Evolución clínica en pacientes con síndrome del túnel carpiano tratados con ultrasonido o infiltración con corticoesteroides / Clinical Evolution in Patients with Carpal Tunnel Syndrome Treated with Ultrasound or Corticosteroid Infiltration

Introducción. El Síndrome del túnel carpiano es la neuropatía periférica compresiva más común de la extremidad superior, que se produce por la compresión del nervio mediano. Los casos leves y moderados pueden tratarse con métodos conservadores como ultrasonido terapéutico o infiltración con corticoesteroides. Objetivo. Describir la evolución clínica de pacientes con síndrome de túnel carpiano tratados con terapia por ultrasonido e infiltración de corticoesteroides. Metodología. Ensayo clínico abierto, en pacientes con síndrome del túnel carpiano leve y moderado, que consultaron del 1 de octubre 2021 al 30 de mayo 2022. Se formaron dos grupos; el que recibió tratamiento con ultrasonido con 12 casos y el grupo tratado con infiltración con corticoesteroides con seis casos. Ambos grupos fueron intervenidos en la consulta inicial, y luego, en las cuatro y ocho semanas posteriores al inicio del tratamiento. Resultados. Se muestran los resultados descriptivos relacionados con la intensidad de dolor, valorada con la Escala Visual Numérica, la infiltración obtuvo dos casos sin dolor y cuatro con dolor moderado, contrario a ultrasonido que se mantuvo con cuatro casos leves, tres moderados y cinco intensos. En los síntomas, la infiltración redujo el número de casos en cuatro de los síntomas estudiados, en cambio el ultrasonido únicamente en dos. En severidad, valorada con el cuestionario de Boston para túnel carpal, con infiltración se obtuvieron dos casos asintomáticos y ninguno con ultrasonido. Respecto a los signos clínicos, el signo de Tinel desapareció en cuatro casos en ambos grupos, mientras que signo de Phalen desapareció en cuatro casos en ultrasonido y dos en infiltración. Conclusión. En intensidad de dolor y grado de severidad, la infiltración generó casos asintomáticos y redujo mayor cantidad de síntomas que el ultrasonido. Ambos tratamientos disminuyeron la presencia de signos clínicos

Introduction. Carpal tunnel syndrome is the most common compressive peripheral neuropathy of the upper extremity, which is caused by compression of the median nerve. Mild and moderate cases can be treated with conservative methods such as therapeutic ultrasound or corticosteroid infiltration. Objective. To describe the clinical evolution of patients with carpal tunnel syndrome treated with ultrasound therapy and corticosteroid infiltration. Methodology. A prospective open clinical trial was conducted in patients with mild and moderate carpal tunnel syndrome who consulted from October 1, 2021 to May 30, 2022. Two groups were formed: the group that received ultrasound treatment with 12 cases and the group treated with corticosteroid infiltration with six cases. Both groups were treated at the initial consultation and then at four and eight weeks after the start of treatment. Results. The descriptive results related to the intensity of pain, evaluated with the Visual Numeric Scale, are shown. Infiltration obtained two cases without pain and four with moderate pain, contrary to ultrasound which was maintained with four mild, three moderate and five intense cases. In symptoms, infiltration reduced the number of cases in four of the symptoms studied, while ultrasound reduced the number of cases in only two. In severity, assessed with the Boston carpal tunnel questionnaire, with infiltration, there were two asymptomatic cases and none with ultrasound. Regarding clinical signs, Tinel's sign disappeared in four cases in both groups, while Phalen's sign disappeared in four cases in ultrasound and two in infiltration. Conclusion. Infiltration produced asymptomatic patients and reduced more symptoms than ultrasonography in terms of pain intensity and severity. Clinical symptoms were less common with both treatments.

Hipoacusia en el síndrome de Vogt-Koyanagi-Harada: reporte de caso y revisión de la literatura / Hearing loss in Vogt-Koyanagi-Harada syndrome: case report and literature review

El síndrome de Vogt-Koyanagi-Harada (VKH) es una rara enfermedad granulomatosa multisistémica caracterizada por aparición de panuveítis grave bilateral y desprendimiento seroso de retina; puede acompañarse de un amplio espectro de síntomas extraoculares como los auditivos, y la afección más frecuente es la hipoacusia neurosensorial. Su etiología se reconoce como respuesta autoinmune mediada por células T contra antígenos de melanocitos presentes en coroides, meninges, cóclea y piel. Asimismo, factores genéticos del huésped se han identificado como predisponentes para su aparición, y es la presencia del alelo HLA-DR4, en particular el subtipo HLA-DRB1 0405, el más estudiado hasta la fecha. El tratamiento se basa en administración de corticosteroides sistémicos en dosis altas, sin embargo, es escasa la evidencia que evalúa específicamente la eficacia de estos medicamentos sobre sus manifestaciones audiovestibulares. Este artículo expone un caso de síndrome de VKH con compromiso auditivo concomitante y realiza una breve revisión narrativa de la literatura.

Vogt-Koyanagi-Harada syndrome (VKHS) is a rare multisystemic granulomatous disease, characterized by severe bilateral panuveitis and serous retinal detachment; it can be associated with a wide spectrum of extraocular symptoms, such as auditory symptoms, and the most common condition is sensorineural hearing loss. Its etio-logy is recognized as a T-cell-mediated autoimmune response against melanocyte antigens present in the choroid, meninges, cochlea, and skin. Likewise, host genetic factors have been identified as predisposing for its development, specifically the pre-sence of the HLA-DR4 allele, the HLA-DRB1 0405 subtype is the most studied up to date. Treatment is based on the administration of high doses of systemic corticos-teroids, however, there is not much evidence that specifically evaluates the efficacy of these medications on their audiovestibular manifestations. This article presents a clinical case of VKH syndrome with concomitant hearing impairment and carries out a short narrative review of the literature.

Research progress on mechanism of traumatic brain injury promoting fracture healing / 中国修复重建外科杂志

OBJECTIVE@#To summarize the research progress on the mechanism related to traumatic brain injury (TBI) to promote fracture healing, and to provide theoretical basis for clinical treatment of fracture non-union.@*METHODS@#The research literature on TBI to promote fracture healing at home and abroad was reviewed, the role of TBI in fracture healing was summarized from three aspects of nerves, body fluids, and immunity, to explore new ideas for the treatment of fracture non-union.@*RESULTS@#Numerous studies have shown that fracture healing is faster in patients with fracture combined with TBI than in patients with simple fracture. It is found that the expression of various cytokines and hormones in the body fluids of patients with fracture and TBI is significantly higher than that of patients with simple fracture, and the neurofactors released by the nervous system reaches the fracture site through the damaged blood-brain barrier, and the chemotaxis and aggregation of inflammatory cells and inflammatory factors at the fracture end of patients with combined TBI also differs significantly from those of patients with simple fracture. A complex network of humoral, neural, and immunomodulatory networks together promote regeneration of blood vessels at the fracture site, osteoblasts differentiation, and inhibition of osteoclasts activity.@*CONCLUSION@#TBI promotes fracture healing through a complex network of neural, humoral, and immunomodulatory, and can treat fracture non-union by intervening in the perifracture microenvironment.

