The role of psychosocial adversity in the aetiology and course of attention deficit hyperactivity disorder

Introduction: Attention deficit/hyperactivity disorder (ADHD) has genetic and environmental aetiological factors. There are few publications on the environmental factors. The objective of this review is to present the role of psychosocial adversity in the aetiology and course of ADHD. Methods: A search was carried out in the following databases: PubMed, ScienceDirect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA and PsycNET. English and Spanish were selected without being limited by type of study or year of publication. Finally, a qualitative synthesis was conducted. Results: ADHD development could be related to exposure to adverse factors in the family, school or social environment. It has been proposed as an explanatory mechanism that adversity interacts with genetic variants and leads to neurobiological changes. There may also be a gene-environment correlation whereby individual hereditary characteristics increase the risk of exposure to adversity, and indirectly increase the probability of developing ADHD. Research on psychosocial adversity represents a big challenge, not only due to the complexity of its construct, but also to the effect of subjective perception of a given event. Conclusions: ADHD aetiology is complex and involves the interaction of both genetic and environmental factors, in which these factors correlate and cause the disorder. The study of the role of psychosocial adversity in ADHD is fundamental, but it remains a task that entails great difficulties.

Introducción: El trastorno por déficit de atención con hiperactividad (TDAH) tiene factores etiológicos genéticos y ambientales. Hay pocas publicaciones acerca de los factores ambientales. El objetivo de esta revisión es presentar el papel de la adversidad psicosocial en la etiología y el curso del TDAH. Métodos: Se llevó a cabo una búsqueda en las siguientes bases de datos: PubMed, ScienceDi-rect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA y PsycNET. Se seleccionaron artículos en inglés y español sin limitar por tipo de estudio o año de publicación. Finalmente, se hizo una síntesis cualitativa. Resultados: El desarrollo del TDAH podría estar relacionado con la exposición a factores adversos en el entorno familiar, escolar o social. Se ha propuesto como mecanismo explicativo que la adversidad interactúa con variantes genéticas y conduce a cambios neurobiológicos. También puede haber una correlación entre gen y ambiente, en la que las características hereditarias individuales aumentan el riesgo de exposición a la adversidad e indirectamente aumentan la probabilidad de sufrir TDAH. La investigación sobre la adversidad psicosocial representa un gran desafío no solo por la complejidad de su constructo, sino también por el efecto de la percepción subjetiva sobre un evento determinado. Conclusiones: La etiología del TDAH es compleja y factores genéticos y ambientales presentan una interacción en la que estos factores se correlacionan y originan el trastorno. El estudio del papel de la adversidad psicosocial en el TDAH es fundamental, pero sigue siendo una tarea que conlleva grandes dificultades.

The aetiology and prevalence of urinary tract infections in Sub-Saharan Africa: a Systematic Review / Etiologia e prevalência de infecções do trato urinário na África Subsaariana: uma revisão sistemática

Objective: This review determined and reports the prevalence of urinary tract infections and aetiological agents common in most sub-Saharan African countries. Methods: A literature search involved Springer, Hindawi, PubMed, Medcrave, Google Scholar, BioMed, and Elsevier databases to identify the urinary tract infection articles published between 2000 and 2021. Results: Of 111 articles obtained from databases, 22 met the qualities to be included in the study. Overall, the prevalence of UTI was 32.12% with Escherichia coli being the most commonly isolated bacteria accounting for 86.4%. Escherichia coli is found in the GIT thus, the proximity between the anus and urinary system makes the contamination easier. Conclusion: The findings of this study provide useful information for the effective intervention of urinary tract infections. Further, it is advised women wipe from front to back whenever they attend the call of nature and or during bathing.

