Instrumento de avaliação prática empírica de materiais termoplásticos para órteses / Empirical practical evaluation instrument for thermoplastic materials for orthoses

Resumo Introdução Após o advento dos termoplásticos de baixa temperatura, sua prevalência na confecção de órteses para membros superiores é identificada por vários autores. A compreensão de suas propriedades, por parte do terapeuta ocupacional e de outros profissionais que atuam na área, é importante no processo de seleção do termoplástico, que segue uma lógica para combinar as características do material à função desejável para cada órtese. Objetivos Sistematizar as características dos termoplásticos de baixa temperatura e, a partir disso, elaborar um instrumento para realizar testes práticos empíricos com os materiais a fim de estabelecer critérios para o seu manuseio e avaliação. Método Pesquisa de caráter exploratório, constituindo a criação de procedimentos de teste e, consequentemente, a elaboração de um instrumento de avaliação de abordagem qualitativa e que valoriza a experiência prática do profissional, que manipula o material e avalia cada requisito. Resultados O instrumento criado contempla 14 caraterísticas do material, acompanhadas de uma definição, um procedimento com recomendações para o teste prático e um campo destinado ao preenchimento das alternativas de resposta. Conclusão O instrumento considera características importantes a serem verificadas durante a avaliação dos materiais e poderá direcionar o olhar e os registros do profissional, auxiliando o nas decisões clínicas. Isso será importante para melhorar a qualidade das órteses e de outros dispositivos de Tecnologia Assistiva confeccionados com esse grupo de materiais. Além disso, a sistematização da avaliação prática dos materiais termoplásticos poderá auxiliar no desenvolvimento de estudos da área da saúde e de pesquisas envolvendo materiais para órteses.

Abstract Introduction After the advent of low-temperature thermoplastics, their prevalence in the manufacture of orthoses for upper limbs has been identified by several authors. The understanding of their properties by occupational therapists and other professionals working in this field is important in the process of selecting the thermoplastic, which follows a logic to match the material's characteristics to the desired function for each orthosis. Objectives Systematize the characteristics of low-temperature thermoplastics and, from that, develop an instrument for carrying out practical empirical tests with the materials, to establish criteria for their handling and evaluation. Method Exploratory study consisting of the creation of testing procedures and, consequently, the development of a qualitative assessment instrument that values ​​the practical experience of the professional who handles the material and evaluates each requirement. Results The created instrument includes 14 material characteristics, accompanied by a definition, a procedure with recommendations for the practical testing, and a field for filling in response alternatives. Conclusions The instrument considers important characteristics to be verified during the evaluation of materials and can direct the professional's observations and records, aiding in clinical decision-making. This will be important to improve the quality of orthoses and other assistive technology devices made with these thermoplastics. In addition, the systematization of the practical evaluation of thermoplastic materials can assist in the development of health studies and research involving materials for orthoses.

Un modelo para la evaluación de las habilidades no técnicas en anestesiología: una revisión de la literatura / A model for the assessment of non-technical skills in anesthesiology: a literature review

Resumen: Hasta 80% de los errores médicos se deben a fallas en factores humanos (mala comunicación, monitoreo inadecuado, fallas de verificación, etc.), por lo que el entrenamiento de los anestesiólogos exige el desarrollo de habilidades no técnicas en anestesiología. Las habilidades no técnicas son las habilidades cognitivas, sociales y personales que complementan las habilidades técnicas, y que contribuyen al desempeño seguro y eficiente de la tarea. En 2004 la Universidad de Aberdeen fue la primera en plantear un modelo para la definición y evaluación de estas habilidades en el ámbito médico. El modelo práctico consta de 15 elementos incluidos en cuatro categorías: manejo de la tarea, trabajo en equipo, conciencia de la situación y toma de decisiones. La herramienta es utilizada por anestesiólogos graduados para evaluar a quienes están en entrenamiento en el quirófano o mediante simulación clínica. La validez de este sistema, así como su importancia en la seguridad del paciente, ha sido demostrada por diferentes estudios.

Abstract: Close to 80% of medical errors are due to human factors (poor communication, inadequate monitoring, failure to check, etc.), which is why training for anaesthetists requires developing essential soft skills for Anaesthesiology. Soft skills are defined as specific cognitive, socio-emotional and interpersonal abilities complementing core skills which contribute to the safe and efficient carrying out of a job-specific task. In 2004, the University of Aberdeen established a first model for defining and evaluating these soft skills. The model consists of 15 elements across four categories: task management, team working, situational awareness and decision-making. The model is a tool employed by postgraduate anaesthesiologists to assess trainees in the operating theatre or through clinical simulation. The validity of this system, as well as its importance for patient safety have been demonstrated in a range of studies.

Cranial bone regeneration with collagen type I and polyvinylpyrrolidone (Fibroquel®) combined with hyaluronic acid in Wistar rats: morphological study / Regeneración ósea craneal con colágeno tipo I y polivinilpirrolidona (Fibroquel®) combinado con ácido hialurónico en ratas Wistar: estudio morfológico

SUMMARY: The purpose of this study was to evaluate by morphological methods, if a mixture of Fibroquel® and hyaluronic acid implanted in an animal model of cranial bone injury could promote bone regeneration. 12 Wistar rats were divided in three groups, control group, bone injury without treatment and bone injury with treatment. After experimental period, bone samples were taken and stained with H & E, Masson trichrome, PAS-D, immunohistochemistry with anti-PCNA monoclonal antibody and applied a semiquantitative morphometric method. Treatment group showed extensive areas of collagen fibers in contact with normal bone tissue, areas of normal histology, PAS positive material and less cellular proliferation. We demonstrated for the first time that a mixture of Fibroquel® and hyaluronic acid implanted in an animal model of cranial bone injury promotes bone regeneration.

