Directrices para presentación de informes de ensayos clínicos sobre intervenciones con inteligencia artificial: extensión CONSORT-AI / Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the CONSORT-AI extension / Diretrizes para relatórios de ensaios clínicos com intervenções que utilizam inteligência artificial: a extensão CONSORT-AI

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ABSTRACT The CONSORT 2010 statement provides minimum guidelines for reporting randomized trials. Its widespread use has been instrumental in ensuring transparency in the evaluation of new interventions. More recently, there has been a growing recognition that interventions involving artificial intelligence (AI) need to undergo rigorous, prospective evaluation to demonstrate impact on health outcomes. The CONSORT-AI (Consolidated Standards of Reporting Trials-Artificial Intelligence) extension is a new reporting guideline for clinical trials evaluating interventions with an AI component. It was developed in parallel with its companion statement for clinical trial protocols: SPIRIT-AI (Standard Protocol Items: Recommendations for Interventional Trials-Artificial Intelligence). Both guidelines were developed through a staged consensus process involving literature review and expert consultation to generate 29 candidate items, which were assessed by an international multi-stakeholder group in a two-stage Delphi survey (103 stakeholders), agreed upon in a two-day consensus meeting (31 stakeholders) and refined through a checklist pilot (34 participants). The CONSORT-AI extension includes 14 new items that were considered sufficiently important for AI interventions that they should be routinely reported in addition to the core CONSORT 2010 items. CONSORT-AI recommends that investigators provide clear descriptions of the AI intervention, including instructions and skills required for use, the setting in which the AI intervention is integrated, the handling of inputs and outputs of the AI intervention, the human-AI interaction and provision of an analysis of error cases. CONSORT-AI will help promote transparency and completeness in reporting clinical trials for AI interventions. It will assist editors and peer reviewers, as well as the general readership, to understand, interpret and critically appraise the quality of clinical trial design and risk of bias in the reported outcomes.

RESUMO A declaração CONSORT 2010 apresenta diretrizes mínimas para relatórios de ensaios clínicos randomizados. Seu uso generalizado tem sido fundamental para garantir a transparência na avaliação de novas intervenções. Recentemente, tem-se reconhecido cada vez mais que intervenções que incluem inteligência artificial (IA) precisam ser submetidas a uma avaliação rigorosa e prospectiva para demonstrar seus impactos sobre os resultados de saúde. A extensão CONSORT-AI (Consolidated Standards of Reporting Trials - Artificial Intelligence) é uma nova diretriz para relatórios de ensaios clínicos que avaliam intervenções com um componente de IA. Ela foi desenvolvida em paralelo à sua declaração complementar para protocolos de ensaios clínicos, a SPIRIT-AI (Standard Protocol Items: Recommendations for Interventional Trials - Artificial Intelligence). Ambas as diretrizes foram desenvolvidas por meio de um processo de consenso em etapas que incluiu revisão da literatura e consultas a especialistas para gerar 29 itens candidatos. Foram feitas consultas sobre esses itens a um grupo internacional composto por 103 interessados diretos, que participaram de uma pesquisa Delphi em duas etapas. Chegou-se a um acordo sobre os itens em uma reunião de consenso que incluiu 31 interessados diretos, e os itens foram refinados por meio de uma lista de verificação piloto que envolveu 34 participantes. A extensão CONSORT-AI inclui 14 itens novos que, devido à sua importância para as intervenções de IA, devem ser informados rotineiramente juntamente com os itens básicos da CONSORT 2010. A CONSORT-AI preconiza que os pesquisadores descrevam claramente a intervenção de IA, incluindo instruções e as habilidades necessárias para seu uso, o contexto no qual a intervenção de IA está inserida, considerações sobre o manuseio dos dados de entrada e saída da intervenção de IA, a interação humano-IA e uma análise dos casos de erro. A CONSORT-AI ajudará a promover a transparência e a integralidade nos relatórios de ensaios clínicos com intervenções que utilizam IA. Seu uso ajudará editores e revisores, bem como leitores em geral, a entender, interpretar e avaliar criticamente a qualidade do desenho do ensaio clínico e o risco de viés nos resultados relatados.

Directrices para los protocolos de ensayos clínicos de intervenciones con inteligencia artificial: la extensión SPIRIT-AI / Guidelines for clinical trial protocols for interventions involving artificial intelligence: the SPIRIT-AI extension / Diretrizes para protocolos de ensaios clínicos com intervenções que utilizam inteligência artificial: a extensão SPIRIT-AI

resumen está disponible en el texto completo

ABSTRACT The SPIRIT 2013 statement aims to improve the completeness of clinical trial protocol reporting by providing evidence-based recommendations for the minimum set of items to be addressed. This guidance has been instrumental in promoting transparent evaluation of new interventions. More recently, there has been a growing recognition that interventions involving artificial intelligence (AI) need to undergo rigorous, prospective evaluation to demonstrate their impact on health outcomes. The SPIRIT-AI (Standard Protocol Items: Recommendations for Interventional Trials-Artificial Intelligence) extension is a new reporting guideline for clinical trial protocols evaluating interventions with an AI component. It was developed in parallel with its companion statement for trial reports: CONSORT-AI (Consolidated Standards of Reporting Trials-Artificial Intelligence). Both guidelines were developed through a staged consensus process involving literature review and expert consultation to generate 26 candidate items, which were consulted upon by an international multi-stakeholder group in a two-stage Delphi survey (103 stakeholders), agreed upon in a consensus meeting (31 stakeholders) and refined through a checklist pilot (34 participants). The SPIRIT-AI extension includes 15 new items that were considered sufficiently important for clinical trial protocols of AI interventions. These new items should be routinely reported in addition to the core SPIRIT 2013 items. SPIRIT-AI recommends that investigators provide clear descriptions of the AI intervention, including instructions and skills required for use, the setting in which the AI intervention will be integrated, considerations for the handling of input and output data, the human-AI interaction and analysis of error cases. SPIRIT-AI will help promote transparency and completeness for clinical trial protocols for AI interventions. Its use will assist editors and peer reviewers, as well as the general readership, to understand, interpret and critically appraise the design and risk of bias for a planned clinical trial.

