Asociación entre el bajo nivel de vitamina B12 y deterioro cognitivo en adultos mayores del centro médico naval del Perú

Introducción: Los adultos mayores son suscepctibles a la malnutrición y el déficit de vitaminas. Objetivo: Determinar la asociación entre el bajo nivel de vitamina B12 y el deterioro cognitivo en adultos mayores del centro médico naval, ubicado en Lima-Perú, en el periodo 2010-2015. Métodos : Se realizó un estudio transversal analítico, a partir de un análisis secundario de la base de datos Texas-Cemena UTMB 2010-2015 del centro de investigación del envejecimiento (CIEN) de la Universidad De San Martín De Porres. Para la cuantificación de la variable de deterioro cognitivo se utilizó el MiniMental test. Para analizar la asociación, se realizó la prueba de chi cuadrado y la regresión de Poisson. Resultados : El 57,6% de los pacientes fueron de sexo masculino y la edad promedio fue de 78 ± 8,4. El 41,2% presentó deterioro cognitivo y el 9,5% de los pacientes presentó déficit de vitamina b12. Los factores independientemente asociados al deterioro cognitivo fueron el antecedente de enfermedad cerebro vascular (RP= 1,38 IC 95% [1,24-1,53]), depresión (RP = 1,88 IC 95% [1,80-1,97]),) y déficit de vitamina B12 (RP = 1,10 ic 95% [1,01-1,20]),). Conclusiones : En el presente estudio se encontró asociación entre un bajo nivel de vitamina B12 y el deterioro cognitivo en adultos mayores.

Introduction: Older adults are susceptible to malnutrition and vitamin deficiency. Objective: To determine the association between the low level of vitamin B12 and cognitive deterioration in older adults from the Naval Medical Center, located in Lima-Peru, in the period 2010-2015. Methods: An analytical cross-sectional study was carried out, based on a secondary analysis of the Texas-Cemena UTMB 2010-2015 database of the center for research on aging (cien) of The University Of San Martín De Porres. To quantify the cognitive impairment variable, the mini mental test was used. To analyze the association, the chi-square test and poisson regression were performed. Results: 57.6% of the patients were male and the mean age was 78 ± 8.4. 41.2% presented cognitive deterioration and 9.5% of the patients presented vitamin B12 deficiency. The factors independently associated with cognitive impairment were a history of cerebrovascular disease (pr= 1.38 95% ci [1.24-1.53]), depression (pr= 1.88 95% ci [1.80-1 .97]) and vitamin B12 deficiency (pr = 1.10 95% ci [1.01-1.20]). Conclusions: In the present study, an association was found between a low level of vitamin B12 and cognitive deterioration in older adults.

Spontaneous Biloma: A Case Report and Literature Review

Bilomas are collections of bile outside the biliary tree. The most frequent etiologies are iatrogenic and trauma. Cases of spontaneous or atraumatic bilomas are rare. Management of bilomas depends on the size and location and may include monitoring only; if the size is < 4 cm, there may be percutaneous or endoscopic intervention. The use of antibiotics depends on the clinical status of the patient. We describe the case of a man who presented with a spontaneous biloma eight years after laparoscopic cholecystectomy and, in addition to signs of choledocholithiasis, a stricture of the common bile duct. In patients with symptoms of biliary pathology, the diagnosis of biloma should be considered even without a history of trauma or recent surgery to initiate appropriate treatment early. Many cases are asymptomatic and resolve spontaneously but occasionally require percutaneous or endoscopic management.

Los biliomas son colecciones de bilis fuera del árbol biliar. Las etiologías más frecuentes son la iatrogenia y el trauma. Los casos de biliomas espontáneos o atraumáticos son poco frecuentes. El manejo de los biliomas depende del tamaño y la localización y puede incluir vigilancia solamente, si el tamaño es < 4 cm, puede haber intervención percutánea o endoscópica. El uso de antibióticos depende del estado clínico del paciente. Presentamos el caso de un hombre que presentó un bilioma espontáneo 8 años después de una colecistectomía laparoscópica que, además de signos de coledocolitiasis, presentaba una estenosis del conducto biliar común. En los pacientes con clínica de patología biliar debe considerarse el diagnóstico de bilioma aun en los casos que no presenten antecedente de trauma o cirugía reciente con el fin de iniciar el tratamiento adecuado tempranamente. Muchos casos son asintomáticos y se resuelven espontáneamente, pero en ocasiones requieren manejo percutáneo o endoscópico.

Oxidative stress in patients with diabetic nephropathy

Background: Diabetic nephropathy (DN) is currently the leading cause of end-stage renal disease globally. Oxidative stress which is classically defined as an event resulting from the magnitude of imbalance between oxidant and antioxidant substances, generated in a setting of oxidation-reduction reactions, and is hypothesized to play a role in the development of diabetic nephropathy. Aim and Objectives: The aim of the study was to assess lipid peroxidation by estimating serum malondialdehyde (MDA) and antioxidant status by assaying paraoxonase-1 (PON-1) in diabetes patients with nephropathy and healthy controls. Furthermore, the study aimed the correlation between MDA and PON-1 levels in patients with diabetic nephropathy. Materials and Methods: A cross-sectional comparative study was conducted in 152 participants, which were divided into two groups as control (n = 76) non-diabetic, healthy, age-, and sex-matched individuals and diabetic patients with nephropathy(n = 76). The study was conducted in Government Medical College, Kozhikode. All the subjects who satisfied the inclusion and exclusion criteria and who gave informed consent were included in a consecutive manner till sample size is achieved. Serum MDA and PON-1 were estimated using spectrophotometry. The data were analyzed using statistical package for the social sciences (SPSS) version 18. Results: Oxidative stress was increased in diabetic nephropathy patients as evidenced by significantly elevated MDA and reduced PON-1 than the normal controls. There was a significant negative correlation of serum MDA with serum PON-1 in patients with diabetic nephropathy. Conclusion: Oxidative stress is an important pathophysiological process for the development of diabetic nephropathy. This study reveals the importance of screening all diabetes patients for oxidative stress. Dietary management and antioxidant supplementation would help them to prevent development of diabetic nephropathy and related complications, which, in turn, improve their quality of life.