Morpho-physiological and phytohormonal changes during the induction of adventitious root development stimulated by exogenous IBA application in Magnolia biondii Pamp / Alterações morfofisiológicas e fito-hormonais durante a indução do desenvolvimento radicular adventício estimulado pela aplicação exógena do AIB em Magnolia biondii Pamp

Magnolia biondii Pamp is an important ornamental tree species widely grown and used as a rootstock in the propagation of different Magnolia varieties. In the current studies, anatomical, physiological and endogenous hormones were studied to check the effect of IBA 750 mg/L on the adventitious rooting and to provide theoretical and technical support for the propagation of Magnolia biondii Pamp through stem cuttings. Two thousand stem cuttings were prepared and divided into two groups i.e., IBA treated cuttings and water control. For the evaluation of antioxidant enzyme activities, and endogenous hormones levels, samples were collected on the day of planting and each 5th day and further steps were carried out in the laboratory according to the protocols and proper precautions. For the anatomical observations, samples were collected on the 13th, 15th, and 17th day for IBA treated cuttings while 21st, 23rd, and 25th day for control. Collected samples were preserved in the FAA solution and further observations were carried out in the laboratory. Anatomical observations showed that it took 13 days for the differentiation of root primordia to the appearance of young adventitious roots in IBA treated cuttings, while it took 21 days to develop primordia in the control. Antioxidant enzyme activities involved in ROS were significantly higher in the IBA treated cuttings compared to control. POD showed a peak on the 13th day before the emergence of roots in IBA treated cuttings while it showed a peak on the 21st day in the control. PPO showed a peak on the 21st day in the IBA treated cuttings while it showed a peak on the 29th day in the control. SOD showed a peak on the 17th day in IBA treated cuttings, while it showed a peak on the 25th day in the control. Exogenous application of IBA enhanced the endogenous IAA and GA3 levels compared to CK, while it reduced the levels of ABA continuously at the time of rooting and then increased gradually. Inclusively, our study suggests that IBA 750 mg/L is efficient for the rooting of Magnolia biondii Pamp cuttings, as it enhanced the process of antioxidant enzyme activities, endogenous hormones levels and reduced the time of root formation which is evident from the anatomical observations.

Magnolia biondii Pamp é uma importante espécie de árvore ornamental muito cultivada e utilizada como porta-enxerto na propagação de diferentes variedades de Magnolia. Nos estudos atuais, hormônios anatômicos, fisiológicos e endógenos foram estudados para verificar o efeito do AIB na dose de 750 mg / L no enraizamento adventício e fornecer suporte teórico e técnico para a propagação de M. biondii Pamp por meio de estacas. Duas mil estacas foram preparadas e divididas em dois grupos, ou seja, tratadas com AIB e controle de água. Para a avaliação das atividades das enzimas antioxidantes e dos níveis de hormônios endógenos, as amostras foram coletadas no dia do plantio e a cada 5 dias, enquanto as demais etapas foram realizadas em laboratório de acordo com os protocolos e os devidos cuidados. Para as observações anatômicas, as amostras foram coletadas no 13º, 15º e 17º dias para estacas tratadas com AIB e no 21º, 23º e 25º dias para o controle. As amostras coletadas foram preservadas em solução FAA, e outras observações foram realizadas em laboratório. Observações anatômicas mostraram a necessidade de 13 dias para a diferenciação dos primórdios radiculares até o aparecimento de raízes adventícias jovens em estacas tratadas com AIB e de 21 dias para o desenvolvimento dos primórdios no controle. As atividades das enzimas antioxidantes envolvidas nas ROS foram significativamente maiores nas estacas tratadas com AIB em comparação com o controle. A POD apresentou pico no 13º dia antes da emergência das raízes nas estacas tratadas com AIB, enquanto no 21º dia apresentou pico no controle. A PPO teve pico no 21º dia nas estacas tratadas com AIB e no 29º dia no controle. A SOD apresentou pico no 17º dia nas estacas tratadas com AIB e no 25º dia no controle. A aplicação exógena de AIB aumentou os níveis endógenos de IAA e GA3 em relação ao controle, enquanto reduziu os níveis de ABA continuamente no momento do enraizamento e, em seguida, aumentou gradativamente. Inclusive, nosso estudo sugere que o AIB na dose de 750 mg / L é eficiente para o enraizamento de estacas de M. biondii Pamp, visto que potencializou o processo de atividades de enzimas antioxidantes e os níveis de hormônios endógenos, além de reduzir o tempo de formação de raízes, o que fica evidente nas observações anatômicas.

Morpho-physiological and phytohormonal changes during the induction of adventitious root development stimulated by exogenous IBA application in Magnolia biondii Pamp

Abstract Magnolia biondii Pamp is an important ornamental tree species widely grown and used as a rootstock in the propagation of different Magnolia varieties. In the current studies, anatomical, physiological and endogenous hormones were studied to check the effect of IBA 750 mg/L on the adventitious rooting and to provide theoretical and technical support for the propagation of Magnolia biondii Pamp through stem cuttings. Two thousand stem cuttings were prepared and divided into two groups i.e., IBA treated cuttings and water control. For the evaluation of antioxidant enzyme activities, and endogenous hormones levels, samples were collected on the day of planting and each 5th day and further steps were carried out in the laboratory according to the protocols and proper precautions. For the anatomical observations, samples were collected on the 13th, 15th, and 17th day for IBA treated cuttings while 21st, 23rd, and 25th day for control. Collected samples were preserved in the FAA solution and further observations were carried out in the laboratory. Anatomical observations showed that it took 13 days for the differentiation of root primordia to the appearance of young adventitious roots in IBA treated cuttings, while it took 21 days to develop primordia in the control. Antioxidant enzyme activities involved in ROS were significantly higher in the IBA treated cuttings compared to control. POD showed a peak on the 13th day before the emergence of roots in IBA treated cuttings while it showed a peak on the 21st day in the control. PPO showed a peak on the 21st day in the IBA treated cuttings while it showed a peak on the 29th day in the control. SOD showed a peak on the 17th day in IBA treated cuttings, while it showed a peak on the 25th day in the control. Exogenous application of IBA enhanced the endogenous IAA and GA3 levels compared to CK, while it reduced the levels of ABA continuously at the time of rooting and then increased gradually. Inclusively, our study suggests that IBA 750 mg/L is efficient for the rooting of Magnolia biondii Pamp cuttings, as it enhanced the process of antioxidant enzyme activities, endogenous hormones levels and reduced the time of root formation which is evident from the anatomical observations.

