Síndromes compresivos del nervio mediano. Revisión y actualización de la bibliografía / Median nerve compression syndromes. Literature review and update

El nervio mediano desciende por el brazo y, en el codo, comienza a atravesar estructuras que pueden generar compresión, como el ligamento de Struthers, el lacertus fibrosus, el pronador redondo, el flexor superficial de los dedos. Finalmente, en la muñeca, se encuentra otro sitio de compresión producido por el ligamento transverso del carpo. Todas estas estructuras pueden provocar signos y síntomas de atrapamiento nervioso y favorecer el deterioro funcional del nervio. Nuestro objetivo es dar a conocer una actualización sobre estos sitios de atrapamiento del nervio mediano, y cómo realizar un diagnóstico preciso e indicar un trata-miento adecuado. Nivel de Evidencia: IV

The median nerve is a nervous structure that begins to cross structures at the level of the elbow that might cause compression. The Struthers ligament, lacertus fibrosus, pronator teres, and flexor digitorum superficialis are among them. Finally, the transverse carpal ligament creates another compression site in the wrist. All these structures can develop pathological signs and symptoms of nerve entrapment, which favors nerve functional degradation. Our objective is to provide an update on these median nerve entrap-ment sites, as well as information on how to establish an accurate diagnosis and provide adequate treatment. Level of Evidence: IV

Nivel de conocimiento, actitudes y prácticas sobre enfermedad periodontal en pacientes diabéticos / Level of knowledge, attitudes and practices on periodontal disease in diabetic patients

RESUMEN Fundamento: La diabetes mellitus y la enfermedad periodontal tienen una relación bidireccional, siendo la prevención la herramienta indispensable para lograr el mejoramiento del nivel de salud bucal. Objetivo: Identificar el nivel de conocimientos, actitudes y prácticas de la enfermedad periodontal en pacientes diabéticos. Metodología: Se realizó un estudio observacional descriptivo de corte transversal de septiembre de 2019 a abril de 2020 en la población diabética de 19 a 40 años del Consultorio Médico de Familia n.o 11 del área de salud de Zaza del Medio perteneciente al municipio Taguasco, provincia Sancti Spíritus. Se estudiaron las variables edad, sexo, nivel de conocimiento, actitudes y prácticas sobre salud bucal. Resultados: En el 67.9 % de los pacientes se observó bajo nivel de conocimientos sobre la enfermedad periodontal, actitud desfavorable el 78.6 % y prácticas deficientes el 57.1 %. Conclusiones: La mayoría de los pacientes diabéticos presentó bajo nivel de conocimientos, actitud desfavorable y prácticas deficientes para lograr la salud periodontal.

ABSTRACT Background: Diabetes mellitus and periodontal disease have a bidirectional relationship, being prevention the essential tool to achieve an improvement in the level of oral health. Objective: To identify the level of knowledge, attitudes and practices of periodontal disease in diabetic patients. Methodology: A cross-sectional descriptive observational study was conducted from September 2019 to April 2020 in the diabetic population aged 19 to 40 years at the doctor´s office 11 in Zaza del Medio health area of Taguasco municipality in Sancti Spíritus province. The variables age, sex, level of knowledge, attitudes and practices on oral health were studied. Results: 67.9 % of the patients had a low level of knowledge about periodontal disease, 78.6 % had an unfavorable attitude and 57.1 % had deficient practices. Conclusions: The majority of diabetic patients presented low level of knowledge, non-favorable attitude and poor practices to accomplish periodontal health.

Epidemiological Analysis of Hospitalizations for Head Trauma in Hospitals of Belém do Pará, Between 2015 and 2019

Objective:The study aimed to describe the epidemiology of cases of hospitalization due to TBI in Belém/PA, between 2015 and 2019.Methodology:This is a descriptive epidemiological study, with a retrospectiveapproach, whose data were obtained through consultation in the Notifiable Diseases Information System.Results:Were 2.103 cases were reported, of which (75, 3%) were male, 80,7% without race/color information, coming largely from the emergency department, with predominance of admission to a Municipal Emergency Hospital (78, 2%). Conclusion:The high incidence of TBI in certain groups, associated with the present need to carry out complete care records, reinforces the need for health information, serving as an epidemiological basis and for the management of services. Therefore, it is extremely important to know the possible causes and act in the planning and elaboration of strategies that aim to prevent the numerous cases of TBI

