Herramientas para el tamizaje de aneurisma de aorta abdominal / Tools for abdominal aortic aneurysm screening

Introducción. El aneurisma de la aorta abdominal (AAA) es la dilatación de la aorta abdominal mayor de 1,5 veces el diámetro esperado. Su prevalencia es variable, con tasas reportadas de hasta el 12,5 %. Se considera como causa de muerte de más de 10.000 personas al año en los Estados Unidos. El objetivo de esta revisión de la literatura fue describir los factores de riesgo y las herramientas de tamizaje de AAA. Métodos. Se realizó una búsqueda de la literatura utilizando dos ecuaciones en bases de datos electrónicas, empleando términos seleccionados de "Medical Subject Heading" (MeSH) y "Descriptores en Ciencias de la Salud" (DeCS). Se evaluó la calidad de los estudios con la herramienta STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Resultados. Se recolectaron 40 artículos y a partir de ellos se construyó el texto de revisión, identificando en estos, los factores de riesgo asociados al desarrollo de AAA, tales como sexo masculino, tabaquismo, hipertensión arterial, antecedente familiar y obesidad, entre otros. La diabetes mellitus parece actuar como factor protector. Dentro de los instrumentos de tamizaje, el ultrasonido abdominal es uno de los más usados. Conclusión. El AAA es una patología multifactorial. En la actualidad la ultrasonografía de aorta es el método de elección para el tamizaje, permitiendo la detección precoz. El tamizaje de AAA con métodos no invasivos, como el ultrasonido, es útil sobre todo en zonas con prevalencia alta de la patología y en pacientes con determinados factores de riesgo.

Introduction. Abdominal aortic aneurysm (AAA) is a dilation of the abdominal aorta greater than 1.5 times the expected diameter. Its prevalence is variable, with reported rates of up to 12.5%. It is considered the cause of death of more than 10,000 people a year in the United States. The objective of this literature review was to describe risk factors and screening tools for AAA. Methods. A literature search was conducted using two equations in electronic databases, using terms selected from "Medical Subject Heading" (MeSH) and "Descriptors in Health Sciences" (DeCS). The quality of the studies was evaluated with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) tool. Results. Forty articles were collected and from them the review text was constructed, identifying the risk factors associated with the development of AAA, such as male sex, smoking, high blood pressure, family history and obesity, among others. Diabetes mellitus seems to act as a protective factor. Among the screening instruments, abdominal ultrasound is one of the most used. Conclusion. AAA is a multifactorial pathology. Currently, aortic ultrasonography is the method of choice for screening, allowing early detection. Screening for AAA with non-invasive methods, such as ultrasound, is useful especially in areas with a high prevalence of this pathology and in patients with certain risk factors.

Aspectos histológicos, genéticos y moleculares de las lesiones preneoplásicas de la mucosa gástrica / Histological, genetic and molecular aspects of preneoplastic lesions of the gastric mucosa

Siendo el cáncer gástrico la 3ª causa de muerte por cáncer en Chile, y existiendo estrategias de tamizaje consistentes en pesquisa de lesiones preneoplásicas de la mucosa gástrica, es relevante conocer los aspectos genéticos y moleculares que puedan ser aplicados, en la optimización de dichas estrategias a grupos de mayor riesgo. El objetivo de este manuscrito fue revisar la evidencia actual en los aspectos señalados, y de la inmunohistoquímica de 4 marcadores (p53, CDX2, MUC2 y S100A9) en la mucosa gástrica normal y en las lesiones preneoplásicas de la misma.

SUMMARY: Since gastric cancer is the 3rd leading cause of death from cancer in Chile, and there are screening strategies consisting of screening for preneoplastic lesions of the gastric mucosa, it is important to know certain genetic and molecular aspects that can be applied in optimizing these strategies for higher risk groups. The aim of this manuscript was to review the current evidence on the aforementioned aspects, and on the immunohistochemistry of 4 markers (p53, CDX2, MUC2 and S100A9) in normal gastric mucosa and in its preneoplastic lesions.

Asociación entre el riesgo nutricional, estancia hospitalaria y diagnóstico médico en pacientes de un hospital del seguro social peruano

Objetivo: Determinar la asociación que existe entre el riesgo nutricional, la estancia hospitalaria y el diagnóstico médico en pacientes hospitalizados en el Centro Especializado de Rehabilitación Profesional (CERP) del Hospital Nacional Guillermo Almenara Irigoyen. Materiales y métodos: Se realizó un estudio observacional de cohorte longitudinal, retrospectivo, que incluyó a las personas hospitalizadas durante el periodo comprendido entre el 1 de julio del 2021 y el 27 de febrero del 2022. Hubo un seguimiento de los pacientes hasta su alta del centro hospitalario (egreso). Se excluyeron los individuos menores de 18 años, gestantes o puérperas, y cuya permanencia fue menor a 24 horas. Los datos de interés fueron recogidos a partir de la revisión de las historias clínicas y kárdex de nutrición. La variable principal fue el riesgo nutricional, el cual fue detectado mediante el Nutritional Risk Screening (NRS) 2002; las variables secundarias fueron los grupos etarios, el sexo, la estancia hospitalaria, el diagnóstico médico principal, la condición de egreso y el estado nutricional. En el análisis de los datos, para la comparación de variables cualitativas o categóricas se utilizó la prueba chi-cuadrado y para variables cuantitativas, la prueba t de Student y ANOVA. Se consideró significancia estadística al valor de p < 0,05. Resultados: Se incluyó un total de 1 929 pacientes. La prevalencia del riesgo nutricional fue 33,13 %. Los pacientes con esta condición presentaron tasas de mortalidad más altas (57,51 %). Se observó que la prevalencia del riesgo nutricional está relacionada con una mayor estancia hospitalaria (4,6 días más) (p < 0,001), con el diagnóstico nutricional de delgadez (48,67 %) (p < 0,001) y con el diagnóstico médico, donde la enfermedad oncológica es la más asociada (50,93 %). Conclusiones: El riesgo nutricional se asocia a una evolución negativa de la enfermedad, lo que origina un aumento de la estancia hospitalaria, la tasa de mortalidad y, por ende, los costos intrahospitalarios. Es importante realizar su detección temprana para poder brindar intervenciones nutricionales adecuadas.

