Infección de vías urinarias a trichosporon asahii. A propósito de 2 casos / Urinary tract infection to trichosporon asahii. About 2 cases

Introducción: Las infecciones de las vías urinarias constituyen una de las patologías infecciosas más frecuentes tanto en la comunidad como en el ámbito hospitalario En el medio hospitalario se ha observado una alta frecuencia de infecciones asociadas a hongos oportunistas, en su mayoría corresponden a especies de Candida spp. Sin embargo, se aíslan otras especies como Trichosporon, donde predomina la especie asahii, en casos de pacientes inmunodeprimidos o con tratamiento previo de antibioticoterapia. Presentación de Casos Clínicos: Se presentan 2 casos donde se aisló en urocultivos Trichosporon asahii. En ambos casos los pacientes presentaron factores de riesgo y síntomas inespecíficos. Conclusión: La presencia de hongos de forma persistente en el tracto urinario es considerada clínicamente significativa. El tratamiento de la funguria debe basarse en el análisis del paciente, de su estado general y de sus factores de riesgo. Para el tratamiento, se observó que el efecto de los triazoles, fueron los más efectivos en el tratamiento de la infección por T. asahii.

Introduction: Urinary tract infections are one of the most frequent infectious pathologies both in the community and in the hospital setting. In the hospital environment, a high frequency of infections associated with opportunistic fungi has been observed, most of which correspond to species of Candida spp. However, other species such as Trichosporon are isolated, where the asahii species predominates (6,7). Presentation of Clinical Cases: Two cases are presented where Trichosporon asahii was isolated in urine cultures. In both cases, the patients presented risk factors and nonspecific symptoms. Conclusion: The persistent presence of fungi in the urinary tract is considered clinically significant (9,10). The treatment of funguria should be based on the analysis of the patient, his general condition and his risk factors (10). For treatment, it was observed that the effect of triazoles was the most effective in the treatment of T. asahii infection (8)

Alterações oftalmológicas em pacientes com COVID-19: revisão narrativa de estudos e séries de casos / Ophthalmic changes in patients with COVID-19: narrative review of studies and case series

O objetivo deste trabalho é descrever casos clínicos e séries de casos relacionados a alterações oftalmológicas em pacientes com diagnóstico de COVID-19. Foi realizada uma revisão narrativa/descritiva de casos clínicos e série de casos. A partir das buscas de dados com descritores pré-definidos, foram integrados na revisão, 17 estudos. Dentre os principais temas identificados, destacam-se: alterações conjuntivais, alterações retinianas e oftalmoparesias. O quadro de alterações da conjuntiva foi prevalente em relação aos demais. Essa revisão incluiu não apenas afecções oculares em adultos, mas também, em crianças e adolescentes. O estudo chama atenção para o fato de que as alterações oculares foram descritas como alteração isolada, alteração precipitante e alteração simultânea ao quadro respiratório. Conclui-se que as afecções oculares vão além de alterações conjuntivais, embora sejam essas preponderantes, havendo ainda alterações retinianas, quadro de oftalmoparesia e ainda a incomum síndrome de Miller Fisher. Novos ensaios irão poder avaliar, qual é de fato, a representatividade dos problemas oculares na cadeia epidemiológica da COVID-19. [au]

The objective of this work is to describe clinical cases and case series related to ophthalmological changes in patients diagnosed with COVID-19. A narrative/descriptive review of clinical cases and case series was performed. Based on data searches with pre-defined descriptors, 17 studies were integrated in the review. Among the main themes identified, the following stand out: conjunctival changes, retinal changes and ophthalmoparesis. The picture of changes in the conjunctiva was prevalent in relation to the others. This review included not only eye disorders in adults, but also in children and adolescents. The study draws attention to the fact that the ocular changes were described as isolated alteration, precipitating alteration and simultaneous alteration to the respiratory condition. It is concluded that ocular conditions go beyond conjunctival alterations, although these are predominant, with retinal alterations, ophthalmoparesis and the unusual Miller Fisher syndrome. New trials will be able to assess, in fact, the representativeness of eye problems in the epidemiological chain of COVID-19. [au]

Aprendizaje Basado en Casos Clínicos (CCBL): una metodología activa aplicable a carreras de ciencias de la salud / Clinical Case-based Learning (CCBL): an active methodology applicable to health sciences careers

Se realizó un análisis bibliográfico sobre la utilización de casos clínicos como estrategia didáctica en las carreras de medicina, enfermería, kinesiología y nutrición. Es fundamental para los docentes estar innovando continuamente en las estrategias de aprendizaje, y promover una flexibilización curricular, para mejorar los procesos de enseñanza universitaria, impulsando un cambio en las metodologías docentes en función del estudiante de manera activa, dando paso a un proceso de enseñanza-aprendizaje dinámico que se adapta a las circunstancias históricas sociales. El objetivo de esta revisión es analizar las evidencias disponibles sobre la utilización de casos clínicos y su aporte a las habilidades y competencias exigidas en los perfiles de estas cuatro carreras de la salud

A bibliographical analysis was carried out on the use of clinical cases as a didactic strategy in medicine, nursing, kinesiology and nutrition undergraduate programs. Is essential for teachers to be continuously innovated in learning strategies, and promote curricular flexibility, to improve university teaching processes, promoting a change in teaching methodologies based on the student in an active way, giving way to a teaching process -dynamic learning that adapts to historical-social circumstances. The objective of this review was to analyze the available evidence on the use of clinical cases and their contribution to the skills and competencies required in the profiles of these four health undergraduate programs

