Estomas: complicaciones, manejo y prevención. Una revisión actual / Stomas: complications, management, and prevention. An updated review

Introducción. La resección segmentaria del intestino y su derivación temporal o definitiva es un procedimiento frecuente en la práctica quirúrgica, que implica la construcción de un estoma. La enfermedad que lleva a la cirugía, las condiciones clínicas del paciente y los aspectos técnicos en la construcción de la ostomía son puntos claves en la evolución posoperatoria. Métodos. Se realizó una revisión de la literatura identificando las complicaciones asociadas a la construcción de estomas, con el objetivo de ofrecer herramientas de tratamiento y toma de decisiones al personal médico involucrado en la atención de estos pacientes. Resultados. La cirugía de urgencia, la inmunosupresión, la obesidad y la técnica en la apertura del orificio en la pared abdominal, favorecen la aparición de complicaciones tempranas que requieren manejo médico o reintervención quirúrgica. Conclusiones. Todo paciente con estoma debe ser valorado minuciosamente por el cirujano y la terapista enterostomal en las primeras 72 horas luego de la cirugía.

Introduction. Segmental resection of the intestine and its temporary or permanent bypass is a frequent procedure in surgical practice, which involves the construction of a stoma. The disease that leads to surgery, the clinical conditions of the patient and the technical aspects in the construction of the ostomy are key points in the postoperative evolution. Methods. A review of the literature was performed, identifying the complications associated with the construction of stomas, with the aim of offering treatment and decision-making tools to the medical personnel involved in the care of these patients. Results. Emergency surgery, immunosuppression, obesity, and the technique used to open the orifice in the abdominal wall favor the appearance of early complications that require medical management or surgical reintervention. Conclusions. Every patient with a stoma must be carefully evaluated by the surgeon and the enterostomal therapist in the first 72 hours after surgery.

Concordance of acid-fast stain result and histopathologic vs clinical diagnosis of leprosy: A three-year retrospective study in a Tertiary Government Hospital and Sanitarium in the Philippines

Objectives@#In the Philippines, there has been a lack of information on the concordance between classifications of Hansen’s disease or leprosy clinically, histopathologically, and with AFS results. The study ultimately aimed to determine the concordance between the clinical diagnosis, histopathological results, and AFS results of patients with leprosy seen at the Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium (DJNRMHS). @*Methods@#This is a descriptive, retrospective, single-center study conducted at the DJNRMHS, a tertiary government hospital and one of the last remaining sanitaria in the country located in northern Metro Manila in the Philippines. The study reviewed and included all the patient records from the years 2017-2019 which included skin biopsy results and slit-skin smear with AFS. Leprosy patients were then classified based on the following classifications: World Health Organization (WHO) and Ridley-Jopling classifications; and the concordance of clinical diagnosis vs the histopathologic findings and clinical diagnosis vs AFS results were determined using kappa testing.

Frecuencia de enfermedades periodontales y características clínicas de pacientes atendidos en la Cátedra de Periodoncia de la Universidad Autónoma de Asunción

Las enfermedades periodontales son consideradas entre las más comunes entre las patologías bucales. Su frecuencia es cada vez más elevada en la población y existen varias patologías sistémicas y hábitos que empeoran su cuadro clínico. El objetivo de este trabajo fue determinar la frecuencia y características clínicas de pacientes con enfermedades periodontales que acuden a la cátedra de periodoncia en la Universidad Autónoma de Asunción en el período de 2011 al 2019. Estudio Observacional, descriptivo, retrospectivo, se procesaron 477 fichas clínicas de pacientes de la cátedra de Periodoncia de la Universidad Autónoma de Asunción desde el año 2011 al 2019. El tipo de muestreo utilizado fue no probabilístico por conveniencia. De las 477 fichas solo se analizaron 317 pacientes que cumplieron con los criterios de inclusión. Fueron el 56.46 % de sexo femenino y 43,53 % de sexo masculino, la mediana de edad fue de 33 (23-48) años. El 53% los pacientes presentaban periodontitis crónica y comorbilidades como diabetes e hipertensión arterial. Solo el 11,9 % fueron fumadores. En cuanto a los pacientes diabéticos la mayoría eran de sexo femenino y de edad avanzada, presentando como diagnóstico más frecuente la periodontitis crónica. El diagnóstico clínico más frecuente de la población estudiada fue la periodontitis crónica, seguido por la gingivitis.

Periodontal diseases are considered among the most common among oral pathologies. Its frequency is increasingly higher in the population and there are several systemic pathologies and habits that worsen its clinical condition. The objective of this work was to determine the frequency and clinical characteristics of patients with periodontal diseases who attend the periodontics department at the Autonomous University of Asunción in the period from 2011 to 2019. Observational, descriptive, retrospective study, 477 clinical records were processed. of patients from the Department of Periodontics at the Autonomous University of Asunción from 2011 to 2019. The type of sampling used was non-probabilistic for convenience. Of the 477 records, only 317 patients who met the inclusion criteria were analyzed. They were 56.46% female and 43.53% male, the median age was 33 (23-48) years. 53% of the patients had chronic periodontitis and comorbidities such as diabetes and high blood pressure. Only 11.9% were smokers. Regarding diabetic patients, the majority were female and elderly, with chronic periodontitis as the most frequent diagnosis. The most frequent clinical diagnosis of the studied population was chronic periodontitis, followed by gingivitis.

