Utilidad de la secuencia de susceptibilidad como predictor de penumbra en la isquemia cerebral aguda / Utility of susceptibility sequence as a predictor of penumbra in acute cerebral ischemia

Resumen Objetivo: El objetivo del tratamiento en accidente cerebrovascular (ACV) isquémico agudo es restablecer la circulación en el área de la penumbra isquémica. La secuencia de susceptibilidad (SWI) puede detectar cambios en el calibre de las venas intracraneanas cuando se altera la relación desoxiHb/oxiHb en áreas hipoperfundidas, lo que permitiría una detección temprana de penumbra isquémica. Material y métodos: Estudio de cohorte retrospectivo. Se incluyeron pacientes con infartos agudos en territorio de la arteria cerebral media. Se evaluaron las secuencias difusión y SWI iniciales y un estudio de control a los siete días. La extensión del ACV se midió con la escala ASPECT en difusión y SWI del ingreso, y en el estudio de control. Se estableció una discordancia SWI/difusión > 2 puntos como variable predictora y la extensión final del infarto como variable de resultado. Resultados: Se incluyeron 31 pacientes, mediana de edad de 72 años (RIC: 61-81). En 13 pacientes se detectó una oclusión vascular proximal, ocho de los cuales tenían discordancia SWI/difusión > 2 puntos (p < 0,0001). En cinco pacientes encontramos incremento del infarto, cuatro con discordancia SWI/difusión (p = 0,01). Conclusión: La presencia de discordancia SWI/difusión puede ser un biomarcador de penumbra isquémica en pacientes con oclusión vascular proximal.

Abstract Objective: The goal of treatment in acute ischemic stroke is to restore circulation in the area of the ischemic penumbra. Susceptibility weighted imaging (SWI) can detect changes in the caliber of intracranial veins when the deoxyHb/oxyHb ratio is altered in hypoperfused areas, which would allow early detection of ischemic penumbra. Material and methods: Retrospective cohort study. Patients with acute infarcts in the territory of the middle cerebral artery were included. Initial diffusion and SWI sequences and a control study at seven days were evaluated. Stroke extension was measured with the ASPECT scale in diffusion and SWI on admission, and in the control study. An SWI/diffusion discrepancy > 2 points was established as a predictor variable and the final extension of the infarct as a result variable. Results: Thirty-one patients were included, median age 72 years (IQR: 61-81). Proximal vascular occlusion was detected in 13 patients, 8 of whom had SWI/diffusion discordance > 2 points (p < 0.0001). In 5 patients we found increased infarction, 4 with SWI/diffusion mismatch (p = 0.01). Conclusion: The presence of SWI/diffusion mismatch may be a biomarker of ischemic penumbra in patients with proximal vascular occlusion.

Perception of malocclusion and school performance in adolescents: a systematic review

Abstract This study aimed to assess the potential association between perception malocclusion and school performance in children and adolescents. An electronic search was performed in ten databases. Based on the PECO acronym (Population, Exposition, Comparator, and Outcome), the eligibility criteria included observational studies that compared the school performance of children and adolescents with and without the perception of malocclusion. There were no restrictions on the language or year of publication. Two reviewers selected the studies, extracted the data, and assessed the risk of bias by using the Joanna Briggs Institute tool for cross-sectional studies. School performance was measured by analyzing student grades; levels of absenteeism; and child or adolescent self-perception and/or the perception of parents, guardians, close friends, and teachers regarding the impact of malocclusion on school performance. The data were described narratively/descriptively. The search resulted in 3,581 registers, of which eight were included in the qualitative synthesis. These studies were published between 2007 and 2021. Two studies concluded that there was no significant association between school performance and perception of malocclusion, five studies found that only some of the children with malocclusion had their school performance affected, and one study concluded that there was a significant association between perception of malocclusion and low school performance. Considering all variables and the very low certainty of evidence, the perception of malocclusion seems to negatively impact school performance when associated with external and subjective factors. Further studies using additional measurement standards are required.

Asociación entre el tiempo de inicio de la ventilación no invasiva y la mortalidad en el edema pulmonar cardiogénico / Relationship between timing of initiation of non-invasive ventilation and mortality in cardiogenic pulmonary edema

Resumen Introducción: La ventilación no invasiva reduce la necesidad de intubación y la estancia en la unidad de cuidados intensivos en los pacientes con edema pulmonar cardiogénico. Objetivo: Evaluar la posible asociación entre el inicio de la ventilación no invasiva desde el ingreso a urgencias con la mortalidad y el requerimiento de intubación en pacientes con edema pulmonar cardiogénico. Método: Estudio analítico de cohorte retrospectiva, en el que se revisaron las historias clínicas de pacientes mayores de 18 años hospitalizados en una institución de Medellín, Colombia. Resultados: 70 pacientes cumplieron los criterios de inclusión y se compararon según el estado vital al alta. Sobrevivientes (49): la edad promedio fue de 63 años, el 34.7% fueron mujeres, el 57.1% tuvieron historia de neumopatía crónica y el 89% eran hipertensos; el promedio para recibir la intervención fue de 10 horas y el 20% requirieron intubación orotraqueal. No sobrevivientes (21): la edad promedio fue de 74 años, el 57.1% fueron mujeres, el 57.1% tuvieron historia de neumopatía crónica y el 90% eran hipertensos; el promedio para recibir la intervención fue de 7 horas y el 62% requirieron intubación. Tiempo de inicio en relación con la mortalidad en el análisis multivariado: odds ratio (OR) 1,05, intervalo de confianza del 95% (IC95%) 0.89-1.24, p = 0.499; y por variable instrumental: 7% de diferencia de medias. En cuanto al tiempo de inicio y su asociación con la necesidad de intubación: OR 0.93, IC95% 0,86-1,01. Conclusiones: Este estudio sugiere que el inicio tardío de la ventilación no invasiva es un factor de riesgo; sin embargo, no se halló asociación estadísticamente significativa, por lo que se requieren estudios adicionales para confirmar este hallazgo.

