Diagnóstico prenatal de clorhidrorrea congénita: reporte de caso / Prenatal diagnosis of congenital chloride diarrhea: A case report

La clorhidrorrea congénita es un trastorno genético infrecuente pero importante caracterizado por una alteración grave del balance hidroelectrolítico como resultado de un defecto en la absorción intestinal de cloruros. Los niños afectados presentan diarrea persistente, deshidratación y malnutrición; el control médico y del desarrollo son complejos. Mejorar la detección prenatal es esencial para facilitar la atención del paciente, las intervenciones tempranas y el asesoramiento genético informado. Sin embargo, a pesar de los avances de la medicina, la naturaleza compleja y la escasa frecuencia de esta entidad, constituyen un desafío para la detección prenatal. En este estudio, se reporta el caso de una embarazada donde los estudios por imágenes de resonancia magnética fetales identificaron en forma efectiva las características típicas de la clorhidrorrea congénita. Se proveen conocimientos sobre las complejidades del diagnóstico y se sugieren caminos para las estrategias de detección temprana de esta enfermedad.

Congenital chloride diarrhea (CCD) is a rare but significant genetic disorder characterized by severe electrolyte imbalances resulting from impaired intestinal chloride absorption. Affected children experience persistent diarrhea, dehydration, and malnutrition, complicating medical and developmental care. The enhancement of prenatal detection is crucial for improved patient management, early interventions, and informed genetic counseling. However, despite advancements in medicine, the complex nature and rarity of CCD make prenatal detection challenging. In this study, we report a fetal case where prenatal magnetic resonance imaging (MRI) effectively identified the distinctive characteristics of CCD, providing insights into the complexities of diagnosis and suggesting avenues for enhanced early detection strategies.

Diagnóstico humanizado: El paciente en el centro - la comunicación que cura / Diagnóstico humanizado: O paciente no centro - comunicação que cura / Humanized Diagnosis: The pacient at the center - communication that Heals

Este texto plantea la importancia de confeccionar protocolos de diagnóstico humanizado que permitan a los profesionales de la salud brindar información sobre patologías y/o discapacidades de manera clara y veraz, humana y delicadamente, facilitando su recepción por parte del paciente y su familia. El diagnóstico humanizado no forma parte únicamente de un protocolo de "urbanidad" en el vínculo médico ­ paciente: es parte integrante y relevante del procedimiento o tratamiento. Este abordaje exige una mirada interdisciplinar. En esta temática hay elementos que se vinculan a lo médico ­ científico; lo jurídico ­ legislativo ­ jurisprudencial y lo político.

Ao longo deste texto, discute-se a importância da elaboração de protocolos diagnósticos humanizados que permitam aos profissionais de saúde fornecerem informações sobre patologias e/ou incapacidades de forma clara e verdadeira, ao mesmo tempo em que humanizada e delicada, facilitando seu acolhimento pelo paciente e sua família. O diagnóstico humanizado não é apenas parte de um protocolo de "civilidade" na relação médico-paciente, mas parte integrante e relevante do procedimento para realizar o tratamento de uma doença ou deficiência. Essa abordagem requer uma abordagem interdisciplinar. Nessa disciplina há elementos que se vinculam ao médico-científico; as esferas jurídica, legislativa e política.

Throughout this text, the importance of creating humanized diagnostic protocols is discussed. These should allow healthcare professionals to provide clear and truthful information about pathologies and/or disabilities in a humane and delicate manner, facilitating their understanding by the patient and their family. Humanized diagnosis is not just part of a "politeness" protocol in the doctor-patient relationship, but an integral and relevant part of the procedure for treating a disease or disability. This approach requires an interdisciplinary perspective, as there are elements that are linked to the strictly medical-scientific, legal-legislative-jurisprudential, and political aspects of this topic.

Desigualdades sociais no diagnóstico do câncer do colo do útero no Brasil: um estudo de base hospitalar / Social inequalities in the diagnosis of cervical cancer in Brazil: a hospital-based study

Resumo O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica.

Abstract The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology.

Metodología en el diagnóstico del Trastorno por Déficit de Atención e Hiperactividad / Methodology in the diagnosis of Attention Deficit Hyper activity Disorder (ADHD)

Resumen Introducción : El objetivo del trabajo es evidenciar la necesidad de aplicar una metodología de evaluación en el Trastorno por Déficit de Atención e Hiperactividad (TDAH) por la falta de acuerdo entre padres y profesores en los criterios del Manual diagnóstico y estadístico de los trastornos mentales, quinta edición (DSM-5). Métodos : Se trata de un estudio descriptivo retros pectivo de tres años y diez meses. La muestra se extrajo de 640 sujetos evaluados y diagnosticados de TDAH, con edades comprendidas entre 8 y 16 años, y un Cociente Intelectual Total (CIT) entre 80 y 120. A los sujetos se les aplicó una evaluación neuropsicológica. Se tuvieron en cuenta determinadas escalas de los cuestionarios: Siste ma de Evaluación de Niños y Adolescentes (SENA) y Eva luación Conductual de la Función Ejecutiva-2 (BRIEF-2), ambos cumplimentados por padres, y los criterios del DSM-5 contestados por padres y profesores. Resultados : Como resultado se observa una baja con cordancia entre las observaciones obtenidas del DSM-5 entre padres y profesores.

Abstract Introduction : The aim of the study is to demonstrate the need to apply an assessment methodology in At tention Deficit Hyperactivity Disorder (ADHD) due to the lack of agreement between parents and teachers on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Methods : This is a retrospective descriptive study of three years and ten months. The sample was drawn from 640 subjects assessed and diagnosed with ADHD, aged between 8 and 16 years, and with a Total Intellectual Quotient (TQ) between 80 and 120. Subjects underwent a neuropsychological assessment. Certain scales of the questionnaires: Child and Adolescent Assessment Sys tem (SENA) and Behavioural Assessment of Executive Function-2 (BRIEF-2), both completed by parents, and the DSM-5 criteria answered by parents and teachers were taken into account. Results : As a result, a low concordance was observed between the observations obtained from the DSM-5 between parents and teachers.

