Sexual dimorphism in the mandible in a Portugese population - Predicting the gender for forensic purpose: a pilot study / Dimorfismo sexual mandibular da população Portuguesa ­ Predição do gênero para análise forense: um estudo piloto

Este estudo teve como objetivo avaliar o dimorfismo sexual em uma coleção de mandíbulas portuguesas através de uma metodologia métrica digital, utilizando análise estatística descritiva, inferencial e multivariada para identificar quais parâmetros são mais dimórficos e quais são os melhores preditores de sexo. Trinta e três mandíbulas (14 mulheres e 19 homens) e pertences pessoais foram fotograficamente registrados com código e sexo. Os dados foram coletados por tomografia e as medidas foram feitas pelo software Simplant Pro. Foram registrados a largura máxima e mínima do ramo mandibular, altura condilar, altura do processo coronoide, altura da sínfise mandibular, ângulo mandibular, distâncias bimentual, biantegonial, bigonial e bicondilar e comprimento máximo mandibular. A análise estatística foi realizada utilizando IBM® SPSS. Os resultados mostraram diferenças estatisticamente significativas para os seguintes parâmetros: altura do processo coronoide, altura do côndilo, comprimento máximo da mandíbula e largura mínima do ramo mandibular. Na análise estatística multivariada foi possível identificar a altura do processo coronoide como melhor preditor de sexo com precisão em 72,2% dos casos. Isto permite uma diferenciação mais fácil entre mandíbulas femininas e masculinas com uma precisão de 64,3% e 78,9%, respectivamente. Foi possível concluir que a altura do processo coronoide é o parâmetro mais dimórfico e o melhor preditor de sexo na amostra.

This study aimed to assess sex dimorphism in a collection of Portuguese mandibles through a digital metric methodology by using descriptive, inferential, and multivariate statistical analysis to identify which parameters are the most dimorphic and which are the best sex predictors. Thirty-three mandibles (14 females and 19 males) and personal belongings were photographically registered with code and sex. Data was collected using tomography, and measurements were made using the Simplant Pro software. The maximum and minimum width of the mandibular ramus, condylar height, coronoid process height, mandibular symphysis height, mandibular angle, bi-mental, bi-antegonial, bi-gonial and bi-condylar distances, and maximal mandibular length were registered. Statistical analysis was performed using IBM® SPSS. The results showed statistically significant differences for the following parameters: coronoid process height, condyle height, the maximum length of the mandible, and the minimum width of the mandibular ramus. In the multivariate statistical analysis, it was possible to identify the coronoid process height as the best sex predictor accurately in 72.2% of cases. This allows for easier differentiation between female and male mandibles with an accuracy of 64.3% and 78.9%, respectively. It was possible to conclude that the coronoid process height is the most dimorphic parameter and the best sex predictor in the sample.

Diagnóstico diferencial e opções de tratamento da úlcera aftosa recorrente: revisão narrativa da literatura / Differential diagnosis and treatment options of recurrent aphrhous ulcer: narrative literature review

Resumo: A úlcera aftosa recorrente (UAR) é uma lesão frequente na mucosa oral de etiologia variada e subdividindo-se clinicamente úlceras menores, maiores e hepertiformes. Caracterizada por formato ovoide, recoberto por uma pseudomembrana e um halo eritematoso, seu diagnóstico é essencial para distinguir outras lesões e o tratamento se faz necessário para tratar a lesão e prevenir recorrências. Desta maneira, o presente estudo teve como objetivo descrever de forma analítica sobre o diagnóstico diferencial e o tratamento da UAR em cavidade oral. Tratou-se de um estudo descritivo, exploratório caracterizado como revisão narrativa da literatura. Os critérios de inclusão estabelecidos foram: estudos que abordassem essa temática, com idiomas inglês e português. O levantamento ocorreu em agosto/2023 a janeiro/2024, através das buscas eletrônicas PubMed, LILACS, SciELO, além da literatura cinzenta Google acadêmico e busca livre secundária. Os Descritores em Ciências da Saúde (DeCS/MeSH) foram cruzados com o operador booleano: "differential diagnosis" AND "aphthous ulcer". A UAR é caracterizada por úlceras arredondadas superficiais que pode persistir por dias ou meses. O seu diagnóstico é fundamentado no histórico do paciente e nas características da lesão. É crucial eliminar possíveis causas de úlceras orais, para evitar confusão com outras lesões, como úlceras traumáticas, imunomedia das ou até mesmo um carcinoma. Diversas terapias são empregadas no manejo da UAR, tais como corticosteroides, suplementos vitamínicos, ozonioterapia e o laser de baixa potência. Portanto, compreender o histórico das lesões é fundamental para diferenciação e diante da diversidade de terapias, é essencial ter estudos que dê esse enfoque.

