Human papillomavirus prevalence and frequency of sexually transmitted diseases in encarcered women by self-sampling approach

SUMMARY OBJECTIVE: This study aimed to assess the sociodemographic and clinical profile of women deprived of their liberty and to identify the prevalence of sexually transmitted diseases and human papillomavirus through self-sampling samples. METHODS: This is an epidemiological, cross-sectional, observational, and descriptive study of the prevalence and correlation of the diagnosis of human papillomavirus infection in 268 encarcered women in Amazonas submitted to self-sampling from June 2019 to September 2020 using the genotyping analysis. Patients with positive and inconclusive results were evaluated by commercialized PCR to detect pathogens causing sexually transmitted diseases. The sample size used was based on a convenience sample. RESULTS: In 268 women, human papillomavirus DNA was detected in 87 (32.5%) of them. Sexually transmitted diseases were detected in 30 (34.48%) of the 87 women with a positive or inconclusive result for human papillomavirus. Women with more than three pregnancies had a higher risk of human papillomavirus detection (p=0.004). CONCLUSION: The prevalence of human papillomavirus and other sexually transmitted diseases in encarcered women in Amazonas is 32.5 and 34.48%, respectively. Most women were single (60.4%) and reported having had more than 15 partners (90.8%).

Experience in the Use of Video Capsule Endoscopy in Patients with Unexplained Iron Deficiency Anemia / Experiencia con el uso de la videocápsula endoscópica en pacientes con anemia ferropénica inexplicada

Abstract Introduction: The prevalence of iron deficiency anemia in developed countries has been estimated between 2-5 %, associated with high morbidity and mortality. Etiological identification is sometimes difficult and requires diagnostic methods, such as video capsule endoscopy (VCE). Aim: This study intends to characterize the findings of this technique in patients with unexplained iron deficiency anemia. Materials and methods: Descriptive observational retrospective study. We describe the VCE findings (PillCamSB2-SB3) in all patients seen between 2011 and 2019. The findings were interpreted according to the Saurin classification: normal (P0), uncertain potential (P1), and high bleeding potential (P2). Results: Of the 490 VCEs performed during the study period, 155 indicated iron deficiency anemia; 106 were women (68.4 %), and the mean age was 57.1 ± 16.6 years. The main comorbidities were cardiovascular in 23 (18.3 %) and arterial hypertension in 16 (12.6 %). Antiplatelets were present in 18 (15.4 %) and anticoagulants in six (5.1 %). Small bowel lesions were vascular in 44 studies (28.4 %), inflammatory in 33 (21.2 %), and neoplastic in seven (4.5 %). Angiectasias were the most frequent lesions in 33 cases (21.3 %). P2 lesions were present in 53 VCEs (34.2 %). Conclusions: VCE is helpful in the study of iron deficiency anemia and helps detect positive findings in the midgut in three out of four patients for which it is indicated. The most frequent significant P2 lesions were vascular. These findings allow providing adequate treatment.

Resumen Introducción: la prevalencia de la anemia ferropénica en países desarrollados se ha estimado entre 2 %-5 %, asociada con una alta morbimortalidad. La identificación etiológica a veces es difícil, y requiere de métodos diagnósticos, como la videocápsula endoscópica (VCE). Objetivo: el objeto del presente estudio fue caracterizar los hallazgos de esta técnica en pacientes con anemia ferropénica inexplicada. Materiales y métodos: estudio descriptivo, observacional y retrospectivo. Se describen los hallazgos de VCE (PillCamSB2-SB3) en todos los pacientes atendidos entre 2011 y 2019. Los hallazgos se interpretaron según la clasificación de Saurin: normal (P0), potencial incierto (P1) y alto potencial de sangrado (P2). Resultados: del total de 490 VCE realizadas durante el período del estudio, 155 se efectuaron con indicación de anemia ferropénica; 106 fueron mujeres (68,4 %) y la edad media fue de 57,1 ± 16,6 años. Las comorbilidades principales fueron cardiovasculares en 23 (18,3 %) e hipertensión arterial en 16 (12,6 %). La ingesta de antiplaquetarios se presentó en 18 (15,4 %) y anticoagulantes en 6 (5,1 %). Las lesiones en el intestino delgado fueron vasculares en 44 estudios (28,4 %), inflamatorias en 33 (21,2 %) y neoplásicas en 7 (4,5 %). Las angiectasias fueron las lesiones más frecuentes en 33 casos (21,3 %). En 53 VCE se presentaron lesiones P2 (34,2 %). Conclusiones: la VCE es útil en el estudio de la anemia ferropénica, y ayuda a detectar hallazgos positivos en el intestino medio en 3 de cada 4 pacientes en los cuales se indica su uso. Las lesiones P2 significativas más frecuentes fueron las vasculares. Estos hallazgos permiten enfocar un tratamiento adecuado.

Stents metálicos autoexpandibles para el manejo endoscópico de las fístulas esofagogástricas / Self-expanding metal stents for endoscopic management of esophageal and gastric fistulas

Resumen Objetivos: mostrar la eficacia y seguridad de los stents metálicos autoexpandibles para el manejo endoscópico de las fístulas esofágicas. Materiales y métodos: se evalúo una serie de casos de manera retrospectiva entre el 2007 y el 2017, en los que se manejaron a 11 pacientes con un stent metálico autoexpandible para el manejo de fístula esofágica, en quienes se realizó el diagnóstico por clínica, endoscopia digestiva alta o estudios radiológicos en la unidad de gastroenterología del Hospital Universitario San Ignacio (HUSI) de Bogotá D. C., Colombia. Resultados: el principal síntoma inicial fue la disnea en 27,3 % de los casos, seguido por tos en un 18,2 %. El hallazgo más frecuentemente encontrado durante el seguimiento fue el derrame pleural en el 36,4 %, se realizó el diagnóstico de fístula en el 45,5 % con esofagograma y el tipo de lesión más reportada fue la fuga en la anastomosis esofagoentérica, con un 45,5 %, seguida de la esofagopleural, con un 36,4 %; y estos pacientes fueron manejados con un stent metálico autoexpandible. En el 100 % hubo éxito técnico y la resolución del defecto se evidenció en el 72,7 % de los casos. La única complicación reportada fue el desplazamiento del stent en el 27,3 %, y en un paciente se requirió el cambio del stent en 3 oportunidades. El promedio de estancia hospitalaria fue de 41,5 días. Conclusiones: el manejo endoscópico de las fístulas esofagogástricas con stents metálicos autoexpandibles es efectivo y seguro, con una baja tasa de complicaciones.

