Infecção materna por SARS-CoV-2: descrição das notificações em gestantes / Maternal infection by SARS-CoV-2: description of notifications in pregnant women

Objetivo: Caracterizar as notificações de infecção por SARS-CoV-2 em gestantes em um município do sul de Santa Catarina. Métodos: Estudo transversal que avaliou as notificações de casos suspeitos de infecção por SARS-CoV-2 em gestantes no município de Tubarão, Santa Catarina, de março de 2020 a outubro de 2021. Coletaram-se os dados das fichas de notificação de infecção por SARS-CoV-2 da Fundação Municipal de Saúde e no Prontuário Eletrônico do Cidadão (PEC) das gestantes notificadas. A comparação da prevalência de confirmação segundo sintomas apresentados e características maternas foi realizada pela razão de prevalência (RP), com intervalo de confiança (IC) de 95%. Resultados: Foram registradas 555 notificações de gestantes suspeitas para a COVID-19, correspondentes a 487 mulheres. A prevalência de confirmação para a doença foi de 27,3%. O sintoma mais frequente no momento da notificação foi cefaleia (53,0%), entretanto o mais associado à confirmação foi a anosmia (RP: 2,28; IC 95%: 1,68-3,09). Das notificações registradas, 35,0% foram realizadas por gestantes que tiveram contato com casos suspeitos ou confirmados de COVID-19. O contato prévio foi mais relatado por gestantes assintomáticas, em comparação às gestantes que apresentaram sintomas (RP: 1,46; IC 95%: 1,12-1,91). Mulheres que relataram contato prévio com suspeitos ou confirmados para a COVID-19 apresentaram maior frequência de doença confirmada, quando comparadas às gestantes não expostas (RP: 1,80; IC 95%: 1,35-2,39). Conclusão: As gestantes, por terem maior susceptibilidade a surtos de doenças e gravidade do quadro, podem ter adotado com mais atenção medidas como a realização de testes diagnósticos quando em contato prévio com casos de COVID-19, mesmo assintomáticas.

Objective: To characterize the notifications of SARS-CoV-2 infection in pregnant women in a city in the South of Santa Catarina. Methods: Cross-sectional study that evaluated notifications of suspected cases of SARS-CoV-2 infection in pregnant women in the municipality of Tubarão, Santa Catarina, from March 2020 to October 2021. Data were collected from the SARS-CoV-2 infection notification forms from the Municipal Health Foundation, and from the Citizen's Electronic Health Record of the notified pregnant women. The comparison of the prevalence of confirmation according to symptoms and maternal characteristics was performed using the Prevalence Ratio (PR), with a confidence interval (CI) of 95%. Results: 555 notifications of suspected pregnant women for COVID-19 were registered, corresponding to 487 women. The prevalence of confirmation for the disease was 27.3%. The most frequent symptom at the time of notification was headache (53.0%), however, the most associated with confirmation was anosmia (PR: 2.28; 95% CI: 1.68-3.09). Of the notifications registered, 35.0% were made by pregnant women who had contact with suspected or confirmed cases of COVID-19. The previous contact was more frequently reported by asymptomatic pregnant women compared to pregnant women who had symptoms (PR: 1.46; 95% CI: 1.12-1.91). Women who reported previous contact with suspected or confirmed COVID-19 had a higher frequency of confirmed disease when compared to unexposed pregnant women (PR: 1.80; 95% CI: 1.35-2.39). Conclusion: Pregnant women, due to their greater susceptibility to disease outbreaks and disease severity, may have adopted more attentive measures such as diagnostic testing in the face of previous contact with cases of COVID-19, even if asymptomatic.

Herramientas diagnostico-terapéuticas en síndromes mielodisplásicos en Uruguay / Diagnostic and therapeutic tools in myelodysplastic syndromes in Uruguay / Instrumentos diagnóstico-terapêuticos nas síndromes mielodisplásicas no Uruguai

Los Síndromes Mielodisplásicos (SMD) son un grupo heterogéneo de enfermedades mieloides. Esta heterogeneidad en la presentación clínica complejiza el diagnóstico requiriendo diversos estudios complementarios. El tratamiento debe ser individualizado y adaptado al riesgo, desde terapias de soporte hasta intervenciones de alto costo. Para conocer la accesibilidad a las herramientas diagnóstico y terapéuticas se realizó una encuesta online dirigida a los hematólogos que asisten pacientes con SMD en Uruguay en 2016 y 2019. Las encuestas fueron respondidas por 32.5% y 26.6% de los miembros de la Sociedad de Hematología del Uruguay. Más del 90% tienen acceso a estudios histológicos, citogenéticos, FISH y citometría de flujo. La posibilidad de realizar paneles de secuenciación masiva se encuentra restringida a menos de 10% derivando la muestra al exterior, siendo mayor en 2019 en comparación a 2016. Los sistemas de estratificación de riesgo más utilizados son el sistema internacional de puntuación de riesgo (IPSS) y su versión revisada (IPSS-R). La disponibilidad de tratamientos de soporte (transfusiones, eritropoyetina y G-CSF), de azacitidina y del trasplante alogénico de precursores hematopoyéticos es amplia. Existió un aumento en indicación de azacitidina en 2019 con respecto a 2016. Sin embargo, el acceso a decitabina, lenalidomida y fármacos quelantes de hierro es escaso y no se cuenta con ensayos clínicos donde incluir pacientes que fallan o no responden a los tratamientos convencionales. La presente encuesta, realizada en dos períodos, describe la realidad y su evolución en nuestro país en cuanto a accesibilidad a herramientas diagnósticas y terapéuticas extrapolables a otras patologías oncohematológicas. Los datos recabados permitirán plantear estrategias tendientes a mejorar el abordaje diagnóstico-terapéutico de los pacientes con SMD en Uruguay.

