The impact of post-COVID multicomponent rehabilitation / O impacto da reabilitação com multicomponentes no pós-COVID

Abstract Introduction Post-COVID-19 syndrome is characterized by chronic fatigue and myalgia, among other symptoms, which can limit activities of daily living. Physical therapy protocols with multicomponent exercises combine strength, resistance, balance and gait, producing sig-nificant improvements in functional mobility. Objective Evaluate whether multicomponent rehabilitation is effective in improving functional mobility and quality of life in individuals with post-COVID-19 syndrome. Methods Randomized controlled trial with 59 volunteers, divided into an intervention (IG) and control group (CG), all of whom underwent initial assessment (T0). The IG performed 24 sessions over 12 weeks and the CG did not undergo training. Functional mobility was analyzed using the 6-minute walk test (6MWT) and the Berg balance scale, while the SF-36 questionnaire assessed quality of life. Results In the 6MWT, the IG covered 464.40 + 81.26 meters (T0) and 518.60 + 82.68 meters (T4). The IG Berg scale scores were 48.00 + 4.00 (T0) and 51.90 + 4.26 (T4). In terms of quality of life, the IG obtained mean scores of 96.26 + 10.14 (T0) and 102.60 + 5.53 (T4). None of these measures was statistically significant. Conclusion Individuals who underwent the multicomponent phys-iotherapy protocol showed statistically nonsignificant increases in the variables studied.

Resumo Introdução A síndrome pós-COVID-19 caracteriza-se por fadiga crônica, mialgia, entre outros sintomas que podem causar limitações na realização das atividades de vida diária. Protocolos de fisioterapia com exercício de multicomponentes combinam força, resistência, equi-líbrio e marcha, e produzem melhorias significativas na mobilidade funcional. Objetivo Avaliar se a reabilitação de multicomponentes é eficaz em promover melhora na mobilidade funcional e qualidade de vida em indivíduos com síndrome pós-COVID-19. Métodos Ensaio clínico randomizado, controlado, realizado com 59 voluntários, divididos em grupo intervenção (GI) e grupo controle (GC). Todos fizeram avaliação inicial (T0); GI realizou 24 sessões durante 12 semanas e GC não realizou treinamento. A análise da mobilidade funcional foi realizada através do teste de caminhada de 6 minutos (TC6m) e da escala de equilíbrio de Berg. O questionário SF-36 avaliou a qualidade de vida. Resultados A distância percorrida no TC6m pelo GI foi de 464,40 + 81,26 metros (T0) e de 518,60 + 82,68 metros (T4). A pontuação na escala de Berg do GI foi de 48,00 + 4,00 (T0) e de 51,90 + 4,26 (T4). Na qualidade de vida, GI apresentou escore com média de 96,26 + 10,14 (T0) e 102,60 + 5,53 (T4). Nenhuma destas medidas foram estatisticamente significantes. Conclusão Os indivíduos que foram submetidos ao protocolo fisioterapêutico de multicomponentes apresentaram incrementos nas variáveis estudadas sem significância estatística.

Circumflex Coronary Artery Fistula Draining into Coronary Sinus

ABSTRACT Coronary artery fistula draining into the coronary sinus is a rare vascular malformation, and its diagnosis and clinical manifestations usually occur late. We describe the case of a 72-year-old female patient with dyspnea on exertion (New York Heart Association Class III) associated with palpitations. The transthoracic echocardiogram showed significant tricuspid insufficiency. Cardiac catheterization showed aneurysm of the circumflex coronary artery and fistula of this artery draining into the coronary sinus. The patient underwent fistula ligation and tricuspid valve repair, with excellent surgical results.

Accidente Lonómico: Reporte de dos casos / Lonomic accident: Report of two cases

Resumen Introducción: dentro de los insectos del orden lepidóptero, la familia Saturniidae tiene más de 2.400 especies, allí se encuentran Hylesia y Lonomia. Objetivo: presentar dos casos de pacientes con accidente lonómico, el manejo y desenlace para reconocer la importancia de estos eventos en las regiones silvestres de la Orinoquia colombiana. Casos clínicos: paciente de 8 años proveniente de área rural quien refería contacto en región palmar de mano derecha con gusanos quién 48 horas después de dicho contacto presentó equimosis en extremidades, flictena sangrante en talón derecho, cefalea, escalofríos y artralgias, además se evidenciaron tiempos de coagulación prolongados. Paciente de 13 años de características similares a las del caso previamente descrito sin presentar manifestaciones clínicas, pero que presentaba tiempos de coagulación prolongados. Se consideró que cursaba con accidente lonómico por lo que se aplicaron 5 ampollas de suero antilonómico polivalente a cada una sin registrar reacciones adversas. En ambos casos cursaron con evolución clínica adecuada con disminución a rangos de seguridad de tiempos de coagulación. Conclusiones: el veneno lonómico actúa en la cascada de coagulación produciendo manifestaciones hemorrágicas de gravedad variable. El suero antilonómico es el único tratamiento eficaz, a pesar de estar disponible desde hace más de 20 años en Brasil hay un 5% de progresión a síndromes hemorrágicos severos y un 1.5 a 2% de mortalidad. A pesar de tener gran relevancia clínica en las Américas existe subregistro, es importante conocer sus manifestaciones y el manejo para así poder evitar complicaciones mortales.

Abstract Background: among the insects of the order Lepidoptera, the family Saturniidae has more than 2,400 species, there are Hylesia and Lonomia. Objective: to present two cases of patients with lonomic accident, the management and outcome to recognize the importance of these events in the wild regions of the Colombian orinoquia. Clinical case: an 8-year-old patient from a rural area who refers to contact in the palmar region of the right hand with worms for more than 48 hours, presents ecchymosis in the extremities, bleeding flictena in the right heel, headache, chills and arthralgias. Clotting times are performed which are prolonged. A 13-year-old patient who also referred contact without presenting clinical manifestations but presenting prolonged clotting times. They are considered to occur due to a lonomic accident, so 5 ampoules of polyvalent antilonomic serum are administered to each one without registering adverse reactions. They have an adequate clinical evolution with a decrease in the safe ranges of clotting times. Conclusions: the lonomic venom acts in the coagulation cascade producing hemorrhagic manifestations of variable severity. Antilonomic serum is the only effective treatment, despite being available for more than 20 years in Brazil, there is a 5% progression to severe hemorrhagic syndromes and 1.5 to 2% mortality. Despite being of great clinical relevance in the Americas, there is an underreporting, it is important to know its manifestations and management in order to avoid fatal complications.

