Fatores Associados aos Triggers e Eventos Adversos em Pediatria / Factors Associated with Triggers and Adverse Events in Pediatrics

Introdução: A ocorrência frequente de eventos adversos durante a internação hospitalar demanda meios proativos de gerenciamento de riscos, incluindo a verificação de rastreadores/triggers. Objetivo: verificar os fatores associados aos triggers e eventos adversos na internação pediátrica. Material e Métodos: Pesquisa transversal embasada na metodologia do Institute for Healthcare Improvement (IHI), por meio da aplicação do Paediatric Trigger Tool (PTT) a uma amostra (n=194) de prontuários de pacientes pediátricos de um hospital do Centro-Oeste do Brasil. Foi realizada análise estatística descritiva, inferencial e regressão de Poisson. Resultados: Mais da metade (n=107; 55,15%) dos pacientes apresentou pelo menos um trigger na internação. Foram identificados 204 triggers/gatilhos, com maior ocorrência de queda de hemoglobina/hematócrito (9,80%), queda de saturação de oxigênio (9,80%) e aumento de marcadores de funções renais (9,20%). Do total de gatilhos, 64 (31,37%) eventos adversos foram confirmados, os quais foram classificados majoritariamente como dano temporário com necessidade de suporte ao paciente (65,62%). O tempo de internação (p-valor=0,004) e o caráter da internação (p-valor<0,001) foram variáveis associadas à ocorrência de triggers. Caráter de internação e admissões provenientes de outras instituições foram preditores na ocorrência de triggers e eventos adversos. Discussão: O estudo encontrou 31,37% dos triggers resultando em danos ao paciente, a detecção precoce é essencial na segurança do paciente pediátrico, internações prolongadas estão ligadas a infecções e eventos adversos, transferências de pacientes exigem medidas de segurança rigorosas e eficazes. Conclusões: internações prolongadas e crianças admitidas via transferência merecem atenção a triggers e/ou eventos adversos concretizados.

Introduction: The frequent occurrence of adverse events during hospital admission demands proactive means of risk management, including checking trackers/triggers. Objective: to verify the factors associated with triggers and adverse events in pediatric hospitalization. Material and Methods: Cross-sectional research based on the Institute for Healthcare Improvement (IHI) methodology, through the application of the Pediatric Trigger Tool (PTT) to a sample (n= 194) from medical records of pediatric patients from a hospital in the Center-West of Brazil. Descriptive, inferential statistical analysis and Poisson regression were performed. Results: More than half (n=107; 55.15%) of patients had at least one trigger upon admission. 204 triggers were identified, with the highest occurrence of a drop in hemoglobin/hematocrit (9.80%), a drop in oxygen saturation (9.80%) and an increase in kidney function markers (9.20%). Of the total triggers, 64 (31.37%) adverse events were confirmed, which were mostly classified as temporary damage requiring patient support (65.62%). The length of stay (p-value=0.004) and the nature of the hospitalization (p-value<0.001) were variables associated with the occurrence of triggers. Character of hospitalization and admissions from other institutions were predictors of the occurrence of triggers and adverse events. Discussion: The study found 31.37% of triggers resulting in harm to the patient, early detection is essential in pediatric patient safety, prolonged hospitalizations are linked to infections and adverse events, patient transfers require rigorous and effective safety measures. Conclusions: Prolonged hospitalizations and children admitted via transfer deserve attention to triggers and/or adverse events.

Introducción: La frecuente aparición de eventos adversos durante el ingreso hospitalario exige medios proactivos de gestión de riesgos, incluida la verificación de rastreadores/disparadores. Objetivo: verificar los factores asociados a desencadenantes y eventos adversos en la hospitalización pediátrica, Material y Métodos: Investigación transversal basada en la metodología Institute for Healthcare Improvement (IHI), mediante la aplicación del Pediatric Trigger Tool (PTT) a una muestra (n= 194) de historias clínicas de pacientes pediátricos de un hospital del Centro-Oeste de Brasil. Se realizaron análisis estadísticos descriptivos, inferenciales y regresión de Poisson. Resultados: Más de la mitad (n=107; 55,15%) de los pacientes presentaron al menos un desencadenante al ingreso. Se identificaron 204 desencadenantes, con mayor incidencia de descenso de la hemoglobina/hematocrito (9,80%), descenso de la saturación de oxígeno (9,80%) y aumento de los marcadores de función renal (9,20%). Del total de desencadenantes, se confirmaron 64 (31,37%) eventos adversos, los cuales en su mayoría fueron clasificados como daños temporales que requirieron apoyo del paciente (65,62%). La duración de la estancia (p-valor=0,004) y la naturaleza de la hospitalización (p-valor<0,001) fueron variables asociadas con la aparición de desencadenantes. El carácter de la hospitalización y los ingresos de otras instituciones fueron predictores de la aparición de desencadenantes y eventos adversos. Discusión: El estudio encontró que el 31,37% de los desencadenantes resultan en daño al paciente, la detección temprana es esencial en la seguridad del paciente pediátrico, las hospitalizaciones prolongadas están vinculadas a infecciones y eventos adversos, los traslados de pacientes requieren medidas de seguridad rigurosas y efectivas. Conclusiones: Las hospitalizaciones prolongadas y los niños ingresados ​​vía traslado merecen atención a los desencadenantes y/o eventos adversos.

Hallazgos en tomografía de tórax en el seguimiento a 4, 8 y 12 meses después de una neumonía grave por COVID-19 / Chest Tomography Findings in Follow-Up at 4, 8 and 12 Months after Severe COVID-19 Pneumonia

Introducción: el SARS-CoV-2 causa daño multiorgánico, con predilección al epitelio respiratorio. Los estudios de imagen en tórax han sido determinantes en muchas patologías y, durante la reciente pandemia, no fue excepción. En el seguimiento con tomografía de tórax post COVID-19 en varias series, se ha observado persistencia de lesiones al egreso y a lo largo de varios meses. El objetivo del trabajo fue describir los hallazgos tomográficos en pacientes con seguimiento hasta un año post egreso hospitalario por COVID-19 moderado-grave. Material y métodos: estudio retrospectivo, observacional, de pacientes hospitalizados por COVID-19 moderado-grave de marzo 2020 a marzo 2022 en el hospital del ISSSTE, Chiapas-México; con prueba RT-PCR SARS-CoV-2 positiva, TC de hospitalización y de seguimiento posterior al egreso (0-4 meses; 4-8 meses; 8-12 meses). Se utilizó la terminología de la sociedad Fleischner. Además, se evaluó la extensión por lóbulo afectado (>75%, 75-50%, 50-25%, <25%). Resultados: Se estudiaron 27 pacientes, 74% hombres, edad promedio 56 años. El patrón tomográfico predominante al ingreso fue el mixto con 56% y extensión pulmonar >75%; vidrio despulido 30% y 11% consolidación. Al cuarto y octavo mes el patrón mixto fue el más frecuente, al doceavo mes persistía en el 33% de los pacientes y en el 30% de los casos la tomografía fue normal. Conforme pasaron los meses, la extensión del daño fue limitándose. Conclusión: el seguimiento con tomografía en COVID-19 moderado-grave es indiscutible. Permite identificar con precisión el patrón tomográfico en los diferentes momentos de la enfermedad, optimizar el tratamiento y disminuir las secuelas.