Abstract Objective: To demonstrate the efficacy and safety of self-expanding metal stents for endoscopic management of esophageal fistulas. Materials and methods: Retrospective case series between 2007 and 2017. A total of 11 patients were treated with self-expanding metal stents for esophageal fistula management, after being diagnosed based on symptoms, upper endoscopy, and/or radiological studies in the gastroenterology unit of the Hospital Universitario San Ignacio (HUSI) in Bogotá D.C, Colombia. Results: The most common initial symptom was dyspnea in 27.3% of cases, followed by cough in 18.2%. The most frequent finding during follow-up was pleural effusion in 36.4% of the cases, of which 45.5% received a diagnosis of fistula through esophagogram. The most reported lesion was esophagoenteric anastomotic leak with 45.5%, followed by esophagopleural injury with 36.4%; these patients were those who received self-expanding metal stent management. Technical success was achieved in 100% of the cases, and the defect was resolved in in 72.7% of them. The only complication reported was stent migration in 27.3%, requiring 3 changes in 1 patient. The average hospital stay was 41.5 days. Conclusions: Endoscopic management of esophagogastric fistulas with self-expanding metal stents is effective and safe, with a low complication rate.

Caracterización de los trastornos manométricos esofágicos en pacientes con enfermedad por reflujo gastroesofágico refractario con síntomas esofágicos / Characterization of esophageal motility disorders in refractory gastroesophageal reflux disease patients with esophageal symptoms

Resumen Introducción: La enfermedad por reflujo gastroesofágico (ERGE) refractaria puede conducir a complicaciones potenciales como la esofagitis persistente, estenosis esofágica, anillo de Schatzki y esófago de Barrett. Este estudio describe la motilidad en pacientes con ERGE refractaria y su relación con síntomas esofágicos. Método: Se realizó un estudio observacional analítico a partir de una cohorte retrospectiva en pacientes con diagnóstico de ERGE refractaria y síntomas esofágicos a quienes se les realizó manometría esofágica de alta resolución más impedanciometría. Se describen las características clínicas y demográficas, y la asociación entre los trastornos manométricos y los síntomas esofágicos. Resultados: Se incluyeron 133 pacientes (edad promedio: 54,1 ± 12,5 años). La pirosis y regurgitación (69,2 %) y la disfagia esofágica (13,5 %) fueron los síntomas más comunes. La motilidad normal (75,2 %), el aclaramiento completo del bolo (75,2 %) y la motilidad esofágica inefectiva (MEI) (18 %) fueron los hallazgos manométricos más frecuentes. La unión gastroesofágica tipos II y IIIb estuvieron presentes en el 35,3% y 33,8 % de los casos, respectivamente. La aperistalsis (3,8 %) y el esófago en martillo neumático (Jackhammer; 0,8 %) fueron infrecuentes. El aclaramiento incompleto del bolo se asoció con disfagia esofágica (p = 0,038) y a MEI (p = 0,008). Ningún síntoma esofágico se relacionó significativamente con trastornos de motilidad. Conclusiones: Los resultados de nuestro estudio sugieren que los trastornos de motilidad son infrecuentes en los pacientes con ERGE refractaria. Adicionalmente, sugieren que la presencia de alteraciones de motilidad esofágica no se relaciona con la presencia de síntomas esofágicos y, por tanto, que el tipo de síntoma presentado no permite predecir la existencia de dichos trastornos.

Abstract Introduction: Refractory gastroesophageal reflux disease (GERD) can lead to potential complications such as persistent esophagitis, esophageal stricture, Schatzki ring, and Barrett's esophagus. This study describes motility in patients with refractory GERD, and its association with esophageal symptoms. Materials and methods: An analytical observational study was carried out in a retrospective cohort of patients diagnosed with refractory GERD and esophageal symptoms who underwent high-resolution esophageal manometry and impedance testing. Clinical characteristics, demographics, and the association between motility disorders and esophageal symptoms are described. Results: 133 patients were included (mean age 54.1 ± 12.5 years). Heartburn and regurgitation (69.2%), and esophageal dysphagia (13.5%) were the most common symptoms. Normal motility (75.2%), complete bolus clearance (75.2%), and ineffective esophageal motility (IEM) (18%) were the most frequent manometric findings. Type II and IIIb gastroesophageal junction were observed in 35.3% and 33.8% of the cases, respectively. Esophageal aperistalsis (3.8%) and Jackhammer esophagus (0.8%) were rare findings. Incomplete bolus clearance was associated with esophageal dysphagia (p=0.038) and IEM (p=0.008). No esophageal symptoms were significantly related to motility disorders. Conclusions: The results of the present study suggest that motility disorders are rare in patients with refractory GERD. They also suggest that esophageal motility disorders are not associated with the presence of esophageal symptoms and, therefore, the type of symptom experienced does not allow predicting the existence of such disorders.