Características sociodemográficas y epidemiológicas de pacientes con inicio clínico de sida en Santiago de Cuba / Sociodemographic and epidemiological characteristics of patients with clinical onset of AIDS in Santiago de Cuba i: en

Introducción: Uno de los desafíos del milenio a nivel mundial es combatir el avance de la epidemia del virus de la inmunodeficiencia humana/sida. Objetivo: Caracterizar a la población de pacientes con inicio clínico de sida según variables sociodemográficas y epidemiológicas. Métodos: Se realizó un estudio observacional y descriptivo, desde el 2017 hasta el 2021, de 87 personas diagnosticadas con inicio clínico del sida en la provincia de Santiago de Cuba. En el análisis estadístico se emplearon medidas de tendencia central y de dispersión, así como la distribución de frecuencias absolutas y relativas; también, se computaron intervalos de confianza de 95 % para las proporciones de las variables seleccionadas. Resultados: La edad promedio en la serie fue de 42 años (79,3 %); asimismo, predominaron el sexo masculino (91,9 %), el estado civil soltero (91,9 %), la vinculación laboral (72,4 %), los colores de la piel mestizo (52,8 %) y negro (39,3 %) y la procedencia urbana (73,5 %). El coito anal fue la principal forma de contagio (84,0 %), en tanto la mayoría de los afectados de ambos sexos (65,2 % en el masculino y 66,7 % en el femenino) no usaban el preservativo y en los hombres primó la homosexualidad (55,0 %). Conclusiones: El inicio clínico del sida predominó en hombres jóvenes solteros, con vínculo laboral, entre los cuales fueron muy significativas las conductas sexuales de riesgo.

Introduction: One of the millennium challenges worldwide is to fight the advance of the human immunodeficiency virus/aids. Objective: To characterize the sick population with clinical onset of AIDS according to sociodemographic and epidemiologic variables. Methods: An observational and descriptive study was carried out, from 2017 to 2021, of 87 people diagnosed with clinical onset of AIDS in Santiago de Cuba province. In the statistical analysis, measures of central tendency and dispersion were used, as well as the distribution of absolute and relative frequencies; also, confidence intervals of 95% were computed for the proportions of selected variables. Results: The average age in the series was 42 years (79.3%), likewise, there was a prevalence of the male sex (91.9%), single as marital status (91.9%), working bond (72.4%), mixed race (52.8%) and black skin color (39.3%), and the urban origin (73.5%). The anal coitus was the main way of infection (84.0%), while the majority of the affected individuals of both sexes (65.2% in males and 66.7% in females) did not use condoms and homosexuality predominated among men (55.0%). Conclusions: The clinical onset of AIDS prevailed in young and single men, with working bond, among whom risky sexual behaviors were very significant.

Estudio de factores clínicos y epidemiológicos en pacientes con diagnóstico de artritis reumatoidea

Fundamento: la artritis reumatoidea es una enfermedad autoinmunitaria crónica que produce daño articular crónico e irreversible que conlleva al deterioro de la calidad de vida y discapacidad permanente con prevalencia mundial de entre 1,0 y 1,5 %. Objetivo: identificar las principales características clínico-epidemiológicas de pacientes con artritis reumatoidea en el Policlínico Docente Área Este de Camagüey. Métodos: se realizó un estudio descriptivo, de serie de casos, realizado en el Policlínico Docente Área Este de Camagüey. Del universo de 108 pacientes fue seleccionada una muestra de 102, una vez aplicados los criterios de elección. Se estudiaron las variables: grupo etáreo, sexo, color de la piel, años de diagnóstico, signos y síntomas clínicos, factores de riesgo; así como complicaciones presentadas. Para el procesamiento de los datos se empleó SPSS y se expresaron en valores absolutos y porcentajes. Resultados: predominó el grupo etáreo de 60 años y más (45,0 %), las mujeres (75,5 %), pacientes de color de piel blanca (66,7 %), con artritis reumatoidea de 16-20 años de evolución (22,5 %), vasculitis (25,5 %) y dolor (94,1 %) dentro de los principales signos y síntomas, mientras el consumo de café (69,6 %) y el sexo femenino se encontraron dentro los factores de riesgo modificables y no modificables. La osteoporosis fue la más notable de las complicaciones presentadas (69,6 %). Conclusiones: en la serie estudiada sobresalió el sexo femenino, la edad avanzada, el dolor como síntoma principal, así como la osteoporosis dentro de las complicaciones presentadas.