Carcinoma primario peritoneal sincrónico con tumor de músculo liso de potencial maligno incierto: reporte de caso

El carcinoma seroso primario peritoneal (CSP) es una neoplasia maligna, agresiva e infrecuente que suele diagnosticarse de manera incidental, luego de haber excluido un primario ovárico. Otra rara entidad es el tumor del músculo liso uterino de potencial maligno incierto (STUMP), que es una patología límite entre leiomiomas y leiomiosarcomas. Su sincronismo no ha sido reportado en la literatura. Presentamos el caso de una mujer de 50 años, con tiempo de enfermedad de doce meses, caracterizado por distensión abdominal progresiva, dolor, pérdida de peso y edema en miembros inferiores. La paciente fue intervenida quirúrgicamente por tumor uterino, a descartar sarcoma, encontrándose además de la neoplasia ginecológica lesiones sólidas peritoneales. El diagnóstico histológico fue STUMP sincrónico con CSP. La evolución fue desfavorable, falleciendo tres semanas después de la cirugía. En la literatura no encontramos casos de coexistencia de estas patologías, por lo que nuestro hallazgo representa un aporte en la oncología ginecológica.

Dilemas éticos dos profissionais de saúde frente aos pacientes fora de possibilidade de cura internados na unidade de terapia intensiva pediátrica / [Ethical dilemmas of professionals health in relation to patients with no possibility of cure hospitalized in the pediatric intensive care unit]

Devido aos avanços tecnológicos no campo da saúde dos últimos anos, os profissionais de saúde deixaram de assistir ao paciente como um indivíduo e passaram a direcionar seu cuidado na doença presente em alguma parte do corpo. O uso indiscriminado destas tecnologias provocaram dilemas éticos acerca do cuidado intensivo diante da criança fora de possibilidade de cura, através de questionamentos filosófico-existenciais inerentes à perspectiva da terminalidade precoce e na não aceitação de incurabilidade de doenças envolvendo crianças, dificultando o estabelecimento do limite entre o curável e o tratável, sendo fruto de angústia frente ao processo de morrer, aumentando probabilidade de agir fazendo o mal. Objetivo: Descrever e analisar os principais dilemas éticos vivenciados pela equipe de saúde do centro de terapia intensiva pediátrica ­ médicos, enfermeiros, fisioterapeutas e psicólogos ­ frente aos pacientes sem possibilidade de cura internados nesta unidade. Metodologia: Pesquisa de abordagem qualitativa com os profissionais de saúde ­ médicos, enfermeiro, psicólogo e fisioterapeuta ­ de um CTI pediátrico de alta complexidade. Foi utilizada entrevista semiestruturada com os profissionais, sendo realizada análise do conteúdo proposta por Bardin. Resultados: Emergiram três categorias após análise de conteúdo, a saber: diferenças conceituais sobre pacientes fora de possibilidade de cura; dificuldades relacionadas à comunicação e uso de terapêuticas desproporcionais. Conclusão: A bioética, enquanto ferramenta para auxiliar a tomada de decisão do profissional de saúde frente aos pacientes fora de possibilidade de cura, poderá auxiliar na resolução desses dilemas no agir para promover saúde e bem-estar

Due to the technological advances in the health concerns on last years, health professionals stopped seeing the patient as an individual and began to direct their care in the illness present in some part of its body. The indiscriminate use of these technologies has led to ethical dilemmas about the intensive care of the child outside the possibility of cure through philosophical-existential questions, inherent to the prospect of early termination and non-acceptance of the incurability of diseases involving children, making it difficult to establish the limit between the curable and the treatable, being the result of anguish in the process of dying, increasing ­ consequently ­ the probability of acting by doing more damages. About the objective: To describe and analyze the main ethical dilemmas experienced by the health team of the pediatric intensive care unit - physicians, nurses, physiotherapists and psychologists - in front of patients with no possibility of cure hospitalized in this unit. About the methodology: Qualitative research with health professionals ­ physicians, nurses, psychologists and physiotherapists ­ of pediatric intensive care of hight complexity hospital. A semi-structured interview was used with the professionals, and an analysis of the content proposed by Bardin was performed. At least the results: Three categories emerged after content analysis, namely: conceptual differences about patients outside the possibility of cure; difficulties related to communication and use of disproportionate therapies. The conclusion embraces bioethics, as a tool to help healthcare professionals make decisions regarding patients that are not curable, may help resolve these dilemmas in action to promote health and well-being

Reflexões sobre a compulsão alimentar: mal-estar, corpo e obesidade / Reflections on binge eating: malaise, body and obesity / Reflexiones sobre la alimentación por atracones: malestar general, cuerpo y obesidad

Muitos são os problemas orgânicos ou psíquicos que surgem em indivíduos obesos. Diante desse mal-estar gerado pela obesidade, as angústias são relatadas com frequência por pacientes em discursos que giram em torno da alimentação e do corpo, carregados de frustrações que remetem a dietas fracassadas para dar conta da supervalorização de um corpo ideal na sociedade contemporânea. Nesse sentido, foi percebido nos relatos clínicos uma repetição, um ciclo vicioso que os pacientes têm dificuldade de interromper. Grande parte desses sujeitos relataram, nos atendimentos em grupo e individuais, que têm a comida como substituto de "algo", de um "vazio" que precisa ser preenchido, pois comem mesmo sem estarem com fome e com uma sensação de perda do controle sobre o ato. Por essa razão, após esse comportamento repetitivo, têm sentimentos de raiva, vergonha e culpa. Este artigo tem por objetivo investigar o mal-estar observado nas pessoas obesas atendidas individualmente na clínica particular e na instituição privada, bem como nos atendimentos realizados em grupo. Busca-se conhecimentos acerca da angústia em relação ao corpo obeso, com vistas a fomentar discussões embasadas pela orientação psicanalítica, utilizando durante os atendimentos a metodologia freudiana e a balintiana no atendimento de grupo.

Many are the organic or psychic problems that arise in obese individuals. Faced with this discomfort generated by obesity, anxieties are frequently reported by patients in discourses that revolve around diet and the body, loaded with frustrations that refer to failed diets to cope with the overvaluation of an ideal body in contemporary society. In this sense, it was perceived in clinical reports a repetition, a vicious cycle that patients have difficulty interrupting. Most of these subjects reported, in group and individual care, that they have food as a substitute for "something", a "void" that needs to be filled, because they eat even without being hungry and with a sense of loss of control over the act. For this reason, after this repetitive behavior, they have feelings of anger, shame and guilt. This article aims to investigate the discomfort observed in obese people treated individually in the private clinic and private institution, as well as in group care. Knowledge about anguish in relation to the obese body is sought, in order to foster discussions based on psychoanalytic orientation, using the Freudian and Balintian methodology during group care

Muchos son los problemas orgánicos o psíquicos que surgen en personas obesas. Frente a este malestar generado por la obesidad, los pacientes informan con frecuencia ansiedades en discursos que giran en torno a la dieta y el cuerpo, cargados de frustraciones que conducen a dietas fallidas para hacer frente a la sobrevaloración de un cuerpo ideal en la sociedad contemporánea. En este sentido, se percibió en los informes clínicos una repetición, un círculo vicioso que los pacientes tienen dificultades para interrumpir. La mayoría de estos sujetos informaron, en atención grupal e individual, que tienen comida como un sustituto de "algo", un "vacío" que necesita ser llenado, porque comen incluso sin tener hambre y con una sensación de pérdida de control sobre el acto Por esta razón, después de este comportamiento repetitivo, tienen sentimientos de ira, vergüenza y culpa. Este artículo tiene como objetivo investigar las molestias observadas en personas obesas tratadas individualmente en la clínica privada y la institución privada, así como en la atención grupal. Buscamos conocimiento sobre la angustia con respecto al cuerpo obeso, para fomentar discusiones basadas en la orientación psicoanalítica, utilizando durante la metodología freudiana y balintiana en la atención grupal.

