Edema pulmonar por reexpansión. Reporte de Caso / Pulmonary edema due to re-expansion. Case Report

Introducción. El edema pulmonar por reexpansión es una complicación poco frecuente, secundaria a una rápida reexpansión pulmonar posterior al drenaje por toracentesis o toracostomía cerrada. Al día de hoy, se ha descrito una incidencia menor al 1 % tras toracostomía cerrada, con mayor prevalencia en la segunda y tercera década de la vida. Su mecanismo fisiopatológico exacto es desconocido; se ha planteado un proceso multifactorial de daño intersticial pulmonar asociado con un desequilibrio de las fuerzas hidrostáticas. Caso clínico. Presentamos el caso de un paciente que desarrolló edema pulmonar por reexpansión posterior a toracostomía cerrada. Se hizo una revisión de la literatura sobre esta complicación. Resultados. Aunque la clínica sugiere el diagnóstico, la secuencia de imágenes desempeña un papel fundamental. En la mayoría de los casos suele ser autolimitado, por lo que su manejo es principalmente de soporte; sin embargo, se han reportado tasas de mortalidad que alcanzan hasta el 20 %, por tanto, es importante conocer los factores de riesgo y las medidas preventivas. Conclusión. El edema pulmonar de reexpansión posterior a toracostomía es una complicación rara en los casos con neumotórax, aunque es una complicación que se puede presentar en la práctica diaria, por lo cual debe tenerse en mente para poder hacer el diagnóstico y un manejo adecuado.

Introduction. Re-expansion pulmonary edema is a rare complication secondary to rapid pulmonary re-expansion after drainage by thoracentesis and/or closed thoracostomy. As of today, an incidence of less than 1% has been described after closed thoracostomy, with a higher prevalence in the second and third decades of life. Its exact pathophysiological mechanism is unknown; a multifactorial process of lung interstitial damage associated with an imbalance of hydrostatic forces has been proposed. Clinical case. We present the case of a patient who developed pulmonary edema due to re-expansion after closed thoracostomy, conducting a review of the literature on this complication. Results. Although the clinic suggests the diagnosis, the sequence of images plays a fundamental role. In most cases, it tends to be a self-limited disease, so its management is mainly supportive. However, mortality rates of up to 20% have been recorded. Therefore, it is important to identify patients with major risk factors and initiate preventive measures in these patients. Conclusions. Re-expansion pulmonary edema after thoracostomy is a rare complication in cases with pneumothorax; however, it is a complication that can occur in daily practice. Therefore, it must be kept in mind to be able to make the diagnosis and an adequate management.

Satisfacción y calidad percibida en cirugía mayor ambulatoria

Fundamento: la calidad es uno de los temas que ha suscitado mayor interés en los investigadores de las más disimiles ramas de la producción, los servicios y las ciencias en los últimos años. Se ha demostrado la necesidad del estudio de la calidad percibida en el ámbito sanitario y, particularmente, en cirugía mayor ambulatoria. Objetivo: evaluar la satisfacción y calidad percibida por pacientes y familiares usuarios de cirugía mayor ambulatoria; determinar la existencia de diferencias en los criterios de pacientes y familiares. Métodos: estudio observacional descriptivo desde enero de 2018 a marzo de 2020 en el Servicio de Cirugía General del Hospital Provincial Arnaldo Milián Castro, de Santa Clara. Se aplicaron entrevistas por vía telefónica a 50 pacientes (intervenidos por cirugía mayor ambulatoria) y a un familiar que lo hubiese acompañado durante el proceso de atención. Resultados: se obtuvieron resultados favorables en la satisfacción y percepción de la calidad en los pacientes y familiares sin evidenciarse diferencias estadísticas significativas entre estos grupos. Conclusiones: la cirugía mayor ambulatoria es una modalidad asistencial bien aceptada por los pacientes y sus familiares acompañantes.

Background quality is one of the issues that has aroused the greatest interest in researchers from the most dissimilar branches of production, services and science in recent years. The need to study the perceived quality in the health field and, particularly, in major outpatient surgery has been demonstrated. Objective: to evaluate the satisfaction and quality perceived by patients and relatives who use major outpatient surgery; to determine the existence of differences in the patients and relatives' criteria. Methods: descriptive observational study from January 2018 to March 2020 at the General Surgery Service of the Arnaldo Milián Castro Provincial Hospital, in Santa Clara. Telephone interviews were applied to 50 patients (operated for major outpatient surgery) and a family member who had accompanied them during the care process. Results: favorable results were obtained in satisfaction and quality perception in patients and relatives without showing significant statistical differences between these groups. Conclusions: major ambulatory surgery is a care modality well accepted by patients and their accompanying families.