Foundation: rheumatoid arthritis is a chronic autoimmune disease that produces chronic and irreversible joint damage that leads to deterioration in quality of life and permanent disability with a worldwide prevalence of between 1.0 and 1.5 %. Objective: to identify the main clinical-epidemiological characteristics of patients with rheumatoid arthritis in the Eastern Area Teaching Polyclinic of Camagüey. Methods: a descriptive case series study was carried out at the Eastern Area Teaching Polyclinic of Camagüey. From the universe of 108 patients, a sample of 102 was selected, once the selection criteria were applied. The variables were studied: age group, sex, skin color, years of diagnosis, clinical signs and symptoms, risk factors; as well as complications presented. SPSS was used to process the data and they were expressed in absolute values ​​and percentages. Results: the age group of 60 years and older predominated (45.0 %), women (75.5 %), patients of white skin color (66.7 %), with rheumatoid arthritis of 16-20 years of evolution (22.5 %), vasculitis (25.5 %) and pain (94.1 %) among the main signs and symptoms, while coffee consumption (69.6 %) and female sex were found among the risk factors. modifiable and non-modifiable risk. Osteoporosis was the most notable of the complications presented (69.6 %). Conclusions: in the series studied, female sex, advanced age, pain as the main symptom, as well as osteoporosis stood out among the complications presented.

Proceso formativo del estudiante de Medicina en la detección de secuelas discapacitantes pos-COVID-19 / Training process of the medical student in the detection of post-COVID-19 incapacitating sequelae i: en

Introducción: En el proceso de capacitación continua de los estudiantes de Medicina resulta necesario incorporar temas de actualidad; asimismo, es importante conocer los problemas para buscar soluciones con el apoyo de la ciencia. Objetivo: Diagnosticar el proceso formativo del estudiante de Medicina en cuanto a la detección de secuelas discapacitantes pos-COVID-19. Métodos: Se realizó un estudio observacional, descriptivo y transversal, con enfoque cualitativo, de 20 estudiantes del quinto año de la carrera de Medicina, pertenecientes a la Universidad de Ciencias Médicas de Camagüey, durante su estancia por la asignatura Salud Pública, desde julio hasta diciembre del 2022. Para tal propósito se diseñó y aplicó un instrumento evaluativo con dimensiones e indicadores. Resultados: Se halló que 50,0 % de dichos estudiantes se ubicó en el rango de edad de 21-26 años, mientras que 65,0 % correspondió al sexo femenino. La dimensión cognitiva fue evaluada de mal, pues 3 indicadores, de los 4 que la integraban, recibieron esa calificación; del mismo modo sucedió con la dimensión instrumental. En cambio, la dimensión actitudinal y sus 2 indicadores fueron calificados de bien. Conclusiones: Existieron insuficiencias en el proceso formativo del estudiante de Medicina, lo que obstaculiza su desempeño profesional. Sobre la base del diagnóstico realizado, se confirma como fortaleza el interés por la búsqueda de información relacionada con la detección de secuelas discapacitantes pos-COVID-19.

Introduction: In the continuous training process of medical students, it is necessary to incorporate current issues; likewise, it is important to know the problems to seek solutions with the science support. Objective: To diagnose the training process of medical students as for the detection of incapacitating sequelae post-COVID-19. Methods: An observational, descriptive and cross-sectional study, with qualitative approach, of 20 students from 5th year of Medicine career, belonging to the University of Medical Sciences in Camagüey was carried out during their stay for the Public Health subject, from July to December, 2022. For such a purpose it was designed and applied an evaluative instrument with dimensions and indicators. Results: It was found that 50.0% of these students were in the age range of 21-26 years, while 65.0% were female. The cognitive dimension was evaluated as bad because 3 indicators, of the 4 that made it up, received that qualification; the same happened with the instrumental dimension. On the other hand, the attitudinal dimension and its 2 indicators were qualified as good. Conclusions: Inadequacies existed in the training process of medical students, which block their professional performance. On the base of the diagnosis, the interest in searching for information related to the detection of post-COVID-19 incapacitating sequelae is confirmed as strength.

Alergia a la leche de vaca: ¿se pueden evitar las pruebas de provocación oral? Un análisis probabilístico basado en datos clínicos / Cow's milk allergy: Can oral food challenges be avoided? A probabilistic analysis based on clinical data

Introducción. La prueba de provocación oral (PPO) para el diagnóstico de alergia a las proteínas de la leche de la vaca (APLV) presenta riesgos y requiere de recursos. Nuestro objetivo fue evaluar condiciones y pruebas complementarias para identificar una alta probabilidad de APLV. Población y métodos. Análisis secundario sobre estudio de pacientes atendidos en una unidad de alergia entre 2015 y 2018. Se determinaron las probabilidades prepruebas asociadas a los síntomas y sus combinaciones, y las probabilidades pospruebas luego de realizadas pruebas cutáneas y determinación de inmunoglobulina E (IgE) sérica. Resultados. Se evaluó la información de 239 pacientes. Se observaron probabilidades mayores al 95 % en pacientes con angioedema y combinación de urticaria y vómitos. Usando puntos de corte propuestos por Calvani et al., la combinación de vómitos con rinitis, sin angioedema, también superó el 95 %. Conclusión. Se ofrece una metodología para identificar pacientes en los que puede diagnosticarse APLV sin realización de PPO.