RESUMEN: El propósito de este estudio fue evaluar por métodos morfológicos, si una mezcla de Fibroquel® y ácido hialurónico implantado en un modelo animal de lesión del hueso craneal podría promover la regeneración ósea. Se dividieron 12 ratas Wistar en tres grupos, grupo control, lesión ósea sin tratamiento y lesión ósea con tratamiento. Después del período experimental, se tomaron muestras de hueso y se tiñeron con H & E, tricrómico de Masson, PAS-D, inmunohistoquímica con anticuerpo monoclonal anti-PCNA y se aplicó un método morfométrico semicuantitativo. El grupo de tratamiento mostró áreas extensas de fibras de colágeno en contacto con tejido óseo normal, áreas de histología normal, material PAS positivo y menor proliferación celular. Demostramos por primera vez que una mezcla de Fibroquel® y ácido hialurónico implantado en un modelo animal de lesión del hueso craneal promueve la regeneración ósea.

Manejo de recursos en crisis, importancia de las ayudas cognitivas en anestesia / Resource management in crisis, importance of cognitive aids in anesthesia

Resumen: Las ayudas cognitivas son herramientas diseñadas para guiar al usuario en situaciones de crisis, tales ayudas proporcionan instrucciones y garantizan que las tareas a realizar durante la emergencia se lleven a cabo con la mayor exactitud y con esto evitar la omisión de la mayor cantidad de pasos o tareas durante el evento. Está demostrado que las ayudas cognitivas aumentan el rendimiento de los anestesiólogos durante las situaciones de crisis simuladas y más cuando se somete al usuario a casos clínicos raros o de baja incidencia. Presentamos el caso de una mujer de 33 años programada a cirugía electiva, la cual acude súbitamente por probable hipertermia maligna desencadenada por desflurane. Un reader encargado de la lectura de las ayudas cognitivas durante el evento guió las acciones así como el tratamiento sintomático y específico posterior al diagnóstico. Actualmente se recomienda no confiar en la memoria en situaciones de crisis, ya que puede haber omisiones importantes en el diagnóstico, tratamiento y pronóstico.

Abstract: Cognitive aids are tools designed to guide the user in crisis situations, such aids provide instructions and ensure that the tasks to be performed during the emergency are carried out with the greatest accuracy and thus avoid the omission of as many steps or tasks during the event. It is demonstrated that cognitive aids increase the performance of anesthesiologists during simulated crisis situations and more when the user is subjected to rare or low incidence clinical cases. We present the case of a 33-year-old woman scheduled for elective surgery, who suddenly presented probable malignant hyperthermia triggered by desflurane. The actions as well as the symptomatic and specific treatment after diagnosis, was guided by a «reader¼ in charge of reading the cognitive aids during the event. It is currently recommended not to rely on memory in crisis situations as there may be important omissions in diagnosis, treatment and prognosis.

Aprendizaje de una simulación: paciente COVID-19 positivo para cirugía de urgencia / Learning from a simulation: Patient COVID-19 positive for emergency surgery

Resumen: Se realizó una simulación in situ del proceso de atención de paciente con diagnóstico de COVID-19 programado para una cirugía de urgencia. Se observó desde la llegada al Departamento de Urgencias y hasta su salida del quirófano. Se llevaron a cabo los protocolos previamente establecidos y se observó por áreas de oportunidad.

Abstract: An in situ simulation was performed of a patient with COVID-19 diagnosis that is schedule for emergency surgery. From the arrival to the Emergency Department to the exit from the operating theatre. Previously stablished protocols were performed, and areas of improvement were looked for.

Everything is about the story / Tudo é sobre a história

Everything in life is about the story, from our every day, our holidays and trips, to going to the theater or the movies. Everything is about the story and attending a simulation-based course is not the exception. From designing and living, a scenario all the way to debriefing and to the whole course experience at the end the participant will take away the story, will remember the story and will share the story. This story has to be designed to the details, has to be told through languages and has an objective centered on the learner. In this reflection, I discuss with the reader my opinion regarding the relevance of creating a memorable story because at the end it is all about the story.

Tudo na vida é sobre a história, desde todos os dias, férias e viagens, até ir ao teatro ou ao cinema. Tudo é sobre a história, e participar de um curso baseado em simulação não é uma exceção. Desde o design e a vida, um cenário até o debriefing e toda a experiência do curso no final, o participante retirará a história, lembrará da história e compartilhará a história. Esta história deve ser projetada com detalhes, precisa ser contada através de idiomas e tem um objetivo centrado no aluno. Nessa reflexão, discuto com o leitor minha opinião sobre a relevância de criar uma história memorável, porque no final tudo se resume à história.

Opinión de los profesionales de la salud sobre un documento de registro de directivas de adecuación de esfuerzo terapéutico en pediatría / Opinion of health professionals on a document to record guidelines for the adequacy of therapeutic efforts in pediatrics / Opinião dos profissionais de saúde sobre um documento de registro de diretrizes de adequação do esforço terapêutico em pediatria

Resumen: Introducción: en la asistencia médica de niños con enfermedades que amenazan o limitan la vida (EALV), en ocasiones, es necesario realizar adecuación del esfuerzo terapéutico (AET). La Unidad de Cuidados Paliativos Pediátricos del Centro Hospitalario Pereira Rossell (UCPP-CHPR) implementó un procedimiento de toma de decisiones sobre AET y registro en la historia clínica. Objetivo: conocer la opinión de los profesionales de la salud respecto a la utilidad del documento de registro de AET, las principales dificultades encontradas y el interés en capacitarse al respecto. Material y método: estudio descriptivo, transversal, mediante encuesta a médicos y licenciados de enfermería del CHPR entre el 23 de octubre y el 12 de noviembre de 2018. Se contó con el aval del Comité de Ética. Resultados: 75,4% (181/240) de los encuestados había asistido a niños con registro de AET; ocasionalmente: 73,5%, frecuentemente: 21,5%. Consideraron útil contar con registros de AET: 30%, y muy útil: 58%. Expresaron encontrar dudas éticas, clínicas o legales, ocasionalmente: 51,4%, frecuentemente: 27,6%; las principales dudas: responsabilidad al cumplir las directivas y la falta de firma de los padres. Las principales dificultades referidas fueron que los padres no cuentan con el documento durante la atención y que éstos están angustiados y solicitan "hacer todo". La mayoría de los profesionales expresó que sería útil o muy útil recibir más información o capacitación sobre las directivas de adecuación del esfuerzo terapéutico (DAET). Conclusiones: la mayoría de los profesionales encuestados habían participado en la atención de niños con registro de AET. Consideraron útil, o muy útil, contar con estos registros, pero expresaron tener dudas clínicas, éticas o legales ocasionalmente.

