Prácticas de Responsabilidad Social Empresarial dirigidas a los stakeholders en PYMEs del Valle del Cauca: literatura vs práctica / Stakeholder-oriented corporate social responsibility practices in SMEs in Valle del Cauca: literature vs. practice / Práticas de Responsabilidade Social Corporativa centradas nas partes interessadas nas PMEs do Valle do Cauca: literatura vs. prática

RESUMEN Las empresas requieren el desarrollo de prácticas de Responsabilidad Social Empresarial - RSE que sean un medio de relación con sus grupos de interés y que evidencien cómo contribuyen en la satisfacción de las necesidades de los mismos. Este artículo busca realizar un análisis descriptivo de las prácticas de RSE por grupo de interés que se presentan en la literatura y hacer un comparativo con las prácticas que reportan las PYMES más exportadoras del Valle del Cauca. Para lo cual se realiza una revisión de los artículos académicos entre 2010 y 2020 y se hace un análisis de contenido sobre las prácticas de RSE publicadas en las páginas web de las PYMES más exportadoras del Valle del Cauca de acuerdo al reporte de la Cámara de Comercio de Cali en el ano 2020, teniendo como base de comparación las dimensiones de RSE econòmica, filantrópica y ético-legal planteadas por Carroll. Los resultados indican que el grupo de interés que mayor cantidad de prácticas percibe por parte de las PYMES analizadas son los empleados y que la dimensión de RSE que más prácticas tienen es la ético-legal. Por último, se halla que múltiples prácticas van dirigidas a dos o más grupos de interés lo que permite una optimización de recursos y un mejor alcance por práctica de RSE aplicada en las PYMES.

ABSTRACT Companies require the development of corporate social responsibility - CSR practices that are a means of relating with their stakeholders and that demonstrate how they contribute to satisfying their needs. This article seeks to carry out a descriptive analysis of CSR practices by stakeholder presented in the literature and to make a comparison with the practices reported by the most exporting SMEs in Valle del Cauca.To this end, a review of academic articles between 2010 and 2020 was carried out and a content analysis was made of the CSR practices published on the web pages of the most exporting SMEs in Valle del Cauca according to the report of the Cali Chamber of Commerce in 2020, using as a basis for comparison the dimensions of economic, philanthropic and ethical-legal CSR proposed by Carroll. The results indicate that the stakeholder group that perceives the greatest number of practices on the part of the SMEs analyzed are the employees, and that the CSR dimension with the most practices is ethical-legal. Finally it is found that multiple practices are aimed at two or more stakeholders, which allows for an optimization of resources and a better scope per CSR practice applied in SMEs.

RESUMO As empresas exigem o desenvolvimento de práticas de Responsabilidade Social Corporativa - RSE que sejam um meio de relacionamento com suas partes interessadas e que mostrem como elas contribuem para satisfazer suas necessidades. Este artigo procura realizar uma análise descritiva das práticas de RSE pelas partes interessadas apresentadas na literatura e fazer uma comparação com as práticas relatadas pelas PMEs mais exportadoras do Valle del Cauca. Para isso, é feita uma revisão dos artigos acadêmicos entre 2010 e 2020 e é feita uma análise de conteúdo das práticas de RSE publicadas nos sites das PMEs mais exportadoras de Valle del Cauca, de acordo com o relatório da Câmara de Comércio de Cali em 2020, usando como base de comparação as dimensões da RSE econômica, filantrópica e ético-legal proposta pela Carroll. Os resultados indicam que o grupo de participantes com o maior número de práticas percebidas pelas PMEs analisadas são os funcionários e que a dimensão de RSE com o maior número de práticas ético-jurídicas. Finalmente, constata-se que múltiplas práticas visam duas ou mais partes interessadas, o que permite uma otimização dos recursos e um melhor escopo por prática de RSE aplicada nas PMEs.

Bruxism an issue between the myths and fact / Bruxismo, un problema entre los mitos y los hechos

Abstract Is our goal in this paper to discuss the current concepts about bruxism, a topic that has been a matter of discussion on the dental field for many years. Recent International efforts have been made to challenge bruxism old definitions; this has derivate to a consensus and an actual new concept that defines bruxism as a behavior instead of a disorder. As a behavior, it is explained in this review how it can have negative health consequences, can be innocuous and how new research support that bruxism can even be a protective factor. Different etiological factors are reviewed in this paper as well the influence of external and internal mechanism related to medications, emotional stress, systemic factors, and potential pharmacological pathways. Moreover, it is briefly summarized the role of oral appliances on sleep bruxism. Finally, clinical considerations and recommendation for the dental professional regarding sings that should be notice during the exam are part of this overview.