Myelodysplastic Syndromes (MDS) constitutes an heterogenous group of hematological malignancies. Reaching an accurate diagnosis, represents in an important number of cases, a major challenge that requires different diagnostic tools. In order to acknowledge the scope of access to those tools in our country, we performed a survey addressed to Uruguayan hematologists who care for MDS patients in their clinical practice. The survey was carried out in 2016 and 2019 among Uruguayan Hematology Society members. Response rate was 32.5% and 26.6% respectively. Access to bone marrow biopsy, cytogenetics, FISH and flow cytometry was accessible to more than 90% of physicians. Less than 10% of respondents were able to request next generation sequencing (NGS) studies and in that case, they have to send them abroad. IPSS and R-IPSS were the most frequently used risk scores. Support treatment such as growth factors and transfusions are widely accessible. Azacytidine and allogenic transplant are available as well. However, access to decitabine, lenalidomide and iron chelating drugs is scarce and there are no clinical trials to include patients who fail or do not respond to conventional treatments. This survey, carried out in two periods, describes the reality and its evolution in our country in terms of accessibility to diagnostic and therapeutic tools that can be extrapolated to other oncohematological pathologies. We were able to get to know our country reality regarding diagnostic and therapeutic tools for MDS patients. This, would represent an important input in order to design health strategies aiming to improve clinical care for our patients.

As Síndromes Mielodisplásicas (SMD) são um grupo heterogêneo de doenças mielóides. Essa heterogeneidade na apresentação clínica torna o diagnóstico mais complexo, exigindo vários estudos complementares. O tratamento deve ser individualizado e adaptado ao risco, desde terapias de suporte até intervenções de alto custo. Para conhecer a acessibilidade de ferramentas diagnósticas e terapêuticas, foi realizada uma pesquisa online dirigida aos hematologistas que atendem pacientes com SMD no Uruguai em 2016 e 2019. As pesquisas foram respondidas por 32,5% e 26,6% dos membros da Sociedad de Hematologia do Uruguai. Mais de 90% têm acesso a estudos histológicos, citogenéticos, FISH e citometria de fluxo. A possibilidade de realização de painéis de sequenciamento massivo está restrita a menos de 10% provenientes da amostra no exterior, sendo maior em 2019 em relação a 2016. Os sistemas de estratificação de risco mais utilizados são o sistema internacional de pontuação de risco (IPSS) e sua versão revisada (IPSS -R). Tratamentos de suporte (transfusões, eritropoietina e G-CSF), azacitidina e transplante alogênico de células-tronco hematopoiéticas estão amplamente disponíveis. Houve aumento da indicação de azacitidina em 2019 em relação a 2016. No entanto, o acesso a decitabina, lenalidomida e quelantes de ferro é escasso e não há ensaios clínicos para incluir pacientes que falham ou não respondem aos tratamentos convencionais. Este inquérito, realizado em dois períodos, descreve a realidade e a sua evolução no nosso país em termos de acessibilidade a instrumentos diagnósticos e terapêuticos que podem ser extrapolados para outras patologias onco-hematológicas. Os dados coletados permitirão propor estratégias destinadas a melhorar a abordagem diagnóstico-terapêutica de pacientes com SMD no Uruguai.

Biologia Molecular como ferramenta de detecção fúngica no sangue: auxílio diagnóstico e redução de gastos / Molecular Biology as a tool for fungal detection on blood: diagnostic aid and cost reduction

Introdução: Os avanços médicos das últimas décadas contribuíram para aumentar a sobrevida de pacientes críticos e com a resposta imune comprometida. Consequentemente, a população em risco de adquirir infecções de origem fúngica também cresceu. Com altas taxas de morbidade e mortalidade, o difícil diagnóstico deste tipo de infecção, em conjunto com terapias ineficazes, gera elevados custos e sobrecarga ao sistema de saúde. Objetivos: Padronizar um método molecular de detecção fúngica diretamente do sangue e avaliar esta técnica comparativamente com a atualmente considerada padrão-ouro (hemocultura), associando aspectos clínicos, tempo de realização das técnicas e os custos envolvidos. Casuística e Métodos:Neste sentido, 94 pacientes com suspeita de infecção de corrente sanguínea foram submetidos a uma técnica de nestedPCR para detecção de DNA fúngico. Resultados: A técnica molecular foi positiva em 48,9% das amostras, enquanto que a hemocultura foi positiva em apenas 13,0% dos casos. Esses resultados demonstram uma alta sensibilidade do nested PCR e com um valor preditivo negativo de 100% em pacientes com suspeita clínica de infecção fúngica sistêmica e em situações de risco. O tempo de realização do método e os custos associados a ele, em comparação à hemocultura, também demonstraram seu potencial para uso clínico. Conclusões: Em comparação com a hemocultura, o método padronizado de nestedPCR constitui um teste rápido e economicamente viável capaz de descartar uma infecção sistêmica provocada por fungo, podendo facilitar o diagnóstico e evitar terapias ineficientes e caras, diminuir o tempo de internação e os impactos econômicos gerados por esse tipo de infecção.