Actualización en la interpretación de la medición del pH e impedanciometría / Updated interpretation of Impedance-pH monitoring

Resumen La enfermedad por reflujo gastroesofágico (ERGE) se define como el tránsito anormal del contenido gástrico hacia el esófago, que se da por una alteración de la barrera antirreflujo, causando síntomas o complicaciones. Para su correcto diagnóstico y abordaje terapéutico, se requiere de la integración de hallazgos clínicos, endoscópicos y monitorización del pH esofágico en 24 horas con o sin impedanciometría, la cual debe ser realizada con especificaciones técnicas, y su interpretación debe basarse en la mejor evidencia clínica disponible, con el objetivo de tener diagnósticos precisos que permitan tomar las mejores decisiones con los pacientes. Recientemente, en el Consenso de Lyon se han incorporado nuevas directrices para el diagnóstico de ERGE por monitorización de pH esofágico, las cuales se revisan en este artículo.

Abstract Gastroesophageal reflux disease (GERD) is defined as the abnormal transit of gastric contents into the esophagus. It is caused by an alteration of the anti-reflux barrier, causing multiple symptoms or complications. In order to achieve accurate diagnosis and proper therapeutic approach, integration of clinical findings, endoscopic findings and 24-hour esophageal pH monitoring, with or without impedancometry, is required. These tests must be performed following technical specifications and their interpretation must be based on the best clinical evidence available to obtain accurate diagnoses that allow making the best decisions to the benefit of patients. Recently, the Lyon Consensus incorporated new guidelines for the diagnosis of GERD by esophageal pH monitoring, which are reviewed in this paper.

Impact of the immunohistochemical panel on patients with breast cancer diagnosis cared for in a referral hospital in the state of Amazonas

Objective: To demonstrate the time between the diagnosis of the disease, the result of the immunohistochemical panel and the beginning of specialized treatment in patients diagnosed with breast cancer seen at the Foundation Center of Oncology of the State of Amazonas, from June to November 2018 and in the same period of 2019. Methods: The study was part retrospective, based on data from medical records, and part prospective, based on data from patients, and we evaluated the time between diagnosis from the immunohistochemical panel and the beginning of specialized treatment in breast cancer patients. Results: 170 patients diagnosed with breast cancer were included, 71 from June to November 2018 and 99 breast cancer patients seen from June to November 2019. The median time between diagnosis and immunohistochemistry results of all patients was 36 days, and comparing the two groups of patients, it was observed that for half of the 2018 patients, the time was less than 105 days, while for half of the 2019 patients, it was less than 27 days. If the times between the result of the immunohistochemical panel and the start of personalized treatment in both groups were compared, it was seen that the median time until the start of treatment was longer for patients in 2018, 94.5 days versus 79 days for patients in 2019. Conclusion: There was a decrease in the time between the diagnosis and the result of the molecular panel in 2019 compared to 2018. Achieving this result more quickly provided the choice of personalized treatment for each patient, having an important impact on survival in that population.

Audiological assessment of children with HIV/AIDS: a meta-analysis / Avaliação audiológica de crianças com HIV/AIDS: uma metanálise

Abstract Objective: To analyze the results of the audiological evaluation of children with HIV and AIDS. Data collection: Systematic review carried out in May 2019 in the Web of Science, PubMed, SciELO, and Scopus databases. Case reports and original articles were included, with no limitationsregarding country or year of publication. Data synthesis: 278 articles were identified; 26 were included, in which HIV/AIDS was shown to be a risk factor for hearing loss (OR = 5.364; p = 0.00). The studies used different audiological exams, with varying methodologies. There was no difference regarding the type of hearing loss (p = 0.119). Conclusion: Longitudinal studies using the same type of examination at all stages are suggested, to allow better monitoring of the effects of HIV on the child's hearing,and studies that provide more methodological details. The knowledge of the influence of HIV on the child's auditory system may lead to the promotion of measures that minimize the prevalence of hearing loss, allow an early diagnosis and timely rehabilitation, so as not to compromise child development.

Resumo Objetivo: Analisar os resultados da avaliação audiológica de crianças com HIV e AIDS. Coleta dos dados: Revisão sistemática realizada em maio de 2019 nas bases Web of Science, Pubmed, SciELO e Scopus. Relatos de caso e artigos originais foram incluídos, sem limitação quanto ao país ou ano de publicação. Síntese dos dados: Foram identificados 278 artigos, sendo que 26 foram incluídos, nos quais o HIV/AIDS foi mostrado como fator de risco para perda auditiva (OR = 5.364; p = 0.00). Os estudos utilizaram diferentes exames audiológicos, com diferentes metodologias. Não houve diferença com relação ao tipo de perda auditiva (p = 0.119). Conclusão: Sugere-se estudos longitudinais usando o mesmo tipo de exame em todas as fases para possibilitar melhor acompanhamento dos efeitos do HIV na audição da criança e estudos que tragam mais detalhes metodológicos. O conhecimento da influência do HIV no sistema auditivo infantil pode levar à promoção de medidas que minimizem a prevalência da perda auditiva, possibilitem diagnóstico precoce e permita reabilitação em tempo hábil para não comprometer o desenvolvimento infantil.

Cómo realizar e interpretar una manometría anorrectal de alta resolución / How to perform and interpret high resolution anorectal manometry

Resumen La manometría anorrectal es la técnica más utilizada para evaluar la función anorrectal y así detectar las anormalidades funcionales del esfínter anal y de coordinación anorrectal. En nuestro laboratorio de fisiología realizamos aproximadamente 15 estudios de manometría anorrectal de alta resolución a la semana, por lo que consideramos que es de vital importancia realizarlo de forma adecuada y tener una correcta interpretación. Mediante este artículo deseamos compartir nuestro protocolo de realización de manometría anorrectal de alta resolución con base en la literatura más relevante.

