Adherencia al tratamiento y nivel de conocimiento en adultos con hipertensión arterial, Asunción 2022

Introducción: la adherencia al tratamiento y el nivel de conocimientos en pacientes con hipertensión arterial son factores claves para controlar esta afección y evitar complicaciones. Objetivos: determinar el grado de adherencia al tratamiento, el nivel de conocimientos y comorbilidades en pacientes con hipertensión arterial de un área urbana de Asunción, Paraguay, en 2022. Metodología: se aplicó un diseño observacional, descriptivo, transversal. Se incluyeron varones y mujeres mayores de 18 años, conocidos portadores de hipertensión arterial, que residen en el barrio Sajonia entre mayo y octubre del 2022. Los datos fueron obtenidos con entrevistas realizadas casa por casa. Se midieron variables demográficas, el nivel de adherencia con el cuestionario de Morisky Green y el de conocimientos sobre la enfermedad con el cuestionario de Batalla. La investigación fue aprobada por el Comité de ética de la Universidad Privada del Este, Paraguay. Resultados: participaron del estudio 425 sujetos, con predominio del sexo femenino (61,1%). La diabetes mellitus fue referida en 28,9% de los entrevistados. El cuestionario de Morisky Green detectó que 60% de los sujetos olvida de tomar su medicación, 25% no la toma en el horario indicado, 29% de la toma si se siente bien y 44% deja de tomarla si siente efectos indeseables. El cuestionario de Batalla halló 7% cree que la hipertensión arterial no es para toda la vida, 9% cree que la afección no se controla con dieta y medicación, y 5,8% no pudo referir al menos un órgano blanco. Conclusión: la adherencia al tratamiento de la hipertensión arterial y el nivel de conocimientos sobre esta afección no fue adecuada.

Introduction: Adherence to treatment and level of knowledge in patients with arterial hypertension are key factors to control this condition and avoid complications. Objectives: To determine the degree of adherence to treatment, the level of knowledge and comorbidities in patients with arterial hypertension in an urban area of ​​Asunción, Paraguay, in 2022. Methodology: An observational, descriptive, cross-sectional design was applied. Men and women over 18 years of age, known carriers of arterial hypertension, residing in Sajonia neighborhood between May and October 2022, were included. The data were obtained through house-to-house interviews. Demographic variables, the level of adherence with the Morisky Green test and the level of knowledge about the disease with the Batalla test were measured. The research was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: Four hundred twenty-five subjects participated in the study, predominantly female (61.1%). Diabetes mellitus was referred to by 28.9% of the interviewees. The Morisky Green test detected that 60% of the subjects forget to take their medication, 25% do not take it at the indicated time, 29% take it if they feel well, and 44% stop taking it if they feel undesirable effects. The Batalla test found that 7% believe that arterial hypertension is not for life, 9% believe that the condition is not controlled with diet and medication, and 5.8% could not refer to at least one target organ. Conclusion: Adherence to the treatment of arterial hypertension and the level of knowledge about this condition was not adequate.

Terapia de REGEN COV como base de terapia inmunomoduladora mixta en pacientes hospitalizados por neumonía por SARS-CoV-2: Serie de casos / REGEN COV Therapy as the Basis of Mixed Immunomodulatory Therapy in Patients Hospitalized for SARS- CoV-2 Pneumonia: Case Series

Los países en desarrollo con sistema de salud de baja inversión encuentran un reto en priorizar el tratamiento de COVID-19 según su eficacia y sus costos. Materiales y métodos: se explora la utilidad hospitalaria de una intervención segura con eficacia ambulatoria comprobada. Se describe la administración de un tratamiento inmunomodulador combinado a base de imdevimab y casirivimab (REGEN COV). Resultados: los resultados individualizados apuntan a resultados prometedores en pacientes de alto riesgo a progresión y mortalidad. Conclusión: se ha demostrado que REGEN COV es eficiente para tratar dicha enfermedad. Sin embargo, se necesitan ensayos clínicos aleatorizados para comprobar su eficacia en combinación. (AU)

Developing countries with low-investment health systems find it challenging to prioritize COVID-19 treatment according to its efficacy and affordability. Materials and methods: therefore, the in-hospital utility of a safe intervention with outpatient efficacy is explored. We describe the administration of immunomodulatory combination therapy based on imdevimab and casirivimab (REGEN COV). Results: individualized results point to promising outcomes in patients at high risk of progression and mortality. Conclusion: REGEN COV has been shown to be efficient in treating said disease. However, randomized clinical trials are needed to verify their efficacy in combination. (AU)

Could be FOXO3a, miR-96-5p and miR-182-5p useful for Brazilian women with luminal A and triple negative breast cancers prognosis and target therapy?

Abstract FOXO3a dysregulation is frequently implicated in tumorigenesis, and its inhibition can occur by several molecular mechanisms. Among these, post-transcriptional suppression by miRNAs has been associated with various cancers initiation. Here, we assessed the expression profiles of the most relevant miRNAs for breast tumorigenesis, using Luminal A (LA) and Triple-Negative (TN) breast cancer from Brazilian patients, by the quantitative real time-PCR method. Their potential prognostic role for the patients was also evaluated. We identified the miRNAs miR-96-5p and miR-182-5p, de-scribed as negative regulators of FOXO3A, with differential expression both in LA and TN tumors when compared to normal tissue. The miR-96-5p and miR-182-5p miRNAs were upregulated in LA (7.82 times, p < 0.005; 6.12 times, p < 0.005, respectively) and TN breast cancer samples (9.42 times, p < 0.0001; 8.51 times, p < 0.0001) compared to normal tissues. The samples with higher miR-96-5p and miR-182-5p expression (FR ≥ 4) were submitted for FOXO3a immunostaining. Reduced protein detection was observed in all of the tumors compared to normal tissues. The most prominent miRNA expression and FOXO3a protein suppression were observed in TN samples (p < 0.001), indicating the relevant role of these molecules in this tumor biology and clinical behavior. Our results corroborate the literature regarding to the relevance of FOXO3a in the breast cancer, and they open new perspectives for alternative target therapy options for Brazilian patients expressing both FOXO3a and its regulatory miRNAs.