Abstract: Recurrent Aphthous Ulcer (RAU) is a common lesion in the oral mucosa with varied etiology, clinically subdivided into minor, major, and herpetiform ulcers. Characterized by an ovoid shape, covered by a pseudomembrane and erythematous halo, its diagnosis is essential to distinguish it from other lesions, and treatment is necessary to address the injury and prevent recurrences. Thus, the present study aimed to analytically describe the differential diagnosis and treatment of RAU in the oral cavity. It was a descriptive, exploratory study characterized as a narrative literature review. Inclusion criteria were established as studies addressing this theme in English and Portuguese. The survey took place from August 2023 to January 2024, through electronic searches on PubMed, LILACS, SciELO, in addition to grey literature such as Google Scholar and secondary free searches. Health Sciences Descriptors (DeCS/MeSH) were crossed with the boolean operator: "differential diagnosis" AND "aphthous ulcer." RAU is characterized by round, superficial ulcers that may persist for days or months. Its diagnosis is based on the patient's history and the characteristics of the lesion. It is crucial to eliminate possible causes of oral ulcers to avoid confusion with other lesions, such as traumatic, immunomediated, or even carcinoma ulcers. Various therapies are employed in the management of RAU, such as corticosteroids, vitamin supplements, ozone therapy, and low-level laser. Therefore, understanding the history of lesions is fundamental for differentiation, and given the diversity of therapies, studies focusing on this aspect are essential.

Optic disc edema and visual loss from paracentral acute middle maculopathy mimicking optic neuritis

ABSTRACT Optic neuritis is an important cause of unilateral and acute visual loss in young adults, but other differential diagnoses should be considered, especially when the disease has an atypical presentation. This report presents the case of a young woman with reduced visual acuity in her right eye, associated with optic disc edema and a relative afferent pupillary defect, that was initially misdiagnosed as optic neuritis and subsequently found to have paracentral acute middle maculopathy, possibly secondary to subtle impending central retinal vein occlusion. This case emphasizes the need to remember that retinal vascular diseases can occasionally mimic optic neuritis. Detailed anamnesis and ophthalmic examination can avoid unnecessary interventions.

Guardians of the ocular surface: lessons learned from a challenging case of Langerhans cell histiocytosis with eyelid involvement

ABSTRACT Langerhans cell histiocytosis comprises a heterogeneous range of clinical manifestations secondary to clonal proliferation of histiocytes, characterized by the accumulation of these cells in various organs and tissues. The ophthalmological component commonly involved is the orbit. Herein, we report a rare case of Langerhans cell histiocytosis with eyelid involvement, which resulted in severe ocular surface complications, which subsequently significantly impacted the patient's quality of life. This case report highlights the fact that despite being rare, Langerhans cell histiocytosis should be included in the differential diagnosis of eyelid lesions. Furthermore, a multidisciplinary approach with a systemic overview is crucial for managing the ocular complications.

Retinoblastoma in Ceara: An epidemiological study in a Brazilian pediatric oncology referral center

