of the Cancer Institute of Solca-Cuenca, a descriptive, retrospective study was carried out during the period from January 2002 to December 2012. We analyzed all cases of patients derived from the area with a diagnosis of soft tissue sarcoma. We excluded patients with neoplasms of secondary origin, with incomplete medical records that made analysis impossible and underage. The variables sex, age, tumor location, histopathological diagnosis and survival were studied. The statistical analysis performed was descriptive. Results: We analyzed 71 cases, 37 women (52.1%). The lesions were located in the lower limb in 38 cases (53.5%) and in the upper limb 10 cases (14.1%.). The most frequent age in 68-77 years 16 cases (22.5%). The most prevalent histological type was Liposarcoma in 34 cases (47.9%) and leimiosarcoma in 15 cases (21.1%). In the cases analyzed, the degree of differentiation that was most frequently presented was grade III, 30 cases (42.3%). Clinical stage II was the most prevalent with 27 cases (38%). The surgical treatment of resection was applied in 59 cases (83.1%). In 20 cases (28.2%) they were treated with adjuvant radiotherapy, and in 24 cases (33.8%) they were treated with adjuvant chemotherapy. The overall survival of the group was 36.5 months, the median progression-free survival of the group studied was 22.7 months. Conclusion: In this report, sex, location, histological type and survival are variables that coincide with those reported with the scientific community. Surgical management was performed in the majority of cases with Radio and Chemo treatment -Adjuvant therapies.

Giant palmar lipoma - an unusual cause of carpal tunnel syndrome / Lipoma palmar gigante - Uma causa pouco usual de síndrome do túnel cárpico

ABSTRACT Lipoma is a quite common type of soft-tissue tumor, but it is rarely found in the hand. Hand lipomas are generally asymptomatic; however, when they become too large or when they are present in some specific location, they can cause symptoms due to compression of the median nerve. These tumors must be correctly characterized preoperatively with imaging exams and the proper management is the complete removal of the tumor and release of the median nerve. The authors present the case of a female patient with , carpal tunnel syndrome due to compression of the median nerve by a giant palmar lipoma, successfully treated with tumor excision and nerve release.,

RESUMO O lipoma é um tumor frequente dos tecidos moles, mas a sua localização na mão é rara. Os lipomas da mão geralmente são assintomáticos; contudo, quando apresentam um grande crescimento ou em determinadas localizações, podem causar sintomas devido à compressão do nervo mediano. Esses tumores devem ser devidamente caracterizados pré-operatoriamente com um exame de imagem e seu correto tratamento baseia-se na sua excisão completa e liberação do nervo mediano. Apresentamos o caso clínico de uma paciente com o diagnóstico de síndrome do túnel carpal resultante de compressão do nervo mediano por um lipoma palmar gigante, tratada com sucesso com lipectomia e descompressão nervosa.

Identification and management of prediabetes: results of the Latin America Strategic Prediabetes Meeting / Identificación y manejo de la prediabetes: resultados del Encuentro Estratégico de Prediabetes de América Latina / Identificação e gerenciamento de prediabetes: resultados da Reunião Estratégica de Prediabetes da América Latina

ABSTRACT To understand the status of prediabetes diagnosis and treatment in Latin America and to evaluate the use of metformin for diabetes prevention in this context. A panel of 15 diabetes experts from seven countries in Latin America met on 14 - 15 August 2014 in Lima, Peru, to review the available literature, discuss the role of prediabetes in type 2 diabetes mellitus and cardiovascular disease, analyze collected information, and make conclusions for prediabetes diagnosis and treatment in Latin America. Prediabetes diagnosis, screening, and treatment, including lifestyle changes, pharmacological treatment, and cost-effectiveness were discussed. Five resulting statements were issued for Latin America: prediabetes is a clinical and public health problem; health care systems do not currently diagnose/treat prediabetes; use of prediabetes risk detection tools are needed region-wide; treatment includes lifestyle changes, multidisciplinary education, and metformin; and registries of patient records and further studies should be supported. The expert panel concluded that in Latin America, preventive treatment through lifestyle changes and metformin are cost-effective interventions. It is important to improve prediabetes identification and management at the primary care level.(AU)

