Disección Aórtica Tipo A como diagnóstico diferencial potencialmente letal de dolor torácico: revisión de casos / Type A Aortic Dissection as a potentially lethal differential diagnosis of chest pain: case Review

Chest pain (CP) is a frequent reason for consultation in emergency departments (ED). It responds to a broad spectrum of pathologies, ranging from banal causes to severe conditions with high mortality. The clinician must be able to distinguish prompt when CP is due to severe pathology and thus make a timely intervention for the patient's benefit. Acute Aortic Syndrome (AAS) is one of the potentially fatal causes of CP. Within this syndrome, we find aortic dissection (AD), intramural hematoma and atherosclerotic penetrating ulcer. AD is the most frequent presentation of AAS. Although it is not a common condition, its high lethality and low suspicion make it of particular interest as a differential diagnosis of CP. The following are two clinical cases of AD of the ascending aortic treated at the Hospital Regional de Talca (HRT) to analyse the clinical characteristics that help to differentiate this condition, the main electrocardiographic and imaging findings, as well as some of its complications and management.

Hipertensión arterial en paciente de raza negra: a propósito de un caso / Hypertension in a black patient: a purpose of a case

Hypertension in black patients is usually more frequent and associated with higher morbidity and mortality. Due to demographic changes in the Chilean population, dealing with this group of patients has become more frequent. The case of a young Haitian patient with severe hypertension and target organ damage is presented.

First description of sarcoptic mange in a wild coati (Nasua narica), in Ecuador, and cooccurrence of canine distemper virus / Primeira descrição da sarna sarcóptica em um coati selvagem (Nasua narica), no Equador, e coocorrência do vírus distemper canino

Abstract We present a case of Sarcoptes and canine distemper virus (CDV) infection in a white-nosed coati (Nasua narica) that was trapped in the dry tropical forest of Cerro Blanco reserve, located in the coastal region of Ecuador. Sarcoptic mange is a highly contagious and zoonotic disease with worldwide distribution that causes epidemics. Mange is produced by Sarcoptes mites that causes severe epidermal damage. Secondary infections and physiological constrictions without treatment can lead to death of the host. In addition, cooccurrence of canine distemper virus was detected via iiRT-PCR from serum samples. Physical analyses showed that 90% of the skin was affected by severe alopecia due to the sarcoptic mange infection. The presence of mites and histopathological analyses confirmed the diagnosis of infection. This coati was taken to a veterinary clinic and was fed every day, but it died after four days. This is the first report of sarcoptic mange and the first report of CDV in white-nosed coatis in South America. Further studies are needed in this region, to seek out other suspected cases, given the high capacity for disease transmission. Preventive actions to avoid epidemic and zoonotic episodes are needed.

Resumo Apresentamos um caso de Sarcoptes e infecção pelo vírus da cinomose canina (CDV) em um quati-do-nariz-branco (Nasua narica) que ficou preso na floresta tropical seca da reserva de Cerro Blanco, localizada na região costeira do Equador. A sarna sarcóptica é uma doença altamente contagiosa e zoonótica de distribuição mundial que causa epidemias. A sarna é produzida por ácaro do gênero Sarcoptes que causa graves danos epidérmicos. Infecções secundárias e constrições fisiológicas sem tratamento podem levar à morte do organismo. Além disso, a coocorrência do vírus da cinomose canina foi detectada, via iiRT-PCR, a partir de amostras de soro. As análises físicas mostraram que 90% da pele estava afetada por alopecia severa devido à infecção pelo ácaro da sarna sarcóptica. A presença de ácaros e análises histopatológicas confirmaram o diagnóstico de infecção. Esse quati foi levado a uma clínica veterinária e foi alimentado todos os dias, mas morreu após quatro dias. Esse é o primeiro relato de sarna sarcóptica e o primeiro relato de CDV em quatis-de-nariz-branco na América do Sul. São necessários mais estudos nessa região, para buscar outros casos suspeitos, dada a alta capacidade de transmissão da doença. Ações preventivas para evitar episódios epidêmicos e zoonóticos, são necessárias.