Introduction. The oral food challenge (OFC) for the diagnosis of cow's milk protein allergy (CMPA) poses risks and requires resources. Our objective was to assess conditions and complementary tests used to identify a high probability of CMPA. Population and methods. Secondary analysis of a study of patients seen at a unit of allergy between 2015 and 2018. Pre-testing probabilities associated with symptoms and their combinations and post-testing probabilities after skin prick testing and serum immunoglobulin E (IgE) levels were determined. Results. The data from 239 patients were assessed. A probability greater than 95% was observed for angioedema and a combination of urticaria and vomiting. Based on the cut-off points proposed by Calvani et al., the combination of vomiting with rhinitis, without angioedema, also exceeded 95%. Conclusion. A methodology is provided to identify patients in whom CMPA may be diagnosed without an OFC.

Factores de riesgo asociados al cáncer vesical en pacientes adultos / Risk factors associated with bladder cancer in adult patients

Introducción: El cáncer vesical es una enfermedad que afecta, generalmente, a pacientes masculinos de la tercera edad. Este tumor tiene dos formas principales de manifestarse: como tumor superficial y de bajo grado, o como neoplasia invasora de alto grado. La mayoría de los pacientes afectados con esta enfermedad presentan como factor de riesgo, el consumo de tabaco. Objetivo: Contribuir al conocimiento de la comunidad científica en lo relativo a los factores de riesgo y al síntoma principal asociados al cáncer vesical en pacientes adultos de la tercera edad. Métodos: Se realizó una revisión sistemática sobre el tema en las bases de datos: SciELO, EBSCO, Scopus, PubMed, y en revistas de Urología. Los artículos fueron publicados en idioma español o inglés. Se realizó un análisis del contenido para lograr la actualización teórica del tema. Conclusiones: El cáncer vesical es una enfermedad multifocal que provoca la aparición de varias neoformaciones dentro del epitelio transicional, en toda su extensión. La presencia de hematuria asintomática en los pacientes adultos fue la causa más común de consulta con el urólogo. Dentro de los factores de riesgo, el principal fue el consumo de tabaco.

Introduction: bladder cancer is a disease that generally affects elderly male patients. This tumour has two main forms of manifestation: as a low-grade superficial tumor or as a high-grade invasive neoplasm. Most of the patients affected with this disease have tobacco consumption as a risk factor. Objective: to contribute to the knowledge of the scientific community in relation to the risk factors associated with bladder cancer in elderly patients. Methods: a systematic review on the subject was carried out in SciELO, EBSCO, Scopus and PubMed databases as well as in Urology journals. Articles published in Spanish or English languages were taken into account. A content analysis was conducted to achieve a theoretical update on this topic. Conclusions: bladder cancer is a multifocal disease that causes the appearance of several neoformations within the transitional epithelium and throughout its entire length. The presence of asymptomatic hematuria in adult patients was the most common reason for consultation with the urologist. The main risk factor was tobacco consumption.

Aspectos clínicos, epidemiológicos e histopatológicos de pacientes con lesiones en la mucosa bucal / Clinical, epidemiological, histological and pathological aspects of patients with lesions in the oral mucosa i: en

Introducción: Las lesiones en la mucosa bucal constituyen un grupo heterogéneo de alteraciones, de cuyo diagnóstico temprano depende el pronóstico y el tratamiento. Objetivo: Caracterizar a pacientes con lesiones en la mucosa bucal según variables clínicas, epidemiológicas e histopatológicas. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de 23 pacientes con lesiones en la mucosa bucal pertenecientes a los consultorios médicos de la familia del reparto Vista Alegre, quienes fueron asistidos en la consulta de estomatología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba desde septiembre del 2021 hasta junio del 2022. Resultados: En la serie predominaron el sexo femenino, el grupo etario de 60 y más años, la estomatitis subprótesis como lesión más frecuente (39,1 %) y los traumatismos crónicos como factores de riesgo (65,2 %); asimismo, en los pacientes remitidos al nivel secundario de atención hubo coincidencia entre los diagnósticos clínico e histopatológico (76,9 % ). Conclusiones: De la valoración clínica, epidemiológica e histopatológica de estas lesiones y de la preparación de los especialistas sobre el tema dependerá el diagnóstico definitivo.

Introduction: Lesions in the oral mucosa constitute a heterogeneous group of disorders which prognosis and treatment depend on the early diagnosis. Objective: To characterize patients with lesions in the oral mucosa according to clinical, epidemiological, histological and pathological variables. Methods: A descriptive, longitudinal and prospective study of 23 patients with lesions in the oral mucosa was carried out. They belonged to the family doctor offices from Vista Alegre neighborhood and were assisted in the Stomatology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba from September, 2021 to June, 2022. Results: In the series there was a prevalence of the female sex, the 60 years and over age group, subprosthesis stomatitis as more frequent lesion (39.1%) and chronic traumatisms as risk factors (65.2%); also, in patients referred to the secondary care level there was coincidence between the clinical, histological and pathological diagnoses (76.9%). Conclusions: The final diagnosis will depend on the clinical, epidemiological, histological and pathological valuation of these lesions and on the preparation of the specialists on the topic.