Summary: Introduction: during the medical care of children with life-threatening or life-limiting conditions (EALV), sometimes is necessary to adequate the therapeutic effort (ATE). The pediatric palliative care unit of the Pereira Rossell Hospital Center (PPCU- PRHC) implemented a decision-making procedure on ATE and its registration in the clinical history. Objective: to know: the opinion of health care professionals regarding the utility of the ATE registration document, the main difficulties found, and the interest in training activities. Material and method: descriptive, cross-sectional study, by means of a survey of physicians and nurses working in the PRHC, between 23 / 10-12 / 11/2018. It was endorsed by the Ethics Committee. Results: 75.4% (181/240) of the respondents had attended children with ATE documents, occasionally: 73.5%, frequently: 21.5%. They considered it useful to have ATE records: 30% and very useful: 58%. They expressed to find ethical, clinical and / or legal doubts, occasionally: 51.4%, frequently: 27.6%; the main doubts: responsibility when fulfilling the directives and the lack of signature of the parents. The main difficulties referred to were: that the parents do not have the document at the consultation, and that they are distressed and ask to "do everything". Most professionals expressed that it would be useful or very useful to receive more information and/ or training on ATE. Conclusions: most of the professionals surveyed had participated in the care of children with ATE registration. They considered it useful or very useful to have these records, but they expressed occasional clinical, ethical and/ or legal doubts.

Resumo: Introdução: na assistência médica de crianças com enfermidades que ameaçam ou limitam a vida (EALV), em algumas ocasiões, é necessário adequar o esforço terapêutico (AET). A Unidade de Cuidados Paliativos pediátricos do Centro Hospitalario Pereira Rossell (UCPP- CHPR) implementou um procedimento para a tomada de decisões sobre AET e registro no prontuário do paciente. Objetivo: conhecer a opinião dos profissionais de saúde em relação à utilidade do documento de registro de AET, as principais dificuldades encontradas, e o interesse em capacitar-se no tema. Material e método: estudo descritivo, transversal, com entrevistas a médicos e enfermeiras do CHPR, no período 23 de outubro - 12 de novembro de 2018. O estudo obteve a aprovação do Comitê de ética. Resultados: 75,4% (181/240) dos entrevistados haviam atendido crianças com registro de AET - ocasionalmente: 73,5%, frequentemente: 21,5%. Consideraram - útil contar com registros de AET: 30% e muito útil: 58%. Declararam encontrar dúvidas éticas, clínicas e/ou legais: ocasionalmente: 51,4%; frequentemente: 27,6%; as principais dúvidas foram: responsabilidade no cumprimento das diretrizes e a falta da assinatura dos pais. As principais dificuldades relatadas foram: os padres não dispõem do documento durante a atenção, estão angustiados e solicitam "fazer tudo". A maioria dos profissionais declarou que seria útil ou muito útil receber mais informação e/ou capacitação sobre as DAET. Conclusões: a maioria dos profissionais entrevistados havia participado no cuidado de crianças com registro de AET. Consideraram útil ou muito útil contar com estes registros, porém expressaram ter dúvidas clínicas, éticas e/ou legais em algumas oportunidades.

Consideraciones crítico-poéticas para pensar la clínica sistémica relacional: propuesta metodológica para investigación en psicoterapia / Critical-Poetic Considerations to Think about Systemic Relational Clinic: A Methodological Proposal for Psychotherapy Research

Resumen La psicoterapia sistémico relacional ha problematizado, en las últimas décadas, sus supuestos representacionales, avanzando hacia nuevas conceptualizaciones de la experiencia psicoterapéutica. Este artículo presenta el trabajo de un equipo de investigación clínica que, siguiendo los planteamientos teórico-clínicos de Marcelo Pakman, se planteó como objetivo general explorar los movimientos entre micropolítica y poética en el proceso terapéutico, a través de una metodología cualitativa de caso único. Las técnicas de producción de datos fueron la observación participante de seis sesiones de psicoterapia, mediante el uso de un espejo unidireccional (Cámara de Gesell), y seis entrevistas en profundidad con la terapeuta y una con el consultante. Se analizó el material desde un enfoque dialógico que estableció una escucha plural del material. En este artículo se presenta en extenso el dispositivo metodológico implementado y se expone una muestra del tipo de reflexiones clínicas que esta metodología permite construir. Finalmente, se discute acerca de las implicancias y desafíos de hacer una investigación clínica dialógica y reflexiva, y su valor para la formación de psicoterapeutas.

Abstract The relational systemic psychotherapy has problematized in recent decades its representational assumptions, moving towards new conceptualizations of psychotherapeutic experience. This article presents the work of a clinical research team that, following the theoretical approaches of Marcelo Pakman, explored the movements between micro politics and poetics through a qualitative case study methodology. Data production techniques included participant observation in unidirectional mirror of six sessions of psychotherapy, and in-depth interviews with the therapist and the patient. The material was analyzed from a dialogical approach that stressed a plural hearing of the material. This article gives full account of the methodological device and it is presented a sample of the type of clinical reflections that this methodology allows to build. Finally, there are discussed the implications and challenges of conducting a dialogical and reflexive clinical research and its value for psychotherapist training.

