Reflexiones para optimizar el triaje en cirugía / Reflections to optimize triage in surgery

Introducción: La categorización de las urgencias quirúrgicas es una necesidad en razón al continuo desequilibrio entre la oferta y la demanda de servicios quirúrgicos en la mayoría de las instituciones donde se encuentra habilitada la prestación del servicio. Hay abordajes en el tema, con estrategias de priorización de los casos quirúrgicos, que consideran escalas y flujogramas, pero su ausente validez externa y las particularidades de las instituciones y aseguradores, han limitado una generalización de los resultados. Métodos: Se efectúa una conceptualización del triaje de las urgencias quirúrgicas con planteamientos críticos y reflexivos soportados en la evidencia. Se identifican, asimismo, las posibles oportunidades para la investigación. Discusión: Los beneficios potenciales de un triaje quirúrgico en situaciones de urgencia, son extensivos a todos los actores del sistema de salud, disminuyen la posibilidad de desenlaces y repercusiones económicas negativas para las instituciones y los aseguradores. La teoría de las colas ofrece el soporte para un entendimiento del tema y contribuye en las soluciones. Su adopción es escasa como parte de una estrategia local de priorización quirúrgica en un contexto de urgencia. Conclusión:La creación de estrategias que establezcan el triaje para el paciente con una urgencia quirúrgica están influenciadas por la participación continua y efectiva de los actores involucrados en el proceso y en su impacto en los desenlaces clínicos

Introduction: Categorizing surgical emergencies is necessary due to the continued imbalance between the supply and demand of surgical services in most institutions where the service is enabled. There are approaches to the subject, with strategies for prioritizing surgical cases, which consider scales and flowcharts, but their lack of external validity and the particularities of the institutions and insurers have limited the generalization of the results. Methods: A conceptualization of the triage of surgical emergencies is carried out with critical and reflective approaches supported by evidence. Potential research opportunities are also identified. Discussion: The potential benefits of surgical triage in emergent situations are extensive to all health system actors, reducing the possibility of adverse outcomes and economic repercussions for institutions and insurers. Queuing theory offers support for understanding the issue and contributes to solutions. However, its adoption is scarce in an emergency as part of a local surgical prioritization strategy. Conclusion: The creation of strategies that establish triage for the patient with a surgical emergency is influenced by the continuous and effective participation of the actors involved in the process and its impact on clinical outcomes

Paraganglioma de cuerpo carotideo / Carotid Body Paraganglioma

Introducción: Los paragangliomas de cuerpo carotideo son tumores neuroendocrinos hipervascularizados raros. Aunque su presentación clínica es frecuentemente asintomática, con el transcurso de los años puede manifestarse como tumores cervicales con o sin déficit neurológico. Objetivo: Presentar el caso de una paciente con tumoración cervical pulsátil de 10 años de evolución que requirió tratamiento quirúrgico. Presentación de caso: Mujer de 42 años procedente del Cusco, Perú, sin antecedentes médicos ni personales de importancia. La paciente acude al Servicio de Cirugía de Cabeza y Cuello por presentar tumoración cervical pulsátil de crecimiento lento progresivo, cefalea y disfagia. Tras realizar ultrasonografía Doppler y angiotomografía se pesquisa tumor cervical derecho hipervascularizado a nivel de la bifurcación de arteria carótida común. Se propone tratamiento quirúrgico de tumoración cervical con resultado anatomopatológico de paraganglioma de cuerpo carotideo. Tuvo una evolución posquirúrgica favorable sin evidencia de recurrencias en el seguimiento. Conclusión: El paraganglioma del cuerpo carotideo es una tumoración rara, de presentación clínica frecuentemente asintomática. Una evaluación minuciosa clínica e imagenológica permiten un diagnóstico adecuado para una planificación quirúrgica óptima(AU)

Introduction: Carotid body paragangliomas are rare hypervascularized neuroendocrine tumors. Although their clinical presentation is frequently asymptomatic, they may manifest as cervical tumors with or without neurological deficit over the years. Objective: To present the case of a patient with a pulsatile cervical tumor of 10 years' evolution that required surgical treatment. Case presentation: A 42-year-old woman from Cusco, Peru, with no medical or personal history of importance. The patient came to the head and neck surgery service for presenting a pulsatile cervical tumor with slow progressive growth, as well as headache and dysphagia. After performing Doppler ultrasonography and angiotomography, a hypervascularized right cervical tumor was observed at the level of the common carotid artery bifurcation. Surgical treatment of the cervical tumor was proposed, whose anatomopathological result was carotid body paraganglioma. Postoperative evolution was favorable, with no evidence of relapses during follow-up. Conclusion: Carotid body paraganglioma is a rare tumor of frequently asymptomatic clinical presentation. A thorough clinical and imaging-based assessment allows an adequate diagnosis for optimal surgical planning(AU)

Factors associated with inadequate treatment of syphilis during pregnancy: an integrative review / Factores asociados al tratamiento inadecuado de la sífilis durante el embarazo: una revisión integradora / Fatores associados ao tratamento inadequado da sífilis na gestação: revisão integrativa

ABSTRACT Objectives: to analyze the evidence available in literature on factors associated with inadequate treatment of syphilis in pregnant women. Methods: an integrative review, carried out in the LILACS, CINAHL, Web of Science, Scopus, PubMed and EMBASE databases, with controlled descriptors therapeutic and prenatal syphilis. Results: nine publications composed the interpretative analysis, in which low education, income and maternal age, temporary lack of medication and HIV infection were associated with inadequate treatment of syphilis during pregnancy, in addition to delay or absence of prenatal care and receiving the 1st dose of penicillin, lack of tests or treatment less than 30 days before childbirth, and partners' low compliance with treatment. Final Considerations: among the main factors associated with inadequate treatment, clinical and sociodemographic aspects stand out, as well as failures in drug dispensing, prescription and monitoring of treatment of pregnant women and their partners by the health system.