Immunogenicity and safety of the combined vaccine for measles, mumps, and rubella isolated or combined with the varicella component administered at 3-month intervals: randomised study

BACKGROUND Field testing required to license the combined measles, mumps, and rubella (MMR) vaccine must take into account the current recommendation of the vaccine in Brazil: first dose at 12 months and second dose at 15 months of age in combination with a varicella vaccine. OBJECTIVES This study aimed to evaluate the clinical consistency, immunogenicity, and reactogenicity of three batches of MMR vaccine prepared with active pharmaceutical ingredients (API) from Bio-Manguinhos, Fiocruz (MMR-Bio), and compare it to a vaccine (MMR produced by GlaxoSmithKline) with different API. METHODS This was a phase III, randomised, double-blind, non-inferiority study of the MMR-Bio administered in infants immunised at health care units in Pará, Brazil, from February 2015 to January 2016. Antibody levels were titrated by immunoenzymatic assays. Adverse events were recorded in diaries. FINDINGS Seropositivity levels after MMR-Bio were 97.6% for measles, 84.7% for mumps, and 98.0% for rubella. After the MMRV vaccine, seroconversion rates and GMT increased substantially for mumps. In contrast, approximately 35% of the children had no detectable antibodies to varicella. Systemic adverse events were more frequent than local events. CONCLUSION The demonstration of batch consistency and non-inferiority of the Bio-MMR vaccine completed the technology transfer. This is a significant technological achievement with implications for immunisation programs.

Atrial fibrillation in acute Chagas disease acquired via oral transmission: a case report

Abstract Atrial fibrillation (AF), a type of supraventricular arrhythmia increases the risk of thromboembolism. Chagas disease has been reported in the Brazilian Amazon region over approximately 20 years. Cardiac abnormalities are recorded in at least 50% of patients and among these, 3.3% develop AF. We describe a case of a 41-year-old man from Muaná, Pará State, who reported a 30-day history of a febrile illness. Acute Chagas disease was confirmed, and an electrocardiogram revealed AF. He was treated with antiparasitic and anti-arrhythmic drugs, beta blockers, and anticoagulants. Reversion to sinus rhythm was observed at his 9-month follow-up.

Cambios en la posición de las estructuras esqueléticas del complejo cráneo-cervical posterior a una cirugía ortognática / Changes in the position of cranio-cervical complex skeletal structures after an orthognatic surgery event

El propósito de este estudio fue investigar si existen cambios en la posición de las estructuras esqueléticas del complejo cráneo-cervical posterior a un tratamiento de cirugía ortognática. Se revisaron 30 expedientes de pacientes con maloclusiones esqueléticas iniciales de clase I, II, y III que fueron sometidos a cirugía ortognática. Se midieron las posiciones pre y posquirúrgicas de las vértebras, hioides y rotación de cráneo en la radiografía lateral de cráneo. Se encontró que los pacientes sometidos a cirugía combinada presentan mayor proporción de cambios de rotación de cráneo en sentido posterior (p = 0.006) y en las mujeres se presentó una tendencia a la rotación posterior de cráneo con la disminución en la distancia del atlas a la base de cráneo (p = 0.23). Es importante reconocer estos cambios de rotación de cráneo en los pacientes quirúrgicos ya que pueden ocasionar recidiva de la cirugía ortognática y/o cefalea occipital.

The aim of the present study was to conduct research on presence of changes in skeletal structures' position of the cervical-cranial complex after treatment involving orthognatic surgery. 30 patient files were reviewed. Patients were afflicted with initial class I, II and III malocclusions which had been treated with orthognathic surgery. With the help of lateral skull X-rays, measurements were taken of pre- and post-surgical positions of vertebrae, hyoid bone, as well as skull rotation. It was found that patients subjected to combined surgery presented greater range of skull rotation changes in a posterior direction (p = 0.006). Female patients presented tendency to posterior skull rotation, and exhibited distance decrease from atlas to skull base (p = 0.23). In surgical patients, it is important to timely identify these skull rotation changes since they might elicit relapse of performed orthognathic surgery and/or occipital headache.

