Determinantes del estado de vacunación infantil: abordando la brecha de equidad en República Dominicana-2019 / Determinants of childhood immunization status: addressing the equity gap in the Dominican Republic­2019

Introducción: Las desigualdades amenazan el progreso del país hacia la equidad y la cobertura de vacunación infantil. Siendo la cobertura inferior a la meta del 90% de la Organización Mundial de la Salud. Objetivo: Identificar los determinantes sociales y las desigualdades en el estado de vacunación infantil en República Dominicana, 2019. Métodos: Se realiza un análisis basado en la Encuesta de Indicadores Múltiples por Conglomerados. Incluyendo una muestra ponderada de 1674 niños de 12-23 meses. Se calcula la regresión logística multinomial para identificar factores asociados a la vacunación. Adoptando p<0,05 para significación estadística. Utilizando una razón de probabilidades ajustada con intervalo de confianza del 95%. Empleando HEAT 4.0 para medir desigualdades y SPSS.23 para gestión y análisis de datos. Resultados: La edad media de los niños fue 17,4±3,5 meses. El 33% de ellos estaban completamente vacunados. La cobertura fue significativamente menor entre hijos de madre sin educación [AOR= 7,27; IC95%= 2,98­17,74]. La mayor cobertura se concentra en niños con altos niveles de educación y riqueza. Conclusión: Para lograr una cobertura de vacunación completa y equitativa, las intervenciones de salud pública deben diseñarse para satisfacer las necesidades de grupos de alto riesgo.

Introduction: In the Dominican Republic, inequalities threaten progress towards childhood vaccination equity and coverage, the latter being inferior to the World Health Organization's 90% goal. Objective: Identify the social determinants and inequalities in the state of childhood vaccination in the Dominican Republic, 2019. Methods: An analysis based on the Multiple Indicator Cluster Surveys is conducted. Including a weighted sample of 1674 children aged 12-23 months. The multinomial logistic regression is calculated to identify factors associated with vaccination. Using p<0,05 for statistical significance and an adjusted probability ratio with a 95% confidence interval. Employing HEAT 4.0 to measure inequalities and SPSS.23 for data management and analysis. Results: The children's mean age was 17,4±3,5 months. 33% of them were completely vaccinated. Coverage was significantly lower in children of mothers without education [AOR= 7,27; CI95%= 2,98­17,74]. Coverage was the highest in kids with high levels of education and wealth. Conclusion: To achieve complete and equitable vaccine coverage, public health interventions should be designed to satisfy the needs of high-risk groups.

Mecanismos de adaptação do coração em atletas de elite do sexo feminino: comparação com indivíduos sadios e tempo de treinamento / Heart adaptation mechanisms in elite female athletes: comparison with healthy individuals and time of training

Fundamento: O exercício intenso e continuado em atletas provoca fenótipos de remodelamento adaptativo, cujos parâmetros podem ser avaliados pela ecocardiografia convencional, e de deformação miocárdica. Assim, foi comparado o remodelamento miocárdico em atletas do sexo feminino (grupo atletas) com mulheres sedentárias da mesma faixa etária (grupo-controle) e entre atletas com maior e menor tempo de treinamento. Métodos: Foram selecionadas 57 futebolistas femininas (grupo atletas) e 25 mulheres sadias sedentárias (grupocontrole). As atletas foram divididas em dois grupos: grupo principal, com 32 atletas, e grupo sub-17, com 25 atletas. Foram determinadas, através de ecocardiografia, as dimensões, a função sistólica e diastólica das câmaras cardíacas e a deformação miocárdica (strain longitudinal, circunferencial, radial e mecânica rotacional), utilizando a estatística Z com significância de p < 0,05. Resultados: A idade dos grupos atletas, controle, principal e sub-17 foi de 22,1±6,3; 21,2±5,0; 26,5±5,1; e 16,5±0,6, respectivamente. O peso, o índice de massa corporal e a frequência cardíaca foram menores no grupo atletas. A espessura das paredes, o índice de massa do ventrículo esquerdo (VE), o volume do átrio esquerdo (AE), a fração de ejeção e as dimensões do ventrículo direito (VD) foram maiores no grupo atletas, mas dentro de valores normais. A deformação miocárdica mostrou diminuição do strain radial, da rotação basal, da rotação apical e do twist, sugerindo mecanismo de reserva contrátil. Esses parâmetros foram menores no grupo principal, que também apresentava maior espessura das paredes, maior volume do AE e maior tamanho do VD, sugerindo que o aumento da reserva contrátil se relaciona com maior tempo de treinamento. Conclusões: As atletas do sexo feminino com treinamento intenso de longa duração apresentam remodelamento adaptativo das câmaras cardíacas e aumento da reserva contrátil observada em repouso, com esses parâmetros mais acentuados nas atletas com maior tempo de treinamento.(AU)