Una mirada a la seguridad del ultrasonido en ecotomografía obstétrica / A look at the safety of ultrasound in obstetric echotomography

Resumen Los índices térmico y mecánico son estimadores de riesgo fetal en una ecografía y se deben controlar sus valores minimizando la exposición. Comparamos los valores de los índices térmico y mecánico obtenidos en exámenes ecográficos obstétricos de pacientes gestantes, con el valor recomendado por la comunidad internacional. Se realizó la estimación de estos índices en 421 ecografías obstétricas en 2019. Los valores fueron comparados entre ellos y con el valor recomendado para cada índice y según el modo de visualización (B, Doppler color y Doppler espectral). Del total de la muestra, para el índice térmico en modo Doppler color un 0,24% superó el valor estándar recomendado y en modo Doppler espectral un 2,85%. Para el índice mecánico se sobrepasó el valor recomendado en modo B en un 11,16%, en un 8,08% en modo Doppler color y, por último, en un 0,48% para el modo Doppler espectral. Los índices mecánico y térmico en esta muestra de exámenes ecográficos obstétricos se encuentran en promedio bajo el valor de referencia. Sin embargo, existe un número importante de casos en que se superan las normas, lo que debe ser una voz de alerta para la comunidad médica.

Abstract The thermal and mechanical indices are the best estimators of fetal risk in an ultrasound and their values should be controlled in order to minimize exposure as much as possible. We compared the values of the thermal and mechanical indices obtained in obstetric ultrasound examinations of pregnant patients, with the value recommended by the international community. These indices were estimated in 421 obstetric ultrasounds during 2019. The estimated values were compared with each other and with the recommended value for each index and according to the display mode (B, color Doppler and spectral Doppler). Of the total sample, for the thermal index in color Doppler mode, 0.24% exceeded the recommended standard value and 2.85%. in spectral Doppler mode. For the mechanical index, the recommended value was exceeded in B mode by 11.16%, in 8.08% in color Doppler mode and, finally, by 0.48% for spectral Doppler mode. The mechanical and thermal indices in this sample of obstetric ultrasound examinations are on average below the reference value. However, there is a significant number of cases in which the standards are exceeded, which should be a warning to the medical community.

Jejunal perforation secondary to kick during kick-boxing practice: laparoscopic management / Perforación yeyunal secundaria a patada durante práctica de kick-boxing: Manejo laparoscópico

Abstract Small bowel injury in a sports setting is a rare occurrence with a paucity of reported cases. A 30-year old male patient consulted for generalized abdominal pain subsequent to secondary blunt abdominal trauma during kick-boxing practice. A computed tomography scan of the abdomen and pelvis revealed a moderate amount of free fluid in both the parietocolic space and the rectovesical pouch, with perihepatic pneumoperitoneum. Emergency laparoscopy was indicated and a closure of small bowel defect was performed. Diagnosis of small bowel injuries is difficult, resulting in delayed treatment and increased mortality and morbidity.

Resumen La lesión intestinal en un entorno deportivo es infrecuente con pocos casos comunicados. Un varón de 30 años consultó por dolor abdominal generalizado posterior a un traumatismo abdominal cerrado secundario a la práctica de kick-boxing. Una tomografía computarizada de abdomen y pelvis reveló líquido libre tanto en el espacio parietocólico como en la bolsa rectovesical, con neumoperitoneo perihepático. Se indicó laparoscopia exploradora con cirugía de rafia intestinal. El diagnóstico de las lesiones del intestino delgado es difícil, lo que provoca un retraso en el tratamiento y un aumento de la mortalidad y la morbilidad.

Entorno laboral saludable en Asia y América del Norte revisión de alcance

Objetivos Realizar una revisión de alcance sobre entorno laboral saludable (ELS) en países de Asia y América del Norte. Métodos Revisión de documentos de diversos diseños metodológicos resultantes de la matriz PRISMA obtenidos en bases de datos como Scopus, PubMed, Biblioteca Virtual de la Salud (BVS) y otros motores de búsqueda entre los años 2015 y 2020 empleando los descriptores Healthy, Workplace, Enviroment Work y conectores AND y OR. Resultados Se obtuvo un total de 36 documentos finales. El 66,7% de los estudios encontrados fueron en países de América del Norte. El 44,4% de las publicaciones se realizaron en el año 2019 y 2020. Se halló que la base de datos que más arrojó publicaciones acerca de ELS fue Scopus y la revista que más publicó fue BVS; igualmente los temas más relevantes para alcanzar ELS fueron la promoción de la salud en el lugar de trabajo mediante la intervención de estrategias encaminadas a los estilos de vida saludables y el impacto de la productividad. Conclusiones Las estrategias de ELS permiten que los programas de promoción de la salud sean implementados en las empresas con el fin de mejorar los estilos de vida y las condiciones laborales de los trabajadores, incentivando la actividad física, la alimentación balanceada, disminuyendo la ingesta de bebidas alcohólicas y el tabaquismo. Los ELS se relaciona con la mejora continua debido a que favorece el aumento de la productividad y por ende es importante que se puedan implementar en el contexto de la educación, negocios, comercio y desarrollo económico.