Análise sobre o conhecimento do pediatra brasileiro sobre a alergia à proteína do leite de vaca / Analysis of brazilian pediatricians' knowledge of cow's milk protein allergy

Analisar o conhecimento de pediatras brasileiros sobre alergia à proteína do leite de vaca (APLV) por meio de um questionário validado. Estudo quantitativo com delineamento transversal no qual foi aplicado um questionário online sobre conhecimentos de APLV. O cálculo amostral foi de 294. O formulário online foi dividido em dois blocos, sendo o primeiro composto por questões de identificação dos pediatras e o segundo composto pelo questionário validado, construído a partir do Consenso Brasileiro de Alergia Alimentar (2018). A avaliação geral do questionário mostrou um percentual de concordância de 91% e Índice de Validade de Conteúdo de 0,95. Os resultados dos questionários aplicados foram apresentados em frequências absolutas e relativas, média, mediana, desvio padrão e percentis. O nível de significância foi estabelecido em 5% (p < 0,05). O questionário validado foi respondido por 1.316 médicos brasileiros, dos quais 1.017 (77,3%) eram do sexo feminino. A média de idade observada foi de 45,50 ± 13,20 anos. Ao analisar o número total de acertos, notou-se que a média de acertos foi de 80,66 ± 10,42%. Os pediatras responderam principalmente a perguntas sobre o conceito e o tratamento da APLV. A questão com menor índice de acertos foi relacionada à investigação clínica e laboratorial. A maioria dos médicos que respondeu ao questionário demonstrou compreender o conceito e as principais recomendações terapêuticas da APLV.

To analyze the knowledge of Brazilian pediatricians about cow's milk protein allergy (CMPA) using a validated questionnaire. Quantitative study with a cross-sectional design in which an online questionnaire on CMPA knowledge was applied. The sample calculation indicated 1024 participants. The online form was divided into two blocks, the first comprising questions on the identification of pediatricians, and the second comprising the validated questionnaire, built from the Brazilian Consensus on Food Allergy (2018). The general evaluation of the questionnaire showed a percentage of agreement of 91% and a Content Validity Index of 0.95. The results of the applied questionnaires were presented in absolute and relative frequencies, mean, median, standard deviation, and percentiles. The level of significance was set at 5% (p <0.05). The validated questionnaire was answered by 1316 Brazilian doctors, of whom 1017 (77.3%) were females, and their mean age was 45.50 ± 13.20 years. The mean total number of correct answers was 80.66 ± 10.42%. Pediatricians mostly answered questions about the concept and treatment of CMPA. The question with the lowest rate of correct answers was related to clinical and laboratory investigation. Most physicians who answered the questionnaire demonstrated they understood the concept and the main CMPA therapeutic recommendations.

Diagnóstico diferencial: ¿Qué es, cómo se hace, dónde lo enseñan? / Differential diagnosis: what is it, how is it done and where is it taught?

El diagnóstico es la piedra angular de la medicina individual, por tanto, dominarlo y conocerlo es esencial para todo médico al indagar en el estado de salud y patológico de los pacientes. Los profesionales de la salud deben dedicar todos sus esfuerzos a su realización, siempre que disponga de los elementos y medios necesarios, tanto teóricos como prácticos, para la correcta utilización del método clínico, elemento esencial del diagnóstico diferencial. En este artículo se abordan los aspectos más relevantes que intervienen en la realización del diagnóstico de los pacientes; se enfatiza en los pasos necesarios para efectuar un verdadero diagnóstico diferencial que posibilite la decantación de las posibilidades etiológicas del cuadro clínico del enfermo. A través de la correcta aplicación del método clínico es posible la aproximación al diagnóstico clínico definitivo del paciente.

Diagnosis is the cornerstone of individual medicine, therefore, mastering it and knowing it is essential for every doctor when inquiring into the health and pathological status of patients. Health professionals must dedicate all their efforts to its realization as long as they have the necessary elements and means, both theoretical and practical, for the correct use of the clinical method, which is an essential element of differential diagnosis. This article addresses the most relevant aspects involved in carrying out patient's diagnosis; emphasis is placed on the necessary steps to carry out a true differential diagnosis that makes it possible to decant the etiological possibilities of the patient's clinical manifestations. It is possible to approach the definitive clinical diagnosis of the patient through the correct application of the clinical method.

Frequência da deficiência auditiva relacionada às infecções congênitas: estudo transversal retrospectivo / Frequency of hearing loss related to congenital infections: retrospective cross-sectional study / Frecuencia de hipoacusia relacionada con infecciones congénitas: un estúdio transversal retrospectivo

Introdução: As infecções congênitas durante a gravidez são indicadores de risco para a deficiência auditiva. Objetivo: Verificar a frequência da deficiência auditiva nas crianças atendidas num serviço público com indicadores de risco de infecções congênitas. Métodos: Trata-se de um estudo transversal retrospectivo. A população do estudo foi de crianças de 0 a 3 anos atendidas no período de 2011 a 2019. Foi realizada consulta e análise no banco de dados da Instituição extraindo informações das crianças quanto à presença de infecção congênita relatada (citomegalovírus, herpes, rubéola, sífilis, toxoplasmose, HIV e Zika vírus) e o diagnóstico audiológico completo. A amostra deste estudo foi constituída por 558 crianças e foram analisadas a presença de coocorrência entre as infecções ou de outros indicadores de risco para a deficiência auditiva. Realizou-se análise descritiva para estabelecer a frequência da deficiência auditiva em relação a cada infecção congênita isolada ou associada a outros indicadores de risco. Resultados: 14,40% das crianças apresentavam o relato de infecção congênita isolada ou em combinação com outro IRDA. A frequência da deficiência auditiva foi de 1,25%, com a presença da perda auditiva sensorioneural em seis crianças (85,71%) e uma perda auditiva do tipo condutiva (14,29%), das quais seis foram bilaterais (85,71%) e uma unilateral (14,29%). Esta frequência de deficiência auditiva foi relacionada ao histórico de citomegalovírus (57,14%), seguido de toxoplasmose (28,57%) e rubéola com Zika vírus (14,29%). Conclusão: A frequência do diagnóstico de deficiência auditiva foi de 1,25% nas crianças com relato de infecções congênitas. (AU)

