Oclusión intestinal en paciente renal crónico secundario a bezoar de telas Reporte de un caso clínico / Intestinal Occlusion in a Chronic Renal Patient Secondary to Textile Bezoar. Clinical Case Report

Resumen Los "bezoar" son conglomerados de materiales no comestibles ingeridos voluntaria o involuntariamente, no digeridos e incapaces de transitar por el tracto intestinal. Principalmente afectan a jóvenes mujeres o adolescentes que presentan el fenómeno llamado "pica", y a pesar de que se ha registrado una alta prevalencia de este fenómeno en pacientes con enfermedad renal crónica (ERC), ha sido poco estudiado. Caso clínico: Paciente del sexo masculino de 35 años de edad que cursa con ERC KDIGO-5 en tratamiento con diálisis peritoneal; se obtiene el hallazgo de "bezoar plástico" transoperatorio (laparotomia por oclusión intestinal) a 10 cm de la válvula ileocecal. El paciente fallece por complicaciones de la patología de origen. Se plantea la necesidad de realizar la búsqueda de comportamientos en pacientes con ERC, que indiquen al cirujano la sospecha, dado que los pacientes generalmente ocultan u omiten referir sobre la ingesta de material extraño.

Abstract The "bezoar" are conglomerates of inedible materials ingested voluntarily or involuntarily, which are not digested and are unable to pass through the intestinal tract. They mainly affect young women or adolescents who present the phenomenon called "pica", despite the fact that a high prevalence of this phenomenon of "pica" has been registered in patients with chronic kidney disease, it has been little studied. Clinical case: A 35-year-old male with CKD KDIGO-5 undergoing peritoneal dialysis treatment, which was found to have a transoperative "plastic bezoar" (laparotomy for intestinal occlusion) 10 cm from the ileocecal valve. The patient died due to complications of his pathology. Discussion: the clinical case raises the need to search for behaviors such as pica in patients with CKD, as well as to develop the suspicion to the surgeon, since patients generally hide or ignore reporting foreign material phagia.

Pica y traumatismo craneoencefálico en un paciente adolescente: recuperación <> con paliperidona / Pica and traumatic brain injury in an adolescent: complete improvement with paliperidone

Presentamos el caso clínico de un adolescente varón de 15 años derivado a Psiquiatría Infanto-Juvenil por realizar ingestas repetitivas de sustancias no nutritivas como gomas de borrar, escamas psoriásicas o incluso pintura de la pared. Entre sus antecedentes somáticos de interés, conviene destacar la Enfermedad de Kawasaki y psoriasis, además de haber sufrido un traumatismo craneoencefálico (TCE) tras lo cual presentó una exacerbación del cuadro. Tras el fracaso en el manejo conductual realizado por parte de su madre y teniendo en cuenta sus rasgos de personalidad caracterizados por una elevada suspicacia y desconfianza hacia los demás, se decide iniciar tratamiento con paliperidona oral produciéndose una rotunda mejoría clínica. Durante todo el seguimiento posterior hasta su mayoría de edad, se ha mantenido la desaparición de la pica. Presentamos el primer caso clínico publicado en la bibliografía actual de un adolescente con el diagnóstico de pica y un TCE previo y una adecuada respuesta a paliperidon

We present a case report of a 15-year-old male adolescent who was referred to our consultation of Children and Adolescent Psychiatry due to persistent eating of non-nutritive substances like rubber, psoriatic scale or wall paint. The patient had the previous diagnostic of Kawasaki Disease and psoriasis. In addition, he had suffered a traumatic brain injury, after which he presented an exacerbation of the clinic. After behaviour therapy failure realized by his mother and taking into account his personality features with high suspicion and distrust of others, he was prescribed paliperidone oral treatment and pica disappeared. During all subsequent follow-up until the age of majority, the disappearance of pica has been maintained. We describe the first case report in the current bibliography of an adolescent with the diagnosis of pica, a previous traumatic brain injury and a good response to oral paliperidone.

Identification of Synthetic Cannabinoid 5F-EDMB-PICA in Suspicious Herbal Products / 法医学杂志

Objective To study the qualitative analysis strategy for unknown synthetic cannabinoid in the suspicious herbal product when no reference substance is available. Methods The synthetic cannabinoid in herbal blend was extracted with methanol. The extract was concentrated by rotary evaporator and separated and purified by preparative liquid chromatography, to obtain high purity synthetic cannabinoid sample. Gas chromatography-mass spectrometry （GC-MS）, ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry （UPLC-QTOF-MS） and nuclear magnetic resonance （NMR） were used to determine the structure of the prepared compound. Results High purity unknown sample （10 mg） was obtained by preparative liquid chromatography. The sample was analyzed by GC-MS, UPLC-TOF-MS and NMR, and through spectrum analysis, the unknown synthetic cannabinoid was determined as 5F-EDMB-PICA. Conclusion The method to extract unknown synthetic cannabinoid from low content herbal products by preparative liquid chromatography was established, and the structure of the unknown sample was identified by comprehensive use of GC-MS, UPLC-QTOF-MS and NMR. The information will assist forensic laboratories in identifying this substance or other compounds with similar structures in their casework.