Abstract Anorectal manometry is the most commonly used technique to evaluate anorectal functioning and coordination and detect functional abnormalities of the anal sphincter. In our physiology laboratory we perform approximately 15 high resolution anorectal manometry studies each week. We consider that proper performance and correct interpretation are vitally important. We want to share our high resolution anorectal manometry protocol based on the most relevant literature through this article.

Embarazo y enfermedad inflamatoria intestinal, una combinación especial: a propósito de un caso y revisión de la literatura / A special combination of pregnancy and inflammatory bowel disease: case report and literature review

Resumen La enfermedad inflamatoria intestinal (EII) comprende un espectro de enfermedades crónicas inmunomediadas que afectan el tracto gastrointestinal, con inicio típico durante el comienzo de la edad adulta. Esta enfermedad ha tenido un incremento de su incidencia a nivel mundial, teniendo en Norteamérica una mayor incidencia. En relación con la enfermedad de Crohn (EC) (20,2 por cada 100 000 personas/año) y en Europa una incidencia de colitis ulcerativa (CU) (24,3 por 100 000 personas/año), considerando que no es una enfermedad curable, la remisión de la misma es el principal objetivo del manejo. Muchas mujeres se encuentran afectadas por EII durante distintos estadios de su vida, incluido durante la vida reproductiva, el embarazo y la menopausia. Es por lo anterior que la forma en la que se maneje la enfermedad en mujeres en edad reproductiva puede afectar el curso de la EII. Son muy relevantes las estrategias de tratamiento y mantenimiento de la salud, para las pacientes con deseo de paridad, la remisión de la enfermedad es muy importante en el momento de la concepción y durante todo el embarazo, para asegurar adecuados resultados tanto para la madre como para el feto. Es bien conocido que la enfermedad activa durante el momento de la concepción y el embarazo se asocia con desenlaces adversos. Además, la enfermedad perianal activa es indicación de parto por cesárea, lo que resulta en un mayor riesgo de cirugía intestinal y complicaciones en el posoperatorio. A continuación, presentamos un caso.

Abstract Inflammatory bowel disease (IBD) comprises a spectrum of chronic immune-mediated diseases that affect the gastrointestinal tract. Onset typical occurs in adulthood. Its incidence is increasing everywhere, the highest incidence of Crohn's disease of 20.2 per 100,000 people/year is in North America while the incidence of ulcerative colitis is 24.3 per 100,000 people/year in Europe. Since it is not curable, the remission is the main objective of management. Many women are affected by IBD at different stages of their lives, including during reproductive life, pregnancy and menopause, so the way the disease is managed in reproductive age women can affect IBD's course. Treatment and maintenance strategies are very relevant. For patients with a desire to have children, disease remission is very important from conception through pregnancy to birth to ensure adequate results for both mother and fetus. It is well known that active disease during conception and pregnancy is associated with adverse outcomes of pregnancy. In addition, active perianal disease is an indication for cesarean delivery which entails increased risk of bowel surgery and complications in the postoperative period. We present a case of IBD during pregnancy.

Incidência de Anaplasma marginale, Babesia bigemina e Babesia bovis em bezerros no semiárido paraibano / Incidence of Anaplasma marginale, Babesia bigemina and Babesia bovis among calves in the semiarid region of Paraiba, Brazil

Este estudo avaliou a incidência de infecções naturais pelos agentes da tristeza parasitária bovina (TPB), Anaplasma marginale, Babesia bovis e Babesia bigemina, em bezerros nascidos em cinco fazendas do semiárido paraibano. Em cada fazenda, foram coletadas amostras de sangue de 6 a 14 bezerros a cada 14 dias durante os primeiros 12 meses de vida de cada animal. As amostras de sangue foram processadas por microhematócrito e testadas por PCR para detecção de DNA de A. marginale, B. bovis e B. bigemina. Em paralelo, foram quantificadas as infestações por carrapatos nos bovinos nas cinco fazendas, assim como as populações de tabanídeos em três fazendas. De 41 bezerros monitorados durante o primeiro ano de vida, 25 (61,0%) apresentaram PCR positivo para A. marginale, 7 (17,1%) para B. bigemina e 3 (7,3%) para B. bovis. Os valores de incidência da infecção por A. marginale variaram de 83,3% a 100% em quatro fazendas. A infecção por B. bigemina ocorreu em bezerros de apenas duas fazendas (incidências de 12,5% e 85,7%) e a por B. bovis em apenas uma (incidência de 42,8%). Em uma fazenda os 14 bezerros permaneceram negativos para A. marginale, B. bigemina e B. bovis durante os 12 meses de acompanhamento. Os resultados de PCR foram confirmados por sequenciamento de DNA de produtos amplificados. A presença de carrapatos Rhipicephalus (Boophilus) microplus foi verificada somente em duas propriedades, nas quais houve infecção por A. marginale, B. bigemina e B. bovis (este último agente em apenas uma delas). Foram capturados 930 tabanídeos no estudo, a maioria durante os períodos de chuvas na região; 70,7% dos tabanídeos corresponderam a Tabanus claripennis. Houve associação significativa entre PCR positivo para A. marginale ou B. bigemina e menores valores de hematócrito. Este estudo demonstra que, mesmo avaliando apenas cinco propriedades rurais, a incidência dos agentes da TPB ocorreu de forma heterogênea na região, corroborando o status de área de instabilidade enzoótica para TPB previamente relatado para o semiárido paraibano.(AU)

