Factors related to academic performance in medical students / Factores relacionados con el desempeño académico en estudiantes de medicina

Abstract Introduction Academic performance in medical students can be influenced by several factors, including those related to mental health and family relationships. Objective To examine the factors affecting academic performance in medical students, specifically considering potential diagnoses of depression. Method A survey was conducted among 747 fourth-year medical students. The survey included questions on sociodemographic variables, mental health, and well-being. The Patient Health Questionnaire (PHQ) was utilized, encompassing sections on depression, anxiety, panic, eating habits, alcohol consumption, and the Stress Perception Scale. Academic performance was assessed based on students' Grade Point Average (GPA). Descriptive statistics, Pearson correlation coefficients, and a linear regression model were employed for data analysis. Results The study revealed several variables significantly associated with GPA. Age (r = -.388), financial situation (r = .241), relationships with cohabitants (r = .165), and relationships with peers (r = .217) were found to have a correlation with academic performance. Additionally, repeating a course was found to be significantly associated with a person's GPA (r = .518) even after controlling for depression. Discussion and conclusion The findings indicate that robust mental health, a favorable financial situation, and positive interpersonal relationships are crucial for achieving optimal academic performance in medical students. These results emphasize the need to address mental health concerns, promote a supportive social environment, and provide financial assistance to enhance the educational outcomes of medical students.

Resumen Introducción El desempeño académico de los estudiantes de medicina puede verse influenciado por varios factores, entre ellos los relacionados con la salud mental y las relaciones familiares. Objetivo Examinar los factores que afectan el desempeño académico en estudiantes de medicina, considerando específicamente los posibles diagnósticos de depresión. Método Se realizó una encuesta entre 747 estudiantes de cuarto año de la carrera de medicina. La encuesta incluyó preguntas sobre variables sociodemográficas, salud mental y bienestar. Se utilizó el Cuestionario de Salud del Paciente (PHQ), que comprende secciones sobre depresión, ansiedad, pánico, hábitos alimentarios, consumo de alcohol y la Escala de Percepción del Estrés. El desempeño académico se evaluó con base en el promedio de calificaciones (GPA) de los estudiantes. Se emplearon estadísticas descriptivas, coeficientes de correlación de Pearson y un modelo de regresión lineal para el análisis de datos. Resultados El estudio reveló varias variables significativamente asociadas con el GPA. Se encontró que la edad (r = -.388), la situación financiera (r = .241), las relaciones con los convivientes (r = .165) y las relaciones con los compañeros (r = .217) tenían correlación con el rendimiento académico. Además, se encontró que repetir un curso estaba significativamente asociado con el GPA de una persona (r = .518) incluso después de controlar la depresión. Discusión y conclusión Los hallazgos indican que una salud mental sólida, una situación financiera favorable y relaciones interpersonales positivas son cruciales para lograr un desempeño académico óptimo en los estudiantes de medicina. Estos resultados enfatizan la necesidad de abordar los problemas de salud mental, promover un entorno social de apoyo y brindar asistencia financiera para mejorar los resultados educativos de los estudiantes de medicina.

"Me echaron de mi casa, empecé a trabajar en la calle": interseccionalidad y apartheid ocupacional en el trabajo sexual. Un estudio de caso / "Eles me expulsaram da minha casa, comecei a trabalhar na rua": interseccionalidade e apartheid ocupacional no trabalho sexual. Um estudo de caso / "They kicked me out of my house, I started working on the street": intersectionality and occupational apartheid in sex work. A case study

Resumen Introducción Las mujeres que se han dedicado al trabajo sexual han sido una comunidad estigmatizada, marginada y alienada socialmente. Particularmente, en el caso de las mujeres trans la situación ha sido peor, enfrentando mayores porcentajes de violencia. Objetivo Analizar la historia de vida de una mujer trans que se desempeña en el trabajo sexual, a partir de un análisis interseccional y ocupacional. Método Empleamos un estudio cualitativo basado en la técnica de investigación Historia de Vida, considerando elementos de la entrevista narrativa ocupacional. Resultados Desde su historia, podemos ver que hay elementos que han interseccionado a lo largo de su vida, tales como los dominios: estructural, disciplinar, hegemónico e interpersonal. Sus elecciones ocupacionales han estado fuertemente influenciadas por su contexto dentro de un apartheid ocupacional, buscando la generación de espacios de resistencia y agencia frente a las diferentes adversidades. Conclusiones Estas situaciones precarizan sus condiciones de vida y ponen en alerta las influencias de los sistemas económicos, políticos, heteronormados, entre otros, en la determinación de la vida de las personas.

Resumo Introdução As mulheres que se envolvem em trabalho sexual têm sido uma comunidade estigmatizada, marginalizada e socialmente alienada. Particularmente no caso das mulheres trans, há o enfrentamento de maiores porcentagens de violência. Objetivo Analisar a história de vida de uma mulher trans que atua no trabalho sexual, a partir de uma análise interseccional e ocupacional. Método Utilizou-se um estudo qualitativo baseado na técnica de pesquisa História de Vida, considerando elementos da entrevista narrativa ocupacional. Resultados A partir de sua história, podemos perceber que há elementos que se cruzaram ao longo de sua vida, como os domínios: estrutural, disciplinar, hegemônico e interpessoal. E que suas escolhas ocupacionais foram fortemente influenciadas por seu contexto dentro de um apartheid ocupacional, buscando gerar espaços de resistência e agenciamento diante de diferentes adversidades. Conclusões Essas situações tornam suas condições de vida precárias e alertam para as influências de sistemas econômicos, políticos, heteronormativos, entre outros, na determinação da vida das pessoas.

Abstract Introduction Women who have engaged in sex work have been a stigmatized, marginalized, and socially alienated community. Particularly, in the case of trans women, there is a bigger percentage of violence. Objective To analyze the life story of a trans woman who works in sex work, based on an intersectional and occupational analysis. Method We used a qualitative study based on the Life History research technique, considering elements of the occupational narrative interview. Results From her history, we can see that there are elements that have intersected throughout her life, such as the domains: structural, disciplinary, hegemonic, and interpersonal. And that her occupational choices have been strongly influenced by her context within occupational apartheid, seeking to generate spaces of resistance and agency in the face of different adversities. Conclusions These situations make her living conditions precarious and alert the influences of economic, political, and heteronormative systems, among others, in determining people's lives.

Diseño y validación de instrumentos para valorar la postura de sedestación y motricidad fina en alumnado de primaria / Design And Validation of Instruments for Assessing Sitting Posture and Fine Motor Function in Primary School Students

Resumen Los niños y las niñas en edad escolar pueden pasar aproximadamente un 80 % de su jornada escolar haciendo uso de la silla. Debido a esta situación, diferentes estudios establecen una relación entre postura y problemas de salud. Señalan además, que las dificultades de escritura pueden afectar la percepción de las propias capacidades. Debido a estos resultados, se ha insistido en la importancia de inculcar hábitos posturales y grafomotrices adecuados desde edades tempranas. Los objetivos principales de este estudio fueron, por un lado, diseñar instrumentos de observación y recolección de datos de los patrones posturales y de grafomotricidad; por otro, validar dichos instrumentos mediante la opinión de personas expertas. Como objetivo secundario se consideró evaluar la consistencia interna del instrumento para valorar la postura de sedestación. En relación con el primer objetivo, ambos instrumentos mostraron valores altos de concordancia inter jueces en cuanto a la pertinencia y precisión de los ítems. Con respecto al segundo, los instrumentos fueron aplicados a una muestra de 93 niños y niñas de 1º y 5º curso de Educación primaria para evaluar la consistencia interna del instrumento postura. Los resultados de confiabilidad por dimensiones mostraron unos valores superiores a 0.7. Los instrumentos diseñados se presentan como herramientas útiles para valorar los patrones relacionados con la postura y la grafomotricidad y contribuir así a la detección de problemas asociados en niños y niñas en edad escolar. En conclusión, estos instrumentos pueden ofrecer directrices adecuadas para elaborar planes de trabajo destinados a atender las necesidades que presente el alumnado.