Caracterización del uso de tofacitinib como tratamiento para COVID-19 / si

Objetivo: El propósito principal de este estudio es caracterizar y comparar la población que recibió tofacitinib con aquella que no fue tratada con este fármaco para la COVID-19 en la Clínica Unión Médica del Norte, durante el año 2020. Métodos: Se realizó un estudio de tipo observacional, retrospectivo transversal de tipo exploratorio y de fuente secundaria. Se analizaron las características de los participantes y su tratamiento en relación con los parámetros de laboratorio y las características clínicas. Resultados: Se incluyeron 507 pacientes ingresados en la unidad de COVID-19 de la Clínica Unión Médica del Norte. Se determinó que las defunciones fueron menores en el grupo que se medicó con tofacitinib (6,45%) en comparación con el grupo que no utilizó dicho fármaco. Asimismo, los medicados con esta terapia ameritaron en menos proporción soporte ventilatorio, sin embargo, hubo más proporción de ingresos a la Unidad de Cuidados Intensivos. Además, se identificó una reducción mayor en la glucemia en aquellos pacientes medicados con tofacitinib, aunque mayores niveles de ferritina y dímero D. Conclusiones: El fármaco tofacitinib puede actuar de manera beneficiosa en relación con la mortalidad y la reducción del uso de ventilación mecánica. En adición, podría colaborar con la evolución de los pacientes. No obstante, nuestra investigación no es concluyente. Es necesario realizar futuras investigaciones confirmatorias de la eficacia de la terapia con tofacitinib para los pacientes con COVID-19.

Objective: The main purpose of this study is to characterize and compare the population that received tofacitinib with those that were not treated with the drug for COVID-19 at the Clínica Unión Médica del Norte, in 2020. Methods: An observational, retrospective, cross-sectional, exploratory, and secondary source study was conducted. A comparison was made between clinical and sociodemographic characteristics, laboratory results and their treatment option. Results: Five hundred and seven patients admitted to the COVID-19 unit of the Clínica Unión Médica del Norte were included. It was determined that lower death rates were registered in the group that received tofacitinib (6.45%) compared to the group that did not use the drug. Likewise, those receiving this therapy required less mechanical ventilation, however, a higher proportion of these patients were admitted to the Intensive Care Unit. In addition, a greater reduction in glycaemia was identified in the patients receiving tofacitinib, but they had higher levels of ferritin and D-dimer. Conclusions: Tofacitinib may be beneficial in terms of mortality rates and reduction in the use of mechanical ventilation. Furthermore, it is promising with respect to positive patient progression. However, our research is not conclusive. Future confirmatory research is needed on the efficacy of tofacitinib therapy for COVID-19 patients.

Infant Temperament: Association with Maternal Depression Symptoms in Pregnancy and Postpartum / Temperamento Infantil: Associação com Sintomas Depressivos Maternos na Gestação e no Pós-Parto / Temperamento Infantil: Asociación con Síntomas Depresivos Maternos en el Embarazo y el Posparto

Abstract Research regarding the association between child temperament and maternal symptoms of depression remains inconclusive. This study aimed to compare the temperament of babies during their first year of life in relation to their mother's depression symptoms in pregnancy and/or postpartum. The study also identified risk factors for negative affectivity, extraversion, and effortful control. Fifty-four mother-infant dyads participated in the study, divided according to maternal depression symptoms into four groups: symptoms during pregnancy, postpartum, at both times, and without symptoms. The Edinburgh Postpartum Depression Scale and Infant Behavior Questionnaire were used. Children of mothers with depression symptoms had higher negative affectivity scores, activity levels, and lower effortful control scores. The prediction analysis revealed that negative affectivity and effortful control were explained by maternal postpartum depression symptoms, indicating that caring for the mother in her adaptation to motherhood can prevent impairment to infant temperament.

Resumo As pesquisas ainda são inconclusivas quanto à associação entre temperamento da criança e sintomas depressivos maternos. Este estudo teve por objetivo comparar o temperamento de bebês durante o primeiro ano de vida, diferenciando-os quanto à presença de sintomas depressivos maternos na gestação e/ou pós-parto e identificar fatores de risco para afeto negativo, extroversão e controle com esforço. Participaram 54 díades mãe-bebê, divididas quanto aos sintomas depressivos maternos em quatro grupos: sintomas na gestação, no pós-parto, nos dois momentos e sem sintomas depressivos. Utilizou-se a escala de Depressão Pós-Parto de Edimburgo e Infant Behavior Questionnaire. Filhos de mães com sintomas depressivos obtiveram maiores escores de afeto negativo, nível de atividade e menor escore de controle com esforço. Na análise de predição, o afeto negativo e controle com esforço foram explicados pelos sintomas depressivos maternos pós-parto, sinalizando que cuidar da mãe, em sua adaptação à maternidade, pode evitar prejuízos ao temperamento infantil.

Resumén Las investigaciónes no son concluyentes con respecto a la asociación entre temperamento infantil y síntomas depresivos maternos. Este estudio tuvo como objetivo comparar el temperamento de bebés durante el primer año de vida, diferenciándolos en cuanto a la presencia de síntomas depresivos maternos en el embarazo y/o el posparto y identificando factores de riesgo para afecto negativo, extroversión y control con esfuerzo. Participaron 54 díadas madre-bebé, divididas en cuatro grupos: síntomas depresivos maternos gestacionales, posparto, en los dos momentos y sin síntomas depresivos. Se utilizaron la Escala de Depresión Posparto de Edimburgo y el Cuestionario de Comportamiento Infantil. Hijos de madres con síntomas depresivos tenían puntajes más altos de afecto negativo, nivel de actividad y más bajos de control con esfuerzo. En el análisis de predicción, síntomas depresivos maternos posparto explicaron afecto negativo y control con esfuerzo, señalizando que cuidar de la adaptación de la madre a la maternidad, puede prevenir daños al temperamento infantil.

