Accuracy of trained technicians in screening orbital and adnexal diseases at rural vision centers in South India

Purpose: To assess the agreement between the diagnosis made by trained technicians at vision centers (VC) and oculoplasty specialists at the base hospital, in patients referred from VC to the orbit and oculoplasty clinic of a tertiary eye care hospital in south India. Methods: This was a retrospective study that compared the findings of VC technicians and the specialists of the orbit and oculoplasty services in a base hospital. A total of 384 patients referred from 17 VCs between May 2021 and May 2022 were included. The diseases were categorized according to the site of involvement as diseases of the eyelids (43%), diseases of the lacrimal system (37.3%), orbital diseases (15.6), and others (4.1%). The mean age of the patients was 35.9 years and 50.6% were females. Medical records of all referred patients who attended the orbit clinic were analyzed. Results: Of the 384 patients, 378 (98.67%) were confirmed to have orbital and adnexal diseases. There was an overall 80% agreement between the diagnosis made by trained VC technicians and oculoplasty specialists; the kappa coefficient was 0.78 (95% confidence interval [CI]: 0.76 to 0.80), with a P value < 0.001. The agreement was the highest for diseases of the lacrimal system (90.9%, kappa coefficient 0.87), followed by eyelid pathologies (80%, kappa coefficient: 0.77). Of these, 54.8% of patients were managed with surgical procedures. Conclusion: There is good agreement between the findings of VC technicians and oculoplasty specialists. Trained technicians can help in the early detection and referral to higher centers. They also help to make sure adherence to treatment and periodic evaluation, especially in resource?constraint settings.

A study establishing sensitivity and accuracy of smartphone photography in ophthalmologic community outreach programs: Review of a smart eye camera

Purpose: Diseases affecting the cornea are a major cause of corneal blindness globally. The pressing issue we are facing today is the lack of diagnostic devices in rural areas to diagnose these conditions. The aim of the study is to establish sensitivity and accuracy of smartphone photography using a smart eye camera (SEC) in ophthalmologic community outreach programs. Methods: In this pilot study, a prospective non?randomized comparative analysis of inter?observer variability of anterior segment imaging recorded using an SEC was performed. Consecutive 100 patients with corneal pathologies, who visited the cornea specialty outpatient clinic, were enrolled. They were examined with a conventional non?portable slit lamp by a cornea consultant, and the diagnoses were recorded. This was compared with the diagnoses made by two other consultants based on SEC videos of the anterior segment of the same 100 patients. The accuracy of SEC was accessed using sensitivity, specificity, PPV, and NPV. Kappa statistics was used to find the agreement between two consultants by using STATA 17.0 (Texas, USA). Results: There was agreement between the two consultants to diagnosing by using SEC. Above 90% agreements were found in all the diagnoses, which were statistically significant (P?value < 0.001). More than 90% sensitivity and a negative predictive value were found. Conclusion: SEC can be used successfully in the community outreach programs like field visits, eye camps, teleophthalmology, and community centers, where either a clinical setup is lacking or ophthalmologists are not available.

Development and validation of the clinical report form for nodular thyroid pathologies

Abstract Objectives: The aim of this study is to develop and validate a novel clinical report form in the format of a structured interview to enable the characterization of the Portuguese population of the Baixo Vouga region with different subtypes of nodular thyroid pathologies (NTyPs). Materials and methods: A structured interview was developed and to the best of our knowledge, this is the first structured interview built and validated for that purpose in Portugal. Results: This structured interview enables the identification of possible correlations between each subtype of nodular lesions and sociodemographic data, consumption habits and lifestyle, endocrine history, and family predisposition. Conclusion: The novel structured interview will simultaneously, enable a detailed characterization of the group of patients with nodular thyroid lesions and will support future metabolomic studies.

Control de historias clínicas clasificadas por patologías a través de una aplicación web

Introducción: Las aplicaciones web actualmente son indispensables para el manejo de los datos en toda organización, permite al usuario acceder y utilizar la información desde cualquier parte del mundo. El uso de las aplicaciones web ha propiciado la agilización de varios procesos. Objetivo: Emplear una aplicación web desarrollada mediante software libre para el control y clasificación de historias clínicas por diferentes patologías del Centro Médico Salud y Vida de Ibarra, Ecuador. Método: Se aplicó una investigación de modalidad mixta cualitativa-cuantitativa la misma que permitió identificar necesidades reales de los pacientes y de los profesionales de esta casa de salud. El uso de la investigación histórica ayudó a conocer cada uno de los procesos que fueron tomados en cuenta en la generación de la historia clínica y cómo poder clasificarlas por patologías. Con ayuda de la investigación bibliográfica se logró recopilar definiciones necesarias para argumentar la base teórica del artículo; a través de la encuesta y entrevista se identificó la disconformidad de los pacientes por factores como el tiempo de espera, la deficiencia de búsqueda y peor aún no encontrarse registrados. Resultados: La agilidad en los procesos de registro de los pacientes y cada uno con su respectiva historia clínica permite que en las próximas citas los especialistas continúen con su diagnóstico. Conclusiones: La aplicación web agiliza de manera efectiva los procesos relacionados a las historias clínicas, lo que contribuye al control y clasificación de dicha documentación.

Introduction: Web applications are currently essential for data management in any organization, they allow the user to access and use information from anywhere in the world. The use of web applications has led to the streamlining of several processes. Objective: To use a web application developed using free software for the control and classification of medical records for different pathologies in the Health and Life Medical Center of Ibarra, Ecuador. Method: A qualitative-quantitative mixed modality research was applied, which allowed us to identify the real needs of the patients and professionals of this health home. The use of historical research helped to know each of the processes that were taken into account in the generation of the clinical history and how to classify them by pathologies. With the help of bibliographic research, it was possible to compile the necessary definitions to argue the theoretical basis of the article; Through the survey and interview, patient dissatisfaction was identified due to factors such as waiting time, search deficiency and, even worse, not being registered. Results: The agility in the patient registration processes and each one with their respective medical history allows the specialists to continue with their diagnosis in the next appointments. Conclusions: The web application effectively streamlines the processes related to medical records, which contributes to the control and classification of said documentation.

