Miositis aguda asociada a infección por virus influenza. Serie de casos en un hospital pediátrico

La miositis aguda benigna asociada a influenza es una complicación esporádica. En Argentina, en el año 2022, hubo un aumento temprano de la circulación de influenza y del número total de las notificaciones, con la aparición de miositis secundarias. Serie clínica retrospectiva de nueve pacientes pediátricos que consultaron por dolor e impotencia funcional de extremidades inferiores, y enzimas musculares elevadas, en el hospital Pedro de Elizalde de la Ciudad Autónoma de Buenos Aires, entre agosto y octubre del 2022. En todos se detectó infección por virus influenza y se recuperaron sin secuelas. La miositis aguda benigna es una entidad infrecuente en la infancia, cuyo diagnóstico es predominantemente clínico y de recuperación ad integrum. Debe ser sospechada en pacientes con clínica compatible en contexto de alta circulación viral. La vigilancia epidemiológica aporta herramientas para identificar los virus circulantes y sus posibles complicaciones.

Benign acute myositis associated with influenza is a sporadic complication. In Argentina, in 2022, there was an early increase in influenza circulation and the total number of notifications, with the appearance of secondary myositis. Retrospective clinical series of nine pediatric patients who consulted for pain and functional impotence of the lower extremities, and elevated muscle enzymes, at the Pedro de Elizalde hospital in the Autonomous City of Buenos Aires, between August and October 2022. In all of them, infection by influenza virus and recovered without sequelae. Benign acute myositis is a rare entity in childhood, whose diagnosis is predominantly clinical and recovery ad integrum. It should be suspected in patients with compatible symptoms in a context of high viral circulation. Epidemiological surveillance provides tools to identify circulating viruses and their possible complications.

Salud mental perinatal en pandemia por covid-19: un estudio con puérperas en dos provincias Argentinas / Perinatal Mental Health in COVID-19 Pandemic: A Study with Postpartum Women in Two Argentine Provinces

RESUMEN INTRODUCCIÓN: La salud mental perinatal está relacionada con los procesos fisiológicos, psicológicos y socioculturales implicados en la concepción, embarazo, parto, puerperio y vínculo temprano, e incluye a la díada madre-bebé. El objetivo de este trabajo fue indagar el impacto de la pandemia por COVID-19 en la salud mental perinatal, específicamente con relación a la depresión posparto (DPP) y las diversas preocupaciones que manifestaron las mujeres en este contexto. MÉTODOS: Se realizó un estudio de corte transversal a través de una encuesta cara a cara con preguntas abiertas y cerradas. Se trabajó con una muestra no probabilística en tres hospitales (dos de la provincia de Entre Ríos y uno de la provincia de Buenos Aires). RESULTADOS: El 68% de las mujeres mostraron indicadores de DPP evaluada con la Escala de Edimburgo, es decir, manifestaron haberse sentido infelices y con dificultades para dormir, con miedo, tristeza, preocupación y pensamientos negativos, en la última semana. Existen relaciones significativas entre la depresión puerperal, el hospital, la cantidad de personas con las que conviven las puérperas y el estado de salud. DISCUSIÓN: Esta investigación permitió generar información útil para mejorar prácticas, intervenciones y políticas que redunden en garantía de derechos en salud mental perinatal.

ABSTRACT INTRODUCTION: Perinatal mental health is related to the physiological, psychological and sociocultural processes involved in conception, pregnancy, childbirth, puerperium and early bonding, and includes the mother-baby dyad. The objective of this work was to investigate the impact of the COVID-19 pandemic on perinatal mental health, specifically in relation to postpartum depression (PPD) and the various concerns expressed by women in this context. METHODS: A cross-sectional study was conducted through a face-to-face survey with open and closed questions. It used a non-probabilistic sample in three hospitals (two from the province of Entre Ríos and one from the province of Buenos Aires). RESULTS: Sixty-eight percent of the women showed indicators of PPD according to the Edinburgh Scale, that is, they stated that they felt unhappy and had difficulty sleeping, with fear, sadness, worry and negative thoughts, in the last week. There are significant relationships between PPD, the hospital, the number of people with whom postpartum women live, and health status. DISCUSSION: This research generated useful information to improve practices, interventions and policies guaranteeing rights in perinatal mental health.