Uso de casos clínicos en inglés como herramienta para desarrollar la competencia comunicativa profesional / The use of clinical cases in english as a tool for developing professional communicative competence

Introducción: En el contexto del dominio del inglés no todos los egresados satisfacen las exigencias de un profesional competente desde el punto de vista comunicativo. Ante tales evidencias, en los cursos de posgrados se han buscados otras vías para profundizar en el inglés de la especialidad, que permitan perfeccionar la competencia comunicativa profesional. Objetivo: Exponer algunas consideraciones sobre el uso de los casos clínicos en inglés como herramienta para desarrollar la competencia comunicativa profesional. Métodos: Estudio descriptivo en la Facultad de Estomatología de La Habana en el primer semestre del curso académico 2020-2021. La información se obtuvo mediante métodos teóricos de análisis, y síntesis de revisiones bibliográficas y documentales sobre el tema. Resultados: El uso de casos clínicos en inglés propició el enriquecimiento del vocabulario técnico de la especialidad; y estimuló el empleo de sinónimos relacionados con el lenguaje estomatológico, y la diferencia entre el lenguaje del estomatólogo y del paciente. Además, se diseñó una guía didáctica en inglés con el vocabulario utilizado para la presentación de casos clínicos que sirve como material de consulta para los estomatólogos y profesores que imparten inglés con fines específicos. Conclusiones: Sin lugar a dudas, el uso de casos clínicos con todas las discusiones que genera, ayuda a desarrollar la competencia comunicativa profesional en inglés(AU)

Introduction: In the context of mastering English, not all graduates meet the demands of a professional who is competent from a communication point of view. With such evidence, in postgraduate courses other ways have been sought to deepen the English of the specialty, which allows perfecting professional communicative competence. Objective: To present some considerations about the use of clinical cases in English as a tool for developing professional communicative competence. Methods: Descriptive study carried out at the Dental School of Havana during the first semester of the 2020-2021 academic year. The information was obtained through theoretical methods of analysis, as well as synthesis of bibliographic and documental reviews on the subject. Results: The use of clinical cases in English led to the enrichment of the technical vocabulary of the specialty. It stimulated the use of synonyms related to the dental terminology, and the difference between the language of the dental doctor and the patient. In addition, a didactic guide in English was designed with the vocabulary used for the presentation of clinical cases, which serves as reference material for dental doctors and professors who teach English for specific purposes. Conclusions: Undoubtedly, the use of clinical cases with all the discussions that it generates, helps develop professional communicative competence in English(AU)

A clínica de Ludwig Binswanger inspirada no Dasein de Heidegger e na fenomenologia genética de Husserl / Ludwig Binswanger's clinic inspired by Heidegger's Dasein and Husserl's genetic phenomenology / La clinique de Ludwig Binswanger inspirée par le Dasein de Heidegger et par la phénoménologie génétique de Husserl / La clínica de Ludwig Binswanger inspirada en el Dasein de Heidegger y en la fenomenología genética de Husserl

A clínica fenomenológica de Ludwig Binswanger propõe uma nova compreensão sobre a psicopatologia ao realçar a importância na história de vida do paciente. Encontra-se dividida em três fases mostrando a fertilidade de seus estudos psicopatológicos após a leitura de Ser e tempo e através da influência husserliana, com o intuito de esclarecer a constituição da experiência delirante. Este artigo tem como objetivo apresentar dois casos clínicos, Lola Voss e Suzanne Urban, para ilustrar a contribuição oferecida por Ludwig Binswanger à psicopatologia fenomenológica em sua segunda e última fase.

Ludwig Binswanger's phenomenological clinic provides a new understanding of psychopathologies by highlighting the importance of patients' life stories. It is divided into three phenomenological stages and shows how fertile his psychopathological studies became after he had read Being and Time and due to Husserl's influence, which he undertook to investigate the formation of delusional experience. This article presents two clinical cases, Lola Voss and Suzanne Urban, to illustrate Ludwig Binswanger's contribution to phenomenological psychopathology in its second and final stage.

La clinique phénoménologique de Ludwig Binswanger propose une nouvelle compréhension de la psychopathologie soulignant l'importance de l'histoire de vie du patient. Les trois phases de sa pensée phénoménologique montrent la fécondité de ses études psychopathologiques, influencées par la lecture de l'Être et Temps et par Husserl, qu'il menait pour élucider la formation de l'expérience délirante. Cet article présente deux cas cliniques, Lola Voss et Suzanne Urban, qui illustrent la contribution apportée par Ludwig Binswanger à la psychopathologie phénoménologique dans sa deuxième et dernière phase.

La clínica fenomenológica de Ludwig Binswanger propone una nueva comprensión de la psicopatología al destacar su importancia en la historia de vida del paciente. Está divida en tres fases, mostrando la fertilidad de sus estudios psicopatológicos tras la lectura de Ser y tiempo, y a través de la influencia de Husserl, a fin de aclarar la constitución de la experiencia delirante. Este artículo tiene como objetivo presentar dos casos clínicos, Lola Voss y Suzanne Urban, para ilustrar la contribución de Ludwig Binswanger a la psicopatología fenomenológica en su segunda y última fase.

