Toxocariasis en edad pediátrica. Presentación de un caso / Toxocariasis in pediatric age. A case presentation

RESUMEN La toxocariasis humana es una importante zoonosis parasitaria causada por formas larvarias del toxocara, un parásito nematodo de perros y gatos. La migración de la larva por los diferentes tejidos blandos en el ser humano genera una serie de entidades clínicas, tales como: toxocariasis encubierta, el síndrome de larva migrans visceral, la toxocariasis ocular y la neurotoxocariasis. Se presenta un caso clínico de un paciente de seis años de edad, hospitalizado a consecuencia de un síndrome febril agudo asociado a dolor abdominal; cuyo examen físico, reveló signos meníngeos, fotofobia, alteraciones en el fondo de ojo y eosinofilia moderada. Teniendo en cuenta la epidemiología, el cuadro clínico y los resultados de estudios serológicos, se concluyó el diagnóstico de larva migrans ocular, para lo cual se utilizó tratamiento específico con una evolución satisfactoria. Esta entidad nosológica requiere de una adecuada valoración socio-epidemiológica de los pacientes, así como de un minucioso examen físico que, unido a las pruebas específicas permitirán el diagnóstico precoz y el tratamiento oportuno.

ABSTRACT Human toxocariasis is an important parasitic zoonosis caused by larval forms of toxocara, a nematode parasite of dogs and cats. The migration of the larva through the different soft tissues in humans generates a series of clinical entities, such as: covert toxocariasis, visceral larva migrans syndrome, ocular toxocariasis and neurotoxocariasis. The clinical case of a six-year-old patient is presented, hospitalized as a result of an acute febrile syndrome associated with abdominal pain; whose physical examination revealed meningeal signs, photophobia, fundus alterations and moderate eosinophilia. Taking into account the epidemiology, the clinical picture and the results of serological studies, the diagnosis of ocular larva migrans was concluded, for which specific treatment was used with a satisfactory evolution. This nosological entity requires an adequate socio-epidemiological assessment of the patients, as well as a thorough physical examination that, together with the specific tests, will allow early diagnosis and timely treatment.

Procedimiento de Whipple: experiencia de un centro en fase de crecimiento en cirugía hepato-bilio-pancreática / Whipple procedure: hepatic-bilio-pancreatic single center experience

La operación de Whipple es el procedimiento quirúrgico de mayor complejidad en cirugía abdominal, este se realiza en pacientes con tumores de la encrucijada pancreatoduodenal, es la única alternativa para tratamiento curativo en fases tempranas de la enfermedad. Objetivo: Determinar los resultados del procedimiento Whipple, en pacientes intervenidos con tumores de la encrucijada pancreatoduodenal en el Hospital General de Enfermedades del Instituto Guatemalteco de Seguridad Social, en el periodo de enero 2,015 a enero 2,020. Método: Descriptivo, observacional, retrospectivo. Resultados: Se incluyeron 42 procedimientos de Whipple, 29 (69%) casos del género masculino y 13 (31%) para el género femenino. La edad media fue de 61.5 años, el 54% presentaban comorbilidad asociada. El 24% utilizo transfusión transoperatoria de hemoderivados, el tiempo quirúrgico de 5.5 horas. La reintervención fue del 4.7%. Complicaciones postoperatorias tempranas 18%. La histología más común fue el carcinoma de cabeza de páncreas en el 43%. La mortalidad postoperatoria temprana fue del 4.7%. El OR de complicaciones asociadas a comorbilidades fue de 1.7 con un IC 0.3046-7.20 y un valor de P: 0.9251 que no es estadísticamente significativo. Conclusiones: Los tumores pancreatoduodenales en nuestra población se presentan en edades más tempranas a lo reportado. La morbimortalidad es similar a lo reportado en otros estudios a nivel latinoamericano, sin embargo las complicaciones están más elevadas que las mejores series internacionales. No existe asociación entre el riesgo de complicaciones con comorbilidades del paciente. (AU)

Whipple operation is the most complex surgical procedure in abdominal surgery, it's performed in patients with tumors of the pancreaticoduodenal crossroads, it is the only alternative for curative treatment in early stages of the disease. Objective: To determine the results of the Whipple procedure in patients operated on with tumors of the ancreaticoduodenal crossroads at the Hospital General de Enfermedades del IGSS in the period from January 2015 to January 2020. Method: Descriptive, observational, retrospective. Results: fourtytwo Whipple procedures were included, 29 (69%) cases of the male gender and 13 (31%) for the female gender. The mean age was 61.5 years, 54% had associated comorbidity. Twentyfour percent used intraoperative transfusion of blood products and surgical time of 5.5 hours. Reoperation was 4.7% with early postoperative complications of 18%. The most common histology was carcinoma of the head of the pancreas in 43%. Early postoperative mortality was 4.7%. The OR of complications associated with comorbidities was 1.7 with a CI 0.3046-7.20 and a P value: 0.9251, which is not statistically significant. Conclusions: Pancreaticoduodenal tumors in our population present at an earlier age than reported. Morbidity and mortality is similar to that reported in other studies. There is no association between the risk of complications with patient comorbidities. (AU)

Obstruccion intestinal por Íleo biliar: reporte de un caso / Biliary Ileus intestinal obstruction. a case report

El ileo biliar es una rara complicación de la colelitiasis no tratada. Presentamos el cuadro clínico y el manejo de un paciente masculino de 72 años (AU)