Introduction: Medical advances in the past decades have contributed to the increase of survival of critically ill patients and the ones with impaired immune response. Consequently, the population at risk of acquiring a fungal infection also has increased. This type of infection generates expensive costs and heavy burden to the Health system. It also brings high morbidity and mortality rates, difficulty in diagnosing, and ineffective therapies. Objectives: Standardize a molecular method of fungal detection directly from blood and compare this technique with the blood culture, which is currently considered the gold standard. It associates clinical aspects, time, and costs involved. Patients and Methods: In this sense, 94 patients with suspected bloodstream infection were submitted to the technique of nested PCR for detection of fungal DNA. Results: The molecular technique was positive in 48.9% of the samples, while the blood culture was positive in only 13% of the cases. These results demonstrate high sensibility of the nested PCR and negative predictive value of 100%. The performing time and the costs associated with the method also demonstrated its value for clinical use. Conclusions: Therefore, the nested PCR is a quick and economically viable test, capable of ruling out a systemic infection caused by fungus, being able to facilitate the diagnosis, avoid inefficient and expensive therapies, and decrease the length of hospital stay, reducing the burden caused by this type of infection.

El dilema de las reintervenciones quirúrgicas / The dilema of surgical reinterventions

RESUMEN Introducción: En la actualidad, la diversidad de criterios relacionados con las reintervenciones quirúrgicas constituyen un verdadero problema científico, por cuanto, resulta de gran importancia profundizar en torno a los principales aspectos cognoscitivos relacionados con este tema a fin de elevar la calidad asistencial y, con esa premisa, el índice de supervivencia, sobre todo en la población envejecida como grupo vulnerable. Objetivos: Identificar los factores que permitan reconocer las condiciones modificables que disminuyan las complicaciones y fallecimientos de los enfermos tributarios de un nuevo tratamiento quirúrgico para salir adelante y sobrevivir. Métodos: Revisión digital de publicaciones actualizadas en español e inglés en bases de datos: Google, Redalyc, PubMed, Medline, Lilacs, Elsevier. Resultados: Las complicaciones posquirúrgicas y las que requieren una reintervención en particular son de origen multifactorial. No existe una definición y una clasificación estandarizada de las complicaciones posquirúrgicas para notificarlas. Las más utilizadas son las objetivas de Clavien Dindo y Accordeon, basadas en la estratificación del tratamiento requerido, el riesgo y gravedad. Conclusiones: A pesar de que el gran avance tecnológico actual en los métodos diagnósticos y terapéuticos ha permitido que los pacientes con complicaciones posquirúrgicas sean reintervenidos con mayor seguridad, la morbilidad y la mortalidad a causa de estas continúan elevadas(AU)

ABSTRACT Introduction: Nowadays, the diverse criteria related to surgical reinterventions are a real scientific problem since it is very important to delve into the main cognitive aspects associated to this topic in order to raise the quality of medical assistance and thus the survival index in the old population as a vulnerable group. Objectives: To identify the factors that allow recognizing the modifiable conditions that lead to less complications and deaths of patients undergoing a new surgical treatment. Methods: Search of updated publications in English and Spanish made in Goggle, Redalyc, PubMed, Medline, Lilacs and Elsevier databases. Results: The postsurgical complications and those requiring surgical reintervention in particular are of multifactoral origin. There is neither one single definition nor one standardized classification of the postsurgical complications to notify them. The most used objective classifications are Claven Dindo and Accordeon, based on the stratification of the required treatment, the risk and the severity. Conclusions: In spite of the fact that the great technological advances in the diagnostic and therapeutic methods have allowed the reoperation of complicated patients with higher margin of safety, morbidity and mortality caused by such complications are still high(AU)

Diagnóstico laboratorial confirmatório da sífilis realizado no Instituto Adolfo Lutz de São José do Rio Preto / Confirmatory laboratory diagnosis of syphilis performed at the Adolfo Lutz Institute in São José do Rio Preto

