Ortodoncia interceptiva con alineadores en un paciente con mordida cruzada en período de dentición mixta / Interceptive orthodontics with clear aligners in a patient with crossbite in a mixed dentition period

La mordida cruzada es una maloclusión que debe recibir tratamiento precoz ya que es potencial causa de desviaciones mandibulares, asimetría facial y trastornos de disfunción temporomandibular. En general se acompaña de la necesidad de estimulación del desarrollo transversal del maxilar superior. En este artículo presentamos un caso clínico tratado con alineadores en el que se planteó como objetivo de primera fase la expansión transversal, con el fin de corregir su mordida cruzada lateral y mejorar la posición de los caninos permanentes en etapa pre-eruptiva en una paciente de 9 años. Luego de dos etapas cortas de tratamiento con alineadores, los resultados fueron satisfactorios. El caso se acompaña de fotos, radiografías y renders iniciales y finales.

Crossbite is a type of malocclusion that must receive early treatment due to its potentiality of causing mandibular deviations, facial asymmetry, and temporomandibular disorders. Generally, it is accompanied by the need to stimulate the transverse development of upper jaw. In the following article, a clinical case will be presented in which a nine-year-old patient was treated with clear aligners in the first phase with the aim of performing the transversal expansion, to correct the lateral crossbite and improving the position of the permanent impacted canines in pre-eruptive stages. After two short treatment stages with clear aligners, the results were positive. The clinical case is complemented with its pertinent clinical photos, radiographies, and renders, both initial and final.

Diverticulosis de intestino delgado, hallazgo intraoperatorio / Diverticulosis of the small bowell, intraoperative finding / Diverticulose do intestino delgado, achado intraoperatório

La diverticulosis puede presentarse en cualquier sector del tubo digestivo. La topografía de intestino delgado es infrecuente, se presenta sobre todo a nivel del yeyuno y en un 35% de los casos se asocia con diverticulosis colónica. Es más frecuente en mayores de 40 años. Los divertículos van disminuyendo de tamaño y número hacia el sector distal. Habitualmente el diagnóstico es incidental, sin embargo, pueden presentar complicaciones de las cuales se destacan por frecuencia el sangrado gastrointestinal y la diverticulitis. Se plantea que la deficiencia de fibra dietética generaría anomalías en el peristaltismo intestinal, lo que junto con fenómenos pseudo-obstructivos y alta presión intraluminal, actuaría en áreas de debilidad focal provocando la lesión. Presentamos el caso de una paciente de 88 años con una oclusión de colon a la cual se le realizó una cirugía de Hartmann, en el intraoperatorio se identificó divertículos de yeyuno sin elementos complicaciones.

Cierre de diastema con alineadores en dentición mixta / Diastema closure with aligners in mixed dentition

En la dentición mixta y permanente temprana, el diastema puede ser una preocupación estética importante para los pacientes y/o sus padres. Este artículo describe el tratamiento de ortodon cia con placas alineadoras, realizado en una pacien- te de 9 años de edad, con diastema interincisivo. Luego de 10 meses de tratamiento, se lograron los objetivos propuestos. El caso se acompaña con fotos, radiografías y renders iniciales y finales(AU)

In mixed and early permanent dentition, diastema can be a major aesthetic concern for patients and their parents. This article describes the orthodontic treatment with aligning plates, performed on a 9-year-old patient with an interincisal diastema. After ten months of treatment, the proposed objectives were achieved. The case is accompanied by photos, x-rays and initial and final renders.

Adecuación del aporte de proteína natural en el tratamiento de la fenilcetonuria: una revisión bibliográfica / Adequacy of natural protein intake in patients with phenylketonuria: bibliographic review