The biliary or Gallstone ileus is a rare complication of the non-treated Cholelithiasis. We present the clinical features and the treatment of a 72 years old patient

Recuento histórico de la cobertura salubrista en las áreas rurales cienfuegueras / Historical count of health coverage in rural areas of Cienfuegos

RESUMEN Se hace un breve resumen sobre la evolución de la cobertura salubrista en la zona montañosa de la provincia de Cienfuegos. Se tiene en cuenta la denuncia realizada por el Comandante en Jefe en el juicio por los hechos del cuartel Moncada y su alegato ¨La Historia me Absolverᨠdonde se aborda la situación precaria de la salud en nuestros campos y las soluciones dadas a partir del establecimiento del Programa del Servicio Médico Rural, la integración Docente Asistencial a través de los Asistenciales, del Contingente Piti Fajardo (6to año) y la creación por el propio Fidel del Programa de la Medicina Familiar y la especialidad de Medicina General Integral, con lo cual se logra la cobertura en salud. Se señala como colofón la graduación de los primeros especialistas en Medicina General Integral y Estomatología General Integral formados íntegramente en los Consultorios del macizo montañoso de nuestro Plan Turquino cienfueguero.

ABSTRACT A brief summary is made on the evolution of health coverage in the mountainous area of the province of Cienfuegos. It takes into account the complaint made by the Commander-in-Chief in the trial for the events of the Moncada barracks and his plea "History will absolve me" where the precarious situation of health in our fields is addressed and the solutions given from the establishment of the Rural Medical Service Program, the integration of Healthcare Teaching through Healthcare, the Piti Fajardo Contingent (6th year) and the creation by Fidel himself of the Family Medicine Program and the specialty of Comprehensive General Medicine, with which achieves health coverage. The graduation of the first specialists in Comprehensive General Medicine and Comprehensive General Stomatology trained entirely in the Clinics of the mountainous massif of our Cienfuegos Turquino Plan is noted as a colophon.

Percepción de los internos sobre la suspensión del internado médico durante la cuarentena por la COVID-19 / Interns' perceptions about the medical internship suspension during the COVID-19 quarantine

RESUMEN El objetivo del estudio fue describir las percepciones de los internos de medicina (IM) sobre la suspensión del internado durante la cuarentena por la COVID-19 en el Perú. Se realizó un estudio descriptivo transversal mediante una encuesta virtual sobre la percepción de la suspensión del internado, las condiciones de retorno y las actividades académicas durante la cuarentena. Participaron en el estudio 353IM, el 54,9% estuvo de acuerdo o totalmente de acuerdo con retornar a sus sedes hospitalarias si se garantizaban las medidas de bioseguridad; más del 90% sentía incertidumbre sobre la fecha de reinicio y el fin de internado, y el 85,6% participaba de clases virtuales académicas. Se concluye que la intención de volver al internado aumenta cuando se garantizan las medidas de bioseguridad. Las sedes hospitalarias deberían garantizar estas medidas y la cobertura de salud de los IM si se propone su retorno a los hospitales.

ABSTRACT The objective of the study was to describe the medical interns' (MI) perceptions about the internship suspension during the COVID-19 quarantine in Peru. A cross-sectional descriptive study was conducted by means of a virtual survey regarding the perception of the internship suspension, return conditions and academic activities during quarantine. A total of 353 MIs participated in the study; 54.9% agreed or totally agreed with returning to their hospital sites if biosecurity measures were guaranteed, more than 90% felt uncertain about the restart and end dates, and 85.6% participated in academic virtual classes. It is concluded that the intention to return to the hospital increases when biosecurity measures are guaranteed. Hospitals should guarantee these measures and ensure health coverage for the MIs, if their return to hospitals is intended.

Possible association between dysnatremias and mortality during hospitalization in patients undergoing acute hemodialysis: analysis from a Peruvian retrospective cohort / Possível associação entre distúrbios do sódio e mortalidade hospitalar em pacientes submetidos a hemodiálise aguda: análise de uma coorte retrospectiva peruana

Abstract Objective: To evaluate the association between dysnatremias or dyschloremias and mortality during hospitalization in patients with acute kidney injury (AKI) or chronic kidney disease (CKD) undergoing acute hemodialysis. Methods: We carried out a retrospective cohort study on adult patients undergoing acute hemodialysis with AKI or CKD diagnosis at a public hospital in Lima, Peru. Dysnatremias were categorized as hyponatremia (Na < 135mmol/L) or hypernatremia (Na > 145mmol/L), and dyschloremias were defined as hypochloremia (Cl < 98 mmol/L) or hyperchloremia (Cl > 109mmol/L). The outcome of interest was mortality during hospitalization. We performed generalized lineal Poisson family models with bias-corrected and accelerated non-parametric bootstrap to estimate the risk ratios at crude (RR) and adjusted analysis (aRR) by gender, age, HCO3 (for all patients) and Liaño score (only for AKI) with CI95%. Results: We included 263 patients (mean age: 54.3 years, females: 43%): 191 with CKD and 72 with AKI. Mortality was higher in patients with AKI (59.7%) than in patients with CKD (14.1%). In overall, patients with hypernatremia had a higher mortality during hospitalization compared to those who had normal sodium values (aRR: 1.82, 95% CI: 1.17-2.83); patients with hyponatremia did not have different mortality (aRR: 0.19, 95% CI: 0.69-2.04). We also found that hyperchloremia (aRR: 1.35, 95% CI: 0.83-2.18) or hypochloremia (aRR: 0.66, 95% CI: 0.30-14.78) did not increase mortality in comparison to normal chloride values. No association between dysnatremias or dyschloremias and mortality during hospitalization was found in CKD and AKI subgroups. Conclusions: In our exploratory analysis, only hypernatremia was associated with mortality during hospitalization among patients with AKI or CKD undergoing acute hemodialysis.