Desarrollo del aprendizaje basado en problemas a través de casos clínicos en semiología para estudiantes de enfermería

El presente artículo tiene como objetivo principal presentar los resultados de la implementación del aprendizaje basado en problemas (ABP) como estrategia didáctica de integración de los conocimientos teóricos mediante la práctica en la asignatura de Semiología en el programa de formación en Enfermería de la Universidad del Magdalena. La investigación se realizó con base en una metodología mixta e introducción de elementos de participación-acción y mediando casos clínicos para el desarrollo de las habilidades del estudiante en la valoración sistemática del paciente. Se realizó un trabajo de índole cuasiexperimental sobre una muestra de 21 estudiantes de cuarto y quinto semestre, basado en el diseño de cinco casos clínicos. Posteriormente y mediante la aplicación de una encuesta tipo Likert de escala 1 a 7 en conocimientos, habilidades y actitudes, con un total de 54 ítems, se determinaron el acuerdo, la aceptación y la tendencia actitudinal respecto al uso de dicha estrategia didáctica con base en ABP como alternativa de cambio. Los resultados permitieron evidenciar el acuerdo pleno de los estudiantes con los criterios esperados por el ABP, así como la comprobación de su plena disposición respecto a la metodología implementada. En general, el grupo evidenció comprender el aporte de la orientación diferencial que provee el uso del ABP mediante los casos clínicos propuestos en el aula para el desarrollo de la asignatura de Semiología.

Our main objective is to introduce the results of the implementation of the problem-based learning method (ABP in Spanish) as a didactic strategy to integrate theorical knowledge and practice in the course of Semiology in the Nursery program of Madgalena University. Re- search was based in a mixed methodology, with an introduction of elements of participative-action and through the management of cli- nical cases for the development of students' skills in the assessment of patients. We carried out a quasi-experimental work on a sample of 21 students of fourth and fifth semester, based on the design of five clinical cases. After that, we applied a Likert-based survey with a scale of 1 to 7 in knowledge, abilities, and attitudes, with a total of 54 items. We determined the agreement, acceptance and attitude trend regar- ding the use of the didactic strategy based in ABP as an alternative for change. Results allowed us to evidence how the students agreed with the expected criteria of ABP, as well as to prove their willingness to use the implemented methodology. In general, the group showed that they understood the contribution to differential orientation provided by the usage of ABP through the clinical cases proposed in the class- room to carry out the course of Semiology.

Este artigo tem como objetivo principal apresentar os resultados da implantação da aprendizagem baseada em problemas (ABP) como estratégia didática de integração dos conhecimentos teóricos mediante a prática na disciplina de Semiologia, no programa de Enfermagem da Universidad del Magdalena, Colômbia. Esta pesquisa foi realizada com base em uma metodologia mista e em uma introdução de elementos de participação-ação e mediando casos clínicos para desenvolver habilidades do estudante na avaliação sistemática do paciente. Foi realizado um trabalho de índole quase-experimental com uma amostra de 21 estudantes de quarto e quinto período, baseado no desenho de cinco casos clínicos. Em seguida, mediante a aplicação de um questionário tipo Likert de escala de 1 a 7 em conhecimentos, habilidades e atitudes, com um total de 54 itens, foram determinados o acordo, a aceitação e a tendência atitudinal a respeito do uso dessa estratégia didática com base na ABP, como alternativa de mudança. Os resultados permitiram evidenciar o acordo pleno dos estudantes com os critérios esperados pela ABP, bem como a comprovação de sua plena disposição quanto a metodologia implantada. Em geral, o grupo evidenciou compreender a contribuição da orientado diferencial que fornece o uso da ABP mediante casos clínicos propostos na sala de aula para desenvolver a disciplina de Semiologia.

Análisis de la casuística equina del área de Grandes Animales de la Clínica Veterinaria U.D.C.A, Bogotá, Colombia / Analysis of equine casuistic in the Large Animals area of the Veterinary Clinic U.D.C.A, Bogotá, Colombia

RESUMEN Conocer las patologías más frecuentes facilita la orientación clínica mejorando el pronóstico de los pacientes. Para determinar las patologías que se presentan en caballos (Equus ferus caballus) en la Clínica Veterinaria U.D.C.A, se realizó un estudio retrospectivo, entre enero y diciembre de 2017. Se analizaron 242 historias, clasificando los casos, según la fecha, procedencia, raza, sexo, edad, diagnóstico definitivo, sistema, tratamiento médico-quirúrgico y evolución. La procedencia más frecuente fue del departamento de Cundinamarca y de Bogotá; 55,8% fueron hembras, 44,2% machos, con edad entre 1 día y 25 años; 24% jóvenes, 76% adultos, con edad promedio de 81,5 meses y desviación estándar de 51,7 meses; la raza predominante fue Caballo Criollo Colombiano (CCC). Los sistemas más afectados fueron músculo esquelético (SME), digestivo (SD), y reproductivo; los casos más frecuentes fueron Arpeo idiopático o hipertonía equina refleja, que ocurrió únicamente en CCC; alteraciones del intestino grueso, y criptorquidia, respectivamente. Tratamiento quirúrgico, se dio a 66,5% de los casos, principalmente, a los del SME, digestivo y reproductivo. La mortalidad fue de 13,7%; fallecieron 13 equinos y a 22, se les practicó eutanasia; los casos mortales, se presentaron principalmente en los del SD, relacionados con cólico y ninguno en los de los sistemas respiratorio, órganos de los sentidos y tegumentario. La casuística es amplia y variada; el SME fue el más afectado en los caballos. El compromiso funcional y vital para los animales hace necesario investigar sobre factores de riesgo del Arpeo idiopático y cólico equino.