Research hotspots in post-discharge follow-up management of preterm infants / 中国当代儿科杂志

Preterm infants, especially those born extremely or very prematurely, are at high risk for growth retardation and neurodevelopmental disorders. Regular follow-up after discharge, early intervention, and timely catch-up growth are important guarantees for improving the quality of life of preterm infants and improving the quality of the population. This article provides an overview of the research hotspots in follow-up management of preterm infants after discharge over the past two years, including follow-up modes, nutritional metabolism and body composition follow-up, growth pattern follow-up, neurodevelopmental follow-up, early intervention, etc., in order to provide clinical guidance and research ideas for domestic peers.

Physical growth and neurodevelopment of preterm infants at the corrected age of 18-24 months / 中国当代儿科杂志

OBJECTIVES@#To investigate the levels of physical growth and neurodevelopment in preterm infants at the corrected age of 18-24 months.@*METHODS@#The physical growth data and neurodevelopment data of 484 preterm infants at corrected age of 18-24 months were prospectively collected by a post-discharge follow-up system for preterm infants. The infants were regularly followed up in Shenzhen Bao'an Maternal and Child Health Hospital Affiliated to Jinan University from April 2018 to December 2021. The neurodevelopment was evaluated by the Children Neuropsychological and Behavioral Scale-Revision 2016. A total of 219 full-term infants served as controls. The infants were divided into groups (extremely preterm, very preterm, moderate late preterm, and full-term) based on gestational age, and the groups were compared in the levels of physical growth and neurodevelopment.@*RESULTS@#Except that the moderate preterm group had a higher length-for-age Z-score than the full-term group (P=0.038), there was no significant difference in physical growth indicators between the preterm groups and the full-term group (P>0.05). Each preterm group had a significantly lower total developmental quotient (DQ) than the full-term group (P<0.05). Except for the social behavior domain, the DQ of other domains in the extremely preterm and very preterm groups was significantly lower than that in the full-term group (P<0.05). The <32 weeks preterm group had a significantly higher incidence rate of global developmental delay than the full-term group (16.7% vs 6.4%, P=0.012), and the incidence rate of global developmental delay tended to increase with the reduction in gestational age (P=0.026).@*CONCLUSIONS@#Preterm infants can catch up with full-term infants in terms of physical growth at the corrected age of 18-24 months, but with a lower neurodevelopmental level than full-term infants. Neurodevelopment monitoring and early intervention should be taken seriously for preterm infants with a gestational age of <32 weeks.

Effect of out-hospital blood pressure management on prognosis of patients with acute aortic syndrome complicated with hypertension after TEVAR / 中华心血管病杂志

Objective: To investigate the influence of blood pressure control after discharge on prognosis of patients with acute aortic syndrome (AAS) complicated with hypertension who underwent thoracic endovascular aortic repair (TEVAR). Methods: This is a retrospective case analysis. Patients diagnosed with AAS complicated with hypertension and undergoing TEVAR in Northern Theater Command General Hospital from June 2002 to December 2021 were consecutively enrolled. Average systolic blood pressure (SBP) and the occurrence of endpoint events were recorded at one month, one year and every 2 years after TEVAR. According to the patients' average SBP, patients with average SBP<140 mmHg (1 mmHg=0.133 kPa) or<150 mmHg were divided into the target blood pressure achievement group, and the others were divided into target blood pressure non-achievement group. Endpoint events included all-cause death, aortic death, stroke, renal insufficiency, aortic related adverse events and a composite of these events (overall clinical adverse events), and re-accepting TEVAR. The incidence of endpoint events was compared between the two groups at each follow-up period. Results: A total of 987 patients were included, aged (55.7±11.7) years, including 779 male (78.9%). When the cutoff value was 140 mmHg, the rate of average target SBP achievement was 71.2% (703/987) at one month, 66.7% (618/927) during 1st to 12th month and 65.1% (542/832) from the first year to the third year after TEVAR. The proportion of patients taking≥2 antihypertensive agents was higher in the group of target blood pressure non-achievement group than the target blood pressure achievement group after TEVAR at 1 month (74.3% (211/284) vs.65.9% (463/703), P=0.010) and during 1st to 12th month (71.5% (221/309) vs. 63.6% (393/618), P=0.016). There were no statistical differences in the all-cause deaths, stroke, aortic related adverse events, and repeat TEVAR between the two groups (All P>0.05) during above follow-up periods. When the cutoff value was 150 mmHg, the rate of target SBP achievement was 89.3% (881/987) at one month, 85.2% (790/927) during 1st to 12th month and 85.6%(712/832) from the first year to the third year after TEVAR. The incidence of clinical total adverse events (8.8% (12/137) vs. 4.2% (33/790), P=0.021) and repeat TEVAR (4.4% (6/137) vs. 1.0% (8/790), P=0.003) in target blood pressure non-achievement group were significantly higher than the target blood pressure achievement group during 1st to 12th month after TEVAR. The incidence of all-cause deaths (5.8% (7/120) vs. 2.4% (17/712), P=0.037) in the target blood pressure non-achievement group was significantly higher than the target blood pressure achievement group from the first year to the third year follow-up period, but there were no statistical differences in the incidence of clinical total adverse events between the two group (P>0.05). Conclusion: Among TEVAR treated AAS patients complicated with hypertension, the average SBP more than 150 mmHg post discharge is associated with increased risk of adverse events. Ideal blood pressure control should be encouraged to improve the outcome of these patients.

Cuidado domiciliar pós alta do prematuro durante a pandemia Covid-19 / Atención domiciliaria tras el alta de bebés prematuros durante la pandemia de Covid-19 / Post-discharge home care of preterm infants during the Covid-19 pandemic

Objetivo: entender como mães vivenciaram o cuidado com seus filhos prematuros em casa em meio à pandemia da COVID-19. Método: estudo qualitativo, descritivo, desenvolvido entre janeiro e dezembro de 2021, mediante entrevistas remotas com 25 mães de prematuros, após um mês da alta hospitalar, com Análise de Conteúdo temática. Resultados: desvelaram-se preocupações maternas referentes ao cuidado com o filho na pandemia, além de influências do período pandêmico na rotina familiar; acompanhamento do seguimento das crianças nos serviços de saúde descontinuado; sobrecarga e medo. Esses aspectos podem expor o bebê a maior risco de alterações do seu desenvolvimento, bem como afetar a autoeficácia materna, uma vez que o receio das complicações decorrentes do nascimento pré-termo associou-se à angústia de possível contaminação pelo coronavírus. Conclusão: a prematuridade vivenciada em meio à pandemia COVID-19 repercutiu negativamente tanto no cotidiano da vida familiar como no acompanhamento de saúde do prematuro.