RESUMO A declaração SPIRIT 2013 tem como objetivo melhorar a integralidade dos relatórios dos protocolos de ensaios clínicos, fornecendo recomendações baseadas em evidências para o conjunto mínimo de itens que devem ser abordados. Essas orientações têm sido fundamentais para promover uma avaliação transparente de novas intervenções. Recentemente, tem-se reconhecido cada vez mais que intervenções que incluem inteligência artificial (IA) precisam ser submetidas a uma avaliação rigorosa e prospectiva para demonstrar seus impactos sobre os resultados de saúde. A extensão SPIRIT-AI (Standard Protocol Items: Recommendations for Interventional Trials - Artificial Intelligence) é uma nova diretriz de relatório para protocolos de ensaios clínicos que avaliam intervenções com um componente de IA. Essa diretriz foi desenvolvida em paralelo à sua declaração complementar para relatórios de ensaios clínicos, CONSORT-AI (Consolidated Standards of Reporting Trials - Artificial Intelligence). Ambas as diretrizes foram desenvolvidas por meio de um processo de consenso em etapas que incluiu revisão da literatura e consultas a especialistas para gerar 26 itens candidatos. Foram feitas consultas sobre esses itens a um grupo internacional composto por 103 interessados diretos, que participaram de uma pesquisa Delphi em duas etapas. Chegou-se a um acordo sobre os itens em uma reunião de consenso que incluiu 31 interessados diretos, e os itens foram refinados por meio de uma lista de verificação piloto que envolveu 34 participantes. A extensão SPIRIT-AI inclui 15 itens novos que foram considerados suficientemente importantes para os protocolos de ensaios clínicos com intervenções que utilizam IA. Esses itens novos devem constar dos relatórios de rotina, juntamente com os itens básicos da SPIRIT 2013. A SPIRIT-AI preconiza que os pesquisadores descrevam claramente a intervenção de IA, incluindo instruções e as habilidades necessárias para seu uso, o contexto no qual a intervenção de IA será integrada, considerações sobre o manuseio dos dados de entrada e saída, a interação humano-IA e a análise de casos de erro. A SPIRIT-AI ajudará a promover a transparência e a integralidade nos protocolos de ensaios clínicos com intervenções que utilizam IA. Seu uso ajudará editores e revisores, bem como leitores em geral, a entender, interpretar e avaliar criticamente o delineamento e o risco de viés de um futuro estudo clínico.

Directrices para los protocolos de ensayos clínicos de intervenciones con inteligencia artificial: la extensión SPIRIT-AI / Guidelines for clinical trial protocols for interventions involving artificial intelligence: the SPIRIT-AI extension / Diretrizes para protocolos de ensaios clínicos com intervenções que utilizam inteligência artificial: a extensão SPIRIT-AI

resumen está disponible en el texto completo

ABSTRACT The SPIRIT 2013 statement aims to improve the completeness of clinical trial protocol reporting by providing evidence-based recommendations for the minimum set of items to be addressed. This guidance has been instrumental in promoting transparent evaluation of new interventions. More recently, there has been a growing recognition that interventions involving artificial intelligence (AI) need to undergo rigorous, prospective evaluation to demonstrate their impact on health outcomes. The SPIRIT-AI (Standard Protocol Items: Recommendations for Interventional Trials-Artificial Intelligence) extension is a new reporting guideline for clinical trial protocols evaluating interventions with an AI component. It was developed in parallel with its companion statement for trial reports: CONSORT-AI (Consolidated Standards of Reporting Trials-Artificial Intelligence). Both guidelines were developed through a staged consensus process involving literature review and expert consultation to generate 26 candidate items, which were consulted upon by an international multi-stakeholder group in a two-stage Delphi survey (103 stakeholders), agreed upon in a consensus meeting (31 stakeholders) and refined through a checklist pilot (34 participants). The SPIRIT-AI extension includes 15 new items that were considered sufficiently important for clinical trial protocols of AI interventions. These new items should be routinely reported in addition to the core SPIRIT 2013 items. SPIRIT-AI recommends that investigators provide clear descriptions of the AI intervention, including instructions and skills required for use, the setting in which the AI intervention will be integrated, considerations for the handling of input and output data, the human-AI interaction and analysis of error cases. SPIRIT-AI will help promote transparency and completeness for clinical trial protocols for AI interventions. Its use will assist editors and peer reviewers, as well as the general readership, to understand, interpret and critically appraise the design and risk of bias for a planned clinical trial.

