Dilatación idiopática de la aurícula derecha. Reporte de caso y revisión de la literatura / Idiopathic dilatation of the right atrium. Case report and literature review

Resumen La dilatación idiopática de la aurícula derecha (DIAD) es una malformación poco frecuente caracterizada por un crecimiento desproporcionado de la aurícula derecha en ausencia de una causa estructural o funcional que la justifique. Presentamos el caso de una paciente con DIAD con diagnóstico desde la etapa prenatal.

Abstract Idiopathic dilatation of the right atrium is a rare malformation characterized by disproportionate growth of the right atrium in the absence of a cause that justifies it. We present the case of a patient with idiopathic dilatation of the right atrium diagnosed since fetal life.

The academic impact of the symposium on endoscopy and minimally invasive spine surgery of the mexican association of spine surgeons - amcico / O impacto acadêmico do simpósio de endoscopia e cirurgia minimamente invasiva da coluna vertebral da associação mexicana de cirurgiões da coluna vertebral - amcico / El impacto académico del simposio de endoscopia y cirugía minimamente invasiva de columna de la asociación mexicana de cirujanos de columna - amcico

ABSTRACT Introduction: The interest in spinal endoscopy is rising, particularly among younger spine surgeons. Formalized postgraduate training programs for endoscopic spinal surgery techniques are lacking behind. Methods: The authors performed a retrospective survey study amongst participants of the 2022 AMCICO endoscopic surgery symposium. Descriptive and correlative statistics were done on the surgeon's responses recorded in multiple-choice questions. In addition, surgeons were asked about their clinical experience and preferences with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, and future training requirements. SPSS (version 27) statistical software package was used for data analysis. Descriptive statistic measures were used to count responses and calculate the mean, range, standard deviation, and percentages. In addition, chi-square statistics were used to determine the strength of the association between factors. Results: The online survey was accessed by 321 surgeons, of which 92 completed it (53.4%). Demographic data showed the majority of responding surgeons being orthopedic surgeons (73.6%) and under the age of 50 (69.2%), with over half (51.1%) having less than three months of formalized training in endoscopic spinal surgery techniques. Most surgeons practiced uni-portal (58.9%) versus bi-portal (3.4%) spinal endoscopy. The transforaminal approach (65.5%) was preferred over the interlaminar method (34.4%). The bi-portal technique was indicated almost exclusively for the lumbar spine (94.8%). For endoscopically assisted spinal fusions, a uni-portal approach was preferred by 72% of surgeons over a bi-portal procedure (24.5%). 84.1% of respondents were interested in navigation, of which 30.7% preferred optical over electromagnetic technology (18.2%). Robotics was of interest to 51.1% of survey participants. Respondents' bias was estimated with course attendance assessments, with 37% of surgeons having attended all three days, 27.2% two days, and 16.3% one day. One-fifth of responding spine surgeons did not participate in any curriculum activities but completed the survey. The academic impact of the AMCICO endoscopy symposium was high, with 68.1% of respondents indicating interest in continued training and 61.1% of trainees ready to apply their newly acquired knowledge base to clinical practice. Conclusion: The interest in spinal endoscopy surgery techniques and protocols is high among AMCICO members. Many surgeons are interested in learning advanced endoscopic surgical techniques to integrate the technology into their surgical procedure portfolio to address common painful conditions of the degenerative spine beyond herniated discs and foraminal stenosis. The authors concluded that its academic impact was high based on the responses given by the participating surgeons. Level of evidence III; Retrospective study.

Resumo: Introdução: O interesse em cirurgia endoscópica da coluna tem aumentado especialmente entre os jovens cirurgiões, contudo, são poucos os centros que atualmente oferecem programas de treinamento nesta disciplina. Métodos: Foi realizada uma pesquisa retrospectiva entre os participantes do simpósio de "Cirurgia Minimamente Invasiva e Endoscópica da Coluna Vertebral" realizado durante o Congresso AMCICO 2022. Estatísticas descritivas e testes de correlação foram aplicados às respostas das perguntas de múltipla escolha. Os cirurgiões foram questionados sobre experiência clínica e preferências pela endoscopia espinhal, histórico de treinamento, tipos de descompressão lombar endoscópica que realizaram e requisitos futuros para um treinamento adicional. O software estatístico SPSS (versão 27) foi utilizado para a análise de dados. As medidas estatísticas descritivas foram utilizadas para quantificar as respostas e calcular a mediana, a média, o desvio padrão e as porcentagens. O qui-quadrado foi empregado para determinar a associação entre os fatores estudados. Resultados: A pesquisa on-line foi visualizada por 321 cirurgiões, dos quais 92 a completaram (53,4%). As informações demográficas mostraram que a maioria dos participantes são cirurgiões ortopédicos (73,6%) e menores de 50 anos (69,2%), com mais da metade deles (51,1%) possuindo menos de 3 meses de treinamento formal em técnicas endoscópicas. A maioria dos cirurgiões pratica abordagens uniportais (58,9%, contra 3,4% bi-portais). A abordagem transforaminal (65,5%) foi preferida em relação à abordagem interlaminar (34,4%). A abordagem biportal foi selecionada como a abordagem indicada para a região lombar (94,8%). Para a fusão endoscopia-assistida, a abordagem unilateral foi preferida por 72% dos participantes contra a abordagem biportal (24,5%). Os sistemas de navegação foram de interesse para 84,1% dos participantes, dos quais 30,7% responderam que preferiam a óptica em vez da eletromagnética (18,2%). O uso da robótica foi de interesse para 51,1% dos participantes. O viés dos participantes foi calculado com base no percentual de participação, onde 37% participaram de todos os 3 dias de conferências, 27,2% participaram de 2 dias e 16,3% participaram de apenas um dia. Um quinto dos cirurgiões não participaram das atividades do simpósio e ainda assim responderam à pesquisa. O impacto acadêmico do simpósio de "Cirurgia Minimamente Invasiva e Endoscópica da Coluna Vertebral" foi alto, com 68,1% dos participantes respondendo que têm interesse em treinamento adicional nestas técnicas e 61,1% respondendo que estão prontos para aplicar novos conhecimentos em sua prática médica. Conclusão: O interesse em técnicas cirúrgicas endoscópicas da coluna vertebral é alto entre os membros da AMCICO. Um grande número de cirurgiões está interessado em aprender técnicas cirúrgicas endoscópicas avançadas da coluna vertebral e integrar esta tecnologia como parte de suas ferramentas cirúrgicas para resolver problemas comuns que afetam a coluna com doença degenerativa, além de hérnias de disco e estenoses foraminais. Baseados nas respostas fornecidas pelos cirurgiões participantes, os autores concluem que o impacto acadêmico foi elevado. Nível de evidência III; Estudo retrospectivo.