Objective: to understand how mothers experienced the care of their preterm infants at home in the midst of the COVID-19 pandemic. Method: qualitative, descriptive study, developed between January and December 2021, through remote interviews with 25 mothers of preterm infants, one month after hospital discharge, with thematic Content Analysis. Results: maternal reoccupations related to child care in the pandemic were revealed, as well as influences of the pandemic period on family routine; monitoring of children in discontinued health services; overload and fear. These aspects may expose the baby to a greater risk of developmental alterations, as well as affect maternal self-efficacy, since the fear of complications resulting from preterm birth was associated with the anguish of possible contamination by the coronavirus. Conclusion: the prematurity experienced in the midst of the COVID-19 pandemic had a negative impact both on the daily life of the family and on the health monitoring of preterm infants.

Objetivo: comprender cómo vivieron las madres el cuidado de sus hijos prematuros en el hogar en medio de la pandemia de COVID-19. Método: estudio cualitativo, descriptivo, desarrollado entre enero y diciembre de 2021, mediante entrevistas remotas a 25 madres de bebés prematuros, un mes después del alta hospitalaria, con Análisis de Contenido temático. Resultados: se revelaron preocupaciones maternas respecto al cuidado de los hijos durante la pandemia, además de las influencias del período pandémico en la rutina familiar; descontinuado el seguimiento de los niños en los servicios de salud; sobrecarga y miedo. Estos aspectos pueden exponer al bebé a un mayor riesgo de cambios en su desarrollo, así como afectar la autoeficacia materna, ya que el miedo a las complicaciones derivadas del parto prematuro se asocia a la angustia de una posible contaminación por el coronavirus. Conclusión: la prematuridad vivida en medio de la pandemia de COVID-19 tuvo un impacto negativo tanto en la vida familiar diaria como en el seguimiento de la salud de los bebés prematuros.

Avaliação de programa de seguimento pós-alta com inteligência artificial para monitorar sinais e sintomas de pacientes em pós-operatório de cirurgias colorretais oncológicas / Evaluation of a post-discharge follow-up program with artificial intelligence to monitor signs and symptoms of patients in the postoperative period of oncological colorectal surgeries

INTRODUÇÃO: Cirurgias colorretais são procedimentos complexos, associados a maiores taxas de complicações e readmissões que procedimentos realizados em outros sítios cirúrgicos. Atualmente, medidas padronizadas visando à recuperação precoce de pacientes submetidos a cirurgias colorretais são adotadas com o objetivo de reduzir o tempo de internação hospitalar. A redução do tempo de internação, entretanto, apesar de ser considerada um desfecho positivo, pode propiciar risco de atraso de diagnóstico e deterioração clínica já que as complicações, geralmente acontecem fora do ambiente hospitalar, dificultando a avaliação e acompanhamento destes pacientes. OBJETIVO: O objetivo do presente estudo foi desenvolver um plano de seguimento pós-alta eletrônico, acessível em smartphones, para monitorar remotamente os sinais e sintomas de pacientes em pós-operatório de cirurgias colorretais, avaliando os desfechos de taxa de admissão no setor de emergência e taxa de complicações graves (Clavien-Dindo 3 a 5), no período de quinze dias de pós-operatório. MATERIAL E MÉTODOS: O projeto foi desenvolvido em duas etapas, sendo a primeira a estruturação da Jornada Digital, com a criação de plataforma com algoritmo para identificação de sintomas e direcionamento de condutas e a segunda a validação do programa em um estudo piloto. Foram incluídos no estudo pacientes a serem submetidos a cirurgias colorretais oncológicas, com idade entre 18 e 80 anos. O estudo foi conduzido nas dependências do A.C.Camargo Cancer Center. O monitoramento dos pacientes e o reporte de sinais e sintomas pelos pacientes foram realizados via plataforma de monitoramento remoto, utilizando-se de smartphone ou computador. RESULTADOS: No estudo piloto, em cada uma das três fases de avaliação dos dados obtidos, algoritmo e instrumento para coleta de dados foram reestruturados, visando atingir maior sensibilidade e especificidade na detecção de complicações pela plataforma, bem como maior satisfação dos pacientes em acompanhamento. A capacidade de detecção de complicações aumentou a cada fase de análise e ajuste, sendo que após a terceira e última fase de ajustes tivemos 45(71,4%) eventos adversos reportados, sendo que destes, 12(19%) foram sintomas classificados como graves. Nessa amostra , a solução digital foi capaz de identificar 3(4,8%) complicações reais com sensibilidade de 75%, especificidade de 84%, acurácia de 83%, valor preditivo positivo de 25% e valor preditivo negativo de 98%. Tivemos ainda , 5(7,9%) erros de preenchimentos detectados e 1(1,6%) complicações não detectadas pela plataforma, por erro de preenchimento do questionário de avaliação diária. A nossa taxa de reinternação por indicação da plataforma, nessa amostra foi de 2(3,2%) e de admissão na emergência, considerando encaminhamento ou não da plataforma foi de 8(12,7%). A adesão completa ao programa de monitoramento foi de 83%, com nota NPS variando de 69 a 95, sendo a maior nota obtida na última fase de avaliação. CONCLUSÃO: A plataforma digital criada mostrou-se segura, com altas taxas de adesão e boa aceitação pelos pacientes, mas ainda precisa ser ajustada com a intenção de reduzir custos de encaminhamento e admissão no setor de emergência.

INTRODUCTION: Colorectal surgeries are complex procedures, associated with higher rates of complications and readmissions than procedures at other surgical sites. Currently, standardized procedures aim the early recovery of patients treated for colorectal surgeries in order to reduce the length of hospital stay. The reduction in hospitalization time, however, despite being considered a positive result, may lead to a risk , since complications generally occur outside the hospital environment, making it difficult to assess and monitor these patients. OBJECTIVE: The aim of the present study was to develop a mobile health app , accessible on smartphones, to remotely monitor the signs and symptoms of patients in the postoperative period of colorectal surgeries, evaluating the outcomes of admission rate in the emergency department and rate of severe complications. (Clavien-Dindo 3 to 5) within a fifteen-day postoperative period. METHODS: The project was developed in two steps, the first being the structuring of the Digital Journey, with the creation of a platform with a decision algorithm for identifying symptoms and directing conducts, and the second the validation of the program in a pilot study. Patients aged between 18 and 80 years old, who were to undergo oncological colorectal surgeries, were included in the study. The study was conducted on the premises of the A.C.Camargo Cancer Center. Monitoring of patients and reporting of signs and symptoms by patients were performed via a remote monitoring platform, using a smartphone or computer. RESULTS: In the pilot study, in each of the three evaluation phases of the data obtained, the decision algorithm and the instrument for data collection were restructured, aiming to achieve greater sensitivity and specificity in the detection of complications by the platform, as well as greater patient satisfaction. The ability to detect complications increased at each analysis and adjustment phase, and after the third and final phase of adjustments, 45 (71.4%) adverse events were reported, of which 12 (19%) were symptoms classified as high grade. In this sample, the digital solution was able to identify 3 (4.8%) real complications with a sensitivity of 75%, specificity of 84%, accuracy of 83%, positive predictive value of 25% and negative predictive value of 98%. We also had, 5(7.9%) errors in filling out detected and 1(1.6%) complications not detected by the platform, due to error in filling out the daily assessment questionnaire. Our rehospitalization rate by indication of the platform, in this sample was 2 (3.2%) and admission to the emergency room, considering referral or not from the platform, was 8 (12.7%). Complete adherence to the monitoring program was 83%, with an NPS score ranging from 69 to 95, the highest score obtained in the last evaluation phase. CONCLUSION: The a mobile health app created was proved to be safe, with high adherence rates and good acceptance by patients, but it still needs to be adjusted with the intention of reducing costs of referral and admission to the emergency department