Resumo Magnolia biondii Pamp é uma importante espécie de árvore ornamental muito cultivada e utilizada como porta-enxerto na propagação de diferentes variedades de Magnolia. Nos estudos atuais, hormônios anatômicos, fisiológicos e endógenos foram estudados para verificar o efeito do AIB na dose de 750 mg / L no enraizamento adventício e fornecer suporte teórico e técnico para a propagação de M. biondii Pamp por meio de estacas. Duas mil estacas foram preparadas e divididas em dois grupos, ou seja, tratadas com AIB e controle de água. Para a avaliação das atividades das enzimas antioxidantes e dos níveis de hormônios endógenos, as amostras foram coletadas no dia do plantio e a cada 5 dias, enquanto as demais etapas foram realizadas em laboratório de acordo com os protocolos e os devidos cuidados. Para as observações anatômicas, as amostras foram coletadas no 13º, 15º e 17º dias para estacas tratadas com AIB e no 21º, 23º e 25º dias para o controle. As amostras coletadas foram preservadas em solução FAA, e outras observações foram realizadas em laboratório. Observações anatômicas mostraram a necessidade de 13 dias para a diferenciação dos primórdios radiculares até o aparecimento de raízes adventícias jovens em estacas tratadas com AIB e de 21 dias para o desenvolvimento dos primórdios no controle. As atividades das enzimas antioxidantes envolvidas nas ROS foram significativamente maiores nas estacas tratadas com AIB em comparação com o controle. A POD apresentou pico no 13º dia antes da emergência das raízes nas estacas tratadas com AIB, enquanto no 21º dia apresentou pico no controle. A PPO teve pico no 21º dia nas estacas tratadas com AIB e no 29º dia no controle. A SOD apresentou pico no 17º dia nas estacas tratadas com AIB e no 25º dia no controle. A aplicação exógena de AIB aumentou os níveis endógenos de IAA e GA3 em relação ao controle, enquanto reduziu os níveis de ABA continuamente no momento do enraizamento e, em seguida, aumentou gradativamente. Inclusive, nosso estudo sugere que o AIB na dose de 750 mg / L é eficiente para o enraizamento de estacas de M. biondii Pamp, visto que potencializou o processo de atividades de enzimas antioxidantes e os níveis de hormônios endógenos, além de reduzir o tempo de formação de raízes, o que fica evidente nas observações anatômicas.

Manejo del paciente con Hipertiroidismo en consulta externa de la Unidad Técnica de Endocrinología del Hospital Carlos Andrade Marín / Management of the patient with hyperthyroidism in the outpatient clinic of the Technical Unit of Endocrinology of the Endocrinology Technical Unit of the Carlos Andrade Marín Hospital

El hipertiroidismo es un trastorno caracterizado por el exceso de hormonas tiroideas. El déficit de yodo es un factor clave en dicha patología y en lugares con suficiencia del mismo se asocian a au-toinmunidad tiroidea. La prevalencia de hipertiroidismo mani-fiesto varía del 0,2% al 1,3% en áreas con suficiencia de yodo, sin embargo, esto puede variar en cada país por diferencias en umbrales de diagnóstico, sensibilidad de ensayo y población se-leccionada. Un reporte de The Third National Health and Nutri-tion Examination Survey (NHANES III) mostró que el hiperti-roidismo manifiesto se presenta en 0,7% de la población general e hipertiroidismo subclínico en el 1,7%1,2.En incidencia, la patología se asocia con la suplementación de yodo, con la mayor frecuencia en áreas de deficiencias, por au-mento de nódulos tiroideos en la población anciana, teniendo a regiones de áreas montañosas como América del Sur, África Central y suroeste de Asia dentro de este grupo. Un meta aná-lisis de estudios europeos mostró una incidencia general de 50 casos por 100000 personas/años1. En Ecuador, según los datos del Instituto Nacional de Estadísticas y Censos (INEC) del 2017, se reportaron 157 casos de hipertiroidismo, de los cuales la En-fermedad de Graves (EG) fue la causa más común, seguida por el bocio multinodular tóxico (BMNT) y finalmente el adenoma tóxico (AT) con una incidencia de 61 %, 24 % y 14 % respecti-vamente3.Los pacientes con esta patología tienen aumento de riesgo com-plicaciones cardiovasculares y mortalidad por todas las causas, siendo falla cardíaca uno de sus principales desenlaces, así el diagnóstico precoz evita estos eventos, principalmente en pobla-ción de edad avanzada.El presente protocolo se ha realizado para un correcto trata-miento de esta patología en el Hospital de Especialidades Carlos Andrade Marín (HECAM).

Hyperthyroidism is a disorder characterized by an excess of thyroid hormones. Iodine deficiency is a key factor in this pa-thology and in places with iodine deficiency it is associated with thyroid autoimmunity. The prevalence of overt hyperthyroidism varies from 0,2% to 1,3% in iodine-sufficient areas; however, this may vary from country to country due to differences in diag-nostic thresholds, assay sensitivity, and selected population. A report from The Third National Health and Nutrition Examina-tion Survey (NHANES III) showed that overt hyperthyroidism occurs in 0,7% of the general population and subclinical hyper-thyroidism in 1,7%1,2.In incidence, the pathology is associated with iodine supplemen-tation, with the highest frequency in areas of deficiencies, due to increased thyroid nodules in the elderly population, having regions of mountainous areas such as South America, Central Africa and Southwest Asia within this group. A meta-analysis of European studies showed an overall incidence of 50 cases per 100000 person/years1. In Ecuador, according to data from the National Institute of Statistics and Census (INEC) in 2017, 157 cases of hyperthyroidism were reported, of which, Graves' di-sease (GD) was the most common cause, followed by toxic mul-tinodular goiter (BMNT) and finally toxic adenoma (TA) with an incidence of 61 %, 24 % and 14 % respectively3.Patients with this pathology have an increased risk of cardiovas-cular complications and all-cause mortality, with heart failure being one of the main outcomes, so early diagnosis avoids these events, mainly in the elderly population.The present protocol has been carried out for the correct treat-ment of this pathology at the Carlos Andrade Marín Specialties Hospital (HECAM).

Consenso colombiano de Falla Intestinal Crónica en Síndrome de Intestino Corto / Colombian Consensus on Chronic Intestinal Failure in Short Bowel Syndrome

Introducción. Los términos falla intestinal crónica, síndrome de intestino corto (SIC) y nutrición parenteral total son muy frecuentes en la práctica clínica cotidiana.El objetivo de esta guía fue establecer un marco de referencia de práctica clínica basado en el mejor de nivel de evidencia en pacientes con falla intestinal crónica secundaria a síndrome de intestino corto. Métodos. Se estableció un grupo de expertos interdisciplinarios en el manejo de la falla intestinal crónica quienes, previa revisión de la literatura escogida, se reunieron de manera virtual acogiendo el método Delphi para discutir una serie de preguntas seleccionadas, enfocadas en el contexto terapéutico de la falla intestinal crónica asociada al síndrome de intestino corto. Resultados. La recomendación del grupo de expertos colombianos es que se aconseje a los pacientes con SIC consumir dietas regulares de alimentos integrales que genere hiperfagia para compensar la malabsorción. Las necesidades proteicas y energéticas dependen de las características individuales de cada paciente; la adecuación del régimen debe ser evaluada a través de pruebas clínicas, antropométricas y parámetros bioquímicos. Se sugiere, especialmente a corto plazo después de la resección intestinal, el uso de análogos de somatostatina para pacientes con yeyunostomía de alto gasto en quienes el manejo de líquidos y electrolitos es problemático. En pacientes con SIC, que son candidatos a tratamiento con enterohormonas, Teduglutida es la primera opción. Conclusión. Existen recomendaciones en el manejo integral de la rehabilitación intestinal respaldadas ampliamente por este consenso y es importante el reconocimiento de alternativas terapéuticos enmarcadas en el principio de buenas prácticas clínicas.