Resumo Objetivo: Avaliar a associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar de pacientes com insuficiência renal aguda (IRA) ou doença renal crônica (DRC) submetidos a hemodiálise aguda. Métodos: O presente estudo de coorte retrospectiva incluiu pacientes adultos submetidos a hemodiálise aguda com diagnóstico de IRA ou DRC em um hospital público de Lima, Peru. Os distúrbios do sódio foram classificados como hiponatremia (Na < 135mmol/L) ou hipernatremia (Na > 145mmol/L), enquanto os distúrbios do cloro foram classificados como hipocloremia (Cl < 98 mmol/L) ou hipercloremia (Cl > 109mmol/L). O desfecho de interesse foi mortalidade hospitalar. Utilizamos modelos de Poisson da família de modelos lineares generalizados com bootstrap não-paramétrico e correção de viés acelerado para estimar os riscos relativos na análise bruta (RR) e ajustada (RRa) para sexo, idade, HCO3 (para todos os pacientes) e escore de Liaño (apenas para IRA) com IC 95%. Resultados: Foram incluídos 263 pacientes (idade média 54,3 anos; 43% do sexo feminino), 191 com DRC e 72 com IRA. A mortalidade foi mais elevada nos pacientes com IRA (59,7%) do que nos indivíduos com DRC (14,1%). No geral, os pacientes com hipernatremia tiveram mortalidade hospitalar mais elevada do que os indivíduos com valores normais de sódio (RRa: 1,82; IC 95%: 1,17-2,83). Os pacientes com hiponatremia não apresentaram mortalidade diferente (RRa: 0,19; IC 95%: 0,69-2,04). Também identificamos que hipercloremia (RRa: 1,35; IC 95%: 0,83-2,18) e hipocloremia (RRa: 0,66; IC 95%: 0,30-14,78) não elevaram a mortalidade em comparação a indivíduos com níveis normais de cloro. Não foi encontrada associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar nos subgrupos com DRC e IRA. Conclusões: Em nossa análise exploratória, apenas hipernatremia apresentou associação com mortalidade hospitalar em pacientes com IRA ou DRC submetidos a hemodiálise aguda.

Factores asociados a la homofobia en estudiantes de Medicina de once universidades peruanas / Factors associated with homophobia in medical students from eleven Peruvian universities

RESUMEN Introducción: Las consecuencias de la homofobia pueden afectar a la integridad y la salud mental y física de los individuos homosexuales en la sociedad. En Perú hay escasos estudios que hayan evaluado la homofobia en la población médico-estudiantil. Objetivo: Determinar los factores sociales, educativos y culturales asociados con la homofobia entre estudiantes de Medicina peruanos. Métodos: Se realizó un estudio de tipo transversal analítico en 12 sedes de Medicina humana peruanas. Se definió homofobia según un test validado, que se asoció con otras variables. Se obtuvieron estadísticos de asociación. Resultados: Las 4 universidades de Lima obtuvieron menores porcentajes de alumnos homofóbicos (15-20%) que las universidades del interior del país (22-62%). Al realizar el análisis multivariable, disminuyeron la frecuencia de homofobia: ser mujer (RPa = 0,74; IC95%, 0,610,92; p = 0,005), estudiar en una universidad de Lima (RPa = 0,57; IC95%, 0,43-0,75; p < 0,001), profesar la religión católica (RPa = 0,53; IC95%, 0,37-0,76; p < 0,001), conocer a un homosexual (RPa = 0,73; IC95%, 0,60-0,90; p = 0,003) y haber atendido a un paciente homosexual (RPa = 0,76; IC95%, 0,59-0,98; p = 0,036); en cambio, ser machista aumentó la frecuencia de homofobia (RPa = 1,37; IC95%, 1,09-1,72; p = 0,007), ajustado por 4 variables. Conclusiones: La homofobia fue menos frecuente entre las mujeres, los que estudiaban en la capital, los que profesan el catolicismo y los que conocen/han atendido a un homosexual; por el contrario, los machistas fueron más homofóbicos.

ABSTRACT Background: The consequences of homophobia can affect the integrity, mental and physical health of homosexual individuals in society. There are few studies in Peru that have evaluated homophobia in the medical student population. Objective: To establish the social, educational and cultural factors associated with homophobia among Peruvian medical students. Methods: A cross-sectional analytical study was conducted in 12 medicine schools in Peru. Homophobia was defined according to a validated test, which was associated with other variables. Statistical associations were identified. Results: The lowest percentages of homophobic students (15-20%) were found in the four universities in Lima, while universities in the interior of the country had the highest percentages (22-62%). Performing a multivariate analysis, we found that the frequency of homophobia was lower for the following variables: the female gender (PRa=0.74; 95% CI, 0.61-0.92; p=0.005), studying at a university in Lima (PRa=0.57; 95% CI, 0.43-0.75; p<0.001), professing the Catholic religion (PRa=0.53; 95% CI, 0.37-0.76;p<0.001), knowing a homosexual (PRa=0.73; 95% CI, 0.60-0.90; p=0.003) and having treated a homosexual patient (PRa=0.76; 95% CI, 0.59-0.98; p=0.036). In contrast, the frequency of homophobia increased in male chauvinists (PRa=1.37; 95% CI, 1.09-1.72; p=0.007), adjusted by four variables. Conclusions: Homophobia was less common in women, in those who study in the capital, those who profess Catholicism and those who know/have treated a homosexual. In contrast, male chauvinists were more homophobic.