Objetivo: Relatamos a prevalência de infecções do trato urinário e agentes etiológicos comuns na maioria dos países da África Subsaariana. Metodos: Uma pesquisa bibliográfica envolveu as bases de dados Springer, Hindawi, PubMed, Medcrave, Google Scholar, BioMed e Elsevier para identificar os artigos que abordavam infecção do trato urinário nos países da África Subsaariana, publicados entre 2000 e 2021. Resultados: Dos 111 artigos obtidos nas bases de dados, 22 atenderam aos criterios de inclusao e foram incluídos no estudo . No geral, a prevalência de UTI foi de 32,12%, sendo a Escherichia coli a bactéria mais comumente isolada, representando 86,4%. A Escherichia coli é encontrada no TGI, portanto, a proximidade entre o ânus e o sistema urinário facilita a contaminação. Conclusao: Os achados deste estudo fornecem informações úteis para a intervenção efetiva das infecções do trato urinário. Além disso, é aconselhável que as mulheres busquem fazer sua higiene intima sempre da parte da frente para trás.

Aetiology of hospital-acquired diarrhoea in under-five children from an urban hospital in East Delhi, India

Background & objectives: Majority of the studies of hospital-acquired diarrhoea conducted in Western countries have focused on the detection of Clostridium difficile in stool samples. Limited Asian and Indian literature is available on hospital-acquired diarrhoea. This study was aimed to describe the aetiological profile for hospital-acquired diarrhoea in children aged below five years. Methods: One hundred children aged one month to five years who developed diarrhoea (?3 loose stools for >12 h) after hospitalization for at least 72 h were enrolled. Children who were prescribed purgatives or undergoing procedures such as enema and endoscopy or those with underlying chronic gastrointestinal disorders such as celiac disease and inflammatory bowel disease were excluded from the study. Stool samples from the enrolled children were subjected to routine microscopic examination, modified Ziel- Nielson (ZN) staining for Cryptosporidium and culture for various enteropathogens. Multiplex PCR was used to identify the strains of diarrhoeagenic Escherichia coli. Rotavirus detection was done using rapid antigen kit. Toxins (A and B) of C. difficile were detected using enzyme immunoassay. Results: Of the 100 samples of hospital-acquired diarrhoea analysed, diarrhoeagenic E. coli (DEC) was found to be the most common organism, detected in 37 per cent of cases (enteropathogenic E. coli-18%, enterotoxigenic E. coli-8%, enteroaggregative E. coli-4% and mixed infections-7%). Cryptosporidium was detected in 10 per cent of cases. Rotavirus was detected in six per cent and C. difficile in four per cent of cases. Interpretation & conclusions: The findings of this study suggest that the aetiological profile of hospital- acquired diarrhoea appears to be similar to that of community-acquired diarrhoea, with DEC and Cryptosporidium being the most common causes. The efforts for the prevention and management of hospital-acquired diarrhoea should, thus, be directed towards these organisms.

Study of Clinical and Etiological Pattern of Anterior Uveitis in Western Odisha

Background and Objectives: Uveitis is a potentially sight-threatening disease affecting people from all over the world. It attributes to 5-20% of legal blindness in developed countries and 25% of blindness in the developing world. Uveitis includes a varied group of intraocular inflammatory conditions that may occur at any age but affect mostly working-age people. The average annual incidence of uveitis has been reported as approximately 14- 17/1,00,000. Aim is to study the clinical and etiological pattern of anterior uveitis. Objectives are to evaluate the clinical pattern of anterior uveitis, to study the etiological pattern of anterior uveitis, to identify the complications of anterior uveitis, to assess the treatment outcome. Methods: A prospective clinical study was done in the Department of Ophthalmology, Rourkela, Odisha during September 2019 - March 2021 (18 months)between the age group of 20-80 years. Each patient was called for follow up on 1st day, 2nd day, 1 week, 3 weeks, 6 weeks from the day of presentation The complications like posterior synechiae, complicated cataract, raised IOP, macular edema were noted and the response to treatment was recorded and evaluated in each patient. Results and conclusion: Despite all efforts to identify the cause, the most common cause of anterior uveitis remained idiopathic (48.6% ) followed by immune related cause (20.3%). Visual acuity was 6/12 or worse in majority of the patients at presentation and following medical line of treatment most patients regained visual acuity of 6/9 or better after 6 weeks, which was statistically significant (p<0.0001).