Introducción: la fenilcetonuria (PKU) es el error congénito del metabolismo de las proteínas más frecuente. El tratamiento dietético consiste en un plan de alimentación con una ingesta de proteínas naturales restringida, un sustituto proteico libre o de bajo contenido en fenilalanina (Phe) y el aporte de alimentos muy bajos en proteínas. El objetivo principal de este trabajo fue investigar si es posible aumentar la ingesta de proteína natural (PN) que se indica a los pacientes con PKU manteniendo los dosajes de Phe en sangre en rangos de seguridad. Materiales y método: se buscaron en 6 bases de datos electrónicas artículos publicados. Se identificaron un total de 154 artículos de Pub Med por intervalo de años desde 1999 a 2020. Se eligieron 15 artículos que se adaptaron a los criterios de inclusión y exclusión y respondían al objeto de estudio de esta revisión bibliográfica. Resultados: hay varios factores que pueden influenciar la estimación de la tolerancia de Phe como la severidad del fenotipo del paciente, la edad, el rango de seguridad de Phe en sangre, la prescripción de Phe y la adherencia al sustituto proteico. Si los niveles de Phe en sangre se mantienen en forma constante dentro del rango adecuado y por un período determinado, se debería considerar un incremento de la ingesta de Phe. El aumento de la ingesta de PN deberá ser realizado de manera controlada, individual y evaluando en forma constante el impacto en los dosajes de Phe en sangre. Conclusión: optimizar la ingesta de PN ofrece una mejora en la calidad de vida de pacientes con PKU, facilita la capacidad del paciente para socializar y contribuye a una mejor adherencia a la dieta(AU).

Introduction: phenylketonuria (PKU) is the most frequent inborn error of protein metabolism. The dietary treatment consists of a diet with a restricted natural protein intake, a free or low phenylalanine (Phe) protein substitute, and the intake of low protein food. The main objective of this work is to analyze if it is possible to increase the natural protein (NP) intake prescribed to PKU patients while maintaining blood Phe dosages within safe range. Materials and method: studies published were searched in 6 electronic data- basis. A total of 154 Pub Med articles were identified by range of years from 1999 to 2020. Fifteen articles which met the inclusion and exclusion criteria and responded to the objective of this bibliographic review were chosen. Results: several factors may influence Phe tolerance, such as severity of the patient´s phenotype, age, blood Phe safe range, Phe prescription and adherence to protein substitute. If Phe blood levels remain constantly within safe range and for a certain period, an increase of Phe intake should be considered. Increase of NP intake must be carried out in a controlled manner, individually and constantly evaluating blood Phe levels. Conclusion: optimizing NP intake offers the PKU patient an improvement in quality of life, facilitates the patient´s ability to socialize and contributes to a better adherence to the diet(AU).

Cuidado de enfermería durante el postoperatorio inmediato / Nursing care during the immediate postoperative period

El postoperatorio inmediato precisa de la asistencia sistematizada y documentada de enfermería, de manera que se garantice la seguridad y los cuidados específicos del paciente. El objetivo del proceso investigativo fue describir las intervenciones de enfermería durante postoperatorio inmediato y los factores que limitan el cuidado en tres unidades hospitalarias de la provincia Imbabura, Ecuador, durante el primer trimestre del 2020. El estudio tuvo un enfoque cuantitati-vo, mediante un estudio no experimental, descriptivo y de corte transversal. La población estuvo conformada por 29 profesionales de las instituciones de salud involucradas. Los datos fueron recopilados mediante un cuestionario validado por una prueba de alfa de Cronbach, obteniendo un valor de 0,84. El análisis de las limitaciones para el desarrollo de las intervenciones de enfer-mería en las dimensiones investigadas permitió establecer el predominio de los elementos relacionados con las demandas de los pacientes (48,28%); siendo la falta de tiempo el menos señalado, para un 6,9%. Los resultados permitieron apreciar que la mayoría de los participantes aplicaba siempre los elementos del cuidado de enfermería durante el posoperatorio relacionados con las 8 dimensiones estudiadas. Sin embargo, se debe señalar que sería importante potenciar el uso de herramientas estandarizadas de valoración como las diversas escalas.

The immediate postoperative period requires systematized and documented nursing care in order to guarantee safety and specific patient care. This research aimed to describe the nursing interventions during the immediate postoperative period and the factors that limit care in three hospital units in the Imbabura province, Ecuador, during the first quarter of 2020. A quantitative, cross-sectional and descriptive study was carried out. The population was made up of 29 profes-sionals from the health institutions involved. The data were collected using a questionnaire validated by a Cronbach's alpha test, obtaining a value of 0.84. The analysis of the limitations for the development of nursing interventions in the dimensions investigated allowed to establish the predominance of the elements related to the demands of the patients (48.28%). The lack of time was the least indicated, for 6.9%. The results allowed to appreciate that the majority of the participants always applied the elements of nursing care during the postoperative period related to the 8 dimensions studied. However, it should be noted that it would be important to promote the use of standardized assessment tools such as the various scales.