Introdução: A sífilis é uma doença infecciosa causada pela bactéria Treponema pallidum, transmitida principalmente pelo contato sexual. O Instituto Adolfo Lutz de São José do Rio Preto (IAL-SJRP) tem um importante papel no controle da sífilis, sendo o laboratório de saúde pública referência para 102 municípios do Departamento Regional de Saúde XV. Objetivo(s): Realizar a confirmação da sífilis em amostras recebidas no IAL-SJRP. Casuística e Métodos: Após triagem nas unidades de saúde, as amostras enviadas para confirmação foram: testes rápidos positivos, VDRL reagentes, crianças 0-18 meses e parceiros de pessoas com sífilis. Foram analisadas 781 amostras de soro de setembro/2016 a agosto/2017 conforme fluxograma do Manual Técnico para Diagnóstico da Sífilis do Ministério da Saúde e adotados testes treponêmicos e não treponêmicos. Resultados: Das 781 amostras enviadas pelas unidades, 299 (38,3%) eram teste rápido positivo, 75 (9,6%) VDRL reagente, 243 (31,1%) eram pacientes controles de tratamento, 23 (2,9%) parceiros, 25 (3,2%) amostras de crianças 0-18 meses e 116 (14,9%) vieram sem justificativa. As amostras recebidas com resultados positivos nos testes rápidos, VDRL e controle de tratamento foram confirmadas em 94,3%, 93,3% e 77% respectivamente. Dentre os parceiros 91,3% foram negativas, amostras de crianças de 0-18 meses 92% foram negativas e, amostras sem justificativas 75 (64,7%) foram positivas, 37 (31,9%) negativas e 4 (3,4%) indeterminadas Conclusão: A confirmação do diagnóstico da sífilis ocorreu em 79,39% das amostras analisadas. O IAL-SJRP como laboratório de referência em saúde pública, tem um importante papel no controle da sífilis.

Aplicación de la escala RIPASA en historias clínicas de pacientes egresados con diagnóstico de apendicitis aguda / The application of the RIPASA scoring system to the clinical files of patients discharged with a diagnosis of acute appendicitis

Introducción: la apendicitis aguda es la enfermedad que mayores cirugías de urgencia demanda en el mundo. Objetivo: establecer la efectividad diagnóstica de la escala RIPASA (Raja Isteri Pengiran Anak Saleha Apendicitis) en historias clínicas de pacientes egresados con diagnóstico de apendicitis aguda. Método: se realizó un estudio transversal de evaluación de pruebas diagnósticas en un universo de 271 historias clínicas de pacientes con diagnóstico al egreso de apendicitis aguda, en los Hospitales Carlos Manuel de Céspedes y Celia Sánchez, Granma. El criterio de inclusión fue la descripción de cada uno de los reactivos de la escala en dichas historias. Se aplicó la escala de RIPASA. Los datos se procesaron en el sistema SPSS 21 versión. Resultados: la edad media de los pacientes fue de 31,79 años predominando el sexo masculino (56,83 por ciento). Del total de pacientes, 98,15 por ciento de los pacientes tuvieron un diagnóstico histológico de apendicitis aguda; 54,98 por ciento resultaron con alta probabilidad de apendicitis aguda, mientras que 29,89 por ciento resultaron en diagnóstico de apendicitis aguda según la escala. El análisis de los resultados de la escala RIPASA arrojó una sensibilidad de la escala del 87 por ciento. Conclusiones: la escala RIPASA demostró valores de sensibilidad diagnóstica en población cubana, acorde a lo reportado en la literatura. Se recomienda su utilización en el diagnóstico de apendicitis aguda(AU)

Introduction: Acute appendicitis is the illness demanding the greatest amount of surgeries worldwide. Objective: To establish the diagnostic effectiveness of the RIPASA scoring system in the clinical files of patients discharged with a diagnosis of acute appendicitis. Method: A cross-sectional study of assessment of diagnostic test was performed in a universe of 271 clinical files of patients with discharge after diagnosis of acute appendicitis in Carlos Manuel de Céspedes Hospital and Celia Sánchez Hospital of Granma Province. The inclusion criterion was the description of each reagent of the scoring system in this files. The RIPASA scoring system was applied, and the data were processed in the system SPSS version 21. Results: The patients' average age was 31.79 years, with a prevalence of the male sex (56.83 percent). 98.15 percent of the patients had a histological diagnostic of acute appendicitis. 54.98 percent of the patients presented high probability of acute appendicitis, while 28.89 percent of them had a diagnosis of acute appendicitis based on the scoring system. The analysis of the results of the RIPASA scoring system produced a scale sensibility at 87 percent. Conclusions: In the Cuban population, the RIPASA scoring system showed values of diagnostic sensibility consistent with what is reported in the scientific literature, a reason why its use is recommended for the diagnosis of acute appendicitis(AU)

Conocimiento acerca de la enfermedad de Von Willebrand entre estudiantes de Odontología / Knowledge about von Willebrand's disease among dental students

Introduction: Von Willebrand's disease is the most common bleeding disorder, and is still underdiagnosed for several reasons, including lack of knowledge about the disease. Objective: to evaluate the knowledge about dental care for patients with von Willebrand's disease in students who attended the last academic year of an undergraduate dental program. Methods: a questionnaire with objective questions was applied to 87 students in order to obtain data on the following variables of interest: gender, term of the program, knowledge about the disease, knowledge about the involved coagulation factor, tests for diagnosis, signs and symptoms, procedures necessary during patient care, and medications that should be avoided in von Willebrand's disease. The data were analyzed using IBM SPSS (21.0) at a significance level of 5 percent. Results: only 21 students (21.14 percent) reported having some knowledge about von Willebrand's disease: 49.02 percent correctly answered that the coagulation factor is involved in von Willebrand's disease, and 29.4 percent correctly answered to the question about the diagnostic tests. Conclusions: students attending the final academic year of an undergraduate dental program have limited knowledge about von Willebrand's disease(AU)