ABSTRACT Know the most frequent pathologies facilitates the clinical orientation improving the prognosis of the patients. To determine the pathologies that occur in horses at the U.D.C.A Veterinary Clinic, a retrospective study was conducted between january and december 2017. 242 clinical histories were analyzed, classifying the cases according to date, origin, race, sex, age, definitive diagnosis, system, medical-surgical treatment and evolution. The most frequent source was the department of Cundinamarca and the city of Bogotá, 55.8% were females, 44.2% males, age between 1 day and 25 years, 24% young, 76% adults with an average age of 81.5 months and a standard deviation of 51.7 months, the predominant breed was Colombian Creole Horse (CCC). The most affected systems were muscle skeletal (ME), digestive (D), and reproductive, the most frequent cases were classic stringhalt or equine reflex hypertonia, which occurred only in CCC, alterations of the large intestine, and cryptorchidism, respectively. Surgical treatment was given to 66.5% of the cases, mainly to SME, digestive and reproductive cases. Mortality was 13.7%, 13 equines died and 22 were euthanized, fatal cases occurred mainly in those of SD related to colic and none in the respiratory, organs of the senses and integumentary systems. The casuistic is wide and varied, the MES was the most affected in the horses attended, the functional and vital commitment for the animals makes it necessary to investigate the risk factors of the classic stringhalt and equine colic.

Learning pain neuroscience education from the WHOQOL-Bref instrument in the classroom. Case reports / Aprendendo a educação em neurociência da dor por meio do instrumento WHOQOL-Bref em sala de aula. Relato de casos

ABSTRACT BACKGROUND AND OBJECTIVES: During the undergraduate course students have the opportunity to learn and understand health promotion and prevention, quality of life and other concepts, but they rarely learn about health education, let alone pain. Knowing that there are gaps in the training of health professionals regarding pain, and in the use of pedagogical methodologies that encourage the active construction of knowledge, the objective of this study was to provide an experience about the process of understanding pain neuroscience education from an instrument and the role-playing technique in the academic environment of Physiotherapy students. CASE REPORTS: During a Basic Complexity class, Physiotherapy students from the Ceilândia campus of the University of Brasília were invited to provide care to a fictitious population and develop explanations and lessons about pain and its processes in the human body using the WHOQOL-Bref questionnaire to evaluate the quality of life of the individual and target the care accordingly. CONCLUSION: The experience provided by the simulation of clinical cases was important for the analysis and discussion of challenging issues such as psychological, social and behavioral factors in the health education process in multi and interdisciplinary interventions.

RESUMO JUSTIFICATIVA E OBJETIVOS: Durante a graduação, os acadêmicos têm a oportunidade de aprender e compreender sobre promoção e prevenção de saúde, qualidade de vida, entre outros conceitos, mas raramente a educação em saúde é colocada nas salas de aula, em especial o entendimento da dor. Sabendo que há lacunas na formação de profissionais de saúde relacionadas ao conhecimento da dor e à utilização de metodologias pedagógicas que incentivem a construção ativa do conhecimento, o objetivo deste estudo promoveu um relato de experiência sobre o processo de entendimento e educação em neurociência da dor, por meio de um instrumento e da técnica de dramatização na vivência acadêmica de estudantes de Fisioterapia. RELATO DOS CASOS: Durante a realização de uma aula de Básica Complexidade, alunos do curso de Fisioterapia da Universidade de Brasília - Campus Ceilândia, foram convidados a vivenciarem um atendimento à uma população fictícia e desenvolverem explicações e ensinamentos sobre a dor e seus processos no corpo humano, utilizando o instrumento WHOQOL-Bref para avaliar a qualidade de vida do indivíduo e direcionar o seu atendimento. CONCLUSÃO: A experiência vivenciada por meio de simulações de casos clínicos na disciplina foi importante para a análise e discussão de questões desafiadoras como fatores psicológicos, sociais, e comportamentais no processo de educação em saúde em intervenções multi e interdisciplinar.

Sexuality and Questions of Gender in Adolescence: Contributions of Psychoanalysis / Sexualidade e Questões de Gênero na Adolescência: Contribuições Psicanalítica

Abstract The institutional clinical practice with adolescents in a university hospital in the present times raises questions about both gender and sexuation. Such questions are not exclusively at the level of practice, but also of theory, requiring it's refinement. We introduce it in the context of psychoanalysis. Methodologically, we left the clinic to question the theory, allowing it to be enriched, as Freud wanted, from the beginning, when he observed that in psychoanalysis there is no theory without clinic. Although we are based on psychoanalytic authors, we do not fail to imply references in authors of the connection fields of psychoanalysis, which often bring fundamental elements to the intended refinement. We conclude by presenting a case to exemplify the questions that led us to the research.