Sesgos cognitivos en anestesia, una causa latente de error humano / Cognitive biases in anesthesia, a latent cause of human error

Resumen: Un concepto que ha causado atención en los últimos años es el de los sesgos cognitivos y su influencia en las decisiones y comportamientos diarios de los seres humanos. Los equipos de trabajo en sala de operaciones se forman de diferentes áreas de especialidad y con distintos niveles de experiencia, todos tienen una función y pueden tomar decisiones que afectan al paciente. Este proceso de toma de decisiones se puede basar en experiencia previa, razonamiento clínico y el contexto; la necesidad de realizar diagnósticos y tratamiento rápido en algunas situaciones hace al anestesiólogo particularmente vulnerable a sesgos cognitivos. Presentamos diferentes ejemplos de sesgos cognitivos que se pueden llegar a presentar en sala de operaciones, como puede ser el sesgo de atención, en el cual un estímulo relevante como la necesidad de asegurar la vía aérea puede hacer que el estado hemodinámico del paciente pase desapercibido. El objetivo de este trabajo es crear conciencia particularmente en los anestesiólogos sobre estos sesgos cognitivos, su presencia en el proceso de toma de decisiones en la sala de operaciones y compartimos un par de formas para ayudar a prevenirlos.

Abstract: A concept that has gained attention in the last years is the existance of cognitive biases and their influence in decision making and behaviour of human beings. Teams in the operating room are formed by different medical specialities with varied levels of experience, everyone has a role and every one can make decisions that have an impact in the patient. This decision making process might be based in previous experience, clinical reasoning, and context; the need to make a rapid diagnosis and treatment in some situations makes the anesthesiologist especially vulnerable to cognitive bias. We present different types of cognitive bias that might be present in the operating room for example the attention bias in which a relevant stimulus like the airway management could make the hemodynamic aspect go unnoticed. The goal of this paper is to aware anesthesiologists in particular about this cognitive biases, their presence in the decision making process in the operating room and to share a couple of ways to prevent them.

Evaluación de la actividad antioxidante de Cnidoscolus chayamansa (Chaya), Euphorbia prostrata (Hierba de la Golondrina) y Jatropha dioica (Sangre de Drago) en ratas Wistar inducidas a hiperglicemia / Evaluation of the antioxidant activity of Cnidoscolus chayamansa (Chaya), Euphorbia prostrata (Herb of the Swallow) and Jatropha dioica (Drago blood) in Wistar rats induced to hyperglycemia

RESUMEN: Estudios recientes han demostrado que los compuestos activos presentes en extractos de C. chayamansa, E. prostrata y J. dioica tienen propiedades antioxidantes. Los resultados obtenidos en nuestro estudio fueron compuestos fenólicos solubles mostraron en C. chayamansa 6,34, E. prostrata 10,67, J. dioica 1,83 mg equiv de ácido gálico/gm BS respectivamente. Los antioxidantes solubles en agua por el método ABTS fueron para C. chayamansa 5.9, E. prostrata 12.7 y para J. dioica 2.5 mM equiv. de trolox/gr BS. Los resultados histopatológicos muestran una mejoría en los tejidos tratados con los extractos después de la inducción a hiperglicemia.

SUMMARY: Recent studies have shown that the active compounds present in extracts of C. chayamansa, E. prostrata and J. dioica have antioxidant properties. The results obtained in our study were soluble phenolic compounds showed in C. chayamansa 6.34, E. prostrata 10.67, J. dioica 1.83 mg equiv of gallic acid/gm BS respectively. The antioxidants soluble in water by the ABTS method were for C. chayamansa 5.9, E. prostrata 12.7 and for J. dioica 2.5 mM equiv. of trolox/gr BS. The histopathological results show an improvement in the tissues treated with the extracts after the induction to hyperglycemia.

Reporte de caso: luxación simultánea carpometacarpiana del pulgar y los cuatro dedos / Case report: simultaneous carpometacarpal dislocation of the thumb and four fingers / Relato de caso: deslocamento carpometacarpal simultâneo do polegar e quatro dedos

Introducción: Las luxaciones carpo-metacarpianas son lesiones poco frecuentes, que van del 0.5 al 1% de las luxaciones de los huesos de la mano. Siendo extremadamente infrecuente la luxación simultanea de los 5 dedos. Objetivo: El objetivo de nuestro trabajo es documentar una lesión poco frecuente producida en un paciente asistido en nuestro centro. Así como realizar una puesta a punto sobre las medidas diagnósticas y terapéuticas de dicha lesión. Caso clínico: Se presenta el caso de un hombre de 63 años, diestro, artesano en hierro y madera, que sufre un accidente de tránsito de alta energía en moto versus auto, sufriendo traumatismo en mano derecha, sin presentar otros traumatismos. De la exploración física, en el departamento de emergencia, se constata la mano derecha dolorida con gran deformidad en dorso. Se diagnosticó: luxación dorsal carpo-metacarpiano de los 5 metacarpianos, con fractura del sector distal del trapecio, trapezoide, hueso grande y ganchoso. Se realizó reducción cerrada en block quirúrgico con anestesia general, siendo la reducción inestable se colocan agujas de Kirschner para su estabilización. Se confecciona, además, una férula de yeso de protección. Se solicitó una tomografía computada de control donde se objetiva buena reducción de las 5 articulaciones carpo-metacarpianas. Se retiraron las agujas de Kirschner a las 6 semanas. A los 3 meses de la lesión presenta una mano indolora, con buen rango de movilidad, con disminución a la fuerza prensil máxima comparada con la contralateral. El paciente reanuda sus tareas, incorporándose totalmente al trabajo a los 6 meses. Presenta, al año de la cirugía, un score de DASH excelente. Discusión: Las luxaciones de los 5 metacarpianos son lesiones extremadamente raras. Se han reportado en el mundo menos de 20 casos. A pesar de los elementos clínicos sugestivos, el diagnostico de esta lesión es difícil, siendo fundamental contar con un enfoque radiológico de perfil estricto de mano. Los resultados de esta lesión son inciertos, la función de la mano y la muñeca se mantiene pero frecuentemente asociado a una reducción de fuerza prensil. Este tipo de trauma lleva, en mayor o menor grado, al desarrollo de artrosis carpo metacarpiana a largo plazo.

