Disminución de la debilidad muscular adquirida en una unidad de cuidados intensivos con la implementación de un protocolo multicomponente: ensayo clínico cuasiexperimental

Introducción. La debilidad adquirida en las unidades de cuidados intensivos es una complicación frecuente de los pacientes con enfermedades críticas, que puede tener un impacto negativo en su pronóstico a corto y a largo plazo. Objetivos. Evaluar si la utilización de un protocolo multicomponente, que incluye movilidad activa temprana, manejo efectivo del dolor, reducción de la sedación, medidas no farmacológicas para prevenir el delirium, estimulación cognitiva y apoyo familiar, puede disminuir la incidencia de debilidad adquirida en las unidades de cuidados intensivos al momento del egreso del paciente. Materiales y métodos. Se trata de un ensayo clínico, no aleatorizado, en dos unidades de cuidados intensivos mixtas de un hospital de tercer nivel. Los participantes fueron pacientes mayores de 14 años con ventilación mecánica invasiva por más de 48 horas. Se aplicó como intervención un protocolo multicomponente y como control se utilizó el cuidado usual o estándar. Resultados. Ingresaron 188 pacientes al estudio, 82 al grupo de intervención y 106 al grupo control. La tasa de debilidad adquirida en las unidades de cuidados intensivos al egreso de la unidad fue significativamente menor en el grupo de intervención (41,3 % versus 78,9 %, p<0,00001). La mediana del puntaje de movilidad al momento del alta de la unidad de cuidados intensivos fue mayor en el grupo de intervención (3,5 versus 2, p<0,0138). No se encontraron diferencias estadísticamente significativas en las medianas de días libres de respiración mecánica asistida, ni de unidad de cuidados intensivos al día 28, tampoco en la tasa de mortalidad general al egreso del hospital (18 versus 15 días, p<0,49; 18,2 % versus 27,3 %, p<0,167). Conclusiones. Un protocolo multicomponente que incluía movilidad activa temprana tuvo un impacto significativo en la reducción de la debilidad adquirida en las unidades de cuidados intensivos al egreso en comparación con el cuidado estándar.

Introduction. Intensive care unit-acquired weakness is a frequent complication that affects the prognosis of critical illness during hospital stay and after hospital discharge. Objectives. To determine if a multicomponent protocol of early active mobility involving adequate pain control, non-sedation, non-pharmacologic delirium prevention, cognitive stimulation, and family support, reduces intensive care unit-acquired weakness at the moment of discharge. Materials and methods. We carried out a non-randomized clinical trial in two mixed intensive care units in a high-complexity hospital, including patients over 14 years old with invasive mechanical ventilation for more than 48 hours. We compared the intervention -the multicomponent protocol- during intensive care hospitalization versus the standard care. Results. We analyzed 82 patients in the intervention group and 106 in the control group. Muscle weakness acquired in the intensive care unit at the moment of discharge was less frequent in the intervention group (41.3% versus 78.9%, p<0.00001). The mobility score at intensive unit care discharge was better in the intervention group (median = 3.5 versus 2, p < 0.0138). There were no statistically significant differences in the invasive mechanical ventilation-free days at day 28 (18 versus 15 days, p<0.49), and neither in the mortality (18.2 versus 27.3%, p<0.167). Conclusion. A multi-component protocol of early active mobility significantly reduces intensive care unit-acquired muscle weakness at the moment of discharge.

Characterization of the dietary and sociodemographic profile of a group of Colombian vegetarian women in childbearing age during the period 2021-2022 / Caracterização do perfil alimentar e sociodemográfico de um grupo de mulheres vegetarianas colombianas em idade fértil no período 2021-2022

ABSTRACT Objective To determine the dietary and sociodemographic profile of vegetarian women of childbearing age (18 and 49 years) from the Valle de Aburrá Metropolitan Area in 2021-2022 Methods Through an online survey, 232 vegetarian and vegan women of childbearing age (18 to 49 years) from the Valle de Aburrá Metropolitan Area were surveyed regarding their sociodemographic characteristics, amount of time following this eating pattern and, type and reason for choosing vegetarianism, physical activity, use of nutritional supplements and frequency of consumption of certain food groups. Descriptive analyses, association of variables with the type of vegetarianism and multinomial regression models were performed. Results A total of 232 vegetarian women were surveyed: 60.8% were between 18 and 30 years of age and belonged mainly to the middle class. According to the type of diet, 68.1% used an ovo-lacto-vegetarian diet, 18.1% were vegan, 9.0% lacto-vegetarian and 4.8% ovo-vegetarian. Among the factors evaluated in their potential relationship with the different types of vegetarianism, it is highlighted that vitamin B12 supplementation presents a statistically significant association when using veganism as a comparison category. Conclusion According to the results, among young female adults the vegetarian eating style predominates, without significant differences as to the educational level, adequate levels of physical activity in most of the population; there was a higher prevalence of ovo-lacto-vegetarianism. Vitamin B12 supplementation was significantly higher in the vegan population, indicating that ovo-lacto and ovo-vegetarian populations may be at high risk of vitamin B12 deficiency.

RESUMO Objetivo O estudo objetivou determinar a associação entre o perfil sociodemográfico e alimentar de mulheres vegetarianas em idade fértil (18 a 49 anos) na região metropolitana de Valle de Aburrá (Colômbia) em 2021-2022. Métodos Por meio de um questionário online, 232 mulheres vegetarianas e veganas em idade fértil (18 a 49 anos) pertencentes à região metropolitana de Valle de Aburrá foram entrevistadas sobre suas características sociodemográficas, tempo, tipo e motivo da escolha do vegetarianismo, atividade física, consumo de suplementos nutricionais e frequência de consumo dos grupos dos alimentos. Foi realizada análise descritiva, associação das variáveis com o tipo de vegetarianismo e modelos de regressão multinomial. Resultados Foram entrevistadas 232 mulheres vegetarianas: 60,8% tinham entre 18 e 30 anos e pertencem principalmente à classe social média. De acordo com o tipo de dieta, 68,1% tinham uma dieta ovolactovegetariana; 18,1%, vegana; 9%, lactovegetariana; e 4,8%, ovovegetariana. Entre os fatores avaliados em sua possível relação com os diferentes tipos de vegetarianismo, destaca-se que a suplementação de vitamina B12 apresenta associação estatisticamente significativa ao ter o veganismo como categoria de comparação. Conclusão De acordo com os resultados, entre mulheres adultas jovens, predomina o estilo alimentar vegetariano, sem diferença significativa observada no nível de escolaridade e níveis adequados de atividade física na maioria da população; há também maior prevalência de ovolactovegetarianismo. A suplementação de vitamina B12 é significativamente maior na população vegana, indicando um alto risco de deficiência nas populações ovolacto e ovovegetarianas.

Síndrome del dedo azul: de la piel a lo multisistémico / Blue digit syndrome: from skin to a multisystemic etiology

El signo del dedo azul (SDA) es una condición poco frecuente causada principalmente por la oclusión de la vasculatura periférica. Clínicamente puede manifestarse como una coloración azulada o eritrocianótica en uno o varios dedos en ausencia de traumatismo y condiciones propias de congelación. Las etiologías son múltiples e incluyen obstrucción del flujo arterial, disminución del flujo venoso y alteración en la viscosidad sanguínea. La importancia de reconocer el signo como motivo de consulta radica en encaminar un diagnóstico temprano e instaurar un tratamiento que evite la evolución natural de la enfermedad hacia la necrosis, amputación o muerte del paciente. Proponemos un algoritmo diagnóstico para reconocer los elementos de la historia clínica que guíen la etiología y los paraclínicos disponibles desde el Servicio de Urgencias.