Abstract Schoolchildren can spend around 80% of their school day sat. In this sense, different studies establish a direct relationship between posture and health problems. Moreover, writing difficulties can also affect the perception of abilities, hence the importance of instilling proper postural and graphomotor habits from an early age. The main objectives of this study were, on the one hand, to design instruments for observation and data collection of postural and graphomotricity patterns and, on the other hand, to validate these instruments through expert opinion. A secondary objective was to evaluate the internal consistency of the instrument to assess the posture of sedestation. Concerning the first objective, both instruments showed high inter-judge concordance in terms of relevance and precision of the items. In relation to the second objective, the instruments were applied to a sample of 93 children from the 1st and 5th grades of primary school to evaluate their internal consistency of the posture instrument. Dimensional reliability results showed values greater than 0.7. The instruments designed are presented as useful tools to assess the patterns related to posture and graphomotricity and thus contribute to detecting problems associated with school-age children. In conclusion, these instruments can provide appropriate guidelines for the development of work plans to meet the needs of students.

Resumo As crianças em idade escolar podem passar aproximadamente 80% do seu dia escolar numa cadeira. Devido a esta situação, diferentes estudos estabelecem uma ligação entre a postura e os problemas de saúde. Eles também apontam que as dificuldades de escrita podem afetar a percepção das próprias habilidades. Devido a estes resultados, a importância de incutir hábitos postural e de caligrafia adequados desde uma idade precoce tem sido enfatizada. Os principais objetivos deste estudo foram, por um lado, conceber instrumentos de observação e recolha de dados de padrões posturais e grafomotores; por outro lado, validar estes instrumentos através da opinião de peritos. Um objetivo secundário foi avaliar a consistência interna do instrumento para provar a postura sentada. Em relação ao primeiro objetivo, ambos os instrumentos mostraram altos valores de concordância entre juízes em termos de relevância e precisão dos itens. Em relação ao segundo objetivo, os instrumentos foram administrados a uma amostra de 93 crianças do 1º e 5º anos do ensino fundamental para avaliar a consistência interna do instrumento de postura. Os resultados da confiabilidade por dimensões mostraram valores acima de 0,7. Os instrumentos desenhados são apresentados como ferramentas úteis para avaliar a postura e os padrões grafomotores e assim contribuir para a detecção de problemas associados em crianças em idade escolar. Em conclusão, estes instrumentos podem fornecer orientações apropriadas para o desenvolvimento de planos de trabalho que respondam às necessidades estudantis.

Características epidemiológicas y clínicas de los niños con COVID-19 asistidos en un prestador de salud privado de Uruguay / Epidemiological and clinical characteristics of children with COVID-19 cared for in a private health provider in Uruguay

INTRODUCCIÓN: Tras la detección de los primeros casos de SARS-CoV-2 y declararse la emergencia sanitaria en el país, la transmisión comunitaria del virus se mantuvo baja a moderada hasta noviembre de 2020 pasando luego a ser media y alta. Los niños bajo 15 años de edad constituyen el grupo menos afectado. El diagnóstico se confirma mediante RT-qPCR. La utilidad del CT (cycle threshold) es discutida. Objetivo: Describir las características epidemiológicas y clínicas de los niños infectados con SARS-CoV-2 y la relación entre el valor del CT y la presentación clínica. METODOLOGÍA: Se realizó un estudio descriptivo, retrospectivo, en pacientes bajo 16 años de edad con infección por SARS-CoV-2, asistidos en un prestador de salud de Montevideo entre la semana epidemiológica (S.E.) 3 del 2020 y la SE 9 del 2021. Se describieron variables clínicas, noción epidemiológica, gravedad y evolución. Se consignó el valor del CT al diagnóstico y se comparó con la presencia de síntomas. RESULTADOS: Los pacientes bajo 16 años representaron el 16,6% del total de infectados (794 en 4.792). El 70% de los casos ocurrió entre los meses de enero y febrero de 2021. El 67,6% presentó contacto intradomiciliario. La media de edad fue 7,5 ± 4,1 años, 51% de sexo masculino. Presentaron síntomas 55% y fueron asintomáticos 45%; no se observaron diferencias significativas en la media, moda y rango de edades de ambos grupos. Ninguno presentó comorbilidades. En el grupo de los 440 pacientes sintomáticos, 55% presentaron fiebre: 32% asociada con otros síntomas, principalmente respiratorios altos y 23% como único síntoma. El valor de CT se obtuvo en 536 de los 794 pacientes (67,5%). La media de CT fue 29,7 ± 5,8 en el grupo de sintomáticos vs. 31,5 ± 5,7 en asintomáticos (p > 0,05). Se hospitalizaron tres pacientes, ninguno requirió cuidados intensivos ni falleció. CONCLUSIONES: La prevalencia e incidencia de la infección por SARS-CoV-2 en niños acompañan a la de adultos y la mayoría cursó formas leves o asintomáticas, sin complicaciones. En esta serie, el valor de CT no fue diferente en niños sintomáticos y asintomáticos. El contacto estrecho intradomiciliario fue la principal fuente de infección.

BACKGROUND: After the detection of the first cases of SARS-CoV-2 and the declaration of a health emergency in the country, community transmission of the virus remained low to moderate until November 2020, later becoming medium and high. Children under 15 years of age constitute the least affected group. The diagnosis is confirmed by RT-qPCR. The usefulness of the CT (cycle threshold) is discussed. AIM: To describe the epidemiological and clinical characteristics of children infected with SARS-CoV-2 and the relationship between the CT value and clinical presentation. METHOD: A descriptive, retrospective study was carried out in patients under 16 years of age with SARS-CoV-2 infection, assisted by a health provider in Montevideo between epidemiological week (EW) 3 of2020 and EW 9 of2021. Clinical variables, epidemiological notion, severity and evolution were described. The CT value at diagnosis was recorded and compared with the presence of symptoms. RESULTS: Patients under 16 years of age represented 16.6% of the total infected (794 in 4,792). 70% of the cases occurred between the months of January and February 2021. 67.6% presented intradomiciliary contact. The mean age was 7.5 ± 4.1 years, 51% were male. 55% presented symptoms and 45% were asymptomatic; no significant differences were observed in the mean, mode and age range of both groups. None presented comorbidities. In the group of 440 symptomatic patients, 55% presented fever: 32% associated with other symptoms, mainly upper respiratory symptoms, and 23% as the only symptom. The CT value was obtained in 536 of the 794 patients (67.5%). The mean CT was 29.7+5.8 in the symptomatic group vs. 31.5 ± 5.7 in asymptomatic patients (p > 0.05). Three patients were hospitalized, none required intensive care and none died. CONCLUSIONS: The prevalence and incidence of SARS-CoV-2 infection in children accompany that of adults and the majority had mild or asymptomatic forms, without complications. In this series, the CT value was not different in symptomatic and asymptomatic children. Close household contact was the main source of infection.