RESUMEN Comprender el estado del diagnóstico y el tratamiento de la prediabetes en América Latina y evaluar el uso de la metformina para la prevención de la diabetes en este contexto. Un panel de 15 expertos en diabetes de siete países de América Latina se reunió del 14 al 15 de agosto de 2014 en Lima, Perú, para revisar la literatura disponible, discutir el papel de la prediabetes en la diabetes mellitus tipo 2 y la enfermedad cardiovascular, analizar la información recolectada y formular conclusiones para el diagnóstico y el tratamiento de la prediabetes en América Latina. Se analizaron el diagnóstico, el tamizaje y el tratamiento de la prediabetes, inclusive los cambios en el estilo de vida, el tratamiento farmacológico y la relación costo-eficacia. Se emitieron cinco conclusiones para América Latina: la prediabetes es un problema clínico y de salud pública; los sistemas de atención de la salud actualmente no diagnostican o no tratan la prediabetes; el uso de herramientas de detección del riesgo de prediabetes es necesario en toda la región; el tratamiento incluye cambios en el estilo de vida, educación multidisciplinaria y metformina; y se debe brindar apoyo para llevar registros de historias clínicas y realizar estudios adicionales. El panel de expertos concluyó que en América Latina el tratamiento preventivo basado en cambios en el estilo de vida y administración de metformina son intervenciones eficaces en relación al costo. Es importante mejorar la identificación y el manejo de la prediabetes en el nivel de atención primaria.(AU)

RESUMO Entender o estado do diagnóstico e tratamento do prediabetes na América Latina e avaliar o uso de metformina para prevenção de diabetes neste contexto. Um painel de 15 especialistas em diabetes de sete países da América Latina reuniu-se de 14 a 15 de agosto de 2014 em Lima, Peru, para analisar a literatura disponível, discutir o papel do prediabetes em diabetes mellitus tipo 2 e doenças cardiovasculares, analisar informações coletadas e fazer conclusões para o diagnóstico e tratamento do prediabetes na América Latina. O diagnóstico, rastreio e tratamento pré-diabetes, incluindo mudanças de estilo de vida, tratamento farmacológico e custo-efetividade foram discutidos. Foram emitidas cinco conclusões resultantes para a América Latina: o prediabetes é um problema clínico e de saúde pública; os sistemas de saúde atualmente não diagnosticam/tratam prediabetes; o uso de ferramentas de detecção de risco de prediabetes é necessário em toda a região; o tratamento inclui mudanças de estilo de vida, educação multidisciplinar e metformina; e devem ser suportados registros de pacientes e outros estudos. O painel de especialistas concluiu que na América Latina, o tratamento preventivo através de mudanças de estilo de vida e metformina são intervenções efetivas em relação ao custo. É importante melhorar a identificação e gestão do prediabetes no nível de atenção primária.(AU)

Quimioterapia en adenocarcinoma de colon. comparación entre esquemas folfox 4 vs. 5fu/lv en estadios clínicos II y III / Chemotherapy in colon adenocarcinoma.comparison between schemes FOLFOX 4 vs. 5FU / LV in clinical stages II and III

El cáncer colorrectal es una de las enfermedades oncológicas más frecuentes. Al principio, para los estadios clinicos IIb y IIIa se usaba 5FU/LV de manera adyuvante, con el advenimiento del oxaliplatino se comenzó a utilizar quimioterapia con esquema FOLFOX 4. El objetivo fue conocer si hubo mejoría en la supervivencia de pacientes que recibieron FOLFOX 4 vs. 5FU/LV. Se realizó un estudio de cohorte histórica mediante revisión de historias clínicas de pacientes con diagnóstico histopatológico de adenocarcinoma de colon estadio clínico II y III en el Hospital SOLCA- Quito, entre los años 2000-2013, tratados con esquema de quimioterapia 5FU/LV vs. FOLFOX 4. Se estudiaron 939 pacientes, de los cuales 177 cumplieron los criterios de inclusión, 69 (38%) recibieron esquema 5FU/LV y 108 (62%) recibieron FOLFOX 4. La supervivencia al primer año fue mayor con FOLFOX 4 (89.8%. IC 95%: 84.32-95.68) que con 5FU/LV (81.2%. IC 95%: 73.16 - 88.84). Sin embargo, no existió diferencia estadísticamente significativa entre ambos esquemas con respecto a la supervivencia durante el periodo estudiado a 13 años (3.169, p: 0.0751). En cuanto al riesgo de recaídas en enfermedad, se observó que FOLFOX 4 desarrolla menos riesgo (OR: 1.91. IC 95%: 0.9655-3.7734,p: 0.04367). No existe una ventaja terapéutica significativa en la adición de oxaliplatino al esquema 5FU/LV.