RESUMO A prática clínica institucional com adolescentes em um hospital universitário atualmente levanta questões tanto sobre gênero quanto sobre sexuação. Tais questões não se colocam exclusivamente a nível da prática, mas também da teoria, exigindo um afinamento desta. Introduzimo-lo no contexto da psicanálise. Metodologicamente, partimos da clínica para questionar a teoria, permitindo enriquecê-la, como queria Freud desde o início, quando observava que, em psicanálise, não há teoria sem clínica. Apesar de nos basearmos em autores psicanalistas, não deixamos de implicar referências em autores dos campos da conexão da psicanálise, que muitas vezes trazem elementos fundamentais para o afinamento pretendido. Terminamos com a apresentação de um caso para exemplificar as questões que nos levaram à pesquisa.

Additive manufacturing to veterinary practice: recovery of bony defects after the osteosarcoma resection in canines

The paper outlines the achievements and challenges in the additive manufacturing (AM) application to veterinary practice. The state-of-the-art in AM application to the veterinary surgery is presented, with the focus of AM for patient-specifi c implants manufacturing. It also provides critical discussion on some of the potential issues design and technology should overcome for wider and more eff ective implementation of additively manufactured parts in veterinary practices. Most of the discussions in present paper are related to the metallic implants, manufactured in this case using so-called powder bed additive manufacturing (PB-AM) in titanium alloy Ti–6AL–4V, and to the corresponding process of their design, manufacturing and implementation in veterinary surgery. Procedures of the implant design and individualization for veterinary surgery are illustrated basing on the four performed surgery cases with dog patients. Results of the replacement surgery in dogs indicate that individualized additively manufactured metallic implants signifi cantly increase chances for successful recovery process, and AM techniques present a viable alternative to amputation in a large number of veterinary cases. The same time overcoming challenges of implant individualization in veterinary practice signifi cantly contributes to the knowledge directly relevant to the modern medical practice. An experience from veterinary cases where organ-preserving surgery with 3D-printed patient-specifi c implants is performed provides a unique opportunity for future development of better human implants.

Chikungunya, enfermedad emergente en América Latina. Descripción de los primeros casos en Chile / Chikungunya, emerging disease in Latin America. Description of the first cases in Chile

Resumen Introducción: Chikungunya (CHIK) se introduce en América el año 2013 diseminándose rápidamente. En 2014, se diagnosticó el primer caso importado en Chile. Objetivos: Identificar pacientes con sospecha clínica de CHIK. Describir sus características clínicas y laboratorio. Pacientes y Métodos: Se enrolaron pacientes con sospecha de CHIK. Se confirmó mediante reacción de polimerasa en cadena (RPC), IgM o IgG CHIKV. Se aplicó encuesta con preguntas demográficas, características del viaje, manifestaciones clínicas y laboratorio a pacientes y médicos tratantes. Resultados: Se enrolaron 21 pacientes, confirmando CHIK en 16 que se analizaron; 12 mujeres (75%), promedio edad 39 años (27-52). Exposición más frecuente fue el Caribe y Sudamérica. El síntoma inicial fue artralgia en 63%. Los síntomas más frecuentes fueron mialgias y malestar general (100%), fiebre y poliartralgia (94%). La mediana de duración de artralgias 90 días (3-262 días) y en 53% > 3 meses. Las articulaciones más comprometidas fueron tobillos, manos y muñecas, 87% con dolor invalidante. La artritis duró más en hombres que en mujeres (p < 0,001). El 38% de pacientes presentó linfopenia y un paciente trombocitopenia leve. Hubo dos hospitalizaciones por cefalea y pielonefritis aguda. Conclusiones: Chikungunya debe sospecharse en viajeros que regresan febriles y con poliartralgias intensas. Medidas de prevención deben ser indicadas a viajeros a zonas de riesgo.

Background: Chikungunya (CHIK) was introduced in The Americas in 2013, spreading rapidly. In 2014, the first imported case was diagnosed in Chile. Aim: To identify patients with clinical suspicion of CHIK and describe their clinical and laboratory characteristics. Patients and Methods: Patients with suspected CHIK were enrolled. All were confirmed by PCR, IgM or IgG CHIK. A structured survey was applied, which included demographic questions, travel characteristics, clinical manifestations, and laboratory results. Results: 21 patients were enrolled and CHIK was confirmed in 16, who were further analyzed; 12 were female (75%), average age 39 years (27-52). The Caribbean and South Americawere the most frequent sites of exposure. In 63%, the initial symptom was arthralgia. Most frequent symptoms were myalgias, malaise (both 100%), fever, and polyarthralgia (both 94%). The median duration of arthralgias was 90 days (3-262); in 53% arthralgias lasted ≥ 3 months. Main joints involved were ankles, hands, and wrists; 87% reported invalidating pain. Arthritis lasted longer in men than in women (p < 0.001). 38% of patients presented lymphopenia and one patient mild thrombocytopenia. Two patients required hospitalization, one with severe headaches, the other with acute pyelonephritis. Conclusions: Chikungunya should be suspected in returning travelers presenting with fever and severe polyarthralgia. Travelers to endemic areas should apply prevention measures to avoid mosquito bites.

La cuestión del método en bioética clínica: aproximación a una metodología adaptada al contexto de la realidad mexicana / The Question of Method in Clinical Bioethics: Approach to a Methodology Adapted to the Context of Mexican Reality / A questão do método em bioética clínica: aproximação a uma metodologia adaptada ao contexto da realidade mexicana

Resumen Este artículo trata la problemática del método para el abordaje bioético de los casos clínicos desde la bioética y analiza las distintas metodologías existentes, resaltando sus aportes y fortalezas, así como sus dificultades. Igualmente, se brindan herramientas de reflexión para la implementación de una metodología adaptada a la realidad mexicana, en las cuales se destacan las características propias de México en el análisis y discernimiento bioético.