Caracterización de pacientes con papiloma laríngeo / Characteristics of patients with lagyngeal papillomatosis

La papilomatosis laríngea es la neoplasia laríngea benigna más común y está causada por el virus de papiloma humano. Se considera que la papilomatosis laríngea tiene un papel independiente como factor de riesgo de cáncer; se clasifica dentro de tres grupos de acuerdo con sus características clínicas: juvenil, adulto y recurrente. Su incidencia asociada a neoplasia maligna es del 4%. Objetivos: Determinar si existen factores de riesgo asociados al tipo de papilomatosis laríngea; y si existe relación con el tipo de papilomatosis y neoplasias asociadas. Metodología: Estudio observacional descriptivo de pacientes que acuden al servicio de Otorrinolaringología del Hospital General San juan de Dios y su caracterización. Resultados: De los 33 pacientes evaluados con papilomatosis laríngea, 51 % fueron del género masculino, la edad promedio sin incluir pacientes pediátricos fue de 23 años. La mediana de reintervenciones es de 4 veces, y la mayoría tiene pérdida del seguimiento. La papilomatosis tipo infantil es la más común con pacientes de 7 a 14 años de edad. Los pacientes con papilomatosis adulta presentaron más factores de riesgo que los pacientes con papilomatosis infantil y recurrente, p=0.01. Los pacientes presentan ronquera, disfonía y dificultad respiratoria. El diagnóstico se realiza por clínica con laringoscopía sin biopsia en la mitad de los pacientes. El 9% de los pacientes estudiados presentaron neoplasia asociada. El número de reintervenciones está asociado a un mayor riesgo de progresión a neoplasia. Conclusión: Los pacientes con papilomatosis adulta presentaron más factores de riesgo que los pacientes con papilomatosis infantil, y el 9% de los pacientes presentan una neoplasia asociada, más alta de la reportada en la literatura.(AU)

Laryngeal papillomatosis is the most common benign neoplasm and is caused by the human papilloma virus. Laryngeal papillomatosis is considered to have an independent role as risk factor. Laryngeal papillomas are classified into three groups, according to their clinical characteristics: juvenile, adult and recurrent. 4% is associated with neoplasia. Objectives: Determine if there are risk factors associated with the type of laryngeal papillomatosis and if there is a relationship with the type of papillomatosis and associated neoplasms. Methodology: Descriptive observational study of patients attending the Otolaryngology service of the General Hospital San Juan de Dios de Guatemala and their characterization. Results: Of the 33 patients evaluated with laryngeal papillomatosis, 51% were male, with an average age of 23 years. The median number of reoperations is 4, and most do not return to follow-up. Infantile type papillomatosis is the most common, with patients 7 to 14 years of age. Patients with adult papillomatosis had more risk factors than patients with infantile and recurrent papillomatosis, p= 0.01. Patients present hoarseness, dysphonia and respiratory distress upon admission. Diagnosis is made clinically with laryngoscopy without biopsy in half of the patients. 9% of the patients studied had associated neoplasia. The number of reoperations is associated with an increased risk of developing a neoplasm. Conclusion: Patients with adult papillomatosis presented more risk factors than patients with infantile papillomatosis. And 9% of the patients present associated neoplasia, higher than reported in the literature

Severe corneal burn due to the accidental application of salicylic acid packed in a plastic dropper bottle / Quemadura corneal grave debida a la aplicación accidental de ácido salicílico envasado en un frasco gotero plástico

Eye burns due to the accidental application of pharmacological or nonpharmacological substances packaged in plastic dropper bottles have been described for more than three decades and continue to occur. These burns can cause potentially serious corneal injuries. We report the case of a patient who mistakenly applied salicylic acid to the right eye after confusing it with an eye lubricant, which caused him a severe corneal burn. Fortunately, after aggressive medical and surgical management (including oxygen therapy and amniotic membrane grafting), the visual results were good. We suggest conducting educational campaigns and taking legislative measures in our country to avoid packaging corrosive substances in this type of dropper bottle to reduce the risk of accidental burns.

Las quemaduras oculares por aplicación accidental de sustancias farmacológicas o no farmacológicas envasadas en frascos goteros plásticos, se han descrito desde hace más de tres décadas y siguen ocurriendo. Estas quemaduras pueden causar lesiones potencialmente graves de la córnea. Se presenta el caso de un paciente que se aplicó ácido salicílico en el ojo derecho al confundir el envase con el de un lubricante ocular, lo que le causó una grave quemadura corneal. Afortunadamente, tras un manejo médico y quirúrgico agresivo (incluida oxigenoterapia e injerto de membrana amniótica) los resultados visuales fueron buenos. Se sugiere hacer campañas educativas y adoptar normas en el país para evitar el envase de sustancias corrosivas en este tipo de frascos goteros, con el fin de disminuir el riesgo de quemaduras accidentales.