COVID 19: Knowledge, opinions and prevention among the populace

Objective: There was a lot of panic when the COVID-19 pandemic started because a lot was not known about it. However, as the disease unfolded, proven scientific universal precautions are recommended to curb its spread. Methods: This was a cross-sectional online survey of people living in Nigeria. Questionnaires were distributed to consenting participants using the SurveyMonkey and data was collected on sociodemographic knowledge of the aetiology and prevention of COVID-19. Analysis was done with the SPSS version 25. Results: Eighty-five participants with age ranging from 18 to 60 years took part in the study. The mean age was 37.35 ± 11.7years. Forty-seven (47%) had knowledge that COVID-19 infection is from a virus. 29.4% thought it is caused by biological weapons, 1.2% from 5G internet, 7.1% as government's ploy to embezzle money and 9.4% conspiracy theory from the world leaders to reduce world's population. All participants knew that hand washing is a preventive measure against the spread of COVID-19 and majority agreed to the use of sanitizers, social distancing and disinfection of surfaces. Only 30.6% agreed that wearing of facemasks will serve as a preventive measure. Over 90% of the participants agreed that dissemination of appropriate information, use of universal precautions, isolation and intensive treatment of those infected can help prevent the spread of COVID-19. 11.8% of participants knew that additional precautions are needed for aerosol generating procedures. Conclusion: The knowledge of COVID-19 aetiology is poor among the populace and the need to wear face masks as a preventive measure in curtailing the spread of COVID-19 needs to be emphasized.

To Assess the Knowledge of Dentists Regarding Dentinal Hypersensitivity in a Tertiary Dental Care Hospital in Bangalore City - A Cross Sectional Survey

Dental pain is most commonly associated with the carious destruction leading to inflammation of the pulp or can also be pain present post operatively; however, much of the dental pain can be attributed to dentinal hypersensitivity (DH). The prevalence of DH is high enough (72.5 % to 98 %) to warrant the development of effective treatment. Surveys among dental professionals worldwide suggest that many lack adequate knowledge about this condition and its management. This study aims to assess the knowledge and awareness of postgraduates and faculty regarding dentinal hypersensitivity in a tertiary dental care hospital in Bangalore. METHODSA descriptive cross-sectional survey was carried out among the staff and post graduate students at Rajarajeswari Dental College & Hospital, Bangalore during October 2019. Ethical clearance was obtained from the Institutional Ethical committee. All the staff and post graduate students who were present on the day of study were included in the study. Informed consent was obtained from all the study participants before the study and participation was entirely voluntary. RESULTSMajority of the participants routinely checked for the signs of DH (F - 77.2 % PG - 77 %) and considered DH as a serious problem (F - 87.5 % PG - 87 %). Participants also thought that DH has to be treated with an interdisciplinary approach (F - 75 % PG - 67.7 %). CONCLUSIONSThe study concludes that even though the knowledge and awareness of Dentinal Hypersensitivity was good, there existed uncertainty concerning diagnosis and management of the same.

Manejo de la fístula anorrectal compleja: LIFT, colgajo de avance y otras técnicas / Management of complex anorectal fistula: LIFT, endorectal advancement flap and others techniques

Resumen Las fístulas anorrectales complejas son un desafío para el coloproctólogo. Son una patología frecuente que afecta la calidad de vida de los pacientes. La patogénesis aún no está clara, estarían involucradas citoquinas y el proceso de transición de epitelio a mesénquima. El gold standard para su estudio es la resonancia nuclear magnética, su uso por sí mismo disminuye la recurrencia. El objetivo del tratamiento es lograr la curación sin afectar la función del esfínter evitando las recidivas. Existen múltiples técnicas, siendo la de mayor aceptación la ligadura interesfinteriana del trayecto fistuloso, con tasa de curación sobre el 70%, con mínimo impacto en continencia. Esta revisión incluye otras técnicas como el colgajo endorrectal de avance, uso de sellante, permacol, células madres, Anal fistula plug, Video asisted anal fistula treatment, Over the scope clip y fistula laser closure.