Blue finger sign (BFS) is a rare condition caused mainly by occlusion of peripheral vasculature. Clinically it may manifest as a bluish, or erythrocyanotic discoloration of one or more fingers in the absence of trauma and freezing conditions. The etiologies are multiple and include arterial flow obstruction, decreased venous flow, and altered blood viscosity. The importance of recognizing the sign as a reason for consultation lies in the early diagnosis and the establishment of a treatment that finally avoids the natural evolution of the disease towards necrosis and finally amputation or death of the patient. We propose a diagnostic algorithm based on recognizing elements of the clinical history that guide the etiology and paraclinical available from the Emergency Department.

Influencia del etiquetado nutricional en la decisión de compra de estudiantes universitarios / Influence of Nutritional Labeling on the Purchase Decision of University Students

Resumen: Antecedentes: el etiquetado nutricional permite a los consumidores tomar mejores decisiones sobre alimentación, lo que contribuye a combatir las enfermedades crónicas no transmisibles. Objetivo: determinar cómo influye la interpretación del etiquetado nutricional, presente en los alimentos industrializados en Colombia, en la decisión de compra de estudiantes de pregrado del área de la salud de la Universidad CES. Materiales y métodos: se realizó un estudio observacional descriptivo en 76 estudiantes de quinto semestre de programas de pregrado del área de la salud. Resultados: la frecuencia en el uso del etiquetado nutricional se asoció con el sexo (p = 0,036), el tipo de programa (p < 0,001) y el conocimiento de la función del etiquetado nutricional (p = 0,000). La buena interpretación del etiquetado nutricional no condicionó la frecuencia en su uso (p = 0,095); además, el nivel de interpretación del etiquetado nutricional no se asoció con el sexo ni con el tipo de programa de pregrado. Finalmente, se encontró que la decisión de compra estaba influenciada por la costumbre (p = 0,018) y la publicidad (p = 0,008) y no por la interpretación del etiquetado nutricional. Conclusiones: aunque el uso del etiquetado nutricional es más frecuente entre las mujeres, los estudiantes de Nutrición y Dietética y entre quienes conocen la función del etiquetado nutricional, la decisión de compra no está influenciada por su interpretación.

Abstract: Background: Nutritional labeling enables consumers to make better food choices, helping to fight chronic non-communicable diseases. Objective: To determine the influence of the interpretation of the nutritional labeling, present in industrialized foods in Colombia, on the purchase decision of undergraduate students in the health area of the CES University. Material and Methods: A descriptive observational study was carried out in a population of 76 fifth-semester students enrolled in the undergraduate programs of the health area. Results: The frequency of nutrition labeling use was associated with sex (p=0.036), the type of undergraduate program (p<0.001), and knowledge of the function of the nutrition labeling (p=0.000). A good interpretation of the nutrition labeling does not condition the frequency of its use (p=0,095). Additionally, the level of interpretation of the nutritional labeling was not associated with sex, nor the type of undergraduate program. Finally, it was found that the purchase decision was influenced by custom (p=0.018) and advertising (p=0,008), and not by the interpretation of the nutrition labeling. Conclusions: Although the use of nutrition labeling is more frequent among women, among students of Nutrition and Dietetics, and among those who are aware of the role of nutrition labeling, the purchase decision is not influenced by its interpretation.

Honeycomb: a template for reproducible psychophysiological tasks for clinic, laboratory, and home use

Objective: To improve the ability of psychiatry researchers to build, deploy, maintain, reproduce, and share their own psychophysiological tasks. Psychophysiological tasks are a useful tool for studying human behavior driven by mental processes such as cognitive control, reward evaluation, and learning. Neural mechanisms during behavioral tasks are often studied via simultaneous electrophysiological recordings. Popular online platforms such as Amazon Mechanical Turk (MTurk) and Prolific enable deployment of tasks to numerous participants simultaneously. However, there is currently no task-creation framework available for flexibly deploying tasks both online and during simultaneous electrophysiology. Methods: We developed a task creation template, termed Honeycomb, that standardizes best practices for building jsPsych-based tasks. Honeycomb offers continuous deployment configurations for seamless transition between use in research settings and at home. Further, we have curated a public library, termed BeeHive, of ready-to-use tasks. Results: We demonstrate the benefits of using Honeycomb tasks with a participant in an ongoing study of deep brain stimulation for obsessive compulsive disorder, who completed repeated tasks both in the clinic and at home. Conclusion: Honeycomb enables researchers to deploy tasks online, in clinic, and at home in more ecologically valid environments and during concurrent electrophysiology.

Método LAMP como alternativa diagnostica para la detección del virus SARS-CoV-2 / LAMP method as a diagnostic alternative for the detection of the SARS-CoV-2 virus / Método LAMP como alternativa de diagnóstico para a detecção do vírus SARS-CoV-2

RESUMEN Introducción: el coronavirus SARS-CoV-2, causante de la enfermedad COVID-19 se ha convertido en un problema de salud pública mundial que requiere la implemen-tación de pruebas de diagnóstico rápidas y sensibles. Objetivo: evaluar y comparar el límite de detección del método LAMP con respecto al método estándar y aplicar el método RT-LAMP para el diagnóstico de SARS-CoV-2 en muestras clínicas de pacientes colombianos. Métodos: se realizó un estudio descriptivo y transversal, analizando un total de 25 muestras de hisopado nasofaríngeo incluyendo muestras negativas y positivas para SARS-CoV-2, a través del método RT-LAMP comparado con el método estándar RT-qPCR. Resultados: el método LAMP detectó ~18 copias del gen N, en 30 min, demostrando un límite de detección similar al obtenido con el método estándar, en un menor tiempo y una concordancia en RT-LAMP del 100 % con los resultados. Conclusiones: RT-LAMP es un método sensible, específico y rápido que puede ser empleado para el diagnóstico de la enfermedad COVID-19.

SUMMARY Introduction: The SARS-CoV-2 coronavirus, that causes the COVID-19 disease, has become a global public health problem that requires the implementation of rapid and sensitive diagnostic tests. Aim: To evaluate and compare the sensitivity of LAMP assay to a standard method and use RT-LAMP for the diagnosis of SARS-CoV-2 in clinical samples from Colombian patients. Methods: A descriptive and cross-sectional study was conducted. A total of 25 nasopharyngeal swab samples including negative and positive samples for SARS-CoV-2 were analyzed, through the RT-LAMP method compared to the RT-qPCR assay. Results: LAMP method detected ~18 copies of the N gene, in 30 min, evidenced a detection limit similar to the standard method, in a shorter time and a concordance in RT-LAMP of 100% with the results. Conclusions: RT-LAMP is a sensitive, specific, and rapid method that can be used as a diagnostic aid of COVID-19 disease.

