Keratitis in patients with corneal foreign bodies: a cross-sectional study in Cali, Colombia / Ceratite em pacientes com corpos estranhos na córnea: um estudo transversal em Cali, Colômbia

ABSTRACT Purposes: To describe the clinical characteristics and factors associated with keratitis in patients with corneal foreign bodies in Colombia. Methods: This cross-sectional study was based on a clinical records review of patients who had corneal foreign bodies and were admitted to the emergency department between June 2018 and June 2019 in Cali, Colombia. The primary outcome was the presence of keratitis diagnosed based on clinical criteria. Univariate and multivariate logistic regression models were used to identify associated factors. Results: A total of 381 corneal foreign bodies in 372 patients were analyzed (median age, 40.0; interquartile range, 29.0-53.0 years; male, 94.7% (n=352). Ninety-five patients developed keratitis (24.9%, 95% confidence interval [CI] 20.8%-29.5%). In the multivariate analysis, age 30 years (odds ratio [OR] 2.15, 95% CI 1.06-4.36), finding of aqueous flare (OR 2.81, 95% CI 1.39-5.66]), and a foreign body in the peripheral cornea (OR 2.05, 95% CI 1.19-3.50] were associated with an increased risk for keratitis. Sex, time between injury and admission, and corneal edema were not related to keratitis (p>0.05). Conclusion: In Cali, Colombia, a high proportion of keratitis was reported in patients with corneal foreign body. Age, an aqueous flare, and a foreign body in the peripheral cornea were the factors associated with keratitis.

RESUMO Objetivo: Descrever as características clínicas e os fatores associados à presença de ceratite em pacientes com corpos estranhos na córnea em uma população colombiana. Métodos: Trata-se de um estudo transversal baseado na revisão dos registros clínicos de pacientes com corpos estranhos na córnea admitidos em um departamento de emergência em Cali, Colômbia, entre junho de 2018 e junho de 2019. O desfecho primário foi a presença de ceratite diagnosticada através de critérios clínicos. Foram utilizados modelos de regressão logística univariada e multivariada para identificar os fatores associados. Resultado: Neste estudo, foi analisado um total de 381 corpos estranhos na córnea em 372 pacientes (idade média: 40,0 anos, intervalo interquartil: 29,0-53,0; sexo masculino: 94,7% [352 casos]). Noventa e cinco casos desenvolveram ceratite (24,9%, intervalo de confiança de 95% — IC 95%: 20,8%-29,5%). Na análise multivariada, para idade ≤30 anos (razão de chances — RC: 2,15, IC 95%: 1,06-4,36), o achado de flare aquoso (RC: 2,81, IC 95%: 1,39-5,66]) e a presença de corpo estranho na periferia da córnea (RC: 2,05, IC 95%: 1,19-3,50) foram associados a um risco aumentado de ceratite. Sexo, tempo entre a lesão e a internação, e edema da córnea não foram relacionados à ceratite (p>0,05). Conclusão: Há uma proporção elevada de ceratite em casos de corpos estranhos na córnea em Cali, Colômbia. Os três fatores associados à ceratite foram a idade, o achado de flare aquoso e a presença de corpo estranho na periferia da córnea.

Alterações oculares decorrentes de picada de abelha na córnea / Ocular changes due to corneal bee sting

RESUMO O propósito deste estudo foi reportar as alterações oculares observadas após picada de abelha com ferrão retido na córnea. Destacamos o tratamento e o desfecho de uma lesão de córnea incomum e sua patogênese. Trata-se de relato de caso e revisão da literatura de lesões oculares por picada de abelha. Paciente do sexo feminino, 63 anos, procurou atendimento oftalmológico de urgência devido à picada de abelha na córnea do olho direito há 6 dias. Queixava-se de embaçamento visual, dor e hiperemia ocular. Apresentou acuidade visual de vultos no olho afetado. Ao exame, notaram-se hiperemia moderada de conjuntiva bulbar, edema corneano com dobras de Descemet e presença do ferrão alojado na região temporal, no estroma profundo da córnea. A paciente foi internada para ser abordada no centro cirúrgico sob anestesia geral. Durante a cirurgia, o ferrão teve que ser retirado via câmara anterior, mediante a realização de uma paracentese e uma lavagem da câmara anterior, com dupla via e solução salina balanceada. Ainda não existe na literatura um tratamento padrão na abordagem de pacientes com lesões oculares por picada de abelha, sendo importantes a identificação e o reconhecimento precoce de possíveis complicações que ameacem a visão.

ABSTRACT The purpose of this study was to report the ocular changes observed after a bee sting with a stinger retained in the cornea. We show the treatment and outcome of an unusual corneal injury and its pathogenesis. This is a case report and literature review of ocular injuries caused by bee stings. A 63-year-old female patient sought emergency ophthalmic care because of a bee sting on the cornea of her right eye six days before. She complained of blurred vision, pain, and ocular hyperemia. She had glare sensitivity on visual acuity in the affected eye. Examination revealed moderate hyperemia of the bulbar conjunctiva, corneal edema with Descemet's folds and a stinger lodged in the temporal region, in the deep stroma of the cornea. The patient was admitted to the operating room under general anesthesia. During surgery, the stinger had to be removed via the anterior chamber, by performing a paracentesis and washing the anterior chamber with a double flushing and balanced saline solution. There is still no standard treatment in the literature for patients with eye injuries caused by bee stings, and early identification and recognition of possible sight-threatening complications is important.