ABSTRACT Purpose: Although Brazil has a high prevalence of retinoblastoma, there is a lack of epidemiological data on the disease. Thus, in this study, we aimed to evaluate the epidemiological profile of patients diagnosed with retinoblastoma in the ophthalmology department of a pediatric tertiary referral hospital in Ceara, Brazil. Methods: A descriptive and cross-sectional study was conducted by retrospectively analyzing the clinical and socioeconomic data from the medical records of pediatric patients followed-up at the hospital between 2007 and 2021. Retinoblastoma was diagnosed on the basis of a fundoscopic or histopathologic examination. Results: The data of 105 patients were included in the study, and the mean patient age at the time of diagnosis was 1.7 years. Most of the patients were women (50.5%) and hailed from rural areas (57.4%), which was associated with a higher tumor stage. Of the 150 patients, 57.1% initially presented with leukocoria. Ocular hyperemia was associated with more advanced stages of retinoblastoma (p=0.004). Bilateral involvement was observed in 25.7% of the patients and at a significantly younger age (p=0.009). The presence of retinal detachment, vascularized lesions, and vitreous seeds significantly increased the likelihood of requiring enucleation. Discussion: This study presents an epidemiological description of retinoblastoma in Brazil, which highlights the significance of early detection. Delayed diagnosis is associated with a poorer visual prognosis and higher mortality rate, particularly in patients with unilateral disease. Risk factors for a more severe disease were retinal detachment, vascularized lesions, and vitreous seeds. The correlation between histopathological features and clinical outcomes was limited. Conclusion: Further studies are required to assess the influence of ocular hyperemia, fundoscopic assessment, and histopathologic findings on the prognosis of retinoblastoma. Moreover, it is critical to devise interventions to reduce the time-to-diagnosis in rural areas.

Rare case of mantle cell lymphoma of the lacrimal sac

ABSTRACT Mantle cell lymphoma of the ocular and periorbital regions is extremely rare but should be considered in the differential diagnosis of lesions affecting the periorbital tissues. In this study, we present a rare case of mantle cell lymphoma of the lacrimal sac in a 65-year-old male presenting with a mass in the lacrimal sac region and epiphora. After clinical examinations and imaging studies, the mucocele was misdiagnosed. Considering the unexpected findings during external dacryocystorhinostomy, a frozen biopsy was performed, which confirmed the diagnosis of lymphoma.

Anterior lamellar corneoscleral keratoplasty for the management of corneal thinning following treatment with mitomycin-C and interferon to treat highly suspected ocular surface squamous neoplasia: a case report

ABSTRACT A patient presented with corneoscleral thinning five months after the treatment of suspected ocular squamous surface neoplasia with mitomycin-C and interferon. For tectonic and aesthetic purposes, we decided to perform lamellar corneoscleral transplantation. The approach used established new tectonic support and corneal homeostasis. This technique might be an option in similar cases.

Clinical, epidemiological, and care profile of hospitalized patients with retinoblastoma in Brazil

ABSTRACT Purpose: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil. Methods: Using data from the Hospital Cancer Registry of the Instituto Nacional de Câncer, patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0-19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20-75, >75 cases). Results: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1-14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals. Conclusions: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services.

Percepción del paciente sobre factores de riesgo que vulneren la dignidad humana durante la hospitalización: estudio transversal en un hospital público de Tamaulipas, México

Introducción: El ser humano que enferma, a veces necesita ser hospitalizado para establecer su homeostasis. Este proceso lo vuelve vulnerable, ya que asume el "estatus de paciente", que afecta también aspectos psico-afectivos y puede hacerlo sentir como un objeto debido al trato de los profesionales de salud que, en ocasiones, es poco empático. Esto produce emociones negativas que generan afecciones para la salud y prolongan la recuperación, lo que a su vez eleva el costo asociado a días de hospitalización. Objetivo: Identificar factores de riesgos que vulneren la dignidad humana de pacientes hospitalizados. Metodología: Estudio descriptivo, cuantitativo. Se identifican factores de riesgo percibidos por pacientes a través del Cuestionario de Percepción de Dignidad de Paciente Hospitalizado (CuPDPH) y del diagnóstico enfermero "Riesgo de compromiso de la dignidad humana 00174" de la NANDA-I. Resultados: De la muestra de 60 pacientes (16 hombres y 44 mujeres), el ítem con mayor puntuación fue "me han llamado por mi nombre" (M = 4.73; DE = 0.84) y el menor, "en ocasiones me he sentido como un objeto" (M = 1.75; DE = 1.29). Asimismo, el factor de riesgo "comprensión inadecuada de la información de salud" fue el más presente (65 %) y "valores incongruentes con las normas culturales" el menos presente (1.7 %). Conclusión: Los factores de riesgo más percibidos por los pacientes en la unidad de salud fueron relacionados con su intimidad, integridad, comprensión de información y privacidad, por lo que es importante estudiar esta variable e intervenirla