Valoración del riego de adicción a tramadol en pacientes con dolor crónico no oncológico / Risk of addiction in patients with tramadol for chronic no cáncer pain

RESUMEN Objetivo El manejo del dolor crónico no oncológico con analgésicos opioides ha sido de importancia para el control de los síntomas y el restablecimiento de la actividad. Sin embargo, el riesgo de adicción asociado a estos medicamentos es ampliamente conocido y evaluado. Este estudio evalúa el riesgo de adicción que presentaban los pacientes con manejo de tramadol describiendo los factores más frecuentes en la muestra estudiada frente a lo reportado en la literatura. Métodos Una muestra de 76 pacientes de una clínica de dolor que están en manejo con tramadol se les administra un cuestionario con características demográficas y con la escala Opioid Risk Tool para el riesgo de adicción. Resultados El 57,89% de los sujetos fueron mujeres; el 55,20% se encontraba entre los 29 y 59 años. El riesgo de adicción moderado se encontró en el 9,09% de las mujeres y en el 37,05% de los hombres. La inclusión de otras enfermedades como ansiedad y trastorno de estrés postraumático aumenta el riesgo de adicción a severo en 6,06% de los hombres. Conclusiones La valoración del riesgo de adicción a opioides debe tener en cuenta los factores encontrados en la población colombiana.

ABSTRACT Objective The management of chronic non-cancer pain with opioid analgesics has been important for the control of symptoms and the restoration of activity, however, the risk of addiction associated with these drugs is widely known. This study evaluates the risk of addiction presented by patients with tramadol treatment, describing the most frequent factors in the sample studied compared to what was reported in the literature. Methods A sample of 76 patients from a pain clinic who are being managed with tramadol are administered a questionnaire with demographic characteristics and with the Opioid Risk Tool scale for the risk of addiction. Results 57.89% of the subjects were women, 55.20% were affected between 29 and 59 years. A moderate risk of addiction was found in 9.09% of women and 37.05% of men. The inclusion of other diseases such as anxiety and post-traumatic stress disorder increases the risk of addiction to severe in 6.06% of men. Conclusions The assessment of the risk of addiction to opioids must consider the factors found in the Colombian population.

Correlación radiológica y clínica en niños con COVID-19. Servicio de Emergencia, Hospital General Quito Sur. 2020 / Radiological and clinical correlation in children with COVID-19. Emergency Department, Hospital General Quito Sur. 2020

RESUMEN Introducción: Una nueva cepa de coronavirus fue aislada, produciendo una nueva enfermedad febril respiratoria, llamada por la OMS enfermedad corona-virus 2019 (COVID-19), anunciando una emergencia sanitaria. Las imágenes se consideran un componente crítico de la evaluación diagnóstica y monitoreo de la progresión de la enfermedad en adultos, de ahí la importancia de conocer los hallazgos en pacientes pediátricos. El objetivo del estudio era identificar los hallazgos radiológicos y su correlación clínica en niños con COVID-19 atendidos en Emergencias Pediátricas del Hospital General del Sur de Quito entre abril-junio 2020. Métodos: Estudio descriptivo, retrospectivo de tipo transversal, incluyó 54 niños con infección confirmada por el virus SARS-CoV-2. Los datos se obtuvieron del sistema AS400. El análisis se realizó con el programa estadístico SPSS, se determinaron porcentajes en las variables nominales y centrales. Resultados: Se realizó tomografía computarizada (TC) de tórax al 46% de los pacientes, no se encontraron alteraciones tomográficas en el 64%, el hallazgo más común fue las opacidades en vidrio esmerilado en el 100% de los casos, seguido por signo del halo asociado a este último en el 44%. El 67% tuvo afectación bilateral. De los pacientes con alteraciones tomográficas, la mayoría se presentó con síntomas leves. Solo los que tuvieron afectación pulmonar mayor al 25% presentaron sintomatología respiratoria importante, uno requirió cuidados intensivos. Conclusiones: La TC no demostró ser útil de manera rutinaria para la evaluación y diagnóstico de COVID-19 en pediatría, reservándose su uso a pacientes con afección respiratoria importante o dete-rioro clínico; se evidenció patrón en vidrio deslustrado y signo de halo. Palabras claves: COVID-19, radiología, tomografía, neumonía, niños.

ABSTRACT new strain of coronavirus was isolated, being responsible for a new febrile and respiratory disease, whose pulmonary syndrome was called coronavirus disease 2019 (COVID-19) by the World Health Organization, announcing a health emergency. Imaging is a critical component of diagnostic evaluation and monitoring of disease progression in adults, hence comes the importance of knowing the findings in pediatric patients. Method: Descriptive, retrospective, cross-sectional study, which included 54 children with confirmed SARS-CoV-2 virus infection. Data was obtained from the AS400 system. The analysis was performed with the SPSS statistical program, percentages were determined in the nominal and central variables. Results: Chest computerized tomography (CT) was performed in 46% of patients, no tomographic alterations were found in 64%, the most common finding on chest CT being ground glass opacities in 100% of cases, followed by the halo sign in 44%. 67% had bilateral involvement. Of the patients with tomographic alterations the majority had mild symptoms. Only those with pulmonary involvement greater than 25% presented significant respiratory symptoms, one required intensive care. Conclusions: CT did not prove to be useful routinely for the evaluation and diagnosis of COVID-19 in pediatrics, reserving its use for patients with significant respiratory disease or clinical deterioration, ground glass pattern and halo sign were evidenced.Keywords: Analgesia, sedation, delirium, withdrawal, multidisciplinary team.