Abstract The article deals with the problem of method for a bioethical approach to clinical cases from the standpoint of bioethics, and analyzes the various methodologies that exist, highlighting their contributions and strengths, as well as their difficulties. Tools for reflecting on how to implement a methodology adapted to the context of contemporary Mexican reality are provided as well. They underscore the characteristics particular to Mexico in bioethical analysis and discernment.

Resumo Este artigo trata da problemática do método para a abordagem bioética dos casos clínicos a partir da bioética e analisa as diferentes metodologias existentes, salientando suas contribuições e fortalezas, bem como suas dificuldades. Além disso, oferecem-se ferramentas de reflexão para a implantação de uma metodologia adaptada à realidade mexicana, nas quais se destacam as características próprias do México na análise e no discernimento bioético.

Utilidad de la discusión de casos clínicos en la enseñanza de pregrado de los estudiantes de medicina

La educación superior se encuentra enfrascada en un constante proceso de mejoras en la calidad de la enseñanza. La carrera de medicina no se encuentra ajena a esta situación y busca alternativas que acerquen cada vez más a los estudiantes de pre grado a un entorno similar al que se enfrentaran una vez que estén graduados. Una alternativa ideal a los problemas de espacio hospitalario son las discusiones de casos clínicos donde si se sigue una metodología correctamente estructurada se logra acercar a los estudiantes a las situaciones reales de la práctica médica cotidiana. Se realiza una revisión bibliográfica con el objetivo de identificar y dar a conocer los elementos organizativos y metodológicos que se deben de seguir para llegar a la feliz realización de la discusión de casos clínicos

Higher education is involved in a constant process of improvements in the quality of education. The medical career is not unaware of this situation and seeks alternatives that will bring more and more students of undergraduate students to an environment similar to the one they will face once they graduate. An ideal alternative to the problems of hospital space are the discussions of clinical cases where, if a properly structured methodology is followed, students are brought closer to the real situations of daily medical practice. A bibliographic review is carried out with the objective of identifying and making known the organizational and methodological elements that must be followed to arrive at the successful completion of the discussion of clinical cases

Retrospective analysis of literatures about 5 145 cases of gastrointestinal Dieulafoy lesion in China / 中华消化杂志

Objective To explore the clinical characters,treatment and prognosis of gastrointestinal Dieulafoy lesion in China.Methods Dieulafoy was used as search term,the literatures about Chinese patients with Dieulafoy lesions from January 1998 to October 2016 were retrieved in the Chinese literature library including China National Knowledge Infrastructure,VIP network,Wanfang database and China Biology Medicine disc,and a total of 515 literatures,5 145 patients were enrolled and analyzed.The gender,age,geographical distribution,location of the lesion,treatment and prognosis of the disease were summarized.Results Among the 5 145 patients (male 3 959,female 1 186) with Dieulafoy disease,the ratio of male to female was 3.34∶1.00.The age was from 3 to 95 years,and mean age was 51 years.The lesion location was mainly in stomach (88.82％,4 570/5 145) and second was small intestine (8.28％,426/5 145).In stomach,the lesions were mainly located in gastric corpus,fundus and cardia.The small intestinal Dieulafoy lesions were mainly located in duodenum.The main manifests were sudden hematemesis,melena,and hematochezia.The treatments mainly was endoscopic treatment (72.56％,3 733/5 145),and second was surgery (25.27％,1 300/5 145).Among the5 145 patients withDieulafoy disease,5 099 patients (99.11％) were cured and 46 patients (0.89％) died.The proportions of endoscopic treatment,interventional therapy and first endoscopic treatment within 24 hours in tertiary hospitals were all higher than those of nontertiary (all P＜0.01).The cure rate of tertiary hospitals (99.22％,3 674/3 793) was significantly higher than that of nontertiary hosptials (98.54％,1 421/1 442) (x2 =0.89,P＜0.05) and the mortality was significantly lower than that of nontertiary hospitals (P＜ 0.05).Conclusions The male is more susceptible to Dieulafoy lesion which occurred at any age than the female in China.The predilection sites of Dieulafoy lesion were stomach and duodenum.The primary treatments were endoscopic treatment and surgery,and the disease usually had a good prognosis.

Construction of Clinical Case Picture Database / 医学信息学杂志

Through the construction practice of the optic nerve disease picture database,the paper discusses the system architecture,database field,data content,picture processing,organization and implementation,and other issues about the construction of the clinical case picture database,states and analyzes the operation effect,points out deficiencies,and provides reference for the construction of relevant picture databases.