Resumen Es nuestro objetivo en este artículo discutir los conceptos actuales sobre el bruxismo, un tema que ha sido motivo de discusión en el campo odontológico durante muchos años. Se han hecho esfuerzos internacionales recientes para desafiar las viejas definiciones de bruxismo; esto ha derivado en un consenso y en la actualidad un nuevo concepto que define al bruxismo como un comportamiento en lugar de un trastorno. Como conducta, se explica en esta revisión cómo puede tener consecuencias negativas para la salud, puede ser inocuo y cómo nuevas investigaciones avalan que el bruxismo puede incluso ser un factor protector. En este artículo se exponen diferentes factores etiológicos, así como la influencia de mecanismos externos e internos relacionados como: medicamentos, estrés emocional, factores sistémicos y posibles vías farmacológicas. Además, se resume brevemente el papel de los aparatos orales en el bruxismo del sueño. Finalmente, se presentan consideraciones clínicas y la recomendación para el profesional en odontología con respecto a los signos que deben ser observados durante el examen clínico son parte de esta revisión.

2021 clinical practice guideline for the early detection, diagnosis, treatment, and monitoring of patients with axial spondyloarthritis. Colombian Association of Rheumatology / Guía de práctica clínica 2021 para la detección temprana, el diagnóstico, el tratamiento y el seguimiento de los pacientes con espondiloartritis axial. Asociación Colombiana de Reumatología

Abstract Introduction: Axial spondyloarthritis is a rheumatic condition affecting young patients with social and occupational consequences. Diagnosis delay is associated with functional impairment and impact on quality of life, requiring a multidisciplinary approach. Objective: To develop a set of recommendations based on the best available evidence for the early detection, diagnosis, treatment, and monitoring of adult patients with axial spondy-loarthritis. Methods: A working group was established, questions were developed, outcomes were graded, and a systematic search for evidence was conducted. A multidisciplinary panel of members was established (including patient representatives), minimizing bias in relation to conflicts of interest. The GRADE approach "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence as well as the direction and strength of recommendations. In total, 11 recommendations on diagnosis (n=2), pharmacological treatment (n=6), non-pharmacological treatment (n=2) and monitoring (n=1) are presented. Results: Sacroiliac joint radiography as the first diagnostic method, and the use of disease activity scales for patient monitoring (ASDAS or BASDAI), are recommended. Nonsteroidal anti-inflammatory drugs are the first treatment option; in case of intolerance or residual pain, acetaminophen or opioids are recommended. In patients with axial involvement, it is recommended not to use conventional disease-modifying antirheumatic drugs or systemic or local glucocorticoids. In patients with failure to non-steroidal anti-inflammatory drugs, anti-TNF or anti-IL17A are recommended. In those patients presenting with anti-TNF failure, starting an anti-IL17A is recommended. Exercise, physical and occupational therapy are recommended as part of treatment. It is recommended not to use unconventional therapies as the only treatment option. Conclusions: This set of recommendations provides an updated guideline for the diagnosis, treatment, and monitoring of patients with axial spondyloarthritis.

RESUMEN Introducción: La espondiloartritis axial es una enfermedad reumatológica que afecta a individuos jóvenes y tiene una gran repercusión sociolaboral. El retraso en el diagnóstico y el tratamiento se asocia con un mayor deterioro funcional y un impacto negativo en la calidad de vida, por lo que requiere un abordaje multidisciplinario. Objetivo: Desarrollar y formular un conjunto de recomendaciones específicas basadas en la mejor evidencia disponible para la detección temprana, el diagnóstico, el tratamiento y el seguimiento de los pacientes adultos con espondiloartritis axial. Métodos: Se configuró un grupo desarrollador, se formularon preguntas clínicas contestables, se graduaron los desenlaces y se realizó la búsqueda sistemática de la evidencia. El panel de la guía fue multidisciplinario (incluyendo representantes de los pacientes) y balanceado, minimizando el sesgo por conflictos de intereses. Se utilizó la aproximación Grading of Recommendations Assessment, Development and Evaluation (GRADE) para evaluar la calidad de la evidencia, al igual que la dirección y la fortaleza de las recomendaciones. Se presentan 11 recomendaciones relacionadas con diagnóstico (n = 2), tratamiento farmacológico (n = 6), tratamiento no farmacológico (n = 2) y seguimiento (n = 1). Resultados: Se recomienda la radiografía de articulaciones sacroilíacas como primer método diagnóstico, y el uso de escalas de actividad para el seguimiento de los pacientes (ASDAS o BASDAI). Los antiinflamatorios no esteroideos son la primera opción de tratamiento; en caso de intolerancia o dolor residual se recomienda acetaminofén u opioides. En pacientes con compromiso axial se recomienda abstenerse de utilizar medicamentos antirreumáticos modificadores de la enfermedad convencionales ni glucocorticoides sistémicos o locales. En pacientes con falla a los antiinflamatorios no esteroideos, se recomienda un anti-TNFα o un anti-IL17A. En pacientes con falla a anti-TNFα, se recomienda iniciar un anti-IL17A. El ejercicio y la terapia física y ocupacional se recomiendan como parte del tratamiento. Se recomienda no utilizar las terapias no convencionales como única opción de tratamiento. Conclusiones: Este conjunto de recomendaciones proporciona una guía actualizada sobre el diagnóstico y el tratamiento de la espondiloartritis axial.