RESUMEN Objetivos: analizar la evidencia disponible en la literatura sobre factores asociados al tratamiento inadecuado de la sífilis en gestantes. Métodos: revisión integradora, realizada en las bases de datos LILACS, CINAHL, Web of Science, Scopus, PubMed y EMBASE, con los descriptores controlados sífilis terapéutica embarazada y prenatal. Resultados: nueve publicaciones componían el análisis interpretativo, en el que la baja escolaridad, renta y edad materna, la falta temporal de medicación y la infección por VIH se asociaron con el tratamiento inadecuado de la sífilis durante el embarazo, además de la demora o ausencia de control prenatal y de recibir la 1a dosis de penicilina, falta de exámenes o tratamiento menos de 30 días antes del parto, y baja adherencia al tratamiento por parte de la pareja. Consideraciones Finales: entre los principales factores asociados al tratamiento inadecuado se destacan los aspectos clínicos y sociodemográficos de la gestante, así como las fallas en la dispensación, prescripción y seguimiento del tratamiento de la gestante y su pareja por parte del sistema de salud.

RESUMO Objetivos: analisar as evidências disponíveis na literatura sobre os fatores associados ao tratamento inadequado da sífilis em gestantes. Métodos: revisão integrativa, realizada nas bases de dados LILACS, CINAHL, Web of Science, Scopus, PubMed e EMBASE, com os descritores controlados sífilis gestantes terapêutica e pré-natal. Resultados: nove publicações compuseram a análise interpretativa, nas quais baixa escolaridade, renda e idade materna, falta temporária do medicamento e infecção por HIV foram associadas ao tratamento inadequado da sífilis na gestação, além do atraso ou ausência do pré-natal e no recebimento da 1ª dose de penicilina, falta de exames ou tratamento com menos de 30 dias antes do parto, e a baixa adesão do parceiro ao tratamento. Considerações Finais: dentre os principais fatores associados ao tratamento inadequado, destacam-se os aspectos clínicos da gestante, sociodemográficos, além de falhas na dispensação do medicamento, prescrição e acompanhamento do tratamento da gestante e do parceiro pelo sistema de saúde.

Análise do tratamento da sífilis gestacional durante o pré-natal no município de Ribeirão Preto - SP / Analysis of the treatment of gestational syphilis during prenatal care in the city of Ribeirão Preto-SP

Introdução: Apesar de ser uma Infecção Sexualmente Transmissível (IST) milenar com avanços no diagnóstico e com tratamento eficaz, a eliminação da sífilis constitui um desafio mundial. A sífilis é considerada um grave e prioritário problema de saúde pública, pois, nas gestantes, a doença traz consequências severas como: abortamento, prematuridade, natimortalidade, manifestações congênitas precoces ou tardias e/ou morte do recém-nascido. A sífilis congênita e todos os desfechos adversos da doença durante a gestação podem ser evitados com triagem oportuna no pré-natal, tratamento adequado para o estágio da sífilis e o monitoramento do controle de cura. Objetivo: Analisar o tratamento e o seguimento pós tratamento para sífilis em gestantes diagnosticadas pela atenção básica, e os fatores associados ao tratamento adequado. Método: Trata-se de um estudo de coorte retrospectivo, realizado por meio de dados secundários, nos quais as gestantes foram acompanhadas desde o diagnóstico até a saída do serviço de pré-natal da atenção básica, que ocorre na 36ª semana de gestação no município de Ribeirão Preto - SP. Os dados foram coletados por meio de dois sistemas de informação, a saber: o Sistema de Informação de Agravos de Notificação (SINAN) e o Sistema HYGIA. Para análise estatística dos dados foi utilizado o software STATA SE version 14. Todos os aspectos éticos foram contemplados. Resultados: Das 316 notificações incluídas no estudo, o tratamento adequado das gestantes ocorreu em 238 (75,3%) mulheres, sendo as variáveis idade (p=0,0406) e idade gestacional (p=0,007) associadas a esse tratamento. Houve 151 (58,8%) gestantes com a raça/cor não branca, 67 (35,5%) com ensino fundamental incompleto, a mediana de idade foi de 23 e 25 anos (respectivamente, tratamento adequado e não adequado), 98 (90%) sem trabalho formal, 230 (73%) com diagnóstico no primeiro trimestre da gestação e 273 (89%) com sífilis latente. Quanto ao seguimento pós tratamento, apenas 17 (5,3%) utilizaram os testes não treponêmicos da forma recomendada. Em 111 (35%) casos não houve tratamento da parceria sexual, sendo o motivo principal o fato do parceiro não ter tido mais contato com a gestante. Conclusão: Na análise do tratamento da sífilis gestacional durante o pré-natal verificou-se que a maioria das mulheres grávidas foram classificadas com o tratamento adequado, sendo esse associado a idade e idade gestacional. Apesar da maioria das gestantes terem feito pelo menos um teste não treponêmico no pós tratamento, somente uma pequena parcela das gestantes, realizaram o seguimento conforme recomendações. Identificou-se que o perfil sociodemográfico dessas gestantes corroboraram com os dados encontrados na literatura