Objectives Conduct a scope review on Healthy Working Environment (ELS, by its initials in Spanish) in Asian and North American countries. Methods Review of documents of various methodological designs resulting from the PRISMA matrix obtained in databases such as Scopus, PubMed, Virtual Health Library (VHL) and other search engines from the years 2015 to 2020 using the following descriptors: Healthy, Workplace, Enviroment Work and the connectors AND and OR. Results A total of 36 final documents were obtained. 66.7% of the studies found were in North American countries. 44.4% of publications were made between 2019 and 2020. It was found that the database that yielded the most publications about ELS was Scopus and the magazine that published the most was VHL; also, the most relevant issues to achieve ELS were the promotion of health in the workplace through the intervention of strategies aimed at healthy lifestyles, and the impact of productivity. Conclusions ELS strategies allow health promotion programs to be implemented in companies in order to improve the lifestyles and working conditions of workers, encou-raging physical activity, balanced eating, and reducing alcohol intake and smoking. The ELS are related to the continuous improvement because it favors the increase of productivity and therefore it is important that they can be implemented in the context of education, business, trade, and economic development.

Validación externa y reproducibilidad del cuestionario PUMA para el diagnóstico de EPOC en una población latinoamericana: validación externa del cuestionario PUMA / External validation and reproducibility of the PUMA questionnaire for the diagnosis of COPD in a Latin American population: external validation of the PUMA questionnaire

Resumen El uso de escalas de predicción clínica puede incrementar la detección temprana de enfermedad pulmonar obstructiva crónica (EPOC). Su rendimiento en población latinoamericana ha sido pobremente estudiado. Nuestro objetivo fue determinar la validez y reproducibilidad del cuestionario PUMA, como herramienta de tamización en atención primaria en población colombiana, mediante un estudio tipo corte transversal; donde se establecieron las características operativas del cuestionario, área bajo la curva de características operativas del receptor (ACOR) y el mejor punto de corte para esta población. 1.980 sujetos fueron incluidos en el análisis. La prevalencia de EPOC correspondió a 18,9%. La capacidad discriminatoria del cuestionario fue de 0,69 (IC95%: 0,66-0,72), para un punto de corte óptimo mayor de 5, con una sensibilidad del 60%, especificidad 66% y un valor predictivo negativo de 88%. La escala PUMA para tamizaje de pacientes en riesgo de EPOC tiene una capacidad discriminatoria moderada y una excelente reproducibilidad en la población estudiada.

The use of clinical prediction scales may increase the early detection of chronic obstructive pulmonary disease (COPD). The performance characteristics of these scales in the Latin American population is poorly studied. We aimed to evaluate validity and reproducibility of PUMA questionnaire as a screening tool in primary care in a Colombian population. A cross-sectional study was performed. Operational characteristics of the questionnaire, the area under the received operator curve (AUROC), and the best cut-off point of the score were calculated. 1,980 individuals were included in this analysis. Prevalence of COPD was 18.9%. AUROC of the questionary was 0.69 (CI95%: 0.66-0.72), with an optimal cut-off point greater than 5 (sensitivity 60%, specificity 66%); predictive negative value was 88%. PUMA's scale for the screening of patients at risk of COPD has a moderate accuracy and an excellent reproducibility in the studied population.

Hernia of the cord with patent omphalomesenteric duct and ileal prolapse in two preterm neonates: case series

@#Hernia of the cord (HOC) is a rare condition that results from failure of the viscera to return to the abdominal cavity by the 10th week of fetal development. It sometimes presents together with a patent omphalomesenteric duct (POMD), another rare condition, which occurs earlier in fetal development. A proportion of POMD cases may also have ileal prolapse (IP) through the POMD lumen. Neonates diagnosed with the combination of these rare clinical conditions require immediate surgical intervention to resect the POMD and non-viable bowel segments, reduce the hernia, and repair the umbilical defect. In this case series, we report two neonates diagnosed with HOC with POMD and IP. One patient who had complete IP was not fit for immediate surgery and died of respiratory distress and sepsis. The other patient had a successful surgical correction of the congenital defects, but succumbed to sepsis postoperatively. Treatment of patients with this combination of clinical conditions should focus mainly on both surgical correction, and infection control and management.

Fishes of the Mitú Region: middle basin of the río Vaupés, Colombian Amazon / Peces de la región de Mitú: cuenca media del río Vaupés, Amazonia colombiana

Abstract: The Amazon River basin hosts the most diverse freshwater ichthyofauna in the world, and yet huge areas of the basin remain unexplored. This is the case for the upper tributaries of the rio Negro, especially those draining the Colombian territory. Here we present a list of 224 species derived from the examination of specimens collected in the Mitú region (Vaupés Department, Colombia), the middle basin of the río Vaupés. Of the species identified in our study, 10 species are recorded from Colombia for the first time, and 26 species are newly recorded from the Colombian Amazon. The number of species we present here comprise almost one-third of the known species diversity of the Colombian Amazon and nearly a tenth of the total number of those known across the entirety of the Amazon basin. The most diverse orders were Characiformes (120 species) and Siluriformes (65 species), and the remaining six orders comprised less than 20% of total species. The study area comprised blackwater systems, which are considered to be nutrient-poor environments. We discuss some ecological aspects that might explain how this highly diverse ichthyofauna originates and is maintain in less productive systems. The list presented here adds an important number of new records and complements the information derived from previous studies, carried out thus far with regards to the fish fauna of the Colombian Amazon.