Conductas de pica en pacientes con enfermedad renal crónica: Una revisión / Pica behaviors in patients with chronic kidney disease: A review

Abstract Pica behaviors (PB) are defined as the persistent intake of non-food substances, this behavior that has been identified in patients with Chronic Kidney Disease (CKD), mainly associated with metabolic alterations derived from the disease. The aim of this work was to perform a systematic review for the identification and description of empirical studies on PB in patients with CKD. Four studies were described based on the PRISMA recommendations, which focused on the evaluation of the prevalence of PB and their relationship with sociodemographic, nutritional, metabolic and quality of life variables, evaluating by means of self-report 668 patients, of whom 164 (24.5%) met criteria for PB. It was identified that the PB were more present in women (69%) and in Afroamericans (65-86%) and in contrast to what is reported a clinical context did not differ statistically in the biological and clinical variables. It is concluded that if PB are presented in a quarter of the population studied, is necessary to have a definition of homogeneous that were defined differently and the forms of evaluation. Finally, reference is made to the lack of inclusion of psychological variables and behavioral type analysis, since, as discussed, PB are a clearly analyzable pattern in behavioral terms.

Resumen Las conductas de pica (CP) se definen como la ingesta persistente de sustancias no alimenticias, forma de comportamiento que se ha identificado en pacientes con enfermedad renal crónica (ERC), asociadas principalmente con alteraciones metabólicas derivadas de la enfermedad. El objetivo de este trabajo fue realizar una revisión narrativa de los estudios empíricos existentes sobre CP en pacientes con ERC. Con base en las recomendaciones PRISMA se describieron cuatro estudios, centrados en evaluar la prevalencia de las CP y su relación con variables sociodemográficas, nutricionales, metabólicas y de calidad de vida, evaluando por medio de herramientas de autoreporte a un total de 668 pacientes, de los cuales 164 (24.5%) cumplieron criterios para CP. Éstas se presentaron más en mujeres (69%) y en afroamericanos (65-86%), y al contrario de lo reportado a nivel clínico, no se encontraron diferencias estadísticamente significativas en las variables biológicas y clínicas. Se concluye que, si bien las CP se presentan en una cuarta parte de la población estudiada, es necesario contar con una definición homogénea, ya que en cada estudio se definieron de manera diferente y, por ende, las formas de evaluación variaron. Finalmente, se hace referencia a la falta de inclusión de variables psicológicas y análisis de tipo conductual, pese a que las CP constituyen un patrón claramente analizable en términos conductuales.

Eating behavior, non-food substance consumption and negative urgency in women / Comportamento alimentar, consumo de substâncias não alimentares e urgência negativa em mulheres

ABSTRACT Objective To evaluate aspects of eating behavior, presence of non-food substance consumption and negative urgency in women from an on-line support group for eating disorders. Methods Participants (n=147) completed questionnaires for binge eating assessment, Intuitive Eating, negative urgency, cognitive restraint and a question of non-food substance consumption. Participants were separated according to criteria for bulimic symptoms and compulsive symptoms. Results The consumption of non-food substances was 4.8% (n=7). The Bulimic Group (n=61) showed higher values for binge eating (p=0.01), cognitive restraint (p=0.01) and negative urgency (p=0.01) compared with the Compulsive Group (n=86). Only the Compulsive Group showed an inverse correlation between scores for binge eating and Intuitive Eating (p=0.01). In both groups, binge eating was inversely correlated with the subscale of body-food choice congruence of Intuitive Eating scale. As expected, the Bulimic Group reached higher values for measures of disordered behaviors such as cognitive restraint and binge eating, and lower scores for Intuitive Eating. Conclusion The aspects of Intuitive Eating are inversely associated with compulsive and bulimic symptoms and the correlation analyses for binge eating and negative urgency agreed with models reported in published literature about negative urgency.

RESUMO Objetivo Avaliar aspectos do comportamento alimentar, presença do consumo de substâncias não alimentares e urgência negativa em mulheres de um grupo de apoio para transtornos alimentares. Métodos As participantes (n=147) preencheram instrumentos para avaliação de compulsão alimentar, Comer Intuitivo, urgência negativa, restrição cognitiva e uma questão para consumo de substâncias não alimentares. Elas foram divididas de acordo com critérios para sintomas bulímicos e sintomas compulsivos. Resultados O consumo de substâncias não alimentares foi de 4,8% (n=7). O Grupo Bulímico (n=61) apresentou maiores valores para compulsão alimentar (p=0,01), restrição cognitiva (p=0,01), e urgência negativa (p=0,01) em relação ao Grupo Compulsivo (n=86). Apenas o Grupo Compulsivo demonstrou correlação inversa entre escores para compulsão alimentar e Comer Intuitivo (p=0,01). Para ambos os grupos, a compulsão alimentar foi inversamente correlacionada com a subescala de escolhas alimentares realizadas em congruência com o estado do corpo do Comer Intuitivo. Como esperado, o Grupo Bulímico apresentou maiores valores para medidas de comportamentos disfuncionais como restrição e compulsão alimentar, e menores escores para Comer Intuitivo. Conclusão Os aspectos do Comer Intuitivo estiveram inversamente associados com os sintomas compulsivos e bulímicos, e os resultados das análises de correlação para Escala de Compulsão Alimentar e urgência negativa concordam com modelos da literatura sobre o envolvimento da urgência negativa.

