Rápida implementación de teledermatología durante la pandemia por COVID-19: lecciones aprendidas de un departamento académico de Dermatología

Background: The day after COVID-19 quarantine started, we initiated patient care through Tele-dermatology. Aim: To report the experience of the implementation of Telemedicine in dermatology and to assess its impact on the number of dermatological visits compared with the pre-pandemic period. Material and methods: The study was conducted between March 27th, 2020, and April 30th, 2020. All patients submitted clinical images of their skin condition via secure email before the telemedicine visit. All telemedicine visits were conducted using the Zoom video conferencing platform. Patient demographics and medical history were recorded. If the dermatologist was unable to reach a diagnosis, the patient was sent for an in-person visit, skin biopsy, or additional laboratory workup. Results: We recorded 1,357 Tele dermatology visits from 1,222 patients aged 29 ± 18 years (38% males). Visits increased from 104 to 298 from the first to the last week, corresponding to 17% of the patient volume seen before the pandemic (1,709 in-person patients/week). A preliminary diagnosis was made in 95% of cases. Ninety percent of patients sent photos. Fifty eight percent of cases were chronic diseases, and were classified as inflammatory in 68%, infectious in 15%, neoplastic/tumoral in 7%, or other conditions in 11%. Less than 1% of these visits were COVID-19 related. Conclusions: In this prospective study of Tele-dermatology lasting five weeks, a preliminary diagnosis could be made in approximately 95% of cases and in the first five weeks of implementation, a volume of consultations equivalent to 17% of those made in the pre-pandemic period was carried out. Therefore, Tele-dermatology can be implemented quickly and successfully in practices when healthcare access is limited.

Análisis de la composición química de litiasis urinaria de 649 pacientes mediante espectroscopía infrarroja, primera experiencia nacional / Chemical composition analysis of 649 urinary stones

Background: Chemical composition analysis of urinary stones is a fundamental part of the metabolic workup of urolithiasis. Aim: To report the chemical composition of urinary stones using infrared spectroscopy. Material and Methods: The chemical composition of rinary stones recovered from 649 patients aged 1 to 97 years (68% males), were analyzed using a Perkin Elmer FTIR Spectrometer, Spectrum Two. Results: Calcium oxalate monohydrate was the most common composition found in 45% of cases, followed by mixed composition, which included three ammonium phosphate stones in 29% of cases. Pure uric acid composition was found in 16% of stones. Three cystine stones were detected. Conclusions: These findings do not differ from those found in developed countries.

Frecuencia de ansiedad y depresión en pacientes coordinados para cirugía electiva en el Hospital de Clínicas Manuel Quintela / Frequency of anxiety and depression in patients coordinated for elective surgery at the Hospital de Clínicas Manuel Quintela

Los trastornos depresivos y de ansiedad son más frecuentes en pacientes que se encuentran a la espera de un acto anestésico-quirúrgico. Estos se consideran factores de riesgo de complicaciones posoperatorias de allí el interés de detectarlos en la consulta preoperatoria. El objetivo del trabajo fue determinar la frecuencia de ansiedad y depresión en pacientes pre-quirúrgicos en el Hospital de Clínicas utilizando la Escala de Ansiedad y Depresión Hospitalaria (Hospital Anxiety and Depression Scale) validada en español mediante un estudio observacional, descriptivo y transversal. Se realizó una encuesta a una muestra tomada al azar, de pacientes prequirúrgicos obtenida de la consulta externa o de las consultas provenientes de salas de internación quirúrgica del Hospital de Clínicas entre julio y septiembre de 2019. La prevalencia global de ansiedad y depresión fue de 44% y 14,5%, respectivamente. Un mayor nivel de depresión fue asociado al sexo femenino, no encontrándose asociación entre otras variables como edad, tipo de cirugía u hospitalización, y la mayor frecuencia de cualquiera de los trastornos. Se concluye que los niveles de ansiedad son relativamente elevados y, junto a la depresión, pueden ser detectados en la consulta preoperatoria de manera sencilla utilizando el instrumento propuesto.