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Rompiendo el efecto ''techo de cristal'' en la generación de evidencia clínica de alto nivel en ortopedia y traumatología / Breaking the "glass ceiling" effect in the generation of high-level clinical evidence in orthopedics and traumatology

Introduction: In clinical studies involving common orthopedic problems and traumatic injuries, randomization methods are difficult to orchestrate. The lack of high-level clinical evidence based on prospective, randomized, double-blind studies is often cited as a major reason for rejecting proposed therapeutic advances in orthopedic surgery. Materials and methods: This opinion document summarizes the limitations of clinical trials in surgical subspecialties. A consensus is presented about how the practicing orthopedic surgeon can produce high-quality clinical evidence and thus make changes to their clinical practice protocols. Results: This literature review revealed that level of evidence classifications vary among surgical subspecialties. Research in orthopedics and traumatology is primarily directed toward diagnosis, preferred treatment, and economic decision analysis, while other prognostic classifications are preferred in other areas, such as plastic surgery. In orthopedics, double-blind controlled studies are rare and often impractical or even unethical. Crossover between randomized surgical trials of study groups is more common. Other difficulties in surgical trials range from: lack of organizational and financial support, institutional approval or ethics committee and registration requirements for clinical trials, and to insufficient time outside of an already busy clinical program to dedicate to this laborious task. uncompensated task. Conclusion: Orthopedic surgery is a subspecialty based on experience and skill. Many innovations begin with enterprising surgeons reporting opinion reports or retrospective cohort studies, many of which are biased. Prospective observational cohort studies with consistent results may offer higher grade clinical evidence than poorly executed randomized trials.

Ampliación de la distribución geográfica y estado de conservación de Ctenoblepharys adspersa (Tschudi, 1845)

Ampliamos la distribución geográfica de Ctenoblepharys adspersa (Liolaemidae), una especie de saurio endémico y amenazado del desierto peruano. Nuestro nuevo registro extiende la distribucion de esta especie en 60 km (línea recta) de la localidad más oriental previamente conocida, la Reserva Nacional de Paracas. Registramos dos tipos de hábitat nuevos para C. adspersa al interior de las estribaciones andinas e identificamos las plantas nativas asociadas a sus hábitats. Además, revisamos el estado de conservación de esta especie y los desafíos que implican su conservación, resaltando que la mayoría de las poblaciones son vulnerables a los impactos en su hábitat producto del desarrollo de infraestructura urbana y/o agrícola.

We extend the geographical distribution of Ctenoblepharys adspersa (Liolaemidae) an endemic and threatened lizard species from the Peruvian desert. Our new record extends the known species distribution ca. 60 km (straight line) east-southeastern from the eastemost record at Paracas National Reserve. We recorded two new type of habitat for C. adspersa that reach to the Pacific foothills and identified the native plants associated to its habitats. Moreover, we review the conservation status and the challenges that facing it, highlighted that most of its populations are vulnerable to the impacts on their habitat caused by the development of urban and agricultural infrastructure.

Consequences of COVID-19 pandemic on myocardial infarction reperfusion therapy and prognosis / Consecuencias de la pandemia COVID-19 en la reperfusión y pronóstico del infarto de miocardio

ABSTRACT Background The coronavirus disease (COVID-19) pandemic affected the prompt diagnosis and treatment of Acute myocardial infarction (AMI). Aim: To characterize the clinical profile of patients with AMI during the COVID-19 pandemic, comparing them with a historical cohort. Material and Methods: A case-control study of 96 patients with AMI transferred to a high-volume percutaneous coronary intervention (PCI) hospital between March and July 2020, and a historical cohort of 269 patients transferred during the same period in 2019. Results: When comparing patients transferred during the pandemic with those of the historical cohort, the former were younger (63 ± 12 vs 68 ± 12 years, p 12 hours from the onset of symptoms (44 vs 0%, p < 0.01), a higher median door-to-device time (4 vs 3 hours, p < 0.01), a higher use of primary percutaneous coronary intervention (97 vs 71%, p < 0.01), and higher frequencies of cardiogenic shock (20 vs 4%, p < 0.01) and mechanical complications (10% vs 2%, p < 0.01). Patients during COVID pandemic had a higher thirty-day overall (20 vs 1.4%, p < 0.01) and cardiovascular mortality (13 vs 1%, p < 0.01). During the outbreak, 40% of patients had positive COVID-19 status, which was a predictor for thirty-day overall mortality (Risk ratio 2.90; 95% confidence intervals 1.14-7.36). Conclusions: During the pandemic patients with AMI exhibited delays in consultations and treatment, higher morbidity, and increased mortality. COVID-19 positivity was associated to worse thirty-day overall survival.

Antecedentes: La pandemia COVID-19 afectó el tratamiento oportuno del infarto agudo de miocardio (IAM). Objetivo: Caracterizar el perfil clínico de pacientes con IAM durante la pandemia COVID-19 y compararlos con una cohorte histórica. Pacientes y Métodos: Estudio caso-control de 96 pacientes con IAM transferidos a un hospital de alto volumen de intervención coronaria percutánea (ICP) entre marzo julio de 2020 y una cohorte histórica de 269 pacientes transferidos en el mismo período de 2019 (n = 269). Resultados: Al comparar los pacientes transferidos durante pandemia y la cohorte histórica, los primeros eran más jóvenes (63 ± 12 y 68 ± 12 años respectivamente, p 12 h desde iniciados síntomas de IAM con elevación ST (44,4 y 0% respectivamente, p < 0,01), una mediana de tiempo puerta-guía mayor (4 y 3 horas respectivamente, p < 0,01), un mayor uso de ICP primaria (97 y 71% respectivamente, p < 0,01), mayor frecuencia de shock cardiogénico (19,8 y 4,1% respectivamente, p < 0.01) y complicaciones mecánicas (10,4 y 1,7% respectivamente, p < 0,01). A treinta días, los primeros tuvieron mayor mortalidad general (19,8 y 1,4% respectivamente p < 0.01) y cardiovascular (12,5 y 1,4% respectivamente, p < 0,01). Durante la pandemia, 40% de los pacientes presentó positividad para COVID-19, siendo un factor predictivo de mortalidad general (razón de riesgo 2,90; intervalos de confianza 95% 1,14-7,36). Conclusiones: Durante la pandemia, hubo retrasos en tiempos de consulta y tratamiento y mayor morbimortalidad del IAM. La positividad de COVID-19 se asoció a peor sobrevida general a treinta días.