2021 clinical practice guidelines for the diagnosis, treatment, and follow-up of patients with peripheral spondyloarthritis. Colombian Association of Rheumatology / Guía de práctica clínica 2021 para el diagnóstico, el tratamiento y el seguimiento de pacientes con espondiloartritis periférica. Asociación Colombiana de Reumatología

ABSTRACT Background: Peripheral spondylarthritis is a chronic Inflammatory disease whose clinical presentation is related to the presence of arthritis, enthesitis and/or dactylitis. This term is used interchangeably with some of its subtypes such as psoriatic arthritis, reactive arthritis, and undifferentiated spondyloarthritis. Objective: To develop and formulate a set of specific recommendations based on the best available evidence for the diagnosis, treatment, and monitoring of adult patients with peripheral spondyloarthritis. Methods: A working group was established, clinical questions were formulated, outcomes were graded, and a systematic search for evidence was conducted. The guideline panel was multidisciplinary (including patient representatives) and balanced. Following the for mal expert consensus method, the GRADE methodology "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence and generate the recommendations. The clinical practice guideline includes ten recommendations related to monitoring of disease activity (n = 1) and treatment (n = 9). Results: In patients with peripheral spondyloarthritis, the use of methotrexate or sulfasalazine as the first line of treatment is suggested, and local injections of glucocorticoids are conditionally recommended. In patients with failure to cDMARDs, an anti TNFα or an anti IL17A is recommended. In case of failure to bDMARDs, it is suggested to use another bDMARD or JAK inhibitor. In patients with peripheral spondylarthritis associated with inflammatory bowel disease, it is recommended to start treatment with cDMARDs; in the absence of response, the use of an anti TNFα over an anti-IL-17 or an anti-IL-12-23 is recom mended as a second line of treatment. In patients with psoriatic arthritis, the combined use of methotrexate with a bDMARD is conditionally recommended for optimization of dosing. To assess disease activity in Psoriatic Arthritis, the use of DAPSA or MDA is suggested for patient monitoring. Conclusions: This set of recommendations provides an updated guideline on the diagnosis and treatment of peripheral spondyloarthritis.

RESUMEN Antecedentes: La espondiloartritis periférica es una patología Inflamatoria crónica cuya presentación clínica está determinada por la presencia de artritis, entesitis y/o dactilitis. Este término se utiliza indistintamente con algunos de sus subtipos como artritis psoriásica, artritis reactiva y espondiloartritis indiferenciada. Objetivo: Desarrollar y formular un conjunto de recomendaciones específicas basadas en la mejor evidencia disponible para el diagnóstico, el tratamiento y el seguimiento de pacientes adultos con espondiloartritis periférica. Métodos: Se constituyó un grupo desarrollador, se formularon preguntas clínicas, se graduaron los desenlaces y se realizó la búsqueda sistemática de la evidencia. El panel de la guía fue multidisciplinario (incluyendo representantes de los pacientes) y balanceado. Siguiendo el método de consenso formal de expertos, se utilizó la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) para para evaluar la calidad de la evidencia y generar las recomendaciones. La guía de práctica clínica incluye 10 recomendaciones: una sobre seguimiento de la actividad de la enfermedad y nueve sobre tratamiento. Resultados: En pacientes con espondiloartritis periférica se sugiere usar metotrexato o sulfasalazina como primera línea de tratamiento y se recomienda en forma condicional la inyección local de glucocorticoides. En los pacientes que fallan a cDMARDs, se recomienda iniciar un anti TNFα o un anti IL17A. Ante falla terapéutica a la primera línea con bDMARDs, se sugiere usar otro bDMARD o un inhibidor JAK. En pacientes con espondiloartritis periférica y enfermedad inflamatoria intestinal asociada, se recomienda iniciar tratamiento con cDMARDs; en ausencia de respuesta, se recomienda el uso de un anti TNFα sobre un anti IL-17 o un anti IL-12-23 como segunda línea de tratamiento. En pacientes con artritis psoriásica se recomienda, de forma condicional, el uso combinado de metotrexato con bDMARD para favorecer la optimización de la dosis de estos. Para evaluar la actividad de la enfermedad en artritis psoriásica, se sugiere el uso del DAPSA o MDA para el seguimiento de los pacientes. Conclusiones: Este conjunto de recomendaciones proporcionan una guía actualizada sobre el diagnóstico y el tratamiento de la espondiloartritis periférica.

Persistent Idiopathic Dentoalveolar pain. Literature review and clinical case treated with intraoral application of Botulinum toxin / Dolor Idiopático Dentoalveolar Persistente (DIDAP). Revisión de literatura y caso clínico tratado con aplicación intraoral de toxina Botulínica

ABSTRACT: Persistent Idiopathic Dentoalveolar Pain (PIDAP) is an orofacial neuropathic pain, which can be difficult to diagnose and is usually accompanied by increasing anxiety from both the patient and the treating dentist. A case of a 38-year-old female patient is presented, and it is shown the diagnostic process and therapeutic approach. The interdisciplinary management accompanied by several pharmacological lines is highlighted: Botulinum toxin was used as an adjunctive treatment allowing it to decrease systemically administered medications dosing and therefore its possible side effects. This condition usually affects psychosocial aspects of the patient and has a major impact on his quality of life. It is very important before initiating an invasive clinical treatment, obtaining a clear differential diagnosis and assessing in some cases the presence of non-odontogenic pain, such as PIDAP.