Introduction: Despite being an ancient Sexually Transmitted Infection (STI) with advances in diagnosis and effective treatment, the elimination of syphilis is a global challenge. Syphilis is considered a serious and priority public health problem because, in pregnant women, the disease has severe consequences such as: abortion, prematurity, stillbirth, early or late congenital manifestations and/or death of the newborn. Congenital syphilis and all adverse disease outcomes during pregnancy can be avoided with timely prenatal screening, appropriate treatment for the stage of syphilis, and monitoring of cure control. Objective: To analyze the treatment and post-treatment follow-up for syphilis in pregnant women diagnosed by primary care, and the factors associated with adequate treatment. Method: This is a retrospective cohort study, carried out using secondary data, in which pregnant women were followed up from diagnosis until leaving the prenatal service of primary care, which occurs in the 36th week of pregnancy in the municipality. from Ribeirão Preto - SP. Data were collected through two information systems, namely: the Notifiable Diseases Information System (SINAN) and the HYGIA System. For statistical analysis of the data, the STATA SE version 14 software was used. All ethical aspects were considered. Results: Of the 316 notifications included in the study, adequate treatment of pregnant women occurred in 238 (75.3%) women, with the variables age (p=0.0406) and gestational age (p=0.007) associated with this treatment. There were 151 (58.8%) pregnant women with non-white race/color, 67 (35.5%) with incomplete primary education, the median age was 23 and 25 years (respectively, adequate and inadequate treatment), 98 (90%) without formal work, 230 (73%) diagnosed in the first trimester of pregnancy and 273 (89%) with latent syphilis. As for post-treatment follow-up, only 17 (5.3%) used non-treponemal tests as recommended. In 111 (35%) cases there was no treatment of the sexual partner, the main reason being the fact that the partner did not have more contact with the pregnant woman. Conclusion: In the analysis of the treatment of gestational syphilis during prenatal care, it was found that most pregnant women were classified as having adequate treatment, which was associated with age and gestational age. Although most pregnant women had at least one non-treponemal test after treatment, only a small portion of pregnant women performed the follow-up as recommended. It was identified that the sociodemographic profile of these pregnant women corroborated the data found in the literature

Enfermedad de Creutzfeldt-Jakob: experiencia de 5 años en un hospital terciario de Chile / Creutzfeldt-Jakob disease, experience in 17 patients

Background: Creutzfeldt-Jakob disease (CJD) is a prion affection that typically produces a rapidly progressive dementia with different neurologic and extra-neurologic manifestations. Aim: To characterize clinical, imaging and electroencephalography findings in patients with a probable CJD. Patients and Methods: A case series study of patients admitted in the Neurology department at a public hospital, between 2014 and 2019. Demographic, clinical, imaging, and electroencephalographic data of patients with probable CJD were analyzed. Results: Seventeen patients aged 63 ± 11 years (53% women) with a probable CJD were gathered. The incidence was 4.7 cases/year per million inhabitants. Twenty four percent of patients had a family history of CJD. The median time between the onset of symptoms and the hospital admission was three months with a survival of four months. The most common clinical manifestations were an amnesic syndrome in 88%, myoclonus in 76%, frontal syndrome and ataxia in 71%. Brain MRI was abnormal in all patients. The preponderant finding was the involvement of the caudate nucleus in 82% of cases. In the EEG, 94% of patients had abnormalities. All had a theta-delta slowing as a base rhythm. The pseudo-periodic pattern was observed in the 29% and status epilepticus in 18%. Conclusions: In this group of patients we observed the heterogeneity of the clinical manifestations of the disease, the frequent imaging and electroencephalographic alterations and the short evolution time leading to death.

Tumores Neuroendocrinos: un desafío transversal / Update on neuroendocrine tumors

Neuroendocrine Tumors (NETs) encompass a wide variety of tumors arising from neuroendocrine cells, which produce bioactive substances. The incidence of NETs increased significantly lately, becoming one of the most common tumors of the digestive tract. Their clinical presentation is as diverse as their capacity for hormone production. Carcinoid syndrome is the most common hormonal syndrome produced by NETs and is characterized by diarrhea, flushing and cardiac valvular lesions. New research brought multiple changes in the classification of these neoplasms and a new understanding about their diagnosis and treatment, promoting a multidisciplinary approach. Somatostatin analogues, radiation, biological, and cytotoxic drugs have improved the prognosis of these patients, which entails a great challenge for healthcare providers.