Actividad antimicrobiana de propóleos de abejas sin aguijón en combinación con ajo, Allium sativum (Amaryllidaceae) / Stingless bees propolis antimicrobial activity in combination with garlic, Allium sativum (Amaryllidaceae)

The excessive use of antibiotics has increased pathogenic microorganisms resistance, which derives in patient mortality. Therefore, the strategies for searching new natural and unconventional strategies has become constant and important. Objective: To determine the antimicrobial activity against methicillin-resistant Staphylococcus aureus (MRSA) against stingless bees propolis. Methods: We evaluated nine (20 %) propolis from stingless bees ethanolic extracts from different regions: Melipona beecheii, Melipona solani, Tetragonisca angustula and Scaptotrigona mexicana. The chemical characterization was performed by liquid chromatography (HPLC) and microbial resistance tests by the macrodilution method, to determine the effect of the combinations. Results: The compounds that were of interests and the most abundant were the following; hydroxycinnamic acids, flavanones, flavonoids and the glycosylated derivatives. Four of the nine propolis were effective against MRSA, which came from the following species; one from M. solani and three from S. mexicana. The minimum inhibitory concentration for S. mexicana was in the range of 3-8 mg mL-1 and for M. solani it was 4 mg mL-1. Isobolographic studies resulted in an additive effect (ɤ = 1) for the combination of Allium sativum with the S. mexicana propolis sambles and an antagonistic effect (ɤ > 1) for the combination of A. sativum with the propolis of M. solani. Conclusions: the combination of extracts with lower concentrations of A. sativum, may be the most effective, than those that were individually tested. More detailed studies are required to define the mechanisms of stingless bees propolis as well as their combination with other organic substances.

Introducción: El uso excesivo de antibióticos ha traído el aumento de resistencia en los microorganismos patógenos que provocan mortalidad de los pacientes. Por consiguiente, la búsqueda de nuevas estrategias naturales y no convencionales se ha vuelto constante e importante. Objetivo: Determinar la actividad antimicrobiana contra Staphylococcus aureus resistente a meticilina (SARM) de los propóleos por abejas sin aguijón. Métodos: Nueve fueron los extractos etanolicos de propóleos al 20 % de las abejas sin aguijón de distintas regiones: de Melipona beecheii, de Melipona solani, de Tetragonisca angustula y de Scaptotrigona mexicana. Se realizó la caracterización química de los compuestos por cromatografía liquida y las pruebas de resistencia microbiana por el método de macrodilución para determinar el efecto de las combinaciones. Resultados: Los compuestos de interés fueron detectados, y destacan como los más abundantes los ácidos hidroxicinámicos, flavanonas, flavonoides y sus derivados glicosilados. Cuatro de los nueve propóleos resultaron efectivos contra SARM, los cuales provinieron, uno de Melipona solani y tres de Scaptotrigona mexicana. La CMI para S. mexicana está en el rango de 3-8 mg mL-1 y para M. solani fue de 4 mg mL-1. Los estudios isobolográficos dieron como resultado un efecto aditivo (ɤ = 1) para la combinación de Allium sativum con los 3 propóleos de S. mexicana y un efecto antagónico (ɤ > 1) para la combinación de A. sativum con el propóleos de M. solani. Conclusiones: la combinación de extractos menores puede ser más efectiva que usando la CE50 de los extractos de forma individual. Se requieren estudios más detallados para definir los mecanismos de los propóleos de las abejas sin aguijón, así como su combinación con otras sustancias orgánicas.

Síndrome de Sjögren neuropsiquiátrico / Neuropsychiatrie Sjögren's Syndrome

RESUMEN El síndrome de Sjögren primario (SSp) es una enfermedad autoinmune que afecta principalmente al tejido glandular. A pesar de ello, puede involucrar otros sistemas, siendo el compromiso neuropsiquiátrico una manifestación extraglandular común. Su presentación clínica varía ampliamente según el dominio que se encuentre afectado, y por tanto puede dividirse en tres grandes categorías: sistema nervioso central, sistema nervioso periférico y psiquiátrico. Algunas de estas complicaciones comparten mecanismos fisiopatológicos comunes, entre los principales la vasculitis/vasculopatía, la infiltración linfocítica y la presencia de anticuerpos antineuronales. La diversidad en la presentación clínica de esta entidad impide hacer una aproximación diagnóstica común, por lo cual la utilización de estudios específicos depende de un adecuado reconocimiento y de la localización por parte del clínico. El tratamiento debe dirigirse al mecanismo fisiopatológico implicado y, de acuerdo con el tipo de manifestación, puede incluso estar limitado al manejo sintomático.

ABSTRACT Primary Sjögren's syndrome is an autoimmune disease that mainly involves glandular tissue. Despite this, it can potentially develop systemic involvement, within which neuropsychiatric manifestations are common. The clinical presentation may vary widely depending on the domain affected, and may thus be classified into three categories: central nervous system, peripheral nervous system, and psychiatric. Some of these complications share a common pathophysiology, amongst which are vasculitis/ vasculopathy, lymphocytic infiltration and positive antineuronal antibodies. The wide clinical presentation makes it difficult to establish a common diagnostic approach, making it essential for the clinician to recognise and localise the type of compromise, so that diagnostic tools can be more advantageously employed. Treatment must be directed towards the underlying pathophysiology, and depending on the type of compromise, it can even be limited solely to the management of symptoms.