RESUMEN: El Dolor Idiopático Dentoalveolar Persistente (DIDAP), es un dolor neuropático orofacial, que puede resultar difícil de diagnosticar y generalmente se acompaña de creciente angustia tanto de parte del paciente como también del odontólogo tratante. Se presenta un caso de una paciente femenina de 38 años en donde se demuestra el proceso diagnóstico y abordaje terapéutico. Se resalta el manejo interdisciplinario acompañado de varias lineas farmacológica: la toxina Botulínica se utilizó como tratamiento coadyuvante para disminuir la dosis de medicamentos administrados por vía sistémica y por ende sus posibles efectos secundarios. Esta condición habitualmente abarca aspectos psicosociales del paciente y tiende a verse sumamente afectada su calidad de vida. Es de suma relevancia antes de iniciar un tratamiento clínico invasivo, obtener un diagnóstico diferencial claro y valorar en algunos casos la presencia de dolor no ontogénico, como el DIDAP.

Applicability of B-mode ultrasonography, ARFI elastography and contrast-enhanced ultrasound in the evaluation of chronic kidney disease in dogs / Aplicabilidade da ultrassonografia modo-B, elastografia ARFI e ultrassonografia contrastada na avaliação da doença renal crônica em cães

The objective of this study was to verify the applicability of B-mode ultrasonography, ARFI elastography and CEUS in the diagnosis of chronic kidney disease and its Stages in dogs. 24 healthy dogs and 28 with CKD were included. In B-mode, the echogenicity, echotexture and cortico-medullary ratio of the kidneys were verified. By elastography, the shear-wave velocity of the cortical (SWVcort) and medullary (SWVmed) regions were determined and tissue deformity was evaluated. Wash-in, wash-out and peak enhancement (TPic) of the contrast in the renal parenchyma were calculated and homogeneity, presence of filling gaps and distinction of filling phases were evaluated by CEUS. Changes in echogenicity, echotexture and cortico-medullary ratio were observed only in sick patients. There was an increase in SWVcort in CKD, with a cutoff point >2.91m/s. Healthy kidneys were non-deformable and 25% had changes in gray scales. There was an increase in wash-in and TPic, changes in filling characteristics, filling failures and difficulty in distinguishing between the Stages in CEUS in CKD. It was found that dogs with CKD 2, 3 and 4 had greater SWVcort and wash-in values than CKD 1. Elastographic and CEUS changes were observed in dogs with CKD, demonstrating the applicability of ultrasonographic techniques in their diagnosis.(AU)

O objetivo deste estudo foi verificar a aplicabilidade da ultrassonografia modo-B, elastografia ARFI e CEUS no diagnóstico da doença renal crônica e seus estágios em cães. Foram incluídos 24 cães saudáveis e 28 com DRC. Pelo modo-B, verificou-se ecogenicidade, ecotextura e relação córtico-medular dos rins. Pela elastografia, foram determinadas as velocidades de cisalhamento das regiões cortical (SWVcort) e medular (SWVmed) e foi avaliada a deformidade tecidual. Calculou-se os temos de wash-in, wash-out e pico de intensidade (TPic) do parênquima renal e avaliou-se homogeneidade, presença de falhas e distinção das fases de preenchimento por contraste por meio de CEUS. Alterações em ecogenicidade, ecotextura e relação córtico-medular foram observadas somente em pacientes doentes. Houve aumento da SWVcort na DRC, com ponto de corte >2.91m/s. Rins saudáveis foram não-deformáveis e 25% apresentou alterações nas escalas de cinza. Houve aumento do wash-in e TPic, alterações nas características de preenchimento, falhas e dificuldade para distinguir as fases de preenchimento do contraste nos rins com DRC. Verificou-se que cães com DRC graus 2, 3 e 4 tiveram valores de SWVcort e wash-in maiores que cães com DRC grau 1. Foram obsrervadas alterações elastográfica e de CEUS em cães com DRC, demonstrando a aplicabilidade destas técnicas ultrassonográficas no seu diagnóstico.(AU)

Applicability of B-mode ultrasonography, ARFI elastography and contrast-enhanced ultrasound in the evaluation of chronic kidney disease in dogs

ABSTRACT: The objective of this study was to verify the applicability of B-mode ultrasonography, ARFI elastography and CEUS in the diagnosis of chronic kidney disease and its Stages in dogs. 24 healthy dogs and 28 with CKD were included. In B-mode, the echogenicity, echotexture and cortico-medullary ratio of the kidneys were verified. By elastography, the shear-wave velocity of the cortical (SWVcort) and medullary (SWVmed) regions were determined and tissue deformity was evaluated. Wash-in, wash-out and peak enhancement (TPic) of the contrast in the renal parenchyma were calculated and homogeneity, presence of filling gaps and distinction of filling phases were evaluated by CEUS. Changes in echogenicity, echotexture and cortico-medullary ratio were observed only in sick patients. There was an increase in SWVcort in CKD, with a cutoff point >2.91m/s. Healthy kidneys were non-deformable and 25% had changes in gray scales. There was an increase in wash-in and TPic, changes in filling characteristics, filling failures and difficulty in distinguishing between the Stages in CEUS in CKD. It was found that dogs with CKD 2, 3 and 4 had greater SWVcort and wash-in values than CKD 1. Elastographic and CEUS changes were observed in dogs with CKD, demonstrating the applicability of ultrasonographic techniques in their diagnosis.