Complex anal fistula are a challenge for colorectal surgeons. It is a common pathology in population. Pathogenesis is still unclear, it would be involved citokines and the process of epitelial to eesenchymal transition. The gold standard for study is MRI, its use reduces recurrences. The goal of treatment is heal the fistula without damaging the function of the sphincter and avoid recurrences. There are multiple techniques, the most accepted is ligation of intersphincteric fistula tract with cure rate over 70%, with minimal impact in continence. This review includes other techniques like rectal advancement flap, fibrin glue, permacol, stem cells, anal fistula plug, video asisted anal fistula treatment, over the scope clip and fistula laser closure.

Aetiological Profile and Antibiogram of Urinary Isolates Causing UTI in Patients Attending a Tertiary Care Hospital of Western Odisha

Although UTI is a female disease, males are also susceptible during the neonatal period and old age. Asymptomatic bacteriuria, cystitis and acute urethral syndrome are the most common clinical type. Etiological profile is variable in different geographical areas, but E. coli is the most common agent worldwide. Klebsiella, Proteus, Pseudomonas are important causes of hospital acquired UTI. Culture sensitivity of early morning mid-stream urine collected by clean catch technique is the gold standard method of diagnosis of UTI. Sensitivity to 3rd generation cephalosporins and cotrimoxazole is variable in different areas but aminoglycoside, nitrofurantoin and carbapenem are almost sensitive worldwide. Resistance to nitrofurantoin and carbapenem has been reported in many areas of world. Before starting empirical therapy, physician should know the local etiological profile and antibiotic sensitivity pattern of uropathogens. We wanted to study the etiological profile and antibiotic sensitivity pattern of urinary isolates in a tertiary care hospital of Western Odisha.METHODSEarly morning mid-stream urine samples of 730 clinically suspected UTI patients were collected by clean catch technique and sent to microbiology department. Cysteine lactose electrolyte deficient (CLED) agar media was seeded with urine with the help of 0.01 ml (4 mm) loop. After incubation for 24 hrs at 370C growth was observed and identified by Gram stain and biochemical tests. Antibiotic sensitivity was performed by disc diffusion method as per CLSI guidelines. Antibiotic sensitivity was performed for all Gram-negative bacteria, Enterococci and Staphylococcus.RESULTSAmong 730 samples, 238 (33%) showed significant bacteriuria and 63 % of significant bacteriuria samples were from female. Middle age females (36-50 yrs.) were more affected (38%) followed by old age (>50 yrs.) male (19%) and old age (>50 yrs.) female (18%). E. coli was the most common bacteria (31%) followed by Enterococci (18%). Fluoroquinolones like nalidixic acid and norfloxacin showed high resistance rate (31%, 42% in case of Gram-negative bacteria and 12%, 25% in case of Staphylococcus species respectively). Nitrofurantoin showed excellent sensitivity to both Gram-positive cocci and Gram-negative bacilli. (80% for gram-negative bacilli and 87 % for Staphylococcus species and 78% for enterococci species). Aminoglycoside and carbapenem showed excellent sensitivity to Gram-negative bacteria (81% and 92% respectively). Third generation cephalosporins showed poor sensitivity (48% to 53%).CONCLUSIONSEnterococci rather than Klebsiella species was the 2nd most common uropathogen in our study. Aminoglycoside was still useful for UTI. Nitrofurantoin was the best option for empirical therapy.

Chronic histiocytic intervillositis in consecutive miscarriages: A potential pitfall in routine examination of conceptus

@#Introduction: Chronic histiocytic intervillositis (CHI) is a rare placental lesion strongly associated with recurrent miscarriages and fetal losses. It requires histopathological diagnosis and can only be made after delivery of the products of conception (POC). We describe a case of CHI in a 41-yearold lady with a 16-year history of thirteen recurrent consecutive first trimester miscarriages. Case report: The patient is a 41-year-old lady who suffered first trimester miscarriages in all her thirteen pregnancies. The relevant clinical investigations revealed neither significant nor helpful findings in determining the cause of recurrent miscarriages. Histological findings in each except one of the submitted conceptual tissue showed similar features of histiocytic aggregates primarily within the intervillous spaces, a characteristic description of CHI. One of the samples showed degenerative changes. Discussion: Practicing pathologists are not familiar with the histological features of CHI and this may be a potential pitfall in routine examination of POCs. Recognising this entity allows for accurate diagnosis and hence better management. The aetiology remains unclear, although an immunopathological basis are being explored.