Introducción: la enfermedad de Von Willebrand es el trastorno hemorrágico más común, y todavía está infradiagnosticada por varias razones, incluyendo la falta de conocimiento acerca de la enfermedad. Objetivo: evaluar el conocimiento acerca del cuidado dental para pacientes con la enfermedad de Von Willebrand en los estudiantes que asistieron al último año de un programa de odontología de pregrado. Métodos: se aplicó un cuestionario con preguntas objetivas a 87 estudiantes para obtener datos sobre las siguientes variables de interés: género, término del programa, conocimiento acerca de la enfermedad, conocimiento sobre el factor de coagulación implicado, pruebas para el diagnóstico, signos y síntomas, procedimientos necesarios durante el cuidado de pacientes y los medicamentos que deben evitarse en la enfermedad de Von Willebrand. Los datos fueron analizados utilizando IBM SPSS (21.0) a un nivel de significación del 5 por ciento. Resultados: solo 21 estudiantes (21,14 por ciento) reportaron tener algún conocimiento sobre la enfermedad de Von Willebrand: 49,02 por ciento respondió correctamente cuál es el factor de coagulación que está involucrado en enfermedad de Von Willebrand, y el 29,4 por ciento respondió correctamente a la pregunta sobre las pruebas diagnósticas. Conclusiones: los estudiantes que asisten al último año de un programa de odontología de grado tienen un conocimiento limitado acerca de la enfermedad de Von Willebrand(AU)

Escala de Epwoth y cuestionario de Stop Bang como predictores del síndrome de apneas hipopneas obstructivas del sueño / Epworth Sleepiness Scale and Stop Bang questionnaire as predictors for the obstructive sleep apnea syndrome / Escala de Epworth e questionário PARAR BANG como preditores de hipopnéias apneia obstrutiva do sono. Síndrome do sono

Introducción: El SAHOS (Síndrome de Apneas e Hipopneas Obstructivas del Sueño) surge de apneas e hipopneas que generan una hipoxia intermitente. La polisomnografía es el gold standard para su diagnóstico. La Escala de Somnolencia de Epworth (ESS) identifica pacientes con somnolencia diurna. El cuestionario Stop Bang reconoce pacientes con riesgo de SAHOS. El objetivo es describir la sensibilidad y especificidad de la ESS y Stop Bang para el diagnóstico de SAHOS realizado con polisomnografía. Métodos: 125 pacientes completaron la ESS, Stop Bang y realizaron una polisomnografía de noche completa. Se confeccionaron dos grupos: pacientes con IAH < 15, y pacientes con IAH ≥ 15. Se calcularon sensibilidad, especificidad, razón de probabilidades (OR) y curvas ROC para el diagnóstico de SAHOS de la ESS y el Stop Bang. Resultados: La prevalencia del grupo IAH ‹ 15 fue de 36%, y del grupo IAH ≥ 15 fue de 64%. Para la ESS, 71 pacientes presentaron somnolencia diurna, 49,3% con un IAH < 15 y 50,7% con un IAH ≥ 15. Especificidad 77,78%, sensibilidad 55%, área bajo la curva ROC 0,6553. Para el cuestionario Stop Bang, 110 pacientes presentaron alto riesgo para SAHOS, 30% con un IAH < 15 y 70% con IAH ≥ 15. Especificidad 26,67%, sensibilidad 96,25%, área bajo la curva ROC 0,7671. Se enfrentaron ambos cuestionarios y calcularon sus OR: ESS, OR=1,1014 (p=0,038); Stop Bang, OR=8,099 (p=0,002). Conclusiones: La sensibilidad de ESS es baja y su área bajo la curva ROC poco significativa. La gran sensibilidad del cuestionario Stop Bang junto con su área bajo la curva ROC, lo convierten en una herramienta de importancia para realizar screening de SAHOS.

Introduction: osa (obstructive sleep apnea) arises from apneas and hypopneas that cause intermittent hypoxia. Polysomnography is the gold standard for its diagnosis. The Epworth Sleepiness Scale (ESS) measures daytime sleepiness. The Stop Bang Questionnaire (SBQ) recognizes patients at risk of OSA. Objectives: describe the sensitivity and specificity of the ESS and SBQ for the diagnosis of OSA accomplished by polysomnography. Methods: 125 adult patients completed the ESS, SBQ and a full night polysomnography. Patients were grouped into two: those with AHI < 15 and those with AHI ≥ 15. Sensibility, specificity, odds ratio (OR) and ROC curves were determined for the ESS and SBQ. Results: The group with AHI ≥ 15 prevailed (64%). 71 patients (56.8%) showed an abnormal ESS´s score; 49.3% showed an AHI < 15 and 50.7% AHI ≥ 15. The specificity was 77.78% and sensitivity 55%. The area under the ROC curve was 0.6553. Regarding the SBQ, 110 patients were within the high risk group; 30% corresponded to an AHI < 15 and 70% AHI ≥ 15. The specificity was 26.67% and sensitivity 96.25%. The area under the ROC curve was 0.7671. The OR for the ESS was 1.1014 (p=0.038) and SBQ, OR = 8.099 (p=0.002). Conclusion: The sensitivity of the ESS is low and the area under the ROC curve insubstantial. The SBQ shows high sensitivity and a remarkable area under the ROC curve, which turn it into an important tool for screening OSA.