A biomarker-based solution for the limited access to early diagnosis and assessment of autism / Una solución basada en biomarcadores para el acceso limitado al diagnóstico precoz y evaluación del autismo

Abstract With the upsurge of community uptake in popula tion-based early screening for autism, the main obstacle to increasing access to early treatment and intervention services is the extremely limited access to high quality diagnosis, specifically the shortage of expert clinicians. Diagnostic evaluation models deployed by academic cen ters of excellence, which typically require the investment of 6-10 hours by specialized multidisciplinary teams, is not a viable solution to the vast needs of communities, resulting in parents' "diagnostic odysseys" and delays, often of several years, for treatment, interventions and supports. Biomarker-based objective procedures for early diagnosis and assessment of autism are now available, clinically validated, and cleared for broad implementa tion by the US Food and Drug Administration (FDA). They are intended to increase access while maintaining high quality. Such solutions, however, will require change in entrenched models of diagnostic care, and aggressive prioritization of the needs of the community at large. If these innovations are successful, the number of children diagnosed in the first three years of life will double or triple. This will, in turn, require much greater inves tments in resources for treatment, including massive workforce training of providers capable of delivering community-viable caregiver-mediated interventions, and of early educators capable of serving autistic children in therapeutic inclusive preschool settings.

Resumen Con el aumento de la aceptación comunitaria de la detección temprana del autismo basada en la pobla ción, el principal obstáculo para aumentar el acceso al tratamiento temprano y a los servicios de intervención es el acceso extremadamente limitado a un diagnóstico de alta calidad, específicamente la escasez de médicos expertos. Los modelos de evaluación diagnóstica imple mentados por centros académicos de excelencia, que normalmente requieren la inversión de 6 a 10 horas por parte de equipos multidisciplinarios especializados, no son una solución viable para las vastas necesidades de las comunidades, lo que resulta en "odiseas diagnósti cas" y retrasos, a menudo de gran importancia, para los padres varios años, para tratamiento, intervenciones y apoyos. Los procedimientos objetivos basados en bio marcadores para el diagnóstico temprano y la evaluación del autismo ya están disponibles, clínicamente validados y aprobados para su amplia implementación por la Ad ministración de Alimentos y Medicamentos de EE. UU. (FDA). Su objetivo es aumentar el acceso manteniendo una alta calidad. Sin embargo, tales soluciones requeri rán cambios en los modelos arraigados de atención de diagnóstico y una priorización agresiva de las necesida des de la comunidad en general. Si estas innovaciones tienen éxito, el número de niños diagnosticados en los primeros tres años de vida se duplicará o triplicará. 51 Esto, a su vez, requerirá inversiones mucho mayores en recursos para el tratamiento, incluida la capacitación masiva de la fuerza laboral de proveedores capaces de brindar intervenciones comunitarias viables mediadas por cuidadores, y de educadores tempranos capaces de atender a niños autistas en entornos preescolares terapéuticos inclusivos.

Transtorno do Espectro Autista e Transtorno Desafiante de Oposição: Dificuldades no diagnostico / Transtorno del Espectro Autista y Trastorno Negativista Desafiante: Dificultades en el diagnóstico / Autism Spectrum Disorder and Oppositional Defiant Disorder: Difficulties in diagnosis

Introdução: O Transtorno do Espectro Autista e Transtorno Desafiante de Oposição, são desordens comumente diagnosticadas em indivíduos ainda na infância. Objetivo: Identificar possíveis fatores dificultadores no diagnóstico diferencial dos referidos transtornos. Metodologia: Foi realizada uma revisão integrativa da literatura, a qual selecionou artigos nas bases de dados Biblioteca Virtual de Saúde, periódico Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e Periódicos Eletrônicos de Psicologia entre os meses de setembro e outubro de 2021. Para tanto, foram utilizadas as palavras chaves Transtorno do Espectro Autista, autismo, Transtorno Desafiante de Oposição, Transtorno Opositor Desafiador, diagnóstico, comorbidades, comportamentos disruptivos e dificuldades diagnósticas. Resultados: Oito artigos foram selecionados para extração de dados. O diagnóstico correto desses transtornos pode ser desafiador devido à sobreposição de sinais com outros transtornos e comorbidades, bem como à diversidade presente no espectro autista e à variedade de manifestações dos transtornos disruptivos. Além disso, a maioria dos estudos destacam os prejuízos na área da comunicação, o comprometimento na área social e os graus de severidade, como sendo características semelhantes entre os dois transtornos, podendo serem possíveis fatores que podem dificultar no diagnóstico do Transtorno do Espectro Autista e Transtorno Desafiante de Oposição, de maneira diferencial ou concomitante. Conclusões: O número de pesquisas relacionadas aos transtornos citados acima é inferior ao que se faz necessário para melhor conhecimento sobre o tema. No que diz respeito as pesquisas de materiais científicos, foram encontradas dificuldades para obtenção de estudos que estivessem de acordo com a nossa pesquisa. Com isso, faz-se necessário mais pesquisas que tentem investigar e compreender o porquê da escassez de material que estudem tais diagnósticos de maneira concomitante (AU).

Introduction: Autism Spectrum Disorder and Oppositional Defiant Disorderare disorders commonly diagnosed in individuals in childhood. Objective:Identify possible factors that hinder the differential diagnosis of these disorders. Methodology:An integrative review of the literature was carried out, which selected articles from the Virtual Health Library databases, Coordination for the Improvement of Higher Education Personnel journal and Electronic Psychology Journalsdatabases between the months of September and October 2021. To this end, the keywords Autistic Spectrum Disorder, autism, Disorder Defiant Disorder, Opposition, Oppositional Defiant Disorder, diagnosis, comorbidities, disruptive behaviors and diagnostic difficulties.Results:Eight articles were selected for data extraction. Correctly diagnosing these disorders can be challenging due to overlapping signs with other disorders and comorbidities, as well as the diversity present in the autism spectrum and the variety of manifestations of disruptive disorders. Furthermore, most studies highlight losses in the area of communication, impairment in the social area and degrees of severity, as being similar characteristics between the two disorders, and may be possible factors that can make it difficult to diagnose Autism Spectrum Disorder and Oppositional Defiant Disorder, differentially or concomitantly. Conclusions:The number of studies related to the disorders mentioned above is lower than what is needed for a better understanding of the subject. With regard to research on scientific materials, difficulties were encountered in obtaining studies that were in accordance with our research. With this, more research is needed to try to investigate and understand the reason for the scarcity of material that studies such diagnoses concomitantly (AU).