Epidemiological and clinicopathological profile of endometrial cancer in Gabon

Introduction: L'objectif général de notre travail était d'apporter une description épidémiologique et clinicopathologique du cancer de l'endomètre au Gabon. Patients et méthode: Cette étude descriptive et rétrospective a été réalisée à l'Institut de Cancérologie de Libreville chez les patientes atteintes du cancer de l'endomètre sur une période de 7 années (de janvier 2012 à octobre 2018). Résultats: Cette étude a inclus 32 patientes et les résultats obtenus ontmontré que ce cancer au Gabon est plus fréquent chez la femme multipare, que histologiquement le type 1 est le plus souvent rencontré et que ce cancer est de haut grade de malignité. De ce travail ressort également la difficulté du suivi des patientes. Conclusion: Le cancer de l'endomètre étant un cancer souvent d'emblée de mauvais pronostic, il est d'intérêt de mettre en place une stratégie de prévention et de management adapté.Mots clés: cancer, endomètre, étude clinicopathologique, suivi, Gabon Abstract:Introduction:The general objective of our work was to provide an epidemiological and clinicopathological description of endometrial cancer in Gabon.

Introduction: The general objective of our work was to provide an epidemiological and clinicopathological description of endometrial cancer in Gabon. Epidemiological and clinicopathological profile of... Patients and method: This descriptive and retrospective study was carried out at Cancer Institute of Libreville in patients with endometrial cancer over a period of 7 years (from January 2012 to October 2018) . Results: This study included 32 patients and the results obtained showed that this cancer in Gabon is more frequent in multiparous women, that histologically type 1 is most often encountered and that this cancer is of high grade malignancy. This work also shows the difficulty of following up patients. Conclusion: As endometrial cancer is often a cancer with a poor prognosis , it is interest to put in place an appropriate prevention and management strategy.

Planejamento virtual em cirurgia ortognática: relato de caso / Virtual planning for orthognathic surgery: case report / Planificación virtual en cirugía ortognática: reporte de caso

Introdução: A correção das deformidades dentofaciais depende do bom diagnóstico, da precisão do planejamento e da correta execução da técnica cirúrgica. Buscando maior precisão, o planejamento virtual para cirurgia ortognática tem sido uma ferramenta amplamente aplicada pela cirurgia bucomaxilofacial. Este trabalho demonstra, por meio de caso clínico, os benefícios adquiridos pelo planejamento virtual, no que diz respeito a quantificação do movimento, avaliação da predição dos tecidos moles e osteotomias, assim como discorre sobre os cuidados e passos necessários para um correto planejamento. Relato do caso: Paciente de perfil classe II, submetida ao protocolo de planejamento virtual com aquisição de imagens tomográficas, escaneamento intraoral e utilização de software digital para avaliação diagnóstica, planejamento e impressão dos guias cirúrgicos. A mesma foi acompanhada durante 3 meses de pós operatório, apresentando boa precisão e previsibilidade nos movimentos cirúrgicos realizados. Discussão: Ao se realizar uma avaliação clínica acurada, somada a aquisição de imagens tridimensionais, a partir das tomografias de face, escaneamentos intraorais e o manejo da tecnologia CAD/CAM, é possível se alcançar maior precisão no planejamento e predictibilidade cirúrgica, bem como realizar um melhor diagnóstico das deformidades transversas. Contudo, deve-se levar em consideração a necessidade de conhecimento teórico-prático para a correta execução dos passos para o planejamento virtual. Considerações finais: Dado o exposto, foi possível observar precisão no resultado obtido e compatibilidade entre os movimentos planejados e executados. Assim como, demonstrou se aspectos relativos a cada um dos passos para o protocolo virtual, expondo-se suas particularidades e diferenças em relação ao planejamento convencional... (AU)

Introducción: La corrección de las deformidades dentofaciales depende de un buen diagnóstico, de la precisión de la planificación y la correcta ejecución de la técnica quirúrgica . Buscando mayor precisión, la planificación virtual para cirugía ortognática ha sido una herramienta aplicada ampliamente por la cirugia bucomaxilofacial. Este trabajo demuestra, por medio de un caso clínico, los beneficios obtenidos por la planificación virtual, en lo que respecta a la cuantificación del movimiento, evaluación de la predicción de los tejidos blandos y de las osteotomia, así enfatizando los cuidados y pasos necesarios para una correcta planificación. Relato de caso: Paciente con perfil clase II, utilizando protocolo de planificación virtual con adquisición de imágenes tomográficas, escaneamento intra-oral y uso de software digital para evaluación diagnóstica, planificación e impresión 3D de los guías quirúrgicos. La paciente tuvo seguimiento pos operatorio por tres meses, corroborando la precisión y previsibilidad de los movimientos quirúrgicos planificados y ejecutados. Discusión: Al realizarse una evaluación clínica acurada, sumando una adquisición de imágenes tridimensionales, a partir de la tomografía facial, escaneamento intra-oral y el manejo de tecnologia CAD/CAM, es posible alcanzar mayor precisión en la planificación y previsibilidad quirúrgica, así como un diagnóstico más acurado de las alteraciones transversas. Con todo, se debe considerar la necesidad de conocimiento teórico práctico para la correcta elaboración de un proyecto de planificación quirúrgica virtual. Consideraciones finales: Por lo expuesto, se observó precisión en el resultado obtenido considerando los movimientos planificados y ejecutados. Así como se describió aspectos relativos a cada uno de los pasos del protocolo virtual utilizado, exponiendo sus particularidades y diferencias en relación a la planificación quirúrgica convencional... (AU)