Características sociodemográficas, clínicas y familiares de pacientes con trastornos mentales de una unidad médica familiar / Sociodemographic, clinical and family characteristics of patients with mental disorders in a family medical unit

RESUMEN: Objetivo: Determinar las características epidemiológicas, clínicas y familiares de los pacientes con trastornos mentales adscritos a una unidad de medicina familiar (UMF) mexicana. Material y métodos: Estudio prospectivo, transversal, observacional, descriptivo, sobre 164 pacientes adscritos a una UMF mexicana, elegidos por muestreo no probabilístico que cumplieron criterios de selección: mayores de 18 años, con trastorno mental, sin impedimento físico o cognitivo. Resultados: Se presentaron 51 hombres y 113 mujeres con edad promedio de 48,6 años; 57% con más de un trastorno mental; los más frecuentes fueron depresión y ansiedad. En escolaridad sobresale licenciatura; 16% reportaron intento de suicidio, 42% tiene más de 6 años diagnosticado. El 64,6% recibe psicoterapia y farmacología; el 18% fue hospitalizado a causa de sus trastornos, gran parte de ellos entre 1 y 4 semanas y 38% tiene algún familiar con algún trastorno mental, Las comorbilidades más frecuentes fueron Hipertensión, obesidad, diabetes mellitus, dislipidemia y artrosis. Los tipos de familia más frecuentes son: nuclear o nuclear simple, con núcleo integrado y núcleo no integrado; subsisten principalmente de los servicios; viven con niveles 1 y 2 de pobreza familiar; son modernas y urbanas en mayor número. Conclusiones: las características sociodemográficas, clínicas y familiares de los pacientes con trastornos mentales adscritos a una unidad de medicina familiar (UMF) mexicana son en su mayoría mujeres, en adultez media, que cursan con más de un trastorno mental (ansiedad y depresión), tratadas con fármacos y psicoterapia, además cursaban con hipertensión, y pertenecen a familias de tipo nuclear simple, de núcleo integrado y núcleo no; subsisten por servicios; viven con niveles 1 y 2 de pobreza familiar, son modernas y urbanas.

ABSTRACT: Objective: To determine the epidemiological, clinical and family characteristics of patients with mental disorders assigned to a Mexican family medicine unit (FMU). Material and methods: Prospective, cross-sectional, observational, descriptive study of 164 patients assigned to a Mexican FMU, chosen by non-probabilistic evidence that they met the selection criteria: older than 18 years, with mental disorder, without physical or cognitive impairment. Results: 51 men and 113 women with a mean age of 48.6 years were presented; 57% with more than one mental disorder; the most frequent were depression and anxiety. In schooling overselling bachelor's degree; 16% reported attempted suicide, 42% have been diagnosed for more than 6 years. 64.6% receive psychotherapy and pharmacology; 18% were hospitalized due to their disorders, most of them between 1 and 4 weeks and 38% have a family member with a mental disorder. The most frequent comorbidities were hypertension, obesity, diabetes mellitus, dyslipidemia and osteoarthritis. The most frequent types of family are: nuclear or simple nuclear, with integrated nucleus and non-integrated nucleus; they subsist mainly on services; they live with levels 1 and 2 of family poverty; are modern and urban in greater number. Conclusions: the epidemiological, clinical and family characteristics of patients with mental disorders assigned to a Mexican family medicine unit (FMU) are mostly women, in middle adulthood, who attend more than a mental disorder (anxiety and depression), treated with drugs and psychotherapy, also had hypertension, and belong to families of simple nuclear type and non-integrated nucleus; subsist on services; they live with levels 1 and 2 of family poverty, they are modern and urban.

Efectividad del gel de clorhexidina y pasta de hidróxido de calcio con clorhexidina como medicamento intraconducto en la eliminación del Enterococcus faecalis / Effectiveness of chlorhexidine gel and calcium hydroxide paste with chlorhexidine as intracanal medicaments in Enterococcus faecalis elimination

El objetivo de este estudio es conocer la efectividad del gel de clorhexidina y pasta de hidróxido de calcio con clorhexidina como medicamento intracanal en la eliminación del Enterococcus faecalis (E. faecalis). Se realizó una revisión bibliográfica mediante una búsqueda exhaustiva en diferentes bases de datos como: PubMed, ScienceDirect, SciELO, Springer, Google Scholar. Se seleccionaron mediante los criterios de inclusión y exclusión 37 artículos publicados en el periodo 2003-2020, los cuales fueron enfocados especialmente en E. faecalis y medicación intracanal. Teniendo como resultados que la clorhexidina en mayor porcentaje resultó ser el medicamento intracanal más eficaz en un tiempo promedio de 7 días, seguida de la combinación de hidróxido de calcio más clorhexidina que actuó de igual manera eliminando el E. faecalis de los canales radiculares, mientras que el hidróxido de calcio no presentó actividad antimicrobiana frente al E. faecalis.

The aim of this study was to know the effectiveness of chlorhexidine gel and calcium hydroxide paste with chlorhexidine as intracanal medicaments in Enterococcus faecalis(E. faecalis) elimination. A bibliographic review was done through an exhaustive search in different databases such as: PubMed, ScienceDirect, Scielo, Springer, Google Scholar. Using inclusion and exclusion criteria, 37 articles published in the period 2003-2020 were selected, which were especially focused on E. faecalis and intracanal medication. The analysis showed that chlorhexidine in a higher percentage was the most effective intracanal medication in an average time of 7 days, followed by the combination of calcium hydroxide plus chlorhexidine that acted in the same way eliminating E. faecalisfrom the root canals, while calcium hydroxide did not show any antimicrobial activity against E. faecalis.

Toxoplasmosis en sistema nervioso central: revisión sobre la patología, abordaje diagnóstico y tratamiento / Toxoplasmosis in the central nervous system: Review of the pathology, diagnostic approach and treatment

RESUMEN La toxoplasmosis es una de las infecciones más comunes en humanos. Debido a la prevalência de la coinfección con VIH, conlleva un alto impacto en los sistemas de salud. Los seres humanos pueden infectarse de toxoplasma al consumir carne mal cocinada de cordero o cerdo que contenga los quistes tisulares, o al consumir agua o alimentos contaminados con heces de gatos. Una vez presente en el humano, el T. gondii se multiplica en los enterocitos y se disemina por el torrente sanguíneo o linfático, parasitando las células musculares, de la retina y frecuentemente el sistema nervioso central. La técnica más usada para la detección de IgG o IgM contra toxoplasma es la técnica de Elisa. Los anticuerpos IgG pueden estar elevados sin tener una infección activa, por lo que el diagnóstico con IgM y posteriormente con test de avidez es fundamental. El líquido cefalorraquídeo muestra pleocitosis leve e hiperproteinorraquia. Las neuroimágenes son de alta utilidad, ya que usualmente la punción lumbar puede estar contraindicada por lesiones que producen efecto de masa. Idealmente, los pacientes deben ser valorados con resonancia magnética en la que típicamente se observan lesiones eccéntricas en ganglios basales con realce en anillo, posteriormente a la aplicación de contraste. Se debe considerar el linfoma del sistema nervioso central como diagnóstico diferencial. El tratamiento suele iniciarse de manera empírica con pirimetamina, sulfadiazina y ácido folínico, con evaluación de la mejoría imagenológica a los 10-14 días. Si no se encuentra disponible, es posible el tratamiento con trimetoprin-sulfametoxazol. El inicio temprano del tratamiento antibiótico es fundamental para el buen pronóstico; en cuatro meses se observa recuperación neurológica completa en menos del 20 % de los casos y a los tres años de seguimiento en aproximadamente el 30 % de los pacientes.