"I Study When All My Family is Asleep". Gender, Time and Space in Online Education in the COVID-19 Pandemic, / "Eu Estudo Enquanto Toda Minha Família Está Dormindo". Gênero, Tempo e Espaço na Educação Online na Pandemia de Covid-19

Abstract The COVID-19 pandemic has radically altered the ways of working, studying, and interacting globally, forcing people and communities to reinterpret their daily activities. This study analyzes the changes experienced by working mothers who began distance studies at an Argentine university during the second year of the pandemic. Results indicated how spaces and time were transformed, and gender inequalities deepened. The pandemic, above all, impacted the positions and negotiations that working mothers managed to establish to continue studying in a virtual university environment. In these cases, conquering time and space for learning is, at the same time, an act of acceptance and innovation as a woman.

Resumo A pandemia do COVID-19 alterou radicalmente as formas de trabalhar, estudar e interagir globalmente, forçando pessoas e comunidades a recriar os significados de suas atividades diárias. Este estudo analisa as mudanças vivenciadas por mães trabalhadoras que iniciaram seus estudos a distância em uma universidade argentina, durante o segundo ano da pandemia. Os resultados indicam como os espaços e tempos se transformam e as desigualdades de gênero se aprofundam. A pandemia, sobretudo, impactou as posições e as negociações que as mulheres mães conseguem estabelecer para continuar estudando em ambiente universitário virtual. Nesses casos, conquistar tempo e espaço para aprender é, ao mesmo tempo, um ato de aceitação e inovação como mulher.

Angioleiomioma en cavidad oral «una neoplasia rara en un sitio poco común¼. Reporte de un caso y revisión de la literatura / Angioleiomyoma in the oral cavity «a rare neoplasm in an unusual site¼. Case report and literature review

El angioleiomioma (AL) es una neoplasia benigna, bien circunscrita y de crecimiento lento, que representa 5% de las neoplasias de tejidos blandos y cuya etiología es desconocida. Se origina del músculo liso, mayormente de las paredes de los vasos sanguíneos; su localización es más frecuente en extremidades, siendo raros en la región de cabeza y cuello, y más aún en cavidad bucal. Histológicamente la lesión se caracteriza por ser un nódulo bien encapsulado con proliferación de fascículos de músculo liso maduro alrededor de la luz de los vasos sanguíneos, cuyas células suelen ser positivas a marcadores de inmunohistoquímica como alfa actina de músculo liso, desmina, HHF35, miosina, calponina y H-caldesmon. El tratamiento actual es la escisión quirúrgica completa con una tasa de recurrencia prácticamente nula. El objetivo es resaltar la importancia del diagnóstico y el manejo correcto de las lesiones intraorales a través de la presentación de un caso clínico de un leiomioma vascular localizado en región nasolabial, además de hacer la revisión de la literatura correspondiente (AU)

The angioleiomyoma (AL) is a benign neoplasm, well circumscribed and slow growing, that represents 5% of the soft tissue neoplasms, whose etiology is unknown. It originates from smooth muscle, mostly from the walls of blood vessels; regarding its location, it more frequently appears in the extremities, being rare in the head and neck region, and even more so in the oral cavity. Histologically, the lesion is characterized by being a well encapsulated nodule with proliferation of mature smooth muscle bundles around the lumen of the blood vessels, whose cells are usually positive for immunohistochemical markers such as alpha smooth muscle actin, desmin, HHF35, myosin, calponin and H-caldesmon. The current treatment is complete surgical excision having zero recurrence rate. The objective of the following article is to educate on the importance of correct diagnosis and management of intraoral lesions through the presentation of a clinical case of a vascular leiomyoma located in the nasolabial region, in addition to reviewing the corresponding literature (AU)

Crisis celíaca y tetania aguda en pediatría. Reporte de un caso / Celiac crisis and acute tetany in pediatrics. Case report

RESUMEN La enfermedad celíaca es una enfermedad sistémica inmunomediada, con un gran espectro de presentaciones clínicas. El término crisis celíaca describe la forma aguda y potencialmente fatal. Clínicamente se caracteriza por diarrea severa, deshidratación y alteraciones metabólicas. Se reporta el caso de un paciente masculino de 7 años de edad que asiste a guardia con tetania, edema en miembros inferiores, esteatorrea y pérdida de peso de 8 meses de evolución, con hallazgos analíticos de hipocalcemia, hipomagnesemia, hipopotasemia y coagulopatía. El diagnóstico de crisis celíaca se realizó sobre la base de hallazgos serológicos y clínicos compatibles con enfermedad celíaca en el contexto de anomalías metabólicas graves y desnutrición aguda, confirmado posteriormente por anatomía patológica. La importancia de este reporte radica en repasar las características de esta grave entidad, que requiere un elevado índice de sospecha para su diagnóstico.