Introduction: Congenital infections during pregnancy are risk indicators for hearing loss. Purpose: To verify the frequency of hearing loss in children attended at the public service with risk indicators for congenital infections. Methods: This is a retrospective cross-sectional study. The population consisted of children aged 0 to 3 years attended in the period from 2011 to 2019. Consultation and analysis were carried out in the Institution's database, extracting information from the children regarding the presence of reported congenital infection (cytomegalovirus, herpes, rubella, syphilis, toxoplasmosis, HIV and Zika virus) and the complete audiological diagnosis. The sample of this study consisted of 558 children and the presence of co-occurrence between infections or other risk indicators for hearing loss was analyzed. Descriptive analysis was performed to establish the frequency of hearing loss in relation to each congenital infection isolated or associated with other risk indicators. Results: 14.40% of the children had a report of isolated congenital infection or in combination with another risk indicator. The frequency of hearing loss was 1.25%, with sensorineural hearing loss in six children (85.71%) and a conductive hearing loss (14.29%), of which six were bilateral (85, 71%) and one unilateral (14.29%). This frequency of hearing loss was related to the history of cytomegalovirus (57.14%), followed by toxoplasmosis (28.57%) and rubella with zika virus (14.29%). Conclusion: The frequency of diagnosis of hearing loss was 1.25% in children with reports of congenital infections. (AU)

Introducción: Las infecciones congénitas durante el embarazo son indicadores de riesgo de hipoacusia. Propósito: Verificar la frecuencia de hipoacusia en niños atendidos en el servicio público con indicadores de riesgo de infecciones congénitas. Métodos: Se trata de un estudio transversal retrospectivo. La población de estudio estuvo constituida por los niños de 0 a 3 años atendidos en el periodo de 2011 a 2019. Se realizó consulta y análisis en la base de datos de la Institución, extrayéndose información de los niños en cuanto a la presencia de infección congénita reportada (citomegalovirus, herpes, rubéola, sífilis, toxoplasmosis, VIH y virus Zika) y el diagnóstico audiológico completo. La muestra de este estudio estuvo constituida por 558 niños y se analizó la presencia de coocurrencia entre infecciones u otros indicadores de riesgo de hipoacusia. Se realizó un análisis descriptivo para establecer la frecuencia de hipoacusia con relación a cada infección congénita aislada o asociada a otros indicadores de riesgo. Resultados: El 14,40% de los niños tenían reporte de infección congénita aislada o en combinación con otro indicador de riesgo. La frecuencia de hipoacusia fue del 1,25%, con hipoacusia neurosensorial en seis niños (85,71%) y hipoacusia conductiva (14,29%), de los cuales seis fueron bilaterales (85,71%) y uno unilateral (14,29%). Esta frecuencia de hipoacusia se relacionó con el antecedente de citomegalovirus (57,14%), seguido de toxoplasmosis (28,57%) y rubéola con virus zika (14,29%). Conclusión: La frecuencia de diagnóstico de hipoacusia fue de 1,25% en niños con reporte de infecciones congénitas. (AU)

Negligência no diagnóstico precoce de hanseníase na atenção primária: um relato de caso / Negligence in the early diagnosis of leprosy in primary care: a case report

A hanseníase é uma doença infecciosa, transmissível, de caráter crônico, com potencial grau de incapacidade, que ainda persiste como problema de saúde pública no Brasil. A demora e a falta de conhecimento técnico para realizar o diagnóstico resulta em inúmeros prejuízos aos pacientes acometidos pela doença, sendo que, a prevenção das incapacidades está relacionada diretamente com o diagnóstico precoce da doença. Com a finalidade de evitar a negligência diagnóstica e o desenvolvimento de incapacidades físicas, ressaltamos a importância do conhecimento técnico sobre o diagnóstico e o manejo da hanseníase por profissionais da saúde em qualquer nível de atenção à saúde ou especialidade.

Hansen is an infectious disease, transmissible, of a chronic nature, with serious potential for disability, which still persists as a public health problem in Brazil. The delay and the lack of technical knowledge to carry out the diagnosis with numerous prejudices to the patients affected by the disease, since the prevention of disabilities is directly related to the early diagnosis of the disease. In order to avoid diagnostic negligence and the development of physical disabilities, we highlight the importance of technical knowledge about the diagnosis and management of training by health professionals at any level of health care or special care.