Resumo: La cuenca del río Amazonas alberga la ictiofauna dulceacuícola más diversa del mundo, sin embargo, grandes áreas de la cuenca permanecen inexploradas. Este es el caso de los afluentes de la parte alta del río Negro, especialmente los sistemas que drenan el territorio colombiano. A continuación, presentamos un listado de 224 especies derivadas del análisis de especímenes recolectados en la región de Mitú, cuenca media del río Vaupés (Departamento de Vaupés, Colombia). De las especies identificadas, 10 especies se registran en Colombia por primera vez y 26 especies para la Amazonía colombiana. El número de especies que presentamos aquí comprende casi un tercio de las especies conocidas para la Amazonía colombiana y casi una décima parte del total de las conocidas para la gran cuenca del Amazonas. Los órdenes más diversos fueron Characiformes (120 especies) y Siluriformes (65 especies), y los seis órdenes restantes comprendieron menos del 20% del total de especies. El área de estudio comprende sistemas de aguas negras que se consideran ambientes poco productivos por sus bajos contenidos de nutrientes. Discutimos aquí algunos aspectos ecológicos que podrían explicar cómo esta ictiofauna tan diversa tiene su origen y es mantenida en estos sistemas poco productivos. La información derivada del presente estudio adiciona nuevos registros de especies de peces para Colombia, y complementa la información derivada de los estudios realizados a la fecha en la Amazonía colombiana.

Presence of incomplete superficial axillary arch and pectoralis quartus muscle in one male body / Presencia en un individuo de un arco axilar superficial incompleto y de un músculo pectoral cuarto

SUMMARY: The anatomical variations of the pectoralis major muscle (PMM) and latissimus dorsi muscle (LDM) range from agenesis to the presence of supernumerary fascicles with a variety of insertions and relationships with the muscles, fascia, vessels, nerves and skeletal components of the shoulder girdle and the axilla. Many of these variations are clinically irrelevant, but extremely interesting and revealing from the perspective of comparative anatomy, ontogeny, and phylogeny. In this report, we present two different supernumerary muscles in the chest of one adult male body, identified during dissection practice of undergraduate medical students at Universidad Surcolombiana. These supernumerary fascicles in the axillary region were caudal to the lower edge of the PMM on the right side of the chest, and in contact with the anterior edge of the LDM on the left side of the chest; each fascicle was inserted in the ipsilateral coracoid process. These observations are congruent with the pectoralis quartus muscle and an incomplete and superficial axillary arch, respectively.

RESUMEN: Las variaciones anatómicas del músculo pectoral mayor (MPM) y del músculo latísimo del dorso (MLD) van desde la agenesia hasta la presencia de fascículos supernumerarios con una variedad de inserciones y relaciones con los músculos, fascias, vasos, nervios y componentes esqueléticos de la cintura escapular y la axila. Clínicamente, muchas de las variaciones son irrelevantes, pero extremadamente interesantes y reveladoras desde la perspectiva de la anatomía comparada, la ontogenia y la filogenia. En este estudio, presentamos dos músculos supernumerarios diferentes en la pared torácica de un hombre adulto, identificados durante la práctica de disección de estudiantes de medicina de la Universidad Surcolombiana. Estos fascículos supernumerarios en la región axilar estaban caudales al margen inferior del MPM en el lado derecho del tórax y en contacto con el margen anterior del MLD en el lado izquierdo del tórax; cada fascículo se insertaba en el proceso coracoides ipsilateral. Estas observaciones son congruentes con el músculo pectoral cuarto y un arco axilar incompleto y superficial, respectivamente.

Papel de la interleuquina-17 en procesos inflamatorios y patologías pulmonares / Role of interleukin-17 in inflammatory processes and pulmonary pathologies

Resumen Introducción: Cuatro de las diez principales causas de muerte en el mundo corresponden a patologías pulmonares donde las infecciones respiratorias se ubican en tercer lugar y a su vez son uno de los principales motivos de consulta médica. Por otro lado, la interleuquina IL-17 parece tener un papel importante en la inmunopatogénesis de un gran número de enfermedades, pues se ha descrito que niveles elevados en sangre periférica u otros fluidos corporales se relacionan con metástasis e infecciones. Diferente a patologías cutáneas e intestinales, donde el papel de la IL-17 se conoce con mayor detalle, en procesos pulmonares su rol es aún controversial. Objetivo: Describir conocimientos actuales sobre la función de la IL-17 en procesos inflamatorios y patologías locales pulmonares. Metodología de búsqueda: Se realizó una búsqueda bibliográfica de artículos originales y revisiones de tema en los motores de búsqueda MEDLINE y Science Direct, de los cuales 50 cumplieron con los criterios de inclusión. Conclusiones: Se encontró que la respuesta de IL-17 parece estar relacionada con buen pronóstico en el caso de algunas neumonías bacterianas. Igualmente, el bloqueo de la vía de señalización de la IL-17 en neoplasias pulmonares podría ser beneficioso y se considera como un potencial blanco terapéutico en estas condiciones, por lo que los estudios en este tema continúan siendo fundamentales para conocer mejor el verdadero rol de esta proteína en diversas condiciones patológicas del pulmón. MÉD.UIS.2021;34(1): 55-62.