Colorectal cancer is one of the most frequent oncologicaldiseases. Initially for stages IIb -IIIa was used 5FU/LV asadjuvant way; with the advent of oxilaplatin began usingchemotherapy with FOLFOX 4 scheme. The objective wasto know if there was improvement in survival of patientswho received FOLFOX 4 vs. 5FU/LV. A historical cohort studywas conducted by reviewing medical records of patientswith histopathological diagnosis of colon adenocarcinomaclinical stage II and III at SOLCA Hospital - Quito, treatedwith scheme 5FU/LV vs. FOLFOX 4 chemotherapy betweenthe years 2000-2013. We studied 939 patients, of whom177 were included in the study, 69 (38%) received 5FU/LV and 108 (62%) received FOLFOX 4 scheme. Survivalto first year was higher with FOLFOX 4 (89.8%. CI 95%:84.32-95.68) than 5FU/LV. There is no statistically significantdifference between the two schemes with respect totheir survival during of 13 years periods studied (3.169, p:0.0751). However, with the diseases relapses, FOLFOX 4was better than 5FU/LV protocol and the patients developless relapses (OR: 1.91. CI 95%: 0.9655-3.7734, p: 0.04367).There is not a significant therapeutic benefit of addingoxaliplatin to 5FU/LV.

Infecção orbitária: experiência no manejo de seis casos / Orbital infeccion: experience on the management of six cases

Infecções orbitárias são enfermidades, que requerem atenção e cuidados especiais. Os principais fatores etiológicos associados são sinusites paranasais e o trauma local. Essas infecções classificam-se em pré-septal e pós-septal e distinguem-se clinicamente, de acordo com a manutenção da acuidade visual e motilidade do globo ocular. O curso da infecção pode agravar com disfunção da motilidade ocular extrínseca, perda de visão e trombose do seio cavernoso. A tomografia computadorizada (TC) é o principal exame imaginológico para a classificação do abscesso, investigação etiológica, determinação da gravidade e a relação do processo com o sistema nervoso central. Este trabalho apresenta e discute o manejo de seis pacientes admitidos com infecção orbitária pelo serviço de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Geral Roberto Santos e em Salvador, Bahia. A TC mostrou não haver disseminação do processo inflamatório para o sistema nervoso central em nenhum dos casos tendo esse achado sido fundamental para determinar que a conduta estivesse restrita à drenagem, sem necessidade de craniotomia. As intervenções cirúrgicas e a antibioticoterapia estavam indicadas devido à importante congestão tecidual e intensa sintomatologia dolorosa. Todos os pacientes apresentaram remissão da infecção e acuidade visual preservada... (AU)

Orbital infections are diseases that require special attention and care. The main risk factors are associated with paranasal sinusitis and local trauma. These infections are classified into pre-septal and post-septal and distinguished clinically according to the maintenance of visual acuity and eye motility. The course of the infection may worsen with extrinsic ocular motility dysfunction, loss of vision and cavernous sinus thrombosis. Computed tomography (CT) is the primary imaging examination for the classification of the abscess, etiologic investigation, determining the severity of the process and the relationship with the central nervous system. This paper presents and discusses the management of six patients admitted with orbital infection by service Oral and Maxillofacial Surgery General Hospital Roberto Santos in Salvador, Bahia. A CT scan showed no spread of the inflammatory process in the central nervous system and in any case this finding was important to determine that the drainage duct was confined without requiring craniotomy. Surgical interventions and antibiotics were given because of the important tissue congestion and intense painful symptoms. All patients had remission of infection and preserved visual acuity... (AU)

Conservative treatment of the dentigerous cyst: report of two cases

The purpose of this paper is to present two cases of dentigerous cyst associated to permanent teeth in children treated by conservative techniques. Dentigerous cyst is the most common developmental cysts of the jaws. Conservative treatment is very effective to this entity and aims at eliminating the cystic tissue and preserving the permanent tooth involved in the pathology. Two techniques are described as conservative treatment for these cysts, marsupialization and the decompression. Two children presented with dentigerous cysts. A female child was affected by a large lesion at the right side of the mandible associated to tooth 45. The other lesion arose at the left maxilla associated to tooth 21 of a male child. Each dentigerous cyst promoted severe tooth displacement. The first patient was treated with decompression and the second with marsupialization.