The depressive and anxiety disorders are more frequent in patients who are waiting a surgical procedure. These are risk factors of postoperative complications. The objective of this work was to determine the incidence of anxiety and depression in the preoperative period at the University Hospital using the Hospital Anxiety and Depression Scale validated in spanish through an observational, descriptive and cross-sectional study. A socio-demographic characterization of patients was carried out and aspects related to imminent surgery were described. The study was conducted in a random sample of pre-surgical patients who attended an outpatient clinic or were hospitalized at the Hospital de Clínicas, between July and September 2019. The global incidence of anxiety and depression was 44% and 14.5% respectively. A mayor level of depression was observed in females, no other statistically significant evidence was found to support an association between the other variables (age, type of surgery, hospitalization) and the higher prevalence of any of the disorders. We concluded that the level of anxiety is high in our population and deserves to be detected, through the implementation of a simple instrument.

Estructura lingüística y Teoría de la Mente en trastorno del lenguaje / Language form and the theory of mind in language impairment

El concepto de Teoría de la Mente (ToM, de su sigla en inglés) hace referencia a la capacidad de ponerse en el lugar de la otra persona y ser así capaz de interpretar creencias, deseos e intenciones de otros. El propósito de esta investigación fue determinar el tipo de relación entre la adquisición de la forma del lenguaje y el desarrollo de la Teoría de la Mente en niños con Trastorno Específico del Lenguaje TEL tipo mixto y en niños con desarrollo típico, debido a que la literatura en relación con el tema es escasa y se focaliza principalmente en niños con autismo. La investigación se llevó a cabo mediante una metodología de tipo cuantitativa, un diseño no experimental-transversal y un alcance descriptivo y correlacional. Los instrumentos utilizados para evaluar el desarrollo de la estructura del lenguaje fueron el Test de Procesos de Simplificación Fonológica TEPROSIF-R y el Test de Comprensión Auditiva de E-Carrow TECAL; en tanto, para determinar el desarrollo de la ToM se utilizaron la prueba de Sally y Anne y la prueba de Mentalización. La muestra fue no probabilística y estuvo constituida por 28 niños con TEL mixto (grupo estudio) y 28 niños con desarrollo normal (grupo control) de 5 a 6 años, 11 meses. Los resultados indicaron que existe una relación entre el desarrollo de la teoría de la mente y el desarrollo de la estructura del lenguaje en su modalidad expresiva y comprensiva, principalmente en los niños con TEL mixto. A partir de estos resultados se puede concluir que es necesario intervenir desde el quehacer fonoaudiológico, además de las habilidades lingüísticas, aquellas habilidades asociadas con la Teoría de la Mente.

The concept of Theory of Mind ToM refers to the ability to put oneself in the other person's place and be able to interpret beliefs, desires and intentions of others. The purpose of this research was to determine the relationship between the development of the language form and the ToM in children with mixed Specific Language Impairment (SLI) and children with typical language development because the literature on the topic is limited and it focuses mainly on children with autism. The research was carried out using a quantitative methodology, a non-experimental-cross-sectional design, and a descriptive and correlational scope. The instrument used to determinate the development of the language structure were Test de Procesos de Simplificación Fonológica (TEPROSIF-R) and Test de Comprensión Auditiva de E-Carrow (TECAL); meanwhile, to evaluate the development of the ToM were used Sally and Anne Task and Mentalization test. The sample consisted on 28 children with SLI (study group) and 28 children with normal language development (control group) from 5 to 6,11 years old. The results indicate that there is a relationship between the development of the ToM and the development of the structure of language in its expressive and comprehensive modality, mainly in children with Mixed SLI. From these results, it is concluded that it is necessary to intervene not only linguistic abilities but also those abilities related to ToM from the speech therapist tasks.