Phasa: todo sobre la arcilla comestible / Phasa: everything about edible clay

La phasa (conocida así entre los pobladores aymaras) es un tipo de arcilla comestible que se encuentra en los suelos, empleada como medicina tradicional en la mayoría de los continentes, principalmente para aliviar o tratar patologías gastrointestinales e infecciones cutáneas. Su consumo se remonta muchos siglos atrás; existe evidencia del uso de este elemento en las Placas de arcilla de Nippur en Mesopotamia (2500 años a. C.). Develar las propiedades bio-físico-químicas de las arcillas comestibles está permitiendo a la ciencia explicar las propiedades terapéuticas que posee y así confirmar los grandes avances en la medicina alternativa que tuvieron nuestros antepasados. El uso de la phasa no se limita a la medicina, sino también a muchas otras ramas de la ciencia. En los últimos 10 años se ha experimentado en la agricultura, veterinaria, incluso en el cuidado del medio ambiente dando resultados muy gratificantes y prometedores.

Phasa, an Aymara's language word, is a type of edible clay found in soils; which is used in traditional medicine worldwide mainly to relieve or treat gastrointestinal pathologies and skin infections. Its consumption dates back many centuries, even millennia ago; there is evidence of the use of this element in the clay plates of Nippur in Mesopotamia (2500 years BC). Revealing the bio-physical-chemical properties of edible clay has allowed science to explain their healing and therapeutic properties and confirms the great advances our ancestors got. The use of phasa is not limited to medicine, it is also used in many other sciences; in the last 10 years it has been used in agriculture and veterinary medicine, getting gratifying results.

Pica, a Little-Known Condition in Dentistry. Case Report / Pica, una Condición Poco Conocida en Odontología. Reporte de un Caso

ABSTRACT: Pica is a condition associated with the chronic, compulsive consumption of a particular substance or material that is not considered food. Culturally it is not accepted by society and its nutritional value is non-existent. When this behavior is repeated consistently for more than one month, it is considered to be Pica. This eating disorder does not have a clear etiology, but is associated with; orality in children, psychotic disorders, nutritional deficiencies, psychosocial problems, autism, family problems, OCD, stress, abuse, family separations and other traumatic events. In order to detect it, it is necessary to perform a correct anamnesis, clinical examination, radiographic examination, complementary examinations such as blood count, as well as a relationship of trust between the dentist and the patient are necessary. All of them will be able to guide us and make us come out of suspicion that this harmful behavior exists, since patients often hide it.

RESUMEN: Pica es una condición asociada al consumo compulsivo y crónico de alguna sustancia o material en particular, que no es considerada alimento. Culturalmente no es aceptado por la sociedad y su valor nutricional es inexistente. Cuando esta conducta se repite consiste-ntemente durante más de un mes, se considera como Pica. Este desorden de comportamiento alimenticio no tiene una etiología clara, pero se asocia a la oralidad en niños, trastornos psicóticos, deficiencias nutricionales, problemas psicosociales, autismo, problemas familiares, TOC, estrés, abuso, separaciones familiares y otros eventos traumáticos. Para detectarla, es necesaria una correcta anamnesis, examen clínico, radiográfico, exámenes complementarios como hemograma, además de una relación de confianza rapport odontólogo- paciente. El conjunto de ellos nos podrán guiar y salir de sospecha que esta conducta dañina existe, ya que los pacientes muchas veces lo esconden.

Commonly Used Vomiting Animal Models / 中国实验方剂学杂志

Vomiting is a common clinical symptom. Long-term severe vomiting could seriously reduce the life quality of patients, so it is necessary to be intervened with antiemetic drugs. Traditional Chinese medicine has a long history in the treatment of vomiting with remarkable a curative effect. It has the advantages of multi-component, multi-target and multi-system synergistic antagonism. However, due to the active substance and unclear mechanism, it is urgent to adopt an internationally recognized vomiting model system to evaluate the antiemetic characteristics, elucidate the vomiting mechanism, and provide reference for better clinical application. Therefore, this paper systematically introduces several vomiting animal models that are widely used at home and abroad. According to the authors' own experimental experience, this paper focuses on the rat and mice pica models for reference of relevant researchers. Specifically, ferrets are an internationally recognized ideal vomiting animal model, and the golden standard for evaluating the effects of antiemetic drugs, suncus murinus is the smallest mammalian vomiting model. Rodents have no vomiting reflexes, but studies have shown that its pica behavior is equivalent to the vomiting behavior of other species. Because the easy availability and operation, the model has been promoted and applied in mainland China. Guizhou mini-pig model is a self-developed medium-sized mammalian vomiting model with a similar anatomical structure and vomiting characteristics to human, and worthy of popularization and application. In conclusion, different vomiting models have their own characteristics that need to be optimized according to the purpose of experiments and samples.