Síndrome de Sjögren primario que debuta con polimiositis mitocondrial, neuropatía axonal y parálisis hipopotasémica: reporte de caso / Onset of primary Sjögren syndrome with mitochondrial polymyositis, axonal neuropathy, and hypokalaemic paralysis: Case report

RESUMEN El síndrome de Sjögren es una entidad multisistémica de naturaleza autoinmune, clásicamente considerada una exocrinopatía debido a la alta frecuencia de síntomas secos (queratoconjuntivitis seca, xerostomía) como resultado de infiltración poliglandular por linfocitos autorreactivos. Sin embargo, menos del 10% de estos pacientes puede iniciar con manifestaciones extraglandulares severas, traducidas en peores desenlaces a largo plazo. Se presenta el caso de una gestante que inició con síndrome de debilidad aguda proximal relacionada con miositis con enfermedad mitocondrial e hipopotasemia severa, en el contexto de acidosis tubular renal distal, como manifestación extraglandular de síndrome de Sjögren primario. Se discuten brevemente manifestaciones neurológicas de esta entidad, incluyendo aquellas secundarias a trastornos metabólicos precipitados por compromiso autoinmune.

ABSTRACT Sjögren's syndrome is a multisystemic autoimmune disorder. It is classically considered as an exocrine disease, given the high frequency of dry symptoms (keratoconjunctivitis sicca, xerostomia) as a result of poly-glandular infiltration by autoreactive lymphocytes. However, less than 10% of these patients can onset with severe extra-glandular manifestations, resulting in worse long-term outcomes. The case of a pregnant woman is presented, who debuted with acute proximal weakness syndrome related to myositis with mitochondrial pathology and severe hypokalaemia in the context of distal renal tubular acidosis, as an extra-glandular manifestation of primary Sjögren's syndrome. Neurological manifestations of this condition are briefly discussed, including those secondary to metabolic disorders precipitated by autoimmune compromise.

Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico

Background: Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology. Aim: To describe a population with MINOCA and its multi-image assessment using IVI or CMR. Material and Methods: Review of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019. Results: Twenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died. Conclusions: Among patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality.

Criterios para la construcción de un instrumento de evaluación funcional en pacientes con enfermedad cerebrovascular / Criteria for Functional Evaluation Instrument Building in Stroke Patients / Critérios para a construção de um instrumento de avaliação funcional em pacientes com enfermedad cerebrovascular

Resumen Introducción: Ninguna escala simple, por diseño, es lo suficientemente abarcadora para evaluar de forma integral la función motora de pacientes con enfermedad cerebrovascular (ECV); sin embargo, es posible la selección de una batería de ellas para controlar las distintas etapas del proceso de rehabilitación. El objetivo de este estudio fue identificar los criterios que sirven de referencia para la construcción de un instrumento de evaluación funcional en pacientes con ECV. Materiales y métodos: Se realizó una búsqueda bibliográfica en las bases de datos PubMed, Rehabilitation Measures Database, EBSCO y Medline, donde se incluyeron escalas de evaluación funcional dirigidas al control de la postura, marcha, equilibrio, tono muscular, miembros superiores e inferiores y actividades de la vida diaria. Resultados: Para la construcción de un instrumento de evaluación funcional se identificaron un total de trece criterios de referencia agrupados en: 1) criterios psicométricos y 2) criterios de diseño y aplicación. Utilizando estos criterios, se seleccionaron las escalas: Barthel Index, Action Research Arm Test, Ashworth Scale y 10 Meter Walk Test. Conclusión: Las escalas seleccionadas brindan información sobre cuatro aspectos relevantes para la evaluación funcional y la práctica terapéutica: autocuidado, función motora, tono muscular y rendimiento físico, estrechamente relacionados con las principales áreas de trabajo durante el proceso de rehabilitación en pacientes con ECV. Los recursos materiales necesarios para su aplicación son mínimos y el tiempo estimado, a partir de la integración de sus tiempos parciales, no sobrepasa los 30 minutos.

Abstract Introduction: No simple scale, by design, is comprehensive enough to comprehensively evaluate the motor function of with stroke patients; however, it is possible to select a battery of them to control the different stages of the rehabilitation process. The objective of this study was to identify the criteria that serve as a reference for the construction of a functional evaluation instrument in stroke patients. Materials and methods: A bibliographic search was conducted in the PubMed, Rehabilitation Measures Database, ebsco and Medline databases, which included functional assessment scales aimed at controlling posture, gait, balance, muscle tone, upper and lower limbs and activities daily life. Results: For construction of a functional evaluation instrument, a total of thirteen reference criteria were identified grouped into: 1) psychometric criteria and 2) design and application criteria. Using these criteria the scales were selected: Barthel Index, Action Research Arm Test, Ashworth Scale, and 10 Meter Walk Test. Conclusion: The selected scales provide information on four relevant aspects for functional evaluation and therapeutic practice: self-care, motor function, muscle tone and physical performance, closely related to main work area during the rehabilitation process in stroke patients. The material resources necessary for its application are minimal and the estimated time, from the integration of its partial times, does not exceed 30 minutes.

Resumo Introdução: Nenhuma escala simples, por concepção, é abrangente o suficiente para avaliar de forma abrangente a função motora de pacientes com doença cerebrovascular (DCV), no entanto, é possível selecionar uma bateria deles para controlar as diferentes etapas do processo de reabilitação. O objetivo deste estudo foi identificar os critérios que servem de referência para a construção de um instrumento de avaliação funcional em pacientes com DCV. Materiais e métodos: Foi realizada uma pesquisa bibliográfica nas bases de dados PubMed, Rehabilitation Measures Database, EBSCO e Medline, que incluíram escalas de avaliação funcional para controle de postura, marcha, equilíbrio, tônus muscular, membros superiores e inferiores e atividades de vida diario. Resultados: Para a construção de um instrumento de avaliação funcional, foram identificados 13 critérios de referência, agrupados em: 1) critérios psicométricos e 2) critérios de projeto e aplicação. Utilizando esses critérios, as escalas foram selecionadas: Barthel Index, Action Research Arm Test, Ashworth Scale, and 10 Meter Walk Test. Conclusão: As escalas selecionadas fornecem informações sobre quatro aspectos relevantes para avaliação funcional e prática terapêutica: autocuidado, função motora, tônus muscular e desempenho físico, intimamente relacionados à principal área de trabalho durante o processo de reabilitação em pacientes com DCV. Os recursos materiais necessários para sua aplicação são mínimos e o tempo estimado, a partir da integração de seus tempos parciais, não excede 30 minutos.