Objective: To determine the association between nutritional risk, hospital stay and medical diagnosis among patients admitted at Centro Especializado de Rehabilitación Profesional (CERP) of Hospital Nacional Guillermo Almenara Irigoyen. Materials and methods: An observational retrospective longitudinal cohort study was conducted with inpatients between July 1, 2021 and February 27, 2022. The patients were followed up until they left the hospital (discharge). Individuals under 18 years of age, pregnant or puerperal women, and those whose stay was less than 24 hours were excluded. The data of interest was collected from the patients' medical records and diet cards. The main variable was the nutritional risk, which was detected using the Nutritional Risk Screening (NRS) 2002. The secondary variables were age group, sex, hospital stay, main medical diagnosis, discharge condition and nutritional status. Data analysis was performed using the chi-square test to compare the qualitative or categorical variables, and the Student's t-test and ANOVA for the quantitative variables. A value of p < 0.05 was considered as statistically significant. Results: A total of 1,929 patients were included in the study. Nutritional risk prevalence accounted for 33.13 %. Patients with this condition showed the highest mortality rates (57.51 %). It was found that nutritional risk prevalence was related to a longer hospital stay (4.6 more days) (p < 0.001), a diagnosis of constitutional thinness (48.67 %) (p < 0.001) and the medical diagnosis, being oncology disorders the most associated ones (50.93 %). Conclusions: Nutritional risk is associated with disease progression, resulting in an increased hospital stay, mortality rate and therefore hospital costs. Early detection is important to provide adequate dietary interventions.

Bibliometric analysis of main diseases due to exposure to altitude in the world / Análise bibliométrica das principais doenças decorrentes da exposição à altitude no mundo

Introduction: Around 140 million people in the world live-in high-altitude regions; however, there are few bibliometric studies. Objective: Describe the scientific production of the main diseases due to exposure to altitude in the world. Methods: Observational study, bibliometric type. After a systematic search in Scopus, original articles were included, whose main variable was mountain sickness, high-altitude cerebral edema and high-altitude pulmonary edema. Characteristics of each study were manually extracted and analyzed using descriptive statistics. Results: 2305 articles were found on mountain sickness (n=1531), high-altitude pulmonary edema (n=549) and high-altitude cerebral edema (n=225), respectively, in Scopus. Regarding the most influential journal was High Altitude Medicine and Biology in all three diseases, the country with the highest number of articles was the United States (458, 168 and 75), the most used language was English (91.31%, 85.33% and 84.19%), the author with the highest number of publications was Bartsh P. (2.94%, 18.60% and 3.42%) and most of the articles were open access (41.08%, 42.06% and 76.53%), respectively. Conclusion: The scientific production of original articles on mountain sickness, high-altitude pulmonary edema and high-altitude cerebral edema in Scopus has increased in recent years; however, it is still scarce compared to other diseases.

Introdução: Cerca de 140 milhões de pessoas no mundo vivem em regiões de grande altitude, porém, existem poucos estudos bibliométricos. Objetivo: Descrever a produção científica sobre as principais doenças decorrentes da exposição à altitude no mundo. Métodos: Estudo observacional, do tipo bibliométrico. Após busca sistemática no Scopus, foram incluídos artigos originais, cuja variável principal foi mal da montanha, edema cerebral de altitude e edema pulmonar de altitude. As características de cada estudo foram extraídas manualmente e analisadas por meio de estatística descritiva. Resultados: Foram encontrados 2.305 artigos sobre mal da montanha (n=1.531), edema pulmonar de altitude (n=549) e edema cerebral de altitude (n=225), respectivamente no Scopus. Em relação ao periódico mais influente foi High Altitude Medicine and Biology nas três doenças, o país com maior número de artigos foi os Estados Unidos (458, 168 e 75), o idioma mais utilizado foi o inglês (91,31%, 85,33% e 84,19%), o autor com maior número de publicações foi Bartsh P. (2,94%, 18,60% e 3,42%) e a maioria dos artigos foi de acesso aberto (41,08%, 42,06% e 76,53%), respectivamente. Conclusão: A produção científica de artigos originais sobre mal da montanha, edema pulmonar de altitude e edema cerebral de altitude em Scopus tem aumentado nos últimos anos, porém ainda é escassa em comparação com outras doenças

Systematic review and comparative analysis of pediatric nutrition screening tools validated in Europe and Canada / Revisión sistemática y análisis comparativo de las herramientas de tamizaje nutricional en pediatría validadas en Europa y Canadá

Abstract Introduction: Nutritional screening is a useful tool for determining the risk of hospital malnutrition; therefore, reviewing the guidelines on its use in the pediatric population is of great importance. Objective: To provide recommendations on the use of nutrition screening tools validated in Canada and Europe in the Colombian pediatric population. Materials and method: A systematic review was conducted using the PRISMA methodology. The quality of the evidence found in the review was assessed using the U.S. Preventive Services Task Force (USPSTF) tool, which was established by the Canadian Task Force on the Periodic Health Examination for assessing preventive actions. Results: Fifteen studies were included in the review as they met the inclusion criteria. In addition, 7 nutrition screening tools were identified (PYMS, iPYMS, PeDiSMART, PNR, STAMP, PMST and STRONGkids). According to guidelines of the European Society for Clinical Nutrition and Metabolism, the PYMS, iPYMS and STRONGkids tools simultaneously assess prognostic variables such as current nutritional status, stability, expected improvement or worsening of the condition, and the influence of the disease process in nutritional deterioration. Regarding concurrent validity, data analysis shows that PYMS, iPYMS and PMST have sensitivities >85%, and that PYMS has a specificity >85%. In terms of reproducibility, PEDISMART, STRONGkids, STAMP and PYMS have an acceptable interobserver agreement (k>0.41). Conclusion: Based on the evidence found, which was analyzed in terms of prognostic variables, concurrent validity and reproducibility, the use of the PYMS tool in the clinical practice is suggested. In contrast, hospitals must assess the applicability of the STAMP and iPYMS tools.