This study evaluated the incidence of natural infection by agents of cattle tick fever (CTF), Anaplasma marginale, Babesia bovis and Babesia bigemina in calves born in five farms within the semiarid region of Paraíba state, Brazil. In each farm, blood samples were collected from 6 to 14 calves every 14 days during the first 12 months of life of each animal. Blood samples were processed by microhematocrit and tested by PCR for detection of DNA of A. marginale, B. bovis and B. bigemina. In parallel, the tick infestations on animals were quantified in the five farms, as well as populations in horseflies in three farms. From a total of 41 calves monitored during the first year of life, 25 (61.0%) had positive PCR for A. marginale, 7 (17.1%) for B. bigemina and 3 (7.3%) to B. bovis. Incidence values for A. marginale infection ranged from 83.3% to 100% in four farms. Infection with B. bigemina in calves was detected at only two farms (incidence of 12.5% and 85.7%) and by B. bovis in just one (42.8% incidence). On one farm 14 calves remained negative for A. marginale, B. bigemina and B. bovis during the 12 month follow-up. PCR results were confirmed by DNA sequencing of amplified products. The presence of Rhipicephalus (Boophilus) microplus was found only in two farms in which there was infection by A. marginale, B. bigemina and B. bovis (the latter agent in only one of them). A total of 930 horseflies were captured in the study, most during periods of rain in the region; 70.7% of horseflies corresponded to Tabanus claripennis. There was significant association between a positive PCR for A. marginale and B. bigemina and lower hematocrit values. This study demonstrates that even evaluating only five rural properties, the incidence of CTF occurred heterogeneously in the region, confirming the status of enzootic instability area for CTF, previously reported for the semiarid region of Paraiba.(AU)

O processo de implementação da Tutoria da Planificação da Atenção Primária em uma Unidade Laboratório de um município do interior de Goiás / The implementation process of the Primary Attention Planning Tutoring in a Laboratory Unit of a municipality of the interior of Goiás

A Planificação da Atenção Primária à Saúde é uma ação do Conselho Nacional de Secretários de Saúde (CONASS), que pretende problematizar e refletir sobre o papel da APS como ordenadora da rede, através de oficinas temáticas, na tentativa de reorganização do processo de trabalho das Equipes de Saúde da Família (ESF). Para complementar as oficinas de planificação colocaram em prática a fase teórica baseada na utilização da Tutoria e de um processo de implementação que tem como fase inicial uma unidade laboratório seguida de uma fase de expansão para outras unidades. O processo de tutoria desenvolveu-se por meio do apoio direto aos profissionais e equipes no exercício de suas funções assistenciais e gerenciais. O objetivo é fortalecer as competências de conhecimento, habilidade e atitudes. Este artigo tem como objetivo relatar a experiência da Tutoria da Planificação da Atenção Primária à Saúde e descrever as ações propostas e realizadas em uma Unidade Laboratório de um município do interior de Goiás, na perspectiva de dispersão e/ou expansão da experiência da Unidade Laboratório para outras Unidades de Saúde. Portanto este estudo se constitui de um relato de experiência vivenciado pela facilitadora e tutora externa do município

The Planning of Primary Health Care is an action of the National Council of Health Secretaries (CONASS), which intends to problematize and reflect on the role of APS as a network facilitator, through thematic workshops, in an attempt to reorganize the work process of the Family Health Teams (ESF). To complement the planning workshops, they put into practice the theoretical phase based on the use of Tutorship and an implementation process that has an initial phase a laboratory unit followed by an expansion phase for other units. The mentoring process developed through direct support to professionals and teams in the exercise of their care and management functions. The goal is to strengthen knowledge, skill and attitude skills. This article aims to report on the experience of the practical part of the Primary Health Care Planning and to describe the actions proposed and carried out in a Laboratory Unit of a municipality in the interior of Goiás, in the perspective of dispersion and / or expansion of the Laboratory Unit experience for other Health Units. Therefore, this study constitutes an experience report by the facilitator and external tutor of the municipality

Effect of hippotherapy in the global motor coordination in individuals with Down Syndrome / Efeito da equoterapia na coordenação motora global em sujeitos com Síndrome de Down

Abstract Introduction: Down syndrome (DS) of all genetic syndromes is the most common. In Hippotherapy, three-dimensional movements, provided by horse walking, awaken in the body of children with DS a large amount of sensory and neuromuscular stimuli, which directly interfere with overall development and the acquisition of motor skills. Objective: To analyze the effects of an Hippotherapy program on global motor coordination variables in individuals with DS of both genders and to compare individuals with the same syndrome who do not practice Hippotherapy. Methods: 41 individuals participated in the study, 20 of them practicing Hippotherapy (EG) and 21 who did not practice Hippotherapy (CG). The Körperkoordinations test für Kinder (KTK) test was used, consisting of four tasks: Balance on beams, Single-lever jump, Side-jump and Transfer on platform for analysis of motor coordination for individuals. Results: Comparing the groups, a significant difference (p < 0.01) was observed for the Lateral Leap Motor Quotient, the EG presented a better score (114.10) than the CG (88.47), and also in the Total Motor Ratio (EG = 115.10, GC = 102.47). The individuals that practice Hippotherapy presented better results in the global motor coordination, with significant difference (p < 0.05). In EG, 5% had high global motor coordination, 40% good and 55% normal, whereas in CG only 10% had good global motor coordination and 90% normal global motor coordination. Conclusion: It can be emphasized that equine therapy presents benefits of improvement in global motor coordination. Specifically in tasks such as the balance beam, single jump and side jump, besides global motor coordination.