Discussion of the clinical case oriented management model / 中国实用护理杂志

Objective To explore the effect of the clinical case oriented management model on nurses comprehensive ability, psychological and critical mind. Methods In 2014 on the implementation ofroutine clinical case management modelas the control group, collected 97 cases of clinical cases. In 2015 on the implementation ofthe clinical case oriented management modelas the observation group, collected 110 cases of clinical cases. Compared two methods of management to improve the nurse management theoretical knowledge, clinical practice ability and deal with the size of the case skills help. When/after clinical special case found the influence for nurses, including psychology, work in the nursing work will, enthusiasm, independent ability to deal with related cases and the nurse critical thinking ability, etc. Results The proportion of the nurses thought that it was helpful to improve the management of theoretical knowledge, clinical practice ability and deal with the size of the case skills and the case analysis of satisfaction were 98.79%(244/247), 99.19%(245/247), 98.79%(244/247), 99.60%(246/247) in the observation group, and 88.57%(217/245), 87.35%(214/245), 87.76%(215/245), 90.61%(222/245) in the control group. The differences were statistically significant (χ2=21.390-27.571, P < 0.01). The proportion of the nurse considered that special case on the psychological effects of nursing work, engaged in the willingness and enthusiasm were the main factor were 15.79%(39/247), 13.77%(34/247), 11.34%(28/247) in the observation group, and 31.84%(78/245), 31.02%(76/245), 30.61%(75/245) in the control group. The differences were statistically significant (χ2=17.475, 21.097, 27.611, P < 0.01). After special case, the percentage of nurses to independently handle the case, help others, loss rates were 97.57%(241/247), 2.02% (5/247), 0.40% (1/247) in the observation group, and 85.71% (210/245), 12.24% (30/245), 2.04% (5/245) in the control group. The proportion of nurses to independently handle the case in the observation group was higher than that in the control group, but the ratio of nurses to help others, loss rates in the observation group were lower than those in the control group, the differences were statistically significant (χ2=22.647, P<0.01).Critical thinking score, the observation group of nurses in the search for truth, open mind, analytical ability, system organization, judging thinking self-confidence, curiosity, cognitive maturity, such as total score were respectively (43.24±4.01), (43.03±4.12), (47.66±4.23), (44.21± 3.92), (44.00 ± 4.97), (52.13 ± 4.44), (48.23 ± 4.85), (319 ± 14.57) points. The control group nurses were respectively (39.00±3.56), (38.90±3.28), (43.65±2.47), (40.55±1.99), (39.00±3.40), (47.87±4.01), (41.89± 5.11), (292.23 ± 6.02) points. The differences were statistically significant(t =12.15-24.19, P < 0.01). Conclusions The clinical case oriented management model can improve nurses comprehensive ability, reduce the adverse impact of the special case for nurses, improve the clinical nurses' critical thinking ability, to ensure patient safety.

Guía metodológica para elaborar el diagnóstico fisioterapéutico según la Clasificación Internacional del Funcionamiento (CIF), de la discapacidad y de la salud / Methodological guide for preparing the physiotherapy diagnosis according to the International Classification of Functioning (CIF), disability and health

El presente artículo tiene como objetivo plantear una guía metodológica que permita a los estudiantes de la Carrera de Fisioterapia y Kinesiología unificar criterios para desarrollar los procesos diagnósticos desde el enfoque biopsicosocial, a partir de las evidencias obtenidas en la evaluación inicial y tomando como base la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF). La idea surge a raíz de las dificultades que se tiene en la formulación del diagnóstico fisioterapéutico, más allá del referente “enfermedad”, asumiendo una identidad propia desde su objeto de estudio como es la función - disfunción del movimiento humano. Se propone el uso de la CIF porque incorpora en su estructura categorías desde la perspectiva corporal, individual y social, los cuales tienen relación estrecha con la naturaleza y niveles de estudio de la Fisioterapia y Kinesiología. Solo así se provee un marco inicial que dinamiza la organización de datos y opiniones clínicas facilitando un sistema de clasificación de acuerdo con las funciones y estructuras corporales, las actividades corporales y la participación en las actividades de la vida diaria, así como la identificación de barreras o facilitadores en el entorno ambiental y las características individuales que forman parte del estado de salud de las personas.

This article aims to raise a methodological guide that allows students of the School of Physiotherapy and Kinesiology unify criteria to develop diagnostic processes from the biopsychosocial approach, based on the evidence obtained in the initial evaluation and based on the ranking International of Functioning, Disability and Health (ICF). The idea stems from the difficulties you have in the formulation of physiotherapy diagnosis, beyond the reference “disease”, assuming an identity from its subject as it is the function - dysfunction of human movement. The use of ICF is proposed that incorporates in its structure categories from body, individual and societal perspective, which are closely related to the nature and levels of study of physiotherapy and kinesiology. Only then an initial framework that streamlines the organization of data and clinical opinion facilitating a classification system according to body functions and structures, bodily activities and participation in activities of daily living, as well as identifying barriers is provided or facilitators in the ambient environment and the individual characteristics that are part of the health status of people.

METODOLOGÍA PARA EL ANÁLISIS DE CASOS CLÍNICOS EN LOS COMITÉS DE BIOÉTICA: ENFOQUES Y PROPUESTAS DE APOYO / METHODOLOGY FOR ANALYZING CLINICAL CASES IN BIOETHICS COMMITTEES: APPROACHES AND PROPOSED SUPPORT / METODOLOGIA PARA A ANÁLISE DE CASOS CLÍNICOS NOS COMITÊS DE BIOÉTICA: ENFOQUES E PROPOSTA DE APOIO

El presente trabajo examina y evalúa los modelos y las metodologías más importantes para la resolución de casos clínicos: 1) el principialismo, 2) el deontologismo, 3) el consecuencialismo, 4) la casuística, 5) la ética de la virtud y 6) la ética centrada en la persona (o ética "personalista"). Se sopesan las fortalezas y debilidades de cada una y se propone, además, un instrumento que facilite este tipo de análisis. Como grupo, se opta por una metodología que articula tres modelos: el enfoque de la virtud, el enfoque centrado en la persona y estos dos en armonía con una ética centrada en los principios. Las razones para esta opción integral están basadas, fundamentalmente, en el reconocimiento de la supremacía de la dignidad de la persona humana y de que las situaciones clínicas complejas requieren de una mirada integral tanto de la persona como de la práctica clínica. Esta última requiere de virtudes, principios éticos y del reconocimiento del ser humano como un ser dotado de dignidad intrínseca y, a su vez, como fundamento de la ética y de la práctica clínica.