Rotura del septum interventricular post infarto agudo al miocardio: una complicación potencialmente letal Revisión de la literatura a propósito de un caso clínico / Ventricular septal rupture after acute myocardial infarction: a potentially lethal complication Case report and literature review

Rupture of the ventricular septum with the appearance of an interventricular communication is an infrequent and life-threatening mechanical complication after acute myocardial infarction. The advent of coronary reperfusion therapies has reduced the incidence of this complication, but mortality remains high. The clinical presentation varies from mild compromise with exertional dyspnea to severe compromise with cardiogenic shock. In this pathology, early diagnosis is fundamental and surgical repair is the treatment of choice. In this article we report an interesting clinical case about a 77-year-old woman who was belatedly referred to our hospital and diagnosed with postinfarction rupture of the ventricular septum with an unfortunately fatal evolution. Relevance of this case lies in its atypical clinical presentation which led to a delay in diagnosis and a missed opportunity for early reperfusion therapy. An updated literature review about rupture of the ventricular septum complicating acute myocardial infarction was carried out.

Manejo del síndrome coronario agudo durante pandemia por COVID ­ 19 / Management of acute coronary syndrome during COVID ­ 19 pandemic

INTRODUCTION: Acute Myocardial Infarction is a medical emergency, being his early and adequate treatment highly effective mainly in relation to reperfusion therapy. Unfortunately, COVID ­ 19 pandemic, has brought changes in its management due to availability of conditioned hemodynamic rooms, infection risk of the professionals, patient conditions and availability of critical unit beds. A review of the topic was made aimed to give a guide for the management of these patients with the available tools. MATERIALS AND METHOD: A review of the topic was made using the Medline/ Pubmed platform, in English and Spanish. Further, published articles in journals as The journal of the American college of cardiology and Circulation were included. CONCLUSIONS: The reperfusion strategies must be used according to the clinical context of the patient. In the acute myocardial infarction with ST elevation, fibrinolytic treatment may be chosen in low risk and without hemodynamic instability. In patients with hemodynamic instability, not eligible for fibrinolytic treatment or in whom this therapy fails, percutaneous angioplasty is indicated considering the protection of personnel. In the case of acute myocardial infarction without ST elevation, the treatment by urgent percutaneous angioplasty is considered in cases of hemodynamic instability or malignant arrhythmias.

Fragmento dorso-ulnar en fracturas de radio distal: clasificación y manejo / Dorso-ulnar fragment in distal radius fractures: classification and treatment