Incidence and clinical significance of FLT3 and nucleophosmin mutation in childhood acute myeloid leukemia in Chile

Abstract Introduction Acute myeloid leukemia (AML) is a heterogeneous disease and approximately one-third of its carriers do not have evident genetic abnormalities. The mutation of specific molecular markers, such as fms-like tyrosine kinase 3 (FTL3) internal tandem duplication (ITD), FLT3 tyrosine kinase domain (TKD) and nucleophosmin (NPM1), are associated with an adverse and favorable prognosis, respectively. Objective The objective was to determine the prevalence of FLT3/ITD and NPM1 in Chilean patients and their association with clinical data and prognosis. Method and Results Two hundred and thirty-two children were studied between 2011 and 2017, the median being 8.6 years (ranging from 1 to 18 months). Acute promyelocytic leukemia (APL) was diagnosed in 29%. The FLT3/ITD-mutated in non-promyelocytic AML was at 10% (14/133) and the FLT3/TKD, at 3.7% (2/54). In APL, it was at 25.4% (16/63). In non-promyelocytic AML, the FLT3/ITD-mutated was associated with a high leucocyte count, the median being 28.5 x mm3 (n= 14) versus 19.4 x mm3 (n= 119), (p= 0.25), in non-mutated cases. In APL, the median was 33.6 x mm3 (n= 15) versus 2.8 x mm3 (n= 47), (p < 0.001). The five-year overall survival (OS) in non-promyelocytic AML with non-mutated and mutated FLT3/ITD were 62.7% and 21.4%, respectively, (p < 0.001); the 5-year event-free survival (EFS) were 79.5% and 50%, respectively, (p < 0.01). The five-year OS in APL with non-mutated and mutated FLT3/ITD was 84.7% and 62.5%, respectively, (p= 0.05); the 5-year EFS was 84.7% and 68.8%, respectively, (p= 0.122). The NPM1 mutation was observed in 3.2% (5/155), all non-promyelocytic AML with the normal karyotype. Conclusion The FLT3/ITD mutation was observed more frequently in APL and associated with a higher white cell count at diagnosis. However, the most important finding was that the FLT3/ITD mutation was associated with a shorter survival in non-promyelocytic AML.

Características clínico-patológicas de los pacientes asistidos en el Centro Docente Asociado de Oncología Médica en el Hospital Departamental de Soriano durante su primer año de funcionamiento / Clinical-pathological characteristics of patients assisted at the Associated Teaching Center of Medical Oncology at Soriano Departmental Hospital during its first year of operation / Características clínico-patológicas dos pacientes atendidos no Centro Docente Associado de Oncologia Médica no Hospital Departamental de Soriano durante seu primeiro ano de funcionamento

Introducción: Según el Ministerio de Salud las muertes por cáncer constituyen un cuarto del total de las defunciones registradas en Uruguay cada año. Objetivo: Conocer el perfíl epidemiológico de los pacientes diagnosticados de cáncer asistidos en el Hospital Departamental de Soriano. Material y métodos: Estudio observacional, retrospectivo y descriptivo que incluyó a los pacientes diagnosticados de cáncer asistidos en el Hospital Departamental de Soriano durante el 2022. Se mantuvo el anonimato de los pacientes en el análisis estadístico y se contó con la aprobación del Comité de Ética del Hospital de Clínicas. Resultados: Se incluyeron 113 pacientes nuevos; 53.1% fueron hombres, siendo la mediana de edad al diagnóstico de 69 años. Los 4 tumores más frecuentes para ambos sexos reunidos fueron: mama, próstata, pulmón y colo-recto; la distribución por estadio fue la siguiente: E IV 48.6% pacientes; EIII 22.5%; EII 26.5%; y EI 2.6%. En el 79.6% de las pacientes se contaba con la confirmación del diagnóstico mediante anatomía patológica. El tiempo entre el diagnóstico y el primer tratamiento oncológico fue ≤ 3 meses para el 88.2% de los pacientes. El total de los pacientes con EIV fueron contactados con la Unidad de Cuidados Paliativos. Únicamente el 15% de los casos fueron discutidos en Comité de Tumores. Conclusiones: Los datos analizados permitieron caracterizar el perfil epidemiológico del cáncer de los pacientes procedente de Soriano asistidos en el ámbito público y pueden contribuir a la implementación de políticas públicas orientadas a la prevención y por ende a la mejora en la asistencia pacientes asistidos.

Introduction: According to the Ministry of Health, cancer deaths constitute a quarter of the total deaths registered in Uruguay each year. Objective: To identify the epidemiological profile of patients diagnosed with cancer treated at the Departmental Hospital of Soriano. Materials and Methods: An observational, retrospective and descriptive study that included patients diagnosed with cancer attended at the Departmental Hospital of Soriano during 2022. The anonymity of the patients was maintained in the statistical analysis and approval was obtained from the Ethics Committee of the Hospital de Clínicas. Results: A total of 113 new patients were included; 53.1% were men, with a median age at diagnosis of 69 years old. The four most frequent tumors for both sexes were: breast, prostate, lung and colorectal; the distribution by stage was as follows: Stage IV 48.6% patients; Stage III 22.5%; Stage II 26.5%; and Stage I 2.6%. In 79.6% of the patients the diagnosis was confirmed by pathological anatomy. The time between diagnosis and first oncological treatment was ≤ 3 months for 88.2% of patients. The total number of patients with Stage IV were contacted by the Palliative Care Unit. Only 15% of the cases were discussed in the Tumor Committee. Conclusions: The data analyzed made it possible to characterize the epidemiological profile of cancer in patients from Soriano assisted in the public sector and may contribute to the implementation of public policies aimed at prevention and, therefore, at improving patient care.

