A systematic review on clinical trials on the different approaches of breast cancer screening uptake in improving screening attendance

Background@#The early stage of cancer can be asymptomatic. Thus, different strategies were utilized to increase breast screening attendance which resulted in better treatment outcomes. Therefore, this review aimed to provide evidence on the effectiveness of the different approaches of breast screening uptake in improving screening attendance.@*Objectives@#The primary objective of this systematic review was to determine the effectiveness of the different approaches to breast screening uptake in improving screening attendance. The secondary objective was to identify the socio-geographic profile that affects the screening uptake.@*Methods@#Online databases, such as PubMed and Cochrane Central Register of Controlled Trials, were searched for studies published between January 2010 to December 2020. This review only included comparative randomized clinical trials involving humans as the research participants. In addition, reference lists of included studies were reviewed to identify additional relevant papers.@*Results@#The study included the review of 12 randomized controlled trials. Seven studies were conducted in a European setting, two in the United States of America, another two studies in Asia, and one study conducted in Canada. The intervention strategy to increase screening uptake were diverse in different studies. Ten of these studies used multiple strategies, while the remaining two studies utilized individualized strategies. Most of the studies were individual-based interventions. One study was a group-based intervention. The results showed that these interventions increase the uptake of breast cancer screening than no intervention at all.@*Conclusions@#The review confirmed that any interventions to increase breast screening uptake showed favorable outcomes in increasing breast screening attendance. However, the effectiveness of any one specific intervention cannot be made as these interventional studies greatly varied in terms of their intervention, study population, and geographical area.

A conceptual model to assess the impact of anthropogenic drivers on water-related ecosystem services in the Brazilian Cerrado / Um modelo conceitual para avaliar o impacto de fatores antropogênicos nos serviços ecossistêmicos relacionados à água no Cerrado

Abstract: The development of strategies that conciliate anthropogenic activities with nature conservation is becoming increasingly urgent, particularly in regions facing rapid conversion of native vegetation to agriculture. Conceptual modelling enables assessment of how anthropogenic drivers (e.g. land use/land cover change and climate change) modify natural processes, being a useful tool to support strategic decision-making. The present work describes a conceptual model to evaluate water-related ecosystem service provision under different land use scenarios in the Matopiba region of the Brazilian Cerrado, the world's most biodiverse savanna and an agricultural frontier. Model variables were determined (direct drivers, indirect drivers, focal components and responses) and the Nature Futures Framework was consulted to incorporate socio-ecological components and feedbacks. Future scenarios were developed considering potential trajectories of drivers and governance responses that may impact land use in the region, including the possibility of full compliance with Forest Code and implementation of the Soy Moratorium in the region. The conceptual model and scenarios developed in the present study may be useful to improve understanding of the complex interactions among anthropogenic drivers, water-related ecosystem services and their potential repercussions for natural and social systems of the region. Governance decisions will be critical to maintaining the ecosystems of the region, the services it provides and the culture and tradition of the people historically embedded in the landscape. In acknowledgment of humanity's dependence on nature, the importance of inverting the way scenarios are used is highlighted. Rather than using scenarios to measure the impacts of different policy options on nature, scenarios representing the desired outcomes for biodiversity and ecosystem services can be used to inform how policies can guarantee ecosystem integrity into the future.

Resumo: O desenvolvimento de estratégias que conciliem atividades antropogênicas com a conservação da natureza tem se tornado cada vez mais urgente, principalmente em regiões que enfrentam uma rápida conversão da vegetação nativa em agricultura. Modelos conceituais permitem avaliar como fatores antropogênicos (por exemplo, mudança de uso e cobertura do solo e mudanças climáticas) modificam os processos naturais, sendo uma ferramenta útil para apoiar a tomada de decisões estratégicas. O presente trabalho descreve um modelo conceitual para avaliar a provisão de serviços ecossistêmicos relacionados à água sob diferentes cenários de uso do solo na região de Matopiba, no Cerrado, a savana com maior biodiversidade do mundo e uma fronteira agrícola. Foram determinadas as variáveis do modelo (fatores diretos, fatores indiretos, componentes focais e respostas) e o Nature Futures Framework foi consultado para incorporar componentes socioeconômicos e feedbacks. Cenários futuros foram desenvolvidos considerando possíveis trajetórias de fatores antropogênicos e respostas de governança que podem impactar o uso do solo na região, incluindo a possibilidade de cumprimento total do Código Florestal e a implementação da Moratória da Soja na região. O modelo conceitual e os cenários apresentados no presente trabalho podem ser úteis para melhorar a compreensão das complexas interações entre fatores antropogênicos, serviços ecossistêmicos relacionados à água e suas possíveis implicações para os sistemas naturais e sociais da região. Decisões de governança serão críticas para manter os ecossistemas da região, os serviços fornecidos por eles, a cultura e tradição das pessoas historicamente inseridas na paisagem. Em reconhecimento da dependência da humanidade em relação à natureza, destaca-se a importância de inverter a maneira como os cenários são usualmente usados. Em vez de mensurar os impactos de diferentes políticas na natureza, cenários representando os resultados desejados para biodiversidade e serviços ecossistêmicos podem ser usados para informar como políticas podem garantir a integridade dos ecossistemas no futuro.