Introdução: O ser humano que adoece, por vezes, necessita ser hospitalizado para restabelecer sua homeostase. Esse processo o torna vulnerável, pois ele assume o "estado de paciente", o que também afeta os aspectos psicoafetivos e pode fazer com que se sinta como um objeto devido ao tratamento por parte dos profissionais de saúde, que, em algumas ocasiões, é pouco empático. Isso gera emoções negativas, que afetam a saúde e prolongam a recuperação, o que, por sua vez, eleva o custo associado aos dias de hospitalização. Objetivo: Identificar fatores de risco que vulneram a dignidade humana de pacientes hospitalizados. Metodologia: Estudo descritivo, quantitativo. Foram identificados fatores de risco percebidos pelos pacientes por meio do Questionário de Percepção de Dignidade do Paciente Hospitalizado (CuPDPH) e do diagnóstico de enfermagem "Risco de comprometimento da dignidade humana 00174" da NANDA-I. Resultados: Da amostra de 60 pacientes (16 homens e 44 mulheres), o item com maior pontuação foi "me chamaram pelo meu nome" (M = 4,73; DP = 0,84) e o menor foi "às vezes me senti como um objeto" (M = 1,75; DP = 1,29). Além disso, o fator de risco "compreensão inadequada das informações de saúde" foi o mais presente (65 %) e "valores incongruentes com as normas culturais" o menos presente (1,7 %). Conclusão: Os fatores de risco mais percebidos pelos pacientes na unidade de saúde estavam relacionados à sua intimidade, integridade, compreensão das informações e privacidade, sendo, portanto, importante estudar essa variável e intervir

Introduction: The human being who gets sick, sometimes needs to be hospitalized to establish his homeostasis. This process makes him/her vulnerable, as he/she assumes the "patient status", which also affects psycho-affective aspects and can make him/her feel like an object due to the treatment of health professionals, which is sometimes not very empathetic. This produces negative emotions that generate health conditions and prolong recovery, which in turn increases the cost associated with days of hospitalization. Objective: To identify risk factors that violate the human dignity of hospitalized patients. Methodology: Descriptive, quantitative study. Risk factors perceived by patients were identified through the Hospitalized Patient Dignity Perception Questionnaire and the NANDA-I nursing diagnosis "Risk of compromise of human dignity 00174". Results: Of the sample of 60 patients (16 men and 44 women), the item with the highest score was "I have been called by name" (M = 4.73; SD = 0.84) and the lowest, "I have sometimes felt like an object" (M = 1.75; SD = 1.29). Likewise, the risk factor "inadequate understanding of health information" was the most present (65 %) and "values incongruent with cultural norms" the least present (1.7 %). Conclusion: The risk factors most perceived by patients in the health unit were related to their intimacy, integrity, understanding of information and privacy, so it is important to study this variable and intervene in it.

Evaluation of the level of information of pediatricians about the diagnosis and management of cryptorchidism

Abstract Objective Evaluate the level of information of pediatricians about the diagnosis and management of cryptorchidism. Method A cross-sectional observational study was conducted using a form via the "Google Forms" platform. The study population included pediatricians and pediatric residents associated with the Brazilian Society of Pediatrics. Seven hundred twenty-eight responses were recorded and analyzed using IBM SPSS v21. Results 728 valid responses were obtained. Of these answers, only 20.5 % answered that the physical examination was sufficient for the diagnosis, and 79.4 % responded that they requested ultrasound as the best test to aid in diagnosing cryptorchidism. When questioned about the ideal age for referring a patient with cryptorchidism, the survey recorded 56.3 % of the responses defending the correct age as six months old, 30.2 % shortly after birth, and 13.2 % at two years old. Other topics were addressed in the form, such as the frequency of evaluation of testicular position and investigation for DDS, among others. Still, the answers to these questions were compatible with current manuals and guidelines on cryptorchidism. Conclusion It is evident that the understanding of the professionals consulted about the diagnosis and management of cryptorchidism needs to be updated with the current practices adopted and that pediatricians, in general, must maintain periodic programs on this subject. Therefore, this topic should be part of a continuing education program with pediatric surgery.