ABSTRACT Celiac disease is an immune-mediated systemic disease with a wide spectrum of clinical presentations. The term celiac crisis describes the acute and potentially fatal form. Clinically it is characterized by severe diarrhea, dehydration, and metabolic disturbances. The case of a 7-year-old male patient attending the ward with tetany, lower limb edema, steatorrhea and weight loss of 8 months of evolution is reported, with analytical findings of hypocalcemia, hypomagnesemia, hypokalemia and coagulopathy. The diagnosis of celiac crisis was made on the basis of serological and clinical findings compatible with celiac disease in the context of severe metabolic abnormalities and acute malnutrition, later confirmed by pathological anatomy. The importance of this report lies in reviewing the characteristics of this serious entity, which requires a high index of suspicion for its diagnosis.

Manejo interdisciplinario para una óptima rehabilitación oral / Interdisciplinary management for optimal oral rehabilitation

Las estrategias para el éxito en la rehabilitación bucal requieren de la interrelación de varias disciplinas que en conjunto logren resultados predecibles y duraderos. La visión individualizada de cada área de especialidad puede conllevar a no ofrecer la mejor alternativa de tratamiento, es por ello que la valoración, el diagnóstico y la planificación del caso clínico debe ser realizada por un equipo interdisciplinario para evitar esta situación y crear una sinergia en donde el «todo sea mayor que la suma de sus partes¼. El objetivo de este trabajo es presentar un caso clínico en el cual intervinieron varias áreas de especialidad: periodoncia, prostodoncia, cirugía oral y patología bucal, logrando devolver la función y la estética a través del manejo interdisciplinario (AU)

The strategies for success in oral rehabilitation require the interrelation of several disciplines, which together, achieve predictable and lasting results. The individualized view of each specialty area may lead to not offering the best treatment alternative, which is why the assessment, diagnosis, and planning of the clinical case must be carried out by an interdisciplinary team to avoid this situation and create a synergy in where the «whole is greater than the sum of its parts¼. The objective of this work is to present a clinical case where several areas of specialty intervened: periodontics, prosthodontics, oral surgery, and oral pathology, thus achieving the return of function and aesthetics through interdisciplinary management (AU)

Coagulopatía asociada a síndrome de malabsorción por enfermedad celíaca / Coagulopathy associated with celiac disease malabsorption syndrome

This article describes a 19-y-old patient with abdominal pain and signs of malnutrition. She had been treated previously with an antibiotic for chronic diarrhea. Laboratory analyses showed the presence mild hypoalbuminemia, and considerably prolonged prothrombin time. Tests revealed that hemostasis improved after the patient received fresh frozen plasma and vitamin k. A coagulation profile showed a decrease in clotting factors V, VII, IX, and fibrinogen. Positive serology (immunoglobulin A antitissue transglutaminase and immunoglobulin A antiendomysial antibodies) and small bowel mucosal histopathology confirmed the presence of celiac disease (CD). The girl recovered completely after she was put on a gluten-free diet. Vitamin K­deficiency is a rare complication that occurs in celiac disease manifestations. In addition to antibiotic therapy, treatment with other drugs that influence vitamin K resorption and metabolism may increase the risk of bleeding in patients with CD with hypoprothrombinemia.

Colistina intraventricular en infección postoperatoria por Pseudomonas aeruginosa multiresistente:Reporte de un caso / Intraventricular Colistin in postoperative infection by resistant Pseudomonas aeruginosa: Report of a pediatric case.