Distribution and diversity of aquatic insects in different water bodies of Qatar / Distribuição e diversidade de insetos aquáticos em diferentes corpos de água do Catar

Aquatic insect fauna remains an important tool for bio indication of environmental disturbance, while maintaining a healthy aquatic system. The purpose of the study was to document and to identify the diversity and distribution patterns of aquatic insect, a highly ignored aspect from the Qatar. Following the standard procedures, the samples were collected from aquatic habitats during the period October 2015 to May 2017 on monthly basis. A total of 11,287 individuals, belonging to 6 orders were captured. Dipterans were the abundant with the percentages of 71.01 (n=8,015), while the lowest percentage was observed for Coleoptera 0.04 (n=05). Twelve insects families were identified, among these five were reported under Diptera, followed by Hemiptera (03), while Coleoptera, Tricoptera, Odonata, and Ephemeroptera were represented by single families. Among the selected localities, Dipterans were collected from 10 stations, followed by Hemiptera (9), Coleoptera (4), Odonota (4), Ephemeroptera (3) and Trichoptera (1) respectively. Among the water bodies samples, streams were the most preferred habitats (n=2,767), while drinking water pools were the least (27). Moreover, the highest Simpson diversity index of 1.48 and lowest of 0.47 was recorded for flooded sewage pool and plastic containers respectively, while the low evenness values were observed for ponds, and less than 1 Margalef's diversity values were seen for all habitats. This study documents the patterns of the diversity and distribution of aquatic insects, and provides a baseline for the future studies from Qatar.

A fauna aquática de insetos continua sendo uma ferramenta importante para a bioindicação de distúrbios ambientais, ao mesmo tempo em que mantém um sistema aquático saudável. O objetivo do estudo foi documentar e identificar a diversidade e os padrões de distribuição dos insetos aquáticos, um aspecto altamente ignorado no Catar. Seguindo os procedimentos padrão, as amostras foram coletadas em hábitats aquáticos durante o período de outubro de 2015 a maio de 2017, mensalmente. Um total de 11.287 indivíduos, pertencentes a seis ordens, foram capturados. Dípteros foram os mais abundantes, com as porcentagens de 71,01 (n = 8.015), enquanto a menor porcentagem foi observada para Coleópteros 0,04 (n = 05). Doze famílias de insetos foram identificadas, destas, cinco foram registradas sob Diptera, seguido por Hemiptera (03), enquanto Coleoptera, Tricoptera, Odonata e Ephemeroptera foram representados por famílias únicas. Dentre as localidades selecionadas, Dipterans foram coletados em 10 estações, seguidos por Hemiptera (9), Coleoptera (4), Odonota (4), Ephemeroptera (3) e Trichoptera (1), respectivamente. Entre as amostras de corpos d'água, os riachos foram os hábitats mais preferidos (n = 2.767), enquanto as piscinas de água potável foram os menos (27). Além disso, o maior índice de diversidade de Simpson de 1,48 e o menor de 0,47 foi registrado para piscina de esgoto inundada e recipientes de plástico, respectivamente, enquanto os valores de baixa uniformidade foram observados para lagoas e menos de 1 valores de diversidade de Margalef foram observados para todos os hábitats. Este estudo documenta os padrões de diversidade e distribuição de insetos aquáticos e fornece uma linha de base para os estudos futuros do Catar.

Distribution and diversity of aquatic insects in different water bodies of Qatar

Abstract Aquatic insect fauna remains an important tool for bio indication of environmental disturbance, while maintaining a healthy aquatic system. The purpose of the study was to document and to identify the diversity and distribution patterns of aquatic insect, a highly ignored aspect from the Qatar. Following the standard procedures, the samples were collected from aquatic habitats during the period October 2015 to May 2017 on monthly basis. A total of 11,287 individuals, belonging to 6 orders were captured. Dipterans were the abundant with the percentages of 71.01 (n=8,015), while the lowest percentage was observed for Coleoptera 0.04 (n=05). Twelve insects families were identified, among these five were reported under Diptera, followed by Hemiptera (03), while Coleoptera, Tricoptera, Odonata, and Ephemeroptera were represented by single families. Among the selected localities, Dipterans were collected from 10 stations, followed by Hemiptera (9), Coleoptera (4), Odonota (4), Ephemeroptera (3) and Trichoptera (1) respectively. Among the water bodies samples, streams were the most preferred habitats (n=2,767), while drinking water pools were the least (27). Moreover, the highest Simpson diversity index of 1.48 and lowest of 0.47 was recorded for flooded sewage pool and plastic containers respectively, while the low evenness values were observed for ponds, and less than 1 Margalefs diversity values were seen for all habitats. This study documents the patterns of the diversity and distribution of aquatic insects, and provides a baseline for the future studies from Qatar.

Resumo A fauna aquática de insetos continua sendo uma ferramenta importante para a bioindicação de distúrbios ambientais, ao mesmo tempo em que mantém um sistema aquático saudável. O objetivo do estudo foi documentar e identificar a diversidade e os padrões de distribuição dos insetos aquáticos, um aspecto altamente ignorado no Catar. Seguindo os procedimentos padrão, as amostras foram coletadas em hábitats aquáticos durante o período de outubro de 2015 a maio de 2017, mensalmente. Um total de 11.287 indivíduos, pertencentes a seis ordens, foram capturados. Dípteros foram os mais abundantes, com as porcentagens de 71,01 (n = 8.015), enquanto a menor porcentagem foi observada para Coleópteros 0,04 (n = 05). Doze famílias de insetos foram identificadas, destas, cinco foram registradas sob Diptera, seguido por Hemiptera (03), enquanto Coleoptera, Tricoptera, Odonata e Ephemeroptera foram representados por famílias únicas. Dentre as localidades selecionadas, Dipterans foram coletados em 10 estações, seguidos por Hemiptera (9), Coleoptera (4), Odonota (4), Ephemeroptera (3) e Trichoptera (1), respectivamente. Entre as amostras de corpos d'água, os riachos foram os hábitats mais preferidos (n = 2.767), enquanto as piscinas de água potável foram os menos (27). Além disso, o maior índice de diversidade de Simpson de 1,48 e o menor de 0,47 foi registrado para piscina de esgoto inundada e recipientes de plástico, respectivamente, enquanto os valores de baixa uniformidade foram observados para lagoas e menos de 1 valores de diversidade de Margalef foram observados para todos os hábitats. Este estudo documenta os padrões de diversidade e distribuição de insetos aquáticos e fornece uma linha de base para os estudos futuros do Catar.