SUMMARY Toxoplasmosis is one of the most common infections in humans. Due to the prevalence of coinfection with HIV, it carries a high impact on health systems. Humans can become infected with toxoplasma by consuming undercooked lamb or pork meat that contains tissue cysts, or by consuming water or food contaminated with cat feces. Once present in humans, T. gondii multiplies in enterocytes and spreads through the blood or lymphatic stream, parasitizing muscle cells, the retina, and frequently the Central Nervous System. The most used technique for the detection of IgG or IgM against toxoplasma is the ELISA technique. IgG antibodies can be elevated without having an active infection, so diagnosis with IgM and later with avidity test is essential. Cerebrospinal fluid shows mild pleocytosis and hyperprotein spinal cord. Neuroimaging is highly useful, since lumbar puncture can usually be contraindicated due to lesions that produce a mass effect. Ideally, patients should be evaluated with magnetic resonance imaging, which typically shows eccentric lesions in the basal ganglia with ring enhancement after the application of contrast. Central Nervous System lymphoma should be considered as a differential diagnosis. Treatment is usually started empirically with pyrimethamine, sulfadiazine, and folinic acid, with evaluation of imaging improvement at 10-14 days. If not available, treatment with trimethoprine-sulfamethoxazole is possible. The early initiation of antibiotic treatment is essential for a good prognosis, in 4 months complete neurological recovery is observed in less than 20 % of cases and after 3 years of follow-up in approximately 30 % of patients.

Producción de leche real vs la calculada a partir de la ENL estimada por el algoritmo de análisis de imágenes red-green-blue de gramíneas / Produção real de leite vs produção de leite calculada a partir da energía líquida de lactação estimada pelo algoritmo para análise de imagens vermelho-verde-azul de gramíneas

ABSTRACT: Knowledge about the net lactation energy (NLE) contained in the dry matter of grasses is necessary to make decisions about forage and the balance of diets for grazing cattle. Its determination is made in laboratories using wet or dry chemistry methods, which are costly, delayed, and sometimes present sampling- or process-related reliability problems. An algorithm, which analyzes the red-green-blue (RGB) images of grasses taken by drone, has been developed as a technological alternative. This has allowed us estimating the NLE level, reducing costs, and changing the sampling system and analysis method. The objective of the present study was to compare the milk production, which was calculated from the NLE and estimated using the algorithm for analysis of RGB images of grasses (included in the TaurusWebs® software), vs the actual milk production. The study was conducted in 15 dairy farms belonging to the dairy control system of the Colácteos dairy cooperative, which are located in the upper tropical region (Department of Nariño, Colombia). The prairies evaluated were composed of mixtures of Kikuyo (Pennisetum clandestinum), Raigrás (Lolium spp), and False Poa (Holcus lanatus). The result was analyzed using a linear regression model (R²=0.86; R=0.93). In the Student´s t-test, the actual and estimated milk production averages were equal (P>0.05). In conclusion, the NLE calculated using the algorithm satisfactorily explains the study livestock production, and the information generated by the algorithm can be used to calculate the NLE of grasses.

RESUMO: O conhecimento sobre a energia líquida de lactação (NLE) contida na matéria seca das gramíneas é necessário para a tomada de decisões sobre forragem e o equilíbrio das dietas para pastagem. Sua determinação é feita em laboratórios usando métodos de química úmida ou seca, que são dispendiosos, atrasados e às vezes apresentam problemas de confiabilidade relacionados a amostras ou processos. Um algoritmo, que avalia as imagens vermelho-verde-azul (RGB) de gramíneas tiradas por drone, foi desenvolvido como uma alternativa tecnológica. Isso nos permitiu estimar o nível de NLE, reduzir custos e alterar o sistema de amostragem e o método de análise. O objetivo do presente estudo foi comparar a produção de leite, calculada a partir do NLE e estimada usando o algoritmo para análise de imagens RGB de gramíneas (incluídas no software TaurusWebs®) versus a produção real de leite. O estudo foi realizado em 15 fazendas leiteiras pertencentes ao sistema de controle de laticínios da cooperativa de laticínios Colácteos, localizada na região tropical superior (Departamento de Nariño, Colômbia). As pradarias avaliadas foram compostas por misturas de Kikuyo (Pennisetum clandestinum), Raigrás (Lolium spp) e False Poa (Holcus lanatus). O resultado foi analisado usando um modelo de regressão linear (R² = 0,86; R = 0,93). No teste t de Student, as médias reais e estimadas de produção de leite foram iguais (P> 0,05). Em conclusão, o NLE calculado usando o algoritmo explica satisfatoriamente a produção animal estudada, e as informações geradas pelo algoritmo podem ser usadas para calcular o NLE das gramíneas.

Covid-19 y la odontología latinoamericana para pacientes con necesidades especiales / Covid-19 and latin american dentistry for patients with special needs / Covid-19 and dental care for patients with special needs in Latin America

Resumen La región de América Latina se ha convertido en la más afectada del mundo por la pandemia del COVID-19. Y personas con necesidades especiales, población ya vulnerable, están sufriendo un impacto significativo de la crisis actual. Dado que estas personas no pueden dejar de ser protegidas y cuidadas, un grupo de profesores de 10 países de América Latina se reunió para analizar la situación de la odontología para pacientes con necesidades especiales en la región. En todos los países, se evidenció que el confinamiento y las restricciones de desplazamiento están interrumpiendo el acceso a bienes y servicios esenciales para ellos. En cuanto a la odontología, la disposición general es posponer los procedimientos de rutina, a menos que sean clínicamente urgentes o de emergencia; adoptar estrictas medidas de protección personal y evitar o minimizar las intervenciones que puedan producir aerosoles. La atención odontológica remota, teleodontología, se considera como una herramienta fundamental en este momento, ya que permite evaluar la necesidad de atención presencial y ofrecer soporte, información y seguridad a los pacientes y familias. La pandemia nos ha demostrado, a todos, que impulsar la Promoción de la Salud es el verdadero camino, y que no debemos esperar a que se presenten condiciones que afecten la calidad de vida.

Resumo: A região da América Latina tem se tornado a mais afetada do mundo pela pandemia do COVID-19. E as pessoas com necessidades especiais, população já vulnerável, estão sofrendo um impacto significativo da crise atual. Uma vez que essas pessoas não podem deixar de ser protegidas e cuidadas, um grupo de professores de 10 países de América Latina se reuniu para analisar a situação da odontologia para pacientes com necessidades especiais na região. Em todos os países se verificaram que o confinamento e restrições de movimento estavam interrompendo o acesso a bens e serviços essenciais para eles. Para a odontologia, a orientação geral é adiar procedimentos de rotina, a menos que seja clinicamente urgente ou emergencial; adotar medidas rígidas de proteção individual e evitar ou minimizar intervenções que possam produzir aerossóis. O atendimento odontológico à distância, teleodontología, é considerada uma ferramenta fundamental neste momento, pois permite avaliar a necessidade de atendimento presencial e oferecer suporte, informação e segurança aos pacientes e famílias. A pandemia tem demostrado, para todos, que trabalhar na Promoção da Saúde é o verdadeiro caminho, e que não devemos esperar por condições que afetem a qualidade de vida.

Abstract Latin America has become the most affected region by the COVID-19 pandemic in the world. People with special needs-an already vulnerable population-are suffering terrible consequences on account of this crisis. These people need to be protected and cared for at all times. Therefore, a group of lecturers from ten Latin American countries came together to analyze the regional situation of dental care for patients with special needs. Every country shows evidence that lockdowns and movement restrictions interrupt these people's access to essential goods and services. The general course of action regarding dental care is to postpone routine procedures unless they are clinically urgent or an emergency, implement strict personal protection measures and avoid or minimize processes that may produce aerosols. Remote dental care is considered essential these days since it allows practitioners to assess the need for face-to-face care and offer support, information, and safety to patients and families. The pandemic has shown us all that supporting health promotion is the true path and that we should not wait until conditions that affect people's quality of life appear to act.