Absceso del uraco y obstrucción intestinal en paciente con obesidad mórbida: reporte de caso / Urachal abscess and intestinal obstruction in a morbidly obese patient: A case report

Las anomalías del uraco representan un bajo porcentaje de las patologías abdominales, no obstante, forman parte del diagnóstico diferencial del abdomen agudo por las complicaciones que puede tener. Aunque son de difícil diagnóstico debido a los síntomas inespecíficos, las imágenes diagnósticas son de gran utilidad para su identificación y caracterización. En pacientes con obesidad mórbida, la presentación del cuadro aumenta el riesgo de morbimortalidad. Por ende, en estos pacientes es necesario un control postoperatorio estricto para evaluar complicaciones secundarias a la resección del uraco. Dado los casos limitados en la literatura, se requieren estudios clínicos adicionales, para brindar un seguimiento adecuado, en aras de identificar complicaciones y el tratamiento precoz de estas

Urachal abnormalities represent a low percentage of abdominal pathologies; however, they are part of the differential diagnosis of acute abdomen due to the complications it may have. Although they are difficult to diagnose due to nonspecific symptoms, diagnostic images are especially useful for their identification and characterization. In patients with morbid obesity, the presentation of the picture increases the risk of morbidity and mortality. Therefore, in these patients, strict postoperative control is necessary to evaluate complications secondary to urachal resection. Given the limited cases in the literature, additional clinical studies are required to provide adequate diagnosis and follow-up in order to identify complications and their early treatment

Characterizing the vaquejada horse herd in the brazilian state of Pernambuco / Caracterização do rebanho pernambucano de equinos de vaquejada

This study aimed to determine the age groups, breeds, and morphological characteristics of horses used in vaquejada competitions, as well as to define how often the animals compete, the results achieved in the contests, and the duration of training. A sample of 1,271 horses used in vaquejada competitions was employed in the study. The first step consisted in interviewing owners to obtain information on the age and breed of the horses, vaquejada circuits in which they compete, frequency of competition in vaquejada, results reached in the trials, and training duration per month, week, and day. The second step obtained 15 linear measurements and calculated eight morphometric indices. The data obtained from the interviews were submitted to descriptive statistical analyses. The linear measurements and morphometric indices were used to compare sexes using a completely randomized experimental design. The results showed that 80.3% of the vaquejada horses were between four and ten years old and that 89% of the animals were of the Quarter Horse. The morphometric measures showed that stallions had higher height at withers, back, and croup and wider heads, chest, and croup than mares and geldings. On the other hand, among the eight indices calculated, only the value of the height at the chest of the stallions was higher than the mean values in mares and geldings. It was found that 79.7% of the horses took part in two to four vaquejada trials a month while 93.3% of the animals underwent fitness training 12 months a year. The results show a predominance of Quarter Horses in the vaquejada contests in Pernambuco and that the trials require the selection of physically larger and stronger stallions. In addition, the animals are submitted to intense training and competition routines.

O estudo objetivou determinar as faixas etárias, raças e características morfológicas dos equinos competidores de vaquejadas em Pernambuco, assim como definir a frequência em que os animais competem, os resultados conquistados nas disputas e a duração dos treinamentos. Foram utilizados 1271 equinos participantes de provas de vaquejada realizadas no sertão e agreste pernambucano. A primeira etapa do trabalho consistiu em uma entrevista aos proprietários dos animais para obter informações sobre a idade dos equinos, raça, circuitos de vaquejada em que competem (oficiais ou não oficiais), frequência de participação em vaquejadas, resultados alcançados nas provas e a duração mensal, semanal e diária dos treinamentos. Na segunda etapa foram mensuradas 15 medidas lineares e calculados oito índices morfométricos. Os dados obtidos a partir das entrevistas foram submetidos à análises estatísticas descritivas. Já as medidas lineares e índices morfométricos foram utilizados para comparar os sexos, por meio de delineamento experimental inteiramente ao acaso. Os resultados morfométricos foram submetidos à análise de variância e as médias comparadas pelo teste de Tukey (P<0,05). Observou-se que 80,3% dos equinos de vaquejada tinham entre quatro e 10 anos de idade e que 89% dos animais eram da raça Quarto de Milha. Em relação às medidas morfométricas, registrou-se nos garanhões maiores alturas na cernelha, dorso e garupa e maiores larguras de cabeça, peito e garupa que nas éguas e nos machos castrados. Por outro lado, dentre os oito índices calculados, apenas o valor do vazio subesternal dos garanhões foi superior as médias das fêmeas e dos machos castrados. Constatou-se que 79,7% dos equinos participavam de duas a quatro provas de vaquejada por mês e que 93,3% dos animais eram condicionados fisicamente 12 meses por ano. Concluiu-se que nas vaquejadas realizadas no estado de Pernambuco há predomínio de equinos da raça Quarto de Milha, na faixa etária entre quatro e dez anos e as provas exigem seleção de garanhões fisicamente maiores e mais fortes. Além disso, os animais são submetidos a intensas rotinas de competições e treinamento.