Background: Intense continuous exercise provokes adaptive remodeling phenotypes in athletes, the parameters of which can be evaluated through conventional echocardiography and myocardial deformation. We compared myocardial remodeling in female athletes (athlete group) with sedentary women of the same age range (control group) and between older and younger athletes. Methods: A total of 57 female soccer players and 25 healthy sedentary women were selected. The athlete group was subdivided into a main group and those under 17 years of age (< 17 group). The dimensions and systolic and diastolic function of the cardiac chambers and myocardial deformation (longitudinal and circumferential, as well as radial strain and rotational mechanics) was determined through echocardiography, using the Z statistic with a significance level of p< 0.05. Results: The mean age of the athlete, control, main, and < 17 groups was 22.1 (SD, 6.3); 21.2 (SD, 5.0); 26.5 (SD, 5.1); 16.5 (SD, 0.6) years, respectively. Weight, body mass index and heart rate were lower in the athlete group. Wall thickness, left ventricular mass index, left atrial (LA) volume, ejection fraction, and right ventricular dimensions were higher in athlete group, but remained within normal ranges. Regarding myocardial deformation, there was decreased radial strain, basal rotation, apical rotation, and twisting in the athlete group, suggesting a contractile reserve mechanism. These parameters were lesser in the main athlete group, who also had greater wall thickness, greater volume in the left atrium (LA) and larger size in the right ventricle (RV), suggesting that increased contractile reserve is related to longer time spent in the sport. Conclusions: In female athletes who had undergone intense long-term training, we observed adaptive remodeling of the cardiac chambers and increased contractile reserve (at rest), and these changes were more pronounced in those with longer involvement in the sport.(AU)

Tell me who your friends are?! The mediating role of friends' use in cannabis abuse

Abstract Objectives To evaluate the relationship between age at onset of cannabis use and cannabis abuse in a sample of Portuguese cannabis users, testing the mediating role of the number of friends using cannabis and comparing these relationships between male and female subsets. Method A sample of 529 Portuguese cannabis users comprising 276 males and 244 females aged from 14 to 21 years completed a sociodemographic questionnaire, the Cannabis Abuse Screening Test (CAST), and answered four questions related to cannabis use. Data were analyzed using the PROCESS macro in SPSS version 26.0. Results Age at onset of cannabis use was negatively related to the number of friends using cannabis, while the number of friends using cannabis had a positive relationship with cannabis abuse. As predicted, the number of friends using cannabis seems to have a mediating role in the relationship between cannabis onset age use and cannabis abuse, since the indirect effect was found to be significant. The pattern of the relationships among the variables observed was found to be similar for both male and female subsets of the sample. However, males reported higher cannabis abuse than females. Conclusion The results highlight the mediating role of friends' use of cannabis in the relationship between age at onset of cannabis use and users' abuse. These results highlight the importance of early intervention in cannabis use. In particular, the pattern of the relationships observed among the studied variables emphasizes the need to monitor and conduct peer training interventions or interventions to promote of social skills.

Social networks as tools for the prevention and promotion of health among youth

Abstract The emergence of information and communication technologies (ICT) has generated a number of research questions, related to their use and potential risk, but also potentials for prevention or health promotion. Online social networks have become an important source of information for users as well as a tool for social relations. As traditional social networks, they can act as vehicles to improve the health of adolescents and youth, as well as play a key role in an educational context. The aim of this work is then to explore the theoretical relevance of ICT, particularly on online social networks, on disease prevention and health promotion of communicable diseases. Literature review points out the role of online social networks, particularly in the field of sexual health, body image, especially eating habits and overweight, as well as smoking and alcohol dependence. Data allow us to understand how online social network behavior and interaction is related to their burden and interventions developed in sexual health and addiction show positive results. More efforts in body image are needed in order to use these tools for prevention and promotion of health from early age.