Ortodoncia Digital. Sistema de Alineación Mediante Placas Transparentes: caso clínico / Digital orthodontics. Alignment system using transparent plates: a clinical case

El tratamiento ortodóncico permite rehabilitar la función como también la estética facial y de la sonrisa. En muchos casos, esto puede realizarse sin la utilización de brackets. Las placas alineadoras realizan movimientos en las arcadas dentarias y las posibilidades y los resultados obtenidos cada vez son mejores. La utilización del sistema de alineación con placas permite que muchos pacientes, que no están dispuestos a utilizar brackets, encuentren una respuesta a sus problemas de oclusión (AU)

Parenting Styles and Coping Strategies in PKU Early Detected Children

Abstract Phenylketonuria (PKU) requires tight control to prevent neurocognitive impairment but reports show that patients may present mild cognitive defects related to higher impulsivity. We hypothesize that chronic intervention may influence the parents and child bonding and the child´s resources to face problems. To describe the PKU parenting styles perceived by the children (PS) and their coping strategies (CS) assessing their relationship with impulsivity, 30 early diagnosed and adequately treated PKU children and 30 non PKU aged-paired controls (CG) were compared. The Argentine Children´s Coping Questionnaire, Argentine Scale Perception of the Relationship with Parents, WISC IV Comprehension Subtest, and CPT II test were administered. PKU PS were based on control: strict to pathologic in the mother and acceptable in the father (both p<0.05 vs. CG). Children significantly sought greater support and showed less emotional control when facing conflicts. These characteristics positively correlated with maternal control r:.383 and r:.398 (both p<0.05). Impulsivity was higher in PKU (p<0.05) but didn´t associate with PS or CS. Maternal strict control wasn´t linked to the higher impulsivity found (possibly neurobiologically based). Nevertheless, if both factors are present, patients may develop a psychological and/or behavioral trait of greater dependency and impulsivity that must be considered in their follow-up.

Alineadores como recurso terapéutico en primera fase / Aligners as a therapeutic resource in the first phase

Este artículo describe el tratamiento de primera fase con placas alineadoras, realizado en un paciente de 7 años de edad, con mordida invertida anterior por torque negativo de pieza 2.1 y falta de espacio para la erupción de incisivos laterales superiores. Entendiendo la importancia de destrabar en forma precoz la oclusión, se planificó su tratamiento con alineadores para realizar una expansión tranversal, corregir el torque del incisivo central y recuperar la forma de la arcada superior, a los fines de restablecer la armonía necesaria para el correcto desarrollo de sus maxilares. Luego de seis meses de tratamiento, se lograron los objetivos propuestos. El caso se acompaña de fotos, radiografías y renders iniciales y finales(AU)

This article describes the first phase treatment with dental alignment plates, performed on a 7 years old patient with an anterior crossbite due to a negative torque of tooth 2.1 and lack of space for the upper lateral incisors eruption. Aware of the importance of early unlocking occlusion, his treatment with aligners was planned to perform a transversal expansion, to correct the torque of the central incisor and recover upper arch shape in order to restore the necessary harmony for the correct development of his jaws. After 6 months of treatment, proposed objectives were achieved. This case is accompanied by photos, x-rays and initial and final renderings(AU)

Modelando una propuesta conceptual para analizar características psicosociales de emprendedores sociales peruanos / Modeling a conceptual proposal to analyze psychosocial characteristics of Peruvian social entrepreneurs

Resumen Objetivo: este estudio tiene como objetivo proponer un abordaje comprensivo de cinco dimensiones teóricas características de los emprendedores sociales, para plantear un modelo conceptual que las analiza desde los constructos psicosociales macro de Creencias y Prácticas. Método: se desarrolló un estudio cualitativo, con 16 emprendedores sociales de la ciudad de Lima (Perú), cuyas trayectorias, por medio de un análisis temático deductivo, se analizaron y operativizaron en tanto creencias y/o prácticas en variables psicosociales más específicas como valores, actitudes, conductas y rasgos. Resultados :la dimensión de Aprecio por Prácticas Sostenibles (APS), de carácter actitudinal, resulta ser el eje articulador en el que confluyen las experiencias de todos los participantes para concretar su visión social, de carácter axiológico, promoviendo conductas competentes de innovación, redes y retornos financieros. Conclusión :se discuten los resultados enfatizando la necesidad de profundizar en el estudio de la dimensión APS de manera contextualizada a las problemáticas sociales del Perú.