Introdução: Segundo o Ministério da Saúde, as mortes por câncer constituem um quarto de todas as mortes registradas no Uruguai a cada ano. Objetivos: Conhecer o perfil epidemiológico dos pacientes diagnosticados com câncer atendidos no Hospital Departamental de Soriano. Material e Métodos: Estudo observacional, retrospectivo e descritivo que incluiu pacientes diagnosticados com câncer atendidos no Hospital Departamental de Soriano durante o ano de 2022. O anonimato dos pacientes foi mantido na análise estatística e foi aprovado pelo Comitê de Ética do Hospital de Clínicas. Resultados: foram incluídos 113 novos pacientes; 53,1% eram homens, com mediana de idade ao diagnóstico de 69 anos. Os 4 tumores mais frequentes para ambos os sexos combinados foram: mama, próstata, pulmão e colorretal; a distribuição por estágio foi a seguinte: E IV 48,6% pacientes; EIII 22,5%; EII 26,5%; EI 2,6%. Em 79,6% dos pacientes houve confirmação do diagnóstico pela patologia. O tempo entre o diagnóstico e o primeiro tratamento oncológico foi ≤ 3 meses para 88,2% dos pacientes. Todos os doentes com DIV foram contactados com a Unidade de Cuidados Paliativos. Apenas 15% dos casos foram discutidos no Comitê de Tumores. Conclusões: Os dados analisados ​​permitiram caracterizar o perfil epidemiológico do câncer em pacientes de Soriano atendidos na esfera pública e podem contribuir para a implementação de políticas públicas voltadas para a prevenção e, consequentemente, para a melhoria na assistência aos pacientes atendidos.

Overall survival in Chilean patients with lymphoma and human immunodeficiency virus: A retrospective cohort study

ABSTRACT Introduction: People living with human immunodeficiency virus (PLWH) still face high morbidity and mortality resulting from lymphoma. Aim: To describe a population of PLWH and lymphoma in a Chilean public hospital and compare the overall survival (OS) with a previously reported cohort from the same institution. Methods: Retrospective single-center cohort study. All the patients diagnosed between 2010 and 2017 were included. Demographic and clinical variables were obtained from medical records. The overall survival (OS) was estimated in treated patients from diagnosis until death or October 2020. The OS was then compared with a cohort of patients diagnosed between 1992 and 2008. Main Results: Eighty-four patients were included. The most common histological types were Burkitt's lymphoma (BL), diffuse large B-cell lymphoma (DLBCL), Hodgkin's lymphoma (HL) and plasmablastic lymphoma (PBL) at 31%, 27%, 21% and 14%, respectively. The three-year OS for the whole cohort of BL, DLBCL, HL and PBL was 58.9%, 65.2%, 47.4%, 76.4% and 50%, respectively. Compared to the cohort of 1992 to 2008, a global increase in the OS was found after excluding HL and adjusting for age and clinical stage (HR 0.38, p = 0.002). However, when the main types were analyzed individually, the increase in the OS was statistically significant only in DLBCL (HR 0.29, p = 0.007). Most patients with DLBCL received CHOP chemotherapy, as in the previous cohort. Conclusion: The OS has improved in this population, despite no major changes in chemotherapy regimens, mainly due to the universal access to antiretroviral therapy.

Affectivity and physical habits in adolescents: A systematic review / Afectividad y hábitos físicos en adolescentes: una revisión sistemática

Introduction: Affectivity has a fundamental role in educational systems' training process. However, there are no updated studies that show the different socio-affective agents used in the creation of physical habits in the child and adolescent population in school systems. Objective: To review and analyze previously published research that studied the influence of affectivity on children and adolescents' physical habits in school systems. Materials and methods: A systematic review was conducted with articles published between 2010 and 2020, which connected affectivity and physical habits. The electronic search was performed through Web of Science, Scopus, and Scielo databases. All articles that studied the influence of affectivity on the population's physical habits were included. Results: Three studies that analyzed the influence of affectivity on children and adolescents' physical habits were found. Conclusions: At the end of the systematic review, it was demonstrated that there is a significant relationship between affectivity and the physical habits in child and adolescent populations. It was also possible to observe that this influence, positive or negative, determines the child and adolescent population's interest in physical activity and sports in adult life.