Presencia de COVID-19 en Argentinos menores de 65 años / Presence of COVID-19 in Argentines under 65 years of age

Antecedentes: la presencia del virus COVID-19 se ha asociado con adultos de 65 años o más. Sin embargo, poco se ha destacado en los jóvenes. Objetivos: determinar la asociación de COVID-19 positivo y edad, sexo, índice de masa corporal (IMC), condiciones de salud subyacentes, hospitalización y muerte.Materiales y métodos: se realizó un estudio transversal en individuos de 18 a 65 años que fueron evaluados para COVID-19 en el Hospital de Agudos Carlos G. Durand de la Ciudad Autónoma de Buenos Aires, en julio de 2020, durante 15 días. Se calcularon datos sobre sexo, edad, tabaquismo, asma e hipertensión. Se utilizó reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR, del inglés reverse transcription polymerase chain reaction) para la detección del ácido ribonucleico ARN de SARS-CoV-2 (en inglés, severe acute respiratory syndrome coronavirus 2). Resultados: se incluyó en el estudio un total de 407 (225 femenino, 55,3%) individuos de 37,5±11,4 años. El 48,6% (189) fue confirmado COVID-19. El IMC promedio fue 27,5±5,2. El 37,1% (151) tenía sobrepeso y el 26,8% (109) era obeso. Hubo una prevalencia significativamente mayor de COVID-19 confirmada en personas con asma (7,9% vs 2,5%; p=0,01). El resultado COVID-19 confirmado se asoció con el sexo masculino (r=-0,12; p=0,02) y la presencia de asma (r=0,11; p=0,02). Los análisis de regresión logística múltiple mostraron que la COVID-19 confirmada se asoció con el sexo masculino (OR 0,62; IC del 95%: 0,42-0,93; p 0,02) y el asma (OR3,30; IC del 95%: 1,17-9,34; p 0,02) ajustado por variables de confusión. Hubo una mayor prevalencia de hipertensión (21,1% vs 5,4%; p=0,024) entre quienes fueron hospitalizados. La hospitalización se asoció con hipertensión (OR5,71 IC del 95%: 1,43-22,75; p 0,014) ajustada por variables de confusión. Conclusiones: la COVID-19 se diagnosticó en individuos menores de 65 años, que es un grupo de edad diferente al reportado habitualmente. La COVID-19 confirmada se asoció con el sexo masculino y el asma. La tasa de individuos hospitalizados fue del 4,4% y se asoció con hipertensión. La tasa de mortalidad de los examinados fue del 0%. Deben realizarse estudios longitudinales futuros para confirmar estos hallazgo

Background: the presence of the COVID-19 virus has been associated with adults aged 65 years and older. However, little has been highlighted in younger people. Objectives: to determine the association of positive COVID-19 and age, sex, body mass index (BMI), underlying health conditions, hospitalization, and death. Materials and methods: a cross-sectional study was performed in individuals aged 18 to 65 who were tested for COVID-19 at a Hospital in Buenos Aires in July 2020 over 15 days. Data on sex, age, smoking, asthma, and hypertension were assessed. RT-PCR was used for the detection of the RNA of SARS-CoV-2. Results: a total of 407 (225 female, 55.3%) individuals aged 37.5±11.4 were included in the study. 48.6% (189) were confirmed COVID-19. The average BMI was 27.5±5.2; 37.1% (151) were overweight and 26.8% (109) obese. There was a significantly higher prevalence of confirmed COVID-19 in individuals with asthma (7.9% vs 2.5%; p=0.01). Confirmed COVID-19 was associated with the male sex (r=-0.12; p=0.02) and the presence of asthma (r=0.11; p=0.02). Multiple logistic regression analyses showed that confirmed COVID-19 was associated with male sex (OR 0.62, 95% CI 0.42-0.93; p 0.02) and asthma (OR3.30, 95% CI 1.17-9.34; p 0.02) adjusted for confounding variables. There was a higher prevalence of hypertension (21.1% vs 5.4%; p=0.024) among those who were hospitalized. Hospitalization was associated with hypertension (OR5.71 95% CI 1.43-22.75; p 0.014) adjusted for confounding variables. Conclusions: we found that COVID-19 was diagnosed in individuals younger than 65 years, which is a different age group than the usually reported. Confirmed COVID-19 was associated with male sex and asthma. The rate of hospitalized individuals was 4.4% and was associated with hypertension. The mortality rate for those tested was 0%. Future longitudinal studies should be performed to confirm these findings

Rutas contra el silencio: análisis de los mecanismos para el manejo y prevención del acoso sexual al interior de la Universidad de Antioquia (Colombia) / Routes against silence: An analysis of the mechanisms for the management and prevention of sexual harassment within the University of Antioquia (Colombia)

Resumen En un momento histórico para el feminismo en el que la conversación sobre el acoso sexual toma fuerza, este trabajo decide indagar sobre el papel de las universidades como instituciones que deben garantizar la seguridad, integridad y salud de sus estudiantes; específicamente la Universidad de Antioquia. El texto se pregunta por la existencia de un protocolo que apoye a los estudiantes víctimas de acoso sexual en la universidad y utiliza una metodología que está dividida en tres etapas: la primera etapa hace una exploración de conceptos académicos y jurídicos que provean una guía acerca de los protocolos que deberían encontrarse; en la segunda etapa se analizan los hallazgos de la primera etapa de una forma crítica, en la tercera etapa se realiza la construcción y sugerencia de un protocolo que se ajuste al contexto de la universidad de Antioquia. Finalmente, se presentan una serie de conclusiones en torno a dichos protocolos y la importancia de una política formal institucional que prevenga, sancione y sensibilice en el tema.

Abstract At a historic moment for feminism in which conversation about sexual harassment takes hold, this work decides to inquire about the role of universities as institutions that must ensure the safety, integrity, and health of their students; specifically the University of Antioquia. This text asks about the existence of a protocol, which supports students who are victims of sexual harassment at the university, and it uses a methodology, which is divided into three stages: the first stage explores academic and legal concepts that provide a guidance on the protocols that should be found. In the second stage, the findings of the first stage are analyzed in a critical way, and in the third stage, the construction and suggestion of a protocol that conforms to the context of the University of Antioquia is carried out. Finally, a number of conclusions are presented around these protocols and the importance of a formal institutional policy that prevents, sanctions, and sensitizes on the issue.

PET-CT en la Epilepsia Refractaria / PET-CT in Drug Resistant Epilepsy

La epilepsia es un trastorno neurológico frecuente en países en vías de desarrollo. Aproximadamente el 30 a 40% es refractaria al tratamiento. El tratamiento quirúrgico en la epilepsia refractaria es una opción en los pacientes con foco epileptógeno único localizado fuera de una zona elocuente. La selección adecuada del paciente es la clave para éxito del tratamiento. La tomografía por emisión de positrones (PET-CT) ha demostrado gran utilidad en la evaluación prequirúrgica en los pacientes con epilepsia refractaria al tratamiento.

Epilepsy is a frequent neurological disorder in developing countries. Approximately 30 to 40% is refractory to treatment. Surgical treatment in drug resistant epilepsy is an option in patients with a single epileptogenic focus located outside of an eloquent area. Adequate patient selection is the key to treatment success. Positron emission tomography (PET-CT) has shown great utility in pre-surgical evaluation in patients with epilepsy drug resistant epilepsy.