Epidemiología del dengue en Centroamérica y República Dominicana / Epidemiology of dengue in Central America and the Dominican Republic

Resumen Introducción: Centroamérica experimenta una alta carga de la enfermedad por dengue aportando cerca de 8% de todos los casos del continente. Este trabajo reporta la epidemiología del dengue en la subregión en un período de 10 años. Objetivos: Documentar la epidemiología del dengue en Centro América y República Dominicana. Material y Métodos: Período de estudio: años 2005-2014. Se recopilaron y analizaron los datos de casos y muertes por dengue de los países de Centro América y República Dominicana, reportados por los Ministerios de Salud y se corroboró con los datos publicados en los boletines en línea y la base de datos interactiva de la Organización Panamericana de la Salud (OPS). Se obtuvieron estadísticas poblacionales de los Institutos Nacionales de Estadística y Censo de cada país. Resultados: Durante el período de estudio fueron notificados 1.118.464 casos de dengue. Reportados 32.431 casos graves, 888 personas fallecidas. La letalidad por caso de dengue fue en promedio 0,08%. Los cuatro serotipos de dengue circularon durante el decenio estudiado. Discusión: La información clínica y epidemiológica, indica tasas de incidencia alta, que han fluctuado en los últimos años, con co-circulación significativa de varios serotipos a la vez. Conclusiones: Se identificaron diferencias notorias en la recolección de datos de la vigilancia entre países. Se determinó un patrón epidemiológico heterogéneo.

Background: Central America experiences a high burden of dengue reporting about 8% of all cases in the continent. This work reports the epidemiology of dengue in the sub region in a 10 years period. Aim: To describe the epidemiology of dengue in Central America and the Dominican Republic. Methods: Study period from 2005 to 2014. The data on dengue cases and deaths of the countries of Central America and the Dominican Republic, reported by the Ministries of Health, were compiled and analyzed and corroborated with the data published in the online bulletins and the interactive database of the Pan American Health Organization (PAHO). Population statistics were obtained from the National Statistics and Census Institutes of each country. Results: During the study period, 1,118,464 cases of dengue were notified. There were 32,431 serious cases reported, 888 people died. The lethality per case of dengue was on average 0.08%. The four dengue serotypes circulated during the decade analyzed. Discussion: Clinical and epidemiological information indicates high incidence rates, which have fluctuated in recent years, with significant co-circulation of several serotypes at the same time. Conclusions: Notorious surveillance data collection differences were identified between countries, determining a heterologous epidemiological pattern.

Centros de recuperación nutricional: 1984-2011 / Nutritional Recovery Centers: 1984-2011

Los centros de recuperación nutricional (CRN) fueron creados por el Dr. José María Bengoa en Venezuela. En el presente estudio se realizó una revisión sistemática cualitativa, de 1984 al 2011, que permitió analizar las modalidades de funcionamiento de los diferentes CRN en el mundo, mediante indicadores de: criterios de admisión, parámetros utilizados en estos centros, así como las modalidades de tratamiento, tiempo de estancia y criterios de alta. Se encontraron diecisiete artículos que describen algunos o todos estos indicadores. El uso de los CRN se encontró en cuatro países de África (Etiopía, Kenia, Malawi y Nigeria), cuatro de América (Bolivia, Brasil, Chile y Nicaragua) y dos en Asia (India y Nepal). Los resultados reflejan la importancia de los CRN en el tratamiento de la desnutrición, sobre todo si se acompaña con la educación de las madres sobre la alimentación, prácticas higiénicas, etc., para un mejor cuidado en el hogar. Nuevas evidencias en el tratamiento de la desnutrición han motivado la evolución de los centros, pero aún así, sus limitaciones persisten. No obstante, las ventajas de su uso son excepcionales. Se propone, de acuerdo con los diferentes tipos de centros, y en base a las deficiencias o limitaciones observadas en su conceptualización y designación, redefinir las NRC bajo el concepto de Centros Globales de Nutrición (GloNuCen) basados en la comunidad y la personalización nutricional, los cuales podrían ser centros fijos en el caso de hospitales y servicios ambulatorios, e instalaciones móviles para situaciones de emergencia que, si duran con el tiempo, puedan convertirse en centros fijos(AU)

The Nutritional Recovery Centers (NRC) were created by Dr. Jose María Bengoa in Venezuela. In the present study a qualitative systematic review was carried out, from 1984 to 2011, allowing us to analyze the operating modalities of the different CRNs in the world, by means of indicators of: admission criteria, parameters used in these centers, as well as their treatment modalities, time of stay and discharge criteria. Seventeen articles have been found that describe some or all of these indicators. The use of NRCs was found in four African countries (Ethiopia, Kenya, Malawi and Nigeria), four in America (Bolivia, Brazil, Chile and Nicaragua) and two in Asia (India and Nepal). The results reflect the importance of NRC in the treatment of malnutrition, especially if it is reinforced with mothers' education about food, hygiene practices, etc., for better home care. New evidence in the treatment of malnutrition has motivated the evolution of the centers, but still, their limitations persist. Nonetheless, the advantages of their use are exceptional. It is proposed, according to the different types of centers, and based on the deficiencies or limitations observed in their conceptualization and designation, to redefine the NRCs under the concept of Global Nutrition Centers (GloNuCen) based on the community and nutritional customization, which could be fixed centers in the case of hospitals and outpatient services, and mobile facilities for emergency situations that, if they last over time, could turn into fixed centers(AU)