Efecto del entrenamiento de la musculatura inspiratoria con válvula umbral sobre la capacidad funcional en mujeres físicamente activas mayores de 60 años / Effect of inspiratory muscle training with threshold valve on functional capacity of physically active women who are older than 60 years of age

Resumen Introducción: Los cambios fisiológicos asociados al envejecimiento generan una serie de modificaciones funcionales, destacando una disminución en la capacidad respiratoria. En este sentido, una estrategia alternativa para mejorar tal condición podría ser el entrenamiento de la musculatura inspiratoria (EMI). Objetivo: Analizar el efecto del EMI con válvula umbral, sobre la capacidad funcional en mujeres físicamente activas mayores de 60 años. Materiales y métodos: Se realizó un EMI con válvula umbral durante 4 semanas, sobre un grupo experimental (GE; n:10), contrastado con un grupo control (GC; n:5). Se valoraron las siguientes variables hemodinámicas y antropométricas: peso, talla, índice de masa corporal (IMC), lactato, doble producto y capacidad funcional, analizando los cambios pre y post entrenamiento. Resultados: en el grupo GE disminuye post intervención la concentración de lactato y la escala de percepción del esfuerzo; 3,16±0,51 a 2,5±0,39 y 5,56 ± 1,81 a 4±2, respectivamente. En el mismo grupo se incrementan los valores de presión inspiratoria máxima (Pimáx) post intervención; 42,11±14,57 a 60,44±14,47. El GC no presentó cambios en sus valores. Conclusión: No se evidencian cambios favorables en los metros recorridos post intervención, sin embargo, el EMI mostró una disminución sobre la concentración de lactato post ejercicio, lo que podría identificar un retraso en la aparición de la fatiga.

Abstract Introduction: Physiological changes associated with aging generate a series of functional modifications, mainly a decrease in respiratory capacity. In this regard, an alternative strategy to improve such a condition could be inspiratory muscle training (IMT). Objective: To analyze the effect of IMT with threshold valve on the functional capacity of physically active women who are older than 60 years of age. Materials and methods: IMT with threshold valve was carried out over a period of 4 weeks, comparing data from the experimental group (GE; n:10) to the control group (GC; n:5). The following hemodynamic and anthropometric variables were assessed: weight, height, body mass index (BMI), lactate, double product (DP) and functional capacity. Pre and post training changes were evaluated. Results: The GE group showed a decrease in both post-intervention lactate concentration (from 3.16±0.51 to 2.5±0.39) and effort perception scale (from 5.56 ± 1.81 to 4±2). On the other hand, this group experienced a post-intervention increase in maximal inspiratory pressure (MIP) from 42.11±14.57 to 60.44±14.47. The GC group did not present changes in its values. Conclusion: Although no evidence was found regarding favorable changes in the walked distance post-intervention, IMT induced a reduction in post-exercise lactate concentration, which could indicate a delay of onset of fatigue.

Responsabilidad social de la universidad cubana en la formación de médicos bolivianos

Como parte de la política de trabajo en las Universidades de Ciencias Médicas cubanas está la formación de estudiantes extranjeros, que responde tanto a intereses por convenios entre países como individuales a través del autofinanciamiento. La Universidad de Ciencias Médicas de Cienfuegos ha graduado más de 2400 jóvenes de 69 países del mundo en sus más de 30 años de formación; entre ellos se encuentran los graduados bolivianos. A más de una década del arribo de jóvenes bolivianos a Cienfuegos y como parte del cumplimiento de la colaboración médica en la República de Bolivia, de quienes fueron sus dirigentes y profesores, este trabajo plantea valorar la consolidación de la formación en Cuba para médicos bolivianos desde sus perfiles de ubicación laboral actuales según diferentes programas de salud en los que se desempeñan. Para cumplimentar este objetivo se realizaron entrevistas con graduados, se participó de conjunto en actividades científicas de la Brigada Médica Cubana, en un curso nacional de posgrado y se realizaron algunas valoraciones en sus puestos laborales actuales.

Part of the policy of the Cuban Medical Universities is the formation of foreign students which meet the requirements of agreements between countries or by self-financing. The University of Medical Sciences has graduated more than 2400 young doctors of 69 countries in its more than thirty years of formation programs, among them Bolivians. At more than a decade of the Bolivian youngsters to Cienfuegos and as part of the fulfillment of the medical collaboration in The Republic of Bolivia, of those who were their teachers and leaders, this work states to value the consolidation of the formation in Cuba for Bolivian doctors from their working profiles according to the different health programs they develop. To comply with this objective, interviews to graduates were realized, there were scientific events together with the Cuban Medical Brigade, in a National postgraduate course and an assessment of their present working positions was done.