Detección precoz de vicios posturales que determinan alteraciones osteomioarticulares en jóvenes / Dearly detection of postural vices determining osteomioarticular alterations in young people

Introducción: La postura corporal se define como la posición de todo el cuerpo o de un segmento de éste en relación con la gravedad. Objetivos: Detectar los vicios posturales en jóvenes. Determinar cuáles de los vicios posturales son frecuentes en los jóvenes. Caracterizar a la población estudiada. Materiales y métodos: diseño metodológico descriptivo observacional de corte trasversal, donde se evaluó la postura a 55 jóvenes utilizando una ficha de evaluación postural preestablecida. Resultados: El 96% de las personas evaluadas presentan vicios posturales, el 80% de las alteraciones de la columna se observa en el plano lateral, 64.4% en el plano antero posterior; en los miembros inferiores un 49% presenta genu recurvatum, 54.3% en la pelvis como anteversión y retroversión; en las extremidades superiores 86,6% presenta asimetría de hombros. El promedio de edad 19 ± 2.2 años, peso, 64 ± 15.7, estatura 167±11.1. El 65,4% de los evaluados fueron del sexo femenino. Discusión: El estudio revela un importante número de personas jóvenes con vicios posturales, los hallazgos coinciden con investigaciones analizadas en que predominan las alteraciones a nivel de la columna como las escoliosis, seguidas del aumento de la cifosis y lordosis lumbar, es importante un programa de detección temprana e higiene postural en los jóvenes a fin de evitar lesiones osteoarticulares

Introduction: Body posture is defined as the position of the whole body or a segment of it in relation to gravity. Objectives: To detect postural defects in young people. Determine which of the postural vices are frequent in young people. Characterize the population studied. Materials and methods: observational descriptive methodological design of cross section, where the posture was evaluated to 55 young people using a pre-established postural evaluation sheet. Results: 96% of the people evaluated presented postural defects, 80% of the alterations of the column are observed in the lateral plane, 64.4% in the anterior anterolateral plane; in the lower limbs 49% present genu recurvatum, 54.3% in the pelvis as anteversion and retroversion; in the upper extremities, 86.6% have shoulder asymmetry. The average age was 19 ± 2.2 years, weight, 64 ± 15.7, height 167 ± 11.1. 65.4% of those evaluated were female. Discussion: The study reveals an important number of young people with postural defects, the findings coincide with researches analyzed in which the alterations at the level of the spine predominate, such as scoliosis, followed by the increase of kyphosis and lumbar lordosis. early detection and postural hygiene in young people in order to avoid osteoarticular injuries

Mamografía por emisión de positrones (PEM) / Positron emission mammography (PEM)

La mamografía por emisión de positrones (PEM) es un estudio de medicina nuclear molecular que utiliza radios trazadores administrados de forma intravenosa, adquiriendo imágenes para localización de la lesión tumoral, así como la valoración de su metabolismo. El pequeño tamaño del detector en estos equipos facilita el uso de componentes de alta resolución y permite una mayor cercanía a la fuente, aumentando la sensibilidad para los fotones de aniquilación. PEM es una modalidad de imagen que utiliza el mismo posicionamiento que la imagen de mamografía. Los resultados del PEM nos son afectados por la densidad mamaria, llegando a obtenerse valores con alta sensibilidad y especificidad para la detección de tumores más pequeños, en etapas más tempranas que el resto de los métodos convencionales de imagen, es de gran utilidad en la estadificación y planeación quirúrgica de la enfermedad, también disminuye el número de procedimientos innecesarios, así como la morbimortalidad en el cáncer de mama.

The PEM is a molecular nuclear medicine study that uses radiotracer administered intravenously, acquiring images to locate the tumor lesion, as well as the assessment of its metabolism. The small size of the detector in these devices facilitates the use of high resolution components and allows a closer proximity to the source, increasing the sensitivity for annihilation photons. Positron emission mammography (PEM) is an image modality that uses the same positioning as the mammography image. The results of the PEM are affected by mammary density, reaching values with high sensitivity and specificity for detection of smaller tumors, in earlier stages than the rest of conventional imaging methods, it is very useful in staging and planning Surgical disease and decreases the number of unnecessary procedures, as well as morbidity and mortality in breast cancer.

Desigualdad en recursos financieros de la Atención Primaria de Salud Municipal en Chile, 2001-2013 / Inequality of financial resources for primary health care

Background: The availability of health care resources is one of the main factors influencing health care inequalities. Aim: To evaluate communal inequality in financial resources for municipal primary care in Chile. Material and Methods: The evolution of income, expenditure and investment per subject enrolled was assessed for the period 2001-2013 in the 320 municipalities that administer municipal health. Inequality was evaluated using Lorenz curves and annual indicators (Gini, Theil, Coefficient of Variation and Reason 90/10). For a panel analysis with fixed effects, the association of these resources with socioeconomic variables and municipal health was evaluated. Results: The Gini of per capita spending increased 1.75 times, while the Gini investment grew by 30%. Per capita spending was significantly and inversely associated with poverty, dependency on the Municipal Common Fund, resources coming from the City Hall, spending per capita, expenses in personnel, performance and investment, rate of years of potential life lost and infant mortality. A direct and significant association was observed with global, less than two years and greater than 64 years urban population, destination of municipal revenue to health, per capita investment in health, rate of healthcare professionals, number of attentions and health care centers and availability of primary emergency facilities. Per capita investment was inversely associated with the number of health care centers and directly to the Fund dependency, municipal health coverage and personnel expenses. Conclusions: Inequality in municipal health funds increased substantially and were associated with social vulnerability, access to municipal health and community health outcomes.

Estado actual de la esclerosis múltiple en Colombia / Current state of multiple sclerosis in Colombia

Introducción: Dos estudios epidemiológicos de esclerosis múltiple (EM) la describen como de bajo riesgo en Colombia. Hay, sin embargo, nuevos sistemas de información que permiten una aproximación más precisa. Objetivo:Estimar la prevalencia nacional de EM, así como por regiones del país, y analizar los costos de los fármacos usados en Colombia. Materiales y métodos: Se obtuvieron datos del Registro Individual de Prestación de Servicios de Salud (RIPS), con el código diagnóstico G35X para esclerosis múltiple, tomando los diagnósticos confirmados nuevos y repetidos entre 2009 y 2013, por sexo, grupo etario y departamento. Para el análisis de medicamentos se usó la base de datos Sismed del 2014, incluyendo los fármacos disponibles en Colombia: interferón beta-1A, interferón beta-1B, acetato de glatiramer, natalizumab, fingolimod y mitoxantrona. Resultados:Según los RIPS, en Colombia se atendieron, en el período 2009-2013, un total de 3.462 personas con diagnóstico de esclerosis múltiple. La prevalencia nacional para el período fue de 7,52/100.000, con las cifras más altas en Bogotá (16,25), donde se atendieron 1.213 pacientes, seguido de los departamentos del Quindío (13,03) y Risaralda (11,18). La mayor proporción de pacientes se encuentra entre los 50 y 54 años de edad, y las mujeres representan más del 70%. Adicionalmente, en 2014 se invirtieron 86.000 millones de pesos (43 millones de dólares) en medicamentos para esclerosis múltiple, lo que equivale a cerca de 25 millones por paciente. Conclusión: Colombia podría ser un país con riesgo intermedio para esclerosis múltiple, una enfermedad que acarrea altos costos para el sistema de salud.

Introduction: Two local epidemiological studies describe Colombia as low risk for multiple sclerosis (MS). New information systems, which allow for a more accurate approximation, are currently available. Objective: To estimate the national prevalence of MS, as well as by regions, and to analyze national drug costs. Materials and methods: We obtained data from the Individual Registry of Health care provision (RIPS), with the diagnosis code G35x for multiple sclerosis, taking the confirmed new and repeated diagnoses between 2009 and 2013, by gender, age group and geographical location. For the analysis of medications, we use the database SISMED 2014 searching for all drugs available in Colombia: interferon beta 1A, interferon beta 1B, glatiramer acetate, natalizumab, mitoxantrone and fingolimod. Results: According to the RIPS, 3,462 patients with diagnosis of MS contacted the health system in Colombia during the period 2009-2013. The national prevalence for the period was 7.52 / 100,000, with the highest figure in Bogota (16.25) with 1213 patients, followed by Quindío (13.03) and Risaralda (11.18). The largest proportion of patients were in the 50 to 54 years age group, and 70% were women. Additionally, in 2014 Colombia spent COP $ 86 billion pesos (43 million US dollars) for MS drugs, around US$12,500 per patient/year. Conclusion: Colombia is a country with intermediate risk for MS, a disease that implies a high direct cost for the health system.