Abstract Introduction: Non-invasive ventilation reduces the need for intubation and intensive care stay in cardiogenic pulmonary edema. Objective: To evaluate the possible relationship between the initiation of non-invasive ventilation on admission to the emergency room and mortality and the need for intubation in patients with cardiogenic pulmonary edema. Method: A retrospective analytical cohort study. A chart review of patients over the age of 18 hospitalized at an institution in Medellín, Colombia. Results: 70 patients met the inclusion criteria and were compared by vital status at discharge. Survivors (49): the average age was 63 years, 34.7% were women, 57.1% had a history of chronic pulmonary disease, 89% had hypertension, 10 hours was the average for receiving the intervention, and 20% required orotracheal intubation. Non-survivors (21): the average age was 74 years, 57.1% were women, 57.1% had a history of chronic pulmonary disease, 90% had hypertension; 7 hours was the average for receiving the intervention, and 62% required intubation. Timing of initiation related to mortality on the multivariate analysis: odds ratio (OR) 1.05, 95% confidence interval (95%CI) 0.89-1.24, p = 0.499; and by instrumental variable: 7% difference in means. With regard to timing of initiation and its association with the need for intubation: OR 0.93, 95%CI 0.86-1.01. Conclusions: This study suggests that late initiation of non-invasive ventilation is a risk factor; however, no statistically significant association was found. Therefore, further studies are needed to confirm this finding.

Collagen cross-linking agents + dimethyl sulfoxide improving the adhesive properties of erosive lesion dentin

Abstract To investigate the effect of the dimethyl sulfoxide combined with cross-linking agents on microtensile bond strength, silver nitrate penetration and in situ degree of conversion analysis of adhesives to the erosive dentin treatment with Cola-based soft drink. One hundred and sixty-six molars were assigned to 20 groups: (1) Treatment: Sound dentin; Erosive dentin; Erosive dentin treated with primer of dimethyl sulfoxide; Erosive dentin treated with DMSO primer containing proanthocyanidin and rivoflavin; (2) Adhesive systems: iBond Universal and Scotchbond Universal; and (3) adhesive strategy: etch-and-rinse or self-etch strategy. After restoration, specimens were sectioned into sticks to be tested. The data from microtensile bond strength (MPa), silver nitrate penetration (%) and in situ degree of conversion (%) were analyzed by (three- and two-factor ANOVA; Tukey's test α=5%). The application of dimethyl sulfoxide combined of not with cross-linkers improved all properties evaluated when compared to only erosive dentin treatment with Cola-based soft drink. However, only when dimethyl sulfoxide was combined to cross-linkers, the values of the microtensile bond strength, silver nitrate penetration and in situ degree of conversion in erosive dentin treatment with Cola-based soft drink was similar to sound dentin, for both adhesives and adhesive strategies. The application of dimethyl sulfoxide combined with the collagen cross-linking agent contributed to increasing the bond strength and degree of conversion in erosive lesion dentin, at the same time that significantly reduction of nanoleakage in this substrate.

Resumo Este estudo investigou o efeito do dimetil sulfóxido combinado a agentes de reticulação de colágeno na resistência de união à microtração, infiltração de nitrato de prata e análise do grau de conversão por Micro-Raman de sistemas adesivos universais para a dentina erosionada por refrigerante a base de Cola. Cento e sessenta molares foram divididos em 20 grupos: (1) Tratamento: Dentina sadia; Dentina erosionada; Dentina erosionada tratada com primer de dimetil sulfóxido; Dentina erosionada tratada com primer contendo 6,5% de proantocianidina e; Dentina erosionada tratada com primer contendo 0,1% de rivoflavina; (2) Sistemas adesivos: iBond Universal e Scotchbond Universal; e (3) estratégia adesiva: estratégia condicionamento e lavagem ou autocondicionate. Após a restauração, os espécimes foram seccionados em palitos e testados. Os dados dos três testes foram analisados estatisticamente (ANOVA de 2 e 3 fatores e teste de Tukey; α = 5%). A aplicação de dimetil sulfóxido combinado ou não agentes de reticulação de colágeno melhorou todas as propriedades avaliadas quando comparado a dentina erosionada. Entretanto, apenas quando o dimetil sulfóxido foi combinado com agentes de reticulação de colágeno, os valores de adesão a dentina, infiltração de nitrato de prata e grau de conversão em dentina erosionada foi semelhante a dentina sadia, para os dois adesivos e estratégias adesivas. A aplicação de dimetil sulfóxido combinado com agentes de reticulação de colágeno contribuiu para aumentar a resistência de união e o grau de conversão dentro da camada híbrida na dentina erodida, ao mesmo tempo que reduziu significativamente a nanoinfiltração neste substrato.

Estudio observacional prospectivo que evalúa la carga de enfermedad del HZ en Colombia / Prospective observational study evaluating the disease burden of HZ in Colombia

Resumen Introducción: el herpes zóster (HZ) es una enfermedad debilitante que afecta negativamente la calidad de vida (CV). Este estudio buscó describir la carga de la enfermedad por el HZ en Colombia. Métodos: estudio prospectivo, observacional, de cohorte única realizado en 10 centros clínicos colombianos. Para ser elegibles, los pacientes tenían que ser inmunocompetentes, ≥50 años de edad, y tener un diagnóstico confirmado de HZ en fase aguda o dolor posherpético. Los resultados del estudio incluyeron el inventario breve del dolor por zóster (ZBPI), la CV evaluada con el cuestionario EQ-5D y la utilización de recursos de atención médica (URAM) debido a HZ. El seguimiento fue de 180 días. Resultados: se incluyeron 154 pacientes con una media (DE) de la edad de 64.6 (9.6) años. La media (DE) del peor dolor agudo fue 8.2 (2.1), mientras la neuralgia posherpética (dolor por HZ ≥3 que persistió ≥90 días) fue reportado por 36.5% de los pacientes. Los predictores significativos del aumento de la carga de dolor fueron la edad avanzada y puntuaciones de peor dolor más altas desde el inicio de la erupción. El aumento en el dolor asociado a HZ estuvo acompañado con reducción significativa en CV, la cual duró aproximadamente 60 días. En términos de la URAM, medicamentos para el HZ y que fueron recetados a 98.7% de los pacientes, incluyendo aciclovir en 85.1% de los pacientes, 79.2% tuvieron un seguimiento por un médico general, 38.2% visitó una sala de emergencia y 29.2% visitó un especialista Conclusión: HZ está asociado a carga de enfermedad significativa en Colombia, incluyendo dolor, impacto en la CV y URAM. A medida que la población colombiana envejece, se deben implementar estrategias para manejar y/o prevenir de manera más efectiva la carga asociada al HZ. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1636).