As avaliações longitudinais de cinco anos em próteses cerâmicas totais fixas implantossuportadas são escassas na literatura: uma revisão sistemática / Five-year longitudinal evaluations on implant-supported total fi xed ceramic prostheses are scarce in the literature: a systematic review

Objetivo: a objetivo desta revisão sistemática foi avaliar estudos clínicos e as taxas de sucesso e complicações protéticas das próteses fixas totais cerâmicas implantossuportadas em pacientes totalmente desdentados, após um período de acompanhamento mínimo de 5 anos. Material e métodos: a pesquisa bibliográfica foi realizada usando as bases de dados eletrônicas Medline/PubMed, entre 1980 a 2015, para estudos clínicos em língua inglesa relatando as complicações protéticas e implantares. Os termos de pesquisa que foram utilizados, isoladamente ou em combinação foram implant-supported restoration, prosthodontic complications, technical complications, mechanical complications, dental implants, screw complications, edentulous arch, metal framework fracture, restoration, acrylic veneer fracture, ceramic veneer fracture, biologic complications e edentulous arch. Resultados: dos 181 artigos recuperados, apenas três estudos cumpriram os critérios de inclusão para esta revisão, sendo três estudos prospectivos. As complicações biológicas e técnicas em implantes e próteses foram identificadas e registradas, incluindo: fraturas dos materiais de suporte da estrutura/recobrimento, soltura do parafuso da prótese e/ou parafuso do pilar, fratura do parafuso protético e/ou parafuso do pilar, deficiências estéticas e desgaste do material. Conclusão: dentro dos limites desta revisão sistemática, os estudos sobre materiais cerâmicos com cinco anos ou mais de acompanhamento são escassos ou inexistentes sugerindo cautela na utilização desse tipo de restauração implantossuportada.

Objective: the objective of this systematic review was to access the clinical studies and as success rates and prosthetic complications of total fi xed ceramic prostheses implanted in fully edentulous patients after a minimum follow-up period of 5 years. Material and methods: a literature search was conducted using Medline/PubMed electronic databases from 1980 to 2015 for English-language clinical studies reporting as prosthetic and implant complications. "Technical complications", "mechanical complications", "dental implants", "screw complications", "edentulous arch", "technical complications", "technical complications". "Fracture of metal structure", "restoration", "acrylic veneer fracture", "ceramic veneer fracture", "biological complications" and "edentulous arch". Results: from the 181 articles retrieved, only 3 studies fullfi lled the inclusion criteria for this review, being prospective studies. Such biological and technical complications in implants and prostheses were identifi ed and recorded, including: structure/veneering material fractures, prosthetic screw loosening and/or abutment screw, prosthetic and/or abutment screw fracture, defi cient esthetics, and material wear. Conclusion: within the limits of this systematic review, studies on ceramic materials with 5 years of follow-up are scarce or non-existent suggesting caution in the use of this type of implant-supported restoration.

Agenesia congénita de clítoris y labios menores en una niña de 8 años / Congenital agensis of clitoris and labia minora in 8-year-old girl

Resumen Antecedentes: La agenesia congénita del clítoris y los labios menores es una malformación poco común y los casos clínicos reportados en la bibliografía son escasos. Caso clínico: Paciente de ocho años llevada al pediatra por probable infección de vías urinarias por leucocituria. Le prescribieron un antibiótico y debido a que persistió la leucocituria le revisaron los genitales externos que se encontraron con enrojecimiento de los labios mayores y del vestíbulo vaginal, con leucorrea, sin clítoris ni labios menores. Conclusiones: Se trata de un caso de agenesia congénita de clítoris y labios menores que se suma a los escasos reportes de esta malformación.

Abstract Background: Congenital agenesis of clitoris and labia minora is a rare malformation, and clinical cases reported in the medical literature are scares. Clinical case: Female from 8 years of age, with suspicion of urinary tract infection by leucocyturia, before the failure of treatment with antibiotic and persistence of the leukocyturia, the external genital review, finding redness of labia majora and the vaginal vestibule and leukorrhea, but there no clitoris or labia minora. Conclusions: This clinical case of congenital and labia minora, joins the few scientific reports of malformation. Embryological review of how this anomaly is carried out is done.

Artes marciais mistas: luta por afirmação e mercado da luta / Mixed martial arts: fighting for statement and market of the fight / Artes marciales mixtas: lucha por la afirmación y mercado de la lucha

Resumo O artigo analisa o processo de construção das artes marciais mistas (MMA), descreve parte da história do valetudo no Brasil, de sua internacionalização, e identifica as marcas de ruptura entre o valetudo e o MMA. Foram consideradas como características próprias da transição do valetudo para o MMA: a profissionalização da categoria; a aceitação pelos veículos de comunicação; o acirramento do controle do corpo e dos códigos de moralidade no ethos dos lutadores; a criação de um novo produto para o mercado da luta; o deslocamento identitário dos lutadores, de representantes de determinada luta para lutadores de MMA.

Abstract This paper analyses the process of construction of Mixed Martial Arts (MMA). Describes part of the history of "valetudo" in Brazil, its internationalization and identifies the split between "valetudo" and MMA. Own characteristics considered as the transition from "valetudo" to MMA: the professional category; acceptance by media; the tightening of body control and codes of morality in the fighters' ethos; the creation of a new product to fight market; displacement identity of the "valetudo" fighters to MMA fighters.