Introdução: As aplicações web são atualmente essenciais para a gestão de dados em qualquer organização, pois permitem ao usuário acessar e utilizar informações de qualquer lugar do mundo. A utilização de aplicações web tem levado à agilização de diversos processos. Objetivo: Utilizar uma aplicação web desenvolvida em software livre para o controle e classificação de prontuários de diferentes patologias no Centro Médico Saúde e Vida de Ibarra, Equador. Método: Foi aplicada uma pesquisa quali-quantitativa de modalidade mista, que permitiu identificar as reais necessidades dos pacientes e profissionais desta casa de saúde. A utilização da pesquisa histórica ajudou a conhecer cada um dos processos que foram levados em consideração na geração da história clínica e como classificá-los por patologias. Com o auxílio da pesquisa bibliográfica foi possível compilar as definições necessárias para argumentar a base teórica do artigo; Por meio da pesquisa e entrevista, foi identificada a insatisfação dos pacientes devido a fatores como tempo de espera, deficiência na busca e, pior ainda, não estar cadastrado. Resultados: A agilidade nos processos de cadastramento de pacientes e cada um com seu respectivo histórico permite que os especialistas continuem com seu diagnóstico nas próximas consultas. Conclusões: A aplicação web agiliza eficazmente os processos relacionados com os registos médicos, o que contribui para o controlo e classificação da referida documentação.

Transtorno de ansiedade em adolescentes: impactos no desenvolvimento e agravamento de outras patologias / Anxiety disorder in adolescents: impacts on the development and worsening of other pathologies / Trastorno de ansiedad en adolescentes: repercusiones en el desarrollo y agravamiento de otras patologías

INTRODUÇÃO: a ansiedade é uma característica inerente ao ser humano, podendo ser considerada uma reação normal ao estresse, compondo assim peça primordial no dinamismo de adaptação no processo de sobrevivência. No entanto a partir do momento que o indivíduo passa a manifestar essa reação de forma persistente, intensa e desproporcional, causando prejuízo a nível social e ocupacional, pode se caracterizar uma patologia. Dessa forma, a adolescência se tornou um tema de crescente interesse na história da psicologia, sendo um período marcado por diversas alterações, tanto a nível fisiológico, quanto psicológico, implicando diretamente o desenvolvimento da ansiedade. OBJETIVO: descrever a respeito dos fatores que influenciam na incidência e prevalência da ansiedade em adolescentes e verificar quais os principais impactos na qualidade de vida desses indivíduos, de tal forma que se perceba a influência no surgimento de outras patologias. METODOLOGIA: a presente pesquisa trata-se de uma revisão integrativa de literatura de cunho exploratório, a partir de uma abordagem qualitativa. RESULTADOS: para construção dessa pesquisa foram analisados 25 artigos no qual 10 artigos foram selecionados, os demais foram descartados por não relacionar com o objetivo desse trabalho. CONCLUSÃO: após análises, é possível concluir que os diversos aspectos impactam no desenvolvimento da ansiedade em adolescentes, como os sociais, familiares e até mesmo religiosos e contribui para a permanência da doença na sociedade, ademais, a psicopatologia pode influenciar o surgimento ou agravamento de outras patologias.

INTRODUCTION: Anxiety is an inherent characteristic of human beings and can be considered a normal reaction to stress, thus composing a key part in the dynamism of adaptation in the survival process. However, from the moment that the individual begins to manifest this reaction in a persistent, intense and disproportionate way, causing damage at a social and occupational level, a pathology can be characterized. In this way, adolescence has become a topic of growing interest in the history of psychology, being a period marked by several alterations, both physiologically and psychologically, directly implying the development of anxiety. OBJECTIVE: to describe the factors that influence the incidence and prevalence of anxiety in adolescents and verify the main impacts on the quality of life of these individuals, in such a way that the influence on the emergence of other pathologies is perceived. METHODOLOGY: this research is an integrative literature review of an exploratory nature, based on a qualitative approach. RESULTS: for the construction of this research, 25 articles were analyzed in which 10 articles were selected, the others were discarded for not relating to the objective of this work. CONCLUSION: after analysis, it is possible to conclude that the various aspects impact the development of anxiety in adolescents, such as social, family and even religious aspects, and contribute to the permanence of the disease in society, in addition, psychopathology can influence the emergence or worsening of other pathologies.

INTRODUCCIÓN: La ansiedad es una característica inherente al ser humano y puede considerarse una reacción normal al estrés, componiendo así una pieza clave en el dinamismo de adaptación en el proceso de supervivencia. Sin embargo, a partir del momento en que el individuo comienza a manifestar esta reacción de forma persistente, intensa y desproporcionada, causando daños a nivel social y laboral, se puede caracterizar una patología. De esta forma, la adolescencia se ha convertido en un tema de creciente interés en la historia de la psicología, siendo un período marcado por diversas alteraciones, tanto fisiológicas como psicológicas, que implican directamente en el desarrollo de la ansiedad. OBJETIVO: describir los factores que influyen en la incidencia y prevalencia de la ansiedad en adolescentes y verificar los principales impactos en la calidad de vida de estos individuos, de forma que se perciba la influencia en el surgimiento de otras patologías. METODOLOGÍA: esta investigación es una revisión bibliográfica integradora de carácter exploratorio, basada en un abordaje cualitativo. RESULTADOS: para la construcción de esta investigación, fueron analizados 25 artículos de los cuales fueron seleccionados 10 artículos, los demás fueron descartados por no relacionarse con el objetivo de este trabajo. CONCLUSIÓN: después del análisis, es posible concluir que los diversos aspectos impactan en el desarrollo de la ansiedad en adolescentes, tales como aspectos sociales, familiares e incluso religiosos, y contribuyen a la permanencia de la enfermedad en la sociedad, además, la psicopatología puede influir en el surgimiento o agravamiento de otras patologías.