INTRODUCCIÓN: El fragmento dorso-ulnar (FDU) en la fractura intraarticular de radio distal es de especial importancia puesto que implica una alteración en la articulación radio-carpiana así como también en la articulación radio-ulnar distal (RUD), donde la incongruencia articular permanente puede generar secuelas a largo plazo. OBJETIVO: Proponer una clasificación del FDU, definiendo cuándo realizar el procedimiento quirúrgico con asistencia artroscópica, basado en una serie consecutiva de casos operados de fractura del radio distal estudiados con tomografía computada (TC). MÉTODO: Estudio descriptivo de una serie de casos de pacientes operados por fractura del radio distal entre enero del 2015 y diciembre del 2016. En base a eso, se elabora una clasificación del FDU y se sugiere un esquema de manejo específico. Se describe el FDU como aquel fragmento específico ubicado en la esquina dorso-ulnar de la carilla articular del radio distal, con compromiso de más del 30% de la superficie articular RUD y más de 5mm desde el borde ulnar hacia radial de la cortical dorsal del radio observado en el corte axial de la TC preoperatoria. Se considera un fragmento mayor (FM) cuando el rasgo de fractura compromete hacia radial hasta el tubérculo de Lister y se considera fragmento menor (Fm) cuando el rasgo no alcanza a comprometer el tubérculo de Lister. Nuestra propuesta de clasificación reconoce 4 tipos: tipo I (FM sin desplazamiento, en fracturas tipo C de la AO); tipo II (FM con desplazamiento, en fracturas tipo C de la AO); tipo III (Fm independiente del desplazamiento, en fracturas tipo C de la AO) y tipo IV (FM/Fm con desplazamiento, en fracturas tipo B2 de la AO). Esquema de manejo: Tipo I síntesis con placa bloqueada por abordaje palmar, sin obligación de asistencia artroscópica. Tipo II síntesis con placa bloqueada por abordaje palmar, con asistencia artroscópica requerida. Tipo III síntesis percutánea dorsal contornillo canulado, bajo asistencia artroscópica. Tipo IV síntesis dorsal con placa o tornillo mediante abordaje dorsal bajo visión directa o con asistencia artroscópica, usando portales artroscópicos volares. RESULTADOS: Se operaron 488 fracturas de radio distal durante el período mencionado; 375 fracturas clasificadas como tipo C de la AO. Del total operadas, solo 392 fracturas contaban con TC peroperatoria, que permitía evaluar la presencia del FDU, el cual estuvo presente en 127/392 de los casos (32,4%). Analizados por grupo, 38 casos presentaban fragmentos tipo I, 22 tipo II, 69 tipo III y 7 tipo IV. DISCUSIÓN: El FDU se presentó en un 32,4% de los casos evaluables por TC en nuestra serie. El manejo dirigido de este fragmento con asistencia artroscópica permitió una reducción anatómica con fijación estable específica de éste. CONCLUSIÓN: Proponemos una nueva clasificación del FDU basada en la TC preoperatoria que permite realizar un adecuado plan prequirurgico y abordar este fragmento de manera específica sugiriendo cuando utilizar asistencia artroscópica.

INTRODUCTION: The dorsal-ulnar fragment (DUF) in the distal radius fracture is of special importance since it implies an alteration in the radio-carpal joint as well as in the distal radio-ulnar joint (DRUJ), where permanent joint incongruence can generate long-term sequelae. OBJECTIVE: To propose a classification of the DUF, advising when to perform arthroscopic assistance, based on a consecutive series of operated cases of distal radius fracture studied with computed tomography (CT). METHODS: Descriptive study of a series of cases of patients operated of distal radius fracture between January 2015 and December 2016. We describe a classification of the DUF and suggest a specific treatment scheme. The DUF is described as that specific fragment located in the dorso-ulnar corner of the articular surface of the distal radius, which involves more than 30% of the articular surface of the DRUJ and more than 5mm of the ulnar edge of the dorsal cortex of the radius observed in the axial section of the preoperative CT. It is considered a major fragment (FM) when the fracture compromises the Lister tubercle and is considered a minor fragment (Fm) when it does not. Our classification recognizes 4 types of DUF: type I (FM without displacement, in type C fractures of the AO); Type II (FM with displacement, in type C fractures of the AO); Type III (Fm independent of displacement, in fractures type C of the AO) and type IV (FM/Fm with displacement, in fractures type B2 of the AO). Treatment scheme: Type I: synthesis with a palmar locked plate without arthroscopic assistance required. Type II: synthesis with palmar locked plate with arthroscopic assistance. Type III dorsal percutaneous synthesis with cannulated screw with arthroscopic assistance. Type IV dorsal synthesis with plate or screw by dorsal approach under direct vision or with arthroscopic assistance using volar portals. RESULTS: A total of 488 distal radius fractures were operated during this period. Only 392 fractures had preoperative CT, which allowed to evaluate the presence of the DUF. It was present in 127/392 of the cases (32.4%). Analyzed by group, 38 cases presented fragments type I, 22 cases type II, 69 cases type III and 7 cases type IV. DISCUSSION: The DUF was presented in 32.4% of the cases in our series. The management of this fragment with arthroscopic assistance allowed an anatomical reduction with specific stable fixation of this fragment. CONCLUSION: We propose a novel classification of the DUF based on preoperative CT that allows a specific management of this fragment and suggest when to use arthroscopic assistance.