RESUMO Introdução: o coronavírus SARS-CoV-2, causador da doença de COVID-19, tornou-se um problema de saúde pública global que requer a implementação de testes diagnósticos rápidos e sensíveis. Objetivo: avaliar e comparar o limite de detecção do método LAMP em relação ao método padrão e aplicar o método RT-LAMP para o diagnóstico de SARS-CoV-2 em amostras clínicas de pacientes colombianos. Métodos: foi realizado um estudo descritivo e transversal, analisando um total de 25 amostras de hissopado nasofaríngeo, incluindo amostras negativas e positivas para SARS-CoV-2, pelo método RT-LAMP em comparação ao método RT-qPCR padrão. Resultados: o método LAMP detectou ~18 cópias do gene N, em 30 min., demonstrando um limite de detecção semelhante ao obtido com o método padrão, em um tempo menor e uma concordância no RT-LAMP de 100% com os resultados. Conclusões: RT-LAMP é um método sensível, específico e rápido que pode ser usado para o diagnóstico da doença de COVID-19.

Production, characterization and kinetic model of biosurfactant produced by lactic acid bacteria

BACKGROUND Biosurfactants are surface active molecules produced by microorganisms which have the ability to disrupt the plasma membrane. Biosurfactant properties are important in the food, pharmaceu tical and oil industries. Lactic acid bacteria can produce cell-bound and excreted biosurfactants. RESULTS The biosurfactant-producing ability of three Lactobacillus strains was analyzed, and the effects of carbon and nitrogen sources and aeration conditions were studied. The three species of lactobacillus eval uated were able to produce biosurfactants in anaerobic conditions, which was measured as the capacity of one extract to reduce the surface tension compared to a control. The decreasing order of biosurfactant production was L. plantarum>Lactobacillus sp.>L. acidophilus. Lactose was a better carbon source than glu cose, achieving a 23.8% reduction in surface tension versus 12.9% for glucose. Two complex nitrogen sources are required for growth and biosurfactant production. The maximum production was reached at 48 h under stationary conditions. However, the highest level of production occurred in the exponential phase. Biosurfactant exhibits a critical micelle concentration of 0.359 ± 0.001 g/L and a low toxicity against E. coli. Fourier transform infrared spectroscopy indicated a glycoprotein structure. Additionally, the kinetics of fermentation were modeled using a logistic model for the biomass and the product, achieving a good fit (R2 > 0.9). CONCLUSIONS L. plantarum derived biosurfactant production was enhanced using adequate carbon and nitrogen sources, the biosurfactant is complex in structure and because of its low toxicity could be applied to enhance cell permeability in E. coli

Principales factores relacionados con las infecciones asociadas a la atención en salud en población neonatal entre 2014 a 2020. Revisión sistemática / Main factors related with the acquisition of health care associated infections in the neonatal population between 2014 to 2020. Systematic review

Introducción. Las infecciones asociadas a la atención en salud son un efecto adverso frecuente. Los neonatos son un grupo poblacional afectado debido a su inmadurez inmunitaria. La Organización Mundial de la Salud estima que estas infecciones varían entre 5% a 25% en función del nivel de ingresos de cada país. En Colombia se evidencia un subregistro para estas infecciones, particularmente en los neonatos. Este estudio buscó identificar los factores de riesgo, microorganismos más comunes, y las vías de transmisión y colonización relacionadas a las infecciones asociadas a la atención en salud en neonatos, según lo reportado en la literatura mundial. Metodología. Se realizó una búsqueda sistemática por duplicado, que incluyó pesquisa de artículos, primera lectura y exclusión de duplicados, conciliación entre autores y evaluación de la calidad, en la base de datos PubMed, con artículos publicados entre los años 2014 a 2019. Resultados. El nivel de evidencia y el grado de recomendación fue bueno en general (niveles 1 y 2, recomendación A y B). Los factores de riesgo más comunes fueron la prematuridad y el bajo peso al nacer, el uso de catéter venoso central, ventilación mecánica, estancia hospitalaria prolongada y el uso de antibióticos por largo tiempo. Se reportaron microorganismos de importancia como Staphylococcus coagulasa negativos y Serratia marcenscens, y vías de transmisión y colonización comunes como el torrente sanguíneo, la vía respiratoria, la gastrointestinal y la piel. Conclusión. Las infecciones asociadas a la atención en salud son más frecuentes de lo estimado y se pueden prevenir con la adopción de políticas sanitarias, como son un correcto lavado de manos, la desinfección del ambiente y equipos médicos, un adecuado cuidado de la piel del neonato y protocolos de aislamiento para pacientes con estas infecciones

Introduction. Health care-associated infections are a frequent adverse effect. Neonates are an affected population group due to their immune immaturity. The World Health Organization estimates that these infections vary between 5% to 25% depending on the income level of each country. In Colombia these infections are underreported, particularly in neonates. The aim of this review was to identify the risk factors, the most common microorganisms, and the routes of transmission for these type of infections in neonates, as reported in the world literature. Methodology. A systematic duplicate search was carried out in PubMed, with articles published between 2014 to 2019, which included a search for articles, reading and exclusion of duplicates, reconciliation between authors, and quality assessment. Results. The level of evidence and the grade of recommendation was optimal in general (levels 1 and 2, recommendation A and B). The most common risk factors were prematurity and low birth weight, the use of central venous catheter, mechanical ventilation, prolonged hospital stay, and long-term use of antibiotics. Microorganisms such as coagulase negative Staphylococcus and Serratia marcenscens were reported, and common routes of transmission such as the bloodstream, respiratory tract, gastrointestinal tract, and skin were described. Conclusion. Health care-associated infections are more frequent than estimated, and can be prevented with the adoption of health policies, such as proper hand washing, disinfection of environmental surfaces and medical equipment, an adequate skin care of the neonate, and isolation protocols for patients with these infections

Perspectivas investigativas en torno a las parejas sin hijos y su relación con el concepto de "familia": Un estado del arte / Investigative perspectives on couples without children and their relationship with the concept of "family": A state of the art

Resumen El objetivo del trabajo que se informa fue mostrar cuáles son las transformaciones que las investigaciones manifiestan sobre la familia e identificar si las parejas sin hijos son consideradas como una tipología emergente de configuración familiar. A partir de una investigación documental al modo de estado del arte, se recolectaron 35 artículos entre 1992 y 2017, que se analizaron desde una perspectiva hermenéutica a partir de los núcleos temáticos "definición y transformación del concepto de 'familia'" y "perspectivas investigativas en torno a la relación entre parejas sin hijos y familia". La mayoría concuerda con que la consanguinidad y la procreación ya no son criterios indispensables para conformar una familia, y así, las parejas sin hijos se constituyen como una nueva tipología familiar que se caracteriza por modos más equitativos, consensuales y democráticos de tomar decisiones; todo esto, bajo el contexto social de una profunda transformación de los roles de género desde el siglo XX.