Programa de estudios para la capacitación de profesores en la plataforma Moodle / Study Program for Teacher's Training in Moodle Platform

Introducción: Se presenta una propuesta de capacitación para contribuir a que los docentes generen y actualicen sus propios cursos en la plataforma virtual de la Facultad de Odontología de La Habana. Objetivo: Diseñar un programa de estudios para el uso de la plataforma virtual Moodle. Métodos: Se realizó un diagnóstico de necesidades de aprendizaje aplicado a una muestra de profesores y se revisó la metodología del curso Entornos Virtuales de Enseñanza Aprendizaje, dirigido por la Universidad Virtual de Salud de Cuba. Resultados: La organización interna del curso se estructuró en tres temas, con carácter semipresencial y duración de 48 horas. Conclusiones: El programa está dirigido a la familiarización de los participantes con el Aula Virtual y con las generalidades de la construcción, montaje y ejecución de las diferentes modalidades de cursos que ofrece la Universidad Virtual de Salud de Cuba(AU)

Introduction: A training proposal is presented for teachers to generate and update their own virtual courses in the Dentistry Faculty of Havana. Objective: To design a study program in the use of the Moodle virtual platform. Methods: A diagnosis of learning needs applied to a sample of professors was made, and the methodology of the Virtual Learning Teaching Environments course, directed by the Virtual Health University of Cuba, was analyzed. Results: The internal organization of the course was structured in three subjects, with a blended nature and duration of 48 hours. Conclusions: The program is aimed at familiarizing participants with the Virtual Classroom and with the generalities of the construction, assembly and execution of courses in the different modalities offered by the Virtual Health University of Cuba, using Moodle platform(AU)

Stingless bee honeys from Soconusco, Chiapas: a complementary approach / Mieles de abejas sin aguijón del Soconusco, Chiapas: enfoque complementario

Abstract Stingless bees are located in the tropic areas, and produced a sweet natural substance called pot honey, with different properties and uses. Recently, most studies are focused on characterizing them, in order to contribute to their knowledge and the establishment of quality laws. Thus physicochemical, acceptance and palynological studies were performed in stingless bee honeys from Soconusco, Chiapas, in order to learn and contribute to their knowledge in the Tropics. Nine honey samples were collected from Melipona solani (Ms), M. beecheii (Mb) and Scaptotrigona mexicana (Sm) in different meliponaries. Our results registered physicochemical values that ranged as follow; pH 2.8-4.8, electrical conductivity (EC) 114-1211 μS/cm, free acidity 24-100 meq/kg, aw 59-71 g/100g, moisture 35-38 %, color 0.13-0.75 Pfund scale, reducing sugars 47-71 %, hidroxymethylfurfural (HMF) not determined - 2.72 mg/100g, and diastase activity 1.92-11.22 DN. On the other hand, the principal component analysis (PCA) of physicochemical values showed that 86.9 % of the total variability between species was explained by the following parameters aw, moisture, free acidity, color, pH, sugars and EC. Sm honeys were associated (PCA) with a higher water content, free acidity and darker colors, while Melipona honeys with a sweeter taste and a lower diastase activity; thus honeys could be grouped by genera. The acceptance test showed that 78 % of honeys were preferred, being the SmCa sample in the category "I likely dislike" due to the bitter taste (disapproved by consumers). The melisopalynological results showed that M. beecheii honeys are monofloral with a 45 % of Fabaceae pollen, while Melipona solani and Scaptotrigona mexicana honeys are multi or polyfloral with diferent pollen types; Fabaceae, Melastomataceae, Malvaceae and Asteraceae. From this complementary study we can asume that it is necessary to implicate researchers with producers, so they could have accesss to stingless bee honey analysis and to help them to improve meliponaries management by identifying and introducing stingless bee flora.(AU)

Resumen En las regiones tropicales se ubican las abejas sin aguijón, las cuales producen una sustancia dulce denominada miel de cántaro con propiedades y usos diferentes a los de las abejas melíferas (Apis mellifera). Actualmente, se han desarrollado diversos trabajos enfocados a su caracterización, con la finalidad de contribuir con su conocimiento y el establecimiento de estándares de calidad. En este estudio se realizaron estudios fisicoquímicos, de aceptación y palinológicos en mieles de abejas sin aguijón de Soconusco, Chiapas. Se recolectaron nueve muestras de miel de las siguientes especies: Melipona solani (Ms), M. beecheii (Mb) y Scaptotrigona mexicana (Sm) en diferentes meliponarios. Nuestros resultados registraron valores fisicoquímicos que variaron de la siguiente manera: pH 2.8-4.8, conductividad eléctrica (CE) 114-1 211 μS/cm, acidez libre 24-100 meq/kg, aw 59-71 g/100 g, humedad 35-38 %, color 0.13-0.75 escala Pfund, azúcares reductores 47-71 %, hidroximetilfurfural (HMF) no determinado - 2.72 mg/100 g, y actividad de la días-tasa 1.92-11.22 ND. Por otro lado, el análisis del componente principal (PCA) de los valores fisicoquímicos mostró que el 86.9 % de la variabilidad total entre las especies se explica por los siguientes parámetros: aw, humedad, acidez libre, color, pH, azúcares y CE. Las mieles de Sm (PCA) se asociaron con un mayor contenido de agua, acidez libre y colores más oscuros, mientras que las mieles de Melipona con un sabor más dulce y una actividad de días-tasa más baja; por lo tanto, las mieles podrían agruparse por géneros. La prueba de aceptación mostró que el 78 % de las mieles eran preferidas, siendo la muestra de SmCa en la categoría "Probablemente no me gusta" debido al sabor amargo (desaprobado por los consumidores). Los resultados melisopalinológicos mostraron que las mieles de M. beecheii son monoflorales con un 45 % de polen de Fabaceae, mientras que las mieles de M. solani y S. mexicana son multi o poliflorales con diferentes tipos de polen: Fabaceae, Melastomataceae, Malvaceae y Asteraceae. De este estudio complementario observamos que se requiere poner en contacto a investigadores y productores, para que el acceso a los análisis de las mieles de abejas sin aguijón sea posible, y así mismo se pueda ayudar con el mejoramiento del manejo de los melionarios al momento de identificar e introducir la flora preferida por las abejas sin aguijón.(AU)

Paquimeningitis hipertrófica. Manifestación inusual en las vasculitis anca-positivas / Hypertrophic Pachymeningitis. Unusual manifestation in vasculitis anca-positive

Introducción: La vasculitis ANCA-positiva es una patología que se caracteriza por daño en vasos de pequeño calibre secundario a auto-anticuerpos. El compromiso del sistema nervioso central es poco común, con complicaciones serias y de difícil diagnóstico. Por eso presenta-mos 3 casos de pacientes con paquimeningitis hipertrófica como manifestación neurológica de vasculitis ANCA-positiva, estudiados en el Hospital Universitario San Ignacio de Bogotá. Casos:Se tratan de dos hombres y una mujer. El hombre del primer caso presentó clínica progresiva de 1 año de evolución de dolor ocular, alteración de la agudeza visual, limitación para los movimientos oculares y disartria (Imagen 1).