Gastrointestinal Foreign Bodies: 14 Years of Experience in a University Clinic

Introduction: Ingesting foreign bodies is a common medical problem, especially in the emergency department. Some small studies describe experiences in this regard. Materials and methods: A descriptive retrospective study included patients with suspected ingestion of foreign bodies admitted to the gastroenterology and GI endoscopy service of the Clínica Universitaria Colombia between January 2007 and August 2020. Results: The age of occurrence of the event was 18 to 95 years, and the average age was 45 years. The foreign bodies ingested and found were variable. The most frequent was fish bones, representing 64.11% of the cases, followed by chicken bones and dietary impaction. Thirty-eight percent of patients required foreign body removal; the most frequently used tool was the foreign body forceps. The primary location was the esophagus in 12.53% of cases, followed by the cricopharynx in 11.18% and the hypopharynx in 10%. Conclusions: The Clínica Universitaria Colombia is a referral site for many gastroenterology emergencies due to its high technological level and extensive human resources. This paper probably describes the largest number of patients with this reason for consultation, which is why this retrospective descriptive study was designed. It shows the demographic characteristics, foreign body types, radiological and endoscopic findings, and associated complications, which help to provide a more accurate knowledge of this pathology.

Introducción: La ingesta de cuerpos extraños es un problema médico frecuente, especialmente en el servicio de urgencias. Existen algunos estudios pequeños que describen las experiencias al respecto. Materiales y métodos: Estudio descriptivo, retrospectivo, en el cual se incluyó a pacientes con sospecha de ingesta de cuerpos extraños, ingresados al servicio de gastroenterología y endoscopia digestiva de La Clínica Universitaria Colombia, entre enero de 2007 y agosto de 2020. Resultados: La edad de ocurrencia del evento se presentó en pacientes desde los 18 hasta los 95 años, y la edad promedio fue de 45 años. Los cuerpos extraños ingeridos y encontrados fueron variables; los más frecuentes fueron la ingesta de espinas de pescado, que representó el 64,11% de los casos, seguido por la ingesta de huesos de pollo y la impactación alimentaria. Un 38% de los pacientes requirieron la extracción de cuerpo extraño y la herramienta usada con mayor frecuencia fue la pinza de cuerpo extraño. La localización principal fue el esófago, en el 12,53% de los casos, seguido por la cricofaringe, en el 11,18%, y la hipofaringe, en el 10%. Conclusiones: La Clínica Universitaria Colombia es un sitio de referencia de una gran cantidad de urgencias en gastroenterología debido a su alto nivel tecnológico y al gran recurso humano que requieren. Este trabajo representa probablemente la cantidad más grande de pacientes con este motivo de consulta, razón por la que se diseñó este estudio descriptivo retrospectivo, que muestra las características demográficas, los tipos de cuerpo extraño, los hallazgos radiológicos y endoscópicos y las complicaciones asociadas, que son de utilidad para tener un conocimiento más real de esta patología.

Cuerpos extraños en esófago: revisión de 84 casos

La presencia de cuerpo extraño esofágico (CEE) es una urgencia habitual en gastroenterología. El protocolo en el manejo y la intervención endoscópica puede ser variable entre las instituciones. Objetivo: Definir características clínicas del CEE en adultos, su diagnóstico radiológico y endoscópico, y complicaciones a partir de una muestra de pacientes en un centro de gastroenterología. Materiales y métodos: serie de casos de pacientes que ingresaron desde urgencias y fueron interconsultados al servicio de gastroenterología con diagnóstico presuntivo de CEE. Se recolectaron variables clínicas, así como características, comorbilidades, tiempo de evolución y oportunidad diagnóstica, estudios confirmatorios, y complicaciones. Resultados: 84 sujetos, 70% hombres, promedio de edad 45 (rango:17-87; SD 12,5) años. En 98,8% de los pacientes se realizó endoscopía digestiva alta de modo urgente, con estancia intrahospitalaria promedio de 2,5 días. 93% sin patología de base asociada, en 6/84 (7,14%) pacientes se documentó patología esofágica estructural o funcional. 59/84 70,2%) pacientes consultaron en las primeras 24 horas, en 57,6% se confirmó endoscópicamente presencia de cuerpo extraño. En 67/84 (79,76%) pacientes se realizó radiografía previa a endoscopia, de los cuales, 62/67 (92,5%) con resultado anormal. 70% de los CEE confirmados fueron espinas de pescado. El sitio más frecuente de localización fue en región cricofaringea en el 90% de los casos. En 66/84 (78,6%) sujetos hubo ausencia de complicaciones, seguido de laceración profunda en 10/84 (11,9%) casos. En 3/84 (3,6%) casos se identificaron complicaciones con requerimiento quirúrgico. Conclusiones: La intervención endoscópica en las primeras 24 horas es un momento oportuno para identificación de complicaciones y brindar el tratamiento indicado.