Aplicações do strain e strain rate na avaliação da função diastólica do ventrículo esquerdo / Strain and strain rate applications in the evaluation of left ventricular diastolic function

A análise da função diastólica utilizando a ecocardiografia convencional (método bidimensional, Doppler espectral e Doppler tecidual) pode não determinar alguns casos de disfunção diastólica ou elevação da pressão do átrio esquerdo. Os parâmetros que estudam a deformação miocárdica (strain rate e strain longitudinal do átrio esquerdo) podem auxiliar no diagnóstico. Descrevem-se aqui os métodos do strain rate diastólico durante o tempo de relaxamento isovolumétrico e no pico do enchimento, a taxa de torção apical e o strain longitudinal máximo do átrio esquerdo, analisando suas aplicações e vantagens

Remarks on the possibility of introducing the fractionated dose of the inactivated poliomyelitis vaccine in the Latin American Child Immunization Schedule

Abstract Given that the last notified case of poliomyelitis due to wild poliovirus type 2 was in 1999, in 2012, the Strategic Advisory Group of Experts on Immunization (SAGE) of the World Health Organization (WHO) recommended the withdrawal of the type 2 component of oral polio vaccine (OPV) and the introduction of a bivalent OPV (bOPV) in all countries by 2016. WHO recommended also that the withdrawal should be preceded by the introduction of at least one dose of inactivated poliovirus vaccine (IPV) in routine immunization schedules. The introduction of IPV prior to the change of the bOPV in 2016 to trivalent OPV (tOPV) was based on the concept of ensuring that a substantial proportion of the population would be protected against type 2 polio after the removal of the type 2 OPV. However, the world's two producers of IPV (Bilthoven Biologicals and Sanofi) have faced problems in the production of this vaccine and therefore reported a reduction of the global supply of IPV. In response to the potential shortage of IPV, at a meeting held on March 10 2017, the SAGE and Technical Advisory Group (TAG) of the Pan American Health Organization (PAHO) urged the countries in the Latin American region to replace the routine administration of the full doses of inactivated polio vaccine (IPV-C) in the immunization schedule (administered by intramuscular route), administering a fraction of the full dose in two intradermal shots (IPV-f). The possibility of this strategy was analyzed by opinion leaders convened by the Paraguayan Society of Pediatrics with the support of the Latin American Society of Pediatric Infectious Diseases (SLIPE) and Latin American Association of Pediatrics (ALAPE). This document presents the results of the discussion.

Função atrial esquerda pelo método de speckle tracking: além da avaliação volumétrica / Left atrial function using speckle tracking: beyond volumetric evaluation

Atualmente, a avaliação da função atrial esquerda é um método emergente que pode ter relação com o prognóstico dos pacientes. Classicamente, as medidas estáticas de diâmetro, área e volume são as mais usadas com esta finalidade. A técnica conhecida como speckle tracking é capaz de fornecer informações dinâmicas do átrio esquerdo ao longo do ciclo cardíaco, assim como detectar alterações na função atrial esquerda em fases subclínicas, antes de ocorrerem aumentos volumétricos ou disfunções diastólicas. Valores de normalidade para o speckle tracking estão sendo propostos, mas as diferenças metodológicas e de técnicas empregadas dificultam sua padronização. Esta revisão da literatura se propõe a discutir os avanços na análise da função atrial esquerda, em especial via speckle tracking

Consideraciones referente a la posibilidad de introducir la dosis fraccionada de la vacuna antipoliomielitis inactivada en el calendario de Inmunizaciones del Niño Latinoamericano / Remarks on the possibility of the introduction of fractionated dose of the inactivated poliomyelitis vaccine in the Latin American Child Immunization Schedule