Introduction. The terms chronic intestinal failure, short bowel syndrome (SBS), and total parenteral nutrition are very common in daily clinical practice. The objective of this guideline was to establish a reference framework for clinical practice based on the best level of evidence in patients with chronic intestinal failure secondary to short bowel syndrome. Methods. A group of interdisciplinary experts in the management of chronic intestinal failure was established who, after reviewing the selected literature, met virtually using the Delphi method to discuss a series of selected questions, focused on the therapeutic context of chronic intestinal failure associated with short bowel syndrome. Results. The recommendation of the Colombian expert group is that patients with SBS be advised to consume regular diets of whole foods that generate hyperphagia to compensate malabsorption. Protein and energy needs depend on the individual characteristics of each patient; the adequacy of the regimen must be evaluated through clinical, anthropometric tests and biochemical parameters. The use of somatostatin analogue is suggested, especially in the short term after bowel resection, for patients with high-output jejunostomy in whom fluid and electrolyte management is problematic. In SBS, who are candidates for enterohormonal therapy, Teduglutide is the first choice. Conclusion. There are recommendations on the comprehensive management of intestinal rehabilitation that are widely supported by this consensus and it is important to recognize therapeutic alternatives framed in the principle of good clinical practice.

Dieta rica em fibra promove efeitos metabólicos, hormonais e de saciedade em mulheres obesas com restrição calórica de curto prazo / High-fiber diet promotes metabolic, hormonal, and satiety effects in obese women on a short-term caloric restriction

ABSTRACT Background: Several mechanisms, including excessive hunger, account for patients' difficulties in maintaining weight loss and dietary changes after caloric restriction. Objective: To evaluate the effect of short-term high-fiber calorie-restricted diet in appetite-regulating hormones, and hunger and satiety sensations in women with obesity. Methds: In a randomized controlled trial study, thirty women with body mass index (BMI) higher than 30 kg/m2, and aged from 20 to 50 years were hospitalized following a calorie-restricted diet (1000 kcal/day) for three days. The experimental group (n=15) received high-fiber diet and the control group (n=15), conventional diet. Body weight, BMI, resting energy expenditure (REE), acylated and total ghrelin, leptin, insulin and glucose, and hunger and satiety sensations were evaluated. Linear regression models with mixed effects (fixed and random effects) helped to assess the variables between the two groups and within the groups. Results: Body weight and BMI decreased in both the experimental and control groups (P<0.001). After the high-fiber diet, postprandial acylated ghrelin (P=0.04), glucose (P<0.001), insulin (P=0.04), and leptin (P=0.03) levels as well as the HOMA-IR index (P=0.01) decreased, whereas satiety improved (P=0.02). Obese women that followed the conventional diet had increased body fat percentage (P=0.04) and lower REE (P=0.02). The two diets did not differ in terms of hunger sensation. Conclusion: A short-term high-fiber diet improves satiety sensations and metabolic parameters while suppressing postprandial acylated ghrelin (60 minutes) and maintaining the resting energy expenditure.

RESUMO Contexto: Vários mecanismos, incluindo a fome excessiva, são responsáveis pelas dificuldades dos pacientes em manter a perda de peso e mudanças na dieta após a restrição calórica. Objetivo: Avaliar o efeito da dieta de curta duração rica em fibras e com restrição calórica nos hormônios reguladores do apetite e nas sensações de fome e saciedade em mulheres com obesidade. Métodos: Em um estudo randomizado controlado, 30 mulheres com índice de massa corporal (IMC) superior a 30 kg/m2 e com idade entre 20 e 50 anos foram hospitalizadas seguindo dieta com restrição calórica (1000 kcal/dia) por 3 dias. O grupo experimental (n=15) recebeu dieta rica em fibras e o grupo controle (n=15), dieta convencional. Foram avaliados peso corporal, IMC, gasto energético de repouso (GER), grelina acilada e total, leptina, insulina e glicose e sensações de fome e saciedade. Modelos de regressão linear com efeitos mistos (efeitos fixos e aleatórios) ajudaram a avaliar as variáveis entre os dois grupos e dentro dos grupos. Resultados: O peso corporal e o IMC diminuíram tanto no grupo experimental quanto no controle (P<0,001). Após a dieta rica em fibras, os níveis de grelina acilada pós-prandial (P=0,04), glicose (P<0,001), insulina (P=0,04) e leptina (P=0,03), bem como o índice HOMA-IR (P=0,01) diminuiu, enquanto a saciedade melhorou (P=0,02). Mulheres obesas que seguiram a dieta convencional apresentaram aumento do percentual de gordura corporal (P=0,04) e menor GER (P=0,02). As duas dietas não diferiram em termos de sensação de fome. Conclusão: Uma dieta rica em fibras de curto prazo melhora as sensações de saciedade e os parâmetros metabólicos, suprimindo a grelina acilada pós-prandial (60 minutos) e mantendo o gasto energético de repouso.

Experimental pain thresholds and psychosocial features across menstrual cycle in myofascial orofacial pain compared to healthy individuals: cross-sectional study / Limiares de dor experimental e características psicossociais ao longo do ciclo menstrual na dor miofascial orofacial em comparação com indivíduos saudáveis: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: The hormonal impact on pain perception during the menstrual cycle is a major focus of study, and further elucidation in temporomandibular disorders (TMD) field is necessary. Thus, this cross-sectional study evaluated experimental pain thresholds, psychosocial features, and clinical pain report on TMD women across menstrual cycle versus healthy controls. METHODS: A total of 220 women's clinical files were screened, with 80 selected and divided into control group (healthy individuals, n=40) and TMD group (myofascial pain, n=40). Regarding the menstrual cycle phases, the files were divided into Pre-Luteal and Luteal. The Perceived Stress Scale (PSS), Pain Catastrophizing Scale (PCS), Mechanical Pain Threshold (MPT), Wind-up (WUR), Pressure Pain Threshold (PPT), Conditioned Pain Modulation (CPM) and Visual Analogue Scale (VAS) were analyzed at a 5% significance level, by Two-Way ANOVA test and post hoc Tukey test. RESULTS: PSS and PCS were significantly different between TMD and control group (p<0.001), regardless of menstrual cycle. Healthy individuals in the Luteal phase presented higher MPT values compared to the other phases (p<0.001). PPT showed significant difference across menstrual phases (p=0.022), but no differences in multiple comparisons. VAS values showed no difference between menstrual cycle phases (p=0.376). CONCLUSION: Finally, healthy individuals in the Luteal phase have higher MPT and PPT values on the orofacial region. Pain report in patients with TMD showed no difference throughout the menstrual cycle, showing that small alterations on experimental pain thresholds may not be clinically relevant. The presence of chronic pain seems to be more related to psychosocial features than hormonal fluctuations.