Surgery-first approach with 3D customized passive self-ligating brackets and 3D surgical planning: Case report

ABSTRACT It is possible to unify three-dimensional customized orthodontic techniques and three-dimensional surgical technology. In this case report, it is introduced a treatment scheme consisting of passive self-ligation customized brackets and virtual surgical planning combined with the orthognathic surgery-first approach in a Class III malocclusion patient. Excellent facial and occlusal outcomes were obtained in a reduced treatment time of five months.

RESUMO É possível unificar técnicas ortodônticas personalizadas e tecnologia de planejamento cirúrgico 3D. No presente relato de caso, apresenta-se um plano de tratamento envolvendo o uso de braquetes autoligáveis passivos personalizados e planejamento cirúrgico virtual, combinado com cirurgia ortognática de benefício antecipado, em um paciente com má oclusão de Classe III. Foram obtidos excelentes resultados faciais e oclusais em um tempo reduzido de tratamento, de 5 meses.

Relación entre dermatoglifos y labio y/o paladar hendido: una revisión de literatura / Relationship between dermatoglyphics and cleft lip and/or palate: a review of literature

El presente artículo revisa los conceptos asociados con los dermatoglifos tales como su clasificación, características y aplica - ciones. Se revisan además las hendiduras orofaciales tales como el labio y paladar hendido y se propone una posible relación entre los dermatoglifos y estas hendiduras orofaciales, entidades que aunque se con- sideran aisladas en un principio, provienen del mismo tejido embrionario, el ectoder - mo, y su periodo de formación se da en las mismas semanas de gestación prenatal, haciendo que factores genéticos y medio - ambientales que influenciarían el desarrollo de el labio y/o paladar hendido asindrómico podrían reflejarse en las huellas dactilares y el tipo de patrón que siguen éstas...(Au)

This article reviews the concepts associated with dermatoglyphs such as their classifi - cation, characteristics and applications. It also reviews orofacial clefts such as cleft lip and palate and proposes a possible re- lationship between dermatoglyphics and these orofacial clefts, entities that are con- sidered isolated at first, but considering that they are derived from the same embryonic tissue, the ectoderm, and their development is in the same period of gestation, making genetic and environmental factors that would influence the development of the asyndromic lip and / or palate could be reflected in the fingerprints and the type of pattern that they follow...(Au)

Urgencia urológica y su manejo en unidad de emergencia / Urological emergencies and their management in a emergency unit

Las urgencias urológicas en el servicio público suelen ser manejadas por la unidad de emergencia. En esta unidad cirujanos generales son quienes deben decidir manejo o indicaciones de hospitalización de estos pacientes. No todas las unidades de emergencia cuentan con especialistas de llamado. Debido a esto quisimos evaluar los conocimientos generales de patología urológica de urgencia y su manejo por cirujanos de las unidades de emergencia. Se realizó encuesta con preguntas de patología urológica de urgencia y su manejo a cirujanos de 2 unidades de emergencia de hospitales tipo I. Se asignó puntaje considerando correctas menos incorrectas/ 2. Se analizan puntajes obtenidos y se compara si existe diferencia entre cirujanos con o sin rotación de urología en programa de especialidad. Se utilizó análisis no paramétrico de Mann-Whitney(p <0,05). Se realizaron 36 encuestados, 29 de los cirujanos recibieron instrucción de urología en su período de formación. Del total de encuestas, el puntaje alcanzado de respuestas correctas varía entre 4,5 y 15,5 de un total de 17 puntos. En 13 casos se obtuvo más del 75 por ciento de los puntos y 3 menos del 50 por ciento. No hubo diferencia entre quienes recibieron o no formación urológica (p 0,99)...