Nexo epidemiológico en niños con diagnóstico de COVID-19. Hospital General del Sur de Quito. 2020 / Epidemiological link in children with diagnosis of COVID-19. Hospital General del Sur de Quito. 2020

Introducción: Los niños con COVID-19 han mostrado antecedentes claros de agrupamiento en infectados en el hogar y comunidad extendida, por lo que es interesante identificar el nexo epidemiológico (contactos) por grados de consanguinidad de casos positivos para COVID-19, desde el punto de vista de prevención de la enfermedad. Método: Estudio descriptivo, retrospectivo de tipo transversal, muestreo no probabilístico, que incluyó 54 niños con infección confirmada por el virus SARS-CoV-2, atendidos en la Emergencia Pediátrica del Hospital General del Sur de Quito durante los meses de abril a junio 2020. Los datos se obtuvieron del sistema de historias clínicas AS400. El análisis se realizó con el programa estadístico SPSS. Se determinaron porcentajes en las variables nominales. Resultados: Se incluyeron 54 niños, la mayoría adolescentes de 10 a 14 años (27,8%), predominó el sexo masculino (55,6%). El 79,65% tuvo contacto con personas COVID-19. El 53,5% tuvo solo un contacto directo, mientras que el resto, dos o más contactos. El nexo epidemiológico de contagio primario correspondió a la madre (32,55%). Conclusión: La investigación arrojó que el sexo masculino, los escolares y adolescentes fueron los más afectados por COVID-19. Por otra parte, el primer contacto con personas enfermas fue un miembro de la familia que, en su mayoría, correspondió a uno o ambos padres. No está claro si algún niño presentó la infección antes que el resto de miembros de la familia.Palabras claves: COVID-19, nexo epidemiológico, grado de consanguinidad, transmisión, contacto

ABSTRACTIntroduction: Children with COVID-19 have shown a clear history of infected grouping at home and in their extended community, that is why it is very inter-esting to define and identify the epidemiological links evidenced in pediatric patients, from the point of view of disease prevention. Objective: To know the epidemiological links of pediatric patients between 1 month and 17 years old with positive result to the Reverse Polymerase Chain Reaction (RT-PCR) test for SARS-CoV-2. Method: Descriptive, retrospective, cross-sectional study, which included 54 children with confirmed infection by the SARS-CoV-2 virus, treated at the Pediatric Emergency of the General Hospital of the South of Quito during the months of April to June 2020. The data was obtained from the AS400 system. The analysis was performed with the SPSS statistical program; percentages were determined in the nominal variables. Results: 54 children were included, most of them adolescents from 10 to 14 years old (27,8%), the male sex predominated (55,6%). 79,65%, had contact with COVID-19 infected people. 53,50% had only one direct contact, while the rest had two or more contacts, 20,95% and 25,55% respectively. The epidemiological nexus for primary contagion corresponds to the mother (32,55%). Conclusion: The research showed that males, school-age children, and adolescents were the most affected by COVID-19. On the other hand, the first contact with sick people was a family member that mostly corresponded to one or both parents. It is not clear if any child developed the infection earlier than other family members.

Positive education in college students: the effects of the "self-knowledge and soul care" workshop on the emotions and character strengths / Educación positiva en estudiantes universitarios: efectos del taller "autoconocimiento y cuidado del alma" sobre las emociones y fortalezas del carácter

Objective: most healthy and unhealthy behaviors are acquired or consolidated during youth, thus a good investment in the future of any nation, should be to promote the development of young people, incorporating them into projects and programs that aspire to increase their subjective wellbeing and personal health. The Psycho-Educational Intervention (PEI) presented here has been shown to have effects on the health and wellbeing of students as well as on their academic performance. However, its effects on strength of character, emotional balance and emotional intelligence are unknown. Materials and methods: in this paper it was shows the effects of this PEI on positive education in a group of 18 students through three questionnaires: VIA-240, PANAS-20 and PIEMO. To estimate the effects of the PEI, a comparison was made between the scores obtained on the three questionnaires before and after the PEI sessions.Results: the results show that not only did character strengths, positive affect and emotional intelligence improve with PEI, but that also the character strengths and the emotional bearings arranged in a network topography changed with intervention. Also, there were some changes in the most connected nodes of the network. Conclusions: these results show that PEI improved the previous reported variables, they also show the way in which the balance of the positive and negative affects, the development of emotional intelligence and the enhancement of character strengths give access to the three pillars of positive psychology..(Au)

Objetivo: las conductas más saludables y no saludables se consolidan durante la juventud, por lo que una buena inversión de futuro de cualquier nación, debe ser promover su desarrollo, incorporándolos en proyectos que aspiren a incrementar su bienestar subjetivo y su salud. Se ha demostrado que la Intervención Psicoeducativa (IPE) que aquí se presenta tiene efectos en la salud y el bienestar de los estudiantes, así como en su rendimiento académico. Sin embargo, se desconocen sus efectos sobre las fortalezas de carácter, el equilibrio emocional y la inteligencia emocional. Materiales y métodos: en este trabajo se muestran los efectos de esta PEI en la educación positiva en un grupo de 18 estudiantes a través de tres cuestionarios: VIA- 240, PANAS-20 y PIEMO. Para su estimación, se realizó una comparación entre las puntuaciones obtenidas en los tres cuestionarios antes y después de las sesiones de la PEI. Resultados: los resultados muestran que no solo mejoraron las variables analizadas, sino que también las fortalezas del carácter y las emociones que están dispuestos en una topografía de red, cambiaron con la intervención. Además, hubo algunos cambios en los nodos más conectados de la red. Conclusiones: estos resultados muestran que la PEI mejoró las variables reportadas anteriormente, también muestran la forma en que el balance de los afectos positivos y negativos, el desarrollo de la inteligencia emocional y la potenciación de las fortalezas del carácter dan acceso a los tres pilares de la psicología positiva..(Au)

Hallazgos clínicos en niños con COVID-19 atendidos en el Servicio de Emergencia / Clinical findings in children with COVID-19 treated in the Emergency Department

RESUMEN Introducción: Los niños han mostrado una menor prevalencia de infección por el virus SARS-CoV-2, así como un curso leve de la enfermedad. Los síntomas que presentan son reflejo de la afectación a nivel respiratorio, digestivo, neurológico y sistémico. Reconocerlos facilita el abordaje de un paciente con sos-pecha de COVID-19. Métodos: Estudio descriptivo, retrospectivo de tipo transversal, que incluyó 51 niños con infección confirmada por el virus SARS-CoV-2 atendidos en la Emergencia Pediátrica del Hospital General del Sur de Quito durante los meses de abril a junio, con edades entre 1 mes y 17 años 11 meses y 29 días. Los datos se obtuvieron del sistema AS400. El análisis se realizó con el programa estadístico SPSS, se determinaron porcentajes en las variables nominales y medidas de tendencia central y dispersión en las numéricas. Resultados: Se incluyeron 51 niños, la mayoría adolescentes de 10 a 14 años (29,4%), y más de la mitad de sexo masculino (56,9%). El 82,4% refirieron manifestaciones clínicas respiratorias. Los síntomas más prevalentes fueron fiebre y tos (68,6%). La mayoría de pacientes presentaron un curso leve de la enfermedad (60,8%), pero los menores de un año presentaron enfermedad severa con mayor frecuencia. Conclusiones: Existe un predominio de afectación del sexo masculino. La mayoría acude por síntomas respiratorios y presentan enfermedad leve. Las manifestaciones clínicas más comunes son fiebre y tos

ABSTRACT Introduction: Children have shown a lower prevalence of SARS-CoV-2 virus infection, as well as a mild course of the disease. The symptoms they present are a reflection of its effect on the respiratory, digestive, neurological and systemic levels. Recognizing them makes it easier to approach a patient with suspected COVID-19. Methods: Descriptive, retrospective, cross-sectional study, which included 51 children with confirmed infection by the SARS-CoV-2 virus treated in the Pediatric Emergency Department of the Hospital General del Sur de Quito during the months of April to June, with ages between 1 month and 17 years 11 months and 29 days. The data was obtained from the AS400 system. The analysis was carried out with the SPSS statistical program, percentages were determined in the nominal variables, whilst measures of central tendency and dispersion were determined in the numerical ones. Results: 51 children were included, most of them adolescents from 10 to 14 years old (29.4%). More than half were male (56,9%). 82,4% reported respiratory clinical manifestations. The most prevalent symptoms were fever and cough (68,6%). Most of the patients had a mild course of the disease (60,8%), but those under one year of age had severe disease more most frequently. Conclusions: There is a predominance of the male sex. Most patients have come with respiratory symptoms and present mild illness. The most common clinical manifestations are fever and cough.