Métodos diagnósticos de la encefalopatía hepática en la atención primaria de salud: Revisión sistemática

La encefalopatía hepática consiste en la disfunción o deterioro cerebral, consecuente a afecciones como insuficiencia hepática e hipertensión portal, en el ámbito médico es catalogada como una grave complicación clínica asociada al daño hepático severo. Se llevó a cabo un estudio cualitativo de revisión sistemática aplicando la declaración PRISMA 2020, en donde se utilizó los documentos disponibles en las diferentes bases de datos y con la aplicación de los operadores booleanos para su búsqueda. De los documentos seleccionados se pudieron obtener 840 referencias de información en una primera búsqueda en las bases de datos y 8 registros de datos. Finalmente, para la investigación se consiguió un total de 16 fuentes bibliográficas. La encefalopatía hepática se compone de un síndrome neuro-psiquiátrico que incluye deterioro psicomotor y/o sensitivo, desorientación, incoordinación, alteración de la memoria, confusión, somnolencia, estupor y coma, existen diversas herramientas para el diagnóstico desde el primer nivel de atención, una de las principales es la anamnesis y la exploración física del paciente donde se espera encontrar hallazgos cognitivos y neuromusculares relacionados a la enfermedad hepática grave, entre los estudios complementarios se emplea principalmente exámenes de laboratorio, Criterios de West Haven, prueba psicométrica, prueba neurofisiológica y estudios de neuroimagen como resonancia magnética.

Hepatic encephalopathy consists of brain dysfunction or deterioration, consequent to conditions such as hepatic insufficiency and portal hypertension, and in the medical field it is cataloged as a serious clinical complication associated with severe liver damage. A qualitative study of systematic review was carried out applying the PRISMA 2020 statement, using the documents available in the different databases and Boolean operators for the search. From the selected documents it was possible to obtain 840 references of information in a first search in the databases and 8 data records. Finally, a total of 16 bibliographic sources were obtained for the research. Hepatic encephalopathy is composed of a neuropsychiatric syndrome that includes psychomotor and/or sensory impairment, disorientation, incoordination, memory alteration, confusion, somnolence, stupor and coma, there are several tools for diagnosis from the first level of care, One of the main ones is the anamnesis and physical examination of the patient where it is expected to find cognitive and neuromuscular findings related to severe liver disease, among the complementary studies are mainly used laboratory tests, West Haven Criteria, psychometric test, neurophysiological test and neuroimaging studies such as magnetic resonance imaging.

A encefalopatia hepática consiste na disfunção ou deterioração cerebral, consequente a condições como a insuficiência hepática e a hipertensão portal, e é classificada no domínio médico como uma complicação clínica grave associada a lesões hepáticas graves. Foi efectuado um estudo de revisão sistemática qualitativa aplicando a declaração PRISMA 2020, utilizando os documentos disponíveis nas diferentes bases de dados e operadores booleanos para a pesquisa. A partir dos documentos selecionados, foi possível obter 840 referências de informação numa primeira pesquisa nas bases de dados e 8 registros de dados. Por fim, obteve-se um total de 16 fontes bibliográficas para a investigação. A encefalopatia hepática é uma síndrome neuropsiquiátrica que inclui comprometimento psicomotor e/ou sensorial, desorientação, incoordenação, comprometimento da memória, confusão, sonolência, estupor e coma, e existem várias ferramentas para o diagnóstico no primeiro nível de cuidados, Um dos principais instrumentos é a anamnese e o exame físico do doente, onde se esperam encontrar achados cognitivos e neuromusculares relacionados com a doença hepática grave. Os estudos complementares incluem testes laboratoriais, os critérios de West Haven, testes psicométricos, testes neurofisiológicos e estudos de neuroimagem, como a ressonância magnética.

Linfoma difuso de células B grandes localizado en paladar. Caso clínico / Diffuse B large cells lymphoma located in the palate. Clinical case

Objetivo: Presentar un caso clínico de linfoma no Hodgkin (subtipo difuso de células B grandes) asentado en paladar duro y describir sus particularidades clínicas, imagenológicas e histopatológicas. Teniendo presente la baja ocurrencia del linfoma difuso de células B grandes primario en la cavidad bucal, es oportuno enfatizar la importancia del reconocimiento de esta entidad. Asimismo, es de considerar la dificultad que conlleva su diagnóstico debido a su manifestación clínica inespecífica por lo que, frecuentemente, se confunde con otras entidades patológicas como procesos inflamatorios odontogénicos. Caso clínico: Un paciente de 82 años acude a la consulta estomatológica privada derivado por su odontóloga. El paciente refería una lesión indolora en el paladar de dos meses de evolución. El examen estomatológico confirmó la presencia de un tumor ulcerado. El diagnóstico de la entidad fue confirmado por medio de biopsia con estudio anatomopatológico junto a técnicas de inmunomarcación.(AU)