Uma questão de tempo: os usos da memória nas aulas de história / A matter of time: the uses of memory in history classes

Levando em consideração que, na atualidade, o tema da memória tem ocupado a agenda de movimentos (ou instituições) classificados como "culturais", o texto faz uma reflexão sobre a fundamentação teórica e os procedimentos metodológicos do conhecimento histórico diante do que se convencionou chamar de "direito à memória". Assim, percebe-se que é preciso estabelecer de maneira mais criteriosa as distinções entre os campos rememorativos e a reflexão crítica que a história pode realizar, no sentido de garantir seu papel educativo.

Alterations of Relevance in Cyber-media Francisco Yus / Alteraciones de la relevancia en los ciber-medios

La forma en que las personas interactúan con otros y acceden a la información ha cambiado drásticamente con la popularización de las “tecnologías de la información y la comunicación (TIC’s)”. Sin embargo, en la teoría de la relevancia Sperber y Wilson (1986) insisten en que nuestro sistema cognitivo se basa en un único criterio cuando interactúa con el mundo circundante: la necesidad de estar orientado hacia la relevancia. Básicamente, cuando interpretamos, cuando accedemos a la información, o cuando aprendemos, todos procedemos a una evaluación de coste-beneficio que pretende obtener información interesante (re-escrita como efectos cognitivos) a cambio del menor esfuerzo de procesamiento posible. El artículo parte de esta premisa de la teoría de la relevancia, pero también muestra cómo los atributos de los ciber-medios alteran la forma en que se evalúa este equilibrio de coste-beneficio y cómo se generan resultados (ir) relevantes a partir de la interacción cognitiva de las personas con estos medios.

The way people interact with other people and access information has changed drastically with the popularisation of “information and communication technologies” (ICT). However, in relevance theory Sperber and Wilson (1986) insist that our cognitive system relies on only one criterion when interacting with the surrounding world: the need to be relevanceoriented. Basically, when interpreting, when accessing information, or when learning, we all engage in a cost-benefit procedure intended to obtain interesting information (named cognitive effects) in exchange for the least mental effort. This article starts with this relevance-theoretic premise, but also shows how the qualities of (now popularized) cyber-media alter the way this cost-benefit balance is assessed and how (ir)relevant outcomes emerge from people’s cognitive interaction with these media.

Avaliação do acesso aos criadouros do aedes Aegypti por agentes de Saúde do Programa Saúde da Família no município do Rio de Janeiro / Access evaluation to the Aedes Aegypti breeding sites by community health agents in Rio de Janeiro citys Family Health Program

Neste estudo foi investigada a capacidade do Agente Comunitário de Saúde (ACS) do Programa Saúde da família (PSF) de verificar a existência de criadouros do Aedes aegypti no município do Rio de Janeiro. Foram percorridos 133 domicílios na companhia dos ACS, observando a pendência e as demais dificuldades de acesso. A pendência foi de 33,3por cento. Na rotina dos ACS, 49,6por cento desses domicílios sempre são visitados, 15,8por cento dos domicílios são visitados na maioria das tentativas, 7,5por cento não são visitados na maioria das tentativas e 27por cento nunca são visitados (domicílios fechados ou moradores nunca encontrados). Dos domicílios visitados 40por cento apresentaram alguma restrição de acesso para verificar a existência de criadouros, em geral, às lajes e caixas dágua. Em aproximadamente 50por cento há algum tipo de entulho domiciliar que dificulta a vistoria de criadouros. Sem a companhia dos ACS, a pendência foi de 45,4por cento, sugerindo que os ACS podem ajudar na redução das pendências. Concluiu-se que as restrições de acesso encontradas nas pendências, nas lajes, caixas dágua e entulhos domésticos impedem que os ACS identifiquem parte dos criadouros, podendo comprometer a eficácia do PSF no controle do Aedes aegypti.