Introducción: La afectividad tiene un papel fundamental dentro del proceso de formación en los sistemas educativos. Sin embargo, no existen estudios actualizados que evidencien los diversos agentes socioafectivos utilizados en la creación de hábitos físicos en la población infantil y adolescente de los sistemas escolares. Objetivo: Analizar investigaciones previamente publicadas que estudiaron la influencia de la afectividad en los hábitos físicos de niños y adolescente de los sistemas escolares. Materiales y métodos: El estudio corresponde a una revisión sistemática. Se evaluaron artículos publicados entre 2010 y 2020 que relacionaron afectividad y hábitos físicos. La búsqueda electrónica se realizó a través de las bases Web of Science, Scopus y Scielo. Se incluyeron todos los artículos que utilizaron la afectividad sobre los hábitos físicos de la población. Resultados: Se encontraron tres artículos que utilizaron la afectividad sobre los hábitos físicos de niños y adolescentes. Conclusiones: Al término de la revisión sistemática, se demostró que existe una tremenda influencia entre la afectividad y los hábitos físicos de la población infantil y adolescente. También se pudo observar que esta influencia, positiva o negativa, condiciona el interés de la población infantil y juvenil por la actividad física y el deporte en la vida adulta.

Enfermedad de Bowen / Bowen's disease

RESUMEN La enfermedad de Bowen es un carcinoma espinocelular in situ que afecta tanto piel como mucosas y que puede progresar hacia un carcinoma espinocelular invasor. Clínicamente se caracteriza por: una placa eritematosa bien definida, de crecimiento lento, bordes irregulares, bien delimitados y escamas o costras suprayacentes. El cuadro clínico se confirma con los datos histopatológicos donde se advierte carcinoma in situ espinocelular. Se presentó un paciente de 35 años con lesión en la piel del hemitórax derecho de 3 años de evolución. Al examen dermatológico presentaba: lesión en placa eritematosa, única, bordes bien definidos, de tamaño 2x2 cm de diámetro, de forma anular, con escamas finas en su superficie, localizada en hemitórax derecho. La piel perilesional mostraba daño actínico crónico. Se realizó exéresis y biopsia de la lesión. Los resultados de la biopsia informaron que el aspecto histológico es consistente con carcinoma espinocelular in situ (enfermedad de Bowen).

ABSTRACT Bowen's disease is a squamous cell carcinoma in situ that affects both skin and mucosa and may progress to invasive squamous cell carcinoma. It is clinically characterized by a well-defined, slow-growing erythematous plaque with irregular, well-demarcated borders and overlying scales or crusts. The clinical presentation is confirmed by histopathological data showing squamous cell carcinoma in situ. We present a 35-year-old male patient with a skin lesion on the right hemithorax of 3 years of evolution. On dermatological examination he presented a single erythematous plaque lesion located on the right hemithorax, with well-defined borders, 2x2 cm in diameter, annular shape and fine scales on the surface. The perilesional skin showed chronic actinic damage. Exeresis and biopsy of the lesion were performed. The biopsy results reported that the histological appearance was consistent with squamous cell carcinoma in situ (Bowen's disease).

Sistema endocannabinoide y cannabidiol en el manejo del dolor en perros: revisión narrativa

Introducción: la marihuana (Cannabis sativa L.) es una planta originaria de Asia cada vez más reconocida por su valor terapéutico en la medicina humana y veterinaria. Contiene una gran cantidad de componentes entre los que destacan los fitocannabinoides, de los cuales los más representativos son el delta-9-tetrahidrocannabinol (THC) y Cannabidiol (CBD) que se acoplan respectivamente a los receptores CB1 y CB2 en el sistema endocannabinoide que es un sistema neurotransmisor entre células que regula varios procesos en los vertebrados como memoria, dolor, inflamación, apetito y procesos inmunológicos entre otros. Objetivo: realizar una síntesis narrativa del sistema endocannabinoide y cannabidiol en el manejo del dolor en perros, a partir de la búsqueda de publicaciones en bases de datos electrónica PubMed, NCBI, SciELO, Science Direct, Dialnet, Google y Google Académico. Resultados: el CBD es el principal cannabinoide utilizado en la terapia del manejo del dolor en perros por sus propiedades analgésicas y carencia de efectos psicoactivos. Conclusión: se evidencia la necesidad de realizar más investigaciones con ensayos clínicos controlados sobre el uso terapéutico del cannabidiol, que tengan validez interna y externa, con poblaciones más significativas en la especie de interés.

SUMMARY Introduction: marijuana (CannabissativaL.) is a plant native to Asia that is increasingly recognized for its therapeutic value in human and veterinary medicine. It contains a large number of components among which the phytocannabinoids stand out, of which the most representative are delta-9-tetrahydrocannabinol (THC) and Cannabidiol (CBD) that are coupled respectively to the CB1 and CB2 receptors in the endocannabinoid system, which is a neurotransmitter system between cells that regulates various processes in vertebrates such as memory, pain, inflammation, appetite and immune processes among others. Aim: to carry out a narrative synthesis of the endocannabinoid and cannabidiol system in the management of pain in dogs, from the search of publications in electronic databases PubMed, NCBI, SciELO, Science Direct, Dialnet, Google and Google Scholar. Results: CBD is the main cannabinoid used in pain management therapy in dogs due to its analgesic proper-ties and lack of psychoactive effects. Conclusion: there is evidence of the need for more research with controlled clinical trials on the therapeutic use of cannabidiol, which have internal and external validity, with more significant populations in the species of interest.