Meditación: análisis crítico de la experiencia de jóvenes universitarios en su vida cotidiana y salud / Meditação: análise crítica da experiência de jovens universitários em seu cotidiano e saúde / Meditation: critical analysis of the experience of young university students in their daily life and health

Resumen Introducción La meditación ha sido una práctica estudiada desde diferentes perspectivas, en especial desde la salud, pero poco desde metodologías cualitativas que den cuenta de los procesos subjetivos de cambio en la vida cotidiana. Objetivo El presente estudio pretende dar cuenta de los significados que un grupo de estudiantes atribuye a la práctica de la meditación en relación a su vida cotidiana. Metódo Desde una metodología cualitativa, se indaga en la experiencia de estudiantes universitarios que participaron en un Curso de Formación General en el cual se realizaron 10 sesiones de meditación. La recolección de datos se realiza a partir de entrevistas semiestructuradas, junto con la revisión de bitácoras personales en las que relatan su experiencia tras cada sesión. Resultados La práctica de la meditación tuvo implicancias en los ámbitos: personal, relacional y societal, destacando el bienestar que genera la meditación en el corto y mediano plazo, aportando al autocuidado, al autoconocimiento y al cambio de perspectiva respecto a sí mismos, a los otros y a la realidad social, favoreciendo acciones transformadoras en estos ámbitos. Conclusión La meditación realizó un quiebre en la vida cotidiana de estos sujetos, experiencia que habría favorecido un pensamiento crítico respecto a su realidad, lo que siendo complementado con otras estrategias desde la terapia ocupacional, podría contribuir a los procesos de intervención asumiendo un rol facilitador para la transformación de la propia vida y de la realidad social.

Resumo Introdução A meditação tem sido uma prática estudada sob diferentes perspectivas, principalmente em saúde, mas pouco em metodologias qualitativas que explicam os processos subjetivos de mudança na vida cotidiana. Objetivo O presente estudo apresenta os significados que um grupo de estudantes atribui a uma prática de meditação na relação com a sua vida cotidiana. Metódo A partir de uma metodologia qualitativa, avaliou-se a experiência de estudantes universitários que participaram de um Curso de Formação Geral onde foram conduzidas 10 sessões de meditação. A coleta de dados foi feita a partir de entrevistas semiestruturadas, juntamente com a revisão de registros pessoais nos quais os alunos apontavam suas experiências após a realização de cada sessão de meditação. Resultados A prática da meditação pelos alunos apresentou implicações no seu nível pessoal, nas relações interpessoais e na participação social, desta forma permitindo correlacionar a meditação ao bem-estar gerado a curto e médio prazos. Contribuiu também para a melhora no que diz respeito a: autocuidado, autoconhecimento, mudança na autopercepção, na percepção com relação aos outros e na realidade social, favorecendo assim ações transformadoras nestas áreas. Conclusão A meditação permite uma pausa na vida cotidiana, favorecendo pensamento um crítico sobre sua realidade e, ao ser complementado com outras estratégias utilizadas pela Terapia Ocupacional, poderia contribuir aos diversos processos de intervenção, assumindo um papel facilitador para transformação da própria vida e da realidade social.

Abstract Introduction Meditation has been a practice studied from different perspectives, especially from health, but little from qualitative methodologies that account for the subjective processes of change in everyday life. Objective The following study pretends to get to know the meaning that a group of students attributes to the use of meditation in their daily life. Method From a qualitative methodology, there is an investigation in the experience of university students who participated in a general training course in which ten meditation meetings were held. The recollection of data was done from semi-structured interviews to the participants, with the review of personal binnacles in which they reported their experience in every meditation. Results The meditation practice had implications in the personal, relational and societal areas, emphasizing the well-being that the meditation generates in the short and medium-term, contributing to self-care, to self-knowledge and the change of the perspective on themselves, on others and the social reality, favoring the transforming actions in these areas. Conclusion The meditation generates a rupture in the subject's daily life, experience that would have favored their critical thinking regarding their reality, which is complemented with other strategies from occupational therapy could contribute to the intervention processes, assuming a facilitating role for the transformation of individual life and social reality.