Determinación de factores relacionados al desarrollo de fístulas palatinas posterior a una palatoplastia primaria / Determination of factors related to the development of palatal fistula after a primary palatoplasty

INTRODUCCION. La fistula palatina es la persistencia de comunicación anormal entre la cavidad nasal y oral post palatoplastia, es la complicación frecuente con: alta morbilidad, problemas para la alimentación, articulación de las palabras inapropiada, halitosis hasta problemas psicosociales como baja autoestima y rechazo social. OBJETIVO. Determinar los factores asociados al desarrollo de fístula palatina. MATERIALES Y MÉTODOS. Estudio observacional, analítico de casos y controles. De una población de 334 Historias Clínicas se tomó muestra de 89 en la Unidad de Plástica y Reconstructiva del Hospital de Especialidades Carlos Andrade Marín de enero 2010 a julio 2019. Criterios de inclusión: datos de pacientes con paladar fisurado reparado por palatoplastia. Criterios de Exclusión: pacientes sin buen seguimiento postquirúrgico y con paladar hendido sin reparación quirúrgica. Los datos fueron obtenidos del sistema AS400, el análisis se realizó mediante el programa estadístico International Business Machines Statistical Package for the Social Sciences. RESULTADOS. El uso de ortopedia prequirúrgica (OR: 0,014; p<0,000) y la alimentación con leche materna (OR: 0,033; p<0,003) fueron factores protectores. DISCUSIÓN. La ortopedia prequirúrgica fue la mejor opción de moldeamiento en pacientes con hendiduras amplias para la aproximación de los segmentos óseos hendidos, como factor protector significativo se encontró a la lactancia materna exclusiva dato que coincide con el estudio de López YD., donde mencionó que produjo mayor estimulación para la fusión de las crestas palatinas a pesar de que no fue estadísticamente significativa. CONCLUSION. Los factores asociados al desarrollo de fístula palatina estadísticamente significativos fueron el uso de ortopedia prequirúrgica y la alimentación con leche materna, catalogados como protectores.

INTRODUCTION. Palatal fistula is the persistence of abnormal communication between the nasal and oral cavity post palatoplasty, it ́s the frequent complication with: high morbidity, feeding problems, inappropriate articulation of words, halitosis and psychosocial problems such as low self-esteem and social rejection. OBJECTIVE. Determine the factors associated with the development of palatal fistula. MATERIALS AND METHODS. Observational, analytical case-control study. From a population of 334 Clinical Histories, a sample of 89 was taken in the Plastic and Reconstructive Unit of the Carlos Andrade Marín Specialty Hospital from january 2010 to july 2019. Inclusion criteria: data from patients with cleft palate repaired by palatoplasty. Exclusion Criteria: patients without good postsurgical follow-up and with a cleft palate without surgical repair. The data were obtained from the AS400 system, the analysis was performed using the International Business Machines Statistical Package for the Social Sciences statistical program. RESULTS. The use of presurgical orthopedics (OR: 0,014; p<0,000) and feeding with breast milk (OR: 0,033; p<0,003) were protective factors. DISCUSSION. Presurgical orthopedics was the best molding option in patients with wide clefts for the approximation of the cleft bone segments, as a significant protective factor, exclusive breastfeeding was found, data that coincides with the study by López YD., where he mentioned that it produced greater stimulation for palatine ridge fusion although it was not statistically significant. CONCLUSION. Statistically significant factors associated with the development of palatal fistula were the use of pre-surgical orthopedics and feeding with breast milk, classified as protective.

La consulta en los tiempos de WhatsApp: una revisión rápida de la literatura / The Consultation in the Times of WhatsApp: A Quick Review of the Literature

Resumen Las tecnologías digitales en salud han permitido que los pacientes estén mejor informados, reducir tiempos y distancias para intervenciones en salud, lo que ha generado un cambio en la relación médico-paciente. El objetivo de este artículo fue explorar la evidencia relacionada con la influencia de WhatsApp en la relación médico-paciente. Por ello, se realizó una rápida revisión de la literatura en cinco bases de datos científicas. Obtuvimos un total de cuatro estudios que completaron los criterios de inclusión para la revisión: un reporte de caso, un estudio de casos y controles y dos estudios observacionales. El 65 % de los estudios incluidos informaron el uso de WhatsApp para la relación médico-paciente. La aplicación WhatsApp puede ser una herramienta útil como canal de comunicación en la relación. Se requiere tener especial cuidado con los aspectos éticos y legales de la comunicación entre profesionales y pacientes.

Abstract Digital technologies in health have allowed patients to be better informed, reduce times and distances for interventions in health, which has generated a change in the doctor-patient relationship. The objective of this article was to explore the evidence related to the influence of WhatsApp among the doctor-patient relationship. Therefore, a rapid review of the literature was carried out in five scientific databases. We obtained a total of four studies who completed the inclusion criteria for the review: a report case study, a case-control study, and two descriptive studies. 65% of the included studies reported the usage of WhatsApp for medical - patient relationship. WhatsApp application can be a useful tool as a communication channel in the relationship. Is required to take special care with ethical and legal aspects of communication between professionals and patients.