The presence of esophageal foreign body (EFB) is a common emergency in gastroenterology. The protocol for management and endoscopic intervention can be variable among institutions. Objective: to define the clinical characteristics of EFB in adults, its radiological and endoscopic diagnosis, and complications based on a sample of patients in a gastroenterology center. Materials and methods: case series of patients admitted from the emergency department and referred to the gastroenterology department with a presumptive diagnosis of EFB. Clinical variables were collected, as well as characteristics, comorbidities, time of evolution and diagnostic opportunity, confirmatory studies, and complications. Results: 84 subjects, 70% men, mean age 45 (range: 17-87; SD 12.5) years. Urgent upper endoscopy was performed in 98.8% of the patients, with an average in-hospital stay of 2.5 days. 93% had no associated underlying pathology, in 6/84 (7.14%) patients structural or functional esophageal pathology was documented. 59/84 (70.2%) patients consulted in the first 24 hours, in 57.6% the presence of foreign body was confirmed endoscopically. In 67/84 (79.76%) patients radiography was performed prior to endoscopy, of which 62/67 (92.5%) had an abnormal result. Seventy percent of confirmed EFB were fish bones. The most frequent site of localization was in the cricopharyngeal region in 90% of the cases. In 66/84 (78.6%) subjects there was absence of complications, followed by deep laceration in 10/84 (11.9%) cases. In 3/84 (3.6%) cases complications requiring surgery were identified. Conclusions: Endoscopic intervention in the first 24 hours is an opportune moment to identify complications and provide the indicated treatment.

Maternal temperament and anxiety sensitivity in children with foreign body aspiration

SUMMARY OBJECTIVE: Foreign body aspiration is one of the childhood emergencies that thoracic surgeons are interested in, and it can cause morbidity and mortality. Although the relationship between various behavioral problems related to children and foreign body aspiration has been investigated so far, there is no study investigating the relationship between maternal temperament and anxiety sensitivity. This study aimed to investigate the relationship between maternal emotional temperament, anxiety sensitivity, and foreign body aspiration. METHODS: Mothers of 18 children with foreign body aspiration have been evaluated by a thoracic surgeon, and 18 healthy controls have also been included in the study. Maternal emotional temperament has been measured with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego - Auto questionnaire scale, and anxiety sensitivity has been measured with the Anxiety Sensitivity Index-3. RESULTS: There has been no statistically significant difference between groups in terms of maternal emotional temperament and anxiety sensitivity. In the logistic regression analysis conducted to determine the predictors of foreign body aspiration, it is determined that the mother's anxious temperament has predicted foreign body aspiration significantly. CONCLUSION: As a result of the study, it can be concluded that mothers' anxious temperament can be considered a risk factor for foreign body aspiration because it affects parenting skills and children's ability to manage behavioral problems. Consistent results could be able to be obtained with studies including larger samples on the subject.

Foreign Body Accidents in a Pediatric Emergency Department

Abstract Introduction Foreign body accidents (FBAs) are frequent in children and can be severe, being a common cause of morbidity and mortality and a public health problem. As these accidents are multifactorial, their cause can only be determined by analyzing the clinical details and characteristics of the object. Knowing the associated mechanisms and factors is essential to determine a risk profile and have a preventive, therapeutic, and diagnostic purpose. Objective The present study aimed to describe the incidence of FBAs in otorhinolaryngology according to their anatomical location, focusing on the aerodigestive system. Methods This is a retrospective study performed by reviewing the medical records of 668 cases seen in the emergency department of a tertiary pediatric hospital in São Paulo, state of São Paulo, Brazil, between 2014 and 2017. Results Foreign bodies (FBs) were found in the digestive system (238/668), in the nasal cavities (206/668), in the ears (182/668), in the oropharynx (34/668), and in the respiratory system (8/668). A total of 91.77% of the patients were treated in the emergency room. The main age group affected was < 5 years old, with no difference between genders. The most frequent complications affected the digestive system and the most serious occurred in cases involving the respiratory system. Conclusion Multidisciplinary teams should be ready in the emergency room to provide adequate care in FBAs. Early diagnosis, FB removal in the emergency room or the surgical center and follow-up are essential. Developing prevention campaigns including a risk profile for certain products and/or materials, helping to ensure safety for consumers, is necessary. For this, a national database with compulsory notification containing relevant information on FBAs in the pediatric population should be created.

Sustancia Cromatofílica: Una Propuesta de Cambio a la Terminologia Histologica y Terminologia Neuroanatomica / Chromatophilic Substance: a Proposal to Change the Terminologia Histologica and Terminologia Neuroanatomica

En Terminologia Histologica y Terminologia Neuroanatomica está registrado el término Substantia chromatophilica de origen grecolatino, con los códigos H2.00.06.1.00009 y 78, respectivamente. Dicho término ha sido empleado para referirse a un conglomerado de estructuras que en unión fungen como maquinaria de síntesis proteica y que son característicos de las células nerviosas. Teniendo en cuenta los lineamientos de la Federative International Programme for Anatomical Terminology (FIPAT) referentes a la denominación de nombres estructurales con un valor descriptivo e informativo, creemos que el término en cuestión no es el más adecuado. Por lo anterior, el objetivo del presente estudio fue analizar y evaluar la concordancia de las raíces grecolatinas que componen el término. Para ello, se llevó a cabo una búsqueda en el Diccionario de la lengua española, Diccionario de Términos Médicos, diccionario VOX Griego-Español y el diccionario VOX Ilustrado Latino-Español Español-Latino. Los resultados obtenidos indican que la palabra chromatophilica no presenta registro en español, sin embargo, sus sinónimos hacen referencia a material biológico afín por los colorantes. En base a lo anterior, proponemos el término Ribocumulus corponeuralis en función de su estructura y ubicación, en reemplazo de Substantia chromatophilica.