Abstract The objective of the work reported was to show the transformations the research shows about the family and to identify if couples without children are considered as an emerging typology of family configuration. The importance of the relationship between the categories of family and a couple without children is that this is a time when a significant reduction in the birth rate can be seen worldwide. Furthermore, households made up of couples who state that they do not want to have children also represent a striking increase. On the other hand, this phenomenon has led to the emergence of research categories such as DINK, Childfree and NoMo families, which converge in the increase of couples without children and of women who do not wish to have children. From a documentary research under the modality of the state of the art, 35 articles were collected for this study between 1992 and 2017, which were analyzed from a hermeneutic perspective from the thematic nuclei "definition and transformation of the concept of 'family'" and "Research perspectives on the relationship between childless couples and family". The search required the following categories in Spanish and English: "significado de familia/meaning of family", "definición de familia/definition of family", "concepto de familia/family concept", "parejas sin hijos/couple without children/childfree/NoMo", "nuevas tipologías familiares/new family typologies", "familia DINK/DINK family" y "familia moderna/modern family". The databases taken into account for the study were Scopus, SciELO, Dialnet Plus, Psicodoc, EBSCO, DOAJ, Redalyc and Google Academic. Most research agrees that consanguinity and procreation are no longer essential criteria for forming a family, and thus, couples without children are constituted as a new family typology characterized by more equitable, consensual and democratic ways of making decisions. The main reason for this change is the new place that women have conquered in society after decades of struggle for their rights, favoring a questioning of the patriarchal system and the hegemonic model of the family called the nuclear family. The discussions about gender imaginaries that began with greater force in the 20th century, give a place to women in working life that, over time, has favored a questioning about the relationship between motherhood and being a woman. Research presents different criteria to define the family, which shows that this is a time when there is not one model but several family models. For its part, this diversity has been expressed not only in the dimension of social representations but also in the legal sphere; This is expressed this way, since several investigations in the field of law show transformations in Latin American constitutions by ways of understanding the family in a more plural way and based on fundamental rights. Finally, the collection of research shows that the study on the category of couples without children is incipient, that is, it corresponds to a phenomenon that, despite enjoying statistical evidence, can be considered emergent in culture insofar as its relevance corresponds to the last decades. Most studies that deal directly or indirectly with the category of childless couple, consider this form of bond as a form of family and explain how at this time this definition is mainly determined by affective criteria, values built between the members, and relational dynamics; leaving in the background the criteria of consanguinity or kinship from the nuclear model.

"Estableciendo vínculos dialógicos que alivian": una mirada desde el patrón estético / "Establishing the Dialogic Bond that Relieves": A View from an Aesthetic Pattern / "Estabelecendo o vínculo dialógico que alivia": Uma visão a partir do um padrão estético

Introducción: La enfermedad cardiovascular es la segunda causa de morbimortalidad en el mundo, genera carga social y económica. La falta de adherencia a los medicamentos cardiovasculares está asociada con múltiples riesgos. Objetivo: Describir la categoría: Estableciendo vínculos dialógicos que alivian desde el patrón estético Materiales y Métodos: Investigación cualitativa con enfoque en la teoría fundamentada basado en Corbin y Strauss. Participaron 12 personas, la recolección de la información fue la entrevista en profundidad. En el análisis se codifico, línea por línea los textos, se etiquetaron códigos, que dieron origen a las subcategorías y categorías, luego se direccionó a examinar los datos de forma teórica, se integró y refinó la categoría. Resultados: Estableciendo vínculos dialógicos que alivian, compuesta por las subcategorías: Experimentado clima de afecto y confianza para el aprendizaje: creando empatía; Estableciendo conexiones de cuidado que dan satisfacción y construyendo sentimientos positivos del encuentro dialógico. Discusión: El establecimiento de vínculos dialógicos que alivian hace parte del conocimiento estético, uno de los patrones de conocimiento identificados por Carper, descrito como "arte de la enfermería". Se caracteriza por ser intangible, y no va más allá del contexto de la experiencia personal de cada individuo. Conclusiones: El vínculo dialógico que alivia, es un encuentro genuino que permite interacción creativa enfermera-paciente. Este se experimenta a través de palabras y gestos que expanden la conciencia del ser humano que vive la experiencia de la enfermedad coronaria y requiere de tratamiento de uso crónico para mantener su control.

Introduction: Cardiovascular disease is the second leading cause of morbidity and mortality worldwide, which generates social and economic burden. Poor adherence to cardiovascular medication is associated with multiple risks. Objective: To describe the category "Establishing the dialogic bond that relieves from the aesthetic pattern." Materials and Methods: A qualitative study based on Corbin and Strauss' theory was conducted with twelve participants. Data were collected using in-depth interviews. In the analysis, texts were line-by-line coded and codes were labeled, which gave rise to subcategories and categories. Then the data were examined on a theoretical basis and categories were integrated and refined. Results: 'Establishing the dialogic bond that relieves' is composed by the subcategories 'experiencing an environment of affection and confidence for learning: creating empathy' and 'establishing connections of care that provide satisfaction and build positive feelings of the dialogic encounter.' Discussion: Establishing the dialogic bond that relieves is part of aesthetic knowledge as one of the patterns of knowledge described as "the art of nursing" that was identified by Carper. It is characterized by being intangible and does not go beyond the context of each individual's personal experience. Conclusions: The dialogic bond that relieves is a genuine encounter that allows creative nurse-patient interaction, experienced through words and gestures that expand the consciousness of human beings experiencing coronary heart disease and requiring chronic treatment to control the disease.

Introdução: As doenças cardiovasculares são a segunda principal causa de morbidade e mortalidade no mundo, o que gera carga social e econômica. A falta de adesão aos medicamentos cardiovasculares está associada a múltiplos riscos. Objetivo: Descrever a categoria "Estabelecer vínculos dialógicos que aliviem de um padrão estético". Materiais e Métodos: Pesquisa qualitativa com foco na teoria baseada em Corbin e Strauss foi realizado com doze participantes. Os dados foram coletados através de entrevistas em profundidade. Na análise, os textos foram codificados linha por linha e os códigos foram etiquetados, o que deu origem as subcategorias e categorias. Em seguida, os dados foram examinados em base teórica e as categorias foram integradas e refinadas. Resultados: 'O estabelecimento do vínculo dialógico que alivia' é composto pelas subcategorias 'experimentando um ambiente de afeto e confiança para a aprendizagem: criando empatia' e 'estabelecendo conexões de cuidados que dão satisfação e constroem sentimentos positivos do encontro dialógico'. Discussão: Estabelecer o vínculo dialógico que alivia é parte do conhecimento estético como um dos padrões de conhecimento descritos como "a arte da enfermagem" que foi identificada por Carper. Caracteriza-se por ser intangível e não vai além do contexto da experiência pessoal de cada indivíduo. Conclusões: O vínculo dialógico que alivia é um encontro genuíno que permite a interação criativa enfermeiro-paciente, experimentada através de palavras e gestos que expandem a consciência do ser humano que sofre de doença coronariana e necessita de tratamento crônico para controlá-la.

Ensaio clínico cego randomizado comparando MMP®, MMP® com 5-FU e injeção intradérmica de 5-FU para o tratamento da hipomelanose gutata idiopática: um estudo- piloto / A single blind, randomized clinical trial comparing MMP®, MMP® with 5-FU, and 5-FU intradermal injection for the treatment of idiopathic guttate hypomelanosis: a pilot study

Introdução: A hipomelanose gutata idiopática (IGH) é uma manifestação comum de fotoenvelhecimento, ainda sem tratamento padrão, apresentando resultados variados às intervenções. Atualmente, no Brasil, o uso de microagulhamento associado ao 5-fluorouracil (5-FU) tem sido proposto para o tratamento da IGH. Objetivo: Comparar três tratamentos, quais sejam: o uso do MMP® (microinfusão de medicamentos na pele) com 5-FU, MMP® apenas para microagulhamento, e com o 5-FU intralesional injetado com seringa de insulina no tratamento da IGH. Métodos: Em um ensaio clínico randomizado e cego, comparamos o MMP® ao 5-FU com: microagulhamento isolado e com 5-FU intralesional por punção para o tratamento de 180 lesões de IGH no antebraço de nove pacientes. Resultados: Após duas sessões de tratamento, o 5-FU intralesional foi o tratamento mais efetivo, com significância estatística quando comparado ao uso de microagulhamento. A eficácia da MMP + 5-FU foi inferior a 5-FU injetável e superior ao microagulhamento isoladamente, embora sem significância estatística. Conclusões: A aplicação intralesional do 5-FU foi mais eficaz no tratamento da leucodermia solar. O uso de menor quantidade de medicamentos é a grande vantagem da técnica MMP + 5-FU. São necessários mais estudos para padronizar estas técnicas.