Resultado de la cirugía a pacientes con tumor cerebral en Cienfuegos

Fundamento: los tumores cerebrales causan elevada mortalidad, disminución de la calidad de vida e impactan de forma negativa en la salud familiar. Objetivo: describir los resultados de las intervenciones quirúrgicas a pacientes con tumores cerebrales en Cienfuegos entre enero de 2012 y diciembre de 2015. Métodos: se realizó un estudio descriptivo de corte transversal en el Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos que abarcó el período entre enero de 2012 y diciembre de 2015. El universo estuvo constituido por 53 pacientes. Las variables estudiadas fueron: edad, sexo, antecedentes de enfermedades crónicas, antecedentes de neoplasia de otra localización, síndrome de inicio, localización anatómica según estudio imagenológico realizado, grado de citorreducción macroscópica, Escala de Karnofsky, tipo histológico del tumor, complicaciones postquirúrgicas y supervivencia a los seis meses de operados. El análisis se basó en estadísticas descriptivas e inferenciales. Resultados: existió un ligero predominio del sexo femenino sobre el masculino. El 67,9 % de los pacientes no presentó comorbilidad asociada, el 45,3 % se inició como un síndrome de hipertensión endocraneana, el 81,9 % presentó localización supratentorial y al 73,6 % se le realizó citorreducción macroscópica total del tumor. El tipo histológico más frecuente fue el astrocitoma 34 %. Hubo una supervivencia de un 60,4 % a los seis meses y solo el 6,2 % de estos tuvo una calidad de vida inferior a 70 puntos según Escala de Karnofsky. Conclusión: se asoció una mayor supervivencia al meningioma meningotelial, destacó la letalidad en astrocitomas grado IV y metástasis de pulmón. La complicación más frecuente y asociada a la mortalidad fue el empeoramiento neurológico postoperatorio.

Foundation: brain tumors cause high mortality, decrease in quality of life and impact negatively family health. Objective: to describe the results of surgical interventions to patients with brain tumors in Cienfuegos between January 2012 and December 2015. Methods: a cross-sectional descriptive study was carried out at the General University Hospital Dr. Gustavo Aldereguía Lima de Cienfuegos, covering the period between January 2012 and December 2015. The universe consisted of 53 patients. The variables studied were: age, sex, history of chronic diseases, history of neoplasia of another location, onset syndrome, anatomical location according to the imaging study performed, degree of macroscopic cytoreduction, Karnofsky scale, tumor type, postoperative complications and survival after six months of surgery. The analysis was based on descriptive and inferential statistics. Results: there was a slight predominance of females over males. 67.9 % of the patients did not present associated comorbidity, 45.3 % started as an endocranial hypertension syndrome, 81.9 % had supratentorial localization and 73.6 % had total macroscopic tumor cytoreduction. The most frequent histological type was astrocytoma 34 %. There was a 60.4 % survival at six months and only 6.2 % had a quality of life lower than 70 points according to the Karnofsky Scale. Conclusion: a greater survival was associated with meningothelial meningioma, emphasizing lethality in grade IV astrocytomas and lung metastasis. The most frequent and associated mortality complication was postoperative neurological deterioration.

The anti-caries activity and toxicity of an experimental propolis-containing varnish

Abstract We investigated the anti-caries effects of an experimental propolis varnish in vivo, and further tested its toxicity against fibroblasts. Fifty-six SPF female Wistar rats were infected with Streptococcus mutans UA159 (SM) and allocated into four groups (n = 14/group): G1, propolis varnish (15%/PV); G2, chitosan varnish (CV/vehicle); G3, gold standard (GS/Duraphat®); and G4, untreated. The animals received a single varnish application on their molars and were submitted to a high cariogenic challenge (Diet-2000, 56% sucrose, and 5% sucrose-added water, ad libitum) for 4 weeks. Total cultivable microbiota and SM were counted, and smooth-surface and sulcal caries were scored. PV, CV and GS cytotoxic effects were tested against fibroblasts. The data were analyzed using ANOVA with the Tukey-Kramer test (p ≤ 0.05). Total microbiota and SM counts did not differ among the treatments (p = 0.78), or in relation to the untreated group (p = 0.52). PV reduced development of smooth-surface enamel caries compared with the untreated group (p = 0.0018), with no significant difference from GS (p = 0.92); however, the PV effects were no longer observed when the dentin was affected. Neither PV nor GS prevented enamel sulcal lesion onset, but GS significantly reduced the severity of dentinal sulcal lesions (p < 0.0001). No significant difference was observed in fibroblast viability between PV and GS (p < 0.0001). In conclusion, PV prevented smooth-surface enamel caries and showed low cell toxicity. Nevertheless, due to the high cariogenic challenge, its effects were not sustained throughout the experiment. Further studies are encouraged to establish a protocol to sustain the long-term anti-caries activity of PV in the oral cavity.

Rivastigmina parches sola o combinada con memantina, comparada con memantina sola en pacientes con enfermedad de Alzheimer moderada y severa: revisión sistemática de la literatura / Rivastigmine patches alone or combined with memantine compared with memantine alone in patients with moderate to severe Alzheimer's disease: Systematic review of the literature

Resumen Introducción: la enfermedad de Alzheimer (EA), una condición neurodegenerativa irreversible y progresiva, es la causa más frecuente de demencia y genera una gran carga económica anual. El objetivo de este estudio fue realizar una revisión sistemática de la literatura para determinar la seguridad y eficacia de rivastigmina parche, sola o en combinación con memantina, comparadas con la memantina en monoterapia para el tratamiento de la EA moderada y severa. Métodos: se realizó una búsqueda sistemática de la literatura. Se incluyeron estudios clínicos controlados aleatorizados de pacientes con diagnóstico de EA moderada a severa, evaluando los desenlaces de eficacia y seguridad. Resultados: los resultados de los estudios experimentales que comparan dosis de rivastigmina en parche, indican una posible diferencia en algunos desenlaces de eficacia, tales como desempeño de las actividades diarias, actividades instrumentales y funcionamiento general en pacientes con EA moderada y severa, sin diferencia significativa en los desenlaces de seguridad. Se observó una tendencia a favor de la terapia combinada en algunos desenlaces como cambio en puntuación de MMSE y actividades diarias instrumentales. Discusión: la evidencia disponible apoya el uso de rivastigmina, y la combinación con memantina parece una opción terapéutica apropiada en casos seleccionados.