This paper examines and evaluates the models and the most important methods for solving clinical cases; namely, 1) principlism, 2) deontologism, 3) consequentialism, 4) casuistry, 5) virtue ethics and 6) ethics centered on the person (or "personalist" ethics). The strengths and weaknesses of each are weighed and an instrument is proposed to facilitate this type of analysis. As a group, the preference is for a methodology that articulates three models: the virtue approach, the person-centered approach, and these two in harmony with an ethics centered on principles. The reasons for this comprehensive option are based primarily on recognition of the primacy of the dignity of the human person and on acknowledgement that complex clinical situations require a comprehensive view of both the person and clinical practice. The latter requires virtues, ethical principles and recognition of the human person as being endowed with inherent dignity and, in turn, as the foundation of ethics and clinical practice.

Este trabalho examina e avalia os modelos e as metodologias mais importantes para a resolução de casos clínicos: 1) o principialismo; 2) a deontologia; 3) o consequencialismo; 4) a casuística; 5) a ética da virtude e 6) a ética centralizada na pessoa (ou ética "personalista"). Consideram-se as fortalezas e as debilidades de cada uma e propõe-se, além disso, um instrumento que facilite esse tipo de análise. Como grupo, opta-se por uma metodologia que articula três modelos: o enfoque da virtude, o enfoque centralizado na pessoa e esses dois em harmonia com uma ética focada nos princípios. As razões para essa opção integral estão baseadas, fundamentalmente, no reconhecimento da supremacia da dignidade da pessoa humana e de que as situações clínicas complexas requerem de um olhar integral tanto da pessoa quanto da prática clínica. Esta última exige virtudes, princípios éticos e reconhecimento do ser humano como um ser dotado de dignidade intrínseca e, por sua vez, como fundamento da ética e da prática clínica.

Análise combinada de casos homeopáticos de alta qualidade / Combined analysis of high-quality homeopathic cases

Um protocolo para Relato de Casos Clínicos Homeopáticos de Alta Qualidade (RCCHAQ) foi desenvolvido por C.N. Cámpora, tendo coerência interna como critério principal, além de categorizar a documentação clínico-patológica que fundamenta o diagnóstico e a pretensão de sucesso terapêutico. A análise conjunta de 4 estudos, no presente trabalho, permitiu elucidar como RCCHAQs podem ser utilizados para avaliar os efeitos da homeopatia hahnemanniana clássica em doenças crônicas de longa evolução. Todos os casos foram tratados de acordo com o método desenvolvido por Cámpora, denominado Fórmula Homeopática de Diagnóstico do Simillimum (FHDS). A duração média das queixas antes d tratamento homeopático foi de 5,4 anos e os casos foram acompanhados por 3 anos em média. Os casos estão completamente documentados em vídeo, atestados assinados, registros de testemunhas, resultados laboratoriais e escalas de dor e qualidade de vida. Todas as pacientes relataram mudanças substanciais, definidas como cura (melhora de mais de 90%) dos sintomas locais, gerais e mentais acompanhando uma profunda transformação de sua atitude vital, descrita como uma sensação de paz, liberdade ou felicidade, segundo a definição do Banco de Relato e Estudo de Casos Homeopáticos de Argentina (BRECHA]. Em todos os casos a medicação convencional prévia foi suspensa num período de 1 a 3 meses. Os resultados mostram que RCCHAQs contribuem a tornar os relatos de cais um recurso confiável no contexto da moderna medicina baseada em evidências, assim como podem ajudar a melhorar o desenho de estudos homeopáticos prospectivos, incluindo ensaios clínicos placebo-controlados.

A High Quality Homeopathic Clinical Case Report (HHQCR) Protocol exhaustively including requisites to constitute a reliable documented clinical report was developed by C.N. Cámpora. The protocol requires measuring homeopathic internal coherence and categorizes clinicalpathological backing documentation. Through joint analysis of 4 cases the present study elucidates how HHQCRs can be used to assess the effects of classical Hahnemannian homeopathy on longstanding chronic diseases. The mean duration of complaints before homeopathic treatment was 5.4 years and the duration of follow up 3 years on average. Cases are fully documented with complete video-recordings of consultations, signed certifications, third party recorded statements, laboratory results and pre-post treatment pain and quality-of-life scales. All the patients reported substantial change, defined as cure (>90% improvement) of local, general and mental symptoms accompanying a deep transformation their life attitude described as a feeling of peace, freedom or happiness. Also all of them were able to discontinue previous conventional treatment within the first 1 to 3 months of homeopathic treatment. The results show that HHQCRs contributes to make case reports a reliable resource within the context of modern evidence-based medicine and might help improving the design of prospective homeopathic studies, including randomized placebo-controlled trials.