Resumen Introducción. El tamizaje nutricional es una herramienta efectiva que permite establecer el riesgo de desnutrición hospitalaria, por consiguiente es importante revisar las directrices respecto a su uso en pediatría. Objetivo. Ofrecer recomendaciones sobre el uso de las herramientas de tamizaje nutricional validadas en Canadá y Europa en población colombiana. Materiales y métodos. Se realizó una revisión sistemática siguiendo la metodología PRISMA. Para la evaluación de la calidad de la evidencia se utilizó la herramienta U.S Preventive Services Task Force, formulada para medir acciones preventivas por la Canadian Task Force on the Periodic Health Examination. Resultados. Se incluyeron 15 estudios que cumplían los criterios de selección y se identificaron 7 herramientas (PYMS, iPYMS, PeDiSMART, PNR, STAMP, PMST y STRONGkids). Según los lineamientos de la Sociedad Europea de Nutrición Clínica y Metabolismo, la PYMS, la iPYMS y la STRONGkids evalúan simultáneamente variables pronósticas como estado nutricional actual, estabilidad, progresión esperada e influencia de la enfermedad. En cuanto a validez concurrente, el análisis de datos muestra que la PYMS, la iPYMS y la PMST tienen sensibilidades >85% y que la PYMS tiene especificidad >85%. Respecto a reproducibilidad, la PEDISMART, la STRONGkids, la STAMP y la PYMS tienen una concordancia inter-observadores aceptable (k>0.41). Conclusión. Según la evidencia analizada en términos de variables pronósticas, validez concurrente y reproducibilidad, se sugiere el empleo en la práctica clínica de la herramienta PYMS, mientras que para el uso de la STAMP y la iPYMS las instituciones deben evaluar su aplicabilidad.

Infarto perioperatorio y cirugía no cardíaca / Perioperative infarction and non-cardiac surgery

Introduction: Perioperative cardiovascular events occur in up to 5-8% of all patients older than 45 years undergoing non-cardiac surgery. Objective: The objective of this article is to perform an updated narrative review about perioperative infarction that occurs in the context of non-cardiac surgery. Methods: A search was proposed with different combinations of the terms: Myocardial infarction (MeSH), perioperative period (Majr), postoperative period (Majr) and anesthesia (MeSH), in PubMed (Medline), OVID y EMBASE databases. Results: Around 29 articles were found with important information for the present review. Conclusions: Myocardial injury, as well as perioperative infarction are common entities, but difficult to diagnose. Its identification and prompt treatment generate a great impact on morbidity and mortality, which is why its active search should be carried out, especially in patients with high cardiovascular risk.

Introducción: Los eventos cardiovasculares perioperatorios ocurren hasta en un 5%-8% de todos los pacientes mayores de 45 años sometidos a cirugía no cardíaca. Objetivo: El objetivo del presente artículo es realizar una revisión narrativa actualizada acerca del infarto perioperatorio que ocurre en el contexto de la cirugía no cardíaca. Metodología: Se planteó una búsqueda con distintas combinaciones de los términos: Myocardial infarction (MeSH), perioperative period (Majr), postoperative period (Majr), anesthesia (MeSH), en las bases de datos PubMed (Medline), OVID y EMBASE. Resultados: Se encontraron alrededor de 29 artículos con información importante para la realizar la presente revisión. Conclusiones: La lesión miocárdica, así como el infarto perioperatorios son entidades frecuentes, pero de difícil diagnóstico. Su identificación y pronto tratamiento genera un gran impacto sobre la morbimortalidad, por lo que debe realizarse su búsqueda activa, especialmente en pacientes con riesgo cardiovascular elevado.

Hernia de Garengeot: presentación de un caso y revisión de la literatura / De Garengeot hernia: a case report and literature review

INTRODUCTION: Femoral hernias have a high risk of strangulation or obstruction, and their acute presentations are associated with a high risk of mortality, occurring in up to 60% of cases with complications. The presence of the appendix within the femoral sac has been described in a maximum of 1% of cases, which has been called Garengeot hernia, but only 0.08% with concomitant appendicitis. CASE REPORT: Woman 56 years old, cholecystectomized, with no other relevant history, 5 months of evolution, right femoral region volume increase, consultation for 24 hours of evolution of habitual pain exacerbation, CT scan showing complicated hernia, with appendix inside of the hernial sac. The right inguinal approach is performed, the cecal appendix is the only content within the hernial sac, with signs of acute appendicitis, appendectomy and hernia repair with Prolene mesh. Diagnosis is confirmed with biopsy. DISCUSSION AND CONCLUSION: Acute appendicitis within De Garengeot's hernia is extremely rare and often difficult to diagnose. The diagnosis of a femoral hernia appendicitis is often obscured by nonspecific clinical findings that indicate a complicated hernia. Computed tomography may be useful to definitively diagnose acute appendicitis contained within a femoral hernia. It is important to always consider De Garengeot hernia as a differential diagnosis in patients with inguinal mass of acute pain, so as not to delay its detection and management.

Rastreamento de câncer em mulheres deficientes: uma revisão integrativa / Cancer screening in women with disabilities: an integrative review

Para tentar reduzir a morbidade e mortalidade por câncer, têm sido utilizadas estratégias de diagnóstico precoce e de rastreamento da doença. Para que as ações de rastreamento sejam eficazes, devem ser disponibilizadas a toda população. Entretanto não é essa a realidade de mulheres com deficiência. Objetivo: Identificar como tem sido realizado o rastreamento de câncer em mulheres com deficiência. Método: Foi realizada uma revisão integrativa da literatura com buscas realizadas nas bases de dados Pubmed, LILACS e Web of Science. Resultados: Foram incluídos 25 artigos, e pode-se observar que mulheres com deficiência apresentaram barreiras para o acesso aos serviços de saúde: escolaridade, renda, nível de incapacidade, estado civil, estar inserido em sistema de saúde privado, idade, ter um cuidador, falta de adaptação dos serviços para pessoas com deficiência e falta de conhecimento dos profissionais e das próprias mulheres. Como consequência dessas barreias, as mulheres com deficiência apresentam menor probabilidade de realizarem os exames de rastreamento. Conclusão: As mulheres com deficiência são menos propensas a comporem os programas de rastreamento do câncer de mama e colo do útero, mesmo entre países desenvolvidos.