Introducción: El surgimiento de bacterias Gram negativas multirresistentes y la aparición de infecciones post quirúrgicas, ha representado un desafío en el manejo antimicrobiano. Las características estructurales de estas bacterias, la formación de biofilms en los dispositivos internos y la presencia de infecciones en órganos de difícil acceso antimicrobiano como el sistema nervioso central, ha obligado a retomar el uso de antibióticos como Colistina por vías de administración poco utilizadas. Caso clínico: Presentamos el caso clínico de un paciente de 2 años de edad con meningo-ventriculitis postquirúrgica causada por Pseudomonas aeruginosa multirresistente manejado con tratamiento combinado de Colistina intraventricular e intravenoso, resultando en éxito terapéutico para el paciente. No se reportó ninguna reacción adversa a la medicación local ni sistémica. Tampoco se reportó recaídas infecciosas posterior al alta. Conclusiones: Los aspectos claves en el manejo de este tipo de infecciones deben ser consideradas: eliminación de la derivación ventrículo peritoneal infectada, óptima cobertura antimicrobiana y elección de la vía de administración más efectiva.

Introduction: The emergence of multi-resistant Gram-negative bacteria and the emergence of post-operative infections has represented a challenge in antimicrobial management. The structural characteristics of these bacteria, the formation of biofilms in internal devices and the presence of infections in organs of difficult antimicrobial access such as the central nervous system, has forced to consider the use of antibiotics such as Colistine through little-used administration routes. Clinical case: We present the clinical case of a 2-year-old patient with post-surgical meningo-ventriculitis caused by multiresistant Pseudomonas aeruginosa managed with combined treatment of intraventricular and intravenous Colistin, resulting in therapeutic success for the patient. No adverse reaction to local or systemic medication was reported. No infectious relapses were reported after discharge. Conclusions: The key aspects in the management of this type of infection have been considered: elimination of the infected peritoneal ventricle derivation, optimal antimicrobial coverage and choice of the most effective route of administration.

Oclusão Percutânea do Apêndice Atrial Esquerdo com Prótese Watchman® / Left Atrial Appendage Closure With the WatchmanTM Device

Introdução: O acidente vascular cerebral secundário à fibrilação atrial tem sido associado a taxas de mortalidade e de incapacidade permanente elevadas, porquanto sua prevenção eficaz é importante. O tratamento com varfarina diminui em 60% o risco de acidente vascular cerebral; todavia, até metade dos pacientes com fibrilação atrial não faz uso da anticoagulação. A oclusão do apêndice atrial esquerdo surgiu como estratégia alternativa para prevenção do acidente vascular cerebral. Métodos: Foram selecionados pacientes com fibrilação atrial, escore de CHA2DS2-VASc ≥ 2, não elegíveis para anticoagulação, para se submeterem ao fechamento percutâneo do apêndice atrial esquerdo com a prótese Watchman®. O procedimento foi realizado sob anestesia geral e guiado por ecocardiografia transesofágica. Resultados: Dos 11 pacientes selecionados, 2 não foram tratados por apresentarem trombo pré ou durante o procedimento, antes do implante do dispositivo. A idade foi de 74 ± 5,1 anos, 66,6% eram do sexo masculino, com escores CHA2DS2-VASc de 4 ± 1,4 e HAS-BLED de 3,4 ± 1,1, 77% tinham contraindicação ou condições sociais desfavoráveis para utilizarem a anticoagulação. O sucesso técnico foi de 100%, sendo alcançada a oclusão completa em todos os casos, com tempo médio de fluoroscopia de 22,1 ± 10,8 minutos e ausência de complicações hospitalares. No seguimento de 78,3 ± 41,5 dias, não ocorreram desfechos clínicos, mas um paciente apresentou trombo no dispositivo e recebeu anticoagulação por 3 meses. Conclusões: A oclusão percutânea do apêndice atrial esquerdo com dispositivo Watchman® é factível e pode ser uma alternativa atrativa na prevenção de acidente vascular cerebral nos pacientes com fibrilação atrial e limitação para anticoagulação.