Introducción: El Trastorno del Espectro Autista y el Trastorno Negativista Desafiante son trastornos comúnmente diagnosticados en individuos en la infancia. Objetivo: Identificar posibles factores que puedan dificultar el diagnóstico diferencial de los trastornos antes mencionados.Metodología:Se realizó una revisión integrativa de la literatura, que seleccionó artículos en las bases de datos Biblioteca Virtual en Salud, revista Coordinación para el Perfeccionamiento del Personal de Educación Superior y Revistas Electrónicas de Psicología entre septiembre y octubre de 2021. Para ello, se utilizaron las palabras clave Trastorno del espectro autista, autismo, Trastorno negativista desafiante, Trastorno negativista desafiante, diagnóstico, comorbilidades, conductas disruptivas y dificultades diagnósticas. Resultados: Se seleccionaron ocho artículos para la extracción de datos. El diagnóstico correcto de estos trastornos puede ser un desafío debido a la superposición de síntomas con otros trastornos y comorbilidades, así como a la diversidad presente en el espectro del autismo y la variedad de manifestaciones de los trastornos disruptivos. Además, la mayoría de los estudios destacan las deficiencias en el área de la comunicación, la deficiencia en el área social y los grados de gravedad, como características similares entre ambos trastornos, que pueden ser posibles factores que dificulten el diagnóstico del Trastorno del Espectro Autista y Trastorno de Oposición Desafiante, ya sea de forma diferencial o concomitante. Conclusiones: El número de estudios relacionados con los trastornos antes mencionados es inferior al necesario para una mejor comprensión del tema. En cuanto a la investigación sobre materiales científicos, se encontraron dificultades para obtener estudios que estuvieran de acuerdo con nuestra investigación. Con esto, se necesita más investigación para tratar de investigar y comprender la razón de la escasez de material que estudie dichos diagnósticos de forma concomitante (AU).

Síndrome de Rapunzel: atadura sicológica y simulación orgánica / Rapunzel syndrome: psychological bondage and organic simulation

Introducción. El síndrome de Rapunzel es una entidad infrecuente, que se presenta como un tricobezoar a causa de una aglomeración de cabello acumulado dentro del tracto gastrointestinal, por lo que simula otras patologías quirúrgicas. Caso clínico. Paciente femenina de 10 años de edad, con tricotilomanía y tricofagia, dolor abdominal y síntomas inespecíficos de obstrucción intestinal de ocho meses de evolución. Al examen físico se encontró abdomen con distensión y masa palpable en epigastrio y mesogastrio. La ecografía permitió hacer el diagnóstico de tricobezoar gástrico extendido hasta el intestino delgado, por lo que se llevó a cirugía para gastrotomía y se extrajo el tricobezoar, con evolución satisfactoria de la paciente. El abordaje integral permitió conocer la atadura sicológica por posible maltrato infantil. Resultado. La paciente tuvo una evolución satisfactoria y se dio egreso al quinto día de hospitalización. Actualmente se encuentra en seguimiento por sicología, siquiatría infantil y pediatría. Discusión. El caso clínico denota la importancia en reconocer situaciones de presentación infrecuente en pediatría, que puedan estar asociadas a alteraciones sicológicas o presunción de maltrato infantil y que se presenten como una condición orgánica recurrente que simule otras patologías abdominales frecuentes en la infancia. El retraso diagnóstico puede conducir a un desenlace no deseado con complicaciones. Conclusión. Se hace mandatorio el manejo integral del paciente pediátrico y aumentar la sensibilidad para reconocer situaciones de presunción de maltrato infantil, sobre todo en pacientes con una condición orgánica quirúrgica recurrente.

Introduction. Rapunzel syndrome is an uncommon condition that manifests as trichobezoars, which are hair bundles in the stomach or small intestine that can mimics other surgical illnesses. Multiple complications can arise from delayed diagnosis and treatment. Clinical case. A 10-year-old female patient with trichotillomania and trichophagia, with abdominal pain and nonspecific symptoms of intestinal obstruction of eight months of evolution. Physical examination revealed epigastric tenderness and a solid mass was palpable in the mesogastric and epigastric region. An abdominal ultrasound showed gastric trichobezoar that extended into the small intestine. A gastrotomy was performed and the trichobezoar was extracted with satisfactory evolution of the patient. The comprehensive approach allowed knowing the psychological bond due to possible child abuse. Results. The patient had a satisfactory evolution and was discharged on the fifth day of hospitalization. He is currently being monitored by psychology, child psychiatry and pediatrics. Discussion. This clinical case highlights the importance of recognizing situations that seldom present in pediatrics, which may have a psychological aspect due to the presumption of child abuse, and which present as a recurrent organic condition simulating other frequent abdominal pathologies in childhood; all of which may lead to an unwanted outcome due to diagnostic delay. Conclusion. The comprehensive management of the pediatric patient is mandatory to recognize situations of presumed child abuse, in the face of a recurrent surgical conditions.

Manifestaciones orales del COVID-19 en Paraguay: resultados de una encuesta en línea

Introducción: Estudios previos han reportado que pacientes infectados con el virus del COVID-19, podrían manifestar sintomatologías a nivel de la cavidad oral. Objetivo: Evaluar la frecuencia de manifestaciones orales asociadas a COVID-19 en un segmento de la población paraguaya y determinar cuáles son las más prevalentes. Metodología: Estudio descriptivo de corte transversal. Fue realizada una encuesta electrónica de enero a marzo del 2022. Los datos fueron presentados como frecuencias y porcentajes y analizados mediante la prueba de chi-cuadrado. El análisis estadístico se realizó con el software R versión 4.0.3. Resultados: La muestra estuvo compuesta por 478 personas. El 79,50 % correspondió al sexo femenino y el 45,19 % tenía entre 25 y 34 años. El 65,48 % informó haber experimentado al menos 1 síntoma o signo oral durante el curso de COVID-19. La pérdida de la sensación de sabores amargos, seguida de la alteración del sabor de los alimentos y la pérdida de la percepción dulce, fueron los síntomas más comunes. Se encontró una proporción significativamente mayor de manifestaciones orales en el rango de 18-24 años (χ²; p= 0,003). Entre las personas que desarrollaron COVID-19 de forma moderada a severa hubo mayor número de manifestaciones de síntomas orales (χ²; p= 0,044). Discusión: Se identificó una alta frecuencia de manifestaciones orales en pacientes con casos de moderados a severos de COVID-19, destacándose los trastornos del gusto como los más predominantes. Los individuos más jóvenes fueron los más afectados.