Application of multidisciplinary team teaching in the training of professional postgraduate students in neurology / 中华医学教育探索杂志

For the issues including inadequate ability for clinical diagnosis and treatment during the training of professional postgraduate students in neurology, this article elaborates on the importance of the application of multidisciplinary team (MDT) teaching from the aspects of the necessity of MDT teaching in the training of professional postgraduate students in neurology and the implementation scope, implementation process, implementation examples, and preliminary teaching results of MDT teaching, so as to provide experience for improving the clinical diagnosis and treatment ability of professional postgraduate students in neurology.

Chinese expert consensus of albumin-bound paclitaxel in the treatment of breast cancer / 中华肿瘤杂志

Breast cancer is the most common malignant tumor of women, which seriously threatens women's health. Albumin-bound paclitaxel is the basic chemotherapy drug for breast cancer treatment. We can promote reasonable clinical medication and improve patients' quality of life by standardizing chemotherapy plans, rationally optimizing treatment strategy and managing adverse reactions of albumin-bound paclitaxel. In order to standardize the clinical application of albumin-bound paclitaxel in breast cancer, Chinese Medical Doctor Association Oncologist Branch Breast Cancer Group and International Medical Exchange Branch of China Anti-Cancer Association consulted guidelines and the latest evidence-based evidences and formulated Chinese expert consensus of albumin-bound paclitaxel in the treatment of breast cancer to provide reference for clinical diagnosis and treatment of breast cancer. The consensus mainly introduces the clinical application strategies and evidence-based evidences of albumin-bound paclitaxel in advanced therapy, neoadjuvant therapy and adjuvant therapy of breast cancer. Among them, the regimens containing albumin-bound paclitaxel are the better recommended regimens for preoperative neoadjuvant and advanced rescue therapy of breast cancer. However, there is little evidence in adjuvant therapy, so it is recommended to use albumin-bound paclitaxel cautiously. We also invited breast cancer clinical experts to vote on some controversial issues, including but not limited to the usage and dosage of albumin-bound paclitaxel, combined medication and management of peripheral neuropathy, and formed consensus recommendations for the reference of breast cancer clinical workers.

Recommendations for diagnosis and treatment of SARS-CoV-2 infection in children / 西安交通大学学报(医学版)

Children are also at high risk of novel coronavirus infection. However, as children are in the developmental stage and their phylogeny is not yet complete, adult guidelines cannot be directly copied in the diagnosis and treatment of SARS-CoV-2 infection in children. Therefore, The Second Affiliated Hospital of Xi’an Jiaotong University organized relevant professionals of Children’s Hospital. Based on the "Diagnosis and Treatment Plan for SARS-CoV-2 Infection (Trial 10th Edition)" issued by the General Office of the National Health Commission of the State Administration of Traditional Chinese Medicine, the diagnosis and treatment plan suggestions for children with novel coronavirus infection in The Second Affiliated Hospital of Xi’an Jiaotong University were formulated by referring to several instructive diagnosis and treatment plans and combining our hospital’s experience in treating children with SARS-CoV-2 infection. This recommendation makes a concise and practical description from the perspectives of epidemiology, clinical manifestations, clinical typing, treatment and nursing of children infected with SARS-CoV-2, and also makes recommendations for the diagnosis and treatment of high-risk factors and complications for the reference of front-line clinical pediatricians so as to achieve timely and reasonable diagnosis and treatment of children infected with SARS-CoV-2. Early identification and active treatment of high-risk and critically patients can minimize the harm caused by complications.

Research progress of multimodal medical image fusion methods / 中国辐射卫生

In the current clinical diagnosis, medical images have become an important basis for diagnosis, and different modes of medical images provide different tissue information and functional information. Single-mode images can only provide single diagnostic information, by which difficult and complicated diseases cannot be diagnosed, and comprehensive and accurate diagnostic results can be obtained only with the help of multiple diagnostic information. The multimodal fusion technology fuses multiple modes of medical images into single-mode images, and thus the single-mode images contain complementary information between multiple modes of images, so that sufficient information for clinical diagnosis can be obtained in a single image. In this paper, the multimodal medical image fusion methods are sorted into two types, namely the traditional fusion method and the fusion method based on deep learning.

Application of prediction models in clinical research / 上海预防医学

Chronic diseases have become an important public health problem for people under 70 years of age worldwide， while also causing a great economic burden. The establishment of clinical prediction models can help to predict the risk of a disease or the prognostic effect of a study subject in advance by means of index testing at the early stage of chronic diseases， and plays an increasingly important role in clinical practice. This study introduces clinical diagnostic prediction models and clinical prognostic prediction models， and reviews clinical data processing， clinical prediction model building， visualization methods and model evaluation from the perspective of the application of clinical prediction models， which contribute to the correct and reasonable use of prediction models in clinical research.