Seeking to reduce cancer morbidity and mortality, screening strategies have been used. For screening actions to be effective, they must be available to the entire population. However, this is not the reality of women with disabilities. Objective: To identify how cancer screening has been performed in women with disabilities. Method: Integrative review with searches performed in the Pubmed, LILACS and Web of Science databases. The PICO strategy was adopted to elaborate the research question, the Mesh descriptors adjusted according to the database. Results: 25 articles were included. Women with disabilities have barriers to access the health services, among them: education, income, level of disability, marital status, not being in private health care, age, having a caregiver, lack of adaptation of services for people with disabilities and lack of knowledge of professionals and women themselves about the importance of screening. Because of these barriers, these women are less likely to have screening tests. Conclusion: Women with any type of disability are less likely to be part of breast and cervical cancer screening programs, even among developed countries.

Fibromixoma Odontogénico Agresivo en Maxila: Abordaje Quirúrgico / Aggressive Odontogenic Fibromixoma in Maxilla: Surgical Approach

RESUMEN: El fibromixoma odontogénico (FM) es una infrecuente lesión benigna que muestra un comportamiento invasivo. Considerada una variante del mixoma odontogénico, presenta un origen mesenquimal controvertido y ligera predilección por el sexo femenino. La lesión está asociada a zonas con estructuras dentales adyacentes, siendo su localización más frecuente la región mandibular posterior. El objetivo de este trabajo fue mostrar un caso agresivo de FM en una paciente, localizado en la zona posterior de maxila, destacando su abordaje quirúrgico. Se reporta un caso de una mujer de 52 años, la cual acudió a la consulta por presentar una masa indolora, firme a la palpación en el lado derecho de la maxila. Radiográficamente se observaba como una imagen radiopaca, de márgenes mal definidos que se extendía en el seno maxilar ipsilateral; la tomografía computarizada pudo evidenciar la expansión de las paredes del antro y la fosa nasal, con compromiso del cigomático y el piso de órbita. Se realizó biopsia incisional y el diagnóstico histopatológico fue de FM. El tratamiento de elección consistió en la resección en bloque, mediante abordaje Weber-Fergusson, acompañada de reconstrucción con placa y malla de titanio para garantizar la suspensión del globo ocular; un nuevo estudio histopatológico, confirmó el diagnóstico inicial. Al año del procedimiento quirúrgico no se evidenció recidiva, observando que el material de reconstrucción mantiene su posición, proporcionado estética y funcionabilidad a la paciente.

ABSTRACT: Odontogenic fibromyxoma (FM) is an infrequent benign lesion that shows with invasive characteristics. Considered a variant of the odontogenic myxoma, it presents a controversial mesenchymal origin and is somewhat more frequent in women. The lesion is associated with areas with adjacent dental structures, with its most frequent location in the posterior mandibular region. The objective of this study was to show an aggressive case of FM in a female, located in the posterior area of the maxilla, emphasizing its surgical approach. A case of a 52-year-old woman, who came to the clinic because of a painless, firm mass on the right side of the maxilla. Radiographically, it was seen as a radiopaque image, with poorly defined margins extending in the ipsilateral maxillary sinus; computed tomography showed the expansion of the walls of the antrum and the nasal cavity, with zygomatic compromise and the orbital floor. An incisional biopsy was performed and the histopathological diagnosis was FM. The treatment of choice consisted of block resection, using a WeberFerguson approach, along with reconstruction with a titanium plaque and mesh to guarantee suspension of the eyeball; a new histopathological study, confirmed the initial diagnosis. One year after the surgical procedure, there is no recurrence, and the reconstruction material maintains its position, providing aesthetic and functionality to the patient.

Tamización poblacional para la detección temprana del cáncer de próstata: ¿Qué hemos aprendido en los últimos 10 años? / Population Screening for Early Detection of Prostate Cancer: ¿What have we Learned in the Last Decade?

Introducción Desde el inicio de la aplicación del cribado para cáncer de próstata basado en el antígeno prostático específico (PSA) hace aproximadamente dos décadas, la controversia sobre los beneficios y desventajas de su uso rutinario ha sido constante. La literatura médica cuenta con múltiples estudios que en ocasiones han revelado resultados contradictorios sobre los posibles beneficios de la tamización con PSA; la tasa de detección de cáncer de próstata indolente detectado parece ser alta y los estudios no demuestran de forma constante los beneficios en términos de reducción de la mortalidad cáncer específica o general. El propósito del presente artículo, es definir a la luz de la literatura médica reciente, la utilidad a nivel poblacional del cribado para cáncer de próstata basado en el antígeno prostático específico. Materiales y métodos Se realizó una revisión en los buscadores Pubmed, Embase y Lilacs utilizando los términos MesH "Prostatic neoplasms," "early detection of cancer," "mass screening," "prostate specific antigen," "digital rectal examination," "Outcome assesment (Health care)." Se filtró la búsqueda hacia estudios ejecutados en humanos, y/o metanálisis y revisiones sistemáticas publicados durante los últimos 10 años. Los abstracts fueron valorados por el grupo de autores e incluidos para análisis según su aporte al objetivo principal del estudio. Algunas referencias adicionales fueron añadidas dada su importancia clínica e histórica. Resultados Se identificaron 23 referencias con la estrategia de búsqueda, se excluyeron del análisis 9 referencias por no aportar datos relevantes para el presente artículo. Se incluyeron para revisión un total de 14 artículos. Discusión La tamización para cáncer de próstata con base en el antígeno específico de próstata sérico es una estrategia que permite aumentar la tasa de detección temprana de cáncer, sin embargo, se asocia a una importante tasa de detección de cáncer de próstata indolente y de sobretratamiento. Los resultados de la literatura evaluada son contradictorios con respecto al efecto que tiene la tamización sobre la mortalidad específica por cáncer, algunos estudios han revelado una disminución de ese ítem en los pacientes sometidos a tamización para cáncer de próstata. Los datos también son contundentes en demostrar que las estrategias de tamización no han impactado la supervivencia general en los grupos estudiados. Se esperan resultados de estudios que incluyan el armamento de estrategias disponibles para estimar el riesgo de cáncer de próstata (imágenes y/o nuevos marcadores tumorales) con el fin de mejorar la relación riesgo/beneficio de la estrategia de cribado para cáncer de próstata. Conclusiones La tamización para cáncer de próstata debe ser una estrategia para la detección temprana del cáncer que se usa de forma consensuada con cada paciente y que debe adaptarse al riesgo individual; el paciente a quien se le aplica el cribado debe entender los potenciales riesgos y beneficios de esta estrategia ya que los datos disponibles no permiten demostrar con alto nivel de evidencia, un beneficio clínico traducido en términos de reducción en la mortalidad del cáncer específica o general.