Resultados precoces y tardíos en resecciones ampliadas en cáncer de colon T4b / Early and late results after multivisceral resections for T4b colonic cancer

Objetivos: Describir las tasas de morbilidad y mortalidad postoperatorias de las resecciones ampliadas de colon en pacientes con tumor en estadio T4b. Material y métodos: Serie de casos, que incluye pacientes con adenocarcinoma colónico clínicamente con compromiso de estructuras adyacentes (T4b), intervenidos de resección multivisceral entre los años 2005 y 2014. Fueron excluidos pacientes con metástasis, con bordes macroscópicamente comprometidos y con datos clínicos incompletos. Las variables resultado fueron la morbilidad y mortalidad postoperatorias a los 30 días. Se aplicó estadística descriptiva. Para las variables categóricas se utilizaron porcentajes, y para las variables continuas se utilizaron la media y mediana como medidas de tendencia central y la desviación estándar o rango como medidas de dispersión. Se aplicó el método de Kaplan-Meier para la sobrevida, y pruebas de Chi cuadrado y log-Rank para el análisis de sobrevida por subgrupos. Resultados: De un universo de 483 pacientes intervenidos por adenocarcinoma colónico, 71 fueron T4b. Se aplicaron criterios de exclusión, resultando una muestra de 46 pacientes. Los órganos más frecuentemente comprometidos fueron: intestino delgado, epiplón, pared abdominal y otro segmento colónico. La morbilidad y mortalidad postoperatorias, de un 21,7 y un 6,5%, respectivamente. Influyeron significativamente en la sobrevida la edad, el antecedente de quimioterapia adyuvante, la presencia de inestabilidad microsatelital y la diferenciación del tumor. Conclusiones: El compromiso multivisceral de los tumores colónicos no es infrecuente, con un 9,5% para nuestra serie. La resección R0 es el tratamiento de elección. Influyen en el pronóstico el tipo histológico y el comportamiento biológico del tumor, así como la quimioterapia adyuvante y la edad del paciente.

Aims: To describe postoperative morbidity and mortality rates in multivisceral resections for T4b colon cancer. Material and methods: Case series of patients diagnosed of T4b colonic adenocarcinoma who underwent multivisceral resection between 2005 and 2014. There were excluded those patients who had metastases, R2 resection and incomplete clinical data. Result variables were morbidity and mortality at 30 days. It was performed descriptive statistic using percentage estimation for categories, average and median for continuous variables and standard deviation or rank as measures of statistical dispersion. It was used Kaplan-Meier method for survival and chi-square and log-Rank for subgroups analysis. Results: From a universe of 483 patients who underwent surgery for colonic adenocarcinoma, whom 71 were staged as T4b, after exclusion criteria were applied it resulted a sample of 46 patients. The small bowel, omentum, abdominal wall and other colonic segment were the more often compromised organs. Postoperative morbidity and mortality were 21.7 and 6.5% respectively. The age, history of adjuvant chemotherapy, presence of microsatellite instability and tumor differentiation had a significant impact in survival. Conclusions: Multivisceral affection in colonic cancer is not uncommon, 9.5% in our series. R0 resection is the treatment of choice. Patient outcome depends on his age, histologic and biologic characteristics of the tumor and adjuvant treatment.

Hemiparesia súbita secundaria a cisticercosis cerebral: presentación de un caso clínico / Sudden hemiparesis secondary to cerebral cysticercosis: presentation of a clinical case