RESUMO: O objetivo deste estudo foi verificar a aplicabilidade da ultrassonografia modo-B, elastografia ARFI e CEUS no diagnóstico da doença renal crônica e seus estágios em cães. Foram incluídos 24 cães saudáveis e 28 com DRC. Pelo modo-B, verificou-se ecogenicidade, ecotextura e relação córtico-medular dos rins. Pela elastografia, foram determinadas as velocidades de cisalhamento das regiões cortical (SWVcort) e medular (SWVmed) e foi avaliada a deformidade tecidual. Calculou-se os temos de wash-in, wash-out e pico de intensidade (TPic) do parênquima renal e avaliou-se homogeneidade, presença de falhas e distinção das fases de preenchimento por contraste por meio de CEUS. Alterações em ecogenicidade, ecotextura e relação córtico-medular foram observadas somente em pacientes doentes. Houve aumento da SWVcort na DRC, com ponto de corte >2.91m/s. Rins saudáveis foram não-deformáveis e 25% apresentou alterações nas escalas de cinza. Houve aumento do wash-in e TPic, alterações nas características de preenchimento, falhas e dificuldade para distinguir as fases de preenchimento do contraste nos rins com DRC. Verificou-se que cães com DRC graus 2, 3 e 4 tiveram valores de SWVcort e wash-in maiores que cães com DRC grau 1. Foram obsrervadas alterações elastográfica e de CEUS em cães com DRC, demonstrando a aplicabilidade destas técnicas ultrassonográficas no seu diagnóstico.

Unusual ventricular activation produced by temporary transvenous cardiac pacing: electrovectorcardiographic findings / Activación ventricular inusual producida por estimulación cardíaca transvenosa temporal: hallazgos electrovectorcardiográficos

Abstract Complete heart block (CHB) results from dysfunction of the cardiac conduction system, which results in complete electrical dissociation. The ventricular escape rhythm can have its origin anywhere from the atrioventricular node to the bundle branch-Purkinje system. CHB typically results in bradycardia, hypotension, fatigue, hemodynamic instability, syncope, or even Stokes-Adams syndrome. Escape rhythm originating above the bifurcation of the His bundle (HB) produces narrow QRSs with relatively rapid heart rate (HR) (except in cases of His system disease). We present a middle-aged man with an HR of 34 bpm, progressive fatigue, in whom a temporary pacemaker was implanted in the subtricuspid region. The post-intervention electrocardiogram had unusual features.

Resumen El bloqueo cardíaco completo (BCC) resulta de la disfunción del sistema de conducción cardíaco, lo que ocasiona una disociación eléctrica completa entre aurículas y ventrículos. El ritmo de escape resultante puede tener su origen en cualquier lugar desde el nodo auriculoventricular hasta el sistema His Purkinje. El BCC generalmente produce bradicardia, hipotensión, fatiga, inestabilidad hemodinámica, síncope o incluso el síndrome de Stokes-Adams. El ritmo de escape que se origina por encima de la bifurcación del haz de His produce intervalos QRS estrechos con frecuencia cardíaca no muy lenta (excepto en casos de enfermedad del sistema Hisiano). Presentamos a un hombre de mediana edad con una frecuencia cardíaca de 34 lpm, fatiga progresiva, en el que se implantó un marcapasos temporario en la región subtricuspídea. El electrocardiograma resultante a la intervención presentó características inusuales.

Impacto del sacrificio de la arteria radial en la perfusión de la mano / Impact of radial artery sacrifice in hand perfusion

Introducción: El ortopedista se enfrenta a situaciones donde impera el sacrificio de la arteria radial, ya sea en el uso del árbol arterial radial como donante de tejido vascularizado o en situaciones donde la arteria radial es lesionada. El objetivo de este estudio fue determinar los cambios morfológicos y funcionales en la circulación de la mano luego del sacrificio de la arteria radial. Materiales y Métodos: Se realizó un estudio de corte transversal sobre la base de una revisión de historias clínicas de 41 pacientes de ambos sexos, sometidos a cirugía de revascularización miocárdica a quienes se les resecó la arteria radial para ser utilizada como injerto. Los pacientes fueron evaluados mediante ecografía bidimensional y Doppler comparativa de ambos antebrazos, oximetría de pulso del dedo índice de ambas manos en reposo y estrés por ejercicio, y centellografía de ambos miembros superiores en reposo y estrés. Se constataron los síntomas y signos subjetivos de intolerancia al frío y en situación de estrés luego del ejercicio. Los resultados fueron valorados estadísticamente. Resultados: Solo dos pacientes (4,8%) tuvieron síntomas de claudicación de la mano operada durante actividades intensas. La valoración comparativa de ambas manos por oximetría de pulso y de perfusión por centellografía no arrojó diferencias estadísticamente significativas. La diferencia fue estadísticamente significativa en la medición ecográfica del diámetro de ambas arterias cubitales. Conclusión: La perfusión de la mano luego del sacrificio de la arteria radial no se ve comprometida. Nivel de Evidencia: IV