Introdução: a maconha (Cannabis sativa L.) é uma planta nativa da Ásia que é cada vez mais reconhecida por seu valor terapêutico na medicina humana e veterinária. Ele contém muitos componentes entre os quais se destacam os fitocanabinóides, dos quais os mais representativos são delta-9-tetrahidrocanabinol (THC) e Canabidiol (CBD) que estão acoplados respectivamente aos receptores CB1 e CB2 no sistema endocanabinóide, que é um sistema neurotransmissor entre as células que regula vários processos nos vertebrados, como memória, dor, inflamação, apetite e processos imunológicos, entre outros. Objetivo: realizar uma síntese narrativa do sistema endocanabinoide e canabidiol no manejo da dor em cães, a partir da busca de publicações nas bases de dados eletrônicas PubMed, NCBI, SciELO, Science Direct, Dialnet, Google e Google Scholar. Resultados: O CBD é o principal canabinoide utilizado na terapia de controle da dor em cães devido às suas propriedades analgésicas e ausência de efeitos psicoativos. Conclusão: há evidências da necessidade de mais pesquisas com ensaios clínicos controlados sobre o uso terapêutico do canabidiol, que tenham validade interna e externa, com populações mais significativas nas espécies de interesse.

Síndrome de Edwards: desde el diagnóstico prenatal hasta el neonatólogo

RESUMEN El síndrome de Edwards o síndrome de trisomía 18 es un trastorno cromosómico autosómico que se caracteriza por la presencia de un cromosoma 18 extra, con rasgos clínicos distintivos. Se presenta un caso con diagnóstico prenatal basados en la ecografía morfológica obstétrica que condujeron a la realización ecocardiografía fetal donde resalta la displasia de la válvula pulmonar con doble lesión y la comunicación interventricular. Posteriormente se realiza cordocentesis para realización del cariotipo y asesoramiento genético.

ABSTRACT Edwards' syndrome, or trisomy 18 syndrome, is an autosomal chromosomal disorder characterized by the presence of an extra chromosome 18, with distinctive clinical features. We present a case with a prenatal diagnosis based on obstetrical morphological ultrasound that led to the performance of a fetal echocardiography with findings of a pulmonary valve dysplasia with double injury and interventricular communication. Subsequently, cordocentesis is performed for karyotyping and genetic counseling.

Características clínicas y epidemiológicas de las neoplasias mieloproliferativas Philadelphia negativas en el sistema público de salud de Chile

Background: Philadelphia-negative myeloproliferative neoplasms (Ph-MPN) are chronic hematological disorders characterized by the overproduction of one or more mature myeloid blood cell lineages. Classical Ph-MPN are polycythemia vera (PV), essential thrombocytopenia (ET) and primary myelofibrosis (PMF). Aim: To assess the epidemiological, clinical and diagnostic characteristics of Ph-MPN in Chile. Material and Methods: Retrospective review of medical records of all patients referred as MPN from 2012 to 2017. Patients with (9;21) translocation were excluded. Results: Data of 462 cases with a median age of 69 years from 10 public hospitals was reviewed. ET was the most frequently Ph-MNP found. The incidence of Ph-MPN was 1.5 x 100.000 cases. The JAK2 V617F mutation study was performed in 96% of patients and only 30% had a bone marrow biopsy. Thrombotic events were observed in 29% of patients. Bleeding events were observed in 7%. Five-year overall survival was 87%. Conclusions: ET is the most frequent Ph-MPN. The mean incidence was lower than reported in the literature, in part because of a sub diagnosis.

Quimioterapia intensiva asociada a imatinib en leucemia linfoblástica aguda del adulto, Philadelphia positivo. Experiencia en un hospital público / Intensive chemotherapy with tyrosine kinase inhibitors in philadelphia-positive acute lymphoblastic leukemia

Background: Before the advent of tyrosine kinase inhibitors (TKIs), patients with Philadelphia-positive Acute Lymphoblastic Leukemia (Ph+ALL) had a poor prognosis. The association of TKIs to intensive chemotherapy (CT) improved outcome. Aim: To evaluate results of an intensive CT protocol including TKI in a public hospital in Santiago, Chile. Material and Methods: All patients with Ph+ALL diagnosed between January 2010 and February 2019, and who met inclusion criteria for intensive CT, received the Ph+ALL national protocol in association with imatinib and were included in this analysis. Results: Thirty-five patients aged 15 to 59 years received treatment. Complete response (CR) was obtained in 97%. Measurable residual disease (MRD) was negative in 61% (19/31 evaluable cases) during follow-up, and 55% (16/29) were MRD (-) before three months. Relapse was observed in 13 cases. Three patients underwent allogeneic hematopoietic stem cell transplant (HSCT), two in CR1. The overall survival (OS) and event-free survival (EFS) at three years were 52 and 34%, respectively. In patients who achieved MRD negativity before three months, no statistically significant differences in OS (64 and 42% respectively, p = 0.15) or EFS (35 and 32% respectively, p = 0.37) were observed. Conclusions: The prognosis of Ph+ALL improved with the association of imatinib to intensive CT. MRD-negative status before three months in this series was not significantly associated with better outcomes. Our series suggests that the Ph+ALL national protocol associated to TKI is a therapeutic alternative with high CR and aceptable MRD (-) rates.