Aetiology of Convulsions in Relation to Clinical, Electrophysiological and Radiological Changes and Management

Introducion: An epileptic seizure may be conceptualized as aparoxysmal pathological process in the brain of a heterogeneousetiology with heteromorphic clinical and electrophysiologicalmanifestation. Current research aimed to study the aetiologyof convulsions in relation to clinical, electrophysiological andradiological changes and management.Material and methods: It was a prospective study carried outon 50 patients of convulsions admitted in the medical wards.Patients with convulsions of all age groups were included inthis study.Results: The incidence of convulsions in those people below18 years of age was 30% and in adults above 50 years ofage was 30%. The incidence is not in confirmation withporter’s studies where it is highest above 80% in the childrenbelow 18 years age. Most common etiology in study wascerebrovascular accidents 13(26%) and followed by infractionin 10 cases(20%). Incidence of seizure was more in males thancompared to females. Most of the patients with seizures werepresented with generalised tonic clonic seizures(20 cases).Conclusion: Focal seizures were more commoner than othergroups of seizures. 20% of patients in this study remainedundiagnosed with obscure aetiology.

Paediatric Uti: Points Of Concern: A Clinicobacteriological Analysis In A Tertiary Care Hospital

Paediatric UTI is a matter of grave concern particularly at less than two years of age due to predisposition to serious future complications and limited treatment options resulting from ever-increasing antibiotic resistance. This study included 392 established cases of paediatric UTI. Gram negative bacteria were isolated in 68.9% cases, predominated by Escherichia coli(34.7%). It was followed by Klebsiella species(27.3%), Enterococcus faecalis(12.2%), Acinetobacter species(7.4%), Pseudomonas aeruginosa(4.3%), and other GNB. Staphylococcus saprophyticus(4.1%) and Staphylococcus aureus(3.1%) were less common. Antibiograms of the isolates showed very low sensitivity to all commonly prescribed antibiotics, namely, ampicillin, amoxyclav, ceftriaxone, cefotaxime, gentamicin, cotrimoxazole, nitrofurantoin, ciprofloxacin and levofloxacin- making them practically irrational to choose. Most of the GNB were susceptible to imipenem, whereas, gram positive cocci were uniformly susceptible to vancomycin and linezolid

Aetiological evaluation of hyponatremia in hospitalised patients and its prognostic implication in disease outcome

Background: Hyponatremia is very common in clinical practice. Proper evaluation of hyponatremia is essential as causes are many and management of it depends on the aetiology and its long-term outcome. Aetiological evaluation of hyponatremia in hospitalised patients and its prognostic implication in disease outcome was undertaken as such studies were rare in this zone.Methods: One hundred patients whose serum sodium level was <135 mEq/L were studied. The serum sodium and osmolality and urinary sodium and osmolality were estimated in all. The degree of hyponatremia, outcome after treatment and duration of hospital stay were analysed.Results: The mean age was 60.5 years. There were 73% males and 27% females. The incidence of hyponatremia was 10.7%. The mean serum sodium was 129.96 mEq/L and urinary sodium was 40.3 mEq/lL while the mean serum osmolality was 272.8 mOsm/kg and urinary osmolality was 357.7 mOsm/kg. Euvolemia, hypervolemia and hypovolemia were observed in 51%, 28% and 21% respectively. The common clinical features were drowsiness (22%), disorientation (20%), fever (28%), nausea (24%), anorexia (15%), vomiting (14%), hiccup (10%). The common causes were SIADH (34%), renal causes (15%), sepsis (13%), endocrinopathy (11%) and diuretics (11%). The common comorbidities were hypertension (66%) and diabetes mellitus (41%). The mortality was 7%. No side effect was observed during management of hyponatremia.Conclusions: Proper management of hyponatremia irrespective of aetiology had a better prognosis. Factors which are modifiable should be searched and rectified.