Introducción: La neurocisticercosis es una infección parasitaria del sistema nervioso central, ocasionada por la etapa larval del parásito Taenia solium. Su prevalencia mundial es de 9,1%. Se presenta a continuación un caso clínico en el que destaca una clínica infrecuente y tamaño de la lesión poco común; caso que fue resuelto con éxito mediante neurocirugía. Presentación del caso: Hombre de 48 años, residente en localidad rural, consultó por cuadro súbito de hemiparesia derecha de predominio crural, posteriormente con aumento de paresia braquial ipsilateral. Al examen físico destacó síndrome piramidal derecho. Se estudió con Tomografía Computarizada que evidenció quiste frontal izquierdo con compresión del área motora, sugerente de lesión parasitaria. Resonancia Nuclear Magnética de Cerebro (RNMC) informó proceso expansivo quístico fronto-parietal parasagital izquierdo de 5 x 5,5 cm, con efecto de masa. Por tamaño, tipo de lesión y clínica se decidió realizar cirugía abierta con extirpación total y biopsia que informó cisticercosis cerebral. El paciente evolucionó con recuperación total de su déficit motor posterior a la cirugía. Discusión: La neurocisticercosis se encuentra dentro de los diagnósticos diferenciales de lesiones quísticas encefálicas. Su clínica es inespecífica, manifestándose comúnmente con convulsiones y cefalea. La RNMC permite el diagnóstico y localización de las lesiones. El tratamiento es médico, quirúrgico o combinado. Generalmente, el manejo se basa en antiepilépticos y antiparasitarios sistémicos, sin embargo en este caso, se decidió el manejo quirúrgico que llevó a una mejoría total del paciente, lo que avala la cirugía precoz como principal medida en lesiones de este tipo

Introduction: Neurocysticercosis is a parasitic infection of the central nervous system, caused by the larval stage of the parasite Taenia solium. Its worldwide prevalence is 9.1%. We present below a clinical case with an infrequent clinical and uncommon lesion size, with surgical resolved. Case report: A 48 year old man, who was a resident of a rural locality, consulted for sudden hemiparesis on the right side of the crural predominance, subsequently with increased ipsilateral brachial paresis. Physical examination highlighted right pyramidal syndrome. It was studied with Computed Axial Tomography that showed left frontal cyst with compression of the motor area, suggestive of parasite lesion. Brain Nuclear Magnetic Resonance (BNMR) reported left parasagittal fronto-parietal cystic expansive process of 5 x 5.5 cm, with mass effect. By size, type of lesion and clinic it was decided to perform open surgery with total extirpation and biopsy that reported cerebral cysticercosis. The patient evolved with complete recovery of motor deficit after surgery. Discussion: Neurocysticercosis is a differential diagnosis of brain cystic lesions. Its clinic is non-specific, commonly manifesting with seizures and headache. The RNMC allows the diagnosis and location of the lesions. The treatment is medical, surgical or combined. Usually, the management is based on antiepileptics and systemic antiparasitic, however in this case, it was decided the surgical management that led to the total improvement of the patient, which guarantees the early surgery as the main measure in lesions of this type

Análisis del tiempo de vida útil en la elaboración de mermelada de higuerón (Cucúrbita Odorífera Vell) con zanahoria (Daucus Carota) / Time analysis of life in the development of marmalade higuerón (Cucurbita Odorifera Vell) with carrot (Daucus Carota)

The aim of this study was to determine the lifespan in making jam by higueron and carrot mixture, motivated by the lack of a number of species of tubers and vegetables, as evidenced by the low consumption of these foods and the lack of appropriate technology for processing the same. The two raw materials are high in vitamins and minerals, higueron suitable for their characteristics and chemical composition is considered a fruit-vegetable, it is possible it industrialization similar to those made with fruits, like the carrot is a food products excellent from the nutritional point of view, contributing to improve the quality of the jam. The treatments were kept under ambient conditions for 40 days when pH were recorded - soluble solids (° Brix) - Heartburn - Microbiological and organoleptic analysis in order to identify the best experimental treatment tests. According to the results obtained and microbiological analysis establishes a lifetime about 6 months.

El objetivo de este estudio fue conocer el tiempo de vida útil en la elaboración de mermelada mediante una mezcla higuerón y zanahoria, motivado por el desconocimiento de un sinnúmero de especies de tubérculos y hortalizas, evidenciado por el bajo consumo de estos alimentos y la carencia de tecnología adecuada para el procesamiento del mismo y aprovechamiento de sus nutrientes. Las dos materias primas de alto contenido de vitaminas y minerales; el higuerón se considera como fruta-hortaliza por sus características y composición química, siendo posible la industrialización en productos semejantes a los elaborados con las frutas. La zanahoria es un alimento excelente desde el punto de vista nutricional por lo que aporta al mejoramiento de la calidad de la mermelada. Los tratamientos se mantuvieron bajo condiciones ambientales durante 40 días en los que se registró pH - sólidos solubles (°Brix) - acidez - análisis microbiológicos y pruebas organolépticas con la finalidad de identificar el mejor tratamiento experimental. De acuerdo a los resultados obtenidos y al análisis microbiológico se establece un tiempo de vida útil alrededor de 6 meses.