SUMMARY: In Terminologia Histologica and Terminologia Neuroanatomica the term Substantia chromatophilica of Greco-Latin origin is registered with the codes H2.00.06.1.00009 and 78, respectively. This term has been used to refer to a conglomerate of structures that together function as protein synthesis machinery and are characteristic of nerve cells. Considering the guidelines of the Federative International Programme for Anatomical Terminology (FIPAT) regarding the denomination of structural names with a descriptive and informative value, we believe that the term in question is not the most appropriate. Therefore, this study aimed to analyze and evaluate the concordance of the Greco-Latin roots that compose the term. For this purpose, a search was conducted in the Diccionario de la Lengua Española, Diccionario de Términos Médicos, Diccionario VOX Griego-Español and the Diccionario VOX Ilustrado Latino-Español Español-Latino. The results obtained indicate that the word chromatophilica is not registered in Spanish, however, its synonyms refer to biological material related to dyes. Based on the aforementioned, we propose the term Ribocumulus corponeuralis based on its structure and location, as a replacement for Substantia chromatophilica.

POLYEMBOLOKOILAMANIA IN THE EMERGENCY DEPARTMENT.

Polyembolokoilamania is a rare but serious medical condition that involves the presence of multiple foreign bodies in the patient's body. This condition can be challenging to diagnose and manage in the emergency department. In this chapter, we will discuss the presentation, diagnosis, and management of polyembolokoilamania in the emergency department.

Principales modificaciones asociadas a la esplenectomía / Main modifications associated with splenectomy

Introducción. El bazo es un órgano linfoide implicado en el reconocimiento antigénico, la depuración de patógenos y la remoción de eritrocitos envejecidos o con inclusiones citoplasmáticas. La esplenectomía es una técnica utilizada tanto para el diagnóstico (linfomas), el tratamiento (trombocitopenia inmune, anemia hemolítica adquirida) y la curación (microesferocitosis hereditaria) de diversas enfermedades. Métodos. Describir los principales cambios hematológicos y complicaciones asociadas al procedimiento de esplenectomía. Discusión. Los cambios posteriores a la esplenectomía pueden ser inmediatos, como la aparición de cuerpos de Howell-Jolly, la trombocitosis y la presencia de leucocitosis durante las primeras dos semanas. Otras complicaciones tempranas incluyen la presencia de trombosis, en especial en pacientes con factores de riesgo secundarios (edad, sedentarismo, manejo hospitalario, obesidad) o un estado hipercoagulable (diabetes, cáncer, trombofilia primaria), siendo tanto el flujo de la vena porta como el volumen esplénico los principales factores de riesgo para su aparición. Las complicaciones tardías incluyen la alteración en la respuesta inmune, aumentando el riesgo de infecciones por bacterias encapsuladas, en conjunto con una reducción en los niveles de IgM secundario a la ausencia de linfocitos B a nivel de bazo. Debido al riesgo de infecciones, principalmente por Streptococcus pneumoniae, la esplenectomía parcial se ha considerado una opción. Conclusión. Una adecuada valoración de la indicación de esplenectomía y la identificación precoz de complicaciones posoperatorias son fundamentales para reducir la mortalidad asociada a la esplenectomía

Introduction. The spleen is a lymphoid organ involved in antigen recognition, pathogen clearance, and removal of aged erythrocytes or those with cytoplasmic inclusions. Splenectomy is a technique used for diagnosis (lymphomas), treatment (immune thrombocytopenia, acquired hemolytic anemia), and cure (hereditary microspherocytosis) of various diseases. Methods. To describe the main hematological changes and complications associated with the splenectomy procedure. Discussion. Changes after splenectomy can be considered immediate: the appearance of Howell-Jolly bodies, thrombocytosis, and leukocytosis during the first two weeks. Other complications include the presence of thrombosis, especially in patients with risk factors (age, sedentary lifestyle, long hospital stay, obesity) or a hypercoagulable state (diabetes, cancer, primary thrombophilia), with both portal vein flow and splenic volume being the main risk factors for its appearance. Late complications include altered immune response, increased risk of infections by encapsulated bacteria, and a reduction in IgM levels secondary to the absence of B lymphocytes in the spleen; due to the risk of diseases mainly by Streptococcus pneumoniae, partial splenectomy has been considered an option. Conclusion. An adequate assessment of the indication for splenectomy and the early identification of complications are essential to reduce the mortality associated with splenectomy

Análisis forense de dientes, materiales de obturación y restauraciones protésicas en restos humanos expuestos a elevadas temperaturas. Revisión de la literatura / Forensic analysis of teeth, filling materials and prosthetic restorations in human remains exposed to high temperatures. Literature review

Resumen El proceso para establecer una identificación odontológica inequívoca se sustenta en la recuperación de la mayor cantidad posible de información post mortem, y su posterior cotejo con aquellos registros ante mortem de la víctima. Los dientes son tejidos del cuerpo humano con una elevada resistencia en su estructura, lo que les permite tolerar el embate de los efectos ambientales como el fuego, la desecación, la descomposición o la inmersión prolongada. En la mayoría de los desastres naturales, y también en los provocados por el hombre, los registros odontológicos pueden contribuir para identificar cuerpos que sería irreconocibles aplicando metodologías tradicionales. En cadáveres quemados o carbonizados, resulta imperativo conservar la evidencia odontológica recuperada, para evitar que su manipulación pueda desvirtuarla e incluso destruirla; por eso se suele fijar y estabilizar antes de ser transportada. Los recursos imagenológicos constituyen una sólida estrategia de perennización de evidencia, los cuales pueden ser complementados por fotografías y toma de impresiones. El presente artículo revisa varios estudios sobre restos dentales, materiales de obturación y aparatos protésicos quemados o carbonizados, haciendo énfasis sobre su importancia en el proceso de identificación humana.