Abstract Objective :This study aims to propose a comprehensive approach to five theoretical dimensions, characteristic of social entrepreneurs, to design a conceptual model that analyzes them based on macro - level psychosocial constructs such as beliefs and practices. Method :A qualitative study was con ducted with 16 social entrepreneurs from the city of Lima (Peru). Using a deductive thematic analysis, their careers were examined and made operative based on their beliefs and/or practices, and on more specific psychosocial variables such as values, attitudes, behaviors and traits. Results :The attitudinal dimension of Positive Attitudes Towards Sustainable Practices (PASP) is the articulating main point in which all participants' experiences come together to define their social vision, of axiological nature, promoting competent behaviors including innovation, networks and financial returns. Conclusion :The results highlight the need to deepen the study of the PASP dimension focused on the Peruvian social issues.

História espiritual e preferência de intervenção religiosa de pacientes crônicos cristãos / Spiritual history and preference for religious intervention of chronic Christian patients / Historia espiritual y preferencia de intervención religiosa de pacientes crónicos cristianos

Objetivo: conhecer e analisar a história espiritual dos pacientes. Métodos: Estudo transversal quantitativo e de intervenção. Foi aplicado o instrumento História Espiritual Abordagem Centrada na Pessoa (ACP); se fosse da vontade do paciente, era realizada uma intervenção religiosa pelos pesquisadores. Resultados: A amostra foi de 100 pacientes internados nas unidades de Clínica Médica Masculina e Feminina de um hospital, com média de idade de 55,73 anos (dp=16,49). A associação das características religiosas com a História Espiritual ACP obteve diferenças estatisticamente significativas. Conclusões: Os pacientes consideraram a fé importante na situação de doença e em outras épocas da vida. Entretanto, não tinham alguém no hospital para falar sobre assuntos religiosos. A intervenção religiosa proposta foi realizada na maioria dos pacientes e a oração Pai Nosso foi a intervenção mais escolhida. Características religiosas foram elementos relevantes e interferiram diretamente na História Espiritual ACP dos pacientes.(AU)

Objectives: to know and analyze the patient's spiritual history. Method: a cross-sectional quantitative and intervention study. Was applied the instrument Spiritual History Person-Centered Approach (PCA), and, if it's the patient's wish, a religious intervention were held by the researchers. Results: The sample consisted of 100 patients hospitalized at Internal Medicine units Male and Female of a hospital, with a mean age of 55.73 years (SD = 16.49), mostly male. The association of religious characteristics with Spiritual History PCA presented a statistically significant difference. Conclusion: Patients considered faith important in the disease situation and at other times of life. However, they had no one in the hospital to talk about religious matters. Religious intervention proposed was performed in most patients and The Our Father prayer was the most chosen intervention. Religious characteristics were relevant elements and directly interfered in patient's spiritual history.(AU)

Objetivos: conocer y analizar la historia espiritual de los pacientes. Métodos: Estudio transversal cuantitativo y de intervención. Se aplicó el instrumento Historia Espiritual Enfoque Centrado en la Persona (ACP); si fuera de la voluntad del paciente, se realizaba una intervención religiosa por los investigadores. Resultados: La muestra fue de 100 pacientes internados en las unidades de Clínica Médica Masculina y Femenina de un hospital, con una media de edad de 55,73 años (dp = 16,49), la mayoría del sexo masculino. La asociación de las características religiosas con la Historia Espiritual ACP presentó diferencias estadísticamente significativas. Conclusiones: Los pacientes consideraran la fe importante en la situación de enfermedad y en otras épocas de la vida. Sin embargo, no había alguien en el hospital para hablar sobre asuntos religiosos. La intervención religiosa propuesta fue realizada en la mayoría de los pacientes y la oración Padre Nuestro fue la intervención más escogida. Las características religiosas fueron elementos relevantes e interfirieron directamente en la Historia Espiritual ACP de los pacientes.(AU)