In our Health System general surgeons usually manage urology’s emergencies. They must decide if a patient needs to be managing inpatient or no. Our objective is tried to determine the general surgeon’s knowledge in some urological diseases. A questionnaire about diagnosis and treatment of urological diseases was applied to general surgeons in 2 emergency apartments. Score was assigned and analyzed.36 general surgeons were interviewed. In 29 cases they had urology rotation during their residency. Score were between 4.5 and 15.5. 13 surgeons got more than 75 percent in their scores. No difference between surgeons with or without urology rotation during their residence was found...

Análisis del cumplimiento de la Guía Clínica del AUGE en pacientes con accidente cerebrovascular isquémico: la utilización de tecnología sanitaria de diagnóstico para prevención secundaria en un hospital público / Compliance with Chilean diagnostic guidelines among patients with ischemic stroke admitted to a public hospital

Background: Acute ischemic stroke in adults was given an Explicit Guarantee of diagnosis and treatment (GES) with Clinical Guidelines in 2007 as part of the on-going Chilean National Health Reform. Aim: To evaluate the adherence to official guidelines with regard to the use of diagnostic methods for patients with acute ischemic stroke during their stay in a public hospital. Patients and Methods: The study included a review of the medical records of 101 patients aged 70 ±13 years (49 males and 52 females) diagnosed with acute ischemic stroke and discharged within August and September of 2008 and 2009 from a public hospital. Three trained ob-servers independently determined the degree of dependency of patients at discharge using the Modified Rankin score. The completion of recommended diagnostic tests (electrocardiogram, carotid Doppler ultrasound and echocardiogram) as well as their overuse was evaluated. Results: Ten patients died before discharge, 38 percent were discharged with and 52 percent were discharged without disabilities. Nineteen percent of patients with a Modified Rankin score of two or less (corresponding to a slight disability) had a complete diagnostic workup, compared with 87 percent of patients with a score of 3 to 5 (moderate to severe disability). In 27 percent of the patients, there was an overuse of diagnostic tests. No association between the diagnostic test use adequacy and year of discharge was observed. Conclusions: There exists a disparity between the recommended diagnostic testing and the actual tests completed among patients with acute ischemic stroke.

Calidad microbiológica del agua utilizada en establecimientos lecheros de la zona de Villa María (Córdoba) / Microbiological quality of the water used in a random sample from dairy farms in Córdoba, Argentina

Se evaluó la calidad bacteriológica del agua de pozo y del agua de lavado en una muestra aleatoria de 50 tambos distribuidos en la cuenca lechera de Villa María (Córdoba), Argentina. La visita a los tambos se realizó en 2007. Un 46 % y un 24 % de los tambos presentaron recuentos de aerobios mesófilos superiores a 500 UFC/ml en el agua de lavado y en el agua de pozo, respectivamente. En un 20 % de los establecimientos se aisló Escherichia coli de ambas fuentes de agua. Pseudomonas aeruginosa registró una alta frecuencia de aislamiento en el agua de pozo (36 %) y en la de lavado (42 %). Un 80 % y un 88 % de los establecimientos contaban con agua de pozo y de lavado no aptas, respectivamente. Los niveles de mesófilos aerobios y de coliformes totales presentes en el agua de pozo mostraron una concordancia moderada con los detectados en el agua destinada al lavado. En virtud de estos resultados, puede afirmarse que un elevado porcentaje de los tambos ubicados en la cuenca lechera de Villa María emplean agua de calidad bacteriológica deficiente, no apta para el ordeño ni el lavado de las instalaciones.

Bacteriological contamination of well water and wash water in a random sample obtained from 50 farms from Villa María (Córdoba) dairy area, Argentina, was evaluated during a visit in 2007. Forty six percent and 24 % of farms showed an aerobic mesophilic bacteria count higher than 500 CFU/ml in wash water and well water, respectively. Escherichia coli was isolated in 20 % of samples from both sources. Pseudomonas aeruginosa showed high frequency of isolation in well water (36 %) and wash water (42 %). Eighty and eighty-eight percent of dairy farms have contaminated well water and wash water, respectively. The findings show moderate concordance between contamination of well water and wash water for mesophilic aerobics and total coliforms. The results reveal that a high percentage of dairy farms in the basin under study have poor bacteriological water quality, not suitable for milking and washing facilities.