Psicopatologias atuais e traumatofilias: Libido Intrassomática detectada em avaliação psicológica da personalidade na análise do discurso e protocolos de testes projetivos atualizados / Psicopatologías actuales y traumatofilias: Libido Intrasomática detectada en evaluación psicológica de personalidad en análisis del discurso y protocolos de tests proyectivos actualizados / Current psychopathologies and traumatophilias: intrasomatic libido detected in psychological assessment of personality in discourse analysis and updated projective testing protocols

A avaliação psicológica no Brasil é regida por Instruções Normativas e Resoluções que indicam as características de personalidade necessárias ou impeditivas para diversas áreas laborais, educacionais e sociais. Postulada por Maldavsky, a Libido Intrassomática (LI) é uma fase libidinal onde são originárias as patologias atuais (Patologias do Desvalimento). A LI pode ser detectada no discurso do sujeito e também em testes como o Z-Teste (Burani, 2020 e 2022) e Questionário Desiderativo -QD (Sneiderman, 2012) de acordo com novos aportes teóricos. Objetivo:O objetivo deste artigo é apresentar a Libido Intrassomática detectada em Avaliação Psicológica da personalidade na análise do discurso e protocolos de testes projetivos atualizados, mediante a aplicação do Z-Teste e Questionário Desiderativo e do discurso do avaliado. Material y Métodos:Analisamos 211 protocolos de QD e Z-Teste, e dados de saúde obtidos ementrevista, de homens com idades entre 30 e 60 anos avaliados para uso de armas. Esta pesquisa foi aprovada na Plataforma Brasil, CAAE: 42474920.4.0000.0123 e integra a tese do autor. Resultados:As análises dos protocolos indicaram quais as erogeneidades predominantes nas respostas: LI apareceu em 15% das respostas do Z-teste e em 13% das respostas do QDcatexias positivas e 37% das respostas de QD catexias negativas. Vinculamos esta frequência aos dados de saúde dos avaliados mediante seu discurso, indicando a presença de hipertensão, diabetes, problemas respiratórios, alergias entre outras as patologias atuais de desvalimento, e em na maioria dos casos em adicções etraumatologias ou tendência a acidentes. Conclusões:A detecção de erogeneidades em respostas de testes projetivos permite não só melhor avaliação de características da personalidade, mas a detecção patologias atuais de desvalimento. A presença de LI em avaliação psicológica para o uso de armas de fogo, indica a necessidade de estudos mais profundos quanto às patologias atuais do desvalimento, sobretudo para esta população AU

La evaluación psicológica en Brasil se rige por Instrucciones Normativas y Resoluciones que señalan las características de personalidad necesarias u obstaculizantes para diversas áreas laborales, educativas y sociales. Postulada por Maldavsky, la Libido Intrasomática (LI) es una fase libidinal donde se originan las patologías actuales (Patologías del Desvalimiento). LI se puede detectar en el habla del sujeto y también en pruebas como el Z-Test (Burani, 2020 y 2022) y el Cuestionario Desiderativo -CD (Sneiderman, 2012) según nuevos aportes teóricos. Objetivo:El objetivo de este artículo es presentar la Libido Intrasomática detectada en Evaluación Psicológica de la personalidad en el análisis del habla y protocolos actualizados de pruebas proyectivas, mediante la aplicación del Z-Test y Cuestionario Desiderativo y el habla evaluada. Material y Métodos:Se analizaron 211 protocolos QD y Z-Test, y datos de salud obtenidos en entrevistas, de hombres de entre 30 y 60 años evaluados por uso de armas. Esta investigación fue aprobada por Plataforma Brasil, CAAE: 42474920.4.0000.0123 y es parte de la tesis del autor. Resultados: El análisis de los protocolos indicó qué erogeneidades predominaron en las respuestas: LI apareció en el 15% de lasrespuestas de la prueba Z y en el 13% de las respuestas QD catexias positivas y 37% de las respostas de QD catexias negativas. Vinculamos esta frecuencia a los datos de salud de los evaluados a través de su discurso, indicando la presencia de hipertensión arterial, diabetes, problemas respiratorios, alergias entre otras patologías actuales de desamparo, y en la mayoría de los casos en adicciones y tendencia a accidentes. Conclusiones: La detección de erogeneidades en las respuestas de los test proyectivos permite no solo una mejor valoración de las características de personalidad, sino también la detección de patologías de desvalimento y patologias actuales. La presencia de LI en la valoración psicológica para el uso de armas de fuego indica la necesidad de profundizar en los estudios sobre las patologías actuales y desvalimiento, especialmente para esta población AU

Psychological assessment in Brazil is governed by Normative Instructions and Resolutions that indicate the necessary or impeding personality characteristics for various work, educational and social areas. Postulated by Maldavsky, Intrasomatic Libido (LI) is a libidinal phase where current pathologies originate (Pathologies of Helplessness). LI can be detected in the subject's speech and also in tests such as the Z-Test (Burani, 2020 and 2022) and the Desiderative Questionnaire -QD (Sneiderman, 2012) according to new theoretical contributions. Objective: The objective of this article is to present the Intrasomatic Libido detected in Psychological Assessment of the personality in the analysis of the speech and updated projective test protocols, through the application of the Z-Test and Desiderative Questionnaire and the evaluated speech.Material and Methods: We analyzed 211 QD and Z-Test protocols, and health data obtained in interviews, from men aged between 30 and 60 years evaluated for use of weapons. This research was approved by Plataforma Brasil, CAAE: 42474920.4.0000.0123 and is part of the author's thesis. Results: Analysis of the protocols indicated which erogeneities were predominant in the responses: LI appeared in 15% of the Z-test responses and in 13% of the QD responses. We linked this frequency to the health data of those evaluated through their speech, indicating the presence of hypertension, diabetes, respiratory problems, allergies among other current pathologies of helplessness, and in most cases in addictions and tendency to accidents. Conclusions: The detection of erogeneities in projective test responses allows not only a better assessment of personality characteristics, but also the detection of current helplessness pathologies. The presence of LI in psychological assessment for the use of firearms indicates the need for deeper studies regarding the current pathologies of helplessness, especially for this population AU

Role Of Ultrasonography In Diagnosis Of Various Biliary System Pathologies

Background:Discuss the role of ultrasound in detecting various gallbladder and biliary tract pathologies in patients presenting as right upper quadrant/epigastric pain/obstructive jaundice especially in emergency situations and demonstrating the incidence of various gallbladder and biliary tract pathologies. Material And Methods:A retrospective observational study of 85 patients having upper abdominal/epigastric pain/obstructive jaundice was carried out at SVP Hospital, ahmedabad. Ultrasound was performed by using MINDRAY RESONA 6 machine. Both curvilinear and linear probes were used for the scanning.Result:The study included 85 patients with 50 female patients and 35 male patients.Most common pathology found was gallbladder calculus (47%). Female gender (72.5%) wasmore prone for having gallstones than male gender (27.5%). Gallstones were commonly associated with diffuse wall thickening and most common pathology associated with diffuse wall thickening was acute calculus and acalculous cholecystitis with both havinga frequency of 30 % each. Gallstones were found a common risk factor for gallbladder perforation as well as gallbladder malignancy. Common pathologies presenting with obstructive jaundice were CBD stones and CBD stricture in which distal CBD was the commonest site for the stones (39%) as well as stricture (50%).In paediatric age group presenting with jaundice common pathologies were choledochal cyst and biliary atresia.Conclusion:Ultrasound is a non-invasive, least expensive,highly sensitive imaging modality and free from radiation for the assessment of the gallbladder and biliary tree pathologies especially in emergency situations