Resumo Introdução: A Síndrome de Down (SD), de todas as síndromes genéticas é a mais comum. Na Equoterapia, os movimentos tridimensionais, proporcionados pelo andadura do cavalo, despertam no corpo das crianças com SD uma grande quantidade de estímulos sensoriais e neuromusculares, que interferem diretamente no desenvolvimento global e na aquisição de habilidades motoras. Objetivo: Analisar os efeitos de um programa de Equoterapia sobre as variáveis de coordenação motora global em indivíduos com SD de ambos os gêneros e comparar indivíduos com a mesma síndrome que não praticam Equoterapia. Métodos: Participaram do estudo 41 indivíduos sendo 20 que praticavam Equoterapia (GE) e 21 que não praticavam Equoterapia (GC). Utilizou-se o teste Körperkoordinations test für Kinder (KTK) composto por quatro tarefas: Equilíbrio sobre traves, Salto monopedal, Salto lateral e Transferência sobre plataforma para análise de coordenação motora para indivíduos. Resultados: Comparando os grupos observou-se diferença significativa (p < 0,01) para o Quociente Motor da Tarefa de Salto lateral, o GE apresentando melhor escore (114,10) em relação ao GC (88,47), e ainda, no Quociente Motor Total (GE =115,10; GC =102,47). Os indivíduos que praticam Equoterapia apresentaram melhores resultados na coordenação motora global, com diferença significativa (p < 0,05). No GE, 5% apresentaram coordenação motora global alta, 40% boa e 55% normal, já no GC, apenas 10% apresentaram coordenação motora global boa e 90% normal. Conclusão: Pode-se destacar que a equoterapia apresenta benefícios de melhora na coordenação motora global. Especificamente nas tarefas como a trave de equilíbrio, salto monopedal e salto lateral, além da coordenação motora global.

Cómo realizar e interpretar una manometría esofágica de alta resolución usando la clasificación de Chicago 3. 0 / How to perform and interpret a high resolution esophageal manometry using the Chicago 3.0 classification

Resumen Con la introducción de la manometría esofágica de alta resolución se revelaron patrones no identificados previamente de la función esofágica. De igual forma, este método diagnóstico adiciona patrones de presión topográfica de la presión esofágica, lo que lleva al desarrollo de nuevas herramientas para el análisis y clasificación de desórdenes motores esofágicos. En la actualidad, la clasificación de Chicago 3.0 es la herramienta de análisis de los diferentes trastornos motores esofágicos. En Colombia, cada día se ve el crecimiento en la realización de este estudio. El artículo propone hacer una revisión de cómo realizar e interpretar una manometría esofágica de alta resolución y clasificar los diferentes trastornos de la motilidad esofágica según la última actualización de la clasificación de Chicago 3.0.

Abstract The introduction of high resolution esophageal manometry has led to the revelation of previously unidentified patterns of esophageal function. Similarly, this diagnostic method has revealed topographic patterns of esophageal pressure which has led to the development of new tools for analysis and classification of esophageal motility disorders. Currently, the Chicago 3.0 classification has become a tool for analysis of the various esophageal motility disorders. In Colombia, the use of this study is spreading and growing. This article reviews of how to perform and interpret high resolution esophageal manometry and shows how to classify esophageal motility disorders according to the latest update of Chicago 3.0.

Guía de práctica clínica para la enfermedad por reflujo gastroesofágico / Clinical practice guideline for disease caused by gastroesophageal reflux

Objetivo: brindar una guía de práctica clínica basada en la evidencia más reciente para el diagnóstico y tratamiento del reflujo gastroesofágico teniendo en cuenta la efectividad y seguridad de las intervenciones dirigidas a pacientes, personal asistencial, administrativo y entes gubernamentales de cualquier servicio de atención en Colombia. Materiales y métodos: esta guía fue desarrollada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología, el Grupo Cochrane ITS y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas clínicas relevantes y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías existentes fueron evaluadas en términos de calidad y aplicabilidad; 1 guía cumplió los criterios de adaptación, por lo que se decidió adaptar 3 preguntas clínicas. El Grupo Cochrane realizó la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas con base en la metodología GRADE. Las recomendaciones de la guía fueron socializadas en una reunión de expertos con entes gubernamentales y pacientes. Resultados: se desarrolló una guía de práctica clínica basada en la evidencia para el diagnóstico y tratamiento de pacientes con reflujo gastroesofágico en Colombia. Conclusiones: el diagnóstico y manejo oportuno de los pacientes con ERGE contribuirá a disminuir la carga de la enfermedad en Colombia, así como de las enfermedades asociadas.

Objective: To provide a clinical practice guideline with the latest evidence for diagnosis and treatment of gastroesophageal reflux for patients, caregivers, administrative and government bodies at all levels of care in Colombia. Materials and Methods: This guide was developed by a multidisciplinary team with the support of the Colombian Association of Gastroenterology, Cochrane STI Group and Clinical Research Institute of the Universidad Nacional de Colombia. Relevant clinical questions were developed and the search for national and international guidelines in databases was performed. Existing guidelines were evaluated quality and applicability. One guideline met the criteria for adaptation, so the group decided to adapt 3 clinical questions. Systematic literature searches were conducted by the Cochrane Group. The tables of evidence and recommendations were made based on the GRADE methodology. The recommendations of the guide were socialized in a meeting of experts with government agencies and patients. Results: An evidence-based Clinical Practice Guidelines for the diagnosis and treatment of gastroesophageal reflux was developed for the Colombian context. Conclusions: The opportune detection and appropriate management of gastroesophageal reflux would contribute to the burden of the disease in Colombia and its associated diseases.