Introduction: Idiopathic guttate hypomelanosis (IGH) is a common photoaging manifestation, with no standard treatment and presenting mixed results to interventions. In Brazil, the use of micro-needling associated with 5-fluorouracil (5-FU) has been proposed to treat IGH. Objective: To compare the use of MMP® (micro-infusion of drugs on the skin) with 5-FU, with MMP® only as micro-needling (with no drugs), and intralesional 5-FU injected with an insulin syringe in the treatment of IGH. Methods: In a single blind randomized clinical trial, we compared the three treatments: MMP® versus MMP with 5-FU and intralesional 5-FU injection for 180 IGH lesions in the forearm of nine patients. Results: After two treatment sessions, 5-FU alone was the most effective treatment, with statistical significance, compared with micro-needling alone. MMP+5-FU efficacy was lower than intralesional 5-FU injection and higher than micro-needling alone, although without statistical significance. Conclusions: The intralesional application of 5-FU was more effective in the treatment of solar leukoderma. The use of a smaller quantity of medication is the great advantage of the MMP + 5-FU technique. Further studies are needed to standardize these techniques.

The Dialogic Bond that Relieves: Encounter to Transcend Therapeutic Adherence / El vínculo dialógico que alivia: encuentro para transcender la adherencia terapéutica / O vínculo dialógico que alivia: encontro para transcender a adesão terapêutica

ABSTRACT Objective: This work sought to describe the meanings constructed by patients with coronary disease (PCD) the communication process used by nurses during the transition from the hospital (coronary care unit) to the home for therapeutic adherence. Method: The article corresponds to a qualitative study, which used an approach through grounded theory. The participants were 12 informants from the city of Medellin, Colombia. Data reliability was guaranteed. Results: Construction of a theoretical postulate: "Reconstructing the significance of treatment: from the indifference to reviving with a dialogic bond that relieves". The process faced by PCD, derived from the communication process, goes from "living in ignorance", "experiencing rupture with the treatment" to "reconstructing: finding sense" and, finally, "finding a state of harmony: new learnings". This last achievement is obtained when creating awareness in the "dialogic bond that relieves". Conclusions: The meaning granted by PCD to the communication process for therapeutic adherence is established when reaching transformation and expanding the conscience (creating awareness) in a "dialogic bond that relieves"; likewise, when this process is full of apathy and indifference, the sense of the treatment is lost.

RESUMEN Objetivo: describir los significados que construye el paciente con enfermedad coronaria del proceso comunicativo utilizado por la enfermera en la transición del hospital (unidad de cuidados coronarios) al hogar, para la adherencia terapéutica. Método: el artículo corresponde a un estudio cualitativo, en el que se usó un abordaje a través de la teoría fundamentada. Los participantes fueron doce informantes de la ciudad de Medellín, Colombia. Se garantizó la confiabilidad de los datos. Resultados: la construcción de un postulado teórico: "Reconstruyendo el significado del tratamiento: de la indiferencia a renacer con un vínculo dialógico que alivia". El proceso que enfrentan los pacientes con enfermedad coronaria, derivado del proceso comunicativo, va desde "viviendo en el desconocimiento", "experimentando ruptura con el tratamiento" hasta "reconstruyendo: encontrando sentido" y, finalmente, "encontrando un estado de armonía: nuevos aprendizajes". Este último logro lo obtienen al crear conciencia en el "vínculo dialógico que alivia". Conclusiones: el significado que le otorgan los pacientes con enfermedad coronaria al proceso comunicativo para la adherencia terapéutica se establece al alcanzar transformación y expandir la conciencia (crear conciencia) en un "vínculo dialógico que alivia"; asimismo, cuando este proceso se encuentra colmado de apatía e indiferencia, se pierde el sentido del tratamiento.

RESUMO Objetivo: descrever os significados que o paciente com doença coronária constrói do processo comunicativo utilizado pela enfermeira na transição do hospital (unidade de cuidados coronários) ao lar para a adesão terapêutica. Método: este artigo corresponde a um estudo qualitativo, no qual foi utilizada uma abordagem por meio da teoria fundamentada. Participaram 12 informantes da cidade de Medellín, Colômbia. Garantiu-se a confiabilidade dos dados. Resultados: a construção de uma premissa teórica "Reconstruindo o significado do tratamento: da indiferença a renascer com um vínculo dialógico que alivia". O processo que os pacientes com doença coronária enfrentam, derivado do processo comunicativo, vai desde "vivendo no desconhecimento", "experimentando ruptura com o tratamento", até "reconstruindo: encontrando sentido" e, finalmente, "encontrando um estado de harmonia: novas aprendizagens". Este último é atingido ao criar consciência sobre o "vínculo dialógico que alivia". Conclusões: o significado que os pacientes com doença coronária outorgam ao processo comunicativo para a adesão terapêutica é estabelecido ao alcançar transformação da consciência e sua expansão (conscientizar) em um "vínculo dialógico que alivia"; além disso, quando esse processo se encontra permeado de apatia e indiferença, perde-se o sentido do tratamento.

Avaliação da eficácia e segurança do microagulhamento com 5-fluorouracil para o tratamento de estrias albas: ensaio clínico randomizado duplo-cego / Evaluation of the efficacy and safety of microneedling with 5-fluorouracil for the treatment of striae alba: double-blind, randomized clinical trial

Introdução: Estrias são um desafio cotidiano ao dermatologista. Na busca por terapias alternativas, surgem o 5-fluorouracil (5-FU) e o microagulhamento ao associarem as seguintes propriedades: inibir fibrose, estimular renovação do colágeno e induzir pigmentação da pele. Objetivo: Avaliar a eficácia e segurança do 5-FU, isolado ou associado ao microagulhamento, no tratamento das estrias albas. Métodos: Estudo duplo-cego comparativo, durante 180 dias, entre três grupos: Grupo A - microagulhamento e 5-FU; Grupo B - 5-FU intralesional; e Grupo C - microagulhamento sem medicação. Mensurou-se a melhora por meio de uma escala numérica de coloração da pele, considerando-se resultados positivos aqueles com redução da discrepância entre a cor da pele adjacente e a da estria. Avaliou-se também a satisfação do paciente e a irritação com cada técnica. Resultados: Grupo A obteve 10% de melhora clínica excelente; 10%, muito boa; e 60%, leve. No grupo B, nenhuma paciente teve melhora excelente ou muito boa. Já no grupo C, observaram-se 20% de melhora clínica muito boa e 70% de melhora leve. Conclusões: Todas as técnicas apresentaram algum grau de melhora das lesões. Assim, propõem- se novos estudos comparando-se as três técnicas, com amostra mais ampla, para avaliar se maior número de sessões resultaria em resultados mais expressivos.