Reabilitação estética com resina composta em paciente jovem: relato de caso clínico / Aesthetic rehabilitation with composite resin in a young patient: a case report

Objetivo: o presente trabalho tem como objetivo relatar um caso clínico de reabilitação de dentes anteriores com facetas em resina composta. Caso clínico: Paciente do sexo masculino, 23 anos, queixava-se de insatisfação com a estética do seu sorriso. No exame clínico foram observadas restaurações insatisfatórias nas incisais e interproximais dos incisivos centrais superiores. Os elementos 12, 22 e 23 apresentavam-se em desarmonia com a face. Após plano de tratamento, foi realizado registro de cor inicial e três sessões de clareamento dental. Na consulta seguinte foi feita profilaxia com pedra pomes extrafina, confecção da guia de silicone através do enceramento, remoção das resinas antigas, seguido de condicionamento ácido e sistema adesivo. Com a guia de silicone e tiras de poliéster em posição foram realizados incrementos de resina composta de dentina e esmalte. Na sequência os excessos foram removidos com pontas diamantadas multilaminadas finas e extrafinas, verificando os contatos oclusais. Posteriormente, foi realizado polimento com borracha de silicone, discos sof-lex e de feltro, associados à pasta diamantada. Ao final do tratamento obteve- se um sorriso esteticamente harmônico e consequentemente a satisfação por parte do paciente. Conclusão: A reabilitação de dentes anteriores com facetas dentárias em resina composta é um tratamento viável para se alcançar um sorriso harmônico.

Objective: The present study aimed to report a clinical case of rehabilitation of anterior teeth with facets in composite resin. Case report: A male patient, 23 years-old, complained with the aesthetics of his smile. In the clinical examination, unsatisfactory restorations were observed in the incisals and interproximal of the upper central incisors. The teeth 12, 22 and 23 were in disharmony with the face. After the treatment plan, initial color registration and three dental bleaching sessions were performed. In the following visit, prophylaxis was made with extrafine pumice stone, preparation of the silicone guide by waxing, removal of the old resins, followed by acid conditioning and adhesive system. With the guide of silicone and polyester strips in place were made increments of resin composed of dentin and enamel. In the sequence, the excesses were removed with thin and extrafine multilaminated diamond tips, checking the occlusal contacts. Subsequently, it was polished with silicone rubber, sof-lex and felt discs, associated to the diamond paste. At the end of the treatment, an aesthetically harmonious smile was obtained and consequently patient satisfaction. Conclusion: The rehabilitation of anterior teeth with dental veneers in composite resin is a viable treatment to achieve a harmonious smile.

Fechamento de diastema com resina composta: relato de caso / Closure of diastema with composite resin: case report

Este trabalho tem o objetivo relatar um caso clínico de fechamento de diastema inter incisivos pela técnica de restauração direta em com resina composta. Paciente, sexo feminino, compareceu a Clínica Integrada de Adultos queixando-se da estética do seu sorriso devido à coloração amarelada e um espaço presente entre os dentes incisivos superiores. No exame clínico notou-se a presença de diastema mesial entre os dentes 11 e 21. Foi feito um plano de tratamento, no qual foi sugerido a paciente o fechamento do diastema por meio de restaurações diretas com resina composta. Após a aprovação da paciente, foi selecionada a cor dos dentes com o auxílio da Escala Vita e proposto a realização de um clareamento antes do tratamento restaurador. Realizado o clareamento e após ter aguardado 21 dias para estabilização da cor, deu início a etapa restauradora, a qual consistiu no ataque ácido seguido pela aplicação do sistema adesivo. A resina composta foi sendo colocada em incrementos de 1mm com o auxílio de fita de poliéster a fim de restabelecer a parede palatina e o contato interproximal. Posteriormente, a resina foi sendo colocada até a face vestibular respeitando a anatomia dentária. Uma semana após a restauração, foi realizado acabamento e polimento com pontas diamantadas tronco-cônicas de granulação fina, discos de lixa, disco de feltro e pasta diamantada. O resultado satisfatório após o fechamento do diastema pela técnica direta em resina composta demonstrou-se uma opção de tratamento viável, uma vez que restabeleceu a função e a estética do sorriso da paciente.

This paper aims to report a clinical case of closure of inter-incisive diastema by the technique of direct restoration with composite resin. A female patient attended the Integrated Adult Clinic complaining about the aesthetics of her smile due to the yellow color and a space between the upper incisor teeth. In the clinical examination, the presence of mesial diastema between teeth 11 and 21 was noted. A treatment plan was made, in which the patient was suggested to close the diastema by means of direct restorations with composite resin. After the patient's approval, the color of the teeth was selected with the aid of the Vita Scale and it was proposed to perform a whitening procedure before the restorative treatment. After bleaching and after waiting 21 days for color stabilization, the restorative stage began, which consisted of the acid attack followed by the application of the adhesive system. The composite resin was placed in 1mm increments with the aid of polyester tape in order to reestablish the palatal wall and interproximal contact. Subsequently, the resin was placed up to the buccal surface, respecting the dental anatomy. One week after the restoration, finishing and polishing was carried out with fine-grained cone-shaped diamond tips, sanding discs, felt disc and diamond paste. The satisfactory result after the closure of the diastema by the direct technique in composite resin proved to be a viable treatment option, since it restored the function and aesthetics of the patient's smile.

Influencia de agentes crioprotectores sobre las cinéticas de congelación de lechuga (Lactuca sativa L.) / Influence of cryoprotective agents on lettuce freezing kinetics (Lactuca sativa L.)

RESUMEN La lechuga es una hortaliza de hoja que no resiste la congelación. Como una alternativa de conservación de lechuga Lactuca sativa L. "Lollo Bionda", se evaluó el efecto de la aplicación de crioprotectores sobre cada una de las etapas de congelación de lechuga. En cada etapa, se evaluó el tiempo de duración, la velocidad y la temperatura de congelación. Como crioprotectores, se utilizaron soluciones de Aloe (Aloe barbadensis Miller), a concentraciones de 70, 80 y 90%; almidón, a concentraciones de 0,5, 1 y 2% p/p y aceite de oliva. Las muestras, se impregnaron con los diferentes crioprotectores y se ultracongelaron. Las temperaturas del material vegetal, se registraron durante una hora, con intervalos de 5s; se construyeron las cinéticas de congelación y sobre las cinéticas, se identificaron las diferentes etapas de congelación. Se encontró que el tipo y la concentración del crioprotector altera, de manera estadísticamente significativa, la temperatura, el tiempo y la velocidad de cada una de las etapas de congelación. Las mayores concentraciones de solutos presentes en Aloe vera al 90%, almidón al 2% y aceite de oliva influyeron considerablemente en la acción crioprotectora de la lechuga.