Phenylalanine Hydroxylase (PAH) Genotyping in PKU Argentine Patients

Abstract Phenylketonuria (PKU, OMIM 261600) is predominantly caused by mutations in the PAH gene. One hundred and three Argentine PKU patients were studied by Sanger sequencing; 101 were completely characterized (90.3% were compound heterozygotes). Fifty-four different pathogenic variants were identified. Mutations were distributed all along the PAH gene but concentrated in exon 7 (26%), 12 (12%), 11 (10%), and 6 (10%). 77% were missense, and 77% affected the enzyme catalytic domain, nine mutations accounted for 57% of 179 studied alleles: p.Arg261Gln (Allele frequency(AF):10.6%), c.1066-11G>A (AF:9,5%), p.Arg408Trp (AF:8,3%), p.Tyr414Cys (AF:5,5%), p.Ala403Val, p.Val388Met, and p.Arg158Gln (AF: 5% each), p.Leu48Ser, and p.Ile65Thr (AF:4% each). The predicted phenotype was assigned by Guldberg´s arbitrary value (AV) and compared with the clinical phenotype based in tolerance to Phe intake. 29.1% (n:30) were hyperphenylalaninemias, 18.5% (n:19) mild-PKU, 27.2% (n:28) moderate-PKU and 25.2 % (n:26) classical-PKU. Genotype/phenotype correlation was statistically significant (p<0.001) Overall concordance was 62,5%: 93.3% in hyperphenylalaninemia, 64.7% in mild-PKU and 65.4% in classical patients. The moderate-PKU showed a weak concordance (17%) with milder AV prediction than clinical assessment. 74% of discordant moderate patients harbored p.Arg261Gln, and p.Val388Met. Our cohort is highly heterogeneous, with predominant Mediterranean influence (mainly Spanish), but with differences with other Latin-American countries.

Narrativas de sostenibilidad en emprendedores sociales de Lima metropolitana / Narratives of sustainability in social entrepreneurs of Lima, Perú

El aprecio por prácticas sostenibles (APS) es una dimensión psicológica actitudinal que la literatura actual define como componente relevante del comportamiento emprendedor social. El presente estudio busca comprender la manera en que esta dimensión se gesta y hace consistente en las narrativas de vida de 10 líderes de emprendimientos sociales de Lima Metropolitana, buscando dar fundamento vivencial a un constructo que, si bien está definido conceptualmente, no ha sido abordado desde las experiencias personales que lo hacen posible. A través de una metodología cualitativa de enfoque narrativo, y bajo una presentación temática de los resultados se identificaron dos grandes narrativas: la Autotrascendencia social y las Prácticas sostenibles, que dan cuenta de un proceso por el cual la persona se posiciona en una consciencia crítica de interconexión y pensamiento sistémico con los otros, para luego ejecutar y diseminar prácticas emprendedoras responsables en beneficio de la sociedad y el mundo. Los resultados brindan insumos para considerar posibles programas de formación sobre sostenibilidad en diferentes etapas de la educación de las personas

Appreciation for sustainable practices (ASP) is an attitudinal psychological dimension that current literature defines as a relevant component of social entrepreneurial behavior. The present study seeks to understand how this dimension is developed and it's consistent in the life narratives of 10 leaders of social enterprises in Lima, in order to state a construct that, although conceptually defined, has not been addressed from the personal experiences that make it possible. Through a qualitative methodology of narrative approach, and under a thematic presentation of the results, two major narratives were identified: Social self-transcendence and Sustainable practices. Both account for a process by which a person develops a critical awareness of interconnection and systemic thinking, to further execute and disseminate responsible entrepreneurial practices for the benefit of society and the world. The results provide inputs to consider possible training programs on sustainability in different stages of people's education

Circumcision: postoperative complications that required reoperation / Postectomia: complicações pós-operatórias necessitando reintervenção cirúrgica

ABSTRACT Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients' age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients' age did not influence in complications.