Introduction: Carpometacarpal join dislocations, are really infrequent injuries, with an incidence that goes from 0,5 to 1% of all bone hand dislocations. Being extremely rare the simultaneous luxation of all five fingers. Objectives: Our work objective is to report a very infrequent injury found on a patient treated at our medical center. As well as getting up to date with diagnosis and treatment of such injury. Clinical case: A 63 year old male case is presented, right-handed, wood and iron artisan, who was involved in a high-impact car crush against a motorbike, suffering a trauma on his right hand, without any other injuries. At the emergency room, the physical examination showed a painful right hand deformed on the back. His diagnosis was dorsal carpometacarpal luxation of all 5 metacarpus, with a distal fracture of the trapezium, trapezoid, capitate and hamate bones. A closed reduction at the surgical room was performed, with general anesthesia, being the reduction unstable therefore Kirschner needles were used for stabilization. A plaster cast was used for its protection. A control tomography was performed showing good reduction of all 5 carpometacarpal joints. Kirschner needles were taken out 6 weeks later, at which point the rehabilitation program was started with the physiatrist team. Three months after the injury, the hand was painless, with a good range of movement, a diminished maximum catching strength compared with the other hand. The patient restarted his usual chores, fully reincorporating to his job 6 months later. He presents an excellent DASH score one year after surgery. Discussion: Luxation of all 5 metacarpus is an extremely rare injury. It has been reported less than 20 cases worldwide. In spite of clinical suggestive elements, the diagnosis of this injury is quite difficult, being of great importance to count with x-rays with a straight profile incidence of the hand. The results of this injury are uncertain; the functionality of the hand and wrist is frequently sustained associated with a reduction of the catching strength. This type of trauma will end up developing in greater or lesser degree, long term carpometacarpal arthrosis.

Introdução: As luxações carpo-metacarpianas são lesões raras, variando de 0,5 a 1% das luxações dos ossos da mão. O deslocamento simultâneo dos 5 dedos é extremamente incomum. Objetivo: O objetivo do nosso trabalho é documentar uma lesão rara produzida em um paciente assistido em nosso centro. Bem como realizar um set-up nas medidas diagnósticas e terapêuticas da referida lesão. Caso clínico: O caso de um homem de 63 anos, destro, artesão em ferro e madeira, que sofre um acidente de motocicleta de alta energia em uma motocicleta contra um carro, sofrendo traumatismo em sua mão direita, sem apresentar outras lesões, é apresentado. A partir do exame físico no pronto-socorro, há uma dor na mão direita com grande deformidade nas costas. Foi diagnosticado: luxação metacarpal do dorsal do carpo dos 5 metacarpos, com fratura do setor trapézio distal, trapézio, osso grande e hamato. Uma redução fechada foi realizada em um bloco cirúrgico com anestesia geral, com a redução instável sendo colocada com fios K para estabilização. Uma tala de gesso protetora também é feita. Solicitou-se tomografia computadorizada de controle, onde foi observada boa redução das 5 articulações carpo-metacarpianas. Os fios de Kirschner foram removidos às 6 semanas. Aos 3 meses após a lesão, ele apresenta uma mão indolor, com boa amplitude de mobilidade, com diminuição da força preênsil máxima em comparação com a força contralateral. O paciente retoma suas tarefas, ingressando totalmente no trabalho aos 6 meses. Um excelente escore DASH é apresentado um ano após a cirurgia. Discussão: As luxações dos 5 metacarpos são lesões extremamente raras. Menos de 20 casos foram relatados no mundo. Apesar dos elementos clínicos sugestivos, o diagnóstico dessa lesão é difícil, sendo fundamental a abordagem radiológica do perfil estrito da mão. Os resultados dessa lesão são incertos, a função da mão e do punho é mantida, mas freqüentemente associada a uma redução na força de preensão. Este tipo de trauma leva, em maior ou menor grau, ao desenvolvimento de artrose metacarpal do carpo a longo prazo.

Principios quirúrgicos y biomecánicos de los métodos de fijación actual en el tratamiento de fracturas de Hoffa / Surgical and biomechanical principles of current fixation methods, in treatment of Hoffa fractures

Las fracturas de los cóndilos femorales en el plano coronal (Hoffa), son lesiones que afectan directamente la biomecánica de la rodilla. Están expuestas a un factor intrínseco de inestabilidad causado por el compromiso de los ligamentos y tendones insertados al fragmento condilar fracturado y a un factor extrínseco de inestabilidad dependiente del estrés mecánico en varo/valgo durante la fase de apoyo de la marcha y movimientos de flexo-extensión. El tratamiento quirúrgico con tornillos canulados sólo permite la compresión interfragmentaria y cierto grado de estabilidad rotacional, sin embargo, ese tipo de fijación podría no ser suficiente para soportar o neutralizar las cargas. Distintos autores han publicado otros métodos de osteosíntesis con el uso de placas en el plano lateral o posterior más la colocación de tornillos en sentido postero-anterior, pero siguen siendo opciones controversiales debido al tipo de morbilidad inherente a cada constructo. El objetivo de este artículo es realizar una revisión de la literatura para analizar la validez de los principios quirúrgicos y biomecánicos en el tratamiento de fracturas tipo hoffa.

Coronal plane fractures of the femoral condyles are commonly known as Hoffa fractures. These are intraarticular fractures that directly affect the biomechanics of the knee and have intrinsic and extrinsic instability patterns. The tendons and ligaments that remain attached to the condylar fragment produce the intrinsic instability. The extrinsic instability is due to the varus/valgus stress applied during the stance phase in the gait cycle as well as the flexion-extension movements. Surgical treatment with cannulated screws only achieves interfragmentary compression and certain amount of rotational stability that is not enough to support or neutralize the loads. Some authors have published different methods of osteosynthesis with lateral or posterior plates in conjunction with screws implanted in the posterior-anterior direction, still these techniques remain controversial due to the morbidity inherent to each construct. The purpose of this article is to review the current concepts of Hoffa fractures including biomechanics and surgical principles with the intention of analyzing their treatment efficacy.