Medication Analysis of Traditional Chinese Medicine Diagnosis and Treatment Guidelines for Allergic Rhinitis Based on Clinical Efficacy Evaluation / 中国实验方剂学杂志

ObjectiveTo explore the role of efficacy evaluation methods in providing evidence for traditional Chinese medicine （TCM） clinical practice guidelines based on a demonstration study of clinical efficacy evaluation of TCM for allergic rhinitis （AR），aiming to enrich the sources of evidence for guideline development. MethodReal-world data of TCM medication for AR were collected and efficacy evaluation was carried out. SPSS 16.0 software was used to calculate the conformity of clinical syndromes，main prescriptions， and medications to the guidelines. Correlation analysis of efficacy and medications was performed according to guideline conformity to compare the differences in medications between real-world clinical applications and current guidelines. ResultA total of 198 cases were collected and the clinical medications were compared with the relevant guidelines for AR. It was found that the clinical syndrome conformity was above 70%，and in addition to the guideline syndrome，there were also syndromes in six meridians and other mixed syndromes in clinical practice. The guideline conformity of the main prescriptions used in clinical practice showed a positive correlation trend with efficacy. There were some differences between the commonly used drugs in clinical practice and those recommended by the guidelines. For example，for lung Qi deficiency and cold syndrome，drugs such as Angelicae Dahuricae Radix， Magnoliae Flos， and Schisandrae Chinensis Fructus were often used. For kidney Yang deficiency syndrome，drugs such as Atractylodis Macrocephalae Rhizoma and Ostreae Concha were often used. For spleen Qi deficiency and weakness syndrome，drugs such as Poria， Cinnamomi Ramulus， and Magnoliae Flos were used. For lung Qi deficiency and cold syndrome in children，drugs such as Chebulae Fructus， Cicadae Periostracum， Zingiberis Rhizoma， and Ginseng Radix et Rhizoma were used. For lung and spleen Qi deficiency syndrome，drugs such as Dioscoreae Rhizoma， Menthae Haplocalycis Herba， Amomi Fructus， and Zingiberis Rhizoma were used. There were also some differences in the commonly used drugs for adults and children. For example，for lung Qi deficiency and cold syndrome，adults often used Angelicae Dahuricae Radix， Magnoliae Flos， and Tribuli Fructus，while children often used Ginseng Radix et Rhizoma， Paeoniae Radix Alba， and Poria. For lung meridian hidden heat syndrome， adults often used Bupleuri Radix， Asari Radix et Rhizoma， Pinelliae Rhizoma， and Xanthii Fructus， while children often used Houttuyniae Herba， Menthae Haplocalycis Herba， Citri Reticulatae Pericarpium， and Massa Medicata Fermentata. ConclusionEffective medication regimens can be screened out based on efficacy evaluation methods，which can help supplement immediate， objective， and clinically relevant evidence of medication for the development of clinical practice guidelines in TCM from the perspective of clinical effectiveness.

Perception of medical students on the development of the clinical reasoning competence / Percepção sobre o desenvolvimento da competência "raciocínio clínico" por graduandos de curso de medicina

Abstract: Introduction: The way by which physicians process clinical reasoning is a relevant topic in the discussions on medical education because, in medical activity, the ultimate goal is to obtain the correct diagnosis and conduct. The challenge is to highlight which factors influence this performance. Objective: The objective of this study is to understand how the development of the clinical reasoning competence occurs according to the medical students' perception. Method: This research has a descriptive focus and employs a qualitative approach in the ordering of data, classification process, and final analysis of information from 36 semi-structured interviews with medical students, from July to September 2020, in Curitiba, Paraná, Brazil. Result: Thematic analysis was carried out, and the category 'perception of the factors that influence its achievement' emerged, with the 'methodological and curricular structure' subcategories perceived as the main influencing factors, through characteristics such as interdisciplinarity, early interaction with practical activities, stimulus to autonomy and teaching guidance. Participation in monitoring, academic leagues and extension projects were also considered, as well as the experience of the process of learning appropriation. Conclusion: The present study addresses the topic of clinical reasoning and brings as a contribution the analysis of the factors that influence its development, during undergraduate school, based on the students' viewpoint. Its results bring benefits to medical education, as they expand the understanding of the process of developing the clinical reasoning competence.

Resumo: Introdução: A forma como os médicos elaboram o raciocínio clínico é um tema relevante nas discussões sobre ensino médico pois, na atividade profissional, o objetivo final é obter diagnóstico e conduta corretos. O desafio está em evidenciar quais fatores influenciam no desempenho dessa competência. Objetivo: Esta pesquisa buscou compreender como o desenvolvimento da competência raciocínio clínico ocorre na percepção de estudantes de Medicina. Método: Com enfoque descritivo e abordagem qualitativa, procedeu-se a ordenação dos dados, classificação e análise final das informações oriundas de 36 entrevistas semiestruturadas com estudantes de graduação em Medicina, entre julho e setembro de 2020, em Curitiba, PR, Brasil. Resultado: Após análise temática, obteve-se a categoria percepção dos fatores que influenciam na aquisição do raciocínio clínico, com as subcategorias estrutura metodológica e curricular percebidos como os principais fatores influenciadores, através de características como interdisciplinaridade, interação precoce com atividades práticas, estímulo a autonomia e orientação docente. Participação em monitorias, ligas acadêmicas e projetos de extensão também foram valorizados, assim como a experiência do processo de apropriação desse aprendizado. Conclusão: A presente pesquisa aborda o tema raciocínio clínico e traz como contribuição a análise dos fatores influenciadores no seu desenvolvimento, durante a graduação, na visão dos estudantes. Seus resultados trazem benefícios para a educação médica, pois ampliam a compreensão do processo de desenvolvimento da competência raciocínio clínico.