Mechanism of Dichroa Alkali Salt Inducing Vomiting Based on Pica in Mice / 中国实验方剂学杂志

Objective: To study the possible mechanism of dichroa alkali salt (DAS) in inducing vomiting. Method: Mice pica model was used to observe the antagonistic effect of the three different kinds of antiemetic drugs[dopamine receptor antagonist metoclopramide, 5-hydroxytryptamine 3 (5-HT3) receptor antagonist ondansetron and neurokinin-1 receptor antagonist aprepitant] on body mass, food intake, kaolin consumption, diarrhea and death induced by DAS to preliminarily clarify the possible pathogenic pathway of DAS. Then, the expression of 5-HT and substance P(SP) in ileum and medulla of mice induced by DAS alone at different time points was detected by enzyme-linked immunosorbent assay to confirm whether DAS could affect the changes of these two neurotransmitters. Result: After treatment with ondansetron and aprepitant, DAS-induced reduction in food intake of mice was significantly improved on the 4th day after continuous administration and on the 1st day after drug administration (Prd day after administration, DAS-induced body mass loss of mice was significantly improved (PConclusion: The mice pica model can be used to effectively characterize DAS-induced vomiting. DAS-induced pica in mice may be associated with the increase of 5-HT and SP in ileum and medulla. Ondansetron and aprepitant can effectively antagonize DAS-induced pica in mice.

A rare presentation of Rapunzel syndrome with multiple small bowel intussusceptions

Rapunzel syndrome is caused by gastric trichobezoar with extended tail and small bowel obstruction. Patients with gastric trichobezoar can be asymptomatic until the bezoar increases in size. We report a case of a girl who visited the emergency department with abdominal pain. She was finally diagnosed with Rapunzel syndrome that causes multiple small bowel intussusceptions associated with trichophagia. Surgery was needed to reduce the multiple intussusceptions, and to remove the large trichobezoar. This case highlights to consider the possibility of Rapunzel syndrome when diagnosing the main cause of intussusceptions.

Variations In Posterior Inferior Cerebellar Artery And Its Clinical Significance In Uttar Pradesh Region: A 64-slice Ct Angiographic Study

Background: Posterior Inferior cerebellar artery (PICA) is the largest and most distal branch of Vertebral artery(VA) arising near the lower end of olive. Variations of PICA are numerous but have been infrequently reported inthis region. Occlusion or blockage of PICA may cause an infarction of the medulla oblongata which plays animportant role in circulatory and respiratory functioning. This may lead to lateral medullary syndrome, alsocalled Wallenberg syndrome. The study focuses on normal and variant anatomy of PICA in Uttar Pradesh regionof North India.Materials and Methods: The study population included 100 subjects, of either sex, who underwent Head and NeckCT Angiography in the Department of Radiodiagnosis, King George’s Medical College, Lucknow, Uttar Pradesh. Thediameters of PICAs of both sides were measured and variations encountered were noted.Results: Mean diameter of PICA was 1.76±0.64 mm on right side and 1.73±0.60 mm on left side. Mean diameter inmales was 1.75±0.62 mm and in females was 1.73±0.62 mm. Variations observed included: Unilateral aplasia ofPICA in 16% with equal prevalence on both sides; bilateral aplasia in 3% cases; hypoplasia of RPICA in10% andhypoplasia of LPICA in 6%. VA-PICA variation where the VA continued as posterior inferior cerebellar artery wasobserved in 8 subjects (4 right, 4 left).Conclusion: The knowledge of normal diameters and variations in PICA supplying the brain can be a useful guideto the surgeons and interventional radiologists for careful pre-operative planning thus helping them in avoidingpotentially life threatening complications.

Ecología poblacional de Cittarium pica (Gastropoda: Trochidae) de San Andrés Isla, Reserva Internacional de Biósfera, Seaflower / Population ecology of Cittarium pica (Gastropoda: Trochidae) of San Andrés Island, International Biosphere Reserve, Seaflower