Aim: To present a clinical case of a non-Hodgkin lymphoma (diffuse large B subtype) located in the hard palate and describe its clinical, imaging and histopathological features. Considering the rare occurrence of primary diffuse large B cell lymphoma in the oral cavity, it is appropriate to emphasize the importance of identifying this entity. In addition, it is significant to note the difficulty that making a diagnosis entails, due to its non-specific clinical manifestation, which is why it is frequently confused with other pathological entities such as odontogenic inflammatory processes. Case report: An 82-year-old male patient was referred to the private dentistry office referred by his dentist. The patient reported a painless lesion on the palate of two months. The stomatological examination confirmed the presence of an ulcerated tumor. The diagnosis of the entity was confirmed by biopsy with anatomopathological study together with immunostaining techniques.(AU)

Surco perineal diagnóstico tardío: a propósito de un caso / Perineal sulcus late diagnosis: about a case

Se presenta caso de preescolar femenina de 3 años, quien presenta un surco perineal o perineal grovee, malformación ano rectal (MAR) baja, caracterizada por un surco perineal que comunica la horquilla vulvar con la región anal. Es necesario conocer dicha MAR ya que puede llevar a confundirse con una agresión sexual, con todas las consecuencias que ello implica, además, de evaluaciones y planteamientos no indicados.

We present the case of a 3-year-old female preschooler with a perineal groove or perineal grovee, a low anorectal malformation (ARM), characterized by a perineal groove that communicates the vulvar fork with the anal region. It is necessary to know this MAR because it can be confused with sexual aggression, with all the consequences that this implies, as well as inappropriate evaluations and approaches.

Acalasia: ¿cómo la diagnosticamos? Nuevas tecnologías / Achalasia: How do we diagnose it? New technologies

Introducción. La acalasia, caracterizada por dismotilidad esofágica, plantea desafíos diagnósticos debido a su presentación variada y baja prevalencia. Aunque su etiología sigue siendo incierta, se implica una disregulación autoinmune. Métodos. Desde una posición reflexiva, se realizó un análisis crítico de la información disponible en las bases de datos, estableciendo las diferentes opciones diagnósticas para acalasia. Resultados. Distinguir la acalasia de afecciones similares, como la enfermedad por reflujo gastroesofágico, es crucial. Los síntomas clave incluyen disfagia, regurgitación, pirosis, dolor retroesternal y pérdida de peso, lo que a menudo conduce a un diagnóstico tardío. Los métodos complementarios abarcan la endoscopia digestiva alta, estudios baritados del esófago, manometría esofágica y tecnologías emergentes, como la sonda de imagen endoluminal funcional (EndoFLIP™). Conclusión. Comprender la presentación clínica de la acalasia y utilizar las modalidades diagnósticas correspondientes facilitan la identificación rápida y el manejo personalizado, asegurando resultados óptimos para los pacientes afectados.

Introduction. Achalasia, characterized by esophageal dysmotility, poses diagnostic challenges due to its varied presentation and low prevalence. While its etiology remains uncertain, autoimmune dysregulation is implicated. Method. From a reflective position, a critical analysis of the information available in the databases was carried out, establishing the different diagnostic options for achalasia. Results. Distinguishing achalasia from similar conditions, such as gastroesophageal reflux disease, is crucial. Key symptoms include dysphagia, regurgitation, heartburn, substernal pain, and weight loss, often leading to delayed diagnosis. Complementary diagnostic methods include upper gastrointestinal endoscopy, barium studies, esophageal manometry, and emerging technologies, like Endoluminal Functional Luminal Imaging Probe (EndoFLIP™). Conclusion. Understanding the clinical presentation of achalasia and using appropriate diagnostic modalities facilitate rapid identification and personalized management, ensuring optimal outcomes for affected patients.