Síndrome de sensibilidad a drogas con eosinofilia y síntomas sistémicos (DRESS) atípico por carbamazepina, a propósito de un caso pediátrico / Drug sensitivity syndrome with eosinophilia and atypical symptoms (DRESS) by carbamazepine: a case report

Introducción: El síndrome de sensibilidad a drogas con eosinofilia y síntomas sistémicos (DRESS) generalmente es acompañado por eosinofilia. Es una enfermedad que pone en peligro la vida del paciente. Se presenta como reacción adversa a infecciones y a medicamentos, usualmente asociada al uso de antiepilépticos. Caso clínico: Paciente de 6 años, masculino, con antecedente de Epilepsia de reciente diagnóstico, que consultó en Servicio de Urgencias dos semanas después de iniciar tratamiento con Carbamazepina, por cuadro caracterizado por eritema de predominio facial, exacerbado con la exposición al sol. Posteriormente presentó fiebre con episodios hasta 40 °C, que se asoció a convulsiones. Después de un exhaustivo estudio se concluyó DRESS atípico (sin eosinofilia), iniciando tratamiento corticoideo con favorable respuesta clínica. Discusión: El síndrome de DRESS, es una enfermedad de difícil diagnóstico por sus múltiples diagnósticos diferenciales y falta de criterios diagnósticos. Es esencial la suspensión inmediata del fármaco causante, para evitar progresión de la enfermedad e iniciar tratamiento precoz.

Background: The drug sensitivity syndrome with eosinophilia and systemic symptoms (DRESS) is usually accompanied by eosinophilia. It is a disease that endangers the life of the patient. It occurs as an adverse reaction to infections and medications, usually associated with the use of antiepileptics. Case report: A 6-year-old patient, male, with a recent diagnosis of epilepsy, who consulted the Emergency Department two weeks after initiating treatment with Carbamazepine because of a condition characterized by facial predominance erythema, exacerbated by sun exposition. Subsequently presented fever with episodes up to 40 ° C, which was associated with seizures. After an exhaustive study, atypical DRESS syndrome (without eosinophilia) was made, initiating corticoid treatment with favorable clinical response. Discussion: DRESS syndrome is a disease difficult to diagnose because of its multiple differential diagnoses and lack of diagnostic criteria. Immediate suspension of the causative drug is essential to prevent progression of the disease and initiate early treatment Keywords: Drug Hypersensitivity Syndrome, Carbamazepine, Corticoid.

Prescripción de analgésicos y reacciones adversas en pacientes hospitalizados / Analgesic's prescription and drug adverse events in hospitalized patients

RESUMEN Justificación. El dolor tiene alta prevalencia en la población general, siendo mayor en pacientes hospitalizados, con cifras cercanas al 80%. El control del dolor no siempre es adecuado debido a varios factores, siendo uno de los más importantes, el escaso conocimiento en el manejo de los analgésicos. Como una de las primeras medidas de mejoramiento asistencial para reducir el dolor en un hospital, debe conocerse la prevalencia de este síntoma y, asimismo, debe analizarse el abordaje terapéutico realizado. Por este motivo este estudio tuvo como objetivo analizar el uso de analgésicos en pacientes de un hospital de cuarto nivel en Bogotá, Colombia, identificar los analgésicos más utilizados, el rango de dosis, las posibles interacciones y reacciones adversas a medicamentos (RAM) existentes. Resultados. El 78,9% de los pacientes hospitalizados presentaban dolor. Se prescribió analgésicos en 561 pacientes hospitalizados. Los más utilizados fueron: acetaminofén (33,3%) y tramadol (29,7%). El rango de duración de la terapia analgésica más común fue de 1 a 5 días (81,7%). Se identificaron 37 casos de sobredosificación y tres de terapia duplicada. Se presentaron 28 casos de reacciones adversas a medicamento (RAM). Discusión. El adecuado tratamiento del dolor cobra vital importancia al evaluar la satisfacción del paciente. Se encuentran diferentes tendencias de uso de analgésicos en pacientes hospitalizados, siendo los más utilizados el acetaminofén y los antiinflamatorios no esteroidéos (AINE). Se debe seguir investigando en este tema, para tener mayor evidencia que permita generar lineamientos para un adecuado alivio del dolor.

Summary Justification. Pain has a high prevalence in the general population, being higher in inpatient, with figures close to 80%. Pain management is not always suitable due to several factors, one of the most important the lack of knowledge in the management of analgesics. One of the first measures of improving care to reduce pain in a hospital should be determine the prevalence of this symptom and analyze the therapeutic approach performed. That is why the aim of this study was to analyze the use of analgesics in patients of a fourth-level hospital in Bogotá, Colombia, identify the most commonly used analgesics, range of doses, possible interactions and adverse drugs reactions. Results. The 78.9% of the patients were pain. Analgesics were prescribed in 561 hospitalized patients. The most used were acetaminophen (33.3%) and tramadol (29.7%). The most common range of duration of analgesic therapy was 1-5 days (81.7%). 37 cases of overdosing and 3 cases of duplicate therapy were identified. 28 cases of adverse drug reactions (ADRs) were presented. Discussion. Proper treatment of pain plays a vital role in assessing patient satisfaction. There are different trends analgesic use in inpatient, being the most used acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). It should further investigate on this issue to have stronger scientific evidence to dictate a universal application guidelines for proper pain relief.