Actinotignum schaalii: reporte de dos casos de bacteriemias en Argentina / Actinotignum schaalii: Report of two cases of bacteremia in Argentina

Resumen Actinotignum schaalii es un patógeno emergente en pacientes ancianos con patologías del tracto urinario. Se describen dos casos de bacteriemias por A. schaalii. Caso 1: Paciente de 79 años, con antecedente de hiperplasia benigna prostética. Ingresó a la guardia por síndrome febril, dolor abdominal y disuria. Caso 2: Paciente de 95 anos con adenomectomía prostética, uretrostomía por estrechez uretral e hiperplasia benigna prostética. Ingresó por síndrome febril, tos productiva, infiltrados bilaterales con imagen paracardíaca derecha y derrame pleural. En ambos pacientes se aisló A. schaalii en hemocultivos, identificado por espectrometría de masas MALDI-TOF MS. Solo en el caso 1 se confirmó que el foco de la bacteriemia fue urinario. Es importante sospechar la presencia de este patógeno emergente en infecciones urinarias con sedimento patológico, sin desarrollo en medios de cultivo tradicionales, para garantizar un tratamiento empírico adecuado, ya que la mayoría de los aislamientos presentan resistencia a ciprofloxacina y trimetoprima-sulfametoxazol.

Abstract Actinotignum schaalii is an emerging pathogen in elderly patients with urinary tract pathologies. Two cases of A. schaalii bacteremia are described. Case 1: 79-year-old patient with a history of benign prostatic hyperplasia. He was admitted to the ward for febrile syn-drome, abdominal pain, and dysuria. Case 2: 95-year-old patient with prostatic adenomectomy, urethrostomy due to urethral stricture, and benign prostatic hyperplasia. He was admitted due to febrile syndrome, productive cough, bilateral infiltrates with right paracardiac image, and pleural effusion. In both patients, A. schaalii was isolated in blood cultures, identified by MALDITOF-MS mass spectrometry. Only in case 1 was it confirmed that the focus of bac-teremia was urinary. It is important to suspect this emerging pathogen in urinary infections with pathological sediment without developing in traditional culture media to ensure ade-quate empirical treatment. Since most of the isolates show resistance to ciprofloxacin and trimethoprim-sulfamethoxazole.

Selection of Lactic Acid Bacteria Isolated from Cocoa and Cassava Fermentation as Potential Probiotic for Pathogenic Microorganisms Control in Poultry Farming

Aims: The overuse of antibiotics in animal farming sector is leading to an increase drug resistant bacteria rate. This situation makes it difficult to treat pathologies in both humans and animals. The aim of this study was to assess some probiotic profiles of lactic acid bacteria strains isolated from cocoa fermentation and traditional cassava ferment for possible use as potentially probiotic strains for the monitoring of pathogenic microorganisms in poultry farming. Methodology: Thus, a total of 267 lactic acid bacteria strains were tested for analysis of the antibacterial activity against the growth capacity of Salmonella and E. coli isolates. Probiotic properties of Lactic acid bacteria were consisted of acidification capacity, resistance to acid shock and to salt bile containing in culture medium and capacity to produce proteolytic and lipolytic enzymes. Results: Among them, 25 strains have induced the high bacterial growth inhibition against these pathogenic bacteria with inhibition zone diameters ranged from 9 to 27 mm. Among these strains, 20 isolates showed high resistance to acid shock at pH ? 4 and six strains were able to grow at pH 3.5 with survival rate range from 30 % to 89 %. Moreover, six of these strains, including four isolates of Lactobacillus plantarum (T1GB8, T11AB17, LAB26, LAB 127), one strain of Leuconostoc mesenteroides (T0AB9) and one isolate of Enterococcus facium (LAB18), have shown capacity to growth with 1 % of bile salts in the medium. Even better, these strains exhibited capacity to produce proteolytic and lipolytic enzymes with halo around the well diameters reached 29 mm for some strains. Conclusion: This study shows the possibility of use probiotics lactic acids bacteria as antibiotics alternative in poultry sector to reduce some avian pathologies affecting the poultry sector in C魌e d'Ivoire.

Investigation on the incidence and risk factors of fetomaternal hemorrhage syndrome in pregnant women in Changsha / 中国输血杂志

【Objective】 To investigate the incidence and possible risk factors of FMH among pregnant women in Changsha. 【Methods】 A total of pregnant women (6~42 weeks of gestation) who underwent prenatal examinations in our hospital from June 2019 to December 2020 were enrolled as subjects. In this study, the modified Kleihauer-Betke (K-B) test was used for preliminary screening and flow cytometry was applied to confirme initially positive samples to evaluate the incidence of FMH and estimate fetal blood loss. The logistic regression analysis was used to study the risk factors of FMH. 【Results】 The incidence of FMH in pregnant women was 10.45% (183/1 752), the average volume of fetal blood loss was (2.50±3.87)mL, and 0.11% (2/1 752) of the fetal losed blood > 30 mL. Univariate analysis showed that age, twin pregnancy, pregnancy complicated with uterine fibroids, in vitro fertilization, fetal growth restriction, preeclampsia, and number of pregnancies may be risk factors for FMH. Multivariate analysis showed that twin pregnancy (OR 2.274, 95%CI: 1.135-4.458, P<0.05) and preeclampsia (OR 2.341, 95%CI: 1.082-4.837, P<0.05) were independent risk factors for FMH. 【Conclusion】 Maternal age and various physiological and pathological factors during pregnancy may be associated with the risk of FMH, especially twin pregnancy and pre-eclampsia are independent risk factors for FMH.