Narrativas de pacientes con síndrome de intestino irritable: análisis de casos / Narratives of patients with irritable bowel syndrome: analysis of cases

Irritable bowel syndrome (IBS) is a psychosomatic disease whose prevalence has increased considerably in recent years. IBS tends to present comorbidity with other psychopathological conditions such as anxiety, phobias, hypochondria and depression, which makes the medical and psychotherapeutic treatment more complex. There is little empirical evidence on psychotherapeutic treatments to help patients cope with these symptoms. The purpose if this study is to describe the narratives of patients with IBS and explore the role that these narratives play in the establishment and persistence of the disease. Two female IBS-patients were selected and an in depth interview was conducted. The dialogue was transcribed and data were analyzed using the biographical approach. The results show that patients have high levels of alexithymia, operational thinking and difficulties in emotional expression; confirming the main features of psychosomatic personality. It is proposed to define specific psychotherapeutic approaches for each patient according to their personality inferred through their narratives, rather than a unified approved technique for all patients with this disease...

El síndrome de intestino irritable (SII) es una enfermedad psicosomática cuya prevalencia ha aumentado considerablemente en los últimos años. Tiende a presentar comorbilidad con otros cuadros psicopatológicos como la ansiedad, fobias, hipocondría y depresión, lo cual otorga mayor complejidad al tratamiento médico y psicoterapéutico. Existe escasa evidencia empírica sobre tratamientos psicoterapéuticos que ayuden a estos pacientes a lidiar con la sintomatología. El presente trabajo tuvo por objetivo describir las narrativas de pacientes que padecen SII y explorar el rol que cumplen estas narrativas en la constitución y mantenimiento de la enfermedad. Se seleccionaron dos pacientes de sexo femenino con diagnóstico médico de SII y se realizó una entrevista en profundidad. El diálogo fue transcrito a texto y los datos fueron analizados desde el enfoque biográfico. Los resultados muestran que las pacientes padecen altos niveles de alexitimia, pensamiento operatorio y dificultades en la expresión emocional; confirmando las principales características de la personalidad psicosomática. Se propone definir abordajes psicoterapéutico específicos a cada paciente de acuerdo a su personalidad inferida a través de sus narrativas, más que una técnica homologada unificada para todos los pacientes que padecen esta enfermedad...

Paratiroidectomía en pacientes renales crónicos en Argentina: estudios prequirúrgicos, tipos de cirugía, recurrencia y persistencia / Parathyroidectomy in chronic kidney disease patients in Argentina: pre surgical studies, types of surgery, recurrence and persistence

La paratiroidectomía (PTx) es el tratamiento de elección en pacientes con HPT 2º severo, refractario al tratamiento médico. Se cuenta con muy poca información en Argentina de este procedimiento, por lo cual se realizó este estudio. Material y Métodos: Se incluyeron 255 pacientes con PTx entre el año 2003 al 2007 de un registro voluntario. Se evaluaron los estudios de localización prequirúrgicos, de laboratorio de metabolismo fosfocálcico previo y posterior a la cirugía y el tipo de técnica quirúrgica utilizada. Se analizó la persistencia y recidiva del HPT postcirugía. Resultados: La tasa de PTx fue de 2,7/1000 pacientes año. 83% de los pacientes tuvieron ecografía de cuello y 59% Sesta Mibi con Tc 99. Hubo una correlación positiva (p<0.001) entre el número de glándulas detectadas por ecografía y Sesta Mibi. La paratiroidectomía realizada fue: subtotal en 77%, total con autoimplante en 14% y total sin autoimplante en 9%. Hubo descensos significativos de Ca y P, fosfatasa alcalina y PTH (1744 ± 788 pg/ml a 247 ±450 pg/ml; p<0.0001) postcirugía. A los 2,4 ±2,5 meses de la PTx, el 72% de los pacientes tenía PTH <250 pg/ml, 19,8% tenía persistencia y 8,3% había recidivado. De acuerdo al tipo de cirugía la persistencia y recidiva fueron para PTx subtotal 22% y 8,3%, PTx total con implante 11% y 11% y PTx total sin autoimplante 13% y 4% respectivamente. La realización de Sesta Mibi no influyó en los resultados de la PTx. No se observaron diferencias entre los centros en relación con persistencia y recidiva. Conclusiones: La tasa de PTx fue muy baja, la ecografía fue el método de localización prequirúrgico preferido y la PTX subtotal la técnica quirúrgica más utilizada. La PTx fue exitosa en la mayoría de los pacientes y la persistencia y recidiva no estuvieron relacionadas con la técnica.

Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary hyperparathyroidism, refractory to medical treatment. There is not enough information about this procedure in Argentina, that is the reason why we performed this study. Material and Methods: 255 patients with PTx were included from the year 2003 to 2007 on a voluntary register. Studies of pre-surgical localization, phosphocalcic metabolism laboratories before and after surgery were evaluated, and the type of surgical technique used. The persistence and recurrence of post-surgical hyperparathyroidism was analyzed. Results: The PTx rate was 2,7/1000 patients year. 83% of the patients had neck echography and 59% Sestamibi scans with Tc 99. There was a positive correlation (p<0,001) between the number of detected glands by echography and Sestamibi. The parathyroidectomy performed was: subtotal in 77%, total with self-implant in 14% and total without self-implant in 9%. There were significant falls of Ca and P, Alkaline Phosphatase and PTH (1744±788 pg/ml to 247±450 pg/ml; p<0.0001) post-surgical. 2.4 ±2,5 months after the PTx, 72% of patients had PTH <250 pg/ml, 19,8% had persistence and 8,3% had recurrence. According to the type of surgery, the persistence and recurrence were for subtotal PTx 22% and 8,3%, total PTx with implant 11% and 11%, and total PTx without selfimplant 13% and 4% respectively. The performance of the Sestamibi scan did not affect the PTx results. No noticeable differences were observed among the centers for persistence and recurrence. Conclusions: The PTx rate was very low, echography was the preferred method of pre-surgical localization, and subtotal PTx was the most used surgical technique. PTx was successful in most of the patients, and persistence and recurrence were not related to the technique.

Maximum bite force idn elderly indigenous and non-indigenous denture wearers

El objetivo de este estudio fue comparar las medidas de fuerza máxima de mordida (MBF) en pacientes desdentados adultos mayores indígenas (Mapuches) y no indígenas, en el momento de recibir sus prótesis totales y un mes posterior a la inserción.Una muestra de 100 sujetos adultos mayores fue dividida en dos grupos: 50 indígenas y 50 no indígenas, cada uno de ellos con 25 pacientes de sexo femenino y 25 masculino. Todos los individuos estudiados eran completamente edéntulos, quienesrecibieron prótesis removibles totales nuevas tanto superior como inferior. Las medidas fueron realizadas en el momento de la inserción de ambas prótesis y posterior a un mes de uso. Seles solicitó a los sujetos que realizaran un esfuerzo máximo con tres mordidas por lado en máxima intercuspidación, con un tiempo de descanso de 2 minutos entre cada medición. El análisisestadístico fue realizado por medio del test t-Student´s. Los valores de fuerza máxima observados en los sujetos indígenas fueron significativamente mayores que en los individuos no indígenas. Además, los valores de fuerza posterior al mes de uso dela prótesis nueva fueron significativamente mas altos que losobtenidos al momento de la inserción de la prótesis. Por otro lado, no se identificaron diferencias significativas en los valores entre los lados izquierdo y derecho. Así, los pacientes indígenasmostraron valores mayores de fuerza masticatoria máxima. También, se pudo observar que los pacientes sufrieron un proceso de adaptación a las prótesis nuevas, en los cuales la fuerza máximamasticatoria posterior a un mes aumentó considerablemente...

Demências rapidamente progressivas. Importância da neuroimagem nas etapas diagnósticas. / Rapidly progressive dementias. Importance of neuroimage in the diagnostic steps.

As demências rapidamente progressivas constituem um grupo heterogêneo de condições clínicas (neurodegenerativas, vasculares, infecciosas, imunomediadas, tóxicas, metabólicas, tumorais, psicogênicas) e cirúrgicas. Avaliação detalhada é imprescindível, devendo ser seguido protocolo extenso constituído por diversas etapas diagnósticas, que compreendem anamnese detalhada, exames clínico e neurológico, e avaliação complementar. É ressaltada a importância da neuroimagem (RM estrutural do cérebro), sendo apresentadas imagens ilustrativas características das principais condições.

Rapidly progressive dementias constitute a heterogeneous group of clinical (neurodegenerative, vascular, infectious, immunomediated, toxic, metabolic, tumoral, psychogenic) and surgical conditions. Detailed evaluation is essential, and an extensive protocol constituted by several diagnostic steps must be followed, which include detailed anamnesis, clinical and neurological examination, and complementary assessment. The importance of neuroimage (structural MRI of the brain) is highlighted, and illustrative images characteristic of the main conditions are presented.

Is ureteral stenting after ureteroscopy really necessary?

To evaluate the use of a Double J stent catheter after uncomplicated ureteroscopy regarding the need for pain killers, lower urinary tract symptoms, fever and the recurrence of stones. Over a period of one year from January 2007 through January 2008, all patients who underwent uncomplicated ureteroscopies at Prince Hussein Urology Center, King Hussein Medical Center were studied. Group A were not stented and group B were stented. The need for pain killers, lower urinary tract symptoms, onset of fever and recurrence of stones were analyzed. A total of 187 patients had uncomplicated ureteroscopies. Seventy-eight [41.7%] patients were stented [Group A] and 109 [58.3%] patients were not stented [Group B]. In the recovery room there was no difference in the need for pain killers but there was a great difference in the first four weeks postoperatively where only 20.2% needed pain killers in group B compared to 62.8% in group A. Only 14.6% of patients in group B had lower urinary tract symptoms while 79.5% in group A were symptomatic. The onset of urinary tract related fever was lower in group B compared to group A [0.91% compared to 3.8%]. There was no difference in stone recurrence at three months between the two groups. Stent placement after uncomplicated ureteroscopy is unnecessary, has no added benefit and is associated with increased morbidities. Good clinical judgment is needed for intraoperative patient evaluation and the decision for the need of ureteric stent