Biologia alimentar de Aequidens tetramerus em macrófitas aquáticas de lagos de várzea da reserva de desenvolvimento sustentável Mamirauá, Região do Médio Solimões, Estado do Amazonas, Brasil / Food biology of Aequidens tetramerus in floodplain lake macrophytes in the Mamirauá sustainable development reserve, Mid-Solimões Region, State of Amazonas, Brazil / Biología alimentaria del Aequidens tetramerus en macrófitas acuáticas de lagos de várzea de la reserva de desarrollo sostenible Mamirauá, Región del Medio Solimões, Estado de Amazonas, Brasil

Estudos sobre a alimentação de peixes são fundamentais para compreender as relações tróficas e estrutura de comunidades ícticas. A espécie em estudo Aequidens tetramerus pertence à família Cichlidae que detém mais de 450 espécies para os neotrópicos, sendo que destes, 287 habitam a América do Sul. Objetivou-se com este estudo compreender a dieta e padrão alimentar de A. tetramerus em lagos de várzea nos ambientes de macrófitas aquáticas da Reserva de Desenvolvimento Sustentável Mamirauá (RDSM), Estado do Amazonas. A análise da dieta foi feita a partir da averiguação do conteúdo estomacal de 59 indivíduos. Determinou-se o Grau de Repleção Estomacal (GRE), Frequência de Ocorrência (FO%), Frequência de Biomassa (FB%) e o Índice de Importância Alimentar (IAi %). Segundo o (GRE), 28 espécimes (39,4%) apresentaram estômagos vazios. A dieta de A. tetramerus foi composta por 12 itens alimentares diferentes. Entretanto, poucos foram predominantes com destaque para insetos (12,6% e 42,7%), em FO% e FB%, respectivamente. Pode-se inferir que A. tetramerus possui hábito carnívoro com tendência a insetivoria, pois quando realizado a combinação dos métodos, por meio da determinação do (IAi %) para verificar a importância das 12 categorias que compuseram a dieta, o item inseto também obteve o maior valor (IAi = 0,71%). Este fato pode estar relacionado ao próprio ambiente de macrófitas aquáticas, pois este é um habitat ideal para a reprodução e desenvolvimento de insetos.(AU)

Studies on the feeding habits of fish are key to understanding the trophic relationships and the structure of ictic communities. The species under study, Aequidens tetramerus, belongs to the Cichlidae family which has over 450 species for the neotropics, of which 287 inhabit South America. The aim of this study was to understand the diet and dietary patterns of A. tetramerus in floodplain lakes in the aquatic macrophyte environments of the Mamirauá Sustainable Development Reserve (RDSM) in the state of Amazonas. The diet was analyzed by investigating the stomach contents of 59 individuals. The degree of stomach repletion (DRS), frequency of occurrence (FO%), frequency of biomass (FB%), and dietary importance index (IAi%) were determined. According to DSR, 28 specimens (39.4%) had empty stomachs. The diet of A. tetramerus was composed of 12 different food items. However, only a few were predominant, with emphasis to insects (12.6% and 42.7% in FO% and FB%, respectively). It can be inferred that A. tetramerus has carnivorous habits with a tendency to be an insectivore, since when the combination of methods was performed, by determining the IAi% to verify the importance of the 12 categories that composed the diet, the insect category also presented the highest value (IAi = 0.71%). This fact may be related to the aquatic macrophyte environment itself, as this is an ideal habitat for the reproduction and development of insects.(AU)

Estudios sobre la alimentación de peces son fundamentales para comprender las relaciones tróficas y estructura de comunidades ícticas. La especie en estudio, Aequidens tetramerus, pertenece a la familia Cichlidae que posee más de 450 especies en neo trópicos, 287 de los cuales habitan en América del Sur. El objetivo de este estudio yace en la compresión de la dieta y el patrón alimentar del A. tetramerus en lagos de vega en los ambientes de macrófitas acuáticas de la Reserva de Desarrollo Sostenible de Mamirauá (RDSM), en el Estado de Amazonas. El análisis de la dieta se realizó investigando el contenido estomacal de 59 individuos. Se determinaron el Grado de Repleción Estomacal (GRE), Frecuencia de Ocurrencia (FO%), Frecuencia de Biomasa (FB%) y el Índice de Importancia Alimentar (IAi%). Según GRE, 28 muestras (39,4%) tenían estómagos vacíos. La dieta de A. tetramerus consistió en 12 alimentos diferentes. Sin embargo, pocos fueron predominantes, con énfasis en insectos (12.6% y 42.7%), en FO% y FB%, respectivamente. Se puede inferir que el A. tetramerus tiene un hábito carnívoro con tendencia insectívora, porque cuando se realiza la combinación de los métodos, determinando el (IAi%) para verificar la importancia de las 12 categorías que componían la dieta, el ítem insecto también obtuvo el valor más alto (IAi = 0.71%). Este hecho puede estar relacionado con el propio ambiente de macrófitas acuáticas, ya que este es un hábitat ideal para la reproducción y el desarrollo de insectos.(AU)

Densidad de la masa ósea y marcadores bioquímicos del metabolismo óseo: estudio transversal en adultos residentes de Lima Metropolitana, Perú / Bone mass density and biochemical markers of bone metabolism: transversal study in adult residents of Metropolitan Lima, Peru

RESUMEN Objetivos. Determinar y correlacionar la densidad mineral ósea (DMO) y los marcadores bioquímicos del metabolismo óseo de adultos de 30 a 40 años de Lima, Perú, en el año 2018. Métodos. Estudio descriptivo, transversal, realizado a 84 mujeres y 53 varones, de 30 a 40 años de edad, residentes en Lima, Perú, sin manifestaciones ni tratamiento de enfermedades metabólicas óseas primarias ni secundarias. Se registró información del estado actual, antecedentes personales fisiológicos, patológicos, familiares y examen clínico. Se midió la DMO por absorciometría dual de rayos X en columna, cadera y antebrazo; en sangre, parathormona, osteocalcina, 25-hidroxi-vitamina-D, hormona luteinizante, estradiol en las mujeres, testosterona en los varones, calcio sérico, fósforo sérico, fosfatasa alcalina, proteínas totales y fracciones, creatinina; en orina N-telopéptido de enlaces de colágeno tipo I, calcio y fósforo, por métodos convencionales. Resultados. La DMO se efectuó a 62 mujeres y 40 varones; 2 mujeres y 1 varón tuvieron osteoporosis, y 3 mujeres y 2 varones osteopenia, retirados para la evaluación estadística; 58 mujeres y 35 varones tuvieron una DMO normal. Los varones tuvieron mayor DMO y concentraciones mayores de calcio, fosfatasa alcalina y creatinina; 14 mujeres y 2 varones tuvieron cifras bajas de 25-OH-vitaminaD. Hubo correlación positiva entre DMO y el IMC. Conclusiones. La DMO normal de personas de 30 a 40 años de Lima fue lineal y hubo una relación positiva con el IMC; hubo osteoporosis en 2 mujeres y 1 varón, osteopenia en 3 mujeres y 2 varones, cifras bajas de 25-hidroxi-vitamina-D en 16 personas.