Variabilidade genética de amostras de Salmonella Typhi isoladas de surto e de casos esporádicos ocorridos em Belém, Brasil / Genetic variability of Salmonella Typhi samples isolated from outbreaks and sporadic cases of typhoid fever in Belém, Brazil

INTRODUÇÃO: Salmonella Typhi é o agente da febre tifóide (doença caracterizada por febre, cefaléia, mialgia, artralgia, diarréia ou constipação), cujo quadro pode se complicar e levar o paciente a óbito. No Brasil, a febre tifóide é endêmica nas regiões Norte e Nordeste, com surtos ocorridos nos meses de intenso calor. OBJETIVO: Analisar e comparar a variabilidade genética de S. Typhi isoladas de surto e casos esporádicos de febre tifóide ocorridos em determinado período na cidade de Belém (PA). MATERIAL E MÉTODOS: Foram analisadas 20 amostras de S. Typhi: 10 isoladas de um surto ocorrido no bairro do Guamá, Belém, entre os meses de dezembro/2005 e março/2006, e 10 de casos esporádicos ocorridos em diferentes localidades da mesma cidade e no mesmo período do surto. A caracterização genética foi realizada pela análise do perfil de macrorrestrição obtido pela enzima XbaI e definido por eletroforese em gel de campo pulsado (PFGE). RESULTADOS: A análise de XbaI-PFGE das amostras estudadas demonstrou uma similaridade genética de 83 por cento a 100 por cento. CONCLUSÃO: Este estudo pôde demonstrar a relação clonal das amostras S. Typhi causadoras de surto e de casos esporádicos de febre tifóide ocorridos na cidade de Belém no período de dezembro/2005 a março/2006.

BACKGROUND: Salmonella Typhi is the causative agent of typhoid fever, illness characterized by fever, migraine, myalgia, arthralgia, diarrhea or constipation, which may have complications and cause death. In Brazil, the typhoid fever is endemic in the Northern and Northeastern regions, with outbreaks occurring in scorching months. OBJECTIVE: To analyse and compare the genetic variability of S. Typhi strains isolated from outbreaks and sporadic cases of typhoid fever occurred in the city of Belém (PA) between December 2005 and March 2006. MATERIAL AND METHODS: Twenty samples of S. Typhi were analyzed: 10 of them were isolated from an outbreak occurred in Guamá neighborhood in Belém, between December 2005 and March 2006, and the other 10 were isolated from sporadic cases in different neighborhoods of the same city in the same outbreak period. The genetic characterization was performed by macrorestriction analysis of genomic DNA with XbaI enzyme defined by pulsed-field gel electrophoresis (PFGE). RESULTS: The Xbal-PFGE analysis of the studied samples revealed a genetic similarity of 83 percent to 100 percent. CONCLUSION: This study demonstrated the clonal relation between the S. Typhi samples from the outbreak and from the sporadic cases of typhoid fever occurred in the city of Belém between December 2005 and March 2006.

A insustentável leveza do tempo: os objetos da sociedade de consumo em aulas de história / The unbearable lightness of time: consumer society objects in the history class

O artigo desenvolve propostas para o uso dos objetos em aulas de história. Argumenta-se que a reflexão sobre as múltiplas relações entre sujeitos e objetos pode ser uma via de acesso para a construção da consciência crítica sobre o tempo, ou melhor, sobre as formas pelas quais acontecem ligações e separações entre passado, presente e futuro. O intuito é afirmar a necessidade de colocar, a partir do cotidiano vivido e de reflexões sobre a sociedade de consumo, a memória dos objetos no ensino de história.

This article propose the use of consumer objects in history classes. It argues that the reflection on the multiple relations between citizens and consumer objects may lead to the development of the awareness of time, or better yet, of the connections or disconnections between past, present, and future. The intention is to state the need of a place for the memory of daily life objects and of the reflection on the consumer society in history education.

Complicaciones urológicas postrasplante renal / Urological complications after kidney transplantation

BACKGROUND: Urological complications represent a common problem in kidney transplant surgery. The estimated incidence of these complications occurs in 3-30% of renal transplants. Solving these complications may improve renal graft survival and, consequently, patient outcome. The objective is to establish the prevalence of urological complications after renal transplantation. METHODS: We retrospectively reviewed 338 patients with kidney transplantations performed at the Transplant Unit of the Specialties Hospital of the Western Medical Center over a 6-year period. Data were obtained from the patients' clinical files about the prevalence of urological complications and their management. Renal graft loss prevalence and mortality were reported. RESULTS: Overall prevalence of urological complications was 5.92%. Onset time of all complications occurred between 1 and 210 days. Diagnosis was established using clinical, laboratory and imaging methods. Endourological management with double-J catheter through cystoscopy was used as the first option of treatment in the majority of patients, having complete resolution in all cases. There was no graft loss or mortality in our patients. CONCLUSIONS: The most common urological complication was the urinary fistulae located at the ureterovesical anastomosis. In comparison with other transplant centers worldwide, our prevalence of urological complications was similar.