Factores socioeducativos asociados a la percepción de maltrato en estudiantes de medicina peruanos / Socioeducational factors associated to the perception of mistreatment in peruvian medical students

Introducción: muchas veces para mejorar el aprendizaje los docentes realizan algún tipo de maltrato, lo que provoca gran frecuencia de este en estudiantes de medicina. Sin embargo, no se han explorado sus determinantes en una población estudiantil extensa. Objetivo: determinar los factores socioeducativos que se asociaron a la percepción del maltrato entre los estudiantes de medicina peruanos. Métodos: estudio transversal analítico, multicéntrico en más de 1 000 estudiantes en todo el Perú. Se usó una encuesta validada para maltrato estudiantil, buscando asociación a variables socioeducativas. Se realizó un muestreo por bola de nieves, se halló asociaciones estadísticas usando modelos lineales generalizados. Resultados: las mujeres sufrían menos maltrato físico (razón de prevalencias ajustadas (RPa): 0,86), pero más sexual (RPa: 1,54). Los de universidades privadas tenían menor maltrato físico (RPa: 0,80), los homosexuales tuvieron mayor maltrato psicológico, académico y sexual (RPa: 1,81; 1,78 y 2,07; respectivamente), los bisexuales mayor maltrato sexual (RPa: 1,50), los que tenían sobrepeso/obesidad mayor maltrato psicológico (RPa: 1,21), a más años en los hospitales se tuvo mayor maltrato psicológico y sexual (RPa: 1,10 y 1,09; respectivamente), los que hacían guardias extras y eran internos de medicina tuvieron mayores maltratos físicos (RPa: 1,22 y 1,40; respectivamente) y académicos (RPa: 1,21 y 1,46; respectivamente), los satisfechos con la carrera tenían menor frecuencia de los cuatro tipos de maltrato. Conclusiones: se encontró que algunos estudiantes eran más maltratados, se deben tomar las medidas para que esto se caracterice, intervenga y reduzca, ya que podría tener consecuencias en el estudiante, su rendimiento y que repercutan hasta cuando este sea profesional(AU)

Introduction: In order to improve learning, teachers so often carry out some type of abuse, which means a high frequency of mistreatment among medical students. However, its determinants have not been explored in an extensive student population. Objective: To determine the socio-educational factors associated with the perception of abuse among Peruvian medical students. Methods: Cross-sectional, analytical, multi-center study in more than one thousand students throughout Peru. A validated survey was used for student abuse, seeking association with socio-educational variables. A snowball sampling was carried out; statistical associations were found using generalized linear models. Results: Women suffered less physical abuse (adjusted prevalence ratio [APR]: 0.86), but more sexual abuse (APR: 1.54). Those from private universities had lower physical abuse (APR: 0.80). Homosexuals had more psychological, academic and sexual abuse (APR: 1.81, 1.78 and 2.07 respectively). Bisexuals had more sexual abuse (APR: 1.50). Those who were overweight/obese suffered more psychological abuse (APR: 1.21). The higher amount of years in hospitals, the more cases of psychological and sexual abuse (APR: 1.10 and 1.09, respectively). Those who did extra shifts and were medical interns had greater physical (APR: 1.22 and 1.40, respectively) and academic (APR: 1.21 and 1.46, respectively) abuse. Those satisfied with the major had less frequent of the four types of abuse.Conclusions: Some students were found to be more mistreated, measures must be taken for this to be characterized, intervened and reduced, since it could have consequences on the students, their performance and may have repercussions until he is a professional(AU)

Os primeiros 24 meses de uma empresa: um estudo de caso de uma distribuidora de chocolates / The First 24 Months a Business a Case Study of a Chocolate

A abertura de uma nova empresa é um grande desafio. Diversos fatores influenciam no sucesso ou no fracasso de um novo empreendimento. Aspectos internos (finanças internas, recursos humanos, produtos, etc.) e externos (políticos, econômicos, tendências de mercado, novas oportunidades, etc.) são fundamentais no desenvolvimento de um novo negócio. Alguns são mais controláveis e previsíveis enquanto outros necessitam de uma análise mais detalhada, para isso o planejamento é essencial. Esta pesquisa tem como objetivo descrever os primeiros 24 meses de uma empresa e fazer um comparativo com as indicações sugeridas pelo Sebrae. A metodologia utilizada é um estudo de caso de uma empresa de distribuição de chocolates localizada na cidade de São Paulo, durante o período de 24 meses, compreendido entre janeiro de 2015 até dezembro de 2016. Como resultado dessa pesquisa, pretende-se identificar pontos convergentes e divergentes entre as ações tomadas pelo empreendedor e as instruções do Sebrae e seus respectivos impactos no negócio

Opening a new business is a big challenge. Several factors influence the success or failure of a new venture. Internal aspects (internal finance, human resources, products, etc.) and external (political, economic, market trends, new opportunities, etc.) are fundamental in the development of a new business. Some are more controllable and predictable while others require more detailed analysis, so planning is essential. This research aims to describe the first 24 months of a company and make a comparison with the indications suggested by Sebrae. The methodology used is a case study of a chocolate distribution company located in the city of São Paulo, during the period of 24 months, between January 2015 and December 2016. As a result of this research, it is intended to identify convergent points And divergent between the actions taken by the entrepreneur and the instructions of Sebrae and their respective impacts on the business