Utilización de un dispositivo móvil de tecnología electrónica para tamizaje de fibrilación auricular: estudio piloto / Use of a mobile electronic technology device for atrial fibrillation screening: pilot study / Uso de dispositivo de tecnologia eletrônica móvel para rastreamento de fibrilação atrial: estudo piloto

La fibrilación auricular (FA) es un problema de salud pública que genera mortalidad y morbilidad, con su mayor impacto en mayores de 65 años. Su detección es especialmente relevante para la población de riesgo. Este estudio piloto propone valorar la utilidad de un dispositivo móvil de tecnología electrónica (DMTE) para el tamizaje de FA. Objetivo primario: evaluar la validez y confiabilidad de un DMTE para identificar FA. Objetivo secundario: validar los procesos de recolección, transmisión, almacenamiento, procesamiento e interpretación de los datos obtenidos. Método: los asistentes a 5 talleres del Plan Ibirapitá (entre el 15 de octubre y el 30 de noviembre de 2018) fueron invitados a participar del estudio. Se utilizó un DMTE (sensor KardiaMobile de AliveCor®) cuyo registro se contrastó con el trazado del ECG de 12 derivaciones realizado en forma casi simultánea. Se compararon los diagnósticos automáticos con los realizados por dos cardiólogos expertos de forma independiente, a partir de la lectura del registro realizado con el DMTE y de un ECG de 12 derivaciones. Resultados: participaron del estudio 114 beneficiarios del Plan Ibirapitá, 78 del sexo femenino. La edad fue de 72,5 ± 5,36 años (rango: 53-87 años). La sensibilidad para el diagnóstico de FA del DMTE fue de 100%, con una especificidad de 96,6%. (VPP = 57,1% VPN = 100%) y una proporción de diagnóstico correcto de 96,8%. El DMTE catalogó como "sin clasificar" al 18,4% de los trazados. Considerando esto, la proporción de diagnóstico correcto disminuyó a 78,9%, sin presentar falsos negativos. Conclusiones: el cribado de FA con la utilización de un DMTE en una población de adultos mayores es factible y confiable. El hallazgo de un 18,4% de trazados con diagnóstico automático "sin clasificar" hace necesario contar con recursos humanos calificados para realizar la confirmación diagnóstica en esos registros.

Atrial fibrillation (AF) is a public health problem generating important morbidity and mortality mainly in > 65 years old population. Detection is key in the population at risk. This pilot study was designed to assess a mobile electronic technology device (METD) usefulness in AF screening. Objective: evaluate validity and reliability of a METD in AF identification. Secondary objective: to validate the process of collection, transmission, storage, method and interpretation of obtained data. Method: participants in 5 Ibirapitá Plan workshops (October 15-November 30, 2018) were invited to participate in the study. A KardiaMobile Alive Cor® METD was used, whose ECG recording was compared with a 12L ECG taken almost at the same time. Automatic METD report was compared with 2 independent cardiologists report considering the METD recording and the 12L ECG. Results: 114 participants (78 female), mean age 72,5 y.o. (SD 5,36; range 53-87) were included. METD sensitivity for AF diagnosis was 100% with a 96.6% specificity (PPV=57,1% NPV=100%), and a 96.8% number of correct diagnosis. A 18.4% of recordings were catalogued as "unclassified" by the METD. Considering this, the proportion of correct diagnosis decreased to 78.9%; there were not false negatives. Conclusions: AF screening with a METD in an older population is feasible and reliable. The finding of 18.4% METD recordings as "unclassified" raises the needs for experts review during diagnosis confirmation.

A fibrilação atrial (FA) é um problema de saúde pública que gera mortalidade e morbidade, com maior impacto em pessoas com mais de 65 anos. Sua detecção é especialmente relevante para a população de risco. Este estudo piloto teve como objetivo avaliar a utilidade de um dispositivo móvel de tecnologia eletrônica (DMTE) para o monitoramento da FA. Objetivo principal: avaliar a validade e confiabilidade de um DMTE para identificar FA. Objetivo secundário: validar os processos de coleta, transmissão, armazenamento, processamento e interpretação dos dados obtidos. Método: participantes de 5 oficinas do Plano Ibirapitá (entre 15 de outubro e 30 de novembro de 2018) foram convidados a participar do estudo. Foi utilizado um DMTE (sensor AliveCor® KardiaMobile), cujo registro foi contrastado com o traçado do ECG de 12 derivações realizado quase simultaneamente. Os diagnósticos automatizados foram comparados com aqueles realizados por dois cardiologistas especialistas independentes, com base na leitura gráfica do DMTE e no ECG de 12 derivações. Resultados: participaram do estudo 114 beneficiários do Plano Ibirapitá, sendo 78 mulheres. A média de idade foi de 72,5 anos (DP 5,36; variação de 53-87 anos). A sensibilidade para o diagnóstico de FA no DMTE foi de 100% com especificidade de 96,6%. (VPP = 57,1% VPN = 100%) e proporção de diagnóstico correto de 96,8%. O DMTE definiu 18,4% dos registros como "não classificados". Portanto, a proporção de diagnósticos corretos diminuiu para 78,9% e não houve falsos negativos. Conclusões: a triagem para FA por meio de DMTE em uma população idosa é viável e confiável. A constatação de 18,4% dos registros com diagnóstico automático "não classificado" torna necessária a existência de recursos humanos qualificados para a realização da confirmação diagnóstica.