Desconforto e dor durante realização da mamografia / Discomfort and pain during mammography

A mamografia é o método mais importante na detecção precoce do câncer de mama. Não obstante, o desconforto e a dor são queixas freqüentes durante o exame. OBJETIVO: Avaliar a freqüência de desconforto e de dor durante a mamografia e identificar fatores relacionados com essas queixas. MÉTODOS: Estudo prospectivo incluindo 2.164 pacientes, sendo que 996 previdenciárias e 1.168 da rede privada. Após o exame, a paciente quantificava a dor sentida, de acordo com uma escala linear analógica. O desconforto foi avaliado qualitativamente por análise multivariada. RESULTADOS: O desconforto foi a queixa de 90 por cento das pacientes; dessas 12 por cento referiram desconforto intenso ou intolerável. Apenas 2 por cento do grupo estudado não apresentaram dor durante o exame. Os fatores associados à dor foram: idade da paciente, o uso de anticoncepcional (ACO), mastalgia prévia e pacientes privadas. O desconforto esteve independentemente associado ao centro de realização do exame (OR = 2,50; IC 1,64-5,17) e à mastalgia prévia (OR = 3,15; IC 1,96-7,12). A aceitabilidade de uma futura mamografia foi de 98 por cento. CONCLUSÃO: Mulheres jovens (< 50 anos), usuárias de ACO, portadoras de mastalgia e provenientes de serviços privados apresentaram maior intensidade de dor e desconforto durante a realização da mamografia.

INTRODUCTION: Mammography is the most important method for early detection of breast cancer, however, patients frequently complain of discomfort and pain. OBJECTIVE: Evaluate how often discomfort and pain are felt during mammography and identify factors that may be associated to these complaints. METHODS: A prospective study including 2,164 patients recruited from public (996) and private (1,168) health services was carried out. After the imaging procedure, patients quantified pain using a linear analogical scale. Discomfort was qualitatively evaluated by multivariate analysis. RESULTS: Discomfort was reported by 90 percent of the patients, and of these 12 percent rated the sensation as intense or intolerable. Only 2 percent of the women in the study group did not feel any pain during the procedure. Factors associated to pain were: age, use of birth control methods (BCM), previous mastalgia and patients from the private health sector. Discomfort was independently associated to the service where the procedure was performed (OR = 2.50 IC 1.64-5.17) and to previous mastalgia (OR = 3.15 IC 1.96-7.12). When asked about a repeat mammography, 98 percent of the patients said they would comply. CONCLUSION: Young women (< 50 years), BCM users, mastalgia patients and women who were using the services of a private clinic felt more intense pain and discomfort during mammography.

Modo de herencia de la resistencia a temefos (abate) en Aedes aegypti (Diptera: Culicidae) de Cuba / Mode of inheritance of temephos (Abate) resistance in Aedes aegypti (Diptera: Culicidae) from Cuba

Se realizó el estudio sobre el modo de herencia de la resistencia al insecticida organofosforado temefos, a partir de una cepa de Aedes aegypti de referencia (SAN-F6), resistente, con un valor de factor de resistencia de 200x, comparado con la cepa de Aedes aegypti susceptible a insecticidas (ROCKEFELLER). Se llevaron a cabo cruces genéticos entre la cepa resistente y la susceptible a temefos, obteniéndose una F1 (cruce). Las hembras de esta F1 del cruzamiento se cruzaron con machos de la cepa ROCKEFELLER (retrocruce) y como resultado se obtuvo que la resistencia a temefos se heredó de forma semidominante, mediada por un solo factor. La actividad de Est-A4, observada en la electroforesis en gel de poliacrilamida y medida mediante ensayos bioquímicos, fue mayor en la cepa resistente a temefos (SAN-F6), menor en la cepa susceptible (ROCKEFELLER) e intermedia en el cruce de estas 2 cepas. Un menor efecto del parental resistente fue observado en el retrocruce tanto en la mortalidad con temefos, como en la actividad de la Est. A4. Estos resultados sugieren que la actividad de esterasas pudiera heredarse también, al igual que la resistencia a temefos, como un carácter semidominante