Background: Stroke secondary to atrial fibrillation has been associated to a high risk of permanent, severe disability, and high early mortality, and therefore its effective prevention is of paramount importance. Warfarin therapy reduces the risk of stroke by 60%, however, half of the patients with atrial fibrillation do not receive anticoagulation. Left atrial appendage closure has emerged as an alternative strategy for stroke prevention. Methods: Patients with atrial fibrillation and CHADSVASc score ≥ 2, not eligible for anticoagulation, were submitted to left atrial appendage closure using the WatchmanTM device. The procedure was performed under general anesthesia and was guided by transesophageal echocardiography. Results: Of the 11 selected patients, 2 were not treated due to thrombi presented prior or during the procedure and before device implantation. Mean age was 74 ± 5.1 years, 66% were male, CHA2DS2-VASc score was 4 ± 1.4, HASBLED score was 3.4 ± 1.1, 77% had contraindications or had unfavorable social conditions for anticoagulation. Technical success was 100% and complete occlusion was obtained in all of the cases, with a mean fluoroscopic time of 22.1 ± 10.8 minutes, and no hospital complications. At a follow-up of 78.3 ± 41.5 days, there were no clinical events but one patient had thrombus formation on the device and received anticoagulation for 3 months. Conclusions: Left atrial appendage closure with the WatchmanTM device is feasible and may be a good alternative therapy for stroke prevention in patients with atrial fibrillation and restrictions for anticoagulation.

Intervenção percutânea em lesão de tronco de coronária esquerda não protegido / Percutaneous coronary intervention for unprotected left main coronary artery lesions

INTRODUÇÃO: Refinamentos da intervenção coronária percutânea (ICP), entre eles a utilização do ultrassom intravascular (IVUS) e da reserva de fluxo fraccionada (FFR), têm permitido o tratamento de lesões complexas com bons resultados. Como consequência, a abordagem percutânea das lesões de TCE se difundiu, incluindo hospitais de menor volume de procedimentos. Nosso objetivo foi apresentar os resultados iniciais e tardios da ICP de lesões de TCE não protegido. MÉTODOS: Foram incluídos pacientes consecutivos tratados em dois centros hospitalares, de agosto do 2009 a julho do 2013. A indicação da estratégia percutânea baseou-se em avaliação clínica, cálculo do escore Syntax, EuroScore e no desejo do paciente. RESULTADOS: Foram tratados 28 pacientes, com idade de 69,2 ± 10,1 anos, 39% eram diabéticos e 39% eram portadores síndrome coronária aguda. Metade dos pacientes tinha EuroScore ≥ 6; o escore Syntax foi de 26,0 ± 8,4 e 82% tinham lesões localizadas na bifurcação. As intervenções foram guiadas por IVUS e/ou FFR em 71,4% dos pacientes, 93% foram tratados com stents farmacológicos, predominantemente pela técnica de 1 stent, e o sucesso angiográfico foi alcançado em 100% dos casos. O acompanhamento foi de 19,2 ± 13,7 meses. A taxa de desfechos clínicos maiores foi de 21,4% no seguimento maior a 4 anos, óbito cardíaco de 14,2%, infarto do miocárdio não fatal de 3,5%, e revascularização da lesão-alvo em 3,5%. CONCLUSÕES: A ICP de TCE não protegido guiada, sempre que possível, por IVUS e/ou FFR é segura e eficaz no curto e longo prazos, na experiência em um hospital com moderado volume de procedimentos.

BACKGROUND: Refinements in percutaneous coronary intervention (PCI), including the use of intravascular ultrasound (IVUS) and fractional flow reserve (FFR), have allowed the treatment of complex lesions with good results. As a result, the percutaneous approach for left main coronary artery (LM) lesions has spread, including centers with a lower volume of PCI procedures. Our objective was to report the early and late outcomes of PCI in unprotected LM lesions. METHODS: Consecutive patients treated at two different hospitals from August 2009 to July 2013 were included. The indication for the percutaneous approach was based on the clinical assessment and the calculation of Syntax score, EuroScore and on the patient's wishes. RESULTS: Twenty-eight patients with mean age of 69.2 ± 10.1 years were treated, 39% were diabetic and 39% had acute coronary syndromes. Half of the patients had EuroScore ≥ 6; the Syntax score was 26.0 ± 8.4 and 82% had LM bifurcation lesions. Interventions were guided by IVUS and/or FFR in 71.4% of the patients, 93% were treated with drug-eluting stents, and the 1-stent technique was used in most occasions. Angiographic success was achieved in 100% of the cases. At the 19.2 ± 13.7 month follow-up, the rate of major adverse cardiac events was 21.4% in the follow-up longer than 4 years, cardiac death 14.2%, non-fatal myocardial infarction 3.5% and target-lesion revascularization 3.5%. CONCLUSIONS: PCI in unprotected LM lesions, guided by IVUS and/or FFR whenever possible, is safe and effective in the short and long-term, in the experience of a hospital with a moderate number of PCI procedures.