As last notified case of poliomyelitis due to wild poliovirus type 2 was 1999, in 2012, the Strategic Advisory Group of Experts on Immunization (SAGE) of the World Health Organization (WHO) recommended the withdrawal of the type 2 component of oral polio vaccine (OPV) and the introduction of bivalent OPV (bOPV) in all countries by 2016. WHO recommended also that the withdrawal should be preceded by the introduction of at least one dose of inactivated poliovirus vaccine (IPV) in routine immunization schedules. The introduction of IPV prior to the change of the bOPV in 2016 to trivalent OPV (tOPV) was based on the concept of ensuring that a substantial proportion of the population would be protected against type 2 polio after the removal of the type 2 OPV. However, the world's two producers of IPV (Bilthoven Biologicals and Sanofi) have faced problems in the production of this vaccine and therefore reported reduction in IPV global supply. In response to the possible shortage of IPV, the SAGE and Technical Adviser Group (TAG) of the Pan American Health Organization (PAHO), in the meeting of March 10, 2017, has urged that countries in the Latinamerican region should replace the routine administration of the full doses of polio inactivated vaccine (IPV-C) in the immunization schedule (administered by intramuscular route) by the administration of a fraction of the full dose in two shots by intradermal route (IPV-f). The possibility of this strategy was analyzed by leaders of opinions gathered by the call of the Paraguayan Pediatric Society with the support of the Latin American Society of Pediatric Infectious Diseases (SLIPE) and Latin American Association of Pediatrics (ALAPE). The results of the discussion are presented in this document.

Avaliação ecocardiográfica das alterações cardíacas tardias provocadas pela Febre Chikungunya / Echocardiographic evaluation of late cardiac abnormalitis caused by the Chikungunya Fever

Fundamento: A febre Chicungunya (CHIKV) provoca dores articulares altamente debilitantes. As complicações são raras, podendo afetar o sistema cardiovascular. Objetivo: Avaliar, com ecocardiografia e strain bidimensional, as alterações cardiovasculares na fase crônica da infecção por CHIKV. Métodos: Foram estudados 32 pacientes, média etária de 56 ± 14 anos, divididos em Grupo A, com evolução < 12 meses (12 pacientes) e Grupo B, com evolução ≥12 meses (20 pacientes). Foram determinadas as dimensões cardíacas, o volume diastólico final do ventrículo esquerdo indexado para superfície corporal; a fração de ejeção do ventrículo esquerdo, o strain longitudinal global do ventrículo esquerdo e o strain longitudinal do átrio esquerdo. Os grupos foram comparados pela análise não pareada. A significância de p foi < 0,05. Resultados: A maioria dos pacientes do Grupo A apresentou hipocontratilidade difusa e diminuição da fração de ejeção do ventrículo esquerdo (45,5 ± 10,4%) com com volume diastólico do ventrículo esquerdo indexado normal (58,7 ± 24,9 mL/m²). A maioria dos pacientes do Grupo B apresentou hipocontratilidade difusa (fração de ejeção do ventrículo esquerdo de 38,2 ± 6,4%) e volume diastólico do ventrículo esquerdo indexado aumentado (88,3 ± 26,4 mL/m²). Foram observadas alterações segmentares em 22% dos pacientes e hipertrofia ou remodelamento em 7 casos de cada Grupo. O strain longitudinal global estava diminuído (-11,9 ± 4,4% no Grupo A e -10,3 ± 3,8% no Grupo B). O strain longitudinal do átrio esquerdo foi de 37,9 ± 17,3% no Grupo A e de 27,5 ± 15,2% no Grupo B. Os pacientes com pericardite apresentavam dimensões e função do VE normais.Conclusão: Entre as complicações cardíacas da febre Chicungunya, a hipocontratilidade difusa com ventrículo esquerdo de dimensões normais foi observada no primeiro ano da evolução crônica e a hipocontratilidade difusa com dilatação do ventrículo esquerdo na evolução mais tardia. Pacientes com espessamento pericárdico não evidenciaram alterações miocárdicas. A ecocardiografia é uma importante ferramenta diagnóstica para os pacientes com infecção por vírus Chicungunya, pois detecta e quantifica as alterações do sistema cardiovascular