Introduction: Orthopedists face situations in which the radial artery is sacrificed, either for its use as donor of vascularized tissue for coverage of soft tissue defects or in situations where the radial artery is injured. The aim of this study was to determine the morphological and/or functional changes in hand circulation after the radial artery is sacrificed. Methods: A cross-sectional study was conducted based on the review of medical records of 41 patients of both sexes who underwent cardiac revascularization surgery in which a radial artery graft was used. Patients were evaluated using twodimensional and Doppler ultrasound comparing both forearms, index finger pulse oximetry of both hands at rest and after stress, and scintigraphy of both upper limbs at rest and after stress. Statistical evaluation was performed. Results: Only two patients (4.8%) had symptoms of hand claudication during intense activities. Comparative assessment of both hands by pulse oximetry and perfusion scintigraphy yielded no statistically significant difference. There was a statistically significant difference in ultrasound measurement of the diameter of both ulnar arteries. Conclusion: Perfusion of the hand after the sacrifice of the radial artery is not compromised. Level of Evidence: IV

Miocardiopatía por estrés: serie de casos / Stress cardiomyopathy: case series

La miocardiopatía por estrés, o takotsubo, se da en respuesta a un evento estresante que causa dilatación aguda del ventrículo izquierdo, disfunción ventricular, elevación de biomarcadores de daño miocárdico y cambios electrocardiográficos sin evidencia de lesiones coronarias significativas. Típicamente se presenta en mujeres posmenopáusicas y es de carácter reversible en la mayoría de los casos. Se reporta una serie de doce pacientes de sexo femenino, en la séptima década de la vida, con miocardiopatía por estrés, que se presentaron en un periodo de nueve años. La principal causa de consulta fue dolor torácico y el desencadenante más común fue de tipo emocional. De estas, el 25% tenía antecedentes médicos cardiológicos y los medicamentos más usados antes del evento fueron el ácido acetilsalicílico, los betabloqueadores y los inhibidores de la enzima convertidora de angiotensina. En todos los casos se documentó deterioro inicial de la función ventricular, que se recuperó en un periodo variable.

Takotsubo stress cardiomyopathy is the result of a stressing event which causes acute ventricular dilation and dysfunction, a rise in myocardial injury biomarkers, electrocardiographic alterations and no significant coronary artery lesions. Typically it presents in postmenopausical women and is usually reversible. We report a case series of twelve patients with stress cardiomyophaty evaluated over a period of nine years. All patients were female around the seventh decade of life. The most common presenting symptom was thoracic pain which presented in all patients, and the main trigger was emotional stress. Approximately 25% of patients had history of cardiovascular disease and the most common medications used previously to de event were acetyl-salicylic acid, betablockers and angiotensin converting enzyme inhibitors (ACE inhibitors). All cases documented impaired ventricular function, which recovered in variable time.

Volumetric properties of (PEG 400 + water) and (PEG 400 + ethanol) mixtures at several temperatures and correlation with the Jouyban-Acree model / Propiedades volumétricas de mezclas binarias (PEG 400 + agua) y (PEG 400 + etanol) a diferentes temperaturas y correlación con el modelo Jouyban-Acree

Molar volumes and excess molar volumes were investigated from density values for (PEG 400 + water) and (PEG 400 + ethanol) binary mixtures at temperatures from 283.15 K to 313.15 K. Both systems exhibit negative excess volumes probably due to increased interactions like hydrogen bonding and/or large differences in molar volumes of components. Volume thermal expansion coefficients were also calculated for binary mixtures and pure solvents. The Jouyban-Acree model was used for density and molar volume correlations of the studied mixtures at different temperatures. The mean relative deviations between experimental and calculated density data were 0.1 and 0.5 %, for aqueous and ethanolic mixtures, respectively; whereas, in molar volume data the values were 18.0 and 6.9 %, for aqueous and ethanolic mixtures, respectively. The trained versions of the model for PEG 400 binary solvents could be used to predict the density values of other PEGs with reasonable prediction error employing the density of mono-solvents.