ABSTRACT Lettuce is a leafy vegetable that does not resist freezing. As an alternative to the lettuce Lactuca sativa L. "Lollo Bionda" lettuce conservation, the effect of the application of cryoprotectants on each of the freezing stages of lettuce was evaluated. In each stage, duration time, speed and freezing temperature were evaluated. Aloe (Aloe barbadensis Miller) solutions at concentrations of 70, 80 and 90%, starch at concentrations of 0.5, 1 and 2% w / w and olive oil were used as cryoprotectants. The samples were impregnated with the different cryoprotectants and deep-frozen. The temperatures of the plant material were recorded for one hour at intervals of 5 s, the freezing kinetics were built and, on the kinetics, the different stages of freezing were identified. It was found that the type and concentration of the cryoprotectant alters in a statistically significant way the temperature, time and speed of each of the freezing stages. The highest concentrations of solutes present in 90% Aloe vera, 2% starch and olive oil significantly influenced the cryoprotective action of lettuce.

Trastornos del sueño y dolor en la enfermedad de Parkinson / Sleep disorders and pain in Parkinson's Disease

RESUMEN Las alteraciones del sueño y el dolor, síntomas que han venido siendo cada vez más reconocidos como síntomas no motores en la enfermedad de Parkinson, pueden ser tan incapacitantes como los síntomas motores e impactan significativamente la calidad de vida de quienes los padecen. En este artículo se habla de la importancia del reconocimiento, el abordaje y el tratamiento de los trastornos del sueño más frecuentes en pacientes como Parkinson, como el trastorno conductual del sueño MOR, el insomnio y sueño fragmentado, la somnolencia diurna y el síndrome de piernas inquietas, así como el abordaje general del dolor en el paciente con esta enfermedad.

SUMMARY Sleep disorders and pain are symptoms that have been increasingly recognized as non-motor symptoms in Parkinson's disease, these no motor symptoms can be some of the most disabling and significantly impact the quality of life of patients that suffer it. This article discusses the importance of the recognition, approach and treatment of the most frequent sleep disorders in patients with Parkinson's disease, such as MOR sleep behavior disorder, insomnia and fragmented sleep, daytime sleepiness and restless legs syndrome, as well as the general approach to pain in patients with this disease.

Conhecimento dos Professores do Ensino Fundamental Quanto ao Manejo Emergencial de Traumatismo Dentários / Knowledge of Primary School Teachers in Emergency Management of Tooth Injuries

Objetivo: Avaliar o nível de conhecimento e segurança de professores do ensino fundamental para lidar com injúrias traumáticas na dentição permanente, antes e após assistirem uma palestra educativa. Materiais e Métodos: Os dados foram coletados por meio de questionários aplicados aos professores de ensino fundamental do 1º ao 9º ano do município de Mineiros-GO, antes e após assistirem uma palestra sobre traumatismo dentário. A amostra foi composta por 32 professores do ensino fundamental de escolas privadas e estaduais do município. Estes professores responderam a um questionário, o qual primeiramente avaliava o perfil do participante e em uma segunda parte avaliava o conhecimento do mesmo sobre traumatismo dentário. Os dados obtidos foram submetidos à uma análise estatística descritiva, para verificar a frequência das respostas de cada questão antes e após a realização da palestra de orientação. Resultados: Apesar da maioria dos professores apresentar um bom tempo de experiência profissional e ter pós-graduação, 80% dos participantes relataram sentir-se despreparados para agir diante de um trauma dentário. Após as orientações fornecidas nas palestras educativas foram observados resultados bastante positivos, aumentando significativamente, de 12,5% para 46,8%, o número de participantes que se sentia preparado para socorrer um aluno com trauma dentário. Conclusão: A falta de conhecimento dos professores em relação a injúria dentária foi evidente. Desse modo, a realização de palestras educativas para esse público mostra ser de grande valia e imprescindível para o sucesso e longevidade do tratamento.

Objective: To evaluate the level of knowledge and safety of primary school teachers in dealing with traumatic injuries in permanent teeth, before and after attending an educational lecture. Materials and methods: Data were collected through questionnaires applied to primary school teachers from the 1st to the 9th year of the city of Mineiros-GO, before and after attending a lecture on dental injuries. The sample consisted of 32 school teachers from private and state schools. These teachers answered a questionnaire, which first evaluated the participant's profile and in a second part evaluated their knowledge about tooth injuries. The data were submitted to a descriptive statistical analysis, to verify the frequency of the answers of each question before and after the orientation lecture. Results: Even though most teachers have a good amount of professional experience and have a postgraduate degree, 80% of the participants reported feeling unprepared to act in the face of tooth injuries. Following the guidelines provided in the educational lectures were observed quite positive results, significantly increasing, of 12.5% to 46.8%, the number of participants who felt prepared to succor a student with tooth injuries. Conclusion: The teachers' lack of knowledge about dental injuries was evident. Thus, educational lectures for this audience showed to be of great value and essential for the success and longevity of the treatment.