Infección por Helicobacter pylori y la hemorragia digestiva alta / Helicobacter Pylori infection and upper gastrointestinal bleeding

Determinar la relación entre la infección por Helicobacter pylori y hemorragia digestiva alta (HDA) y su frecuencia fue el objetivo de la investigación, siendo ésta de tipo descriptivo correlacional con 50 pacientes con hemorragia digestiva, que acudieron al Servicio de Gastroenterología del Hospital Nacional Arzobispo Loayza de Perú, durante los meses de julio a octubre del 2021. Se elaboró un instrumento de recolección de información para las variables; edad, género, procedencia, ocupación y grado de instrucción. Se determinó la presencia de H. pylori a través de la realización de biopsia gástrica (identificación histopatológica). Para determinar la correspondencia entre las variables de la investigación, se utilizó la correlación de Pearson. Al evaluar el riesgo entre las patologías gastrointestinales y sufrir HDA se encontró para enfermedad ulcero péptica un (OR=7,1 IC: 1,394-35,987), gastritis (OR=13,7 IC: 1,068-174,81), y litiasis vesicular (OR=1,2 IC: 1,056-1,352). Dentro de los hábitos de los pacientes con HDA, 1 de cada 4 reportó consumir bebidas alcohólicas, 1 de cada 8 manifestó tabaquismo, y 1 de 2 reportó hábito cafeico. Se encontró una correlación positiva entre las variables hemorragia digestiva alta e infección por H. Pylori, ya que el coeficiente reportado es igual a 0,685. Se determinó una correlación positiva entre las variables hemorragia digestiva alta e infección por H. pylori en pacientes valorados por el servicio de gastroenterología del hospital. La infección por H. Pylori es de prevalencia elevada en la población general, sin embargo, el estudio muestra que no se manifiesta frecuentemente con sintomatología sangrante alta(AU)

Determining the relationship between infection by Helicobacter pylori and upper gastrointestinal bleeding (UGH) and its frequency was the objective of the investigation, this being descriptive correlational with 50 patients with gastrointestinal bleeding, who attended the Gastroenterology Service of the Arzobispo Loayza National Hospital. from Peru, during the months of July to October 2021. An information recollection instrument was developed for the variables; age, gender, origin, occupation and level of education. The presence of H. pylori was determined by performing a gastric biopsy (histopathological identification). To determine the correspondence between the research variables, the Pearson correlation was used. When evaluating the risk between gastrointestinal pathologies and suffering from UGIB, peptic ulcer disease (OR=7.1 CI: 1.394-35.987), gastritis (OR=13.7 CI: 1.068-174.81), and gallstones were found. (OR=1.2 CI:1.056-1.352). Among the habits of patients with HDA, 1 out of 4 reported consuming alcoholic beverages, 1 out of 8 reported smoking, and 1 out of 2 reported a coffee habit. A positive correlation was found between the variables upper gastrointestinal bleeding and H. Pylori infection, since the reported coefficient is equal to 0.685. A positive correlation was found between the variables upper gastrointestinal bleeding and H. pylori infection in patients assessed by the gastroenterology service of the hospital. H. Pylori infection is highly prevalent in the general population, however, the study shows that it does not manifest frequently with high bleeding symptoms(AU)

La concentración de fluoruro en agua potable y la fluorosis dental en niños / Fluoride concentration in drinking water in relation to dental fluorosis in children

Dental treatment is a highly sought-after but costly procedure in the world, so it is important to consider measures to prevent dental disease. Among the ways of prevention, drinking water fluoridation, which involves adding relevant amounts of fluoride to the water supply reaching communities, stands out. However, it is not clear whether there are enough researchers who have addressed the issue, or that their methodology has been adequate to provide alternatives to solve some conditions, such as dental fluorosis, which, in contrast, is manifested by excessive fluoride intake. The main objective was to explore and analyse the academic production on the concentration of fluoride present in drinking water in order to find a relationship with dental fluorosis in children. To this end, the PRISMA model was used as a starting point in order to carry out a systematic review of academic articles chosen according to selection criteria. These will be extracted from five databases, using a documentary-type methodology, whose data collection will be carried out in virtual environments. From this, it was concluded that the academic production includes the concentration of fluoride in drinking water as a means of prevention for dental pathologies; however, the levels of fluoride allowed in children should be known, as the excess of fluoride in the teeth causes dental fluorosis, which turns out to be the cause of psychological complexes in children due to an aesthetic issue.

El tratamiento dental es un procedimiento muy solicitado en el mundo, pero costoso de realizar; por lo que, es importante considerar medidas para prevenir enfermedades dentarias. Entre las formas de prevención, destaca la fluoración del agua potable, que implica añadir cantidades pertinentes de flúor al suministro de agua que llega a las comunidades. Sin embargo, no se precisa si existen suficientes investigadores que hayan abordado el tema, o que su metodología empleada haya sido la adecuada como para brindar alternativas para solucionar algunas afecciones, tales como la fluorosis dental que; en contraste, se manifiesta por la excesiva ingesta de flúor. El objetivo principal, realizar una exploración y análisis de la producción académica sobre la concentración de flúor presente en el agua potable con el fin de encontrar una relación con la fluorosis dental en niños. Para ello, se partió del modelo PRISMA con el fin de proceder una revisión sistemática de artículos académicos escogidos mediante criterios de selección. Estos serán extraídos de cinco bases de datos, valiéndose entonces, de una metodología de tipo documental, cuya recolección de datos se efectuará en entornos virtuales. A partir de ello, se concluyó que la producción académica incluye a la concentración del flúor en agua potable como un modo de prevención para patologías dentales; no obstante, se debe conocer los niveles de flúor permitido en los niños, pues el exceso de flúor en los dientes origina fluorosis dental, la cual resulta ser causante de complejos psicológicos en los niños debido a un tema estético.