Abstract Introduction: herpes zoster (HZ) is a debilitating disease with a negative effect on quality of life (QL). This study sought to describe the burden of disease of HZ in Colombia. Methods: this was a prospective, observational single-cohort study in 10 Colombian clinical centers. To be eligible, patients had to be immunocompetent, ≥50 years old, and have a confirmed diagnosis of acute phase HZ or postherpetic pain. The study outcomes included the Zoster Brief Pain Inventory (ZBPI), QL assessed through the EQ-5D questionnaire, and healthcare resource utilization (HCRU) due to HZ. Patients were followed for 180 days. Results: 154 patients were included with a mean (SD) age of 64.6 (9.6) years. The mean (SD) worst acute pain was 8.2 (2.1), while postherpetic neuralgia (HZ pain ≥3 which lasted for ≥90 days) was reported by 36.5% of the patients. The significant predictors of increased pain burden were advanced age and higher worst pain score from the onset of the rash. Increased HZ-related pain was associated with a significant reduction in QL, which lasted approximately 60 days. In terms of HCRU, HZ medications were prescribed for 98.7% of the patients, including acyclovir in 85.1%; 79.2% were followed by a general practitioner; 38.2% were seen in the emergency room and 29.2% consulted a specialist. Conclusion: HZ is associated with a significant burden of disease in Colombia, including pain and an impact on QL and HCRU. As the Colombian population ages, strategies should be implemented to more effectively manage and/or prevent the HZ-related burden. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1636).

Métodos diagnósticos en hipertensión portal / Diagnostic methods of portal hypertension

Resumen La hipertensión portal es un síndrome caracterizado por el incremento en el gradiente de presión portal, definido por la diferencia entre la presión de la porta y la vena cava inferior. Esta presión depende del flujo venoso y la resistencia vascular. En los pacientes cirróticos estas dos variables están alteradas de manera suprafisiológica, inicialmente por la lesión estructural dependiente de fibrosis y los nódulos de regeneración y posteriormente por cambios dinámicos vasculares que causan vasoconstricción intrahepática y vasodilatación esplácnica, lo cual explica las manifestaciones sistémicas de la cirrosis. La importancia de la hipertensión portal radica en la frecuencia y severidad de las complicaciones asociadas, especialmente la hemorragia variceal y otras como ascitis, peritonitis bacteriana espontanea, síndrome hepatorrenal y encefalopatía hepática. El objetivo de este artículo es realizar una revisión actualizada sobre el uso de las pruebas diagnósticas invasivas y no invasivas disponibles para el estudio de la hipertensión portal y su aplicación en la práctica clínica.

Abstract Portal hypertension is characterized by an increase in the portal pressure gradient, which is defined as the difference between the portal venous pressure and the pressure within the inferior vena cava. Such a pressure depends on venous flow and vascular resistance. In patients with cirrhosis, both variables are altered, initially due to fibrosis-dependent structural injury and regeneration nodules, and subsequently by vascular dynamic changes that cause intrahepatic vasoconstriction and splanchnic vasodilation, which explains the systemic manifestations of cirrhosis. The importance of portal hypertension lies in the frequency and severity of associated complications, especially variceal hemorrhage, but also ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. The objective of this article is to carry out an updated review on the use of invasive and non-invasive diagnostic tests available for the study of portal hypertension and their application in clinical practice.

Caracterización sociodemográfica, clínica y terapéutica de pacientes con falla cardiaca con fracción de eyección intermedia: cohorte MED-ICAi / Sociodemographic, clinical and therapeutic characteristics of patients with heart failure with mid-range ejection fraction: MED-ICAi cohort

Resumen Antecedentes: Clásicamente, la falla cardiaca se ha clasificado en dos grupos, según tengan fracción de eyección preservada o reducida; no obstante, en fecha reciente se ha añadido el grupo de fracción intermedia, y aún existe gran desconocimiento sobre sus características fisiopatológicas y clínicas. Objetivo: Caracterizar el grupo de pacientes con fracción intermedia en cuanto a sus variables sociodemográficas, clínicas y de tratamiento. Método: Se realizó un estudio descriptivo, retrospectivo, en el que se analizaron historias clínicas de pacientes con falla cardiaca hospitalizados por agudización en el periodo comprendido entre enero de 2015 y diciembre de 2017. Resultados: Se revisaron 1536 historias clínicas, de las cuales 864 cumplían los criterios de inclusión. El grupo con fracción intermedia correspondió a 83 (9.6%) pacientes, en quienes se encontró predominio del sexo femenino (53%) y una edad mediana de 77 años. La coronariopatía fue la etiología más frecuente (26.5%), mientras que la falta de adherencia a los medicamentos fue la causa principal de descompensación (14.5%). Los medicamentos más usados fueron los betabloqueadores y la furosemida, tanto al ingreso como al egreso. El grupo con mayor mortalidad fue el de fracción de eyección reducida (4.1%). La estancia hospitalaria, el ingreso y la estancia en la unidad de cuidados intensivos fueron similares en todos los grupos, independientemente de la fracción de eyección. Conclusiones: Los hallazgos son similares a los descritos en otras poblaciones internacionales y en algunas nacionales, y avalan la hipótesis de un fenotipo intermedio con un comportamiento etiológico semejante al de la fracción de eyección reducida.

Abstract Background: Classically, heart failure has been classified in two groups, depending on a preserved or reduced ejection fraction, but a mid-range ejection fraction group has been introduced recently, and there is still great ignorance about its physiopathological and clinical characteristics. Objective: To characterize this group of patients as for their sociodemographic, clinical and treatment variables. Method: We carried out a descriptive, retrospective study, by analyzing medical records from patients hospitalized with acute heart failure between January 2015 and December 2017. Results: We reviewed 1536 medical records of which 864 met the inclusion criteria. The mid-range ejection fraction group corresponded to 83 (9.6%) of patients, of which the majority were women (53%), with a median age of 77 years, coronary heart disease as the most frequent etiology (26.5%) and lack of adherence to medications as the main cause of decompensation (14.5%). The most frequently used drugs were betablockers and furosemide, both upon admission and discharge. Mortality was higher between patients with reduced ejection fraction (4.1%). Hospital stay, admission to and length of stay in an ICU, were similar between all groups regardless of ejection fraction. Conclusions: Our findings are similar to those described in previous international and national cohorts, and support the hypothesis of an intermediate phenotype with an etiology similar to that seen with a reduced ejection fraction.