Introdução: sahos (síndrome da apneia e hipopneia obstrutiva do sono) surge de apnéias e hipopnéias que geram hipóxia intermitente. A polissonografia (PSG) é o gold standard para o diagnóstico. A Escala de Sonolência de Epworth (ESS) identifica pacientes com sonolência diurna. O questionário Stop bang reconhece pacientes em risco de doenca de SAHOS. O objetivo de este trabalho é descrever a sensibilidade e especificidade da ESS e do questionario Stop Bang para diagnóstico de SAHOS feito coma PSG. Métodos: 125 pacientes completaram a ess, o stop bang efisseram uma psg con oximetria de noite completa. Dividiram-se os pacientes em dois grupos: com IAH < 15 e 50,7% com um IAH ≥ 15. A especificidade foi de 77,78%, a sensibilidade de 55%, e a área abaixo da curva ROC 0,6553. Enquanto ao questionário stop bang, 110 pacientes apresentaram alto risco de SAHOS, 30% com um IAH < 15 e 70% com IAH ≥ 15. Especificidade de 26,67%, 96,25% de sensibilidade, e 0,7671 da área abaixo da curva. Se comparam ambos questionários e foi calculada sua OR: ESS, OR = 1,1014 (p = 0,038); Stop Bang, OR = 8,099 (p = 0,002). Conclusões: a sensibilidade ess é baixa e a área baixo da curva roc insignificante. A alta sensibilidade do questionário Stop Bang junto com a área baixo da curva ROC o tornam uma ferramenta muito importante para o sreening de esta doença.

El ultrasonido como indicador de ausencia de injuria abdominal en el trauma / The ultrasound as an indicator of absence of abdominal injury in trauma

Introducción: los traumatismos abdominales constituyen una importante carga en los servicios de urgencia. La ecografía es un método diagnóstico de gran difusión en la actualidad. Objetivo: determinar la utilidad diagnóstica del ultrasonido para predecir la ausencia de injuria en pacientes con traumatismo abdominal. Método: se realizó un estudio observacional y prospectivo, en 68 pacientes, en el Hospital Militar Dr. Luis Díaz Soto, desde enero hasta diciembre 2015, a los cuáles se les realizó ecografía inicial en búsqueda de daño. Se describieron los procederes diagnósticos posteriores al primer ultrasonido y su demora en horas. Resultados: 77,2 por ciento presentó ultrasonido inicial negativo y 14 pacientes necesitaron otros estudios, siendo el ultrasonido evolutivo el de mayor indicación después de 6 horas del primer estudio. Solo dos pacientes presentaron evidencia de daño abdominal para una sensibilidad de la ecografía del 88 por ciento, especificidad 100 por ciento, valor predictivo negativo 96,2 por ciento e índice de eficacia 97 por ciento. Conclusiones: la combinación de hallazgos negativos en un estudio ecográfico inicial y la evolución clínica favorable durante un período de observación de 12 - 24 horas virtualmente excluye injuria abdominal por trauma(AU)

Introduction: The abdominal trauma is an important problem in emergency services and the ultrasound is a widely used diagnostic method nowadays. Objective: To establish the diagnostic usefulness of ultrasound scan to predict absence of injury in patients with abdominal trauma. Method: Prospective and observational research study was made in 68 patients in Dr. Luis Diaz Soto military hospital from January to December 2015. An initial ultrasound was performed on these patients for injure location. The secondary diagnostic exams after the first ultrasound scan and how long they lasted were described. Results: In the group, 77.2 percent of the patients showed negative results in the initial ultrasound exam whereas 14 patients needed another diagnostic procedure. The evolutionary ultrasound was the one providing more indications after 6 hours of the first exam. Only two patients showed evidence of abdominal injury for a sensitivity index of 88 percent, 100 percent specificity, 96.2 percent negative predictive value and 97 percent effectiveness Conclusions : The combination of negative findings in the initial ultrasound and the favorable clinical progress during 12 to 24 hours virtually discard the existence of abdominal injure from trauma(AU)

Algunas especificidades concernientes al paciente politraumatizado grave / Some Specifics Concerning About Severe Trauma Patient

El trauma se produce con patrones definidos que permiten identificar factores de riesgo como género (masculino), edad (las extremas de la vida), nivel socioeconómico (bajo), uso de sustancias peligrosas y adictivas, problemas psicológicos y escasa educación relacionada con la seguridad. La mortalidad por lesiones traumáticas graves se mantiene alta. La evaluación precoz de la severidad del trauma permite tratar adecuadamente y con inmediatez a los lesionados, mejorar el pronóstico y lograr que egresen vivos la mayoría de ellos. Por esas razones, constituye un tema de actualidad continuar profundizando sobre sus aspectos cognoscitivos en general, y los relacionados con las principales características de los politraumatizados graves, en particular. Solo contando con equipos multidisciplinarios altamente capacitados y con los recursos necesarios para su atención pre hospitalaria y luego de su hospitalización, puede lograrse la disminución de la mortalidad por esta causa(AU)