RESUMO JUSTIFICATIVA E OBJETIVOS: O impacto do ciclo menstrual na percepção da dor é um foco importante de estudo, sendo necessária uma maior elucidação na disfunção temporomandibular (DTM). Assim, este estudo transversal avaliou limiares de dor experimental, características psicossociais e relatos de dor em mulheres com DTM ao longo do ciclo menstrual, comparadas com controles saudáveis. MÉTODOS: 220 prontuários de mulheres foram analisados, sendo 80 selecionados para os grupos de controle (saudáveis, n=40) e DTM (dor miofascial, n=40). Nas fases do ciclo menstrual, as pacientes foram divididas nas categorias Pré-Luteal e Luteal. Os instrumentos Escala de Estresse Percebido (PSS), Escala de Pensamentos Catastróficos (PCS), Limiar de Dor Mecânica (MPT), Wind-up Ratio (WUR), Limiar de Dor à Pressão (PPT), Modulação Condicionada da Dor (CPM) e Escala analógica visual (EAV) foram analisados com nível de significância de 5%, pelos testes ANOVA de dois fatores e Tukey post hoc. RESULTADOS: As escalas PSS e PCS foram significativamente diferentes entre os grupos DTM e controle (p<0,001), independentemente do ciclo menstrual. Indivíduos saudáveis na fase luteal apresentaram MPT maior em comparação com outras fases (p,0,001). O PPT mostrou diferença significativa entre as fases menstruais (p=0,022), sem diferença nas comparações múltiplas. Os valores da EAV não apresentaram diferença entre as fases menstruais (p=376). CONCLUSÃO: Indivíduos saudáveis na fase luteal têm MPT e PPTl maior na região orofacial. Os relatos de dor em pacientes com DTM não mostraram diferença ao longo do ciclo menstrual, indicando que pequenas alterações nos limiares experimentais podem ser clinicamente relevantes. A presença de dor crônica parece estar mais relacionada com características psicossociais do que com flutuações hormonais.

A cross-sectional study to assess hypothyroid status of pregnant women at 12–16 weeks of gestation

Background: Physiological changes occur during pregnancy. These changes include metabolic, hematologic, cardiovascular, renal, and respiratory changes. In some cases, these changes may alter and lead to complications which result in adverse pregnancy outcomes. In India, hypothyroidism in pregnancy has a prevalence of 4.8–11%. Aims and Objectives: The aim of this study was to estimate the prevalence of hypothyroidism in pregnant women at 12–16 weeks of gestation. Materials and Methods: A cross-sectional study was planned on pregnant women attending the ANC clinic of Outpatient Department of Obstetrics and Gynecology at K.L. E’S Dr Prabhakar Kore Hospital and Medical Research Center Belagavi. Serum thyroid stimulating hormone (TSH) was estimated in the study participants. Serum TSH levels >4.5 ?IU/ml were labeled as hypothyroid pregnant women. Results: In our study, the prevalence of hypothyroidism was observed to be 8.68%. Conclusion: Hence, we conclude that all pregnant women should be screened for hypothyroidism at earlier weeks of gestation.

Implicaciones cardiovasculares de la terapia hormonal cruzada en el proceso de feminización / Cardiovascular implications of cross hormone therapy in the feminization process / Implicações cardiovasculares da terapia de hormônios cruzados no processo de feminização

En la actualidad la identidad de género es una parte importante en la salud mental de un individuo. Por la creciente libre expresión de género, con un enfoque principal en las personas transgénero, cuyo término se refiere a una persona que se auto percibe con el sexo opuesto al que fue asignado al nacer. Entre los principales tratamientos para mejorar esta condición son: la psicoterapia para ayudar a lidiar con el estrés del rechazo social, la terapia hormonal para el proceso de feminización o masculinización y la cirugía. Objetivo. Determinar implicaciones cardiovasculares de la terapia hormonal cruzada en el proceso de feminización. Metodología. Se realizó una revisión bibliografía de literatura, en donde se evalúa el riesgo de enfermedad cardiovascular en publicaciones de estudios relevantes en el campo de la endocrinología publicados entre 2017 y 2022. Se utilizó la siguiente base de datos para la búsqueda de información, Scielo, Taylor & Francis, PubMed y ScienceDirect, Conclusión. Los efectos adversos de la terapia hormonal cruzada son de alto riesgo para el proceso de feminización afectado el sistema cardiovascular de forma irreversible. En ello influyen los tipos de fármacos, vía de administración, antecedentes de enfermedades cardiovasculares y ciertos hábitos, que afecta directamente con el desarrollo de trombosis venosa profunda, obesidad, hipertensión y diabetes mellitus. Por ello, hay muchas variables a considerar antes de iniciar un proceso de cambio, ya que este requiere de un equipo multidisciplinario y un seguimiento continuo para obtener los resultados esperados.

Today gender identity is an important part of an individual's mental health. Because of the increasing free expression of gender, with a main focus on transgender people, which term refers to a person who perceives themselves as having the opposite sex to the one they were assigned at birth. Among the main treatments to improve this condition are: psychotherapy to help deal with the stress of social rejection, hormone therapy for the process of feminization or masculinization, and surgery. Objective. To determine cardiovascular implications of cross-hormone therapy in the feminization process. Methodology. A literature review was performed, where the risk of cardiovascular disease is evaluated in publications of relevant studies in the field of endocrinology published between 2017 and 2022. The following database was used to search for information, Scielo, Taylor & Francis, PubMed and ScienceDirect, Conclusion. The adverse effects of cross-hormone therapy are of high risk for the feminization process affected the cardiovascular system irreversibly. This is influenced by the types of drugs, route of administration, history of cardiovascular disease and certain habits, which directly affect the development of deep vein thrombosis, obesity, hypertension and diabetes mellitus. Therefore, there are many variables to consider before initiating a process of change, since this requires a multidisciplinary team and continuous follow-up to obtain the expected results.

Hoje, a identidade de gênero é uma parte importante da saúde mental de um indivíduo. Devido à crescente liberdade de expressão de gênero, com foco principal nas pessoas transgêneros, este termo se refere a uma pessoa que se percebe como sendo do sexo oposto ao que lhe foi atribuído no nascimento. Entre os principais tratamentos para melhorar esta condição estão: psicoterapia para ajudar a lidar com o estresse da rejeição social, terapia hormonal para o processo de feminização ou masculinização, e cirurgia. Objetivo. Determinar as implicações cardiovasculares da terapia de hormônios cruzados no processo de feminização. Metodologia. Foi realizada uma revisão da literatura, avaliando o risco de doenças cardiovasculares em publicações de estudos relevantes no campo da endocrinologia publicadas entre 2017 e 2022. O seguinte banco de dados foi usado para buscar informações, Scielo, Taylor & Francis, PubMed e ScienceDirect, Conclusão. Os efeitos adversos da terapia com hormônios cruzados são de alto risco para o processo de feminização que afeta irreversivelmente o sistema cardiovascular. Isto é influenciado pelos tipos de drogas, via de administração, histórico de doenças cardiovasculares e certos hábitos, que afetam diretamente o desenvolvimento de trombose venosa profunda, obesidade, hipertensão e diabetes mellitus. Portanto, há muitas variáveis a serem consideradas antes de iniciar um processo de mudança, pois isto requer uma equipe multidisciplinar e um monitoramento contínuo para obter os resultados esperados.