Patologia do desempenho: TDAH, drogas estimulantes e formas de sofrimento no capitalismo / Performance pathology: ADHD, stimulant drugs, and forms of suffering in the capitalism / Patología de desempeño: TDAH, drogas estimulantes y formas de sufrimiento en el capitalismo

O consumo de medicamentos estimulantes cresceu nos últimos anos, no Brasil e no mundo. Pessoas de diferentes idades, especialmente crianças e adolescentes, passaram a consumir estimulantes como a principal terapêutica utilizada para tratar o transtorno do déficit de atenção e hiperatividade (TDAH). Nesse contexto, estimulantes como as anfetaminas e o metilfenidato, mais conhecidos pelos nomes comerciais de Adderall e Ritalina, ganharam visibilidade social em razão da associação desses psicofármacos ao aperfeiçoamento de funções psíquicas como a atenção e o aumento na qualidade e no tempo de rendimento dos sujeitos nas mais variadas atividades. Com isso, aumentou também a procura desses estimulantes por pessoas que não estão em tratamento médico, mas que buscam aprimorar seu desempenho nas atividades que realizam. Diante desse cenário, o objetivo deste artigo foi demonstrar como o crescimento no consumo de estimulantes, seja por sujeitos em tratamento médico ou não, está relacionado aos processos de socialização hegemônicos nas sociedades capitalistas atualmente. Articulando o contexto apresentado com os conceitos da psicanálise lacaniana, foi possível concluir que o consumo massivo de estimulantes está relacionado aos processos de patologização e medicalização da existência, colocados em movimento por uma articulação entre o discurso médico-científico e o discurso do capitalista na contemporaneidade.(AU)

The consumption of stimulating drugs has grown in recent years in Brazil and worldwide. People of all ages, especially children and adolescents, started to use stimulants as the main therapy used to treat attention deficit hyperactivity disorder (ADHD). In this context, stimulants such as amphetamines and methylphenidate, better known by the trade names Adderall and Ritalin, have gained social visibility due to the association of these psychoactive drugs with the improvement of psychic functions such as attention and the increase in quality and performance time of subjects in the most varied activities. As a result, the demand for these stimulants has also increased by people who are not undergoing medical treatment, but who seek to improve their performance in the activities they perform. Given this scenario, this article aimed to demonstrate how the growth in the consumption of stimulants, whether by subjects undergoing medical treatment or not, is related to the hegemonic socialization processes in capitalist societies today. Articulating the context presented with the concepts of Lacanian psychoanalysis, it was possible to conclude that the massive consumption of stimulants is related to the processes of pathologization and medicalization of existence, set in motion by an articulation between the medical-scientific discourse and the capitalist discourse in contemporary times.(AU)

El consumo de drogas estimulantes ha crecido en los últimos años, en Brasil y en otros países. Diversas personas, especialmente niños y adolescentes, comenzaron a usar estimulantes como la terapia principal utilizada para tratar el trastorno por déficit de atención con hiperactividad (TDAH). En este contexto, los estimulantes como las anfetaminas y el metilfenidato, mejor conocidos por los nombres comerciales Adderall y Ritalina, han ganado visibilidad social debido a la asociación de estas drogas psicoactivas a la mejora de las funciones psíquicas, como la atención y el aumento de la calidad y el tiempo de rendimiento de los pacientes en diversas actividades. Como resultado, la demanda de estos estimulantes también ha aumentado por las personas que no reciben tratamiento médico, pero que buscan mejorar su desempeño en las actividades que realizan. Dado este escenario, el objetivo de este artículo era demostrar cómo el crecimiento en el consumo de estimulantes, ya sea por sujetos que reciben tratamiento médico o no, está relacionado con los procesos de socialización hegemónica en la sociedad capitalista actual. De la articulación del contexto presentado con los conceptos del psicoanálisis lacaniano se concluye que el consumo masivo de estimulantes está relacionado con los procesos de patologización y medicalización de la existencia, puestos en marcha por una articulación entre el discurso médico-científico y el discurso capitalista en los tiempos contemporáneos.(AU)

The characterization of a hospitalized population at the pediatric emergency service of mother and child hospital, Marrakech, Morocco

Introduction: the pediatric emergency department is the first contact between the population and the hospital. Consequently, its dysfunction influences the quality of general health care. However, any successful policy must first be based on convincing results hence the need to better explore this service, diagnose the various dysfunctions, and survey disease trends to identify the needs of the local population. In this perspective, we propose to describe the epidemiological profile of children hospitalized at the emergency service of the Mother-Child hospital, University Hospital Centre Marrakech, and establish the prevalence table for childhood pathologies. Methods: a retrospective study was carried out in pediatric emergency services for 1658 hospitalized patients between March 2015 and December 2018. The collected data concerns mainly the socio-demographic, clinical profile, evolution status, mode of admission, and medical history. Results: the characterization of the studied population by sex and age showed a predominance of Male with a sex ratio of 1.36, infants with 625 patients. Concerning the final diagnosis, the most frequent pathologies affected the respiratory system in 28% of cases, then the digestive system (11.3%), while infectious pathologies represented 10.7% of admissions. The death rate in the emergency department was 7.4%. Multivariate analysis of the data showed a statistically significant relationship between the final diagnosis (16 diseases by a system according to The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and age, season, and weight. Thus, for the association between Diseases of the digestive system and weight (aOR=1.052, 95% CI= 1.019-1.086, p=0.02). While for Diseases of the skin and subcutaneous tissue and the autumn season (aOR=11.37, 95% CI= 1.272-<101.777, p=0.03) and age has a negative significance for most diseases. Conclusion: the epidemiological profile study will allow knowledge of patient´s pathologies typology for a well-supported and better definition of needs.

Índice PROFUND y mortalidad intrahospitalaria en pacientes pluripatológicos. Análisis post-hoc / PROFUND index and intrahospital mortality in plurypathological patients. A post-hoc analysis

Resumen El índice PROFUND se desarrolló y validó para predecir mortalidad a 12 meses en pacientes pluripatológicos. Sin embargo, su valor potencial para predecir mortalidad intrahospitalaria no ha sido suficientemente estudiado. Se evaluó la capacidad del índice PROFUND en comparación con la proteína C re activa (PCR), la albúmina, y el ancho de distribución eritrocitaria (ADE) para predecir mortalidad intrahospitalaria, mediante el análisis posterior de una cohorte prospectiva de 111 pacientes pluripatológicos internados en clínica médica. La edad promedio fue 75.8 ± 9.3 años. La mortalidad intrahospitalaria fue de 17% (19 pacientes). La mediana (RIQ) del índice PROFUND, albúmina, PCR y ADE en los fallecidos y sobrevivientes fue 12 (4) y 6 (7) p< 0.0001, 2.5 (0.4) y 2.6 (0.8) p 0.295, 58 (64) y 40 (60) p 0.176, 14.5 (2) y 14.6 (3) p 0.523, respectivamente. El análisis logístico multivariado mostró que el índice PROFUND se asocia con mortalidad intrahospitalaria (p 0.0003). El riesgo de fallecer durante la internación es 20% mayor por cada punto que se incrementa el índice PROFUND (OR 1.2, IC95% 1.1-1.4). El área bajo la curva de las características operativas del receptor (AUC-ROC) del índice PROFUND para predecir mortalidad durante la internación (0.760, IC95% 0.628-0.891) fue mayor a la del ADE, PCR y albúmina (0.494 IC95% 0.364-0.624 p 0.012; 0.583 IC95% 0.437-0.728 p 0.028; 0.621 0.494-0.748 p 0.109, respectivamente). El índice PROFUND se asocia a mortalidad intrahospitalaria, con una mayor capacidad predictiva que los biomarcadores estudiados, lo cual se sumaría a su valor pronóstico a largo plazo en pacientes pluripatológicos.