Abstract The process to establish an unequivocal dental identification is based on the recovery of the greatest possible amount of post mortem information, and its subsequent comparison with the ante mortem records of the victim. Teeth are tissues of the human body with high resistance in their structure, which allows them to tolerate the onslaught of environmental effects such as fire, desiccation, decomposition, or prolonged immersion. In most natural disasters, an also in those caused by men, dental records can help identify a body that would be unrecognizable using traditional methodologies. In burned or charred corpses, it is imperative to preserve the recovered dental evidence, to avoid its manipulation from distorting and even destroying it; this is why it is usually fixed and stabilized before being transported. Imaging resources constitute a solid strategy for the perpetuation of evidence, which can also be complemented by photographs and impression taking. This article reviews several studies on dental remains, materials and burned or charred prosthetic devices, emphasizing their importance in the human identification process.

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA), medical treatment of severe systemic compromise: case report

Case description: A 42-year-old woman with severe pulmonary and mediastinal inflammatory involvement, secondary to infiltration of a silicone-related allogenic material with systemic migration. Clinical findings: The patient developed esophageal and bronchial stenosis, recurrent infections, malnutrition, and respiratory deterioration, making surgical removal of the allogenic material impossible. Treatment and outcome: Clinical and radiological improvement was achieved after treatment with multiple intravenous and oral immunomodulators. Clinical relevance: Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is a heterogeneous disease resulting from exposure to allogenic substances in a susceptible subject. These substances cause autoimmune or autoinflammatory phenomena. Since ASIA was described ten years ago, its diagnostic criteria are still under discussion, with an uncertain prognosis. The ideal therapy is based on eliminating the causative substance, but this is not always possible. Therefore, it is necessary to start an immunomodulatory treatment, using it in this patient, a scheme that had not been previously reported in the literature.

Descripción del caso: Mujer de 42 años con compromiso inflamatorio pulmonar y mediastinal severo, secundario a infiltración de un material alogénico relacionado con la silicona con migración sistémica. Hallazgos clínicos: La paciente desarrolló estenosis esofágica y bronquial, infecciones recurrentes, desnutrición y deterioro respiratorio, imposibilitando la extracción quirúrgica del material alogénico. Tratamiento y resultado: Mejoría clínica y radiológica lograda tras un tratamiento con múltiples inmunomoduladores intravenosos y orales. Relevancia clínica: El síndrome autoinmune / inflamatorio inducido por adyuvantes (ASIA) es una enfermedad heterogénea que resulta de la exposición a sustancias alógenas en un sujeto con susceptibilidad genética. Estas sustancias inducen fenómenos autoinmunitarios o autoinflamatorios. Desde que ASIA fue descrito hace 10 años, sus criterios diagnósticos continúan en discusión, con un pronóstico incierto. El tratamiento idóneo se basa en eliminar la sustancia causante, pero no siempre es posible, por lo cual se hace necesario iniciar un tratamiento inmunomodulador, empleándose en esta paciente un esquema que no había sido reportado previamente en la literatura.

AURAL SYRINGING: A ONE SIZE FITS ALL SOLUTION FOR EAR FOREIGN BODIES?

Objectives: To ascertain if aural syringing is a one size ?ts all solution for aural foreign body removal in a rural setting A Record based descriptive study was looked at paediatric and adult patients Methods: with Aural FB (foreign bodies) who visited ER (Emergency) and ENT-OPD (Out Patient Department) of a single institution between January 2022 and December 2022.The Diagnosis of Aural foreign bodies was based on personal history and Otoscopic ?ndings. Patient characteristics, foreign body type, removal attempts and complications were evaluated with respect to clinical setting and patient outcome. The Data was obtained from the records. 86 patients were brought to Results: the emergency department and ENT-OPD over a 12-month period with foreign bodies of the EAC (External Auditory Canal). Otolaryngologists used otoscope and standard metallic aural syringe as their mainstay of management. Analysis of ER and OPD cases revealed Inorganic aural foreign bodies were 65.11% and 34.88% were Organic foreign bodies. Unilateral Purulent Aural Discharge was in 46.51% (40) patients, pain in 17.44% (15), Ear Bleeding in 8.13% (7), conductive hearing loss and tinnitus was 10.46% (9) and itching in 4.65% (4). Duration of Symptoms was <1 week in 65.11% (56) cases ,1-2 weeks in 22.09% (19) and 2-4 weeks in 12.79% (11) cases. Successful removal of foreign bodies from ear by only applying aural syringing was achieved in 91.86% of cases, and usage of other methods of aural foreign body removal Forceps, Hook and Suction in 5.8% and foreign body removal under GA was 2.32% were recorded Aural foreign bodies were commonly seen in paediatric Conclusion population. Patients commonly present to the ER and OPD for removal of EAC foreign bodies. The common inorganic aural foreign bodies were cotton tip, stone and eraser whereas ?y, lice and bee were the organic FB. The most common symptoms and complications of aural FBs, were unilateral purulent discharge followed by pain, ear Bleeding, Tympanic membrane perforation, external meatus laceration, chronic otitis media and facial Nerve paralysis. The most common procedures used were Syringing followed by Forceps, hook and suction. It is observed that aural syringing performed by the trained hands of an otolaryngologist is a very effective method and can almost be described as a one size ?ts all solution for managing foreign bodies in EAC with some notable exceptions.