Cardiac abnormalities among chronic hemodialysis patients

Objective: The annual mortality of cardiovascular diseases of dialysis patients is higher than the general population. The tranc-thoracic echocardiography allows the evaluation of the heart structure and function within the trated patients by hemodialysis in order to identify patients with cardiovascular high risk. Methods: This work is a descriptive retrospective study. The objective is to determine the major cardiac abnormalities diagnosed with echocardiography in patients with chronic hemodialysis and to list their epidemiological, clinical and biological characteristics at the time of the study. Results: The average age of our patients is of 50.2 ± 7 years with an average hemodialysis endurance of 12.1± 2.4 years. The main etiologies of the chronic renal failure were essentially the diabete type 2, the arterial hypertension and chronic nephritis tubule-interstitial. The most cardiac abnormalities was the left ventricular hypertrophy. The presence of a systolic or diastolic arterial hypertension has been noted as a significant factor fostering the LVH within the chronic hemodialysis (p=0.002).The anemia is not said to be associated to the development of the left ventricular hypertrophy(p=0.09). Conclusions: This study revealed the etiology leading to chronic renal failure insufficiency. Echocardiography accurately diagnosed cardiac abnormalities such as left ventricular hypertrophy. The study allowed to detect the factors involved in the development of this HVG especialy systolic arterial hypertension. This result permit us to act on these factors in order to prevent the cardiovascular events to which hemodialysis patients will be exposed.

A study of etiology, clinical profile and outcome in children aged 1-12 years presenting with fever of 1-3 weeks duration in a tertiary hospital

Background: The objective of the study was to find out the etiology, associated signs and symptoms of fever of 1-3 weeks in the age group of 1-12 years and their outcome following treatment in a tertiary care hospital.Methods: This was an observational prospective study conducted at Institute of child health and hospital for children, Egmore, Chennai during the period from January 2011 to October 2012. A total of 621 children aged 1-12 years with 1-3 weeks of fever were included in the study. Demographic, clinical and diagnostic data were collected and analyzed for each patient and outcome was assessed for different types of febrile illness.Results: Out of 621 patients enrolled in the study, enteric fever was diagnosed in majority cases followed by respiratory tract infection, urinary' tract' infection' in' 102' (16.4%), leptospirosis in 78 (12.6%), malaria in 60(9.7%), dengue fever in 8 (7.7%) rickettsia infection in 36 (5.8%), tuberculosis in 24 (3.9%), CNS infection in 18 (2.9%), viral hepatitis in12 (1.9%), malignancy in 5(0.8%), connective tissue disorder in 4 (0.6%), localized infection in 2 (0.3%) cases. The incidence was unknown in 10 patients (1.6%). Fever and vomiting were the common symptom seen in all the patients. Mortality was observed 18 (2.94%) cases.Conclusions: The similarity of illness and complexity in etiological conditions demonstrates the complications of diagnosis and treatment of fevers. The present study findings provided rationale information for development of guidelines necessary for treatment and thereby reducing the mortality rate in children of age 1-12 years with incidence of febrile illness.

Aetiological profile of fever in neonatal and paediatric population in hospital setting