Retention of cemented zirconia copings on TiBase abutments / Retenção de copings de zirconia cimentados sobre pilares tibase

ABSTRACT This study evaluated the influence of resin cements and glass ionomers on tensile strength and types of failure of zirconia copings cemented on titanium base abutments. Forty-two samples were prepared, which were formed by a Cone Morse implant, a titanium abutment with the fixing screw, and a zirconia structure made using a CAD/CAM system. The samples (n = 42) were randomly distributed according to the cementing agent: resin-modified glass ionomer cement (RelyX Luting 2), self-adhesive resin cement (RelyX U200), and self-curing resin cement (Multilink N). After cementation of the copings, half of the samples from each group (n = 7) were randomly selected and subjected to thermocycling (5000 cycles). A tensile load test was performed on a universal testing machine until failure occurred (1 mm). In addition, the type of failure was analyzed using the two-way analysis of variance test and Tukey's post-hoc test (α = 0.05). Lower tensile load was observed for the glass ionomer cement (p < 0.001) regardless of the evaluation period. After thermocycling, a significant reduction in tensile load values was verified for both evaluated cements (p = 0.047). For the resin cements, failures were predominantly of the screw fracture type (82.1%) already with the use of glass ionomer cement, and 28.5% of the failures were of an adhesive type between the zirconia coping and the cement. Resin cements have better stability under tensile load compared to resin glass ionomers when cementing zirconia copings on titanium base abutments.

RESUMO Este estudo avaliou influência dos cimentos resinosos e a base de ionômero de vidro na resistência à tração e os tipos de falhas de copings de zircônia cimentados sobre pilares TiBase. Foram confeccionadas 42 amostras, sendo estas formadas por implante cone morse, pilar de titânio (TiBase) com o parafuso de fixação e uma estrutura de zircônia (coping de Zr) confeccionado através do sistema CAD/CAM. As amostras (n =42) foram aleatoriamente distribuídas de acordo com o agente de cimentação: (cimento de ionômero de vidro modificado por resina [RelyXTMLuting2]; cimento resinoso autoadesivo [RelyXTM U200] e cimento resinoso autopolimerizavel (Multilink® N). Após cimentação dos copings, metade das amostras de cada grupo (n = 7) foram aleatoriamente selecionadas e submetidas a termociclagem (5000 ciclos). O Teste de resistência a tração foi realizado em uma máquina de ensaio universal, até que ocorresse a falha (1 mm/min). Adicionalmente, o tipo de falha foi analizado. Os dados foram analisados pelo teste ANOVA two-way e post teste de Tukey's (α = 0.05). Menor média de resistência a tração foi observada para o cimento de ionômero de vidro (p < 0,001) independente do período de avaliação. Após a termociclagem, foi verificada uma redução significativa nos valores de resistênca a tração, para os cimentos avaliados (p=0,047). Para os cimentos resinosos, as falhas foram predominantemente do tipo fratura do parafuso (82,1%) já com o uso do cimento de ionômero de vidro, 28,5% das falhas foram de tipo adesiva entre o coping de Zr e o cimento. Cimentos resinosos apresentam melhor estabilidade na resistência a tração em comparação a ionmeros de vidro resinosos na cimentação de copings de zircônia sobre pilares TiBase.

Effect of surface treatments on the adhesive properties of metallic brackets on fluorotic enamel

ABSTRACT Objective: To compare the effectiveness of the pretreatment with sandblasting and deproteinization with NaOCl on bond strength (SBS), in situ conversion degree (CD) of brackets in fluorotic enamel, and enamel etching pattern. Methods: A total of 90 non-carious maxillary premolars were used. The teeth were then assigned to six experimental groups according to: enamel surface (sound and fluorotic enamel); surface treatment (Regular etch with 37% phosphoric acid [RE]; 5.2% sodium hypochlorite + phosphoric acid [NaOCl + RE]; sandblasting + phosphoric acid [sandblasting + RE]). After storage in distilled water (37°C/24h), the specimens were tested at 1 mm/min until failure (SBS). Enamel-resin cement interfaces were evaluated for CD using micro-Raman spectroscopy. The enamel-etching pattern was evaluated under a scanning electron microscope. Data from SBS and in situ CD values were analyzed using ANOVA two-away and Tukey test (α=0.05). The enamel etching pattern was evaluated only qualitatively. Results: For sound enamel, RE showed the highest SBS values, when compared to NaOCl + RE and Sandblasting + RE groups (p< 0.01). Regarding CD, only NaOCl + RE significantly compromised the mean DC, in comparison with other groups (p= 0.002). For fluorotic enamel, the Sandblasting + RE group significantly increased the mean SBS values, in comparison with RE group (p= 0.01) and no significant change was observed for CD (p> 0.52). Conclusions: The application of NaOCl or sandblasting associated to phosphoric acid improved the SBS of the brackets in fluorotic enamel without compromising the CD of the resin cement, with improving of enamel interprismatic conditioning.

RESUMO Objetivo: Comparar a efetividade do pré-tratamento com jateamento e desproteinização com NaOCl na resistência de união (SBS), grau de conversão in situ (GC) dos braquetes metálicos ao esmalte fluorótico e o padrão de condicionamento do esmalte. Métodos: Foi utilizado um total de 90 pré-molares superiores livres de cárie. Os dentes foram divididos em seis grupos experimentais, de acordo com: superfície do esmalte (Esmalte Sadio e Fluorótico); tratamento de superfície (Condicionamento com ácido fosfórico a 37% [ER]; Hipoclorito de sódio a 5,2% + ácido fosfórico [NaOCl + ER]; e jateamento + ácido fosfórico [Jateamento + ER]). Após armazenamento em água destilada (37oC/24 h), os espécimes foram testados a 1 mm/min até a falha (SBS). As interfaces esmalte-cimento foram avaliadas para GC usando espectroscopia micro-Raman. O padrão do condicionamento do esmalte foi avaliado sob microscopia eletrônica de varredura. Os dados da SBS e GC foram analisados utilizando ANOVA dois fatores e teste de Tukey (α= 0,05). O padrão de condicionamento do esmalte foi avaliado apenas qualitativamente. Resultados: Para o esmalte sadio, o ER apresentou os maiores valores de SBS, quando comparado aos grupos NaOCl + ER e Jateamento + ER (p< 0,01). Em relação ao GC, apenas a média do grupo NaOCl + ER foi comprometida significativamente em comparação aos outros grupos (p= 0,002). Para o esmalte fluorótico, Jateamento + ER aumentou significativamente a média dos valores de SBS, em comparação com o grupo ER (p= 0,01) e nenhuma mudança significativa foi observada no GC (p> 0,52). Conclusões: A aplicação de NaOCl ou jateamento associado ao ácido fosfórico melhorou a SBS dos braquetes no esmalte fluorótico sem comprometer o GC do cimento resinoso, com a melhoria do condicionamento interprismático do esmalte.