Abstract Introduction: Four out of ten major causes of death in the world are due to pulmonary pathologies where respiratory infections are in third place and in turn, are one of the main reasons for medical consultation. Interleukin (IL)-17 seems to have an important role in the immunopathogenesis of many diseases. Elevated levels of IL-17 in peripheral blood or other body fluids have been reported to be associated with metastases and infections. Likewise, the role that IL-17 has in the skin and intestinal pathology is clearly known, however; its role within pulmonary pathologies is controversial yet. Objective: To describe the current knowledge on the role of IL-17 in inflammatory processes and pulmonary pathologies. Search Methodology: A bibliographic search of original and review papers was carried out in the MEDLINE and Science Direct database, in which 50 articles matched the inclusion criteria. Conclusions: The response involving IL-17 in the lung seems to be related to a good prognosis in the case of some bacterial pneumonia. Blocking the IL-17 signaling pathway in lung cancer could be beneficial and is considered as a potential therapeutic target under these conditions, so studies on this subject must be continued to better understand the true role of this protein in every pathologic lung condition. MÉD.UIS.2021;34(1): 55-62.

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

Histomorphometric evaluation of human extraction sockets treated with autologous fibrin, sticky bone or biphasic calcium phosphate / Avaliação histomorfométrica de alvéolos dentários humanos pós-extração tratados com fibrina autóloga, aglutinado ósseo ou fosfato de cálcio bifásico

ABSTRACT It is essential to maintain the alveolar bone ridge to ensure the success of implant therapy. Platelet-rich fibrin (PRF) may benefit bone repair, but its quantitative microscopic results are still inconclusive. The aim of this study was to histomorphometrically analyze human dental alveoli after extraction treated with autologous fibrin, biphasic calcium phosphate or sticky bone. The sample consisted of healthy adult volunteer patients, with clinical and tomographic indication for single post-extraction graft of upper premolars for maintenance of the alveolar ridge and subsequent implantation. The 10 remaining patients in the study were divided into three groups according to the type of filling used in the dental socket: autologous PRF plug covered by a PRF membrane (G1), PRF associated with an alloplastic graft based on hydroxyapatite with beta tricalcium phosphate covered by a collagen membrane (G2) or alloplastic graft based on beta tricalcium phosphate covered by collagen membrane (control). After 8 months, bone biopsies were performed at the grafted sites and the patients underwent implant-prosthetic rehabilitation. Paraffin-embedded tissue blocks were routinely processed and sectionsfrom different depths were mounted in 3 slides and stained with HE. The histomorphometric evaluation analyzed 30 photomicrographs per block, quantifying the percentage presence of newly formed bone, connective tissue and remaining biomaterial using the ImageJ software. Parametric data enabled intergroup comparisons using ANOVA and Tukey's post-hoc test for multiple comparison with statistical significance of 5% (p<0.05), with normality of the 3 groups by the Jarque-Bera test (p>0.05). There was a higher mean of newly formed bone in G1 (68.83%) compared to G2 (35.69%) and control (16.28%). There was greater presence of connective tissue in the control (61.56%). Remaining biomaterial was higher in G2 (15.75%), but did not differ statistically from the control. Bone regeneration obtained with PRF alone or sticky bone suggests the efficacy of these therapies, encouraging the clinical use of this blood concentrate in dental procedures.

RESUMO A manutenção do rebordo ósseo alveolar é prerrogativa para o sucesso da terapia com implantes. A fibrina rica em plaquetas (PRF) poderia beneficiar o reparo ósseo, mas seus resultados microscópicos quantitativos são ainda inconclusivos. O objetivo deste trabalho foi analisar histomorfometricamente alvéolos dentários humanos pós-extração tratados com fibrina autóloga, fosfato de cálcio bifásico ou sua associação. A amostra consistiu de pacientes adultos voluntários saudáveis, com indicação clínica e tomográfica de enxerto unitário pós-exodontia de pré-molares superiores para manutenção de rebordo alveolar e posterior implante. Os 10 pacientes remanescentes no estudo foram divididos em 3 grupos de acordo com o tipo de preenchimento usado no alvéolo dentário: plug de PRF autóloga recoberto por membrana de PRF (G1), PRF associada a enxerto aloplástico de hidroxiapatita com beta fosfato tricálcio recoberto por membrana de colágeno (G2) ou enxerto aloplástico de beta fosfato tricálcio recoberto por membrana de colágeno (controle). Após 8 meses, foram realizadas biópsias ósseas nos locais enxertados e os pacientes seguiram a reabilitação implanto-protético. Blocos histológicos incluídos em parafina foram microtomizados para gerar 3 lâminas de secções em diferentes profundidades, que foram coradas em HE. A avaliação histomorfométrica analisou 30 fotomicrografias por bloco, quantificando a presença percentual de osso neoformado, tecido conjuntivo e biomaterial remanescente pelo programa ImageJ. Os dados paramétricos permitiram comparações intergrupos usando ANOVA e pós-teste de comparações múltiplas de Tukey com significância estatística de 5% (p<0,05), havendo normalidade dos 3 grupos pelo teste Jarque-Bera (p>0,05). Houve maior média de osso neoformado em G1 (68,83%) em comparação a G2 (35,69%) e controle (16,28%). Houve maior presença de tecido conjuntivo no controle (61,56 %). Biomaterial remanescente foi maior em G2 (15,75%), mas não diferiu estatisticamente para o controle. A regeneração óssea obtida com PRF isolada ou em associação sugere a eficácia destas terapias, encorajando o uso clínico deste concentrado sanguíneo em procedimentos odontológicos.