Introduction: The correction of dentofacial deformities depends directly on a good diagnosis, the precision of the surgical planning and the correct execution of the technique. Seeking greater precision, virtual planning for orthognathic surgery has been a tool widely applied in oral and maxillofacial surgery. This work demonstrates, through a case report, the benefits acquired by virtual planning, regarding the quantification of movement, evaluation of the prediction of soft tissues and osteotomies, as well as discusses the accuracy and steps necessary for a correct planning. Case report: Class II facial profile patient, submitted to the virtual planning protocol with acquisition of tomographic images, intraoral scanning and use of digital software for diagnostic evaluation, planning and printing of surgical guides. She was followed up for 3 months after the operation, showing good precision and predictability in the surgical movements performed. Discussion: When performing an accurate clinical evaluation, added up to the acquisition of three-dimensional images, from face tomography, intra-oral scans and the management of CAD/CAM technology, it is possible to achieve greater precision in surgical planning and predictability, as well as accomplish a better diagnosis of transverse deformities. However, one must take into account the need for theoretical practical knowledge for the correct execution of the steps for virtual planning. Final considerations: Given the above, it was possible to observe precision in the result obtained and compatibility between the planned and executed movements. As well, aspects related to each of the steps for the virtual protocol were demonstrated, exposing their particularities and differences in relation to conventional planning... (AU)

Necrosis uterina tras sutura de compresión hemostática: reporte de caso y revisión de la literatura / Uterine necrosis following hemostatic compression suture: case report and review of the literature

Objetivos: presentar un caso de necrosis uterina tras técnica de sutura hemostática por hemorragia posparto y hacer una revisión de la literatura para determinar la técnica de sutura utilizada, los hallazgos clínicos, la técnica diagnóstica y el tratamiento realizado en los casos clínicos descritos. Materiales y métodos: se presenta el caso de una mujer de 34 años que consultó por dolor abdominal al octavo día tras cesárea por placenta previa, que precisó sutura de B-Lynch por atonía uterina y cuyo diagnóstico fue necrosis uterina. La paciente requirió histerectomía abdominal total, con evolución satisfactoria. Se realizó una búsqueda sistemática de la literatura en las bases de datos Medline vía Pubmed, Embase y Web of Science. Se buscaron series y reportes de casos y cohortes de mujeres con necrosis uterina posterior al uso de suturas de compresión uterina para control de hemorragia posparto. Se analizaron variables sociodemográficas y clínicas al diagnóstico, técnica de sutura, pruebas diagnósticas y tratamiento. Resultados: se incluyeron 23 estudios con 24 pacientes. El 83 % de las necrosis ocurrieron tras cesárea. La técnica más utilizada fue B-Lynch (66 %), seguida de Cho (25 %). Los síntomas más frecuentes fueron fiebre y dolor abdominal. La prueba diagnóstica más utilizada fue la tomografía computarizada (9 de 24 casos). En la mayoría de casos se realizó histerectomía (75 %). Conclusiones: la necrosis de la pared uterina es una complicación infrecuente pero grave. Sería recomendable el diseño de cohortes de seguimiento de mujeres sometidas a estos procedimientos para determinar la incidencia de complicaciones asociadas.

Objectives: To present a case of uterine necrosis following hemostatic suturing to control postpartum bleeding, and to review the literature in order to identify the suture techniques employed, clinical findings, diagnostics and treatment in the clinical cases described. Materials and Methods: A 34-year-old woman presenting with abdominal pain eight days after cesarean delivery due to placenta previa who required B-Lynch compression suture due to uterine atony, and who was diagnosed with uterine necrosis. The patient underwent total abdominal hysterectomy with a satisfactory recovery. A systematic literature search was conducted in the Medline vía Pubmed, Embase and Web of Science databases. The search included case series and reports, and cohorts of women with uterine necrosis following the use of uterine compression sutures for postpartum bleeding. The analysis included sociodemographic and clinical variables at the time of diagnosis, suturing technique, diagnostic tests and treatment. Results: Overall, 23 studies with 24 patients were included. Of all necrosis cases, 83% occurred following cesarean section. B-Lynch was the suturing technique most frequently used (66 %), followed by the Cho suture (25 %). The most frequent symptoms were fever and abdominal pain. The most commonly used diagnostic test was computed tomography (9/24 cases). Hysterectomy was performed in the majority of cases (75 %). Conclusions: Although rare, uterine wall necrosis is a serious complication. It would be advisable to design follow-up cohort studies of women undergoing these procedures in order to determine the incidence of associated complications.

Secuelas del COVID-19, un desafío de la salud pública: Revisión bibliográfica / Sequelae of COVID-19, a public health challenge: Literature review / Secuelas del COVID-19, um desafio de saúde pública: revisão bibliográfica

La infección por SARS-CoV-2 (COVID-19) fue declarada como pandemia el 11 de marzo de 2020, esta enfermedad surgió en diciembre de 2019 en Wuhan, China, cuando un grupo de personas presentaron neumonía de causa desconocida. La transmisión del coronavirus ocurre a través de la vía aérea por medio de gotitas respiratorias y el periodo de incubación dura aproximadamente 5 días. Los síntomas más comunes son fiebre, tos seca o productiva, dificultad para respirar, fatiga, mialgias, náuseas/vómitos o diarrea, cefalea, debilidad, rinorrea, anosmia o la ageusia/disgeusia. El virus deja secuelas multiorgánicas y trastornos neuropsiquiátricos. Objetivo. El objetivo de la revisión es identificar los trastornos médicos y emocionales como consecuencia de la infección por SARS-CoV-2. Metodología. Mediante búsquedas en Tripdatabase, PubMED, Medscape, Cochrane Database, Google Académico, repositorios de guías clínicas y páginas oficiales de la Organización Panamericana de la Salud, Organización Mundial de la Salud y Ministerio de Salud Pública del Ecuador de artículos que contemplen acerca de las secuelas post-COVID-19. Conclusión. Se evidencia que la infección por COVID-19 genera múltiples secuelas entre las más prevalentes se encuentran: amnesia, inatención, cefalea, delirio y manía, linfopenia, disnea y fatiga por lo que es importante reconocer el desempeño del personal sanitario en la atención primaria y hacer un seguimiento para identificar problemas en los pacientes que sufrieron infección por coronavirus con el fin de orientar su tratamiento.

SARS-CoV-2 (COVID-19) infection was declared a pandemic on March 11, 2020, this disease emerged in December 2019 in Wuhan, China, when a group of people presented with pneumonia of unknown cause. Transmission of the coronavirus occurs through the airborne route via respiratory droplets and the incubation period lasts approximately 5 days. The most common symptoms are fever, dry or productive cough, shortness of breath, fatigue, myalgia, nausea/vomiting or diarrhea, headache, weakness, rhinorrhea, anosmia or ageusia/dysgeusia. The virus leaves multi-organ sequelae and neuropsychiatric disorders. Objective. The objective of the review is to identify medical and emotional disorders as a consequence of SARS-CoV-2 infection. Methodology. Through searches in Tripdatabase, PubMED, Medscape, Cochrane Database, Google Scholar, repositories of clinical guidelines and official pages of the Pan American Health Organization, World Health Organization and Ministry of Public Health of Ecuador for articles on post-COVID-19 sequelae. Conclusion. It is evident that COVID-19 infection generates multiple sequelae among the most prevalent are: amnesia, inattention, headache, delirium and mania, lymphopenia, dyspnea and fatigue so it is important to recognize the performance of health personnel in primary care and follow up to identify problems in patients who suffered coronavirus infection in order to guide their treatment.