Trauma occurs with defined patterns that identify risk factors as gender (male), age (the end of life), socioeconomic stratus (low), use of dangerous and addictive substances, psychological problems and poor education related to safety. Mortality from severe traumatic injuries remains high. Early assessment of trauma severity allows proper and immediate treatment of the injured patient, as well as improving prognosis and achieving that most of patients are alive at discharge. For these reasons, it is a topical issue continue to deepen on its cognitive aspects in general and those related to the main characteristics of severe trauma patients in particular. Decrease in mortality by this cause can be only achieved with highly trained multidisciplinary teams and resources for pre and post hospital care(AU)

Medicina militar para lesionados con secuelas de los conflictos bélicos / Military medicine for injuries with sequelae of armed conflicts

La medicina militar ha incorporado a su arsenal terapéutico novedosas técnicas para restablecer la salud y disminuir las secuelas en los heridos de los conflictos bélicos y catástrofes, cuyo número ha sido tres veces superior a los decesos. Las lesiones mortales e invalidantes más frecuentes son las de extremidades, traumatismos craneoencefálicos y hemorragias que se acompaña muchas veces de quemaduras, provocan secuelas muy limitantes o comprometen la vida de los combatientes y de la población presente en la catástrofe. Este trabajo pretende hacer mención de algunas técnicas novedosas de tratamiento que se emplean en la actualidad y su impacto en la rehabilitación y recuperación de las víctimas, tanto en conflictos bélicos como durante situaciones de desastre.

Military medicine has been incorporated a large number of new techniques in order to improve the restoration of the wounded victims and decrease the amount of sequels among the injured people during the war and civil disasters, which number exceed about three times the number of combat or disaster-related deaths. The must frequent fatal or disability-related injuries are the extremities lesions, head trauma and hemorrhage, frequently associated with burns lead to serious sequels and disability or compromise the life of combatants and civilians. The present paper intent to show some current techniques employed now a days and their impact in the restoration and rehabilitation of the victims of both, war conflicts and civilian disasters.

Imágenes diagnósticas: conceptos y generalidades / Diagnostic images: Concepts and generalities

Imágenes diagnósticas son el conjunto de estudios, que mediante la tecnología, obtienen y procesan imágenes del cuerpo humano. Para entender mejor los conceptos básicos y generalidades, se llevó a cabo una revisión de la literatura correspondiente para recopilar información sobre la historia, mecanismos de generación de imagen, términos, indicaciones y contraindicaciones, así como ventajas y desventajas de los estudios por imagen que actualmente se utilizan con mayor frecuencia, como, Rayos X; Ultrasonido; Tomografía Computarizada (TC) y Resonancia Magnética (RM)...(AU)

Aspectos bioéticos en el tratamiento de la retinopatía diabética / Bioethical aspects of the treatment of diabetic retinopathy

La medicina es una práctica tan antigua como la humanidad, que se ha ido modificando y enriqueciendo con la revolución científico-técnica, pero siempre sigue los mismo principios y normas éticas que establecen una relación médico- paciente basada en el respeto, la confianza y el precepto hipocrático de no hacer daño. En el quehacer del ejercicio de la medicina, la mayoría de los procedimientos diagnósticos, terapéuticos y profilácticos involucran riesgos, esto se aplica especialmente a la investigación biomédica y a todos aquellos novedosos medios diagnósticos y tratamientos que pueden ocasionar cierto perjuicio al aplicarlo. La retinopatía diabética constituye una de las principales causas de ceguera en pacientes en edad laboral. La búsqueda de alternativas de tratamiento para esta enfermedad debe evaluar siempre los riesgos y beneficios.

Medicine is such an old practice as the mankind. It has been modified and enriched with the scientific and technical revolution advances, but it always follows the same principles and ethical standards that set the physician-patient relationship based on respect, confidence and the Hippocratic precept of doing no harm. In the medical practice, most of the diagnostic, therapeutic and prophylactic procedures involve risks. This is especially true for the biomedical research and mainly for all those novel diagnostic and therapeutic methods which can cause some damage when applied. Diabetic retinopathy is one of the main causes of blindness in working-age patients. Searching alternative treatments for this illness should always evaluate the risks and the advantages.

Informe final fase I validación de pruebas rápidas de VIH en población general / Final Report Phase I Validation of Rapid HIV Tests in the General Population

Ante la norma que establece que los grupos de alto riesgo de padecer VIH deben hacerse la prueba cada 6 meses, hace falta mejorar la calidad, eficacia y rapidez de las mismas. Por ello el objetivo general del documento es: "Actualizar y validar el algoritmo diagnóstico de VIH utilizando pruebas rápidas recomendadas por OPS/OMS, como herramientas para la toma de decisiones diagnósticas para el control de la infección por VIH". Mencionan el número aproximado de pacientes que participaron en las encuestas: "Durante el período de vigilancia fueron enrolados 267, 223 y 378 pacientes para las encuestas de PDR, ADR12 y ADR48, respectivamente."