Distribution and host range of Bephratelloides cubensis Ashmead (Hymenoptera: Eurytomidae) in Mexico

The annona fruit borer wasp Bephratelloides cubensis Ashmead was recorded for the first time damaging "ilama" fruits Annona diversifolia (Anonaceae) in Coatlan del rio, Morelos, Cacahuamilpa and El Ocotillo, Guerrero, Mexico. Geographical distribution, hosts and damage are mentioned.

¿Puede la atorvastatina mejorar la respuesta a sildenafil en hombres con disfunción eréctil que no respondieron inicialmente a sildenafil? / Can atorvastatine increase sildenafil response in patients resistant to initial sildenafil therapy?

La disfunción eréctil puede ser una de las manifestaciones de enfermedad vascular generalizada, caracterizada por disfunción endotelial. Las estatinas pueden mejorar la función endotelial, incluso antes de alterar el perfil lipídico. Objetivo: Evaluar la mejoría de disfunción eréctil con atorvastatina en pacientes que no respondieron inicialmente a sildenafil. Material y métodos: Estudio controlado, placebo, randomizado, doble ciego, en el cuál se incluyeron hombres con disfunción eréctil moderada a severa, apesar de un esquema adecuado de Sildenafil. Se definió disfunción eréctil con un cuestionario auto administrado, score < o = a 16, según el Indice Internacional de Función Eréctil. La mejoría en el score de disfunción eréctil con Sildenafil fue reevaluada a los 6 y 12 semanas de tratamiento con Atorvastatina (80mg/día) v/s placebo. Resultado: Se incluyeron 18 hombres (edad media de 62 +/-12 años), con un score medio de 7.9 +/-5.8 y una duración media de la disfunción eréctil de 5.2 años. El tratamiento con Atorvastatina disminuyó el colesterol LDL en un 39 por ciento y resultó en una mejoría en el score de 7.6 (p < 0.05) con Sildenafil; este efecto se mantuvo por 6 semanas. El grupo placebo si bien logró mejoría en el score, esta no tuvo significación estadística. Conclusión: El tratamiento con Atorvastatina mejora la función sexual y la respuesta a sidenafil oral en hombres que no respondieron inicialmente al tratamiento con Sildenafil. Los resultados de este estudio avalan la hipótesis de que la disfunción vascular endotelial contribuye a la disfunción eréctil en pacientes no respondedores a Sildenafil.

Introduction: Erectile dysfunction (ED) may be one manifestation of a generalized vascular disordercharacterized by endothelial dysfunction. Statins may improve endothelial function, even before modifying the lipid profile. Objective: We sought to determine whether the addition of a statin would improve ED in men who initially responded poorly to sildenafil. Methods: Men with moderate to severe ED despite an adequate sildenafil trial were enrolled in this randomized, double-blind, placebo-controlled pilot study. ED was defined using a validated self-administered questionnaire as a score of <16 on the International Index of Erectile Function (erectile function domain score range of 6-30). Improvement in ED score withsildenafil and atorvastatin (80 mg daily) versus sildenafil and placebo was reassessed at 6 and 12 weeks of treatment. Results: Eigthteen men (mean age 62 +/- 12 years) with a mean domain score of 7.9 +/- 5.8 anda mean duration of ED of 5.2 years were enrolled in the study. Treatment with sildenafil and atorvastatin decreased mean low-density lipoprotein cholesterol by 39 percent and resulted in an improvement in erectile function domain score of 7.6 (P < 0.036). This effect was observed at 6 weeks of treatment. The increase in domain score in the sildenafil and placebo group was not statistically significant. Conclusions: Addition of atorvastatin to oral sildenafil significantly improves ED in men who initially responded poorly to sildenafilalone. The results of this pilot study supports the hypothesis that vascular endothelial dysfunction contributesto ED in sildenafil nonresponders and deserves further testing in a large clinical trial.