A study on the mode of inheritance of temephos resistance was conducted using a temephos resistant Aedes aegypti reference strain (SAN-F6) with a value of resistance factor of 200x, compared with the insecticides susceptible Aedes aegypti strain (ROCKEFELLER). Genetic crossings were performed between temephos resistant and susceptible strains. An F1 crossing was attained. The females of this F1 crossing were crossed with males from the ROCKEFELLER strain (retrocrossing), and it was found that the temephos resistance was inherited in a semidominant way and as a monofactorial trait. The activity of Est-A4 observed in the polyacrylamide gel electrophoresis and measured by biochemical assays was higher in the strain resistant to temephos (SAN-F6), lower in the susceptible strain (ROCKEFELLER), and intermediate in the crossing of these two strains. A lower effect of the resistant parental strain was observed in the retrocrossing, both in the mortality with temephos and in the activity of Est. A4. These results suggest that the esterase activity may also be inherited, as well as the resistance to temephos, as a semidominant character.

Complicações na febre tifóide: relato de um caso atípico e considerações sobre suas implicações no diagnóstico e no controle / Complications in typhoid fever: description of an anusual case and its bearing on diagnosis and control

Apresenta-se um caso de febre tifóide que cursou com hepatite colestática cujo diagnóstico foi dado pela coprocultura. A negativação das provas para hepatites virais, malária e leptospirose, e a pronta resposta ao tratamento com ciprofloxacina corroboraram o diagnóstico de febre tifóide. Nas áreas endêmicas, essa hipótese deve ser lembrada diante das icterícias febris.

A case of typhoid fever with colestatic hepatitis is described, with diagnosis made by stool culture. Examination for malaria, leptospirosis and viral hepatitis were all negatives. These results and the rapid response of the patient to treatment with ciprofloxacin confirmed the diagnosis of typhoid fever and indicate the importance of considering typhoid fever in cases of fever with jaundice.

Fractura de pene: urgencia urológica / Fracture of penis: urológica urgency

La fractura de pene (ruptura de los cuerpos cavernosos) es una emergencia urológica poco frecuente. El trabajo considera la hipótesis de que el abordaje quirúrgico inmediato disminuye la incidencia tanto de incurvaciones patológicas del pene, así como de disfunción eréctil secundaria. Se analizan retrospectivamente seis casos de ruptura de cuerpos cavernosos que se diagnosticaron y trataron en el Hospital Clínica Alcívar y el Hospital Luis Vernaza de Guayaquil. En todos los casos se procedió a una intervención quirúrgica inmediatamente a la presentación en la sala de emergencia, con drenaje del hematoma y rafia de la albugínea del cuerpo cavernosos afectado. Se presentaron seis pacientes entre 24 y 52 años (x=31 años) con diagnóstico clínico de fractura peneana...

Estudio prospectivo de 2000 pacientes diabéticos de la unidad de diabetes del Hospital Vargas; seguidos con determinación de hemoglobina glicosilada, tratados con educación terapéutica y apoyo social con beca de insulina medicamentos bajo costo (SUMED), durante 55 meses (1995-2000) / Study prospective of 2000 diabetic patients of the unit of diabetes of the Hospital Vargas followed with determination of hemoglobin glicocilada tried with therapeutic education therapy and social support with sholars hip of insulin medications under cost between 55 moths (1995-2000)

El proceso educativo comienza desde el momento de la primera consulta médica y se le da continuidad en las consultas sucesivas de control, igualmente se procura hacerlo en los períodos de hospitalización. A nivel de auditorio principal del hospital se realiza cada último martes del mes, entre 10 y 11 am; una charla a los pacientes, a sus familiares y a la comunidad en general. Esta programación se anuncia con varias meses de anticipación en la cartelera de la UDHV. Estas reuniones tienen un objetivo de información, motivación y en muchos casos tenemos la convicción de observar un real aprendizaje con cambios en el estilo de vida, comprensión adecuada del régimen nutricional y terapéutico. Además generan un entorno positivo de apoyo en el ámbito hospitalario