Assistência de enfermagem em pacientes com Demência do Corpo de Lewy / Nursing assistance in patients with Lewy's Body Dementia

Objetivo: Investigar sobre a assistência de Enfermagem a pacientes com Demência do Corpo de Lewy. Método: Revisão integrativa da literatura, pela busca nas bases de dados, entre os anos de 2009 a 2021, utilizando os descritores: Doença por corpos de Lewy, Doença de Alzheimer, Doença de Parkinson, Assistência de Enfermagem. Resultado: A Demência do Corpo de Lewy é uma doença de difícil diagnóstico, por causa das semelhanças com as Doenças de Alzheimer e Parkinson, seu tratamento é baseado nessas patologias, não seguindo protocolos específicos da doença. A enfermagem tem por função principalmente orientar a família e oferecer uma assistência integral tanto para o paciente, quanto para o cuidador. Conclusão: É necessária, a realização de mais estudos, para entender como assistir um paciente diagnosticado com esta patologia adequadamente, dando suporte para um cuidado de enfermagem mais científico e integral, estabelecendo rotinas, promoveno assim qualidade de vida ao paciente e sua família.(AU)

Objective: To investigate Nursing care for patients with Lewy Body Dementia. Method: Integrative literature review, using the Scielo database, between 2009 and 2021, using the descriptors: Lewy body disease, Alzheimer's disease, Parkinson's disease, Nursing care. Result: Lewy Body Dementia is a disease that is difficult to diagnose, because of the similarities with Alzheimer's and Parkinson's Diseases, its treatment is based on these pathologies, not following disease-specific protocols. Nursing's main function is to guide the family and offer comprehensive care for both the patient and the caregiver. Conclusion: Further studies are needed to understand how to properly care for a patient diagnosed with this pathology, supporting a more scientific and comprehensive nursing care, establishing routines, thus promoting quality of life for patients and their families.(AU)

Objetivo: Investigar el cuidado de Enfermería a pacientes con Demencia con Cuerpos de Lewy. Método: Revisión integrativa de la literatura, utilizando la base de datos Scielo, entre 2009 y 2021, utilizando los descriptores: Enfermedad de cuerpos de Lewy, Enfermedad de Alzheimer, Enfermedad de Parkinson, Cuidados de enfermería. Resultado: La Demencia con Cuerpos de Lewy es una enfermedad de difícil diagnóstico, debido a las similitudes con el Alzheimer y el Parkinson, su tratamiento se basa en estas patologías, no siguiendo protocolos específicos de la enfermedad. La función principal de enfermería es orientar a la familia y ofrecer una atención integral tanto al paciente como al cuidador. Conclusión: Se necesitan más estudios para comprender cómo cuidar adecuadamente a un paciente diagnosticado con esta patología, apoyando un cuidado de enfermería más científico e integral, estableciendo rutinas, promoviendo así la calidad de vida de los pacientes y sus familias.(AU)

Diagnóstico precoce de acetonemia subclínica em vacas holandesas por mensuração de corpos cetônicos / Early diagnosis of subclinical acetonemia in holstein cows by measuring ketone bodies / Diagnóstico precoz de acetonemia subclínica en vacas holstein mediante la medición de cuerpos cetónicos

O trabalho foi realizado em uma fazenda de exploração leiteira em Castrolanda, no município de Castro ­ PR. O sistema de manejo é free-stall, com 220 vacas da raça Holandesa com RHA305 de 6.740 litros. Foram coletadas amostras de sangue de 18 vacas de pré-parto, 4 dias antes da data prevista para o parto; e nos dias 4, 7 e 12 pós-parto, mediante punção venosa coccígea, utilizando-se SnapTest digital Ketovet®, constituindo 72 amostras, no período de fevereiro a maio de 2020. Em 4 vacas o BHB do sangue total apresentou-se acima do limite para cetose subclínica no quarto dia após o parto e 17 apresentaram-se acima do limite no sétimo dia, declinando em seguida, principalmente devido às intervenções clínicas. As médias e desvios-padrão foram: D - 4: 0,89 ± 0,257061; D 4: 1,05 ± 0,283279; D 7: 1,81 ± 0,456131; e D 12: 1,19 ± 0,437762. O benefício do monitoramento de BHB foi a imediata intervenção clínica, evitando-se a severidade por instalação de quadro clínico e as enfermidades concomitantes.(AU)

The study was carried out on a dairy farm in Castrolanda, in the county of Castro - PR. The management system is free stall, with 220 Holstein cows with RHA305 of 6,740 liters. Blood samples were collected from 18 pre-calving cows, 4 days before the expected date of calving; and on days 4, 7 and 12 postpartum, by means of coccygeal venipuncture, using SnapTest digital Ketovet®, constituting 72 samples, from February to May 2020. In 4 cows the BHB of whole blood was shown above the limit for subclinical ketosis on the fourth day after delivery and 17 presented above the limit on the seventh day, then declining mainly due to clinical interventions. The means and standard deviations were D -4: 0.89 ± 0.257061; D 4: 1.05 ± 0.283279; D 7: 1.81 ± 0.456131; and D 12: 1.19 ± 0.437762. The benefit of monitoring BHB was immediate clinical intervention, avoiding clinical ketosis and concomitant illnesses.(AU)