Derivación ventrículo-cava para hidrocefalia en casos extremos. Una alternativa viable / Ventriculocaval shunt for hydrocephalus in extreme cases. A viable alternative

Introducción. El manejo de la hidrocefalia habitualmente comprende la derivación del líquido cefalorraquídeo hacia alguna cavidad corporal. En circunstancias especiales, los pacientes requieren de abordajes alternos y el cirujano se enfrenta al empleo de opciones extremas. Caso clínico. En este estudio se presentan dos pacientes que se sometieron quirúrgicamente a una derivación ventrículo-cava a través de un acceso vascular periférico. Conclusiones. La técnica representó un abordaje de fácil aplicación y con mínimas complicaciones que nos brinda una opción de rescate en aquellos pacientes complicados. En los casos presentados, el empleo de esta técnica fue exitoso.

Background. Hydrocephalus management usually involves cerebrospinal fluid shunting into some corporal cavity. Under special circumstances, patients require alternate approaches, and the surgeon faces the use of extreme options. Case report. In this study we present two patients who were surgically approached with ventriculocaval shunt through peripheral vascular access. Conclusions. The technique represented an easy application with minimal complications, an approach that provides a rescue option in cases of complicated hydrocephalus. In our case, this technique was successful.

Dentes retidos: novas perspectivas de localização / Impacted teeth: new diagnostic perspectives

As radiografias convencionais são úteis e fáceis de usar para o diagnóstico de dentes retidos, porém, pela característica de fornecerem imagens bidimensionais e sobrepostas, dificultam o planejamento da cirurgia. O uso da tomografia computadorizada tem se difundido por permitir a visualização de pequenas estruturas anatômicas maxilofaciais relevantes para intervenções cirúrgicas e por possibilitar a visualização das suas relações espaciais em três dimensões. Objetivo e relato dos casos: Relatar os casos de dois pacientes que apresentavam dentes retidos na região anterior da maxila, os quais foram avaliados por tomografia computadorizada. Discutem-se especificidades deste moderno método de diagnóstico por imagem e as vantagens clínicas advindas dessas imagens, pois foi possível identificar a localização precisa dos dentes retidos, a distância das corticais, de acidentes anatômicos e de outros dentes. Considerações finais: A tomografia computadorizada mostrou ser um exame complementar muito importante e preciso para o diagnóstico planejamento cirúrgico e controle pós-operatório de dentes retidos.

Prevalência de complicações oftalmológicas em portadores de fraturas do complexo zigomático / Prevalence of ophthalmic complications in individuals with fractures of the zygomatic complex

OBJETIVO: Realizar estudo observacional e retrospectivo da prevalência de complicações oftalmológicas em indivíduos portadores de fratura de complexo zigomático. MATERIAL E MÉTODO: Foi realizada a análise retrospectiva por consulta a prontuários dos pacientes atendidos no ambulatório de Cirurgia Buco-Maxilo-Facial do Hospital Geral Roberto Santos, no período de janeiro de 2005 a junho de 2009. RESULTADOS: Este estudo mostrou uma maior incidência de fraturas no sexo masculino, sendo a amostra composta por 70 homens (92,2%) e 6 mulheres (7,8%) com idade média de 20 a 39 anos. Dentre as causas, destacaram-se os acidentes de trânsito, envolvendo, motocicleta, carros e bicicleta que foram os agentes etiológicos mais comuns em ambos os sexos, perfazendo um total de 41 casos (54,0%). As complicações oftalmológicas observadas podem ser classificadas em menores (transitórias) e maiores (que necessitam de tratamento adicional). CONCLUSÃO: Pacientes portadores de fraturas 67 do complexo zigomático apresentam incidência elevada de complicações oftalmológicas, o que justifica o atendimento multidisciplinar desses pacientes.

OBJECTIVES: To conduct an observational and retrospective study of the prevalence of ophthalmic complications in individuals with fractures of the zygomatic complex. MATERIAL AND METHODS: This retrospective analysis was carried out by consulting the records of the patients treated at the Oral and Maxillofacial Surgery Clinic of the Roberto Santos General Hospital from January 2005 to June 2009. RESULTS: The study, comprising 70 men (92.2%) and 6 women (7.8%) aged between 20 and 39 years, showed a higher incidence of fractures in males. Road accidents involving motorcycles, cars and bicycles were the most common etiological agent in both sexes, accounting for a total of 41 cases. The ophthalmic complications observed can be classified as minor (transitory) and major (requiring further treatment). CONCLUSIONS: Patients with fractures of the zygomatic complex present a high incidence of ophthalmic complications, which justifies their treatment in a multidisciplinary fashion.