Características sociodemográficas y clínicas de pacientes con diagnóstico nuevo de VIH / Sociodemographic and clinical characteristics of patients with new HIV diagnosis

Objetivo: Caracterizar de forma sociodemográfica y clínica pacientes con diagnóstico nuevo de VIH, que fueron hospitalizados en una Clínica Universitaria de alta complejidad entre el año 2010 - 2016. Materiales y métodos: Se realizó un estudio observacional, descriptico, de corte transversal por medio de revisión de historias clínicas, que incluyo pacientes ≥14 años, a quienes se les diagnosticó VIH durante la hospitalización y tuvieran al menos un conteo de linfocitos CD4. Resultados: La mediana para la edad fue 41 años (RIC 31 - 51), el 85,1% eran hombres. Los principales síntomas al ingreso fueron generales/sistémicos (70,2%). 99 pacientes (61,5%) tenían infecciones oportunistas siendo tuberculosis la más frecuente (34,3%). La mediana para el conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4<200 células/mm3 , no pertenecer al régimen contributivo, ingresar con síntomas respiratorios, tener diagnóstico de neumonía, criterios de falla multiorgánica o necesidad de UCI/UCE. Conclusión: Para nuestro caso la mayoría de pacientes con diagnóstico nuevo de VIH se encontraban en estados avanzados de inmunosupresión con alta carga de enfermedades definitorias de SIDA. Es importante fortalecer las políticas de salud pública para diagnosticar más temprano la infección por VIH.

Purposes: To characterize sociodemographic and clinical aspects in newly diagnosed HIV patients that were hospitalized at a university health center between 2010 - 2016. Methods: We made an observational descriptive cross - sectional study reviewing clinical records, including patients older than 14 years old, who were diagnosed with HIV infection during hospitalization and at least a CD4 count. Results: Median age at diagnosis was 41 years old (IQR 31 - 51), 85% were men. The main symptoms were general/systemic (70.2%). 99 patients (61.5%) had opportunist infections, being tuberculosis the most frequent (34.3%). The median CD4 were 88 cells/mm3 (IQR 27 - 327) and 77% were classified as AIDS. 29 patients died (18%), finding as a risk factor for mortality don't having a good health care insurance, low CD4 count, having respiratory symptoms, pneumonia diagnosis, multiple organic failure's criteria and ICU admission. Conclusion: In our case, the majority of patients with a new diagnosis of HIV were in advanced stages of immunosuppression with a high burden of AIDS defining diseases. It is important to strengthen public health policies to diagnose HIV infection earlier.

Effect of self-etching primer associated to hydrofluoric acid or silane on bonding to lithium disilicate

Abstract To evaluate the effect of combining 5% hydrofluoric acid (HF) and silane (SI) with the self-etching ceramic primer on the immediate and after 1-year of water storage on bonding efficacy, conditioning pattern (CP) and chemical interaction (CI) to the lithium disilicate. A total of 16 CAD/CAM blocks of lithium disilicate (LD) were cut into four square sections (n=64). For bonding efficacy evaluation, the LD specimens were divided into 4 groups (n=10): 1) HF+SI; 2) self-etching ceramic primer (MEP); 3) HF+MEP; 4) MEP+SI. After each treatment, an adhesive system was applied and Tygon matrices were filled with a dual-cured resin cement followed by light curing. Cylinder specimens (0.8 mmx0.5mm) were stored in water (37 °C for 24 h or 1-year) and submitted to the μSBS test (2-way ANOVA and Tukey's test; a=0.05). CP and CI were only evaluated qualitatively. No significant difference on the μSBS was observed between groups (p=0.73), but reduced μSBS was observed after 1-year of water storage (p>0.0001). After application of HF+SI and MEP, reduction in a number of siloxane bonds was observed, suggesting the coupling of SI on the LD surface. HF or HF+MEP produced a higher dissolution of the glassy matrix than the use of MEP alone. The MEP can be an alternative to traditional ceramic treatment once the chemical interaction and long-term bond strength were similar between both groups. The association of hydrofluoric acid or silane with a self-etching ceramic primer did not add any benefits in terms of chemical interaction and bonding stability.

Resumo Avaliar o efeito da combinação de ácido fluorídrico ou silano com o primer autocondicionante de cerâmicas sobre a eficácia da união imediata e após 1 ano de armazenamento em água, padrão de condicionamento e interação química desses tratamentos com o dissilicato de lítio. Um total de 16 blocos CAD/CAM de dissilicato de lítio (DL) foram cortados em quatro seções quadradas (n=64). Os espécimes de DL foram divididos em 4 grupos: 1) ácido fluorídrico a 5% + silano (HF + SI); 2) primer autocondicionante de cerâmica (MEP); 3) HF + MEP; 4) MPE + SI. Após cada tratamento, o sistema adesivo foi aplicado e as matrizes Tygon foram preenchidas com cimento resinoso dual (Variolink® II), seguido de fotopolimerização. Espécimes em forma de cilindro (0.8 mmÆ x 0.5 mm), foram armazenados em água (37 °C por 24h ou 1 ano) e submetidos ao teste μSBS (ANOVA dois fatores e teste de Tukey; a=0,05). Para avaliação das interações químicas por Espectroscopia Raman, os espécimes de DL foram divididos em 3 grupos (n=4): 1) sem tratamento (DL); 2) HF + SI; e 3) MEP. Para avaliação do padrão de condicionamento da superfície cerâmica após os tratamentos por MEV, os espécimes de DL foram divididos em 3 grupos (n=3): 1) DL; 2) HF; 3) MEP; e 4) HF + MEP. Ambos os métodos foram avaliados apenas qualitativamente. Não foi observada diferença significativa na μSBS imediata entre os grupos (p=0,73), mas após 1 ano de armazenamento das amostras em água, reduziu μSBS (p>0,0001). HF ou HF + MEP produziram uma maior dissolução da matriz vítrea do que o uso de MEP sozinho. Após a aplicação de SI e MEP, observou-se redução de ligações de siloxano, sugerindo o acoplamento da camada de silano na superfície do DL. O primer autocondicionante cerâmico pode ser uma alternativa ao tratamento cerâmico tradicional, uma vez que a interação química e a resistência de união a longo prazo, quando comparada ao tratamento tradicional foram estatisticamente semelhantes. A associação de ácido fluorídrico ou agente de acoplamento silano com um primer autocondicionante de cerâmicas não agregou nenhum benefício em termos de interação química e estabilidade.