Background: Chicungunya fever causes highly debilitating joint pains. Complications are rare and may affect the cardiovascular system. Objective: To evaluate, with echocardiography and two-dimensional strain, the cardiovascular changes in the chronic phase of the Chikungunya infection. Methods: The study included 32 patients, mean age 56 ± 14 years divided into Group A, with < 12 months evolution (12 patients) and Group B, with ≥ 12 months evolution (20 patients). The cardiac dimensions, left ventricular end-diastolic volume indexed to body surface, left ventricular ejection fraction, left ventricular global longitudinal strain and left atrial longitudinal strain were determined. The groups were compared using unpaired analysis. The p significance was < 0.05. Results: Most Group A patients presented diffuse hypocontratility and decreased left ventricular ejection fraction (45.5 ± 10.4%) with normal left ventricular diastolic indexed volume (58.7± 24.9 mL/m²). Most Group B patients presented diffuse hypocontratility (ejection fraction 38.2 ± 6.4%) and increased left ventricular diastolic indexed volume (88.3 ± 26.4 mL/m²). There was segmental changes in 22% of the patients, and hypertrophy or remodelling in seven cases of each Group. There was decreased global longitudinal strain in both Groups (-11.9 ± 4.4% in Group A and -10.3 ± 3.8% in Group B). Lef atrial longitudinal strain were 37.9 ± 17.3% in Group A and 27.5 ± 15.2% in Group B. Patients with pericarditis had normal left ventricular dimensions and function. Conclusion: The cardiac complications of Chikungunya fever was diffuse hypocontratility with left ventricular normal size observed in the first year of chronic evolution and diffuse hypocontratility with left ventricular dilation observed in later evolution. Patients with pericardial thickening did not present myocardial issues. Echocardiography can be used as an important tool in patients with Chikungunya fever, since it can detects early abnormalities in the cardiovascular system

Hallazgos por imagen en pacientes con atresia de vías biliares en el Hospital de Especialidades Carlos Andrade Marín en el período de enero 2016 - marzo 2017 / Imaging findings in patients with biliary atresia in Carlos Andrade Marín Specialties Hospital, in the period between Jan 2016-Mar 2017

Introducción. Revisión de los hallazgos clínicos y radiológicos de la atresia de la vía biliar, una anomalía del desarrollo biliar que tiene un riesgo alto de mortalidad por las complicaciones asociadas si no se la corrige oportunamente. Material y métodos. Serie de siete casos reportados en el Hospital de Especialidades Carlos Andrade Marín en el periodo enero 2016 a marzo 2017, seis mujeres y un varón, todos con cuadro clínico de ictericia prolongada, acolia, patrón de colestasis, hallazgos por imagen y biopsias sugestivas de atresia de vías biliares. Resultados. Todos los pacientes presentaron ictericia y coluria, en exámenes de laboratorio patrón colestásico en todos los pacientes, en los estudios de imagen el hallazgo predominante en sospecha de atresia de vías biliares fue la ausencia de la vesícula biliar y el signo del cordón triangular solamente en tres pacientes, en la biopsia hepática todos mostraron algún grado de fibrosis hepática. Discusión. La atresia de la vía biliar es una enfermedad compleja y grave, en nuestra serie de casos se confirma la utilidad del ultrasonido como método de diagnóstico de atresia de vías biliares ya que es un método mucho más accesible que la resonancia magnética que generalmente tiene menor disponibilidad y mayor costo. Conclusión. El ultrasonido abdominal es una herramienta extremadamente valiosa en sospecha clínica de atresia de vías biliares, debe realizarse un diagnóstico oportuno para mejorar el pronóstico de los pacientes.

Introduction. This is a review of clinical and radiological findings of biliary atresia, an anomaly of biliary tree development that carries a high risk of mortality due to complications unless they are corrected in a short time. Materials and methods. We reviewed a series of seven cases reported at Carlos Andrade Marín Specialties Hospital, from January 2016 to March 2017. Six women and one male were followed. All of them showed clinical signs such as long term jaundice, cholestasis, as well as, imaging findings and liver biopsies, suggesting biliary tract atresia. Results. All patients presented jaundice and choluria, in laboratory tests a cholestasic pattern in all of them, in the imaging studies the predominant finding in suspicion of biliary atresia was the absence of gallbladder and the triangular cord sign in only three patients, in the liver biopsy all of them showed some degree of liver fibrosis. Discussion. Bile duct atresia is a complex and serious disease. In our case serie we confirmed the utility of ultrasound as diagnosis method in biliary duct atresia, is more available than magnetic resonance which is more expensive and less available in different centers. Conclusion. Abdominal ultrasound is an extremely valuable tool in clinical suspicion of biliary atresia, a timely diagnosis must be made to improve patient´s prognosis.