Efectividad de un programa de rehabilitación autoadministrado en el tratamiento del síndrome de hombro doloroso en atención primaria de salud: un estudio clínico aleatorizado, simple ciego / Effectiveness of a self-administered rehabilitation program for shoulder pain syndrome in primary health care

Background: Shoulder pain syndrome (SPS) is frequent and management in primary care is precarious, with a high rate of referral without adequate treatment, overloading rehabilitation and orthopedic services. Aim: To assess the effectiveness of a self-administered rehabilitation program in adults with shoulder pain syndrome in primary care. Patients and Methods: A randomized, single-blind clinical trial (evaluators) with an experimental group (self-administered rehabilitation) and a control group (standard physical therapy) was carried out in 271 adult patients aged 18 or older with unilateral shoulder pain lasting more than six weeks and less than three months. The primary outcome was the recovery perceived by the patient. Constant score for function, quality of life using SF-36, simple shoulder test (SST) and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were also calculated at six, 12 and 24 weeks of follow-up. Results: The self-administered rehabilitation program showed an adjusted effectiveness of 51% at the end of treatment compared to 54% of the standard physical therapy (p > 0.05). No differences in the evolution of the other scores assessed were observed between groups. Conclusions: A self-administered rehabilitation program for painful shoulder was non-inferior than usual physical therapy.

Consumo de sustancias en adolescentes: consideraciones para la práctica médica / Substance use in adolescents: Considerations for medical practice

Resumen El consumo de sustancias entre jóvenes y adolescentes representa un importante problema de salud que se relaciona con lesiones y accidentes graves, discapacidad, trastornos por consumo de sustancias y otros trastornos psiquiátricos, ideación y conducta suicida, conductas sexuales de riesgo, entre otros. Se trata de un problema de salud pública que se ha incrementado de manera considerable en los últimos años. El objetivo de este artículo es revisar los aspectos generales del consumo de sustancias de abuso en adolescentes, como: epidemiología, factores de riesgo, tamizaje, evaluación, diagnóstico, algunas consideraciones para la referencia y tratamiento en un hospital general. Como resultado, se identificó que existen múltiples factores de riesgo del inicio del consumo de sustancias, así como de la aparición de un trastorno por consumo de sustancias. Entre éstos destacan factores individuales, familiares y medioambientales. Asimismo, se identificaron estrategias para la detección temprana, orientación y referencia a tratamiento integral, conocidos como SBIRT (de sus siglas en inglés de Screnning, Brief Intervention, Reference to Treatment). Por último se concluye que la implementación de programas SBIRT en un hospital general es eficaz para mejorar el vínculo entre los servicios del hospital y los programas especializados para tratamiento de los trastornos por consumo de sustancias.

Abstract Substance abuse among young adults and teenagers represents a considerable health issue, as substance use can be associated to serious injuries, accidents, disabilities, substance use and other psychiatric disorders, suicidal ideation and suicidal behavior, sexual risk practices, among others. In the last years, this health problem has been increasing significantly. The objective of this article is to present a review of general aspects of substance abuse in adolescents, such as: epidemiology, risk factors, screening, evaluation, diagnosis, some considerations for referral and general hospital treatment. As a result, it was found that several risk factors have been identified, such as individual, family and environmental factors. Also, strategies for early detection, counsel and reference to integrated treatment known as SBIRT (Screnning, Brief Intervention, Reference to Treatment) were identified. Finally, it is concluded that the implementation of SBIRT programs in general hospital are effective to improve the link between general hospital services to specialized programs for the treatment of substance use disorders.

Principios quirúrgicos en fracturas de platillos tibiales con compromiso de columna posterior / Surgical principles in posterior column tibial plateau fractures

Las fracturas de platillos tibiales son lesiones complejas que incluyen una variedad de patrones morfológicos cada vez mejor caracterizados en la literatura. Históricamente, los esquemas de clasificación se han basado en evaluar los rasgos de fractura en el plano frontal y las técnicas quirúrgicas en lograr la fijación de esos fragmentos, sin tomar en consideración el compromiso óseo que ocurre en la región posterior de los platillos tibiales. Con el advenimiento de la clasificación columnar basada en tomografía computada, se han logrado desarrollar estrategias de fijación optimizada, dando cada vez más relevancia a la columna posterior. Este artículo realiza una revisión extensa de la literatura, otorgando los fundamentos quirúrgicos que explican la importancia del tratamiento específico de la columna posterolateral y posteromedial, con el fin de restablecer la biomecánica normal de la rodilla y el razonamiento quirúrgico de las diversas vías de abordaje específicas para una reducción y osteosíntesis satisfactoria de esos fragmentos.

Tibial plateau fractures are complex injuries which include a variety of morphological patterns that have been increasingly better characterized in the literature. Historically, classifications have focused on description of fracture patterns in the frontal plane, while surgical techniques have focused on reduction of these fragments not considering the osseous defects that occur on the posterior region of the tibial plateau. With new CT scan column based classifications, strategies to optimize fixation have been developed, giving relevance to the posterior column. This article is an exhaustive review of the literature, providing the surgical foundations that explain the importance of specific treatment of the posterolateral and posteromedial column, aiming to restore normal knee biomechanics. Furthermore, this article provides the diverse specific surgical approaches rationale for a satisfactory open reduction and internal fixation of these fragments.