Síncope y paro cardiorrespiratorio, formas graves de presentación de la embolia pulmonar central: reporte de tres casos clínicos / Syncope and cardiorespiratory arrest, severe forms of presentation of central pulmonary embolism: report of three clinical cases / Síncope e parada cardiorrespiratória, formas graves de apresentação de embolia pulmonar central: relato de três casos clínicos

El tromboembolismo pulmonar tiene una presentación clínica variada. Es fundamental tener un alto índice de sospecha para arribar al diagnóstico oportuno. El síncope se asocia a casos graves y tiene importancia pronóstica. El tratamiento trombolítico es la piedra angular en el subgrupo de pacientes de alto riesgo. Se presentan tres casos clínicos de tromboembolia pulmonar de alto riesgo con el fin de discutir el escenario clínico de presentación y el tratamiento instaurado.

Pulmonary thromboembolism has a varied clinical presentation. It is essential to have a high index of suspicion to arrive at a timely diagnosis. Syncope is associated with severe cases and is of prognostic significance. Thrombolytic treatment is the cornerstone in the subgroup of high-risk patients. Three clinical cases of high-risk pulmonary thromboembolism are presented in order to discuss the clinical presentation scenario and the established treatment.

O tromboembolismo pulmonar tem a presentação clínica variada. É essencial ter um alto índice de suspeita para chegar a um diagnóstico oportuno. A síncope está associada a casos graves e tem significado prognóstico. O tratamento trombolítico é a pedra angular no subgrupo de pacientes de alto risco. São apresentados três casos clínicos de tromboembolismo pulmonar de alto risco para discutir o quadro clínico e o tratamento instituído.

Ateneo General de la Residencia de Psicopedagogía: ¡Atención! Adultxs aprendiendo / Psicopedagogic Residente General atheneaum: Attention! Adults learning

El Equipo de Psicopedagogía y residentes de esa especialidad del Centro de Salud Nº 15, de la Ciudad de Buenos Aires, desarrolló actividades relacionadas con el aprendizaje en y con adultos, durante la pandemia de Covid-19. En un primer eje, se presentan diferentes aristas del concepto de educación, y el de aprendizaje. En un segundo eje, se describe el proceso que realizan los adultos en diversas instancias de aprendizaje, así como sus motivaciones y deseos.

Características clínico dermatoscópica de pacientes pediátricos con nevos melanocíticos congénitos / Dermatoscopic clinical characteristics of pediatric patients with congenital melanocytic nevi

Introducción: El nevo melanocítico congénito es una lesión pigmentada melanocítica, que está generalmente presente en el momento del nacimiento. La dermatoscopia es una técnica útil en el diagnóstico de los nevos. Objetivo: Examinar las características clínicas y dermatoscópicas de pacientes pediátricos con nevos melanocíticos congénitos. Métodos: Investigación de tipo descriptivo transversal. La población incluyó 340 pacientes pediátricos que asistieron a la consulta de dermatoscopia del Hospital Pediátrico Universitario "José Luis Miranda", Santa Clara, entre abril 2016- abril de 2017. La muestra quedó constituida por 128 pacientes con diagnóstico de nevos melanocíticos congénitos. Los datos obtenidos se analizaron a través del paquete estadístico SPSS 21.0. Se emplearon los métodos de la estadística descriptiva. Resultados: El cambio clínico más frecuente fue el crecimiento en 76 (47,8 por ciento) nevos. La localización más comprometida fue en los miembros superiores con 28 (17,6 por ciento) nevos. Existió una relación estadísticamente significativa (p< 0,05) entre el tamaño de los nevos y la localización en zonas fotoexpuestas con la presencia de cambios clínicos. El patrón en empedrado (27,7 por ciento) fue el más frecuente; sin embargo, el patrón globular (24,5 por ciento) se observó en todas las localizaciones. Ninguno de los nevos detectados empeoró hacia el melanoma maligno. Conclusiones: La mayoría de los nevos melanocíticos congénitos en este trabajo aparecieron desde el nacimiento. La presencia de cambios clínicos fue más evidente en las regiones fotoexpuestas. No se observó ningún nevo con estructuras o patrones dermatoscópicos relacionados con malignidad(AU)