Preditores do uso do Facebook pelos adolescentes portugueses: Contributos de um estudo exploratório / Predictors of Facebook use among Portuguese adolescents: Contributes of an exploratory study

Resumo A generalização do uso das redes sociais online, tem trazido oportunidades e constrangimentos ao mesmo tempo-ou até mais depressa-que a investigação e o conhecimento sobre este tópico. Neste trabalho, pretendemos explorer o papel de variáveis pessoais e psicossociais no uso do Facebook, recorrendo a um conjunto de questionários de autorrelato junto de uma amostra de 386 adolescentes portugueses. Os resultados obtidos permitem verificar diferenças na utilização em função do género, uma relação positiva com a idade, a autorregulação e autoestima, sendo a interação com pares da sua rede de contactos offline o mais forte preditor para o uso das redes sociais. Estes dados sugerem o papel desta aplicação como um meio para manter o contacto com os pares.

Abstract The widespread use of social networks has brought opportunities and constraints at the same time, even faster than research and knowledge on this topic. In this paper, we intend to explore the role of personal and psychosocial variables in Facebook use, considering a set of self-report questionnaires to a sample of 386 Portuguese adolescents. We found gender differences in social network use, a positive relationship with age, self-regulation and self-esteem, with peer interaction with offline contacts as the strongest predictor for social network use. These data suggest the role of this application as a mean to maintain contact with peers.

Osteoporosis, hallazgos en radiología convencional. Reporte de un caso / Osteoporosis, findings in conventional radiology. Report of a case

Introducción El presente artículo hace una revisión sobre los hallazgos radiológicos mediante radiografía simple, así como también los hallazgos clínicos en el diagnóstico de la osteopetrosis una enfermedad poco común que afecta el desarrollo normal óseo, se trata de un caso clínico reportado en el Hospital Pediátrico Baca Ortiz de la Ciudad de Quito. Reporte de Caso: Nos apoyamos en la presentación de un caso clínico de una paciente que acude por consulta externa con cuadro de fatiga y decaimiento de 2 años de evolución, se realizan exámenes complementarios demostrando presencia de anemia así como los hallazgos característicos de osteopetrosis por imagen posteriormente detallados. Conclusiones: La osteopetrosis es una enfermedad poco común, compleja y por lo menos con cuatro subtipos que difieren en la forma de herencia o de las manifestaciones adicionales asociadas, sin embargo todas se caracterizan por presentarse clínicamente con fatiga debido a anemia crónica, puede presentar o no hepatoesplenomegalia, conjuntamente asociadas siempre a osteoesclerosis difusa con ensanchamiento óseo, fracturas patológicas.

Introduction This article reviews the radiological findings by simple radiography as well as the clinical findings in the diagnosis of osteopetrosis, a rare disease that affects normal bone development. This is a case report reported in the Hospital Pediátrico Baca Ortiz at Quito City. Case Report: We rely on the presentation of a clinical case of a patient who goes by external consultation with fatigue and decay of 2 years of evolution, complementary tests are performed demonstrating the presence of anemia as well as the characteristic findings of osteopetrosis by image later detailed. Conclusions: Osteopetrosis is an uncommon, complex disease and with at least four subtypes that differ in the form of inheritance or associated additional manifestations, however all are characterized by presenting clinically with fatigue due to chronic anemia, may present or not hepatosplenomegaly, Always associated with diffuse osteosclerosis with bone spreading, pathological fractures.

Avaliação da Função Diastólica Utilizando Ecocardiografia Doppler e Strain Bidimensional / Diastolic Function Assessment with Doppler Echocardiography and Two-Dimensional Strain

Fundamento: A avaliação da disfunção diastólica do ventrículo esquerdo (VE) apresenta significativo número de disfunções indeterminadas, principalmente quando a fração de ejeção (FE) está preservada. O strain longitudinal global (SLG), e o strain rate sistólico (SRs) e diastólico precoce (SRd), pode ser útil para reclassificar os pacientes assim diagnosticados. Objetivo: Avaliar, com SLG, SRs e SRd, pacientes com disfunção diastólica, comparar com indivíduos saudáveis e verificar o valor aditivo do método. Métodos: Estudados 149 pacientes (idade 62,2 ± 10,6 anos) com disfunção diastólica (49,7% grau 1; 15,4% grau 2; 18,1% grau 3 e 16,8% indeterminada) e 189 indivíduos sadios (idade 44,5 ± 13,3 anos). Aferidas dimensões e função do VE e átrio esquerdo (AE), velocidades Doppler mitral e tecidual e suas relações, SLG, SRs e SRd do VE. Avaliação dos dados pelos testes de Kolmogorov-Smirnoff, Kruskal-Wallis, análise de regressão múltipla e área sob a curva ROC. Dados significativos quando p < 0,05. Resultados: Na disfunção diastólica as dimensões e espessura do VE estavam aumentadas e verificou-se menor FE. O Doppler mitral e tecidual estava alterado e o volume do AE e a velocidade de refluxo tricúspide estavam aumentados. O SLG e SRs estavam diminuídos na disfunção grau 2 e 3 e o SRd diminuído já na disfunção grau 1, correlacionando-se melhor com a disfunção diastólica. O valor de corte da curva ROC para o SRd foi 1,0 s-1 . Conclusão: A disfunção diastólica complementada com strain rate miocárdico parece acrescentar sensibilidade e especificidade nos casos em que a função diastólica é indeterminada, podendo ser usado para reclassificar estes pacientes