RESUMO A declaração SPIRIT 2013 tem como objetivo melhorar a integralidade dos relatórios dos protocolos de ensaios clínicos, fornecendo recomendações baseadas em evidências para o conjunto mínimo de itens que devem ser abordados. Essas orientações têm sido fundamentais para promover uma avaliação transparente de novas intervenções. Recentemente, tem-se reconhecido cada vez mais que intervenções que incluem inteligência artificial (IA) precisam ser submetidas a uma avaliação rigorosa e prospectiva para demonstrar seus impactos sobre os resultados de saúde. A extensão SPIRIT-AI (Standard Protocol Items: Recommendations for Interventional Trials - Artificial Intelligence) é uma nova diretriz de relatório para protocolos de ensaios clínicos que avaliam intervenções com um componente de IA. Essa diretriz foi desenvolvida em paralelo à sua declaração complementar para relatórios de ensaios clínicos, CONSORT-AI (Consolidated Standards of Reporting Trials - Artificial Intelligence). Ambas as diretrizes foram desenvolvidas por meio de um processo de consenso em etapas que incluiu revisão da literatura e consultas a especialistas para gerar 26 itens candidatos. Foram feitas consultas sobre esses itens a um grupo internacional composto por 103 interessados diretos, que participaram de uma pesquisa Delphi em duas etapas. Chegou-se a um acordo sobre os itens em uma reunião de consenso que incluiu 31 interessados diretos, e os itens foram refinados por meio de uma lista de verificação piloto que envolveu 34 participantes. A extensão SPIRIT-AI inclui 15 itens novos que foram considerados suficientemente importantes para os protocolos de ensaios clínicos com intervenções que utilizam IA. Esses itens novos devem constar dos relatórios de rotina, juntamente com os itens básicos da SPIRIT 2013. A SPIRIT-AI preconiza que os pesquisadores descrevam claramente a intervenção de IA, incluindo instruções e as habilidades necessárias para seu uso, o contexto no qual a intervenção de IA será integrada, considerações sobre o manuseio dos dados de entrada e saída, a interação humano-IA e a análise de casos de erro. A SPIRIT-AI ajudará a promover a transparência e a integralidade nos protocolos de ensaios clínicos com intervenções que utilizam IA. Seu uso ajudará editores e revisores, bem como leitores em geral, a entender, interpretar e avaliar criticamente o delineamento e o risco de viés de um futuro estudo clínico.

Atribuciones sobre las causas de la pobreza general e infantil en Argentina / Attributions on the causes of general and child poverty in Argentina

Resumen El estudio acerca de las causas de la pobreza ha sido influenciado por la teoría de la atribución, lo que permitió identificar los juicios predominantes que las personas establecen sobre tales causas. Los estudios locales sobre las atribuciones causales de la pobreza son escasos y no se ha identificado ninguno referido a las causas de la pobreza infantil, a pesar de las altas tasas de su incidencia en el país. Así, el presente estudio propone evaluar las atribuciones causales de la pobreza general e infantil por parte de adultos de Argentina, empleando dos cuestionarios (uno sobre las causas de la pobreza en general y el otro sobre la pobreza infantil en particular) implementados de manera virtual. La muestra incluyó a 1 659 participantes (17 a 90 años), quienes debieron indicar la importancia de cada ítem como causa de la pobreza en una escala tipo Likert de cinco puntos. En cuanto al cuestionario sobre las causas de la pobreza general, el análisis exploratorio permitió identificar una estructura de tres factores -similar a la identificada en otros estudios: individualista, estructurales y fatalistas-, la cual no fue verificada en el análisis confirmatorio. Con respecto al cuestionario sobre las causas de la pobreza infantil, se identificó y se confirmó un modelo de dos factores (que podrían estar relacionados con atribuciones estructurales y familiares) que representa una nueva evidencia en el campo. Los resultados sugieren diferencias en las atribuciones de las causas de pobreza general e infantil, cuyos posibles mecanismos (e. g., modulación por parte de factores individuales, contextuales y culturales) deberían explorarse en estudios futuros.

Abstract In the last decades, different studies have addressed the perspectives of people regarding the causes of poverty, as they could play a fundamental role in the development of individual and social attitudes, beliefs and expectations towards people living in such a condition, and in the strategies implemented to solve related problems and issues. In addition, many of those studies have investigated the causes of poverty using the theoretical model proposed by Feagin (1972), which suggests three broad explanations: (1) individualistic (i. e., causal attribution is placed on the poor themselves); (2) structural (i. e., poverty is due to external social and economic factors); and (3) fatalistic (i. e., poverty is attributed to factors such as bad luck). Most of those studies have been carried out considering the causes of poverty in general, which means that there is very little research aimed at studying specifically the causes of child poverty. Given the high incidence of poverty in Argentina the knowledge about such perspectives is of interest for multiple basic and applied purposes. In this sense, the present study proposed to evaluate the attributions of the causes of poverty in general and child poverty in particular, by adults from Argentina, through two virtual questionnaires (one asking for the causes of poverty in general, and the other for the causes of child poverty). The sample included responses from 1 659 citizens of Argentina from 17 to 90 years old (M = 45.72, SD = 16.94). The questionnaires included 32 items aimed at evaluating the attribution of causes of general poverty, and 30 items related to child poverty. Participants were asked to indicate the importance of each item as a cause of poverty on a five-point Likert-type scale (1 = does not matter; 5 = extremely important). Exploratory and confirmatory factor analyses were implemented (separately from the general and child questionnaires) and retained items with factor loadings at .40 or above. In addition, for the general questionnaire, a second approach was implemented to analyze if the factorial structure supported by different studies in the literature was confirmed in this sample. For such a purpose, confirmatory factor analyses were implemented. Regarding the questionnaire for the causes of general poverty, the exploratory analysis allowed identifying a three-factor structure (as in the case of other studies) (RMSEA = .071; CFI = .94; TLI = .93), which was not verified in the confirmatory analysis (RMSEA = .103; CFI = .88; TLI = .86). On the other hand, the results of the second approach suggest the confirmation of the two-factor model proposed in the literature (RMSEA = .083; CFI = .96; TLI = .95). This pattern of results suggests sensitivity to the inclusion of new items. In this sense, in future studies it would be important to invest efforts in determining new items from consultations with experts and other social actors. Regarding the questionnaire for the causes of poverty in children, two-factor model was identified and confirmed (RMSEA = .074; CFI = .94; TLI = .93), which is a new piece of evidence in the field, suggesting variability in the attribution of causes of poverty according to the considered age group, and whose potential mechanisms in comparison with the studies on adult poverty should be explored in future research (e. g., individual, contextual and cultural factors). Finally, this study confirms that having valid and reliable instruments to explore the causal attributions of general and child poverty would be important to advance in the understanding of poverty as a complex and multidimensional phenomenon.