Introduction: Congenital melanocytic nevi is a melanocytic pigmented lesion, which is usually present at birth. Dermatoscopy is a useful technique in the diagnosis of nevi. Objective: To examine the clinical and dermatoscopic characteristics of pediatric patients with congenital melanocytic nevi. Methods: Cross-sectional descriptive type research. The data obtained were analyzed through the SPSS 21.0 statistical package. The methods of descriptive statistics were used. Results: The most common clinical change was growth, in 76 (47.8 percent) nevi. The most compromised location was in the upper members with 28 (17.6 percent) nevi. There was a statistically significant relation (p< 0.05) among the size of the nevi and the location in photoexposed areas with the presence of clinical changes. The cobbled pattern (27.7 percent) was the most common; however, the globular pattern (24.5 percent) was observed in all locations. None of the detected nevi worsen towards malignant melanoma. Conclusions: Most congenital melanocytic nevi are shown from birth. The presence of clinical changes was most evident in photoexposed regions. No nevi was observed with dermatoscopic structures or patterns related to malignancy(AU)

Ventana Aortopulmonar. reporte de caso

RESUMEN La ventana aortopulmonar es una malformación cardiaca congénita poco frecuente que se encuentra entre el 0,2% y 0,6% de todas las cardiopatías congénitas. Consiste en una comunicación entre la aorta ascendente y el tronco de la arteria pulmonar en presencia de dos arterias con dos válvulas semilunares. Se presenta el caso de un lactante de 6 meses con 5,860 kg remitido al servicio de cardiología infantil por dificultad respiratoria y escasa ganancia ponderal. Entre los métodos diagnósticos se realiza la ecocardiografía doppler color requiriendo posteriormente complementar dicho método con cateterismo cardiaco y posterior resolución quirúrgica.

ABSTRACT Aortopulmonary window is a rare congenital heart malformation that is found in between 0.2% and 0.6% of all congenital heart disease. It consists of a communication between the ascending aorta and the trunk of the pulmonary artery in the presence of two arteries with two semilunar valves. We present the case of a 6-month-old infant weighing 5,860 kg referred to the pediatric cardiology service due to respiratory distress and low weight gain. As part of the diagnostic workup, color Doppler echocardiography was performed, along with subsequent cardiac catheterization and surgical resolution.

Aplicación de propuestas para el perfeccionamiento de la atención en cirugía mayor ambulatoria y de corta estadía / Application of proposals for the ambulatory and short-stay major surgery improvement of care

RESUMEN Fundamento: se han evidenciado dificultades en la coordinación entre los niveles primario y secundario de salud en el proceso de atención a pacientes en la cirugía mayor ambulatoria y la cirugía de corta estadía. En respuesta a esta situación se diseñaron propuestas asistenciales (un modelo teórico-asistencial, un manual para la organización procedimental y un modelo de historia clínica) en etapas investigativas anteriores. Objetivo: evaluar la satisfacción y calidad percibida por pacientes y familiares con la aplicación de un modelo asistencial, un manual de procedimientos y un modelo de historia clínica para el perfeccionamiento asistencial en cirugía mayor ambulatoria y cirugía de corta estadía. Métodos: desde el 4 de enero de 2016 hasta el 28 de diciembre de 2017 se efectuó un estudio cuasi-experimental para evaluar la satisfacción y calidad percibida por pacientes sin experiencia en cirugía mayor ambulatoria o de corta estadía y un familiar acompañante en cada caso. Se aplicó un diseño con un grupo experimental y otro de control solo con post-prueba para pacientes y familiares. Los grupos experimentales estuvieron constituidos por 50 pacientes y 50 familiares respectivamente y los grupos de control por 67 pacientes y 67 familiares. La satisfacción y calidad percibida fueron evaluadas mediante escalas ascendentes de 1 hasta 5 puntos. Resultados: se obtuvieron niveles más favorables en la satisfacción y percepción de la calidad en los pacientes y familiares de los grupos experimentales. Conclusiones: la aplicación de las propuestas asistenciales contribuyó al logro de elevados niveles de satisfacción y calidad percibida en los usuarios.

ABSTRACT Background: difficulties have been evidenced in the coordination between the primary and secondary health levels in the process of caring for patients in major outpatient surgery and short-stay surgery. In answer to this situation, healthcare proposals (a theoretical-healthcare model, a manual for procedural organization and a clinical history model) were designed in previous research stages. Objective: to evaluate the satisfaction and quality perceived by patients and relatives with the application of a care model, a procedure manual and a clinical history model for major outpatient surgery and short-stay surgery improvement of care. Methods: from January the 4th, 2016 to December the 28th, 2017, a quasi-experimental study was carried out to evaluate the satisfaction and quality perceived by patients with no experience in major outpatient or short-stay surgery and a companion relative in each case. A design was applied with an experimental group and a control group only with post-test for patients and relatives. The experimental groups consisted of 50 patients and 50 relatives respectively and the control groups of 67 patients and 67 relatives. Satisfaction and perceived quality were evaluated using ascending scales from 1 to 5 points. Results: more favorable levels of satisfaction and perception of quality were obtained in patients and relatives of the experimental groups. Conclusions: the application of the healthcare proposals contributed to the achievement of high levels of satisfaction and perceived quality in the users.