Introduction: Previous studies have reported that patients infected with the COVID-19 virus could manifest symptoms in the oral cavity. Objective: To evaluate the frequency of oral manifestations associated with COVID-19 in a segment of the Paraguayan population and determine the most prevalent ones. Methods: Descriptive cross-sectional study. An electronic survey was conducted from January to March 2022. The data were presented as frequencies and percentages and analyzed using the chi-square test. Statistical analysis was performed with R software version 4.0.3. Results: The sample consisted of 478 individuals. 79.50% were female, and 45.19% were between 25 and 34 years old. 65.48% reported having experienced at least 1 oral symptom or sign during the course of COVID-19. The loss of the sensation of bitter tastes, followed by the alteration of the taste of foods and the loss of sweetness perception, were the most common symptoms. A significantly higher proportion of oral manifestations was found in the 18-24 age range (χ²; p= 0.003). Among people who developed COVID-19 in a moderate to severe form, a greater number of oral symptom manifestations were observed (χ²; p= 0.044). Discussion: A high frequency of oral manifestations was identified in patients with moderate to severe cases of COVID-19, with taste disorders standing out as the most predominant. Younger individuals were the most affected.

El diagnóstico pedagógico personalizado del luchador, en la etapa de perfeccionamiento básico

Conocer las manifestaciones del comportamiento del luchador en la etapa inicial de ejecución del entrenamiento deportivo permite caracterizar, proyectar y controlar el proceso, con una dirección científica. Por ello la presente investigación plantea como objetivo proponer indicadores para el diagnóstico pedagógico personalizado del luchador, en la etapa de perfeccionamiento básico y lograr la efectividad en la formación integral de su personalidad. Ante la situación presentada se realizaron observaciones al comportamiento de los luchadores en el ambiente familiar, escolar, social y deportivo; además de encuestas y entrevistas que permitieron caracterizar el proceso investigado y pronosticar los posibles resultados, para luego desarrollar una eficiente intervención formativa. Las conclusiones derivadas del estudio y análisis de los resultados evidenciaron que los indicadores de diagnóstico pedagógico personalizado del luchador, en la etapa de perfeccionamiento básico contribuyeron con efectividad, en la formación integral de su personalidad.

Conhecer as manifestações do comportamento do lutador na etapa inicial do treinamento esportivo permite caracterizar, projetar e controlar o processo, com uma direção científica. Por essa razão, o objetivo desta pesquisa é propor indicadores para o diagnóstico pedagógico personalizado do lutador, na etapa de aperfeiçoamento básico, e alcançar a eficácia na formação integral de sua personalidade. Diante da situação apresentada, foram feitas observações do comportamento dos lutadores no ambiente familiar, escolar, social e esportivo; além de pesquisas e entrevistas que permitiram caracterizar o processo investigado e prever os possíveis resultados, para então desenvolver uma intervenção formativa eficiente. As conclusões derivadas do estudo e da análise dos resultados mostraram que os indicadores do diagnóstico pedagógico personalizado do lutador, na etapa de aperfeiçoamento básico, contribuíram efetivamente para a formação integral de sua personalidade.

Knowing the manifestations of the wrestler's behavior in the initial stage of sports training execution allows to characterize, project and control the process, with a scientific direction. Therefore, the objective of this research is to propose indicators for the personalized pedagogical diagnosis of the wrestlers, in the basic improvement stage and to achieve effectiveness in the comprehensive formation of his personality. Given the situation presented, observations were made of the behavior of the wrestlers in the family, school, social and sports environment; in addition to surveys and interviews that allowed to characterize the investigated process and predict possible results, to then develop an efficient training intervention. The conclusions derived from the study and analysis of the results showed that the personalized pedagogical diagnosis indicators of the wrestler, in the basic improvement stage, contributed effectively to the comprehensive formation of his personality.

La táctica como fundamento esencial en el proceso de preparación del futbolista

El fútbol es un deporte de oposición, cooperación, donde se interrelacionan las estructuras y las funciones específicas que lo rigen, de carácter eminentemente táctico y de ahí la necesidad que tienen los jugadores de relacionarse para organizarse colectivamente con eficacia en las situaciones ofensivas, defensivas, y las transiciones de ambas acciones, las cuales van a surgir el resto de capacidades técnicas, físicas, de teóricas y psicológicas según las necesidades de la idea de juego. Esta investigación, enmarcada en el proceso de preparación táctica de la selección provincial de fútbol de mayores de Pinar del Río, tuvo objetivo determinar el estado en que se encuentra la preparación táctica de los jugadores según el modelo de juego planificado para enfrentar el torneo nacional y definir la metodología de entrenamiento sustentada en los sistemas modernos de preparación fundamentado en el componente táctico como dimensión rectora en el proceso. Con la utilización de métodos teóricos, empíricos, y de nivel estadístico, se guía todo el proceso de la investigación a través de observaciones a entrenamientos, entrevistas y mediciones del comportamiento táctico en partidos oficiales, con lo cual se pudo corroborar en los resultados alcanzados una serie de insuficiencias y limitaciones tácticas en las dimensiones e indicadores valorados que denota que problemas en la preparación para la competencia.

O futebol é um esporte de oposição, cooperação, onde as estruturas e funções específicas que o regem estão inter-relacionadas, de natureza eminentemente tática e daí a necessidade de os jogadores se relacionarem entre si para se organizarem coletivamente de forma eficaz em situações ofensivas e defensivas, e as transições de ambas as ações, que darão origem ao resto das capacidades técnicas, físicas, teóricas e psicológicas de acordo com as necessidades da ideia de jogo. Esta pesquisa, enquadrada no processo de preparação tática da equipe de futebol sênior provincial de Pinar del Río, teve como objetivo determinar o estado da preparação tática dos jogadores de acordo com o modelo de jogo planejado para enfrentar o torneio nacional e definir a metodologia de treinamento com base nos modernos sistemas de preparação baseados no componente tático como uma dimensão orientadora no processo. Com a utilização de métodos teóricos, empíricos e estatísticos, todo o processo da pesquisa foi orientado por meio de observações em sessões de treinamento, entrevistas e medições do comportamento tático em jogos oficiais, com os quais foi possível corroborar nos resultados alcançados uma série de insuficiências e limitações táticas nas dimensões e indicadores avaliados que denotam problemas na preparação para a competição.