"Este caso me desorientó... " / "This case disoriented me..."

Paciente masculino de 66 años que se presentó al servi-cio de guardia y urgencias por cuadro clínico caracteriza-do por mareos de 3 meses de evolución e inestabilidad de la marcha de 24 hs de evolución. Como único signo positi-vo al examen físico se constató dismetría de miembros su-periores. Se decidió estudiar con TC de cerebro en donde se identificó, en topografía pineal y tercer ventrículo, una voluminosa lesión ocupante de espacio, sólida, de aproxi-madamente 27 x 21 mm de densidad heterogénea, con pro-bable relación a restos hemáticos en distintos estadios evo-lutivos asociada a calcificaciones periféricas

Lesión medular como complicación de la vertebroplastia y la cifoplastia / Spinal cord injury as a complication of vertebroplasty and kyphoplasty

La vertebroplastia y la cifoplastia son técnicas percutáneas mínimamente invasivas que se hallan indicadas en el tratamiento del dolor asociado con fracturas vertebrales osteoporóticas y tumorales. Aunque han demostrado ser técnicas seguras, pueden dar lugar a complicaciones derivadas de la llamada 'fuga de cemento'. Presentamos el caso clínico de dos mujeres con 37 y 62 años, quienes presentaron fracturas toracolumbares múltiples, la primera de etiología traumática y la segunda osteoporótica, con afectación de muro posterior. Tras implementarse dichas técnicas las pacientes presentaron lesión medular incompleta por escape de cemento al canal medular; en el segundo caso se produjo también embolismo pulmonar por cemento. A fin de solucionar dichas complicaciones, se realizaron sendas laminectomías con extracción del material y las pacientes ingresaron a tratamiento rehabilitador; en la paciente con embolismo se inició procedimiento de anticoagulación. Al alta, ambas presentaban mejoría exploratoria y realizaban marcha con ortesis. Se concluye que la vertebroplastia y la cifoplastia son técnicas relativamente seguras aunque no exentas de complicaciones, pues la fuga de cemento a los plexos venosos constituye una complicación conocida y reportada. Es importante una apropiada selección de pacientes, comprobando la integridad del muro posterior; así mismo, los pacientes deben ser evaluados cuidadosamente desde el punto de vista respiratorio.

Vertebroplasty and kyphoplasty are minimally invasive percutaneous techniques indicated for the treatment of pain associated with osteoporotic and tumor vertebral fractures. Although they have proven to be safe techniques, they can give rise to complications derived from the so-called 'cement leakage'. We present the clinical case of two women aged 37 and 62 years, who presented multiple thoracolumbar fractures, the first of traumatic etiology and the second osteoporotic, with posterior wall involvement. After implementing these techniques, the patients presented incomplete medullary lesion due to cement leakage into the medullary canal; in the second case there was also pulmonary embolism due to cement. In order to solve these complications, two laminectomies were performed with removal of the material and the patients were admitted for rehabilitation treatment; in the patient with embolism, anticoagulation procedure was started. At discharge, both patients showed exploratory improvement and were walking with orthosis. We conclude that vertebroplasty and kyphoplasty are relatively safe techniques, although they are not free of complications, since cement leakage to the venous plexus is a known and reported complication. Appropriate patient selection is important, checking the integrity of the posterior wall; likewise, patients should be carefully evaluated from the respiratory point of view.

Actualización general de inmunoterapia en cáncer / Cancer immunotherapy: an update

Cancer is one of the leading causes of death worldwide. The success rate of conventional anticancer therapeutic approaches such as chemotherapy is limited by the non-specific toxicity and low specificity towards specific tumors, which are highly dependent on the mutational burden present on each patient. Similarly, targeted therapies have proven to induce resistance in numerous malignancies. Therefore, immunotherapy has emerged as a better approach to discriminate between "the own" and "the non-own", which occurs through two types of mechanisms, innate and acquired immunity. Acquired immunity is one of the targets for new immunotherapeutic treatments, unleashing the power of antigen-specific T cells as a potential therapeutic weapon for cancer treatment. Thus, immunotherapy modifies the own immune system to increase the recognition and elimination of cancer cells by identifying these cancer antigens. One of the advantages of immunotherapy, when compared to conventional anticancer approaches, is the generation of long-term immunity (immunological memory). Currently, there are different potential types of immunotherapy in cancer to promote the modulation of the immune response. Among them, the use of cytokines, vaccines, viruses, monoclonal antibodies, and the generation of adaptive immune response cells have achieved successful results in some types of cancer.