Introduction: Stretch marks are an everyday challenge to the dermatologist. In the search for alternative therapies, we find 5-fluorouracil (5-FU) and microneedling for associating the following properties: inhibition of fibrosis, stimulation of collagen renovation and induction of skin pigmentation. Objective: To evaluate the efficacy and safety of 5-FU, in isolation or associated to microneedling, for the treatment of white stretch marks (striae alba). Methods: Comparative, double-blind study over 180 days, between 3 groups: Group A: microneedling and 5-FU; Group B intralesional 5-FU and Group C microneedling without medication. We measured improvement through a numerical scale of skin coloration, considering positive results those with reduction of the discrepancy between the adjacent skin and the stretch mark. We also evaluated patient satisfaction and irritation with each technique. Results: Group A achieved 10% of excellent clinical improvement, 10% very good and 60% mild. In group B, none of the patients had excellent of very good improvement. In group C, there was 20% of very good clinical improvement and 70% of mild. Conclusions: All techniques showed some degree of improvement of the lesions. Therefore, we propose new studies comparing all three techniques, with a larger sample, to evaluate if more treatments would result in better results.

Toxina botulínica para o tratamento de hidrocistomas faciais / Botulinum toxin for the treatment of facial hidrocystomas

Introdução: Hidrocistomas são cistos cor da pele ou translúcidos, únicos ou múltiplos, que aparecem na face. Têm origem na glândula sudorípara écrina ou apócrina e, às vezes, são desfigurantes. Podem ser tratados com cirurgia, eletrodissecção ou cáusticos, mas costumam ser recidivantes e os tratamentos podem deixar cicatrizes ou discromias. A toxina botulínica A (BoNT-A) foi sugerida como terapia em poucos casos na literatura. Objetivo: Analisar os efeitos da toxina botulínica em casos de hidrocistoma da face. Métodos: Estudo observacional retrospectivo de série de casos. Foram avaliados pacientes portadores de hidrocistoma na face, tratados com BoNT-A. Resultados: De 13 pacientes avaliados, cinco foram incluídos, a maior casuística descrita até o momento. Destes, todas as lesões tratadas apresentaram melhora clínica durante o período avaliado. Quatro pacientes mostraram regressão parcial e um, regressão total das lesões. Conclusões: Nesta série de casos, a BoNT-A mostrou resultados positivos e duradouros no tratamento de hidrocistomas faciais, sem efeitos adversos.

Introduction: Hidrocystomas are skin-colored or translucent cysts, single or multiple, appearing on the face. They originate in the eccrine or apocrine sweat gland and are sometimes disfiguring. They can be excised by surgery, electrodissection, or by caustics, but are usually recurrent and the treatments can leave scars or dyschromia. Botulinum toxin A (BoNT-A) has been suggested as therapy in few cases in the literature. Objective: To analyze the effects of BoNT-A in cases of facial hidrocystomas. Methods: Retrospective observational study of case series. Patients with facial hidrocystomas treated with BoNT-A at the Cosmiatry Outpatient Dermatology Clinic of the Hospital do Servidor Público Municipal de São Paulo, were evaluated. Results: Of the 13 patients evaluated, 5 were included, the largest case series described so far. Of these, all lesions treated showed clinical improvement during the period evaluated. Four patients showed partial regression and one, total regression of the lesions. Conclusion: In this series of cases, BoNT-A showed positive and long-lasting results in the treatment of facial hidrocytsomas, with no adverse effects.

Significados del proceso comunicativo enfermera-paciente con enfermedad coronaria para la adherencia terapéutica / Meanings of the nurse-patient communication process with coronary disease for therapeutic adherence

La Adherencia Terapéutica es un fenómeno multidimensional que depende de múltiples factores, siendo uno de ellos el proceso comunicativo en la transición (alta) que experimentan los pacientes con enfermedad coronaria y la enfermera. Lo que viven en dicho proceso es un determinante que condiciona a otorgarle un significado positivo o negativo al tratamiento, lo que conlleva a darle o no continuidad a este (adherencia terapéutica). Objetivo: Describir los significados que construye el paciente con enfermedad coronaria del proceso comunicativo utilizado por la enfermera en la transición hospital (Unidad de cuidado coronarios: UCC) al hogar, para la Adherencia Terapéutica. Método: Se usó un abordaje cualitativo a través de la teoría fundamentada. Los participantes fueron 12 informantes de la ciudad de Medellín, Colombia. Se tuvieron en cuenta las normas éticas internacionales, y el trabajo fue revisado por un comité de ética institucional. Hallazgos: Los resultados arrojaron un postulado teórico: "Reconstruyendo el significado del tratamiento: de la indiferencia a renacer con un vínculo dialógico que alivia". El proceso que enfrentan los pacientes con enfermedad coronaria, derivado del proceso comunicativo, va desde "viviendo en el desconocimiento", "experimentando ruptura con el tratamiento" hasta "reconstruyendo: encontrando sentido" y, finalmente, "encontrando un estado de armonía: nuevos aprendizajes", este logro lo obtienen al crear conciencia en el "vínculo dialógico que alivia". Discusión: Los resultados se analizaron a la luz de las teorías de vínculos, la comunicación, el cuidado de enfermería y otras disciplinas. Conclusiones: El estudio concluye que el significado que le otorgan los pacientes con enfermedad coronaria al proceso comunicativo para la adherencia terapéutica está determinado en alcanzar transformación y expandir la conciencia (crear conciencia) en un "vínculo dialógico que alivia"; así mismo, cuando este proceso es colmado de apatía e indiferencia se pierde el sentido del tratamiento.

The Therapeutic Adherence is a multidimensional phenomenon that depends on multiple factors, one of them being the communicative process experienced by patients with coronary disease during the (high) transition with the nurse. What they live in this process is a determinant that conditions to give a positive or negative meaning to the treatment, which leads to giving or not to this continuity (therapeutic adherence). Objective: To describe the meanings that the patient with coronary artery builds within the communicative process that the nurse uses in the home hospital transition for Therapeutic Adherence. Method: A qualitative approach was used, using the Grounded Theory. The participants were 12 informants from the city of Medellín, Colombia. International ethical standards were taken into account and reviewed by an institutional ethics committee. Findings: The results yielded a theoretical postulate: "Reconstructing the meaning of treatment: from indifference to rebirth with a dialogical bond that relieves". The process that confronts patients with coronary disease derived from the communicative process ranges from "living in ignorance", experiencing break with treatment to "re-constructing: finding meaning" and, finally, "finding a state of harmony: new learning", this achievement is obtained by creating awareness in the "dialogic link that relieves." Discussion: The results were analyzed in light of the theories of links, communication, nursing care and other disciplines. Conclusions: The study concludes that the meaning given by patients with coronary disease to the communicative process for Therapeutic Adherence is determined to reach transformation and expand consciousness (create awareness) in a "dialogic link that relieves", likewise when this process is filled with apathy and indifference the sense of treatment is lost.