A infecção pelo SARS-CoV-2 (COVID-19) foi declarada pandêmica em 11 de março de 2020, esta doença surgiu em dezembro de 2019 em Wuhan, China, quando um grupo de pessoas apresentou uma pneumonia de causa desconhecida. A transmissão do coronavírus ocorre pela via aérea através de gotículas respiratórias e o período de incubação dura aproximadamente 5 dias. Os sintomas mais comuns são febre, tosse seca ou produtiva, falta de ar, fadiga, mialgia, náusea/vômito ou diarréia, dor de cabeça, fraqueza, rinorréia, anosmia ou ageusia/disgeusia. O vírus deixa seqüelas de múltiplos órgãos e distúrbios neuropsiquiátricos. Objetivo. O objetivo da revisão é identificar desordens médicas e emocionais como conseqüência da infecção pelo SARS-CoV-2. Metodologia. Através de pesquisas em Tripdatabase, PubMED, Medscape, Cochrane Database, Google Scholar, repositórios de diretrizes clínicas e páginas oficiais da Organização Pan-Americana da Saúde, Organização Mundial da Saúde e Ministério da Saúde Pública do Equador para artigos sobre seqüelas pósCOVID-19. Conclusão. É evidente que a infecção COVID-19 gera múltiplas seqüelas entre as mais prevalentes são: amnésia, desatenção, dor de cabeça, delírio e mania, linfopenia, dispneia e fadiga, por isso é importante reconhecer o desempenho do pessoal de saúde na atenção primária e acompanhar para identificar problemas em pacientes que sofreram infecção por coronavírus, a fim de orientar seu tratamento.

Evaluación neurológica durante el primer año en niños muy bajo peso al nacer con infección por citomegalovirus / Neurological evaluation during the first year in very low birth weight children with cytomegalovirus infection

Introducción: La infección congénita por citomegalovirus es causa de pérdida auditiva y alteraciones cognitivas. La infección perinatal por este virus es más frecuente en neonatos< 1500 g y produce menos secuelas neurológicas. Objetivo: Describir la evaluación neurológica en el primer año de vida en niños muy bajo peso al nacer con infección por citomegalovirus. Métodos: Estudio descriptivo y longitudinal en el que se incuyeron 14 neonatos< 1500 g, con diagnóstico de infección congénita o perinatal por citomegalovirus; a los cuales se les realizó evaluación del neurodesarrollo, ultrasonido craneal, potenciales evocados auditivos de tallo cerebral y potenciales visuales a las 40 semanas, a los seis meses y al año de edad gestacional corregida. En la primera evaluación se realizó además, electroencefalograma. Resultados: El 43 por ciento tuvo infección congénita y 57 por ciento infección perinatal. A las 40 semanas se evaluaron completamente 79 % de los casos, a los seis meses 64 por ciento y al año 36 por ciento. No se observaron anormalidades en el ultrasonido craneal, ni en el electroencefalograma. Al año de edad corregida, se detectaron alteraciones ligeras del neurodesarrolo en 33,3 por ciento del total de casos (2/6) y con igual porcentaje en los niños con infección congénita (1/3) y perinatal (1/3). En ningún paciente evaluado se detectó sordera neurosensorial, ni daño del nervio visual. Conclusiones: Las alteraciones del neurodesarrollo encontradas al año de edad corregida pueden estar relacionadas con la prematuridad o la infección por citomegalovirus. El seguimiento a mediano y largo plazo es necesario para detectar otras secuelas neurológicas de debut tardío(AU)

Introduction: Congenital cytomegalovirus infection is a cause of hearing loss and cognitive impairments. Perinatal infection by this virus is more frequent in neonates< 1500 g and produces fewer neurological sequelae. Objective: To describe neurological evaluation in the first year of life in very low birth weight children with cytomegalovirus infection. Methods: A descriptive and longitudinal study involving 14 neonates< 1500 g, with a diagnosis of congenital or perinatal cytomegalovirus infection; to which neurodevelopmental evaluation, cranial ultrasound, auditory brain stem evoked potentials and visual potentials were performed at 40 weeks, six months and one year of corrected gestational age. In the first evaluation, electroencephalogram was also performed. Results: 43 percent had congenital infection and 57 percent perinatal infection. At 40 weeks, 79 percent of cases were fully evaluated, at six months 64 percent and at one year 36 percent. No abnormalities were observed on the cranial ultrasound or electroencephalogram. At one year of corrected age, slight alterations in neurodevelopment were detected in 33.3 percent of all cases (2/6) and with the same percentage in children with congenital (1/3) and perinatal (1/3) infection. In no patient evaluated, sensorineural deafness or visual nerve damage was detected. Conclusions: The neurodevelopmental alterations found at one year of corrected age may be related to prematurity or cytomegalovirus infection. Medium- and long-term follow-up is necessary to detect other late-onset neurological sequelae(AU)

Utilidad de la proteína C reactiva en el posoperatorio inmediato de un paciente reumático con apendicitis aguda / Usefulness of C-reactive protein in the immediate postoperative period of rheumatic patients with acute appendicitis

Las enfermedades reumáticas son un grupo de afecciones que se caracterizan por la presencia de manifestaciones y complicaciones sistémicas derivadas del proceso inflamatorio mantenido. Los reactantes de fase aguda, como es el caso de la proteína C reactiva constituyen un marcador de actividad de la enfermedad. Sin embargo, su utilidad se magnifica en los pacientes reumáticos que tienen que ser sometidos a una intervención quirúrgica, circunstancia en la que se tornan un marcador eficiente que muestra la magnitud del proceso inflamatorio. Se presenta el caso de una paciente femenina de 53 años edad, con diagnóstico de artritis reumatoide y síndrome de Sjögren secundario, que tuvo que ser sometida a intervención quirúrgica por diagnóstico de apendicitis aguda. Se realizó seguimiento clínico y de laboratorio utilizando la proteína C reactiva como marcador de elección para monitorear la intensidad del proceso inflamatorio resultante de la intervención quirúrgica y de los efectos de esta en la actividad clínica de las enfermedades reumáticas de base. Después del tratamiento quirúrgico y medicamentoso, la paciente fue dada de alta hospitalaria sin manifestaciones articulares, digestivas ni alteraciones de los exámenes de laboratorio(AU)

Rheumatic diseases are a group of conditions characterized by the presence of systemic manifestations and complications derived from the sustained inflammatory process. Acute phase reactants, such as C-reactive protein, constitute a marker of disease activity. However, its usefulness is magnified in those rheumatic patients who have to undergo surgery, being an efficient marker that shows the magnitude of the inflammatory process. We present the case of a 53-year-old female patient diagnosed with rheumatoid arthritis and secondary Sjögren's syndrome who had to undergo surgery due to a diagnosis of acute appendicitis. Clinical and laboratory follow-up was performed using C-reactive protein as the marker of choice to monitor the intensity of the inflammatory process resulting from the surgical intervention and its effects on the clinical activity of underlying rheumatic diseases(AU)