Resumen Cittarium pica es un gasterópodo conspicuo de los litorales rocosos del Caribe. Dada su importancia en la dieta de las comunidades del Caribe, éste ha sido sobrexplotado, incluso en algunos lugares se ha extinguido, por lo cual algunos países lo han incluido dentro de la lista roja de invertebrados marinos. En la isla de San Andrés Colombia la pesca es artesanal y no tiene regulaciones, conllevando a una disminución de su población. Teniendo en cuenta la importancia socioeconómica, cultural y ecológica de C. pica, así como su grado de vulnerabilidad a la extinción, es urgente desarrollar acciones de manejo que incrementen la resiliencia de la especie y el sostenimiento del recurso. Para evaluar el estado de la población de C. pica de la isla, se estimó la estructura por talla y por sexo, talla de maduración, y los parámetros de crecimiento a partir del análisis de datos de frecuencia de tallas. De septiembre a diciembre 2013 y de enero a marzo 2014, se recolectaron al azar 458 ejemplares en ocho estaciones representativas del litoral rocoso de la isla. Se midió el diámetro de la base de la concha, se determinó el sexo y el tamaño mínimo de maduración. El 80 % de la población consistió de individuos pequeños < 25.5 mm. La proporción de sexos fue de 1:1, excepto en noviembre y el tamaño mínimo de inicio de la madurez para sexos combinados fue de 14.07 mm. Los parámetros de von Bertalanffy K (0.730 año-1), L∞ (110.78 mm) y Φ (3.95) son mayores respecto a otras poblaciones del Caribe. La mortalidad total fue de 3.39 año-1, la mortalidad natural y por pesca fue de 1.02 año-1 y 2.36 año-1, respectivamente. El máximo reclutamiento se estimó para junio y la tasa de explotación máxima entre 0.563 y 0.640, para tamaños de captura de 40 y 50 mm. La tasa de explotación se estimó en 0.70, lo que sugiere una fuerte presión sobre el recurso. Por lo anterior, se recomienda vedar por completo la captura manual de C. pica hasta que un monitoreo evidencie que la población se recupera en la isla.

Abstract Cittarium pica is a conspicuous gastropod of the rocky coastlines of the Caribbean. Given its importance in the diet of Caribbean communities, it has been over-exploited, even reaching extinction in some places, and the species has been included in the red lists of marine invertebrates in some countries. Its fishery in San Andres Island-Colombia is artisanal without any regulation, leading to a decrease in its population. Taking into account the socio-economic, cultural and ecological importance of C. pica and its vulnerability to extinction, it is urgent to develop management actions directed to increase the resilience of the species and its sustainability as a fishery resource. To assess the current population state of C. pica from San Andrés Island, we estimated size structure, sex structure, maturation size, and growth parameters, based on length-frequency data analysis. From September to December 2013, and January to March 2014, we randomly collected 458 individuals at eight representative sites of the rocky shores of the island. We measured the longest diameter of the shell base, determined the sex by the color of the gonad, and thus determined the minimum maturation size. We found, that 80 % of the population consisted of small individuals < 25.5 mm sizes. The sex ratio was 1:1 except in November, where males were more abundant. The minimum size at the beginning of maturity for both sexes was 14.07 mm. The growth parameters of von Bertalanffy: K (0.730 yr-1), L∞ (110.78 mm) and Φ (3.95) were higher when compared to other populations of the Caribbean. The total mortality was 3.39 yr-1, while natural and fishing mortalities were 1.02 yr-1 and 2.36 yr-1, respectively. The maximum annual recruitment pulse was estimated for June, and the maximum exploitation rate for a sustainable yield was between 0.563 and 0.640, when the catch size was greater than 40 mm or 50 mm, respectively. The exploitation rate was estimated in 0.70, suggesting a strong extractive resource pressure. With these results we recommend the closure of the fishery and constant monitoring to promote and the population recovery is verified. Until a monitoring shows that the population recovers on the island.

Picamalácia na gestação de risco e aspectos psicológicos relacionados / Pica in the pregnancy and psychological aspects related / Pica en el embarazo y aspectos psicologicos relacionados

Com base em delineamento descritivo e exploratório, objetivou-se avaliar indicadores emocionais (sinais de estresse, ansiedade e depressão) e de enfrentamento (coping) em sete gestantes adultas com Diabetes Mellitus e relato de práticas de picamalácia. A prática de picamalácia na gestação atual foi identificada por meio de entrevista validada, antes das participantes responderem aos instrumentos para avaliação psicológica: (a) Inventário de sinais e sintomas de stress de Lipp (ISSL), para avaliar estresse; (b) Escalas BECK, Inventário BAI e BDI, para avaliar ansiedade e depressão; (c) Escalas Modos de Enfrentamento de Problemas (EMEP), para identificas estratégias de enfrentamento frente ao estresse; e (d) Roteiro de entrevista elaborado para pesquisa. As gestantes foram entrevistadas individualmente e seu relato foi analisado em macro-categorias pela metodologia de Bardin. Indicadores de estresse, ansiedade e depressão foram encontrados em todas as gestantes e as práticas de picamalácia mais referidas foram pagofagia (30,8%) e ingestão de fruta com sal (30,8%). Todas as gestantes apresentavam em comum uma sensação de satisfação após a prática da picamalácia. Tendo em vista possíveis associações entre este transtorno alimentar e desfechos desfavoráveis, considera-se importante investigar a picamalacia a fim de propor uma assistência pré-natal mais efetiva na melhora da saúde da díade mãe-filho.

Based on a descriptive and exploratory research design, this study aimed to evaluate emotional (sings of stress, anxiety and depression) and coping indicators in seven pregnant women with diabetes and pica reporting practices. The pica reporting practices in their current pregnancies were identified before they answered the following instruments for psychological evaluation: (a) Inventory of signs and symptoms of stress of Lipp (ISSL), to evaluate stress; (b) BECK Scales, BAI and BDI Inventory, to evaluate anxiety and depression; (c) Scales of Ways of Coping (EMEP), to identify coping strategies to deal with stress; (d) an Interview Guide created for this study. The pregnant women were interviewed individually and their reports were analyzed into macro-categories by the Bardin's methodology. Indicators of stress, anxiety and depression were found in all pregnant women, whose most reported practice was pagofagia (30.8%) and fruit with salt (30.8%). The verbal report revealed that all women had a feeling of satisfaction after the practice of pica. Given that the associations between this eating disorder and unfavorable outcomes, it is important to investigate the pica in order to propose a more effective prenatal care in improving the health of the mother-child dyad.