Tipos de partos y niveles de oxitocina, cortisol y hormonas tiroideas en plasma del cordón umbilical / Types of deliveries and levels of oxytocin, cortisol and thyroid hormones in umbilical cord plasma

Introducción: La placenta sintetiza y secreta varias hormonas que permiten la regulación del embarazo, el trabajo de parto y la adaptación metabólica materno-fetal. Su comportamiento asociado al tipo de parto puede dar información relevante sobre efectos epigenéticos. Objetivo: Describir el tipo de parto con los niveles de oxitocina, cortisol y hormonas tiroideas en plasma de cordón umbilical al nacer. Método: A 50 mujeres con embarazos principalmente normales se les cuantificaron los niveles neurohormonales en plasma de cordón umbilical, obtenido inmediatamente tras el periodo expulsivo. Los resultados se incorporaron a la base de datos clínicos de cada participante y se analizaron con Stata v.14.0. El protocolo fue aprobado por el comité de ética. Resultados: Hubo 33 partos vaginales (12 espontáneos, 13 acelerados y 8 inducidos) y 17 cesáreas (7 electivas y 10 de urgencia). Se observaron mayores niveles de cortisol en los partos vaginales acelerados; las cesáreas tuvieron menores niveles de cortisol y hormona estimulante de la tiroides. Las intervenciones clínicas, con altos o bajos niveles hormonales, están en directa relación con el tipo de parto. Conclusiones: El cortisol y la hormona estimulante de la tiroides medidos en plasma de cordón umbilical variaron según el tipo de parto. Esto es una primera cuantificación de hormonas en plasma de cordón umbilical y su posible regulación placentaria a propósito del tipo de parto.

Introduction: The placenta synthesizes and secretes several hormones allowing the regulation of pregnancy, labor and maternal-fetal metabolic adaptation. Their behavior associated with the type of delivery, may provide relevant information on epigenetic effects. Objective: To describe the type of delivery with the levels of oxytocin, cortisol and thyroid hormones in umbilical cord plasma at birth. Method: Neurohormonal levels from umbilical cord plasma obtained immediately post expulsion, were quantified in 50 women with mainly normal pregnancies. Results incorporated into the clinical database of each participant, statistically analyzed in Stata v.14.0. Protocol approved by ethics committee. Results: 33 were vaginal deliveries (12 spontaneous, 13 accelerated, 8 induced) and 17 cesarean sections (7 elective and 10 emergency). Higher cortisol levels were observed in accelerated vaginal deliveries, cesarean sections had lower cortisol and thyroid stimulating hormone levels. While clinical interventions, with high or low hormone levels, were related to the type of delivery. Conclusions: Cortisol and thyroid stimulating hormone measured in umbilical cord plasma varied according to the type of delivery. This is a first quantification of hormones in umbilical cord plasma and their possible placental regulation in relation to the type of delivery.

Actualización del consenso chileno SOCHINEP-SER para el manejo de las sibilancias recurrentes del preescolar / Update of the chilean consensus SOCHINEP-SER for the management of recurrent wheezing in preschool children

Las sibilancias recurrentes del preescolar son un problema prevalente. 50% de todos los niños tiene al menos un episodio de sibilancias en los primeros 6 años. Sin embargo, solo 4 % de los menores de 4 años tiene diagnóstico de asma. Por este motivo es fundamental realizar una adecuada anamnesis y examen físico tendientes a descartar causas secundarias, lo que debe ser complementado con exámenes de laboratorio de acuerdo con la orientación clínica. En la actualidad se recomienda indicar tratamiento de mantención con corticoides inhalados en aquellos niños que tengan episodios repetidos de obstrucción bronquial y que tengan una alta probabilidad de respuesta favorable a esta terapia. Se ha demostrado que aquellos pacientes que tienen un recuento de eosinófilos en sangre > 300 células por mm3 o aquellos que presentan una prueba cutánea positiva o IgE específicas positivas para alérgenos inhalados, responderán adecuadamente al tratamiento con esteroides inhalados.

Recurrent wheezing in preschoolers has a high prevalence. 50% of all children have at least one wheezing episode in the first six years of life. However, only 4% of children under four years of age are diagnosed with asthma. Therefore, it is essential to carry out an adequate medical history and physical examination to rule out secondary causes, which must be complemented with laboratory tests in accordance with clinical guidance. It is recommended to indicate maintenance treatment with inhaled corticosteroids to those children who have repeated episodes of wheezing and who have a high probability of a good response to this therapy. It has been demonstrated that those patients who have blood eosinophil count > 300 cells per mm3 or those who have a positive skin test or positive specific IgE for inhaled allergens will have a good response to inhaled corticosteroids.

Particularidades del entrenamiento físico y el control de los factores de riesgo en la población trans y de género diverso / Particularities of physical training and control of risk factors in the transgender and gender-diverse population

Resumen La población trans y de género diverso (TGD) tiene una gran relevancia en relación con la práctica de ejercicio y deporte. Se destacan desafíos específicos, como la inactividad física motivada por razones internas y externas, incluida la discriminación en entornos deportivos. Existen aspectos psicológicos y efectos de la terapia hormonal que generan implicaciones para la dificultar participación en competiciones deportivas. También se menciona la disparidad en los factores de riesgo cardiovascular y se plantea la necesidad de políticas deportivas inclusivas basadas en evidencia científica. El artículo enfatiza la importancia de abordar los aspectos sociales, psicológicos y médicos para promover la salud física y mental de la población TGD, especialmente en el ámbito deportivo profesional.

Abstract The transgender and gender-diverse (TGD) population holds significant relevance concerning exercise and sports practices. Specific challenges are highlighted, such as physical inactivity driven by internal and external reasons, including discrimination in sports environments. Psychological aspects and hormonal therapy effects create implications for hindering participation in sports competitions. Disparities in cardiovascular risk factors are also mentioned, emphasizing the need for inclusive sports policies based on scientific evidence. The article underscores the importance of addressing social, psychological, and medical aspects to promote the physical and mental health of the TGD population, particularly in the professional sports area.

Arritmias en personas transgénero / Arrhythmias in transgender individuals

Resumen La necesidad de mejorar el acceso a servicios de salud para la comunidad transgénero se ha vuelto evidente, especialmente en relación con el riesgo cardiovascular, que es más alto en comparación con la población general. Los procedimientos quirúrgicos y las terapias hormonales son comunes en esta población para reafirmar la identidad de género, pero plantean desafíos, ya que se asocian con alteraciones en el metabolismo de lípidos, la concentración de grasa corporal y la resistencia a la insulina. Además, existe un aumento en el riesgo de eventos cardiovasculares adversos, como tromboembolia venosa, accidente cerebrovascular e infarto de miocardio. La influencia de las hormonas sexuales en las propiedades electrofisiológicas del corazón ha sido estudiada, destacando diferencias entre géneros que pueden predisponer a la población transgénero a arritmias cardiacas. La terapia hormonal exógena, tanto para mujeres como para hombres trans, puede afectar el intervalo QT y aumentar el riesgo de arritmias, incluida la fibrilación auricular. Aunque la incidencia de arritmias en la población transgénero aún no está completamente clara, la evidencia sugiere la necesidad de un monitoreo cardiovascular cuidadoso y la consideración de factores de riesgo antes de iniciar terapias hormonales.