Resumen El artículo analiza el proceso de construcción de las artes marciales mixtas (MMA). Describe parte de la historia del valetudo en Brasil, de su internacionalización e identifica la diferencia entre el valetudo y las MMA. Se consideraron como características propias de la transición del valetudo para las MMA: la profesionalización de la categoría; la aceptación por parte de los medios de comunicación; el refinamiento del control del cuerpo y del código moral en el ethos de los luchadores; la creación de un nuevo producto para el mercado de la lucha; el cambio identitario de los luchadores, de representantes de determinada lucha a luchadores de MMA.

A luta livre no século XX no Rio de Janeiro / Wrestling in the 20th century in Rio de Janeiro / La lucha libre en el siglo XX en Rio de Janeiro

Este estudo tem como objetivo analisar a trajetória da luta livre no Rio de Janeiro no século passado. Os dados provêm de quatro entrevistas com protagonistas dessa luta, com idades entre 46 e 78 anos e de revistas de lutas. Trabalhando com memória e história oral, verificamos que a luta livre carioca se aprimorou por movimento interno e através da hibridização com outras modalidades de combate, rumo à esportivização. A análise permitiu concluir que a luta livre afirmou e reconstruiu sua identidade em confronto com o jiu-jítsu.

This study aims at analyzing the history of wrestling in Rio de Janeiro during the last century. The data come from four interviews with practitioners aged 46-78. Working with memory and oral history, we found that wrestling in the city developed and improved by hybridizing with other forms of combat, pointing towards sportivization. The analysis allowed us to conclude that wrestling asserted its identity in opposition to jiu jitsu.

Este estudio tiene como objetivo analizar la trayectoria de la lucha libre en Rio de Janeiro, en el siglo pasado. Los datos provienen de cuatro entrevistas con protagonistas de esa lucha, con edades entre 46 y 78 años. Trabajando con memoria e historia oral, constatamos que la lucha libre en Rio de Janeiro fue mejorada por un movimiento interno a través de la hibridación con otras modalidades de combate. El análisis permitió concluir que la lucha libre confirmó y reconstruyó su identidad, en confronto con otras con el jiu jitsu.

Low-concentrated nonvital bleaching effect on bond strength of composite resin restorations / Efeito de clareadores não-vitais pouco concentrados sobre a força de cisalhamento de restaurações de resina composta

Objective: To investigate if short-term dentin bleaching with low-concentrated substances affects the bond strength of immediate resin composite restorations. Material and Methods: The buccal surfaces of fifty molar crowns were ground for dentin exposure and randomly assigned into 5 groups (n=10), according to the following treatments: sodium perborate + water; sodium perborate + 6% hydrogen peroxide; 6% hydrogen peroxide; 35% hydrogen peroxide (positive control), or no bleaching agent (negative control). The specimens were immediately restored with resin composite. Seven days after treatments, the shear bond test was performed in a universal test machine at a crosshead speed of 0.5 mm/min. Data were analyzed using ANOVA and Tukey’s HSD test (α = 0.05). Results: The shear bond strength mean values for the negative control group were higher than all experimental and positive control groups (p < 0.000), whose differences were not statistically significant (p > 0.05). Conclusion: Short-term dentin bleaching with sodium perborate+water, 6% hydrogen peroxide, or sodium perborate mixed with 6% hydrogen peroxide reduced the shear bond strength of immediate resin composite restorations.

Objetivo: Investigar se o clareamento rápido da dentina com substâncias de baixa concentração afeta a resistência de união ao cisalhamento de restaurações imediatas de resina composta. Material e Métodos: As superfícies vestibulares de cinquenta molares foram desgastadas para exposição da dentina e então aleatoriamente alocadas em 5 grupos (n = 10), de acordo com as substâncias clareadoras: perborato de sódio + água; perborato de sódio + peróxido de hidrogênio a 6%; peróxido de hidrogênio a 6%; peróxido de hidrogênio a 35% (controle positivo); ou nenhum agente clareador (controle negativo). Os espécimes foram imediatamente restaurados com resina composta. Sete dias após os tratamentos, testes de resistência ao cisalhamento foram realizados em uma máquina de ensaios universal a uma velocidade de cruzeta de 0,5 mm/min. Os dados foram analisados com os testes ANOVA e Tukey HSD (α = 0,05). Resultados: Os valores de resistência ao cisalhamento do grupo controle negativo foram maiores do que os dos grupos experimentais e controle positivo (p < 0,001), cujas diferenças não foram estatisticamente significativa (p > 0,05). Conclusão: Clareamentos dentinários rápidos com perborato de sódio, peróxido de hidrogênio 6% ou perborato de sódio misturado com peróxido de hidrogênio 6% reduziram a força de resistência ao cisalhamento de restaurações imediatas de resina composta.