A Pilot Study On Identification And Management Of Drug Induced Sexual Dysfunction: A Collaborative Approach By Clinical Pharmacist And Psychiatrist

Objective: To assess the role of clinical pharmacists in the identification and management of drug-induced sexual dysfunction in collaboration with the psychiatrist and also to determine the prevalence and pattern of drug-induced sexual dysfunction, identify nature and extend of drug-induced sexual dysfunction, and assess the pattern of management of drug-induced sexual dysfunction. Methods: This periodic prevalence interventional study was carried out among patients who visited the psychiatric department of a university hospital over three month’s period. Patients were screened for sexual dysfunction using the Arizona Sexual Experience Scale (ASEX) by study pharmacists. Results: Of the 100 patients reviewed, only 50% of subjects met the study criteria. Depression (42%) was the most common clinical diagnosis among the study patients. The overall prevalence of drug-induced sexual dysfunction was 16%. A higher incidence of drug-induced sexual dysfunction was observed in men (62.5%). Decrease libido (40%) was the most prominently observed drug-induced sexual dysfunction in both genders. Antidepressant (50%) was the most common class of drugs implicated in sexual dysfunction. Drug-induced sexual dysfunction was pharmacologically managed with vaginal lubrication (40%), Tadalafil (20%) and Tadalafil+Dapoxetine combination (40%). Conclusion: With this study, provided a vision, further how prospective studies in this arena may be carried out for better understanding drug-induced sexual dysfunction and how a clinical pharmacist can contribute for better health care of patients in the sex clinic by collaborating with medical practitioners.

The position of combined medical treatment in acromegaly

ABSTRACT Advances in combination medical treatment have offer new perspectives for acromegaly patients with persistent disease activity despite receiving the available medical monotherapies. The outcomes of combination medical treatment may reflect both additive and synergistic effects. This review focuses on combination medical treatment and its current position in acromegaly, based on clinical studies evaluating the efficacy and safety of combined medical treatment(s) and our own experiences with combination therapy. Arch Endocrinol Metab. 2019;63(6):646-52

Fracturas de falanges tratadas con placas de osteosintesis: Resultados a corto plazo / Phalangeal fractures treated with osteosynthesis plates. Short-term results

Introducción: Se realizo un estudio de cohorte prospectivo para evaluar los resultados funcionales de pacientes laborales con fracturas de falange tratadas mediante placas y establecer factores de mal pronostico. Materiales y Métodos: Desde mayo de 2012 hasta mayo de 2014, 55 pacientes laborales con fracturas de falange fueron operados consecutivamente, mediante reduccion y osteosintesis con placa y tornillos. Cuarenta y dos (39 hombres, edad promedio 30.76 anos) fueron evaluados, con 68 falanges operadas (primera falange 15, segunda falange 53). El 28% de las fracturas fueron expuestas; el 38,24%, conminutas y el 11,76% tenia compromiso articular. El seguimiento promedio fue de 3.38 meses. Resultados: Se logro la consolidacion osea de todas las fracturas a los 1.8 meses. La movilidad para el pulgar (Gingrass) fue buena en dos casos y regular en uno. En los restantes dedos (Belsky), fue excelente (35%), buena (55%) y mala (9%). El puntaje DASH promedio fue de 18,53. Se observaron peores resultados en las fracturas de la primera falange respecto de la segunda falange y en pacientes con mas edad que en los mas jovenes, ambos con significancia estadistica. No hubo relacion entre el resultado y las demas variables estudiadas. Cuatro pacientes tuvieron complicaciones (9,5%). Conclusiones: Al comparar nuestra serie con otras publicadas, hubo menos complicaciones y los resultados fueron similares, pero a diferencia de otros autores, no acostumbramos a retirar el material ni a realizar tenolisis ni artrolisis. Se logro la consolidacion osea en todos los casos y los resultados fueron satisfactorios en el 90% de los pacientes. Nivel de Evidencia: IV

Introduction: A prospective cohort study was carried out to evaluate functional results in workers with phalangeal fractures treated with plates and to establish poor prognostic factors. Methods: From May 2012 to May 2014, 55 workers with phalangeal fractures were operated on consecutively by reduction and fixation with plate and screws. Forty-two patients (39 men; average age 30.76 years) were evaluated, with 68 operated phalanges (first phalanx 15, second phalanx 53). Twenty-eight percent of fractures were open, 38.24% comminuted and 11.76% had joint involvement. Average follow-up: 3.38 months. Results: Bone union was achieved in all fractures in 1.8 months. Gingrass score for the thumb was good in two cases and regular in one. In the remaining fingers, Belsky score was excellent (35%), good (55%), and poor (9%). Average DASH score was 18.53. Worse results were observed in the first phalanx fractures with respect to the second and in older patients than in the younger, both with statistical significance. No relationship was observed among the outcome and other variables studied. Four patients had complications (9.5%). Conclusions: When comparing our findings with other studies, the rate of complications was small, and similar results were obtained, but unlike other authors, we are not used to removing hardware with tenolysis or arthrolysis. Bone union was achieved in all cases and results were satisfactory in 90% of patients. Level of Evidence: IV