Introduction In the last decade, the prostate-specific antigen based screening for prostate cancer have evoque a lot of controversies on the basis of his risk ­ benefit ratio; there are controversial data about the impact of this strategy in the male cancer specific and general mortality. The aim of this article is to show the most recent findings and to define the utility of the population screening for early detection of prostate cancer. Material and Methods A literature review was performed in PubMed, Embase and Lilacs using the MeSH terms: "Prostatic neoplasms," "early detection of cancer," "mass screening," "prostate specific antigen," "digital rectal examination" and "Outcome assesment (Health care)" which was limited to scientific articles published in the past 10 years. The abstracts were evaluated and excluded if they were not related to primary aim of this article. Some references were included given their clinical relevance. Results 23 articles were retrieved, and after reviewing the abstracts, 9 articles were excluded as they were not related to our primary aim. The analysis was performed in 14 articles. Discussion The prostate-specific antigen based population screening has been associated with an early diagnosis of prostate cancer even, in a non significative clinical stage, and consequent overtreatment. The literature which was evaluated have controvesial outcomes on the cancer-specific mortality, however none of the articles evaluated shown a significant impact in male general mortality. In the overcoming years, we expect the results of some investigations which includes additional tools for the screening of prostate cancer (multiparametric prostate resonance imaging, new tumoral markers), to improve the risk-benefit of this strategy. Conclusions The population prostate cancer screening should be made in well-informed patients and shared based decision process. The urologist and patient should to know the potential benefits and risks of this strategy, because there is not high grade level of evidence which supports a significant effect of this strategy in male general and cancer-specific mortality.

Artificial Intelligence Applications in Type 2 Diabetes Mellitus Care: Focus on Machine Learning Methods / 대한의료정보학회지

OBJECTIVES: The incidence of type 2 diabetes mellitus has increased significantly in recent years. With the development of artificial intelligence applications in healthcare, they are used for diagnosis, therapeutic decision making, and outcome prediction, especially in type 2 diabetes mellitus. This study aimed to identify the artificial intelligence (AI) applications for type 2 diabetes mellitus care. METHODS: This is a review conducted in 2018. We searched the PubMed, Web of Science, and Embase scientific databases, based on a combination of related mesh terms. The article selection process was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Finally, 31 articles were selected after inclusion and exclusion criteria were applied. Data gathering was done by using a data extraction form. Data were summarized and reported based on the study objectives. RESULTS: The main applications of AI for type 2 diabetes mellitus care were screening and diagnosis in different stages. Among all of the reviewed AI methods, machine learning methods with 71% (n = 22) were the most commonly applied techniques. Many applications were in multi method forms (23%). Among the machine learning algorithms applications, support vector machine (21%) and naive Bayesian (19%) were the most commonly used methods. The most important variables that were used in the selected studies were body mass index, fasting blood sugar, blood pressure, HbA1c, triglycerides, low-density lipoprotein, high-density lipoprotein, and demographic variables. CONCLUSIONS: It is recommended to select optimal algorithms by testing various techniques. Support vector machine and naive Bayesian might achieve better performance than other applications due to the type of variables and targets in diabetes-related outcomes classification.

Características clínicas y epidemiológicas de la estrongiloidiasis en un hospital del Norte del Perú / Clinical and epidemiological characteristics of strongyloidiasis in a hospital in Northern Peru

Introducción: La infección por Strongyloides stercoralis constituye una de las enfermedades tropicales desatendidas en áreas endémicas como Perú, con una frecuencia global de 6,6%. Se puede diferenciar cuatro síndromes clínicos: agudo (SA), crónico (SC), hiperinfección (SH) y estrongiloidiasis diseminada (ED). Objetivo: Describir las características clínicas y epidemiológicas de los pacientes con diagnóstico de estrongiloidiasis. Material y métodos: Se estudió en forma retrospectiva 27 casos de pacientes con estrongioloidiasis atendidos en los meses de julio del 2014 a agosto del 2015 en el Hospital Regional Lambayeque, Perú. Resultados: Los pacientes tuvieron una mediana de edad de 41 años (rango intercuartílico: 2 a 84) y 74% (20/27) fueron varones. Se encontraron 10 casos (37,04%) de SC y 10 casos (37,04%) de SH. Del total, 63% presentaron eosinofilia, 85,2% anemia y 85,1% diarrea; 59,3% tuvo algún tipo de inmunocompromiso y 18,5% fallecieron. Conclusiones: La mayoría de pacientes con estrongiloidiasis de este estudio presentaron SC y SH, eosinofilia, anemia y algún tipo de inmunocompromiso. Asímismo, la alta frecuencia de estrongiloidiasis severa en pacientes con inmunocompromiso revela la necesidad de un tamizaje coproparasitológico con métodos específicos (Baerman y cultivo en agar) con el fin de detectar y tratar a tiempo la infección crónica previa.

Background: Strongyloides stercoralis infection is a neglected tropical disease in endemic areas such as Peru, with an overall frequency of 6.6%. Four clinical syndromes can be distinguished: acute (AS), chronic (CS), hyperinfection (HS) and disseminated strongyloidiasis (DS). Objective: To describe the clinical and epidemiological characteristics of patients diagnosed with strongyloidiasis. Material and methods: 27 clinical charts of patients with estrongioloidiasis admitted from July 2014 to August 2015 at the Hospital Regional Lambayeque, from Peru, were reviewed. Results: The median age was 41 years (Interquartile range: 2 to 84) and 74% (20/27) were males. There were 10 (37.04%) cases of CS and 10 cases (37.04%) of HS. Of the total, 63% presented eosinophilia, 85.2% anemia and 85.1% diarrhea; 59.3% were some type of immunocompromise and 18.5% died. Conclusions: The majority of patients with strongyloidiasis in this study presented CS and HS, eosinophilia, anemia, diarrhea and some type of immunocompromise. Also, the high frequency of severe strongyloidiasis in patients with immunocompromise reveals the need for a coproparasitological screening with specific methods (Baerman and agar culture) to detect and treat previously chronic infection.