Factores predictivos relacionados con la aparición y el pronóstico visual de la endoftalmitis traumática / Predictive factors related to the occurrence and visual prognosis of traumatic endophthalmitis

Objetivo: determinar los factores predictivos relacionados con la aparición y el pronóstico visual de la endoftalmitis traumática. Métodos: se realizó un estudio longitudinal de serie de casos durante dos años, en 191 pacientes con trauma ocular a globo abierto severo. Se realizó interrogatorio, examen físico oftalmológico completo, refracción dinámica y en caso necesario ultrasonido ocular, radiografía y/o tomografía axial computarizada. Resultados: la prevalencia de endoftalmitis traumática se presentó en el 12,04 por ciento de los pacientes. La media de la edad fue 40,87 ± 14,25 con rango de 16-70 años, con predominio del sexo masculino (95,65 por ciento) y ojo derecho (69,57 por ciento). El análisis univariado de factores de riesgo de endoftalmitis traumática mostró significación estadística para ambiente (p= 0,052), presencia de cuerpo extraño intraocular (p= 0,069), disrupción cristalineana (p< 0,0001), tamaño de la herida (p< 0,0001)y reparación primaria de la herida (p< 0,0001). En el 26 por ciento de los pacientes con heridas autosellantes se decidió suturar, y todos los que tenían heridas autosellantes y desarrollaron endoftalmitis se encontraban dentro de las no suturadas. En el análisis univariado de factores de riesgo para el pronóstico visual de endoftalmitis traumática resultaron estadísticamente significativos: desprendimiento de retina (p=0,059), tamaño de la herida (p= 0,058) y uso de antibiótico sistémico (p= 0,004). Conclusiones: en el enfrentamiento del paciente con trauma ocular a globo abierto es esencial la profilaxis de endoftalmitis traumática, con seguimiento estricto del paciente. Puede ser aconsejable antibiótico sistémico, y constituye pilar importante la individualización mediante identificación de factores de riesgo que justifica la administración de antibiótico intravitreo(AU)

Objective: to determine predictive factors related with the occurrence and the visual prognosis of traumatic endophthalmitis. Methods: longitudinal case series study of 191 patients with severe open globe trauma conducted in two years. The patients answered a questionnaire, underwent complete physical ophthalmological exam and dynamic refraction, and if necessary, ocular ultrasound, x-and/or computed tomography scanning were applied. Results: prevalence of traumatic endophthalmitis was 12,04 percent. Mean age was 40,87 ± 14,25 (range of 16-70 year years). Males (95,65 percent) and the right eye (69,57 percent) predominated. The risk factor analysis related with traumatic endophthalmitis showed statistical significance for environment (p= 0,052), presence of intraocular foreign body (p= 0,069), rupture of the lens (p< 0,0001), wound size (p< 0,0001) and primary wound repair (p< 0,0001). Twenty six percent of patients with spontaneous closing wounds were sutured. All the patients with spontaneous closing wounds, who developed endophthalmitis, were in the non-sutured group. Retinal detachment (p= 0,059), wound size (p= 0,058) and systemic antibiotic use (p= 0,004) were statistically significant factors for the visual prognosis. Conclusions: in the management of patients with ocular open globe trauma, it is essential to prevent traumatic endophthalmitis, with strict follow-up of the patient. It may be advisable to administer systemic antibiotic, and another important pillar will be the individualization of treatment through identifying the risk factors supporting the administration of an intravitreal antibiotic(AU)

Analysis of the reaction of subcutaneous tissues in rats and the antimicrobial activity of calcium hydroxide paste used in association with different substances

The aim of this study was to evaluate the subcutaneous tissue response in rats and the antimicrobial activity of intracanal calcium hydroxide dressings mixed with different substances against E. faecalis. Fifty four rats were divided into three experimental groups according to the vehicle in the calcium hydroxide treatment: 0.4% chlorohexidine in propylene glycol (PG),Casearia sylvestris Sw in PG and calcium hydroxide+PG (control group). The pastes were placed into polyethylene tubes and implanted into the subcutaneous tissue. After 7, 14 and 30 days, the samples were processed and histologically evaluated (hematoxylin and eosin). The tissue surface in contact with the material was analyzed, and the quantitative analysis determined the volume density occupied by the inflammatory infiltrate (giant cells, polymorphonuclear cells and mononuclear cells), fibroblasts, collagen fibers and blood vessels. For the antimicrobial analysis, 20 dentin blocks infected with E. faecalis were treated with calcium hydroxide pastes in different vehicles; 0.4% chlorhexidine in PG, PG, extract fromCasearia sylvestris Sw in PG and a positive control (infection and without medication) for 7 days. The efficiency of the pastes was evaluated by the live/dead technique and confocal microscopy. The results showed that 0.4% chlorhexidine induced a higher inflammatory response than the other groups. The Casearia sylvestris Sw extract showed satisfactory results in relation to the intensity of the inflammatory response. In the microbiological test, there were no statistical differences between the evaluated intracanal dressings and the percentage of bacterial viability was between 33 and 42%. The control group showed an 86% viability. Antimicrobial components such as chlorhexidine or Casearia sylvestris Sw did not improve the antimicrobial activity against E. faecalis in comparison to the calcium hydroxide+PG treatment. In addition, the incorporation of chlorhexidine in the calcium hydroxide paste promoted the highest inflammatory response.

Reconstrução de dentes para o tratamento endodôntico / Teeth reconstruction for endodontic treatment

O isolamento do campo operatório com o dique de borracha é fundamental para o tratamento endodôntico, porém alguns dentes se apresentam com grande destruição coronária, dificultando ou mesmo impedindo sua colocação. A reconstrução da coroa dentária por meio de resina fotoativada é um procedimento fácil de ser realizado e que, além de reforçar a coroa do dente, propicia maior facilidade para fazer o isolamento do mesmo. Este artigo descreve a técnica para a reconstrução da coroa dental, para isolamento do campo operatório com dique de borracha.