Antinociceptive activity of Sargassum polyceratium and the isolation of its chemical components

Abstract Marine algae have been the focus of important studies over the past fifty years, with a considerable number of components important to chemists and taxonomists having been isolated and characterized. The scientific data available on Sargassum polyceratium are extremely limited. The objective of the present study was to evaluate the antinociceptive activity of an ethanol extract of S. polyceratium and to isolate its components. Intraperitoneal treatment with ethanol extract of S. polyceratium reduced the number of acetic acid-induced writhes and the amount of time spent in paw-licking in the second phase of the formalin test. Ethanol extract of S. polyceratium also reduced the amount of time spent in paw-licking in the glutamate test; however, there was no difference in the reaction time in the hot plate test at any of the doses tested. The chemical components isolated from ethanol extract of S. polyceratium were identified using one- and two-dimensional spectroscopic methods such as infrared spectroscopy, mass spectrometry and 1H and 13C nuclear magnetic resonance spectroscopy. The analytical results were also compared with data obtained in the literature. The following porphyrin derivatives were isolated from S. polyceratium: 132-hydroxy-(132-R)-pheophytin-a, 132-hydroxy-(132-S)-pheophytin-a, pheophytin-a, and the steroid fucosterol. The present results indicate that the ethanol extract of S. polyceratium has antinociceptive activity. In addition, four new substances were isolated from the species evaluated.

Analgésicos en el paciente hospitalizado: Revisión de tema / Analgesics in hospitalized patients: Topic review

El dolor como experiencia subjetiva es de alta incidencia en el paciente adulto hospitalizado, por tal motivo el uso de analgésicos en estos pacientes tiene gran impacto en la evolución clínica y en la calidad de la estancia hospitalaria. Entre las opciones terapéuticas para el manejo del dolor se encuentran antiinflamatorios no esteroideos (AINEs), opioides, paracetamol, metamizol; los cuales se pueden administrar en diferentes formas farmacéuticas, que se adaptan a las condiciones de cada uno de los pacientes. Actualmente, el uso de opioides está siendo reevaluado, así como las técnicas de administración, entre las que se destacan la analgesia controlada por el paciente y la analgesia intervencionista (analgesia epidural, bloqueo de nervios periféricos y la infiltración local). El éxito de la terapia analgésica no solo consiste en el adecuado uso de los analgésicos, sino también en las estrategias usadas para objetivar el dolor; esto se consigue por medio de la aplicación de escalas para cuantificar el dolor, de las cuales se destacan la escala visual análoga, la escala verbal numérica y la de valoración verbal.

Pain as a subjective experience is high incidence in the adult hospitalized patient, so the use of analgesics in these patients has a high impact on their medical developments and their comfort during their hospital stay. Among the therapeutic options for pain management there are Non-Steroidal Anti- Inflammatory drugs (NSAIDs), Opioids, Paracetamol and Metamizol. Each has different pharmaceutical dosage forms to adjust to the condition of each patient. Currently the use of Opioids is being re-evaluated as well as the management techniques like patient-controlled analgesia and interventionist analgesia(epidural analgesia, peripheral nerve blocks and local infiltration). The success of analgesic therapy consists of the appropriate use of analgesics and in the strategies used to objectify the pain; this can be achieved with the implementation of scales to quantify the pain like the visual analogous scale, numeric verbal scale and the verbal assessment.

Hard technology in the intensive care unit and the subjectivity of nursing workers / A tecnologia dura na unidade de terapia intensiva e a subjetividade dos trabalhadores de enfermagem / Tecnologia duro en la unidad de cuidados intensivos y la subjetividad de los trabajadores de enfermería

Objetivos: identificar a opinião dos trabalhadores de enfermagem sobre o uso da tecnologia dura no cotidiano de trabalho e descrever as repercussões do uso da tecnologia dura na dimensão subjetiva destes trabalhadores. Método: Pesquisa descritiva e qualitativa. Os dados foram coletados no período de setembro e outubro de 2010, por meio de entrevista semiestruturada e as informações foram tratadas pelo método de análise temática de conteúdo. Participaram do estudo 05 enfermeiros e 05 técnicos de enfermagem. Resultados: Os resultados mostraram aspectos positivos e negativos do uso da tecnologia dura e o impacto do uso desta tecnologia no contexto da Unidade de Terapia Intensiva. Conclusão: Concluí-se que as repercussões são multifatoriais na subjetividade do trabalhador e objetivamos que este trabalho impulsione novas pesquisas envolvendo a tecnologia dura e a saúde do trabalhador.

Objectives: To identify the views of nursing staff on the use of technology in everyday hard work and describe the impact of technology use in the subjective dimension of these hard workers. Method: descriptive and qualitative. Data were collected between September and October 2010, through semi-structured interviews and the information has been processed by the method of thematic content analysis. The study included 05 nurses and 05 nursing technicians. Results: The results showed positive and negative aspects of technology use and the harsh impact of the use of this technology in the context of the Intensive Care Unit. Conclusion: It is concluded that the effects are multifactorial in the subjectivity of the worker and that this work aimed to boost research involving new technology and hard worker health.