El estudio se realizó en una explotación lechera de Castrolanda, en la comarca de Castro - PR. El sistema de manejo es estabulación libre, con 220 vacas Holstein con RHA305 de 6.740 litros. Se recogieron muestras de sangre de 18 vacas pre- parto, 4 días antes de la fecha prevista de parto; y en los días 4, 7 y 12 postparto, mediante venopunción coccígea, utilizando SnapTest digital Ketovet®, constituyendo 72 muestras, desde febrero a mayo de 2020. En 4 vacas la BHB de sangre total se mostró por encima del límite para cetosis subclínica en el cuarto día después del parto y 17 presentaron por encima del límite en el séptimo día, disminuyendo después debido principalmente a intervenciones clínicas. Las medias y desviaciones estándar fueron D -4: 0,89 ± 0,257061; D 4: 1,05 ± 0,283279; D 7: 1,81 ± 0,456131; y D 12: 1,19 ± 0,437762. El beneficio de monitorizar la BHB fue la intervención clínica inmediata, evitando la cetosis clínica y las enfermedades concomitantes.(AU)

Cases of Orbital Cellulitis Revealing Neglected Intraocular Foreign Bodies

Background: Orbital cellulitis is defined as acute inflammatory orbital swelling of infectious origin. Most often secondary to sinusitis. Intraocular foreign bodies neglected because of their small size, or sometimes radio-transparent nature, can be difficult to diagnose even with radiology and be responsible for orbital cellulitis. We demonstrate the diagnostic and therapeutic difficulties.Patients and Methods: This is a retrospective descriptive study of patients with unilateral orbital cellulitis revealing neglected intraocular foreign bodies, conducted in the Department of Adult Ophthalmology, Hospital August 20, 1953, involving 58 patients, from January 2015 until December 2020.Results: The average age of the patients was 38.5 years. The most affected age group was between 21 and 30 years with a clear male predominance. A decrease in visual acuity was found in all patients (unilateral blindness 43%) and a cellulitis complicated by a purulent melt (43%). All patients received medical treatment, including intravitreal injections of antibiotics in 71% of cases, and surgical treatment consisting of extraction of the foreign body and immediate evisceration of the eyeball in 25% of cases.Conclusion: Orbital cellulitis, although mostly secondary to sinusitis, can reveal various etiologies such as intra-orbital foreign bodies that can go unnoticed and be life-threatening and functionally damaging, especially when the diagnosis is made late and management is inappropriate. The presence of an intraocular foreign body must be suspected in all cases of orbital trauma associated with a palpebral wound, even if it is minimal, or in the presence of a clinical aggravation. Any delay in diagnosis and/or treatment can lead to serious complications that can affect the functional and even vital prognosis. The surgical treatment consists of the extraction of the foreign body. The recourse to evisceration in our context unfortunately continues to persist at high rates; because of the delay of consultation and thus of the management.

Research on effect of pulsatile external auditory canal irrigation on foreign bodies in children / 中国实用护理杂志

Objective:To explore the methods to improve the success rate of external canal foreign body washing and reduce the incidence of adverse reaction in children (≤14 years old).Methods:This study was a randomized controlled trial. A total of 60 pediatric patients with ear canal foreign bodies who were admitted to the otolaryngology-head and neck surgery clinic of Shengjing Hospital Affiliated to China Medical University from January 2021 to May 2022 were selected. The patients were divided into the experimental group and the control group by the random number table method, with 30 cases in each group. The experimental group were treated with pulsatile external auditory canal irrigation method, while the control group were treated with the conventional ear canal flushing method. The success rate of flushing, the flushing time, the incidence of adverse reactions and satisfaction of the patient's family were compared between the two groups.Results:The success rate of flushing was 80.0% (24/30) in the experimental group and 46.7% (14/30) in the control group, with statistically significant difference ( χ2= 7.18, P <0.05). The flushing time was (140.80 ± 44.48) s in the experimental group and (296.60 ± 82.79) s in the control group, with statistically significant difference ( t=9.08, P <0.05). The incidence of adverse reactions was 23.3% (7/30) in the experimental group and 63.3% (19/30) in the control group, with statistically significant difference ( χ2=9.77, P<0.05). The satisfaction of the patient's family was 93.9% (28/30) in the experimental group and 36.7% (11/30) in the control group, with statistically significant difference ( χ2=21.17, P<0.05). Conclusions:The pulsatile external auditory canal irrigation method can improve the success rate of ear canal foreign body flushing, shorten the flushing time and reduce the adverse reactions. The need for surgery and hospitalization due to ear canal foreign body, the suffering of patients and the corresponding cost can be decreased accordingly. The new treatment showed clear advantages clinically and should be widely applied.

The clinical value of 123I-metaiodobenzylguanidine myocardial imaging in the diagnosis of dementia with Lewy bodies / 生物医学工程学杂志

Metaiodobenzylguanidine (MIBG) is an analog of norepinephrine that accumulates in sympathetic nerve endings soon after intravenous administration. The degree of accumulation reflects the uptake, storage and release of transmitters by noradrenergic neurons. Myocardial imaging with 123I labeled MIBG ( 123I-MIBG) can be used to estimate the extent of local myocardial sympathetic nerve damage, which has been widely used in the diagnosis and treatment of various heart diseases. In recent years, numerous studies have been carried out on the application of 123I-MIBG in the diagnosis of degenerative diseases of the nervous system (such as Parkinson's disease and dementia of Lewy body), and have made some achievements. The purpose of this review is to summarize the current clinical application of 123I-MIBG myocardial imaging in the diagnosis of dementia with Lewy bodies, the problems in imaging technology and the possible research directions in the future, so as to provide valuable reference information for clinicians to reasonably and accurately apply this technology in the early diagnosis and discrimination of dementia.