Soccer is a sport of opposition and cooperation, where the specific structures and functions that govern it are interrelated, of an eminently tactical nature and hence the need for players to relate to organize themselves collectively effectively in offensive, defensive, and the transitions of both actions, from which the rest of the technical, physical, theoretical and psychological capacities will emerge according to the needs of the game idea. This research, framed in the tactical preparation process of the provincial senior soccer team of Pinar del Río, had the objective of determining the state of the tactical preparation of the players according to the game model planned to face the national tournament and define the training methodology supported by modern preparation systems based on the tactical component as a guiding dimension in the process. With the use of theoretical, empirical, and statistical methods, the entire research process is guided through observations of training, interviews, and measurements of tactical behavior in official matches, with which it was possible to corroborate in the results achieved a series of insufficiencies and tactical limitations in the valued dimensions and indicators that denote problems in preparation for the competition.

Hemoglobina reticulocitaria en el diagnóstico precoz de la anemia por deficiencia de hierro / Reticulocyte hemoglobin in the early diagnosis of iron deficiency anemia / Hemoglobina de reticulócitos no diagnóstico precoce da anemia por deficiência de ferro

La anemia por deficiencia de hierro es un problema prevalente a nivel global que aparece en niños, adolescentes y mujeres en edad fértil, son los más afectados. La hemoglobina reticulocitaria es un nuevo biomarcador prometedor para el diagnóstico temprano. Objetivo. Evaluar la hemoglobina reticulocitaria para el diagnóstico precoz de anemia por deficiencia de hierro. Metodología. Se realizó una revisión sistemática en bases de datos biomédicas como PubMed, Scielo, Researchgate, Base, Cochrane Library y DOAJ; se incluyeron 24 estudios observacionales (2018-2023) sobre el uso de la hemoglobina reticulocitaria en el diagnóstico de anemia por deficiencia de hierro; se extrajeron datos sobre las características de los estudios, los valores de sensibilidad y especificidad de este biomarcador. Resultados. La hemoglobina reticulocitaria presentó una sensibilidad agrupada de 90% y una especificidad de 89,5% en los estudios analizados. También mostró una diferencia de medias significativa de -2,88 (IC 95%: -3,36 a -2,40) entre grupos con y sin anemia por deficiencia de hierro. Se encontró una heterogeneidad sustancial entre los resultados de los diferentes estudios (I2=95%; p<0,00001). Conclusión. La hemoglobina reticulocitaria demostró elevada sensibilidad y especificidad, así como una diferencia significativa entre grupos con y sin la condición, lo que evidencia su utilidad como prueba para la detección temprana de la anemia por deficiencia de hierro.

Iron deficiency anemia is a prevalent global health problem that appears in children, adolescents and women of childbearing age, who are the most affected. Reticulocyte hemoglobin is a promising new biomarker for early diagnosis. Objective. To evaluate reticulocyte hemoglobin for the early diagnosis of iron deficiency anemia. Methodology. A systematic review was conducted searching biomedical databases including PubMed, Scielo, Researchgate, Base, Cochrane Library and DOAJ; 24 observational studies (2018-2023) were included on the use of reticulocyte hemoglobin in the diagnosis of iron deficiency anemia; data were extracted on the characteristics of the studies and the sensitivity and specificity values of this biomarker. Results. Reticulocyte hemoglobin showed a pooled sensitivity of 90% and a specificity of 89.5% in the studies analyzed. It also showed a significant mean difference of -2.88 (95% CI: -3.36 to -2.40) between groups with and without iron deficiency anemia. Substantial heterogeneity was found among the results of the different studies (I2=95%; p<0.00001). Conclusion. Reticulocyte hemoglobin demonstrated high sensitivity and specificity, as well as a significant difference between groups with and without the condition, which shows its usefulness as a test for the early detection of iron deficiency anemia.

A anemia por deficiência de ferro é um problema de saúde global prevalente que aparece em crianças, adolescentes e mulheres em idade fértil, sendo os mais afetados. A hemoglobina reticulocitária é um novo biomarcador promissor para o diagnóstico precoce. Objetivo. Avaliar a hemoglobina reticulocitária para o diagnóstico precoce da anemia por deficiência de ferro. Metodologia. Foi realizada uma revisão sistemática com busca em bases de dados biomédicas incluindo PubMed, Scielo, Researchgate, Base Cochrane Library e DOAJ; foram incluídos 24 estudos observacionais (2018-2023) sobre o uso da hemoglobina reticulocitária no diagnóstico de anemia por deficiência de ferro; foram extraídos dados sobre as características dos estudos e os valores de sensibilidade e especificidade deste biomarcador. Resultados. A hemoglobina reticulocitária apresentou sensibilidade agrupada de 90% e especificidade de 89,5% nos estudos analisados. Também mostrou uma diferença média significativa de -2,88 (IC 95%: -3,36 a -2,40) entre grupos com e sem anemia por deficiência de ferro. Encontrou-se heterogeneidade substancial entre os resultados dos diferentes estudos (I2=95%; p<0,00001). Conclusão. A hemoglobina reticulocitária demonstrou elevada sensibilidade e especificidade, bem como uma diferença significativa entre grupos com e sem a condição, o que evidencia a sua utilidade como teste para a detecção precoce da anemia por deficiência de ferro.

Actualización en taxonomía, diagnóstico y tratamiento de las dermatofitosis / Update on taxonomy, diagnosis and treatment

Los dermatofitos son un grupo de hongos responsables de las dermatofitosis o tiñas, pudiendo afectar piel, uñas y pelo. En la actualidad están constituidos por los géneros Epidermophyton, Trichophyton, Microsporum, Arthroderma, Paraphyton, Lophophyton y Nannizzia. El examen microscópico directo y el cultivo en agar siguen siendo el estándar de oro para la identificación, sin embargo, en ocasiones se requiere de la biología molecular para poder corroborar una determinada especie. Dependiendo de la localización, del número de lesiones y de la extensión, el tratamiento de las dermatofitosis puede ser tópico o sistémico. Trichophyton indotineae y T tonsurans pueden expresar resistencia a la terbinafina y azoles, respectivamente.