Trombosis de la vena central de la retina (TVCR) bilateral asociada a síndrome de hiperviscosidad en una Macroglobulinemia de Waldenström (MW) - a propósito de un caso / Bilateral central retinal vein thrombosis (TVCR) associated with hyperviscosity syndrome in a Waldenström Macroglobulinemia (MW) - a case report

Introducción: la Macroglobulinemia de Waldenström (MW) es un tipo raro de linfoma de células B caracterizado por la proliferación de células linfoplasmocíticas que secretan altas cantidades de inmunoglobulinas M (IgM) monoclonales. Puede presentarse con una amplia gama de síntomas, entre ellos los derivados del aumento de la viscosidad plasmática. Métodos: reportamos un caso de MW que presentó una trombosis de la vena central de la retina (TVCR) bilateral en el contexto de un síndrome de hiperviscosidad (SHV). El objetivo de este trabajo fue revisar algunos aspectos clínicos de la MW, con especial énfasis en el SHV y la TVCR. Resultados: las manifestaciones clínicas y de laboratorio de la MW son inespecíficas y comunes a otras neoplasias hematológicas. El SHV se produce cuando los niveles de IgM sobrepasan los 3 mg/dL, situación que ocurre en un 15-30 por ciento de los pacientes. La TVCR es una complicación grave y rara asociada al SHV, presentándose típicamente como una pérdida de agudeza visual indolora. El fondo de ojo exhibe signos característicos, como tortuosidad venosa y hemorragias retinales hasta la periferia, y la angiografía con fluorosceína y la OCT pueden orientar al diagnóstico y guiar el manejo. El tratamiento incluye la plasmaféresis y tratamientos oftalmológicos basados en agentes antioangiogénicos. Conclusión: la MW es una enfermedad incurable. Sin embargo, es importante sospechar una TVCR en pacientes que debutan con una pérdida de agudeza visual, ya que existen tratamientos efectivos en el manejo de esta complicación. (AU)

Introduction: Waldenstrom's Macroglobulinemia (WM) is a rare type of B-cell lymphoma characterized by proliferation of lymphoplasmocitarian cells that secrete high amounts of monoclonal immunoglobulin M (IgM). It may present with a wide range of symptoms, including the ones that derivatives of the increase in plasma viscosity. Methods: we report a case of WM that presented a bilateral central retinal vein occlusion (CRVO) in the context of a hyperviscosity syndrome (HVS). The objective of this study was to review clinical aspects of the WM, with special emphasis on the HVS and the CRVO. Results: the WM laboratory and clinical manifestations are common to other hematological malignancies. The HVS occurs when levels of IgM exceed 3 mg/dL, situation that occurs in 15-30 percent of patients. The CRVO is a serious and rare complication associated with the HVS, typically presented as a painless visual acuity loss. The fundoscopic examination exhibits characteristic signs, such as venous tortuousity and retinal hemorrhages in all four quadrants and most numerous in the periphery; angiography with fluoroscein and the OCT can orientate the diagnosis and guide the management. The treatment includes plasmapheresis and other ophthlamological treatments based on antiangiogenic agents. Conclusion: the WM is an incurable disease. However, it is important to suspect a CRVO in patients who made their debut with a loss of visual acuity, since there are effective treatments in the management of this complication.(AU)

Hematoma subcapsular hepático asociado a síndrome de HELLP en el puerperio / Hepatic subcapsular hematoma associated with HELLP syndrome in the puerperium

El hematoma subcapsular hepático es una complicación grave del embarazo, asociada a preeclampsia severa o síndrome de HELLP. Al ser poco frecuente se requiere un alto índice de sospecha para realizar el diagnóstico precozmente, lo que determinará su pronóstico. A pesar de los avances en cirugía y medicina intensiva es una patología que sigue teniendo una elevada morbimortalidad materno fetal. Damos a conocer el caso de una paciente que cursó un embarazo sin incidentes hasta el parto, posterior a lo cual presenta síndrome de HELLP y un hematoma subcapsular hepático, que evolucionó favorablemente con tratamiento conservador.(AU)

A hepatic subcapsular hematoma is a serious complication of pregnancy, associated with severe preeclampsia or HELLP syndrome. Due to the low frequency of this presentation, a high suspicion index is required for early diagnosis, which it will determine its prognosis. Despite the advances in surgery and intensive medicine, it still has high maternal-fetal morbidity and mortality. In the present work, we report the case of a patient who had a physiological pregnancy until labor. Subsequently, the patient developed HELLP syndrome and hepatic subcapsular hematoma, which evolved favorably with conservative treatment. (AU)