Consumo de alcohol, conducta antisocial e impulsividad en adolescentes españoles / Consumo de álcool, conduta antissocial e impulsividade em adolescentes espanhóis / Alcohol consumption, antisocial behavior and impulsivity in Spanish adolescents

Resumen La relación entre el consumo de alcohol y la conducta antisocial en adolescentes ha sido ampliamente reportada en investigaciones anteriores. El objetivo principal de este estudio es evaluar dicha relación, además de estudiar cómo influye en ella la impulsividad. Se utilizó la Escala Rutgers Alcohol Problem Index (RAPI) para evaluar el consumo de alcohol, la Escala de Conducta Antisocial y Delictiva en Adolescentes, y la Escala de Impulsividad de Barratt para la conducta antisocial. Se hizo un muestreo no probabilístico de tipo intencional que resultó en una muestra compuesta por 212 adolescentes con edades entre los 12 y los 18 años (M = 14.1, DE = 1.48). Los resultados mostraron que las variables que mejor predicen la conducta antisocial en adolescentes son el consumo de alcohol y la impulsividad cognitiva; y se comprobó que existen diferencias significativas en la conducta antisocial según el género, pero no en función del consumo de alcohol. Respecto al nivel de edad, se encontraron diferencias significativas entre todos los niveles de edad en el consumo de alcohol; así como diferencias en la conducta antisocial entre la adolescencia temprana y la adolescencia media, y entre la adolescencia temprana y la adolescencia tardía. Se discuten las posibles implicaciones de la vinculación entre el consumo de alcohol y el delito, en virtud de los resultados obtenidos.

Resumo A relação entre o consumo de álcool e a conduta antissocial em adolescentes tem sido amplamente relatada em pesquisas anteriores. O objetivo principal deste estudo é avaliar tal relação, além de estudar como a impulsividade tem influência nela. Utilizou-se a Escala Rutgers Alcohol Problem Index (Rapi) para avaliar o consumo de álcool, a Escala de Condutas Antissociais e Delitivas em Adolescentes e a Escala de Impulsividade de Barratt para a conduta antissocial. Foi feita uma amostragem não probabilística de tipo intencional que resultou em uma amostra composta por 212 adolescentes com idades entre 12 e 18 anos (M = 14.1, DP = 1.48). Os resultados mostraram que as variáveis que melhor predizem a conduta antissocial em adolescentes são o consumo de álcool e a impulsividade cognitiva; ainda, ficou comprovado que existem diferenças significativas na conduta social de acordo com o gênero, mas não em função do consumo de álcool. Com relação ao nível de idade, foram encontradas diferenças significativas entre todos os níveis de idade no consumo de álcool, assim como diferenças na conduta antissocial entre a adolescência precoce e a adolescência média, e entre a adolescência precoce e a adolescência tardia. Discutem-se as possíveis implicações da associação entre o consumo de álcool e o delito em virtude dos resultados obtidos.

Abstract The relationship between alcohol use and antisocial behaviour in teenagers has been widely reported in previous research. Our main aim was to evaluate this relationship, and also to study how impulsivity influences it. The instruments used were the Rutgers Alcohol Problem Index (RAPI), to evaluate alcohol consumption; the Scale of Antisocial and Criminal Behaviour in Teenagers, and the Barratt Impulsiveness Scale, to assess these behaviors in the youth. The sampling method was non probabilistic and intentional, and the sample consisted of 212 teenagers aged between 12 and 18 years (Average=14.1, SD=1.48). The results showed that the variables which better predict anti-social behaviour in teenagers are alcohol consumption and cognitive impulsiveness. On the other hand, it was found that there are significant differences in antisocial behavior according to gender, but not in terms of alcohol consumption. Regarding age level, significant differences were found in alcohol consumption between all age levels, and in antisocial behavior are concentrated between early and medium adolescence, and between early and late adolescence. The possible implications of the link between alcohol consumption and crime by virtue of the results obtained are discussed.

Motor and non-motor wearing-off and its impact in the quality of life of patients with Parkinson's disease / Flutuações motoras e não-motoras e seu impacto na qualidade de vida de pacientes com doença de Parkinson

ABSTRACT The wearing-off phenomenon is common in patients with Parkinson's disease. Motor and non-motor symptoms can fluctuate in relation to the "on/off" periods. Objective: To assess the impact of motor and non-motor wearing-off on activities of daily living and quality of life of patients with PD. Methods: A cross-sectional study was carried out. All patients were evaluated using the Movement Disorders Society Unified Parkinson's Disease Rating Scale. Wearing-off was assessed using the Wearing-Off Questionnaire-19, and quality of life was assessed using the Parkinson's Disease Questionnaire-8. Results: A total of 271 patients were included; 73.4% had wearing-off; 46.8% had both motor and non-motor fluctuations. Patients with both motor and non-motor wearing-off had a worst quality of life compared with those with only motor fluctuations (p = 0.047). Conclusions: Motor and non-motor fluctuations have an impact on activities of daily living and quality of life. Non-motor wearing-off may have a higher impact.

RESUMO O fenômeno de encurtamento do fim de dose é comum em pacientes com doença de Parkinson. Tanto os sintomas motores quanto os não motores podem flutuar em relação aos períodos de "on/off". Objetivo: Avaliar o impacto das flutuações motoras e não-motoras nas atividades da vida diária e qualidade de vida em pacientes com doença de Parkinson. Métodos: Um estudo transversal foi realizado. Todos os sujeitos foram avaliados utilizando a escala unificada para a doença de Parkinson da Sociedade de Distúrbios do Movimento. O encurtamento do fim de dose foi avaliado através do questionário WOQ-19 e a qualidade de vida foi avaliada através do PDQ-8. Resultados: Um total de 271 pacientes foram incluídos, 73,4% tiveram deterioração de fim de dose. A maioria dos pacientes tiveram tanto flutuações motoras quanto não-motoras (46,8%). Os pacientes com ambos os tipos de flutuações motoras e não-motoras tiveram pior qualidade de vida do que pacientes apenas com flutuações motoras (p = 0.047). Conclusões: Pacientes com flutuações motoras e não-motoras tiveram impacto significativo nas atividades da vida diária e na qualidade de vida. As flutuações não-motoras parecem ter um impacto maior que as flutuações motoras sobre a qualidade de vida.