Persistent trigeminal artery: angio-tomography and angio-magnetic resonance finding / Artéria trigeminal persistente: achado na angio-tomografia e angio-ressonância magnética

The trigeminal artery (TA) is the most common embryonic carotid-vertebrobasilar anastomosis to persist into adulthood. It typically extends from the internal carotid artery to the basilar artery. Persistent primitive arteries are usually found incidentally, but are often associated with vascular malformation, cerebral aneurysm and, in case of TA, with trigeminal neuralgia. We present one patient with TA as a cause of trigeminal neuralgia and in other three as an incidental finding, on TC and MR angiograms.

Artéria trigeminal (AT) é a anastomose carótido-vertebrobasilar mais comum a persistir na vida adulta. Tipicamente estende-se da artéria carótida interna até a artéria basilar. Artérias primitivas persistentes são usualmente um achado incidental, mas freqüentemente estão associadas a malformações vasculares, aneurismas e, no caso da AT, a neuralgia do trigêmio. Apresentamos um paciente com AT como causa de neuralgia do trigêmio e em outros três como um achado incidental, em angiogramas por tomomografia computadorizada e ressonância magnética.

Fever in the intensive care unit of King Hussein medical center

To determine the main causes of fever in the intensive care unit at King Hussein Medical Center. Patients admitted to the intensive care unit at King Hussein Medical Center between the periods from May 2007 to December 2007 without fever were monitored for the onset of fever above 38.3 degrees centigrade. The cause of fever was determined clinically, through laboratory investigations and radiologically following the algorithm adopted from the Journal of the American College of Chest Physicians. The causes were analyzed to determine the main causes of fever in King Hussein Medical Center intensive care units. The most common cause of fever in our intensive care unit was ventilator-associated pneumonia. [VAP] [42.1%] followed by catheter-related infection [17.1%]. Other causes included wound infection, intra abdominal collections, urinary tract infection, drug-induced fever, meningitis, aspiration, and central causes. About 4% of the patients remained with an unknown cause of fever. King Hussein Medical Center is one of the main referral centers for critical care patients in Jordan, There is a large number of ventilator dependant patients with multiple lines, which contributes to the high incidence of ventilator-associated pneumonia and catheter-related sepsis. It is of vast importance to determine the cause of fever and tackle it properly

Supraestructure maxillectomy and orbital exenteration for treatment of basal cell carcinoma of inferior eyelid: case report and review.

Basal cell carcinoma (BCC) is the most frequent type of skin cancer in humans, with cumulative exposure to ultraviolet radiation as an important risk factor for development of illness such as severe solar burns during childhood or adolescence. BCC is mainly located on sun-exposed sites, head and neck being the areas of more incidences; although nose, eyelids and periorbitary tissue are unfavorable due to cosmetic results that BCC involves. Tumors can be classified as nodular, superficial, micronodular, morphea variety, infiltrating, pigmented, metatypic and fibroepithelioma of Pinkus. Several treatment options such as surgical and nonsurgical are available. The goal of treatment is complete excision of the tumor with preservation of surrounding structures in a way aesthetically acceptable. Mohs' micrographic surgery is the standard treatment for all nonmelanoma skin cancers. Orbital exenteration is also used for treatment of malignancies of ocular tissues, mainly squamous cell carcinoma, sebaceous cell carcinoma and BCC. The tissue beneath the surgical site can be left for second-intention granulation or covered with a cutaneous implant of partial thickness. The case of a 77-year-old patient is presented with BCC of inferior eyelid of 14 years' duration, formerly managed with radiotherapy; however, due to recurrent illness and invasion to the maxillary antrum, he needed supraestructure maxillectomy with left orbital exenteration.