Dermatophytes are a group of fungi responsible for dermatophytosis or ringworm, which can affect the skin, nails and hair. Currently, they are assembled by the genera Epidermophyton, Trichophyton, Microsporum, Arthroderma, Paraphyton, Lophophyton and Nannizzia. Direct microscopic examination and culture on agar remain the gold standard for identification, however, molecular biology is sometimes required to confirm a certain species. Depending on the location, the number of lesions and the extension, the treatment of dermatophytosis can be topical or systemic. Trichophyton indotineae and T tonsurans can express resistance to terbinafine and azoles, respectively.

Psicanálise profana: diagnóstico e experiência trans / Psychanalyse profane: diagnostic et expérience trans / Profane psychoanalysis: diagnosis and trans experience

Este artigo parte do exame da relação entre o poder de normalização, o dispositivo diagnóstico e a patologização da transexualidade para expor a função da norma em diferentes prismas na discussão sobre o normal e o patológico no contexto da experiência trans. São pautadas as dificuldades decorrentes dos pressupostos normativos que servem como diretrizes para políticas públicas e privadas de acesso ao processo transexualizador. Mediante uma discussão epistêmica, a experiência trans e sua patologização são analisadas em relação à função diagnóstica na psiquiatria e na psicanálise, observando o rigor de suas especificidades. Por fim, a orientação lacaniana é apresentada como alternativa à psiquiatrização e patologização da experiência trans, tendo em vista o seu distinto uso diagnóstico, o privilégio da singularidade em sua prática e o caráter subversivo de sua epistemologia.

Cet article commence par examiner la relation entre le pouvoir de normalisation, le dispositif de diagnostic et la pathologisation de la transsexualité pour exposer la fonction de la norme sous différents angles dans la discussion sur le normal et le pathologique dans le contexte de l'expérience trans. Les difficultés découlant des hypothèses normatives qui servent de lignes directrices aux politiques publiques et privées sur l'accès au processus de transsexualisation sont mises en question. À travers une discussion épistémique, l'expérience trans et sa pathologisation sont analysées en relation avec la fonction diagnostique en psychiatrie et en psychanalyse, en observant la rigueur de leurs spécificités. Enfin, l'orientation lacanienne est présentée comme une alternative à la psychiatrisation et à la pathologisation de l'expérience trans, compte tenu de son usage diagnostique distinct, du privilège de la singularité dans sa pratique et du caractère subversif de son épistémologie

This article begins by examining the relationship between the power of normalization, the diagnostic device and the pathologization of transsexuality to expose the function of the norm from different perspectives in the discussion about the normal and the pathological in the context of the trans experience. Difficulties arising from normative assumptions that serve as guidelines for public and private policies on access to the transsexualization process are examined. Through an epistemic discussion, the trans experience and its pathologization are analyzed in relation to the diagnostic function in psychiatry and psychoanalysis, observing the rigor of their specificities. Finally, the Lacanian orientation is presented as an alternative to the psychiatrization and pathologization of the trans experience, given its distinct diagnostic use, the privilege of singularity in its practice and the subversive character of its epistemology

Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis

ABSTRACT Purpose: The aim of this study is to perform a high-quality meta-analysis using only randomized controlled trials (RCT) to better define the role of postoperative antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL). Materials and Methods: A literature search for RCTs in EMBASE, PubMed, and Web of Science up to May 2023 was conducted following the PICO framework: Population—adult patients who underwent PCNL; Intervention—postoperative antibiotic prophylaxis until nephrostomy tube withdrawal; Control—single dose of antibiotic during the induction of anesthesia; and Outcome—systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The protocol was registered on the PROSPERO database (CRD42022361579). We calculated odds ratios (OR) and 95% confidence intervals (CI). A random-effects model was employed, and the alpha risk was defined as < 0.05. Results: Seven articles, encompassing a total of 629 patients, were included in the analysis. The outcome of SIRS or sepsis was extracted from six of the included studies, while the outcome of postoperative fever was extracted from four studies. The analysis revealed no statistical association between the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal and the occurrence of SIRS/sepsis (OR 1.236, 95% CI 0.731 - 2.089, p=0.429) or fever (OR 2.049, 95% CI 0.790 - 5.316, p=0.140). Conclusion: Our findings suggest that there is no benefit associated with the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal in patients undergoing percutaneous nephrolithotomy (PCNL). We recommend that antibiotic prophylaxis should be administered only until the induction of anesthesia in PCNL.

Diagnostic utility, disease activity, and disease phenotype correlation of serum ASCA, pANCA, and PR3-ANCA in pediatric inflammatory bowel disease

Abstract Objective: This study aimed to evaluate the diagnostic utility, disease activity, and phenotypic association of serum anti-Saccharomyces cerevisiae antibody (ASCA), perinuclear anti-neutrophil cytoplasmic antibody (pANCA), PR3-ANCA, and MPO-ANCA in pediatric patients with inflammatory bowel disease (IBD). Methods: Pediatric patients diagnosed with IBD were recruited and classified as Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) through full investigation. The Paris classification was used to evaluate disease phenotypes of pediatric CD and UC. Results: In all, 229 pediatric patients with IBD (CD 147, UC 53, IBD-U 29) were included. The ASCA IgG seropositivity significantly differed among the three groups (CD 75.4%, UC 17.5%, and IBD-U 60.0%; p < 0.001). PR3-ANCA positive rates were the highest in UC (24.0%), followed by IBD-U (17.6%), and none in CD (p = 0.002); pANCA-positive rates were higher in IBD-U (33.6%), followed by UC (28.0%) than in CD (1.4%) (p < 0.001). Regarding disease phenotype, perianal disease revealed higher serum ASCA IgG titers (median 36.7 U/mL in P1 vs. 25.2 U/mL in P0, p = 0.019). Serum ASCA IgG and IgA cutoff values to distinguish CD were 32.7 (U/mL) and 11.9 (U/mL), respectively, with a specificity of 80.0%. Conclusion: Serological biomarkers of ASCA IgG and IgA were effective for differentiating CD in pediatric IBD patients, and serum pANCA and PR3-ANCA, but not MPO-ANCA, were effective in distinguishing UC and IBD-U. Furthermore, measuring serological titers of ASCA IgG and IgA may help differentiate CD and evaluate the disease activity and phenotype of pediatric IBD in practice.