En este artículo se calcularon los volúmenes molares y molares de exceso a partir de valores de densidad para los sistemas PEG 400 + agua y PEG 400 + etanol, en todo el intervalo de composición, a temperaturas entre 283,15 y 313,15 K. Los sistemas estudiados presentan volúmenes de exceso negativos probablemente debido a las fuertes interacciones por unión de hidrógeno entre las moléculas de los dos compuestos y a la gran diferencia en los volúmenes molares de los dos componentes puros. También se calcularon los coeficientes de expansión térmica-volumétrica en los solventes puros y las respectivas mezclas. Asimismo, se usó el modelo Jouyban- Acree para correlacionar la densidad y el volumen molar de las mezclas a las distintas temperaturas. Las desviaciones medias relativas en densidad fueron 0,1% y 0,5% para las mezclas acuosas y etanólicas, respectivamente, mientras que las desviaciones obtenidas para volumen molar fueron 18% y 6,9% para las mezclas acuosas y etanólicas, respectivamente. Los modelos obtenidos para las mezclas binarias con PEG 400 pueden usarse para predecir los valores con otros PEG, con un adecuado margen de error, utilizando las densidades de los solventes puros.

Termodinámica de disolución de triclosán y triclocarbán en algunos solventes orgánicos volátiles / Solution thermodynamics of triclosan and triclocarban in some volatile organic solvents

Thermodynamic functions of Gibbs energy, enthalpy, and entropy for the solution processes of the antimicrobial drugs Triclosan (TS) and Triclocarban (TCC) in five volatile organic solvents were calculated from solubility values at temperatures from 293.15 to 313.15 K. TS and Triclocarban solubility was determined in acetone, acetonitrile (AcCN), ethyl acetate (AcOEt), methanol (MetOH), and cyclohexane (CH). The excess of Gibbs energy and the activity coefficients of the solutes were also calculated. The TS solubilities were greater than those of TCC in all the solvents studied. At 298.15 K the solubility diminished for TS in the order, acetone > AcOEt > AcCN > MetOH > CH, while it diminished for TCC in the order, acetone > AcOEt > MetOH > AcCN > CH. On the other hand, thermodynamic quantities relative to the transfer process of these drugs from CH to all other organic solvents, as well as from water to organic solvents for TS were also calculated in order to estimate the hydrogen-bonding contributions.

Sensibilidade do eletrocardiograma na hipertrofia ventricular de acordo com gênero e massa cardíaca / Electrocardiogram sensitivity in left ventricular hypertrophy according to gender and cardiac mass

FUNDAMENTO: Sabe-se que vários fatores interferem na sensibilidade do Eletrocardiograma (ECG) no diagnóstico da Hipertrofia Ventricular Esquerda (HVE), sendo o gênero e a massa cardíaca alguns dos principais. OBJETIVO: Avaliar a influência do sexo na sensibilidade de alguns dos critérios utilizados para a detecção de HVE, de acordo com a progressão do grau de hipertrofia ventricular. MÉTODOS: De acordo com o gênero e com o grau de HVE ao ecocardiograma, os pacientes foram divididos em três grupos: HVE leve, moderada e severa. Avaliou-se a sensibilidade do ECG para detectar HVE entre homens e mulheres, conforme o grau de HVE. RESULTADOS: Dos 874 pacientes, 265 eram homens (30,3 por cento) e 609, mulheres (69,7 por cento). Os critérios [(S + R) X QRS], Sokolow-Lyon, Romhilt-Estes, Perúgia e padrão strain mostraram alto poder discriminatório no diagnóstico de HVE entre homens e mulheres nos três grupos de HVE, com desempenho superior na população masculina e destaque para os escores [(S + R) X QRS] e Perúgia. CONCLUSÃO: A sensibilidade diagnóstica do ECG é maior com o aumento da massa cardíaca. O exame é mais sensível entre homens, destacando-se os escores [(S + R) X QRS] e Perúgia.

BACKGROUND: Several factors are known to interfere with electrocardiogram (ECG) sensitivity when diagnosing Left Ventricular Hypertrophy (LVH), with gender and cardiac mass being two of the most important ones OBJECTIVE: To evaluate the influence of gender on the sensitivity of some of the criteria used to detect LVH, according to the progression of ventricular hypertrophy degree. METHODS: According to gender and the degree of LVH at the echocardiogram, the patients were divided in three groups: mild, moderate and severe LVH. ECG sensitivity to detect LVH was assessed between men and women, according to the LVH degree. RESULTS: Of the 874 patients, 265 were males (30.3 percent) and 609, females (69.7 percent). The [(S + R) X QRS], Sokolow-Lyon, Romhilt-Estes, Perugia and strain criteria showed high discriminatory power in the diagnosis of LVH between men and women in the three groups with LVH, with a superior performance in the male population and highlighting the importance of the [(S + R) X QRS] and Perugia scores. Conclusion: The diagnostic sensitivity of the ECG increases with the cardiac mass. The examination is more sensitive in men, highlighting the importance of the [(S + R) X QRS] and Perugia scores. CONCLUSION: The diagnostic sensitivity of the ECG increases with the cardiac mass. The examination is more sensitive in men, highlighting the importance of the [(S + R) X QRS] and Perugia scores.