Microalbuminuria como indicador precoz de Hipertrofia Ventricular Izquierda en pacientes diabéticos tipo 1 y 2, no hipertensos

Se diseña trabajo de tipo descriptivo, transversal y correlacional cuyo objetivo es relacionar la Microalbuminuria (MA) en pacientes diabéticos tipo 1 y 2 No hipertensos, como marcador bioquímico precoz de Hipertrofia Ventricular Izquierda (HVI). A lo efectos se incluyeron 197 pacientes de la consulta de diabetes del Hospital Francisco Antonio Risques de Caracas; luego de aplicar criterios de inclusión se seleccionaron 16 Pacientes con DM tipo 1 y 2. En el grupo control se incluyeron 8 sujetos sanos. A los dos grupos se les realizó ecocardiograma MB y determinó por turbidimetría los niveles de albúmina en muestra parcial de orina de 2 horas. Los datos fueron analizados aplicando pruebas estadísticas descriptivas y correlacionales a través del programa SPSS 10.0. La MA resultó positiva en 75% de los pacientes diabéticos seleccionados; 94% de los pacientes diabéticos presento HVI, de estos 80% presentó simultáneamente microalbuminuria. Estos datos permitan inferir una tendencia entre MA e HVI, en razón de p=0.07.

A descriptive, transversal and correlational study was designed to assess the relationship between non hypertensive diabetic type 1 and 2, microalbuminurea (MA) as a indicator for left ventricular hypertrophy (LVI). We include 197 patients from Francisco Antonio Risques Caracas Hospital´s diabetes consult; exclusion criteria were applied, and 16 diabetic (both type 1 and 2) patients were selected. Control group was formed by 8 healthy subjects. Ekg MB and 2 hour urine sample albumine was collected from each group. Descriptive and correlational analysis were performed to the data obtained by the SPSS 10.0 software. The MA resulted positive in 75% of diabetic patients, and 95% presented LVI; 80% resulted both positive for MA and LVI. This data allows to establish a positive correlation between MA and LVI with p=0,07.

Lepra: evaluación inmunonológica de contactos intradomiciliarios / Leprosy: an assessment of contacts inmunonológica intradomiciliary

Los contactos intradomiciliarios de pacientes con lepra representan una población con riesgo de infección . El uso combinado de pruebas cutáneas y ELISA revela el grado de sensibilización, la capacidad de respuesta inmunológica y casos subclínicos de la enfermedad. Con base en lo anteriormente expuesto y con la finalidad de justificar el uso de estas pruebas, de rutina en otros contactos, se entrevistó el evaluó clínicamente a 211 contactos intradomiciliarios, de 32 casos de lepra registrados. Se colocó a los contactos lepramina intradérmica y se determinó niveles de anticuerpos específicos contra M. leprae (prueba de ELISA con PGL-1). De la población evaluada, 99.88 por ciento presentó reacción de Fernández negativa y 2/3 de ella presentó una reacción de Mitsuda positiva. Sólo 30.85 por ciento constituyó un grupo de riesgo por presentar reacción de Mitsuda negativa. Al correlacionar las pruebas cutáneas con el ELISA se mostró que ninguno presentaba lepra en fase subclínica y que un sólo caso de ELISA débilmente positivo resultó ser una infección pasada autolimitada. No se justifica usar todas las pruebas inmunológicas, en todos los contactos. Se recomienda usar pruebas cutáneas para detectar grupos de riesgo y para orientar quimiprofilaxis, reservado el uso del ELISA sólo para grupos de riesgo demostrado.

Estudio comparativo sobre la eficacia y tolerancia del policosanol y la simvastatina en pacientes con hipercolesterolemia tipo II / Study comparative on the effectiveness and tolerance of the policosanol and the simvastatin in patient with hipercholesterolemia type II

Cuarenta y nueve (49) pacientes con hipercolesterolemia tipo II fueron enrolados en estudio prospectivo y comparativo a fin de evaluar el efecto terapéutico y la tolerabilidad de 10 mg de Policosanol y Simvastatina sobre el colesterol total, el LDL-Colesterol, HDL-Colesterol, Triglicéridos y los índices Colesterol total/HDL-Colesterol y LDL-Colesterol/HDL-Colesterol. Previo al tratamiento, los pacientes siguieron una dieta estándar para reducción de colesterol durante 4 semanas. Ambos productos redujeron los niveles de colesterol total (Simvastatina 20 por ciento y Policosanol 21 por ciento), el LDL-Colesterol (Simvastatina 24 por ciento y Policosanol 30 por ciento). Los niveles de triglicéridos se redujeron en 24 por ciento en el grupo que recibió Simvastatina y 10 por ciento en el grupo que recibió Policosanol. En ambos grupos se observó una evaluación de los niveles de HDL-Colesterol sin alcanzar éste significación estadística. Los índices colesterol total/HDL-Colesterol y LDL-Colesterol/HDL-Colesterol descendieron de manera importante con ambos tratamientos. Ambas drogas fueron bien toleradas, ningún paciente salió del estudio a causa de efectos adversos, se observó una tendencia en el grupo que recibió Policosanol a mejorar los niveles de Aspartalo-aminotransferasa previamente alterados