Impacto de la aplicación de una guía clínica basada en la evidencia en el tratamiento del reflujo vesicoureteral primario en el niño / Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children

Objetivo: Analizar en qué manera se ha modificado la actitud terapéutica en un hospital de tercer nivel tras la implementación de la guía clínica para el tratamiento del reflujo vesicoureteral (RVU) primario en niños. Población y métodos: Estudio retrospectivo sobre una cohorte de pacientes con RVU primario (1989-2015), de entre 0 y 15 años, en un hospital terciario. Se comparó la conducta terapéutica antes y después de la aparición de la guía clínica (2008). Resultados: Se incluyeron 297 pacientes (49, 8% de niños, 50, 2% de niñas), edad media al momento del diagnóstico de 21, 71 meses. El grado de RVU fue: RVU I-III 45, 1%, RVU IV-V 54, 9%; 124 fueron tratados tras la implementación de la guía clínica (grupo 1), 173, con anterioridad (grupo 2). El período medio de seguimiento fue de 124, 32 meses. El tratamiento conservador fue la terapia de inicio en el 70, 3% de los pacientes del grupo 1 y en el 67, 9% del grupo 2. El número de cirugías se mantuvo constante (31, 45% vs. 31, 79%), con un incremento en el número de procedimientos endoscópicos (p < 0, 005). El perfil de paciente se ha modificado a raíz de la aplicación del algoritmo propuesto por dicha guía. Hubo menos intervenciones en pacientes con RVU IV-V (82, 32% vs. 59, 9%, p= 0, 000) y daño renal al momento del diagnóstico (49, 4% vs. 9, 8%, p= 0, 000). Conclusiones: La aplicación de la guía clínica ha favorecido una conducta conservadora inicial en pacientes con RVU de alto grado y nefropatía, en los que, tradicionalmente, se indicaba la cirugía desde el inicio. La utilización de las guías clínicas favorece una conducta unánime basada en la evidencia, que disminuye los procedimientos invasivos innecesarios.

Objective: To analyze changes in the therapeutic approach at a tertiary care hospital following the implementation of a clinical guideline for the treatment of primary vesicoureteral reflux (VUR) in children. Population and methods: Retrospective study conducted in a cohort of patients with primary VUR (1989-2015) aged 0-15 years at a tertiary care hospital. The therapeutic approach before and after the development of the clinical guideline (2008) was compared. Results: A total of297 patients (49.8% boys, 50.2% girls) were included; their mean age at the time of diagnosis was 21.71 months. VUR grading was: VUR I-III 45.1%, VUR IV-V 54, 9%; 124 were treated after the implementation of the clinical guideline (group 1), and 173, before (group 2). The mean follow-up period was 124.32months. A conservative approach was the initial treatment in 70.3% of group 1 patients and 67.9% of group 2 patients. The number of surgeries remains constant (31.45% versus 31.79%), with an increase in the number of endoscopic surgeries (p < 0.005). The profile of patients has changed based on the application of the algorithm proposed by the guideline. Fewer surgeries were done in patients with VUR IV-V (82.32% versus 59.9%, p= 0.000) and there were fewer cases of kidney damage at diagnosis (49.4% versus 9.8%, p= 0.000). Conclusions: The implementation of the clinical guideline has favored an initially conservative approach in patients with severe grade VUR and nephropathy, for whom surgery was traditionally indicated initially. Using clinical guidelines favors a unanimous, evidence-based approach that reduces the performance of unnecessary invasive procedures.

Gold is not always gold: Bahía Málaga, touristification strategies in the Colombian pacific / El oro no siempre es dorado: bahía málaga, estrategias de turistificación en el pacífico colombiano

RESUMEN Este artículo aborda la manera en que las comunidades negras en el Pacífico colombiano apropian los conceptos medio ambiente y desarrollo para implementar proyectos de ecoturismo étnico, que en ocasiones se ven bajo el lente de intereses económicos de políticos, empresarios y miembros de las mismas comunidades. La apuesta metodológica de este trabajo privilegia el lugar de la etnografía y el trabajo de campo como herramientas fundamentales para conocer desde la cotidianidad de las comunidades las realidades sociales que aquí se plantean. Estas concepciones dan cuenta de la disputa actual generada desde el Estado por conservar los recursos medioambientales o apostarle a una idea de desarrollo basada en las políticas neoliberales insertadas en la Constitución colombiana de 1991 y el nuevo orden político nacional. Sin embargo, las comunidades nos muestran que estos debates no son necesariamente excluyentes.

ABSTRACT This article discusses how black communities in the Colombian Pacific appropriated concepts about environment and development, which many a times are under the lens of the economic interests of politicians, businessmen and members of the communities themselves. The methodological approach of this study privileges ethnography and fieldwork, which are two key tools to know about the daily life of the communities' social realities presented here. These concepts serve to account the current debate on the question about conserving environmental resources or betting on an idea of development based on neoliberal policies embedded in the Colombian Constitution of 1991 and the new national political order. Nevertheless, communities show that such debates are not necessarily exclusionary.

Derrame pericárdico y pericarditis purulenta por Salmonella: un caso excepcional / Pericardial effusion and purulent pericarditis caused by Salmonella: an exceptional case

Resumen Las complicaciones cardiovasculares asociadas a las infecciones por la Salmonella son raras y suceden entre el 1 a 5% de los pacientes. Las enfermedades del pericardio son extremadamente inusuales con pocos casos reportados en la literatura. Presentamos el caso de un adulto mayor con síntomas de derrame pericárdico y hallazgos de pericarditis purulenta en quien la etiología corresponde a infección por la Salmonella spp. confirmada por hallazgos clínicos, de imágenes diagnósticas, microbiológicos, quirúrgicos e histopatológicos.