Summary Introduction: Alzheimer's disease (AD), an irreversible, progressive neurodegenerative condition, is the most common cause of dementia and generates a high economic burden. The aim of this study was to conduct a systematic review of the literature to determine the safety and efficacy of rivastigmine patch, alone or in combination with memantine, compared with memantine monotherapy for the treatment of moderate to severe AD. Methods: A systematic search of the literature was conducted. Including randomized controlled trials of patients diagnosed with moderate to severe AD, evaluating outcomes of effectiveness and safety. Results: The results of experimental studies comparing doses of rivastigmine patches indicate a possible difference in some of the outcomes of effectiveness such as performance in activities of daily living, instrumental activities, and overall functioning, in patients with moderate and severe AD, without significant difference in safety outcomes. A trend in favor of combination therapy in some of the outcomes, as change in MMSE score and instrumental daily activities, was observed. Discussion: The available evidence supports the use of rivastigmine, and the association with memantine seems an appropriate therapeutic option in selected cases.

Deformación sistólica longitudinal del ventrículo izquierdo en pacientes pediátricos con antecedente de enfermedad de Kawasaki / Left ventricular longitudinal systolic strain in children with history of Kawasaki disease

Resumen Objetivo La enfermedad de Kawasaki (EK) es una vasculitis sistémica cuya complicación más grave es la formación de lesiones coronarias, las cuales pueden llevar a infarto del miocardio y muerte súbita. El estudio ecocardiográfico es parte del seguimiento obligado de los pacientes con EK. La deformación sistólica longitudinal (DSL) medida mediante speckle tracking es una herramienta precisa para evaluar la función de la fibra miocárdica (longitudinal) del ventrículo izquierdo. No se ha establecido la utilidad en la práctica clínica de la DSL en niños con antecedente de EK. El objetivo de este estudio fue analizar si la presencia de lesiones coronarias condiciona alteraciones en la DSL segmentaria y su correspondencia con el territorio coronario en donde se encuentra la lesión. Método Serie de casos. Se realizó un estudio ecocardiográfico completo y la evaluación de la DSL a niños con antecedente de EK al menos 6 meses después de la fase aguda. Resultados Se estudiaron 9 pacientes. La mediana de edad fue de 6 años (mínimo 2 y máximo 17). El 56% era de sexo masculino. El 77% presentó aneurismas coronarios. La DSL resultó alterada en el 56% de la muestra estudiada. Dentro de los pacientes que presentaron una DSL anormal, todos mostraron aneurismas coronarios y lesiones estenóticas u oclusivas demostradas mediante cateterismo de arterias coronarias, además de alteraciones de la perfusión miocárdica en estudio de Medicina Nuclear. Conclusiones En la muestra estudiada, los pacientes en quienes se encontró una DSL anormal, resultaron tener lesiones coronarias que condicionaban isquemia o infarto.

Abstract Objective Kawasaki disease (KD) is a systemic vasculitis that affects young children. Coronary artery aneurisms, ectasia and stenosis are its main complications and may lead to ischemic heart disease or sudden death. Echocardiography evaluation it's mandatory in all patients with history of KD. Left ventricular longitudinal systolic strain (LVLSS) measured by speckle tracking it's an accurate tool to evaluate global and segmental left ventricle mechanics. Clinical utility of LVLSS in children with KD hasn't been established. The goal of this study was to analyse if the presence of coronary lesions alters segmental LVLSS and if there is a relationship with the affected coronary territory. Method Case series. A complete transthoracic echocardiography with LVLSS was performed in children with history of KD with at least 6 months after the acute phase. Results Nine patients where studied, with a median age of 6 years (minimum 2 and maximum 17). A percentage of 56 were male, and 77% had coronary aneurisms. An abnormal LVLSS was found in 56% of the population studied. All of the patients that had an abnormal LVLSS had coronary aneurisms with stenosis or complete occlusion confirmed by invasive coronary angiography and abnormal Nuclear Medicine perfusion scans. Conclusions On the population studied, all patients with an abnormal LVLSS had obstructive coronary lesions and ischemic heart disease.

Por una cultura de la calidad del proceso formativo en las carreras de Ciencias Médicas / Quality of the formative process in the careers of Medical Sciences

La calidad de la educación superior es un reto indispensable para la universidad en el siglo XXI; constituye la calidad educativa un reclamo constante expresado por estudiantes, profesores y por la comunidad académica a nivel internacional; para la universidad médica cubana es importante esta problemática. Con una historia que data desde 1726, la formación inicial o de pregrado en la carrera de Medicina resulta de un devenir caracterizado por referencias a la calidad, aún cuando los criterios valorativos varían con el tiempo, el avance de los conocimientos científicos y los requerimientos de la sociedad.

The quality of the superior education is an indispensable challenge for the university in the XXI century; it constitutes the educational quality a constant inducement expressed by students, professors and for the academic community at international level; for the Cuban medical university it is important this problem. With a history that dates from 1726, the initial or pre grade formation in the career of Medicine result to become characterized by references to the quality, still when the valuables approaches vary with the time, the advance of the scientific knowledge and the requirements of the society.