Abstract The PROFUND index was developed and valid to predict mortality at 12 months in polypathological patients (PP). However, its potential value for predicting in-hospital mortality has not been sufficiently studied. The ability of the PROFUND index in comparison with C-reactive protein (CRP), albumin, and red blood cell distribu tion width (RDW) to predict in-hospital mortality was evaluated through the subsequent analysis of a prospective cohort of 111 multiple pathological patients admitted to the clinic medical. The mean age was 75.8 ± 9.3 years. In-hospital mortality was 17% (19 patients). The median (IQR) of the PROFUND index, albumin, CRP and ADE in the deceased and survivors was 12 (4) and 6 (7) p < 0.0001, 2.5 (0.4) and 2.6 (0.8) p 0.295, 58 (64) and 40 (60) p 0.176, 14.5 (2) and 14.6 (3) p 0.523, respectively. The multivariate logistic analysis showed that the PROFUND index is associated with in-hospital mortality (p 0.0003). The risk of dying during hospitalization is 20% higher for each point that the PROFUND index increases (OR 1.2, 95% CI 1.1-1.4). The area under the curve the receiver operating characteristic (AUC-ROC) of the PROFUND index to predict mortality during hospitalization (0.760, 95% CI 0.628-0.891) was higher than that of the RDW, CRP and albumin (0.494 95% CI 0.364-0.624 p 0.012; 0.583 95% CI 0.437-0.728 p 0.028; 0.621 0.494-0.748 p 0.109, respectively). The PROFUND index is associated with in-hospital mortality, with a greater predictive capacity than the biomarkers studied, which would add to its long-term prognostic value in multiple pathological patients.

Análisis retrospectivo de registros clínicos de una población felina, a partir de los rangos etarios definidos por la International Cat Care / Clinical Record Retrospective Analysis of a Cat Population based on the Age Ranges Defined by the International Cat Care

Resumen En el presente estudio se realizó un análisis retrospectivo a 1199 fichas clínicas de felinos, pertenecientes a una clínica veterinaria entre los años 2008-2013, con el propósito de establecer el orden de importancia de las distintas patologías. Dicho análisis se basó en la categoría etaria de la International Cat Care (ICC) y consideró las variables sistema afectado, raza, sexo y condición reproductiva. Del total de fichas, el 69 % (827/1199) correspondieron a pacientes con patologías, donde el sistema más afectado correspondió al sistema tegumentario (20,1 %). La raza con mayor representación correspondió a los tipo doméstico común (DC), con un 98,42 %, mientras que el 1,58 % restante fue representado por ejemplares de raza. Con respecto a la distribución por sexo, esta afectó al 52,29 % de los machos y al 47,71 % de las hembras. De acuerdo con el rango etario, el mayor porcentaje de patologías se presentó en los junior, con un 41,53 %. Con respecto a la condición reproductiva, el 76,15 % de las fichas clínicas analizadas correspondió a animales enteros, los castrados representaron el 7,51 % y la diferencia porcentual restante (16,35 %) incluyó a todos aquellos pacientes en los cuales no existía dicha información.

Abstract This study was conducted as a retrospective analysis of 1199 cat clinical files in a veterinary clinic between 2008 and 2013. The study aims to determine an importance ranking for the different pathologies. This analysis is based on the age categories provided by the International Cat Care (ICC) and takes into account the variables: affected system, race, sex, and reproductive condition. Out of the total files, 69% (827/1199) accounted for patients with pathologies and the integumentary system was the most frequently affected (20.1 %). The most frequently found race was the common home cat (CHC) with 98.42% while the remaining 1.58 % accounted for specific race specimens. Regarding the sex distribution, 52.29% of affected cats were male and 47.71% were female. Regarding the age ranges, a higher percentage of pathologies was found in junior cats, with 41.53%. Regarding the reproductive condition, 76.15% of the clinical files analyzed herein belong to non-neutered cats and 7.51% to neutered cats. The remaining percentage difference (16.35 %) includes all the patients without this specific information.

Imaging technologies for the detection of sinus pathologies of odontogenic origin. A review / Herramientas imagenológicas para la detección de patologías sinusales de origen odontogénico. Una revisión

Sinus pathologies of odontogenic origin (SPO) are common in the clinical consultation; however, the dentist has some complications to detect them because their discovery is usually incidental and through imaging studies that, in most cases, are of low quality. The objective of this review is to describe the pertinent imaging resources that allow the detection of the most frequent SPO and, at the same time, carry out an updated review of the scientific literature in order to recognize the imaging of both the maxillary sinus and the dental organs. The scientific literature focused on this topic, published between 2014 and 2020, was consulted. The review showed two important results: the first is that Cone Beam Tomography (CBCT) represents the imaging modality with the best performance for the detection of SPO by what can be considered the gold standard for this purpose. The second is that the most frequent SPO is sinus mucositis, which is related to odontogenic conditions such as periapical lesions and periodontal affectations. Although Cone Beam Computed Tomography (CBCT) is the most appropriate tool to detect SPO compared to images obtained by 2D devices, there are also other alternatives such as magnetic resonance imaging and ultrasonography, which seem to have a promising future. (AU)

Las patologías sinusales de origen odontogénico (PSO) son frecuentes en la consulta clínica; sin embargo, el odontólogo tiene algunas complicaciones para detectarlos porque su descubrimiento suele ser incidental y mediante estudios de imagen que, en la mayoría de los casos, son de baja calidad. El objetivo de esta revisión es describir los recursos de imagen pertinentes que permitan la detección de las PSO más frecuentes y, al mismo tiempo, realizar una revisión actualizada de la literatura científica con el fin de reconocer la imagenologia tanto del seno maxilar como de los órganos dentales. Se consultó la literatura científica centrada en este tema, publicada entre 2014 y 2020. La revisión arrojó dos resultados importantes: el primero es que la tomografía de haz cónico (TCHC) representa la modalidad de imagen con mejor desempeño para la detección de PSO, por lo que se puede considerar el estándar de oro para este propósito. La segunda es que la PSO más frecuente es la mucositis sinusal, que se relaciona con afecciones odontogénicas como lesiones periapicales y afectaciones periodontales. Si bien la TCHC es la herramienta más adecuada para detectar la SPO en comparación con las imágenes obtenidas con dispositivos 2D, también existen otras alternativas como la resonancia magnética y la ecografía, que parecen tener un futuro prometedor. (AU)