Características y supervivencia de pacientes con cáncer de seno metastásico HER2-positivo en la era post-trastuzumab / Characteristics and survival of patients with HER2-positive metastatic breast cancer in the post-trastuzumab era

Resumen Introducción: Existen múltiples factores pronóstico de la supervivencia en el cáncer de mama metastásico (CMM). Los dos factores mejor estudiados son la expresión de receptores hormonales (RH) y el estatus HER2, por lo que su determinación es obligada en toda paciente con diagnóstico de CMM. El 80% de los tumores expresan RH y el 20% son HER2-positivo. El objetivo de este estudio es determinar los factores pronóstico de la supervivencia global (SG) de pacientes con diagnóstico de CMM HER2-positivo atendidos entre 2009 y 2015 en el Instituto de Cancerología de Medellín (Colombia). Métodos: Estudio observacional retrospectivo. Se realizaron las curvas de supervivencia mediante el método de Kaplan-Meier comparadas con Log-Rank test y se analizaron los factores que influyeron en la supervivencia mediante la regresión de Cox. Resultados: Se incluyeron 101 pacientes. La mediana de seguimiento fue 46,6 meses (rango 13-155 meses), la SG a cinco años fue 41% (IC95%: 31%-50%) y a diez años 13% (IC95%: 4%-30%). Tuvieron mayor SG pacientes con enfermedad en recaída, con estadios I y II, las mayores de 40 años, menopáusicas, con tumores con grado histológico bajo y co-expresión de receptores hormonales. Las pacientes que recayeron tuvieron mayor SG que las que hicieron metástasis de novo (HR: 0,47, IC95%: 0,27-0,81) ajustado por las otras variables. Conclusiones: La supervivencia de estas pacientes fue semejante al de otros países, al igual que las líneas de tratamiento y la terapia recibida.

Abstract Introduction: There are multiple risk factors associated with the prognosis of survival of metastatic breast cancer (MBC). The two major risk factors are the expression of hormonal receptors (HR) and HER 2 neu, and the reason why they are requested in every MBC patient. The large majority (80%) of breast tumors are HR positive, and 20% are HER 2 positive. The aim of this study was to determine the prognostic factors associated with the overall survival (OS) of patients diagnosed with HER 2 positive MBC seen between January 2009 and December 2015 in the Instituto de Cancerología (Medellín-Colombia). Methods: A retrospective observational study was conducted, with survival analysis using the Kaplan-Meier method. The survival curves were compared using the Log-Rank Test, and factors associated with survival were analyzed using the Cox regression. Results: 101 patients were included in the study. The median survival time was 46.6 months (Range 13-155 months), the 5-year OS was 41% (95% CI; 31%-50%) and the 10-year OS 13% (95% CI; 4%-30%). Higher overall survival was found for patients with relapsed disease, those with stages I and II, patients older than 40 years, postmenopausal, tumors with low histological grade and with co-expression of hormonal receptors. The patients with relapse of disease had a higher OS than the de novo patients after being adjusted for the other factors (HR: 0.47, 95% CI; 0.27-0.1). Discussion: The overall survival time is similar to that of other countries, as well as the lines of treatment and therapy received.

Surgical site infection after breast cancer sur gery at 30 days and associated factors / Infección del sitio operatorio en cirugía oncológica de mama a 30 días y factores asociados

Background: The incidence of surgical site infection (SSI) in breast surgery has been higher than expected, considering this is a clean surgical procedure. Few studies have reported an incidence of less than 5.0% and most publications report an incidence of between 10.2% and 30.0%. Objective: To estimate the incidence, associated factors and interval free from infection at 30 days postsurgery in women who underwent oncological and reconstructive breast surgery. Methods: Prospective cohort study of women with breast cancer who underwent conservative or radical breast surgery at a reference medical center in Medellín, Colombia. The outcomes were SSI and time to the event. The survival analysis of freedom from infection was performed using the Kaplan Meier method and the Cox proportional hazard model for multivariate analysis. Results: Of the 308 consecutive surgical breast oncology procedures performed, 161 (52.3%) were quadrantectomies and 147 (47.7%) were mastectomies, with an SSI incidence of 16.2% (50 cases). The associated risk factors were seroma-hematoma, which occurred in 79 (25.6%) cases, hazard ratio (HR) 2.7 (95% CI 1.5-4.9); and the presence of drainage devices, HR 5.6 (95% CI 2.2-14.3). The median time to the development of SSI was 16 days. Conclusion: Our study shows that the presence of postoperative seroma-hematoma and long-term drainage device use were independent risk factors for SSI in oncological breast surgery. (c) 2016 ACIN. Published by Elsevier Espana,˜ S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Antecedentes: La incidencia de infección del sitio operatorio (ISO) en cirugía de mama ha sido mayor de lo esperado, considerando este como un procedimiento quirúrgico limpio. Pocos estudios han reportado una incidencia menor del 5,0% y la mayoría de publicaciones la ubican entre 10,2 y 30,0%. Objetivo: Estimar la incidencia, los factores asociados y el intervalo libre de infección a 30 días, en las mujeres que se sometieron a cirugía oncológica y reconstructiva de mama. Métodos: Estudio de cohorte prospectivo en mujeres con cáncer de mama, que se sometieron a cirugía de mama conservadora o radical en un centro médico de referencia de Medellín, Colombia. Los resultados fueron infección del sitio operatorio y tiempo al evento. El análisis de supervivencia libre de infección se realizó con el método de Kaplan Meier y el modelo multivariado de riesgos proporcionales de Cox. Resultados: Seguimiento a 308 procedimientos quirúrgicos oncológicos de mama consecutivos; 161 (52,3%) fueron cuadrantectomías y 147 (47,7%) mastectomías, con una incidencia de ISO de 16,2% (50 casos). Los factores de riesgo asociados fueron: seroma-hematoma 79 (25,6%), HR 2,7 (IC 95%: 1,5; 4,9) y la presencia de dispositivos de drenaje, HR 5,6 (IC 95% 2,2; 14,3). El tiempo medio para el desarrollo de SSI fue de 16 días. Conclusión: Nuestro estudio mostró que la presencia de seroma hematoma posoperatorios y el uso extendido de dispositivos de drenaje fueron factores independientes para la presentación de infección del sitio operatorio en cirugía oncológica de mama.

Mortalidad asociada a la presión arterial de ingreso a urgencias en pacientes con trauma encéfalo-craneano: un estudio de cohorte retrospectiva / Mortality and blood pressure in emergency patients with traumatic brain injury: a retrospective cohort study / Mortalidade associada a pressão arterial de entra-da a urgências em doentes com trauma encéfalo-craneano: um estudo de coorte retrospectiva

Introducción: en pacientes con trauma encéfalo-craneano (TEC) la presión arterial en el momento de la admisión por urgencias tiene una relevancia especial por ser la base de la presión de perfusión cerebral. El propósito de esta investigación fue estimar la asociación entre los valores de presión arterial al ingreso a urgencias y la mortalidad hospitalaria en dichos pacientes. Métodos: cohorte retrospectiva en pacientes mayores de 18 años con diagnóstico de TEC admitidos al Hospital Pablo Tobón Uribe entre enero de 2012 y enero de 2014. Se hizo una regresión logística multivariable para estimar el efecto independiente de los valores de presión arterial en la mortalidad. Resultados: en 582 pacientes la mediana de edad fue 36 años (rango intercuartílico = 25-59) y el 77,1 % (n = 449) eran hombres. La mortalidad según los valores de presión arterial sistólica al ingreso en las categorías de <100, 100-150 y >150 mm Hg fue 34,6 % (18/52), 13,3 % (56/421) y 29,4 % (32/109), respectivamente. En el análisis univariable tanto la presión menor de 100 como la mayor de 150 mm Hg se asociaron con mortalidad, pero dicha asociación perdió magnitud y significado estadístico (OR = 1,81; IC95 % = 0,94-3,48 y OR = 1,91; IC95 % = 0,86-4,54, respectivamente) al ajustar por la escala de coma de Glasgow, la saturación de oxígeno y la presencia de edema cerebral. Conclusiones: no se demostró asociación estadísticamente significativa entre los valores de presión arterial al ingreso a urgencias y la mortalidad en los pacientes con TEC.