Objetivos: Identificar los puntos de vista del personal de enfermería sobre el uso de la tecnología en el trabajo duro todos los días y describir el impacto del uso de la tecnología en la dimensión subjetiva de las trabajadoras. Método: Estudio descriptivo y cualitativo. Los datos fueron recogidos entre septiembre y octubre de 2010, a través de entrevistas semi-estructuradas y que la información haya sido procesada por el método de análisis de contenido temático. En el estudio participaron 05 enfermeras y 05 técnicos de enfermería. Resultados: Los resultados mostraron aspectos positivos y negativos del uso de la tecnología y el impacto severo de la utilización de esta tecnología en el contexto de la Unidad de Cuidados Intensivos. Conclusión: Se concluye que los efectos son multifactoriales en la subjetividad del trabajador y que este trabajo tuvo como objetivo impulsar la investigación con las nuevas tecnologías y la salud del trabajador duro.

Trastornos por déficit de atención: consideraciones desde la psicología para un diagnóstico comprensivo integral / Attention deficit disorder: considerations from psychology for an integral comprehensive diagnosis

Se revisa el diagnóstico de Trastorno por Déficit de Atención en niños, en relación a su prevalencia (8 por ciento al 12 por ciento de los niños en edad escolar), siendo uno de los principales motivos de consulta en nuestro país. El objetivo del artículo es integrar los aportes de la mirada médica y la psicología en el diagnóstico, para que permitan otorgar las directrices de un tratamiento que considere el contexto y la particularidad de cada sujeto. Se describen los criterios diagnósticos utilizados y las implicancias de éste en el área de la salud mental, educación, familia y sociedad. Se plantea la comprensión desde la psicología, poniendo énfasis en considerar la inatención como síntoma de diversos cuadros emocionales en la infancia, al observar que desde el modelo médico generalmente este síntoma se reduce a un cuadro neurobiológico y a un posterior tratamiento principalmente farmacológico. La no consideración desde el paradigma de la complejidad y la multicausalidad en el diagnóstico, excluye áreas del desarrollo socio afectivo del niño que pueden ser fundamentales en la generación y el mantenimiento del cuadro. Se releva la necesidad de abordar este cuadro con una mirada más amplia en el diagnóstico e intervención, considerando los aspectos subjetivos e interaccionales, buscando así dar cuenta de un diagnóstico clínico completo y de un abordaje comprensivo integral.

This study reviews the diagnosis of attention deficit disorder in children, in relation to its prevalence (8 percent to 12 percent of school-age children), which makes it one of the main reasons for consultation in Chile. The article seeks to integrate the contributions of the medical and psychological points of view in the diagnosis, allowing the outline of treatment guidelines that take into account the context and the particularity of each subject. We describe the diagnostic criteria and the implications of this diagnosis in the area of mental health, education, family and society. We then approach the discussion from the psychology, underlining the lack of attention as a symptom of various emotional childhood disorders, observing that from the medical model this symptom is generally reduced to a neurobiological disorder and leads to an exclusively pharmacological treatment. We estimate that no consideration from the paradigm of the complexity and causality in the diagnosis, excludes the development of socio-affective areas of the child which can be critical in the generation and maintenance of the disorder. We finally propose deliverance of a wider look in the diagnosis of ADD, considering subjective aspects through the articulation of the medical assessment with a psychological evaluation. This would allow a full clinical diagnosis and an integrated comprehensive approach.

Experiencia de trabajo grupal con padres de niños con Síndrome de Déficit Atencional

El Programa de Trastornos del Desarrollo del C.S.M. San Joaquín, de la Universidad Católica implementó una modalidad de intervención grupal para padres de hijos con SDA. El taller consta de seis sesiones teórico-prácticas, donde se busca brindar apoyo, favorecer estrategias educativas, asegurar el compromiso con la intervención y evaluar los resultados de las estrategias implementadas. La experiencia de los años 2007 y 2008 revelaron que existe poca delimitación entre el sistema parental y el filial, dificultad en el desarrollo de la autonomía, inquietudes respecto del rol de padres y sentimiento de exclusión respecto del tratamiento de su hijo y de la ayuda recibida en general. Este tipo de intervención disminuye la sensación de exclusión en los padres y permite mejor elaboración del diagnóstico, además de optimizar el tiempo de atención respecto de las consultas individuales. Palabras Claves: Síndrome de Déficit Atencional, rol de padres, intervención con Padres, intervención grupal, familia y déficit atencional

The Program for Developmental Disorders of the Universidad Católica de Chile implemented a workshop for parents with children with Attention Deficit Disorder (ADD). The aim was to support and educate them regarding the difficulties that they have with their children. The results revealed a lack of boundaries between the parental and the filial system, the existence of difficulties in the development of autonomy, worries about the parental role and feelings of exclusion with respect to the treatment in which their child participates. This type of intervention diminishes the feeling of exclusion in the parents and allows a better elaboration of the diagnosis. Parents also get a different, more positive view of their child, and there is an improvement in the time use of individual consultation. Key Words: Attention Deficit Disorder, parenting, family and ADD, Groups, parental intervention.