Ressuscitação cardiopulmonar: discrepância entre o procedimento de ressuscitação e o registro no prontuário / Cardiopulmonary resuscitation: discrepancy between the actual cardiopulmonary resuscitation and the documentation in the medical record

Objetivo: Descrever as caracteristicas de pacientes não ressuscitados em um hospital-escola pediátrico de nível terciário, caracterizar como foi feito o registro da não ressuscitação no protuário e avaliar os aspectos éticos e legais envolvidos na ressuscitação cardiopulmonar. Método: Foi feito um estudo tipo coorte prospectivo, exploratório e observacional de todas as paradas cardiorrespiratórias (PCR) neste período. Os médicos que atenderam cada PCR foram entrevistados, geralmente nas primeiras 24 pós o evento. Posteriormente foi revisto o prontuário para confrontar a informação referente à ressuscitação cardiopulmonar com o fato registrado no prontuário. São discutidos aspectos ético-legais envolvidos na ressuscitação cardiopulmonar. Resultados: Durante o ano de estudo houve 176 PCRs. Destas 47 (26,7 por cento) não foram ressuscitadas. Foram excluídos 2 casos; na avaliação de 45 pacientes, 64,4 por cento (29/45) estavam em ventilação mecânica e 48,9 por cento (23/45) usavam drogas vasoativas. O óbito ocorreu em 60 por cento (27/45) na UTI. O diagnóstico à admissão mais frequente foi sepse em 28,8 por cento (13/45) e broncopneumonia e insuficiência respiratória em 27 por cento (12/45). a doença de base mais encontrada foi a oncológica com 28,8 por cento (13/45). Foi possível avaliar o registro do óbito prontuários de pacientes não ressuscitados. Em 11 destes 40 (27,5 por cento) a descrição era: "constatado óbito"e nos outros 29 (72,5 por cento) constava: "feitas manobras habituais de ressuscitação sem sucesso". Conclusão: Este trabalho comprovou que o registro inverídico no prontuário em relação aos procedimentos de ressuscitação ocorreu com muita frequência. É injustificavel a discrepância encontrada entre o que foi realizado e o que foi registrado no prontuário. Esta conduta se deve ao receio das consequências legais de uma conduta médica que foi adota em benefício do paciente e é justificável, portanto, do ponto de vista ético

Utilidad de una evaluación olfativa y visual para detectar evidencias intramuros de humo de cigarro / Usefulness of an olfactory and visual evaluation to detect evidences of indoor cigarette smoke

Objetivo. Probar la utilidad de una evaluación olfativa y visual para detectar evidencias ambientales intramuros de humo de cigarro. Material y métodos. Se crearon condiciones diferentes, una con mucho o poco olor a cigarro y otra con la certeza absoluta de que no se había fumado. Se capacitaron a dos miembros de la clínica para Tabaquismo para reconocer estas dos condiciones. Se hizo una inspección visual para determinar si existían ceniceros o colillas apagadas en los ceniceros o en el piso así como cajetillas de cigarros, y se determinó si existían señalamientos de no fumar. Resultados. Se realizaron un total de 40 ensayos y las observadoras coincidieron el 100 por ciento de las veces (Kappa=1). La sensibilidad y la especificidad de la evaluación olfativa y visual fue de 100 por ciento en los dos casos. Conclusiones. Se pueden concluir que esta prueba es útil, no es costosa y es accesible para cualquier institución que desee implantarlo

Silagens de sorgo de porte alto com diferentes teores de tanino e de umidade no colmo. III - Quebra de compostos nitrogenados / Forage sorghum silages with different tannin concentrations and moist stem or not. III - Effets on nitrogenous compounds

Quadro híbridos de sorgo de porte alto, com diferentes teores de tanino e de umidade no colmo, foram ensilados em silos de laboratório de tubos "PVC", e abertos após 1 (P2), 7 (P3), 14 (P4), 28 (P5) e 56 (P6) dias, para estudo da fermentaçäo. Foram feitos 24 tratamentos com quatro repetiçöes cada, sendo quatro híbridos (H1=colmo suculento e alto tanino, H2=colmo seco e baixo tanino, H3=colmo seco e alto tanino, e H4=colmo suculento e baixo tanino) combinados com seis períodos, sendo o primeiro período antes de ensilar (P1). Determinaram-se os teores de matéria seca (MS), proteína bruta (PB), nitrogênio amoniacal (N-NH3 subscrito) e tanino. Utilizou-se o teste SNK para comparaçäo entre médias, com um delineamento experimental inteiramente ao acaso, em esquema fatorial 4x6. Os valores de PB näo variaram entre híbridos e entre períodos. Todos os híbridos apresentaram produçäo de N-NH3 subscrito ao longo da fermentaçäo, que tendeu a ser mais baixa nos sorgos de alto tanino. Os valores de tanino reduziram-se com a ensilagem