Caracterización de pacientes alérgicos a picadura de abeja que reciben inmunoterapia / Characterization of allergic patients to bee sting that receive immunotherapy

La alergia al veneno de abejas provoca reacciones de leves a severas con compromiso para la vida. La inmunoterapia con veneno de himenópteros es un tratamiento eficaz y protege a los pacientes alérgicos de sufrir reacciones sistémicas ante nuevas picaduras. Nos propusimos caracterizar los pacientes alérgicos a picaduras de abeja que reciben inmunoterapia. Se realizó un estudio observacional descriptivo de corte longitudinal en pacientes alérgicos a las picaduras de abeja tratados con inmunoterapia de extracto de abeja en el Hospital Universitario General Calixto García de La Habana, Cuba. La muestra fue de 17 pacientes que cumplieron los criterios de inclusión. Usamos técnicas de estadística descriptiva: promedio, probabilidad y puntaje estandarizado, así como técnicas de estadística inferencial tales como Chi cuadrado, verificando asociación significativa entre las variables; el nivel de significación empleado fue del 5 por ciento (p˂0,05). La tercera década de la vida fue la edad promedio de los pacientes. Se observó predominio del sexo masculino y residencia en zona urbana. Alrededor de la mitad de los pacientes tenían rinitis y antecedentes familiares de asma. Todos los pacientes tuvieron reacciones locales, la mayoría se re-expusieron a la picadura; de ellos, solo el 20 por ciento presentaron reacciones alérgicas sistémicas después de la inmunoterapia. Se concluye que la reactividad cutánea al extracto de abeja se redujo con el tratamiento de inmunoterapia(AU)

Allergy to bee venom may cause from mild to severe reactions threatening the patient´s life. Immunotherapy with hymenopter venom is an effective treatment that can protect allergic patients from suffering systemic reactions to new stings. The aim of this study was to characterize allergic patients to bee sting that receive immunotherapy. A descriptive longitudinal observational study was carried out in allergic patients to bee sting receiving immunotherapy with bee extracts in the University Hospital General Calixto García, Havana, Cuba. A sample of 17 patients with inclusion criteria was analyzed. Descriptive statistical techniques were used: mean, probability, standardized score, as well as, inferential statistic techniques such as the Chi square; verifying significant association between variables. The level of signification was 5 percent (p˂0.05). The third decade of life was the average age of the patients in this study; male sex and, urban residents were predominant. Around half of the patients had rhinitis and family history of asthma. All patients had local reactions; most of the patients were re-exposed to stings. Only 20 percent of patients reported systemic allergic reaction after immunotherapy. Skin reactivity to bee extract was reduced with the immunotherapy(AU)

Hiperplasia de células neuroendocrinas que simula tumor sólido de páncreas / Neuroendocrine cell hyperplasia mimicking a solid pancreatic tumor

RESUMEN La hiperplasia de células neuroendocrinas pancreáticas es una patología donde se produce un aumen to en el número de células de los islotes de Langerhans y a veces puede simular un proceso tumoral. Caso clínico: presentamos el caso de un paciente con tumor sólido de cola de páncreas, sintomático, al que se le realizó esplenopancreatectomía corporocaudal laparoscópica. El resultado anatomopatoló gico posterior informó una hiperplasia neuroendocrina. Conclusión: la hiperplasia de células neuroen docrinas debería considerarse en el diagnóstico diferencial de tumores sólidos de páncreas. La alterna tiva quirúrgica laparoscópica es factible cuando no es posible establecer el diagnóstico prequirúrgico con estudios de imágenes o biopsia.

ABSTRACT Pancreatic endocrine cell hyperplasia is defined as an increase in the number of cells of Langerhans islets and can sometimes mimic a tumoral process. Case report: a male patient with a symptomatic solid tail of pancreas tumor underwent laparoscopic distal pancreatectomy and splenectomy. The pathological examination reported neuroendocrine cell hyperplasia. Conclusion: pancreatic endocrine cell hyperplasia should be considered in the differential diagnosis of solid pancreatic tumors. Laparoscopic surgery is feasible when the preoperative diagnosis with imaging tests of biopsy is not possible.

Nuevo coronavirus (COVID-19). Un análisis bibliométrico / Coronavirus disease (COVID-19). A bibliometric analysis

The new coronavirus pandemic (COVID-19) has spread to 180 countries, causing more than half a million confirmed cases and more than 40 thousand deaths. The main objective of this study was to analyze the world scientific production related to COVID-19. A literature search was performed using the Scopus database. A total of 547 published documents were identified, analyzing characteristics such as: type of publication, collaboration index, most productive countries, scientific journals, the institutions that are publishing the most on the subject and indicators of citations and impact. China was ranked first with 213 published documents (20.9%). Regarding the journals with the higher number of published documents, these were , and the . Likewise, was identified as the institution presenting the highest leadership regarding the number of publications. The total number of citations for all the publications was of 1.685. The h-index of the retrieved articles was of 42, and four articles were found with more than 100 quotations. This study offers a first approach to the global efforts aimed to this new area of research, which in only three months has substantially increased, and is expected to remain being prolific.

La pandemia del nuevo coronavirus (COVID-19) se ha extendido a 180 países, ocasionando más de medio millón de casos confirmados y más de 40.000 muertes. El objetivo principal de este estudio fue analizar la producción científica mundial relacionada con el COVID-19. Se realizó una búsqueda bibliográfica utilizando la base de datos Scopus. Se identificaron un total de 547 documentos publicados, analizándose características tales como: modalidad de publicación, los índices de colaboración, los países más productivos, las revistas científicas, las instituciones que más están publicando sobre el tema e indicadores de citación e impacto. Se identifica a China como el país que ocupa el primer lugar con 213 (20,9%) documentos publicados. Por su parte, , y el son las revistas con mayor número de documentos publicados. A su vez, se identifica a la como la institución que presenta mayor liderazgo respecto al número de publicaciones. El número total de citas de todas las publicaciones fue de 1.685, el índice h de los artículos recuperados fue de 42 y se ubican cuatro artículos con más de 100 citas. El presente estudio ofrece una primera aproximación a los esfuerzos globales dirigidos a esta nueva área de investigación, que en solo tres meses se ha incrementado de forma sustancial y que se estima continúe siendo prolífica.