A Study on Concordance of Pre and Post-surgical Biopsy in Oral Carcinoma

Background: Clinically suspicious oral lesions are usually first dealt with an incisional biopsy. The management and treatment plan of these entities depends mainly on this report. The disparity in incisional and excisional biopsy report is an important area of concern affecting the patient’s management. Objective: Aim of the study was to compare retrospectively the incisional (presurgical) and excisional (post-surgical) biopsy reports of proven cases of carcinomas. Material and Methods: A total of 98 excisional biopsy cases of proved oral carcinoma were selected. Both incisional and excisional biopsy reports were retrieved. Sex predilection, Frequency of site of tumor, correlation between incisional and excisional biopsy, type of biopsy and change in the status were studied and statistically analyzed. Significance between Pre-biopsy and post biopsy was statistically analyzed using Chi-Square Tests. Results: There was concordance of 66.3% in incisional and excisional biopsy report. 33.7% cases showed disparity. Upgrading in the excisional biopsy report was noted in 15.30% cases. Downgrading was noted in 14.26% cases. When statistically analyzed the difference in pre-and post-biopsy was statistically insignificant. Conclusion: Incisional biopsy was found to have certain restriction in the valuation of Oral lesions. Clinicians should be vigilant the possibility of under diagnosis from incisional biopsy and even undetected carcinoma in the incisional specimen, especially of nonhomogeneous lesions.

Efectos de la edad sobre la valoración emocional durante la etapa preescolar / Effects of age on the emotional appraisal during preschool

La valoración emocional es el proceso por el cual se generan distintas respuestas emocionales a partir de las evaluaciones subjetivas del individuo sobre diferentes aspectos de los estímulos, tales como la relevancia personal de la situación y las opciones de afrontamiento, entre otras. Es decir, una misma situación percibida por dos personas distintas puede provocar reacciones emocionales diferentes. Estas variaciones pueden deberse a la existencia de diferencias individuales, sociales y culturales en la valoración de los estímulos. El estudio de la valoración emocional en las/os niñas/os añade dificultades relacionadas con el desarrollo de las emociones y con la categorización de las mismas durante la etapa preescolar. Una forma de explorar estas cuestiones es utilizar tareas con distintas valencias para evaluar el procesamiento de la información con diferente contenido emocional en niñas/os. Diversas investigaciones abordaron este tema, pero son escasos los trabajos que profundizaron el estudio en esta etapa del desarrollo cognitivo. El objetivo de este trabajo fue analizar la valoración de una muestra de niñas/os de 4 y 5 años en una tarea con estímulos visuales de diferente contenido emocional (negativo, neutro y positivo). En los resultados se consideró la cantidad de acuerdos entre las respuestas dadas por las/os niñas/os y la valencia relativa inherente a la tarea. Se observó un efecto de la edad sobre la valoración emocional, evidenciado a través de mayor acuerdo en las/os niñas/os de 5 años, en comparación con las/os de 4. Asimismo, las/os niñas/os de 5 años mostraron una tendencia a asociar con mayor acuerdo los estímulos emocionales (positivos y negativos), en comparación con los neutros. Estos resultados señalan la importancia de considerar la atribución de emociones como un proceso en desarrollo durante esta etapa infantil.

The emotional appraisal is the process through which different emotional responses are generated based on individual subjective evaluations of different aspects of stimuli, such as personal relevance of the situation and coping options, among others. Thus, a same situation perceived by two different persons can generate two different emotional appraisals. This difference would be due to cognitive, social and cultural variations in the assessment of the stimuli. The study of emotional appraisal in children adds difficulties related to the development of emotions and emotional categorization. One way to explore these issues is to use tasks with different valences to assess in-formation processing with different emotional content. Different studies addressed this but few approach the preschool period. The aim of this study was to analyze the assessment of different visual stimuli with negative, neutral and positive emotional contents in a sample of children aged 4 and 5 years. Results showed and effect of age in the number of agreements between the answers given by children and the relative valence inherent to the task. Specifically, 5-year-old children evidenced more agreements than 4-year-old. In addition, 5-year-old children were more likely to congruently associate the emotional images (valences positive and negative) in comparison to neutral ones. These results highlight the importance of considering the attribution of emotions as a developing process during the preschool period.

Renal cortex copper concentration in acute copper poisoning in calves / Concentração de cobre no córtex renal na intoxicação aguda de cobre em bezerros

The aim of this study was to estimate the diagnostic value of renal cortex copper (Cu) concentration in clinical cases of acute copper poisoning (ACP). A total of 97 calves that died due to subcutaneous copper administration were compiled in eleven farms. At least, one necropsy was conducted on each farm and samples for complementary analysis were taken. The degree of autolysis in each necropsy was evaluated. The cases appeared on extensive grazing calf breeding and intensive feedlot farms, in calves of 60 to 200 kg body weight. Mortality varied from 0.86 to 6.96 percent, on the farms studied. The first succumbed calf was found on the farms between 6 and 72 hours after the susbcutaneous Cu administration. As discrepancies regarding the reference value arose, the local value (19.9 parts per million) was used, confirming the diagnosis of acute copper poisoning in 93 percent of the analyzed kidney samples. These results confirm the value of analysis of the cortical kidney Cu concentration for the diagnosis of acute copper poisoning.