Effect of chlorhexidine varnish on gingival growth in orthodontic patients: a randomized prospective split-mouth study

Introduction: Fixed orthodontic appliances patients suffer limitations on the effective control of biofilm by mechanical methods, bringing the need of a coadjutant in the control of inflammation and oral health improvement.Objective: The aim of this prospective split-mouth blind study was to analyze the effect of a 40% chlorhexidine (CHX) varnish on gingival growth of patients with orthodontic fixed appliances. Methods: Healthy teenage patients with fixed orthodontic appliances and increased gingival volume were recruited (n = 30). Each individual was his own control, having in the maxilla one control side and one treatment side. An application of varnishes occurred on the vestibular area of the upper premolars and first molar crowns, on the control side (placebo varnish) and on the experimental side (EC40(r) Biodentic CHX varnish). The varnishes and sides were randomly chosen and its identification and group was kept by a third party observer and it was not revealed to the researchers and participants until the end of study. In order to establish a baseline registration, digital photographs were taken by a trained photographer before varnish application at baseline (T0), as well as 14 days (T14) and 56 days (T56) after the application. The gingival volume was calculated indirectly using the vestibular areas (mm2) of the upper second premolars' clinical crowns by RapidSketch(r) software, at all study times. The data were analyzed using ANOVA and the Turkey-Krammer test.Results:It was observed, in the final sample of 30 individuals, that at T0, the control and treatment groups were similar. At T14 and T56, a progressive reduction of the clinical crown area was seen in the control group, and an increase in the average area was detected in the experimental group (p < 0,05).Conclusions: The use of 40% CHX varnish decreases the gingival overgrowth in patients undergoing orthodontic treatment. Further studies are necessary to set the action time and frequency of application.

Introdução: pacientes com aparelhos ortodônticos fixos sofrem limitações no controle efetivo de biofilme por métodos mecânicos, trazendo a necessidade de um coadjuvante no controle na inflamação e melhora na saúde bucal.Objetivo:esse estudo cruzado prospectivo randomizado teve como objetivo analisar o efeito do verniz de clorexidina (CHX) a 40% no crescimento gengival de pacientes com aparelhos ortodônticos fixos.Métodos:indivíduos adolescentes com aparelhos ortodônticos fixos e aumento de volume gengival foram recrutados para a pesquisa (n = 30). Cada participante atuou como seu próprio controle, tendo, na maxila, um lado controle e um tratamento. No lado controle, aplicou-se verniz placebo e no lado experimental, o verniz EC40(r) Biodentic CHX, ambos na face vestibular das coroas dos pré-molares e primeiro molar superiores. Os vernizes e lados foram escolhidos de forma aleatória e a identificação deles e a que grupo pertenciam foi mantida por um terceiro observador, não sendo revelada aos pesquisadores nem aos participantes até o final do estudo. Fotografias digitais foram tiradas por um fotógrafo treinado, antes da aplicação do verniz no tempo inicial (T0), bem como 14 dias (T14) e 56 dias (T56) após a aplicação. O volume gengival foi calculado indiretamente, por meio das áreas vestibulares (mm2) das coroas dos segundos pré-molares superiores, com o softwareRapidSketch(r), em todos os tempos de estudo. Os dados foram analisados usando ANOVA e teste de Turkey-Krammer.Resultados:na amostra final de 30 indivíduos, observou-se que, em T0, os grupos controle e tratamento foram semelhantes. Já em T14 e T56, foi observada uma progressiva redução na área da coroa clínica no grupo controle, e um aumento na área média do grupo experimental (p< 0,05).Conclusão:o uso do verniz de CHX a 40% diminui o excessivo crescimento gengival em pacientes sob tratamento ortodôntico. Estudos futuros são necessários para se determinar o tempo de ação e a frequência de aplicação.

Arteria subclavia derecha aberrante en niños examinados en el Instituto Nacional de Cardiología Ignacio Chávez (1992-2012) / Aberrant right subclavian artery in children examined at the National Institute of Cardiology Ignacio Chavez (1992-2012)

Objetivos: Dentro de las malformaciones vasculares de las arterias en el tórax encontramos: 1) doble arco aórtico; 2) arco aórtico derecho y conducto arterioso izquierdo persistente; 3) arteria subclavia derecha aberrante; 4) arteria pulmonar izquierda aberrante, y 5) arteria innominada anómala. Se revisan los pacientes con arteria subclavia derecha aberrante y su manejo. Métodos: Se estudiaron en forma retrospectiva los expedientes de 29 pacientes en edad pediátrica, de enero de 1992 a diciembre 2012, con las siguientes variables: edad de inicio de los síntomas, manifestaciones clínicas, defectos cardiovasculares, método diagnóstico y abordaje quirúrgico. Resultados: El mayor número de pacientes cursó de forma asintomática, únicamente el 31% lo hizo con síntomas durante el primer año de vida, y se llevó a cabo el diagnóstico en un 35% mediante cateterismo. Fue la persistencia del conducto arterioso la cardiopatía más frecuente, con un 13%; el síndrome de Down se encontró en un 21% de los pacientes. El tratamiento más utilizado fue la sección de la arteria subclavia aberrante para la liberación del esófago. Conclusiones: Es importante la sospecha diagnóstica en pacientes con sintomatología durante la alimentación, con trastornos de la deglución con sólidos y, en algunos casos, con disfagia o hasta con dificultad respiratoria. Un número significativo de estos pacientes no son diagnosticados oportunamente, algunos alcanzan la edad adulta sin diagnóstico. El hallazgo de esta malformación ocurre durante los estudios de imagen, cuando se evalúa la aorta o en el estudio del reflujo gastroesofágico, ya que con el trago de bario se aprecia la compresión extrínseca del esófago.

Objectives: Congenital vascular malformations of the major arteries in the chest have been classified into 5 groups: 1) double aortic arch; 2) right aortic arch with left ligament or persistent ductus arteriosus; 3) aberrant subclavian artery; 4) aberrant left pulmonary artery, and 5) anomalous innominate artery. We reviewed the patients with aberrant right subclavian artery and their treatment. Methods: We studied retrospectively the records of 29 patients with aberrant right subclavian artery in childhood, from January 1992 to December 2012, analyzing the following variables: age at onset, clinical manifestations, associated cardiovascular defects, diagnosis and surgical approach method. Results: We found that most patients have an asymptomatic course, only 31% of them course with symptoms during the first year of life, with an incidental diagnosis of 35% during catheterization or other imaging studies. Patent ductus arteriosus was the most frequently associated congenital malformation, with 13%. Down's syndrome was found in 21%. The most common treatment was surgical section of the aberrant subclavian artery to release the esophagus. Conclusions: This vascular abnormality must be suspected in those patients with dysphagia, dyspnea, chest pain during feeding or breathing difficulties. A significant number of patients are not diagnosed in time, some reach adulthood without a diagnosis. This malformation is often found in imaging studies when evaluating the aorta or in a gastroesophageal reflux study, in which the barium bolus reveals the extrinsic compression of the esophagus.