Abstract The need to improve access to health services for the transgender community has become evident, especially concerning cardiovascular risk, which is higher compared to the general population. Surgical procedures and hormone therapies are common in this population to affirm gender identity, but they pose challenges as they are associated with disruptions in lipid metabolism, body fat concentration, and insulin resistance. Additionally, there is an increased risk of adverse cardiovascular events such as venous thromboembolism, stroke, and myocardial infarction. The influence of sex hormones on the electrophysiological properties of the heart has been studied, highlighting gender differences that may predispose the transgender population to cardiac arrhythmias. Exogenous hormone therapy, for both transgender women and men, can affect the QT interval and increase the risk of arrhythmias, including atrial fibrillation. Although the incidence of arrhythmias in the transgender population is not entirely clear, evidence suggests the need for careful cardiovascular monitoring and consideration of risk factors before initiating hormone therapies.

"Mulher, você não precisa disso": discursos em embate sobre a pílula e a supressão da menstruação / "Woman, you don't need this": Negotiation of discourses on the pill and menstrual suppression / "Mujer, no necesitas esto": Discursos en conflicto sobre la píldora y la supresión de la menstruación

Resumo O discurso médico do século XIX listava uma série de desordens físicas e mentais associadas aos órgãos reprodutivos das mulheres (Rohden, 2009). Um fenômeno corporal até hoje frequentemente construído como patológico é a menstruação (Vieira, 2002), para o qual existe uma ferramenta médica de intervenção amplamente empregada: a pílula anticoncepcional. Como o período menstrual é muitas vezes visto como um problema, sua interrupção por meio da ingestão contínua da pílula é recorrentemente propagada como a solução (Kissling, 2013). À luz dessas ideias, analiso como duas mulheres autoidentificadas como feministas negociam significados sobre a pílula, a menstruação e a supressão menstrual em entrevistas orais semiestruturadas. O objetivo do trabalho é investigar como sentidos biomédicos sobre o corpo feminino são discursivamente reificados, desafiados e corporificados.

Abstract Nineteenth century's medical discourse listed a series of physical and mental disorders caused by women's reproductive organs (Rohden, 2009). A bodily function that until nowadays has been frequently constructed as pathological is menstruation (Vieira, 2002), for which there is a widely employed medical tool of intervention: the contraceptive pill. As the period is often seen as a problem, its suppression through the uninterrupted use of the pill is recurrently advertised as the solution (Kissling, 2013). In light of these ideas, I analyse how two self-identified feminist women negotiate meanings around the pill, menstruation and menstrual suppression in semi-structured oral interviews. The purpose of the work is to investigate how biomedical meanings of the female body are discursively reified, challenged and embodied.

Resumen El discurso médico del siglo XIX enumeraba una serie de trastornos físicos y mentales asociados a los órganos reproductivos de la mujer (Rohden, 2009). Un fenómeno corporal que con frecuencia se interpreta como patológico es la menstruación (Vieira, 2002), para la cual existe una herramienta médica intervencionista ampliamente utilizada: la píldora anticonceptiva. Como el período menstrual a menudo se ve como un problema, su interrupción a través de la toma continua de la píldora se propaga recurrentemente como la solución (Kissling, 2013). A la luz de estas ideas, analizo cómo dos mujeres autoidentificadas como feministas negocian significados sobre la píldora, la menstruación y la supresión menstrual en entrevistas orales semiestructuradas. El objetivo de este trabajo es investigar cómo los significados biomédicos sobre el cuerpo femenino son materializados, cuestionados y encarnados discursivamente.

Valores de referencia para la tirotropina y hormonas tiroideas en embarazadas cubanas / Reference values for thyrotropin and thyroid hormones in pregnant women in Cuba

Introducción: Los parámetros de función tiroidea en las embarazadas se modifican durante el embarazo y son específicos para cada población. Objetivo: Establecer los valores de referencia para la tirotropina y las hormonas tiroideas en una población de embarazadas cubanas. Métodos: Estudio transversal, en el municipio Plaza de la Revolución de La Habana, Cuba, a 362 gestantes sin antecedentes personales o familiares de enfermedad tiroidea, con anticuerpos anti-tiroideos negativos y ausencia de lesiones en el ultrasonido tiroideo. Se analizaron edad materna, edad gestacional, raza, hábito de fumar, paridad, uso de suplementos yodados, índice de masa corporal, tirotropina, tiroxina total y libre, triyodotironina total y libre. Se establecieron los intervalos de referencia para cada parámetro mediante los percentiles 2,5 y 97,5 como límites inferior y superior, respectivamente. Resultados: Los valores de referencia en el primer, segundo y tercer trimestres fueron para la tirotropina 0,1-3,3 mUI/L, 0,6-3,4 mUI/L y 0,3-3,9 mUI/L; para la TT4 90,1-204,1 nmol/L, 92,2-189,2 nmol/L y 79,8-170,4 nmol/L; para la FT4 7,3-16,7 pmol/L, 6,3-17,3 pmol y 5,6-12,7 pmol/L; para la TT3 1,8-3,9 nmol/L, 1,8-3,9 nmol/L y 1,7-4,0 nmol/L y para la FT3 1,0-7,4 pmol/L, 0,7-6,3 pmol/L y 0,7-5,4 pmol/L, respectivamente. Conclusiones: Se determinaron por primera vez los valores de referencia para la tirotropina y las hormonas tiroideas en una población de embarazadas cubanas; estos difieren de los establecidos por los kits diagnósticos y de los recomendados por las guías internacionales previas (AU)

Introduction: Thyroid function parameters in pregnant women are modified during pregnancy and are specific for each population. Objective: To establish reference values for thyrotropin and thyroid hormones in a population of Cuban pregnant women. Methods: Cross-sectional study, in the Plaza de la Revolución municipality, of 362 pregnant women without personal or family history of thyroid disease, with negative anti-thyroid antibodies and absence of lesions in the thyroid ultrasound. Maternal age, gestational age, race, smoking, number of pregnancies, use of iodine supplements, body mass index, thyrotropin, total (TT4) and free (FT4) thyroxine, total (TT3) and free (FT3) triiodothyronine were analyzed. Reference intervals were established for each parameter using the 2.5 and 97.5 percentiles as lower and upper limits, respectively. Results: The reference values in the first, second and third trimesters were for thyrotropin 0.1-3.3 mIUI/L, 0.6-3.4 mIU/L and 0.3-3.9 mIU/L; for TT4 90.1-204.1 nmol/L, 92.2-189.2 nmol/L and 79.8-170.4 nmol/L; for FT4 7.3-16.7 pmol/L, 6.3-17.3 pmol and 5.6-12.7 pmol/L; for TT3 1.8-3.9 nmol/L, 1.8-3.9 nmol/L and 1.7-4.0 nmol/L and for FT3 1.0-7.4 pmol/L, 0.7-6.3 pmol/L and 0.7-5.4 pmol/L, respectively. Conclusions: Reference values for thyrotropin and thyroid hormones were determined for the first time in a population of Cuban pregnant women. These values differ from those established by the manufacturer of the diagnostic kits and from those recommended by previous international guidelines (AU)

The Role of Thyroid Hormones, Vitamins, and Microelements in Female Infertility / O papel dos hormônios da tiroide, das vitaminas e dos microelementos na fertilidade feminina