O objetivo deste trabalho foi estimar o valor diagnóstico de concentração de cobre (Cu) no córtex do rim em casos clínicos da intoxicação cobre aguda (ACP). Um total de 97 bezerros foi compilado em onze fazendas. Pelo menos, uma necropsia foi realizada em cada caso e foram colhidas amostras para análise complementar. O grau de autólise em cada necropsia foi avaliado. Os casos aparecem em criação extensiva e também em fazendas de confinamento intensivo. Os pesos dos animais variavam de 60 até 200 kg. Mortalidade variou entre 0,86 e 6,96 por cento, em todas as fazendas estudadas, o primeiro animal morto foi observado entre 6 e 72 horas após à administração parenteral de Cu. Surgirem discrepâncias em relação ao valor de referência a ser usado. O valor local (19. 9 partes por milhão) foi usado, confirmando o diagnóstico de intoxicação aguda de cobre em 93 por cento das amostras analisadas nos rins. Estes resultados confirmam o valor diagnóstico da concentração de Cu no rim córtex para o diagnóstico de ACP.

Diagnostic value of copper parameters to predict growth of suckling calves grazing native range in Argentina / Valor diagnóstico dos parâmetros de cobre para prever o crescimento de bezerros lactantes em pastagem nativas na Argentina

A study was conducted to evaluate the predictive diagnostic value of different copper (Cu) parameters as indicators of average daily gain (ADG) in growing calves. The effects in calves of cow Cu supplementation in the last one-third gestation period were also evaluated. Five supplementation trials, with a total of 300 calves, were carried out. Two groups of 30 calves were randomly assigned to each trial, one group was parenterally supplemented (SG) and the other was not supplemented (NSG). Trials began when calves were three-month-old and ended at weaning time. At each sampling calves were weighed and blood was taken to determine Cu concentrations in plasma, Whole Blood (WB), Red Cells (RC) and Packed Cell Volume (PCV). Liver samples from six animals of each group were taken both at the beginning and at the end of the trial. In two trials the mothers of the SG received Cu supplementation at the last one- third gestation period. Four of the five trials exhibited low ADG in the NSGs. In these groups, plasma Cu concentration decreased rapidly before low ADG was detected, which occurred with values remaining below 25µg/dl. The decrease of RC Cu concentration was considerably slow. WB showed an intermediate position. PCV in the SGs was higher than in the NSGs in all trials. Cow supplementation was insufficient to generate a liver storage able to last after calves reached the 3 months of age. These data could be useful to predict the risk of low ADG in grazing calves.

Foi realizado um estudo para predisser o valor diagnóstico de diferentes parâmetros de cobre (Cu) como indicadores de ganho médio diário (ADG) na criação de bezerros. Também foram avaliados os efeitos da suplementação com Cu nas vacas no último terço da gestação. Cinco ensaios de suplementação, com um total de 300 bezerros, foram realizados. Dois grupos de 30 bezerros foram atribuídos aleatoriamente em cada proba, um grupo foi parenteralmente suple mentado (SG) e o outro não foi suplementado (NSG). Os ensaios começaram quando os bezerros tinham três meses de idade e terminou ao tempo do destete. Em cada ensaio os bezerros foram pesados e mostras do sangue foi tomada para determinar as concentrações Cu no plasma, sangue total (WB), eritrócitos (RC) e hematócrito (PCV). Amostras de fígado foram colhidas em seis animais de cada grupo tanto no início quanto no final do ensaio As mães do SG receberam suplementação de Cu no último terço da gestação em dois ensaios. Quatro dos cinco ensaios apresentavam baixa ADG nos NSGs. Nesses grupos, a concentração plasmática de Cu diminuiu rapidamente antes que a baixa do ADG fossei detectada, o que ocorreu com os valores abaixo 25 µg/d. A diminuição da concentração de RC Cu foi bastante lenta. WB mostrou uma posição intermédia. PCV nos SGs foi mais elevado do que nos NSGs em todos os ensaios. A suplementação das vacas foi insuficiente para gerar um armazenamento hepático capaz de durar até os 3 meses de idade dos bezerros. Estes dados poderiam ser úteis para prever o risco de baixa ADG em bezerros em pastagem.

Generación de eeectricidad a partir de una celda de combustible microbiana tipo pem / Electricity enerration from a pem microbial fuel cell / Geraçãode eletriicidade a partir de uma célula de combustível microbiana tipo pem

Se empleó una celda de combustible microbiana (CCM) a escala de laboratorio para la generación de electricidad. La celda consistió de dos cámaras separadas por una membrana de intercambio protónico (PEM). Se utilizaron electrodos de papel carbón y un catolito acuoso burbujeado con aire para proveer O2 disuelto al electrodo. La generación de potencia en la CCM, se debió a la presencia de bacterias como biocatalizadores en la cámara del ánodo. Las bacterias fueron obtenidas de un inóculo mixto anaerobio de tipo entérico, empleando agua residual sintética (ARS) como sustrato. Se determinó la influencia de la temperatura y el pH sobre el rendimiento de la CCM, encontrando que la mayor densidad de potencia fue generada a temperatura mesofílica de 35 ±5°C y pH entre 5 y 6. Empleando resistencias de 600 y 1000W se obtuvieron densidades de 640 y 336mW·m-2, respectivamente. La eficiencia coulómbica obtenida fue de 59,8%. Este tipo de sistemas resultan atractivos para la generación de electricidad y a la vez para la degradación de la fracción orgánica.