Gestión del rendimiento: Comprometidos por un mejor desempeño. Conoce más sobre la etapa de seguimiento de metas de la gestión del rendimiento / Performance Management: Committed to better performance. Learn more about the goal tracking stage of performance management

Habiendo culminado el 22/06/2022 la etapa de planificación con el establecimiento de metas y suscripción del formato de la Gestión del Rendimiento (GDR), se dio inicio a la etapa de seguimiento de metas (23/06/2022 al 22/12/2022), desarrollándose el pasado 7 y 8 de julio cuatro talleres virtuales, dónde se explicó temas como las reuniones de seguimiento, la documentación de evidencias, el cálculo del avance de las metas de desempeño y las oportunidades de mejora

Boletín epidemiológico 24 - 2022. Semana epidemiológica del 12 al 18 de junio del 2022 / Epidemiological bulletin 24 - 2022. Epidemiological week from June 12 to 18, 2022

Luego del llamado realizado por la Asamblea Mundial de la Salud en el 2014, para que los países implementen medidas que garanticen y fortalezcan la vigilancia, la prevención, el acceso al tratamiento y el control de las hepatitis virales en todos los países, nos preguntamos ¿Qué avances hemos tenido? En el 2016, con la finalidad de fortalecer la atención del recién nacido y seguimiento del niño expuesto a madres con hepatitis B en el Perú, se aprobó el documento técnico "Plan Nacional para la Eliminación de la Transmisión Materno Infantil del VIH, Sífilis, y Hepatitis B, en el Perú 2017-2021", en la cual se establece como objetivos acciones para reducir la transmisión infantil de hepatitis B a un 5%. En referido documento se identifican limitantes como: el bajo porcentaje de niñas y niños expuestos tamizados, pérdida del seguimiento de gestantes y de niños y niñas expuestos, y la débil coordinación entre los servicios de la salud.

Treatment of Distal Tibiofibular Syndesmosis Injury Associated with Ankle Fractures with Suture Button / Tratamento da lesão da sindesmose tibiofibular distal associada às fraturas do tornozelo com suture button

Abstract Objective To evaluate the results obtained from the surgical treatment of malleolar ankle fractures associated with distal tibiofibular syndesmosis (DTFS) injury submitted to conventional surgical procedure for fracture fixation and DTFS fixation by suture button (SB). Methods Forty-nine patients were retrospectively evaluated, with a mean age of 45 years old and a mean follow-up of 34.1 months. Clinical and functional evaluation was based on the visual analogue scale (VAS) and on the American Foot and Ankle Society Score (AOFAS) for ankle and hindfoot, return to routine activities, and return to sport. Results The postoperative mean AOFAS and VAS were, respectively, 97.06 (confidence interval [CI 95%: 95.31-98.81] and 0.16 [CI 95% 0,04 - 0,29]. All patients returned to previous daily activities, and only 12 showed some residual symptom. There was no postoperative instability in any patient. Forty-six patients returned to sports activities and, of these, only 1 did not return to the level prior to the injury. Only two patients presented SB-related alterations. There was no report of dissatisfaction. Conclusion In malleolar fractures of the ankle with DTFS injury, the fixation of syndesmosis with SB demonstrated excellent postoperative results. Level of Evidence IV, retrospective case series.

Resumo Objetivo Avaliar os resultados obtidos do tratamento cirúrgico das fraturas maleolares do tornozelo associadas a lesão da sindesmose tibiofibular distal (STFD) submetidas a procedimento cirúrgico convencional de fixação da fratura e fixação da STFD pelo suture button (SB). Métodos Avaliou-se retrospectivamente 49 pacientes com uma média de idade de 45 anos e seguimento médio de 34,1 meses. A avaliação clínica e funcional foi baseada na escala visual analógica (EVA) e na escala American Foot and Ankle Society Score (AOFAS, na sigla em inglês) para tornozelo e retropé, retorno às atividades da rotina e retorno ao esporte. Resultados As médias pós-operatórias das escalas AOFAS e EVA foram, respectivamente, 97,06 (índice de confiança [IC 95%: 95,31 - 98,81] e 0,16 [IC 95% 0,04 - 0,29]. Todos os pacientes retornaram às atividades prévias do cotidiano, sendo que apenas 12 apresentaram algum sintoma residual. Não se verificou instabilidade pós-operatória em nenhum paciente. Ao todo, 46 pacientes retornaram às atividades desportivas e, destes, apenas 1 não retornou ao nível prévio à lesão. Apenas dois pacientes apresentaram alterações relacionadas ao SB. Não houve relato de insatisfação. Conclusão Em fraturas maleolares do tornozelo com lesão da STFD, a fixação da sindesmose com o SB demonstrou excelentes resultados pós-operatórios. Nível de Evidência IV, série de casos retrospectiva.

Elevación de seno maxilar sin injerto y colocación simultánea de implante dental / Graftless maxillary sinus lift with simultaneous dental implant placement

Introducción: La elevación de seno maxilar con implante dental simultáneo, sin el uso de substitutos óseos, ha retomado la teoría del potencial de neoformación ósea, que el coágulo de sangre alojado bajo la membrana de Schneider por sí solo presenta. Excluyendo así la necesidad de materiales exógenos. Objetivo: Exponer la efectividad de la elevación de seno maxilar con implante dental simultáneo, sin el uso de injerto, mediante la evaluación de la cantidad de ganancia ósea vertical. Presentación de casos: Caso 1: Paciente de 62 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica de ventana lateral debido a altura ósea reducida de 5,24 mm. Luego del período de seguimiento tomográfico de 12 meses, después de la carga protésica, se logró una altura ósea vertical de 10,2 mm, lo que dio como resultado una ganancia ósea vertical de 4,96 mm. Caso 2: Paciente de 48 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica transalveolar, mediante el uso de piezoeléctrico debido a una altura ósea reducida de 8,33 mm. Luego del período de seguimiento radiográfico de 4 meses, antes de la carga protésica, se logró una altura ósea vertical de 11,55 mm, lo que dio como resultado una ganancia ósea vertical de 3,19 mm. Conclusiones: Con base en estos 2 informes de casos, la elevación de seno maxilar e implante dental simultáneo sin injerto se asocian con la reducción de la morbilidad quirúrgica, menor probabilidad de procesos infecciosos y menor costo de la cirugía. Por lo tanto, puede considerarse una alternativa quirúrgica para la colocación de implantes en el maxilar posterior superior debido a deficiencias óseas verticales, independientemente de la técnica (lateral o transalveolar(AU)