Permanent pacemaker implantation in complete congenital fetal atrioventricular (AV) block: a case report / Implantación de marcapasos permanente en bloqueo atrioventricular (AV) fetal congénito completo: reporte de caso

Abstract: One of the most common pathologies attributed to lupus neonatal refers to atrioventricular (AV) congenital block, which diagnosis can be made between 16 and 30 weeks of gestation due to persistent fetal bradycardia. The development of this disease is mostly related to maternal anti-Ro/SSA and anti-Smith autoantibodies. Currently, there are a number of alternatives for prenatal and postnatal treatment, with some controversy about their viability. The placement of a permanent pacemaker is presented as one of the most appropriate procedures currently, even with the risks awarded. This case report describes the placement of a permanent pacemaker to a two-month-old newborn with high maternal contents of anti-Ro/SSA and anti-Smith nuclear autoantibodies, with a favorable outcome.(AU)

Resumen: Una de las patologías más comunes atribuidas al lupus neonatal se refiere al bloqueo congénito atrioventricular (AV), diagnóstico que se puede realizar entre 16 y 30 semanas de gestación debido a bradicardia fetal persistente. El desarrollo de esta enfermedad se relaciona principalmente con los anticuerpos anti-Ro/SSA materno y anti-Smith. Actualmente, existen varias alternativas para el tratamiento prenatal y postnatal, con cierta controversia sobre su viabilidad. La colocación de un marcapasos permanente se presenta como uno de los procedimientos más adecuados actualmente, incluso con los riesgos adjudicados. Este relato de caso describe la colocación de un marcapasos permanente en un recién nacido de dos meses con alto contenido materno de autoanticuerpos anti-Ro/SSA y anti-Smith, con un resultado favorable.(AU)

Genome-wide association study for birth, weaning and yearling weight in Colombian Brahman cattle

Abstract Genotypic and phenotypic data of 1,562 animals were analyzed to find genomic regions that potentially influence the birth weight (BW), weaning weight at seven months of age (WW) and yearling weight (YW) of Colombian Brahman cattle, with genotyping conducted using Illumina Bead chip array with 74,669 SNPs. A Single Step Genomic BLUP (ssGBLP), approach was used to estimate the proportion of variance explained by each marker. Multiple regions scattered across the genome were found to influence weights at different ages, also dependent on the trait component (direct or maternal). The most interesting regions were connected to previously identified QTLs and genes, such as ADAMTSL3, CAPN2, CAPN2, FABP6, ZEB2 influencing growth and weight traits. The identified regions will contribute to the development and refinement of genomic selection programs for Zebu Brahman cattle in Colombia.

Avaliação da proteína acídica fibrilar glial como marcador da injúria por isquemia-reperfusão hepática / Evaluation of glial fibrillar acidic protein as a marker of hepatic ischemia-reperfusion

OBJETIVO: Avaliar a expressão da Proteína Acídica Fibrilar Glial após a injúria por isquemia-reperfusão. MÉTODOS: vinte e quatro ratos foram distribuídos em quatro grupos: Controle, submetidos à anestesia e biópsia hepática; Simulação, injeção de heparina através da veia cava e dissecção do pedículo hepático superior, biópsia após 24 horas; Isquemia 30 minutos, mesmo procedimento do grupo Simulação, acrescido de clampeamento do pedículo hepático superior por 30 minutos; Isquemia 90 minutos, mesmo procedimento do grupo Isquemia 30 minutos, porém com período de clampeamento de 90 minutos. Após 24 horas de observação, os animais foram submetidos à laparotomia e seus fígados avaliados macroscopicamente, microscopicamente, por coloração de Hematoxilina-Eosina (HE) e submetidos à análise da expressão da GFAP por Western Blotting. RESULTADOS: Não se observou diferença no aspecto macroscópico dos fígados entre os diferentes grupos experimentais, tendo todos evidenciado morfologia normal. A análise por HE não evidenciou diferenças significativas, no que diz respeito à morfologia lobular. Por outro lado, nos grupos isquemia, foram encontrados infiltrados neutrofílicos e pequenas áreas de necrose. A expressão de GFAP foi semelhante em todos os grupos, seja qualitativamente quanto quantitativamente. CONCLUSÃO: A expressão da Proteína Acídica Fibrilar Glial não se alterou em nosso modelo de isquemia-reperfusão.

OBJECTIVE: To evaluate the expression of Glial Fibrillary Acidic Protein (GFAP) after ischemia-reperfusion injury. METHODS: twenty four rats were divided into four groups: Control, submitted to anesthesia and liver biopsy; Sham, receiving injection of heparin through the vena cava and hepatic pedicle dissection, with liver biopsy after 24 hours; Ischemia-30, the same as Sham group, plus hepatic pedicle clamping for 30 minutes; and Ischemia-90, the same procedure of Ischemia-30 group, but with clamping period of 90 minutes. After 24 hours of observation, the animals underwent laparotomy and we evaluated their livers macroscopically, microscopically by hematoxylin-eosin (HE) and analyzed the expression of GFAP by Western Blotting. RESULTS: There was no difference in the gross appearance of the livers between the different experimental groups, all having demonstrated normal morphology. HE analysis showed no significant differences with respect to lobule morphology. On the other hand, in the ischemia groups we observed neutrophilic infiltrates and small areas of necrosis. GFAP expression was similar in all groups, either qualitatively and quantitatively. CONCLUSION: The expression of Glial Fibrillary Acidic Protein did not change in our model of ischemia-reperfusion.

Conocimientos, actitudes y habilidades de los adolescentes escolarizados del sector público de Barranquilla (Colombia) relacionados con su sexualidad / Knowledge attitudes and skills in adolescents from the public sector of Barranquilla (Colombia) related to their sexuality

Objetivo: Determinar los conocimientos, actitudes y prácticas de los adolescentes escolarizados del sector público de Barranquilla (Colombia) relacionados con su sexualidad. Materiales y métodos: Estudio descriptivo transversal, en una muestra probabilística de tamaño mínimo de 2460 adolescentes de edades entre 10 a 19 años, de ambos sexos, de los grados 6 a 11 (bachillerato). Los datos fueron recolectados mediante la técnica de encuesta utilizando un formulario autodiligenciado. Resultados: el 58 % de los encuestados eran mujeres; y cabe destacar que un 1% refirió que tenía algún tipo de relación estable. Entre los principales resultados están: padres como modelo para seguir; poco modelaje de profesores; inicio temprano de relaciones sexuales en ambos sexos (en mujeres 14,76 años [±1.6] y en hombres 13,79 años [±2,12]); expectativas poco claras de relaciones sexuales futuras (21 % planea tener >2 parejas sexuales no al mismo tiempo y 8,6 % al mismo tiempo); segmentos de adolescentes que tienen relaciones sexuales en grupo (12.7 % de hombres vs. 4% de mujeres [p<0.05]) y por dinero (14 % de aquellos que tuvieron sexo); bastante conocimiento sobre sexo seguro (67.4 % de hombres y 63.2 % de mujeres creen en el preservativo como método para el sexo seguro [p<0,05]), enfermedades de transmisión sexual, virus de la inmunodeficiencia/síndrome de inmunodeficiencia adquirida (70.6 % en hombres y 69.2% en mujeres [p>0,05]) y mecanismos de transmisión, pero poca aplicación del condón y otras medidas de prevención e identificación de falencias en la educación sexual de los adolescentes. Conclusiones: Existe un déficit grande en el proceso de educación, que se refleja en los resultados, lo que implica hacer ajustes en los programas de promoción de la salud sexual y reproductiva ofrecidos por el ente territorial a través de sus secretarías de Salud y Educación de Barranquilla. De igual manera, se detectan inconsistencias entre el grado de conocimiento con las actitudes y prácticas de los adolescentes, lo cual incide negativamente en el desarrollo de su sexualidad.