Basado en un diseño descriptivo y exploratorio, el objetivo del estudio fue evaluar los indicadores de estrés, ansiedad, depresión y afrontamiento en siete mujeres embarazadas diagnosticadas con diabetes y informes de la pica. La práctica de pica fue identificada a través de una entrevista aplicada antes de los siguientes instrumentos de evaluación psicológica: (a) Inventario de los signos y síntomas de estrés Lipp (ISSL), para evaluar el estrés; (b) Escalas de BECK de Ansiedad y Depresión (BAI y BDI), para evaluar la ansiedad y la depresión; (c) Escala Modos de Afrontamiento de Problemas (EMEP), para evaluar las estrategias de afrontamiento delante el estrés y (d) Entrevista individual preparada para la investigación. Las entrevistas fueran analizadas por la metodología de Bardin. Indicadores de estrés, ansiedad y depresión se encontraron en todas ellas, la práctica de pica más reportada fue pagofagia (30,8 %) y las frutas con sal (30,8 %). Las participantes reportaron un sentido de satisfacción después de la práctica. Teniendo en cuenta las asociaciones entre los trastornos alimentarios y desenlaces desfavorables, se considera importante investigar la Pica con el fin de proponer un cuidado prenatal más eficaz para la mejora de la salud de la díada madre-hijo.

Pica en Pediatría. Complicaciones en tres casos observados en el Servicio de Anatomía Patológica del Hospital Pediátrico "Juan Pablo II", Corrientes / Pica in Pediatrics. Complications in three cases observed in the Pathological Anatomy Service of the "Juan Pablo II" Pediatric Hospital, Corrientes

La Pica es un síndrome caracterizado por la ingestión persistente de más de un mes de sustancias no nutritivas, se presenta en pacientes con alteración de la salud mental de cualquier causa con padecimientos de orden metabólico, enfermedad celíaca, drepanocitosis, déficit de nutrientes y embarazadas, entre otros. Las complicaciones asociadas a la Pica varían según el tipo de sustancia consumida, manifestándose como obstrucción intestinal -siendo esta la más frecuente- infecciones y desnutrición. Asimismo, observamos que el 75% de los pacientes atendidos necesita cirugía, el 30% sufre complicaciones y hasta el 11% fallece a consecuencia de la Pica o complicaciones postoperatorias. Por ser un síndrome de etiología no bien clarificada, multifactorial y recidivante, los pacientes debe ser evaluados y tratados por un equipo de salud multidisciplinario. En el presente estudio se presentan tres casos de pacientes pediátricos autóctonos de la provincia de Corrientes y una breve revisión y actualización clínica del tema.

Isolated Posteroinferior Cerebellar Artery Dissection Diagnosed by High-Resolution Vessel Wall MRI

Arterial dissection is an important cause of stroke. We report two cases of isolated posterior inferior cerebellar artery (PICA) dissection diagnosed by high-resolution vessel-wall MRI (HRVW-MRI). One subject complained of abrupt-onset vertigo and headache, and the other subject had headache, vertigo, and Horner syndrome. Conventional MRA showed only focal dilatation of the PICA, but HRVW-MRI revealed intramural hematoma and double-lumen contour in the PICA, suggesting arterial dissection. We suggest that the use of HRVW-MRI should be considered when diagnosing isolated PICA dissection in a PICA infarct with an unknown cause.

Fatores nutricionais e psicológicos associados com a ocorrência de picamalácia em gestantes / Nutritional and psychological factors associated with the occurrence of pica in pregnant women

Resumo OBJETIVO: Avaliar fatores nutricionais e psicológicos associados com a ocorrência da prática da picamalácia em gestantes atendidas em maternidade pública do Rio de Janeiro, Brasil. MÉTODOS: Estudo descritivo, de caráter exploratório, realizado com 13 gestantes (idades entre 16 e 40 anos) com diagnóstico de picamalácia na gestação atual identificada em entrevista padronizada na consulta com nutricionista que abordava questões sobre ocorrência e frequência do transtorno, além dos tipos de substâncias ingeridas. Após assinarem o Termo de Consentimento Livre e Esclarecido (TCLE), todas as gestantes passaram por avaliação nutricional e, posteriormente, sete foram submetidas à avaliação psicológica com instrumentos padronizados para medida de ansiedade e estresse, além da avaliação de estratégias de enfrentamento (coping ) diante de estressores. RESULTADOS: As práticas de picamalácia mais referidas foram pagofagia (30,8%) e fruta com sal (30,8%). Observou-se ocorrência de algum grau de estresse e ansiedade em todas as gestantes com picamalácia, assim como alguma comorbidade (69,2%) e sintomatologia digestiva (84,6%). As estratégias decoping mais prevalentes foram "focada em práticas religiosas/pensamento fantasioso" e "busca de suporte social", ambas com 42%. CONCLUSÃO: Considerando que a picamalácia pode associar-se com maior risco perinatal, é fundamental que essa prática seja investigada durante o atendimento pré-natal e que ocorra a adoção de práticas preventivas obstétricas, psicológicas e nutricionais para reduzir complicações para a mãe e o concepto.