Background: The evaluation of left ventricular (LV) diastolic dysfunction presents a significant number of indeterminate dysfunctions, especially when ejection fraction (EF) is preserved. Global longitudinal strain (GLS) and systolic strain rate (SSR) and early diastolic strain rate (EDSR) may be useful for reclassifying diagnosed patients. Objective: To evaluate, using GLS, SSR and EDSR, patients with diastolic dysfunction, compare with healthy individuals, and determine the additive value of the method. Methods: The study included 149 patients (age 62.2 ± 10.6) with diastolic dysfunction (49.7% grade 1; 15.4% grade 2; 18.1% grade 3 and 16.8% unspecified) and 189 healthy individuals (age 44.5 ± 13.3). Left ventricular (LV) and left atrial (LA) dimensions and function, mitral and tissue Doppler velocities and their ratios, GLS, SSR and EDSR have been determined. Data evaluation using the Kolmogorov-Smirnoff, KruskalWallis tests, multiple regression analysis and area under the ROC curve. Data were considered significant when p < 0.05. Results: In diastolic dysfunction, LV dimensions and thickness were increased and EF was lower. Mitral and tissue Doppler revealed abnormalities and LA volume and tricuspid regurgitation velocity were increased. GLS and EDSR were decreased in dysfunction grade 2 and 3 and EDSR was decreased in dysfunction grade 1, correlating better with diastolic dysfunction. The ROC cutoff value for the EDSR was 1.0 s-1. Conclusion: Diastolic dysfunction supplemented with myocardial strain rate seems to add sensitivity and specificity where the diastolic function is indeterminate and may be used for reclassifying these patients

Aplicação da Ecocardiografia na Detecção Precoce de Cardiotoxicidade por Quimioterapia / Application of Echocardiography in the Early Detection of Cardiotoxicity by Chemotherapy

A cardiotoxicidade produzida por agentes quimioterápicos, especialmente para tratar câncer de mama, presenta significativa incidência, muitas vezes necessitando tratamento específico e/ou obrigando a redução ou suspensão do tratamento quimioterápico. A cardiotoxicidade se caracteriza por provocar dano celular, reversível ou não, que conduz à insuficiência cardíaca. Os principais indicadores dessas alterações podem ser detectados pela ecocardiografia convencional, por meio da fração de ejeção do ventrículo esquerdo e pelas técnicas que avaliam a deformação miocárdica, como o strain longitudinal global, hoje considerados marcadores essenciais para essa análise. Analisa-se a cardiotoxicidade produzida por antraciclinas, anticorpos monoclonais e sua associação, mostrando esta última alarmante incidência, especialmente em pacientes idosas.

Relações entre suporte social, autorregulação e consumo de outras substâncias em adultos portugueses

Neste estudo, investigaram-se as relações entre suporte social percebido, auto-regulação e comportamentos de consumo de álcool, tabaco e outras substâncias psicoactivas. A amostra foi constituída por 340 participantes. O suporte social correlacionou-se favoravelmente com a auto-regulação, mas somente na vertente de satisfação com o apoio social é que se observou esta tendência de forma evidente. O número de figuras de apoio diferenciou-se significativamente com o uso de tabaco, o que sugere o âmbito afiliativo de algumas substâncias psicoactivas. Nesse sentido, o uso de tabaco pode estar associado a uma rede social mais ampla, mas não com a qualidade do suporte social.

In this study the relationships between perceived social support, self-regulation and consuming behaviors of tobacco and other psychoactive substances we investigated. The sample consisted of 340 adult participants. Social support correlated positively with self-regulation, but was solely in the aspect of satisfaction with social support that this trend was noted clearly. The number of support providers differed considerably with the use of tobacco, which suggests the affiliative scope of some psychoactive substances. Accordingly, the use of tobacco may be associated with a larger social network, but not with the quality of social support.