Hippotherapy and respiratory muscle strength in children and adolescents with Down syndrome / Equoterapia e força muscular respiratória em crianças e adolescentes com síndrome de Down

Introduction Individuals with Down syndrome may have decreased respiratory muscle strength due to hypotonia, a common characteristic in this population. Objective To analyze the effects of a hippotherapy program on respiratory muscle strength in individuals with Down syndrome. Materials and methods The study included 41 subjects, 20 of which were in the hippotherapy practicing group (PG) and 21 of which were in the non-practicing group (NPG). Study subjects were of both sexes, aged 7-13 years, and all diagnosed with Down syndrome. A manovacuometer was used to measure respiratory muscle strength, following the protocol proposed by Black and Hyatt (23). Statistical analysis was performed by means of descriptive distribution. After verifying normality and homoscedasticity of the variables, the Mann-Whitney test was used to determine differences between the means of the two groups (PG and NPG), and the Spearman’s rank correlation coefficient test was used to view possible relationships with age and time practicing hippotherapy. Significance was set at p < 0.05. Results and discussion Individuals who practiced hippotherapy showed improvements in both inspiratory and expiratory respiratory muscle strength, although no significant difference was demonstrated. Conclusion This study demonstrates that hippotherapy benefits respiratory muscle strength in individuals with Down syndrome, and that the youngest subjects had the best results. .

Introdução Os indivíduos portadores de síndrome de Down (SD) podem apresentar uma redução da força muscular respiratória, principalmente em função da hipotonia, característica comum nessa população. Objetivo Analisar o efeito de um programa de equoterapia sobre a força muscular respiratória em indivíduos com SD. Materiais e métodos Participaram do estudo 41 indivíduos, sendo 20 pertencentes ao grupo praticantes (GP) e 21 ao grupo não praticante (GNP), de ambos os sexos, com idades compreendidas entre 7 e 13 anos, todos diagnosticadas com síndrome de Down (SD). Utilizou-se a manovacuometria para aferição da força muscular respiratória, seguindo o protocolo proposto por Black e Hyatt (23). A análise estatística deu-se a partir de uma distribuição descritiva. Após verificado a normalidade e homocedasticidade das variáveis utilizou-se o teste de Mann Whitney para verificar as diferenças entre as médias dos grupos (GNP e GP), como a utilização do teste de correlação de Spearman para visualizar possíveis relações com a idade e o tempo de prática de equoterapia. Adotou uma significância de p < 0,05. Resultados e discussão Os indivíduos que realizavam a equoterapia apresentaram melhoras em relação à força muscular respiratória, tanto inspiratória (MIP) quando expiratória (MEP), embora não apresentando diferença significativa em relação ao grupo não praticante. Conclusão Este estudo demonstra que o programa de equoterapia apresenta benefícios na força muscular respiratória em indivíduos com SD e que principalmente os mais jovens obtiveram melhores resultados. .

Linfangiectasias en yeyuno como causa de sangrado digestivo oscuro manifiesto / Clinical case of lymphangiectasia in jejunum as a cause of manifest obscure gastrointestinal bleeding / Clinical case of lymphangiectasia in jejunum as a cause of manifest obscure gastrointestinal bleeding

El sangrado digestivo oscuro constituye entre 10 y 20% de todas las causas de sangrado digestivo. La etiología está claramente relacionada con el grupo etario en que se presente. Las linfangiectasias del yeyuno son una causa rara de sangrado digestivo, pero puede llegar a ser de alta mortalidad en caso de que no se detecte tempranamente. Reportamos un caso de un paciente joven sin historia previa de enfermedad, con sangrado digestivo manifestado por melenas, con anemización severa, con estudios endoscópicos iniciales normales, en quien hacemos abordaje con estudios para intestino delgado (video cápsula endoscópica y enteroscopia anterógrada de doble balón), con los que hacemos el diagnóstico y es llevado a cirugía, con adecuada evolución clínica y curación de la enfermedad. (Acta Med Colomb 2015; 40: 158-161).

Obscure gastrointestinal bleeding is between 10 to 20% of all causes of gastrointestinal bleeding. The etiology is clearly related to the age group in which it is presented. Lymphangiectasia in jejunum is a rare cause of gastrointestinal bleeding, but can have high mortality if not detected early. A case of a young patient with no history of previous disease presenting gastrointestinal bleeding manifested by melaena, with severe anemia and normal initial endoscopic studies, is presented. The diagnosis was made by endoscopic video capsule and antegrade double-balloon enteroscopy and surgery was performed with adequate clinical evolution and cure of the disease. (Acta Med Colomb 2015; 40: 158-161).

Cómo realizar e interpretar una manometría esofágica de alta resolución / How to Perform and Interpret High-resolution Esophageal Manometry

Con la introducción de la manometría esofágica de alta resolución se revelaron patrones no identificados previamente de la función esofágica normal así como hallazgos anormales. De igual forma, adiciona patrones de presión gráficos y topografía de la presión esofágica, lo que lleva al desarrollo de nuevas herramientas para el análisis y clasificación de desórdenes motores esofágicos. En la actualidad la clasificación de Chicago es el método diagnóstico de análisis de los diferentes trastornos motores esofágicos; en Colombia, día a día vemos el crecimiento en la realización de este estudio. El artículo propone hacer una revisión de cómo realizar e interpretar una manometría esofágica de alta resolución.

The introduction of high-resolution esophageal manometry allowed physicians to identify both previously unidentified normal esophageal functions and patterns and various abnormalities. The creation of new charts of pressure patterns and the topography of esophageal pressure has led to the development of new tools for analysis and classification of esophageal motor disorders. At present, the Chicago classification is the diagnostic method of analysis used for various esophageal motor disorders. In Colombia, we see the use of high-resolution esophageal manometry growing on a daily basis. In this article we review how to perform and interpret high-resolution esophageal manometry.

Criptococosis esófago-gastroduodenal: reporte de caso / Esophageal Gastroduodenal Cryptococcosis: A Case Report

Existen pocos pacientes inmunodeprimidos o no, con implicación del tracto gastrointestinal por Cryptococcus neoformans, tanto en su manifestación local como enfermedad aislada y diseminada tipo criptococcemia. Reportamos un caso de criptococosis con compromiso esofágico, gástrico y duodenal en un paciente diagnosticado con SIDA C3. Según nuestro conocimiento, y búsqueda en la literatura, ha sido el único caso reportado en Colombia y América Latina.