ABSTRACT Objectives. To determine and correlate the bone mineral density (BMD) and the biochemical markers of bone metabolism in adults 30 to 40 years old from Lima, Perú, in year 2018. Methods. A total of 84 women and 53 men, 30 to 40 years old from Lima, Perú, were submmited to a descriptive, transversal study. They did not have symptoms nor treatment for bone metabolic diseases. Information about their present health state, personal and familiar physiological and pathological history and physical examinatión were registered. BMD was measured by dual energy-X-ray absorptiometry in spine, hip and forearm. Parathormone, osteocalcine, 25-hidroxi-vitamine-D, luteinizing hormone, estradiol in women, testosterone in men, calcium, phosphorus, alkaline fosfatase, total and fractionated proteins, creatinine were measured in blood; in urine N-telopéptide, calcium and phosphorus by conventional methods. Results. BMD was measured in 62 women and 40 males; 2 women and 1 man had osteoporosis and 3 women and 2 men osteopenia, who were taken out of statistical evaluation; 58 women and 35 men showed a normal BMD. Male subjects had a greater BMD, higher calcium, alkaline fosfatase and creatine blood concentrations than the female ones; 14 women y 2 men had low 25-OH-vitaminaD concentrations. A positive correlation between the BMD and BMI was found. Conclusions. The normal BMD of persons 30 to 40 years old showed a linear figure and there was a positive correlate with the BMI; premature osteoporosis in 2 women and 1 men as well as osteopenia in 3 women y 2 men was found, low concentrations of 25-hidroxi-vitamine-D was detected in 16 persons.

Adenoma Pleomorfo de Parótida, Manejo Quirúrgico: A Propósito de un caso / Pleomorphic adenoma of the parotid gland, surgical management: a case report

INTRODUCCIÓN: El adenoma pleomorfo es el tumor benigno más común de las glándulas salivales y particularmente de la glándula parótida, la característica principal de este tumor benigno es su crecimiento lento, provocando la presencia notoria de una masa a nivel facial o cervical. Su tratamiento es quirúrgico y uno de los principales riesgos, es la posibilidad de parálisis facial posquirúrgica. Presentamos un caso, resuelto de forma quirúrgica mediante parotidectomía parcial, que conlleva la disección del nervio facial. CASO CLÍNICO: Se trató de una paciente de sexo femenino de 34 años de edad que acude para valoración por presentar masa de crecimiento lento en región parotídea derecha, negó asociación con dolor o parálisis facial. Luego de valoración tomográfica y por PAAF, se diagnosticó Adenoma Pleomorfo de parótida y se decidió parotidectomía parcial derecha. EVOLUCIÓN: Para el tratamiento quirúrgico se recurrió a la técnica descrita en la bibliografía con la variante en la incisión, se usó incisión modificada de Blair. Se logró extirpar la totalidad del tumor. Paciente en su postquirúrgico mediato, presentó parálisis facial, tratada con corticoides, fue dada de alta con una puntuación de House Brackmann CONCLUSIÓN: En concordancia con la bibliografía citada, el manejo adecuado de esta patología es netamente quirúrgico, la realización de parotidectomía en casos de tumoración de glándulas salivales es la única manera de evitar que la masa provoque lesiones a nivel de estructuras cercanas, como el nervio facial. Su correcta disección e identificación están dentro de los principales asuntos dentro del procedimiento.(au)

BACKGROUND: Pleomorphic adenoma is the most common benign tumor of the salivary glands, particularly of the parotid gland. The main characteristic of this benign tumor is its slow growth, causing the noticeable presence of facial or cervical mass. The treatment is surgery, with the main risk of postoperative facial paralysis. We present a case report, resolved surgically with a partial parotidectomy, which involves dissection of the facial nerve. CASE REPORTS: A 34 year old female patient, seeking medical attention due to a slow-growing mass in the right parotid region. Patient denied associated symptoms. After CT and Fine needle puncture, the patient was diagnosed of a pleomorphic adenoma of the parotid gland, and treated with right partial parotidectomy. EVOLUTION: The surgical technique used is described on literature, with a variant in the incision type. We used modified Blair incision. The whole tumor was removed. After surgery patient presented with facial paralysis, she was treated with corticoids. Patient was discharged with a House Brackmann 1 score. CONCLUSIONS: Accordingly with literature, the resolution of this pathology is surgical, paratidectomy is the only treatment that avoids the mass causing damage to adjacent structures, like the facial nerve. The proper identification and dissection of this nerve, is one of the main concerns of the procedure.(au)

The very elderly surgical population in a critically ill scenario: clinical characteristics and outcomes / A população cirúrgica muito idosa em cuidados intensivos: características clínicas e desfechos

Abstract Background: The elderly population is an especially heterogeneous group of patients with a rising number of surgical interventions being performed in the very elderly patient. The aim of this study was to evaluate the correlation between different age strata and functional status with the surgical outcome of the elderly patient. Methods: Retrospective cohort study conducted in a Surgical Intensive Care Unit (SICU), between 2006 and 2013. A total of 2331 surgical patients' ≥ 65 years old were included. Patients were grouped according to age: Older Elderly Group (OEG: 65‒85 years old); Very Elderly Group (VEG > 85 years old). Demographic and perioperative data were recorded. Revised Cardiac Risk Index, APACHE II and SAPS II scores were calculated and postoperative complications were documented. Variables were compared on univariate analysis. Results: The incidence of the VEG was 5.4%. This group had a higher proportion of non-elective surgery (22.4% vs. 11.2%, p < 0.001), higher APACHE II (12.0 vs. 10.0, p < 0.001) and SAPS II (26.6 vs. 22.2, p < 0.001) scores, higher incidence of organ failure (24.6% vs. 17.6%, p = 0.048) and a higher mortality rate during SICU (14.0% vs. 5.2%, p = 0.026) and hospital stay (9.3% vs. 5.0%, p = 0.012). Conclusion: We found that very elderly patients represented a significant proportion of patients admitted to the SICU. They had higher severity scores with a higher prevalence of organ failure and were more likely to undergo non-elective surgery. They had worse outcomes in regarding mortality during SICU and hospital stay.

Resumo Introdução: A população idosa envolve um grupo muito heterogêneo de doentes, com um crescente número de doentes muito idosos a serem propostos para cirurgia. O objetivo do presente estudo foi avaliar a relação entre diferentes grupos etários e estados funcionais com os resultados cirúrgicos do doente idoso. Métodos: Estudo retrospectivo de coorte realizado em uma Unidade de Cuidados Intensivos Cirúrgica (UCIC) que incluiu um total de 2331 doentes cirúrgicos com idade ≥ 65 anos, entre 2006 e 2013. Os doentes foram agrupados de acordo com a idade: doentes idosos (65-85 anos); doentes muito idosos (DMI > 85 anos). Dados demográficos e perioperatórios foram registrados. Índice de Risco Cardíaco Revisto, scores de APACHE e SAPS II foram calculados e complicações pós-operatórias, documentadas. As variáveis foram comparadas em análise univariada. Resultados: A incidência de DMI foi de 5,4%. Este grupo foi mais frequentemente submetido à cirurgia não eletiva (22,4%vs.11,2%; p< 0,001), apresentou scores maiores de APACHE II (12,0vs.10,0; p< 0,001) e SAPS II (26,6 vs. 22,2; p< 0,001), maior incidência de insuficiência do órgão (24,6%vs.17,6%; p= 0,048) e uma mortalidade superior na UCIC (14,0%vs.5,2%; p= 0,026) e no hospital (9,3% vs.5,0%; p= 0,012). Discussão: Os piores resultados nos DMI podem refletir uma maior vulnerabilidade a complicações pós-operatórias, possivelmente relacionadas com múltiplas comorbilidades e uma reserva fisiológica diminuídas. Conclusão: Os doentes muito idosos representaram uma porção importante dos doentes admitidos na UCIC, tinham scores de gravidade mais elevados e maior prevalência de falência orgânica e foram mais frequentemente submetidos a cirurgias não eletivas. Tinham piores resultados relativamente à mortalidade durante a permanência na UCIC e no hospital.