Abstract PURPOSE: To evaluate the nutritional and psychological factors associated with the occurrence of the practice of pica in pregnant women attending a public hospital in Rio de Janeiro, Brazil. METHODS: The study was based on a descriptive design with exploratory features, and conducted on 13 adult and adolescent pregnant women aged 16 to 40 years with a diagnosis of pica in the current pregnancy. Pica was diagnosed by a nutritionist in a standardized interview situation, when questions about the occurrence and frequency of pica, and types of substance ingestion were investigated. After signing the Informed Consent Form (ICF), all participants were evaluated by a nutritionist and seven of them were submitted to psychological assessment with standardized instruments to evaluate stress and anxiety, and to assess coping strategies. RESULTS: The type of pica most frequently reported was pagophagia (30.8%) and the consumption of fruit with salt (30.8%). The most prevalent coping strategies were "religious practice-focused" and "seeking social support", both presented by 42% of the pregnant women. We observed the occurrence of some degree of stress and anxiety in all pregnant women, as well as comorbidities (69.2%) and gastrointestinal symptoms (84.6%). CONCLUSION: Considering that pica may be associated with increased perinatal risk, it is very important to investigate this disorder during prenatal care, and to dopt obstetric, psychological and nutritional preventive practices to reduce the complications for mother and fetus.

Tratamiento quirúrgico de aneurisma de la arteria cerebelosa postero inferior gigante embolizado / Surgical treatment of embolized giant posteroanterior cerebellar artery aneurysm

Objetivo: descripción de la resolución quirúrgica de un aneurisma complejo, gigante de circuito posterior (arteria cerebelosa posteroinferior), embolizado previamente, y la evolución postoperatoria. Descripción: Paciente de 48 años de edad con antecedentes de hidrocefalia obstructiva, e hipertensión de fosa posterior, la cual fue tratada por vía endovascular hace 4 años, con colocación de derivación ventricular, y craniectomía descompresiva de fosa posterior, con evolución progresiva de déficit de pares craneales bajos, y síndrome de hipertensión endocraneana. Intervención: Se realizó abordaje extremo lateral con drilado parcial del cóndilo occipital, control proximal de la arteria vertebral, y reconstrucción de la pared aneurismática del sector arteria vertebral- arteria cerebelosa posteroinferior (PICA), mediante microcirugía, con posterior apertura del saco dural y remoción de coils y trombosis intraaneurismática, removiendo el efecto de masa aneurismático. Conclusión: El tratamiento microquirúrgico con la técnica de la reconstrucción parietal del aneurisma y el control proximal del mismo, en conjunto con abordajes de base de cráneo permiten el definitivo y adecuado tratamiento para los aneurismas gigantes de la pica.

Objective: to describe the surgical treatment for complex, giant, embolized, PICA aneurysm and the follow up.Description: 48 years old, female patient with clinical history of obstructive hydrocephalus and posterior fossa´s hipertension. The treatment was endovascular surgery with coils and venricular shunt with posterior fossa´s deccompresive surgery 4 years ago. The clinical evolution was poor. Due to low cranial nerves déficit and progressive posterior fossa´s hipertension, we performed microsurgical treatment Intervention: We performed extreme lateral approach with partial drilling of occipital condile, wiht proper proximal vascular vertebral control, and vascular parietal artery reconstruction in the vertebral-posterior inferior cerebellar artery (PICA) aneurysmatic segment,with microsurgery, posterior opening of the dome and coils remotion. Conclusion: Microsurgical treatment with reconstruction parietal technique, proximal vascular control and skull base approaches are the definitive and more adecuated treatment for giant PICA aneurysms.

El "chaco": arcilla medicinal comestible del altiplano peruano y sus propiedades en la patología digestiva / The "Chaco": eatable medicinal clay in the Peruvian highlands and his properties in digestive diseases

Los pobladores del altiplano peruano-boliviano consumen una sustancia natural conocida como "chaco", muy difundida desde la época precolombina y apreciada por sus propiedades digestivas. El Chaco es una arcilla medicinal comestible que es usada en forma de suspensión con agua para cohibir molestias dispépticas o manifestaciones ácido-pépticas. En esta contribución damos a conocer aspectos físico-químicos de la composición del Chaco, estudios experimentales en animales que evalúan su efecto antiulceroso y una prueba in vitro que estudia su propiedad antiácida. El mecanismo de acción terapéutico propuesto se debe a una acción citoprotectora sobre la mucosa gástrica por mecanismos independientes de la inhibición de la secreción ácida, ya que no posee propiedad antiácida in vitro. Además tiene una capacidad de adsorción a distintas moléculas orgánicas debido a su gran superficie externa y carga tetraédrica que hace que interaccione con sustancias polares como el agua y toxinas. El otro propósito de esta contribución especial, es reconocer la coexistencia de la "Medicina Tradicional" y la "Medicina Occidental", situación que conlleva a la necesidad de la investigación preclínica de diversos recursos naturales.