There are very few patients, whether they are immunocompromised or not, with their gastrointestinal tracts compromised by Cryptococcus neoformans. This is true for both local manifestations as an isolated disease and for the disseminated disease of cryptococcoma. We report a case of cryptococcosis with esophageal, gastric and duodenal compromise in a patient diagnosed with Category 3 AIDS. To our knowledge after a search of the literature, this is the only reported case in Colombia and Latin America.

Seroprevalence and risk factors for cattle anaplasmosis, babesiosis, and trypanosomiasis in a Brazilian semiarid region / Soroprevalencia e fatores de risco para anaplasmose, babesiose e tripanosomiase bovina em uma região semiárida do Brasil

The seroprevalence of Anaplasma marginale, Babesia bigemina, Babesia bovis and Trypanosoma vivax and the risk factors for these infections were investigated in 509 cows on 37 farms in the semiarid region of Paraíba, northeastern Brazil. Cow serum samples were tested by means of immunofluorescence assay (IFA) against each specific antigen. The mean seroprevalence values per farm were 15.0% (range: 0-75%) for A. marginale, 9.5% (range: 0-40%) for B. bigemina and 26.9% (range: 0-73.7%) for B. bovis. All cows tested negative for T. vivax. Higher prevalence for A. marginale was significantly associated with less frequent acaricide spraying per year and with higher use of injectable antihelminthics. Presence of cows positive for B. bigemina was significantly associated with acaricide use and with presence of horse flies on the farm. Both occurrence and higher prevalence of B. bovis were significantly associated with recent observations of ticks on cattle. Overall, the present results indicate that the region investigated is an enzootically unstable area for A. marginale, B. bigemina and B. bovis, since most animals were seronegative to at least one agent.

A soroprevalência de Anaplasma marginale, Babesia bigemina, Babesia bovis e Trypanosoma vivax, assim como os fatores de risco para estas infecções, foram investigadas em 37 fazendas (total de 509 vacas) da região semiárida da Paraíba, nordeste do Brasil. A presença de anticorpos nos soros dos animais foi detectada pela técnica de imunofluorescência indireta, utilizando antígenos específicos. Os valores médios de soroprevalência por fazenda foram 15,0% (0-75%) para A. marginale, 9,5% (0-40%) para B. bigemina, e 26,9% (0-73,7%) para B. bovis. Todas as vacas foram soronegativas para T. vivax. As maiores prevalências de A. marginale foram significativamente associadas com menor uso de carrapaticidas por ano e com uso mais frequente de antihelmínticos injetáveis. A soroprevalência de B. bigemina foi significativamente associada com o uso de carrapaticidas, e com a presença de mutucas na fazenda. Tanto a ocorrência como a maior soroprevalência para B. bovis nas fazendas foram significativamente associadas com a presença recente de carrapatos nos bovinos. No geral, os resultados indicam que as fazendas amostradas estão situadas em área de instabilidade enzoótica para A. marginale, B. bigemina, e B. bovis, uma vez que a maioria dos animais foi soronegativa para pelo menos um dos agentes.

Frequência de anticorpos para paratuberculose em bovinos no semiarido paraíbano / Frequency of antibodies against paratuberculosis in cattle in the state of Paraiba

A paratuberculose é uma doença importante em bovinos na Paraíba, tendo sido diagnosticados, pelo Hospital Veterinário da Universidade Federal de Campina Grande, cinco focos da doença nos últimos quatro anos. Neste trabalho objetivou-se realizar um estudo sorológico em rebanhos com e sem histórico da doença para estimar a frequência da infecção por Mycobacterium avium subsp. paratuberculosis (Map) em diferentes regiões do semiárido Paraibano. Utilizando o teste de ELISA pesquisou-se a frequência de animais soropositivos contra Map em duas fazendas onde tinha sido diagnosticada a doença, encontrando-se 72,22% (13/18) e 68,75% (11/16), respectivamente de bovinos sorologicamente positivos. Amostras de soro de 486 bovinos de 36 fazendas sem histórico da doença de diferentes regiões da Paraíba (sertão, cariri e agreste), também foram examinados por ELISA. A frequência de animais soropositivos foi de 10,08±1,07% (49/486). Foram encontrados animais positivos em 21 (58.33%) das 36 fazendas estudadas. Os resultados sugerem que o agente da paratuberculose está disseminado em bovinos na Paraíba e que são necessárias medidas de controle para diminuir a frequência de casos clínicos e subclínicos da doença.

Paratuberculosis is an important disease of cattle in the state of Paraíba, northeastern Brazil. In the Veterinary Hospital of the Federal University of Campina Grande, five outbreaks of paratuberculosis were diagnosed in the last four years. The objective of this paper is to report the frequency of antibodies against paratuberculosis in different regions of the state of Paraíba, in farms with previous diagnosis of the disease and in farms without diagnosis. The prevalence of antibodies against paratuberculosis, examined by ELISA, in two farms with cases of the disease, was of 72.22% (13/18) and 68.75% (11/16), respectively. Serum samples from 486 healthy cattle from 36 farms without paratuberculosis diagnosis, from three different regions of Paraíba (sertão, cariri, and agreste), were also examined by ELISA. The frequency of antibodies was 10.08±1,07% (49/486). Antibodies against paratuberculosis were found in 21 (58.33%) out of 36 farms examined. These results suggest that paratuberculosis is an important disease of cattle in the state of Paraíba and that control measures to decrease the prevalence of the disease are necessary.