RESUMO Objetivo Avaliar as complicações pós-operatórias de postectomia que necessitaram de reintervenção cirúrgica. Métodos Estudo retrospectivo com análise de prontuários de pacientes submetidos à postectomia entre 1o de maio de 2015 a 31 de Maio de 2016. Resultados Foram realizadas 2.441 postectomias no período, sendo 501 utilizando a técnica clássica e 1.940 utilizando o dispositivo Plastibell. Apresentaram complicações que necessitaram reintervenção cirúrgica 3,27% dos pacientes. Quando separados por técnica operatória, 3,4% das postectomias com Plastibell foram reoperadas, comparando com 3% das postectomias convencionais (p=0,79). A estenose de prepúcio foi mais frequentemente encontrada na técnica clássica, com significância estatística (p<0,001). Sangramento foi mais frequente nos casos com uso do Plastibell, porém sem diferença significativa (p=0,37). A idade dos pacientes também foi avaliada para investigar se esta variável influenciou na taxa de complicações pós-operatórias, porém não houve diferença significativa. Conclusão Não houve diferença estatisticamente significativa quando comparadas as complicações entre as diferentes técnicas cirúrgicas utilizadas neste serviço. A estenose de prepúcio foi mais frequentemente encontrada nos pacientes operados pela técnica convencional enquanto demonstrou-se tendência a maior sangramento com uso do Plastibell. A idade dos pacientes não influenciou na presença de complicações.

Estudio y manejo de nódulos tiroideos por médicos no especialistas. Consenso SOCHED / Study and management of thyroid nodes by non specialist physicians: SOCHED consensus

The thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.

Sobre la adherencia al tratamiento: Análisis de un caso clínico a la luz del modelo transteórico / PATIENT'S ADHESION TO TREATMENT: ANALYSIS OF A CLINICAL CASE REFERRED TO A TRANSTHEORETICAL MODEL

Antecedentes: Determinadas patologías crónicas, asociadas con hábitos perniciosos y con las que convive el enfermo durante muchos años afectando cada vez más su calidad de vida y eventualmente amenazando su vida misma, requieren abordajes terapéuticos interdisciplinarios que modifiquen la resistencia a su corrección. Objetivo: demostrar la utilidad del modelo transteórico. Diseño: observacional-descriptivo de un caso clìnico. Lugar de aplicación: Hospital Universitario de atención terciaria. Método: consta de cinco etapas: Precontemplación, Contemplación, Preparación para la acción, Acción y Mantenimiento del cambio logrado (Método Transteórico de Prochaska y Di Clemente). Resultado: Se logró la adhesión del paciente a conductas e indicaciones rechazadas en un principio. Logrando mejorar su control metabólico, y de otros factores de riesgo. Conclusiones:el modelo terapéutico aplicado a este paciente con una enfermedad de evolución crónica sin conciencia de la misma, resultó eficaz

Background: Certain chronic diseases associated with harmful habits with which some patients live for many years that affect both their quality of life and eventually threaten life itself, require multidisciplinary therapeutic approaches that change the patient´s resistance to habits being corrected. Objective: To show the benefits of the transtheoretical model. Design: Observation of case report Setting: tertiary care at University Hospital Method: The method consists of five stages: Precontemplation, Contemplation, Preparation for action, Action, and Maintenance of the achieved change (The Transtheoretical Model by Prochaska & Di Clemente) Result: The patient´s adhesion to behaviour and medical advice which had initially been rejected was achieved. The insulin dose was reduced obtaining adequate glycaemic control, there was an improvement in the lipid profile, and adhesion to the nutritional treatment strengthened. This led to the beginning of body weight loss and the treatment of an ulcer on the sole of the patient´s foot. Conclusions: The therapeutic model applied to this patient with a chronic disease without awareness was effective

Evaluación de echinococcosis canina en la zona de alta montaña en la provincia de Tucumán, Argentina / Evaluation of canine echinococcosis in the high mountain area of province of Tucumán, Argentina / Avaliação de equinococose canina na zona de alta montanha na província de Tucumán, Argentina