Is Genetic Counseling a Form of Eugenics? / Asesoramiento genético: ¿una práctica que estimula la eugenesia? / Assessoria genética: uma prática que estimula a eugenia?

Abstract Introduction: Genetic counseling can be practiced under four scenarios: preconception, preimplantation, prenatal, and postnatal (which is similar to preconception). Some authors argue that it should be considered a form of eugenics. The aim of this article is to present different views expressed in the literature regarding the relation between genetic counseling and eugenics. Materials and methods: A search of articles was conducted in several academic databases using the MeSH/DeCS terms bioethics, medical genetics, genetic counseling, and eugenics. Articles were included if they discussed eugenics or genetic screening. Articles were excluded if they provided a technical description of procedures. The selection was made after examining titles, abstracts, and full texts. Results: Fifty-seven articles were selected for analysis. In preconception counseling, the "reproductive beneficence principle" can be based on eugenic practices of the early twentieth century. In pre-implantation consultation, the genetic selection of embryos can be considered eugenic when it is used to change the natural course of reproduction or used for non-medical purposes. Prenatal diagnosis, when linked to abortion as a response to congenital malformations, can be considered negative eugenics. Conclusion: At present, eugenics can be defined in multiple ways. By some definitions, genetic counseling can be framed as a eugenic practice. However, the design of health policies and the interests of society may influence the autonomy of individuals. The possibility of generating a genetic selection of individuals, on the other hand, can be constituted as positive eugenics.

Resumen Introducción: el asesoramiento genético es una práctica que puede enmarcarse en cuatro escenarios: preconcepcional, preimplantación, prenatal y posnatal (similar al preconcepcional). Para algunos autores este tipo de práctica se considera eugenesia. El objetivo del presente artículo es exponer los distintos puntos de vista, descritos en la literatura, sobre la relación del asesoramiento genético con la eugenesia. Materiales y métodos: se buscaron artículos en bases de datos académicas con los términos MeSH/DeCS bioética, genética médica, asesoramiento genético y eugenesia. Se incluyeron artículos que hablaran sobre eugenesia o sobre cribaje genético; se excluyeron artículos con la descripción técnica de procedimientos. La selección se realizó por título, resumen y texto completo. Resultados: se seleccionaron 57 artículos para el análisis. En el asesoramiento preconcepcional, el "principio de beneficencia procreativa" se considera que parte de posturas similares a las prácticas eugenésicas de principios del siglo XX. En la consulta preimplantación, la selección genética de embriones puede considerarse eugenesia cuando se usa para alterar el curso natural de la procreación o para fines no médicos. El diagnóstico prenatal, cuando se vincula con el aborto por malformaciones congénitas, puede considerarse eugenesia negativa. Conclusión: en la actualidad, la eugenesia abarca múltiples definiciones. Según la definición escogida, el asesoramiento genético puede enmarcarse como una práctica eugenésica. Sin embargo, el diseño de políticas de salud y el interés de la sociedad puede influir en la autonomía de los individuos. Por otro lado, la posibilidad de generar una selección genética de individuos puede constituirse como eugenesia positiva.

Resumo Introdução: a assessoria genética é uma prática que pode enquadrar-se em quatro cenários: pré-concepcional, pré-implantação, pré-natal e pós-natal (similar o pré-concepcional). Para alguns autores este tipo de prática considera-se eugenia. O objetivo do presente artigo é expor os distintos pontos de vista, descritos na literatura, sobre a relação da assessoria genética com a eugenia. Materiais e métodos: buscaram-se artigos em bases de dados acadêmicas com os termos eSH/DeCS bioética, genética médica, assessoria genética e eugenia. Incluíram-se artigos que falaram sobre eugenia ou sobre rastreio genético; excluíram-se artigos com a descrição técnica de procedimentos. A seleção se realizou por título, resumo e texto completo. Resultados: selecionaram-se 57 artigos para a análise. Na assessoria pré-concepcional, o "princípio d beneficência procriativa" se considera que parte de posturas similares às práticas eugénicas de começos do século XX. Na consulta pré-implantação, a seleção genética de embriões pode considerar-se eugenia quando se usa para alterar o curso natural da procriação ou para fins não médicos. O diagnóstico pré-natal, quando se vincula com o aborto por malformações congénitas, pode considerar-se eugenia negativa. Conclussão: na atualidade, a eugenia abarca múltiplas definições. Segundo a definição escolhida, a assessoria genética pode enquadrar-se como uma prática eugénica. No entanto, o desenho de políticas de saúde e o interesse da sociedade pode influir na autonomia dos indivíduos pode constituir-se como eugenia positiva.

Comparison of partially-absorbable lightweight mesh with heavyweight mesh for inguinal hernia repair: multicenter randomized study

PURPOSE: Prosthetic mesh is widely used for inguinal hernia repair; however, pain and stiffness can develop. This study was a prospective, multicenter, single-blind, randomized trial to assess postoperative pain and quality of life according to mesh type after inguinal hernia repair. METHODS: Forty-seven patients who underwent Lichtenstein repair for unilateral inguinal hernia with prosthetic mesh were enrolled and randomly allocated to the partially-absorbable lightweight mesh (LW group, n = 24) or heavyweight mesh group (HW group, n = 23). Data were collected using a visual analogue scale (VAS), Carolinas Comfort Scale (CCS), and Activities Assessment Scale (AAS) at screening and postoperative day 1, 7, 90, and 120; foreign body sensation, sense of stiffness, and sense of pull during activity were also evaluated. RESULTS: There were no significant differences in patients' demographics and clinical characteristics between groups. The VAS at day 90 was significantly lower in the LW group (0.46 ± 0.78 vs. 0.96 ± 0.82, P = 0.027). The CCS and AAS were significantly lower in the LW group at day 1 (51.33 ± 20.29 vs. 64.65 ± 22.64, P = 0.047 and 39.83 ± 9.88 vs. 46.43 ± 7.82, P = 0.015, respectively). Foreign body sensation was significantly lower in the LW group at day 120 (4.2% vs. 30.4 %, P = 0.023), as was sense of stiffness (P = 0.023). The sense of pull during activity was lower in the LW group at day 90 and 120 (P = 0.012 and P = 0.022, respectively). There was no recurrence or serious complication during follow-up. CONCLUSION: Partially-absorbable lightweight prosthetic mesh can be used for inguinal hernia repair safely and improve functional outcomes and quality of life after surgery.