Epidemiological profile of congenital syphilis in the municipality of São Luís, 2008-2017 / Perfil epidemiológico da sífilis congênita no município de São Luís (MA), 2008­2017

Introduction: Congenital syphilis is a disease of great magnitude due to increasing numbers of new annual cases, affecting a large contingent of children, which translates into high incidence rates. The occurrence of syphilis cases evidences failures in health services, especially in prenatal care. Objective: To describe the epidemiological profile of congenital syphilis in the municipality of São Luís. Methods: Descriptive study with a quantitative approach. Congenital syphilis data recorded in SINAN from 2008 to 2017 were used. Results: The detection rate in the municipality shows a continuous increase. A total of 1,060 cases of congenital syphilis were diagnosed in neonates, 1,017 (96.0%) after the first week of life. Regarding the final diagnosis of cases, it was observed that 967 (91.2%) were classified as early congenital syphilis. The predominant maternal age range was 20 to 34 years, corresponding to 743 cases (70.1%). Regarding access to prenatal care, 802 (75.6%) mothers underwent prenatal care, while 219 (20.66%) did not. Among those who received prenatal care, 352 (33.0%) were diagnosed with syphilis during prenatal care, 481 (46.0%) were diagnosed at the time of delivery/curettage, and 59 (5.0%) were diagnosed after childbirth. Regarding the treatment regimen during pregnancy, 736 (70.0%) received inadequate treatment, 95 (8.0%) received no treatment and 62 (6.0%) received adequate treatment. Conclusion: The study contributed to the identification of possible losses in the stages of such care, and in obtaining qualified information that will guide decision-making and planning of health actions, supporting the epidemiological surveillance work in guiding managers and health teams.

Introdução: A sífilis congênita é uma doença de grande magnitude, pelos crescentes números de casos novos anuais, afetando grande contingente de crianças, que traduz elevadas taxas de incidência. A ocorrência dos casos de sífilis evidencia falhas dos serviços de saúde, principalmente na atenção pré-natal. Objetivo: Descrever o perfil epidemiológico da doença no município de São Luís. Métodos: Estudo descritivo com abordagem quantitativa. Utilizaram-se dados de sífilis congênita registrados no Sistema de Informação de Agravos de Notificação, no período de 2008 a 2017. Resultados: A taxa de detecção no município apresenta crescente aumento. Foram diagnosticados 1.060 casos em neonatos, sendo 1.017 (96%) após a primeira semana de vida. Quanto ao diagnóstico final dos casos, observou-se que 967 (91,2%) foram classificados como sífilis congênita recente. A faixa etária da mãe predominante era de 20 a 34 anos, correspondendo a 743 casos (70,1%). Quanto ao acesso ao pré-natal, 802 (75,6%) das mães fizeram prénatal, enquanto 219 (20,66%) não fizeram. Entre aquelas que fizeram, 352 (33%) tiveram diagnóstico de sífilis durante o pré-natal, 481 (46%) no momento do parto/curetagem e 59 (5%) após o parto. Em relação ao esquema de tratamento da gestante, 736 (70%) receberam tratamento inadequado, 95 (8%) não receberam tratamento e 62 (6%) receberam tratamento adequado. Conclusão: O estudo contribuiu para a identificação de eventuais perdas nas etapas desse cuidado e a obtenção de informações qualificadas, que irão nortear tomadas de decisão e planejamento das ações em saúde, subsidiando o trabalho da vigilância epidemiológica na orientação aos gestores e equipes de saúde.

Fobia infantil: do transtorno psiquiátrico à resposta sintomática na psicanálise / Child phobia: from the psychiatric disorder to the symptomatic response in psychoanalysis / Fobia infantil: del trastorno psiquiátrico a la respuesta sintomática en el psicoanálisis

Este artigo propõe uma discussão em torno da abordagem psicanalítica do sintoma fóbico em contraposição à forma como a fobia é abordada pela Psiquiatria, mais especificamente no DSM-V, e as implicações dessas abordagens para a clínica com crianças. Mesmo não tendo conduzido a análise de crianças, Freud lança as bases para tal prática, ao reconhecer que as experiências infantis geram angústia, inclusive neuroses. Em Psicanálise, privilegia-se a escuta do sujeito, ainda que em tenra idade, algo ilustrado com destreza pelo caso do Pequeno Hans. Por outro lado, a noção psiquiátrica de transtorno barra a participação do sujeito na elaboração daquilo que lhe é mais singular, seu sofrimento. Dessa forma, a discussão aqui proposta busca pensar as consequências, para a clínica com crianças, de se tratar a fobia como um transtorno do qual o sujeito precisa se ver livre, recusando o valor de verdade do sintoma.

This paper discusses the psychoanalytical approach of the phobic symptom, in comparison to the way phobia is approached by psychiatry, more specifically in the Diagnostic and Statistical Manual of Mental Disorders–V (DSM-V, and the effects these approaches have on the clinic for children. Even though Freud did not carry out the analysis of children, he set the basis for this practice by stating that childhood experiences can be the source of anguish and even neurosis. In psychoanalysis, listening to the subject is paramount, even in early childhood; that is what the case of "Little Hans" illustrates. On the other hand, the psychiatric notion of disorder prevents the subject from taking part in the process of dealing with his own suffering. The present discussion seeks, therefore, to reflect upon the consequences, for the clinic with children, of treating the symptom of phobia as a disorder from which the subject needs to be set free, denying its value of truth.

Ocratoxinas y su potencial nefrótico / Ocratoxins and their nephrotoxic potential

Las ocratoxinas son metabolitos fúngicos que están presentes en una gran variedad de alimentos y sus subproductos. La nefrotoxicidad es su principal efecto tóxico, relacionado a su vez con distintos síndromes clínicos como la necrosis tubular o la nefropatía de los Balcanes. La mayor parte de la información que se conoce sobre estas sustancias proviene de reportes de casos, ensayos en animales o estudios experimentales in vitro. Este documento ofrece una visión general sobre las ocratoxinas, su mecanismo tóxico, su efecto nefrotóxico; así como un panorama sobre su regulación actual en Colombia.

Ochratoxins are fungal metabolites that are present in a wide variety of foods and their byproducts. Nephrotoxicity is its main toxic effect, related in turn to different clinical syndromes such as tubular necrosis or Balkan nephropathy. The information that is known about these substances comes from case reports, animal trials or in vitro experimental studies. This document offers an overview of ochratoxins, toxic mechanism, nephrotoxic effect, and a panorama of their current regulation in Colombia.