Evolução da esclerite nodular com biomicroscopia ultrassônica: relato de caso / Evolution of nodular scleritis with ultrasound biomicroscopy: case report

Estabelecer padrão evolutivo de um caso de esclerite nodular à ultrassonografia de alta frequência durante o tratamento. Mulher, 27 anos, com manifestação inicial de uveíte intermediária, edema macular bilateral após tratamento clínico com corticosteroide tópico e via oral. Após quatro meses, observou-se a formação de um nódulo escleral no olho direito quando foi submetido à ultrassonografia de alta frequência (Paradigm, transdutor de 50 MHz, técnica de imersão). A lesão do olho direito foi caracterizada à ultrassonografia de alta frequência como uma lesão nodular da parede anterior temporal inferior associada à redução localizada da espessura da escleral. Após a injeção intravítrea de triancinolona para tratamento do edema macular, observou-se a regressão clínica do nódulo escleral no olho direito, mantendo reduzida a espessura escleral. A ultrassonografia de alta frequência auxiliou no diagnóstico da esclerite nodular durante as fases de tratamento e na identificação da sua sequela característica, o afinamento escleral.

To stablish evolutionary pattern of a case of nodular scleritis with high frequency ultrasound during treatment. Twenty-seven year old female, initial manifestation of intermediate uveitis, bilateral macular edema after clinical treatment with topical and oral steroids. After four months, we observed the formation of a scleral nodule in the right eye when patient underwent high frequency ultrasound (Paradigm, 50 MHz transducer, immersion technique). The lesion in right eye was characterized at high frequency ultrasound as a nodular lesion located at the anterior inferior temporal wall associated with localized reduction of scleral thickness. After intravitreal injection of triamcinolone for treatment of macular edema, clinical regression of the scleral nodule was observed in right eye, maintaining reduced scleral thickness. High frequency ultrasound assisted in the diagnosis of nodular scleritis during the phases of treatment and in the identify its characteristic sequel feature, the scleral thinning.

Posicionamento das alças de lentes intraoculares implantadas intencionalmente no sulco ciliar através da biomicroscopia ultrassônica / Positioning of intraocular lens haptics intentionally implanted in the ciliary sulcus by ultrasound biomicroscopy

OBJETIVOS: Avaliar a posição das alças das lentes intraoculares implantadas intencionalmente no sulco ciliar, em olhos submetidos à cirurgia de catarata com complicação de ruptura de cápsula posterior, e correlacionar os achados com alterações clínicas observadas no exame oftalmológico, utilizando a biomicroscopia ultrassônica. MÉTODOS: Onze olhos (11 pacientes) que apresentaram ruptura de cápsula posterior durante a cirurgia de catarata com implantação intencional das alças no sulco ciliar foram submetidos ao exame oftalmológico e biomicroscopia ultrassônica. Biomicroscopia ultrassônica avaliou os seguintes parâmetros: posicionamento da porção distal das alças, inclinação e descentração da lente intraocular. O exame oftalmológico foi focalizado para avaliar a presença de "flare" e células na câmara anterior, depósitos na lente e defeitos de transiluminação de íris. A pressão intraocular foi medida, a pigmentação do trabeculado foi determinada, e a avaliação fundoscópica foi necessária para afastar a presença de ruptura retiniana periférica e edema de mácula. RESULTADOS: Tempo pós-operatório médio para os exames: 103,09 ± 32,93 dias. Assimetria da posição foi observada em 3 olhos (27,2%), que tinham alça no sulco ciliar e a segunda alça localizada na pars plana em 2 olhos, associada à inclinação e descentração da lente intraocular; ou no corpo ciliar (1 olho). O exame oftalmológico observou: 5 (45,5%) olhos com defeitos de transiluminação de íris, 2 (18,1%) olhos com descentração da lente intraocular; 1 olho (9%) apresentou hipertensão intraocular. Em todos os casos observou-se hiperpigmentação do trabeculado à gonioscopia. Nenhum caso de rotura periférica de retina e/ou edema de mácula foi relatado. CONCLUSÕES: A biomicroscopia ultrassônica foi capaz de localizar as alças das lentes intraoculares implantadas intencionalmente no sulco ciliar durante cirurgia complicada de catarata, e pôde demonstrar a relação da descentração da lente intraocular com a implantação assimétrica das alças.

PURPOSE: To evaluate the position of haptics of intraocular lens intentionally implanted in the ciliary sulcus in eyes undergoing cataract surgery complication associated with intraoperative posterior capsule rupture, as well as to correlate the findings with clinical changes observed in ophthalmic examination, utilizing ultrasound biomicroscopy. METHODS: Eleven eyes (11 patients) who had posterior capsule rupture during cataract surgery with intentional implantation of the haptics in the ciliary sulcus, underwent complete ophthalmic examination and ultrasound biomicroscopy. Ultrasound biomicroscopy evaluated the parameters: positioning of the distal portion of the haptics, tilt and decentration of the intraocular lens. Ophthalmic examination was aimed to evaluate the presence of flare and cells in the anterior chamber, deposits on the lens and iris transillumination defects. Intraocular pressure was measured, pigmentation of the trabecular meshwork was determined, and a fundoscopic evaluation was needed to rule out peripheral retinal rupture and macular edema. RESULTS: Mean postoperative time for the examinations: 103.09 ± 32.93 days. Asymmetry of the haptics positioning was observed in 3 eyes (27.2%) that had one haptic in the ciliary sulcus, the second haptic was placed in the pars plana in 2 eyes, associated to intraocular lens tilt and decentration; or in the ciliary body (1 eye). Ophthalmic examination observed: 5 (45.5%) eyes with iris transillumination defects, 2 (18.1%) with intraocular lens decentration; 1 eye (9%) presented ocular hypertension. In all cases trabecular hyperpigmentation was observed at gonioscopy. No cases of peripheral retinal rupture and/or macular edema were reported. CONCLUSIONS: Ultrasound biomicroscopy was able to locate the intraocular lens haptics intentionally implanted in the ciliary sulcus during complicated cataract surgery, and could demonstrate the relation of intraocular lens decentration to assymetric haptic implantation.

Análisis de sobrevida según perfil biológico de pacientes uruguayas con cáncer de mama / Survival data analysis by biological profile of uruguayan patients with breast cancer

Introducción: el cáncer de mama (CM) constituye una enfermedad heterogénea reconociéndose subtipos con diferentes características mediante, entre otras técnicas, el estudio del nivel de expresión tumoral de los receptores hormonales (RRHH) y del HER2. Previamente reportamos la relación entre estos subtipos y características clínico-patológicas en pacientes uruguayas. Objetivo:analizar la sobrevida libre de enfermedad (SVLE) de pacientes uruguayas con cáncer de mama de acuerdo a su subtipo biológico, definido en base a la expresión tumoral de HER2 y RRHH evaluada mediante inmunohistoquímica. Material y método:se revisaron historias clínicas de pacientes intervenidas quirúrgicamente por CM estadios I-III en un período de dos años, realizándose el cálculo de SVLE para todas las pacientes y según subtipo biológico. Resultados:con seguimiento mediano de 40 meses, la SVLE a dos años para el total de las pacientes fue de 92,3%; 94% para las pacientes RRHH+/HER2-, 91% para las triple negativas (TN) y 71,4% para las HER2+. La comparación de las curvas de SVLE, según los diferentes subtipos, mostró menor SVLE para las pacientes HER2+ (p = 0,03) y similar SVLE de las pacientes RRHH+/HER2- y TN (p = 0,86). Conclusiones: las pacientes uruguayas con CM presentan una SVLE a dos años acorde a los reportes internacionales. Las pacientes HER2+ presentan una mayor tasa de recidivas,lo cual también es coincidente a lo reportado. La similar SVLE a dos años de las pacientes RRHH+/HER 2- y de las TN no se explicaría por diferencias en características clínico-patológicas, planteándose como hipótesis una mayor proporción de pacientes del subtipo luminal B entre las pacientes RRHH+/ HER 2-.