Comparison of partially-absorbable lightweight mesh with heavyweight mesh for inguinal hernia repair: multicenter randomized study

PURPOSE: Prosthetic mesh is widely used for inguinal hernia repair; however, pain and stiffness can develop. This study was a prospective, multicenter, single-blind, randomized trial to assess postoperative pain and quality of life according to mesh type after inguinal hernia repair. METHODS: Forty-seven patients who underwent Lichtenstein repair for unilateral inguinal hernia with prosthetic mesh were enrolled and randomly allocated to the partially-absorbable lightweight mesh (LW group, n = 24) or heavyweight mesh group (HW group, n = 23). Data were collected using a visual analogue scale (VAS), Carolinas Comfort Scale (CCS), and Activities Assessment Scale (AAS) at screening and postoperative day 1, 7, 90, and 120; foreign body sensation, sense of stiffness, and sense of pull during activity were also evaluated. RESULTS: There were no significant differences in patients' demographics and clinical characteristics between groups. The VAS at day 90 was significantly lower in the LW group (0.46 ± 0.78 vs. 0.96 ± 0.82, P = 0.027). The CCS and AAS were significantly lower in the LW group at day 1 (51.33 ± 20.29 vs. 64.65 ± 22.64, P = 0.047 and 39.83 ± 9.88 vs. 46.43 ± 7.82, P = 0.015, respectively). Foreign body sensation was significantly lower in the LW group at day 120 (4.2% vs. 30.4 %, P = 0.023), as was sense of stiffness (P = 0.023). The sense of pull during activity was lower in the LW group at day 90 and 120 (P = 0.012 and P = 0.022, respectively). There was no recurrence or serious complication during follow-up. CONCLUSION: Partially-absorbable lightweight prosthetic mesh can be used for inguinal hernia repair safely and improve functional outcomes and quality of life after surgery.

Imaging in the Diagnosis of Symptomatic Forearm Muscle Herniation.

Symptomatic muscle herniations are an unusual cause of upper extremity pain that is rarely reported in the literature. Out of 18 reported cases of upper extremity herniations, only 3 were caused by strenuous exertion6. Dynamic ultrasound and Dynamic MRI test are the very good tool for diagnosis of muscle herniation, FNAC and biopsy are rarely needed. This article describes a successful repair of a 22yr old manual worker’s ventral forearm herniation with polypropylene mesh. Prevalence Muscle herniation in an extremity is a well-known cause of pain, even though there have been extremely few documented cases. In a 2009 report published by the “Journal of Hand and Microsurgery,” only 200 cases of herniated muscles of the extremities had been reported since the mid-1800s, and only 17 cases of muscle herniation in the upper limb have been described10. Characteristics A herniated muscle in the forearm can cause mild to severe localized pain, affect grip, cause nerve pain or have no physical symptoms at all. Causes of documented cases include sporting or occupational activities, or an unrelated primary medical condition. Patients usually have a swollen mass that increases in size when the affected muscle is engaged and decreases when the muscles are relaxed. One differential diagnosis for a herniated forearm muscle is a tumor. Muscle herniation in the forearm typically affects males in their adolescent or young-adult years1. We report a case of a disappearing forearm nodule that appeared with muscle contraction. This is characteristic of a transfascial muscle hernia. Ultrasound and MRI are the key to identifying an area of fascial alteration. Treatment alternatives of this unusual condition are discussed.

Diagnosis of cervical intraepithelial neoplasia by visual inspection with acetic acid among Chinese women: a meta-analysis / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the performance of visual inspection with acetic acid (VIA) in preliminary screening of cervical cancer and its precancerous lesions among Chinese women by meta-analysis of diagnosis.</p><p><b>METHODS</b>Pubmed, Cochrane, Wanfang, CNKI and Weipu databases were employed to search for citations using the MeSH terms as "acetic acid", "cervical intraepithelial neoplasia", and "cervical cancer" both in Chinese and English. Additional relevant references cited in retrieval articles were also searched.40 pieces of research paper related with screening of cervical cancer and precancerous lesions of cervical cancer in Chinese women by VIA were collected. Bivariate random effects model was adopted using SAS 8.02.</p><p><b>RESULTS</b>Twenty-two studies including 23 330 cases were finally selected in the analysis, among which 19 studies were reported in Chinese and the other 3 in English. These studies were reported from 2004 to 2010 and the age-range of subjects was between 15 and 81 years old. Stratified analysis of diagnosis threshold showed that the pooled diagnostic odds ratio (DOR) of VIA for CIN1+ (4.11, 95%CI: 3.20 - 5.04) was similar to that for CIN2+ (4.45, 95%CI: 3.73 - 5.15). Either CIN1+ or CIN2+, the DOR in younger women (≤ 40 year) (4.22, 95%CI: 3.29 - 5.16; 4.53, 95%CI: 3.46 - 5.47) was also similar to it in older women (> 40 year) (3.66, 95%CI: 2.27 - 5.37; 4.26, 95%CI: 3.32 - 5.26). There was no difference in the screening performance between county-level doctors (DOR = 4.62, 95%CI: 3.13 - 5.93) and municipal-level doctors (DOR = 4.48, 95%CI: 3.71 - 5.16).</p><p><b>CONCLUSION</b>The screening performances of VIA were relatively consistent among different lesion grades and aging groups of Chinese women. After professional training, there was no difference in performance between county-level hospitals and municipal-level hospitals.</p>