Alterações eletrocardiográficas na intoxicação aguda por antidepressivotricíclico e suas implicações clínicas: [revisão] / Electrocardiographic alterations in acute tricyclic antidepressant intoxication and its clinical implications: [review]

Introdução: A intoxicação aguda por antidepressivos tricíclicos é comum nas salas de emergência. Anormalidades no eletrocardiograma de 12 derivações (ECG) são associadas a este tipo de intoxicação, com implicações diagnósticas e prognósticas. O ECG pode ter valor incremental principalmente em situações de alteração de consciência, convulsões ou distúrbios do ritmo cardíaco associado. Objetivo: Revisar as principais alterações eletrocardiográficas descritas na intoxicação por antidepressivos tricíclicos e estabelecer suas implicações prognósticas no manejo desta condição clínica. Metodologia: Pesquisa bibliográfica no MEDLINE (PubMEd) limitada aos artigos publicados entre 1980 e 2010 em língua inglesa, utilizando-se unitermos (tricyclic antidepressant overdose OR tricyclic antidepressant intoxication OR tricyclic antidepressant poisoning OR tricyclic antidepressant ingestionAND electrocardiography). Dos 133 artigos identificados, foram selecionados 44 para a revisão...

Introduction: The acute poisoning by tricyclic antidepressants is common in emergency rooms. Abnormalities in 12-lead electrocardiogram (ECG) are associated with this type of poisoning, with diagnostic and prognostic implications. The ECG may have incremental value especially in situations of altered consciousness, seizures or heart rhythm disturbances associated. Objective: To review the electrocardiographic changes described in tricyclic antidepressant poisoning and to establish their prognostic implications in the management of this condition. Methods: Bibliographic search in MEDLINE (PubMed) limited to articles published between 1980 and 2010 in English, using key words (tricyclic antidepressant overdose OR tricyclic antidepressant intoxicationOR tricyclic antidepressant poisoning OR tricyclic antidepressant ingestion AND electrocardiography). Of the 133 articles identified, 44 were selected for review...

Asociación de lupus eritematoso sistémico y esclerosis múltiple: esclerosis lupoide. Descripción de cuatro casos / Asociation between systemic lupus erythematosus and multiple sclerosis: lupoid sclerosis

La esclerosis múltiple (EM) y el lupus eritematoso sistémico (LES) con o sin síndrome antifosfolípido son enfermedades autoinmunes. Se ha descrito en varias ocasiones la asociación de estas enfermedades o se ha descrito el cuadro clínico de la EM con características de laboratorio de LES. Cuando afectan al sistema nervioso central pueden hacerlo en forma definida para cada enfermedad pero también pueden hacerlo en forma interpuesta o combinada de las dos enfermedades, a lo que se le ha llamado esclerosis lupoide, haciendo que en algunos casos sea difícil la diferenciación de las dos enfermedades y por lo tanto direccionar el tratamiento. Presentamos cuatro casos de esclerosis lupoide, discutimos acerca de las características clínicas y de laboratorio de esta entidad y hacemos una diferenciación de la esclerosis múltiple y de la afectación neurológica del LES, especialmente por imágenes y resultados de laboratorio.

Multiple sclerosis (MS) and Systemic Lupus Erythematosus (SLE) with/without antiphospholipid syndrome are autoinmune illnesses. It has been described in many occasions the association of these two illnesses and the clinical picture of MS with characteristics of laboratory of SLE. When they affect to the central nervous system they can make it in a defined form for each illness or they can also make it in interposed or combined form of the two illnesses what has been called lupoid sclerosis; making that in some cases difficult the differentiation of the two illnesses and therefore to address the treatment. We present four cases of lupoid sclerosis, discuss the clinical and laboratory characteristics of this entity and we make a differentiation of the multiple sclerosis with the neurological affectation of SLE especially for images and laboratory results.

Anti-hypertensive drugs have different effects on ventricular hypertrophy regression: [review]

OBJECTIVES: There is a direct relationship between the regression of left ventricular hypertrophy (LVH) and a decreased risk of mortality. This investigation aimed to describe the effects of anti-hypertensive drugs on cardiac hypertrophy through a meta-analysis of the literature. METHODS: The Medline (via PubMed), Lilacs and Scielo databases were searched using the subject keywords cardiac hypertrophy, antihypertensive and mortality. We aimed to analyze the effect of anti-hypertensive drugs on ventricle hypertrophy. RESULTS: The main drugs we described were enalapril, verapamil, nifedipine, indapamina, losartan, angiotensin-converting enzyme inhibitors and atenolol. These drugs are usually used in follow up programs, however, the studies we investigated used different protocols. Enalapril (angiotensin-converting enzyme inhibitor) and verapamil (Ca++ channel blocker) caused hypertrophy to regress in LVH rats. The effects of enalapril and nifedipine (Ca++ channel blocker) were similar. Indapamina (diuretic) had a stronger effect than enalapril, and losartan (angiotensin II receptor type 1 (AT1) receptor antagonist) produced better results than atenolol (selective â1 receptor antagonist) with respect to LVH regression. CONCLUSION: The anti-hypertensive drugs induced various degrees of hypertrophic regression.