Introduction: breast cancer constitutes an heterogeneous disease. Two sub-types have been distinguished through the study of the tumor expression level of hormone receptors tumors, and level of HER2 expression, among other techniques. We previously reported therelation between these sub-types and the clinical and pathological characteristics of Uruguayan women.Objective: to analyse the disease-free survival (DFS) of Uruguayan patients with breast cancer, according to their biological sub-type, defined based on the tumor expression of hormone receptors and HER2 expression which were assessed by immune-histologicalchemistry staining. Method: all clinical records of patients who had undergone breast cancer surgery (Stages I-III) during a two year period were reviewed. The disease-free survival rate was calculated for all patients and according to their biological profile.Results: forty months follow up revealed disease-free survival upon two years of 92.3% for all patients;94% for hormone receptor positive /HER2 negative patients, 91% for triple negative patients, and 71.4% for hormone receptor positive patients.Comparing the DFS curves, for the different sub-types, evidenced a lower DFS for HER2+ patients (p = 0.03), and similar DFS for hormone receptor positive/HER2 negative and triple negative (p = 0.86). Conclusions:uruguayan patients with breast cancershow a two-year-DFS that matches international reports. HER2+ patients evidence a higher relapse rate, also consistent with international reports. Similar DFS upon two years, between hormone receptor positive/HER2 negative patients and triple negative patients cannot be due to differences in the clinical-pathologicalcharacteristics, thus a hypothesis is considered: there is a larger proportion of patients of the luminal B breast cancer sub-type among hormone receptor positive/HER2 negative patients.

Introdução: o câncer de mama (CM) é uma patologia heterogênea, apresentando subtipos com diferentes características determinadas, entre outras técnicas, pelo estudo do nível de expressão tumoral dos receptoreshormonais (RRHH) e do HER2. Em um artigo anterior descrevemos a relação entre esses subtipos e as características clínico-patológicas em pacientes uruguaias. Objetivo: analisar a sobrevida livre de enfermidade(SVLE) de pacientes uruguaias com CM de acordo a seu subtipo biológico, definido pela expressão tumoral deHER2 e RRHH avaliada por imunohistoquímica. Material e método:foram revisados os prontuários de pacientes operadas por cirurgia por CM estadios I-III em um período de dois anos; realizou-se o cálculo de SVLE de todas as pacientes e de acordo com o subtipo biológico. Resultados: o seguimento com uma mediana de 40meses mostrou uma SVLE aos dois anos para todas as pacientes de 92,3%; 94% para as pacientesRRHH+/HER2-, 91% para a triple negativa (TN) e 71,4% para as HER2+.A comparação das curvas de SVLE, segundo os diferentes subtipos, mostrou uma menor SVLE para as pacientes HER2+ (p = 0,03) e similar SVLE para as pacientes RRHH+/HER2- y TN (p = 0,86). Conclusões: as pacientes uruguaias com CM apresentam uma SVLE a dois anos compatível com resultados internacionais. As pacientes HER2+ apresentaram uma taxa maior de recidivas, resultados que coincidemcom resultados internacionais. A SVLE aos dois anos similar para pacientes RRHH+/HER2- e TN não pode serexplicada pelas diferenças nas características clínico-patológicas, considerando-se como hipótese umaproporção maior de pacientes do subtipo luminal B entre as pacientes RRHH+/HER2-.

Macular hole: 10 and 20-MHz ultrasound and spectral-domain optical coherence tomography / Buraco macular: ultrassonografia de 10 e 20 MHz e tomografia óptica de domínio espectral

PURPOSE: Optical coherence tomography (OCT) is valuable for macula evaluation. However, as this technique relies on light energy it cannot be performed in the presence of opaque media. In such cases, the ultrasound (US) may predict some macular features. The aim of this study was to characterize images obtained by ultrasound with 10 and 20-MHz transducers comparing to OCT, as well as to analyze the relationship between the vitreous and retina in eyes with macular hole (MH). METHODS: 29 eyes of 22 patients with biomicroscopic evidence of MH at different stages were included. All patients were evaluated using ultrasonography with 10 and 20-MHz transducers and OCT. RESULTS: OCT identified signs of MH in 25 of 29 eyes. The remaining 4 cases not identified by US were pseudoholes caused by epiretinal membranes. In MH stages I (2 eyes) and II (1 eye), both transducers were not useful to analyze the macular thickening, but suggestive findings as macular irregularity, operculum or partial posterior vitreous detachment (PVD) were highlighted. In stages III (14 eyes) and IV (5 eyes), both transducers identified the double hump irregularity and thickening. US could measure the macular thickness and other suggestive findings for MH: operculum, vitreomacular traction and partial or complete PVD. In cases of pseudoholes, US identified irregularities macular contour and a discrete depression. CONCLUSION: 10-MHz US was useful for an overall assessment of the vitreous body as well as its relationship to the retina. The 20-MHz transducer allowed valuable information on the vitreomacular interface and macular contour. OCT provides superior quality for fine morphological study of macular area, except in cases of opaque media. In these cases, and even if OCT is not available, the combined US study is able to provide a valid evaluation of the macular area improving therapeutic approach.

OBJETIVO: A tomografia de coerência óptica (OCT) é um método diagnóstico valioso para estudo da mácula. Entretanto, por se basear na energia luminosa, não pode ser realizada quando existe opacidade de meios. Nesses casos, o ultrassom (US) pode predizer algumas características maculares. Este estudo teve como objetivos caracterizar imagens obtidas por US com transdutores de 10 e 20-MHz comparadas ao OCT, assim como analisar a relação vitreorretiniana em olhos com buraco macular (BM). MÉTODOS: Vinte e nove olhos de 22 pacientes com evidência biomicroscópica de BM em diferentes estágios foram incluídos. Todos os pacientes foram avaliados com ultrassonografia utilizando transdutores de 10 e 20-MHz e OCT de domínio espectral. RESULTADOS: OCT diagnosticou BM em 25 dentre 29 olhos estudados. Os 4 casos não identificados por US eram pseudoburacos decorrentes de membrana epirretiniana. Nos BM estágios I (2 olhos) e II (1 olho), ambos transdutores não foram úteis para analisar o espessamento macular, mas foram identificados sinais sugestivos como irregularidade macular, opérculo ou descolamento parcial do vítreo posterior (DVP). Nos estágios III (14 olhos) e IV (5 olhos), ambos transdutores identificaram irregularidade, dupla corcova e espessamento macular. O US foi capaz de medir a espessura macular e identificar outros indícios de BM, como opérculo, tração vitreorretiniana e DVP. Em pseudoburacos, o US identificou irregularidades no contorno macular e discreta depressão. CONCLUSÃO: US de 10-MHz foi útil para uma avaliação global do corpo vítreo e sua relação à retina. O US de 20-MHz forneceu informações importantes sobre a junção vitreorretiniana e contorno macular. OCT fornece qualidade superior para estudo morfológico da região macular, exceto em casos de opacidade de meios. Nesses casos, ou quando o exame tomográfico não for disponível, o estudo ultrassonográfico de 10 e 20-MHz é capaz de proporcionar análise válida da região macular e auxiliar na abordagem terapêutica.