Congenital hyperinsulinism and surgical outcome in a single tertiary center in Brazil

Abstract Objective: Congenital hyperinsulinism (CHI) is a heterogeneous genetic disease characterized by increased insulin secretion and causes persistent hypoglycemia in neonates and infants due to dysregulation of insulin secretion by pancreatic β cells. Babies with severe hypoglycemia and for whom medical treatment has been ineffective usually require surgical treatment with near-total pancreatectomy. To evaluate the clinical and surgical aspects affecting survival outcomes in babies diagnosed with CHI in a single tertiary care center. Methods: Retrospective Cohort study involving a single university tertiary center for the treatment of CHI. The authors study the demographics, clinical, laboratory, and surgical outcomes of this casuistic. Results: 61 % were female, 39 % male, Birth weight: 3576 g (±313); Age of onset of symptoms: from the 2nd hour of life to 28 days; Time between diagnosis and surgery ranged between 10 and 60 days; Medical clinical treatment, all patients received glucose solution with a continuous glucose infusion and diazoxide. 81 % of the patients used corticosteroids, 77 %. thiazide, 72 % octreotide, 27 % nifedipine; Neurological sequelae during development and growth: 54 % had some degree of delay in neuropsychomotor development, 27 % obesity. Surgery was performed open in 6 and 12 minimally invasive surgery (MIS). Histopathology: 2 focal and 16 diffuse, Length of stay (days) was lower in MIS (p < 0.05). Survival was 100 %. Conclusions: CHI is a rare and difficult-to-manage tumor that must be performed in a multidisciplinary and tertiary center. Most surgical results are good and the laparoscopic approach to disease has been the best choice for patients.

Detección de las necesidades de capacitación de los asistentes de farmacia / Detection of training needs in pharmacy assistants

Introducción: La capacitación es, sin duda, uno de los temas actuales más importantes cuando se habla de competitividad, innovación y mejora continua de una empresa. Este proceso implica: detección de necesidades, planeación, implementación, evaluación, retroalimentación y seguimiento de resultados. El eje fundamental de este proceso es el Diagnóstico de Necesidades de Capacitación, pues señala de manera precisa los aspectos sobre los cuales ha de trabajar el capacitador. Objetivo: Realizar un diagnóstico de las necesidades de capacitación de los asistentes de farmacia del Municipio Santa Clara. Métodos: Para elaborar el Diagnóstico de Necesidades de Capacitación se utilizó el método comparativo. Este método se basa en la identificación de las discrepancias entre lo que es y lo debe ser, lo que posibilita constatar los requisitos que son necesarios cubrir. Se utilizaron como técnicas la entrevista y la encuesta. Resultados: Finalmente, después del análisis de todos los datos obtenidos de las matrices y preguntas abiertas, se elaboró el Diagnóstico de Necesidades de Capacitación final que se entregó a la Empresa Farmacias y Ópticas. Conclusiones: Estos resultados mostraron que esta empresa necesita de manera inmediata implementar actividades de capacitación a sus asistentes de farmacia en lo referente a conocimientos.

Introduction: training is, undoubtedly one of the most important current issues when talking about competitiveness, innovation and continuous improvement of a company. This process involves: detection of needs, planning, implementation, evaluation, feedback and monitoring of results. The fundamental axis of this process is the Diagnosis of Training Needs, since it indicates precisely the aspects on which the trainer must work. Objective: to carry out a diagnosis of the training needs in pharmacy assistants from Santa Clara municipality. Methods: the comparative method was use to prepare the Training Needs Diagnosis. This method is based on the identification of discrepancies between what is and what should be; it made possible to verify the necessary requirements to be met. Interviews and surveys were used as techniques. Results: Finally, after analyzing all the data obtained from the matrices and the open questions, a final Diagnosis of Training Needs was prepared and delivered to the Pharmacy and Optics Company. Conclusions: these results showed that this company needs to immediately implement training activities for their pharmacy assistants in terms of knowledge.

Carcinoma basocelular de vulva: relato de caso / Basal cell carcinoma of the vulva: case report

Introdução: O carcinoma basocelular (CBC) de vulva é uma condição rara que corresponde a menos de 0,4% dos casos de CBC e de 2% a 4% das neoplasias de vulva. O CBC de vulva é mais comum entre mulheres brancas, multíparas e na pósmenopausa, especialmente na sétima década de vida. O objetivo é relatar um caso de CBC de vulva no qual discutiram-se os aspectos do diagnóstico e tratamento. Relato de Caso: Mulher de 63 anos de idade, G1P1A0, chega ao consultório em janeiro de 2022 para tratamento de lesão persistente em vulva. Realizou-se biópsia incisional que mostrou tratar-se de provável carcinoma basocelular nodular com invasão da derme. A paciente submeteu-se a uma ressecção do tumor com margens macroscópicas livres e sutura primária. A cirurgia não teve complicações no pré-operatório e no pós-operatório. O histopatológico da peça cirúrgica mostrou tratar-se de carcinoma basocelular nodular com área irregular, plana, branco, medindo 0,7x0,4cm, com as margens laterais distando 7,0 e 5,0mm e profundas, 5,9mm; todas livres. Conclusão: O caso relatado é raro, tendo sido o tratamento de ressecção cirúrgica do CBC de vulva com margens bem-sucedido. Catorze meses após a cirurgia, a paciente encontra-se sem evidências de recidiva local ou regional.