Background: Febrile illness in children is a common cause of admission to hospital globally, with significant associated morbidity and mortality. Dengue, malaria, scrub typhus, typhoid and leptospirosis have been identified as major causes of acute undifferentiated febrile illness in Thailand, Malaysia, and Nepal. Climate variation, over population and urbanization may all contribute to the emergence and reemergence of infections in tropical regions like Tamil Nadu. The objectives of this study were to describe the aetiology of fever in hospitalized neonatal and Pediatric population. A descriptive study was designed.Methods: A prospective observational study was conducted. All children from 0 to 18 years admitted as in-patients. Sample size was calculated to be 650. Basic laboratory tests were done in all cases.Results: Out of a total of 650 children maximum number (40.7% n=265) of patients had short duration of fever between 1 to 3 days. Majority (56%) of patients had temperature between 100.4 to 101F. Only 5 children were confirmed to have malaria. Maximum number of pus cells found was 80 to 100 in 3 children in urine examination. Total Infectious cases were 631 (97.07%).Conclusions: Infectious aetiology was more common than non-infectious aetiology. Among all aetiologies, viral fever particularly dengue was the most common aetiology. Enteric fever was the second most common infectious cause of fever after viral fever.' Short febrile illness (1 to 5 days) was the most common type of fever in children admitted in hospital. In neonates, the most common cause of fever was probable sepsis followed by dehydration fever.

Sarcopenia: Causes, Consequences, Prevention and Treatment

@#The phenomenon of age-related loss of muscle mass and strength was named sarcopenia in 1988 by Rosenberg. Since then, sarcopenia has evolved to include the loss of muscle function in the definition. Sarcopenia has a high prevalence in specific clinical conditions and in the older population and can lead to significant morbidity, poor recovery from adverse events and ultimately, institutionalisation. In spite of the severe health care burden posed, the diagnosis and treatment of sarcopenia have yet to become standard care. Emerging consensus on definition and diagnosis by the international work groups on sarcopenia with tailored population-based cut-offs and growing evidence-based management options will facilitate the meeting of these needs.

Curva de Spee: causas y tratamiento de su descompensación / Spee curve: causes and treatment of its discompensation

En el presente artículo se analiza y pasa revista a la bibliográfica acerca de la Curva de Spee: su etiología, los diferentes factores que pueden descompensarla, y los posibles tratamientos para corregirla en caso deestar alterada. Una mordida abierta esqueletal o dentaria, o una mordida profunda esqueletal o dentaria pueden modificarla, pudiendo utilizarse varios recursos y técnicas para tratar estos desórdenes, y así nivelar la curva.

In the present paper, the literature is analysed and reviewed the Curve of Spee: its aetiology, the different factors that can decompensate it, and the possible treatments to correct it in case of beingaltered. An open skeletal or dental bite, or a deep skeletal ordental bite can modify it, being able to use several resources and techniques to treat these disorders, and thus to level the curve.

Identificación de las causas de muerte fetal en una institución hospitalaria de atención materna de Cartagena, Colombia, 2012-2014 / Identification of the causes of foetal demise in a maternal care institution in Cartagena, Colombia, 2012-2014

Objetivo: determinar las causas de las muertes fetales registradas en una institución pública de referencia en Cartagena, Colombia, durante los años 2012-2014. Materiales y métodos: serie de casos. Se incluyeron los óbitos fetales que fueron sometidos a autopsia en la Clínica Maternidad Rafael Calvo de Cartagena, institución pública de segundo nivel de complejidad, que atiende a pacientes afiliadas al régimen subsidiado por el Estado. Se realizó muestreo consecutivo. Se evaluaron la edad gestacional, el sexo y la causa clínica de la muerte mediante el sistema ReCoDe que permite clasificar la muerte fetal mediante nueve categorías. Los resultados se presentan mediante estadística descriptiva. Resultados: se evaluaron 458 fetos con reporte de autopsia. Se estableció la causa de la muerte de manera probable o posible en 440 casos (97 %). Las principales condiciones asociadas a la muerte fetal fueron la insuficiencia placentaria (44,7 %), seguidas de las alteraciones relacionadas con el líquido amniótico (18,6 %), la causa materna (12,8 %), y las causas fetales (12 %). El 2,8 % de los casos fueron clasificados como inexplicados. Conclusiones: el sistema de clasificación ReCoDe permitió la adecuada clasificación de la causa de muerte en el 97 % de los óbitos fetales sometidos a autopsia.