Sepsis neonatal: aspectos fisiopatológicos y biomarcadores / Neonatal sepsis: physiopathology and biomarkers

Resumen La sepsis neonatal es una causa importante de morbilidad y mortalidad en recién nacidos a nivel mundial. Su diagnóstico es difícil por sus manifestaciones clínicas inespecíficas y la poca disponibilidad de métodos diagnósticos eficientes. En la fisiopatología de la sepsis se ha descrito una respuesta inmune excesiva o suprimida que puede conducir a desenlaces potencialmente fatales. Se ha estudiado la utilidad pronóstica, diagnóstica y de seguimiento de factores solubles que se alteran en la sepsis neonatal y se han agrupado bajo el término biomarcadores de sepsis neonatal. Aquí se describen los principios fisiopatológicos de la sepsis neonatal y las características de los biomarcadores más usados para su diagnóstico, además, se mencionan detalles de otros marcadores que también han sido estudiados recientemente. Actualmente, se recomienda el uso de un biomarcador temprano en combinación con uno tardío para lograr un mejor rendimiento, sin embargo, aún no se ha identificado un biomarcador ideal para la sepsis neonatal. MÉD.UIS.2019;32(3):35-47

Abstract Neonatal sepsis is a major cause of morbidity and mortality in newborns worldwide. Its diagnosis remains a challenge due to the nonspecific clinical findings and the lack of efficient diagnostic tools. In the physiopathology of neonatal sepsis, an excessive or suppressed immune response has been described, which can lead to potentially fatal conditions. The prognostic, diagnostic, and follow-up value of several soluble factors altered in neonatal sepsis has been studied. These have been grouped under the term neonatal sepsis biomarkers. Here, aspects of the physiopathology in neonatal sepsis and the characteristics of the most studied biomarkers used for neonatal sepsis diagnosis are described, also, details about other recently studied markers are mentioned. Currently, the use of an early-warning biomarker together with a late-warning biomarker is recommended to get higher diagnostic accuracy. However, a single ideal biomarker for neonatal sepsis has not been found yet. MÉD.UIS.2019;32(3):35-47

Vigilância da resistência a antibióticos contra o Helicobacter pylori na região do Biobío (Chile) em uma década / Antibiotic resistance surveillance of helicobacter pylori at the biobío region (chile) in a decade

ABSTRACT BACKGROUND: Helicobacter pylori infection in Chile remains as a public and private health-care system's challenge, with a prevalence of the infection over 70%. Nowadays, antibiotic treatment of the infection is mandatory to prevent the arising of severe associated diseases but failures in the eradication therapy mainly due to clarithromycin resistance has been observed worldwide and first line eradication therapy seems to be not effective anymore in several geographical areas. Thus, health-care systems are committed to maintain an epidemiological surveillance upon the evolution of the antibiotic resistance of this priority 2 pathogen. OBJECTIVE: This work reports a 10 years surveillance of the primary antibiotic resistance of H. pylori clinical isolates at the Biobío region-Chile, and the evolution of resistance toward amoxicillin, clarithromycin, levofloxacin, metronidazole, and tetracycline among the species. METHODS: H. pylori strains were investigated during the periods 2005-2007 (1435 patients analysed) and 2015-2017 (220 patients analysed) by inoculating a saline homogenate biopsy onto the surface of Columbia agar (Oxoid, Basingstoke, UK) - supplemented with 7% horse red blood cells plus DENT inhibitor (Oxoid, Basingstoke, UK) - following by incubation at 37ºC under 10% CO2 atmosphere for five days. Antibiotic resistance pattern of the isolates was assessed using the disk diffusion test in Müeller-Hinton agar supplemented with 7% horse red blood cells followed by incubation for further three days under 10% CO2 atmosphere. Statistical analysis was done using the SPSS v22 software and P values <0.05 were considered statistically significant. RESULTS: A total of 41% of 1435 patients were detected to be infected with H. pylori by bacteriological culture in 2005-2007 period, meanwhile 32.7% from 220 patients were also infected in 2015-2017 period. The clinical isolates of H. pylori are mostly susceptible to amoxicillin and tetracycline (both over 98% of strains), but less susceptible to levofloxacin in both periods analysed (over 79% of the strains). On the other hand, metronidazole continuous showing the highest score of resistant isolates (over 40% of resistant strains), although an 18% fewer resistant strains were observed in 2015-2017 period. Clarithromycin, the key antibiotic in eradication therapies, has an increased frequency of resistant strain isolated in the decade (22.5% in 2005-2007 and 29.2% in 2015-2017). Multidrug resistant strains (two, three and four antibiotics) were also detected in both periods with the highest scores for simultaneous resistance to clarithromycin-metronidazole (18%) and clarithromycin-metronidazole-levofloxacin (12.5%) resistant strains. According to gender, the isolates resistant to amoxicillin, clarithromycin and metronidazole were more frequent in female, with a specific increment in amoxicillin and clarithromycin resistance. CONCLUSION: The frequency of clarithromycin resistance (29.2%) detected in 2015-2017 suggests that conventional triple therapy is no longer effective in this region.