La echinococcosis es un serio problema para la salud pública en Argentina. Es una zoonosis producida por el cestode de la familia Taeniidae, Echinococcus granulosus, siendo el perro el principal hospedador definitivo. El objetivo de este trabajo fue evaluar la echinococcosis en perros en la zona de alta montaña de la provincia de Tucumán. La principal actividad económica en esta zona es la cría de ganado para consumo familiar, sobre todo ovino. Las condiciones climáticas, las distancias y la falta de movilidad adecuada hacen difícil el acceso a los servicios de salud y a los establecimientos educativos. Se evaluaron seis parajes en un primer estudio con 103 muestras de materia fecal canina y se encontró que el 39,8% (41/103) fueron positivas. El estudio se repitió en dos localidades después de desparasitar a los perros mensualmente durante dos años. En estas áreas se observó una disminución de muestras con resultado positivo; en Chaquivil la variación fue del 57,1% al 10,0% y en San José de Chasquivil, fue del 47,1% al 11,1%. Estos resultados llevan a la conclusión de que es necesario realizar y planificar las actividades de control. Sería de suma importancia realizar la evaluación en otras localidades.

Canine echinococcosis is a serious public health problem in Argentina. It is a parasite zoonosis produced by a cestode of the Taeniidae family, Echinococcus granulosus, the dog being the principal definite host. The objective of this work was to evaluate echinococcosis in dogs in the high mountain area of the province of Tucumán. The main economic activity in this area is livestock breeding, mostly sheep, for family consumption. Climate conditions, distances and the lack of adequate mobility make it difficult to access to health services and educational facilities. Six places of the region were evaluated. The first study was carried out with 103 samples of canine faeces, 39.8% (41/103) being positive. The study was repeated in two localities, after deworming dogs monthly for two years. In these areas, a decrease of positive specimens was obtained: in Chaquivil, variation was 57.1% to 10.0% and in San José de Chasquivil, it was 47.1% to 11.1%. These results lead to the conclusion that it would be necessary to conduct and plan control activities. The assessment of other locations would be of utmost importance.

A equinococose é um problema sério para a saúde pública na Argentina. É uma zoonose produzida pelo cestode da família Taeniidae, Echinococcus granulosus, sendo o cão o principal hospedeiro definitivo. O objetivo deste trabalho foi avaliar a equinococose em cães na zona de alta montanha da Província de Tucumán. A atividade econômica principal nesta zona é a criação de gado para consumo familiar, principalmente o ovino. As condições climáticas, as distâncias e a falta da mobilidade adequada tornam difícil o acesso aos serviços da saúde e aos estabelecimentos educacionais. Seis lugares da região foram avaliados num primeiro estudo com 103 amostras da matéria fecal canina, sendo que 39.8% (41/103) foram positivas. O estudo foi repetido em duas localidades, depois de desverminar os cães mensalmente durante dois anos. Nessas áreas foi observada uma diminuição de amostras com resultado positivo; em Chaquivil a variação foi de 57.1% para 10.0% e em San José de Chasquivil, foi 47.1% para 11.1%. Estes resultados levam à conclusão de que é necessário realizar e planejar as atividades do controle. Seria de extrema importância fazer a avaliação em outras localidades.

Comentario sobre "Reflexiones acerca de la eutanasia en Colombia" / Commentary on "Reflections about euthanasia in Colombia"

We have read with great interest the Reflections about euthanasia in Colombia. It has reminded us that the support to decriminalize euthanasia is usually based on ordinary arguments: an emotional appeal of someone else's pain, rejection of disproportionate therapies, and praise to the autonomy of the individual. All of the above are mentioned in the text. With the emotional argument of mitigating pain and suffering to accomplish a smooth and easy transit or the idea of love and feelings of human solidarity with the sufferer, empathy is the logical consequence ("I wouldn't want to go through that") and presume that what is appropriate and piety-deserving is giving the patient an efficient and immediate exit. The rejection we all have against therapeutic obstinacy (cause useless suffering because of failure to adapt the therapy to the patient's situation, prognosis and values) leads to extreme positions that present euthanasia as the only option to avoid and prevent such disproportionate treatments. Finally, this autonomist and individualistic argument, transforms the respect for the right to refuse therapy or choose among several options inherent to lex artis into submission to the patient's wish, imposing his/her will as the only healthcare criterion. Beyond these arguments, when the debate turns into radical positions, the rejection of euthanasia is frequently presented as a religious issue, a Jewish-Christian cultural atavism or a moral imposition in the name of beliefs alien to a secular society.