Introduction: Basal cell carcinoma (BCC) of the vulva is a rare condition that accounts for less than 0.4% of BCC cases and 2% to 4% of vulvar neoplasms. BCC of the vulva is more common among white, multiparous and postmenopausal women, especially in the seventh decade of life. The aim is to report a case of BCC of the vulva in which aspects of diagnosis and treatment were discussed. Case report: A 63-year-old woman, G1P1A0, arrives at the office in January 2022 for treatment of a persistent lesion on her vulva. An incisional biopsy was performed and showed that it was likely nodular basal cell carcinoma with invasion of the dermis. The patient underwent tumor resection with free macroscopic margins and primary suture. The surgery had no complications preoperatively or postoperatively. The histopathology of the surgical specimen showed that it was a nodular basal cell carcinoma with an irregular, flat, white area, measuring 0.7x0.4cm, with the lateral margins 7.0 and 5.0mm apart and 5.9mm deep; all free. Conclusion: The reported case is rare, with surgical resection of BCC of the vulva with margins being successful. Fourteen months after surgery, the patient has no evidence of local or regional recurrence.

Tumor filoide borderline gigante e recidivante: ressecção e reconstrução da mama / Recurrent giant borderline phyllodes tumor: resection and breast reconstruction

O tumor filoide é uma neoplasia fibroepitelial rara que representa 0,3 a 1% de todas as neoplasias mamárias. De acordo com a classificação histopatológica, 12 a 26% são do tipo borderline e aproximadamente 15% desses tumores recorrem após excisão cirúrgica. O tratamento recomendado para todos os tipos de tumor filoide é a excisão cirúrgica, e no caso de tumores gigantes o tratamento deve ser multidisciplinar. Apresentamos o caso de uma mulher de 46 anos com tumor filoide na mama esquerda que recorreu 4 anos após a excisão cirúrgica. O estudo anatomopatológico qualificou-o como tumor gigante e o estudo histopatológico relatou tumor filoide borderline. Foi submetida a excisão cirúrgica com mastectomia esquerda e reconstrução mamária com retalho de grande dorsal mais enxerto de gordura. A paciente apresentou evolução favorável sem recidiva. Concluindo, o tumor filoide gigante borderline recorrente é raro e seu manejo cirúrgico representa um desafio tanto na excisão quanto na reconstrução mamária.

Phyllodes tumor is a rare fibroepithelial neoplasm that represents 0.3 to 1% of all breast neoplasms. According to histopathologic classification, 12 to 26% are borderline type and approximately 15% of these tumors recur after surgical excision. The recommended treatment for all types of phyllodes tumor is surgical excision, and in the case of giant tumors the treatment should be multidisciplinary. We present the case of a 46-yearold woman with a phyllodes tumor in the left breast that recurred 4 years after surgical excision. The anatomopathological study qualified it as a giant tumor and the histopathological study reported a borderline phyllodes tumor. She underwent surgical excision with left mastectomy and breast reconstruction by means of a latissimus dorsi flap plus fat graft. The patient presented a favorable evolution without recurrence. In conclusion, the recurrent giant borderline phyllodes tumor is rare and its surgical management represents a challenge both in breast excision and reconstruction.

Congruencia Diagnóstica Clínica-Histopatológica de Lesiones en Cavidad Oral, en la Faculta de Odontología, Universidad de Costa Rica, en el Período 2016-2019

El conocimiento de la patología oral, y su correcto diagnóstico es fundamental en Odontología, puesto que un diagnóstico tardío, particularmente en casos de lesiones premalignas o malignas, pueden conducir a serias consecuencias para el paciente. El objetivo de este trabajo fue establecer la congruencia diagnóstica clínica - histopatológica de lesiones en cavidad oral en pacientes que asistieron a la Facultad de Odontología, Universidad de Costa Rica, y a quienes se les realizó biopsia de la lesión, durante el período 2016-2019. El estudio fue descriptivo y retrospectivo, basado en datos de reportes histopatológicos en la población mencionada, por presentar alguna lesión, de tejidos blandos o duros, en cavidad oral. La muestra estadística fue por conveniencia, no probabilística y no aleatoria. Las técnicas estadísticas utilizadas fueron descriptivas para el análisis de la información, el cual se basó en la distribución de frecuencias y cruce de variables. El procesamiento estadístico de los datos se diseñó en una base de datos creada en Excel. La muestra comprendió 160 reportes histopatológicos de los cuales se excluyeron 14. La edad promedio de los pacientes fue 42 años (rango 2 - 78 años). La proporción hombre: mujer correspondió 1:1.4, predominado el sexo femenino en 58,9 %. La congruencia del diagnóstico histopatológico con el diagnóstico clínico correspondió a 55,8 %. La congruencia de los diagnósticos demuestra el conocimiento del profesional en identificar la lesión clínicamente de forma correcta, lo que permite actuar en el momento preciso y confirmar la impresión clínica diagnóstica de una patología mediante el estudio histopatológico, el cual es el estándar oro. El problema radica en aquellos casos en que hay discrepancia diagnóstica, pues exige conocer los factores responsables de esta discrepancia, exige la búsqueda de soluciones y exige reforzar y redireccionar la formación académica del profesional y de los estudiantes para reconocer y describir estas lesiones.

Knowledge of oral pathology and its correct diagnosis is fundamental in Dentistry, since a late diagnosis, particularly in cases of premalignant or malignant lesions, can lead to serious consequences for the patient. The objective of this study was to establish the clinical- histopathological diagnostic consistency of lesions in the oral cavity in patients who attended the Faculty of Dentistry, Universidad de Costa Rica, and who underwent a biopsy of the lesion, during the period 2016-2019. The study was descriptive and retrospective, based on data from histopathological reports in the mentioned population, due to presenting some lesion, soft or hard tissue, in the oral cavity. The statistical sample was for convenience, non- probabilistic nor random. The statistical techniques used were descriptive for the analysis of the information, which was based on frequency distribution and crossing of variables. The statistical processing of the data was designed in a database created in Excel. The sample collects 160 histopathological reports, of which 14 were excluded. The average age of the patients was 42 years (range between 2 - 78 years old).The male:female ratio corresponded to 1:1.4, with a predominance of the female sex at 58.9 %.The congruence of the histopathological diagnosis with the clinical diagnosis corresponded to 55.8 %. Diagnostic consistency demonstrates knowledge of the professional in correctly identifying the lesion clinically, which allows acting at the precise moment and confirming the diagnostic clinical impression of the pathology via histopathological study which is the gold standard. The problem lies in those cases in which there is a diagnostic discrepancy, since it requires having knowledge of the underlying factors and therefore, requires searching for solutions, reinforcing and redirecting the academic training of professionals and students to recognize and describe these lesions.