Avaliação ultrassonográfica intracoronária de imagem angiográfica duvidosa durante intervenção percutânea em bifurcação / Intravascular ultrasound evaluation of equivocal angiographic imaging during percutaneous coronary intervention of bifurcation lesions

O uso do ultrassom intracoronário (USIC) para guiar o implante do stent em bifurcações, especialmente na detecção de complicações relacionadas ao procedimento, tem diminuído as taxas de desfechos clínicos maiores. Neste artigo, reportamos o caso de um paciente submetido a intervenção em bifurcação, em que o fio-guia ultrapassou inadvertidamente por trás das hastes proximais do stent, levando à deformação de sua borda. A complicação foi suspeitada na angiografia e confirmada com o USIC. O USIC foi fundamental no diagnóstico, na confirmação do reposicionamento correto do fio-guia, e na avaliação da ótima expansão e da aposição completa das hastes do stent, prevenindo possível desfecho trombótico precoce e garantindo o resultado a longo prazo.

The use of intravascular ultrasound (IVUS) to guide stent implantation in bifurcation lesions, especially for the detection of procedure-related complications, has decreased the rates of major clinical outcomes. We report a case of a patient undergoing bifurcation intervention, where the guidewire inadvertently was passed behind the proximal stent struts, deforming the stent edge. This complication was suspected at the angiography and was confirmed by IVUS. IVUS was crucial for the diagnosis, to confirm the correct repositioning of the guidewire, and to assess the optimal expansion and complete apposition of stent struts, thus preventing a possible early thrombotic event and ensuring a good long-term outcome.

Consumo de alcohol y tabaco en estudiantes de pregrado de una universidad privada de Medellín, 2007 / Alcohol and tobacco use by university undergraduate students of Medellín, 2007

Objetivo: identificar las características demográficas del consumo de alcohol y tabaco en estudiantes de pregrado de una universidad de Medellín, Colombia, durante el primer periodo académico de 2007. Metodología: es un estudio descriptivo transversal. Se tomó una muestra representativa de 1406 estudiantes de pregrado. El instrumento para recolectar la información fue un cuestionario autoaplicado. Resultados: el estudio encuestó a 1406 estudiantes, con un promedio de edad de 20,8 años. El 51,2% de los encuestados fueron mujeres y el estado civil predominante fue el de soltero (97,6%). Se encontraron prevalencias anuales de 94,0% y 42,4%, para alcohol y tabaco respectivamente. El riesgo de alcoholismo, según el test de CAGE fue del 8%, mientras que el riesgo de dependencia a la nicotina, según el test de Fagerstrõm, fue del 6%. El sexo masculino y el grupo de 16 a 24 años tuvieron las mayores prevalencias de consumo de estas sustancias y las mayores proporciones de dependencia a la nicotina o de alto riesgo de alcoholismo. Conclusión: el consumo de alcohol y/o tabaco en estudiantes es un problema que merece atención de los organismos encargados de los programas de bienestar universitario.

Objective: to identify the demographic, as well as the tobacco and alcohol use characteristics of undergraduate students from a Medellín, Colombia, well-known university during the first 2007 academic period. Methodology: a transversal descriptive study was carried of a representative population of 1.406 undergraduate students from the said educative institution. The study instrument was an auto-applied questionnaire. Results: during the study period 1.406 students were interviewed, with an average age of 20,8 years. Other general characteristics of the population were: 51,2% of the interviewed people was female and the predominant marital status was single (97,6%). Annual prevalence of 94,0% and 42,4% for alcohol and tobacco use were found, respectively. Alcoholism risk, according to the CAGE test, was 8%, while nicotine dependence risk was 6% according to the Fagerstrõm test. Males and the 16-24 ages group have the highest substance use prevalence and the highest alcoholism and/or nicotine dependence risk. Conclusion: alcohol and tobacco use in this studied university is a problem deserving attention from health care offices.