Abstract Objective It is well known that female infertility is multifactorial. Therefore, we aimed to compare the effects of thyroid dysfunction, vitamin deficiency, and microelement deficiency in fertile and infertile patients. Materials and Methods Between May 1st, 2017, and April 1st, 2019, we conducted a retrospective case-control study with of 380 infertile and 346 pregnant patients (who normally fertile and able to conceive spontaneously). The fertile patients were selected among those who got pregnant spontaneously without treatment, had a term birth, and did not have systemic or obstetric diseases. The levels of thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), anti-thyroid peroxidase (anti-TPO), vitamin D, vitamin B12, folic acid, ferritin, and zinc of both groups were compared. Results There was no difference between patients in the infertile and pregnant groups in terms of low normal and high serum T3 and T4 levels (p = 0.938; p > 0.05) respectively, nor in terms of normal and high anti-TPO levels (p = 0.182; p > 0.05) respectively. There was no significant difference regarding patients with low, insufficient, and sufficient vitamin D levels in the infertile and pregnant groups (p = 0.160; p >0.05) respectively. The levels of folic acid, ferritin, and zinc of the infertile group were significantly lower than those of the pregnant group. Conclusion The serum levels of folic acid, ferritin, and zinc in infertile patients presenting to our outpatient clinic were lower than those o the fertile patients.

Resumo Objetivo Sabe-se que a infertilidade feminina é multifatorial. Portanto, nosso objetivo foi comparar os efeitos da disfunção tireoidiana, deficiência de vitaminas e deficiência de microelementos em pacientes férteis e inférteis. Materiais e Métodos Entre 1° de maio de 2017 e 1° de abril de 2019, realizamos um estudo retrospectivo caso-controle com 380 pacientes inférteis e 346 grávidas (normalmente férteis e capazes de conceber espontaneamente). As pacientes férteis foram selecionadas entre aquelas que engravidaram espontaneamente sem tratamento, tiveram parto a termo e não apresentavam doenças sistêmicas ou obstétricas. Os níveis de hormônio estimulante da tireoide (TSH), triiodotironina (T3), tiroxina (T4), antitireoide peroxidase (anti-TPO), vitamina D, vitamina B12, ácido fólico, ferritina e zinco de ambos os grupos foram comparados. Resultados Não houve diferença entre as pacientes dos grupos inférteis e gestantes em relação aos níveis altos de sérumT3 e T4 normais baixos e altos (p = 0,938; p > 0,05), respectivamente nem aos níveis normais e altos de anti-TPO (p = 0,182; p > 0,05), respectivamente. Não houve diferença significativa em relação aos pacientes com níveis baixos, insuficientes e suficientes de vitamina D nos grupos inférteis e gestantes (p = 0,160; p > 0,05), respectivamente. Os níveis de ácido fólico, ferritina e zinco do grupo infértil foram significativamente menores do que os do grupo grávida. Conclusão Os níveis de sérum de ácido fólico, ferritina e zinco nas pacientes inférteis atendidas em nosso ambulatório foram menores do que nas pacientes férteis.

Actualización del consenso chileno SOCHINEP-SER para el manejo de las sibilancias recurrentes del preescolar / Update of the chilean consensus SOCHINEP-SER for the management of recurrent wheezing in preschool children

Las sibilancias recurrentes del preescolar son un problema prevalente. 50% de todos los niños tiene al menos un episodio de sibilancias en los primeros 6 años. Sin embargo, solo 4% de los menores de 4 años tiene diagnóstico de asma. Por este motivo es fundamental realizar una adecuada anamnesis y examen físico tendientes a descartar causas secundarias, lo que debe ser complementado con exámenes de laboratorio de acuerdo con la orientación clínica. En la actualidad se recomienda indicar tratamiento de mantención con corticoides inhalados en aquellos niños que tengan episodios repetidos de obstrucción bronquial y que tengan una alta probabilidad de respuesta favorable a esta terapia. Se ha demostrado que aquellos pacientes que tienen un recuento de eosinófilos en sangre > 300 células por mm3 o aquellos que presentan una prueba cutánea positiva o IgE específicas positivas para alergenos inhalados responderán adecuadamente al tratamiento con esteroides inhalados.

Recurrent wheezing in preschoolers has a high prevalence. 50% of all children have at least one wheezing episode in the first six years of life. However, only 4% of children under four years of age are diagnosed with asthma. Therefore it is essential to carry out an adequate medical history and physical examination to rule out secondary causes, which must be complemented with laboratory tests in accordance with clinical guidance. It is recommended to indicate maintenance treatment with inhaled corticosteroids to those children who have repeated episodes of wheezing and who have a high probability of a good response to this therapy. It has been demonstrated that those patients who have blood eosinophil count > 300 cells per mm3 or those who have a positive skin test or positive specific IgE for inhaled allergens will have a good response to inhaled corticosteroids.

Effects on the sex hormone profile in obese patients undergoing bariatric surgery / Efectos en el perfil hormonal sexual en pacientes obesos sometidos a cirugía bariátrica

We aimed to carry out a systematic review and meta-analysis of the effects of bariatric surgery on fertility in men with obesity. To assess the methodological quality of the included studies, the Cochrane-ROBINS-I tool for non-randomized studies was used. Three hundred and eighty-four articles were found. A statistically significant improvement in total testosterone levels was evidenced in all the patients; some studies did not find a correlation between this increase and the improvement in seminal parameters. Only one article showed a slight increase in estradiol levels (not statistically significant, 33.3-32 pg/mL, p: 0.68). Normal or low levels of LH and FSH were present both before and after the procedure. The total sperm count decreased at 6 months and was significantly lower at 12 months. There was not evidence of changes in seminal volume, sperm motility, and vitality. Although our systematic review shows changes on sexual hormonal parameters in men, with an increase in total testosterone levels, a negative one was also found on semen quality. More prospective and randomized studies are required, hopefully of the Latin American population, which can help confirm this association

Nuestro objetivo fue realizar una revisión sistemática y un metaanálisis de los efectos de la cirugía bariátrica sobre la fertilidad en hombres con obesidad. Para evaluar la calidad metodológica de los estudios incluidos, se utilizó la herramienta Cochrane-ROBINS-I para estudios no aleatorios. Se encontraron 384 artículos. Se evidenció una mejoría estadísticamente significativa en los niveles de testosterona total en todos los pacientes; algunos estudios no encontraron una correlación entre este aumento y cambios en los parámetros seminales. Solo un artículo mostró un ligero aumento en los niveles de estradiol (no estadísticamente significativo, 33,3 a 32 pg/ml, p: 0,68). Los niveles normales o bajos de LH y FSH estaban presentes tanto antes como después del procedimiento. El recuento total de espermatozoides disminuyó a los 6 meses y fue significativamente menor a los 12 meses. No hubo evidencia de cambios en el volumen seminal, la motilidad y la vitalidad de los espermatozoides. Aunque nuestra revisión sistemática muestra cambios sobre los parámetros hormonales sexuales en hombres, con un aumento de los niveles de testosterona total, también se encontró uno negativo sobre la calidad seminal. Se requieren más estudios prospectivos aleatorizados, ojalá en población latinoamericana, que ayuden a confirmar esta asociación.