The use of rubber dam is vital for endodontic treatment, however some teeth present themselves with large coronary destruction hindering or even preventing the placement of the rubber dam. The reconstruction of dental crown using light-activated resin is a procedure that in addition to strengthening the crown of the tooth facilitates posterior isolation of the tooth. This article describes a technique for reconstruction of dental crown with the purpose of facilitating the use of rubber dam.

La pubertad en niños chilenos muestra un adelantamiento en el inicio del crecimiento testicular / Age of onset of puberty in Chilean boys according to testicular volume and Tanner stage

Background: A secular trend towards a younger age of puberty onset has been reported in Chilean girls. Aim: To evaluate the age of onset of puberty and prevalence of early puberty in Chilean boys. Material and Methods: A pediatric endocrinologist examined 319 children attending schools in central Santiago. Pubertal development was assessed by testicular volume (TV) and genital inspection (GI) using Tanner graduation. Precocious and early puberty development was diagnosed if TV ≥ 4 ml or GI > stage 2 occurred in boys younger than 9 years and at 9-10 years of age, respectively. Results: Pubertal onset occurred at 10.2 ± 1.5 years according to TV and at 11.1 ± 1.6 years according to GI (p < 0.01). Before the age of nine, 15.2% of children had a VT ≥ 4 ml, 3% had genital changes in GI and only 3% had both changes simultaneously. Early puberty was observed in 23.8% of children according to TV and 9.5% according to GI. However, no child of less than 11 years old had a TV ≥ 4 ml, genital changes and pubic hair simultaneously. Late pubertal stages occurred at the same age according to both criteria used. Body mass index z score was not associated with the age of pubertal onset. Conclusions: Testicular enlargement occurs one year earlier than changes in genitalia according to inspection. Testicular growth, but not late stages of puberty, are occurring one year earlier than previously reported in Chile 10 years ago.

Rat subcutaneous tissue response to calcium silicate containing different arsenic concentrations

Objective: To evaluate the response of rat subcutaneous tissue in implanted polyethylene tubes that were filled with GMTA Angelus and Portland cements containing different arsenic concentrations. Material and Methods: Atomic absorption spectrophotometry was utilized to obtain the values of the arsenic concentration in the materials. Thirty-six rats were divided into 3 groups of 12 animals for each experimental period. Each animal received two implants of polyethylene tubes filled with different test cements and the lateral of the tubes was used as a control group. After 15, 30 and 60 days of implantation, the animals were killed and the specimens were prepared for descriptive and morphometric analysis considering: inflammatory cells, collagen fibers, fibroblasts, blood vessels and other components. The results were analyzed utilizing the Kuskal-Wallis test and the Dunn's Multiple test for comparison (p<0.05). Results: The materials showed, according to atomic absorption spectrophotometry, the following doses of arsenic: GMTA Angelus: 5.01 mg/kg, WPC Irajazinho: 0.69 mg/kg, GPC Minetti: 18.46 mg/kg and GPC Votoran: 10.76 mg/kg. In a 60-day periods, all specimens displayed a neoformation of connective tissue with a structure of fibrocellular aspect (capsule). Control groups and MTA Angelus produced the lower amount of inflammatory reaction and GPC Minetti, the highest reaction. Conclusions: There was no direct relationship between the concentration of arsenic present in the composition of the materials and the intensity of the inflammatory reactions. Higher values, as 18.46 mg/kg of arsenic in the cement, produce characteristics of severe inflammation reaction at the 60-day period. The best results were found in MTA angelus. .

Regeneração óssea em alvéolos de ratos após enxerto de osso bovino inorgânico medular e biocerâmica sintética densa / Alveolar bone regeneration in rats after grafting of anorganic bovine bone and thick synthetic bioceramic

Introdução: é incerto se o uso de biomateriais em cirurgiasparendodônticas é capaz de facilitar ou induziro processo de regeneração óssea. Esse estudo analisou,comparativamente, os efeitos do preenchimento de alvéolosde ratos com osso bovino inorgânico medular euma biocerâmica sintética densa no processo de regeneraçãoóssea. Material: Quarenta e oito ratos albinosWistar foram distribuídos, aleatoriamente, em três grupos,que, após a extração dentária, tiveram os alvéolos preenchidosda seguinte forma: GI (n = 12) coágulo (controle);GII (n = 18) osso bovino inorgânico medular; GIII (n = 18)biocerâmica sintética densa. As amostras foram obtidasem 7, 15 e 30 dias pós-cirurgia. Foram realizadas análisesmicroscópicas quantitativas do infiltrado inflamató-rio, densidade fibroblástica, densidade angioblástica eneoformação óssea. Os dados foram submetidos ao testede Kruskal-Wallis (α < 0,05) para detectar diferenças entreos grupos no mesmo intervalo de tempo. Resultados:apesar de terem sido detectadas algumas diferenças entreos grupos experimentais e o controle para infiltrado inflamatórioe densidade angioblástica em 07 dias, e formaçãoóssea em 15 dias, no período de 30 dias o processo de reparofoi semelhante para todos os grupos. Conclusões:não houve diferença entre os dois materiais empregados,os quais não atrasaram o processo de regeneração óssea,e, se usados em cirurgias parendodônticas, podem atuarcomo materiais osteocondutores e osteopreenchedoresnos grandes defeitos ósseos.