RESUMO CONTEXTO: A infecção por Helicobacter pylori no Chile permanece como um desafio do sistema de saúde público e privado, com prevalência da infecção acima de 70%. Hoje em dia, o tratamento antibiótico da infecção é obrigatório para prevenir o surgimento de graves doenças associadas, mas falhas na terapia de erradicação, principalmente devido à resistência à claritromicina, têm sido observadas em todo o mundo, e a terapia de erradicação de primeira linha parece não ser mais eficaz em várias áreas geográficas. Assim, os sistemas de saúde estão comprometidos em manter uma vigilância epidemiológica sobre a evolução da resistência aos antibióticos deste patógeno prioritário tipo 2. OBJETIVO: Este trabalho relata uma vigilância de 10 anos da resistência antibiótica primária de isolados clínicos de H. pylori na região do Biobío-Chile, e a evolução da resistência em relação à amoxicilina, claritromicina, levofloxacina, metronidazol e tetraciclina entre as espécies. MÉTODOS: As cepas de H. pylori foram investigadas durante os períodos 2005-2007 (1435 pacientes analisados) e 2015-2017 (220 pacientes analisados) inoculando uma biópsia de homogeneizado fisiológico na superfície do agar Columbia (Oxoid, Basingstoke, Reino Unido) - suplementado com 7% de glóbulos vermelhos do cavalo mais o inibidor de DENTE (Oxoid, Basingstoke, Reino Unido) - seguindo pela incubação em 37ºC a atmosfera de 10% de CO2 por cinco dias. O padrão de resistência aos antibióticos dos isolados foi avaliado utilizando-se o teste de difusão em disco em agar Müeller-Hinton suplementado com 7% de glóbulos vermelhos de cavalo seguidos de incubação por mais três dias a atmosfera de 10% de CO2. A análise estatística foi realizada utilizando-se o software SPSS V22 e os valores de P<0,5 foram considerados estatisticamente significantes. RESULTADOS: Um total de 41% dos 1435 pacientes foram detectados como contaminados por H. pylori pela cultura bacteriológica no período 2005-2007, ao mesmo tempo 32,7% de 220 pacientes foram contaminados igualmente no período 2015-2017. Os isolados clínicos de H. pylori são principalmente suscetíveis à amoxicilina e tetraciclina (tanto mais de 98% das cepas), mas menos suscetíveis à levofloxacina em ambos os períodos analisados (mais de 79% das cepas). Por outro lado, o metronidazol permaneceu mostrando a maior pontuação de resistentes isolados (mais de 40% de cepas resistentes), embora tenham sido observados 18% menos cepas resistentes no período de 2015-2017. A claritromicina, o antibiótico-chave em terapias de erradicação, tem uma frequência aumentada de cepa resistente isolada na década (22,5% em 2005-2007 e 29,2% em 2015-2017). Cepas multirresistentes (dois, três e quatro antibióticos) também foram detectadas em ambos os períodos com os maiores escores de resistência simultânea à claritromicina-metronidazol (18%) e claritromicina-metronidazol-levofloxacina (12,5%) cepas resistentes. De acordo com o sexo, os isolados resistentes à amoxicilina, claritromicina e metronidazol foram mais frequentes no sexo feminino, com incremento específico em amoxicilina e resistência à claritromicina. CONCLUSÃO: A frequência de resistência à claritromicina (29,2%) detectada em 2015-2017 sugere que a terapia tripla convencional não é mais efetiva nesta região.

Visual scanning preferences in low birth weight preterm infants / Preferências de rastreamento visual em prematuros nascidos com baixo peso

Abstract Introduction Few studies have used eye tracking as a screening tool for autism spectrum disorder (ASD) in preterm infants. Objectives To evaluate fixation time on social and non-social figures and percentage of preterm babies who gazed at the images. Methods This was a cross-sectional study of 31 preterm infants born weighing ≤ 2,000 g in which eye gaze was evaluated at 6 months of corrected age. Six boards with social and non-social figures were projected on a computer screen, successively, evaluating time and percentage of preterm babies who gazed at each board. The Modified Checklist for Autism in Toddlers (M-CHAT) was answered at 18 months of corrected age. Results Preterm infants showed longer visual fixation time on social figures compared with non-social images, regardless of the position of the social figure on the board. Similar percentages of preterm infants gazed either at social or non-social figures, at social figures with a direct or an indirect look, and at the eyes or mouth of the social figures. No preterm infant screened positive on the M-CHAT. Conclusion At 6 months of corrected age, preterm infants show the ability to gaze in an eye-tracking test, with preference for social figures, suggesting that this tool could be useful as another screening instrument for ASD.

Resumo Introdução Poucos estudos utilizaram a varredura visual como ferramenta para rastreamento de transtorno do espectro do autismo (TEA) em bebês prematuros. Objetivos Avaliar bebês prematuros quanto ao o tempo de fixação de olhar em figuras sociais e não sociais e a porcentagem deles que olharam para as imagens. Métodos Este estudo transversal incluiu 31 bebês prematuros com ≤ 2.000 g ao nascer, cujo rastreamento visual foi avaliado aos 6 meses de idade corrigida. Seis pranchas com figuras sociais e não sociais foram projetadas em tela de computador, sucessivamente, avaliando-se o tempo e porcentagem de prematuros que olharam para cada prancha. O Modified Checklist for Autism in Toddlers (M-CHAT) foi respondido aos 18 meses de idade corrigida. Resultados Os bebês prematuros apresentaram maior tempo de fixação visual em figuras sociais do que não sociais, independentemente da posição da figura social na prancha. Porcentagens similares de prematuros olharam tanto para figuras sociais como para não sociais, para figuras sociais com olhar direto ou indireto, e para boca ou olhos das figuras sociais. Nenhum prematuro foi rastreado positivamente pelo M-CHAT. Conclusão Aos 6 meses de idade corrigida, prematuros apresentaram habilidade para varredura em teste de rastreamento visual, com preferência por figuras sociais, sugerindo que esta ferramenta pode ser útil como mais um instrumento para rastreamento de TEA.