Introduction: Maxillary sinus lift with simultaneous dental implantation without using bone substitutes, reapproaches the theory about the bone neoformation potential of the blood clot housed under the Schneider membrane, all by itself, thus excluding the need to use exogenous materials. Objective: Discuss the effectiveness of graftless maxillary sinus lift with simultaneous dental implant placement through an evaluation of the amount of vertical bone gain. Case presentation: Case 1: Female 62-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by lateral window technique due to a reduced bone height of 5.24 mm. After a 12-month tomographic follow-up period subsequent to prosthetic loading, a 10.2 mm vertical bone height was achieved, resulting in 4.96 mm vertical bone gain. Case 2: Female 48-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by transalveolar technique using a piezoelectric generator due to a reduced bone height of 8.33 mm. After a 4-month radiographic follow-up period, before prosthetic loading, an 11.55 mm vertical bone height was achieved, resulting in 3.19 mm vertical bone gain. Conclusions: According to these two case reports, graftless maxillary sinus lifting with simultaneous dental implantation is associated to reduced surgical morbidity, a lesser probability of infectious processes and lower surgical costs. It may therefore be considered to be a surgical alternative for implant placement in the posterior maxilla due to vertical bone deficiencies, regardless of the technique used (lateral or transalveolar(AU)

Caracterización clínica epidemiológica de los pacientes con enfermedad de la Peyronie infiltrados con células mononucleares / Clinical Epidemiological Characterization of Peyronie's Disease Patients Infiltrated With Mononuclear Cells

Introducción: La enfermedad de la Peyronie resulta poco común e involucra a hombres de mediana edad. Objetivo: Caracterizar los aspectos clínicos y epidemiológicos de los pacientes con enfermedad de la Peyronie infiltrados con células mononucleares. Métodos: Se realizó un estudio observacional, analítico, longitudinal prospectivo en el Hospital General Docente "Comandante Pinares" desde junio de 2015 hasta mayo de 2018, con una muestra de 159 pacientes. Se controlaron las variables de edad, color de la piel, factores etiológicos, curvatura y desviación del pene además de síntomas y signos. Resultados: El mayor número de pacientes correspondieron a la edad de 50-59 años, de piel blanca, grados de curvatura entre 20o y 39o. Después del tratamiento 115 pacientes se encontraron con curvatura menor a 20o y desviación dorsal. Las causas más frecuentes de los microtraumas a nivel de pene resultan durante al acto sexual o en estado flácido del pene (105/159). La diabetes mellitus y la hipertensión arterial, con 59,7 y 30,8 por ciento, respectivamente resultan los factores etiológicos más frecuentes; los síntomas y signos fueron el dolor y la curvatura, 115 pacientes presentaron ausencia de dolor al hacer la comparación de la media al concluir el tratamiento, resultando significativo (p= 0,0000). Conclusiones: La enfermedad de la Peyronie resulta frecuente en pacientes de la quinta década de la vida, con color de piel blanca. La causa más frecuente son los microtraumas en la actividad sexual, la diabetes mellitus y la hipertensión arterial como antecedentes patológicos personales. Existe mejoría de la sintomatología en los pacientes infiltrados con células mononucleares(AU)

Introduction: Peyronie's disease is rare and involves middle-aged men. Objective: To characterize the clinical and epidemiological aspects of patients with Peyronie's disease infiltrated with mononuclear cells. Methods: An observational, analytical, prospective longitudinal study was carried out at the "Comandante Pinares" General Teaching Hospital from June 2015 to May 2018, with a sample of 159 patients. The variables of age, skin color, etiological factors, curvature and deviation of the penis, as well as symptoms and signs, were controlled. Results: The largest number of patients corresponded to the age of 50-59 years, white skin, degrees of curvature between 20o and 39o. After treatment, 115 patients were found to have curvature less than 20o and dorsal deviation. The most frequent cause of penile microtrauma is during sexual intercourse or in the flaccid state of the penis (105/159). Diabetes mellitus and arterial hypertension, with 59.7 and 30.8 percent, respectively, are the most frequent etiological factors; the symptoms and signs were pain and curvature, 115 patients presented absence of pain when comparing the mean at the end of the treatment, being significant (p= 0.0000). Conclusions: Peyronie's disease is frequent in patients of the fifth decade of life, with white skin color. The most frequent cause are microtraumas in sexual activity, diabetes mellitus and arterial hypertension as personal pathological antecedents. There is improvement of the symptoms in patients infiltrated with mononuclear cells(AU)

Técnicas de citogenética para el estudio de las leucemias / Cytogenetic techniques for the study of leukemias

Introducción: La leucemia se define como un proceso clonal de células hematopoyéticas, que se origina cuando las células sanguíneas que se producen en la médula ósea, cambian y se multiplican sin control. Esta se caracteriza por su heterogeneidad genética y se explica a través de mecanismos causados por alteraciones cromosómicas utilizados en la práctica clínica diaria como biomarcadores útiles para el diagnóstico, el pronóstico o la predicción de respuesta al tratamiento. Objetivo: Describir las técnicas de citogenética convencional y molecular para el diagnóstico y seguimiento de las leucemias. Métodos: Se realizó una revisión de la literatura en inglés y español, a través del sitio web PubMed y el motor de búsqueda Google Académico, de artículos publicados en los últimos cinco años. Se hizo un análisis y resumen de la bibliografía revisada. Análisis y síntesis de la información: En el transcurso de los años la citogenética ha proporcionado información crucial para el diagnóstico y el pronóstico de las neoplasias hematológicas. Tanto las técnicas de citogenética convencional y molecular, como la hibridación in situ fluorescente, la hibridación in situ fluorescente multicolor, el cariotipo espectral, la hibridación genómica comparada y los microarreglos, participan en el reconocimiento de alteraciones cromosómicas y de genes, así como de interacciones involucradas en el proceso de oncogénesis. Conclusiones: Las técnicas de citogenética contribuyen al diagnóstico, a la estratificación pronóstica y a la aplicación del tratamiento según el tipo o subtipo de leucemia(AU)

Introduction: Leukemia is defined as a clonal process of hematopoietic cells, which occurs when blood cells that are produced in the bone marrow change and multiply uncontrollably. This is characterized by its genetic heterogeneity and is explained through mechanisms caused by chromosomal alterations that are used in daily clinical practice as useful biomarkers for diagnosis, prognosis or prediction of response to treatment. Objective: To describe the conventional and molecular cytogenetic techniques used for the diagnosis and monitoring of leukemias. Methods: A review of the literature in English and in Spanish was carried out, in the PubMed website and using the search engine Google, for articles published in the last five years. We performed analysis and summary of the reviewed bibliography. Analysis and synthesis of information: Cytogenetics over the years has provided crucial information for the diagnosis and prognosis of hematologic malignancies. Both conventional and molecular cytogenetic techniques such as fluorescent in situ hybridization, multicolor fluorescent in situ hybridization, spectral karyotype, comparative genomic hybridization and microarrays, participate in the recognition of chromosomal and gene alterations, as well as interactions involved in the oncogenesis process. Conclusions: These cytogenetic techniques contribute to the diagnosis, prognostic stratification and application of treatment according to the type or subtype of leukemia(AU)