Histological and immunohistochemical assessment of the immunological aspect of certain cells in human palatine tonsils

Tonsils contain four specialized lymphoid compartments that together are involved in immune functions. The capacity of tonsillar lymphocytes to counter infections may be altered during one's lifetime. The classification of lymphocytes by CD antigen expression is now widely used in clinical medicine and experimental immunology. The present work was designed to study the distribution of CD4 and CD8 antigen expression in T lymphocytes in human tonsils at different periods of life. Sixty-two tonsillar specimens were obtained from still birth infants and from children aged 1-9 years. Paraffin sections were prepared and stained with H and E and with immunohistochemical stains to demonstrate CD4 and CD8 T lymphocytes. The distribution of these cells in the different components of the tonsils was evaluated with an image analyzer. The obtained data were statistically analyzed using SPSS. There was a significant increase in the distribution of stained CD4 and CD8 T lymphocytes in the interfollicular areas, mantle zones of lymphoid follicles, and partially in the germinal centers of the examined tonsils with the advancement of age. Activated T lymphocytes differentiate into several subtypes, among which are CD4 and CD8 cells. These types of T lymphocytes express surface antigens, which can interact with different foreign pathogens

Role of cancer antigen 125 in active pulmonary tuberculosis

Conventional TB diagnosis continues to rely on smear microscopy, culture and chest radiography. Other non-conventional approaches include detection of immunological response and the search for biochemical markers. Cancer antigen 125 [Ca-125] was evaluated mainly in patients with extra pulmonary TB. This study was designed to detect the role of Ca-125 in differentiating pulmonary tuberculosis from other pulmonary infections. Also to determine the value of Ca-125 was an indicator of response to anti-tuberculous drugs. Eighty patients were included in the study, 27 with active pulmonary TB and 33 with other pulmonary infections. Twenty healthy volunteers were used as a control group. Measurement of serum Ca-125 was performed once in all groups, it was re-assayed after 4 months of anti-tuberculous drugs among patients with active pulmonary TB. There was a significant increase of Ca-125 among patients with active pulmonary TB than the other groups, which decrease significantly after anti-tuberculous drugs. The sensitivity and specificity of Ca-125 were found to be 81.4% and 95%, respectively, at a 34.6 U/ml cut-off point. Ca-125 can be a useful marker in differentiating pulmonary TB from other pulmonary infections and in assessment the response to anti-tuberculoussis drugs

Diagnostic value of ultrasound guided biopsy in patients with malignant pleural effusion

To study the diagnostic value of ultrasound guided biopsy in patients with malignant pleural effusion. This study involved 40 patients with malignant pleural effusion of indeterminate aetiology. All patients had a contrast CT chest performed and were divided into 3 Groups according to their radiologic appearance: GROUP 1: 10 patients having pleural effusion only. GROUP 2: 15 patients having pleural effusion and pleural thickening. GROUP 3: 15 patients having pleural effusion and pleural mass lesions. All 3 groups of patients underwent ultrasound examination in the Radiology department. In patients of Groups 2 and 3, ultrasound fluid aspiration and ultrasound guided core biopsy of the pleura were attempted. Patients of all 3 Groups performed Medical thoracoscopy in the interventional pulmonology unit. In Group 1 patients, US guided biopsy was contraindicated and could not be performed due to absence of pleural thickness, nodulation or masses. Thoracoscopy was performed in them all with a sensitivity reaching 90%. In Group 2, a malignant aetiology was reached in 5/10 cases whom had adequate tissue retrieval [sensitivity 50%]. In Group 3, 12/15 patients were diagnosed by US guided biopsy [sensitivity 80%]. The mean sensitivity of US guided biopsy in both Groups was 65%. Thoracoscopy was then performed successfully in all of patients in Groups 2 and 3 with a diagnostic sensitivity of 100% each. The mean diagnostic sensitivity of thoracoscopy for all 3 Groups was 96.7%. The US guided pleural biopsy with a Tru-cut needle is simple, safe and well tolerated. It is especially useful for patients with pleural tumour, thickened pleura, small amounts of pleural effusion or loculated pleural effusion

Value of thoracoscopic pleural brush in the diagnosis of exudative pleural effusion

Nowadays, medical thoracoscope had been established to have greater diagnostic yield in the diagnosis of exudative pleural effusion. Forceps biopsy and pleural brush could be used through medical thoracoscope to obtain pleural cytopathological specimens, however the most popular used one was the forceps biopsy. To evaluate the value of thoracoscopic pleural brush in the diagnosis of exudative pleural effusion. Interventional prospective study. Endoscopy Unit, Chest Department, Assiut University Hospital, Egypt. The study was conducted upon 28 patients with exudative pleural effusion from January 2011 to December 2011, in whom both the conventional pleural tapping and closed pleural biopsy were not conclusive. All patients submitted for medical thoracoscope, where forceps biopsy and pleural brush specimens were taken for all patients. Thoracoscopic pleural specimens were diagnostic in 26 patients out of 28 ones [92.9%]. Histopathological examination of thoracoscopic specimens revealed malignant lesions in [20 patients], TB in [two patients] and non specific inflammation in [four patients]. Forceps biopsy was positive in 22 patients, while pleural brush was positive in 17 patients. Thoracoscopic pleural brush was the only diagnostic modality in four patients all were adenocarcinoma. The lesions were mostly on the visceral pleura in one patient in whom visceral pleural brush was taken, while bleeding occurred with forceps biopsy in the other three patient. No complications recorded with pleural brush procedures. Thoracoscopic pleural brushing could be done easily and safely and allows obtaining pleural cellular material in areas dangerous to take biopsy specimens. It could augment the diagnostic yield of medical thoracoscope