A microbial fuel cell (MFC) at laboratory scale was used for the generation of electricity. The cell consisted of two compartments separated by a proton exchange membrane (PEM). Carbon paper electrodes and an aqueous catholyte supplied with air to provide dissolved O2 to the electrode were used. The power generation in the MFC, was due to the presence of bacteria as biocatalysts in the anode chamber. The bacteria were obtained from a mixed anaerobic type enteric inoculum, using synthetic wastewater as substrate. The influence of temperature and pH on the performance of the MFC was determined. The highest current densities, of 640 and 336mW·m-2, were obtained at the mesophilic temperature 35 ±5°C and pH between 5 and 6, using resistances of 600 and 1000W, respectively. The coulombic efficiency obtained was 59.8%. Such systems are attractive for electricity generation, at the same time that they disintegrate the organic fraction of waste water.

Empregou-se uma célula de combustível microbiana (CCM) a escala de laboratório para a geração de eletricidade. A célula consistiu de duas câmaras separadas por uma membrana de intercâmbio protônico (PEM). Utilizaram-se elétrodos de papel carbono e um católito aquoso borbulhando com ar para prover ao elétrodo O2 dissolvido. A geração de potência na CCM foi devida à presença de bactérias como biocatalizadores na câmara do ânodo. As bactérias foram obtidas de um inóculo misto anaeróbio de tipo entérico, empregando água residual sintética (ARS) como substrato. Determinou-se a influência da temperatura e o pH sobre o rendimento da CCM, encontrando que a maior densidade de potência foi gerada com a temperatura mesofílica de 35 ±5°C e pH entre 5 e 6. Empregando resistências de 600 e 1000W se obtiveram densidades de 640 e 336mW·m-2, respectivamente. A eficiência coulómbica obtida foi de 59,8%. Este tipo de sistemas resulta atrativo para a geração de eletricidade e por sua vez para a degradação da fração orgânica.

Planificación en niños de edad preescolar: efectos de la pertenencia a hogares con necesidades básicas insatisfechas (NBI) / Planning on preschoolers: effects of belonging to households with unsatisfied basic needs (NBI)

En el presente trabajo se comparó el desempeño de niños provenientes de hogares con (NBS) y sin (NBI) satisfacción de necesidades básicas en una prueba clásica de planificación: Torre de Londres (TOL). Se observó que la muestra de 4 años de niños NBI alcanzó niveles máximos más bajos, un promedio mayor de tiempos de planificación y ejecución, mayor cantidad de ensayos con número insuficiente de movimientos en distintos niveles de dificultad y puntajes más bajos. En la de 5 años se observó la misma tendencia exceptuando el nivel máximo alcanzado y el puntaje. Estos hallazgos sugieren que de la constelación de condiciones ambientales de los hogares NBI (caracterizados predominantemente como habitando viviendas de tipo inconveniente y en condiciones de hacinamiento) resulta una deprivación tal que afectaría las condiciones de desarrollo del desempeño dependendiente de circuitos prefrontales, caracterizable como menos eficiente en el manejo de los recursos de los procesos de memoria de trabajo espacial y planificación...

Planificación en niños de edad preescolar: efectos de la pertenencia a hogares con necesidades básicas insatisfechas (NBI) / Planning in preschool children: effects of belonging to households with unsatisfied basic needs (UBN) and the street: possibilities of facilitating resilient processes

En el presente trabajo se comparó el desempeño de niños provenientes de hogares con (NBS) y sin (NBI) satisfacción de necesidades básicas en una prueba clásica de planificación: Torre de Londres (TOL). Se observó que la muestra de 4 años de niños NBI alcanzó niveles máximos más bajos, un promedio mayor de tiempos de planificación y ejecución, mayor cantidad de ensayos con número insuficiente de movimientos en distintos niveles de dificultad y puntajes más bajos. En la de 5 años se observó la misma tendencia exceptuando el nivel máximo alcanzado y el puntaje. Estos hallazgos sugieren que de la constelación de condiciones ambientales de los hogares NBI (caracterizados predominantemente como habitando viviendas de tipo inconveniente y en condiciones de hacinamiento) resulta una deprivación tal que afectaría las condiciones de desarrollo del desempeño dependendiente de circuitos prefrontales, caracterizable como menos eficiente en el manejo de los recursos de los procesos de memoria de trabajo espacial y planificación.

This study compares performance of preschool children with satisfied (SBN) and unsatisfied basic needs (UBN) (poverty criterion) on a typical cognitive function task: Tower of London (TOL). Compared with SBN children, UBN 4-year-olds reached lower maximum levels, increased thinking- and executive time, more trials with insufficient moves at different levels of difficulty and lower scores. UBN 5-year-olds showed the same tendency except for maximum levels and score. These findings suggest that UBN home environment brings about a condition that affects prefrontal-circuit-dependent performance, which becomes less efficient in the processing of spatial working memory and planning strategies.

Influencias ambientales sobre el desempeño cognitivo en la prueba A no B de una población de niños argentinos de entre 6 y 14 Meses / Environmental effects on cognitive performance in a 6 to 14 month-old child population

En el presente trabajo se plantea la utilización de la prueba A no B de Piaget con retardo como instrumento para diferenciar el desempeño cognitivo dependiente del desarrollo y maduración de sistemas cerebrales en poblaciones infantiles pertenecientes a ambientes de crianza diferenciados por sus características socioeconómicas (INDEC). Luego de la administración de dicha prueba a 250 niños de entre 6 y 14 meses, los resultados indican que el impacto de la insatisfacción de las necesidades básicas, tal como son definidas por el método de medición de pobreza NBI, afecta una medida del procesamiento cognitivo que incluye un componente de memoria de trabajo espacial involucrado con los circuitos ubicados en la corteza prefrontal dorsolateral.