Radiografía panorámica: una herramienta invaluable para el estudio del componente óseo y dental del territorio maxilofacial / Panoramic radiographs: an invaluable tool for the study of bone and teeth components in the maxillofacial region

RESUMEN: La radiografía panorámica es probablemente el examen de rutina más solicitado por los dentistas en el mundo. Entre sus ventajas están su bajo costo, rapidez y mayor seguridad debido a que los formatos digitales han permitido disminuir las dosis y tiempos de exposición a la radiación. Su potencial como herramienta diagnóstica radica en la posibilidad que tiene el clínico de observar el territorio maxilofacial casi en su totalidad, pudiendo realizar un estudio anatómico y morfológico acabado de diferentes regiones. En esta revisión se quiere ofrecer una mirada general de la amplia gama de usos que se le pueden dar a la radiografía panorámica, tanto en la clínica como en el ámbito de la investigación, destacando su potencial como herramienta de diagnóstico y su importancia para algunas áreas de especialidad en odontología.

SUMMARY: The panoramic radiograph is in all likelihood, the routine exam most required by dentists in the clinic worldwide. Among the advantages of using this type of radiograph, is that it is inexpensive, quick and also safer in digital format since it reduces the radiation dose and time of exposure. Its potential as a diagnostic tool is based on the possibility to explore almost all of the maxillofacial area, allowing a proper anatomic and morphological study of different areas at the same time. In this review, we aimed to provide an overview of the multiple uses of panoramic radiographs, highlighting its potential as a diagnostic tool and also its importance in some specialized areas of dentistry.

Características clínicas de Soiling en pacientes postoperados de enfermedades anales en el Hospital General San Juan de Dios / Clinical settings of patients with postoperative Soiling at San Juan de Dios Hospital

Introducción: El soiling es el escape inconsciente de pequeñas cantidades de materia fecal después de una evacuación normal. Se ha reportado una prevalencia del 7-23% en otros países y se ha observado una alta incidencia después de esfinterotomías y fistulotomías (35-45%). Material y Métodos: Se realizó un estudio observacional que incluyó 80 pacientes con patologías anales que acudieron a la consulta externa del Hospital General San Juan de Dios donde se aplicó un cuestionario de 8 ítems. Resultados: Se evaluaron 80 pacientes, la mayoría son hombres, de la quinta década. La enfermedad anal más frecuente son las hemorroides y el tratamiento quirúrgico más frecuente la hemorroidectomía. La incidencia de soiling definitivo (presencia de manchado a los 6 meses) es del 22.5%. Las variables asociadas fueron el género masculino, el tipo de enfermedad y procedimiento quirúrgico, el enrojecimiento, la picazón anal, el uso de protector en la región anal, la sensación de materia fecal y la limpieza en región anal. El ser hombre presenta un riesgo 6 veces mayor y el presentar enrojecimiento en la región anal aumenta el riesgo de 27 veces de presentar soiling definitivo. Conclusión: El soiling se presenta en un quinto de los pacientes que son operados de patologías anales en el Hospital General San Juan de Dios. La presencia de eritema, picazón anal, el uso de protector en la región anal, la sensación de materia fecal y la limpieza en región anal son variables estadísticamente asociadas al mismo. (AU)

Introduction: Soiling is the unconscious escape of small amounts of fecal matter after a normal bowel movement. A prevalence of 7-23% was reported in other countries and a high incidence was observed after sphincterotomies and fistulotomies (35-45%). Material and Methods: A observational study that included 80 patients with anal pathologies who attended the outpatient clinic of the San Juan de Dios General Hospital during 2018-2019, where an 8-item questionnaire was applied. Results: Eighty patients were evaluated, the majority are men, in their fifth decade. The most common anal disease is hemorrhoids, and the most common surgical treatment is hemorrhoidectomy. The incidence of definitive soiling (presence of spotting at 6 months) is 22.5%. The variables associated with definitive soiling were male gender, type of disease and surgical procedure, redness, anal itching, use of a protector in the anal region, the sensation of fecal matter, and cleanliness in the anal region. Being male presents a 6 times greater risk of definitive soiling and having redness in the anal region presents a 27 times greater risk of definitive soiling. Conclusion: Soiling occurs in a fifth of the patients operated for anal pathologies at the San Juan de Dios General Hospital. The presence of erythema, anal itching, the use of a protector in the anal region, the sensation of stool, and cleanliness in the anal region are statistically associated variables with soiling. (AU)

Dictamen médico legal de un análisis de voz, ¿cómo hacerlo? / Medical legal opinion of a voice analysis, how to do it?

La acústica forense es una disciplina de la criminalística que ha alcanzado una ma-durez analítica que obliga a que el perito en análisis de voz se especialice en adquirir conocimientos en fonética, tecnologías de sonido, habla, voz, lenguaje, patologías del habla y la voz, así como procesamiento de la señal sonora. Cuando un dictamen deba ser realizado por un profesional de la salud completamente ajeno a la técnica legal, se tropieza con una falta de protocolos, métodos y procedimientos de trabajo que le permitan entregar un informe técnico, válido y validado para la realización de una entrevista y su posterior análisis comparativo de voces, lo que promueve la necesidad de elaborar una ruta o guía metodológica a través de medios académicos físicos o electrónicos para el desarrollo de este conocimiento y su difusión profesional y científica

Forensic acoustics is a criminalistics discipline that has reached an analytical maturity that requires the expert in voice analysis to specialize in acquiring knowledge in pho-netics, sound technologies, speech, voice, language, speech, and voice pathologies, as well as sound signal processing. When an opinion must be made by a health profes-sional completely unrelated to the legal technique, he encounters a lack of protocols, methods, and work procedures that allow him to deliver a technical, valid, and vali-dated report for conducting an interview and its subsequent comparative analysis of voices, which promotes the need to develop a methodological route or guide through physical or electronic academic means for the development of this knowledge and its professional and scientific dissemination