Objective: To determine knowledge, attitudes and practices of adolescents, from public schools in Barranquilla, related to their sexuality. Materials and methods: We performed a cross-sectional study in a random sample of 2.460 adolescents aged 10 to 19 years, of both sexes, in grades 6 to 11 (high school). Data were collected using a self-report survey. Results: 58% of the participants were women, and 1% of the sample reported having a stable romantic relationship. The main results are: Parents as a role models, lack of role models in teachers, early onset of sexual intercourse in both sexes (14,76 years [±1.6] in women, and 13,79 years [±2,12] in men); unclear expectations of future sex partners (21% plan to have 2 or more sexual partners not at the same time, and 8,6% at the same time), segments of teenagers having group sex (12.7% of men vs. 4% of women [p<0.05]) and for money (14% of those who had had sex), enough knowledge about safe sex (67.4% of men and 63.2% of women believe in condoms as a safe sex method for having sex [p<0,05]), sexually transmitted diseases and human immunodeficiency virus/ acquired immunodeficiency syndrome (70.6% of men and 69.2% of women [p>0,05]) and its transmission mechanisms, but limited use of condoms and other family planning methods, and identification of weaknesses in sexual education of adolescents. Conclusions: There is an apparent failure in the education processes of adolescents, reflected in the results of the study. This failure implies to make adjustments in the current Sexual Health Promotion Programs offered by Health and Education authorities of Barranquilla. The present study detects some inconsistencies in the knowledge, atitudes and practices of adolescents from Barranquilla that impact upon their sexuality development in a negative way.

Precisión diagnóstica de la escala RIPASA para el diagnóstico de apendicitis aguda: análisis comparativo con la escala de Alvarado modificada / Diagnostic accuracy of the RIPASA Score for the diagnosis of acute appendicitis: comparative analysis with the modified Alvarado Score

Objetivo: Evaluar en forma comparativa la escala de Alvarado modificada y la escala RIPASA, para conocer su utilidad en el diagnóstico de apendicitis aguda en un hospital de tercer nivel de atención del sector salud. Sede: Hospital General de México. Diseño: Estudio prospectivo, transversal, comparativo y observacional. Análisis estadístico: Medidas de tendencia central, análisis para pruebas diagnósticas (sensibilidad, especificidad, valores predictivos, likelihood ratio o coeficiente de probabilidad) y curva ROC. Pacientes y métodos: De acuerdo al cálculo de tamaño de muestra se estudiaron 70 pacientes, que ingresaron al Servicio de Urgencias del Hospital General de México con síndrome doloroso abdominal sugestivo de apendicitis aguda, se les realizaron estudios de laboratorio y gabinete. Aplicando en forma simultánea las escalas de Alvarado modificada y la RIPASA. Se anotaron hallazgos clínicos, quirúrgicos e histopatológicos del apéndice. Resultados: La escala de Alvarado presentó una sensibilidad de 89.5% y especificidad de 69.2%, la RIPASA presentó una sensibilidad de 91.2% y especificidad de 84.6%. El área bajo la curva ROC de la escala RIPASA fue de 0.93, superior a la de Alvarado de 0.89. Si la decisión quirúrgica se hubiera realizado con base en la escala de Alvarado, las apendicectomías negativas se hubieran presentado en 18.3% pacientes, y con RIPASA disminuirían a 15.7%. Conclusiones: Ambas escalas presentaron buena sensibilidad para el diagnóstico de apendicitis aguda. La escala RIPASA presentó mejor especificidad y valores predictivos, con menor probabilidad de apendicectomías negativas. La escala RIPASA presenta mayor exactitud diagnóstica que la de Alvarado.

Objective: To assess comparatively the Modified Alvarado and the RIPASA scores, to know their usefulness in the diagnosis of acute appendicitis in a third level health care hospital. Setting: General Hospital of Mexico. Design: Prospective, cross-sectional, comparative, and observational study. Statistical analysis: Central Tendency Measures, analyses for diagnostic tests (specificity, sensitivity, predictive values, likelihood ratio) and ROC curve. Patients and methods: According to the established sample size, we studied 70 patients that were admitted at the Emergency Ward of the General Hospital of Mexico, with abdominal pain syndrome suggestive of acute appendicitis. Laboratory and imaging studies were performed. The modified Alvarado and RIPASA scores were applied simultaneously. Clinical, surgical, and histopathological findings were recorded. Results: The Alvarado score presented a sensitivity of 89.5% and a specificity of 69.2%, whereas RIPASA presented a sensitivity of 91.2% and specificity of 84.6%. The area under the ROC curve for the RIPASA score was 0.93, higher than that of the Alvarado with 0.89. If surgical decision had been based on the Alvarado score, negative appendicectomies would have been encountered in 18.3% of patients, and with RIPASA they would have diminished to 15.7%. Conclusions: Both scores presented a good sensitivity for the diagnosis of acute appendicitis. RIPASA presented better specificity and predictive values, with a lower likelihood of negative appendicectomies. The RIPASA score had a better diagnostic accuracy than the Alvarado score.