Introduction: Blood pressure is of special relevance in patients with traumatic brain injury (TBI) at admission to emergency services, since it is the basis of cerebral perfusion pressure. The purpose of this research was to estimate the association between blood pressure values measured on admission and hospital mortality in patients with TBI. Methods: Retrospective cohort study in patients older than 18 years admitted with TBI to Hospital Pablo Tobón Uribe, in Medellín (Colombia) between January 2012 and January 2014. A multivariate logistic regression model was performed to estimate the independent effect of blood pressure values on mortality. Results: 582 patients with a median age of 36 years (IQR = 25-59) 77.1 % of them males (n = 449) were evaluated. Mortality according to categories of systolic blood pressure at admission (<100, 100-150 and >150 mmHg) was as follows: 34.6 % (18/52), 13.3 % (56/421) and 29.4 % (32/109), respectively. Univariate analysis showed that blood pressure less than 100 or greater than 150 mm Hg were associated with hospital mortality, but that association lost magnitude and statistical significance (OR = 1.81; 95 % CI = 0.94-3.48 and OR = 1.91; 95 % CI = 0.86-4.54, respectively) after adjustment by Glasgow coma scale, oxygen saturation and cerebral edema. Conclusions: We did not demonstrate a statistically significant association between blood pressure values at admission to the emergency service and mortality in patients with TBI.

Introdução: em doentes com trauma encéfalo-craneano (TEC) a pressão arterial no momento da admissão por urgências tem uma relevância especial por ser a base da pressão de perfusão cerebral. O propósito desta investigação foi estimar a associação entre os valores de pressão arterial ao ingresso a urgências e a mortalidade hospitalar em ditos doentes. Métodos: coorte retrospectiva em doentes maiores de 18 anos com diagnóstico de TEC admitidos no Hospital Pablo Tobón Uribe entre janeiro de 2012 e janeiro de 2014. Se fez uma regressão logística multi-variável para estimar o efeito independente dos valores de pressão arterial na mortalidade. Resultados: em 582 doentes a média de idade foi 36 anos (RIC = 25-59) e 77,1 % (n = 449) eram homens. A mortalidade segundo os valores de pressão arterial sistólica ao ingresso nas categorias de <100, 100-150 y >150 mm Hg foi 34,6 % (18/52), 13,3 % (56/421) e 29,4 % (32/109), respectivamente. Na análise univariável tanto a pressão menor de 100 como a maior de 150 mm Hg se associaram com mortalidade, mas dita associação perdeu magnitude e significado estatístico (OR = 1,81; IC95 % = 0,94-3,48 e OR = 1,91; IC95 % = 0,86-4,54, respectivamente) ao ajustar pela escala de coma de Glasgow, a saturação de oxigeno e a presença de edema cerebral. Conclusões: não se demostrou associação estatisticamente significativa entre os valores de pressão arterial ao ingresso a urgências e a mortalidade nos doentes com TEC.

Efectos irritantes en piel, mucosas respiratorias y oculares en trabajadores expuestos a humos de asfalto de una empresa de infraestructura vial en Cundinamarca, Colombia / Irritant effects on the skin, respiratory and eye mucous, in workers exposed to asphalt fumes of a road infrastructure company: Cundinamarca, Colombia / Efeitos irritantes na pele e mucosas respiratórias e oculares em trabalhadores expostos à fumaça de asfalto, estudo de caso em uma empresa de infraestrutura rodoviária, Cundinamarca, Colômbia

Objetivo: identificar los posibles factores de riesgo del individuo y ocupacionales asociados a la presencia de efectos irritantes en piel y mucosas de trabajadores expuestos a asfalto en una empresa de infraestructura vial en el 2012. Mate- riales y métodos: se realizó un estudio de prevalencia analítica mediante la aplicación de cuestionarios de síntomas respiratorios, dermatológicos, autoreporte de síntomas oculares y realización de un examen médico de participación voluntaria a trabajadores expuestos que elaboran y aplican asfalto. Se utilizó la regresión logística en el análisis estadís- tico. Resultados: de 24 trabajadores dedicados a la elaboración de asfalto, 22 (95,8%) presentaron diferentes síntomas irritantes, cinco (20,8%) efectos irritantes de la piel, 12 (50,0%) signos de irritación ocular y 9 (37,5%) efectos en las vías respiratorias bajas. De 111 trabajadores que aplican asfalto, 108 (97,3%) presentaron diferentes síntomas irritantes, 61 (55,0%) efectos irritantes de la piel, 93 (83,8%) presentaron signos oculares, 20 (18,0%) efectos en las vías respiratorias bajas. La antigüedad en el oficio de 5 a 10 años se asoció con la presencia de síntomas oculares, OR=15,9 (IC 95% 1,63-154,53) y con síntomas de irritación en piel (OR= 4,1 (IC 95% 1,45-11,96). La antigüedad en el oficio mayor a 10 años en los trabajadores que elaboran el asfalto y la jornada laboral mayor a 10 horas en trabajadores que aplican el asfalto se asoció a efectos respiratorios (OR=15,0 (IC 95% 1,03-218,3), OR= 15,7 (2,05-120,67 respectivamente) Conclusión: los efectos en salud se presentaron en los trabajadores clasificados en niveles de exposición Alto o Muy Alto y en aquellos con tiempo en el oficio mayor a cinco años, lo que sugiere una probable relación...

Objective: to identify potential risk factors and occupa- tional individual associated with the presence of irritating effects on skin and mucous membranes of workers exposed to asphalt in road infrastructure company in 2012. Materials and Methods: a study of analytical prevalence is performed by applying questionnaires respi- ratory and dermatological symptoms, ocular symptoms by self-reported and undergo a medical examination. With voluntary participation of workers exposed to road infrastructure company. Results: 24 workers dedicated to the production of asphalt, 22 (95.8%) presented diffe- rent irritative symptoms, five (20.8%) with skin irritating effects, 12 (50.0%) with signs of irritation ocular and 9 (37.5%) with effects on the lower respiratory tract. 111 workers applying asphalt, 108 (97.3%) had different irri- tative symptoms, 61 (55.0%) with skin irritating effects, 93 (83.8%) had ocular signs, 20 (18,0 %) with effects on the lower respiratory tract. Relationship between senio- rity in the task from 5 to 10 years with the presence of ocular symptoms was found, OR = 15.9 (95% CI 1.63 to 154.53), and presence of symptoms of skin irritation (OR = 4.1 (95% CI 1.45 to 11.96). A seniority in task upper to 10 years in the workers elaborating the asphalt and a workday upper to 10 hours in workers applying asphalt was associated with respiratory effects ((OR = 15.0 (95% CI 1 03-218.3), (OR = 15.7 (2.05 to 120.67) respectively). Conclusion: health effects occurred in workers classi- fied in high or very high exposure levels and those with time on the job more than 5 years, which may indicate a probable occupational relationship between these symp- toms and exposure levels. Specific measures to reduce exposure and improve medical surveillance, as well as assessment of concentrations of exposures to asphalt fumes.

Syndrome in question

Abstract The Iso-Kikuchi Syndrome is a rare condition characterized by nail dysplasia involving the index fingers, including micronychia, polyonychia, anonychia, irregular lunula, malalignment and hemionychogryphosis. On the antero-posterior image, radiologic examination reveals a narrowing of the distal phalanx. The lateral image shows a Y-shaped bifurcation of the distal phalanx. We report a case of a patient with typical clinical and radiologic signs of Iso-Kikuchi Syndrome.