Objective: To determine the causes of foetal demise documented in a public referral institution in Cartagena, Colombia between 2012-2014. Materials and methods: Case series including foetal demises taken to autopsy at the Rafael Calvo Maternal Clinic in Cartagena, a level II public institution that sees patients affiliated to the State subsidised healthcare regime. A consecutive sampling was used. Gestational age, sex and the clinical cause of death were analysed using the ReCoDe system in which 9 categories are used to classify foetal demise. Descriptive statistics are used to present the results. Results: Overall, 458 foetuses with an autopsy report were assessed. Possible or probable cause of death was established in 440 cases (97 %). The main conditions associated with foetal death were placental insufficiency (44.7 %), followed by amniotic fluid abnormalities (18.6 %), maternal causes (12.8 %), and foetal causes (12 %). Of all the cases, 2.8 % were classified as unexplained. Conclusions: The ReCoDe classification system was useful for classifying the cause of death in 97 % of foetal demises taken to autopsy.

Características clínicas e histológicas de adenopatías en pacientes pediátricos / Clinical and histological characteristics of adenopathies in paediatric patients

Introducción: Las adenopatías son una causa muy frecuente de consulta en la población infantil, estando presente hasta en el 44% de los niños menores de 5 años. En algunos casos se requiere la toma de biopsias ganglionares para esclarecer el diagnóstico. Objetivo: Describir las características clínicas e histopatológicas de pacientes pediátricos con adenopatías sometidos a biopsias ganglionares. Pacientes y método: Estudio descriptivo, retrospectivo. Se incluyó la totalidad de los niños menores de 15 años a los que se les realizó biopsia ganglionar en hospital de alta complejidad en un periodo de 4 años. Se evaluaron las características demográficas, clínicas y de laboratorio de los pacientes, así como el diagnóstico histopatológico de las biopsias realizadas. Resultados: Sesenta y un niños, 54,1%, fueron del sexo masculino, mediana de edad de 6 años. El diagnóstico patológico más frecuente fue hiperplasia reactiva (50,8%), seguido de enfermedad neoplásica (27,9%), enfermedad granulomatosa crónica (4,9%) e infección bacteriana (3,3%). De las enfermedades neoplásicas, el linfoma de Hodgkin fue el más común, siendo su localización más frecuente la cervical (60,6%). Conclusiones: Con este estudio se demuestra la importancia de realización de diagnósticos diferenciales en el abordaje de pacientes con adenopatías. Al igual que lo reportado en la literatura mundial, la etiología benigna es la causa más común de adenopatías en niños.

Background: Lymphadenopathy is a common cause for medical consultation in the child population, accounting for up to 44% in children under 5 years old. In some cases, it is required to take lymph node biopsy specimens in order to clarify the diagnosis. Objective: To describe the clinical and histological features of paediatric patients with lymphadenopathy and lymph node biopsies. Patients and method: Descriptive and retrospective study conducted in Medellin (Colombia) in a fourth-level hospital between January 1st of 2009 and December 31st of 2012. In the study, lymph node biopsy specimens were taken from children under 15 years old. Demographic, clinical and laboratory features, and characteristics of the patients were evaluated, as well as the histopathological diagnosis of the lymph node biopsies. Results: From the child population, 61 children met the eligibility criteria and 33 (54.1%) of them were male with an average age of 6 years old. The most common pathological diagnoses in the study group were as follows: reactive hyperplasia (50.8%), neoplasms (27.9%), chronic granulomatous disease (4.9%), and bacterial infection (3.3%). It could be concluded from the findings in the study that Hodgkin lymphoma is very common among the neoplastic diseases, with 18%, and the most frequent location was the neck with 60.6%. Conclusions: This study demonstrates the importance of performing a differential diagnosis when approaching patients with lymphadenopathy. As reported in the world medical literature, benign origin is the most common cause of lymphadenopathy in children.

Tricky typhus ticks two: A report of two sisters from North India presenting with acute respiratory distress syndrome due to scrub typhus.

Scrub typhus is emerging as an important cause of acute febrile illness in Northern India. This is a report of two sisters presenting concurrently with acute respiratory distress syndrome. A diagnosis of scrub typhus was made in both the patients, and they were successfully treated with doxycycline.