Pityriasis lichenoides: assessment of 41 pediatric patients

Abstract Objectives This study aims to evaluate the characteristics and treatment response of patients with pityriasis lichenoides seen in the last 43 years in a pediatric dermatology service. Methods This was a retrospective, analytical, longitudinal study of patients under 15 years of age. The medical records were reviewed and data were presented as frequencies, means and variances. Student's t-test, Mann-Whitney test, Fisher's exact test, Pearson/Yates chi-square test and multivariate logistic regression model were used, with p < 0.05 considered. Results 41 patients were included, 32 (78.0%) with pityriasis lichenoides chronica (PLC), five (12.2%) with pityriasis lichenoides et varioliformis acuta (PLEVA) and four (9.8%) with clinical PLC without biopsy. The age range of school children and adolescents was 19 (46.3%) and 13 (31.7%) respectively and 27 (65.8%) were male. Two peaks of the highest frequency were observed between 2004 and 2006 (10 patients - 24.4%) and another between 2019 and 2021 (6 patients - 14.7%). There was remission in 71.9% (n = 23), with 56.6% (n = 17) of those who used antibiotic therapy and 80% (n = 4) of those who had phototherapy. The chance of remission was 13 times greater in patients with disease onset after 5 years of age. Conclusions The clinical form most commonly found was PLC mainly in school children and adolescents. The frequency peaks coincided with infectious outbreaks. The remission rate was satisfactory with antibiotic therapy, but higher with phototherapy. Remission was greater in patients with disease onset after 5 years of age.

Defecto del tubo neural: encefalocele occipital. Reporte de caso / Neural Tube Defect: Occipital Encephalocele. A case Report

Resumen El encefalocele es una malformación congénita del sistema nervioso central rara. Se estima que la prevalencia es de aproximadamente 1 de cada 5,000-40,000 recién nacidos vivos. Puede involucrar diferentes sitios anatómicos como la región occipital, frontal, temporal y parietal. La cuarta y quinta semana del desarrollo embriológico son imprescindibles para el desarrollo de la cabeza y el cuello. Cuando existe un fallo en la separación del ectodermo superficial del neuroectodermo, aparecen defectos del tubo neural, en donde se pueden originar los encefaloceles. Genéticamente se puede explicar por la teoría disembriológica, la cual involucra a ciertos genes mutados que interfieren en mecanismos celulares importantes en el desarrollo neural temprano. Actualmente, gracias a las herramientas de cribado prenatal como la ecografía, es posible identificarlos desde la vida intrauterina. Es sumamente importante realizar un diagnóstico temprano para protocolizar y brindar un tratamiento individualizado, en donde se involucrará a un equipo multidisciplinario. A pesar que algunos casos suelen ser compatibles con la vida, el pronóstico dependerá del sitio anatómico involucrado, así como el manejo quirúrgico oportuno. Entre las secuelas más importantes se encuentra el déficit intelectual.

Abstract Encephalocele is a rare congenital malformation of the central nervous system. The prevalence is estimated to be about 1 in 5,000-40,000 live births. It can affect various anatomical locations such as the occipital, frontal, temporal, and parietal regions. The fourth and fifth weeks of embryonic development are critical for the development of the head and neck. When there is a failure in the separation of the superficial ectoderm from the neuroectoderm, neural tube defects occur, from which encephaloceles may arise. Genetically it can be explained by the dysembryological theory, which involves certain mutated genes that interfere with important cellular mechanisms in early neuronal development. Currently, thanks to prenatal screening tools such as ultrasound, it is possible to identify them from intrauterine life. It is extremely important to make an early diagnosis to establish protocols and provide individualized treatment, involving a multidisciplinary team will be involved. Even though some cases are usually compatible with life, the expected prognosis of the anatomical site involved as well as timely surgical management. One of the most important sequelae is intellectual deficit.

Innovative perspectives on the value of diagnostic tests in clinical practice / Perspectivas innovadoras sobre el valor de las pruebas diagnósticas en la práctica clínica

Abstract Diagnostic tests have intrinsic characteristics such as sensitivity, specificity, overall accuracy and likelihood ratios which define their operational performance. It is not uncommon to find in the literature that test value and clinical utility are defined based exclusively on those characteristics. This paper introduces several arguments aimed at prompting a reflection regarding the characteristics that define the true value of diagnostic tests in clinical practice. It concludes with the view that the value of each diagnostic test needs to be established in accordance with the circumstances in which it is used, taking into account extrinsic characteristics such as in whom it is used, when, where and by who.