Caracterización sociodemográfica y clínica de una población con falla cardíaca aguda: cohorte MED-ICA / Sociodemographic and clinical profile of a population with acute heart failure: MED-ICA cohort

Resumen Objetivo: Determinar las características epidemiológicas de adultos con insuficiencia cardiaca aguda admitidos en un hospital universitario. Métodos: Estudio de cohorte retrospectivo, descriptivo. Revisión de historias clínicas de mayores de 18 años hospitalizados entre julio y diciembre de 2015 en un hospital de Medellín, Colombia. Resultados: Se incluyeron 361 pacientes con insuficiencia cardíaca aguda. 193 (53,4%) fueron mujeres, cuya mediana de edad fue 76 años. 183 (50,6%) tenían fracción de eyección (FEVI) reducida, 19 (5,2%) FEVI intermedia y 148 (40,9%) FEVI preservada. El tratamiento farmacológico previo al ingreso incluía IECA/ARA2 en 253 (70%) pacientes, betabloqueador en 212 (58,7%) y espironolactona en 92 (25,4%). La principal causa de falla cardíaca aguda fue la presencia de taqui-bradiarritmias (17,5%), seguida de infección (17,2%) y exacerbación de neumopatía crónica (16,3%). La clasificación clínica de la descompensación fue Stevenson B en 335 (92,7%) pacientes, Stevenson C en 20 (5,5%) y Stevenson L en 6 (1,6%). La mediana de hospitalización fue 6 días (4-9 días). 30 pacientes (8,3%) fallecieron, 50% por infecciones asociadas a la descompensación cardiaca y 20% por síndrome coronario agudo. Conclusión: Se hallaron similitudes con estudios internacionales, pero mayor mortalidad vinculada principalmente a infección como factor precipitante de descompensación. Se caracterizaron factores desencadenantes y etiología, datos útiles en la práctica clínica. Hubo alta carga de comorbilidades, cuya descompensación impactó de manera significativa en la agudización de la falla cardiaca. El subgrupo con fracción de eyección intermedia presentó particularidades que ameritan mayor caracterización.

Abstract Objective: To determine the epidemiological characteristics of adults with acute heart failure admitted to a University Hospital. Method: A retrospective, descriptive cohort study conducted by reviewing the medical notes of patients over 18 years-old and admitted between July and December 2015 to a hospital in Medellin, Colombia. Results: The study included 361 patients with acute heart failure, with a mean age of 76 years, and of whom 193 (53.4%) were women. A reduced ejection fraction (LVEF) was observed in 183 (50.6%) patients, 19 (5.2%) with an intermediate LVEF, and 148 (40.9%) with normal LEVF. The pharmacological treatment prior to admission included angiotensin-converting-enzyme (ACE) inhibitors / angiotensin II receptor antagonists (ARA2) in 253 (70%) patients, a beta-blocker in 212 (58.7%), and spironolactone in 92 (25.4%). The main cause of acute heart failure was the presence of tachy-brady-arrhythmias (17.5%), followed by infection (17.2%), and exacerbation of chronic pulmonary disease (16.3%). The clinical classification of the decompensation was Stevenson B in 335 (92.7%) patients, Stevenson C in 20 (5.5%), and Stevenson L in 6 (1.6%). The mean admission time was 6 (4-9) days. There were 30 (8.3%) deaths, 50% due to infections associated with cardiac decompensation and 20% due to acute coronary syndrome. Conclusion: Similarities were found with international studies, but there was a higher mortality mainly linked to infection as a decompensation precipitating factor. The triggering factors and aetiology are presented, which are useful data in clinical practice. There was a high level of comorbidities, and their decompensation had a significant impact on the exacerbation of heart failure. The sub-group with the intermediate ejection fraction had features that require further characterisation.

Diseño de un alimento infantil listo para consumir fortificado con hierro a base de arveja (Pisum sativum) / Design of a ready-to-eat child food fortified with pea-based iron (Pisum sativum)

Resumen Introducción: La deficiencia de hierro es uno de los problemas nutricionales más prevalentes a nivel mundial y afecta principalmente a la población vulnerable como niños menores de 5 años. Los alimentos fortificados de consumo infantil hacen parte de las estrategias de intervención y se elaboran a partir de la mezcla ingredientes como cereales, frutas, leguminosas, entre otros. La arveja, es una leguminosa que puede ser empleada con el fin de aprovechar sus propiedades nutricionales. Objetivo: Diseñar un alimento infantil con arveja (Pisum sativum) listo para consumir, fortificado con hierro e higienizado por pasteurización. Materiales y métodos: Se seleccionó el porcentaje de arveja adecuado en el alimento mediante análisis sensorial. La selección de la sal de hierro se realizó mediante análisis fisicoquímico y sensorial empleando sulfato ferroso y hierro aminoquelado. Posteriormente se evaluó el crecimiento de microorganismos mesófilos con el fin de seleccionar el tratamiento térmico de pasteurización. La evaluación de vida útil se llevó a cabo a través de pruebas sensoriales. Finalmente se realizó la evaluación fisicoquímica, composicional y microbiológica del alimento higienizado. Resultados: La adición de arveja en porcentajes no mayores al 6,5% dentro de la formulación del alimento resultó aceptable para los padres de niños menores de 5 años. Por otra parte la sal seleccionada por generar menos cambios sobre el color y la acidez del alimento durante el almacenamiento fue hierro aminoquelado. Los resultados de tratamiento térmico mostraron que para reducir la concentración inicial de mesófilos y obtener un alimento de buena calidad de acuerdo con la normativa colombiana vigente fue necesario someter el alimento a 85°C durante 13 minutos (0,45 D), con lo que se consiguió mantener la calidad inicial del alimento durante 12 días bajo refrigeración. Conclusiones: El alimento desarrollado cumple con los criterios sensoriales y microbiológicos exigidos en la normativa colombiana vigente y es apto para el consumo, además se puede catalogar como alto en hierro y buena fuente de proteína, aportando el 25% y el 15% de la recomendación diaria en Colombia respectivamente.

Abstract Introduction: Iron deficiency is one of the most prevalent nutritional problems at the global level which mainly affects the vulnerable population as children under 5 years of age. Fortified foods of child consumption are part of the intervention strategies, which are made from the mixture of ingredients such as cereals, fruits, legumes, among others. Pea is a legume that can be used in order to take advantage of its nutritional properties. Objective: To design a ready-to-eat child food with peas (Pisum sativum), fortified with iron and sanitized by pasteurization. Materials and methods: The appropriate percentage of peas in the food was selected by sensory analysis. The selection of iron salt was made by physicochemical and sensory analysis using ferrous sulphate and chelate iron. Subsequently, the growth of mesophilic microorganisms was evaluated in order to select the pasteurization heat treatment. The useful life evaluation was carried out through sensory tests. Finally, the physico-chemical, compositional and microbiological evaluation of the sanitized food was implemented. Results: The addition of peas in percentages not greater than 6.5% within the food formulation was acceptable for parents of children under 5. On the other hand, the selected salt to generate less changes on the color and acidity of the food during storage was chelate iron. The results of heat treatment showed that for reducing the initial concentration of mesophiles and obtaining a good quality food according to the Colombian regulations in force, it was necessary to submit the food to 85 °C for 13 minutes (0.45 D), which managed to maintain the initial quality of the food for 12 days under refrigeration. Conclusions: The developed food complies with the sensory and microbiological criteria demanded in the Colombian regulations in force and is suitable for consumption. Besides, it can be catalogued as high in iron and a good source of protein, contributing with 25% and 15% of the daily recommendation in Colombia, respectively.