The inhabitants of the peruvian-bolivian plateau consume a natural substance known as "Chaco", widespread since pre-Columbian era and appreciated for its digestive properties. The Chaco is an edible medicinal clay that is used as slurry with water to restrain dyspeptic discomfort or acid-peptic manifestations. In this contribution we present physicochemical aspects of the composition of the Chaco, experimental animal studies that evaluate its antiulcer effect and in vitro test that studies the antacid property. The proposed mechanism of therapeutic action is due to a cytoprotective effect on the gastric mucosa by independent mechanisms of acid secretion inhibition, as it has no antacid property in vitro. Also it has an adsorptivity to different organic molecules due to their large surface area and tetrahedral charge that makes it to interact with polar substances such as water and toxins. The other purpose of this special contribution is to recognize the coexistence of "Traditional Medicine" and "Western Medicine", a situation which leads to the need for preclinical research of various natural resources.

Técnica CROSS en cicatrices de acné / CROSS technique in acne scars

La cicatrización patológica es una complicación frecuente del acné que resulta del daño en la piel que se produce durante la curación de dicho proceso inflamatorio. Muchos pacientes desarrollarán cicatrices a pesar de un tratamiento oportuno y adecuado. A grandes rasgos se consideran dos tipos de cicatrización patológica: excesiva (cicatrices hipertróficas y queloides) e insuficiente (cicatrices atróficas). Estas últimas se ven en el 80-90% delos casos y se subclasifican en pica hielo, ondulada y en caja. Múltiples tratamientos se usan para eliminar las cicatrices del acné. A menudo, una combinación de varias técnicases necesaria para un tratamiento efectivo. La técnica CROSS es una modalidad terapéutica segura, eficaz y rentable en el tratamiento de las cicatrices pica hielo sin complicaciones significativas.

Pathological scarringis a common complication of acne that results from the skin damagethat occurs during the healing of this inflammatory process. Many patients develop scarringdespite a timely and appropriate treatment. Roughly two types of scarring are considered:excessive (hypertrophic scars and keloids) and insufficient (atrophic scars). The latter are seen in 80-90% of cases and are subclassified into ice pick, rolling and box car. Multiple treatments are used to remove acne scars. Often a combination of several techniquesis necessary for an effective treatment. The CROSS technique is a safe, effective andprofitable therapeutic modality for the treatment of ice pick scars without significant complications.

Evaluación endoscópica de la deglución. Resultados en pacientes con tumores benignos y malignos de laringe y hipofaringe, tratados con cirugía transoral con láser de CO2 / Functional endoscopic evaluation of swallowing. Results inpatients with benign and malignant tumors of the larynx and hypopharynx treated with transoral CO2 laser surgery / A avaliação endoscópica da deglutição. Os resultados em pacientes com tumores benignos e malignos da laringe e hipofaringe tratados com cirurgia transoral laser de CO2

La utilización del LASER de CO2 en laringología comenzó en la década del ‘80, permitiendo la exéresis de tumores por vía transoral. Su indicación se basa en los excelentes resultados oncológicos. La función deglutoria postquirúrgica es un factor importante en la calidad de vida de los pacientes con cáncer del tracto aerodigestivo superior. Los resultados de la deglución son relevantes para elegir la modalidad terapéutica, la cual debe ser no sólo efectiva en controlar el cáncer sino también en preservar la función del órgano. El grado y el tipo de alteración deglutoria deben ser determinados en forma precisa, para establecer el tratamiento postoperatorio adecuado. Esto es posible mediante estudios como la videodeglución y la evaluación endoscópica de la deglución (FEESST)...

The CO2 laser have been used for treatment of laryngeal cancers since 1980, with excellent oncological results. The swallowing plays an important roll in superior aerodigestive cáncer patient. Swallowing results are relevant to choose the therapeutic modality, which must be effective in controlling not only cancer but also in preserving organ function. The degree and type of swallowing impairment must be determined precisely, to establish the appropriate postoperative treatment. This is possible through studies like videodeglucion and endoscopic evaluation of swallowing (FEESST)...

O uso do laser de CO2 laringologia começou nos anos 80, permitindo a excisão tumor transoral. A indicação baseia-se nos excelentes resultados oncológicos. Função de deglutição pós-cirúrgico é uma importante qualidade de vida de pacientes com câncer do fator trato aerodigestivo superior. Engolindo resultados são relevantes para escolher a modalidade terapêutica, que deve ser eficaz no controle não só do câncer, mas também em preservar a função do órgão. O grau e tipo de comprometimento da deglutição deve ser determinada com precisão, para estabelecer o tratamento pós-operatório adequado. Isso é possível através de estudos como videodeglucion e avaliação endoscópica da deglutição (FEESST)...