Resumen Las pruebas diagnósticas tienen características intrínsecas, como la sensibilidad, especificidad, exactitud global y las razones de verosimilitud, que definen su desempeño operacional. No es infrecuente encontrar en la literatura que se valore la prueba y se defina su utilidad clínica exclusivamente de acuerdo con estas características. En este documento se presentan varios argumentos que permiten reflexionar sobre las características que verdaderamente definen el valor de las pruebas diagnósticas en la práctica clínica. Se concluye con una perspectiva en la que el valor de cada prueba diagnóstica se establece de acuerdo con las circunstancias de uso de la misma: de quién, cuándo, dónde y en quién se use la prueba, y todas estas son características extrínsecas de una prueba diagnóstica.

Diaphragmatic Rehabilitation Therapy for the Management of Supragastric Belching: Case Series and Literature Review / Terapia de rehabilitación diafragmática para el manejo del eructo supragástrico: serie de casos y revisión de la literatura

Abstract Belching is a physiological event that allows air to be released from the esophagus or stomach to the pharynx. It can become excessive, bothersome, and difficult to control in some patients, making it a common reason for consultation with a gastroenterologist. This paper aims to present a series of cases from our experience at a gastrointestinal motility reference center in managing patients with supra gastric belching using diaphragmatic rehabilitation therapy and to conduct a literature review.

Resumen El eructo es un evento fisiológico que permite la liberación de aire desde el esófago o estómago hasta la faringe. En algunos pacientes se puede tornar excesivo, molesto y de difícil control, y es uno de los motivos de consulta con el gastroenterólogo. El objetivo de este trabajo es presentar una serie de casos de nuestra experiencia en un centro de referencia de motilidad gastrointestinal en el manejo de pacientes con eructo supragástrico con terapia de rehabilitación diafragmática y realizar una revisión de la literatura.

Tratamiento de paciente clase III esqueletal por hipoplasia maxilar con canino superior retenido / Treatment of skeletal class III patient due to maxillary hypoplasia with retained upper canine

La maloclusión clase III esqueletal por hipoplasia maxilar puede provocar la retención de algunas piezas dentales, ocupando los caninos superiores el tercer lugar de los dientes más afectados; por lo que es necesario el trabajo interdisciplinario con otras especialidades odontológicas para su correcto abordaje quirúrgico. Mientras que, para la corrección de la hipoplasia maxilar, el expansor Hyrax es el tratamiento ortopédico más utilizado en pacientes con crecimiento remanente. Se presenta caso clínico de paciente femenina de 14 años, clase III esqueletal por hipoplasia maxilar, biotipo mesofacial, perfil cóncavo, mordida cruzada anterior y posterior unilateral izquierda con canino superior derecho retenido. Los principales objetivos fueron: corregir la mordida cruzada y traccionar el canino retenido a su correcta posición. Al finalizar el tratamiento se eliminó la mordida cruzada y se logró la expansión palatina, incorporando así, el canino retenido en el arco dentario. En conclusión, el correcto diagnóstico, el adecuado plan de tratamiento y la atención temprana de la paciente fueron factores indispensables ya que proporcionaron un pronóstico favorable y un tratamiento conservador, evitando futuras complicaciones y tratamientos invasivos.

Skeletal class III malocclusion due to maxillary hypoplasia can cause the retention of some teeth, with the upper canines occupying the third place of the most affected teeth; therefore, interdisciplinary work with other dental specialties is necessary for its correct surgical approach. Likewise, for the correction of maxillary hypoplasia, the Hyrax expander is the most commonly used orthopedic treatment in patients with remnant growth. We present a clinical case of a 14-year-old female patient, skeletal class III due to maxillary hypoplasia, mesofacial biotype, concave profile, left unilateral anterior and posterior crossbite with retained right upper canine. The main objectives were: to correct the crossbite and pull the retained canine to its correct position. At the end of the treatment, the crossbite was eliminated and palatal expansion was achieved, thus incorporating the canine retained in the dental arch. In conclusion, the correct diagnosis, the adequate treatment plan and the early care of the patient were indispensable factors since they pro-vided a favorable prognosis and conservative treatment, avoiding future complications and invasive treatments.