Abstract Cardiovascular complications associated to Salmonella infections are rare and happen in around 1 to 5% of patients. Pericardium diseases are extremely unusual with few cases reported in literature. We report the case of an old adult with symptoms of pleural effusion and findings of purulent pericarditis where the etiology corresponded to an infection of Salmonella spp confirmed with clinical findings and imaging, microbiological, surgical and histopathological results.

Hypothalamic transcriptional expression of the kisspeptin system and sex steroid receptors differs among polycystic ovary syndrome rat models with different endocrine phenotypes

OBJECTIVES: Polycystic ovary syndrome is a heterogeneous endocrine disorder that affects reproductive-age women. The mechanisms underlying the endocrine heterogeneity and neuroendocrinology of polycystic ovary syndrome are still unclear. In this study, we investigated the expression of the kisspeptin system and gonadotropin-releasing hormone pulse regulators in the hypothalamus as well as factors related to luteinizing hormone secretion in the pituitary of polycystic ovary syndrome rat models induced by testosterone or estradiol. METHODS: A single injection of testosterone propionate (1.25 mg) (n=10) or estradiol benzoate (0.5 mg) (n=10) was administered to female rats at 2 days of age to induce experimental polycystic ovary syndrome. Controls were injected with a vehicle (n=10). Animals were euthanized at 90-94 days of age, and the hypothalamus and pituitary gland were used for gene expression analysis. RESULTS: Rats exposed to testosterone exhibited increased transcriptional expression of the androgen receptor and estrogen receptor-β and reduced expression of kisspeptin in the hypothalamus. However, rats exposed to estradiol did not show any significant changes in hormone levels relative to controls but exhibited hypothalamic downregulation of kisspeptin, tachykinin 3 and estrogen receptor-α genes and upregulation of the gene that encodes the kisspeptin receptor. CONCLUSIONS: Testosterone- and estradiol-exposed rats with different endocrine phenotypes showed differential transcriptional expression of members of the kisspeptin system and sex steroid receptors in the hypothalamus. These differences might account for the different endocrine phenotypes found in testosterone- and estradiol-induced polycystic ovary syndrome rats.

Endocarditis y artritis séptica por Salmonella no Typhi productora de β-lactamasas de espectro extendido: A case report / Endocarditis and arthritis caused by extended spectrum β-lactamase-producing non-Typhi Salmonella

We present the case of a patient with endocarditis and arthritis caused by extended spectrum β-lactamase producing non-Typhi Salmonella, with incomplete response (defined as persistence of Salmonella in joint fluid) to initial instituted treatment (trimethoprim-sulfamethoxazole) and posterior recovery with ertapenem. The disease was associated with implantable central venous catheter infection. Five percent of patients with non-Typhi Salmonella gastroenteritis develop bacteremia. Infective endocarditis and joint infection has been reported in 1,4% and less than 1% of cases, respectively.

Se presenta el caso de un paciente con endocarditis y artritis séptica por Salmonella no Typhi productora de β-lactamasas de espectro extendido que presentó una respuesta incompleta (definida como la persistencia de Salmonella en el líquido articular) al tratamiento inicial con cotrimoxazol y que posteriormente mejoró con ertapenem. La enfermedad se asoció al uso de un catéter venoso implantable. El 5% de los pacientes con gastroenteritis por Salmonella no Typhi desarrolla una bacteriemia. La endocarditis infecciosa y la artritis ha sido reportada en 1,4-5% de los casos y en menos de 1%; respectivamente.

Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis / El examen del líquido céfalo raquídeo puede ser útil en el diagnóstico de neurosífilis en pacientes VIH + asintomáticos con sífilis

ABSTRACT Lumbar puncture in neurologically asymptomatic HIV+ patients is still under debate. There are different criteria for detecting neurosyphilis through cerebrospinal fluid (CSF), especially in cases that are negative through the Venereal Disease Research Laboratory (VDRL), regarding cellularity and protein content. However, a diagnosis of neurosyphilis can still exist despite negative VDRL. Treponema pallidum hemagglutination assay (TPHA) titers and application of the TPHA index in albumin and IgG improve the sensitivity, with a high degree of specificity. Thirty-two patients were selected for this study. VDRL was positive in five of them. The number of diagnoses reached 14 when the other techniques were added. It was not determined whether cellularity and increased protein levels were auxiliary tools in the diagnosis. According to our investigation, CSF analysis using the abovementioned techniques may be useful in diagnosing neurosyphilis in these patients.

RESUMO La punción lumbar (PL) en pacientes VIH+ neurológicamente asintomáticos es controversial. Existen diferentes criterios para detectar en el líquido cefalorraquídeo (LCR) neurosífilis (NS): el examen Venereal Disease Research Laboratory (VDRL) en primer lugar, en caso de negatividad: la celularidad y el tenor de proteinas. Sin embargo el diagnóstico de NS puede ser sostenido a pesar de la negatividad de las técnicas mencionadas. La titulación del Treponema pallidum hemagglutination assay (TPHA) y la aplicación del índice de TPHA en Albúmina e Ig G mejoran la sensibilidad asociando elevado grado de especificidad. 32 pacientes fueron seleccionados para este estudio, el VDRL fue positivo en 5. El diagnóstico se elevó a 14 cuando se sumaron el resto de las técnicas. No se evidenció que la celularidad y el aumento de proteínas fueran herramientas auxiliares para el diagnóstico. De acuerdo a nuestro trabajo el estudio del LCR con las técnicas señaladas puede ser de utilidad en el diagnóstico de NS en estos pacientes.