Mesotelioma primario del pericardio / Primary pericardium mesothelioma

Introducción: El mesotelioma primario de pericardio (MPP) es una neoplasia extremadamente rara, que se origina de las células mesoteliales del pericardio. Esta neoplasia tiene la capacidad de invadir estructuras adyacentes y de originar metástasis a distancia; sin embargo, por su localización, generalmente es mortal en forma precoz. Hasta el momento se han informado alrededor de 200 casos en el mundo. Objetivo: Describir un caso de MPP diagnosticado por autopsia y realizar una discusión de este tema. Caso clínico: Mujer de 56 años de edad, quien ingresa por anorexia, pérdida de peso, disfagia y disnea de un año de evolución, posteriormente se acompaña de masa cervical supraclavicular derecha. Además, se evidenció esfuerzo respiratorio. La radiografía y TAC de tórax documentaron aumento mediastinal, y derrame pleural y pericárdico. El estudio citológico del aspirado con aguja fina de la masa cervical y la citología de líquido pleural, fueron compatibles con neoplasia maligna. La paciente presentó deterioro progresivo y muerte. Se realizó autopsia donde se encontró corazón encarcelado totalmente por neoplasia multinodular, con múltiples áreas de necrosis. El estudio histopatológico documentó un MPP. Conclusión: El MPP es una neoplasia poco frecuente, la cual es generalmente fatal debido a la sensibilidad de los órganos que compromete. Por este motivo, este tumor es generalmente diagnosticado en autopsia, posterior a una muerte desencadenada, en la mayoría de los casos, por taponamiento cardíaco.

Background: Primary pericardial mesothelioma (PPM) is an extremely rare neoplasm originated from pericardium mesothelial cells. This tumor has the ability to invade adjacent structures and cause distant metastases, but its location, is usually fatal early. About 200 cases are worldwide reported. Aim: A case of PPM diagnosed by autopsy is presented. Case report: 56-years-old Female, who was admitted for anorexia, weight loss, dysphagia, and dyspnea of one year of evolution, later accompanied by right supraclavicular neck mass. Was evident respiratory effort. The chest radiograph and CT scan documented increased mediastinal space and pleural and pericardial effusion. The cytological analyses of the fine needle aspiration of neck mass and pleural fluid were compatible with malignancy. The patient had progressive deterioration and death. Autopsy was performed which was found completely incarcerated heart by a multinodular tumor with multiple areas of necrosis. The histopathological study show a PPM. Conclusion: PPM is a rare malignancy, which is usually fatal because of the sensitivity of organs compromised. Therefore, this tumor is usually diagnosed at autopsy after death, in most cases secondary to cardiac tamponade.

The Relationship between Cognitive Decline Elderly People and Blood Metal Levels : A Systematic Review

OBJECTIVES: There have been several previous studies that the pathology of Alzheimer's disease (AD) might be in part caused or exacerbated by metals. But inconsistent results are often seen in evaluation of levels of metals in Alzheimer's disease patient's blood and control group. So, we conducted a systematic review using a comprehensive search strategy to find out whether there is significant difference between cognitive decline elderly people and normal control group. METHODS: Studies were searched in Pubmed, CINAHL and EMBASE with predefined words according to MeSH and purpose of this study. 996 studies were selected as primary screening, and two reviewers extracted relevant data independent of each other. 172 studies fulfilled the inclusion criteria. 32 studies about aluminum, copper, lead, mercury, cadmium finally selected. The Newcastle-Ottawa Scale (NOS) was used for assessing the quality of studies. To synthesize the results of this study, summarized table was made. RESULTS: In most studies, blood levels of mercury were high in cognitive decline group. But the majority study shows lead was not that different between cognitive decline group and control group. Measurements of other metal levels in whole blood, plasma, serum were inconsistent. However, there are not enough evidences to generalize with just number of studies since the studies have various degrees of validity. CONCLUSION: There is lack of evidences, till now, to use blood levels of metals as diagnostic purpose or predicting prognosis. Further studies which are supplemented limitations of previous studies are needed.

Lesões escamosas intraepiteliais de baixo grau: conduta em mulheres adultas / Low-grade intraepithelial lesions: management in adult women

O objetivo deste estudo foi rever o acompanhamento adequado das pacientes adultas com diagnóstico citológico de lesão intraepitelial de baixo grau (LSIL). Foi realizada busca eletrônica de publicações no Medline, SciELO e Mesh (por meio do PubMed), LILACS, EBSCO e Google Acadêmico. As diretrizes foram identificadas e sumarizadas. As diretrizes consideradas válidas foram aquelas elaboradas para França, Canadá, Brasil, Europa, Estados Unidos, Nova Zelândia, Hong Kong e Índia. Tais documentos recomendaram três estratégias diferentes: repetição da citopatologia com intervalo de seis meses antes de encaminhar para colposcopia, encaminhamento direto à colposcopia ou realização do teste de DNA do papilomavírus humano (HPV) nas pacientes com diagnóstico de LSIL. As recomendações encontradas variam de acordo com fatores relacionados à paciente e às condições governamentais de cada país. Concluiu-se que a repetição citológica no intervalo de seis meses, conduta preconizada pelo Ministério da Saúde, mostra-se adequada em termos de custo-efetividade para a realidade do Brasil

The purpose of this work was to review the appropriate management of adult patients with low-grade squamous intraepithelial lesions (LSIL) citologic diagnosis. An electronic search of publications in Medline, Scielo and Mesh (through PubMed), LILACS, EBSCO and Academic Google was carried out. The valid guidelines considered were those prepared for France, Canada, Brazil, Europe, United States, New Zealand, Hong Kong and India. Such documents recommend three different strategies: to repeat citopathology at intervals of six months before refer to colposcopy, to refer directly to colposcopy or to carry out the human papiloma virus (HPV) DNA test in patients with LSIL diagnosis. The recommendations found varied according to factors related to the patient and the governmental conditions of each country. It was concluded that repeat citopathology at intervals of six months, management recommended by the Brazilian Ministry of Health, is appropriate in terms of cost-effectiveness for Brazil