Ensayo clínico cruzado y aleatorizado para comparar dos modelos farmacocinéticos de propofol usando índices de entropía / Randomized cross-over clinical trial comparing two pharmacokinetic models of propofol using entropy indices

Introduction: There are two different pharmacokinetic models (Marsh and Schnider) for the administration of total intravenous anesthesia with propofol, the parameter differences could have some impact over the depth of anesthesia. Objective: To determine if there is a significant difference in the variability of depth of anesthesia suggesting that one model is superior in achieving a more stable and predictable depth of anesthesia during surgery. Methods: A cross-over clinical trial was conducted on 16 healthy patients programmed for upper or lower limb ambulatory orthopedic surgery. Patients were randomly assigned to (i) effect site target controlled infusion of propofol with Marsh model at a target concentration of 2.5 μg/ml for 20 min, a 20 min washout, then propofol was administered with Schnider model at the same effect site target for the reminder of the surgery, or (ii) the reverse sequence. Differences in variability of depth of anesthesia, were assessed by comparing records of spectral entropy indices during surgery through an unpaired t-test. Results: There was no evidence of significant difference in the mean variances of either spectral entropy indices between the two models (p-value: 0.57 for State Entropy, p-value: 0.51 for Response Entropy). Conclusion: The study suggests that both pharmacokinetic models are equivalent in terms of stability of depth of anesthesia. It is important to keep testing determinants of the efficacy of the models in different types of population because their behavior according to individual characteristics of patients or variables such as cost-effectiveness could end up tilting the scale.

Introducción: Hay dos modelos farmacocinéticos diferentes para la administración de la anestesia total intravenosa con propofol (Marsh y Schnider), las diferencias entre los parámetros podrían tener algún impacto sobre la profundidad anestésica. Objetivo: Comparar la variabilidad de la profundidad anestésica durante administración de infusión de propofol con los modelos de Marsh y Schnider para determinar si hay diferencias significativas que sugieran que uno de los modelos es superior en lograr una profundidad anestésica más estable y predecible. Métodos: Estudio clínico cruzado, controlado y aleatorizado llevado a cabo en 16 pacientes programados para cirugía ambulatoria de ortopedia. Los pacientes fueron asignados aleatoriamente a i) infusión controlada por objetivo de propofol con el modelo de Marsh a una concentración objetivo en sitio de efecto de 2.5μg/ml durante 20 minutos, 20 minutos de periodo de lavado, seguido de infusión de propofol con modelo de Schnider a la misma concentración objetivo; o ii) la secuencia inversa. La diferencia en variabilidad de profundidad anestésica fue evaluada mediante la comparación de registros de índices de entropía con una prueba t no pareada. Resultados: No se encontró evidencia de diferencias significativas de la varianza media en los índices de entropía espectral asociada a los modelos (valor-p: 0.57 para entropía de estado, valor-p: 0.51 para entropía de respuesta). Conclusión: El estudio sugiere que ambos modelos son equivalentes en términos de estabilidad de profundidad anestésica. Es importante continuar estudiando la eficacia de los modelos en diferentes tipos de población, dado que su comportamiento según características individuales de los pacientes o variables cómo costo-efectividad podrían inclinar la balanza.

Configuración política de la categoría discapacidad en Colombia: relación Estado y ciudadanía / Political configuration of disability as a category in Colombia: Relationship between State and citizenship

Antecedentes. El Estado como institución de poder tiene la capacidad de reconocer y garantizar los derechos y deberes de los ciudadanos. La relación entre Estado y ciudadanía permite a la población con discapacidad legitimar sus derechos y ser partícipes de la elaboración, decisión y ejecución de los asuntos que le conciernen. Objetivo. En este documento se presentan los hallazgos de las categorías Estado y ciudadanía derivados del estudio Análisis histórico de la construcción política de la categoría discapacidad en Colombia con el objetivo de reconstruir la historia de los acontecimientos sociales que determinaron las transformaciones sociopolíticas de la discapacidad entre los años 1986 y 2012. Materiales y métodos. Seis categorías fueron analizadas en 283 fuentes primarias y secundarias; el análisis se realizó en tres niveles: macro (políticas y lineamientos de nivel mundial), meso (políticas, jurisprudencia y legislación) y micro (sociedad civil organizada). Las orientaciones teóricas usadas fueron el concepto de campo social de Bourdieu y el concepto de biopoder de Foucault; las orientaciones metodológicas aquí empleadas están en la perspectiva de los estudios históricos críticos e históricos sociales de la discapacidad. Resultados. Se exponen tres periodos históricos que representan los puntos de giro en el concepto sociopolítico de la discapacidad en Colombia. Conclusión. Existe una constante tensión entre el Estado y los ciudadanos en situación de discapacidad: las políticas públicas sobre discapacidad en Colombia han favorecido, y son el resultado de la emergencia y configuración de, sujetos políticos conscientes de sus capitales sociales, de manera que su ejercicio político trasforma la configuración del poder. Sin embargo, estas acciones no se extienden homogéneamente a todas las regiones del país, de manera que las acciones políticas y ciudadanas de la discapacidad, dada la estructura del Estado colombiano, son disímiles en las regiones.

Background. The State as an institution of power has the ability to recognize and guarantee the rights and duties of citizens. The relationship between State and citizens allows people with disabilities to legitimize their rights and become partners in the development, decision and execution of the issues that concern them. Objective. This document presents the findings of the categories State and Citizenship, derived from the study "Historical Analysis of the Political Construction of the Disability Category in Colombia", in order to reconstruct the history of the social events that determined the political changes of disabled people between 1986 and 2012 . Materials and Methods. Six categories were analyzed in 283 primary and secondary sources. The analysis was performed at three levels: the macro one (politics and guidelines worldwide); the meso one (politics, jurisprudence and legislation), and the micro one (the organized civil society). The theoretical approaches used were the Bourdieu's concept of social field and the Foucault's concept of biopower. On the other hand, the methodological approaches used here were based on a critical-historical and social-historical studies perspective. Results. Three historical periods that represent turning points in the sociopolitical concept of disability in Colombia are exposed. Conclusion. There is a constant tension between the State and citizens with disabilities. Public policies on disability in Colombia have favored, and they are the result of the emergence and configuration of political subjects aware of their social capitals. So his political exercise transforms the configuration of power. However, these actions do not extend in the same way to all regions of the country, thus political and civic actions on disability, given the structure of the Colombian State, differ from region to region.

Avaliação da microdureza superficial de resinas compostas, variando os métodos de fotoativação / Microhardness evaluations of composite resins using different polymerization methods

Objetiva-se avaliar a eficiência de três métodos de fotoativação sobre quatro resinas compostas, através do ensaio de microdureza Knnop. Quatro resinas compostas foram selecionadas: R1-NaturalLook®- DFL, R2-Opallis®-FGM, R3-Ice®-SDI e R4-FiltekTMZ350XT 3M/ESPE. Um total de 120 amostras, divididas em 4 grupos experimentais (n=30), sendo 10 fotoativadas com luz halógena contínua (F1), 10 com o LED (F2) e 10 com luz halógena pulsátil (F3). A microdureza Knnop da superfície foi determinada em microdurômetro, sob uma carga de 50g por 15s, perfazendo um total de três indentações por amostra. Os dados obtidos foram analisados por ANOVA e teste de Tukey com 5% de significância. Para todos os materiais testados e métodos de fotoativação, a microdureza dos materiais R1 e R2 não foram influenciados pelos diferentes métodos (p>0,05), a microdureza do material R3 foi maior quando do uso da luz halógena contínua do que com luz halógena pulsátil (p<0,05) e a microdureza do material R4 quanto ao uso do LED foi inferior aos outros métodos. Das resinas microhíbridas a que apresentou microdureza superior foi a R3. A resina R4 obteve a melhor microdureza no estudo independente do método de fotoativação. A luz halógena continua apresentou resultado superior ao sistema de LED.

Objective is to evaluate the efficiency of three activation methods on four composite resins by testing microhardness Knnop. Four composites were selected: R1-NaturalLook®-DFL, R2-Opallis®-FGM, R3-Ice®-SDI and R4-FiltekTMZ350XT 3M/ESPE. A total of 120 samples were divided into 4 groups (n = 30), 10 light-cured with halogen light continuous (F1), 10 with LED (F2) and 10 with halogen light pulsed (F3). Microhardness Knnop surface was determined by microhardness under a load of 50g for 15s, for a total of three indentations per sample. Data were analyzed by ANOVA and Tukey's test at 5% significance. For all tested materials and methods of curing, the hardness of materials R1 and R2 were not influenced by different methods (p> 0.05), the hardness of the material R3 was greater when using halogen continuous light than halogen light pulsatile (p <0.05) and R4 microhardness of the material as the use of LED was less than other methods. Microhybrid resins that showed higher hardness was R3. The resin R4 achieved best in independent study hardness of polymerization method. The halogen light continuous showed superior results to LED system.

El corazón en lupus eritematoso sistémico: revisión estructurada de la literatura / The heart in systemic lupus erythematosus: Structured literature review

Resumen El lupus eritematoso sistémico es una enfermedad inflamatoria de origen autoinmune que puede comprometer múltiples órganos. La enfermedad cardiaca puede ocurrir en los pacientes con diagnóstico ya establecido y puede ser la manifestación inicial en algunos de ellos. La gravedad del compromiso cardiaco, en esta enfermedad, puede variar hasta producir condiciones amenazantes para la vida y puede afectar cualquier estructura o tejido del corazón. Adicionalmente, la inflamación sistémica presente en esta entidad se asocia a aterosclerosis acelerada, que puede llevar a enfermedad cardiaca isquémica de presentación temprana, incrementando significativamente el riesgo de enfermedad cardiovascular cuando se compara con la población general. Las principales características de las manifestaciones cardiacas en el lupus eritematoso sistémico se discuten a continuación, así como su pronóstico y tratamiento.

Abstract Systemic lupus erythematosus is an inflammatory disorder of autoimmune origin that can involve multiple organs. Cardiac compromise can occur in patients with established disease, or it can be the initial manifestation in some of these patients. The heart commitment in this disorder can vary in their severity until producing life-threatening conditions, and it can affect any structure or heart tissue. Additionally, the systemic inflammation present is associated to accelerated atherosclerosis that can evolve to early ischemic heart disease, increasing the risk of cardiovascular illness significantly when it is compared with general population. The main characteristics of heart manifestations in systemic lupus erythematosus are discussed, as well as their diagnosis and treatment.

Diagnóstico y tratamiento de las complicaciones biliares asociadas al trasplante hepático / Diagnosis and treatment of biliary complications associated with liver transplantation

Las complicaciones biliares se presentan en 10 - 25% de los pacientes que reciben un trasplante hepático y pueden causar una importante morbilidad e incluso la pérdida del injerto. Las complicaciones más comunes son la estenosis biliar (anastomótica y no anastomótica), fuga biliar y litiasis biliar. La gran mayoría de estas complicaciones puede tratarse con éxito mediante colangiopancreatografía retrógrada endoscópica. Esta revisión se centra en el diagnóstico, factores de riego y tratamiento endoscópico de las complicaciones biliares asociadas al trasplante hepático

Biliary complications ocurr in 10 - 25% of liver transplant recipients and are associated to a significant morbidity and the possibility of graft failure. The most common biliary complications are strictures (both anastomotic and non-anastomotic), bile leaks and stones. Most of these complications can be appropriately managed with endoscopic retrograde cholangiopancreatography. This article will review the diagnosis, risk factors, and endoscopic management of biliary complications related to liver transplantation

Enfermedad de Castleman (hiperplasia angiofolicular linfoide): presentación de caso / Castleman’s disease (Angiofolicular Lymphoid Hyperplasia): a case report

En este artículo se presenta el caso de una mujer de 29 años de edad con un cuadro clínico consistente en síndrome constitucional y linfopenia. En una tomografía se evidenciaron nódulos retroperitoneales, resecados quirúrgicamente, y se confirmó, mediante un estudio histológico, como enfermedad de Castleman tipo vascular hialino. Esta es una entidad de comportamiento generalmente benigno, poco frecuente, con hallazgos imagenológicos tomográficos y por resonancia magnética que sugieren la presencia de la enfermedad. En este artículo se revisan las características imagenológicas de esta enfermedad y sus posibles diagnósticos diferenciales.